While there is no universal definition for the Metaverse, many define it as “a virtual reality space in which users can interact with an environment generated by computer and with other users.” The Metaverse is described as a virtual world that exists parallel to the physical world, where users can interact with each other and with digital representations of objects and environments.
The Metaverse has been the subject of much speculation in recent years, with many people predicting that it will become the next big thing in technology. Some have even gone so far as to compare it to the Internet, suggesting that it will be just as transformative. The Metaverse has been discussed in the context of everything from social networking to education and to medicine.
In the current issue of Anesthesia & Analgesia, Bignami et al discuss the topic of the Metaverse and anesthesia. In their article, they suggest that Meta-Anesthesia is emerging, and we must be ready to incorporate this new construct within the traditional academic approach of patient care, education, and research. While we agree with the content of “The Open Mind” written by Bignami et al, we would like to provide some additional insights.
First, while the Metaverse, with its potential for immersive and interactive experiences, has generated significant excitement in the health care industry, it is important to remember that any technology or innovation in health care must provide added value to the patients and/or to the providers, rather than simply being the latest “new thing.” This requirement is at the heart of value-based care, which prioritizes delivering high-quality care that achieves the best possible outcomes for patients while minimizing costs. Value-based care also focuses on providing the right technology, at the right time, and in the right setting.
When considering the potential use of the Metaverse in health care, it is essential to evaluate its potential value in terms of improving patient outcomes and experiences. It is also important to consider the costs associated with implementing and using the technology and to note that the Metaverse is likely not a panacea for all anesthesia challenges. It is a tool that must be used in conjunction with other approaches to improve patient outcomes and experiences. Furthermore, the use of the Metaverse must be carefully evaluated and integrated into existing care processes to ensure that it adds value and does not disrupt care delivery.
Along those lines, the Wall Street Journal published an article on March 29, 2023, titled “The Metaverse Is Quickly Turning Into the Meh-taverse.” The article discusses how the Metaverse, which was a hot topic in tech a few years ago, is now facing strong challenges such as slow user adoption due to expensive hardware requirements and glitchy technology. While the hype around the Metaverse has receded, and it is unclear when it will reach critical mass, Mark Zuckerberg still sees the Metaverse as a long-term focus for Facebook after artificial intelligence (AI), which now seems to be the technology that can deliver results in the near short term.
We believe that the Metaverse is just a new platform, and its success or failure will depend mostly on what components will be incorporated into this platform. Bignami et al only mention the Internet of Things (IoT) in passing; however, we submit that the IoT is at the heart of the future of Meta-Anesthesia — and indeed, “Metaverse in Medicine can be defined as the medical Internet of Things (MIoT) facilitated using augmented reality and virtual reality glasses.” In medicine, IoT refers to the use of connected medical devices and sensors that can collect and transmit health data over the Internet. MIoT includes (for example) wearable devices that monitor heart rate, blood pressure, and physical activity, smart pill bottles that track medication adherence and send reminders to patients, and much more. As such, in order for the Metaverse to be successful within the context of clinical care, data from various wearables need to be incorporated into this platform.
Bignami et al also mention the term “digital twin” in passing when discussing perioperative optimization, but we would like to elaborate on this topic, because just like IoT, digital twin is at the core of any successful model of the anesthesia Metaverse. Within the context of this editorial, a digital twin is the virtual model of a patient, medical device, or hospital that can be used for simulation, monitoring, and optimization purposes.
Creating a digital twin can be a complex and challenging process, involving a wide range of technical, organizational, and strategic considerations. Some of the key challenges of creating a digital twin include the need of a vast amount of data, including sensor data, historical data, and other inputs. Collecting and integrating these data can be a significant challenge, particularly when working with patients. Such constraints will determine whether using the Metaverse for perioperative optimization of patients has any advantages over the much cheaper approach of telemedicine or simple immersive/virtual reality.
One also has to remember that even after the data for a digital twin have been collected, they must be used to develop a detailed model of the patient or medical device being simulated. This can be a complex process, requiring advanced modeling and simulation tools and techniques. The digital twin patient must also be integrated with other systems and technologies to enable real-time monitoring and control. This can be a significant challenge, particularly when working with legacy systems or complex environments.
Finally, even once the digital patient has been created, it must be regularly maintained and updated to ensure that it remains accurate and up to date. Within the setting of preoperative evaluation, information such as facial structure and difficult intubation cannot be relayed by an animation-digital twin but can be relayed by hologram-digital twin. This means that we cannot only focus on the issue of availability of and cost of devices, but we must focus on holographic technology that could be used in home settings — and such a technology is currently far from reality.
The other point that was not raised by Bignami et al is the subject of wearable technology, which is again connected to the issue of the digital twin. Providing information on, for example, heart rate, blood pressure, pulse oximetry, and fitness level, which may be already available from apps such as Health (Apple), will further enhance the construct of the digital twin to make it more usable in the real world.
Finally, Bignami et al mention the preoperative psychological benefits of using the Metaverse for information and preoperative exposure to the operating room and the hospital. We submit (again) that providing an old intervention using a new medium does not represent progress. That is, simple provision of information is the lowest level of an intervention directed at behavioral change or reducing anxiety, and ideally, reducing preoperative anxiety or changing behavior before surgery should rely on the triad of information provision, modeling, and enhancing coping skills. Those are best done using a tailored approach rather than a generic approach. That is, rather than simply allowing patients to explore the virtual world of the operating room, build an intervention that is based on intake-matrix-output. First obtain baseline information about the patient that will influence the anxiety of the patient before surgery and then modify the output based on this information. For example, input the information of coping style and trait anxiety of the patient (digital twin) and then modify the output to the patient based on these baseline variables. This reflects, once again, that rather than only focusing on how you deliver an intervention (ie, Metaverse), you must also focus on the intervention itself.
In conclusion, we suggest that while Bignami et al have provided in their current commentary paper a nice introduction on the topic, the use of Metaverse in the perioperative setting is highly complex and should consider topics such as IoT and digital twins. Because of the complexity of such constructs, the timeline for wide adoption of the Metaverse in routine clinical care will take at least 5 to 10 years. Bill Gates said, “We always overestimate the change that will occur in the next two years and underestimate the change that will occur in the next ten. Don’t let yourself be lulled into inaction.” This suggests that while we may overestimate progress in the Metaverse in the short term, we should not underestimate the potential of this platform in the long term. While we agree that the Metaverse has the potential to transform the perioperative delivery of care, it is essential to remember that it must be used in a value-based way. The Metaverse should not be seen as the newest thing in health care that we must adopt into the field of anesthesiology, but rather as a tool that must provide added value to patients and health care providers.
Conflicts of Interest: Z. N. Kain is supported by the National Institutes of Health, and has served as a speaker and consultant for Medtronic, Pacira, and Mend. He is also the founder and president of the American College of Perioperative Medicine.
Conflicts of Interest: M. P. Cannesson is a consultant for Edwards Lifesciences and Masimo Corp, and has funded research from Edwards Lifesciences and Masimo Corp. He is also the founder of Sironis and Perceptive Medical, and he owns patents and receives royalties for closed-loop hemodynamic management technologies that have been licensed to Edwards Lifesciences.
