Eran Orr: XRHealth's VR Offerings, Platform for Clinicians, and Journey into Space
Jessica Hagen speaks with Eran Orr, CEO and Founder of XRHealth, about the power of virtual reality technology, uses for patients and clinicians, and mental health care in space.
Jessica Hagen
Hello, and welcome back to Psychiatry XR. I'm your host, Jessica Hagen. And we are thrilled to welcome Eran Orr, CEO and Founder of extended reality platform XRHealth. Eran, it's great to have you.
Eran Orr
Thanks for having me.
Jessica Hagen
So, to give our listeners a bit of background about you and the company: You founded XRHealth after seeing the power of XR, after a long rehabilitation process, right? That was a personal process for you. And then the company has since grown to be quite dominant in the XR space. So, tell us a bit about XR for our listeners who may not know a lot about it.
Eran Orr
So maybe I'll start by introducing myself briefly. I'm not originally from the healthcare scene. I'm a former F-16 pilot. And I was diagnosed with suffering from whiplash injury due to the active flight and the G forces. And then the idea came about to combine the virtual reality in rehab. The first application was specific for neck injuries and whiplash. But then we understood that the power of this technology is by far greater than what we anticipated. And today, we have over 150 different types of applications for a variety of use cases, in physical therapy, occupational therapy, and mental health. We completed over half a million VR treatments. We have two different types of business models. One is we are selling the technology to hospitals and rehab centers and clinics. But the second business model, which I think is very unique in the market, is that we will also have our own clinics, virtual reality clinics where we are treating patients remotely using virtual reality where we're shipping headsets back home and treating them in virtual reality. That's basically it in a nutshell.
Jessica Hagen
So where are some of those clinics located?
Eran Orr
So it's all virtual. We have operational virtual clinics in the US in all the big states. It's per state in the US because everything is regulated on a state level. We also have a clinic in Australia, where most of those patients there are ASD patients with amazing results. We are now about to launch a clinic in Israel, and we will probably launch a clinic in Europe, probably in Spain, next year.
Jessica Hagen
Yeah, XRHealth has had quite a year so far! I mean, you've had a lot of announcements that have been pretty amazing. You actually announced in April that you were merging with Amelia, right? And I know that Kim, Dr. Bullock, has spoken a lot about her use of Amelia in practice at Stanford. And so what has been the benefit of that merger on your end? How did that kind of elevate your offerings?
Eran Orr
So, one of the things that we realized is that the power of this technology is not just in a single use, and it's a combination of two things. First is: the power of the technology is the combination of different types of environments where the clinician can operate the VR as a tool, and basically decide what type of environments and activities and exposures based on what the patient actually needs. And some, you know, I think, especially in the Western world, at some point, we forgot that any injury or disease, you're not just treating the symptom, or you're not just treating that specific part of your body. And I think VR on that front can provide the full, holistic picture. Then you can treat chronic conditions in a very holistic way. And the second thing that convinced us to do and merge the two companies: I think both companies decided to put the clinician in the center of the technology. From the get-go, we decided to take a different approach. We thought that the digital therapeutic concept of giving someone software and hope that would work by itself as a drug, we believe that a very challenging goal, because we still believe that the clinician is a crucial role in the healing process.
Jessica Hagen
Absolutely.
Eran Orr
And both companies designed the products with that in mind. And we had a lot of experience on the physical therapy and occupational therapy. Amelia had a lot of experience on the mental health side. So, it made sense for both companies to offer an holistic VR therapeutic platform with a clinician in the center and have the clinician the ability to offer a full range of applications and then leverage to the full extent the power of this technology. And we are seeing benefits of that decision like on a daily basis in any type of activity that we're doing now.
Jessica Hagen
The last episode that we did was with Dr. Howard Gurr, and Dr. Gurr and Kim started talking about Amelia’s previous application of homework or, you know, the ability for physicians to be able to give homework. Is that coming back?
Eran Orr
It's not just coming back. We are actually amplifying everything regarding homework.
Jessica Hagen
Ah, Kim is going to be very happy about that.
Eran Orr
Yeah, one of the things that we are realizing now, and we're asking ourselves on a daily basis, is that how can we leverage the technology to treat more patients and leverage the capabilities of a clinician to enable treatment, even though they're not in real time with the patient?
Jessica Hagen
Right.
Eran Orr
It's also true by the way for physical therapy and occupational therapy, but in mental health, I think it's even more profound than the physical rehab. We need to find a way to still have the patient move forward in their treatment without the clinician in real time doing something. And when you look at the different technologies in the market today, I don't think there's any technology besides virtual reality for mental health that can allow that and enable that type of process. Now, if we can combine and harness the VR technology, to reduce burden from clinicians, especially in mental health clinicians, but still have the same impact, and still have patients progressing, we can change dramatically how the market is operating today and enable more patients to get treatment. Because today, worldwide, doesn't matter if it's in the US or in Europe or in Australia, you don't have enough clinicians. You just don't have.
Jessica Hagen
There’s not.
Eran Orr
And it's very transactional, like the reason that mental health treatment is very, very expensive, or very transactional, all goes back to supply-demand problem. And we believe our technology can solve that. And that's what we're trying to do now. And that's why I'm saying it's sort of the homework of Amelia, we had something similar in XRHealth of a treatment plan. And we're planning next year, to come up with something very, very meaningful that we believe will enable— our goal is to get to at least 100x of capacity of a clinician, if we'll be able to do that on the technology side.
Jessica Hagen
Wow, that's fantastic. Yeah, there's definitely the supply and demand issue that's going on within mental health, as you talked about. So, I love the fact that you're saying we need to concentrate on the clinician, but let's also give patients this tool to be able to continue to improve while they're at home, which in turn does help the clinician, right?
Eran Orr
So, the way that we are looking at that, and what I'm telling my clinicians is: my job, or our job, is to turn them into super clinicians. That's our job. Now, the way to do that is not just give a tool for a patient to do homework. The question is, can we provide treatment and have the patient do what they're supposed to do, but have the clinician instead of just doing real time activity, take a seat of: I’m monitoring what I recommended the patient to do, I'm monitoring him or her if they're actually making progress as I'm expecting them to do, and then I can intervene only when I'm needed. If the technology is doing their job, and I'm monitoring that things are progressing, maybe I can spend more time with other patients that are not progressing. And on the patient side, can we create an experience that they will feel it's close enough like my clinician is real time with me. And there are different types of techniques and different types of tools. But that's basically what we're trying to do here. And again, I think we are making a lot of progress. And I believe that in a few months, we'll be able to present something that will be very exciting to the market.
Jessica Hagen
And, to circle back a little bit about that, XRHealth was awarded a patent for your learning system technology that adjust training and treatment protocols according to a patient's biometric and motion data. Right? So how does that technology work, and what is it useful for—as you just mentioned, giving clinicians more insight—but what else is it useful for? How does it help psychiatrists in particular?
Eran Orr
So we now have 24, by the way, patents of different types, so…
Jessica Hagen
Oh, so not just one.
Eran Orr
That specific patent that you're referring to, was the first one that I submitted back in 2016. And the idea was, before the Apple Watch and before the biometrics, but the general idea was, can we measure stress, anxiety pain by using different types of biometric devices like a galvanic skin response, heart rate variability, EEG? And can we adjust the treatment in real time based on your metrics, and we add a closed loop system where you can actually self-regulate yourself, but not just as an experience but as a therapeutic tool. And then also have the clinician the ability to adjust that type of engagement. And I think one of the very interesting things that we are seeing with VR is we have the ability to hijack the brain to treat the body. And it's a very, very powerful tool. And if we can harness that type of very powerful experience, but also fine tune it to the specific needs of the specific patient, I think we can reduce the amount of different types of narcotics that we're using today, especially in the psychiatric world, but still get the same impact of those narcotics. Now, like other narcotics or drugs, and again, the psychiatrist is the one deciding which type of drug to prescribe and doses and when.
Jessica Hagen
Right, absolutely.
Eran Orr
The question is, can we provide the psychiatrist or the mental health counselors the same ability like they're prescribing specific drugs and get the same impact using those types of technologies, with far less side effects. So again, it's a process, but I think the technology is getting there. I think we're seeing more and more clinicians open to the idea of an understanding of how impactful that could be. Your podcast, by the way, is an example of how and what we should do in order to market those devices and those types of technologies that are out there.
Jessica Hagen
The technology that was initially announced was said to be able to be combined with the Apple Watch, with Apple's new augmented reality, the Vision Pro headset, to provide this closed loop AI enabled treatment. The Vision Pro looks like a pretty amazing headset. I mean, it looks fantastic. It is quite expensive for the average user, right, and even for some clinicians. So, who is the intended user for this offering?
Eran Orr
There will be a full spectrum of devices in the market. And Apple, as always, likes to take the premium side of the aisle. And our goal is to have technologies compatible with all the different types of headsets in the market. And the clinicians will need to decide whatever is suitable for them, and each clinician will make their own decisions. I think an interesting thing that the new technology, not just the biofeedback, but entire different types of things that Apple announced and other companies are announcing is the ability to do it also remote in back home with the same impact, like you're in person. And I think that's what we'll see in the coming years that instead of doing it to the type of interview now, or if I'm taking you through therapeutics side, I believe it will be far more effective in a 3D type of environment, as long as I will feel and the patient will feel that we are in the same room. And then you can add different types of components that would make a big impact. And you can add biometrics feedback. And all of that suddenly opens a whole new set of possibilities for treatment. And again, improved access to care hopefully will reduce the burden from clinicians because now you can serve a lot more people. But I do think that, like any other technologies out there, there will be the more expensive one that will enable you to do more stuff, and there will be more cheaper ones. Even today, we have people that are still using the Google Cardboard versions that Amelia created back in 2013 because that's what they believe is the right thing for them and their patients. And we have clinicians and hospitals buying the newest headset that just came out a week ago, right? So, it's like, I think you will always have that spectrum, and our job is to try to support that spectrum as much as possible to enable all clinicians and all patients that want to use the technology to improve their health, to use whatever they want.
Jessica Hagen
As the technology progresses, I kind of see how AI would be really useful in creating virtual environments that can just be made on the fly, right? Is that something that you at XRHealth have thought about or are exploring or?
Eran Orr
Of course, and I think one of the things that without a doubt will happen, the only question is when. Think about how powerful it will be when a psychiatrist or a mental health counselor or social worker or psychologist, doesn't really matter, they want to create an experience because they believe the experience is what will help the patient or trigger an event in order for them to start the conversation and the treatment— we're seeing that, by the way, around PTSD a lot, right. And when you want to do exposure therapy for that matter, how do you actually create that? And if we can do that and provide the clinicians basically endless amount of environments, and anything that they want, they just speak their mind. And that's it that just happens.
Jessica Hagen
Right, it just occurs.
Eran Orr
Right? That opens endless amount of possibilities to this industry, right. But I think VR for mental health and emerging AI capabilities in the new headsets will be very, very important for the industry.
Jessica Hagen
Absolutely. I agree with you, I think it's going to be really, really valuable. And the more adoption that occurs within the mental health community, I think the more that you will see how valuable it really could be. I think a lot of times right now, providers are really hesitant to adopt the technology first, because some of them, they just don't understand it, you know, and then some of them think that it would be really difficult to actually implement it into their practice. When you come across providers who are hesitant about implementing it, what do you tell them?
Eran Orr
First of all, we need to do a better job. Us as a company and us as an industry, we need to do a better job to enable them to use the technology in an easy-to-digest way. We just announced that we launched a few weeks ago, a package where the goal of that product was less than 10 seconds for a clinician to get the patient inside virtual reality.
Jessica Hagen
Oh valuable. So valuable.
Eran Orr
And that's how we structured that package, we basically stripped out all the complexity. No WiFi, even connectivity, like very, very simple.
Jessica Hagen
Wow.
Eran Orr
Thirteen different types of applications that are mainly stress, anxiety, cognitive behavioral therapy, mindfulness, some more like 50-ish, different type of 360 environment. And not because it's a full therapeutic tool with all the capabilities— it's probably 5% of our capabilities on the technology side. But it enables the patient and the clinician to step into virtual reality very easily. Right, with no friction. And what we're seeing now is that after they are seeing the value of the technology in an easy-to-digest way, now they're willing to take it to the next level and they hear about, “Okay, how can we treat? What other things can we do with this technology?” And I think us as a company, we thought that features and options will create value and what we actually saw, it created friction and increased the problem for adoption. So that's on our side. And I think we're getting to a better place there. And I think we need to also keep communicating and publish papers and get patient feedback out there and show more and more clinician success stories. And I see that now more and more. I think now we have over 50 clinical trials combined both Amelia and XRHealth, and over half a million VR treatments. We have patients from the age of eight to 93, both on-site and back home. And I think we have enough data to get into a conversation both clinically in usability and workflows and reimbursement. I think now we're getting to a point that we can have fruitful conversations. And usually when I'm getting pushback about the technology, I usually solve it by saying, “You know what, just try.”
Jessica Hagen
Just try it. Yeah.
Eran Orr
Just try it. And let's talk in a month.
Jessica Hagen
Yeah, that's smart that kind of you made a teaser to kind of get people, “Well try it out and see what you think about it.”
Eran Orr
Yeah. I can tell you that now that I'm leaning more to mental health, I found, for example, again, we are now investing a lot in PTSD and how we can, you know, adjust our platform for PTSD and as a PTSD specific package. And I wasn't familiar with the EMDR technique at all, if you're not coming from a mental health background, I never heard about that. And the first time someone told me about EMDR, I was like, what, what?
Jessica Hagen
What?
Eran Orr
And I realized that I have no doubt that at the beginning, you know, when people tried to implement EMDR, I have no doubt that a lot of people said that this would never work. This would never work. Doesn’t make sense. It looks like…
Jessica Hagen
Right, right.
Eran Orr
But, you know, over time, when you ask clinicians today, what's one of the best ways to treat trauma? EMDR is like that's the common practice today, right? Like no one is debating anymore, whether this is but I have no doubt that when it started, you know, that wasn't the case. Right?
Jessica Hagen
Right.
Eran Orr
It took a long time to convince clinicians that eye movement have any type of relationship to how you process trauma. I think that we'll see the same type of pattern in VR, just the difference is that possibilities in VR and in using this technology is by far greater. But on the educational component, I think it's roughly the same process that we'll see.
Jessica Hagen
Right. And you XRHealth recently announced that you are sending a VR headset into space alongside the HTC VIVE and Nords Space ApS and you're actually creating a headset that can be used in microgravity conditions, right? Can you tell us a little bit about this, and this is for the benefit of astronauts mental health.
Eran Orr
So first of all, I'm, by the time which we are recording this, it’s already in space.
Jessica Hagen
It's already in space!
Eran Orr
And more than that, we got a message that it's working,
Jessica Hagen
Oh, fantastic!
Eran Orr
Few days ago, and it was a long process, two and a half years of development. The main challenge there was to make sure that the headset is working in a zero-gravity environment. For the audience that haven’t tried VR, it's a 360. And it's all centered based on, you know, your positioning. And in space, it is what it is, positioning can change—
Jessica Hagen
Yeah.
Eran Orr
—and one of the big challenges, and I think HTC did an amazing job of figuring out how to utilize that. And on the mental health side, to be four to six months in a very closed environment with the same people, you know, far away from home, and you need to be in high performance all the time. So, the idea is that: Can we allow the astronauts to have some time for themselves, and disconnect from the current environment, in order to enable them to actually keep the high performance? One of my clinicians gave me an example, which I like to iterate here that, and I wasn’t thinking about that before getting into the mental health space is that: When you're running for a long period of time, or if you are doing exercise for a long period of time, if you won't give yourself time to recover, you will get injured.
Jessica Hagen
Right.
Eran Orr
It is what it is. Very easy to understand when you're doing those types of activities. Mental health is the same. If you're in a high-performance type of environment, high stress for a long period of time, you will get injured. It just reflects in a different way on your body and on your mind. And the astronauts use case is exactly that, right. They need to perform every day, their schedule is measured by the minute for six months, they know exactly what they're doing every single minute, they have a lot of high stressful situations and tasks that they need to do. And the VR allows them, at least in the current design that we did, just to zone out under again the same concept that it will give them time to regroup, to recover, and make sure they're maintaining their high performance. And I have no doubt that this is an example that if it will be successful, it will be relevant on Earth for a lot of use cases.
Jessica Hagen
Right.
Eran Orr
And I believe that in the next decade, we'll see more and more of those headsets, and more and more of those missions, especially now that we're about to start flying because ‘humanity’!
Jessica Hagen
Right.
Eran Orr
You know, at some point, we will fly to Mars, which is two years and not four months. So, all those things will become far more difficult and more extreme. And I think VR will be a very important tool in order to make sure that other people that are doing those tasks are still at the top of their game, even though the environment and everything is relatively intense.
Jessica Hagen
Absolutely. Well, I look forward to having you on again at a later date when you have more announcements that you would like to make.
Eran Orr
We are now doing an announcement every couple of weeks, so you just need to pick.
Jessica Hagen
Okay, so maybe a little bit farther out.
Eran Orr
Exactly.
Jessica Hagen
Yeah. Eran, thank you so much for joining me. Do you have anything else that you want to add for our listeners?
Eran Orr
Keep doing the amazing job that you're doing. Let’s work together to spread the word of how this technology can help clinicians and patients. And again, I believe that we can change the industry and take the entire industry forward by start implementing this technology on a grader scale.
Jessica Hagen
I agree. I think this technology is definitely going to change a lot in mental health care. Thank you again for joining me.
Eran Orr
Thanks for having me.
Jessica Hagen
That's it for this episode of Psychiatry XR. We hope you gained a new perspective on using extended reality in healthcare and thank you for listening. This episode is brought to you by Psychiatry XR, apsychiatry podcast about immersive technology in mental health. For more information about Psychiatry XR visit our website at psychiatryxr.com. Be sure to subscribe to the podcast and tune in again next month to hear from another guest about XR use in psychiatric care. You can join us monthly on Apple Podcasts, Twitter, Spotify, or wherever you get your podcast. Psychiatry XR was produced by Kim Bullock, Faaizah Arshad and myself Jessica Hagen. Please note this podcast is distinct from Dr. Bullock's clinical, teaching, and research roles at Stanford University. The information provided is not medical advice and should not be considered or taken as a replacement for medical advice. This episode was edited by David Bell and music and audio was produced by Austin Hagen. See you next time.