The Evolution of Ready Teddy
This post is the roadmap of the VR Mock MRI, iteration to iteration, win and loss, that came about to eventually become Ready Teddy, an award winning, patent pending product, that challenges the way we think about healthcare delivery.
First iteration of a VR MRI
Adoption of User Centered Design
MRIs are scary and intimidating
MRIs are an intimidating procedure for most people, particularly for children. With the additional necessity to stay perfectly still, doctor’s are often relegated to sedating young patients often with anesthetics like propofol or ketamine in order to get quality MRI images. 49% of children are sedated for their scans, determined by limited information like age, length of scan, and asking parents ‘Can your child sit still for 45 min?’. However, research shows that with adequate preparation and the utilization of play therapies sedation rates can be lowered by 40%. Sedation is being over prescribed.
Much of my career has been in academic neuroimaging, where I was responsible for creating data pipelines, analyzing MRI data, and acquiring images from children across the developmental landscape. It was clear that exposure therapy using the traditional mock MRI was an effective way to reduce anxiety, reduce head motion inside the MRI, and resulted in much better quality data. However, the use of the traditional mock MRI was a luxury. When I moved to USC, there wasn’t the space for a 15 sqft mock MRI. Ultimately, we were left to our own devices and threw out a massive amount of data and the wasted the associated funding.
How can I provide the same value of a mock MRI to a small scale radiology suite?
While I was brainstorming ideas, exciting new applications were being created in Virtual Reality and health. Novel applications of VR exposure therapy to treat PTSD and other behavioral disorders were being used to desensitize and habituate people from fearful situations.
A VR headset, with its established use cases in exposure therapy, and the ability to simulate environments seemed like a natural fit. Applying the technology to MRI preparation would reduce the spatial requirements from 15 sqft to 3 sqft. The greater opportunity however, rested in the native properties of a VR hardware. The primary concern of quality data in a MRI is head movement, something a VR headset automatically measures in order to render images synchronously. Using these analogous data metrics, VR is the perfect fit of a particular technology to a specific medical use case.
After a crude first attempt, I asked my partner, Noah, who is a software mastermind to join me and build the next iteration. We created Teddy to be the child friendly guide through an MRI experience. Keeping in mind user centered design, camera angles are at 4’ tall, the height of the average 8 year old, our target user. We ran the script through Hemingway to ensure the language matched the comprehension of the target audience. Lastly, we created a mini-game to help illustrate exactly what it means to “stay perfectly still, just like a statue”. I wrote the code, Noah built the visuals, we had a new and improved product. In tandem, I looked outside of the academic world, and saw that this is an even larger issue for clinicians. A large scale product was taking shape.
Early value proposition deck slide
Clarity in visuals and messaging
Our first victory came after I submitted our product to the Medical Capital Innovation Competition at the Cleveland Clinic. We were accepted and had to fly to Cleveland and compete with a few other startups for a grand prize of $6k. At that point, we were so bootstrapped we calculated the pot odds (some quick poker calculations) about the cost/benefit of attending. Fortunately, we submitted and won our first ever business competition. A few weeks later I presented at the Iovine and Young Academy Graduate Development Prize and won $10k to further the development of the VR Mock MRI. Securing these funds meant we would dedicate more time on the project and provided validation that we were on the right track. After extensive user testing and customer discovery interviews we added another mini-game training the user to stay still using biofeedback. We added a professional voice over and improved the product more and more. Biz dev kicked in, I got us support from HP with hardware to further development, took part as a Oculus LaunchPad Fellow 2019, secured more grant funding from the Entertainment Technology Center, the Center for Cultural Innovation, and were admitted into the USC Marshall Greif Incubator. For my Master’s degree capstone project we built out the look, the feel, of Ready Teddy.
User Personas
Doctor / Child Life
Care about the success of their patient. Want quality MRI images. Throughput is an imposed metric of success. Easy administration without disrupting clinical protocol is fundamental.
Patient 6-10 yo
Fear of the unknown and surprises in care are worse than the procedures themselves. Look to parents for guidance and support. Wants to go home as soon as possible.
The economics of pediatric healthcare innovation and the problem with Fee-for-service. (actual sedation rates between two differing institutions)
While conducting customer discovery interviews it became clear the disparity of sedation rates between institutions. The reason for these disparities are numerous (cultural buy-in, top down institutional support, etc) based on my research the primary driver is population bias. In the graphic to the left, the institution with an amazing 18% sedation rate serves a fairly homogenous, primarily English speaking, more wealthy patient population. The institution with 65% sedation serves a lower income, diverse population, primarily medicaid. Medicaid only reimburses a fraction of the actual costs of the MRI or any other procedure. Privately insured patients are subsidizing government insurance, making these privately insured patients a desired population. In turn, hospitals serving wealthier privately insured patients have more income, more resources, more time, to dedicate to each patient and assist them with avoiding sedation. The cycle persists, with higher quality of care attracting more privately insured patients, widening the gap between resources dedicated between patient populations. Ready Teddy, and other healthcare innovation, should aim to be easily deployed with a diversity of populations in mind, to allow access to all institutions the benefits that can bridge the disparity of care.
Recent developments include forming our Delaware C company, submitted utility patent, we are in frequent talks with Radiology suites all around the globe, and institutional support from Children’s Hospital Los Angeles and University of California San Francisco. We still have tricks up our sleeves, something I can’t divulge at this point. I’m hoping that everyone that reads this post will be able to utilize Ready Teddy to prepare their little ones for an MRI. Eventually we will expand our reach to address the fears of adults.
A greater question remains, if VR can be used to prepare patients for an MRI, what are the remaining applications for this still emerging technology? How can the embodiment and presence that VR enables be utilized for healthcare and wellbeing?
Undoubtedly more stories to tell and more exciting trails to uncover.
Adopted Institutions
