Virtual Reality at the US Department of Veterans Affairs : a guest contribution

Virtual Reality is applied in multiple use cases at the Veterans Administration

« The US Department of Veterans Affairs has been an early adopter of eHealth tools at every stage, from the electronic medical record to Artificial Intelligence, » according to VRforHealth co-founder Denise Silber « and Virtual Reality is no exception. We met up with Anne Lord Bailey and Caitlin Rawlins at the 6th Annual IVRHA Virtual Reality & Healthcare Global Symposium, where they presented an overview of the Virtual Reality activities at the VA. We are delighted to publish this original article with the latest update from the team. »

An Update on Virtual Reality Activities at the US Department of Veterans Affairs

Extended reality (XR), particularly virtual reality (VR), is at the forefront of disruptive innovations in the healthcare industry, and the U.S. Department of Veterans Affairs (VA) is helping pave the way forward. Prior to 2017, only a handful of VA frontline staff in a few VA Medical Centers were integrating XR into Veteran care and employee training. The efforts were disjointed and siloed at best, with no avenue to share best practices and resources.  VA’s Office of Healthcare Innovation and Learning (OHIL) is now leveraging its strategic programs to bridge the gaps and support the simulation, scaling, and sustainment of XR with the goal of improving and saving Veteran lives as well as improving employee wellness and engagement. 

Simulate:

OHIL’s Simulation Learning, Evaluation, Assessment, and Research Network (SimLEARN) encourages the use the XR by developing and providing simulation related to XR for clinical and non-clinical use. Specifically, the Emerging Healthcare Technology Integration (EHTI) program developed an assessment model to help with evaluation. The EHTI team assesses the technology landscape, identifies solutions to advance the standard of clinical practice, works toward the integration into professional development, and supports inclusive workflows in a risk-free environment.

Scale:

OHIL’s VHA IE (Innovation Ecosystem) helps grow the innovation muscle of frontline staff and advocate for end-user driven design.  Given limited and disjointed adoption of XR just 5 years ago, VHA IE, recognizing both a problem and an opportunity, established the VHA XR Network.  The Network is a community that exists to gather clinicians, researchers, administrators, and leaders onto a common platform to identify challenges, share resources, evaluate opportunities, facilitate collaborations, and co-design solutions. As of June 2022, the VHA XR Network now supports over 1,000 VA staff members across more than 150 VA facilities.

Since its inception, the VHA XR Network has launched three multi-site pilots assessing almost twenty different XR use cases such as falls risk assessment, neurological risk assessment, pain management, anxiety, post-traumatic stress disorder (PTSD), physical and occupational therapy, and empathy training for employees; facilitated donation of XR equipment across 36 VA sites; and created a thriving Community of Practice with two specialty community spin-offs and a variety of Office Hours. Additionally, the Network collaborated with the VA Creative Arts Therapy program to introduce a 56-site XR for Creative Arts Therapy initiative. 

  • VHA Employees: Five VA medical facilities are currently using XR technologies to support employees’ wellness and to mitigate burnout. During a monthly VHA XR Network call, a clinician shared a picture of the employee wellness cart created at her facility. The cart included refreshments, coffee, and a VR headset, and was rolled around to different units to improve employee morale. Since that strong practice was shared, a new spinoff community focused on employee wellness has emerged and additional sites have adopted the practice. Data is currently be gathered to further support use in this setting, but anecdotal responses from employees have shown receptivity, engagement, excitement, and appreciation.  In addition to employee wellness, XR is being explored by VA clinicians for surgical planning and co-designed for various clinical and non-clinical employee-facing use-cases. 
  • Veterans: As XR is implemented across VA, the data on Veteran benefits speak for themselves. For example, at one facility over three hundred sessions have been completed using VR to provide positive distraction  to help decrease pain, anxiety, boredom and concerning behaviors while also aiding relaxation. For Veterans suffering from acute and chronic pain, 66% saw a drop in pain intensity. Ninety-five percent experienced a decrease in anxiety. One hundred percent of Veterans using XR to aid with behavioral concerns felt a decrease in restlessness, and 93% of those Veterans exhibited overall improved behaviors. 
    • Pain and anxiety management was the strongest initial focus of XR exploration in the VA but use cases continue to expand at a rapid rate.
    • VA clinicians and researchers are now investigating and piloting the use of various XR content as adjunct to physical, occupational, recreational therapy, and creative arts therapy; treatments for substance use disorder; treatment-resistant depression; PTSD; and ocular disorders.
    • For example, 56 VA Medical Centers are currently using XR to augment Creative Arts Therapy by offering ten virtual experiences, including musical museums, sculpting, drama and oration, musical instruments, mindfulness, muscle relaxation, and more.   
    • As use-cases have expanded, so have patient areas where XR is available. XR can now be found on medical-surgical, intensive care, inpatient mental health, spinal cord injury, and residential treatment units, VA Community Living Centers (short and long-term care and hospice), various outpatient clinics, operating rooms, and even in Veterans’ homes.  

Sustain:

OHIL’s Center for Care and Payment Innovation (CCPI) was established to develop and test innovative approaches to payment and service delivery models. The CCPI team is working to test and assess the business case for integrating XR into Veteran care and to evaluate how XR might transform standard care models. Currently, multiple efforts are underway to assess the value of adding XR to Veteran care, including assessment of at home physical therapy/occupational therapy. 

The efforts of CCPI combined with the existing resources of the Network – including standard operating procedures, documentation templates, cleaning procedures, and contracting and procurement guidance – help to ensure employees have what they need to start and sustain XR programs. 

Looking ahead:

Together with key stakeholders across VA, industry, academia, and other government agencies, OHIL is helping define the future of XR in healthcare, enhancing Veteran care delivery, and changing the way we think about healthcare innovation. 

A Veteran living in a VA Community Living Center and only able
to venture outside of the Center for short periods of time
is exploring familiar mountains in this VR experience.
A VA employee is participating in VR training
to learn how to best utilize VR with her patients.