Six Months into VA's 5G-Enabled Hospital Project

Weeks after the Veterans Affairs Department rolled out plans to steer one of the world’s first 5G-enabled hospitals in February, the emergence of the novel coronavirus presented a stark disruption.

But according to a federal official driving the effort, the nascent-but-evolving infrastructure is generating needed capabilities and a foundation for innovation, even as the pandemic persists. 

“This is a profound and dramatic time in history, and as you'd expect, COVID-19 has impacted our roadmap,” Dr. Thomas Osborne, director of VA’s National Center for Collaborative Healthcare Innovation told Nextgov last week. “It's impacted everybody.”

Osborne also serves as the chief medical informatics officer at the VA’s Palo Alto Healthcare System, the California-based hospital tapped to house the work. Through a public-private partnership deemed “Project Convergence,” Verizon provides a 5G network backbone, and Microsoft offers its HoloLens information delivery platform and headset that’s used with imaging software from Medivis, enabling officials to transform complex health information into interactive 3D holograms, models and overlays. 

In the recent conversation, Osborne detailed how VA quickly pivoted to reprioritize efforts early in the public health emergency, and made progress on the next-generation wireless endeavor despite the difficulties that arose in its first six months of existence. He also shed light on insiders’ evolving vision for what’s to come and what they’re learning along the way.

“You can train, and teach, and educate, and interact with things in ways that, you know, it's like science fiction—but it's really happening,” he said. 

Pandemic-Induced Pivots and Progress

Echoing sentiment felt by essential workers across the health care landscape, for Osborne, “it’s been such a blur,” since the novel coronavirus surfaced as a threat. 

“The days can feel like weeks and the weeks feel like days sometimes,” he explained. “It's been a very dramatic time for everybody.”

When COVID-19 hit, VA personnel were forced to reprioritize efforts and make new considerations about who could enter the Palo Alto-based hospital (and others across the nation) to immediately ensure that the facility was as safe as possible. This caused an initial distraction from focus on the 5G effort. Osborne added that many of the people who’d work on logistics, engineering, planning and other elements of the initiative “refocused on how we can shore up our internal infrastructures to prepare ourselves to support the potential surge, and/or other things that we need to do to best care for our patients.” Further, under the VA’s “fourth mission,” he said the agency has the responsibility to care not just for veterans, but also act as a sort of safety net for America’s neighboring health care systems if they were to be overwhelmed. So in the early days, officials also worked to convert intensive care unit beds and other areas into isolation wards so they could provide further support.

“That certainly took bandwidth away from the efforts of getting the infrastructure in place—no doubt,” Osborne said. “Nonetheless, we are on course to get a lot of this stuff done.”

At the launch of the 5G effort in February, Verizon delivered what it deems a “network on wheels” to Palo Alto’s facility. Osborne said the standalone, zero-trust system provides advanced wireless capabilities in a defined area in the hospital. The team had also developed a roadmap to relay the signal across the hospital’s campus by the end of the year in hopes to eventually integrate 5G-enabled innovation into surgical care. 

Though insiders are considering extending the signal’s reach with antenna and cells if need be, Osborne said the team is also looking into whether it would be more effective and efficient to lay physical fiber—another way to deliver 5G. The intention would ultimately be to “bring that into a central communicating hub in the hospital infrastructure, and then relay that signal throughout the entire health care system,” he explained. Working with partners, Osborne said VA officials are now puzzling out a plan to bring physical fiber into the hospital.

“We've had multiple meetings and we’ve had a couple of visits about planning that out, and marking the areas where the cable is going to be and how it would intersect, and integrate and plug in,” Osborne said. “So I'd say if you were to ask where we are on the roadmap of having the 5G light up the entire health care system, we're probably about a third of the way there.”

And while Project Convergence hinges on 5G, Osborne added that at the start of the pandemic, officials across the agency also thought through tools and resources already in VA’s disposal that could be quickly optimized and repurposed “to help fight this battle.” Department officials began working with Verizon and Medivis to re-focus some ongoing work. VA officials connected with Verizon’s Critical Response Team, he said, and subsequently planned out and offered new technology and boosted connectivity across isolated areas in its health care system. 

With Medivis, the agency aimed to re-pivot plans that were further down in its 5G roadmap that could accelerate solutions to new pandemic-induced needs. The medical technology company uses augmented reality and artificial intelligence to advance surgical and health care visualization. Osborne and team recognized that the system also offered an opportunity to bring people who are meant to be social distancing together in a virtual environment and enable them to collectively interact.

Osborne said he’s very pleased with the VA team’s response, as well as its partners, for being open and flexible to the needs at hand and enabling the continued delivery of care—through plans not even included in the agency’s initial roadmap.

“Everyone, everywhere got hit by surprise by COVID-19 and all of us were forced to react. However, as part of the reaction to sort of pull back and sort of figure out how we can shore up our windows and base for the storm ... tons of innovation has been pouring out,” Osborne said. “And this is a place where I think we can find that all of that is going to accelerate—and this infrastructure provides a foundation, which will allow people to do things in ways that they may not have done before.”

5G In Action 

The capabilities the agency aims to unleash broadly fall into two separate workflows: education and training, and medical use cases. 

While the latter requires a long path to integrate 5G into patient care because the agency will need to test and scrutinize every component, VA has already begun optimizing the system for uses that encompass education and training. 

“So if you consider that a picture's worth 1,000 words—you hear this all the time—then a three-dimensional holographic image that you can manipulate in front of you in space and time, how many words would that be worth? You know, maybe a million,” Osborne said. “It brings things to life in ways that you just can't imagine.”

While books are two-dimensional and cadavers can’t be reassembled after layers are removed in research, the 5G-enabled electronic, interactive system can be manipulated in ways that bring heightened depth to understanding anatomy and physiology. To help visualize what the work looks like, Osborne explained that the team recently used the system to expand a model of a human body “to the size of a giant that was three stories tall.”

“You could walk into the rib cage and the heart, and you could feel the different parts and the pieces in sort of a very intuitive way where you became interactive—it almost became like you personified some of these pieces, so it's much more intuitive and easy to learn,” Osborne explained. “That's really dramatic, and you can maneuver them and change them. Then doing that at the same time with your friends and your colleagues and talking about things in ways that you just never did before, it bridges a gap that is pronounced.”

The work could potentially be done using 4G infrastructure, though there’d be a bit of latency. Instead, 5G enables the necessary, robust infrastructure. Having initially led a demo session to introduce staff to the capabilities, Osborne said he’s now working with officials across surgery, nursing, medicine and other services within the health care system to optimize and make use of the available capabilities.

As 5G-boosted education and training continue to evolve, the team is also diligently planning for potential medical use cases that can be applied in patient care. The 5G capabilities have not yet evolved to safely, directly touch those being treated at the hospital yet, but Osborne offered a glimpse into some future use cases that the agency envisions. 

Just as the advanced tool can be used to train and upskill health care providers, officials see its potential to be integrated into patient education and help veterans better understand their own ailments. Insiders believe this will increase patients’ informed consent about procedures they’ll undergo, by offering them an opportunity to see and interact with 3D models of what their insides look like and what treatments will involve. Also on the near-horizon is integrating the system to support doctors in pre-surgical planning to help surgeons strategize their best approach custom to patients’ needs, such as targeting a tumor in a compromising location. The hope is also that eventually, the system could underpin remote procedural assistance where doctors in separate locations can aid one another in real-time via the advanced platform. 

Leaders in the medical field also generally have to travel to conferences to share their expertise with others, Osborne noted, but the 5G capabilities could actually allow providers to essentially stream procedures to audiences from around the world, providing a three-dimensional view of how experts operate.  

“That, I believe, would be a paradigm shift about how we share information—not only because it's more effective, but also because in this time of COVID-19 nobody wants to get on an airplane, and sit amongst 100 other people,” Osborne said.

The use cases are anticipated to potentially roll out in that order, ultimately culminating to bedside, and/or operating room surgical guidance for more safer and effective procedures, which Osborne noted is a "major goal” of the collaboration. 

“I think it's very possible that we can do all those things within a timeline of five years—probably less. But the first couple, we could probably do in the order of a year, without a doubt,” he explained. “I know, because we've already started doing this and have worked out some of the kinks.”

Beyond that, Osborne and his team at Palo Alto hope the effort will become a model for launching 5G-enabling connectivity across the agency’s health care enterprise. 

“Innovation is a work in progress by definition,” he said. “There's stuff that we know we want to do and there's stuff that we haven't even thought of yet that’s going to be important.”