System uses VR and 360 video to teach health informatics at U of T

The Masters of Health Informatics (MHI) program at the Institute of Health Policy, Management and Evaluation at the University of Toronto develops students into health informaticians who bridge the gap between technology and the health information needs of clinicians, patients, administrations, and policy-makers. One of the foundational courses is the Complexity of Clinical Care for Non-Clinicians course.

This course previously included an opportunity for students to shadow clinicians – such as nurses – in their real-world environments so they can better apply program learnings to actual healthcare problems. “The shadowing component of the Complexity of Clinical Care for Non-Clinicians class was invaluable,” says Jennifer Tin, alumni of the MHI program. “Healthcare environments are so incredibly complex and nuanced, and to be a good health informatician you really do need a good grasp of what those workflows are in order to integrate technologies seamlessly and meaningfully.”

However, due to the current health human resources shortage, students no longer have the opportunity to shadow nurses in real clinical environments.

As alumni of the program, we suggested using virtual reality as an innovative way to help bridge that gap. Virtual reality (VR) was a novel teaching tool for the MHI program; and with the support from Dr. Karim Keshavjee, program director of the MHI program, we worked with course instructors Dr. Gillian Strudwick and Dr. Damian Jankowicz to validate the concept.

The initiative was approved for $50,000 of funding by the Ontario Exchange program through eCampus Ontario. We were also matched with SimFront, a private-sector company, to provide expertise in virtual reality for education.

Finally, we consulted educators and researchers with experience in VR. One of the key takeaways from our consultations was to deliberately focus on creating the user experience that is as realistic and authentic as possible.

This was a guiding principle for us as we worked through the planning and execution of this project. We decided to leverage 360 video – which allows the viewer to control the view and look around – rather than computer-generated virtual reality and to set our sights on finding a true clinical environment to film in, rather than a simulation lab.

We were fortunate to be able to partner with Michael Garron Hospital. The facility was undergoing a campus transformation, which included the construction of the new Ken and Marilyn Thomson Patient Care Centre.

And we had the exciting opportunity to film in one of the units before it was used for clinical care for the first time.

The unit included patient beds, vital signs monitoring equipment, hoists, linen carts, workstations, wall mounted hand sanitizers, and real-time location systems (RTLS).

After filming, SimFront delivered four “360 videos”, which highlighted common interactions between nurses, patients and technology used on the unit. Each video, which can be used with VR headsets or traditional 2D displays, demonstrates a key hospital workflow: shift handover, assessments, medication administration, and patient discharge.

In the first video, the incoming nurse receives handover from the outgoing nurse at the team station, where they review the eWhiteboard in the electronic health record (EHR), then navigate to the patient chart to see patient medical history, orders, medication administration record (MAR), and clinical notes.

The second video shows the nurse conducting initial rounds and assessment of a patient, including vital signs, pain assessment, orientation to environment, and reviewing orders.

In the third video, the nurse administers an oral pain medication (including barcode scanning devices and MAR documentation) and receives an alert to re-assess the patient’s pain.

The fourth video highlights the discharge process, where the nurse reviews the discharge package with the patient’s family and discharges the patient back to the community.

There has been favourable feedback from students to the videos, and we plan to continue developing them.

An-Qi Shen is an RN, Director of Clinical Innovation at Think Research, and Adjunct Lecturer at U of T. Melissa Menecola is an RN and Sessional Lecturer at U of T.