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January 26: Today on TownHall Jake Lancaster, Chief Medical Information Officer at Baptist Memorial Health Care talks with Mark Zhang, Associate CMIO at Brigham and Women's Hospital and Medical Director at Brigham Digital Innovation Hub about the emerging technology extended reality. In this episode they discuss how Mark came to found the American Medical Extended Reality Association (AMXRA). How will its existence along with similar organizations be important to the future of the technology? How are healthcare organizations using extended reality technologies and what is next for it? What process did Mark use to research the XR space to create an XR club within his organization?

You can listen to Mark’s previous episode on TownHall here:

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Today on This Week Health.

I think that XR is going to be almost inevitable not just for healthcare, but just in. and it's just a matter of time right? when you buy into that, it's not that much of a leap to realize that it's gonna fundamentally change how medicine be practiced

Welcome to this week, health Community Town Hall is our show hosted by leaders on the front lines with interviews of people making things happen in healthcare with technology. My name is Bill Russell. I'm creator of this Week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years now, we've been making podcasts that amplify great thinking to propel Healthcare forward. We wanna thank our show partners for investing in our mission to develop the next generation of health leaders now onto today's.

Hey everybody. I'm Jake Lancaster. I am the Chief Medical Information Officer for Baptist Memorial Healthcare based outta Memphis, Tennessee.

And today we're excited to have back on Dr. Mark Zang.

Mark, welcome to the program. Thanks, Jake. It's as usual. It's always , a privilege and a pleasure.

Well, just to refresh the audience's memory, tell us just a little bit about yourself and your background.

Of course, of course. So I'm , a palliative care physician at Dana-Farber, Brigham and Women's, and also a clinical information.

I'm the A C M I O for digital innovation at Brigham and Women's, where I run a team called the Digital Innovation Hub at Brigham.

Great to have you back, and today I'm excited to talk to you about a new concept for me, extended reality in healthcare. What is it and how are you involved?

Yeah, yeah.

So, maybe let's, do the definitions. We'll start there because I think it is a fairly. It's not that new, but at least for me over the last year, I've learned a lot and I'm still learning every day. But extended reality is really this umbrella term for a lot of

technologies that are, what I would say emerging within the medical. Field including virtual reality. So those, are kind of the headsets like Oculus and others have created where when you put them on, you are taken to kind of a, new world, right? Like it's a totally digital world.

A new experience, not kind of connected with our current, like, where you are or what. . The other kind of technologies within the xr, which is kind of the abbreviation for extended reality umbrella are things like augmented reality where instead of being fully included or occluded and you're in this new virtual.

Augmented reality is really about adding kind of, a digital layer onto your real world, right? So like, think about a heads up display or having kind of that type of experience. Overlaid Pokemon Go, for instance, A Pokemon Go or, yeah, yeah. Well, that could be, yes. Pokemon Go. I think. I've never played it, but I imagine, I think I understand.

Or HoloLens, that's, a type of augmented reality, something like that. And then there's a concept called mixed reality. And it's actually interesting because there are a lot of ways. To kind of, and, and there's a lot of interest I think in this space of mixed reality, which is where you kind of have those digital assets within your real world.

But they understand and know their context into the world. So, for example, if you have a. A Mixed reality experience, regardless of the, technology you're using. You could have like an avatar or some kind of digital asset on a table and it would understand that there's like a hard surface that it's interacting with.

So the asset, the digital asset is actually interacting. in context of the table, or if you were to kind of put your hand in front of the digital asset it would include so you wouldn't be able to see it anymore. So it's actually a an item that is in context within the real world.

So that's kind of the concept of mixed reality. And then you have kind of the underlying technologies and concepts that support like these modalities. And that's where the concepts of like the Metaverse or things like that live XR is, am I. Perspective , is kind of that umbrella that kind of encompasses all of these technologies , and frankly, future technologies that will maybe we just don't know about yet.

Right? Like I, think like the haptics to make the immersion or this type of work even more immerse, right? Like the, these are, other things that xr it falls under that umbrella.

No, thank you. That was really helpful to divine those terms. Yeah, it's still a new concept.

You know, I think all of us have heard of, meta at this point and, Oculus. But how are organizations using these technologies in healthcare?

Yeah, it's a really, really good question. And actually it was the question that really started this effort. So I'll tell you a little bit of kind of how I got into it.

And I'm, again, I'm gonna preface all this by saying I am not an expert in this field. I'm a learner. But I'm learning more and I'm getting,

you're coming on a podcast. You're an expert. I'm an expert, whatever you talk about while you're on podcasts.

That's fair, that's fair. you know, We've been kind of on this journey for the last, I would say, a little bit over a year or so.

And really, my team at the, I hub our task at Brigman Women's, as we talked about during our last podcast. Is really support kind of emerging technologies and understand how they fit within our, academic environment, medical environment.

And, during Covid we were like many groups very much in a hybrid. I'm still, as you can see, I'm still in kind of a hybrid situation. And myself personally but others on the team, we were using kind of VR headsets for recreation or to work out or do other things.

ns of dollars potentially by,:

Like what's the current state of medical xr? . And as we were thinking about this, we also started thinking about, well, really we don't know. We're the innovation group at the Brigham. And we don't know, we're not a subject matter expert here, and there are a ton of new emerging technologies where we just have like very little subject matter expertise centrally within our group.

So how do we actually like. build this subject matter expertise in like a reproducible way. So what we actually came up with is kind of a variation on the medical education axiom of C one, do one, teach one. Where we're breaking it into like these phases. We have a C phase, we have a do, and then a teach phase, right?

As we, kind of grow our subject matter expertise. Both. Our internal use, but also as essentially a service and an offering for the larger institution to be an expert, like be the group that has a understanding of some of these technologies. And the C phase is a , pretty simple one.

It's just understanding the diligence. I think what's unique to how we're approaching. . Our C phase is we started with both looking externally, so understanding just the current state of MXR, just as an industry as a whole, what other institutions are doing, what solutions are out there, what's just kind of the state of the reality of Mxr.

But then importantly, we also looked inwards. So we looked at mgb at Mass General Brigham to understand what. Are people doing this already? it, is there already like a really robust kind of group or groups that are really supporting this work? And we started this, as I said, late last year and we're still kind of learning about new technologies, new companies, and also frankly, new researchers and new groups at M Mgb that are working.

But what we found internally was pretty surprising. We found over a hundred. Individuals at National Brigham that were either actively working or supporting XR efforts. Over 20 research projects. Many with NIH funding. , or funding in the space. And it was spread out across multiple institutions at Mass General Brigham, and also we found two kind of what we call anchor organizations at mgb already doing great work supporting this buring community.

So one at Mass General Hospital, the ar vr lab, which was based in radiology and another. At Brigham and Women's which is the Strattice Lab, which is our simulation center at Brigham. And they were doing incredible work. And we find like more and more kind of use cases and technologies like groups already using these technologies every day.

nd. It is priorities for:

The one thing we also saw is that there wasn't a central. Organizing community for this. Everyone was doing great work. Many in a vacuum, many siloed. So one of the efforts that we kind of transitioned to as we made our recommendations to move to the due phase was let's create more of a community internally at Mass General Brigham for all these folks.

doing Mxr, and we're kind of actualizing that in a couple of ways. The first is we've created a digital community using Microsoft teams where we try and collate and engage with all the folks we find out about. So they have one central place to communicate. Mm-hmm. . We're also creating a monthly newsletter, kind of highlighting some of the creators and, researchers, but also, using that as a central kind of asynchronous communi.

Platform. the third, which is very exciting, is we've actually started doing what we call XR Club, which is a monthly in-person and virtual meetup where we iHub our team, we host, we cater the, event. And we'll typically have a researcher to m g. Present their work, but also have a forum for others to try out the new technologies and also collaborate and learn more from the community.

We're actually having our fourth one today. This afternoon. Yeah. Yeah, yeah. Yeah. We're truly committed. And in December, we're actually gonna do our first virtual reality XR Club. Some of it for practical reasons, I think December's a hard month to get people in person.

But second, I think it's a kind of cool opportunity to try out, really practice what we preach and, do it in vr. Yeah,

I was about to say, it's, kind of ironic that you'll have in-person virtual reality club meetings. It really should all be virtual.

Well, so actually when we really first started, one of the first things we.

I have a very small team at the iHub and we all got quest headsets. Mm-hmm. , Oculus Quest headset. MedQuest, I guess is their new name. More official name. And we did a lot of our meetings when we were all pretty remote in vr and it was a pretty, pretty interesting experience. So we're hoping to kind of do this at a larger scale with these XR clubs.

So this is a long way. So then the last part is the teach, which is really. Trying to better contribute to the field of M X R through academic venues, whether it's posters or papers, perspectives, or frankly even just being in these doing a podcast or presenting about kind of some of this work.

During this whole thing, , so there's the mgb, the work we're doing at mgb, we, and we're doing this under the umbrella of what we, we call next up. So that's our emerging technologies kind of program. And for this effort, it's next up extended reality where we're kind of using all this.

But, hopefully in the future there'll be other next steps as we look at other emerging technologies, and we'll use this c do teach framework to do the work. As we were looking in the RC phase, externally, we found some kind of parallels to what we saw at mgb. There are incredible groups and individuals and systems already very much doing work in the XR space.

Brennan Spiegel and Omer. Over at Cedar Sinai are doing quite a bit of work and have done quite a bit of work using virtual reality for pain. And they even have a really interesting kind of consult service using vr out at Cedars. They've been doing it for some time now.

There are other groups like the International Virtual Reality Healthcare Association. That are really helping to kind of create community within VR and also researchers at the nih and other groups like Ossner that are really working in this space. Hopkins has some great work and University of Maryland actually just got a pretty incredible grant to create like an xr.

Institute looking at this type of work

yeah, I mean, it is becoming more prominent. Even us we've had a proposal recently with our oncology group to use it for, for that, you know, pain and infusions virtual reality goggles during those. So it's, it's certainly

it's happening emerging, right?

It's, it's emerging. It's emerging. So you. Where we found, just like what we found at mgb, we're seeing these like many flowers bloom. But there wasn't really a truly comprehensive kind of community for this work. There were some burgeoning communities, I would say, but importantly for the field of mxr, what I saw.

Doing this was that there wasn't actually a medical society dedicated to mxr and I'm always been a fan of committing and just doing the thing. So I created it, I created the American Medical Extended Reality Association, and when I say I created it, I don't mean it's a single-handed thing.

It's, this is now , work that's being done by many different hands. And our goal is really to create. A medical society for the 21st century that we think is gonna play a major role in kind of care delivery moving forward. We're , seven weeks old, so we just turned seven weeks.

Officially it's a nonprofit moving towards 5 0 1 . And we have 58 members across the nation, and actually a couple international members as well. Now we're still kind of growing primarily by word of mouth, but hopefully these kind of efforts like going on your podcast , and other events will help kind of get the message out.

Where an interdisciplinary group, it's called the American Medical Extended Reality Association, or AM M X R A. And the mission of A M X R A is to really advance the science and practice of medical extended reality through advancing care, delivery, scientific investigation, innovation, education, advocacy and community.

So that's really what we're trying to do. And as I said, we're seven weeks old, so we're really like creating it as we go. And it's, been really exciting to, see this work kind of continue to, to move forward. The last thing I'll say with AM M X R A is that just like amia, in fact, as we created a M X R A I looked towards our medical society as informaticians as really a template or an example of.

A field that isn't defined by a professional group And by definition has to be interprofessional. How do you do that in a, meaningful way. And one thing with a M X R A is we are truly an innerprofessional group. So our membership spans physicians of all types. So internists gastroenterologists, neurosurgeons psychiatrists and others. But also nurses and researchers and clinicians mental health experts, psychologists we have also developers and entrepreneurs who are working in the industry side.

So really I think the, goal and the mission is really to kind of move forward. Medical xr. As a field as a whole, and we're doing this as the professional society for this field.

Well, that's great. Thank you so much, mark. I know I've learned a lot. So tell me just to close out, what is next for XR?

Is M G B gonna build a hospital to care for all the metaverse patients and their illnesses?

Yeah. You know, I think what's next for xr? I'm very excited in this space. I think there's a lot, of potential and really I think the work moving forward is, , and also there have been a lot of examples of actualizing that potential individually.

And as we kind of move. What I am hoping for with both the efforts that we're doing at mgb and also the efforts with A M X R A are to try and create some of those foundational pieces to help standardize and propagate some of the best options and best use cases and really kind of kickstart the field even more.

So that's my hope. My vision, I really, wish and, want to see this, type of reality to ha happen is that, I, I think that XR is going to be almost inevitable not just for healthcare, but just in. and it's just a matter of time right? when you buy into that, it's not that much of a leap to realize that it's gonna fundamentally change how medicine be practiced and.

If that's a case, we need groups like A M X R A to help guide and and shepherd this, work, but also make sure that it's safe and based on, the best evidence available , and frankly set some guidelines , for this effort. This is gonna be in collaboration with many others that are working in this space.

But my hope is that AM M X R A plays a nice.

Thanks and, and thanks again for everybody for listening. Please join us again next time.

Thank you.

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