good morning or good afternoon to you all um I'm Christa Thompson with clear triage and I'm so excited that you all have joined us today for our very first 10 for 10 webinar with Dr David Thompson um just a couple of quick housekeeping things before we start our conversation today so you should see a chat button at the bottom of your screen you can use this to message a member of our team today um if you have any questions or just a general message please drop that in the chat if you have questions for our presenter they will be forwarded to him after the webinar today a recording of This webinar is also going to be available after the conclusion of this session at uh clear tri.com on our blog so you can check that we will also be sending out an email when that's available and then lastly I hope you're not but if you're experiencing any technical issues please go ahead and message us using that chat button or you're welcome to email us at support clear tri.com so without further Ado I'm going to stop sharing and we will turn our cameras on here and then um we're going to go ahead and just jump into this conversation with Dr Thompson so again let's see there we go well welcome Dr Thompson we are so excited to have you here um I we're we're excited to welcome you and for those of you joining us Dr David Thompson is board certified in both internal medicine and emergency medicine with over 30 years of clinical and Leadership experience as one of the two senior medical editors at Schmid Thompson clinical content he has led the development of widely used telea Health Resources including the adult after hours and adult office hours nurse teleah Health triage protocols that are used within clear triage his work also includes development of symptom checker healthbot consumer engagement natural language processing and telea health applications he performs benchmarking work with medical call centers aggregating data from more than 6 and a half million telephone triage calls a prolific author and speaker he has made lasting contributions to Global healthc care in the areas of telea Health quality improvement and patient centered care we are so excited again to kick off this 10 for 10 webinar uh speaker series with you Dr David Thompson so welcome Dr Thompson welcome to all of our attendees today we're so excited to have you guys with us well thank you very much Christa it's just a pleasure to be here and thank you for such a fine introduction you know before we start perhaps I've got a question for you if that's okay absolutely you know Christa we share the same last name Thompson we do are we related in some sort of way I am so glad that you have asked this Dr Thompson because I get this question quite a bit when I am meeting our customers and folks for the first time no we are not related though we do share a last name but there is no relation there you're right there's no relation but it's it's it's a pleasure to be with you here today let's um you got a bunch of questions for me today let's jump into it I do I'm so excited so to get started I think I think we all just kind of want to learn a little bit about um about your career and what what kind of got you started so what influenced you most in your early medical career that's a good starting question um you know someone once said Chris that life is a journey with problems to solve lessons to learn but most of all experiences to enjoy and I tell you it's been a great journey this pathway that that I've taken through College medical school then residency training 35 years working as an emergency position and gosh now 25 years authoring teleah Health triage guidelines in terms of people who influenced me in my early medical career um you know there were so many fine Physicians that provided excellent mentoring coaching instruction and modeling that I internalized all along the way I remember My First Medical School clinical rotation at Cook County Hospital working in the wards of of general surgery I remember Dr Olga jonason her Stern Authority intelligence and high expectations I remember so many good Role Models during my residency also Physicians who were strong clinicians and also strong leaders doctors like George T Castello Dr David all Dr James Matthews I also learned from my physician peers during residency doctors for example friends and colleagues Dr David Dany and Dr Craig Rosenberg we learn together in the ER and of course even then during my residency I learned so much from the nurses um in the emergency department with whom we work side by side and I continue to do that even today I'll also call out my first emergency medicine um job this is many years ago I worked at mcneel hospital with doctors's Alan spaone and Dr Jeff Schwarz and I think they were the ones who first introduced me to this idea of using technology to improve um clinical operations so many positive influences have helped me along the way so good good first question yeah no it it sounds it sounds like it for sure and so you're talking about kind of that early that early history in your medical career and your career could have taken many paths right what Drew you specifically to nurse triage protocols well actually at Christa my K has taken many paths that's true in in addition to emergency medicine for 35 years I've had a number of other work um experiences that have positively influenced the way I think about and approach authoring editing and trying to continually improve our guidelines um looking back on some of them you know as far back as 1991 I first developed a software program called chart review while working as an ER physician and it could read through hundreds of ER records per minute filter them out by diagnosis and date range and then actually do documentation checking on for the Physicians for quality insurance measures wow um I served as um the medical director and chair of the mcneel hospital emergency department for 5 years and in that role I worked on systems policies procedures to improve clinical care and patient safety I served as the Chief Information officer for a large Physician Group um large physician staffing company and had responsibilities for technology development data analytics and benchmarking and I served as the chief medical officer for a large physician billing company that build for close to two million patients a year uh over a thousand position um providers that we build for and had um lead or had educational oversight for all physician documentation and compliance issues um going on I I founded a digital Health company that created software for natural language processing triage chatbots and diagnosis symptom checking and lastly um I've been on both hospital-based and National quality insurance committees which have influenced the way I think about our approach to Quality so kind of a long answer to your question but lots of lots of different things that have helped get me to where I am currently and so to follow up on that so how did you initially become involved with the nurse telephone triage protocols what inspired your interest how did you how did you start that work with the with Schmidt Thompson with Dr well in 1995 so that's a few years back I was working in the emergency department at mcneel hospital serving as the medical director and also the chair of the Department of Emergency medicine and it was a good time to be there mcneel hospital and health network was located in the western suburbs of Chicago and it was going through a bit of a Renaissance we had very enlightened leadership who were trying to do some new and Innovative things we had a fantastic medical staff and the physicians in the emergency department at the time were some of the best um Physicians with whom I worked the nurses and the ER were also excellent many medical call centers got their start in the mid and late 1990s this trend was facilitated by um advances in telefony and also computer hardware technology which in turn made possible for the first time certain types of software applications like medical call center software and our emergency department leadership working with the executive leadership of the hospital we put together a written plan for launching a medical call center at the mcneel health network and in 1996 we um launched a 24x7 full AG range medical call center Tony nska who was the assistant nurse manager of the ER at the time became the manager of of the department Tony and I plus a great group of emergency nurses jumped into this project enthusiastically you know we we did what everybody has to do we wrote detailed policies and procedures we developed an onboarding program for training in the software and clinical processes we set up a QA committee and quality improvement audits so that was kind of that was the start so when did you first meet Dr Barton SCH well this is the important part this is when I first had the opportunity to meet uh meet Dr Schmidt so in 1996 um there was a new and growing company that had a software program that could be used for performing telea Health triage in medical call centers the software company's name was National Health enhancement systems or nhes and the software program was called centrx there centrx was one of the first programs to store display and allow nurses to interact with the teleah health triage guideline there were two sets of content in the software the Pediatric content of course was written by Dr Schmidt because even at that time Dr Schmidt or Dr Bart was well recognized as being the predominant physician clinician leader in this area and was and is considered the father of teleah Health triage um in preparation for launching the mcneel medical call center I took it upon myself to recruit a group of er primary care and specialy Physicians to review every single one of the pediatric and adult guidelines that was that were present in the software we printed them all out we put them into large three- ring binders and then we distributed them to to our workers group I had the chance to read through all of them back in 1995 there were many fewer guidelines but still between the two content content sets there was close to close to 200 maybe over 200 we went through the guidelines we marked them up with red and blue pens and we met his work group and then finally customized the guideline made edits within the software which was quite difficult at the time now here here's two points first we Dr Schmidt's pediatric guidelines when we read through them were just excellent of the over 100 guidelines we made only minor changes to a handful they were just great however the adult guidelines were written by a health information company not affiliated in any way with Dr Schmidt they were much weaker in clinical decision-making care advice and just common sense so our work group ended up making substantive changes to probably over 90% of these guidelines in the weeks and months prior to launching the call center so I believe it was during this period or perhaps just shortly after launching the call center that I first um um contacted Bart and benefited from his deep expertise and his calm Authority so there you go so so that's so how did you start working with Dr Schmidt then to start so you you've told us how you met but then obviously um there's there's been development since that meeting because of where we are now so how how did we get to the point where you actually started writing those guidelines so Chris is asking me to expand so I will expand I am um yes um so four and a half years later in 1999 um the administration of our Hospital decided to close down our medical call center the call center had been frankly very successful from a clinical operations standpoint you know we had a 24x7 call center we implemented a number of innovative programs such as asthma disease management and pregnancy support we had a needle stick hotline we worked closely both with um their new health maintenance organization as well as the ACO that they had however the hospital was located in an urban area which means that there was many other hospitals in close proximity and it was very difficult to Pro prove return on investment because of the natural flow of patients to nearby hospitals so they closed the um closed the call center in about 1999 and one day um shortly thereafter um a lady by the name of Sue Alman gave me a a phone call Sue was a warm energetic and um super bright early leader in this growing field of tele Health she contacted me on behalf of Dr Schmidt and she approached me with the idea of developing an adult content set of teleah Health triage guidelines that would be as clinically robust as Barts and have a parallel structure and um organization and logic and um I spoke with Bart at length shortly thereafter and as they say the rest is um the rest is history that's amazing well thank you sue wherever whever Su and thank you Bart yes of course thank you Dr Schmid um but yes that that connection was was huge so how how did did your skills and expertise complement and build upon that initial work that has that was done by Dr Schmid at that time nice question um Bart and I um share a number of interesting and important areas of skill and background for example and maybe you know this but both of us are trained in engineering before medical school and as a result we have a similar analytic approach to thinking about and developing the complex algorithmic logic that is required to successfully have um telea Health triage guidelines that support patient safety and further we both just enjoy this process and when I was first started working with Bart he was already well known and well established in this area of teleah Health triage and he brought to our partnership um many years of experience as a pediatrician as a call center medical director ctor and as a writer of Pediatric teleah Health triage guidelines he brought to our partnership an evidence-based well tested and very robust set of pediatric guidelines he also brought his deep clinical expertise pragmatism logical thinking and just common sense so he he brought a lot to it um however there were a number of areas in which my skills and background were different different and that they complemented Barts my residency training was in Internal Medicine and emergency medicine and um I was double boarded in both and by the year 2000 when I first started working with Bart I had 15 years of full-time full age range um emergency department experience I had developed a very strong um interest in information technology I participated in our hospital it committee um wrote reporting queries on the hospital Mainframe at the time and even wrote a software program that served as an ER log an emergency department log to track patients now when I joined Bart in the year 2000 his triage guidelines were all stored as word processing documents I designed developed and implemented a relational database that could serve as a Content management system for both the adult and the Pediatric content this relational database allowed us to impose a structured and standardized format to the content that allowed us to store the content and deliver it to our software Partners in a consistent and reliable manner so that's um that's the answer to that question wonderful that that makes sense so what role do you think nurse triage protocols play and improve improving patient outcomes and overall health care efficiency well um Christa Healthcare is um frankly complex from most patients perspective and medical call centers serve as an important access point I think that's the key thing for ill and injured patients triage nurses can provide Health navigation for these patients the goal is to guide the the right patient to the right level of care at the right time triage nurses also um provide education and support for patients who may lack Health knowledge or are just simply uncertain what to do and an effective nurse triage process supports the quadruple aim and that would be the quadruple aim of better clinician experiences better patient um experiences lower costs and better outcomes of patient safety so where do teleah Health triage protocols fit into this well nurse triage protocols do three things first they provide a structured framework or script for talking to a patient second they provide decision support to the triager to help recommend the best level of care and third and just as importantly they provide a evidence-based standardized care advice to share with the patient so that every nurse that's delivering care is saying the same thing to the patient 24 hours a day very important absolutely um absolutely and and following up on on the care advice there too um really appreciate all the work you and your team have done this year I know our our clear triage customers appreciate that too um and building out those those care advice patient education handouts so um so Bravo to your team on on that um so I I want to talk a little bit about your editorial team I know over the years you have focused on assembling a strong editorial team why has this been such an important part of your work the um it has been an important part of our work because we really consider the fact of having clinical governance a part of everything that we do and clinical governance is a stepwise approach to ensuring that all the changes that we make to the care advice to the triage logic is researched reviewed viewed written tested and then finally approved and this is possible when one has a team of people working together in a collaborative manner um I'm blessed or we're blessed to have a very strong adult and pediatric editorial team on the adult team we've got um five individuals we've got Dr um Gary Marx who serves as our um medical editor on the team and he's got a background in tele medicine emergency medicine and clinical informatics we have three nurse editors that's Cheryl Patterson Janine firer and Courtney book Janine and Cheryl have an extensive many years background in telea health which they bring to the table Courtney book and I actually first worked together as in the emergency department at Northwest Memorial hospital and she has many years of experience in the emergency department and also in clinical Administration so just a a really excellent team that makes this work possible and and you also work with a broader review team how does their input contribute to improving and refining the protocols yes in the addition to the um editorial team we have a clinical advisory uh Committee of currently 11 nurse and Physicians from Top call centers across um North America this group participates in our guideline review process our Journal Review and provides um a geographically broad perspective on telea health they're great we also in addition to our clinical advisory committee we have established several very high performing work groups focusing on very specific areas of content development and updating each workg group has three to five nurses and Physicians who have substantial subject matter expertise in that area and those work groups currently are we have a hospice workg group a oncology workg group a Women's Health workg Group and a patient care advice topic workg Group which is working on you know generating patient care advice that's really focused on health literacy and plain language we're also in the process of standing up a new work Group which Lori O'Brien will be leading which will focus on new opportunities in digital health and teleah health trios that is exciting I did not know that so that I'm I'm excited to hear that um so speaking of kind of the the evolving world of telea health so these protocols were first created as you've said decades ago right what are some of the most significant changes or improvements that you have seen over the years um well decades we'll just say 25 years ago it's the they've been evolving for the um there have been many significant changes to our clinical content this past um 25 years for example the guidelines have um evolved and expanded as a result of changes in health care and Public Health needs yeah um for example we have added new guidelines for Mera that was back in 2007 radiation exposure 2011 concussion and traumatic brain injury marijuana use transgender issues and of course covid-19 and I think that we made close to 18 different updates for covid-19 over a threeyear period just a just a lot of work there um in the last several years we've also added many new specialty specific guidelines um plus a set of 24 H hospice guidelines two examples of specially specific guidelines would be um new guidelines for um followup of total hip and total knee Replacements um in addition to this we've um added tele medicine tagging to the guidelines to facilitate handoffs from a triage nurse to a tele medicine physician or to a primary care physician who's providing tele medicine care we have made health literacy and plain language Central to the way that we write health information and we have shifted um to gender neutral pronouns in circumstances where physiologic gender specificity is not required um each year uh the number of guidelines increases for 2024 there were 434 adult telea Health after hours guidelines and 360 four pediatric ones it's a big content set now yes if and uh just as a quick shout out if any of the people in the audience have further questions about any of these changes Patty Maynard our very hardworking head of Business Development would welcome hearing from you on the stcc website so just reach out to her and if anyone needs Patty's contact information as Dr Thompson shared that is available on the website um you can also just uh drop a message in the chat and our team will be happy to to help you get that contact information as well um and speaking of talking with folks from the field how do you incorporate feedback from triage nurses and healthc Care Professionals into those updates or changes that you make on those protocols this is a good question you know we um we very much welcome clinical input questions and suggestions from our clinical Partners um nearly every day of the week we receive feedback from nurse and physician leaders across the country almost every day of the week um Bart and I and our editorial teams consider this input to be gold we just love to get it and in every case uh we we respond to every email that we get so if you send us a suggestion we will respond um sometimes we may also even talk with the nurses or physician leaders by phone or by video teleconference we answer the questions we um sometimes provide research and support and sometimes we actually make changes based on their input so this the dialogue often results in changes and improvements to the clinical content to the benefit of all all users so that's really great um this input um from nurse and physician leaders across the country is a central and maybe the most important part of our quality improvement process and and we often um you know will forward you that that feedback as a vendor and so if if any of you are on the call today and wondering how you can get feedback to Dr Thompson and Dr and their teams um and you are a clear triage customer you're more than welcome to send us that feedback and we will make sure that it gets to them or um I'm assuming there's a way that they can reach out to you guys through Patty directly so that's AB absolutely correct there's you can go right onto our website there's a web form that you can use toh contact us there you go okay I want to switch gears a little bit so we've we've been kind of talking about what's brought you and and the team at Schmid Thompson to the point you are today I want to I want to look a little bit at the future and talk a little bit about the future of of triage so with the rise in AI artificial intelligence and Medicine how do you see it shaping the future of nurse triage and healthc care more broadly and I apologize that I'm asking this question because I know that we could probably talk for hours um about this but just any kind of General thoughts that you might offer today um boy I agree we could easily talk for hours about this this is a hugely complex and very large um area of possible discussion um but let's try to step into it um but speak shortly at the same time um so first the definition and the definition here's the definition that I think everybody body should kind of write down or remember artificial intelligence or AI is a branch of computer science that focuses on creating systems capable of and this is the key part performing tasks that typically require human intelligence so that's a really good definition AI encompasses a broad area um which can include machine learning computer vision natural language processing large language models or llms Robotics and many other areas as well in the context of medicine AI has a potential to revolutionize the way Healthcare is delivered including teleah Health triage the integration of AI into tea health and this is I'm going to put this all in all caps may be able to enhance efficiency approved patient outcomes and optimized resource allocation so I'm going to go out on a a branch here but I'm gonna say that AI may be more of an impetus for change for both Social and Health Care change than the internet ever was um a couple more specifics one of the more um promising applications of AI in tah health is the use of large language models and these models um as you probably know are trained on huge data sets of text and as a result can understand and generate humanlike language making them except exceptionally useful for interacting with patients especially if it's done under the guiding hand of a of a good nurse Tre usure um so I do believe that um that we should explore the use of AI and that look for ways to use AI working in tandem with this huge Corpus of content that we've developed for the Schmidt Thompson clinical guidelines so that we can try to better Aid and support the triage nurse with real-time prompts and automation of documentation so that was that's a short answer to a very complex question it is a very complex complex question and I I wish we had all the Time in the World to dig into that today because I know it's top of mind for a lot of folks um but kind of a followup to that so what is your Vis vision for the future of nurse telephone triage and how do you see the protocols or guidelines evolving to meet those emerging needs so you're looking for a vision statement so here's a vision statement as I kind of think out loud um we need to continue to look for ways to improve teleah health triage we can't just do the same thing that we've always been doing we need to evolve to make the process even better for our triage nurses and to do this we need to do a number of things um we need to look for ways to incorporate new technologies such as large language models and artificial intelligence to facilitate this process we need to look for ways to capture clinical information as data rather than as a narrative of text that we store or write down we need to look for ways to make the documentation process for the triage nurse easier faster and better so that we can actually reduce the length of triage calls and make the nurses more efficient as part of the process make documentation just seamless so that there's a seamless um overlap between the documentation process in capturing meaningful data and finally um integration of Data Systems is essential um we need to look for ways to capture information at the front end of an encounter perhaps even before the tri nurse first talks with the patient we need to look for a way to pass that data into the triage counter in an effective way we need to then perform triage efficiently like we talked about in terms of speeding up documentation providing support to the triage nurse and then we need to at the conclusion of the encounter we need to capture that information again as data and pass it in a coded inst structured manner to Downstream users Downstream providers such as tele medicine doctors or primary care doctors or or followup nurses so that's that's my vision of where we need to be I like that and and all very um very relevant and meaningful points and and agree and and so you know we we covered a little bit of the future again we could go into that I'm sure for hours on end but we don't have that time today so I want I want to just get some of your Reflections um kind of looking back so what do you enjoy most most about your work and how has it shaped your perspective on Healthcare and then kind of a secondary question are there any particular achievements or Milestones that you're most proud of w those are frankly two different questions um in terms of in terms of Milestones um I will say that um probably the first important Milestone was almost 25 years ago when I completed the first 50 adult teleah Health triage guidelines and I went from this faith that we could do this to the knowledge that we would be successful in this area um another important early Milestone was um when Bart and I signed our first licensing agreement with lvm systems and epic software and they were successfully able to import our content from the database into their software and now we currently have over a a dozen companies using our protocols including clear tries absolutely um and so the third Milestone I'll mention is uh that every spring is now a milestone for us because in April of every year we publish an update to the after hours guidelines and in July we publish an update to the office hours guidelines and each year it feels like another Milestone another successful hurdle that we've accomplished and this spring 2025 will be um our 25th update of the buil content so that's that's kind of a that's kind of a w yeah yeah um you asked me also about um do we still have time because you asked me also about things I enjoy we have a few minutes left and then I have one um very important follow-up question okay Clos question okay one surprise question the um um in terms of things I enjoy most about my work um I enjoy the intellectual challenge of writing um the decision logic and bed in the Tage guidelines I like that a lot I enjoy working with our editorial team members our clinical advisory committee and our special work groups and that's it's so collaborative and congenial it's just fantastic I enjoy answering questions from our clinical partners and software Partners across the country and supporting their good efforts and I simply enjoy and take personal satisfaction in stewardship that's a great word in the context of Health for information stewardship is the responsibility for creating maintaining and disseminating content that is both patient Centric and accurate so that's stewardship it's a great word so I love this work um hopefully you can tell I I absolutely can and I'm guessing that um everyone else listening to this today can as well and okay so my last question for all of those listening today um those there may be some triage nurses on this call I'm guessing that there there are actually quite a few triage nurses on this call today um many of whom probably use your content um on a daily basis you've had a direct impact on tens of thousands if not more uh Tri Asner says throughout the US Canada the world really is there any anything that you would like to share with them that we have not covered today yes um first and foremost I want to thank each and every one of them for the dedicated the work that they do on the front lines of tellah Health triage it's awesome tellah Health triage is an important and challenging work area for nurses I also want to thank um all the nurse leaders and physician leaders for the suggestions that they have made for improvements and expansion of our content as I said before this is gold and we appreciate your input and um perhaps Chris also thank you thank you very much for um kind of facilitating this interview today so thank you yeah no this has been great I really appreciate you um taking the time to do this with us today I have learned I feel like I know a lot about Schmid Thompson obviously um working with clear triage or working at Clear triage but there are things I learned today that I did not know so I absolutely appreciate you also taking the time to um to share today um and thank you to all of our attendees as well um thank you for being with us on our first 10 for 10 webinar series we will um have our next series on February 19th it is with um the renowned Carol ruttenberg we are so excited to talk with Carol about decision support tools and nurse telephone triage if you have not registered yet you can do that at Clear tri.com 10 for1 um and we'll get you signed up and registered if there are any other questions please submit them before you go using the chat and we will forward all questions on to Dr Thompson um and then you can also email us at support cage.com if there is anything else that we can help with so thank you everyone um thank you clear triage team thank you Dr Thompson thank you to all of the attendees uh this has been a a great and very informative Let's see we went a little over we promised 30 minutes we went a little over but I personally think it was worth it so thank you everyone um for joining us today really really appreciate it