A VRforHealth Interview with Physician and Committed VR Innovator, Dr José Ferrer Costa

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The culture at BSA is all about pushing boundaries. Whether it’s dabbling in robotics or pioneering VR applications like the projects I manage, the support and infrastructure are there. And it’s not just about having the latest tech. It’s about how we use it to better understand and engage with our community. Dr José Ferrer Costa, BSA, Badalona, Spain

About Badalona Serveis Assistencials

Badalona Serveis Assistencials (BSA) is a public organization in Spain that manages health and social care services in the city of Badalona and surrounding areas in the Barcelona metropolitan region of Catalonia. It operates a range of facilities including a hospital, primary care centers, social care facilities. BSA combines both public health and social care services, making it unique in the region for these services, as well for its eHealth innovation.

Participating in pioneering European projects in areas like digital health and senior care, BSA embodies a culture of innovation and research. This culture is enriched by partnerships with academic and industry leaders, and a commitment to stringent governance standards, ensuring BSA remains at the forefront of healthcare innovation”

Meet Dr José Ferrer Costa

We are delighted to publish this interview by Denise Silber with Dr Jose Ferrer Costa, a physician at BSA, and  a committed contributor to the application of Virtual Reality in healthcare.

DS: Please tell us about your background — why you chose to become a doctor, how you joined BSA, your current responsibilities.

Growing up with both parents as doctors, I saw the demanding nature of the medical profession and initially doubted it was the path for me. However, when it was time to choose a career, after observing a few surgeries something just clicked. The precision, the impact—it spoke to me. That’s when I knew I wanted to join the medical field.

I began my medical career in Brazil, graduating in 2000. My professional development was enriched by international exchange programs, including a three-month clinical rotation in Barcelona in 1999 that had a significant impact on me. During this time, ironically, I lived in a student house in Badalona, a place I’d later call home.

Post-graduation, I worked as a General Practitioner in a rural Brazilian community, intending to save money for my move to Spain. It was there that I realized family medicine was my calling. Instead of focusing on surgeries or specific conditions, it was about treating people. I found immense satisfaction in getting to know my patients and providing comprehensive care. It’s this holistic focus that led me to specialize in family medicine and still keeps me engaged in my work today.

In 2003 I moved to Spain and joined Badalona Serveis Assistencials (BSA) for my family medicine residency. I served as a General Practitioner at BSA for nearly two decades. Over the years, I’ve expanded my expertise, obtaining a master’s degree in Acupuncture and Traditional Chinese Medicine and engaging in the mentorship of medical residents.

In 2022, I transitioned to BSA’s innovation and research teams, dedicating my full energy to these roles.  In my current position at BSA, I am mostly focusing on projects involving Virtual Reality (VR). I manage various VR projects aimed at healthcare, medical education, and clinical research. These include mental well-being programs, immersive training modules for medical and nurse professionals, and VR protocols to enhance patient care. This role combines my passion for patient care with my enthusiasm for technological innovation, keeping me 150% engaged in this rewarding and ever-evolving field.

I’m also in the process of establishing a VR HUB within BSA to facilitate the development of in-house VR projects. Surprisingly, or perhaps not, I picked up VR development during the pandemic in 2020. Let’s call it a ‘productive lockdown,’ if you will. This newfound passion has led me to become a VR content developer. I now create simulations and upload them as apps into VR headsets, further extending the limits of how we use technology in healthcare and education.

DS: We’d like to hear more about how BSA is using health IT to innovate in health and social care services. As a physician working at BSA, how do you and your patients benefit from the BSA IT system and services ?

At BSA, what really distinguishes us is not high-tech gadgetry; it’s our people—dedicated healthcare providers who are unwavering in their commitment to patient care. Our IT system serves as a supportive tool rather than a focal point, enhancing our ability to connect with patients. In Catalonia, we have a universal patient interface where individuals can access their medical files, fostering transparency and engagement. Another key feature that has been particularly impactful is ‘e-consulta.’ Instead of waiting two weeks for an appointment to discuss a lab result, you can now message your doctor from your phone. Your doctor reviews your file, consults guidelines, and sends back an informed answer. While this can’t replace the need for in-person visits, it eases the burden on the system. By resolving minor issues digitally, we free up valuable appointment slots, thus reducing the waiting time for those who truly need an in-person visit.

The culture at BSA is all about pushing boundaries. Whether it’s dabbling in robotics or pioneering VR applications like the projects I manage, the support and infrastructure are there. And it’s not just about having the latest tech. It’s about how we use it to better understand and engage with our community. We even have awesome collaborations with universities and international projects that keep us at the forefront of healthcare innovation.

Together with my team in the innovation department, we manage a range of projects aimed at both improving organizational efficiency and patient care. One notable initiative involves using thermal vision robots to enhance patient supervision and prevent falls. My specific role centers on developing VR content, from creating VR exercises for cognitive stimulation, relaxing sceneries for pain management or emergency clinical VR scenarios, while building alliances with technical partners that share the same passion for the impactful good use of VR. To bring these projects to real life, we actively form alliances with technical partners who share our commitment to impactful healthcare innovation.

This week marks the official opening of our immersive room at the Intermediate Care Center, featuring a VR projection system from BROOMX. This innovative setup is designed to extend the benefits of virtual reality to those who may not be suitable candidates for using VR headsets, such as patients with advanced dementia or agitation. Additionally, the system accommodates family members and groups of patients for rehabilitation, cognitive stimulation, or relaxation experiences. The realization of this project would not have been possible without the generous donation from the Rotary Club.

DS: When did you first become interested in the healthcare uses of virtual reality? Which applications do you use yourself?

My initial contact with the world of VR was purely recreational, a hobby I picked up in 2019. But things took a turn in 2020 when I joined Educators in VR (EDVR), an international collective engaged in pushing the boundaries of VR and XR in education. I was invited to co-found the XR Medical and Healthcare Team within EDVR, and it was through this experience that VR took on a new dimension for me, pivoting towards healthcare applications. Since 2021, I’ve had the honor of hosting bi-weekly events, bringing together professionals and companies committed to innovating in the fields of healthcare and medical education.

On a more personal note, I’ve tried my hand at various VR relaxation apps like TRIPP, Healium, and Flow, just to name a few. These experiences not only offered me respite but also inspired me to create my own virtual worlds centered around meditation and relaxation. When I’ve opened my creations to the public, the positive feedback I received was incredibly encouraging.

Fast-forward to 2021, and I found myself collaborating with Nuria Moran, a physician colleague at BSA, who is an expert in mindfulness for healthcare workers. Together, we launched ‘Projecte Benestar,’ a customized VR educational program aimed at teaching mindfulness and emotional management tools to healthcare professionals. At a time when work-related stress was at an all-time high due to the pandemic, we sought to make a meaningful contribution to our colleagues’ emotional well-being.

DS: What are you researching and hoping to achieve with Virtual Reality through this research?

It’s a thrilling journey we’re on at BSA, and I have to give a nod to our management for recognizing the immense potential of VR in healthcare. The trust and responsibility they’ve placed in me have been both affirming and liberating, allowing me to fully unlock my creative and research capabilities.

When we launched ‘Projecte Benestar,’ it served dual purposes. On one hand, it aimed at preventing burnout among healthcare workers. On the other hand, it acted as an evangelizing tool for VR technology, a role I’ve been embracing through my involvement with Educators in VR. The project has achieved notable successes; our pilot study demonstrated marked improvements in emotional well-being, thereby validating the efficacy of our VR-based interventions. But what truly excited me was that participants, after experiencing the capabilities of VR firsthand, started reaching out with their own innovative ideas on how to integrate this technology into patient care. This was not only a validation of the program but also an indicator that the potential of VR was beginning to be recognized at a grassroots level within our community.

As we move forward, our research projects have been invigorated with prospective studies currently under ethical review. These new endeavors aim to explore the role of VR in cognitive stimulation and pain management and are being executed in collaboration with Barcelona-based company Reality Telling. This underscores our commitment to a multidisciplinary approach, pulling in expertise from the tech industry to augment our clinical insights. Additionally, our partnership with i3Simulations has matured, resulting in the development of two new emergency training scenarios, further enriching our VR-based educational portfolio. Notably, the growing interest and active participation from our IT department indicate that the VR Hub is organically expanding its capabilities.

DS: What do you think are the most promising avenues for the development of wide scale clinical use of VR?

In my perspective, the scope of VR in healthcare is profoundly impactful when utilized effectively. In the realm of education, it has the power to transform medical emergency simulations involving virtual patients, elevating patient safety. It also serves as an invaluable tool for soft-skills training, like improving communication abilities and conflict management skills. In the field of rehabilitation, our focus extends beyond physical and cognitive exercises; we’re exploring VR’s potential for enhancing social skills, particularly among individuals with neurodiversity. When it comes to mental health, VR can be a game-changer. It offers strategies to conquer phobias, fosters resilience against stress, and provides a comforting escape during acute moments of distress, such as during treatment for chronic ulcers or other medical procedures. If provided with adequate resources, I can foresee a surge of innovative ideas that could leverage the full spectrum of VR’s capabilities in healthcare.

DS: What do you see as the current obstacles to the expansion of VR and do you have any solutions?

It’s not a surprise if I say funding is one of the biggest hurdles, especially in a public healthcare system like we have in Spain. Relying on donations and grants is a must, but it also takes a lot of time and effort. You’ve got to write proposals, meet with potential donors, and make a convincing case for why your project deserves the funding. It’s almost like a second job on top of everything else. And even when you get the funds, you’re usually working on a tight budget, which adds another layer of challenge to the project.

As for the ethical considerations, that’s a whole other ballgame. While VR has been around in healthcare for some time, it’s still not universally accepted. We have to be really careful about how we conduct our research. There are ethical approvals to secure and guidelines to follow to make sure we’re using the technology responsibly. It’s vital to show not just that VR works, but that it’s safe, effective, and respects patient privacy and well-being. Cutting corners is not an option; doing so could undermine the entire field and potentially do harm.

All these obstacles don’t dampen my enthusiasm, though. They’re just puzzles to solve. And the rewards—improved patient care, reduced healthcare worker burnout, and groundbreaking research—are well worth the effort.

DS: Thank you José for a fantastic interview. I look forward to our continuing exchanges.