Thomas F. Osborne, MDa,b; David M. Arreolaa; Zachary P. Veigulis, MSAa; Christopher Morley, MDc; Osamah Choudhry, MDc; Wenbo Lanc; Kristopher R. Teagued; Ryan Vega, MDd,e; Satish M. Mahajan, PhDa Correspondence: Thomas Osborne (thomas.osborne@va.gov)
aUS Department of Veterans Affairs, Palo Alto Health Care System, California
bStanford University School of Medicine, California
cMedivis, Inc., New York, New York
dUS Department of Veterans Affairs, Washington, DC
eGeorge Washington University School of Medicine and Health Sciences, Washington, DC
Author disclosures
No financial support was provided for the conduct or preparation of this manuscript. Medivis provided the mixed reality software and hardware for the demonstration. Three of the coauthors are Medivis employees but did not collect or analyze the data. No other authors have a financial interest in Medivis.
Disclaimer
The opinions expressed herein are those of the authors and do not necessarily reflect those of Federal Practitioner, Frontline Medical Communications Inc., the US Government, or any of its agencies.
Ethics and consent
This study was determined to be nonresearch by the Stanford University (Stanford, CA, USA), Institutional Review Board which is the Institutional Review Board for the US Department of Veterans Affairs, Palo Alto Health Care System. No identifiable information was collected.
Background: Augmented reality (AR) has a wide range of potential applications to enhance health care. Understanding how the introduction of a new technology may impact employees is essential for overall health care system success.
Methods: Survey responses were obtained before and after a health care–focused interactive AR demonstration at a US Department of Veterans Affairs (VA) medical center. Data were assessed with descriptive statistics, Wilcoxon signed rank matched pairs test, pooled t test, and analysis of variance.
Results: A total of 166 individuals participated in the demonstration and survey. Statistically significant improvements were seen after the use of the new AR technology in each of the categories assessed using a 5-point Likert scale. Scores for perceptions of institutional innovativeness increased from 3.4 to 4.5 (a 22% increase; P < .001); employee excitement about the VA increased from 3.7 to 4.3 (a 12% increase; P < .001); and employee likelihood to continue working at VA increased from 4.2 to 4.5 (a 6% increase; P < .001). Subgroup analysis demonstrated statistically significant differences by employee veteran status, VA tenure, and sex. Respondents felt strongly that this type of work will positively impact health care and that the VA should continue these efforts.
Conclusions: An AR demonstration significantly increased employee excitement and intention to continue employment at the VA and provided valuable insights about the most impactful uses of AR in health care.
Building the health care system of the future requires the thoughtful development and integration of innovative technologies to positively transform care.1-4 Extended reality (XR) represents a spectrum of emerging technologies that have the potential to enhance health care. This includes virtual reality (VR), where a computer-generated visual experience fills the screen; augmented reality (AR), which allows users to see computer-generated images superimposed into an otherwise normal real-world field of view; and mixed reality (MR), which allows users to interact and manipulate computer-generated AR images.
Clinicians and researchers have begun exploring the potential of XR to address a wide variety of health care challenges. A recent systematic review concluded that many clinical studies in this area have small sample sizes and are in the preclinical, proof-of-concept stage, but demonstrate the potential and impact of the underlying VR, AR, and MR technologies.5 Common emerging health care uses for XR include medical education, training, presurgical planning, surgical guidance, distraction therapy for pain and anxiety, and home health indications, including rehabilitation.5-39
A scoping review of emerging health care applications for XR technologies is provided in the Appendix.
Importantly, some researchers have raised concerns regarding the adaptability of the health care workforce with emerging technologies, and their interest in new methods of delivering care.7,39 Successful deployment of any novel health care technology depends on multiple factors, including alignment with staff needs, receptivity to those solutions, customization to specific preferences, and usability.1,3,40-42 Unfortunately, the implementation of some health care technologies, such as electronic health records that did not account for end-user requirements, resulted in employee fatigue, burnout, and negative staffing turnover.42-44 Conversely, elevated employee morale and operational performance have been directly linked to a climate of inclusion and innovation.45-47 In this assessment, we sought to understand US Department of Veterans Affairs (VA) employees’ perceptions and expert opinions related to the introduction of new AR/MR technology.
Methods
The VA Palo Alto Health Care System (VAPAHCS) consists of 3 inpatient hospitals and 7 outpatient clinics, provides a full range of care services to > 90,000 enrolled veterans with 800 hospital beds, 3 nursing homes, and a 100-bed domiciliary. The facility also runs data-driven care projects in research, innovation, and evidence-based practice group under nursing services.48 This project was performed by the VA National Center for Collaborative Healthcare Innovation at the VAPAHCS campus.
The combined technical system used for this assessment included a wireless communication network, AR/MR hardware, and software. Medivis AnatomyX software displayed an interactive human anatomy atlas segmented into about 6000 individual interactive parts. Medivis SurgicalAR received US Food and Drug Administration clearance for presurgical planning and was used to transform and display deidentified diagnostic images (eg, magnetic resonance images and computed tomography) in 3-dimensional (3D) interactive holograms (Figures 1 and 2).
The wireless Microsoft HoloLens 2 AR/MR headset was used for viewing and sensor-enabled collaborative interaction. Multiple participants in the same physical location simultaneously participated and interacted with 3D holograms. The interactive hologram data were enabled for 3D stereoscopic viewing and manipulation.
