Reflexion Health, a digital healthcare company based in San Diego, has been busy promoting their Virtual Exercise Rehabilitation Assistant (VERA) since receiving FDA clearance in November of 2015. VERA is an all-in-one device that utilizes a tele-rehab platform to help patients perform prescribed in-home exercise programs while monitoring their compliance and reporting results back to their physical therapists. The goal is to increase patient access to rehabilitation services while also improving patient adherence.
The VERA system consists of the VERA software, a touch screen, and a Microsoft Kinect camera capable of capturing 3D motion of the patient’s entire body. VERA’s software uses an avatar that appears on the screen to educate and demonstrate the patient’s prescribed rehabilitation exercises. The patient is then asked to perform each exercise while the camera captures the patient’s body movements at a rate of 30 times per second to reconstruct the patient’s skeletal position in space and calculate joint angles and limb velocity. The data captured is then run against certain constraints for each exercise, allowing VERA to give real-time feedback to patients on their performance and how to improve their technique. 
Automated reports are created and sent to providers to allow them to continuously monitor patient adherence and make any necessary modifications to the prescribed exercise programs. Providers are able to send patients self-report outcome measures to formally assess patient progress, and telemedicine visits can be set-up between the clinician and patient utilizing the VERA camera equipment.
Reflexion Health aims to simplify the use of VERA for patients and clinicians by handling all of the logistics, such as installing the device at the patient’s home, offering full support to all parties throughout rehabilitation, and retrieving the system upon patient discharge from therapy. Additionally, the VERA system includes an embedded Wi-Fi jetpack that automatically connects to a patient’s phone service even if an in-home Wi-Fi network is unavailable.
Reflexion Health views VERA as a platform technology. However, as Medicare currently moves towards creating bundle payments – reimbursing a pre-determined amount of money – for specific surgeries, VERA is particularly beneficial for managing patients following total knee and hip replacements. VERA allows organizations to meet this reimbursement challenge by cutting the cost and improving the efficiency of post-surgical rehabilitation through limiting the number of in-person therapy visits without jeopardizing patient outcomes. It also allows patients to avoid unnecessary travel and insurance copayments. In no way does the VERA system mean to undermine the importance of skilled physical therapy. “It’s really meant to extend the coaching and the judgment of a skilled clinician,” said Dr. Joseph (Joe) Smith, MD, Ph.D., CEO and president of Reflexion Health. “It’s not meant to replace them, obviously, but it’s meant to extend their judgment back to the patient’s home.”
Dr. Smith also believes the “medical approach” that VERA takes is what sets it apart from other similar products on the market, such as the Wii-Hab, stating, “We at Reflexion Health think rehabilitation is serious medicine. If you look at VERA versus other products, we have not gamified that. VERA offers specific clinician instructions and measures and compares patient data against a prescribed exercise protocol… We take a pretty strict medical approach to this as opposed to pretending it is a game.” The company reports positive patient satisfaction and outcomes from early adopters of the VERA system. Dr. Smith notes, “We did net promoter scores on the last couple hundred patients, and they were in the high eighties and low nineties… We believe VERA is good economically and good in terms of outcomes and patient satisfaction, but let’s put that to the real test… I think everybody deserves to know the answer in a very objective format.”
Reflexion Health recently teamed up with Duke Clinical Research Institute (DCRI) to formally compare the financial and clinical outcomes of using VERA for rehabilitation compared to traditional physical therapy following total knee replacement. This randomized controlled trial was underway as of last month and is expected to include 300 patients. In the meantime, VERA is already available to interested providers.
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