Hello, my name is Emmanuel Opati. I am the assistant administrative director in the office of telemedicine at Johns Hopkins Medicine. Today we are going to talk about the history of telemedicine in the US, and also look at the current landscape of telemedicine. So the history of telemedicine in the US is very exciting. The first documented use of telemedicine in the US was in 1959, when the telephone lines were used to transmit images across Pennsylvania. And in the early 1960s in Nebraska, closed circuit TV was used for psychiatric consultations between the Nebraska Psychiatric Institute and the Norfolk State Hospital. As you can see there is a person actually doing consultations, and that was back in the early 1960s. It was not until 1967 that telemedicine was used in urban settings. This was in Boston at Massachusetts General Hospital, by Dr. Kenneth Bird. The story goes that Dr. Bird was an attending at MGH, and used to commute to Logan airport where they had a satellite operation. In the summer of 1967, Dr. Bird asked his then resident Dr. Jay Sanders a question, what if I bought TV cameras and put one at Logan airport in Boston, and another one at the MGH emergency room, and began to examine patients on TV? Dr. Sanders says he thought it was the, and I quote, the stupidest idea he had ever heard in his life, but he had enough common sense to realize the idea came from his professor. This was when the two way modality of interacting with patients on screen was first used in the US. And when Dr. Bird died in 1991, New York Times ran a headline saying, Dr. Bird 73, used TV for diagnosis. So we can clearly see that Dr. Jay Sanders was the first resident to incorporate telemedicine in his residency training, and has been at it since then. And for that reason, he is widely considered the father of telemedicine as we know it today. Dr. Jay Sanders is an adjunct professor of medicine here at the Johns Hopkins School of Medicine. All right, so we're going to look at telemedicine pre COVID. Pre COVID, the health care delivery system had been built for in person, face to face encounter, business plans, workflows, and staffing models were all based on in person encounters. Telemedicine was on the periphery, constrained by too many challenges, including licensure restrictions, unclear billing regulation. Telemedicine was only periphery that it was limited to only grant funded projects for the most part. And in all those cases we talked about in the history, including the programs that were set up by the father of telemedicine, Dr. Jay Sanders, telemedicine was viewed as novel and experimental. It was never regarded as a modality of delivering care by the mainstream healthcare delivery system. As a result, there was no business plan developed around it. Now, telling me telemedicine after the advent of COVID is different. The current landscape of telemedicine is very exciting. Every technology goes through what is called the technology adoption cycle. As you can see there on your left side of the screen, the technology adoption cycle goes through early adopters, early majority, late majority, and laggards. To institutionalize any technology, it must have at least the early majority adopters, that's about 34% on the curve, to make the market work, and to make the technology be adaptable institutionally. Telemedicine on the other hand was basically institutionalized overnight because of COVID. Overnight telemedicine became the safest way for patients to access care. In all those examples we discussed earlier, including programs set up by the father of telemedicine, Dr. Jay Sanders, telemedicine was never regarded as a model of care. As you can see on the second graph, because of COVID, telemedicine was adopted across the health care system. And in April of 2020 is what hit the highest adoption, and as you can see it is flattened out now. Almost basically every hospital in the United States has used telemedicine if they are still open. Today, telemedicine is an integral part of healthcare delivery here at the Johns Hopkins Medicine. Patients and providers love it. Both patients and providers expect telemedicine to be one of the care modalities of care today. Investment and infrastructure, investments go after markets. Telemedicine is a growing market, one in four outpatient visits are now done via telemedicine. A recent report by J.D. Power, reported that generation Y and generation Z, had the highest contact with the health plan during COVID, meaning that they were the highest utilizers of telemedicine during COVID-19. Forbes and Kaiser recently reported that COVID-19 made telemedicine a hit. This is mostly because both providers and patients love it. The foundational infrastructure and technology that enables the delivery of both asynchronous and synchronous care is already developed. Investment in developing infrastructure is minimal. And most investments ain't and infrastructure in telemedicine today is moving telemedicine towards personalized medicine, such as remote patient monitoring applications, an impatient application. Large hospitals and health care systems are also investing in developing their own telemedicine capabilities to capitalize on the revenue opportunities that COVID-19 unlock. Some of the areas that are attracting investment include, OnDemand care. This is for both urgent care and specialty care. As I mentioned, remote patient monitoring, such as monitoring blood glucose levels or heart rhythm. Inpatient is a growing area of investment by health care systems, specifically scaling up patient safety observation program. Patient safety observation is when a hospital has a dedicated resource, who sits in a room with a patient that needs to be observed in case there is a risk of the patient not being able to follow instruction. Right now, hospitals have to hire somebody to do that in every room they have a patient. Hospitals are investing in telemedicine infrastructure to be able to monitor more than one, or even up to ten patients using just one resource. This is an area of investment and growth in telemedicine as of now. So after talking about the current landscape of telemedicine, what is the future of telemedicine? The future of telemedicine is really exciting. I believe that there is no future of healthcare without telemedicine. I also believe that the future of telemedicine means we will get rid of hyphens, for example, someone will be able to say I have a doctor's appointment tomorrow, without having to specify that I have a telemedicine appointment tomorrow, or an in person appointment tomorrow. Health care will be delivered as high quality health care regardless of the modality. As we discussed, telemedicine has a great history in this country, and starting all the way in the 1950s to 1960s in Boston. Yeah, the father of telemedicine was basically formed to 2020 when overnight doctors offices became virtual offices and everybody started using telemedicine as the safest way to see patients, to the future where telemedicine is embedded in the health care delivery system of the country. It's very exciting and we can't wait to get to the future. Thank you very much.