.jpg)
The Sim Cafe~
The Sim Cafe~
Exploring VR's Role in Modern Healthcare with Triton Ong of DoxyMe
Curious about how virtual reality is revolutionizing telehealth? Join us for an enlightening episode with Triton Ong, the science lead at DoxyMe, as he takes us on his journey from the University of Florida to the forefront of VR in healthcare. Triton shares how DoxyMe's mission to break down healthcare barriers fuels their innovative telemedicine solutions, and how user feedback is crucial in their development process. You'll hear about the integration of VR technology into their offerings and the collaborative efforts of the DoxyMe team driving telehealth research forward.
Ever wondered how VR could transform phobia treatment or enhance mental health therapies? This episode provides a deep dive into DoxyMe's groundbreaking VR applications for exposure therapy, especially for phobias related to animals like dogs, spiders, and snakes. Triton discusses the extensive research, user testing, and the promising results from their feasibility study. We also explore the broader implications of VR in healthcare, including its potential benefits for gender and sexuality therapy, relaxation, and mental health. Get a glimpse of the visionary 15-year plan for an immersive telehealth platform that could redefine how we interact with healthcare providers.
Website: https://doxy.me/en/
LinkedIn : https://www.linkedin.com/in/tritonong/
Innovative SimSolutions.
Your turnkey solution provider for medical simulation programs, sim centers & faculty design.
The views and opinions expressed in this program are those of the speakers and do not necessarily reflect the opinions or positions of anyone at Innovative Sim Solutions or our sponsors. This week's podcast is brought to you by Beaker Health. Beaker Health is a user-generated and peer-reviewed community educational platform designed for healthcare organizations. We let your community connect and engage with one another freely and efficiently. Beaker Health, where dissemination and measuring impact comes easily. Welcome to The Sim Cafe, a podcast produced by the team at Innovative Sim Solutions, edited by Shelly Houser. Join our host, Deb Tauber, and Jerrod, Jeffries as they sit down with subject matter experts from across the globe to reimagine clinical education and the use of simulation. So pour yourself a cup of relaxation, sit back, tune in and learn something new from The Sim Cafe.
Deb Tauber:Welcome to another episode of The Sim Cafe, and today we are very fortunate to have Triton Ong, and he was recommended to us by Lynn Welsh. So, Trition, Jerrod, hello, hello. Why don't you tell our listeners a little bit about yourself?
Triton Ong:Sure. Thanks, Deb. So yeah, my name is Triton Ong. I'm the science lead at Doxy. Me we do telemedicine solutions, and what's really unique about my position here is that I'm focused science lead at Doxy. Me, we do telemedicine solutions, and what's really unique about my position here is that I'm focused on a lot of the academic and scientific and scholarly research.
Triton Ong:So my background is in psychology, specifically behavior analysis, and I got my PhD from the University of Florida where I studied with Jesse Dallery. So Jesse Dallery was really famous at the time for pioneering a lot of telehealth based behavior analysis for smoking cessation. And you know, back then it was very novel, it was something that hadn't really been tried before and it was very there's a lot of skepticism around that kind of thing. So I was a good fit with his lab. I kind of learned a lot from him and I eventually started to branch into things outside of the psychology world, looking in virtual reality and serious games for healthcare. So this led me to working with Marco Suvacic and Azra Biharatz, again at the University of Florida just randomly kind of found these two people and we started working on applying virtual reality in the intensive care unit. So at the time again very fortuitous timing. We were focused mostly on the patient care experience. You know there's a lot of downtime, a lot of people just kind of in pain, uncomfortable, staring at the ceiling, kind of thing. So naturally we tried to apply VR for them. And what do you know, covid happened and we have this device that's in the intensive care unit in the frontline healthcare environment where also the healthcare providers themselves are facing new challenges and new needs for mental health care. So my career has been very, very lucky and just like random timing so far and everything's really really played out in a lot of favors ways and eventually I started working here at Doxy. me.
Triton Ong:So what really attracted me to Doxy. Me was, honestly, the executive team, because it's a small, for-profit company. But the team created Doxy. Me specifically to overcome healthcare barriers. So Brandon Welch is our CEO. He created this company when he was a poor, little, meager grad student, like all of us were at some point, and he was just really kind of annoyed with how hard it was to find easy to access telehealth for people in rural areas. So he invented his own thing. His whole motto is simple, free and secure, and that's really what we kind of follow now.
Triton Ong:During COVID we had an enormous uptake of usage, obviously because everyone switched to telehealth, because they had to and to kind of continue on our business. That's when I joined the team. I joined Dr Brian Vanell as the director of our research team and Dr Samantha Page, and then also a number of other people who are still at the company that's Hiral Soni, dr Hiral Soni and a lot of other people here as well. So Julia Ivanova, molly Cummins yeah, there's just a lot of people. I want to make sure I get the names, because it's really what I found here is that it's a big team effort to drive a lot of the research that we do for telehealth. There's obviously, you know, we're a for-profit company, we're mostly tech bros, but what really drives us is the motivation to help healthcare providers. So we spend a lot of our time talking with healthcare providers and that's really what drove us ultimately to look into VR.
Jerrod Jeffries:Can you just give us an example, so one who are your users and then to tell us what you started with and then how you eventually got to VR Like? So give me specific examples of use cases from the customer standpoint and the product.
Triton Ong:Sure Great question. So our users are pretty all over the place in terms of their specialty and their age range and their types of patients that they see. So we're kind of to give you the simplest, most direct answer all things telehealth. So we have physical therapists, we have social workers, we have a lot of mental and behavioral health care providers, we have dentists who use DocsM me solutions and even clinical researchers. So it's really all over the place. If, if they're doing healthcare and they need a remote solution that's HIPAA compliant and simple, they kind of use DoxM e. So because we have such a large and diverse network of users, we can kind of sample from them and recruit them for research and help them, you know, get their insights for informing our not only the current products that we have, how we can make these better for people who are using them today, but also what's on the horizon. You know, what do you see happening 5, 10, 15 years from now? What are the needs that the core of the technology is not meeting right now? So one day our CEO, brandon, just kind of on a whim, picked up a Quest 2 headset for him and his kids, right, Because it's a hot new item, it was on sale they were very aggressively priced when they first came out, if you guys remember that back in the day and he knew right away that this was something that needed to be part of telehealth, not only today, but it's something that he believes is something is going to be the future of telehealth, because right now we're here on a Zoom screen and all this stuff, so we're making good eye contact, but it's like it's not the same as the in-person experience. So that's always been the thing about telehealth is that it is a good adjunct, it is a good supplement, it is a good way to deliver a lot of critical healthcare needs when distance is a challenge, when access is a challenge and things like that. But it's missing a lot of that in-person component and there's just no way to do that over webcam. So we're looking to new immersive and innovative technologies to see what is this going to look like in 10 years. As Brandon says, all the time it's skating to where the puck is going, not where it is right now. So now that he had seen that, that's when they hired me and they brought me on board. I have my experience in virtual reality for the ICU and what we did is.
Triton Ong:We started very, very slowly to explore, you know, first off, what does it say in the literature? And we published a pretty recent review of extended reality, specifically how it was used for the COVID pandemic over telehealth not just virtual reality in the clinic, but virtual reality applied over telehealth during the pandemic. And then we also started to interview a lot of our users and we found a couple who were doing that kind of thing. So it's a lot of just like boots on the ground, seeing who the actual innovators are, meeting with these people pushing the front lines and doing crazy innovative stuff and basically seeing like, so what are the challenges that you guys have right? What's wrong with the technologies that you have? How come everyone isn't using this? That's kind of the leading questions that we had and what we found were the major challenges.
Triton Ong:Was there just isn't much content out there for therapists who want to offer VR services. It's not very clear. Like, okay, so if I get a headset, what app do I download? What app do I tell my clients to download? Is there a service that is specifically designed for this kind of thing? Of these services? Which of them have clinical data, things like that? So there's just a lot of like a lack of knowledge in terms of easily accessible, easily digestible information. So that's one of the biggest things that we're working on at Docs Me is really to just produce that kind of clinical data and finding out that kind of thing.
Triton Ong:So really the biggest effort that I've been leading here is partnering with, again, the people who are doing the actual work. So we've been actively participating with Dr Jessica Stone's group. They're the Mental Health and Virtual Reality International Consortium. They are trying to pool together all of this experience, all of this firsthand knowledge, and just share it with each other as clinicians. So they're trying to do that for mental health care. And then there's Dr Mark Zhang at the American Medical XR Association, and then there's also Brennan Spiegel over at the Journal of Medical XR and VMed. So there's all these new organizations popping up around, people who are trying to do this.
Triton Ong:So we know there's an arms race. We know there's a lot of excitement around what this technology can do for healthcare and it's just a matter of getting the information accessible and sharing it in ways that are going to be helping the field to grow. So that's one of the biggest challenges just getting the information out there. Once the information is out there and this is what our phase one grant was for was to explore like, okay, so what are the other implementation challenges of this kind of thing? And the first and kind of maybe only the last thing people care about when we ask them this question is like how much does this cost? Right?
Triton Ong:Everyone in the field right now who's practicing came up in like the previous decades and whatnot, through the educational processes and we saw all these fancy devices that do virtual reality for healthcare and they cost like $200,000. So that's the history that we have to kind of challenge in people's minds who are practicing today. It's like I don't have a million dollars and I can't build a new building for this whole new thing. So the first part of that is really just explaining to people like, okay, do you have a smartphone? Does your client have a smartphone? Because you can put it in a cardboard interface and get like 60, 70% of the way to what you could really want there. So we know there are a number of companies who are already offering services like that and that's really incredible. And now these new technologies that are showing up that are very consumable, these all-in-one headsets from people like Pico and Meta and HTC.
Triton Ong:We think these are the new direction to go in. We do envision a way, a future, where there's, you know, one of these devices in every household, just like a computer or a printer or television and things like that. So we are kind of working to see, you know, partnering with industry, people like Meta and people like lucid reality labs, and we're trying to pair with academics and clinical researchers and practitioners and we're just trying to. We're trying to make everyone join hands. That's that's really what the job is right now is how do we get this to work for everybody? Because we think this opens a lot of opportunities now, and it also what I'm most excited about is the potential care that this can create. That doesn't exist right now.
Jerrod Jeffries:So I want to touch on one thing. You said Triton was, and you said you got a grant One who was the grant from? And then you said it was phase one. So how many? Yeah, tell me a little bit more about the grant piece.
Triton Ong:Sure, sure, yeah. So it was a phase one SBIR with the National Institutes of Mental Health and that was a joint effort between us here at DoxyMe. Me. Me. Me and also researchers at the University of South Florida, that's Dr Brian Bunnell and at the time, his postdoc, Caitlin Schuller. So we really tackled this from an innovative perspective in terms of how can we do this where we're getting good product research, we are really keeping this as close as we can to the people, the end users, therapists and their clients. And then also how can we do this in a rigorous academic manner where we're producing data that is not only useful for our company, not only useful for our product, but can produce generalizable information that we can share with other people who are interested in this kind of thing. So the phase one grant was a really like no brainer thing for us to go for and we're very glad to have gotten it and we're happy to say that we are wrapping it now. Right now we're winding down the phase one activities and we've achieved all of the goals that we propose.
Triton Ong:So the first part of that grant was really to just explore, like, what people want from this kind of technology. We did a lot of interviews, a lot of surveys, a lot of implementation questions, things like that. We kind of worked directly with the developers at Lucid Reality Labs to kind of distill all of those insights down into designs. We then took those designs, made some iterative prototypes, did a lot of user testing, a lot of iterative feedback and things like that from our direct end users. We sent them headsets and everything as a show of our appreciation and just to get feedback on it and we developed a prototype that works for what we need it to be now.
Triton Ong:And then our third part of that was taking that prototype and conducting a small scale feasibility study. So this was I think we had about 30 people randomly assigned to get either our DoxyMe VR or standard tele-mental health for treatment of phobias, specifically for small animals, and what we found is that not only were our methods feasible and pretty sound, but even now, with our janky just trial and error like does this procedure work? We were able to see that the differences between the two groups were really not detectable. We're still analyzing this data now, but what we're showing is that the clinical outcomes are pretty much the same between those two groups, and that's what we're looking to do in our.
Triton Ong:Phase two is now that we have this data, now that we have this app, now that we know that this method is feasible, we're going to do a large scale, fully powered clinical trial to see what this looks like in the real world and how it stands a test of time. We're really excited about that because to have that clinical data I think is the last piece to this puzzle. We have the app, we have the users. We just need to have the piece of paper that shows. You know, this is something that we've tested vigorously and it stands the test of time.
Deb Tauber:So, Trition, what I hear you saying is that you're essentially using simulation in virtual reality to overcome phobias, and specifically to dogs and spiders and snakes. Is that true?
Triton Ong:Yes, that's correct. So we started with exposure therapy because that was the one again based on our previous academic research with our users is the thing that it's the most effective evidence based therapy that is simultaneously the hardest to do over standard telehealth. Imagine like a Zoom call I can show you, you know, I can hold up my phone that has a picture of a dog, I can screen share a video of a dog and things like that, but that doesn't produce the same effect on the client that you need in order to evoke that anxiety response. The whole purpose of exposure therapy is to make them have that anxiety response in very measured, gradually increasing manner. So the whole appeal that we had with VR and why we started with exposure therapy is that it's the most evidence-based application of VR, of any kind of healthcare application out there. It's exposure therapy. So another benefit to doing this is that there are plenty of 3D models already out there for dogs and spiders and snakes. They're already animated. We can put sounds to it. We work with Lucid to make this a really tight, very functional app and it's very scalable so we can add any of the three new models we want in there. We can switch to different rooms for situations and things like that. And the real appeal that you're getting at here, deb, is that this is something that traditionally, to do exposure therapy correctly, I guess to the T with something like a dog If someone's very phobic of dogs, you would need to have them come to your office.
Triton Ong:You would need to have an animal trainer there with a highly trained dog that could engage in certain patterns of behavior and then trust that that animal trainer and that dog and your client and the staff in your office can kind of make this work in a way that's safe and repeatable. So obviously there's a lot of problems with that. It's very difficult, it's very costly. You kind of have to physically alter your office for this one session, for this one client, kind of thing. So even though therapists know this is the best treatment for anxiety and specific phobias, most people don't do it just because it's too difficult to do.
Triton Ong:And that was really like the heartbreaking thing that we wanted to tackle. It's like, okay, can we sort of fix this? Can we take this perfect thing and it's imperfect implementation and can we use new technologies to kind of fix it? And that's what we're finding With our app, with virtual reality exposure therapy, especially delivered with telehealth. Your client doesn't have to go anywhere. They can do this from the safety and security and the comfort of their own home. With virtual reality, you don't have to hire an animal handler and you don't have to worry about whether or not the dog's going to freak out and bite somebody. So, all of these difficulties, all of these caveats, all of these what ifs, we're kind of erasing them and seeing like okay, now that we have it in a virtual format, in a simulation, how does this play out? Does this have the clinical impacts that we're looking for? Is this easy to do? Can we scale this for our users? That's kind of all the questions we're trying to answer all in one thing.
Deb Tauber:That's really fascinating. Now, what other implications do you see this being used for in the future, because it sounds like you had some success with the dogs, spiders and snakes and what other things do you see?
Triton Ong:In terms of simulations, one of the things that's really stuck out is there are a lot of people who are interested in therapy for gender and sexuality, and if you do this in person, you know, you do a lot of role play, you do a lot of talking, you can do some certain therapies where you're like facing a mirror and things like that. But the first step we had to developing our VR app was getting avatars in there, and that was something we didn't really think about when we were doing it. But having someone create what they look like, what body they have, you know, the color of their hair, their gender, the color of their eyes, the clothes that they wear these are things that are relevant to therapies that don't really exist yet, or at least not in a way that you can do without very serious, potentially permanent options like surgery, for example. So we're hearing a lot of people who are very interested in gender therapy using this kind of technology. The other thing about it is just like even simpler is just the ability to relax. This is such a difficult thing to talk about, I feel, here in the West, and particularly here in America, where it's like the taking a break is a very big ask of any random person here. So this kind of goes back to you know what we were doing when I was at the university of Florida, where it's just the ability to put on this device that takes you out of your current environment and lets you focus on your feelings, your emotions, the state of your body and to kind of recenter and to calm yourself down. That is a powerful tool that I think we're just now starting to figure out. There are great apps like Trip, for example.
Triton Ong:Headspace, I believe, is looking into some VR simulations for meditation, and these are awesome things that it's difficult to explain, it's difficult to describe. If you look at a video of someone doing it, it's going to look goofy. But I mean, that's all VR. It's something you really have to experience. It is a device that you put on that can alter your state of mind in a direction that is. It's very fast, it's very efficient and it is something that can create generalizable skills for relaxation and things like that. So the potential to teach these relaxation skills in VR with your client is really what we're interested in.
Triton Ong:That dynamic is, again, one of the biggest focuses of our work right now is that live virtual interaction between the therapist and their client or the doctor and their patient. You know what have you. So it could even be something like one of the biggest things we're interested in is looking at medical imaging. So, for example, take the classic case of, like you got a broken hip bone or something like that. You go into your office, your doctor's office, they put up this big white blob of an x-ray, they point to a bunch of stuff and they say, like, hand it to you and you can look at it. That develops a totally different experience and a level of empathy and understanding that we're really interested in exploring. And it all goes back to what you're saying. There is the ability to simulate anything. We kind of have the matrix now to kind of summarize it all. Whatever you want, we can put it in there, if it exists in a 3D format. So sky's the limit.
Jerrod Jeffries:I love it. I mean, there is so many different avenues and, as you're saying, it's like you're removing so many of the variables that have usually impeded progress or have users or clients have seen previously. So it's a brave new world out there previously.
Deb Tauber:So it's a brave new world out there. Triton, what's your long-term vision? Now, I know when you think about it. Covid was able to really exponentially move the timeline forward, really just jumped the gun on it. But what do you see before people are really using?
Triton Ong:sure, sure. So part of that long-term vision is this assumption we're making that immersive technologies maybe not virtual reality, maybe not augmented reality, but some type of immersive technology is going to be present in every household in the world at some point. So to prepare for that, what we really want to offer is going to be just basically, comprehensive healthcare using that kind of immersive technology that's in your home. So we are looking to build this thing out to be I don't want to say a platform necessarily, but just like a one-stop shop for all things evidence-based, immersive telehealth, sort of like. If you've ever played VR chat and this is I don't like that I'm going to say this, but it's the only words that I have to say this we want to make the VR chat for healthcare Just a thing.
Triton Ong:You start up, you know, you put on this device and then you can go anywhere, you can meet anybody, you can have them meet you. You can, you can do anything in there. That's kind of what we want this to be. And to build this thing out out to be evidence-based. Again, very heavy emphasis on the evidence-based part is going to be a lot of academic research, like we're doing right now.
Triton Ong:So we're taking this very slow. We do have like a 15 year kind of idea of where this is going, but it's going to be based on what providers want first. So we're looking to prioritize that in terms of like what's the biggest need and what's the easiest thing that we can kind of grab and solve right away? Exposure therapy was a starting point, but now that we have the core technology there, now that we have the ability to put a provider and their patient together in VR, now that we have all the infrastructure in place, we can just kind of drag and drop stuff in there as needed and then do some more clinical testing and see how it plays out. So we're really looking to the providers to tell us, like, where do we take this now?
Deb Tauber:Thank you.
Jerrod Jeffries:Yeah, I mean it sounds like a good idea. And the thing is also I mean it's great that you guys have this 15 year strategy or potential vision, but, as we all are seeing, it changes so fast, so it's you gotta be a little flexible as well.
Triton Ong:So but yeah, and I think that's our greatest weakness right now, but it's also our greatest strength. We are not dependent on VR revenue to drive this VR development. Because we can partner with the National Institute of Mental Health, for example, and we have so many good friends in academia, like Brian Bunnell at the University of South Florida, we can kind of sustain this thing indefinitely, even if it's not making us money. So it's really for us like again, part of that 15 year plan is just what do people need and how can we sustain this research into the future? We're really excited for what people bring to us and how we can meet the needs that are not being met.
Deb Tauber:Thank you, thank you. Now, if our listeners want to get a hold of you they have more questions. They want to, or providers want to get a hold of you to figure out how to help their clients with telehealth and virtual reality. What would the steps to do that be?
Triton Ong:Sure, great question, Deb. I think the first place to start would be to go to just Doxy. Me and sign up for an account. All of our telehealth solutions are evidence-based, they are free for life and they are all HIPAA compliant. They come with a business associate agreement by default. So if you want to just see what we have and just check it out, just get an account and just start clicking around. If you'd like to reach out to me directly, you can find me on LinkedIn or just email me at TritionOng@doxyme , and I'm very responsive. I'm happy to talk to anyone about just about anything, and so is anyone else at Doxy. me. So just really, we're waiting to hear from you all.
Deb Tauber:Okay, wonderful, great, anything, any words of wisdom that you'd like to leave our listeners with?
Triton Ong:Yeah, I think if I could ask everyone listening one favor, it would be to engage in more discussions like this. We were chatting about this before we hit the record button, but it's the hardest thing right now is that it's just dark. Everything's happening in the dark. We know there are incredible innovations happening, but I mean, you don't show up on a Google search so I can't find you. We know there are incredible innovators out there who are doing wild things with virtual reality, but they don't respond when we send out calls for research participants to find out what people are doing. So we don't. We literally don't know what's going on.
Triton Ong:So the more we can, you know, partner with associations like International VR Healthcare Association, like MHVR Consortium, like the American Medical XR Association, the more that we can kind of put wind into these organizations, the wider the networks become, and the more information, the more insights we can share with each other. I see this exclusively as growth potential for everyone. I don't think there's anyone competing against anyone right now. So, yeah, just reach out, have more conversations. If you get an email from me, I promise I'm not a scammer. I don't make money based on how much users we have. I'm just trying to learn.
Deb Tauber:So, yeah, reach out All right.
Jerrod Jeffries:Thank you.
Deb Tauber:Well, with that happy simulating.
Disclaimer/ Beaker Health/ Intro:Thanks to Beaker Health for sponsoring this week's podcast. Beaker Health, where dissemination and measuring impact comes easy. Thanks for joining us here at The Sim Cafe. We hope you enjoyed. Visit us at www. innovativesimsolutions. com and be sure to hit that like and subscribe button so you never miss an episode. Innovative Sim Solutions is your one-stop shop for your simulation needs, a turnkey solution.
