In this episode, we’re pleased to welcome guests, Gita Barry, President of Immersive Healthcare at Penumbra, Inc. and Thomas Hutchinson, Executive Director of Digestive Health and Experiential Reality at Hoag Hospital, to discuss the future of providers integrating new tools.Learn how to listen to The Hospital Finance Podcast® on your mobile device.
Highlights of this episode include:
- Overview of Penumbra and the REAL System
- Key benefits of VR or immersive therapeutics
- REAL System in the acute care rehab unit setting
- Benefits to patients and providers using VR
- Cost benefits of using this technology
Kelly Wisness: Hi, this is Kelly Wisness. Welcome back to the award-winning Hospital Finance Podcast. We’re pleased to welcome guests, Gita Barry and Thomas Hutchinson. Gita Barry serves as President of Immersive Healthcare at Penumbra, Inc., building on her 25-plus years of medical device, commercial, and development experience. Prior to joining Penumbra in 2016, she worked at Stryker Corporation for 12 years where she held a variety of positions with successively greater responsibility. She’s also held various product development roles with other cardiovascular medical device companies. She received a BS in Biomedical Engineering from the University of Miami in Florida and an Executive MBA from Santa Clara University.
Thomas Hutchinson serves as the Executive Director of Digestive Health and Experiential Reality at Hoag Hospital in Newport Beach, overseeing the development of clinical operations, strategic vision, and physician alignment. He has been with Hoag for more than a decade and progressed through finance, strategy, and now administration. Thomas received his BA from the University of San Diego in Economics and received his MBA from the University of Redlands. In this episode, we’re discussing the future of providers integrating new tools.
Thank you for joining us today, Gita and Thomas.
Thomas Hutchinson: Thank you for having us.
Gita Barry: Thanks for having us.
Kelly: Awesome. So great to have the two of you on today. Well, let’s go ahead and jump in. Starting with Gita, can you give me an overview of Penumbra and the REAL System, both i-Series and y-Series.
Gita: Sure. So, Penumbra is a medical device company, really expanding more broadly into broader areas of healthcare. If you’re familiar with Penumbra products, you might know us as an interventional device company with products that are typically found in cath labs and ORs. But the REAL System is something a bit different. We are working in the area of immersive healthcare, immersive therapeutics. And so the REAL System is this incredible opportunity where we harness everything we know as a medical device company and bring that together with technology. In this case, very specifically with VR, sometimes called spatial computing. And we use that both in the rehabilitation space with our REAL System y-Series, and also in more of a wellness destruction, pain management space with our i-Series product. And so we build a platform technology. We have the technology. We build the experiences, the activities themselves, and we build that into a whole lot of measures and insights because our goal is to be able to help support patients, but also self-support therapists as they continue to look at how to make better and better therapeutic decisions for their patients to advance them on their journey on their overall care journey.
Kelly: Sounds great. So, Gita, what are some of the key benefits of VR or immersive therapeutics in areas like health outcomes, adherence to treatment, and mental well-being?
Gita: What’s great about VR is that it allows you to immerse. So first and foremost, right, if you can get someone into an experience and out of the moment that they’re in, that’s how you get the sense of distraction. There’s all sorts of evidence out in the field, thousands of papers that show the benefit of that concept of immersion for patients. You can do things in VR that you may not realize were otherwise possible, or at least very difficult. Patients, for example, patients at Hoag will tell us that, “I didn’t know I could move my arm that way,” or, “I haven’t seen my arm move that way in so long.” And so our VR technology can help enable someone in one respect to travel the world with the concepts of distraction therapy. Maybe they’re not able to travel anymore, but now they can go back to Paris, and they can remember those experiences and share those with family members and share what they experienced. Or what we do is we’re in the rehabilitation setting, and we’re driving– we’ve got this great tool to drive patient motivation, adherence to therapy. All of that leads to better outcomes. And beyond that, because of our proprietary full-body tracking technology that comes with our y-Series product, we learn. We learn and we learn back for patients. And so what we can do is provide therapists with new information about how their patient is moving. We can give them new measures, new insights to help them optimize the plan of care.
Kelly: Quite fascinating. So, this one’s over to Thomas. How long has Hoag been using VR, and when did you decide to make it, the REAL System, a regular part of care?
Thomas: So, we’ve been using virtual reality and augmented reality at Hoag for almost a decade now. It was first brought to us by Dr. Robert Lewis, who is a neurosurgeon that specializes in pituitary tumors. He realized that if you were to convert CT and MR into a 3D reconstruction of the patient’s brain and tumor, not only could he preplan his surgical approach, but he could also fly the patient through their own brain so they understand their condition and what’s going to happen next when they approach surgery. And the education and retention that it led to from this patient experience was so substantial that we realized we need to expand it beyond the surgical room and into the hospital. And so in early 2021, we decided to roll out across our inpatient platform for patients who are suffering from anxiety or stress or nausea, and really see what the benefit was on those measurements. And over 1,000 patients later, we realized the impact on those scores was pretty significant.
And so we looked at a number of program directors across hospital, from our chemical dependency unit to our palliative care, to our home health industry, and now it’s being deployed across several different programs. But the main one we’re using it for at the moment is in our acute rehab unit and outpatient rehab units, which is the REAL Y System. What we noticed was patients are much more engaged in their rehabilitation program. And even on days where they don’t feel like doing it because they’re exhausted or frustrated, they do look forward to getting into the system and gamifying that rehabilitation process. And so as Gita mentioned, they were able to stretch beyond their preconceived notion of their limits and then the VR system. And that is the benefit. It is a true immersion, and it takes you away from the constraints we put on ourselves mentally. And it allows us to reach just a little bit beyond– a little bit more creative with how we approach healthcare.
Kelly: That’s very cool. And so, Thomas, how are you using the REAL System in the acute care rehab unit in the chemical dependency treatment and employee and caregiver wellness?
Thomas: Yeah. So, with the acute rehab, it is very much the y-Series. We spend about a couple hours each morning getting the patients ready for their exercises. Then we obviously put on the device, and they go about their exercises. And our rehab therapists are able to track their daily improvement, but also share that feedback with them. And so they can see their increased movement. And so it’s become a great addition to our platform and our offering. In our outpatient chemical dependency unit, we actually offer it in a daily group therapy session. And what it’s shown to do, as we’ve taken measurements on, is lower the blood pressure, lower the heart rate, lower the stress, and make people have a moment of relief from their struggles with chemical addiction. And it’s led to a lot of interesting developments such as patients who are so frustrated when they leave. They’ll take 20 minutes in a VR headset and want to stay within the program, although they’ll want to engage with another chemical. But again, 20 minutes in a headset, and they no longer have that desire. And so it creates a brief moment of reprieve that allows them to reset their anxieties and their stresses.
And so as it was so powerful, we said this needs to be part of our program offering. And then for our caregivers, obviously, during COVID and post-COVID, there’s been a lot of stress and pressures put on our healthcare providers. And so as the complexities of healthcare continue to increase, and as the comorbidities of our patients continue to increase, their stresses grow. And by providing 20 to 30 minutes of a relaxation technique via a VR headset, it has shown to decrease their stress and anxiety and their willingness to return to work over the course of a few weeks of very brief immersiveness in a VR headset.
Kelly: Wow. I mean, that is so impressive. So, Thomas, again, what are the benefits to patients and providers using VR?
Thomas: So, for patients, what we’re really seeing now is compliance. When it comes to education or becoming more acceptable to receiving information on how to improve their health, VR has been a great medium to encourage that behavior. And so going back to the inpatient floors, we were getting notes from patients saying, “I wasn’t able to sleep, but after this experience in the headset, I now can rest peacefully,” or, “I wasn’t able to sit up due to pain, but I feel much better, and I can sit up and eat for the first time in two days.” And of course, that starts to translate into cost savings for the hospital. Less days in the hospital. Less pharmaceuticals administered. Quicker turnover times, which if there’s a bad crunch, that obviously leads to a greater return. And similar to our outpatient setting, where in-patients no longer need to leave a program or no longer require an advanced intervention. These are things that are very tangible, both to healthcare administration and to the patient. Again, quicker recovery, better outcomes, less money spent delivering care. It’s really a win-win for everyone.
And then for the providers, what they’re seeing is satisfaction and the patients being more willing to take in their advice and quickly advance their healing process. And so from the program directors that have embraced this VR technology, they’re so enthused about what’s coming. They’re all engaged in quality improvement projects and research trials to really show how VR is advancing healthcare in ways that we couldn’t get patients to do before.
Kelly: That is fantastic. Those are some great benefits. And back to Gita, what are you hearing from doctors and patients from partners like Hoag that are using the REAL System?
Gita: So, we hear all sorts of great things, right? And I think what Thomas has just shared is what we’re hearing. We hear the elements of, “My patients are more engaged. My patients are coming back for these sessions.” What we hear from therapists – because if you think about our rehab product, it’s appropriate for physical therapists, occupational therapists, language therapists, as well as recreation therapists – you hear everyone finding new ways to engage their patients. And a lot of times, it’s about unlocking the patient. Can you get them- can you get them motivated to move them forward? You can have the best therapist, but if the patient’s not motivated, they’re not engaged to do that work, it’s going to be really hard to move them forward in their care journey. What we hear on things like i-Series, Thomas, I feel like this was something that you shared with us. In addition to what you’re seeing is that with something like i-Series on the floor, for example, on a hospital wing type of floor, you’re finding that you also have a little bit more productivity from your staff. Because a lot of that distraction time can allow people to be able to be distracted and immersed in an activity, whether that’s being on a beach, seeing animals on a safari, doing a cognitive activity. That would be time that they would be talking and asking questions of their providers, the nurses, for example, on that floor.
And so what we hear is that it actually makes the staff a little bit more productive. I didn’t think about this. So, I was at the dentist one day and you thought about how much they talk while you’re talking at the dentist, right? That’s all distraction therapy. They’re so used to distracting people. So, I think there’s also these great opportunities to increase productivity in addition to what you get the benefit of from a patient perspective and overall clinical outcomes. Thomas, what do you think? I mean, I feel like I’m repeating what you’ve shared with me, but I feel like that’s been some of the work that you’ve seen as well.
Thomas: Yeah, I’m glad you brought that up, Gita, because it was one of our challenges on the floors, which was to get nurses to use the headsets for patients. And of course, everyone feels like they’re too busy to deliver the headset and give them instructions, which could take a few minutes. But then when they start to see, well, the patients engaged in the headset for 30 minutes, they’re not pressing the call button, they’re not asking for pain medication, they’re not really drawing all the resources from the floor and allowing the nurses to either chart or see other patients, they didn’t realize they now have expanded capacity because the patient is very satisfied in their bed with a headset on. And so yeah, Gita, I appreciate you bringing that up because it is a huge benefit. And similar to the outpatient setting, the staff is no longer overstressed because patients now have a medium to lower their stressors and their anxieties and their fears. And so it’s created a significant improvement in morale, which of course leads to productivity improvements and staff retention. So yeah, both on the financial from a patient side, but also from a staff and HR perspective, it’s been a huge benefit.
Gita: Part of what Thomas just described to us is part of the feedback that we like to collect from our customers so we can make our products even better. A lot of what we want to do is make it as easy as possible for the clinician to be able to jump into the product or for the patient to jump into the product. Thomas and the team at Hoag has been great about giving us feedback. For example, just that, how do we make this as easy as possible to jump in? The benefit of being a platform technology and not just an app on a headset that you’re buying. We have a whole tutorial that allows a patient to jump in if it’s their first time using it. If they’re comfortable with it and they want to jump straight in, they can skip the tutorial. But the idea is to avoid manuals and guide books and a lot of other information. We want to make it as easy as possible for people to get into the system, for the benefits that Thomas just described.
Kelly: No. Sure. That makes a lot of sense. Back over to Thomas, so what are the cost benefits to using this technology?
Thomas: So, I think there’s no reimbursement yet for virtual reality, but I believe it’s on the way because it is proving as a viable stress and pain reducer. And so obviously, that’s got implications for pharmaceutical applications. So, we have seen and tracked, are we reducing the prescription of opioids versus say a Tylenol based on their pain scores? And the answers that we found internally were yes. And so there is definitely a cost savings from a pharmaceutical perspective as well as a length of stay. But what we’re finding, and I think, to go back to Dr. Rob Lewis’s perspective is patient retention and interest in the program. So not necessarily cost benefit, but actually potentially a revenue generator by patients willing to stay at Hoag because they’ve had a great experience or they now fully understand their condition. Patients talk to me about the programs and how we’re utilizing VR to augment what we’re offering. We’ve seen a significant increase in market share due to these immersive therapies and immersive education events. And so, for a cost benefit, definitely some tangible, but from a patient retention and growing market share and awareness, it’s been pretty substantial.
Kelly: That’s great. And Gita, how is emerging tech like VR changing healthcare for the better?
Gita: So, I think of it as like any other tool, right? So, the first thing I think is to think about it as not so much about VR, but it’s about having a technology that can help. Because if there were different technology that could do those same things, I would advocate for it. Like new tools, it provides a whole opportunity for providers to think through their creativity in treating patients. Sometimes it’s as basic as having something new and having something different to offer, which is both motivating to the patient as well as to the therapists, the nurses, the providers who are using the product. What’s unique about virtual reality is that you can do things that are usually impossible or maybe not as easy to do. The example I love to provide, specific in rehab with our REAL System y-Series, is that we can throw things at the patient in virtual reality. You can’t really throw things at patients in real life and do that effectively. We can also do things that occupational therapists do today, but they’re not always the easiest things to accomplish. So, we have an activity, for example, called shower sanctuary. A patient can practice bathing. This is a really important activity of daily living that can be very important to our neural rehab patient, for example.
You can imagine the concept of trying to take a patient and ensure that they’re ready for a shower. There are lots of great ways that occupational therapists do that today. Occupational therapists get so excited by seeing our shower sanctuary opportunity because they go, “Oh, I can use this as an assessment. I can use this as a way to see, is my patient ready for that experience when I do that in the shower?” Because you’ve got modesty issues. You’ve got challenges with just the mechanics of getting someone into the shower setting. So, we can do a lot now that is something that’s not as possible to do. Or we can make that easier to do in terms of gauging, is the patient ready with something in virtual reality? It’s a whole new way of thinking about care by doing that work. We can also expand the sites of care. So again, we can bring the technology into the home. Virtually, we can get patients to get out of their hospital room. So, you get different ways to get patients to think about doing work. And I can’t say enough about the insights to help improve decision making. It’s all great if it’s all fun and games, but the differences of what we’re starting to bring, particularly with our y-Series product, with the proprietary full body tracking, is we can give you more information that currently a therapist has to eyeball about the patient. And they trust their eyeballs. We want our therapist to trust their eyeballs. But if we can give them a little bit more information, we can help them along that path.
For example, we can show them how the patient is balancing. What does sway look like with that patient? That’s something that’s harder for a therapist to do with their eyeballs. Many are great at it. Many might like this as an additional tool. And so we have all sorts of great additions to the product that are either in the product today or that we’re working towards in terms of balance and other ways to manage patient trunk control, for example, if you can see how much a patient is leaning more to the right or the left. You now can have that information. And if you wanted that patient to be more one direction or another, you can choose different activities because you can actually review that with the patient and say, “Hey, look, we were really too far to the right today. Let’s spend some more time really challenging your left from a trunk control perspective.” So that’s what we can do with unique technology like this. And it’s about elevating that experience for both the patient and the therapist, the patient and the provider, whether that’s wellness, distraction, rehabilitation. That’s the benefit of what we’re doing here. Otherwise, it’s just fun and games. And it’s got to be more than fun and games for folks like Thomas to be excited about technology like this.
Thomas: And Gita and Kelly, Gita actually reminded me about something. So, for our acute rehab unit, we actually have a physical car on campus for patients to practice getting in and out of, right? And that was how we differentiate it. We offered saying, this is a functional movement you need to do to demonstrate that you are moving in the right direction, and you can do these basic necessities of life. And that goes back to your shower example. And so, this is where the excitement of virtual reality comes, is now we’re really able to scale these immersive and really physical experiences for patients, and chart how they’re improving, chart their deficiencies, and really pinpoint where we need to focus our attention. And as Gita mentioned, as we start to move in the home environment, this is where maybe the true cost savings comes, where you don’t need to build more expensive licensed facilities, but you can now outsource it to the home environment. And you can do more remote work and get more patients engaged with your programs. And so that’s where we see this going, and that’s why we’re so excited to be participating in virtual reality and to be partnering with a company like Penumbra, who’s very engaged in co-developing material and making sure we’re taking care of our populations in the best way possible.
Kelly: It’s certainly exciting times. To conclude, Thomas, any other thoughts on VR and its potential at the health system level?
Thomas: We’re so excited for this technology, and we know how much it’s going to change healthcare. Our biggest hurdle right now is actually to what Gita said originally, which is it’s an immersive experience in getting patients, providers, and staff to just try on the headset to experience what we’re talking about. It’s very difficult to describe and generate excitement until they put on the headset and then they get it, right? You have to try it to understand it. And so, we’re creeping towards that tipping point where it’s going to be shown to be super effective across all our programs and platforms, from patient retention to patient education, to staffing satisfaction, to physician engagement, to compliance. The entire world of healthcare will have some interaction with VR or AR as it continues to grow. And we’re just excited to see where it goes and to help push these applications forward.
Kelly: Definitely. Like I said, very exciting times. Well, thank you so much for joining us today, Gita and Thomas, and for sharing your valuable perspectives and knowledge on this very interesting topic.
Thomas: Thank you for having us.
Gita: Thank you, Kelly, right, and thank you, Thomas. Again, Penumbra can make the technology, right, but it takes systems like Hoag Health, visionaries like Thomas, like Dr. Rob Lewis, to see the value of this and to help really bring technology like this to patients and providers. We could not be more thankful for the partnership with Hoag.
Kelly: Sounds like a great partnership. And if a listener wants to learn more or contact either of you to discuss this topic further, how best can they do that? Gita, do you want to go first?
Gita: Sure. So, more information about the REAL System, you can go to https://www.realsystem.com/, or reach out to me on LinkedIn – Gita Barry, G-I-T-A, Barry, and would love to hear from you.
Kelly: Thomas, what about you? How can people reach out?
Thomas: I think my Hoag email is probably the best way to reach out. It’s email@example.com. We’re, as an organization, very excited to share our practices, share how we deploy things, share our challenges, and then ultimately resolution with our quality assurances department, our infection prevention department. But we’re looking for other collaborators in healthcare to really push this forward because it is the future. And the more we all work together, I think the faster we’re going to make this happen.
Kelly: Most definitely. Such a great topic, and thank you both again. And thank you all for joining us for this episode of The Hospital Finance Podcast. Until next time…
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