Virtual Environments for Healthcare

Parvati Dev, PhDCEO, CliniSpace

www.InnovationInLearning.comwww.clinispace.com

© 2012 IIL Inc. Serious Play, August 21, 2012 2

My co-pilot has never flown this model of plane

before …

… but I have flown 200 hours on the simulator

and am certified for this model

© 2012 IIL Inc. Serious Play, August 21, 2012 3

My resident has never done this

surgical procedure before …

… but my chief is watching me very carefully as I do it.

WHY DOES THIS MATTER ?

© 2012 IIL Inc. Serious Play, August 21, 2012 4

The Cost in Life and Money

The cost of medical errors is huge– $22-38B (source: AHRQ)

An example – Septicemia– 2% of hospital discharges in the U.S. include septicemia– Average charge is > $60,000 per case

Prevention requires systemic change through training– One case prevented can pay for the training

Prevention training is difficultKnowledge, Skills, ATTITUDErequires emotional engagement

Learning through Role playing is emotionally engaging

© 2012 IIL Inc. Serious Play, August 21, 2012 5

WHY VIRTUAL ENVIRONMENTS MAY BE THE BEST APPROACH TO ENGAGEMENT

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Medical Training

Current approach:– Classes, e-learning, manikins,

standardized patients

– Problems in scalability, expense, lack of engagement

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Virtual Environments are immersive

And immersive experiential learningIs DISRUPTIVE

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So immersive that it’s real

© 2012 IIL Inc. Serious Play, August 21, 2012 9Comm. of the ACM

Virtual Emergency Room Environment

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HOW EFFECTIVE ARE VIRTUAL ENVIRONMENTS ?

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Comparison of Team Leadership Before and After Practicing Four Resuscitation Scenarios on a Human Patient Simulator (HPS) or in an Online Virtual Emergency Department (VED) with Virtual Patients

The Data Show . . .

WHAT ARE VIRTUAL ENVIRONMENTS ?

© 2012 IIL Inc. Serious Play, August 21, 2012 13

Scientific meeting inWorld of Warcraft (May 2008)

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Azeroth

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Scientific meeting inWorld of Warcraft (May 2008)

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20 JUNE 2008, VOL 320, SCIENCE, www.sciencemag.org

‘Congressional Hearing’ in Second Life

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PROTOTYPE VIRTUAL ENVIRONMENTForterra, 2005

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Multi- casualtyIncidentTrainingEvent

@ Stanford

– 2005

Multi- player,OnlineGame

Technologyby

Forterra–

2005

CliniSpace Virtual Emergency Department

© 2012 IIL Inc. Serious Play, August 21, 2012 19

COMPONENTS OF A MEDICAL VIRTUAL ENVIRONMENT

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REALISTIC CLINICAL SPACES, INCLUDING IN BATTLEFIELD

© 2012 IIL Inc. 21Serious Play, August 21, 2012

PHYSICIAN, NURSE, THERAPIST, PATIENT, SOLDIER, BABY AVATARS

© 2012 IIL Inc. 22Serious Play, August 21, 2012

VIRTUAL PATIENTS, DYNAMIC PHYSIOLOGY AND ACTIONS

© 2012 IIL Inc. 23Serious Play, August 21, 2012

VIRTUAL OBJECTS THAT INTERACT WITH PATIENT AND EACH OTHER

© 2012 IIL Inc. 24Serious Play, August 21, 2012

CASE AUTHORING, USER ACTION TRACKING AND ASSESSMENT

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Example of use

http://vimeo.com/41082428

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INTERMEDIATE QUESTIONS

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ANOTHER WAY OF LOOKING AT VIRTUAL ENVIRONMENTS

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The Virtual Environment is the ‘System’ around the Virtual Patient

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Virtual PatientVirtual Patient

Protocols, policies, rules

People/ Team(real, computer)

Devices, supplies, meds

The Virtual Environment is the ‘System’ around the Virtual Patient

It is the “theater” -- environment -- within which you can “role play”

The “virtual patient” may play a Key or a Supporting Role

Virtual environments extend the usability of virtual patient Virtual

PatientVirtual Patient

Protocols, policies, rules

People/ Team(real, computer)

Devices, supplies, meds

© 2012 IIL Inc. 30Serious Play, August 21, 2012

THE ‘SANDBOX’ AND THE ‘CAMPAIGN’

© 2012 IIL Inc. Serious Play, August 21, 2012 31

Which one to build?

SandboxExplore the environmentUnguided ‘play’Automated responsiveness to

player input

Play has its own rewards– Engaging - Save the patient

Environment rich enough to satisfy

CampaignTrigger actions cause game to

advance – the ‘narrative’

Reward is in advancement– Levels, side missions– Earn badges and promotion– Compete with self, others,

teams

Carefully crafted ‘story’

© 2012 IIL Inc. Serious Play, August 21, 2012 32

http://www.gamasutra.com/view/feature/4081/the_history_and_theory_of_sandbox_.php?print=1

Our experience: Which one to build?

SandboxUnguided ‘play’Environment must be rich

enough to be satisfying

This is CliniSpace today

Need much more contentAnd still need specified goals

CampaignTrigger actions cause game to

advance – the ‘narrative’Carefully crafted ‘story’

CS BattleCare, etc

Sub-goals, overall goal are likedBut want some exploration !

© 2012 IIL Inc. Serious Play, August 21, 2012 33

BUSINESS MODELS FOR VIRTUAL ENVIRONMENTS

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System Overview

Content Applications

Platform

UsersUsers

© 2012 IIL Inc. 35Serious Play, August 21, 2012

Platform businesses

Platforms (Second Life, OLIVE, Unity)

Specialized worlds(medical, kids, adult entertainment)- Simulations of disease, equipment

Specialized worlds(medical, kids, adult entertainment)- Simulations of disease, equipment

Custom development

New platforms

Customization (branding, layout,

language)

Further specialization(Equipment testing in

virtual OR)

Third Party developers

UsersUsersIntegration with other

technologies (Characters with AI, Natural

language processing)

Trainers, curriculum developers

Trainers, curriculum developers

© 2012 IIL Inc. 36Serious Play, August 21, 2012

CliniSpace: A Medical Platform

© 2012 IIL Inc. Serious Play, August 21, 2012 37

Platform businesses

Platforms (Second Life, OLIVE, Unity)

Specialized worlds(medical, kids, adult entertainment)- Simulations of disease, equipment

Specialized worlds(medical, kids, adult entertainment)- Simulations of disease, equipment

Custom development

New platforms

Customization (branding, layout,

language)

Further specialization(Equipment testing in

virtual OR)

Third Party developers

UsersUsersIntegration with other

technologies (Characters with AI, Natural

language processing)

Trainers, curriculum developers

Trainers, curriculum developers

© 2012 IIL Inc. 38Serious Play, August 21, 2012

BUSINESS ECOSYSTEMS

© 2012 IIL Inc. Serious Play, August 21, 2012 39

Ecosystem around a platform- from “Virtual World Monetization”, Stanford, 2010

3D virtual sets for

machinimaFace

customization

Animations3D

medical avatars

Automatic assessment

of performance

Dynamic pathophysiolog

y models

Virtual actors

Medical furniture

MedicalPlatform

Behavior therapy

Embedded knowledge (nursing, medical)

Curriculum development

Fitness support

Experience designer

Resell spaces – branded or white label

User-generated

content

Designing game or

competition dynamic

Virtual goods

Behavior alteration

through avatar association

Therapy sessionsIncrease

engagement of traditional

interactive content

Standardized role players

Greeters, patients, sales

person

Actors for machinima

moviesProduct

design using VR/AR

Adding sensor networks to

worlds

“Normalize” very different people and activities so that they can exercise together

© 2012 IIL Inc. 40Serious Play, August 21, 2012

Ecosystem around a platform- from “Virtual World Monetization”, Stanford, 2010

3D virtual sets for

machinima

Animations3D

medical avatars

Dynamic pathophysiolog

y modelsVirtual actors

Medical furniture Medical

Platform

Experience designer

Virtual goods

Standardized role players

Greeters, patients, sales

person

Actors for machinima

movies

© 2012 IIL Inc. 41Serious Play, August 21, 2012

Resell spaces – branded or white label

Ecosystem around a platform- from “Virtual World Monetization”, Stanford, 2010

Automatic assessment

of performance

MedicalPlatform

Embedded knowledge (nursing, medical)

Curriculum development

User-generated

content

Designing game or

competition dynamic

Increase engagement of traditional

interactive content

Product design using

VR/AR

Adding sensor networks to

worlds

© 2012 IIL Inc. 42Serious Play, August 21, 2012

Face customization

Ecosystem around a platform- from “Virtual World Monetization”, Stanford, 2010

MedicalPlatform

Behavior therapy

Fitness support

Behavior alteration

through avatar association

Therapy sessions

“Normalize” very different people and activities so that they can exercise together

© 2012 IIL Inc. 43Serious Play, August 21, 2012

Distribution/Revenue Models

Per clinical session per patient e.g.

therapy

Link with music and movie assets to drive

serious uses

subscriptions

Freemium

Grants and federal funding

Certification

Rent a seat or space

Virtual goods

MedicalPlatform

courses

Per virtual patient per

year

Loss of federal reimbursement

(Medicare / Medicaid)

Per actor-hour

License for bundle of seats

per year

© 2012 IIL Inc. 44Serious Play, August 21, 2012

Resell spaces – branded or white label

In conclusion …...

Virtual environments can impact the cost of healthcare

- By changing attitudes by training with role playing

A virtual environment is an entire ‘system’ around a virtual patient (or patients)

To succeed, virtual environments must scale up to include multiple business models and a business eco-system

© 2012 IIL Inc. Serious Play, August 21, 2012 45

www.clinispace.comparvati@clinispace.com2012, CLINISPACE, INC.

©© 2012 IIL Inc. 46Serious Play, August 21, 2012

THANK YOU & QUESTIONS

Slides are on SlideShare.Search for ‘parvatidev’ or ‘clinispace’

Email us atinfo@clinispace.comparvati@clinispace.com

© 2012 IIL Inc. Serious Play, August 21, 2012 47

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