Authors
Rigo Segovia, PharmD, Annie Vo, PharmD, BCPS, Emily Gamroth, PharmD, Priyan Lad, PharmD, Chad Compagner, PharmD
Introduction
The metaverse is a broad term that describes an integrated and shared virtual space. A singular metaverse that is fully networked and immersive has yet to be developed, but platforms using virtual reality (VR), augmented reality (AR), or mixed reality (MR) are numerous. Applications focused on taking users to a different space tend to favor VR, where the environment is entirely virtual. Conversely, usage focused on providing additional information or multitasking favor AR or mixed reality, where virtual elements are more interactive alongside physical elements. This article will explore pharmacy applications in each of these environments and other healthcare applications that may be extrapolated to pharmacy practice.
Virtual Reality
VR technology offers a unique three-dimensional interface that allows users to interact with computer-generated environments1. VR has long been used for entertainment purposes, and its potential in healthcare has been gaining momentum. From adjunctive treatment for pharmacotherapy to pharmacy training, virtual reality has shown promising results in a variety of healthcare applications.
It has emerged as a promising adjunctive therapy for pain management in healthcare. By providing immersive 3D virtual experiences, individuals suffering from various types of acute and chronic pain can achieve reductions in their pain levels. This therapeutic benefit is attributed to the phenomenon of “simple distraction,” where the patient’s attention is diverted from their physical discomfort toward the virtual reality environment2-3.
VR may also be beneficial in augmenting the existing non-pharmacologic options for mental health conditions4-5. For example, VR exposure therapy can transport patients to simulated environments that replicate triggers and situations that are difficult to recreate in real life. This simulation can provide patients with a safe and controlled environment to confront their fears and work through their mental health challenges. Additionally, VR therapy can be particularly beneficial for patients resistant to traditional forms of therapy or who live in remote areas where access to mental health services may be limited2-5.
This technology has shown great potential in the field of pharmacy education. Simulating patient interactions offers an immersive learning experience for pharmacy students without the risk of patient harm. Additionally, VR can visualize complex anatomy and pharmacologic interactions, giving students a deeper understanding of these concepts. Several studies have demonstrated the effectiveness of VR technology in education, highlighting its ability to improve student engagement, knowledge retention, and performance. With the growing demand for highly skilled pharmacists and the need to prepare students for real-world scenarios, VR technology offers a promising solution for delivering high-quality education in a safe and controlled environment6-9. This technology can also significantly reduce the cost of providing hands-on training for students8.
Augmented Reality
AR allows users to experience the real world, with virtual elements integrated into this view10. This integration of digital information can include overlaying a user’s view, providing a composite view of both the virtual and physical world. In some cases, users can interact with these elements amidst the real world. AR can also help facilitate auditory and sensory interaction to enhance user experience. In this way, AR supplements reality rather than replacing it.
AR has already had some success in general healthcare, such as in medical training and assistance during surgical procedures. In the area of medical training, AR could expand traditional methods of anatomy education by superimposing imaging of anatomical structures onto a living human ‘trainee’ rather than the traditional cadaver11. In addition, AR technology could help visualize more complex systems of the human body, along with its dynamic nature and patient-specific idiosyncrasies. Hamza and colleagues developed a system that provided a 3D visualization of the complex nature of the lungs, including possible deformations12. Finally, AR can help improve laparoscopic surgeries, which provide less invasive intervention for patients but can be more demanding for the surgeons in terms of concentration and execution of complex motor skills. An AR environment could offer realistic haptic feedback or physical sensation while training on a mannequin and project anatomical imaging to provide realistic practice13.
Specific applications of AR in the field of pharmacy are still in their infancy. However, similar opportunities utilized in medical training could also be applied to pharmacy education, such as more engaging teaching techniques rather than traditional didactic settings14. In addition, AR could also offer more engaging and interactive medication education materials for patients or even provide patients with identification of pills along with information about dosage, side effects, and interactions. Additionally, AR could provide medication safety through identification of counterfeit pills15.
Mixed Reality
MR combines VR and AR, where users can interact with objects in both the physical and virtual worlds. Commercially, various devices can deliver the MR experience, such as the Microsoft HoloLens 2, Google Glass 2, and the Magic Leap 1 and 216. Although MR is similar to AR because they share traits, the technology world maintains that they are distinct categories17.
To access MR’s magical and immersive experience, users require wearable technologies generically called MR head-mounted displays (MRHMDs). MRHMDs have the potential to revolutionize pharmacy education, practice, and patient outcomes. These devices are equipped with eye-tracking technology and physical vibrations, enabling users to interact fully with the virtual world around them. Prototypes of MRHMDs continue to be developed and studied in different domains and are evaluated on computing power and ergonomics, to name a few17.
Historically, pharmacy education was typically done in a physical classroom and had recently incorporated virtual learning to protect learners and staff from COVID-19. MR can take virtual lectures and practice to the next level by allowing educators to develop engaging simulations of pharmacy topics and medical scenarios. These experiences could assist remote learners and be an adjunct tool for onsite learning. For example, wearing an MRHMD would help display the exact area to administer vaccines or provide vital information during a cardiac arrest, such as chest compression depth18.
MR can also enhance and further personalize the medication counseling experience. Imagine that a patient would consent to share personal health information with the pharmacist via a virtual platform. The pharmacist wearing the headset would see the patient’s recent labs, vitals, and current medications, all while counseling the patient. Polypharmacy and low health literacy can make it difficult for patients to keep up with all the nuances of their medications and can lead to adverse drug events. Patients could use MRHMDs to display drug information while holding different prescription bottles. This information could include an indication, intended administration time, instructions, and prescriber comments.
Barriers
There are many barriers to consider before widespread adoption of a virtual world or metaverse is seen throughout pharmacy practice, including but not limited to hardware adoption, cost, standards/ethical issues, and privacy/security risks. For patient interactions to occur in a virtual world, both parties must purchase hardware, which can range from $300 to $1,000. In addition to maintenance and troubleshooting, there also needs to be an assessment of supporting technology, such as internet bandwidth, Wi-Fi strength, and Bluetooth connection19. Similar to the adoption of telehealth, new technologies can lead to social disparities with those who are less technologically inclined, have no access to, or cannot afford the technology. In these cases, it would be imperative to incorporate data on social determinants of health (SDOH), such as unstable housing, into the process20.
In some cases where more sensitive data is collected from facial recognition and sensors placed in the home, security, and privacy risks must also be assessed. With any new technology, the creation of standards or ethical guidelines on how to operate in a virtual world may take time to be developed, and there are often unintended consequences that should be assessed before adopting this technology. The Gartner hype cycle shows how initial expectations of the capability and functionality of new technology are overestimated in the media or public perception. There may still be inflated expectations before healthcare can benefit from any practical or widespread adoption of these technologies21.
Conclusion
While a fully networked and immersive metaverse has yet to be formed, development and exploration through VR, AR, and MR have been advancing. Applications related to healthcare are often focused on education, such as by enhancing pharmacy lectures and by providing another avenue for delivering patient education. Clinically, VR and AR are also being investigated as non-pharmacologic options for managing anxiety, pain, and mental health. Regardless of the effectiveness of these applications, cost and security remain barriers to widespread adoption. Overall, VR, AR, MR, and the developing virtual world show potential to improve healthcare with many unexplored areas remaining.
References
1. Ventola CL. Virtual Reality in Pharmacy: Opportunities for Clinical, Research, and Educational Applications. P T. 2019;44(5):267-276.
2. Wang E, Thomas JJ, Rodriguez ST, Kennedy KM, Caruso TJ. Virtual reality for pediatric periprocedural care. Curr Opin Anaesthesiol. 2021;34(3):284-291. doi:10.1097/ACO.0000000000000983
3. Ridout B, Kelson J, Campbell A, Steinbeck K. Effectiveness of Virtual Reality Interventions for Adolescent Patients in Hospital Settings: Systematic Review. J Med Internet Res. 2021;23(6):e24967. Published 2021 Jun 28. doi:10.2196/24967
4. Freeman D, Reeve S, Robinson A, et al. Virtual reality in the assessment, understanding, and treatment of mental health disorders. Psychol Med. 2017;47(14):2393-2400. doi:10.1017/S003329171700040X
5. Caponnetto P, Triscari S, Maglia M, Quattropani MC. The Simulation Game-Virtual Reality Therapy for the Treatment of Social Anxiety Disorder: A Systematic Review. Int J Environ Res Public Health. 2021;18(24):13209. Published 2021 Dec 15. doi:10.3390/ijerph182413209
6. Dean S, Halpern J, McAllister M, Lazenby M. Nursing education, virtual reality and empathy?. Nurs Open. 2020;7(6):2056-2059. Published 2020 Jul 1. doi:10.1002/nop2.551
7. Saab MM, Hegarty J, Murphy D, Landers M. Incorporating virtual reality in nurse education: A qualitative study of nursing students' perspectives. Nurse Educ Today. 2021;105:105045. doi:10.1016/j.nedt.2021.105045
8. Hauze SW, Hoyt HH, Frazee JP, Greiner PA, Marshall JM. Enhancing Nursing Education Through Affordable and Realistic Holographic Mixed Reality: The Virtual Standardized Patient for Clinical Simulation. Adv Exp Med Biol. 2019;1120:1-13. doi:10.1007/978-3-030-06070-1_1
9. Zhao J, Xu X, Jiang H, Ding Y. The effectiveness of virtual reality-based technology on anatomy teaching: a meta-analysis of randomized controlled studies. BMC Med Educ. 2020;20(1):127. Published 2020 Apr 25. doi:10.1186/s12909-020-1994-z
10. Azuma RT. A survey of Augmented Reality. Presence: Teleoperators and Virtual Environments. 1997;6(4):355-385. doi:10.1162/pres.1997.6.4.355
11. Blum T, Kleeberger V, Bichlmeier C, Navab N. Mirracle: An augmented reality magic mirror system for anatomy education. IEEE Xplore. Published online March 2012. doi:10.1109/vr.2012.6180909
12. Hamza-Lup FG, Santhanam AP, Imielińska C, Meeks SL, Rolland JP. Distributed augmented reality with 3-D lung dynamics--a planning tool concept. IEEE Trans Inf Technol Biomed. 2007;11(1):40-46. doi:10.1109/titb.2006.880552
13. Kamphuis C, Barsom E, Schijven M, Christoph N. Augmented reality in medical education? Perspectives on Medical Education. 2014;3(4):300-311. doi:10.1007/s40037-013-0107-7
14. Babichenko D, Patel R, Grieve V, et al. Sterilear: Exploration of augmented reality and computer vision approaches for real-time feedback in sterile compounding training. 2020 6th International Conference of the Immersive Learning Research Network (iLRN). Published online 2020. doi:10.23919/ilrn47897.2020.9155164
15. Ciapponi A, Donato M, Gülmezoglu AM, Alconada T, Bardach A. Mobile apps for detecting falsified and substandard drugs: A systematic review. PLOS ONE. 2021;16(2). doi:10.1371/journal.pone.0246061
16. Palumbo A. Microsoft HoloLens 2 in Medical and Healthcare Context: State of the Art and Future Prospects. Sensors (Basel). 2022;22(20):7709. Published 2022 Oct 11. doi:10.3390/s22207709
17. Gerup J, Soerensen CB, Dieckmann P. Augmented reality and mixed reality for healthcare education beyond surgery: an integrative review. Int J Med Educ. 2020;11:1-18. Published 2020 Jan 18. doi:10.5116/ijme.5e01.eb1a
18. Fijacko N, Strnad M, Skok P, Ketis ZK, Zofsnik U, Grief R. The Use of Mixed Reality to Teach Healthcare Providers Cardiopulmonary Resuscitation: A Mapping Review. AGN. 2022;1.
19. Chengoden R, Victor N, Huynh-The T, et al. Metaverse for healthcare: A survey on potential applications, challenges and future directions. Accepted manuscript. IEEE Access. 11:12765-12795. Published online September 9, 2022. doi:10.1109/access.2023.3241628
20. Alkureishi MA, Choo ZY, Rahman A, et al. Digitally Disconnected: Qualitative Study of Patient Perspectives on the Digital Divide and Potential Solutions. JMIR Hum Factors. 2021;8(4):e33364. Published 2021 Dec 15. doi:10.2196/33364
21. Shi Y, Herniman J. The role of expectation in innovation evolution: Exploring hype cycles. Technovation. 2023;119:102459. doi:10.1016/j.technovation.2022.102459