Expert Perspectives on Future 6G-Enabled Hospital Metaverse

The discussions of the digitalization of hospitals, in general, indicated that a huge step was taken in the development and use of digital services and platforms during pandemics. Due to social distancing, people learned to use digital service portals, which advise maintaining well-being with personal actions and activities or guide self-diagnostics as preliminary care action. “Individuals are progressively becoming accustomed to utilizing sensors and wearables to manage their well-being and acquire the skills to analyze health data for self-care”. (Interviewee 4). Moreover, many tasks like discussions with chat service, video consultancy, or renewing prescriptions happen now based on individuals’ own activity.

Considering the digitalization of medical actions, “the biggest benefits have been reached, in imaging and various analysis tasks when high data volumes can be analyzed and transferred in a minimum time.” (Interviewee 4) Imaging patients produce high volumes of data, which needs to be analyzed powerfully in a short time for diagnostics. Often, masses of data are sent to other locations, which assumes high data transfer capabilities. Another remarkable advantage of digitalization has been “in the analysis of biosignals, where digitalization of analysis methods has enabled the detection and identification of some rare illnesses.” (Interviewee 4). Analysis and comparison of patient data with a vast amount of reference cohort data enables, e.g., to recognize deviations from normal trends of health data. More generally, the high increase in computing power making, e.g., real-time 3D video analyses, has been a crucial change in the patient care processes. For future improvement, doctors propose “to develop a system which enables real-time situational awareness e.g. in urgent cases, when the operation room needs to be prepared for a patient arriving with an ambulance.” (Interviewee 1). The increase of edge computing capability of 5G and beyond technologies will help to achieve a real-time situational picture based on patient data. Subsequently, instead of processing high volumes of data in VR glasses, the data can be transferred wirelessly to the surrounding 6G network i.e. “implementation of edge computing can be used for off-loading. The glasses’ weight will be dramatically reduced, thus increasing the usability of the metaverse.” (Interviewee 8).

Another aspect where digitalization helps is the serious lack of professionals, specialists, and other resources, which even challenges the delivery of public health care services as statutory debts. This is further “challenged by the demographics, which show the number of elderly to be in high growth, resulting in an increasing need for health services.” (Interviewee 2) Subsequently, some advancements are rather easy to develop like “simple practical improvement would be to minimize the time used for manual data collection from patients being still today a frequently repeating activity, which has even caused cons in false medication due to human errors. (Interviewee 1)” All this could be probably decreased by the integration of devices and instruments with improved data management processes, though, considering all the privacy rules. Moreover, developing data management practices by adopting increasingly more artificial intelligence technologies would help in the decision-making of operational patient processes.

Digitalization has considerably streamlined hospital workflows, enhancing the efficiency of clinical work. The digital care pathway not only reduces the time health professionals spend on filling out patient forms but also simplifies data retrieval. Appointment bookings can be effortlessly managed through digital protocols, while patient interactions, including pre-surgery preparations, can now be seamlessly conducted through mobile apps.

Typical stakeholders of hospital operational and development processes are based on both internal and external functions. Each organizational unit is the process owner of its special medical focus area or support function, and it needs to present plans and reasoning for its activity, procurement, and investments to the cost control function. When it comes to hospital patient care processes, the interviews revealed that there exists some room for development. Often the evaluations of processes are conducted internally, which often does not disclose all the process deficiencies. The hospital management oversees processes and needs to take action when shortages are detected. The process developers have co-operated with external specialists and researchers when targeting improvements.

Most of the medical units have specific devices and instruments, which are taken care of by the maintenance unit. This team is crucial to keeping the operations functional and in continuous completeness. Some of the processes, devices, and instruments are sensitive to environmental conditions like temperature or humidity, which need to be stable and constant. For that purpose, the hospital property management controls particular premises to maintain optimal circumstances of patient processes in various use cases. Through the patient care processes high volumes of data are generated constantly. Collection, protection, analysis, and safe sharing of data are assumed to have high-capacity computing and data transfer capabilities. The ICT department is responsible for operating, maintaining, and developing the data infrastructure. Moreover, various other support functions as stakeholders exist in the hospital. Logistics is responsible for the delivery of numerous things that are needed in the processes. Another support function is the security office to maintain overall security in the hospital premises.

The constraints on digitalization and developing the 6G-enabled metaverse fall into different categories. Both the telecommunication and health industries are highly regulated. At the societal level, the current regulation appears bureaucratic and does not enable new businesses or innovations to enter hospitals due to the long clinical trial period and heavy process of preparation for certification and documentation, which is applied to medical innovations.

At the organizational level, the regulation of medical procurement also limits the potential for innovation adoption. Few resources with potentially insufficient competence are allocated to the purchase of future-oriented technology and equipment, such as the necessary VR glasses, or infrastructure for a virtual simulation environment. “It took a long time for us to get permission from the research management group to buy more advanced and expensive VR and head glasses for our VR project.” (Interviewee 5). Safety for sensitive health data is obviously seen in hospitals. The interoperability among different technological solutions is not compatible, and collaboration between data-driven solutions is not sufficient, so innovation solutions are dead without sufficient investment from external investors.

At the individual level, technology resistance has been cited by most of the interviewees. Our empirical finding indicates that digitalization simplifies the processes of documenting, archiving, and searching for patient data, and it benefits the process of treatment. However, digitalization also increases the workload, e.g., time spent on inserting patient information into different systems. A common statement is that technology cannot replace human contact with patients. This is not the aim of developers either, but they are developing solutions for routine tasks e.g. to decrease time spent with computers when manually exporting and importing information between data systems. Also, remote or virtual consultation with doctors or nurses is often resisted by the customers. This can be potentially decreased when positive experiences about the virtual meetings are gained. A favourable experience can be e.g. quick digital appointment with the doctor on the next day instead of queueing for one week for a physical meeting with the professionals and the result of the consultation is the same in both cases. Many physical meetings could be replaced by virtual negotiations. Due to outdated infrastructure, errors often occur in documenting processes, sometimes, just simply because of e.g., “the shortage of computer memory, or an unreliable network and bad connection” (Interviewee 3). These administrative tasks prevent doctors from concentrating on treatment and clinical work.

Although the current digitalization has brought benefits to clinical treatment, processes, and services, further development is expected to improve the efficiency and effectiveness of clinical work. Considering the emerging technologies such as 6G and the Metaverse, detailed specifications or well-defined expectations are still lacking. However, based on our interviews, there is a strong demand for connecting physical objects, people, locations, and services to optimize work processes, which may lead to saving costs and improving the quality of care. Based on the interviewees’ backgrounds and knowledge, they identified the use cases for the Metaverse and 6G.

Use Case 1 (Designing Smart Hospital). When constructing or renovating smart hospitals, 3D models can be generated within the metaverse to visualize prototypes and designs. This enables stakeholders to immerse themselves in the design phase, providing them with the ability to experience and convey their ideas. “…to understand how to make that location work better. E.g., how to place certain operation models and blocks, see if there are enough spaces around them to be able to move around and how to place the different displays and devices there. Then maybe renovating a whole room for totally different use cases or new types of operations” (Interviewee 6). This proactive approach helps in identifying design flaws and facilitates essential modifications.

The metaverse can be used to simulate various room configurations and dynamic aspects of hospitals, such as combining different rooms, to enhance planning and decision-making. “Metaverse goes even one step further because you can actually go inside the space with other people and visualize the way how to utilize.” (Interviewee 6). The huge benefit of the metaverse is that simulates different situations in a faster way and brings more capabilities to enable you to move around to get a more realistic situation.

Metaverse simulates hospital capabilities and navigation e.g., covid 19 brought a huge number of patients into the hospital, metaverse can simulate the situation at the design stage by knowing the capabilities of the hospital and for building dynamics, like pop-up hospital rooms. Metaverse provides a higher-level understanding of the whole hospital building behaviors and environments by data coming from sensors at objects and people. “You can track the patients and instruments, like fleet management.” (Interviewee 6). Data produced by sensors from the rooms in the hospital environment and its connection to the virtual environment gives a real understanding of the situation. “They have glasses for data, obviously the same thing for real-time. And this way you can maybe much, much more efficiently kind of handle the situations. Inventories can be handled more efficiently by floating from many angles” (Interviewee 6).

Use Case 2 (Improvement of Medical Workflow). A common use case involves the urgency of preparing for a critical surgical procedure, especially when there is preliminary information about a severely injured patient arriving via ambulance. “When a patient is coming to an ambulance, it’s a big mess in the hospital because they are calling to each other and we need to be prepared. It’s coming, it’s coming. And then where do we have free space and where are the needed instruments and equipment?” (Interviewee 1). The efficient planning and coordination of essential medical devices, equipment, operation rooms, and estimated arrival time at various locations are crucial but often challenging to accomplish on short notice.

Use case 3 (Surgery Modeling). Some initial experiences about metaverse have been gathered, e.g., through 3D modeling of the skull, which is seen as a huge benefit in specific processes of diagnosing head-related illnesses. “Doctors could be with VR glasses on with zero latency connection in real-time seeing how the operations work and capture the movement seeing what happening. With pictures from the machine, you cannot see and move.” (Interviewee 7). VR technologies, e.g. latest video device can get realistic images on VR that add value to telemedicine. The treatment will not solely rely on pictures and videos but allow doctors to see real situations in VR. Data safety and security are very important for metaverse usage in hospitals, “I think the networks were closed so that you had black on service and hope on data handling inside of buildings.” (Interviewee 2). Therefore, the indoor and local network of 6G is needed.

Use Case 4 (Situational Awareness of Patients/Hospital - Mobility/Location/Navigating/Tracking). Remote monitoring of a patient in a remote location, e.g., at home, whose real-time vital data is available, and the doctor needs to make decisions for the care actions of local professionals beside the patient. “Some visions foresee hospital beds at homes, increasing the need for situational awareness. The response will be much faster when we see this happening in real-time, e.g., by metaverse” (Interviewee 7). 6G will enable the positioning of various objects. This can be utilized in prompt indoor navigation of personnel, patients, or visitors. With 6G capabilities, data is sent and processed in real time, allowing for immediate alarms if a critical event occurs. Tracking is essential to determine the locations of machines and equipment, as well as doctors and patients. Wireless solutions enable not only the mobility of patients and doctors but also allow machines and equipment to be positioned, tracked, and moved to the required locations. Instead of wasting time fetching instruments along long corridors, the personnel could call the autonomously navigating instruments to arrive in the operations room.

Use Case 5 (Pain Management and Mental Therapy). Experiments show good results in the treatment of chronic pain or mental illness with virtual technology like VR because with chronic conditions, patients are not willing to travel to the hospital all the time when they need to talk with doctors, particularly for some patients with serious illness and disabilities. “Building services for those patients who are at home almost 24 h per day, would be a huge potential. In the metaverse, those people will be able to travel around the world and see different places, engaging in various activities, as technology advances and realism improves. It’s beneficial for pain management and mental health.” (Interviewee 7).

Use Case 6 (Training and Education). Metaverse can provide training not only for health professionals but also for healthy individuals and patients. Metaverse supports preventive health and provides guidelines to prevent, reparation e.g., surgery in the virtual situation that can replace health care professionals for counseling. “We should support healthy people to stay healthy…I think the metaverse is an excellent example of where we can encourage people to exercise, build virtual agents to be their friends, and guide them in their daily lives to improve their health” (Interviewee 5).

The hospital-tested metaverse environment will guide prevention in the correct direction because the internet is full of information regarding diseases, but not all the information is valid and represents the true situation “metaverse we can even develop these kinds of new tools of screening evidence, you know, making sure that what we present to our patients is correct information”.

Education of new healthcare professionals in immersive environments supports learning of medical tasks and processes after which working in the real environment is more familiar without having worked there before. “A good example is training in the automotive industry by VR, the accident rate dropped like 60% after training with VR solutions.” (Interviewee 4).

We apply the adapted 6G visioning framework by answering the fundamental questions of actions to be taken for building 6G future networks proposed by [35]. The related questions in [35] help to identify value addressed by use cases described in interviews. Since this study focuses on the healthcare context, the usage scenarios will be based on the hospital patient care pathways and their situational usage. The study results are presented in Table 2.

The crucial link between the metaverse and 6G lies in real-time data connection and analysis, focusing on the effective utilization of diverse data sources such as patient information, environmental factors, sensors, and medical devices. In this context, connectivity facilitates connections among people, physical objects, and virtual realism through data. The illustrated use cases indicate that mobility is important in hospitals to connect patients, doctors, nurses, and needed medical equipment and machines, particularly during emergencies, and for remote patient monitoring. Mobility, e.g., mobility in ambulances and its connection to hospital environments, is critical to ensuring patient safety. Seamless data transmission across department boundaries will enhance mobility in ambulances, streamlining and seamlessly coordinating people, equipment, and facilities in a hospital environment, leading to situational awareness and more effective and timely responses to emergencies.

Situation awareness is one of the key values identified from use cases. To support situation awareness, a seamless wireless connection is required for real-time communication among different objects, e.g. sensors from patients, real-time data from medical instruments and equipment, and location and positioning of health staff. Flexibility allows optimized usage and combination of hospital wards and rooms without having to move around the equipment. Due to the sensitive medical and treatment data and safety operations, a secure, closed indoor network is needed to ensure the stability and safety of data.

Metaverse requires more reliable connections and faster data processing speeds to support the efficient exchange and collaboration of a large network of interconnected devices and sensors for hospitals. The fifth Generation (5G) communication network cannot meet the growing demands and requirements for metaverse use cases that require latency and reliability of short-packet transmission [41, 42]. Therefore, Six-Generation (6G) Networks are expected to eliminate time and space barriers to optimize healthcare workflow [43] and meet the demand for seamless connectivity and ubiquitous intelligence [15]. The 6G is posited to support massive connectivity, empower AI and ML for real-time data analytics [44], and support the metaverse development for health practices and services with energy-efficient solutions.

Drawing from the use cases identified and analyzed, this paper has identified the key values and related capabilities, usage scenarios, and impact of 6G and metaverse in hospitals shown in Fig. 2.

The evolution of the metaverse will rely on the network of 6G as core infrastructure and services. 6G, as a general-purpose technology, offers the foundational platform and capability necessary for metaverse enabled services and its development [45] in hospitals. The 6G network alone, in the absence of metaverse as a practical application, would probably lack some key characteristics essential in the healthcare context. Thus, the metaverse, an emerging technology, is integrated within the 6G framework to unleash its capabilities contributing to each stage of the patient care pathway from emergency to rehabilitation. Consequently, the development of both metaverse and 6G will progress in tandem, hand in hand, offering local services in hospitals.