Public healthcare in Serbia is transformed through innovative use of mixed reality technology powered by Artificial Intelligence, that increased efficiency and quality of healthcare, minimized risks and efforts, and optimizes procedures. Through remote collaboration, doctors have the same insight into patient’s condition without the need of physical presence, enabling joint real time inputs and medical interventions with experts from anywhere, as well as remote education for medical students.
Faced with the greatest healthcare challenges of today (staffing shortages, preventable medical errors, difficulty finding appropriate expert in the field, need for delivery system transformation and future of healthcare possibilities), we started with innovative practical application of new technologies for addressing these challenges.
The COVID pandemic amplified the problems for medical professionals, such as chronic stress and exhaustion at work, with an increasing incidence of burnout. The need for reduction of the staff’s exposure in the red zone led to most demanding patients in the intensive care being rarely treated by the most experienced physicians. The risk of communication errors became higher, since sharing of data and information on the patients’ condition was usually reduced to the basic information because the full paper documentation in the red zone is considered infectious, and may not be taken out of the red zone. In addition, the protective equipment made it difficult for clinicians in the red zone to monitor all the results and observations while examining the patients. The communication of red zone physicians with the outside staff is difficult, while the need for such communication is immense, in particular when difficult decisions are to be made, which directly affected the patient’s survival and success of treatment.
With the support from the Office of the Prime Minister and through partnership with Microsoft, University Hospital Center “Dr Dragiša Mišović” piloted Hololens2, mixed reality device that revolutionized healthcare collaboration and improved efficiency and quality of healthcare, as well as working conditions for doctors. Rather than the entire medical team, only one doctor enters with the mixed reality headset and views all relevant medical documentation and images as 3D holograms, while other doctors monitor from outside providing input and advice, while having the same experience and information as the doctor in the red zone.
Excellent results during the pandemic traced the path for future scenarios of surgeons that are now able to share real-time best practices during the course of the intervention with their peers. As one groundbreaking application of virtual hologram technology, the doctors in Serbia performed a unique intervention on the spine in collaboration with doctors from Germany. Additionally, anesthesiologist and vascular surgeons from Serbia and Malta conducted real time remote collaboration.
Medical education is another sector where application of mixed reality achieved excellent results. During the pandemic, students of medicine had limited access to regular practical work activities (visiting the patients, diagnostics, medical councils). By using mixed reality, students now have a chance to see patients in real time and follow diagnostic procedures, while located at safe place, avoiding COVID exposure. Mixed reality can also enable more students to experience visiting hospitals, which is why a virtual reality lab is established to improve practical work of students of medicine.
Aside from international collaboration, mixed reality can play a key role in enabling the highest level of healthcare even in the most remote areas. In this way, a small number of experts from different fields can be hired to solve numerous problems, without the need for their immediate presence. This saves time and money, and raises the quality of the service since top medical teams can remotely treat patients whenever they are located.
This initiative was recognised by the Office of Prime Minister and the Ministry of Health, that included all activities as part of a formal public sector project “Innovations in Healthcare”. Numerous Hololens2 devices were acquired and a network of hospitals and experts is currently being formed, in order to solve the most difficult situations and problems that doctors face in their daily work. Long-term plan is a wide national application in all regional medical centers equipped with mixed reality technology. In parallel, Government of Serbia is working with the Medical Faculty, University of Belgrade on improvements of use cases and procedures by increasing the capacity of the Simulation center, to enable students and healthcare workers practical simulation, higher involvement and better insights in healthcare practice.
What Makes Your Project Innovative?
- Innovations in regular procedures (The mixed reality technology enables hands-free audio and video communication with the medical team members outside of the COVID red zone, together with holographic documents and images, with nearly no risk of infection and significantly reduced level of stress and exhaustion).
- Minimizing exposure of health workers (instead of 3, only 1 doctor visits red zone with even better effect).
- Through AI-powered speech-recognition technology, patient notes can be dictated for simple storage and sharing with the doctors in the next shift, which is also crucial for continuous patient care.
- Innovations in communication, enablement of real time collaboration with experts worldwide (The mixed reality technology enables hands-free audio and video real time communication with the team outside of the red zone, together with holographic documents and images).
- Innovations in practical work and education of medical students, patients and healthcare workers.
What is the current status of your innovation?
The pilot project was implemented at the University Clinical-Hospital Center “Dr Dragiša Mišović-Dedinje” and the Faculty of Medicine, University of Belgrade in April 2021. Initially, the mixed reality technology was implemented in the COVID red zone, however later further applications of the innovations were implemented. With the support of the Office of the Prime Minister, the project will be scaled further by introducing mixed reality in a network of hospitals, in order to facilitate collaboration with all medical professionals across the country.
Medical students are actively learning at the Virtual/Mixed Reality Lab, which is part of the Simulation Center. The Government has also initiated the establishment of the Center for Innovative Technologies at the Faculty of Medicine, University of Belgrade.
Collaborations & Partnerships
- The doctors at the Hospital Center “Dr Dragiša Mišović” and Faculty of Medicine partnered with Microsoft to create the innovative application of Hololens2 mixed reality technology.
- ApoQlar provided Virtual Surgical Intelligence software for creation of 3D holograms of MRI/CT scans.
- Office of the Prime Minister with the Ministry of Health coordinated the collaboration, trainings of doctors, establishment of the Simulation lab for medical students and scaling that possibility to other hospitals.
Users, Stakeholders & Beneficiaries
By introducing new technologies in everyday practice, this innovation enhanced efficiency which resulted in significant savings and improvement of the public healthcare system. The beneficiaries are primarily patients, who are receiving improved quality of healthcare, while users – doctors and students – are benefiting from better working conditions, collaboration and better education.
Results, Outcomes & Impacts
Results have been measured through the pilot study, conducted at the hospital intensive care unit and presented to the expert public at the 17th World Congress of Anesthesiologists, as well as published in the book “Handbook of Research on Implementing Digital Reality and Interactive Technologies to Achieve Society 5.0”. The time spent by doctors in the highly infectious area of COVID red zones was significantly reduced. Fewer doctors had to stay at the same time, the number of entries was reduced, while the average time spent was reduced by 21% or 76 minutes on average. Long-term benefits can be expected in terms of reducing the physical and mental strain of doctors, better decision making in complex situations as well as improved efficiency and quality of health care. A large majority of the doctors said the device is not complicated to use and helps them make better-informed decisions. Overall satisfaction was reported by 86 % of the physicians who participated in the pilot project.
Challenges and Failures
As this truly is a ground-breaking innovation, certain level of resistance from traditionalist medical professionals could be expected. Around 35% of doctors found Hololens2 complicated to use, which is why training of doctors was a necessary component of this innovation. It is highly recommended to initiate implementation with colleagues ready for changes and innovations, making it much easier to get support form the rest, driving by successful example. Other possible challenges could be the battery duration limits, internet connection stability and rate issues, which can be overcome with the addition of wireless network extenders.
Conditions for Success
The Prime Minister has placed innovation as one of the priorities of the Government. The Office of the Prime Minister fosters cross-sectoral collaboration, which resulted in many public sector applications of the latest technology developed in Serbia, such as Hololens2. Synergy and alignment between public sector stakeholders and doctors is the key.
Talent is the key strength of the tech ecosystem and Serbian talents are globally known for engineering excellence and outstanding mastery of emerging technologies. Tech education is integrated into formal education and starts as early as the age of 7. Last year, the entire school generation comprised of around 70.000 students finished their primary school with coding skills, as Python, Scratch, Pygame and Jupiter are part of the mandatory curricula.
Serbia also has a thriving Artificial Intelligence ecosystem and is among the first countries to adopt AI Strategy, while the AI Institute is becoming a regional factory of AI leaders.
Mixed reality technology has immense potential in providing the best care from all relevant doctors, no matter the location or the infectious state of the patient.
Based on the excellent results of mixed reality application in the COVID red zones, doctors at the University Hospital Center “Dr Dragiša Mišović” performed a unique intervention on the spine using virtual hologram technology with real-time consultation with doctors from Germany. Real-time remote collaboration of anesthesiologist and vascular surgeons was also conducted with doctors from Serbia and Malta.
Aside from even more international collaboration, the Government has equipped all regional hospitals with the mixed reality devices, to enable access to best hospital treatment to every patient in the country via remote consultation of medical professionals.
Emerging technologies are a huge opportunity for the entire public sector that can solve problems that were might previously impossible to solve. However, the innovation ecosystem is only as strong as the network between all stakeholders. Only through cross-sectoral collaboration, the most innovative applications of tech can be identified and implemented.
In order to encourage everyone in the public sector to think of new ways how to introduce innovation, this case was included in the online training “Fourth Industrial Revolution: New Technologies” available for the entire public sector. Through highlighting the novel ways how mixed reality can be used in the public sector, civil servants are encouraged to think of possible applications of all emerging technologies such as AI, Blockchain, etc. in their everyday work.
- Diffusing Lessons - using what was learnt to inform other projects and understanding how the innovation can be applied in other ways
3 January 2023