Rene – Hi! Welcome back to Meta Minutes, your bite-sized pieces of the metaverse. My name is Rene from Valorem Reply and today we're going to talk about the future of healthcare and patient care in the metaverse and for this I'm honored to have a special expert guest today, Paul Swider. Hi Paul and welcome to the show, how are you today?

Paul - I'm doing amazing, how are you today?

Rene – Fantastic! So ready to talk about healthcare and patient care and metaverse? But before we dive into the topic, can you tell us a little bit about your background as it relates to the metaverse and of course healthcare as well?

Paul – Yeah, absolutely. So I have about 25 years of experience with clinical informatics and healthcare technology. I've built several successful systems in healthcare for companies in North America, some of which have been commercialized etc. Currently, I'm the founding chief executive officer of a SAS healthcare company based out of Boston, which is sort of the healthcare hub of North America if you will and I also organize the Boston Healthcare Technology community and user group, which is a cloud-based technology community that's based out of Boston but we serve a global community and then from a metaverse perspective, you know, my career focus has been on healthcare but also technology and so I consider myself a sort of developer architect if you will, and so I'm very familiar with the metaverse concepts from a developer architect perspective if you will.

Rene – Awesome! Well interesting with the global Meetup from Boston streaming to the world. So this is what we all love about the internet and being connected with each other right like there are no barriers in fact and well with the metaverse, it gets into the 3D and whatnot right but let's actually dive into this a little bit. It's a simple but also a complex question. What is the metaverse for you and where do you see the potential, especially in your field?

Paul – Yeah, great question. So for me, I think, when I start to think about metaverse, I like to make a distinction upfront because I do feel like there are two different paths or folks talking about metaverse if you will. So I feel on one side, we have the cloud companies and other software companies talking about metaverse and when they're talking about it tends to be in the context of business use cases, organization use cases and we and we hear a lot about merging you know VR Technologies with other technologies to create this metaverse there is this other definition though that as a software architect I find compelling and that is the introduction of W3 technologies and ownership and the true integration of what some might call the next internet right with some of these metaverse technologies and frankly I think those are two they can be two different conversations right? So I would first frame my remarks around the first example that I gave, right? So I tend to work more with products like Microsoft cloud for healthcare, you know, SAP and Oracle have healthcare offerings and so I'm really dialled into what the business community and what the cloud providers are doing with metaverse and so what I look at it from a healthcare perspective, it's looking at those existing technologies and then marrying it, you know, in the healthcare spaces.

Rene - That's actually a pretty nice take on this one but let's actually talk a little bit more about healthcare and especially the role of augmented reality, AR, and virtual reality VR. I mean, they have been used since along time. In fact I just saw an article, it was the charity in Berlin like Lodge Hospital there basically in Berlin and they had an article about lung covid and treating patients there and as a as a kind of the banner image for the article they had a person wearing a VR headset which was pretty cool so there I know there's a lot of stuff already ongoing right? With VR especially but also with AR and you can see a lot of amazing examples for AR and mixed reality as well. There's a lot of training use cases for example even in the operation room mixed reality like the Hololens has been used not just for training but for actually surgery like there was an event two years ago or so I don't recall but they called it like the first live surgery or something, it was in Paris if I remember correctly but anyhow so like this is all over the place but can you like, of course you have much more insight, so can you share some of the insights and state of the art where the metaverse is adding value for healthcare.

Paul - Yeah absolutely! You know, so first just to build on the event that you had talked about. I forget where it happened as well but you know that's sort of picked up some speed. So what I mean by that is, I noticed recently that there's actually a full conference on healthcare and metaverse that's happening in Spain in 2023 in an entire event that will talk about nothing but metaverse and healthcare and you know, you mentioned an interesting example of folks using metaverse like technologies, you know with goggles and augmented reality. In the example you gave it's covid and that's an interesting use case because you know if you think about health care it's not just covid but there are many examples where healthcare providers would need to, you know, wear PPE right as they go into surgery or as they're treating patients with various ailments and so really that this is an issue prior to the pandemic and it will continue to be an issue going forward. Now what I really like about this example in the metaverse is it's actually a use case that's pretty easy to apply an ROI to. So what I mean by that is if you know that you do a thousand, you know your hospital system, and you know you do a thousand of so many procedures per year and the cost for that PPE is you know x and by the way, PPE is not just a mask right like we're just we tend to think of that now because we just got out of the pandemic but PPE means gloves, it means sterile equipment, it means you know the mask, right? This stuff gets very expensive as it adds up and so if what we can do is do the basic math okay if we do a thousand of these procedures and we separate the patient through some sort of hybrid care model where the patient where the provider doesn't have to worry about the PPE then you can actually do the math and do a hard cost dollar savings you know on that particular use case of the metaverse technologies. Another fascinating example you mentioned quickly, is assisted surgery. And so this is not really a new concept you know. We've been, you know, especially when we look at products like Dynamics and SAP and Oracle, you know, they tend to have this concept of like remote assist, where a provider can remotely do surgery and we've been talking about that for a long time but what's different now is marrying that technology to things like machine learning and AI and so what's happening now into in the next step is that providers, they're surgeons when they're actually doing the surgery they're not seeing an augmented, you know sort of image of the human body generalized, they're actually looking at that patient's internal organs projected above the patient. So, you know, from a provider perspective, they're able to very quickly look up see the internal organs, look down and then see them you know physically in front of them as well. So this is really important for multiple reasons, you know, when you're treating patients, especially in you know as you're preparing for surgery and going into surgery you really want to have as holistic of a view as possible of the patient you know. You and I'm sure, you could appreciate that as a human, right? Like if you're getting surgery, you want your doctor to know everything about you not only but during the surgery but even before. Like, you know, do I really need this, like this is all my data right, and so the assisted surgery is really interesting and it's growing by leaps and bounds. Again when I saw this recent demo, there's a company that begins with the name of q but you could Google a case study, but it's fascinating this is a product that's already out, and again the physician is seeing the actual internal organs of the patient while they're performing the surgery.

Rene - That's impressive and I honestly, I was always a little bit sceptical before I saw this live surgery event that, you know, if someone, for example, uses a head mounted device like a HoloLens that there's a little bit too much distraction or you know a couple of other issues that arise but by then I talked and you also confirmed this, you know, what you just said is like, when I talked with a surgeon well they right now they look on an extra screen right, like an extra screen to see and for example MRI or CT scan or whatever they need and with this they have hands-free right, they have the screen right in front but they can also just virtually, move the screen to whatever place it fits well, like just maybe a little bit above the patient and so they don't need to always look and go to the screen and do some procedures, they have the screen right in front of them and one thing I've always been saying and presentations about the HoloLens when I talked about using it for mechanical engineering or other things in production, it's hands-free computing, right? You wear the computer on your head with semi-transparent displays basically and you can use both hands for real-world tools and also what you said, with the remote assistance, it's a big factor outside of healthcare that I can use both hands.

Paul – Yeah, the other one last thing, I would add on this in case, you know, this use case is that when we think about assisted surgery, your brain, at least mine does, it tends to go right to the complicated scenarios, right, where a provider is doing some advanced heart surgery or something but you also have to remember that when we, I like to think about global health, in terms of globally and global health right and often times the people that are impacted the most by some of these ailments are are in countries that are less developed and have less access to equipment and providers right. So I think there's a lot to be said not only on the ROI perspective, from a business context like running a hospital and you can save time with this but also I think just from a humanity perspective and being able to help people in other parts of the world, you know. The first thing that comes to mind for me is like cleft surgery right. It's something very common that has to be done there, you know, lots of children born in developing countries where if they develop a cleft it's something that, you know, it may impair them for life and it might impact how they find a job, how they end up in University. Unfortunately, that you know that's just the way it is but if we can, if we can help some of these folks remotely with this same remote assist and maybe it's just augmenting another provider that's there right? It doesn't also have to take over so I would just like to mention that as well, you know, somebody that's really, for me, I'm passionate about global health and helping others and I think oftentimes we overlook the obvious use case of helping those less fortunate in other areas as well.

Rene – Yeah, it's a very good point because we might just think about the western world if you will, because we have this technology right here and so we wouldn't think about like, oh this could actually be useful in more developing countries where they might not have this technology, but I can, for example, take a HoloLens and send it there right and that's just a small package and they don't need the whole kind of setup with extra monitor and stuff I can send a small unit and wow I love this, this is awesome, like this we should do this like you know remove the systems for developing countries like with certain experts and like you said, it doesn't have to be from somewhere like overseeing it or whatever you mean but it could be also someone local, that is just not there because local in certain countries means hours of travel a day or whatever kind of travel time. Awesome, no this is a great fantastic use case.

Paul - If you had an Azure stack backpack, right? So there's actually a backpack that's designed for remote clinics etc. So you know if you take an Azure stacked backpack with some HoloLens from a technology perspective you have much of what's required to open a clinic pretty much anywhere in the world. Especially when we start to look at things like Starlink right and the ability to take away dead zones, I mean, you know, the three of those technologies combined you know, Starlink, Azure stack in a backpack and then metaverse technologies, using some of the exciting stuff Microsoft and other vendors is working on, it's just amazing right from my perspective.

Rene – Yeah, no it could totally change the game and like the remote assistance is pretty amazing, we haven't talked about telepresence, right? That's another point, like you, as a patient could consult with a remote doctor that might be totally somewhere else but you cannot just hear them on the phone or whatever, you can see them as a hologram maybe in front of you.

Paul - As a matter of fact, we're seeing a ton of that in the United States right now. One of the things that you'll learn the more time you spend in healthcare is that the technology sort of follows the dollars if you will and how a place that would allow the insurance companies to bill for remote procedures including mental health. So now the providers in the hospital systems actually have the incentive to engage in these hybrid care models and reach out to patients right? So when I say hybrid care, I'm talking about this mix of virtual and real world care which I think, you know, to your point metaverse fits nicely with, as that continues to grow out that's where I think, you know, in the hybrid care Telehealth space, you know, that's where we might see the biggest impact with these metaverse technologies.

Rene -Yeah, that's for sure but let's also talk about the kind of adoption, well-known issues but challenges that are likely there, right? I'm pretty sure that you know the whole kind of adoption won't be that easy and that will be also quite some challenges when it comes to policies and regulations but also medical certifications and last but not least also user acceptance in the end. So, what are some of the challenges you see and what do you think, how can we address those?

Paul – Yeah, I think, you know, so there's, I think there's two sides to this. There's the tech side and the non-tech side and I'm probably better off answering the tech side. Like I'm not, you know, you're right, there are some human perceptions about hybrid care and how folks might take that and I'm that I'm just not an expert in that you know but I can talk about the challenges from a tech perspective and I actually think adopting metaverse technologies, you know, again once you get past the human problem from a tech perspective it's not that big of a leap and so what I mean by that is that one of the things that healthcare organizations and hospital systems are already dealing with today is how they can safely surface secure patient data to the cloud and other tools so that providers can collaborate more effectively on treating the patient. At the end of the day, that's what we're all shooting for. First, I should say we want better quality outcomes right, we want that KPI to go up, we want people to think that after they leave the hospital they're satisfied the disease was taken care of the doctor, handled it perfectly etc, right? And so you know, we're already working on a lot of stuff to make that happen. So, for example, there's a huge push in the Industry cloud and Cloud for healthcare. Microsoft has Microsoft cloud for healthcare that's why I spend a lot of my time the last couple of years actually, I'm very passionate about the cloud for healthcare, it's built on Dynamics which sits atop Power Platform dataverse etc. Now, in order to get that patient data out to Cloud for healthcare and these other tools that in itself is sort of the technology problem right, the good thing is, that's been addressed. There's actually some really cool data technologies centered around FHIR, so for folks listening this is FHIR, if you wanted to Google it afterward and essentially FHIR is the data standard that allows you to pull data from your electronic health record and then either synchronize that or surface it with things like the cloud or metaverse. So you see where I'm going with this, it's like once you solve that FHIR problem, and by the way that includes not just data in your electronic medical record but also the metadata that's associated with any Imaging right you're like, your Dicom images from X-ray, radiology, mammography, whatever the technology is Imaging, you need to peel that metadata then you need to get your electronic health Data, FHIR is going to allow you to do that. So I would submit from a technology perspective that's the important part to nail and if you do that, then you're going to be able to take advantage of that data, you know, not only with industry Cloud but with things like metaverse or perhaps both together, that's a real world situation as well where you have industry cloud and cloud for healthcare but then you're augmenting it with things like guides for training or assisted surgery or PPE reduction like we had like we had mentioned. So I guess I would answer in that way. I hope that helps, I'm certainly not trying to avoid the question but at the end of the day I really believe it starts with our data sets you know and getting those in a secure way to where we can use them regardless of whether that's a patient portal in the cloud or you know our metaverse technologies.

Rene – You’re right. I mean this is the foundation we need, like you know, safe and very secure data transmission. For example, I was just writing an article about some rather new technology for security called homomorphic encryption which allows you to basically run certain analytics. I mean not a lot but at this point certain things like certain arithmetic operations, directly on encrypted data and this is super important because like if you think about, like you know, typically also I'm sure like hospitals and so on also have external data processors where they give the data to run some analytics and so on and this is sometimes where leaks happen right and so security and privacy is a core foundation and having the data also in such a format that you can take heterogeneous data sources and bring them together in whatever, I don't know, data lake or I mean you're probably more of an expert in that stuff for sure but make it such that it's homogeneous and can be consumed for analytics.

Paul - Absolutely yeah and so for folks listening, if you wanted to find out a little bit more about this on the Microsoft side, there's a new service called Azure Health Data Services, which is essentially Microsoft's managed service for FHIR and there's some really great learning courses that you can go through as well and again the idea would be to take all the cool stuff that you're learning about here with the meta minutes, you know because it's not just the topic today but it's really all of these topics that Rene is talking about the metaverse piece and then you put it together with this new health data services from Microsoft the FHIR services and by the way you know if you're using another cloud, FHIR exists on other clouds as well. This is not something that you know where you have to be tied to one vendor or not you know, I tend to live more in the Microsoft world than Microsoft cloud for healthcare, so I think of azure services. So again, I would encourage folks listening, if you think this is fascinating, just look up Azure Health Data Services, look up FHIR services and again there's some really wonderful Microsoft learn modules, there's even an architect tech-level class coming out from Microsoft in October, a mock class that will talk about cloud for healthcare and some of these advanced concepts that we've talked about today.

Rene – Wow, this is amazing, thank you also for all the external stuff and you know getting started, if you want to dive a little bit deeper into the technology there. thank you so much Paul, we're already at the end of the show but we could talk for many more hours since very much insightful, but again thank you so much for your time. that was very much appreciated.

Paul - My pleasure, and congratulations and keep up the great work. I love listening to your shows. It's just great stuff, great topics!

Rene - Thank you so much! And thanks everyone for joining us for yet another episode of Meta Minutes, your bite-sized pieces of the metaverse. Watch our blog, follow our social media channels, subscribe to our YouTube to hear all about the next episodes and of course you can always visit our website to watch all the previous episodes. Until then, stay safe, take care and see you soon in the metaverse!

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