AgeTech Collaborative™ participant XR Health is a telemedicine provider that specializes in virtual clinics and therapies using virtual reality headsets, with a particular focus on making the tech accessible and easy-to-use for older adults. We spoke with founder Eran Orr about his journey in founding the company, navigating the complexities of the U.S. healthcare system and the future of virtual reality in the AgeTech health care space.
This interview has been edited for length and clarity.
I was wondering if you could begin by introducing yourself and talking about the origins of XR Health.
I’m from Israel originally. I was an F-16 pilot in the Israeli Air Force, and I was diagnosed as suffering from whiplash injury due to the active flight and the G-forces. I was doing my own rehab to deal with that, and at the same time, I saw people playing with those old virtual reality (VR) devices — the ones where you stick your phone into a box and put it up to your eyes.
So the combination of rehab and VR, to me, looked obvious. We were one of the first companies to register VR applications with the FDA for cervical spine rehab. And then we expanded from physical therapy to pain management and cognitive applications.
Then a big shift happened two and a half years ago, when we decided to be not just the developer of the platform, but also to become a certified provider. So we launched virtual clinics where we treat patients remotely using our own proprietary technology. So that's our main business today. We have virtual clinics in Massachusetts, Michigan, Florida, Australia and Israel.
Doing therapy with a VR headset sounds cool. How does it work?
One of our clinicians, usually a physical therapist or an occupational therapist, will hold a video call to make sure that a client is suitable to use VR. We then ship them a headset with pre-installed with medical software. There’s no gaming, no entertainment, just FDA-registered applications — or you could call them virtual treatment rooms.
Basically, the patient gets the headset and downloads a mobile app that guides them on how to use the VR for the first time. And then they conduct these virtual treatment sessions completely remotely.
Can you describe the content inside VR in more detail? Let's say I'm an older adult and I'm interested in this. I get the headset, I put it on. What am I literally going to see? Is it all pre-loaded programs? Am I talking with someone in real time?
It's a full library of content, not just one single application. You have applications that are more like games, but they're therapeutic games where the clinician can control and see what you're seeing, what you're doing inside the game.
For example, in one of the games, you’re in a circus holding two swords and you need to pop balloons in the circus, and the clinician can modify the locations of the balloons and their frequency. And while you’re popping the balloons, we are measuring everything that you’re doing, such as your reaction time, smoothness, peak velocity, eye tracking and so on — a lot of clinical data that then can help the clinician to evaluate your performance.
Another application is called the go/no go test. You’re on a beach and you have boxing gloves on your hands, each a different color. And there’s a set of lights popping up in front of you, with colors corresponding to the gloves. And all you need to do is touch the right light according to the color of your glove. But while you're doing that, we are measuring how impulsive you are, how many mistakes you make, reaction time, a lot of interesting things.
On the pain management side, we have cognitive behavioral therapy applications that guide you how to cope with your pain. And we are now launching support groups in virtual reality where you can meet other people who have your condition, along with a clinician who guides the group in real time.
Imagine how the brick-and-mortar system works today. You step into a hospital, and you have multiple treatment rooms and multiple clinicians that you have to navigate. With XR Health, you have it all in the metaverse just by putting your glasses on. You can do it in virtual reality and all from the comfort of your home, which for the senior population is a game changer.
You mentioned pivoting from being just a platform developer to becoming a certified health care provider. What inspired you to make that shift?
I think in the health care arena, especially in the U.S., it's very hard to incorporate new technologies, especially technologies as innovative as we are. It basically means that if clinics or hospitals want to adopt them, they have to change their workflows. And we knew that we can provide amazing value to patients, especially the senior population. We had no doubt about the validity of the technology or the clinical benefits that patients can receive from it, but in the first five years, it was basically an uphill battle with these organizations. So we found that it's easier for us to do it ourselves instead of trying to convince everyone that this is the future, that this is the way to go.
You mentioned focusing on the older or aging population, which is not necessarily known for embracing cutting-edge tech such as VR. How do you make it accessible and convince older adults that this is a really terrific thing for them?
We built the entire platform with seniors in mind. That was part of our partnership with AARP from the beginning.
One beautiful thing about VR is that once you're inside it, all the interactions are like you are interacting in real life. One of the pilots that we did with AARP members was mind-blowing, because they spent 15 minutes inside VR interacting and having fun. Then we asked them to fill out a survey on a tablet — and no one was able to fill out the survey using the tablet. The tablet was too complicated for the participants, but the VR was very easy for them to navigate.
For the last two years, we’ve been focused on reducing the friction of actually getting inside the VR. We're trying to hit a mark of less than 10 seconds from the moment you want to enter VR, until you are actually in VR. Personally, I think that frictionless experience itself is far more important than the content. The content will become a commodity at some point. What’s important is how to take this amazing technology and enable people, especially the senior population, to have a frictionless experience so they’ll use it.
Does every session have a clinician on the other end, moderating in real time?
We have two options: You can synchronize or interact with a clinician in real time, and the clinician can do whatever you want, even set up the virtual treatment room based on what you need. And in between the sessions, you can use the headset on your own.
What do you do with the data that you capture?
One big problem in the brick-and-mortar outpatient market is that no one actually knows what's working and what's not. But now with VR, every time someone enters that virtual treatment room, we generate a snapshot of data that the clinician can compare to your previous performance. But they can also compare it to all your peers and other patients who are suffering from the same condition or disease. Then the clinician can intervene and make decisions based on data and not eyeballing, you know, what they believe is right. We are already seeing far better engagement and outcomes than in brick-and-mortar clinics. I don't know if it will take five years or ten years, but I think eventually most clinics will be transformed and be using the new metaverse that we're now building.
It's clear that your focus has been on seniors, but do younger people use XR Health?
In Australia specifically we have very good results with kids with autism spectrum disorder ASD. We are trying to bring that knowledge to the U.S.
What unexpected challenges have you encountered and how have you handled them?
The challenges are endless! But first, I thought that everything would happen faster: the adoption of the technology, the form factor, the market adoption. I was expecting health care providers to adopt new technology and to be more open-minded. Everything is happening — it’s just a lot slower than I anticipated.
Then, it took us a long time to understand the regulatory and reimbursement systems of the U.S. health care system, which is unbelievably complex and fragmented. And I have some perspective because I know what the Israeli health care looks like, and we are also operating in Australia. The U.S. is by far the most difficult.
What words of advice do you have for other health startups in this healthcare tech space?
I think they need to be prepared. It will take longer and be more expensive than what they believe it will be. But having said that, I think my best advice to any young startup is: You have to keep pushing forward, no matter what. Stamina and resilience are the two most important characteristics that the entrepreneur needs, because at some point you'll hit a wall. If you don't know how to walk around it or walk through it, then everything stops. So you need to constantly find ways to make it happen in any way you can.