The Virtual Doctor is In

There was a time when doctors made house calls. That time is coming again, except now your doctor will be able to make 100 at once, while performing surgery at the same time. Dr. Leslie Saxon’s USC Center for Body Computing and USC’s Virtual Care Clinic leverage commercial tech innovations to advance medical care and delivery.

BY: Cuyler Gibbons
IMAGES: Courtesy of Keck School of Medicine of USC


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Dr. Leslie Saxon, Founding Director of the USC Center for Body Computing.

“First thing we have to do is take your picture,” says Dr. Leslie Saxon, Founder and Director of USC’s Center for Body Computing, as she enthusiastically greets me at the Playa Vista campus location of the recently opened Virtual Care Clinic. I’m here to learn about the still nascent yet rapidly expanding field of digital medicine, and Dr. Saxon wants to show me what the face of the medical future that she envisions will look like—it turns out, just like an actual face, in fact. It’s where science fiction becomes science reality.

Dr. Saxon established the Center for Body Computing in 2006, with the goal of developing consumer driven technological solutions in medical care and delivery.
The CBC employs an interdisciplinary approach, that partners not only the school of medicine, but business, engineering, even cinematic arts with visionaries and professionals expert in everything from wearable sensors to mobile applications to immersive, virtual realities. It’s a cross-field pollination strategy intended to develop healthcare solutions through technology that involves the patient in their own care.

Digital technology as a major, integrated part of medical care may seem intuitive in some ways today, but 10 years ago, as Scott Dorman, the CBC’s Managing Director says, things were different. “Back in 2007, when Dr. Saxon founded the center this was before digital health was even ‘a thing.’ She has an unusual blend of skills. Aside from being an interventional cardiologist…she also has a deep understanding of technology and how those two can work together to produce products that people actually will use and incorporate into their lifestyle. While [medical skill coupled with tech vision] is becoming more commonplace, back in 2007, it didn’t really exist.”

Dr. Saxon is not only the Founder and Executive Director of the USC Center for Body Computing, she’s also a professor of clinical medicine at the Keck School of Medicine of USC, chief of cardiovascular medicine and leads USC’s Cardiovascular Research Unit. This is an extensive resume but one that alone fails to provide a real clue to the source of her passion and affinity for exploring the digital edge, and her evident desire to help forge the spear point of a virtual medical revolution. She admits to a general fondness for tech, but the true origins of her passionate belief lie in practical experience.

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Dr. Rohit Varma’s and Dr. Leslie Saxon’s virtual avatars.

As a heart surgeon, she had been intimately involved in the design, development and implementation of a heart implant for patients suffering from heart failure. Encountering significant success in developing the clinical trials, Dr. Saxon soon found herself spending all her time in surgery, implanting the device, and little to no time communicating with her patients. “It was the early days, and for 10 years it was very hard to do. I was expert in it so I spent most of my time implanting it. Suddenly I wasn’t there for my patients. I knew there was so much more here but….” she gestures openly and pauses before going on and clasping her hands together, “then the devices became networked and I saw instantly, this is how you virtually take care of people.” Where before, she explains, the patient would have to come in every four months so the device could be “interrogated” and reprogramed, now the device could be interrogated wirelessly everyday. She started a research program and showed that in some 100,000 patients, those who had their device monitored remotely lived an average of three times as long. This was partly due to the predictive power of all that data, but also, Dr. Saxon believes as she says, “Even though they weren’t seeing the actual data themselves, patients felt more engaged. They felt you were caring for them. This created a higher level of compliance behavior. That’s what really got me into this.”

“This” is what I’ve come to explore, and as we begin my tour Dr. Saxon is assured, direct and emphatic about her vision of the role of digital technology in medical care, and the role of her Center for Body Computing in facilitating that future. But rather than pedantic, she seems to genuinely enjoy putting the complex pieces of this puzzle together for a layman, as palatably as possible. And in a larger coincident sense, much of what she hopes to accomplish involves taking the often clinically sterile, impersonal and incomprehensible medical consumer experience and integrating it comfortably and efficiently within the totality of her patients, and eventually all patients’ lives. What she sees is at once an ambitious and complex multi-disciplinary, high-tech vision of the future, with a multitude of applications and inherent efficiencies, and a patient-centric effort to simply make health care delivery more understandable, convenient and comfortable for the ultimate consumer, while improving outcomes at the same time.

Virtual doctor avatars that move, speak and emote realistically are first captured in “The Tent.” This innovative computer driven photo array is the product of The Character Animation and Simulation Research Group, run by USC Research Assistant Professor, Ari Shapiro, PHD. Shapiro and his group are “responsible for much of the innovation happening in virtual care”, says Dr. Saxon.

We begin at “the tent,” a piece of technology created on-site in conjunction with USC’s tech incubator, the Institute for Creative Technologies. The Tent is a canvas enclosure that holds a circular array of 100 individual cameras hooked up to a computer that melds the 100 images into a single 3D representation. This is the starting point from where Dr. Saxon eventually hopes to turn one actual physical doctor into a virtual army of doctors capable of answering questions and guiding healthcare choices, simultaneously for any number of patients, anywhere in the world. The technology is sophisticated and capable of creating a digital avatar that not only looks and speaks like the doctor photographed, but changes facial expression and emotes appropriately. This is cool stuff, no doubt, but as Dr. Saxon explains, the avatars are more than just sexy technology.

She sites research that demonstrates that in many cases, because of the often sensitive nature of health related issues, people are more forthright with an avatar than with an actual human. Also, people are not always predisposed to properly assimilate information at a time or place not of their choosing. Evidence shows that when a patient feels more in control of the encounter, they are more prepared to receive and process what they hear. And, of course, the resource allocation implications of turning one doctor into many are profound.

Screen Shot 2016-07-25 at 5.23.03 PMAs Dr. Saxon pointedly explains, “We think that our experts are our biggest asset here at USC, and if we can spread them out more cheaply and efficiently across larger populations everybody is going to win and then we don’t have to go and build USC Dubai, right?”
Dr. Rohit Varma is the Interim Dean of the Keck School of Medicine of USC, and a professor and Chair of the Department of Ophthalmology. He’s also Director of the USC Roski Eye Institute, the first of USC’s clinical services to integrate with Dr. Saxon’s Virtual Care Clinic. He says a personal interest in digital applications was partly responsible for his early digital adoption philosophy, but Dr. Varma is also keen to illustrate the fact that he sees it as the best way to address the critical need to expand expert clinical reach in the years to come. “We just published a piece looking at vision loss in the US over the next 35 years, and we expect a doubling of the people who suffer from vision loss in that time,” he says. “Yet, as of now we are not increasing the number of trained technicians in eye care, because there is a cap on the number of positions for residency training imposed by the federal government. In order to extend our reach we have to find innovative ways of getting highly specialized individuals out into disparate communities.”

While Avatars may be the “front-people” of digital medicine, the virtual cloning of an individual doctor experience is but one small piece of the broad virtual care spectrum encompassing numerous other equally clever, and technologically sophisticated implementation platforms. The commonality inherent in the technologies employed is their ability to involve patients more directly in their own care, to make them true participants rather than merely passive recipients.

Integral to the structure and mission of the Virtual Care Clinic, is an “eco-system” of eight “foundational partners” with expertise in mobile apps, data collection and analysis systems, diagnostic and wearable sensors, experiential design, and engaging, expert, patient health information. The eye institute Dr. Varma runs, and foundational partner VSP Global, the largest vision insurer in the world, provide one of the first examples of the power and scalability of these public/private partnerships. Together with the VCC, they are working to develop eyewear with an accurate remote activity sensor, connected to an experiential app that drives charitable giving. As Dr. Saxon says, “VSP Global has 85 million people they provide vision care for. They are ambitious and they want to reach out into broader digital health.”

Virtual immersive realities are another case in point. Building on US Army studies on the pre-training and pre-deployment impact of virtual immersive experience— exposing soldiers virtually to the expected conditions of their upcoming deployments—Dr. Saxon has begun to study the effects on patients exposed to an immersive virtual surgery experience, prior to the actual procedure. Those effects may go beyond reduced anxiety to include more tangible effects such as a positive impact on pain perception.

Screen Shot 2016-07-25 at 5.26.11 PMAlso stemming from the Army study, immersion, or exposure therapy, has proven effective in the treatment of PTSD. As Dr. Saxon explains, “You can take a person into a Humvee for instance, and introduce sights and sounds under a kind of therapeutic guidance where you eventually desensitize the person to the events that traumatized them.” Of course surgery can itself be a traumatic experience. And Dr. Saxon says it’s not unusual for a patient to emerge from a major surgery with Post Traumatic Stress. In these cases, “we want to use this therapy to desensitize them after the procedure because they really can have major adjustment disorders,” she says.

While a virtual immersive experience is certainly compelling in a medical context, more prosaically Dr. Saxon is looking straightforwardly at how basic information is imparted. As she says, “If you go into your retirement account, you can see a summary, but you can also go deep and get the raw data. Which obviously very few people do. But we want the medical data available to be absolutely as personal, but we’re very concerned with the best way to present this. A lot of it is about context. Suppose you get a diagnosis of prostate cancer. It can be emotional. We want you to look at the material in the comfort of your garden at home, and get not just the content, but the comfort that you need.” Whether that information comes via a simple PDF download, a consultation with your virtual physician, or an immersive reality experience, it will ideally be tailored specifically to your need and capability, and informed by your past experience with the system.

While physicians are ideally interested in relaying information to their patients – about process, outcomes, required behaviors, etc.—they often display less than a considered approach to the manner of that communication. A consideration of how best to deliver it so it can be most effectively received and assimilated. Not that most physicians wouldn’t prefer that their patients understand what was before them and what was to be expected or required, just that they rarely think about the most effective way of achieving that. It turns out telling a story, a compelling narrative that stars the patient, is vital. The fact that the Managing Director of the Center for Body Computing, Scott Dorman, comes not from a medical, but entertainment background, is a testament to the importance of providing engaging narrative in Dr. Saxon’s ultimate digital health care model.

Screen Shot 2016-07-25 at 5.26.34 PMIn fact, communication, networked, fully integrated communication, is central to the whole endeavor. Enhanced communication, not only between the patient and the physician but also between the patient and themselves can be made possible through the bio-feed-back afforded by wearable, implantable, and even digestible devices. The improved ability of a physician to demonstrate what his patient should expect, and to explain the options, and implications of the proposed intervention in the most emotionally appropriate and intellectually accessible format available can be, not only greatly facilitated in a digital environment, but actually created where it otherwise would not exist. Realities can be replicated virtually to assimilate individuals for future exposure or to desensitize those damaged by past real experiences. Time and place barriers to quality care and advice can fall away, as all-the-time, real-time access to virtual health care expertise finds reality in an army of avatar physicians armed to the teeth with a limitless cloud of data, and the technological ability to relay individualized information. This is the story of the future of medicine that Dr. Saxon wants to tell, and create at the same time.

Here at the magazine, we understand the power of narrative too, and we always like to tell a good story, though we’re partial to happy endings. “Well,” says Dr. Saxon, “this isn’t my ‘top of the mountain’ delusion, at least I hope not. But what I think we’re building is a whole virtual global health care system that will be 90 percent digital, and going to a bricks and mortar facility will be just 10 percent of the activity. It’s really a very interesting time and place we are in right now.”

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