SPEAKER 0
Once again, we'll have the Center for Intelligent Health Care, but apparently technology, we're having a few challenges here, so I think we're in an exciting time now. As I was saying, working with the new foundation and Jeff Gold to raise money for the for the center as part of the Big Ideas program, we've updated our website and I would encourage everyone to look at the Center for Intelligent Health Care. So it's you and see Dot Edu Slash CHC. I think we're up over 80 members now of the center, and I see that we have people now, literally from coast to coast with roots. I'm giving you some credit for being near the coast, but Dr. Patsy us from. Florida is joining us. And so this is kind of exciting. Skip, you're on a coast, but I think it's the Gulf Coast. So I think things are great tonight. It is my pleasure to introduce Dr. Boyer. Dr. Boyer. And if I get your title wrong, please let me know just how you doing the introduction? Yeah, I can do it. This is even better. I'm introducing Justin Cramer. Justin is one of my. Folks that worked with me on a CPA way back in the early 2000s and then went off and hung around Bruce Bryan, the Utah folks was back on faculty and is our director of continuing medical education. Thank you. So, yeah, so Dr Pamela Boyd is going to be talking to us tonight. The title of her talk is I Excel, improving human performance and effectiveness in health care. So she's currently the associate vice chancellor for clinical simulation at Excel. And for those of you guys who don't know, I Excel is D.M.C. Center for experience of Experiential Learning with a focus on simulation technologies for health care. She was brought on when the center was founded in 2015 and has been really instrumental in its growth and success. She has a master's degree and Ph.D. in counseling and education from the Ohio State University. And then prior to coming on you and issues at the University of Toledo, my understanding in a similar role as executive director of the interprofessional immersive simulation center. So Dr. Blairs It's a pleasure to have you speak.

SPEAKER 1
All right. Can everybody hear me? Yep. Good. Well, thank you so much. That was a lovely introduction and I'm delighted to share the story of I excel with you all. It does, in fact, and has the potential to link closely with the work that's being done by the Center for Intelligent Health Care. But like the Center for Intelligent Health Care, we are also on a journey. We're still in the process of building, not literally constructing, but building the programing in this in this great facility. If it's OK with you, I would like to share a PowerPoint because what we're doing is extremely visual, which is you will see part of the idea, but it's a very, very bold, very aggressive investment on the part of the state of Nebraska, the University Foundation and all local philanthropists and even the city contributed to this this building. The total cost of the building will take your breath away a little bit. It's one hundred and twenty million dollars and we're very, very grateful that we were able to raise that kind of money around this project because at the center of it is improving the health outcomes of patients that this particular journey is improving it through improving training and education and transforming the model from the classroom to experiential learning. So I'm going to just pull up a little PowerPoint. I'm going to share my screen and pull up a visual for you. Let's see if I could make that large. Bear with me a moment. Over here here. There we go. And then I'm going to put it into play so you can see how gorgeous this center is. It's purposefully designed to make a statement. It's situated on the Health Science Campus in Omaha, Nebraska, and it's been up and running for about eight. We started reopened actually just as COVID was breaking out in March 2020. As as John said or as Justin said, it's all about improving health care, improving human performance and effectiveness in health care. And that had implications for the building, which we'll share with you. It has a rather interesting mix of an academic and efficient business mission. And I won't read from the slides you were able to read, but it's an interesting balance and an interesting blend to manage. I will say we started with the academic mission because if we do not have an academic mission in the center, then we will have not have the credibility that we need to carry out the rest of the mission. And after all, our students, our residents and our hospital health care providers are our top priority. We did a lot of groundwork before we built this building. We looked at what is safe, what is aviation, what is nuclear power, what the railroads, what are the military doing about safety and quality and health care in their in their particular arenas? Because, as you all know, in health care, we really have a significant problem with avoidable deaths due to medical error. If the estimates are right and I know they're controversial, but there are an estimated 400000 avoidable deaths per year in the United States due to medical error. It's not only a problem in the United States, it's a global problem. So we actually do have a lot of interest in what we're doing because that is our goal is to reduce medical errors through improving and enhancing training programs. So one of the first jobs we found is that everybody who does this needs to break down the silos, especially the military. They're making great attempts at that. And that was one of the things that we really heard from other disciplines that breaking down the silos between the disciplines within that entity. The other was that we needed to explore a highly advanced technologies, new methods of delivering knowledge that it must be data driven digital and in most instances, incorporate modeling and simulation. Entrepreneurial, because if you have the highly tech center, you have to replenish the equipment you have to update, you have to keep on the cutting edge and how do you fund that? And it's also an innovation hub because you want to excite people about learning and research and development hub, often with industrial military partners. So the groundwork really started to embed these concepts in in the in the programmatic component. Fundamentally, what we called it was the triple helix model. That's not an original term, but it did describe how we were doing it and how we wanted to take really full advantage of the synergy in those in those in that Venn diagram. When we work with federal military, industry and academia partnership, that is exactly, by the way, what's happening in the center, even though these are just some schematics. But it gives you a sense there are actually five levels to this building. And I'm going to be describing those two use of the Davis Global Center is the building itself, but the program is I Excel, I Excel stands for interprofessional experiential center for Enduring Learning, which is kind of cool. I think our chancellor came up with that, which was very neat. The purpose of the program itself is interprofessional, experiential, competency based and what that that has, as you know, different connotations for how you assess performance. It's really designed to serve not only our current generation of learners, but our new generation learn very, very differently. They're highly digital, they adopt the center very fast. They are very independent learners. They like to explore knowledge on their own. And what we have to make sure is that the knowledge they do explore is evidence based and and valid. We want to, as I said earlier mentioned, we want to measure educational and clinical outcomes. And we're interested in pay in learner safety as well as patient safety. And that became very, very apparent as COVID began to take over our lives in March 2020 as we were moving in. I won't read the list because I'll be repeating myself a little bit. But the other critical thing is it's not just health care disciplines. We are also extremely interested in already collaborating with other disciplines, as you see listed there. The state of Nebraska was very, very keen to not have this, just be based in Omaha, and for people who got it, received an education in Omaha or the patients who receive care in Omaha to receive the benefit. So the charge to us was to also have a statewide national and global outreach connectivity, which we do in fact have. And I'll be describing that a little bit as we go through the presentation. But remote and distributed learning across this great state of Nebraska, which you probably will know is 500 miles wide to present some challenges because there are training sites all across Nebraska, as well as critical access hospitals and first responders who need to have up-to-date health care information and training. And speaking of that, we do actually have. They were funded by a grant from the Helmsley Foundation. We do have four mobile units that are attached to the center that serve the Four Corners, the four quadrants of of Nebraska. But the people who do the training also train here, and we can also connect remotely. But there they are. Think this chimney rock behind behind the truck on the top right there? We also work as well as dealing with or serving our own health care professionals. We also work a lot with emergency room, EMS, Fire and LifeFlight and do exercises out of doors. I thought you might be interested in the facility design because it has a very, very purposeful design. It wasn't very easy in the first design, but we hired architects was not as imaginative as we wanted because as I said earlier, we needed to inspire. So as we. Look, because we built this facility, the first thing about it was that we felt it had to be territory neutral if it was converted in the in the College of Nursing or the College of Medicine Dentistry, or it would then belong. The culture would belong to that discipline because we wanted to advance into professional collaboration and training and especially a teach team training. We wanted a facility that was standalone, that was owned by everybody. It didn't belong to one discipline or an or another. It needed to be inspirational, they needed to work, no, when they walked through the doors that they were going to think differently do things differently. And. Take some risks because it was a safe environment, it is a safe environment in which to take risks, and you can see on the right hand side that is an absolutely stunning 8K wall, which we put the images we create in our visualization hub and different images each day, and we can also do broadcasts on that wall. It's a very versatile wall, but it's a very inspiring. The building had to be accessible. What we have found in the past is when we build simulation centers, if they're not close to the clinicians and the health care professionals, they really don't come with a we've built it on the campus, close to the hospital, close to the colleges, and it's very, very accessible in all weathers with bridges so that they can run across, do their exercises and then go back to whatever they were doing before, which is often patient care. It had to be highly flexible and future proof, and that the design is certainly designed for that. It has a lot of walls that can go up into the ceiling or can be. We can change and morph as time goes on. Importantly, it needed to house the replicated total health care system from home to hospital and back. And I think this might be something that would interest this group because what we can actually do is practice the transfer of care, which, by the way, you will know is where patients are most vulnerable in the health care system. The communication from team to team, the smooth transitions and those can all be practiced because we have cameras in the rooms, in the replicated hospital rooms and we have cameras in the corridors and we have home units. We have every single kind of health care environment. You can imagine where we can practice not only individual disciplines in their particular venues, but also we can. We can do home to hospitals that can transfer from team to team. We have a very, very advanced infrastructure, and this is where we're very much hoping to collaborate with George and Justin and team around integration, connectivity and data capture. And as I said, this is a journey. It didn't happen overnight when we moved into the building, but we're well on the journey towards this. The facility design has five different floors, which houses total these these hospital units, so these homes, I should say health health care units at the on the top floor, we have advanced surgical skills where we use fresh tissue. And that, of course, is for the advanced procedure this. On the clinical simulation floor, we use mostly human patient simulators, and we use we use it sort of simulation models and nasogastric. They learn how to do simple things like IVs, nasogastric tubes, but also very complex scenarios using human patient simulators on the first level, which is where you go into the door into the front doors. It's all visualization, 3D virtual reality and holographic reality. And the Global Center for Health Security is a very specialized training unit for bio preparedness. We work with the federal government on training for disaster preparedness and bio preparedness. And then in the lower level is the simulated Community Care and Ambulance Bay. One of the trucks is stored there, but also a home unit. Also, we have an austere environment. So we had to hire. One of the most important things about this building was what goes behind the walls. And so one of the very, very first things we did was we broke the mold a little bit and we hired the first people we actually hired, which were definitely on a par and if not slightly ahead of the architects, because we knew the data capture data dissemination from this building was going to be critical. So behind it, it was again what was behind the walls, as well as the sort of gee whiz that you can actually see. I've already talked about the design was to facilitate team training and handoffs. In a way, it was built around the technologies. And again, the whole goal was to capture data because if we have a vision or a mission that is to improve human performance and effectiveness in health care will, then you need to be able to prove and demonstrate that you do. Actually, you think the mission works? As I've said, it houses multiple simulation modalities, and interestingly, they work in a hybrid model. A surgeon can go up to procedure. This can go up to that level three, but they can also move down to the visualization hub to look at scans in 3D and even learn how to do procedures that virtually before going up to the to the third floor. We have significant community engagement we had already always planned for that, but this is a really a topic on its own. But one of the things we have found is that there's a desperate need for workforce development into this arena, not just in Nebraska again, but it's nationwide and worldwide. So we do our part to work with the STEM programs in the community to encourage young people to go into health care, but also teach them how to do some of the magic things that happen in the center with the with the technology, the digital technology. Early on, we knew we were going to capture data. This is a complex model. They just show it to you to show that a lot of thought went into this in the planning. It wasn't an afterthought. Obviously, our ultimate goal is to use artificial intelligence to help us analyze things quickly. But fundamentally, we have a data capture program or system in place, and we are continuously improving it and capturing data and we want. My goal was to capture the data in real time so can use any moment in time. What about finances were what are our stuff? What programs were going on in the center? Which which disciplines were using the center? What level of training? And all of that is getting captured as automatically as we possibly can under the circumstances right now. So as I said, it's a journey, it's really happened in phases. The first phase was as we as I mentioned earlier, as we moved into the Davis Global Center. COVID was breaking out, but it was actually quite a momentous experience. We had CNN outside the door. We had federal agents all over the building because if you recall, Nebraska at that time was receiving the was receiving the patients or the passengers from the Diamond Princess who had been exposed to COVID. And at that point in our history, we thought the quarantine was the the answer. Of course, that didn't last very long. But in no fit on our federal floor that I showed you where we did the specialized biocontainment training that the federal government paid for. They the quid pro quo was that they wanted to have 20 quarantine units on that floor. And so it was quite quite a baptism as we moved into the building. We also had installers there because the technology goes in last because it has to be dust free. And so we we had people from Japan, Belgium, Helsinki, the United Kingdom all desperately trying to get the technology installed so they could get that home before the borders closed, which of course, they eventually did. So that was ah, or early start in the center. What we did was we immediately focused on PPE training for health care professionals and students so that they would feel safe and they'd not only know how to don and doff, but they'd know how to do procedures and how to communicate as teams, even in all the gear that they had to wear. That's still ongoing, by the way. There was a desperate need to do nasal pharyngeal swab training. This is one of the flaws you could see that working with the models, but we actually worked for the company to create a new model because there was that what actually what was happening was our EMT surgeons were coming to us saying that some of these procedures being done incorrectly and they were actually potentially, if done wrong, having doing some pretty significant damage. So we did training of all kinds of all everybody who was going out to doing swabbing from National Guard to pharmacists to nurses. So right at the early stage of our journey, this this COVID was very much our focus and protecting our health care providers and providing value. The other thing that happened was we stayed active all through COVID, we were very busy. We also were called upon to do lots and lots of live virtual events so that we could get information out to the rural communities. We found for our first responders didn't have gear. They didn't know if they just had one mask between them, two who wore it. How did they clean an ambulance? So we had these live virtual events with subject matter experts who are medical subject matter experts who were able to get information out to the people who so desperately need it, who weren't in cities. We were called upon to do quite a few of these, and some of those were national. And so that was our era where and this to some extent still is with so many conferences or so much communication and knowledge dissemination is happening remotely. So the team got pretty good at productions. So just to sort of take you through the center a little bit, I talked about the of the the top level, the third level. This is the surgical suite. We probably have about 30 to 40 surgical companies working with us right now. They're mostly doing workshops and training workshops, but there's also some research and development, beginning with these companies in cooperation with them. So we have to have quite the business infrastructure to make sure those are done ethically and within boundaries and IP is protected and all of the things that you already know about. It's just another glimpse. This floor was the was adopted, this level was adopted very, very quickly, very, very rapidly. In fact, even last weekend, we were here all weekend. We contracted with one of the surgery companies to train their trainees, and that very much comes into the train that train there. Sorry, they're technical people. That comes very much into the business mission aspect. So these are some of the other tools up there. It's kind of fun because it is right on the cutting edge of seeing things emerge, for example, we're seeing a massive surge in point of care ultrasound and we're seeing another massive surge in robotics and whether it used to be just one company, now there are four and so on. This is on the next level down than this, but if you look at the spaceship picture on the right, that is a control tower where we have the hospital settings like intensive care units, trauma suites and so on around the outside of those and the human patient simulators get driven from that center control room. We also have cameras in all the rooms that capture people's interactions and efficiencies, and they have debriefing rooms. The big part of simulation is pre briefing the exercise itself and then debriefing, and they're able to watch their performance on camera as a team and the team analyzes their performance and their behavior and how they could have done things differently. So the principles of adult learning are very much embedded into all these scenarios, but it's everything from neonatal care to elder care to everything in between. We do have a contract with the Air Force to run this see star's training program. And it's like you probably have heard of the Sea Stars program. I think there are five of them around the country. This particular one, of course, focuses on highly infectious diseases, and that's because we have a tremendous history that you and M.S. of having experts in Ebola and highly infectious diseases. So that was, I can't say, honestly, center attracted these programs. It's largely due due to some of the incredible medical expertize we have on this campus that is really quite quite quite stunning. This is the visualization area. So there's the big Sony, the big Sony eight K wall I talked about with a different image right on the right. You're in the atrium there and you can look up to the different floors from inside the building. The atrium doubles up as a reception center and so on. We have had close to 43000 trainees through the center since March 2020. Actually, I would say forty three thousand people through the center, 80 percent of whom are trainees and 20 percent of whom are really high level visitors, maybe politicians, senators, military leaders to see what's going on and to see how we can partner with them. On the top left, you can see in an interactive digital wall, on the top, in the middle, on the left, you can see a five sided interactive cave. There's a digital twin in there of a crash coat. You'd be surprised how many people have, how few people know what's in a crash cart when they need it and how it stops and where everything is in there. So it's terribly important that they practice just very simple things like understanding how a crash cart works and how it stopped, and we can do that virtually. And then on the bottom left, these are interactive digital worlds that are connected across the state in real time. So one of the biggest challenges is where we have the technology. We have to create the content ourselves, so we have a visualization hub that has 10 people in it with different skill sets who work with our subject matter experts or clinicians to create highly accurate medical content for the virtual world. And the content and create can be used for head mounted displays. It can be used in caves, it can be used, make the students and learners can even take it on in 2D on their mobile devices to review it and to practice. Refresh the refresh. They've had some breakthroughs, I thought we want to share with you. One of them is we've been learning how to create polygraphs. Well, yes, there's a bit of theater in that. But on the other hand, that's President Carter in a polygraph. He's a university president and he's talking in holographic form to who whoever's in the theater about the value of simulation, how it made him a first class aviator. He actually holds the record, I believe, for aircraft landing landings on an aircraft carrier, and he doesn't have to be present to greet. He can greet everybody is holograph and. We can make holograms of our professors, and ultimately the goal is to be able to disseminate these holographic not quite there yet, but we're learning how to create them and it's interesting because a lot of people. What we're finding is we're being asked to do a lot of legacy bill legacy polygraphs, which is a wonderful thing so that we can keep people alive and their pearls of wisdom for posterity, that lifelike form. Going back to the workforce and I want to be very sensitive to time, so we have time for questions, but this is a real challenge. And so what we did was we worked with a company to start in a virtual reality innovation academy. And part of it was selfish because we needed to hire people ourselves. We would need to go to the West Coast, the East Coast. And although we did find some local people and they would have an 11 month course where they learned how to create digital content and and then we would hire some of them. And they also all got jobs, which was interesting in other disciplines like architecture or so on. Construction, real estate marketing, because this it seems as if 3D and virtual reality is at last being adopted more widely. That was the model we created with a company that has the little light that goes on when you do the nasopharyngeal swabbing, the more accurately. That was the Orient search, and that's one of our EMT surgeons on the top right to help mastermind this and recognized the need and that as she has gone to market. This is some of the 3D imagery that's being created. Let me see, I want to make sure this will work. All right. So what you're seeing here is our visualization team working with the subject matter experts to sort of bring learning to life, and this is a part of the blood coagulation cascade simulation, which is a much larger project and it's fiber, fibrinogen binding platelets. And one of our faculty, Dr. Scott Koketso, decided that the coagulation cascade was so hard to understand that if we could make it visual and we have a lot, there's a lot to this particular module, but this is just a little glimpse into some of the modules. This one is rather fun. This is and a COVID 19 infection and its antibodies swarming. We see if I can make it work. Typekit. So again, it's showing how the virus into the cell and how the antibodies swarm against it. And again, these are just little glimpses into some of the breakthroughs because this was a vision when we started. And what we're seeing is this this vision is really coming to life. This is a stint by Fear, a Haitian project that was done by one of our cardiologists and team, and it's to do with stent placement that is to do with very personalized and placement based on scans and by purification of the arteries and designing a stent that will fit and expand a very, sort of very personalized kind of stent. So this was part of the research and development, but we aren't able to take real patient data and put it into these 3D worlds so that research and development can occur and youth projects or procedures can emerge again just at the front end of the journey. But it's definitely happening. I spoke a little bit about digital twinning. This is this. This was contracted by one of the companies who wanted to, especially during COVID, be able to demonstrate how their bids worked rather than send salesmen out. So we did a number of these for them and actually was our first first revenue. We earned. This one is another example, and this can go in head mounted display sets or on these things, we have good eye benches which are 3-D on 3-D sort of platforms. The students take to this like ducks to water. This is a pelvic model which can be dissected, labeled, manipulated. The students were finding the Jux. Learning about the juxtaposition of the pelvic organs was very difficult. So the sort of bottom line is that the the sky's the limit when it comes to imagination about what you can do with the virtual worlds, if you have the right team, the right subject matter experts and you can make evidence based medical content. There's an absolute dearth of it out there. So just sort of as I come too close, I think I should talk to you a little bit about the fact that we do have measures success and we are taking it very businesslike approach to return on investment. And where you would find us now in our journey is maturing the business strategy and we're sort of doing all the contracts. The CDA was because after all, we were a startup ourselves and with keeping track of everything that's going on in the center from the finance perspective as well as from the education and training and academic perspective. I wish I could show you the dashboard, we're not quite ready to show it to you, but if you'd like to see it, how it works as happened in real time and I can get any what are the activities on the floor I can put in the dates that I want to know. Is it just today? Is it since opening, which is you're seeing now? What is the in-kind? What are the in-kind activities we do to make sure we beat the state in the academic mission? We even track the costs of that so we can show the state that we are bringing them value for their investment because they do support our operational budget. And so at any time we can see what's going on, what the usage is by discipline, by level of training and so on. So as we think about Wow, what have we done to US health hub, where we're really feeling we ought to be thinking about Excel and beyond so that we don't just stick here, we've still got a lot of maturing to do a lot of maturing, but we do see that we're going to need to expand that visualization hub because the demand we are working with United States strategic in discussions with them about starting a specialized academy digital technology academy for their employees or their hires. We need to extend our exile community academy and we are looking at post-COVID-19 digital and health care workforce development opportunities because we're now in a very new world with different needs and a shortage of healthcare professionals. So we've got our work cut out for us. We're also currently exploring and testing 5G networks, beginning getting ready to talk to to the team here about how we could perhaps collaborate, but we knew we had to have data first. Of all the important things that we've talked about, it's the culture that man who we hired on a nimble, responsive, accountable. Are they creative? And are they also scientific? So finding the right workforce was really, really critical to help our faculty and students adopt the role that this wonderful center has to offer. And as I said, it's where we're doing this in stages that things are going so far very well. So I hope I didn't gallop through that too fast, but I knew you wanted some time for questions and answers. And thank you so much for listening, and we'll look forward to working with you when we're ready and I don't think we're far from. I don't think we're too far from being ready. So, John, thank you very much.

SPEAKER 0
That was a tour de force.

SPEAKER 1
Oh, it was a quick fly through.

SPEAKER 0
I mean, I think you're exactly right. And I think what I like about this is it fits so well with what we're trying to do in the Center for Intelligent Health Care. And as we talk about too intelligently simplifying health care to understand the data flow, the workflow and, you know, improving human and computer cognition. So I see lots of opportunities. I think for Dr. Kramer is working with you on some projects, and I just think there's a lot of things that we're going to see in terms of education and in terms of different models of training and gamification and that sort of stuff that we haven't really addressed yet. We're still kind of stuck in the 1920s model of education, and I think this is exactly the way we're going forward.

SPEAKER 1
Think it might be nice for Justin to talk a little bit about the work he does in the center if he's not put too much on the spot?

SPEAKER 0
Yeah, I mean, I interacted with Bill Glass and came to you and embassy with an interesting kind of 3-D printing and modeling. And I've sort of since diverged into more of an interest in AI based image segmentation. But I've kind of had an interest in creating simulators, work with neurosurgery to do craniotomy simulators, worked in our own program to create kind of simple lumbar puncture simulators. I think I've been. More impressed with the potential for kind of hands-on simulation as opposed to air VR type programs. I guess that was one of my questions for you, Dr. Bowyer's is how much are you guys using air and VR versus more kind of hands on physical simulators?

SPEAKER 1
I would say that the the hands on simulators are being used quite extensively because that's what healthcare professionals are kind of used to. That's clearly this visualization flaw is much more experimental. Where the hands on is experiential is more tried and true when we could touch and feel and interact. The surgical floor has really surprised us in terms of the need and the use of the third for both surgical and the surgeons in the procedure lists, the visualization hub is surprisingly busy. Our biggest limitation is the number of staff to create the requested modules, so we have to have a process where we select modules that can be shared among the disciplines rather than once discipline or sub discipline. Because we're trying to sort of spread the spread the love and make whatever we create useful for more than just a narrow audience. But I believe my belief is that with the digital. The digital students that this digital generation, we're going to see a lot more use of visualization for learning and knowledge transfer. We're seeing it happen. The students take to it like ducks to water. Thank you. They love the fact that they can access it whenever they want to, and they can refresh it and and do sort of self study. We get a lot more requests. We're getting a lot of requests from students to come in and learn to practice on their own or use the visualization technology on their own or in small groups to learn. It's kind of an interesting trend to watch.

SPEAKER 2
There's an excellent doctor. I'm a basic science researcher. I am wondering if there is space for exploring some like, for example, like routine drug interactions of small of for these type of interactions. Is this mostly like sulfur in exploratory mode? Or do you have expertize of people who can help us with those kind of simulations?

SPEAKER 1
Yes, probably the 3D cad walls and the cave would be the place where that would be most attractive to basic science researchers to understand and manipulate data visually. And yes, what we are doing is because it's a complex technological center. We have a team that are trained to work with the subject matter. Experts like yourself to work in these environments and to sort of. I just don't think we've tapped tap the full potential of them yet. I believe predictive modeling, drug interactions, all of those things are there to happen. Are we doing it right now? Not yet. We're working with our virologists and immunologist for obvious reasons about viral viral interactions with the Delta variant and how how transmission occurs, because that's sort of the topic of now. But I think there's tremendous opportunity for research using these these these, this technology in your field.

SPEAKER 2
So, so the follow up question, so can students come over there and then explore these things on their own? Is this OK in some areas they can?

SPEAKER 1
Yes. Okay.

SPEAKER 2
Thank you.

SPEAKER 1
We have desert. There are some rooms that it too too highly, too complicated, but students in this day and age are very facile with the interactive digital walls, with turning on the 3D card wall and manipulating it themselves. That that is very good at it, they were almost born doing it, so OK.

SPEAKER 2
Wonderful. Thank you.

SPEAKER 1
Better than us.

SPEAKER 2
And this is a very impressive tour of the simulation center here in Utah, we have a lot of this has been exploring as well, but it's scattered all around campus and it's really, really nice to have it in the white area. As you mentioned, sort of content creation is one of the bottlenecks for this, and I think we already have dozens of modules and we need hundreds or thousands of modules, particularly for case based learning and simulations. And any any thoughts about it. Are there some standards of how to develop these in a way that can be shareable across institutions? You already mentioned sort of multipurpose thing. Some of them and we we do some of that for nurses and medical students and pharmacy students and so forth. But but it seems like that bottleneck is always going to be with my ability to scale and share modules content.

SPEAKER 1
I think that's right. I think there's a tremendous advantage from a cost perspective of having it all under one roof. Because it would when it develops independently in different areas of the campus, which of course with it, it certainly can't do, nobody's restricting that here. But what happens then is you start competing for people who can create the content that the technology is the easy part. It's expensive, but it's the easy part. And. It's just. I mean, we have to have artists, computer programmers, renderers designers, and they meet as a team and they have a I to somebody's whiteboard. As we were waiting to meet, we have these big walls with all the storyboarding on it. We have little hotel rooms where the faculty can come in and meet with the team and describe what it is they want. And then the team looks at it for feasibility. And again, we have these criteria. Can it be used in to professionally? Can it be used at different levels of training? Can it is it is there value in putting it in 3D? Maybe it's just as it could be learned just as well in 2D in that case, there's no point in it really using the 3D tech, very, very difficult concept to understand. And. I don't know, it's it's so it's could be tremendously costly from a staffing perspective and because of the scarcity of people who can do this and then when you do find them, they have to learn to work as a team. So I would encourage greatly encourage these hubs on a campus. But I know it's it's not easy to prescribe what campuses do because of academic freedom, but we do find ourselves becoming now a source for the deans to call us and say one of my faculty members has been to a conference and likes this software or likes this technology and wants me to buy it. What do you think? And so we do a careful analysis for the deans. Because the days are really gone, I think when people can just. Buy things because they like them in the individual programs or colleges, because it's the support of it and the content creation that's so critical. As far as sharing across we, we are under some, I would say, healthy pressure to because we've got such highly accurate medical content and there's a sort of a dearth of it out there. We are looking to partner with some major companies to help disseminate it so that we can fulfill some of the business mission. And that's a difficult line to walk because as academic exhibitions where we're we're collaborators and there's as people, we want to share it, but. We're probably going to work with a company to help disseminated. She. It's the new world, right?

SPEAKER 0
Thank you. Any other questions? If not, thank you very much, Dr. Bill and you

SPEAKER 1
for listening and we look forward, we really will look forward to working with you all. We're just not in a full state of maturity yet, but we're getting that. Thank you. Thank you.