An interview with Adrian Leu on the role for creativity in healthcare

Given the launch of products such as the Samsung Gear VR or Pokemon GO, many of us are experimenting with developments in technology such as Virtual Reality (VR) and Augmented Reality (AR) to both create, share and consume content. One of the challenges in Digital Health when it comes to creating an app is where the expertise will come from for building it? It’s an even bigger challenge if you want to find organisations who can build cutting edge VR/AR experiences for you. I strongly believe that the health & social sectors would benefit significantly from greater engagement with the creative sector. Here in the UK, it’s not just London that offers world leading creativity, it’s all around the nation. 

Now in my own personal quest to understand who can help us build a future of Immersive Health, I’ve been examining who the leaders are in the creative sector, and who has a bold enough vision for the future that could well be the missing ingredient that could help us make our healthcare systems fit for the 21st century. I was at an event earlier this year in London where I heard a speaker, Adrian Leu, talk about the amazing work they are doing in VR. Adrian Leu is the CEO of Inition, a multidisciplinary production company specializing in producing installation-based experiences that harness emerging technologies with creative rigour.

So I decided to venture down to their headquarters in London, and interview Adrian.

1. Inition – Who are they?
We are a multi disciplinary team, and have built our reputation looking at new technologies before they become available commercially and how these technologies can be combined to create creative solutions. We are quite proficient in creating experiences which combine, software and hardware. We’ve done many firsts, including one of the first AR experiences. We also did the 1st VR broadcast of a catwalk show from London Fashion Week for Topshop.

We have a track record of over 13 years and hundreds of installations in both the UK and abroad, and we are known for leveraging new technologies for creative communications well before they hit the mainstream; We have have been augmenting reality since 2006, printing in 3D since 2005, and creating virtual realities since 2001. There aren’t many organisations out there who can say the same! We have also combined 3D printing with AR. I’m really proud that we have a finely tuned mixture of people strong on individual capabilities but very interested in what’s happening around them.

We work as an integrator of technology in the area of visual communications. Our specific areas move and shift as the times change. Currently we are doing a lot of stuff in VR, 2 years ago we were doing a lot of AR. Whilst others are talking about this tech, we have tried a lot of them, and we know the nitty gritty of the practical implementations.

We’ve worked with many sectors: pharma, oil/gas, automotive, retail, architectural (AEC), defense and aerospace, and the public sector.

2. What are the core values at the firm?
People are driven here by innovation, creativity, things which have a purpose, and at the end of the day, a mix of all 3 elements. The company was actually founded by 3 men who came from a Computer Sciences and simulation background. It has been run independently for 11 years, then acquired by a PLC 4 years ago, and one of the founders is still with us. Since last year, I have been CEO. My background is data visualisation, my PHD was in medical visualisation, where I was using volumetric rendering to reconstruct organ representations from MRIs.
3. Which of your projects are you proudest of?
Our work with the Philharmonia Orchestra and the Southbank Centre is one of them. This was the 1st major VR production from a UK symphony orchestra. In fact, there is a Digital Takeover of the Royal Festival Hall taking place between 23rd September and 2nd October 2016. What’s interesting for me, is the intersection of music, education and technology. If you really want to engage young people with classical music, you have to use their tools. It’s a whole narrative that we are presenting, it offers someone a sight of sounds, what it feels like to be in the middle of an orchestra and be part of their effort to bring the music to its audience.

The other project is our live broadcast of the TopShop catwalk show at London Fashion week 2 years ago. It was filmed in real time at the Tate Modern, and broadcasted to the TopShop flagship store on Oxford Street. Customers won the chance to use VR headsets to be (remotely) present at the event from the store.

For me, what both projects show is the power of telepresence and empathy.

4. Many people believe that VR is only for kids and/or limited to gaming - how do you see the use of VR?
Well, a lot of VR is driven by marketing at the moment, and as a point of entry, VR will be used to go after the low hanging fruit. There is nothing wrong with that. Any successful project will have to have great content, not to see any wires, invisibility, to have a clear purpose, an application and ultimately, a sustainable business model. 

For example, if you are in the property industry, if you allow clients to see 50 houses in VR, they won’t make the decision from the VR headset, but they might filter to 20 from the 50. So it will impact the bottom line.  The connected thinking is not yet done, it will come.  I can see VR being used in retail, i.e. preparation for new product line. You can recreate the retail store in VR, reducing the costs with remote presence.

5. What are the types of projects you’ve done for healthcare clients to date?
Most projects were about the visual communication of ideas, of data or the visual impact of drugs on people. Or at a conference, we helped showcase something that is interactive or engaging, for example, recreate a hospital bed, where there is a virtual patient, and you can see the influence of the drugs through their body. 

Another project we did was showing how it feels to have a panic attack - to help a HCP understand what a patient is going through (in terms panic attack). There are lots of implications from VR, the first technology that could help to generate more empathy for patients. We’ve also done work with haptic and tracking technologies. One example is our work with hospitals and university departments, we tracked a surgical procedure, right down to tracking finger movements, the way a student does a certain procedure and compared that to a certain standard. Thus giving them the opportunity to practice in the immersive environment.

6. What are your future ideas for the use of immersive tech?
Let’s return to empathy. You can create virtual worlds, that someone living with autism may be able to understand, where they can express things. It’s about really understanding what someone is going through, whether it’s curing of phobias or preparing soldiers to go into war.

7. In the future, do you think that doctors would prescribe a VR experience when they prescribe a new drug?
It's the power of the visual communication. I don’t see why we couldn’t have the VR experience as THE treatment.

8. What do you think is coming in the future, above and beyond what’s here today?
Haptics? Smell? The ability to combine physical stuff with the virtual stuff, where you can even smell and touch in a virtual world. An interesting experiment would be to see what could happen if we were expecting something but in VR we had something else, how could it hit our brain?

I can imagine a future where we could superimpose, diagnostic and procedural led images onto the patient. A future where a neurosurgeon would use AR to project 3D imagery from MRIs or CT scans in real time over the brain to  be guided by the exact position of the tumour during to surgery. It’s only a matter of time before this can be available.

9. Who will drive VR/AR adoption in healthcare?
It will be consumers, since that’s the big change we have seen this year, in terms of technology that is becoming available to the man on the street. People will become more accustomed to the tech, we can see that lots of startups are focusing on this, and in the end, I expect the NHS will be looking into this as a strategic priority.

We understand that adoption has to be research driven, there is a need for solid evidence. We are actually part of a European project called V-Time, as a technology partner along with the University of Tel Aviv, and it’s for the rehabilitation of elderly people who have had a fall. It consisted of a treadmill, their feet tracked and in front of them was a big screen. They would have to walk on a pavement in a city, from time to time, facing a variety of virtual obstacles which they have to avoid. The system was analysing how well they were doing that.

10. If a surgeon is reading this, and you wanted to inspire them to think about immersive tech in their work, what would you say?
My father was a surgeon, and he was very empathetic with his patients. He always treated them like they were part of his family. He was always taking calls at night from the patient’s relatives.

If in the future, we can create technology, where immersive systems can explain what’s happening, getting patients and their families more involved, explaining what will happen during the operation, the different things that the surgeon can do and how it will impact the results.

Surgeons have very limited time to do this explanation, I’m confident we can use immersive technologies and visual communication to give the relatives the information and reassurance they seek. If someone is presented with the option of having a surgical procedure but is unsure, why can’t we use VR so patients can be right there in the surgery, and that experience could help them determine whether they actually want to go ahead with the surgery or not? Could the immersive experience help someone get past the fear of having that operation?

11. What about VR and a visit to the GP?
We already have virtual visits over Skype, but what if we threw in haptics. You have the doctor and the patient wearing data (haptics) gloves and in this virtual doctor's office, the patient can help the doctor feel exactly what they are feeling in terms of the location of rash/pain, the exact SPOT. 

Or maybe a cap for the head, for when the patient wants to explain about their headaches, being able to point to the exact spot where the pain is the greatest. A remote physical examination in the virtual world with haptics. 

Another scenario, is when I get into my virtual environment, I have all the other data coming from my Apple watch, other biosensors, vital sign streaming. My doctor could discuss this with me in the virtual room.

12. Which country/city in the world is leading innovation in immersive tech?
It depends upon the area. Some would assume it’s Silicon Valley. In my opinion, London is more advanced in VR/AR. Why? London is THE creative hub, and a lot of immersive tech is driven by creative industries.

The UK as a whole has a thriving creative sector, and the NHS could certainly benefit from greater cross-sector collaboration. We’ve worked for example in the past with and Guys and St Thomas.

13. What would you advise people in healthcare who want to explore the world of immersive tech?
People can come and visit us and play with a variety of tools, it might not be something that’s exactly what they need, but it’s a good experience. Inition’s Demo Lab is a very safe and instructive “sandbox”.

The Demo Lab

The Demo Lab

We can have conversations with people about these technologies, we know how to connect these things together. We’re open to anyone internationally, what drives us are projects that are going to improve the wellbeing of people. What we can’t do is large scale research, without getting partners involved. We can give you a lot of advice, and we can even create prototypes that can be validated through large scale studies. We are open to conversations, whether you are a large pharmaceutical company, in charge of a medical school or even a GP in a small practice.

Adrian Leu & Inition are both on Twitter and click here for the Inition website.

[Disclosure: I have no commercial ties with the individuals or organisations mentioned above]

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Immersive Health: Are we ready?

That's the question that I've been reflecting upon over the last 12 months. Some of you may have noticed that in 2016, there is much more news, discussion and excitement with regard to Virtual Reality (VR) technology. Every other day there is some new announcement, and more and more people are believing that this could play a greater role in our future. Google has recently extended its foray into mobile VR beyond their Cardboard initiative with the announcement of their new Daydream platform. VR itself has been around for a while now, and I remember reading about the concept of VR when I took my first Computer Science class 29 years ago! 

Life is in 360, so why shouldn't our experiences be in 360 too? What really caught my attention in 2015 was a tweet by Susannah Fox when she was at TED 2015 after she had watched Chris Milk's talk "How Virtual Reality can create the ultimate empathy machine" and reading how it had impressed her. This really piqued my curiosity with respect to VR and its applications, as when we think of VR, we often associate it with computer games simply for entertainment. I was skeptical that putting on a VR headset could generate empathy for others. In his TED talk, Milk showed the 'Clouds over Sidra' VR experience he created, and after viewing it in VR, I was very surprised at how it made me feel. 

I was also inspired when attending the Body Computing Conference last autumn at USC, where Dr Leslie Saxon announced their new Virtual Care Clinic as well as announcing the winners of their VR Medical Hackathon. In fact, USC's Institute for Creative Technologies is one of the original pioneers when it comes to VR in healthcare as you can see in this short video.

In my quest to understand the future, I started to purchase many of these new devices as soon as they came onto the market. I believe it's important to try new hardware and software for more than a day or two in order to determine what it's like to live with the technology. I purchased a Samsung Gear VR, and ended up using it to demo VR experiences at the world's 1st Pop-Up Museum of Happiness in London at the start of 2016. I offered attendees the chance to experience guided meditation at the beach, snowboarding or diving in the ocean with the whales.

With Sam Cookney, we helped people attending the pop up Museum of Happiness in London, experience Virtual Reality. This man tried a 360 video using a Samsung Gear VR, which took him on a helicopter ride in the mountains, followed by snowboarding Hear his immediate reaction to the experience.

It was fascinating to see the range of reactions to the Gear VR, some thought it was terrible, and others enjoyed meditating on the beach so much, they didn't want to take the headset off and come back to the real world. Seeing some people smiling and laughing after a few minutes with a headset with a smartphone inside of it compelled me to keep exploring the potential uses of this technology. For example, given aging populations, how do we immerse ourselves in the world of someone aged 85, who lives alone and has multiple long term conditions? In Australia, a Virtual Dementia Experience has been developed, which "is an immersive, interactive virtual reality experience that invades the senses and takes people into the world of a person living with dementia, simulating thoughts, fears and challenges." That's already here today, so what might we do in the future?

It's not just about consuming VR content but creating it too. It's now possible to buy a 360 camera, record your own 360 video, and upload it to YouTube & Facebook which both support 360 videos. You can then share the video, and whoever views it can watch it on their computer, their smartphone or even using a VR headset. Personally, I suggest using a smartphone whilst connected to wifi or a VR headset if you have access to one. Dr Shafi Ahmed recently made history by performing a cancer surgery in London, live streamed using 360 cameras located in the operating theatre, which allowed people around the globe to watch the surgery up close and personal in Virtual Reality. 

Sometimes, there are unexpected findings associated with the use of emerging technology such as a 360 camera. Many of us might dismiss it as a gimmick for every day use. We can't assume how this tech will or will not impact lives. We often just have to get out there and try something new, even if we don't know what to expect. Our sense of wonder and curiosity takes us towards new horizons. I was delighted to read Molly Watt's post on how using a 360 camera has helped her see the world differently by taking 360 images, despite losing her peripheral vision a few years ago. If you haven't done so already, do read my last post which was an interview with Molly on how she is putting Usher Syndrome on the map. If you ask me for a list of the top 10 people that influence my thinking about the future of technology, Molly would definitely be in that list. I firmly believe that citizens should have the freedom to find or even make their own solutions. Couple that mindset with advances in technology available to consumers, and we are heading for a world where our children will attend school and assume that 'invention literacy' was always part of the curriculum. 

This year, I've used telemedicine services in the UK where I had a video call with a doctor using my tablet. Will my telemedicine visit with the doctor in 2020 be in Virtual Reality? What if the doctor could visit me virtually in my own home, and by seeing my home environment in 360 degrees, be able to pick up social and environmental cues that could help them make a more accurate diagnosis? Or what if taking a selfie with a 360 camera allowed researchers looking at smoking cessation programs to understand smoking triggers in someone's social and physical environment with one 360 image? That's a core element of a pitch from a team I was part of at a recent Cancer Research UK Innovation Workshop that led to us winning an award for funding to conduct a pilot study. The 360 image you see embedded below was taken moments after we won. You can move around the entire image and immerse yourself in that moment, much more than a regular image. 

Our team just got awarded funding at @crukresearch #innovation workshop #cancerprevention - Spherical Image - RICOH THETA

I recently gave a talk at Health 2.0 Amsterdam, called 'Immersive Health: Are we ready?' and I used my Ricoh Theta S 360 camera to record my talk. The resolution of the video could be better, which is why I've also gone out and also purchased 4K 360 cameras such as the Insta360 and the Kodak PixPro SP360. Our existing infrastructure is usually not quite ready to cope with these new technologies. For example, I tried embedding the 360 video in this post, but it didn't display as a 360 video, just a regular one. Hence, I had to insert links to my 360 videos throughout this post, which require you to click on, and then it launches YouTube where you can have the full 360 video experience. Now, when you watch the 360 video of my talk in Amsterdam on your phone, move the phone around and you'll change the position of the video! 

2016 has also seen the launch of two long awaited VR headsets, one called the Oculus Rift and the other is the HTC Vive. These are the most advanced products consumers can buy today, and I've bought both of them. Whilst they deliver an immersive experience that is unparalleled by any other technology available to consumers, there are a few drawbacks. The first of which is price. I paid almost £800 for the HTC Vive, and I needed to buy a rather high end gaming PC to use it, which was another £1,400. The Oculus Rift was cheaper at £529, and I've opted to get a VR ready laptop for use with the Rift, which is an eye watering £2,200. So, this level of VR tech is not affordable to the masses yet, but neither were the original mobile phones when they were first launched.

You may wonder, when it comes to making us healthier and happier, where is the value in these expensive VR systems? Well, hospitals are starting to experiment with these advanced products. For example, C.S Mott. Children's hospital in the USA, has been using the Oculus Rift with sick children who were stuck in a hospital ward for a length of time.

There is a compelling read on Reddit, entitled "Oculus Rift saved my sanity while stuck in the hospital, Thanks!" This story was written by a patient in the USA, who upon facing being stuck on the top floor of the hospital for treatment decided to bring in his own system to the hospital. The part that stood out to me the most is "All from my top floor prison of a floor I couldn't leave. This was my getaway, for the rest of the stay. Teleporting me away from the sterile, dry and bland existence that was my hospital room. I was playing my flight simulators and space simulators, racing cars and playing FPS. Life was good again." Granted, this isn't a clinical trial, but it's a positive outcome, their own success story, and a brilliant example of patients as innovators. 

Researchers have been testing VR for some time now, most of the proven use cases seem to be with exposure therapy. For example, 12 years ago, this study looked at the use of VR and computer games as exposure therapy for people with a fear of driving after a car accident. In this study from 16 years ago, researchers looked at the use of VR to overcome fear of flying. What else could we achieve now given the VR technology has evolved and we now have an array of VR products from cheap to expensive, available in the consumer market? There is also the expected array of hype with VR that we have to navigate, just like the hype that still surrounds wearables, big data and AI etc. Finding the signal within the noise won't be easy. We can't just jump into working with this technology because it's new and shiny, we all have to operate with finite resources, no matter how big an organisation we work in.

There are so many questions to answer before we can even begin to explore this arena. What can VR replace or augment? What can we do with VR that we never thought was possible before? Will we be prescribed a VR experience by our doctor alongside our medication so we can better understand the benefits of adhering to our treatment plan? What does the ongoing refinement of VR tech mean for medical education? What are the long term risks of using these headsets for extended periods of time? Is the use of VR going to isolate us or immerse us? Who can actually afford to use VR?

That's why I decided to launch my VR for Health & Social Care workshop in London. Since I've invested in many of the latest devices, tested them myself, have been reviewing the scientific literature to understand what's been studied so far, researched future trends in VR and thought of how they might be used across Health & Social Care, why not blend that all together into an interactive learning experience for people who want to be able to make informed decisions about VR. These devices whether they be the headsets or the cameras are best experienced with your own eyes. In my workshop, one of the things you'll be learning is how to take take, process and upload 360 videos, and then viewing the content you create, in Virtual Reality! Unlocking creativity is key, and I really do believe that the creative industries will have a much larger role to play when it comes to improving our health in the future. There is a deficit of imagination when it comes to new ideas and inventions today, and collectively we must be bolder in imagining the world we want to create for our children, and our grandchildren. 

For some of you, VR may turn out to be something you want to utilise immediately, for others it may still have too many limitations to be of value until the technology and related services evolve. To that end, I've worked with experts such as Dr Keith Grimes for clinical input and Shirley Ayres for her depth of experience in the social sector, when designing the workshop to ensure that you'll walk away with knowledge that you can apply immediately in your own work. 

The workshops are 4 hours in duration, and are held on selected Mondays, Wednesdays and Fridays in London during June and July. I've deliberately limited each workshop to 4 attendees, as I want to maximise the learning opportunity for each of you. I've been to conferences where there are long lines just to try out the latest VR systems for a couple of minutes, and if you have an unexpected reaction to VR, you're in a public place where everyone to see. 

The workshop has the same content, experience and devices across the 23 dates, so you can simply choose a date that's convenient for you. I've already received requests to run the workshops in other parts of the UK, if that's something you'd like, please contact me to discuss.

You can read more about the workshop and book your ticket here

Finally, I've made another 360 video when I was preparing for the workshop yesterday at the venue. You can take a look around the classroom as well as see the devices you'll be getting to use during the workshop. 

[Disclosure: I have no commercial ties with the individuals or organisations mentioned above, apart from Dr Keith Grimes and Shirley Ayres who I have hired to consult on the design of my workshop]

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