My name is Manny Berenji. I'm an occupational and environmental medicine physician. I wear a couple of different hats. I work primarily at UC Irvine, the Department of Occupational Environmental Medicine program. I also work at the VA Long Beach healthcare system. I am the chief of occupational health services and also lead environmental health physician. But really more than anything, I am a technologist. I do see the potential of incorporating all the technologies that are coming and already here. I'm not sure if you all attended Dr. McKinney and Dr. Clement's talk earlier today. They really set the stage for me to really start to expand upon some of the concepts they brought up with respect to how we can utilize technologies like generative AI, machine learning, virtual reality. How can we actually start incorporating these technologies into OEM practice today? Dr. Saito, who I hope will be here, but he actually tasked me with putting together this presidential task force, looking at how AECOM can really start advancing digital transformation. And with my environmental health experience, I want to make sure that we actually incorporate planetary health into our digital transformation paradigm. So hopefully you'll all indulge me today. This is really just to introduce these topics to you and really start some conversations about how we envision developing this technology in our respective workplaces, whether it's in a clinic, in a consulting practice, or what have you. So embracing digital transformation. Change is hard. I mean, there's so much coming at us every given day. How do we actually start processing this technology and try to incorporate it into our clinical workflows and our regulatory paradigms? And also with the changing climate, there is so much happening with respect to our planetary ecosystems. A lot of these technologies do utilize high amounts of energy, and there are these discussions happening in the energy sector as well as in the health sector about how do we actually start to wrap our heads around the energy utilization. So while we want to be able to use these technologies to help advance our ability to take care of patients and deliver high quality care, there is an energy component to that. So hopefully we can start to have these conversations and really start to develop multidisciplinary teams to address these problems. So healthcare transformation. So the way that I envision digital innovation in the OEM space really is multi-pronged. I just wanted to introduce some of these topics to you for discussion purposes. But really the way that I'm envisioning it, we can really utilize these technologies to improve healthcare delivery, enhancing worker well-being, all the while minimizing environmental impact. I think if we have these three concepts in mind, when we start to advance the technology, be able to incorporate these paradigms into our clinical and respective workplaces, I do think that we can do this, but we really need to be intentional about how we understand the technology and the potential ramifications for our patients and our environments. So clearly there are challenges. I know we continue to battle high healthcare costs. There are continuing inefficiencies in care delivery, and we continue to battle occupational and environmental hazards, not only in the workplaces, but in our ambient environments. So how do we systematically address these obstacles and try to close these gaps? This is really just food for thought, and we can continue these discussions afterwards. But I just wanted to at least bring this to your attention, because these technologies, they're great, but they come at a cost. And who's going to pay for it? I mean, really we're having these fundamental discussions about insurers. Are they going to pay for the utilization of these wearable devices and these sensors? Are they going to be able to develop that payer infrastructure to be able to see the value that these technologies can bring our patients and delivering better outcomes? I still think that we're kind of in the early stages of really processing this information, but I just wanted to at least bring this to your greater awareness. So advancing worker health through digital technologies. Many of you attended Dr. McKinney and Dr. Clement's talk earlier today, and they did a phenomenal job of kind of laying that foundation. How can we use generative AI and machine learning algorithms to help with the early detection of occupational diseases, especially with respiratory conditions? I mean, there's so much potential for being able to incorporate machine learning algorithms to pinpoint if someone's going to develop a condition like silicosis, for instance. I'm actually developing a partnership with some folks actually here at the University of South Florida where we can start developing these machine learning algorithms to really predict the development of pneumoconiosis even before a person starts to develop symptoms based on their respective worker cohorts. I mean, there's a lot of potential for this technology, but we have to make sure that we're bringing the teams together, asking the right questions, and making sure that we have a deliberative scientific process by which we can evaluate these questions. Enhanced monitoring of worker health. A lot of you may know about the wearables. I'm not sure how many of you are wearing a smartwatch, but that, I was going to say a couple of us already. I mean, that is information that is essentially going into the cloud. It's actually being run through an algorithm and can actually provide specifics with respect to how are we living every single moment of our day, and how can we actually start to incorporate a technology like the smartwatch in the worker environment. I know a lot of us work for companies, multinational companies. A lot of us are in the consulting world. How do we actually set that infrastructure to be able to monitor an individual's heart rate oxygenation level? A lot of the workers that we take care of work in very precarious environments. Heat stress is a real thing. How can we actually start to utilize some of these technologies to kind of help us identify who is at risk and making sure that we can develop the protocol to take them out of the work environment if we see that there are indicators that we can predict will lead to potential injury or illness. I wanted to touch upon personalized health interventions. There's been a lot of talk about personalized medicine and precision medicine. I think this is a really exciting area for us in OEM to really start to flesh out how we envision developing individualized risk models for being able to assess an individual's potential for developing any said disease or illness. Clearly we have to be mindful of data privacy and personalized health information being disseminated in a way that's going to compromise a person's confidentiality, but I do think that there are ways that we can get involved in this space. I wanted to touch upon telemedicine. I know a lot of us had started using this technology in the early days of the pandemic. I was one of those clinicians who unfortunately my clinic got shut down during the pandemic and I had to completely convert my in-person practice to a virtual practice. I was lucky to be in an environment where I could be a champion for telemedicine just by virtue of having such a disruptive force like the pandemic. We had to change our entire way of delivering healthcare literally within days. It took something of that magnitude to bring telemedicine to the forefront. From that experience, I realized the power of telemedicine to continue to deliver high quality care to our worker populations. I just wanted to bring up a couple of ways where we can continue to utilize this technology, whether it's through a remote consultation, real-time health monitoring, and now with the advancement of virtual care delivery. I know a lot of us are facing challenges with reimbursement. I know I had. Hopefully there will continue to be discussions about making sure that there is parity between a virtual consultation and an in-person consultation, but I think telemedicine is here to stay and how we continue to utilize the technology in OEM is important. I think I've already touched upon this earlier, but just to bring it back to the forefront, how do we incorporate wearable technologies and in using these technologies to enhance occupational safety? I think there is infinite possibilities here. Being able to track vital signs, monitoring exposure hazards, and then ultimately being able to promote healthy behaviors. How can we actually help our respective patients make, essentially empower them to make good decisions about their health so that they can continue to lead productive lives? I think there's a lot of ways we can do this. This is an area of personal interest to me, data analytics. A lot of us work in clinical environments. We work in respective corporations, and being able to take in all these data points and be able to make sense of it so we can make informed decisions, not only for our patients but for our clients. I think this is really where the rubber meets the road. We have the population health know-how to develop the frameworks for data infrastructure and making sure that we are able to make data informed decisions when it comes to our patient populations. I'm very excited to see the possibilities here. Making sure that we train our physicians, our nurse practitioners, our physician assistants in this lexicon is going to be key. I wanted to touch upon sustainability. I know there's been a lot of discussion about corporate sustainability and making sure that corporations and healthcare organizations really understand that sustainability is one of the pillars of maintaining a healthy and thriving organization. As occupational and environmental medicine clinicians and practitioners, we really have a large say in this area. Our training gives us that fundamental understanding about the importance of having a thriving environment and a healthy environment so we can continue to do our jobs and continue to be productive members of society. As many of you know, we continue to battle the climate crisis. Being able to create these thriving environments where we can reduce our carbon footprint and be able to create eco-friendly healthcare solutions so we can minimize greenhouse gas emissions. I think there is ways where we can develop that fundamental framework and be able to really be at the table when it comes to how these decisions are being made, both at the C-suite level and really at the clinical level. Ultimately, we want to promote a healthier workplace environment. As occupational and environmental medicine physicians, we have a lot of say in this area. I'm very optimistic that we will continue to expand the knowledge in sustainability and how it applies to workplace environments. This is just kind of getting into some of the topics I've already mentioned, looking at the digital healthcare evolution and OEM, telemedicine, health tech innovations, and really global partnerships. How do we actually leverage our positions as OEM practitioners to have these conversations and bridge the gaps and making sure that our stakeholders understand the potential of digital innovation when it comes to creating better outcomes for our patients and our workers. We need to continue to educate our colleagues, both in medicine and outside of medicine, about the potential of this technology to really inform and to promote healthy workplaces across the globe. I think I had mentioned this earlier, but we always have to be cognizant of the regulatory issues that come with the utilization of these technologies. Data privacy is clearly one of those. We need to make sure that we're addressing regulatory compliance, as well as patient confidentiality, and to be able to have a say in that, we have the knowledge and the expertise to provide that knowledge to respective stakeholders. Whether it be CMS or other federal agencies, we bring that unique perspective about patient confidentiality as it applies to the worker populations. So we need to leverage that knowledge and make sure that we are at the table when those decisions are being made. Ultimately, we need to also ensure that we're training our next generation of clinicians and practitioners, making sure that our residents are up to speed with how to utilize these technologies and their day-to-day activities. Having folks like Dr. McKinney, who is double board certified in occupational and environmental medicine, as well as clinical informatics, he's been a role model for me personally. I'm actually pursuing board specialization in clinical informatics because I see the power of having that knowledge to be able to do the work that we need to do. So hopefully this will be a continuing conversation. I would love to be able to incorporate clinical informatics into OEM training, and hopefully we can start these conversations here at AOHC. So this is really just highlighting how we can optimize digital transformation, and it's a multi-pronged approach, engaging our stakeholders to make sure that they understand the potential of this technology, at the same time making sure that we're utilizing it in an intentional way and being mindful of the regulatory frameworks. How do we establish clear goals for utilizing this technology in clinical practice, as well as in our occupational safety management? And then really continuous quality improvement. I know a lot of us are already using this technology. We're developing those large language models. But how do we continuously assess if these models are actually working, and making sure that we can be mindful of potential biases? I think we need to make sure that we're incorporating these types of evaluatory processes in place. And lastly, fostering a culture of innovation. I think a lot of us understand the power of digital technology and its potential impact on OEM practice, but making sure that we can continue to inspire our fellow colleagues who may be slightly reticent to utilize the technology, make sure that we stay curious and we can inspire others. I don't have a lot of real-world case studies, but I'm hoping that with the folks in this room and continuing to build upon the knowledge, we can have more case studies to share in the future. This is just looking at innovative trends in digital healthcare. I've already mentioned a few of these. Being able to utilize generative AI to drive diagnostics. How do we utilize predictive analytics for preventive interventions? And virtual reality and OEM practice. I know we have a couple of folks here who are in the tech space, and they're already developing these models for virtual reality to conduct physical examinations virtually. I think there's a lot of knowledge and expertise in this room, and if we put our minds together, we can really achieve some great things. And lastly, fostering collaboration. We need to continue to partner with our respective colleagues in industry, as well as in academia, in developing these industry academic collaborations. We also need to develop public and private partnerships and making sure that we're doing standardized knowledge sharing for technological advancements. So these are just a couple of my recommendations. We need to invest in digital infrastructure. We need to invest in workforce training. We need to prioritize data security, and we need to foster a culture of innovation. And I'm hopeful that we can do that with AECOM. And I also wanted to touch upon planetary health. As we start to advance these technologies, we need to be mindful of how these technologies are impacting our greater environments. So making sure that whatever interventions that we develop utilizing technology, that we have that climate consciousness, and making sure we incorporate these sustainability metrics. So now I'm going to segue to some of the work I've been doing with Dr. Saito as part of his presidential task force, really trying to look at digital transformation through a planetary health lens. So the objective of the task force was to create thought leadership on OEM and digital transformation, and seeing how AECOM can be in a better position as really as a global hub for everything technological when it comes to OEM. So goal number one was to start to develop the thought leadership. We really need to start putting together content when it comes to understanding the technology and how we see the applications in OEM practice. All in the while, making sure that we're being climate conscious about how these technologies are having an environmental impact and how we can minimize that environmental impact. This is really kind of a breakdown as what I envision in terms of the pillars of technology as it applies to OEM practice. So clearly generative AI machine learning is one bucket and how we can start to develop the infrastructure for how we can apply these large language models in OEM practice. The second pillar is augmented reality and virtual reality applications in how we deliver healthcare as well as how we do medical education. The third pillar is developing surveillance advances, including sensors and wearable devices, and developing the data analytic infrastructure to analyze the data. And then lastly, corporate sustainability and making sure that we have the analytics in place for our corporate clients. So with respect to updates this past year, I've been able to convene an AI machine learning working group. We have a couple of folks, some of them are in the audience. We're trying to start putting together the outline and we're in process of developing content. So if anyone wants to join this effort, we're more than happy to have you. We need all the best minds to be able to produce a paper that's going to put OEM on the map. Goal number two for the presidential task force was to develop a second position paper on telemedicine and really kind of providing some historical context as to how telemedicine was utilized in OEM practice. Pre-pandemic, during the pandemic, and what we anticipate telemedicine to be post-pandemic. And how do we incorporate some of these new technological advancements that we've mentioned, like remote patient monitoring, generative AI, machine learning, into occupational environmental medicine practice. I've been fortunate to connect with some of my peers at the American Medical Association to really start to develop this infrastructure, as well as the regulatory framework. And I partnered with the Digital Health Strategy Division within the Physician Innovation Network at AMA. And I'm happy to share some of the work that we've done. So over the last year, I've been invited to a number of discussions with the AMA. I was recently invited to their, there was an event in Las Vegas called HLTH. It's a huge digital technology conference where startups, venture capitalists, and healthcare practitioners all come together to discuss innovations in healthcare. And I was invited by the AMA to be part of a Physician Innovation Network panel, talking about the potential applications of technology in OEM. And it was a big hit. Providing that perspective is important, because a lot of times we're not in the room when it comes to decisions being made about healthcare delivery and technological advancements. So I highly recommend to all of you that you continue to be ambassadors of the specialty, making sure that you continue to educate folks who may not know what OEM is and what we bring to the table. And I was very fortunate to be in that position at this conference, and just meeting people who are doing these amazing innovations in healthcare. And being able to be a part of those conversations, to me that's the first step. I'm also working on advancing the telemedicine paper. Some of my peers had started the initial work in the early 2020s, and I wanna make sure that we update that to include some of the regulatory landscape as it pertains to reimbursement. So hopefully I'm gonna be able to get this together in the next few months, have the board take a look, and we can get that out for publication in JOEM. This is goal number three, so really developing additional subspecialties when it comes to occupational environmental health and health informatics. I really wanna be able to continue to advance the knowledge base when it comes to climate change and how we can leverage the power of data to be able to make informed decisions about how we deliver healthcare. And I wanted to kind of share some of the partnerships I've been able to develop during this time. So in my pursuit to pursue clinical informatics specialization, I recently joined the American Medical Informatics Association, and I have been very impressed with these professionals. They are physicians, health informatics trained PhDs, nurses who have specialization in nursing informatics. It's a very diverse group of individuals, but they understand the power of data. And I've been very fortunate to start working with these folks to not only educate them about OEM, but how we can actually leverage our knowledge of occupational environmental medicine and driving the development of new specializations. So I'm happy to say that we actually created a climate health informatics working group, and we're continuing to develop papers and webinars to educate our respective colleagues about what climate health informatics is, and how we can start to utilize the data coming from not only the healthcare industry, but from other sources. NOAA has all this data about temperature, and CDC has all this data as well. So how do we start to incorporate all these data sources to start analyzing the data and how it impacts our worker populations? I think there's a lot of potential for ACOM to start partnering with these associations, and I'm hopeful that we can continue these conversations in the future. In that vein, I was recently invited to another digital technology conference called VIVE, and I had the fortune of talking about the impacts of climate change on marginalized communities. I live in Los Angeles, and I take care of folks in a volunteer clinic in South Central Los Angeles, and I see the impacts of climate change and environments on these folks. So I was able to provide that perspective on this panel with a few of my peers from the informatics community, and really starting these conversations is the first step, and educating our fellow peers in the technology spaces to ensure that they understand that whatever technologies that they're developing, that they have that occupational environmental understanding. So I thought it was a great way to kind of share that knowledge and continue the discussions. So the future state. What do we envision our technologies to do for our workers and our respective patients? I think there's been a lot of discussion today about all these technologies like generative AI and machine learning, virtual reality. A lot of it sounds like buzzwords, but we're really at that pivotal moment where we need to start setting up the strategic plan. How do we envision this technology to impact our patients in the next five to 10 years? So hopefully we can start these conversations here at AOHC and continue to propel these discussions forward. That's all I had. I'm happy to take questions. Thank you. And so this is over a nine-month period. What we did is we extracted data from the EMR, which has the location of each of the patients, used aggregate data. And then using a Euclidean distance, not an actual travel distance, but basically as a crow flies, which actually underestimates the actual drop-off. We found that over this nine-month period of time, 19,385 metric tons of CO2 was saved. And this is equivalent to 2,181,000 gallons of gasoline emissions that we were able to save. And it goes on and on in terms of comparison. So it's really a dramatic environmental reason, rationale to continue telemedicine in terms of compensating it, in addition to any health outcomes of concern. The other project was a project that looked at, first, there was a project done initially in terms of outcomes, in terms of caring for people in and of youth, premature infants, versus sending them home for a period of three weeks earlier than the water was sent home. And then caring for them at home with a combination of virtual care and occasional home visit, while the outcomes were the same. However, this, again, were engineering students at the college who did a life cycle analysis, meaning, what was the waste saved? And what was the emissions saved with that? And I don't have all the numbers here, but it was fabulous savings from a carbon emission perspective. That's great. We need to write this up, because I really would love to highlight some of these practical cases. To me, that's how we learn, and we adopt best practices. If we have real life examples, I would love to be able to put those together in a compendium as part of our paper, and I would love to talk to you about that. So the first case, what has been published? Oh, great. Excellent. Excellent. Any other questions or comments? Yes, sir, in the back. Yes, ma'am. So I'm currently an occupational medicine resident, once upon a time resident. So I love everything about this. So the question I have is, going from the paradigm you have here, which I love, from concepts to practical, scalable implementation, what do you feel are the bottlenecks that you anticipate as you go from where we are, from 0 to 1 and 1 to 1,000? And the next question I have, I know quantum computing is like a buzzword. Is there any relevance for that to be incorporated into this paradigm, of evolving our capabilities? I'm sorry, sir. Can you repeat the second question? I don't think I got that. Is there any relevance of quantum computing, in addition to AI, for what we're trying to do here? So I'm going to address the first question first, and then hopefully I can try to come up with the answer to the second one, because I'm not sure if I have a good answer for the second question. In terms of being able to scale these types of technologies and applications to the workplace, we're going to need resources. And I'm not just talking financial resources. We need knowledge resources. We need to have clinicians who have expertise in the technologies themselves. I mean, we have some of these folks in the room. But quite frankly, I think we need to incorporate clinical informatics training into OEM training. The next generation of OEM clinicians are going to be data analysts. And how we actually start to bring all this information and start to distill it down to the nuts and bolts, we need to make sure that our residents and our clinicians understand the language of data, and making sure that they can apply it in real time. So I think there needs to be a fundamental transformation of how we train our residents and our clinicians so that they are equipped with the resources that they need to be able to make those data-informed decisions. Unfortunately, I don't think I have a good answer for you for the second question. If anyone else has any ideas or recommendations, feel free to just jump in. I might have to research that one for you, sir, but I will definitely get back to you. Feel free to come up to me after the discussion, and I'll get your contact information. Any other comments or questions? Gentleman in the middle. That's you, yeah. Dr. Smith, chief of public health out at Fort Campbell. I think this is a great talk. A lot of very poignant decisions taken on where we should be going in the future. I just want to kind of hear your thoughts on how we are going to, we as an occupational health body, are going to operationalize the use of wearables and what that advertising is going to be to get workers to give us that data and allow us to take measurements. Because there's a lot of resistance. Even for our industrial hygienists who are going out and doing standardized evaluations, there's a lot of resistance. So to be able to say, hey, why don't you give me the access to your wearable to wear all day, every day, so that I can use it to be safer? Yeah, right. That can instill a lot of concern, a lot of speculation on whether you're only going to look at the time that they're working or if there's going to be a monetary amount to the value of that data. That's the next big question that I see. How do you sell this to administrators to be able to get that? Right. I think these are great questions. Honestly, I think it's going to take stakeholder engagement, not only with the C-suite, but also with unions. A lot of us have experience working with various different stakeholders across the industry, making sure that we're transparent in how we're collecting the information, how the information is going to be utilized, and making sure that we're following the rules and regulations as they currently exist. I actually think we need to be more vocal in how the technology regulatory frameworks are developed and making sure that we bring that data privacy perspective to these conversations. I know that this work can be done, but we need to be methodical and essentially intentional when it comes to really. understanding that the data, having the safeguards in place. I'm sure you all have been following what's been happening with cybersecurity lately. I mean, the whole change healthcare debacle that continues, I think over half of Americans had their data essentially leaked. And to me, that is just the tip of the iceberg. We really need to develop our cybersecurity infrastructure. But these are great points, and honestly, I think we need to continue these conversations and hopefully develop these frameworks as a team. Yes, Michelle, go ahead. Thank you, so thank you, Dr. Branby. That was a great presentation, lots to think about. I just wanted to comment on what has been brought up about getting from zero to one. That is very, very difficult, and I've had the opportunity to work with the CDC on occupational data for some. One of the key takeaways we've found thus far is the buy-in from the frontline staff, the people that are talking to your patients. Because you bring up a good point, you know, people are reluctant to give even their occupation because they don't know what you're going to do with this information. So we've gotten a lot of leverage by getting a champion, a front desk person that could then teach the rest of the staff the importance of this, help them communicate to the patients, address concerns as they're checking the patient in. So that's been a key takeaway from our project thus far. It takes a lot of time and a lot of work, but you don't have to go anywhere. Thank you. Thank you, Michelle. Yes, sir. I'm Dr. Eric. I'm the chief of occupational medicine at Miller Air Force Base. What do you recommend to get into this field? So as I'm looking to transition out of the military, this is something that I'm wanting to get into. And so I briefly looked up clinical informatics and how to get into that. You need someone on the task force. Thank you. But what do you recommend? How to get smart on this? Yeah. I mean, I'm just going to relay my personal experience. I mean, I kind of started to look into clinical informatics a few years ago during the height of the pandemic, just because of what was happening in my clinical practice. I was working with some of our epic folks at Boston Medical Center, which is where I was during the pandemic. And I was talking to some of the clinical informaticists there. And I realized that I didn't have the knowledge. So I needed to start determining ways to get the knowledge. So really just starting to ask the clinical informaticists at your respective health care institution, looking at courses that you can take. I'm currently pursuing board specialization through the practice pathway, through ABPM. Unfortunately, they're bringing that to a close, which is not something I think is a good idea. Because I want to make sure that clinicians have the ability to still do the training and still be able to work at the same time. But I think that's changing. They really want folks to do formalized clinical informatics training in a two-year fellowship. I'm hoping that the powers that be will extend the practice pathway option. Because to me, that's the way to get more clinicians into the space. If you give them the opportunities to leverage educational opportunities through the American Medical Informatics Association. I mean, quite frankly, I think ACOM could be a part of this. I mean, we'll have to have the conversations with our leadership. But I think being able to at least have ways to provide the education to our members at a discount. I mean, there's a lot of opportunities there. So please talk to me afterwards. I'd love to share more. But these are just my general impressions right now. Yeah, Myles, go ahead. Yeah, hi. I'm Dr. Myles Weston with the International Health Service. And actually, one of my roles is health innovation. I think one of the challenges we also have is just how we're going to pay for this and the commercialization. I know that during the pandemic, we were working with MITRE on some mass technology where we could actually identify the COVID cases at the city level globally, which is pretty cool. But we didn't figure it out until pretty much the pandemic was over. And then companies kind of said, well, we don't need it anymore. They're probably going to need it soon again. But I think the challenge is commercially, how do you – all this stuff takes a lot of time and money. And organizations typically are late adopters of these things. So it's trying to make it by the end, which is also a big challenge. I think that's a good point, Myles. But at the same time, I think we need to make sure that there are going to be continuing threats, whether it's infectious disease or other potential hazards that come up, making sure that corporations and health care institutions realize that we need to have the data infrastructure in place, and making sure that we can start to create incentives for them to actually take that first step. You know, creating a community of practice, having some of the early adopters just get on board, creating those use cases, and then disseminating to the greater corporate world. You know, if you have a few of those adopters, then the rest will follow. I mean, that's kind of how I envision that working out, because I do know that a lot of these corporations understand data, and they want to make data-informed decisions. We just have to be able to get some of those early adopters to get on the bandwagon, demonstrate in a use case, and then really start getting this information out to these trade conferences. I just started recently attending some of these trade conferences, and they're hungry for this knowledge, but we're not in the room. So we need to make sure that we start to kind of identify where these conferences are, have a contingent of some of us OEM clinicians, making sure that we can give, you know, webinars, we can have panel discussions, making sure that we're talking to folks from industry, venture capital, PE firms. I mean, they want this information, but we have to be in the room. Yes, ma'am. Cherie. I'm Cherie Peltier. My question is somewhat related to this gentleman here with privacy. You've mentioned that throughout. The data is not protected in the same way as the medical information in our records. So what is in our current initiatives? What is in the pipeline? What do we expect to see in regards to safety? That is one of the key things that will allow the front line to buy into this. Honestly, I think we need to do it. We just need to do it as a collective, because we can't just wait for some regulatory agency to do it. I think we need to start finding our fellow legal colleagues who have experience in digital privacy. I mean, this is a side topic, but I'm actually working on another position paper on digital privacy, and we're actually reaching out to the greatest legal minds in the United States to get their insights, and then really start to come up with regulatory frameworks that we can essentially pitch to the respective regulatory agencies. I don't think we should wait for someone to do it. I think we should do it. Yes, ma'am. Go ahead. I have a question. I had some legal background, so I ended up doing research on telemedicine law when I was in university. And what I found was that I did compare the telemedicine law and compare the U.S. law to other nations such as Europe. When we try to extend telemedicine in regulatory perspective, the United States has a great disadvantage, because right now the medical board, the licensing is controlled by the state. And if you want to be a leader in telemedicine, I think it is kind of regulatory change. You know that health and medical license was originally state-based regulatory activity, but telemedicine makes it kind of go outside of that. It brings it into international commerce, not even interstate commerce. And those doctors in Europe have no barrier to any of the telemedicine outside of their country, because their location of practice is defined by where the physician is, not where the patient is. And the United States has no barrier. Right now, if somebody wants to have telemedicine for any of you, and you want to connect with a patient who's out of state, you kind of have this question about, am I licensed to do this? And that's a big barrier. I'm glad you brought that up. I know that in my telemedicine research, I've encountered that as well. I do think that there needs to be some reimagination of how we practice telemedicine. I know in the last couple of years, there's now what's called the compact license. I don't know if you all have knowledge of that. But in about half the states in the United States, if you're licensed in one of those states, you can technically apply for a license in one of those compact states. And you have to pay a nominal fee. But essentially, that's kind of open the way for a lot of clinicians who want to practice across state lines. If you have that compact license, you pretty much have half the United States covered. Unfortunately, I only have six medical licenses, and they're not in the compact. So I'm kind of out of luck. But I mean, I think that's an important issue in the United States. And really, from an international perspective, I mean, you brought up some really interesting points, and I would love to talk to you afterwards. How do we set up the international regulatory framework for how we deliver telemedicine? My suggestion is we need to go a little European ground, especially for international medicine. If we define our location, like if we define the practice from our location, which is like European, then you'll be able to find a location in Germany. Right now, we don't know whether we are allowed to do that. I would love to talk to you, because I think you're bringing up some really great points. And I would love to be able to kind of discuss that further. So feel free to come up to me after the talk. Gentleman in the back who's standing. It's because they don't have a robust infrastructure underlying. It seems like we're potentially facing garbage in, garbage out problems here with informatics. Where do we stand with development of a common interface and language in the EHR from a top level? Honestly, that's a great question. I don't think I'm smart enough to answer it. Does anyone have an answer? I mean, I think you're bringing up some good points. I agree. I think we need to have some standardization in terms of data language and processing, and how we can actually have that uniformly applied across various different healthcare institutions. I think you bring up some good points. We need to make sure that we're at least bringing this up to the respective stakeholders and at least having those conversations in the hope that we can start to really make some waves in that area. Because I agree. If we don't get on top of that, we're going to continue to have problems. I think that's where you need to go. You need to go to NIST first. You need to go to IEEE. Because I believe in developing communication standards in the community. So you need to have that collaboration between NIST and IEEE. Because I see it all the time. There's a spectrum on the backside of it. So I think that's where you need to start. Actually, that's a great point. We should talk later, because I'm always looking for new potential collaborations. I mean, I just kind of started this work. But honestly, I think this presidential task force needs to continue, and we need to have a five- and ten-year strategic plan for how OEM can really start to make waves in these respective spaces. Yes, sir, please. So as occupational physicians, we're also should be concerned about the impact of these new technologies on the health of our healthcare providers. So I think we have a very recent example in terms of the launch of the EMRs and how it was obviously built for financial purposes as opposed to healthcare purposes, as opposed to user-friendly user interface purposes. So I think that one of the things that should be on this task force, if you will, is really to think about how to mitigate potential impact stresses associated with launching new technologies. The second point I just want to make, the second point we brought up, one of the sessions yesterday was the risk of running after shiny new technologies that may make someone a lot of money but may not accomplish any of their promised goals, better outcomes, easier use, more efficiency, et cetera, et cetera. An example was robotics, robotic herniography versus laparoscopic herniography. The robotic one cost $100,000, the laparoscopic I think was $40,000, and the robotic trained physician didn't know how to do the herniography. So there clearly are some risks in terms of the impact on the healthcare workforce, number one, and number two, in terms of really whether or not the investment is worth its fees. I'm going to address your first question. I think you're referring to clinician burnout in terms of adopting a lot of these new protocols and workflows. I'm doing a lot, but I'm actually doing some work on clinician burnout and documentation burden and how we can actually leverage technology to reduce the burden, especially on primary care providers who unfortunately take the brunt of all the new and all these new additional steps that they have to take in the EHR. I know Michelle knows this, but we recently joined a group called the End Burnout Group. They are a group of informaticists who are really trying to fundamentally change the way that we document. I mean, a lot of the things that we do in healthcare when we document is really for reimbursement purposes, and CMS kind of sets those guidelines. But I think we need to reimagine how we document. How we can actually leverage technology to work for the clinicians. I'm not sure if you all have heard of ambient listening. I mean, essentially there are technologies where it can actually start to kind of take the narrative from the clinician and the patient and then really start to produce essentially a document based on that discussion. So really my hope is that we can start to use the technology that's essentially intended for clinicians, and I think this has been the biggest issue for the last few decades. The EHR was developed without clinician input for the most part, and essentially clinicians turned into data entry monkeys. I mean, let's be real. That's what it is. So how can we actually change that narrative and utilize technology in a way that's going to help the clinician deliver better care instead of having to type while they're seeing a patient and not having that eye-to-eye contact, utilizing technologies like ambient listening and some of these natural language processing modalities to create a cohesive note that captures all the elements, at the same time making sure that the clinician can really attend to the patient right in front of them. I'm pretty optimistic because I know there's a lot of discussions happening right now, and there are these amazing startups out there that are actually developing that technological infrastructure. It's just a matter of how we start to incorporate this into our respective clinical workflows. And then that brings up another point. How do we get C-suite to actually agree to essentially put the resources that are needed to set that infrastructure in place? So I think there are a couple of moving parts involved, but I do think that there is hope. Groups like the End Burnout Group, I'm happy to share more information with whoever wants to learn more about this group. I mean, these people are phenomenal. They're actually working with some standards organizations as we speak. They've actually made some inroads with HL7, which is the international standards body, to really start to kind of develop these standards and try to make them less onerous for the clinician, and then really having conversations with other stakeholders like CMS. A lot of what we document really is not necessary. We need to make sure that we kind of get back to the fundamentals when it comes to taking care of patients. And to me, I mean, I'm not sure if you all do medical record reviews. Like, you literally have to sift through pages and pages of fluff to get to the assessment and plan. Like, to me, that's where the note is. Like, you want to get the clinician's assessment. You want to understand what's happening to this patient. How can we start filtering through all the noise and get to the core element of what the note really should be, the clinician's impression and what their ultimate plan is? So I think there's some innovations happening in the documentation space, which I'm very excited about. Yes, sir, in the back. Yes, ma'am. Just a quick question on clinical informatics. So my first time was math. I did physics. I love that world. What is the value of doing a fellowship versus just getting involved in the right working group, the right project, and just doing the work? Yeah, honestly, this is a great question. I'm kind of in the latter camp. I just decided to start doing the work and find the people who are in the spaces that I want to get into. Luckily, I still think I'm going to meet the eligibility criteria through the practice pathway. But I've already talked to the folks at the American Medical Informatics Association. I essentially told them that you're going to alienate literally thousands and thousands of clinicians who want to become clinical informaticists just because you're going to close down this practice pathway. And I think it's a mistake. I think they should still have that as an option. But for right now, if you're really interested, feel free to join our work group. I mean, we want to make sure that we have the best and the brightest minds involved in this work because how we set this up now is going to dictate our success as a specialty. We really have to jump on this bandwagon now because otherwise we're going to be left behind. And we don't want to be kind of trying to kind of pick up where we could have really started to be the thought leaders in developing the technology that works for us as OEM clinicians and practitioners. I just don't want to be left behind. And so I took it upon myself to really start building the knowledge and finding these people who are interested in the same things I am and developing those partnerships and just leading by example. I think we're at time. Thank you all so much for joining us, and let's continue these conversations. Thank you.

Dr. Manny Berenji

occupational and environmental medicine physician

generative AI

machine learning

virtual reality

healthcare delivery

worker well-being

environmental impact

digital transformation