1 00:00:06,581 --> 00:00:08,483 >> HI, WELCOME, EVERYONE. THANK 2 00:00:08,483 --> 00:00:11,819 YOU SO MUCH FOR JOINING US 3 00:00:11,819 --> 00:00:13,988 TODAY. I AM YOUR HOST FOR 4 00:00:13,988 --> 00:00:15,890 TODAY'S EVENT, ORGANIZED BY 5 00:00:15,890 --> 00:00:18,259 NATURAL LANGUAGE PROCESSING AND 6 00:00:18,259 --> 00:00:20,028 TEXT MINING SPECIAL INTEREST 7 00:00:20,028 --> 00:00:22,663 GROUP AT NIH. WE ARE EXTREMELY 8 00:00:22,663 --> 00:00:27,001 EXCITED TO INTRODUCE OUR TODAY 9 00:00:27,001 --> 00:00:28,102 SPEAKER, DR. ANDREW TAYLOR, 10 00:00:28,102 --> 00:00:31,205 BOARD CERTIFIED EMERGENCY 11 00:00:31,205 --> 00:00:35,576 PHYSICIAN AND INFORMATICIST AND 12 00:00:35,576 --> 00:00:36,944 PROFESSOR AND VICE CHAIR OF 13 00:00:36,944 --> 00:00:38,379 RESEARCH AND INNOVATION IN 14 00:00:38,379 --> 00:00:39,580 DEPARTMENT OF EMERGENCY MEDICINE 15 00:00:39,580 --> 00:00:42,383 AT UNIVERSITY OF VIRGINIA. DR. 16 00:00:42,383 --> 00:00:45,186 TAYLOR IS THE DIRECTOR OF THE 17 00:00:45,186 --> 00:00:49,924 CODE LAW, STANDS FOR THE 18 00:00:49,924 --> 00:00:54,395 CLABORATORY FOR DIGITAL HEALTH 19 00:00:54,395 --> 00:01:01,202 AND MEDICAL SQUARE AND HIS 20 00:01:01,202 --> 00:01:03,504 DESIGN, EVALUATION AND 21 00:01:03,504 --> 00:01:04,572 IMPLEMENTATION OF DIGITAL HEALTH 22 00:01:04,572 --> 00:01:06,641 TOOLS IMPROVE DECISION MAKING 23 00:01:06,641 --> 00:01:10,144 AND REDUCE DIAGNOSTIC ERROR IN 24 00:01:10,144 --> 00:01:12,914 REAL WORLD CLINICAL 25 00:01:12,914 --> 00:01:14,849 ENVIRONMENTS. I CANNOT WAIT TO 26 00:01:14,849 --> 00:01:16,417 HEAR HIS IDEAS AND VISIONS 27 00:01:16,417 --> 00:01:19,120 TOWARDS ACHIEVING A BETTER 28 00:01:19,120 --> 00:01:22,223 HEALTH OUTCOMES. OUR TALK TODAY 29 00:01:22,223 --> 00:01:28,229 WILL BE AROUND 40 MINUTES LONG, 30 00:01:28,229 --> 00:01:29,864 FOLLOWED BY 10 MINUTES FOR Q&A. 31 00:01:29,864 --> 00:01:33,134 FOR Q&A YOU CAN USE MY EMAIL, 32 00:01:33,134 --> 00:01:34,469 DISPLAYED ON THE BOTTOM OF THE 33 00:01:34,469 --> 00:01:38,172 SLIDE, OR YOU CAN USE THE 34 00:01:38,172 --> 00:01:39,273 BUTTON, SEND LIKE FEEDBACK 35 00:01:39,273 --> 00:01:42,643 BUTTON ON THE TOP LEFT OF YOUR 36 00:01:42,643 --> 00:01:44,946 VIDEO CAST SCREEN AND SEND IN 37 00:01:44,946 --> 00:01:48,082 QUESTIONS. WITHOUT FURTHER 38 00:01:48,082 --> 00:01:51,786 ADIEU, PLEASE WELCOME DR. ANDREW 39 00:01:51,786 --> 00:01:52,053 TAYLOR. 40 00:01:52,053 --> 00:01:56,324 >> THANKS. LET ME GET THE SCREEN 41 00:01:56,324 --> 00:02:05,299 SET UP HERE. JUST LET ME KNOW IF 42 00:02:05,299 --> 00:02:06,033 YOU ALL CAN SEE. 43 00:02:06,033 --> 00:02:07,969 >> WE CAN SEE. 44 00:02:07,969 --> 00:02:11,339 >> JUST MINIMIZING THIS BOX AND 45 00:02:11,339 --> 00:02:12,540 GET STARTED. GREAT SICHLT 46 00:02:12,540 --> 00:02:14,842 AWESOME TO BE HERE TODAY. WE ARE 47 00:02:14,842 --> 00:02:17,145 GOING TO TALK ABOUT LEVERAGING 48 00:02:17,145 --> 00:02:18,146 LARGE LANGUAGE MODEL FOR 49 00:02:18,146 --> 00:02:22,016 DIAGNOSTIC SAFETY AND QUALITY 50 00:02:22,016 --> 00:02:23,818 IMPROVEMENT. I'M GOING TO KEEP 51 00:02:23,818 --> 00:02:25,253 THE SCOPE FAIRLY NARROW AND 52 00:02:25,253 --> 00:02:26,988 MOSTLY FOCUS ON QUALITY 53 00:02:26,988 --> 00:02:29,590 IMPROVEMENT ASPECTS OF THIS. 54 00:02:29,590 --> 00:02:33,928 THERE ARE NUMEROUS APPLICATIONS 55 00:02:33,928 --> 00:02:34,996 OF LARGE LANGUAGE MODELS RELATED 56 00:02:34,996 --> 00:02:37,865 TO DIAGNOSTIC SAFETY AND 57 00:02:37,865 --> 00:02:39,100 QUALITY. WE JUST OBVIOUSLY DON'T 58 00:02:39,100 --> 00:02:40,401 HAVE TIME TO COVER ALL SO WE 59 00:02:40,401 --> 00:02:42,436 WILL KEEP IT A LITTLE LIMITED. 60 00:02:42,436 --> 00:02:44,739 THE OTHER THING I WANTED TO SAY 61 00:02:44,739 --> 00:02:46,440 IS I WILL PROBABLY TALK AT A 62 00:02:46,440 --> 00:02:47,742 HIGH LEVEL, PROBABLY COVER MORE 63 00:02:47,742 --> 00:02:50,211 OF THE CLINICAL ASPECTS OF 64 00:02:50,211 --> 00:02:52,246 THINGS, BUT THEN WE WILL GET 65 00:02:52,246 --> 00:02:56,918 INTO A LITTLE AROUND KIND OF THE 66 00:02:56,918 --> 00:02:59,587 INFORMATICS, NLP ASPECT OF 67 00:02:59,587 --> 00:03:01,389 THINGS AS WELL. SO YOU HAVE DONE 68 00:03:01,389 --> 00:03:03,658 THE INTRODUCTIONS. I WILL 69 00:03:03,658 --> 00:03:05,393 LARGELY SKIP OVER THIS. MY 70 00:03:05,393 --> 00:03:07,962 RESEARCH IS IN DIGITAL HEALTH, 71 00:03:07,962 --> 00:03:10,364 KIND OF ACROSS A VARIETY OF 72 00:03:10,364 --> 00:03:12,333 DIFFERENT DOMAINS. REALLY I 73 00:03:12,333 --> 00:03:15,236 THINK -- I'M PRIMARILY FOCUSED 74 00:03:15,236 --> 00:03:17,672 -- OUR RESEARCH LAB IS FOCUSED 75 00:03:17,672 --> 00:03:19,507 ON MAKING A DIFFERENCE. IN 76 00:03:19,507 --> 00:03:21,976 GENERAL, THAT IS THROUGH TWO 77 00:03:21,976 --> 00:03:24,545 MECHANISMS OF ONE IS REALLY 78 00:03:24,545 --> 00:03:25,846 UNDERSTANDING PATIENTS AND 79 00:03:25,846 --> 00:03:27,748 POPULATIONS THROUGH DATA SCIENCE 80 00:03:27,748 --> 00:03:31,018 AND SUPPORT IDENTIFICATION AND 81 00:03:31,018 --> 00:03:32,587 FURTHER INTERVENTIONS. THE 82 00:03:32,587 --> 00:03:36,324 SECOND IS REALLY PROVIDING 83 00:03:36,324 --> 00:03:37,592 DECISIONS THROUGH TRANSLATIONAL 84 00:03:37,592 --> 00:03:40,127 AI. SO THIS IS THE GENERAL 85 00:03:40,127 --> 00:03:42,196 OUTLINE. I WILL LEAVE HOPEFULLY 86 00:03:42,196 --> 00:03:43,764 PLENTY OF TIME FOR QUESTIONS AND 87 00:03:43,764 --> 00:03:45,633 EVERYTHING ELSE. WE WILL GO OVER 88 00:03:45,633 --> 00:03:50,238 A LITTLE CONTEXT. I WANTED GIVE 89 00:03:50,238 --> 00:03:52,173 YOU A FEEL FOR THE EMERGENCY 90 00:03:52,173 --> 00:03:53,941 ROOM CONTEXT, BECAUSE THAT IS 91 00:03:53,941 --> 00:03:55,843 WHAT WE ARE TALKING ABOUT MOST 92 00:03:55,843 --> 00:03:58,246 OF WHAT WE ARE TALKING ABOUT. IF 93 00:03:58,246 --> 00:04:00,414 YOU HAVEN'T BE BUT MOST HAVE SO 94 00:04:00,414 --> 00:04:01,115 YOU PROBABLY HAVE A SENSE HOW 95 00:04:01,115 --> 00:04:04,385 BAD IT IS. WE WILL TALK ABOUT 96 00:04:04,385 --> 00:04:06,354 CURRENT DIAGNOSTIC SAFETY 97 00:04:06,354 --> 00:04:08,522 PROGRAMS TO FAVOR MORE OF THE 98 00:04:08,522 --> 00:04:10,391 CONTEXT AND TALK ABOUT USE OF 99 00:04:10,391 --> 00:04:11,959 LARGE LANGUAGE MODELS FOR 100 00:04:11,959 --> 00:04:13,227 DIAGNOSTIC SAFETY.LY KIND OF 101 00:04:13,227 --> 00:04:16,530 WRAP UP WITH A LITTLE DISCUSSION 102 00:04:16,530 --> 00:04:18,833 AROUND FUTURE RESEARCH AND JUST 103 00:04:18,833 --> 00:04:20,968 CONCLUSIONS AND OPEN IT UP FOR 104 00:04:20,968 --> 00:04:22,236 QUESTIONS. SO WE WILL START WITH 105 00:04:22,236 --> 00:04:25,873 SOME CONTEXT. I LOVE THIS QUOTE 106 00:04:25,873 --> 00:04:29,543 BY ANTHONY BORDAINE TALK ABOUT 107 00:04:29,543 --> 00:04:33,180 CONTEXT AND MEMORY PLAY POWERFUL 108 00:04:33,180 --> 00:04:35,416 ROLES IN ALL THE GREAT MEALS IN 109 00:04:35,416 --> 00:04:39,153 ONE'S LIFE. I THINK IT IS REALLY 110 00:04:39,153 --> 00:04:40,554 IMPORTANT TO KIND OF UNDERSTAND 111 00:04:40,554 --> 00:04:43,791 THE CONTEXT IN EMERGENCY CARE TO 112 00:04:43,791 --> 00:04:45,126 REALLY UNDERSTAND WHY OFTENTIMES 113 00:04:45,126 --> 00:04:47,795 WE STRUGGLE I THINK WITH 114 00:04:47,795 --> 00:04:51,098 DIAGNOSTIC ACCURACY AND 115 00:04:51,098 --> 00:04:53,901 EXCELLENCE. SO THE FIRST THING 116 00:04:53,901 --> 00:04:55,569 TO REALIZE IN THIS KIND OF 117 00:04:55,569 --> 00:04:57,405 DOMAIN IS THERE IS AN INCREASE 118 00:04:57,405 --> 00:05:00,107 IN RISING PATIENT COMPLEXITY AND 119 00:05:00,107 --> 00:05:03,811 MULTI -MORBIDITY. I LOVE THIS 120 00:05:03,811 --> 00:05:05,546 GRAPHIC THAT WAS DONE. IT REALLY 121 00:05:05,546 --> 00:05:08,049 KIND OF SHOWS YOU HOW PATIENT 122 00:05:08,049 --> 00:05:10,251 POPULATIONS HAVE REALLY STARTED 123 00:05:10,251 --> 00:05:11,686 TO SHIFT AND CHANGE. AND WHAT WE 124 00:05:11,686 --> 00:05:13,387 ARE SEEING WITHIN THE EMERGENCY 125 00:05:13,387 --> 00:05:14,689 DEPARTMENT. SOT THE BASIC IDEAS 126 00:05:14,689 --> 00:05:17,792 WE ARE SEEING PATIENTS WITH LOTS 127 00:05:17,792 --> 00:05:19,727 MORE COMPLEXITY, LOT MORE 128 00:05:19,727 --> 00:05:22,430 MULTI -MORBID CONDITIONS AND 129 00:05:22,430 --> 00:05:24,999 FROM A DIAGNOSTIC STANDPOINT, 130 00:05:24,999 --> 00:05:26,634 REALLY WHAT THAT COMES DOWN TO 131 00:05:26,634 --> 00:05:29,470 IS A HUGE AMOUNT OF INFORMATION 132 00:05:29,470 --> 00:05:31,539 OVERLOAD WHEN WE ARE MAKING 133 00:05:31,539 --> 00:05:33,441 DECISIONS. THE CLASSIC EXAMPLE I 134 00:05:33,441 --> 00:05:36,177 GIVE IN THIS SPACE IS, YOU KNOW, 135 00:05:36,177 --> 00:05:39,313 WE HAVE KIND OF THESE RUNNING 136 00:05:39,313 --> 00:05:40,948 USER-FACING COMPONENTS THROUGH 137 00:05:40,948 --> 00:05:48,589 THE EHR DISPLAYING DIAGNOSE S 138 00:05:48,589 --> 00:05:52,360 AND MEDICATIONS. COULD BE 30, 40 139 00:05:52,360 --> 00:05:53,394 DIFFERENT PROBLEMS LONG. IT CAN 140 00:05:53,394 --> 00:05:56,030 BE MIXED UP. YOU CAN HAVE 141 00:05:56,030 --> 00:06:00,234 MEDICATIONS THAT ARE, YOU KNOW, 142 00:06:00,234 --> 00:06:02,370 20-LONG AND OFTEN ARE POORLY 143 00:06:02,370 --> 00:06:05,239 MANAGE ED FROM THE STANDPOINT OF 144 00:06:05,239 --> 00:06:10,144 WHICH ARE ACTIVE AND -- (AUDIO 145 00:06:10,144 --> 00:06:11,812 ISSUE) TO GET A FULL VIEW AROUND 146 00:06:11,812 --> 00:06:14,248 WHAT PROBLEM THEY ARE COMING IN, 147 00:06:14,248 --> 00:06:16,684 WHETHER THAT IS CHEST PAIN OR 148 00:06:16,684 --> 00:06:18,119 SOMETHING ELSE. THEN THE NEXT 149 00:06:18,119 --> 00:06:20,421 THING I WANTED TO KIND OF JUST 150 00:06:20,421 --> 00:06:25,192 HINT AT IS JUST THE GENERAL 151 00:06:25,192 --> 00:06:27,027 WORKFORCE SHORTAGE AND BURNOUT 152 00:06:27,027 --> 00:06:28,596 BECAUSE IT IS WELL PUBLICIZED 153 00:06:28,596 --> 00:06:30,664 WITHIN THE LAY PRESS. I THINK 154 00:06:30,664 --> 00:06:33,234 THE LAST WELL-PUBLICIZED IS HOW 155 00:06:33,234 --> 00:06:34,368 MUCH IT AFFECTS ALL OF THE 156 00:06:34,368 --> 00:06:37,605 EMERGENCY DEPARTMENT WORKFORCE. 157 00:06:37,605 --> 00:06:48,149 THAT IS FROM NURSING (AUDIO 158 00:06:56,590 --> 00:06:56,924 ISS 159 00:06:56,924 --> 00:06:57,892 ISSUE) AROUND ACCURACY. IF WE 160 00:06:57,892 --> 00:07:00,294 HAVE TIME AT THE END THERE ARE 161 00:07:00,294 --> 00:07:01,462 INTERESTING CONVERSATIONS AROUND 162 00:07:01,462 --> 00:07:04,932 THE APPLICATION OF AI WITHIN THE 163 00:07:04,932 --> 00:07:07,868 EMERGENCY -- WITHIN HEALTH CARE 164 00:07:07,868 --> 00:07:09,970 AT-LARGE AND WHETHER THAT IS 165 00:07:09,970 --> 00:07:13,541 GOING TO FEED INTO FURTHER 166 00:07:13,541 --> 00:07:15,209 DISPARITIES AND CARE. A LOT OF 167 00:07:15,209 --> 00:07:17,278 TIMES WHAT I WORRY ABOUT MOST IS 168 00:07:17,278 --> 00:07:18,145 SMALL RURAL HOSPITALS THAT 169 00:07:18,145 --> 00:07:19,880 AREN'T ABLE TO DO THE THINGS 170 00:07:19,880 --> 00:07:22,483 LIKE I'M GOING TO SHOW YOU LATER 171 00:07:22,483 --> 00:07:24,552 ON AND REALLY NOT BE ABLE TO 172 00:07:24,552 --> 00:07:28,088 IMPLEMENT A LOT OF THE AI 173 00:07:28,088 --> 00:07:30,357 SYSTEMS THAT CAN IMPROVE CARE IN 174 00:07:30,357 --> 00:07:32,593 THE FUTURE. OBVIOUSLY VERY HUGE 175 00:07:32,593 --> 00:07:35,229 ISSUES AROUND MENTAL HEALTH AND 176 00:07:35,229 --> 00:07:39,400 SUBSTANCE ABUSE CRISISES. MOST 177 00:07:39,400 --> 00:07:41,302 IS THOUGHT WITHIN THE EMERGENCY 178 00:07:41,302 --> 00:07:43,604 DEPARTMENT. A LOT OF THOSE 179 00:07:43,604 --> 00:07:45,840 FACTORS ARE THEN FEEDING INTO 180 00:07:45,840 --> 00:07:47,875 SIGNIFICANT CHALLENGES WITH 181 00:07:47,875 --> 00:07:49,243 CROWDING AND BOARDING AND 182 00:07:49,243 --> 00:07:51,779 THROUGH-PUT CHALLENGES IN THE 183 00:07:51,779 --> 00:07:52,847 EMERGENCY DEPARTMENT SPACE. YOU 184 00:07:52,847 --> 00:07:55,149 HAVE LOTS OF FINANCIAL PRESSURES 185 00:07:55,149 --> 00:07:57,785 FROM THE HOSPITAL ENVIRONMENT. 186 00:07:57,785 --> 00:07:59,186 WORKFORCE SHORTAGES. FROM 187 00:07:59,186 --> 00:08:02,389 BURNOUT AND OTHER ISSUES. THEN, 188 00:08:02,389 --> 00:08:12,833 YOU KNOW, LIMITED BED SPACE, 189 00:08:12,833 --> 00:08:14,435 FAMILY STRESS, WORKPLACE 190 00:08:14,435 --> 00:08:16,237 VIOLENCE OCCURRING. YOU CAN 191 00:08:16,237 --> 00:08:19,440 THINK ABOUT YOU HAVE THIS KIND 192 00:08:19,440 --> 00:08:21,242 OF CRAZY MORE CHAOTIC EMERGENCY 193 00:08:21,242 --> 00:08:24,378 DEPARTMENT THAT'S BEEN 194 00:08:24,378 --> 00:08:26,313 TRADITIONALLY IN THE PAST. THEN 195 00:08:26,313 --> 00:08:28,015 WE RUN INTO THIS YEAR AROUND 196 00:08:28,015 --> 00:08:30,084 DIAGNOSTIC ERRORS. THIS IS A 197 00:08:30,084 --> 00:08:32,887 NUMBER THROWN OUT FROM AN HRQ 198 00:08:32,887 --> 00:08:36,223 REPORT. I HAVE SEEN VARYING 199 00:08:36,223 --> 00:08:37,424 NUMBERS WHEN COMES TO OVERALL 200 00:08:37,424 --> 00:08:39,760 KIND OF DIAGNOSTIC ACCURACY AND 201 00:08:39,760 --> 00:08:41,762 ERROR RATES WITHIN THE EMERGENCY 202 00:08:41,762 --> 00:08:45,165 DEPARTMENT. YOU KNOW, ANYTHING 203 00:08:45,165 --> 00:08:47,134 BETWEEN 1% AND 10%. THEN I THINK 204 00:08:47,134 --> 00:08:50,271 THERE ARE A LOT OF ONGOING 205 00:08:50,271 --> 00:08:51,071 STUDIES TO REALLY KIND OF NARROW 206 00:08:51,071 --> 00:08:54,341 DOWN THIS NUMBER TO FIGURE OUT 207 00:08:54,341 --> 00:08:56,477 WHAT THAT ACTUALLY NUMBER IS. 208 00:08:56,477 --> 00:08:58,579 BUT IT IS NOT FIGURED OUT. AND 209 00:08:58,579 --> 00:09:03,017 WE ARE MAKING DIAGNOSTIC ERRORS 210 00:09:03,017 --> 00:09:05,152 IN THE DEPARTMENT ON A REGULAR 211 00:09:05,152 --> 00:09:07,087 BASIS. THE LAST PART I WANT TO 212 00:09:07,087 --> 00:09:09,356 GIVE YOU, JUST AROUND SOME 213 00:09:09,356 --> 00:09:13,027 CONTEXT IS THINKING ABOUT 214 00:09:13,027 --> 00:09:15,996 EMERGENCY CARE AS A CONTINUUM. I 215 00:09:15,996 --> 00:09:21,068 LOVE THIS GRAPHIC FROM THE WHO 216 00:09:21,068 --> 00:09:23,170 BECAUSE IT I THINK SHOWS THE 217 00:09:23,170 --> 00:09:25,005 CARE JOURNEY OR PROCESS FOR 218 00:09:25,005 --> 00:09:27,007 PATIENTS. I ALSO THINK IT 219 00:09:27,007 --> 00:09:29,777 HIGHLIGHTS POTENTIAL 220 00:09:29,777 --> 00:09:31,679 OPPORTUNITIES FOR AI AND LARGE 221 00:09:31,679 --> 00:09:35,249 LANGUAGE MODELS AND CHATBOTS, 222 00:09:35,249 --> 00:09:38,018 FROM STARTING AT A PARTICULAR 223 00:09:38,018 --> 00:09:40,154 SCENE AND HAVING INTERACTIONS 224 00:09:40,154 --> 00:09:48,862 WITH EMS AND BYSTANDERS AT THE 225 00:09:48,862 --> 00:09:52,733 SCENE AND ISSUES WITHIN THE 226 00:09:52,733 --> 00:09:54,835 EMERGENCY DEPARTMENT AND ALL THE 227 00:09:54,835 --> 00:09:56,537 CARE POST EMERGENCY DEPARTMENT. 228 00:09:56,537 --> 00:09:58,272 I WON'T TALK ABOUT IT TODAY BUT 229 00:09:58,272 --> 00:09:59,239 I THINK THERE ARE REAL 230 00:09:59,239 --> 00:10:01,642 OPPORTUNITIES FOR BETTER DATA 231 00:10:01,642 --> 00:10:03,110 COLLECTION THROUGH LARGE 232 00:10:03,110 --> 00:10:05,179 LANGUAGE MODEL APPLICATIONS AND 233 00:10:05,179 --> 00:10:07,047 CHATBOT APPLICATIONS IN HELPING 234 00:10:07,047 --> 00:10:08,782 PATIENTS NAVIGATE THAT CARE 235 00:10:08,782 --> 00:10:11,685 PROCESS AND ALSO FROM A 236 00:10:11,685 --> 00:10:12,886 FOLLOW-UP STANDPOINT. THE MAIN 237 00:10:12,886 --> 00:10:14,755 THING, WHAT YOU WANT TO TAKE 238 00:10:14,755 --> 00:10:16,490 AWAY, IS REALLY THINK ABOUT THE 239 00:10:16,490 --> 00:10:19,793 WHOLE KIND OF EMERGENCY CARE 240 00:10:19,793 --> 00:10:23,464 PROCESS IS REALLY A CONTINUUM IN 241 00:10:23,464 --> 00:10:25,733 THIS SPACE. I WILL SWITCH GEARS 242 00:10:25,733 --> 00:10:29,470 A LITTLE BIT. WE WILL TALK ABOUT 243 00:10:29,470 --> 00:10:30,371 DIAGNOSTIC SAFETY. I'M GOING TO 244 00:10:30,371 --> 00:10:32,172 FRAME IT FROM KIND OF THE 245 00:10:32,172 --> 00:10:34,008 NEGATIVE ASPECT FROM DIAGNOSTIC 246 00:10:34,008 --> 00:10:39,580 ERROR. SO THIS IS A DEFINITION 247 00:10:39,580 --> 00:10:42,883 FROM THE NATIONAL ACADEMY OF 248 00:10:42,883 --> 00:10:44,918 MEDICINE, THIS IS FAILURE TO 249 00:10:44,918 --> 00:10:46,320 ACCURATELY DIAGNOSE A PATIENT'S 250 00:10:46,320 --> 00:10:47,788 HEALTH PROBLEMS OR COMMUNICATE 251 00:10:47,788 --> 00:10:50,124 THAT INFORMATION TO THE PATIENT. 252 00:10:50,124 --> 00:10:52,526 I THINK THE SECOND PIECE IS 253 00:10:52,526 --> 00:10:53,560 PARTICULARLY INTERESTING. 254 00:10:53,560 --> 00:10:54,461 OFTENTIMES WE DON'T THINK ABOUT 255 00:10:54,461 --> 00:10:55,863 THE COMMUNICATION PART THAT 256 00:10:55,863 --> 00:10:57,665 REALLY NEEDS TO BE CONVEYED TO 257 00:10:57,665 --> 00:11:00,668 THE PATIENT, NOT BE CONSIDERED A 258 00:11:00,668 --> 00:11:02,169 DIAGNOSTIC ERROR. WITHIN KIND OF 259 00:11:02,169 --> 00:11:04,171 THE DIAGNOSTIC ERROR SPACE, 260 00:11:04,171 --> 00:11:08,042 THERE ARE MULTIPLE DIFFERENT 261 00:11:08,042 --> 00:11:10,110 SUB-COMPONENTS. MISDIAGNOSIS. 262 00:11:10,110 --> 00:11:13,213 PROBABLY THE TERM THAT WAS MOST 263 00:11:13,213 --> 00:11:14,615 FREQUENTLY USED IN THE PAST WERE 264 00:11:14,615 --> 00:11:15,916 CONDITIONS NOT IDENTIFIED AT 265 00:11:15,916 --> 00:11:17,818 ALL. I MIGHT CHANGE THAT OR 266 00:11:17,818 --> 00:11:20,521 MODIFY THAT A LITTLE TO SAY THE 267 00:11:20,521 --> 00:11:22,322 CONDITION IS NOT IDENTIFIED 268 00:11:22,322 --> 00:11:23,624 POINT WHERE INTERVENTION WOULD 269 00:11:23,624 --> 00:11:25,192 HAVE BEEN HELPFUL. OTHERWISE IT 270 00:11:25,192 --> 00:11:28,062 WOULD BE -- WE WOULDN'T KNOW IT 271 00:11:28,062 --> 00:11:30,964 WAS A DIAGNOSIS TO HAVE TAKEN 272 00:11:30,964 --> 00:11:32,900 PLACE. THEN THERE ARE WRONG 273 00:11:32,900 --> 00:11:35,469 DIAGNOSES OR INCORRECT LABELS 274 00:11:35,469 --> 00:11:36,937 APPLIED TO PATIENTS. MOST I 275 00:11:36,937 --> 00:11:39,006 THINK OF THE LITERATURE WHEN WE 276 00:11:39,006 --> 00:11:41,241 ARE TALKING ABOUT DIAGNOSIS AND 277 00:11:41,241 --> 00:11:42,609 DIAGNOSTIC ERROR AT THIS POINT 278 00:11:42,609 --> 00:11:44,478 IS REALLY FRAMED AROUND THIS 279 00:11:44,478 --> 00:11:47,614 IDEA OF DELAYED DIAGNOSIS. I 280 00:11:47,614 --> 00:11:49,817 WILL GIVE YOU AN EXAMPLE OF 281 00:11:49,817 --> 00:11:51,618 THAT. SO THIS IS THE KIND OF 282 00:11:51,618 --> 00:11:53,220 EXAMPLE I WILL GIVE THROUGHOUT 283 00:11:53,220 --> 00:11:55,389 THE TALK. SO A PATIENT COMES IN 284 00:11:55,389 --> 00:11:58,092 TO THE EMERGENCY DEPARTMENT. 285 00:11:58,092 --> 00:11:59,693 THEY HAVE ABDOMINAL PAIN. THEY 286 00:11:59,693 --> 00:12:02,162 ARE SEEN, THEY ARE EVALUATED, 287 00:12:02,162 --> 00:12:04,565 THE PHYSICIAN THINKS ULTIMATELY 288 00:12:04,565 --> 00:12:11,071 THAT LET'S SAY IT IS GASTRO 289 00:12:11,071 --> 00:12:12,706 INTERITIS, THEY DISCHARGE AND 290 00:12:12,706 --> 00:12:15,109 THREE DAYS LATER SHOW UP AT 291 00:12:15,109 --> 00:12:17,444 PRIMARY CARE DOCTOR, HAVE PIPE, 292 00:12:17,444 --> 00:12:19,747 THE PRIMARY CARE ORDERS THE CT, 293 00:12:19,747 --> 00:12:22,850 THIS IS PERFORMED, THEY HAVE 294 00:12:22,850 --> 00:12:23,917 APPENDICITIS AND NEED TO COME 295 00:12:23,917 --> 00:12:26,120 BACK INTO THE HOSPITAL SYSTEM 296 00:12:26,120 --> 00:12:29,523 THAT. WOULDN'T FALL UNDER A 297 00:12:29,523 --> 00:12:31,125 MISDIAGNOSIS UNDER THIS SCENARIO 298 00:12:31,125 --> 00:12:33,026 BUT DELAY THAT HAD INTERVENTION 299 00:12:33,026 --> 00:12:35,195 OF SURGERY AFTER. SO A LOT OF 300 00:12:35,195 --> 00:12:37,364 KIND OF DIAGNOSTIC ERRORS, 301 00:12:37,364 --> 00:12:40,167 SAFETY SPACE IS REALLY FRAMED 302 00:12:40,167 --> 00:12:43,937 FROM THAT STANDPOINT. THE OTHER 303 00:12:43,937 --> 00:12:46,540 ASPECT OF THIS, JUST TO KEEP IN 304 00:12:46,540 --> 00:12:47,641 MIND, IS WHETHER OR NOT THERE IS 305 00:12:47,641 --> 00:12:51,111 THE POTENTIAL FOR HARM AND HOW 306 00:12:51,111 --> 00:12:54,848 THAT FACTORS IN TO OPPORTUNITIES 307 00:12:54,848 --> 00:12:57,851 AND MISSED OPPORTUNITIES WITHIN 308 00:12:57,851 --> 00:13:01,488 THIS SPACE. OKAY. SO NOW WE HAVE 309 00:13:01,488 --> 00:13:04,391 A LITTLE BIT OF KIND OF 310 00:13:04,391 --> 00:13:06,360 BACKGROUND CONTEXT AROUND THIS. 311 00:13:06,360 --> 00:13:08,495 SO I THINK WHAT I WANTED TO DIVE 312 00:13:08,495 --> 00:13:11,331 INTO IS REALLY WHAT ARE THE 313 00:13:11,331 --> 00:13:12,533 CURRENT PROBLEMS WITH DIAGNOSTIC 314 00:13:12,533 --> 00:13:14,902 QUALITY IMPROVEMENT? WHY ARE WE 315 00:13:14,902 --> 00:13:17,271 HAVING CHALLENGES? WHY IS THAT 316 00:13:17,271 --> 00:13:23,010 NUMBER 6%, NOT MUCH LOWER. THE 317 00:13:23,010 --> 00:13:25,345 THINGS I CAN REALLY BOIL IT DOWN 318 00:13:25,345 --> 00:13:27,281 TO ARE THESE THREE COMPONENTS. 319 00:13:27,281 --> 00:13:33,453 ONE IS WE HAVE A SYSTEM OF PO 320 00:13:33,453 --> 00:13:35,422 CAPTURE. I WILL GO INTO THESE. 321 00:13:35,422 --> 00:13:36,723 THE SYSTEMS AREN'T REALLY 322 00:13:36,723 --> 00:13:38,959 ESCAPABLE AT THIS POINT. WE 323 00:13:38,959 --> 00:13:40,127 DON'T DO A GREAT JOB OF 324 00:13:40,127 --> 00:13:44,331 MEASURING THEM WHEN WE DO 325 00:13:44,331 --> 00:13:51,471 CAPTURE THEM IN SOME WAY. I HAVE 326 00:13:51,471 --> 00:13:55,742 BEEN IN AND THESE ARE THE TWO 327 00:13:55,742 --> 00:14:00,848 PRIMARY FRAMEWORKS WHERE 328 00:14:00,848 --> 00:14:02,482 DIAGNOSTIC ERRORS ARE NOTICED 329 00:14:02,482 --> 00:14:04,551 WITHIN THE SYSTEM. FOR THE 330 00:14:04,551 --> 00:14:06,153 EMERGENCY DEPARTMENT, MOST QI 331 00:14:06,153 --> 00:14:07,287 PROGRAMS ARE GOING TO HAVE SOME 332 00:14:07,287 --> 00:14:17,764 KIND OF 72-HOUR RETURNED A 333 00:14:19,233 --> 00:14:23,370 ADMISSION SURVEILLANCE AND ARE 334 00:14:23,370 --> 00:14:25,072 DISCHARGED, ADMITTED, CREATES A 335 00:14:25,072 --> 00:14:27,074 FLAG, REVIEW THE POTENTIAL CASES 336 00:14:27,074 --> 00:14:29,610 AND LOT OF US ARE NOT GOING TO 337 00:14:29,610 --> 00:14:33,046 HAVE ANYTHING TO DO WITH 338 00:14:33,046 --> 00:14:39,453 DIAGNOSTIC SAFETY OR ERRORS SO A 339 00:14:39,453 --> 00:14:41,622 LOT OF NOISE FROM A DIAGNOSTIC 340 00:14:41,622 --> 00:14:44,925 SAFETY STANDPOINT. THE OTHER IS 341 00:14:44,925 --> 00:14:47,694 MANUAL REPORTING. THE ANNUAL 342 00:14:47,694 --> 00:14:49,329 AROUND THE APPENDICITIS IS A 343 00:14:49,329 --> 00:14:54,701 COMMON SCENARIO, WHERE IT IS 344 00:14:54,701 --> 00:14:55,335 NOTICED WITHIN THE SYSTEM BY 345 00:14:55,335 --> 00:14:58,472 SOME OTHER PROVIDER. THAT ERROR 346 00:14:58,472 --> 00:14:59,706 PROCESS NEEDS TO BE THEN 347 00:14:59,706 --> 00:15:02,643 COMMUNICATED BACK TO THE PRIMARY 348 00:15:02,643 --> 00:15:04,211 TEAM OR DEPARTMENT. SO THAT MAY 349 00:15:04,211 --> 00:15:14,354 OR MAY NOT OCCUR. THERE ARE 350 00:15:14,354 --> 00:15:15,188 SYSTEMS THAT ALLOW FOR 351 00:15:15,188 --> 00:15:20,961 ELECTRONIC REPORTING. THOSE 352 00:15:20,961 --> 00:15:22,396 PROCESSES ARE IN PLACE BUT 353 00:15:22,396 --> 00:15:25,666 INFREQUENTLY USED SO IN GENERAL 354 00:15:25,666 --> 00:15:28,669 WE HAVE PRETTY POOR CAPTURE WHEN 355 00:15:28,669 --> 00:15:30,270 COMES TO THESE WHAT I CALL A 356 00:15:30,270 --> 00:15:34,107 NEAR KIND OF REAL-TIME BASIS 357 00:15:34,107 --> 00:15:39,146 WITHIN A HEALTH CARE SYSTEM. THE 358 00:15:39,146 --> 00:15:43,517 SECOND PART IS THE QI SYSTEMS 359 00:15:43,517 --> 00:15:45,886 ARE NOT SCALEABLE SO YOU THINK 360 00:15:45,886 --> 00:15:50,190 ABOUT THIS. A LOT WILL BE 361 00:15:50,190 --> 00:15:52,225 FOCUSED ON ONE DISEASE PROCESS. 362 00:15:52,225 --> 00:15:54,594 YOU MAY HAVE ROLLED OUT WITHIN 363 00:15:54,594 --> 00:15:56,697 YOUR HOSPITAL SYSTEM SOMETHING 364 00:15:56,697 --> 00:15:58,498 AROUND MISSTROKED DIAGNOSIS. SO 365 00:15:58,498 --> 00:16:03,337 IT TYPICALLY IS VERY 366 00:16:03,337 --> 00:16:05,205 DISEASE-ORIENTED. THESE ARE THE 367 00:16:05,205 --> 00:16:07,274 WAYS THEY ARE CONSTRUCTED. 368 00:16:07,274 --> 00:16:10,644 SOMETIMES NEEDS TEAM ORIENTATION 369 00:16:10,644 --> 00:16:16,450 AROUND THIS AND YOU NEED 370 00:16:16,450 --> 00:16:18,418 DIFFERENT STRUCTURES AROUND 371 00:16:18,418 --> 00:16:20,120 DISEASE PROCESSES. THIS IMPACTS 372 00:16:20,120 --> 00:16:22,189 THE QI SYSTEMS THAT ARE THERE. I 373 00:16:22,189 --> 00:16:23,757 THINK AT THIS POINT WHEN WE WILL 374 00:16:23,757 --> 00:16:26,193 GO INTO A LITTLE MORE DETAIL 375 00:16:26,193 --> 00:16:28,962 AROUND SOME ELECTRONIC WAYS OF 376 00:16:28,962 --> 00:16:31,898 CAPTURING THESE DIAGNOSTIC 377 00:16:31,898 --> 00:16:32,566 ERRORS, IF YOU KIND OF OPENED 378 00:16:32,566 --> 00:16:35,335 THE FLOOD GATES AND APPLIED MORE 379 00:16:35,335 --> 00:16:38,038 SIMPLISTIC PROCEDURES TO 380 00:16:38,038 --> 00:16:39,606 CAPTURING DIAGNOSTIC ERRORS 381 00:16:39,606 --> 00:16:41,808 WITHIN THE SYSTEM YOU WOULD GET 382 00:16:41,808 --> 00:16:42,843 THIS FLOOD OF WAY TOO MUCH NOISE 383 00:16:42,843 --> 00:16:45,612 WITHIN THE SYSTEM. YOU WOULD 384 00:16:45,612 --> 00:16:50,784 OVERWHELM QI TEAMS. SO YOU KIND 385 00:16:50,784 --> 00:16:58,859 OF LOSE A LOT OF THAT DIAGNOSTIC 386 00:16:58,859 --> 00:17:00,727 ERRORS BACK, UPDATING TEAM 387 00:17:00,727 --> 00:17:07,100 STRUCTURES AND PROCESSES KIND OF 388 00:17:07,100 --> 00:17:08,869 WITHIN THE SPACE TO IMPROVE 389 00:17:08,869 --> 00:17:10,303 OUTCOMES. IF THOSE SYSTEMS 390 00:17:10,303 --> 00:17:12,339 AREN'T ESCAPABLE YOU AREN'T ABLE 391 00:17:12,339 --> 00:17:14,374 TO KIND OF LEARN BOTH SYSTEM 392 00:17:14,374 --> 00:17:16,209 LEVEL ISSUES AND MAYBE PROVIDER 393 00:17:16,209 --> 00:17:17,744 LEVEL ISSUES IF YOU ARE TALKING 394 00:17:17,744 --> 00:17:21,748 ABOUT JUST A FEW DIAGNOSIS PER 395 00:17:21,748 --> 00:17:24,151 PROVIDER PER YEAR. THEN THE LAST 396 00:17:24,151 --> 00:17:26,019 PART ABOUT THIS IS THAT EVEN IN 397 00:17:26,019 --> 00:17:28,388 THOSE SCENARIOS LOT OF TIMES 398 00:17:28,388 --> 00:17:32,426 THEY ARE NOT WELL MEASURED SO 399 00:17:32,426 --> 00:17:35,395 GOING BACK TO THAT INITIAL 400 00:17:35,395 --> 00:17:38,598 EXAMPLE IF THE APPENDICITIS 401 00:17:38,598 --> 00:17:40,400 OCCURS, IT GETS REPORTED BACK, 402 00:17:40,400 --> 00:17:44,237 THERE MAY BE AN EMAIL EXCHANGE 403 00:17:44,237 --> 00:17:47,140 BETWEEN -- TO DEPARTMENTAL 404 00:17:47,140 --> 00:17:50,410 OPERATIONAL LEADERSHIP AND THE 405 00:17:50,410 --> 00:17:51,344 PROVIDER REGARDING THE ERROR 406 00:17:51,344 --> 00:17:53,613 THAT MAY NOT BE SYSTEMATICALLY 407 00:17:53,613 --> 00:17:56,750 CAPTURED IN ANY STANDARDIZED 408 00:17:56,750 --> 00:17:59,219 WAY. A LOT OF TIMES THERE IS NOT 409 00:17:59,219 --> 00:18:01,221 GOING TO BE A PARTICULAR SCORING 410 00:18:01,221 --> 00:18:02,722 SYSTEM AROUND THAT OR ANY TYPE 411 00:18:02,722 --> 00:18:04,991 OF GRADING WHERE YOU CAN KIND OF 412 00:18:04,991 --> 00:18:07,127 LEARN ADDITIONAL COMPONENTS OR 413 00:18:07,127 --> 00:18:11,731 ASPECTS FROM THOSE TYPES OF 414 00:18:11,731 --> 00:18:16,369 CASES. SO THERE ARE SOME SYSTEMS 415 00:18:16,369 --> 00:18:19,206 THAT ARE IN PLACE THAT ARE A 416 00:18:19,206 --> 00:18:20,574 LITTLE AT A HIGHER LEVEL OF 417 00:18:20,574 --> 00:18:22,375 SCALE THAN WHAT I KIND OF 418 00:18:22,375 --> 00:18:23,810 MENTIONED BEFORE. PROBABLY THE 419 00:18:23,810 --> 00:18:26,113 MOST WELL KNOWN ARE E-TRIGGERS 420 00:18:26,113 --> 00:18:32,786 FOR DIAGNOSTIC SURVEILLANCE.LY 421 00:18:32,786 --> 00:18:34,387 TAKE TIME TO WALK THROUGH THIS 422 00:18:34,387 --> 00:18:39,659 PROCESS. E-TRIGGERS ARE A 423 00:18:39,659 --> 00:18:42,095 LOOK-BACK MECHANISM FOR 424 00:18:42,095 --> 00:18:43,830 IDENTIFYING DIAGNOSTIC ERRORS. 425 00:18:43,830 --> 00:18:45,866 SO SIMILAR TO THE EXAMPLE I 426 00:18:45,866 --> 00:18:50,036 GAVE, I WILL KIND OF I'LL KIND 427 00:18:50,036 --> 00:18:52,372 OF FRAME IT AROUND THAT. THE 428 00:18:52,372 --> 00:18:54,174 BASIC ED IS IS YOU IDENTIFY 429 00:18:54,174 --> 00:18:56,143 DIAGNOSIS THAT HAPPENED WITHIN A 430 00:18:56,143 --> 00:18:59,679 SYSTEM. LET'S SAY A PULMONARY 431 00:18:59,679 --> 00:19:01,348 EMBOLISM HAPPENED IN THE SYSTEM. 432 00:19:01,348 --> 00:19:03,683 THEN YOU WOULD LOOK BACK IN TIME 433 00:19:03,683 --> 00:19:05,285 TO SEE IF AN EMERGENCY 434 00:19:05,285 --> 00:19:07,220 DEPARTMENT VISIT OR, YOU KNOW, 435 00:19:07,220 --> 00:19:08,655 COULD BE A PRIMARY CARE OR 436 00:19:08,655 --> 00:19:12,025 HOSPITAL VISIT OCCURRED. THEN 437 00:19:12,025 --> 00:19:15,162 THERE NEEDS TO BE SOME TYPE OF 438 00:19:15,162 --> 00:19:16,630 FLAG OR SYSTEM TO SAY WHETHER 439 00:19:16,630 --> 00:19:18,899 THERE WAS A POTENTIAL 440 00:19:18,899 --> 00:19:20,800 MISDIAGNOSIS ON THAT VISIT. 441 00:19:20,800 --> 00:19:22,502 SOMETIMES THAT IS DONE THROUGH 442 00:19:22,502 --> 00:19:25,639 SYMPTOM DISEASE PAIRS. FOR 443 00:19:25,639 --> 00:19:28,608 INSTANCE, FOR PULMONARY 444 00:19:28,608 --> 00:19:31,211 EMBOLISM, YOU LOOK BACK AND THE 445 00:19:31,211 --> 00:19:33,947 EMERGENCY DEPARTMENT VISIT HAD A 446 00:19:33,947 --> 00:19:35,949 CHIEF COMPLAINT OF SHORTNESS OF 447 00:19:35,949 --> 00:19:36,783 BREATH OR CHEST PAIN THAT. 448 00:19:36,783 --> 00:19:39,753 MIGHT BE THE TRIGGER FOR YOUR QI 449 00:19:39,753 --> 00:19:43,390 TEAM TO DO FURTHER REVIEW WITHIN 450 00:19:43,390 --> 00:19:47,460 THAT. SO YOU CAN, YOU KNOW, 451 00:19:47,460 --> 00:19:49,262 THINK ABOUT MULTIPLE CHALLENGES 452 00:19:49,262 --> 00:19:53,366 WITH THIS. ONE IS THAT THE 453 00:19:53,366 --> 00:19:55,135 DIAGNOSIS THAT'S OCCURRING, IT 454 00:19:55,135 --> 00:19:57,537 IS SOMETIMES DIFFICULT TO 455 00:19:57,537 --> 00:20:02,375 IDENTIFY, YOU KNOW, TO GET AN 456 00:20:02,375 --> 00:20:04,010 ACCURATE PHENOTYPE THAT THERE IS 457 00:20:04,010 --> 00:20:06,112 AN ACCURATE DIAGNOSIS THAT IS 458 00:20:06,112 --> 00:20:08,014 HAPPENING. FOR THE PULMONARY EM 459 00:20:08,014 --> 00:20:11,818 BOLL LIS M, COULD BE A PATIENT 460 00:20:11,818 --> 00:20:14,354 HAD A CHRONIC EMBOLISM AND FOR 461 00:20:14,354 --> 00:20:16,456 BILLING PURPOSES OR OTHER GOT 462 00:20:16,456 --> 00:20:19,226 PLACED ON A PROBLEM LIST WITHIN 463 00:20:19,226 --> 00:20:21,228 THE HOSPITAL STAY, THAT THAT 464 00:20:21,228 --> 00:20:22,529 DIAGNOSIS SHOWS UP AGAIN BUT IT 465 00:20:22,529 --> 00:20:25,465 IS NOT A NEW DIAGNOSIS. SO 466 00:20:25,465 --> 00:20:27,500 THERE'S CHALLENGES ABOUT GETTING 467 00:20:27,500 --> 00:20:30,270 TO ACCURATE REPRESENTATIONS OF 468 00:20:30,270 --> 00:20:32,172 NEW DIAGNOSES THAT ARE HAPPENING 469 00:20:32,172 --> 00:20:33,907 WITHIN THE SYSTEM. ONE NATURAL 470 00:20:33,907 --> 00:20:36,743 LANGUAGE PROCESSING APPLICATION, 471 00:20:36,743 --> 00:20:38,178 OR IN THIS CASE MOSTLY LARGE 472 00:20:38,178 --> 00:20:41,348 LANGUAGE MODEL APPLICATIONS, 473 00:20:41,348 --> 00:20:45,485 WOULD BE LOOKING AT DIAGNOSTIC 474 00:20:45,485 --> 00:20:47,354 RADIOLOGY NOTES WHERE MOST THESE 475 00:20:47,354 --> 00:20:49,122 DIAGNOSES AT LEAST IN EMERGENCY 476 00:20:49,122 --> 00:20:52,225 CONTEXT ARE GOING TO BE 477 00:20:52,225 --> 00:20:54,060 HAPPENING. AND GETTING TO 478 00:20:54,060 --> 00:20:55,829 ACCURATE REPRESENTATIONS OF 479 00:20:55,829 --> 00:20:57,731 WHETHER THEY ARE ACUTE OR 480 00:20:57,731 --> 00:20:59,699 CHRONIC PROCESS THAT IS ONGOING 481 00:20:59,699 --> 00:21:02,035 THERE AND LABELING THE DIAGNOSIS 482 00:21:02,035 --> 00:21:05,272 FROM THAT AS OPPOSED TO USING 483 00:21:05,272 --> 00:21:08,441 DIAGNOSIS CODES. BUT THERE ARE 484 00:21:08,441 --> 00:21:09,809 OBVIOUSLY ISSUES THAT ARE -- 485 00:21:09,809 --> 00:21:12,445 EVEN WITH KIND OF THAT SPACE AS 486 00:21:12,445 --> 00:21:14,381 WELL. SO THAT IS, YOU KNOW, ONE 487 00:21:14,381 --> 00:21:16,049 KIND OF CLASSIC ISSUE AROUND 488 00:21:16,049 --> 00:21:19,185 THESE TRIGGER TOOLS. THE SECOND 489 00:21:19,185 --> 00:21:22,689 PART IS THAT KIND OF NOISE 490 00:21:22,689 --> 00:21:25,292 ASPECT WHEN YOU LOOK BACK. YOU 491 00:21:25,292 --> 00:21:26,493 KNOW, A LOT OF QUALITY 492 00:21:26,493 --> 00:21:28,662 IMPROVEMENT TEAMS, YOU ARE 493 00:21:28,662 --> 00:21:30,330 ASKING -- OR EMERGENCY 494 00:21:30,330 --> 00:21:32,132 PHYSICIANS, PRIMARY CARE 495 00:21:32,132 --> 00:21:33,900 DOCTORS, WHATEVER IS REALLY PART 496 00:21:33,900 --> 00:21:35,869 OF THAT DEPARTMENT THAT IS 497 00:21:35,869 --> 00:21:37,737 LOOKING INTO DIAGNOSTIC SAFETY, 498 00:21:37,737 --> 00:21:39,973 YOU ARE ASKING THEM TO GO 499 00:21:39,973 --> 00:21:43,176 THROUGH CHARTS AND SPEND 500 00:21:43,176 --> 00:21:52,419 CONSIDERABLE TIME TO CREATE OR A 501 00:21:52,419 --> 00:21:54,254 RESOURCE ASK ON YOUR SYSTEM SO 502 00:21:54,254 --> 00:21:55,655 YOU WANT TO MAKE SURE YOU ARE 503 00:21:55,655 --> 00:21:58,558 PRETTY ACCURATE WITH YOUR 504 00:21:58,558 --> 00:21:59,826 INITIAL TRIGGER IN 505 00:21:59,826 --> 00:22:01,528 IDENTIFICATION OF THE CASE 506 00:22:01,528 --> 00:22:05,865 THAT'S BEING PUSHED TO THE QI 507 00:22:05,865 --> 00:22:08,001 TEAM. SO APPEARS SYMPTOM DISEASE 508 00:22:08,001 --> 00:22:09,502 PAIR IS PROBABLY NOT GOING TO 509 00:22:09,502 --> 00:22:11,838 WORK WELL FOR MOST OF THE CASES 510 00:22:11,838 --> 00:22:13,973 WHERE YOU ARE GOING TO GET 511 00:22:13,973 --> 00:22:16,343 EXCESSIVE AMOUNT OF NOISE WITHIN 512 00:22:16,343 --> 00:22:18,378 THE SYSTEM FROM THAT. NOW YOU 513 00:22:18,378 --> 00:22:20,347 CAN THINK ABOUT THESE TRIGGERS 514 00:22:20,347 --> 00:22:25,618 FURTHER DEVELOPED USING AI. SO 515 00:22:25,618 --> 00:22:27,921 INSTEAD OF DISEASE SYMPTOM PAIR 516 00:22:27,921 --> 00:22:31,124 NOW WE WILL BUILD OUT AI MODELS 517 00:22:31,124 --> 00:22:33,660 FOR EACH DIAGNOSIS SO WE WILL 518 00:22:33,660 --> 00:22:39,699 TRAIN MODEL AT THE TIME OF THE 519 00:22:39,699 --> 00:22:40,200 INIT 520 00:22:40,200 --> 00:22:41,935 INITIAL E. D. DIAGNOSIS TO 521 00:22:41,935 --> 00:22:43,269 DETERMINE IF THEY HAVE A 522 00:22:43,269 --> 00:22:46,373 PARTICULAR CONDITION THAT. GETS 523 00:22:46,373 --> 00:22:48,375 CHALLENGING BECAUSE OF WHOEVER 524 00:22:48,375 --> 00:22:50,076 THE OUTCOME IS PRESENT OR NOT 525 00:22:50,076 --> 00:22:52,645 AND HOW THAT GETS TRAINED, THOSE 526 00:22:52,645 --> 00:22:55,682 ARE POTENTIAL OPTIONS FOR 527 00:22:55,682 --> 00:22:56,616 IMPROVING THE INITIAL 528 00:22:56,616 --> 00:22:58,918 IDENTIFICATION AND SENSITIVITY 529 00:22:58,918 --> 00:23:02,422 AND SPECIFICITY AROUND SOME OF 530 00:23:02,422 --> 00:23:05,625 THOSE ALGORITHMS. ALL OF THIS 531 00:23:05,625 --> 00:23:08,027 FITS INTO THIS LARGER KIND OF 532 00:23:08,027 --> 00:23:09,429 TECHNICAL WORK SYSTEM WHERE WE 533 00:23:09,429 --> 00:23:10,864 ARE REALLY KIND OF THINKING 534 00:23:10,864 --> 00:23:13,800 ABOUT FEEDBACK MECHANISMS AND 535 00:23:13,800 --> 00:23:15,135 LOOPS. YOU MAY BE ASKING, YOU 536 00:23:15,135 --> 00:23:17,103 ARE DOING TRIGGER SYSTEMS LIKE 537 00:23:17,103 --> 00:23:20,473 WHAT IS THE ULTIMATE END GOAL. A 538 00:23:20,473 --> 00:23:22,642 LOT OF THIS AT THIS POINT IS 539 00:23:22,642 --> 00:23:25,678 ABOUT FEEDBACK MECHANISMS TO 540 00:23:25,678 --> 00:23:28,014 PROVIDERS AND, YOU KNOW, I THINK 541 00:23:28,014 --> 00:23:32,051 THAT HAS BEEN WHERE A LOT OF THE 542 00:23:32,051 --> 00:23:37,056 KIND OF TAILORED RESPONSES FOR 543 00:23:37,056 --> 00:23:37,991 DIAGNOSTIC SAFETY HAVE TAKEN 544 00:23:37,991 --> 00:23:40,627 PLACE THERE ARE A LOT OF FOCUS 545 00:23:40,627 --> 00:23:44,030 ON COGNITIVE BIAS WITH PROVIDERS 546 00:23:44,030 --> 00:23:46,933 AND CHANGES TO THEIR APPROACHES 547 00:23:46,933 --> 00:23:48,968 TO PATIENTS. SO THINKING ABOUT 548 00:23:48,968 --> 00:23:51,438 IT FROM A SYSTEMS ASPECT OF, YOU 549 00:23:51,438 --> 00:23:54,374 KNOW, ARE THERE ASPECTS OF THE 550 00:23:54,374 --> 00:23:55,575 OVERALL ORGANIZATIONAL STRUCTURE 551 00:23:55,575 --> 00:23:58,378 THAT MAY BE CONTRIBUTING TO 552 00:23:58,378 --> 00:24:00,547 DIAGNOSTIC ERRORS. SO CLEAR 553 00:24:00,547 --> 00:24:02,649 QUESTIONS WOULD BE IS BOARDING 554 00:24:02,649 --> 00:24:04,818 AND CROWDING CONTRIBUTING OR 555 00:24:04,818 --> 00:24:08,321 CAUSING DIAGNOSTIC ERRORS WITHIN 556 00:24:08,321 --> 00:24:09,956 THE SYSTEM. YOU CAN'T REALLY DO 557 00:24:09,956 --> 00:24:11,191 THAT UNLESS YOU ARE KIND OF 558 00:24:11,191 --> 00:24:14,294 ALREADY AT SCALE ACROSS MULTIPLE 559 00:24:14,294 --> 00:24:16,629 DIAGNOSES TO BE ABLE TO MEASURE 560 00:24:16,629 --> 00:24:20,266 THOSE ASPECTS OF KIND OF THE 561 00:24:20,266 --> 00:24:22,735 DIAGNOSTIC PROCESS. SO HOW CAN 562 00:24:22,735 --> 00:24:29,676 LARGE LANGUAGE MODELS AND NLP 563 00:24:29,676 --> 00:24:31,411 KIND OF HELP? THERE'S A COUPLE 564 00:24:31,411 --> 00:24:33,546 OF DIFFERENT WAYS. THE FIRST IS 565 00:24:33,546 --> 00:24:36,516 REALLY THINKING ABOUT SCALING 566 00:24:36,516 --> 00:24:38,117 ACROSS DISEASE. SO, YOU KNOW, 567 00:24:38,117 --> 00:24:41,554 WHEN WE TALK ABOUT THAT KIND OF 568 00:24:41,554 --> 00:24:43,056 TRIGGER SYSTEM AND YOU ARE 569 00:24:43,056 --> 00:24:45,058 EITHER USING DISEASE SYMPTOM 570 00:24:45,058 --> 00:24:46,626 PAIRS, EVEN FOR THAT YOU NEED TO 571 00:24:46,626 --> 00:24:47,894 DEVELOP OUT A FULL LIST OF 572 00:24:47,894 --> 00:24:49,562 DISEASE SYMPTOM PAIRS FOR 573 00:24:49,562 --> 00:24:52,198 WHATEVER DIAGNOSES YOU HAVE OF 574 00:24:52,198 --> 00:24:54,334 PARTICULAR INTEREST. IF YOU ARE 575 00:24:54,334 --> 00:24:56,002 GOING TO BUILD OUT AI MODELS 576 00:24:56,002 --> 00:24:57,804 LIKE STANDARD MACHINE LEARNING 577 00:24:57,804 --> 00:25:00,273 MODELS, YOU WOULD NEED TO 578 00:25:00,273 --> 00:25:01,140 POTENTIALLY BUILD OUT MULTIPLE 579 00:25:01,140 --> 00:25:02,775 DIFFERENT MODELS FOR ALL OF THE 580 00:25:02,775 --> 00:25:06,412 DISEASE PROCESSES YOU ARE 581 00:25:06,412 --> 00:25:09,282 INTERESTED AT AND -- BUT I THINK 582 00:25:09,282 --> 00:25:13,186 WITH A LOT OF THE IN-BUILD 583 00:25:13,186 --> 00:25:15,722 KNOWLEDGE COMPONENTS LARGE 584 00:25:15,722 --> 00:25:17,357 LANGUAGE MODELS HAVE IT IS MUCH 585 00:25:17,357 --> 00:25:19,726 EASIER TO FEED IN A PARTICULAR 586 00:25:19,726 --> 00:25:22,061 DIAGNOSIS AND SAY OKAY, THIS WAS 587 00:25:22,061 --> 00:25:24,197 THE DIAGNOSIS SEVEN DAYS LATER. 588 00:25:24,197 --> 00:25:27,100 NOW I NEED YOU TO KIND OF LOOK 589 00:25:27,100 --> 00:25:29,135 BACK AT THE PRIOR VISIT AND SEE 590 00:25:29,135 --> 00:25:29,969 WHETHER OR NOT THE PRESENTATION 591 00:25:29,969 --> 00:25:31,604 WAS CONSISTENT. WE WILL TALK 592 00:25:31,604 --> 00:25:35,508 ABOUT THAT MORE IN JUST A 593 00:25:35,508 --> 00:25:38,111 MINUTE. IT THEN ALLOWS THAT 594 00:25:38,111 --> 00:25:39,479 GENERALIZATION OF THE SCREENING 595 00:25:39,479 --> 00:25:41,414 ON THE PRIOR VISIT SO WE ARE 596 00:25:41,414 --> 00:25:45,351 ABLE TO TAKE IN A LOT OF 597 00:25:45,351 --> 00:25:47,720 DIFFERENT CONTEXT FROM VARIOUS 598 00:25:47,720 --> 00:25:49,589 ASPECTS OF THE ELECTRONIC HEALTH 599 00:25:49,589 --> 00:25:51,891 RECORD. WE CAN PULL IN NOTES, 600 00:25:51,891 --> 00:25:52,892 STRUCTURED INFORMATION ALL IN 601 00:25:52,892 --> 00:25:55,295 KIND OF A MULTI -MODAL FASHION 602 00:25:55,295 --> 00:25:59,265 TO DO THE INITIAL SCREENING. IF 603 00:25:59,265 --> 00:26:01,067 WITHIN THE PROMPT STRUCTURE -- I 604 00:26:01,067 --> 00:26:02,969 WILL GO INTO MORE DETAIL ABOUT 605 00:26:02,969 --> 00:26:04,304 THIS, YOU CAN THINK ABOUT 606 00:26:04,304 --> 00:26:07,707 CREATING BETTER SCORING 607 00:26:07,707 --> 00:26:09,642 MECHAN 608 00:26:09,642 --> 00:26:11,878 MECHANISMS FOR DEEPER INSIGHTS 609 00:26:11,878 --> 00:26:14,280 INTO WHY POTENTIALLY THERE WAS A 610 00:26:14,280 --> 00:26:16,449 MISDIAGNOSIS, WHAT ASPECTS WERE 611 00:26:16,449 --> 00:26:21,154 MISSED, WAS THERE A LACK OF 612 00:26:21,154 --> 00:26:23,690 IMAGING, ORDERING, ALL THOSE 613 00:26:23,690 --> 00:26:24,791 COMPONENTS. I THINK LAST PART 614 00:26:24,791 --> 00:26:29,696 IS, YOU KNOW, FROM A LONG-TERM 615 00:26:29,696 --> 00:26:32,632 FLEXIBLE ADAPTIVE COMPONENT OF 616 00:26:32,632 --> 00:26:34,400 THESE LARGE LANGUAGE MODELS ARE 617 00:26:34,400 --> 00:26:36,035 CHANGING, THEY ARE VERY FLEXIBLE 618 00:26:36,035 --> 00:26:38,271 IN WHAT THEY CAN DO, HOW YOU CAN 619 00:26:38,271 --> 00:26:42,108 CHANGE THEM FROM ONE PROCESS TO 620 00:26:42,108 --> 00:26:43,576 ANOTHER. SO JUST TO KIND OF GIVE 621 00:26:43,576 --> 00:26:45,545 YOU A FLAVOR FOR THIS WHEN I WAS 622 00:26:45,545 --> 00:26:49,148 TALKING ABOUT -- THIS IS KIND OF 623 00:26:49,148 --> 00:26:50,383 HOW WE HAVE SET UP OUR SYSTEMS 624 00:26:50,383 --> 00:26:53,686 TO HELP WITH THIS. YOU CAN THINK 625 00:26:53,686 --> 00:26:57,156 ABOUT KIND OF MULTI MODAL 626 00:26:57,156 --> 00:27:00,860 CLINICAL DATA COMING IN, IN THE 627 00:27:00,860 --> 00:27:02,929 EMERGENCY CONTEXT FROM AN NLP 628 00:27:02,929 --> 00:27:04,731 ASPECT. MOST OF THE KIND OF 629 00:27:04,731 --> 00:27:06,866 EMERGENCY CONTEXT IS COMING FROM 630 00:27:06,866 --> 00:27:09,702 PROVIDER NOTES AND NURSING NOTES 631 00:27:09,702 --> 00:27:11,671 BUT YOU COULD THINK ABOUT 632 00:27:11,671 --> 00:27:13,740 PULLING IN -- IF IT WAS A CHEST 633 00:27:13,740 --> 00:27:15,908 PAIN PATIENT OR MISSED MI, 634 00:27:15,908 --> 00:27:19,012 PULLING IN MOST RECENT 635 00:27:19,012 --> 00:27:22,181 CARDIOLOGY NOTES AND OTHER 636 00:27:22,181 --> 00:27:24,117 AREAS. INJECTING STRUCTURE 637 00:27:24,117 --> 00:27:25,251 INFORMATION LIKE LABORATORY 638 00:27:25,251 --> 00:27:27,520 RESULTS AND VITAL SIGNS. THAT 639 00:27:27,520 --> 00:27:29,856 PROVIDES YOUR OVERALL CONTEXT 640 00:27:29,856 --> 00:27:34,494 FUSION THAT YOU ARE ABLE TO 641 00:27:34,494 --> 00:27:45,038 FINALLY MAKE POTENTIALS ON TOP 642 00:27:45,338 --> 00:27:47,540 OF THAT. SO WE'VE KIND OF -- 643 00:27:47,540 --> 00:27:49,142 THIS IS AN EARLIER VERSION OF 644 00:27:49,142 --> 00:27:51,644 OUR KIND OF GENERAL PROMPT 645 00:27:51,644 --> 00:27:53,546 STRUCTURE.LY GO INTO DIFFERENT 646 00:27:53,546 --> 00:27:55,014 COMPONENTS OF THIS. THIS IS THE 647 00:27:55,014 --> 00:27:57,650 OVERALL OUTLINE OF WHERE WE 648 00:27:57,650 --> 00:27:59,352 INITIALLY STARTED. SO WE HAVE 649 00:27:59,352 --> 00:28:01,087 SOME DETAILED INSTRUCTIONS. I 650 00:28:01,087 --> 00:28:03,623 WILL SHARE THOSE IN A MINUTE. 651 00:28:03,623 --> 00:28:08,061 THEN WE ARE APPLYING A SET OF 652 00:28:08,061 --> 00:28:10,163 CRITERIA, CALLED A SAFER TX 653 00:28:10,163 --> 00:28:13,166 CRITERIA, THAT HAS 11 654 00:28:13,166 --> 00:28:15,435 COMPONENTS. REALLY LESS THAN 655 00:28:15,435 --> 00:28:17,837 THAT. BUT THE NUMBER OF 656 00:28:17,837 --> 00:28:20,239 INSTRUCTIONS ARE 11. AND THEN 657 00:28:20,239 --> 00:28:23,142 THEY ARE -- WITHIN EACH OF THOSE 658 00:28:23,142 --> 00:28:24,110 CRITERIA YOU HAVE POINTS ABOUT 659 00:28:24,110 --> 00:28:26,245 WHETHER THERE IS AGREEMENT OR 660 00:28:26,245 --> 00:28:26,779 NOT AGREEMENT FOR THAT 661 00:28:26,779 --> 00:28:29,682 PARTICULAR ASPECT OF IT. THEN WE 662 00:28:29,682 --> 00:28:33,986 WOULD INJECT NOTES WITHIN THE 663 00:28:33,986 --> 00:28:36,255 PROMPT ITSELF. THEN GIVE THE 664 00:28:36,255 --> 00:28:38,057 SYSTEM THE FINAL DIAGNOSIS. I 665 00:28:38,057 --> 00:28:41,127 WILL SHOW YOU EACH OF THESE IN 666 00:28:41,127 --> 00:28:42,762 TURN. SO I WON'T READ THROUGH 667 00:28:42,762 --> 00:28:44,797 THIS, BUT YOU CAN JUST KIND OF 668 00:28:44,797 --> 00:28:47,133 GET A GENERAL SENSE OF THE WAY 669 00:28:47,133 --> 00:28:49,001 INSTRUCTIONS WERE. IT JUST KIND 670 00:28:49,001 --> 00:28:52,138 OF LAYS OUT WHAT'S GOING TO BE 671 00:28:52,138 --> 00:28:55,475 ASKED OF THE SYSTEM MOVING 672 00:28:55,475 --> 00:28:57,143 FORWARD AND APPLYING THE SCORE 673 00:28:57,143 --> 00:28:59,078 WITHIN THAT AND COMING UP WITH 674 00:28:59,078 --> 00:29:02,248 KIND OF AN EVENTUAL ASSESSMENT 675 00:29:02,248 --> 00:29:03,783 ABOUT A MISSED DIAGNOSTIC 676 00:29:03,783 --> 00:29:06,319 OPPORTUNITY OR NOT THAT. IS THE 677 00:29:06,319 --> 00:29:09,522 INITIAL FRAMING. THESE ARE THE 678 00:29:09,522 --> 00:29:11,791 CRITERIA COMPONENTS. AGAIN, THIS 679 00:29:11,791 --> 00:29:13,092 IS ONE OF THOSE ASPECTS THAT 680 00:29:13,092 --> 00:29:15,094 ALLOWS US TO BE ABLE TO HAVE A 681 00:29:15,094 --> 00:29:18,598 LITTLE MORE INSIGHT INTO THIS 682 00:29:18,598 --> 00:29:22,535 KIND OF OVERALL SUB COMPONENT 683 00:29:22,535 --> 00:29:25,805 THAT MAY BE DRIVING DIAGNOSTIC 684 00:29:25,805 --> 00:29:28,908 ERRORS IN THESE DIFFERENT 685 00:29:28,908 --> 00:29:30,743 CONTEXTS. THEN FOR THIS, WHEN WE 686 00:29:30,743 --> 00:29:32,712 STARTED OUT, WE WERE BOTH 687 00:29:32,712 --> 00:29:34,680 INJECTING IN THE ORIGINAL 688 00:29:34,680 --> 00:29:36,716 VISITS. WHEN YOU DID THE 689 00:29:36,716 --> 00:29:39,552 LOOKBACK PERIOD, WE WERE PUSHING 690 00:29:39,552 --> 00:29:43,656 IN THOSE NOTES. THEN ALSO GIVING 691 00:29:43,656 --> 00:29:45,391 THE FOLLOW-UP CONTEXT AROUND 692 00:29:45,391 --> 00:29:48,928 THAT SO WHEN THE DIAGNOSIS 693 00:29:48,928 --> 00:29:49,495 OCCURRED. I MENTIONED 694 00:29:49,495 --> 00:29:52,465 APPENDICITIS CASE, WE WOULD THEN 695 00:29:52,465 --> 00:29:53,599 LOOK AT THE NOTE ASSOCIATED WITH 696 00:29:53,599 --> 00:29:55,368 THE PRIMARY CARE DOCTOR AT TIMES 697 00:29:55,368 --> 00:29:58,938 TO GIVE ADDITIONAL CONTEXT 698 00:29:58,938 --> 00:30:01,474 AROUND WHAT HAPPENED IN THE 699 00:30:01,474 --> 00:30:04,310 MEANTIME. WITH THE IDEA BEING IF 700 00:30:04,310 --> 00:30:06,879 YOU ARE AT A SEVEN-DAY WINDOW 701 00:30:06,879 --> 00:30:09,081 AND LIKE THE PATIENT HAD FOUR 702 00:30:09,081 --> 00:30:10,983 DAYS WITHOUT ANY PAIN AND FELT 703 00:30:10,983 --> 00:30:13,619 PERFECTLY FINE, THEN ALL OF A 704 00:30:13,619 --> 00:30:14,720 SUDDEN STARTED DEVELOPING 705 00:30:14,720 --> 00:30:16,689 WORSENING PAIN AGAIN, MAKES IT 706 00:30:16,689 --> 00:30:18,157 POTENTIALLY LESS LIKELY THE 707 00:30:18,157 --> 00:30:20,560 INITIAL DIAGNOSIS WAS 708 00:30:20,560 --> 00:30:21,460 APPENDICITIS. SO HAVING SOME OF 709 00:30:21,460 --> 00:30:26,332 THAT CONTEXT HELPS. THEN WE FEED 710 00:30:26,332 --> 00:30:30,136 IN THE FINAL DIAGNOSIS SO THE 711 00:30:30,136 --> 00:30:33,072 LLM ALREADY KNOWS, NOT GOING DE 712 00:30:33,072 --> 00:30:36,242 NOVO, IS TRYING TO MAKE 713 00:30:36,242 --> 00:30:36,843 ASSESSMENT ABOUT THE INITIAL 714 00:30:36,843 --> 00:30:38,544 VISIT AND WHETHER THERE WAS A 715 00:30:38,544 --> 00:30:41,948 POTENTIAL MISSED DIAGNOSTIC 716 00:30:41,948 --> 00:30:44,684 OPPORTUNITY WITHIN THAT SPACE. 717 00:30:44,684 --> 00:30:47,353 WHERE DOES KIND OF ALL THAT GET 718 00:30:47,353 --> 00:30:49,021 US? SO OVERALL IF YOU ARE 719 00:30:49,021 --> 00:30:50,556 THINKING ABOUT THIS IN BUILDING 720 00:30:50,556 --> 00:30:52,992 OUT KIND OF A FULL QI SPACE, 721 00:30:52,992 --> 00:30:56,395 THIS IS KIND OF WHERE WE ARE 722 00:30:56,395 --> 00:31:00,333 MOVING TOWARDS. SO INSTEAD OF 723 00:31:00,333 --> 00:31:03,569 REALLY HAVING THE SYMPTOM 724 00:31:03,569 --> 00:31:05,504 DISEASE PAIR OR SIMPLE LOOK-BACK 725 00:31:05,504 --> 00:31:08,307 WE ARE USING THE LLMs TO DO THE 726 00:31:08,307 --> 00:31:09,909 ASSESSMENT FOR THOSE PRIOR SIS 727 00:31:09,909 --> 00:31:12,078 SITS. IT ALLOWS US TO BE ABLE TO 728 00:31:12,078 --> 00:31:15,448 SCALE FROM ONE OR TWO DISEASE 729 00:31:15,448 --> 00:31:18,050 PROCESSES TO -- WE HAVE USED A 730 00:31:18,050 --> 00:31:21,454 LIST OF ABOUT 200. THAT IS JUST 731 00:31:21,454 --> 00:31:24,457 BASED UPON HIGH ACUITY, 732 00:31:24,457 --> 00:31:26,425 CAN'T-MISS DIAGNOSES WITHIN THE 733 00:31:26,425 --> 00:31:28,327 EMERGENCY DEPARTMENT. THE IDEA 734 00:31:28,327 --> 00:31:30,396 IS YOU WOULD IDENTIFY THOSE WITH 735 00:31:30,396 --> 00:31:34,100 STRONG POTENTIAL FOR MISSED 736 00:31:34,100 --> 00:31:40,039 DIAGNOSTIC OPPORTUNITY. THOSE 737 00:31:40,039 --> 00:31:42,875 THEN ARE IN THAT LIST SO YOU ARE 738 00:31:42,875 --> 00:31:45,678 NOT OVER-BURDENING YOUR QI TEAM 739 00:31:45,678 --> 00:31:48,581 IN THIS PROCESS. I'M NOT SURE IF 740 00:31:48,581 --> 00:31:52,752 WE WILL GET TO A SYSTEM WHERE 741 00:31:52,752 --> 00:31:54,186 ATTRIBUTION OF A DIAGNOSTIC 742 00:31:54,186 --> 00:31:58,024 ERROR IS FULLY AUTOMATED WITHIN 743 00:31:58,024 --> 00:32:03,129 AN AI SYSTEM -- FROM JUST A 744 00:32:03,129 --> 00:32:06,866 FEEDBACK MECHANISM, IT MAY BE 745 00:32:06,866 --> 00:32:09,302 DIFFICULT TO GET ADAPTIVE 746 00:32:09,302 --> 00:32:10,236 CHANGES IN PROVIDER S IF YOU ARE 747 00:32:10,236 --> 00:32:12,338 ONLY USING AN AI SYSTEM AS 748 00:32:12,338 --> 00:32:14,040 OPPOSED TO HAVING OTHER HUMANS 749 00:32:14,040 --> 00:32:17,310 IN THE LOOP WITH THAT PROCESS. 750 00:32:17,310 --> 00:32:19,445 SO THAT IS KIND OF WHERE WE ARE 751 00:32:19,445 --> 00:32:20,846 NOW. THE NICE THING ABOUT THIS 752 00:32:20,846 --> 00:32:23,683 IS BECAUSE YOU ARE MOVING OUT 753 00:32:23,683 --> 00:32:26,919 REALLY TO SCALE AND LOOKING AT 754 00:32:26,919 --> 00:32:30,356 HUNDREDS OF DIFFERENT DIAGNOSES 755 00:32:30,356 --> 00:32:33,159 ACROSS THE ENTIRE SYSTEM, YOU 756 00:32:33,159 --> 00:32:35,361 ARE ABLE TO BUILD OUT QUALITY 757 00:32:35,361 --> 00:32:37,496 DASHBOARDS WITH A LOT MORE I 758 00:32:37,496 --> 00:32:38,731 THINK DEPTH THAN YOU OTHERWISE 759 00:32:38,731 --> 00:32:41,567 WOULD BE ABLE TO. SO HOW ARE WE 760 00:32:41,567 --> 00:32:43,970 KIND OF DOING THIS? I SHOULD SAY 761 00:32:43,970 --> 00:32:47,807 SO I KIND OF SIT IN TWO WORLDS 762 00:32:47,807 --> 00:32:51,177 RIGHT NOW. I WAS RECENTLY AT 763 00:32:51,177 --> 00:32:52,778 YALE, NOW AT THE UNIVERSITY OF 764 00:32:52,778 --> 00:32:54,447 VIRGINIA. WE ARE DOING THAT 765 00:32:54,447 --> 00:32:56,182 PROCESS AT BOTH THESE 766 00:32:56,182 --> 00:32:57,350 INSTITUTIONS BUT THIS KIND OF 767 00:32:57,350 --> 00:33:01,520 GIVES YOU A BASIC SETUP OF HOW 768 00:33:01,520 --> 00:33:03,289 THIS PROCESS IS HAPPENING. I 769 00:33:03,289 --> 00:33:05,358 WILL SAY THIS WAS TAKEN FROM 770 00:33:05,358 --> 00:33:09,362 SOME OTHER WORK WE HAD AROUND 771 00:33:09,362 --> 00:33:12,698 OPIOID USE DISORDER AND 772 00:33:12,698 --> 00:33:13,432 PHENOTYPE INFORMATION BUT THE 773 00:33:13,432 --> 00:33:14,600 INFRASTRUCTURE IS RELATIVELY THE 774 00:33:14,600 --> 00:33:21,240 SAME. SO WE ARE USING A COME POE 775 00:33:21,240 --> 00:33:22,141 TUIT 776 00:33:22,141 --> 00:33:23,009 COMPUTATIONAL HEALTH PLATFORM 777 00:33:23,009 --> 00:33:25,077 USING INFORMATION FROM CLARITY 778 00:33:25,077 --> 00:33:30,383 AND KABOODLE WITHIN EPIC, 779 00:33:30,383 --> 00:33:33,085 UPDATED WITHIN A 24-HOUR BASIS 780 00:33:33,085 --> 00:33:34,553 THAT. IS IMPORTANT IN THINKING 781 00:33:34,553 --> 00:33:36,055 THIS. WE HAVE NOT MOVED TO A 782 00:33:36,055 --> 00:33:39,291 SYSTEM WHERE YOU HAVE AUTOMATIC 783 00:33:39,291 --> 00:33:40,426 IDENTIFICATION OF DIAGNOSTIC 784 00:33:40,426 --> 00:33:41,961 ERROR. A LOT OF REASONS THAT 785 00:33:41,961 --> 00:33:44,864 WILL BE AT LEAST CURRENTLY 786 00:33:44,864 --> 00:33:47,400 DIFFICULT IS BECAUSE DOCUMENTARY 787 00:33:47,400 --> 00:33:49,168 OFTENTIMES DOES NOT OCCUR UNTIL 788 00:33:49,168 --> 00:33:52,138 AFTER VISITS HAVE BEEN COMPLETED 789 00:33:52,138 --> 00:33:53,739 AND SOMETIMES MULTIPLE HOURS 790 00:33:53,739 --> 00:33:55,775 AFTER WARDS. WE WOULD LOVE IT IF 791 00:33:55,775 --> 00:33:57,810 ALL THE DOCUMENTATION WAS DONE 792 00:33:57,810 --> 00:33:59,545 PRIOR TO PATIENTS LEAVING, BUT 793 00:33:59,545 --> 00:34:01,313 THAT IS JUST NOT THE REALITY. 794 00:34:01,313 --> 00:34:04,884 THAT MAY CHANGE AS WE SEE MORE 795 00:34:04,884 --> 00:34:09,955 AND MORE MBAI INTRODUCE BUD 796 00:34:09,955 --> 00:34:13,159 LIMITS YOUR ABILITY TO DO TRULY 797 00:34:13,159 --> 00:34:15,127 REALTIME ASSESSMENT FOR 798 00:34:15,127 --> 00:34:16,662 POTENTIAL MISSED DIAGNOSTICS IN 799 00:34:16,662 --> 00:34:18,431 THE SPACE SO WE ARE REALLY 800 00:34:18,431 --> 00:34:22,201 WORKING ON A 24-HOUR WINDOW POST 801 00:34:22,201 --> 00:34:23,869 THESE VISITS. BUT THAT 802 00:34:23,869 --> 00:34:27,039 INFORMATION IS PROCESSED WITHIN 803 00:34:27,039 --> 00:34:29,475 THE COMPUTATIONAL HEALTH 804 00:34:29,475 --> 00:34:31,077 PLATFORM. FOR BOTH ENVIRONMENTS 805 00:34:31,077 --> 00:34:34,914 WE ARE WORKING WITHIN 806 00:34:34,914 --> 00:34:38,050 ACCOMODATIVE MODEL, O█MOF, THEN 807 00:34:38,050 --> 00:34:39,919 RUN SCRIPTS FOR FINDING NOTES 808 00:34:39,919 --> 00:34:44,056 AND OTHER STRUCTURED 809 00:34:44,056 --> 00:34:44,623 INFORMATION. THERE IS AN 810 00:34:44,623 --> 00:34:46,158 OPPORTUNITY TO PUSH THAT DATA 811 00:34:46,158 --> 00:34:48,928 BACK INTO EPIC IN A COUPLE OF 812 00:34:48,928 --> 00:34:51,931 WAYS. ONE IS THROUGH DATALINK. 813 00:34:51,931 --> 00:34:53,299 BUT RIGHT NOW THE MAIN MECHANISM 814 00:34:53,299 --> 00:34:55,201 WE ARE GOING TO WORK KIND OF 815 00:34:55,201 --> 00:34:57,937 BUILDING IN FROM THE QI 816 00:34:57,937 --> 00:34:59,638 STANDPOINT IS THAT AREA THAT I 817 00:34:59,638 --> 00:35:01,740 KIND OF MENTIONED BEFORE, 818 00:35:01,740 --> 00:35:04,510 BUILDING OUT DASHBOARDS AND 819 00:35:04,510 --> 00:35:08,581 IDENTIFICATION FOR THE QI TEAMS 820 00:35:08,581 --> 00:35:10,549 MOVING FORWARD AFTER WARDS. THE 821 00:35:10,549 --> 00:35:12,551 OTHER THING, WITHIN THE EL 822 00:35:12,551 --> 00:35:15,020 SYSTEM THERE'S A COUPLE OF 823 00:35:15,020 --> 00:35:16,989 MODELS THAT ARE WITHIN THE 824 00:35:16,989 --> 00:35:19,091 SYSTEMS. (?) IS ONE. THERE IS 825 00:35:19,091 --> 00:35:21,660 ALSO AN OPPORTUNITY FOR USING 826 00:35:21,660 --> 00:35:23,596 OPEN AI WITHIN AZURE 827 00:35:23,596 --> 00:35:25,798 ENVIRONMENT. THAT IS THE SAME, 828 00:35:25,798 --> 00:35:29,001 AT LEAST AZURE IS SAME AT EVA AS 829 00:35:29,001 --> 00:35:30,803 WELL. SO WHAT ARE SOME OF THE I 830 00:35:30,803 --> 00:35:38,611 THINK BROADER ISSUES AND 831 00:35:38,611 --> 00:35:41,714 CHALLENGES? ONE IS THE OVERALL 832 00:35:41,714 --> 00:35:44,950 SYSTEM TO BE ABLE TO WEIGH IN ON 833 00:35:44,950 --> 00:35:47,419 POTENTIAL FOR MISSED DIAGNOSIS. 834 00:35:47,419 --> 00:35:50,789 OVERSIGHT OF THAT SYSTEM. SO WE 835 00:35:50,789 --> 00:35:53,425 GO FROM ONLY FINDING POTENTIALLY 836 00:35:53,425 --> 00:35:55,628 A FEW MISSED DIAGNOSES, AND MOST 837 00:35:55,628 --> 00:36:01,400 OF THE TIME WHEN I TALK TO I. T. 838 00:36:01,400 --> 00:36:03,469 TEAMS THEY SAY THEY GET THREE, 839 00:36:03,469 --> 00:36:05,671 FOUR A MONTH, MAYBE LESS, WHICH 840 00:36:05,671 --> 00:36:08,274 IS NOT CONSISTENT WITH WHAT YOU 841 00:36:08,274 --> 00:36:09,275 SEE FROM A RESEARCH STANDPOINT, 842 00:36:09,275 --> 00:36:13,412 SO WE KNOW THERE'S A LOT OF 843 00:36:13,412 --> 00:36:14,813 UNDERREPORTING. IF THAT NUMBER 844 00:36:14,813 --> 00:36:16,949 GREATLY EXPANDS, FIGURING OUT 845 00:36:16,949 --> 00:36:19,118 HOW YOU ARE GOING TO OVERSEE AND 846 00:36:19,118 --> 00:36:21,820 MANAGE THAT BECOMES AN ISSUE, 847 00:36:21,820 --> 00:36:25,457 ALSO BECOMES AN ISSUE FROM A 848 00:36:25,457 --> 00:36:27,293 RESOURCE STANDPOINT. THIS ALSO I 849 00:36:27,293 --> 00:36:30,229 THINK FEEDS BACK INTO ISSUES 850 00:36:30,229 --> 00:36:33,432 AROUND, YOU KNOW, EQUITY AND 851 00:36:33,432 --> 00:36:34,500 DISPARITIES AT THE SYSTEM LEVEL. 852 00:36:34,500 --> 00:36:37,937 WE TALK ABOUT IMPLEMENTING THESE 853 00:36:37,937 --> 00:36:41,707 TYPES OF AI SYSTEMS WITHIN RURAL 854 00:36:41,707 --> 00:36:43,375 HOSPITALS, ET CETERA. THEN THE 855 00:36:43,375 --> 00:36:45,244 LAST IS REALLY STANDARDIZING A 856 00:36:45,244 --> 00:36:48,647 LOT OF THIS PROCESS, SO YOU MAY 857 00:36:48,647 --> 00:36:50,382 HAVE DIFFERENT GROUPS CHOOSING 858 00:36:50,382 --> 00:36:53,352 DIFFERENT SETS OF DIAGNOSES OR 859 00:36:53,352 --> 00:36:55,888 USING DIFFERENT SCORING CRITERIA 860 00:36:55,888 --> 00:36:57,489 AND WAYS OF DOING REPORTING 861 00:36:57,489 --> 00:36:59,525 AROUND THIS. SO I THINK THERE 862 00:36:59,525 --> 00:37:01,260 NEEDS TO BE CONTINUED WORK IN 863 00:37:01,260 --> 00:37:04,129 THAT SPACE TO REALLY HELP OUT 864 00:37:04,129 --> 00:37:05,431 THAT STANDARDIZATION PROCESS SO 865 00:37:05,431 --> 00:37:07,866 THAT EVENTUALLY HOPEFULLY WE 866 00:37:07,866 --> 00:37:10,236 COULD GET TO LARGE-SCALE 867 00:37:10,236 --> 00:37:11,570 MULTI INSTITUTIONAL 868 00:37:11,570 --> 00:37:13,038 AGGREGATIONAL AND GET TO BETTER 869 00:37:13,038 --> 00:37:16,008 NUMBERS FOR DIAGNOSTIC ERROR 870 00:37:16,008 --> 00:37:19,411 WITHIN THE EMERGENCY DEPARTMENT 871 00:37:19,411 --> 00:37:22,381 SPACE AND ELSEWHERE. SO KIND OF 872 00:37:22,381 --> 00:37:24,350 FUTURE RESEARCH FOR US, AS WE 873 00:37:24,350 --> 00:37:27,286 ARE DOING BUILD-OUT FOR THESE. 874 00:37:27,286 --> 00:37:29,888 BUT I THINK ONCE WE GET THERE, 875 00:37:29,888 --> 00:37:33,559 THERE IS A REAL OPPORTUNITY FOR 876 00:37:33,559 --> 00:37:34,660 DESCRIPTIVE CHARACTERIZATIONS 877 00:37:34,660 --> 00:37:38,397 BECAUSE WE ARE NOW AT-SCALE AND 878 00:37:38,397 --> 00:37:41,600 HAVE A LOT MORE KIND OF CAPTURE 879 00:37:41,600 --> 00:37:46,238 OF DIAGNOSTIC SAFETY WITHIN THE 880 00:37:46,238 --> 00:37:48,941 SYSTEM. I'M INTERESTED IN 881 00:37:48,941 --> 00:37:50,809 LOOKING AT ORGANIZATIONAL AND 882 00:37:50,809 --> 00:37:53,545 TEAM RISK FACTOR S SO THAT 883 00:37:53,545 --> 00:37:56,982 EXAMPLE I MENTIONED ABOUT 884 00:37:56,982 --> 00:37:58,817 BOARDING, YOU CAN THINK ABOUT A 885 00:37:58,817 --> 00:38:00,653 LOT ARE OCCURRING AT NIGHTTIME 886 00:38:00,653 --> 00:38:04,523 VERSUS DAY. IS IT OCCURRING ON A 887 00:38:04,523 --> 00:38:07,760 PHYSICIAN'S FIFTH DAY OF WORKING 888 00:38:07,760 --> 00:38:09,228 OR THE EIGHTH HOUR THEY ARE INTO 889 00:38:09,228 --> 00:38:11,163 THEIR SHIFT. ALL THOSE ARE 890 00:38:11,163 --> 00:38:12,364 REALLY INTERESTING QUESTIONS 891 00:38:12,364 --> 00:38:14,366 THAT POTENTIALLY CAN MOVE THE 892 00:38:14,366 --> 00:38:17,903 NEEDLE FROM A DIAGNOSTIC SAFETY 893 00:38:17,903 --> 00:38:19,071 STANDPOINT. THEN I THINK MOVING 894 00:38:19,071 --> 00:38:20,973 FORWARD WITH DISSEMINATION, HOW 895 00:38:20,973 --> 00:38:22,941 CAN YOU PACKAGE THESE TOOLS UP 896 00:38:22,941 --> 00:38:25,277 TO USE THEM ACROSS MULTIPLE 897 00:38:25,277 --> 00:38:27,946 ORGANIZATION. THEN THE LAST IS 898 00:38:27,946 --> 00:38:31,684 REALLY OPTIMIZATION. IT IS 899 00:38:31,684 --> 00:38:33,285 IMPROVING THAT RECOGNITION OR 900 00:38:33,285 --> 00:38:35,788 TRIGGER SYSTEM SO YOU BECOME 901 00:38:35,788 --> 00:38:37,923 MORE EFFICIENT OVERALL WITH THE 902 00:38:37,923 --> 00:38:40,826 PROCESS. I THINK WE WILL SEE 903 00:38:40,826 --> 00:38:43,295 CONTINUED OPT MIZATION FROM 904 00:38:43,295 --> 00:38:46,231 FURTHER DEVELOPMENT OF LARGE 905 00:38:46,231 --> 00:38:47,333 LANGUAGE MODELS AS WE MOVE 906 00:38:47,333 --> 00:38:50,369 FORWARD. SO THANK YOU VERY MUCH 907 00:38:50,369 --> 00:38:52,738 THAT. IS MY LAB TEAM. I WILL 908 00:38:52,738 --> 00:38:55,908 CLOSE DOWN THIS AND OPEN IT UP 909 00:38:55,908 --> 00:38:57,643 FOR QUESTIONS. 910 00:38:57,643 --> 00:38:59,745 >> THANK YOU SO MUCH. YOU 911 00:38:59,745 --> 00:39:02,114 TOUCHED ON SO MANY IMPORTANT 912 00:39:02,114 --> 00:39:03,982 POINTS. IT IS JUST SO 913 00:39:03,982 --> 00:39:05,651 OVERWHELMING IN TERMS OF HOW 914 00:39:05,651 --> 00:39:08,053 POWERFUL THE SYSTEMS ARE. HOW 915 00:39:08,053 --> 00:39:10,356 DIFFICULT IT IS TO IMPLEMENT 916 00:39:10,356 --> 00:39:14,326 THEM IN THE CLINICAL 917 00:39:14,326 --> 00:39:20,032 ENVIRONMENT. SO YOU ARE FOCUSED 918 00:39:20,032 --> 00:39:22,935 ON FINDING THIS DIAGNOSIS 919 00:39:22,935 --> 00:39:24,203 QUALITY, QUALITY IMPROVEMENT 920 00:39:24,203 --> 00:39:27,272 FROM THE QUALITY IMPROVEMENT 921 00:39:27,272 --> 00:39:28,974 STANDPOINT. ARE YOU CURRENTLY 922 00:39:28,974 --> 00:39:32,478 USING LLMS TO HELP YOU WITH 923 00:39:32,478 --> 00:39:33,512 DIAGNOSIS? 924 00:39:33,512 --> 00:39:41,687 >> YEAH, I THINK THAT IS THE 925 00:39:41,687 --> 00:39:43,622 EASIEST PATHWAY INITIALLY INTO 926 00:39:43,622 --> 00:39:48,494 THE DIAGNOSTIC KIND OF QUALITY 927 00:39:48,494 --> 00:39:51,363 IMPROVEMENT SPACE AS OPPOSED TO 928 00:39:51,363 --> 00:39:53,465 HAVING A LARGE LANGUAGE MODEL 929 00:39:53,465 --> 00:39:56,869 WORKING IN PARALLEL WITH A 930 00:39:56,869 --> 00:39:58,804 PROVIDER GENERATING A 931 00:39:58,804 --> 00:39:59,471 DIFFERENTIAL AND EVERYTHING 932 00:39:59,471 --> 00:40:01,173 ELSE. I THINK WE ARE GET THERE 933 00:40:01,173 --> 00:40:04,977 YOU GO BUT IT IS SO DEPENDENT 934 00:40:04,977 --> 00:40:06,678 UPON YOUR UNDERLYING 935 00:40:06,678 --> 00:40:08,547 INFRASTRUCTURE AND THE WAY YOU 936 00:40:08,547 --> 00:40:12,818 HAVE YOUR EHR SET UP AND THE EHR 937 00:40:12,818 --> 00:40:15,254 INTEGRATION BECOMES VERY 938 00:40:15,254 --> 00:40:16,722 DIFFICULT. I THINK OBVIOUSLY THE 939 00:40:16,722 --> 00:40:19,591 HOPE IS YOU WILL HAVE THESE 940 00:40:19,591 --> 00:40:22,294 RUNNING SIDE-BY-SIDE, LONG-TERM, 941 00:40:22,294 --> 00:40:26,965 BUT WE ARE NOT THERE YET. BUT 942 00:40:26,965 --> 00:40:27,900 HOPEFULLY WE WILL BE SOON. 943 00:40:27,900 --> 00:40:29,468 >> I HAVE A QUESTION FROM ONE OF 944 00:40:29,468 --> 00:40:32,805 OUR VIEWERS, FROM RACHEL SABO. 945 00:40:32,805 --> 00:40:34,473 THE QUESTION IS HOW DO YOU 946 00:40:34,473 --> 00:40:38,277 HANDLE PROTECTING PII DATA 947 00:40:38,277 --> 00:40:41,046 INCLUDED INTO THE LLM. I THINK 948 00:40:41,046 --> 00:40:46,385 FOLLOW-UP QUESTIONS. HOW DO YOU 949 00:40:46,385 --> 00:40:49,188 COOLING DATA EFFICIENTLY? IS 950 00:40:49,188 --> 00:40:52,925 SOMEONE MANUALLY COPYING AND 951 00:40:52,925 --> 00:40:54,026 PASTING TO THE LLM PROMPT? 952 00:40:54,026 --> 00:40:59,631 >> YES. FOR THE FIRST ONE, THE 953 00:40:59,631 --> 00:41:01,700 AZURE OPENING AI ENVIRONMENTS, 954 00:41:01,700 --> 00:41:05,504 THAT IS A SECURE HIPAA COMPLIANT 955 00:41:05,504 --> 00:41:07,306 ENVIRONMENT, NO SHARED DATA IS 956 00:41:07,306 --> 00:41:09,641 COMING OUT THAT. IS THE SETUP A 957 00:41:09,641 --> 00:41:14,112 LOT ARE GOING WITH AT THIS 958 00:41:14,112 --> 00:41:15,914 POINT. SO USING STATE LESS 959 00:41:15,914 --> 00:41:18,951 SYSTEMS TO BE ABLE TO DO THAT 960 00:41:18,951 --> 00:41:21,887 AND THEY ARE ALREADY AROUND KIND 961 00:41:21,887 --> 00:41:25,023 OF THE HIPAA COMPLIANT ASPECTS 962 00:41:25,023 --> 00:41:26,859 AND ASSURANCES. THE OTHER WAY IS 963 00:41:26,859 --> 00:41:28,827 HAVE YOUR MODEL IN YOUR 964 00:41:28,827 --> 00:41:30,395 INSTITUTION, IN YOUR 965 00:41:30,395 --> 00:41:31,864 COMPUTATIONAL HEALTH PLATFORM 966 00:41:31,864 --> 00:41:36,134 AND TO USE THAT MODEL SO ONE 967 00:41:36,134 --> 00:41:38,203 EXAMPLE OF LIKE POTENTIALLY 968 00:41:38,203 --> 00:41:40,105 USING A MODEL THAT'S BEEN 969 00:41:40,105 --> 00:41:42,407 DEVELOPED WITH REALLY KIND OF A 970 00:41:42,407 --> 00:41:44,376 MEDICAL FOCUS THAT EXISTS IN 971 00:41:44,376 --> 00:41:48,547 YOUR -- THERE IS NO REAL 972 00:41:48,547 --> 00:41:50,249 EXCHANGE OF DATA OUTSIDE OF 973 00:41:50,249 --> 00:41:52,618 THAT. THE SECOND WAS -- SO THE 974 00:41:52,618 --> 00:41:54,286 EMERGENCY DEPARTMENT IS A LITTLE 975 00:41:54,286 --> 00:41:56,522 EASIER PROBABLY THAN OTHER 976 00:41:56,522 --> 00:41:58,690 CONTEXT WHEN COMES TO DIAGNOSIS. 977 00:41:58,690 --> 00:42:01,293 SO, YOU KNOW, IT CAN KIND OF 978 00:42:01,293 --> 00:42:05,097 CONFINE THAT DIAGNOSTIC EVENT 979 00:42:05,097 --> 00:42:08,867 AROUND THE ACTUALLY EMERGENCY 980 00:42:08,867 --> 00:42:10,536 DEPARTMENT CARE. SO THERE IS A 981 00:42:10,536 --> 00:42:12,671 MUCH MORE LIMITED SET OF NOTES 982 00:42:12,671 --> 00:42:15,073 THAT I NEED TO BE ABLE TO SEARCH 983 00:42:15,073 --> 00:42:17,576 THROUGH AND REALLY JUST THE 984 00:42:17,576 --> 00:42:19,545 PROVIDER NOTE, NURSING NOTE TO 985 00:42:19,545 --> 00:42:21,513 GET A GOOD CONTEXT AROUND THAT. 986 00:42:21,513 --> 00:42:23,949 YOU COULD THINK LIKE IF YOU ARE 987 00:42:23,949 --> 00:42:25,117 LOOKING AT IN-HOSPITAL 988 00:42:25,117 --> 00:42:26,385 ENVIRONMENT IS MUCH MORE 989 00:42:26,385 --> 00:42:28,120 CHALLENGING, RIGHT. YOU ARE 990 00:42:28,120 --> 00:42:30,355 POTENTIALLY LOOKING AT MULTI, 991 00:42:30,355 --> 00:42:32,558 MULTI DAYS OF NOTES ACROSS A 992 00:42:32,558 --> 00:42:36,094 VARIETY OF DIFFERENT PROVIDERS 993 00:42:36,094 --> 00:42:38,230 AND FIGURING OUT HOW TO BE 994 00:42:38,230 --> 00:42:40,232 EFFICIENT ARE GOING TO BE 995 00:42:40,232 --> 00:42:41,533 CHALLENGES MOVING FORWARD IN 996 00:42:41,533 --> 00:42:43,602 THAT SPACE. SO I GUESS I WOULD 997 00:42:43,602 --> 00:42:46,171 LIKE THE EMERGENCY DEPARTMENT 998 00:42:46,171 --> 00:42:48,206 FOR THAT. WE HAVE THESE 999 00:42:48,206 --> 00:42:49,441 DISCREET EVENTS AND TIME 1000 00:42:49,441 --> 00:42:51,877 PERIODS. IT IS EASIER TO LOOK 1001 00:42:51,877 --> 00:42:53,445 BACK AND ATTRIBUTE WHETHER THERE 1002 00:42:53,445 --> 00:42:55,847 WAS A POTENTIAL MISDIAGNOSIS OR 1003 00:42:55,847 --> 00:42:57,149 NOT. THAT IS PROBLEM LAY LOT 1004 00:42:57,149 --> 00:43:01,920 MORE DIFFICULT THAN OTHER 1005 00:43:01,920 --> 00:43:02,254 ENVIRONMENTS. 1006 00:43:02,254 --> 00:43:04,856 >> YEAH, WOULDN'T IT BE 1007 00:43:04,856 --> 00:43:06,792 FASCINATING WE COULD KNOW A 1008 00:43:06,792 --> 00:43:09,828 PATIENT HISTORY AND YOUR LLM IN 1009 00:43:09,828 --> 00:43:11,964 THE EMERGENCY DEPARTMENT WOULD 1010 00:43:11,964 --> 00:43:13,265 ACTUALLY HAVE THAT BACKGROUND 1011 00:43:13,265 --> 00:43:16,568 KNOWLEDGE WHEN HELPING YOU WITH 1012 00:43:16,568 --> 00:43:18,637 DIAGNOSIS FOR THAT PARTICULAR 1013 00:43:18,637 --> 00:43:18,904 PATIENT. 1014 00:43:18,904 --> 00:43:21,540 >> YEAH, THAT IS ANOTHER -- I 1015 00:43:21,540 --> 00:43:22,941 DIDN'T TALK ABOUT BECAUSE I 1016 00:43:22,941 --> 00:43:25,444 THINK THERE IS STILL A LOT OF 1017 00:43:25,444 --> 00:43:27,813 IMPLEMENTATION CHALLENGES. BUT 1018 00:43:27,813 --> 00:43:29,848 THE OTHER ASPECT OF THIS, I LIKE 1019 00:43:29,848 --> 00:43:33,185 TO CALL LIKE EITHER DECISION 1020 00:43:33,185 --> 00:43:35,787 HYGIENE OR THE DECISION 1021 00:43:35,787 --> 00:43:44,062 ENVIRONMENT THAT ALONG WITH 1022 00:43:44,062 --> 00:43:50,135 SUMMARIZATION. SO WE STRUGGLE 1023 00:43:50,135 --> 00:43:51,770 WITH MANAGING THAT VERY LONG 1024 00:43:51,770 --> 00:43:53,605 PROBLEM LIST SOR LOOK BACK 1025 00:43:53,605 --> 00:43:55,307 THROUGH NOTES TO SEE IF A 1026 00:43:55,307 --> 00:43:58,777 PROBLEM HAD A CATH OR PROCEDURE. 1027 00:43:58,777 --> 00:44:00,045 OBVIOUSLY THINGS GET MISSED 1028 00:44:00,045 --> 00:44:01,513 BECAUSE WE DON'T HAVE A LOT OF 1029 00:44:01,513 --> 00:44:03,782 TIME AND IT IS TOUGH TO DO THOSE 1030 00:44:03,782 --> 00:44:05,817 SEARCHES. I THINK AS WE MOVE 1031 00:44:05,817 --> 00:44:07,152 FORWARD THAT INFORMATION 1032 00:44:07,152 --> 00:44:09,121 SUMMARIZATION AND SYNTHESIS 1033 00:44:09,121 --> 00:44:11,890 ASPECT THAT WILL BE DRIVEN BY 1034 00:44:11,890 --> 00:44:12,524 LARGE LANGUAGE MODELS IS GOING 1035 00:44:12,524 --> 00:44:15,127 TO BE HUGELY HELPFUL TO 1036 00:44:15,127 --> 00:44:16,128 PROVIDERS BECAUSE IT WILL GIVE 1037 00:44:16,128 --> 00:44:18,063 THEM A BETTER CONTEXT AND 1038 00:44:18,063 --> 00:44:19,398 UNDERSTANDING OF THE PATIENT. 1039 00:44:19,398 --> 00:44:20,866 YOU CAN THINK ABOUT THIS. IT CAN 1040 00:44:20,866 --> 00:44:22,934 BE VERY CONTEXT DEPENDENT TOO. 1041 00:44:22,934 --> 00:44:25,037 IF THE PATIENT COMES IN WITH 1042 00:44:25,037 --> 00:44:26,371 CHEST PAIN IT IS ONLY LOOKING 1043 00:44:26,371 --> 00:44:28,440 FOR INFORMATION THAT WOULD BE 1044 00:44:28,440 --> 00:44:30,308 RELEVANT FOR CHEST PAIN 1045 00:44:30,308 --> 00:44:33,311 DIAGNOSIS OF SOME SORT. THAT CAN 1046 00:44:33,311 --> 00:44:35,247 BE -- YOU CAN COMPLETELY CHANGE 1047 00:44:35,247 --> 00:44:37,349 THE WHOLE USER INTERFACE BASED 1048 00:44:37,349 --> 00:44:39,384 ON THOSE TYPES OF KIND OF 1049 00:44:39,384 --> 00:44:42,788 CONTEXT COMPONENTS FROM THE 1050 00:44:42,788 --> 00:44:46,058 CHIEF COMPLAINTS AND WHATEVER 1051 00:44:46,058 --> 00:44:48,260 FOR THE PATIENT. 1052 00:44:48,260 --> 00:44:53,699 >> YEAH, YEAH. DO YOU HAVE A 1053 00:44:53,699 --> 00:44:53,999 QUESTION? 1054 00:44:53,999 --> 00:44:56,034 >> YEAH. FIRST OF ALL, THANK YOU 1055 00:44:56,034 --> 00:44:59,137 FOR THE TERRIFIC TALK. I HAVE 1056 00:44:59,137 --> 00:45:00,739 ONE CLARIFICATION QUESTION AND 1057 00:45:00,739 --> 00:45:01,306 ONE OTHER QUESTION. 1058 00:45:01,306 --> 00:45:01,940 >> SURE. 1059 00:45:01,940 --> 00:45:04,576 >> CAN YOU CLARIFY THAT. WHEN 1060 00:45:04,576 --> 00:45:08,046 YOU SAY WORK FLOW DIAGRAM, YOU 1061 00:45:08,046 --> 00:45:09,781 MENTIONED ABOUT 24 HOURS, DOES 1062 00:45:09,781 --> 00:45:13,785 THAT MEAN THE AI IS POSITIONED 1063 00:45:13,785 --> 00:45:15,787 TO DETEXT MISDIAGNOSIS WITHIN 24 1064 00:45:15,787 --> 00:45:17,622 HOURS TIME FRAME? IS THAT WHAT 1065 00:45:17,622 --> 00:45:18,590 IT IS SUPPOSED TO BE DOING? 1066 00:45:18,590 --> 00:45:21,493 >> IT WOULD BE. IT IS REALLY 1067 00:45:21,493 --> 00:45:23,528 DEPENDENT ON THE DATABASE 1068 00:45:23,528 --> 00:45:27,933 UPDATES, RIGHT. SO THE ETLs ARE 1069 00:45:27,933 --> 00:45:30,202 COMING OUT ARE ONLY ON A 24-HOUR 1070 00:45:30,202 --> 00:45:31,603 TIME FRAME. SO NOTES AREN'T 1071 00:45:31,603 --> 00:45:33,805 GOING TO BE UPDATED. YOU COULD 1072 00:45:33,805 --> 00:45:36,274 THINK ABOUT THE WINDOW TO BE 1073 00:45:36,274 --> 00:45:39,578 PROBABLY THE ABILITY OF THE 1074 00:45:39,578 --> 00:45:41,813 SYSTEM DO DIAGNOSIS AND 1075 00:45:41,813 --> 00:45:43,115 ATTRIBUTION IS PROBABLY IMPROVED 1076 00:45:43,115 --> 00:45:44,816 BY THE LONGER WINDOW THAT 1077 00:45:44,816 --> 00:45:46,818 HAPPENS, SO IT IS PROBABLY 1078 00:45:46,818 --> 00:45:50,122 EASIER TO SEVEN-DAY ON 24-HOUR 1079 00:45:50,122 --> 00:45:54,326 BASIS TO MAKE THATS ASSESSMENT. 1080 00:45:54,326 --> 00:45:57,262 MAINLY BECAUSE NOTES ARE STILL 1081 00:45:57,262 --> 00:45:58,897 IN FLUX. PEOPLE AREN'T 1082 00:45:58,897 --> 00:46:00,265 COMPLETING AND YOU MAY HAVE 1083 00:46:00,265 --> 00:46:02,367 UPDATES TO NOTES OR LABS AND 1084 00:46:02,367 --> 00:46:04,069 OTHER THINGS THAT AREN'T THERE. 1085 00:46:04,069 --> 00:46:07,172 BUT THAT IS THE -- THAT IS ONE 1086 00:46:07,172 --> 00:46:07,806 OF THE CURRENT -- 1087 00:46:07,806 --> 00:46:09,841 >> YEAH, THE REASON I ASK THIS, 1088 00:46:09,841 --> 00:46:14,379 I WAS WONDERING, IS THIS MAINLY 1089 00:46:14,379 --> 00:46:16,314 FOR HELPING QUALITY ASSURANCE -- 1090 00:46:16,314 --> 00:46:18,416 QUALITY IMPROVEMENT FOR THE 1091 00:46:18,416 --> 00:46:20,786 FUTURE PATIENTS VERSUS THIS IS 1092 00:46:20,786 --> 00:46:22,788 SOMETHING THAT CAN ALSO AFFECT 1093 00:46:22,788 --> 00:46:24,756 THE CURRENT PATIENTS? YOU KNOW 1094 00:46:24,756 --> 00:46:26,124 WHAT I MEAN? 1095 00:46:26,124 --> 00:46:29,761 >> RIGHT. THAT IS SOMETHING THAT 1096 00:46:29,761 --> 00:46:31,429 WE HAVE THOUGHT ABOUT, IS THIS 1097 00:46:31,429 --> 00:46:33,899 EARLY NOTIFICATION OF THIS 1098 00:46:33,899 --> 00:46:35,867 POTENTIAL RETURN. WE HAD THOSE 1099 00:46:35,867 --> 00:46:37,068 TYPE OF MECHANISMS IN EMERGENCY 1100 00:46:37,068 --> 00:46:38,703 DEPARTMENTS FOR OTHER THINGS SO 1101 00:46:38,703 --> 00:46:41,306 A PATIENT LET'S SAY GETS 1102 00:46:41,306 --> 00:46:43,108 DISCHARGED BUT HAVE A LAB THAT 1103 00:46:43,108 --> 00:46:45,277 COMES BACK INDICATIVE OF 1104 00:46:45,277 --> 00:46:46,244 SOMETHING MORE SERIOUS SO THEY 1105 00:46:46,244 --> 00:46:49,114 GET CALLED BACK. YOU COULD 1106 00:46:49,114 --> 00:46:49,981 THEORETICALLY HAVE SOMETHING 1107 00:46:49,981 --> 00:46:52,551 VERY SIMILAR IN THIS SPACE WHERE 1108 00:46:52,551 --> 00:46:55,787 THE LLM IS REVIEWED AT THE 1109 00:46:55,787 --> 00:46:57,422 24-HOUR MARK. SAYS OH, THERE IS 1110 00:46:57,422 --> 00:46:59,424 A POTENTIAL MISS HERE . 1111 00:46:59,424 --> 00:47:01,426 THE TROUBLE WITH THAT IS IT 1112 00:47:01,426 --> 00:47:04,863 DOESN'T HAVE THE FINAL DIAGNOSIS 1113 00:47:04,863 --> 00:47:06,097 YET. THERE IS A LIMITATION 1114 00:47:06,097 --> 00:47:07,465 BECAUSE YOU ARE NOT FEEDING IN 1115 00:47:07,465 --> 00:47:09,501 TO SAY THIS WAS THE DIAGNOSIS, 1116 00:47:09,501 --> 00:47:12,304 THIS WAS THE PRIOR CONTEXT. SO 1117 00:47:12,304 --> 00:47:14,573 THERE IS SOME LIMITATION SO I 1118 00:47:14,573 --> 00:47:16,208 TOTALLY AGREE THAT IS AN 1119 00:47:16,208 --> 00:47:17,576 OPPORTUNITY IN THE FUTURE. I 1120 00:47:17,576 --> 00:47:19,744 THINK THE QUESTION IS LIKE HOW 1121 00:47:19,744 --> 00:47:21,079 MUCH IMPACT DOES THAT HAVE ON 1122 00:47:21,079 --> 00:47:22,848 THE HEALTH SYSTEM AND HOW MANY 1123 00:47:22,848 --> 00:47:25,750 PEOPLE ARE YOU CALLING BACK? YOU 1124 00:47:25,750 --> 00:47:26,818 WOULD NEED A PRETTY SPECIFIC 1125 00:47:26,818 --> 00:47:28,520 SYSTEM SO YOU ARE NOT CALLING 1126 00:47:28,520 --> 00:47:32,290 BACK 10%, 20% OF PATIENT 1127 00:47:32,290 --> 00:47:33,058 POPULATION. ALL THOSE THINGS 1128 00:47:33,058 --> 00:47:34,893 WOULD HAVE TO BE WORKED OUT. 1129 00:47:34,893 --> 00:47:38,363 >> YEAH. IF I MAY, ANOTHER 1130 00:47:38,363 --> 00:47:41,266 QUESTION I HAVE IS, NOW 1131 00:47:41,266 --> 00:47:44,569 DEVELOPED THIS AI MODEL BASED 1132 00:47:44,569 --> 00:47:45,937 SYSTEM, I DON'T THINK I HEARD 1133 00:47:45,937 --> 00:47:48,373 MUCH ABOUT HOW ARE YOU GOING TO 1134 00:47:48,373 --> 00:47:49,708 EVALUATE THIS? HOW DO YOU KNOW 1135 00:47:49,708 --> 00:47:52,744 THIS IS GOOD ENOUGH TO BE 1136 00:47:52,744 --> 00:47:54,112 IMPLEMENTED IN YOUR HEALTH CARE 1137 00:47:54,112 --> 00:47:54,379 SETTINGS? 1138 00:47:54,379 --> 00:47:56,615 >> YEAH, SO THE PROCESS WE ARE 1139 00:47:56,615 --> 00:47:59,851 GOING TO GO THROUGH FROM AN 1140 00:47:59,851 --> 00:48:00,719 EVALUATION STANDPOINT IS A LOT 1141 00:48:00,719 --> 00:48:03,755 OF THE -- SO A LOT OF MANUAL 1142 00:48:03,755 --> 00:48:06,358 REVIEW, SO USING THE QI TEAM TO 1143 00:48:06,358 --> 00:48:08,493 MAKE ASSESSMENT ABOUT HOW WELL 1144 00:48:08,493 --> 00:48:12,297 THE AI IS IDENTIFYING THE 1145 00:48:12,297 --> 00:48:14,199 OPPORTUNITIES, THE DISADVANTAGE 1146 00:48:14,199 --> 00:48:16,434 IS THE FLAGS AND IDENTIFICATION 1147 00:48:16,434 --> 00:48:19,838 OF CASES, YOU ARE A LITTLE 1148 00:48:19,838 --> 00:48:21,406 UNBALANCED. IF YOU ARE ONLY 1149 00:48:21,406 --> 00:48:22,974 PULLING IN THE ONES THE SYSTEM 1150 00:48:22,974 --> 00:48:25,377 IS ALREADY IDENTIFYING, YOU ARE 1151 00:48:25,377 --> 00:48:26,378 ONLY CLARIFYING THOSE POTENTIAL 1152 00:48:26,378 --> 00:48:30,982 ONES THAT ARE THE FALSE 1153 00:48:30,982 --> 00:48:32,284 POSITIVES. THAT IS ONE THING WE 1154 00:48:32,284 --> 00:48:34,719 ARE WORKING THROUGH. SOME OF 1155 00:48:34,719 --> 00:48:36,688 THIS JUST REQUIRES SAMPLING. WE 1156 00:48:36,688 --> 00:48:38,924 HAVE ALSO STARTED THINKING ABOUT 1157 00:48:38,924 --> 00:48:40,425 EXPLORING DOING SOME FINE-TUNING 1158 00:48:40,425 --> 00:48:42,160 AND TRAINING OF SMALLER MODELS 1159 00:48:42,160 --> 00:48:44,329 TO BE ABLE TO ALIGN WITH SOME OF 1160 00:48:44,329 --> 00:48:48,466 THE KIND OF QI FEEDBACK AND THE 1161 00:48:48,466 --> 00:48:50,302 SCORING COMPONENTS. ONE OF THE 1162 00:48:50,302 --> 00:48:52,270 THINGS I MENTIONED THE SCORING 1163 00:48:52,270 --> 00:48:53,972 ASPECTS OF THINGS BUT WE HAVE 1164 00:48:53,972 --> 00:48:56,174 SEEN THE LARGE LANGUAGE MODELS, 1165 00:48:56,174 --> 00:48:57,742 THEY TEND TO GO TOWARD THE 1166 00:48:57,742 --> 00:48:59,511 EXTREMES. IT IS EITHER THE POINT 1167 00:48:59,511 --> 00:49:01,012 SCORE SYSTEM IS VERY LOW OR IT 1168 00:49:01,012 --> 00:49:03,581 IS VERY HIGH AND THERE IS NOT A 1169 00:49:03,581 --> 00:49:05,450 LOT IN THE NUANCE IN THE MIDDLE, 1170 00:49:05,450 --> 00:49:08,320 SO I THINK THERE'S DEFINITELY 1171 00:49:08,320 --> 00:49:10,422 WORK TO HAPPEN IN THAT SPACE. 1172 00:49:10,422 --> 00:49:12,958 THEN YEAH, I THINK ULTIMATELY IT 1173 00:49:12,958 --> 00:49:16,561 WILL COME DOWN TO THE QI TEAM IN 1174 00:49:16,561 --> 00:49:18,730 EVALUATION ABOUT HOW WELL WE ARE 1175 00:49:18,730 --> 00:49:20,598 DOING IN IDENTIFYING THEM AND 1176 00:49:20,598 --> 00:49:22,767 COMPARING IT TO EXISTING SYSTEMS 1177 00:49:22,767 --> 00:49:26,638 AS WELL. BECAUSE THEY WILL STILL 1178 00:49:26,638 --> 00:49:32,944 PROBABLY HAVE THE REPORTING 1179 00:49:32,944 --> 00:49:33,845 MECHANISMS AS WELL. 1180 00:49:33,845 --> 00:49:36,948 >> I HAVE A BUNCH OF QUESTIONS. 1181 00:49:36,948 --> 00:49:39,017 MAYBE I CAN DO ONE MORE BECAUSE 1182 00:49:39,017 --> 00:49:42,187 WE PROMISED TO WRAP UP AROUND 1183 00:49:42,187 --> 00:49:43,989 2:15. SO THE QUESTION IS, SEEMS 1184 00:49:43,989 --> 00:49:47,092 TO ME LIKE YOU NEED REAL-TIME 1185 00:49:47,092 --> 00:49:48,660 DATA TO OBTAIN DATA FROM 1186 00:49:48,660 --> 00:49:50,462 PATIENTS COMING TO THE ER. COULD 1187 00:49:50,462 --> 00:49:53,098 THEY BE PING ED WITH A FEW BRIEF 1188 00:49:53,098 --> 00:49:54,432 QUESTIONS THAT WOULD HELP 1189 00:49:54,432 --> 00:49:56,001 SHEPHERD THEM TO THE CORRECT 1190 00:49:56,001 --> 00:49:57,335 DOCTOR OR SPECIALIZATION OR FLAG 1191 00:49:57,335 --> 00:49:59,838 THE SEVERITY OF THE CASE? 1192 00:49:59,838 --> 00:50:01,906 >> SO YEAH, I WOULD -- THAT IS 1193 00:50:01,906 --> 00:50:03,341 ANOTHER -- DEFINITELY ANOTHER 1194 00:50:03,341 --> 00:50:06,378 AREA OF TOPIC AND DISCUSSION. SO 1195 00:50:06,378 --> 00:50:09,147 I CONSIDER THESE LIKE THE KIND 1196 00:50:09,147 --> 00:50:12,017 OF PRE-TRIAGE OR KIND OF -- LIKE 1197 00:50:12,017 --> 00:50:15,653 AN AI-BASED TRIAGE SYSTEM WHERE 1198 00:50:15,653 --> 00:50:19,224 IT IS REALLY FIGURING OUT IS THE 1199 00:50:19,224 --> 00:50:21,993 CASE AN EMERGENCY, CAN WE DO A 1200 00:50:21,993 --> 00:50:23,395 BETTER JOB OF GETTING PATIENTS 1201 00:50:23,395 --> 00:50:26,364 TO THE RIGHT SPACES, COULD THEY 1202 00:50:26,364 --> 00:50:27,632 POTENTIALLY GET URGENT CARE, DO 1203 00:50:27,632 --> 00:50:29,701 THEY NEED TO COME TO THE 1204 00:50:29,701 --> 00:50:30,635 EMERGENCY DEPARTMENT TO 1205 00:50:30,635 --> 00:50:32,437 FACILITATE THEM BY FOLLOWING UP 1206 00:50:32,437 --> 00:50:34,172 WITH THEIR PRIMARY CARE DOCTOR 1207 00:50:34,172 --> 00:50:35,473 THE NEXT DAY? I DEFINITELY THINK 1208 00:50:35,473 --> 00:50:37,275 WE ARE GOING TO SEE THOSE 1209 00:50:37,275 --> 00:50:39,177 SYSTEMS. THERE ARE A COUPLE OF 1210 00:50:39,177 --> 00:50:41,179 COMPANIES I KNOW THAT ARE 1211 00:50:41,179 --> 00:50:43,415 ALREADY IN THAT MARKET TO HELP 1212 00:50:43,415 --> 00:50:45,717 BETTER FACILITATE PATIENTS ALONG 1213 00:50:45,717 --> 00:50:48,153 THEIR CARE JOURNEY. SO YEAH, I 1214 00:50:48,153 --> 00:50:50,822 COMPLETELY AGREE THAT THAT IS 1215 00:50:50,822 --> 00:50:52,924 HAPPENING TO OTHER PIECE I ALL 1216 00:50:52,924 --> 00:50:55,193 LOUED TO A LITTLE BIT WAS 1217 00:50:55,193 --> 00:50:56,795 PATIENTS WE HAVE SEEN IN 1218 00:50:56,795 --> 00:50:58,897 EMERGENCY DEPARTMENT BUT IN 1219 00:50:58,897 --> 00:51:00,999 OTHER ENVIRONMENTS THERE, IS A 1220 00:51:00,999 --> 00:51:02,867 LOT OF DOWN TIME WITH PROCESS. 1221 00:51:02,867 --> 00:51:04,469 MOST PATIENTS IN OUR EMERGENCY 1222 00:51:04,469 --> 00:51:05,136 DEPARTMENTS ARE STAY THERE YOU 1223 00:51:05,136 --> 00:51:08,840 GO SEVERAL HOURS. THE ABILITY TO 1224 00:51:08,840 --> 00:51:10,508 BE ABLE TO COLLECT A DIFFERENT 1225 00:51:10,508 --> 00:51:12,343 -- OTHER INFORMATION ABOUT THEM 1226 00:51:12,343 --> 00:51:14,512 RELATED TO THE CARE PROCESSES, 1227 00:51:14,512 --> 00:51:17,282 WE ARE NOT REALLY DOING I THINK 1228 00:51:17,282 --> 00:51:20,485 A GREAT JOB OF THAT RIGHT NOW SO 1229 00:51:20,485 --> 00:51:21,052 EVEN TALK ABOUT SOCIAL 1230 00:51:21,052 --> 00:51:22,620 DETERMINANTS OF HEALTH OR, YOU 1231 00:51:22,620 --> 00:51:25,256 KNOW, DOING SCREENING FOR CANCER 1232 00:51:25,256 --> 00:51:27,325 AND OTHER THINGS, THOSE -- WE 1233 00:51:27,325 --> 00:51:29,894 DON'T REALLY HAVE SYSTEMS RIGHT 1234 00:51:29,894 --> 00:51:32,864 NOW. THE ASK CURRENTLY FOR A LOT 1235 00:51:32,864 --> 00:51:36,901 IS FOR NURSING TO DO THAT TYPE 1236 00:51:36,901 --> 00:51:39,571 OF SCREENING. AS I MENTIONED 1237 00:51:39,571 --> 00:51:42,140 PREVIOUSLY, NURSING STAFF IS 1238 00:51:42,140 --> 00:51:44,609 ALREADY OVERBURDENED AND BURNED 1239 00:51:44,609 --> 00:51:47,045 OUT. SO THINGS TO OFFLOAD THOSE 1240 00:51:47,045 --> 00:51:49,147 TYPES OF TASKS ON THEM WOULD I 1241 00:51:49,147 --> 00:51:51,950 THINK BE HELPFUL. 1242 00:51:51,950 --> 00:51:54,652 >> YEAH, YEAH. PERSONALLY, TO 1243 00:51:54,652 --> 00:51:57,088 ME, THOSE CASES WHERE 1244 00:51:57,088 --> 00:51:58,823 MISDIAGNOSIS HAPPENS THEY FIELD 1245 00:51:58,823 --> 00:51:59,824 LIKE A GOLD MINE BECAUSE THESE 1246 00:51:59,824 --> 00:52:01,993 ARE CASES WHERE WE HAVE 1247 00:52:01,993 --> 00:52:03,128 PARTICULARLY PARTICULAR 1248 00:52:03,128 --> 00:52:04,062 DIFFICULT TO DIAGNOSE SO WOULD 1249 00:52:04,062 --> 00:52:05,930 BE AMAZING TO HAVE A COLLECTION 1250 00:52:05,930 --> 00:52:08,566 FOR FINE-TUNING OF LLMS OR ANY 1251 00:52:08,566 --> 00:52:12,704 OTHER TRAINED MODELS. I WANT TO 1252 00:52:12,704 --> 00:52:14,372 THANK YOU SO MUCH FOR THIS VERY 1253 00:52:14,372 --> 00:52:16,841 EXCITING AND INTERESTING TALK. 1254 00:52:16,841 --> 00:52:18,810 CAN WE HOPE THAT YOU MAY COME 1255 00:52:18,810 --> 00:52:22,380 BACK TO US IN SOME NEAR FUTURE 1256 00:52:22,380 --> 00:52:23,715 AND UPDATE WITH THE PROGRESS IN 1257 00:52:23,715 --> 00:52:25,817 THE SYSTEMS IN THE EMERGENCY 1258 00:52:25,817 --> 00:52:27,585 CARE BASED ON THE NUMBER OF 1259 00:52:27,585 --> 00:52:28,953 QUESTIONS A LOT OF PEOPLE WERE, 1260 00:52:28,953 --> 00:52:30,922 YOU KNOW, VERY INTERESTED IN 1261 00:52:30,922 --> 00:52:33,258 THIS TALK. THANK YOU SO MUCH, 1262 00:52:33,258 --> 00:52:33,591 DR. TAYLOR. 1263 00:52:33,591 --> 00:52:34,993 >> YEAH, THANK YOU ALL VERY 1264 00:52:34,993 --> 00:52:38,329 MUCH. 1265 00:52:38,329 --> 00:52:45,537 >> THANKS, BYE. (TRANSCRIBING OF 1266 00:52:45,537 --> 00:52:50,375 THIS CALL HAS STOPPED. 1267 00:52:50,375 --> 00:53:00,618 )