Immersive technologies such as augmented reality (AR), virtual reality (VR), and mixed reality (MR) have the potential to transform health care, alleviate pain and anxiety, deliver new types of treatments and diagnostics, and change how and where care is delivered (asamonitor.pub/49UMbu2).

“The use of immersive technologies may not always be reimbursable. However, at Stanford Children’s, we believe that the extra effort is worth it, because we see the returns in patient satisfaction, cooperation, and smiles.”

“As anesthesiologists, we take on a more encompassing role as perioperative leaders, so we are well-positioned to use this new technology to its fullest advantage,” says Thomas Caruso, MD, PhD, cofounder and codirector of the Stanford Chariot Program, a translational research and clinical lab at Stanford Medicine Children’s Health that is designed to create and accelerate the application of immersive, therapeutic technology to improve the well-being of pediatric patients.

“We refer to it as ‘immersive technologies’ because we don’t focus on using just virtual reality, augmented reality, or mixed reality devices. Instead, we go where the technology is leading and are not defined by the boundaries of any one device,” says Dr. Caruso. The Chariot Program has three domains in which it employs immersive technologies:

  • Anxiety and pain relief: Immersive technologies are used as therapeutic adjuncts to help reduce pain perception and minimize anxiety, particularly with patients who require postoperative dressing changes and wound care. They also seek to reduce anxiety around the overall care period, which is often a bigger issue than pain itself. By using customized software developed specifically for these purposes, they’re able to recharacterize the experience, and patients often report less pain because their anxiety was ameliorated.
  • Education: Within the patient realm, the program employs a certified and credentialed teacher who uses immersive technologies to continue the educational experience of the patient. Dr. Caruso notes there is not a lot of attention given to the psychosocial effects when a child is taken out of their routine and admitted to the hospital. Increasing the patient’s sense of normalcy improves cooperation, patient experience, and their sense of well-being.

Education is also provided to medical providers by performing simulations for different medical crises. The Chariot team has developed novel software using AR to revolutionize the way medical simulations are conducted for trainees, faculty, and medical students.

  • Rehabilitation: By coupling physical therapy with immersive technology such as VR, they have improved patient cooperation and experience. Stanford is currently renovating their hospital gym to include motion caption systems with spatial audio and haptics to bring cutting-edge rehabilitation techniques to their patients.

These domains are put into practice through:

  • Clinical programs: Immersive tech depots filled with VR headsets and other devices are located on every wing of the hospital, and consult orders for sessions with the Chariot team are available within electronic medical records.
  • Research: Extensive research and clinical trials are conducted every year, says Dr. Caruso. “Typically, if you’re a busy research lab, you’re not also developing clinical programs. The Chariot Program functions more similarly to a Center.”
  • Software development: While off-the-shelf software can be okay, it’s not always quite right for the situations that arise in a health care setting. The Chariot Program has developed more than 20 different novel software programs.

“The results have been phenomenal, but I think it’s because the program is so well-integrated within the hospital,” explains Dr. Caruso.

It all started as a quality improvement project in 2015. Parents wanted to calm their children before surgery but were looking for alternatives to typical medications, like midazolam. Samuel Rodriguez, MD, a friend and colleague of Dr. Caruso since residency, thought he’d try a nonpharmacologic approach. He purchased a portable projector and projected a video game on a screen attached to a patient’s bed to relieve anxiety before surgery.

“Sam’s patients really liked it, and I thought every kid should get to try it. I was director of the perioperative quality improvement team, so I suggested we conduct a QI project and make projectors available to any anesthesiologist who wanted to use them,” recalled Dr. Caruso.

They used traditional QI methodology to develop workflows and processes, including establishing a cleaning schedule for the projectors and screens. After six months, the project was complete, and they thought it was over. However, a small article written by the media team at Stanford Medicine Children’s Health was picked up by NPR, which led to recognition and a collaboration with the hospital’s philanthropic foundation.

“We first used philanthropic donations to create VR content and customized software for the projector. Fast forward, and our program has grown exponentially since then,” says Dr. Caruso. “Now, we are a team of 15 people. We have a consult service within our hospital, and we’re integrated into the electronic medical record. Nurses and physicians can write a consult for the Stanford Chariot Program, and we determine how immersive technology may be helpful for their patients.”

After presenting their research at conferences, Drs. Caruso, Rodriguez, and codirector Dr. Ellen Wang began to think about how to provide the technology to other hospitals. They approached Stanford’s Office of Technology Licensing team, which agreed to license the software to a nonprofit distributor they created named Invincikids (asamonitor.pub/3T0MtsF). “The nonprofit route was the right way to go,” says Dr. Caruso. “We developed these technologies through philanthropic donations, and we didn’t want to charge patients and hospitals for them. Cost should not be a barrier for any children accessing our technologies.”

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A series of videos and training manuals on the Invincikids website walks providers through the act of bringing the technology to their facilities, and help is only a phone call away, says Dr. Caruso. “My colleagues and I provide a lot of collaborative advice to other hospitals. We’re happy to help. When implementing a new program in a new hospital, ideally, you’d have executive sponsorship and an anesthesiologist champion. It’s the collaboration of those two people, coupled with the Invincikids training and software licensing, that makes a successful program. Now, Invincikids technologies are found in nearly 40 U.S. hospitals and more than 15 international hospitals.”

In the next 12-18 months, the Chariot Program will be working on several projects, including testing the technology in an adult hospital and combining mixed reality, haptics, and motion for rehabilitative services.

“We know these technologies are not going to replace general anesthesia, but they definitely have a role in enhancing and improving care,” says Dr. Caruso. “The use of immersive technologies may not always be reimbursable. However, at Stanford Children’s, we believe that the extra effort is worth it, because we see the returns in patient satisfaction, cooperation, and smiles.”