VA expands use of extended reality tech across healthcare operations

The Department of Veterans Affairs is amplifying its use of immersive technologies to enhance clinical care, with a top agency official saying VA is looking to further build upon early adoption of the tools across its healthcare operations. 

These augmented, mixed and virtual reality capabilities — collectively known as extended reality — simulate or overlay digital information onto real-world surroundings through the use of wearable headsets. While immersive technologies are often used for gaming and entertainment purposes, researchers and medical professionals have found that these tools also have a wide range of therapeutic uses. 

In a recent interview with Nextgov/FCW, Anne Lord Bailey — the executive director of VA’s Strategic Initiatives Lab — said veterans are particularly suited to benefit from uses of extended reality tools alongside more traditional clinical care.

“What we're also seeing is that our patient population, as you can imagine, has a high incidence of chronic pain, high incidence of mental health complications, a high need for wellness tools, relaxation, stress management, mental health support,” Bailey said. “And those are areas where we've seen really unique benefits with immersive technology, like virtual reality, where we have a modality of engagement.”

Moving VR beyond early adoption

VA’s Strategic Initiatives Lab was launched in October 2023 with the goal of researching, testing and scaling emerging technologies that can be leveraged to enhance veteran care. It is housed within the Veterans Health Administration, the VA’s healthcare arm.

The lab’s work has included a particular focus on the benefits of using extended reality, which Bailey said “delivers some really unique value.”

Even before the lab was established, however, Bailey noted that early VR adopters — including providers and caregivers — “have been off and running with this technology now for nine years.” VA is trying to maximize these early immersive technology uses with greater adoption of the headsets for veterans who would likely benefit the most from their use.

VA has identified more than 40 clinical indications for immersive technology uses across its health operations, including for PTSD, depression and chronic pain. Veterans at most of the VA’s network of over 170 medical facilities are able to receive the headsets if their clinicians deem them to be of potential benefit, although access can vary. 

“Any VA medical center, any providers that are scoped to order based on the indication — so if it's a pain provider, they could order it for pain at any medical center — can order this technology for their veterans, but ultimately it's the local facilities' decision as far as access and availability,” Bailey said, adding that “we support the medical centers in that way.”

Bailey said more than 6,000 veterans across VA’s healthcare operations have benefited from using VR so far, although she noted that this figure is likely an undercount.

“We provide documentation templates to make it easier for providers who are using VR in clinical practice,” she said. “If they use those documentation templates, we're actually able to see utilization and the data from that on a dashboard. So we know that at least, I think, it's 6,100 last time that I looked … veterans have used the technology, and we know that is a very conservative estimate because not everybody is using those documentation templates.”

How it works

Although the process for accessing extended reality headsets can vary by veteran needs, Bailey said providers typically either determine that the use of the technology would be beneficial, or the veteran raises the idea to their clinician and “then together they make a shared medical decision.” 

Veterans who would use the VR tool at home first do a trial to understand how it works and see if it will benefit them. Providers document that experience, and then place an order for the device to be sent to the veterans’ home if it is deemed to be helpful.

“Now, let's say they're using it for pain management,” Bailey said about a hypothetical veteran. “So the patient is able to then access the technology at home in the middle of the night if they wake up in pain in the afternoon [or] if something in particular is triggering pain or stressful. So it's available on demand to them when they need it, which is really important. Then the provider is able to follow up with the patient at specific intervals to make sure, one, they're using it, and two, how it's working, and then can adjust what they want them to do with it based on that response.”

Veterans using VR are usually seated or lying down to minimize the risk of falls. The visuals inside the headsets also vary based on the underlying condition. A veteran experiencing acute pain, for instance, may experience an interactive environment meant to be relaxing or distracting. 

“If you think about breathing exercises, for example, rather than just sitting and knowing, ‘Okay, I need to breathe in to breathe out,’ and sort of talking yourself through it in the headset, you may breathe and a tree starts to grow, or an animal starts to move closer or further from you, or you may start to advance through a forest, or along a beach or a different type of environment,” Bailey said.

She said the typical clinical protocol is for veterans to use the tools for eight to 12 weeks, although there is room for them to continue benefiting from the headsets.

“We're identifying ways to say, ‘For eight to 12 weeks, you need to do this particular protocol. After that, to maintain what you've used and grown, here are some more wellness tools or support mechanisms that we can use the technology for,’” Bailey said. 

And veterans who have used the headsets have reported benefits that extend beyond the condition for which they were being treated.

“What's really fascinating about VR is where we're prescribing VR for chronic pain, and then the patient comes back and communicates to us, 'Hey, my pain is better, yes, and also I'm able to better engage with my family, I'm sleeping better,'” Bailey said. “So those are the parts that we're also trying to evaluate — what is that connection, and how are we seeing that broader impact beyond just single indications?”

Uses of immersive tech

Further deployments of VR for more targeted therapeutic purposes have been guided by collaboration between VA units, as well as on-the-ground input from clinicians. 

Bailey noted that the Strategic Initiatives Lab is working with VHA’s Pain Management, Opioid Safety and Prescription Drug Monitoring Program Office to further expand chronic pain patients’ access to VR tools.

Right now, that focus has extended to 25 medical centers; Bailey said the goal is to expand to 45 additional centers before the end of the year. VA partnered with VR health provider Mynd Immersive to help amplify veteran access to these headsets. 

These efforts, she added, are significantly assisted by the work of VA providers. 

Bailey said, for instance, that a pain physical therapist at the San Francisco VA medical center has been playing a key role in this effort by “helping us from a really practical and human-centered design approach understand the clinical workflow, the documentation process — some of those non-sexy parts of implementation, if you will. But those will ultimately make it easier to expand to all medical centers.”

Additional efforts at other medical facilities — including VA Gulf Coast, VA Central Arkansas and the department’s Clinical Resource Hubs that offer remote care — are also focused on the intersection of chronic pain and insomnia, which Bailey noted is correlated with an increased risk of suicide. 

“It's not just doctors and nurses, right?” she said about those involved in the process. “It's clinical providers across the board, which helps increase access. But as we're thinking about those kinds of things, we're learning what's the best way to expand this and make it really normal, so we can make it easier for everybody to access.”