Parallel universe: Entering an online 3-D world

The medical community is trying to find real-life benefits from the virtual reality of Second Life.

By — Posted Sept. 8, 2008

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In Second Life, a computer world where just about anything goes, several physicians and health care professionals are finding that "anything" can include work that makes real life easier for themselves, their colleagues and their patients.

But in a world void of the laws and protections governing real-life medical professionals, taking advantage of the opportunities a virtual world offers comes with risks.

"There's more to it than 'Hey, this is a very cool application,' " said Maurice Ramirez, DO, PhD, president and founder of the Orlando, Fla., consulting firm High Alert. "Done right, this could solve a myriad of problems. Done wrong, it is a security nightmare to not only patients but to doctors."

Reporter Pamela Lewis Dolan crossed between real life and virtual life for this story on the medical-related activity in the online 3-D world inhabited by millions since San Francisco-based Linden Lab launched Second Life in 2003 (link).

Passages in italics indicate Dolan is navigating Second Life as Annastasia Blaisdale, her avatar, or online character. Straight type represents Dolan writing as herself. In both worlds, everyone to whom Dolan -- or Blaisdale -- spoke was aware of her real name and her status as an amednews staff reporter.

Virtual education

I entered the Second Life universe as a newly born avatar, wearing a standard-issue polka dot dress and with my brown hair pulled back in a loose bun, and landed in the middle of a city park surrounded by several dozen creatures, few of which I recognized as human.

One had the bodily features and face of the Incredible Hulk but was wearing a tie-dyed shirt and matching tutu with gold-colored combat boots. A halo accompanied his unicorn horn, but he looked anything but angelic.

After wandering among punk rocker ghosts with large breasts stuffed into tight corsets, clowns with fishing poles, and muscle men wearing ball gowns, I teleported to the Ann Myers Medical Center.

Fellow avatar Elspet Glasgow met me at the entrance and offered to give me a tour.

In a typical day at the virtual hospital, a wolf in surgical scrubs roams the halls; visitors are escorted via a group teleporter; and an empty room can be instantly "rezzed" (an in-world term for created or made to appear) into a lecture hall complete with seats, stage and lectern.

While the hospital could be described as a futuristic fantasy world, some serious medical training and collaboration occurs there and is applied to real life.

The AMMC was founded by Doctor Ann Buchanan, the avatar name for a real-life doctor based in the United Kingdom who named the hospital after her mother. Doctor Buchanan, who didn't want her real name used, said her intention was to provide a place where medical and nursing students from around the world could meet to practice skills learned in the classroom. The center has a radiology department, a surgery center, an emergency department, a birthing center, a psychology center and a women's health center. There will soon be a neurosurgery department and a cardiac care center.

Glasgow, who also wanted to be identified only by her avatar name, is a real-life infectious diseases specialist from Scotland doing research in the U.S. She is one of several physicians who regularly meet at the AMMC to design and teach courses and lectures for students. Physicians and students work with virtual builders to construct specialty-specific training tools. AMMC members have created virtual simulations of MRIs, x-rays, CT scans and mammograms, for example. And a surgeon is working with builders to create simulations of robotic surgical equipment.

Glasgow said some continuing medical education providers have contacted AMMC about becoming a CME center, a service that exists on other virtual platforms, but not yet in Second Life.

Several schools and organizations in the U.S., Canada and Europe have been experimenting in recent months with using Second Life for training and education. Programs run through Second Life can be supplemental to class work, independent study, or part of the curriculum. Two community colleges, for example, are offering virtual training for their nursing programs.

Futuristic sales pitch

On a recent Friday morning, I met avatar Gina McAlpine for a tour of the IBM Virtual Healthcare Island. The island, still in early stages of development, has a futuristic feel. At the Information Hub, I learned about IBM's strategic plan to transform health care by 2015. McAlpine said the island was created to show how that plan can be placed into action.

Virtual Healthcare Island was the 50th Second Life island IBM created. Company spokeswoman Gina Jesberg, the controller behind avatar Gina McAlpine, said Second Life has allowed IBM's sales team to replace its previous PowerPoint presentation with an interactive display of its technology.

Hospitals, too, are learning that the virtual world is a good place to test-run future concepts.

Palomar Pomerado Health has a hospital under construction in Escondido, Calif., that is expected to open in 2011. Orlando Portale, the hospital's chief innovation officer, said after PPH received a $500 million bond, the largest ever issued in the state, it decided to create a virtual mock-up on Second Life, as a way of showing taxpayers what their dollars are helping to create.

This virtual hospital is architecturally modeled as an exact replica of what will be Palomar Medical Center West. Through a partnership with IT leader Cisco, visitors also can see some of the technology that will run the hospital when it opens in three years and preview plans for future technology.

"You can give people an idea of what is possible, but it may not be actually available when we open in 2011," Portale said. PPH plans to keep its virtual hospital up and running even after the real one opens so it can continue experimenting with new technologies for additional building phases.

Imaginative thinking

After my meeting with McAlpine, I decided I needed a checkup. I set out to find a doctor who could examine me. But I quickly discovered most of the American physicians on Second Life are there for research and education, not to practice medicine.

There were, however, many counselors and psychologists who were available to meet with me, and support groups I could join.

Some U.S. physicians have expressed interest in using Second Life as an extension to their practices. But they are moving cautiously.

The idea of physicians providing care through Second Life is "perhaps the most innovative and interesting [use of the virtual world], and perhaps the most dangerous," said Joseph Kvedar, MD, director of the Center for Connected Health, the telemedicine division of Partners HealthCare in Boston.

Potential problems include imposter patients, or even real patients with serious problems who the physician can't contact in real life.

Chicago psychiatrist Kourosh Dini, MD, explored the possibility of virtual visits after Second Life launched. He consulted an attorney who told him not to touch it. A few years later another attorney told him to contact his state licensing board.

"The best consensus I could get was to stay within the borders of the state," he said. He would have to create a verification system to ensure that every patient he consulted in Second Life was a real-life resident of Illinois. Dr. Dini decided to pursue the idea only if it made sense for an existing patient. So far, his patients have expressed virtually no interest.

Dr. Dini has, however, found the virtual world to be the perfect outlet to experiment with a different approach to group therapy. Twice a week, a group of avatars meet to listen to music at Dr. Dini's virtual venue. As a musician himself, the doctor believes in the meditative benefits of music. But lugging equipment to and from real-life office and home is too cumbersome to be practical, he said. "Second Life has enabled that aspect of working for me."

There are a handful of foreign doctors who provide in-world consultations for patients who may too embarrassed to see a physician in real life. One doctor from Spain, for example, is reaching out to teens for discussions about sexually transmitted diseases, and to adults who may be facing addiction issues.

While some U.S. physicians are involved with support groups, most, like Dr. Dini, are reluctant to set up shop for one-on-one consultations. But some psychologists have and are charging real money for individual counseling.

As a way to "get our feet wet," Dr. Kvedar said the Center for Connected Health Care has partnered with Daniel Hoch, MD, a neurologist from Massachusetts General Hospital who is providing relaxation therapy to a pilot group in Second Life. The group meets twice a week in-world to go through guided meditations designed to reduce stress.

Dr. Kvedar said the opportunities for doctors on Second Life are plentiful. But "you have to have a little imagination.

During my time in Second Life I did, indeed, come across imaginative ways physicians and other health care professionals were using the virtual world in positive ways. I was able to experience life as a schizophrenic at the University of California, Davis, Virtual Hallucinations facility. I met avatar JS Vavoom (John Miller, RN, in real life), who uses the virtual world to teach his real-life nursing students at Tacoma (Wash.) Community College the decision-making skills that he believes are nearly impossible to learn in a classroom. I also met Gentle Lady, whose mission is to help other people with disabilities learn that the only limitations that exist in the virtual world are the ones you create yourself.

The physicians I met in Second Life were always a welcome presence, especially in the beginning, as they helped me make my way around, even teaching me how to stay upright while I walked. They proved that physicians hold strong to their mission of helping people, even if those people happen to come in the form of dancing bears or flying mermaids.

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How it works

Second Life is an online, 3-D virtual world launched in 2003 by Linden Research Inc., also known as Linden Labs. Everything in this world is created by its residents.

You enter the world through an avatar, an online character you create to be a reflection of your real-life self -- or an animal, alien, beast or anything else. Once in-world, an avatar can buy land, build a house, create a business, socialize or simply explore.

Residents hold intellectual property rights to their creations, so they can buy, sell or trade products using Linden dollars, the Second Life monetary system. Linden dollars can be exchanged for U.S. dollars at several in-world currency exchanges.

Second Life is populated by more than 9 million residents from around the world, with an average of about 50,000 online at any given time.

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Virtual support for real-life problems

On Second Life's HealthInfo Island, there's the Path of Support, offering avatars connections with others facing similar real-life challenges.

Through virtual reality, people can meet for support groups at community centers or coffee shops, or on scenic hilltops.

"I am sure ... people don't come to Second Life thinking, 'Hey, I think I'll see if there's a support group for Crohn's!' (There is one.) They come in because they are curious, and stay because they find affiliations for social and support activities," said Carol Perryman, coordinator for HealthInfo Island.

Perryman has been a medical librarian for more than 20 years and is a PhD student at the University of North Carolina at Chapel Hill.

"The thing about Second Life, and the thing I find so compelling, is that it's immersive and it's a three-dimensional space that has permanence. It is inhabitable. Perceptually, it's a much more emotional experience as opposed to reading text in a chat room," said John Lester, director of the Boston operations of Linden Lab. Lester previously worked for Massachusetts General Hospital, where he created online communities for patients with neurological disorders.

"Our brains are wired to crave a sense of place. We like to be in stimulating environments with other people. You don't get that in a chat room; you barely get that in a telephone call."

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Creating virtual abilities

Alice Krueger, a technical writer from Centennial, Colo., has multiple sclerosis and is unable to get around without the aid of a wheelchair or crutches. She said her condition has essentially left her homebound.

But most every day, Krueger is out riding horses, going on nature walks and swimming. And most nights you can find her at a dance club -- all without any mobility aids. Krueger said Second Life has given her, as avatar Gentle Heron, the ability to do things she used to enjoy in real life but is now unable to do.

Krueger has joined with two other Second Life users to found a nonprofit organization called Virtual Ability. Its stated goal is to train people with physical or mental disabilities to participate in activities on Second Life. Virtual Ability gives each user an individualized skills assessment, and refers them for help with assistive hardware or software as necessary. It also offers a support group and social center.

Krueger said there are more than 70 groups on Second Life to support people with various disabilities or chronic conditions.

Because it has become an important part of her life, she said that she understands how easy it would be to let Second Life become a substitute for real life. So Virtual Ability employs a volunteer addiction expert who helps to identify and counsel compulsive gamers.

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External links

Second Life (link)

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