It’s not often that we can sing the praises of the Covid era but in the case of telehealth, it was a boon opportunity. The traditional forms of video-based communication like Zoom and Microsoft Teams were already operating in workplaces, schools and households. However, Covid saw an explosion of augmented reality (AR), virtual reality (VR) and mixed reality (MR) technologies that took those communication capabilities to the next level. The technology has the potential to amplify the mental health telemedicine experience.
In a systematic review of available technologies Arrigo Palumbo, an electronics engineer and professor at the Department of Medical and Surgical Sciences at Magna Græcia University, says extended reality (XR), which includes VR, AR and MR, has been emerging methodologies for several years, but today technological and scientific advances have made them suitable to allow users to experience a spectacular imaginary world, generating realistic images, sounds and other sensations.
Researcher Anton Shufutinsky and his colleagues report one of the most promising applications of these technologies is in advancing telepresence, or the ability of a participant to appear present at a remote location. Mixed Reality allows scenarios that are nearing complete telepresence through what is called holoportation.
Holoportation, Naveen Joshi, CEO of Allerin explains in Forbes, is 3D capture technology, using 3D cameras placed at different points of view to capture and reconstruct a person’s image in 3D, adding that the technology compresses and transfers the image in real-time. “The technology aids in listening, seeing and even interacting with other users and objects in a virtual world,” he said.
The benefit of telepresence is the ability to interact with remotely located participants more meaningfully than was previously possible. Holoportation provides real-time presence with three-dimensional capability, in which interactions can include not just a flat representation but a reconstruction of the physical setting (i.e., the room, the furniture in the room and the entire head-to-toe person), thereby allowing the transference of non-verbal communication, including hand gestures, body positioning, formal attire and emotional responses.
Healthcare is an industry with great interest in the potential for this technology as a tool for education, remote surgery, supervision of young doctors and supporting the health of people in remote locations. NASA flight surgeon Dr. Josef Schmid was holoported on to the International Space Station in October 2021. Schmid said the technology, when combined with mixed reality displays, allows users to interact remotely in 3D “as if they are actually present in the same physical space.” “NASA will use this for private medical conferences, private psychiatric conferences, private family conferences and to bring VIPs onto the space station to visit with astronauts,” he said.
The ability to connect with people in a location of their choice in a more personal way could benefit those working in mental health. It opens up significant possibilities for countries with vast open spaces with few inhabitants, such as Australia, Canada, Antarctica and rural areas in the United States and places where qualified staff are few. Or when natural disasters such as floods, fires and volcanic eruptions prevent access to an area and people are isolated and feeling very vulnerable. NASA’s Dr Schmid says whether in space or other remote places, such as offshore oil rigs or military operations, the technology can help bring people together.
Erin Cook, director of Quality, Transformation, Evaluation, Valuation, Ethics and Virtual Care at the CIUSSS du Centre-Ouest-de-l’Île-de-Montréal, an integrated health network in Montreal, has first-hand experience with the benefits of holoportation. The centre has 34 different sites spanning the entire continuum of care, including primary care, acute care, two rehab hospitals, six long-term care sites and a whole range of home care services for the elderly population. As Covid-19 took hold, the CEO wanted a hospital-at-home program so their hospitals could meet the demand for beds. This required a creative response in a very short period.
“We mobilized the entire organization and within 72 hours admitted our first patient into the program,” Cook said. “Fast forward two years later, and we’ve not just had a hospital in-the-home program but expanded that to include a facilitated discharge program.”
Erin said there are many examples of how the technology has been used across the different care streams within the centre including supporting mental health patients. She shares that while some patients are on medications like clozapine that require consistent monitoring, adherence is an ongoing challenge. “Many don’t adhere well to the drug because they don’t want to come in for the blood test, which presents a whole bunch of compliance challenges,” she said. “The program has overcome this challenge and our health professionals have seen a lot of improved compliance with the integration of point-of-care testing.”
Headsets and augmented reality applications are helping manage many different kinds of mental health treatments. People with dementia and Alzheimer’s disease can use these tools to help them remember important moments and feelings from their lives. Those with depression and stress can use similar tools to learn how to overcome their fears and improve their relaxation techniques without exposing themselves to potentially worrying situations.
Dr John Brayley, chief psychiatrist in South Australia, agrees that technology can offer new hope for better care in remote areas, but it is not a silver bullet. While telehealth is a necessary fact of life in a country like Australia, one of the concerns expressed by mental healthcare professionals is that technology solutions should not become the only approach offered. Face-to-face engagement builds rapport and is critical when discussing suicidal ideation. Being in the moment with the person is critical and this happens best in real life. Ideally, a combination of telehealth and in-person visits should be available.
Expanding our workforce capabilities
Of course, in-person visits require a workforce that is accessible to all. However, countries across the globe are experiencing workforce challenges with shortages in every aspect and at every level of healthcare. The potential to use holoportation in training and supervision offers a solution to this challenge. In the future, we will be able to transmit true representations of ourselves into the digital world using holoportation anywhere in the world and in real time. Users can see, hear and interact with people in real time as if they were in the same physical location. Technology can fade into the background as conversations become as natural as they are face-to-face. It’s not difficult to imagine a psychiatrist providing supervision support to another colleague via this technology or upskilling the peer workforce to develop safety plans in collaboration with a person experiencing suicidal distress and being able to check in with them on occasion.
One of the distinguishing attributes of holoportation over live face-to-face meetings is the ability to have the events automatically recorded from multiple perspectives and directions. Holoportation includes the functional capability of 3D replay and review, which can be used for scenario observation and post-event analysis. Though the primary purpose of holoportation is to provide live, real-time 3D capture, the interactions can also be recorded, providing the capability for the participants to practically walk into a living memory. With permission granted by the person receiving mental health support, this has the potential to engage family and other trusted support networks in the planning and delivery of mental health care. Something that many health services currently find very challenging.
Caution is required – it’s not all sunshine and roses
The advantages of these technologies are plentiful and exciting, and it’s easy to imagine the ease with which many of our tasks and communications may become when we adopt the innovations described. Introducing such technology does not come without some disadvantages and ethical concerns. For the most part, holoportation (like many disruptive technologies) is expensive and requires vast amounts of bandwidth and computer resources. However, in the long term, the ongoing evolution of technology and dropping prices will likely make this solution more of a reality.
Another challenge, as Palumbo notes in the systematic review, is that holoportation can cause cybersickness. This term identifies the cluster of symptoms a user experiences during or after exposure to an immersive environment. A physiological response to an unusual sensory stimulus, like motion sickness, characterizes this phenomenon. The incidence and degree of intensity vary based on the duration of exposure and nature of the virtual content and display technology.
There are also ethical concerns surrounding holoportation as a replacement for face-to-face interaction. Shufutinsky cites ethical concerns surrounding the technology as a replacement for face-to-face interaction. First, there’s a concern that the humanity that comes with face-to-face human interaction may be lost, mainly because there is an incomplete sensory connection.
Another ethical concern is employment. Think about the flow-on effect of a decrease in travel, which either directly or indirectly could affect numerous industries that support travel. Furthermore, over extended periods of time, skills would be lost or limited, which would be difficult or time-consuming to recover if a disaster were to render technology unusable.
Ethical questions involve access and education. The world is a disparate place, and billions of people around the world do not have access to technology or to training and education for using these technologies. Security and privacy also pose a potential threat as technologies such as holoportation and facial recognition become common. The public today is very uneasy about the ability of agencies and other entities to track, record, and investigate our personal preferences.
The end user’s opinion counts
Despite these current disadvantages, when it comes to the practical use of technology today, Erin Cook says, “The doctors love it. The nurses said it made it easier to access professionals, and the patients accepted it — they did not find it scary, nor did they refuse treatment if someone was wearing the technology headsets.”
And she says there are benefits to the health network. “We compared operational costs of running an actual unit versus the hospital at home unit, and we see significant savings with staffing, in terms of reducing infections, all of those things. In all the efforts where we did evaluate costs, we saw a reduction. If you’re looking at sort of the global episode of care, it’s definitely cost-beneficial.”
While we are not yet into the realms of everyday telepresence … preparing for the future would be wise. Of course, regulatory conditions in healthcare must be met, along with the hurdles of cost, ethics and privacy, but these have been perennial challenges with every advance in science and technology. There is no reason not to be an early adopter and use this innovation to provide quality healthcare, including mental health care, to anyone, anywhere, any time it’s needed.
See what it is all about here …..holoportation: virtual 3D teleportation in real-time (Microsoft Research) (youtube.com)
