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today with Dr. Michael Megerdichian,
the Chief System Medical Simulation

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Officer at New York City Health and
Hospitals. Michael,

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thank you so much for joining us today.

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Thank you so much for having me.
I really appreciate it.

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For our listeners, as background,
New York City Health and Hospitals is the

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largest municipal health system in the
United States with the largest health

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care simulation fellowship program in the
world. It is headquartered in New York,

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New York with 4,
500 beds across 11 acute care hospitals,

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supported by 9,
400 physicians like Michael. So Michael,

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When you're using EMR data to target
simulation interventions,

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what does that pipeline look like and
where does it get stuck?

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So that's actually a really challenging
piece to what we've been trying to do.

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And I think that that's where we've been
kind of hitting some walls,

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but at the same time having some
breakthroughs.

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The EMRs are generally made to develop
the opportunity to generate revenue.

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And so it's not really focused on looking
at standards of care.

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Group?

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It's not really focused on looking at
clinical practice in a way

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that thinks about are we hitting the mark,
are we exceeding the mark,

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are we falling behind?
And so what we've been trying to do is to

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use the EMR to inform essentially
databases and to create database

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infrastructures like dashboards to say,
hey,

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are we hitting this quality improvement
metric or this quality metric?

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So one example that we've been using it
for is offering buprenorphine,

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which is a medication specific for
treating opiate withdrawal.

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And what we're trying to see is whether
or not providers have increased their

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utilization of ordering buprenorphine.

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after we did an intervention using
simulation education and seeing whether

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or not we can use the data in the EMR to
track whether or not we are hitting the

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marks that we're hoping to hit in terms
of are our prescribers giving this

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medication or not,
or is there an increase? And so

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We've been trying to use the EMR to tell
that story. Where it becomes challenging,

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though,
is there are so many different codes for

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tracking whether or not somebody has an
opioid use disorder and whether or not

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they are willing to take on this
medication or not.

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is something that is not really
translated through the EMR. And instead,

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Mmh.

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it's really intended to say, hey,
this person came in,

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they have opioid use disorder,
we can bill them at that billing rate.

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And so how we're actually navigating,
doing,

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essentially looking at the language used,
how the physician writes in the note,

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the interaction and the engagement,
it is user dependent.

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And so if you've not created your EMR in
a way that is interested in the question

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that you care about,
then it's really hard to extrapolate

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whether or not an intervention,
be it simulation or quality improvement,

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is actually leaving its mark

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On the system or not, and...

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So a few things. First of all,
it sounds like what you're doing is

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leveraging Epic to evaluate the
effectiveness of your educational

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interventions. Is that correct?

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Exactly, yeah.

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And so it occurs to me that we may have
jumped the gun here.

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For the benefit of my listeners,
and excuse me for not asking initially,

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would you mind giving a few sentence
description of why there is a chief

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system medical simulation officer and
exactly what falls within your purview?

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Because it's a little bit

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outside the lane of the CIO stack we
usually speak to.

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Yeah,
so the Chief System Medical Simulation

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Officer was a position created for the
purpose of deploying simulation or

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healthcare simulation to this largest
public healthcare public hospital system.

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And initially,
the idea was addressing 2 particular

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problems.
But we had a problem with infections with

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central lines. And so

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We wanted to be able to use healthcare
simulation to reduce the incidence of

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infection, because one infection,
depending on AskHR data,

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can be anywhere between 46 to $80,
000 per infection cost to the hospital.

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The other was in shoulder dystocia,
where we had three large lawsuits back in

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the earlier 2000s.

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where it cost the system $10 million.
And so that was why healthcare simulation

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was created.
But what we've done with it since then is

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we've made it a vehicle of quality
improvement and patient safety.

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And so in doing that,
it has become of great interest for me as

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the lead of this to use data systems to
inform

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why we're doing an intervention,
whether or not the intervention is being

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effective or wasting people's time,
and when we need to pivot.

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And then lastly,
whether or not we need to reintroduce

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another intervention because the effects
of the original intervention has waned.

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So there's like a degradation effect to
it.

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Mhm.

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And so we have to think about when do we
need to reinsert ourselves to push again.

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So back on the topic of simulation,
as a simulation fellowship and virtual

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reality use cases scale across a system
the size of New York City Health and

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Hospitals,
what's the hardest part of running that

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technology consistently across the many
different sites of cares?

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Uh, that, that, that's in the system.

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So it really is thinking about whether or
not there are people who are able to use

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the technology, one, and then two,
whether or not you have the ability to

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store and deploy the technology within
the area.

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So using it is whether or not somebody
can run a simulator. So for example,

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we use Laerdal and Gamard simulator
systems.

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Mhm.

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which require a certain level of
proficiency.

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And so in order to scale the use of those
particular systems, we're actually create,

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we've created train the trainer programs
so that nurse educators,

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other educators within residency programs,
as well as people within quality can come

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and learn how to use them.

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and then deploy them within
scenario-driven exercises to create

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experiences.
So that's taking a robot and literally

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having it run vital signs,
make it breathe, blink,

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do all the different things that a human
can do,

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and to recreate an experience to think
about how we actually performed in that

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experience.

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So just before we get into VR,
I'm trying to understand,

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VR is different.

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I'm imagining kind of one of those CPR
dummies that has additional tech built

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into it.
Is that what we're talking about here?

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So, but that's just the base level of it,
right?

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Yeah.

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And so there are the CPR dummies that
have additional tech.

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They can look at how well you're doing
chest compressions.

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00:07:11.508 --> 00:07:11.988
Mhm.

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They can see how well you're actually
breathing with a bag valve mask.

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But there are now ones that actually act
as birthing simulators.

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There are ones that can have a heart
attack and you can locate exactly what

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vessel based on

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whatever you plan for the experience to
be is blocked and it can recreate an EKG

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and an echo accordingly.
There are elements that allow you to

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offer, you know, using ultrasound.
We even have simulators now where we can

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do full surgeries based on our trauma.
We do a full trauma surgery where

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Somebody has had a gunshot wound and the
bullet has ricocheted across the abdomen

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00:07:51.588 --> 00:07:51.748
Mm.

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and into the chest.
And so as the kind of the technology as

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well as the fidelity,
meaning the realism of these experiences

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00:08:01.395 --> 00:08:05.348
is growing,
what we're able to do is just expanding.

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00:08:05.748 --> 00:08:08.930
Adding VR and AR,
now that's adding another element of what

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/45-1
00:08:08.930 --> 00:08:10.628
we can actually achieve as well.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/46-0
00:08:11.028 --> 00:08:13.910
Let's delve into that because I
interrupted you a moment ago.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/46-1
00:08:13.910 --> 00:08:16.468
What are you doing with augmented and
virtual reality?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/47-0
00:08:17.348 --> 00:08:22.820
So augmented reality is something that is
still kind of, it's in development.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/47-1
00:08:22.820 --> 00:08:26.117
We haven't gotten to where I think it
will be,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/47-2
00:08:26.117 --> 00:08:31.378
but I do think that that is where the
future is for healthcare simulation.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/47-3
00:08:31.378 --> 00:08:35.447
The reality is,
is that hospitals have geographic as well

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/47-4
00:08:35.447 --> 00:08:35.588
as

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/49-0
00:08:35.708 --> 00:08:39.336
physical structure spaces that are fixed.
You can't change them.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/49-1
00:08:39.336 --> 00:08:43.131
And if you are doing that,
you're doing a study of whether you need

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/48-0
00:08:40.428 --> 00:08:40.948
Mhm.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/49-2
00:08:43.131 --> 00:08:46.034
to change them for process flows and
systems flows.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/49-3
00:08:46.034 --> 00:08:50.332
But what it does is it allows you to
create an experience within that actual

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/49-4
00:08:50.332 --> 00:08:53.625
present reality.
And I think when we're looking at quality

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/49-5
00:08:53.625 --> 00:08:55.188
improvement, patient safety,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/50-0
00:08:55.428 --> 00:09:00.242
that's going to be a game-changing tool.
And so more investment into that, I think,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/50-1
00:09:00.242 --> 00:09:03.852
is where we need to go,
because the reality is practicing in a

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/50-2
00:09:03.852 --> 00:09:07.348
virtual environment is very good for
educational foundation.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/50-3
00:09:07.348 --> 00:09:11.417
Or if you're creating a virtual
environment to think about process and

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/50-4
00:09:11.417 --> 00:09:15.028
flow before you started a project,
that's another opportunity.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/52-0
00:09:15.988 --> 00:09:20.024
But augmented reality is working within
the confines of the space that you

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/52-1
00:09:20.024 --> 00:09:22.769
already exist in.
And so how those systems work is

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/51-0
00:09:21.348 --> 00:09:22.068
So, just...

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/52-2
00:09:22.769 --> 00:09:23.308
important.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/53-0
00:09:23.668 --> 00:09:27.087
To be concrete,
are we talking augmented reality?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/53-1
00:09:27.087 --> 00:09:32.832
There's somebody in New York City Health
and Hospitals who's a Greenbelt Six Sigma,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/53-2
00:09:32.832 --> 00:09:38.439
and they have a project and they want to
envision how to reconfigure the workflow

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/53-3
00:09:38.439 --> 00:09:42.748
with the nurses station on the 4th floor,
and then they put on

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/54-0
00:09:43.108 --> 00:09:48.788
AR goggles or tell me exactly how AR
would work with a concrete example or two.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/57-0
00:09:48.588 --> 00:09:52.496
Yeah,
so I think I would start actually with VR

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/57-1
00:09:52.496 --> 00:09:56.893
first, right?
Where I would have this particular Lean

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/55-0
00:09:54.388 --> 00:09:55.148
Let's do that.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/57-2
00:09:56.893 --> 00:10:03.408
Six Sigma person will build out the space
with VR, with technology around that,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/56-0
00:09:59.588 --> 00:09:59.988
Hello.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/57-3
00:10:03.408 --> 00:10:09.108
and then create a patient flow and even
partner a little bit with AI.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/59-0
00:10:09.188 --> 00:10:13.633
because now VR and AI are actually coming
together really nicely,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/59-1
00:10:13.633 --> 00:10:18.954
where you can create experiences where
the AI can create a patient dynamic and

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/58-0
00:10:13.748 --> 00:10:14.228
Mhm.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/59-2
00:10:18.954 --> 00:10:23.938
interaction that could change the
effectiveness of the flow of the space.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/59-3
00:10:23.938 --> 00:10:28.114
It's really interesting.
And we're actually partnering with a

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/59-4
00:10:28.114 --> 00:10:30.068
couple of different companies

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/61-0
00:10:30.388 --> 00:10:33.776
looking to see where we can harness these
opportunities.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/61-1
00:10:33.776 --> 00:10:38.235
But you would want to map that out
probably in a virtual environment first

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/61-2
00:10:38.235 --> 00:10:41.802
with the configurations,
and then bring it into your actual

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/61-3
00:10:41.802 --> 00:10:46.558
environment and see whether or not your
virtual environment matches your actual

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/61-4
00:10:46.558 --> 00:10:49.828
environment.
And that's where AR can actually come in.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/63-0
00:10:50.108 --> 00:10:54.046
So I can then, just like with,
what's that game where people had their

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/63-1
00:10:54.046 --> 00:10:58.263
phones up and they saw the little,
they're trying to catch a little animal,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/62-0
00:10:57.868 --> 00:10:58.628
pokémon.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/63-2
00:10:58.263 --> 00:11:02.035
I can't remember, pokémon Go.
You can do the same thing within your

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/63-3
00:11:02.035 --> 00:11:05.586
clinical environment,
but have pokémon be a patient arriving at

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/63-4
00:11:05.586 --> 00:11:09.968
the desk and you've got your goggles on
and you're watching the flow of what's

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/63-5
00:11:09.968 --> 00:11:10.468
going on.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/64-0
00:11:11.268 --> 00:11:13.839
We are getting there.
We are not 100% there,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/64-1
00:11:13.839 --> 00:11:15.268
but we are getting there.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/65-0
00:11:14.468 --> 00:11:20.703
So are the VR and AR applications
entirely contained within the AR and VR

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/65-1
00:11:20.703 --> 00:11:24.664
hardware,
or is it supported with some kind of

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/65-2
00:11:24.664 --> 00:11:27.108
cloud infrastructure as well?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/66-0
00:11:28.308 --> 00:11:33.180
So there is a lot of them actually have a
big cloud infrastructure that's

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/66-1
00:11:33.180 --> 00:11:37.328
supporting them. The VR,
I think the limitation right now that

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/66-2
00:11:37.328 --> 00:11:42.529
I've seen with what they're doing is VR
is really focusing on education alone.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/66-3
00:11:42.529 --> 00:11:46.808
And I think that's limiting.
Not to say that the VR doesn't have

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/66-4
00:11:46.808 --> 00:11:49.508
opportunities for education because there

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/67-0
00:11:49.588 --> 00:11:51.993
are.
And I actually think that they're

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/67-1
00:11:51.993 --> 00:11:55.880
focusing on some of the wrong things,
but it is largely cloud.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/67-2
00:11:55.880 --> 00:11:58.841
And so everything is drawn down from the
cloud.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/67-3
00:11:58.841 --> 00:12:03.653
Some of the hard parts to manage are
actually the firewalls that exist within

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/67-4
00:12:03.653 --> 00:12:08.588
hospital systems to be able to pull from
the cloud and bring it to the headset.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/68-0
00:12:08.668 --> 00:12:14.013
for the purposes of actualizing some of
these things. So at my institution,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/68-1
00:12:14.013 --> 00:12:19.147
if I get new software, be it VR, AR,
or any other program, to be honest,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/68-2
00:12:19.147 --> 00:12:24.773
it's six months of reviews that it has to
go through to make sure that it's not

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/68-3
00:12:24.773 --> 00:12:29.908
somehow tapping into our EMR or our data
systems or something like that.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/70-0
00:12:30.868 --> 00:12:34.064
And that has made it really hard for
deployment,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/70-1
00:12:34.064 --> 00:12:37.326
which you had asked me about a little bit
before,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/70-2
00:12:37.326 --> 00:12:40.458
is if we want to get on the ground and
running,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/70-3
00:12:40.458 --> 00:12:45.677
there are some really hard stops to kind
of get to it before we even get to the

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/70-4
00:12:45.677 --> 00:12:48.548
human factors of adoption to be able to
go.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/69-0
00:12:46.308 --> 00:12:46.788
Mhm.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/72-0
00:12:49.188 --> 00:12:53.203
So you said that AI is applied to
simulation, I guess,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/72-1
00:12:53.203 --> 00:12:58.678
for potentially generating scenarios or
scoring performance or supporting,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/72-2
00:12:58.678 --> 00:13:03.204
I guess, new workflows.
What would need to be true for you to

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/72-3
00:13:03.204 --> 00:13:07.658
trust it and deploy it,
or what needed to be true before you

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/72-4
00:13:07.658 --> 00:13:08.388
deploy it?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/73-0
00:13:08.468 --> 00:13:08.948
It.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/74-0
00:13:09.908 --> 00:13:14.547
So there are a couple things that have
given me some trepidation around AI.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/74-1
00:13:14.547 --> 00:13:18.820
I think it's an amazing partner for what
we are trying to accomplish.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/74-2
00:13:18.820 --> 00:13:21.568
Like you said,
it does scenario development.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/74-3
00:13:21.568 --> 00:13:26.268
There are actually some really good
papers out there demonstrating the value

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/74-4
00:13:26.268 --> 00:13:30.419
of scenario development.
You can design lesson objectives that are,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/74-5
00:13:30.419 --> 00:13:32.068
you know, smart focused for

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/76-0
00:13:32.788 --> 00:13:38.296
your learning group. So there's specific,
measurable, achievable, realistic,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/76-1
00:13:38.296 --> 00:13:42.302
and time bound.
It will also try to tap into, you know,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/76-2
00:13:42.302 --> 00:13:48.168
things like PubMed and look for the most
recent evidence base for the purposes of

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/76-3
00:13:48.168 --> 00:13:53.748
making sure that the clinical scenario
design aligns with what truly is true.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/75-0
00:13:54.628 --> 00:13:54.868
Okay.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/77-0
00:13:55.108 --> 00:13:57.996
Is it perfect? No.
And we see like open evidence,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/77-1
00:13:57.996 --> 00:14:01.058
for example,
working on trying to identify like what

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/77-2
00:14:01.058 --> 00:14:05.506
is the highest quality evidence that we
can pull from to be able to achieve,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/77-3
00:14:05.506 --> 00:14:08.336
you know,
information that will help you in real

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/77-4
00:14:08.336 --> 00:14:11.687
time. You know,
largely when people are doing this within

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/77-5
00:14:11.687 --> 00:14:14.517
simulation,
they're using large language models,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/77-6
00:14:14.517 --> 00:14:17.348
like they're using Claude,
they're using Gemini.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/79-0
00:14:17.748 --> 00:14:20.963
It gives you a decent output.
I've played with it myself,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/79-1
00:14:20.963 --> 00:14:25.509
but you have to check it and you have to
know what you're looking for in order to

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/79-2
00:14:25.509 --> 00:14:30.054
be able to say, hey, this is worthwhile.
So one thing you would need that I would

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/79-3
00:14:30.054 --> 00:14:32.937
want is that somebody knows how to do it,
you know,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/79-4
00:14:32.937 --> 00:14:37.372
separately from AI so that they can check
AI's work and make sure that it's not

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/79-5
00:14:37.372 --> 00:14:38.148
hallucinating.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/78-0
00:14:38.788 --> 00:14:39.108
Mm.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/82-0
00:14:39.068 --> 00:14:42.526
When it comes to assessment,
I also worry about hallucinations.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/82-1
00:14:42.526 --> 00:14:45.390
And I think,
I assume that you've probably done this

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/82-2
00:14:45.390 --> 00:14:49.226
where like you put in a prompt into the
AI and it gives you an answer.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/82-3
00:14:49.226 --> 00:14:52.036
Next day you come back,
you put in the same prompt,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/82-4
00:14:52.036 --> 00:14:55.494
you get a different answer.
And so that variability is a little

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/80-0
00:14:52.548 --> 00:14:53.028
Yeah.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/82-5
00:14:55.494 --> 00:14:58.628
concerning because if I'm using it as an
assessment tool,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/81-0
00:14:58.788 --> 00:14:59.348
Mhm.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/83-0
00:14:59.028 --> 00:15:02.917
to standardize assessment.
And I think that that's really important

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/83-1
00:15:02.917 --> 00:15:07.206
when we're thinking about education.
I recently wrote a paper about how in

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/83-2
00:15:07.206 --> 00:15:10.066
education,
there's a lot of bias that gets played

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/83-3
00:15:10.066 --> 00:15:14.413
into it, and it creates opportunity.
It can really hurt somebody's learning

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/83-4
00:15:14.413 --> 00:15:17.501
and everything.
The AI is going to be doing that too,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/83-5
00:15:17.501 --> 00:15:18.188
potentially.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/85-0
00:15:18.468 --> 00:15:22.184
Right?
And so I would want consistent evaluation

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/85-1
00:15:22.184 --> 00:15:26.962
that is tried and true,
validated and unwavering to be able to

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/84-0
00:15:26.308 --> 00:15:26.788
Mhm.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/85-2
00:15:26.962 --> 00:15:33.256
look at something with good reliability.
And I don't think it's 100% there when it

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/85-3
00:15:33.256 --> 00:15:37.428
comes to monitoring if I were to put a
video in there.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/86-0
00:15:37.828 --> 00:15:42.885
and compare one person's performance
against another person's performance.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/86-1
00:15:42.885 --> 00:15:48.145
And so I think there has to be a lot of
work and research done on making sure

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/86-2
00:15:48.145 --> 00:15:53.607
that we're achieving that on a consistent
basis if we're thinking about using or

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/86-3
00:15:53.607 --> 00:15:57.788
teaching the AIs to be assessment tools
within SIM education.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/87-0
00:15:58.228 --> 00:16:02.982
So I want to segue a little bit.
So you mentioned we're talking about AI.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/87-1
00:16:02.982 --> 00:16:07.801
I would be interested in your thoughts on
AI guardrails, but more broadly,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/87-2
00:16:07.801 --> 00:16:10.629
I'm interested in data governance.
Earlier,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/87-3
00:16:10.629 --> 00:16:15.448
you mentioned that it's a six-month
review process to get new hardware and

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/87-4
00:16:15.448 --> 00:16:18.468
software approved to be pulled from the
cloud.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/88-0
00:16:18.748 --> 00:16:23.223
Could you speak about kind of security
and compliance and, you know,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/88-1
00:16:23.223 --> 00:16:28.216
how it's HIPAA compliant and kind of what
security concerns and AI guardrail

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/88-2
00:16:28.216 --> 00:16:33.599
concerns you have and what your processes
are for ensuring patient safety and also

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/88-3
00:16:33.599 --> 00:16:38.788
the integrity and safety of the data
within New York City Health and Hospitals?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/89-0
00:16:39.268 --> 00:16:42.074
Yeah,
so I think there's a couple of things

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/89-1
00:16:42.074 --> 00:16:46.346
specific to my area. One,
I will say that New York City Health and

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/89-2
00:16:46.346 --> 00:16:51.384
Hospitals is becoming very vigilant about
any software that has AI capability.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/89-3
00:16:51.384 --> 00:16:54.701
And so they are doing even longer reviews
for them.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/89-4
00:16:54.701 --> 00:16:57.188
We use a program called Viant to create

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/90-0
00:16:58.228 --> 00:17:01.894
videos, essentially.
You can create animated videos and AI can

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/90-1
00:17:01.894 --> 00:17:06.143
help you create those. You can have,
you can put in a script and it will

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/90-2
00:17:06.143 --> 00:17:10.858
generate something for you that you can
use for either education or information.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/90-3
00:17:10.858 --> 00:17:14.466
And a lot of the different groups,
we started using it first,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/90-4
00:17:14.466 --> 00:17:17.668
a lot of different groups started jumping
into it. But

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/92-0
00:17:17.908 --> 00:17:21.216
as AI became part of its reality,
now it's kind of,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/92-1
00:17:21.216 --> 00:17:25.607
we're getting pulled back.
We're not being allowed to use as much of

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/91-0
00:17:23.508 --> 00:17:23.988
Mmh.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/92-2
00:17:25.607 --> 00:17:30.761
the AI infrastructure because they are
developing their process of understanding

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/92-3
00:17:30.761 --> 00:17:35.342
what is risky and what is not.
And I would say that we are still in the

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/92-4
00:17:35.342 --> 00:17:37.188
early phases of that process.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/93-0
00:17:37.988 --> 00:17:43.285
With simulation in AI,
and if we are using AI as a simulation

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/93-1
00:17:43.285 --> 00:17:47.471
tool,
there is a huge cybersecurity risk around,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/93-2
00:17:47.471 --> 00:17:51.829
I think,
if we are collecting video and that video

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/93-3
00:17:51.829 --> 00:17:59.006
is being evaluated by someone or by an AI,
and that is stored on an AI cloud in any

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/93-4
00:17:59.006 --> 00:17:59.348
way,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/95-0
00:17:59.508 --> 00:18:03.024
and perhaps that provider has a
malpractice claim,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/95-1
00:18:03.024 --> 00:18:07.712
that that actually could leak.
And so some of the things that we do

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/94-0
00:18:03.988 --> 00:18:04.188
Yeah.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/95-2
00:18:07.712 --> 00:18:12.952
around healthcare simulation to think
about privacy is to make sure that we

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/95-3
00:18:12.952 --> 00:18:18.468
have a policy on data and that we do a,
we eliminate the data within two weeks.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/96-0
00:18:18.748 --> 00:18:24.163
unless it's related to research,
because we don't want that data to leak

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/96-1
00:18:24.163 --> 00:18:29.207
in any way, shape, or form.
And so we have to make sure that the AI

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/96-2
00:18:29.207 --> 00:18:34.548
has some form of auto-deletion that's
happening and verify that there's

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/96-3
00:18:34.548 --> 00:18:38.628
auto-deletion to make sure that any of
that data is...

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/97-0
00:18:40.308 --> 00:18:45.368
is never able to be grabbed again for the
purpose of malpractice.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/97-1
00:18:45.368 --> 00:18:49.661
I think that that's where we really need
to be careful.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/97-2
00:18:49.661 --> 00:18:55.104
And there also has to be a board of
ethics around AI. Like we need to,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/97-3
00:18:55.104 --> 00:18:56.868
as hospitals or medical

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/98-0
00:18:57.828 --> 00:19:02.833
People need to come and bring our heads
around AI within the sphere that I'm

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/98-1
00:19:02.833 --> 00:19:08.228
talking about, but I think in all spheres,
to think about how we are collaborating

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/98-2
00:19:08.228 --> 00:19:13.558
with it in the most ethical way possible.
And what expectations do we have around

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/98-3
00:19:13.558 --> 00:19:17.068
the people who are using it to permit
them to use it?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/99-0
00:19:17.188 --> 00:19:20.483
because I think you've probably seen more
recently,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/99-1
00:19:20.483 --> 00:19:24.476
there's been a lot of writing around
people just not thinking,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/99-2
00:19:24.476 --> 00:19:29.419
they're just using AI. And, you know,
the ability to distinguish and to think

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/99-3
00:19:29.419 --> 00:19:34.299
about what's good about this information,
what's bad about this information,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/99-4
00:19:34.299 --> 00:19:36.708
how am I going to use it and apply it,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/100-0
00:19:37.428 --> 00:19:41.777
We need to be teaching to that in order
to be able to make sure that people are

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/100-1
00:19:41.777 --> 00:19:43.028
using it appropriately.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/102-0
00:19:43.828 --> 00:19:47.286
So we're approaching the end of the
podcast episode.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/102-1
00:19:47.286 --> 00:19:50.484
I have two final questions I'd like to
ask. One,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/102-2
00:19:50.484 --> 00:19:55.639
I'd just like to touch upon what your
technology partner landscape looks like,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/102-3
00:19:55.639 --> 00:20:00.729
the extent to which you're trying to
design these solutions yourselves versus

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/102-4
00:20:00.729 --> 00:20:02.948
pulling in your VR and AR vendors.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/101-0
00:20:01.988 --> 00:20:02.468
Mhm.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/103-0
00:20:03.108 --> 00:20:07.749
I wonder where you wish you had more help
rather than another vendor to manage.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/103-1
00:20:07.749 --> 00:20:10.707
Is there,
if you look towards managed solutions to

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/103-2
00:20:10.707 --> 00:20:15.116
manage all the AI tech in one place,
would you prefer to more manage it all

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/103-3
00:20:15.116 --> 00:20:18.771
in-house, build it in-house?
What are your thoughts on kind of

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/103-4
00:20:18.771 --> 00:20:22.948
managing partners and the extent to which
partners can add value versus

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/104-0
00:20:23.188 --> 00:20:25.348
Like, but you're at the cost of control.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/105-0
00:20:26.268 --> 00:20:28.913
Yeah,
so I think when we're thinking about

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/105-1
00:20:28.913 --> 00:20:33.836
partnerships, it's important to co-create.
And I think that that's the way that

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/105-2
00:20:33.836 --> 00:20:36.851
we've been approaching it.
There's dual benefit.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/105-3
00:20:36.851 --> 00:20:40.296
One is that if you're co-creating with an
organization,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/105-4
00:20:40.296 --> 00:20:44.788
they may be a little more cost lenient on
you when you're thinking about

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/107-0
00:20:45.188 --> 00:20:49.317
getting a particular product,
because they're benefiting in the fact

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/107-1
00:20:49.317 --> 00:20:53.027
that they're getting your expertise to
develop a new product.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/107-2
00:20:53.027 --> 00:20:57.635
Largely people who are within these areas
don't have necessarily the medical

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/107-3
00:20:57.635 --> 00:21:01.644
expertise for what they're trying to
create. And so in doing that,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/107-4
00:21:01.644 --> 00:21:04.456
they're going to want to collaborate with
you.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/107-5
00:21:04.456 --> 00:21:07.748
So what we've been doing is we've been
partnering with

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/108-0
00:21:08.068 --> 00:21:11.355
different groups and creating content
with them.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/108-1
00:21:11.355 --> 00:21:16.186
And this allows us an education in what
are we, what is the capability?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/108-2
00:21:16.186 --> 00:21:20.883
What are the possibilities?
And it allows us to think about different

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/108-3
00:21:20.883 --> 00:21:25.982
ways of deploying it and using it that we
might not have considered before.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/108-4
00:21:25.982 --> 00:21:26.788
I think it's

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/109-0
00:21:27.188 --> 00:21:32.877
We were not trained to understand the
full scale of what AR, VR, even AI can do.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/109-1
00:21:32.877 --> 00:21:38.216
And so partnering with people who you
trust will allow you to probably push

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/109-2
00:21:38.216 --> 00:21:43.906
that technology further for the purposes
of achieving goals that you hadn't even

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/109-3
00:21:43.906 --> 00:21:47.348
thought of when you first went into the
venture.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/110-0
00:21:47.908 --> 00:21:52.128
Some of the listeners of this episode may
be wondering, this is all great.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/110-1
00:21:52.128 --> 00:21:56.292
I understand the value here for medical
simulation, for formal education,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/110-2
00:21:56.292 --> 00:22:00.287
for those academic medical centers where
there's a school of medicine,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/110-3
00:22:00.287 --> 00:22:03.664
there's a school of nursing,
there are opportunities there.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/110-4
00:22:03.664 --> 00:22:07.828
I can see there are use cases for just
any health system with clinicians.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/112-0
00:22:08.148 --> 00:22:13.981
Can you just take a moment to speak to
the benefits to health systems that lack

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/112-1
00:22:13.981 --> 00:22:16.388
a formal educational environment?

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/113-0
00:22:17.268 --> 00:22:22.816
So I would say we get bucketed as
education so frequently that that runs a

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/113-1
00:22:22.816 --> 00:22:27.995
risk of missing opportunity.
And so I think if you think of education

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/113-2
00:22:27.995 --> 00:22:32.951
as an arm that lives under quality
improvement and patient safety,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/113-3
00:22:32.951 --> 00:22:37.908
healthcare simulation offers so many
opportunities to partner with

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/114-0
00:22:38.388 --> 00:22:42.799
quality improvement and patient safety.
Largely when quality improvement and

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/114-1
00:22:42.799 --> 00:22:46.465
patient safety come out,
they may be trained in, like you said,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/114-2
00:22:46.465 --> 00:22:49.502
Lean Six Sigma,
or they might have access to the IHI

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/114-3
00:22:49.502 --> 00:22:54.257
tools that are available, like, you know,
how do you do an FEMA or how do you do a

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/114-4
00:22:54.257 --> 00:22:58.611
driver diagram, fishbone diagram.
But what healthcare simulation does is it

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/114-5
00:22:58.611 --> 00:23:02.908
moves the ideas and theory to true
experience, which allows you to reflect

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/115-0
00:23:03.108 --> 00:23:05.918
without causing harm,
without hurting process,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/115-1
00:23:05.918 --> 00:23:10.043
before you deploy a new idea.
And so say you don't want to invest in

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/115-2
00:23:10.043 --> 00:23:14.825
the resource for the purpose of education,
because education versus the timing,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/115-3
00:23:14.825 --> 00:23:19.309
you might want to outsource that.
You want to make sure you're moving your

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/115-4
00:23:19.309 --> 00:23:22.119
patients.
But when we're talking about quality

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/115-5
00:23:22.119 --> 00:23:25.348
improvement, patient safety,
and reduction of claims,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/116-0
00:23:25.588 --> 00:23:30.288
reduction of litigation,
simulation is a proven track record to be

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/116-1
00:23:30.288 --> 00:23:33.725
able to have a return on investment
financially.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/116-2
00:23:33.725 --> 00:23:39.197
We're getting better in our field to
demonstrate that, but with Central Line,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/116-3
00:23:39.197 --> 00:23:42.354
$80,000,
we actually showed for our shoulder

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/116-4
00:23:42.354 --> 00:23:47.125
dystocia work, for every $1 spent,
we saved between 7:00 and $12 in

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/116-5
00:23:47.125 --> 00:23:48.388
litigation claims.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/118-0
00:23:49.108 --> 00:23:52.700
They actually did an explode out within
England.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/118-1
00:23:52.700 --> 00:23:57.832
If they did this 30-minute simulation
training for shoulder dystocia,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/118-2
00:23:57.832 --> 00:24:02.230
the country would save $1 billion over a
30-year cycle. So,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/117-0
00:24:01.148 --> 00:24:01.428
Wow.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/118-3
00:24:02.230 --> 00:24:07.729
and that's just one pathophysiology.
And so we have to think a little more

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/118-4
00:24:07.729 --> 00:24:11.028
dynamically around how healthcare
simulation

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/119-0
00:24:11.188 --> 00:24:15.046
can actually be used in so many different,
it can be in space planning.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/119-1
00:24:15.046 --> 00:24:19.012
It can be used in quality improvement
projects. It could be used in, hey,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/119-2
00:24:19.012 --> 00:24:23.086
you know, we're closing down this OR.
We need to practice actually moving a

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/119-3
00:24:23.086 --> 00:24:27.159
patient from one floor to another floor
to go to an OR during an emergency.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/119-4
00:24:27.159 --> 00:24:31.125
We need to practice helping people
recognize where are safety concerns by

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/119-5
00:24:31.125 --> 00:24:33.108
creating a room of horrors, you know.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/121-0
00:24:34.228 --> 00:24:37.748
or even thinking about escalation when
people,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/121-1
00:24:37.748 --> 00:24:41.044
like violence and mental health
escalation,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/121-2
00:24:41.044 --> 00:24:44.339
all these things that we're thinking
about,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/121-3
00:24:44.339 --> 00:24:50.107
how do people get trained to react to
those situations so that they are not,

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/121-4
00:24:50.107 --> 00:24:53.028
that they are prepared for them? And so

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/120-0
00:24:52.148 --> 00:24:52.548
Yeah.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/122-0
00:24:53.188 --> 00:24:54.468
Gotta think about it differently.

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/123-0
00:24:54.948 --> 00:24:58.905
Okay, well,
we've covered a lot of ground today

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/123-1
00:24:58.905 --> 00:25:04.429
talking about medical simulation.
We've spoken about AR and VR and

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/123-2
00:25:04.429 --> 00:25:10.695
especially medical simulation within the
context of quality improvement and

97c5041a-8b6a-4723-99c9-a7875ddcdd1f/123-3
00:25:10.695 --> 00:25:13.828
patient safety, enabling data to drive