The Department of Veterans Affairs has increasingly been using immersive technologies, like augmented reality and virtual reality headsets, to supplement healthcare offerings for retired servicemembers, but a VA official says the use of these tools outside of agency medical facilities for clinical purposes will eventually warrant additional ethical and privacy considerations.
VA has over 40 active use cases of AR and VR, with the department using the tools to aid in their delivery of clinical care for suicide prevention, PTSD treatment and other medical conditions. The approach, which accelerated during the COVID-19 pandemic, is now used at more than 170 of the department’s medical centers. The department said it currently has approximately 3,500 VR headsets.
Caitlin Rawlins, who works in the Veterans Health Administration’s Office of Healthcare Innovation and Learning as the director of clinical technology innovation, has been one of the co-leads of VA’s immersive technology efforts for the past eight-plus years. Speaking at an AR/VR conference on Tuesday, Rawlins said many of these patient-facing uses “include avatars and [non-player characters] for things like peer support, for things like in-vivo exposure therapy.”
When it comes to exposure therapy for veterans, Rawlins said “you can do that in a very realistic way inside of a VR headset, where the clinician can actually control the environment, they can monitor [the veteran’s] vital signs and how they’re reacting to the environment, and do so in a safe and very mobile way.”
She laid out a scenario where a veteran might have to deal with an aggressive waitress and said “you can really get real reactions to things that are in those virtual worlds.” Rawlins added that these tools are meant to supplement the work of clinicians and are not intended to supplant their roles in the healthcare process.
VA has also been using AR and VR for training and education purposes, including for department staff when it comes to sexual harassment prevention and firearms safety, “where we’re able to do more roleplaying and teaching people to have more productive conversations around different topics.”
As the use of these medical-related technologies moves out of clinical settings into private spaces, however, Rawlins said VA and other healthcare providers will likely have to address novel data privacy questions.
While she said current data privacy laws and protections for patients’ personally identifiable information cover uses of the tools in medical centers, “even in the eyes of the VA, if that data is being captured outside of a VA facility, it is no longer considered VA-owned data.”
“So we don’t have the same control over it in the way that we do for things that are captured inside of a medical center,” she added. “And that’s, I think, a really important thing to point out, because then it becomes more of an ethical consideration.”
Rawlins said clinicians who provide AR and VR tools for patients to use in their home have a responsibility to make sure they are aware of what data is being collected, where it will be stored, who has access to it and what they are using it for — “including if their VA clinician has access to it, and what they’re going to be using it for in terms of their healthcare.”
She added that it is an ethical concern that should be considered regardless of any rules or regulations that might be implemented in the future.
“I think that’s something that we absolutely have to consider as we start spreading out more, especially with healthcare applications of the technology that’s going into patients’ homes and potentially capturing [personally identifiable information], that is patient-generated health data, but that our patients may not be fully aware of what’s being captured and how it’s being used,” Rawlins said.
Some devices already give providers the opportunity to remotely monitor their patients, such as pacemakers that can transmit data back to medical offices.
The Trump administration also announced at the end of July that it secured support from more than 60 medical and technology firms for an initiative designed to make health data shareable and interoperable across different tools. The effort includes, in part, a push to make the use of digital health technologies more accessible to Americans.
