“We’re definitely joining a much bigger ecosystem, and we’re really excited about that,” said Shadow Health Co-Founder and CEO David Massias. “If we go back to our biggest goals – better trained nurses, improved global patient outcomes, and the highest performing teams possible – we can go farther and get there faster as a part of a tremendous global organization than we ever could going alone.”

Shadow Health is an educational technology startup bridging the “academic to practice skills” gap in health care by providing rich, interactive, digital learning environments for nursing and allied health education programs. The company uses virtual patients that communicate with nursing students who interact with the patient much as they would in a clinical situation. The global pandemic has increased the need for the lifelike interactions Shadow Health offers with a diverse range of virtual patients.

“It’s great to see the hard work of one of our UF faculty, Ben Lok, reach the market in a very impactful way,” said Jim O’Connell, assistant vice president of technology commercialization at UF. “It’s also an example of how long it takes for university-stage technology to find traction and why universities need to support their startups, often for very extended periods of time.”

Since its commercial launch in 2011, the startup has grown from a company of 2 to a team of 150, most based in Gainesville. The company was one of the first resident clients in UF Innovate | The Hub. Elsevier has close to 10,000 employees, and RELX has multiples of that.

“Shadow Health’s purpose is to accelerate global health. We’ve been working steadily – and successfully – toward that goal for almost 10 years now,” Massias said. “In our first year we had a total of 3 nursing schools, this year we’ll serve 900. We started with a few hundred nursing students. This year, we’ll serve close to 200,000. So things have been going well, but becoming a part of Elsevier means we can get to our goal even faster and as part of a much larger team committed to our same vision, mission, and values.”

UF researchers began with a single question: “Can talking to a virtual human help you get better at talking with real humans?”

The company’s patented digital patient technology came from a team of researchers in human-centered computing in UF’s Department of Computer & Information Science & Engineering that included Shadow Health co-founders Benjamin Lok and Aaron Kotranza. Their natural language processor-based technology addresses communication gaps nursing students often experienced in the transition from school to a clinical practice setting.

“We help train students to ask that one more critical question, display empathy and educate the patient at the right time,” Lok said.

Elsevier also works with healthcare educators to prepare students for careers in medicine, nursing and health professions. The acquisition advances both companies in their goal to provide the best in conversation-based learning to improve health professionals’ communications skills and clinical judgment.

“I’m very excited to share that every Shadow Health employee was invited to join Elsevier as a part of the acquisition,” Massias said. “Even more exciting is that Elsevier is not only committed to Shadow Health staying in Gainesville, but we’re actively working on plans to grow here. They see Gainesville like we do – a great place to live and work and build teams and companies that want to change the world.”

Shadow Health continues to build, test, and ship its next simulation projects but is also scaling up because of new resources that are part of joining Elsevier.

“We’ve had an African proverb above our door for years now which sums it up: ‘If you want to go fast, go alone. If you want to go far, go together,’” Massias said. “With Elsevier and the ability to train more nurses, reach more global markets, and provide our people with professional opportunities worldwide, we really are better together.”

By Sara Dagen, marketing & communications manager, UF Innovate

One potential casualty of the COVID-19 pandemic might have been nursing programs. Might have been but wasn’t, due to a virtual-patient interaction program created by University of Florida researcher Benjamin Lok.  

Because personal protective equipment was in high demand, nursing students, such as those at Liberty University in Virginia, could not enter hospitals to gain clinical practice experience required for graduation. Certainly, the need to train the next generation of nurses on the frontline of patient care had never been greater, but traditional routes to getting experience were not possible.  

“Our students are going to get their hours, there is no question about it, and the Board has come up with a few exceptions to help get our students ready to go,” said Liberty University Dean Shanna Akers. 

One of those exceptions was the move to use Shadow Health’s Digital Clinical Experiences, which provides virtual patient encounters for undergraduate and graduate nursing students. Lok co-founded Shadow Health.  

“Currently, thousands of nursing students are able to continue their preparation by using Shadow Health’s virtual patients to practice clinical reasoning and therapeutic communication skills,” Lok shared.  

Liberty University adapted its program to a virtual format, adding 500 hours of required clinical practice by using virtual clinical simulations with digital patients created by Lok and Shadow Health.  

Lok, a professor in the Department of Computer and Information Science within the College of Engineering, was UF Innovate’s Inventor of the Year for fiscal year 2019. 

He created a virtual patient interaction system that allows future healthcare providers to practice their communication skills. His technology that built Shadow Health started with a question. 

“How can we use virtual characters, the ones we see in video games, to train communications skills?” Lok said. “How do you train someone to talk to someone else?” 

He and his research group began working in the realm of virtual reality around 16 years ago. This thought process led Lok and his team to explore high-stakes patient communication in the medical field. 

Growing up with his mother as a nurse, Lok witnessed the difficulties she faced with patient interactions and her lack of a way to practice them.  

Through a combined effort of more than 100 researchers from the field of medicine, psychology, computer science, and education, Lok and his team created Shadow Health. A software program, it focuses on training educators and students with a conversation-based simulation for patient interaction in clinical settings. 

UF Innovate | Tech Licensing connected David Massias, a local entrepreneur, with Lok to create Shadow Health. Massias encouraged Lok to use his computerized virtual patients to help the nursing field. UF graduate, Dr. Aaron Kotranza, worked with Massias and Lok and co-founded Shadow Health as well.   

The team dreamed of creating an environment where skills such as empathy could be further developed without the time-crunch of treating patients. Without the added pressure, providers can use Shadow Health software to explore patient interaction scenarios that they may or may not regularly encounter in the field.  

“Being allowed to ‘fail’ in a safe environment is how we get better; it’s how we improve,” Lok said.  

Lok said that his ultimate goal is to improve the communication skills of doctors and nurses. As high-stakes communications such as patient-provider interactions are difficult to practice, he and his team began developing ways that providers could role-play scenarios. 

In this environment, one may be faced with a diverse group of people. Hence, Lok and his team based the virtual patients in many different personal backgrounds. This included age, race, socioeconomic status, gender, identity, and sexual orientation.  

The Shadow Health suite also allows users to talk with virtual patients using open-ended questions. Providers can view a patient’s health record and use the data collected from the interview to determine the correct treatment plan. 

Creating an environment for doctors and nurses to improve communication skills has led Shadow Health technology to be implemented in UF’s College of Nursing. Over 1,800 partner schools use the software as well. 

According to Lok, students can assess their performance and score to gauge their progress in using the Digital Clinical Experience Score. Instructors can use the student’s score as a grade in their course. Shadow Health’s built-in student performance index also provides detailed feedback that can help students identify their strengths and weaknesses. 

Despite Shadow Health’s many benefits, Lok said he never expected his invention to have such a wide-ranging impact. 

One-quarter of all nursing students in the United States and Canada are currently using Shadow Health in their training, Lok said.  Most people he interacts with on a daily basis become touched in some way by with his technology whether they know it or not. 

“That’s what’s been most rewarding about this,” he said. “It’s expanded my thinking and made me see how people can be impacted by your ideas.” 

Shadow Health Update

In early January 2021 Shadow Health announced that the company was acquired by Elsevier, a global leader in information and analytics, that is part of RELX, an even larger global provider of information-based analytics. The acquisition will hasten Shadow Health’s ability to reach its biggest goals.

Written by Denielle Smith and Kyle Chambers, marketing interns at UF Innovate | Tech Licensing. Denielle graduated with a bachelor’s degree in biomedical engineering from the University of Florida and plans to pursue her master’s degree at Cornell beginning this fall. Kyle graduated with a bachelor’s degree in journalism and biology and plans to pursue a career in science communications.