Healthcare in the Metaverse
How behavioral health, provider education and more will change as we blue skidoo into the embodied internet
“The Metaverse is a massively scaled and interoperable network of real-time rendered 3D virtual worlds which can be experienced synchronously and persistently by an effectively unlimited number of users with an individual sense of presence, and with continuity of data, such as identity, history, entitlements, objects, communications, and payments.”
Source: Matthew Ball
The metaverse is so hot right now 🥵. Finally, the opportunity has dawned for humanity to achieve escape velocity from our flesh-and-bone prisons and transcend into virtual Edens to… attend meetings?
As futurists contemplate the range of advancements made possible by this tech-enabled manifest destiny, one might wonder: are there any applications to healthcare? With most healthcare products and services being inextricably tethered to our physical bodies, it’s not an obvious “yes”.
As a framework for brainstorming some ideas, we can start by identifying the unique capabilities of metaverse tech and how these capabilities can level-up the modalities of care available today. Specifically, metaverse use cases in healthcare would likely take advantage of the ability to:
Create deep immersion via richly rendered 3D spaces
Synchronously convene with both real peers and programmed entities in those spaces
Interact with co-inhabitants via programmable inputs/outputs
Simulate activities/events/situations that are rare or dangerous in real life
Transform one-to-one experiences to one-to-many experiences
The confluence of the capabilities above unlocks a core power of the metaverse which I would call immersive learning experiences. The prospective healthcare use cases I explore below are centered around this idea that the metaverse can enhance our ability to acquire skills/knowledge from difficult to access sources (due to geographic or supply constraints) in a memorable, impactful way.
Super Virtual Behavioral Health
Behavioral health is the most intuitive specialty for potential metaverse use cases. Behavioral health treatment modalities least involve our physical bodies (e.g. cognitive behavior therapy). This is a big reason why behavioral health is also the specialty with the greatest adoption of telemedicine to date.
Source: McKinsey - July 2021
What would behavioral health look like in the metaverse? There are probably layers to this.
The most basic layer would be a virtual-world clinic which bridges the in-person and telemedicine experience. This does not seem super compelling in most settings because there appears little marginal benefit achieved in a 3D rendered virtual environment vs. synchronous video. But one big exception I can think of is autism care for children1.
One of the standards of care for Autism Spectrum Disorders is ABA therapy:
In [Applied Behavior Analysis, or “ABA”] therapy, the [board-certified assistant behavior analyst, or “BCBA”] works with the autistic person and their care team to identify a goal and break it down into small parts. For example, learning to wash hands may be broken down into these steps:
Turning on the faucet
Wetting hands
Picking up the soap
Lathering hands
Rinsing hands
Turning off the faucet
Drying hands with a towel
Each step that is performed successfully is followed by a positive response, such as a reward or natural reinforcer in the environment. Unwanted behaviors are generally ignored and the person is redirected toward the practice skill. Rewards differ depending on the person and their interest, but can include things like praise, a toy or book, or TV time. Positive reinforcement and repetition are the main tools of ABA practitioners. Punishment should never be used as a tool to draw out a desired behavior.
Source: Autism Speaks
Skill acquisition is a core tenant of ABA therapy. While several companies like Elemy and Breakthrough Behavior (a Sopris portfolio co.) provide ABA therapy IRL, the value-add of the metaverse would be is three-fold.
First, it offers enhanced connectivity into the supply of clinicians (similar to telemedicine). This itself is critical because the supply for autism care clinicians is severely constrained:
Source: Spectrum News
Second, 3D rendered environments of the metaverse would provide a perfect venue for traditional ABA therapy activities to take place - i.e. interactive skill acquisition activities like the aforementioned hand-washing example. Third, over time, the metaverse could offer the ability to leveraged programmed entities and activities to shift ABA care from one-to-one to one-to-many - i.e. instead of having a synchronous session with a BCBA in the virtual environment, designers could build programmed experiences with “NPC”-like entities, thereby extending the “supply” of clinicians with digital content than can be recycled infinitely.
This third component, creating one-to-many programmed experiences, starts to encroach on the territory of digital therapeutics, which I view as that next layer of potential behavioral health use cases. There are a number of companies exploring metaverse-like digital therapeutics for mental healthcare - e.g. BehaVR, Rey/OxfordVR, Psious. Where these tools make the most of VR-enabled environments is effectively skill acquisition - exposing patients to stressors of their mental health issues (e.g. daily activities that may cause someone anxiety) and helping patients acquire coping skills to better manage these situations.
While really cool and promising, the challenge around some of these next-gen therapeutics is probably going to be proving clinical outcomes. This isn’t exactly a metaverse-specific problem - proving behavioral health outcomes, especially quantitatively, is a pervasive issue across the industry today. Demonstrating outcomes to drive consumer adoption, let alone validation from regulatory bodies, will be a persistent challenge over the medium term.
Educating Healthcare Providers and Staff
Training people is a basic application of the “skill acquisition” power of the metaverse. The use of VR in training clinicians dates back decades. In the future, one could imagine a full-fledged virtual hospital where staff across functions could be onboarded and trained in simulated environments. Actually, you don’t have to imagine it; allow me to introduce a simultaneously fascinating and unhinged experience in the game Roblox.
If you haven’t talked to any elementary school-aged kids in the last 5 years, the skinny on Roblox is that it is a online game platform which enables users to create worlds and games for other users, from expansive Second Life-like open-worlds to really narrow concepts like “Work at a Pizza Place,” in which you role-play being a pizza shop employee.
There are several popular games which involve simulated hospitals. That they exist isn’t the surprising part (kids love to pretend to be doctors); it’s the level of depth built into these role-playing games that I find absolutely mind-boggling.
Enter the “Robloxian General Hospital,” the most robust hospital “game” on Roblox. The game consists of players role-playing different jobs in the hospital. The level of structure is absurd. This fake hospital has an entire org chart of real people pretending to be hospital employees in roles ranging from hospital receptionist up through executive management. The community has a guidebook that rivals the clinical ops manuals from some of our portfolio companies. None of the procedures described in the guide are actually programmed into the game (more on that later) - it’s basically a script for the role-play exercise. The Roblox Hospital even has a detailed onboarding process - e.g. if you want to “work” at the hospital, you must complete an interview process and attend an onboarding training session hosted by more experienced players. Skip through the videos below for a taste.
I am just blown away that kids are spending hours of their free time pretending to be hospital receptionists. But all of this detail provides a rough draft of what virtual trainings - whether in post-secondary education or workplace education settings - could look like. Remember, platforms like Roblox have MASSIVE reach. >55% of 9-12-year-olds play Roblox on a weekly basis. The hospital game has >2.5mm plays to date alone. There is an entire generation that will enter the work force in 10-15+ years which is metaverse-native. For this generation, learning in metaverse environments will be second nature.
In the near-to-medium term, the relevance of virtualized training environments is probably limited to situations where training/education is tightly focused around following a specific script, similar to the Roblox game guidebook. Groups that provide in-person care with a distributed network of clinicians would be a perfect candidate for this type of virtual training platform. For example, home-health providers that need to source clinicians nationwide but need to maintain a homogenous training experience.
Over the long term, the most powerful advantage of the metaverse in provider training/education would be to simulate events or procedures with virtual bodies (e.g. VR surgery training). These simulations could be infinitely repeatable, massively increasing the availability of reps per student.
Some groups (see companies like OssoVR, PrecisionOS) are driving progress toward this latter goal today. But there’s a big technology gap. With the technology we have today, VR-platforms can help students learn the steps of a procedure and go through the motions. This works well enough for repetitive procedures like medical device implants.
But for a robust virtual surgery experience, the simulation would have to model a virtual body to work and respond to inputs like a real body.
The development of virtual reality simulation of surgical procedures has begun, but well-described technical obstacles must be overcome to permit varied training in a clinically realistic computer-generated environment. These challenges include development of realistic surgical interfaces and physical objects within the computer-generated environment, modeling of realistic interactions between objects, rendering of the surgical field, and development of signal processing for complex events associated with surgery. Of these, the realistic modeling of tissue objects that are fully responsive to surgical manipulations is the most challenging…
Given how little we know about how organs respond to stimulus in real life, programming them into a virtual experience is a gargantuan task. Still, while that “holy grail” use case might be years away, we can make meaningful incremental progress along the way.
Other Half-Baked Notions
Allow me to indulge in a few additional, albeit very far-fetched ideas that come to mind:
Patient Education and Pharma Advergaming
Metaverse immersive learning experiences could extend to teaching patients about their conditions. I’m imagining a Ms. Frizzle inspired virtual field trip showing patients the impact their conditions have on their organs and body functions.
The vivid visual representations unlocked by something like that could help drive sustainable behavior changes (like seeing a smoker’s black lungs during D.A.R.E.). Pharma companies could even create virtual advergaming experiences built around this notion
Enhanced Patient Experiences
The metaverse could provide a portal to escapist entertainment for patients who are otherwise limited in the ability to experience life. For example, one could imagine how enabling SNF patients to engage with immersive content in VR settings could improve patient satisfaction
Decentralized Clinical Touchpoints
Borrowing from the digital therapeutic concepts above, it’s possible we could see 3D rendered virtual trial sites for clinical trials. Something like that could provide a platform for patient reported outcomes in a more interactive format
Loneliness Treatments
As we learn more about the correlation of loneliness and health outcomes, metaverse technologies may enable a range of one-to-many companionship products that diminish loneliness. We’re already on the way there - technologies Replika come to mind
All told, we’re a long way from knowing what tools and platforms might emerge as folks continue to build this embodied internet, but there’s good reason to hope that there might be some novel applications that solve for the limitations of our physical world.
Autism Spectrum Disorders are not exactly behavioral health conditions in the way that behavioral health conditions are typically defined (most definitions refer to conditions like anxiety, depression, substance abuse disorders, etc.). I am kind of conflating the two here because they are related. For what it’s worth, NAMI includes Autism as a commonly occurring diagnosis for individuals who also have more conventional behavioral health conditions.
Disclaimer:
This content is being made available for educational purposes only and should not be used for any other purpose. The information contained herein does not constitute and should not be construed as investment advice, an offering of advisory services, or an offer to sell or solicitation to buy any securities or related financial instruments in any jurisdiction. Certain information contained herein concerning economic trends and performance is based on or derived from information provided by independent third-party sources. The author believes that the sources from which such information has been obtained are reliable; however, the author cannot guarantee the accuracy of such information and has not independently verified the accuracy or completeness of such information or the assumptions on which such information is based.
Lot of interesting thoughts here - agree on big opp for behaviorial health (think CBT for PTSD is another big category in addition to ABA/NDBI interventions). As someone currently going through med school I'd put a finer point how the metaverse could support training staff - think can be good to train medical decision-making (what to do when lab X comes back with value Y in the setting of vitals Z) but procedural stuff (surgery technique) is hard unless you're working with physicians that have regular access to the real deal.