Q&A with the community
An inside look at the important work being done by graduate students across the country at the intersections of immersive technology and healthcare.
Q&A with Christy Cheung

Christy Cheung

PharmD Candidate, Pharmacogenomics & Digital Health

Christy is a 2019 Pharm.D Candidate at the University of British Columbia in Vancouver, who has an interest in learning how to work with technology to disrupt healthcare from within.

Background
Q: One-liner. Tell us a little bit about what you're currently working on.
A: Getting ready to explore the pharmaceutical industry and to immerse myself in healthcare innovation/technology. 
Q: Do you remember your first-ever VR experience? Where was it, and what was it?
A: My first ever VR experience was using the Oculus Rift and Touch to play a game, but prior to that, I was exposed to VR technology through a digital health conference, in which the presenter introduced the idea of VR medical simulation and training.
As a second-year student then, I was intrigued by the integration of technology into the clinical setting, but I struggled to find concrete real-world examples. When I saw that demo, I was instantly drawn in.
Q: How did you first become interested in using VR in your particular healthcare setting?
A: We are visual creatures by nature. Benefits of VR in education have been elucidated, and include increased engagement, reduced misinterpretation, better understanding of complex theories, and increased memory retention.
This does not only apply to education in the classroom setting, but also broadly to other fields. In healthcare practices, and particularly in the pharmacy profession, we are responsible for counselling patients on their medications and medical conditions. Non-adherence to medications accounts for a large proportion of hospital visits, reasons for which include lack of proper education, especially in complex treatment regimens. It is not difficult to empathize with the patient, recently admitted to the hospital for a myocardial infarction (heart attack) and discharged with five brand new medications.
You can only imagine the immense frustration and lack of motivation upon the patient’s return home. Perhaps, then, we should leverage the use of enhanced visual (and auditory) cues to guide a patient on their medication journey?
Let's talk about your work
Q: Why is right now an exciting time to be involved in using VR in a clinical setting? 
A. Healthcare lags behind all other industries. We have been slow to adopt technology in the clinical setting and, in many ways, we still are.
Having said that, there is an incredible movement of healthcare professionals, computer scientists, entrepreneurs, designers, and others, exploring the intersection of healthcare and technology. It is no question that there is potential for technology to improve patient care.
Virtual reality technology was born into the industry of game design, but it has taken on somewhat of a career switch. There has been a growing body of work looking at applications of VR in Alzheimer's Disease and dementia, but there's more.
From creating social interactions to support children with an autism spectrum disorder to inhibiting the brain from processing pain responses in hospitalized patients, VR continues to blossom in the clinical setting.
Q: What is it about VR in particular that makes it a good fit for what you’re doing?
A. The benefits of VR are widespread. I mentioned that educating patients is integral to medication adherence and I believe that VR is a useful tool that pharmacists can use as they explain the medications to their patients. Counselling patients at the counter involves more than what the medication is for and its directions for use; it requires a mention about potential drug- and food-interactions, side effects, what to monitor for, and how to manage side effects should they occur.
Pharmacists are well trained in providing medication knowledge, but oftentimes, it can be miscommunicated or misinterpreted by the patient. We can just as easily list all the side effects the patients should watch out for, but even if we use layman’s terms, can our patients really grasp what is cause for concern? How can we employ technology like virtual reality to help patients better understand the medications they are taking and what the medications do to their bodies?
Oral medications may be simple to understand, but how about self-administered injections or inhalers for asthma and COPD? It becomes even more crucial that patients learn how to use proper technique when they go home. If in the community pharmacy, patients could be guided by a VR experience on how to perform a subcutaneous injection or how to use a certain inhaler, this would lead to improved adherence to the medication, not to mention, increased comfort and confidence by the patients.
Q: What do you wish your peers and others knew about VR that might be commonly misunderstood or misleading about the technology’s capabilities?
A. In healthcare, we have traditionally been skeptics of the use of technology in our day-to-day practice. Many clinicians, still, are quick to dismiss the potential of emerging technology to support patient care.
Last year, Amazon acquired PillPack, which seemed to cause a seismic wave across the profession of pharmacy. So, are automated dispensing machine soon to replace the job of community pharmacists? The entrance of the mammoth technology companies like Amazon, Apple, Microsoft, and Google, into healthcare is certainly causing disruption, but I would argue that it only provides opportunities for pharmacists to do what they were trained to do, - medication review, address drug interactions, optimize chronic disease management, - and not the dispensing role that we are often still perceived as.
While I have not encountered any misconceptions about virtual reality in my interactions thus far, I do believe that more clinicians should be open to using VR technologies as adjunctive tools in their practice. Whether it is used to improve education of patients about their conditions and medications, or simply as a method of distraction for children receiving vaccinations, VR has broad applications in healthcare, and I believe that VR can truly enhance a patient’s journey within the healthcare system.
Q: Any teams or individuals stand out whose work has inspired some of your thinking?
A. IKONA Health was the first that I encountered, boldly bringing virtual reality technologies into healthcare, and differentiating itself from others by always thinking from the patient’s perspective. Their vision grew from a personal patient experience and they never lost sight of that, which is apparent in their work. The team is passionate. They frequently interact with patients and healthcare professionals to understand the challenges that lie within, and they are determined to use interactive technologies to empower the patient and their healthcare providers.
Onward. What might the future look like?
Q:  Do you think there are any underserved areas within healthcare where VR has the potential to make an immediate impact?
A. Anxiety and depression are commonly associated with a number of chronic conditions. This can arise from some inherent physiological disorder in the body, but oftentimes, it is the result of prolonged frustration with managing the disease and the eventual loss of hope.
While medications do play an important role, it is not the only answer. For example, it has been proven that combining pharmacotherapy with behavioural therapy is superior to either of those options alone in select mental health disorders.
Studies of all kinds are underway to assess how VR can fit into a patient’s psychotherapy to alleviate mental health symptoms. I see a future in which VR technology, when co-prescribed with treatment modalities, will help stabilize a patient’s condition more rapidly.
Q: It seems like mass adoption is eternally just around the corner. Are there any catalysts that you think might help get us there a bit faster? (regulatory, hardware, new industry entrants, payers, geography, etc)
A. It begins with early adopters and innovators, who see the value in bringing VR applications to clinical practice. Eventually though, we reach a bottleneck, comprised of regulatory bodies, which require substantial convincing before widespread adoption.
In healthcare, we live in an era of evidence-based medicine. While the World Health Organization recently published the first-of-its-kind guidelines on digital health interventions, the main obstacle is a lack of robust clinical trial data.
Groups like IKONA have been actively engaging with the healthcare community for some time and with continued persistence, coupled with increased awareness, I am confident that we will be able to initiate clinical trials with VR technologies in diverse institutional settings. VR has already, and continues to show great promise across a spectrum of diseases. Now, we just need to prove its benefits.
Q: Okay, here’s the ‘there-is-no-box’ question: what’s your vision for the potential of VR’s role in the future of healthcare?
A. The sheer number of VR startups in the healthcare field speaks not only to its versatility, but also, to its potential. This very technology brings about immersive experiences for the user, which in our industry, includes the patient, their caregiver(s), and anyone along the healthcare continuum with whom the patient interacts. You can only imagine how many people VR can impact.  
Dr. Anand Veeravagu, head of the Stanford Neurosurgical Simulation Lab referred to VR as "a window into the brain - and a window into the brain of the particular patient [being operated on]."
Analogous to the rest of medicine, gone are the days of a one-size-fits-all treatment approach for patients.
Virtual reality helps clinicians individualize therapy with greater certainty and it gives patients the confidence they need to manage their disease. And with that, transforms the way we practice and understand healthcare altogether.
Q: You made it to the end.  You also might have inspired some people out there who are now reading this. How should they get in touch with you?
A. Feel free to get in touch with me by email, through LinkedIn, or through my personal blog.