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Privileged Insight: Virtual Rehabilitation Assistants in the Home

By March 2, 2018 August 26th, 2019 No Comments

Outpatient rehabilitation from illness, injury or surgical procedures is a $30 billion-plus segment of health care. The process of rehabilitation can be complex, is typically tailored to the individual, and is critically dependent upon patient effort and engagement.

Most post-acute rehabilitation and recovery actually occurs in the home, with skilled office- or hospital-based clinicians prescribing the specific activities and/or exercises to be performed between in-person visits when clinicians typically have only brief and infrequent glimpses of patient progress. Unless great care is taken, patients striving to recover at home are often left with unanswered questions or important misconceptions about their recovery programs. Delayed recognition of these issues, failure to promptly identify complications or lack of patient engagement can slow recovery, increase costs and impact the overall quality.

For typical home-based rehabilitation, relevant information about a patient’s progress between face-to-face visits is most often sparse, qualitative and self-reported, so that when recovery is delayed or derailed, it is challenging to understand the root cause. It is this lack of objective, quantitative, clinical insight into home-based recovery that is an understandable key driver of the increased frequency of face-to-face visits early in the recovery process.

But this is all about to change.

Digital assistants, telemedicine, computer vision, and augmented and virtual reality systems are finally able to allow clinicians the privileged insight into the full process of outpatient, at-home recovery. Patients can look forward to on-demand, expert guidance on their recovery, all while enjoying therapy in the safety and comfort of their own homes. Clinicians can look forward to a streamlined workflow and population-level dashboards that provide more objective and actionable information about their patients’ trajectory of recovery, wherever they may be.

Early results using Reflexion Health’s VERA® (Virtual Exercise Rehabilitation Assistant) platform highlight the opportunities with this new modality and demonstrate value in four key areas: patient, provider, process and payor.

  • Patients – When built with a deep understanding of the patient journey through the entire care pathway, digital rehabilitation assistants can dramatically improve the patient experience. From early education and expectation-setting, to helpful reminders, to detailed risk assessments, to animated and interactive patient-specific instructions, all the way through to detailed measurement and audio-visual feedback, these systems can guide patients through the entirety of their rehabilitation experience. Patients comment on the convenience of having an on-demand assistant and describe an added sense of accountability as they can quickly see how they are doing against objective metrics and milestones. Some focus on the cameras and recorded data as making them feel as though ‘their doctor is watching.’ Others anthropomorphize the avatar and feel a personal responsibility to do their work because ‘she is waiting.’ Whatever the driver, this sense of accountability combined with the comfort of knowing they are performing their regimen correctly and the coaching of an engaging avatar has resulted in unprecedented levels of adherence to prescribed therapy.

  • Providers – The exigencies of today’s healthcare environment only allow for brief and occasional clinical visits, with the result being that well over 95% of the process of recovery process is currently unmonitored/invisible. With home-based digital rehabilitation assistants, the entire process of rehabilitation can be visualized, objectively quantified, distilled, and indexed to contemporaneous functional assessments and patient-reported outcomes. Quick review of clinician dashboards can enable identification of patients needing additional attention, assuring that all patients are getting the care they need, and that clinicians are focusing their time and resources of those patients most in need.

  • Process – “You cannot manage what you do not measure.” Digital rehabilitation assistants provide a first opportunity to systematically and objectively document previously unmeasured aspects of the rehabilitation process (i.e., exactly what which therapies were performed, when, how often, how accurately, how quickly, etc) and then link these objective data with objective assessment of long-term outcome. Only with a careful understanding of the interaction between performed rehabilitation routines and ultimate outcome can we begin to optimize each patient’s course and outcome.

  • Payor – Digital rehabilitation assistants offer the possibility of same or better outcomes with decreased costs. Increased engagement drives greater effort and quicker recovery. Technology-enabled self-care replaces some in-person visits. Clinician dashboards enable early identification of those in need of more hands-on care to prevent complications. If long-term results track our early observations, digital rehabilitation assistants offer greater patient convenience and satisfaction, comparable or better outcomes, with lower utilization of in-person visits while also providing unprecedented objective visibility throughout the recovery process.

Some lessons learned in the early going:

In a general sense, a large and growing percentage of patients are comfortable using digital devices to help manage their health (see this recent survey). However, not every rehabilitation patient has wifi or a broad-band connection in their home. For digital rehabilitation assistants to reach the broadest population, it is important that they be designed with integrated internet access. Additionally, while there is some concern that seniors may be unaccepting of such digital assistants or find their use too complicated, by paying careful attention to user interface design, the reality can be quite the opposite, with seniors reporting being delighted by the ease and convenience of use.

The adoption of home-based digital rehabilitation assistants into the care pathway requires stakeholder alignment. Adoption can be delayed by some clinician stakeholders’ concerns of declining revenue for in-person encounters, even as experience accumulates that:

  1. patients prefer the associated convenience;

  2. adherence to prescribed regimens are dramatically improved;

  3. recovery times are shortened (likely as a result of greater adherence to prescribed therapy), and

  4. there are associated cost savings in fewer office visits, co-pays and travel expenses,

Digital rehabilitation assistants do more than provide patients with an on-demand digital companion for the rehabilitation journey. They also provide clinicians a smart window into what had been the black box of at-home rehabilitation. This privileged insight into the post-acute period opens the door to an enhanced understanding of what works, what doesn’t, what’s needed for optimal recovery, and forever crosses the Rubicon for optimized and patient-centered rehabilitation.


Dr. Joseph (Joe) Smith is President & CEO of Digital Health Corp and Reflexion Health.