Computer mediated reality technologies: A conceptual framework and survey of the state of the art in healthcare intervention systems

The trend of an ageing and growing world population, particularly in developed countries, is expected to continue for decades to come causing an increase in demand for healthcare resources and services. Consequently, demand is growing faster than rises in funding. The UK government, in partnership with the European Commission's Vision for 2020, propose a paradigm shift towards the delivery of more patient-centred self-care interventions, facilitated by novel ubiquitous computer mediated reality technology applications, as a key strategy to overcome the scarcity of health resources gap. If this vision is to become a reality, it is crucial that state of the art research focuses efforts on the development of applications that support the delivery of patient-centred self-care interventions.This study presents a conceptual framework, a system impact assessment taxonomy and systematic literature review of the state of the art in Computer Mediated Reality Technologies (CMRT) research. The intended function of the CMRT applications are considered systematically, with a view to establish the extent to which existing research focuses on delivering digitised, patient-centred healthcare applications, the care contexts in which these are delivered, and the specific CMRTs that are used to deliver such applications.A conceptual framework of the state of the art is derived via a systematic concept-centric incremental thematic analysis protocol. The survey considers systems that have been presented within the literature between 2010 and 2017. Primarily, the literature is considered in the context of the type of patient-practitioner relationship that the respective applications support, i.e. Traditional, Collaborative, or Patient-centred care, and the phase of healthcare intervention that is supported i.e. Primary-care, Secondary-Care and Tertiary-care. Inclusion criteria focuses on systematic CMRT implementations and analysis considers a range of clinical contexts (type), settings (location) and system specification concepts consisting of Augmented, Virtual and Mixed Reality technology in conjunction with 3D-Modelling. As a measure of the value added by respective CMRT systems, an impact assessment is carried out according to the National Service Framework Research Quality metric, and via a bespoke overall System Value score metric.Several research challenges emerge as a result of surveying the research literature, which include: a large quantity of research effort being focused on invasive surgical procedures through CMRT from a paternalistic Traditional patient-practitioner perspective; lack of research effort in the CMRT healthcare domain that develop ubiquitous systems which specifically target the older population within the home setting; little to no consideration of ecological validity and design architecture for user or interface interaction of systems; current CMRT systems are lacking deployment on ubiquitous mobile platforms; protecting and informing patients when using sensory/camera based CMRT from the privacy of their home through self-assessment means. In terms of impact, Traditional CMRT systems achieve the highest score for Research Quality, and Patient-Centred Systems achieve the highest scores for System Value. In response to these challenges, recommendations and future research directions are proposed to overcome each respective challenge.