Abstract
There will always be those who sound the alarm as soon as a new technology threatens to change daily life. Sometimes, this hand wringing is warranted; other times, the worries amount to nothing. Most often, however, it is a complex mix of the two: new technologies arrive with both pros and cons.
When it comes to the rapid transition to a computer-based society, most have eagerly embraced the daily conveniences and improvements brought about by technology. Yet, legitimate concerns do exist. Particularly, healthcare professionals often note the negative impact that increasing use of computers has had on the health of individuals across age groups. As all aspects of society from school to work to entertainment to commerce to transportation transition online, people have gravitated toward an increasingly sedentary lifestyle.
A 2019 paper in the journal's special issue on augmented reality (AR) 1 revealed that the health consequences of this reduced physical activity can be serious. As of 2015, only about a quarter of high school students and adults met recommended exercise guidelines, and it is well known that physical inactivity increases the risk of serious health conditions such as coronary heart disease, stroke, hypertension, and osteoporosis.
Nonetheless, as with most technologies, this move toward living life—at least in part—in an immersive online world is not all bad. Many technology proponents are hailing the development of this type of world (called the metaverse) as a harbinger of a golden age for both physical and behavioral healthcare.
Exactly What Is the Metaverse
Sci-fi author Neal Stephenson coined the term “metaverse” in his 1992 cyberpunk novel Snow Crash. 2 Thirty years later, the metaverse—the immersive sequel to today's text-and-picture-based Internet, a seamless merging of the physical and digital worlds—is being heralded as the future of the online experience. Taking advantage of artificial intelligence, AR, virtual reality (VR), and ever-increasing connectivity (such as 5G networks), the metaverse promises to provide online environments that are more immersive, experiential, and interactive than those of today. The metaverse aims, through two-way interaction between the virtual and physical worlds, “to become the most advanced form of human–computer interaction allowing individuals to act, communicate and become present in digital and digitally enhanced physical environments.” 3
Tech titans have embraced this concept wholeheartedly. Mark Zuckerberg, the founder of Facebook, is so certain that the metaverse is the way of the future that on October 28, 2021, he renamed his firm “Meta” and committed to putting $10 billion into its metaverse division to signal a focus on this new world. 2 Microsoft too is integrating VR offices and avatars into its “Teams” remote collaboration software. 4
Games Are Leading the Way
Tech companies are eager not to start from scratch though. Many have recognized that online games already have a head start on both creating the infrastructure and accumulating massive user bases to be successful in the metaverse. For example, games such as Roblox, Minecraft, Fortnite, Animal Crossing, and World of Warcraft have already proven that immersive virtual worlds can be both popular and profitable. Consumers spent $178bn on video games in 2020, and these players are already primed and ready to spend their hard-earned cash on virtual property. Around 75% of the industry's revenue comes from games that allow the sale of virtual goods such as clothes for players' avatars. 2
In January 2022, Microsoft announced 4 that it was nearing a $70 billion deal to buy Activision Blizzard, the video game publisher of World of Warcraft and other top-selling games. This purchase indicates that Microsoft, like other tech companies, predicts rapid growth in the virtual space and is betting on video games to position themselves favorably as the metaverse develops.
Beyond simply attracting players to increase profit margins, games such as those mentioned above, and the firms that now own them, have important roles in shaping both what the metaverse will look like and what it can and will be used for.
Metaverse for Healthcare
Although healthcare providers have begun to embrace digital alternatives to in-person treatments such as apps and VR, overall, they have not historically been early adopters. 5 On the user side, however, the online games industry has created scores of consumers for whom virtual worlds are already an established cultural norm. The early adopters of virtual healthcare products and services will be those who already participate in the space today: gamers, coders, and remote workers who are comfortable operating in virtual worlds. 4
The COVID-19 pandemic helped to usher in a new era for both healthcare providers and consumers, necessity encouraging them to become comfortable with remote options of receiving healthcare online such as telehealth visits and home delivery of medicines. This has shifted how patients interact with providers, how they access information and care, and how they buy medical products and services.
According to futurist Bernard Marr, the metaverse has the potential to impact healthcare due to the convergence of three major technological trends: (a) telepresence, (b) digital twinning, and (c) blockchain. 6 These three concepts could come together to create entirely new means for delivering care, potentially lowering costs and vastly improving patient outcomes.
Telepresence for Telemedicine
The technology around telepresence, the ability of people to “be together” virtually even while apart physically, has boomed in the past year or two, largely because of the pandemic, and much of this advancement has occurred in the field of healthcare. Before 2020, just 43% of healthcare facilities had the ability to provide remote treatment to patients. Today, mere months later, that figure is hovering at 95%. 6 In other words, in an extremely short span of time, the vast majority of healthcare providers have developed the ability to treat patients from afar.
One key technology that has been enabling next-level immersion for decades is VR. The immersion (the sense of “being there”) provided by VR enhances the experience of telepresence, allowing both patients and their providers to interact naturally, just as they would in person. It follows that as technology becomes more accessible to the general population, and more people already have VR hardware and software in their homes as part of gaming systems, a greater population of clinicians may soon begin recommending that patients use VR at home as part of their ongoing treatment.
This is an exciting concept for behavioral health especially. Decades of research has shown that for many patients, lasting change happens when they are able to confront the situations that cause them distress and learn how to cope with them constructively with the help of a therapist. 7 The use of advanced technologies such as VR can make this type of treatment especially effective and convenient, creating an intermediate step for patients before they feel ready to participate in real-world exposure sessions.
However, it is important not to get caught up in the enthusiasm for the in-home availability of telepresence technology. If patients are left to their own devices and are thrown into the fully immersive world of VR without support, they may be unable to manage their anxieties in a healthy and effective way. This is where the metaverse can add value. As the metaverse materializes, healthcare providers can begin to engage in therapy with patients in the metaverse and only after that have them practice on their own, eventually translating coping skill sets to the real world. The metaverse can serve as a transitional stage between current in-person VR therapy sessions and real-world experiences.
Winning with Digital Twinning
A digital twin is “a virtual model, or simulation, of any object, process, or system, generated using real-world data, for the purpose of learning more about its real-world counterpart.” 6 In the case of the metaverse, online immersive video games are already hosting millions of people in online platforms with realistic graphics, massive world maps, and commerce systems built in. Their sophisticated software “engines” can act as general purpose simulation software, creating a common language in which 3D worlds are built, allowing outside firms and individual users to craft their own items and environments within the metaverse. What better foundation to build upon to bring healthcare online.
In the case of exposure therapy within the metaverse, the digital twin could be a version of a patient's classroom or office, or even a visual reproduction of patients themselves. In the metaverse, there is the opportunity for healthcare providers to truly accompany patients into specific individualized environments, thus enhancing the efficacy of treatment.
The Blockchain Building Blocks
Healthcare is a field still in the Dark Ages in some ways when it comes to technology, with its fax machines and paper forms. Healthcare leaders have expressed concerns about privacy, ethics, and safety as healthcare moves online. This is where another metaverse technology—blockchain—can help. Blockchain is defined as “distributed and encrypted databases that allow data to be stored and transferred securely in a way that no one except the data owner can tamper with.” 6
In healthcare, blockchain's most obvious use would be in the management and security of individual health data. Unlike reams of paper or transfer via unsecured email or online portals, blockchain could allow patients to own their medical records on a secure personal file. Purportedly blockchain is unhackable, yet it is simple to give consent to any clinician anywhere in the world to review the records with the click of a button.
The metaverse, with its capabilities for immersion, customization, and security, has an important role to play in the future of healthcare, allowing for the proactive prediction, prevention, and treatment of health concerns, leading to better patient outcomes. There may be quite a few obstacles to overcome, particularly around people's attitudes toward the idea of receiving healthcare online, but with video games already hosting millions of people in online platforms, at-home gaming technology may well be the key to unlocking the future of online healthcare.