 Greetings to all of you today and welcome to our webcast on telemedicine and its role in improving patient safety. I want to welcome our guest speakers for today, Dr. Ronald Weinstein and Dr. Jeff Dunn, who will discuss the evolution of telemedicine and its recent developments, especially regarding its very promising role in improving patient safety and particularly in the context of what's going on today with the current pandemic crisis. So let me introduce our speakers and we'll dive right in to the conversation. Ronald Weinstein, MD, is the director of the National Award winning Arizona telemedicine program, which he founded in 1996. Dr. Weinstein is a Mass General Hospital trained pathologist, and in fact he was the chairman of pathology at the University of Arizona when I came there in 1995. Historically he was the first resident physician to sign out a telemedicine case at the MGH way back in 1968, about a half century ago. He went on to invent patent and commercialize telepathology, which today is a billion dollar industry. Dr. Weinstein has served as president of six professional organizations, including the American Telemedicine Association, where he is president emeritus. He is universally recognized as a pioneer in the field of telemedicine. Dr. Jeff Dunn, DO is a physician entrepreneur who is currently working as a telehospitalist for St. Luke's Health System in Kansas City, where he is providing inpatient care via telemedicine. He is a champion of patient safety and quality as it is enabled by innovation and technology. Jeff founded Redivis Health in 2015, which is a medical software company that provides augmented intelligence for time critical events such as cardiac arrest and sepsis. So with those introductions, let us begin with our first question. I'll ask Ron Weinstein to foresee our future. We must always understand our past. You've all heard the famous quote on that. Those who cannot learn from history are condemned to repeat it. Can you give us a brief overview of the history of telemedicine? It's original mission and strategies and how those have developed over the years. Ron. So thanks, Steve, for the introduction. It's a pleasure to be with you today. Certainly safety is an issue that would be foremost in every pathologist's mind because when we do autopsies is to find out what the patient had but also what went wrong. Telemedicine really dates back in the United States back into the 1960s and it was an outgrowth of space medicine. And NASA was looking for terrestrial applications of health care and that was very, very important in launching the original programs. Telemedicine really, I would say, went into its current curve around 1995 and in 1995 there were a handful of programs in the country. Most of them were doing either tele radiology or telepsychiatry. There were about 500,000 cases a year. And over the years, there was a pretty steady growth at the rate of 20 to 25% in terms of number of cases. So if you roll forward 25 years, you'll find out that we were up to about 37 million cases by 2019. And 2019 went into 2020 and COVID came along and caused what is either going to be defined by history as a surge or a tsunami. Big differences there. And we're now estimating that the number of cases for the current year will be about a billion. So we will have gone from 37 million estimate to a billion in a year. There are over 100 applications of telemedicine being done. It's been quite heavily commercialized. We now are about 400 companies in the United States providing direct to hospital services, which was the first large area of implementation on the back of radiology. And then much more recently the last five years direct to consumer which has really taken off and we'll probably end up dwarfing what we did in terms of direct to hospital. And so that's the the short part of the growth of telemedicine. It's become a big area of investment into companies that do telemedicine services in 2017 alone about $280 million came out of Silicon Valley investment companies for telemedicine services specifically. And today there are companies on the big stock exchanges that have evaluations of over $12 billion. So it's become a big industry and a big factor in healthcare in the United States. Thank you very much Ron to Jeff. Do you have anything to add on Ron's history overview and how is your own involvement in telemedicine developed over the last years. Yeah, thank you. Thank you for having me and good to be with you Ron. Just to give you a little background on myself. So I finished my residency in 2006. So really started to see the the wide adoption of the EHR back in 2006. It took me till about 2012 or 13 to experience my first telehealth visit. And it wasn't widely adopted then. So I remember the equipment was large and cumbersome. And really what we've seen in the last 10 years as far as adoption of new technology that's more user centric, more usability involved in that has really what I've seen in the last three years. So you can use technologies you see things like FaceTime and different lay people apps that have really I think made telehealth evolve quite rapidly. So what I've seen is these technologies have got more usable. There's more devices to use like stethoscopes when you're listening to a patient. And really at the at the core of telehealth, I believe is to put your eyes and to be able to listen to a patient at any time in any geography. So I think that the patient safety movement has evolved quite rapidly with the help of telehealth. Thanks, Jeff. And with that view of the of the past and present, what do you see coming in the future for telemedicine that we haven't yet seen. And how has that been affected or will be affected by the COVID pandemic. Well, go ahead. That's Jeff. A couple things that I see so some of the things that I've been using with telehealth or dragon dictation so the enablement of being able to dictate and notes and making that easier for provider. I really do believe that the devices will end up evolving. So doing bedside echoes as you're looking and evaluating a patient I think would be extremely helpful. And then I see also the consolidation of the technology. I have about seven apps on my phone that I use at any one time. I use three different EMRs because I covered 19 different hospitals. So I really think that these platforms need to get together and really combine and improve the user experience of the provider. That's great. Thanks, Jeff. Back to you, Ron. What are your additional thoughts on the future of telemedicine things that we have not yet seen. And how do you think that will impact patient safety. Well, I think there are a couple of things. First of all, telemedicine is actually very underdeveloped use of telemedicine in areas like mindfulness and areas like counseling and coaching and marrying telemedicine with health literacy and actually creating cradle to grave portals for people's education where we can have mass customization of what they've learned and updating it so that it's relevant to their lives. All of that's within the capable capability of telemedicine. But I think that's what's going to be emerging quite quickly is the addition of other areas to the doctors black bag. Robotics certainly is going to expand considerably. Automation, of course, is very present in the pathology world today. But automation is going to come a long way. And then we have the huge area of AI. And AI is going to begin to come into the workforce from the bottom up. It's first going to be the AIDS and the the nurses assistants and so on and so forth and moving up up the scale up toward the actual healthcare professionals at the doctoral level. And those are going to be huge areas, but they're also going to be areas where safety is going to emerge as a progressively greater and greater factor. You know, they've now shown that an automated car can go 8.1 miles without having some kind of a fatal problem. So as we get into AI, the obstacles are going to be enormous, but the rewards are going to be enormous. And that's, that's all for the next decade. Thank you, Ron. That's a great lead into my next question, which is about obstacles. Dr. Dunn, what what do you see as obstacles and challenges for for achieving these goals in the near future? Yeah, that's a great question. I, I gave up practicing for about five years to run the company right of us health, which is a clinical decision support company, and came about during this pandemic of wanting to help out. And I can tell you that what we've seen from a adoption curve of the federal government, CMS adopting users like myself, because a license in Kansas being able to help out New York, that has been extremely accelerated. And I think a federal approach to the standardization of telemedicine is really needed. When you start talking about state licensures, you get very siloed. You have 50 different ways to do things. So I really see that the value in creating one standard licensor, as far as telemedicine. That way, when you have your next pandemic, and you have surges in New York and New Jersey and in Florida, you can have the doctor worse workforce as well as some some of these advanced providers help out and not have to wait to get stamped or licensure, etc. They can just go help where the surge needs it. So Jeff, as a follow up to that, how can telemedicine organizations and the patient safety movement work together to overcome these types of challenges. No, I think that it's definitely they're in parallel universes, the patient safety movement as well as telehealth. If you can imagine being a second year resident in the VA taking care of the patient and not having access to a potentially an attending back like we had it in the day, you never have a time when you can't get help. So having the ability to have your phone at the very least be able to have somebody that knows more than you about something be able to port in and help you. I think that's what patient safety is all about. So you never feel like you don't have that security blanket there. And I really believe that both of these swim lanes are very much supporting of each other. I fully agree and I really look forward to seeing these these different parts of organized medicine, working more closely together. Ron, what what are your concluding thoughts on this how can organize pellet telemedicine which you have been such a key part of work together with patient safety and in particular with the patient safety movement which we are representing here today what are our first steps. In establishing that collaboration. Right. First of all, I want to thank Jeff, I think the points that he are made. He's making our pure gold. So he articulates that so well. You know, I think I think that there's a moment in time right now that's very important. And I have, I hope the safety movement jumps in. We are trying, we are trying to get the telemedicine movement, but none of us, none of us, including last year's medical school graduates, none of us took a rotation in telemedicine or had instruction in medical school because medical schools resisted doing that really until now. And we've tried for years to get it into the curriculum and try to work with the double AMC and they're pretty much they gave us awards but then turned a deaf ear. So we're at the point right now I'm sitting out a committee that's a program committee for a virtual symposium on telemedicine being sponsored by the double AMC and the mass general and it's going to be in September. And I'm trying very hard to get safety in it's mainly on what should be the core competencies for telemedicine. And when I bring up well we really should be talking into professional education that's been a long time commitment of mine as well. We don't want to talk about this is not this is not about nurses. Really. Well how about safety. Oh no no we just want to talk about telemedicine. We have to succeed in that because this is the point at which the template for the next 10 years for medical education to meet core competence is going to take place. And we really and I am on the committee can't we have to be campaigning to say that is part of the discussion but that's a co equal in the discussion and we're going to try to push that forward. But be aware that this is the moment in time kind of very much like the Flexner report in its own way. This is the point at which curriculum will be defined for the next 25 years and the window of opportunity is barely open but we have to bear down and get involved and be visible. Now the other thing I would say based on you know long long experience in organized medicine. We have to be writing editorials. We have to be writing op ed pieces. We have to get out of our own journals and really talk about how do we get into jam and the Journal of Medicine and those journals in order to be visible. This is really the moment to move forward and I would certainly look forward to moving ahead with the two of you specifically on those specific projects. Thank you Ron that was extremely well said. In fact I would add, as you said we need to start teaching telemedicine and medical school. We also need to start doing a lot more teaching of patient safety in medical school and reducing medical errors. I remember that was not even discussed back when I was in medical school. I think there's a little bit going on now, but it has a ways to go. Dr. Dunn, what are your concluding thoughts? Is this a useful conversation and what do you see as the next steps in developing this collaboration? This has been a wonderful conversation. It makes me want to have several more conversations on it to be perfectly honest. I really do agree with Ron that this needs to be part of the medical education. I really see that medical simulation is one of those big title waves. The whole saying of see one do one teach one. You don't have to practice on people anymore. You can practice on a mannequin. So I think that that's a perfect place to be able to employ these technologies and practice on them is while you're doing medical simulation, learn how to do telehealth too. So I do think that this is a huge part of medical education as we go into the future. You learn how to do, you know, learning how to have a tough conversation with the family, learning how to use the telehealth technologies, doing medical simulation to practice. This is really what the patient safety movement is all about in my opinion. Well said, and I'm glad you brought up simulation because that that tickles me as you might know my previous life was aeronautical engineering. And I think there are a lot of lessons from aviation that can be brought into patient safety and telemedicine as well. Simulation is just one of those. This has really stimulated me. I want to thank you both for your participation in this patient safety movement webcast. I think it has been wonderful. I think it has been a very stimulating discussion and I really hope it will be the beginning of a long term collaboration between organized telemedicine and the patient safety movement. I want to thank all of you in the audience for your for your attendance and participation, and please email us any questions you have. You can send those emails to clinical CLINICAL at patientsafetymovement.org, that is the email address to send your comments, questions and suggestions. Thank you very much and have a great day.