Hello everyone, my name is Gomaleng. I'm a research fellow at Barrow Neurological Institute. I hope you all are well and staying safe. I would like to thank the BNNS Scientific Committee for giving me the opportunity to present our research, where we assess if the audio-video recording of the patient-physician encounter increases the risk of malpractice claims. Dr. Randall Porter, who is the senior author on this paper, is the founder of the medical memory. That's the application system that we use for video recording the clinical visits. Digital recording of clinical visits and telemedicine is becoming very popular, especially in this pandemic, when their patient and their attendants have limited access to the medical facility. There was a survey done in the UK in 2015, including 130 participants where 69% of them showed desire of recording. 15% said that they have secretly done so, and 11% knew someone who has secretly recorded their clinical visits. Let's say 38 out of 15 states have one-party consent law, which means that as long as one party, in this case patient, give consent to record the conversation, they won't be legally liable. However, there could be ethical implications like HIPAA violation, taking discussion out of context, or manipulation of the physician. We believe that the solution lies with the healthcare providers. So in 2015, the senior author launched a smart device application system, the medical memory, for the video recording of the clinical visit or VROC. In the top left corner, we can see that there is a tablet with a built-in microphone and camera placed on a stand in the corner of the office facing physician and patient in a very non-obtrusive manner. In the right top figure, we can see that the physician can move it around, showing the image findings. In the bottom left corner, we can see the patient's view that they have all the list of the videos. Once the visit is completed, the video gets uploaded on the HIPAA compliance server. And then in the right bottom image, we can see the video. And in the bottom, there is an option of sharing the video with the other healthcare providers or the patient's family members. And the shared video cannot be shared by the recipient, again, reducing the risk of a violation of privacy. The risk of malpractice in neurosurgery is very important because it has limited the use of the video recording of clinical visit. The reason is that neurosurgery has been constantly identified not only sub-specialty with the highest mean malpractice payment, but also have the highest number of malpractice claims. So with this, our objective was to analyze whether the use of this tool is associated with an increased risk of professional liability claims. We also wanted to study the trend of claims for our entire institution and to compare before the use of this video recording device, has there been any change when compared to after the use. And we also wanted to study the trends of claim against the physician who are using it, like what were it like before and after. So we did an in-depth analysis of our institution's lawsuit, including three claims, a precautionary claim, and there is no formal complaint, but only physician red flagged the case because of an adverse outcome. When there is a complaint filed by a patient demanding compensation, usually monetary, it's called claim action. And if it goes to the court, it becomes a lawsuit. The data was very different for, it varies a lot between the physician for the usage of this video recording device. Some had five videos in a year and some had 500 with just within a month. So in order to have uniform comparison, we calculated the mean of entire institute and whichever physician has a higher than above average usage, they were called uniform. So we do not report any lawsuit or any paid claim actions against the user in three years of use. And we do see there is an increase in the number of videos recorded every year, but we only had two precautionary claims and one claim action, which was dismissed. And also we do not see an increase in the frequency of the precautionary claim as the physician are being recorded. So they are not too conscious and there's dark red flagging a lot of cases. And there was one instance of low paid lawsuit and then now they are user, but in 2010, they were not. So that's an interesting finding. Now we are comparing VROC users with non-users. We see that the number of patients are very high in the non-user group, which can be explained by the number of physician. But when we compare the rate of the medical malpractice claims per physician year, which is calculated by the number of physician who faced claim divided by any claim divided by the total number of physician practicing in that year, we get the rate and we do not report any significant difference between the VROC users and non-users with the p-value of 0.66. We compare the institution's loss run before and after the use of VROC. The total number of patient, there is no difference between period one and two. In the mean, there is no difference. The annual growth rate of number of patient using VROC is 23%. And when we compare the rate for any claims and paid claims between the two period time periods, there is no significant difference. So in the top graph, we see that the institution's loss run from 2000 to 2017, and the rate is going downward. And in 2015, when we started the use of the VROC, we do not see any increase in the rate. Also, in the bottom graph, I want to highlight the distribution of claim, which was very interesting. It's against the entire institute. So we had 146 occurrences, 91 of them were precautionary, so two-third of them were precautionary. So there weren't even formal complaints. So out of 52 claims which were filed, only seven resulted in settlement. So 86 were dismissed. Even when they become lawsuits, most of them were dismissed. This was also found in another study where only 19% of the claims in neurosurgery resulted in a payment. So this leads to the question that is the assumed burden of the malpractice claim is higher than the actual burden, and which is limiting the use of VROC. Another question is asked that maybe there is a selection bias because only physicians who have good communication skills are using it. But this is a retrospective study. It's harder to find the confounding factors. And we only wanted to study the trends of the claim feature. Prospective studies can answer these questions. And we believe that physicians allowing themselves to be recorded elucidate the transparency, which leads to the strengthening of the relationship between the physician and patient and developing this trust. So there was one instance when a lawsuit was filed by the patient, but that patient did not mention the primary surgeon who was a user. So it could be one of the contributing factors to the behavior. So in the future, we plan to use it in the inpatient setting. We are already doing research on it. Researchers can also use those videos for studying the nonverbal aspect of the physician-patient communication. The VROC can also be used for keeping the record of patient progress. And even patients can review their own progress. And for example, their gait and facial nerve functioning and the use of VROC with the artificial intelligence is also being studied. So in contrary to the popular belief, video recording of the clinical visit does not increase the frequency of the malpractice claims or the risk of malpractice claims. There were around 40,000. We have had around 40,000 videos with more than 15,000 patients using it, but there have been no paid claims or any lawsuits. So we believe that when it's provided from the healthcare provider, this tool becomes very useful where we can maximize the efficacy and minimize the risk, including the risk of violation of privacy. My references. And with that, I would like to thank you for your time and attention. Have a nice day.

audio-video recording

patient-physician encounters

malpractice claims

digital recording

HIPAA violations