Why the VA is leading on virtual reality

Leaders from the U.S. Department of Veterans Affairs told Becker's its use of immersive technology such as virtual reality can inform health systems around the country.

The VA has more than 3,000 VR headsets used by veterans at over 170 VA medical centers and outpatient clinics. More than 2,500 clinicians and staff are involved in implementing and testing the technology. The organization is believed to be the largest health system adopter of VR.

"There are a lot of applications to the broader American healthcare system," said Shereef Elnahal, MD, undersecretary for health at the VA (and former president and CEO of Newark, N.J.-based University Hospital). "There's essentially an epidemic of substance use disorder, but also mental health conditions. And so hopefully we can learn from what other health systems are doing, but also teach the broader American healthcare system why it's so important to invest in this."

So-called immersive technology, or extended reality, has become a big part of the VA's approach to healthcare, with the health system having 40 clinical indications for the digital tools. Worn at home or at the clinic, the headsets can be more cost-effective — running a few hundred dollars each — and carry fewer side effects than traditional medical treatments, which they can also augment.

The VA most commonly uses the technology to treat chronic pain, placing veterans into relaxing virtual environments — like, say, a forest or snowy landscape — accompanied by soothing sounds.

The health system also employs it for the treatment of phantom limb syndrome for veterans who have lost arms or legs.

"As their brain is trying to process the absence of that limb, the response neurologically is to feel pain," Dr. Elnahal explained. "And so what augmented reality can do is actually create a mirror image in real time when the veteran is wearing the goggles and reproduce the leg visually. And the veteran experiences pain relief in a really fascinating way with that technology."

The devices can also make physical therapy more akin to a video game. For instance, veterans might play pinball and see their hands as pinball machine flippers.

"If you've ever been prescribed physical therapy, you get a little tired of doing it the standard way," said Susan Kirsh, MD, deputy assistant undersecretary for health at the VA's Office of Discovery, Education and Affiliate Networks. "This offers a more engaging modality to be able to track the range of motion and work with a therapist and put it into an environment where it's fun."

Veterans also use the headset for therapeutic peer support groups, where they meet virtually in a room with avatars of other remotely located veterans. Dr. Elnahal called it a "more intimate environment for virtual care; otherwise, you're looking at a flat screen when it comes to telehealth."

"I'm a veteran myself; 100% of my care is at the VA. It's different when you're connecting with peer support with another veteran, really having that face-to-face, that lived experience," said Alfred Montoya Jr., the VA's deputy assistant undersecretary for health for operations. Before, "you couldn't have that virtual room of all veterans getting together. You can share those stories and instantly feel at home. That's to me what's so exciting."

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