Mixed Reality

Intelligence
Healthcare Edition

December 2020
Table of Contents

Background 04

Methodology 05

Who We Talked To – October 2020 06

Things To Know About Mixed Reality 07

Mixed Reality in Healthcare 08

Final Thoughts 21

Detailed Research Objectives & Audience Recruit 22

 Learn more

To learn how mixed reality solutions can support

and enhance your business, or to connect with a
mixed reality specialist, please visit
https://aka.ms/MixedRealityDesk.

3 Mixed
© Hypothesis Reality
Group Intelligence:
2020. © MicrosoftHealthcare Edition
2020. All rights reserved. 10/20
 Background

As companies across the world begin employing immersive technologies to

drive efficiencies, Mixed Reality is poised to change the way businesses
operate. Mixed Reality blends the digital and physical world by overlaying 3D
digital objects onto the user’s physical world, offering a way for users to
interact organically using head-mounted devices (HMDs). Located at the
center of the virtuality continuum, the capabilities of Mixed Reality render it
uniquely positioned to transform the workplace as we know it.

Microsoft has been at the forefront of the immersive technology market and a
trailblazer in Mixed Reality, innovating in both hardware and software to offer
cross-platform Mixed Reality solutions. With the introduction of HoloLens, the
first untethered Mixed Reality headset designed with business use cases in
mind, Microsoft established itself as a leader in the Mixed Reality space and
validated the enterprise value of this nascent industry by partnering with
prominent entities in contracts worth up to half a billion dollars.

In October 2020, Microsoft and Hypothesis embarked on an initiative to hear

from IT and Business Decision Makers across three countries with the goal of
developing a deeper understanding of how Mixed Reality is being utilized
across three key industries: manufacturing, retail, and healthcare. This paper
deep dives into how healthcare organizations are using and considering Mixed
Reality technologies. While the primary data collected are quantitative, this
report also illuminates customer stories that bring said data to life, providing a
comprehensive picture of Mixed Reality use in the market today.

Furthermore, this report also aims to uncover the ways in which Mixed Reality
may evolve in the future.

4 Mixed Reality Intelligence: Healthcare Edition

 Methodology

Microsoft commissioned Hypothesis Group, an insights, design, and strategy

agency, to execute the Mixed Reality Intelligence research.

The Mixed Reality Intelligence Research occurred in October 2020, when a

15-minute online survey was conducted with over 700 decision makers
involved in mixed reality decisions at mid-market and enterprise companies
from a range of manufacturing, healthcare, and retail companies across the
US, Germany, and Japan.

In addition, the research deep dives into customer stories from interviews
between Microsoft and mixed reality decision makers at enterprise
companies around the world that use HoloLens 2.

Healthcare Customer Stories

5 Mixed Reality Intelligence: Healthcare Edition

 Who We Talked To
October 2020 BDMs & ITDMs
in Healthcare
who work at mid-market or
enterprise-size companies
(500+ employees)

75%
Familiar with
Mixed Reality
Self-stated &
Pass a knowledge test

99%
Have influence/
decision making power
on Mixed Reality
strategies

96%
in Mixed Reality
adoption or
evaluation

93%
Use or plan to use
HMDs for Mixed
Reality

Final Audience

6 Mixed Reality Intelligence: Healthcare Edition

 Things To Know About Mixed Reality

1 Within healthcare, 3-in-4 organizations are currently using Mixed Reality

solutions via HMDs (though lower than in manufacturing and retail). In the
next 12-24 months, all in healthcare expect to invest as much in the
technology as they do today, or even more. Among those currently using
Mixed Reality or considering it for the future, the technology is critical to
organizational success (99% agreement).

2 Healthcare organizations are held back from using Mixed Reality by complex
regulatory processes and the extensive use of legacy systems that permeate
the industry, both for current and prospective users. Budget concerns are also
a top inhibitor among prospective users, but once the technology is proven
among current users, the cost is less of a concern.

3 Mixed Reality is used most in healthcare for Training & Simulation solutions to
prepare and educate healthcare workers, including medical students who
could be potential users over their entire career. Using Mixed Reality for
Remote Assistance and Contextual Data Overlay is not as common, but both
have strong growth potential in the next 12 months.

4 On average, the majority (about 2-in-3) of healthcare organizations that use

Mixed Reality estimate a return of 40% or more from their investments across
Training & Simulation, Remote Assistance, and Contextual Data Overlay
applications. Customer success stories from Case Western Reserve University,
Imperial College Healthcare, and Medivis demonstrate how HoloLens 2
solutions meet and exceed these industry expectations.

7 Mixed Reality Intelligence: Healthcare Edition

Mixed Reality in
Healthcare
 The Big Picture

Compared to Manufacturing and Retail, Mixed Reality usage is notably lower in

the Healthcare sector. That said, 3-in-4 Healthcare organizations surveyed are
currently using Mixed Reality solutions, and a majority (60%) have committed to
adoption beyond the trial phase. Most Mixed Reality users in Healthcare find
themselves in relatively early stages of implementation, with 62% of current users
having employed the technology for less than two years. Across the three markets
examined, usage skews akin to manufacturing: German Healthcare organizations
boast the highest number of current users (84%) and Japanese organizations the
least (67%); U.S. organizations align with the overall average (75%). (Exhibit 1)

EXHIBIT 1. CURRENT VS. PROSPECTIVE USERS OF MIXED REALITY

75%
Current Users
25% of HMDs
Prospective Users Including those trialing
Plan to use MR in
the next 12 months
60%
Currently using
products or solutions

15%
Trialing products
or solutions

9 Mixed Reality Intelligence: Healthcare Edition

 Among Healthcare organizations currently using Mixed Reality, there is widespread agreement
that the technology is crucial to their success. Furthermore, while Mixed Reality is at present less
ubiquitous in Healthcare compared to other industries, organizations are nevertheless confident
that its value will increase over time. This prediction about the future value of Mixed Reality
solutions is reflected in organizations’ investment plans: current users are committed to Mixed
Reality technologies and will continue to invest the same or more in coming years; fewer than
1% plan to invest less than they currently do. Indeed, for Healthcare organizations to continue
their commitment to offering the best healthcare services, their practices must integrate the
most current technological capabilities available. “There are so many ways Mixed Reality will be
used in the future in Healthcare,” explains a current Mixed Reality IT Decision Maker and
healthcare provider. “We will fall behind if we don’t continue to develop our use of this
technology.”

Among current users, Mixed Reality usage in the next 12 months will be highest among
organizations with more than 5,000 employees, with growth among these very large enterprises
projected at nearly 100%. That said, the smallest Healthcare providers surveyed (those with
between 500 and 1,000 employees) anticipate a growth rate almost double that of the medium-
sized enterprises, suggesting that--even for companies with less disposable income--Mixed
Reality solutions are seen as a viable growth strategy to justify the price tag. (Exhibit 2)

EXHIBIT 2. MIXED REALITY CURRENT VS. FUTURE VALUE

Very critical 62% +4 66%

Somewhat critical 37% 33%

Not that critical/ 1% 2%
Not critical at all
Current Value Future Value

10 Mixed Reality Intelligence: Healthcare Edition

 Mixed Reality Barriers

Both prospective and current users in EXHIBIT 3. BARRIERS TO USING

Healthcare cite implementation MIXED REALITY MORE (TOP 5)
challenges such as issues with
timing/deployment and software
incompatibilities as top barriers for Top 5 Barriers For Current Users
using Mixed Reality. Compliance issues
also surface as a salient barrier for users Issues with timing and deployment 26%
in Healthcare, an industry with extensive
use of legacy systems and complex Too complex to integrate
25%
regulatory processes. Logically, the with legacy systems
Healthcare industry is subject to
Still in the process of implementing current
substantial regulation, and this barrier 22%
MR solutions
likely accounts for the underutilization
of Mixed Reality solutions in this Too many compliance/
22%
industry despite its high valuation regulatory challenges
among IT and Business Decision Makers.
(Exhibits 3 & 4) Want to work out existing MR challenges 22%

Prospective Mixed Reality users in

Healthcare also cite the imperative to
store data in the cloud as a chief EXHIBIT 4. BARRIERS TO CURRENTLY
concern. Cyberattacks on hospitals, USING MIXED REALITY (TOP 5)
clinics and medical complexes are on
the rise, with hackers threatening to
Top 5 Barriers For Prospective Users
hold Personal Health Information (PHI)
hostage in exchange for ransom Too complex to integrate
26%
payments. Because cloud storage comes with legacy systems
with additional security vulnerabilities,
this must be an important consideration Too many compliance/regulatory
26%
challenges
for Healthcare organizations
considering trial and/or adoption of Incompatible with
24%
Mixed Reality, both out of caution for existing software solutions
their patients’ safety as well as their own
liability. Across the three markets, Don’t have enough budget 19%
German Healthcare Mixed Reality users
are the most inhibited by security and Concerned about storing data
18%
liability concerns. (Exhibits 3 & 4) in a public cloud

11 Mixed Reality Intelligence: Healthcare Edition

 Training and Simulation

Deep Dive into

In training new employees and practitioners, Healthcare providers are faced with
a unique challenge: the work itself is hands-on, but any training that takes place
in an authentic environment runs the risk of adversely impacting patient care.
Mixed Reality, consequently, provides an ideal solution for Healthcare
organizations, who can use the technology to create holographic simulations of
medical scenarios to train and educate healthcare workers. Implementing
Training and Simulation through Mixed Reality allows workers to learn how to
examine, diagnose, and treat patients, and practice technical surgical skills in a
low-risk simulated environment that is as close to real-life as possible but devoid
of real-life consequences. Nearly half of Healthcare organizations currently utilize
Mixed Reality for Training and Simulation, and another 31% are currently
considering adoption. (Exhibit 5) Case Western Reserve University in Cleveland,
Ohio is a vanguard of this use case.

EXHIBIT 5. USAGE VS. CONSIDERATION OF MIXED REALITY

FOR TRAINING AND SIMULATION

45% 31% 24%

12 Mixed Reality Intelligence: Healthcare Edition

 USING HOLOLENS 2 FOR TRAINING & SIMULATION

The Medical Department at Case Western

Reserve University has identified an
opportunity to teach anatomy more
effectively and provide students with
hands-on training in a low-risk
environment, without putting any patients
at risk. Case Western is using their
HoloAnatomy software on HoloLens 2 to
teach students anatomy in a highly visual
environment where they can practice skills
in interactive, 3D scenarios. While
originally designed to supplement
traditional classroom training, this Mixed
Reality use case has taken on a more
prominent role during the COVID-19
pandemic, allowing medical students to
complete the first-ever remote-only “[With HoloLens 2]
HoloAnatomy course. With survey data
Students are learning at
published by the American Medical
Association indicating that 81% of the same level or better,
students said that HoloAnatomy sessions they are doing it faster
were as good as or better than in-person and they are retaining
instruction, Radiology Professor Mark
knowledge better. That's
Griswold of the Case Western Reserve
University School of Medicine argues that dream stuff, as a teacher.”
Mixed Reality “ha[s] global implications Mark Griswold
Professor, Department of Radiology
for how education is delivered.” Case Western Reserve University

13 Mixed Reality Intelligence: Healthcare Edition

 While a majority of Healthcare organizations have only recently implemented
Mixed Reality for this use case, the results thus far are encouraging: more than
two-thirds of current users estimate an ROI of 40% or higher and an average
improvement of 48% in knowledge retention , the most desirable outcome for
this use case . The potential for Mixed Reality to improve knowledge retention is
exemplified by Case Western, whose medical students using HoloLens 2 and
HoloAnatomy retained 120% more knowledge over the course of a year as
compared to their peers who did not use the technology, and saw a 50%
improvement in grades compared to traditional textbook learning. These
outcomes suggest that the ability to see and interact with 3D images for
anatomy classes helps students not only learn, but deeply internalize the
knowledge. With undeniable success in learning and performance outcomes,
Case Western plans to implement HoloLens teaching solutions across various
other departments.

USING HOLOLENS 2 FOR TRAINING & SIMULATION

14 Mixed Reality Intelligence: Healthcare Edition

 Remote Assistance

Deep Dive into

The Healthcare industry has leveraged Mixed Reality solutions to connect

practitioners in ways that were previously unimaginable. Mixed Reality for Remote
Assistance allows healthcare workers to stream real, 3D videos of the patients they
are treating to remote colleagues or experts, and allows doctors to share
knowledge and expertise, and deliver care without having to be in the same room-
-or even the same hospital--as the patient. Nearly 2-in-5 Healthcare organizations
currently use Mixed Reality for this use case.
(Exhibit 6)

Imperial College Healthcare has become one of its most visible proponents during
the COVID-19 pandemic of using Remote Assistance. When the COVID-19
pandemic brought an overwhelming volume of highly-contagious patients into
their hospital, Imperial College Healthcare was faced with an unprecedented
challenge to keep its physicians safe while providing healthcare for COVID-19
patients. The hospital decided to adopt Dynamics 365 Remote Assist with
HoloLens 2, which transmits a secure live video feed to a remote location in the
hospital, allowing healthcare teams to see everything a doctor treating a COVID-
19 patient in person can see. By implementing this creative solution, Imperial has
been able to provide the best possible care for an increasing number of COVID-19
patients while reducing its physicians’ exposure to the virus.

EXHIBIT 6. USAGE VS. CONSIDERATION OF MIXED REALITY

FOR REMOTE ASSISTANCE

39% 35% 26%

15 Mixed Reality Intelligence: Healthcare Edition

 USING HOLOLENS 2 FOR REMOTE ASSISTANCE

Approximately two-thirds of current users “We’re now looking into

estimate an ROI of 40% or higher when using
Mixed Reality for Remote Assistance, and this other areas where we can
optimism is borne out in the Imperial College use HoloLens 2 because it is
Healthcare case: Remote Assist allowed the improving healthcare
hospital to decrease exposure to COVID-19
without removing the
patients by as much as 83% while
simultaneously ensuring that each patient human; you still have a
received the same quality of care and expertise, doctor next to your bed,
regardless of who was--or wasn’t--in the room. treating you.”
In addition to the dramatic increase in
employee safety, the implementation of Jim Kinross
Remote Assist on HoloLens 2 has driven other Senior Lecturer
Imperial College Healthcare
positive outcomes at Imperial. Most notably, it
significantly reduced their consumption of
Personal Protective Equipment (PPE) during a
critical time in which PPE was extremely limited.

16 Mixed Reality Intelligence: Healthcare Edition

 While the pandemic was the impetus for integrating Mixed Reality for Remote
Assistance into Imperial College Healthcare’s protocol, this use case promises to
revolutionize the Healthcare system well beyond the availability of a COVID-19
vaccine. “COVID-19 will change everything forever in terms of the way we work
and how we work,” explains James Kinross, Senior Lecturer at Imperial. “I can see
the point where these sorts of tools will be the norm.” Indeed, Remote
Assistance may well be the solution the Healthcare industry has been looking for
to address other systemic issues, such as the dearth of medical experts in rural
areas of the United States.

USING HOLOLENS 2 FOR REMOTE ASSISTANCE

17 Mixed Reality Intelligence: Healthcare Edition

 Contextual Data Overlay

Deep Dive into

Beyond changing the way healthcare providers interact with and treat patients,
Mixed Reality has the potential to transform the way doctors perform surgery.
With Contextual Data Overlay, surgeons can register a virtual overlay of medical
imaging (MR or CT scan) in patients to guide diagnosis or surgical navigation.
They can use hand motions to interact with and manipulate images to visualize
surgical scenarios and make faster, more informed decisions during surgical
operations. Nearly 2-in-5 Healthcare organizations currently use Mixed Reality for
Contextual Data Overlay. (Exhibit 7)

At the forefront of this use case is surgical AR company Medivis, which builds
augmented reality data integration and visualization tools for surgeons. Invasive
operations are fraught with preventable mistakes, as reliance on 2D imaging (CT,
MRI) for surgical procedures leaves the door open to potential error. Medivis had
been searching for a superior visualization technology to improve surgical
accuracy when they decided to partner with Microsoft to develop a Mixed Reality
surgical planning product, SurgicalAR for HoloLens 2. This custom Contextual Data
Overlay is designed to empower surgeons and clinicians to maximize surgical
accuracy and deliver better, safer patient outcomes.

EXHIBIT 7. USAGE VS. CONSIDERATION OF MIXED REALITY

FOR CONTEXTUAL DATA OVERLAY

38% 33% 29%

18 Mixed Reality Intelligence: Healthcare Edition

 Increasing patient safety and improving
operational precision are both top of mind for
Healthcare organizations implementing Mixed
”It excites us when we can Reality for Contextual Data Overlay, and
do these routine procedures Medivis’s Surgical AR software on HoloLens 2
in an inherently superior brings both of these outcomes into focus.
With the ability to overlay high fidelity, 3D
way, so we can get our
images of complex pathology directly onto
patients out of the the patient, surgeons are able to make more
operating room and safely informed decisions before and during surgery,
back to their families.” consequently improving accuracy; for
instance, Medivis has placed catheters with
Chris Morley millimeter accuracy in a fraction of the time.
Radiologist
Medivis
Moreover, Contextual Data Overlay has
increased patient safety by reducing exposure
to radiation: at least 200 operations have
been performed using HoloLens 2.

USING HOLOLENS 2 FOR CONTEXTUAL DATA OVERLAY

19 Mixed Reality Intelligence: Healthcare Edition

 With over two-thirds of current users estimating an ROI of 40% or higher for this
Mixed Reality use case, Contextual Data Overlay is the surgical solution of the
future. As Medivis Radiologist Chris Morely explains, “Holographically overlaying
patient data at the point of care can reduce procedure times, complication rates,
and radiation exposure.” Yet, while the benefits of employing Contextual Data
Overlay are tangible, almost one-third of Healthcare organizations surveyed are
neither current nor prospective users of the use case; this number is particularly
high among Japanese companies, who are 14% less likely to be current users than
the group as a whole (24% vs. 38%, respectively). Ultimately, despite the clear
advantages offered by Mixed Reality for Contextual Data Overlay, regulatory
barriers may render it one of the slower technologies to be trialed and adopted.

USING HOLOLENS 2 FOR CONTEXTUAL DATA OVERLAY

20 Mixed Reality Intelligence: Healthcare Edition

 Final Thoughts

As immersive technologies continue to transform reality as we know it, Mixed

Reality has emerged not as a VR-light but as a business tool in its own right.
With its unique ability to blend the real and the digital, Mixed Reality offers
solutions that are as diverse as they are innovative, boasting use cases ranging
from training healthcare workers to improving surgical precision. Ideas that felt
like science fiction just a decade ago are now quite literally at our fingertips, and
bold companies must think creatively about how they can use Mixed Reality to
differentiate themselves in an increasingly competitive digital marketplace.

Across markets and industries, the benefits of implementing Mixed Reality

technologies are vast, and three major themes emerge. First, by integrating
digital elements into real spaces, Mixed Reality reduces the constraints imposed
by toggling between our physical environments and our screens. Second, Mixed
Reality solutions offer distinctive advantages for education--be it corporate or
academic--by allowing students and trainees to develop hands-on experience
performing tasks that could be detrimental or costly if executed by novices in a
real-world context. Finally, Mixed Reality allows us to do something that was
previously unthinkable: be two places at once. Infinitely more sophisticated than
video calling, Mixed Reality technologies can transport individuals who are miles
apart into the same digital space, allowing them to interact with their
surroundings and with one another as if the space between them had all but
vanished. Particularly in the context of a global pandemic, this ability to emulate
togetherness feels indispensable.

21 Mixed Reality Intelligence: Healthcare Edition

Detailed Research Objectives
& Audience Recruit

The objectives of the research included:

1. Understand the current Mixed Reality landscape including adoption, challenges, and outcomes​
2. Explore current Mixed Reality projects, including how Mixed Reality is
being used within key industries and customer stories​​
3. Quantify ROI expectations of decision-makers and demonstrate how
ROI is realized through customer stories​​
4. Uncover the ways in which Mixed Reality may evolve in the future

To meet the screening criteria, Mixed Reality professionals needed to be:

A business decision maker or IT decision maker at their company​
Employed full-time at a mid-market or enterprise-level company (500 employees or more)​
Ages 25-64​
Familiar with Mixed Reality​
Involved in decision making for Mixed Reality technologies​
Adopting or evaluating Mixed Reality technologies​
Work in Manufacturing, Healthcare, or Retail industries

Of the 251 healthcare Mixed Reality professionals interviewed

for the research wave in October 2020:
100 Mixed Reality Professionals were interviewed in the US
76 Mixed Reality Professionals were interviewed in Germany
75 Mixed Reality Professionals were interviewed in Japan

Note: Research was conducted during the global COVID-19 pandemic,

which was at varying stages of escalation/containment

© Hypothesis Group 2020. © Microsoft 2020. All rights reserved. 10/20