Contributors: Gary Danoff and Jay Kothari
To learn more about Gary and Jay, click here.
The CDC estimates that as many as 4.5 million people in the United States have used home health services since 2015, the majority of whom are aged 65 or older. As this population in the United States grows, the frequency, type, and volume of home healthcare services needed for both acute and, perhaps even more so, non-acute needs will also increase:
Acute home healthcare: Care provided by skilled and licensed medical personnel employed by healthcare agencies.
Non-acute home-based care: Care such as dressing, bathing, meal preparation assistance, toileting and moving about safely; most often provided by family, friends, or, as of 2019, some portion by non-skilled home healthcare as covered services added by Center for Medicare and Medicaid Services (CMMS) under Medicare Advantage (MA) plans. These services can also be provided by home health agencies as an out-of-pocket expense unless long term care insurance is in place.
As the need for home health services increases, several considerations and concerns appear related to its availability, affordability, and coverage. Specifically:
- If a person does not have health insurance coverage or Medicaid, or, if their particular plan does not reimburse for the newly covered non-skilled home healthcare, how will they afford non-acute home-based care?
- For home healthcare agencies, will they be able to staff roles with non-skilled home healthcare employees and provide them adequate training?
- For those people who cannot afford healthcare coverage or are not eligible for Medicaid and rely on friends and family, or live where home healthcare and skilled provider services have limited availability, will these populations be underserved?
The accelerating growth rate in the U.S. population segment needing home healthcare service, lack of coverage for those populations requiring in-home health, staffing challenges, and increasing costs related to training healthcare workers has created a need for new supportive technologies and solutions to provide adequate in-home healthcare services.
Virtual and Augmented Reality technologies have been leveraged in the training of medical staff, as well as various forms of treatment. Augmented Reality, or ‘AR’ solutions, specifically, have demonstrated measurable impact in the efficiency and quality of healthcare provided in-home by both skilled and non-skilled workers.
Applications of Virtual and Augmented Reality in Training of Medical Staff
Although Virtual Reality (‘VR’) is largely associated with gaming and entertainment, there are several applications in business and enterprise use cases. The VR industry is expected to grow to $45 billion by 2024, with healthcare seeing clear benefits in the simulation of surgery, training of medical staff, and driving compliance in procedures.
VR devices and their supporting applications have demonstrated utility in the medical training space in a variety of ways, from helping to train surgeons and allowing them to visualize a procedure prior to an operation to being excellent for enabling medical students to virtually explore the human anatomy.
Using Oculus Go “Immersive VR simulations help learners build new memories through realistic experiences that traditional methods cannot provide,” says Rachel Umoren MD, MS of the University of Washington and Seattle Children’s Hospital. “Doctors and other healthcare providers can repeat a task over and over in the simulation with standardized feedback, honing and perfecting their skills.”
Another device, used for mixed reality, Microsoft HoloLens has some great applications in the medical simulation and training space. Several universities and medical centers are enhancing their physician training and surgical procedures with the use of the HoloLens. This enables students and other staff to get detailed expertise in complicated procedures by practicing on virtual patients.
Leveraging Augmented Reality for Home Healthcare
The value of devices like Oculus Go or HoloLens in training and simulation is clear and growing. However, for medical staff like nurses and home healthcare workers, those large devices are impractical for all day wear and have limited application in their daily tasks.
Smaller devices like Glass Enterprise Edition from Google have an ergonomic, human fit form factor that is similar to wearing a pair of eyeglasses, which makes it comfortable for extended wear. It provides 2-way video for remote assistance, and a voice-controlled interface, with a line of sight display that enables use-cases like step-by-step instructions and helps ensure adherence with established procedures. Some key use cases include:
- Medical records: Enable medical staff to document electronic medical records, hands-free, thereby saving time that can be spent providing medical care instead of creating documentation.
- Remote expert assistance: In the event a caretaker or healthcare worker needs assistance from a medical expert, such as a physician, the caretaker or home health worker can stream their perspective to a remote expert and get guidance for the task at hand hands free to interact with the patient.
- Step-by-step instructions: Using step-by-step instructions with intermediate checkpoints greatly improves the overall compliance to established procedures while increasing efficiency and reducing errors.
As an example, imagine a skilled home healthcare worker is changing the wound dressing on the calf of a patient recovering from vein removal from a bypass. Even though they’ve performed this procedure many times, something looks a little off and they notice the depth and diameter of the wound is not progressing from week to week according to the chart. Wearing Google Glass they call for a consultation with an on-call doctor contracted with the home healthcare company.
The expert physician can see the perspective of the healthcare worker, take note of the wound, and instruct the home health worker to touch around the margins. Since the caregiver is connected hands-free, they are left with both hands free to work with the patient and follow the physician’s instructions. The remotely located doctor can send annotated images to the caregiver to supplement any verbal instructions they may be providing. All of the audio and video images shared can be stored in any public cloud, including the Google Cloud Platform.
Additionally, through two-way audio occurring simultaneously, it is possible to assess if there is the beginning of an infection, and, along with other vitals, the doctor can determine if a course of antibiotics is appropriate. Benefits of introducing AR Medical in this example include: no readmission, reduced stress for the patient, continuity of care with the home healthcare provider, lower cost, and a faster recovery time. An added benefit of leveraging Glass versus a tablet, smartphone, or other device is that because it is hands-free, it helps the caretaker stay focused on the task at hand and also conforms to standards related to patient-provider hygiene.
As more people require home healthcare, leveraging Virtual and Augmented Reality devices like Oculus Go and HoloLens will improve the training of healthcare workers. Similarly, devices like Glass Enterprise Edition will improve the overall efficiency and quality of home healthcare, as well as increase the availability of both acute and non-acute services as more care is delivered in the home setting and the population ages.
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Twitter at @jkothari