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GOOD MORNING.

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WELCOME TO OUR WORKSHOP.

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TRANSFORMING HYPERTENSION

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DIAGNOSIS AND MANAGEMENT, IN THE

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ERA OF ARTIFICIAL INTELLIGENCE.

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TODAY WE HAVE THREE SESSIONS

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WITH EXCELLENT SPEAKERS UNTIL

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4:00 P.M. EASTERN TIME.

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TOMORROW WE BEGIN AT 11:00 A.M.

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EASTERN TIME AND CONCLUDE WITH

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SESSIONS 4 AND 5.

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WE'LL HAVE A BREAK TODAY AFTER

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SESSIONS 1 AND 2.

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WE ASK THAT YOU TYPE YOUR

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QUESTIONS IN THE CHAT BOX

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ACADEMIC KEEP -- AND KEEP YOUR

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VOLUME ON MUTE UNLESS SPEAKING.

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WE ASK THAT YOU KEEP YOUR VIDEO

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OFF UNLESS YOU ARE SPEAKING AS

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WELL.

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I'D LIKE TO BEGIN BY INTRODUCING

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OUR FIRST SPEAKER TODAY, DR.

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GOFF, DIRECTOR OF THE DIVISION

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OF CARDIOVASCULAR SCIENCE NHLBI,

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BEFORE THAT WAS DEAN AND

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PROFESSOR OF EPIDEMIOLOGY,

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COLORADO SCHOOL OF PUBLIC HEALTH

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AND AT THE WAKE FOREST SCHOOL OF

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MEDICINE.

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HE RECEIVED AN M.D. FROM

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UNIVERSITY OF NORTH CAROLINA,

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Ph.D. IN EPIDEMIOLOGY FROM

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UNIVERSITY OF TEXAS HOUSTON

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SCHOOL OF PUBLIC HEALTH.

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HE IS AN ELECTED MEMBER OF THE

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AMERICAN EPIDEMIOLOGICAL

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SOCIETY, FELLOW OF AMERICAN

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COLLEGE OF PHYSICIANS, AMERICAN

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HEART ASSOCIATION.

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HE HAS PUBLISHED OVER 300

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MANUSCRIPTS, BOOK CHAPTERS AND

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SCIENTIFIC REPORTS. 

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PLEASE WELCOME DR. GOFF.

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>> THANKS, I APPRECIATE
THE KIND

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INTRODUCTION.

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I WANT TO WELCOME EVERYONE TO

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THIS REALLY IMPORTANT WORKSHOP.

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IT'S IMPORTANT FOR US AS AN

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INSTITUTE AND CLOSE TO MY HEART.

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I SEE LONGTIME FRIENDS AND

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COLLEAGUES HERE.

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WHEN HE WAS AT THE UNIVERSITY OF

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TEXAS HOUSTON SCHOOL OF PUBLIC

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HEALTH IN THE LAST MILL ENYUM, I

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CUT MY TEETH THERE WITH THE

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TRIAL.

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IT'S BEEN A LONG JOURNEY TO TRY

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TO GET TO THE POINT WHERE WE CAN

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ELIMINATE HYPERTENSION OR

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RELATED CARDIOVASCULAR DISEASES.

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WHICH IS ONE OF THE PILLARS AND

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STRATEGIC VISION AND

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IMPLEMENTATION PLAN FOR THE

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DIVISION OF CARDIOVASCULAR

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SCIENCES AT NHLBI.

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SO, ELIMINATION OF HYPERTENSION

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OR HYPERTENSION-RELATED

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CARDIOVASCULAR DISEASE IS A GOAL

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FOR US.

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WHY?

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WELL, THE GLOBAL BURDEN OF

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DISEASE PROJECT TELLS US THAT

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HIGH BLOOD PRESSURE IS LEADING

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CAUSE OF DEATH ON THIS PLANET.

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I OFTEN SAY, WELL, THAT'S JUST

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THIS PLANET BUT IT SHOULD COUNT

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FOR SOMETHING.

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SO FOCUSING ON PREVENTION,

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DETECTION, TREATMENT, AND

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CONTROL OF HIGH BLOOD PRESSURE

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MUST BE ONE OF OUR HIGHEST

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PRIORITIES, GIVEN THAT HIGH

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BLOOD PRESSURE IS LEADING CAUSE

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OF DEATH AND DISABILITY ON THE

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PLANET.

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SO, WHAT YOU'RE GOING TO BE

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DOING OVER THE NEXT COUPLE DAYS

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GIVING US INPUT AND IDENTIFYING

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OPPORTUNITIES TO ADVANCE THIS

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PART OF OUR STRATEGIC VISION IS

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JUST CRITICALLY IMPORTANT.

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WE THANK YOU VERY MUCH.

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WE KNOW THERE ARE MANY THINGS

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YOU COULD BE DOING, ESPECIALLY

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THESE DAYS.

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THE FACT THAT YOU CHOSE TO SPEND

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TIME WITH US IS SOMETHING FOR

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WHICH WE'RE GRATEFUL.

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SO WE WANT TO MAKE GOOD USE OF

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YOUR TIME AND INPUT.

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HOW WILL WE DO THAT?

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WELL, THERE'S SOME THINGS THAT

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ARE STRAIGHTFORWARD.

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WE'LL GET A REPORT ON OUR

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WEBSITE.

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WE HOPE TO GET THAT REPORT OUT

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WITHIN THE NEXT MONTH OR SO, SO

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THE INFORMATION IS TIMELY WHEN

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WE SHARE IT WITH THE BIOMEDICAL

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RESEARCH COMMUNITY.

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FOR THAT WE'LL BE LEANING ON YOU

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AND ESPECIALLY YOUR CO-CHAIRS,

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WHO WILL BE WORKING WITH US AND

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YOU TO GET THAT REPORT OUT

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PROMPTLY.

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WE ALSO ANTICIPATE THAT YOU MAY

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WANT TO PUT TOGETHER A PAPER FOR

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SUBMISSION FOR PUBLICATION TO A

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PEER-REVIEWED JOURNAL, WE'LL

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SUPPORT THAT IF THAT'S SOMETHING

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YOU WOULD LIKE TO DO.

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IT'S NOT A REQUIREMENT BUT IT'S

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OFTEN A USEFUL WORK PRODUCT OUT

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OF A WORKSHOP LIKE THIS.

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IF YOU DO THAT WE HOPE YOU'LL DO

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IT PROMPTLY AND GET THE

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INFORMATION OUT WITHIN SIX

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MONTHS OR SO AT THE LATEST SO

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THAT AGAIN IT'S TIMELY FOR THE

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BIOMEDICAL RESEARCH COMMUNITY TO

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GET YOUR IMPORTANT INSIGHTS AND

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INPUT.

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WE ALSO HOPE THAT AT THE END OF

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THIS YOU AND THE OTHERS WHO ARE

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LISTENING WILL BE STIMULATED TO

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SUBMIT INVESTIGATOR-INITIATED

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APPLICATIONS TO THE INSTITUTE.

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THE VAST MAJORITY OF THE

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RESOURCES THAT WE HAVE ARE GIVEN

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OUT EACH YEAR IN

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INVESTIGATOR-INITIATED -- TO

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INVESTIGATOR-INITIATED

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APPLICATIONS.

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WE HOPE THIS WILL STIMULATE

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IDEAS THROUGH THAT PROCESS.

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WE USE YOUR INPUT TO GUIDE

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SELECT PAY.

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WE HAVE A POT OF FUNDS THAT WE

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RESERVE EACH YEAR TO BE ABLE TO

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PICK UP APPLICATIONS THAT COME

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IN THROUGH THE PEER-REVIEWED

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PROCESS THAT ARE NOT QUITE ON

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THE RIGHT SIDE OF THE PAYLINE

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BUT ARE STRATEGICALLY ALIGNED.

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GIVEN THE IMPORTANCE OF THIS

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AREA TO OUR MISSION AND

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STRATEGIC VISION, WE USE YOUR

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INPUT TO HELP GUIDE OUR SELECT

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PAY PROCESS.

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NOW, THERE ARE SOMETIMES FUNDING

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OPPORTUNITIES THAT ARE ANNOUNCED

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IN ASSOCIATION WITH WORKSHOPS.

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I WANT TO SET REASONABLE

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EXPECTATIONS BECAUSE WE DO MORE

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WORKSHOPS EACH YEAR THAN WE CAN

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POSSIBLY PUT OUT WELL-FUNDED

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FUNDING OPPORTUNITIES.

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SO WHETHER A FUNDING OPPORTUNITY

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GROWS OUT OF THIS WORKSHOP OR

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NOT IS I THINK YET TO BE

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DETERMINED.

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IT'S A POSSIBILITY, BUT IT'S NOT

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A DEFINITE.

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DEPENDS HOW STRONG THE IDEAS ARE

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AND HOW PRACTICAL THEY ARE AND

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THE RESOURCES THAT WE HAVE TO BE

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ABLE TO PUT BEHIND IDEAS.

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BUT WE WILL TAKE YOUR INPUT VERY

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SERIOUSLY.

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THIS IS AN ISSUE THAT'S JUST

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CRITICAL TO OUR MISSION.

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AND IT'S, YOU KNOW, IF YOU LOOK

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AT OUR STRATEGIC VISION

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IMPLEMENTATION PLAN AND YOU LOOK

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ACROSS OUR PILLARS, I MENTIONED

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THIS IS ONE OF THE SIX PILLARS,

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IT'S RELATED TO SEVERAL OTHERS.

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ONE OF OUR PRIORITIES IS TO

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ADDRESS SOCIAL DETERMINANTS OF

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CARDIOVASCULAR HEALTH AND HIGH

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BLOOD PRESSURE IS A MAJOR PART

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OF THE HEALTH INEQUITY CHALLENGE

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IN OUR COUNTRY.

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SO ADDRESSING SOCIAL

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DETERMINANTS OF HEALTH

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INEQUITIES WILL HELP US ADDRESS

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HYPERTENSION.

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ANOTHER PILLAR IS PROMOTING

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CARDIOVASCULAR ACROSS THE

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LIFESPAN.

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WE KNOW THAT BLOOD PRESSURE

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TENDS TO GO UP WITH AGE IN

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COUNTRIES IN WHICH A LOT OF

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SODIUM IS CONSUMED.

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IF WE'RE ABLE TO WORK OUT A WAY

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TO PREVENT THE AGE-RELATED

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INCREASE OR AGE-ASSOCIATED

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INCREASE IN BLOOD PRESSURE, THAT

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WILL ALSO GO A LONG WAY TOWARDS

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ADDRESSING HEALTH DISPARITIES

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AND PREVENTING

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HYPERTENSION-RELATED

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CARDIOVASCULAR DISEASES.

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SO I'M LOOKING FORWARD TO YOUR

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INPUT ON THE TOPICS YOU'RE GOING

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TO BE DISCUSSING OVER THE NEXT

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COUPLE DAYS TO REALLY HELP US

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RETHINK HOW WE APPROACH THESE

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PARTS OF OUR MISSION.

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AND WITH THAT, I'M GOING TO PASS

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THE BATON BACK TO DR. ITURRIAGA

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AND THE CO-CHAIRS SO WE CAN GET

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ON WITH THE WORK OF THE DAY. 

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THANK YOU VERY MUCH.

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>> THANK YOU, DR. GOFF.

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I'D LIKE TO INTRODUCE THE TWO

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CO-CHAIRS, DOCTORS SHAH AND

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SHIMBO.

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DR. SHAH IS ASSOCIATE PROFESSOR

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UNIVERSITY OF UTAH SCHOOL OF

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MEDICINE, CLINICAL RESEARCH

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SCIENTIST, OVERALL GOAL IS TO

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IMPROVE GLOBAL CARDIOVASCULAR

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HEALTH BY EMPHASIZING QUALITY

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AND VALUE INSIDE AND OUTSIDE OF

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TRADITIONAL HEALTH CARE DELIVERY

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SYSTEM.

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DR. SHAH'S WORK FOCUSES ON

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EMPOWERING PEOPLE TO ACHIEVE

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HEALTH BY BUILDING AND

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DELIVERING NEW TOOLS AND

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RESOURCES THAT WORK.

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SHE HAS EXPERIENCE AS A HEALTH

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SERVICES RESEARCHER WITH

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EXPERTISE IN CLINICAL

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INFORMATICS, COMPARATIVE

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EFFECTIVENESS, OBSERVATIONAL

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STUDY DESIGN.

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ACADEMIC WORK INCLUDES CREATING

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PHENOTYPES AND ANALYSIS-READY

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DATASETS.

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PREVIOUS ACHIEVEMENTS INCLUDE

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NIH GRANTS, DORIS DUKE AWARD,

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INAUGURAL WOMAN AS AN ESCALATOR

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AWARD.

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DR. SHIMBO IS A

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PHYSICIAN-SCIENTIST, PROFESSOR

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OF MEDICINE AT COLUMBIA

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UNIVERSITY IRVING MEDICAL

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CENTER.

261
00:09:24,925 --> 00:09:27,294
HE RECEIVED A BACHELOR OF

262
00:09:27,294 --> 00:09:29,730
SCIENCE FROM JOHNS HOPKINS

263
00:09:29,730 --> 00:09:30,364
UNIVERSITY IN BIOMEDICAL

264
00:09:30,364 --> 00:09:33,000
ENGINEERING, M.D. FROM ALBANY

265
00:09:33,000 --> 00:09:35,069
MEDICAL COLLEGE.

266
00:09:35,069 --> 00:09:37,171
AFTER COMPLETING AN INTERNAL

267
00:09:37,171 --> 00:09:40,340
MEDICINE RESIDENCY HE WENT ON TO

268
00:09:40,340 --> 00:09:43,177
COMPLETE CHIEF MEDICAL RESIDENCY

269
00:09:43,177 --> 00:09:46,980
IN INTERNAL MEDICINE IN

270
00:09:46,980 --> 00:09:47,748
CARDIOVASCULAR MEDICINE, MOUNT

271
00:09:47,748 --> 00:09:50,184
SINAI HOSPITAL BEFORE JOINING

272
00:09:50,184 --> 00:09:52,252
FACULTY AT COLUMBIA UNIVERSITY

273
00:09:52,252 --> 00:09:53,454
IN 2003.

274
00:09:53,454 --> 00:09:55,422
DR. SHIMBO IS DIRECTOR OF

275
00:09:55,422 --> 00:09:58,025
COLUMBIA HYPERTENSION CENTER AND

276
00:09:58,025 --> 00:09:59,693
LABORATORY, CONDUCTS RESEARCH

277
00:09:59,693 --> 00:10:03,163
INTO THE BEHAVIORAL AND

278
00:10:03,163 --> 00:10:04,398
BIOLOGICAL MECHANISMS THAT

279
00:10:04,398 --> 00:10:05,599
UNDERLIE HYPERTENSION AND

280
00:10:05,599 --> 00:10:06,667
CARDIOVASCULAR DISEASE.

281
00:10:06,667 --> 00:10:09,870
HE IS AN EXPERT IN THE DIAGNOSIS

282
00:10:09,870 --> 00:10:11,939
AND TREATMENT OF HYPERTENSION

283
00:10:11,939 --> 00:10:14,808
AND HOW HYPERTENSION AND ITS

284
00:10:14,808 --> 00:10:16,310
PHENOTYPES ARE RELATED TO

285
00:10:16,310 --> 00:10:17,511
CARDIOVASCULAR DISEASE ONSET.

286
00:10:17,511 --> 00:10:19,379
I'M NOW TURNING OVER THE

287
00:10:19,379 --> 00:10:24,752
WORKSHOP TO OUR WONDERFUL

288
00:10:24,752 --> 00:10:25,018
CO-CHAIRS.

289
00:10:25,018 --> 00:10:26,053
>> OKAY.

290
00:10:26,053 --> 00:10:28,889
GOOD MORNING HERE IN NEW YORK.

291
00:10:28,889 --> 00:10:31,091
I AM FIRST GOING TO SAY A FEW

292
00:10:31,091 --> 00:10:32,926
WORDS, AND THEN I'M GOING TO

293
00:10:32,926 --> 00:10:34,595
HAVE DR. SHAH TAKE US THROUGH

294
00:10:34,595 --> 00:10:36,897
THE AGENDA FOR DAY 1.

295
00:10:36,897 --> 00:10:39,399
I'M GOING TO END BY GOING

296
00:10:39,399 --> 00:10:40,934
THROUGH DAY 2.

297
00:10:40,934 --> 00:10:44,671
YOU HEARD FROM DR. GOFF.

298
00:10:44,671 --> 00:10:47,708
I'M A CARDIOLOGIST, AS WELL AS

299
00:10:47,708 --> 00:10:49,042
DR. SHAH.

300
00:10:49,042 --> 00:10:51,578
I'M FOCUSED ON HYPERTENSION, I

301
00:10:51,578 --> 00:10:54,181
AM BIASED, IT'S BECOMING MORE

302
00:10:54,181 --> 00:10:56,416
RELEVANT GIVEN IT'S THE NUMBER

303
00:10:56,416 --> 00:10:57,551
ONE KILLER WORLDWIDE.

304
00:10:57,551 --> 00:11:02,055
AND IN THE UNITED STATES,

305
00:11:02,055 --> 00:11:03,290
UNFORTUNATELY, BP CONTROL RATES

306
00:11:03,290 --> 00:11:07,094
HAVE WORSENED EVEN BEFORE THE

307
00:11:07,094 --> 00:11:09,062
PANDEMIC, HAVE GOTTEN WORSE

308
00:11:09,062 --> 00:11:11,365
DURING THE PANDEMIC.

309
00:11:11,365 --> 00:11:14,568
GIVEN HOW IMPORTANT HYPERTENSION

310
00:11:14,568 --> 00:11:18,472
IS, TO ME IT'S TIME TO HIT THE

311
00:11:18,472 --> 00:11:21,508
RESET BUTTON AND IDENTIFY

312
00:11:21,508 --> 00:11:22,843
PRIORITIES FOR BLOOD PRESSURE

313
00:11:22,843 --> 00:11:23,343
CONTROL.

314
00:11:23,343 --> 00:11:25,379
THIS SESSION IS FOCUSED ON

315
00:11:25,379 --> 00:11:26,680
ARTIFICIAL INTELLIGENCE.

316
00:11:26,680 --> 00:11:28,315
YOU HAVE SEEN EVERYWHERE

317
00:11:28,315 --> 00:11:29,516
ALGORITHMS ARE EVERYWHERE, I

318
00:11:29,516 --> 00:11:31,251
JUST PICKED UP THE JAMA LAST

319
00:11:31,251 --> 00:11:33,887
NIGHT AND SAW TWO MORE

320
00:11:33,887 --> 00:11:36,089
PUBLICATIONS ON A.I. AND MEDICAL

321
00:11:36,089 --> 00:11:37,324
HEALTH.

322
00:11:37,324 --> 00:11:39,927
AND WHAT'S CLEAR IS IT'S ALL

323
00:11:39,927 --> 00:11:41,562
OVER SOCIAL MEDIA, AND AS WELL

324
00:11:41,562 --> 00:11:44,631
AS NOT JUST JAMA BUT OTHER

325
00:11:44,631 --> 00:11:46,033
PUBLISHED JOURNALS.

326
00:11:46,033 --> 00:11:50,304
AND IT'S PRETTY CLEAR THAT

327
00:11:50,304 --> 00:11:53,173
INDUSTRY PARTNERS ARE INCREASING

328
00:11:53,173 --> 00:11:55,042
INVESTMENTS, FACEBOOK, GOOGLE,

329
00:11:55,042 --> 00:11:59,379
MICROSOFT, REALLY DOUBLING DOWN

330
00:11:59,379 --> 00:12:03,450
ON A.I. I PERSONALLY HAVE CHUTE

331
00:12:03,450 --> 00:12:06,086
CHAT USED CHATGPT AND OTHERS AND

332
00:12:06,086 --> 00:12:06,887
HAVE BEEN IMPRESSED.

333
00:12:06,887 --> 00:12:09,590
I THINK THE CHALLENGES THAT A.I.

334
00:12:09,590 --> 00:12:12,659
IS NOW BEING USED SOMEWHAT IN

335
00:12:12,659 --> 00:12:15,062
SOME MEDICAL DISCIPLINES AND AS

336
00:12:15,062 --> 00:12:17,598
WELL AS, FOR EXAMPLE,

337
00:12:17,598 --> 00:12:18,465
HYPERTENSION, THERE'S BEEN SOME

338
00:12:18,465 --> 00:12:19,700
CONCERNS THAT HAVE ARISEN.

339
00:12:19,700 --> 00:12:20,667
SOME QUESTIONS THAT HAVE COME

340
00:12:20,667 --> 00:12:23,737
ABOUT IS HOW GOOD ARE THE

341
00:12:23,737 --> 00:12:26,340
ALGORITHMS, DO THEY REALLY HELP

342
00:12:26,340 --> 00:12:28,675
HUMAN HEALTH, AND WHAT ARE THE

343
00:12:28,675 --> 00:12:31,078
POTENTIAL RISKS AND DOWN SIDES.

344
00:12:31,078 --> 00:12:33,614
SO, DR. SHAH, MYSELF, AND THE

345
00:12:33,614 --> 00:12:35,449
ENTIRE NIH STAFF WHO PUT THIS

346
00:12:35,449 --> 00:12:37,251
SESSION TOGETHER REALLY DESIGNED

347
00:12:37,251 --> 00:12:40,187
THIS SESSION AROUND A.I. AND ITS

348
00:12:40,187 --> 00:12:42,155
USE IN HYPERTENSION DIAGNOSIS,

349
00:12:42,155 --> 00:12:43,357
IN MANAGEMENT.

350
00:12:43,357 --> 00:12:45,525
THE WAY THE SESSION'S BEEN

351
00:12:45,525 --> 00:12:48,061
DESIGNED, THE WORKSHOP, IS IT'S

352
00:12:48,061 --> 00:12:50,797
CLEAR WITH SO MANY PEOPLE

353
00:12:50,797 --> 00:12:52,099
INVOLVED, CLINICIANS, INDUSTRY

354
00:12:52,099 --> 00:12:54,268
LEADERS, LEGAL AND REGULATORY

355
00:12:54,268 --> 00:12:57,137
EXPERTS, PUBLIC HEALTH EXPERTS,

356
00:12:57,137 --> 00:12:57,704
CLINICAL RESEARCHERS, DATA

357
00:12:57,704 --> 00:12:58,906
SCIENTISTS, ET CETERA WE'RE

358
00:12:58,906 --> 00:13:01,608
DEEPLY CONCERNED THAT WE'RE

359
00:13:01,608 --> 00:13:04,278
SPEAKING DIFFERENT LANGUAGES.

360
00:13:04,278 --> 00:13:06,780
AND I ALWAYS THINK OF THE

361
00:13:06,780 --> 00:13:07,981
PICTURE OF THE BLIND MONKS

362
00:13:07,981 --> 00:13:10,284
HOLDING DIFFERENT PARTS OF THE

363
00:13:10,284 --> 00:13:11,485
ELEPHANT, DESCRIBING THE

364
00:13:11,485 --> 00:13:14,421
ELEPHANT BUT OF COURSE

365
00:13:14,421 --> 00:13:16,957
DESCRIBING DIFFERENT PIECES.

366
00:13:16,957 --> 00:13:17,658
THE DESCRIPTIONS SOUND DIFFERENT

367
00:13:17,658 --> 00:13:19,459
BUT THEY ARE THE SAME ELEPHANT

368
00:13:19,459 --> 00:13:24,498
WHAT YOU'LL SEE FROM THE

369
00:13:24,498 --> 00:13:27,000
DIFFERENT SESSIONS IS THAT WE

370
00:13:27,000 --> 00:13:29,536
WANT TO EDUCATE EACH OTHER ON

371
00:13:29,536 --> 00:13:32,906
THE DIFFERENT CONTENT IN THIS

372
00:13:32,906 --> 00:13:33,140
AREA.

373
00:13:33,140 --> 00:13:35,642
IF YOU'RE A HYPERTENSION EXPERT

374
00:13:35,642 --> 00:13:36,743
AND LISTEN, YOU MIGHT SAY

375
00:13:36,743 --> 00:13:37,911
THERE'S NOTHING NEW HERE BUT

376
00:13:37,911 --> 00:13:40,047
REALLY THE TARGET IS THE OTHER

377
00:13:40,047 --> 00:13:41,114
PEOPLE WHO DON'T KNOW.

378
00:13:41,114 --> 00:13:43,116
AND SO WE HOPE THAT YOU LEARN

379
00:13:43,116 --> 00:13:45,619
FROM THE AREAS THAT YOU'RE NOT

380
00:13:45,619 --> 00:13:45,953
FAMILIAR WITH.

381
00:13:45,953 --> 00:13:48,155
AND AT THE END OF THE DAY, THERE

382
00:13:48,155 --> 00:13:51,191
WILL BE LOTS OF DISCUSSION ABOUT

383
00:13:51,191 --> 00:13:52,960
THE BENEFITS AND DOWN SIDES TO

384
00:13:52,960 --> 00:13:57,331
A.I. AND HYPERTENSION. 

385
00:13:57,331 --> 00:13:58,198
WITH THAT INTRODUCTION, I'LL

386
00:13:58,198 --> 00:14:01,468
HAVE YOU TAKE US THROUGH DAY 1.

387
00:14:01,468 --> 00:14:04,137
>> THAT SOUNDS GREAT.

388
00:14:04,137 --> 00:14:06,440
THANK YOU FOR PARTICIPATING, AND

389
00:14:06,440 --> 00:14:08,976
NIH STAFF FOR HELPING ORGANIZE.

390
00:14:08,976 --> 00:14:12,145
THIS HAS GOT ME EXCITED BECAUSE

391
00:14:12,145 --> 00:14:14,881
I LOVE HOW THIS GROUP OF

392
00:14:14,881 --> 00:14:15,849
SESSIONS AND SPEAKERS SPANS THE

393
00:14:15,849 --> 00:14:18,685
WHOLE RANGE OF WHAT WE NEED TO

394
00:14:18,685 --> 00:14:19,886
REALLY ADVANCE THE FIELD, NOT

395
00:14:19,886 --> 00:14:22,222
JUST FROM A SCIENCE STANDPOINT,

396
00:14:22,222 --> 00:14:24,691
ACTUALLY GET SOMETHING DONE

397
00:14:24,691 --> 00:14:24,992
STANDPOINT.

398
00:14:24,992 --> 00:14:27,227
I'M EXCITED ABOUT THE AGENDA.

399
00:14:27,227 --> 00:14:29,830
I'LL BRIEFLY GO OVER WHAT WE

400
00:14:29,830 --> 00:14:31,498
HAVE FOR DAY 1 TODAY.

401
00:14:31,498 --> 00:14:33,266
TODAY WE'LL HAVE THREE SESSIONS.

402
00:14:33,266 --> 00:14:36,770
THE FIRST SESSION IS BRIDGING

403
00:14:36,770 --> 00:14:38,505
THE COMMUNICATIONS GAP BETWEEN

404
00:14:38,505 --> 00:14:39,806
POPULATION HEALTH, CLINICAL

405
00:14:39,806 --> 00:14:40,907
MEDICINE, ENGINEERING.

406
00:14:40,907 --> 00:14:43,977
AND AS DR. SHIMBO ALLUDED TO,

407
00:14:43,977 --> 00:14:45,412
THIS CONCEPT THAT IN SOME WAYS

408
00:14:45,412 --> 00:14:49,583
NOW I WORK A LOT WITH ENGINEERS

409
00:14:49,583 --> 00:14:50,550
BUT WE SPEAK DIFFERENT LANGUAGES

410
00:14:50,550 --> 00:14:52,085
AND HOW DO WE GET ON THE SAME

411
00:14:52,085 --> 00:14:53,086
PAGE TO DO SOMETHING THAT

412
00:14:53,086 --> 00:14:56,657
MATTERS AND DO IT FAST.

413
00:14:56,657 --> 00:14:58,992
SECOND SESSION IS BLOOD PRESSURE

414
00:14:58,992 --> 00:15:00,527
MEASUREMENT, HYPERTENSION RISK,

415
00:15:00,527 --> 00:15:01,828
AND BLOOD PRESSURE CONTROL.

416
00:15:01,828 --> 00:15:03,330
WE'LL LEARN ABOUT SORT OF THE

417
00:15:03,330 --> 00:15:05,065
CURRENT STATE OF BLOOD PRESSURE

418
00:15:05,065 --> 00:15:07,200
CONTROL AND TREATMENT AND

419
00:15:07,200 --> 00:15:07,968
PREVALENCE AND AWARENESS, AGAIN

420
00:15:07,968 --> 00:15:10,470
MAYBE WE HAVE ENGINEERS IN THE

421
00:15:10,470 --> 00:15:11,805
AUDIENCE, GET EVERYBODY ON THE

422
00:15:11,805 --> 00:15:12,439
SAME PAGE.

423
00:15:12,439 --> 00:15:14,541
FINALLY TODAY WE HAVE MAKING A

424
00:15:14,541 --> 00:15:18,011
DENT IN THE PROBLEM. 

425
00:15:18,011 --> 00:15:23,483
WE HAVE SCIENCE, TOOLS,

426
00:15:23,483 --> 00:15:24,184
ENGINEERS, PHYSICIANS, HOW ARE

427
00:15:24,184 --> 00:15:26,887
WE GOING TO MAKE A DIFFERENCE?

428
00:15:26,887 --> 00:15:29,022
THEY BEGINNING WE'LL HAVE OUR

429
00:15:29,022 --> 00:15:29,956
KEYNOTE SPEAKER WHO I WILL

430
00:15:29,956 --> 00:15:32,259
INTRODUCE IN A MINUTE HERE.

431
00:15:32,259 --> 00:15:32,559
THANK YOU.

432
00:15:32,559 --> 00:15:34,995
>> THANK YOU, DR. SHAH.

433
00:15:34,995 --> 00:15:37,531
DAY 2 WE START AT THE SAME TIME,

434
00:15:37,531 --> 00:15:39,266
11 A.M.

435
00:15:39,266 --> 00:15:44,304
AND WE WILL END AT 4:00 P.M.

436
00:15:44,304 --> 00:15:44,571
TOMORROW.

437
00:15:44,571 --> 00:15:46,840
AND DAY 2 WILL START OFF WITH

438
00:15:46,840 --> 00:15:49,342
SESSION NUMBER 4, WHICH IS ON

439
00:15:49,342 --> 00:15:50,811
REAL WORLD IMPLEMENTATION

440
00:15:50,811 --> 00:15:52,079
CHALLENGES AND ISSUES.

441
00:15:52,079 --> 00:15:56,349
THIS SESSION WILL FOCUS ON THE

442
00:15:56,349 --> 00:15:58,518
REAL WORLD PRACTICALITY ISSUES

443
00:15:58,518 --> 00:15:59,953
THAT ARE OCCURRING OR AFFECT

444
00:15:59,953 --> 00:16:04,558
USING A.I. IN THE CLINICAL CARE

445
00:16:04,558 --> 00:16:08,295
OF PATIENTS WITH HYPERTENSION.

446
00:16:08,295 --> 00:16:10,931
SESSION 5 IS A DISCUSSION.

447
00:16:10,931 --> 00:16:15,068
IT'S A GROUP DISCUSSION FROM 2

448
00:16:15,068 --> 00:16:17,370
TO 3, INVITED SPEAKERS AND

449
00:16:17,370 --> 00:16:18,572
MODERATORS WILL ACTUALLY GO INTO

450
00:16:18,572 --> 00:16:19,206
A ROOM.

451
00:16:19,206 --> 00:16:22,309
THIS WON'T BE AVAILABLE TO THE

452
00:16:22,309 --> 00:16:22,542
PUBLIC.

453
00:16:22,542 --> 00:16:23,710
WE'LL BE DISCUSSING BEHIND THE

454
00:16:23,710 --> 00:16:25,245
SCENES EVERYTHING THAT WE

455
00:16:25,245 --> 00:16:26,346
LEARNED FROM EACH OTHER AND

456
00:16:26,346 --> 00:16:28,782
WE'RE GOING TO COME OUT WITH

457
00:16:28,782 --> 00:16:30,750
ANSWERS TO THREE QUESTIONS.

458
00:16:30,750 --> 00:16:34,254
RESEARCH GAPS AND HIGH PRIORITY

459
00:16:34,254 --> 00:16:35,655
QUESTIONS, WHAT ARE BARRIERS TO

460
00:16:35,655 --> 00:16:37,524
ADDRESSING GAPS AND QUESTIONS,

461
00:16:37,524 --> 00:16:39,059
AND RECOMMENDATIONS HOW TO MOVE

462
00:16:39,059 --> 00:16:41,194
THIS FIELD FORWARD.

463
00:16:41,194 --> 00:16:42,996
AND THEN FROM -- AT 3:00 WE'LL

464
00:16:42,996 --> 00:16:44,397
RETURN TO THE ROOM, AND THAT

465
00:16:44,397 --> 00:16:47,567
WILL THEN BE OPEN TO THE PUBLIC.

466
00:16:47,567 --> 00:16:51,071
AND WE'LL PRESENT EACH OF OUR

467
00:16:51,071 --> 00:16:52,839
FINDINGS AND RECOMMENDATIONS AND

468
00:16:52,839 --> 00:16:55,675
THOUGHTS TO THE GENERAL PUBLIC

469
00:16:55,675 --> 00:16:58,111
REGARDING THE THREE QUESTIONS

470
00:16:58,111 --> 00:16:59,513
THAT I JUST NAMED.

471
00:16:59,513 --> 00:17:03,350
FINALLY AT THE END, WE'LL HAVE A

472
00:17:03,350 --> 00:17:05,085
CLOSE-UP, 3:45 TO 4:00, AND AT

473
00:17:05,085 --> 00:17:07,721
THAT POINT WE'LL END THE

474
00:17:07,721 --> 00:17:08,355
SESSION.

475
00:17:08,355 --> 00:17:11,324
BEFORE WE START WITH OUR KEYNOTE

476
00:17:11,324 --> 00:17:14,161
SPEAKER, I WILL SAY I WANT TO

477
00:17:14,161 --> 00:17:16,997
REITERATE TO THE AUDIENCE,

478
00:17:16,997 --> 00:17:18,431
VIRTUAL AUDIENCE, PLEASE,

479
00:17:18,431 --> 00:17:19,332
PLEASE, PLEASE TYPE YOUR

480
00:17:19,332 --> 00:17:20,967
QUESTIONS IN THE CHAT BOX.

481
00:17:20,967 --> 00:17:24,437
WE WILL BE MONITORING THOSE

482
00:17:24,437 --> 00:17:24,771
QUESTIONS.

483
00:17:24,771 --> 00:17:26,072
THE MODERATORS THAT HAVE BEEN

484
00:17:26,072 --> 00:17:28,074
ASSIGNED TO EACH SESSION AS WELL

485
00:17:28,074 --> 00:17:31,578
AS DR. SHAH AND MYSELF WILL USE

486
00:17:31,578 --> 00:17:32,479
THESE QUESTIONS.

487
00:17:32,479 --> 00:17:33,547
WE WILL CRAFT THESE QUESTIONS

488
00:17:33,547 --> 00:17:36,183
THAT WE CAN ASK OUR SPEAKERS

489
00:17:36,183 --> 00:17:38,251
BECAUSE THERE'S A LOT OF

490
00:17:38,251 --> 00:17:40,987
BUILT-IN DISCUSSION TIME WITHIN

491
00:17:40,987 --> 00:17:41,755
EACH SESSION.

492
00:17:41,755 --> 00:17:43,056
SO, WITHOUT FURTHER ADO I'M

493
00:17:43,056 --> 00:17:44,824
GOING TO JUST HAND IT BACK OVER

494
00:17:44,824 --> 00:17:48,528
TO DR. SHAH WHO IS GOING TO

495
00:17:48,528 --> 00:17:49,462
INTRODUCE OUR KEYNOTE SPEAKER.

496
00:17:49,462 --> 00:17:50,597
>> EXCELLENT.

497
00:17:50,597 --> 00:17:51,698
THANK YOU.

498
00:17:51,698 --> 00:17:54,100
IT IS REALLY MY HONOR TO

499
00:17:54,100 --> 00:17:57,704
INTRODUCE DR. ERICA SPATZ,

500
00:17:57,704 --> 00:17:58,305
KEYNOTE SPEAKER, FOR TODAY.

501
00:17:58,305 --> 00:18:01,241
SHE WILL BE TALKING ABOUT THE

502
00:18:01,241 --> 00:18:02,542
BLOOD PRESSURE NEXUS.

503
00:18:02,542 --> 00:18:05,278
DR. SPATZ IS AN ASSOCIATE

504
00:18:05,278 --> 00:18:05,946
PROFESSOR OF CARDIOVASCULAR

505
00:18:05,946 --> 00:18:07,280
MEDICINE EPIDEMIOLOGY AT THE

506
00:18:07,280 --> 00:18:09,115
YALE SCHOOL OF MEDICINE.

507
00:18:09,115 --> 00:18:11,384
AND SHE'S ALSO FOUNDER OF THE

508
00:18:11,384 --> 00:18:12,953
YALE HEART AND VASCULAR CENTER

509
00:18:12,953 --> 00:18:15,222
FOR THE DIGITAL HYPERTENSION

510
00:18:15,222 --> 00:18:15,655
PROGRAM.

511
00:18:15,655 --> 00:18:19,159
AS YOU CAN SEE HER EXPERTISE IS

512
00:18:19,159 --> 00:18:20,293
PERFECT FOR TODAY.

513
00:18:20,293 --> 00:18:22,295
ACCOLADES ARE NUMEROUS.

514
00:18:22,295 --> 00:18:24,864
I COULD LIST A LOT BUT I WANT TO

515
00:18:24,864 --> 00:18:26,633
TALK ABOUT WHY SHE'S THE PERFECT

516
00:18:26,633 --> 00:18:27,701
PERSON FOR THIS KEYNOTE.

517
00:18:27,701 --> 00:18:30,871
LOTS OF US DO REALLY EXCELLENT

518
00:18:30,871 --> 00:18:32,739
SCIENCE, BUILD TOOLS, WRITE

519
00:18:32,739 --> 00:18:33,106
CODE.

520
00:18:33,106 --> 00:18:35,475
BUT PEOPLE WHO GET OUT INTO THE

521
00:18:35,475 --> 00:18:37,010
COMMUNITY AND UNDERSTAND THE

522
00:18:37,010 --> 00:18:38,578
PEOPLE AND THE CHALLENGES PEOPLE

523
00:18:38,578 --> 00:18:42,082
IN COMMUNITIES FACE RELATED TO

524
00:18:42,082 --> 00:18:43,283
HYPERTENSION, THOSE PEOPLE

525
00:18:43,283 --> 00:18:44,484
REALLY UNDERSTAND THE PROBLEM

526
00:18:44,484 --> 00:18:46,920
THAT NEEDS TO BE SOLVE AND THAT

527
00:18:46,920 --> 00:18:48,989
IS DR. SPATZ.

528
00:18:48,989 --> 00:18:50,690
WITHOUT FURTHER ADO, I HAND IT

529
00:18:50,690 --> 00:18:55,228
OVER TO HER.

530
00:18:55,228 --> 00:18:59,466
>> THANK YOU SO MUCH.

531
00:18:59,466 --> 00:19:03,904
I'D LIKE TO THANK NHLBI AND

532
00:19:03,904 --> 00:19:05,305
CO-CHAIRS WHO ARE COLLEAGUES AND

533
00:19:05,305 --> 00:19:08,909
FRIENDS AND THOUGHT LEADERS IN

534
00:19:08,909 --> 00:19:09,242
HYPERTENSION.

535
00:19:09,242 --> 00:19:11,578
I'M PRIVILEGED TO TALK ABOUT THE

536
00:19:11,578 --> 00:19:13,179
BLOOD PRESSURE NEXUS, REAL WORLD

537
00:19:13,179 --> 00:19:13,947
CHALLENGES IN COMMUNITIES WITH

538
00:19:13,947 --> 00:19:22,389
OR AT RISK FOR HYPERTENSION.

539
00:19:22,389 --> 00:19:22,923
NEXT SLIDE.

540
00:19:22,923 --> 00:19:27,861
THANK U  YOU.

541
00:19:27,861 --> 00:19:35,602
THESE ARE MY DISCLOSURES.

542
00:19:35,602 --> 00:19:36,303
NEXT SLIDE.

543
00:19:36,303 --> 00:19:42,208
I'M GOING TO TELL YOU ABOUT A

544
00:19:42,208 --> 00:19:43,843
PATIENT JOURNEY.

545
00:19:43,843 --> 00:19:45,078
YOU CAN ADVANCE.

546
00:19:45,078 --> 00:19:45,545
SORRY.

547
00:19:45,545 --> 00:19:51,651
YOU CAN ADVANCE ONE.

548
00:19:51,651 --> 00:19:52,285
AND AGAIN.

549
00:19:52,285 --> 00:19:58,959
SO THIS IS A STORY OF THE

550
00:19:58,959 --> 00:20:00,493
42-YEAR-OLD BLACK MAN, WHO I MET

551
00:20:00,493 --> 00:20:02,362
IN THE HOSPITAL IN 2017,

552
00:20:02,362 --> 00:20:04,531
HOSPITALIZED WITH NEW ONSET

553
00:20:04,531 --> 00:20:06,833
HEART FAILURE, EJECTION FRACTION

554
00:20:06,833 --> 00:20:10,003
OF 15%, VERY LOW.

555
00:20:10,003 --> 00:20:13,273
DIAGNOSED WITH A NON-ISCHEMIC

556
00:20:13,273 --> 00:20:13,840
CARDIOMYOPATHY, CAUSE BEING

557
00:20:13,840 --> 00:20:15,775
UNCONTROLLED BLOOD PRESSURE AT

558
00:20:15,775 --> 00:20:18,445
THE AGE OF 42.

559
00:20:18,445 --> 00:20:20,213
YOU CAN ADVANCE.

560
00:20:20,213 --> 00:20:21,648
YOU CAN ADVANCE AGAIN.

561
00:20:21,648 --> 00:20:23,249
I LOOKED BACK AND WONDERED HOW

562
00:20:23,249 --> 00:20:26,319
COULD THIS BE THAT THIS OCCURRED

563
00:20:26,319 --> 00:20:29,389
IN A 42-YEAR-OLD MAN AND FOUND

564
00:20:29,389 --> 00:20:30,690
HE FIRST ENTERED OUR HEALTH

565
00:20:30,690 --> 00:20:31,992
SYSTEM ONE YEAR PRIOR WITH

566
00:20:31,992 --> 00:20:33,960
EMERGENCY ROOM VISIT FOR KNEE

567
00:20:33,960 --> 00:20:34,160
PAIN.

568
00:20:34,160 --> 00:20:36,930
HIS BLOOD PRESSURE WAS DETECTED

569
00:20:36,930 --> 00:20:39,666
TO BE 200/120, STARTED ON

570
00:20:39,666 --> 00:20:41,334
MEDICATION, GIVEN APPOINTMENT

571
00:20:41,334 --> 00:20:42,402
WITH PRIMARY CARE PROVIDER.

572
00:20:42,402 --> 00:20:43,937
HE SHOWED UP FOR THAT

573
00:20:43,937 --> 00:20:46,673
APPOINTMENT AND WE LEARNED HE IS

574
00:20:46,673 --> 00:20:49,409
A SINGLE DATA CARING FOR TWO

575
00:20:49,409 --> 00:20:52,379
YOUNG CHILDREN, WIFE PASSED AWAY

576
00:20:52,379 --> 00:20:54,014
OF BREAST CANCER, WORKING TWO

577
00:20:54,014 --> 00:21:00,620
JOBS, OBESE, DIDN'T EAT WELL, NO

578
00:21:00,620 --> 00:21:00,954
SYMPTOMS.

579
00:21:00,954 --> 00:21:04,524
CAN YOU HEAR ME OKAY?

580
00:21:04,524 --> 00:21:05,825
>> WE CAN HEAR YOU.

581
00:21:05,825 --> 00:21:08,028
>> OKAY, GREAT.

582
00:21:08,028 --> 00:21:09,262
SORRY.

583
00:21:09,262 --> 00:21:10,697
HIS BLOOD PRESSURE WAS 172/90.

584
00:21:10,697 --> 00:21:13,700
HE WAS TOLD TO COME BACK IN A

585
00:21:13,700 --> 00:21:16,236
MONTH, YET NEVER SHOWED UNTIL

586
00:21:16,236 --> 00:21:18,438
PRESENTATION FOR HEART FAILURE.

587
00:21:18,438 --> 00:21:18,838
NEXT SLIDE.

588
00:21:18,838 --> 00:21:21,074
WHEN I MET HIM IN THE HOSPITAL

589
00:21:21,074 --> 00:21:23,810
AND YOU CAN ADVANCE ANOTHER TIME

590
00:21:23,810 --> 00:21:26,546
ON THE SLIDE.

591
00:21:26,546 --> 00:21:27,313
THANK YOU.

592
00:21:27,313 --> 00:21:30,283
I WAS DETERMINED TO CHANGE THE

593
00:21:30,283 --> 00:21:31,451
COURSE FOR THIS GENTLEMAN.

594
00:21:31,451 --> 00:21:33,553
I MET HIM IN THE CARDIOLOGY

595
00:21:33,553 --> 00:21:35,321
CLINIC, TRIED TO BUILD THAT

596
00:21:35,321 --> 00:21:38,057
CONNECTION, AND BUILD A PLAN

597
00:21:38,057 --> 00:21:39,459
TOGETHER TO ADVANCE GDMT.

598
00:21:39,459 --> 00:21:40,360
I FAILED.

599
00:21:40,360 --> 00:21:43,296
TWO YEARS LATER HE PRESENTS WITH

600
00:21:43,296 --> 00:21:47,033
DISABLING STROKE FROM LEFT

601
00:21:47,033 --> 00:21:47,834
VENTRICULAR THROMBUS, A TRAGIC

602
00:21:47,834 --> 00:21:50,970
CASE THAT CONTINUES TO MAKE ME

603
00:21:50,970 --> 00:21:52,071
EMOTIONAL BECAUSE I CONTINUE TO

604
00:21:52,071 --> 00:21:53,940
CARE FOR HIM AND STRUGGLE WITH

605
00:21:53,940 --> 00:21:56,209
LOU TO HAVE PREVENTED THIS

606
00:21:56,209 --> 00:21:56,443
OUTCOME.

607
00:21:56,443 --> 00:21:57,977
SOME MAY SAY THIS IS ON HIM.

608
00:21:57,977 --> 00:22:00,613
HE DIDN'T FOLLOW UP.

609
00:22:00,613 --> 00:22:01,648
BUT IS IT?

610
00:22:01,648 --> 00:22:04,017
HOW ARE WE AS A LEARNING HEALTH

611
00:22:04,017 --> 00:22:05,952
SYSTEM REFLECTING ON THESE CASES

612
00:22:05,952 --> 00:22:07,487
AND USING THESE CASES TO

613
00:22:07,487 --> 00:22:10,990
INNOVATE AND TO BE BETTER?

614
00:22:10,990 --> 00:22:14,294
BLOOD PRESSURE NEXUS IS REALLY

615
00:22:14,294 --> 00:22:16,463
ABOUT COMBINING THE MEDICAL,

616
00:22:16,463 --> 00:22:20,733
SOCIAL, TECHNOLOGY, IN ORDER TO

617
00:22:20,733 --> 00:22:23,903
CREATE BETTER OUTCOMES FOR

618
00:22:23,903 --> 00:22:24,237
PATIENTS.

619
00:22:24,237 --> 00:22:25,338
NEXT SLIDE.

620
00:22:25,338 --> 00:22:26,639
ROOT CAUSE ANALYSIS WE NEED DO

621
00:22:26,639 --> 00:22:27,273
THAT, RIGHT?

622
00:22:27,273 --> 00:22:30,009
IT'S NOT JUST THAT WE UNDERSTAND

623
00:22:30,009 --> 00:22:31,878
MR. GREEN, OUR PATIENT, AT THE

624
00:22:31,878 --> 00:22:32,779
INDIVIDUAL LEVEL.

625
00:22:32,779 --> 00:22:34,848
WE UNDERSTAND HIS STRUGGLES.

626
00:22:34,848 --> 00:22:36,716
BUT IT GOES DEEPER, RIGHT?

627
00:22:36,716 --> 00:22:39,886
MR. GREEN LIVED IN NEW HAVEN.

628
00:22:39,886 --> 00:22:41,754
HE LIVES IN A NEIGHBORHOOD, I

629
00:22:41,754 --> 00:22:44,724
SEE THE ARROWS ARE OFF, BUT AT

630
00:22:44,724 --> 00:22:48,628
THE TOP OF THAT NEW HAVEN, NEW

631
00:22:48,628 --> 00:22:50,196
HALLVILLE WITH SOME OF THE

632
00:22:50,196 --> 00:22:54,334
HIGHEST RATES OF POVERTY, YET

633
00:22:54,334 --> 00:22:55,969
LOWEST LIFE EXPECTANCY, UNDER 74

634
00:22:55,969 --> 00:22:58,938
YEARS IN THE HIGHLY POPULATED

635
00:22:58,938 --> 00:22:59,139
AREA.

636
00:22:59,139 --> 00:23:04,544
THERE'S HIGHER E.D. VISITS FOR

637
00:23:04,544 --> 00:23:06,579
HYPERTENSION, STROKE, A LOT OF

638
00:23:06,579 --> 00:23:09,449
CRIME AND VIOLENCE.

639
00:23:09,449 --> 00:23:10,650
THIS BOOK IS ABOUT THIS

640
00:23:10,650 --> 00:23:17,323
NEIGHBORHOOD CALLED "THE OTHER

641
00:23:17,323 --> 00:23:18,525
SIDE OF PROSPECT."

642
00:23:18,525 --> 00:23:22,462
I PICTURE IS TAKEN FROM ACROSS

643
00:23:22,462 --> 00:23:23,997
THE STRAIGHT FROM BARBER SHOPS

644
00:23:23,997 --> 00:23:24,664
WE'RE SCREENING FOR

645
00:23:24,664 --> 00:23:25,098
HYPERTENSION.

646
00:23:25,098 --> 00:23:27,400
IT'S ABOUT A YOUNG BOY FALSELY

647
00:23:27,400 --> 00:23:28,268
ACCUSED OF MURDER.

648
00:23:28,268 --> 00:23:32,438
THE STRESSES OF GROWING UP IN

649
00:23:32,438 --> 00:23:33,206
THIS ENVIRONMENT THAT HAS A LOT

650
00:23:33,206 --> 00:23:35,808
OF CRIME AND LACK OF

651
00:23:35,808 --> 00:23:36,109
OPPORTUNITY.

652
00:23:36,109 --> 00:23:38,011
I THINK ABOUT THIS BEING THE

653
00:23:38,011 --> 00:23:38,678
NEIGHBORHOOD WHERE MY PATIENT

654
00:23:38,678 --> 00:23:41,414
AND SO MANY OTHER PATIENTS ARE

655
00:23:41,414 --> 00:23:41,948
GROWING UP.

656
00:23:41,948 --> 00:23:44,150
YET HERE WE ARE TRYING TO MAKE A

657
00:23:44,150 --> 00:23:46,119
CONNECTION WITH A PATIENT, AND

658
00:23:46,119 --> 00:23:48,621
MAYBE POTENTIALLY IGNORING OR

659
00:23:48,621 --> 00:23:50,056
NOT EVEN VALIDATING WHAT THE

660
00:23:50,056 --> 00:23:51,691
FACTORS ARE CONTRIBUTING TO

661
00:23:51,691 --> 00:23:54,460
THEIR HIGH BLOOD PRESSURE.

662
00:23:54,460 --> 00:23:54,961
NEXT SLIDE.

663
00:23:54,961 --> 00:23:58,131
THIS IS NOT JUST A STORY ABOUT

664
00:23:58,131 --> 00:23:58,798
POVERTY.

665
00:23:58,798 --> 00:24:00,867
MANY HIGH PROFILE HIGHLY

666
00:24:00,867 --> 00:24:03,069
EDUCATED SUCCESSFUL PEOPLE HAVE

667
00:24:03,069 --> 00:24:07,340
ALSO SUFFERED FROM POOR

668
00:24:07,340 --> 00:24:09,742
HYPERTENSION OUTCOMES, TRAGIC

669
00:24:09,742 --> 00:24:10,610
OUTCOMES.

670
00:24:10,610 --> 00:24:12,478
SHALON IRVING WAS A CDC

671
00:24:12,478 --> 00:24:13,780
RESEARCHER, WHEN PREGNANT AND

672
00:24:13,780 --> 00:24:18,484
HAD A TOUGH PREGNANCY, AFTER SHE

673
00:24:18,484 --> 00:24:19,819
DELIVERED BABY SHE REPORTED NOT

674
00:24:19,819 --> 00:24:21,754
FEELING WELL, HAVING A HEADACHE,

675
00:24:21,754 --> 00:24:22,555
HIGH BLOOD PRESSURE.

676
00:24:22,555 --> 00:24:25,191
TOLD TO GO HOME AND REST.

677
00:24:25,191 --> 00:24:29,462
SHE DIED OF A STROKE.

678
00:24:29,462 --> 00:24:33,166
JOHN SINGLETON, SAME DIRECTOR OF

679
00:24:33,166 --> 00:24:37,437
BOYS IN THE HOOD, DIED AT 51 OF

680
00:24:37,437 --> 00:24:38,671
A STROKE, BOTH FAMILIES WERE

681
00:24:38,671 --> 00:24:39,639
ACTIVE WITH MULTIPLE SOCIETIES

682
00:24:39,639 --> 00:24:44,344
TO GET THE WORD OUT AROUND

683
00:24:44,344 --> 00:24:46,412
HYPERTENSION, AS YOU'VE HEARD

684
00:24:46,412 --> 00:24:49,382
THE MOST COMMON AND DEADLY

685
00:24:49,382 --> 00:24:52,986
KILLER ACROSS THE GLOBE FOR

686
00:24:52,986 --> 00:24:54,087
PEOPLE THROUGHOUT.

687
00:24:54,087 --> 00:24:57,390
WE KNOW THERE ARE SIGNIFICANT

688
00:24:57,390 --> 00:25:01,661
DISPARITIES BY RACE, INCOME, AND

689
00:25:01,661 --> 00:25:01,928
GEOGRAPHY.

690
00:25:01,928 --> 00:25:02,428
NEXT SLIDE.

691
00:25:02,428 --> 00:25:04,931
YOU CAN ADVANCE.

692
00:25:04,931 --> 00:25:06,032
THANKS.

693
00:25:06,032 --> 00:25:08,568
SO, BETWEEN 2000 AND 2018,

694
00:25:08,568 --> 00:25:12,739
HYPERTENSION-RELATED DEATHS HAVE

695
00:25:12,739 --> 00:25:15,241
INCREASED, STAGNATED, OR

696
00:25:15,241 --> 00:25:15,541
DECELERATED.

697
00:25:15,541 --> 00:25:17,777
IF YOU LOOK AT THE TOP TWO LINES

698
00:25:17,777 --> 00:25:19,412
THEY REPRESENT BLACK MEN AND

699
00:25:19,412 --> 00:25:20,179
BLACK WOMEN.

700
00:25:20,179 --> 00:25:23,016
YOU CAN SEE THAT THEY HAVE A

701
00:25:23,016 --> 00:25:26,285
TWO-FOLD HIGHER RATE THAN OTHER

702
00:25:26,285 --> 00:25:30,256
RACE/ETHNICITY GROUPS ACROSS ALL

703
00:25:30,256 --> 00:25:30,757
HYPERTENSION-RELATED

704
00:25:30,757 --> 00:25:31,557
CARDIOVASCULAR DISEASE OUTCOMES.

705
00:25:31,557 --> 00:25:36,462
THE PROBLEMS ARE ONLY GETTING

706
00:25:36,462 --> 00:25:36,696
WORSE.

707
00:25:36,696 --> 00:25:39,999
NEXT SLIDE.

708
00:25:39,999 --> 00:25:40,867
NEXT SLIDE.

709
00:25:40,867 --> 00:25:42,535
THESE ARE DATA FROM NHANES,

710
00:25:42,535 --> 00:25:44,404
COMMUNITY STUDY.

711
00:25:44,404 --> 00:25:46,806
HERE WE'RE LOOKING AT

712
00:25:46,806 --> 00:25:47,507
HYPERTENSION AWARENESS,

713
00:25:47,507 --> 00:25:49,308
TREATMENT, CONTROL BY RACE AND

714
00:25:49,308 --> 00:25:49,742
ETHNICITY.

715
00:25:49,742 --> 00:25:52,912
WHAT I WANT TO BRING OUT HERE IS

716
00:25:52,912 --> 00:25:54,247
THAT THERE ARE DIFFERENCES BY

717
00:25:54,247 --> 00:25:55,348
RACE AND ETHNICITY, BUT ALL

718
00:25:55,348 --> 00:25:59,852
GROUPS ARE NOT DOING WELL.

719
00:25:59,852 --> 00:26:01,621
SO ONLY -- 1 IN 4 PEOPLE ARE

720
00:26:01,621 --> 00:26:03,356
UNAWARE THEY HAVE HIGH BLOOD

721
00:26:03,356 --> 00:26:03,756
PRESSURE.

722
00:26:03,756 --> 00:26:06,159
1 IN 4 ARE NOT TREATED.

723
00:26:06,159 --> 00:26:08,394
ONLY 1 IN 4 HAVE BLOOD PRESSURE

724
00:26:08,394 --> 00:26:11,464
UNDER CONTROL. 

725
00:26:11,464 --> 00:26:12,899
YOU CAN ADVANCE.

726
00:26:12,899 --> 00:26:17,403
THESE ARE ALSO DATA FROM NHANES.

727
00:26:17,403 --> 00:26:18,805
HYPERTENSION CONTROL RATES

728
00:26:18,805 --> 00:26:20,006
ACROSS THE LAST DECADE AND A

729
00:26:20,006 --> 00:26:23,276
HALF ARE ACTUALLY GETTING WORSE.

730
00:26:23,276 --> 00:26:26,145
STARTING IN 2013, WHICH

731
00:26:26,145 --> 00:26:31,918
COINCIDES WITH WHEN THE JNC 8

732
00:26:31,918 --> 00:26:33,920
GUIDELINES CAME OUT, FOR PEOPLE

733
00:26:33,920 --> 00:26:37,657
ON TREATMENT WORSE CONTROL.

734
00:26:37,657 --> 00:26:39,392
THIS SUGGESTS BIG GUIDELINES,

735
00:26:39,392 --> 00:26:40,393
POLICY CHANGES CAN AFFECT BLOOD

736
00:26:40,393 --> 00:26:44,530
PRESSURE OUTCOMES AND WE KNOW

737
00:26:44,530 --> 00:26:48,167
THEY ARE DECLINING FURTHER WITH

738
00:26:48,167 --> 00:26:48,534
COVID-19.

739
00:26:48,534 --> 00:26:50,336
THE PROBLEM IS EVEN WORSE THAN

740
00:26:50,336 --> 00:26:51,270
WE MIGHT IMAGINE.

741
00:26:51,270 --> 00:26:55,808
I SHOWED A LOT OF DATA AROUND

742
00:26:55,808 --> 00:26:57,877
HYPERTENSION THAT, 140/90 CUT

743
00:26:57,877 --> 00:26:58,745
POINT.

744
00:26:58,745 --> 00:27:01,948
NOW WE USE 130/80 BASED ON MOST

745
00:27:01,948 --> 00:27:06,452
RECENT GUIDELINES. 

746
00:27:06,452 --> 00:27:08,087
THERE'S OTHER PHENOTYPES

747
00:27:08,087 --> 00:27:10,056
INCLUDING MASKED WHEN NORMAL IN

748
00:27:10,056 --> 00:27:11,824
OFFICE, ELEVATED IN OUTPATIENT

749
00:27:11,824 --> 00:27:12,258
SETTINGS.

750
00:27:12,258 --> 00:27:14,327
MASKED HYPERTENSION IS

751
00:27:14,327 --> 00:27:16,996
ASSOCIATED WITH CARDIOVASCULAR

752
00:27:16,996 --> 00:27:21,100
OUTCOMES, SORELY UNDERDETECTED. 

753
00:27:21,100 --> 00:27:22,835
IN THIS STUDY YOU CAN SEE AMONG

754
00:27:22,835 --> 00:27:25,171
PEOPLE WITH NORMAL BLOOD

755
00:27:25,171 --> 00:27:27,774
PRESSURE IN THE OFFICE, 13% HAD

756
00:27:27,774 --> 00:27:30,309
MASKED HYPERTENSION, AMONG

757
00:27:30,309 --> 00:27:31,244
PEOPLE WITH PRE-HYPERTENSION,

758
00:27:31,244 --> 00:27:34,914
ELEVATED BLOOD PRESSURE IN THE

759
00:27:34,914 --> 00:27:38,651
OFFICE, 36% HAD MASKED

760
00:27:38,651 --> 00:27:38,985
HYPERTENSION.

761
00:27:38,985 --> 00:27:39,786
YOU CAN ADVANCE.

762
00:27:39,786 --> 00:27:41,921
THIS IS INTERESTING BECAUSE WHY

763
00:27:41,921 --> 00:27:43,523
WOULD A PERSON HAVE HIGH BLOOD

764
00:27:43,523 --> 00:27:45,758
PRESSURE ONLY OUTSIDE OF THE

765
00:27:45,758 --> 00:27:46,025
OFFICE?

766
00:27:46,025 --> 00:27:47,627
WE'VE GOT TO THINK ABOUT THE

767
00:27:47,627 --> 00:27:49,262
STRESSORS THAT MIGHT OCCUR.

768
00:27:49,262 --> 00:27:53,766
THIS GROUP FROM UNIVERSITY OF

769
00:27:53,766 --> 00:27:55,168
ALABAMA STUDIED WHY SOME PEOPLE

770
00:27:55,168 --> 00:27:56,402
HAVE HIGHER BLOOD PRESSURES

771
00:27:56,402 --> 00:28:05,545
OUTSIDE OF THE OFFICE. 

772
00:28:05,545 --> 00:28:08,748
THEY LOOKED AT ALDOSTERONE

773
00:28:08,748 --> 00:28:10,049
LEVELS AND COMPARED.

774
00:28:10,049 --> 00:28:12,218
INTERESTINGLY ENOUGH, THEY FOUND

775
00:28:12,218 --> 00:28:16,856
THAT THE LEVEL IN THE MASKED

776
00:28:16,856 --> 00:28:19,258
GROUP WAS HIGHER IN OUTPATIENT

777
00:28:19,258 --> 00:28:20,927
AS COMPARED TO GROUP WITH

778
00:28:20,927 --> 00:28:22,895
CONTROLLED HYPERTENSION.

779
00:28:22,895 --> 00:28:24,931
HOWEVER, IN THE CLINIC THE

780
00:28:24,931 --> 00:28:26,833
ALDOSTERONE LEVELS WERE THE

781
00:28:26,833 --> 00:28:27,567
SAME.

782
00:28:27,567 --> 00:28:28,234
THEY HAVE POSTULATED OUTPATIENT,

783
00:28:28,234 --> 00:28:30,770
WHEN PATIENTS WERE IN THEIR REAL

784
00:28:30,770 --> 00:28:34,273
WORLD THOSE WITH MASKED

785
00:28:34,273 --> 00:28:34,941
HYPERTENSION HAVE INCREASED

786
00:28:34,941 --> 00:28:35,775
SYMPATHETIC RESPONSE.

787
00:28:35,775 --> 00:28:41,647
THE WHOLE CASCADE OF STRESS

788
00:28:41,647 --> 00:28:43,249
HORMONES AND ALDOSTERONE SYSTEM

789
00:28:43,249 --> 00:28:47,787
IS ELEVATED IN PEOPLE WITH

790
00:28:47,787 --> 00:28:48,221
MASKED HYPERTENSION.

791
00:28:48,221 --> 00:28:56,762
IF WE'RE NOT DETECTING AND

792
00:28:56,762 --> 00:28:58,831
CAPTURING, WE'RE MISSING AN

793
00:28:58,831 --> 00:29:00,366
OPPORTUNITY TO IMPROVE OUTCOMES,

794
00:29:00,366 --> 00:29:05,738
IN A SIGNIFICANT PROPORTION OF

795
00:29:05,738 --> 00:29:06,172
PEOPLE.

796
00:29:06,172 --> 00:29:07,273
NEXT SLIDE.

797
00:29:07,273 --> 00:29:09,242
OUR PATIENT, MR. GREEN, AND MANY

798
00:29:09,242 --> 00:29:12,211
OTHERS ARE IN THAT RED CIRCLE,

799
00:29:12,211 --> 00:29:15,281
AND WE'RE WORKING WITH THEM IN A

800
00:29:15,281 --> 00:29:16,249
20-MINUTE VISIT.

801
00:29:16,249 --> 00:29:17,650
THAT'S OUR INTERACTION WITH

802
00:29:17,650 --> 00:29:17,984
THEM.

803
00:29:17,984 --> 00:29:19,852
BUT THEIR LIFE, THEIR WORLD IS

804
00:29:19,852 --> 00:29:22,255
ALL OF THESE DIFFERENT LEVELS.

805
00:29:22,255 --> 00:29:23,256
IT'S THEIR LIFESTYLE.

806
00:29:23,256 --> 00:29:24,991
IT'S SOCIAL AND COMMUNITY

807
00:29:24,991 --> 00:29:25,491
NETWORKS.

808
00:29:25,491 --> 00:29:26,425
IT'S WHERE THEY WORK.

809
00:29:26,425 --> 00:29:29,395
IT'S WHETHER THEY HAVE ACCESS TO

810
00:29:29,395 --> 00:29:31,464
FOOD, OR SAFE WATER, OR GREEN

811
00:29:31,464 --> 00:29:34,000
SPACES TO EXERCISE.

812
00:29:34,000 --> 00:29:35,067
AND IT'S SOCIOECONOMIC CULTURAL

813
00:29:35,067 --> 00:29:36,369
AND ENVIRONMENTAL CONDITIONS

814
00:29:36,369 --> 00:29:37,937
THAT THEY ARE LIVING IN DAY IN

815
00:29:37,937 --> 00:29:39,038
AND DAY OUT.

816
00:29:39,038 --> 00:29:40,673
AND THAT WE NEED TO KIND OF

817
00:29:40,673 --> 00:29:41,974
CAPTURE AND BE ABLE TO BRING

818
00:29:41,974 --> 00:29:45,478
INTO OUR CARE PLANS IN ORDER TO

819
00:29:45,478 --> 00:29:47,013
IMPROVE OUTCOMES.

820
00:29:47,013 --> 00:29:47,647
NEXT SLIDE.

821
00:29:47,647 --> 00:29:50,516
HOW DO WE DO THIS?

822
00:29:50,516 --> 00:29:52,818
DIGITAL HEALTH REPRESENTS A PATH

823
00:29:52,818 --> 00:29:54,020
FORWARD.

824
00:29:54,020 --> 00:29:57,189
WE CAN BETTER CAPTURE OUR

825
00:29:57,189 --> 00:30:01,527
PATIENTS' CONTEXT AND BUILD

826
00:30:01,527 --> 00:30:02,762
CONNECTIONS WITH OUR PATIENTS.

827
00:30:02,762 --> 00:30:04,830
DIGITAL HEALTH TECHNOLOGY IS

828
00:30:04,830 --> 00:30:06,465
HELPING US WITH CAPTURING BLOOD

829
00:30:06,465 --> 00:30:07,800
PRESSURE AND HEART RATE AND

830
00:30:07,800 --> 00:30:08,668
SLEEP AND ACTIVITY.

831
00:30:08,668 --> 00:30:10,903
WE'RE DOING GREAT AND EVEN ABLE

832
00:30:10,903 --> 00:30:13,806
TO CAPTURE A LOT OF DAILY

833
00:30:13,806 --> 00:30:15,474
LIFESTYLE BEHAVIORS LIKE

834
00:30:15,474 --> 00:30:16,208
EXERCISE, NUTRITION, STRESS

835
00:30:16,208 --> 00:30:16,642
LEVELS.

836
00:30:16,642 --> 00:30:19,045
BUT HOW DO WE IMPLEMENT AT THE

837
00:30:19,045 --> 00:30:19,612
BEDSIDE?

838
00:30:19,612 --> 00:30:22,348
EVEN THE BEST DOCTORS AND NURSES

839
00:30:22,348 --> 00:30:24,216
HAVING THESE CONVERSATIONS WITH

840
00:30:24,216 --> 00:30:26,953
PATIENTS IN THE CLINIC ARE STILL

841
00:30:26,953 --> 00:30:29,588
LIMITED AND PATIENTS ARE STILL

842
00:30:29,588 --> 00:30:31,557
LEFT TO JUGGLE ALL

843
00:30:31,557 --> 00:30:32,325
RECOMMENDATIONS ONCE THEY LEAVE

844
00:30:32,325 --> 00:30:38,230
OUR OFFICE.

845
00:30:38,230 --> 00:30:39,131
NEXT SLIDE.

846
00:30:39,131 --> 00:30:43,169
SO I SUBMIT TO YOU THAT LAYING

847
00:30:43,169 --> 00:30:45,471
EVEN THE BEST TECHNOLOGY ONTO

848
00:30:45,471 --> 00:30:47,006
THIS INFRASTRUCTURE DOESN'T

849
00:30:47,006 --> 00:30:47,239
WORK.

850
00:30:47,239 --> 00:30:49,642
WE'RE STILL MOSTLY IN PERSON,

851
00:30:49,642 --> 00:30:51,610
STILL PHYSICIAN BASED, STILL

852
00:30:51,610 --> 00:30:53,279
RELYING ON SCHEDULED FOLLOW-UPS

853
00:30:53,279 --> 00:30:56,115
AND AT BEST THOSE ARE AT 3, 6,

854
00:30:56,115 --> 00:30:57,216
12 MONTHS.

855
00:30:57,216 --> 00:30:58,217
WE DON'T PRESCRIBE HOME BLOOD

856
00:30:58,217 --> 00:30:59,952
PRESSURE CUFFS.

857
00:30:59,952 --> 00:31:06,192
WHEN  DO WE DON'T TEACH HOW TO

858
00:31:06,192 --> 00:31:09,562
USE IT, SYNC WITH RECORDS, SO

859
00:31:09,562 --> 00:31:11,864
OFTEN BLAME THE THE PATIENT FOR

860
00:31:11,864 --> 00:31:14,767
NOT CONFORMING WITH WHAT WE'VE

861
00:31:14,767 --> 00:31:15,935
PRESCRIBED, WHICH IS UNTENABLE.

862
00:31:15,935 --> 00:31:19,138
IT'S NOT PRACTICAL.

863
00:31:19,138 --> 00:31:20,006
NEXT SLIDE.

864
00:31:20,006 --> 00:31:23,275
SOCIETY BLOOD PRESSURE NEXUS IS

865
00:31:23,275 --> 00:31:24,076
COMPLEX.

866
00:31:24,076 --> 00:31:24,777
YOU CAN ADVANCE.

867
00:31:24,777 --> 00:31:26,379
WE NEED TO THINK ABOUT

868
00:31:26,379 --> 00:31:26,779
ENGAGEMENT.

869
00:31:26,779 --> 00:31:29,081
WE NEED TO THINK ABOUT

870
00:31:29,081 --> 00:31:30,449
MEASUREMENT, IMPLEMENTATION,

871
00:31:30,449 --> 00:31:31,951
BLOOD PRESSURE OUTCOMES, BIG

872
00:31:31,951 --> 00:31:35,855
HEALTH OUTCOMES AND HEALTH

873
00:31:35,855 --> 00:31:36,889
EQUITY.

874
00:31:36,889 --> 00:31:37,390
ADVANCE.

875
00:31:37,390 --> 00:31:38,524
REGARDING ENGAGEMENT WE KNOW

876
00:31:38,524 --> 00:31:41,627
HYPERTENSION IS A SILENT

877
00:31:41,627 --> 00:31:41,894
CONDITION.

878
00:31:41,894 --> 00:31:50,903
IT'S  CREATING CHALLENGES WITH

879
00:31:50,903 --> 00:31:52,438
INFLECTION POINTS WHERE BLOOD

880
00:31:52,438 --> 00:31:54,273
PRESSURE IS HIGHER.

881
00:31:54,273 --> 00:31:57,710
PEOPLE NEED TO BELIEVE THEY ARE

882
00:31:57,710 --> 00:31:58,711
AT RISK.

883
00:31:58,711 --> 00:31:59,645
IT CAN'T BE NORMALIZED.

884
00:31:59,645 --> 00:32:02,181
PEOPLE NEED TO FEEL THEY HAVE

885
00:32:02,181 --> 00:32:04,583
THE CAPACITY TO MAKE CHANGES TO

886
00:32:04,583 --> 00:32:05,051
IMPROVE OUTCOMES.

887
00:32:05,051 --> 00:32:07,119
WE NEED TO TAKE INTO

888
00:32:07,119 --> 00:32:08,888
CONSIDERATION THE SOCIAL

889
00:32:08,888 --> 00:32:10,389
STRESSORS, LIFESTYLE BEHAVIORS,

890
00:32:10,389 --> 00:32:11,490
ENGAGE PEOPLE IN SHARED DECISION

891
00:32:11,490 --> 00:32:13,993
MAKING SO THEY CAN HELP

892
00:32:13,993 --> 00:32:14,493
CO-DESIGN PLANS.

893
00:32:14,493 --> 00:32:15,761
WE NEED TO THINK ABOUT

894
00:32:15,761 --> 00:32:17,730
MEASUREMENTS IN THE OFFICE AND

895
00:32:17,730 --> 00:32:22,701
AT HOME, THINK ABOUT PHENOTYPES

896
00:32:22,701 --> 00:32:24,403
OF MASKED HYPERTENSION, WHAT IS

897
00:32:24,403 --> 00:32:28,908
THE LIFETIME OF EXPOSURE,

898
00:32:28,908 --> 00:32:30,076
ESPECIALLY STRESSORS AT HOME AND

899
00:32:30,076 --> 00:32:30,843
ACROSS THE LIFETIME.

900
00:32:30,843 --> 00:32:35,448
HOW DO WE UNDERSTAND AND

901
00:32:35,448 --> 00:32:36,315
INTERPRET BLOOD PRESSURE

902
00:32:36,315 --> 00:32:39,718
LABILITY IN THE CONTEXT OF OTHER

903
00:32:39,718 --> 00:32:40,119
COMORBIDITIES?

904
00:32:40,119 --> 00:32:42,988
WE NEED TO THINK ABOUT ACCESS TO

905
00:32:42,988 --> 00:32:45,391
BLOOD PRESSURE CUFFS, SYNCING

906
00:32:45,391 --> 00:32:47,026
WITH EHR, CARE TEAM, WHAT DOES

907
00:32:47,026 --> 00:32:53,032
THAT LOOK LIKE?

908
00:32:53,032 --> 00:32:57,103
DECISION SUPPORT, COMBINATION

909
00:32:57,103 --> 00:33:00,072
AND POLY PILLS, ARE THEY

910
00:33:00,072 --> 00:33:02,241
FEASIBLE AND ACCESSIBLE AND HOW

911
00:33:02,241 --> 00:33:04,009
WE PUT OUT POPULATION HEALTH

912
00:33:04,009 --> 00:33:06,979
MEASURES, CAN WE INTEGRATE HOME

913
00:33:06,979 --> 00:33:08,380
BLOOD PRESSURE MONITORING

914
00:33:08,380 --> 00:33:10,082
MEASUREMENTS, CAN WE INTERPRET

915
00:33:10,082 --> 00:33:12,785
CUFFLESS DATA WHICH WE KNOW IS

916
00:33:12,785 --> 00:33:16,589
SOON TO COME.

917
00:33:16,589 --> 00:33:18,457
ARE WE IMPACTING ORGAN DAMAGE,

918
00:33:18,457 --> 00:33:19,992
CARDIOVASCULAR EVENTS, AFFECTING

919
00:33:19,992 --> 00:33:22,294
BRAIN HEALTH, AFFECTING

920
00:33:22,294 --> 00:33:23,295
FUNCTIONAL STATUS?

921
00:33:23,295 --> 00:33:24,930
AND ARE WE DOING THIS THROUGH A

922
00:33:24,930 --> 00:33:26,999
LENS OF HEALTH EQUITY?

923
00:33:26,999 --> 00:33:29,835
WE HAVE INEQUITIES IN BLOOD

924
00:33:29,835 --> 00:33:30,903
PRESSURE CONTROL.

925
00:33:30,903 --> 00:33:32,605
ARE WE MOVING THE NEEDLE ON

926
00:33:32,605 --> 00:33:34,540
EARLY AGE OF ONSET AFFLICTING

927
00:33:34,540 --> 00:33:36,208
MORE BLACK MEN AND WOMEN IN OUR

928
00:33:36,208 --> 00:33:36,675
COUNTRY.

929
00:33:36,675 --> 00:33:40,379
ARE WE MOVING THE NEEDLE ON

930
00:33:40,379 --> 00:33:41,347
PREMATURE MORTALITY?

931
00:33:41,347 --> 00:33:46,418
ARE WE LOOKING AT OUR HEALTH

932
00:33:46,418 --> 00:33:47,653
SYSTEMS AND IMPACT OF

933
00:33:47,653 --> 00:33:50,122
HYPERTENSION ON GENERATIONAL

934
00:33:50,122 --> 00:33:51,790
HEALTH AND WEALTH WHICH AFFECTS

935
00:33:51,790 --> 00:33:55,728
COMMUNITIES WRIT LARGE.

936
00:33:55,728 --> 00:33:57,062
NEXT SLIDE.

937
00:33:57,062 --> 00:33:58,063
THE NATIONAL INSTITUTE ON

938
00:33:58,063 --> 00:33:59,999
MINORITY HEALTH AND HEALTH

939
00:33:59,999 --> 00:34:01,433
DISPARITIES PROVIDES A HELPFUL

940
00:34:01,433 --> 00:34:03,502
FRAMEWORK WHEN YOU'RE DESIGNING

941
00:34:03,502 --> 00:34:04,003
STUDIES.

942
00:34:04,003 --> 00:34:06,672
I ENCOURAGE US TO USE THIS, IT

943
00:34:06,672 --> 00:34:08,674
FORCES YOU TO THINK ABOUT LEVELS

944
00:34:08,674 --> 00:34:11,510
OF INFLUENCE AND DOMAINS OF

945
00:34:11,510 --> 00:34:13,379
INFLUENCE AND HOW THOSE INTERACT

946
00:34:13,379 --> 00:34:15,581
SO WE CAN DESIGN INTERVENTIONS

947
00:34:15,581 --> 00:34:16,982
AND CAPTURE OUTCOMES THAT REALLY

948
00:34:16,982 --> 00:34:22,254
GET TO THE COMPLEXITIES OF THIS

949
00:34:22,254 --> 00:34:22,454
WORK.

950
00:34:22,454 --> 00:34:24,557
NEXT SLIDE.

951
00:34:24,557 --> 00:34:26,292
THE DESIGNING PROGRAMS THAT

952
00:34:26,292 --> 00:34:27,159
LEVERAGE TECHNOLOGY, I PUSH YOU

953
00:34:27,159 --> 00:34:29,461
TO USE WHAT'S OUT THERE.

954
00:34:29,461 --> 00:34:31,130
WE HAVE SO MUCH GOOD BASIS FOR

955
00:34:31,130 --> 00:34:33,199
ALL OF THE WORK THAT YOU'RE

956
00:34:33,199 --> 00:34:36,268
GOING TO BE DOING.

957
00:34:36,268 --> 00:34:39,371
ONE ARE PRINCIPLES FROM AMERICAN

958
00:34:39,371 --> 00:34:42,808
HEART ASSOCIATION TARGET BM MAP,

959
00:34:42,808 --> 00:34:44,343
MEASURE ACCURATELY, ACT RAPIDLY,

960
00:34:44,343 --> 00:34:46,645
PARTNER WITH PATIENTS, THREE

961
00:34:46,645 --> 00:34:49,248
PRINCIPLES TO GET US FAR IF WE

962
00:34:49,248 --> 00:34:49,849
DO THAT WELL.

963
00:34:49,849 --> 00:34:51,250
IT NEEDS TO BE DATA DRIVEN.

964
00:34:51,250 --> 00:34:54,854
I DON'T HAVE TO TELL YOU THAT,

965
00:34:54,854 --> 00:34:58,157
AND WE NEED TO USE

966
00:34:58,157 --> 00:35:01,227
PATIENT-CENTERED APPROACHES,

967
00:35:01,227 --> 00:35:05,664
THINK ABOUT MULTI-DISCIPLINARY

968
00:35:05,664 --> 00:35:06,799
TEAMS AND

969
00:35:06,799 --> 00:35:07,299
[AUDIO DISTORTION]

970
00:35:07,299 --> 00:35:09,101
ABOUT REMOTE BLOOD PRESSURE

971
00:35:09,101 --> 00:35:10,202
MANAGEMENT, COMBINATION PILLS,

972
00:35:10,202 --> 00:35:11,971
MAKING IT EASY AND ADDRESS

973
00:35:11,971 --> 00:35:16,108
SOCIAL DETERMINANTS OF HEALTH.

974
00:35:16,108 --> 00:35:16,775
NEXT SLIDE.

975
00:35:16,775 --> 00:35:19,178
WE DID PILOT WORK AT YALE WHERE

976
00:35:19,178 --> 00:35:22,681
WE WERE LOOKING TO UNDERSTAND

977
00:35:22,681 --> 00:35:25,751
FACILITATORS AND BARRIERS TO

978
00:35:25,751 --> 00:35:26,385
DIGITAL HEALTH UPTAKE, STUDIES

979
00:35:26,385 --> 00:35:29,889
200 LOW INCOME PATIENTS, HALF

980
00:35:29,889 --> 00:35:32,091
SPANISH-SPEAKING ONLY.

981
00:35:32,091 --> 00:35:35,694
WE HAD THEM REGISTER AND SYNC

982
00:35:35,694 --> 00:35:38,430
RECORDS, TRACKERS, CUFFS, INTO A

983
00:35:38,430 --> 00:35:39,531
SINGLE PLATFORM AND SURVEYED

984
00:35:39,531 --> 00:35:42,368
OVER THE COURSE OF 12 WEEKS.

985
00:35:42,368 --> 00:35:44,136
WE PROVIDED MOTIVATION AND

986
00:35:44,136 --> 00:35:44,637
SUSTAINED ENGAGEMENT AND

987
00:35:44,637 --> 00:35:46,839
ADDRESSED SOCIAL DETERMINANTS OF

988
00:35:46,839 --> 00:35:47,306
HEALTH.

989
00:35:47,306 --> 00:35:48,941
THESE RESULTS ARE REPORTED IN

990
00:35:48,941 --> 00:35:50,809
THE STUDY BUT WHAT I WANT TO

991
00:35:50,809 --> 00:35:52,778
HIGHLIGHT, YOU CAN ADVANCE ONE,

992
00:35:52,778 --> 00:35:54,980
IT'S GOING TO HIGHLIGHT THE

993
00:35:54,980 --> 00:35:57,149
PERSON IN THIS PICTURE, OUR

994
00:35:57,149 --> 00:35:58,384
COMMUNITY HEALTH WORKER.

995
00:35:58,384 --> 00:36:01,553
SHE WAS REALLY AT THE EPICENTER

996
00:36:01,553 --> 00:36:02,755
OF PATIENTS AND THEIR

997
00:36:02,755 --> 00:36:03,088
COMMUNITIES.

998
00:36:03,088 --> 00:36:05,824
SHE WORKED WITH US AS CLINICIANS

999
00:36:05,824 --> 00:36:07,993
AND INVESTIGATORS AND WORKED

1000
00:36:07,993 --> 00:36:08,994
WITH INDUSTRY, OUR TECH

1001
00:36:08,994 --> 00:36:10,863
COLLABORATORS, IN ORDER TO BRING

1002
00:36:10,863 --> 00:36:11,697
THIS TOGETHER.

1003
00:36:11,697 --> 00:36:13,799
ONE PERSON WAS ABLE TO WORK WITH

1004
00:36:13,799 --> 00:36:16,769
200 PEOPLE TO KEEP THEM ENGAGED,

1005
00:36:16,769 --> 00:36:18,070
AND REALLY SHOWED THEM HOW TO

1006
00:36:18,070 --> 00:36:19,171
USE THIS TECHNOLOGY TO IMPROVE

1007
00:36:19,171 --> 00:36:19,605
THEIR HEALTH.

1008
00:36:19,605 --> 00:36:23,642
I CAN'T TELL YOU THE VALUE OF

1009
00:36:23,642 --> 00:36:26,045
THIS COMMUNITY HEALTH WORKER IN

1010
00:36:26,045 --> 00:36:26,812
REALLY LEVERAGING THE TECHNOLOGY

1011
00:36:26,812 --> 00:36:29,014
THAT WE WERE TRYING TO INTRODUCE

1012
00:36:29,014 --> 00:36:33,852
IN THIS POPULATION.

1013
00:36:33,852 --> 00:36:34,620
NEXT SLIDE.

1014
00:36:34,620 --> 00:36:37,122
YALE, DR. SHAH MENTIONED, WE

1015
00:36:37,122 --> 00:36:39,091
HAVE A YALE DIGITAL HEALTH

1016
00:36:39,091 --> 00:36:40,526
PROGRAM.

1017
00:36:40,526 --> 00:36:42,394
WE RECEIVE REFERRALS FROM

1018
00:36:42,394 --> 00:36:44,463
PROVIDERS FOR PATIENTS WITH

1019
00:36:44,463 --> 00:36:45,097
POORLY CONTROLLED HYPERTENSION,

1020
00:36:45,097 --> 00:36:47,199
ALSO ON THE LABOR AND DELIVERY

1021
00:36:47,199 --> 00:36:49,735
FLOORS, USING OUR PROGRAM IN THE

1022
00:36:49,735 --> 00:36:57,910
POSTPARTUM POPULATION FOR WOMEN

1023
00:36:57,910 --> 00:36:59,778
WITH PRE-ECLAMPSIA, STAND OF

1024
00:36:59,778 --> 00:37:00,012
CARE.

1025
00:37:00,012 --> 00:37:03,048
WE'RE IN THE COMMUNITY IN

1026
00:37:03,048 --> 00:37:03,916
BARBERSHOPS, CHURCHES, TRYING TO

1027
00:37:03,916 --> 00:37:05,017
DETECT HYPERTENSION AND GET

1028
00:37:05,017 --> 00:37:07,019
PEOPLE INVOLVED IN REMOTE BLOOD

1029
00:37:07,019 --> 00:37:07,986
PRESSURE MONITORING PROGRAMS.

1030
00:37:07,986 --> 00:37:10,189
WE GIVE THEM A BLOOD PRESSURE

1031
00:37:10,189 --> 00:37:11,390
CUFF THAT'S BLUETOOTH ENABLED,

1032
00:37:11,390 --> 00:37:13,592
SYNC THEM WITH MEDICAL RECORDS,

1033
00:37:13,592 --> 00:37:16,428
AND WE HAVE DIVERSE TEAM OF

1034
00:37:16,428 --> 00:37:18,063
PHARMACISTS ABLE TO DO

1035
00:37:18,063 --> 00:37:19,365
TELEHEALTH VISITS, SEE PEOPLE ON

1036
00:37:19,365 --> 00:37:24,069
A WEEKLY OR BIWEEKLY BASIS,

1037
00:37:24,069 --> 00:37:25,270
TITRATE MEDICATIONS, USING AN

1038
00:37:25,270 --> 00:37:26,505
AGREEMENT BETWEEN PHYSICIANS AND

1039
00:37:26,505 --> 00:37:28,040
PHARMACISTS THAT ALLOWS THEM TO

1040
00:37:28,040 --> 00:37:29,875
PRESCRIBE AND ADDRESS BARRIERS

1041
00:37:29,875 --> 00:37:32,077
TO HEALTH.

1042
00:37:32,077 --> 00:37:33,178
YOU CAN ADVANCE.

1043
00:37:33,178 --> 00:37:34,713
WE'RE WORKING WITH PROJECT

1044
00:37:34,713 --> 00:37:36,682
ACCESS NEW HAVEN WHICH IS WHERE

1045
00:37:36,682 --> 00:37:37,783
THE COMMUNITY HEALTH WORKER

1046
00:37:37,783 --> 00:37:41,086
COMES FROM IN ORDER TO ADDRESS

1047
00:37:41,086 --> 00:37:41,820
SOCIAL DETERMINANTS OF HEALTH,

1048
00:37:41,820 --> 00:37:44,923
MANY TIMES THE BARRIERS ARE

1049
00:37:44,923 --> 00:37:45,758
IMPLEMENTATION BARRIERS THAT

1050
00:37:45,758 --> 00:37:50,929
COMMUNITY HEALTH WORKERS CAN

1051
00:37:50,929 --> 00:37:51,296
ADDRESS.

1052
00:37:51,296 --> 00:37:53,599
NEXT SLIDE.

1053
00:37:53,599 --> 00:37:54,033
NEXT SLIDE.

1054
00:37:54,033 --> 00:37:55,968
SO WHAT ARE SOME LESSONS LEARNED

1055
00:37:55,968 --> 00:37:56,769
THAT MAYBE YOU COULD TAKE WITH

1056
00:37:56,769 --> 00:38:00,406
YOU AS YOU HEAR THE DIFFERENT

1057
00:38:00,406 --> 00:38:01,340
TALKS TODAY?

1058
00:38:01,340 --> 00:38:04,410
THERE IS HIGH SATISFACTION IN

1059
00:38:04,410 --> 00:38:05,944
OUR PROGRAM AMONGST CLINICIANS,

1060
00:38:05,944 --> 00:38:06,912
PHYSICIANS NEED TO WARM UP TO

1061
00:38:06,912 --> 00:38:09,515
THE IDEA OF LETTING GO OF THE

1062
00:38:09,515 --> 00:38:11,517
REINS AND NOW THEY ARE WELCOMING

1063
00:38:11,517 --> 00:38:13,819
THE HELP THEY ARE GETTING BUT IT

1064
00:38:13,819 --> 00:38:14,353
TOOK TIME.

1065
00:38:14,353 --> 00:38:17,423
A CULTURE SHIFT NEEDS TO HAPPEN.

1066
00:38:17,423 --> 00:38:18,624
PHARMACISTS AND COMMUNITY HEALTH

1067
00:38:18,624 --> 00:38:19,625
WORKERS PRACTICE TO THEIR

1068
00:38:19,625 --> 00:38:21,593
LICENSE HAVING THE IMPACT THEY

1069
00:38:21,593 --> 00:38:24,329
WERE TRAINED TO DO.

1070
00:38:24,329 --> 00:38:25,197
REMOTE PATIENT MONITORING NEEDS

1071
00:38:25,197 --> 00:38:26,832
A LOT OF WORK, LIKE IF WE'RE

1072
00:38:26,832 --> 00:38:29,034
GOING TO USE CUFFS WE NEED TO

1073
00:38:29,034 --> 00:38:30,569
MAKE SURE FIT IS GOOD AND

1074
00:38:30,569 --> 00:38:32,070
GETTING A GOOD FIT IS REALLY

1075
00:38:32,070 --> 00:38:32,504
HARD.

1076
00:38:32,504 --> 00:38:35,040
WE NEED TO GET VALID DEVICES,

1077
00:38:35,040 --> 00:38:36,508
FIGURE HOW TO ENCOURAGE

1078
00:38:36,508 --> 00:38:37,976
ADHERENCE TO OUTPATIENT BLOOD

1079
00:38:37,976 --> 00:38:38,544
PRESSURE MONITORING.

1080
00:38:38,544 --> 00:38:40,813
WE NEED TO THINK ABOUT THE DATA

1081
00:38:40,813 --> 00:38:41,580
ASCERTAINMENT AND AGGREGATION,

1082
00:38:41,580 --> 00:38:46,852
HOW DO WE MAKE IT SIMPLE?

1083
00:38:46,852 --> 00:38:53,292
WE NEED TO RELEARN DATA WE'RE

1084
00:38:53,292 --> 00:38:55,160
ACQUIRING, HOW DO WE USE DATA TO

1085
00:38:55,160 --> 00:38:56,995
INDIVIDUALIZE CARE AND KEEP

1086
00:38:56,995 --> 00:38:58,664
PEOPLE ENGAGED IN THE

1087
00:38:58,664 --> 00:39:01,200
LONGITUDINAL WAY ACROSS 12-WEEK

1088
00:39:01,200 --> 00:39:01,433
PROGRAM?

1089
00:39:01,433 --> 00:39:02,835
SHOULD IT BE ONE YEAR?

1090
00:39:02,835 --> 00:39:04,470
HOW DO WE INCORPORATE AND PIVOT

1091
00:39:04,470 --> 00:39:06,872
WHEN PEOPLE ARE HAVING STRESSFUL

1092
00:39:06,872 --> 00:39:09,408
EVENTS, COMPETING HEALTH OR

1093
00:39:09,408 --> 00:39:09,875
NON-HEALTH PRIORITIES?

1094
00:39:09,875 --> 00:39:12,444
WE NEED TO THINK ABOUT WHO WE'RE

1095
00:39:12,444 --> 00:39:14,980
NOT REACHING.

1096
00:39:14,980 --> 00:39:17,082
WHO ARE NO-SHOWS, WHO DON'T HAVE

1097
00:39:17,082 --> 00:39:20,085
A PRIMARY CARE PROVIDER, WHO ARE

1098
00:39:20,085 --> 00:39:21,753
WE ONLY SEEING IN THE EMERGENCY

1099
00:39:21,753 --> 00:39:23,622
DEPARTMENT OR HOSPITAL?  WHO IN

1100
00:39:23,622 --> 00:39:25,491
THE FAMILY AND PEER GROUP, IN

1101
00:39:25,491 --> 00:39:26,692
THE COMMUNITY MIGHT ALSO BENEFIT

1102
00:39:26,692 --> 00:39:28,227
FROM THE INFORMATION THAT WE'RE

1103
00:39:28,227 --> 00:39:30,095
SHARING WHEN WE'RE INTERACTING

1104
00:39:30,095 --> 00:39:30,796
WITH PATIENTS?

1105
00:39:30,796 --> 00:39:34,666
THEN WE NEED TO THINK ABOUT

1106
00:39:34,666 --> 00:39:35,334
SUSTAINABILITY.

1107
00:39:35,334 --> 00:39:37,870
HOW DO WE COMPENSATE, HOW DO WE

1108
00:39:37,870 --> 00:39:38,637
PROVIDE INCENTIVES FOR

1109
00:39:38,637 --> 00:39:39,338
PHARMACISTS, COMMUNITY HEALTH

1110
00:39:39,338 --> 00:39:43,108
WORKERS TO BUILD OUT THAT

1111
00:39:43,108 --> 00:39:43,942
MULTI-DISCIPLINARY TEAM AND

1112
00:39:43,942 --> 00:39:44,843
ENCOURAGE HEALTH SYSTEMS TO DO

1113
00:39:44,843 --> 00:39:46,745
THE RIGHT THING.

1114
00:39:46,745 --> 00:39:48,480
NEXT SLIDE.

1115
00:39:48,480 --> 00:39:50,415
MR. GREEN, OUR PATIENT, IS ONE

1116
00:39:50,415 --> 00:39:51,316
OF MANY.

1117
00:39:51,316 --> 00:39:54,386
THAT'S OUR CHARGE.

1118
00:39:54,386 --> 00:39:55,154
NEXT SLIDE.

1119
00:39:55,154 --> 00:39:58,023
WE KNOW DIGITAL HEALTH IS

1120
00:39:58,023 --> 00:39:58,257
NEEDED.

1121
00:39:58,257 --> 00:40:02,928
WE KNOW IT CAN MAKE CARE

1122
00:40:02,928 --> 00:40:04,463
CONVENIENT AND EFFICIENT, IT CAN

1123
00:40:04,463 --> 00:40:07,199
REVEAL BLOOD PRESSURE PHENOTYPES

1124
00:40:07,199 --> 00:40:10,035
THAT MATTER, WE KNOW IT CAN

1125
00:40:10,035 --> 00:40:12,771
CAPTURE CONTEXTUAL FACTORS AND

1126
00:40:12,771 --> 00:40:14,973
HAVE THIS GREAT, GREAT GOAL THAT

1127
00:40:14,973 --> 00:40:16,608
WE CAN INDIVIDUALIZE CARE PLANS

1128
00:40:16,608 --> 00:40:17,943
IF WE UNDERSTAND MORE ABOUT

1129
00:40:17,943 --> 00:40:19,678
PEOPLE'S BLOOD PRESSURE AND MORE

1130
00:40:19,678 --> 00:40:21,880
ABOUT THE SOCIAL AND BIOLOGICAL

1131
00:40:21,880 --> 00:40:23,048
FACTORS THAT ARE CONTRIBUTING.

1132
00:40:23,048 --> 00:40:28,820
I KNOW WE CAN IMPROVE OUTCOMES.

1133
00:40:28,820 --> 00:40:29,288
NEXT SLIDE.

1134
00:40:29,288 --> 00:40:32,257
BLOOD PRESSURE IS A NEXUS, IT'S

1135
00:40:32,257 --> 00:40:34,660
GOING TO REQUIRE BOLD CHANGE.

1136
00:40:34,660 --> 00:40:36,194
WE NEED FUNDAMENTALLY CHANGE THE

1137
00:40:36,194 --> 00:40:38,597
DELIVERY SYSTEM TO DO THIS WELL.

1138
00:40:38,597 --> 00:40:41,767
WE NEED TO MOVE FROM OUR HEALTH

1139
00:40:41,767 --> 00:40:42,768
SYSTEMS SILOS TO COMMUNITY

1140
00:40:42,768 --> 00:40:44,169
PARTNERSHIP.

1141
00:40:44,169 --> 00:40:50,108
WE NEED TO MOVE FROM ONEROUS

1142
00:40:50,108 --> 00:40:52,044
MEASUREMENTS IN THE OFFICE.

1143
00:40:52,044 --> 00:40:55,881
WE NEED TO MOVE FROM BEING

1144
00:40:55,881 --> 00:41:04,289
REACTIVE TO PRO-ACTIVE, FROM

1145
00:41:04,289 --> 00:41:09,561
BEING PHYSICIAN CENTRIC TO TEAM

1146
00:41:09,561 --> 00:41:13,332
CENTRIC, FROM FEE FOR SERVICE TO

1147
00:41:13,332 --> 00:41:14,700
VALUE-BASED CARE.

1148
00:41:14,700 --> 00:41:19,204
BLOOD PRESSURE IS INDEED A VERY

1149
00:41:19,204 --> 00:41:21,473
COMPLEX NEXUS.

1150
00:41:21,473 --> 00:41:22,574
YOU CAN ADVANCE.

1151
00:41:22,574 --> 00:41:24,876
THE SURGEON GENERAL HAS THE CALL

1152
00:41:24,876 --> 00:41:26,912
TO ACTION TO CONTROL

1153
00:41:26,912 --> 00:41:29,348
HYPERTENSION, I ENCOURAGE YOU TO

1154
00:41:29,348 --> 00:41:37,556
READ THIS AMAZING RESPONSE THAT

1155
00:41:37,556 --> 00:41:38,557
DR. MENSAH LED.

1156
00:41:38,557 --> 00:41:40,325
IT'S WONDERFUL TO HAVE THE

1157
00:41:40,325 --> 00:41:41,493
SURGEONS GENERAL BEHIND THIS.

1158
00:41:41,493 --> 00:41:43,262
THE NHLBI AS YOU HEARD FROM DR.

1159
00:41:43,262 --> 00:41:45,330
GOFF IS DEDICATED TO FUNDING

1160
00:41:45,330 --> 00:41:46,732
STUDIES THAT ADVANCE

1161
00:41:46,732 --> 00:41:47,633
HYPERTENSION AND HEALTH EQUITY,

1162
00:41:47,633 --> 00:41:49,801
AND THIS IS AN ENORMOUS

1163
00:41:49,801 --> 00:41:50,202
OPPORTUNITY.

1164
00:41:50,202 --> 00:41:52,104
I WOULD LIKE TO IMAGINE, YOU CAN

1165
00:41:52,104 --> 00:41:55,507
ADVANCE, THAT OTHER KEY FUNDERS

1166
00:41:55,507 --> 00:41:57,709
LIKE PCORI AND AMERICAN HEART

1167
00:41:57,709 --> 00:41:58,810
ASSOCIATION WITH DOUBLING DOWN

1168
00:41:58,810 --> 00:42:00,545
ON STUDIES AND RESEARCH TO

1169
00:42:00,545 --> 00:42:02,314
ADVANCE HYPERTENSION IN OUR

1170
00:42:02,314 --> 00:42:04,716
PATIENT POPULATIONS AND IN OUR

1171
00:42:04,716 --> 00:42:05,717
COMMUNITIES AND GLOBALLY

1172
00:42:05,717 --> 00:42:05,984
WORLDWIDE.

1173
00:42:05,984 --> 00:42:07,586
WITH THAT I'D LIKE TO THANK YOU

1174
00:42:07,586 --> 00:42:09,988
SO MUCH FOR YOUR ATTENTION TODAY

1175
00:42:09,988 --> 00:42:12,190
AND AM THRILLED TO HEAR YOUR

1176
00:42:12,190 --> 00:42:15,227
TALKS AND BE CHARGED BY THE WORK

1177
00:42:15,227 --> 00:42:17,296
THAT IS GOING TO COME OUT OF

1178
00:42:17,296 --> 00:42:17,763
THESE TWO DAYS.

1179
00:42:17,763 --> 00:42:27,973
THANK YOU SO MUCH FOR HAVING ME.

1180
00:42:27,973 --> 00:42:29,408
>> WHAT AN INCREDIBLY

1181
00:42:29,408 --> 00:42:30,776
INFORMATIVE KEYNOTE, PERFECT TO

1182
00:42:30,776 --> 00:42:33,612
KICK OFF THE SESSIONS.

1183
00:42:33,612 --> 00:42:34,246
THANK YOU.

1184
00:42:34,246 --> 00:42:37,449
SO, DR. SHAH IS GOING TO

1185
00:42:37,449 --> 00:42:39,184
MODERATE THE NEXT SESSION.

1186
00:42:39,184 --> 00:42:42,821
BRIDGING THE COMMUNICATION GAP

1187
00:42:42,821 --> 00:42:44,222
BETWEEN POPULATION-HEALTH,

1188
00:42:44,222 --> 00:42:45,957
CLINICAL MEDICINE, ENGINEERING.

1189
00:42:45,957 --> 00:42:48,794
>> THANK YOU.

1190
00:42:48,794 --> 00:42:50,896
THAT WAS AMAZING, DR. SPATZ.

1191
00:42:50,896 --> 00:42:52,130
YOU COVERED STARTING FROM THE

1192
00:42:52,130 --> 00:42:54,733
PEOPLE TO THE END, THE WHOLE

1193
00:42:54,733 --> 00:42:55,400
SYSTEM.

1194
00:42:55,400 --> 00:42:56,468
THAT WAS AN AMAZING

1195
00:42:56,468 --> 00:42:58,870
PRESENTATION.

1196
00:42:58,870 --> 00:43:00,472
THANK YOU FOR PARTICIPATING.

1197
00:43:00,472 --> 00:43:03,942
SO, LET'S MOVE ON NOW TO OUR

1198
00:43:03,942 --> 00:43:06,344
FIRST SESSION.

1199
00:43:06,344 --> 00:43:07,779
BRIDGING THE COMMUNICATION GAP,

1200
00:43:07,779 --> 00:43:09,348
NEAR AND DEAR TO MY HEART, I

1201
00:43:09,348 --> 00:43:11,516
WORK WITH A LOT OF ENGINEERS.

1202
00:43:11,516 --> 00:43:13,352
WE'RE FROM DIFFERENT PLANETS.

1203
00:43:13,352 --> 00:43:15,654
A FEW PEOPLE HERE HAVE

1204
00:43:15,654 --> 00:43:18,156
SUCCESSFULLY DONE THIS.

1205
00:43:18,156 --> 00:43:19,424
SOME PHYSICIAN, SOME COMPUTER

1206
00:43:19,424 --> 00:43:21,093
SCIENTISTS AND ENGINEERS WHO

1207
00:43:21,093 --> 00:43:21,860
MADE THIS WORK.

1208
00:43:21,860 --> 00:43:25,163
I'M THRILLED TO PRESENT THE

1209
00:43:25,163 --> 00:43:29,000
GROUP LEER.

1210
00:43:29,000 --> 00:43:31,837
DR. BOBAK MORTAZAVI, TEXAS A
& M

1211
00:43:31,837 --> 00:43:32,170
UNIVERSITY.

1212
00:43:32,170 --> 00:43:34,439
HE'S DONE WONDERFUL WORK

1213
00:43:34,439 --> 00:43:35,440
COLLABORATING WITH CARDIOLOGISTS

1214
00:43:35,440 --> 00:43:37,743
AND DEVELOPING NEW TECHNOLOGY IN

1215
00:43:37,743 --> 00:43:42,447
THE FIELD.

1216
00:43:42,447 --> 00:43:44,082
NEXT DR. ATTIA

1217
00:43:44,082 --> 00:43:45,384
CO-DIRECTOR OF ARTIFICIAL

1218
00:43:45,384 --> 00:43:46,818
INTELLIGENCE AT THE MAYO CLINIC.

1219
00:43:46,818 --> 00:43:48,987
HE ALSO HAS TRAINING IN

1220
00:43:48,987 --> 00:43:50,422
ELECTRICAL ENGINEERING, HAS DONE

1221
00:43:50,422 --> 00:43:52,557
AMAZING WORK LEVERAGING THE

1222
00:43:52,557 --> 00:43:53,592
MAYO'S HEALTH SYSTEM DATA TO

1223
00:43:53,592 --> 00:43:55,927
ADVANCE THE FIELD.

1224
00:43:55,927 --> 00:43:58,563
AND FINALLY DR. AHMAD,

1225
00:43:58,563 --> 00:44:00,499
PRACTICING PHYSICIAN, ADVANCED

1226
00:44:00,499 --> 00:44:03,001
HEART FAILURE PHYSICIAN, THE

1227
00:44:03,001 --> 00:44:06,838
ASSOCIATE DIRECTOR CENTER FOR

1228
00:44:06,838 --> 00:44:12,210
ARTIFICIAL INTELLIGENCE AT THE

1229
00:44:12,210 --> 00:44:12,944
BLOOM INSTITUTE.

1230
00:44:12,944 --> 00:44:13,445
I'LL MODERATE.

1231
00:44:13,445 --> 00:44:14,713
IF THINGS ARE GETTING CLOSE TO

1232
00:44:14,713 --> 00:44:18,750
TIME LIMIT I MIGHT STEP IN TO

1233
00:44:18,750 --> 00:44:19,985
ASK THE PRESENTERS TO MOVE

1234
00:44:19,985 --> 00:44:20,218
FORWARD.

1235
00:44:20,218 --> 00:44:21,920
AT THE END WE'LL HAVE A PANEL

1236
00:44:21,920 --> 00:44:22,387
DISCUSSION.

1237
00:44:22,387 --> 00:44:23,488
IF YOU PUT YOUR QUESTIONS IN THE

1238
00:44:23,488 --> 00:44:25,123
CHAT I'LL KEEP UP WITH THOSE.

1239
00:44:25,123 --> 00:44:26,425
AND I THINK IT'S GOING TO BE A

1240
00:44:26,425 --> 00:44:27,392
WONDERFUL SESSION.

1241
00:44:27,392 --> 00:44:37,269
WITH THAT, I WILL HAND IT OVER

1242
00:44:37,269 --> 00:44:38,470
TO DR. MORTAZAVI.

1243
00:44:38,470 --> 00:44:39,771
>> THANK YOU FOR THE

1244
00:44:39,771 --> 00:44:41,006
INTRODUCTION, I'M EXCITED TO

1245
00:44:41,006 --> 00:44:41,873
SPEAK WITH YOU TODAY.

1246
00:44:41,873 --> 00:44:43,508
I HAVE THE PLEASURE OF BEING

1247
00:44:43,508 --> 00:44:47,012
ABLE TO TALK ABOUT SOME OF THE

1248
00:44:47,012 --> 00:44:48,213
ENGINEERING TERMS THAT MAYBE

1249
00:44:48,213 --> 00:44:51,516
SHOULD BE HELPFUL FOR MERGING

1250
00:44:51,516 --> 00:44:53,819
WITH CLINICIANS, MYSELF, I

1251
00:44:53,819 --> 00:44:55,086
TRAINED WITH CARDIOLOGISTS AT

1252
00:44:55,086 --> 00:44:56,588
THE YALE SCHOOL OF MEDICINE,

1253
00:44:56,588 --> 00:45:00,692
HAVE HAD THE FORTUNE OF WORKING

1254
00:45:00,692 --> 00:45:02,661
WITH THEM CLOSELY, HAVE THESE

1255
00:45:02,661 --> 00:45:04,996
DISCLOSURES THAT ARE FUNDING

1256
00:45:04,996 --> 00:45:06,932
WORK IN THIS AREA.

1257
00:45:06,932 --> 00:45:08,133
SO, JUST TO GO THROUGH HERE,

1258
00:45:08,133 --> 00:45:10,402
IT'S GOING TO BE DIFFICULT TO

1259
00:45:10,402 --> 00:45:13,939
TALK ABOUT ALL OF THE TERMS IN

1260
00:45:13,939 --> 00:45:14,973
ENGINEERING THAT ARE NECESSARY

1261
00:45:14,973 --> 00:45:15,907
FOR HYPERTENSION MANAGEMENT BUT

1262
00:45:15,907 --> 00:45:18,109
I'M HOPING GOING THROUGH THIS

1263
00:45:18,109 --> 00:45:20,312
OUTLINE WE CAN TALK ABOUT

1264
00:45:20,312 --> 00:45:23,815
GENERALLY KEY MODELS AND TERMS

1265
00:45:23,815 --> 00:45:25,684
TO USE, LANGUAGE THAT NEEDS TO

1266
00:45:25,684 --> 00:45:27,519
BE CONSISTENT ACROSS ENGINEERS

1267
00:45:27,519 --> 00:45:30,255
AND CLINICIANS.

1268
00:45:30,255 --> 00:45:31,990
I WHEN I STARTED SPENT AN

1269
00:45:31,990 --> 00:45:33,625
EMBARRASSING AMOUNT OF TIME

1270
00:45:33,625 --> 00:45:35,393
FIGURING OUT DIFFERENCE BETWEEN

1271
00:45:35,393 --> 00:45:37,462
SOME MEASUREMENTS WE USE, LIKE

1272
00:45:37,462 --> 00:45:40,332
AREA UNDER THE ROC CURVE AND

1273
00:45:40,332 --> 00:45:42,767
STATISTICS AND LEARNING THESE

1274
00:45:42,767 --> 00:45:45,470
ARE THE SAME THINGS.

1275
00:45:45,470 --> 00:45:47,539
IT'S THINGS LIKE THIS THAT

1276
00:45:47,539 --> 00:45:48,206
CHALLENGE INTEGRATING BETWEEN

1277
00:45:48,206 --> 00:45:49,341
FIELDS BUT WE CAN UNDERSTAND

1278
00:45:49,341 --> 00:45:51,142
SORT OF WHAT ARE THE KEY KINDS

1279
00:45:51,142 --> 00:45:54,212
OF MODELS AND TECHNIQUES USED,

1280
00:45:54,212 --> 00:45:58,850
AND TALK ABOUT JUST SORT OF

1281
00:45:58,850 --> 00:46:00,485
ADVANCED SURVEY OF MODELS AND

1282
00:46:00,485 --> 00:46:01,786
SENSING AND THINGS AVAILABLE TO

1283
00:46:01,786 --> 00:46:04,689
US TO TRY TO PROMOTE NEW

1284
00:46:04,689 --> 00:46:07,926
SOLUTIONS HERE. 

1285
00:46:07,926 --> 00:46:10,228
MOST OF THIS IS JUST A QUICK

1286
00:46:10,228 --> 00:46:11,530
SURVEY OF THINGS YOU MIGHT HEAR

1287
00:46:11,530 --> 00:46:15,267
IN DIFFERENT TALKS AS WE GO

1288
00:46:15,267 --> 00:46:16,601
THROUGH THE DAY AND HOPEFULLY

1289
00:46:16,601 --> 00:46:18,470
LOOK FAMILIAR TO SOME THINGS AND

1290
00:46:18,470 --> 00:46:19,337
EXCITES YOUR INTEREST IN

1291
00:46:19,337 --> 00:46:21,072
LEARNING ABOUT SOME THINGS THAT

1292
00:46:21,072 --> 00:46:21,606
DON'T.

1293
00:46:21,606 --> 00:46:22,741
TYPICALLY WHEN WE LOOK AT A

1294
00:46:22,741 --> 00:46:25,010
BUNCH OF THESE STUDIES AND

1295
00:46:25,010 --> 00:46:30,682
GATHER DATA WE LOOK AT

1296
00:46:30,682 --> 00:46:33,451
SUPERVISED MACHINE LEARNING

1297
00:46:33,451 --> 00:46:34,753
TECHNIQUES.

1298
00:46:34,753 --> 00:46:36,821
SUPERVISED MODELS HAVE DATA

1299
00:46:36,821 --> 00:46:37,822
POINTS AND DIAGNOSING SOMETHING

1300
00:46:37,822 --> 00:46:40,458
WITH HYPERTENSION OR NOT

1301
00:46:40,458 --> 00:46:41,226
DIAGNOSING CARDIOVASCULAR

1302
00:46:41,226 --> 00:46:43,728
DISORDER OR NOT BASED ON THESE

1303
00:46:43,728 --> 00:46:45,096
TECHNIQUES THAT INVOLVE GRABBING

1304
00:46:45,096 --> 00:46:46,131
DATA AND UNDERSTANDING WHETHER

1305
00:46:46,131 --> 00:46:48,867
YOU HAVE THESE THINGS OR WHAT

1306
00:46:48,867 --> 00:46:54,139
ARE THE TIMES FOR THESE EVENTS. 

1307
00:46:54,139 --> 00:46:55,674
IT'S IMPORTANT AS WE'VE COVERED

1308
00:46:55,674 --> 00:46:56,875
UNDERSTANDING A SUITE OF

1309
00:46:56,875 --> 00:47:00,045
MEASUREMENTS TO UNDERSTAND

1310
00:47:00,045 --> 00:47:03,748
THINGS THAT ARE NOT -- WE WANT

1311
00:47:03,748 --> 00:47:05,183
TO DIAGNOSE HYPERTENSIVE STATUS

1312
00:47:05,183 --> 00:47:07,352
AND PREDICT THE RISKS OF

1313
00:47:07,352 --> 00:47:07,619
OUTCOMES.

1314
00:47:07,619 --> 00:47:09,888
IT ISN'T JUST BEING ABLE TO

1315
00:47:09,888 --> 00:47:10,956
DISCRIMINATE BETWEEN ONE CLASS

1316
00:47:10,956 --> 00:47:12,223
OR ANOTHER BUT UNDERSTAND THE

1317
00:47:12,223 --> 00:47:17,329
RANGE OF PROBABILITY, CHANGES

1318
00:47:17,329 --> 00:47:20,732
AND RISKS, AND

1319
00:47:20,732 --> 00:47:21,800
THRESHOLD-SPECIFIC THINGS.

1320
00:47:21,800 --> 00:47:25,437
AS WE MOVE FORWARD AND DISCUSS

1321
00:47:25,437 --> 00:47:27,939
THESE TECHNIQUES AND SOLUTIONS,

1322
00:47:27,939 --> 00:47:29,808
WE NEED A SUITE OF MEASUREMENTS.

1323
00:47:29,808 --> 00:47:33,078
ANY ONE NUMBER IS NOT GOING TO

1324
00:47:33,078 --> 00:47:36,681
BE DEFINITIVE UNTIL IT TELLS US

1325
00:47:36,681 --> 00:47:38,783
THOUSAND ADDRESS PROBLEMS AND

1326
00:47:38,783 --> 00:47:41,853
INTERVENE EARLY. 

1327
00:47:41,853 --> 00:47:42,754
THIS INCLUDES CLASSIFICATION

1328
00:47:42,754 --> 00:47:47,859
TECHNIQUES, AND REGRESSION

1329
00:47:47,859 --> 00:47:48,393
MEASUREMENTS.

1330
00:47:48,393 --> 00:47:49,294
REGRESSION MEASUREMENTS ARIC

1331
00:47:49,294 --> 00:47:50,161
THATTING NOVEL SENSING

1332
00:47:50,161 --> 00:47:52,230
TECHNIQUES AND BEING ABLE TO

1333
00:47:52,230 --> 00:47:53,131
PREDICT BLOOD PRESSURE

1334
00:47:53,131 --> 00:47:54,933
MEASUREMENTS AS WE GO ALONG, SO

1335
00:47:54,933 --> 00:48:02,407
CORRELATION ROOT MEAN SQUARE

1336
00:48:02,407 --> 00:48:03,241
ERROR, MEAN ABSOLUTE DIFFERENCE,

1337
00:48:03,241 --> 00:48:05,443
AND WHAT THEY ARE TELLING YOU IS

1338
00:48:05,443 --> 00:48:06,478
THAT WHAT PERCENTAGE OF THE

1339
00:48:06,478 --> 00:48:11,416
TIME, HOW FAR OFF ARE THESE SORT

1340
00:48:11,416 --> 00:48:12,884
OF MAYBE COMMERCIALLY AVAILABLE

1341
00:48:12,884 --> 00:48:13,818
DEVICES PRESENTING DATA VERSUS

1342
00:48:13,818 --> 00:48:15,453
WHAT YOU MIGHT MEASURE IN THE

1343
00:48:15,453 --> 00:48:16,321
CLINIC.

1344
00:48:16,321 --> 00:48:18,657
IF WE HAVE A SUITE, WE CAN THINK

1345
00:48:18,657 --> 00:48:19,824
ABOUT THE ADVANCEMENTS IN

1346
00:48:19,824 --> 00:48:23,895
ENGINEERING THAT ALLOW US TO

1347
00:48:23,895 --> 00:48:26,197
POTENTIALLY HELP DEVELOP AND

1348
00:48:26,197 --> 00:48:29,834
TECHNOLOGY AND INTERVENTION TO

1349
00:48:29,834 --> 00:48:31,670
AID IN ADDRESSING BURDENS.

1350
00:48:31,670 --> 00:48:34,205
WHAT I'M EXCITING ABOUT IN

1351
00:48:34,205 --> 00:48:36,041
COMING TALKS, OTHER TERMS YOU

1352
00:48:36,041 --> 00:48:38,009
MIGHT HEAR FROM SENSORS, WE LIKE

1353
00:48:38,009 --> 00:48:42,947
TO TALK ABOUT SPECIFICALLY

1354
00:48:42,947 --> 00:48:43,581
WEARABLES, NEARABLES,

1355
00:48:43,581 --> 00:48:44,049
IMPLANTABLES, SENSING

1356
00:48:44,049 --> 00:48:45,350
TECHNOLOGIES ON THE PATIENT OR

1357
00:48:45,350 --> 00:48:48,086
NEAR THE PATIENT WITH THE

1358
00:48:48,086 --> 00:48:49,954
PATIENT, AND HAVE IT

1359
00:48:49,954 --> 00:48:52,891
CONTINUOUSLY MEASURE THINGS.

1360
00:48:52,891 --> 00:48:56,494
THEY CAN COME FROM MORE

1361
00:48:56,494 --> 00:48:58,263
CLINICALLY ORIENTED LIKE

1362
00:48:58,263 --> 00:48:59,364
AMBULATORY CUFF OR COMMERCIALLY

1363
00:48:59,364 --> 00:49:00,865
AVAILABLE TECHNIQUES THAT MAY

1364
00:49:00,865 --> 00:49:04,169
HAVE MORE LONGITUDINAL USE AND

1365
00:49:04,169 --> 00:49:05,470
MORE UPTAKE IN COMMUNITIES THAT

1366
00:49:05,470 --> 00:49:08,673
DON'T HAVE MAYBE BURDENS OF

1367
00:49:08,673 --> 00:49:10,742
USING SIGNIFICANT BULKY CLINICAL

1368
00:49:10,742 --> 00:49:15,880
DEVICES LIKE FITNESS TRACKERS,

1369
00:49:15,880 --> 00:49:18,183
CONTINUOUS GLUCOSE MONITORS

1370
00:49:18,183 --> 00:49:23,555
BROADENING ACCEPTABILITY ACROSS

1371
00:49:23,555 --> 00:49:25,857
PATIENT POPULATIONS, NOT JUST

1372
00:49:25,857 --> 00:49:28,927
TYPE 1 DIABETICS. 

1373
00:49:28,927 --> 00:49:32,964
A TREND IS TAKE THESE

1374
00:49:32,964 --> 00:49:33,965
TECHNOLOGIES THAT USE SENSING

1375
00:49:33,965 --> 00:49:36,234
SOLUTIONS AND SEE IF WE IS

1376
00:49:36,234 --> 00:49:37,335
DEVELOP NEW TECHNIQUES WHILE

1377
00:49:37,335 --> 00:49:38,336
MEASURING BLOOD PRESSURE.

1378
00:49:38,336 --> 00:49:40,738
FOR EXAMPLE, ONE THAT I'M

1379
00:49:40,738 --> 00:49:42,841
INVOLVED WITH USES ELECTRICAL

1380
00:49:42,841 --> 00:49:47,112
IMPULSES TO IDENTIFY RADIAL

1381
00:49:47,112 --> 00:49:48,079
ARTERY AND TRACK PRESSURE FLOW.

1382
00:49:48,079 --> 00:49:52,784
IF YOU CAN DO THIS DATA CAPTURE,

1383
00:49:52,784 --> 00:49:55,687
THE BIGGEST CONCERN AS

1384
00:49:55,687 --> 00:49:58,156
ENGINEERS, WHAT DO YOU WITH SUCH

1385
00:49:58,156 --> 00:50:02,761
OVERWHELMING AMOUNTS OF DATA,

1386
00:50:02,761 --> 00:50:03,862
THESE THINGS ARE ALMOST --

1387
00:50:03,862 --> 00:50:04,929
DIFFICULT TO DEAL WITH.

1388
00:50:04,929 --> 00:50:06,865
WHAT WE'RE TALKING ABOUT MAY BE

1389
00:50:06,865 --> 00:50:08,766
A SINGLE MEASUREMENT AT A VISIT

1390
00:50:08,766 --> 00:50:10,401
OR PERIODIC, NOW I'M TALKING

1391
00:50:10,401 --> 00:50:11,703
ABOUT GIVING YOU A CONTINUOUS

1392
00:50:11,703 --> 00:50:12,504
SIGNAL SIMILAR TO SOMETHING YOU

1393
00:50:12,504 --> 00:50:21,146
WOULD SEE IN ELECTROCARDIOGRAM.

1394
00:50:21,146 --> 00:50:23,114
NOW LOOK AT ADVANCEMENTS IN

1395
00:50:23,114 --> 00:50:25,216
TECHNIQUES AVAILABLE TO LOOK AT

1396
00:50:25,216 --> 00:50:28,586
WAVE FORMS OF DATA, CONTINUOUS

1397
00:50:28,586 --> 00:50:31,556
CAPTURES OF BIOMETRIC SIGNALS

1398
00:50:31,556 --> 00:50:33,625
RATHER THAN MAYBE STANDARD

1399
00:50:33,625 --> 00:50:36,161
METRIC OR THRESHOLD DATES,

1400
00:50:36,161 --> 00:50:40,832
VALUES CAPTURED PERIODICALLY.

1401
00:50:40,832 --> 00:50:44,135
WE'LL DIVE INTO ANOTHER SET OF

1402
00:50:44,135 --> 00:50:45,870
TERMS, WE'LL DESCRIBE THEM AS A

1403
00:50:45,870 --> 00:50:51,142
HIGH LEVEL TUTORIAL HERE, ONE

1404
00:50:51,142 --> 00:50:52,911
THING PARTICULARLY POPULAR ARE

1405
00:50:52,911 --> 00:50:55,313
DEEP LEARNING TECHNIQUES.

1406
00:50:55,313 --> 00:50:57,382
WHAT THESE ARE, UNIVERSAL

1407
00:50:57,382 --> 00:50:58,817
ESTIMATORS THAT CAN LEARN AND

1408
00:50:58,817 --> 00:51:01,653
INFER PATTERNS FROM RAW DATA.

1409
00:51:01,653 --> 00:51:04,989
WHEREAS PREVIOUSLY I MIGHT NEED

1410
00:51:04,989 --> 00:51:07,358
AN ECG SIGNAL AND DETECT PEAKS

1411
00:51:07,358 --> 00:51:13,064
AND QRS COMPLEXES AND UNDERSTAND

1412
00:51:13,064 --> 00:51:14,833
AN AREA UNDER ELEVATION, I CAN

1413
00:51:14,833 --> 00:51:16,234
PROVIDE DEEP LEARNING TECHNIQUE

1414
00:51:16,234 --> 00:51:17,669
WITH RAW SIGNALS WITHOUT SUCH

1415
00:51:17,669 --> 00:51:20,071
ANNOTATIONS AND SEE IF IT CAN

1416
00:51:20,071 --> 00:51:24,442
LEARN SETS OF FEATURES AND

1417
00:51:24,442 --> 00:51:25,877
PARAMETERS AND RELATIONSHIPS

1418
00:51:25,877 --> 00:51:28,279
THAT IDENTIFY NEW THINGS,

1419
00:51:28,279 --> 00:51:29,480
PRESENT NEW KNOWLEDGE, AND

1420
00:51:29,480 --> 00:51:31,349
IMPORTANTLY THESE KIND OF

1421
00:51:31,349 --> 00:51:34,519
TECHNIQUES CAN BE CONTINUALLY

1422
00:51:34,519 --> 00:51:35,620
ADAPTED, CONTINUALLY UPDATED AND

1423
00:51:35,620 --> 00:51:37,689
LEARN MULTIPLE THINGS AT ONCE,

1424
00:51:37,689 --> 00:51:38,423
SO THINGS RELATED TO BLOOD

1425
00:51:38,423 --> 00:51:42,961
PRESSURE IF WE'RE CAPTURING

1426
00:51:42,961 --> 00:51:43,828
CHARACTERISTICS OVER STUDIES, WE

1427
00:51:43,828 --> 00:51:45,463
DON'T HAVE TO THINK ABOUT EACH

1428
00:51:45,463 --> 00:51:47,098
AS INDIVIDUAL THINGS, JUST

1429
00:51:47,098 --> 00:51:49,534
LOOKING AT THE SYSTOLIC OR JUST

1430
00:51:49,534 --> 00:51:51,069
LOOKING AT DIASTOLIC OR CHANGES

1431
00:51:51,069 --> 00:51:53,104
IN HEART RATE, BUT ACTUALLY CAN

1432
00:51:53,104 --> 00:51:57,609
CAPTURE A SET OF SENSING DATA ON

1433
00:51:57,609 --> 00:51:58,710
THE PARTICIPANT AND LEARN,

1434
00:51:58,710 --> 00:52:06,484
INTERNAL REPRESENTATIVE

1435
00:52:06,484 --> 00:52:07,185
 REPRESENTATIONS AND

1436
00:52:07,185 --> 00:52:12,390
PREDICTING SYSTOLIC AND 

1437
00:52:12,390 --> 00:52:16,995
DIASTOLIC, PERHAPS NOT RELATING

1438
00:52:16,995 --> 00:52:20,865
IN THE SAME FUNCTION, WE USE

1439
00:52:20,865 --> 00:52:23,768
MULTI-TASK LEARNING LENDING TO

1440
00:52:23,768 --> 00:52:26,938
THE THING THAT'S ALL OVER THAT

1441
00:52:26,938 --> 00:52:28,373
WE'VE BEEN HEARING ABOUT,

1442
00:52:28,373 --> 00:52:29,474
GENERATEIVE MODELS.

1443
00:52:29,474 --> 00:52:31,209
IF WE CAN TAKE THESE DEEP

1444
00:52:31,209 --> 00:52:33,077
LEARNING TECHNIQUES AND PROVIDE

1445
00:52:33,077 --> 00:52:36,247
ENOUGH DATA TO THEM, THEY BECOME

1446
00:52:36,247 --> 00:52:38,116
CAPABLE OF REPRESENTING WHAT A

1447
00:52:38,116 --> 00:52:40,718
PATIENT AND CURRENT PATIENT

1448
00:52:40,718 --> 00:52:42,487
STATE LOOKS LIKE, INDEPENDENT OF

1449
00:52:42,487 --> 00:52:42,687
TASK.

1450
00:52:42,687 --> 00:52:44,355
WHETHER IT'S TRYING TO MEASURE

1451
00:52:44,355 --> 00:52:47,725
SYSTOLIC BLOOD PRESSURE OR

1452
00:52:47,725 --> 00:52:50,928
CLASSIFY HYPERTENSION OR NOW YOU

1453
00:52:50,928 --> 00:52:53,965
WANT TO MODEL RISKS OF ACUTE

1454
00:52:53,965 --> 00:52:57,969
EVENT IN THE NEXT SIX MONTHS, 12

1455
00:52:57,969 --> 00:52:59,570
OR 18 MONTHS, RATHER THAN

1456
00:52:59,570 --> 00:53:00,538
BUILDING DATASETS AND

1457
00:53:00,538 --> 00:53:01,739
INDEPENDENT STUDIES, WHAT WE CAN

1458
00:53:01,739 --> 00:53:03,274
DO IS LOOK AT OBSERVATIONAL

1459
00:53:03,274 --> 00:53:04,275
DATA, COLLECT IT OVER LARGE

1460
00:53:04,275 --> 00:53:06,444
PERIODS OF TIME OVER LARGE

1461
00:53:06,444 --> 00:53:07,278
POPULATION SOURCES, AND SORT OF

1462
00:53:07,278 --> 00:53:08,813
START TO LEARN WHAT DATA

1463
00:53:08,813 --> 00:53:13,451
REPRESENTS DIFFERENT TASKS AND

1464
00:53:13,451 --> 00:53:14,752
THINGS ABOUT PATIENTS, AND WE

1465
00:53:14,752 --> 00:53:17,288
CAN GENERATE FROM THIS AND LEARN

1466
00:53:17,288 --> 00:53:19,123
ALL KINDS OF DIFFERENT TASKS

1467
00:53:19,123 --> 00:53:19,457
FROM THIS.

1468
00:53:19,457 --> 00:53:20,925
AND THIS IS, YOU KNOW, YOU HAVE

1469
00:53:20,925 --> 00:53:24,595
HEARD A LOT OF THESE THINGS

1470
00:53:24,595 --> 00:53:26,264
LATELY, GENERATIVE MODELS,

1471
00:53:26,264 --> 00:53:27,231
SPECIFICALLY LARGE LANGUAGE

1472
00:53:27,231 --> 00:53:29,734
MODELS THAT ENABLE THINGS LIKE

1473
00:53:29,734 --> 00:53:30,835
CHAT GPT AND SUCH, TO BE ABLE TO

1474
00:53:30,835 --> 00:53:39,610
CREATE EXPLANATIONS ANSWERS AND

1475
00:53:39,610 --> 00:53:40,378
DESCRIPTIVES BEHIND DATA TOO

1476
00:53:40,378 --> 00:53:45,216
COMPLEX TO UNDERSTAND ON ITS

1477
00:53:45,216 --> 00:53:45,650
OWN.

1478
00:53:45,650 --> 00:53:47,085
THESE ARE FEASIBLE IN RECENT

1479
00:53:47,085 --> 00:53:49,721
YEARS SPECIFICALLY BECAUSE OF

1480
00:53:49,721 --> 00:53:50,588
THE COMPUTATIONAL AND

1481
00:53:50,588 --> 00:53:51,456
ENGINEERING ADVANCEMENTS THAT

1482
00:53:51,456 --> 00:53:52,991
WE'VE HAD.

1483
00:53:52,991 --> 00:53:54,392
WHILE DEEP LEARNING HAS EXISTED

1484
00:53:54,392 --> 00:53:56,928
FOR A LONG TIME, IT'S COMING TO

1485
00:53:56,928 --> 00:53:59,230
THE FOREFRONT NOW BEING ABLE TO

1486
00:53:59,230 --> 00:54:01,032
USE THESE THINGS, UNDERSTAND AND

1487
00:54:01,032 --> 00:54:05,036
REPRESENT WHAT DATA LOOKS LIKES

1488
00:54:05,036 --> 00:54:06,137
AND TRANSFER ACROSS POPULATIONS.

1489
00:54:06,137 --> 00:54:08,840
WE MIGHT HAVE A STUDY LIKE THE

1490
00:54:08,840 --> 00:54:09,974
ONE DR. SPATZ MENTIONED AT YALE

1491
00:54:09,974 --> 00:54:12,810
LOOKING AT PATIENTS AND

1492
00:54:12,810 --> 00:54:14,445
COLLECTING DATA AROUND THE

1493
00:54:14,445 --> 00:54:15,880
CONNECTICUT AREA, AND SAY, OKAY,

1494
00:54:15,880 --> 00:54:17,482
WHAT ABOUT MY PATIENT POPULATION

1495
00:54:17,482 --> 00:54:19,450
IN TEXAS, DO THEY LOOK THE SAME,

1496
00:54:19,450 --> 00:54:19,884
DIFFERENT?

1497
00:54:19,884 --> 00:54:25,056
HOW MUCH DO I NEED REPLICATE TO

1498
00:54:25,056 --> 00:54:26,891
GENERATE DATA TO IMPLEMENT THESE

1499
00:54:26,891 --> 00:54:28,226
SOLUTIONS HERE AND TREAT

1500
00:54:28,226 --> 00:54:30,094
PATIENTS IN TEXAS SIMILAR TO HOW

1501
00:54:30,094 --> 00:54:32,263
SHE MIGHT BE DOING IN

1502
00:54:32,263 --> 00:54:32,563
CONNECTICUT.

1503
00:54:32,563 --> 00:54:34,465
THE BEAUTY IS ONCE I CAN GET

1504
00:54:34,465 --> 00:54:36,100
ENOUGH DATA TO SORT OF LEARNING

1505
00:54:36,100 --> 00:54:38,603
AND GENERATE WHAT I THINK

1506
00:54:38,603 --> 00:54:42,039
DIFFERENT PATIENTS AT DIFFERENT

1507
00:54:42,039 --> 00:54:43,141
STAGES OF THEIR CARDIOVASCULAR

1508
00:54:43,141 --> 00:54:44,375
HEALTH AND HYPERTENSION LOOK

1509
00:54:44,375 --> 00:54:46,511
LIKE, I CAN TAKE THESE MODELS

1510
00:54:46,511 --> 00:54:49,280
AND ONLY JUST SORT OF FINE TUNE

1511
00:54:49,280 --> 00:54:53,651
THEM AND SAY, LOOK, WE KNOW

1512
00:54:53,651 --> 00:54:54,252
CLINICALLY, PHYSIOLOGICALLY

1513
00:54:54,252 --> 00:54:55,853
THERE ARE THINGS GOING ON THAT

1514
00:54:55,853 --> 00:54:57,622
ARE GOING TO BE COMMON, AND I

1515
00:54:57,622 --> 00:55:00,358
NEED TO LEARN THE ACUTE

1516
00:55:00,358 --> 00:55:01,759
DIFFERENCES THAT COME IN

1517
00:55:01,759 --> 00:55:04,162
CAPTURING DATA AND THEN SEEING

1518
00:55:04,162 --> 00:55:06,130
WHAT OUTCOMES COME AND MIGHT

1519
00:55:06,130 --> 00:55:09,867
PATIENT POPULATIONS, PERHAPS MY

1520
00:55:09,867 --> 00:55:11,836
SORT OF RURAL UNDERREPRESENTED

1521
00:55:11,836 --> 00:55:13,104
AREAS IN SOUTHEAST TEXAS. 

1522
00:55:13,104 --> 00:55:18,409
THAT RAISES A CHALLENGE,

1523
00:55:18,409 --> 00:55:19,944
HOPEFULLY YOU CAN LOOK AT LINKS

1524
00:55:19,944 --> 00:55:21,913
AND FOLLOW UP WITH ME, ONE KEY

1525
00:55:21,913 --> 00:55:23,414
IS GOING TO BE PRIVACY CONCERNS

1526
00:55:23,414 --> 00:55:25,516
THAT COME UP IN THESE KIND OF

1527
00:55:25,516 --> 00:55:25,817
THINGS.

1528
00:55:25,817 --> 00:55:27,151
FEDERATED LEARNING IS A TERM WE

1529
00:55:27,151 --> 00:55:28,519
ALL NEED TO BECOME FAMILIAR

1530
00:55:28,519 --> 00:55:29,887
WITH, WHICH SUGGESTS THAT

1531
00:55:29,887 --> 00:55:31,756
THERE'S A METHOD BY WHICH THESE

1532
00:55:31,756 --> 00:55:32,757
DEEP LEARNING TECHNIQUES, ONCE

1533
00:55:32,757 --> 00:55:35,393
WE CAN TRAIN THEM AND UNDERSTAND

1534
00:55:35,393 --> 00:55:37,995
WHAT GENERATES DIFFERENT PATIENT

1535
00:55:37,995 --> 00:55:39,330
STATES AND REPRESENTS PATIENTS

1536
00:55:39,330 --> 00:55:41,499
PROPERLY, I CAN SHARE THAT

1537
00:55:41,499 --> 00:55:42,100
INFORMATION WITHOUT SHARING

1538
00:55:42,100 --> 00:55:47,305
PATIENT DATA. 

1539
00:55:47,305 --> 00:55:49,407
I CAN LOOK AT WHAT WE LEARNED

1540
00:55:49,407 --> 00:55:51,242
FROM DIFFERENT HOSPITALS AND

1541
00:55:51,242 --> 00:55:53,878
COMMUNITIES, DIFFERENT CENTERS

1542
00:55:53,878 --> 00:55:57,248
AROUND THE COUNTRY, AND THEN

1543
00:55:57,248 --> 00:55:59,650
LEARN HOW TO ADAPT WITHOUT

1544
00:55:59,650 --> 00:56:04,489
NEEDING MAYBE THE PHI THAT GOES

1545
00:56:04,489 --> 00:56:06,224
WITH COLLECTING AND TRAINING IN

1546
00:56:06,224 --> 00:56:06,891
CONNECTICUT.

1547
00:56:06,891 --> 00:56:09,627
SO I THINK WHILE REGULATORY

1548
00:56:09,627 --> 00:56:11,162
THINGS ARE A CONCERN, THIS IS

1549
00:56:11,162 --> 00:56:12,230
PERHAPS AN APPROACH WE CAN

1550
00:56:12,230 --> 00:56:14,298
FIGURE OUT HOW TO WORK TOGETHER

1551
00:56:14,298 --> 00:56:17,635
WITHOUT HAVING THE BURDEN OF THE

1552
00:56:17,635 --> 00:56:19,103
CHALLENGE OF DAILY USE WITH EACH

1553
00:56:19,103 --> 00:56:19,303
OTHER.

1554
00:56:19,303 --> 00:56:21,639
AND IF WE CAN DO ALL THESE

1555
00:56:21,639 --> 00:56:24,475
THINGS, THE LAST THING THAT

1556
00:56:24,475 --> 00:56:28,513
NEEDS TO BE IMPORTANT IS

1557
00:56:28,513 --> 00:56:28,913
EXPLAINABILITY AND

1558
00:56:28,913 --> 00:56:29,313
INTERPRETABILITY.

1559
00:56:29,313 --> 00:56:31,048
HOW DO YOU TRUST THAT IT'S

1560
00:56:31,048 --> 00:56:32,717
DEVELOPING SOMETHING CORRECTLY?

1561
00:56:32,717 --> 00:56:36,254
HOW DO YOU UNDERSTAND RISK WORKS

1562
00:56:36,254 --> 00:56:38,823
WELL, HOW DO YOU KNOW YOU'RE

1563
00:56:38,823 --> 00:56:40,458
MODELING CORRECTLY NOT DEALING

1564
00:56:40,458 --> 00:56:41,325
WITH BIAS?

1565
00:56:41,325 --> 00:56:43,861
THERE'S A SERIES OF

1566
00:56:43,861 --> 00:56:44,529
EXPLAINABILITY AND INTERPRETABLE

1567
00:56:44,529 --> 00:56:51,169
A I THAT NEEDS TO GO WITH

1568
00:56:51,169 --> 00:56:54,705
TECHNIQUES. 

1569
00:56:54,705 --> 00:56:56,340
YOU NEED TO TRUST IDENTIFYING

1570
00:56:56,340 --> 00:56:58,109
THIS IS A HUSKY IN THE PICTURE

1571
00:56:58,109 --> 00:56:59,544
BECAUSE IT'S TAKING FEATURES OF

1572
00:56:59,544 --> 00:57:01,312
THE DOG AND NOT, SAY,

1573
00:57:01,312 --> 00:57:05,116
IDENTIFYING IN TRAINING SET ALL

1574
00:57:05,116 --> 00:57:06,784
THE FEATURES HAD SNOW IN THE

1575
00:57:06,784 --> 00:57:07,084
BACKGROUND.

1576
00:57:07,084 --> 00:57:10,521
IF WE DO THAT WE GET TO SOME

1577
00:57:10,521 --> 00:57:11,455
FURTHER ADVANCEMENTS THAT WE'LL

1578
00:57:11,455 --> 00:57:13,124
HEAR ABOUT LATER TODAY FROM

1579
00:57:13,124 --> 00:57:15,860
SPEAKERS ABOUT HOW WE CAN THEN

1580
00:57:15,860 --> 00:57:16,827
PHENOTYPE AND TREAT AND

1581
00:57:16,827 --> 00:57:17,361
INTERVENE.

1582
00:57:17,361 --> 00:57:18,596
IF WE CAN UNDERSTAND

1583
00:57:18,596 --> 00:57:19,196
REPRESENTATION, WE NO LONGER

1584
00:57:19,196 --> 00:57:23,968
HAVE TO LOOK AT TREATMENT AFFECT

1585
00:57:23,968 --> 00:57:27,538
ACROSS LARGE SCALES BUT WE CAN

1586
00:57:27,538 --> 00:57:27,972
IDENTIFY PHENOTYPIC

1587
00:57:27,972 --> 00:57:29,540
NEIGHBORHOODS AND REGIONS AND DO

1588
00:57:29,540 --> 00:57:31,075
UNSUPERVISED CLUSTERING.

1589
00:57:31,075 --> 00:57:31,842
WE TAKE THESE REPRESENTATIONS,

1590
00:57:31,842 --> 00:57:34,145
WITHOUT WORRYING ABOUT THE

1591
00:57:34,145 --> 00:57:37,949
DOWNSTREAM TASKS, SEEING WHO

1592
00:57:37,949 --> 00:57:39,150
LOOKS SIMILAR, WHO DOESN'T, AND

1593
00:57:39,150 --> 00:57:40,151
UNDERSTAND WHAT KIND OF

1594
00:57:40,151 --> 00:57:41,786
TREATMENTS SEEM TO BE SUCCESSFUL

1595
00:57:41,786 --> 00:57:42,553
OR NOT.

1596
00:57:42,553 --> 00:57:46,924
FROM THOSE, WE CAN THEN DO THE

1597
00:57:46,924 --> 00:57:48,259
LAST TERM THAT HAS NOT SEEN AS

1598
00:57:48,259 --> 00:57:50,094
MUCH IN THE CLINICAL FIELD AND

1599
00:57:50,094 --> 00:57:52,063
DOMAIN, NEED COME IN MORE AND

1600
00:57:52,063 --> 00:57:53,397
MORE, REINFORCEMENT LEARNING.

1601
00:57:53,397 --> 00:57:55,466
SO THIS IDEA THAT ENGINEERING

1602
00:57:55,466 --> 00:57:56,334
TECHNIQUES CAN BE TAUGHT WHEN

1603
00:57:56,334 --> 00:57:57,768
THEY ARE DOING WELL AND WHEN

1604
00:57:57,768 --> 00:57:59,403
THEY ARE DOING POORLY AND ADAPT

1605
00:57:59,403 --> 00:58:00,204
PROPERLY.

1606
00:58:00,204 --> 00:58:02,573
SO YOU TAKE THESE PHENOTYPIC

1607
00:58:02,573 --> 00:58:06,244
REGIONS, THE MODEL CAN LEARN THE

1608
00:58:06,244 --> 00:58:07,111
RIGHT SPHERE AROUND THE PERSON

1609
00:58:07,111 --> 00:58:10,481
TO LOOK AT TO UNDERSTAND

1610
00:58:10,481 --> 00:58:12,116
LOCALIZED TREATMENT EFFECT TO

1611
00:58:12,116 --> 00:58:16,754
THEN PROVIDE POTENTIAL CLINICAL

1612
00:58:16,754 --> 00:58:17,555
DECISION SUPPORT.

1613
00:58:17,555 --> 00:58:20,825
THAT'S A SIGNIFICANT NUMBER OF

1614
00:58:20,825 --> 00:58:21,192
TERMS.

1615
00:58:21,192 --> 00:58:22,693
I HOPE MOST ARE MORE FAMILIAR

1616
00:58:22,693 --> 00:58:24,228
THAN NOT GIVEN ADVANCES BUT IF

1617
00:58:24,228 --> 00:58:25,863
WE CAN LEARN FROM THESE

1618
00:58:25,863 --> 00:58:26,964
TECHNIQUES WE HAVE THE ABILITY

1619
00:58:26,964 --> 00:58:30,601
AND TOOL SETS NOW TO TRY TO

1620
00:58:30,601 --> 00:58:32,103
REALLY DEVELOP TECHNIQUES THAT

1621
00:58:32,103 --> 00:58:34,005
YOU ALL HAVE DONE OVER DECADES

1622
00:58:34,005 --> 00:58:35,272
BUT MAYBE HAVE NOT USED THE

1623
00:58:35,272 --> 00:58:40,211
TERMS WE HAVE WITH RESPECT TO

1624
00:58:40,211 --> 00:58:40,811
GENERATIVE MODELS AND

1625
00:58:40,811 --> 00:58:42,980
REPRESENTING STATES BEING THE

1626
00:58:42,980 --> 00:58:44,282
SAME AS PHENOTYPING AND

1627
00:58:44,282 --> 00:58:46,017
CLUSTERING, AND IF WE CAN LOOK

1628
00:58:46,017 --> 00:58:47,885
AT THAT WE ENABLE CONTINUOUS

1629
00:58:47,885 --> 00:58:50,421
MEASUREMENT ALSO, WE CAN RUN

1630
00:58:50,421 --> 00:58:51,622
INTO ADDITIONAL CHALLENGES OF,

1631
00:58:51,622 --> 00:58:54,258
YOU KNOW, CAUSAL INFERENCE

1632
00:58:54,258 --> 00:58:55,660
ISSUES, MISSING DATA, AND AT THE

1633
00:58:55,660 --> 00:58:57,094
END REALLY CHALLENGE OURSELVES

1634
00:58:57,094 --> 00:58:59,363
TO LOOK AT THE REGULATORY

1635
00:58:59,363 --> 00:59:00,064
HURDLES THAT COME ACROSS.

1636
00:59:00,064 --> 00:59:01,365
IF YOU CAN GET PATIENTS TO

1637
00:59:01,365 --> 00:59:05,903
GENERATE THIS DATA, WHO OWNS

1638
00:59:05,903 --> 00:59:10,875
DATA, HOW DO YOU SHARE, HOW DO

1639
00:59:10,875 --> 00:59:12,076
WE ENABLE SHARED DECISION MAKING

1640
00:59:12,076 --> 00:59:13,277
AND COMMUNITY LEARNING WITHOUT

1641
00:59:13,277 --> 00:59:16,013
HAVING PRIVACY AND ACCESS

1642
00:59:16,013 --> 00:59:17,348
ISSUES, WITHOUT POTENTIALLY

1643
00:59:17,348 --> 00:59:18,616
HAVING INSURANCE REGULATORY

1644
00:59:18,616 --> 00:59:18,849
ISSUES.

1645
00:59:18,849 --> 00:59:23,888
IN PARTICULAR I'M VERY EXCITED

1646
00:59:23,888 --> 00:59:24,889
TO HEAR LUCIA SAVAGE SPEAK

1647
00:59:24,889 --> 00:59:30,227
TOMORROW FROM THE LEGAL SIDE. 

1648
00:59:30,227 --> 00:59:35,633
I LOOK FORWARD TO YOUR

1649
00:59:35,633 --> 00:59:35,900
QUESTIONS.

1650
00:59:35,900 --> 00:59:38,035
I'M EXCITED TO TALK ABOUT

1651
00:59:38,035 --> 00:59:38,703
SENSING AND MODELING TECHNIQUES

1652
00:59:38,703 --> 00:59:40,871
THROUGH THE COURSE OF THE NEXT

1653
00:59:40,871 --> 00:59:41,138
FEW DAYS.

1654
00:59:41,138 --> 00:59:42,740
>> THANK YOU SO MUCH.

1655
00:59:42,740 --> 00:59:47,311
THAT WAS AMAZING. 

1656
00:59:47,311 --> 00:59:51,148
AS YOU CAN SEE, HE HAS A WIDE

1657
00:59:51,148 --> 00:59:52,116
RANGE OF EXPERTISE.

1658
00:59:52,116 --> 00:59:53,351
PLEASE PUT YOUR QUESTIONS IN THE

1659
00:59:53,351 --> 00:59:56,053
CHAT AND I'LL TRY TO KEEP TRACK

1660
00:59:56,053 --> 00:59:58,489
FOR OUR DISCUSSION AT THE END OF

1661
00:59:58,489 --> 01:00:02,760
THE THREE TALKS. 

1662
01:00:02,760 --> 01:00:06,030
NEXT DR. ATTIA WILL TALK ABOUT

1663
01:00:06,030 --> 01:00:07,231
ENGINEERS ARE FROM EARTH,

1664
01:00:07,231 --> 01:00:09,900
CLINICIANS ARE FROM VENUS.

1665
01:00:09,900 --> 01:00:13,504
>> THANK YOU AGAIN FOR
THIS

1666
01:00:13,504 --> 01:00:14,472
OPPORTUNITY TO TALK AND

1667
01:00:14,472 --> 01:00:20,044
PARTICIPATE IN THIS REALLY

1668
01:00:20,044 --> 01:00:20,811
EXCITING SESSION.

1669
01:00:20,811 --> 01:00:22,480
I DIDN'T CHANGE THE TOPIC BUT

1670
01:00:22,480 --> 01:00:25,416
I'M GOING TO ADDRESS AS AN

1671
01:00:25,416 --> 01:00:29,053
ENGINEER AS AN EXTENT, LOOKING

1672
01:00:29,053 --> 01:00:32,223
AT THE IDEA, AND WHAT WE NEEDED

1673
01:00:32,223 --> 01:00:35,493
TO DO TO OPEN DIVERSITY, TO

1674
01:00:35,493 --> 01:00:37,061
ACTUALLY IMPLEMENT THIS INTO

1675
01:00:37,061 --> 01:00:40,464
PRACTICE.

1676
01:00:40,464 --> 01:00:48,205
THESE ARE MY DISCLOSURES. 

1677
01:00:48,205 --> 01:00:50,174
AGAIN, I'LL DISCUSS HOW THIS

1678
01:00:50,174 --> 01:00:53,677
ENGINEERS WORK TOGETHER WITH

1679
01:00:53,677 --> 01:00:53,978
PHYSICIANS.

1680
01:00:53,978 --> 01:00:56,413
BUT THE USE CASE I'M GOING TO

1681
01:00:56,413 --> 01:01:00,017
DISCUSS IS DETECTION OF LOW

1682
01:01:00,017 --> 01:01:04,188
EJECTION FRACTION USING APPLE

1683
01:01:04,188 --> 01:01:04,588
WATCH.

1684
01:01:04,588 --> 01:01:06,490
AND MAYO APPLE WATCH STUDY.

1685
01:01:06,490 --> 01:01:08,125
APPLE DID NOT SUPPORT THIS STUDY

1686
01:01:08,125 --> 01:01:09,226
IN ANY WAY.

1687
01:01:09,226 --> 01:01:12,396
WE USED THE APPLE WATCH BECAUSE

1688
01:01:12,396 --> 01:01:19,970
WE HAD ACCESS. 

1689
01:01:19,970 --> 01:01:24,875
LEFT  VENTRICULAR FUNCTION

1690
01:01:24,875 --> 01:01:28,179
AFFECTS 2% OF THE GLOBAL

1691
01:01:28,179 --> 01:01:30,247
POPULATIONS, HIGH RATE OF

1692
01:01:30,247 --> 01:01:31,448
CLINICAL HEART FAILURE,

1693
01:01:31,448 --> 01:01:38,789
HOSPITALIZATION AND DEATH.

1694
01:01:38,789 --> 01:01:41,759
AS WE'VE HEARD IN KEYNOTE, THE

1695
01:01:41,759 --> 01:01:46,931
MAIN ISSUE IS IDENTIFYING THESE

1696
01:01:46,931 --> 01:01:47,598
PATIENTS.

1697
01:01:47,598 --> 01:01:50,534
AND IDENTIFICATION IS EXTENSIVE,

1698
01:01:50,534 --> 01:01:52,636
NOT READILY AVAILABLE TESTS LIKE

1699
01:01:52,636 --> 01:01:54,271
ECHO CARDIOGRAM.

1700
01:01:54,271 --> 01:01:57,107
CAN WE USE SOMETHING THAT'S MORE

1701
01:01:57,107 --> 01:02:03,347
UBIQUITOUS AND CHEAPER TO USE? 

1702
01:02:03,347 --> 01:02:06,283
WE TALKED ABOUT ECG, THE

1703
01:02:06,283 --> 01:02:08,619
REPORTING OF THE ELECTRICAL

1704
01:02:08,619 --> 01:02:10,454
ACTIVITY OF THE HEART.

1705
01:02:10,454 --> 01:02:18,896
IF YOU PUT A SENSOR ON EACH,

1706
01:02:18,896 --> 01:02:21,098
YOU'LL GET MORPHOLOGY AND ECG.

1707
01:02:21,098 --> 01:02:22,566
THE PROBLEM IS HUMANS CANNOT

1708
01:02:22,566 --> 01:02:26,570
DETECT LOW EJECTION FRACTURE

1709
01:02:26,570 --> 01:02:28,205
FROM ECG BUT MAY A.I. WOULD BE

1710
01:02:28,205 --> 01:02:31,141
ABLE TO DO IT AFTER SEEING

1711
01:02:31,141 --> 01:02:35,412
ENOUGH EXAMPLES. 

1712
01:02:35,412 --> 01:02:37,815
WE STARTED WITH 600,000

1713
01:02:37,815 --> 01:02:40,985
PATIENTS, ECHO AND ECG PAIR,

1714
01:02:40,985 --> 01:02:43,621
AFTER DATA CLEANING, MAJORITY OF

1715
01:02:43,621 --> 01:02:47,892
WORK FOR MOST SCIENTISTS,

1716
01:02:47,892 --> 01:02:50,528
CREATING GOOD DATASETS, WE HAD

1717
01:02:50,528 --> 01:02:52,930
100,000 PATIENTS, USING A THIRD

1718
01:02:52,930 --> 01:02:57,635
FOR TRAINING, THE REST FOR

1719
01:02:57,635 --> 01:03:02,673
VALIDATION. 

1720
01:03:02,673 --> 01:03:06,844
WE FEED IN INPUT, ALL ECG, WE

1721
01:03:06,844 --> 01:03:10,681
DID NOT FEET QT PR, WE FIT IN

1722
01:03:10,681 --> 01:03:11,849
ECG AS A WHOLE.

1723
01:03:11,849 --> 01:03:14,685
AND DOING TRAINING FOR TRAINING

1724
01:03:14,685 --> 01:03:16,220
SAID WE SHOWED EJECTION FRACTION

1725
01:03:16,220 --> 01:03:17,988
FROM THE ECHO.

1726
01:03:17,988 --> 01:03:20,724
WE ASKED IT TO FIND PATTERNS IF

1727
01:03:20,724 --> 01:03:23,560
THE EF IS BELOW 35% OR ABOVE IT.

1728
01:03:23,560 --> 01:03:25,963
WE WOULD LATER CHANGE IT TO 40

1729
01:03:25,963 --> 01:03:27,831
TO MATCH THE GUIDELINES, BUT

1730
01:03:27,831 --> 01:03:30,234
IT'S THE SAME CONCEPT.

1731
01:03:30,234 --> 01:03:32,636
SHOW ECG, ASK BINARY QUESTION

1732
01:03:32,636 --> 01:03:34,838
ABOUT EJECTION FRACTION, AGAIN

1733
01:03:34,838 --> 01:03:38,976
HUMAN CONSIST NOT DO, BUT

1734
01:03:38,976 --> 01:03:40,311
BECAUSE WE HAD MATCHED PATIENTS

1735
01:03:40,311 --> 01:03:42,179
WE COULD TRAIN THE NETWORK.

1736
01:03:42,179 --> 01:03:44,882
WE USED THE AREA UNDER THE CURVE

1737
01:03:44,882 --> 01:03:51,121
TO SELECT OUR BEST MODEL.

1738
01:03:51,121 --> 01:03:57,161
YOU SEE 0.5 IS RANDOM TEST, 1 IS

1739
01:03:57,161 --> 01:03:58,696
PERFECT.

1740
01:03:58,696 --> 01:04:02,533
WE HAD AUC OF 0.93, SPECIFICITY

1741
01:04:02,533 --> 01:04:04,902
86% COMPARING FAVORABLY TO OTHER

1742
01:04:04,902 --> 01:04:12,042
MEDICAL TESTS. 

1743
01:04:12,042 --> 01:04:15,412
WE THEN KNEW WHY IT IS BETTER

1744
01:04:15,412 --> 01:04:17,715
THAN ECHO FOR SCALABILITY,

1745
01:04:17,715 --> 01:04:23,520
TAKING IT TO MOBILE PHONE 

1746
01:04:23,520 --> 01:04:25,155
WEARABLES MAKE IT MORE SCALABLE

1747
01:04:25,155 --> 01:04:27,358
BUT WE DON'T HAVE SIGNALS IN OUR

1748
01:04:27,358 --> 01:04:29,093
HEALTH SYSTEM AND DIDN'T WANT TO

1749
01:04:29,093 --> 01:04:30,194
GIVE AWAY APPLE WATCHES SO

1750
01:04:30,194 --> 01:04:33,497
NEEDED TO FIND A WAY TO RECORD

1751
01:04:33,497 --> 01:04:37,334
PATIENTS AND GET SIGNALS WHILE

1752
01:04:37,334 --> 01:04:39,603
KEEPING THEM ENGAGED.

1753
01:04:39,603 --> 01:04:43,140
IF THE ECG IS GENERATED BY WATCH

1754
01:04:43,140 --> 01:04:44,208
WILL WORK AS WELL BECAUSE THERE

1755
01:04:44,208 --> 01:04:54,652
ARE A LOT OF DIFFERENCES.

1756
01:04:54,985 --> 01:04:56,687
LYING SUPINE, OBVIOUS POSITIONS,

1757
01:04:56,687 --> 01:04:58,455
SKIN IS PREPPED, QUALITY IS MUCH

1758
01:04:58,455 --> 01:04:58,689
BETTER.

1759
01:04:58,689 --> 01:05:01,058
WHEN I DO AN APPLE WATCH ON MY

1760
01:05:01,058 --> 01:05:03,460
WATCH, I MIGHT BE SITTING ON THE

1761
01:05:03,460 --> 01:05:07,765
COUCH, LAYING DOWN, SO ON. 

1762
01:05:07,765 --> 01:05:12,002
THE FIRST AIM WAS TO DEVELOP

1763
01:05:12,002 --> 01:05:13,904
INFRASTRUCTURE TO RECORD

1764
01:05:13,904 --> 01:05:19,076
REMOTELY AND SECURELY, SECOND TO

1765
01:05:19,076 --> 01:05:22,513
ADAPT USING A SINGLE WATCH ECG.

1766
01:05:22,513 --> 01:05:25,115
WE DID WEARABLE STUDIES REMOTELY

1767
01:05:25,115 --> 01:05:26,550
AND DIGITALLY, SENT E-MAILS, NO

1768
01:05:26,550 --> 01:05:31,155
ONE WAS IN DIRECT CONTACT WITH

1769
01:05:31,155 --> 01:05:31,422
PATIENTS.

1770
01:05:31,422 --> 01:05:33,757
SINGLE STUDY SENT SURVEY WITH

1771
01:05:33,757 --> 01:05:36,627
THE MAYO APP AND ASKED TWO

1772
01:05:36,627 --> 01:05:36,894
QUESTIONS.

1773
01:05:36,894 --> 01:05:38,028
DO YOU HAVE AN APPLE WATCH AND

1774
01:05:38,028 --> 01:05:39,563
WOULD YOU BE WILLING TO

1775
01:05:39,563 --> 01:05:40,130
PARTICIPATE?

1776
01:05:40,130 --> 01:05:44,701
IF YES TO BOTH WE SEND THEM A

1777
01:05:44,701 --> 01:05:48,005
SHORT CONSENT FORM USING PTRAX

1778
01:05:48,005 --> 01:05:50,207
WHICH THEY SIGN USING DIGITAL

1779
01:05:50,207 --> 01:05:54,011
SIGNATURE. 

1780
01:05:54,011 --> 01:05:56,547
THEY CONSENT AND RECEIVE A LINK.

1781
01:05:56,547 --> 01:06:03,020
THIS WAS CREATED INTERNALLY IN

1782
01:06:03,020 --> 01:06:05,355
MAYO CLINIC, SOFTWARE ENGINEERS

1783
01:06:05,355 --> 01:06:06,824
AND A LOT OF TECH.

1784
01:06:06,824 --> 01:06:10,327
THIS APP ALLOWS PATIENTS TO

1785
01:06:10,327 --> 01:06:13,964
UPLOAD ECGs TO UDP AND DIGITAL

1786
01:06:13,964 --> 01:06:16,733
DASHBOARD. 

1787
01:06:16,733 --> 01:06:22,005
WE NEED TO SEE IF WE CAN RUN THE

1788
01:06:22,005 --> 01:06:27,678
A.I. MODEL USING SINGLE LEAD, WE

1789
01:06:27,678 --> 01:06:28,712
HAD TO RETRAIN.

1790
01:06:28,712 --> 01:06:31,048
YOU CAN SEE THIS IS A PATIENT

1791
01:06:31,048 --> 01:06:33,350
THAT HAS AN APPLE WATCH, WITHIN

1792
01:06:33,350 --> 01:06:34,651
A FEW MINUTES FROM EACH OTHER,

1793
01:06:34,651 --> 01:06:38,021
YOU CAN SEE EVEN THOUGH THE

1794
01:06:38,021 --> 01:06:39,790
MORPHOLOGIES ARE SIMILAR THERE

1795
01:06:39,790 --> 01:06:41,759
ARE BIG DIFFERENCES IN THE HIGH

1796
01:06:41,759 --> 01:06:47,898
FREQUENCY NOISE, IN THIS CASE,

1797
01:06:47,898 --> 01:06:50,968
SO WE HAD TO WEIGHT TO NOT USE

1798
01:06:50,968 --> 01:06:57,107
FEATURES NOT EXISTING  EXISTINGN

1799
01:06:57,107 --> 01:07:00,077
APPLE WATCH.

1800
01:07:00,077 --> 01:07:02,913
WE LOWERED THE NUMBER OF LEADS.

1801
01:07:02,913 --> 01:07:04,915
RETRAINED THE NETWORK.

1802
01:07:04,915 --> 01:07:07,684
NOW WITH THE SYNTHETIC DATA, AUC

1803
01:07:07,684 --> 01:07:11,021
DROPPED TO 0.88 BECAUSE WE HAVE

1804
01:07:11,021 --> 01:07:14,191
SIGNIFICANTLY LESS DATA SO THAT

1805
01:07:14,191 --> 01:07:16,160
MAKES SENSE.

1806
01:07:16,160 --> 01:07:25,469
WE WERE ABLE TO COLLECT 125,000

1807
01:07:25,469 --> 01:07:29,206
ECGs FROM 2454 PATIENTS, 56%

1808
01:07:29,206 --> 01:07:32,342
WOMEN, FROM 21 TO 92, FROM 45

1809
01:07:32,342 --> 01:07:33,911
STATES, 11 COUNTRIES, IN LESS

1810
01:07:33,911 --> 01:07:38,415
THAN FIVE MONTHS. 

1811
01:07:38,415 --> 01:07:40,050
WE LOOKED AT USE STATISTICS.

1812
01:07:40,050 --> 01:07:41,952
YOU HEAR A LOT IN THE NEXT TWO

1813
01:07:41,952 --> 01:07:43,720
DAYS, WE LOSE A LOT OF PATIENTS

1814
01:07:43,720 --> 01:07:49,226
BECAUSE NOT  ALWAYS KNOW HOW TO

1815
01:07:49,226 --> 01:07:50,861
USE SYSTEM, HARDER AT HOME

1816
01:07:50,861 --> 01:07:52,062
VERSUS SOMEONE HELPING YOU IN

1817
01:07:52,062 --> 01:07:53,597
THE CLINIC.

1818
01:07:53,597 --> 01:07:55,365
WE LOOK HOW OFTEN ANT HOW LONG

1819
01:07:55,365 --> 01:07:59,636
THEY USE IT, THEY USE EIGHT

1820
01:07:59,636 --> 01:08:02,139
TIMES ON AVERAGE, WHICH MATCHES

1821
01:08:02,139 --> 01:08:03,807
UP WITH NOTIFICATIONS.

1822
01:08:03,807 --> 01:08:05,142
ALSO MOST PATIENTS USED UNTIL

1823
01:08:05,142 --> 01:08:07,211
THE LAST DAY OF THE STUDY,

1824
01:08:07,211 --> 01:08:11,448
NORMALIZED TIME FOR USE.

1825
01:08:11,448 --> 01:08:12,549
THEY WERE ENGAGED AND KEPT

1826
01:08:12,549 --> 01:08:13,417
SENDING DATA.

1827
01:08:13,417 --> 01:08:14,418
ANOTHER INTERESTING FINDING THAT

1828
01:08:14,418 --> 01:08:16,587
AS THE PATIENTS WERE OLDER THEY

1829
01:08:16,587 --> 01:08:20,657
USED THE APP MORE OFTEN, AND

1830
01:08:20,657 --> 01:08:21,658
WHICH WAS ACTUALLY SURPRISING.

1831
01:08:21,658 --> 01:08:22,392
WE WERE WORRIED THE ONLY

1832
01:08:22,392 --> 01:08:25,696
PATIENTS THAT WOULD USE IT WERE

1833
01:08:25,696 --> 01:08:26,997
YOUNGER PATIENTS BUT SEEMS LIKE

1834
01:08:26,997 --> 01:08:29,600
PATIENTS THAT ARE OLDER ACTUALLY

1835
01:08:29,600 --> 01:08:30,868
WERE MORE INTERESTED IN

1836
01:08:30,868 --> 01:08:33,837
CONTRIBUTING THEIR DATA TO THE

1837
01:08:33,837 --> 01:08:36,506
STUDY. 

1838
01:08:36,506 --> 01:08:39,676
WE TOOK PATIENTS WITH CLINICALLY

1839
01:08:39,676 --> 01:08:41,378
INDICATED ECHO CARDIOGRAM AT THE

1840
01:08:41,378 --> 01:08:45,616
SAME TIME, WITHIN 30 DAYS, 421

1841
01:08:45,616 --> 01:08:47,351
PATIENTS WITH ECHO CAN APPLE

1842
01:08:47,351 --> 01:08:53,890
WATCH ECG AND TOOK ALL THE APPLE

1843
01:08:53,890 --> 01:08:54,891
WATCH ECG.

1844
01:08:54,891 --> 01:08:58,629
16 HAD EF LESS THAN 40.

1845
01:08:58,629 --> 01:09:01,898
DURING MODEL THAT WAS TRAINED ON

1846
01:09:01,898 --> 01:09:02,766
SYNTHETIC DATA, REAL DATA

1847
01:09:02,766 --> 01:09:08,005
COLLECTED BY PATIENTS IN THEIR

1848
01:09:08,005 --> 01:09:12,276
OWN HOME, AUC 0.885, SENSITIVITY

1849
01:09:12,276 --> 01:09:13,577
AND SPECIFICITY 81%, HUMANS

1850
01:09:13,577 --> 01:09:20,751
CANNOT DO LOOKING AT ECG. 

1851
01:09:20,751 --> 01:09:23,787
WE COLLECTED DATA FROM 125,000

1852
01:09:23,787 --> 01:09:24,788
ECGs, 46 STATES, 11 COUNTRIES,

1853
01:09:24,788 --> 01:09:28,959
APPLIED MAYO A.I. TO APPLE

1854
01:09:28,959 --> 01:09:29,293
WATCH.

1855
01:09:29,293 --> 01:09:31,595
WE'RE DOING SIMILAR WORK FOR

1856
01:09:31,595 --> 01:09:32,896
ADDITIONAL DISEASES, AND PEOPLE

1857
01:09:32,896 --> 01:09:36,199
WHO ARE INTERESTED IN

1858
01:09:36,199 --> 01:09:38,101
HYPERTENSION WE'RE ACTIVELY

1859
01:09:38,101 --> 01:09:42,406
LOOKING AT, ONE OF THE POSTDOCS

1860
01:09:42,406 --> 01:09:44,508
PUBLISHED IN ACC, AND WORK

1861
01:09:44,508 --> 01:09:47,344
SHOWING WE CAN DETECT HISTORIC

1862
01:09:47,344 --> 01:09:48,712
DYSFUNCTION FROM AN ECG IN

1863
01:09:48,712 --> 01:09:50,080
SIMILAR WAY BUT THE MOST

1864
01:09:50,080 --> 01:09:53,050
IMPORTANT THING FOR TODAY IS

1865
01:09:53,050 --> 01:09:57,754
THAT THIS WORK REQUIRED A LOT OF

1866
01:09:57,754 --> 01:10:00,924
PEOPLE FROM DIFFERENT EXPERTISE,

1867
01:10:00,924 --> 01:10:02,693
ENGINEERS, COORDINATORS, APP

1868
01:10:02,693 --> 01:10:03,460
DEVELOPERS, ENGINEERS,

1869
01:10:03,460 --> 01:10:03,794
STATISTICIANS.

1870
01:10:03,794 --> 01:10:07,197
I WANTED TO SPEND THE LAST FEW

1871
01:10:07,197 --> 01:10:09,499
MINUTES HOW WE ALIGN THE STARS.

1872
01:10:09,499 --> 01:10:11,535
WE FOUND IN THE LAST EIGHT YEARS

1873
01:10:11,535 --> 01:10:14,404
SINCE WE STARTED A.I. GROUP THAT

1874
01:10:14,404 --> 01:10:17,641
LANGUAGE BARRIER IS THE MAIN

1875
01:10:17,641 --> 01:10:18,241
PROBLEM. 

1876
01:10:18,241 --> 01:10:19,309
ENGINEERS DON'T UNDERSTAND

1877
01:10:19,309 --> 01:10:21,178
MEDICINE AND CLINICIANS DON'T

1878
01:10:21,178 --> 01:10:23,380
UNDERSTAND TECHNOLOGY AS WELL AS

1879
01:10:23,380 --> 01:10:23,880
ENGINEERS.

1880
01:10:23,880 --> 01:10:25,916
WE TRIED TO FIND WAYS TO

1881
01:10:25,916 --> 01:10:26,883
UNDERSTAND THE PROBLEM AND GET

1882
01:10:26,883 --> 01:10:30,053
THEM TO TALK TO EACH OTHER.

1883
01:10:30,053 --> 01:10:31,688
AND FOR ENGINEERS, FOR EXAMPLE,

1884
01:10:31,688 --> 01:10:32,990
THE BIGGEST PROBLEM IS THAT

1885
01:10:32,990 --> 01:10:34,524
NUMBERS DON'T ALWAYS TELL THE

1886
01:10:34,524 --> 01:10:35,659
WHOLE STORY.

1887
01:10:35,659 --> 01:10:36,593
CLINICAL CONTEXT IS IMPORTANT,

1888
01:10:36,593 --> 01:10:36,827
RIGHT?

1889
01:10:36,827 --> 01:10:41,665
WE DON'T WANT THESE MODELS TO BE

1890
01:10:41,665 --> 01:10:47,671
COMPLETELY AUTONOMOUS, LOOK AT

1891
01:10:47,671 --> 01:10:49,106
CONTEXT, SHOWING AN OUTCOME A

1892
01:10:49,106 --> 01:10:51,408
PHYSICIAN CAN'T DO ANYTHING OUT,

1893
01:10:51,408 --> 01:10:53,577
TO US SHOULD BE A LOW PRIORITY.

1894
01:10:53,577 --> 01:10:58,882
AND WE HAVE TO  BUILD IN A WAY

1895
01:10:58,882 --> 01:11:01,151
BECAUSE WE DON'T WANT TO ADD TO

1896
01:11:01,151 --> 01:11:03,186
CLINICAL BURDEN OF CLINICIANS.

1897
01:11:03,186 --> 01:11:06,723
FOR CLINICIANS WE HAD TO TEACH

1898
01:11:06,723 --> 01:11:10,761
A.I. IS NOT A MAGIC BULLET, IF

1899
01:11:10,761 --> 01:11:11,628
NOT SUPPORTED BY BIOLOGY IT

1900
01:11:11,628 --> 01:11:12,529
WON'T WORK.

1901
01:11:12,529 --> 01:11:16,032
IT'S A BLACK BOX, NOT A MAGIC

1902
01:11:16,032 --> 01:11:16,366
BOX.

1903
01:11:16,366 --> 01:11:18,869
CAN ONLY SEE PATTERNS IN

1904
01:11:18,869 --> 01:11:19,202
BIOLOGY.

1905
01:11:19,202 --> 01:11:21,605
WHAT CLEARLY DRIVES THE ACCURACY

1906
01:11:21,605 --> 01:11:29,713
IS THE DATA, ACCURACY OF IT, HOW

1907
01:11:29,713 --> 01:11:32,549
LABOR IS ADJUDICATED, AND WE ASK

1908
01:11:32,549 --> 01:11:34,451
THE QUESTION, IS THERE A GOLD

1909
01:11:34,451 --> 01:11:35,652
STANDARD TO ANSWER.

1910
01:11:35,652 --> 01:11:38,822
SO, TO DO THAT AND ANSWER THESE

1911
01:11:38,822 --> 01:11:41,525
QUESTIONS, WE EMBEDDED

1912
01:11:41,525 --> 01:11:42,959
ENGINEERING IN THE PRACTICE,

1913
01:11:42,959 --> 01:11:44,261
PART OF THE CARDIOVASCULAR

1914
01:11:44,261 --> 01:11:45,929
MEDICINE DEPARTMENT, NOT FROM

1915
01:11:45,929 --> 01:11:46,229
ENGINEERING.

1916
01:11:46,229 --> 01:11:49,533
THEY SIT IN THE SAME PHYSICAL

1917
01:11:49,533 --> 01:11:49,733
SPACE.

1918
01:11:49,733 --> 01:11:51,935
THEY OBSERVE PROCEDURES.

1919
01:11:51,935 --> 01:11:55,439
AND EACH OF THEM HAVE DUAL

1920
01:11:55,439 --> 01:11:55,772
APPOINTMENTS.

1921
01:11:55,772 --> 01:11:57,941
ENGINEERS ARE PART OF THE A.I.

1922
01:11:57,941 --> 01:12:01,678
LAB, ALSO PART OF THE CATH,

1923
01:12:01,678 --> 01:12:05,515
ECHO, ECG LABS, THEY CAN ATTEND

1924
01:12:05,515 --> 01:12:09,453
EVENTS TO IMPROVE THOSE, AND

1925
01:12:09,453 --> 01:12:10,554
COMMUNICATION SKILLS.

1926
01:12:10,554 --> 01:12:14,624
AS YOU CAN SEE WE ACTUALLY ASK

1927
01:12:14,624 --> 01:12:15,826
QUESTIONS, WHY ARE YOU DOING

1928
01:12:15,826 --> 01:12:17,561
THIS AND THAT, WE HAVE A CME

1929
01:12:17,561 --> 01:12:20,397
ONCE A YEAR THAT WE INVITE

1930
01:12:20,397 --> 01:12:22,065
ENGINEERS AND PHYSICIANS TO

1931
01:12:22,065 --> 01:12:25,202
LEARN ABOUT WHAT EACH OTHER IS

1932
01:12:25,202 --> 01:12:26,303
DOING, AND IT'S IMPORTANT TO

1933
01:12:26,303 --> 01:12:28,605
UNDERSTAND THERE ARE MORE STARS

1934
01:12:28,605 --> 01:12:30,907
IN THE SOLAR SYSTEM, AS I

1935
01:12:30,907 --> 01:12:33,844
MENTIONED, BUT WE CAN ONLY DO IT

1936
01:12:33,844 --> 01:12:34,945
TOGETHER, THESE MODELS WILL

1937
01:12:34,945 --> 01:12:38,014
BE -- WILL HAVE TO BE TESTED IN

1938
01:12:38,014 --> 01:12:39,449
THE WILD.

1939
01:12:39,449 --> 01:12:42,052
DIGITAL STUDIES, TO DO THESE WE

1940
01:12:42,052 --> 01:12:43,920
NEED DIVERSE TEAMS.

1941
01:12:43,920 --> 01:12:47,757
TO SQUEEZE THAT SOLAR SYSTEM

1942
01:12:47,757 --> 01:12:48,959
ANALOGY, WE ALL UNDERSTAND IT'S

1943
01:12:48,959 --> 01:12:51,328
NOT THE PHYSICIAN OR NOT THE

1944
01:12:51,328 --> 01:12:53,396
ENGINEERS, THE PATIENT SHOULD BE

1945
01:12:53,396 --> 01:12:54,965
IN THE CENTER, I THINK WE CAN

1946
01:12:54,965 --> 01:13:00,370
ALL BE ALIGNED AND WORK TOGETHER

1947
01:13:00,370 --> 01:13:01,771
TO BENEFIT AND IMPROVE HUMAN

1948
01:13:01,771 --> 01:13:02,205
HEALTH.

1949
01:13:02,205 --> 01:13:03,740
THANK YOU FOR THIS OPPORTUNITY.

1950
01:13:03,740 --> 01:13:11,948
AND IF YOU HAVE ANY QUESTIONS. 

1951
01:13:11,948 --> 01:13:12,582
>> WONDERFUL.

1952
01:13:12,582 --> 01:13:13,150
THANK YOU.

1953
01:13:13,150 --> 01:13:17,854
I CAN SEE YOU HAVE SUCCESSFULLY

1954
01:13:17,854 --> 01:13:19,055
TRAVERSED THIS COMMUNICATION

1955
01:13:19,055 --> 01:13:19,289
BARRIER.

1956
01:13:19,289 --> 01:13:20,624
I LIKE YOUR LAST LINE, THERE'S

1957
01:13:20,624 --> 01:13:22,692
MANY STARS IN THE SOLAR SYSTEM.

1958
01:13:22,692 --> 01:13:26,096
WE'LL BE HEARING ABOUT ALL THOSE

1959
01:13:26,096 --> 01:13:27,264
OR PLANETS, REGULATORY PRIVACY,

1960
01:13:27,264 --> 01:13:28,598
ALL THE OTHER PIECES OF THE

1961
01:13:28,598 --> 01:13:28,965
PUZZLE.

1962
01:13:28,965 --> 01:13:32,302
I APPRECIATE THAT GREAT TALK.

1963
01:13:32,302 --> 01:13:36,039
AND NOW LAST BUT NOT LEAST WE

1964
01:13:36,039 --> 01:13:37,774
HAVE DR. AHMAD FROM NORTHWESTERN

1965
01:13:37,774 --> 01:13:39,543
MEDICINE WHO WILL BE TALKING

1966
01:13:39,543 --> 01:13:42,045
ABOUT THE BLOOD PRESSURE DATA

1967
01:13:42,045 --> 01:13:44,147
PUZZLE PIECES, AND I THINK DR.

1968
01:13:44,147 --> 01:13:45,115
ATTIA ALLUDED TO THIS.

1969
01:13:45,115 --> 01:13:47,117
90% OF THE WORK IS FINDING AND

1970
01:13:47,117 --> 01:13:48,518
CLEANING UP THAT DATA.

1971
01:13:48,518 --> 01:13:52,189
LOOKING FORWARD TO IT.

1972
01:13:52,189 --> 01:13:55,892
THANK YOU.

1973
01:13:55,892 --> 01:13:59,896
>> GREAT, THANK YOU.

1974
01:13:59,896 --> 01:14:00,530
ONE SECOND.

1975
01:14:00,530 --> 01:14:00,997
OKAY.

1976
01:14:00,997 --> 01:14:04,634
CAN YOU SEE MY SLIDES?

1977
01:14:04,634 --> 01:14:05,001
>> WE DO.

1978
01:14:05,001 --> 01:14:05,735
>> GREAT.

1979
01:14:05,735 --> 01:14:06,670
THANK YOU.

1980
01:14:06,670 --> 01:14:09,739
THANK YOU TO THE ORGANIZERS FOR

1981
01:14:09,739 --> 01:14:12,275
INVITING ME, I'M EXCITED TO

1982
01:14:12,275 --> 01:14:14,377
COVER THIS TOPIC, DATA PUZZLE

1983
01:14:14,377 --> 01:14:15,579
PIECES.

1984
01:14:15,579 --> 01:14:17,647
THESE ARE MY DISCLOSURES.

1985
01:14:17,647 --> 01:14:21,051
SO WE'RE ASKED BY ORGANIZERS TO

1986
01:14:21,051 --> 01:14:22,719
HIGHLIGHT KEY TAKEAWAYS FROM THE

1987
01:14:22,719 --> 01:14:23,553
TALKS.

1988
01:14:23,553 --> 01:14:25,555
TO COVER THESE THREE QUESTIONS I

1989
01:14:25,555 --> 01:14:27,190
PLAN TO HIGHLIGHT SIX AREAS.

1990
01:14:27,190 --> 01:14:29,059
ONE IS HOW DO WE IMPROVE DIGITAL

1991
01:14:29,059 --> 01:14:31,695
INFRASTRUCTURE IN OUR HEALTH

1992
01:14:31,695 --> 01:14:33,563
CARE ECOSYSTEM, DATA ECOSYSTEM.

1993
01:14:33,563 --> 01:14:35,298
TWO, HOW DO WE INCREASE

1994
01:14:35,298 --> 01:14:36,933
EFFICIENCY OF PROCESSING ANNUAL

1995
01:14:36,933 --> 01:14:38,034
HARMONIZING COMPLEX DIVERSE

1996
01:14:38,034 --> 01:14:38,368
DATA.

1997
01:14:38,368 --> 01:14:44,908
THREE, HOW DO WE IMPROVE DATA

1998
01:14:44,908 --> 01:14:46,876
INTEGRATION, EHR USABILITY.

1999
01:14:46,876 --> 01:14:53,216
FOUR, HOW DO WE TEST DEVICES AND

2000
01:14:53,216 --> 01:14:55,852
DIGITAL HEALTH TOOLS, FIVE CROSS

2001
01:14:55,852 --> 01:14:57,354
TRAINING EXPERTS, AND SIX

2002
01:14:57,354 --> 01:15:02,225
ADVANCING EQUITY WITH AI/mL

2003
01:15:02,225 --> 01:15:03,660
DIGITAL HEALTH TOOLS THAT DR.

2004
01:15:03,660 --> 01:15:07,964
SPATZ SPOKE ABOUT EARLIER.

2005
01:15:07,964 --> 01:15:09,866
THIS IS FOUR MAIN AREAS, FIRST

2006
01:15:09,866 --> 01:15:12,268
AN OVERVIEW OF THE ECOSYSTEM FOR

2007
01:15:12,268 --> 01:15:14,571
HYPERTENSION, THEN THE ROLE OF

2008
01:15:14,571 --> 01:15:17,107
STANDARDS TO DRIVE HYPERTENSION

2009
01:15:17,107 --> 01:15:18,608
DIAGNOSIS IN THIS ERA.

2010
01:15:18,608 --> 01:15:20,477
THEN EXAMPLES OF INTEGRATION OF

2011
01:15:20,477 --> 01:15:23,346
HOME BP INTO HEALTH SYSTEMS AND

2012
01:15:23,346 --> 01:15:24,314
PROMISING AREAS AND CHALLENGES

2013
01:15:24,314 --> 01:15:27,584
IN THE ERA OF A.I.

2014
01:15:27,584 --> 01:15:29,252
AND SO AS WE'VE HEARD, WE'RE

2015
01:15:29,252 --> 01:15:31,321
LIVING IN A WORLD IN WHICH DATA

2016
01:15:31,321 --> 01:15:34,157
CONTINUES TO GROW EACH DAY.

2017
01:15:34,157 --> 01:15:36,693
NORMAL SCIENCE DATA IS GENERATED

2018
01:15:36,693 --> 01:15:39,095
THROUGH DAILY INTERACTIONS CAN

2019
01:15:39,095 --> 01:15:40,497
TECHNOLOGY ACROSS SOCIETY.

2020
01:15:40,497 --> 01:15:41,698
THERE'S BEEN GROWTH OF HEALTH

2021
01:15:41,698 --> 01:15:45,101
CARE DATA, OLDER DATA FROM 2020.

2022
01:15:45,101 --> 01:15:48,171
I CAN SEE THE AMOUNT CONTINUES

2023
01:15:48,171 --> 01:15:49,572
TO GROW.

2024
01:15:49,572 --> 01:15:51,775
AS I'VE MENTIONED THIS IS A

2025
01:15:51,775 --> 01:15:54,411
GROWING ECOSYSTEM OF DEVICES TO

2026
01:15:54,411 --> 01:15:56,379
MEASURE BLOOD PRESSURE, MOVING

2027
01:15:56,379 --> 01:15:57,347
BEYOND TRADITIONAL BLOOD

2028
01:15:57,347 --> 01:15:57,814
PRESSURE CUFF.

2029
01:15:57,814 --> 01:16:04,020
AND THIS IS A FIGURE FROM A NICE

2030
01:16:04,020 --> 01:16:07,757
PAPER HIGHLIGHTING NEED OF

2031
01:16:07,757 --> 01:16:09,526
CONSENSUS STANDARDS FOR ACCURACY

2032
01:16:09,526 --> 01:16:11,995
OF THESE DEVICES, WE'LL TALK

2033
01:16:11,995 --> 01:16:12,796
ABOUT THIS LATER TODAY.

2034
01:16:12,796 --> 01:16:16,399
IT'S IMPORTANT WE HAVE STANDARDS

2035
01:16:16,399 --> 01:16:17,934
WITH ACCURACY BECAUSE FOR THESE

2036
01:16:17,934 --> 01:16:21,004
GARBAGE IN REALLY MEANS GARBAGE

2037
01:16:21,004 --> 01:16:22,105
OUT.

2038
01:16:22,105 --> 01:16:25,508
IDEALLY WE TAKE THESE DATA FROM

2039
01:16:25,508 --> 01:16:26,910
WEARABLES AND MERGE WITH OTHER

2040
01:16:26,910 --> 01:16:28,011
DATA THAT WE KNOW ARE IMPORTANT

2041
01:16:28,011 --> 01:16:31,081
TO HEALTH CARE AND MANAGEMENT OF

2042
01:16:31,081 --> 01:16:34,150
PATIENTS INCLUDING OMICS DATA,

2043
01:16:34,150 --> 01:16:35,485
MICROBIOME DATA, EHR DATA, AND

2044
01:16:35,485 --> 01:16:38,555
IDEALLY WOULD HAVE A WAY TO

2045
01:16:38,555 --> 01:16:39,756
MERGE THESE DATA TOGETHER, FOR A

2046
01:16:39,756 --> 01:16:41,725
NUMBER OF OPPORTUNITIES TO

2047
01:16:41,725 --> 01:16:42,425
IMPROVE CARE, PHYSICIAN

2048
01:16:42,425 --> 01:16:44,661
STRATEGIES BASED ON BLOOD

2049
01:16:44,661 --> 01:16:45,762
PRESSURE PHENOTYPES, DIGITAL

2050
01:16:45,762 --> 01:16:47,664
CLINICAL TRIALS, HOSPITAL AT

2051
01:16:47,664 --> 01:16:50,033
HOME PROGRAM, VIRTUAL HEALTH

2052
01:16:50,033 --> 01:16:53,203
COACHING WHICH IS ESPECIALLY

2053
01:16:53,203 --> 01:16:55,371
EXCITING GIVEN EMERGENCE OF

2054
01:16:55,371 --> 01:16:56,940
LARGE LANGUAGE MODELS.

2055
01:16:56,940 --> 01:16:59,476
THESE WOULD SEND INFORMATION

2056
01:16:59,476 --> 01:17:00,744
COMMONS AND RUN MULTI-MODAL

2057
01:17:00,744 --> 01:17:02,979
MODELS THAT WERE TALKED ABOUT

2058
01:17:02,979 --> 01:17:04,614
EARLIER TODAY, AND DEVELOP

2059
01:17:04,614 --> 01:17:07,450
INFERENCE AND USE IN GROUP CARE.

2060
01:17:07,450 --> 01:17:08,451
THERE IS A DIFFERENCE BETWEEN

2061
01:17:08,451 --> 01:17:12,889
WHAT I THINK WE HOPE TO DO AND

2062
01:17:12,889 --> 01:17:14,357
WHAT IS IN THE CLINIC AND LIVES

2063
01:17:14,357 --> 01:17:14,958
OF OUR PATIENTS.

2064
01:17:14,958 --> 01:17:18,628
THIS IS ME IN THE CLINIC.

2065
01:17:18,628 --> 01:17:20,063
THIS IS MY EXPERIENCE.

2066
01:17:20,063 --> 01:17:26,736
PATIENTS BRING IN DATA, VERY

2067
01:17:26,736 --> 01:17:31,775
WELL DETAILED, HELPFUL TO HAVE

2068
01:17:31,775 --> 01:17:33,076
DATA.

2069
01:17:33,076 --> 01:17:35,278
IT'S A CHALLENGE HOW TO

2070
01:17:35,278 --> 01:17:37,447
INCORPORATE, HOW MUCH IS

2071
01:17:37,447 --> 01:17:38,548
DOCUMENTED INTO EPIC ITSELF, AND

2072
01:17:38,548 --> 01:17:41,951
HOW CAN I USE THIS IN THE BEST

2073
01:17:41,951 --> 01:17:44,821
WAY TO TAKE CARE OF MY PATIENTS?

2074
01:17:44,821 --> 01:17:46,756
IT'S A CHALLENGE THAT THERE ARE

2075
01:17:46,756 --> 01:17:51,127
A LOT OF MODELS, TRADITIONAL

2076
01:17:51,127 --> 01:17:52,228
MODELING TECHNIQUES AND DEEP

2077
01:17:52,228 --> 01:17:52,695
LEARNING.

2078
01:17:52,695 --> 01:17:58,268
THIS IS A FIGURE I LOVE TALKING

2079
01:17:58,268 --> 01:18:00,336
ABOUT HOW THERE ARE DIFFERENT

2080
01:18:00,336 --> 01:18:04,274
WAYS IN WHICH MODELS DO NOT

2081
01:18:04,274 --> 01:18:05,675
ULTIMATELY IMPACT CLINICAL CARE.

2082
01:18:05,675 --> 01:18:10,613
I DO THINK THIS IS A TIME FOR

2083
01:18:10,613 --> 01:18:12,015
HOPE IN THIS SPACE BECAUSE WE

2084
01:18:12,015 --> 01:18:15,185
HAVE AN OPPORTUNITY BECAUSE DATA

2085
01:18:15,185 --> 01:18:19,923
IS BEING -- THERE ARE A LOT MORE

2086
01:18:19,923 --> 01:18:21,458
OPPORTUNITIES TO INTEGRATE.

2087
01:18:21,458 --> 01:18:22,358
TO FIGURE OUT WHAT "STAR WARS"

2088
01:18:22,358 --> 01:18:26,196
MOVIE OF THIS WAS FROM, YODA DID

2089
01:18:26,196 --> 01:18:29,132
NOT ACTUALLY SAY THIS, THAT MAY

2090
01:18:29,132 --> 01:18:33,837
HAVE BEEN CHAT TV HALLUCINATING.

2091
01:18:33,837 --> 01:18:36,372
I'M EXCITED.

2092
01:18:36,372 --> 01:18:40,176
I THINK WE'VE BEEN SEEING MORE

2093
01:18:40,176 --> 01:18:41,744
AND MORE DATA LIBERATION FROM

2094
01:18:41,744 --> 01:18:43,146
ELECTRONIC HEALTH RECORD, AND

2095
01:18:43,146 --> 01:18:46,216
THE 21ST CENTURY CURES ACT

2096
01:18:46,216 --> 01:18:47,417
STARTS PENALIZING EHR VENDORS

2097
01:18:47,417 --> 01:18:48,818
AND HEALTH SYSTEMS FOR BLOCKING

2098
01:18:48,818 --> 01:18:50,486
INFORMATION, BUILDING ON A

2099
01:18:50,486 --> 01:18:52,121
DECADE OF LEGISLATION FROM A

2100
01:18:52,121 --> 01:18:53,223
VARIETY OF STAKEHOLDERS, MANY

2101
01:18:53,223 --> 01:18:56,392
LIKELY ON THIS CALL, TO DRIVE

2102
01:18:56,392 --> 01:18:58,161
INTEROPERABILITY AND DATA

2103
01:18:58,161 --> 01:18:59,729
EXCHANGE.

2104
01:18:59,729 --> 01:19:05,902
IT'S EXCITING NOW DATA --

2105
01:19:05,902 --> 01:19:10,540
PATIENTS CAN ACCESS VIA FHIR AND

2106
01:19:10,540 --> 01:19:13,142
IT'S STANDARDIZED, THROUGH

2107
01:19:13,142 --> 01:19:13,943
APIs FROM VENDORS.

2108
01:19:13,943 --> 01:19:17,180
NEXT I'LL TALK ABOUT ROLES OF

2109
01:19:17,180 --> 01:19:17,447
STANDARDS.

2110
01:19:17,447 --> 01:19:21,484
THIS IS A BRIEF STANDARDS 101

2111
01:19:21,484 --> 01:19:22,986
SUMMARY SLIDE THAT I TOOK FROM

2112
01:19:22,986 --> 01:19:23,887
THE GOVERNMENT.

2113
01:19:23,887 --> 01:19:26,856
THERE ARE DIFFERENT CATEGORIES

2114
01:19:26,856 --> 01:19:27,824
OF STANDARDS.

2115
01:19:27,824 --> 01:19:31,427
VOCABULARY AND CODE SETS,

2116
01:19:31,427 --> 01:19:34,364
SEMANTICS, THEIR FUNCTION IS

2117
01:19:34,364 --> 01:19:38,868
INFORMATION UNDERSTOOD, AND

2118
01:19:38,868 --> 01:19:43,039
TYPES CAN INCLUDE RxNORM OR

2119
01:19:43,039 --> 01:19:44,474
SNOMED, THERE'S SYNTAX STANDARDS

2120
01:19:44,474 --> 01:19:46,676
THAT ARE USED TO MAKE SURE

2121
01:19:46,676 --> 01:19:50,613
INFORMATION ITSELF IS IN AN

2122
01:19:50,613 --> 01:19:51,481
APPROPRIATE FORMAT.

2123
01:19:51,481 --> 01:19:53,550
CCDA IS TYPE OF STANDARD BUT

2124
01:19:53,550 --> 01:19:56,753
FHIR IS MORE COMMONLY USED.

2125
01:19:56,753 --> 01:19:58,688
THERE ARE STANDARDS FOR

2126
01:19:58,688 --> 01:19:59,789
TRANSPORT SECURITY AND SERVICES,

2127
01:19:59,789 --> 01:20:01,658
THESE ARE REALLY IMPORTANT FOR

2128
01:20:01,658 --> 01:20:08,798
ENABLING THIRD PARTY ACCESS TO

2129
01:20:08,798 --> 01:20:10,099
DATA VIA FHIR APIs.

2130
01:20:10,099 --> 01:20:12,268
I WANT TO HIGHLIGHT OTHER GROUPS

2131
01:20:12,268 --> 01:20:13,036
IN THIS SPACE.

2132
01:20:13,036 --> 01:20:14,837
FHIR IS A REALLY IMPORTANT

2133
01:20:14,837 --> 01:20:15,672
STANDARD THAT LIKELY A LOT OF

2134
01:20:15,672 --> 01:20:17,507
YOU HEARD ABOUT AND ARE USING IN

2135
01:20:17,507 --> 01:20:18,975
YOUR WORK.

2136
01:20:18,975 --> 01:20:22,111
SET OF RULES AND SPECIFICATIONS

2137
01:20:22,111 --> 01:20:23,980
FORE CHANGING HEALTH CARE DATA,

2138
01:20:23,980 --> 01:20:32,188
DESIGNED TO BE FLEXIBLE,

2139
01:20:32,188 --> 01:20:33,790
ADAPTABLE.

2140
01:20:33,790 --> 01:20:35,358
THE USCDI THAT VENDORS ARE

2141
01:20:35,358 --> 01:20:37,794
MANDATED TO MAP TO, THERE'S

2142
01:20:37,794 --> 01:20:40,096
DIFFERENT VERSIONS OVER TIME,

2143
01:20:40,096 --> 01:20:42,599
AND DRAFT VERSION 4 IN JANUARY

2144
01:20:42,599 --> 01:20:45,902
OF 2023.

2145
01:20:45,902 --> 01:20:48,404
OPEN mHEALTH IS USING

2146
01:20:48,404 --> 01:20:49,505
STAKEHOLDER-DRIVEN GROUP USING

2147
01:20:49,505 --> 01:20:52,108
STANDARDS FOR MOBILE HEALTH

2148
01:20:52,108 --> 01:20:53,543
DATA.

2149
01:20:53,543 --> 01:20:55,645
THIS IS AN EXAMPLE OF A FHIR

2150
01:20:55,645 --> 01:20:56,813
REPRESENTATION OF BLOOD

2151
01:20:56,813 --> 01:20:57,080
PRESSURE.

2152
01:20:57,080 --> 01:21:01,751
YOU CAN SEE HERE THERE'S A BLANK

2153
01:21:01,751 --> 01:21:03,319
CODE ASSIGNED, A VALUE, AND THIS

2154
01:21:03,319 --> 01:21:04,954
IS A NARRATIVE VERSION.

2155
01:21:04,954 --> 01:21:08,157
THERE'S ALSO MACHINE READABLE

2156
01:21:08,157 --> 01:21:08,992
VERSIONS OF THIS.

2157
01:21:08,992 --> 01:21:11,594
ONE OF THE REALLY AMAZING THINGS

2158
01:21:11,594 --> 01:21:14,664
ABOUT HAVING DATA MAPPED TO FHIR

2159
01:21:14,664 --> 01:21:17,200
IS THAT IT'S AN ECO-SYSTEM SMART

2160
01:21:17,200 --> 01:21:19,369
TOOLS LED BY PEOPLE OUT OF

2161
01:21:19,369 --> 01:21:22,538
BOSTON CHILDREN'S HOSPITAL AND

2162
01:21:22,538 --> 01:21:24,273
TOMORROW YOU'LL HEAR A TALK FROM

2163
01:21:24,273 --> 01:21:28,011
ONE OF THE LEADERS OF SMART ON

2164
01:21:28,011 --> 01:21:29,312
FHIR INTEGRATING TOOLS INTO

2165
01:21:29,312 --> 01:21:31,748
CLINICAL CARE, AFFORDING THE

2166
01:21:31,748 --> 01:21:33,049
OPPORTUNITY TO DEVELOP WORK

2167
01:21:33,049 --> 01:21:35,685
FLOWS AND APPS THAT CAN LEVERAGE

2168
01:21:35,685 --> 01:21:37,453
HOME BLOOD PRESSURE MONITORING

2169
01:21:37,453 --> 01:21:40,156
INTO CLINICAL CARE IN AN

2170
01:21:40,156 --> 01:21:41,157
EFFICIENT SCALABLE WAY.

2171
01:21:41,157 --> 01:21:45,828
THERE'S ALSO A COMMUNITY OF

2172
01:21:45,828 --> 01:21:48,598
FOLKS, CODEX, TRYING TO WORK ON

2173
01:21:48,598 --> 01:21:51,901
THE ISSUE OF SILOED HEALTH CARE

2174
01:21:51,901 --> 01:21:53,102
DATA.

2175
01:21:53,102 --> 01:21:55,171
THEY STARTED IN ONCOLOGY, ALSO

2176
01:21:55,171 --> 01:21:56,039
IN GENOMICS AND CARDIOVASCULAR,

2177
01:21:56,039 --> 01:21:58,541
TO HELP THINK ABOUT HOW DO WE

2178
01:21:58,541 --> 01:22:02,412
TAKE DATA GENERATED FROM PEOPLE,

2179
01:22:02,412 --> 01:22:04,480
AND USE THAT DATA ACROSS THE

2180
01:22:04,480 --> 01:22:06,916
PATIENT'S JOURNEY AND ENTIRE

2181
01:22:06,916 --> 01:22:09,552
HEALTH CARE ECOSYSTEM.

2182
01:22:09,552 --> 01:22:12,055
AND THESE ARE -- THIS SLIDE

2183
01:22:12,055 --> 01:22:14,791
SUMMARIZES WHAT CODEX DOES FROM

2184
01:22:14,791 --> 01:22:17,093
THEIR WEBSITE BELOW, HOW THEY

2185
01:22:17,093 --> 01:22:23,866
HAVE A SYSTEM TO PRIOR TOPICS,

2186
01:22:23,866 --> 01:22:24,967
EXECUTE PILOTS AT SCALE.

2187
01:22:24,967 --> 01:22:27,804
AS I MENTIONED THERE'S A CARDX,

2188
01:22:27,804 --> 01:22:31,541
THE GROUP WORKING ON

2189
01:22:31,541 --> 01:22:32,508
CARDIOVASCULAR DISEASE, FIRST IS

2190
01:22:32,508 --> 01:22:33,242
HYPERTENSION MANAGEMENT.

2191
01:22:33,242 --> 01:22:36,879
THESE ARE GOALS FROM THEIR SITE.

2192
01:22:36,879 --> 01:22:47,390
TO CREATE INTEGRATED AUTOMATED

2193
01:22:47,790 --> 01:22:53,529
VENDOR AGNOSTIC STANDARD, ENABLE

2194
01:22:53,529 --> 01:22:55,832
LIQUIDITY BETWEEN DEVICES,

2195
01:22:55,832 --> 01:22:56,466
HARMONIZE HYPERTENSION

2196
01:22:56,466 --> 01:22:57,800
VOCABULARY, AND DEVELOP DATAE

2197
01:22:57,800 --> 01:22:59,435
CHANGE STANDARDS FOR HOME BLOOD

2198
01:22:59,435 --> 01:23:02,939
PRESSURE DEVICE AND DATA

2199
01:23:02,939 --> 01:23:06,976
COMMUNICATION BETWEEN PATIENTS

2200
01:23:06,976 --> 01:23:07,543
AND CLINICIANS.

2201
01:23:07,543 --> 01:23:10,713
AND THIS IS A SUMMARY FROM THE

2202
01:23:10,713 --> 01:23:12,782
WEBSITE OF HOW THEY ENVISION

2203
01:23:12,782 --> 01:23:15,251
THIS ECOSYSTEM WORKING.

2204
01:23:15,251 --> 01:23:17,286
THE PATIENT AND PERSON HAS

2205
01:23:17,286 --> 01:23:19,589
DEVICES, THEY CAN SHARE VIA

2206
01:23:19,589 --> 01:23:22,759
FHIR, BLOOD PRESSURE DAD,

2207
01:23:22,759 --> 01:23:23,626
PERSONAL HEALTH, PATIENT

2208
01:23:23,626 --> 01:23:30,099
GUIDANCE ENGINES THAT WORK ON

2209
01:23:30,099 --> 01:23:32,502
TOP OF THE PERSONAL HEALTH AND

2210
01:23:32,502 --> 01:23:38,074
CAN BE SHARED VIA FHIR TO EHR,

2211
01:23:38,074 --> 01:23:39,475
WHICH CLINICIAN FACING PORTALS

2212
01:23:39,475 --> 01:23:42,879
CAN BE BUILT, INFORMED FROM THE

2213
01:23:42,879 --> 01:23:43,646
GUIDELINES.

2214
01:23:43,646 --> 01:23:48,684
EVENTUALLY YOU CAN ALSO THEN

2215
01:23:48,684 --> 01:23:50,419
SHARE INFORMATION, ALSO WITH

2216
01:23:50,419 --> 01:23:51,287
PAYERS TOO.

2217
01:23:51,287 --> 01:23:53,289
A KEY STEP IS TO MAKE SURE

2218
01:23:53,289 --> 01:23:56,325
GUIDELINES AND QUALITY MEASURES

2219
01:23:56,325 --> 01:24:00,296
CAN BE COMPUTABLE IN USING 

2220
01:24:00,296 --> 01:24:01,397
DIGITAL HEALTH DATA, A LOT OF

2221
01:24:01,397 --> 01:24:04,133
WORK OPPORTUNITIES IN THAT

2222
01:24:04,133 --> 01:24:04,333
SPACE.

2223
01:24:04,333 --> 01:24:09,172
THERE'S ALSO A LOT OF INTEREST

2224
01:24:09,172 --> 01:24:12,542
IN OMICS, AND HOW OMICS,

2225
01:24:12,542 --> 01:24:15,311
DIFFERENT TYPES OF DATA CAN BE

2226
01:24:15,311 --> 01:24:17,280
USED TO PREDICT ADVERSE EVENTS.

2227
01:24:17,280 --> 01:24:19,015
AND THERE ARE GROUPS WORKING ON

2228
01:24:19,015 --> 01:24:23,486
THINKING ABOUT HOW DO WE

2229
01:24:23,486 --> 01:24:24,353
REPRESENT GENOMICS DATA WITH

2230
01:24:24,353 --> 01:24:27,423
FHIR, AND INTEGRATE THAT INTO

2231
01:24:27,423 --> 01:24:28,824
CLINICAL CARE, EMPOWER PATIENTS

2232
01:24:28,824 --> 01:24:30,927
WITH DATA TO BE USED FOR

2233
01:24:30,927 --> 01:24:31,594
RESEARCH IF THEY CHOOSE, AND

2234
01:24:31,594 --> 01:24:35,198
THIS IS AN IMPORTANT AREA OF

2235
01:24:35,198 --> 01:24:37,633
DEVELOPMENT ENABLED BY STANDARDS

2236
01:24:37,633 --> 01:24:39,368
AND THE CHEAPNESS AND

2237
01:24:39,368 --> 01:24:40,636
ACCESSIBILITY OF CLOUD COMPUTING

2238
01:24:40,636 --> 01:24:40,970
AND STORAGE.

2239
01:24:40,970 --> 01:24:43,206
THERE ARE A NUMBER OF COMMON

2240
01:24:43,206 --> 01:24:45,641
DATA MODELS ALSO FOR RESEARCH

2241
01:24:45,641 --> 01:24:47,276
AND SURVEILLANCE.

2242
01:24:47,276 --> 01:24:51,113
THESE INCLUDE MODELS LIKE

2243
01:24:51,113 --> 01:24:52,615
ODYSSEY, PCORnet AND OTHERS

2244
01:24:52,615 --> 01:24:54,383
SHOWN HERE, VERY IMPORTANT FOR

2245
01:24:54,383 --> 01:24:57,019
BOTH RESEARCH AND QUALITY

2246
01:24:57,019 --> 01:24:57,987
EFFORTS AND SURVEILLANCE

2247
01:24:57,987 --> 01:24:58,521
EFFORTS.

2248
01:24:58,521 --> 01:25:01,490
AND THERE'S A LOT OF ACTIVE WORK

2249
01:25:01,490 --> 01:25:02,792
ON HARMONIZING ACROSS DIFFERENT

2250
01:25:02,792 --> 01:25:06,629
DATA MODELS. 

2251
01:25:06,629 --> 01:25:11,133
HERE I SHOW OMOP ON FHIR, REPORT

2252
01:25:11,133 --> 01:25:13,202
ON CROSSWALKS, A LINK FROM NIH

2253
01:25:13,202 --> 01:25:14,837
THAT HIGHLIGHTS IMPORTANT

2254
01:25:14,837 --> 01:25:17,673
RESOURCES FOR MAPPING FHIR TO

2255
01:25:17,673 --> 01:25:19,542
OTHER COMMON DATA MODELS.

2256
01:25:19,542 --> 01:25:29,619
AND THIS IS WORK FROM OUR GROUP,

2257
01:25:29,619 --> 01:25:34,957
AND IN THIS WORK WE USED A

2258
01:25:34,957 --> 01:25:37,260
LANGUAGE CQL, CLINICAL QUALITY

2259
01:25:37,260 --> 01:25:39,662
LANGUAGE TO FIND A PHENOTYPE OF

2260
01:25:39,662 --> 01:25:42,865
HEART FAILURE, RAN ACROSS OMOP

2261
01:25:42,865 --> 01:25:46,135
AND FHIR, DATA REPRESENTED IN OH

2262
01:25:46,135 --> 01:25:48,104
MOPE AND FIRE, USING THIS QUERY.

2263
01:25:48,104 --> 01:25:50,273
WITH THE GROWTH AND USE OF

2264
01:25:50,273 --> 01:25:51,707
STANDARDS, MORE AND MORE

2265
01:25:51,707 --> 01:25:53,576
OPPORTUNITIES WILL BE THERE TO

2266
01:25:53,576 --> 01:25:54,577
EFFICIENTLY DEVELOP PHENOTYPES

2267
01:25:54,577 --> 01:25:57,280
AND RUN THEM ACROSS MULTIPLE

2268
01:25:57,280 --> 01:26:00,216
TYPES OF DATA. 

2269
01:26:00,216 --> 01:26:02,318
NEXT I WANT TO HIGHLIGHT HOW

2270
01:26:02,318 --> 01:26:05,554
HOME BP MEASUREMENT IS USED IN

2271
01:26:05,554 --> 01:26:06,155
HEALTH SYSTEMS.

2272
01:26:06,155 --> 01:26:11,294
THERE ARE A LOT THROUGH VENDORS

2273
01:26:11,294 --> 01:26:14,030
AND PLATFORMS.

2274
01:26:14,030 --> 01:26:15,998
HERE AT NORTHWESTERN THIS IS LED

2275
01:26:15,998 --> 01:26:22,505
BY DR. STEVE PERSE WILL,L. 

2276
01:26:22,505 --> 01:26:24,473
WE PARTNERED WITH OMRON,

2277
01:26:24,473 --> 01:26:25,107
INTEGRATED INTO EPIC.

2278
01:26:25,107 --> 01:26:27,109
THIS IS WHAT IT LOOKS LIKE TO

2279
01:26:27,109 --> 01:26:28,077
THE CLINICIAN.

2280
01:26:28,077 --> 01:26:30,479
YOU CAN SEE HERE IT GOES IN THE

2281
01:26:30,479 --> 01:26:33,015
PATIENT FLOW SHEET.

2282
01:26:33,015 --> 01:26:34,417
YOU CAN VIEW STRUCTURED DATA

2283
01:26:34,417 --> 01:26:36,285
WITH MEDICATION IN THIS VIEW.

2284
01:26:36,285 --> 01:26:39,355
DIFFERENT VIEWS, CAN YOU SEE

2285
01:26:39,355 --> 01:26:41,657
GRAPHICALLY WITH MEDS.

2286
01:26:41,657 --> 01:26:45,161
HERE'S ANOTHER VIEW AS WELL.

2287
01:26:45,161 --> 01:26:47,096
THIS IS AN IMPROVEMENT TO GET A

2288
01:26:47,096 --> 01:26:48,764
BETTER VIEW OF A PATIENT'S BLOOD

2289
01:26:48,764 --> 01:26:51,067
PRESSURE, IT'S A LOT BETTER THAN

2290
01:26:51,067 --> 01:26:52,268
THE VERSION WE USED PREVIOUSLY,

2291
01:26:52,268 --> 01:26:56,739
STILL A LOT OF ROOM FOR

2292
01:26:56,739 --> 01:26:57,273
IMPROVEMENT.

2293
01:26:57,273 --> 01:27:00,676
INSTITUTE OF CHICAGO, LED BY DR.

2294
01:27:00,676 --> 01:27:03,312
BERNSTEIN, INFORMATICS FELLOW,

2295
01:27:03,312 --> 01:27:05,047
LEVERAGING EXISTING PLATFORMS BY

2296
01:27:05,047 --> 01:27:07,817
APPLE AND GOOGLE, AND USED THAT

2297
01:27:07,817 --> 01:27:09,985
TO WRITE BLOOD PRESSURE INTO

2298
01:27:09,985 --> 01:27:12,421
MYCHART AND EPIC, DEVELOPED A

2299
01:27:12,421 --> 01:27:14,156
WORKFLOW WITH CLINICAL TEAM TO

2300
01:27:14,156 --> 01:27:17,126
MAKE SURE PATIENTS DID NOT HAVE

2301
01:27:17,126 --> 01:27:18,127
OPTIMAL PROFESSIONAL MEASUREMENT

2302
01:27:18,127 --> 01:27:22,398
HAD TITRATION OF DRUGS, AND

2303
01:27:22,398 --> 01:27:23,499
TITRATION OF MEDICATION REGIMEN.

2304
01:27:23,499 --> 01:27:26,235
AND SO LASTLY I WANT TO TALK

2305
01:27:26,235 --> 01:27:27,636
ABOUT PROMISING AREAS AND

2306
01:27:27,636 --> 01:27:31,707
CHALLENGES IN THE ERA OF A.I.

2307
01:27:31,707 --> 01:27:36,278
THESE ARE MY SIX KEY TAKEAWAYS

2308
01:27:36,278 --> 01:27:37,480
TO TACKLE THE THREE QUESTIONS.

2309
01:27:37,480 --> 01:27:41,317
FIRST I WANT TO TALK ABOUT

2310
01:27:41,317 --> 01:27:43,285
PROMISING AREA OF IMPROVING

2311
01:27:43,285 --> 01:27:46,922
DIGITAL INFRASTRUCTURE IN HEALTH

2312
01:27:46,922 --> 01:27:49,125
ECOSYSTEM COURTESY OF

2313
01:27:49,125 --> 01:27:49,892
NORTHWESTERN MEDICINE.

2314
01:27:49,892 --> 01:27:52,728
WE'VE INVESTED TRYING TO DEVELOP

2315
01:27:52,728 --> 01:27:54,230
A DIGITAL PLATFORM, MOVING FROM

2316
01:27:54,230 --> 01:27:56,532
THE DATA WAREHOUSE TO THE CLOUD,

2317
01:27:56,532 --> 01:27:58,534
AND SO THIS IS OVER

2318
01:27:58,534 --> 01:28:00,836
ARCHITECTURE, AS YOU CAN SEE,

2319
01:28:00,836 --> 01:28:03,572
I'LL WALK THROUGH THESE.

2320
01:28:03,572 --> 01:28:05,174
YOU CAN IMAGINE THAT A PATIENT

2321
01:28:05,174 --> 01:28:07,476
HAS A WEARABLE AND THE WEARABLE

2322
01:28:07,476 --> 01:28:08,911
SENDS ELEVATED HEALTH

2323
01:28:08,911 --> 01:28:09,578
MEASUREMENT OF SOME KIND,

2324
01:28:09,578 --> 01:28:11,013
WHETHER BLOOD PRESSURE OR

2325
01:28:11,013 --> 01:28:18,220
SOMETHING ELSE, VIA MESSAGE TO

2326
01:28:18,220 --> 01:28:19,889
THE CLOUD.

2327
01:28:19,889 --> 01:28:21,090
INGESTED AND TRIGGERS EVENT

2328
01:28:21,090 --> 01:28:24,593
ENGAGE THAT PROCESS AND

2329
01:28:24,593 --> 01:28:26,262
PUBLISHED AS ELEVATED TOPIC,

2330
01:28:26,262 --> 01:28:27,863
STORED IN DATA WAREHOUSE.

2331
01:28:27,863 --> 01:28:31,033
I CAN HAVE A.I. MODEL THAT

2332
01:28:31,033 --> 01:28:36,405
SUBSCRIBES TO THAT EVENT ENGINE,

2333
01:28:36,405 --> 01:28:38,607
READ IT AND TRIGGER, IDEALLY

2334
01:28:38,607 --> 01:28:41,777
BASED ON FHIR, MORE SCALABLE.

2335
01:28:41,777 --> 01:28:43,846
AND DEPENDING ON OUTPUT AND YOU

2336
01:28:43,846 --> 01:28:46,482
WHO IT'S SET UP COULD SEND SCORE

2337
01:28:46,482 --> 01:28:48,217
AS A NEW EVENT TRIGGERS

2338
01:28:48,217 --> 01:28:50,085
NOTIFICATION TO THE PROVIDER OR

2339
01:28:50,085 --> 01:28:51,187
WHATEVER IS SET UP TO TAKE CARE

2340
01:28:51,187 --> 01:28:53,956
OF PATIENTS WITH THAT PARTICULAR

2341
01:28:53,956 --> 01:28:54,156
ALERT.

2342
01:28:54,156 --> 01:28:55,691
I THINK WE'RE IN THE PROCESS OF

2343
01:28:55,691 --> 01:29:00,396
A LOT OF HEALTH SYSTEMS AND IN

2344
01:29:00,396 --> 01:29:01,597
GENERAL EVOLVING OUR SYSTEMS TO

2345
01:29:01,597 --> 01:29:02,565
BETTER INCORPORATE THESE TYPES

2346
01:29:02,565 --> 01:29:05,568
OF DATA BUT WE STILL HAVE A WAYS

2347
01:29:05,568 --> 01:29:08,270
TO GO, BOTH HERE AT NORTHWESTERN

2348
01:29:08,270 --> 01:29:08,737
AND NATIONALLY.

2349
01:29:08,737 --> 01:29:09,905
I THINK ANOTHER PROMISING AREA

2350
01:29:09,905 --> 01:29:13,108
IN THIS SPACE IS HOW DO WE

2351
01:29:13,108 --> 01:29:14,743
PROCESS AND HARMONIZE COMPLEX

2352
01:29:14,743 --> 01:29:16,178
DIVERSE DATA.

2353
01:29:16,178 --> 01:29:18,681
LARGELY MODELS HAVE HUGE

2354
01:29:18,681 --> 01:29:21,550
POTENTIAL IN THIS AREA.

2355
01:29:21,550 --> 01:29:25,254
THIS IS A TWEET FROM JOSH MENDEL

2356
01:29:25,254 --> 01:29:27,756
WHO WORKS AT MICROSOFT, ONE OF

2357
01:29:27,756 --> 01:29:32,127
THE LEADING THINKERS IN SMART ON

2358
01:29:32,127 --> 01:29:33,329
FHIR AND TOOK COMPLEX

2359
01:29:33,329 --> 01:29:34,230
DOCUMENTATION FROM EPIC AND

2360
01:29:34,230 --> 01:29:36,398
QUICKLY CLEANED IT UP IN A WAY

2361
01:29:36,398 --> 01:29:38,501
THAT'S MORE USABLE IN JSON

2362
01:29:38,501 --> 01:29:38,868
FORMAT.

2363
01:29:38,868 --> 01:29:41,237
THIS COULD BE USEFUL AS WE LOOK

2364
01:29:41,237 --> 01:29:43,072
THROUGH THE EXPERTS FROM EHRs,

2365
01:29:43,072 --> 01:29:46,942
MY PRIOR WORK WE LOOKED AT THE

2366
01:29:46,942 --> 01:29:49,778
QUALITY OF MAPPING TO CCBA, I

2367
01:29:49,778 --> 01:29:53,182
SUSPECT, I HAVEN'T TAKEN A DEEP

2368
01:29:53,182 --> 01:29:56,886
DIVE YET BUT ISSUES WITH DATA

2369
01:29:56,886 --> 01:29:58,320
QUALITY, OPPORTUNITY TO AUTOMATE

2370
01:29:58,320 --> 01:30:00,189
THE WAY WE ANALYZE THESE

2371
01:30:00,189 --> 01:30:01,090
STANDARDS AND ULTIMATELY CLEAN

2372
01:30:01,090 --> 01:30:05,427
THEM UP AND MAKE THEM USABLE.

2373
01:30:05,427 --> 01:30:06,962
I THINK ANOTHER PROMISING AREA

2374
01:30:06,962 --> 01:30:11,467
IS HOW DO WE IMPROVE DATA

2375
01:30:11,467 --> 01:30:14,303
INTEGRATION AND EHR USABILITY.

2376
01:30:14,303 --> 01:30:15,871
I DESCRIBE USER-CENTERED DESIGN

2377
01:30:15,871 --> 01:30:17,306
PROCESS TO CREATE IDEAL WAY TO

2378
01:30:17,306 --> 01:30:19,141
VISUALIZE BLOOD PRESSURE FOR

2379
01:30:19,141 --> 01:30:19,441
CLINICIANS.

2380
01:30:19,441 --> 01:30:20,676
YOU CAN SEE THIS IS A MUCH

2381
01:30:20,676 --> 01:30:22,545
IMPROVED VERSION OF WHAT I

2382
01:30:22,545 --> 01:30:24,046
SHOWED EARLIER THAT WE'RE USING

2383
01:30:24,046 --> 01:30:27,449
IN EPIC AND OUR WORKFLOW HERE.

2384
01:30:27,449 --> 01:30:28,884
AND I THINK ANOTHER REALLY

2385
01:30:28,884 --> 01:30:30,853
PROMISING AREA IS USE OF LARGE

2386
01:30:30,853 --> 01:30:33,355
LANGUAGE MODELS FOR DATA

2387
01:30:33,355 --> 01:30:36,759
INTEGRATION, FROM THE MOVIE

2388
01:30:36,759 --> 01:30:38,193
"OFFICE SPACE" YEARS AGO, ONE OF

2389
01:30:38,193 --> 01:30:41,230
MY FAVORITE MOVIES FROM A LONG

2390
01:30:41,230 --> 01:30:42,665
TIME AGO.

2391
01:30:42,665 --> 01:30:45,067
THIS IS ABOUT DISGRUNTLED OFFICE

2392
01:30:45,067 --> 01:30:46,268
WORKERS WHO TAKE A FAX MACHINE

2393
01:30:46,268 --> 01:30:48,804
AND SPARK IT IN A FIELD.

2394
01:30:48,804 --> 01:30:51,207
I DO THINK THAT THERE'S

2395
01:30:51,207 --> 01:30:52,074
OPPORTUNITY WHERE WE START

2396
01:30:52,074 --> 01:30:53,275
INTERACTING WITH COMPUTERS IN A

2397
01:30:53,275 --> 01:30:55,611
MORE EFFICIENT WAY INSTEAD OF

2398
01:30:55,611 --> 01:30:56,912
HAVING COMPLICATED GRAPHICAL

2399
01:30:56,912 --> 01:30:58,914
USER INTERFACES, CLICK ALL THE

2400
01:30:58,914 --> 01:31:02,084
TIME, START USING NATURAL

2401
01:31:02,084 --> 01:31:02,952
LANGUAGE INTERFACE.

2402
01:31:02,952 --> 01:31:04,486
BILL GATES PUBLISHED A BLOG POST

2403
01:31:04,486 --> 01:31:06,121
ABOUT THIS TOO.

2404
01:31:06,121 --> 01:31:07,323
THAT CAN TRANSFORM OUR

2405
01:31:07,323 --> 01:31:09,191
INTERACTION AND HELP US BE MORE

2406
01:31:09,191 --> 01:31:11,827
EFFICIENT AND TAKE CARE OF

2407
01:31:11,827 --> 01:31:12,828
PATIENTS BETTER.

2408
01:31:12,828 --> 01:31:14,363
I ALSO THINK THERE'S A LOT OF

2409
01:31:14,363 --> 01:31:16,432
CHALLENGES ALONG THE WHOLE

2410
01:31:16,432 --> 01:31:18,801
PIPELINE OF USING -- INTEGRATING

2411
01:31:18,801 --> 01:31:19,602
PATIENT GENERATED HEALTH DATA.

2412
01:31:19,602 --> 01:31:24,073
THE FIGURE ON THE LEFT IS FROM A

2413
01:31:24,073 --> 01:31:25,174
REVIEW OF PATIENT-GENERATED

2414
01:31:25,174 --> 01:31:27,943
HEALTH DATA INTERVIEWING LEADERS

2415
01:31:27,943 --> 01:31:30,312
IN THE SPACE.

2416
01:31:30,312 --> 01:31:32,715
YOU CAN SEE EACH KEY THEME UNDER

2417
01:31:32,715 --> 01:31:35,451
CORE AREAS OF DATA CAPTURE,

2418
01:31:35,451 --> 01:31:36,018
TRANSFER, REVIEW.

2419
01:31:36,018 --> 01:31:37,653
AND ALSO I THINK THERE'S GOING

2420
01:31:37,653 --> 01:31:38,954
TO BE A LOT OF WORK THAT NEEDS

2421
01:31:38,954 --> 01:31:41,256
TO BE DONE THINKING ABOUT LOU DO

2422
01:31:41,256 --> 01:31:43,792
WE SURFACE MODELS, MACHINE

2423
01:31:43,792 --> 01:31:44,493
LEARNING MODELS TO CLINICIANS,

2424
01:31:44,493 --> 01:31:48,831
THE FIGURE ON THE RIGHT FROM

2425
01:31:48,831 --> 01:31:52,034
DUKE, A NICE EXAMPLE OF A FOOD

2426
01:31:52,034 --> 01:31:53,135
LABEL EQUIVALENT TO MACHINE

2427
01:31:53,135 --> 01:31:58,040
LEARNING MODELS TO HELP

2428
01:31:58,040 --> 01:31:59,575
CLINICIANS UNDERSTAND HOW THE

2429
01:31:59,575 --> 01:32:00,876
MODEL IS TRAINED AND HOW IT

2430
01:32:00,876 --> 01:32:03,078
SHOULD BE USED.

2431
01:32:03,078 --> 01:32:06,148
ANOTHER PROMISING AREA, TESTING

2432
01:32:06,148 --> 01:32:07,549
DEVICES IN PRAGMATIC TRIALS.

2433
01:32:07,549 --> 01:32:09,652
THE FIGURE ON THE LEFT IS FROM A

2434
01:32:09,652 --> 01:32:15,624
REVIEW THAT   TALKS ABOUT

2435
01:32:15,624 --> 01:32:16,525
STRATEGIES TO DRIVE IMPROVEMENT

2436
01:32:16,525 --> 01:32:19,295
IN QUALITY OF CARE FOR PATIENTS

2437
01:32:19,295 --> 01:32:19,928
WITH HYPERTENSION.

2438
01:32:19,928 --> 01:32:22,097
THE RIGHT I THINK IS A FIGURE

2439
01:32:22,097 --> 01:32:23,866
THAT SHOWS SOME DIFFERENT

2440
01:32:23,866 --> 01:32:25,934
PHENOTYPES OF PATIENTS WITH

2441
01:32:25,934 --> 01:32:29,772
HYPERTENSION AND EVENTUALLY HAVE

2442
01:32:29,772 --> 01:32:30,506
POTENTIALLY TARGETED

2443
01:32:30,506 --> 01:32:31,173
NON-PHARMACOLOGIC OR

2444
01:32:31,173 --> 01:32:32,474
PHARMACOLOGIC THERAPIES BASED ON

2445
01:32:32,474 --> 01:32:36,745
PHENOTYPE IF WE HAVE A LOW

2446
01:32:36,745 --> 01:32:39,048
PROFILE WIDELY USED 24-HOUR

2447
01:32:39,048 --> 01:32:39,982
BLOOD PRESSURE MONITOR.

2448
01:32:39,982 --> 01:32:42,451
THIS IS TO LEVERAGE LATEST FROM

2449
01:32:42,451 --> 01:32:44,420
IMPLEMENTATION SCIENCE AND

2450
01:32:44,420 --> 01:32:46,155
DESIGN TRIALS THAT MEASURE

2451
01:32:46,155 --> 01:32:47,256
CLINICAL EFFECTIVENESS OF DEVICE

2452
01:32:47,256 --> 01:32:50,759
OR TOOL, ALSO HOW IT'S

2453
01:32:50,759 --> 01:32:51,960
IMPLEMENTED ITSELF AND

2454
01:32:51,960 --> 01:32:54,263
IMPLEMENTATION STRATEGIES.

2455
01:32:54,263 --> 01:32:58,100
AND IT'S IMPORTANT FOR ANY MLA

2456
01:32:58,100 --> 01:32:59,968
TRIAL TO ADHERE TO IMPORTANT

2457
01:32:59,968 --> 01:33:01,537
STANDARDS OUT THERE AND ON THE

2458
01:33:01,537 --> 01:33:06,075
RIGHT YOU CAN SEE CHART THAT

2459
01:33:06,075 --> 01:33:08,043
HIGHLIGHTS CURRENT mL CLINICAL

2460
01:33:08,043 --> 01:33:11,880
TRIALS AND SOME OPPORTUNITIES TO

2461
01:33:11,880 --> 01:33:14,950
IMPROVE REPORTING THEM.

2462
01:33:14,950 --> 01:33:15,684
ANOTHER PROMISING AREA RELATED

2463
01:33:15,684 --> 01:33:18,120
TO CLINICAL TRIALS HOW DO WE

2464
01:33:18,120 --> 01:33:19,888
BUILD UP THE INFRASTRUCTURE TO

2465
01:33:19,888 --> 01:33:22,624
EXECUTE THESE TRIALS AT SCALE.

2466
01:33:22,624 --> 01:33:25,894
AND NIH ALREADY SUPPORTS A

2467
01:33:25,894 --> 01:33:29,965
NUMBER OF INITIATIVES AND

2468
01:33:29,965 --> 01:33:35,971
CARDIOVASCULAR TRIAL AND AI/ ML

2469
01:33:35,971 --> 01:33:38,841
SPACE, BUT HELP IT WILL TO SCALE

2470
01:33:38,841 --> 01:33:45,314
AND TEST INTERVENTIONS EFFICIENT

2471
01:33:45,314 --> 01:33:49,351
LIP ACROSS DIVERSE POPULATIONS.

2472
01:33:49,351 --> 01:33:51,553
ANOTHER GAP TO TRAIN PEOPLE TO

2473
01:33:51,553 --> 01:33:54,056
SPEAK BOTH LANGUAGES.

2474
01:33:54,056 --> 01:33:57,926
WE STARTED A FELLOWSHIP THREE

2475
01:33:57,926 --> 01:33:59,995
YEARS AGO, TAKING FELLOWS, AND

2476
01:33:59,995 --> 01:34:01,930
EVEN FROM INTERNAL MEDICINE

2477
01:34:01,930 --> 01:34:05,033
RESIDENTS, SPEND A YEAR WITH

2478
01:34:05,033 --> 01:34:05,901
ENGINEERS, MASTER IN

2479
01:34:05,901 --> 01:34:06,568
ENGINEERING, RECRUIT THEM

2480
01:34:06,568 --> 01:34:10,072
INTERNALLY OR PUT THEM IN

2481
01:34:10,072 --> 01:34:13,008
DIFFERENT POSITIONS IN ACADEMICS

2482
01:34:13,008 --> 01:34:14,209
OR HEALTH TECH.

2483
01:34:14,209 --> 01:34:18,814
LASTLY I WANT TO BRIEFLY MENTION

2484
01:34:18,814 --> 01:34:20,149
IMPORTANCE OF THINKING OF

2485
01:34:20,149 --> 01:34:22,217
VIEWING TECHNOLOGY WITH EQUITY

2486
01:34:22,217 --> 01:34:22,885
LENS.

2487
01:34:22,885 --> 01:34:24,553
DR. SPATZ DISCUSSED THIS

2488
01:34:24,553 --> 01:34:26,488
EARLIER, AND IT WILL BE COVERED

2489
01:34:26,488 --> 01:34:26,855
TOMORROW.

2490
01:34:26,855 --> 01:34:28,991
IT'S REALLY IMPORTANT TO THINK

2491
01:34:28,991 --> 01:34:32,394
ABOUT HOW DO WE USE TOOLS TO

2492
01:34:32,394 --> 01:34:33,729
IMPACT MULTI-LEVEL AND

2493
01:34:33,729 --> 01:34:35,030
MULTI-FACETED FACTORS TO

2494
01:34:35,030 --> 01:34:39,034
CONTRIBUTE TO HEALTH INEQUITIES

2495
01:34:39,034 --> 01:34:39,835
RELATED TO HYPERTENSION.

2496
01:34:39,835 --> 01:34:42,004
THANK YOU FOR YOUR TIME AND

2497
01:34:42,004 --> 01:34:42,271
ATTENTION.

2498
01:34:42,271 --> 01:34:44,706
I LOOK FORWARD TO THE

2499
01:34:44,706 --> 01:34:45,007
DISCUSSION.

2500
01:34:45,007 --> 01:34:46,308
>> THANK YOU SO MUCH.

2501
01:34:46,308 --> 01:34:53,182
THAT WAS A TOUR DE FORCE IN

2502
01:34:53,182 --> 01:34:54,750
TERMS OF DATA INFRASTRUCTURE.

2503
01:34:54,750 --> 01:34:56,218
SO EVERYBODY, IF YOU HAVE

2504
01:34:56,218 --> 01:34:57,653
QUESTIONS PLEASE PUT THEM IN THE

2505
01:34:57,653 --> 01:34:59,521
CHAT, I'LL TRY TO KEEP AN EYE.

2506
01:34:59,521 --> 01:35:02,791
WE HAVE SOME TIME NOW FOR A

2507
01:35:02,791 --> 01:35:04,560
PANEL DISCUSSION SO WE CAN PICK

2508
01:35:04,560 --> 01:35:06,295
THE BRAINS OF THESE BRILLIANT

2509
01:35:06,295 --> 01:35:07,930
PEOPLE WHO HAVE CROSSED THIS

2510
01:35:07,930 --> 01:35:14,503
CHASM BETWEEN THE CLINICAL WORLD

2511
01:35:14,503 --> 01:35:16,138
AND ENGINEERING WORLD.

2512
01:35:16,138 --> 01:35:17,339
I'M GOING TO HIGHLIGHT A FEW

2513
01:35:17,339 --> 01:35:18,740
THEMES THAT CAUGHT MY ATTENTION

2514
01:35:18,740 --> 01:35:19,875
AND START WITH A FEW QUESTIONS.

2515
01:35:19,875 --> 01:35:22,811
SO SOME OF THE THEMES I HEARD IS

2516
01:35:22,811 --> 01:35:25,214
THAT WE HAVE A LOT OF MODELS AND

2517
01:35:25,214 --> 01:35:25,681
COMPUTATIONAL POWER.

2518
01:35:25,681 --> 01:35:27,749
AS FAR AS I CAN SEE THAT

2519
01:35:27,749 --> 01:35:29,518
INCREASE IN COMPUTE POWER IS NOT

2520
01:35:29,518 --> 01:35:29,952
STOPPING.

2521
01:35:29,952 --> 01:35:33,889
IT'S GOING TO KEEP GROWING.

2522
01:35:33,889 --> 01:35:36,191
AND ADVANCEMENT OF TECH AND

2523
01:35:36,191 --> 01:35:37,726
PARTICULARLY HOW HUMANS INTERACT

2524
01:35:37,726 --> 01:35:40,362
WITH TECH OR SOME COMPUTATIONAL

2525
01:35:40,362 --> 01:35:41,330
PLATFORMS IS ALSO GROWING FAST.

2526
01:35:41,330 --> 01:35:44,299
WE HAVE A TON OF DATA,

2527
01:35:44,299 --> 01:35:45,500
PARTICULARLY HEALTHCARE DATA,

2528
01:35:45,500 --> 01:35:46,468
AND DIGITAL INFRASTRUCTURE IS

2529
01:35:46,468 --> 01:35:49,204
ADVANCING TO BE ABLE TO

2530
01:35:49,204 --> 01:35:50,973
HARMONIZE AND AGGREGATE DATA IN

2531
01:35:50,973 --> 01:35:54,142
WAYS THAT MAKE IT MORE SCALABLE

2532
01:35:54,142 --> 01:35:55,010
FOR USE.

2533
01:35:55,010 --> 01:35:56,979
BUT WHEN CHALLENGED NOW WE

2534
01:35:56,979 --> 01:35:59,414
SEE -- ONE CHALLENGE IS WE NEED

2535
01:35:59,414 --> 01:36:00,949
TRUE INTEGGATION OF DIFFERENT

2536
01:36:00,949 --> 01:36:02,684
TYPES OF EXPERTISE AND HEARD

2537
01:36:02,684 --> 01:36:04,653
BOTH SIDES, WHERE AT MAYO

2538
01:36:04,653 --> 01:36:07,956
ENGINEERS ARE HANGING OUT WITH

2539
01:36:07,956 --> 01:36:09,291
CLINICIANS, AT NORTHWESTERN

2540
01:36:09,291 --> 01:36:10,826
ENGINEERS -- CLINICIANS ARE

2541
01:36:10,826 --> 01:36:14,863
HANGING OUT WITH ENGINEERS, GOOD

2542
01:36:14,863 --> 01:36:17,933
TWO-WAY ROADS, LEADING TO THE

2543
01:36:17,933 --> 01:36:19,668
IMPORTANT CONCEPT WE HEARD THAT

2544
01:36:19,668 --> 01:36:21,870
THE NUMBERS ALONE WILL NEVER

2545
01:36:21,870 --> 01:36:23,639
SOLVE THE PROBLEM.

2546
01:36:23,639 --> 01:36:24,940
IT'S THE CLINICAL CONTEXT THAT

2547
01:36:24,940 --> 01:36:25,274
MATTERS.

2548
01:36:25,274 --> 01:36:27,342
NUMBERS DO NOT TELL THE WHOLE

2549
01:36:27,342 --> 01:36:27,543
STORY.

2550
01:36:27,543 --> 01:36:30,612
THESE ARE SOME OF THE THEMES I

2551
01:36:30,612 --> 01:36:30,812
HEARD.

2552
01:36:30,812 --> 01:36:33,148
OH, AND 90% OF THE WORK IS

2553
01:36:33,148 --> 01:36:34,249
CREATING GOOD DATASETS.

2554
01:36:34,249 --> 01:36:36,551
IT'S HARD WORK.

2555
01:36:36,551 --> 01:36:38,320
IT'S TEDIOUS, IT'S NOT GLAMOROUS

2556
01:36:38,320 --> 01:36:41,189
BUT IT'S THE FOUNDATION AND

2557
01:36:41,189 --> 01:36:42,691
HOPEFULLY SOME STUFF FARAZ WILL

2558
01:36:42,691 --> 01:36:46,328
MAKE THAT WORK FASTER AND

2559
01:36:46,328 --> 01:36:46,562
EASIER.

2560
01:36:46,562 --> 01:36:47,629
THESE ARE SOME THEMES.

2561
01:36:47,629 --> 01:36:50,032
MAYBE I'LL START WITH A

2562
01:36:50,032 --> 01:36:50,332
QUESTION.

2563
01:36:50,332 --> 01:36:53,969
ALL OF YOU HAVE TAKEN SOME FORM

2564
01:36:53,969 --> 01:36:55,837
OF COMPUTE OR TECH AND SOLVED A

2565
01:36:55,837 --> 01:36:56,204
PROBLEM.

2566
01:36:56,204 --> 01:36:59,341
I'LL PUT ON MY SUBMISSION HAT

2567
01:36:59,341 --> 01:37:00,342
FOR A MINUTE.

2568
01:37:00,342 --> 01:37:04,379
WHEN YOU STARTED HOW WAS THAT

2569
01:37:04,379 --> 01:37:05,113
PROBLEM DEFINED?

2570
01:37:05,113 --> 01:37:06,181
A CLINICIAN HAS AN IDEA,

2571
01:37:06,181 --> 01:37:07,449
SOMETHING THEY WANT TO TACKLE

2572
01:37:07,449 --> 01:37:09,718
AND WORK WITH ENGINEERS OR

2573
01:37:09,718 --> 01:37:17,993
COMPUTER SCIENCE PEOPLE, WHERE

2574
01:37:17,993 --> 01:37:27,502
DID THE IDEA START?

2575
01:37:27,502 --> 01:37:30,572
>> IT NEEDS A VILLAGE.

2576
01:37:30,572 --> 01:37:34,710
WE'VE BEEN DOING IT, MANY

2577
01:37:34,710 --> 01:37:35,944
PROCEDURES WE ATTEND, WE ASK

2578
01:37:35,944 --> 01:37:37,012
CLINICIANS WHY ARE YOU DOING

2579
01:37:37,012 --> 01:37:39,982
THAT, RIGHT? 

2580
01:37:39,982 --> 01:37:43,118
WHAT'S THE NEXT STEP?

2581
01:37:43,118 --> 01:37:45,654
MOST OF THE TIME THERE ARE

2582
01:37:45,654 --> 01:37:46,488
STRAIGHTFORWARD ANSWERS BUT

2583
01:37:46,488 --> 01:37:47,723
SOMETIMES -- ACTUALLY, I DON'T

2584
01:37:47,723 --> 01:37:50,158
KNOW, WE'VE ALWAYS DONE THAT,

2585
01:37:50,158 --> 01:37:50,359
RIGHT?

2586
01:37:50,359 --> 01:37:55,697
AND SOME OF THE QUESTIONS ARE

2587
01:37:55,697 --> 01:37:56,365
VERY NAIVE.

2588
01:37:56,365 --> 01:38:01,536
WE'VE DEVELOPED A MODEL THAT

2589
01:38:01,536 --> 01:38:04,906
LOOKS AT ATRIAL FIBRILLATION,

2590
01:38:04,906 --> 01:38:06,908
THAT STARTED AS A TECHNICAL

2591
01:38:06,908 --> 01:38:07,342
CHALLENGE.

2592
01:38:07,342 --> 01:38:14,049
WE DIDN'T KNOW WHICH PATIENTS,

2593
01:38:14,049 --> 01:38:16,084
MAYBE TRY TO PREDICT WHO HAS AS

2594
01:38:16,084 --> 01:38:17,185
SECOND MODEL.

2595
01:38:17,185 --> 01:38:19,154
CLINICIAN SAID THAT'S A USEFUL

2596
01:38:19,154 --> 01:38:23,625
WAY FOR US TO KNOW IF A

2597
01:38:23,625 --> 01:38:25,060
CRYPTOGENIC PATIENT HAS AF OR

2598
01:38:25,060 --> 01:38:28,030
NOT. 

2599
01:38:28,030 --> 01:38:29,998
A LOT STARTS WITH SPONTANEOUS

2600
01:38:29,998 --> 01:38:30,632
DISCUSSIONS.

2601
01:38:30,632 --> 01:38:31,733
SOMETIMES WE HAVE BRAINSTORMING

2602
01:38:31,733 --> 01:38:35,037
SESSIONS THAT WE CAN SAY WE HAVE

2603
01:38:35,037 --> 01:38:36,805
THIS TEST, AND ESPECIALLY NOW

2604
01:38:36,805 --> 01:38:38,340
WITH FRAMEWORKS IN PLACE, A

2605
01:38:38,340 --> 01:38:39,107
BIGGER TEAM.

2606
01:38:39,107 --> 01:38:41,610
IT'S EASIER TO DO IT IN A

2607
01:38:41,610 --> 01:38:43,478
STRUCTURED WAY BUT ESPECIALLY

2608
01:38:43,478 --> 01:38:46,448
WITH A SMALL TEAM, ONE OR TWO

2609
01:38:46,448 --> 01:38:47,849
ENGINEERS, SPENDING A LOT OF

2610
01:38:47,849 --> 01:38:53,455
TIME WITH THEM WITH

2611
01:38:53,455 --> 01:38:56,191
AUTOMATICALLY CASCADE THE IDEAS,

2612
01:38:56,191 --> 01:38:56,792
RIGHT?

2613
01:38:56,792 --> 01:38:57,726
ASKING THE QUESTIONS, LOOKING AT

2614
01:38:57,726 --> 01:38:59,594
THE DATA, SEEING WHAT'S

2615
01:38:59,594 --> 01:38:59,961
AVAILABLE.

2616
01:38:59,961 --> 01:39:00,796
EVENTUALLY THAT'S THE MOST

2617
01:39:00,796 --> 01:39:02,431
IMPORTANT THING.

2618
01:39:02,431 --> 01:39:05,267
YOU HAVE TO LOOK AT WHAT YOU

2619
01:39:05,267 --> 01:39:08,103
HAVE AVAILABLE AND THEN START

2620
01:39:08,103 --> 01:39:08,770
FISHING EXPEDITION.

2621
01:39:08,770 --> 01:39:11,606
>> YES. 

2622
01:39:11,606 --> 01:39:12,340
SOUNDS LIKE THE

2623
01:39:12,340 --> 01:39:12,908
CROSS-POLLINATION APPROVE.

2624
01:39:12,908 --> 01:39:16,211
IF YOU DO IT ENOUGH AND SPEND

2625
01:39:16,211 --> 01:39:18,547
TIME TOGETHER, SMART PEOPLE WILL

2626
01:39:18,547 --> 01:39:22,884
FIND THE RIGHT QUESTIONS. 

2627
01:39:22,884 --> 01:39:24,419
I MADE A COUPLE RELATED

2628
01:39:24,419 --> 01:39:25,520
QUESTIONS IN THE CHAT.

2629
01:39:25,520 --> 01:39:27,923
ONE PERSON MADE A COMMENT, A.I.

2630
01:39:27,923 --> 01:39:30,459
CAN DIRECT OUR ATTENTION TO

2631
01:39:30,459 --> 01:39:32,094
VARIOUS SIGNALS BUT WE NEED TO

2632
01:39:32,094 --> 01:39:33,795
SELECT MEANINGFUL SIGNALINGS.

2633
01:39:33,795 --> 01:39:35,897
ANOTHER QUESTION, WHAT ROLE DO

2634
01:39:35,897 --> 01:39:37,999
YOU SEE A.I. PLAYING IN CLEANING

2635
01:39:37,999 --> 01:39:39,901
AND HARMONIZING DATA.

2636
01:39:39,901 --> 01:39:42,604
I THINK THOSE ARE SORT OF

2637
01:39:42,604 --> 01:39:43,605
RELATED BECAUSE MEANINGFUL

2638
01:39:43,605 --> 01:39:46,875
SIGNALS MEANS YOU CLEANED TO

2639
01:39:46,875 --> 01:39:47,876
SOME EXTENT.

2640
01:39:47,876 --> 01:39:49,945
AND THAT'S A TEDIOUS PROCESS.

2641
01:39:49,945 --> 01:39:54,316
SO SIGNAL DATA IS A GREAT

2642
01:39:54,316 --> 01:39:54,816
EXAMPLE.

2643
01:39:54,816 --> 01:39:56,718
MAYBE TONS AND TONS OF SIGNAL

2644
01:39:56,718 --> 01:40:00,589
DATA, HOW DO YOU DO THAT?

2645
01:40:00,589 --> 01:40:02,991
QUOTE/UNQUOTE USING A.I. TO DO

2646
01:40:02,991 --> 01:40:03,959
THAT CLEANING?

2647
01:40:03,959 --> 01:40:05,060
>> FANTASTIC QUESTION.

2648
01:40:05,060 --> 01:40:07,496
IT'S GOING TO BE THE MOST

2649
01:40:07,496 --> 01:40:08,663
IMPORTANT THING TO ADDRESS.

2650
01:40:08,663 --> 01:40:11,166
LUCKILY THERE ARE SOME MODELS

2651
01:40:11,166 --> 01:40:16,238
THAT CAN TEACH US WHAT SORT OF

2652
01:40:16,238 --> 01:40:18,206
CORE DATA SHOULD LOOK LIKE, WHAT

2653
01:40:18,206 --> 01:40:20,509
ENDS UP BEING COMMON, NOT THAT

2654
01:40:20,509 --> 01:40:21,143
IT ELIMINATES OUTLIERS BECAUSE I

2655
01:40:21,143 --> 01:40:22,811
THINK ONE OF THE THINGS WE CAN

2656
01:40:22,811 --> 01:40:25,480
GET AS WE COLLECT MORE DATA IS

2657
01:40:25,480 --> 01:40:26,648
THAT UNIQUE DATA SHOULDN'T BE

2658
01:40:26,648 --> 01:40:29,151
CONSIDERED AS RARE OR MISSING,

2659
01:40:29,151 --> 01:40:30,819
BUT ACTUALLY AS REPRESENTATIVE

2660
01:40:30,819 --> 01:40:31,786
OF SOMETHING DIFFERENT.

2661
01:40:31,786 --> 01:40:35,190
SO WHAT'S NEEDED ARE A SERIES OF

2662
01:40:35,190 --> 01:40:37,058
TECHNIQUES THAT CAN CLEAN AND

2663
01:40:37,058 --> 01:40:40,996
HARMONIZE DATA, AT LEAST BY SOME

2664
01:40:40,996 --> 01:40:42,330
MEANINGFUL METRIC, SOME CLINICAL

2665
01:40:42,330 --> 01:40:44,966
STANDARD, SO IT'S PROVIDING YOU

2666
01:40:44,966 --> 01:40:47,135
WITH EITHER STANDARDIZED SIGNALS

2667
01:40:47,135 --> 01:40:48,770
OR NEW SIGNALS THAT YOU CAN

2668
01:40:48,770 --> 01:40:52,507
UNDERSTAND WHY THEY ARE

2669
01:40:52,507 --> 01:40:53,375
OUTLIERS.

2670
01:40:53,375 --> 01:40:57,846
THERE ARE TECHNIQUES SORT OF

2671
01:40:57,846 --> 01:41:00,582
AUTOINCLUDING WITH A.I. MODELS

2672
01:41:00,582 --> 01:41:02,684
GIVE DATA AT INPUT, TELL IT TO

2673
01:41:02,684 --> 01:41:04,753
DO ITS MAGIC INTERNALLY, HAVE IT

2674
01:41:04,753 --> 01:41:05,854
GENERATE OUTPUT AND MATCH TO SEE

2675
01:41:05,854 --> 01:41:08,490
HOW FAR THAT OUTPUT IS FROM

2676
01:41:08,490 --> 01:41:11,560
RECONSTRUCTING THE INPUT.

2677
01:41:11,560 --> 01:41:12,994
AUTOENCODING TECHNIQUES ARE

2678
01:41:12,994 --> 01:41:14,629
REMARKABLY GOOD AT DE-NOISING

2679
01:41:14,629 --> 01:41:14,863
SIGNALS.

2680
01:41:14,863 --> 01:41:18,366
WHAT YOU CAN THEN DO IS USE

2681
01:41:18,366 --> 01:41:21,403
THESE TECHNIQUES TO SORT OF

2682
01:41:21,403 --> 01:41:22,370
BOUND REASONABLE SPACE AND

2683
01:41:22,370 --> 01:41:23,738
PROVIDE CLINICIAN A TOOL.

2684
01:41:23,738 --> 01:41:27,142
YOU'RE NOT THROWING OUT SIGNALS

2685
01:41:27,142 --> 01:41:29,444
BECAUSE I DON'T ACTUALLY KNOW IF

2686
01:41:29,444 --> 01:41:31,513
AN OUTLIER VALUE IS FEASIBLE OR

2687
01:41:31,513 --> 01:41:32,714
NOT, FOR EXAMPLE.

2688
01:41:32,714 --> 01:41:35,417
BUT YOU PROVIDE A THRESHOLD,

2689
01:41:35,417 --> 01:41:36,885
TUNEABLE KNOB THAT CAN BE USED

2690
01:41:36,885 --> 01:41:42,324
IN THE LOOP TO DECIDE I DON'T

2691
01:41:42,324 --> 01:41:43,758
WANT TO CONSIDER EXTREME

2692
01:41:43,758 --> 01:41:47,362
OUTLIERS, OR I DO, YOU CAN USE

2693
01:41:47,362 --> 01:41:48,063
TECHNIQUES TO SUMMARIZE

2694
01:41:48,063 --> 01:41:49,464
PLAUSIBLE AND UNCERTAIN RANGES.

2695
01:41:49,464 --> 01:42:00,008
FROM THERE I THINK IT BECOMES A

2696
01:42:01,009 --> 01:42:03,211
FUNCTION OF HOW MUCH MIGHT

2697
01:42:03,211 --> 01:42:04,679
PROVIDE VALUE.

2698
01:42:04,679 --> 01:42:05,914
A.I. IS PLAYING A KEY ROLE BUT

2699
01:42:05,914 --> 01:42:09,951
AS SORT OF A BOX YOU CAN PLAY

2700
01:42:09,951 --> 01:42:18,393
AROUND WITH,  PROBABLY TIERS,

2701
01:42:18,393 --> 01:42:20,629
HERE IS DATA THAT'S OBVIOUSLY

2702
01:42:20,629 --> 01:42:22,764
GARBAGE, HERE IS DATA THAT SEEMS

2703
01:42:22,764 --> 01:42:26,701
CLEAN, AND HERE IS DATA IN THE

2704
01:42:26,701 --> 01:42:28,703
MIDDLE THAT YOU HAVE TO DECIDE

2705
01:42:28,703 --> 01:42:31,640
WHAT YOU'RE GOING TO DO, THAT

2706
01:42:31,640 --> 01:42:33,642
HAS VALUE TOO, I THINK.

2707
01:42:33,642 --> 01:42:35,677
>> WHAT YOU'RE SAYING IS
THAT

2708
01:42:35,677 --> 01:42:36,611
HUMANS ARE STILL IN THE LOOP AND

2709
01:42:36,611 --> 01:42:39,481
THAT'S GOING TO BE THE CASE FOR

2710
01:42:39,481 --> 01:42:41,516
A LONG TIME?

2711
01:42:41,516 --> 01:42:42,484
>> I THINK SO.

2712
01:42:42,484 --> 01:42:45,120
AS THEY ARE ABLE TO GENERATE

2713
01:42:45,120 --> 01:42:45,854
THESE THINGS, THE HUMAN STILL

2714
01:42:45,854 --> 01:42:48,089
NEEDS TO BE IN THE LOOP BECAUSE

2715
01:42:48,089 --> 01:42:49,057
YOU HAVE TWO FACTORS.

2716
01:42:49,057 --> 01:42:50,592
YOU HAVE THE MODEL TO DECIDE

2717
01:42:50,592 --> 01:42:51,893
THINGS THAT YOU'RE ALREADY

2718
01:42:51,893 --> 01:42:52,761
FAMILIAR WITH AND HAVE

2719
01:42:52,761 --> 01:42:54,095
CONFIDENCE IN.

2720
01:42:54,095 --> 01:42:57,132
IF IT GENERATES SOMETHING NEW,

2721
01:42:57,132 --> 01:43:00,235
THERE'S A SERIES OF POTENTIALS

2722
01:43:00,235 --> 01:43:01,436
OF BIAS AND CONFOUNDING THINGS

2723
01:43:01,436 --> 01:43:02,637
WITH RESPECT TO WHAT DATA TRAINS

2724
01:43:02,637 --> 01:43:06,908
THE MODEL THAT YOU NEED SOME

2725
01:43:06,908 --> 01:43:08,109
GAME TO TRUST.

2726
01:43:08,109 --> 01:43:11,179
IT MAY BE GENERATING NEW

2727
01:43:11,179 --> 01:43:12,947
INFORMATION BUT THE MORE YOU'RE

2728
01:43:12,947 --> 01:43:14,582
INVOLVED YOU'LL UNDERSTAND WHY

2729
01:43:14,582 --> 01:43:16,151
IT'S BEING GENERATE AND TRUST IT

2730
01:43:16,151 --> 01:43:17,352
AND GO FROM THERE.

2731
01:43:17,352 --> 01:43:18,987
>> THAT TO ME MEANS THAT

2732
01:43:18,987 --> 01:43:21,823
BUILDING ON THIS IDEA OF

2733
01:43:21,823 --> 01:43:22,924
CROSS-POLLINATION AND PEOPLE

2734
01:43:22,924 --> 01:43:24,559
MOVING TO DIFFERENT FIELDS THEY

2735
01:43:24,559 --> 01:43:26,428
HAD NOT BEEN IN PREVIOUSLY,

2736
01:43:26,428 --> 01:43:28,496
PHYSICIANS HAVE TO GET OUT OF

2737
01:43:28,496 --> 01:43:32,767
THEIR COMFORT ZONE AND BE MORE

2738
01:43:32,767 --> 01:43:33,868
COMPUTATIONAL AND MAP SAVVY THAN

2739
01:43:33,868 --> 01:43:35,770
IN THE PAST TO PARTICIPATE IN

2740
01:43:35,770 --> 01:43:40,342
THESE HUMAN IN THE LOOP THINGS.

2741
01:43:40,342 --> 01:43:42,777
WHAT ARE THE STEPS TO CONSIDER

2742
01:43:42,777 --> 01:43:44,512
WHEN PROPOSING OR DEVELOPING

2743
01:43:44,512 --> 01:43:46,147
A.I. MODELS FOR DIAGNOSTIC

2744
01:43:46,147 --> 01:43:46,614
SUPPORT?

2745
01:43:46,614 --> 01:43:49,651
I'LL BUILD ON THAT ONE.

2746
01:43:49,651 --> 01:43:51,086
ONE PIECE OF THAT IS LET'S SAY

2747
01:43:51,086 --> 01:43:54,122
YOU DO BUILD SOMETHING FOR

2748
01:43:54,122 --> 01:43:58,393
DIAGNOSTIC OR ADDRESSING SOME

2749
01:43:58,393 --> 01:44:00,028
PROBLEM YOU'VE IDENTIFIED IN

2750
01:44:00,028 --> 01:44:00,829
YOUR HEALTH CARE DELIVERY, HOW

2751
01:44:00,829 --> 01:44:03,331
DO YOU KEEP TRACK OF THE FACT IT

2752
01:44:03,331 --> 01:44:03,631
WORKS?

2753
01:44:03,631 --> 01:44:04,532
DATASETS WILL CHANGE.

2754
01:44:04,532 --> 01:44:08,136
WHEN YOU GO LIVE YOUR DATASET

2755
01:44:08,136 --> 01:44:09,437
WILL CHANGE, YOU DON'T KNOW IF

2756
01:44:09,437 --> 01:44:12,407
IT'S WORKING THE WAY WITH THE

2757
01:44:12,407 --> 01:44:14,376
FIRST VALIDATION MODEL.

2758
01:44:14,376 --> 01:44:17,545
FARAZ, YOU IMPLEMENTED STUFF ON

2759
01:44:17,545 --> 01:44:18,680
HEART FAILURE SIDE.

2760
01:44:18,680 --> 01:44:19,614
DO YOU KEEP TRACK?

2761
01:44:19,614 --> 01:44:22,016
>> IT'S A GREAT QUESTION.

2762
01:44:22,016 --> 01:44:24,986
YEAH, WE DO.

2763
01:44:24,986 --> 01:44:28,790
WE HAVE THE COMMITTEE, A.I.

2764
01:44:28,790 --> 01:44:30,225
CATALYST COMMITTEE,

2765
01:44:30,225 --> 01:44:32,193
INTERDISCIPLINARY, WITH

2766
01:44:32,193 --> 01:44:33,728
CLINICIANS, ENGINEERS,

2767
01:44:33,728 --> 01:44:35,363
SCIENTISTS, HUMAN COMPUTER

2768
01:44:35,363 --> 01:44:37,999
EXPERTS, EVERYONE INVOLVED FROM

2769
01:44:37,999 --> 01:44:39,768
IDEA INCEPTION TO DEPLOYMENT,

2770
01:44:39,768 --> 01:44:41,169
POST DEPLOYMENT SURVEILLANCE.

2771
01:44:41,169 --> 01:44:44,239
SO AS WE GO THROUGH THE PROCESS

2772
01:44:44,239 --> 01:44:45,974
WE VALIDATE MODELS AS BEST WE

2773
01:44:45,974 --> 01:44:46,975
KNOW IN DIFFERENT POPULATIONS

2774
01:44:46,975 --> 01:44:47,842
OVER TIME.

2775
01:44:47,842 --> 01:44:49,511
ONCE DEPLOYED WE'RE WORKING ON

2776
01:44:49,511 --> 01:44:51,479
SETTING UP SYSTEMS WHICH WE

2777
01:44:51,479 --> 01:44:52,881
MODEL PERFORMANCE OVER TIME, SET

2778
01:44:52,881 --> 01:44:54,516
CHECK-INS, AND MAKE SURE IT'S

2779
01:44:54,516 --> 01:45:01,089
PERFORMING AS WE THINK IT WILL.

2780
01:45:01,089 --> 01:45:02,090
IDEALLY CAN RETAIN MODELS OVER

2781
01:45:02,090 --> 01:45:04,492
TIME TO IMPROVE QUALITY OF CARE.

2782
01:45:04,492 --> 01:45:06,027
THIS IS ALL VERY EARLY DAYS IN

2783
01:45:06,027 --> 01:45:09,297
THE WORK WE'RE IN, WE'RE STILL

2784
01:45:09,297 --> 01:45:10,231
LEARNING AS WE GO.

2785
01:45:10,231 --> 01:45:12,233
>> YES, JUST LOOKING AT
SOME

2786
01:45:12,233 --> 01:45:12,801
QUESTIONS HERE.

2787
01:45:12,801 --> 01:45:14,669
ONE OF THOSE, HOW DO WE BUILD

2788
01:45:14,669 --> 01:45:16,538
TRUST IN MACHINE LEARNING

2789
01:45:16,538 --> 01:45:17,071
MODELS?

2790
01:45:17,071 --> 01:45:19,507
THAT'S LIKE A BIG, BIG QUESTION.

2791
01:45:19,507 --> 01:45:22,343
SO MAYBE IF I COULD TAKE OFF ONE

2792
01:45:22,343 --> 01:45:24,679
PIECE OF THAT AND GET YOUR

2793
01:45:24,679 --> 01:45:24,946
FEEDBACK.

2794
01:45:24,946 --> 01:45:27,582
AGAIN, LET'S SAY YOU HAVE A

2795
01:45:27,582 --> 01:45:29,250
MODEL, LET'S SAY HYPERTENSION,

2796
01:45:29,250 --> 01:45:32,086
SOME MODEL THAT USES A LOT OF

2797
01:45:32,086 --> 01:45:33,021
INFORMATION TO DIAGNOSE PRESENCE

2798
01:45:33,021 --> 01:45:33,955
OR ABSENCE.

2799
01:45:33,955 --> 01:45:36,891
THAT HAS TO GET REGULATORY

2800
01:45:36,891 --> 01:45:41,496
CLEARANCE OR PASS THE REGULATORY

2801
01:45:41,496 --> 01:45:41,830
THRESHOLD.

2802
01:45:41,830 --> 01:45:42,797
BUT IT'S SOLELY DEPENDENT ON THE

2803
01:45:42,797 --> 01:45:49,370
DATA ON WHICH YOU TRAIN THE

2804
01:45:49,370 --> 01:45:49,938
VALIDATOR, RIGHT?

2805
01:45:49,938 --> 01:45:51,573
SO IF YOU NEED TO DEVELOP TRUST

2806
01:45:51,573 --> 01:45:55,710
IN THAT KNOWING IT'S NOT TRAINED

2807
01:45:55,710 --> 01:45:56,711
ON THE FULL POPULATION, WHAT

2808
01:45:56,711 --> 01:45:58,213
WOULD YOU THINK OF THIS IDEA?

2809
01:45:58,213 --> 01:46:00,748
WHAT IF THERE WERE SOME

2810
01:46:00,748 --> 01:46:02,717
STANDARDIZED DATASET FOR OUTCOME

2811
01:46:02,717 --> 01:46:05,353
X, HYPERTENSION, LET'S SAY, AND

2812
01:46:05,353 --> 01:46:08,156
THAT ALL MODELS WERE TRAINED TO

2813
01:46:08,156 --> 01:46:09,724
GET WORK -- AND THIS IS DEFINED

2814
01:46:09,724 --> 01:46:10,725
BY PEOPLE WHO UNDERSTAND PEOPLE

2815
01:46:10,725 --> 01:46:12,560
LIKE DR. SPATZ WHO UNDERSTAND

2816
01:46:12,560 --> 01:46:14,195
THE COMMUNITIES AND NEEDS AND

2817
01:46:14,195 --> 01:46:15,196
PEOPLE, CONTEXT WHERE PEOPLE

2818
01:46:15,196 --> 01:46:16,731
NEED IT, THEY CAN SAY, OKAY, IF

2819
01:46:16,731 --> 01:46:20,001
YOU'RE GOING TO PUT THIS THING

2820
01:46:20,001 --> 01:46:21,970
ON THE MARKET, IT MUST WORK, SHE

2821
01:46:21,970 --> 01:46:23,738
KNOWS THAT POPULATION.

2822
01:46:23,738 --> 01:46:26,708
YOU HAD TO MEET THAT BAR.

2823
01:46:26,708 --> 01:46:29,644
WHAT DO YOU THINK OF SOMETHING

2824
01:46:29,644 --> 01:46:30,512
LIKE THAT?

2825
01:46:30,512 --> 01:46:34,916
STANDARDIZED SETS, YOU HAVE TO

2826
01:46:34,916 --> 01:46:35,517
PERFORM AGAINST?

2827
01:46:35,517 --> 01:46:39,854
>> I'D BE HAPPY TO TAKE
THE

2828
01:46:39,854 --> 01:46:40,155
FIRST STAB.

2829
01:46:40,155 --> 01:46:42,690
SO, I THINK COLLEAGUES ARE DOING

2830
01:46:42,690 --> 01:46:45,226
EXCELLENT WORK WITH DIGITAL

2831
01:46:45,226 --> 01:46:47,061
CENTER NOW, AND ONE OF OUR

2832
01:46:47,061 --> 01:46:48,897
COLLEAGUES IS A CARDIOLOGIST

2833
01:46:48,897 --> 01:46:52,200
ACTUALLY, WE'RE IN THE PROCESS

2834
01:46:52,200 --> 01:46:54,502
OF IMPROVING MODELS NOW.

2835
01:46:54,502 --> 01:46:57,572
YOU SEE THEY PROPOSE WHAT YOU

2836
01:46:57,572 --> 01:46:57,839
PROPOSED.

2837
01:46:57,839 --> 01:46:59,741
BECAUSE THEY HAVE TO TAKE ONE

2838
01:46:59,741 --> 01:47:03,578
BENCH MARK FOR ALL STUDIES, ONE

2839
01:47:03,578 --> 01:47:04,979
FOR HYPERTENSION, USUALLY THESE

2840
01:47:04,979 --> 01:47:08,483
MODELS LOOK AT VERY SPECIFIC

2841
01:47:08,483 --> 01:47:08,750
OUTCOMES.

2842
01:47:08,750 --> 01:47:12,220
WE HAD TO GO TO DIFFERENT

2843
01:47:12,220 --> 01:47:14,088
HOSPITALS WITH DIFFERENT

2844
01:47:14,088 --> 01:47:15,290
DEMOGRAPHICS OF PATIENTS, AND

2845
01:47:15,290 --> 01:47:18,660
SHOW THAT THE WORKS ON ALL OF

2846
01:47:18,660 --> 01:47:21,095
THEM, RIGHT?

2847
01:47:21,095 --> 01:47:27,435
SO I THINK FDA ROLE IS CRUCIAL,

2848
01:47:27,435 --> 01:47:29,070
MAKING SURE MODELS HELP

2849
01:47:29,070 --> 01:47:31,606
PATIENTS, AND USUALLY NEED TO GO

2850
01:47:31,606 --> 01:47:35,443
ONE STEP FURTHER. 

2851
01:47:35,443 --> 01:47:38,279
EXTERNAL VALIDATION IS THE

2852
01:47:38,279 --> 01:47:39,714
ABSOLUTE MUST, BUT HOW

2853
01:47:39,714 --> 01:47:44,185
CLINICIANS USING THE TOOL BEHAVE

2854
01:47:44,185 --> 01:47:45,386
IS ANOTHER VERY IMPORTANT TASK

2855
01:47:45,386 --> 01:47:50,858
BECAUSE MOST OF THESE MODELS ARE

2856
01:47:50,858 --> 01:47:52,193
GIVING THE CLINICIAN ONE

2857
01:47:52,193 --> 01:47:52,961
INSIGHT, RIGHT?

2858
01:47:52,961 --> 01:47:54,128
BUT CLINICIAN IS LOOKING AT THE

2859
01:47:54,128 --> 01:47:55,496
PATIENT, THERE'S A MILLION

2860
01:47:55,496 --> 01:47:56,664
THINGS THEY ARE CONSIDERING,

2861
01:47:56,664 --> 01:47:56,864
RIGHT?

2862
01:47:56,864 --> 01:47:59,634
WE NEED TO SEE IF THAT SPECIFIC

2863
01:47:59,634 --> 01:48:00,802
INSIGHT ACTUALLY IMPROVES THE

2864
01:48:00,802 --> 01:48:03,004
PATIENT CARE OVER THE LONG TERM.

2865
01:48:03,004 --> 01:48:05,640
THE MINIMUM IS AS YOU SUGGESTED

2866
01:48:05,640 --> 01:48:08,576
A BASELINE, A VERY

2867
01:48:08,576 --> 01:48:09,177
DEMOGRAPHIC-SPECIFIC ANALYSIS,

2868
01:48:09,177 --> 01:48:12,413
BUT I THINK WE HAVE TO HAVE A

2869
01:48:12,413 --> 01:48:15,350
HIGHER BAR AND HAVE PRACTICE

2870
01:48:15,350 --> 01:48:15,883
VALIDATION AT WORK.

2871
01:48:15,883 --> 01:48:18,553
>> THAT'S A REALLY
EXCELLENT

2872
01:48:18,553 --> 01:48:20,188
POINT BECAUSE THERE'S UNKNOWN

2873
01:48:20,188 --> 01:48:21,022
EFFECTS ON JUST IMPLEMENTATION,

2874
01:48:21,022 --> 01:48:23,925
NOTHING TO DO WITH THE TECH,

2875
01:48:23,925 --> 01:48:25,226
SLOWLY ON IMPLEMENTATION SIDE,

2876
01:48:25,226 --> 01:48:26,861
UNINTENDED EFFECT YOU DIDN'T

2877
01:48:26,861 --> 01:48:32,233
THINK OF AND MAKE SURE THAT

2878
01:48:32,233 --> 01:48:33,735
WHATEVER YOU'RE IMPLEMENTING IS

2879
01:48:33,735 --> 01:48:36,237
STILL HAVING EFFECTIVENESS WITH

2880
01:48:36,237 --> 01:48:42,944
THOSE FACTORS INCLUDED.

2881
01:48:42,944 --> 01:48:44,145
ANOTHER GOOD QUESTION, WHAT

2882
01:48:44,145 --> 01:48:46,347
PRACTICAL ADVICE WOULD YOU GIVE

2883
01:48:46,347 --> 01:48:49,517
EARLY CAREER CLINICIAN AND

2884
01:48:49,517 --> 01:48:52,020
RESEARCHERS REACHING OUT TO A.I.

2885
01:48:52,020 --> 01:48:52,286
ENGINEERS?

2886
01:48:52,286 --> 01:48:54,555
>> IT'S A GREAT QUESTION.

2887
01:48:54,555 --> 01:48:56,958
I MEAN, WHEN I REACHED OUT TO

2888
01:48:56,958 --> 01:48:58,059
COLLABORATORS WHO WERE

2889
01:48:58,059 --> 01:48:59,794
ENGINEERS, REALLY FILLING THE

2890
01:48:59,794 --> 01:49:02,130
CLINICAL PROBLEM, EXPLAINING

2891
01:49:02,130 --> 01:49:05,600
THAT, GETS THEM EXCITED TO

2892
01:49:05,600 --> 01:49:06,601
PARTNER.

2893
01:49:06,601 --> 01:49:09,003
AND I THINK A LOT OF ENGINEERS

2894
01:49:09,003 --> 01:49:11,205
ARE EXCITED, HOW DO WE DEVELOP A

2895
01:49:11,205 --> 01:49:12,840
MODEL EMPLOYED IN PRACTICE AND

2896
01:49:12,840 --> 01:49:14,142
CHANGE CARE.

2897
01:49:14,142 --> 01:49:16,577
SELLING YOUR STRENGTHS AND THE

2898
01:49:16,577 --> 01:49:18,179
PROBLEM IS REALLY IMPORTANT.

2899
01:49:18,179 --> 01:49:20,181
BUILDING A BACKGROUND SO YOU

2900
01:49:20,181 --> 01:49:21,783
UNDERSTAND BASICS, A TON OF

2901
01:49:21,783 --> 01:49:22,583
SELF-LEARNING OPPORTUNITIES TO

2902
01:49:22,583 --> 01:49:24,552
BUILD UP A BASIC BACKGROUND IN

2903
01:49:24,552 --> 01:49:26,087
BIG DATA SCIENCE, THE SPACE, AND

2904
01:49:26,087 --> 01:49:27,855
SO I THINK LEARNING THE LANGUAGE

2905
01:49:27,855 --> 01:49:31,225
TOO IS REALLY IMPORTANT TO THOSE

2906
01:49:31,225 --> 01:49:31,592
COLLABORATIONS.

2907
01:49:31,592 --> 01:49:34,095
>> YEAH, I'LL DOUBLE ON
THAT

2908
01:49:34,095 --> 01:49:34,295
ONE.

2909
01:49:34,295 --> 01:49:35,830
THAT SECOND ONE.

2910
01:49:35,830 --> 01:49:37,699
IF YOUR EARLY CAREER GETS INTO

2911
01:49:37,699 --> 01:49:40,201
THE WEEDS, ANYBODY CAN LEARN HOW

2912
01:49:40,201 --> 01:49:42,704
TO WRITE CODE THESE DAYS.

2913
01:49:42,704 --> 01:49:43,805
AND STATISTICS.

2914
01:49:43,805 --> 01:49:47,208
MOSTLY I TELL EARLY CAREER

2915
01:49:47,208 --> 01:49:48,276
PHYSICIANS, LEARN STATISTICS.

2916
01:49:48,276 --> 01:49:49,277
THAT'S REALLY IMPORTANT.

2917
01:49:49,277 --> 01:49:51,145
YEAH, HAVE YOU HAD GOOD

2918
01:49:51,145 --> 01:49:51,446
EXPERIENCE?

2919
01:49:51,446 --> 01:49:54,749
>> I MIGHT ECHO THAT
SENTIMENT.

2920
01:49:54,749 --> 01:49:56,918
ON THE FLIP SIDE TOO AS YOU

2921
01:49:56,918 --> 01:49:58,352
START TO LEARN THESE THINGS I

2922
01:49:58,352 --> 01:50:00,555
THINK AS A RESULT YOU'LL THEN

2923
01:50:00,555 --> 01:50:02,523
QUICKLY BE ABLE TO TELL ON THE

2924
01:50:02,523 --> 01:50:05,126
FLIP SLIDE WHO ARE THE ENGINEERS

2925
01:50:05,126 --> 01:50:06,327
INTERESTED IN EMBEDDING WITHIN

2926
01:50:06,327 --> 01:50:09,397
MEDICINE AND LEARNING MORE,

2927
01:50:09,397 --> 01:50:09,630
RIGHT?

2928
01:50:09,630 --> 01:50:12,567
I CAN GO AND AT LEAST SPEAK TO

2929
01:50:12,567 --> 01:50:13,434
SOME EXTENT OF CARDIOVASCULAR

2930
01:50:13,434 --> 01:50:14,802
PROBLEMS AND CHALLENGES OF

2931
01:50:14,802 --> 01:50:18,039
COLLECTING DATA AND, YOU KNOW,

2932
01:50:18,039 --> 01:50:18,806
UNDERSTANDING THAT A

2933
01:50:18,806 --> 01:50:20,441
REINFORCEMENT LEARNING ALGORITHM

2934
01:50:20,441 --> 01:50:22,310
PLAYS A GAME AND FAILS A FEW

2935
01:50:22,310 --> 01:50:24,612
TIMES UNTIL IT LEARNS IS FINE

2936
01:50:24,612 --> 01:50:26,914
BUT YOU CAN'T INTENTIONALLY FAIL

2937
01:50:26,914 --> 01:50:29,751
50 TIMES WITH A PERSON.

2938
01:50:29,751 --> 01:50:33,488
YOU'LL START TO FIND MORE

2939
01:50:33,488 --> 01:50:34,055
ENGAGED COLLABORATORS THERE

2940
01:50:34,055 --> 01:50:35,123
EXCITED ABOUT TRYING TO SOLVE A

2941
01:50:35,123 --> 01:50:45,299
CLINICAL PROBLEM VERSE  --  VERS

2942
01:50:45,299 --> 01:50:47,635
THE ONES WITH SOMETHING THEY CAN

2943
01:50:47,635 --> 01:50:49,437
RUNOFF LINE, THERE ARE DIFFERENT

2944
01:50:49,437 --> 01:50:51,105
LEVELS OF COLLABORATIONS BUT THE

2945
01:50:51,105 --> 01:50:52,940
MOST SUCCESSFUL WILL MAKE

2946
01:50:52,940 --> 01:50:54,041
GROUNDBREAKING SOLUTIONS, THAT

2947
01:50:54,041 --> 01:50:55,777
CAN GET BOTH SIDES INTO THE

2948
01:50:55,777 --> 01:50:57,111
NITTY-GRITTY SO THEY ARE WILLING

2949
01:50:57,111 --> 01:51:00,114
TO BE ENGAGED AT A FREQUENT

2950
01:51:00,114 --> 01:51:00,314
BASIS.

2951
01:51:00,314 --> 01:51:05,753
>> YEAH, IF WE BRING IT
BACK TO

2952
01:51:05,753 --> 01:51:06,954
THE NIH AND NHLBI, THERE ARE

2953
01:51:06,954 --> 01:51:10,992
WAYS, MAYBE THERE ARE WAYS THAT

2954
01:51:10,992 --> 01:51:11,425
THE NATIONAL FUNDING

2955
01:51:11,425 --> 01:51:12,393
ORGANIZATIONS, YOU KNOW, CAN

2956
01:51:12,393 --> 01:51:13,194
SUPPORT THIS.

2957
01:51:13,194 --> 01:51:14,462
YOU HAVE TO REALLY GET OUT OF

2958
01:51:14,462 --> 01:51:17,698
YOUR COMFORT ZONE TO DO THIS

2959
01:51:17,698 --> 01:51:19,567
WORK AND OF COURSE THERE'S

2960
01:51:19,567 --> 01:51:20,201
WONDERFUL CAREER DEVELOPMENT

2961
01:51:20,201 --> 01:51:22,837
PROGRAMS AT THE NIH THAT CAN BE

2962
01:51:22,837 --> 01:51:24,605
GEARED TOWARDS THIS NEED WHICH I

2963
01:51:24,605 --> 01:51:27,675
THINK WE CLEARLY IDENTIFY HERE.

2964
01:51:27,675 --> 01:51:32,480
ALL RIGHT. 

2965
01:51:32,480 --> 01:51:32,880
LET'S SEE.

2966
01:51:32,880 --> 01:51:35,082
I GUESS, DO YOU HAVE ANY

2967
01:51:35,082 --> 01:51:35,349
QUESTIONS?

2968
01:51:35,349 --> 01:51:38,686
WE HAVE A BREAK PLANNED HERE.

2969
01:51:38,686 --> 01:51:41,322
>> I DON'T KNOW IF YOU SAW
--

2970
01:51:41,322 --> 01:51:42,190
YOU MIGHT HAVE ADDRESSED MY

2971
01:51:42,190 --> 01:51:43,424
QUESTION IN THE CHAT TALKING

2972
01:51:43,424 --> 01:51:46,661
ABOUT EARLY YEAR.

2973
01:51:46,661 --> 01:51:53,734
>> LET ME GO BACK HERE. 

2974
01:51:53,734 --> 01:51:55,336
>> I CAN REITERATE.

2975
01:51:55,336 --> 01:51:59,073
I SEE THE VALUE OF A.I.,

2976
01:51:59,073 --> 01:51:59,740
CERTAINLY.

2977
01:51:59,740 --> 01:52:03,444
I'M THINKING FROM THE POINT OF

2978
01:52:03,444 --> 01:52:05,413
VIEW PREVENTIVE CARE, CLINICAL

2979
01:52:05,413 --> 01:52:08,916
CARE, WITH A YOUNG PHYSICIAN OR

2980
01:52:08,916 --> 01:52:10,251
MID-CAREER USING THESE, DO THEY

2981
01:52:10,251 --> 01:52:12,553
HAVE TO UNDERSTAND WHAT'S UNDER

2982
01:52:12,553 --> 01:52:15,256
THE HOOD IN ORDER TO IMPLEMENT?

2983
01:52:15,256 --> 01:52:17,425
I.E. UNDERSTAND ITS LIMITATIONS

2984
01:52:17,425 --> 01:52:19,660
AND STRENGTHS? 

2985
01:52:19,660 --> 01:52:20,628
YOU'RE HANDING A TOOL TO

2986
01:52:20,628 --> 01:52:22,496
SOMEBODY, DO YOU SEE WHAT I'M

2987
01:52:22,496 --> 01:52:22,730
SAYING?

2988
01:52:22,730 --> 01:52:24,799
HOW MUCH DO THEY HAVE TO KNOW OR

2989
01:52:24,799 --> 01:52:28,836
SHOULD WE RELY JUST ON YOU ALL

2990
01:52:28,836 --> 01:52:31,339
WHO CROSS THE DIVIDE?

2991
01:52:31,339 --> 01:52:33,007
DID YOU UNDERSTAND WHAT I'M

2992
01:52:33,007 --> 01:52:34,609
SAYING? 

2993
01:52:34,609 --> 01:52:35,743
THAT'S THE QUESTION, NOT A

2994
01:52:35,743 --> 01:52:36,110
COMMENT.

2995
01:52:36,110 --> 01:52:37,712
I DON'T KNOW WHAT THE ANSWER IS

2996
01:52:37,712 --> 01:52:40,214
BUT I THOUGHT IT WOULD POSE IT

2997
01:52:40,214 --> 01:52:41,182
TO YOU ALL.

2998
01:52:41,182 --> 01:52:44,051
>> I CAN START AND OTHERS
CAN

2999
01:52:44,051 --> 01:52:44,719
JUMP IN.

3000
01:52:44,719 --> 01:52:46,687
IT DEPENDS ON USE CASE, SOME

3001
01:52:46,687 --> 01:52:49,090
CASES IN WHICH THEY DO NEED TO

3002
01:52:49,090 --> 01:52:49,891
HAVE SOME DEEPER UNDERSTANDING

3003
01:52:49,891 --> 01:52:52,693
WHAT'S UNDER THE HOOD.

3004
01:52:52,693 --> 01:52:54,662
OTHER USE CASES WHERE IF IT'S A

3005
01:52:54,662 --> 01:52:58,065
TOOL OR DEVICE TESTED IN A

3006
01:52:58,065 --> 01:52:59,267
RANDOMIZED CONTROLLED TRIAL AND

3007
01:52:59,267 --> 01:53:01,135
MEETS EVIDENCE BAR TO BE USED IN

3008
01:53:01,135 --> 01:53:01,869
PRACTICE THEY PROBABLY DON'T

3009
01:53:01,869 --> 01:53:02,937
NEED TO UNDERSTAND DETAILS OF

3010
01:53:02,937 --> 01:53:07,041
ALGORITHM BUT NEED TO UNDERSTAND

3011
01:53:07,041 --> 01:53:08,242
THE EVIDENCE THAT THE STUDY,

3012
01:53:08,242 --> 01:53:11,212
DETAILS OF THE STUDY THAT TEST

3013
01:53:11,212 --> 01:53:21,055
IT TO USE IT, HOW TO USE IT. 

3014
01:53:21,055 --> 01:53:21,822
>> THE CURRENT GENERATION

3015
01:53:21,822 --> 01:53:23,991
WORKING ON THESE THINGS NEED TO

3016
01:53:23,991 --> 01:53:25,526
HAVE SOME EXPERIENCE, YOU KNOW,

3017
01:53:25,526 --> 01:53:29,096
SOME MERGED PROGRAM OF

3018
01:53:29,096 --> 01:53:31,332
ENGINEERING/MEDICINE TO HELP

3019
01:53:31,332 --> 01:53:32,767
DEVELOP, VALIDATE, DEVELOP TRUST

3020
01:53:32,767 --> 01:53:34,368
IN THE TECHNIQUES, UNTIL A POINT

3021
01:53:34,368 --> 01:53:36,037
IN WHICH THEY BECOME COMMON

3022
01:53:36,037 --> 01:53:38,873
ENOUGH THAT YOU CAN THEN

3023
01:53:38,873 --> 01:53:39,874
ABSTRACT DETAILS AND TRUST YOU

3024
01:53:39,874 --> 01:53:41,842
KNOW WHAT IT'S DOING AND WHY IT

3025
01:53:41,842 --> 01:53:43,311
PRODUCES WHAT IT PRODUCES

3026
01:53:43,311 --> 01:53:44,111
WITHOUT UNDERSTANDING WHAT IT'S

3027
01:53:44,111 --> 01:53:54,622
DOING UNDER THE HOOD. 

3028
01:53:54,622 --> 01:53:55,156
>> I AGREE.

3029
01:53:55,156 --> 01:53:57,091
IF YOU WANT TO BE PART OF

3030
01:53:57,091 --> 01:53:59,260
BUILDING THE TOOL YOU GOT TO

3031
01:53:59,260 --> 01:54:00,895
UNDERSTAND A LOT MORE THAN IF

3032
01:54:00,895 --> 01:54:02,630
YOU'RE ON THE DELIVERY SIDE,

3033
01:54:02,630 --> 01:54:11,539
WHERE YOU HAVE TO UNDERSTAND THE

3034
01:54:11,539 --> 01:54:12,073
TYPICAL THINGS ABOUT

3035
01:54:12,073 --> 01:54:13,607
INTERVENTION, DOES THIS MATCH

3036
01:54:13,607 --> 01:54:14,709
THE POPULATION I'M TREATING,

3037
01:54:14,709 --> 01:54:16,544
WHAT'S THE TREATMENT EFFECT, DO

3038
01:54:16,544 --> 01:54:20,715
I HAVE TO THINK ABOUT PRE-TEST

3039
01:54:20,715 --> 01:54:22,350
PROBABILITY, THAT SORT OF THING.

3040
01:54:22,350 --> 01:54:23,484
IF YOU WANT TO BUILD TOOLS THEN

3041
01:54:23,484 --> 01:54:26,087
YOU HAVE TO GET INTO THE WEEDS I

3042
01:54:26,087 --> 01:54:28,155
THINK. 

3043
01:54:28,155 --> 01:54:33,361
>> THANK YOU FOR ANSWERING
MY

3044
01:54:33,361 --> 01:54:36,030
QUESTION. 

3045
01:54:36,030 --> 01:54:39,333
>> DO YOU THINK WE SHOULD
GO TO

3046
01:54:39,333 --> 01:54:39,533
BREAK?

3047
01:54:39,533 --> 01:54:43,904
>> YEAH, WHY DON'T WE TAKE
A

3048
01:54:43,904 --> 01:54:46,474
BREAK HERE, BIO-BREAK, GRAB SOME

3049
01:54:46,474 --> 01:54:48,976
COFFEE, AND THEN AT 1:15 WE'LL

3050
01:54:48,976 --> 01:54:51,912
BE BACK FOR SESSION 2, BLOOD

3051
01:54:51,912 --> 01:54:52,480
PRESSURE MEASUREMENT,

3052
01:54:52,480 --> 01:54:54,081
HYPERTENSION RISK, BLOOD

3053
01:54:54,081 --> 01:54:54,849
PRESSURE CONTROL.

3054
01:54:54,849 --> 01:54:56,543
SO WE'LL TAKE A SHORT BREAK

3055
01:54:56,543 --> 01:54:58,512
WE'RE GOING TO KEEP MOVING

3056
01:54:58,512 --> 01:54:58,846
FORWARD HERE.

3057
01:54:58,846 --> 01:55:01,248
FIRST I WANT TO THANK THE

3058
01:55:01,248 --> 01:55:04,451
SPEAKERS FROM SESSION 1, REALLY

3059
01:55:04,451 --> 01:55:05,752
LAID SOME EXCELLENT GROUND WORK.

3060
01:55:05,752 --> 01:55:06,720
YOU KNOW, LAYING OUT THE STATE

3061
01:55:06,720 --> 01:55:10,023
OF THE FIELD FROM THE TECH AND

3062
01:55:10,023 --> 01:55:11,458
ENGINEERING SIDE TO MOVE FORWARD

3063
01:55:11,458 --> 01:55:12,326
ON THE NEXT SESSIONS.

3064
01:55:12,326 --> 01:55:15,295
THANK YOU TO ALL THREE OF YOU.

3065
01:55:15,295 --> 01:55:17,831
NOW TO SESSION 2, I'LL INTRODUCE

3066
01:55:17,831 --> 01:55:24,738
OUR MODERATOR, DR. KEITH

3067
01:55:24,738 --> 01:55:26,340
FERDINAND, ENDOWED CHAIR AT

3068
01:55:26,340 --> 01:55:29,209
PROFESSOR AT TULANE UNIVERSITY,

3069
01:55:29,209 --> 01:55:32,446
NATIONAL LEADER AND CHAMPION IN

3070
01:55:32,446 --> 01:55:32,913
PREVENTIVE CARDIOLOGY,

3071
01:55:32,913 --> 01:55:35,115
PARTICULARLY RACIAL AND ETHNIC

3072
01:55:35,115 --> 01:55:37,150
MINORITIES AND PUSHING US

3073
01:55:37,150 --> 01:55:38,819
FORWARD IN FOCUSING ON AND NOT

3074
01:55:38,819 --> 01:55:41,154
LOSE EVER SIGHT OF HEALTH EQUITY

3075
01:55:41,154 --> 01:55:42,589
THINGS WE NEED TO FOCUS ON.

3076
01:55:42,589 --> 01:55:44,524
IT'S MY PLEASURE TO INTRODUCE

3077
01:55:44,524 --> 01:55:46,159
KEITH FERDINAND AS THE MODERATOR

3078
01:55:46,159 --> 01:55:46,660
OF OUR NEXT SESSION.

3079
01:55:46,660 --> 01:55:49,663
>> THANK YOU FOR THE KIND

3080
01:55:49,663 --> 01:55:50,097
PRODUCTION.

3081
01:55:50,097 --> 01:55:54,601
SESSION 2 IS GOING TO LOOK AT

3082
01:55:54,601 --> 01:55:55,702
BLOOD PRESSURE MEASUREMENT,

3083
01:55:55,702 --> 01:55:56,670
HYPERTENSION RISK AND BLOOD

3084
01:55:56,670 --> 01:55:58,338
PRESSURE CONTROL.

3085
01:55:58,338 --> 01:56:00,073
WE HAVE EXCELLENT SPEAKERS,

3086
01:56:00,073 --> 01:56:03,243
DIVERSE IN TERMS OF GEOGRAPHY

3087
01:56:03,243 --> 01:56:05,679
AND INTEREST, STARTING WITH DR.

3088
01:56:05,679 --> 01:56:06,413
ABDULLAH, FROM COLUMBIA

3089
01:56:06,413 --> 01:56:09,483
UNIVERSITY IN NEW YORK,

3090
01:56:09,483 --> 01:56:11,018
DISCUSSING BLOOD PRESSURE

3091
01:56:11,018 --> 01:56:12,786
MEASUREMENT INSIDE AND OUTSIDE

3092
01:56:12,786 --> 01:56:15,956
OF THE OFFICE.

3093
01:56:15,956 --> 01:56:18,592
DR. ABDALLA, YOU MAY START.

3094
01:56:18,592 --> 01:56:28,969
>> THANK YOU SO MUCH.

3095
01:56:31,338 --> 01:56:33,240
I'M GOING TO DISCUSS DEVICES

3096
01:56:33,240 --> 01:56:40,480
USED FOR BLOOD PRESSURE

3097
01:56:40,480 --> 01:56:41,682
MEASUREMENT, GUIDELINE

3098
01:56:41,682 --> 01:56:43,317
APPROACHES, FOR FUTURE RESHAPED

3099
01:56:43,317 --> 01:56:44,751
BY CURRENT APPS IN LITERATURE.

3100
01:56:44,751 --> 01:56:45,552
BLOOD PRESSURE IS TYPICALLY

3101
01:56:45,552 --> 01:56:50,991
MEASURED IN THE OFFICE FROM THE

3102
01:56:50,991 --> 01:56:52,726
BRACHIAL ARTERY, THIS WAS DONE

3103
01:56:52,726 --> 01:57:00,267
USING MERCURY COLUMN  DEVICE, NW

3104
01:57:00,267 --> 01:57:04,438
RECOMMENDING USE OF AUTOMATIC

3105
01:57:04,438 --> 01:57:05,772
DEVICE FOLLOWING A STANDARDIZED

3106
01:57:05,772 --> 01:57:10,043
PROCEED 

3107
01:57:10,043 --> 01:57:13,113
PROTOCOL, SEATED FOR FIVE

3108
01:57:13,113 --> 01:57:15,649
MINUTES, NOT OFTEN DONE IN BUSY

3109
01:57:15,649 --> 01:57:16,183
OFFICE SETTINGS.

3110
01:57:16,183 --> 01:57:18,585
WE MEASURE IN OFFICE TO DIAGNOSE

3111
01:57:18,585 --> 01:57:28,462
WITH HYPERTENSION OR HIGH BLOOD

3112
01:57:28,462 --> 01:57:30,297
PRESSURE OR BLOOD PRESSURE

3113
01:57:30,297 --> 01:57:30,530
CONTROL.

3114
01:57:30,530 --> 01:57:34,901
BLOOD PRESSURE IN THE OFFICE HAS

3115
01:57:34,901 --> 01:57:38,538
MANY LIMITATIONS, FOR SOME IT IS

3116
01:57:38,538 --> 01:57:40,273
NOT REFLECTIVE OF THE OUTSIDE

3117
01:57:40,273 --> 01:57:40,574
ENVIRONMENT.

3118
01:57:40,574 --> 01:57:44,878
OUT OF OFFICE BLOOD PRESSURE CAN

3119
01:57:44,878 --> 01:57:46,079
PROVIDE MORE DATA POINTS,

3120
01:57:46,079 --> 01:57:47,047
COMPARED WITH THE SNAPSHOT

3121
01:57:47,047 --> 01:57:49,583
COMING INTO THE OFFICE WITH

3122
01:57:49,583 --> 01:57:49,950
CLINICIAN.

3123
01:57:49,950 --> 01:57:51,785
AND CAN TELL US REALLY HOW BLOOD

3124
01:57:51,785 --> 01:57:53,186
PRESSURE MAY VARY EITHER OVER

3125
01:57:53,186 --> 01:57:56,056
24-HOUR PERIOD OR SEVERAL DAYS

3126
01:57:56,056 --> 01:57:59,126
OR WEEKS.

3127
01:57:59,126 --> 01:58:00,961
MULTIPLE DATA HAS SHOWN IT MAY

3128
01:58:00,961 --> 01:58:03,196
BE ASSOCIATED WITH DISEASE

3129
01:58:03,196 --> 01:58:05,699
OUTCOMES COMPARED TO OFFICE

3130
01:58:05,699 --> 01:58:09,636
BLOOD PRESSURE, THE 2017 ACC/AHA

3131
01:58:09,636 --> 01:58:10,504
GUIDELINES AND 21 GUIDELINES

3132
01:58:10,504 --> 01:58:13,273
RECOMMEND OUT OF OFFICE BLOOD

3133
01:58:13,273 --> 01:58:20,047
PRESSURE FOR DIAGNOSTIC

3134
01:58:20,047 --> 01:58:20,380
CONFIRMATION.

3135
01:58:20,380 --> 01:58:25,218
THE 2017 SPECIFIC OUT OF OFFICE

3136
01:58:25,218 --> 01:58:26,053
FOR MEDS.

3137
01:58:26,053 --> 01:58:27,687
THERE ARE TWO WAYS BLOOD

3138
01:58:27,687 --> 01:58:29,022
PRESSURE IS TYPICALLY MEASURED

3139
01:58:29,022 --> 01:58:36,663
OUTSIDE THE OFFICE, USING

3140
01:58:36,663 --> 01:58:37,030
AUTOMATED.

3141
01:58:37,030 --> 01:58:40,300
ON THE LEFT SIDE WORN FOR 24 OR

3142
01:58:40,300 --> 01:58:43,236
48 HOURS, CAN MEASURE BLOOD

3143
01:58:43,236 --> 01:58:44,638
PRESSURE FREQUENTLY THROUGH THE

3144
01:58:44,638 --> 01:58:46,306
AWAKE OR DAYTIME PERIOD, OR

3145
01:58:46,306 --> 01:58:47,507
SLEEP NIGHTTIME PERIOD.

3146
01:58:47,507 --> 01:58:48,942
DOES NOT REQUIRE AN INDIVIDUAL

3147
01:58:48,942 --> 01:58:50,977
TO INITIATE BLOOD PRESSURE

3148
01:58:50,977 --> 01:58:51,378
READINGS.

3149
01:58:51,378 --> 01:58:54,414
THE OTHER IS HOME BLOOD PRESSURE

3150
01:58:54,414 --> 01:58:55,482
MONITORING, SELF-MEASURED BLOOD

3151
01:58:55,482 --> 01:58:55,782
PRESSURE.

3152
01:58:55,782 --> 01:58:57,217
WHICH DOES REQUIRE AN INDIVIDUAL

3153
01:58:57,217 --> 01:58:58,752
TO INITIATE BLOOD PRESSURE

3154
01:58:58,752 --> 01:59:00,954
READINGS, THE DEVICE IS USED

3155
01:59:00,954 --> 01:59:03,690
OVER SEVERAL DAYS OR WEEKS.

3156
01:59:03,690 --> 01:59:04,458
I'LL PROVIDE ADDITIONAL

3157
01:59:04,458 --> 01:59:05,659
INFORMATION ON EACH LATER.

3158
01:59:05,659 --> 01:59:09,529
FIRST I WANT TO TALK ABOUT THE

3159
01:59:09,529 --> 01:59:12,132
LIMITATIONS OF OFFICE BLOOD

3160
01:59:12,132 --> 01:59:12,499
PRESSURE.

3161
01:59:12,499 --> 01:59:13,967
IN PARTICULAR INCLUDING THE

3162
01:59:13,967 --> 01:59:16,503
INABILITY TO IDENTIFY CERTAIN

3163
01:59:16,503 --> 01:59:18,438
ABNORMAL BLOOD PRESSURE

3164
01:59:18,438 --> 01:59:18,738
PHENOTYPES.

3165
01:59:18,738 --> 01:59:19,873
TRADITIONAL DEFINITION OF

3166
01:59:19,873 --> 01:59:21,608
HYPERTENSION IS BASED ON OFFICE

3167
01:59:21,608 --> 01:59:23,944
BLOOD PRESSURE REPRESENTED HERE

3168
01:59:23,944 --> 01:59:25,445
ON THE LEFT SIDE.

3169
01:59:25,445 --> 01:59:27,114
WHEN YOU CROSS-CLASSIFY OFFICE

3170
01:59:27,114 --> 01:59:29,916
BLOOD PRESSURE WITH OUT OF

3171
01:59:29,916 --> 01:59:31,118
OFFICE, USING HOME BLOOD

3172
01:59:31,118 --> 01:59:33,887
PRESSURE MONITORING OR AWAKE OR

3173
01:59:33,887 --> 01:59:37,924
DAYTIME ABPM WE HAVE FOUR

3174
01:59:37,924 --> 01:59:38,225
PHENOTYPES.

3175
01:59:38,225 --> 01:59:40,327
TWO HIGHLIGHTED IN RED REPRESENT

3176
01:59:40,327 --> 01:59:42,863
A MISMATCH.

3177
01:59:42,863 --> 01:59:43,497
WHITE COAT HYPERTENSION, HIGH

3178
01:59:43,497 --> 01:59:44,498
OFFICE BLOOD PRESSURE BUT OUT OF

3179
01:59:44,498 --> 01:59:48,535
OFFICE IS NOT HIGHER THAN

3180
01:59:48,535 --> 01:59:49,636
NORMAL.

3181
01:59:49,636 --> 01:59:50,737
THE SECOND IS MASKED

3182
01:59:50,737 --> 01:59:53,140
HYPERTENSION, WHERE OFFICE BLOOD

3183
01:59:53,140 --> 01:59:56,510
PRESSURE IS NOT HIGH BUT OUT OF

3184
01:59:56,510 --> 01:59:57,611
OFFICE IS HIGH.

3185
01:59:57,611 --> 01:59:59,379
IT IS OFTEN MISSED IN THE OFFICE

3186
01:59:59,379 --> 02:00:00,147
BECAUSE OBVIOUSLY OFFICE BLOOD

3187
02:00:00,147 --> 02:00:01,781
PRESSURE IS NOT HIGH BY

3188
02:00:01,781 --> 02:00:04,184
DEFINITION BUT AN EXTREMELY

3189
02:00:04,184 --> 02:00:07,154
DANGEROUS PHENOTYPE ASSOCIATED

3190
02:00:07,154 --> 02:00:08,355
WITH CARDIOVASCULAR DISEASE

3191
02:00:08,355 --> 02:00:08,588
EVENTS.

3192
02:00:08,588 --> 02:00:10,957
COMPARED TO OFFICE BLOOD

3193
02:00:10,957 --> 02:00:15,996
PRESSURE, AMBULATORY MONITOR CAN

3194
02:00:15,996 --> 02:00:18,732
TAKE AUTOMATED READINGS EVERY 15

3195
02:00:18,732 --> 02:00:21,034
TO 30 MINUTES OVER A 24-HOUR

3196
02:00:21,034 --> 02:00:22,269
PERIOD.

3197
02:00:22,269 --> 02:00:24,971
ON THE RIGHT HIGHEST IN AWAKE OR

3198
02:00:24,971 --> 02:00:26,840
DAYTIME PERIOD, AND THAT DIP

3199
02:00:26,840 --> 02:00:29,242
DURING THE SLEEP PERIOD.

3200
02:00:29,242 --> 02:00:31,878
ADPM CAN IDENTIFY SEVERAL BLOOD

3201
02:00:31,878 --> 02:00:32,546
PRESSURE PHENOTYPES INCLUDING

3202
02:00:32,546 --> 02:00:34,614
ELEVATION IN BLOOD PRESSURE IN

3203
02:00:34,614 --> 02:00:37,918
SLEEP OR 24-HOUR PATTERN OF

3204
02:00:37,918 --> 02:00:39,653
BLOOD PRESSURE, INCLUDING

3205
02:00:39,653 --> 02:00:40,420
DIPPING.

3206
02:00:40,420 --> 02:00:43,023
I MENTIONED CAN DETECT WHITE

3207
02:00:43,023 --> 02:00:46,860
COAT AND MASKED, CAN BE USED TO

3208
02:00:46,860 --> 02:00:49,162
DIAGNOSE WITH POSTPRANDIAL,

3209
02:00:49,162 --> 02:00:52,866
POSTURAL OR DRUG INDUCED

3210
02:00:52,866 --> 02:00:53,166
HYPOTENSION.

3211
02:00:53,166 --> 02:00:54,501
AMBULATORY BLOOD PRESSURE HAS

3212
02:00:54,501 --> 02:00:56,136
STRONGER ASSOCIATION WITH

3213
02:00:56,136 --> 02:00:58,371
CARDIOVASCULAR DISEASE EVENTS

3214
02:00:58,371 --> 02:01:00,440
THAN OFFICE BLOOD PRESSURE.

3215
02:01:00,440 --> 02:01:03,043
THERE ARE SEVERAL LIMITATIONS.

3216
02:01:03,043 --> 02:01:04,477
SEVERAL STUDIES REPORTED POOR

3217
02:01:04,477 --> 02:01:09,616
PATIENT TOLERABILITY FROM THE

3218
02:01:09,616 --> 02:01:11,685
CUFF INFLATING SO FREQUENTLY, UP

3219
02:01:11,685 --> 02:01:13,687
TO HALF REPORTED SLEEP

3220
02:01:13,687 --> 02:01:14,654
DISRUPTION.

3221
02:01:14,654 --> 02:01:16,523
IT'S EXPENSIVE, COSTS MORE THAN

3222
02:01:16,523 --> 02:01:16,756
$2,000.

3223
02:01:16,756 --> 02:01:19,693
DEVICES HAVE TO BE PLACED AT

3224
02:01:19,693 --> 02:01:20,894
SPECIALIZED CENTERS WHERE DEVICE

3225
02:01:20,894 --> 02:01:23,630
MUST BE RETURNED, DATA

3226
02:01:23,630 --> 02:01:24,164
DOWNLOADED, PREPARED,

3227
02:01:24,164 --> 02:01:26,266
INTERPRETATION OF REPORTS DOES

3228
02:01:26,266 --> 02:01:27,567
REQUIRE EXPERTISE.

3229
02:01:27,567 --> 02:01:30,170
THE DEVICE ISN'T READILY

3230
02:01:30,170 --> 02:01:31,071
AVAILABLE.

3231
02:01:31,071 --> 02:01:31,938
OVERALL UTILIZATION OF ABPM IN

3232
02:01:31,938 --> 02:01:34,774
THE U.S. IS LOW DESPITE THE FACT

3233
02:01:34,774 --> 02:01:38,278
THAT CMS HAS BEEN REIMBURSING

3234
02:01:38,278 --> 02:01:42,115
ALBEIT AT LOWER RATES TO DETECT

3235
02:01:42,115 --> 02:01:44,384
WHITE COAT HYPERTENSION FOR

3236
02:01:44,384 --> 02:01:46,219
ALMOST TWO DECADES.

3237
02:01:46,219 --> 02:01:51,858
FROM 2007 TO 2010 ONLY 0.1% OF

3238
02:01:51,858 --> 02:01:53,927
MEDICARE PATIENTS,

3239
02:01:53,927 --> 02:01:57,430
BENEFICIARIES, ACTUALLY HAD ABPM

3240
02:01:57,430 --> 02:01:57,998
CLAIMS.

3241
02:01:57,998 --> 02:01:59,499
IN CONTRAST HOME OR

3242
02:01:59,499 --> 02:02:00,800
SELF-MEASURED IS MORE WIDELY

3243
02:02:00,800 --> 02:02:02,569
AVAILABLE, MAYBE A MORE

3244
02:02:02,569 --> 02:02:05,071
PRAGMATIC APPROACH IN CLINICAL

3245
02:02:05,071 --> 02:02:05,672
PRACTICE.

3246
02:02:05,672 --> 02:02:06,940
TO DO IT PROPERLY DOES REQUIRE

3247
02:02:06,940 --> 02:02:09,876
CERTAIN AMOUNT OF TRAINING OF

3248
02:02:09,876 --> 02:02:10,210
OUR PATIENTS.

3249
02:02:10,210 --> 02:02:11,177
BLOOD PRESSURE MEASUREMENT

3250
02:02:11,177 --> 02:02:13,947
SHOULD BE OBTAINED FOLLOWING

3251
02:02:13,947 --> 02:02:16,116
PROTOCOL SIMILAR TO WHAT SHOULD

3252
02:02:16,116 --> 02:02:19,185
BE PERFORMED IN THE OFFICE.

3253
02:02:19,185 --> 02:02:20,153
GUIDELINES SUGGEST INDIVIDUALS

3254
02:02:20,153 --> 02:02:22,155
PERFORM TWO READINGS IN THE

3255
02:02:22,155 --> 02:02:24,691
MORNING, TWO AT NIGHT, FOR SEVEN

3256
02:02:24,691 --> 02:02:25,025
DAYS.

3257
02:02:25,025 --> 02:02:26,760
THERE'S SOME DATA TO SHOW THAT

3258
02:02:26,760 --> 02:02:29,829
THREE DAYS OF READINGS ARE

3259
02:02:29,829 --> 02:02:30,497
ACCEPTABLE.

3260
02:02:30,497 --> 02:02:32,432
AND IN GENERAL PEOPLE THINK THIS

3261
02:02:32,432 --> 02:02:35,735
IS MUCH MORE FEASIBLE WHEN

3262
02:02:35,735 --> 02:02:36,503
COMPARED TO ABPM.

3263
02:02:36,503 --> 02:02:38,905
WHAT ARE THE LIMITATIONS OF HOME

3264
02:02:38,905 --> 02:02:41,975
BLOOD PRESSURE MONITORING?

3265
02:02:41,975 --> 02:02:44,377
UNLIKE ABPM MOST HOME BLOOD

3266
02:02:44,377 --> 02:02:46,112
PRESSURE DEVICES CAN'T MEASURE

3267
02:02:46,112 --> 02:02:47,113
BLOOD PRESSURE DURING SLEEP,

3268
02:02:47,113 --> 02:02:52,285
THOUGH THERE ARE NOCTURNAL

3269
02:02:52,285 --> 02:02:53,453
DEVICES, NOT WIDELY AVAILABLE,

3270
02:02:53,453 --> 02:02:56,489
OUR THE COUNTER DEVICES ARE NOT

3271
02:02:56,489 --> 02:02:58,591
VALIDATED, PATIENTS MAY PICK UP

3272
02:02:58,591 --> 02:03:00,060
SOMETHING THAT IS A DEVICE

3273
02:03:00,060 --> 02:03:03,797
THAT'S NOT CORRECT.

3274
02:03:03,797 --> 02:03:05,098
OFTEN THEY ONLY SUPPLY ONE CUFF

3275
02:03:05,098 --> 02:03:05,965
SIZE.

3276
02:03:05,965 --> 02:03:08,401
MANY ARE NOT USING THE CORRECT

3277
02:03:08,401 --> 02:03:11,037
CUFF SIZE.

3278
02:03:11,037 --> 02:03:12,872
BEST USUALLY WITH

3279
02:03:12,872 --> 02:03:13,273
CO-INTERVENTIONS.

3280
02:03:13,273 --> 02:03:21,247
AUTOMATIC RECORDING IS NOT

3281
02:03:21,247 --> 02:03:23,383
ALWAYS AVAILABLE, COPY OF A

3282
02:03:23,383 --> 02:03:24,017
PATIENT BRINGING IN BLOOD

3283
02:03:24,017 --> 02:03:27,554
PRESSURE RECORDINGS ON A PIECE

3284
02:03:27,554 --> 02:03:29,522
OF PAPER.

3285
02:03:29,522 --> 02:03:30,990
LONG-TERM ADHERENCE IS CHALLENGE

3286
02:03:30,990 --> 02:03:32,025
ASKING SOMEONE OVER DAYS OR

3287
02:03:32,025 --> 02:03:34,361
WEEKS OR MONTHS TO CONTINUE

3288
02:03:34,361 --> 02:03:35,895
CHECKING BLOOD PRESSURE TWICE IN

3289
02:03:35,895 --> 02:03:38,832
THE MORNING, TWICE AT NIGHT.

3290
02:03:38,832 --> 02:03:42,035
AGAIN, REIMBURSEMENT RATES ARE

3291
02:03:42,035 --> 02:03:42,202
LOW.

3292
02:03:42,202 --> 02:03:43,570
MAIN CHALLENGES IS BLOOD

3293
02:03:43,570 --> 02:03:44,938
PRESSURE THRESHOLDS, CHASE TO

3294
02:03:44,938 --> 02:03:46,172
UNDERSTAND WHAT MODALITY

3295
02:03:46,172 --> 02:03:47,173
PROVIDES THE BEST ESTIMATE OF

3296
02:03:47,173 --> 02:03:48,375
TRUE BLOOD PRESSURE.

3297
02:03:48,375 --> 02:03:50,243
TO QUOTE THE GUIDELINES PRO

3298
02:03:50,243 --> 02:03:51,978
SIGHS RELATIONSHIP BETWEEN

3299
02:03:51,978 --> 02:03:53,546
OFFICE READINGS, AMBULATORY AND

3300
02:03:53,546 --> 02:03:55,248
HOME READINGS IS UNSETTLED.

3301
02:03:55,248 --> 02:03:56,249
THERE'S GENERAL AGREEMENT THAT

3302
02:03:56,249 --> 02:03:57,884
OFFICE BLOOD PRESSURES ARE OFTEN

3303
02:03:57,884 --> 02:04:00,653
HIGHER THAN AMBULATORY AND HOME

3304
02:04:00,653 --> 02:04:01,955
BLOOD PRESSURES.

3305
02:04:01,955 --> 02:04:04,891
I HIGHLIGHT THE DIFFERENCES IN

3306
02:04:04,891 --> 02:04:07,727
BLOOD PRESSURE THRESHOLDS FOR

3307
02:04:07,727 --> 02:04:10,263
HOME BLOOD PRESSURE, DAYTIME,

3308
02:04:10,263 --> 02:04:12,332
SLEEP, 24 HOUR ABPM, AND OFFICE

3309
02:04:12,332 --> 02:04:15,301
BLOOD PRESSURE THRESHOLD OF

3310
02:04:15,301 --> 02:04:18,271
130/80 MILLIMETERS OF MERCURY,

3311
02:04:18,271 --> 02:04:22,075
AND 140/90 MILLIMETERS OF

3312
02:04:22,075 --> 02:04:22,642
MERCURY.

3313
02:04:22,642 --> 02:04:23,410
OFFICE THRESHOLD OF 130/80 DO

3314
02:04:23,410 --> 02:04:25,145
YOU HAVE THE SAME THRESHOLD FOR

3315
02:04:25,145 --> 02:04:27,380
HOME BLOOD PRESSURE AND DAYTIME

3316
02:04:27,380 --> 02:04:30,283
ABP M.

3317
02:04:30,283 --> 02:04:36,856
THIS IS NOT TRUE AT 140/90.

3318
02:04:36,856 --> 02:04:39,359
WHAT ARE THE BIGGEST UNANSWERED

3319
02:04:39,359 --> 02:04:42,629
QUESTIONS, WHICH DEVICE IS

3320
02:04:42,629 --> 02:04:43,062
SUPERIOR?

3321
02:04:43,062 --> 02:04:45,932
I MOST ASSOCIATE WITH EVENTS AND

3322
02:04:45,932 --> 02:04:46,332
MORTALITY.

3323
02:04:46,332 --> 02:04:47,133
WE CONDUCTED SYSTEMATIC REVIEW

3324
02:04:47,133 --> 02:04:49,903
OF MORE THAN A THOUSAND

3325
02:04:49,903 --> 02:04:51,871
ARTICLES, IDENTIFIED ONLY NINE

3326
02:04:51,871 --> 02:04:56,342
ARTICLES FROM SEVEN COHORTS

3327
02:04:56,342 --> 02:04:57,210
EXAMINING WHETHER BLOOD PRESSURE

3328
02:04:57,210 --> 02:04:58,545
HOME BLOOD PRESSURE MONITORING

3329
02:04:58,545 --> 02:05:04,017
IS MORE STRONGLY ASSOCIATED WITH

3330
02:05:04,017 --> 02:05:06,753
CARDIOVASCULAR EVENTS OR

3331
02:05:06,753 --> 02:05:07,353
MORTALITY.

3332
02:05:07,353 --> 02:05:08,288
WHEN AMBULATORY BLOOD PRESSURE

3333
02:05:08,288 --> 02:05:11,891
WAS ADJUSTED FOR HOME BLOOD

3334
02:05:11,891 --> 02:05:14,527
PRESSURE, SYSTOLIC BLOOD

3335
02:05:14,527 --> 02:05:17,530
PRESSURE ON ABPM WAS ASSOCIATED

3336
02:05:17,530 --> 02:05:19,699
IN TWO OF FOUR COHORTS, THREE OF

3337
02:05:19,699 --> 02:05:22,302
FOUR FOR DIE TOLIC.

3338
02:05:22,302 --> 02:05:24,337
WHEN HOME BLOOD PRESSURE WAS

3339
02:05:24,337 --> 02:05:26,606
ADJUSTED FOR AMBULATORY BLOOD

3340
02:05:26,606 --> 02:05:28,208
PRESSURE, SYSTOLIC BLOOD

3341
02:05:28,208 --> 02:05:32,378
PRESSURE ON HOME MONITORING IS

3342
02:05:32,378 --> 02:05:33,580
ASSOCIATED WITH OUTCOMES IN

3343
02:05:33,580 --> 02:05:34,981
ZERO, NO STUDIES REPORTING IT,

3344
02:05:34,981 --> 02:05:37,550
ONLY ONE OF TWO FOR DIASTOLIC

3345
02:05:37,550 --> 02:05:38,418
BLOOD PRESSURE.

3346
02:05:38,418 --> 02:05:42,121
WE STILL HAVE LACK OF DATA, AND

3347
02:05:42,121 --> 02:05:43,756
WE'LL DISCUSS THIS LATER, A

3348
02:05:43,756 --> 02:05:44,991
MAJOR BARRIER.

3349
02:05:44,991 --> 02:05:45,925
CLEARLY AN UNANSWERED QUESTION

3350
02:05:45,925 --> 02:05:47,760
GIVEN THE SMALL NUMBER OF

3351
02:05:47,760 --> 02:05:50,230
STUDIES IN THE LITERATURE.

3352
02:05:50,230 --> 02:05:58,805
NONETHELESS, DEPICTED ON THE

3353
02:05:58,805 --> 02:06:01,641
BOTTOM 2017 ACCAHA GUIDELINES,

3354
02:06:01,641 --> 02:06:03,943
UNTREATED USING DAYTIME ABPM IS

3355
02:06:03,943 --> 02:06:05,612
PREFERRED WITH HOME MONITORING

3356
02:06:05,612 --> 02:06:06,946
AS ALTERNATIVE.

3357
02:06:06,946 --> 02:06:10,617
FOR THOSE TREATED, I.E. ON

3358
02:06:10,617 --> 02:06:12,051
ANTI-HYPERTENSIVE MEDICATION FOR

3359
02:06:12,051 --> 02:06:13,019
EXAMPLE THE ALGORITHM SUGGESTS

3360
02:06:13,019 --> 02:06:16,089
USING HOME BLOOD PRESSURE

3361
02:06:16,089 --> 02:06:18,191
MONITORING, THE PREFERRED

3362
02:06:18,191 --> 02:06:19,726
APPROACH, SECONDARILY

3363
02:06:19,726 --> 02:06:21,694
ALTERNATIVE DAYTIME ABPM ONCE

3364
02:06:21,694 --> 02:06:25,198
HOME BLOOD PRESSURE MONITORING

3365
02:06:25,198 --> 02:06:26,065
IS DONE.

3366
02:06:26,065 --> 02:06:28,902
NOW, BESIDE LACK OF DATA ON

3367
02:06:28,902 --> 02:06:30,970
OUTCOMES, VALUES OBTAINED USING

3368
02:06:30,970 --> 02:06:31,638
HOME VERSUS AMBULATORY

3369
02:06:31,638 --> 02:06:38,878
MONITORING DO NOT ALWAYS AGREE.

3370
02:06:38,878 --> 02:06:40,947
WE EXAMINE ABPM ON MASKED

3371
02:06:40,947 --> 02:06:42,482
HYPERTENSION, THE DANGEROUS

3372
02:06:42,482 --> 02:06:44,651
PHENOTYPE, USING DATA FROM

3373
02:06:44,651 --> 02:06:46,085
IMPROVING DETECTION OF

3374
02:06:46,085 --> 02:06:50,123
HYPERTENSION COHORT. 

3375
02:06:50,123 --> 02:06:51,558
THE IDL IS COMMUNITY-BASED STUDY

3376
02:06:51,558 --> 02:06:54,527
OF NEW YORK ADULTS WHO UNDERWENT

3377
02:06:54,527 --> 02:06:55,795
AMBULATORY AND HOME BLOOD

3378
02:06:55,795 --> 02:06:58,965
PRESSURE AND OFFICE BLOOD

3379
02:06:58,965 --> 02:07:00,533
PRESSURE MEASUREMENTS.

3380
02:07:00,533 --> 02:07:06,539
IN OUR SAMPLE, A LITTLE OVER 300

3381
02:07:06,539 --> 02:07:08,508
INDIVIDUALS, THE MAJORITY, 61%,

3382
02:07:08,508 --> 02:07:11,144
HAD MASKED HYPERTENSION ONLY

3383
02:07:11,144 --> 02:07:13,880
DETECTED BY ABPM.

3384
02:07:13,880 --> 02:07:17,050
30% HAD MASKED HYPERTENSION

3385
02:07:17,050 --> 02:07:19,452
DETECTED ON ABPM AND HOME

3386
02:07:19,452 --> 02:07:22,522
MONITORING, A SMALL MINORITY,

3387
02:07:22,522 --> 02:07:27,126
9%, MASKED HYPERTENSION DETECTED

3388
02:07:27,126 --> 02:07:28,494
ON HOME MONITORING BUT NOT

3389
02:07:28,494 --> 02:07:28,962
AMBULATORY.

3390
02:07:28,962 --> 02:07:31,064
IF YOU ONLY DO HOME, YOU

3391
02:07:31,064 --> 02:07:32,498
MISCLASSIFY MANY IF NOT THE

3392
02:07:32,498 --> 02:07:35,101
MAJORITY OF INDIVIDUALS WHO HAVE

3393
02:07:35,101 --> 02:07:36,202
DANGEROUS PHENOTYPE MASKED

3394
02:07:36,202 --> 02:07:45,511
HYPERTENSION AS YOU MIS60% ONLY

3395
02:07:45,511 --> 02:07:46,546
DETECTED ON ABPM.

3396
02:07:46,546 --> 02:07:48,414
IN THE LITERATURE ONE OF THE

3397
02:07:48,414 --> 02:07:50,316
GROUPS THAT'S MOST AT RISK ARE

3398
02:07:50,316 --> 02:07:51,017
BLACK ADULTS.

3399
02:07:51,017 --> 02:07:57,090
SO WE HAVE TO THINK ABOUT THIS

3400
02:07:57,090 --> 02:07:58,625
HEALTH INEQUITY PERSPECTIVE,

3401
02:07:58,625 --> 02:07:59,926
MISSING THIS DANGEROUS PHENOTYPE

3402
02:07:59,926 --> 02:08:03,763
USING HOME BLOOD PRESSURE

3403
02:08:03,763 --> 02:08:05,198
MONITORING ALONE.

3404
02:08:05,198 --> 02:08:07,800
NOW, INTERESTINGLY ENOUGH, HOME

3405
02:08:07,800 --> 02:08:08,368
BLOOD PRESSURE MONITORING,

3406
02:08:08,368 --> 02:08:10,637
PRELIMINARY DATA MAY BE MORE

3407
02:08:10,637 --> 02:08:12,405
RELIABLE THAN OFFICE BLOOD

3408
02:08:12,405 --> 02:08:15,241
PRESSURE AND ABPM, MORE STRONGLY

3409
02:08:15,241 --> 02:08:16,676
CORRELATED WITH ORGAN DAMAGE.

3410
02:08:16,676 --> 02:08:20,613
THIS IS DATA FROM THE IDH COHORT

3411
02:08:20,613 --> 02:08:22,148
COMPARING INDIVIDUALS ON OFFICE

3412
02:08:22,148 --> 02:08:23,549
BLOOD PRESSURE, HOME BP,

3413
02:08:23,549 --> 02:08:25,084
AMBULATORY BLOOD PRESSURE, WHEN

3414
02:08:25,084 --> 02:08:27,053
ALL WERE ASSESSED USING

3415
02:08:27,053 --> 02:08:29,255
GUIDELINE-RECOMMENDED

3416
02:08:29,255 --> 02:08:29,555
APPROACHES.

3417
02:08:29,555 --> 02:08:33,526
WE'VE COMPARED RELIABILITY OF

3418
02:08:33,526 --> 02:08:36,929
OFFICE IN THREE VISITS, THREE

3419
02:08:36,929 --> 02:08:38,965
READINGS, MEASURED BY ABPM EVERY

3420
02:08:38,965 --> 02:08:40,166
30 MINUTES, BLOOD PRESSURE

3421
02:08:40,166 --> 02:08:41,834
MEASURED BY HOME BLOOD PRESSURE

3422
02:08:41,834 --> 02:08:44,037
MONITORING USING TWO MORNING AND

3423
02:08:44,037 --> 02:08:45,471
TWO EVENING READINGS OVER A

3424
02:08:45,471 --> 02:08:47,340
WEEK.

3425
02:08:47,340 --> 02:08:50,710
WE LOOKED AT ASSOCIATIONS WITH

3426
02:08:50,710 --> 02:08:52,578
LESS VENTRICULAR MASS INDEX ON

3427
02:08:52,578 --> 02:08:53,680
2D ECHO.

3428
02:08:53,680 --> 02:08:55,648
THE COEFFICIENTS ARE REPRESENTED

3429
02:08:55,648 --> 02:08:57,383
ON THE FIRST TABLE.

3430
02:08:57,383 --> 02:08:58,551
FOR OFFICE BLOOD PRESSURE .9,

3431
02:08:58,551 --> 02:09:01,654
HIGHEST FOR HOME BLOOD PRESSURE

3432
02:09:01,654 --> 02:09:11,431
AT .94, AWAKE ON 24 HOUR.

3433
02:09:11,431 --> 02:09:15,134
THE MODEL BELOW WAS ADJUSTED,

3434
02:09:15,134 --> 02:09:18,638
THE ESTIMATED DIFFERENCE IN LEFT

3435
02:09:18,638 --> 02:09:20,673
VENTRICULAR MASS INDEX FOR

3436
02:09:20,673 --> 02:09:23,876
10-MILLIMETER HIGHER 3.2 GRAMS

3437
02:09:23,876 --> 02:09:27,380
FOR OFFICE BP, 4.04 HOME BLOOD

3438
02:09:27,380 --> 02:09:30,683
PRESSURE, AS WELL AS 3.71 GRAMS

3439
02:09:30,683 --> 02:09:33,720
PER METER SQUARED FOR

3440
02:09:33,720 --> 02:09:34,020
AMBULATORY.

3441
02:09:34,020 --> 02:09:36,522
FULLY ADJUSTED MODEL 3 INCLUDES

3442
02:09:36,522 --> 02:09:38,691
COVARIATES OF MODEL 2 AND ALL

3443
02:09:38,691 --> 02:09:41,828
THREE, ONLY HOME WAS ASSOCIATED

3444
02:09:41,828 --> 02:09:43,830
WITH HIGHER LEFT VENTRICULAR

3445
02:09:43,830 --> 02:09:45,031
MASS INDEX.

3446
02:09:45,031 --> 02:09:46,666
THIS WOULD SUGGEST WHEN BLOOD

3447
02:09:46,666 --> 02:09:57,176
PRESSURE IS ASSESSED, ABPM MAY

3448
02:09:57,543 --> 02:09:58,344
NOT BE IMMEDIATED, ESPECIALLY

3449
02:09:58,344 --> 02:10:01,447
WITH RESPECT TO DETECTION OF

3450
02:10:01,447 --> 02:10:05,818
ORGAN DAMAGE, MIGHT BE A

3451
02:10:05,818 --> 02:10:08,888
PARADIGM SHIFT.

3452
02:10:08,888 --> 02:10:10,289
IN SUMMARY PRESSING QUESTIONS,

3453
02:10:10,289 --> 02:10:12,125
STILL MUCH EXCITEMENT IN THE

3454
02:10:12,125 --> 02:10:13,526
FIELD, JUST PROVIDING A FEW

3455
02:10:13,526 --> 02:10:15,995
REFLECTIONS ON WHAT THE MOST

3456
02:10:15,995 --> 02:10:17,330
PROMISING AREAS ARE.

3457
02:10:17,330 --> 02:10:21,801
WE OBVIOUSLY KNOW WE'RE IN A

3458
02:10:21,801 --> 02:10:23,536
CONSUMER-DRIVEN MARKET, WE'VE

3459
02:10:23,536 --> 02:10:26,839
ALLUDED TO WRIST DEVICE, EMR

3460
02:10:26,839 --> 02:10:33,246
INTEGRATION, CUFFLESS WAS

3461
02:10:33,246 --> 02:10:34,380
ALLUDED TO ALREADY.

3462
02:10:34,380 --> 02:10:36,616
WHAT'S INTERESTING IS THE

3463
02:10:36,616 --> 02:10:38,017
CURRENT DEVICES DISTURB SLEEP.

3464
02:10:38,017 --> 02:10:39,886
WE DON'T HAVE A TRUE ESTIMATE OF

3465
02:10:39,886 --> 02:10:44,924
WHAT SLEEP BLOOD PRESSURE IS.

3466
02:10:44,924 --> 02:10:46,993
CUFFLESS MAY BE A WAY AROUND

3467
02:10:46,993 --> 02:10:47,593
THIS.

3468
02:10:47,593 --> 02:10:49,095
I WOULD CHALLENGE US TO SAY CAN

3469
02:10:49,095 --> 02:10:51,531
WE DISRUPT THE CONCEPT OF OFFICE

3470
02:10:51,531 --> 02:10:52,932
BLOOD PRESSURE, ONLY RELY ON OUT

3471
02:10:52,932 --> 02:10:54,066
OF OFFICE, MAYBE THAT'S THE

3472
02:10:54,066 --> 02:10:56,335
FUTURE IN PARTICULAR IN THE

3473
02:10:56,335 --> 02:10:57,303
PANDEMIC SHOWED MANY PEOPLE

3474
02:10:57,303 --> 02:11:00,273
COULDN'T COME TO THE CLINICIAN

3475
02:11:00,273 --> 02:11:00,773
OFFICE.

3476
02:11:00,773 --> 02:11:03,676
WHAT ARE THE GAPS?

3477
02:11:03,676 --> 02:11:05,077
I THINK MORE UNIFORM BLOOD

3478
02:11:05,077 --> 02:11:05,845
PRESSURE THRESHOLDS ACROSS

3479
02:11:05,845 --> 02:11:09,348
OFFICE AND OUT OF OFFICE

3480
02:11:09,348 --> 02:11:10,116
MEASUREMENTS AREN'T REALLY

3481
02:11:10,116 --> 02:11:13,719
UNDERSTOOD BY MANY IN TERMS OF

3482
02:11:13,719 --> 02:11:15,021
IMPLEMENTATION, CAN WE IMPROVE

3483
02:11:15,021 --> 02:11:22,562
UPON MEASUREMENT, THIS MIGHT BE

3484
02:11:22,562 --> 02:11:24,096
ANOTHER PARADIGM SHIFT, MAYBE WE

3485
02:11:24,096 --> 02:11:26,065
SHOULD DISRUPT AND IMPROVE THE

3486
02:11:26,065 --> 02:11:27,400
OFFICE MEASUREMENT, SOMETHING

3487
02:11:27,400 --> 02:11:29,035
CALLED UNATTENDED OFFICE BP

3488
02:11:29,035 --> 02:11:30,469
WHERE YOU TEACH PATIENTS TO

3489
02:11:30,469 --> 02:11:32,104
SELF-MEASURE BLOOD PRESSURE.

3490
02:11:32,104 --> 02:11:34,507
WE STILL DON'T KNOW OPTIMUM

3491
02:11:34,507 --> 02:11:36,709
METHODOLOGY AND FREQUENCY OF

3492
02:11:36,709 --> 02:11:38,644
HOME BLOOD PRESSURE MONITORING.

3493
02:11:38,644 --> 02:11:43,249
I'LL END WITH KEY CHALLENGES AND

3494
02:11:43,249 --> 02:11:43,850
BARRIERS.

3495
02:11:43,850 --> 02:11:45,885
I'VE DISCUSSED THE RELIABILITY

3496
02:11:45,885 --> 02:11:47,753
AND VALIDATION OF

3497
02:11:47,753 --> 02:11:48,955
NON-TRADITIONAL DEVICES IS HUGE.

3498
02:11:48,955 --> 02:11:50,756
THERE'S LACK OF DATA WITH OUT OF

3499
02:11:50,756 --> 02:11:53,192
OFFICE AND OFFICE BLOOD PRESSURE

3500
02:11:53,192 --> 02:11:56,262
CONDUCTED AT THE SAME TIME.

3501
02:11:56,262 --> 02:11:57,597
AND CANNOT HIGHLIGHT ENOUGH

3502
02:11:57,597 --> 02:11:58,898
THERE'S BARRIERS TO

3503
02:11:58,898 --> 02:12:01,868
IMPLEMENTATION AND ACCESS TO

3504
02:12:01,868 --> 02:12:04,036
CARE, IMPACT OF STRUCTURAL LEVEL

3505
02:12:04,036 --> 02:12:06,806
FACTORS, HEARKENING TO DR.

3506
02:12:06,806 --> 02:12:07,573
SPATZ'S KEYNOTE ADDRESS.

3507
02:12:07,573 --> 02:12:10,743
WE TALK ABOUT CURING OR BATTLING

3508
02:12:10,743 --> 02:12:13,379
HYPERTENSION BUT WE NEED TO

3509
02:12:13,379 --> 02:12:15,147
UNDERSTAND HOW DO WE EVEN GET

3510
02:12:15,147 --> 02:12:18,618
ACCESS TO CARE, TO OUR PATIENTS.

3511
02:12:18,618 --> 02:12:21,254
I'LL ANNOUNCE MY FUNDING SOURCES

3512
02:12:21,254 --> 02:12:21,687
AND SAY THANK YOU.

3513
02:12:21,687 --> 02:12:23,122
>> THANK YOU.

3514
02:12:23,122 --> 02:12:25,858
YOU COVERED A LOT OF GROUND.

3515
02:12:25,858 --> 02:12:27,059
IT'S IMPORTANT TO RECOGNIZE

3516
02:12:27,059 --> 02:12:29,028
HYPERTENSION IS THE MOST POTENT

3517
02:12:29,028 --> 02:12:31,497
AND PREVALENT CARDIOVASCULAR

3518
02:12:31,497 --> 02:12:33,766
RISK FACTORS, MEASUREMENT IS SO

3519
02:12:33,766 --> 02:12:34,066
HAPHAZARDLY.

3520
02:12:34,066 --> 02:12:35,968
WE'RE GOING TO HEAR ON

3521
02:12:35,968 --> 02:12:37,770
DETERMINING BLOOD PRESSURE USING

3522
02:12:37,770 --> 02:12:44,710
NOVEL TECHNOLOGIES VIA A.I. BY

3523
02:12:44,710 --> 02:12:49,181
DR. STERGIOU, UNIVERSITY OF

3524
02:12:49,181 --> 02:12:55,755
ATHENS IN GREECE. 

3525
02:12:55,755 --> 02:12:57,523
WHILE WE'RE WAITING, I SHOULD

3526
02:12:57,523 --> 02:12:58,958
NOTE THERE ARE VALIDATED SOURCES

3527
02:12:58,958 --> 02:13:01,260
WHERE YOU CAN FIND MORE

3528
02:13:01,260 --> 02:13:02,328
INFORMATION ON MAKING SURE

3529
02:13:02,328 --> 02:13:04,430
PATIENT HAS BLOOD PRESSURE

3530
02:13:04,430 --> 02:13:10,303
DEVICE THAT ACTUALLY WORKS

3531
02:13:10,303 --> 02:13:11,537
CORRECTLY, VALIDATE BP, IN THE

3532
02:13:11,537 --> 02:13:12,838
CHAT, THOSE ARE IMPORTANT

3533
02:13:12,838 --> 02:13:19,845
BECAUSE MANY DEVICES JUST DON'T

3534
02:13:19,845 --> 02:13:21,147
WORK WELL.

3535
02:13:21,147 --> 02:13:21,480
ARE YOU HERE?

3536
02:13:21,480 --> 02:13:24,617
>> CAN YOU HEAR ME?

3537
02:13:24,617 --> 02:13:24,850
>> YES.

3538
02:13:24,850 --> 02:13:30,690
>> THANK YOU FOR ASKING ME
TO BE

3539
02:13:30,690 --> 02:13:34,093
PREPARED FOR THIS TALK, WHICH

3540
02:13:34,093 --> 02:13:36,963
MEANS I HAVE LOOK AT NEW

3541
02:13:36,963 --> 02:13:39,665
INFORMATION IN MORE DETAIL.

3542
02:13:39,665 --> 02:13:40,566
THIS IS MY DECLARATION OF

3543
02:13:40,566 --> 02:13:42,068
POTENTIAL CONFLICT OF INTEREST.

3544
02:13:42,068 --> 02:13:44,470
NO RELATION TO THIS TALK.

3545
02:13:44,470 --> 02:13:47,673
I HAVE ALSO TO SAY THAT ALTHOUGH

3546
02:13:47,673 --> 02:13:55,681
I'M WORKING IN ATHENS, GREECE, I

3547
02:13:55,681 --> 02:13:57,550
COME FROM VENICE, LOOKING AT

3548
02:13:57,550 --> 02:13:59,518
WHAT PEOPLE MUST DO, AND WE'RE

3549
02:13:59,518 --> 02:14:03,990
INTERESTED IN WHAT THEY DO

3550
02:14:03,990 --> 02:14:06,826
BECAUSE THEY AFFECT US, AND WE

3551
02:14:06,826 --> 02:14:08,894
TRY TO TAKE ADVANTAGE FROM WHAT

3552
02:14:08,894 --> 02:14:11,430
THEY DO.

3553
02:14:11,430 --> 02:14:14,400
OF COURSE, WE'RE SKEPTICAL, AND

3554
02:14:14,400 --> 02:14:15,935
CAUTIOUS WITH WHAT THE ENGINEERS

3555
02:14:15,935 --> 02:14:16,235
DO.

3556
02:14:16,235 --> 02:14:18,637
AND WE WANT TO MAKE SURE THAT

3557
02:14:18,637 --> 02:14:24,677
WHAT THEY GIVE US IS A REAL

3558
02:14:24,677 --> 02:14:29,281
BENEFIT TO OUR PATIENTS. 

3559
02:14:29,281 --> 02:14:29,915
CUFFLESS BLOOD PRESSURE

3560
02:14:29,915 --> 02:14:32,885
MEASUREMENT IS EXCITING TO

3561
02:14:32,885 --> 02:14:34,186
EVERYBODY, FROM EXPERTS TO

3562
02:14:34,186 --> 02:14:36,655
PRACTITIONERS AND TO PATIENTS,

3563
02:14:36,655 --> 02:14:37,256
TO PEOPLE.

3564
02:14:37,256 --> 02:14:41,961
IT IS A METHOD THAT CAN GIVE US

3565
02:14:41,961 --> 02:14:42,928
THE FULL PICTURE OF BLOOD

3566
02:14:42,928 --> 02:14:43,462
PRESSURE.

3567
02:14:43,462 --> 02:14:50,069
IF WE HAVE THAT, IF WE GET IT

3568
02:14:50,069 --> 02:14:52,905
RIGHT, OFFICE, HOME, AMBULATORY

3569
02:14:52,905 --> 02:14:54,974
DOESN'T EXIST.

3570
02:14:54,974 --> 02:14:57,309
WHITE COAT, MASKED DOESN'T

3571
02:14:57,309 --> 02:14:59,745
EXIST, BECAUSE WE HAVE THE FULL

3572
02:14:59,745 --> 02:15:00,713
PICTURE, ALL THE INFORMATION

3573
02:15:00,713 --> 02:15:11,257
ABOUT BLOOD PRESSURE PROFILE AND

3574
02:15:13,759 --> 02:15:14,994
BEHAVIOR OVER TIME.

3575
02:15:14,994 --> 02:15:18,798
IT'S SOMETHING IT WEAR ON THE

3576
02:15:18,798 --> 02:15:24,203
WRIST BUT COULD BE A RING, ON

3577
02:15:24,203 --> 02:15:24,970
YOUR GLASSES.

3578
02:15:24,970 --> 02:15:27,239
AND THIS IS SOMETHING YOU WEAR

3579
02:15:27,239 --> 02:15:28,674
ALL THE TIME.

3580
02:15:28,674 --> 02:15:33,045
BUT THIS IS ONE PICTURE OF

3581
02:15:33,045 --> 02:15:36,115
CUFFLESS MEASUREMENT POTENTIAL.

3582
02:15:36,115 --> 02:15:37,950
THERE'S ANOTHER EQUALLY

3583
02:15:37,950 --> 02:15:39,085
ATTRACTIVE AND QUITE DIFFERENT

3584
02:15:39,085 --> 02:15:43,923
POTENTIAL, AND IT IS THIS ONE.

3585
02:15:43,923 --> 02:15:47,426
IMAGINE IF ALL PEOPLE WHO OWN A

3586
02:15:47,426 --> 02:15:48,727
SMARTPHONE WOULD PUT THEIR

3587
02:15:48,727 --> 02:15:50,896
FINGER ON THE SMARTPHONE AND USE

3588
02:15:50,896 --> 02:15:57,036
ITS SENSORS TO GET A RELIABLE

3589
02:15:57,036 --> 02:15:59,105
BLOOD PRESSURE MEASUREMENT.

3590
02:15:59,105 --> 02:16:01,907
OR LEAVE THE CAMERA OF THE

3591
02:16:01,907 --> 02:16:04,910
SMARTPHONE TO LOOK AT THE FACE

3592
02:16:04,910 --> 02:16:08,047
AND TAKE A SIGNAL AND MAYBE IT

3593
02:16:08,047 --> 02:16:11,717
CAN GIVE YOU A GOOD VALUE OF

3594
02:16:11,717 --> 02:16:13,452
BLOOD PRESSURE.

3595
02:16:13,452 --> 02:16:15,855
SUCH HUGE POTENTIAL AND

3596
02:16:15,855 --> 02:16:25,931
INTEREST, AND  VARIOUS SIGNALS,

3597
02:16:25,931 --> 02:16:28,868
PPG IS THE MOST POPULAR, REALLY

3598
02:16:28,868 --> 02:16:32,471
MANY DEVICES USING PPG AS BASIS

3599
02:16:32,471 --> 02:16:38,611
TRYING TO PROVIDE MEASUREMENTS

3600
02:16:38,611 --> 02:16:40,479
OF BLOOD PRESSURE.

3601
02:16:40,479 --> 02:16:43,749
YOU CAN SEE STEEP INCREASE IN

3602
02:16:43,749 --> 02:16:49,989
PUBLICATIONS RELATED TO PPG

3603
02:16:49,989 --> 02:16:50,222
SIGNALS.

3604
02:16:50,222 --> 02:16:54,160
I THINK IT'S  IMPORTANT TO START

3605
02:16:54,160 --> 02:16:58,230
WITH THIS SLIDE ABOUT HOW IT

3606
02:16:58,230 --> 02:17:00,332
WORKS. 

3607
02:17:00,332 --> 02:17:02,935
ONE THING PPG SIGNAL, A LOOK AT

3608
02:17:02,935 --> 02:17:09,742
THE WAVEFORM, SOMETIMES COMBINED

3609
02:17:09,742 --> 02:17:13,012
WITH ECG TO GIVE US PULSE

3610
02:17:13,012 --> 02:17:14,413
ARRIVAL TIME, THE TRAVEL, SPEED

3611
02:17:14,413 --> 02:17:18,584
FOR WHICH THE PULSE RATE TRAVELS

3612
02:17:18,584 --> 02:17:21,754
ACROSS THE ARTERIAL TREE.

3613
02:17:21,754 --> 02:17:24,056
AND ALSO THESE DEVICES GET SOME

3614
02:17:24,056 --> 02:17:26,725
KIND OF INFORMATION FOR THE

3615
02:17:26,725 --> 02:17:29,195
INDIVIDUAL USER, AND THIS IS

3616
02:17:29,195 --> 02:17:31,497
PERSONAL BIOMETRIC INFORMATION,

3617
02:17:31,497 --> 02:17:38,137
COULD SHALL THE AGE, GENDER, THE

3618
02:17:38,137 --> 02:17:40,372
SIZE, BODY SIZE, HEIGHT AND

3619
02:17:40,372 --> 02:17:46,712
WEIGHT, OR COULD BE CLASSIC

3620
02:17:46,712 --> 02:17:47,580
CUFFLESS MEASUREMENT.

3621
02:17:47,580 --> 02:17:49,114
WHEN YOU HAVE CUFFLESS

3622
02:17:49,114 --> 02:17:51,517
ESTIMATION BY A NOVEL DEVICE,

3623
02:17:51,517 --> 02:17:55,454
YOU GET TWO DIFFERENT KINDS OF

3624
02:17:55,454 --> 02:18:00,526
DATA WHICH SHOWED THE OUTPUT.

3625
02:18:00,526 --> 02:18:03,696
ONE IS HEMODYNAMIC COMPONENT,

3626
02:18:03,696 --> 02:18:05,564
MEASUREMENT, PPG ALONE OR PLUS

3627
02:18:05,564 --> 02:18:09,468
PTT, BUT ALSO YOU HAVE A

3628
02:18:09,468 --> 02:18:10,236
PREDICTIVE COMPONENT.

3629
02:18:10,236 --> 02:18:13,339
AND WE KNOW THAT YOU CAN PRETTY

3630
02:18:13,339 --> 02:18:15,407
WELL PREDICT THE BLOOD PRESSURE

3631
02:18:15,407 --> 02:18:19,011
OF A POPULATION BASED ON THE

3632
02:18:19,011 --> 02:18:23,983
AGE, SEX, WEIGHT, HEIGHT, SO ON.

3633
02:18:23,983 --> 02:18:26,518
SO, THE OUTPUT OF THE CUFFLESS

3634
02:18:26,518 --> 02:18:28,320
DEVICE IS COMBINATION OF THE

3635
02:18:28,320 --> 02:18:32,157
TWO, AND IT'S IMPORTANT TO KNOW

3636
02:18:32,157 --> 02:18:33,425
IN WHAT PROPORTION EACH

3637
02:18:33,425 --> 02:18:35,928
CONTRIBUTES TO BLOOD PRESSURE

3638
02:18:35,928 --> 02:18:37,496
VALUE WE SEE.

3639
02:18:37,496 --> 02:18:42,868
SO, THIS IS THE PULSE WAVE, THEY

3640
02:18:42,868 --> 02:18:46,472
KNOW THE PULSE RATE, HOW IT GOES

3641
02:18:46,472 --> 02:18:55,347
UP, RIGHT SIDE OF THE PULSE

3642
02:18:55,347 --> 02:19:01,453
RATE, ENGINEERS HAVE A LOOK, CUT

3643
02:19:01,453 --> 02:19:05,291
IT INTO PIECES, THEY LOOK AT

3644
02:19:05,291 --> 02:19:08,894
SMALL FEATURES AND ANALYZE AND

3645
02:19:08,894 --> 02:19:12,731
GIVE OUT FEATURES FROM THE PULSE

3646
02:19:12,731 --> 02:19:13,632
WAVE, AND HAVE OTHER FEATURES

3647
02:19:13,632 --> 02:19:19,738
FROM THE RISK OF THE PPG SIGNAL

3648
02:19:19,738 --> 02:19:22,574
AND FROM THE DEMOGRAPHIC

3649
02:19:22,574 --> 02:19:23,876
EDUCATION AND OTHER FEATURES,

3650
02:19:23,876 --> 02:19:27,513
THEY CAME UP WITH ALMOST 100

3651
02:19:27,513 --> 02:19:31,216
FEATURES FOR SINGLE MEASUREMENT

3652
02:19:31,216 --> 02:19:35,087
THAT CAN'T INFERENCE THE OUTPUT.

3653
02:19:35,087 --> 02:19:38,190
SO, WHEN YOU HAVE CUFFLESS,

3654
02:19:38,190 --> 02:19:39,792
INTERPLAY OF REFERENCE BLOOD

3655
02:19:39,792 --> 02:19:41,026
PRESSURE MEASUREMENT WITH CUFF

3656
02:19:41,026 --> 02:19:44,496
DEVICE, IF IT IS USED.

3657
02:19:44,496 --> 02:19:46,131
DEMOGRAPHIC INFORMATION ABOUT

3658
02:19:46,131 --> 02:19:49,902
THE USER IF THEY ARE USED, AND

3659
02:19:49,902 --> 02:19:50,969
MEASUREMENT.

3660
02:19:50,969 --> 02:19:56,775
HEMODYNAMIC COMPONENT WHICH IS

3661
02:19:56,775 --> 02:19:59,378
PPG, PLUS OR MINUS PAT, THIS IS

3662
02:19:59,378 --> 02:20:04,783
AN INTERPLAY OF THESE FACTORS. 

3663
02:20:04,783 --> 02:20:07,953
AND WHAT HAPPENS IS THAT AS

3664
02:20:07,953 --> 02:20:08,854
CLINICIAN, THE INVESTIGATORS

3665
02:20:08,854 --> 02:20:10,255
LOOK AT THE ASSOCIATIONS OF

3666
02:20:10,255 --> 02:20:13,425
THESE FEATURES WITH A CUFF BLOOD

3667
02:20:13,425 --> 02:20:16,128
PRESSURE MEASUREMENT.

3668
02:20:16,128 --> 02:20:21,500
AND REGRESSIONS.

3669
02:20:21,500 --> 02:20:25,771
THEY PUT THEM IN THE MODEL AND

3670
02:20:25,771 --> 02:20:26,872
TRIED TO PREDICT SYSTOLIC BLOOD

3671
02:20:26,872 --> 02:20:27,506
PRESSURE.

3672
02:20:27,506 --> 02:20:31,677
BUT THERE ARE MORE COMPLEX

3673
02:20:31,677 --> 02:20:35,180
MODELS.

3674
02:20:35,180 --> 02:20:37,583
YOU MIGHT ASK THE MODEL TO

3675
02:20:37,583 --> 02:20:39,551
EXTRACT THE FEATURES SO YOU

3676
02:20:39,551 --> 02:20:42,521
DON'T KNOW WHICH FEATURES ARE

3677
02:20:42,521 --> 02:20:46,759
TAKEN INTO ACCOUNT.

3678
02:20:46,759 --> 02:20:53,565
SO THIS IS AUTOMATED SYSTEM,

3679
02:20:53,565 --> 02:20:56,168
SEVERAL MODELS FOR DEEP LEARNING

3680
02:20:56,168 --> 02:20:56,835
ALONE.

3681
02:20:56,835 --> 02:20:58,270
WHETHER HAVE YOU DEMOGRAPHIC

3682
02:20:58,270 --> 02:21:07,913
DATA, WHETHER YOU HAVE IMAGE OR

3683
02:21:07,913 --> 02:21:10,749
SENSOR, SO ON, ASK PEOPLE.

3684
02:21:10,749 --> 02:21:14,686
WE HAVE DIFFERENT DEVICES.

3685
02:21:14,686 --> 02:21:25,230
WE HAVE THE PULSE WAVE ANALYSIS,

3686
02:21:27,766 --> 02:21:29,668
FACIAL VIDEO, OTHERS

3687
02:21:29,668 --> 02:21:31,637
OSCILLOMETRIC, ULTRASOUND

3688
02:21:31,637 --> 02:21:33,272
TECHNIQUES FOR CUFFLESS, VOLUME

3689
02:21:33,272 --> 02:21:34,506
CONTROL TECHNIQUES.

3690
02:21:34,506 --> 02:21:38,644
APART FROM THAT SOME DEVICES

3691
02:21:38,644 --> 02:21:46,084
REQUIRE INDIVIDUAL USER

3692
02:21:46,084 --> 02:21:46,852
CALIBRATION OR INITIATION, THE

3693
02:21:46,852 --> 02:21:49,354
DEVICE NEEDS TO KNOW ABOUT THE

3694
02:21:49,354 --> 02:21:54,827
USER OR MAY NOT REQUIRE PERIODIC

3695
02:21:54,827 --> 02:21:55,127
CALIBRATION.

3696
02:21:55,127 --> 02:21:56,795
THE OTHER PROBLEM WE FACE IS

3697
02:21:56,795 --> 02:22:06,872
THAT SOME OF THESE DEVICES HAVE

3698
02:22:06,872 --> 02:22:09,374
SOME REGULATORY APPROVAL.

3699
02:22:09,374 --> 02:22:11,944
THIS DOES NOT MEAN THEY ARE

3700
02:22:11,944 --> 02:22:14,880
CLINICALLY USEFUL FOR US.

3701
02:22:14,880 --> 02:22:18,183
I'M GOING TO SHOW YOU VERY

3702
02:22:18,183 --> 02:22:28,727
RECENT DATA IN THE LAST YEAR AND

3703
02:22:29,728 --> 02:22:31,096
O-NEGATIVE, SMALL EXPERIMENT,

3704
02:22:31,096 --> 02:22:35,033
USING FINGER PPG AND PAT, USED

3705
02:22:35,033 --> 02:22:37,002
DIFFERENT TECHNIQUES TO CHANGE

3706
02:22:37,002 --> 02:22:39,171
BLOOD PRESSURE, AND THESE

3707
02:22:39,171 --> 02:22:41,807
TECHNOLOGIES COULD NOT TRACK

3708
02:22:41,807 --> 02:22:44,676
CHANGES IN BLOOD PRESSURE.

3709
02:22:44,676 --> 02:22:47,946
THIS IS SAMSUNG DEVICE.

3710
02:22:47,946 --> 02:22:51,683
SAMSUNG SMARTWATCH WHICH HAS

3711
02:22:51,683 --> 02:22:52,551
IMPLEMENTED CUFFLESS TECHNOLOGY,

3712
02:22:52,551 --> 02:22:55,254
PPG, STUDY HAS BEEN PUBLISHED

3713
02:22:55,254 --> 02:23:02,694
AND SHOWS THAT THIS DEVICE

3714
02:23:02,694 --> 02:23:04,563
CANNOT ESCAPE TOO FAR, CANNOT

3715
02:23:04,563 --> 02:23:07,499
FALL CHANGING BLOOD PRESSURE

3716
02:23:07,499 --> 02:23:11,670
DURING 24-HOUR PERIOD. 

3717
02:23:11,670 --> 02:23:15,307
THIS IS ANOTHER DEVICE WHICH

3718
02:23:15,307 --> 02:23:18,277
ATTRACTED A LOT OF ATTENTION,

3719
02:23:18,277 --> 02:23:21,313
STUDY NOW IN PRESS, JOURNAL OF

3720
02:23:21,313 --> 02:23:24,416
HYPERTENSION, SHOWING CAN TRACK

3721
02:23:24,416 --> 02:23:27,786
ONLY ONE-THIRD OF THE BLOOD

3722
02:23:27,786 --> 02:23:29,321
PRESSURE DROP DURING SLEEP.

3723
02:23:29,321 --> 02:23:31,490
AND THIS IS ANOTHER DEVICE WHICH

3724
02:23:31,490 --> 02:23:34,226
ALSO SUFFERS FROM THE SAME

3725
02:23:34,226 --> 02:23:34,893
PROBLEM.

3726
02:23:34,893 --> 02:23:37,195
IT TRACKS LESS THAN 50% OF THE

3727
02:23:37,195 --> 02:23:40,933
DROP OF BLOOD PRESSURE DURING

3728
02:23:40,933 --> 02:23:41,133
SLEEP.

3729
02:23:41,133 --> 02:23:46,171
BUT I'D LIKE TO BRING YOUR

3730
02:23:46,171 --> 02:23:48,373
ATTENTION IN THIS PROJECT, BY

3731
02:23:48,373 --> 02:23:48,707
MICROSOFT.

3732
02:23:48,707 --> 02:23:51,343
YOU KNOW MICROSOFT RESEARCH IS

3733
02:23:51,343 --> 02:23:52,644
AN OPEN SOURCE COMPANY, WHICH

3734
02:23:52,644 --> 02:23:55,147
MEANS WE KNOW WHAT THEY DO.

3735
02:23:55,147 --> 02:23:56,582
AND WHEN THEY FINISH THEY GIVE

3736
02:23:56,582 --> 02:23:57,382
THE DATA.

3737
02:23:57,382 --> 02:23:59,685
THEY ARE PUBLICLY AVAILABLE.

3738
02:23:59,685 --> 02:24:03,388
IT'S A HUGE PROJECT.

3739
02:24:03,388 --> 02:24:04,990
PAPER SIGNED BY 23

3740
02:24:04,990 --> 02:24:06,558
INVESTIGATORS, MORE THAN 1,000

3741
02:24:06,558 --> 02:24:07,359
PARTICIPANTS, PROBABLY TOOK

3742
02:24:07,359 --> 02:24:10,295
SEVERAL YEARS TO BE COMPLETED.

3743
02:24:10,295 --> 02:24:12,064
IT INCLUDES NOT ONLY LOW BLOOD

3744
02:24:12,064 --> 02:24:13,465
PRESSURE PEOPLE BUT ALSO

3745
02:24:13,465 --> 02:24:15,400
HYPERTENSIVE, NOT ONLY YOUNG

3746
02:24:15,400 --> 02:24:25,944
PEOPLE BUT ALSO OLD AND HAD SOME

3747
02:24:26,578 --> 02:24:27,045
REFERENCE.

3748
02:24:27,045 --> 02:24:29,448
THEY TESTED FOUR TECHNOLOGIES

3749
02:24:29,448 --> 02:24:30,015
FOR CUFFLESS MEASUREMENT AND

3750
02:24:30,015 --> 02:24:32,951
THEY HAD THE ADVANTAGE TO BE

3751
02:24:32,951 --> 02:24:35,120
ABLE TO IMPROVE TECHNOLOGY

3752
02:24:35,120 --> 02:24:45,530
DURING THE EXPERIMENTS.

3753
02:24:47,633 --> 02:24:53,472
THEY INVESTIGATED FOUR WAVEFORM

3754
02:24:53,472 --> 02:24:54,239
MODELS.

3755
02:24:54,239 --> 02:24:58,443
FOR EACH TWO COMPONENTS, ONE IS

3756
02:24:58,443 --> 02:25:00,912
HEMODYNAMIC COMPONENT,

3757
02:25:00,912 --> 02:25:03,882
MEASUREMENT BASED ON PPG, ECG,

3758
02:25:03,882 --> 02:25:05,584
OR COMBINATION, HAD PREDICTIVE

3759
02:25:05,584 --> 02:25:09,988
COMPONENT WHICH IS BASED ON

3760
02:25:09,988 --> 02:25:12,758
CALIBRATION, TIME OF DAY,

3761
02:25:12,758 --> 02:25:13,225
ESTIMATION.

3762
02:25:13,225 --> 02:25:16,161
AND IN THIS STUDY THEY ALSO

3763
02:25:16,161 --> 02:25:17,295
REPORTED BASELINE MODEL WHICH

3764
02:25:17,295 --> 02:25:19,998
MEANS WHAT DO YOU GET IF YOU

3765
02:25:19,998 --> 02:25:21,566
SKIP THE HEMODYNAMIC COMPONENT

3766
02:25:21,566 --> 02:25:23,602
AND PREDICT THE BLOOD PRESSURE

3767
02:25:23,602 --> 02:25:28,206
BASED OF THE CUFF BLOOD PRESSURE

3768
02:25:28,206 --> 02:25:28,874
CALIBRATION.

3769
02:25:28,874 --> 02:25:30,709
THIS IS WHAT THEY GOT.

3770
02:25:30,709 --> 02:25:34,980
YOU SEE THE BEST OF THE FOUR

3771
02:25:34,980 --> 02:25:39,685
WAVEFORM PICTURES, AND THIS WILL

3772
02:25:39,685 --> 02:25:42,220
BE COMPARED, PREDICTION ALONE.

3773
02:25:42,220 --> 02:25:45,257
YOU CAN SEE MEASUREMENT IN GREEN

3774
02:25:45,257 --> 02:25:47,559
GAVE NO ADDITIONAL INFORMATION

3775
02:25:47,559 --> 02:25:50,829
ON THE MEASUREMENT APART FROM

3776
02:25:50,829 --> 02:25:54,666
THAT PREDICTED MODEL WHICH MEANS

3777
02:25:54,666 --> 02:25:55,834
HEMODYNAMIC COMPONENT, THE

3778
02:25:55,834 --> 02:26:01,473
MEASUREMENT DID NOT HELP THE

3779
02:26:01,473 --> 02:26:02,741
ACCURACY OF THE DEVICE.

3780
02:26:02,741 --> 02:26:05,844
THERE ARE POSITIVE STUDIES WHICH

3781
02:26:05,844 --> 02:26:08,346
I WON'T PRESENT, STATIC

3782
02:26:08,346 --> 02:26:11,216
VALIDATION IMMEDIATELY POST

3783
02:26:11,216 --> 02:26:13,819
CALIBRATION, USELESS EXPERIMENT,

3784
02:26:13,819 --> 02:26:16,254
ALL DEVICES PASS.

3785
02:26:16,254 --> 02:26:17,355
THEY PROVIDE CORRELATION, HAVE

3786
02:26:17,355 --> 02:26:27,866
SMALL SAMP  SAMPLE SIZE, YOUNG

3787
02:26:28,800 --> 02:26:29,701
PARTICIPANTS, LOW BLOOD

3788
02:26:29,701 --> 02:26:30,035
PRESSURE.

3789
02:26:30,035 --> 02:26:33,338
I'D LIKE TO TALK ABOUT HOW TO

3790
02:26:33,338 --> 02:26:41,413
TEST THESE AND WE'VE BEEN HAPPY

3791
02:26:41,413 --> 02:26:43,181
IN 2018 TO AGREE ON UNIVERSAL

3792
02:26:43,181 --> 02:26:45,917
PROTOCOL TO BE USED GLOBALLY.

3793
02:26:45,917 --> 02:26:47,686
WELL, THESE STANDARDS WHICH HAVE

3794
02:26:47,686 --> 02:26:51,857
BEEN DEVELOPED FOR CUFF DEVICES

3795
02:26:51,857 --> 02:26:54,559
IS ALMOST ZERO INFORMATION FOR

3796
02:26:54,559 --> 02:26:56,862
MOST OF CUFFLESS DEVICES

3797
02:26:56,862 --> 02:26:59,598
REQUIRING CALIBRATION.

3798
02:26:59,598 --> 02:27:01,800
CUFF OR DEMOGRAPHICS.

3799
02:27:01,800 --> 02:27:06,037
THE IEEE HAS DEVELOPED A

3800
02:27:06,037 --> 02:27:07,506
STANDARD IN 2014, AMENDMENT

3801
02:27:07,506 --> 02:27:10,342
LATER ON, BUT NOT A COOKBOOK ON

3802
02:27:10,342 --> 02:27:17,215
LOU TO EXACTLY DO THIS WORK.

3803
02:27:17,215 --> 02:27:21,520
THE STUDY PROTOCOL WHICH IS ONLY

3804
02:27:21,520 --> 02:27:25,757
FOR CONTINUOUS CUFFLESS DEVICES.

3805
02:27:25,757 --> 02:27:28,293
SO, HOW THESE DEVICES SHOULD BE

3806
02:27:28,293 --> 02:27:28,593
TESTED?

3807
02:27:28,593 --> 02:27:32,430
NOT IN THE WAY WE TEST CUFF

3808
02:27:32,430 --> 02:27:32,664
DEVICES.

3809
02:27:32,664 --> 02:27:36,902
THIS TESTING HAS TO BE MUCH MORE

3810
02:27:36,902 --> 02:27:37,335
COMPLEX.

3811
02:27:37,335 --> 02:27:44,576
FIRST, WE NEED TO HAVE REFERENCE

3812
02:27:44,576 --> 02:27:48,647
MANUAL AUSCULTATORY MEDICINE, TO

3813
02:27:48,647 --> 02:27:53,351
USE IN CLINICAL HYPERTENSION.

3814
02:27:53,351 --> 02:27:56,388
VALIDATION, WE NEED POST

3815
02:27:56,388 --> 02:27:57,589
CALIBRATION ASSESSMENT, MINIMAL

3816
02:27:57,589 --> 02:27:58,924
INFORMATION, ONLY USEFUL

3817
02:27:58,924 --> 02:28:02,861
PARTICULARLY FOR DEVICES THAT DO

3818
02:28:02,861 --> 02:28:05,063
NOT NEED INITIALIZATION OR

3819
02:28:05,063 --> 02:28:05,363
CALIBRATION.

3820
02:28:05,363 --> 02:28:07,232
THE MOST IMPORTANT PART OF THE

3821
02:28:07,232 --> 02:28:09,634
TEST IS TO TEST THE ABILITY OF

3822
02:28:09,634 --> 02:28:10,268
THIS DEVICE TO TRACK BLOOD

3823
02:28:10,268 --> 02:28:11,303
PRESSURE CHANGES.

3824
02:28:11,303 --> 02:28:14,472
THIS IS THE MOST WEAK POINT OF

3825
02:28:14,472 --> 02:28:15,774
THE TECHNOLOGIES.

3826
02:28:15,774 --> 02:28:20,045
WE NEED TESTING FOR

3827
02:28:20,045 --> 02:28:21,546
POSITION/MOTION, AND WE NEED TO

3828
02:28:21,546 --> 02:28:23,648
CHECK STABILITY OVER TIME FOR

3829
02:28:23,648 --> 02:28:26,084
THOSE DEVICES WHICH REQUIRE

3830
02:28:26,084 --> 02:28:26,952
PERIODIC CALIBRATION.

3831
02:28:26,952 --> 02:28:30,755
THE PROBLEM IS WE HAVE DIFFERENT

3832
02:28:30,755 --> 02:28:32,190
TECHNOLOGIES, DIFFERENT DEVICES

3833
02:28:32,190 --> 02:28:34,226
AND INTENDED USES, AND WE HAVE

3834
02:28:34,226 --> 02:28:36,561
FOR EACH ONE TO SEE WHETHER IT'S

3835
02:28:36,561 --> 02:28:40,398
WEARABLE, OR NOT, IF IT'S CUFF

3836
02:28:40,398 --> 02:28:43,602
INITIATED OR NOT, IF DEMOGRAPHIC

3837
02:28:43,602 --> 02:28:48,173
OR NOT, AUTOMATED OR OCCASIONAL,

3838
02:28:48,173 --> 02:28:48,840
PROVIDES CONTINUOUS MEASUREMENT,

3839
02:28:48,840 --> 02:28:52,043
MEASURES ALWAYS AT HEART LEVEL

3840
02:28:52,043 --> 02:28:54,246
AND WHEN YOU ANSWER ALL THESE

3841
02:28:54,246 --> 02:28:55,847
QUESTIONS ABOUT THE SINGLE

3842
02:28:55,847 --> 02:28:59,484
DEVICE, THEN YOU'LL BE ABLE TO

3843
02:28:59,484 --> 02:29:05,190
TAILOR WHICH PROTOCOL AND WHICH

3844
02:29:05,190 --> 02:29:07,792
TEST EACH DEVICE REQUIRES.

3845
02:29:07,792 --> 02:29:10,962
SO, ANSWERING TO THE THREE

3846
02:29:10,962 --> 02:29:12,163
QUESTIONS I WAS ASKED TO ANSWER,

3847
02:29:12,163 --> 02:29:16,234
WHAT IS THE MOST PROMISING

3848
02:29:16,234 --> 02:29:19,838
SCIENTIFIC AREAS, IT SEEMS

3849
02:29:19,838 --> 02:29:23,441
SENSORS NEED TO BE DEVELOPED

3850
02:29:23,441 --> 02:29:26,745
FURTHER AND PROBABLY PPG ALONE

3851
02:29:26,745 --> 02:29:27,946
MOST ENGINEERS SAY CANNOT

3852
02:29:27,946 --> 02:29:33,652
MEASURE PRESSURE. 

3853
02:29:33,652 --> 02:29:36,621
SO MULTI-SENSORS COMBINING WITH

3854
02:29:36,621 --> 02:29:40,358
OTHER SENSORS MIGHT IMPROVE THE

3855
02:29:40,358 --> 02:29:44,062
ESTIMATION OF BLOOD PRESSURE.

3856
02:29:44,062 --> 02:29:46,998
AND I LED THAT THERE ARE MORE

3857
02:29:46,998 --> 02:29:48,867
MODELS FOR MACHINE LEARNING AND

3858
02:29:48,867 --> 02:29:53,238
DEEP LEARNING THAT CAN BE

3859
02:29:53,238 --> 02:29:53,672
INVESTIGATED.

3860
02:29:53,672 --> 02:29:56,508
AND CERTAINLY THE LARGER THE

3861
02:29:56,508 --> 02:30:00,779
DATASET, THE BETTER THE LEARNING

3862
02:30:00,779 --> 02:30:02,213
OF THE MODEL.

3863
02:30:02,213 --> 02:30:04,382
GAPS IN KNOWLEDGE, HOW TO MOVE

3864
02:30:04,382 --> 02:30:05,717
FORWARD, NEED IMPROVE MODEL

3865
02:30:05,717 --> 02:30:08,119
TRAINING, DATA QUALITY AND

3866
02:30:08,119 --> 02:30:09,421
DIVERSITY, WE NEED DATABASES TO

3867
02:30:09,421 --> 02:30:11,523
INCLUDE PEOPLE WITH HIGH AND LOW

3868
02:30:11,523 --> 02:30:15,226
BLOOD PRESSURE, YOUNG AND OLD,

3869
02:30:15,226 --> 02:30:16,127
WITH DIFFERENT SKIN PIGMENTATION

3870
02:30:16,127 --> 02:30:22,467
AND ANYTHING ELSE THAT MIGHT

3871
02:30:22,467 --> 02:30:25,770
AFFECT DIFFERENT SENSORS,

3872
02:30:25,770 --> 02:30:27,839
AFFECTED BY DIFFERENT

3873
02:30:27,839 --> 02:30:28,139
PARAMETERS.

3874
02:30:28,139 --> 02:30:31,543
WE NEED MORE DATA PER SUBJECT,

3875
02:30:31,543 --> 02:30:33,311
BETTER HAVE MORE INFORMATION PER

3876
02:30:33,311 --> 02:30:33,645
SUBJECT.

3877
02:30:33,645 --> 02:30:38,116
AND WE NEED TO VALIDATE AND TEST

3878
02:30:38,116 --> 02:30:39,150
THESE ALGORITHMS.

3879
02:30:39,150 --> 02:30:43,154
AND THE KEY CHALLENGES AND

3880
02:30:43,154 --> 02:30:46,358
BARRIERS HINDERING PROGRESS, IT

3881
02:30:46,358 --> 02:30:48,093
SEEMS THAT MY UNDERSTANDING IS

3882
02:30:48,093 --> 02:30:52,931
WE'RE NOT TOO CLOSE TO HAVE

3883
02:30:52,931 --> 02:30:55,000
MEASUREMENT WITH SENSORS,

3884
02:30:55,000 --> 02:30:58,803
CUFFLESS, IN OUR PEOPLE.

3885
02:30:58,803 --> 02:31:00,672
A PROBLEM IS THE HETEROGENEITY

3886
02:31:00,672 --> 02:31:02,207
OF TECHNOLOGY AND DEVICES WHICH

3887
02:31:02,207 --> 02:31:03,742
AS I SAID NEED DIFFERENT

3888
02:31:03,742 --> 02:31:04,509
TESTING.

3889
02:31:04,509 --> 02:31:06,378
WE CAN'T COME OUT WITH A SINGLE

3890
02:31:06,378 --> 02:31:11,950
STANDARD FOR ALL OF THEM.

3891
02:31:11,950 --> 02:31:16,187
AND CERTAINLY WE HAVE TO GO FOR

3892
02:31:16,187 --> 02:31:17,422
MORE COMPLEX VALIDATION

3893
02:31:17,422 --> 02:31:19,190
PROCEDURES WITH THESE DEVICES.

3894
02:31:19,190 --> 02:31:22,894
WE CAN'T GET IT SO EASY AS WE

3895
02:31:22,894 --> 02:31:25,997
DID FOR THE CUFF DEVICES.

3896
02:31:25,997 --> 02:31:28,700
WE STILL DO NOT HAVE UNIVERSALLY

3897
02:31:28,700 --> 02:31:31,036
ACCEPTED PROCEDURES FOR THESE

3898
02:31:31,036 --> 02:31:31,336
DEVICES.

3899
02:31:31,336 --> 02:31:33,438
MY FINAL SLIDE IS A STATEMENT WE

3900
02:31:33,438 --> 02:31:40,712
PUBLISHED LAST YEAR.

3901
02:31:40,712 --> 02:31:43,415
NO QUESTION THEY HAVE

3902
02:31:43,415 --> 02:31:44,516
CONSIDERABLE POTENTIAL FOR

3903
02:31:44,516 --> 02:31:47,252
CHANGING WHATEVER WE DO FOR

3904
02:31:47,252 --> 02:31:49,320
DIAGNOSING AND MONITORING OF

3905
02:31:49,320 --> 02:31:49,654
HYPERTENSION.

3906
02:31:49,654 --> 02:31:53,158
IF WE GET IT RIGHT WE DON'T NEED

3907
02:31:53,158 --> 02:31:54,959
OFFICE, HOME, AMBULATORY.

3908
02:31:54,959 --> 02:31:57,796
BUT WE DO HAVE FUNDAMENTAL

3909
02:31:57,796 --> 02:32:02,367
QUESTIONS ABOUT THE ACCURACY,

3910
02:32:02,367 --> 02:32:04,569
PERFORMANCE, AND IMPLEMENTATION.

3911
02:32:04,569 --> 02:32:07,205
AND ALL THESE HAVE TO BE

3912
02:32:07,205 --> 02:32:08,506
CAREFULLY ADDRESSED BEFORE WE

3913
02:32:08,506 --> 02:32:11,676
CAN RECOMMEND THEM FOR CLINICAL

3914
02:32:11,676 --> 02:32:12,010
USE.

3915
02:32:12,010 --> 02:32:13,912
THANK YOU.

3916
02:32:13,912 --> 02:32:18,883
>> THANK YOU FOR SUCH A

3917
02:32:18,883 --> 02:32:19,751
FORWARD-THINKING PRESENTATION,

3918
02:32:19,751 --> 02:32:20,385
THE BEDROCK OF THE PROMISE OF

3919
02:32:20,385 --> 02:32:22,353
CONTROLLING BLOOD PRESSURE HAS

3920
02:32:22,353 --> 02:32:23,188
NOT BEEN FULFILLED AT THE

3921
02:32:23,188 --> 02:32:24,355
PRESENT TIME.

3922
02:32:24,355 --> 02:32:28,193
WE'LL HEAR FROM DR. PAUL WHELTON

3923
02:32:28,193 --> 02:32:30,061
FROM TULANE SCHOOL OF UNIVERSITY

3924
02:32:30,061 --> 02:32:35,200
SCHOOL OF MEDICINE AND TROPICAL

3925
02:32:35,200 --> 02:32:36,968
MEDICINE, WHERE I AM, UPDATE ON

3926
02:32:36,968 --> 02:32:38,837
TREATMENT AND CONTROL OF HIGH

3927
02:32:38,837 --> 02:32:39,270
BLOOD PRESSURE.

3928
02:32:39,270 --> 02:32:39,471
PAUL?

3929
02:32:39,471 --> 02:32:39,904
>> THANK YOU.

3930
02:32:39,904 --> 02:32:44,075
A PLEASURE TO BE WITH EVERYONE

3931
02:32:44,075 --> 02:32:45,376
TODAY.

3932
02:32:45,376 --> 02:32:46,911
I'M GOING TO TALK ABOUT

3933
02:32:46,911 --> 02:32:48,913
HYPERTENSION PREVALENCE AND

3934
02:32:48,913 --> 02:32:49,781
BLOOD PRESSURE CONTROL.

3935
02:32:49,781 --> 02:32:52,417
I DO NOT HAVE ANY CONFLICTS OF

3936
02:32:52,417 --> 02:32:54,919
INTEREST THAT I'M AWARE OF.

3937
02:32:54,919 --> 02:32:58,423
LET ME JUST START BY SAYING MOST

3938
02:32:58,423 --> 02:33:01,626
OF THE REPORTS ON PREVALENCE AND

3939
02:33:01,626 --> 02:33:02,594
CONTROL OF HYPERTENSION COME

3940
02:33:02,594 --> 02:33:05,563
FROM NHANES, AND THAT'S

3941
02:33:05,563 --> 02:33:06,498
PERFECTLY SENSIBLE AND

3942
02:33:06,498 --> 02:33:09,400
UNDERSTANDABLE BECAUSE IT IS OF

3943
02:33:09,400 --> 02:33:10,034
COURSE NATIONALLY REPRESENTATIVE

3944
02:33:10,034 --> 02:33:10,235
DATA.

3945
02:33:10,235 --> 02:33:11,903
THERE ARE A LOT OF DATA POINTS

3946
02:33:11,903 --> 02:33:14,772
BECAUSE THE SURVEY IS DONE ON A

3947
02:33:14,772 --> 02:33:15,773
BIENNIAL BASIS.

3948
02:33:15,773 --> 02:33:17,942
AND THE BLOOD PRESSURE

3949
02:33:17,942 --> 02:33:25,183
MEASUREMENT METHODS ARE

3950
02:33:25,183 --> 02:33:26,151
RELATIVELY STABLE.

3951
02:33:26,151 --> 02:33:29,120
SINCE 1999, BLOOD PRESSURES HAVE

3952
02:33:29,120 --> 02:33:32,824
BEEN MEASURED ONLY AT MOBILE

3953
02:33:32,824 --> 02:33:33,925
EXAMINE CENTER, STANDARDIZED

3954
02:33:33,925 --> 02:33:35,927
PROTOCOL, GREAT DEAL OF

3955
02:33:35,927 --> 02:33:38,196
ATTENTION TO QUALITY CONTROL.

3956
02:33:38,196 --> 02:33:39,531
TYPICALLY THREE SYSTOLIC AND

3957
02:33:39,531 --> 02:33:42,800
DIASTOLIC MEASURES, A FOURTH IF

3958
02:33:42,800 --> 02:33:43,234
NECESSARY.

3959
02:33:43,234 --> 02:33:45,236
AND NHANES RECOMMENDS AVERAGING

3960
02:33:45,236 --> 02:33:51,109
THE LAST TWO PRESSURES TO GET

3961
02:33:51,109 --> 02:33:53,178
AVERAGE ESTIMATE, ALTHOUGH MANY

3962
02:33:53,178 --> 02:33:54,746
INVESTIGATORS AVERAGE ALL THREE

3963
02:33:54,746 --> 02:33:57,248
BECAUSE WE KNOW THAT IN THAT

3964
02:33:57,248 --> 02:34:02,820
NHANES DATASET THAT ACTUALLY HAS

3965
02:34:02,820 --> 02:34:04,122
PERFECTLY ACCEPTABLE.

3966
02:34:04,122 --> 02:34:09,260
BETWEEN 2009 AND 2018, THE

3967
02:34:09,260 --> 02:34:15,733
MEASUREMENTS WERE MADE WITH

3968
02:34:15,733 --> 02:34:18,736
AUSCULTORY METHODS, SYSTOLIC K

3969
02:34:18,736 --> 02:34:25,944
1, DIASTOLIC K 5.

3970
02:34:25,944 --> 02:34:29,113
IN 2017 USING 907, OVERSEEN BY

3971
02:34:29,113 --> 02:34:31,983
HOUSE TECHNICIAN.

3972
02:34:31,983 --> 02:34:36,688
IN THAT FIRST BIENNIAL SURVEY,

3973
02:34:36,688 --> 02:34:43,361
2017-2018, NHANES UNDERTOOK

3974
02:34:43,361 --> 02:34:44,696
RANDOMIZED COMPARISON OF

3975
02:34:44,696 --> 02:34:55,206
OSCILLOMETRIC AND AUSCULTORY.

3976
02:34:56,307 --> 02:34:58,009
OSCILLOMETRIC WERE 6.15

3977
02:34:58,009 --> 02:35:02,180
MILLIMETERS LOWER ON AVERAGE,

3978
02:35:02,180 --> 02:35:06,985
DIASTOLICS 1.3 HIGHER ON AVERAGE

3979
02:35:06,985 --> 02:35:08,186
COMPARED TO OSCILLOMETRIC

3980
02:35:08,186 --> 02:35:08,653
MEASUREMENTS.

3981
02:35:08,653 --> 02:35:12,257
WORTH BEARING IN MIND NHANES

3982
02:35:12,257 --> 02:35:13,458
DEFINITIONS OF HYPERTENSION

3983
02:35:13,458 --> 02:35:14,659
DIFFER FROM GUIDELINE

3984
02:35:14,659 --> 02:35:15,560
RECOMMENDATIONS FOR HOW IT

3985
02:35:15,560 --> 02:35:18,263
SHOULD BE DONE.

3986
02:35:18,263 --> 02:35:23,835
GUIDELINES I THINK ALMOST ALL

3987
02:35:23,835 --> 02:35:26,137
GUIDELINES RECOMMEND THAT

3988
02:35:26,137 --> 02:35:27,739
PRESSURES BE OBTAINED AT

3989
02:35:27,739 --> 02:35:32,910
REPEATED VISITS, GOING BACK TO

3990
02:35:32,910 --> 02:35:41,019
EARLY DAYS, THE TURN OF THE

3991
02:35:41,019 --> 02:35:41,219
1900s.

3992
02:35:41,219 --> 02:35:43,187
GNC AND HCC/AHA HAVE THE SAME

3993
02:35:43,187 --> 02:35:48,660
REPRESENT ATION, TWO OR MORE

3994
02:35:48,660 --> 02:35:49,661
ACCURATE MEASUREMENTS AND

3995
02:35:49,661 --> 02:35:51,162
FURTHER RECOMMENDATION THAT HIGH

3996
02:35:51,162 --> 02:35:53,898
OFFICE OR CLINIC BP BE CONFIRMED

3997
02:35:53,898 --> 02:35:57,669
WITH AN OUT OF OFFICE BLOOD

3998
02:35:57,669 --> 02:35:58,303
PRESSURE.

3999
02:35:58,303 --> 02:36:00,938
SO NHANES ESTIMATES OF

4000
02:36:00,938 --> 02:36:03,875
HYPERTENSION PREVALENCE WILL

4001
02:36:03,875 --> 02:36:05,476
OVERESTIMATE GUIDELINE

4002
02:36:05,476 --> 02:36:05,910
DEFINITION, DEFINED

4003
02:36:05,910 --> 02:36:06,411
HYPERTENSION.

4004
02:36:06,411 --> 02:36:09,480
THERE ARE LOTS OF PUBLICATIONS,

4005
02:36:09,480 --> 02:36:10,715
PROBABLY MORE THAN HERE, MANY

4006
02:36:10,715 --> 02:36:12,016
FROM MY OWN DEPARTMENT.

4007
02:36:12,016 --> 02:36:18,690
I'M GOING TO SHOW DATA FROM TWO.

4008
02:36:18,690 --> 02:36:21,426
FROM THE DORANS PAPER AND PAUL

4009
02:36:21,426 --> 02:36:23,194
MUNTNER AND COLLEAGUES.

4010
02:36:23,194 --> 02:36:24,829
OVERALL PATTERNS IN ALMOST ALL

4011
02:36:24,829 --> 02:36:26,664
OF THESE PUBLICATIONS ARE QUITE

4012
02:36:26,664 --> 02:36:27,832
SIMILAR, ALTHOUGH THE ABSTRACT

4013
02:36:27,832 --> 02:36:31,269
VALUES DO DIFFER A LITTLE BIT.

4014
02:36:31,269 --> 02:36:34,439
I'M GOING TO SHOW THE DORANS

4015
02:36:34,439 --> 02:36:37,942
PUBLICATION BECAUSE I THINK IT

4016
02:36:37,942 --> 02:36:41,245
GIVES A NICE SORT OF VIEW OF

4017
02:36:41,245 --> 02:36:49,987
MANY DATA POINTS.

4018
02:36:49,987 --> 02:36:52,090
IT PRECEDES OSCILLOMETRIC.

4019
02:36:52,090 --> 02:36:58,463
THE MUNTNER IS MORE RECENT, FROM

4020
02:36:58,463 --> 02:36:59,630
2009 THROUGH 2020.

4021
02:36:59,630 --> 02:37:03,234
AND IT PROVIDES A LOT OF DATA.

4022
02:37:03,234 --> 02:37:09,273
THERE'S A LOT OF DETAILED

4023
02:37:09,273 --> 02:37:09,841
INFORMATION, THE SUPPLEMENT

4024
02:37:09,841 --> 02:37:11,109
PROVIDES ESTIMATES THAT ARE

4025
02:37:11,109 --> 02:37:14,846
MODIFIED, THAT'S IN THE MAIN

4026
02:37:14,846 --> 02:37:16,914
PAPER, ALSO UNMODIFIED, AND A

4027
02:37:16,914 --> 02:37:17,915
LOT MORE.

4028
02:37:17,915 --> 02:37:19,016
SO, IN THIS PRESENTATION I'M

4029
02:37:19,016 --> 02:37:20,418
GOING TO SHOW WHAT'S IN THE MAIN

4030
02:37:20,418 --> 02:37:24,789
PAPER, THAT IS THE MODIFIED

4031
02:37:24,789 --> 02:37:26,224
READINGS, FOR OSCILLOMETRIC THAT

4032
02:37:26,224 --> 02:37:31,696
CAN BE COMPARABLE OVER TIME TO

4033
02:37:31,696 --> 02:37:40,238
THE OSCILLOMETRIC MEASUREMENTS.

4034
02:37:40,238 --> 02:37:42,073
AND IN MUNTNER BASED ON

4035
02:37:42,073 --> 02:37:42,807
READINGS.

4036
02:37:42,807 --> 02:37:51,549
YOU'LL SEE UP HERE FROM 1999

4037
02:37:51,549 --> 02:37:54,118
THROUGH 2016, A FEW THINGS, EACH

4038
02:37:54,118 --> 02:37:55,887
BIENNIAL SURVEYS HAS A PRETTY

4039
02:37:55,887 --> 02:37:57,855
GOOD SAMPLE SIZE, EVEN WHEN

4040
02:37:57,855 --> 02:37:59,490
LOOKING AT THIS MAJOR SUBGROUPS,

4041
02:37:59,490 --> 02:38:01,893
YOU STILL HAVE A GOOD DEAL OF

4042
02:38:01,893 --> 02:38:02,160
PRECISION.

4043
02:38:02,160 --> 02:38:05,963
I WANT TO POINT OUT THAT USE OF

4044
02:38:05,963 --> 02:38:12,203
BLOOD PRESSURE MEDS IN GENERAL

4045
02:38:12,203 --> 02:38:13,070
POPULATION INCREASED

4046
02:38:13,070 --> 02:38:14,172
PROGRESSIVELY THROUGH 2008,

4047
02:38:14,172 --> 02:38:17,542
2009, SORT OF STABLE EVER SINCE.

4048
02:38:17,542 --> 02:38:22,914
I WANT TO POINT OUT EVEN IN THE

4049
02:38:22,914 --> 02:38:23,781
GENERAL POPULATION, NOT

4050
02:38:23,781 --> 02:38:24,882
SELECTING OUT PATIENTS GOING TO

4051
02:38:24,882 --> 02:38:30,455
CLINICS BUT IN THE GENERAL

4052
02:38:30,455 --> 02:38:34,859
POPULATION, RISK RATE EQUAL OR

4053
02:38:34,859 --> 02:38:36,828
GREATER THAN 10%, ACCHA HIGH

4054
02:38:36,828 --> 02:38:39,230
RISK, QUITE HIGH, 20% OF THE

4055
02:38:39,230 --> 02:38:39,764
POPULATION HAD THAT.

4056
02:38:39,764 --> 02:38:43,267
MUCH HIGHER WHEN YOU GO TO

4057
02:38:43,267 --> 02:38:46,871
CLINIC SETTINGS.

4058
02:38:46,871 --> 02:38:51,275
AND YOU'LL SEE FOUR DEPICTIONS

4059
02:38:51,275 --> 02:38:52,577
OF TRENDS, SYSTOLIC.

4060
02:38:52,577 --> 02:38:54,278
I WON'T GO THROUGH IN DETAIL BUT

4061
02:38:54,278 --> 02:38:57,181
YOU'LL SEE THE GENERAL PATTERN,

4062
02:38:57,181 --> 02:39:06,524
ALL OF THESE SUBGROUPS THAT

4063
02:39:06,524 --> 02:39:09,594
THERE'S A PROGRESSIVE DECLINE,

4064
02:39:09,594 --> 02:39:16,033
AND UPTICK, CERTAINLY NO

4065
02:39:16,033 --> 02:39:18,102
IMPROVEMENT AFTER THAT.

4066
02:39:18,102 --> 02:39:21,939
I'M GOING TO CATEGORICAL DATA.

4067
02:39:21,939 --> 02:39:23,641
IN THE MUNTNER ET AL.

4068
02:39:23,641 --> 02:39:27,545
PRESENTATION FOR MOST OF THE

4069
02:39:27,545 --> 02:39:29,280
TIME FRAME THE 140/90 DEFINITION

4070
02:39:29,280 --> 02:39:30,381
WOULD HAVE APPLIED IN CLINICAL

4071
02:39:30,381 --> 02:39:31,482
PRACTICE.

4072
02:39:31,482 --> 02:39:35,419
THAT'S WHAT WAS RECOMMENDED..

4073
02:39:35,419 --> 02:39:39,123
THAT'S WHAT I'LL FOCUS ON,

4074
02:39:39,123 --> 02:39:39,724
SELF-REPORT OF TAKING

4075
02:39:39,724 --> 02:39:41,092
ANTI-HYPERTENSIVE MEDICATION.

4076
02:39:41,092 --> 02:39:42,059
HERE IS PREVALENCE.

4077
02:39:42,059 --> 02:39:47,331
YOU CAN SEE AT THE 140/90, A

4078
02:39:47,331 --> 02:39:49,100
LITTLE OVER 30%, MAYBE SLIGHT

4079
02:39:49,100 --> 02:39:51,969
TREND UPWARDS, IT'S NOT

4080
02:39:51,969 --> 02:39:52,937
STATISTICALLY SIGNIFICANT.

4081
02:39:52,937 --> 02:39:54,272
OBVIOUSLY IT'S AGE DEPENDENT.

4082
02:39:54,272 --> 02:39:57,341
YOU GET INTO THE UPPER AGE RANGE

4083
02:39:57,341 --> 02:40:01,712
OF 75+, YOU GET A VERY HIGH

4084
02:40:01,712 --> 02:40:02,246
PREVALENCE.

4085
02:40:02,246 --> 02:40:05,116
IF WE LOOK BY GENDER, RATE,

4086
02:40:05,116 --> 02:40:09,687
ETHNICITY, WHAT STANDS OUT IS

4087
02:40:09,687 --> 02:40:10,888
THAT NON-HISPANIC BLACKS,

4088
02:40:10,888 --> 02:40:12,990
PREVALENCE OF THAT HIGH CUT

4089
02:40:12,990 --> 02:40:13,958
POINT FOR DEFINITION OF

4090
02:40:13,958 --> 02:40:15,826
HYPERTENSION IS VERY, VERY HIGH.

4091
02:40:15,826 --> 02:40:19,230
MUCH HIGHER THAN ANY OF THE

4092
02:40:19,230 --> 02:40:21,632
OTHER RACE/ETHNICITY GROUPS IN

4093
02:40:21,632 --> 02:40:22,500
THE ITS.

4094
02:40:22,500 --> 02:40:24,168
I'M FOCUSING ON U.S. DATA

4095
02:40:24,168 --> 02:40:27,004
BECAUSE THIS IS AN NHANES

4096
02:40:27,004 --> 02:40:27,338
WORKSHOP.

4097
02:40:27,338 --> 02:40:31,175
I MEAN, AN NHLBI WORKSHOP.

4098
02:40:31,175 --> 02:40:33,744
LOOKING AT AWARENESS, YOU CAN

4099
02:40:33,744 --> 02:40:37,214
SEE OVERALL PATTERN ON THE LEFT

4100
02:40:37,214 --> 02:40:38,649
PANEL.

4101
02:40:38,649 --> 02:40:41,018
THERE'S A NOMINALLY SIGNIFICANT

4102
02:40:41,018 --> 02:40:41,452
DECLINE.

4103
02:40:41,452 --> 02:40:44,188
THAT'S TRUE FOR THE PATTERN --

4104
02:40:44,188 --> 02:40:46,057
THE PATTERN TRUE FOR ALL AGE

4105
02:40:46,057 --> 02:40:50,761
GROUPS, MORE SIGNIFICANT FOR

4106
02:40:50,761 --> 02:40:53,164
OLDEST AGE GROUP, SEEING DECLINE

4107
02:40:53,164 --> 02:40:53,965
IN AWARENESS.

4108
02:40:53,965 --> 02:40:57,068
IF WE LOOK AT DRUG TREATMENT,

4109
02:40:57,068 --> 02:41:00,504
THOSE AWARE THAT THEY HAD

4110
02:41:00,504 --> 02:41:03,240
HYPERTENSION, IT'S QUITE HIGH,

4111
02:41:03,240 --> 02:41:05,643
OVERALL ABOUT A LITTLE OVER 90%.

4112
02:41:05,643 --> 02:41:08,079
OF COURSE ESPECIALLY HIGH IN THE

4113
02:41:08,079 --> 02:41:09,814
OLDER AGE GROUP.

4114
02:41:09,814 --> 02:41:14,185
IF WE LOOK MORE GENERALLY AT

4115
02:41:14,185 --> 02:41:15,920
DRUG TREATMENT BROADLY, NOT JUST

4116
02:41:15,920 --> 02:41:17,421
IN THOSE BEING TREATED BUT IN

4117
02:41:17,421 --> 02:41:21,192
THE GENERAL POPULATION AS A

4118
02:41:21,192 --> 02:41:23,494
WHOLE, IT'S LOWER.

4119
02:41:23,494 --> 02:41:26,664
AND YOU'LL SEE THERE'S

4120
02:41:26,664 --> 02:41:28,866
PROGRESSIVE TENDENCY FOR A

4121
02:41:28,866 --> 02:41:30,001
DECLINE.

4122
02:41:30,001 --> 02:41:39,910
YOU'LL SEE THAT FOR THE LAST

4123
02:41:39,910 --> 02:41:47,184
TIME PERIOD, WE'RE LOOKING AT --

4124
02:41:47,184 --> 02:41:48,152
UPPER AGE RAGE, 50%.

4125
02:41:48,152 --> 02:41:50,354
THIS IS IN THOSE BEING TREATED.

4126
02:41:50,354 --> 02:41:53,524
THIS IS THE GENERAL.

4127
02:41:53,524 --> 02:41:56,460
AND PROGRESSIVE DECLINE,

4128
02:41:56,460 --> 02:41:57,662
SIGNIFICANT OVERALL, ESPECIALLY

4129
02:41:57,662 --> 02:41:59,530
SIGNIFICANT IN THE UPPER AGE

4130
02:41:59,530 --> 02:41:59,730
RANGE.

4131
02:41:59,730 --> 02:42:06,904
WHETHER THIS RELATES TO THE FACT

4132
02:42:06,904 --> 02:42:08,973
THAT ACCHA WE RECOMMEND 130/80,

4133
02:42:08,973 --> 02:42:13,477
LESS THAN 130, AND OLDER AGE

4134
02:42:13,477 --> 02:42:15,880
RANGE, A WAY TO COMPETING

4135
02:42:15,880 --> 02:42:18,949
GUIDELINE FROM ACP AND AAFP,

4136
02:42:18,949 --> 02:42:21,118
WHICH DURING THIS EARLY TIME

4137
02:42:21,118 --> 02:42:24,622
PERIOD IS DIFFERENT NOW, BUT

4138
02:42:24,622 --> 02:42:27,058
DURING THE SAME TIME PERIOD,

4139
02:42:27,058 --> 02:42:28,793
RECOMMENDED YOU COULD HAVE

4140
02:42:28,793 --> 02:42:33,397
SYSTOLIC AS HIGH AS 150 AND BE

4141
02:42:33,397 --> 02:42:36,467
COMFORTABLE UNLESS SOMEBODY HAD

4142
02:42:36,467 --> 02:42:37,768
VERY HIGH RISK.

4143
02:42:37,768 --> 02:42:39,170
THAT MAY HAVE HAVE SOMETHING TO

4144
02:42:39,170 --> 02:42:43,007
DO WITH IT, PERHAPS THE FACT

4145
02:42:43,007 --> 02:42:44,875
THAT HEDIS CONTINUES TO USE

4146
02:42:44,875 --> 02:42:46,110
140/90 MAY HAVE SOMETHING TO DO

4147
02:42:46,110 --> 02:42:46,944
WITH IT.

4148
02:42:46,944 --> 02:42:49,146
CAN'T BE SURE.

4149
02:42:49,146 --> 02:42:54,085
IF WE LOOK BY GENDER AND

4150
02:42:54,085 --> 02:42:54,652
RACE/ETHNICITY, NON-HISPANIC

4151
02:42:54,652 --> 02:42:57,488
BLACKS, WE NOT ONLY HAVE HIGHER

4152
02:42:57,488 --> 02:43:01,225
PREVALENCE, WE NOT ONLY HAVE

4153
02:43:01,225 --> 02:43:02,193
MORE OF ANY PARTICULAR LEVEL

4154
02:43:02,193 --> 02:43:07,665
COMPARED TO ANY OTHER GROUP,

4155
02:43:07,665 --> 02:43:09,400
ALSO HAVE LEAST EFFECTIVE

4156
02:43:09,400 --> 02:43:10,868
TREATMENT AND CONTROL THAN OTHER

4157
02:43:10,868 --> 02:43:14,138
GROUP, A DISMAL PICTURE.

4158
02:43:14,138 --> 02:43:15,840
I'LL LOOK AT 130/80, THIS WOULD

4159
02:43:15,840 --> 02:43:17,842
ONLY APPLY TO THE LAST OF THE

4160
02:43:17,842 --> 02:43:20,377
THREE PERIODS THAT I'M SHOWING

4161
02:43:20,377 --> 02:43:23,314
FROM THE MUNTNER PAPER.

4162
02:43:23,314 --> 02:43:25,282
HERE'S PREVALENCE, MUCH HIGHER

4163
02:43:25,282 --> 02:43:27,485
COMPARED TO 140/90, OBVIOUSLY.

4164
02:43:27,485 --> 02:43:31,388
ALMOST 50% OF THE POPULATION.

4165
02:43:31,388 --> 02:43:35,693
AND AGAIN VERY AGE DEPENDENT,

4166
02:43:35,693 --> 02:43:39,230
LIKEWISE SIMILAR TO 140/90,

4167
02:43:39,230 --> 02:43:40,097
STRIKINGLY DIFFERENT IN

4168
02:43:40,097 --> 02:43:41,799
NON-HISPANIC BLACKS, COMPARED TO

4169
02:43:41,799 --> 02:43:47,404
ALL THE OTHER RACE/ETHNICITY

4170
02:43:47,404 --> 02:43:48,005
GROUPS.

4171
02:43:48,005 --> 02:43:49,840
HERE'S AWARENESS.

4172
02:43:49,840 --> 02:43:52,343
AWARENESS IS CONSIDERABLY LOWER,

4173
02:43:52,343 --> 02:43:54,211
AND REALLY ONLY ABLE TO LOOK

4174
02:43:54,211 --> 02:43:56,714
REASONABLY AT THE LAST TIME

4175
02:43:56,714 --> 02:43:57,915
PERIOD TO SEE AWARENESS

4176
02:43:57,915 --> 02:44:00,217
IMPROVED, AND WHAT WE'RE SEEING

4177
02:44:00,217 --> 02:44:03,420
HERE IS, NO, AWARENESS DID NOT

4178
02:44:03,420 --> 02:44:04,622
IMPROVE DESPITE RECOMMENDATION

4179
02:44:04,622 --> 02:44:07,458
FROM ONE OF THE MAJOR GUIDELINES

4180
02:44:07,458 --> 02:44:11,729
WE SHOULD FOCUS ON 130/80, AND

4181
02:44:11,729 --> 02:44:14,265
PARTICULARLY SEEING DECLINE IN

4182
02:44:14,265 --> 02:44:16,767
OLDER AGE RANGES.

4183
02:44:16,767 --> 02:44:18,068
ANTI-HYPERTENSIVE DRUG TREATMENT

4184
02:44:18,068 --> 02:44:20,371
IN THOSE AWARE.

4185
02:44:20,371 --> 02:44:25,409
AGAIN, IT'S LESS SO THAN IN THE

4186
02:44:25,409 --> 02:44:25,743
140/90.

4187
02:44:25,743 --> 02:44:28,712
AND NO REAL SENSE THAT THERE'S

4188
02:44:28,712 --> 02:44:29,680
MUCH IMPROVEMENT IN DRUG

4189
02:44:29,680 --> 02:44:33,951
TREATMENT IN THE LAST TIME

4190
02:44:33,951 --> 02:44:34,185
PERIOD.

4191
02:44:34,185 --> 02:44:36,020
HERE IS CONTROL, IN THE GROUP

4192
02:44:36,020 --> 02:44:37,555
BEING TREATED.

4193
02:44:37,555 --> 02:44:40,658
AND NO EVIDENCE FOR IMPROVEMENT

4194
02:44:40,658 --> 02:44:43,127
IN CONTROL IN THE LAST TIME

4195
02:44:43,127 --> 02:44:43,494
PERIOD.

4196
02:44:43,494 --> 02:44:45,763
IF ANYTHING, IT'S DECLINING.

4197
02:44:45,763 --> 02:44:46,764
IT'S NOT STATISTICALLY

4198
02:44:46,764 --> 02:44:47,698
SIGNIFICANT BUT THE TREND

4199
02:44:47,698 --> 02:44:54,538
CERTAINLY IS IN THE WRONG

4200
02:44:54,538 --> 02:44:55,506
DIRECTION.

4201
02:44:55,506 --> 02:44:57,575
LOOKING AT CONTROL, AGAIN NO

4202
02:44:57,575 --> 02:44:59,243
EVIDENCE FOR IMPROVEMENT IN THAT

4203
02:44:59,243 --> 02:45:01,545
LAST TIME PERIOD.

4204
02:45:01,545 --> 02:45:02,613
SO, VERY DISTURBING PICTURE.

4205
02:45:02,613 --> 02:45:04,481
NOW, I WANT TO SHOW TWO OTHER

4206
02:45:04,481 --> 02:45:06,917
SLIDES AND THEN I'LL STOP.

4207
02:45:06,917 --> 02:45:12,389
I WANT TO SHOW A SLIDE OF

4208
02:45:12,389 --> 02:45:15,459
TEMPORAL TRENDS FROM SPRINT.

4209
02:45:15,459 --> 02:45:17,228
LEFT-HAND PANEL HAZARD RATIOS,

4210
02:45:17,228 --> 02:45:17,962
CARDIOVASCULAR MORTALITY.

4211
02:45:17,962 --> 02:45:25,069
AND AS YOU KNOW IN SPRINT, WE AS

4212
02:45:25,069 --> 02:45:26,170
INVESTIGATORS ENCOURAGE AND TALK

4213
02:45:26,170 --> 02:45:29,707
TO AND SO ON PRIMARY CARE

4214
02:45:29,707 --> 02:45:31,075
PHYSICIANS, STILL IN CHARGE OF

4215
02:45:31,075 --> 02:45:33,077
PATIENTS, BUT GAVE A LOT OF

4216
02:45:33,077 --> 02:45:33,444
ADVICE.

4217
02:45:33,444 --> 02:45:35,512
DURING THE TIME THE TRIAL IS

4218
02:45:35,512 --> 02:45:37,882
BEING DONE HAZARD RATIO WENT

4219
02:45:37,882 --> 02:45:40,618
DOWN PROGRESSIVELY, AND IN A

4220
02:45:40,618 --> 02:45:42,353
VERY NICE DIRECTION.

4221
02:45:42,353 --> 02:45:43,587
AND THEN TRIAL WAS STOPPED.

4222
02:45:43,587 --> 02:45:45,890
THERE'S A PERIOD AFTER THE TRIAL

4223
02:45:45,890 --> 02:45:47,625
WAS STOPPED WHERE WE STOPPED

4224
02:45:47,625 --> 02:45:49,026
GIVING ADVICE AND HANDED BACK

4225
02:45:49,026 --> 02:45:52,563
THE CARE OF THE PATIENTS TO

4226
02:45:52,563 --> 02:45:53,898
PRIMARY CARE PHYSICIANS.

4227
02:45:53,898 --> 02:45:55,532
THEY ALWAYS WERE IN CHARGE BUT

4228
02:45:55,532 --> 02:45:57,067
WE STOPPED GIVE ADVICE.

4229
02:45:57,067 --> 02:45:58,535
SORT OF A GENERAL HANDOVER

4230
02:45:58,535 --> 02:46:00,337
PERIOD, IT TAKES A WHILE TO DO

4231
02:46:00,337 --> 02:46:00,671
THAT.

4232
02:46:00,671 --> 02:46:02,439
THEN THERE'S A PERIOD AFTER

4233
02:46:02,439 --> 02:46:03,507
EVERYTHING IS COMPLETELY HANDED

4234
02:46:03,507 --> 02:46:05,476
BACK TO THE PRIMARY CARE

4235
02:46:05,476 --> 02:46:07,144
PHYSICIANS.

4236
02:46:07,144 --> 02:46:08,112
YOU SEE HAZARD RATIOS COMING

4237
02:46:08,112 --> 02:46:11,715
BACK UP TO WHERE IT STARTED,

4238
02:46:11,715 --> 02:46:12,149
MORE OR LESS.

4239
02:46:12,149 --> 02:46:14,985
WE CAN'T BE SURE TO UNDERSTAND

4240
02:46:14,985 --> 02:46:16,654
WHY THAT OCCURRED, BUT WE CAN

4241
02:46:16,654 --> 02:46:17,521
LOOK AT BLOOD PRESSURES.

4242
02:46:17,521 --> 02:46:20,257
IF YOU LOOK AT BLOOD PRESSURES,

4243
02:46:20,257 --> 02:46:25,162
DURING THE TRIAL, SHOWN HERE ON

4244
02:46:25,162 --> 02:46:26,797
THE TWO LINES, NICE SEPARATION.

4245
02:46:26,797 --> 02:46:30,234
WHEN WE LOOK AT ELECTRONIC

4246
02:46:30,234 --> 02:46:35,906
HEALTH RECORD PRESSURES, TAKEN

4247
02:46:35,906 --> 02:46:37,007
CONCURRENTLY FOR OFFICE VISITS,

4248
02:46:37,007 --> 02:46:38,742
NOT DONE AS WELL, OF COURSE, AS

4249
02:46:38,742 --> 02:46:40,978
YOU WOULD EXPECT.

4250
02:46:40,978 --> 02:46:44,181
THEY TEND TO OVERESTIMATE. 

4251
02:46:44,181 --> 02:46:45,249
THERE WILL BE UNDERESTIMATION

4252
02:46:45,249 --> 02:46:47,751
BUT THEY TEND TO OVERESTIMATE SO

4253
02:46:47,751 --> 02:46:50,387
YOU GET HIGHER SYSTOLIC AND

4254
02:46:50,387 --> 02:46:52,022
DIASTOLICS WITH A NICE

4255
02:46:52,022 --> 02:46:53,223
SEPARATION NONETHELESS.

4256
02:46:53,223 --> 02:46:54,425
AS YOU FOLLOW OVER TIME WHAT

4257
02:46:54,425 --> 02:46:56,126
YOU'RE SEEING IS IN THE STANDARD

4258
02:46:56,126 --> 02:46:57,628
GROUP THERE'S NOT MUCH EVIDENCE

4259
02:46:57,628 --> 02:46:59,797
THAT THEY ARE GETTING MORE

4260
02:46:59,797 --> 02:47:03,200
INTENSIVE TREATMENT. 

4261
02:47:03,200 --> 02:47:04,501
IN THE MORE INTENSIVELY TREATED

4262
02:47:04,501 --> 02:47:08,105
GROUP WHICH WE HOPE WOULD

4263
02:47:08,105 --> 02:47:09,673
CONTINUE TO HAVE FAIRLY

4264
02:47:09,673 --> 02:47:12,476
INTENSIVE TREATMENT, THEY ARE

4265
02:47:12,476 --> 02:47:13,377
PROGRESSIVELY GOING BACK UP AND

4266
02:47:13,377 --> 02:47:16,547
YOU'RE BACK TO BUSINESS AS USUAL

4267
02:47:16,547 --> 02:47:17,114
UP HERE.

4268
02:47:17,114 --> 02:47:18,849
SO, THIS IS DISTURBING.

4269
02:47:18,849 --> 02:47:20,918
IT'S NOT SURPRISING.

4270
02:47:20,918 --> 02:47:22,019
WE'VE SEEN THIS AFTER MANY

4271
02:47:22,019 --> 02:47:22,987
EFFICACY TRIALS.

4272
02:47:22,987 --> 02:47:26,857
WE DO THE EFFICACY TRIALS.

4273
02:47:26,857 --> 02:47:27,992
THEY DEMONSTRATE THE BENEFIT.

4274
02:47:27,992 --> 02:47:30,427
WHAT WE SEE IS IN PRACTICE THERE

4275
02:47:30,427 --> 02:47:33,097
ARE A LOT OF FACTORS THAT

4276
02:47:33,097 --> 02:47:33,864
INFLUENCE MANAGEMENT OF CARE,

4277
02:47:33,864 --> 02:47:38,168
AND WHAT WE'RE SEEING HERE IS

4278
02:47:38,168 --> 02:47:39,636
VERY POOR ADOPTION TO THE

4279
02:47:39,636 --> 02:47:44,908
FINDINGS OF THE SPRINT TRIAL.

4280
02:47:44,908 --> 02:47:47,511
NOW, ONE LAST DATA SLIDE HERE,

4281
02:47:47,511 --> 02:47:49,113
JUST TO SAY WE'RE DOING

4282
02:47:49,113 --> 02:47:49,480
TERRIBLY.

4283
02:47:49,480 --> 02:47:51,348
ON THE OTHER HAND, WE ABSOLUTELY

4284
02:47:51,348 --> 02:47:53,217
KNOW WHAT TO DO TO GET BLOOD

4285
02:47:53,217 --> 02:47:53,784
PRESSURES DOWN.

4286
02:47:53,784 --> 02:47:56,720
I WON'T GO INTO IT IN DETAIL BUT

4287
02:47:56,720 --> 02:47:59,223
THIS IS A GENERAL MODEL OF CARE

4288
02:47:59,223 --> 02:48:01,759
THAT HAS WORKED VERY WELL IN

4289
02:48:01,759 --> 02:48:03,293
HIGH-INCOME COUNTRIES, IT'S

4290
02:48:03,293 --> 02:48:06,897
WORKED VERY WELL IN LOW-INCOME

4291
02:48:06,897 --> 02:48:07,197
COUNTRIES.

4292
02:48:07,197 --> 02:48:07,865
STARTS WITH A COMMITMENT,

4293
02:48:07,865 --> 02:48:10,934
WHETHER IT'S AT THE PROVIDER

4294
02:48:10,934 --> 02:48:15,973
LEVEL, COUNTRY LEVEL, OR THE

4295
02:48:15,973 --> 02:48:17,508
INSTITUTION, OR HEALTH SYSTEM.

4296
02:48:17,508 --> 02:48:20,344
IT INVOLVES HAVING A BACKGROUND

4297
02:48:20,344 --> 02:48:23,614
OF HEALTH PROMOTION, SIMPLE

4298
02:48:23,614 --> 02:48:25,049
EVIDENCE-BASED PROTOCOLS FOR

4299
02:48:25,049 --> 02:48:27,584
COUNSELING PEOPLE FOR LIFESTYLE

4300
02:48:27,584 --> 02:48:29,553
IMPROVEMENT AND FOR

4301
02:48:29,553 --> 02:48:30,621
ANTI-HYPERTENSIVE DRUG

4302
02:48:30,621 --> 02:48:34,925
TREATMENT, RELIABLE ACCESS TO

4303
02:48:34,925 --> 02:48:38,729
MEDICATION IS VERY IMPORTANT.

4304
02:48:38,729 --> 02:48:39,396
COMMUNITY-BASED PATIENT-CENTERED

4305
02:48:39,396 --> 02:48:41,265
TEAM CARE, WITH ACCURATE BLOOD

4306
02:48:41,265 --> 02:48:43,300
PRESSURE MEASUREMENTS AND

4307
02:48:43,300 --> 02:48:44,301
INFORMATION TRACKING.

4308
02:48:44,301 --> 02:48:50,307
THIS IS THE MODEL USED IN W.H.O.

4309
02:48:50,307 --> 02:48:52,176
HEARTS PROGRAM, IN HYPERTENSION

4310
02:48:52,176 --> 02:48:53,610
LEAGUE, AND MOST RECENTLY THE

4311
02:48:53,610 --> 02:48:56,780
SORT OF MODEL USED FOR THE

4312
02:48:56,780 --> 02:48:59,616
COMMUNITY HEALTH CARE WORKER

4313
02:48:59,616 --> 02:49:02,453
TRIAL RURAL CHINA WHICH HAD

4314
02:49:02,453 --> 02:49:05,022
DRAMATIC DIFFERENCES IN SYSTOLIC

4315
02:49:05,022 --> 02:49:06,557
BLOOD PRESSURE BETWEEN THE

4316
02:49:06,557 --> 02:49:07,091
INTERVENTION VILLAGES AND

4317
02:49:07,091 --> 02:49:08,392
CONTROL VILLAGES.

4318
02:49:08,392 --> 02:49:09,927
IN FACT BIGGER DELTA IN BLOOD

4319
02:49:09,927 --> 02:49:13,097
PRESSURE THAN WE GOT IN SPRINT,

4320
02:49:13,097 --> 02:49:15,399
OVER 21 MILLIMETERS OF MERCURY

4321
02:49:15,399 --> 02:49:17,901
SYSTOLIC, AND YOU WOULD EXPECT

4322
02:49:17,901 --> 02:49:20,871
HUGE HEALTH BENEFITS BOTH

4323
02:49:20,871 --> 02:49:22,940
CARDIOVASCULAR AND ALL-CAUSE

4324
02:49:22,940 --> 02:49:23,474
MORTALITY.

4325
02:49:23,474 --> 02:49:27,111
IN SUMMARY MOST REPORTS OF

4326
02:49:27,111 --> 02:49:28,345
HYPERTENSION PREVALENCE AND

4327
02:49:28,345 --> 02:49:31,081
CONTROL ARE BASED ON NHANES,

4328
02:49:31,081 --> 02:49:35,319
MOST REPORTS FOR THE U.S.

4329
02:49:35,319 --> 02:49:37,855
THAT MAKES SENSE.

4330
02:49:37,855 --> 02:49:39,389
AND ADULTS WE'VE TENDED TO SEE

4331
02:49:39,389 --> 02:49:45,496
MEAN SYSTOLIC BLOOD PRESSURE

4332
02:49:45,496 --> 02:49:53,070
GOING DOWN TO 2018, 2010, SLIGHT

4333
02:49:53,070 --> 02:49:56,573
UPTICK, PREVALENCE 140/90,

4334
02:49:56,573 --> 02:50:02,379
STABLE AT 30%, AND DECLINES IN

4335
02:50:02,379 --> 02:50:03,347
AWARENESS, AND CERTAINLY DEFINES

4336
02:50:03,347 --> 02:50:04,882
AND CONTROL RATE.

4337
02:50:04,882 --> 02:50:09,786
IF WE LOOK AT 130/80, OBVIOUSLY

4338
02:50:09,786 --> 02:50:11,255
HIGHER PREVALENCE.

4339
02:50:11,255 --> 02:50:13,757
NO EVIDENCE IN MORE RECENT YEARS

4340
02:50:13,757 --> 02:50:15,492
THERE'S BEEN ANY IMPROVEMENT

4341
02:50:15,492 --> 02:50:20,531
COMPARED TO THE EARLIER PERIODS

4342
02:50:20,531 --> 02:50:22,499
AND ACHIEVING THE 130/80, IT WAS

4343
02:50:22,499 --> 02:50:23,600
MENTIONED EARLIER IN THE SESSION

4344
02:50:23,600 --> 02:50:28,405
LESS THAN A QUARTER OF THE U.S.

4345
02:50:28,405 --> 02:50:29,039
ADULT POPULATION WERE ACHIEVING

4346
02:50:29,039 --> 02:50:31,708
BLOOD PRESSURE GOAL OF LESS THAN

4347
02:50:31,708 --> 02:50:33,744
130/80, THAT'S OBVIOUSLY WORSE

4348
02:50:33,744 --> 02:50:35,112
IN SOME SUBSETS IN THE

4349
02:50:35,112 --> 02:50:35,679
COMMUNITY.

4350
02:50:35,679 --> 02:50:39,383
I THANK YOU FOR ALLOWING ME TO

4351
02:50:39,383 --> 02:50:40,150
PRESENT TODAY.

4352
02:50:40,150 --> 02:50:41,418
>> THANK YOU.

4353
02:50:41,418 --> 02:50:44,721
A LOT OF DATA, MUCH OF IT

4354
02:50:44,721 --> 02:50:45,022
SOBERING.

4355
02:50:45,022 --> 02:50:47,024
NEXT PRESENTATION TIES BACK INTO

4356
02:50:47,024 --> 02:50:52,162
THE CONCEPT OF HYPERTENSION AND

4357
02:50:52,162 --> 02:50:53,597
A.I.

4358
02:50:53,597 --> 02:50:55,799
DR. SONYA MAKHNI, USING A.I. TO

4359
02:50:55,799 --> 02:50:56,767
PRE-DIDN'T HYPERTENSION STATUS

4360
02:50:56,767 --> 02:50:59,069
AND BLOOD PRESSURE, COMES FROM

4361
02:50:59,069 --> 02:51:01,205
THE MAYO CLINIC ROCHESTER

4362
02:51:01,205 --> 02:51:01,471
MINNESOTA.

4363
02:51:01,471 --> 02:51:03,707
>> NICE TO MEET YOU ALL.

4364
02:51:03,707 --> 02:51:06,076
HOPEFULLY YOU CAN HEAR ME AND

4365
02:51:06,076 --> 02:51:12,950
SEE MY SLIDES OKAY.

4366
02:51:12,950 --> 02:51:13,417
>> YES.

4367
02:51:13,417 --> 02:51:16,053
>> I'M A CLINICAL
INFORMATIST,

4368
02:51:16,053 --> 02:51:17,120
HOSPITALIST AT MAYO CLINIC,

4369
02:51:17,120 --> 02:51:27,664
MEDICAL DIRECTOR AT MAY O CLINIC

4370
02:51:28,265 --> 02:51:28,599
PLATFORM.

4371
02:51:28,599 --> 02:51:33,136
NO CONFLICTS OF INTEREST TO

4372
02:51:33,136 --> 02:51:33,370
REPORT.

4373
02:51:33,370 --> 02:51:37,407
NOT TO SPENT MUCH TIME ON THE

4374
02:51:37,407 --> 02:51:38,742
BACKGROUND, WE'VE HEARD

4375
02:51:38,742 --> 02:51:39,509
HYPERTENSION IS VERY COMMON, ONE

4376
02:51:39,509 --> 02:51:42,479
OF THE MOST IMPORTANT RISK

4377
02:51:42,479 --> 02:51:43,547
FACTORS FOR CARDIOVASCULAR

4378
02:51:43,547 --> 02:51:44,214
DISEASE.

4379
02:51:44,214 --> 02:51:47,284
INCREASES RISK OF MANY OTHER

4380
02:51:47,284 --> 02:51:47,584
CONDITIONS.

4381
02:51:47,584 --> 02:51:49,253
MANAGING THESE CONDITIONS IS NOT

4382
02:51:49,253 --> 02:51:52,556
ONLY CHALLENGING BUT COSTLY AS

4383
02:51:52,556 --> 02:51:52,756
WELL.

4384
02:51:52,756 --> 02:51:54,391
THERE'S AMPLE EVIDENCE TO

4385
02:51:54,391 --> 02:51:56,693
SUGGEST EARLY DETECTION OF

4386
02:51:56,693 --> 02:51:58,028
HYPERTENSION IN CONJUNCTION WITH

4387
02:51:58,028 --> 02:51:59,663
GOOD BLOOD PRESSURE CONTROL AND

4388
02:51:59,663 --> 02:52:02,065
CORRECTION OF LIFE HABITS CAN

4389
02:52:02,065 --> 02:52:03,700
FURTHER REDUCE PROGRESSION OF

4390
02:52:03,700 --> 02:52:08,071
THE DISEASE AND DEVELOPMENT OF

4391
02:52:08,071 --> 02:52:09,606
DOWNSTREAM CONSEQUENCES.

4392
02:52:09,606 --> 02:52:11,475
SO THIS UNDERSCORES THE

4393
02:52:11,475 --> 02:52:16,947
IMPORTANCE OF EARLY ACCURATE

4394
02:52:16,947 --> 02:52:17,481
DIAGNOSIS.

4395
02:52:17,481 --> 02:52:18,148
WE'VE HEARD MEASURING MEASURING

4396
02:52:18,148 --> 02:52:20,150
BLOOD PRESSURE IN AROUND OUT OF

4397
02:52:20,150 --> 02:52:22,452
THE OFFICE AND LIMITATIONS OF

4398
02:52:22,452 --> 02:52:23,754
CURRENT PRACTICES.

4399
02:52:23,754 --> 02:52:25,722
TO BRIEFLY RECAP OUR OUT OF

4400
02:52:25,722 --> 02:52:27,257
OFFICE MEASUREMENTS CAN BE

4401
02:52:27,257 --> 02:52:30,560
DIFFICULT TO OBTAIN DUE TO

4402
02:52:30,560 --> 02:52:36,333
AVAILABILITY OF EQUIPMENT, COST

4403
02:52:36,333 --> 02:52:38,769
AND LOGISTICAL ISSUES, AND IN

4404
02:52:38,769 --> 02:52:40,937
ABPM CAN BE DISRUPTIVE, IN THE

4405
02:52:40,937 --> 02:52:42,706
CASE OF HOME MEASUREMENT

4406
02:52:42,706 --> 02:52:44,474
ACCURATE BLOOD PRESSURE

4407
02:52:44,474 --> 02:52:53,417
MEASUREMENTS DEPENDS ON HAVING A

4408
02:52:53,417 --> 02:52:54,951
VALIDATED DEVICE AND CORRECT

4409
02:52:54,951 --> 02:52:55,485
USE.

4410
02:52:55,485 --> 02:52:59,556
THESE ARE OVER LIMITED

4411
02:52:59,556 --> 02:53:00,123
TIMEFRAMES.

4412
02:53:00,123 --> 02:53:02,959
IF HOME OPTIONS ARE NOT POSSIBLE

4413
02:53:02,959 --> 02:53:05,128
PATIENTS NEED TO DEMONSTRATE

4414
02:53:05,128 --> 02:53:06,029
CERTAIN NUMBER MUCH ELEVATED

4415
02:53:06,029 --> 02:53:08,432
MEASUREMENTS IN THE OFFICE AGAIN

4416
02:53:08,432 --> 02:53:11,168
OVER CERTAIN TIMES WHICH

4417
02:53:11,168 --> 02:53:13,236
REQUIRES MULTIPLE DOCTOR VISITS

4418
02:53:13,236 --> 02:53:16,406
AND AS WE HEARD THERE ARE MANY

4419
02:53:16,406 --> 02:53:17,307
FACTORS THAT MIGHT PREVENT

4420
02:53:17,307 --> 02:53:20,677
SOMEONE FROM BEING ABLE TO CARRY

4421
02:53:20,677 --> 02:53:22,212
THESE VISITS OUT.

4422
02:53:22,212 --> 02:53:25,382
AND IN GENERAL, OFFICE VISITS

4423
02:53:25,382 --> 02:53:28,652
HAVE ISSUES OF WHITE COAT

4424
02:53:28,652 --> 02:53:30,554
HYPERTENSION, MASKED

4425
02:53:30,554 --> 02:53:32,289
HYPERTENSION, GENERALLY NOT

4426
02:53:32,289 --> 02:53:33,590
REFLECTIVE OF VARIABILITY.

4427
02:53:33,590 --> 02:53:36,793
AND THEN EVEN IF YOU CAN GET

4428
02:53:36,793 --> 02:53:37,627
ACCURATE MEASUREMENTS, WORK

4429
02:53:37,627 --> 02:53:40,530
AROUND ALL THESE THINGS I

4430
02:53:40,530 --> 02:53:41,631
MENTIONED, OUR GUIDELINES ARE

4431
02:53:41,631 --> 02:53:42,165
ONE-SIZE-FITS-ALL.

4432
02:53:42,165 --> 02:53:44,034
WE DON'T HAVE A DEEP

4433
02:53:44,034 --> 02:53:46,002
UNDERSTANDING OF HOW SUBGROUPS

4434
02:53:46,002 --> 02:53:51,041
OF PATIENTS MAY DIFFER IN

4435
02:53:51,041 --> 02:53:52,909
OPTIMAL TARGETS, THERE ISN'T

4436
02:53:52,909 --> 02:53:54,544
MUCH PHENOACTIVIC

4437
02:53:54,544 --> 02:53:56,546
DIFFERENTIATION IN DIAGNOSING

4438
02:53:56,546 --> 02:53:58,048
WHEN WE TREAT IT.

4439
02:53:58,048 --> 02:54:00,984
CLEARLY THERE ARE SEVERAL

4440
02:54:00,984 --> 02:54:03,620
BARRIERS TO ATTAINING THOSE

4441
02:54:03,620 --> 02:54:04,721
RELIABLE MEASUREMENTS WHICH

4442
02:54:04,721 --> 02:54:08,658
COMPLICATES EARLY AND ACCURATE

4443
02:54:08,658 --> 02:54:10,227
DIAGNOSIS.

4444
02:54:10,227 --> 02:54:12,262
AND HETEROGENEITY OF PEOPLE MAY

4445
02:54:12,262 --> 02:54:15,665
GET POSSIBLE, IF NOT LIKELY

4446
02:54:15,665 --> 02:54:18,935
TARGETS ARE DIFFERENT ACROSS

4447
02:54:18,935 --> 02:54:22,005
SUBGROUPS,  ONE-SIZE-FITS-ALL

4448
02:54:22,005 --> 02:54:23,006
APPROACH IS NOT ADEAL.

4449
02:54:23,006 --> 02:54:24,975
THERE'S A GREAT CASE FOR

4450
02:54:24,975 --> 02:54:26,276
LEVERAGING A.I. SOLUTIONS TO

4451
02:54:26,276 --> 02:54:28,578
HELP PREDICT HYPERTENSION IN

4452
02:54:28,578 --> 02:54:29,346
PATIENTS.

4453
02:54:29,346 --> 02:54:33,049
THE ABILITY TO ACCURATELY

4454
02:54:33,049 --> 02:54:34,584
PREDICT HYPERTENSION STATUS

4455
02:54:34,584 --> 02:54:37,421
WITHOUT INTERVENTION LIKE ABPM

4456
02:54:37,421 --> 02:54:39,523
ALLOW PCPs TO EFFECTIVELY AND

4457
02:54:39,523 --> 02:54:41,691
EFFICIENTLY DIAGNOSIS AND MANAGE

4458
02:54:41,691 --> 02:54:42,893
PATIENTS.

4459
02:54:42,893 --> 02:54:44,861
AS WELL AS MINIMIZING RISK OF

4460
02:54:44,861 --> 02:54:49,699
HARM FOR UNDERTREATMENT OR

4461
02:54:49,699 --> 02:54:50,033
OVERTREATMENT.

4462
02:54:50,033 --> 02:54:52,402
WE NEED TO BE ABLE TO UNDERSTAND

4463
02:54:52,402 --> 02:54:53,537
PATIENTS' CLINICAL STATES WHEN

4464
02:54:53,537 --> 02:54:55,806
NOT WITHIN OUR WALLS, WHICH IS

4465
02:54:55,806 --> 02:54:58,208
OVER 99% OF THEIR LIVED

4466
02:54:58,208 --> 02:54:58,542
EXPERIENCES.

4467
02:54:58,542 --> 02:55:01,411
AND WE NEED TO EXPAND OUR

4468
02:55:01,411 --> 02:55:05,115
EFFORTS, IF WE CAN SAFELY AND

4469
02:55:05,115 --> 02:55:06,082
APPROPRIATELY CREATE A.I.

4470
02:55:06,082 --> 02:55:10,353
SOLUTIONS TO HELP US WE CAN

4471
02:55:10,353 --> 02:55:11,455
POTENTIALLY EXPAND OUR REACH TO

4472
02:55:11,455 --> 02:55:12,722
THESE PATIENTS.

4473
02:55:12,722 --> 02:55:16,393
THERE'S TWO COMMON -- THIS IS A

4474
02:55:16,393 --> 02:55:17,694
SIMPLIFICATION, TWO COMMON

4475
02:55:17,694 --> 02:55:23,934
APPROACHES TO DETECTION USING

4476
02:55:23,934 --> 02:55:26,903
A.I.

4477
02:55:26,903 --> 02:55:31,508
IN CLASSIFICATION MODELS,

4478
02:55:31,508 --> 02:55:33,477
ALGORITHMS DETECT HYPERTENSION

4479
02:55:33,477 --> 02:55:35,979
AS A LABEL, TRAINED ON THE

4480
02:55:35,979 --> 02:55:38,381
TRAINED DATASET, BASED ON THAT

4481
02:55:38,381 --> 02:55:42,452
TRAINING CATEGORIZE DATA INTO

4482
02:55:42,452 --> 02:55:47,257
CLASSES.

4483
02:55:47,257 --> 02:55:49,125
THERE'S OFTEN EXTRACTED DATA

4484
02:55:49,125 --> 02:55:54,297
FROM EHRs, FOR EXAMPLE, AND

4485
02:55:54,297 --> 02:55:55,832
OUTCOME IS CATEGORICAL, LEVELS,

4486
02:55:55,832 --> 02:56:01,705
YES OR NO, OR PRE-HYPERTENSION,

4487
02:56:01,705 --> 02:56:03,607
NO HYPERTENSION.

4488
02:56:03,607 --> 02:56:04,641
REGRESSION MODELS GENERATE

4489
02:56:04,641 --> 02:56:06,877
CONTINUOUS VALUES, THAT WOULD BE

4490
02:56:06,877 --> 02:56:08,645
A NUMERIC MEASUREMENT WHICH WE

4491
02:56:08,645 --> 02:56:18,688
ALSO GOT TO HEAR ABOUT AS WELL.

4492
02:56:18,688 --> 02:56:20,924
AS WE'VE HEARD THERE ARE OTHER

4493
02:56:20,924 --> 02:56:23,960
SOURCES THAT CAN BE USED, THE

4494
02:56:23,960 --> 02:56:26,463
RAW SIGNALS THEMSELVES OR

4495
02:56:26,463 --> 02:56:27,797
EXTRACTED FEATURES.

4496
02:56:27,797 --> 02:56:30,867
ULTIMATELY THEY OUTPUT A NUMERIC

4497
02:56:30,867 --> 02:56:31,401
VALUE.

4498
02:56:31,401 --> 02:56:33,470
THERE ARE DIFFERENT BUT SIMILAR

4499
02:56:33,470 --> 02:56:36,339
WAYS TO EVALUATE PERFORMANCE OF

4500
02:56:36,339 --> 02:56:38,174
THESE MODELS DEPENDING ON TYPE

4501
02:56:38,174 --> 02:56:42,112
VIEWS AS WELL.

4502
02:56:42,112 --> 02:56:43,980
PUT ANOTHER WAY, CLASSIFICATION,

4503
02:56:43,980 --> 02:56:46,283
FUNCTION TO DIVIDE DATASET INTO

4504
02:56:46,283 --> 02:56:49,219
CLASS, MAPPING INPUT TO DISCRETE

4505
02:56:49,219 --> 02:56:51,321
OUTPUT Y, REGRESSION FINDS

4506
02:56:51,321 --> 02:56:53,823
CORRELATION BETWEEN DEPENDENT

4507
02:56:53,823 --> 02:56:58,328
AND INDEPENDENT VARIABLES,

4508
02:56:58,328 --> 02:56:59,829
MAPPING TO CONTINUOUS VARIABLE

4509
02:56:59,829 --> 02:57:00,597
OUTPUT Y.

4510
02:57:00,597 --> 02:57:03,900
THERE HAVE BEEN MANY ALGORITHMS

4511
02:57:03,900 --> 02:57:06,937
OF TYPES, AND I'LL SUMMARIZE AT

4512
02:57:06,937 --> 02:57:08,805
HIGH LEVEL WHAT THOSE LOOK LIKE.

4513
02:57:08,805 --> 02:57:11,675
KEEP IN MIND THIS IS JUST A

4514
02:57:11,675 --> 02:57:14,377
SUBSET OF WHAT IS IN

4515
02:57:14,377 --> 02:57:14,711
PUBLICATIONS.

4516
02:57:14,711 --> 02:57:18,214
YOU HAVE YOUR -- ON THE LEFT

4517
02:57:18,214 --> 02:57:19,149
MORE REGRESSION.

4518
02:57:19,149 --> 02:57:27,724
CLINICAL DATA ON THE RIGHT.

4519
02:57:27,724 --> 02:57:29,826
CLASSIFICATION MODEL USE

4520
02:57:29,826 --> 02:57:31,761
CLINICAL AND SOCIODEMOGRAPHIC

4521
02:57:31,761 --> 02:57:33,630
DATA INCORPORATING AGE, BMI,

4522
02:57:33,630 --> 02:57:35,398
GENDER, SYSTOLIC BLOOD PRESSURE,

4523
02:57:35,398 --> 02:57:38,468
HEART RATE.

4524
02:57:38,468 --> 02:57:39,903
LESS FREQUENTLY ACTUALLY

4525
02:57:39,903 --> 02:57:41,671
INCORPORATE OTHER VERY USEFUL

4526
02:57:41,671 --> 02:57:46,710
FACTORS SUCH AS RACE, LIFE

4527
02:57:46,710 --> 02:57:49,446
HABITS, GEOGRAPHY, YOU CAN

4528
02:57:49,446 --> 02:57:51,848
IMAGINE PAPERS THAT SHOW HOW

4529
02:57:51,848 --> 02:57:53,183
CRIME IMPACTS HYPERTENSION,

4530
02:57:53,183 --> 02:57:54,851
THAT'S NOT TYPICALLY

4531
02:57:54,851 --> 02:57:55,518
INCORPORATED IN STUDIES.

4532
02:57:55,518 --> 02:57:58,788
AND AGAIN LIKE I MENTIONED

4533
02:57:58,788 --> 02:58:00,824
OUTCOME IS A CLASSIFICATION.

4534
02:58:00,824 --> 02:58:04,995
HYPERTENSION YES OR NO.

4535
02:58:04,995 --> 02:58:05,428
STAGE.

4536
02:58:05,428 --> 02:58:07,297
ONE-YEAR RISK, PRESENCE OR

4537
02:58:07,297 --> 02:58:10,166
ABSENCE OF HYPERTENSION.

4538
02:58:10,166 --> 02:58:11,134
THERE ARE MORE POSSIBILITIES.

4539
02:58:11,134 --> 02:58:14,504
SO THIS IS A SMALL SAMPLE OF

4540
02:58:14,504 --> 02:58:15,405
MANY CLASSIFICATION MODELS.

4541
02:58:15,405 --> 02:58:19,109
I WANTED TO HIGHLIGHT A COUPLE

4542
02:58:19,109 --> 02:58:19,876
THINGS.

4543
02:58:19,876 --> 02:58:21,911
MORE RELEVANT TO THE PROCESS,

4544
02:58:21,911 --> 02:58:24,014
WHICH WILL SORT OF PAVE THE WAY

4545
02:58:24,014 --> 02:58:27,217
FOR LIMITATIONS I'LL TALK ABOUT

4546
02:58:27,217 --> 02:58:27,550
LATER.

4547
02:58:27,550 --> 02:58:29,185
FIRST THE DATASET COLUMN.

4548
02:58:29,185 --> 02:58:31,254
I'VE INCLUDED SAMPLE SIZE OF THE

4549
02:58:31,254 --> 02:58:33,423
DATASET, NOT TO BE CONFUSED AS

4550
02:58:33,423 --> 02:58:38,795
ACTUAL SIZE OF THE COHORTS USED.

4551
02:58:38,795 --> 02:58:39,896
CLEARLY SMALLER BUT TYPICALLY

4552
02:58:39,896 --> 02:58:41,431
DATASETS WOULD NOT ONLY BE

4553
02:58:41,431 --> 02:58:43,533
NARROWED DOWN BASED OFF

4554
02:58:43,533 --> 02:58:44,934
INCLUSION AND EXCLUSION CRITERIA

4555
02:58:44,934 --> 02:58:48,538
BUT ALSO DUE TO DATA QUALITY

4556
02:58:48,538 --> 02:58:49,005
ISSUES.

4557
02:58:49,005 --> 02:58:51,841
WHICH I'LL TOUCH ON LATER BUT

4558
02:58:51,841 --> 02:58:54,678
THE DATA IS IMPORTANT AND CAN

4559
02:58:54,678 --> 02:58:56,012
IMPACT OVERALL PERFORMANCE AND

4560
02:58:56,012 --> 02:58:57,847
GENERALIZABILITY OF THE MODEL.

4561
02:58:57,847 --> 02:59:00,684
IF THE RIGHT COHORT ISN'T USED

4562
02:59:00,684 --> 02:59:02,018
OR IF THERE ISN'T SUFFICIENT

4563
02:59:02,018 --> 02:59:06,056
DIVERSITY IN THE DATASET, OR IF

4564
02:59:06,056 --> 02:59:07,590
DATASET ITSELF HARBORS BIAS,

4565
02:59:07,590 --> 02:59:10,493
THAT WILL IMPACT THE MODEL, IN

4566
02:59:10,493 --> 02:59:15,598
OTHER CONTEXT, IT'S NOT THAT OWN

4567
02:59:15,598 --> 02:59:16,132
DATASET.

4568
02:59:16,132 --> 02:59:19,969
NEXT YOU CAN SEE THE USE OF THE

4569
02:59:19,969 --> 02:59:21,504
COMMON VARIABLES I MENTIONED,

4570
02:59:21,504 --> 02:59:23,139
YOUR MODEL TAKES DIFFERENT

4571
02:59:23,139 --> 02:59:24,407
VARIABLES INTO CONSIDERATION,

4572
02:59:24,407 --> 02:59:28,945
THIS CAN BE DUE TO FUNDAMENTAL

4573
02:59:28,945 --> 02:59:30,246
MODEL DESIGN, AVAILABILITY OF

4574
02:59:30,246 --> 02:59:31,848
DATA OR OTHER FEATURE SELECTION

4575
02:59:31,848 --> 02:59:34,651
METHODS THAT MAY LEAD TO THAT

4576
02:59:34,651 --> 02:59:38,121
PARTICULAR COMBINATION OF

4577
02:59:38,121 --> 02:59:38,655
PREDICTORS.

4578
02:59:38,655 --> 02:59:44,794
AGAIN, THERE'S MANY ML ALGORITHM

4579
02:59:44,794 --> 02:59:48,298
TIMES, A LOT COMPARE MODELS AND

4580
02:59:48,298 --> 02:59:49,933
USE THE BEST PERFORMING ONES.

4581
02:59:49,933 --> 02:59:59,676
THAT PERFORMANCE IS JUDGED USING

4582
02:59:59,676 --> 03:00:00,076
METRICS.

4583
03:00:00,076 --> 03:00:00,977
SENSITIVITY, SPECIFICITIES,

4584
03:00:00,977 --> 03:00:02,278
ACCURACY.

4585
03:00:02,278 --> 03:00:04,814
IT'S INTERESTING TO THINK ABOUT

4586
03:00:04,814 --> 03:00:06,349
METRICS IN MEANINGFUL CLINICAL

4587
03:00:06,349 --> 03:00:07,117
TERMS.

4588
03:00:07,117 --> 03:00:09,419
NOT ALL STUDIES CAN EXPLAIN FOR

4589
03:00:09,419 --> 03:00:10,854
EXAMPLE PREDICTION ACCURACY AS

4590
03:00:10,854 --> 03:00:16,326
PERFORMANCE METRIC IN THAT

4591
03:00:16,326 --> 03:00:16,893
MEANINGFUL CONTEXT.

4592
03:00:16,893 --> 03:00:20,029
IF WE'RE SAYING HYPERTENSION IS

4593
03:00:20,029 --> 03:00:22,232
UNDERDIAGNOSED AND USING A

4594
03:00:22,232 --> 03:00:23,867
DATASET THAT DOESN'T ACTUALLY

4595
03:00:23,867 --> 03:00:29,506
REFLECT THE TRUE PREVALENCE OF

4596
03:00:29,506 --> 03:00:33,076
HYPERTENSION, ACCURACY OF 99.5%

4597
03:00:33,076 --> 03:00:35,812
HELPFUL, PREDICTIVE?

4598
03:00:35,812 --> 03:00:38,214
ALSO IS THAT MAYBE AN OVERFIT

4599
03:00:38,214 --> 03:00:40,416
ALGORITHM, USING TOO MANY

4600
03:00:40,416 --> 03:00:41,484
FACTORS, BUT IT'S A COMPLEX

4601
03:00:41,484 --> 03:00:44,120
QUESTION BUT ALL OF THESE SORTS

4602
03:00:44,120 --> 03:00:47,791
OF ASPECTS OF ALGORITHM

4603
03:00:47,791 --> 03:00:48,625
DEVELOPMENT ARE IMPORTANT.

4604
03:00:48,625 --> 03:00:50,126
THIS TRANSITIONS TO THE NEXT

4605
03:00:50,126 --> 03:00:52,328
MODEL TYPE WE TALKED ABOUT,

4606
03:00:52,328 --> 03:00:54,631
REGRESSION PLOD ALSO THAT INTAKE

4607
03:00:54,631 --> 03:00:57,467
SIGNALS TO OUTPUT A NUMBER.

4608
03:00:57,467 --> 03:01:04,240
WE HAD THE OPPORTUNITY TO

4609
03:01:04,240 --> 03:01:07,443
DIVERSITY DEEPER.

4610
03:01:07,443 --> 03:01:16,186
THE ADVANTAGE IS  THEY CAN SERVE

4611
03:01:16,186 --> 03:01:20,223
AS PROXY, BE CONTINUOUS,

4612
03:01:20,223 --> 03:01:24,727
NON-INVASIVE, WITH ECG AND PPG

4613
03:01:24,727 --> 03:01:26,162
BEING MOST COMMONLY USED

4614
03:01:26,162 --> 03:01:28,464
PREDICTORS, OTHER SIGNALS USED

4615
03:01:28,464 --> 03:01:28,898
AS WELL.

4616
03:01:28,898 --> 03:01:31,534
AGAIN, THERE ARE MANY MODELS

4617
03:01:31,534 --> 03:01:35,271
USING A COMBINATION OF SIGNAL

4618
03:01:35,271 --> 03:01:38,107
DATA, PERFORMANCE METRICS I HAVE

4619
03:01:38,107 --> 03:01:39,542
HERE MEAN ABSOLUTE ERROR CAN

4620
03:01:39,542 --> 03:01:39,843
VARY.

4621
03:01:39,843 --> 03:01:44,681
ERROR OF 11 IS MAYBE NOT HELPFUL

4622
03:01:44,681 --> 03:01:46,649
PRACTICALLY SPEAKING BUT 2 COULD

4623
03:01:46,649 --> 03:01:49,052
BE MORE USEFUL.

4624
03:01:49,052 --> 03:01:51,554
IT'S INTERESTING TO NOTE THAT

4625
03:01:51,554 --> 03:01:52,856
SOME OF THESE DATASETS

4626
03:01:52,856 --> 03:01:56,292
INCORPORATE MORE OF THE EHR TYPE

4627
03:01:56,292 --> 03:01:58,027
DATA, SOME LESS.

4628
03:01:58,027 --> 03:02:00,096
AND IDEALLY WE WOULD LOVE RICH

4629
03:02:00,096 --> 03:02:04,400
DATASETS THAT HAVE ALL DIFFERENT

4630
03:02:04,400 --> 03:02:06,769
TYPES OF DATA TYPES.

4631
03:02:06,769 --> 03:02:09,873
SIMILARLY THERE ARE HANDFULS OF

4632
03:02:09,873 --> 03:02:11,407
MOVED ALSO THAT ARE VERY

4633
03:02:11,407 --> 03:02:15,011
INTERESTING WHEN WE THINK OF

4634
03:02:15,011 --> 03:02:15,778
HYPERTENSION DETECTION AND

4635
03:02:15,778 --> 03:02:16,246
DIAGNOSIS.

4636
03:02:16,246 --> 03:02:18,615
THERE ARE MODELS THAT USE

4637
03:02:18,615 --> 03:02:21,684
UNSUPERVISED LEARNING TO PREDICT

4638
03:02:21,684 --> 03:02:22,552
DIFFERENT HYPERTENSION

4639
03:02:22,552 --> 03:02:23,086
PHENOTYPES.

4640
03:02:23,086 --> 03:02:26,289
OTHERS BETWEEN PRIMARY AND

4641
03:02:26,289 --> 03:02:27,824
SECONDARY HYPERTENSION, FURTHER

4642
03:02:27,824 --> 03:02:29,792
DISTINGUISH BETWEEN ETIOLOGY OF

4643
03:02:29,792 --> 03:02:30,660
ENDOCRINE HYPERTENSION, FOR

4644
03:02:30,660 --> 03:02:31,094
EXAMPLE.

4645
03:02:31,094 --> 03:02:33,830
THERE ARE ALGORITHMS THAT USE

4646
03:02:33,830 --> 03:02:36,900
OMIC DATA TO PREDICT

4647
03:02:36,900 --> 03:02:37,901
HYPERTENSION THROUGH VARIOUS

4648
03:02:37,901 --> 03:02:39,535
MODELS, LOOKING AT GENES

4649
03:02:39,535 --> 03:02:39,869
SPECIFICALLY.

4650
03:02:39,869 --> 03:02:42,372
AND OF COURSE THERE ARE MODELS

4651
03:02:42,372 --> 03:02:43,806
IN RESEARCH TO IDENTIFY VARIOUS

4652
03:02:43,806 --> 03:02:48,177
RISK FACTORS THAT WE MIGHT BE

4653
03:02:48,177 --> 03:02:48,611
MISSING.

4654
03:02:48,611 --> 03:02:50,046
AND THESE TOPICS I MENTION

4655
03:02:50,046 --> 03:02:51,881
REPRESENT SOME OF THE MORE

4656
03:02:51,881 --> 03:02:54,284
INTERESTING SCIENTIFIC AREAS OF

4657
03:02:54,284 --> 03:02:57,287
STUDY WITHIN HYPERTENSION. 

4658
03:02:57,287 --> 03:03:00,657
IF WE CAN EFFECTIVELY INTEGRATE

4659
03:03:00,657 --> 03:03:02,859
MULTIOMIC DATA FROM DIFFERENT

4660
03:03:02,859 --> 03:03:06,329
SOURCES LIKE EHR, GENOME

4661
03:03:06,329 --> 03:03:08,665
DATABASES, IMAGING,

4662
03:03:08,665 --> 03:03:09,565
CARDIOVASCULAR IMAGING, WEARABLE

4663
03:03:09,565 --> 03:03:14,671
DEVICE, EVEN ENVIRONMENTAL AND

4664
03:03:14,671 --> 03:03:18,608
BEHAVIORAL DATA WE CAN LEVERAGE

4665
03:03:18,608 --> 03:03:20,376
TO ELUCIDATE EVEN DEEPER

4666
03:03:20,376 --> 03:03:20,677
INSIGHTS.

4667
03:03:20,677 --> 03:03:23,646
AND THOSE INCLUDE THINGS I

4668
03:03:23,646 --> 03:03:24,180
MENTIONED.

4669
03:03:24,180 --> 03:03:25,648
UNCOVERING NEW RISK FACTORS,

4670
03:03:25,648 --> 03:03:27,050
SHIFTING DIAGNOSIS AND TREATMENT

4671
03:03:27,050 --> 03:03:33,923
TO BE MORE PRECISE AND

4672
03:03:33,923 --> 03:03:34,824
PERSONALIZED ESPECIALLY, WITH

4673
03:03:34,824 --> 03:03:35,625
CUTOFFS FOR DIAGNOSIS.

4674
03:03:35,625 --> 03:03:38,661
WE CAN BETTER UNDERSTAND FACTORS

4675
03:03:38,661 --> 03:03:39,429
THAT CONTRIBUTE TO TREATMENT

4676
03:03:39,429 --> 03:03:41,331
SUCCESS AND THE HOPE IS THE

4677
03:03:41,331 --> 03:03:42,932
FUTURE INVESTIGATIONS WILL BE

4678
03:03:42,932 --> 03:03:46,336
ABLE TO EXPAND UPON AND VALIDATE

4679
03:03:46,336 --> 03:03:50,740
ABILITY OF A.I. TO DIAGNOSE

4680
03:03:50,740 --> 03:03:51,808
HYPERTENSION AND PREDICT BLOOD

4681
03:03:51,808 --> 03:03:52,075
PRESSURE.

4682
03:03:52,075 --> 03:03:55,178
THERE ARE MANY GAPS THAT NEED TO

4683
03:03:55,178 --> 03:03:57,680
BE FILLED, MANY ARE NOT JUST

4684
03:03:57,680 --> 03:03:59,549
SPECIFIC TO HYPERTENSION.

4685
03:03:59,549 --> 03:04:03,386
I TOOK THE BROAD APPROACH OF

4686
03:04:03,386 --> 03:04:04,921
WHAT IS HINDERING FROM

4687
03:04:04,921 --> 03:04:06,789
PERSPECTIVE THAT COULD BE

4688
03:04:06,789 --> 03:04:08,858
APPLIED TO OTHER DISEASES AND

4689
03:04:08,858 --> 03:04:09,258
CONTEXTS.

4690
03:04:09,258 --> 03:04:12,028
WE'VE BEEN ABLE TO TALK ABOUT

4691
03:04:12,028 --> 03:04:14,564
SOCIAL DETERMINANTS OF HEALTH,

4692
03:04:14,564 --> 03:04:16,966
NEEDS THAT THESE ARE EXPLORED IN

4693
03:04:16,966 --> 03:04:17,600
CONJUNCTION WITH CONTRIBUTING

4694
03:04:17,600 --> 03:04:18,067
FACTORS.

4695
03:04:18,067 --> 03:04:23,539
THERE'S A HUGE NEED FOR NEW

4696
03:04:23,539 --> 03:04:26,275
DATASETS THAT INCORPORATE SDOH

4697
03:04:26,275 --> 03:04:26,476
DATA.

4698
03:04:26,476 --> 03:04:29,112
IT'S VERY COMPLEX BUT IMPORTANT

4699
03:04:29,112 --> 03:04:32,949
TO ADDRESS SO WE CAN RECTIFY THE

4700
03:04:32,949 --> 03:04:34,150
PROBLEMS OF UNDERDIAGNOSIS IN

4701
03:04:34,150 --> 03:04:35,685
OUR DATA, FOR EXAMPLE.

4702
03:04:35,685 --> 03:04:41,691
THERE ARE ALSO DOZENS OF

4703
03:04:41,691 --> 03:04:43,326
STUDIES, FEW EXTERNALLY

4704
03:04:43,326 --> 03:04:44,761
VALIDATED THROUGH CLINICAL

4705
03:04:44,761 --> 03:04:45,962
PERSPECTIVE STUDIES EVEN AT

4706
03:04:45,962 --> 03:04:46,396
DIFFERENT SITES.

4707
03:04:46,396 --> 03:04:49,465
WE NEED TO UNDERSTAND HOW THESE

4708
03:04:49,465 --> 03:04:53,069
MODELS PERFORM IN THE REAL

4709
03:04:53,069 --> 03:04:53,636
WORLD.

4710
03:04:53,636 --> 03:04:55,838
AND MODELS DO NOT INCLUDE BIAS

4711
03:04:55,838 --> 03:04:56,472
ANALYSIS WHICH MAKES THEM

4712
03:04:56,472 --> 03:04:58,474
DIFFICULT TO UNDERSTAND IN THE

4713
03:04:58,474 --> 03:04:59,542
CONTEXT OF CERTAIN SUBGROUPS.

4714
03:04:59,542 --> 03:05:01,844
IF WE DON'T UNDERSTAND HOW

4715
03:05:01,844 --> 03:05:04,147
MODELS PERFORM WITHIN DIVERSITY

4716
03:05:04,147 --> 03:05:06,549
WENT GROUPS WE CAN POTENTIALLY

4717
03:05:06,549 --> 03:05:14,424
DELIVER WORSE CARE AND CAUSE

4718
03:05:14,424 --> 03:05:15,625
HARM.

4719
03:05:15,625 --> 03:05:17,160
ALSO CHALLENGES, TECHNICAL

4720
03:05:17,160 --> 03:05:19,929
LIMITATIONS IN THAT THESE

4721
03:05:19,929 --> 03:05:21,464
DATASETS ARE LIMITED.

4722
03:05:21,464 --> 03:05:24,534
REPRESENT A SINGULAR POPULATION,

4723
03:05:24,534 --> 03:05:25,635
UNCLEAR DATA QUALITY.

4724
03:05:25,635 --> 03:05:28,805
NOT MANY WAYS TO ADDRESS DATA

4725
03:05:28,805 --> 03:05:30,206
QUALITY CURRENTLY.

4726
03:05:30,206 --> 03:05:32,275
ALSO THESE ALGORITHMS ARE

4727
03:05:32,275 --> 03:05:33,743
TRAINED ON RETROSPECTIVE DATA

4728
03:05:33,743 --> 03:05:37,680
WHICH HAS ITS OWN ISSUES.

4729
03:05:37,680 --> 03:05:39,982
THEY ARE DIFFICULT TO REPRODUCE,

4730
03:05:39,982 --> 03:05:42,151
REQUIRES SHARING A LOT OF

4731
03:05:42,151 --> 03:05:44,353
INFORMATION WHICH IS DIFFICULT

4732
03:05:44,353 --> 03:05:49,058
TO DO AND THAT'S HOW FEDERATED

4733
03:05:49,058 --> 03:05:53,996
NETWORKS ARE INTERESTED.

4734
03:05:53,996 --> 03:05:56,599
FINALLY MANY ADOPTION

4735
03:05:56,599 --> 03:05:57,967
CHALLENGES, TRANSPARENT AND

4736
03:05:57,967 --> 03:05:58,634
EXPLAINABILITY MOST SIGNIFICANT,

4737
03:05:58,634 --> 03:05:59,802
A LOT OF INTERESTING WORK GOING

4738
03:05:59,802 --> 03:06:02,738
ON IN HOW WE CAN ADDRESS THESE

4739
03:06:02,738 --> 03:06:06,909
NEEDS BUT IT'S VERY COMPLEX.

4740
03:06:06,909 --> 03:06:08,778
THE MORE COMPLEX THE MODEL, THE

4741
03:06:08,778 --> 03:06:11,481
MORE DIFFICULT TO EXPLAIN.

4742
03:06:11,481 --> 03:06:17,220
AS A CLINICIAN, IT'S HARD.

4743
03:06:17,220 --> 03:06:20,756
AND WORKFLOW INTEGRATION ISSUES

4744
03:06:20,756 --> 03:06:23,893
WE'LL TALK ABOUT LATER.

4745
03:06:23,893 --> 03:06:25,328
MAYO CLINIC PLATFORM IS TRYING

4746
03:06:25,328 --> 03:06:26,529
TO ADDRESS CHALLENGES.

4747
03:06:26,529 --> 03:06:29,398
SOME DATA CHALLENGES THROUGH

4748
03:06:29,398 --> 03:06:31,234
DISTRIBUTIVE DATA NETWORK WHERE

4749
03:06:31,234 --> 03:06:35,271
WITH COMMON DATA MODEL AND

4750
03:06:35,271 --> 03:06:36,906
QUALITY CONTROL MECHANISMS, AND

4751
03:06:36,906 --> 03:06:39,108
SOLUTION DISCOVERY, OPENING UP

4752
03:06:39,108 --> 03:06:41,177
THESE DATA SOURCES BY

4753
03:06:41,177 --> 03:06:42,612
DE-IDENTIFYING, SO ALLOWING

4754
03:06:42,612 --> 03:06:46,582
OTHER PEOPLE TO TEST AND

4755
03:06:46,582 --> 03:06:46,949
INNOVATE.

4756
03:06:46,949 --> 03:06:48,417
VALIDATION IS SOMETHING WE'RE

4757
03:06:48,417 --> 03:06:51,821
TRYING TO TACKLE, NOT ONLY

4758
03:06:51,821 --> 03:06:53,789
MATHEMATICALLY BUT IN THE LENS

4759
03:06:53,789 --> 03:06:54,857
OF BIAS AND CLINICAL

4760
03:06:54,857 --> 03:06:55,458
INTERPRETATION.

4761
03:06:55,458 --> 03:07:02,865
SO WHAT DOES IT MEAN FOR CARE?

4762
03:07:02,865 --> 03:07:04,467
AND WORKFLOW AND DEPLOYMENT, HOW

4763
03:07:04,467 --> 03:07:05,735
DO WE GET THE RIGHT PREDICTION

4764
03:07:05,735 --> 03:07:07,570
AT THE RIGHT TIME AND KEEP

4765
03:07:07,570 --> 03:07:11,974
INVENTORY OF HOW THAT MODEL IS

4766
03:07:11,974 --> 03:07:12,275
PERFORMING.

4767
03:07:12,275 --> 03:07:14,043
SO, THAT'S ALL I HAVE.

4768
03:07:14,043 --> 03:07:15,411
THANK YOU SO MUCH FOR INVITING

4769
03:07:15,411 --> 03:07:16,546
ME TO SPEAK.

4770
03:07:16,546 --> 03:07:19,849
I LOOK FORWARD TO FURTHER

4771
03:07:19,849 --> 03:07:20,149
DISCUSSION.

4772
03:07:20,149 --> 03:07:25,288
>> THANK YOU VERY MUCH.

4773
03:07:25,288 --> 03:07:26,923
WE'RE RUNNING BEHIND BUT WE'LL

4774
03:07:26,923 --> 03:07:28,691
HAVE TIME FOR A FEW QUESTIONS.

4775
03:07:28,691 --> 03:07:30,226
THOSE WHO NEED A BREAK, FEEL

4776
03:07:30,226 --> 03:07:30,560
FREE.

4777
03:07:30,560 --> 03:07:32,595
WE'LL BE STARTING AGAIN IN

4778
03:07:32,595 --> 03:07:35,798
APPROXIMATELY 10 TO 15 MINUTES.

4779
03:07:35,798 --> 03:07:38,034
WE KNOW THAT WE HAVE TO

4780
03:07:38,034 --> 03:07:39,068
COMMUNICATE WITH PATIENTS TO

4781
03:07:39,068 --> 03:07:40,603
MAKE SURE THE BLOOD PRESSURES

4782
03:07:40,603 --> 03:07:43,739
THAT ARE DONE OUTSIDE THE OFFICE

4783
03:07:43,739 --> 03:07:44,273
ARE INCORPORATED.

4784
03:07:44,273 --> 03:07:46,142
HAVE YOU FOUND TRYING TO

4785
03:07:46,142 --> 03:07:49,545
INTEGRATE DIRECTLY INTO THE

4786
03:07:49,545 --> 03:07:50,846
HEALTH RECORD WORKS, THAT'S

4787
03:07:50,846 --> 03:07:52,248
SOMETHING THAT'S BEING DONE?

4788
03:07:52,248 --> 03:07:53,816
>> YEAH, IT DEPENDS ON THE

4789
03:07:53,816 --> 03:07:56,652
HEALTH CARE SYSTEM, RIGHT?

4790
03:07:56,652 --> 03:07:58,554
SO FOR SOME LARGE ACADEMIC

4791
03:07:58,554 --> 03:08:00,056
CENTERS, YES, THAT'S THE ABILITY

4792
03:08:00,056 --> 03:08:02,892
TO INTEGRATE THEM IN.

4793
03:08:02,892 --> 03:08:04,994
I THINK DATA WAS PRESENTED.

4794
03:08:04,994 --> 03:08:06,963
OTHER ACADEMIC CENTERS, IT'S NOT

4795
03:08:06,963 --> 03:08:11,100
POSSIBLE, BECAUSE OF THE IP

4796
03:08:11,100 --> 03:08:13,502
SECURITY CONCERNS OF PARTNERING

4797
03:08:13,502 --> 03:08:14,036
WITH PARTICULAR DEVICE

4798
03:08:14,036 --> 03:08:15,137
COMPANIES, ET CETERA.

4799
03:08:15,137 --> 03:08:19,475
IT'S BEEN A CHALLENGE, IN MY OWN

4800
03:08:19,475 --> 03:08:19,775
EXPERIENCE.

4801
03:08:19,775 --> 03:08:21,277
IN NEW YORK CITY IT'S BEEN

4802
03:08:21,277 --> 03:08:23,479
DIFFICULT TO GET THE FULL

4803
03:08:23,479 --> 03:08:26,215
INTEGRATION IN THE WAY ONE WOULD

4804
03:08:26,215 --> 03:08:28,351
WANT IT TO BE.

4805
03:08:28,351 --> 03:08:29,585
>> UNDERSTOOD.

4806
03:08:29,585 --> 03:08:32,121
YOU MENTIONED SOME OF THE

4807
03:08:32,121 --> 03:08:35,324
DEVICES HAVE BEEN STUDIED AND

4808
03:08:35,324 --> 03:08:36,192
APPROVED, NOT NECESSARILY VALID.

4809
03:08:36,192 --> 03:08:37,693
IS THERE ANYTHING ON THE MARKET

4810
03:08:37,693 --> 03:08:39,895
RIGHT NOW THAT'S BOTH APPROVED

4811
03:08:39,895 --> 03:08:47,003
AND VALID IN TERMS OF MEASURING

4812
03:08:47,003 --> 03:08:48,204
BLOOD PRESSURE?

4813
03:08:48,204 --> 03:08:52,808
AND WHILE YOU'RE -- ARE YOU

4814
03:08:52,808 --> 03:08:54,510
THERE, DR. STERGIOU?

4815
03:08:54,510 --> 03:08:56,112
>> THERE'S NO DEVICE THAT

4816
03:08:56,112 --> 03:08:56,979
FULFILLS THE REQUIREMENT FOR

4817
03:08:56,979 --> 03:08:58,114
CLINICAL USE.

4818
03:08:58,114 --> 03:08:59,849
THE MAIN PROBLEM IS THEIR

4819
03:08:59,849 --> 03:09:04,120
ABILITY TO TRACK CHANGES IN

4820
03:09:04,120 --> 03:09:05,988
BLOOD PRESSURE.

4821
03:09:05,988 --> 03:09:11,560
I HAVEN'T SEEN ANY DATA TOWARDS

4822
03:09:11,560 --> 03:09:13,195
TECHNOLOGY, BLOOD PRESSURE WITH

4823
03:09:13,195 --> 03:09:15,831
TREATMENT IS GOING TO TRACK

4824
03:09:15,831 --> 03:09:17,800
BLOOD PRESSURE CHANGE IN THESE

4825
03:09:17,800 --> 03:09:20,436
PATIENTS, IN WHOM THERE'S

4826
03:09:20,436 --> 03:09:21,637
NOTHING ELSE CHANGED ABOUT THE

4827
03:09:21,637 --> 03:09:23,072
BLOOD PRESSURE, AND THESE ARE

4828
03:09:23,072 --> 03:09:27,009
THE PROBLEMS WITH PREDICTING THE

4829
03:09:27,009 --> 03:09:28,978
BLOOD PRESSURE BECAUSE WE CHANGE

4830
03:09:28,978 --> 03:09:31,047
BLOOD PRESSURE WEEKEND NOTHING

4831
03:09:31,047 --> 03:09:32,248
ELSE.

4832
03:09:32,248 --> 03:09:37,386
I HAVEN'T SEEN DEVICES WHICH CAN

4833
03:09:37,386 --> 03:09:38,054
TRACK APPROPRIATELY NOCTURNALLY,

4834
03:09:38,054 --> 03:09:41,657
THIS IS WHAT WE DO IN CLINICAL

4835
03:09:41,657 --> 03:09:41,924
PRACTICE.

4836
03:09:41,924 --> 03:09:42,758
>> DR. WHELTON, WE'VE HAD

4837
03:09:42,758 --> 03:09:46,262
PERSONAL DISCUSSIONS IN THE

4838
03:09:46,262 --> 03:09:49,332
CHAT, MULTIPLE CONVERSATIONS,

4839
03:09:49,332 --> 03:09:50,733
WHY PERSISTENT POOR CONTROL IN

4840
03:09:50,733 --> 03:09:52,535
BLACK AMERICAN POPULATION,

4841
03:09:52,535 --> 03:09:54,937
DOESN'T SEEM TO BE GOING AWAY,

4842
03:09:54,937 --> 03:09:56,238
PERSISTENT FOR DECADES, WE DON'T

4843
03:09:56,238 --> 03:09:58,541
SEE IMPROVEMENT.

4844
03:09:58,541 --> 03:09:58,941
WHAT'S THE REASON?

4845
03:09:58,941 --> 03:10:01,711
>> YOU'RE MORE OF AN
EXPERT THAN

4846
03:10:01,711 --> 03:10:03,579
ANYBODY ON THIS, CERTAINLY THAN

4847
03:10:03,579 --> 03:10:04,447
ME ON THIS CALL.

4848
03:10:04,447 --> 03:10:10,019
ON THE ONE HAND WE HAVE SEEN

4849
03:10:10,019 --> 03:10:15,024
SOME IMPROVEMENTS, YOU CAN TAKE

4850
03:10:15,024 --> 03:10:19,962
SOME CREDIT, WE SAW IMPROVEMENTS

4851
03:10:19,962 --> 03:10:22,064
IN AWARENESS, TREATMENT.

4852
03:10:22,064 --> 03:10:27,970
BUT STILL VERY, VERY POOR.

4853
03:10:27,970 --> 03:10:29,271
AWARENESS GOING DOWN.

4854
03:10:29,271 --> 03:10:31,240
TREATMENT POOR CONTROL, VERY

4855
03:10:31,240 --> 03:10:31,540
SUBSTANDARD.

4856
03:10:31,540 --> 03:10:34,410
PROBABLY HAS A LOT DO WITH THE

4857
03:10:34,410 --> 03:10:36,612
SOCIAL DETERMINANTS OF HEALTH.

4858
03:10:36,612 --> 03:10:37,913
IT REALLY UNDERLIES THE PROBLEM.

4859
03:10:37,913 --> 03:10:39,782
IT IS A VERY DIFFICULT AREA TO

4860
03:10:39,782 --> 03:10:42,284
TACKLE, AS YOU WELL KNOW.

4861
03:10:42,284 --> 03:10:45,020
I THINK THE SAD THING IS WE HAVE

4862
03:10:45,020 --> 03:10:48,524
MODELS THAT WE KNOW WORK.

4863
03:10:48,524 --> 03:10:49,392
THEY WORK IN NON-HISPANIC

4864
03:10:49,392 --> 03:10:51,360
BLACKS, JUST AS WELL AS IN

4865
03:10:51,360 --> 03:10:51,594
WHITES.

4866
03:10:51,594 --> 03:10:54,330
THEY WORK ALL OVER THE WORLD.

4867
03:10:54,330 --> 03:10:56,298
AND TRICK REALLY IS NOT ONLY TO

4868
03:10:56,298 --> 03:10:57,733
UNDERSTAND THAT MODEL BUT TO

4869
03:10:57,733 --> 03:10:59,668
IMPLEMENT IT.

4870
03:10:59,668 --> 03:11:01,437
THAT'S WHAT HAPPENS IN PRACTICE.

4871
03:11:01,437 --> 03:11:02,104
THERE'S NOT PROPER

4872
03:11:02,104 --> 03:11:04,373
IMPLEMENTATION OF WHAT WE KNOW

4873
03:11:04,373 --> 03:11:06,175
WORKS.

4874
03:11:06,175 --> 03:11:07,176
AND THAT'S THE FRUSTRATION OF

4875
03:11:07,176 --> 03:11:08,344
DOING ANY OF THE TRIALS.

4876
03:11:08,344 --> 03:11:12,047
YOU AND I GO BACK TO THE DAYS OF

4877
03:11:12,047 --> 03:11:13,916
BAHAD, WE'VE SEEN MANY EFFICACY

4878
03:11:13,916 --> 03:11:15,418
TRIALS, MOST RECENTLY SPRINT

4879
03:11:15,418 --> 03:11:17,420
THAT DEMONSTRATED WITHOUT

4880
03:11:17,420 --> 03:11:18,921
QUESTION THE BENEFIT OF A

4881
03:11:18,921 --> 03:11:22,124
TREATMENT, AND WE'VE SEEN THAT

4882
03:11:22,124 --> 03:11:23,959
LARGELY IGNORED IN CLINICAL

4883
03:11:23,959 --> 03:11:26,629
PRACTICE, VERY FRUSTRATING AND

4884
03:11:26,629 --> 03:11:29,365
WORSE OBVIOUSLY IN

4885
03:11:29,365 --> 03:11:31,901
HISPANIC/BLACK COMMUNITY THAN IN

4886
03:11:31,901 --> 03:11:34,970
OTHER RACE/ETHNICITY GROUPS IN

4887
03:11:34,970 --> 03:11:35,905
THE U.S.

4888
03:11:35,905 --> 03:11:38,007
>> THIS IS NOT JUST A
NUMBER.

4889
03:11:38,007 --> 03:11:41,944
IT HAS A POWERFUL EFFECT ON

4890
03:11:41,944 --> 03:11:42,945
CARDIOVASCULAR OUTCOMES, MORE

4891
03:11:42,945 --> 03:11:44,380
STROKE, EARLIER HEART ATTACK,

4892
03:11:44,380 --> 03:11:45,681
MORE HEART FAILURE, MORE CHRONIC

4893
03:11:45,681 --> 03:11:46,115
KIDNEY DISEASE.

4894
03:11:46,115 --> 03:11:48,717
SO THIS IS NOT JUST LOOKING AT

4895
03:11:48,717 --> 03:11:50,152
THE PERCENTAGE OF POPULATION

4896
03:11:50,152 --> 03:11:54,323
THAT HAS CONTROL, IT TRANSLATES

4897
03:11:54,323 --> 03:11:59,995
INTO MORBIDITY AND MORTALITY.

4898
03:11:59,995 --> 03:12:05,234
DR. MAKHNI,  VARIABILITY OF THE

4899
03:12:05,234 --> 03:12:06,902
HUMAN EXPERIENCE, HOW CAN YOU

4900
03:12:06,902 --> 03:12:09,405
PREDICT BASED ON CHANGES?

4901
03:12:09,405 --> 03:12:10,706
HUMANS CHANGE BEHAVIOR ALL THE

4902
03:12:10,706 --> 03:12:11,040
TIME.

4903
03:12:11,040 --> 03:12:12,141
WHATEVER DATA YOU'RE PUTTING IN,

4904
03:12:12,141 --> 03:12:13,676
TOMORROW MAY NOT BE VALID.

4905
03:12:13,676 --> 03:12:18,481
HOW DO YOU ADDRESS THAT?

4906
03:12:18,481 --> 03:12:19,281
>> COMPLEX QUESTION.

4907
03:12:19,281 --> 03:12:21,550
I THINK, YOU KNOW, WE MIGHT NOT

4908
03:12:21,550 --> 03:12:23,452
REALLY BE CLOSE TO FULLY BEING

4909
03:12:23,452 --> 03:12:24,987
ABLE TO ADDRESS THAT CONCERN.

4910
03:12:24,987 --> 03:12:27,823
BUT I THINK THERE ARE WAYS THAT

4911
03:12:27,823 --> 03:12:29,859
WE CAN BE MORE CREATIVE AND

4912
03:12:29,859 --> 03:12:32,261
CLEVER HOW WE INTEGRATE DATA

4913
03:12:32,261 --> 03:12:32,728
SOURCES.

4914
03:12:32,728 --> 03:12:35,030
SOME WORK GOING ON IN CHICAGO

4915
03:12:35,030 --> 03:12:37,766
THAT I WAS FORTUNATE TO BE

4916
03:12:37,766 --> 03:12:41,470
INVOLVED IN INVOLVED CONCEPT OF

4917
03:12:41,470 --> 03:12:43,439
SOCIO-DATA, DATA FROM OUR LIVED

4918
03:12:43,439 --> 03:12:44,740
ENVIRONMENT THAT, YOU KNOW,

4919
03:12:44,740 --> 03:12:47,610
INCLUDES NOT JUST CRIME BUT YOU

4920
03:12:47,610 --> 03:12:51,881
CAN GET DATASETS ON TRAFFIC AND

4921
03:12:51,881 --> 03:12:52,748
AIR POLLUTION.

4922
03:12:52,748 --> 03:12:55,918
AND THERE ARE SCENARIOS YOU CAN

4923
03:12:55,918 --> 03:12:59,321
IMAGINE HOW THAT SOCIAL AND

4924
03:12:59,321 --> 03:13:03,058
ENVIRONMENTAL DATA IN TANDEM

4925
03:13:03,058 --> 03:13:04,693
WITH CLINICAL AND OTHER SIGNAL

4926
03:13:04,693 --> 03:13:07,196
DATA POINTS WHERE MAYBE YOU CAN

4927
03:13:07,196 --> 03:13:08,430
CREATE A LONGITUDINAL

4928
03:13:08,430 --> 03:13:11,233
EXPERIENCE, AND KIND OF CREATE

4929
03:13:11,233 --> 03:13:13,869
PROXIES FOR CERTAIN ACTIVITIES,

4930
03:13:13,869 --> 03:13:17,940
SO MAYBE THERE'S A HIGHER BLOOD

4931
03:13:17,940 --> 03:13:19,575
PRESSURE LEVEL AT NIGHT WHEN A

4932
03:13:19,575 --> 03:13:21,010
CERTAIN PERSON GETS HOME FROM

4933
03:13:21,010 --> 03:13:25,948
WORK, IT'S A TOUGH AREA. 

4934
03:13:25,948 --> 03:13:28,551
YOU CAN EXTRAPOLATE VARIOUS

4935
03:13:28,551 --> 03:13:30,753
INFERENCES ON THAT LIVED

4936
03:13:30,753 --> 03:13:31,053
EXPERIENCE.

4937
03:13:31,053 --> 03:13:32,821
>> A QUESTION IN THE CHAT,
I'M

4938
03:13:32,821 --> 03:13:35,224
NOT SURE WHO MAY GIVE AN ANSWER.

4939
03:13:35,224 --> 03:13:39,962
ASKED ABOUT VALIDITY OF

4940
03:13:39,962 --> 03:13:42,164
ELECTRONIC EQUIPMENT USED BY

4941
03:13:42,164 --> 03:13:42,631
I-HEALTH.

4942
03:13:42,631 --> 03:13:44,366
DOES ANYONE KNOWN ABOUT I-HEALTH

4943
03:13:44,366 --> 03:13:47,736
AND THE EQUIPMENT?

4944
03:13:47,736 --> 03:13:49,939
NO ONE?

4945
03:13:49,939 --> 03:13:51,473
DR. ABDALLA, ONE THING WE DO IN

4946
03:13:51,473 --> 03:13:53,108
NEW ORLEANS, WE HAVE PILOT

4947
03:13:53,108 --> 03:13:56,045
STUDIES, NOT A BIG STUDY,

4948
03:13:56,045 --> 03:13:56,879
SELF-DEFINED AFRICAN AMERICANS

4949
03:13:56,879 --> 03:13:59,782
GAVE THEM VALID BLOOD PRESSURE

4950
03:13:59,782 --> 03:14:02,484
DEVICES AND NOT CALLING BUT

4951
03:14:02,484 --> 03:14:04,153
TEXTING, SOME MACHINES CAN

4952
03:14:04,153 --> 03:14:05,454
BLUETOOTH BLACK TO THE

4953
03:14:05,454 --> 03:14:06,989
TECHNICIAN, A MEDICAL STUDENT, I

4954
03:14:06,989 --> 03:14:09,959
DIDN'T DO A THING, SHOWED

4955
03:14:09,959 --> 03:14:10,926
INCREASE IN INHERENCE AND

4956
03:14:10,926 --> 03:14:12,261
CONTROL WITHOUT EVEN CALLING OR

4957
03:14:12,261 --> 03:14:13,228
TALKING TO THE PATIENT.

4958
03:14:13,228 --> 03:14:17,633
DO YOU THINK THAT'S GOING TO BE

4959
03:14:17,633 --> 03:14:20,135
A VALID WAY OF COMMUNICATIONS OF

4960
03:14:20,135 --> 03:14:20,402
PATIENTS?

4961
03:14:20,402 --> 03:14:22,204
>> MAYBE.

4962
03:14:22,204 --> 03:14:27,910
IT'S INTRIGUING DATA. 

4963
03:14:27,910 --> 03:14:29,011
WE HAVEN'T DISCUSSED DIGITAL

4964
03:14:29,011 --> 03:14:29,244
DEVICE.

4965
03:14:29,244 --> 03:14:34,717
SOMEONE IN THE  CHAT TALKED ABOT

4966
03:14:34,717 --> 03:14:34,917
THIS.

4967
03:14:34,917 --> 03:14:36,018
SOMETIMES THROWING TECHNOLOGY IS

4968
03:14:36,018 --> 03:14:38,287
PART OF THE SOLUTION BUT DOESN'T

4969
03:14:38,287 --> 03:14:40,723
GO BACK TO STRUCTURAL ISSUES.

4970
03:14:40,723 --> 03:14:42,124
ONLY A SMALL PROPORTION MAY BE

4971
03:14:42,124 --> 03:14:43,859
ABLE TO GET ACCESS OR BE

4972
03:14:43,859 --> 03:14:45,194
INVOLVED IN RESEARCH STUDIES BUT

4973
03:14:45,194 --> 03:14:47,496
REALLY THE QUESTION FOR ALL OF

4974
03:14:47,496 --> 03:14:49,565
US ON THIS CALL IS HOW DO WE

4975
03:14:49,565 --> 03:14:51,467
SCALE THIS AT LARGE, RIGHT?

4976
03:14:51,467 --> 03:14:54,536
NOT JUST IN, YOU KNOW, OUR U.S.

4977
03:14:54,536 --> 03:14:55,704
COMMUNITIES BUT ALSO GLOBALLY.

4978
03:14:55,704 --> 03:14:58,974
HYPERTENSION IS STILL THE

4979
03:14:58,974 --> 03:15:02,945
LEADING CAUSE OF MORTALITY

4980
03:15:02,945 --> 03:15:03,212
WORLDWIDE.

4981
03:15:03,212 --> 03:15:06,415
>> I HAVE A BIOWATCH ON
NOW, I

4982
03:15:06,415 --> 03:15:07,583
USE IT FOR STEPS, HOW MANY STEMS

4983
03:15:07,583 --> 03:15:11,787
YOU TAKE -- HOW MANY STEPS YOU

4984
03:15:11,787 --> 03:15:13,656
TAKE A DAY.

4985
03:15:13,656 --> 03:15:15,524
YOU PUT COLD WATER ON THE

4986
03:15:15,524 --> 03:15:16,191
SELF-MONITORING BLOOD PRESSURE

4987
03:15:16,191 --> 03:15:17,826
BUT IS IT USEFUL, IS THERE ANY

4988
03:15:17,826 --> 03:15:23,832
DEVICE FOR BLOOD PRESSURE WE CAN

4989
03:15:23,832 --> 03:15:26,502
USE EVEN NOT VALIDATED

4990
03:15:26,502 --> 03:15:26,802
COMPLETELY?

4991
03:15:26,802 --> 03:15:29,838
>> I CANNOT FIND ANY
POSITIVE

4992
03:15:29,838 --> 03:15:32,474
FEEDBACK FOR THE PRESENT TIME

4993
03:15:32,474 --> 03:15:34,343
ABOUT SOME PROMISES.

4994
03:15:34,343 --> 03:15:37,079
REALLY DEVICES CAN CHANGE

4995
03:15:37,079 --> 03:15:38,080
EVERYTHING.

4996
03:15:38,080 --> 03:15:39,181
REALLY, EVERYTHING.

4997
03:15:39,181 --> 03:15:41,250
AND CAN BE A GREAT IMPROVEMENT.

4998
03:15:41,250 --> 03:15:44,753
THAT'S WHY EVERYBODY LIKES THEM.

4999
03:15:44,753 --> 03:15:46,255
BUT IT DOESN'T SEEM THAT WHAT WE

5000
03:15:46,255 --> 03:15:50,325
HAVE FOR THE MOMENT CAN DO ANY

5001
03:15:50,325 --> 03:15:51,393
HELP.

5002
03:15:51,393 --> 03:15:54,797
THERE'S A DISCUSSION ABOUT THE

5003
03:15:54,797 --> 03:15:58,434
TRENDING DEVICES, THESE DEVICES

5004
03:15:58,434 --> 03:16:02,137
CANNOT MEASURE, IN THE WAY YOU

5005
03:16:02,137 --> 03:16:03,572
HAVE SET UP CLINICAL, I DON'T

5006
03:16:03,572 --> 03:16:09,812
SEE HOW THEY CAN BE USEFUL

5007
03:16:09,812 --> 03:16:10,145
UNFORTUNATELY.

5008
03:16:10,145 --> 03:16:12,548
MAYBE PREDICTION WHICH WE'RE NOT

5009
03:16:12,548 --> 03:16:15,617
FAMILIAR WITH THAT, WE WANT TO

5010
03:16:15,617 --> 03:16:18,554
MEASURE, NOT PREDICT, BUT MAYBE

5011
03:16:18,554 --> 03:16:22,524
PREDICTION IS MORE FEASIBLE FOR

5012
03:16:22,524 --> 03:16:24,927
SCREENING, BUT THE SENSORS BEING

5013
03:16:24,927 --> 03:16:29,198
ABSOLUTE MEASUREMENTS FOR US TO

5014
03:16:29,198 --> 03:16:30,733
USE FOR DECISION MAKING, IT

5015
03:16:30,733 --> 03:16:34,903
DOESN'T SEEM TO BE EASY, OR TOO

5016
03:16:34,903 --> 03:16:35,104
CLOSE.

5017
03:16:35,104 --> 03:16:36,071
>> THANK YOU.

5018
03:16:36,071 --> 03:16:38,807
I'M SMILING BECAUSE IN THE CHAT

5019
03:16:38,807 --> 03:16:40,676
I SPOKE ABOUT OUR VERY NICE

5020
03:16:40,676 --> 03:16:45,914
STUDY WHICH WE GAVE PATIENTS

5021
03:16:45,914 --> 03:16:47,683
DEVICES, SOMEBODY SAID TEXTING

5022
03:16:47,683 --> 03:16:49,651
IS NOT FOR EVERYBODY.

5023
03:16:49,651 --> 03:16:50,753
THERE ARE POSTPARTUM WOMEN THAT

5024
03:16:50,753 --> 03:16:54,123
GOT TIRED AND ASKED THEM TO

5025
03:16:54,123 --> 03:16:54,323
STOP.

5026
03:16:54,323 --> 03:16:55,557
THE HUMAN EXPERIENCE JUST

5027
03:16:55,557 --> 03:16:57,760
VARIES, DEPENDING ON THE

5028
03:16:57,760 --> 03:16:58,827
POPULATION, WHO YOU'RE STUDYING.

5029
03:16:58,827 --> 03:17:01,130
PAUL, YOU'LL HAVE THE LAST THREE

5030
03:17:01,130 --> 03:17:02,765
MINUTES, MAYBE TAKE TWO AND IF

5031
03:17:02,765 --> 03:17:03,999
ANYONE ELSE HAS SOMETHING ELSE

5032
03:17:03,999 --> 03:17:07,136
THEY CAN CHIP IN.

5033
03:17:07,136 --> 03:17:09,438
I'M STILL PERPLEXED, YOU HAVE

5034
03:17:09,438 --> 03:17:10,439
BLOOD PRESSURE CONTROL RATES

5035
03:17:10,439 --> 03:17:11,740
THAT IMPROVE THROUGHOUT THE

5036
03:17:11,740 --> 03:17:11,940
WORLD.

5037
03:17:11,940 --> 03:17:16,311
YOU SAID WORLDWIDE YOU MENTIONED

5038
03:17:16,311 --> 03:17:17,312
THE CHINA EXPERIENCE,

5039
03:17:17,312 --> 03:17:18,413
IMPROVEMENTS IN CONTROL.

5040
03:17:18,413 --> 03:17:19,515
WHY ARE WE NOT DOING IT IN THE

5041
03:17:19,515 --> 03:17:20,716
UNITED STATES?

5042
03:17:20,716 --> 03:17:22,618
I DON'T GET IT.

5043
03:17:22,618 --> 03:17:23,652
>> IT'S FRUSTRATING.

5044
03:17:23,652 --> 03:17:25,854
I WILL SAY ONE THING.

5045
03:17:25,854 --> 03:17:28,157
I DO A LOT OF GLOBAL HEALTH WORK

5046
03:17:28,157 --> 03:17:29,124
AROUND BLOOD PRESSURE.

5047
03:17:29,124 --> 03:17:33,629
AND ONE THING THAT YOU FIND IN

5048
03:17:33,629 --> 03:17:36,131
ALMOST EVERY REMOTE AREA, IT'S

5049
03:17:36,131 --> 03:17:38,567
NOT UNIVERSAL, BUT IT'S AN

5050
03:17:38,567 --> 03:17:42,037
iPHONE OR EQUIVALENT, YOU GO

5051
03:17:42,037 --> 03:17:46,141
INTO THE FLOATING VILLAGES IN

5052
03:17:46,141 --> 03:17:53,048
LAKE TITICAK A, THEY HAVE A SOLR

5053
03:17:53,048 --> 03:17:54,950
PANEL, TV, iPHONES, EVEN IN

5054
03:17:54,950 --> 03:17:55,884
SUB-SAHARAN AFRICA.

5055
03:17:55,884 --> 03:17:57,853
IN THE FUTURE IF THERE'S A WAY

5056
03:17:57,853 --> 03:17:59,822
TO REALLY GET iPHONES TO WORK,

5057
03:17:59,822 --> 03:18:03,091
I THINK THAT HAS MUCH BROADER

5058
03:18:03,091 --> 03:18:03,859
APPLICABILITY THAN WRIST WATCHES

5059
03:18:03,859 --> 03:18:06,595
WHICH PEOPLE AREN'T GOING TO BUY

5060
03:18:06,595 --> 03:18:09,998
BUT WILL BUY A MOBILE PHONE.

5061
03:18:09,998 --> 03:18:11,200
IT'S VERY FRUSTRATING.

5062
03:18:11,200 --> 03:18:13,502
THE QUESTION IS SO FRUSTRATING

5063
03:18:13,502 --> 03:18:15,437
BECAUSE WE KNOW WHAT WORKS.

5064
03:18:15,437 --> 03:18:18,307
WE HAVE THE EFFICACY STUDIES.

5065
03:18:18,307 --> 03:18:21,577
AND IT'S BEEN DARN DIFFICULT TO

5066
03:18:21,577 --> 03:18:21,910
IMPLEMENT.

5067
03:18:21,910 --> 03:18:23,779
WE KNOW WHEN IT'S DONE, IT'S NOT

5068
03:18:23,779 --> 03:18:24,546
THE MODEL.

5069
03:18:24,546 --> 03:18:25,747
THE MODEL WORKS.

5070
03:18:25,747 --> 03:18:30,552
WE KNOW WHEN IT'S DONE WITH A

5071
03:18:30,552 --> 03:18:33,722
HIGH LEVEL OF EXECUTION, IT

5072
03:18:33,722 --> 03:18:34,957
WORKS WONDERFULLY WELL.

5073
03:18:34,957 --> 03:18:37,659
THE CHINA STUDY WAS A GREAT

5074
03:18:37,659 --> 03:18:40,629
EXAMPLE, MORE THAN 21

5075
03:18:40,629 --> 03:18:42,297
MILLIMETERS OF MERCURY SYSTOLIC

5076
03:18:42,297 --> 03:18:43,498
DIFFERENCE, HUGE CARDIOVASCULAR

5077
03:18:43,498 --> 03:18:44,066
BENEFITS.

5078
03:18:44,066 --> 03:18:46,668
THE MOST RURAL OF RURAL AREAS.

5079
03:18:46,668 --> 03:18:49,705
AND WE'VE SEEN THE SAME THING IN

5080
03:18:49,705 --> 03:18:52,774
HIGH-INCOME COUNTRIES.

5081
03:18:52,774 --> 03:18:54,409
IT'S VERY FRUSTRATING TO SEE

5082
03:18:54,409 --> 03:18:57,679
THAT IT'S NOT HAPPENING,

5083
03:18:57,679 --> 03:19:00,883
FRUSTRATING TO SEE NO INTEREST

5084
03:19:00,883 --> 03:19:08,323
IN QUALITY OF MEASUREMENTS,

5085
03:19:08,323 --> 03:19:10,893
HEDIS WILL NOT TOUCH IT OR GET

5086
03:19:10,893 --> 03:19:14,463
OFF THE 140/90 GUIDELINE.

5087
03:19:14,463 --> 03:19:16,198
EVERYONE IS RECOMMENDING A LOWER

5088
03:19:16,198 --> 03:19:20,369
TARGET. 

5089
03:19:20,369 --> 03:19:21,536
WE HAVE TO BE PERSISTENT.

5090
03:19:21,536 --> 03:19:23,705
>> THANK YOU TO THE
PRESENTERS.

5091
03:19:23,705 --> 03:19:27,009
I'LL TURN IT BACK OVER TO DR.

5092
03:19:27,009 --> 03:19:27,242
SHIMBO.

5093
03:19:27,242 --> 03:19:28,677
>> THANK YOU.

5094
03:19:28,677 --> 03:19:29,311
WONDERFUL DISCUSSION.

5095
03:19:29,311 --> 03:19:31,546
WE HAVE RUN A LITTLE BIT BEHIND.

5096
03:19:31,546 --> 03:19:33,515
SO WE'RE GOING TO ASK PEOPLE TO

5097
03:19:33,515 --> 03:19:35,717
COME BACK, WE'LL TAKE A BREAK,

5098
03:19:35,717 --> 03:19:40,856
ASK PEOPLE TO COME BACK SHARP AT

5099
03:19:40,856 --> 03:19:42,925
2:45 EASTERN STANDARD TIME.

5100
03:19:42,925 --> 03:19:44,693
AT WHICH TIME WE'LL BEGIN

5101
03:19:44,693 --> 03:19:46,762
SESSION 3, THE FINAL SESSION

5102
03:19:46,762 --> 03:19:47,541
THIS AFTERNOON.

5103
03:19:47,541 --> 03:19:52,747
I THINK WE SHOULD GET

5104
03:19:52,747 --> 03:19:53,414
STARTED.

5105
03:19:53,414 --> 03:19:55,082
I'D LIKE TO OPEN SESSION 3,

5106
03:19:55,082 --> 03:19:59,186
MAKING A DENT IN THE PROBLEM.

5107
03:19:59,186 --> 03:20:01,856
WE STARTED WITH TECHNOLOGY AND

5108
03:20:01,856 --> 03:20:04,925
A.I. FOCUS, SESSION 2 SLANTED

5109
03:20:04,925 --> 03:20:06,594
TOWARD HYPERTENSION AND BLOOD

5110
03:20:06,594 --> 03:20:07,194
PRESSURE.

5111
03:20:07,194 --> 03:20:11,065
NOW WE ARE WELL EDUCATED ABOUT

5112
03:20:11,065 --> 03:20:12,066
A.I. AND HYPERTENSION, THE

5113
03:20:12,066 --> 03:20:12,933
PROBLEMS THERE.

5114
03:20:12,933 --> 03:20:16,103
THIS SESSION IS GOING TO FOCUS

5115
03:20:16,103 --> 03:20:19,273
ON A.I., INTERSECTION OF A.I.

5116
03:20:19,273 --> 03:20:19,673
AND HYPERTENSION.

5117
03:20:19,673 --> 03:20:24,211
I'D LIKE TO ASK OUR FIRST

5118
03:20:24,211 --> 03:20:34,688
SPEAKER, DR. JANE LEOPOLD TO

5119
03:20:35,022 --> 03:20:35,189
PRESENT.

5120
03:20:35,189 --> 03:20:36,791
ASSOCIATE PROFESSOR AT HARVARD

5121
03:20:36,791 --> 03:20:38,325
MEDICAL SCHOOL, DIRECTOR OF

5122
03:20:38,325 --> 03:20:40,861
CARDIOVASCULAR RESEARCH CORE OF

5123
03:20:40,861 --> 03:20:42,096
BRIGHAM AND WOMEN'S HOSPITAL.

5124
03:20:42,096 --> 03:20:42,396
WELCOME.

5125
03:20:42,396 --> 03:20:45,566
USING A.I. FOR PRIMARY

5126
03:20:45,566 --> 03:20:48,068
PREVENTION OF CV DISEASE WITH A

5127
03:20:48,068 --> 03:20:51,472
FOCUS ON HYPERTENSION, PRECISION

5128
03:20:51,472 --> 03:20:53,007
PUBLIC HEALTH.

5129
03:20:53,007 --> 03:20:53,507
THANK YOU AND WELCOME.

5130
03:20:53,507 --> 03:20:56,410
>> THANK YOU FOR THE KIND

5131
03:20:56,410 --> 03:20:58,179
INVITATION, TALKS SO FAR HAVE

5132
03:20:58,179 --> 03:20:59,914
BEEN FANTASTIC, I HOPE MY

5133
03:20:59,914 --> 03:21:01,882
DISCUSSION HERE ABOUT PRECISION

5134
03:21:01,882 --> 03:21:04,718
PUBLIC HEALTH WILL TIE IN WELL

5135
03:21:04,718 --> 03:21:07,488
WITH EVERYTHING.

5136
03:21:07,488 --> 03:21:08,556
THESE ARE MY DISCLOSURES.

5137
03:21:08,556 --> 03:21:14,662
AND SO IF WE'RE GOING TO TALK

5138
03:21:14,662 --> 03:21:15,896
ABOUTPRECISION MEDICINE WE HAVE

5139
03:21:15,896 --> 03:21:19,300
TO DEFINE IT.

5140
03:21:19,300 --> 03:21:20,935
IN OUR CURRENT TREATMENT SCHEME

5141
03:21:20,935 --> 03:21:22,870
MOST THERAPIES ARE DESIGNED FOR

5142
03:21:22,870 --> 03:21:25,206
THE AVERAGE PATIENT BASED ON

5143
03:21:25,206 --> 03:21:29,743
RESULTS FROM CLINICAL TRIALS.

5144
03:21:29,743 --> 03:21:31,979
HOWEVER, THIS ONE-SIZE-FITS-ALL

5145
03:21:31,979 --> 03:21:35,749
APPROACH MAY WORK FOR SOME, NOT

5146
03:21:35,749 --> 03:21:35,983
OTHERS.

5147
03:21:35,983 --> 03:21:41,088
IF YOU LOOK ATPRECISION MEDICINE

5148
03:21:41,088 --> 03:21:51,565
MED  ASSIGN -- MEDICINE YOU

5149
03:21:52,233 --> 03:21:53,367
ACCOUNT FOR DIFFERENCES

5150
03:21:53,367 --> 03:21:54,235
REQUIRING DEEP PHENOTYPING.

5151
03:21:54,235 --> 03:21:55,436
WE WANT TO GET THE RIGHT

5152
03:21:55,436 --> 03:21:57,304
TREATMENT OR INTERVENTION TO THE

5153
03:21:57,304 --> 03:21:59,807
RIGHT PATIENT AT THE RIGHT TIME

5154
03:21:59,807 --> 03:22:00,975
FOR PRECISION PUBLIC HEALTH WE

5155
03:22:00,975 --> 03:22:03,444
WANT TO FOCUS ON THE HEALTHY

5156
03:22:03,444 --> 03:22:11,185
INDIVIDUALS AND THOSE AT RISK

5157
03:22:11,185 --> 03:22:11,952
FOR DISEASE.

5158
03:22:11,952 --> 03:22:14,154
THERE'S A CONTINUUM OF DISEASE,

5159
03:22:14,154 --> 03:22:16,790
INDIVIDUALS ARE EITHER IN IDEAL

5160
03:22:16,790 --> 03:22:18,325
HEALTH, DEVELOP RISK FACTORS FOR

5161
03:22:18,325 --> 03:22:22,496
A DISEASE OR ACTUALLY HAVE

5162
03:22:22,496 --> 03:22:23,797
ESTABLISHED DISEASE, AND THERE'S

5163
03:22:23,797 --> 03:22:25,099
VARYING GRADIENTS OF DISEASE

5164
03:22:25,099 --> 03:22:27,201
RISK OR SEVERITY WITHIN EACH OF

5165
03:22:27,201 --> 03:22:31,372
THE GROUPS, IT'S A SPECTRUM, BUT

5166
03:22:31,372 --> 03:22:33,440
THERE'S PLASTICITY IN THE

5167
03:22:33,440 --> 03:22:34,975
PHENOTYPES SO INDIVIDUALS CAN

5168
03:22:34,975 --> 03:22:36,610
TRANSITION BETWEEN GROUPS, AND

5169
03:22:36,610 --> 03:22:38,379
THIS CAN OCCUR EITHER OVER TIME

5170
03:22:38,379 --> 03:22:41,081
AND THIS WAS ALLUDED TO EARLIER,

5171
03:22:41,081 --> 03:22:45,519
OR IT CAN OCCUR IF WE CHANGE

5172
03:22:45,519 --> 03:22:47,488
DEFINITION OF WHAT CONSTITUTES

5173
03:22:47,488 --> 03:22:49,790
DISEASE AND HEALTH.

5174
03:22:49,790 --> 03:22:52,192
AS YOU CAN RECALL, THIS ACTUALLY

5175
03:22:52,192 --> 03:22:54,695
HAPPENED WHEN WE CHANGED THE

5176
03:22:54,695 --> 03:22:56,130
DEFINITION OF WHAT CONSTITUTES

5177
03:22:56,130 --> 03:22:58,332
HYPERTENSION, AND THE SAME THING

5178
03:22:58,332 --> 03:23:03,137
HAPPENED WHEN WE CHANGED

5179
03:23:03,137 --> 03:23:05,205
DEFINITION OF WHAT CONSTITUTES

5180
03:23:05,205 --> 03:23:07,207
HYPERCHOLESTEROL EMIA.

5181
03:23:07,207 --> 03:23:10,144
WE HAVE TO RECOGNIZE A LOT OF

5182
03:23:10,144 --> 03:23:12,246
HETEROGENEITY IN CARDIOVASCULAR

5183
03:23:12,246 --> 03:23:12,846
DISEASES.

5184
03:23:12,846 --> 03:23:15,616
SO HISTORICALLY WE USED TO THINK

5185
03:23:15,616 --> 03:23:17,718
THAT -- AND THIS IS QUITE A

5186
03:23:17,718 --> 03:23:20,354
WHILE AGO, THAT A DISEASE WAS

5187
03:23:20,354 --> 03:23:22,656
CAUSED BY A SINGLE GENE VARIANT

5188
03:23:22,656 --> 03:23:25,392
THAT MAY HAVE BEEN RESPONSIBLE

5189
03:23:25,392 --> 03:23:28,295
FOR MULTIPLE DIFFERENT TYPES OF

5190
03:23:28,295 --> 03:23:29,530
PHENOTYPES, AND THAT THIS IS

5191
03:23:29,530 --> 03:23:35,436
REALLY HOW WE ENDED UP WITH A

5192
03:23:35,436 --> 03:23:36,537
COMPLEX CARDIOVASCULAR

5193
03:23:36,537 --> 03:23:36,904
PATHOPHENOTYPE.

5194
03:23:36,904 --> 03:23:38,739
BUT THERE'S A LOT OF

5195
03:23:38,739 --> 03:23:39,740
HETEROGENEITY IN DISEASE.

5196
03:23:39,740 --> 03:23:42,910
IF YOU LOOK AT THESE

5197
03:23:42,910 --> 03:23:46,180
CARDIOVASCULAR PHENOTYPES, HERE

5198
03:23:46,180 --> 03:23:50,417
I HIGHLIGHTED ACUTE MYOCARDIAL

5199
03:23:50,417 --> 03:23:51,151
INFARCTION, CARDIOMYOPATHIES,

5200
03:23:51,151 --> 03:23:53,754
ALL OF THESE HAVE GENE VARIANTS

5201
03:23:53,754 --> 03:23:54,521
ASSOCIATED WITH THEM.

5202
03:23:54,521 --> 03:23:56,590
WE KNOW WHAT THE GENE VARIANTS

5203
03:23:56,590 --> 03:23:57,024
DO.

5204
03:23:57,024 --> 03:23:59,994
BUT IF YOU LOOK AT REALLY HOW

5205
03:23:59,994 --> 03:24:09,737
THEY EXPRESS THEMSELVES THEY CAN

5206
03:24:09,737 --> 03:24:11,038
HAVE DIFFERENT OUTWARD

5207
03:24:11,038 --> 03:24:13,674
PHENOTYPES, MORE COMPLICATED

5208
03:24:13,674 --> 03:24:16,010
THAN FOCUSING ON GENETICS ALONE.

5209
03:24:16,010 --> 03:24:17,845
WE TEND TO THINK OF THIS,

5210
03:24:17,845 --> 03:24:19,913
INCORPORATING THINGS THAT WE'VE

5211
03:24:19,913 --> 03:24:23,650
HEARD SEVERAL TIMES BEFORE

5212
03:24:23,650 --> 03:24:27,554
TODAY, THAT THERE'S BIOLOGICAL

5213
03:24:27,554 --> 03:24:30,090
RISK, THERE ARE POSSIBLE

5214
03:24:30,090 --> 03:24:33,494
ACQUIRED RISK FACTORS RELATED TO

5215
03:24:33,494 --> 03:24:35,262
OUR EXPOSURES, AND THERE'S

5216
03:24:35,262 --> 03:24:38,632
GENETIC VARIANTS THAT REALLY

5217
03:24:38,632 --> 03:24:45,806
COME TOGETHER TO CREATE

5218
03:24:45,806 --> 03:24:47,107
DIFFERENT ENDOPHENOTYPES,

5219
03:24:47,107 --> 03:24:49,410
INFORMING CARDIOVASCULAR

5220
03:24:49,410 --> 03:24:49,777
PATHOPHENOTYPE.

5221
03:24:49,777 --> 03:24:51,478
FOR ANYONE THAT DOESN'T BELIEVE

5222
03:24:51,478 --> 03:24:54,681
IN THE INTERACTION BETWEEN, SAY,

5223
03:24:54,681 --> 03:24:55,549
LIFESTYLE, EXPOSURES, GENETICS

5224
03:24:55,549 --> 03:24:57,651
AND HOW THEY MODIFY EACH OTHER,

5225
03:24:57,651 --> 03:25:02,122
THERE WAS A REALLY NICE ANALYSIS

5226
03:25:02,122 --> 03:25:04,358
DONE WHERE THEY POOLED TOGETHER

5227
03:25:04,358 --> 03:25:06,193
RESULTS FROM 50,000 PARTICIPANTS

5228
03:25:06,193 --> 03:25:09,997
FROM THREE STUDIES AND DEVELOPED

5229
03:25:09,997 --> 03:25:13,600
A POLYGENIC RISK SCORE FROM 50

5230
03:25:13,600 --> 03:25:15,302
SNPs ASSOCIATED WITH CORONARY

5231
03:25:15,302 --> 03:25:20,507
ARTERY DISEASE AND HAD DATA ON

5232
03:25:20,507 --> 03:25:24,978
LIFESTYLES, SO LOOKED AT TOBACCO

5233
03:25:24,978 --> 03:25:26,747
USE, WEIGHT, BMI, PATIENT DIET

5234
03:25:26,747 --> 03:25:28,282
AND PHYSICAL ACTIVITY, AND

5235
03:25:28,282 --> 03:25:30,350
CONSTRUCTED WHAT THEY CALLED A

5236
03:25:30,350 --> 03:25:34,088
LIFESTYLE SCORE.

5237
03:25:34,088 --> 03:25:35,189
EITHER FAVORABLE, INTERMEDIATE

5238
03:25:35,189 --> 03:25:35,656
OR UNFAVORABLE.

5239
03:25:35,656 --> 03:25:40,260
IN EACH OF THE WELL KNOWN

5240
03:25:40,260 --> 03:25:42,563
STUDIES, INDIVIDUALS WHO HAD

5241
03:25:42,563 --> 03:25:43,964
KNOWN GENETIC RISK ACTUALLY

5242
03:25:43,964 --> 03:25:47,401
COULD HAVE THAT GENETIC RISK

5243
03:25:47,401 --> 03:25:49,136
MODIFIED BY LIFESTYLE FACTORS.

5244
03:25:49,136 --> 03:25:50,871
SO, ALL OF THESE THINGS ARE

5245
03:25:50,871 --> 03:25:59,847
IMPORTANT AND THEY ALL COME INTO

5246
03:25:59,847 --> 03:26:00,147
PLAY.

5247
03:26:00,147 --> 03:26:02,483
IF YOU LOOK AT PRECISION

5248
03:26:02,483 --> 03:26:05,752
MEDICINE WE RECOGNIZE THAT AGAIN

5249
03:26:05,752 --> 03:26:07,287
PATIENTS WITH OUTWARD PHENOTYPES

5250
03:26:07,287 --> 03:26:08,689
SUCH AS HYPERTENSION WHO

5251
03:26:08,689 --> 03:26:11,358
APPEARED THE SAME ARE ACTUALLY A

5252
03:26:11,358 --> 03:26:13,327
MIXED GROUP OF INDIVIDUALS.

5253
03:26:13,327 --> 03:26:17,931
AND IF WE GO FORWARD AND WE DO

5254
03:26:17,931 --> 03:26:19,466
DEEP PHENOTYPING AND COLLECT A

5255
03:26:19,466 --> 03:26:23,303
LOT OF DATA, WE CAN THEN ANALYZE

5256
03:26:23,303 --> 03:26:25,472
IN MANY WAYS AND, AGAIN, THIS IS

5257
03:26:25,472 --> 03:26:27,241
JUST SHOWING A NETWORK ANALYSIS

5258
03:26:27,241 --> 03:26:30,644
BUT WE CAN USE THIS TO

5259
03:26:30,644 --> 03:26:33,814
SUBCATEGORIZE THE PATIENTS INTO

5260
03:26:33,814 --> 03:26:35,115
DIFFERENT CLUSTERS MORE ALIKE,

5261
03:26:35,115 --> 03:26:43,223
THIS MAY BE HELPFUL IN TERMS OF

5262
03:26:43,223 --> 03:26:45,425
IDENTIFYING BIOMARKERS FOR

5263
03:26:45,425 --> 03:26:47,494
MEDICATION DISTRIBUTION OR FOR

5264
03:26:47,494 --> 03:26:48,795
TAILORING DIFFERENT EXPOSURES

5265
03:26:48,795 --> 03:26:54,368
FOR THE PATIENTS. 

5266
03:26:54,368 --> 03:26:56,470
THEY ALSO WILL HELP INFORM

5267
03:26:56,470 --> 03:26:57,471
ENROLLMENT IN CLINICAL STUDIES.

5268
03:26:57,471 --> 03:27:01,275
THE ISSUE  THAT COMES UP WHEN YU

5269
03:27:01,275 --> 03:27:03,043
TALK ABOUT PRECISION PUBLIC

5270
03:27:03,043 --> 03:27:05,445
HEALTH DESPITE HAVING CLUSTERED

5271
03:27:05,445 --> 03:27:07,080
PHENOTYPES, WE REALLY WANT TO

5272
03:27:07,080 --> 03:27:10,184
KNOW WHAT CAN WE FIND OUT ABOUT

5273
03:27:10,184 --> 03:27:11,485
AN INDIVIDUAL PATIENT OR PERSON,

5274
03:27:11,485 --> 03:27:15,322
SO WHAT CAN WE FIND OUT ABOUT

5275
03:27:15,322 --> 03:27:16,456
THEIR INDIVIDUAL PHENOTYPE FROM

5276
03:27:16,456 --> 03:27:19,927
ALL OF THIS DATA TO HELP US DO

5277
03:27:19,927 --> 03:27:21,795
SOMETHING FOR THEM THAT WILL

5278
03:27:21,795 --> 03:27:25,199
PREVENT THEM FROM DEVELOPING

5279
03:27:25,199 --> 03:27:25,532
HYPERTENSION.

5280
03:27:25,532 --> 03:27:27,367
AND SO, YOU KNOW, ALONG WITH

5281
03:27:27,367 --> 03:27:28,468
DATA COLLECTION, AND ALL OF THE

5282
03:27:28,468 --> 03:27:32,272
WAYS THAT WE CAN GO FORWARD, AND

5283
03:27:32,272 --> 03:27:34,374
ANALYZE ALL THESE DATA, THERE'S

5284
03:27:34,374 --> 03:27:35,576
REALLY INTERESTING AND NEAT WAYS

5285
03:27:35,576 --> 03:27:36,877
TO PUT IT TOGETHER.

5286
03:27:36,877 --> 03:27:39,646
I KNOW THAT EARLIER WE TALKED A

5287
03:27:39,646 --> 03:27:41,715
LOT ABOUT DIFFERENT A.I. MODELS.

5288
03:27:41,715 --> 03:27:45,319
I ALSO PUT A PLUG IN HERE FOR

5289
03:27:45,319 --> 03:27:47,387
NETWORK MEDICINE WHICH USES SOME

5290
03:27:47,387 --> 03:27:54,194
SAME METHODOLOGY BUT LINKS

5291
03:27:54,194 --> 03:27:56,363
TOGETHER ALL OF THESE FACTORS.

5292
03:27:56,363 --> 03:28:01,969
THIS LOOKS LIKE REALLY AN IMAGE

5293
03:28:01,969 --> 03:28:03,370
OF HAIRBALLS THESE ARE

5294
03:28:03,370 --> 03:28:04,271
INDIVIDUAL PERSON-SPECIFIC

5295
03:28:04,271 --> 03:28:04,738
NETWORKS.

5296
03:28:04,738 --> 03:28:07,541
YOU CAN SEE HOW THEY LOOK

5297
03:28:07,541 --> 03:28:07,808
DIFFERENT.

5298
03:28:07,808 --> 03:28:10,944
THIS IS FROM 18 PATIENTS WHO ALL

5299
03:28:10,944 --> 03:28:14,214
HAVE THE SAME OUTWARD PHENOTYPE,

5300
03:28:14,214 --> 03:28:16,183
IN THIS CASE HYPERTROPHIC

5301
03:28:16,183 --> 03:28:16,550
CARDIOMYOPATHY.

5302
03:28:16,550 --> 03:28:18,051
NONE OF THEM HAD ANY OF THE

5303
03:28:18,051 --> 03:28:19,486
KNOWN MUTATIONS THAT WERE

5304
03:28:19,486 --> 03:28:20,354
ASSOCIATED WITH THE DISEASE.

5305
03:28:20,354 --> 03:28:23,290
AND IF YOU LOOK AT THE NETWORKS,

5306
03:28:23,290 --> 03:28:26,460
THEY ALL LOOK QUITE DIFFERENT.

5307
03:28:26,460 --> 03:28:27,661
SO, THERE'S VERY INTERESTING

5308
03:28:27,661 --> 03:28:32,165
WAYS TO FIND OUT THINGS ABOUT

5309
03:28:32,165 --> 03:28:32,599
INDIVIDUALS.

5310
03:28:32,599 --> 03:28:35,769
NOW, WE TALKED EARLIER ALSO

5311
03:28:35,769 --> 03:28:37,204
ABOUT DATA COLLECTION.

5312
03:28:37,204 --> 03:28:39,940
WHEN WE SEE OUR PATIENTS, WE

5313
03:28:39,940 --> 03:28:42,009
COLLECT A CERTAIN AMOUNT OF

5314
03:28:42,009 --> 03:28:44,745
DATA, AND THIS MAY BE COLLECTED

5315
03:28:44,745 --> 03:28:47,914
EITHER AT THE INITIAL

5316
03:28:47,914 --> 03:28:49,116
PRESENTATION OR OVER TIME, BUT

5317
03:28:49,116 --> 03:28:54,821
YOU CAN EITHER LOOK AT THIS

5318
03:28:54,821 --> 03:28:57,991
SAYING WE DO SEVEN OR EIGHT

5319
03:28:57,991 --> 03:28:59,660
TESTS, HISTORY AND PHYSICAL,

5320
03:28:59,660 --> 03:29:03,630
BLOOD WORKS, OR HAVE SEVEN OR

5321
03:29:03,630 --> 03:29:06,099
EIGHT TESTS, APPROXIMATELY 2,000

5322
03:29:06,099 --> 03:29:07,067
VARIABLES TO TRY TO UNDERSTAND

5323
03:29:07,067 --> 03:29:15,042
WHO IS AT RISK FOR DEVELOP

5324
03:29:15,042 --> 03:29:15,642
HYPERTENSION.

5325
03:29:15,642 --> 03:29:17,544
WE SEND ROUTINE LAB WORK, BUT

5326
03:29:17,544 --> 03:29:20,314
THE ROUTINE LAB WORK CAN

5327
03:29:20,314 --> 03:29:22,049
ACTUALLY, YOU KNOW, ALSO BE

5328
03:29:22,049 --> 03:29:23,817
INFORMATIVE, AND THIS CAN

5329
03:29:23,817 --> 03:29:26,553
ACTUALLY SERVE AS A LIQUID

5330
03:29:26,553 --> 03:29:27,020
BIOPSY.

5331
03:29:27,020 --> 03:29:28,622
SO, WHEN YOU CAN'T GET TISSUE,

5332
03:29:28,622 --> 03:29:29,856
WHEN YOU NEED TO PREDICT

5333
03:29:29,856 --> 03:29:31,925
SOMETHING THAT WILL HAPPEN IN

5334
03:29:31,925 --> 03:29:35,562
THE FUTURE, YOU CAN ACTUALLY USE

5335
03:29:35,562 --> 03:29:38,598
THESE SAMPLES FOR OMICS, WHICH

5336
03:29:38,598 --> 03:29:40,901
WAS AGAIN DISCUSSED EARLIER, AND

5337
03:29:40,901 --> 03:29:44,738
THESE TYPES OF STUDIES ARE

5338
03:29:44,738 --> 03:29:45,806
BECOMING MORE PREVALENT OWING TO

5339
03:29:45,806 --> 03:29:49,443
THE EASE AND ACCESSIBILITY OF

5340
03:29:49,443 --> 03:29:51,611
THE PLATFORMS, THE DECREASE IN

5341
03:29:51,611 --> 03:29:54,247
COST OVER TIME, INCREASE IN

5342
03:29:54,247 --> 03:29:55,982
SENSITIVITY, AND THE FACT THAT

5343
03:29:55,982 --> 03:30:00,487
THEY ARE BECOMING MORE

5344
03:30:00,487 --> 03:30:06,493
REPRODUCIBLE. 

5345
03:30:06,493 --> 03:30:09,996
THERE'S AN IDEA HERE THAT

5346
03:30:09,996 --> 03:30:11,331
THERE'S A LOT OF DATA BUT WE

5347
03:30:11,331 --> 03:30:13,467
DON'T KNOW THE MINIMUM AMOUNT OF

5348
03:30:13,467 --> 03:30:16,370
DATA THAT WE NEED TO ACTUALLY

5349
03:30:16,370 --> 03:30:19,172
GET THE INFORMATION WE WANT.

5350
03:30:19,172 --> 03:30:21,842
AND THAT IS TO BE ABLE TO

5351
03:30:21,842 --> 03:30:25,746
PREDICT WHO WILL DEVELOP

5352
03:30:25,746 --> 03:30:26,847
INCIDENT HYPERTENSION, AND

5353
03:30:26,847 --> 03:30:27,447
SPECIFICALLY WHICH INDIVIDUALS

5354
03:30:27,447 --> 03:30:33,220
ARE AT RISK FOR IT. 

5355
03:30:33,220 --> 03:30:34,855
SO WHILE WE'RE TALKING ABOUT

5356
03:30:34,855 --> 03:30:38,258
USING A.I. TO, YOU KNOW, EITHER

5357
03:30:38,258 --> 03:30:39,593
PREDICT WHO WILL DEVELOP

5358
03:30:39,593 --> 03:30:41,361
DISEASE, WHO HAS DISEASE, ET

5359
03:30:41,361 --> 03:30:43,296
CETERA, WE ALSO NEED TO

5360
03:30:43,296 --> 03:30:44,931
RECOGNIZE THAT OUR PATIENTS ARE

5361
03:30:44,931 --> 03:30:46,566
ACTUALLY AT HOME DOING EXACTLY

5362
03:30:46,566 --> 03:30:48,769
THE SAME THING, BUT IN A

5363
03:30:48,769 --> 03:30:49,736
DIFFERENT WAY.

5364
03:30:49,736 --> 03:30:51,805
AND THIS WAS AN INTERESTING

5365
03:30:51,805 --> 03:30:55,976
STUDY THAT WAS DONE IN DECEMBER

5366
03:30:55,976 --> 03:30:59,713
OF LAST YEAR, WHERE A NUMBER OF

5367
03:30:59,713 --> 03:31:05,051
INVESTIGATORS PUT TOGETHER A

5368
03:31:05,051 --> 03:31:07,354
25-QUESTION ASSESSMENT, LOOKING

5369
03:31:07,354 --> 03:31:08,255
AT TYPICAL QUESTIONS PATIENTS

5370
03:31:08,255 --> 03:31:13,727
COULD ENTER AT  -- ONLINE TO GET

5371
03:31:13,727 --> 03:31:14,327
INFORMATION ABOUT PREVENTING

5372
03:31:14,327 --> 03:31:15,796
CARDIOVASCULAR DISEASE.

5373
03:31:15,796 --> 03:31:19,733
THEY ASKED THESE QUESTIONS OF A

5374
03:31:19,733 --> 03:31:22,369
CHATBOT, THREE DIFFERENT TIMES,

5375
03:31:22,369 --> 03:31:24,371
AND HAD CARDIOLOGISTS SCORE THE

5376
03:31:24,371 --> 03:31:24,671
ANSWERS.

5377
03:31:24,671 --> 03:31:27,741
AND SO WHAT THEY FOUND WHEN THEY

5378
03:31:27,741 --> 03:31:31,812
DID THIS IS 85% OF THE TIME THE

5379
03:31:31,812 --> 03:31:32,779
RESPONSES WERE APPROPRIATE, BUT

5380
03:31:32,779 --> 03:31:34,481
THAT MEANS 15% OF TIME OUR

5381
03:31:34,481 --> 03:31:35,649
PATIENTS WEREN'T GETTING THE

5382
03:31:35,649 --> 03:31:36,383
RIGHT INFORMATION.

5383
03:31:36,383 --> 03:31:42,856
OR AT LEAST WHAT WE THOUGHT WAS

5384
03:31:42,856 --> 03:31:43,824
NOT THE RIGHT INFORMATION.

5385
03:31:43,824 --> 03:31:45,592
WE NEED TO REMEMBER THAT WE'RE

5386
03:31:45,592 --> 03:31:51,064
NOT THE ONLY ONES USING THESE

5387
03:31:51,064 --> 03:31:54,000
TOOLS TO UNDERSTAND HOW TO

5388
03:31:54,000 --> 03:31:58,939
PREVENT DISEASE OR GET

5389
03:31:58,939 --> 03:31:59,606
INFORMATION ABOUT IT.

5390
03:31:59,606 --> 03:32:03,109
NOW, WHEN TALKING ABOUT USING

5391
03:32:03,109 --> 03:32:05,278
A.I. TO PREDICT INCIDENT

5392
03:32:05,278 --> 03:32:07,914
HYPERTENSION, PRECISION PUBLIC

5393
03:32:07,914 --> 03:32:09,015
HEALTH APPROACH TO HYPERTENSION,

5394
03:32:09,015 --> 03:32:11,351
THIS IS A VERY INTERESTING AREA

5395
03:32:11,351 --> 03:32:13,487
BECAUSE THERE HASN'T BEEN A LOT

5396
03:32:13,487 --> 03:32:15,722
OF WORK DONE HERE.

5397
03:32:15,722 --> 03:32:19,125
AND THIS IS A TERRITORY WIDE

5398
03:32:19,125 --> 03:32:21,761
OPEN FOR FURTHER INVESTIGATION.

5399
03:32:21,761 --> 03:32:25,866
SO AMONG, YOU KNOW, ONE OF THE

5400
03:32:25,866 --> 03:32:28,802
FEW STUDIES RELATED TO THIS AREA

5401
03:32:28,802 --> 03:32:32,005
WAS A STUDY THAT WAS DONE IN

5402
03:32:32,005 --> 03:32:35,075
JAPAN, WHERE ALL EMPLOYERS

5403
03:32:35,075 --> 03:32:36,943
ACTUALLY HAVE TO GIVE FREE

5404
03:32:36,943 --> 03:32:42,182
ANNUAL PHYSICALS TO ALL OF THE

5405
03:32:42,182 --> 03:32:42,449
EMPLOYEES.

5406
03:32:42,449 --> 03:32:44,484
THESE INVESTIGATORS TOOK 20,000

5407
03:32:44,484 --> 03:32:47,521
PATIENTS, AND THEY LOOKED AT

5408
03:32:47,521 --> 03:32:53,093
BLOOD PRESSURE LEVELS AT THE

5409
03:32:53,093 --> 03:32:55,328
INITIAL EXAM, AND THEN THEY

5410
03:32:55,328 --> 03:32:57,831
LOOKED TWO YEARS OUT.

5411
03:32:57,831 --> 03:32:59,699
AND SO THEY CREATED A MODEL TO

5412
03:32:59,699 --> 03:33:03,270
FIGURE OUT WHO WAS GOING TO

5413
03:33:03,270 --> 03:33:05,705
DEVELOP INCIDENT HYPERTENSION.

5414
03:33:05,705 --> 03:33:07,040
SO, IN THEIR DERIVATION COHORT

5415
03:33:07,040 --> 03:33:09,743
THEY HAD A VERY NICE AREA UNDER

5416
03:33:09,743 --> 03:33:11,611
THE CURVE.

5417
03:33:11,611 --> 03:33:13,480
IN THE VALIDATION COHORT, NOT

5418
03:33:13,480 --> 03:33:14,681
QUITE AS HIGH.

5419
03:33:14,681 --> 03:33:18,385
BUT WHEN THEY WENT TO LOOK AT

5420
03:33:18,385 --> 03:33:19,920
PREDICTORS OF WHAT -- FROM ALL

5421
03:33:19,920 --> 03:33:21,888
THE DATA THEY ENTERED, WHAT WERE

5422
03:33:21,888 --> 03:33:24,424
THEIR TOP PREDICTORS OF BLOOD

5423
03:33:24,424 --> 03:33:26,326
PRESSURE, IT TURNED OUT THAT

5424
03:33:26,326 --> 03:33:30,230
SYSTOLIC BLOOD PRESSURE WHEN

5425
03:33:30,230 --> 03:33:32,866
THEY WERE MAKING MEASUREMENTS

5426
03:33:32,866 --> 03:33:34,167
FOR AORTIC STIFFNESS, A YEAR

5427
03:33:34,167 --> 03:33:40,774
BEFORE, WAS REALLY THE BEST

5428
03:33:40,774 --> 03:33:41,174
PREDICTOR.

5429
03:33:41,174 --> 03:33:42,509
KEEP THAT IN MIND AS WE TALK

5430
03:33:42,509 --> 03:33:45,011
ABOUT OTHER STUDIES.

5431
03:33:45,011 --> 03:33:46,780
ANOTHER ONE LOOKED AT ELECTRONIC

5432
03:33:46,780 --> 03:33:48,081
HEALTH REPORT DATABASE FROM THE

5433
03:33:48,081 --> 03:33:49,416
STATE OF MAINE.

5434
03:33:49,416 --> 03:33:50,951
AND THIS WAS INTERESTING BECAUSE

5435
03:33:50,951 --> 03:33:55,989
THEY HAD ACCESS TO ABOUT 900,000

5436
03:33:55,989 --> 03:33:58,058
CASES WITH DATA.

5437
03:33:58,058 --> 03:34:02,228
THEY USED THIS TO DEVELOP A

5438
03:34:02,228 --> 03:34:04,297
MODEL THAT INCLUDED OVER 1500

5439
03:34:04,297 --> 03:34:06,933
VARIABLES, AND AMONG THESE

5440
03:34:06,933 --> 03:34:07,801
VARIABLES HAD SOCIOECONOMIC

5441
03:34:07,801 --> 03:34:09,769
INDICATORS, WHICH I THOUGHT WAS

5442
03:34:09,769 --> 03:34:10,804
INTERESTING.

5443
03:34:10,804 --> 03:34:14,007
AND THEN THEY CREATED A

5444
03:34:14,007 --> 03:34:14,774
PROSPECTIVE COHORT OF

5445
03:34:14,774 --> 03:34:16,209
INDIVIDUALS AND THEY FOLLOWED

5446
03:34:16,209 --> 03:34:18,078
THEM TO CLASSIFY THEM AS BEING

5447
03:34:18,078 --> 03:34:22,248
AT VERY LOW RISK FOR DEVELOPING

5448
03:34:22,248 --> 03:34:24,284
HYPERTENSION WITHIN A YEAR UP TO

5449
03:34:24,284 --> 03:34:26,753
BEING VERY HIGH RISK FOR

5450
03:34:26,753 --> 03:34:27,721
DEVELOPING HYPERTENSION.

5451
03:34:27,721 --> 03:34:29,589
SO WHEN THEY TESTED THEIR MODEL

5452
03:34:29,589 --> 03:34:32,759
THEY FOUND OUT FOR THE VERY LOW

5453
03:34:32,759 --> 03:34:34,928
RISK PATIENTS, ONLY ABOUT 1

5454
03:34:34,928 --> 03:34:36,696
PERCENT OF THOSE INDIVIDUALS

5455
03:34:36,696 --> 03:34:40,433
WERE MISCLASSIFIED AND DID GO ON

5456
03:34:40,433 --> 03:34:41,601
TO DEVELOP HYPERTENSION, AND

5457
03:34:41,601 --> 03:34:43,737
AMONG INDIVIDUALS IN THE VERY

5458
03:34:43,737 --> 03:34:46,673
HIGH RISK GROUP ABOUT 50% OF

5459
03:34:46,673 --> 03:34:47,574
THOSE INDIVIDUALS DID DEVELOP

5460
03:34:47,574 --> 03:34:52,078
HYPERTENSION WITHIN A YEAR. 

5461
03:34:52,078 --> 03:34:56,282
SO THE MODEL TO --

5462
03:34:56,282 --> 03:35:05,392
[ NO AUDIO ] 

5463
03:35:05,392 --> 03:35:06,059
TO PREDICT INCIDENT HYPERTENSION

5464
03:35:06,059 --> 03:35:07,927
IN THE LOW RISK GROUP AND HIGH

5465
03:35:07,927 --> 03:35:10,764
RISK GROUP, IF YOU LOOK AT THE

5466
03:35:10,764 --> 03:35:12,999
VERY LOW RISK GROUP, WHEN THEY

5467
03:35:12,999 --> 03:35:16,269
LOOKED AT INDIVIDUALS AND

5468
03:35:16,269 --> 03:35:18,104
STRATIFIED THEM BY PREEXISTING

5469
03:35:18,104 --> 03:35:21,941
CONDITIONS, SO WHAT THEY CALL

5470
03:35:21,941 --> 03:35:23,576
PRE-HYPERTENSION, DIABETES, EVEN

5471
03:35:23,576 --> 03:35:26,880
MENTAL ILLNESS, ABOUT 85% OF

5472
03:35:26,880 --> 03:35:29,049
INDIVIDUALS DID NOT DEVELOP

5473
03:35:29,049 --> 03:35:30,483
HYPERTENSION WITHIN THE COURSE

5474
03:35:30,483 --> 03:35:31,618
OF THE NEXT YEAR.

5475
03:35:31,618 --> 03:35:34,621
WHEN YOU LOOK AT THOSE IN THE

5476
03:35:34,621 --> 03:35:38,124
VERY HIGH RISK CATEGORY, WITH

5477
03:35:38,124 --> 03:35:43,063
ALL OF THESE OTHER CONDITIONS,

5478
03:35:43,063 --> 03:35:44,397
ABOUT 55% OF THEM DEVELOPED

5479
03:35:44,397 --> 03:35:48,535
HYPERTENSION WITHIN A YEAR.

5480
03:35:48,535 --> 03:35:50,537
SO REALLY HAVING ONE COMORBID

5481
03:35:50,537 --> 03:35:52,672
CONDITION IN THE HIGH RISK

5482
03:35:52,672 --> 03:35:54,140
CATEGORY WAS IMPORTANT.

5483
03:35:54,140 --> 03:35:55,975
WHEN THEY ACTUALLY DIVIDED THIS

5484
03:35:55,975 --> 03:35:58,278
UP INTO INDIVIDUALS WHO HAD AT

5485
03:35:58,278 --> 03:36:00,146
LEAST ONE CHRONIC DISEASE SHOWN

5486
03:36:00,146 --> 03:36:02,415
ON THE RIGHT VERSUS NONE AND

5487
03:36:02,415 --> 03:36:04,284
STRATIFIED BY MALE VERSUS

5488
03:36:04,284 --> 03:36:07,353
FEMALE, AGE, ET CETERA, YOU CAN

5489
03:36:07,353 --> 03:36:11,658
SEE THAT AMONG PATIENTS WHO HAD

5490
03:36:11,658 --> 03:36:12,726
NO CHRONIC DISEASES, YOU KNOW,

5491
03:36:12,726 --> 03:36:14,394
THEY TENDED TO DO FAIRLY WELL

5492
03:36:14,394 --> 03:36:16,229
OVER THE COURSE OF THE YEAR.

5493
03:36:16,229 --> 03:36:20,300
REALLY WITH THE EXCEPTION OF

5494
03:36:20,300 --> 03:36:21,601
INDIVIDUALS WHO HAD DEPRESSION,

5495
03:36:21,601 --> 03:36:23,169
OR ADVANCING AGE.

5496
03:36:23,169 --> 03:36:26,239
SO, WE ALREADY KNOW AGE FACTORS

5497
03:36:26,239 --> 03:36:26,539
IN.

5498
03:36:26,539 --> 03:36:28,541
BUT THE FACT THE DEPRESSION

5499
03:36:28,541 --> 03:36:30,810
DOUBLES YOUR RISK OF DEVELOPING

5500
03:36:30,810 --> 03:36:32,779
HYPERTENSION WAS INTERESTING.

5501
03:36:32,779 --> 03:36:37,584
AMONG PATIENTS WHO HAD AT LEAST

5502
03:36:37,584 --> 03:36:39,586
ONE CHRONIC -- ONE DIAGNOSIS OF

5503
03:36:39,586 --> 03:36:41,254
CHRONIC DISEASE THEIR RISK OF

5504
03:36:41,254 --> 03:36:42,756
DEVELOPING HYPERTENSION OVER THE

5505
03:36:42,756 --> 03:36:46,159
COURSE OF THE YEAR REGARDLESS OF

5506
03:36:46,159 --> 03:36:54,267
THE MALE/FEMALE AND AGE LEVEL

5507
03:36:54,267 --> 03:36:57,303
WAS STILL PRETTY HIGH.

5508
03:36:57,303 --> 03:36:58,938
WE CANNOT FORGET ABOUT THE

5509
03:36:58,938 --> 03:37:00,907
SOCIAL DETERMINANTS OF HEALTH

5510
03:37:00,907 --> 03:37:03,109
BECAUSE USING THE SPEARMAN RANK

5511
03:37:03,109 --> 03:37:06,746
CORRELATION, THEY WERE ALSO ABLE

5512
03:37:06,746 --> 03:37:11,851
TO SHOW EDUCATION, INSURANCE

5513
03:37:11,851 --> 03:37:14,287
COVERAGE, SALARY, AND

5514
03:37:14,287 --> 03:37:15,488
AVAILABILITY OF LOCAL MARKETS

5515
03:37:15,488 --> 03:37:19,859
AND STORES AND GREEN SPACES FOR

5516
03:37:19,859 --> 03:37:23,129
EXERCISE ALL WERE IMPORTANT FOR

5517
03:37:23,129 --> 03:37:27,500
DETERMINING THE RISK TO INCIDENT

5518
03:37:27,500 --> 03:37:27,834
HYPERTENSION.

5519
03:37:27,834 --> 03:37:29,269
AND FINALLY, ANOTHER GROUP

5520
03:37:29,269 --> 03:37:31,905
ACTUALLY ASKED THE QUESTION THAT

5521
03:37:31,905 --> 03:37:33,239
I POSED EARLIER, WHICH IS WHAT

5522
03:37:33,239 --> 03:37:35,642
CAN YOU FIND OUT WHEN YOU HAVE

5523
03:37:35,642 --> 03:37:38,278
JUST A MINIMAL AMOUNT OF

5524
03:37:38,278 --> 03:37:39,679
INFORMATION THAT YOU'RE PUTTING

5525
03:37:39,679 --> 03:37:40,980
INTO YOUR MODEL?

5526
03:37:40,980 --> 03:37:43,850
AND SO IN THIS STUDY THEY TOOK A

5527
03:37:43,850 --> 03:37:47,120
NUMBER OF INDIVIDUALS, THIS WAS

5528
03:37:47,120 --> 03:37:49,522
DONE IN BEIJING, AND, YOU KNOW,

5529
03:37:49,522 --> 03:37:51,291
ASKED JUST QUESTIONS ABOUT THE

5530
03:37:51,291 --> 03:37:55,862
CLINICAL VARIABLES ON THE LEFT.

5531
03:37:55,862 --> 03:38:05,738
SO TYPICAL AGE, BMI, WAIST

5532
03:38:05,738 --> 03:38:06,840
CIRCUMFERENCE, FAMILY HISTORY,

5533
03:38:06,840 --> 03:38:08,041
HOW MUCH STRESS YOU'RE UNDER.

5534
03:38:08,041 --> 03:38:12,078
WHEN YOU LOOK AT THE PREDICTION

5535
03:38:12,078 --> 03:38:15,915
OF INCIDENT HYPERTENSION THEY

5536
03:38:15,915 --> 03:38:19,018
RAN THIS THROUGH FOUR MODELS AND

5537
03:38:19,018 --> 03:38:20,119
GOT DIFFERENT PERFORMANCE

5538
03:38:20,119 --> 03:38:21,754
RESULTS FOR EACH ONE WHICH I

5539
03:38:21,754 --> 03:38:22,622
THOUGHT WAS, AGAIN, ALSO

5540
03:38:22,622 --> 03:38:25,091
INTERESTING AND SPEAKS TO THE

5541
03:38:25,091 --> 03:38:29,295
FACT THAT WE NEED TO REALLY PAY

5542
03:38:29,295 --> 03:38:30,063
ATTENTION TO METHODOLOGY.

5543
03:38:30,063 --> 03:38:32,498
BUT THEY ALSO WERE ABLE TO SHOW

5544
03:38:32,498 --> 03:38:35,869
IN THIS STUDY THAT WHEN YOU

5545
03:38:35,869 --> 03:38:38,071
LOOKED AT THE FEATURE IMPORTANCE

5546
03:38:38,071 --> 03:38:41,040
FOR RANKING VARIABLES BMI CAME

5547
03:38:41,040 --> 03:38:43,543
OUT HIGHER THAN AGE, YOU KNOW,

5548
03:38:43,543 --> 03:38:44,544
FAMILY HISTORY, WAIST

5549
03:38:44,544 --> 03:38:47,614
CIRCUMFERENCE AND OTHER THINGS

5550
03:38:47,614 --> 03:38:50,350
WE KNOW ARE RELATED TO RISK FOR

5551
03:38:50,350 --> 03:38:53,419
INCIDENT HYPERTENSION.

5552
03:38:53,419 --> 03:38:56,356
SO NOW WE'VE GOT, YOU KNOW,

5553
03:38:56,356 --> 03:38:57,657
SEVERAL STUDIES THAT TELL US

5554
03:38:57,657 --> 03:38:59,425
SOMETHING A LITTLE BIT DIFFERENT

5555
03:38:59,425 --> 03:39:01,160
WITH EACH STUDY.

5556
03:39:01,160 --> 03:39:04,230
SO, THIS ALSO SPEAKS TO THE IDEA

5557
03:39:04,230 --> 03:39:05,865
OF REPRODUCIBILITY, WHAT WENT

5558
03:39:05,865 --> 03:39:08,301
INTO THE MODEL, HOW GOOD WERE

5559
03:39:08,301 --> 03:39:15,408
THE MODELS, AND WHAT CAN WE

5560
03:39:15,408 --> 03:39:17,810
LEARN FROM THEM.

5561
03:39:17,810 --> 03:39:21,748
WE HAVE REALLY PROMISING SCIENCE

5562
03:39:21,748 --> 03:39:24,284
IN THIS AREA, AND THIS CONCEPT

5563
03:39:24,284 --> 03:39:26,586
OF MAKING PROGRESS IN DEEP

5564
03:39:26,586 --> 03:39:28,021
PHENOTYPING AND FINDING WAYS TO

5565
03:39:28,021 --> 03:39:31,291
INCLUDES ALL OF THESE DATA,

5566
03:39:31,291 --> 03:39:34,594
INCLUDING NETWORK MEDICINE FOR

5567
03:39:34,594 --> 03:39:35,695
ANALYSIS, IS REALLY PROGRESSING.

5568
03:39:35,695 --> 03:39:38,331
THE FACT THAT PEOPLE ARE

5569
03:39:38,331 --> 03:39:39,966
FOCUSING ON INCIDENT DISEASE AND

5570
03:39:39,966 --> 03:39:42,168
DISEASE INCEPTION AS OPPOSED TO

5571
03:39:42,168 --> 03:39:44,137
JUST TREATING ESTABLISHED

5572
03:39:44,137 --> 03:39:48,174
DISEASE IS ALSO INCREDIBLY

5573
03:39:48,174 --> 03:39:48,441
IMPORTANT.

5574
03:39:48,441 --> 03:39:50,143
THEN MANY OF MY OTHER COMMENTS

5575
03:39:50,143 --> 03:39:52,545
HERE, WHAT DO WE NEED TO MOVE

5576
03:39:52,545 --> 03:39:54,881
THE FIELD FORWARD AND WHAT'S

5577
03:39:54,881 --> 03:39:57,684
HINDERING US ARE COMMON THEMES

5578
03:39:57,684 --> 03:39:59,652
THAT PEOPLE HAVE SPOKEN ABOUT

5579
03:39:59,652 --> 03:40:00,553
BEFORE.

5580
03:40:00,553 --> 03:40:02,722
I WOULD JUST ADD HERE THAT ONE

5581
03:40:02,722 --> 03:40:06,492
OF THE THINGS WE NEED TO FIGURE

5582
03:40:06,492 --> 03:40:11,397
OUT IS WHEN -- WHAT IS REALLY

5583
03:40:11,397 --> 03:40:12,932
THE SO-CALLED GO/NO-GO TIME

5584
03:40:12,932 --> 03:40:19,172
POINT FOR DISEASE  INCEPTION

5585
03:40:19,172 --> 03:40:20,807
PROCESS WHERE WE CAN'T INTERVENE

5586
03:40:20,807 --> 03:40:23,876
AND CAN WE INTEGRATE ALL THESE

5587
03:40:23,876 --> 03:40:25,411
THINGS TOGETHER, PRECISION

5588
03:40:25,411 --> 03:40:27,714
PUBLIC HEALTH, NETWORK MEDICINE,

5589
03:40:27,714 --> 03:40:29,682
A.I. FOR RISK PREDICTION, AND

5590
03:40:29,682 --> 03:40:34,053
THEN KEY CHALLENGES AND BARRIERS

5591
03:40:34,053 --> 03:40:38,324
REALLY COME DOWN TO WIDESPREAD

5592
03:40:38,324 --> 03:40:41,394
ACCEPTANCE, STANDARDIZING DATA

5593
03:40:41,394 --> 03:40:42,428
COLLECTION, CURATION, SECURITY,

5594
03:40:42,428 --> 03:40:44,764
PRIVACY, AND DEVELOPING THE

5595
03:40:44,764 --> 03:40:47,533
SOLID PARTNERSHIPS BETWEEN THE

5596
03:40:47,533 --> 03:40:49,268
STAKEHOLDERS AND REALLY GETTING

5597
03:40:49,268 --> 03:40:51,471
BACK TO PUBLIC ACCEPTANCE,

5598
03:40:51,471 --> 03:40:52,905
ACCEPTANCE FROM, YOU KNOW, THE

5599
03:40:52,905 --> 03:40:55,575
PATIENTS THAT WE WOULD LIKE TO

5600
03:40:55,575 --> 03:40:58,378
BE WORKING WITH, TO HELP IRON

5601
03:40:58,378 --> 03:40:59,912
THIS OUT AND BRING PRECISION

5602
03:40:59,912 --> 03:41:02,949
PUBLIC HEALTH TO THE FOREFRONT.

5603
03:41:02,949 --> 03:41:06,319
SO THANK YOU VERY MUCH.

5604
03:41:06,319 --> 03:41:11,391
>> THANK YOU, DR. LEOPOLD.

5605
03:41:11,391 --> 03:41:13,826
I HAVE SOME QUESTIONS FOR THE

5606
03:41:13,826 --> 03:41:15,795
DISCUSSION PERIOD.

5607
03:41:15,795 --> 03:41:19,499
NEXT SPEAKER IS DR. BULL,

5608
03:41:19,499 --> 03:41:21,467
MASTER'S IN PUBLIC HEALTH,

5609
03:41:21,467 --> 03:41:22,869
TULANE UNIVERSITY SCHOOL OF

5610
03:41:22,869 --> 03:41:27,673
PUBLIC HEALTH AND ENTREPRENEUR

5611
03:41:27,673 --> 03:41:28,908
-- TROPICAL

5612
03:41:28,908 --> 03:41:34,347
MEDICINE, Ph.D. IN SOCIOLOGY.

5613
03:41:34,347 --> 03:41:36,549
I FORGOT TO UNMUTE MYSELF.

5614
03:41:36,549 --> 03:41:38,851
I'LL START OVER.

5615
03:41:38,851 --> 03:41:41,354
I'D LIKE TO INTRODUCE DR. BULL,

5616
03:41:41,354 --> 03:41:45,858
WHO RECEIVED MASTER'S IN PUBLIC

5617
03:41:45,858 --> 03:41:48,995
HEALTH, TULANE UNIVERSITY,

5618
03:41:48,995 --> 03:41:49,662
Ph.D. IN SOCIOLOGY FROM

5619
03:41:49,662 --> 03:41:51,531
GEORGIA STATE UNIVERSITY.

5620
03:41:51,531 --> 03:41:53,633
SHE IS A FOUNDING FACULTY MEMBER

5621
03:41:53,633 --> 03:41:56,903
IN THE COLORADO SCHOOL OF PUBLIC

5622
03:41:56,903 --> 03:41:59,305
HEALTH, 2006.

5623
03:41:59,305 --> 03:42:00,073
CURRENTLY HOLDS POSITION OF

5624
03:42:00,073 --> 03:42:03,276
PROFESSOR OF COMMUNITY AND

5625
03:42:03,276 --> 03:42:04,010
BEHAVIORAL HEALTH.

5626
03:42:04,010 --> 03:42:04,243
WELCOME.

5627
03:42:04,243 --> 03:42:11,117
YOU'RE GOING TO TALK ABOUT

5628
03:42:11,117 --> 03:42:11,717
A.I.-ENABLED HEALTHBOTS.

5629
03:42:11,717 --> 03:42:14,954
>> CAN YOU HEAR ME AND SEE
MY

5630
03:42:14,954 --> 03:42:15,188
SLIDES?

5631
03:42:15,188 --> 03:42:16,489
>> I CAN HEAR YOU.

5632
03:42:16,489 --> 03:42:19,092
I SEE YOUR SLIDES AT THE MOMENT.

5633
03:42:19,092 --> 03:42:19,592
>> GREAT.

5634
03:42:19,592 --> 03:42:30,103
>> IT'S IN PRESENTER MODE
FYI.

5635
03:42:33,072 --> 03:42:35,541
>> OKAY.

5636
03:42:35,541 --> 03:42:37,643
>> THERE'S AN ICON, BOTTOM

5637
03:42:37,643 --> 03:42:37,844
RIGHT.

5638
03:42:37,844 --> 03:42:39,645
>> HOW'S THAT?

5639
03:42:39,645 --> 03:42:40,780
STILL PRESENTER?

5640
03:42:40,780 --> 03:42:45,351
I'M GOING TO TRY DOING A PDF.

5641
03:42:45,351 --> 03:42:45,651
HOW'S THAT?

5642
03:42:45,651 --> 03:42:48,888
>> LOOKS GOOD TO ME.

5643
03:42:48,888 --> 03:42:50,623
>> I THINK SOMETHING PUT
THEM

5644
03:42:50,623 --> 03:42:52,692
UP, AND MIGHT ADVANCE THEM FOR

5645
03:42:52,692 --> 03:42:52,859
ME.

5646
03:42:52,859 --> 03:42:53,392
IS THAT CORRECT?

5647
03:42:53,392 --> 03:42:54,127
>> THAT'S CORRECT.

5648
03:42:54,127 --> 03:42:55,962
WE'LL SHARE THE SLIDES FOR YOU.

5649
03:42:55,962 --> 03:43:00,433
JUST TELL US NEXT SLIDE PLEASE.

5650
03:43:00,433 --> 03:43:02,201
>> GREAT, THANK YOU.

5651
03:43:02,201 --> 03:43:05,371
 IT'S LOVELY TO BE HERE TO TALK

5652
03:43:05,371 --> 03:43:07,240
ABOUT HEALTHBOTS TO SUPPORT

5653
03:43:07,240 --> 03:43:08,875
PATIENT SELF-MANAGEMENT.

5654
03:43:08,875 --> 03:43:11,277
DR. LEOPOLD SET ME UP NICELY FOR

5655
03:43:11,277 --> 03:43:12,712
THIS TALK.

5656
03:43:12,712 --> 03:43:18,718
BEFORE I GO ON, I WANTED TO MAKE

5657
03:43:18,718 --> 03:43:19,752
ACKNOWLEDGMENTS.

5658
03:43:19,752 --> 03:43:23,322
SOME WORK IS FUNDED BY AN NHLBI

5659
03:43:23,322 --> 03:43:25,424
STUDY, THE NUDGE STUDY, ALL THE

5660
03:43:25,424 --> 03:43:28,961
FOLKS LISTED ON THIS SLIDE ARE

5661
03:43:28,961 --> 03:43:30,029
COLLABORATORS ON THAT STUDY.

5662
03:43:30,029 --> 03:43:31,664
SOME WORK I'M TALKING ABOUT IS

5663
03:43:31,664 --> 03:43:39,338
FUNDED BY THE COLORADO

5664
03:43:39,338 --> 03:43:49,849
DEPARTMENT OF PUBLIC HEALTH. 

5665
03:44:01,961 --> 03:44:03,229
TODAY TALKING ABOUT LEVERAGING

5666
03:44:03,229 --> 03:44:05,164
TO MANAGE CHRONIC CARDIOVASCULAR

5667
03:44:05,164 --> 03:44:06,432
CONDITIONS, ALSO CHALLENGES THAT

5668
03:44:06,432 --> 03:44:08,701
WE FACE IN THE NEAR TERM FOR

5669
03:44:08,701 --> 03:44:13,306
LEVERAGING A.I. TO SUPPORT

5670
03:44:13,306 --> 03:44:13,973
PATIENTS.

5671
03:44:13,973 --> 03:44:15,675
FINALLY ENDING WITH OPTIMIZING

5672
03:44:15,675 --> 03:44:18,444
OPPORTUNITIES FOR OUR

5673
03:44:18,444 --> 03:44:19,212
A.I.-ENABLED CHAT BOTS.

5674
03:44:19,212 --> 03:44:20,413
NEXT SLIDE PLEASE.

5675
03:44:20,413 --> 03:44:22,582
I WON'T SPEND A LOT OF TIME.

5676
03:44:22,582 --> 03:44:24,450
EVERYONE KNOWS THIS CONTEXT BUT

5677
03:44:24,450 --> 03:44:26,552
I WANT TO UNDERSCORE THREE

5678
03:44:26,552 --> 03:44:26,886
POINTS.

5679
03:44:26,886 --> 03:44:30,489
WE'VE HEARD A LOT TODAY ABOUT

5680
03:44:30,489 --> 03:44:33,326
THE PROBLEM OF CARDIOVASCULAR

5681
03:44:33,326 --> 03:44:34,060
ILLNESS.

5682
03:44:34,060 --> 03:44:35,494
WE'VE HEARD ABOUT DISPARITIES

5683
03:44:35,494 --> 03:44:37,196
AND THE NEED TO PAY GREATER

5684
03:44:37,196 --> 03:44:38,497
ATTENTION TO THOSE.

5685
03:44:38,497 --> 03:44:40,132
WE'VE ALSO HEARD ABOUT THE

5686
03:44:40,132 --> 03:44:42,101
OPPORTUNITIES THAT WE HAVE FOR

5687
03:44:42,101 --> 03:44:49,242
PATIENTS TO ENGAGE IN

5688
03:44:49,242 --> 03:44:49,976
SELF-MANAGEMENT, STRONGLY

5689
03:44:49,976 --> 03:44:52,511
EVIDENCE-BASED, AND EFFECTIVE. 

5690
03:44:52,511 --> 03:44:55,781
WHAT IS THE OPPORTUNITY?

5691
03:44:55,781 --> 03:44:58,284
WE HAD DISCUSSION ON EARLIER

5692
03:44:58,284 --> 03:45:00,820
PANEL ABOUT THINGS LIKE ACCESS.

5693
03:45:00,820 --> 03:45:03,089
SO I WILL SHARE THAT, YOU KNOW,

5694
03:45:03,089 --> 03:45:04,423
EVERYONE KNOWS THE AVAILABILITY

5695
03:45:04,423 --> 03:45:06,692
OF MOBILE PHONES AND POPULARITY

5696
03:45:06,692 --> 03:45:11,530
OF TEXT MESSAGING IS BECOMING

5697
03:45:11,530 --> 03:45:14,467
ALMOST UNIVERSAL.

5698
03:45:14,467 --> 03:45:16,335
DESPITE LIMITATIONS IN PEOPLE'S

5699
03:45:16,335 --> 03:45:17,436
ENTHUSIASM FOR TEXT MESSAGING,

5700
03:45:17,436 --> 03:45:19,171
WE'VE BEEN ABLE TO SEE THAT IT'S

5701
03:45:19,171 --> 03:45:20,506
A VERY EFFECTIVE WAY TO REACH

5702
03:45:20,506 --> 03:45:22,808
OUT TO PEOPLE AND MEETS THEM

5703
03:45:22,808 --> 03:45:23,342
WHERE THEY ARE.

5704
03:45:23,342 --> 03:45:25,645
THEY ARE USED TO USING THESE

5705
03:45:25,645 --> 03:45:25,978
SYSTEMS.

5706
03:45:25,978 --> 03:45:27,813
MORE PATIENTS HAVE ACCESS TO THE

5707
03:45:27,813 --> 03:45:28,681
INTERNET AND USE PATIENT

5708
03:45:28,681 --> 03:45:29,148
PORTALS.

5709
03:45:29,148 --> 03:45:31,651
THIS IS AN AREA WHERE I DO

5710
03:45:31,651 --> 03:45:32,852
RECOGNIZE THERE'S STILL

5711
03:45:32,852 --> 03:45:35,955
REMAINING A DECENT LEVEL OF

5712
03:45:35,955 --> 03:45:40,960
DIGITAL DIVIDE, ALTHOUGH THAT IS

5713
03:45:40,960 --> 03:45:46,332
SHRINKING, EVEN IN LOWER AND

5714
03:45:46,332 --> 03:45:47,366
MIDDLE INCOME SETTINGS PEOPLE

5715
03:45:47,366 --> 03:45:48,668
USE PHONES TO ACCESS

5716
03:45:48,668 --> 03:45:50,936
COMMUNICATION THROUGH THE

5717
03:45:50,936 --> 03:45:51,203
INTERNET.

5718
03:45:51,203 --> 03:45:55,308
AND THIRD, PEOPLE ARE WELCOMING

5719
03:45:55,308 --> 03:46:00,479
FOR FAMILIAR, SEEING THEM WHEN

5720
03:46:00,479 --> 03:46:09,522
THEY DO SHOPPING ONLINE, SEEING

5721
03:46:09,522 --> 03:46:15,494
THEM IN PROVIDER PORTALS. 

5722
03:46:15,494 --> 03:46:18,764
THIS IS AN EXAMPLE OF A TEXT

5723
03:46:18,764 --> 03:46:21,167
MESSAGE THAT'S GENERIC, THAT CAN

5724
03:46:21,167 --> 03:46:22,601
BE SENT OUT.

5725
03:46:22,601 --> 03:46:27,506
AND THROUGH A TELEPHONE, AND WE

5726
03:46:27,506 --> 03:46:30,376
HAVE GOOD EVIDENCE FROM RESEARCH

5727
03:46:30,376 --> 03:46:33,846
THAT THIS APPROACH DOES WORK TO

5728
03:46:33,846 --> 03:46:36,048
IMPROVE MEDICATION ADHERENCE, OR

5729
03:46:36,048 --> 03:46:37,583
PATIENT CONSISTENCY KEEPING

5730
03:46:37,583 --> 03:46:39,652
APPOINTMENTS, FOR EXAMPLE.

5731
03:46:39,652 --> 03:46:41,087
NEXT SLIDE PLEASE.

5732
03:46:41,087 --> 03:46:43,122
SO, OUR OWN WORK IN THE NUDGE

5733
03:46:43,122 --> 03:46:45,791
STUDY LOOKED AT WHETHER OR NOT

5734
03:46:45,791 --> 03:46:48,327
WE COULD OPTIMIZE MESSAGES AND

5735
03:46:48,327 --> 03:46:50,062
MAKE THEM MORE BIDIRECTIONAL AND

5736
03:46:50,062 --> 03:46:50,329
ENGAGING.

5737
03:46:50,329 --> 03:46:53,666
SO THIS IS AN EXAMPLE OF A FIRST

5738
03:46:53,666 --> 03:46:56,068
GENERATION BOT, NOT AN

5739
03:46:56,068 --> 03:46:58,170
A.I.-ENABLED BOT, BUT FROM OUR

5740
03:46:58,170 --> 03:46:59,472
PRELIMINARY ANALYSES OF THE

5741
03:46:59,472 --> 03:47:04,143
NUDGE DATA WE SEE THIS APPROACH,

5742
03:47:04,143 --> 03:47:07,713
THE INTERACTIVE FEATURE, AS WELL

5743
03:47:07,713 --> 03:47:08,381
AS OPTIMIZED MESSAGE CONTENT

5744
03:47:08,381 --> 03:47:10,783
I'LL TALK ABOUT IN A MOMENT,

5745
03:47:10,783 --> 03:47:14,387
THOSE TWO APPROACHES ARE

5746
03:47:14,387 --> 03:47:17,490
SIGNIFICANTLY SUPERIOR TO THE

5747
03:47:17,490 --> 03:47:19,325
GENERIC MESSAGING FOR INCREASING

5748
03:47:19,325 --> 03:47:22,528
ADHERENCE TO MEDICATION REFILL

5749
03:47:22,528 --> 03:47:23,429
FOR CARDIOVASCULAR MEDICATIONS.

5750
03:47:23,429 --> 03:47:25,664
AND SO THEREFORE WE CAN SEE

5751
03:47:25,664 --> 03:47:30,503
HIGHER PROPORTION OF DAYS

5752
03:47:30,503 --> 03:47:32,705
COVERED, FOR MEDICATIONS, AND

5753
03:47:32,705 --> 03:47:35,307
IMPROVED PATIENT SELF-MANAGEMENT

5754
03:47:35,307 --> 03:47:35,574
BEHAVIORS.

5755
03:47:35,574 --> 03:47:36,842
NEXT SLIDE PLEASE.

5756
03:47:36,842 --> 03:47:39,779
NOW WE HAVE THE OPPORTUNITY TO

5757
03:47:39,779 --> 03:47:41,647
LEVERAGE NATURAL LANGUAGE

5758
03:47:41,647 --> 03:47:43,849
PROCESSING AS WELL AS MACHINE

5759
03:47:43,849 --> 03:47:46,786
LEARNING FOR MORE ENGAINING AND

5760
03:47:46,786 --> 03:47:50,089
DYNAMIC EXPERIENCE, SO PEOPLE

5761
03:47:50,089 --> 03:47:52,158
AREN'T FORCED INTO

5762
03:47:52,158 --> 03:47:53,125
FIRST-GENERATION TYPE BOTS.

5763
03:47:53,125 --> 03:47:55,227
THIS IS AN EXAMPLE OF HOW THAT

5764
03:47:55,227 --> 03:47:58,164
MIGHT WORK.

5765
03:47:58,164 --> 03:47:59,265
IT USES SYSTEM DIALOGUE

5766
03:47:59,265 --> 03:48:00,266
CLASSIFICATION, SOMETHING WE'RE

5767
03:48:00,266 --> 03:48:02,768
USING RIGHT NOW.

5768
03:48:02,768 --> 03:48:04,837
AND THE PERSON CAN EITHER

5769
03:48:04,837 --> 03:48:08,107
RESPOND TO A PUSH NOTIFICATION

5770
03:48:08,107 --> 03:48:10,409
THAT THEY GET, OR THEY CAN

5771
03:48:10,409 --> 03:48:11,744
INITIATE A CONVERSATION.

5772
03:48:11,744 --> 03:48:13,479
AND WHAT HAPPENS FIRST IS THEY

5773
03:48:13,479 --> 03:48:16,949
GET TO USE THEIR OWN WORDS AND

5774
03:48:16,949 --> 03:48:19,318
THEIR OWN -- AND TALK ABOUT

5775
03:48:19,318 --> 03:48:20,953
THEIR OWN PREFERRED TOPIC.

5776
03:48:20,953 --> 03:48:23,889
THE SYSTEM CAN USE NATURAL

5777
03:48:23,889 --> 03:48:25,391
LANGUAGE PROCESSES TO CLASSIFY

5778
03:48:25,391 --> 03:48:26,959
AND PUT BACK A RESPONSE THAT

5779
03:48:26,959 --> 03:48:28,961
MATCHES THE INTENT OF THEIR

5780
03:48:28,961 --> 03:48:29,428
QUESTION.

5781
03:48:29,428 --> 03:48:31,697
THE MACHINE LEARNING COMES ABOUT

5782
03:48:31,697 --> 03:48:35,301
WHEN THAT CLASSIFICATION DOESN'T

5783
03:48:35,301 --> 03:48:36,936
HAPPEN CONSISTENTLY, WE CAN

5784
03:48:36,936 --> 03:48:38,370
RECLASSIFY SO THE NEXT TIME

5785
03:48:38,370 --> 03:48:40,639
SOMEBODY ASKS A QUESTION IN THAT

5786
03:48:40,639 --> 03:48:43,075
VEIN IT CAN BE RECLASSIFIED SO

5787
03:48:43,075 --> 03:48:45,678
THAT IT IS CONTINUALLY UPDATED

5788
03:48:45,678 --> 03:48:49,281
WITH MORE USERS.

5789
03:48:49,281 --> 03:48:49,682
NEXT SLIDE PLEASE.

5790
03:48:49,682 --> 03:48:52,685
SO, THIS IS FROM A STUDY THAT

5791
03:48:52,685 --> 03:48:55,521
CAME OUT LAST YEAR, AROUND THIS

5792
03:48:55,521 --> 03:48:59,458
TIME, LOOKING AT A REVIEW OF

5793
03:48:59,458 --> 03:49:02,294
CONVERSATIONAL AGENTS, CHAT

5794
03:49:02,294 --> 03:49:03,963
BOTS, IN PERSON-CENTERED CARE.

5795
03:49:03,963 --> 03:49:06,699
IN GENERAL FOUND THAT VERY FEW

5796
03:49:06,699 --> 03:49:08,100
OF THESE ARE TRULY OPTIMIZED

5797
03:49:08,100 --> 03:49:10,302
WITH THE FEATURES THAT WE KNOW

5798
03:49:10,302 --> 03:49:17,877
CAN WORK.

5799
03:49:17,877 --> 03:49:19,278
NEXT SLIDE PLEASE.

5800
03:49:19,278 --> 03:49:23,549
THEY LOOKED AT 78 DIFFERENT

5801
03:49:23,549 --> 03:49:26,285
CHATBOTS, PRIMARY CARE AND

5802
03:49:26,285 --> 03:49:28,020
MENTAL HEALTH.

5803
03:49:28,020 --> 03:49:30,556
FEWER THAN 10% HAD THEORETICAL

5804
03:49:30,556 --> 03:49:31,023
FRAMEWORK.

5805
03:49:31,023 --> 03:49:33,392
WE USED THESE TO IMPROVE EFFECT

5806
03:49:33,392 --> 03:49:35,227
SIZE AND HAVE GREATER PRECISION

5807
03:49:35,227 --> 03:49:37,663
IN TARGETING HEALTH BEHAVIORS

5808
03:49:37,663 --> 03:49:39,532
AND OUTCOMES.

5809
03:49:39,532 --> 03:49:42,334
ONLY 12% WERE HIPAA COMPLIANT,

5810
03:49:42,334 --> 03:49:43,569
LIKELY A NON-STARTER FOR

5811
03:49:43,569 --> 03:49:45,638
PROVIDERS AND PROVIDER CARE

5812
03:49:45,638 --> 03:49:45,971
SYSTEMS.

5813
03:49:45,971 --> 03:49:50,576
AND ONLY A FEW ARE TRULY USING

5814
03:49:50,576 --> 03:49:53,212
MACHINE LANGUAGE AND -- MACHINE

5815
03:49:53,212 --> 03:49:56,649
LEARNING AND NATURAL LANGUAGE

5816
03:49:56,649 --> 03:49:57,249
PROS EGGS.

5817
03:49:57,249 --> 03:50:00,019
I'LL TALK ABOUT GAPS WE HAVE IN

5818
03:50:00,019 --> 03:50:02,087
OUR KNOWLEDGE FOR A.I. HEALTH

5819
03:50:02,087 --> 03:50:03,923
BOTS, THREE I WANT TO FOCUS ON.

5820
03:50:03,923 --> 03:50:11,297
THE FIRST IS RELATED TO OUR

5821
03:50:11,297 --> 03:50:18,037
TECHNOLOGY, INFRASTRUCTURE AND

5822
03:50:18,037 --> 03:50:18,270
SYSTEM.

5823
03:50:18,270 --> 03:50:21,106
ONE ISSUE THEY WOULD LIKE TO SEE

5824
03:50:21,106 --> 03:50:22,107
SOME INTEGRATION WITH THEIR

5825
03:50:22,107 --> 03:50:24,977
SYSTEMS TO HELP WITH WORKFLOW.

5826
03:50:24,977 --> 03:50:28,681
WE NEED TO HAVE PROVIDER AND

5827
03:50:28,681 --> 03:50:29,615
PATIENT-FACING SYSTEMS.

5828
03:50:29,615 --> 03:50:33,485
AND THEN THE THIRD WE'VE TALKED

5829
03:50:33,485 --> 03:50:40,159
ABOUT SEVERAL TIMES TODAY,

5830
03:50:40,159 --> 03:50:40,793
INTEROPERABILITY, FHIR-ENABLED

5831
03:50:40,793 --> 03:50:42,261
TO LINK TO OTHER CHAT BOTS

5832
03:50:42,261 --> 03:50:45,064
SYSTEMS ARE WORKING WITH.

5833
03:50:45,064 --> 03:50:46,265
NEXT SLIDE PLEASE.

5834
03:50:46,265 --> 03:50:48,801
SO IN OUR OWN SYSTEM WHAT WE'RE

5835
03:50:48,801 --> 03:50:51,070
SEEING, WHAT WE'RE USING RIGHT

5836
03:50:51,070 --> 03:50:52,304
NOW, ADDRESSES ALL OF THESE.

5837
03:50:52,304 --> 03:50:55,808
ON THE LEFT WHAT YOU SEE THERE

5838
03:50:55,808 --> 03:50:57,476
IS THE USER COULD INITIATE A

5839
03:50:57,476 --> 03:51:03,515
QUESTION, WE'RE USING THE

5840
03:51:03,515 --> 03:51:04,583
MACHINE LANGUAGE PROCESSING TO

5841
03:51:04,583 --> 03:51:05,918
GET A RESPONSE.

5842
03:51:05,918 --> 03:51:08,220
ALL OF THOSE COMMUNICATIONS ARE

5843
03:51:08,220 --> 03:51:09,755
DOCUMENTED IN A LOG.

5844
03:51:09,755 --> 03:51:11,824
HERE IS WHERE HIPAA COMPLIANCE

5845
03:51:11,824 --> 03:51:15,194
COMES IF. 

5846
03:51:15,194 --> 03:51:17,296
IF WE'RE COLLABORATING WITH A

5847
03:51:17,296 --> 03:51:18,263
HEALTH CARE DELIVERY SYSTEM, FOR

5848
03:51:18,263 --> 03:51:19,932
EXAMPLE, AND IT'S GOING THROUGH

5849
03:51:19,932 --> 03:51:22,034
A TEXT MESSAGE ON THE PHONE,

5850
03:51:22,034 --> 03:51:25,304
WHICH MIGHT BE PREFERRED FOR THE

5851
03:51:25,304 --> 03:51:27,673
PATIENT, THAT TELEPHONE NUMBER

5852
03:51:27,673 --> 03:51:29,875
IS PHI, PROTECTED HEALTH

5853
03:51:29,875 --> 03:51:30,409
INFORMATION.

5854
03:51:30,409 --> 03:51:31,844
SO THAT NEEDS TO EITHER BE --

5855
03:51:31,844 --> 03:51:34,246
MAKE SURE THE LOG IS STORED

5856
03:51:34,246 --> 03:51:37,249
BEHIND A FIRE WALL, AND THE

5857
03:51:37,249 --> 03:51:46,725
TELEPHONE NUMBERS CAN GET

5858
03:51:46,725 --> 03:51:48,694
ENCRYPTED OR THERE COULD BE DATA

5859
03:51:48,694 --> 03:51:50,596
USE AGREEMENTS, BUT THERE'S WAYS

5860
03:51:50,596 --> 03:51:51,430
TO ADDRESS HIPAA COMPLIANCE.

5861
03:51:51,430 --> 03:51:53,332
YOU HAVE TO PAY CLOSE ATTENTION

5862
03:51:53,332 --> 03:51:54,066
TO THEM.

5863
03:51:54,066 --> 03:51:57,036
THE SECOND ISSUE OF PATIENT AND

5864
03:51:57,036 --> 03:51:58,003
PROVIDER-FACING CONTENT, SO WHEN

5865
03:51:58,003 --> 03:51:59,438
WE WORK WITH PROVIDERS THEY TELL

5866
03:51:59,438 --> 03:52:01,073
US AGAIN AND AGAIN THEY DO NOT

5867
03:52:01,073 --> 03:52:04,476
WANT TO BE THE PERSON WHO LOOKS

5868
03:52:04,476 --> 03:52:07,212
THROUGH THE LOG AND SEES EVERY

5869
03:52:07,212 --> 03:52:08,514
SINGLE EXCHANGE WITH THE

5870
03:52:08,514 --> 03:52:08,847
CHATBOT.

5871
03:52:08,847 --> 03:52:10,382
THAT'S WAY TOO MUCH FOR THEM.

5872
03:52:10,382 --> 03:52:12,117
THEY WANT THESE THINGS TO HELP

5873
03:52:12,117 --> 03:52:14,453
THEM WITH WORKFLOW, NOT IMPEDE

5874
03:52:14,453 --> 03:52:15,220
THEIR WORKFLOW.

5875
03:52:15,220 --> 03:52:16,622
SO, THERE'S TWO WAYS THAT WE'RE

5876
03:52:16,622 --> 03:52:19,024
WORKING ON THAT.

5877
03:52:19,024 --> 03:52:21,093
THE FIRST IS TO IDENTIFY WHAT

5878
03:52:21,093 --> 03:52:22,861
ARE KEY PIECES OF INFORMATION

5879
03:52:22,861 --> 03:52:25,064
THAT PROVIDERS DO WANT, AND

5880
03:52:25,064 --> 03:52:26,598
GENERATE AN ALGORITHM TO PUSH

5881
03:52:26,598 --> 03:52:28,901
OUT THAT INFORMATION WHEN IT

5882
03:52:28,901 --> 03:52:29,601
BECOMES APPARENT.

5883
03:52:29,601 --> 03:52:31,870
SUCH AS WHEN WE KNOW THAT A

5884
03:52:31,870 --> 03:52:33,806
PATIENT HAS NOT FILLED OR IS

5885
03:52:33,806 --> 03:52:37,643
INDICATING THAT THEY DON'T PLAN

5886
03:52:37,643 --> 03:52:37,876
TO.

5887
03:52:37,876 --> 03:52:41,146
OR THEY HAVE GONE TO AN URGENT

5888
03:52:41,146 --> 03:52:42,014
CARE FACILITY.

5889
03:52:42,014 --> 03:52:44,550
ON THE OTHER THING ON THE TOP

5890
03:52:44,550 --> 03:52:46,385
RIGHT IS GENERATION OF

5891
03:52:46,385 --> 03:52:47,386
DASHBOARDS THAT ARE REALTIME

5892
03:52:47,386 --> 03:52:48,654
THAT PROVIDERS CAN TAKE A LOOK

5893
03:52:48,654 --> 03:52:50,823
AT TO SEE HOW MANY PEOPLE ARE

5894
03:52:50,823 --> 03:52:52,758
USING THE SYSTEM, WHAT ARE THE

5895
03:52:52,758 --> 03:52:53,826
PRIMARY QUESTIONS THAT PEOPLE

5896
03:52:53,826 --> 03:52:55,160
HAVE, WHAT ARE THE TIMES OF DAY

5897
03:52:55,160 --> 03:52:58,564
AND DAYS OF THE WEEK, WHEN THE

5898
03:52:58,564 --> 03:53:00,733
SYSTEM USES HIGHEST VOLUME.

5899
03:53:00,733 --> 03:53:04,570
THE THIRD ISSUE FOR

5900
03:53:04,570 --> 03:53:06,538
INFRASTRUCTURE IS RELATED TO

5901
03:53:06,538 --> 03:53:06,939
INTEROPERABILITY.

5902
03:53:06,939 --> 03:53:08,207
LOTS OF IDEAS CAME THROUGH THE

5903
03:53:08,207 --> 03:53:10,843
TALKS TODAY.

5904
03:53:10,843 --> 03:53:12,711
IF SOMEBODY IS WEARING A

5905
03:53:12,711 --> 03:53:13,779
WEARABLE DEVICE AND INFORMATION

5906
03:53:13,779 --> 03:53:17,516
SUGGESTS THAT THEY NEED TO BE

5907
03:53:17,516 --> 03:53:18,717
GIVEN AN ALERT, THAT COULD BE

5908
03:53:18,717 --> 03:53:20,486
PUSHED TO THEM THROUGH A CHATBOT

5909
03:53:20,486 --> 03:53:21,987
AND THEY COULD ENGAGE WITH THE

5910
03:53:21,987 --> 03:53:24,289
SYSTEM TO GET THEIR QUESTIONS

5911
03:53:24,289 --> 03:53:24,556
ANSWERED.

5912
03:53:24,556 --> 03:53:28,994
THIS IS ALSO AN EXAMPLE OF

5913
03:53:28,994 --> 03:53:29,661
INTEROPERABILITY WITH

5914
03:53:29,661 --> 03:53:30,095
SCHEDULING.

5915
03:53:30,095 --> 03:53:33,065
THEY WOULDN'T HAVE TO LEAVE THE

5916
03:53:33,065 --> 03:53:35,334
CHATBOT IF THE SYSTEM COULD

5917
03:53:35,334 --> 03:53:43,876
IDENTIFY IMMEDIATELY  PLACES THY

5918
03:53:43,876 --> 03:53:45,511
COULD GET AN APPOINTMENT OR

5919
03:53:45,511 --> 03:53:45,944
MEDICATION.

5920
03:53:45,944 --> 03:53:50,682
THE OTHER IS RELATED TO CONTENT.

5921
03:53:50,682 --> 03:53:52,985
WE'VE HEARD ABOUT SYSTEMS WHERE

5922
03:53:52,985 --> 03:53:54,286
YOU COULD HAVE COMMUNICATION,

5923
03:53:54,286 --> 03:53:58,123
NOT JUST WITH THE A.I. BUT ALSO

5924
03:53:58,123 --> 03:54:00,192
WITH TEXT MESSAGING PROGRAMS OR

5925
03:54:00,192 --> 03:54:04,129
OTHER HEALTH BEHAVIOR TYPES OF

5926
03:54:04,129 --> 03:54:05,764
INITIATIVES WE'VE LEARNED FROM

5927
03:54:05,764 --> 03:54:08,233
OUR OWN RESEARCH AND RESEARCH

5928
03:54:08,233 --> 03:54:09,501
ACROSS MANY COLLEAGUES IN THE

5929
03:54:09,501 --> 03:54:13,906
FIELD THAT WHEN YOU HAVE

5930
03:54:13,906 --> 03:54:14,873
OPTIMIZED AND THEORY BASED

5931
03:54:14,873 --> 03:54:16,642
MESSAGING THAT USES HEALTH

5932
03:54:16,642 --> 03:54:18,510
COMMUNICATION AND BEHAVIOR

5933
03:54:18,510 --> 03:54:20,145
CHANGE THEORY WE CAN DO BETTER

5934
03:54:20,145 --> 03:54:22,347
AND CAN IMPACT NOT JUST HEALTH

5935
03:54:22,347 --> 03:54:24,850
BEHAVIOR BUT HEALTH OUTCOMES.

5936
03:54:24,850 --> 03:54:27,886
SO CHANGES IN THINGS LIKE

5937
03:54:27,886 --> 03:54:29,121
COMPLIANCE WITH CHILDHOOD

5938
03:54:29,121 --> 03:54:31,190
VACCINES OR HIV TESTING, FOR

5939
03:54:31,190 --> 03:54:31,423
EXAMPLE.

5940
03:54:31,423 --> 03:54:34,927
WE NEED TO MAKE SURE THAT

5941
03:54:34,927 --> 03:54:36,161
MESSAGES ARE CULTURALLY RELEVANT

5942
03:54:36,161 --> 03:54:39,097
AND TAILORED, AND THEY FOCUS ON

5943
03:54:39,097 --> 03:54:39,731
DISPARITIES.

5944
03:54:39,731 --> 03:54:42,167
I'M GOING TO COME BACK TO THAT.

5945
03:54:42,167 --> 03:54:45,003
PLEASE GO TO THE NEXT SLIDE AND

5946
03:54:45,003 --> 03:54:47,506
I'LL SET THE STAGE FOR THAT.

5947
03:54:47,506 --> 03:54:51,043
WE'VE HEARD NOT JUST TODAY BUT

5948
03:54:51,043 --> 03:55:01,220
AM AP LOT  -- A LOT ABOUT CHAT

5949
03:55:01,220 --> 03:55:01,553
GPT.

5950
03:55:01,553 --> 03:55:05,824
A GROUP DID THIS LAST MONTH,

5951
03:55:05,824 --> 03:55:07,993
LOOKED AT CHAT GPT RESPONSES

5952
03:55:07,993 --> 03:55:10,062
AROUND CARDIOVASCULAR DISEASE

5953
03:55:10,062 --> 03:55:12,464
PREVENTION RECOMMENDATIONS.

5954
03:55:12,464 --> 03:55:14,766
THEY FOUND THAT THE SYSTEM DOES

5955
03:55:14,766 --> 03:55:17,402
HAVE PROMISE, IT LACKS PRECISION

5956
03:55:17,402 --> 03:55:19,671
AND CORRECTNESS IN 16% OF

5957
03:55:19,671 --> 03:55:21,106
RESPONSES WHICH COULD BE

5958
03:55:21,106 --> 03:55:21,540
PROBLEMATIC.

5959
03:55:21,540 --> 03:55:24,509
I THINK THAT MIGHT BE A

5960
03:55:24,509 --> 03:55:25,143
NON-STARTER FOR MANY.

5961
03:55:25,143 --> 03:55:28,547
AND THEY ALSO HAVE LIMITED

5962
03:55:28,547 --> 03:55:30,883
READABILITY AND NO CONSIDERATION

5963
03:55:30,883 --> 03:55:31,950
OF DIVERSITY.

5964
03:55:31,950 --> 03:55:32,951
NEXT SLIDE PLEASE.

5965
03:55:32,951 --> 03:55:36,455
I'M GOING TO COME BACK TO THAT

5966
03:55:36,455 --> 03:55:37,990
ISSUE OF CULTURAL

5967
03:55:37,990 --> 03:55:39,291
APPROPRIATENESS AND DISPARITIES.

5968
03:55:39,291 --> 03:55:40,726
WE'VE HEARD LOTS TODAY ABOUT

5969
03:55:40,726 --> 03:55:42,261
SOCIAL DETERMINANTS OF HEALTH.

5970
03:55:42,261 --> 03:55:44,563
HERE'S WAYS THAT WE'RE TRYING TO

5971
03:55:44,563 --> 03:55:46,431
ADDRESS THAT IN A WAY TO MAKE

5972
03:55:46,431 --> 03:55:48,367
SURE THAT MESSAGES CAN RESONATE

5973
03:55:48,367 --> 03:55:50,135
AND PEOPLE WILL STAY ENGAGED

5974
03:55:50,135 --> 03:55:51,236
WITH SYSTEMS.

5975
03:55:51,236 --> 03:55:52,504
SO WE'VE GOT EXAMPLES HERE OF

5976
03:55:52,504 --> 03:55:55,173
WHAT WE'RE TRYING TO DO WHICH IS

5977
03:55:55,173 --> 03:55:58,677
TO PUSH OUT MESSAGES AND ASSESS

5978
03:55:58,677 --> 03:55:59,211
WHAT ARE SPECIFIC SOCIAL

5979
03:55:59,211 --> 03:56:01,213
DETERMINANTS OF HEALTH THAT

5980
03:56:01,213 --> 03:56:03,582
PEOPLE ARE STRUGGLING WITH SAY

5981
03:56:03,582 --> 03:56:06,318
IN AREAS OF HOUSING OR FOOD OR

5982
03:56:06,318 --> 03:56:06,952
TRANSPORTATION.

5983
03:56:06,952 --> 03:56:08,086
AND THIS TOP LEFT MESSAGE

5984
03:56:08,086 --> 03:56:16,295
SUGGESTS THAT THE USER MAY HAVE

5985
03:56:16,295 --> 03:56:19,131
DIFFICULTY WITH FOOD, PROMPTING

5986
03:56:19,131 --> 03:56:20,766
REFERRAL TO FOOD BANK OR

5987
03:56:20,766 --> 03:56:22,200
RESOURCES FOR LOW COST FOOD.

5988
03:56:22,200 --> 03:56:24,603
WE SEE AN EXAMPLE WHERE THE

5989
03:56:24,603 --> 03:56:25,604
PATIENT MIGHT EXPLAIN THAT

5990
03:56:25,604 --> 03:56:28,340
MEDICATION COST IS AN ISSUE.

5991
03:56:28,340 --> 03:56:30,309
AND WE CAN GIVE THEM REFERRALS

5992
03:56:30,309 --> 03:56:33,145
TO GET LOWER COST MEDICATIONS.

5993
03:56:33,145 --> 03:56:36,882
AND THEN FINALLY ANOTHER EXAMPLE

5994
03:56:36,882 --> 03:56:38,417
OF INTEROPERABILITY, WE CAN LINK

5995
03:56:38,417 --> 03:56:39,618
PATIENTS TO SCHEDULE AN

5996
03:56:39,618 --> 03:56:40,919
APPOINTMENT TO TALK TO A

5997
03:56:40,919 --> 03:56:43,989
PROVIDER OR HAVE A TELEHEALTH

5998
03:56:43,989 --> 03:56:44,423
VISIT.

5999
03:56:44,423 --> 03:56:45,624
OR PHONE CALL THAT ALLOWS THEM

6000
03:56:45,624 --> 03:56:48,160
IN THIS CASE TO TALK TO A

6001
03:56:48,160 --> 03:56:48,493
PHARMACIST.

6002
03:56:48,493 --> 03:56:51,563
SO THAT THEY CAN IMMEDIATELY GET

6003
03:56:51,563 --> 03:56:53,098
SUPPORT FOR WHAT THE THINGS THAT

6004
03:56:53,098 --> 03:56:55,834
THEY NEED.

6005
03:56:55,834 --> 03:56:58,003
NEXT SLIDE PLEASE.

6006
03:56:58,003 --> 03:57:00,572
THIRD AREA OF GAP IN KNOWLEDGE

6007
03:57:00,572 --> 03:57:04,476
IS RELATED TO TEAM SCIENCE, ALSO

6008
03:57:04,476 --> 03:57:05,744
CAME UP TODAY.

6009
03:57:05,744 --> 03:57:08,413
NEED FOR INTEGRATED TEAMS, NOT

6010
03:57:08,413 --> 03:57:11,149
JUST COMPUTER SCIENTISTS AND

6011
03:57:11,149 --> 03:57:12,884
CLINICIAN EXPERTS BUT ALSO

6012
03:57:12,884 --> 03:57:15,087
SOCIAL SCIENTISTS FOR CONTENT

6013
03:57:15,087 --> 03:57:18,156
DESIGN AND THEN THINK MORE

6014
03:57:18,156 --> 03:57:20,425
BROADLY ABOUT HEALTH ECONOMISTS,

6015
03:57:20,425 --> 03:57:24,696
WHO CAN TALK ABOUT COSTS, AND

6016
03:57:24,696 --> 03:57:27,966
COLLECTIVELY THESE GROUPS SHOULD

6017
03:57:27,966 --> 03:57:32,037
BE WORKING ON QUESTIONS THAT ARE

6018
03:57:32,037 --> 03:57:40,045
EXPLORING SCALABILITY AS WELL AS

6019
03:57:40,045 --> 03:57:41,146
IMPLEMENTATION AND ON HEALTH

6020
03:57:41,146 --> 03:57:43,248
OUTCOMES AT THE POPULATION

6021
03:57:43,248 --> 03:57:43,648
LEVEL.

6022
03:57:43,648 --> 03:57:45,717
NEXT SLIDE PLEASE.

6023
03:57:45,717 --> 03:57:48,253
IN CONCLUSION I'M GOING TO

6024
03:57:48,253 --> 03:57:50,355
SUGGEST PROMISING AREAS FOR

6025
03:57:50,355 --> 03:57:52,090
ADVANCEMENT WOULD BE TO DEVELOP

6026
03:57:52,090 --> 03:57:55,727
A.I. HEALTH BOTS THAT HAVE THESE

6027
03:57:55,727 --> 03:58:00,232
SIX FEATURES UTILIZE NATURAL

6028
03:58:00,232 --> 03:58:04,236
LANGUAGE PROCESSING, WIDELY

6029
03:58:04,236 --> 03:58:07,639
ACCESSIBLE ACROSS DIFFERENT

6030
03:58:07,639 --> 03:58:08,073
PLATFORMS.

6031
03:58:08,073 --> 03:58:10,275
THEY NEED TO BE HIPAA COMPLIANT.

6032
03:58:10,275 --> 03:58:14,413
IT'S NOT A BIG HURDLE.

6033
03:58:14,413 --> 03:58:16,948
THEY SHOULD OFFER LINKAGE TO

6034
03:58:16,948 --> 03:58:17,916
CARE AND INTEROPERABILITY WITH

6035
03:58:17,916 --> 03:58:19,818
OTHER TYPES OF SYSTEMS THAT

6036
03:58:19,818 --> 03:58:23,055
WE'VE TALKED ABOUT TODAY.

6037
03:58:23,055 --> 03:58:24,489
THEY SHOULD OFFER PERSUASIVE

6038
03:58:24,489 --> 03:58:26,024
COMMUNICATIONS AND WE CAN

6039
03:58:26,024 --> 03:58:26,992
CONTROL COMMUNICATION WITH THE

6040
03:58:26,992 --> 03:58:29,394
CONTENT THAT WE KNOW WILL BE

6041
03:58:29,394 --> 03:58:31,530
EFFECTIVE IN IMPACTING HEALTH

6042
03:58:31,530 --> 03:58:35,300
BEHAVIOR AND HEALTH OUTCOMES.

6043
03:58:35,300 --> 03:58:36,735
FINALLY THEY SHOULD BE

6044
03:58:36,735 --> 03:58:37,069
ADAPTABLE.

6045
03:58:37,069 --> 03:58:39,805
IF YOU WOULD BE INTERESTED IN

6046
03:58:39,805 --> 03:58:40,672
COLLABORATING ON DEVELOPING OR

6047
03:58:40,672 --> 03:58:42,007
EVALUATING THOSE I WOULD LOVE TO

6048
03:58:42,007 --> 03:58:42,641
HEAR FROM YOU.

6049
03:58:42,641 --> 03:58:45,243
THANKS VERY MUCH FOR YOUR TIME.

6050
03:58:45,243 --> 03:58:48,680
>> THANK YOU VERY MUCH,
DR.

6051
03:58:48,680 --> 03:58:49,114
BULL.

6052
03:58:49,114 --> 03:58:49,881
APPRECIATE IT.

6053
03:58:49,881 --> 03:58:51,616
I'VE BEEN MONITORING THE CHAT.

6054
03:58:51,616 --> 03:58:55,020
THERE'S A LOT OF GOOD DISCUSSION

6055
03:58:55,020 --> 03:58:57,956
FOR THE DISCUSSION PANEL.

6056
03:58:57,956 --> 03:59:02,227
I'D LIKE TO INTRODUCE DR. KHERA

6057
03:59:02,227 --> 03:59:04,429
FROM YALE UNIVERSITY, LEADS THE

6058
03:59:04,429 --> 03:59:06,398
CARDIOVASCULAR DATA SCIENCE LAB.

6059
03:59:06,398 --> 03:59:07,499
ALSO CLINICAL DIRECTOR FOR

6060
03:59:07,499 --> 03:59:09,801
CENTER FOR HEALTH INFORMATICS

6061
03:59:09,801 --> 03:59:12,337
AND ANALYTICS AT YALE CENTER FOR

6062
03:59:12,337 --> 03:59:13,305
OUTCOMES RESEARCH AND

6063
03:59:13,305 --> 03:59:14,406
EVALUATION.

6064
03:59:14,406 --> 03:59:17,342
HE WILL TALK ABOUT A.I. TOP

6065
03:59:17,342 --> 03:59:18,543
INDIVIDUALIZE TREATMENT RESPONSE

6066
03:59:18,543 --> 03:59:19,311
IN HYPERTENSION.

6067
03:59:19,311 --> 03:59:19,544
WELCOME.

6068
03:59:19,544 --> 03:59:27,686
>> I'M GOING  TO SHARE MY
OWN

6069
03:59:27,686 --> 03:59:27,919
SLIDES.

6070
03:59:27,919 --> 03:59:30,288
>> NO PROBLEM.

6071
03:59:30,288 --> 03:59:31,223
>> THANK YOU.

6072
03:59:31,223 --> 03:59:31,456
>> OKAY.

6073
03:59:31,456 --> 03:59:32,757
>> PERFECT.

6074
03:59:32,757 --> 03:59:33,458
THANKS SO MUCH.

6075
03:59:33,458 --> 03:59:35,861
CAN YOU SEE MY SLIDES?

6076
03:59:35,861 --> 03:59:38,130
>> YES, I CAN SEE THEM,
VERY

6077
03:59:38,130 --> 03:59:38,330
CLEAR.

6078
03:59:38,330 --> 03:59:39,731
>> PERFECT.

6079
03:59:39,731 --> 03:59:40,765
THANKS SO MUCH.

6080
03:59:40,765 --> 03:59:44,169
THANKS FOR HAVING ME HERE.

6081
03:59:44,169 --> 03:59:45,937
THANKS FOR THE KIND

6082
03:59:45,937 --> 03:59:46,638
INTRODUCTION.

6083
03:59:46,638 --> 03:59:48,540
EXCELLENT MORNING OF TALKS.

6084
03:59:48,540 --> 03:59:50,075
I'M PRIVILEGED TO PRESENT SMALL

6085
03:59:50,075 --> 03:59:51,977
COMPONENT OF WHAT WE CAN OFFER

6086
03:59:51,977 --> 03:59:56,214
THROUGH A.I. IN THE TREATMENT

6087
03:59:56,214 --> 03:59:57,182
RESPONSE OPTIMIZATION

6088
03:59:57,182 --> 03:59:57,782
HYPERTENSION.

6089
03:59:57,782 --> 04:00:00,385
THE TALK IS ABOUT

6090
04:00:00,385 --> 04:00:00,986
INDIVIDUALIZING TREATMENT

6091
04:00:00,986 --> 04:00:03,054
RESPONSE IN HYPERTENSION.

6092
04:00:03,054 --> 04:00:04,456
I HAVE SOME DISCLOSURES.

6093
04:00:04,456 --> 04:00:06,291
KEY IS NOTE IS ANY ALGORITHM I

6094
04:00:06,291 --> 04:00:09,494
DISCUSS IN THIS PRESENTATION IS

6095
04:00:09,494 --> 04:00:12,297
ONLY RESEARCH USE, NOT FOR

6096
04:00:12,297 --> 04:00:13,532
CLINICAL USE YET.

6097
04:00:13,532 --> 04:00:16,034
FOCUS MAY BE ABOUT HYPERTENSION

6098
04:00:16,034 --> 04:00:16,701
BUT LARGELY ABOUT PRECISION

6099
04:00:16,701 --> 04:00:17,569
HEALTH CARE.

6100
04:00:17,569 --> 04:00:19,337
THAT MEANS FOR A GIVEN

6101
04:00:19,337 --> 04:00:22,941
INDIVIDUAL HOW DO WE PROVIDE

6102
04:00:22,941 --> 04:00:23,575
MANAGEMENT THAT IMPROVES THEIR

6103
04:00:23,575 --> 04:00:27,412
HEALTH AND BASE THE DECISION ON

6104
04:00:27,412 --> 04:00:28,313
THEIR UNIQUE FEATURES.

6105
04:00:28,313 --> 04:00:31,149
GIVEN A LARGE NUMBER OF BIAS AND

6106
04:00:31,149 --> 04:00:34,452
CONFOUNDING IN REAL WORLD DATA

6107
04:00:34,452 --> 04:00:36,421
FINDING SIGNATURES OF RESPONSE

6108
04:00:36,421 --> 04:00:43,195
AND SOLUTIONS IS CHALLENGING.

6109
04:00:43,195 --> 04:00:45,597
RANDOMIZED TRIALS REPRESENT

6110
04:00:45,597 --> 04:00:48,433
LARGE STUDIES, THAT TAKE AWAY

6111
04:00:48,433 --> 04:00:49,334
CHALLENGES, SPECIFICALLY AROUND

6112
04:00:49,334 --> 04:00:51,603
BIAS AND CONFOUNDING BY

6113
04:00:51,603 --> 04:00:53,371
INDICATION.

6114
04:00:53,371 --> 04:00:57,509
THE WAY TO LEVERAGE DATA ARE

6115
04:00:57,509 --> 04:00:57,742
LIMITED.

6116
04:00:57,742 --> 04:01:04,649
FOR EVERY DISEASE, ESPECIALLY

6117
04:01:04,649 --> 04:01:07,586
HYPERTENSION A PROPORTION GET

6118
04:01:07,586 --> 04:01:09,521
ENROLLED, AND THE FINDING,

6119
04:01:09,521 --> 04:01:11,656
POSITIVE OR NEGATIVE, NEEDS TO

6120
04:01:11,656 --> 04:01:13,825
APPLY UNIFORMLY TO ALL, TAKING

6121
04:01:13,825 --> 04:01:15,594
AWAY DIFFERENCES.

6122
04:01:15,594 --> 04:01:22,567
HOWEVER THIS APPROACH IS

6123
04:01:22,567 --> 04:01:22,834
IMPRECISE.

6124
04:01:22,834 --> 04:01:24,669
MORE SPECIFICALLY, RCTs FOCUS

6125
04:01:24,669 --> 04:01:25,904
ON AVERAGE DIFFERENCE BETWEEN

6126
04:01:25,904 --> 04:01:28,707
TWO GROUPS IN THE INTERVENTION

6127
04:01:28,707 --> 04:01:30,675
AND CONTROL ARMS, AND THIS FORM

6128
04:01:30,675 --> 04:01:32,544
OF INTERPRETATION IS BEDROCK OF

6129
04:01:32,544 --> 04:01:38,683
SCIENCE BUT HAS LIMITATIONS.

6130
04:01:38,683 --> 04:01:40,218
WE HAVE TO DISCARD INFORMATION

6131
04:01:40,218 --> 04:01:42,754
FROM LARGE HUMAN EXPERIMENT WITH

6132
04:01:42,754 --> 04:01:45,023
LARGE RESOURCES INVESTED, DATA

6133
04:01:45,023 --> 04:01:45,790
ARE DISRECORDED.

6134
04:01:45,790 --> 04:01:46,992
WHAT REALLY HAPPENS IN A

6135
04:01:46,992 --> 04:01:48,426
CLINICAL TRIAL, SOME INDIVIDUALS

6136
04:01:48,426 --> 04:01:49,961
MAY BENEFIT FROM THERAPY, OTHERS

6137
04:01:49,961 --> 04:01:52,264
MAY NOT.

6138
04:01:52,264 --> 04:01:53,565
AND BY CHANCE MANY WILL

6139
04:01:53,565 --> 04:01:56,501
EXPERIENCE AN ADVANTAGE IN EACH

6140
04:01:56,501 --> 04:01:58,270
STUDY ARM, MANY HAVE TRIED TO

6141
04:01:58,270 --> 04:02:00,772
ADDRESS THIS IN DIFFERENT WAYS.

6142
04:02:00,772 --> 04:02:05,277
THE MOST COMMON AGE-OLD APPROACH

6143
04:02:05,277 --> 04:02:10,849
IS SUBGROUP COMPARISONS.

6144
04:02:10,849 --> 04:02:15,153
INDIVIDUAL SUBGROUPS CONTINUE TO

6145
04:02:15,153 --> 04:02:17,222
BE CLINICALLY HETEROGENEOUS

6146
04:02:17,222 --> 04:02:18,657
AMONG THEMSELVES, THEORETICAL

6147
04:02:18,657 --> 04:02:21,059
UNTIL A PUSH TO SHARE DATA LED

6148
04:02:21,059 --> 04:02:24,195
BY NHLBI.

6149
04:02:24,195 --> 04:02:25,330
MAJOR ADVANCES FROM CLINICAL

6150
04:02:25,330 --> 04:02:35,807
TRIALS HAVE BEEN PROMPTED BY

6151
04:02:37,208 --> 04:02:39,778
DATA SHARING A BioLINCC, 218

6152
04:02:39,778 --> 04:02:41,713
SUBMISSIONS, VARIOUS ASPECTS OF

6153
04:02:41,713 --> 04:02:42,947
INTERPRETING CLINICAL TRIAL DATA

6154
04:02:42,947 --> 04:02:45,450
AND INFERENCE BASED ON

6155
04:02:45,450 --> 04:02:47,652
PARTICIPANT LEVEL DATA.

6156
04:02:47,652 --> 04:02:49,954
MANY STUDIES SUBMITTED DURING

6157
04:02:49,954 --> 04:02:52,057
THE CHALLENGE SPECIFICALLY

6158
04:02:52,057 --> 04:02:52,924
FOCUSED ON HETEROGENEITY

6159
04:02:52,924 --> 04:02:54,659
ESTIMATES INCLUDING BY OUR

6160
04:02:54,659 --> 04:02:58,096
GROUP, MANY FOUND COMMON

6161
04:02:58,096 --> 04:03:01,599
PREDICTORS OF TREATMENT EFFECTS.

6162
04:03:01,599 --> 04:03:04,969
USING SPRINT DATA CONTINUES TO

6163
04:03:04,969 --> 04:03:07,172
BE OF INTEREST WITH PUBLICATIONS

6164
04:03:07,172 --> 04:03:10,542
WITH VARIOUS NOVEL AND EMERGING

6165
04:03:10,542 --> 04:03:11,309
STRATEGIES.

6166
04:03:11,309 --> 04:03:13,511
WHAT IS THE DIFFERENCE BETWEEN

6167
04:03:13,511 --> 04:03:14,479
APPROACHES TO INDIVIDUALIZING

6168
04:03:14,479 --> 04:03:18,550
TREATMENT EFFECT ESTIMATES? 

6169
04:03:18,550 --> 04:03:21,052
IT CAN BE CLASSIFIED A

6170
04:03:21,052 --> 04:03:22,253
PROGNOSTIC VERSUS PREDICTIVE.

6171
04:03:22,253 --> 04:03:28,560
STUDIES I MENTIONED HAVE LARGELY

6172
04:03:28,560 --> 04:03:30,795
FOCUSED A PROGNOSTIC.

6173
04:03:30,795 --> 04:03:32,430
CENTRAL ASSUMPTION IS LARGEST

6174
04:03:32,430 --> 04:03:34,499
DRIVER OF EFFECT DIFFERENCES

6175
04:03:34,499 --> 04:03:36,034
BETWEEN INDIVIDUALS IS BASELINE

6176
04:03:36,034 --> 04:03:41,239
ABSOLUTE RISK FOR EFFICACY OR

6177
04:03:41,239 --> 04:03:42,374
SAFETY OUTCOME.

6178
04:03:42,374 --> 04:03:43,942
THERE ARE DIFFERENCES IN

6179
04:03:43,942 --> 04:03:46,544
ABSOLUTE RISK REDUCTION ACROSS

6180
04:03:46,544 --> 04:03:46,978
INDIVIDUALS.

6181
04:03:46,978 --> 04:03:48,847
THE ASSUMPTION THAT INDIVIDUALS

6182
04:03:48,847 --> 04:03:49,848
WITH GIVEN CHARACTERISTICS HAVE

6183
04:03:49,848 --> 04:03:52,250
THE SAME RISK REDUCTION MAY NOT

6184
04:03:52,250 --> 04:03:54,252
BE COMPLETE AND COMPREHENSIVE.

6185
04:03:54,252 --> 04:03:56,354
SEVERAL HIGH RISK INDIVIDUALS WE

6186
04:03:56,354 --> 04:04:02,961
HAVE NON-MODIFIABLE RISK BASED

6187
04:04:02,961 --> 04:04:03,828
ON UNIQUE CHARACTERISTICS,

6188
04:04:03,828 --> 04:04:05,029
PRESENTED IN THE SCHEMATIC ON

6189
04:04:05,029 --> 04:04:07,465
THE RIGHT LEADING TO VARIABLE

6190
04:04:07,465 --> 04:04:08,767
ABSOLUTE RISK REDUCTION FOR

6191
04:04:08,767 --> 04:04:16,107
HIGHER BASE THAN ABSOLUTE RISK.

6192
04:04:16,107 --> 04:04:20,044
THE VALUE CAN BE BUILT TO

6193
04:04:20,044 --> 04:04:21,146
IDENTIFY RISK FACTORS

6194
04:04:21,146 --> 04:04:23,214
INDEPENDENT OF STUDY ARM USING

6195
04:04:23,214 --> 04:04:27,719
THAT APPROACH TO DEFINE HIGH

6196
04:04:27,719 --> 04:04:28,920
POPULATIONS.

6197
04:04:28,920 --> 04:04:29,788
ADDITIONAL LAYER IS ADDED,

6198
04:04:29,788 --> 04:04:32,624
INTERVENTION AND CONTROL ARMS

6199
04:04:32,624 --> 04:04:37,328
ARE BUILT, DIFFERENCE IS

6200
04:04:37,328 --> 04:04:38,430
QUANTIFIED, ASSESSING EVEN

6201
04:04:38,430 --> 04:04:39,731
INTERACTION EFFECTING ON

6202
04:04:39,731 --> 04:04:41,199
RELATIVE RISK SCALE BUT

6203
04:04:41,199 --> 04:04:43,468
OPPORTUNISTIC, WHAT COMES OUT OF

6204
04:04:43,468 --> 04:04:47,372
DATA AND ANALYSIS, BUT NOT

6205
04:04:47,372 --> 04:04:47,705
MODELS.

6206
04:04:47,705 --> 04:04:50,141
PREDICTIVE MODELS ARE EFFECT

6207
04:04:50,141 --> 04:04:52,644
MODELING APPROACH EXAMINE

6208
04:04:52,644 --> 04:04:53,745
WHETHER A PARTICIPANT RECEIVING

6209
04:04:53,745 --> 04:04:57,715
INTERVENTION HAD A GREATER

6210
04:04:57,715 --> 04:05:03,154
REDUCTION IN THEIR ADVERSE EVENT

6211
04:05:03,154 --> 04:05:05,256
PROFILE THAN RECEIVING STANDARD.

6212
04:05:05,256 --> 04:05:07,759
WHAT WE MODEL IS EFFECT ESTIMATE

6213
04:05:07,759 --> 04:05:09,294
OR EFFECT SIZE.

6214
04:05:09,294 --> 04:05:12,997
IF WE COULD DEFINE THIS BASED ON

6215
04:05:12,997 --> 04:05:14,532
PATIENT CHARACTERISTICS, WE HAVE

6216
04:05:14,532 --> 04:05:15,400
POTENTIAL OF GENERALIZING

6217
04:05:15,400 --> 04:05:17,502
OBSERVATION TO PEOPLE NOT

6218
04:05:17,502 --> 04:05:17,769
ENROLLED?

6219
04:05:17,769 --> 04:05:18,002
TRIALS.

6220
04:05:18,002 --> 04:05:20,572
I WANT TO USE THE EXAMPLE OF THE

6221
04:05:20,572 --> 04:05:22,740
RECENT STUDY TO DEFINE APPROACH

6222
04:05:22,740 --> 04:05:26,144
OF PERSONALIZING BENEFIT AND

6223
04:05:26,144 --> 04:05:29,981
RISK OF TREATMENT STRATEGIES IN

6224
04:05:29,981 --> 04:05:30,715
HYPERTENSION.

6225
04:05:30,715 --> 04:05:32,383
WE'VE DONE A FEW.

6226
04:05:32,383 --> 04:05:35,353
HERE ADDRESSING BLOOD PRESSURE

6227
04:05:35,353 --> 04:05:37,522
TREATMENT USING SPRINT AND

6228
04:05:37,522 --> 04:05:39,390
ACCORD DATA.

6229
04:05:39,390 --> 04:05:44,896
I'LL LEAVE THE QR CODE UP FOR

6230
04:05:44,896 --> 04:05:46,197
ONE SECOND.

6231
04:05:46,197 --> 04:05:46,865
PERFECT.

6232
04:05:46,865 --> 04:05:48,500
ON THE LEFT INCLUDES PATIENTS

6233
04:05:48,500 --> 04:05:50,702
WITHOUT DIABETES OR PRIOR

6234
04:05:50,702 --> 04:05:53,571
STROKE, LARGE REDUCTION IN MAJOR

6235
04:05:53,571 --> 04:05:54,639
ADVERSE CARDIOVASCULAR EVENTS,

6236
04:05:54,639 --> 04:05:55,673
INTENSIVE VERSUS STANDARD BLOOD

6237
04:05:55,673 --> 04:06:05,517
PRESSURE LOWERING, SYSTOLIC OF

6238
04:06:05,517 --> 04:06:07,352
120 OR 140.

6239
04:06:07,352 --> 04:06:10,121
THE ACCORD TRIAL WITH DIABETES

6240
04:06:10,121 --> 04:06:12,290
OR SAME INTERVENTION, ON THE

6241
04:06:12,290 --> 04:06:12,724
RIGHT.

6242
04:06:12,724 --> 04:06:14,592
WE CAN ATTRIBUTE TRIAL

6243
04:06:14,592 --> 04:06:18,530
DIFFERENCES, TRIALS WERE JUST

6244
04:06:18,530 --> 04:06:19,731
DIFFERENT.

6245
04:06:19,731 --> 04:06:21,366
DOES SPRINT SUGGEST PROFILES

6246
04:06:21,366 --> 04:06:24,302
WHICH CAN IDENTIFY THOSE IN

6247
04:06:24,302 --> 04:06:27,272
ACCORD THAT BENEFIT FROM BLOOD

6248
04:06:27,272 --> 04:06:29,107
PRESSURE LOWERING SUCH THERE'S

6249
04:06:29,107 --> 04:06:33,511
INDIVIDUALIZED PROFILE TO

6250
04:06:33,511 --> 04:06:35,480
INTENSIVE BLOOD PRESSURE

6251
04:06:35,480 --> 04:06:35,980
LOWERING.

6252
04:06:35,980 --> 04:06:41,052
WHO DO WE STUDY HETEROGENEITY? 

6253
04:06:41,052 --> 04:06:43,454
UNLIKE CASE CONTROL STUDIES

6254
04:06:43,454 --> 04:06:45,323
PEOPLE RESEMBLE EACH OTHER, A

6255
04:06:45,323 --> 04:06:49,294
DISTRIBUTION OF FEATURES, SO,

6256
04:06:49,294 --> 04:06:54,132
FOR EXAMPLE, A WOMAN WITH CKD,

6257
04:06:54,132 --> 04:06:57,502
140/95, A MAN WITH CKD, SIMILAR

6258
04:06:57,502 --> 04:06:58,303
CREATININE, LOWER BLOOD

6259
04:06:58,303 --> 04:07:01,172
PRESSURE, THIRD PERSON A WOMAN

6260
04:07:01,172 --> 04:07:02,340
WITHOUT CKD, LOWER CREATININE,

6261
04:07:02,340 --> 04:07:04,642
SIMILAR BLOOD PRESSURE, AND SO

6262
04:07:04,642 --> 04:07:10,982
FORTH ON ALL COMBINATIONS OF

6263
04:07:10,982 --> 04:07:11,416
FEATURES.

6264
04:07:11,416 --> 04:07:14,953
WHILE I SHOW THIS IN TWO

6265
04:07:14,953 --> 04:07:17,555
DIMENSION, IT CAN BE DONE IN ANY

6266
04:07:17,555 --> 04:07:17,889
DIMENSION.

6267
04:07:17,889 --> 04:07:19,424
A PATIENT WITH ALL

6268
04:07:19,424 --> 04:07:20,625
CHARACTERISTICS HAS MULTIPLE

6269
04:07:20,625 --> 04:07:22,493
SHARED FEATURES WITH SOME

6270
04:07:22,493 --> 04:07:24,696
PEOPLE, CLOSED IN THE

6271
04:07:24,696 --> 04:07:25,997
MULTI-DIMENSIONAL PLANE, AND

6272
04:07:25,997 --> 04:07:30,902
FARTER FROM OTHERS WITH FEWER

6273
04:07:30,902 --> 04:07:31,569
SHARED CHARACTERISTICS.

6274
04:07:31,569 --> 04:07:32,570
THIS HAS BEEN CHALLENGING FOR A

6275
04:07:32,570 --> 04:07:33,104
LONG TIME.

6276
04:07:33,104 --> 04:07:35,740
IF YOU TAKE THIS TRIAL AND MAKE

6277
04:07:35,740 --> 04:07:39,544
A PROJECTION IN ALL PHENOTYPIC

6278
04:07:39,544 --> 04:07:40,445
CHARACTERISTICS, FOCUS ON THE

6279
04:07:40,445 --> 04:07:43,381
LOCATION OF A SINGLE PERSONAL IN

6280
04:07:43,381 --> 04:07:45,249
THE PHENOTYPIC SPACE THEY WILL

6281
04:07:45,249 --> 04:07:47,452
BE SURROUNDED BY OTHER

6282
04:07:47,452 --> 04:07:49,621
INDIVIDUALS LIKE THEM, HALF

6283
04:07:49,621 --> 04:07:51,089
WOULD HAVE RECEIVED THE

6284
04:07:51,089 --> 04:07:53,591
INTERVENTION, THE OTHER HALF

6285
04:07:53,591 --> 04:07:54,225
CONTROL.

6286
04:07:54,225 --> 04:07:55,693
GIVEN FACT RANDOMIZED TRIAL,

6287
04:07:55,693 --> 04:07:59,263
RANDOM ALLOCATION OF EFFECT.

6288
04:07:59,263 --> 04:08:00,565
FARTHER YOU GO, LESSER LOOKS

6289
04:08:00,565 --> 04:08:02,667
LIKE INDEX PERSON.

6290
04:08:02,667 --> 04:08:09,107
THIS CAN BE USED TO INFER

6291
04:08:09,107 --> 04:08:09,874
TREATMENT VERSUS CONTROL BY HOW

6292
04:08:09,874 --> 04:08:12,844
FAR THE TRIAL IS FROM THE INDEX

6293
04:08:12,844 --> 04:08:13,378
PATIENT.

6294
04:08:13,378 --> 04:08:14,812
AND WHETHER THEY RECEIVE

6295
04:08:14,812 --> 04:08:17,548
INTERVENTION OR CONTROL, YOU CAN

6296
04:08:17,548 --> 04:08:19,317
CONDUCT EQUIVALENT FOR THAT

6297
04:08:19,317 --> 04:08:21,719
INDEX PERSON.

6298
04:08:21,719 --> 04:08:23,688
AND WEIGH THEM BY DISTANCE AND

6299
04:08:23,688 --> 04:08:26,524
REPEAT THIS FOR EVERY PERSON IN

6300
04:08:26,524 --> 04:08:29,727
THE TRIAL WHO MAY HAVE A

6301
04:08:29,727 --> 04:08:32,864
DIFFERENT ESTIMATE AND REPEATED

6302
04:08:32,864 --> 04:08:34,632
THROUGHOUT -- FOR THE ENTIRE

6303
04:08:34,632 --> 04:08:36,601
ACTIVATION WHICH ALLOWS AN

6304
04:08:36,601 --> 04:08:37,802
INDIVIDUALIZED HAZARD ESTIMATE

6305
04:08:37,802 --> 04:08:40,772
FOR EACH PERSON'S UNIQUE

6306
04:08:40,772 --> 04:08:41,105
NEIGHBORHOOD.

6307
04:08:41,105 --> 04:08:50,715
THIS IS WHAT WE DID IN SPRINT,

6308
04:08:50,715 --> 04:08:52,150
TOOK ALL PRE-RANDOMIZATION

6309
04:08:52,150 --> 04:08:54,786
FEATURES, AND INCLUDED ALL

6310
04:08:54,786 --> 04:08:56,554
CONTINUOUS CATEGORICAL FEATURES,

6311
04:08:56,554 --> 04:09:01,025
LABS, ANYTHING IN TABLE 1.

6312
04:09:01,025 --> 04:09:02,560
ASSESSED SIMILARITY, USING A

6313
04:09:02,560 --> 04:09:05,830
METRIC FROM 0 TO 1, DISTANCE IS

6314
04:09:05,830 --> 04:09:07,498
0 BETWEEN TWO INDIVIDUALS,

6315
04:09:07,498 --> 04:09:08,900
MATCHED ON CHARACTERISTICS

6316
04:09:08,900 --> 04:09:09,167
PERFECTLY.

6317
04:09:09,167 --> 04:09:14,038
1 REPRESENTS MATCHING ON NONE OF

6318
04:09:14,038 --> 04:09:16,808
THE CHARACTERISTICS, DIGITALIZED

6319
04:09:16,808 --> 04:09:22,280
USING UMAP FOR INTERPRETATION.

6320
04:09:22,280 --> 04:09:25,783
UMAP'S 2D REPRESENTATION HAS

6321
04:09:25,783 --> 04:09:28,419
PROJECTION AND COMPLEX

6322
04:09:28,419 --> 04:09:30,388
ASSOCIATIONS, CONSTRUCTING A

6323
04:09:30,388 --> 04:09:32,890
MODEL THAT FINDS EFFECTS LIKE I

6324
04:09:32,890 --> 04:09:34,892
SHOWED AND OPERATIONALIZE FOR

6325
04:09:34,892 --> 04:09:36,394
ALL SPRINT TRIAL PARTICIPANTS.

6326
04:09:36,394 --> 04:09:39,997
THE OUTPUT OF THAT IS THIS

6327
04:09:39,997 --> 04:09:42,533
OUTCOME MAP.

6328
04:09:42,533 --> 04:09:44,702
EACH DOT IS A PERSON.

6329
04:09:44,702 --> 04:09:46,237
COLOR AND DEPTH INDICATES LOG

6330
04:09:46,237 --> 04:09:49,307
HAZARD RATIO FOR THE PRIMARY

6331
04:09:49,307 --> 04:09:50,274
OUTCOME OF SPRINT.

6332
04:09:50,274 --> 04:09:53,444
ON THE RIGHT NET CLINICAL

6333
04:09:53,444 --> 04:09:56,848
BENEFIT, PRIMARY OUTCOME OR ANY

6334
04:09:56,848 --> 04:09:58,483
ADVERSE EVENT.

6335
04:09:58,483 --> 04:10:01,219
AS YOU CAN SEE, MOST PATIENTS

6336
04:10:01,219 --> 04:10:02,653
BENEFITED FROM THE PRIMARY

6337
04:10:02,653 --> 04:10:03,621
OUTCOME IN SPRINT.

6338
04:10:03,621 --> 04:10:07,258
BUT DEGREE OF BENEFIT VARIES.

6339
04:10:07,258 --> 04:10:08,893
WHILE THIS PROCESS WAS

6340
04:10:08,893 --> 04:10:09,627
COMPUTATIONAL INTENSIVE WE

6341
04:10:09,627 --> 04:10:15,700
FURTHER BUILT LAYER ON TOP,

6342
04:10:15,700 --> 04:10:17,001
IDENTIFYING MINIMUM PATIENT

6343
04:10:17,001 --> 04:10:18,636
FEATURES PRESENT ACROSS MULTIPLE

6344
04:10:18,636 --> 04:10:21,405
NEIGHBORHOODS AND CONSISTENTLY

6345
04:10:21,405 --> 04:10:22,907
ASSOCIATED WITH BENEFIT FOR

6346
04:10:22,907 --> 04:10:25,109
MAJOR CARDIOVASCULAR EVENT FROM

6347
04:10:25,109 --> 04:10:25,676
INTENSIVE BLOOD PRESSURE

6348
04:10:25,676 --> 04:10:29,046
LOWERING, AND SO WE COULD BUILD

6349
04:10:29,046 --> 04:10:30,348
PREDICTIVE MODEL FOR

6350
04:10:30,348 --> 04:10:31,249
INDIVIDUALIZED EFFECT ESTIMATE

6351
04:10:31,249 --> 04:10:35,520
FOR MAJOR CARDIOVASCULAR EVENTS.

6352
04:10:35,520 --> 04:10:38,022
THIS MODEL WITH EIGHT TOP

6353
04:10:38,022 --> 04:10:39,023
FEATURES, COMBINATION SUFFICIENT

6354
04:10:39,023 --> 04:10:42,827
TO IDENTIFY MAJORITY OF

6355
04:10:42,827 --> 04:10:43,528
RESPONSE.

6356
04:10:43,528 --> 04:10:45,329
BASED ON SHAP VALUES, THE

6357
04:10:45,329 --> 04:10:49,167
FEATURES ARE MARKED HERE,

6358
04:10:49,167 --> 04:10:50,701
SIMILAR TO OTHER TRIAL STUDIES.

6359
04:10:50,701 --> 04:10:57,375
THESE WERE THEN USED TO MAKE A

6360
04:10:57,375 --> 04:10:58,709
CALCULATOR, ONLINE CALCULATOR

6361
04:10:58,709 --> 04:11:01,879
THAT CAN PREDICT HAZARD RATIOS

6362
04:11:01,879 --> 04:11:04,715
AND FOR THE CALCULATOR, FEATURES

6363
04:11:04,715 --> 04:11:06,484
WERE BROKEN DOWN, COMPLEX

6364
04:11:06,484 --> 04:11:08,319
FEATURES COMBINATIONS OF OTHER

6365
04:11:08,319 --> 04:11:09,754
FEATURES, WE TAKE NINE INPUTS

6366
04:11:09,754 --> 04:11:11,289
AND GIVE YOU THE PREDICTED

6367
04:11:11,289 --> 04:11:16,994
EFFECT ESTIMATE FOR A PERSON.

6368
04:11:16,994 --> 04:11:19,730
CAN YOU ACCESS THIS ON THE WEB

6369
04:11:19,730 --> 04:11:20,598
PAGE.

6370
04:11:20,598 --> 04:11:22,800
WE HAVE THIS MODEL, AND THIS

6371
04:11:22,800 --> 04:11:25,069
TOOL, CAN HOST IT, IT CAN BE

6372
04:11:25,069 --> 04:11:29,040
EMBEDDED IN EHR, BUT WHAT IF

6373
04:11:29,040 --> 04:11:30,608
WE'RE FINDING SOMETHING SPURIOUS

6374
04:11:30,608 --> 04:11:31,209
IN SPRINT?

6375
04:11:31,209 --> 04:11:35,279
WE SAID IF THERE WAS A PROFILE

6376
04:11:35,279 --> 04:11:36,914
WE EXPECTED IT TO FOLD OVER TO

6377
04:11:36,914 --> 04:11:42,820
ACCORD, IT'S HARD TO BELIEVE

6378
04:11:42,820 --> 04:11:46,090
PATIENTS WITH DIABETES WITH

6379
04:11:46,090 --> 04:11:48,626
FUNDAMENTALLY DIFFERENCE.

6380
04:11:48,626 --> 04:11:50,261
USING ACCORD, ADVERSE

6381
04:11:50,261 --> 04:11:51,262
CARDIOVASCULAR EVENTS STILL,

6382
04:11:51,262 --> 04:11:53,631
CALCULATING EFFECT ESTIMATE FOR

6383
04:11:53,631 --> 04:11:55,633
BENEFIT, USING OUR TOOL, IN THE

6384
04:11:55,633 --> 04:11:56,500
SPRINT TRIAL APPLIED TWO

6385
04:11:56,500 --> 04:11:58,669
PATIENTS IN THE ACCORD TRIAL,

6386
04:11:58,669 --> 04:12:01,639
FOUND A SIGNIFICANT QUANTITATIVE

6387
04:12:01,639 --> 04:12:03,507
INTERACTION SUCH THAT

6388
04:12:03,507 --> 04:12:04,942
INDIVIDUALSIZED PROFILE BASED ON

6389
04:12:04,942 --> 04:12:06,844
SPRINT IDENTIFIED PATIENTS WHO

6390
04:12:06,844 --> 04:12:08,212
BENEFITED FROM INTENSIVE BLOOD

6391
04:12:08,212 --> 04:12:10,615
PRESSURE LOWERING IN ACCORD WITH

6392
04:12:10,615 --> 04:12:12,250
A 30% RELATIVE RISK REDUCTION IN

6393
04:12:12,250 --> 04:12:14,018
THOSE WITH HIGH EFFECT ESTIMATE,

6394
04:12:14,018 --> 04:12:19,657
DEFINED AS LOW MEDIAN RISK, BUT

6395
04:12:19,657 --> 04:12:21,792
IN THE PLOT ON THE RIGHT.

6396
04:12:21,792 --> 04:12:23,427
WE'RE ASSESSING WHAT SURROGATES

6397
04:12:23,427 --> 04:12:24,962
WE CAN USE TO DEFINE.

6398
04:12:24,962 --> 04:12:27,565
WE DON'T HAVE TO CONDUCT

6399
04:12:27,565 --> 04:12:30,234
FIVE-YEAR STUDY TO EVALUATE OUR

6400
04:12:30,234 --> 04:12:30,601
TOOL.

6401
04:12:30,601 --> 04:12:34,839
AS I MENTIONED, WE HAVE SEVERAL

6402
04:12:34,839 --> 04:12:37,008
APPLICATIONS AND VARIATIONS, IN,

6403
04:12:37,008 --> 04:12:39,977
DIAGNOSTICS, DIABETES

6404
04:12:39,977 --> 04:12:41,612
MANAGEMENT, SO FORTH, THAT BUILD

6405
04:12:41,612 --> 04:12:43,915
ON HOW APPROACH EVOLVED OVER

6406
04:12:43,915 --> 04:12:46,984
TIME, ALL AVAILABLE AS RESEARCH

6407
04:12:46,984 --> 04:12:51,689
TOOLS. 

6408
04:12:51,689 --> 04:12:55,293
KEY TAKEWAYS, CLINICAL DATA

6409
04:12:55,293 --> 04:13:00,431
SHARING IS INSTRUMENTAL. 

6410
04:13:00,431 --> 04:13:07,338
APPLICATIONS OF mL/AI CAN

6411
04:13:07,338 --> 04:13:08,639
OPERATIONAL MODELS.

6412
04:13:08,639 --> 04:13:10,041
THERE ARE CHALLENGES.

6413
04:13:10,041 --> 04:13:15,546
WHAT IS THE GOLD STANDARD? 

6414
04:13:15,546 --> 04:13:16,981
THERE IS NONE.

6415
04:13:16,981 --> 04:13:19,250
WE'RE BUILDING COMPLEX TREATMENT

6416
04:13:19,250 --> 04:13:23,888
EFFECTS, RIGOROUS EVALUATION OF

6417
04:13:23,888 --> 04:13:25,856
EXISTING MODELS TO ASSESS

6418
04:13:25,856 --> 04:13:27,491
DETECTION OF THESE

6419
04:13:27,491 --> 04:13:30,027
INDIVIDUALIZED EFFECTS.

6420
04:13:30,027 --> 04:13:31,195
HOW DO TRIALS WORK?

6421
04:13:31,195 --> 04:13:32,196
REPRESENTATION IN TRIALS HAS

6422
04:13:32,196 --> 04:13:36,667
BEEN AN ISSUE FOR A LONG TIME.

6423
04:13:36,667 --> 04:13:37,702
AS I MENTIONED, VALIDATION

6424
04:13:37,702 --> 04:13:40,171
REQUIRES US TO DO PRAGMATIC

6425
04:13:40,171 --> 04:13:46,677
DESIGNS AND BUILD NETWORKS TO

6426
04:13:46,677 --> 04:13:47,611
ASSESS SUFFICIENTLY.

6427
04:13:47,611 --> 04:13:48,245
THANK YOU.

6428
04:13:48,245 --> 04:13:50,147
ALL THANKS TO MY AMAZING LAB

6429
04:13:50,147 --> 04:13:55,386
MEMBERS FOR THE WORK I

6430
04:13:55,386 --> 04:13:57,021
PRESENTED, ESPECIALLY THE

6431
04:13:57,021 --> 04:13:58,422
CARDIOLOGY FELLOW AT YALE, FIRST

6432
04:13:58,422 --> 04:13:59,523
AUTHOR ON THE WORK IN THE

6433
04:13:59,523 --> 04:14:01,459
CLINICAL TRIALS I PRESENTED

6434
04:14:01,459 --> 04:14:01,659
TODAY.

6435
04:14:01,659 --> 04:14:01,959
THANK YOU.

6436
04:14:01,959 --> 04:14:03,461
>> THANK YOU.

6437
04:14:03,461 --> 04:14:04,795
APPRECIATE IT.

6438
04:14:04,795 --> 04:14:07,431
LAST SPEAKER IS DR. CHANG,

6439
04:14:07,431 --> 04:14:08,432
ASSOCIATE PROFESSOR IN

6440
04:14:08,432 --> 04:14:10,401
DEPARTMENT OF POPULATION SCIENCE

6441
04:14:10,401 --> 04:14:14,538
CO-DIRECTOR CENTER FOR KIDNEY

6442
04:14:14,538 --> 04:14:18,709
HEALTH RESEARCH, NEPHROLOGIST AT

6443
04:14:18,709 --> 04:14:19,377
GEISINGER.

6444
04:14:19,377 --> 04:14:21,545
IF WE COULD ADD 15 MINUTES TO

6445
04:14:21,545 --> 04:14:24,615
NOW, EXPECTING THAT YOUR TALK

6446
04:14:24,615 --> 04:14:26,584
ABOUT END AT 3:54, AND THE

6447
04:14:26,584 --> 04:14:30,087
SESSION ENDS AT 4:00.

6448
04:14:30,087 --> 04:14:35,226
I'M GOING TO EXTEND THIS AND LET

6449
04:14:35,226 --> 04:14:36,227
THE AUDIENCE KNOW THAT WE'RE

6450
04:14:36,227 --> 04:14:37,161
GOING TO GO THAT LONG.

6451
04:14:37,161 --> 04:14:40,498
IF YOU HAVE TO LEAVE AT 4:00

6452
04:14:40,498 --> 04:14:42,566
THAT'S PERFECTLY FINE.

6453
04:14:42,566 --> 04:14:43,768
DR. CHANG, YOU MAY PROCEED.

6454
04:14:43,768 --> 04:14:46,537
>> THANK YOU SO MUCH.

6455
04:14:46,537 --> 04:14:52,777
THANKS TO THE NHLBI AND AMAZING

6456
04:14:52,777 --> 04:14:58,315
PRESENTERS WITH TALKS TODAY.

6457
04:14:58,315 --> 04:14:59,750
MY DISCLOSURES.

6458
04:14:59,750 --> 04:15:01,919
SO, I ABSORBED A LOT OF GREAT

6459
04:15:01,919 --> 04:15:03,254
INFORMATION FROM EVERYTHING THAT

6460
04:15:03,254 --> 04:15:05,756
PEOPLE HAVE SAID BEFORE ME.

6461
04:15:05,756 --> 04:15:07,091
AND THE COMMENTS.

6462
04:15:07,091 --> 04:15:13,431
AND SO I'M PRESENTING THIS FROM

6463
04:15:13,431 --> 04:15:16,067
VIEW OF CLINICIAN-SCIENTIST, AND

6464
04:15:16,067 --> 04:15:18,469
TRYING TO UNDERSTAND ALSO HOW

6465
04:15:18,469 --> 04:15:21,505
WOULD YOU ACTUALLY USE THESE

6466
04:15:21,505 --> 04:15:24,175
TOOLS IN CLINICAL PRACTICE.

6467
04:15:24,175 --> 04:15:25,676
WE'RE OFTEN WORKING ON QUALITY

6468
04:15:25,676 --> 04:15:27,111
IMPROVEMENT WITH OUR POPULATION

6469
04:15:27,111 --> 04:15:32,249
HEALTH GROUP, AND A LARGE HEALTH

6470
04:15:32,249 --> 04:15:33,818
SYSTEM, AND WE'RE OFTEN SENSING

6471
04:15:33,818 --> 04:15:35,419
INFORMATION ABOUT A.I. TOOLS AND

6472
04:15:35,419 --> 04:15:37,521
PEOPLE WANTING TO ADOPT

6473
04:15:37,521 --> 04:15:38,322
DIFFERENT THINGS.

6474
04:15:38,322 --> 04:15:40,357
I'M GOING TO DESCRIBE EXISTING

6475
04:15:40,357 --> 04:15:45,529
LITERATURE ON USE OF A.I. AND

6476
04:15:45,529 --> 04:15:46,597
PREDICTING HYPERTENSIVE OR

6477
04:15:46,597 --> 04:15:48,032
SEQUELAE, CHRONIC KIDNEY DISEASE

6478
04:15:48,032 --> 04:15:49,467
AS EXAMPLE CONDITION, DESCRIBE

6479
04:15:49,467 --> 04:15:50,868
UNMET NEEDS AND POTENTIAL FOR

6480
04:15:50,868 --> 04:15:53,737
A.I. TO IMPROVE EARLY DIAGNOSIS

6481
04:15:53,737 --> 04:15:54,271
AND MANAGEMENT.

6482
04:15:54,271 --> 04:15:56,407
AND DESCRIBE KEY CHALLENGES AND

6483
04:15:56,407 --> 04:16:06,517
BARRIERS USING A.I. IN THIS

6484
04:16:06,517 --> 04:16:06,750
CONTEXT.

6485
04:16:06,750 --> 04:16:09,787
WE'VE HEARD WILL BLOOD PRESSURE

6486
04:16:09,787 --> 04:16:16,694
AND -- ABOUT BLOOD PRESSURE AND

6487
04:16:16,694 --> 04:16:19,563
END ORGAN DAMAGE, HOW CAN WE

6488
04:16:19,563 --> 04:16:20,965
PREDICT BETTER, FIT PREDICTION

6489
04:16:20,965 --> 04:16:22,600
MODEL INTO EXISTING CLINICAL

6490
04:16:22,600 --> 04:16:24,802
WORKFLOW, WHICH IS OFTEN VERY

6491
04:16:24,802 --> 04:16:27,204
CHALLENGING. 

6492
04:16:27,204 --> 04:16:29,006
AND DO WE HAVE EVIDENCE THAT USE

6493
04:16:29,006 --> 04:16:34,411
OF A.I. PREDICTION MODELS CAN

6494
04:16:34,411 --> 04:16:35,546
HELP OUTCOMES.

6495
04:16:35,546 --> 04:16:38,082
THIS IS WAYS THAT IT COULD BE

6496
04:16:38,082 --> 04:16:39,583
USED, POPULATION OR HEALTH

6497
04:16:39,583 --> 04:16:42,019
SYSTEM LEVEL WHERE YOU CAN

6498
04:16:42,019 --> 04:16:43,154
IDENTIFY HYPERTENSIVE PATIENTS

6499
04:16:43,154 --> 04:16:44,755
AT PARTICULARLY HIGH RISK FOR

6500
04:16:44,755 --> 04:16:46,056
END ORGAN DAMAGE, AND MAYBE

6501
04:16:46,056 --> 04:16:48,959
THERE'S SOME NEED FOR SCREENING

6502
04:16:48,959 --> 04:16:49,894
OF HYPERTENSION-RELATED

6503
04:16:49,894 --> 04:16:50,561
CONDITIONS.

6504
04:16:50,561 --> 04:16:56,133
YOU CAN ALSO POTENTIALLY USE

6505
04:16:56,133 --> 04:16:59,637
RISK THRESHOLDS, AS PEOPLE

6506
04:16:59,637 --> 04:17:05,109
MENTIONED, THERE'S CLINICIAN

6507
04:17:05,109 --> 04:17:05,676
INERTIA.

6508
04:17:05,676 --> 04:17:09,947
AT THE INDIVIDUAL LEVEL, CAN WE

6509
04:17:09,947 --> 04:17:11,482
INCORPORATE, CLINICIANS IN

6510
04:17:11,482 --> 04:17:12,449
SHARED DECISION MAKING WITH

6511
04:17:12,449 --> 04:17:13,551
PATIENTS SO THEY UNDERSTAND

6512
04:17:13,551 --> 04:17:17,388
RISKS AND THAT MAY ACTUALLY HELP

6513
04:17:17,388 --> 04:17:22,193
DRIVE DECISION MAKING AND

6514
04:17:22,193 --> 04:17:25,462
ADDRESS CLINICAL INERTIA.

6515
04:17:25,462 --> 04:17:28,632
HEART FAILURE, I'M TOUCHING

6516
04:17:28,632 --> 04:17:29,200
BRIEFLY.

6517
04:17:29,200 --> 04:17:32,603
APOLOGIES TO THOSE THAT STUDY

6518
04:17:32,603 --> 04:17:32,903
EXTENSIVELY.

6519
04:17:32,903 --> 04:17:37,541
1 TO 2%, 4% ABOVE 65 TO 70 YEARS

6520
04:17:37,541 --> 04:17:39,376
OF AGE, ARE MORTALITY IS HIGH.

6521
04:17:39,376 --> 04:17:46,050
IN TERMS OF A.I. LITERATURE,

6522
04:17:46,050 --> 04:17:48,519
REVIEWS SHOWING THAT ARE IN

6523
04:17:48,519 --> 04:17:49,820
VARIOUS STUDIES THERE IS A LOT

6524
04:17:49,820 --> 04:17:53,557
OF POTENTIAL BIAS IN VALIDATION

6525
04:17:53,557 --> 04:17:55,426
PROCEDURES, LACK OF ADDRESSING

6526
04:17:55,426 --> 04:17:56,927
CALIBRATION WAS COMMON IN A LOT

6527
04:17:56,927 --> 04:17:58,596
OF PUBLISHED PAPERS.

6528
04:17:58,596 --> 04:18:01,865
AND NO EVIDENCE OF SUPERIORITY

6529
04:18:01,865 --> 04:18:05,135
OVER LOGISTIC REGRESSION FOR

6530
04:18:05,135 --> 04:18:06,036
PREDICTING HEART FAILURE

6531
04:18:06,036 --> 04:18:07,538
REHOSPITALIZATION, MAYBE SOME

6532
04:18:07,538 --> 04:18:08,305
IMPROVEMENT FOR PREDICTING

6533
04:18:08,305 --> 04:18:09,006
MORTALITY WAS SHOWN.

6534
04:18:09,006 --> 04:18:10,941
AND OF COURSE THERE'S TONS OF

6535
04:18:10,941 --> 04:18:13,911
HETEROGENEITY BETWEEN THE

6536
04:18:13,911 --> 04:18:17,314
STUDIES AND POPULATION.

6537
04:18:17,314 --> 04:18:19,483
THINKING ABOUT OTHER

6538
04:18:19,483 --> 04:18:20,985
COMPLICATIONS, MILD COGNITIVE

6539
04:18:20,985 --> 04:18:22,319
IMPAIRMENT AND DEMENTIA AFFECTS

6540
04:18:22,319 --> 04:18:24,555
LOTS OF PEOPLE IN OUR SOCIETY

6541
04:18:24,555 --> 04:18:30,761
GETTING ORDINARY,  UP TO  1/3 OF

6542
04:18:30,761 --> 04:18:31,428
OLDER ADULTS.

6543
04:18:31,428 --> 04:18:34,164
INTENSIVE BLOOD PRESSURE CONTROL

6544
04:18:34,164 --> 04:18:36,100
MAY PREVENT COGNITIVE IMPAIRMENT

6545
04:18:36,100 --> 04:18:36,867
FROM SPRINT MIND.

6546
04:18:36,867 --> 04:18:42,139
AND THERE HAVE BEEN VARIOUS RISK

6547
04:18:42,139 --> 04:18:43,340
PREDICTIONS DEVELOPED USING

6548
04:18:43,340 --> 04:18:45,075
VARIOUS CLINICAL FACTORS AND A

6549
04:18:45,075 --> 04:18:48,245
LOT HAVE BEEN VALIDATED IN OTHER

6550
04:18:48,245 --> 04:18:48,812
COHORTS.

6551
04:18:48,812 --> 04:18:49,880
THERE'S OTHER SOURCES OF DATA

6552
04:18:49,880 --> 04:18:51,515
THAT ARE USUALLY IN SMALLER

6553
04:18:51,515 --> 04:18:53,717
STUDIES LOOKING AT BRAIN

6554
04:18:53,717 --> 04:18:54,485
IMAGING, GENETICS, INFORMATION

6555
04:18:54,485 --> 04:19:00,824
ON TOP OF RISK SCORES, VOICE

6556
04:19:00,824 --> 04:19:04,328
DATA, COGNITIVE FUNCTION TESTS,

6557
04:19:04,328 --> 04:19:08,399
BIOSAMPLES, A LOT OF RESEARCH

6558
04:19:08,399 --> 04:19:10,234
AND POTENTIAL WITH ANIMAL MODELS

6559
04:19:10,234 --> 04:19:13,504
THAT CAN IDENTIFY FACTORS THAT

6560
04:19:13,504 --> 04:19:19,109
ARE NOT EASY FOR HUMANS TO SEE

6561
04:19:19,109 --> 04:19:19,543
EASILY.

6562
04:19:19,543 --> 04:19:22,946
I'M POINTING OUT ONE PARTICULAR

6563
04:19:22,946 --> 04:19:24,682
STUDY, U.K. BIOBANK, RESEARCHERS

6564
04:19:24,682 --> 04:19:29,720
HAD USED DATA FROM THIS TO LOOK

6565
04:19:29,720 --> 04:19:34,458
AT 366 CANDIDATE VARIABLES TO

6566
04:19:34,458 --> 04:19:35,192
PREDICT DEMENTIA.

6567
04:19:35,192 --> 04:19:37,695
U.K. BIOBANK THEY HAVE REGULAR

6568
04:19:37,695 --> 04:19:41,298
CLINICAL PREDICTORS, ALSO

6569
04:19:41,298 --> 04:19:44,134
ADDITIONAL TESTS, THEY HAVE

6570
04:19:44,134 --> 04:19:46,370
APOE4, A GENETIC RISK FACTOR, A

6571
04:19:46,370 --> 04:19:52,476
GAME WHERE THEY HAVE TO MATCH

6572
04:19:52,476 --> 04:19:57,281
PAIRS OF CARDS, OTHER THINGS.

6573
04:19:57,281 --> 04:20:02,986
THEY HAD A MUCH BETTER AUC THAN

6574
04:20:02,986 --> 04:20:06,357
CLINICAL RISK SCORES, AND GOOD

6575
04:20:06,357 --> 04:20:07,057
CALIBRATION.

6576
04:20:07,057 --> 04:20:11,929
THIS WILL NEED EXTERNAL

6577
04:20:11,929 --> 04:20:12,363
VALIDATION.

6578
04:20:12,363 --> 04:20:15,899
IN TERMS OF CHRONIC KIDNEY

6579
04:20:15,899 --> 04:20:18,736
DISEASE, THIS AFFECTS 1 IN 7

6580
04:20:18,736 --> 04:20:20,170
U.S. ADULTS, COMMON WITH

6581
04:20:20,170 --> 04:20:22,439
HYPERTENSION, MOST COMMON RISK

6582
04:20:22,439 --> 04:20:28,145
FACTORS DIABETES, HYPERTENSION,

6583
04:20:28,145 --> 04:20:31,248
YOU CAN CONSIDER CONSIDER CKD

6584
04:20:31,248 --> 04:20:33,751
AND IT'S IMPORTANT TO POINT OUT

6585
04:20:33,751 --> 04:20:37,121
PATIENTS HAVE NO IDEA THEY HAVE

6586
04:20:37,121 --> 04:20:38,122
CHRONIC KIDNEY DISEASE.

6587
04:20:38,122 --> 04:20:41,625
THIS IS THE SCHEMA THAT WE USE

6588
04:20:41,625 --> 04:20:52,035
TO CLASSIFY KIDNEY DISEASE BY

6589
04:20:52,035 --> 04:20:52,736
ESTIMATED GLOMULAR FILTRATION

6590
04:20:52,736 --> 04:20:54,338
RATE, OR A URINE TEST FOR

6591
04:20:54,338 --> 04:20:55,739
PATIENTS AT RISK, YOU CAN USE

6592
04:20:55,739 --> 04:20:59,476
THAT TO PREDICT RISK IN BOTH OF

6593
04:20:59,476 --> 04:21:01,545
THOSE THINGS ON TOP OF EACH

6594
04:21:01,545 --> 04:21:02,980
OTHER CAN DRIVE DECISION MAKING

6595
04:21:02,980 --> 04:21:08,919
IN TERMS OF HOW  AGGRESSIVE YOU

6596
04:21:08,919 --> 04:21:12,890
TREAT AND REFERRAL PATTERNS.

6597
04:21:12,890 --> 04:21:15,592
THIS HAS BEEN INTEGRATED INTO A

6598
04:21:15,592 --> 04:21:20,931
RISK EQUATION SCORE, WORK DONE

6599
04:21:20,931 --> 04:21:25,669
WITH MANY COHORTS AROUND THE

6600
04:21:25,669 --> 04:21:26,003
WORLD.

6601
04:21:26,003 --> 04:21:31,442
SOURCE DATA FROM CANADA. 

6602
04:21:31,442 --> 04:21:35,612
THEY HAD EXCELLENT

6603
04:21:35,612 --> 04:21:38,248
DISCRIMINATION AUC 0.9

6604
04:21:38,248 --> 04:21:39,249
PREDICTING KIDNEY FAILURE,

6605
04:21:39,249 --> 04:21:41,418
CALIBRATION CAN BE AN ISSUE

6606
04:21:41,418 --> 04:21:43,187
SOMETIMES, ESPECIALLY FOR THE

6607
04:21:43,187 --> 04:21:45,088
NON-NORTH AMERICAN COHORTS

6608
04:21:45,088 --> 04:21:47,024
INCLUDED IN THE STUDY.

6609
04:21:47,024 --> 04:21:50,093
SO THIS IS A STANDARD -- SOME

6610
04:21:50,093 --> 04:21:51,962
HAS FLOWED INTO ELECTRONIC

6611
04:21:51,962 --> 04:21:52,930
HEALTH RECORDS.

6612
04:21:52,930 --> 04:21:55,332
IT'S NOT UNIVERSAL QUITE YET BUT

6613
04:21:55,332 --> 04:21:56,433
THIS REALLY IS PROBABLY ONE OF

6614
04:21:56,433 --> 04:22:02,139
THE MAIN THINGS WE WILL BE USING

6615
04:22:02,139 --> 04:22:03,240
TO DRIVE DECISION MAKING, WE'D

6616
04:22:03,240 --> 04:22:06,877
LIKE TO KEEP ROLLING OUT.

6617
04:22:06,877 --> 04:22:12,349
ONE OF THE PROBLEMS, YOU NEED

6618
04:22:12,349 --> 04:22:15,619
ALBUMIN CREATININE RATIO TO HELP

6619
04:22:15,619 --> 04:22:16,353
RISK STRATIFY KIDNEY DISEASE,

6620
04:22:16,353 --> 04:22:20,023
AND YOU CAN SEE AMONG PATIENTS

6621
04:22:20,023 --> 04:22:21,758
WITH DIABETES OR HYPERTENSION AT

6622
04:22:21,758 --> 04:22:28,899
RISK, VERY FEW END UP GETTING

6623
04:22:28,899 --> 04:22:30,968
ALBUMINEREA SCREENING, 5% FOR

6624
04:22:30,968 --> 04:22:32,836
HYPERTENSION, THAT RESULTS IN

6625
04:22:32,836 --> 04:22:34,571
UNDERDIAGNOSIS OF CHRONIC KIDNEY

6626
04:22:34,571 --> 04:22:36,206
DISEASE AND PROBABLY CONTRIBUTES

6627
04:22:36,206 --> 04:22:38,809
TO AWARENESS PROBLEM.

6628
04:22:38,809 --> 04:22:40,377
AND ALSO THERE'S A LOT OF

6629
04:22:40,377 --> 04:22:42,479
REASONS WE'RE NOT OPTIMIZING USE

6630
04:22:42,479 --> 04:22:43,881
OF MEDICATIONS AND GETTING BLOOD

6631
04:22:43,881 --> 04:22:45,749
PRESSURE UNDER CONTROL BUT

6632
04:22:45,749 --> 04:22:50,020
THAT'S DEFINITELY CONTRIBUTING

6633
04:22:50,020 --> 04:22:51,989
TO THAT.

6634
04:22:51,989 --> 04:22:54,291
IMAGINE AN A.I. RISK SCORE

6635
04:22:54,291 --> 04:22:56,159
THAT'S ABLE TO STRATIFY

6636
04:22:56,159 --> 04:22:57,027
HYPERTENSION PATIENTS INTO

6637
04:22:57,027 --> 04:23:01,832
HIGHER OR LOWER BUCKETS OF CKD

6638
04:23:01,832 --> 04:23:06,637
RISK, YOU CAN IMPLEMENT

6639
04:23:06,637 --> 04:23:09,072
POPULATION LEVEL STRATEGY TO

6640
04:23:09,072 --> 04:23:10,707
IMPROVE ALBUMINEREA SCREENING

6641
04:23:10,707 --> 04:23:12,776
THROUGH NUDGES, IMPROVE

6642
04:23:12,776 --> 04:23:15,612
ADHERENCE, AMONG THOSE WHO HAVE

6643
04:23:15,612 --> 04:23:18,248
KIDNEY DISEASE OR COULD QUALIFY

6644
04:23:18,248 --> 04:23:20,450
FOR TREATMENT, THAT MAY INFORM

6645
04:23:20,450 --> 04:23:22,619
CLINICAL DECISION MAKING AND

6646
04:23:22,619 --> 04:23:26,123
IMPROVE THE USE OF CARDIO RENAL

6647
04:23:26,123 --> 04:23:27,891
RISK REDUCING TREATMENTS.

6648
04:23:27,891 --> 04:23:29,626
SO I THINK THERE'S BEEN QUITE A

6649
04:23:29,626 --> 04:23:35,332
FEW STUDIES ON USE OF A.I. CKD.

6650
04:23:35,332 --> 04:23:37,200
I HAVE A COUPLE.

6651
04:23:37,200 --> 04:23:38,702
BOTTOM LINE, THERE'S A LOT OF

6652
04:23:38,702 --> 04:23:41,338
STUDIES, SOME HAVE EXTERNAL

6653
04:23:41,338 --> 04:23:43,874
VALIDATION, SOME DON'T.

6654
04:23:43,874 --> 04:23:47,578
DIFFERENT OUTCOMES.

6655
04:23:47,578 --> 04:23:49,212
SOME USE OTHER BIOMARKERS NOT

6656
04:23:49,212 --> 04:23:51,181
REGULARLY COLLECTED IN CLINICAL

6657
04:23:51,181 --> 04:23:53,817
PRACTICE, AND OF COURSE WILL

6658
04:23:53,817 --> 04:23:55,218
IMPROVE THE RISK PREDICTION.

6659
04:23:55,218 --> 04:23:58,288
THESE ARE TWO STUDIES THAT I'M

6660
04:23:58,288 --> 04:24:01,458
GOING FOCUS ON MORE HERE, SO

6661
04:24:01,458 --> 04:24:04,861
THIS FIRST ONE WAS A NICE STUDY

6662
04:24:04,861 --> 04:24:08,365
DONE USING ADMINISTRATIVE DATA

6663
04:24:08,365 --> 04:24:10,200
FROM CANADA, MANITOBA, SO THEY

6664
04:24:10,200 --> 04:24:14,037
HAD 77,000 IN THE COHORTS,

6665
04:24:14,037 --> 04:24:16,673
VALIDATED RESULTS IN EXTERNAL

6666
04:24:16,673 --> 04:24:18,008
ALBERTA, CANADA, COHORT.

6667
04:24:18,008 --> 04:24:20,777
AND THIS ONE REQUIRED THEM TO

6668
04:24:20,777 --> 04:24:21,745
HAVE EGFR GREATER THAN 10.

6669
04:24:21,745 --> 04:24:26,350
AND THEY HAD TO HAVE THE RATIO,

6670
04:24:26,350 --> 04:24:28,085
THAT URINE TEST, AVAILABLE.

6671
04:24:28,085 --> 04:24:29,686
THEY LOOKED AT OTHER COMMONLY

6672
04:24:29,686 --> 04:24:31,588
MEASURED LABS THAT COME UP IN

6673
04:24:31,588 --> 04:24:32,789
CLINICAL PRACTICE.

6674
04:24:32,789 --> 04:24:35,492
AND THEN THE OUTCOME WAS 40%

6675
04:24:35,492 --> 04:24:39,863
DECLINE IN EGFR, KIDNEY FAILURE,

6676
04:24:39,863 --> 04:24:44,468
AN ACCEPTED OUTCOME FOR KIDNEY

6677
04:24:44,468 --> 04:24:44,901
PROBLEMS.

6678
04:24:44,901 --> 04:24:51,942
AND THEY USED RANDOM FORCE.

6679
04:24:51,942 --> 04:24:54,478
AND SO OVERALL NOT SURPRISING

6680
04:24:54,478 --> 04:24:59,683
THEY WERE ABLE TO PREDICT KIDNEY

6681
04:24:59,683 --> 04:25:00,917
FAILURE AND EGFR DECLINE, ABLE

6682
04:25:00,917 --> 04:25:03,186
TO COMPARE IT TO SORT OF THE

6683
04:25:03,186 --> 04:25:04,321
PREEXISTING MODEL THAT I

6684
04:25:04,321 --> 04:25:07,357
MENTIONED SO HEAT MAP MODEL

6685
04:25:07,357 --> 04:25:10,027
BASED OFF EGFR AND ACR CATEGORY,

6686
04:25:10,027 --> 04:25:12,095
AND SHOW THERE'S SIGNIFICANT

6687
04:25:12,095 --> 04:25:14,498
IMPROVEMENT IN THE AUC COMPARED

6688
04:25:14,498 --> 04:25:19,002
TO THAT, AND THROW IN OTHER

6689
04:25:19,002 --> 04:25:20,504
CLINICAL FACTORS LIKE DIABETES,

6690
04:25:20,504 --> 04:25:21,938
HYPERTENSION, STROKE, ET CETERA,

6691
04:25:21,938 --> 04:25:23,907
WE'RE ABLE TO PREDICT BETTER.

6692
04:25:23,907 --> 04:25:26,643
YOU CAN SEE SOME OF THE FACTORS

6693
04:25:26,643 --> 04:25:33,483
THAT WERE IMPORTANT BEYOND ACR

6694
04:25:33,483 --> 04:25:34,851
AND EGFR, UREA, HEMATOCRIT AND

6695
04:25:34,851 --> 04:25:35,652
GLUCOSE.

6696
04:25:35,652 --> 04:25:38,388
THAT WAS A NICE STUDY.

6697
04:25:38,388 --> 04:25:39,923
THEY HAVE PRETTY GOOD

6698
04:25:39,923 --> 04:25:43,627
CALIBRATION THAT THEY SHOW HERE.

6699
04:25:43,627 --> 04:25:44,728
THERE'S EXTERNAL VALIDATION,

6700
04:25:44,728 --> 04:25:51,301
COMMONLY MEASURED LAB DATA USING

6701
04:25:51,301 --> 04:25:52,469
REAL EHR DATA, APPLICABLE.

6702
04:25:52,469 --> 04:25:54,237
YOU REQUIRE PATIENTS TO HAVE ACR

6703
04:25:54,237 --> 04:26:01,244
DATA AND A LOT ARE NOT TESTED

6704
04:26:01,244 --> 04:26:02,446
APPROPRIATELY.

6705
04:26:02,446 --> 04:26:09,319
SO, THIS IS ANOTHER STUDY, THE

6706
04:26:09,319 --> 04:26:19,863
EUROPEAN DATABASE, ALSO INCLUDES

6707
04:26:27,270 --> 04:26:28,171
OTHER COUNTRIES.

6708
04:26:28,171 --> 04:26:29,272
TRY TO PREDICT IF THEY ARE GOING

6709
04:26:29,272 --> 04:26:33,210
TO END UP WITH END STAGE KIDNEY

6710
04:26:33,210 --> 04:26:33,744
DISEASE.

6711
04:26:33,744 --> 04:26:36,379
WHAT THEY FOUND WAS THAT THE

6712
04:26:36,379 --> 04:26:40,317
KFRE, COMPARED TO THE KIDNEY

6713
04:26:40,317 --> 04:26:43,286
FAILURE RISK EQUATION, PREDICTED

6714
04:26:43,286 --> 04:26:45,789
SIMILAR AUC AS ALGORITHM.

6715
04:26:45,789 --> 04:26:46,990
AND HOWEVER THE OTHER

6716
04:26:46,990 --> 04:26:49,292
INTERESTING THING IS THAT YOU

6717
04:26:49,292 --> 04:26:51,928
DON'T REQUIRE THE ACR TO USE THE

6718
04:26:51,928 --> 04:26:52,896
ALGORITHM THAT THEY DEVELOPED,

6719
04:26:52,896 --> 04:26:54,998
THEY ARE ABLE TO GENERATE

6720
04:26:54,998 --> 04:26:59,402
PREDICTION ON ALL THE PATIENTS,

6721
04:26:59,402 --> 04:27:00,337
WHEREAS THE ALBUMINEREA WAS

6722
04:27:00,337 --> 04:27:03,840
AVAILABLE BE ON 30% OF SIX

6723
04:27:03,840 --> 04:27:06,042
MONTH, 16% OF 24-MONTH COHORT,

6724
04:27:06,042 --> 04:27:11,181
IF YOU'RE SEEING A PATIENT IN

6725
04:27:11,181 --> 04:27:13,784
CLINIC THIS MIGHT BE ABLE TO

6726
04:27:13,784 --> 04:27:14,384
GENERATE SOMETHING CLINICALLY

6727
04:27:14,384 --> 04:27:19,923
USEFUL, THIS IS FROM THE PAPER

6728
04:27:19,923 --> 04:27:22,092
OF RISK REPORT, SHOWING THE RISK

6729
04:27:22,092 --> 04:27:26,797
PROFILE OVER TIME, WHICH FACTORS

6730
04:27:26,797 --> 04:27:29,766
ARE PROTECTIVE VERSUS NOT A RISK

6731
04:27:29,766 --> 04:27:33,270
FACTOR, AND THEN THE OVERALL

6732
04:27:33,270 --> 04:27:35,205
RISK, AND WHAT MISSING

6733
04:27:35,205 --> 04:27:36,640
INFORMATION IS NOT THERE THAT

6734
04:27:36,640 --> 04:27:40,811
COULD BE INFORMATIVE AS WELL.

6735
04:27:40,811 --> 04:27:43,647
THIS IS A SIMULATION THAT THEY

6736
04:27:43,647 --> 04:27:46,383
DID WHERE THEY TOOK SEVERAL

6737
04:27:46,383 --> 04:27:50,320
NEPHROLOGISTS AND HAD THEM

6738
04:27:50,320 --> 04:27:53,290
EVALUATE CASES, ACTUAL CASES,

6739
04:27:53,290 --> 04:27:54,191
AND PROVIDE CLASSIFICATION

6740
04:27:54,191 --> 04:27:56,226
WHETHER PATIENTS WERE HIGH RISK

6741
04:27:56,226 --> 04:27:57,227
OR NOT.

6742
04:27:57,227 --> 04:27:59,296
AND THEN COMPARED TO WHAT IF

6743
04:27:59,296 --> 04:28:02,799
THEY USED THEIR ALGORITHMS AND

6744
04:28:02,799 --> 04:28:05,869
COMPARED TO THE CLINICIAN, YOU

6745
04:28:05,869 --> 04:28:08,839
CAN SEE ON THE PART B SECTION

6746
04:28:08,839 --> 04:28:13,410
HERE THAT THEY ARE ABLE TO HAVE

6747
04:28:13,410 --> 04:28:14,311
A GREATER IMPACT ON A

6748
04:28:14,311 --> 04:28:15,345
HYPOTHETICAL SITUATION WHERE YOU

6749
04:28:15,345 --> 04:28:17,147
TAKE THOSE PATIENTS THAT ARE

6750
04:28:17,147 --> 04:28:18,348
HIGH RISK AND GIVE THEM

6751
04:28:18,348 --> 04:28:20,951
SOMETHING TO REDUCE RISK OF

6752
04:28:20,951 --> 04:28:24,421
KIDNEY FAILURE COMPARED TO THE

6753
04:28:24,421 --> 04:28:24,955
EXPERT OPINION.

6754
04:28:24,955 --> 04:28:27,224
SO, THIS WOULD BE A GOOD

6755
04:28:27,224 --> 04:28:28,658
APPROACH WHERE YOU COULD TRY TO

6756
04:28:28,658 --> 04:28:30,760
IDENTIFY THOSE AT HIGHEST RISK

6757
04:28:30,760 --> 04:28:32,295
AND THEN HEALTH CARE IS A

6758
04:28:32,295 --> 04:28:35,365
LIMITED RESOURCE, SO YOU DRIVE

6759
04:28:35,365 --> 04:28:39,502
IT TOWARDS THE HIGHEST RISK

6760
04:28:39,502 --> 04:28:40,370
PATIENTS.

6761
04:28:40,370 --> 04:28:42,472
THAT'S ONE OF THE SCIENTIFIC

6762
04:28:42,472 --> 04:28:44,774
AREAS TRYING TO IMPLEMENT A

6763
04:28:44,774 --> 04:28:50,013
TOOL, WHETHER CKD OR HEART

6764
04:28:50,013 --> 04:28:52,215
FAILURE, OR DEMENTIA, TRY TO

6765
04:28:52,215 --> 04:28:54,818
IMPACT SHARED DECISION MAKING

6766
04:28:54,818 --> 04:28:56,686
AND IMPROVE CLINICAL CARE, MAYBE

6767
04:28:56,686 --> 04:28:58,788
USE IT TO DETECT EARLY

6768
04:28:58,788 --> 04:29:01,191
MODIFIABLE DISEASE AT THE

6769
04:29:01,191 --> 04:29:02,959
POPULATION LEVEL, AND THEN ALSO

6770
04:29:02,959 --> 04:29:04,361
WHAT HAPPENS WHEN YOU

6771
04:29:04,361 --> 04:29:10,834
INCORPORATE ALL THESE OTHER DATA

6772
04:29:10,834 --> 04:29:12,903
SOURCES, WEARABLES, EKG,

6773
04:29:12,903 --> 04:29:15,071
BIOMARKERS AS WELL.

6774
04:29:15,071 --> 04:29:17,374
OTHER GAPS IN KNOWLEDGE, DO WE

6775
04:29:17,374 --> 04:29:19,342
KNOW THAT OUR PATIENTS AND

6776
04:29:19,342 --> 04:29:21,077
PROVIDERS ARE GOING TO ACCEPT

6777
04:29:21,077 --> 04:29:26,349
THE A.I.-BASED ALGORITHMS?

6778
04:29:26,349 --> 04:29:28,318
CAN WE ACTUALLY SHOW, WE NEED TO

6779
04:29:28,318 --> 04:29:30,287
SHOW YOU CAN GET IMPROVEMENT,

6780
04:29:30,287 --> 04:29:33,690
SOME COMMENTS IN THE CHAT,

6781
04:29:33,690 --> 04:29:34,424
MAKING THINGS MORE COMPLICATED

6782
04:29:34,424 --> 04:29:37,494
MAY NOT BE IN THE BEST INTEREST,

6783
04:29:37,494 --> 04:29:40,330
IF THE SIMPLE ANSWER IS HARD

6784
04:29:40,330 --> 04:29:41,031
ENOUGH ITSELF.

6785
04:29:41,031 --> 04:29:43,967
WE NEED TO GENERATE EVIDENCE TO

6786
04:29:43,967 --> 04:29:45,402
SHOW ALL THIS.

6787
04:29:45,402 --> 04:29:49,005
SOME OTHER KEY CHALLENGES AND

6788
04:29:49,005 --> 04:29:50,774
BARRIERS, INTEROPERABILITY, DATA

6789
04:29:50,774 --> 04:29:53,176
SHARING AS MENTIONED BEFORE, AND

6790
04:29:53,176 --> 04:29:54,678
PRIVACY ISSUES AROUND THAT.

6791
04:29:54,678 --> 04:29:56,246
LACK OF VALIDATION OF THE

6792
04:29:56,246 --> 04:29:58,114
COHORTS, AND SOME OF THAT

6793
04:29:58,114 --> 04:30:00,417
PROBABLY IS RELATED TO

6794
04:30:00,417 --> 04:30:01,451
DIFFICULTIES OF SHARING DATA AND

6795
04:30:01,451 --> 04:30:04,154
THERE'S A LOT OF TALK ABOUT

6796
04:30:04,154 --> 04:30:05,021
FEDERATED MODELS.

6797
04:30:05,021 --> 04:30:07,424
EXPLAINABILITY OF A.I. IS VERY

6798
04:30:07,424 --> 04:30:09,392
IMPORTANT IN UNDERSTANDING, YOU

6799
04:30:09,392 --> 04:30:11,695
KNOW, THE DIFFERENT SUPERVISOR

6800
04:30:11,695 --> 04:30:13,897
VERSUS UNSUPERVISED LEARNING,

6801
04:30:13,897 --> 04:30:17,067
AND THEN OF COURSE ON THE

6802
04:30:17,067 --> 04:30:17,834
MANUFACTURERS, REGULATORY

6803
04:30:17,834 --> 04:30:18,802
CONSTRAINTS, LACK OF

6804
04:30:18,802 --> 04:30:21,004
REIMBURSEMENT FOR A.I. AND SOME

6805
04:30:21,004 --> 04:30:23,406
OF THE BIGGER CHALLENGES THAT

6806
04:30:23,406 --> 04:30:26,142
HAVE BEEN DISCUSSED SO FAR ON

6807
04:30:26,142 --> 04:30:31,181
THE UNIQUE PROPERTIES OF THESE

6808
04:30:31,181 --> 04:30:33,483
AND HOW FDA IS ADAPTING TO

6809
04:30:33,483 --> 04:30:34,684
FIGURE OUT THESE PROBLEMS.

6810
04:30:34,684 --> 04:30:38,221
THANK YOU VERY MUCH FOR YOUR

6811
04:30:38,221 --> 04:30:40,156
ATTENTION AND STAYING LATER.

6812
04:30:40,156 --> 04:30:44,894
THIS IS JUST A PHOTOGRAPH OF

6813
04:30:44,894 --> 04:30:46,963
ABIGAIL GEISINGER WHO FOUNDED

6814
04:30:46,963 --> 04:30:48,698
OUR HOSPITAL SYSTEM AT THE AGE

6815
04:30:48,698 --> 04:30:53,203
OF 85 IN 1915, AND I THINK IT'S

6816
04:30:53,203 --> 04:30:55,305
SOMETHING WE LIKE TO REFLECT,

6817
04:30:55,305 --> 04:30:56,606
IMAGINE WHAT SHE WOULD THINK

6818
04:30:56,606 --> 04:30:59,109
ABOUT WHAT'S GONE ON FROM THIS

6819
04:30:59,109 --> 04:31:00,543
HUMBLE HEALTH SYSTEM SHE BUILT

6820
04:31:00,543 --> 04:31:03,046
TO NOW WE'RE TALKING ABOUT

6821
04:31:03,046 --> 04:31:04,481
INCORPORATING A.I. INTO CLINICAL

6822
04:31:04,481 --> 04:31:05,448
DECISION MAKING AND CARE.

6823
04:31:05,448 --> 04:31:09,085
SO THANK YOU VERY MUCH FOR YOUR

6824
04:31:09,085 --> 04:31:09,352
ATTENTION.

6825
04:31:09,352 --> 04:31:12,222
>> THANK YOU, DR. CHANG.

6826
04:31:12,222 --> 04:31:13,223
I THINK WE'LL QUICKLY TRANSITION

6827
04:31:13,223 --> 04:31:14,858
INTO DISCUSSION PERIOD.

6828
04:31:14,858 --> 04:31:17,827
WE'RE GOING TO GO A LITTLE BIT

6829
04:31:17,827 --> 04:31:18,628
BEYOND 4:00.

6830
04:31:18,628 --> 04:31:20,130
I HAVE A QUESTION.

6831
04:31:20,130 --> 04:31:22,399
I'VE BEEN MONITORING THE CHAT.

6832
04:31:22,399 --> 04:31:24,267
I TWO MAIN QUESTIONS FOR OUR

6833
04:31:24,267 --> 04:31:28,304
GROUP OF SPEAKERS FOR THIS

6834
04:31:28,304 --> 04:31:28,538
SESSION.

6835
04:31:28,538 --> 04:31:31,808
SO, AS I WAS LISTENING TO YOUR

6836
04:31:31,808 --> 04:31:33,143
TALKS, MONITORING THE CHAT, I

6837
04:31:33,143 --> 04:31:35,645
THINK THERE'S A PRESSURE POINT

6838
04:31:35,645 --> 04:31:37,981
BETWEEN WHAT I CALL THE LAW OF

6839
04:31:37,981 --> 04:31:40,383
AVERAGES, WHICH ARE THE THINGS

6840
04:31:40,383 --> 04:31:42,552
THAT WE ASSESS IN CLINICAL

6841
04:31:42,552 --> 04:31:45,388
TRIALS. 

6842
04:31:45,388 --> 04:31:45,588
RIGHT?

6843
04:31:45,588 --> 04:31:46,823
ONE GROUP RANDOMIZED, AND THEN

6844
04:31:46,823 --> 04:31:49,793
THE CONTROL, AND ON AVERAGE THE

6845
04:31:49,793 --> 04:31:50,860
GROUP DOES BETTER WITH REGARDS

6846
04:31:50,860 --> 04:31:52,295
TO BLOOD PRESSURE REDUCTION AND

6847
04:31:52,295 --> 04:31:55,899
CARDIOVASCULAR EVENTS THAN THE

6848
04:31:55,899 --> 04:31:56,332
CONTROL.

6849
04:31:56,332 --> 04:31:58,201
OF COURSE, IN CLINICAL CARE WE

6850
04:31:58,201 --> 04:32:00,603
FOCUS ON THE INDIVIDUAL.

6851
04:32:00,603 --> 04:32:04,974
I NOTICE THIS KIND OF BALANCE

6852
04:32:04,974 --> 04:32:06,643
BETWEEN USING EHR ALERTS,

6853
04:32:06,643 --> 04:32:09,245
PERHAPS DRIVEN BY A.I. BOTS,

6854
04:32:09,245 --> 04:32:10,880
CHAT BOTS, WHO WERE IDENTIFYING

6855
04:32:10,880 --> 04:32:15,385
PEOPLE THAT SHOULD BE SCREENED

6856
04:32:15,385 --> 04:32:17,821
FOR HYPERTENSION, OR HAVE THEIR

6857
04:32:17,821 --> 04:32:18,288
HYPERTENSION TREATMENT

6858
04:32:18,288 --> 04:32:20,657
INTENSIFIED BECAUSE THEY ARE

6859
04:32:20,657 --> 04:32:22,292
POORLY CONTROLLED, AND SO IT'S

6860
04:32:22,292 --> 04:32:25,261
ALMOST LIKE A DECISION SUPPORT.

6861
04:32:25,261 --> 04:32:27,664
AND THAT MODEL EVERYONE GETS THE

6862
04:32:27,664 --> 04:32:30,300
SAME SORT OF STEPPED

6863
04:32:30,300 --> 04:32:30,733
INTERVENTION.

6864
04:32:30,733 --> 04:32:32,902
HEY, YOU'RE NOT WELL CONTROLLED.

6865
04:32:32,902 --> 04:32:35,872
YOU SHOULD DO DIET AND EXERCISE,

6866
04:32:35,872 --> 04:32:39,576
AFTER THREE MONTHS YOU SHOULD

6867
04:32:39,576 --> 04:32:40,376
MOVE TO MEDICATION, THAT'S

6868
04:32:40,376 --> 04:32:44,747
SOMETHING I SAW IN THE CHAT, ONE

6869
04:32:44,747 --> 04:32:45,115
SIZE FITS ALL.

6870
04:32:45,115 --> 04:32:48,251
THEN ON THE OTHER HAND I KNOW

6871
04:32:48,251 --> 04:32:49,486
FROM THE TRIALS HUGE

6872
04:32:49,486 --> 04:32:50,887
HETEROGENEITY IN HOW PEOPLE

6873
04:32:50,887 --> 04:32:51,121
RESPOND.

6874
04:32:51,121 --> 04:32:53,623
SO, FOR EXAMPLE, SHOULD WE BE

6875
04:32:53,623 --> 04:32:57,760
USING A.I. RISK SCORE TO

6876
04:32:57,760 --> 04:32:59,429
DETERMINE WHO SHOULD BENEFIT

6877
04:32:59,429 --> 04:33:00,997
FROM DIET, EXERCISE, VERSUS A

6878
04:33:00,997 --> 04:33:04,134
LIFE COACH, WHO HAVE YOU GET A

6879
04:33:04,134 --> 04:33:05,568
CALCIUM CHANNEL BLOCKER VERSUS

6880
04:33:05,568 --> 04:33:07,103
ACE INHIBITOR, ONE PERSON MAY

6881
04:33:07,103 --> 04:33:07,971
BENEFIT OVER ANOTHER.

6882
04:33:07,971 --> 04:33:09,939
SO I WANTED TO ASK THIS GROUP, I

6883
04:33:09,939 --> 04:33:14,110
KNOW YOU'RE ALL IN THE A.I.

6884
04:33:14,110 --> 04:33:14,344
FIELD.

6885
04:33:14,344 --> 04:33:16,579
WHAT DO YOU THINK ABOUT THAT

6886
04:33:16,579 --> 04:33:18,815
SORT OF BALANCE BETWEEN

6887
04:33:18,815 --> 04:33:21,584
TREATMENT FOR ALL VERSUS

6888
04:33:21,584 --> 04:33:25,755
TREATMENT FOR AN INDIVIDUAL? 

6889
04:33:25,755 --> 04:33:28,725
CAN THAT BE PERSONALIZED?

6890
04:33:28,725 --> 04:33:29,726
ANYONE CAN ANSWER.

6891
04:33:29,726 --> 04:33:31,995
>> I SEE MYSELF ON THE
RIGHT.

6892
04:33:31,995 --> 04:33:34,063
I'M NEXT TO YOU.

6893
04:33:34,063 --> 04:33:34,430
>> GO FOR IT.

6894
04:33:34,430 --> 04:33:39,235
>> I THINK THIS IS OF
COURSE

6895
04:33:39,235 --> 04:33:40,236
AGE-OLD TENSION BETWEEN PUBLIC

6896
04:33:40,236 --> 04:33:42,539
HEALTH AND PRECISION MEDICINE.

6897
04:33:42,539 --> 04:33:44,507
AND SOME OF THE GOALS OF THE

6898
04:33:44,507 --> 04:33:47,544
MEETING TODAY, I HOPE, WERE

6899
04:33:47,544 --> 04:33:48,444
ASPIRATIONAL RATHER THAN

6900
04:33:48,444 --> 04:33:48,778
FOUNDATIONAL.

6901
04:33:48,778 --> 04:33:49,045
>> RIGHT.

6902
04:33:49,045 --> 04:33:52,382
>> WHAT IS HAPPENING IN
REALITY.

6903
04:33:52,382 --> 04:33:55,018
SO FOR MANY PATIENTS THESE

6904
04:33:55,018 --> 04:33:55,952
INDIVIDUALIZED STRATEGIES ARE

6905
04:33:55,952 --> 04:33:57,086
PROBABLY NOT SUITABLE FOR

6906
04:33:57,086 --> 04:33:58,621
MAJORITY OF OUR SOCIETY RIGHT

6907
04:33:58,621 --> 04:33:59,255
NOW.

6908
04:33:59,255 --> 04:34:01,357
AND I FEEL LIKE THE HOPE, I MEAN

6909
04:34:01,357 --> 04:34:04,327
THE GOAL OVERALL IS METHODS, AS

6910
04:34:04,327 --> 04:34:05,528
METHODS EMERGE, YOU'RE SEEING

6911
04:34:05,528 --> 04:34:07,630
THIS PATIENT, WHO YOU HAVE

6912
04:34:07,630 --> 04:34:08,932
ACHIEVED THAT STATE WHERE

6913
04:34:08,932 --> 04:34:10,466
PATIENTS ARE ALL SCREENED,

6914
04:34:10,466 --> 04:34:12,001
DIAGNOSED, THEY GET TREATED,

6915
04:34:12,001 --> 04:34:15,939
COME TO YOUR PRACTICE, ARE THERE

6916
04:34:15,939 --> 04:34:19,008
WAYS YOU CAN OPTIMIZE NET

6917
04:34:19,008 --> 04:34:21,411
CLINICAL BENEFIT, THAT'S WHEN

6918
04:34:21,411 --> 04:34:22,879
ALL STRATEGIES ARE UNDEFINED

6919
04:34:22,879 --> 04:34:27,417
RISK OR COMMUNICATING AND SO

6920
04:34:27,417 --> 04:34:27,617
FORTH.

6921
04:34:27,617 --> 04:34:28,017
>> GOOD COMMENT.

6922
04:34:28,017 --> 04:34:30,253
DO YOU HAVE ANYTHING TO ADD?

6923
04:34:30,253 --> 04:34:31,187
>> SURE.

6924
04:34:31,187 --> 04:34:33,356
I MEAN, I WOULD JUST ADD THAT

6925
04:34:33,356 --> 04:34:35,792
THE ANSWER IS WE HAVE A LOT OF

6926
04:34:35,792 --> 04:34:37,227
GREAT TOOLS THAT NEED TO BE

6927
04:34:37,227 --> 04:34:38,528
DEVELOPED, BUT WE ACTUALLY DON'T

6928
04:34:38,528 --> 04:34:42,031
KNOW THE ANSWER TO THE QUESTION.

6929
04:34:42,031 --> 04:34:44,000
BECAUSE WE NEED TO ACTUALLY

6930
04:34:44,000 --> 04:34:48,137
EVALUATE THIS IN A ROBUST WAY,

6931
04:34:48,137 --> 04:34:49,138
AND FIND OUT.

6932
04:34:49,138 --> 04:34:50,673
AND IT GOES TO A COMMENT THAT

6933
04:34:50,673 --> 04:34:52,075
WAS IN THE CHAT BEFORE.

6934
04:34:52,075 --> 04:34:57,013
DO WE NEED THE CADILLAC OR VW

6935
04:34:57,013 --> 04:34:57,780
BEETLE?

6936
04:34:57,780 --> 04:34:58,615
WE DON'T KNOW.

6937
04:34:58,615 --> 04:35:01,384
>> I WOULD ADD ONE THING,
THAT,

6938
04:35:01,384 --> 04:35:04,787
YOU KNOW, IT COULD BE A SHARED

6939
04:35:04,787 --> 04:35:06,623
DECISION MAKING PART OF THE

6940
04:35:06,623 --> 04:35:07,257
PROCESS.

6941
04:35:07,257 --> 04:35:11,861
IT CAN BE BOTH,  AND, WHERE YOU

6942
04:35:11,861 --> 04:35:13,730
MIGHT WANT TO SAY YOUR

6943
04:35:13,730 --> 04:35:14,831
PRESCRIPTION IS MORE PHYSICAL

6944
04:35:14,831 --> 04:35:16,599
ACTIVITY BUT THAT PERSON MAY NOT

6945
04:35:16,599 --> 04:35:17,834
HAVE ANY DESIRE OR INCLINATION

6946
04:35:17,834 --> 04:35:20,637
TO DO THAT ARE.

6947
04:35:20,637 --> 04:35:22,505
SO IT WOULD BE BETTER TO START

6948
04:35:22,505 --> 04:35:24,040
CAN SOMETHING THEY CAN BE

6949
04:35:24,040 --> 04:35:24,674
SUCCESSFUL BEFORE MOVING ON.

6950
04:35:24,674 --> 04:35:27,543
IT HAS TO BE A PARTNERSHIP WHERE

6951
04:35:27,543 --> 04:35:30,046
THE PERSON HAS AGENCY AND OF IN

6952
04:35:30,046 --> 04:35:33,316
DECIDING WHAT THEY CAN TAKE ON

6953
04:35:33,316 --> 04:35:33,750
AS WELL.

6954
04:35:33,750 --> 04:35:35,385
>> THAT MAKES SENSE.

6955
04:35:35,385 --> 04:35:36,386
THANK YOU.

6956
04:35:36,386 --> 04:35:37,387
DR. CHANG, ANYTHING TO ADD?

6957
04:35:37,387 --> 04:35:40,757
I WANT TO MAKE SURE EVERYONE IS

6958
04:35:40,757 --> 04:35:40,957
HEARD.

6959
04:35:40,957 --> 04:35:43,593
>> YEAH, I THINK IT'S --
MAYBE

6960
04:35:43,593 --> 04:35:45,862
IT'S NOT EITHER/OR, FROM AN

6961
04:35:45,862 --> 04:35:47,664
NHLBI FUNDING PERSPECTIVE, OF

6962
04:35:47,664 --> 04:35:49,299
COURSE, THE MONEY IS, YOU KNOW,

6963
04:35:49,299 --> 04:35:52,035
FUNDING HAS TO BE ALLOCATED A

6964
04:35:52,035 --> 04:35:52,368
CERTAIN WAY.

6965
04:35:52,368 --> 04:35:55,004
YEAH, I THINK YOU HAVE TO

6966
04:35:55,004 --> 04:35:56,973
ADDRESS BOTH SIMULTANEOUSLY, YOU

6967
04:35:56,973 --> 04:35:59,509
GOT TO THINK BEYOND, WITH THE

6968
04:35:59,509 --> 04:36:01,811
PATIENTS WE HAVE A PATIENT

6969
04:36:01,811 --> 04:36:03,346
ADVISORY GROUP MEETING, AND I

6970
04:36:03,346 --> 04:36:05,081
DISCUSSED SOME OF THE A.I.

6971
04:36:05,081 --> 04:36:07,083
CONCEPTS WITH THEM, JUST TO GET

6972
04:36:07,083 --> 04:36:09,152
ANY KIND OF SENSE.

6973
04:36:09,152 --> 04:36:11,754
AND I MEAN IT SEEMS FROM A SMALL

6974
04:36:11,754 --> 04:36:13,956
SAMPLE, PATIENTS WANT TO KNOW

6975
04:36:13,956 --> 04:36:16,025
MORE INFORMATION, SO IF THERE IS

6976
04:36:16,025 --> 04:36:17,627
A WAY TO EFFECTIVELY PERSONALIZE

6977
04:36:17,627 --> 04:36:19,962
CARE WITH SOME OF THESE TOOLS,

6978
04:36:19,962 --> 04:36:21,364
THE PATIENTS DO WANT TO KNOW,

6979
04:36:21,364 --> 04:36:24,233
WHETHER IT WORKS OR NOT, THAT'S

6980
04:36:24,233 --> 04:36:24,867
THE NEXT STEP.

6981
04:36:24,867 --> 04:36:29,038
>> THAT'S A GREAT POINT.

6982
04:36:29,038 --> 04:36:29,839
GREAT POINT.

6983
04:36:29,839 --> 04:36:31,774
HERE IS MY SECOND QUESTION.

6984
04:36:31,774 --> 04:36:35,611
I'M LISTENING TO YOUR TALKS.

6985
04:36:35,611 --> 04:36:39,449
DR. LEOPOLD, YOUR TALK MADE ME

6986
04:36:39,449 --> 04:36:39,649
THINK.

6987
04:36:39,649 --> 04:36:41,317
FOR SECONDARY PREVENTION, A LOT

6988
04:36:41,317 --> 04:36:43,820
OF EVIDENCE WITH REGARDS TO

6989
04:36:43,820 --> 04:36:45,788
HYPERTENSION MANAGEMENT, YOU'VE

6990
04:36:45,788 --> 04:36:47,090
BEEN DIAGNOSED ALREADY, REALLY

6991
04:36:47,090 --> 04:36:51,594
SEEMS LIKE IT'S CENTERED IN THE

6992
04:36:51,594 --> 04:36:52,628
EHR.

6993
04:36:52,628 --> 04:37:00,136
AND OBVIOUSLY SOMEPLACE LIKE DR.

6994
04:37:00,136 --> 04:37:02,205
CHANG, GEISINGER HAS A HUGE

6995
04:37:02,205 --> 04:37:03,406
DATABASE, VERY EFFECTIVE.

6996
04:37:03,406 --> 04:37:06,142
BUT FOR PREVENTION HOW DO YOU

6997
04:37:06,142 --> 04:37:08,678
DEAL WITH THE 40-YEAR-OLD MALE,

6998
04:37:08,678 --> 04:37:10,646
MAKING IT, WHO HAS NEVER SEEN A

6999
04:37:10,646 --> 04:37:13,149
DOCTOR, NO TOUCH POINT, THEY ARE

7000
04:37:13,149 --> 04:37:15,017
NOT IN A STUDY.

7001
04:37:15,017 --> 04:37:17,286
IS A.I. OFF LIMITS TO THAT

7002
04:37:17,286 --> 04:37:17,653
PERSON?

7003
04:37:17,653 --> 04:37:20,556
WHERE I'M GOING WITH THIS, NOT

7004
04:37:20,556 --> 04:37:26,496
TO PUT YOU ON THE SPOT, WE KNOW

7005
04:37:26,496 --> 04:37:27,730
THAT SOME SOCIAL MEDIA

7006
04:37:27,730 --> 04:37:30,900
TECHNOLOGY COMPANIES ARE USING

7007
04:37:30,900 --> 04:37:32,001
ONLINE BEHAVIOR TO PREDICT WHAT

7008
04:37:32,001 --> 04:37:34,070
PEOPLE ARE GOING TO PURCHASE OR

7009
04:37:34,070 --> 04:37:36,239
EVEN WHAT MEDICAL CONDITION THEY

7010
04:37:36,239 --> 04:37:37,006
HAVE.

7011
04:37:37,006 --> 04:37:37,206
RIGHT?

7012
04:37:37,206 --> 04:37:41,077
SO, I WANTED TO ASK YOU, DR.

7013
04:37:41,077 --> 04:37:42,912
LEOPOLD, WHEN IT COMES TO

7014
04:37:42,912 --> 04:37:45,014
PRECISION HEALTH, I KNOW THERE'S

7015
04:37:45,014 --> 04:37:48,050
AN ASPIRATIONAL LIST OF DATA

7016
04:37:48,050 --> 04:37:49,252
INPUTS, CURRENTLY IN MY MIND

7017
04:37:49,252 --> 04:37:52,789
THOSE DON'T EXIST FOR PEOPLE WHO

7018
04:37:52,789 --> 04:37:54,524
ARE NOT ACCESSING RESEARCH STUDY

7019
04:37:54,524 --> 04:37:57,493
OR CLINICAL CARE, OR MAYBE I'M

7020
04:37:57,493 --> 04:37:57,693
WRONG.

7021
04:37:57,693 --> 04:37:59,796
>> NO, YOU'RE ABSOLUTELY
RIGHT.

7022
04:37:59,796 --> 04:38:03,633
I MEAN, THIS IS WHERE THIS WHOLE

7023
04:38:03,633 --> 04:38:05,368
CONCEPT OF YOUR ENVIRONMENT,

7024
04:38:05,368 --> 04:38:06,636
YOUR EXPOSURES HAS TO BE

7025
04:38:06,636 --> 04:38:09,305
REALLY -- YOU HAVE TO START

7026
04:38:09,305 --> 04:38:10,740
THINKING OUTSIDE THE USUAL

7027
04:38:10,740 --> 04:38:12,241
MEASURES FOR THIS.

7028
04:38:12,241 --> 04:38:15,244
SO, YOU KNOW, IS IT SOMETHING

7029
04:38:15,244 --> 04:38:17,180
WHERE USING A.I. YOU FIND OUT

7030
04:38:17,180 --> 04:38:21,250
THAT THERE'S JUST A LINK

7031
04:38:21,250 --> 04:38:22,151
BETWEEN, SAY, PURCHASES OF

7032
04:38:22,151 --> 04:38:23,553
TYLENOL BECAUSE YOU HAVE A

7033
04:38:23,553 --> 04:38:27,290
HEADACHE AND THE HEADACHE IS

7034
04:38:27,290 --> 04:38:28,591
REALLY ATTRIBUTABLE TO

7035
04:38:28,591 --> 04:38:30,126
HYPERTENSION, OR CAN YOU -- YOU

7036
04:38:30,126 --> 04:38:32,495
KNOW, IS THERE DATA WE CAN

7037
04:38:32,495 --> 04:38:34,730
COLLECT ELSEWHERE, OUTSITE OF

7038
04:38:34,730 --> 04:38:36,833
THE EHR THAT POINTS US TOWARDS

7039
04:38:36,833 --> 04:38:38,768
SOMEONE WHO IS EITHER AT RISK OR

7040
04:38:38,768 --> 04:38:43,706
WHO IS ABLE TO -- WHO IS GOING

7041
04:38:43,706 --> 04:38:45,107
TO DEVELOP DISEASE?

7042
04:38:45,107 --> 04:38:47,844
AND, AGAIN, WE HAVE TO INTERACT

7043
04:38:47,844 --> 04:38:55,952
WITH, SAY, PEOPLE WHO UNDERSTAND

7044
04:38:55,952 --> 04:38:57,487
HUMAN BEHAVIOR, AND WHAT SHOULD

7045
04:38:57,487 --> 04:38:59,355
BE COLLECTED, WHICH ONES SHOULD

7046
04:38:59,355 --> 04:39:00,957
WE COLLECT.

7047
04:39:00,957 --> 04:39:02,625
>> THAT MAKES SENSE.

7048
04:39:02,625 --> 04:39:05,928
ANYONE ELSE HAVE ANY FEEDBACK

7049
04:39:05,928 --> 04:39:06,696
ABOUT MY QUESTION?

7050
04:39:06,696 --> 04:39:11,367
NOT MEANT TO PICK ON DR.

7051
04:39:11,367 --> 04:39:14,670
LEOPOLD. 

7052
04:39:14,670 --> 04:39:15,571
ANYTHING ELSE?

7053
04:39:15,571 --> 04:39:16,606
>> I AGREE COMPLETELY.

7054
04:39:16,606 --> 04:39:18,941
THE ONLY CONCERN WOULD BE

7055
04:39:18,941 --> 04:39:19,809
PRIVACY, AND HOW APPROPRIATE IT

7056
04:39:19,809 --> 04:39:22,778
IS TO IDENTIFY THIS FEATURE, AND

7057
04:39:22,778 --> 04:39:24,180
FLAG SOMEONE, ESPECIALLY WITH

7058
04:39:24,180 --> 04:39:27,250
MISTRUST OF THE HEALTH SYSTEM OF

7059
04:39:27,250 --> 04:39:33,389
SOCIAL MEDIA ORGANIZATIONS.

7060
04:39:33,389 --> 04:39:35,358
>> THAT MAKES SENSE.

7061
04:39:35,358 --> 04:39:40,162
>> WE HAVEN'T EXPLOITED
SOCIAL

7062
04:39:40,162 --> 04:39:40,596
NETWORKS.

7063
04:39:40,596 --> 04:39:42,465
THE PATIENT MIGHT HAVE PEOPLE IN

7064
04:39:42,465 --> 04:39:43,900
THEIR PERSONAL NETWORKS THEY

7065
04:39:43,900 --> 04:39:44,767
COULD INFLUENCE.

7066
04:39:44,767 --> 04:39:49,305
SO YOU MIGHT NOT BE TALKING

7067
04:39:49,305 --> 04:39:49,505
ABOUT

7068
04:39:49,505 --> 04:39:49,906
[AUDIO DISTORTION]

7069
04:39:49,906 --> 04:39:53,409
BUT YOU COULD REACH OUT TO HAVE

7070
04:39:53,409 --> 04:39:55,177
THEM INFLUENCE OTHER PEOPLE.

7071
04:39:55,177 --> 04:39:59,215
>> MAKES SENSE.

7072
04:39:59,215 --> 04:39:59,515
OKAY.

7073
04:39:59,515 --> 04:40:02,585
IF ANYONE HAS OTHER COMMENTS?

7074
04:40:02,585 --> 04:40:03,686
ONE MORE QUESTION.

7075
04:40:03,686 --> 04:40:05,755
THIS GOES BACK TO A QUESTION

7076
04:40:05,755 --> 04:40:08,958
ASKED IN AN EARLIER SESSION BUT

7077
04:40:08,958 --> 04:40:10,359
IT WAS LEFT UNANSWERED.

7078
04:40:10,359 --> 04:40:16,399
I'M NOT A DATA SCIENTIST, I'M A

7079
04:40:16,399 --> 04:40:17,133
REGULAR HYPERTENSION RESEARCHER.

7080
04:40:17,133 --> 04:40:24,340
THIS IS A MASSIVE AMOUNT MUCH

7081
04:40:24,340 --> 04:40:29,745
DATA, DATA INPUTS. 

7082
04:40:29,745 --> 04:40:33,015
WE TALKED ABOUT GENETICS,

7083
04:40:33,015 --> 04:40:34,216
EPIGENETIC, INSIDE AND OUTSIDE

7084
04:40:34,216 --> 04:40:35,651
THE OFFICE BLOOD PRESSURE,

7085
04:40:35,651 --> 04:40:36,953
PREDICTOR, SO FORTH.

7086
04:40:36,953 --> 04:40:40,122
IT SEEMS OVERWHELMING.

7087
04:40:40,122 --> 04:40:43,526
WITH ALL THAT DATA, THAT WE HAVE

7088
04:40:43,526 --> 04:40:46,829
TO GO THROUGH, HOW DO WE

7089
04:40:46,829 --> 04:40:47,096
INTEGRATE?

7090
04:40:47,096 --> 04:40:49,365
WE DON'T HAVE A SYSTEM SET UP TO

7091
04:40:49,365 --> 04:40:50,433
INTEGRATE IT RIGHT NOW.

7092
04:40:50,433 --> 04:40:55,805
BUT IF YOU HAD ALL THE MONEY IN

7093
04:40:55,805 --> 04:40:58,207
THE WORLD FROM NIH, HOW WOULD

7094
04:40:58,207 --> 04:40:58,975
YOU IMPLEMENT SOMETHING?

7095
04:40:58,975 --> 04:41:01,611
WHAT DOES THE IDEA LOOK LIKE?

7096
04:41:01,611 --> 04:41:03,346
I'M THINKING 20 OR 30 YEARS IN

7097
04:41:03,346 --> 04:41:04,447
THE FUTURE.

7098
04:41:04,447 --> 04:41:06,282
JUST TRYING TO THINK PIE IN THE

7099
04:41:06,282 --> 04:41:06,482
SKY.

7100
04:41:06,482 --> 04:41:11,687
DO HAVE YOU ANY COMMENTS ABOUT

7101
04:41:11,687 --> 04:41:11,887
THAT?

7102
04:41:11,887 --> 04:41:15,257
>> I THINK SOME STUFF,
SPOT ON

7103
04:41:15,257 --> 04:41:17,426
ABOUT RELATION OF EHR.

7104
04:41:17,426 --> 04:41:22,999
IF A CHATBOT DOES EXIST FOR

7105
04:41:22,999 --> 04:41:24,200
PATIENT INTERACTION, MEASUREMENT

7106
04:41:24,200 --> 04:41:28,704
CAN BE DONE FOR AMBULATORY BLOOD

7107
04:41:28,704 --> 04:41:30,439
PRESSURE MEASUREMENT AND

7108
04:41:30,439 --> 04:41:31,207
SYNTHESIZES, NOT JUST

7109
04:41:31,207 --> 04:41:32,208
AGGREGATES, CAN BE USEFUL.

7110
04:41:32,208 --> 04:41:39,115
IT JUST MEANS IT  HAS TO BE

7111
04:41:39,115 --> 04:41:39,749
INDEPENDENTLY VALIDATED.

7112
04:41:39,749 --> 04:41:46,355
>> WE ALSO NEED STANDARDS.

7113
04:41:46,355 --> 04:41:46,722
STANDARDIZATION.

7114
04:41:46,722 --> 04:41:47,089
>> MAKES SENSE.

7115
04:41:47,089 --> 04:41:50,960
I DON'T KNOW HOW YOU WORK WITH

7116
04:41:50,960 --> 04:41:51,627
EHR DATA.

7117
04:41:51,627 --> 04:41:57,900
I'M NOT A DATA SCIENTIST.

7118
04:41:57,900 --> 04:42:00,636
DR. SPATZ MENTIONED SEEMS LIKE A

7119
04:42:00,636 --> 04:42:07,410
BIG EFFORT IS TO CLEAN IT FIRST.

7120
04:42:07,410 --> 04:42:15,818
ONE FINAL QUESTION FROM DR. FINE

7121
04:42:15,818 --> 04:42:16,118
FROM NHLBI.

7122
04:42:16,118 --> 04:42:18,354
DR. LEOPOLD INDICATES WHETHER

7123
04:42:18,354 --> 04:42:21,190
IMPROVEMENT CARES WOULD BE

7124
04:42:21,190 --> 04:42:23,793
HELPFUL FOR EVENTS YEARS IN THE

7125
04:42:23,793 --> 04:42:26,896
FUTURE, REQUIRING LARGE SAMPLES,

7126
04:42:26,896 --> 04:42:28,097
RANDOMIZATION OR EQUIVALENT AND

7127
04:42:28,097 --> 04:42:29,565
LONG PERIODS OF OBSERVATION.

7128
04:42:29,565 --> 04:42:31,667
WHAT ARE SOLUTIONS TO THE COST

7129
04:42:31,667 --> 04:42:32,802
OF ROBUST VALIDATION, WHAT ARE

7130
04:42:32,802 --> 04:42:38,474
NEXT STEPS?

7131
04:42:38,474 --> 04:42:39,141
HOW DO WE VALIDATE?

7132
04:42:39,141 --> 04:42:41,210
WE'RE NOT DOING A HUGE

7133
04:42:41,210 --> 04:42:43,345
RANDOMIZED TRIAL, I GUESS.

7134
04:42:43,345 --> 04:42:49,685
MAYBE, I DON'T KNOW.

7135
04:42:49,685 --> 04:42:50,252
>> NO.

7136
04:42:50,252 --> 04:42:54,190
BUT I THINK WE REALLY DO NEED AN

7137
04:42:54,190 --> 04:42:58,894
ENORMOUS SAMPLE SIZE, AND REALLY

7138
04:42:58,894 --> 04:43:00,763
TO FIGURE OUT THE DURATION OF

7139
04:43:00,763 --> 04:43:02,264
TIME THAT'S CONSIDERED

7140
04:43:02,264 --> 04:43:04,600
ACCEPTABLE AND WHAT DATA TO

7141
04:43:04,600 --> 04:43:05,501
COLLECT.

7142
04:43:05,501 --> 04:43:08,070
AND I THINK CLUES ARE GOING TO

7143
04:43:08,070 --> 04:43:09,972
COME FROM THESE VERY LARGE

7144
04:43:09,972 --> 04:43:13,242
LONGITUDINAL STUDIES, WHAT COMES

7145
04:43:13,242 --> 04:43:14,677
TO MIND IS FRAMINGHAM WHICH HAS

7146
04:43:14,677 --> 04:43:18,280
COLLECTED DATA OVER A VERY LONG

7147
04:43:18,280 --> 04:43:18,481
TIME.

7148
04:43:18,481 --> 04:43:22,852
AND, YOU KNOW, A LOT OF THESE

7149
04:43:22,852 --> 04:43:24,420
OTHER OBSERVATIONAL STUDIES THAT

7150
04:43:24,420 --> 04:43:27,456
ARE -- THAT HAVE DONE

7151
04:43:27,456 --> 04:43:28,958
OUTSTANDING JOBS PHENOTYPING

7152
04:43:28,958 --> 04:43:30,559
PATIENTS, I THINK THERE'S CLUES

7153
04:43:30,559 --> 04:43:33,596
WE HAVEN'T CONSIDERED YET.

7154
04:43:33,596 --> 04:43:35,464
 

7155
04:43:35,464 --> 04:43:35,965
>> THANK YOU.

7156
04:43:35,965 --> 04:43:41,036
>> FIRST AND FOREMOST I'M
A

7157
04:43:41,036 --> 04:43:41,370
CARDIOLOGIST.

7158
04:43:41,370 --> 04:43:42,872
BUT I KNOW ABOUT THE TECH WORLD.

7159
04:43:42,872 --> 04:43:45,508
THIS IS WHERE THIS ACADEMIC

7160
04:43:45,508 --> 04:43:48,043
INDUSTRY COLLABORATION COULD

7161
04:43:48,043 --> 04:43:50,980
REALLY HELP, WHAT IS TECH GOOD

7162
04:43:50,980 --> 04:43:51,547
AT?

7163
04:43:51,547 --> 04:43:53,415
SCALE THINGS AND DRIVING DOWN

7164
04:43:53,415 --> 04:43:53,616
COST.

7165
04:43:53,616 --> 04:43:55,251
IS THERE INCENTIVE TO DO STUDIES

7166
04:43:55,251 --> 04:43:58,888
IN A MORE SCALABLE LOWER COST

7167
04:43:58,888 --> 04:44:08,888
WAY?