How virtual reality helps VA patients in clinical, group therapy

Dr. Shereef Elnahal has gone all in on virtual and augmented reality since joining the Veterans Health Administration.

President Joe Biden appointed Elnahal, the former CEO of Newark, New Jersey-based University Hospital, to serve as undersecretary for health at the VA in July 2022. In his two years running the nation's largest integrated health system, Elnahal has championed the use of immersive technology. The system has deployed more than 3,500 virtual and augmented reality headsets at more than 170 medical centers, a 250% increase from around 1,000 headsets deployed in 2023.

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“Any use case you can think of around connecting veterans to each other is enabled with virtual and augmented reality,” Elnahal said. “We're really proud of what we've done so far because we've really scaled this across our system.” 

The VA's $1.2 billion budget allows it to give veterans the opportunity to use the technology at no cost, unlike other providers and vendors working to get payer reimbursement. Still, its experimentation with the technology — it has more than 40 use cases helping expand its clinical footprint, deal with staffing issues and bring it into clinical workflows — could serve as an example for other health systems looking to emulate the VA's success. 

Virtual reality for clinical therapy

Virtual reality headsets are bought by individual VA medical centers and regional VA health networks, which have varying budgets for the technology. The centers also have different patient populations, which means the headsets are used for different purposes. 

The VA has 24 active pilots underway for virtual and augmented reality. Elnahal said some VA networks and centers use the technology for clinical therapy to help patients with anxiety, post-traumatic stress disorder, phantom limb pain and other common veteran conditions. The technology can simulate serene environments or guide patients in games like archery for therapeutic reasons. 

“The gamification aspect of that is important because it keeps the veteran focused on a goal in the virtual reality game,” Elnahal said. “Sometimes that means lifting up their arm high to do something when the pain before had made them think that they had limited range of motion.”

Virtual reality for group therapy 

The technology also has been useful in group therapy, connecting veterans in rural areas with one another, Elnahal said.

“It's often the case that veterans who've been through the same lived experience as other veterans, who've been through deployments for war and the trauma of those experiences, can often be the most important stakeholder to get that veteran to a stage where they're willing to pursue treatment for post-traumatic stress disorder,” he said.

When the VA launched a virtual reality-enabled peer social network, its goal was to get six medical centers to evaluate 100 patients using the technology. In the first three days of being available to veterans, more than 3,000 patients signed up.

“Our goal is to leverage that social support for those veterans…having them encourage and support each other…away from the loneliness and isolation to bring them into the healthcare system where their more acute and chronic needs can be treated,” said Anne Bailey, executive director of the VA's Strategic Innovation Lab.

Virtual reality buy-in from clinicians

Getting adoption among clinicians and patients has been no easy task, Bailey said. VA clinicians were initially hesitate to promote the technology to their patients and the agency had limited resources to travel across the country to promote adoption. Over time, clinicians have seen how it can improve outcomes and patient engagement, she said.

"That's the challenge with innovation. Sometimes our resources are limited. We have to be scrappy, we have to pull out magic tricks and build community and collaborations," Bailey said. "But what's really driven us the entire time has been that veteran engagement, veteran response and the clinicians seeing a benefit in how they deliver care." 

Clinicians have embraced the technology because it can provide care to veterans, particularly in rural locations, where there just aren't enough clinicians to meet patient demand, Bailey said.

What’s also helped adoption is the VA is able to transfer clinical data from headsets to patients' health records, allowing clinicians to better understand how the therapies are helping patient outcomes and adjust accordingly. 

“As the largest integrated healthcare system in the country, the VA is stepping out and saying this technology is important and it’s making a difference. That means the rest of industry is starting to see the potential,” Bailey said. “How do we make this normal across the healthcare system? The truth is nobody's ever done that before with this technology. And VA is well positioned to be the first to do it.”