In healthcare, we have a habit of mistaking innovation for progress. New technologies like extended reality (the umbrella term for virtual, augmented and mixed reality and/or haptics) break into the healthcare economy with much fanfare, pilots are launched, papers are published and for a moment, it feels like transformation is happening. It can feel like the world of digital healthcare is finally experiencing that much used term, transformation. But more often than not, the system absorbs none of it. The innovation sits at the edges, admired, but not adopted.
I’m Ross O’Brien, a former NHS Commissioner and provider of mental health services and a life long digital health pioneer. I’ve spent a lot of my career working at that boundary, where promising technologies meet the front line of health systems, and one thing has become clear. The biggest barriers to change in healthcare are rarely technological. They are more often than not structural. That was the starting point for our work at the XR Health Alliance. When we first looked at Extended Reality (XR) in healthcare, the evidence was already there for its efficacy. XR research has been pioneered by folks like Albert ‘Skip’ Rizzo for over three decades. We already have evidence of how XR can improve outcomes, reduce costs, and deliver care in fundamentally different ways across pain, rehabilitation, clinical skills training, patient education and mental health. In some cases, it is achieving comparable results at a fraction of the cost. And yet, almost none of it was scaling. Not because it didn’t work, but because the system didn’t know how to use it or whether it should be supported.
When innovation isn’t enough
What myself and my co-founder (the fantastic and innovative Sarah Ticho) uncovered wasn’t a technology problem. It was a healthcare economy wide coordination problem. Developers were building solutions without clear routes into healthcare systems. Clinicians were keen to build solutions but lacked the technological understanding or system wide resources to support adoption. Regulators were cautious but operating in frameworks that hadn’t been designed for immersive or interactive technologies. Investors saw potential, but not enough certainty to commit at scale. In other words, everything was moving, but nothing was systematically connecting.
That diagnosis became the foundation for our early work and, ultimately, helped shape national investment through the Mindset XR programme. It’s often described as a UK Research and Innovation £20 million funding initiative. In reality, its significance was something else entirely. It was an attempt to fix the system to support, nurture and grow the movement around the technology. And it worked, at least in part! Mindset XR has been progressively rolled out across a scaling year on year programme by the fantastic NHS Health Innovation Network South East London. Beneficiaries began to see something we hadn’t seen before, a sector moving from isolated pilots towards early-stage adoption. A market starting to form. Adoption starting to happen. A success…..? Across the UK, many positive outcomes can be observed, but if you zoom out beyond the UK, the picture looks very different.
Why XR is still lagging behind
Globally, healthcare has accelerated its adoption of digital technologies, particularly in the field of AI. Regulatory frameworks are evolving, data infrastructures are maturing, and governments are actively shaping the conditions for scale. Recent analysis from the World Health Organization highlights just how coordinated this effort has become, with countries building national strategies, governance models, and regulatory pathways to support AI integration into health systems. XR hasn’t received the same treatment.
Despite its potential, and despite growing evidence, its adoption remains fragmented. The same barriers we identified in the UK still exist globally, and in some cases, they are even more pronounced. Regulation is inconsistent. Evidence isn’t standardised. Procurement pathways are unclear. And perhaps most critically, there is still no coherent market structure for XR in healthcare. There is no App Store, no shared infrastructure, no obvious path from innovation to adoption. And so, progress and true transformation remains stalled.
The missing connection: Games and Health
At the same time, something else has been happening, largely outside of healthcare. The gaming industry has quietly built one of the most sophisticated ecosystems for engagement, behaviour change, and global distribution that exists anywhere in the world. It is a huge global industry that is worth more than the entire film industry at an estimate of roughly $180–$200bn+ annually. It understands how to capture attention, sustain motivation, and scale experiences to millions of users. Healthcare, meanwhile, continues to struggle with patient engagement, adherence, and workforce capacity. The overlap is obvious, but the connection has barely been made. Gaming is still not treated as a serious component of health system design. It sits adjacent to healthcare, occasionally intersecting, rarely integrated. That is starting to look less like an oversight, or a missed opportunity.
A similar picture of health intervention games organic growth is becoming evident. Genres like ‘Cosy Games’ are developing, which cater for mental health and wellbeing, but almost as a by product, or a happy accident of an industry obsessed with Kawai or Cuteness. We also see lots of fitness based games which flirt with the idea of mental wellness whilst the industry generally shies away from more evidence based, therapy grade interventions. However this is changing. Games are being released like Sea Hero Quest which are research driven serious games, designed to support early detection of Alzheimer’s disease. It’s a game distributed as a mobile + VR experience, prioritising data collection and cognitive assessment over commercial gameplay depth. The outcome? A game that identifies people at genetic risk (ApoE4 carriers) based on how they navigate the game even when they show no deficits on standard tests. Get that! A game that does a better job than standard evidence based clinical assessment methods! Why are we not shouting about it? Why isn’t it available to a global audience as standard? We are also seeing a movement in the gaming economy to define safe and ethical gameplay development. UNICEF have launched an initiative working with games developers like Lego and Sesame Workshop (of Sesame Street fame) as well as Games for Change (a global nonprofit organisation that focuses on using video games, XR, and interactive media to drive real-world social impact) to share frameworks like the Responsible Innovation in Technology for Children (RITEC) Design Toolbox which set out to standardise how games should be designed in terms of emotions, relationships, identities, diversity, equity and inclusion and a whole lot more.
We are starting to see green shoots in an ecosystem with huge potential for impact. eMHIC’s role can also be vital here. The unique perspective and network of a global agency supporting innovation in mental health is invaluable to us. We look forward to the continued support and onwards collaboration of working with Anil Thapliyal, Charles Curie, and the whole team.
A different way of thinking about scale
If there’s one lesson from the last ten years of growth in XR and Game Health solutions, it’s this. You don’t scale health innovation by producing more of it. You scale it by changing the conditions around it. That means thinking beyond individual technologies and focusing instead on systems: How regulation adapts to new categories of innovation; How evidence is generated, shared, and trusted; How markets are structured and accessed; How industries that have never worked together begin to collaborate. It’s not glamorous work. But it’s the work that determines whether innovation survives beyond the pilot stage. And it’s the work that XR and increasingly gaming now requires at a global level.
This is the context for the Global XR, Gaming and Health Report the XR Health Alliance are now developing. Not as simply a way of cataloguing technologies, but as an attempt to answer a more fundamental question, what would it take to embed immersive and creative technologies into healthcare systems at scale? The ambition is simple, but not small. To move from fragmentation to coordination, from isolated success to repeatable models, from innovation to adoption. That means learning from the positives achieved by the Mindset XR model, working across regulators, health systems, developers, and critically, industries like gaming that have until now been largely excluded from the conversation. It also means being honest about where things stand. Because while progress has been made, the system is still catching up. Procurement remains complex, regulatory clarity is still evolving, evidence frameworks are not yet where they need to be. The conditions for scale are emerging, but they are not yet fully in place.
A moment of opportunity
Healthcare doesn’t get many moments like this. Moments where multiple technologies converge. Where systems are under pressure to change. Where the cost of doing nothing becomes harder to justify than the risk of doing something new. At the XR Health Alliance, we believe that this is one of those moments. XR has already shown what is possible. Gaming shows what is scalable. AI is showing how quickly systems can adapt when the right conditions are created. The question now is whether we can bring those threads together, and do it deliberately. Because if we don’t, the pattern will repeat. Innovation will continue to outpace adoption. Evidence will continue to outpace decision-making. And potential will continue to sit just out of reach. But if we do get it right, the impact won’t be marginal. It will be systemic. And that’s the shift healthcare has been waiting for.
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