November 27, 2020 • 43 mins
This week we speak with 'doctorpreneur' Dr Evelyn Chan. Dr Chan is a peadiatric doctor turned CEO and co-founder of Virtual Reality start up Smileyscope.
Evelyn studied medicine and surgery at Monash University in Australia before becoming a Rhodes Scholar at the University of Oxford where she studied medical anthropology and public health. She then worked at the Boston Consulting Group, specialising in public sector and healthcare strategy.
As the CEO and co-founder of Smileyscope Evelyn is now working to change the experiences of children in clinical settings. Smileyscope grew out of Everlyn’s own clinical experience and aims to transform paediatric needle procedures through patient-centred Virtual Reality.
As we will hear some of the advantages that Evelyn has found in her work is that VR is able to decrease patient pain and anxiety and makes it quicker and safer for clinicians to perform procedures.
Evelyn gives us a great insight into the process that she went through in getting her company to where it is today and in doing so conducted the largest clinical study on VR in a paediatric setting anywhere in the world. She shares some great insights into lessons learned and we really hope you enjoy this conversation as much as we did.
Follow Smileyscope on Twitter here.
Visit our shop here to purchase a copy of the Thinking of Oscar Cookbook - Made with Love or Facecovering. THANK YOU!
Thinking of Oscar website and contact details can be found here.
Follow us on Twitter here or Instagram here.
Theme Music - ‘Mountain’
–
copyright Lisa Fitzgibbon 2000
Written & performed by Lisa Fitzgibbon,
Violin Jane Griffiths
Podcast artwork thanks to The Podcast Design Experts
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
Evelyn (00:00):
I noticed in paediatrics that there were lots of
(00:02):
children. The first questionthey would ask me was, am I
going to get a shot today? Or doI need a blood test? Or, you
know, it seemed to eclipse thewhole conversation about what
they came in for. They were justvery fixated and wanted to know
and was stressing about this onequestion. What I had noticed
when I'd sort of done a lot ofshifts with it. Children, you
(00:25):
know, if you can calm them down,if you can calm the parents down
and make it a much more relaxedexperience that IV or that
needle can go in a lot moreeasily? So I think it was about
how can we scale that bestpractice and make it a much more
safe and enjoyable experiencefor children.
David (00:48):
This is Episode 10 of the second season of the Not Mini
Adults Podcast Pioneers forChildren's Health Care and Well
Being. My name is David Cole andonce again, I'm joined by my
wife Hannah. We are the cofounders of children's charity
Thinking of Oscar this week, weare joined by Dr. Evelyn Chan.
Dr. Chan is a paediatric doctorturned CEO and co founder of
(01:10):
virtual reality startupSmileyscope. Evelyn studied
medicine and surgery at MonaschUniversity in Australia, before
becoming a Rhodes Scholar at theUniversity of Oxford. Where she
studied medical anthropology andpublic health as the CEO and co
founder of Smileyscope. She isnow working to change the
experiences of children inclinical settings. Smileyscope
(01:31):
grew out of Evelyn's ownclinical experience and aims to
transform paediatric needleprocedures through patient
centred virtual reality. As wewill hear some of the advantages
that Evelyn has found in herwork is that VR is able to
decrease patient pain andanxiety and make it quicker and
safer for clinicians to performprocedures. Evelyn gives us a
(01:53):
great insight into the processthat she went through in getting
her company to where it istoday. In doing so conducted the
largest clinical study of VR, ina paediatric setting anywhere in
the world. She shares some greatinsights into lessons learned.
We really hope you enjoyed thisconversation as much as we did.
(02:18):
Evelyn. Hi, thank you so muchfor joining us on the Not Mini
Adults Podcast. We're sodelighted to have you.
Evelyn (02:25):
Thanks so much, David and Hannah. Great to be here.
David (02:31):
You're currently in Australia, so you're the second
person that we've had on thepodcast from from Australia,
although, as we were kind ofdiscussing, when we first met,
actually, you kind of spend yourtime between between the US and
Oz but obviously, due to COVID,you're kind of staying put I
(02:52):
guess, at this point in time.
Evelyn (02:54):
That's right. Yeah.
David (02:56):
So before we kind of get into it. Virtual reality is
something that we've beenwanting to discuss for a long
time. We've had, I think, quitea few inquiries coming to us and
talking about, you know, isthis, is this something that is
is real, is this something thatwe should be looking at? Is this
something that we would fund? Ordo you know, kind of things or
(03:20):
what have you. So it'sdefinitely a topic that really
interests us? I think, you know,many people out there, but I
guess the best best place tostart is, you know, how did you
get to where you are in terms ofworking in VR? But really kind
of what what motivated you to bewanting to work with children to
(03:40):
begin with?
Evelyn (03:42):
Yes, I suppose I'll start with the latter half of
the question. I thinkpaediatrics was the first part
of the journey. For me, I grewup with a younger brother with
severe autism. So he'snonverbal, needed 24 hour care.
My parents had some poor sort ofhealth experiences early on with
(04:03):
him, you know. I think there wasthis theory around refrigerator
parents and all sorts of thingslike that. I think it was a
couple of negative interactionsreally put them off the health
system early on. Saying that asa sort of older child. I was
about 9 or 10, when he was born,I could really see how that
impacted them and their mentalhealth and their relationship.
(04:26):
But also how it impacted oursort of ongoing healthcare there
on. Because afterwards, it waslike, I don't really feel like
going to bring him to the doctorif things were going wrong. So I
think early on, I sort ofthought if you could really
change that trajectory ofhealthcare. Have those fantastic
experiences early on, then youwould actually be able to have a
(04:49):
great relationship movingforward and it could change the
trajectory of someone'shealthcare and how they thought
about their disease or soughthealth care. So I think, you
know, growing up I felt I lovethe science and I loved the art
of medicine. So that just seemedlike a natural place to go, you
know, paediatrics, you couldmake a great impact early on.
(05:10):
Hopefully bend the curve andchange that trajectory. Then
from, I suppose the second partwas around virtual reality, and
that that came a lot later. So Ithink with VR I had noticed
that. I mean, I suppose firstup, I should say, with patient
care, I had noticed inpaediatrics that there were lots
(05:31):
of children. The first questionthey would ask me was, am I
going to get a shot today? Or doI need a blood test? Or, you
know, it seemed to eclipse thewhole conversation about what
they came in for. They were justvery fixated and wanted to know
and were stressing about thisone question. What I had noticed
when I had sort of done a lot ofshifts was that children, you
(05:54):
know, if you can calm them down,if you calm the parents down and
make it a much more relaxedexperience that IV or that
needle can go in a lot moreeasily? So I think it was about
how can we scale that bestpractice and make it a much more
safe and enjoyable experiencefor children. So I actually
(06:14):
didn't come across VR until acouple of years ago. I'd sort of
heard words about it being thenext big thing. But then when I
tried it on myself, I sort ofthought, you know, this could
potentially be a fascinating,scalable technology where a
child can virtually escaped tothe procedure room at the sort
(06:34):
of important points where itwould be really helpful for a
child to be somewhere else andbe able to reframe that
experience. Think about itdifferently. So that was kind of
where I started thinking aboutVR, and its applicability in
certain parts of healthcare.
David (06:53):
The patient experience has been something that we've
been, I guess, it was prettymuch the first thing that we did
when we started the charity. Sowhen Oscar was in hospital, you
know, blood tests andcanulations and what have you,
we're pretty horrendous for allof us, obviously, mostly for
him. But for the playspecialists, for the nurses, for
(07:14):
the doctors and everything else.
So when we had the opportunity,then one of the first things
that we funded was an Acuvein.
So a vein finder, because wefelt that it was something that
would have been beneficial tohim. So when you were, before
you kind of moved into the techside of things? What What kinds
(07:35):
of things were you seeing thatwere working or not, and the
experience that people were, youknow, that the children were
getting, whilst they were inhospital?
Evelyn (07:46):
Yes, I suppose we're talking about the fundamentals
of sort of procedural care.
There's sort of the physicalpositioning, so making sure the
child is feeling safe. So weusually sit them up on the
parent or the parent giving thema big hug rather than them lying
down because I feel a lot morevulnerable that way. Obviously,
the psychological distraction.
(08:08):
So whether that be bubbles,toys, their favourite game, you
know, a clown, a doctor orsomething like that and then the
pharmacological side. So if wecan give them a local
anaesthetic or some way ofdecreasing the pain on their
side, that's important as well.
Then, you know, for youngerchildren, it would be also
(08:28):
providing sucrose or sugar,essentially, which has been
shown to decrease the pain aswell. Or in younger children
again, breastfeeding is alsosomething that can be quite
supportive around procedures. SoI think we always say, you know,
we want all those fundamentaltenants that have procedural
care.
Hannah (08:49):
Someone had mentioned to us early on that if you could,
cant get the exact phrasing way,so correct me if you remember
exactly where this came from DC.
If you could distract a childthen their perception of pain
would be reduced. What are thecorrelations there? You talked
about sucrose, which I didn'tknow before that it could
(09:10):
actually reduce pain, I justthought it was a distraction,
you know, helpful distraction.
But are there actually, youknow, when you're bringing the
toy in for example, is it thatthey're distracted? And they
feel less pain or they'redistracted? So the pain is less
noticeable? If you see what Imean?
Evelyn (09:30):
It's a good question. So I mean, I suppose the theory
comes back to this idea of theirgated pain theory. So this idea
that if you can engage more ofthe senses, then you have less
bandwidth, I suppose, or lessability to pay attention to that
pain. So I think that's why VRbecame a really interesting, you
(09:52):
know, technology for us becausewe're saying, you know, rather
than it being a 2D, TV or movingimage where suddenly doing 3D
it's much more immersive, it'sactually interactive. So you're
engaging more of that, you know,more of the attention than if
you're watching a television. Soit is I suppose that theory
(10:14):
that, you know, you're not beingable to pay attention to the
pain and anxiety doesn'tregister as much.
Hannah (10:20):
Yeah. Okay, that makes sense thank you.
David (10:23):
At what point did you kind of realise that VR could be
or, you know, any kind oftechnology, but but VR in this
scenario could actually play areally, you know, fundamental
part in that kind of alleviationof pain and trying to help
children through theseprocedures.
Evelyn (10:44):
I think we've sort of had seen it myself and
experienced it and sort ofthought how immersive it was. My
co founder, Paul was an adult,respiratory physician and he was
seeing a lot of patients who aretransitioning from, you know,
paediatric to adult care. He wassaying, you know, he looked
(11:04):
after children with cysticfibrosis. He said, you know,
what do you do with thesechildren? They're so
traumatised, that they're askingto be put to sleep, to get an IV
cannula in every three days, youknow, there's so needle phobic,
you know, what can we do tohelp? He was actually the one
that put two and two together,because I'd said, You know, I
(11:25):
came back from this really coolVR thing, it could be really
interesting in healthcare. Hesaid, you know, could this be
really interesting, particularlyfor procedures, where there's a
lot of pain and anxiety aroundthat. So we looked at the
literature, and we sort of foundthat the defence force in the
80s, in the US had actually donequite a lot of research around
(11:45):
how virtual reality might beable to decrease the need, or
the dose of opioid medicationwhen they're doing very painful
burns, dressings, changes onsoldiers. So that was something
that sort of thought, hang on,that's a really interesting
concept now that VR is much morewidely available. Also, rather
(12:07):
than being hooked up to agigantic computer, we could do
it on our phone, essentially,you know, could we apply this to
much more common, you know, lesspainful, but very common
procedures?
David (12:20):
Then Smileyscope was born, I guess.
Evelyn (12:23):
Exactly. Yeah. We then started, I suppose much more on
the research side of what couldwe find off the shelf for
ourselves. So it was very mucha, you know, the usual clinician
story of, you know, we analysedall the literature, we looked
through, I think it was about13,000 papers, and we did a
systematic review. Analysed theresearch that have been done.
(12:43):
From that realise that therewere a lot of gaps in the
research and that had had verysmall, you know, numbers in the
studies. So from there sort ofthought, you know, how can we
validate this into a much largerstudy. From there sort of looked
around off the shelf products,and we sort of thought, you
know, there are a couple ofessential key criteria that we
(13:05):
wanted. We wanted to ensure thatthe patient had something that
was distracting, but it alsoneeded to be predictable for the
clinician, we didn't want themto move around. So you know, I
didn't really want to give thema rollercoaster ride or a
dinosaur walk when they wouldmove suddenly and I've missed
the vein. It also sort of neededto bring in the best practices
(13:27):
that we already knew about. Sothat physical positioning, you
know and the psychologicaldistraction. Within
psychological distraction, weknow that things like deep
breathing and visualisation andcognitive behavioural therapies
are really important in that. Sowe couldn't find something that
was really off the shelf thatworked for us. So we ended up,
(13:49):
you know, saying, let's try andcreate our own. So sort of
started working with patientsand families and clinicians to
develop that.
Hannah (14:00):
Where the two activities happening in parallel? So did
you conduct the clinical trialat the same time as making some
progress in developing theproduct? Or did one fully inform
the other? How did those twopieces of work fit together?
Evelyn (14:18):
Yeah, so I suppose we started with the research on,
you know, the landscape and whathad already been done before.
Sort of did that systematicreview and analysed all the data
and sort of ended up saying,look, there's a correlation
between VR being helpfulcompared to current modalities.
Then that sort of researchinformed the next part, which
(14:41):
was quite fun around thediscovery. So we worked with
about 100 patients and theirfamilies who had had, you know,
from the spectrum of, they hadgreat blood tests to really bad
ones and said, where would youlike to go if you could
virtually escape the procedureroom and you know, about 90% of
Ozzy kids said they would liketo go underwater? So then we
(15:03):
sort of broke down the procedureinto, you know, so what does
that tornakit feel like? Theywould say maybe a diving band,
and what would sort of theantiseptic wash feel like and
they said, you know, waveswashing over your arms. What
would the needle feel like.
We've got some reallyinteresting answers, as you can
(15:23):
imagine fromkids. But the onethat we felt worked really well
and was actually quite a commonthing was fish nibbling, because
you can imagine the fish being aDory fish or, you know, a
stingray, or whatever you wantto. So that could kind of
accommodate the different typesof pain that a child could feel
or in the case of, if they hadlocal anaesthetic, they wouldn't
(15:44):
really feel the pain, but itwould just feel like something
on their skin. So that was areally kind of good way of
reframing the sensations. Wekind of choreograph that. We
worked with a digital team,which had worked with Disney
before. So we learned somefascinating things about how you
work with kids. You know, howyou don't want the fish to
(16:06):
approach them directly face on.
It was kind of something likethat, you know, the fish would
swim around and loop aroundbefore they kind of land on your
arm. All those sorts oftechniques that I think we sort
of really brought in thatclinical and digital best
practice. Once we created theVR, we then said, Let's go to
clinical trials and actuallytest this out. So we sort of had
(16:30):
pretty much the fully developedproduct, from the start when we
started recruiting patients
Hannah (16:36):
Must have been an incredibly exciting journey,
maybe with some unexpectedtwists and turns. So for
example, when you were talkingabout the digital team that you
were working with in thebackground that they brought in.
Evelyn (16:48):
Yeah, I think I learned a lot about, you know. Sprint
reviews and all sorts oftechnical terms. But really
enjoyed it. I think they werefantastic to work with. I think
combining the two so we couldreally think about, you know,
visually, how do we make thisreally beautiful, exciting and
wonderful experience. As well asthat sort of clinical side of
(17:10):
how can we bring in what wealready know, as best practice
and make that fun, was a reallyenjoyable process.
David (17:18):
What else did the kids say in terms of what the needle
could be?
Evelyn (17:23):
So one of the ones was a dolphin bumping you. So we do
actually have them riding on adolphin when they get their IV
in? So that was something thatwe've could bring in. A whale
spurting. Yeah, so lots of coralbrushing across you. So yes,
lots of different interestingsensations.
David (17:47):
No Great Whites taking chunks out of their arm thank
goodness then.
Evelyn (17:50):
I think we did,but that was probably a teenager that's
suggested that.
David (17:55):
Thats what I thought.
Hannah (17:59):
So then you go into the clinical trials and I know that
this is the trial that youcompleted was the largest
clinical trial of its kind forVR technology, is that correct?
Evelyn (18:11):
That's right, yeah, for procedural care. So essentially,
we designed this, as we reallywanted to make sure that we had
the numbers to be able to havean informed result that we were
confident would be statisticallysignificant. So we also want it
to be quite generalizable acrossdifferent cohorts. So we sort of
said, well, where are twodepartments where a lot of IVs
(18:35):
and venipuncture, so blood drawshappen. We thought, let's pick
the emergency department,because often, you know,
families will come in, they'reoften coming in with some other
reason and don't expect to get ablood test or an IV. Then let's
pick the children who come infrom the community and usually
well, but needing regular bloodtests, so they've had this
(18:56):
before. So we chose thephlebotomy or pathology
outpatient lab as well. So wedid this in two large hospitals
in Melbourne, and we recruitedfrom there and we ended up
getting about 120 to 130patients in each of those
groups. So the in the emergencydepartment and in the phlebotomy
(19:19):
lab. From there we sort of thenrecruited them said, you know,
there's an option when we'retesting this new VR technology.
But we want to do it like arandomised control trial. So
it's kind of like apharmaceutical trial in the
sense that you don't know whichgroup you're going to be
allocated to beforehand. All thequestions are very standardised.
(19:45):
So then we found that, you know,we're kind of have this envelope
and once we've sort of askedthem all the baseline questions.
We would find out which groupthey were allocated to. The
children in the VR group wouldhave the VR experience and then
the children In the standard ofcare group would get still best
practice care. So it was a veryactive control. It wasn't like
(20:06):
we put them in the room withoutanything. Then after that we
sort of compared sort of theirbaseline pain and anxiety that
was reported by the child, thecaregiver or the parent. There
was the procedure list and alsoan observer. So that we had
those four different peoplegiving their perspective so that
(20:28):
we could actually kind of matchand make sure that they were
directionally in the same sortof, you know, precinct of what
the pain or anxiety would belike. We also measure things
like, you know, first sticksuccess and how long it took to
do the procedure as well. Thenfrom that, we actually found
that, interestingly, in thevirtual reality group, that
(20:51):
there was a significant drop inpain and anxiety. Parents
reported less distress from thechild as well, up to 75%, less
distress. We actually found thatthere was less need to restrain
children or hold down theprocedural arm. So by about
half, and that sort of meantthat you wouldn't need as much
(21:13):
force and you wouldn't need tonecessarily bring in an
additional person to support thearm.
David (21:36):
What age range were you working with in this clinical
trial?
Evelyn (21:43):
Yeah, so I suppose that was another really interesting
thing. We wanted to ensure thatchildren, when they first have
their first permanent memories,around the age of three or four
years old, would be able to havea good experience of their first
needles. So, you know, mostchildren have four year old
vaccinations. So we sort ofthought 4 to 11 was kind of age
(22:06):
range. Virtual Reality, as youprobably know, most people
recommend, sort of 10 years andabove with the commercial
headsets. We did bring this tothe ethics board, and we said,
Look, this is going to be a veryshort procedure, you know, three
to five minutes, you know, theycan take it off if they want to.
I suppose, you know, we werealso doing a lot of the adverse
(22:29):
effects, side effects collectingas well, so that we could see
whether there was any differencein the children who were given
the VR compared to the controlgroup. What we ended up finding
was actually that the childrenin the VR group didn't have any
sort of differences in the theside effects reported. Now the
(22:50):
Common side effects of the era,you know, eyestrain, dizziness,
they might feel nauseous. Thereare also some things that can be
correlated with being nervous ingeneral. So I think there were
some children in both groupsthat were just anxious about the
blood test. So it's hard toreally pull and see, you know,
(23:12):
what was VR and what was, youknow, what was just anxiety
about the blood test? But therewere no differences between
those two groups?
Hannah (23:22):
Did you find that VR suited the younger age bracket
equally as the older agebracket, or vice versa? Or was
there part of that demographicthat you felt was going to be
your optimal age range to targetmoving forward?
Evelyn (23:40):
It's a great question. I wish we had an even bigger trial
where we could break down agegroups. Maybe that's something
we do in future is figure out,you know, where, you know, and
what works best for children.
But one of the interestingthings that we noticed from the
trial was when we worked withour digital company, we said,
let's target this for childrenabout the age of five. We're
(24:01):
actually finding anecdotallythat children around six or
seven, were responding better toit. I think they cognitively
understood that we're stillgoing to have the blood test,
this was going to help supportthem through the blood test. So
I think they, they were able toenjoy that more. I think when
(24:21):
you're stressed you're notcognitively at your best either.
I think that was something thatwe've kept in mind as we develop
future products is, you know,when we're aiming for a five
year old, you know, we probablygot to think about simplifying
the language a little bitbecause just to factor in the
stress and anxiety of being inhospital.
David (24:43):
Yeah, there's so there's so many questions going through
my head around that becausethinking when you said, you
know, it's the first it's thatfirst experience that a child
might have in hospital. Thefirst thing that they
experienced is that someonesticks a needle in their arm.
It's not a great one. Especiallyat the age of three and four,
when they're starting to reallykind of have memories and go
(25:04):
ahead with it. It's justfascinating as to where that
kind of level is that they willactually make a difference.
Where they fully aware of whatwas actually happening to them.
So I'm just trying to think, youknow, we've got a nearly three
year old now. If we told himthat he was about to have a
(25:28):
blood test, would he actuallyrealise and understand what that
meant? Especially if you put aheadset on, not that any of our
children have used VR, as such,but they're all you know,
associated screen time and whathave you. Do they do they fully
(25:49):
understand, or are they aware ofwhat is going to be happening to
them I guess?
Evelyn (25:54):
Yeah, I mean, I think by the age of four, and I mean, I
suppose there's a big spectrum,right. But I think they usually
can understand what's imaginaryand what's the real thing. So we
were quite clear when weexplained it to them, that you
know, that we're still going toget the blood test and that they
(26:14):
were able to get I suppose adistraction. One of the things
that they could do was sort ofhave a peek and look around so
that they could kind of movebetween both worlds. We didn't
want them fully in the VR. Inthe VR world. Still be there and
understand what was going on,but just reframe it differently.
(26:35):
I think it was just that sevenyear old group kind of really
understood it straightaway andit was a very easy explanation.
David (26:42):
How many children were actually in the trial in the
end?
Evelyn (26:46):
Yeah, so a total of 253 children and so roughly half
were in the VR group.
David (26:54):
I think one of the interesting things is that
whenever you talk about fundingfor paediatric startups or
paediatric innovations. One ofthe first things that people
talk about is the inability insome respects and obviously, it
depends on the technology, itdepends on what they're trying
to do the trial or the drugtrial, or whatever it is, but
(27:17):
the inability to actually do ,orthe feasibility of doing trials
with kids. So is there anythingthat you have learned that you
can share in terms of bestpractice or, you know, thoughts
just around that, that elementof it?
Evelyn (27:33):
Yeah, it's a good question. I've only ever done
paediatric trials. So I think,you know, when you're working in
paediatric hospitals, you justrealise there's going to be that
extra level of scrutiny aroundside effects and impact on
children and ensuring thisconsent. Instead of the older
children acent, which I supposeyou know, they've got to agree
(27:54):
to it as well. But I think apartfrom that, I think it's just
understanding that, you know,bringing in children into a
clinical trial and being able tounderstand the perspectives and
the dynamics is important. So,you know, our qualitative
research, so the sort ofcomments and quotes that we
(28:15):
collected. Sort of understandingthe child and ensuring that the
tools that we measured, wereclinically validated for
children was really important aswell. But I think otherwise, it
is very much like a standard.
randomised control trial.
Hannah (28:32):
What about from the point of view of getting
investment? So and I'm thinkingin the same way, you know, the
same sort of perspective asDavid said. Sort of lessons
learned that others listeningmight learn from that. Did you
face any unique challenges whenyou were trying to get investors
on board? As a human and as aparent what you're doing sounds
(28:59):
really sensible. But you know,we've had some conversations
where we know that paediatricsegment is a smaller market
opportunity to be addressing.
What did that mean for you whenyou were having those types of
conversations?
Evelyn (29:18):
Yeah, I mean, I think investment is challenging for
everyone. Probably for us, wewere like quite a bit further
down in a development before wethought we need to get
investment because, you know,initially, this was something
that Paul and I wanted to createfor our own clinical practice.
So it was very much sort of thattraditional following, sort of
(29:39):
how do we do it an internalhospital clinical trial. I think
it was really only after theclinical trial and we took away
the devices from the hospitalafter we did the investigation.
Then clinicians came back andsaid, you know, actually we'd
really like to use these please.
How much should we be paying?
(30:01):
Then suddenly we were thinkingabout the business model. How do
we expand the business side ofthings. So I think for us having
that clinical trial and theevidence base there already was
really helpful. I think probablythere are definitely challenges
with paediatric care and beingable to demonstrate how these
(30:22):
can impact patients long term,if you can intervene early was
important. I think just gettingthe right funders on board,
people who understand it's a bigproblem and that this can have a
huge impact. So we've ended upsort of just through many, many
meetings, finding the rightpeople and having the
(30:43):
discussions around, you know,what's important for them, and
ensuring it aligns with, youknow, what our aims and
aspirations are.
David (30:51):
Sales 101 that. Give them what they want and then take it
away. Show them what they couldhave then take it away. Yeah. So
you can get it back. So are youare you still practising from a
clinical perspective?
Evelyn (31:07):
No, not today. So I decided to step away from that
and focus on Smileyscope fulltime.
David (31:17):
If we didn't have a global pandemic, what would your
kind of life look like in termsof working with Smileyscope and
working with hospitals? Becauseas we kind of touched on at the
beginning, you, I guess, you gobetween Australia and the US at
this point in time?
Evelyn (31:33):
Yeah, so I think one of the great things about my job is
it's sort of always changing.
You know, one day, I'll betalking to clinicians about
using the headset, aboutresearch about potential other
applications. The next day, I'msort of talking to investors.
I'm sort of pitching atcompetitions. I'm sort of
(31:54):
thinking about how do we kind ofincrease the value proposition,
understanding the broader trendsin healthcare, you know, with
digital health is booming inmany ways right now. But, you
know, VR is still relatively newin healthcare and sort of what
are the stepping stones? Whatare the elements that we need to
really bring this intomainstream care? I spend quite a
(32:16):
lot of my time in Australia, Isuppose my clinical networks are
established here. Our softwareteam is here as well. Sort of
thinking about how do we expandwith us and the cultural and
healthcare differences aboutworking in the US has been very
interesting, but also quite achallenge to navigate.
David (32:43):
Yeah, but I guess even more so now that you're doing it
allremotely? Where have you gotSmileyscope working in hospitals
currently?
Evelyn (32:54):
Yes, we do. So we've got them in a lot of the large
paediatric hospitals inAustralia and quite a few of the
paediatric departments ingeneral hospitals as well. We
built this initially for venousaccess. So IV canulas, and blood
draws. Just because we thoughtthat was one of the most common
(33:17):
and feared needle proceduresthat children report that
obviously it's being used a lotin vaccinations at the moment.
So we're working with a lot ofclinics and hospitals on, you
know, how can we get children toreturn to care around COVID.
There's been a slip in thenumber of children staying up to
date with vaccines. So how canwe try and bring them back and
(33:39):
encourage them there. Then sortof on the other procedures in
the hospital, you know, in theemergency department, there'll
be suturing, or stitching upwounds, there'll be plasters to
be applied or removed, which canbe quite scary as well. So all
sorts of interesting sort ofprocedures in the emergency
(34:01):
department. Then it's startingto be used in things like port
access, so for chemotherapy.
Then for children with, youknow, through Cerebral Palsy,
there's Botox injections, whichare quite horrible. They have
about, you know, they might haveup to 20 injections in a
session, and to help sort ofrelax their muscles. So Smiley
(34:22):
Scope being used there. We'rehoping to do a bit more research
around that as well. How can wesupport children when there's
multiple procedures involved?
Hannah (34:33):
Ultimately, would you have different virtual
experiences dependent upon theprocedure that's taking place.
Because you said at thebeginning, when you were talking
about there's a flow and so nowthere's a fish nibbling here or
now there's something brushingpast you and you know, at that
point, you must have a way ofknowing what's going on, you
(34:54):
know, within the VR experience,so that, you know, now is the
point in time at which you'regoing to conduct this part of
the procedure. That's going tovary, depending on the use case,
if you like, you know, as you'vejust described it a few minutes
ago.
Evelyn (35:09):
Yeah, so once clinicians started telling us, they're
applying it to different areasand procedures. What we've done
with the needle procedures iswe've actually built in sort of
a menu option beforehand, so youcan choose which body part you'd
like the fish to come into. Fora port access it would be kind
of around the collarbone, thatthe fish will come in and nibble
(35:32):
or if it's, you know, they'redoing a tummy injection, we can
have them nibbling there aswell. So it is kind of more
focused around differentprocedures. Then we're sort of
starting to work on other areasas well, where clinicians are
said, you know, I'd really liketo have some support around. One
example is MRI machines. So VRcan't go into the MRI, at least
(35:56):
not in its usual form. But thereare a lot of children who would
like to have a mock MRI orpractice MRI beforehand. As
clinicians, we'd also like totest whether they can sit still
and lie still there long enoughfor an MRI procedure, which can
be, you know, between, you know,15 minutes to half an hour. So
(36:19):
it's a long time to lie still ina very noisy tunnel. So we're
able to simulate that and alsobe able to make it a more
enjoyable experience. So, youknow, we've got one storyline
that we're working on at themoment where for younger
children again, we workedclosely with a lot of children
around what would you like toexperience. They have like a
(36:42):
bakery theme. So you've got thisgiant donut, which is the MRI.
There, you know, lots of noisesaround the bakery while you're
helping Puggles, the penguin,sort of make donuts. Then for
the aura children, it's more ofa space theme. They're shooting
through space and seeingcomments and hearing the rocket
(37:03):
ship going through space. So Ithink being at a reframe and
make these a more enjoyableexperience, cognitively and then
supporting how they get throughthat procedure. That's something
that we've created a newexperience for.
David (37:18):
So what next? You talk a little bit about and we'll make
sure that in the shownotes, andwhat have you that we we can put
some links to your website andsome of the videos and what have
you, but you talk about that inthe future, you'd like to have a
kind of suite of products.
You've kind of touched on on afew of them, but what's your you
know, what's your long term,what would you ideally like to
(37:39):
get to?
Evelyn (37:43):
So I think for us, we realised that, you know, medical
procedures, very scary forpatients. So really, you know,
that's the kind of pointy end ofmedicine that we want to focus
on is how can we improve patientexperience? How can we improve
efficiencies in procedures, andthrough sort of being able to
support patients? For us, we'renot really we're pretty tech
(38:07):
agnostic. So VR has been afantastic support for, you know,
during a needle procedure. It'salso great for, you know,
experiencing things that youmight be going through for an
MRI, for example or evensometimes when they're doing
minor procedures. Where theymight be in the theatre or
(38:27):
surgical suites. But you can beawake. So we're sort of thinking
about VR from thoseperspectives. But also, you
know, how do we provide theeducation beforehand so that
patients can get it in a waythat's child friendly, that they
can understand easily? Then, sowe're sort of starting to think
(38:48):
about areas like selfinjectables and using AR and
other interactive technologies.
So we've got one, which is, youknow, where you actually swing
the phone into your abdomen? Soyou can feel, how fast it needs
to be? What sort of pressure andhow long do you have to hold for
to ensure that you've got, youknow, safely given your insulin
injection or your epi pen, forexample. So we're sort of
(39:13):
looking at all different typesof tech on how can you improve
procedures?
David (39:20):
Sorry, I've just got to ask this. I have a relatively,
you know, good understandingalbeit you know, at a basic
level of what VR and AR is, butcan you just just describe what
AR is, as opposed to virtualreality. Augmented reality as
opposed to virtual reality?
Evelyn (39:39):
Yeah, so augmented reality. I mean, I suppose it's
a spectrum again, but augmentedreality is where you've got
parts of real life and parts oflike, you know, parts, which are
kind of put on to a real lifeexperience. So I think Pokemon
GO would be the most commonthing people would understand it
would be augmented reality.
Where you can still see thestreet, but you can see some
(40:01):
Pokemon characters. And VR ismuch more like the virtual
experience where you'reliterally in a different virtual
world. But I suppose asdifferent layers of what the
computer is generated in termsof the environment that you're
in.
David (40:18):
Perfect. Evelyn, thank you so much. From my tech brain
point of view, as it were,there's so many questions I
have, and we could go on for forages. But just kind of bearing
in mind, it's early in themorning with you don't want to
keep you all day as it were. Butone of the questions that we ask
(40:40):
everybody that comes on thepodcast is if you had a magic
wand and you could do anythingto change, you could change
anything within paediatrichealthcare. What what would it
be?
Evelyn (40:56):
Really tricky one. I mean, I think this is probably
even broader than justpaediatrics. But I think, sort
of effective and equitableimplementation. So that uptake
of best practice is often quiteslow and uneven in medicine.
Imagine the leaps and boundsthat we could achieve in health
(41:18):
care if we could implement allof those known best practices
that we've sort of researchedand being able to prove and
already know about, you know, ifwe could implement that across
the world. We would be in afantastic state.
David (41:31):
Absolutely. No, as I think we discussed the kind of
democratisation of knowledge inwhatever geis that is, yeah,
absolutely important. So well,thank you so much for joining
us on the podcast. It's beenit's been a real pleasure
talking to you and sointeresting what you're doing we
wish you you know, so much luckwith with it. I'm sure it's
going to be you know,successful. Hopefully, in the
(41:55):
not too distant future, you'regoing to be able to, you know,
travel again, and start toreally get Smileyscope out
here as much as you possibly an.
Evelyn (42:03):
Guys, thanks so much, David. And Hannah, I've had a
great time speaking with you andamazing work. Thank you
David (42:10):
Thank you.
Hannah (42:11):
Thank you
David (42:20):
Thank you again for joining us on the Not Mini
Adults Podcast. A big thank youto Dr. Evelyn Chan for joining
us and sharing her story. We'reso grateful to everyone that
tunes in on a weekly basis tolisten to the stories and the
interviews that we have. If youknow of anyone that you think
that we should be talking to,then please do get in touch. You
can find all the details forSmileyscope and of course
(42:42):
hinking of Oscar in the showotes. We have two more episodes
eft in this second season ofhe podcast before we take some
ime off over Christmas. Solease do join us again then.
I noticed in paediatrics that there were lots of
(00:02):
children. The first questionthey would ask me was, am I
going to get a shot today? Or doI need a blood test? Or, you
know, it seemed to eclipse thewhole conversation about what
they came in for. They were justvery fixated and wanted to know
and was stressing about this onequestion. What I had noticed
when I'd sort of done a lot ofshifts with it. Children, you
(00:25):
know, if you can calm them down,if you can calm the parents down
and make it a much more relaxedexperience that IV or that
needle can go in a lot moreeasily? So I think it was about
how can we scale that bestpractice and make it a much more
safe and enjoyable experiencefor children.
David (00:48):
This is Episode 10 of the second season of the Not Mini
Adults Podcast Pioneers forChildren's Health Care and Well
Being. My name is David Cole andonce again, I'm joined by my
wife Hannah. We are the cofounders of children's charity
Thinking of Oscar this week, weare joined by Dr. Evelyn Chan.
Dr. Chan is a paediatric doctorturned CEO and co founder of
(01:10):
virtual reality startupSmileyscope. Evelyn studied
medicine and surgery at MonaschUniversity in Australia, before
becoming a Rhodes Scholar at theUniversity of Oxford. Where she
studied medical anthropology andpublic health as the CEO and co
founder of Smileyscope. She isnow working to change the
experiences of children inclinical settings. Smileyscope
(01:31):
grew out of Evelyn's ownclinical experience and aims to
transform paediatric needleprocedures through patient
centred virtual reality. As wewill hear some of the advantages
that Evelyn has found in herwork is that VR is able to
decrease patient pain andanxiety and make it quicker and
safer for clinicians to performprocedures. Evelyn gives us a
(01:53):
great insight into the processthat she went through in getting
her company to where it istoday. In doing so conducted the
largest clinical study of VR, ina paediatric setting anywhere in
the world. She shares some greatinsights into lessons learned.
We really hope you enjoyed thisconversation as much as we did.
(02:18):
Evelyn. Hi, thank you so muchfor joining us on the Not Mini
Adults Podcast. We're sodelighted to have you.
Evelyn (02:25):
Thanks so much, David and Hannah. Great to be here.
David (02:31):
You're currently in Australia, so you're the second
person that we've had on thepodcast from from Australia,
although, as we were kind ofdiscussing, when we first met,
actually, you kind of spend yourtime between between the US and
Oz but obviously, due to COVID,you're kind of staying put I
(02:52):
guess, at this point in time.
Evelyn (02:54):
That's right. Yeah.
David (02:56):
So before we kind of get into it. Virtual reality is
something that we've beenwanting to discuss for a long
time. We've had, I think, quitea few inquiries coming to us and
talking about, you know, isthis, is this something that is
is real, is this something thatwe should be looking at? Is this
something that we would fund? Ordo you know, kind of things or
(03:20):
what have you. So it'sdefinitely a topic that really
interests us? I think, you know,many people out there, but I
guess the best best place tostart is, you know, how did you
get to where you are in terms ofworking in VR? But really kind
of what what motivated you to bewanting to work with children to
(03:40):
begin with?
Evelyn (03:42):
Yes, I suppose I'll start with the latter half of
the question. I thinkpaediatrics was the first part
of the journey. For me, I grewup with a younger brother with
severe autism. So he'snonverbal, needed 24 hour care.
My parents had some poor sort ofhealth experiences early on with
(04:03):
him, you know. I think there wasthis theory around refrigerator
parents and all sorts of thingslike that. I think it was a
couple of negative interactionsreally put them off the health
system early on. Saying that asa sort of older child. I was
about 9 or 10, when he was born,I could really see how that
impacted them and their mentalhealth and their relationship.
(04:26):
But also how it impacted oursort of ongoing healthcare there
on. Because afterwards, it waslike, I don't really feel like
going to bring him to the doctorif things were going wrong. So I
think early on, I sort ofthought if you could really
change that trajectory ofhealthcare. Have those fantastic
experiences early on, then youwould actually be able to have a
(04:49):
great relationship movingforward and it could change the
trajectory of someone'shealthcare and how they thought
about their disease or soughthealth care. So I think, you
know, growing up I felt I lovethe science and I loved the art
of medicine. So that just seemedlike a natural place to go, you
know, paediatrics, you couldmake a great impact early on.
(05:10):
Hopefully bend the curve andchange that trajectory. Then
from, I suppose the second partwas around virtual reality, and
that that came a lot later. So Ithink with VR I had noticed
that. I mean, I suppose firstup, I should say, with patient
care, I had noticed inpaediatrics that there were lots
(05:31):
of children. The first questionthey would ask me was, am I
going to get a shot today? Or doI need a blood test? Or, you
know, it seemed to eclipse thewhole conversation about what
they came in for. They were justvery fixated and wanted to know
and were stressing about thisone question. What I had noticed
when I had sort of done a lot ofshifts was that children, you
(05:54):
know, if you can calm them down,if you calm the parents down and
make it a much more relaxedexperience that IV or that
needle can go in a lot moreeasily? So I think it was about
how can we scale that bestpractice and make it a much more
safe and enjoyable experiencefor children. So I actually
(06:14):
didn't come across VR until acouple of years ago. I'd sort of
heard words about it being thenext big thing. But then when I
tried it on myself, I sort ofthought, you know, this could
potentially be a fascinating,scalable technology where a
child can virtually escaped tothe procedure room at the sort
(06:34):
of important points where itwould be really helpful for a
child to be somewhere else andbe able to reframe that
experience. Think about itdifferently. So that was kind of
where I started thinking aboutVR, and its applicability in
certain parts of healthcare.
David (06:53):
The patient experience has been something that we've
been, I guess, it was prettymuch the first thing that we did
when we started the charity. Sowhen Oscar was in hospital, you
know, blood tests andcanulations and what have you,
we're pretty horrendous for allof us, obviously, mostly for
him. But for the playspecialists, for the nurses, for
(07:14):
the doctors and everything else.
So when we had the opportunity,then one of the first things
that we funded was an Acuvein.
So a vein finder, because wefelt that it was something that
would have been beneficial tohim. So when you were, before
you kind of moved into the techside of things? What What kinds
(07:35):
of things were you seeing thatwere working or not, and the
experience that people were, youknow, that the children were
getting, whilst they were inhospital?
Evelyn (07:46):
Yes, I suppose we're talking about the fundamentals
of sort of procedural care.
There's sort of the physicalpositioning, so making sure the
child is feeling safe. So weusually sit them up on the
parent or the parent giving thema big hug rather than them lying
down because I feel a lot morevulnerable that way. Obviously,
the psychological distraction.
(08:08):
So whether that be bubbles,toys, their favourite game, you
know, a clown, a doctor orsomething like that and then the
pharmacological side. So if wecan give them a local
anaesthetic or some way ofdecreasing the pain on their
side, that's important as well.
Then, you know, for youngerchildren, it would be also
(08:28):
providing sucrose or sugar,essentially, which has been
shown to decrease the pain aswell. Or in younger children
again, breastfeeding is alsosomething that can be quite
supportive around procedures. SoI think we always say, you know,
we want all those fundamentaltenants that have procedural
care.
Hannah (08:49):
Someone had mentioned to us early on that if you could,
cant get the exact phrasing way,so correct me if you remember
exactly where this came from DC.
If you could distract a childthen their perception of pain
would be reduced. What are thecorrelations there? You talked
about sucrose, which I didn'tknow before that it could
(09:10):
actually reduce pain, I justthought it was a distraction,
you know, helpful distraction.
But are there actually, youknow, when you're bringing the
toy in for example, is it thatthey're distracted? And they
feel less pain or they'redistracted? So the pain is less
noticeable? If you see what Imean?
Evelyn (09:30):
It's a good question. So I mean, I suppose the theory
comes back to this idea of theirgated pain theory. So this idea
that if you can engage more ofthe senses, then you have less
bandwidth, I suppose, or lessability to pay attention to that
pain. So I think that's why VRbecame a really interesting, you
(09:52):
know, technology for us becausewe're saying, you know, rather
than it being a 2D, TV or movingimage where suddenly doing 3D
it's much more immersive, it'sactually interactive. So you're
engaging more of that, you know,more of the attention than if
you're watching a television. Soit is I suppose that theory
(10:14):
that, you know, you're not beingable to pay attention to the
pain and anxiety doesn'tregister as much.
Hannah (10:20):
Yeah. Okay, that makes sense thank you.
David (10:23):
At what point did you kind of realise that VR could be
or, you know, any kind oftechnology, but but VR in this
scenario could actually play areally, you know, fundamental
part in that kind of alleviationof pain and trying to help
children through theseprocedures.
Evelyn (10:44):
I think we've sort of had seen it myself and
experienced it and sort ofthought how immersive it was. My
co founder, Paul was an adult,respiratory physician and he was
seeing a lot of patients who aretransitioning from, you know,
paediatric to adult care. He wassaying, you know, he looked
(11:04):
after children with cysticfibrosis. He said, you know,
what do you do with thesechildren? They're so
traumatised, that they're askingto be put to sleep, to get an IV
cannula in every three days, youknow, there's so needle phobic,
you know, what can we do tohelp? He was actually the one
that put two and two together,because I'd said, You know, I
(11:25):
came back from this really coolVR thing, it could be really
interesting in healthcare. Hesaid, you know, could this be
really interesting, particularlyfor procedures, where there's a
lot of pain and anxiety aroundthat. So we looked at the
literature, and we sort of foundthat the defence force in the
80s, in the US had actually donequite a lot of research around
(11:45):
how virtual reality might beable to decrease the need, or
the dose of opioid medicationwhen they're doing very painful
burns, dressings, changes onsoldiers. So that was something
that sort of thought, hang on,that's a really interesting
concept now that VR is much morewidely available. Also, rather
(12:07):
than being hooked up to agigantic computer, we could do
it on our phone, essentially,you know, could we apply this to
much more common, you know, lesspainful, but very common
procedures?
David (12:20):
Then Smileyscope was born, I guess.
Evelyn (12:23):
Exactly. Yeah. We then started, I suppose much more on
the research side of what couldwe find off the shelf for
ourselves. So it was very mucha, you know, the usual clinician
story of, you know, we analysedall the literature, we looked
through, I think it was about13,000 papers, and we did a
systematic review. Analysed theresearch that have been done.
(12:43):
From that realise that therewere a lot of gaps in the
research and that had had verysmall, you know, numbers in the
studies. So from there sort ofthought, you know, how can we
validate this into a much largerstudy. From there sort of looked
around off the shelf products,and we sort of thought, you
know, there are a couple ofessential key criteria that we
(13:05):
wanted. We wanted to ensure thatthe patient had something that
was distracting, but it alsoneeded to be predictable for the
clinician, we didn't want themto move around. So you know, I
didn't really want to give thema rollercoaster ride or a
dinosaur walk when they wouldmove suddenly and I've missed
the vein. It also sort of neededto bring in the best practices
(13:27):
that we already knew about. Sothat physical positioning, you
know and the psychologicaldistraction. Within
psychological distraction, weknow that things like deep
breathing and visualisation andcognitive behavioural therapies
are really important in that. Sowe couldn't find something that
was really off the shelf thatworked for us. So we ended up,
(13:49):
you know, saying, let's try andcreate our own. So sort of
started working with patientsand families and clinicians to
develop that.
Hannah (14:00):
Where the two activities happening in parallel? So did
you conduct the clinical trialat the same time as making some
progress in developing theproduct? Or did one fully inform
the other? How did those twopieces of work fit together?
Evelyn (14:18):
Yeah, so I suppose we started with the research on,
you know, the landscape and whathad already been done before.
Sort of did that systematicreview and analysed all the data
and sort of ended up saying,look, there's a correlation
between VR being helpfulcompared to current modalities.
Then that sort of researchinformed the next part, which
(14:41):
was quite fun around thediscovery. So we worked with
about 100 patients and theirfamilies who had had, you know,
from the spectrum of, they hadgreat blood tests to really bad
ones and said, where would youlike to go if you could
virtually escape the procedureroom and you know, about 90% of
Ozzy kids said they would liketo go underwater? So then we
(15:03):
sort of broke down the procedureinto, you know, so what does
that tornakit feel like? Theywould say maybe a diving band,
and what would sort of theantiseptic wash feel like and
they said, you know, waveswashing over your arms. What
would the needle feel like.
We've got some reallyinteresting answers, as you can
(15:23):
imagine fromkids. But the onethat we felt worked really well
and was actually quite a commonthing was fish nibbling, because
you can imagine the fish being aDory fish or, you know, a
stingray, or whatever you wantto. So that could kind of
accommodate the different typesof pain that a child could feel
or in the case of, if they hadlocal anaesthetic, they wouldn't
(15:44):
really feel the pain, but itwould just feel like something
on their skin. So that was areally kind of good way of
reframing the sensations. Wekind of choreograph that. We
worked with a digital team,which had worked with Disney
before. So we learned somefascinating things about how you
work with kids. You know, howyou don't want the fish to
(16:06):
approach them directly face on.
It was kind of something likethat, you know, the fish would
swim around and loop aroundbefore they kind of land on your
arm. All those sorts oftechniques that I think we sort
of really brought in thatclinical and digital best
practice. Once we created theVR, we then said, Let's go to
clinical trials and actuallytest this out. So we sort of had
(16:30):
pretty much the fully developedproduct, from the start when we
started recruiting patients
Hannah (16:36):
Must have been an incredibly exciting journey,
maybe with some unexpectedtwists and turns. So for
example, when you were talkingabout the digital team that you
were working with in thebackground that they brought in.
Evelyn (16:48):
Yeah, I think I learned a lot about, you know. Sprint
reviews and all sorts oftechnical terms. But really
enjoyed it. I think they werefantastic to work with. I think
combining the two so we couldreally think about, you know,
visually, how do we make thisreally beautiful, exciting and
wonderful experience. As well asthat sort of clinical side of
(17:10):
how can we bring in what wealready know, as best practice
and make that fun, was a reallyenjoyable process.
David (17:18):
What else did the kids say in terms of what the needle
could be?
Evelyn (17:23):
So one of the ones was a dolphin bumping you. So we do
actually have them riding on adolphin when they get their IV
in? So that was something thatwe've could bring in. A whale
spurting. Yeah, so lots of coralbrushing across you. So yes,
lots of different interestingsensations.
David (17:47):
No Great Whites taking chunks out of their arm thank
goodness then.
Evelyn (17:50):
I think we did,but that was probably a teenager that's
suggested that.
David (17:55):
Thats what I thought.
Hannah (17:59):
So then you go into the clinical trials and I know that
this is the trial that youcompleted was the largest
clinical trial of its kind forVR technology, is that correct?
Evelyn (18:11):
That's right, yeah, for procedural care. So essentially,
we designed this, as we reallywanted to make sure that we had
the numbers to be able to havean informed result that we were
confident would be statisticallysignificant. So we also want it
to be quite generalizable acrossdifferent cohorts. So we sort of
said, well, where are twodepartments where a lot of IVs
(18:35):
and venipuncture, so blood drawshappen. We thought, let's pick
the emergency department,because often, you know,
families will come in, they'reoften coming in with some other
reason and don't expect to get ablood test or an IV. Then let's
pick the children who come infrom the community and usually
well, but needing regular bloodtests, so they've had this
(18:56):
before. So we chose thephlebotomy or pathology
outpatient lab as well. So wedid this in two large hospitals
in Melbourne, and we recruitedfrom there and we ended up
getting about 120 to 130patients in each of those
groups. So the in the emergencydepartment and in the phlebotomy
(19:19):
lab. From there we sort of thenrecruited them said, you know,
there's an option when we'retesting this new VR technology.
But we want to do it like arandomised control trial. So
it's kind of like apharmaceutical trial in the
sense that you don't know whichgroup you're going to be
allocated to beforehand. All thequestions are very standardised.
(19:45):
So then we found that, you know,we're kind of have this envelope
and once we've sort of askedthem all the baseline questions.
We would find out which groupthey were allocated to. The
children in the VR group wouldhave the VR experience and then
the children In the standard ofcare group would get still best
practice care. So it was a veryactive control. It wasn't like
(20:06):
we put them in the room withoutanything. Then after that we
sort of compared sort of theirbaseline pain and anxiety that
was reported by the child, thecaregiver or the parent. There
was the procedure list and alsoan observer. So that we had
those four different peoplegiving their perspective so that
(20:28):
we could actually kind of matchand make sure that they were
directionally in the same sortof, you know, precinct of what
the pain or anxiety would belike. We also measure things
like, you know, first sticksuccess and how long it took to
do the procedure as well. Thenfrom that, we actually found
that, interestingly, in thevirtual reality group, that
(20:51):
there was a significant drop inpain and anxiety. Parents
reported less distress from thechild as well, up to 75%, less
distress. We actually found thatthere was less need to restrain
children or hold down theprocedural arm. So by about
half, and that sort of meantthat you wouldn't need as much
(21:13):
force and you wouldn't need tonecessarily bring in an
additional person to support thearm.
David (21:36):
What age range were you working with in this clinical
trial?
Evelyn (21:43):
Yeah, so I suppose that was another really interesting
thing. We wanted to ensure thatchildren, when they first have
their first permanent memories,around the age of three or four
years old, would be able to havea good experience of their first
needles. So, you know, mostchildren have four year old
vaccinations. So we sort ofthought 4 to 11 was kind of age
(22:06):
range. Virtual Reality, as youprobably know, most people
recommend, sort of 10 years andabove with the commercial
headsets. We did bring this tothe ethics board, and we said,
Look, this is going to be a veryshort procedure, you know, three
to five minutes, you know, theycan take it off if they want to.
I suppose, you know, we werealso doing a lot of the adverse
(22:29):
effects, side effects collectingas well, so that we could see
whether there was any differencein the children who were given
the VR compared to the controlgroup. What we ended up finding
was actually that the childrenin the VR group didn't have any
sort of differences in the theside effects reported. Now the
(22:50):
Common side effects of the era,you know, eyestrain, dizziness,
they might feel nauseous. Thereare also some things that can be
correlated with being nervous ingeneral. So I think there were
some children in both groupsthat were just anxious about the
blood test. So it's hard toreally pull and see, you know,
(23:12):
what was VR and what was, youknow, what was just anxiety
about the blood test? But therewere no differences between
those two groups?
Hannah (23:22):
Did you find that VR suited the younger age bracket
equally as the older agebracket, or vice versa? Or was
there part of that demographicthat you felt was going to be
your optimal age range to targetmoving forward?
Evelyn (23:40):
It's a great question. I wish we had an even bigger trial
where we could break down agegroups. Maybe that's something
we do in future is figure out,you know, where, you know, and
what works best for children.
But one of the interestingthings that we noticed from the
trial was when we worked withour digital company, we said,
let's target this for childrenabout the age of five. We're
(24:01):
actually finding anecdotallythat children around six or
seven, were responding better toit. I think they cognitively
understood that we're stillgoing to have the blood test,
this was going to help supportthem through the blood test. So
I think they, they were able toenjoy that more. I think when
(24:21):
you're stressed you're notcognitively at your best either.
I think that was something thatwe've kept in mind as we develop
future products is, you know,when we're aiming for a five
year old, you know, we probablygot to think about simplifying
the language a little bitbecause just to factor in the
stress and anxiety of being inhospital.
David (24:43):
Yeah, there's so there's so many questions going through
my head around that becausethinking when you said, you
know, it's the first it's thatfirst experience that a child
might have in hospital. Thefirst thing that they
experienced is that someonesticks a needle in their arm.
It's not a great one. Especiallyat the age of three and four,
when they're starting to reallykind of have memories and go
(25:04):
ahead with it. It's justfascinating as to where that
kind of level is that they willactually make a difference.
Where they fully aware of whatwas actually happening to them.
So I'm just trying to think, youknow, we've got a nearly three
year old now. If we told himthat he was about to have a
(25:28):
blood test, would he actuallyrealise and understand what that
meant? Especially if you put aheadset on, not that any of our
children have used VR, as such,but they're all you know,
associated screen time and whathave you. Do they do they fully
(25:49):
understand, or are they aware ofwhat is going to be happening to
them I guess?
Evelyn (25:54):
Yeah, I mean, I think by the age of four, and I mean, I
suppose there's a big spectrum,right. But I think they usually
can understand what's imaginaryand what's the real thing. So we
were quite clear when weexplained it to them, that you
know, that we're still going toget the blood test and that they
(26:14):
were able to get I suppose adistraction. One of the things
that they could do was sort ofhave a peek and look around so
that they could kind of movebetween both worlds. We didn't
want them fully in the VR. Inthe VR world. Still be there and
understand what was going on,but just reframe it differently.
(26:35):
I think it was just that sevenyear old group kind of really
understood it straightaway andit was a very easy explanation.
David (26:42):
How many children were actually in the trial in the
end?
Evelyn (26:46):
Yeah, so a total of 253 children and so roughly half
were in the VR group.
David (26:54):
I think one of the interesting things is that
whenever you talk about fundingfor paediatric startups or
paediatric innovations. One ofthe first things that people
talk about is the inability insome respects and obviously, it
depends on the technology, itdepends on what they're trying
to do the trial or the drugtrial, or whatever it is, but
(27:17):
the inability to actually do ,orthe feasibility of doing trials
with kids. So is there anythingthat you have learned that you
can share in terms of bestpractice or, you know, thoughts
just around that, that elementof it?
Evelyn (27:33):
Yeah, it's a good question. I've only ever done
paediatric trials. So I think,you know, when you're working in
paediatric hospitals, you justrealise there's going to be that
extra level of scrutiny aroundside effects and impact on
children and ensuring thisconsent. Instead of the older
children acent, which I supposeyou know, they've got to agree
(27:54):
to it as well. But I think apartfrom that, I think it's just
understanding that, you know,bringing in children into a
clinical trial and being able tounderstand the perspectives and
the dynamics is important. So,you know, our qualitative
research, so the sort ofcomments and quotes that we
(28:15):
collected. Sort of understandingthe child and ensuring that the
tools that we measured, wereclinically validated for
children was really important aswell. But I think otherwise, it
is very much like a standard.
randomised control trial.
Hannah (28:32):
What about from the point of view of getting
investment? So and I'm thinkingin the same way, you know, the
same sort of perspective asDavid said. Sort of lessons
learned that others listeningmight learn from that. Did you
face any unique challenges whenyou were trying to get investors
on board? As a human and as aparent what you're doing sounds
(28:59):
really sensible. But you know,we've had some conversations
where we know that paediatricsegment is a smaller market
opportunity to be addressing.
What did that mean for you whenyou were having those types of
conversations?
Evelyn (29:18):
Yeah, I mean, I think investment is challenging for
everyone. Probably for us, wewere like quite a bit further
down in a development before wethought we need to get
investment because, you know,initially, this was something
that Paul and I wanted to createfor our own clinical practice.
So it was very much sort of thattraditional following, sort of
(29:39):
how do we do it an internalhospital clinical trial. I think
it was really only after theclinical trial and we took away
the devices from the hospitalafter we did the investigation.
Then clinicians came back andsaid, you know, actually we'd
really like to use these please.
How much should we be paying?
(30:01):
Then suddenly we were thinkingabout the business model. How do
we expand the business side ofthings. So I think for us having
that clinical trial and theevidence base there already was
really helpful. I think probablythere are definitely challenges
with paediatric care and beingable to demonstrate how these
(30:22):
can impact patients long term,if you can intervene early was
important. I think just gettingthe right funders on board,
people who understand it's a bigproblem and that this can have a
huge impact. So we've ended upsort of just through many, many
meetings, finding the rightpeople and having the
(30:43):
discussions around, you know,what's important for them, and
ensuring it aligns with, youknow, what our aims and
aspirations are.
David (30:51):
Sales 101 that. Give them what they want and then take it
away. Show them what they couldhave then take it away. Yeah. So
you can get it back. So are youare you still practising from a
clinical perspective?
Evelyn (31:07):
No, not today. So I decided to step away from that
and focus on Smileyscope fulltime.
David (31:17):
If we didn't have a global pandemic, what would your
kind of life look like in termsof working with Smileyscope and
working with hospitals? Becauseas we kind of touched on at the
beginning, you, I guess, you gobetween Australia and the US at
this point in time?
Evelyn (31:33):
Yeah, so I think one of the great things about my job is
it's sort of always changing.
You know, one day, I'll betalking to clinicians about
using the headset, aboutresearch about potential other
applications. The next day, I'msort of talking to investors.
I'm sort of pitching atcompetitions. I'm sort of
(31:54):
thinking about how do we kind ofincrease the value proposition,
understanding the broader trendsin healthcare, you know, with
digital health is booming inmany ways right now. But, you
know, VR is still relatively newin healthcare and sort of what
are the stepping stones? Whatare the elements that we need to
really bring this intomainstream care? I spend quite a
(32:16):
lot of my time in Australia, Isuppose my clinical networks are
established here. Our softwareteam is here as well. Sort of
thinking about how do we expandwith us and the cultural and
healthcare differences aboutworking in the US has been very
interesting, but also quite achallenge to navigate.
David (32:43):
Yeah, but I guess even more so now that you're doing it
allremotely? Where have you gotSmileyscope working in hospitals
currently?
Evelyn (32:54):
Yes, we do. So we've got them in a lot of the large
paediatric hospitals inAustralia and quite a few of the
paediatric departments ingeneral hospitals as well. We
built this initially for venousaccess. So IV canulas, and blood
draws. Just because we thoughtthat was one of the most common
(33:17):
and feared needle proceduresthat children report that
obviously it's being used a lotin vaccinations at the moment.
So we're working with a lot ofclinics and hospitals on, you
know, how can we get children toreturn to care around COVID.
There's been a slip in thenumber of children staying up to
date with vaccines. So how canwe try and bring them back and
(33:39):
encourage them there. Then sortof on the other procedures in
the hospital, you know, in theemergency department, there'll
be suturing, or stitching upwounds, there'll be plasters to
be applied or removed, which canbe quite scary as well. So all
sorts of interesting sort ofprocedures in the emergency
(34:01):
department. Then it's startingto be used in things like port
access, so for chemotherapy.
Then for children with, youknow, through Cerebral Palsy,
there's Botox injections, whichare quite horrible. They have
about, you know, they might haveup to 20 injections in a
session, and to help sort ofrelax their muscles. So Smiley
(34:22):
Scope being used there. We'rehoping to do a bit more research
around that as well. How can wesupport children when there's
multiple procedures involved?
Hannah (34:33):
Ultimately, would you have different virtual
experiences dependent upon theprocedure that's taking place.
Because you said at thebeginning, when you were talking
about there's a flow and so nowthere's a fish nibbling here or
now there's something brushingpast you and you know, at that
point, you must have a way ofknowing what's going on, you
(34:54):
know, within the VR experience,so that, you know, now is the
point in time at which you'regoing to conduct this part of
the procedure. That's going tovary, depending on the use case,
if you like, you know, as you'vejust described it a few minutes
ago.
Evelyn (35:09):
Yeah, so once clinicians started telling us, they're
applying it to different areasand procedures. What we've done
with the needle procedures iswe've actually built in sort of
a menu option beforehand, so youcan choose which body part you'd
like the fish to come into. Fora port access it would be kind
of around the collarbone, thatthe fish will come in and nibble
(35:32):
or if it's, you know, they'redoing a tummy injection, we can
have them nibbling there aswell. So it is kind of more
focused around differentprocedures. Then we're sort of
starting to work on other areasas well, where clinicians are
said, you know, I'd really liketo have some support around. One
example is MRI machines. So VRcan't go into the MRI, at least
(35:56):
not in its usual form. But thereare a lot of children who would
like to have a mock MRI orpractice MRI beforehand. As
clinicians, we'd also like totest whether they can sit still
and lie still there long enoughfor an MRI procedure, which can
be, you know, between, you know,15 minutes to half an hour. So
(36:19):
it's a long time to lie still ina very noisy tunnel. So we're
able to simulate that and alsobe able to make it a more
enjoyable experience. So, youknow, we've got one storyline
that we're working on at themoment where for younger
children again, we workedclosely with a lot of children
around what would you like toexperience. They have like a
(36:42):
bakery theme. So you've got thisgiant donut, which is the MRI.
There, you know, lots of noisesaround the bakery while you're
helping Puggles, the penguin,sort of make donuts. Then for
the aura children, it's more ofa space theme. They're shooting
through space and seeingcomments and hearing the rocket
(37:03):
ship going through space. So Ithink being at a reframe and
make these a more enjoyableexperience, cognitively and then
supporting how they get throughthat procedure. That's something
that we've created a newexperience for.
David (37:18):
So what next? You talk a little bit about and we'll make
sure that in the shownotes, andwhat have you that we we can put
some links to your website andsome of the videos and what have
you, but you talk about that inthe future, you'd like to have a
kind of suite of products.
You've kind of touched on on afew of them, but what's your you
know, what's your long term,what would you ideally like to
(37:39):
get to?
Evelyn (37:43):
So I think for us, we realised that, you know, medical
procedures, very scary forpatients. So really, you know,
that's the kind of pointy end ofmedicine that we want to focus
on is how can we improve patientexperience? How can we improve
efficiencies in procedures, andthrough sort of being able to
support patients? For us, we'renot really we're pretty tech
(38:07):
agnostic. So VR has been afantastic support for, you know,
during a needle procedure. It'salso great for, you know,
experiencing things that youmight be going through for an
MRI, for example or evensometimes when they're doing
minor procedures. Where theymight be in the theatre or
(38:27):
surgical suites. But you can beawake. So we're sort of thinking
about VR from thoseperspectives. But also, you
know, how do we provide theeducation beforehand so that
patients can get it in a waythat's child friendly, that they
can understand easily? Then, sowe're sort of starting to think
(38:48):
about areas like selfinjectables and using AR and
other interactive technologies.
So we've got one, which is, youknow, where you actually swing
the phone into your abdomen? Soyou can feel, how fast it needs
to be? What sort of pressure andhow long do you have to hold for
to ensure that you've got, youknow, safely given your insulin
injection or your epi pen, forexample. So we're sort of
(39:13):
looking at all different typesof tech on how can you improve
procedures?
David (39:20):
Sorry, I've just got to ask this. I have a relatively,
you know, good understandingalbeit you know, at a basic
level of what VR and AR is, butcan you just just describe what
AR is, as opposed to virtualreality. Augmented reality as
opposed to virtual reality?
Evelyn (39:39):
Yeah, so augmented reality. I mean, I suppose it's
a spectrum again, but augmentedreality is where you've got
parts of real life and parts oflike, you know, parts, which are
kind of put on to a real lifeexperience. So I think Pokemon
GO would be the most commonthing people would understand it
would be augmented reality.
Where you can still see thestreet, but you can see some
(40:01):
Pokemon characters. And VR ismuch more like the virtual
experience where you'reliterally in a different virtual
world. But I suppose asdifferent layers of what the
computer is generated in termsof the environment that you're
in.
David (40:18):
Perfect. Evelyn, thank you so much. From my tech brain
point of view, as it were,there's so many questions I
have, and we could go on for forages. But just kind of bearing
in mind, it's early in themorning with you don't want to
keep you all day as it were. Butone of the questions that we ask
(40:40):
everybody that comes on thepodcast is if you had a magic
wand and you could do anythingto change, you could change
anything within paediatrichealthcare. What what would it
be?
Evelyn (40:56):
Really tricky one. I mean, I think this is probably
even broader than justpaediatrics. But I think, sort
of effective and equitableimplementation. So that uptake
of best practice is often quiteslow and uneven in medicine.
Imagine the leaps and boundsthat we could achieve in health
(41:18):
care if we could implement allof those known best practices
that we've sort of researchedand being able to prove and
already know about, you know, ifwe could implement that across
the world. We would be in afantastic state.
David (41:31):
Absolutely. No, as I think we discussed the kind of
democratisation of knowledge inwhatever geis that is, yeah,
absolutely important. So well,thank you so much for joining
us on the podcast. It's beenit's been a real pleasure
talking to you and sointeresting what you're doing we
wish you you know, so much luckwith with it. I'm sure it's
going to be you know,successful. Hopefully, in the
(41:55):
not too distant future, you'regoing to be able to, you know,
travel again, and start toreally get Smileyscope out
here as much as you possibly an.
Evelyn (42:03):
Guys, thanks so much, David. And Hannah, I've had a
great time speaking with you andamazing work. Thank you
David (42:10):
Thank you.
Hannah (42:11):
Thank you
David (42:20):
Thank you again for joining us on the Not Mini
Adults Podcast. A big thank youto Dr. Evelyn Chan for joining
us and sharing her story. We'reso grateful to everyone that
tunes in on a weekly basis tolisten to the stories and the
interviews that we have. If youknow of anyone that you think
that we should be talking to,then please do get in touch. You
can find all the details forSmileyscope and of course
(42:42):
hinking of Oscar in the showotes. We have two more episodes
eft in this second season ofhe podcast before we take some
ime off over Christmas. Solease do join us again then.
Popular Podcasts
Stuff You Should Know
If you've ever wanted to know about champagne, satanism, the Stonewall Uprising, chaos theory, LSD, El Nino, true crime and Rosa Parks, then look no further. Josh and Chuck have you covered.
Dateline NBC
Current and classic episodes, featuring compelling true-crime mysteries, powerful documentaries and in-depth investigations. Follow now to get the latest episodes of Dateline NBC completely free, or subscribe to Dateline Premium for ad-free listening and exclusive bonus content: DatelinePremium.com
Las Culturistas with Matt Rogers and Bowen Yang
Ding dong! Join your culture consultants, Matt Rogers and Bowen Yang, on an unforgettable journey into the beating heart of CULTURE. Alongside sizzling special guests, they GET INTO the hottest pop-culture moments of the day and the formative cultural experiences that turned them into Culturistas. Produced by the Big Money Players Network and iHeartRadio.