Virtual reality has been on the healthcare scene for quite a few years now, but it’s only within the last half decade or so that the technology has started to resemble an effective medical technology. While its potential use cases are varied to say the least, a couple of standout approaches such as pain distraction therapy now boast a healthy body of data suggesting its prowess under experimental conditions and in a live deployment.

However, it doesn’t take an expert in the field to notice that very few providers are jumping out of their seats to purchase and deploy VR. Much like other novel medical technologies, there’s still a mound of work to be done regarding implementation practices, reimbursement and other practical considerations if VR is to become mainstream care.

“We have the science; we have meta-analyses now of multiple, tens and tens of randomized controlled trials for pain management,” Dr. Brennan Spiegel, director of health services research at Cedars-Sinai, said last week during a Connected Health Conference panel on immersive technologies. “Really, that’s not the issue anymore. … To me, it’s about how do we use the infrastructure that we currently have? What are the paradigms we can currently work this in?”

Tackling these issues will be nothing short of a challenge, yet Spiegel and the other VR evangelists speaking on the panel view each as an important and encouraging milestone for the young technology.

“We’ve gone from more of a pie in the sky, ‘What a great technology, think of all the things we can do!’ to ‘What are the cleaning protocols in order to make this durable medical equipment usable in wards that have infection control policies?’” Dr. Anthony Sossong, medical director of the Harvard-affiliated McLean-Franciscan Child Community-Based Acute Treatment Program, said. “It’s really interesting to watch this move forward, and I think it’s very exciting to think about how we can use the technology to specifically facilitate the care of medical delivery.”

Working within the hospital

Certainly there’s no shortage of hurdles. Clinical staff, support teams and patients alike all need to be comfortable with operating the technology and troubleshooting any potential issues. Some healthcare VR vendors are taking this kind of education requirements upon themselves through software design and onboarding programs, Kyle Rand, CEO and cofounder of VR company Rendever said, and the task is admittedly getting a little less burdensome thanks to the growing consumer VR market.

“You can actually take a headset, throw it in a backpack or on a plane with you, and then when you’re with some friends you can just pull it out. That means that more people have an understanding of what VR is having seen it, which means when they come into the hospital or healthcare setting [and] someone offers them VR, it’s not like this foreign thing that nurses have to explain,” he said. “They have that exposure, so the fact that the consumer market is growing is amazing for us in the enterprise setting.”

But there’s only so much that vendors can do from the outside to ensure smooth deployments. By and large, it’s up to the hospitals themselves to hash out the best ways to get the headsets to patients, monitor their use and ensure that each device is prepared for its next use. Some of these responsibilities potentially fall under the oversight of a hospital IT department’s medical device team, although Spiegel said that his organization has designated “virtualists” who specialize in keeping these tools up and running.

“We have a technician whose job it is to go and administer the treatment, and monitor that headset and retrieve it,” he said. “We’re talking now about having cabinets with UV lights where the nursing staff can check in and check out the headset, just like any other durable medical equipment that we’re managing in a hospital.”

VR hardware is strong, now onto the software

There’s also the question of which specific hardware a hospital interested in VR should be purchasing for use. The panelists were generally positive on this front, noting that there is no shortage of headset options to choose from that are all generally effective in delivering an immersive experience. Promised hardware revisions from headset vendors such as improved hand and eye tracking will certainly be welcome, they said, but at the moment providers can pick out devices that will suit their shifting cost, complexity, degree of motion and sanitation needs.

At this point, it’s the experiences and therapies these devices will deliver that should be the primary concern.

“The headset is sort of like a syringe. What I mean by that is what matters is not so much the syringe, but the medicine that goes through the syringe; the syringe is a platform that we use to deliver the medication,” Spiegel said. “I’m sure we all have our own interests in terms of what headsets are best, but the headsets are always changing. What matters is, to me, the software.”

Spiegel stressed the need for a diverse and curated software library by extending his medication analogy — if a doctor were to treat every single patient with only one or two different drugs, then they wouldn’t be a very effective physician. Dr. Joann Difede, a professor of psychology at Weill Cornell Medical College who’s treated PTSD patients with VR for years, likened the software curation and technology deployment challenges to the development of any other “standard of care,” which can help guide interested programs starting from scratch.

“That’s probably the more exciting buzz that goes with all of these infrastructure delivery problems we’re talking about: A standard of care for children under the age of 12, for example, a standard of care for the elderly where there are greater risks for falls, standard of care for PTSD patients,” she said. “That’s why we’re having all these conferences and meetings trying to come up with [best practices], so then we can advise people: ‘The universal protocol for infection control is hand washing. Well, the universal protocol for VR in kids is X kinds of software, delivered with this equipment, and this company does the training, that company does the service, and they all meet the FDA or Joint Hospital Commission standards for good practice.’ Just as we’ve done for drug delivery and drug testing, but we’re not quite there yet.”

Settling the bill

Even if each of these challenges was nailed down and easy to deploy, the panel was hard pressed to see many hospitals taking the plunge without reimbursement. Difede said tackling the “unsexy question of regulation” is likely the first step to getting payers on board, with Spiegel noting that the FDA has announced its first public panel on VR to be held in March.

Some providers are already finessing some of the broader billing codes to finance their services, he continued, but the technology is going to have to see broader support if VR is going to make it the last mile to adoption and large-scale implementation.

“Right now, there are clinicians who are getting reimbursed for VR. So for example, VR exposure therapies for phobias,” Spiegel said. “There isn’t a code for VR exposure therapy, but there’s a code for exposure therapy and there’s a guy, Dr. Howard Gurr, who’s out in Long Island. That’s most of what he does — he distinguishes his clinic by virtue of using VR exposure therapy, but he bills for that service. There are rehabilitation clinicians who are using VR in FDA-cleared programs for stroke rehabilitation that can fall under different billing codes.

“All of this is to say that this is really scaling now. There’s a lot of regulators, agencies starting to evaluate this — and I feel like we’re almost there to get this paid for — but until that happens [VR is] still a little bit of a niche thing.