THE METAVERSE AND HEALTHCARE – PART 3
APPLYING THE SCIENCE
By Carl L. Larsen, President & COO, OXIO Health, Inc.
In the first blog of our Metaverse series, we introduced the concept called, “The Metaverse and Healthcare” – an evolution of the internet alternately referred to Web3.0. Significantly enough, the CEO of Facebook®, Mark Zuckerberg, renamed this multi-billion-dollar company, “Meta.” In Part 2’s blog, titled, “The Underlying Technologies,” we explored the overarching technologies stacks that are needed for The Metaverse to function as it is presently envisioned.
If you’re just jumping in on this blog, please read the first two blogs that set-up our discussion here. The fundamental question we are addressing is – how could The Metaverse improve health and wellness outcomes, empower the patient and provider while reducing costs of the delivery of healthcare and wellness? These are the areas that need most improvement across the entire landscape of health and wellness, regardless of individual demographic, in order for the following advancements and innovations to succeed.
The practice of medicine and the broader area of healthcare always has and always will be about data, or perhaps better stated, the collection and analysis of data. As a data-centric company, we understand that only the right integration of technology will help us change the ever-increasing cost of care. As a team, we have created multiple applications for healthcare use, including a Certified Ambulatory Care Electronic Health Record or EHR. We have also generated 30 healthcare-related communications and computer security utility patents issued by the U.S. Patent and Trademark Office (USPTO). Data has become the driving force for the production and development of technology through the past two or more decades.
Perhaps not insignificant is that one of the key characters on “Star Trek©” was named “Data,” which makes me wonder if Gene Roddenberry had a premonition about the future after all. Unfortunately, that technological innovations portrayed on the screen have so far failed to materialize fully and impact today’s healthcare systems. Even the advancement of telemedicine, and the high utilization of 70% of physician encounters that peaked though 2020, has crashed dramatically from a peak of over 70% around 10%. The Metaverse may usher in the next evolution of Remote Patient Care (RPM).
Up to about a decade ago, we find medical record data being recorded on paper largely by hand. Since 2010, and with billions of dollars investments in capital and time, the acquisition of patient medical data was upgraded to be collected through installed EHR applications first on servers and the next from here onto the Cloud. Now, two-way remote wearable devices and other technology is allowing for live and interactive remote patient care management or RPM. We are seeing this accelerated because of Covid-19 as every provider from primary care to specialists and even hospitals were forced to adapt. We have passed the point of no return – healthcare has crossed the Rubicon and what lies ahead is to be discovered.
Healthcare data is intrinsically and intensely private, as much or more so than our personal financial data. We expect continued pressure to acquire more data that will in turn require increasingly secure and protected communications as greater volumes of personal medical and health related data is being transmitted over the internet. Ensuring security of personal medical records and information was one of the factors driving the Health Insurance Portability and Accountability Act (HIPAA) of 1996. This law remains in place, but may need further strengthening to reduce the “technology gap” that exists with the technologies that have been invented in the past quarter century.
We identified this coming explosion of data nearly five (5) years ago and began pre-positioning the Company (OXIO Health, Inc.) and developing the patents, technology, IP and subsidiaries to be central to the solution to the issues that were, and still are, a part of this burgeoning healthcare data bubble. The issues needing to be addressed by the industry are:
- The information ‘silos’ where important patient or individual data could be locked away in a number of data vaults that are accessed through the program that acquired the data.
- The lack of data analysis – so much of the health-related data is simply data that has not been analyzed or cultivated and is therefore of little use though if analyzed properly could be of great value to the patient, individual and clinician.
- Data vaults are growing like weeds in the springtime, popping up everywhere and many are very special use. Good data, but with a narrow application or value on its own but potentially confirmatory if integrated with other data.
- Data theft – the stealing or use for profit of an individual’s private, personal medical and health information without their consent.
So, how does The Metaverse address the issue of Healthcare Data?
We believe it can play a huge role in building a safe, secure and agnostic open-source landscape on which healthcare companies and can build their platforms and programs that are not only beneficial to the individual, but also to the population at large through cross-sharing of de-identified data. One stated goal is full-interoperability and open exchange of data across the expanse of the The Metaverse.
The Metaverse and Healthcare Data
Because healthcare has been the furthest behind in the adoption of technology, it stands to reason that any significant broad-based technology development will mandate shifts in one or more segments of healthcare. For this reason, I suspect that healthcare and the practice of medicine is likely to be the one most transformed by The Metaverse through the advanced technology such as Virtual Reality/Augmented Reality, Artificial Intelligence, predictive medicine, machine learning and data analytics. Machine Learning will have major impact in areas such as medical imaging, 4th generation Electronic Health Record (EHR) data, robotic surgeries using Deep Reinforcement Learning with 5G / 6G+, as just one example. Applications of machine learning to wearable devices allowing us to process sensor data in real time to enable predictive and preventive health care (see our patents on episodic health events).
Areas like precision medicine, that are powered by variational autoencoders and other technologies, perform high-level data analysis looking for causal connections to observed patient conditions or events that may be used to improve patient outcomes. The ability to mine, with patient consent, their de-identified medical data to assist in significantly reducing the time during clinical trials and shorten the time to market for novel drugs. No longer performing trial and error research in the lab using disease or virus samples, but elevating these to their digital form and performing research without the need for actual animal or human involvement in clinical trials. Learning with Differential Privacy will be an essential tool to scale The Metaverse healthcare technology across the broad landscape given the sensitivity and importance of data privacy and regulations such as HIPAA and General Data Protection Regulation (GDPR).
Unquestionably the concept of healthcare data has evolved incredibly in the last 25 years, and while the true doubling time for this technology has not been properly estimated, it is clearly shortening year over year. We are truly on the forefront of an historic, once in a lifetime, shift in the practice of medicine and the delivery of care to the population, not just those involved in care management.
The Metaverse – The New Frontier for Healthcare
The Metaverse opens the gateway to a broad landscape that could both enhance, as well as possibly replace, the traditional practice of medicine; however, many of these technologies and processes have been around – some for decades – but with the emphasis being given the digital realm, they are being brought to the forefront. Doctors have always relied on direct patient-doctor interaction, specifically the face-to-face interaction where the physician can look at the patient’s color, their eyes, their tongue and throat, palpate areas of pain, reflexes, and check vital signs. These have always required a “hands-on” capability by the clinician. There is something ‘sacrosanct’ about the patient-doctor relationship and for many people this tradition will not easily die.
Also, since the invention of the telephone, the back-up to face to face interaction was the voice on the other end. Primary Care Physicians (PCP) tell me that if they know the patient, the phone can provide as much as 95% of the information they need, and the video is much more for the emotional and psychological component of healthcare. However, that is about to change for our perspective.
There are several areas within healthcare in which The Metaverse brings major potential, and we want to explore a few of these briefly.
Virtual and augmented reality is being used by doctors and medical experts to train other doctors and their medical staffs not just at advanced university, but also at community colleges and technical schools. Virtual reality is being leveraged to take a student into a human body and allow a 360-degree view of a “virtual” patient to review the ailment and test various procedures to be applied in the real world. There are many other potential uses of The Metaverse in medical training, but the use case to advance training and skills is significant because a human being, whether the patient or a cadaver, are not needed and there is zero risk to a live patient.
Many surgical procedures now employ the use of robotics and recently there have been successful surgeries conducted across continent using robotics. Complicated surgical procedures are now being adapted to use Augmented reality whether the removal of a tumor or very delicate spinal surgery. Physicians are looking at new ways to add precision to their surgical procedures. Robot-assisted surgeries have become commonplace and by adding AI and Data Analytics to the process The Metaverse will enable even more precision and accuracy in the surgery procedures.
Bringing Healthcare Providers and Consumers Together
Many still look at The Metaverse as an extension of the gaming platform such as Roblox® which is a natural inclination given the state of computer gaming, use of Avatars in both and the digital lens through which it is entered. The wellness and fitness industry has been the first to adapt with fitness apps, smarter workouts and Virtual instructors. A report by GrandView Research stated that the global augmented reality market size was valued at UD 17.67 billion in 2020 and was expected to increase at a compound annual growth rate (CAGR) of 43.8%.
The Future of Managed Care
Managed Care is a common term in healthcare, but it simply means “a system of healthcare in which patients agree to visit only certain doctors and hospitals, and in which the cost of treatment is monitored by a managing company.” This may sound a lot like the definition of a Health Maintenance Organization, HMO where beneficiaries are dis-incentivized from seeking healthcare “out-of-network” and use only the “in-network” physicians and facilities; however, this is not the case as Managed Care is much broader than simply insurance.
There have been a plethora of managed care companies and organizations including the MCO – Managed Care Organization, MSO – Management Services Organizations, ACO – Accountable Care Organization, DCO – Direct Contracting Organization and so on. The list is long with each one attempting to provide care management to a defined group of individuals within a demographic or contractual profile.
As mentioned previously, for many years, healthcare delivery entailed the physical interaction between a patient and physician as the means to evaluate the patient. The common steps performed by the physician have typically been:
- Obtaining patient history, description of symptoms and collecting relevant data
- physical examination – emphasis on physical and on presence
- generating a provisional and differential diagnosis
- testing (ordering, reviewing, and acting on test results)
- reaching a final clinical diagnosis
- consultation (referral to seek clarification, if indicated)
- providing discharge instructions, monitoring, and follow-up
- documenting these steps and the rationale for decisions made
Within the context healthcare in The Metaverse, each of these areas used by the physician to reach their clinical diagnosis and final discharge of the patient would be performed within the digital realm, including a patient examination that could be done via IoT devices and an infrared camera allowing the doctor to see areas of potential problem that would not be seen even in a face-to-face exam. Also, neither patient nor doctor constrained in a physical location, they could be thousands of miles apart, connected via The Metaverse and the VR/AR – telehealth portal, electronic healthcare records, and wearable devices that provide the collection of relevant data and feed into the AI-engine(s), data analytics and comparative databases, predictive medicine applications all performing real-time diagnostics. This is not unlike what we do when we take our car into the shop for a checkup – the computer runs the diagnostics and compares our care to the manufacturer’s specification. In this case, the comparison is to the baseline health of the patient established over successive visits. In this example, our bodies, including our mental activity can be measured against our own baseline wellness quotient (see out patents on Qx2® and Qx3®) and others in our population demographic. Certainly, lab tests that require physical presence will require the patient to present themselves, but even these can be envisioned to be done via The Metaverse robotically.
Funding for these have yet to be developed. Breakthrough applications, wrapped into The Metaverse of Healthcare ™, is happening at a near exponential growth rate though real results on a broad scale are yet to be demonstrated and are likely are several years away. I expect that what we will see is ‘islands of innovation’ sprouting up, relying on The Metaverse concept, that demonstrate high-value use cases and become the beginning of the true value proposition for The Metaverse of Healthcare.
Given all the visioning and forecasting for the future of The Metaverse of Healthcare the real question should be, ‘What does this mean for the delivery of care to the population? How will population be improved, patient-doctor interaction be enhanced with greater engagement by both, and how will the overall cost of providing healthcare be reduced?’
Total Care Management (TCM): Implications for Healthcare and Wellness
Regardless of how the healthcare system evolves into a digital world, the real world with flesh and blood patients will still need to be served. Yet, the digital world of avatars and virtual or augmented reality, the “gamification” of healthcare, will give providers a multitude of new tools and capabilities to diagnosis and manage individual health and wellness regardless of where the physical individual may be. There must be melding of old with new in order for the ‘evolution’ of healthcare into The Metaverse to succeed.
Healthcare delivery around the U.S. is beginning to redeploy with three key goals: improving the experience and quality of care, improving the health of populations, and reducing the per capita costs of health care. 1Understanding and effectively managing population health is central to each of the goals and necessary to regain control of our nation’s healthcare system. Total Care management (TCM) has emerged back out of the shadows where it had been pushed 20 years ago to become the leading practice-based strategy for managing the health of populations.
The readoption of the TCM strategy opens the door to the opportunities now being discussed and tried in those visionaries moving forward with The Metaverse of Healthcare. We anticipate that the issues and problems in our healthcare system that were previously well-covered cracks and emerged as gaping chasms because of the 2020 COVID pandemic will be addressed over time with an evolving hybrid delivery of care model that embraces traditional ‘hands-on’ practice of medicine with an integration of technology, or as we have referred to it “Technology-infused Health Care”.
The key elements in evolving the nation’s healthcare system involving a ‘hybrid’ Care Management model are the following, Coordination of Care, Self-Management of Care and Outreach and Education.
Coordination of Care
Care coordination is an integral part of routine primary care for all individuals, regardless of age or demographic, to ensure ‘care plan’ compliance. Individuals in our population considered “high risk “, or “high-cost” will have more specialized care coordination requirements and the management of the health of these individuals whether between providers or family members remains a critical need. Services to the high risk or high-cost populations is another point in the care continuum to ensure continuity and compliance to the care plan designed for health maintenance or improvement.
The Metaverse and affiliated technologies will bring a major enhancement to the Care Coordination Cycle with the entire population whether the care is through assigned caregivers in a special facility such as a rehab or Assisted Living Facility (ALF) or is self-managed by the individual. The IoT / wearable devices will continue to provide an increasing benefit to all categories of patient / consumer using a variety of readily available apps to track and manage their health. In facilities this will begin to substantially reduce the workload on staff and greatly improve the accuracy of care. Other technologies, including AI, predictive medicine (including those measuring key parameters of the individual) will provide advance or timely warning of a medical episode that will allow early intervention.
The Metaverse through virtual and augmented resources will allow a physician to “see” their patient remotely and interact in a very life-like way. This will allow an increase in the frequency of interactions with the patient and an opportunity to enhance the patient-doctor relationship that will improve the quality of care to the patient and enhance their healthcare experience.
Self-Management of Care
This category is also very broad stretching from the direct support for patients with chronic conditions or in transition of care to those that are healthy and managing their own health and wellness. Key to this element fulfilling its goal is data, healthcare data. Much needs to be real-time and presented to either a caregiver, patient or consumer in an understandable and actionable fashion. Unless the information that is presented is useable and actionable, the individual will eventually ignore the information, whether valuable or not, and the care management for that individual is deteriorated or ceases.
Self-Management will heavily utilize the virtual and augmented reality, as well as the IoT wearable devices. Regardless of age or demographic, the virtual reality can be of value to the patient or consumer.
Outreach and Education
Nowhere will the virtual and augmented reality worlds be of more use than in the outreach and education of patients and consumers, whether to instruct the patient on the use of a blood pressure cuff or a sports enthusiast in the best workout routines for their physique and goals.
Education about disease and ailments is in a critical shortage in the care management area and in the older population needs to be continually reinforced. With patients, the compliance and adherence to treatment or care plans is paramount and The Metaverse can provide the motivation and encouragement regardless of nearly any age or other demographic. Understanding the nature and use of the wearable devices to ensure that the data is clean and good requires education and re-education of the patient and being able to access the care plan and have it reviewed as often as needed with a ‘nurse or doctor avatar’ would be a significant advantage to many who need the constant reminder.
The use cases for The Metaverse in Healthcare are far too numerous to mention; however, what is clear is that The Metaverse coalesces a wide range of capabilities and functionalities that are beneficial across the entire continuum of care = from young to old – high risk / high cost to in the peak of health. The challenge is not in identifying use cases, but in managing the plethora of apps and programs to ensure cross-platform interoperability, and yet ensure the highest levels of security possible for the medical data.
The final piece to this increasingly complex puzzle is the use of blockchain technology in healthcare. There are many viable uses of the blockchain in healthcare from revenue cycle management to patient healthcare records (Non-HIPAA) to pharmaceuticals. The advantage of the blockchain is the immutability, or inability to change or tamper with the record without extraordinary computing power such as the Quantum computer.
One very viable application is in the area of the Personal Healthcare Record (PHR) for patients and consumers. There are several points to a value proposition for this use case:
- Individuals have the assurance that their PHR is secure and are not being sold without their permission, as is presently the case with the EHRs where personal health data is sold by companies for a profit to research and testing companies without the individual’s knowledge or consent,
- Put control of the individual’s PHR in their control with the ability to provide the information to their physicians on a one-time or open basis. The PHR could have the ability to record, analyze and disseminate real-time or historical data obtained from a variety of IoT wearable devices
- The ability to provide compensation to individuals for their voluntary participation in medical and bioscience research and development,
- Worldwide access to their PHR via internet anywhere in the world – for the tourist it’s like having their entire medical record at their fingertips – the healthcare / medical records follow the patient, nothing is more patient-centric, and
- Access to a patented Artificial Intelligence-based applications that provide a medical metadata analytical toolsets for an anonymous comparison of their key wellness metrics across the spectrum of users eventually worldwide.
The blockchain, with distributed ledger technology (DLT) provides a proven, secure method for managing patient records, as well as providing a platform for capturing consumer real-time data from wearable devices to wellness assessments and comparisons of other consumers in a de-identified, or Metaverse environment.
In future blogs, we will be exploring the unique capability that the blockchain and DLT provide, in addition to the use of SMART contracts, as well as tokens to universalize the PHR platform. A universal, consumer owned and managed PHR is finally within reach – one that will facilitate Remote Patient Monitoring (RPM), as well as managing an individual’s chronic conditions such as A-fib, hypo- or hyper glycemia, respiratory conditions (O2 Sat for emphysema and congestive heart failure patients). When combined with AI, Predictive Medicine, deep data analytics and episodic tracking algorithms, we will eventually be able to predict life-threatening or altering situations as Myocardial Infarctions, Coronary Thrombosis, Strokes, and other such conditions before they occur with sufficient warning to mitigate or even stop these before they occur!
With The Metaverse and blockchain / DLT, we are on the cusp of a new dimension in population health worldwide. It will take several million users and several years to obtain the data inertia for many of these visions to become reality, but they are visible on the horizon.
As the Mission Statement of the Starship Enterprise said “…to go where no man has gone before…” We are seeking out new territory in healthcare by bringing a universal personal healthcare record to the control of the individual, using highly-encrypted and immutable technology to ensure security, and providing interoperability and interconnectedness; not just between machines or machines and people, but also person to person, simultaneously and The Metaverse is the new ‘uni-verse.’
Stay tuned for more episodes of the Starship Metaverse……