Extended Reality

Control Rather Than Treatment?

John Fraim

One of greatest technologies of computers is generating alternative worlds known as virtual, augmented or mixed realties. All are now referred to under the umbrella term “extended reality” or (XR). While the best-known uses for XR are in the entertainment and training (via simulation) industries, the use of XR is now being extended to treatment in the healthcare industry.

As reported on the U.S Department of Veterans Affairs site, the Veterans Health Administration launched the XR Network in the fall of 2020 to bring emerging XR technologies to veterans across the U.S. The XR Network, spearheaded by VHA’s Care & Transformational Initiatives portfolio (CTI) is focused on testing and refining innovative care models and transformational initiatives that can be meaningfully scaled to impact Veteran care. CTI works closely with a variety of partners from academia, industry, non-profits and other government agencies.

The CTI enables Veterans nationwide to receive XR sessions to treat veteran health challenges like post-traumatic stress disorder (PTSD), anxiety, depression and chronic pain. Veterans who choose to experience XR care might spend 30 minutes walking through a peaceful forest, listening to the soft sounds of waves on the beach, or collecting coins in an engaging memory game. As one Veteran put it: “That was like going to see a good movie – you don’t want it to end.”

For Veterans suffering from chronic pain, XR sessions offer pain reduction with diminished use of opioids. One survey of Veterans found a 72% reduction in opioid usage for post-operative patients receiving XR treatments. For Veteran patients, this success is twofold: they experience the positive benefits of XR, while also reducing potential negative side effects of opioid therapy.

The XR Network includes VA frontline staff, VA researchers, medical center leaders, and external collaborators from industry, academia and other government agencies. Together, the XR Network is made up of thought leaders helping to advance the use of XR throughout VA to better serve Veterans. Through knowledge sharing, staff training, and clinical evaluation of XR, the network is building XR projects from the ground up and scaling successful pilots. The XR Network supports VA facilities at any and every stage of interest and development, serving as a force multiplier that transforms individual efforts into nationwide impact for Veterans.

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Started in the fall of 2020, by June of 2021, the program has grown to more than 50 sites utilizing XR with more than 200 VA employees actively involved with the XR Network. In June of 2021, the agency confirmed plans to steer the network’s first-ever, multi-site improvement pilot. In June, the XR Network plans to initiate its first multi-site quality improvement pilot, focusing on multiple inpatient and outpatient use cases.

Collectively, the XR Network’s members serve as thought leaders on how best to advance the spread of XR technology throughout VHA to better serve our Nation’s Veterans and ultimately impact health care delivery nationwide. The XR Network exists to amplify small-scale, grassroots health care innovations and expand them nationwide, leveraging lessons learned to help pave the way for future teams with radical ideas.

The monthly Community of Practice call has grown to just over 160 participants representing over 60 VA facilities. Three hundred sessions have been completed using XR as a distraction tool to help treat pain, stress and anxiety, boredom and restless behaviors while also aiding relaxation. For Veterans suffering from acute and chronic pain, 61% saw a drop in pain intensity thanks to use of XR. One hundred percent of Veterans using XR to aid with restless behaviors felt a decrease in restlessness following a session, and 67% of those Veterans also exhibited an increase in calm and cooperative behavior. Ultimately, these results just scratch the surface of how XR can impact Veteran care.

XR is on the cutting edge of health care, and by providing an extended network to develop and grow it this emerging tech, VHA IE is placing Veterans at the forefront of care. It is boundary-breaking work like this that VHA IE was built for. The VHA Innovation Ecosystem (VHA IE) is the catalyst for discovery and spread of mission-driven health care innovation for the Veteran community. It is the nation’s largest integrated health system. 

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Outwardly, the VA’s XR Network is certainly a feel-good program to help veterans move on with their lives after health issues from active duty. Statistics reported above certainly are admirable and move forward treatment for our most worthy group of citizens. Overall, it seems a good thing that previous entertainment and simulation training uses of XR are being extended to healthcare treatment. 

Yet behind all the positive benefits of the veteran XR Network, is there a hidden agenda? We ask this question because the factors in the XR Network program might also be used for the purposes other than treatment. 

Think about this for a moment. The VA operates the nation’s largest integrated health system with access to the greatest number of patients not only for treatment but also experimentation of XR for the purposes of control. Already, there are huge resources devoted to this program. And – as noted in the above news – many areas outside the VA are also involved such as academia, industry, non-profits and other government agencies. 

With this in mind, it is not difficult to surmise that there might be less feel-good purposes for the VA XR Network. Even if this is not currently planned, there is reason to suspect that the experiments from these first months of the XR Network have benefits and consequences far outside the veterans’ community to society in general. Those in the VA might know this or not. But it is a good bet that others are watching the experiments with XR in the veterans’ community with much interest. Certainly, those so-called “partners” with the VA in private industry, academia, non-profits and other government agencies. 

Interestingly, we have not heard much about XR in recent times with artificial intelligence getting far more attention. Might it be time to give more attention XR? It’s getting attention in the treatment of veterans. Maybe it should be more attention in its potential use to control all citizens?

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