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BACKGROUND Augmented reality (AR) and virtual reality (VR) have increasingly appeared in the medical literature in the past decade, with AR recently being studied for its potential role in remote health care delivery and communication. Recent literature describes AR’s implementation in real-time telemedicine contexts across multiple specialties and settings, with remote emergency services in particular using AR to enhance disaster support and simulation education. Despite the introduction of AR in the medical literature and its potential to shape the future of remote medical services, studies have yet to investigate the perspectives of telemedicine providers regarding this novel technology. OBJECTIVE This study aimed to understand the applications and challenges of AR in telemedicine anticipated by emergency medicine providers with a range of experiences in using telemedicine and AR or VR technology. METHODS Across 10 academic medical institutions, 21 emergency medicine providers with variable exposures to telemedicine and AR or VR technology were recruited for semistructured interviews via snowball sampling. The interview questions focused on various potential uses of AR, anticipated obstacles that prevent its implementation in the telemedicine area, and how providers and patients might respond to its introduction. We included video demonstrations of a prototype using AR during the interviews to elicit more informed and complete insights regarding AR’s potential in remote health care. Interviews were transcribed and analyzed via thematic coding. RESULTS Our study identified 2 major areas of use for AR in telemedicine. First, AR is perceived to facilitate information gathering by enhancing observational tasks such as visual examination and granting simultaneous access to data and remote experts. Second, AR is anticipated to supplement distance learning of both minor and major procedures and nonprocedural skills such as cue recognition and empathy for patients and trainees. AR may also supplement long-distance education programs and thereby support less specialized medical facilities. However, the addition of AR may exacerbate the preexisting financial, structural, and literacy barriers to telemedicine. Providers seek value demonstrated by extensive research on the clinical outcome, satisfaction, and financial benefits of AR. They also seek institutional support and early training before adopting novel tools such as AR. Although an overall mixed reception is anticipated, consumer adoption and awareness are key components in AR’s adoption. CONCLUSIONS AR has the potential to enhance the ability to gather observational and medical information, which would serve a diverse set of applications in remote health care delivery and education. However, AR faces obstacles similar to those faced by the current telemedicine technology, such as lack of access, infrastructure, and familiarity. This paper discusses the potential areas of investigation that would inform future studies and approaches to implementing AR in telemedicine.

BACKGROUND In the last decade, mixed reality technologies including augmented reality (AR) have emerged in healthcare as tools for data visualization and simulation learning. AR technology, which has largely been explored for communication and collaboration in non-health contexts, could play a role in shaping future remote medical services and training. This review summarizes existing articles implementing AR in real-time (“synchronous”) telemedicine and telementoring to create a foundation for healthcare providers and developers to understand future opportunities in remote care and education. OBJECTIVE This review describes the AR devices and platforms used in real-time telemedicine and telementoring, the tasks for which AR has been implemented, and the ways these implementations were evaluated in order to identify gaps in research that provide opportunity for further study. METHODS We searched PubMed, Scopus, Embase, and MEDLINE to identify English-language articles from January 1, 2012, through February 13, 2022 involving AR technology in a real-time interaction related to telemedicine or telementoring. The search terms were “augmented reality” OR “AR” AND “remote” OR “telemedicine” OR “telehealth” OR “telementoring.” Conference abstracts, systematic reviews, meta-analyses, and perspective-based studies were excluded. Articles that met criteria and related to healthcare were included for analysis. RESULTS 31 articles met inclusion criteria and were categorized within themes of patient evaluation, medical intervention, and education. 16 AR devices and platforms were identified, with the most common features being the ability for remote users to annotate and virtually display their hands or tools in the local user’s view. Most studies focus on consultation and procedural education, with surgery, emergency, and hospital medicine being the most represented specialties. End variables were most often measured with feedback surveys and interviews. The most common objective measures were time to task completion and performance. Long-term outcome and resource cost measurements were rare. Across the studies, user feedback was consistently positive for perceived efficacy, feasibility, and acceptability. Comparative trials demonstrate that AR-assisted conditions have noninferior reliability and performance and do not consistently extend procedure times compared to in-person controls. CONCLUSIONS Studies implementing AR in telemedicine and telementoring have demonstrated the technology’s ability to enhance access to information and facilitate guidance in multiple healthcare settings. However, AR’s role as an alternative to current telecommunication platforms or even in-person interactions remains to be validated, with many disciplines and provider-to-non-provider uses still lacking robust investigation. Additional longitudinal and randomized controlled studies with comparisons to existing methods would offer the most insight to this intersection, but a lack of standardized tools and adoption may hinder the creation of larger cohort studies. Overall, AR has the potential to complement and advance the capabilities of remote medical care and learning, creating a unique opportunity of involvement for innovators, providers, and patients.

To examine the effect of a clinic workflow intervention on follow-up for routine ercutaneous nephrostomy tube (PCN) exchanges.An intervention consisting of automated electronic tracking for all PCN placements and exchanges followed by phone call reminders to schedule a follow-up exchange 60 days post-procedure was introduced on March 19, 2019. All PCN exchanges performed from March 19, 2018 to September 18, 2019 were identified through a local electronic database search to assess the impact of intervention as a quality improvement project. Basic demographic information and procedure details were collected. Routine follow-up at our institution is recommended every 90 days. The exchange rates within 90 days were compared between groups using a Chi-squared test.A total of 160 PCN placements or exchanges were performed pre-intervention and 69 PCN exchanges were performed post-intervention. Pre-intervention, 75/160 (46.3%) were exchanged within 90 days compared to 47/69 (68.1%) exchanged within 90 days post-intervention. The remainder had delayed follow-up due to loss to follow-up or scheduling delays. Post-intervention, there was a significantly improved rate of compliance for PCN exchanges within the recommended 90 days at our institution (p-value = 0.002).Automated tracking and phone call follow-up at 60 days post-procedure is a simple and effective intervention that can improve compliance for routine PCN exchanges and reduce the number of patients that are lost to follow-up.