#572: Bioflight VR for Medical Training, Patient Behavior Modification, & Diagnosis

The design team behind Bioflight VR has worked on television shows such as CSI and ER, and they’ve been able to translate their VFX visualization skills into a virtual reality medical education venture. Their original plans were to use virtual reality to help doctors utilize the volumetric information captured in MRIs, CAT scans, and ultrasounds to improve upon medical diagnosis from 2D slices of data, but they started to gain more traction with creating a couple of different types of educational experiences. They started creating time-lapse experiences showing the long-term impacts of sodium consumption and smoking in videos meant for doctors to show patients to inspire behavior modification, and they also created a number of interactive medical training scenarios that would allow medical students to experience intense emergency room scenarios that would allow them to be evaluated based upon their competency and performance.

I had a chance to catch up with co-founder and chief creative officer Rik Shorten at the Silicon Valley Virtual Reality conference both in May 2016 as well as a follow-up and update in March of 2017. This interview tracks the evolution of Bioflight VR starting with ambitions to use VR for medical diagnosis, and then their pivot focusing more on medical training and patient behavioral modification and education the following year. There are a lot of opportunities for virtual reality to become a huge part of telemedicine and providing a platform to visualize data that you collect about your body, but virtual reality seems to be making it’s first strides into the medical field through patient and student education before the more advanced and higher-end applications of medical diagnosis and distributed telemedicine are adopted.


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Rough Transcript

[00:00:05.452] Kent Bye: The Voices of VR Podcast. Hello, my name is Kent Bye, and welcome to The Voices of VR Podcast. So on today's episode, I'm going to feature a couple of interviews that I did with Rick Shorten of BioFlight VR about a year apart, starting back in May of 2016, and then a year later in March of 2017, both at the Silicon Valley Virtuality Conference. So my first interview with BioFlight VR, they were really focused on trying to use VR for medical diagnostics. So be able to take CAT scans, MRIs and ultrasounds and take what would usually be shown in 2D and then be able to display that into a volumetric 3D within virtual reality for the doctors to be able to make a diagnosis. And then a year later, they did a little bit of a pivot to focus more on the medical education aspect. So to be able to look at the impacts of eating sodium and what would that look like to your heart over many years of continuing the same behavior. So medical education to be able to show to patients, but also medical training to be able to create these super intense medical training situations that give doctors a lived experience of actually going through these different scenarios rather than reading about them in a book. So that's what we're going to be covering on today's episode of the Voices of VR podcast. And so we're going to start with the interview I did with Rick back in May of 2016 at the Silicon Valley Virtual Reality Conference, and then I'll follow it up with the interview I did with him a year later in March of 2017. So with that, let's go ahead and dive right in.

[00:01:38.390] Rik Shorten: So my name is Rick Shorten. I'm the CEO and CCO of BioFlight VR. We're specifically focused on a medtech VR application for diagnostics, education, and training in the VR space. So we're working with a doctor group and a radiologist group, and we asked them what their pain points were in diagnosis. So what's the weaknesses of the existing tool sets that they've been using to diagnose MR, CT, ultrasound, any scanning modality that is patient-specific. So what are the problems you guys have? What are the things you would like improved? And what can we build in VR for you? So that's where we started. And we've gone through now three iterations of our alpha to figure out what this platform needs to be so that surgeons can use it together with radiologists. It can offer remote diagnostic opportunities. So if you imagine somebody messes up their knee snowboarding and they go to the doctor and they're complaining about pain. The doctor will probably order a CT or an MRI of that patient's knee and then they'll look at it in black and white slides or flat 2D screens. If you've ever seen MRI images, most people don't know what they're looking at. Doctors do, but patients don't. So we feel there's a better way inside of BioFlight to be able to identify pathology and damage and abnormalities because nothing can hide in VR. It's stereoscopic, it's 3D, with full layering capabilities so the doctors can swipe away parts of the image they don't want, looking for that damage. And then the flip side of that is once they've diagnosed a patient, they can turn around and show the patient in 3D what they found and why. And I think that'll go a long way to patient education and learning. this is my body, this is what's happening, and this is why the doctor's prescribing a particular treatment.

[00:03:23.473] Kent Bye: And so, what have been some of the early reactions to doctors who, in some sense, they've trained themselves to do this translation from 3D into TD, but I'd imagine it'd be a lot more intuitive for them to make decisions and judgments faster, perhaps.

[00:03:38.309] Rik Shorten: And we found that, and I think that BioFlight's mandate is to run concurrent with existing systems. We're not talking about replacing existing systems. I think for 90% of the time, a radiologist is an expert, a surgeon has seen these images and they trust them. But there's an area of diagnosis that I think is sort of ignored in the sense that anything that goes beyond the norm or anything that's complex, they quickly reach a ceiling for their diagnostic tool sets. And I think that's the area where BioFlight wants to be. is a chance for higher fidelity, more intuitive control over the data, and a way for them to uncover pathology and then share that in a real-time environment in stereoscopic space where there's nothing that can't be viewed. And if you're talking about expertise and diagnosis, that's not always represented in the town that you live in. So if you think about a platform like BioFlight that's cloud-based, expertise in Boston can inform a diagnosis in Poughkeepsie. And I think that kind of virtualization of medicine is super important as far as the democratization of it. So where you are shouldn't determine how good the diagnostic expertise is. And I think BioFlight can go a long way to putting a common denominator down for diagnostic expertise and sharing that outside of geography and not making that a function of how good your diagnosis is.

[00:04:56.742] Kent Bye: So maybe you could expand on that specific portion a little bit in terms of the cloud integration and the remote people. What brought that about? And are there going to be people who are specializing in diagnosis? What do you see that going in the future? Because usually that has been very localized to just a local hospital.

[00:05:13.565] Rik Shorten: And that's right. And I think because, you know, at point of care, it's, you know, traditionally medicine is geography based. And a lot of people you hear stories about people having to travel eight hours to get a treatment. So people are used to that. But I think if we're going to innovate through technology, and we're going to use a platform based system, Where you can share, there can be collaborative study in diagnosis because you can share this in an interactive environment. And two people can be talking in real time and walking around a 3D image, annotating, you know, and talking to each other about it. I think the reason why we want to focus on that is because there's plenty of imaging systems in medicine. Some allow you to collaborate back and forth. They're not stereoscopic. They're not VR. But I think what's missing is building out a smart platform. That's not just one machine talking to another machine but something that is Accessible no matter where you are and it's not dependent on you having a million-dollar GE machine sitting beside you or a terminal That you know what? I mean, it's not plugged into a legacy system. It's more democratized than that. So anybody from Google Cardboard up to an Oculus or a Vive could jump into the same session and look at it. So if you're talking about spreading this around the globe, a hardware should not be an access to those expensive systems, should not be a barrier to you being able to access this data. And that's a big part of it. Why we would build it cloud-based and why we would make it smart and why we would want to connect people, I think that's a strength of the platform. And that's an important part of what we're building.

[00:06:38.868] Kent Bye: What has been some of the anecdotal feedback from doctors that have started to see this system?

[00:06:44.541] Rik Shorten: Every time we take a new iteration back to our radiologist group and our surgical group back in Louisiana, they're blown away. So every iteration where we get feedback from them as far as the way that we should represent the different segmentation from the scan data, how we should build out an interface, the kind of tools they want to use, the tools they don't want to use. Because existing systems are one size fits all, and a lot of specialists have specific ways of diagnosing, and if we can find a customized interface or one that is customizable, which is not a thing that happens a lot in medicine. It's sort of a Windows 95, sit down, all the drop-down menus, here's the tools, you have to navigate your way through that to find the tools you want. If we can simplify that and bring that into 2016 versus 1995, then you're going to have a smoother path, a faster path, a more efficient path to diagnosis, and that's part of it too. The user experience is hugely important. for us and how do our end users want to connect with each other inside the platform and what that looks like as far as a collaborative space, but also the tool set that they need. A surgeon only needs five tools where a radiologist needs 20. So their design experiences, their user experiences should be different, but they're not today. So that's part of what we want to do as well is just customize that because that's how it's going to get used. That's how it's going to be effective.

[00:08:00.590] Kent Bye: Now when someone gets a CT scan or an MRI, I'd imagine that at this point the output of those scans gets somehow translated into these 2D slices that then the doctor looks at. Where do you enter into the pipeline in terms of getting access to that data? Are you reconstructing it into a 3D model or are you taking it more of a raw feed and preserving that 3D nature of that data?

[00:08:21.808] Rik Shorten: The current scanning modalities all capture 3D data. The DICOM data comes out as a point cloud, so it comes out as something that 3D can naturally use. And their systems today will give you a 3D image on a flat 2D screen, which is not VR. And that's a big differentiator because people will say, well, we've already got 3D and we never use it because it doesn't help us locate anything we can't see in the slides. But when they put a headset on, it changes very quickly because they realize the virtualization of that and the ability to be inside of it bigger than one-to-one at room scale. I mean, if you're looking at a patella, you know, it's the top part of a knee and it's the same size as your head versus the size of a quarter, it's a very different experience. And if you're trying to get in there and locate pathology or locate a hairline fracture or a torn menisci, that's the kind of scale you need. The systems don't provide that currently.

[00:09:10.696] Kent Bye: And so, yeah, what are some other dimensions of why is it easier to diagnose in VR than on a 2D medium?

[00:09:17.709] Rik Shorten: I think what they've found is that there's an immersive nature to VR and people, you know, we always say it's a show-and-tell technology. When people put the headset on, they realize that they're in a different environment, there's a level of focus, and there's also a level of being inside of something that requires you to focus. Because the minute you're seeing something that's larger than life, and you can go in there and you can see it from all sides, and it's also, you know, it's a discovery medium because In a system like an Oculus, you can lean in and look around and it's tracking your upper body, and suddenly you're making discoveries that are very natural. You look up, which is a natural thing to do when you're looking for things, whereas if you're on a 2D screen, you've got to navigate that with a mouse and a scroll bar. So getting into the places that you can inside of a VR environment, is very different than trying to navigate that on a flat 2D screen. So we're finding all of this discovery is happening naturally because it's a medium that people get familiar with very quickly and they're very comfortable and they find things inside of VR that often get missed when they're just going through black and white 2D slides.

[00:10:21.989] Kent Bye: Now, it sounds like it's a pretty clear qualitative improvement, but how do you start to translate that into numbers in terms of proving a case to sell a product that it's such and such more effective than diagnosing? How do you speak to that, or how do you translate that into data that you can give to these potential customers to tell the story of your company?

[00:10:43.353] Rik Shorten: And that's going to be part of what comes out of our beta and testing group. There needs to be the AB, the old AB, you know, here's how we've diagnosed traditionally, here's how we diagnose in VR, what got missed in the first traditional way, what's been found the non-traditional way. A quick anecdotal story about that is one of our doctors who's 30 years as a surgeon, the radiologist and him looked at the MR and they thought they had a a patient that required a partial knee, for instance. And so they scheduled surgery, he came in, they put him in under general anesthesia, they went in to do a scope just to verify, and they realized that he had pathology on the other side of his knee that they missed. Which meant that if they had done the surgery then, he would have been back a year from now complaining about pain in the lateral compartment, which would have required them to take out the partial knee and then redo the entire knee as a full knee replacement, for example. So they had to shut down surgery and send the guy home for six weeks and wait for him to come back and do it all over again. So, you know, that's a $30,000 to $40,000 burn rate for not getting the surgery done. So if you think about a system like BioFlight, if we could have shown them something that they wouldn't have missed otherwise, just think about the X factor there. Even if that's 1% of surgeries that don't get misdiagnosed, If you're talking about medicine in this country today, that's millions and millions and millions of dollars that doesn't get burned on a misdiagnosis. So we think even at that 1-5% level, that's moving the needle a lot when it comes to optimizing doctor performance and making sure that the patient outcomes are better because they're not coming in twice for surgery, they're not getting the wrong surgery done. So anything we can do to minimize that, even if it's just small to start, I think is going to validate the platform and get people comfortable with these new technologies and figuring out a way to deploy them effectively without slowing the doctors down, without upending the current systems, but giving them a value add on top of the existing systems and getting everybody comfortable with it.

[00:12:39.098] Kent Bye: And so as you're moving forward, how do you plan on bundling what you're actually giving to these hospitals? Is it going to be some sort of like Oculus Rift mixed with a PC and then your software and the cloud-based integration? What is it all that you're delivering and what's the business model in terms of how you plan on charging some sort of subscription or flat fee?

[00:12:59.643] Rik Shorten: Well, there's a lot of different ways we can go. We're a software-based service and not a hardware, but that doesn't mean that there's not an opportunity for a black box solution where we've got something that's custom made for our end user. If you imagine a hub in a spoke model, maybe there is a higher end system down in the radiologist department. There is more powerful tools that the radiologist might want to deploy because they're seeing these images all day. Whereas a surgeon upstairs couldn't have a Samsung gear or some other lightweight HMD and then the the data and diagnosis could be pushed You know the session could be saved and the radiologist could upload that and say I'll walk you through my diagnosis and the doctor could put the headset on and he could look at it and say Yep, I see what you're seeing, I see your annotation, I'm walking around it, I'm checking it out, and here's my notes, or I concur, and away we go. Now how we deploy that, there's a lot of different ways to deploy it. We don't want the hardware to be a barrier to entry. Hospitals are under huge budget crunches right now, so unlike other systems that want to provide a hardware solution and a software solution to run their their package. We want this to be as easily adoptable as a hospital could make it. We're talking about $100 headsets and smartphones that most doctors have. We're talking a couple of thousand dollars for an Oculus installation should they want that. So we want to make sure that our software is not going to get hung up on that. We could give away the headsets as part of our business model if we wanted to, but we could give $100 headsets to 100 doctors at a hospital as a way to move in and then start our service that they use. And whether that is a cost per render, so each patient is $1 or whatever that is, or it's a monthly subscription for a certain amount of cases, there's a lot of different ways that we can get there. I think for us first is to just build a compelling product. Like you said, prove the metrics, show them why this is better, faster, cheaper and it's going to make the patient outcomes better and it's going to optimize their doctor performance. And I think everyone from insurance companies to hospital administrators to doctors themselves, who are really small businesses, anything that optimizes their workflow and provides better outcomes is going to be good for every stakeholder.

[00:15:07.443] Kent Bye: And is this something that can go beyond diagnosis and start to be used to actually plan surgeries and before they go in, go into some sort of shared virtual environment and kind of talk things over? Or is that something that they already have established methods to do?

[00:15:20.954] Rik Shorten: I don't think there's a lot of, I think there's a small amount of cases that are worked on by multiple teams in multiple locations. But I think that should change for the reasons I mentioned earlier. You know, if you have a serious heart, anomaly and you live in the Midwest, well maybe Tufts and Boston should be diagnosing, you know, the world's foremost cardiologists should be looking at your scans. But right now that's just impossible. If there's a platform that allows those to connect, we kind of see a world where maybe 500 of the best radiologists are tapped into the platform. and these are competent, experienced people, and then it sort of becomes a service where maybe it's not your local radiologist who's diagnosing these, but maybe it's a team, and maybe that's a new business that finding the efficiencies or the inefficiencies currently in medicine. If you look at a specialist like a rheumatologist, they're busy 20% of the day in most hospitals because they just don't have enough cases coming in for them to have to diagnose. The other 80% of the day, that rheumatologist is sitting there not doing anything. If he's experienced and he's sitting down in MD Anderson in Texas, why can't he spend the next 70% of his day pulling down and diagnosing cases from around the US? So that's the kind of thing that we hope organically comes out of a platform. If people have access to it and it's valuable, then how do we bring all of this expertise in and then optimize that so we're not the burn rate for delivering medicine at point of care is reduced. And we think there's opportunities there as well, not just in orthopedics, not just in cardio. There's a lot of different verticals once that platform has been built because it's going to take the data that the users are generating and it's going to provide very valuable analytics as far as how patients are being diagnosed and patient outcomes. And that kind of nice feedback loop is something that I think is going to add incredible value to people that are making decisions about how to provide point of care or medicine at point of care for patients.

[00:17:10.056] Kent Bye: And in talking to other different VR rehabilitation medical applications, there seems to be this trend towards using VR and immersive technologies to move towards a more personalized medicine. And so I'm curious from your perspective and the diagnosis and this med tech from your vantage point, if you also see a personalization or some of these other trends of what is virtual reality doing to medicine and how is it changing medicine?

[00:17:35.856] Rik Shorten: Well, you know, I've had a lot of interesting discussions, some here yesterday, just in regards to the same thing. If you're talking about preventative medicine and you're talking about a patient owning their personal health and being a director of their personal health and taking an interest in it, and the idea of not providing sick care, but providing health care. So not waiting until it's gone so far that they wind up in the ER, but empowering them to follow their metrics and to pay attention to their data, I think if we give it to them in a way that they feel emotionally connected to and they know it's theirs. You know, here's a data point for you today, and this is not a study about 10,000 other people with the same situation. Here's your diagnosis, here's where you are today. If you do these things, this is your path to health. If you don't do these things, here's the other path. And I think if you make it personal and people can see the virtualized trajectory of their own health, I think they're going to own that. I think they're going to pay attention to it versus just waiting for another doctor appointment and having a doctor tell them what's happened in the last three months. I think people, you know, from wearables and sensors and all that on down are going to take this seriously if we can aggregate it and we can put it in a context that makes it a personal health mission for them versus just some abstract statistic about their condition.

[00:18:47.371] Kent Bye: So it sounds like they may go into a doctor and see that they have a condition that if things progress and get worse, then they don't do these exercises or whatnot. Then they may have to do surgery or something. So how do you see VR playing into that? And is that something more of a general wearables? Or is this something specifically about the immersive nature of virtual reality and all the different tracking technologies that they'd be able to kind of track their progress over time?

[00:19:12.640] Rik Shorten: And for us, this may be a business for us three years from now, I don't know. But I know that gathering the data we're going to gather about both the user and the expert in the system diagnosing is going to give us some very valuable inflection points about how to turn that data around and inform people with it, whether it's training doctors or informing patients. I think how that gets constructed, there's a lot of different ways to do it. You know, we don't have a roadmap for it, but I see it. And I see the fact that people are paying attention, and they're tracking their behaviors, and they're getting used to that, and they're getting used to getting feedback from something that they have in their pocket, or a smartwatch, or something that's, it's almost like, oh, it does that too? Okay, well, then I guess it's gonna track how many steps, and the food I eat, and my heart rate for the day, and I'm gonna get to see that, that big data's gonna be visualized for me in a way that I can understand. And I still think there's more room to grow there, and that's going to be an important thing. How do you visualize that data to make it relevant to people and not just bar graphs? But that's another product as well. But for us, I think if you're talking about somebody, you know, if you're saying this is you, this is virtually you, and there's a way for us to show in a simulation fashion, for instance, in VR, this is the physiology, you know, and this is a visual representation of that physiology. Maybe it's, you know, it's your arteries hardening. Maybe it's a physiological process over time that people can't really understand, because you just, if a mountain moves an inch a year, does anybody see it? If you can show them three years of compliance on a protocol, and they're like, wow, that really made a difference to me, and this is where I can wind up, I think if we can find a way to visualize that, they're gonna be able to compress that, you know, the treatment time, and really get a chance to understand it. And, you know, with medicine, you're either compliant or you're not. You're either doing it and you get the help, or you're not doing it and you're not getting the help. So I think there's a big area there where we can dive in and show it to them in a real way that means something to them. And it's a challenge, but I think it'd be an interesting challenge to take on.

[00:21:05.987] Kent Bye: And what are some of the privacy implications in terms of sharing data on the cloud? I imagine that you'd have to be following all the laws around HIPAA and everything else to make sure that that remains private. But what are the special considerations that you have to do in order to enable a cloud-based diagnosis through virtual reality?

[00:21:24.620] Rik Shorten: I think we'd have the same. There's a lot of existing encryption protocols for transfer of data across state lines. There's FDA regulations as far as a diagnostic product, and there's also the HIPAA rules just as far as stripping patient identity from the data. But what we found is patients that we've asked to be part of the study, or we've said, hey, can we use your data in this study? And here's how we want to use it and why we think it's important. Every single person has said yes. Nobody said I have privacy concerns about this. I don't want Now, we're not saying who this person is or putting a name to it, but we're saying this is a 45-year-old man with this condition, you know, living in this geographic area. Here's some of the other filters that we would put this through as far as doing a comparison or figuring out what his metrics are. I don't know that we're going to get a lot of pushback from the actual Patients probably will get pushback from HIPAA about it or the FDA about it, making sure that we're compliant. But I think there's existing protocols for that. We would adhere to all of that. But I think people are, when they see the value of the collection of this data and they benefit from it personally, I think people will go along and I don't expect a lot of pushback from the patients themselves.

[00:22:29.405] Kent Bye: And finally, what do you see as kind of the ultimate potential of virtual reality and what it might be able to enable?

[00:22:35.647] Rik Shorten: I think there's, you know, we're talking with our doctors about problems that this technology might solve three, five, ten years from now. Our first challenge for us is to, you know, and it was well illustrated in the keynote, what are the problems we need to solve this year, next year, to make sure that five years from now virtual reality is something people take seriously and they rely on, and it's their go-to. So VR becomes the default and not the fringe. And I think the future of VR, it's important for us to get it right now. There needs to be strong leadership and we need to come up with practical, usable, reliable products in VR that make sure it has a lifespan beyond the hype. And so I'm not sure if that answered your question, but I think that's our challenge today. And I think I can answer that question if we get over this hump of this year and prove that it's got enterprise applications and it can practically help people, not just entertain people with games or immersive experiences, but this is technology that's transformative and can actually save lives and help people, and I think once we get there, the sky's the limit.

[00:23:37.582] Kent Bye: Awesome. Anything else that's left unsaid that you'd like to say?

[00:23:41.704] Rik Shorten: Not so much, but I think, you know, Shawna is always determined for us to illustrate where we came from. You know, my team and I have spent a decade doing film and television in Hollywood, and we spent eight years on CSI, and people say, why are you guys the right guys to do this kind of work? And I say because we've had a chance to understand how to create really immersive experiences and dynamic experiences that also inform. And it's a natural for us to take that Hollywood experience and turn it into a practical application. And so when people say, what's your motivation? I say, well, you know, I entertained people for a decade, but now maybe this is an application that can save lives as opposed to just entertaining middle America. So that's our motivation for the team. And that's why we're so passionate about it.

[00:24:25.465] Kent Bye: Oh wow, so you would do like the special effects on CSI for people who were doing forensic analysis and now you're doing the actual sci-fi interfaces to be able to give doctors the ability to diagnose the 3D immersive MRIs.

[00:24:39.337] Rik Shorten: That's exactly right and I was eight years as the visual effects supervisor on CSI and that's where we pioneered the forensic look of that inside the body world. So it's sort of germane to what we're doing now and that's the six degrees of it is that's where we started and the visual team is used to telling stories that are scientifically and medically accurate. And so for us to put this in the doctor's hands and put this in the hands of patients, it's going to kind of be, it'll be the CSI effect for medicine. These are the images that they're going to see inside of a platform like BioFlight are going to be next level and they're going to, that's the stuff they've come to expect. New doctors, you know, they grew up on Xbox. They expect interfaces and experiences that are intuitive and engaging and interesting. And I think that's going to be part of the challenge is how do we make a product for 2017 and beyond and not something that was built 25 years ago.

[00:25:26.178] Kent Bye: So I imagine that the doctors that they go in there, they may feel like they're stepping into the future and being able to see all these next generation interfaces then.

[00:25:33.841] Rik Shorten: Exactly. And I think, you know, in medicine for a long time, it's been, you know, function before form. And I think that's where part of our convergence point is, is making sure this stuff, should the doctors want it, you know, or should the patients want it, is making something visually representative to what they're used to seeing. And I think that'll go a long way to adoption, is this is not some sort of esoteric, This is not imaging that they've never seen before and they have no relationship to and I think that's an important step It may be small to some people and maybe some people don't care But when we put the renders, you know that we've done on the shows like CSI into a VR environment let people walk around It's jaw-dropping and they do see the future You're right, and they do see this as a high watermark for where medical imaging should go and diagnostics should go Awesome.

[00:26:16.969] Kent Bye: Well, thank you so much for your time Rick. You're welcome. Thanks a lot So that was an interview that I did with Rick Shorten of BioFlight VR back in May of 2016. And let's go ahead and dive in. A year later, March 2017, at the Silicon Valley Virtual Reality Conference, they had did a little bit of a pivot of taking their skills and graphics and be able to actually create these educational pieces for training and patient education and patient behavioral modification, as well as some training scenarios that were designed for medical students. So with that, let's go ahead and dive right in.

[00:26:49.193] Rik Shorten: So my name is Rick Shorten, I'm the CCO and one of the co-founders of BioFlight, and our focus has been primarily medical education and training, and our partnerships in North America and in the US are from medtech companies to premier universities, medical schools, clinics, and then also collaborating with other VR partners. So, you know, our domain knowledge in medicine and our ability to create very high fidelity content, people are reaching out. They have a great idea and they need execution. And so we've wound up becoming consultants and VR Sherpas and everything else you can imagine because it's needed. And so we've taken on that role and we engage in a lot of different ways. Sometimes we build everything, sometimes we build the front end and the design experience, and sometimes we are a cog in the wheel.

[00:27:38.800] Kent Bye: Yeah, I just had a chance to go through some of these video experiences. And I had this direct experience of being able to kind of see my heart beat. Not my heart, but a heart. But I could sort of imagine that it was my heart. And that you're doing these things like if you eat too much sodium or salt, then this is the effect of that. So you see the long-term effect of what actually happens to your heart. So maybe you could talk a bit about what you're trying to do with these videos and where they're going to end up.

[00:28:04.388] Rik Shorten: Sure. So, you know, if you're talking about patient behavior modification, the use of VR, you know, how do we move the needle when you're trying to make something personal for somebody? You know, if you have a diagnosis, you know, you go into your doctor and he says, I'm a little bit worried about your blood pressure, it's high, and, you know, what's your diet look like? And, oh, well, you know, I eat, maybe I shouldn't eat some things, I should, you know, I should slow down on the high-fat, high-salty foods. I think what the doctors are asking for are content with context. And they want to make sure they have materials that they can put in front of patients that's more than a brochure. Or, hey, go Google this on the internet to find out what's happening to your body. If you stay on the track you're on, here's some potential outcomes. And can we create VR tools that help them visualize that and make it real for them? So the point of this is, working with Cedars, is to say, part of your population, you're worried about their sodium intake. telling them they're having too much sodium is not working. They come back year over year with hypertension and high blood pressure. What can we do to maybe affect their decisions? And so part of what you saw, Kent, was just a vignette about, hey, if you're at a supermarket, you're in your kitchen, you're making decisions about your nutrition, what does that do? What's the immediate effect on that? And what's that effect over time? And I think that's where a lot of people either go right or they go wrong. And making little moves for a week or two or a month aren't going to make a difference. But if we can show you what five years on this track looks like to you, is that going to convince you to make those choices of different choices today? And I think that's the thesis around some of this patient education stuff. How do we make it real? How do we show them over time in a way that's going to get them to stop and make some real changes? And that's the hope of the doctors and that's the hope of the hospital.

[00:29:42.696] Kent Bye: Yeah, I think it's sort of leveraging this point of out of sight, out of mind, things that you can't see, you don't think about. But also with the advent of film cameras, we had this ability to do these time lapses, so to be able to capture large swaths of time. And so adding both being able to go inside your body and look at what's actually happening with your organs, but also add that time dimension such that if you make this choice, then this is the consequence. So it's being able to connect the dots between choices and consequences. And so with that, I'm curious to hear what has been some of the reactions or evidence of the advocacy of using VR for some of these patient behavioral modification strategies.

[00:30:23.125] Rik Shorten: Well, it's it, you know, and it is, and you speak about causality and making it and really getting the patient to stop and think about that. You know, all of these things that we're doing are in, are in study, you know, smoking cessation, weight loss, healthy living choices. These are, they're all in study now. So I think the next time we talk, I'll have some information because when we work with these partners, it's, it's not enough to create this content and say, wow, isn't that a beautiful heart? oh my gosh, now I can see what's happening to my heart over time. It's really figuring out with our users whether this is effective or not. And, you know, this is round one. And I'm sure by round five we're going to find a way to create these engaging experiences that do affect them personally and emotionally and physically and that motivate change. So we're still working with the users. We're still trying to figure out what works best. And, you know, what you saw was the beta.

[00:31:10.727] Kent Bye: So another experience I had a chance to try out was training for doctors, like being in the room and in a very intense situation. And I was surprised to feel how intense it felt, even though I knew that this was not a real situation, but I could feel the tension around, you know, okay, what choices do you make? The thing I found really interesting is that you have all of these options that you're giving the doctor. It's a little open-ended as to, and it's not like a dialogue box as to, you know, check yes or no, but you kind of are able to teleport around and actually kind of engage with different things that you would actually normally engage with if you were in this situation. So maybe you could talk a bit about these training scenarios that you've been cultivating and then where you see that going.

[00:31:51.438] Rik Shorten: You know, I think if we start from a place where, you know, the way doctors are trained today is a lot of theoretical and not enough practical, this is where VR can step in and close the knowledge gap and the experience gap. And if you're talking about a confident doctor or somebody who's mastered their craft, it's someone who's done it, who has the experience and who's done it over and over and over again. And when they have something in front of them, You know, they've seen it. They've been there before. There's a confidence level. And there's also understanding of outcomes, you know, in different ways. And I think when you talk about these types of training simulations that we're building, it's how do we make it high stakes enough so that they feel there is a physiological experience for them. But then also, you know, beyond testing the cognitive knowledge, we want to make sure that they understand the jeopardy. Yes, this is a virtual patient, but someday it won't be. And if you're a first-year resident and you see a ticking clock and your team is staring at you and you have a worried parent standing beside you, freaking out because their one-year-old son is cyanotic and he's turning blue, you have very limited time to make decisions as a doctor. It's very high pressure. And when you're dealing with patients, especially children, it's an incredibly stressful experience. And so if you can put people in training simulations that make them feel like they've been there and done that and they've dealt with some of their fears, They've been able to optimize their response and they've been able to debrief at the end of the experience and understand the quantitative and qualitative decisions that they made. Can we help them be better doctors? Can we close that experience gap for them and make them competent? Let them try it over and over in a low-stakes environment to the point when they see this in real life they're going to feel like they've been there and they're going to be able to act accordingly and they're going to be able to take command of their emotions and focus on diagnosis and treatment the most optimal way and so we feel like these types of products are going to be invaluable on a go forward for medical training and you know that you saw a glimpse of that.

[00:33:42.422] Kent Bye: And so BioFlight VR, it seems like you're doing all sorts of different dimensions from everything from patient education, doctor education, but also potentially even using your technology in the practice of actually conducting medicine. And so maybe you could talk a bit about an update as to what are the things that you've been working on and really focusing on.

[00:34:00.023] Rik Shorten: You know, for us, I think, you know, since we talked last time, you know, the partnerships that have been put in front of us are really going to allow us to grow, you know, the education platform in an accelerated manner. You know, what's important to the ecosystem that we're trying to build is making sure it's content rich and it's valuable content and people can access it anywhere, anytime. And, you know, not just VR labs in hospitals and medical schools, but how can students practice asynchronously from their teachers? How do they access a mobile version of this? How do we distribute this content but still be able to test its efficacy and make sure that it's valuable to the user? So I think there's a lot of technical hurdles that the solutions aren't available. So part of our job is knitting that together and our vision for that is providing that foundational content and creating a toolbox that other developers in the medical community that have a specialty, maybe they want to create something for rheumatology. That might not be something that we touch, but they develop it, and they stand on our shoulders using our toolbox for analytics, for HIPAA-compliant code, and they can just say, look, I need an operating room with a patient, and here are the conditions, and here's the variables I want to test and measure, and here's the experience I want to create for the user. If we can get them 75% of the way there with our platform and our toolbox, well, then we're going to have a really nice feedback loop for content creation, and that supports the next generation of content creators. and it draws medical excellence to our platform because what they find there is valuable and then they can create things of value.

[00:35:29.865] Kent Bye: Yeah, that's the thing that I find really interesting is that you've found this niche of content production where there's both a market need and demand, but also the money to actually pay for it and also distribution channels. So it sounds like you're kind of focusing on content, there's distribution channels, but there's also funding that's either coming from grants or is there also like insurance money that's also potentially paying for some of this in terms of preventative health?

[00:35:54.050] Rik Shorten: I think there's opportunities. I think, you know, right now we're still, even though we're building content for specific use case, I think as more people in the medical community experience it, they get to see how it's going to impact their specific function. You know, the role that they play in, in medical delivering medical care, whether it's on the payer side, on the insurance side of the doctor side, or a hospital administrator, or, you know, the Dean of medicine at Duke university, they all have an interest in making sure that their training is optimal. and that the patient outcomes are always improving. You know, and if you're talking about teaching students today, it's all moving to competency-based and performance-based, you know, analysis. We have to show that it's not enough that you just attend medical school for four years and don't kill somebody, so now you're a doctor. It should be because you're really, really good at what you're doing, and we've been able to prove that. So I think that, you know, as this content gets out into the world and more people see it, I think all of the stakeholders in medical care from the payer side through to the patient are going to realize that this is a valuable supplemental and augmented material that they need to include in their education and training and their training protocols.

[00:36:58.514] Kent Bye: The other interesting trend that I see is that within the medical field with these VR experiences it's really putting the power back into the hands of people to be able to start to take care of their own health based upon the decisions they make. Not so much that they go to a doctor and have them give them some medicine to fix their problems but yet there's choices they can make day-to-day that they can change their health and I think that part of what you're trying to do is connect those dots between giving them a VR experience that shows them those choices they could be making so that they take more control over their own health.

[00:37:30.147] Rik Shorten: Yeah, and you know, everyone complains about information being so siloed in medicine and who has access to what tools and what hospital you go to, you know, depends on the level of care and information you get about your diagnosis and what your treatment options are and what medical plan you have determines what doctors recommend to you. All of that seems really fragmented and broken. And I think if we can democratize information, trading for sure, but information on the patient side, I mean, the whole telemedicine thing, the idea of, you know, people, HRV monitors and everything that you wear these days, you know, people are tracking their own physiological biomarkers and they're learning about their bodies. and making decisions or understanding things sooner or being able to track when they're given a diagnosis and treatment option, they can track it. They don't always have to go back to the doctor to see if things are changing. So yes, I agree. Empowering the patient is step one because most of the reason why patients get readmitted or the outcomes are weak is because of compliance. And so if we can give them tools that either inform them better or let them track their progress or inspire them to make change, I think all of that, those outcomes, to me, they have nowhere to go but up. So that's the role I see this technology playing.

[00:38:40.856] Kent Bye: You kind of alluded here to the quantified self movement where people are tracking all this data. Is this something you've also started to look at in terms of seeing if people could have an immersive experience of that data at all?

[00:38:51.799] Rik Shorten: Yeah, I think there needs to be a place where you're, you know, a snapshot of your life. If you imagine yourself at 20 years old and you start capturing all of the biometrics of yourself there. And it just becomes something you upload like your photo gallery, but it's your body over time. You know, a virtual avatar of your body over time. And you can, you can stress test yourself. You can see what certain treatment protocols would do to your body. Like if we can make it that personal, then everybody is going to have the ability to at least self-educate, maybe not self-diagnose, but at least self-educate and really understand the changes they make over time, but have that information. And if we're measuring, if it becomes a thing where every device, whether it's a smartphone or a wearable, just becomes commonplace, we're going to have a huge trove of data that we can pull in and turn around and find a great way to visualize it and show the patient and show the user, here's what's happening. Here is your body over time, and this is the changes. And you can see an effect, and those changes are real, and they're also personal. And I think that's going to make the difference. delivery of health care and also in compliance and patient outcomes. When it's real and it feels like it's them and not just some generic number, you know, one in 10,000 or whatever, if you make it one, one to one, I think you're going to see a real change. You know, that's the position we're in. We hope to be able to enable that.

[00:40:09.625] Kent Bye: And so I've been looking at privacy in VR a lot lately, and looking at the biometric data is sort of like a new frontier in a lot of ways. I think there's a couple things that are really tricky and challenging about that. First of all, there's this fact that most of the biometric data is being captured within a context of medical situation, which is usually protected under HIPAA. But if you're a commercial entity and any data that you hand over, there's the third party doctrine, which essentially says that any data that you give to any third party has no reasonable expectation of remaining private. So you kind of have this context switch of both the medical context, but also your private data. So just curious if you've thought about that in terms of the privacy implications and how to be a consumer provider of a VR service, but yet still find ways of protecting user privacy.

[00:40:56.177] Rik Shorten: You know, I think it's going to definitely be an opt-in situation. I think there's a lot of decisions people make about the level of privacy they expect in return for the value proposition for them. So I think that's a conversation to have. Are people willing to not make their information public, but contribute it to the greater good? You know, if you're talking about evidentiary medicine and having the value of that, you know, if you have these case studies, and that's how we learn, if we know what the diagnosis was, we know what the patient did through their treatment, and now we know the outcome, you know, that is so valuable in both teaching future doctors and clinicians, but also teaching the public about potential outcomes. And I think if you can make it valuable for them, I think you're going to find most people will opt in because they see the value on the back end. being able to be part of that database because what they pull out of it is meaningful and valuable to them. And so I would like to frame our discussion and policy around that and make the value case just so compelling that people are willing to do that. And like I said, I don't want it turned against them. We don't want them to feel like someone's going to turn around and say, oh, you're sick. So, you know, now we've got that and we're going to hold that up in front of you. I think there's ways to do it where we learn from everybody's medical experience through life without it becoming a liability.

[00:42:10.174] Kent Bye: Great. And finally, what do you think is kind of the ultimate potential of virtual reality and what it might be able to enable?

[00:42:17.565] Rik Shorten: Honestly, I think this is, you know, since we started working, the technology has evolved. It's already evolved twice. You know, inside of two years, we've got, I mean, everything from the software development tools, the APIs and SDKs that are being developed, never mind the stuff that's coming from our hardware partners. Where it's going to go from here, I want it to be in a place where everybody's using it and it becomes a daily habit. You know, that's my hope. You know, let's start there because right now it feels very niche. It's been very focused on gaming and we're enterprise side and we're consumer side as well, but not in a way that's just to entertain people. We want this to be a valuable part of how they learn and how people train. And so my hope for the future of VR, AR, mixed reality, everything that I already don't know about, is that it really becomes just commonplace. I want the technology to find its way into every home in whatever way it's most valuable to the user. So we think that what we're providing is going to be valuable in that space, and not just something like a casual gamer. This is going to be something that affects their lives, and they're going to learn, and their kids are going to learn through it, and the adults are going to learn through it. And part of the self-improvement movement, I think this technology can play a huge role.

[00:43:29.173] Kent Bye: Awesome. Well, thank you so much. You're welcome. Thanks, Ken. So that was Rick Shorten of BioFlight VR. And yeah, that was a couple of interviews that I did with him back in May of 2016, as well as March 2017 at the Silicon Valley Virtual Reality Conference. So I have a number of different takeaways about this interview is that first of all, I think the long-term vision of BioFlight VR in terms of bringing VR into hospitals in order to do diagnostics, so to be able to use the volumetric affordances of virtual reality to be able to go beyond just looking at these images that are in 2D and to have a full volumetric view of this data. I think that is for sure going to happen. I think it's more of a question of when that's going to happen and what path that's going to be. It seems like a year later that Bioflat VR did a bit of a pivot in terms of really focusing on the educational aspects of being able to create these highly polished visualizations of what would happen to, say, your heart if you ate a lot of sodium over a long period of time. And I have to say that was one of the most striking experiences that I had at the Silicon Valley Virtual Reality Conference in 2017. just because it really just stuck with me. It was a little bit like being able to experience a time lapse of the impact of a certain behavior and to be able to tie it to what that actually does to my body. Now I think that Rick is right to say that at some point we're going to get to the point where we're going to do this quantified self type of self-monitoring of recording all this data and then make that available to be able to visualize and to perhaps be able to fast forward or rewind. Using data from your own body to be able to look at the impact of your behaviors over time I think is going to be a huge potential application. And it's more of logistics around actually collecting that data and making it available and then handling all the various privacy concerns around that. So there was this interview with Tristan Harris of Time Well Spent where he was talking about our compulsive behaviors and how we are spending our time on these different applications on our cell phones. And his organization, Time Well Spent, was looking at the correlation between the time that you spend on various applications like either Snapchat or Facebook or WeChat and trying to draw out this time that you're spending on there. Are you happy or do you regret it? And he did find that there was actually a correlation between the time of the sites that you spend the most time on and the regret that you have, or that you're actually not happy with those decisions. And so what this is telling me is that there's a certain amount of our unconscious behaviors that are just kind of compulsive, and we're acting out of these habits, and we're getting results that we may not be happy with. And I think this is a huge insight for virtual reality and looking at how much of our body and our unconscious behaviors is driving our behaviors in the world. And when it comes to our health and being able to tie decisions that we're making on a micro scale day-to-day and how that impacts our body over time, I think these types of applications from BioFlight VR may be able to connect those dots in terms of being able to give us a visualizations of the long-term impact of some of these small decisions that we're making day-to-day. And if we change those habits, those compulsive behaviors, and to be a little bit more intentional for what kind of choices we're making, whether it's through exercise or what we're eating, then this could have a huge impact for being able to connect those dots between the impacts of these small decisions and what happens to our body over time. And the training scenario that I saw from BioFlight VR was super intense. I mean, you're thrown into this emergency room with this baby who's like one years old and it's turning blue and it's about to die. And the mother is screaming like, oh, save my baby. You know, like you'd expect that that's an intense situation where there's a mother and their baby and the baby's blue and you got to figure out what to do. I had no idea what to do, and so I had to ask for help for all the different steps along the way. But it was just a super intense experience that made me feel like I had that lived experience of being in that situation, which is a lot different than reading about it in a book. And I think that is where virtual reality training for doctors is, I think, going to be a huge thing. And what Rick said is that these medical education institutions are moving more towards this competency-based and performance-based analysis of whether or not you're ready to be a doctor, rather than just if you're able to pass a written test or read a book. You have to actually have the lived experience in order to know that you're actually prepared. And virtual reality is able to put you in these simulated environments to give you that simulacrum of what that direct experience might feel like. And just finally, I think that there is going to be this trend eventually where doctors do diagnosis remotely, where there's people who are doing this distributed diagnosis and telemedicine. This is maybe something that the market is eventually gets to over a number of years after there's enough of using the virtual reality technologies and other applications. What it sounds like is that there's more interest to be able to have a gear VR and to be able to have a doctor talk about a certain condition that someone may have and then to put them into a virtual reality experience that gives patients a direct volumetric experience of what's happening to their body. And so there's these different VR experiences and educational experiences and patient behavior modification experiences that BioFlatVR is working on and that they're bootstrapping their company focused on this baseline of these educational VR experiences and then moving into the training and then eventually once the doctors have had an experience of what you can do for a training context, then eventually, maybe in the next five or 10 years, we'll start to see a lot more virtual reality technologies move into the medical field when it comes to doing diagnosis. So that's all that I have for today. And I just wanted to thank you for listening to the Voices of VR podcast. And if you'd like to help the podcast, there's a couple of things you can do. First of all, you can just spread the word, tell your friends. And secondly, you can consider becoming a member of the Patreon because this is a listener supported show and any donations that you are able to contribute will help ensure that I can continue to bring you this type of coverage. So you can become a member today at patreon.com slash Voices of VR. Thanks for listening.

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