We need "flight simulators" for training in healthcare. This talk was presented to the Bio2Device group in the Silicon Valley / San Francisco Bay Area in August 2011.

1. Online Virtual Environments for Healthcare Professionals’ Training Parvati Dev, PhD CEO, CliniSpace

2. Virtual Environments 3D Networked Multi-person World of Warcraft Second Life Open Sim, Avaya, OLIVE, VastPark …….. CliniSpace © 2011 IIL Inc. GameTech 2011 at Orlando 2

3. The problem we want to address Issues of Patient Safety and Healthcare Quality which increase Healthcare costs Method Immersive Training

4. Example: Training for patient safety The cost of medical errors is huge $22-38B (source: AHRQ) Prevention requires systemic change through training An example – Septicemia 2% of hospital discharges in the U.S. include septicemia Average charge is > $60,000 per case One case prevented can pay for the training This training is difficult, requires emotional engagement Role playing is emotionally engaging Virtual medical spaces are very effective role playing environments © 2011 IIL Inc. GameTech 2011 at Orlando 4

6. And training was completed in 2 monthsPotential savings $40,000 and 4 months per trainee

7. CliniSpace © 2011 IIL Inc. GameTech 2011 at Orlando 6 Virtual Learning Environments

8. CliniSpace An immersive, collaborative, online environment that represents authentic medical spaces Dynamic patient and interactive medical objects in a navigable 3D space Enables team training in a simulated ED or ICU Remote collaboration with team members in-world Creates safe and effective learning opportunities for critical events AND routine care Clinical decision making (minimize cognitive error) Communication skills (error prevention strategies) Medical protocols (ACLS, BLS) © 2011 IIL Inc. GameTech 2011 at Orlando 7

9. What makes up amulti-uservirtual environment?

10. Tracking and Performance Assessment from database Manual Assessment Mentor / Guide Scenarios based on Curriculum Virtual Patients w physiology 3D Building ED, ward, exam room, clinic Medical Objects with functionality Virtual Role Players Real Role Players Virtual World Platform

11. The Components Virtual Patients w physiology 3D Building ED, ward, exam room, clinic Medical Objects with functionality Virtual Role Players Real Role Players Virtual World Platform

12. CliniSpace Environments CliniSpace™ Conference Room Reception Intensive Care Emergency Care Urgent Care Ward Medical Clinic

13. We can represent any space

14. The patient and environment interact Some variables are observed monitor, hematology report Some variables are affected by actions in the environment saline drip replenishes blood fluid volume antibiotic reduces circulating cytokines and causes the body temperature to drop Variables also affect the patient patient appearance (bleeding, pallor, rash) actions (vomiting, coughing) © 2011 IIL Inc. GameTech 2011 at Orlando 13

15. Medical objects

16. Medical objects

18. Blood volume Blood pressure Heart rate Oxygen saturation Respiratory rate Bleeding

20. Virtual Role Players

21. Real Role Player

22. Scenarios based on Curriculum Mentor / Guide Virtual Patients w physiology 3D Building ED, ward, exam room, clinic Medical Objects with functionality Virtual Role Players Real Role Players Virtual World Platform

23. Scenario RN: Dr. Smith, do you think it would be appropriate to give Mr. Appleberry some pain medication and put in orders for labs and diagnostics. [RN: I think you should come and see this guy pretty soon] MD: Yes, I would like you to give Mr. Appleberry 1-2 of Morphine and order the following: CBC, Chem 8, UA and KUB [Note: MD/confederate can prompt or just give the order to the learner if no recommendation is given] RN: Dr. Smith let me repeat and clarify your orders.

24. Mentor / Guide

25. Tracking and Performance Assessment from database Manual Assessment Scenarios based on Curriculum Mentor / Guide Virtual Patients w physiology 3D Building ED, ward, exam room, clinic Medical Objects with functionality Virtual Role Players Real Role Players Virtual World Platform

27. Assessing Behavior © 2011 IIL Inc. GameTech 2011 at Orlando 26

28. Protocols and Checklists © 2011 IIL Inc. GameTech 2011 at Orlando 27

29. What can you do with avirtual environment?

30. Patient Assessment in Nursing Patient, post-op, after fracture has been set Review the chart Speak with patient Do assessment Decide on interventions Physician orders (medications, other) Patient safety issues Patient comfort issues Write up notes © 2011 IIL Inc. GameTech 2011 at Orlando 29 – with feedback layer – with game layer

31. Advanced Nursing Scenarios Procedure scenarios Multi-tasking Dealing with distractions Communication scenarios Based on accepted guidelines – TeamSTEPPS Close the communication loop; use names Clarification and check back Raising concerns through a hierarchy © 2011 IIL Inc. GameTech 2011 at Orlando 30

32. IHI – Learning safety ‘bundles’ © 2011 IIL Inc. GameTech 2011 at Orlando 31 Technology Assessment

33. Learning rules for patient safety Number of safety items checked Number identified accurately as correct or incorrect implementation Understanding of safety issues as identified through discussion © 2011 IIL Inc. GameTech 2011 at Orlando 32

34. Assessment items Multi-player Learner Rest of team Discussion of evidence 30+ bundles Game? © 2011 IIL Inc. GameTech 2011 at Orlando 33

35. Faculty authoring © 2011 IIL Inc. GameTech 2011 at Orlando 34

36. Learning medical billing codes Number of accurately coded notes © 2011 IIL Inc. GameTech 2011 at Orlando 35

37. HPS VED HPS VED The Data Show . . . Pre-test Values Post-test Values 60 50 40 30 20 10 0 Comparison of Team Leadership Before and After Practicing Four Resuscitation Scenarios on a Human Patient Simulator (HPS) or in an Online, Virtual Emergency Department (VED) with Virtual Patients

38. Current and near future uses Virtual Medical Center In negotiation Practising communication Nurse to physician Practising assessment of patient Nursing Managing sepsis Under development Learning billing codes 100,000 members in organization Learning safety protocols Under evaluation Learning medical Spanish Research project © 2011 IIL Inc. GameTech 2011 at Orlando 37

39. Thank you & questions IIL slides are on SlideShare. Search for ‘parvatidev’ or ‘clinispace’ Emailmeat parvati@clinispace.com © 2011 IIL Inc. GameTech 2011 at Orlando 38