September 10, 2024 • 36 mins
Ever wondered how virtual reality can revolutionize healthcare? Join us as we dive into an enlightening conversation with Dr. Anne Bailey and Caitlin Rawlins from the VA, who are pioneering the use of immersive technology to transform the care veterans receive. Anne, the pharmacy practitioner and executive director of the Strat Lab, and Caitlin, a registered nurse and Director of Clinical Tech Innovation, share their inspiring journey from conventional healthcare roles to spearheading VR initiatives. Learn about how their collaboration over the past seven years has led to innovative solutions for post-operative pain and anxiety management.
Discover how the VA is making waves with VR technology through veteran experience events across the country, engaging nearly 350 veterans in the past year and a half. With VR now in use at 165 VA sites, including medical centers and outpatient clinics, we delve into impactful initiatives like the firearm safe handling module developed in conjunction with the Veteran Crisis Line. This groundbreaking module offers a safe and realistic environment to teach firearm terminology and safe storage practices, playing a crucial role in suicide prevention.
Finally, hear compelling stories of veterans whose lives have been transformed by VR. From managing chronic pain at home to overcoming PTSD and even improving mental well-being for those with cognitive impairments, VR is making significant strides in healthcare. Learn about the collaboration between veterans, clinicians, and developers to create customized VR environments, complete with mindfulness content, deep breathing exercises, and exposure therapy. Listen to strategies for managing resistant learners and the impressive impact VR has had on reducing opioid use post-surgery. Don't miss this episode packed with inspiring success stories and the future potential of VR in transforming veteran care.
Anne and Caitlin's email address- vaimmersive@va.gov
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(00:48):
Welcome The Sim Cafe, apodcast produced by the team at
Innovative Sim Solutions, editedby Shelly Houser.
Join our host, Deb Tauber, andco-host Jerrod Jeffries, our
host Deb Tauber and co-hostJerrod Jeffries, as they sit
(01:08):
down with subject matter expertsfrom across the globe to
reimagine clinical education andthe use of simulation.
So pour yourself a cup ofrelaxation, sit back, tune in
and learn something new TheSim Cafe.
Deb Tauber (01:30):
Welcome to another episode of The Sim Cafe.
And today we're here with Anneand Caitlin, and they're from
the VA.
And Anne, why don't you tellour guests a little bit about
yourself?
Anne Bailey (01:42):
Yeah, I'd be glad to.
So my name is Anne Bailey.
I'm a pharmacy practitioner bytraining.
I have grown up in the VA, Idid my residency in VA, but now
I am the executive director ofthe Strat Lab and the goal of
our program is to identify themost disruptive technology that,
if it proves successful, couldreally transform how we think
about healthcare delivery andexperience.
(02:03):
And as a part of that, ourlargest portfolio of effort is
VA Immersive, where we overseethe implementation of immersive
technology across the entirehealthcare system.
So I am the lead for VAImmersive.
Deb Tauber (02:16):
Thank you, Caitlin.
Why don't you go ahead andintroduce yourself to our guests
as well?
Absolutely.
Caitlin Rollins (02:22):
So I'm Caitlin Rollins.
I'm a registered nurse byclinical backgrounds.
I'm currently in the Office ofHealthcare Innovation and
Learning within the VA and myactual title is the Director of
Clinical Tech Innovation.
But of course I play a role aswell in VA Immersive.
Deb Tauber (02:40):
Thank you.
Why don't you guys enlightenour guests on what you're doing,
what you're leading at the VAas far as virtual reality and
immersive experiences?
Anne Bailey (02:53):
Absolutely so I can tell you one perspective of the
story and then Pastor Caitlinlet her share her perspective as
well.
So we started this togetherabout seven years ago.
I was an innovation specialistat the VA in Asheville, North
Carolina, and also apractitioner as well.
Caitlin was a bedside nurse andbrought to me a project that
she'd been working on for usingvirtual reality specifically for
(03:16):
post-operative knee pain andanxiety.
It had some really compellingand exciting results not only
clinical results, but a lot ofevidence of veteran and staff
engagement.
At the same time, I was workingwith a group of people in the
3D printing world who arecreating this 3D printing
network, bringing peopletogether, basically around a
particular technology in acommunity space.
(03:40):
And so when we think about thatkind of network not the wires
that connect things, but thepeople that connect each other
and we saw an opportunity totake an exciting technology that
was showing a lot of promise,take that and then expand it
across the entire healthcaresystem by building a community
around it.
Caitlin Rollins (03:57):
Yeah, I mean I think that that covers a lot of
it for sure.
I mean it's been a wild journeythat Ann and I have been on for
the past seven years, butwhenever I found immersive
technology at the bedsideinitially, like I said, it was
really as an opportunity to findsomething else to offer
patients as anon-pharmacological approach or
intervention to help with painand anxiety management.
(04:20):
And, as Ann said, that initialpilot was so successful.
You know, the first patientthat we ever used it with was 84
years old, had just had a totalknee replacement, Couldn't.
His pain was just not beingvery well helped by opioids or
other pain medications.
This older gentleman put a VRheadset on his head and all of a
sudden he had complete relieffrom his pain.
(04:42):
And it was in that moment that Iwas like all right, well, I
wasn't sure I was anticipatingthis was going to work as well
as it did, but it did.
And after that initial datacollection, of course, connected
with Anne, my innovationspecialist at Asheville, and
started trying to brainstormways to bring this to the
broader organization indifferent ways, and that
(05:05):
inevitably ended up with thefirst community of practice
around it.
You know the smattering offolks who are really interested
in the technology but weren'treally sure how to really get it
off the ground yet, and that,of course, has grown
significantly over the years tobecome this giant network and
resource hub for our VAemployees that are wanting to
use this technology to improveveteran healthcare.
Deb Tauber (05:27):
Caitlin, can you talk to me a little bit about
how you got started with this?
One day you just decided oh, Ithink I'm going to bring in a
headset to my patients.
How do you?
You know?
Where did this come from?
Caitlin Rollins (05:39):
It was something kind of like that.
I suppose I was notorious forbeing the nurse on a very busy
post-operative ward that wasinterested in alternative
medicine and complementary andintegrative health, and our
chief of orthopedic surgery atthe time was like hey, Caitlin,
I know you're into all theseother things outside of standard
medicine.
(05:59):
I have a friend who is apracticing anesthesiologist who
started a virtual realitycompany.
They really want to work withthe VA and want to help veterans
.
Would you mind taking a look atwhat they've created to see if
you think there's anything to it?
And myself, you know I'm anartist by background as well,
and so for me it was like thisinteresting intersection of two
(06:23):
halves of my life, where I'dbeen previously an artist and
became a nurse and now all of asudden this technology comes up
that brings together imagery andpositive distraction and
expression and then turns itinto something that's also
beneficial in a healthcaresetting.
So it was that, that coolcombination of things that
really got my attention and mademe want to push it through the
(06:46):
pathway that got it into actualpractice, which I can tell you
is not without its grief andbarriers bringing new technology
into healthcare, but it wassomething that was worthwhile
after I experienced it the firsttime.
Deb Tauber (06:59):
I love that grief and barriers because every time
someone gets away from somethingelse they grieve that loss.
Jerrod Jeffries (07:08):
Caitlin, I also want to make sure I understood.
It was the first patient.
It was about seven years agoyou were mentioning, but was the
first user.
Was that the 80, 84 year old?
?
Jerrod Jeffrie (07:18):
misunderstanding .
Yeah, that's incredible.
I mean to actually embrace andkind of accept this mask going
on his face to be like, okay,this is what's going on and
pushing forward to.
I think that's that reallyshows the power of what you're
doing.
Caitlin Rollins (07:32):
Yeah, absolutely.
And I know I don't know if youwant to mention that story that
we just had come through today,actually about an older
gentleman and one of theimmersive products.
Anne Bailey (07:41):
Yeah, somebody sent us a story today of someone
about the same age I can'tremember if he was 82 or 84.
I could probably pull it uppretty quickly, but they
actually sent a device into hishome and he was able to learn to
use the technology quickly overZoom.
And so we have seen andcontinue to gather data.
You know, one of the thingsthat we do is these veteran
experience events, where ourteam two or three members of our
(08:04):
team go to the VA medicalcenters around the country at
their invitation and have, youknow, a four to five hour demo
day.
Basically, we set up headsetsaround the room and veterans and
staff can come and go as theylike and give us feedback on
what they think of thetechnology.
Would they like to see more ofit?
How?
You know?
How did they?
How was their experience?
And so far, we've done this atsix different medical centers
(08:25):
over the last year and a halfand almost 350 veterans more
than 60% had never used thetechnology before, but 91% said
it was easy to use or very easyto use and 95% say they want
more of it in their, in theirhealthcare, which is, you know,
the story that that Caitlin wastelling of the origin is really
(08:45):
interesting is the thing thatpeople don't always know about
this story is how many times wewere told no, initially like
that.
We were crazy that virtualhealth care wasn't a thing.
But the fact that veterans andstaff, the more they got their
heads and headsets, the morethey tried it and the more we
were able to work together as acommunity to lower some of those
barriers of adoption, the themore it took off.
Jerrod Jeffries (09:06):
That's incredible.
So you said it's been doneacross six sites.
Anne Bailey (09:10):
Now the veteran experience has been done across
six sites, but we have over2,800 frontline staff engaged in
utilizing this technology at165 unique VA sites of care, 154
of those being medical centers,18 others being some of our
community-based outpatientclinics or vet centers, things
(09:30):
like that but 154 of VA's 172medical centers are utilizing
this technology now across atleast 40 different indications
for use.
We probably need to send outanother ask for how everybody's
using it, because I hear thingsI'm like I don't think we knew
they were doing that withtechnology.
So it's been a lot of fun tosee the community really take
hold of this and run with it.
Deb Tauber (09:51):
So in your role as an innovation specialist.
How did they come up with thatrole?
How does that work?
Anne Bailey (09:58):
How does that work?
That's a great question.
So the office that Caitlin isin now, the Office of Healthcare
, innovation and Learning, hasfour different programs across
that office.
One is the innovation ecosystem, which is really focused on
building the innovation muscleof frontline staff, and that's
where the innovation specialistslive Caitlin I don't know
what's the latest number, it waslike 40-something medical
(10:20):
centers.
Caitlin Rollins (10:21):
Jerrod, it's at least 40.
I know that they're adding likesix to eight new sites in
October too, but that's at least40.
I know that they're adding likesix to eight new sites in
October too, but that's at least40.
Anne Bailey (10:28):
So as that program grows, what it means is those
facilities are dedicating to putat least one full-time
equivalent staff person, so itcould be four people that fill
the role, but usually it's onethat are really focused on
building that innovation culture, facilitating that for staff.
Both Caitlin and I have beeninnovation specialists in the
past.
And then the other threeprograms in the office, just for
(10:50):
your awareness, one is Centerfor Care and Payment Innovation,
so they're focused oninnovative business and care
models.
We have special permission fromCongress to try some different
things.
As you know, congress is ourboard of directors, so that's
really important.
There is also SimLearn, whichis of interest to you guys, I'm
sure I know that we brieflydiscussed that, but Simulation,
learning, evaluation, assessmentand Research Network.
(11:12):
They have a fully simulatedhospital called the SimVet
Center in Orlando, florida,across the street from the
Orlando VA Medical Center.
And then Office of AdvancedManufacturing does focus on
building what we can't buy, sofocused on advanced
manufacturing.
Deb Tauber (11:27):
Jared, what were you going to ask?
I wanted to get clear on howthis is possible.
Well, one.
Jerrod Jeffries (11:34):
That's quite the difference between six
institutions versus 150, youknow, mid-hundreds that's one
but two, and last time we werechatting as well, I remember we
were talking about a fewdifferent cases, and one that
really kind of struck myinterest was that of the firearm
safe handling.
I was curious if we could gointo some of the different
modules or activities that usersare able to be trained on
(11:58):
within this virtual reality XRworld.
Anne Bailey (12:02):
Absolutely.
And actually we kicked off thispilot, yes, over the last two
days in New Orleans, so I got alot of enthusiasm coming out
right now about all of that.
But so firearms safe handlingone of the things we know about
suicide prevention is the numberone way to prevent suicide is
lethal means safety and firearmssafe handling is part of that.
Now our veterans are veryfamiliar with firearms and often
(12:25):
have many, but our caregiversand staff their caregivers, our
staff may or may not havefamiliarity with firearms and
that terminology.
Especially in a moment ofcrisis, that terminology really
matters.
So, as you can imagine, wecan't force people to go to gun
ranges or meet with police orhandle weapons to learn that
terminology or learn thosetechniques.
(12:45):
So we have worked with theVeteran Crisis Line from our
Office of Suicide Prevention.
They have been the subjectmatter experts who have brought
their curriculum for firearmsafe handling and we've put that
into a virtual realityexperience.
We now have six differentfirearms.
There are some handguns andsome long guns and in that
experience you learn theterminology but you also walk
(13:09):
through disarming, locking andsafely storing weapons.
Va, as a suicide preventioneffort, gives away gun locks
very liberally the cable locks Ihad when I was seeing patients.
I had a box of them next to meand you'd ask you know, veterans
, how many guns do you have inyour home?
For?
Ok, here's eight gun locks,just in case you have friends
and you want to help them aswell.
(13:30):
And what we've learned withthis experience is that one,
people feel safe handlingweapons in this environment.
Two, it's realistic enough that, even though I reminded them
and others as they're goingthrough it, you're going to see
a table in front of you in thisvirtual experience.
But when you're done with theexperience and it tells you to
set the firearm down, there isno actual table in front of you.
(13:50):
You are sitting in a chair, notat a table.
People almost always drop thehand controller, so we make sure
they have those safety strapson, showing how realistic it is.
But the other thing is thatpeople don't know how to use gun
locks.
Deb Tauber (14:07):
And so we've been able to show them that in this
environment it's been reallypowerful, and I'm sure that's
not something that somebodywants to say oh, I don't know
how to lock up a gun, that'sexactly right.
Anne Bailey (14:12):
Oh sure, I'll take it.
I'm sure I can figure this out,but that's right.
Deb Tauber (14:16):
And how many veterans have been through this
training at this point.
Anne Bailey (14:20):
Yep.
So this training is for ourstaff.
We've been doing field testing,so we've been to seven medical
centers until yesterday and wedeployed it with 20 staff across
10 different medical centersand over the next three months
each of those will have about100 staff at their feedback on
the actual experience.
Is it realistic?
Does the voice bother you?
(14:41):
You know things like that thatwould impact people's acceptance
of it or receptivity to it.
And the other thing is we'llget pre and post information.
How did, what did you knowabout guns before?
What did you know after Similarquestions, what we would ask if
they were doing it in a 2Dtraining environment?
Because we do, as healthcaresystems have computer-based
(15:04):
training, but you can imaginehow people just kind of click
through those things and youdon't necessarily even know what
they say, and so we'll asksimilar questions to see if we
can get some data on how muchmore effective the training is.
Jerrod Jeffries (15:16):
So I have a question when it comes back to
when you get feedback, so say,and by all means it's 90 plus
percent, kind of this NPS scoreor likability and kind of
efficacy it seems but say forthis you want to change
something the voice orsomething's not scientifically
(15:39):
correct or there's somethingthat's maybe not completely
kosher.
What's the process of changingsomething within the module or
the training, and how long doesthat take?
Anne Bailey (15:51):
That's a good question.
So one of the things that'simportant to know is that there
are multiple different types ofagreements we have with some of
these companies.
There's one which is you buythe thing off the shelf and
nothing changes about it.
You just put it out there intothe wild and use it with
patients.
That is our least favorite, tobe honest, because the
technology is still young enoughand early enough and our
(16:13):
patients are still learning, andstaff that we want to be able
to say this worked and thisdidn't.
And so the second is wepurchased with terms in the
contract that talk about addingnew content or editing or
adjusting or updating thecontent.
Caitlin's worked on a reallybig project with that over the
last two years now for chronicpain and suicide prevention,
(16:34):
where we both got off the shelfcontent and developed content.
Caitlin, you can talk aboutthat as well.
Then the other two are one, thefirearm safe handling, which
we've done this type of approachwith two others as well.
Prevention of sexual harassmentand an inpatient discharge
experience, where we areactually writing scripts from a
blank slate and funding thedevelopment from nothing into
(16:57):
the actual experience, and to dothat.
It is part of the contractingprocess to repeatedly go to
medical centers, get feedbackand iterate on it.
That's part of how the contractis written, and so we've
developed it over eachexperience, from blank slate to
completion and ready to deploy.
It takes about a year, but itincludes somewhere between
(17:18):
generally about five to 10visits to different medical
centers to test it and try it,get feedback, iterate and test
it again, and then the final oneis the one that we use the most
, and that's a cooperativeresearch and development
agreement.
Over the last seven years wehave never been a consistently
funded program.
We take money from wherever wecan get it from, and so have
(17:38):
also relied heavily on thewonderful immersive community
that's out there that is veryagreeable to collaboration and
co-design and co-development.
And so through a cooperativeresearch and development
agreement, we're oftenco-designing, co-developing,
prototyping, taking somethingand giving feedback on it.
Under the terms of that type ofagreement, where it's just
(17:58):
mutual provisions of resources,you get to test it in an actual
clinical, real-world environment.
You get real veteran feedbackor staff, depending on what your
experience is and then they getthe benefit to test something
in that real-world environment.
It's that mutual exchange ofresources.
But, caitlin, I'd love for youto talk more about your
experience with some of this.
Caitlin Rollins (18:18):
Yeah, I wanted to add to that conversation too
about, especially with ourcooperative research and
development agreements, thosecollaborations, because they're
so important.
They keep our clinicians andthe veterans at the center of
what is being used in the VA,because in industry of course
you can create these amazingthings, these amazing products,
(18:38):
amazing technology.
But it doesn't mean that, evenif you've got great research
studies showing that it'svaluable, it doesn't mean it's
going to be easy to integrateinto actual clinical care.
You know you really need thatreal world experience.
How does this product work in areal world setting?
What are the issues with theprocess of integrating it into
(18:59):
care?
And so I think thosecollaborations are so incredibly
important because they bringtogether healthcare and industry
so that you can work togetherto build the best solution for
healthcare that meetseverybody's needs.
And so it's incrediblyimportant collaborative process.
And I think for that particularproject that Anne mentioned that
(19:19):
is intended for chronic painand suicide prevention, it
brought together kind of both ofthose worlds where you've got
like the procurement of off theshelf product.
But you're also doing the workof a CRADA in many ways, because
you're building new content indirect collaboration and with
feedback from both veterans andclinicians that are actually
(19:39):
going to be using it in some wayend users of that particular
product.
So that project took basiccontent that included things
like 360 videos andmindfulness-based content, deep
breathing exercises, sequentialmuscle relaxation type content
and then added to it some veryspecific customized environments
(19:59):
that were built with our actuallike clinicians providing
feedback on what the scriptingwas, what the details of the
imagery look like.
Every bit of those environmentsdeveloped with actual
clinicians to build newrelaxation environments, new
kind of complementary andintegrative health type
environments, as well as somenovel in vivo exposure
(20:22):
environments, which I think areincredibly important and
increasing access to a difficultto provide therapy.
Deb Tauber (20:29):
And how do you manage your resistant learners?
Caitlin Rollins (20:33):
I think it's all about kind of support too.
We have our early adopters, thepeople that are excited from the
very beginning about thistechnology, and they don't
require a lot of coercion topick up the devices to use them
in whatever way they areintended, whether it's employee
or veteran or caregiver facing.
But I think some of thehesitation usually lies in
(20:55):
clinicians and other employeesfeeling like they don't have the
bandwidth to learn somethingnew.
So whenever you're trying tointegrate something new into
healthcare, whether it'simmersive technology or
otherwise, you really need tomake sure they feel supported.
Make sure you think about andask them for their opinion on
what resources they need to makeit easier for them to use.
(21:16):
And I think that's where the VAImmersive and the VHA XR
network have been so incrediblyimportant in allowing this
technology to scale is becauseit provides that support system.
They have 2,000 plus employeesacross the country that can help
answer their questions.
They have our team that helpdevelop national resources to
(21:38):
make it easier for them to adoptthe technology in whatever way
they'd like to.
So I think that's a big pieceof it and, anne, maybe you have
something else to add to thattoo.
Anne Bailey (21:48):
I think one of the things that's really interesting
and Caitlin touched on this alittle bit is how you introduce
people to the technology.
That's why we talk a lot aboutheads and headsets, why we talk
a lot about headsets andheadsets and the fact that there
are people it actually is veryuncommon for us to encounter
people who don't want to try it,and those who don't want to try
(22:09):
it often are won over by seeingit screencasted so they can see
what other people see, or byseeing people experience it.
I had it happen yesterday.
We had talked through a fewdifferent experiences outside of
the firearms and I was talkingwith the group the 20 or so
people who were there andtelling them some of the other
things that VA Immersive isdoing with immersive technology
(22:31):
and wanted them to experiencethings other than the one
experience they were gonna bereally focused on over the next
several months.
And we had some quick peoplewho jumped up quickly and wanted
to try it, people who arehesitant and then but then saw
their, their colleagues, try itand enjoy the experience and
then they tried it.
And so I think so much is howyou introduce it, how you talk
(22:54):
about it and even things that Ithink about, like when we talk
about contraindications andprecautions, potential side
effects of cyber sickness from apharmacist provider perspective
, those lists are allsignificantly shorter than
almost any medication that wewould recommend for so many
different indications, and oncea patient takes a medication, I
(23:15):
can't take that back right.
We have to go through thecourse of whatever happens next
and hope that it's great.
But with this technology, ifpeople were to experience cyber
sickness, you'd take it allright.
I mean, the risk is so low andhelping people see that as well
as the value, I think it reallymade a big difference for how
it's grown across VA.
Deb Tauber (23:36):
Now have you guys used it for narcotic reductions.
Caitlin Rollins (23:40):
That was definitely one of the side
effects, I suppose, of even thatoriginal project that I did in
the Asheville VA, the very firstproject focusing on
post-operative knee pain andanxiety associated with surgery.
And of course then it spread toother orthopedic surgeries and
then all surgeries and then ofcourse to other inpatient units
(24:01):
and to all over the hospital.
But it started with justpost-operative knee pain and
that initial project ended upbecoming one of the
interventions that the facilitywas implementing as part of an
overall enhanced recovery aftersurgery protocol, and that
protocol was focused onincreasing the amount of
non-pharmacologicalinterventions and non-opioid
(24:23):
pain medications, kind of acrossthe board for all surgeries.
So as part of that program,that initial virtual reality
piloting helped to decreaseopioid use in those total knee
arthroplasty patients by over70% in less than three months,
which was an incredible decreasein opioid use.
(24:43):
And then, as it started rollingout to other surgeries, we
started seeing decreases inopioid use across all of the
different surgery types and evenat this point, even years later
, seven years later, there'sstill a sustained decrease in
opioid use by over 30% acrossall of the surgeries at that
facility, which is incredible.
(25:05):
Now, that being said, for someof our national pilots, like our
at-home chronic pain managementpilot that we've been doing.
We're not necessarily trackingmedication use associated with
that, but the overall goal of aprogram like that is to provide
a tool to those patients thatthey can use in their homes
independently to help betterself-manage their chronic pain.
(25:27):
So if it's a patient that hashistorically been relying on
opioids to help manage thatchronic pain, we're trying to
provide additional tools thatwill allow them to use something
other than opioids in thosescenarios.
Because even as a nurse, and Iand you've probably heard this
as a pharmacist many of ourpatients that take opioids don't
(25:48):
want to, but they feel likethey're out of options and it's
the one thing that can bringthem some level of relief.
So if we can provide somethingand immersive technology has the
potential to allow them to notfeel their pain for the first
time in 10 years because theyare distracted and learning
skills that allow them to bettermanage their pain, and that's
(26:09):
huge.
Deb Tauber (26:11):
Caitlin, what are they seeing in this video when
they're in this experience?
What is actually showing up inthe virtual reality headset?
It looks like she's frozen,yeah.
Anne Bailey (26:23):
I can tell you a little bit the products that
we're using.
Caitlin Rollins (26:26):
Oh, there she is you were frozen for a second
Caitlin.
Yeah, of course.
So it definitely varies byproduct and by use case, but
even in a single use case it canvary.
So for pain management, forexample, if it's for, Do you
want me to fill in the gap, or?
Anne Bailey (26:43):
wait till she's there?
Jerrod Jeffries (26:44):
No, that'd be great.
Anne Bailey (26:45):
Yeah, so it depends on the indication.
For example, if you think aboutpain, which I think is what she
was getting into acute pain isreally about positive
distraction.
So then the question is, doesthe patient need something
that's interactive for positivedistraction or relaxing for
positive distraction, and sothat helps guide the selection
For chronic pain?
A lot of times it's skilldevelopment and learning
(27:07):
experiences.
So mindful practice, cognitive,behavioral therapy, pain,
neuroscience, education, thingslike that, where you're creating
experiences and going throughexperiences, for example, a
breathing, you breathe andsomething grows right or
something moves.
So there's some interactionwith your actual, with some
biofeedback, but also with theexperiences.
(27:29):
Caitlin, you froze again, butif you want to add to that, go
for it.
Jerrod Jeffries (27:33):
Well, and I want to come back to one other
question that I think Caitlinwas touching upon, but you both
addressed the question, and thathas to do with the cooperation
or working together with youguys' program.
Could you let our listenersknow how best to get together in
terms of cooperation for youtwo?
Are you the program you'reworking on?
Anne Bailey (27:53):
Absolutely so.
If it's just about learningmore about what we're up to,
innovationvagov is a websitethat has an immersive specific
page on it, and there's lots ofour stories and links and
resources there.
If you want to reach out to us,vaimmersivevagov is our email
address and that goes to ourentire team, so we'd love to
(28:14):
hear from people Do you have amost like an exciting success
story that you could share withus recently.
Jerrod Jeffries (28:23):
Oh man, that's, that's a hard to pick one,
right.
Oh, that's a good problem tohave and that is a good problem
I will tell you.
Anne Bailey (28:29):
Oh man, I even yesterday, and Jeff, I was
telling you a little bit aboutthis.
We used to, you know, seeingthis change over time.
We used to do presentations andget a lot of questions at the
end A lot of technical questions, definition questions, how to,
what, if all these questions.
Yesterday I did a usualpresentation, got a couple of
questions and then everybodyeverybody else that raised their
(28:50):
hand wanted to tell a story ofhow they'd talked to a veteran
at their medical center abouthow the technology was helping
them.
One woman said, yeah, I just goover into the inpatient unit
and talk to the veterans thathave used VR and hear how it's
changed their lives.
And you, like I know it soundslike I'm making this up, but I
promise you that I am not.
We now publish these storiesbecause they're exceptional.
(29:12):
One of my favorites was a storyfrom Denver, va, where they had
a patient who was homebound, whoreally needed to come to the
medical center for his care, andhe just was socially isolated
chronic pain, debilitating PTSD,the whole thing, very complex
comorbid conditions and theythought, well, we might as well
send him a headset right Like,let's try this.
(29:33):
They are a phenomenal pain teamthat has a lot of different
tools and things that they usewith patients, so they send a
headset.
Not only does this patient nowcome in for his care, he has
also signed up to be a peerspecialist, which means he is
being trained to one on one orin group settings, help other
veterans who are isolated orhomicidal, suicidal mental
(29:54):
health challenges I mean areally complex job description.
And because of this change nowhe's signed up to and that, to
me, is ideal, right, like notonly did it help him, but it
brought him to a place tomultiply who he was and help
other people I think it wasreally powerful.
There's a million other storiesabout patients that are, as
(30:17):
they're actively passing away,asking for VR so that they can
go to their home because they'dexperienced it at different
times through the hospice carejourney.
I mean, there's just so many.
Caitlin, I know you have amillion too, so I don't know if
you can come up with one or twoquickly.
Caitlin Rollins (30:32):
I think some of them.
You know one I already tried todescribe earlier, where it's a
patient with chronic pain.
As you probably know, veteransexperience chronic pain at a
higher rate and a higherseverity level than any other
population, and so some of thesepatients literally have had no
reprieve from their pain fordecades, which is incredibly
(30:55):
awful, you know, and we need todo more about it.
But whenever I have a patientthat you can put a VR headset on
and their face just lights upall of a sudden because and you
can just see them visiblyrelaxing you know patients that
have been tense for decades allof a sudden just visibly
relaxing and they'll tell you Idon't feel my back anymore, I
(31:15):
don't feel my leg anymore.
This is the first time I've hadrelief from this pain in 20
years.
You know that is huge, likethat sort of story, and we see
it over and over again.
So it's not even just a singleveteran story, it's really just
multiple that you hear that fromon a regular basis.
Anne's heard me tell this storyevery time we chat about veteran
(31:36):
stories and Anne happened to bethere and it was one of the
first patients that we ever usedvirtual reality with.
That actually has a cognitiveimpairment.
So a lot of people would assumethat if you have dementia,
alzheimer's, that you can'treally use the technology.
Well, that's absolutely nottrue and it can be incredibly
helpful for those patients tohelp decrease restlessness,
agitation, to make them feelcalmer, to take them back to a
(31:58):
time maybe that they rememberbetter.
But this was a patient who had alot of behavioral health issues
, was having to consistently besent from our community living
center, which is like along-term care facility, to an
inpatient psychiatric wardbecause of those mental health
issues.
And we put her in a virtualreality headset for the first
(32:19):
time and this female veteranwho's wheelchair bound, like all
of a sudden her face went fromher typical like kind of
aggravated, like angry personato somebody who was like
laughing and smiling and shejust changed into a completely,
completely different person infront of our eyes.
And so for a patient like that,who may often have to get
(32:39):
antipsychotics or anxiolyticsthings to help with anxiety or
those kinds of psychoticepisodes that she's having, if
you can put her in a headset andturn her into this happy person
who's spinning circles in herwheelchair, that's amazing.
Deb Tauber (32:53):
Wow, anything that you guys want to add for our
listeners.
Any final closing thoughts?
Anne Bailey (33:00):
I would say lean in .
You know, we've seen thischange exponentially over the
last seven years and certainlyfeel like we are have not even
reached the peak yet ofpotential, and our ultimate goal
is just to normalize it.
Right, we don't want this to bethe flavor of the week or the
(33:21):
trend of the whatever we believe, and we are moving forward in
such, and this is both inpatient care and staff training
and education, as well asemployee well-being.
Right, it's not just abouttraining and educating our staff
, but it's also helping themtake a break and deescalate some
of the situations they findthemselves on a day-to-day basis
.
But our goal is for this to bea new modality that is very
(33:44):
normal in healthcare and we lookforward to seeing that continue
to grow and change over thenext several years.
Caitlin Rollins (33:49):
And I think I would probably va.
gov just say hear, hear to that.
Deb Tauber (33:54):
Yeah, this is some great work you guys are doing.
You need to keep it up and youneed to spread the word, and
hopefully our listeners will be.
If they have questions for youguys, is there a way they can
get to you?
Anne Bailey (34:06):
yeah, that va immersive a is the best place to
reach out there.
We're also pretty easy to findon linkedin, if that's a better
place for listeners also.
Um, deb and j, thank you somuch for allowing us to join you
and have this conversation.
Things like this and peoplelike you are really the front
end of all of this and making ithappen, because if you guys
(34:27):
don't help us tell the story,then it never gets told.
So, thank you, we definitelycould not do this without you
guys.
Jerrod Jeffries (34:33):
Thank you and Caitlin, I'm impressed with this
scrappiness, this hustle thatyou guys have and you and you
just keep calling and keepgetting different types of
funding.
You keep cooperating.
It's, you know, throwing itright back at you.
It's people like you that kindof cooperate and collaborate and
and help you, help so manypeople.
So it's it's coming fromdifferent angles and putting
these different types ofdisciplines together to to
(34:55):
create change and somethingbetter for all veterans.
And then it only starts there.
It just keeps pushing forward.
we will conclude, and thank youso much for being guests.
We really appreciate it.
Anne Bailey (35:16):
Thank you.
DIsclaimer/ Innvovative (35:16):
Thanks to Innovative Sim Solutions for
sponsoring this week's podcast.
Thank you so much for beingguests.
We really appreciate it.
Thank you Thanks to InnovativeSim Solutions for sponsoring
this week's podcast.
Innovative Sim Solutions willmake your plans for your next
Sim Center a reality.
Contact Deb Tauber and her teamtoday.
(35:38):
Thanks for joining us here atthe Sim Cafe.
We hope you enjoyed Visit us atwww.
innovativesimsolutions.
com and be sure to hit that likeand subscribe button so you
never miss an episode.
Innovative Sim Solutions isyour one-stop shop for your
(35:59):
simulation needs, a turnkeysolution.
The views and opinions expressed in
this program are those of thespeakers and do not necessarily
reflect the opinions orpositions of anyone at
Innovative Sim Solutions or oursponsors.
This week's podcast issponsored by Innovative Sim
Solutions.
Are you interested in thejourney of simulation
accreditation?
Do you plan to design a newsimulation center or expand your
(00:24):
existing center?
What about taking your programto the next level?
Give Deb Tauber from InnovativeSim Solutions a call to support
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Learn more at www.
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com or just reach out to DebContact today.
(00:48):
Welcome The Sim Cafe, apodcast produced by the team at
Innovative Sim Solutions, editedby Shelly Houser.
Join our host, Deb Tauber, andco-host Jerrod Jeffries, our
host Deb Tauber and co-hostJerrod Jeffries, as they sit
(01:08):
down with subject matter expertsfrom across the globe to
reimagine clinical education andthe use of simulation.
So pour yourself a cup ofrelaxation, sit back, tune in
and learn something new TheSim Cafe.
Deb Tauber (01:30):
Welcome to another episode of The Sim Cafe.
And today we're here with Anneand Caitlin, and they're from
the VA.
And Anne, why don't you tellour guests a little bit about
yourself?
Anne Bailey (01:42):
Yeah, I'd be glad to.
So my name is Anne Bailey.
I'm a pharmacy practitioner bytraining.
I have grown up in the VA, Idid my residency in VA, but now
I am the executive director ofthe Strat Lab and the goal of
our program is to identify themost disruptive technology that,
if it proves successful, couldreally transform how we think
about healthcare delivery andexperience.
(02:03):
And as a part of that, ourlargest portfolio of effort is
VA Immersive, where we overseethe implementation of immersive
technology across the entirehealthcare system.
So I am the lead for VAImmersive.
Deb Tauber (02:16):
Thank you, Caitlin.
Why don't you go ahead andintroduce yourself to our guests
as well?
Absolutely.
Caitlin Rollins (02:22):
So I'm Caitlin Rollins.
I'm a registered nurse byclinical backgrounds.
I'm currently in the Office ofHealthcare Innovation and
Learning within the VA and myactual title is the Director of
Clinical Tech Innovation.
But of course I play a role aswell in VA Immersive.
Deb Tauber (02:40):
Thank you.
Why don't you guys enlightenour guests on what you're doing,
what you're leading at the VAas far as virtual reality and
immersive experiences?
Anne Bailey (02:53):
Absolutely so I can tell you one perspective of the
story and then Pastor Caitlinlet her share her perspective as
well.
So we started this togetherabout seven years ago.
I was an innovation specialistat the VA in Asheville, North
Carolina, and also apractitioner as well.
Caitlin was a bedside nurse andbrought to me a project that
she'd been working on for usingvirtual reality specifically for
(03:16):
post-operative knee pain andanxiety.
It had some really compellingand exciting results not only
clinical results, but a lot ofevidence of veteran and staff
engagement.
At the same time, I was workingwith a group of people in the
3D printing world who arecreating this 3D printing
network, bringing peopletogether, basically around a
particular technology in acommunity space.
(03:40):
And so when we think about thatkind of network not the wires
that connect things, but thepeople that connect each other
and we saw an opportunity totake an exciting technology that
was showing a lot of promise,take that and then expand it
across the entire healthcaresystem by building a community
around it.
Caitlin Rollins (03:57):
Yeah, I mean I think that that covers a lot of
it for sure.
I mean it's been a wild journeythat Ann and I have been on for
the past seven years, butwhenever I found immersive
technology at the bedsideinitially, like I said, it was
really as an opportunity to findsomething else to offer
patients as anon-pharmacological approach or
intervention to help with painand anxiety management.
(04:20):
And, as Ann said, that initialpilot was so successful.
You know, the first patientthat we ever used it with was 84
years old, had just had a totalknee replacement, Couldn't.
His pain was just not beingvery well helped by opioids or
other pain medications.
This older gentleman put a VRheadset on his head and all of a
sudden he had complete relieffrom his pain.
(04:42):
And it was in that moment that Iwas like all right, well, I
wasn't sure I was anticipatingthis was going to work as well
as it did, but it did.
And after that initial datacollection, of course, connected
with Anne, my innovationspecialist at Asheville, and
started trying to brainstormways to bring this to the
broader organization indifferent ways, and that
(05:05):
inevitably ended up with thefirst community of practice
around it.
You know the smattering offolks who are really interested
in the technology but weren'treally sure how to really get it
off the ground yet, and that,of course, has grown
significantly over the years tobecome this giant network and
resource hub for our VAemployees that are wanting to
use this technology to improveveteran healthcare.
Deb Tauber (05:27):
Caitlin, can you talk to me a little bit about
how you got started with this?
One day you just decided oh, Ithink I'm going to bring in a
headset to my patients.
How do you?
You know?
Where did this come from?
Caitlin Rollins (05:39):
It was something kind of like that.
I suppose I was notorious forbeing the nurse on a very busy
post-operative ward that wasinterested in alternative
medicine and complementary andintegrative health, and our
chief of orthopedic surgery atthe time was like hey, Caitlin,
I know you're into all theseother things outside of standard
medicine.
(05:59):
I have a friend who is apracticing anesthesiologist who
started a virtual realitycompany.
They really want to work withthe VA and want to help veterans
.
Would you mind taking a look atwhat they've created to see if
you think there's anything to it?
And myself, you know I'm anartist by background as well,
and so for me it was like thisinteresting intersection of two
(06:23):
halves of my life, where I'dbeen previously an artist and
became a nurse and now all of asudden this technology comes up
that brings together imagery andpositive distraction and
expression and then turns itinto something that's also
beneficial in a healthcaresetting.
So it was that, that coolcombination of things that
really got my attention and mademe want to push it through the
(06:46):
pathway that got it into actualpractice, which I can tell you
is not without its grief andbarriers bringing new technology
into healthcare, but it wassomething that was worthwhile
after I experienced it the firsttime.
Deb Tauber (06:59):
I love that grief and barriers because every time
someone gets away from somethingelse they grieve that loss.
Jerrod Jeffries (07:08):
Caitlin, I also want to make sure I understood.
It was the first patient.
It was about seven years agoyou were mentioning, but was the
first user.
Was that the 80, 84 year old?
?
Jerrod Jeffrie (07:18):
misunderstanding .
Yeah, that's incredible.
I mean to actually embrace andkind of accept this mask going
on his face to be like, okay,this is what's going on and
pushing forward to.
I think that's that reallyshows the power of what you're
doing.
Caitlin Rollins (07:32):
Yeah, absolutely.
And I know I don't know if youwant to mention that story that
we just had come through today,actually about an older
gentleman and one of theimmersive products.
Anne Bailey (07:41):
Yeah, somebody sent us a story today of someone
about the same age I can'tremember if he was 82 or 84.
I could probably pull it uppretty quickly, but they
actually sent a device into hishome and he was able to learn to
use the technology quickly overZoom.
And so we have seen andcontinue to gather data.
You know, one of the thingsthat we do is these veteran
experience events, where ourteam two or three members of our
(08:04):
team go to the VA medicalcenters around the country at
their invitation and have, youknow, a four to five hour demo
day.
Basically, we set up headsetsaround the room and veterans and
staff can come and go as theylike and give us feedback on
what they think of thetechnology.
Would they like to see more ofit?
How?
You know?
How did they?
How was their experience?
And so far, we've done this atsix different medical centers
(08:25):
over the last year and a halfand almost 350 veterans more
than 60% had never used thetechnology before, but 91% said
it was easy to use or very easyto use and 95% say they want
more of it in their, in theirhealthcare, which is, you know,
the story that that Caitlin wastelling of the origin is really
(08:45):
interesting is the thing thatpeople don't always know about
this story is how many times wewere told no, initially like
that.
We were crazy that virtualhealth care wasn't a thing.
But the fact that veterans andstaff, the more they got their
heads and headsets, the morethey tried it and the more we
were able to work together as acommunity to lower some of those
barriers of adoption, the themore it took off.
Jerrod Jeffries (09:06):
That's incredible.
So you said it's been doneacross six sites.
Anne Bailey (09:10):
Now the veteran experience has been done across
six sites, but we have over2,800 frontline staff engaged in
utilizing this technology at165 unique VA sites of care, 154
of those being medical centers,18 others being some of our
community-based outpatientclinics or vet centers, things
(09:30):
like that but 154 of VA's 172medical centers are utilizing
this technology now across atleast 40 different indications
for use.
We probably need to send outanother ask for how everybody's
using it, because I hear thingsI'm like I don't think we knew
they were doing that withtechnology.
So it's been a lot of fun tosee the community really take
hold of this and run with it.
Deb Tauber (09:51):
So in your role as an innovation specialist.
How did they come up with thatrole?
How does that work?
Anne Bailey (09:58):
How does that work?
That's a great question.
So the office that Caitlin isin now, the Office of Healthcare
, innovation and Learning, hasfour different programs across
that office.
One is the innovation ecosystem, which is really focused on
building the innovation muscleof frontline staff, and that's
where the innovation specialistslive Caitlin I don't know
what's the latest number, it waslike 40-something medical
(10:20):
centers.
Caitlin Rollins (10:21):
Jerrod, it's at least 40.
I know that they're adding likesix to eight new sites in
October too, but that's at least40.
I know that they're adding likesix to eight new sites in
October too, but that's at least40.
Anne Bailey (10:28):
So as that program grows, what it means is those
facilities are dedicating to putat least one full-time
equivalent staff person, so itcould be four people that fill
the role, but usually it's onethat are really focused on
building that innovation culture, facilitating that for staff.
Both Caitlin and I have beeninnovation specialists in the
past.
And then the other threeprograms in the office, just for
(10:50):
your awareness, one is Centerfor Care and Payment Innovation,
so they're focused oninnovative business and care
models.
We have special permission fromCongress to try some different
things.
As you know, congress is ourboard of directors, so that's
really important.
There is also SimLearn, whichis of interest to you guys, I'm
sure I know that we brieflydiscussed that, but Simulation,
learning, evaluation, assessmentand Research Network.
(11:12):
They have a fully simulatedhospital called the SimVet
Center in Orlando, florida,across the street from the
Orlando VA Medical Center.
And then Office of AdvancedManufacturing does focus on
building what we can't buy, sofocused on advanced
manufacturing.
Deb Tauber (11:27):
Jared, what were you going to ask?
I wanted to get clear on howthis is possible.
Well, one.
Jerrod Jeffries (11:34):
That's quite the difference between six
institutions versus 150, youknow, mid-hundreds that's one
but two, and last time we werechatting as well, I remember we
were talking about a fewdifferent cases, and one that
really kind of struck myinterest was that of the firearm
safe handling.
I was curious if we could gointo some of the different
modules or activities that usersare able to be trained on
(11:58):
within this virtual reality XRworld.
Anne Bailey (12:02):
Absolutely.
And actually we kicked off thispilot, yes, over the last two
days in New Orleans, so I got alot of enthusiasm coming out
right now about all of that.
But so firearms safe handlingone of the things we know about
suicide prevention is the numberone way to prevent suicide is
lethal means safety and firearmssafe handling is part of that.
Now our veterans are veryfamiliar with firearms and often
(12:25):
have many, but our caregiversand staff their caregivers, our
staff may or may not havefamiliarity with firearms and
that terminology.
Especially in a moment ofcrisis, that terminology really
matters.
So, as you can imagine, wecan't force people to go to gun
ranges or meet with police orhandle weapons to learn that
terminology or learn thosetechniques.
(12:45):
So we have worked with theVeteran Crisis Line from our
Office of Suicide Prevention.
They have been the subjectmatter experts who have brought
their curriculum for firearmsafe handling and we've put that
into a virtual realityexperience.
We now have six differentfirearms.
There are some handguns andsome long guns and in that
experience you learn theterminology but you also walk
(13:09):
through disarming, locking andsafely storing weapons.
Va, as a suicide preventioneffort, gives away gun locks
very liberally the cable locks Ihad when I was seeing patients.
I had a box of them next to meand you'd ask you know, veterans
, how many guns do you have inyour home?
For?
Ok, here's eight gun locks,just in case you have friends
and you want to help them aswell.
(13:30):
And what we've learned withthis experience is that one,
people feel safe handlingweapons in this environment.
Two, it's realistic enough that, even though I reminded them
and others as they're goingthrough it, you're going to see
a table in front of you in thisvirtual experience.
But when you're done with theexperience and it tells you to
set the firearm down, there isno actual table in front of you.
(13:50):
You are sitting in a chair, notat a table.
People almost always drop thehand controller, so we make sure
they have those safety strapson, showing how realistic it is.
But the other thing is thatpeople don't know how to use gun
locks.
Deb Tauber (14:07):
And so we've been able to show them that in this
environment it's been reallypowerful, and I'm sure that's
not something that somebodywants to say oh, I don't know
how to lock up a gun, that'sexactly right.
Anne Bailey (14:12):
Oh sure, I'll take it.
I'm sure I can figure this out,but that's right.
Deb Tauber (14:16):
And how many veterans have been through this
training at this point.
Anne Bailey (14:20):
Yep.
So this training is for ourstaff.
We've been doing field testing,so we've been to seven medical
centers until yesterday and wedeployed it with 20 staff across
10 different medical centersand over the next three months
each of those will have about100 staff at their feedback on
the actual experience.
Is it realistic?
Does the voice bother you?
(14:41):
You know things like that thatwould impact people's acceptance
of it or receptivity to it.
And the other thing is we'llget pre and post information.
How did, what did you knowabout guns before?
What did you know after Similarquestions, what we would ask if
they were doing it in a 2Dtraining environment?
Because we do, as healthcaresystems have computer-based
(15:04):
training, but you can imaginehow people just kind of click
through those things and youdon't necessarily even know what
they say, and so we'll asksimilar questions to see if we
can get some data on how muchmore effective the training is.
Jerrod Jeffries (15:16):
So I have a question when it comes back to
when you get feedback, so say,and by all means it's 90 plus
percent, kind of this NPS scoreor likability and kind of
efficacy it seems but say forthis you want to change
something the voice orsomething's not scientifically
(15:39):
correct or there's somethingthat's maybe not completely
kosher.
What's the process of changingsomething within the module or
the training, and how long doesthat take?
Anne Bailey (15:51):
That's a good question.
So one of the things that'simportant to know is that there
are multiple different types ofagreements we have with some of
these companies.
There's one which is you buythe thing off the shelf and
nothing changes about it.
You just put it out there intothe wild and use it with
patients.
That is our least favorite, tobe honest, because the
technology is still young enoughand early enough and our
(16:13):
patients are still learning, andstaff that we want to be able
to say this worked and thisdidn't.
And so the second is wepurchased with terms in the
contract that talk about addingnew content or editing or
adjusting or updating thecontent.
Caitlin's worked on a reallybig project with that over the
last two years now for chronicpain and suicide prevention,
(16:34):
where we both got off the shelfcontent and developed content.
Caitlin, you can talk aboutthat as well.
Then the other two are one, thefirearm safe handling, which
we've done this type of approachwith two others as well.
Prevention of sexual harassmentand an inpatient discharge
experience, where we areactually writing scripts from a
blank slate and funding thedevelopment from nothing into
(16:57):
the actual experience, and to dothat.
It is part of the contractingprocess to repeatedly go to
medical centers, get feedbackand iterate on it.
That's part of how the contractis written, and so we've
developed it over eachexperience, from blank slate to
completion and ready to deploy.
It takes about a year, but itincludes somewhere between
(17:18):
generally about five to 10visits to different medical
centers to test it and try it,get feedback, iterate and test
it again, and then the final oneis the one that we use the most
, and that's a cooperativeresearch and development
agreement.
Over the last seven years wehave never been a consistently
funded program.
We take money from wherever wecan get it from, and so have
(17:38):
also relied heavily on thewonderful immersive community
that's out there that is veryagreeable to collaboration and
co-design and co-development.
And so through a cooperativeresearch and development
agreement, we're oftenco-designing, co-developing,
prototyping, taking somethingand giving feedback on it.
Under the terms of that type ofagreement, where it's just
(17:58):
mutual provisions of resources,you get to test it in an actual
clinical, real-world environment.
You get real veteran feedbackor staff, depending on what your
experience is and then they getthe benefit to test something
in that real-world environment.
It's that mutual exchange ofresources.
But, caitlin, I'd love for youto talk more about your
experience with some of this.
Caitlin Rollins (18:18):
Yeah, I wanted to add to that conversation too
about, especially with ourcooperative research and
development agreements, thosecollaborations, because they're
so important.
They keep our clinicians andthe veterans at the center of
what is being used in the VA,because in industry of course
you can create these amazingthings, these amazing products,
(18:38):
amazing technology.
But it doesn't mean that, evenif you've got great research
studies showing that it'svaluable, it doesn't mean it's
going to be easy to integrateinto actual clinical care.
You know you really need thatreal world experience.
How does this product work in areal world setting?
What are the issues with theprocess of integrating it into
(18:59):
care?
And so I think thosecollaborations are so incredibly
important because they bringtogether healthcare and industry
so that you can work togetherto build the best solution for
healthcare that meetseverybody's needs.
And so it's incrediblyimportant collaborative process.
And I think for that particularproject that Anne mentioned that
(19:19):
is intended for chronic painand suicide prevention, it
brought together kind of both ofthose worlds where you've got
like the procurement of off theshelf product.
But you're also doing the workof a CRADA in many ways, because
you're building new content indirect collaboration and with
feedback from both veterans andclinicians that are actually
(19:39):
going to be using it in some wayend users of that particular
product.
So that project took basiccontent that included things
like 360 videos andmindfulness-based content, deep
breathing exercises, sequentialmuscle relaxation type content
and then added to it some veryspecific customized environments
(19:59):
that were built with our actuallike clinicians providing
feedback on what the scriptingwas, what the details of the
imagery look like.
Every bit of those environmentsdeveloped with actual
clinicians to build newrelaxation environments, new
kind of complementary andintegrative health type
environments, as well as somenovel in vivo exposure
(20:22):
environments, which I think areincredibly important and
increasing access to a difficultto provide therapy.
Deb Tauber (20:29):
And how do you manage your resistant learners?
Caitlin Rollins (20:33):
I think it's all about kind of support too.
We have our early adopters, thepeople that are excited from the
very beginning about thistechnology, and they don't
require a lot of coercion topick up the devices to use them
in whatever way they areintended, whether it's employee
or veteran or caregiver facing.
But I think some of thehesitation usually lies in
(20:55):
clinicians and other employeesfeeling like they don't have the
bandwidth to learn somethingnew.
So whenever you're trying tointegrate something new into
healthcare, whether it'simmersive technology or
otherwise, you really need tomake sure they feel supported.
Make sure you think about andask them for their opinion on
what resources they need to makeit easier for them to use.
(21:16):
And I think that's where the VAImmersive and the VHA XR
network have been so incrediblyimportant in allowing this
technology to scale is becauseit provides that support system.
They have 2,000 plus employeesacross the country that can help
answer their questions.
They have our team that helpdevelop national resources to
(21:38):
make it easier for them to adoptthe technology in whatever way
they'd like to.
So I think that's a big pieceof it and, anne, maybe you have
something else to add to thattoo.
Anne Bailey (21:48):
I think one of the things that's really interesting
and Caitlin touched on this alittle bit is how you introduce
people to the technology.
That's why we talk a lot aboutheads and headsets, why we talk
a lot about headsets andheadsets and the fact that there
are people it actually is veryuncommon for us to encounter
people who don't want to try it,and those who don't want to try
(22:09):
it often are won over by seeingit screencasted so they can see
what other people see, or byseeing people experience it.
I had it happen yesterday.
We had talked through a fewdifferent experiences outside of
the firearms and I was talkingwith the group the 20 or so
people who were there andtelling them some of the other
things that VA Immersive isdoing with immersive technology
(22:31):
and wanted them to experiencethings other than the one
experience they were gonna bereally focused on over the next
several months.
And we had some quick peoplewho jumped up quickly and wanted
to try it, people who arehesitant and then but then saw
their, their colleagues, try itand enjoy the experience and
then they tried it.
And so I think so much is howyou introduce it, how you talk
(22:54):
about it and even things that Ithink about, like when we talk
about contraindications andprecautions, potential side
effects of cyber sickness from apharmacist provider perspective
, those lists are allsignificantly shorter than
almost any medication that wewould recommend for so many
different indications, and oncea patient takes a medication, I
(23:15):
can't take that back right.
We have to go through thecourse of whatever happens next
and hope that it's great.
But with this technology, ifpeople were to experience cyber
sickness, you'd take it allright.
I mean, the risk is so low andhelping people see that as well
as the value, I think it reallymade a big difference for how
it's grown across VA.
Deb Tauber (23:36):
Now have you guys used it for narcotic reductions.
Caitlin Rollins (23:40):
That was definitely one of the side
effects, I suppose, of even thatoriginal project that I did in
the Asheville VA, the very firstproject focusing on
post-operative knee pain andanxiety associated with surgery.
And of course then it spread toother orthopedic surgeries and
then all surgeries and then ofcourse to other inpatient units
(24:01):
and to all over the hospital.
But it started with justpost-operative knee pain and
that initial project ended upbecoming one of the
interventions that the facilitywas implementing as part of an
overall enhanced recovery aftersurgery protocol, and that
protocol was focused onincreasing the amount of
non-pharmacologicalinterventions and non-opioid
(24:23):
pain medications, kind of acrossthe board for all surgeries.
So as part of that program,that initial virtual reality
piloting helped to decreaseopioid use in those total knee
arthroplasty patients by over70% in less than three months,
which was an incredible decreasein opioid use.
(24:43):
And then, as it started rollingout to other surgeries, we
started seeing decreases inopioid use across all of the
different surgery types and evenat this point, even years later
, seven years later, there'sstill a sustained decrease in
opioid use by over 30% acrossall of the surgeries at that
facility, which is incredible.
(25:05):
Now, that being said, for someof our national pilots, like our
at-home chronic pain managementpilot that we've been doing.
We're not necessarily trackingmedication use associated with
that, but the overall goal of aprogram like that is to provide
a tool to those patients thatthey can use in their homes
independently to help betterself-manage their chronic pain.
(25:27):
So if it's a patient that hashistorically been relying on
opioids to help manage thatchronic pain, we're trying to
provide additional tools thatwill allow them to use something
other than opioids in thosescenarios.
Because even as a nurse, and Iand you've probably heard this
as a pharmacist many of ourpatients that take opioids don't
(25:48):
want to, but they feel likethey're out of options and it's
the one thing that can bringthem some level of relief.
So if we can provide somethingand immersive technology has the
potential to allow them to notfeel their pain for the first
time in 10 years because theyare distracted and learning
skills that allow them to bettermanage their pain, and that's
(26:09):
huge.
Deb Tauber (26:11):
Caitlin, what are they seeing in this video when
they're in this experience?
What is actually showing up inthe virtual reality headset?
It looks like she's frozen,yeah.
Anne Bailey (26:23):
I can tell you a little bit the products that
we're using.
Caitlin Rollins (26:26):
Oh, there she is you were frozen for a second
Caitlin.
Yeah, of course.
So it definitely varies byproduct and by use case, but
even in a single use case it canvary.
So for pain management, forexample, if it's for, Do you
want me to fill in the gap, or?
Anne Bailey (26:43):
wait till she's there?
Jerrod Jeffries (26:44):
No, that'd be great.
Anne Bailey (26:45):
Yeah, so it depends on the indication.
For example, if you think aboutpain, which I think is what she
was getting into acute pain isreally about positive
distraction.
So then the question is, doesthe patient need something
that's interactive for positivedistraction or relaxing for
positive distraction, and sothat helps guide the selection
For chronic pain?
A lot of times it's skilldevelopment and learning
(27:07):
experiences.
So mindful practice, cognitive,behavioral therapy, pain,
neuroscience, education, thingslike that, where you're creating
experiences and going throughexperiences, for example, a
breathing, you breathe andsomething grows right or
something moves.
So there's some interactionwith your actual, with some
biofeedback, but also with theexperiences.
(27:29):
Caitlin, you froze again, butif you want to add to that, go
for it.
Jerrod Jeffries (27:33):
Well, and I want to come back to one other
question that I think Caitlinwas touching upon, but you both
addressed the question, and thathas to do with the cooperation
or working together with youguys' program.
Could you let our listenersknow how best to get together in
terms of cooperation for youtwo?
Are you the program you'reworking on?
Anne Bailey (27:53):
Absolutely so.
If it's just about learningmore about what we're up to,
innovationvagov is a websitethat has an immersive specific
page on it, and there's lots ofour stories and links and
resources there.
If you want to reach out to us,vaimmersivevagov is our email
address and that goes to ourentire team, so we'd love to
(28:14):
hear from people Do you have amost like an exciting success
story that you could share withus recently.
Jerrod Jeffries (28:23):
Oh man, that's, that's a hard to pick one,
right.
Oh, that's a good problem tohave and that is a good problem
I will tell you.
Anne Bailey (28:29):
Oh man, I even yesterday, and Jeff, I was
telling you a little bit aboutthis.
We used to, you know, seeingthis change over time.
We used to do presentations andget a lot of questions at the
end A lot of technical questions, definition questions, how to,
what, if all these questions.
Yesterday I did a usualpresentation, got a couple of
questions and then everybodyeverybody else that raised their
(28:50):
hand wanted to tell a story ofhow they'd talked to a veteran
at their medical center abouthow the technology was helping
them.
One woman said, yeah, I just goover into the inpatient unit
and talk to the veterans thathave used VR and hear how it's
changed their lives.
And you, like I know it soundslike I'm making this up, but I
promise you that I am not.
We now publish these storiesbecause they're exceptional.
(29:12):
One of my favorites was a storyfrom Denver, va, where they had
a patient who was homebound, whoreally needed to come to the
medical center for his care, andhe just was socially isolated
chronic pain, debilitating PTSD,the whole thing, very complex
comorbid conditions and theythought, well, we might as well
send him a headset right Like,let's try this.
(29:33):
They are a phenomenal pain teamthat has a lot of different
tools and things that they usewith patients, so they send a
headset.
Not only does this patient nowcome in for his care, he has
also signed up to be a peerspecialist, which means he is
being trained to one on one orin group settings, help other
veterans who are isolated orhomicidal, suicidal mental
(29:54):
health challenges I mean areally complex job description.
And because of this change nowhe's signed up to and that, to
me, is ideal, right, like notonly did it help him, but it
brought him to a place tomultiply who he was and help
other people I think it wasreally powerful.
There's a million other storiesabout patients that are, as
(30:17):
they're actively passing away,asking for VR so that they can
go to their home because they'dexperienced it at different
times through the hospice carejourney.
I mean, there's just so many.
Caitlin, I know you have amillion too, so I don't know if
you can come up with one or twoquickly.
Caitlin Rollins (30:32):
I think some of them.
You know one I already tried todescribe earlier, where it's a
patient with chronic pain.
As you probably know, veteransexperience chronic pain at a
higher rate and a higherseverity level than any other
population, and so some of thesepatients literally have had no
reprieve from their pain fordecades, which is incredibly
(30:55):
awful, you know, and we need todo more about it.
But whenever I have a patientthat you can put a VR headset on
and their face just lights upall of a sudden because and you
can just see them visiblyrelaxing you know patients that
have been tense for decades allof a sudden just visibly
relaxing and they'll tell you Idon't feel my back anymore, I
(31:15):
don't feel my leg anymore.
This is the first time I've hadrelief from this pain in 20
years.
You know that is huge, likethat sort of story, and we see
it over and over again.
So it's not even just a singleveteran story, it's really just
multiple that you hear that fromon a regular basis.
Anne's heard me tell this storyevery time we chat about veteran
(31:36):
stories and Anne happened to bethere and it was one of the
first patients that we ever usedvirtual reality with.
That actually has a cognitiveimpairment.
So a lot of people would assumethat if you have dementia,
alzheimer's, that you can'treally use the technology.
Well, that's absolutely nottrue and it can be incredibly
helpful for those patients tohelp decrease restlessness,
agitation, to make them feelcalmer, to take them back to a
(31:58):
time maybe that they rememberbetter.
But this was a patient who had alot of behavioral health issues
, was having to consistently besent from our community living
center, which is like along-term care facility, to an
inpatient psychiatric wardbecause of those mental health
issues.
And we put her in a virtualreality headset for the first
(32:19):
time and this female veteranwho's wheelchair bound, like all
of a sudden her face went fromher typical like kind of
aggravated, like angry personato somebody who was like
laughing and smiling and shejust changed into a completely,
completely different person infront of our eyes.
And so for a patient like that,who may often have to get
(32:39):
antipsychotics or anxiolyticsthings to help with anxiety or
those kinds of psychoticepisodes that she's having, if
you can put her in a headset andturn her into this happy person
who's spinning circles in herwheelchair, that's amazing.
Deb Tauber (32:53):
Wow, anything that you guys want to add for our
listeners.
Any final closing thoughts?
Anne Bailey (33:00):
I would say lean in .
You know, we've seen thischange exponentially over the
last seven years and certainlyfeel like we are have not even
reached the peak yet ofpotential, and our ultimate goal
is just to normalize it.
Right, we don't want this to bethe flavor of the week or the
(33:21):
trend of the whatever we believe, and we are moving forward in
such, and this is both inpatient care and staff training
and education, as well asemployee well-being.
Right, it's not just abouttraining and educating our staff
, but it's also helping themtake a break and deescalate some
of the situations they findthemselves on a day-to-day basis
.
But our goal is for this to bea new modality that is very
(33:44):
normal in healthcare and we lookforward to seeing that continue
to grow and change over thenext several years.
Caitlin Rollins (33:49):
And I think I would probably va.
gov just say hear, hear to that.
Deb Tauber (33:54):
Yeah, this is some great work you guys are doing.
You need to keep it up and youneed to spread the word, and
hopefully our listeners will be.
If they have questions for youguys, is there a way they can
get to you?
Anne Bailey (34:06):
yeah, that va immersive a is the best place to
reach out there.
We're also pretty easy to findon linkedin, if that's a better
place for listeners also.
Um, deb and j, thank you somuch for allowing us to join you
and have this conversation.
Things like this and peoplelike you are really the front
end of all of this and making ithappen, because if you guys
(34:27):
don't help us tell the story,then it never gets told.
So, thank you, we definitelycould not do this without you
guys.
Jerrod Jeffries (34:33):
Thank you and Caitlin, I'm impressed with this
scrappiness, this hustle thatyou guys have and you and you
just keep calling and keepgetting different types of
funding.
You keep cooperating.
It's, you know, throwing itright back at you.
It's people like you that kindof cooperate and collaborate and
and help you, help so manypeople.
So it's it's coming fromdifferent angles and putting
these different types ofdisciplines together to to
(34:55):
create change and somethingbetter for all veterans.
And then it only starts there.
It just keeps pushing forward.
we will conclude, and thank youso much for being guests.
We really appreciate it.
Anne Bailey (35:16):
Thank you.
DIsclaimer/ Innvovative (35:16):
Thanks to Innovative Sim Solutions for
sponsoring this week's podcast.
Thank you so much for beingguests.
We really appreciate it.
Thank you Thanks to InnovativeSim Solutions for sponsoring
this week's podcast.
Innovative Sim Solutions willmake your plans for your next
Sim Center a reality.
Contact Deb Tauber and her teamtoday.
(35:38):
Thanks for joining us here atthe Sim Cafe.
We hope you enjoyed Visit us atwww.
innovativesimsolutions.
com and be sure to hit that likeand subscribe button so you
never miss an episode.
Innovative Sim Solutions isyour one-stop shop for your
(35:59):
simulation needs, a turnkeysolution.
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