This newsletter discusses the growing use of digital technologies in healthcare. It covers how digital tools are being used to track and model the spread of coronavirus. It also discusses applications of virtual reality for medical training, pain management, and personal health. Upcoming events on digital therapeutics and innovation in healthcare are also listed.

1. February 2020
Digital Medicine Comes of Age
Digital Medicine and Pandemics
Virtual Reality and Immersive Experiences in Healthcare
Virtual Reality and Medical Training
Digital Therapeutics
Bridging the Gap Midlands Conference
Upcoming Events Calendar.
This edition of the ISDM Europe E-Newsletter reflects on the growing use and value of disruptive digital technologies
within the medical profession, evolving from their use in clinical diagnostics towards their approval for use as
prescriptive medicines to address physical and mental conditions.
This comes at a time when we are responding to the Coronavirus tragedy in China and its global impact. Digital
technologies developed for applications outside the medical profession are likely to play a vital role in the prevention
and impact mitigation of instances of new viruses such as SARS, MERS and now CORONAVIRUS.
I am pleased to include a guest article from Todd Maddox and Tim Fitzpatrick of IKONA Health in the USA on the use
of virtual reality and immersive experiences in training and education.
In this Edition
• Digital Medicine and Pandemics
• Virtual Reality and Immersive Experiences in Healthcare
• Virtual Reality and Medical Training
• Digital Therapeutics
• Bridging the Gap Midlands Conference
• Upcoming Events Calendar.
Digital Medicine and Pandemics
Map tracks coronavirus outbreak in near-real time

2. A team at the Johns Hopkins Center for Systems Science and Engineering has built a map that shows the spread of the
coronavirus in near-real time.
The map is regularly updated with data from the WHO, CDC, and other sources, and illustrates how the virus is
spreading in China and beyond. This information comes from Spatial Source with more details available from their
web site at https://www.spatialsource.com.au/gis-data/map-tracks-coronavirus-outbreak-in-near-real-time
This is an example of how a multi-disciplinary approach enabled by digital technologies can be very valuable in
tackling a global emergency.
Data collected from a variety of sources, analysed using big data techniques and presented visually on a map in near-
real time not only supports executive decision making but also brings an understanding of the seriousness of the
situation and contributes to predictive modelling tools.
Previous experience gathered from the SARS and MERS pandemics has been invaluable in predicting how Coronavirus
is likely to spread and informs measures to mitigate its impact but the characteristics of Coronavirus and its
transmission from human to human before any symptoms emerge adds a new and very serious dimension to the
situation. It means that there are potentially large numbers of carriers who are unaware of their condition and can
consequently infect many more people before they can be identified.
This raises not only technological issues around how sufferers and their movements can be identified and tracked but
also moral and ethical issues around human rights and privacy. The technologies exist in smartphones and wearable
devices for both location tracking and health monitoring that would be invaluable in early recognition and
management of pandemics but data privacy issues limit their potential on a large scale.
In the past, I have suggested the idea of a citizen’s health charter designed to encourage citizens to use advances in
consumer wearable technologies for personal health management with incentives to voluntarily share this data
(properly anonymised) for both personal health management and public health policy making. This concept is not far
removed from the incentives given by the insurance industry to users of wearable devices willing to share details of
their physical activity and health.
Virtual Reality and Immersive Experiences in Healthcare
Virtual Reality Applications for Clinical Diagnosis and Treatment
Like many technologies developed for consumers, virtual reality technologies are finding a place in clinical practice
in a growing range of application areas. Significantly, we are beginning to see applications developed for virtual
reality headsets receiving FDA approval for medical practice for both physical and mental conditions.
I envisage that this will become a major growth area as an alternative to pharmaceutical drug interventions. I have
listed below some of the developments and application areas.
VR and Immersive Experiences for Pain Relief
One of the earliest examples of the use of VR and games for Pain relief was the “Snow World” research project in
which burns patients wore a VR headset whilst having their dressings changed. Through the use of brain scans
during the treatment, clinicians were able to show that patients using the headset and game experienced less pain
than other patients.
VR and Immersive Experiences for Pre-Operation Preparation

3. As with the use of VR and games for pain relief, there are already research projects exploring the potential of
immersive experiences for use both before and during surgical operations as an alternative and/or supplement to
anaesthetics. It is the experience of being totally immersed that shifts the patient mental focus away from the
procedure and reduces the need for pharmaceutical interventions
VR and Immersive Experiences for Personal Health Management
Oculus recently announced a Beta version of a VR platform called Alcove for use with headsets such as the Oculus
GO and Quest. There are many potential clinical applications for this environment but the Beta version includes a
virtual patio area with artefacts that include VR based exercises designed for personal health management.
VR and Immersive Experiences for Dementia and Cognitive Development
Mental Health, stress and burn-out are growing problems in today’s society. A tranquil virtual environment with
appropriate sound and visual cues, coupled with exercises that test and develop cognitive functions has already
gained FDA approval in the USA. A series of applications developed by XR Health test reactions times and short term
memory functions that can not only help to indicate early signs of dementia but also support its treatment. There is
also a project in the UK in a hospital for patients with moderate to severe dementia using VR headsets to immerse
patients in a range of different environments to improve their sense of well-being.
VR and Immersive Experiences for Physical and Mental Rehabilitation
Using virtual reality headsets to undergo physical and/or mental training exercises could be used to help patients
focus on effective therapies by increasing motivation and/or exposing patients to positive experiences that can
impact both the sense of well-being and motivation to address clinical issues.
VR and Wearables – Future Developments
One of the challenges of using any clinical intervention is finding reliable ways to accurately determine effectiveness
at a personal level. This is because the impact of almost every medical intervention to address a chronic condition is
either not obvious immediately or can only be measured over a long period. I envisage that next generation
consumer wearables capable of accurate real-time monitoring of vital signs will be able to be linked to adjust VR
experiences based on the clinical outcomes of the experiences. As an example, imagine a patient being exposed to a
tranquil immersive environment being monitored in real-time with a combination of Artificial Intelligence and
wearable device data being used to adjust the environment and sounds/music to suit the patient.
Virtual Reality in Medical Education and Training
I am grateful to Todd Maddox of Ikona Health for submitting this article. Todd and Ikona Health have published many
papers to share on the Linkedin platform.

4. The Promise of VR in Healthcare Education and Training
“Learning is an experience. Everything else is just information.”
Albert Einstein
This quote from Albert Einstein is supported by the neuroscience of learning, memory and performance, and is the
primary reason why virtual reality (VR) is so effective in healthcare education and training. VR is grounded in
experiential learning, but also broadly engages experiential, cognitive, behavioral and emotional learning centers in
the brain in synchrony.
Although each of the four learning systems in the brain are distinct, they all reside within the same brain with
massive, dependent interconnections. In nearly all healthcare situations information needs to be stored and retained
(cognitive), motor skills must be perfected (behavior), situational awareness must be strong (emotional), and all of
these must be present within the relevant work context (experiential). In other words, ideally all four learning and
performance systems in the brain should be activated in synchrony.
That is exactly what VR does to the brain!
Patient education and training: This is an area where VR can add significant value. Although 84% of adults have
contact with their primary care provider each year, comprising 883,700,000 office visits, only 1 in 10 patients are
health literate. Low health literacy increases stress and anxiety in patients costing the U.S. economy $238 billion
annually. The two primary education methods – written materials and one-on-one interactions – are not working.
Although cheap, scalable, and available, written materials are usually poorly suited for explaining complex medical
situations and conditions, making cognitive processing difficult and error prone. Although experiential and personal,
one-on-one interactions are often inconsistent and are not scalable. VR has all of the pros and alleviates all of the
cons of these two primary educational methods. VR is experiential, personal, consistent, scalable and available 24/7.
VR can enhance patient education, familiarization and training around medical conditions, medical procedure and
device training, and hospital familiarization to name a few. This reduces patient stress and increases patient
confidence and satisfaction.
Provider education and training: In much the same way that VR can enhance patient education and training, VR is
equally valuable in provider education and training. Provider education is dominated by written materials, and one-
on-one interaction. VR has all of the strengths of these educational tools, but also addresses all of the concerns. VR is
experiential, personal, consistent, scalable and available 24/7. Critically, providers can obtain VR experiences as many
times as they like. This builds expertise, confidence and satisfaction and allows providers to develop the broad-based
situational awareness that is so important when dealing with ever changing healthcare settings. Finally, and perhaps
most importantly, VR is an ideal tool for empathy building in healthcare providers. The ability to “walk a mile in
someone else’s shoes” allows providers to see and feel what it is like to be a patient. This facilitates effective
communication and understanding.
The future of VR in patient and provider education and training is now. With VR patients and providers can enhance
their understanding – one experience at a time.
For a more detailed examination of the Promise of VR in Healthcare follow this here.
For peer reviewed research focused on VR in healthcare follow this link.
--
Todd Maddox, Ph.D., Learning Scientist at IKONA Health
Tim Fitzpatrick PhD, Co-Founder and CEO of IKONA Health
Digital Therapeutics
The London Digital Therapeutics Event

5. Examples of Companies involved in Digital Therapeutics
Imaginary (Italy)
Milan-based serious games specialists Imaginary have pioneered the use of serious games and immersive
technologies for digital therapeutics. One of their Flagship projects is REHABILITY (www.rehability.me) which uses
games technologies and mechanics to develop, monitor and feedback progress on rehabilitation programmes for a
variety of clinical conditions including strokes and parkinsons disease. These rehabilitation programmes not only
guide patients through exercises in their own homes instead of at expensive rehabilitation clinics, they also use
gamification strategies to motivate patients and capture progress data for remote clinical support.
Imaginary have also worked on an EU project targetting autistic children
(https://www.youtube.com/watch?v=4Sn9jEKvjlo&t=23s) and a gamified application for sufferers of cystic fibrosis
https://www.youtube.com/watch?v=DJ8pP2aFmFc&t=35s
Totem Learning (UK)
Totem Learning, a leading UK based digital learning company, is currently doing a lot of interesting work within the
health care sector including mental health awareness, Stroke rehabilitation, care home training, emergency building
evacuation for disabled people, and a variety of independence building apps for people with sight loss. Their solutions
include the use of virtual reality, apps that employ accessibility functions both standard and customised by the team,
scenario exploration and social rehabilitation worlds. Their clients include the Canadian National Institute for the
Blind the NHS and specialist players across the healthcare and rehabilitation fields. Totem is also in the early stages of
a collaboration with a leading Autism research charity.
Helen Routledge, CEO, Totem Learning said "digital tools are perfect for use in health care, the work we are doing
means that wherever you are based geographically you can access help and learning materials from your home and
get support where you need it most. Most of all, our solutions are helping people be more confident in themselves;
confident to talk about difficult subjects such as mental health, confident to attend appointments and confident to
improve their own lives."
DTx London 2020 Conference
As a follow up to my thoughts on the role of virtual reality and immersive experiences for clinical interventions, I have
included a paragraph from the organisers of the Digital Therapeutics event, DTx London 2020 to be held on June 9-11.
There is a link to the web site in the upcoming events table below.
“We are very excited to announce the official launch of DTx London held 9-11th June. The DTx event series is regarded
as the meeting place for the digital therapeutics industry attracting leading digital therapeutics companies, pharma,
payors, providers and others who make up the infrastructure of the space. Having begun in February of 2018, the DTx
event series now boasts up to 300 senior attendees and is what we like to call a Goldilocks event: attracting enough
senior leaders to have everyone who needs to be there in attendance, but small enough to allow for intimate and in-
depth conversations. If digital therapies are in your wheelhouse, DTx London is the place to be."
Christopher Goy
Conference Producer
Bridging the Gap Midlands – Innovation and the NHS
Jimmy Endicott of ChatHealth Keynote Presentation

6. Encouraging innovation and supporting entrepreneurs to bring digital health solutions to the NHS was the theme of a
one day conference in Hinckley on January 30th
. There were some inspiring and practical presentations on a range of
topics including :-
• NHSX work on digital innovation
• AHSN and the Innovator featuring the experience of Entrepreneur Jimmy Endicott (see above image)
• Skills Labs on :-
o Gathering Real World Evidence
o NHSX Digital Standards
o Export and Overseas Trade
o Navigating the NHS
o How to develop a Business Case
o Regulations and NHS requirements
• The Accelerated Access Collaborative
• The Association of British Healthtech Industries
Alongside the presentations and skills lab workshops were networking opportunities, special business clinics and a
central exhibition area.
It was an excellent event and particularly inspiring were the practical experience of presenters like Jimmy Endicott of
ChatHealth sharing his experience of bringing and innovative mobile personal mental health app to market in
partnership with the NHS and Nick Brown, Commercial Manager of the East Midlands Academic Health Sciences
Network, with some very useful guidance on developing a business case that has maximum chance of success of
gaining entry into the NHS market.
Upcoming Digital Health Events
Date Event Location Web Address
Feb 4 Introduction to
NHS Market
Access
Leicester, UK https://www.medilinkem.com/event/introduction-to-
nhs-market-access/
Feb 7 EAI HealthWear
2020 - 2nd EAI
International
Conference on
Wearables in
Healthcare
Lecco, Italy http://healthwear-conference.org/
Mar 9-13 HIMSS Global
Health
Conference
Orlando, Florida https://www.himssconference.org/
Mar 10-11 Digital Health
Technology Show
2020
London, UK https://www.digitalhealthtechshow.com/seminars.aspx
Mar 17-19 Smart Devices
Symposium
Osaka, Japan http://www.bitcongress.com/sds2020/
Mar 24-25 Digicare 2020 Santiago, Chile http://digicare-conf.org/
March 26-28 Nursing 2020 Singapore https://nursingresearchconference.com/
April 1-2 Med-Tech
Innovation
Birmingham, UK https://med-techexpo.com/event/en/page/home
April 8-9 International
Conference on
Mental Health
and Psychiatry
Amsterdam,
Netherlands
https://mentalhealth.gavinconferences.com
April 12-13 Biomedicine,
Bioinformation
and Intelligent
Computing 2020
(BBIC2020)
Hangzhou, China http://www.bbic2020.org/

7. April 20-21 7th International
Conference on
Public Healthcare
and Epidemiology
Tokyo, Japan https://public-healthcare.pulsusconference.com/call-
for-abstracts
April 29-30 11th
Medical
Innovations Expo
Milton Keynes,
UK
https://www.ebme.co.uk/seminar/registration
May 5-6 World Digital
Healthcare
Congress
London, UK https://digitalhealthcareworldcongress.com/
May 11-12 50th World
Congress on
Advanced Nursing
Research
Vienna, Austria https://nursingresearch.nursingmeetings.com/
May 18-19 2nd World
Congress on
Nursing,
Healthcare and
Hospital
Management
Valencia, Spain https://conferenceera.com/nursing-healthcare-
hospital-management-conference/
May 18-20 Pervasive Health
2020
Atlanta, USA http://pervasivehealth.org/
May 21-22 Humanoid
Robotics,Artificial
intelligence and
Automation
London, UK https://humanoid.annualcongress.com/
May 26-28 Healthcare Asia
Week
Singapore https://www.asiahealthcaresummit.com/
May 26-28 HIMSS Health 2.0 Helsinki, Finland https://www.himsseuropeconference.eu/
Jun 9-11 Digital
Therapeutics DTx
London
London, UK https://www.dtxlondon.com/
Jun 10-11 Wear It
Innovation
Summit
Berlin, Germany https://www.wearit-berlin.com/
July 22-23 Medical and
Clinical Case
Reports Global
Congress
London, UK https://globalcasereports.gavinconferences.com/
July 23-24 Medical Tourism
2020
Dubai, UAE https://www.longdom.com/medicaltourism
August 3rd
International
Digital Medicine
Conference (ISDM
2020)
Guiyang, China TBA
Sept 22-24 International
conference on
Nursing &
Healthcare
Paris, France https://nursing.magnuscorpus.com/
Oct 19-21 5th Nursing World
Conference (NWC
2020)
Orlando, USA https://nursingworldconference.com/
Nov 9-11 The 4th
International
Biotechnology
Congress (IBC-2020)
Dubai, UAE https://www.bitcongress.com/ibc2020

8. If you would like any presentations, videos or documents circulated to the ISDM network, I am happy to provide this
service free of charge for any material relevant to readers of this newsletter. If you are interested, contact me at
david@davidwortley.com
The views and opinions expressed in this newsletter are personal.
Best Wishes
David Wortley FRSA
President International Society of Digital Medicine (European Chapter)
Landline: +441327811827
Mobile Phone : +447896659695
Email : david@davidwortley.com
Web: http://www.isdm.eu
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