Virtual Hospital Research Articles

Reflections on empathic design: a K-16 perspective

This paper offers a response to the article entitled, “Empathic design: imagining the cognitive and emotional learner experience” (Tracey and Hutchinson, Educational Technology Research and Development 67(5):1259–1272, 2019). This review examines the recent published study on empathic design in consideration of practical applications for K-16 settings. The case study explores the alignment of the designers’ sensitivities with the learner perceptions of a web-based collaborative tool, the Virtual Hospital, developed for health professionals. Aspects of the study and empathic design can be useful in the development and evaluation of similar tools across all educational levels. The noted flexibility in the design discussions and the continued focus towards student affect are two facets which could support the development of educational technology tools. One noted limitation when applying the findings to K-16 students is that the collaborative program in the study was designed for health professionals with advanced degrees. Two suggestions are offered to make a comparable project more suitable for the K-16 environment. First, build an evaluative piece that contains an objective assessment to measure collaboration and second, include the teacher perspective in the design and evaluative process. The reviewed study offers an excellent blueprint for further work with empathic design.

Insights From Rapid Deployment of a "Virtual Hospital" as Standard Care During the COVID-19 Pandemic.

Pandemics disrupt traditional health care operations by overwhelming system resource capacity but also create opportunities for care innovation. To describe the development and rapid deployment of a virtual hospital program, Atrium Health hospital at home (AH-HaH), within a large health care system. Prospective case series. Atrium Health, a large integrated health care organization in the southeastern United States. 1477 patients diagnosed with coronavirus disease 2019 (COVID-19) from 23 March to 7 May 2020 who received care via AH-HaH. A virtual hospital model providing proactive home monitoring and hospital-level care through a virtual observation unit (VOU) and a virtual acute care unit (VACU) in the home setting for eligible patients with COVID-19. Patient demographic characteristics, comorbid conditions, treatments administered (intravenous fluids, antibiotics, supplemental oxygen, and respiratory medications), transfer to inpatient care, and hospital outcomes (length of stay, intensive care unit [ICU] admission, mechanical ventilation, and death) were collected from electronic health record data. 1477 patients received care in either the AH-HaH VOU or VACU or both settings, with a median length of stay of 11 days. Of these, 1293 (88%) patients received care in the VOU only, with 40 (3%) requiring inpatient hospitalization. Of these 40 patients, 16 (40%) spent time in the ICU, 7 (18%) required ventilator support, and 2 (5%) died during their hospital admission. In total, 184 (12%) patients were ever admitted to the VACU, during which 21 patients (11%) required intravenous fluids, 16 (9%) received antibiotics, 40 (22%) required respiratory inhaler or nebulizer treatments, 41 (22%) used supplemental oxygen, and 24 (13%) were admitted as an inpatient to a conventional hospital. Of these 24 patients, 10 (42%) required ICU admission, 1 (3%) required a ventilator, and none died during their hospital admission. Generalizability is limited to patients with a working telephone and the ability to comply with the monitoring protocols. Virtual hospital programs have the potential to provide health systems with additional inpatient capacity during the COVID-19 pandemic and beyond. Atrium Health.

Effectiveness of an Ophthalmic Hospital-Based Virtual Service during the COVID-19 Pandemic

The management of ophthalmic diseases in the virtual hospital can be implemented and is complementary to those of on-site F2F clinics. Virtual clinical service may be a useful model in the post-COVID-19 pandemic "new normal".

Designing a paediatric hospital information tool with children, parents, and healthcare staff: a UX study

BackgroundThe hospital patient pathway for having treatment procedures can be daunting for younger patients and their family members, especially when they are about to undergo a complex intervention. Opportunities to mentally prepare young patients for their hospital treatments, e.g. for surgical procedures, include tools such as therapeutic clowns, medical dolls, or books and board games. However, while promising in reducing pre-operative anxiety and negative behaviours, they may be resource intensive, costly, and not always readily available. In this study, we co-designed a digital hospital information system with children, parents and clinicians, in order to prepare children undergoing medical treatment.MethodThe study took place in the UK and consisted of two parts: In part 1, we purposively sampled 37 participants (n=22 parents, and n=15 clinicians) to understand perceptions and concerns of an hospital information platform specifically design for and addressed to children. In part 2, 14 children and 11 parents attended an audio and video recorded co-design workshop alongside a graphic designer and the research team to have their ideas explored and reflected on for the design of such information technology. Consequently, we used collected data to conduct thematic analysis and narrative synthesis.ResultsFindings from the survey were categorised into four themes: (1) the prospect of a hospital information system (parents’ inputs); (2) content-specific information needed for the information system (parents’ and clinicians’ inputs); (3) using the virtual information system to connect young patients and parents (parents’ inputs); and (4) how to use the virtual hospital information system from a clinician’s perspective (clinicians’ inputs). In contrast, the workshop highlighted points in times children were most distressed/relaxed, and derived the ideal hospital visit in both their and their parents’ perspectives.ConclusionsThe findings support the use of virtual information systems for children, in particular to explore and learn about the hospital, its facilities, and the responsibilities of healthcare professionals. Our findings call for further investigations and experiments in developing safer and more adequate delivery of care for specific age groups of healthcare users. Practical and theoretical implications for improving the quality and safety in healthcare delivery are discussed.

Role of 3D printing in the protection of surgical and critical care professionals in the COVID-19 pandemic

Background and objectiveThere is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment.MethodsA working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution.ResultsThe following supplies are produced: 1) devices that help protect providers: face protection screens (2400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas.Conclusions3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.

Narratives of illness in a Chinese virtual hospital

This study explores 60 individual narratives of illness presented in the initiating messages of threads that are posted in a well-known virtual space, ‘Tianya Hospital’ (????), in China. ‘Tianya Hospital’ is a discussion board where website users discuss their own or their loved ones’ health problems with other participants, who may be either health experts or patients with similar illnesses. Adopting the approach of mediated discourse analysis, the study aims to find out what is narrated (i.e., narrative presentation categories), what stance is taken and what the patterns and functions of the narrative presentation and the stance taking are. Some narrative presentation categories identified in this study are to some degree associated with existing face-to-face medical consultation phases, while others are related to a ‘timescale’ frame and the ‘sick role’ concept. The findings also show that the online narratives present not only the description of health problems, but also epistemic and affective stances. Some features of the narrative presentation organization and the stance taking in narratives can perform particular functions, such as serving to legitimize patients’ or patients’ caregivers’ complaints about healthcare services

A novel virtual hospital at home model during the coronavirus disease 2019 (COVID-19) pandemic.

A remote home monitoring program can provide a safe care mechanism for a diverse population of COVID-19 infected patients who do not meet admission criteria, yet have risk factors for severe COVID-19 complications. Remote monitoring may also be beneficial in managing future surge hospital capacities.

User Perceptions of Virtual Hospital Apps in China: Systematic Search.

BackgroundVirtual hospital apps are mobile apps that offer functionalities of online consultation, medical guidance, health community forums, referrals, outpatient appointments or virtual hospital-to-home care services. With an increasing number of online medical and health care consulting services, virtual hospital apps have made health care more accessible and fairer for all, especially in China. However, they have occurred without control or regulation. User evaluation can provide directions to help apps optimize identification, lower risks, and guarantee service quality.ObjectiveWe aimed to conduct a systematic search for virtual hospital apps in China. To get a global view, virtual hospital apps were assessed and characterized by means of quantitative analysis. To get a local view, we conducted a content feedback analysis to explore user requirements, expectations, and preferences.MethodsA search was conducted of the most popular Apple and Android app stores in China. We characterized and verified virtual hospital apps and grouped apps according to quantification analysis. We then crawled apps and paid attention to corresponding reviews to incorporate users’ involvement, and then performed aspect-based content labeling and analysis using an inductive approach.ResultsA total of 239 apps were identified in the virtual hospital app markets in China, and 2686 informative corresponding reviews were analyzed. The evidence showed that usefulness and ease of use were vital facts for engagement. Users were likely to trust a consulting service with a high number of downloads. Furthermore, users expected frequently used apps with more optimization to improve virtual service. We characterized apps according to 4 key features: (1) app functionalities, including online doctor consultation, in-app purchases, tailored education, and community forums; (2) security and privacy, including user data management and user privacy; (3) health management, including health tracking, reminders, and notifications; and (4) technical aspects, including user interface and equipment connection.ConclusionsVirtual hospitals relying on the mobile internet are growing rapidly. A large number of virtual hospital apps are available and accessible to a growing number of people. Evidence from this systematic search can help various types of virtual hospital models enhance virtual health care experiences, go beyond offline hospitals, and continuously meet the needs of individual end users.

Hospital Diabetes Meeting 2020.

Patients with diabetes may experience adverse outcomes related to their glycemic control when hospitalized. Continuous glucose monitoring systems, insulin-dosing software, enhancements to the electronic health record, and other medical technologies are now available to improve hospital care. Because of these developments, new approaches are needed to incorporate evolving treatments into routine care. With the goal of educating healthcare professionals on the most recent practices and research for managing diabetes in the hospital, Diabetes Technology Society hosted the Virtual Hospital Diabetes Meeting on April 24-25, 2020. Because of the coronavirus disease 2019 (COVID-19) pandemic, the meeting was restructured to be held virtually during the national lockdown to ensure the safety of the participants and allow them to remain at their posts treating COVID-19 patients. The meeting focused on (1) inpatient management and perioperative care, (2) diabetic ketoacidosis and hyperglycemic hyperosmolar state, (3) computer-guided insulin dosing, (4) Coronavirus Disease 2019 and diabetes, (5) technology, (6) hypoglycemia, (7) data and cybersecurity, (8) special situations, (9) glucometrics and insulinometrics, and (10) quality and safety. This meeting report contains summaries of each of the ten sessions. A virtual poster session will be presented within two months of the meeting.

Papel de la impresión 3D para la protección de los profesionales del área quirúrgica y críticos en la pandemia de COVID-19

Background and objectiveThere is a shortage of supplies for the protection of professionals during the COVID-19 pandemic. 3D printing offers the possibility to compensate for the production of some of the equipment needed. The objective is to describe the role of 3D printing in a health service during the COVID-19 pandemic, with an emphasis on the process to develop a final product ready to be implemented in the clinical environment. MethodsA working group was formed between the healthcare administration, clinicians and other public and private institutions in Cantabria, Spain coordinated by the Valdecilla Virtual Hospital. The process included receiving the printing proposals, learning about the printing resources in the region, selecting the devices, creating a team for each project, prototyping, evaluation and redesign, manufacturing, assembly and distribution. ResultsThe following supplies are produced: 1) devices that help protect providers: face protection screens (2,400 units), personalized accessories for photophores (20 units) and ear-protection forks for face-masks (1,200 units); 2) products related to the ventilation of infected patients: connectors for non-invasive ventilation systems; and 3) oral and nasopharyngeal swabs (7,500 units) for the identification of coronavirus carriers with the aim of designing action protocols in clinical areas. Conclusions3D printing is a valid resource for the production of protective material for professionals whose supply is reduced during a pandemic.

Implementation, Characteristics, and Effectiveness of an Ophthalmic Hospital-Based Virtual Clinical Service in China During COVID-19

Background: The COVID-19 pandemic crisis is posing challenges for clinical practice worldwide. We describe the characteristics and effectiveness of a virtual clinical service run by a tertiary ophthalmic center in China with an aim to provide practical guidance for such services during and beyond the pandemic. Methods: We conducted a longitudinal observational study. To provide the diagnosis and treatment of eye diseases under stringent epidemic control measures, the Zhongshan Ophthalmic Center (ZOC) established a virtual clinical service (virtual 2020) by harnessing several digital technologies (5G telecommunication networks, big data analytics, artificial intelligence (AI) and blockchain technology). Multiple interrelated services were offered online, including AI prescreening, virtual live consultation, and online pharmacy. We extracted data from the online clinical service records, along with on-site face-to-face (F2F) clinical records obtained from February 1 to March 13 in 2020 (F2F 2020) as well as a similar period in 2019 (F2F 2019) for analysis. We analyzed the clinical service pattern by day and time; indication of visit and demographics of age, gender, and geographical origin between three groups: virtual 2020, F2F 2020, and F2F 2019. Findings: A total of 38,038 visits to the ZOC were conducted online and F2F from February 1 to March 13, 2020, including 10,641 visits from an AI chatbot, 9,850 virtual live consultations by 127 doctors, and 17,547 on-site F2F consultations in the clinics. With the gradual opening of on-site outpatient and emergency services, online service numbers steadily increased. The AI chatbot services after office hours (8 pm to 8 am) accounted for 26.9% of the total visits, which was significantly higher than the proportions of virtual live consultations (10.9%) and on-site F2F consultations (3.5%) in 2020. Among the indications for virtual live consultation, specific disease consultation was the most common across all ages (64.7–70.7%); younger patients tended to have visual symptoms (18–34 years old, 60.4%), whereas seniors were more likely to require prescription renewal (>55 years old, 63.5%). Virtual live consultation in 2020 was more common in younger (median age 32 years) and female patients (53.3%) than in the F2F 2020 or F2F 2019 groups. Ocular surface diseases were the most frequent diagnosis in the virtual live consultations, which differed from the top diagnosis in F2F 2020 (retinopathy) and F2F 2019 (refraction) groups (P<0.05 comparisons between groups). Interpretation: The management of many ophthalmic diseases online in a virtual hospital setting can be implemented and is complementary to those of physical on-site F2F clinics. Virtual clinical service may be a useful model of care in the post-COVID19 pandemic “new normal”. Funding Statement: The study was supported by the National Key RD Guangzhou Key Laboratory Project (202002010006); Guangdong Science and Technology Innovation Leading Talents (2017TX04R031); the National Natural Science Foundation of China-General Programs (81770967, 81873675); National Natural Science Fund for Distinguished Young Scholars (81822010); the National Natural Science Foundation -Young Scientists Fund (81800810) and the Science and Technology Planning Projects of Guangdong Province (2018B010109008). Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: This study followed the principles outlined in the Declaration of Helsinki. The study protocol was approved by the ethical board committee of the Zhongshan Ophthalmic Center, Sun Yat-sen University (2020KYPJ012).

A Glimpse Into the Future.

The novel coronavirus will forever change the world in ways we have yet to realize What will our lives look like when the crisis abates? Will we still shake hands? Will my Italian relatives still kiss me on both cheeks (or just give air kisses)? When this is over there may be fewer elderly, more guns, less movie theaters and greater paranoia in America but perhaps more generosity and kindness as well Most of what will change after the pandemic is beyond my ability to guess However, I see more clearly the changes that will come to Emergency Medicine once the Hot Zone has cooled Let's pull back the curtain of time and glimpse into the future for our specialty after the Time of COVID

Telepsychotherapy in the age of COVID-19: A commentary.

This is a commentary on 15 articles addressing some of the major emergent challenges in provision of mental health services during the COVID-19 pandemic crisis, offering telepsychology as a viable and elegant solution to maintaining psychotherapy within and after the pandemic. The papers in the special issue both build on existing telepsychotherapy initiatives and offer rapid responses to the early phase of COVID-19. Two papers explore the relative effectiveness of in-person supervision and telesupervision, proposing telesupervision as a feasible alternative; and extending practical considerations to maintain effective clinical care in training settings while implementing telepsychology. Ten papers address technological challenges, with recommendations to create, enhance, and optimally configure telepsychotherapy services for clients across the mental health spectrum from common mental health problems, clinical high risk for psychosis, high risk for suicide, posttraumatic stress disorder, and family intervention. Turning to process, two papers explore psychotherapists' attitudes toward online psychotherapy and their use of technology in practice. Finally, one paper addressed system considerations, describing the development of a virtual partial hospital program for acute psychiatric patients stepping down from inpatient hospitalization. We discuss the key themes emerging from this corpus of work, linking these themes to the current state of evidence regarding the mental health response to the COVID-19 pandemic. Crucially, the value of this special issue goes beyond the current crisis, enabling psychotherapists to be better prepared for physical distancing situations that they may face in the future.

Development of a virtual partial hospital program for an acute psychiatric population: Lessons learned and future directions for telepsychotherapy.

Research suggests that individuals may benefit from participation in a partial hospital program (PHP) following discharge from inpatient psychiatric hospitalization. Indeed, PHPs are designed to facilitate further stabilization and skill-building before discharge to the community. As a result, our hospital-located in a large metropolitan area in the Northeastern United States-has long maintained a commitment to providing this critical level of care. However, during the COVID-19 pandemic, these in-person PHP services were discontinued in response to public health recommendations and to ensure the safety and well-being of patients and staff. To maintain this important point along the psychiatric care continuum, hospital leadership encouraged our PHP team to pursue an alternative approach to treatment delivery: video-based telepsychotherapy. This article describes the development of a virtual PHP that serves acute psychiatric patients stepping down from inpatient hospitalization. First, we provide an overview of the original in-person PHP and then discuss the process of its transition to a virtual format. Next, we describe in detail the components of our newly developed virtual PHP, highlighting adaptations necessitated by patients and staff being remote from our physical hospital. Finally, we present preliminary evidence of our virtual PHP's acceptability and feasibility, based on experiences with our 23 patients to date; discuss lessons learned from this program development effort; and recommend future directions for research and clinical practice. Information provided herein aims to guide the development of other virtual PHPs and telepsychotherapy programs that similarly strive to offer intensive treatment to an acute psychiatric population.

Avera eCARE: Medical Student Education in Telemedicine

Purpose: The purpose of this research study is to explore medical student knowledge of and interest in telemedicine services in urban and rural communities. In the past, medical students have reported feeling unprepared to use telemedicine and uninformed about laws regarding telemedicine usage following graduation. However, they also reported that telemedicine training is relevant and important for their future work.&#x0D; Methods: Study participants included medical students taking part in a two day telemedicine education program in 2018 and 2019. The first day includes a faculty seminar where students are introduced to telemedicine by experts in telemedicine innovations. The second day is a simulation day (SIM) where medical students complete a rotation at the Avera eCARE virtual hospital hub. A survey was given prior to the faculty seminar and re-administered following the SIM day. Questions asked about telemedicine knowledge, curriculum, and willingness to practice via telemedicine.&#x0D; Results: A Chi-square analysis was used to look for associations’ pre/post by year. Both years show an increase in favorable responses for questions to telemedicine training and education. For analyses by topic area, we created clusters of questions to build scores. T-tests were used to look for associations’ pre/post by year. The analysis resulted in three topic areas to build scores. Both years show a significant increase in both Rating of Overall Knowledge and Interest in Curriculum and Utilization. There is no significant difference in Willingness to Practice.&#x0D; Conclusions: Results show notable differences in how students perceive and understand telemedicine after structured exposure to telemedicine services. Further, this study demonstrates students' need for and interest in more telemedicine training opportunities in their curriculum. Results demonstrate no significant difference in the willingness to practice in rural settings. Future studies may focus on how telemedicine training is perceived by those more willing to work in rural communities.

Virtual Pharmacy Programs to Prepare Pharmacy Students for Community and Hospital Placements

Objective. To explore and evaluate pharmacy students' perceptions of the value and relevance of virtual community and virtual hospital on-campus placement programs. Methods. Students enrolled in a Master of Pharmacy program completed the required Virtual Community Placement (VCP) program and/or the Virtual Hospital Placement (VHP) program. A six-item questionnaire was administered to students after completion of each of the virtual programs to elicit students' perceptions of the value and relevance of the virtual programs. Additional data related to the relevance of specific workshops were collected, including students' self-reported confidence levels to undertake placement in a real-world setting following completion of the virtual programs. Results. Surveys were completed by 61 students in the VCP program and 50 students in the VHP program. Students perceived the virtual programs to be beneficial, with the majority (84% of the VCP students and 98% of the VHP students) reporting that the programs should be an essential component of any pharmacy degree. The majority of students (72%) self-reported an increase in their confidence levels in undertaking a real-world experiential placement after they completed their virtual hospital placement. Conclusion. Completing virtual placement programs prior to pharmacy students beginning their first "real world" pharmacy placements had a positive effect on student learning and confidence levels. Pharmacy students' feedback from this study regarding the relevance of specific learning modules and laboratory sessions will inform future curriculum development of the virtual placement programs.

Hospital virtual «José M. Rivera»: 10 años simulando

IntroductionHealthcare needs specific learning in technical skills, aptitudes, and knowledge. The aims of this article are to show the possibilities of simulation in these areas, as well summarising the state of knowledge, and analysing the meaning of digital technology. MethodsThe research methodology includes student satisfaction surveys, with statistical data analysis regarding the quality of the teaching received and the new technologies incorporated. ResultsAs result of these analyses and the support received, the progressive configuration of the virtual hospital has been achieved. ConclusionsThe change in educational paradigm is based, among others, on simulation and digital technology.

Transition from an MBBS to an MD program – Using innovation and thinking outside the square

This article was migrated. The article was marked as recommended. Background There has been a trend globally to move from a Bachelor of Medicine, Bachelor of Surgery (MBBS) to a Doctor of Medicine (MD) for primary medical education. This shift has seen many Australian universities change to an MD, mostly from graduate entry programs. This paper describes the novel and unique 3+2 model from one Australian university, that enabled undergraduate entry, student flexibility, and a master's exit qualification without increasing time.Methods The method included a curriculum review in 2013 where its problem-based learning curriculum shifted from a seven to a five-semester program; changing the third year to a virtual hospital clinical year using simulation, and introducing in 2016 a new 3+2 curriculum model in the final two years using a 100 point system as a masters level program. ResultsThe MD model was described in the external evaluation as 'novel and innovative', where students can choose from three project options - a research project, or a professional project or an international capstone experience as well as a number of scholarly tasks. The structure is fully integrated with the existing curriculum and assessment process, supported by an innovative technology platform.ConclusionNow in its third year of implementation this innovative model is breaking new ground in the way in which a masters level MD program could be developed, whilst maintaining undergraduate entry.

Potential direct secondary care cost benefits of HealthyWeightHub - Virtual Hospital 2.0 digital lifestyle intervention

HealthyWeighHub (HWH) is a 12-month coaching and education service designed to help patients with obesity make permanent life changes, launched and expanded gradually in Helsinki University Hospital (HUS) Healthvillage since 2016.&#x0D; We examined the direct secondary care cost benefits of HWH, measured with potential capacity freed (PCF) compared to conventional group coaching (CGC). Costs included health care, patient co-payments and travelling expenses. First, we evaluated the PCF actualized in the first two years from 2016 to 2018 in the HUS Specific Catchment Area (HUS ERVA). Then, we predicted the PCF at Finnish national level, if HWH was implemented gradually over the five years from 2018 to 2022, aimed at treating 1 % of adults with obesity annually in 2022.&#x0D; HWH’s actualized PCF was €2.69 million compared to CGC in the first two years in HUS ERVA. If the patients who received CGC had been treated with HWH instead, total PCF could have been €3.71 million. At Finnish national level, providing CGC to 1 % of adults with obesity was predicted to cost €28.0 million (€5.08 per capita) annually in 2022. With HWH predicted cost was €7.31 million (€1.33 per capita), meaning an annual PCF of €20.7 million (€3.75 per capita) in 2022 and cumulative five-year PCF of €57.5 million (€10.43 per capita). Compared to CGC, HWH is estimated to enable treatment of approximately 3.8-times more patients with obesity at the same cost.&#x0D; HWH can be more affordable than CGC and a potentially efficient tool to combat the obesity epidemic. Future evaluations should examine HWH’s effectiveness and impact on the indirect costs associated with weight loss and long-term illness.

Virtual Hospital with Real-Time Image Diagnosis

Recently, deep learning models such as deep convolutional neural networks have shown great success in different imaging tasks in general and in detection of diabetic retinopathy in particular. An automated detection system is undoubtedly a great help for the screening stage of diabetic retinopathy for further treatment to reduce the burden on the public health system. In this paper, a general framework for automated detection virtual environment is developed as a virtual hospital using a convolutional neural network (CNN) approach as imaging end. Image classification is done in two stages. The best model being 87.12% accurate for the first stage on more than 53000 images which is better than previous works tested only on very less amount of test data. Using this model, a standalone application is generated with extra features for user interaction to be used by the patient in the virtual hospital when he presses a key on the keyboard.