>>OPENING REMARKS BY SPECIAL GUEST DIRECTOR OF NIH, FRANCIS COLLINS WELCOME TO NHLBI WORKSHOP AS COVID 19 MADE PAINFULLY CLEAR HEALTH DISPARITIES AND INEQUITIES CONTINUE. MORBIDITY AND MORTALITY AND MUST ADDRESS THE FUNDAMENTAL CAUSES AND IDENTIFY RESEARCH, PROGRAMS THAT COULD HELP INTRODUCE, TEST AND IMPLEMENT EFFECTIVE INTERVENTIONS. IN THAT REGARD A PROGRAM AT NIH CALLED UNITE WHICH HAS BEEN PUT TOGETHER IN RESPONSE IN THIS GROWING APPRECIATION THAT STRUCTURAL RACISM IS PART OF THE BIOMEDICAL RESEARCH FABRIC OVER THE LAST 400 YEARS, AIMS TO TRY TO ADDRESS BOTH THE LACK OF DIVERSITY IN OUR WORKFORCE AND TO LOOK WITH NEW EYES AT OUR HEALTH DISPARITY RESEARCH AGENDA TO MAKE SURE WE ARE NOT TINKERING AROUND THE EDGES OF THE FUNDAMENTAL CAUSES OF SUCH DISPARITIES WHICH BASICALLY COME DOWN TO STRUCTURAL RACISM OPPOSED TO TACKLING THOSE MORE DIRECTLY WHICH IS WHAT WE NOW AIM TO DO. THAT IS AN EFFORT THAT IS ENGAGED WITH DOZENS OF INDIVIDUALS AT NIH AT VARIOUS JOB DESCRIPTIONS, SENIORITY LEVELS AND THE VAST MAJORITY OF THEM ARE PEOPLE WHO HAVE THEMSELVES LIVED A LIFE OF SOMEONE WHO IS OF COLOR AND THEREFORE EXPERIENCED THE SUBTLE AND SOMETIMES NOT SO SUBTLE WAYS IN WHICH OUR SOCIETY CONTINUES TO LOOK AT ALMOST EVERY ISSUE WITH EYES THAT ARE STILL COLORED BY RACISM. SO WE'RE DETERMINED TO DO WHAT WE CAN IN TERMS OF NEW RESEARCH ON HEALTH DISPARITIES AS A KEY COMPONENT OF THAT UNITE INITIATIVE AND JUST LAST MONTH ANNOUNCED A NEW NIH COMMON FUND PROGRAM THE TRANSFORMATIVE RESEARCH INITIATIVE TO TRY TO DEVELOP, IMPLEMENT AND DISSEMINATE INNOVATIVE, EFFECTIVE INTERVENTIONS TO ADDRESS HEALTH DISPARITY. WE'RE NOT SATISFIED BY CATALOGING THE CAUSES BUT INTERVENTION TO CHANGE OUTCOMES. THERE'LL BE A PHASE TWO COMING IN WINTER OF 2022. WE CAN LOOK AT SOME EFFORTS THAT HAVE GONE ON IN NIH IN THAT SPACE AND ONE TO BE MENTIONED IS THE SPRINT PROGRAM TO AIM TO UNDERSTAND WHAT IS THE APPROPRIATE LEVEL OF BLOOD PRESSURE TO AIM FOR TO TRY TO REDUCE CARDIOVASCULAR CONSEQUENCES. AND MANAGE MANY TO A LOWER SYSTOLIC BLOOD PRESSURE TO LESS THAN 120 MILLIMETERS OF MERCURY REDUCES RISK OF HEART ATTACK AND STROKE AND RISK AND THE PATIENTS WERE HIGHLY DIVERSE BUT MOST RECRUITED FROM MAJOR MEDICAL CENTERS. NEWER TRIALS ADAPT THIS PROTOCOL TO THE FEDERAL CENTER AND WE NEED TO FURTHER INVEST IN OUR CLINICAL TRIAL EFFORTS TO BE SURE WE'RE ENROLLING PEOPLE FROM ALL SECTORS SO WE'LL KNOW WHETHER AN INTERVENTION IS EQUALLY SUCCESSFUL. YOU CERTAINLY WORKED HARD ON THAT WITH THE VACCINE TRIALS AND LEARNED A LOT OF LESSONS AND THE COMMUNITY ENGAGEMENT ALLIANCE LED BY DR. GIBBONS AND ELISEO HAS TRIED TO COORDINATE THEM IN A WAY THAT HAS MORE EFFECTIVE OUTREACH CAPABILITIES AT A TIME WHERE WE REALLY WANTED TO SEE THAT HAPPEN FOR VACCINE TRIALS AND TRIALS OF NEW DIAGNOSTIC TESTS AND FOR VACCINE ADMINISTRATION. ANOTHER PROGRAM I WANT TO MENTION TO YOU BECAUSE IT FITS INTO THIS SAME SPACE IS THE PROGRAM AT NIH RADX, RAPID ACCELERATION OF DIAGNOSTICS. THIS EFFORT FUNDED BY CONGRESS A YEAR AGO WAS PUT IN PLACE TO TRY TO ACCELERATE THE DEVELOPMENT OF HIGHLY ACCURATE DIAGNOSTIC TESTS FOR COVID-19 INCLUDING THOSE THAT COULD BE DONE AT THE POINT OF CARE OR EVEN AT HOME WHICH IS NOW MADE POSSIBLE BY THIS PROGRAM AND THE TECHNOLOGIES THAT HAVE BEEN DEVELOPED. WE BASICALLY TURNED NIH INTO A VENTURE CAPITAL LAB AND INVITED COMPANIES WITH NEW IDEAS ABOUT THIS VIRAL DETECTION AND BRING THE IDEAS FORWARD. WE GAVE THEM QUITE A GOING OVER IN WHAT WE CALL THE SHARK TANK AND OUT OF ABOUT 700 THAT CAME FORWARD, WE ENDED UP WITH 28 OF THESE HIGHLY SUCCESSFUL AND ALREADY OUT THERE NOW BEING UTILIZED TO DO THIS KIND OF DIAGNOSTIC TESTING INCLUDING SOME BEING TESTED IN HOME TESTING RIGHT NOW. THAT WAS AN INTERESTING EXPERIENCE. BY THE WAY, ANOTHER PART OF RADX WE REALIZED IS IF WE'RE DOING THIS IN A MEANINGFUL WAY WE HAVE TO MAKE THESE TESTS PARTICULARLY AVAILABLE IN UNDER SERVED POPULATIONS. TO RADX UP, AS IT'S CALLED, IS INVESTING TENS OF HUNDREDS OF MILLIONS OF DOLLARS IN AN EFFORT TO MAKE SURE TESTING IS ACCESSIBLE IN THE COMMUNITIES WHERE IT'S NOT BEEN SO EASY TO COME BY AND SEE WHETHER WE COULD BY THAT EFFORT REDUCE THE FREQUENCY OF ILLNESS FROM COVID-19. THAT'S A VERY MAJOR PART OF OUR EFFORTS ACROSS THE COUNTRY. JUST THINK FOR A MINUTE THOUGH ABOUT THAT APPROACH AND WHETHER THERE MAY BE OTHER WAYS IN THAT COULD BE APPLIED TO THE CONDITIONS YOU'RE TALKING ABOUT TODAY IN TERMS OF HEART, LUNG, BLOOD AND SLEEP BECAUSE JUST LAST WEEK, IT WAS ANNOUNCED IN THE PRESIDENT'S BUDGET FOR FISCAL YEAR' 22 A NEW UNIT AT NIH TO BE STOOD UP. IF YOU KNOW ABOUT THE DEPARTMENT OF DEFENSE, DARPA IS THE FAMOUS PART OF THE DEFENSE DEPARTMENT THAT HAS COME UP WITH THINGS LIKE INTERNET AND GPS AND TAKE A BOLD APPROACH TO IDENTIFYING NEW OPPORTUNITIES AND GENERATE SOME COMPETITION AND MAKE INVESTMENTS. VERY MUCH LIKE WE DID WITH RADX. ARBAH WILL ALLOW IT TO TAKE THE STATEMENT STRATEGY FORWARD. IMAGINE APPLYING THAT TO SPEED UP THE DEVELOPMENT OF SAFE, INEXPENSIVE AND ACCURATE AMBULATORY BLOOD PRESSURE MEASUREMENTS TO TRANSFORM OUR ABILITY TO MANAGE HYPERTENSION. LIKE WIDE IF WE HAD HOME BASED AMBULATORY MEASURES OF METABOLISM INCLUDING GLUCOSE, IMAGINE WHAT THAT COULD DO TO OUR MANAGEMENT OF DIABETES. AND IF WE HAD A COMPETITION TO COME UP WITH HIGHLY EFFECTIVE AND EASY TO USE DETECTION OF APNEA AT HOME THINK WHAT THAT COULD DO? AS YOU THINK ABOUT THE ISSUES TODAY GIVE THAT SOME THOUGHT WITH NEW FOR ENCOURAGING THOSE KINDS OF TECHNOLOGIES THAT WOULD HAVE APPLICATIONS TO UNDER SERVED POPULATIONS TO BE ACCESSIBLE AND AFFORDABLE AND HIGHLY ACCURATE? WHAT COULD WE DO? RADX IS A STARTING POINT AND TAKE THAT MODEL FORWARD. TODAY YOU'LL HEAR MORE ABOUT INNOVATIONS AND PARTNERSHIPS AND COMMUNITY OUTREACH STRATEGIES AND HOW THEY'RE BEING APPLIED TO DIVERSE, UNDER SERVED POPULATIONS AND WANT TO HEAR YOUR THINKING AND IMPROVE THE HEALTH OF ALL, AND INCLUSIVE OF ALL. AS THE NIH DIRECTOR WE'RE COMMITTED TO THIS EFFORT AND MAYBE MAKING A NEW STEP FORWARD HERE IN THE CONTEXT OF WHAT WE HAVE BEEN LEARNING ABOUT HEALTH DISPARITIES AND STRUCTURAL RACISM. WE WON'T BE SATISFIED AS BUSINESS AS USUAL AND DO THINGS TRULY INNOVATIVE AND ALTER THE HISTORY OF RACIAL INEQUITIES AND THOSE APPLIED TO HEALTH AND AT THE NATIONAL INSTITUTES OF HEALTH IT'S OUR JOB TO FIGURE OUT HOW TO DO IT. GO TO IT PEOPLE AND HAVE A WONDERFUL DAY AND GLAD I GOT TO SPEAK TO YOU ON THE SECOND DAY AND LOOK FORWARD TO HEARING THE OUTCOMES OF THE WORKSHOP. THANK YOU. >> WE WANTED TO THANK DR. COLLINS FOR HIS INTRODUCTORY REMARKS. NOW WE'LL MOVE TO THE PLENARY PRESENTATION GIVEN BY DR. BRUCE TROMBERG THE DIRECTOR AT THE NATIONAL INSTITUTES OF HEALTH AND HE ALSO LEADS NIBIBs RADX TECH INNOVATION INITIATIVE FOR COVID-19 TESTING CAPACITY AND PERFORMANCE AND WILL TALK TO US ABOUT RADX TECH THE DIAGNOSTICS OF UNPRECEDENTED SPEED AND SCALE. >> THANK YOU, MARGARET. I'D LIKE TO SHARE MY SLIDES. ARE WE IN PRESENTATION VIEW? THANK YOU TO DR. COLLINS FOR THE FANTASTIC INT FANTASTIC INT FANTASTIC INTRODUCTION TO THE RADX AND THIS IS A MODEL FOR ADVANCING ACCESSIBLE TECHNOLOGIES FOR UNDER SERVED AND UNDER REPRESENTED POPULATIONS A TRANSFORMATIVE APPROACH. I HOPE TO HELP EVERYBODY UNDERSTAND THE PROCESS THAT WE'VE GONE THROUGH AND SOME OF THE IMPACT. NIBIB HAS BEEN AT THE CENTER VORTEX OF THE RESPONSE WITH COVID WITH TESTING TECHNOLOGIES AND HAS BEEN AN ALL-HANDS EFFORT FOR THE ENTIRE INSTITUTE. WE'RE A SMALL INSTITUTE AND HAD SUBSTANTIAL INCREASES IN FUNDING TO BE ABLE TO DO THIS. LAST YEAR CONGRESS IN A FOURTH CONGRESSIONAL SUPPLEMENT GAVE $500 MILLION TO NIBIB FOR ADVANCING TECHNOLOGIES. WE SET UP PARTNERSHIPS WITHIN NIH AND THE GOVERNMENT AND THE OFFICE OF THE DIRECTOR RECEIVED A BILLION OF THAT AND CREATED FOUR SPECIFIC VERSIONS OF RADX. RADX TECH AND ADP IMMEDIATE TECHNOLOGY ACCELERATING ENGINES AND RADX RAD A LONGER TERM APPROACH AND RADX U.P. DEDICATED TO BRINGING TESTING AND DIAGNOSTIC TECHNOLOGY TO UNDER SERVED POPULATIONS. THE MISSION OF THE PROGRAM HAS BEEN TO UNDOPTIMIZE PERFORMANCE TECHNOLOGIC PERFORMANCE AND OPERATIONAL AND WORK FLOW AND MATCH THEM WITH NEEDS OF VERY DIFFERENT COMMUNITIES. WE HAVE BEEN LEADING AT NIBIB RADX TECH AND ATP. AND WE FORMS FREQUENT INTERACTIONS AND BARDA HAS BEEN A SPECTACULAR PARTNER AND CONTRIBUTED ANOTHER $300 MILLION TO THE PROGRAM AND ADDITIONAL SUPPLEMENT FROM CONGRESS AT THE END OF THE YEAR WHERE WE RECEIVED ANOTHER $100 MILLION. THE OFFICE OF THE ASSISTANT SECRETARY OF HEALTH, DOD, CMS AND CDC WE'VE BEEN WORKING WITH. I WANT TO POINT OUT NHLBI NEXT TO NIBIB HAS BEEN THE LARGEST NUMBER OF PEOPLE ACROSS THE NIH INTERACTING WITH RADX TECH. THERE'S ABOUT 50 ACROSS PROGRAMS CONTRACTS AND GRANTS MANAGEMENT AND THE CONTRACTS OFFICE HAS BEEN ESSENTIAL FOR US TO MOVE FORWARD IN THEIR CONTRACTING WITH ALL THE COMPANIES AS YOU'LL SEE AND YOU CAN SEE THE PROGRAM OFFICERS THAT HAVE HAD SUBSTANTIAL CONTRIBUTIONS TO THE PROGRAM. WITHOUT NHLBI WE WOULD NOT HAVE THIS PROGRAM. FROM AN ACADEMIC STRUCTURAL POINT OF VIEW WE SUPPORTED A NETWORK MANY YEARS. THE CENTER OF THE NETWORK IS A COORDINATING CENTER AT THE INNOVATION INSTITUTE AT MGH. JOHNS HOPKINS AND EMORY AND U MASS AND THE CAP CAT CENTER AND ALL HAVE UNIQUE ROLES AND RESPONSIBILITIES. WE ADDED NONPROFITS, VENTURE WELL AND OTHERS AND A DEPLOYMENT CORE AND VALIDATION CORE AND CLINICAL STUDIES CORES AT UMASS. THE NETWORK HAS ABOUT 500 DIFFERENT EXPERTS AND CONTRIBUTORS TO THE ENTIRE PROGRAM. THE OPERATIONS OF THE NETWORK INCLUDE REVIEWING AND FUNDING PROPOSALS. BY THE CREATION OF THIS PROGRAM WE'RE ABLE TO PROVIDE FUNDS TO THESE CENTERS AND THEY CAN ADMINISTER FUNDS TO PEOPLE WHO WIN AWARDS. THEY CAN TEST AND VALIDATE NEW TECHNOLOGIES AND PROVIDE EXPERT GUIDANCE IN A VERY DYNAMIC AND INTERACTIVE WAY TO OPTIMIZE THE DEVELOPMENT OF DIAGNOSTIC TECHNOLOGIES. THIS NETWORK IS NOW CONNECTED WITH RADX UP, IF YOU RECALL, IS THE UNDER SERVED AND UNDER REPRESENTED POPULATION ANOTHER $500 MILLION PROGRAM ESTABLISHED BY THE NIH. WE'RE ABLE TO ENSURE THERE'S FLOW BACK AND FORTH SO THE LATEST AND BEST TECHNOLOGIES ARE DELIVERED TO THE POPULATION OPTIMIZED FOR THE NEEDS OF THE U.P. STUDIES. THE PROCESS THE NETWORK HAS IMPLEMENTED IN ORDER TO GET THE BEST IDEAS OUT, ACCELERATE AND ADVANCE THEM IS AN INNOVATION FUNNEL. I WON'T GO INTO DETAILS ON THIS BUT WE CALLED OUT TO THE INNOVATION ENTREPRENEURIAL COMMUNITY AND HAD OVER 700 APPLICATIONS SUBMITTED TO THE RADX PROGRAM AND HAD ROLLING SUBMISSION BEGINNING APRIL 29, FIVE DAYS AFTER THE LAUNCH OF THE PROGRAM LAST YEAR AND A SERIES OF EVALUATIONS WITH PHASES OF FUNDING AND FEEDBACK TO ALL THE GRANT SUBMISSIONS AND ULTIMATELY THERE IS A PHASE 2 OF FUNDING THAT SUPPORTS MANUFACTURING AND SCALE UPS OF. THE TECHNOLOGIES ARE ENRICHED BY VALE DATING AND DERISKING THEM AND ESTABLISHING TIME LINES AND THEIR ABILITY TO DELIVER TESTING DEVICES THAT CAN BE SCALED UP AND MANUFACTURED AND DISTRIBUTED WIDELY WITHIN FIVE TO SIX MONTHS. WE'VE NOW SPEND $590 MILLION ON THOSE MANUFACTURING AND SCALE UP EFFORTS. WE SUPPORTED MANY COMPANIES WITH MANY INNOVATIVE TECHNOLOGIES. THIS IS A SNAPSHOT OF YOU OF WHAT THESE TECHNOLOGIES LOOK LIKE AND WHAT YOU CAN SEE IS THEY BREAK DOWN ON THE RIGHT SIDE OF THE SCREEN INTO POINT OF CARE AND HOME-BASED APPROACHES BOTH PCR AND ANTIGEN LATERAL FLOW ASSAY APPROACHES. A COUPLE OF THESE ARE NOW FDA CLEARED FOR FULLY OVER THE COUNTER HOME USE. WE ALSO SUPPORTED LABORATORY BASED TECHNOLOGIES RANGE FROM POP-UP LABS AND THOSE WHICH CAN DO 100,000 TESTS PER DAY AND LAB PRODUCTS. AND THERE'S A COMPANY MAKING INNOVATIVE SWAB APPROACHES AND SALIVA APPROACHES AND NANO APPROACHES THAT IMPROVE DETECTION LIMITS AND CRISPR APPROACH. THE PRIMARY TAKE HOME IS MANY OF THESE TECHNOLOGIES ARE INEXPENSIVE AND COST OF GOODS ARE QUITE DIFFERENT THAN THEY ARE IN TRADITIONAL APPROACHES. PORTABLE AND ACCESSIBLE WITH RAPID RESPONSE TURNAROUND TIMES. IN EVALUATING THE OVERALL IMPACT OF THE PROGRAM, FIVE MONTHS AFTER LAUNCH IN SEPTEMBER OF 2020 WE STARTED TO SEE MANUFACTURING EXPANSION IN SCALE UP AND THAT HAS CONTINUED TO GROW OVER TIME SO BY MARCH OF 2021 WE'VE SEEN IN INCREASE IN CAPACITY FROM THE COMPANIES WE'VE SUPPORTED BY 240 MILLION NEW TESTS. SO THAT WAS ALMOST 2 MILLION TESTS PER DAY BEING CREATED IN MARCH 2021. 17 EMERGENCY USE AUTHORIZATIONS HAVE BEEN ISSUED AND AS I MENTIONED TWO FULLY OFFER THE COUNTER AT-HOME TESTS. WE'VE SUPPORTED THOUGH THERE ARE ONLY 31 COMPANIES IN PHASE 2 WITH MANUFACTURE AND SCALE UP, WE HAVE A NUMBER OF COMPANIES WE'VE REDIRECTED INTO OTHER COMMERCIALIZATION AND DEVELOPMENT PROGRAMS AND CONTINUE TO SUSTAIN AND SUPPORT FOR ABOUT 50 COMPANIES BUT OVER 100 HAVE BEEN SUPPORTED OVERALL. WE PROJECT OUT IN JUNE AND SEPTEMBER TO BE PRODUCING BETWEEN 5 AND 7 MILLION TESTS PER DAY SO THIS KIND OF EXPANSION WILL BE CONTINUING WITH NEW TECHNOLOGIES. THE VALIDATION CORD AT GEORGIA EMORY TECH HAVE HELP AND WANT TO FOCUS IN ON A PERFORMANCE GAP MANY HAVE BECOME FAMILIAR WITH PCR WITH LIMITS OF DETECTION ON THE ORDER DETECTION AND OTHERS THREE TO FOUR ORDERS OF MAGNITUDE HIGHER THAN PCR APPROACHES. THEY CAN PERFORM WITH SIMILAR SPECIFICITY AND SENSITIVITY IF USED ON LABEL. IF YOU USE ANTIGEN TEST IN SYMPTOMATIC INDIVIDUALS THEY PERFORM QUITE WELL BUT EVERYONE WOULD LIKE TO DO SCREENING IN ASYMPTOMATIC INDIVIDUALS AND WHERE PERFORMANCE BREAKS DOWN AND WHY WE'D LIKE TO SEE NEW APPROACHES THAT BRIDGE THIS GAP. THESE NEW APPROACHES INCLUDE A BRUTE FORCE AFFORCE AND CRISPR, MICROFLUIDICS AND NANO PARTICLES AND SEEING INTERESTING WORK WITH WAVE GUIDE TECHNOLOGIES AND NANO MATERIALS AND WE'VE ALSO BEEN ABLE TO DEVELOP NEW GUIDANCE THAT TAKES ADVANTAGE OF EXISTING TECHNOLOGIES BUT PUTS THEM INTO POSITIONS WHERE THEY CAN HAVE A GREATER IMPACT IN SCREENING AND SURVEILLANCE. AND ONE OF THESE IS THE IDEA OF POOLING A SOCIAL NETWORK OR A POD USING INEXPENSIVE HANDHELD PARTICLE RT PR DEVICES MADE BY NISBY AND BIO TECH AND CAN HANDLE A POOL OF INDIVIDUALS UP TO 10 OR 15 IN A POOL. YOU CAN IMAGINE DEPLOYING IT IN A CLASSROOM OR WORK TEAM, A WORK GROUP OR LABORATORY, A FAMILY. THEY BECOME VERY COST EFFECTIVE WHEN YOU CONSIDER THE PRICE PER PERSON. THEY HAVE EXQUISITE SENSITIVITY ON THE ORDER OF THAT AND HAVE THE FORM FACTOR THAT MAKES THEM PORTABLE AND ACCESSIBLE AND TURNAROUND TIME THAT'S IMMEDIATE. 30 MINUTES TO GET THE ANSWER FOR THE ENTIRE SOCIAL NETWORK. ANOTHER WAY IS THROUGH THE CLINICAL STUDY CORE AND HERE THERE'S THREE MAJOR STUDIES ONGOING TO GET REAL WORLD GUIDAN GUIDANCE HOW THE TECHNOLOGIES WORK FIRST IS AT UNIVERSITY OF ILLINOIS, JOHNS HOPKINS AND UMASS AND HAVE 200 SUBJECTS ENROLLED TO ASK THE QUESTION OF HOW MANY SERIAL, LONGITUDINAL LATERAL FLOW ASSAYS OR THE CADENCE MUCH THESE, THAT WILL GIVE YOU PERFORMANCE THAT'S FUNCTIONALLY EQUIVALENT TO RTPCR. THE SECOND MAJOR STUDY IS AN AT HOME STUDY TO EVALUATE HOW AT HOME SAMPLING CAN WORK WITH DIGITAL HEALTH PLATFORMS. DO THEY PROVIDE VALUE AND ENHANCE PERFORMANCE OR PROVIDE VALUE TO THE USERS AND THE THIRD IS A LARGE POPULATION STUDY I'LL MENTION IN A SECOND. AND KEY FINDINGS FROM THIS ARE COMING OUT JUST NOW. THIS IS A PRE PRINT BY THIS MULTI INVESTIGATOR GROUP AT HOPKINS AND UIUC AND U MMASS THAT SHOWS LATERAL FLOW ASSAYS CAN HAVE SENSITIVITY COMPARABLE, ACTUALLY IDENTICAL EFFECTIVELY TO RTPCR AND IF YOU REDUCE THE CADENCE TO ONCE A WEEK YOU MINIMIZE THE SENSITIVITY TO LEVELS OF APPROXIMATELY 80% DEPENDING ON WHETHER THAT INDIVIDUAL IS SYSTEMATIC OR ASYMPTOMATIC AND SHOWS THE WAY FOR HOW TO BEST USE LATERAL FLOW ASSAYS ON CADENCE TO GET VERY GOOD AND RELIABLE INFORMATION. THIS IS IMPACTED IN FACT THE FDA SCREENING AUTHORIZATION FOR SEQUENTIAL LONGITUDINAL ANTIGEN TESTING AND NOW THERE'S SEVERAL COMPANIES THAT HAVE FULL EUA SCREENING BASED ON THE SCEN SHALL SAMPLING CONCEPT. THE PRINCIPLE HAS APPLIED ON A STUDY WITH 2 MILLION RAPID ANTIGEN TESTS THIS IS THE SAY YES TO COVID TEST. THE RADX U.P. TEAM AT THE DUKE COORDINATING UNDER THE AND UNC COORDINATING CENTER ARE PLAYING A CRITICAL ROLE IN IMPLEMENTING AND LAUNCHING THE STUDY AND MANAGING THE OPERATIONS. IT'S COLLABORATION BETWEEN THE CDC AND THE NIH AND PUBLIC HEALTH. TESTING IS DONE ON A REGULAR CADENCE AS IDENTIFIED BY THE PRELIMINARY STUDIES WE'VE BEEN ABLE TO DO AND OUTCOME MEASURES PASSIVE. WE'RE LOOKING AT CELL PHONE MOBILITY DATA AND WASTE WATER IN ORDER TO ASSESS THE CHAIN OF TRANSMISSION OF THE VIRUS CAN BE INTERRUPTED. THE LAST CORE IS THE DEPLOYMENT CORE AND I ENCOURAGE EVERYONE TO LOOK AT WHEN TO TEST DOT-ORG AND MASKING AND VACCINATION AND HELPS UNDERSTAND FOR A GIVEN SIZE OF AN ORGANIZATION HOW MANY TESTS YOU NEED TO PERFORM AT WHAT FREQUENCY. THERE ARE PLAY BOOKS ACCESSIBLE ALSO FOR DIFFERENT SETTINGS. ONE CAN CONNECT YOUR ORGANIZATION WITH THE VENDORS THEMSELVES. YOU CAN ACTUALLY PURCHASE TESTS AND THERE IS ALSO A TASK FORCE ON VARIANTS ORGANIZED THROUGH THIS CORE. SO KIND OF FINALLY IN A SUMMARY OF ALL OF THE TECHNOLOGIC POSSIBILITIES WE'VE WORKED ON DIGITAL HEALTH PLATFORMS AND THESE CAN PLAY A CENTRAL ROLE IN IN TAKING TEST RESULTS READING LATERAL FLOW ASSAYS AND PROVIDING DIGITAL CONFIRMATION OF THE RESULT. TRACKING SYMPTOMS, PROVIDING INSTRUCTIONS FOR USE AND INTEGRATING WEARABLES. THIS IS QUITE POSSIBLE AND CARE EVOLUTION IS ONE OF THE PERFORMERS WE'VE BEEN SUPPORTING AND THEY'VE BEEN ABLE TO DO ALL OF THIS. WE'VE BEEN DEVELOPING STANDARDS TO BE ABLE TO TRANSMIT THIS INFORMATION BOTH TO ELECTRONIC HEALTH RECORDS, STATE AND FEDERAL AUTHORITIES THAT CAN FACILITATE THINGS LIKE CONTRACT TRACING AND HEALTH STATUS INDICATIONS. FINALLY, I WOULD LIKE TO CONCLUDE SOME OF YOU MAY HAVE SEEN THIS NATURE BIO TECH EDITORIAL THAT CAME OUT LAST WEEK. IT'S REALLY PRETTY EXCITING AND I THINK A CALL TO ACTION FOR OUR COMMUNITY. SO I'LL JUST SORT OF READ THIS EXPLODED PART HERE. THEY NOTE THAT RADX HAS RADICALLY SHIFTED THE FUNDING AVAILABLE FOR INNOVATIVE DIAGNOSTICS AND GREATLY SHORTENED PRODUCT DEVELOPMENT TIMES BUT IT WILL BE ALL FOR NOT IF THE ONE PERSON, ONE TEST PARADIGM ISN'T EXCHANGED FOR ROBUST INFRASTRUCTURE AND RATIONAL REIMBURSEMENT SYSTEM FOR DIAGNOSTIC LED MEDICINE. FOR TOO LONG WE TALKED THE TALK OF PRECISION MEDICINE AND NOW'S THE TIME TO WALK THE WALK. I DIDN'T WRITE THE WORDS. THAT WAS THE EDITOR. BUT THAT'S THE CALL TO ACTION FOR OUR COMMUNITY TEAMING UP BETWEEN TECHNOLOGY DEVELOPERS, AND EPIDEMIOLOGY AND POLICY MAKERS AND THAT'S THE PATH FORWARD. I'LL STOP THERE. I DON'T KNOW IF WE HAVE ANY TIME FOR QUESTIONS. >> THANK YOU, DR. TROMBERG FOR THE EXCELLENT TALK ON THE DIAGNOSTICS. IT CAN BE IMPLEMENTED FOR OUR UNDER SERVED COMMUNITY. UNFORTUNATELY WE DON'T HAVE TIME FOR Q&A. WE'LL MOVE TO OUR NEXT SESSION. I'M PLEASED TO WELCOME THE CHAIR OF OUR UNDERSTANDING THE COMMUNITY SESSION, DR. MONICA WEBB-HOOPER. SHE IS THE DEPUTY DIRECTOR OF THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES NIMHD A NATIONALLY RECOGNIZED BEHAVIORAL SCIENTIST AND HEALTH PSYCHOLOGIST AND DEDICATED HER CARE TO THE SCIENTIFIC STUDY OF MINORITY HEALTH AND RACIAL AND ETHNIC DISPARITIES WITH A FOCUS ON THE HEALTH BEHAVIOR CHANGE. SHE'S ALSO THE CO-CHAIR OF THE "U" COMMITTEE OF THE UNITE INITIATIVE. DR. WEBB-COOPER, OVER TO YOU. >> THANK YOU, VERY MUCH AND HELLO EVERYONE. I'M DELIGHTED TO BE HERE AND HAVING THE OPPORTUNITY TO CHAIR THIS IMPORTANT SESSION WHICH IS FOCUSSED ON UNDERSTANDING THE COMMUNITY. THIS SESSION WILL COVER SCIENCE SEEKING TO UNDERSTAND AND ADDRESS THE NEEDS OF POPULATIONS THAT EXPERIENCE HEALTH DISPARITIES INCLUDING YOU'LL HEAR ABOUT COMMUNITIES OF LESS PRIVILEGED SOCIO ECONOMIC STATUS, UNDER SERVED COMMUNITIES AND RACIAL ETHNIC PRIORITIZED GROUPS. WHEN WE SPEAK OF COMMUNITIES, THESE ARE SOCIAL GROUPS. GROUPS OF PEOPLE LIVING IN THE SAME PLACE OR HAVING A PARTICULAR CHARACTERISTIC IN COMMON. COMMUNITIES OFTEN FEEL A FEELING OF FELLOWSHIP WITH OTHERS AS A RESULT OF SHARING COMMON ATTITUDES, INTERESTS AND GOALS. DURING THE PRESENTATION OF THIS SESSION YOU'LL ALSO HEAR ABOUT APPROACHES TO CONDUCTING RESEARCH WITHIN COMMUNITY CONTEXT AND SETTINGS AND WORKING WITH KEY STAKEHOLDERS. WORKING WITH COMMUNITY STAKEHOLDERS ADDS TO THE MEANING AND RICHNESS OF OUR RESEARCH. THE SIGNIFICANT INVOLVEMENT OF STAKEHOLDERS AT ALL LEVELS AND DISCIPLINES AT COMMUNITY-BASED ORGANIZATIONS, AS WELL AS THE LAY COMMUNITY MEMBERS IS A MUST FROM WHERE I SIT IN RESEARCH AND ALL DE MAINS AND ESPECIALLY TRUE IN THE CONTEXT OF RESEARCH AMONG UNDER SERVED POPULATIONS. NIH HAS DEMONSTRATED A COMMITMENT TO COMMUNITY ENGAGED RESEARCH. ONE EXAMPLE IS THE INITIATIVE DR. COLLINS AND DR. TROMBERG REFERENCED AND THE COMMUNITY ALLIANCE AGAINST COVID-19 DISPARITY OR THE SEAL INITIATIVE CO-LED BY NHLBI AND THE NATIONAL INSTITUTE ON MINORITY HEALTH AND HEALTH DISPARITIES. SEAL IS THROUGH A MULTI SECTOR ALLIANCE COMMITTED TO THE MISSION OF REDUCING COVID-19 AND OTHER DISPARITIES. THE GOAL HERE IS HEALTH EQUITY WHICH REFERS TO ALL PEOPLE HAVING A FAIR AND JUST OPPORTUNITY TO ATTAIN THE HIGHEST LEVEL OF HEALTH. WHILE IT SOUNDS LIKE A SIMPLE CONCEPT AND IT'S A TERM WE HEAR WITH INCREASING FREQUENCY, CONDUCTING TRUE EQUITY WORK IS QUITE THE CHALLENGE. ACHIEVING HEALTH EQUITY REQUIRES VALUING EVERYONE EQUALLY AND IMPLEMENTING EFFORTS TO ADDRESS INEQUITIES THAT ARE AVOIDABLE AND WE ELIMINATE HEALTH AND HEALTH CARE DISPARITIES WITHOUT WORSENING THE HEALTH OF ANY POPULATION. IT ALSO REQUIRES A SHIFT IN HOW WE DESIGN INTERVENTIONS AND THINK OF POPULATIONS WITH HEALTH DISPARITIES WHICH ARE OFTEN AT THE INDIVIDUAL LEVEL AND INCLUDE LABELS I THINK ARE ERRONEOUS SUCH AS HARD TO REACH OR DIFFICULT TO TREAT. SO I SUGGEST WE MOVE AWAY FROM INTERVENTIONS THAT SEEK TO FIX POPULATIONS WITH HEALTH DISPARITIES WHICH CAN BE VIEWED AS DEFICIT MODELS TOWARDS APPROACHES THAT EMPHASIZE INDIVIDUAL AND COMMUNITY LEVEL ASSETS. INTERVENE ON UP STREAK AND SOCIAL DETERMINATES OF HEALTH AND RESOURCES PROPORTIONAL TO THE NEED. GIVEN THE CURRENT EMPHASIS WE'RE AT AN IMPORTANT JUNCTURE. IF WE CAPITALIZE ON THIS MOMENTUM WE HAVE A REAL OPPORTUNITY TO SEE MANY BREAKTHROUGHS. AT THIS TIME, I'D LIKE TO INTRODUCE OUR FIRST SPEAKER, DR. JEAN-LOUIS WHO'S PRESENTATION IS ENTITLED TRANSFORMATIONAL STAKEHOLDER ENGAGEMENT A MODEL TO INCREASE ANALYSIS -- TO IMPROVE SLEEP CIRCADIAN HEALTH IN VULNERABLE COMMUNITIES. >> WE HAVE TRIED TO UNDERSTAND THE DISPARITIES AND DESIGNING AND IMPLEMENTING SOLUTION-FOCUSSED INNOVATIVE INTERVENTIONS TO REDUCE SUCH DISPARITIES. I'M PLEASED TO SHOW OVER THE LAST FOUR DECADES THERE'S BEEN A SIGNIFICANT THREAT IN LOOKING AT SLEEP RELATED DISPARITIES OR REAL DIFFERENCES AMONG DIFFERENT ETHNIC GROUPS IN TERMS OF SLEEP QUALITY AND PREVALENCE AND WE HAD A WORKSHOP AT THE NIH WHERE WE INVITED EXPERTS TO REDUCE SUCH DISPARITIES. THAT IS PUBLISHED IN A SPECIAL ISSUE OF SLEEP MEDICINE ABOUT FIVE YEARS AGO. AS A GRADUATE OR FELLOW AT UCSD IN THINKING ABOUT SLEEP RELATED DISPARITIES. 20 YEARS AGO WE REALIZED THERE WERE DIFFERENCES BETWEEN BLACKS AND WHITES IN TERMS OF QUALITY BUT THEN WE'RE NOT TALKING NECESSARILY ABOUT SLEEP DISPARITIES WE LOOKED AT LITERATURE. AND WE SAW THERE ARE DIFFERENCES WITH THE PREVALENCE OF SHORT SLEEP DEFINED AS SLEEPING LESS THAN SEVEN HOURS AND WE SEE INDEED FOR BOTH GROUPS PREVALENCE IS UPWARDS BUT BLACKS IN PARTICULAR THE DIFFERENCE IN 1977 WAS 6 PER PERCENTAGE POINTS WHERE IN 2019 THERE WAS A DIFFERENCE. SAME IS TRUE IF YOU LOOK AT DATA WE SAW BLACKS ARE SLEEPING MUCH LESS COMPARED TO WHITES. THERE ARE CONSEQUENCES TO SLEEPING TOO LITTLE OR TOO MUCH. THERE'S INDICATION OF POSSIBLE CONSEQUENCE OF NOT BEING ABLE TO SLEEP ENOUGH. YOU MAY HAVE SEEN THE DATA THAT SHOWS SLEEPING TOO LITTLE YOU'RE AT RISK OF CARDIOVASCULAR DISEASE OR STROKE OR OTHERS. THE BOTTOM LINE IS WHAT YOU HEARD BEFORE, IT'S ABOUT TRUST. WE CAN HAVE AN INFLUENCE IN DETERMINING WHAT THE MECHANISMS SAW AND HOW TO REDUCE DISPARITIES YOU HAVE TO BE ABLE TO BUILD TRUST AND THIS PROCESS REQUIRES A LONG TIME. I WANT TO SHARE SOME INFORMATION IN HOW WE GO ABOUT DETERMINING WHAT METHOD OF ENGAGEMENT IS BEST. THE FIRST IS TRANSACTIONAL AND THE OLD MODEL. WE BRING FOLKS FROM THE COMMUNITY TO PROOIFD A LEVEL OF INFORMATION ON WHAT TO USE TO REDUCE DISPARITY. THEN WE TALK ABOUT THE TRANSITIONAL INVOLVEMENT BUT ULTIMATELY WE WANT TO USE TRANSFORMATIONAL AND NOT ONLY BUY-IN FROM ALL MEMBERS OF THE COMMUNITY AND WHERE MEMBERS OF THE COMMUNITY FEEL THEY ARE FULLY AWARE OF THE PROCESS AND ENGAGED IN THE PROCESS AND ULTIMATELY, WE WANT TO EMPLOY TRANSFORMATIONAL STAKEHOLDER ENGAGEMENT. WE WANT TO MOVE FOLKS FROM NOT BEING AWARE OF A PARTICULAR PROBLEM TO BECOMING AN ADVOCATE. IN THIS CASE WE'RE TALKING SCIENCE AND MOST FOLKS IN THE COMMUNITY WE SERVE OR UNDER SERVED ARE NOT AWARE OF THE INEQUITY AND CONSEQUENCES OF SLEEP DISORDERS SO OUR TASK IS TO MOVE THEM FROM NOT BEING AWARE OF THOSE TO BEING ADVOCATE FOR PRACTICES TO REDUCE DISPARITIES IN SLEEP AND CIRCADIAN HEALTH AND MODELS MAKE IT POSSIBLE TO ACCOMPLISH THAT IS ONE WE TALK ABOUT AND HAS THREE STEPS. FIRST STEP IS BECOME KNOWLEDGEABLE AND UNDERSTAND WHAT THE RESOURCES ARE TO LEVERAGE THEM WHERE IT'S NECESSARY. YOU WANT TO HAVE GOOD STRONG EQUITABLE PARTNERSHIPS AND UNDERSTAND THE CULTURE AND THE ENVIRONMENT. THEN GO TO STEP TWO, YOU GO FROM AWARENESS ULTIMATELY TO HAVING FULL EMPOWERMENT YOU WANT TO MAKE SURE FOLKS IN THE COMMUNITY CAN TAKE CARE OF THEIR OWN NEEDS THEY CAN KEEP IT GOING FOR A WHILE SENSE THE IDEA OF SUSTAINABILITY. STEP THREE, WE HAVE TO GO WHERE PEOPLE ARE. AND HOPE FOLKS WILL COME TO US GO TO THEM AND IN OUR GROUP WE GO TO THE BARBERSHOP AND BEAUTY SHOP AND PLACES OF WORSHIP. WE HOPE TO GO FROM THERE AND HAVE CAPACITY AND DISSEMINATE THE INFORMATION. THIS IS A MODEL WE USE AND WE HAD FOUR LEVELS AND USED A SURVEY AND FOCUS GROUPS AND DISSEMINATE INFORMATION AND ULTIMATELY YOU HAVE TO GO BACK TO THE COMMUNITY AND SHARE BACK WHAT THE RESULTS WERE WITH THE COMMUNITY. IN THE PROCESS THERE WAS A DELP DELPHI SURVEY AND WE BROUGHT IN CBOs TO UNDERSTAND THE COMMUNITY. WE HAVE A NUMBER OF WORKSHOPS AND TALKS ABOUT SLEEPING DISORDER AND THE OUTCOME WAS WHAT WE CALL A SHARED [INDISCERNIBLE] AND COME TOGETHER TO REALIZE THEY'RE ALL PART OF THE COMMUNITY AND HAVE TO BE SERVED AND HAVE TO BE IN A SYMPTOMATIC WAY. THE SECOND IS CALLED A SLEEPING DISPARITY SUMMIT ABOUT TWO YEARS AGO A AGO AND AND FOLKS WHO UNDERSTAND THE COMMUNITY AND THE OUTCOME WAS THE SLEEP DISPARITIES WORKFORCE WE HAVE BEEN USING THE LAST 15 YEARS AND NOTICE BELOW THAT WE HAVE GROUPS WITH MEDICAL SOCIETIES AND AGENCIES AS WELL AS CBOs IN BROOKLYN AND QUEENS NEW YORK. QUEENS, NEW YORK. AND THIS ONE IS AN EXAMPLE WHERE THE IDEA WAS TO ENGAGE THE COMMUNITY IN A WAY WE CAN DESCRIBE AND DEVELOP INFORMATION TO HELP THEM UNDERSTAND SLEEP IMPORTANCE AND DO CERTAIN THINGS TO MAKE SURE THEY'RE SLEEPING WELL SO LOOK AT CARDIOVASCULAR DISEASE. THE OUTCOME LED TO SLEEP APNEA AS AN IMPORTANT FACTOR THAT HAD TO BE ADDRESSED IN THEIR COMMUNITY. SLEEP APNEA IS VERY IMPORTANT. IT IS CONNECTED TO PHYSIOLOGIC AND MEDICAL PROBLEMS AND PSYCHOSOCIAL PROBLEMS AND THE LIKE. IN THE FIRST STUDY WE PUT TOGETHER DIFFERENCES AS A FUNCTION OF WHERE WE CONDUCTED THE RESEARCH. THE NSF FOLKS WILL TELL YOU IT'S ABOUT % AT THE BARBERSHOP IT'S 43% AND AT A COMMUNITY CLINIC BEFORE PEOPLE HAVE HIGH BLOOD PRESSURE IT'S ABOUT 59%. IF YOU THINK OF REACHING THE COMMUNITY IN BROOKLYN, NEW YORK IT'S ABOUT 48% AND WHAT'S INTERESTING IS OF ALL THOSE AT RISK IT'S INDICATED AND WE TALKED ABOUT THE BARBERSHOP AND BEAUTY SALON AND CHURCHES AND IF YOU HAVE SLEEP APNEA YOU MIGHT UNDERSTAND HIGH BLOOD PRESSURE SAY PROBLEM IN THOSE COMMUNITIES AND THEREFORE WE SCREEN FOR PARAMETERS BEYOND SLEEPING DISORDER ITSELF. THAT'S PRETTY MUCH THE SENSE WE HAVE IN THE COMMUNITY THAT'S NOT THAT IMPORTANT UNTIL WE REALIZE AND SHOW THEM RATHER SLEEP IS INDEED VERY IMPORTANT TO THEIR HEALTH. AND WE TRIED TO GET A SENSE OF THIS AND SOME WENT FOR EVALUATION. AND A PERCENTAGE OF THOSE PEOPLE WERE EVALUATED AND FOUND TO HAVE SLEEP APNEA. THIS TELLS YOU THERE'S A LOT OF PEOPLE IN THE COMMUNITY THAT HAVE SLEEP APNEA ARE NOT BEING DIAGNOSED AND TREATED AND THIS GIVES A SENSE TO WHAT TO DO TO RECEIVE ADEQUATE CARE FOR THE SLEEP PROBLEMS. IN A FIVE-YEAR STUDY WE FOUND IF YOU TAILOR INFORMATION TO THE COMMUNITY WE CAN INCREASE THE ADHERENCE LEVEL BY FIVEFOLD. THAT STUDY WAS IMPORTANT BECAUSE IT PROVIDED INFORMATION ABOUT WHAT'S MISSING. WE FOUND OUT THAT THE COMMUNITY HAS ENROLLMENT DONE NOT JUST AT THE CLINIC AND THERE WERE STUDIES AT HOME AND INDICATED THEY WANTED TO HAVE INFORMATION PROVIDED BY THEIR PEERS AND FELT STRONGLY THEY PREFER TO HAVE INFORMATION WITH ACCESS TO DETERMINE THIS FOR THEMSELVES. THIS LED TO ANOTHER STUDY. ONE STUDY ESSENTIALLY IS A DIRECT RESPONSE TO THEIR REQUEST. THEY WANTED TO HAVE PEERS PROVIDE INFORMATION. AND FOLKS THAT CAN MEET WITH THEM AT THE BARBERSHOP AND BEAUTY SALON AND CHURCHES. THOSE INDIVIDUALS HAD TO BE TRAINED IN CIRCADIAN HEALTH AND TOOK ABOUT FIVE WEEKS TO TRAIN THEM AND THEY DID RECEIVE A CERTIFICATE OF COMPLETION DEMONSTRATED RIGHT HERE. I'M HAPPY TO SHOW THAT AS A RESULT OF THAT LEVEL OF ENGAGEMENT WHEN COVID-19 STARTED, THESE BECAME OUR COVID HEALTH CHAMPIONS. THEY RECEIVED INFORMATION US FROM AND IN TURN SHARING INFORMATION WITH THEIR COMMUNITY AND TALKING ABOUT INFORMATION ABOUT HOW TO PROTECT THEMSELVES AS WELL AS WITH VACCINES AND THE LIKE. ANOTHER STUDY WE DID, A STUDY AND AND WE HAD HEALTH INFORMATION APPROPRIATE FOR MEMBERS AS WELL AS FOR THEIR PURPOSES. THIS LED TO A STUDY WHICH LASTED ABOUT FIVE YEARS. THIS PRELIMINARY DATA SHOWS IF YOU LOOK AT SELF-EFFICACY THAT'S THE LIKELIHOOD PEOPLE WOULD GO TO THE CLINIC AND GET TESTED AND PEOPLE EXPOSED TO THE INFORMATION RECEIVED INFORMATION TAILORED TO THEIR NEEDS. WE'VE TARGETED THE PATIENT LEVEL OF HEALTH DISPARITY AND HAVEN'T DONE HEALTH OR PATIENT-LEVEL DISPARITIES. WE'RE NOW BEGINNING TO DO THAT. THE NEXT STEP IS TO BEGIN TO UNDERSTAND WHAT'S HAPPENING IN TERMS OF SYSTEM LEVEL DISPARITIES AND PROVIDER LEVEL DISPARITIES. THAT HASN'T BEGUN. THE HOPE IS THAT NOT ONLY CAN WE SHOW WE CAN HELP REDUCE DISPARITIES AT THE THE PATIENT AND SYSTEM AND PROVIDER LEVEL. AND AS A RESULT OF THE INITIAL ENGAGEMENT THERE WERE ENVIRONMENTAL FACTORS AFFECTING THIS. WE WENT BACK TO THE NIH AND REPORTED WE'RE TRYING TO UNDERSTAND THE PSYCHOSOCIAL FACTORS THAT MAKE IT IMPOSSIBLE FOR THEM TO GET A GOOD NIGHT'S SLEEP LEADING TO COGNITIVE DYSFUNCTION AND CARDIOVASCULAR DISEASE PROBLEMS. HERE'S AN EXAMPLE OF WHAT THE PROJECT LOOKS LIKE NOW BECAUSE INITIALLY THAT'S NOT HOW IT WAS DESIGNED. WE WANTED TO VISIT THE LABORATORY AND BECAUSE OF WHAT HAPPENED TO COVID-19 THE WHOLE THING HAD TO BE RE-IMAGINED AND SHIFTED TO THE PATIENT'S HOME, THEY RECEIVE INFORMATION VIA YOUTUBE CHANNEL SO THEY UNDERSTAND HOW TO OPERATE THE MACHINES AS WELL AS SHIPPING THEM BACK FOR ANALYSIS LATER. THE WHOLE THING WAS COLLECTED AND STARTED IN A HUB WHERE. -- IN A HUB. HERE'S AN EXAMPLE OF WHAT IT LOOKS LIKE AND I THINK MY TIME IS UP. IF WE HAVE QUESTIONS, WE CAN ENTERTAIN THOSE. THANK YOU. >> THANK YOU. THAT WAS AN INFORMATIVE AND FANTASTIC PRESENTATION. I WANT TO OPEN IT UP FOR QUESTIONS FROM THE AUDIENCE. IF YOU HAVE QUESTIONS, OTHERWISE I HAVE A QUESTION FOR YOU. >> YES. >> I DON'T SEE ANY QUESTIONS IN THE CHAT JUST YET SO I'LL ASK YOU A QUESTION. CAN YOU COMMENT ON ONGOING EFFORTS TO UNDERSTAND AND ADDRESS SYSTEM AND PROVIDER LEVEL RACIAL ETHNIC DISPARITIES IN O.S.A. CARE. >> FANTASTIC QUESTION. OUR EFFORTS HAVE FOCUSSED PRIMARILY ON PATIENT LEVEL DISPARITIES. WE'RE NOW BEGINNING TO THINK ABOUT, OKAY, WE HAVE MANAGED TO GET THESE GUYS TO BECOME AWARE AND SOME HAVE SCREENED BUT YES WE HAVE NOT BEGUN AND AT THE DEBRIEFING WE FOUND THE INTRINSIC PROBLEMS IN THE HEALTH CARE SYSTEM WE HAVE TO ADDRESS AND PROPOSE ANOTHER STUDY TO ADDRESS THIS AND HOPE THEY'LL BE FUNDED THROUGH THIS. IN TERMS OF ENGAGING PROVIDERS WHERE THERE'S BIAS LEADING TO BLACKS AND LATINO, HOW DO WE ADDRESS THAT? THERE ARE PROBLEMS WITH FOLKS WHO MAY BE UNINSURED OR NOT INSURED AND WHAT SHOULD THEY FOLLOW AND IT WILL REQUIRE ENGA ENGAGEMENT TO UNDERSTAND THE DIFFERENT AVENUES. >> I APPRECIATE THAT VERY MUCH. WE HAVE TIME DURING THE Q&A LATER AND HAVE OTHER QUESTIONS THAT HAVE COME IN AND SOME WHO APPRECIATED YOUR TALK IN THE CHAT. DURING THE Q&A WE'LL COME BACK FOR ADDITIONAL QUESTIONS. THANK YOU SO MUCH FOR A GREAT PRESENTATION. >> THANK YOU. >> AT THIS TIME I'D LIKE TO INTRODUCE OUR NEXT PRESENTER, DR. DAVID HARRISON. HE'LL BE SPEAKING ON COMMUNITY OUTREACH APPROACHES TO THE TREATMENT OF HYPERTENSION. WELCOME, DR. HARRISON. >> SORRY, I WAS MUTED. SO I'M GOING TO TALK ABOUT COMMUNITY APPROACHES TO TREAT HYPERTENSION. I THINK THE SETTING HAS ALREADY BEEN MADE FOR THIS PRESENTATION BUT HYPERTENSION IS THE HUGE RISK FACTOR FOR ALL KINDS OF COMORBIDITIES INCLUDING HEART ATTACK, STROKE, HEART FAILURE, ARRHYTHMIAS, RENAL FAILURE AND EXTREMELY PREVALENT ACCORDING TO RECENT AHAACC GUIDELINES. ALMOST HALF THE POPULATION HAS HYPERTENSION AND THIS INCREASES WITH AGING. ACCORDING TO THE GLOBAL BURDEN OF DISEASE STUDY, A RECENT ANALYSIS FROM THIS STUDY SHOWS HIGH SYSTOLIC PRESSURE IS THE LEADING RISK FACTOR FOR DISEASE IN THE WORLD. SO THIS IS NOT ONLY UNITED STATES PROBLEM BUT A GLOBAL PROBLEM. AND ONE OF THE ISSUES I THINK IS RELEVANT TO OUR DISCUSSION TODAY IS THAT THERE ARE CLEAR RACIAL DISPARITIES IN CARDIOVASCULAR DISEASE AND PARTICULARLY HYPERTENSION. NON-HISPANIC BLACK HAVE THE HIGHEST RATE OF HYPERTENSION AND HYPERTENSION RELATED DEATH OF ANY RACIAL, ETHNIC OR SEX GROUP IN THE UNITED STATES. AND BLACK MEN HAVE LESS POSITION INTERACTION THAN BLACK WOMEN AND LOWER RATES OF HYPERTENSION TREATMENT AND CONTROL. THIS IS JUST AN ANALYSIS OF THE DATA THAT SHOW THE INCIDENTS OF HYPERTENSION IS HIGHEST AMONG BOTH BLACK MEN AND BLACK WOMEN AND IF YOU LOOK AT CONTROL IT'S LOWEST IN BLACK MEN COMPARED TO ALL OTHER RACIAL GROUPS ANALYZED IN THIS STUDY. SO WHY DOES THIS HAPPEN? WELL, THERE'S A NUMBER OF PROPOSED REASONS. ONE INCLUDES COMORBIDITIES LIKE OBESITY, DISEASE. THERE'S A HIGHER INCIDENTS OF RESISTANT HYPERTENSION. THAT IS HYPERTENSION THAT PERSISTS WITH TREATMENT. THERE ARE UNDOUBTEDLY GENETIC AND EPIGENETIC FACTORS INVOLVED. THERE'S ENVIRONMENTAL FACTORS INCLUDING DIET, STRESS. THE LAST PRESENTATION TALKED ABOUT DIFFICULTIES WITH SLEEP WHICH CONTRIBUTES TO HYPERTENSION. FETAL AND EARLY LIFE EXPERIENCES. SALT SENSITIVITY IS GREATER IN AFRICAN AMERICANS THAN IN OTHER ETHNIC GROUPS. LACK OF ACCESS TO CARE AND MEDICATION AND THEN DISTRUST OF MEDICAL AND PHARMACEUTICAL INDUSTRIES. I MIGHT SAY, MY IMPRESSION IS THIS IS NOT AN ETHNIC ISSUE. I SEE THIS AMONG MY OWN PATIENTS THAT ARE BOTH CAUCASIAN AND BLACK. THIS IS MY GOOD FRIEND, RON VICTOR, WHO PASSED AWAY AND DEVELOPED METHODS TO REACH OUT TO THE COMMUNITY TO IMPLEMENT CARE OF HYPERTENSION. HE IMPLEMENTED A PROGRAM IN LOS ANGELES AND OTHER AREAS AND WANT TO TALK ABOUT HOW WE ADOPTED THIS TO THE NASHVILLE AREA. WHY USE THE BARBERSHOP AS A MEANS OF TREATING HYPERTENSION. THE IDEA A BARBER IS CONNECTED TO HYPERTENSION DATES BACK TO THE MIDDLE AGES. BARBERS WERE SURGEONS AT ONE TIME AND WERE TRUSTED INDIVIDUALS WHO HAD LONG LASTING RELATIONSHIPS. CLIENTS SEE BARBERS FREQUENTLY SOMETIMES WEEKLY OR BI-WEEKLY AND THE BARBERSHOP IS CONSIDERED A COMFORTABLE ENVIRONMENT AN EXCHANGE OF INFORMATION AND BARBERSHOP OUTREACH HAS BEEN AROUND SINCE THE 1980s. THIS IS ERIC MOHAMED THE LEAD BARBER FOR RON'S PROGRAM IN LOS ANGELES. I'LL TALK ABOUT HIS EFFORTS IN A MOMENT. RON DID TWO STUDIES I WANT TO BRIEFLY TALK ABOUT AND THEN INT INTRODUCE OUR EXPERIENCE. ONE WAS A PAPER HE INITIALLY PERFORMED IN THE DALLAS AREA IN WHICH HE BASICALLY ASKED BARBERS TO TAKE CLIENT'S BLOOD PRESSURES AND SEE IF IT WAS ELEVATED AND FOLLOW THE INDIVIDUALS OVER A PERIOD OF ABOUT 10 MONTHS AND PROVIDED SOME PERSONALIZED HEALTH MESSAGES AND EXTENSIVE DISCUSSION WITH THE PATRONS BUT DID NOT IMPLEMENT CARE IN THIS SETTING. WHAT THEY BASICALLY FOUND IS SUMMARIZED HERE. THERE WAS A LOWERING OF BLOOD PRESSURE OF ABOUT 8 MILLIMETERS SYSTOLIC AND 3 MILLIMETERS DIASTOLIC IN THE INTERVENTION GROUP. THEY HAD A COMPARATOR GROUP GIVEN LITERATURE BUT NOT THE INTENSE COACHING AND THE INTERVENTION GROUP AND THEY HAD A LOWERING OF BLOOD PRESSURE OF ABOUT 5 MILLIMETERS MERCURY AND THE DIFFERENCE IN THE GROUPS WERE SMALL AND CANNOT REACH STATISTICAL SIGNIFICANCE. THIS WAS CONSIDERED KIND OF A NEGATIVE STUDY BUT PROMISING AND THIS PROMPTED RON TO INITIATE ANOTHER STUDY HE BEGAN WHEN HE MOVED TO THE LOS ANGELES AREA ADD CEDAR SINAI IN WHICH HE DECIDED TO HAVE AN INTERVENTION GROUP IN WHICH A PHARMACIST WOULD VISIT THE BARBERSHOPS AND CHECK BLOOD PRESSURE AND COULD PRESCRIBE MEDICATION. SO THIS ALLOWED THE PHARMACIST TO PROVIDE A MUCH MORE INTENSIVE MEANS OF CARE THAN ENCOUNTERED IN HIS FIRST STUDY. THERE WAS A CONTROL GROUP IN WHICH WAS LIKE THE DALLAS INTERVENTION WHERE THE CLIENTS WERE URGED TO SEEK PHYSICIANS IF THEY HAD HYPERTENSION. SO THIS IS JUST A LITTLE BIT ABOUT HOW THE STUDY WAS PERFORMED BUT THEY ENROLLED 319 CLIENTS. THIS INVOLVED ABOUT 80 BARBER SHOPS IN THE LOS ANGELES AREA. THEY HAD A VERY GOOD RETENTION RATE OF ABOUT 90%. SO THIS INVOLVED AN INTERACTION WEN THE PHARMACISTS AND BARBER AND PATRON AND THERE WAS A PHYSICIAN THAT WAS ALWAYS IN THE PERIPHERY WHO OVERSAW THE ACTIVITIES OF THE PHARMACIST AND INTERACT WITH THE PHARMACIST TO ADVICE CARE. THIS IS AGAIN ERIC MOHAMED THE LEAD BARBER IN THE LOS ANGELES PROJECT AND THIS IS ADAIR BLILER THE PHARMACIST AND THERE WAS A CALCIUM CHANNEL BLOCKER AND INHIBITER AND DIERETIC AND WOULD ADD AN ANTAGONIST AND PLERONONE AND SAW ALMOST A 30 MILLIMETER MERCURY LOWERING IN THE INTERVENTION AND 7 MILLIMETER LOWERING IN THE CONTROL GROUP AND OVERALL ALMOST A 21 MILLIMETER REDUCTION IN SYSTOLIC PRESSURE DIFFERENCE BETWEEN THE INTERVENTION AND THE CONTROL GROUP. AND THIS WAS REFLECTED BY A SIMILAR CHANGE IN DIASTOLIC BLOOD PRESSURE. THIS WAS AMAZING. IF YOU LOOK AT STUDIES THAT HAVE USED RECEPTOR BLOCKERS OR ACE INHIBITORS THE AVERAGE BLOOD PRESSURE LOWERING IS 8 TO 10 MILLIMETER OF LOWERING AND A 21 MILLIMETER LOWERING OF BLOOD PRESSURE IS AMAZING. I'D LIKE TO SHARE WITH YOU OUR EXPERIENCE IN NASHVILLE. RON AND I WORKED AGAIN MANY YEARS AND WERE GOOD FRIENDS AND ENCOURAGED US TO ESTABLISH THIS PROGRAM IN THE NASHVILLE AREA. I WAS ASSISTED IN THIS TREMENDOUSLY ASSISTED BY THE WORK OF CARRY CAVANAUGH AND DEVICA NAIR AND WE WORKED WITH BARBERSHOPS IN THE NASHVILLE AREA. OUR EXPERIENCE -- I DON'T HAVE A LOT OF DATA. I SHOULD SAY WE'RE JUST WRAPPING THIS PROJECT UP. I WOULD SAY WE'VE HAD THREE CONCLUSIONS THAT I WOULD LIKE TO EMPHASIZE FOR THE GROUP TODAY. FIRST WE WERE VERY IMPAIRED BY THE COVID PANDEMIC. THE BARBERSHOP SHUT DOWN FOR THREE MONTHS AND DIDN'T ENROLL AS MANY SUBJECTS AS WE WISH WE HAD AND NOW HAVE ABOUT 40 COMPLETING THE PROTOCOL AND THERE ARE STATE AND REGULATORY HURDLES UNIQUE TO TENNESSEE AND NASHVILLE AND I'M SURE OTHERS WILL ENCOUNTER WHEN TRY TO IMPLEMENT SUCH PROGRAMS. BUT THE THIRD IS THAT WE WERE ABLE TO CONFIRM AND AT LEAST FROM PRELIMINARY DATA IT LOOKS LIKE WE'RE GETTING A PO MILLIMETER -- 30 MILLIMETER MERCURY LOWERING OF BLOOD PRESSURE AND THE PROGRAM WAS NOT UNIQUE TO LOS ANGELES OR THE GROUP AT CEDAR SINAI BUT PROBABLY APPLICABLE TO ALL PROGRAMS. IN SUMMARY, TO DISCUSS OUR OUTCOMES THE PHARMACIST GUIDED TREATMENT OF HYPERTENSION IS EFFECTIVE AND OTHER SETTINGS OF POPULATIONS WILL LIKELY BENEFIT. FOR EXAMPLE, SALONS FOR HAIRSTYLING. OTHER HEALTH CARE PROVIDERS LIKELY EFFECTED LIKE NURSE PRACTITIONERS ASIDE FROM PHARMACISTS AND OTHER DISEASES COULD BE MANAGED IN THIS FASHION. I THINK SOME OBVIOUS ONES INCLUDE DIABETES, HYPERCHOLESTEROLEMIA AND OBESITY IN OUR STUDY AND IN LOS ANGELES THE BARBERS WERE GIVEN FINANCIAL INCENTIVES TO PARTICIPATE AND THAT MAY NOT BE FEASIBLE IN THE REAL WORLD. MANY SUBJECTS REQUIRE SCREENING TO IDENTIFY THOSE TO BE ENROLLED. THIS IS PRETTY INTENSIVE. THEY HAVE TO SCREEN 20 SUBJECTS TO FIND ONE THAT FULFILLS CRITERIA TO BE TREATED IN THIS FASHION. THE LOS ANGELES EXPERIENCE IS GOING TO HAVE TO AT LEAST BE MODIFIED TO BE APPLIED IN OTHER AREAS. OF COURSE OUR STUDY WAS ONLY IN MALES BUT I THINK IT WOULD ALSO BE APPLICABLE TO FEMALES AS WELL. I JUST SAW THIS THE DAY I HAD TO SUBMIT MY SLIDES THERE WAS AN NPR ARTICLE SHOWING YOU CAN USE THE BARBERSHOPS TO GIVE VACCINATIONS. AT LEAST ONE BARBERSHOP IN MILWAUKEE WAS DOING THIS. I THOUGHT THIS WAS A PRECIOUS PICTURE SHOWS A LITTLE FELLOW GETTING A HAIRCUT AND WERE ABLE TO GET VACCINATION IN THIS WAR BERBER SHOP SETTING. AND ANOTHER ASPECT I THINK IS RELEVANT TO THIS WORKSHOP. I WAS FORTUNATE TO RECEIVE FUND FROM THE AMERICAN HEART ASSOCIATION FOR THE FIRST STRATEGICALLY FOCUSSED RESEARCH NETWORK AND HAVE A POPULATION PROJECT. THAT WAS DIRECTED BY DR. TOMMY WANG NOW THE CHAIR OF MEDICINE AT U.T. SOUTHWESTERN AND TWO OF THE MAJOR INVESTIGATORS WITH WERE DEEPAK GUPTA AND [INDISCERNIBLE] MUNOS AND A STUDY ORIGINATED AT VANDERBILT. THE IDEA BEHIND THIS IS TO USE A POPULATION-BASED STRATEGY TO TREAT DISEASE. THIS GETS INTO THE DEBATE ABOUT POPULATION VERSUS INDIVIDUAL PREVENTION STRATEGIES AND TRADITIONAL TREATMENT HAS IDENTIFIED HIGH RISK PERSONS AND THIS IS ENDORSED BY MAJOR GUIDELINES. POPULATION-BASED STRATEGIES FOCUS ON SHIFTING THE ENTIRE RISK POPULATION BY BROADLY APPLIED LOW-COST INTERVENTIONS WITH FEW SIDE EFFECTS. AND ONE OF THE ISSUES IS MANY PERSONS WHO HAVE A CARDIOVASCULAR EVENT WOULD BE CLASSIFIED BY CONVENTIONAL ALGORITHMS AS BEING AS LOW AT IMMEDIATE RISK AND THEREFORE MAY NOT BENEFIT FROM BROADLY APPLIED TREATMENT STRATEGY. -- INTERMEDIATE RISK. WE HAVE CLINICS IN RED DOTS SCATTERED THROUGHOUT THE SOUTHEASTERN UNITED STATES INVOLVING 86,000 PEOPLE. THERE ARE MORE THAN 70 HEALTH CENTERS. BILL BLOT IS THE P.I. AND THIS IS A GREAT INFRASTRUCTURE FOR RECRUITMENT AND FOLLOW-UP IT'S AN UNDER SERVED POPULATIONS THE MEDIAN INCOME IS $14,000 AND HAVE A HIGH RISK OF CARDIOVASCULAR DISEASE. OUR PRIMARY SETTING WAS THE FRANKLIN HEALTH CENTER IN SOUTHERN ALABAMA BUT HAD A NUMBER OF OTHER CENTERS THAT WERE INVOLVED AS WELL. SO WE TREATED A LARGE NUMBER OF PEOPLE WITH THE POLY PILL AND OUR POLY PILL INCLUDED ATORVASTATIN AND AMLODIPINE AND LOSARTAN AND HYDROCHLOROTHIAZIDE AND 91% OF OUR PARTICIPANTS COMPLETE THE TRIAL. THESE ARE OUTCOMES FOR THE STUDY I THINK ARE IMPORTANT. THE SYSTOLIC PRESSURE AT BASELINE WAS 140 THEY WERE HYPERTENSIVE AND AT 12 MONTHS THE BLOOD PRESSURE WAS LOWERED BY 9 MILLIMETERS MERCURY AND THE CHOLESTEROL WAS LOWERED AND THEIR CARE WAS BEING DIRECTED BY PHYSICIANS IN THE SAME CLINICS. DIASTOLIC PRESSURE FOLLOWED THE SAME PATTERN. SO OUR CONCLUSIONS AND CONSIDERATIONS FROM THIS POLY PILL PROJECT WAS THAT ONE SIDES FITS ALL APPROACH TO PREVENTION CONTRADICTS CURRENT TRENDS IN PRECISION MEDICINE BUT WHILE PRECISION MEDICINE HAS VIRTUES, A BROADER APPROACH MAY BENEFIT PATIENT WHOSE FACE BARRIERS TO -- PATIENTS WHO FACE BARRIERS IN PRECISION MEDICINE AND DUE TO LACK OF INCOME AND MULTIPLE VISITS AND DRUG DOSE ADJUSTMENT ARE PROBLEMATIC IN POPULATIONS WITH LOW SOCIO ECONOMIC STATUS AND THE REGIMENT MAY BE ATTRACTIVE WHERE SUCH BARRIERS ARE COMMON AND BARRIERS TO PROGRESS AND EXTENDING PROVEN CARE TO UNDER SERVED AND MINORITY POPULATIONS REMAINS A MAJOR UNMET NEED IN THE TREATMENT OF HYPERTENSION AND CARDIOVASCULAR DISEASES AND EFFECTIVE THERAPIES ARE ESTABLISHED, SAFE AND REASONABLY INEXPENSIVE AND OFTEN UNDER DEPLOYED AND NOT SUSTAIN AND BARRIERS ARE MISINFORMATION AND MISTRUST AND LACK OF MINORITY CARE PROVIDERS, INCONVENIENCE AND COMPLEX IN CARE AND OPPORTUNITIES INCLUDE OUTREACH TO COMMUNITY SETTINGS, INVOLVEMENT OF PHYSICIAN EXTENDERS AND TELEMEDICINE AND COMMUNITY ADVOCATES AND SIMPLIFIED MEDICAL REGIMENTS. I'D BE HAPPY TO TAKE QUESTIONS. >> THANK YOU, VERY MUCH, DR. HARRISON. NICE PRESENTATION. WE HAVE TIME FOR A COUPLE QUESTIONS AND HAVE A COUPLE IN THE CHAT I'M GOING TO ASK. THE FIRST QUESTION IS HOW -- WHAT ARE YOUR RECOMMENDATIONS FOR BUILDING LONG-TERM RELATIONSHIPS BETWEEN BARBERS AND HEALTH CARE PROVIDERS GIVEN THE NATURE OF SMALL BUSINESSES IN AN ALREADY ECONOMICALLY TENUOUS COMMUNITY AND DISTRUST OF MEDICAL COMMUNITY AMONG RACIAL AND ETHNIC POPULATIONS. >> THE QUESTION ACTUALLY ADDRESSES THE HURDLES WE SEE. WE FOUND A NUMBER OF BARBERS IN THE NASHVILLE AREA THAT WERE VERY EAGER TO DEVELOP THESE RELATIONSHIPS. WE ALSO FOUND IT HELPFUL TO HAVE A PHARMACIST THAT WAS A MINORITY WHO I THINK IDENTIFIED WITH THESE GROUPS AND INTERACTED WITH THEM. WE WORKED WITH MAYOR'S OFFICE, WITH REPRESENTATIVES IN THE MAYOR'S OFFICE AND OTHER COMMUNITY REPRESENTATIVES TO ESTABLISH THE PROGRAM. AND I THINK IT IS POSSIBLE IF ONE TAKES MEASURES SUCH AS THOSE WE EMPLOYED TO DEVELOP LONG-TERM RELATIONSHIP WITH THE SUBGROUPS. ONE THING WE FOUND AS OUR PROGRAM BECAME SUCCESSFUL AND WE STARTED ENROLLING CLIENTS LOCALLY, OTHER BARBERS WANTED TO GET INVOLVED AND ASK IF THEY CAN GET THEIR BARBERSHOP ENROLLED IN OUR PROGRAM. >> GREAT. THERE ARE OTHER QUESTIONS THAT HAVE COME IN AND I'LL ROLL THOSE OVER FOR THE END OF SESSION TO KEEP THINGS MOVING BUT WE APPRECIATE YOUR PRESENTATION AND LOOK FORWARD TO ASKING ADDITIONAL QUESTIONS THAT HAVE COME UP. THANK YOU. AT THIS TIME I'D LIKE TO INTRODUCE OUR NEXT PRESENTATION CO-PRESENTATION BY MARCIA O'LEARY AND LYLE BEST. THEY'RE PRESENTATION IS ENTITLED DIAGNOSTICS AND DISEASE MANAGEMENT TOOLS IN AMERICAN INDIAN COMMUNITIES. >> THANK YOU. THIS IS MYSELF AND MY HUSBAND. WE HAVE A SMALL AMERICAN INDIAN RESEARCH GROUP OF 41 EMPLOYEES LOCATED ACROSS TWO STATES. 85% OF OUR STAFF ARE CURRENTLY TRIBAL MEMBERS AND WE BELIEVE WE HAVE TO GROW OUR OWN SO THAT IS OUR GOAL TO TRY TO EMPLOY PEOPLE IN MEANINGFUL JOBS THAT MAKE THEM WANT TO BECOME PART OF THE SOLUTION. SO CURRENTLY WE'RE WORKING ON APPROXIMATELY 19 DIFFERENT PROJECTS AGAIN ACROSS FOUR OR FIVE DIFFERENT CLINICAL SITES IN THE DAKOTAS. WE ARE WORKING ON A COVID-19 TRIAL AND AN EQUIPMENT COMPANY AND THE PROGRAM YOU'RE PROBABLY MOST FAMILIAR WITH IS THE STRONG HEART STUDY. >> THANK YOU. JUST A BIT ABOUT MYSELF TO ORIENT YOU, I GREW UP IN A SMALL TOWN IN NORTH DAKOTA. I RECEIVED MY MD DEGREE IN 1974 AND FINISHED A FAMILY MEDICINE RESIDENCY IN 1977 AND WORKED FOR THE INDIAN HEALTH SERVICE AS A FAMILY PHYSICIAN AND LAST FOUR YEARS AS AN AREA MATERNAL HEALTH CONSULTANT. I'VE BEEN A PRINCIPAL OR CO-INVESTIGATOR ON THREE DIFFERENT NIH STUDIES TO DATE FROM 2000 TO THE PRESENT AND WORKED IN PRIVATE PRACTICE PART-TIME IN A SMALL TOWN IN NORTH DAKOTA FOR ABOUT 10 YEARS. PLEASE CONTINUE, MARCIA. >> OKAY. SO FIRST OF ALL, I'D LIKE TO SET THE SCREEN FOR YOU. THIS IS A PLACE OF EXTREME TEMPERATURES AND EXTREME WEATHER AND CONDITIONS IN ALL KINDS. WE HAVE VERY MUCH EVERYTHING FROM BLOODS TO -- FLOODS TO DROUGHTS AND COMMONLY IN THE WINTER TO MINUS 20 AND BLIZZARDS AND TORNADOS. WE LIKE TO SEE IT KEEPS THE RIFFRAFF OUT BUT ALSO A CASE OF WHERE A LOT OF PEOPLE COME AND LOOK HERE AND GO OH, MY GOSH, THIS SAY HARD PLACE TO LIVE. AS YOU CAN SEE THIS IS THE ROAD TO MY HOUSE AND MY CLOSEST NEIGHBOR IS FIVE MILES AWAY. WE HAVE SOME OF THE MOST SPARSELY SPREAD COMMUNITY IN THE NATION AND LITERALLY FIVE MILES FROM OUR CLOSEST NEIGHBOR. WE HAVE A LOT OF CULTURE, LET ME SAY. WE HAVE A RICH CULTURE, LIFE STYLES. INCOMES ARE VERY DIVERSE BUT WE HAVE PEOPLE THAT HAVE A LOT OF FEDERAL JOBS IN OUR AREA BUT ALSO HAVE A LOT OF AGRICULTURE AND A LOT OF POVERTY. WE OPERATE IN SOME OF THE LOWEST PER CAPITA INCOMES IN THE NATION ON THE CHEYENNE RIVER AND ON A NATION AT PINE RIDGE AND ACROSS THE OTHER RESERVATIONS IN THE DAKOTAS. THOUGH WE HAVE ARICH CULTURES, VALUES AND LIFE STYLES WE HAVE A TREMENDOUS AMOUNT OF DIVERSITY. KIND OF AT THE OPPOSITE ENDS OF THE SPECTRUM BUT AS WE ALL KNOW, CHANGE HAPPENS AT THE RATE OF TRUST. THIS IS WHY IT'S IMPORTANT TO INVOLVE THE COMMUNITY AND RECOGNIZE OUR COMMUNITY IS MANY DIFFERENT THINGS. WE ARE BORDER TOWNS AND TRIBAL NATIONS AND MULTIPLE JURISDICTIONS IN OUR COMMUNITIES. WE HAVE MULTIPLE DIFFERENT TYPES OF HEALTH CARE SERVICES FROM INDIAN HEALTH SERVICE TO PRIVATE TO COUNTY TO STATE SERVICES AND SO BEING ABLE TO GET ACROSS ALL THE DIFFERENT BARRIERS IS SOMETHING THAT'S VERY DIFFICULT AND OFTEN TIMES HARD FOR PEOPLE TO GET SERVICES. -- SERVICES IN THAT ENVIRONMENT. ONE OF THE THINGS WE THINK THAT'S REALLY IMPORTANT AT THE BOTTOM YOU'LL SEE EDIE AND TOM WELTY THE FIRST FOLKS WITH THE STRONG HEART STUDY AND IT'S CRITICAL FOR RELATIONSHIPS IN OUR COMMUNITIES AND I CAN'T DO THAT WITH A PICTURE OR WITH JUST KNOWING IT. WE DON'T NEED MISSIONARIES HERE AS WE ALWAYS SAY. WE NEED PEOPLE THAT BELIEVE IN OUR COMMUNITIES AND ARE WILLING TO GIVE FOLKS AN EVEN PLAYING FIELD. SO DR. WELTE AND DR. BEST HAVE HAD A LIFE TIME OF COMMITMENT TO MAKING THAT HAPPEN. WE KNOW THERE'S BEEN A LOT OF HISTORICAL TRAUMA. THE THING I THINK IS IMPORTANT HERE THIS IS A PICTURE FROM WOUNDED KNEE, IN ALL THE TIME THAT SINCE THIS HAPPENED AND HUNDREDS OF PEOPLE HAVE BEEN -- THERE'S BEEN HISTORICAL TRAUMA FROM THIS GROUP AND HAS IMPACTED MANY PEOPLE. OVER ALL THAT TIME, NOBODY HAS ACKNOWLEDGED THE WRONG THAT WAS DONE TO THE LOCOTA PEOPLE AND IT WAS IMPORTANT FOR DR. GIBBONS WHEN HE CAME TO THE DAKOTAS TO VISIT AND WENT TO WOUNDED KNEE AND GOT A FIRST-HAND EXPERIENCE OF THE TRAUMA AND TRAGEDY. THAT WAS REALLY IMPORTANT TO OUR COMMUNITY FOR HIM TO PAY HIS RESPECTS THERE IT WAS MEANINGFUL AND WE APPRECIATE THAT. YOU CAN SEE WE HAVE A LONG HISTORY OF MISUSE OF DATA AND I'M NOT GOING TO GO OVER ALL THESE BUT WE ALSO HAVE A LOT OF BENEFITS. WHENEVER WE'RE WORKING WITH OUR TRIBAL NATIONS WE HAVE TO RECOGNIZE WE HAVE TO BALANCE THAT AND ACKNOWLEDGE THAT THERE'S BEEN THIS UBIQUITOUS EXPERIENCE AND IT WAS ACROSS MORE THAN JUST NATIVE COMMUNITIES BUT PEOPLE HERE HAVE LONG MEMORIES. AND IMPACTS THE ENTIRE TRIBE. IT'S IMPORTANT FOR EVERYBODY TO UNDERSTAND THAT. THESE HAVE TO BE BALANCED AND ACKNOWLEDGED. >> I'LL CONTINUE ON FROM THERE AND LET YOU KNOW WHEN I NEED TO CHANGE SLIDES. SO MARCIA'S GIVEN YOU A VERY GOOD VISUAL GLIMPSE OF LIFE ON THE FRONTIER. TO ADD MORE OBJECTIVE DATA, HERE YOU SEE A COLLECTION OF COUNTIES FROM NORTH AND SOUTH DAKOTA. ON THE LEFT IS SLOPE COUNTY WITH ONE HALF PERSON PER SQUARE MILE. AND CASS WITH 80 AND WASHINGTON, D.C. WITH 3200 PEOPLE PER SQUARE MILE. IN TERMS OF GEOGRAPHY, EAGLE VIEW HAS A POPULATION OF ABOUT 1,000. THE NEXT LARGEST TOWN IS 3400 IN MOBRIDGE 80 MILES AND 90 MILES AWAY YOU REACH PIERRE WITH 14,000 AND THERE'S A HOSPITAL WITH LIMITED HOSPITAL BUT PIERRE DOES HAVE AN ICU AND 170 MILES IN EAGLE BUTTE AND RAPID CITY YOU REACH POPULATION OF 75,000, A MORE SOPHISTICATED MEDICAL FACILITY. IN TERMS OF EXPECTS, AS YOU MIGHT EXPECT, 45% OF THE POPULATION IN THE THREE SURROUNDING COUNTIES AROUND EAGLE BUTTE LIVE BELOW THE POVERTY LINE AND YOU EAGLE BUTTE WOULD BE A GOOD CANDIDATE FOR A FOOD DESERT. HERE YOU SEE PICTURES FROM THE FRUITS AND VEGETABLE SECTION OF THE EAGLE BUTTE GROCERY STORE. THOUGH THERE'S SERIOUS NUTRITIONAL ISSUE IT'S NOT DUE TO LACK OF FRUITS AND VEGETABLE. 15% OF THE POPULATION HAVE BACHELOR'S DEGREE OR ABOVE WHERE IT'S ABOUT 35% IN PIERRE AND 60% IN WASHINGTON, D.C. I SHOW THE SLIDE TO EMPHASIZE THE UNITED STATES, IN MY OPINION WILL NEVER RESEARCH OR INNOVATE ITS WAY OUT OF THE HEALTH INEQUITY WE HAVE. WE MUST PROVIDE EQUITABLE ACCESS. ON THE LEFT YOU SEE A PHOTOGRAPH OF THE CENTER AT THE MAYO CLINIC AND THE WARD IN THE SOUTH BRONC WHERE I TRAINED IN 1974. WE HAD 17 BEDS ON ONE SIDE AND 17 BEDS UP THE OTHER SIDE AND ON A GOOD DAY WE'D HAVE TWO NURSES TO ASSIST WITH OUR CARE. GRANTED, LINCOLN HOSPITAL HAS BEEN REBUILT BUT I GUARANTEE THERE'S SIMILAR INEQUITIES THAT EXIST YET TODAY YOU JUST DON'T HAVE PHOTOGRAPHS TO DESCRIBE THEM. I'VE BEEN BLESSED TO BE INVOLVED IN COMMUNITY BASED PARTICIPATORY RESEARCH FROM TE START AND A WONDERFUL PARADIGM TO IMPROVE THE EFFECTIVENESS OF RESEARCH AND IMPROVE THE ABILITY TO TRANSLATE FINDINGS INTO IMPROVED HEALTH CARE. IT'S MUCH EASIER SAID THAN DONE. SOME WAYS IT CAN AND SHOULD BE STRENGTHENED IS FOR INSTITUTIONS WOULD PROVIDE FUNDING TO BUILD ON THE STRENGTH OF BOTH THE LOCAL PROFESSIONALS AND THEIR RESIDENTS AND LEADERS IN RURAL AND FRONTIER COMMUNITIES. WE NEED TO BE ENCOURAGING RESEARCH AND CONTINUOUS ADULT LEARNING FOR ALL PROFESSIONALS AND BUILD IT INTO CAREER PATHS AND JOB EXPECTATIONS. I THINK NIH HAS BEGUN TO REALIZE THE NEED FOR DIVERSIFYING THE RESEARCH POPULATION THERE IS ENGAGED WITH WITH US AND I APPLAUD THAT. I THINK THERE NEEDS TO STILL BE INCREASED RECOGNITION OF LOCAL INVESTIGATOR'S KNOWLEDGE AND A DEEMPHASIS ON PRELIMINARY DATA IN EVALUATING PROPOSALS. I THINK NIH NEEDS TO PARTNER MORE WITH TRIBAL AND OTHER UNDERGRADUATE INSTITUTIONS RATHER THAN FOCUSSING MORE ON RESEARCH INTENSIVE INSTITUTIONS. I THINK MORE FLEXIBILITY IN TERMS OF BUDGETING, INCREASED ABILITY TO CARRY OVER FUNDS FROM YEAR TO YEAR REDEES -- AND I'M INVOLVED WITH A PROGRAM THAT PROHIBITS CERTAIN INVESTIGATES BEYOND UNDERSTANDING AND A LONGITUDINAL UNDERSTANDING FOR COHORTS INTERESTED IN FURTHERING HEALTH AND WE'VE COME TO AND IT'S UNDER CONTRACT AT THIS POINT. SO THINGS LIKE THAT NEED TO BE ADDRESSED. IN GENERAL NIH NEEDS TO REDUCE THE REPORTING WORK LOAD AND IN THE INDIAN HEALTH SERVICE IN RECENT YEARS HAS HAD DISCOURAGEMENT FOR OUTSIDE ACTIVITY FOR EMPLOYEES HINDERING COLLABORATION AND RESEARCH AND THERE'S A WAREHOUSE WITH VALUABLE REPOSITORY OF CLINICAL INFORMATION THAT COULD BE USED FOR BOTH FURTHERING RESEARCH AND IMPROVING CLINICAL CARE. IT'S BEEN DIFFICULT TO ACCESS THIS DATA IN GENERAL. OVER MY YEARS IN PRACTICE WHAT HAVE I SEEN IN TERMS OF INNOVATIONS AND HOW THEY IMPACT MY PRACTICE? THE DEVELOPMENT OF STATINS AS ACE INHIBITERS HAS A TREMENDOUS BOON FOR CARDIOVASCULAR CARE. TELEMEDICINE HAS MADE CONTRIBUTIONS BUT I THINK STILL HAS SOME CONCERNS AND PROBLEMS THAT NEED TO BE ADDRESSED. THERE HAVE BEEN GADGETS IN TECHNOLOGY THAT IMPROVED CARE. PULSE OXIMETRY AND HEMOGLOBIN MEASUREMENTS AND THE VACCINES WE'VE SEEN DEVELOPED OVER THE YEARS HAVE BEEN BENEFICIAL. WHAT DO WE NEED IN THE FUTURE? WE NEED IMPROVED BEHAVIOR OR PHARMACOLOGIC IMPROVEMENT FOR METH AMPHETAMINE ADDICTION AND OBESITY AND SPECIFICALLY WE COULD USED INCREASED SCREENING FOR ATRIAL FIBRILLATION AND BEHAVIORAL INTERVENTION FOR IMPROVED DIETS. SCREENING AND TREATMENT FOR PREECLAMPSIA AND UPTAKE FOR INFLUENZA AND OTHERS. THIS IS JUST A SUMMARY SLIDE WITH POINTS I TRIED TO MAKE AND HAPPY TO ENTERTAIN ANY QUESTIONS THE LAST FIVE MINUTES. >> I WOULD ALSO ADD, DR. BEST, THAT ONE OF THE IMPORTANT THINGS WE AS A NATION NEED TO LOOK AT IS FRONTIER FUNDING FORMULAS TO SUPPORT BUILDING INFRASTRUCTURE WITHIN OUR COMMUNITIES. >> THANK YOU, MARCIA. >> THANK YOU SO MUCH. THAT WAS REALLY AN ENLIGHTENING PRESENTATION AND HIGHLIGHT THE KEY ISSUES IN WORKING IN AMERICAN INDIAN COMMUNITIES AND ON THE FRONTIER. A QUESTION FOR YOU, WHAT ADDITIONAL PROCEDURES ARE NECESSARY THAT THE RESEARCH COMMUNITY SHOULD BE AWARE OF TO WORK COOPERATIVELY AND COLLABORATIVELY WITH AMERICAN INDIAN COMMUNITIES? >> A RECOGNITION THAT TRIBAL NATIONS ARE SOVEREIGN NATIONS AND NOT LIKE WORKING WITH OTHER INSTITUTIONS. THERE'S A PROCESS THAT HAS TO BE FOLLOWED AND MOST TRIBES ARE OPEN TO THAT. BUT IT DOESN'T OPERATE IN THE PACE OF WHAT IS FREQUENTLY THE REQUIREMENTS OF AN APPLICATION. SO THERE HAS TO BE A LOT MORE PLANNING OUT IN ADVANCE IN ORDER TO DEVELOP RELATIONSHIPS, ESTABLISH UNDERSTANDING, GET THE VARIOUS APPROVALS THROUGH THE TRIBAL PROGRAMS AND THEIR IRBs WHICH ARE OFTEN NOT MEETING ON A REGULAR BASIS. IT'S A DIFFERENT SYSTEM. IT WORKS BUT YOU HAVE TO BE PREPARED TO DO THE WORK TO ESTABLISH RELATIONSHIPS. >> THE. -- >> THANK YOU. CAN YOU TALK ABOUT WHETHER THERE'S SPECIFIC MEDICAL CONDITIONS UNIQUE WITHIN AMERICAN INDIAN COMMUNITIES WHICH SPECIAL ATTENTION? >> I THINK ONE OF THE FINDINGS FROM THE STRONG HEART STUDY IS THAT THE RISK FACTORS FOR CARDIOVASCULAR DISEASE, FIRST OF ALL, CARDIOVASCULAR IS AN IMPORTANT PUBLIC HEALTH PROBLEM AN INDIAN HEALTH COUNTRY NOT RECOGNIZED 30, 40 YEARS AGO BUT IN ADDITION THE RISK FACTORS ARE SIMILAR TO THE NON-INDIAN POPULATION. FREQUENTLY, INDIAN PEOPLE WILL ASK WHAT IS DIFFERENT ABOUT US THAT NEEDS DIFFERENT CARE AND SO ON AND I THINK IT MAY NOT BE A WELCOMING ANSWER BUT THERE'S NOT A BIG DIFFERENCE THAT REQUIRES DIFFERENT CARE AND THAT'S GOOD BECAUSE WE WOULDN'T WANT TO HAVE TO PROVE AGAIN AND AGAIN THIS PARTICULAR MEDICATION WORKS AN INDIAN PEOPLE AS WELL AS IT DOES OTHER. THAT WOULD PROBABLY NOT BE DONE FROM A PHARMACOLOGIC STANDPOINT. I THINK IT'S GOOD NEWS TO HEAR THAT GENERALLY SPEAKING WHAT WE HAVE IS EFFECTIVE. >> ONE OTHER QUESTION AND THEN TRANSITION TO OUR NEXT PRESENTATION. THOUGH YOU MENTIONED THE SUPPLY OF FRESH VEGETABLES AND FRUITS BE AVAILABLE IS ONE ISSUE THE COST TO LESS NUTRITION FOODS? >> I'M GLAD THAT QUESTION CAME UP AND DOUBLE CHECKED WITH AMANDA FREDS A NATIVE PERSON HERSELF AND IN THE STUDY. SHE DID A FOOD SURVEY AND AMAZINGLY ENOUGH THE COST OF FRUITS AND VEGETABLES IN EAGLE BUTTE IS 6% LOWER THAN BISMARCK AND PIERRE. THAT BAFFLES ME. I WOULD NEVER HAVE ANTICIPATED THAT AND WHAT SHE FOUND IN HER FOOD SURVEY. >> THIS IS A DISCUSSION THAT DR. BEST AND I HAVE FREQUENTLY ON THE ISSUE OF FRESH FRUITS AND VEGETABLES IN OUR RESERVATION COMMUNITIES AND OUR LOCAL STORE DOES A FANTASTIC JOB. IT DOES. IT SERVES A CERTAIN POPULATION BUT THE ISSUE IS NOT -- I THINK THE ISSUE ISN'T COST, IT'S LEARNED BEHAVIOR. WE HAVE THE NUTRITION OF POVERTY HERE. PEOPLE WILL USE THEIR FOOD STAMPS BECAUSE THAT IS THEIR MEANS OF TRADE AND BARTER OR TO TREAT THEIR CHILDREN AND GRANDCHILDREN. I CAN'T BUY YOU TENNIS SHOES BUT I CAN BUY YOU A BAG OF CHIPS. THERE'S A CULTURE OF NUTRITION THAT GOES HAND IN HAND WITH POVERTY THAT HAS AN ECONOMIC SIDE TO IT WE NEED TO LOOK AT. >> THANK YOU. EXCELLENT POINT. THANK YOU FOR THE PRESENTATIONS AND WE'LL CIRCLE BACK DURING OUR Q&A TOWARD THE END. HAPPY TO INTRODUCE OUR NEXT PRESENTER, DR. OLVEEN CARRASQUILLO. WELCOME. >> THANK YOU, IT'S A PLEASURE TO BE HERE SHARING SOME OF THE WORK WE'VE BEEN DOING DOWN HERE IN MIAMI. WITH THAT I'LL SHARE MY SCREEN AND YOU'LL TELL ME WHETHER YOU CAN SEE MY SLIDES IN ONE SECOND. WE'LL TALK ABOUT OUR TOOLS AND SUMMARIZE SIMILAR TO WHAT ALL THE OTHER PARTICIPANTS TODAY HAVE MENTIONED. NORMALLY, WHEN WE TALK ABOUT KNOWING THE COMMUNITY, WHICH IS THE SUB THEME OF THIS, THESE ARE THE KINDS OF SLIDES WE PUT IN WHEN WE DO GRANTS AND A LOT OF MY WORK IS LATINO POPULATION AND TALK ABOUT HOW WE MAKE UP AN INCREASING PERCENTAGE OF THE LATINO POPULATION AND THIS MAGIC NUMBER BETWEEN 2045, LATINOS WILL MAKE UP A QUARTER OF THE POPULATION AND IT'S IMPORTANT TO KNOW THE DATA AND STATS. HERE IS DIFFERENT IN TRAINING OUR MEDICAL STUDENTS AND RESIDENTS AND I'D ARGUE PART OF THE TRAINING WE SHOULD PROBABLY DO FOR ALL OF OUR RESEARCHERS AS WELL WHEN YOU THINK ABOUT COMMUNITY OUTREACH. AND A LOT OF THAT IS WHAT I CALL REALLY KNOWING THE COMMUNITY. THIS IS A THING WE DO WHICH IS A BRIEF HISTORY OF HISPANICS IN MIAMI AND HAVE ONE FOR AFRICAN AMERICANS. SOME IS DATA. WE TALK A LITTLE BIT ABOUT THE CHANGING DEMOGRAPHICS OF FLORIDA AND PUERTO RICOS ARE A BIGGER GROUP AND IN MIAMI-DADE COUNTY AND TALK ABOUT THE STUFF WE TEACH IN ELEMENTARY SCHOOL AND PEOPLE FORGOT ABOUT LATINOS BEING THE PEOPLE WHO DISCOVER FLORIDA AND COLONIZE AND WE TALK ABOUT STUFF LIKE THE CUBAN REFUGEE CRISIS AND THE MARIEL BOATLIFT CRISIS AND THE DIFFERENT GENERATIONS IN CUBANS AND HAVE DIFFERENT EXPERIENCES FROM THE WEALTHIER INITIAL CUBANS TO THE ONES THAT CAME AFTER AND CHANGING DEMOGRAPHICS AND WHAT IS HAPPENING IN NICARAGUA AND WE HAVE A LARGE VENEZUELAN POPULATION AND IN THEIR HOME COUNTRIES WE TALK ABOUT SCREENING FOR CANCER AND HEALTH MAY NOT BE THE HIGHEST PRIORITY LIST FOR PEOPLE GIVEN THE LIVED EXPERIENCE THEY COME FROM AND IT'S IMPORTANT WE DEAL WITH PATIENT AND PARTICIPANTS IN OUR RESEARCH STUDIES. WE KEEP THAT CONTEXT UP IN MIND WHERE PARTICIPANTS COME FROM. AGAIN THE EVENTS TWO YEARS AGO HAPPENING IN NICARAGUA AND HOW YOU ADDRESS WHAT THEY'RE THINKING OF IS WHAT THEIR FAMILY BACK HOME IS GOING THROUGH. WE PUT SOME OF THIS WITHIN CONTEXT. WE SHOW THE DIABETES DATA AND THEN TALK ABOUT THIS STUFF. AND SOMETHING THE NICARAGUAN POPULATION TALK ABOUT AND WHETHER PEOPLE KNOW WHAT FRIT FRITANGA AND WHEN YOU GO THERE THESE HAVE THE FOODS YOU SHOULD SELECT AND KNOWING THIS AND YOU NEED BOOTS IN THE GROUND TO KNOW THE COMMUNITY. AND THERE'S A LOT OF COMMUNITY HEALTH WORKERS. COMMUNITY HEALTH WORKERS HAVE BEEN KEY TO MY WORK WE'VE DONE IN THE POPULATION AND THEY'RE KEY TO HAVING PEOPLE AS PART OF THE RESEARCH TEAMS THAT KNOW AND UNDERSTAND THE COMMUNITY. THIS IS ONE OF OUR FIRST STUDIES A RANDOMIZED STUDY OF COMMUNITY HEALTH WORKERS AND PATIENTS WITH DIABETES. THIS WE DID SEVERAL YEARS AGO AND THESE ARE COMMUNITY HEALTH WORKERS AND THEY DO WHAT MANY OF US REALIZE THEY WENT WITH PATIENTS TO THEIR HOMES, CLINIC VISITS AND ASSISTED WITH WHAT I CALL RECALL SOCIAL ISSUES BUT ADDRESSING SOCIAL DETERMINATES OF HEALTH AND DO HEALTH EDUCATION AND A LOT OF THIS WAS DEVELOPED BY COMMUNITY HEALTH WORKERS, ATTENDING COOKING CLASSES AND ORGANIZE FAMILY PICNICS TO SHOW HOW TO HAVE FUN AND EXERCISE AND TRIPS TO SUPER MARKETS AND WHERE PEOPLE SHOP NOT LIKE HERE WE HAVE PUBLIX WHERE MANY DON'T GO AND THEY GO TO THE LATINO SUPER MARKETS, FOR EXAMPLE, BUT HELPED TO BE PART OF THE RESEARCH TEAM AND EVEN WRITING SOME OF OUR PAPERS, AND INTEGRATED IN OUR RESEARCH TEAMS. WE FOUND SOME OUTCOMES FOR BLOOD PRESSURE AND A1C AND FOUND THOSE RANDOMIZED THE INTERVENTION HAD POSITIVE OUTCOMES AND I'LL TALK ABOUT THE LIMITATION OF THESE AT THE END. AND THEN IMPROVED ACCESS TO CARE WHICH IS A LOT OF WHAT THEY DID WAS PATIENT NAVIGATION MAKING SURE THEY HAVE APPOINTMENTS AND SHOWED THAT AS WELL WHICH IS ALL GOOD AND WRITTEN SEVERAL PAPERS ABOUT THE MORE NUTS AND BOLTS TALES ABOUT THE COMMUNITY HEALTH WORKERS AND MORE NARRATIVES AND DESCRIBING THE POPULATION IN RICHER DETAIL THAN USUALLY COMES OUT IN THE OUTCOMES PAPER WHICH ARE OVERLY IMPORTANT FOR PEOPLE TO UNDERSTAND AND COMMUNITY HEALTH WORKERS TO TRANSLATE IT INTO MEDICAL SCIENTIFIC EASE. AFTER THAT WE PIVOTED AND THIS WAS ANOTHER STUDY WE DID USING THE SAME COMMUNITY HEALTH WORKERS AS DIABETES AND PREVENTING SECONDARY STROKE WHICH IS A LOT OF ABOUT BLOOD PRESSURE CONTROL AND TOOK PARTICIPANTS AND RANDOMIZED THEM TO A COMMUNITY HEALTH WORKERS AND USED THE SAME TEAM FROM THE COMMUNITY HEALTH WORKERS AND ADJUSTED IT TO STROKE AND BLOOD PRESSURE INTERVENTION. THIS WAS THE NEW TOOL WE DECIDED TO USE. IT WAS PART OF A SPECIFIC RFA TO INCLUDE TECHNOLOGY. WE STARTED USING A PHONE TO DELIVER HEALTH MESSAGES AND MONITOR BLOOD PRESSURE AND TESTED THAT AS AN INTERVENTION. WE FOUND WE WERE ABLE TO TEACH PEOPLE HOW TO DO THIS. WE'RE TALKING SIMPLE TEXT-BASED MESSAGING USING PHONES AND DID DEVELOP MAN MANUALS AND DEVELOPED THE PREFERENCE GUIDES FOR PARTICIPANTS AND LITTLE BOOKS AND A LOT OF IT WAS DETAILED AND TRAINING PEOPLE HOW TO DEVELOP THE MANUALS. THESE ARE THE KINDS OF TEXTS THEY'D GET AND THE COMMUNITY HEALTH WORKER WOULD SEE THEIR RESPONSES. SOME WERE THEY FEELING DES PRESSED, SOME WERE ABOUT BLOOD PRESSURE AND HEALTH MESSAGING. THEY'D GET AT LEAST ONE MESSAGE A DAY IN THIS INTERVENTION. MORE SAMPLE TEXT. AGAIN MORE FOCUSSED ON BLOOD PRESSURE AND THEN ALL THE ALGORITHMS WE HAVE TO DEVELOP DEPENDING ON WHAT THE BLOOD PRESSURE IS AND IT DID TAKE A LOT OF PROGRAMMING AND BACK END WORK, HOW DO YOU ROTATE THE MESSAGES, WHAT DO YOU DO WITH ALL THESE THINGS AND WAS PRETTY EXTENSIVE AND IT WAS A LOT OF WORK DEVELOPING THE BACK END WORK FOR IT. WHAT THE COMMUNITY HEALTH WORKERS FOUND WAS MOST THE NEEDS AND A LOT OF WHAT THEY DID WAS ADDRESSING SOCIAL DETERMINATES OF HEALTH. THESE ARE PEOPLE AFTER A STROKE WERE HOME AND NOT DOING HOME BLOOD PRESSURE MONITORING BECAUSE THEY CAN'T AFFORD A HOME BLOOD PRESSURE AND A LOT OF THE OTHER THINGS MANY DIDN'T HAVE CELL PHONES AND HOW DO YOU GET A FREE CELL PHONE, FOR EXAMPLE, LEGAL ASSISTANCE AND HOW TO QUALIFY FOR THE CHARITY CARE PROGRAMS AND MENTAL HEALTH WAS HUGE. A LOT OF THEIR FOCUS IS WHAT MANY ARE TALKING ABOUT THE SOCIAL DETERMINATES OF HEALTH AND SERVICE INTENSIVE. SIX OR SEVEN HOME VISITS, 37 PHONE CALLS OVER A ONE-YEAR PERIOD SO AN AINTENSIVE -- INTENSIVE INTERVENTIONS FROM THE COMMUNITY HEALTH WORKERS AND LOW-TECH APPROACHES. WE ALSO GOT THINGS LIKE WHEN PEOPLE STOPPED ANSWERING WE FOUND WAS EQUALLY IMPORTANT FOR SOCIAL DETERMINATES OF HEALTH AND PERHAPS THEY GOT MUGGED AND HAD NO PHONE AND SOME COULDN'T PAY THE PHONE BILL THAT MONTH AND MANY ARE MONTHLY PLANS AND DIDN'T HAVE MONEY TO PAY AND WE FOUND OUT RESPONSE RATES ARE MORE IMPORTANT DETERMINATES THAN BLOOD PRESSURE PRESSURES THEMSELVES. OVERALL WE HAVEN'T PUBLISHED THIS BECAUSE I'VE BEEN WORKING ON COVID THE LAST YEAR BUT WE DID SHOW THESE ARE PEOPLE AFTER THE STROKE THE BLOOD PRESSURE TENDED TO DRIFT UP A BIT THIS IS WHEN ADJUSTED FOR COVARIATES AND WE DID FIND AN IMPACT ON STROKE AND WE'RE HAPPY AND ON BLOOD PRESSURE FOR STROKE PREVENTION WHICH WE'RE VERY HAPPY ABOUT AND THE TECHNOLOGY AND THE INTERVENTION IS 199 PARTICIPANTS AND TWO-THIRDS CONSENTED TO USING THE TECHNOLOGY. THE OTHER ONE-THIRD DIDN'T WANT TO USE IT AND OUT OF THOSE ABOUT HALF RESPONDED TO AT LEAST ONE MESSAGE, 50% OF THE TIME. OVER ALL-TH -- OVERALL YOU SEE THE PERCENTAGE AND SOME CHARACTERISTICS, YOUNGER AGE, INCOME AND OTHERS WERE POSITIVELY ASSOCIATED WITH USING THE TECHNOLOGY AND THOSE THAT PARTICIPATED MORE ACHIEVED LOWER BLOOD PRESSURE BUT THERE WERE CONFOUNDING AND DEMONSTRATED IMPROVEMENTS IN HEALTH NEW JERSEY OF THE PROPORTION ACTIVELY USING THE TECHNOLOGY AND THOSE THAT THOUGHT IT WAS EASY AND MOTIVATED THEM. POSITIVE DATA BUT ONLY A THIRD OF THE RECIPIENTS THAT WERE ACTIVE TECHNOLOGY USERS. THIS IS ONE PROJECT WE DID ON CANCER LOOKING AT A NEW WAY TO DETECT FOR CERVICAL CANCER WHICH IS USING WOMEN SELF-SAMPLING THEMSELVES DOING SWABS THEMSELVES AND USE HEALTH WORKERS TO GET THE WOMEN AND KNOW WHERE TO GO AND RECRUIT WOMEN WHO HAVEN'T BEEN ADEQUATELY SCREENED. THIS IS IN A CHURCH IN MIDDLE HAITI. THIS IS IN A LATINO PHARMACY WHERE THEY SET UP SHOP BECAUSE THEY KNEW PEOPLE IN THE PHARMACY WERE ABLE TO DO THAT AND SIMILAR STORY HERE COMPARED TO NO INVENTION AND NAVIGATING THEM TO A PRIMARY CARE CLINIC THOSE WHO GOT THE INTERVENTION WERE LIKELY TO COMPLETE CERVICAL CANCER SCREENING USING THE LOW-TECH TECHNOLOGY. WE ALSO TALKED ABOUT SOME OF THE CHALLENGES IN THE STUDIES WITH HPV BECAUSE IT'S IMPORTANT FOR PEOPLE TO BE AWARE THE OUTCOME LOOKS NICE BUT THERE'S REAL CHALLENGES THAT GO IN DEVELOPING THIS FROM THE INSTITUTION END AND WORKING WITH COMMUNITY PARTNERS. THE LATEST TECHNOLOGY IS ADDRESSING HOME BASED TESTING AND INTERVENTIONS AND LOW TECH AND IN ADDITION TO HPV SAMPLING AND FECAL SAMPLING AND PARTICIPANTS DO THIS AT HOME AND MAIL BACK A SAMPLE AND ADDED HIV SCREENING AND ANOTHER WAY PARTICIPANTS CAN DO THIS AT HOME USING SWABS AND WE WERE SURPRISED WHAT SOME WERE AGREEING TO DO TESTING FOR HEPATITIS C AND BASICALLY TRYING TO BRIDGE THE GAP AND DELIVER HOME SERVICES AND TO BE ANALYZED AND I CAN TELL YOU WITH UPTAKE IN THE PREVENTIVE SERVICES USING THE HOME BASED TESTING TECHNOLOGIES. AND PART IS DEVELOPING THE RESEARCH OF INFRASTRUCTURE AND WE WORKED WITH A UNIVERSITY TO DEVELOP WHAT WE CALL CITY LIGHT FOR COMMUNITY HEALTH WORKERS NOT AS EXTENSIVE AS WHAT WE REQUIRE FOR PEOPLE IN THE INSTITUTION. THAT WAS ALSO POSITIVE. WE TRAINED OVER 200 COMMUNITY HEALTH WORKERS IN FLORIDA TO DO THIS RESEARCH CURRICULUM AND THEN PCORI LET US EXPAND TO TEXAS, CALIFORNIA AND NOW WE TRAINED OVER 800 COMMUNITY HEALTH WORKERS USING THAT CURRICULUM. THE FEEDBACK WAS POSITIVE. WE DO A LOT OF PRE/POST TEST AND THE FEEDBACK FROM THE WORKERS OF THE TRAINING HAS BEEN POSITIVE. EVEN THOUGH I WAS TRYING NOT TO TALK ABOUT COVID I STILL HAVE TO TALK ABOUT COVID. WE RECENTLY WROTE UP AND A BECOME CAME OUT ALREADY IF NOT IT'S COMING SOON ABOUT COMMUNITY HEALTH WORKERS AND DID A CHAPTER IN COMMUNITY HEALTH WORKERS IN RESEARCH AND PCORI RECENTLY LET US EXPAND THIS TO DO RESEARCH IN THE COVID ERA FOR TRAINING COMMUNITY HEALTH WORKERS. SOME IS COVID 101 AND TRY TO EXPOSE THEM TO SOCIAL MEDIA AND VIDEO CONFERENCING TOOLS. WE ALL KNOW HOW TO USE ZOOM BUT MANY OF THE COMMUNITY HEALTH WOKKER WAS A MORE CHALLENGE -- WORKERS WAS MORE OF A CHALLENGE TO GET ON ZOOM AND GIVE A BRIEF OVERVIEW IN THIS CURRICULUM AND WE'RE DEVELOPING IT NOW BUT IMPORTANT TOOLS IN THE COVID ERA HOW CHWs DO RESEARCH. >> FIVE MINUTES LEFT. >> AND FROM THE CTSAs WE WROTE UP ABOUT THE COMMUNITY ENGAGE MANY AND WORKED WITH THE COMMUNITY ENGAGE MANY COMPONENTS DURING COVID WHICH HAS CHANGED THE WAY WE DO RESEARCH OBVIOUSLY. ONE OF THE KEY LESSONS IS WHEN HAVE YOU THINGS LIKE COVID A LOT OF THE COMMUNITY PARTNERS WANT TO FOCUS ON BASED NEEDS AND A LOT OF WHAT WE'VE DONE AND I'M NOT A PARTICIPANT IN THE SEAL INITIATIVE BUT IT WAS INITIALLY ABOUT COVID PRECAUTIONS AND NOW WE SHIFTED TO VACCINE UPTAKE AND DOING A LOT OF VACCINE UP TAKE. FOR A LOT OF OUR PARTNERS WITH SOMETHING LIKE COVID HAPPENS THEY JUST WANT US THERE TO SUPPORT AND HELP THEM IN THEIR ISSUES AND THEY SEE THAT IMPORTANTLY AND WHEN THINGS LIKE COVID HAPPEN, THE IMPORTANCE OF HAVING THE BI-DIRECTIONAL RELATIONSHIPS WE'VE BEEN WORKING WITH PARTNERS OVER A DECADE AND CONTINUE TO INVOLVE THEM IN THE PROJECTS WE NEED LONG-TERM PARTNERING AND DID FIND USING THESE DIGITAL APPROACHES CAN WORK. IT TAKES A LITTLE BIT OF EFFORT FROM SOME PARTNERS AND DO IT AND PEOPLE SEEM TO LIKE IT. >> THE ADAPTATIONS WE'VE DONE TO OUR PROGRAMS. SOME WAS ON PAUSE DURING COVID BUT NOW WE'VE BEEN ABLE TO PIVOT A LOT OF THIS. NOW WE USE VIDEO AND WHAT'S APP IS THE APPLICATION EVERY LATINO SEEMS TO KNOW HOW TO USE AND THAT'S BEEN POSITIVE. A LOT OF NON-FACE TO FACE APPROACHES AND HAD TO PICK UP SAMPLES AT THE DOOR RATHER THAN HAVING THEM HANDED TO US AND WE GET PARTICIPANTS AND GET STUDY. AND RETENTION HAS IMPROVED FOR STUDIES AND THEY'RE AT HOME NOT WORKING AND WE ARE NOT SURE WHAT LED TO IMPROVED RETENTION IN SOME OF THIS. LASTLY, THERE'S A LOT OF OPPORTUNITIES. WE'RE DOING TELEVIGILANCE PROGRAM OF PEOPLE WHO GET VIDEO CAMERAS AND PEOPLE CAN LOOK IN MOUTHS AND EARS AND LISTEN TO THEM AND THESE ARE RIGHT THINGS ON RESEARCH AND HOW IT IMPACTS DIFFERENT MINORITY POPULATIONS. THERE'S MANY OPPORTUNITIES COVID HAS LED TO IN TERMS OF DIAGNOSTIC TOOLS CLINICIANS ARE USING RIGHT NOW. I'LL END WITH THIS SLIDE. WHAT I'M TRYING TO SAY IS THERE'S A LOT OF PROMISING DIAGNOSTIC AND DISEASE MANAGEMENT TOOLS WHICH KEEP COMING AND CAN ADDRESS DISPARITIES BUT THEY'RE NOT A PANACEA AND FOR MANY IT'S THE LOW-TECH APPROACHES THAT WORK AND WE NEED A ROBUST AND COMMUNITY ENGAGEMENT INFRASTRUCTURE AND HAVING SOMETHING PROJECT SPECIFIC YOU NEED COMMITMENTS THERE FOR THE LONG TERM AND IT'S ABOUT WHAT MONICA SAID WHICH IS ADDRESSING THE FUNDAMENTAL DRIVERS AND SUSTAINABILI SUSTAINABILITY IN THE Q&A AND THE BLOOD PRESSURE A1C OR WHETHER SOMEONE HAD THE ADEQUATE SCREENING MAY NOT BE THE BEST O OUTCOME MEASURE AND HELPING PEOPLE WITH THEIR SOCIAL NEEDS AND STUFF I GAVE YOU ARE PROBABLY MORE IMPORTANT OUTCOMES WEATHER THAN THEIR A1C OR BLOOD PRESSURE IMPROVED BY A COUPLE MILLIMETERS OF MERCURY. >> THANK YOU, VERY MUCH. THERE'S ONE QUICK QUESTION BEFORE WE TRANSITION. WE HAVE PEOPLE WHO SEE A PHONE AS A RISK FACTOR FOR GETTING ROBBED OR IN A FIGHT. HOW DO YOU SUPPORT THOSE INDIVIDUALS? >> IT HAPPED A COUPLE TIMES WHERE PEOPLE -- HAPPENED A COUPLE TIMES WHERE PEOPLE GOT THEIR PHONES STOLIN -- STOLEN IN OUR STUDY AND WE TALK ABOUT THEM TO PROTECT THEM BUT PHONES ARE UBIQUITOUS AND A LOT OF THE ELDERS JUST HAVE THE TEXT BASED CAPABILITY BUT IT'S A CHALLENGE BUT I DO UNDERSTAND, YES, IT IS -- PEOPLE GET ROBBED AND WE RECENTLY HAD THAT IN OUR STUDY AND HOW DO YOU GET A REPLACEMENT PHONE AS PART OF WHAT WE DID. >> THANK YOU FOR YOUR PRESENTATION AND WE LOOK FORWARD TO MORE DURING THE Q&A. I'M HAPPY TO INTRODUCE DR. PATRICIA O'BRIEN RICHARD SUNSHINE AND THE TITLE OF HER PRESENTATION IS ANSWERING THE CALL RACIAL HEALTH DISPARITIES IN KOEFRD AMONG ESSENTIAL WORKERS IN THE URBAN LANDSCAPE. >> THANK YOU FOR HAVING ME SHARE ON THE PRESENTATION. >> THE DIFFERENCES ARE GREATEST FOR BLACK AMERICANS AND WE KNOW AS HEALTH PROFESSIONALS WHEN YOU CARE THE NUMBERS TO WHITE PATIENTS THERE'S TWO TO THREE TIMES AS LIKELY TO DIE OF PREVENTIBLE HEART DISEASE AND STROKE AS WELL AS THEY HAVE HIGHER RATES OF CANCER AND ASTHMA. THE FLU, PNEUMONIA AND DIABETES AND PARTICULARLY HIV/AIDS AND HOMICIDE. FOR MANY VARIOUS CONDITIONS THERE'S MANY REASONS FOR THIS HOWEVER WE ALSO KNOW THAT THERE IS STRUCTURAL RACISM AND UNEQUAL TREATMENT. THAT ALSO WE HAVE TO RECOGNIZE AND CONTRIBUTE IN TERMS OF DISEASE AND DEATH. THIS IS ONLY WORSENED IN COVID. SO AS WE KNOW, SO FAR HERE IN AMERICA HALF A MILLION DEATHS AND AROUND THE WORLD 30 MILLION. SO THE NUMBER CONTINUES TO RISE AND WE'RE ALSO KEEPING TRACK OF THIS WITH JOHNS HOPKINS AND THE CORONAVIRUS RESOURCE CENTER. IT'S IMPORTANT TO ACKNOWLEDGE THAT THOSE NUMBERS WHEN WE LOOK AT THOSE NUMBERS WE SEE SO MANY OF THEM ARE FROM THE BLACK COMMUNITY. ALSO ESSENTIAL WORKERS. SO AS IT'S FORTUITOUS AND THIS IS ONE THE HIGHEST MONTHS BEFORE CORONAVIRUS KILLED MORE BLACK PEOPLE AT DISPROPORTIONATELY HIGHER RATES THAN IN RESOURCE AND HEALTH AND ACCESS TO CARE. WE SEE THIS ESPECIALLY WHEN WE LOOK AT AFRICAN AMERICANS THAT THEY HAVE HAD THE BURDEN AND HAD TO BARE THE BURDEN OF COVID. I HIGHLIGHTED THE SEVERAL STATES TO JUST MAKE US AWARE THAT PARTICULARLY WE CAN LOOK AT ILLINOIS THOUGH BLACK AMERICANS ARE 15% OF THE STATE'S POPULATION THEY MADE OVER 41% OF THE DEATHS. WE SEE IT SO ON AND SO FORTH ESPECIALLY FOR NEW YORK WHICH IS WHERE WE ARE I'M IN RUTGERS UNIVERSITY AND WE'RE IN THE NEW YORK CITY'S BACK YARD AND THEIR METROPOLITAN AREA. EVEN HERE FOR US, IT HIT HOME LAST YEAR IN APRIL AT THIS TIME. I KNOW FOR MYSELF, PERSONALLY, THERE'S NO ONE THAT HAS NOT BEEN AFFECTED BY COVID AND PARTICULARLY THE BLACK MONTGOMERY AND FOR MYSELF PERSONALLY I'VE BEEN PERSONALLY AFFECTED. LAST YEAR DURING COVID I ACTUALLY LOST MY NUMBER ONE HERO, MY DAD. THREE WEEKS BEFORE THAT I LOST TWO AUNTS SEVEN DAYS APART. SO MY MOTHER LOST HER HUSBAND OF 50 YEARS AND THEN BEFORE THAT SHE LOST TWO SISTERS SEVEN DAYS APART. WHAT MAKES IT ALL SO SAD IS THAT THIS YEAR ON VALENTINE'S DAY WE HAD A THIRD AUNT WHO WAS ACTUALLY A COVID SURVIVOR AND SHE PASSED AWAY AS WELL THIS YEAR ON VALENTINE'S DAY AND MY FAMILY HAS SUFFERED IN TERMS OF SEVERAL DEATHS AND PARTICULARLY MY FATHER AND THERE'S AUNTS. I REMEMBER OUR FAREWELL TO MY FATHER WAS IN A PARKING LOT OF A FUNERAL HOME BECAUSE AT THAT TIME IN NEW YORK THERE WERE VERY FEW PLACES WHERE YOU COULD BURY YOUR LOVED ONES AND EVERY FUNERAL HOME WAS OVER BOOKED AND OVERWHELMED. WE SEE THIS HAPPENING AND SHARE THIS AS AN ANECDOTE PERSONALLY AND WE ARE AWARE THE PANDEMIC FELT MORE IN THE URBAN AND UNDER SERVED COMMUNITY NON-HISPANIC BLACKS. AS WE LOOK AND SAY OKAY, WHY IS THISHAPPENING THERE'S MANY REASONS. ONE OF THE MAIN THING WE HAVE TO REMEMBER IS COVID-19 ONLY EXPOSED THE SYSTEMIC AND RACIAL INJUSTICES OF BLACK AFRICAN AMERICANS AND RACIAL DISPARITIES IN HEALTH, WE KNOW THIS IN EDUCATION, INCARCERATION, EMPLOYMENT, INCOME, HEALTH AND HOME OWNERSHIP, VOTER ACCESS, VARIOUS OTHER SOCIO ECONOMIC FACTORS. WHEN WE LOOK AT BLACK ESSENTIAL WORKERS, ALL THESE FACTORS WERE EXACERBATED BY THE SIMPLE FACT THAT THEY HAD TO CONTINUE TO BE EXPOSED TO COVID-19. HERE ARE A FEW KEY CHALLENGES OF BLACK ESSENTIAL WORKERS. WE KNOW THIS BECAUSE WE SEE THIS IN THE BLACK COMMUNITY PARTICULARLY THOSE IN THE URBAN LANDSCAPE. WE SEE FOR MANY BLACK ESSENTIAL WORKERS THEY RESIDE IN HIGH INTENSITY HOUSING. THEY CULTURALLY LIVE WITH SEVERAL FAMILY MEMBERS WHICH I WANT TO SAY WAS MY CASE PERSONALLY. MY MOTHER, MY THREE AUNTS WERE ALL ESSENTIAL WORKERS. SO THIS IS A PERSONAL INVESTMENT I'M INTERESTED IN IN BUILDING RESEARCH AROUND THIS. CULTURALLY, MY FAMILY LIKE OTHERS IN THE BLACK COMMUNITY, LIVED IN MULTI FAMILY DWELLINGS IN THE URBAN COMMUNITY. WE SEE THIS CULTURALLY AMONG BLACK COMMUNITIES WE SEE THIS IN THE URBAN LANDSCAPING ARE LIVING AMONG SEVERAL FAMILY MEMBERS. THERE'S MANY DEPTHS IN TERMS OF EDUCATION, WEALTH AND INCOME IS PREVALENT AND LASTLY BUT DEFINITELY NOT LIMITED TO, THE OCCUPATIONAL DISPARITIES. FOR BLACK ESSENTIAL WORKERS, STAYING HOME, WHICH IS A PRIVILEGE MANY OF US HAVE BEEN ABLE TO HAVE, IS TRULY NOT AN OPTION. AGAIN, IT IS A CONSTANT AND OVER EXPOSURE TO COVID AND ALSO THIS IS AN EXACERBATION OF THE FACTORS THAT ALREADY EXISTS IN THE STRUCTURAL INEQUITIES IN THE LANDSCAPE FOR BLACK AMERICANS. SO AS WE DISCUSS THE KEY BARRIERS TO OCCUPATIONAL DISPARITIES, WE NEED TO PAY ATTENTION TO HOW THIS AFFECTS THE HEALTH DISPARITIES OF BLACK ESSENTIAL WORKERS. SO BLACK ESSENTIAL WORKERS HAVE ANSWERED THE CALL AND SO IN COVID THEY CONTINUE TO KEEP ALL OF OUR LIVES MOVING DURING THE CLOSER AT THE RESEARCH WE FIND THAT THESE DISPARITIES SPECIFICALLY OCCUPATIONALLY EXACERBATED THEIR CONTINUAL EXPOSURE AND SO WE SEE HERE THAT IN MANY AREAS IN TERMS OF OCCUPATIONAL DISPARITIES, TRANSPORTATION, MATERIAL MOVING, HEALTH CARE SUPPORT WHERE WE'RE FOCUSSING ON TODAY AND FOOD PREPARATION AND SERVING, WHEN WE ANALYZE THE OCCUPATIONAL FACTORS WE DO SEE ESSENTIAL WORKERS HAVE THIS DISPARITY IN THE PANDEMIC. IT MAGNIFIES HOW THE OCCUPATIONAL AND THIS LIST IS NOT LIMITED. THERE ARE OTHER AREAS SUCH AS BUILDING AND GROUNDS, CLEANING, PERSONAL CARE AND SERVICES, OFFICE AND ADMINISTRATIVE SUPPORT, COMMUNITY AND SOCIAL SERVICES AND SO WE FIND THAT AGAIN THERE IS A DISCREPANCY AMONG OTHER GROUPS FOR OKAY PAYINGS WHICH LEAD AND CONTRIBUTE TO -- OCCUPATIONS WHICH LEAD TO HEALTH DISPARITIES. BLACK ESSENTIAL WORKERS FACE SPECIFIC CHALLENGES. AS THEY FACE THE SPECIFIC CHALLENGES IT WILL REQUIRE SPECIFIC SOLUTIONS. I AM EXCITED TO SHARE SOME OF THE OPPORTUNITIES THAT WE'VE BEEN UNCOVERING IN OUR WORK AND AGAIN THIS IS SOMETHING WE ARE BUILDING IN TERMS OF ESSENTIAL WORKERS. ONE OF THE MAIN FACTORS WE ARE SEEING IS THAT THESE OPPORTUNITIES MUST BE INTERSECTIONAL AND MUST AFFECT VARIOUS ASPECTS ACROSS PUBLIC HEALTH INCLUDING BUT NOT LIMITED TO HEALTH POLICY, TRAINING ON IMPLICIT BIAS, AND TRAINING AND TECHNOLOGY. LET'S LOOK AT THE SYSTEMIC CHANGE NEED TO OCCUR. WHEN WE LOOK CLOSELY AT THE SYSTEMIC CHANGES WE SEE HIRING PRACTICES MUST CHANGE IN OUR HEALTH SECTOR AND OTHER INDUSTRIES BECAUSE WHEN WE SEE THE STATISTICS ON IMPLICIT BIAS WE NEED AN INCREASE IN TRAINING ON IMPLICIT BIAS. ONE AREA I FOCUS ON IS DUE -- DUALITY IN THE WORKPLACE AND THEY'RE AWARE OF THEIR ROLE BUT CARRYING WITH THEM THE BURDEN AND EMOTIONAL STRESS WHAT'S HAPPENING IN THE BROADER BLACK COMMUNITY AND ACROSS THE WORLD PERHAPS THEIR OWN PERSONAL COVID STORIES AND WHAT'S HAPPENING IN THE NATION AND THE DEATHS OF UNARMED BLACK PEOPLE. THESE ARE ASPECTS WE HAVE TO BRING INTO THE CONVERSATION. SO THESE ARE SOME EMOTIONS AND FEELINGS I'M UNCOVERING IN RESEARCH AND SPEAKING TO VARIOUS ESSENTIAL WORKERS AND PROFESSIONALS THAT THESE ARE AREAS IN THE CORPORATE SETTING THEY FEEL A SENSE OF DUALITY IN THE WORKPLACE, THOUGH THEY'RE THERE THEY'RE ALSO EMOTIONALLY WORRIED, CONCERNED, HAVING VARIOUS ISSUES OF ANXIETY OF WHAT'S HAPPENING IN THEIR FAMILY REGARDING COVID AND ALSO REGARDING WHAT'S HAPPENING IN THE UNEQUAL TREATMENT OF BLACK PEOPLE. THEY'RE BRINGING ALL OF THIS TO WORK. I'M CURRENTLY BUILDING THIS RESEARCH AMONG CORPORATE AND HEALTH PROFESSIONALS OF COLOR AND KNOWN AS DUALITY IN THE WORKPLACE. I HAVE TO STRIVE TO ACKNOWLEDGE THE CHALLENGES OUR BLACK ESSENTIAL WORKERS ARE FACING. THEY ARE CARRYING WITH THEM THIS EXTRA BURDEN OF OVER EXPOSURE PHYSICALLY AND EMOTIONALLY AS WELL. . >> We know technology has been a tremendous opportunity and so I definitely want to encourage those of us in technology continue to build that work. Next slide, please. Keeping with the theme of technology, mental health has also been a priority for black essential workers who -- regarding particularly burnout and aloe static load regarding stress upon stress in already stressful environments we do have a case study that we have developing an app to really check in on black essential workers. Particularly community health workers. So they can communicate and find resources throughout the day. And so this is done basically through their phone and this is, again, it's a case study that we're building and we're -- focusing on community health workers. But we're hoping that this will help prevent burnout. And also this is an opportunity for them to be able to have resources at their fingertips while they are going about their day. Going into the homes of many that are already in the urban landscape and, again, exacerbating their exposure to COVID-19 but we're hopeful that being able to provide this opportunity to combine technology and also their well-being, this will be a strategy that we'll be able to use that we could perhaps scale and move on forward with other community health workers and ultimately, other essential workers. Next slide, please. Last but not least, one of the things I think we have to consider is we really need to address this from an intersectional approach. And we know that things do not change unless policies change so we must work hand in hand with policymakers and continue to encourage not just the research but also the advocacy to create lasting change for essential workers. Next slide, please. And so as I wrap up our answering the call presentation, focusing on black essential workers I just want to reiterate some of these practicals in terms of public health practice, awareness, and change and practice. Training on implicit bias and health care. Technology in terms of mobile health practice as a key opportunity and then also in addressing well-being among black essential workers. And lastly, public health practice. Thank you and now I will take any questions that you have. >> Thank you so much, really, excellent presentation. And let me, you know -- on behalf of everyone in the audience, I would like to offer my condolences, sincere condolences on the loss, the losses, the major losses that you and your family have experienced through COVID. I think many can relate. My father-in-law as an example who is an African American senior, retired, has lost seven individuals, family and friends over the past -- really within the first eight months of the pandemic. And so what you said in that story, your own experience, certainly resonated with me and I'm sure many others. You're right, we're all affected in many ways by the pandemic. So -- a question for you, the pandemic as has been noted has really changed, many of the ways that we connect and support each other. What can employers of black essential workers do to make sure they are staying connected and supporting their employees and staff? >> Thank you so much for your condolences and absolutely, the loss is compounded and felt everywhere across race, across the world. So thank you for that. And I think it is interesting that loss can -- out of loss can create opportunities for research. Such as this. And for change. And so I have always felt that it's never really a loss if we can learn from it and if we can implement practices for progress. So thank you for that. One of the things I think that's very important as I'm building this work is how black essential workers feel and I think that they have been lost and that's why I titled the presentation answering the call. They have stepped up to the call. And, you know, I myself have been privileged to work from home as I look out of the window and I see my mailman, you know, through storm, through winter, any rainy day, continually throughout COVID delivering my mail, my Amazon packages, I think for employees to feel differently, for black essential workers and others to really feel differently, they must feel valued. And appreciated by their employers. Because they are answering the call. They are taking on the burden and the challenge of overexposure and it is really great that we do have access to vaccines now. But at the height of COVID. This is where we saw the greatest loss. And so I think it's very important that employees are particularly black essential workers are acknowledged that they are valued. That there are spaces for them to share their emotions, their feelings, and I also think it's important that we include them in the solutions. That they are the ones that are out there on the frontline, visiting patients, really doing the work in various industries. Not just in health care. And so I think we need to include them in the process, technology is a great way to include them and this is what we're doing with our case study, is really giving them an opportunity to check in on their well-being and to see how they're doing because we know that stress affects our work. And so if we want to continue in this work, we have to prevent burnout. We have to create opportunities for essential workers to thrive. >> Thank you so much. Well we appreciate your presentation and after our next presentation we will be opening up for Q&A. So we'll probably be able to delve in a little bit deeper. Thank you. >> Thank you. >> So I have the pleasure now of introducing our final presentation for this session, Dr. Michael Synder and the presentation is the detection of COVID-19 and other health information using -- actually you see the presentation here. COVID-19 detection with the la coda. Thank you so much. >> All right. Can I use my own screen or should I -- first slides or should I use that one? Great. >> Please share your screen. >> Great. Thank you. All right. So I am, yeah, I'm delighted to show you what we're up to with the same group that Marsha presented a little earlier working with the la coda group and they told you about the challenges there. We are specifically focused on COVID-19 right now. Now this as I say, same population, the Native American population. Centered in eagle butte and surrounding community. We first kind of involved with this a little over a decade ago to try to bring technologies to better understand the arthritis which is another a much higher incidence than other locations in the surrounding community and we actually have discovered some auto antigens as a consequence of studying this particular group then about five years ago we were fortunate to be part of a large group and able to actually use -- leverage that, what we're up to to build a Native American Biobank. The first of its kind that we believe. And it's really a Biobank that's intended -- set up by the Native American community for the Native American community to actually bring a lot of different activities there. It's actually a catalyst for trying to bring science into the community, and genomics in particular. Bring in a lot of aspects of community engagement and also start dealing with issues around sustainability. So a whole series of activities that are all centered around building this Biobank and the Biobank itself is a lab that's storing, as I say Native American materials as well as data surrounding those. So as part of this we were able to get a grant to be able to start to try to bring COVID-19 detection into the reservation and the closest testing at the time was several hours away and so we were able to get funded and this is what we're doing right inside the Biobank actually. Just trying to set up state of the art testing. You've heard about the samology methodology we're using here at Stanford. And we're using antigen testing to see who has been infected which we think has a certain value from the research and spreading side. And I want to tell you about novel technologies because I haven't heard that brought up either which is these wearable for trying to detect COVID-19 onset. This is actually a pretty complicated project to actually set these things up that involves the Biobank which is the center of the peer. Involves Marsha's group, Stanford, community engagement group, scientific engagement groups, of course tribal approvals and all this as well. It's quite a challenge to get these projects up and running as we've discovered but it's also a lot of fun and a lot of learning now if you think about it, you heard a lot about detection and, in fact, you know, right at the outset you heard about the rad X program focused on PCR and antigen detection. There's nothing wrong with that. But it is the classic testing. Usually people get tested once they have symptoms and for the gold standard PCR the turn around time is 1-3 days and they're not all that cheap. A cheap thing people do is taking temperature and I would argue that, 300-year-old technology and it doesn't really all work all that well. Especially the infrared ones I never seen anyone turn away at the restaurant door. It reads very, very low when I get done this way because it's cold outside and your skin's cold so it doesn't really seem to work. But if you think about it wearables are pretty good devices because they can measure things like smart watches or rings, they literally make hundreds of thousands of measurements on you everyday to measure you 24/7 and actually employable right now. 21% of the U.S. population, 50 million people are wearing a smart watch right now and they measure you 24/7. So basically they're measuring heart rate, heart rate variability. They all do that and different devices different things. Some measure skin temperature very accurately. Respiration rate for some. Blood oxygen is not so accurate but you can get the changes measured pretty easily and blood pressure same thing so these devices do measure a lot of different things as I say and some of the devices will measure 2.5 million measurements on you every single day. And, again, you can do this 365 days a year. So I won't get into the number of years ago, I guess four years ago we published to detect Lyme disease. I discovered mine with a simple smart watch. Symptom onset. And we show that had -- showed that worked retrospectively for viral infections. Skin temperature does work, it's been more variable and we could show that we could pick up people's viral infection in advance of symptoms both on retrospective on me, including in asymptomatic cases quite interesting. As well as on three other people. One of them who got sick twice. And as you might imagine when the pandemic came a year ago we had been improving the algorithms as well as building an infrastructure which I will talk about a little bit at the end that's quite scaleable to millions of people and we very quickly, you know, modified our study, partnered with some leading smart watch companies, right off the bat got 500 -- 5300 people enrolled and they were wearing a smart watches and had a COVID-19 diagnosis. And they had a diagnosis, with the symptom date which was step one can we actually detect when people are getting ill with a smart watch and the answer is yes. This is our very first case, a diagnosis state here in purple. Here's the symptom date here. Here is the resting heart rate. This individual, what we call a standard deviation plot. You can see shifts from people's baseline and you can see this very first case this individual's resting heart rate jumped up nine and a half days prior to symptom onset. You can't miss that signal. Very clear. We'll talk about this in a minute. An online detection system. By the way we'd love to have you enrolled in our study. Presumably this person has been running around spreading this illness during this presymptomatic period. Turns out it worked 26 of the 32. 81% of the folks we could detect. That number's held up. The illness from the shifting heart rate. The median is four days prior. Seven days prior to diagnosis and it's not specific for COVID. Other respiratory viral infections will have the same effect. There, the median time is two days prior to illness and that makes sense because COVID tends to have a longer presymptomatic period. It's not a huge jump up in heart rate for some people it's as little as two beats per minute. This is the median number but it's the fact that you make so many measurements on people it's easy to see that two beats her minute jump up. This is retrospective data. So what it does is it takes your baseline information for 28 days and does an hour by hour sliding window and looks for deviation from that baseline. And if you get a certain jump up, it will set off an alarm. Now we set the alarming frequency to go off every two months because you can make it more sensitive but then you get more non-COVID alarms. Or you make it less sensitive and it'll just take longer for you to detect your illness. And so other things do trigger as I mentioned before, other illnesses, excessive alcohol, not two drinks for dinner but if you tie one on. Once every two months we think is a pretty good compromise but you can adjust it up or down. So you decide how frequently you want the sensitivity to be and here's our first case once again. This is a person who we -- pick it up nine days ahead of time from this sliding window. Detection. Here's another person I think there's seven or nine days. Again, there are other alarms, these are real elevations of resting heart rate. Turns out four out of seven people have what we call a holiday bump and that can be due to stress, can be inlaw stress or something. Can be heart rate, can be too much alcohol or, sorry, travel. All these things might contribute. So you do -- you do have to contextualize the information. There's another illness that picks it up. Even healthy people will have this -- you will see this. And these are -- again, real signals where you don't always know what the cause is so once we show this all worked we run a realtime alerting system. So this launched in December. We're trying to get as many people enrolled as possible because we want to improve our algorithms and make them as accurate as possible. We know other kinds of information will contribute to the signal. It's hard to get frit -- it from the companies. Data we think will make this more and more accurate but anyway it does work. I will show you the numbers in a minute. We set up in a very simple -- a red alarm goes off if you get a jump up in heart rate and this is one example. So this person received an alarm here and three days later, their symptoms appeared and they got diagnosed and they were positive and so far, a combination of retrospective and prospective data from the study, by the way it works for Apple Watch, for Fitbit, for Garmin. We're running about 73% deTEVENLT detection and that's it's not perfect but it does work. At some level which we think is good because these are people who just, you know, wearing a normal watch and a smart watch you would say and you can detect the signal. So it also worked on asymptomatic cases we don't yet know the frequency but from the group we've studied so far we've picked up three cases of asymptomatic infection. Here's one example here. Let's see, this is fit -- sorry, Fitbit. Sorry, I'm trying to move my chat window. So here's the diagnosis. I lost count but I think it's about a dozen die S dies -- dozen days prior tod y diagnosis. You can see an elevated signal. You can pick up these -- what seem to be asymptomatic cases and they just have to get picked up because they were getting screened. I don't think this ends at basically, infectious disease. It's going to be very powerful especially when you pull all kinds of data. We recently tried to figure out what clinical markers can be associated with smart watch data and because you can pull in quite a bit of different data types. We've done some machine learning and be able -- machine learning models, several different model to pick up symptoms. And other sorts of things as well. We can get a bit of a signal from glucose regulation. I.e., diabetes. From smart watch. And this is not enough to actually give you diagnosis. Nor is it speIit intended to but it can alert you something is up and we can improve on this because this is an older watch but we can get fist signs -- first signs of this from a smart watch. We built this infrastructure. For personal health dashboard and it pulls in all your wearable data, your clinical data and your microbiome data. We do a lot of deep data on folks and it pulls it all in and can display it in any fashion, daily, weekly, monthly. We want to push this back to the consumer. And let them best undersee their health and actually follow their health and so we've actually built this on the cloud and set up in a way where we can literally now monitor tens of millions of people. So we are trying to roll more folks as I say, and as a cloud-based system, highly secure, secure as you can be. All encrypted to be able to pull data in on people and follow them in realtime and ping them back. You just have to alert -- you just have to sync the app once a day and it will tell you have a red alert or green alert. So we will talk about needs and challenges. I think Marsha and Lyle covered virtually everything I was going to say. I think education is useful. I don't know how many times you have to fill out a form that we're a sovereign nation so they own the data and somehow that doesn't sink in on reporting parts and then there are barriers, aside from, again, the things that were already covered I do find running studies does take quite a bit of effort but opportunities are pretty enormous we already made some, as I say, around rheumatoid arthritis some interesting discovers and of course we hope to have really incredible health impact in this very rural community and I should point out wearables we think are very, very suited to these remote communities because people are pretty far away from health systems and actually to be able to have an online health monitor in realtime we think will be very, very powerful. So we have been fortunate to work with a lot of amazing people here. So we had our first collaborator. Chris Guthrie and Marsha and Lyle have been fantastic collaborators as well and all the work on our side. And we have a team of folks who built the infrastructure. That's what we've been up to. Happy to take questions if you have any. >> Thank you, Dr. Synder, great presentation. There is a question for you in the chat but I'll pose. What is your perspective on broadband issues related to remote populations?. >> That's a great question. It turns out that Marsha and Lyle should chime in on this but most people do have a smart phone. Mind you, sometimes the reception's not so great but it will still work for the alarming system that we're setting up. All you have to do is say -- is sync us up. The way it works as a smart watch is synced to your iPhone. So the data's going into your iPhone so whenever you sync up your iPhone even if it's only partial reception you should be able to get these health folders. I think it will still work and you probably know something like 60% of the planet has a smart phone. So my goal to be honest is really to put a smart phone on 60% of the planet. I think easily, you know, Jeff Bezoses could >> YOU'RE MUTED. THANK YOU TO ALL THE SPEAKERS FOR AN EXCELLENT SESSION. WE WILL NOW MOVE TO OUR PANEL DISCUSSION. THIS PANEL WILL INCLUDE THE SESSION CHAIR AND SESSION SPEAKERS. OUR PANEL MODERATORS ARE DR. MARISHKA BROWN, MAKEDA WILLIAMS AND BISHOW ADHIKARI. THIS IS AN OPPORTUNITY FOR THE AUDIENCE, FOR A DEEPER DIVE INTO THE CHALLENGES, BARRIERS AND OPPORTUNITIES THAT WERE DISCUSSED TODAY. SO DR. MONICA HOOPER, START WITH YOUR QUESTIONS OR SOME QUESTIONS FROM THE SESSION THAT HAVE NOT BEEN ADDRESSED YET. THANK YOU. >> SURE. THANK YOU. THANKS AGAIN TO ALL THE PRESENTATIONS. IT'S AMAZING WE'RE EXACTLY ON TIME. VERY SUCCINCT AND INFORMATIVE, THAT DOESN'T ALWAYS HAPPEN. THAT'S FANTASTIC. I THANK THE SPEAKERS FOR THAT. I'M GOING BACK AROUND TO THE BEGINNING. THERE WERE A FEW QUESTIONS THAT CAME UP THAT HAD NOT BEEN ADDRESSED. I'D LIKE TO POSE THE FIRST QUESTION TO YOU. CAN YOU COMMENT ON INTERVENTIONS TO ADDRESS SLEEP HEALTH DISPARITIES AMONG LATINO/HISPANIC COMMUNITIES? >> THANK YOU FOR THE QUESTION. I'M NOT AWARE OF ANY SIGNIFICANT STUDY, FUNDED STUDY, OVER A LONG PERIOD OF TIME TO INVESTIGATE THIS BUT I CAN TELL YOU, A COLLEAGUE IN ARIZONA AT THE MEXICAN BORDER IS CURRENTLY LOOKING AT SLEEP-RELATED CARDIOVASCULAR DISEASE AMONG MEXICAN AMERICANS, A PROJECTS TWO YEARS IN, WE SHOULD ABLE TO HAVE SOME SENSE OF WHAT'S HAPPENING AT LEAST IN THE COMMUNITY. I'M ALSO AWARE THERE'S A NEW STUDY THAT STARTED AT THE UNIVERSITY OF MIAMI LOOKING AT COGNITIVE IMPAIRMENT, SLEEP APNEA, AMONG OLDER LATIN-X COMMUNITIES, A PROMISING STUDY, WE SHOULD KNOW WHETHER OR NOT THAT MITIGATES RISK FOR DEMENTIA. OTHERWISE THE TYPE OF STUDY WE DISCUSSED BEFORE WITH REGARDS TO DIRECT ENGAGEMENT THAT IS MEANINGFUL TO ADDRESS SLEEP NEEDS AND CIRCADIAN NEEDS IN HISPANIC OR LATIN-X COMMUNITIES THERE MAY BE SMALL STUDIES BUT THIS STUDY IS SO COMPLICATED, SO TIME CONSUMING, WE'VE GOT TO HAVE A LONG FIVE-YEAR STUDY TO GET AT THE BOTTOM OF THIS. >> THANK YOU VERY MUCH. I'M GOING TO ASK ONE OTHER QUESTION. I'LL PRIORITIZE THE QUESTION THAT CAME INTO THE CHAT AND THEN CIRCLE BACK WITH ANY OTHER QUESTIONS THAT I HAVE OR OTHERWISE. ONE OTHER QUESTION FOR YOU, THAT CAME IN ON THE CHAT WAS HOW DO YOU CORRELATE OR WORK, CONCERN WITH DENTAL CLINICIANS. >> HOW DO CORRELATE WITH -- >> DENTAL CLINICIANS. >> DENTAL CONDITIONS? >> DENTAL CLINICIANS, DENTISTS. >> WELL, THE CONNECTION IS PERHAPS OBVIOUS. IF YOU GO TO A CLINIC, THE PERSON SEE YOU IS A PULMONOLOGIST, MIGHT BE INCLINED TO PROVIDE CPAP TREATMENT, MAY TRY A DENTIST, FOR A DENTAL APPLIANCE. YOU MAY WANT A DENTIST COME IN, AND SEE IF THEY CAN DO A BETTER JOB. IN THAT WAY YOU CAN DO THAT. BUT I HAVE TO TELL YOU IN MY OWN WORK I HAVE NOT SEEN THAT PLAY OUT VERY WELL. >> OKAY. ONE OTHER QUESTION FOR YOU FROM THE CHAT, AND THEN I'LL ASK SOME OF THE OTHER PANELISTS SOME QUESTIONS FOR THEM, CAME IN ON THE CHAT, CAN YOU TALK ABOUT THE PROCESS THAT YOU UNDERTOOK OF DEVELOPING THE RELATIONSHIPS WITH STAKEHOLDERS, THE PERSON WAS ASKING, WONDERING ABOUT CONSTRAINTS OF DOING SO WITHIN THE TIME LIMITED GRANT PROJECT. >> THIS IS ANOTHER WONDERFUL QUESTION. I'VE BEEN LEADING THE FIGHT FOR 15 YEARS, THEY ASK ME ALL THE TIME. THE CONCERN IS BECAUSE IT TAKES SUCH A LONG PERIOD OF TIME, WOULD THAT AFFECT MY PROMOTION BECAUSE I CAN'T GET PUBLICATIONS, ENOUGH PUBLICATION TO SHOW MY WORK HAS BEEN MEANINGFUL, IN MY CASE I CAN TELL YOU, JUST TO BE ABLE TO HAVE THEM ACCEPT ME AS ONE OF THEIRS, I HAD TO GO A NUMBER OF TIMES FOR A HAIRCUT TO SHOW I'M ONE OF THEM, FOR THE COMMUNITIES WITH CHURCHES I HAD TO ATTEND MULTIPLE SERVICES, IT CAN TAKE UP TO TWO YEARS. IT'S DIFFICULT TO PUBLISH WHILE YOU'RE DOING THIS. IF YOU'RE DOING THIS KIND OF WORK, IF YOU'RE A JUNIOR FACULTY EARLY, YOU GOT TO TELL YOUR CHAIR THAT'S WHAT IT'S GOING TO TAKE. YOU'RE GOING TO HAVE TO LOOK AT ME VERY DIFFERENTLY WHEN IT COMES TIME TO TENURE. IT'S REALLY IMPORTANT WORK BUT IT'S A DIFFERENT MINDSET. SO WE HAVE TO -- I COUNSEL JUNIOR FACULTY, IT JUST TAKES TIME. NOT EVERYBODY CAN DO THAT. I'M SURE THE NIH IS LISTENING. WE HAVE TO HAVE SPECIAL PROVISION FOR MINORITY SCIENTISTS WHO REALLY WANT TO DO THIS KIND OF WORK BECAUSE IT'S REALLY DIFFERENT. >> POINT WELL TAKEN AND DUALLY NOTED. I HAVE A QUESTION FOR DOCTORS O'LEARY AND BEST, IN THE CHAT. CAN CAN YOU COMMENT ON THE CHALLENGES WITH THE INFRASTRUCTURE IN THE TRIBAL NATIONS IN TERMS OF TECHNOLOGY, EXPERTISE, ET CETERA, HOW BIG IS THIS CHALLENGE, HOW CAN IT BE ADDRESSED OR CAN IT BE ADDRESSED? >> I'M NOT SURE IF MARCIA IS WITH US AT THE MOMENT. I THINK A NUMBER OF PEOPLE HAVE ADDRESSED THIS, DR. SCHNEIDER, AND EARLIER IN THE CONFERENCE AS WELL, THAT THIS LEAPFROGGING TECHNOLOGY IN A SENSE THAT GOING FROM HARD WIRED SERVICES PARTICULARLY FOR TELECOMMUNICATIONS TO WIRELESS SERVICE, AND I THINK THAT'S SEEN PARTICULARLY IN DEVELOPING COUNTRIES, BUT IN GENERAL, BROADBAND SERVICES ARE RELATIVELY ACCESSIBLE IN OUR TRIBAL NATIONS, AT LEAST IN THE DAKOTAS, IT'S TRUE THERE ARE SOME PLACES WITH VERY POOR COVERAGE. THERE'S ONE SMALL COMMUNITY ABOUT 20 MILES FROM EAGLE BUTTE, WE'VE BEEN TRYING TO CONTACT PEOPLE AND THEY HAVE VERY POOR CELL PHONE COVERAGE. THE NUMBER OF PEOPLE WITH CELL PHONES, NOT MYSELF INCLUDED, IS VERY, VERY COMMON. SO CELL PHONES ARE OUT THERE. MANY, MANY, MANY PEOPLE USE THEM. AND GENERALLY SPEAKING, WE HAVE COVERAGE. IN TERMS OF EXPERTISE, IT WAS MENTIONED BY DR. SCHNEIDER, WORKS WITH MISSOURI BREAKS, PREVIOUSLY I.T. PERSON AT INDIAN HEALTH SERVICE, GENERALLY SPEAKING WE HAVE EXPERTISE, ALTHOUGH IT'S ONE OR TWO OR MAYBE THREE PEOPLE IN THE COMMUNITY. SO IT'S PRETTY THIN, BUT IT'S THERE. >> OKAY. I WOULD JUST ADD THAT ACCESS TO CELL PHONES, THERE'S A REAL CIRCADIAN RHYTHM TO THEM. A LOT OF TIMES THESE ARE PAY-FOR-SERVICE. AS OPPOSED TO PINE RIDGE WHERE THEY GET FREE PHONES, CHEYENNE RIVER DOES NOT. AND SO PEOPLE AT THE END OF THE MONTH WILL RUN OUT OF THEIR MONEY AND THEY WON'T HAVE ACCESS. SO WHEN YOU HAVE PROGRAMS THAT WILL UPLOAD WHEN YOU GET INTO A SERVICE AREA, THAT'S IDEAL. BUT IF IT'S REQUIRING TO USE THEIR SERVICE CARD, YOU'RE GOING TO RUN OUT. WE HAVE A LOT OF OUR SMALLER -- OUR COMMUNITIES ARE BASED AROUND HISTORICAL PLACES WHERE WATER IS FOUND, A LOT OF PLACES MOST SPOTS, AND SO THOSE AREAS THERE ISN'T GOOD CELL SERVICE, LOW SPOTS. WE'RE LOOKING TO THE DAY WHEN THERE WILL BE SATELLITE SERVICE IN OUR AREA BUT UNTIL THAT HAPPENS -- AND THEN THE OTHER THING THAT HAPPENS A LOT OF TIMES, IT'S LIKE ANY TYPE OF INFRASTRUCTURE THING, WHEN YOU'VE GOT LARGE EXPANSE OF AREA, LESS THAN THREE PEOPLE PER SQUARE MILE, IT'S HARD FOR ENTITIES TO INVEST IN, WHETHER IT'S WATER OR CELL PHONE SERVICE, WHATEVER IT IS, WITHOUT SOME KIND OF FEDERAL ASSISTANCE. SO A LOT OF TIMES YOU'VE GOT ONE COMPANY THAT WILL COME IN AND THEY MIGHT BE AT&T, ANOTHER COMPANY WILL COME IN, THEY DON'T TALK TO EACH OTHER. SO YOU CAN'T GO ACROSS -- IF YOU HAVE VERIZON, YOU CAN'T USE THE AT&T TOWER. SO PEOPLE WON'T KNOW -- YOU CAN SEE THE TOWER, YOU CAN ACTUALLY STAND IN THE SHADOW OF THE TOWER BUT YOU CAN'T USE IT. IT DOES NOT HAVE -- YOU CAN'T HAVE ACCESS TO IT BECAUSE YOU'VE GOT ANOTHER SERVICE. SO, THERE'S BARRIERS THAT NEED TO BE ADDRESSED BUT I THINK WE'RE WORKING TOWARDS THAT AND I DO THINK THAT THE IDEA OF WEARABLE TECHNOLOGY AS A MEANS TO HELP PEOPLE REDUCE BARRIERS TO SOME OF THEIR BASIC HEALTH CARE ISSUES HAS GOT A LOT OF PROMISES, VERY HOPEFUL. >> THANK YOU. I APPRECIATE THAT MUCH. I'M GOING TO BRING IN DR. HARRISON TO THE CONVERSATION. THERE WERE SOME QUESTIONS FOR YOU DURING YOUR PRESENTATION OR JUST AFTER, WHAT TO POSE. ONE WAS DID YOUR TEAM PARTNER OR PLAN TO PARTNER WITH MEHARRY MEDICAL COLLEGE, HBCU, IN THESE EFFORTS AS MEHARRY IS IN NASHVILLE? >> WE ARE WORKING WITH MEHARRY. I OVERLOOKED MENTIONING THAT IN MY PRESENTATION. VANDERBILT AND MEHARRY WORK CLOSELY TOGETHER, SOME OF OUR PATIENTS, OUR CLIENTS ACTUALLY USED MEHARRY CLINICIANS TO PARTNER WITH THE PHARMACISTS FOR THEIR MANAGEMENT. >> OKAY. THANK YOU. AND THEN A QUICK QUESTION FOR YOU, DR. HARRISON, IS YOUR BARBERSHOP STUDY FUNDED BY NHLBI. >> BY A SUPPLEMENT TO OUR CTSA, WITHOUT THAT COULDN'T HAVE STARTED ON THIS. WE'RE APPRECIATE OF THE SUPPORT FROM THE NIH. NOT NHLBI BUT FOR THE CTSA MECHANISM. >> GOT IT. ONE OTHER QUESTION FROM YOUR PRESENTATION, FROM THE CHAT, HAVE YOU CONSIDERED UTILIZING HAIRDRESSERS, OTHER SERVICES FOR WOMEN, TO REPLICATE THIS IN OTHER POPULATIONS? >> YEAH, I THINK I MENTIONED THAT. IN FACT, THE LOS ANGELES GROUP IS BEGINNING A PROJECT IN WOMEN. TURNS OUT AMONG BLACK WOMEN THEY ARE MUCH BETTER AT SEEING THE DOCTOR THAN BLACK MEN ARE. AND WE -- SO RON, WHEN HE BEGAN THIS STUDY, WAS DRAWN TO THE FACT THAT BLACK MEN WERE RELUCTANT TO SEE PHYSICIANS, HE WASN'TED TO -- HE WASN'TED TO REACH -- HE WANTED TO REACH OUT TO THEM. YOU'RE CORRECT, THIS SHOULD BE USED IN ALL SETTINGS WHERE PEOPLE ARE MORE COMFORTABLE, IT'S MORE CONVENIENT TO SEE A HEALTH CARE PROVIDER. >> THANK YOU. I HAVE A QUESTION FOR DR. CARRASQUILLO. CAN YOU ELABORATE, YOU MENTIONED THIS, BUT I'M WONDERING IF YOU COULD ELABORATE ON WHY THE HISTORICAL CONTEXT IS SO IMPORTANT FOR WORKING WITH LATINO COMMUNITIES IN A SCIENTIFIC STUDY AND HOW HAVING THAT CONTEXT CAN OR SHOULD IMPACT THE RESEARCH QUESTIONS OR APPROACHES, HOW WOULD SOMEONE TAKE THAT INTO ACCOUNT? >> IT'S NOT LATINO, RIGHT? IT'S FOR ANY COMMUNITY. >> OKAY. >> I THINK UNDERSTANDING THAT IF IT'S CRITICALLY IMPORTANT, I MEAN, A LOT OF TIMES YOU SEE VERY WELL MEANING RESEARCH TEAMS, JUST DESIGN AND DEVELOP INTERVENTIONS THAT DON'T TAKE, YOU KNOW, REAL MEASURE, EXISTING REALITIES, WHAT COMMUNITIES ARE GOING THROUGH, WHAT THEIR EXPERIENCES HAVE BEEN. A LOT OF TIMES PEOPLE HAVE NO CONTEXTUAL KNOWLEDGE OF, HEY, THIS IS WHAT'S ON THE MINDS RIGHT NOW, YOU KNOW, HAVING THEM PARTICIPATE IN THIS STUDY, IS NOT THE -- YOU HAVE TO TAILOR YOUR MESSAGES IN THAT CONTEXT, WHAT YOU WANT TO DO WITH LIVED EXPERIENCES. I FIND IT IN AMAZING IN FLORIDA, PEOPLE DON'T KNOW GOOD CUBA, WHY ONE SET OF IMMIGRANT GROUPS MAY NOT GET ALONG WITH ANOTHER, INTERVENTION FOR ONE SET OF CUBANS MAY NOT WORK FOR ANOTHER SET OF CUBANS, FOR EXAMPLE. IT'S KEY. BUT THAT'S TRUE FOR ANY COMMUNITY, I THINK, NOT JUST THE LATINOS, YOU HAVE TO KNOW A LOT OF WHERE THEY CAME FROM AND WHERE THEY ARE AT TO ACTUALLY START THINKING ABOUT WHAT INTERVENTIONS MAY WORK. >> THANK YOU. APPRECIATE THAT. ANOTHER QUESTION THAT CAME IN, AT THE END OF YOUR PRESENTATION WAS A COMMENTER APPRECIATING THE IDEA OF COMPLIANCE AS AN INDICATOR OF SOCIAL DETERMINANTS OF HEALTH WONDERING IF YOU CAN EXPAND ON THAT, COMMENTING THIS IS AN INTERESTING IDEA AND IT WAS RELATED TO A POINT THAT YOU MADE ON YOUR SLIDE. >> THE COMPLIANCE WITH SOCIAL DETERMINANTS OF HEALTH? OR ADDRESSING SOCIAL DETERMINANTS OF HEALTH? >> SO, THE COMMENT WAS I THINK THE IDEA OF COMPLIANCE AS AN INDICATOR OF SOCIAL DETERMINANTS OF HEALTH IS A GOOD IDEA, AN INTERESTING ONE, WONDERING IF YOU CAN EXPAND ON THAT? >> I'M NOT SURE BUT I THINK A LOT OF OUR STUDIES HAVE TO DO IS THINK BEYOND TRADITIONAL, YOU KNOW, NIH-TIME OUTCOMES EVERYONE WANTS TO SEE. CLEARLY WE MEASURE COMPLIANCE OF ANYBODY, MEDICATION COMPLIANCE, THAT'S UNQUESTIONED, A SECONDARY OUTCOME, WE THINK OF WHAT A LOT OF COMMUNITY PARTNERS ARE MUCH MORE FOCUSED, A LOT OF THESE PROBLEMS IN HEALTH WE SEE IN THINGS LIKE BLOOD PRESSURE, A1c, LDLs HAVE MORE TO DO WITH SOCIAL DETERMINANTS. AND RATHER THAN DETERMINING IMPACTS, START MEASURING REAL SOCIAL DETERMINANTS OF HEALTH OUTCOMES AS PRIMARY OUTCOME AND SHOULD BE THE FOCUS OF YOUR REAL CHALLENGES TO ADDRESS SOCIAL DETERMINANTS OF HEALTH, THAT SHOULD REALLY SOME OF THE OUTCOMES. I THINK A LOT OF CHALLENGES, I THINK A LOT OF STUDY SECTIONS AND REVIEWERS STILL LOOK AT THOSE MORE SKEPTICALLY, THE QUESTION OF SUSTAINABILITY, A LOT OF HEALTH PARTNERS WHEN YOU DESIGN HEALTH INTERVENTIONS AND MOVE A LITTLE BIT BEYOND TRADITIONAL HEALTH OUTCOMES, THEY ALSO FEEL UNSURE, UNCERTAIN ABOUT THOSE THINGS. BUT PERSONALLY, I MEAN, WE HEAR FROM COMMUNITY PARTNERS ALL THE TIME THESE ARE NOT THE OUTCOMES THAT MATTER TO US. >> THANK YOU. MY NEXT QUESTIONS ARE FOR DR. O'BRIAN RICHARDSON. YOU TALKED ABOUT WAYS THAT EMPLOYERS WITH CONNECT WITH AND SUPPORT THEIR EMPLOYEES. WHAT DO YOU -- DO YOU THINK THAT EMPLOYERS OF ESSENTIAL WORKERS SHOULD REQUIRE VACCINES? >> THIS IS A DEBATABLE TOPIC, A CURRENT DEBATABLE TOPIC BECAUSE WE KNOW OF DISTRUST BETWEEN THE PHARMACEUTICAL COMPANY, HISTORICALLY, AND THE BLACK COMMUNITY. HOWEVER, I DO BELIEVE THAT'S WHERE WE'RE HEADED. AND SO I THINK THAT THAT IS A VIABLE PATHWAY THAT EMPLOYERS SHOULD CONSIDER, BUT I THINK THAT SHOULD BE REACHED WITH CONVERSATION, MUCH, MUCH CONVERSATION, AND INPUT AND INCLUSION IN TERMS OF REALLY ALLOWING THOSE FROM THAT COMMUNITY THAT ARE ESSENTIAL WORKERS TO CREATE A SPACE FOR THEM TO SHARE THEIR CONCERNS BECAUSE WE KNOW THERE'S NO WAY WE CAN DENY THE HISTORICAL BACKGROUND THERE AND SO THERE HAS TO BE EQUALLY THE AMOUNT OF EDUCATION AND INVOLVEMENT FROM EMPLOYERS TO ENSURE A SAFE FUTURE REGARDING COVID. >> OKAY. THANK YOU. ANOTHER QUESTION FOR YOU. WHAT DO YOU THINK THAT HEALTH CARE SYSTEMS AND PROVIDERS CAN DO TO CONNECT WITH AND SUPPORT BLACK ESSENTIAL WORKERS? >> WELL, AS I SAID IN MY PRESENTATION, I THINK WE REALLY NEED TO CONSIDER THE OPPORTUNITY OF TRAINING, AND SO WE KNOW THAT THERE IS CONCERN AROUND IMPLICIT BIAS, AND SO WE HAVE SEEN THIS IN THE LITERATURE WHEN WE HAVE PATIENTS THAT ARE SEEN BY DOCTORS THAT ARE NOT REPRESENTATIVE OF THEIR CULTURE OR RACE. AND SO REPRESENTATION MATTERS. IT'S VERY IMPORTANT THAT THERE IS TRAINING AROUND IMPLICIT BIAS, STARTING EVEN IN MEDICAL SCHOOL, IN THE TRAINING. I THINK IT NEEDS TO BE EQUALLY AS IMPORTANT AS SOCIAL DETERMINANTS OF HEALTH. I THINK THAT WOULD BE A GREAT PLACE FOR IT TO BE. BUT I ALSO THINK IT'S IMPORTANT FOR THE HEALTH CARE COMMUNITY TO PARTNER WITH POLICYMAKERS, AS I SHARED IN MY PRESENTATION. THINGS ARE NOT CHANGING UNLESS A POLICY CHANGES SO IT'S IMPORTANT WE CONTINUE WITH OUR RESEARCH. BUT WE ALSO HAVE TO SEE THAT IT GETS IN THE HAND OF ADVOCATES AND THOSE THAT CAN MAKE A DIFFERENCE IN TERMS OF CHANGES, IN TERMS OF PRACTICES AND POLICY. >> THANK YOU. OKAY. SO NEXT QUESTIONS FOR DR. SNYDER. A QUESTION THAT WAS RAISED, HOW DO YOU ENSURE THAT YOUR APP, WITH THAT APP, YOU DO NOT REPRESENTLY SYSTEMIC BIAS IN MACHINE LEARNING, HOW DID YOU BUILD EQUITY INTO YOUR SYSTEM? >> TWO COMMENTS THERE. ONE WOULD BE OBVIOUSLY TRAINING IT ON ALL THE RELEVANT POPULATIONS IS REALLY, REALLY IMPORTANT. AND THAT IS A BIG ISSUE WITH MACHINE LEARNING AND DEEP LEARNING, YOU MAY HAVE HEARD ABOUT BIASES WHEN YOU USE THOSE APPROACHES, IF YOU DON'T HAVE THE RIGHT STARTING POPULATION. SO WE ARE TRYING TO BE AS REPRESENTATIVE AS POSSIBLE, REACH AS BROADLY AS POSSIBLE, TO MAKE SURE WE'RE DOING IT. THAT'S WHY WE DO WANT TO GET A NUMBER OF FOLKS FROM THE NATIVE AMERICAN COMMUNITY ENGAGED IN THIS. THE OTHER THING THAT'S DIFFERENT ABOUT WHAT WE'RE DOING IS A LOT OF WHAT WE'RE DOING IS BUILT ON INDIVIDUAL MODELS, MEANING WE GET PEOPLE'S INDIVIDUAL BASELINES, ACTUALLY LOOK FOR SHIFTS FROM THAT. SO, BECAUSE EVERYBODY IS SO DIFFERENT, EVEN ACROSS -- EVEN WITHIN A RACE PEOPLE ARE VERY DIFFERENT SO WE'RE BUILDING PERSONAL BASELINES AND LOOK FOR DEVIATIONS FROM THAT. SO THAT IN PRINCIPLE SHOULD WORK FOR ALL FOLKS WHEN YOU'RE COMPARING YOUR DISEASE SELF AGAINST YOUR HEALTHY SELF. WE THINK THAT'S PROBABLY THE BEST WAY TO AVOID BIAS BUT WE DO WANT TO MAKE SURE WHATEVER WE BUILD DOES WORK ON ALL GROUPS. RIGHT NOW WE'RE ABOUT 81% EFFECTIVE RETROSPECTIVELY, ABOUT 73% PROSPECTIVELY SO MORE DATA WILL BE POWERFUL. WE KNOW NOT ALL DATA TYPES MAY WORK WELL. YOU MAY KNOW THAT BLOOD OXYGEN MONITORING, SPO2 USING REFLECTIVE DEVICES LIKE WEARABLES IS NOT GOOD ON DARK-SKINNED PEOPLE SO THAT'S A PROBLEM. AND THOSE MEASUREMENTS WILL NOT BE VERY GOOD, YOU HAVE TO UNDERWEIGH THOSE IN MODEL BUILDING SO THERE'S DIFFERENT ASPECTS TO THIS. BUT IT IS THE POWER OF A.I. TO BE ABLE TO BUILD, AGAIN, PERSONAL MODELS REGARDLESS OF RACE, THAT'S CERTAINLY THE GOAL. >> GOT IT. THANK YOU FOR THAT. ANOTHER QUESTION FOR YOU, I THINK A BIGGER QUESTION, AND THEN ONE IN THE CHAT THAT I THINK IS RELATED, HOW EXACTLY WITH WEARABLES DETECT COVID-19 AND CAN YOU COMMENT WHETHER YOU COMBINED OTHER BIOMARKERS AND BASELINE MEASURES TOGETHER WITH THE HEART BEAT CHANGES TO SEE IF THIS APPROACH INCLUDES DIAGNOSIS? >> YEAH, SO RIGHT NOW WE'RE MOSTLY BUILDING AROUND RESTING HEART RATE, SLEEP. HEART RATE VARIABILITY IS THE SIGNAL. HARDEST IS GETTING DATA FROM COMPANIES. FITBIT AND APPLE DOESN'T SHARE, THAT WOULD HELP US IMPROVE OUR ACCURACY. DATA TYPES AND DATA RESOLUTION IS MUCH MORE LIMITED THAN WE WOULD LIKE. TO BE HONEST, SILICON VALLEY WAY, WE START OUR OWN COMPANY TO BUILD A SMART WATCH THAT'S MEANT TO BE A HEALTH WATCH, NOT MEANT TO READ YOUR E-MAIL OR ANSWER YOUR PHONE OR ANYTHING LIKE THAT OFF YOUR WATCH. IT'S MEANT TO FOLLOW YOUR HEALTH. IT'S MEANT TO TAKE THE HIGH RESOLUTION DATA AND DATA, MODEL WE SET UP IS NOT GOING TO GO BACK TO THE COMPANY. THE DATA WILL COME TO US AT STANFORD, RIGHT FROM THE INDIVIDUAL, HIGHLY SECURE, SO IT'S A WAY OF TRYING TO GET DATA WE WANT AND THEN I THINK WE'LL REALLY GET IMPROVED SIGNALS. AT LEAST THAT'S THE GOAL. SO IT WILL BE A VERY DIFFERENT MODEL FROM WHAT'S ON THE COMMERCIAL SIDE, PART COMMERCIAL IN THE SENSE OF SELLING THE DEVICE BUT ACADEMIC IN THE SENSE THE DATA IS NOT MEANT -- YOU KNOW, IT'S MEANT TO BE PRIVATE, MEANT TO BE USED FOR BASICALLY HEALTH IMPROVEMENT. >> THANK YOU. OKAY. SO, NOW I WANT TO HAVE A LITTLE BIT MORE OF A GENERAL QUESTION FOR THE PANEL AND INVITE YOU TO ANSWER ANY OF THESE QUESTIONS AS YOU SEE FIT. ONE OF THE QUESTIONS THAT I THINK I HEARD A THREAD OF THIS, THINKING ABOUT CHALLENGES, NEXT STEPS OF RESEARCH PROGRAM. IF YOU COULD ELABORATE WHAT YOUR SUSTAINABILITY PLANS LOOK LIKE BEYOND THE FUNDED RESEARCH. YOU'VE DONE THE WORK. YOU'RE BUILDING TRUSTED RELATIONSHIPS WITH COMMUNITY PARTNERS. YOU'RE GOING INTO COMMUNITIES, AND CLEARLY THE INFRASTRUCTURE THAT YOU'RE SETTING UP WE NEED TO HAVE THEM SUSTAINED. WHAT ARE YOUR PLANS FOR DOING THAT? WHAT INPUT HAVE YOU RECEIVED FROM THE COMMUNITY ABOUT SUSTAINABILITY? >> I THINK, YEAH, I THINK THIS IS AN ESSENTIAL CHALLENGE TO THE WORK. YOU KNOW, YOU DEVELOP THESE GREAT PROGRAMS, AND YOU SHOW THEY WORK, BUT THEN GETTING THEM SUSTAINED BEYOND THE GRANT FUNDING PERIOD, WITH COMMUNITY HEALTH WORKERS WE HEAR THEY ARE NOT CREDENTIALS, SO WE DEVELOPED A CREDENTIALING PATHWAY AND THEY BEING CREDENTIALED IN OUR STATE BUT HEALTH SYSTEMS, ESPECIALLY THOSE BUDGET ORIENTED, ARE NOT SUPPORTIVE OF FUNDING THESE INNOVATIVE PROGRAMS. A LOT OF STUFF USING HOME-BASED TESTING, FAIRLY QUALIFIED HEALTH CENTERS ARE SUPPORTIVE IF IT'S SUPPORTED THROUGH A MECHANISM. BUT THE MILLION DOLLAR QUESTION IS WHO IS GOING TO PAY FOR THESE LONG TERM? AND ALL THE DEEP POCKETS TURN AWAY FROM THIS. YOU HAVE TO GO TO DONORS, FOUNDATIONS, TRY TO PUT IT INTO A RESEARCH GRANT. BUT IT IS ONE OF MY BIGGEST CHALLENGES THAT I CAN'T GET UPTAKE FOR A LOT OF THIS STUFF WE SHOW WORKS. TO ANSWER YOUR QUESTION, YOU GO BEYOND THAT. IN A MANNER THAT'S NOT FUNDED THROUGH DONORS OR FOUNDATIONS OR THE NIH. AND IT IS RATHER MORE FRUSTRATING THINGS THAT I THINK FOR A LOT OF WHAT WE DO. >> I'D LIKE TO AMPLIFY THAT A LITTLE BIT TOO. I THINK IT'S DEFINITELY A PROBLEM AS YOU SEE IN CONVINCING THE GOVERNMENT TO PICK UP TECHNOLOGIES AND TECHNIQUES THAT WILL GREATLY IMPROVE HEALTH. EVEN BEFORE THAT, WE'VE HAD A NUMBER OF PROPOSALS GONE TO NIH REVIEW AND COMES BACK, WELL, WE DON'T THINK THIS IS SUSTAINABLE SO WE'RE NOT EVEN GOING TO CONSIDER TESTING IT, WHICH I THINK IS, YOU KNOW, STILL MORE OF A PROBLEM. SO JUST THROW THAT OUT THERE AS WELL. >> YEAH, FIVE YEARS IS PROBABLY NOT ENOUGH TO BE SUSTAINABLE FOR ANYTHING. WHAT WE'RE TRYING TO DO IS, LYLE, MARCIA AND I, BUILDING A HIGH-TECH LAB WE'RE HOPEFUL, AND THERE ARE DISCOVERIES COMING OUT OF THE NEW AUTOANTIGEN THAT COULD POTENTIALLY TURN INTO A DIAGNOSTIC THAT COULD TURN INTO REVENUE GENERATING. WE HOPE YOU COULD POTENTIALLY PARTNER WITH PHARMACEUTICAL COMPANIES SO THERE'S A LONG-TERM VISION BUT IT'S NOT THE KIND OF THING YOU'RE GOING TO EXECUTE IN FIVE YEARS. IT WILL TAKE LONGER. IF YOU DO BUILD, WE'LL TRY TO TECH AREA WE HOPE WILL GROW OUT USEFUL TECHNOLOGY THAT WILL LEAD TO, I HOPE, I'M A POLLYANNA, OPTIMIST TYPE OF PERSON, I HOPE THAT GET A NUGGET AT LEAST, BUILD USEFUL THINGS THAT WILL BE SUSTAINABLE. MINIMALLY WE'LL EDUCATE A LOT OF PEOPLE AROUND COOL STUFF, RIGHT? THE I.T. STRUCTURE, THE WHOLE COMPUTATIONAL STRUCTURE. SO THE WORST CASE WE'LL EDUCATE PEOPLE, I THINK AROUND, YOU KNOW, HIGH TECHNOLOGY, WHICH I THINK WILL BE POWERFUL, HOPEFULLY GENERATE ECONOMIC REVENUE BUT THAT'S THE LONG TERM VISION, NOT A FIVE-YEAR VISION. >> I ALSO THINK WE'VE BEEN TAKING A BIRDSEYE VIEW OF THE WORK WE DO FOR A LONG TIME, RIGHT? AT SOME POINT THAT HAS TO STOP. BUT YOU NEED TO STILL CONTINUE THAT. I THINK THAT HEALTH ECONOMICS, THE CHANGE IN A LOT OF THE GRANT OR REQUIRING HEALTH ECONOMICS AS PART OF THEIR PROPOSALS IS VERY HELPFUL BECAUSE IF WE CAN CONTINUE THAT BIRDSEYE VIEW AND SAY, OKAY, BY REDUCING THIS CHRONIC ILLNESS OR THAT CHRONIC ILLNESS IT'S GOING TO, YOU KNOW, REDUCE FALLS, REDUCE DIABETES, WHATEVER IT IS, IN THE LONG RUN IT'S CERTAINLY GOING TO SAVE OUR COMMUNITIES, YOU KNOW, WHETHER IT'S OUR HEALTH COMMUNITIES, WHETHER IT'S OUR NATIVE COMMUNITIES, WHETHER IT'S OUR BLACK AMERICAN COMMUNITIES OR HISPANIC COMMUNITIES, BUT AT THE END OF THE DAY I THINK THAT BUILDING ENVIRONMENTS IN OUR COMMUNITIES WHERE PEOPLE CAN INTERN AND CAN FEEL LIKE THEY CAN GET A FOOT IN AND THEY CAN BE PARTNERS WITH THAT, AND REALLY BUILDING TRUE PARTNERS, NOT JUST ONES THAT ARE THERE TO WRITE PAPERS, YOU KNOW, WE'RE ALL FAMILIAR WITH THE CONCEPT OF HELICOPTER SCIENCE, BUT IT HAS HAD A LASTING IMPACT AND IT'S ONE OF THE REASONS WHY PEOPLE ARE SO RESISTANT TO WORKING WITH SCIENCE, BECAUSE THIS IS NOT ABOUT US, THIS IS ABOUT YOU AND YOUR EFFORT TO BECOME TENURED OR WHATEVER IT IS. OR YOUR PUBLICATION. AND SO BUILDING TRUE PARTNERS WHERE WE RECOGNIZE THAT EACH OF US PLAY A ROLE, WHETHER SCIENTISTS OR TRIBAL GOVERNMENT OR WHETHER IT'S INTERN OR RESEARCH ASSISTANT OR MID-LEVEL, HAVING TRUE PARTNERS WHERE EVERYBODY IS REALLY VALUED I THINK IS CRITICALLY IMPORTANT. >> EXCELLENT POINT, DR. O'LEARY. IT DOES RESONATE WITH MANY DIFFERENT COMMUNITIES, IT IS SOMETHING THAT WE HAVE BEEN GUILTY OF IN THE MEDICAL AND HEALTH COMMUNITY. IT'S SO IMPORTANT, ESPECIALLY NOW, WE NEED TO EXPLORE WAYS TO PARTNER WITH THE COMMUNITY, REALLY WORK WITH THE COMMUNITY, ALLOW THEM TO IN MANY CASES LEAD THE WORK THAT IS GOING TO IMPACT THEIR FUTURE, THEIR HEALTH. >> I WOULD ADD THAT I THINK IT DEPENDS ON WHAT ASPECT OF THE PROGRAM IS SUSTAINABLE. IF YOU ARE THINKING ABOUT HEALTH COMMUNICATION, IN OUR CASE WE CHECK WITH EDUCATORS, THEY ARE STILL ENGAGED, STILL TALKING ABOUT CPAP IN THEIR RESPECTIVE COMMUNITIES, AND ALSO BECAUSE WE HAVE A LONG STANDING STUDENT COMMITTEE WE GET ASKED ALL THE TIME TO DO TALKS AT CHURCHES. SO IN THAT WAY BY BEING AVAILABLE, SO THE MESSAGE CONTINUES OF IF YOU ARE THINKING ABOUT HEALTH COMMUNICATION, SUSTAINABILITY IS EASIER. IF YOU THINK ABOUT CONTINUING A PARTICULAR PROGRAM THAT REQUIRES WEARABLES OR SPINNING OR REFERRALS FOR THEIR CARE, THAT'S VERY CHALLENGING. >> WE CAN A COUPLE MINUTES LEFT. HOW YOUR TECHNOLOGY OR YOUR APPROACH CAN BE LEVERAGES AND OPTIMIZED TO DIAGNOSE OR MANAGE HEART, LUNG, BLOOD AND SLEEP DISEASES IN UNDERSERVED COMMUNITIES. >> I'LL JUMP IN. THESE DEVICES ARE DIRT CHEAP. YES, YOU CAN SPEND $240, BUT IN THE FUTURE THEY WILL BE $30. SINCE MOST PEOPLE HAVE A SMARTPHONE, PAIRING A $30 SMARTWATCH WITH THAT WILL GIVE SOME LEVEL OF HEALTH INFORMATION. THERE'S A CERTAIN AMOUNT OF A-FIB THAT CAN GET PICKED UP, HAVE TO WATCH OUT FOR FALSE POSITIVES, HEART FAILURE, THEY WILL IMPROVE. WEARABLE TECHNOLOGY HAS THE POTENTIAL TO GET TO MANY GROUPS AT LOW COST. I THINK THERE'S BIG CHALLENGES AROUND DATA, PEOPLE BEING CONCERNED ABOUT HOW THEIR DATA IS USED, BECAUSE THE ABUSES OUT THERE BUT I THINK WE CAN GET PAST THAT, WE CAN GET HEALTH INFORMATION TO A LOT OF PEOPLE. I VIEW IT TO DRIVING A CAR. YOU ARE DON'T DRIVE A CAR WITHOUT A DASHBOARD. AND I THINK IT'S FUNNY THAT WE DRIVE AROUND PEOPLE WITHOUT HEALTH DASHBOARDS BECAUSE, YOU KNOW, YOUR SMARTPHONE WILL BE THE HEALTH DASHBOARD OF THE FUTURE AND SO WE SHOULD JUST MAKE IT THAT WAY. >> GOT IT. >> WE NEED TO ALIGN INCENTIVES THE RIGHT WAY. AFTER STROKE DISCHARGE, $30,000 AT LEAST HOSPITALIZATION, DON'T HAVE A $30 HOME BLOOD PRESSURE METER, IT'S RIDICULOUS FIGHTING WHO PAYS THAT. HPV SCREENING KITS ARE A COUPLE DOLLARS, NOBODY WANTS TO PAY FOR THEM BUT WILL HAVE $200 TO SEE ME IN MY CLINIC WHEN I CAN MAIL HER A KIT FOR $5. YOU CAN DO THE ECONOMICS AND LEVERAGE THIS BUT IT'S MOVING INCENTIVES THE RIGHT WAY. >> UNDERSTOOD. >> COULD I ADD ANOTHER POINT? WITH THE STATEMENT IN THE CHAT, FULLY ANSWERED THE QUESTION, THE IDEA WAS HOW DO WE DO RESEARCH IN THE CONSTRUCT NIH FUNDING. FOR YOUNG SCIENTISTS THINK IT ABOUT ONE FOR INSTANCE, PROPOSING MIXED METHODS MAKES SENSE. IT GIVES YOU ABOUT A YEAR OR TWO OR SO JUST TO FINISH THE WORK OF THE COMMUNITY ENGAGEMENT AND THEN YOU CAN DO AN INTERVENTION. OTHERWISE IT'S DIFFICULT. MIXED METHOD APPROACH GETS TO THAT, TO SOME DEGREE. >> THANK YOU. I KNOW WE'RE AT TIME. AT THIS POINT WE'LL JUMP IN. I WANT TO THANK ALL OF YOU SO MUCH. THIS IS A REALLY FASCINATING AND IMPORTANT PANEL SO I'M HONORED TO HAVE THE CHANCE TO CHAIR THE SESSION AND I THANK YOU FOR YOUR PRESENTATIONS. A ROUND OF APPLAUSE. >> THANK YOU. THANK YOU, DR. MONICA HOOPER. THANK YOU, EVERYONE, FOR AN OUTSTANDING DISCUSSION. WE'LL BREAK FOR LUNCH. THE LAST SESSION, FEDERAL PARTNERSHIPS, WILL BEGIN AT 1:30 P.M. EASTERN TIME. THANK YOU. WE WILL START OUR FEDERAL PARTNERSHIP SESSION NOW. I WILL INTRODUCE YOU THE CHAIR. DR. MARTIN MENDOZA AND KATHLEEN ROUSCHE, DR. MENDOZA, UNITED STATES DEPARTMENT OF HEALTH AND HUMAN SERVICES, IN THIS CAPACITY HE PROVIDES LEADERSHIP, OVERSIGHT AND DIRECTION IN DEVELOPING HEALTH POLICIES AND INITIATIVES DESIGNED TO ADDRESS ELIMINATION OF LET DISPARITY AND ADVANCE HEALTHY COMMUNITY. DR. KATHLEEN ROUSCHE IS DIRECTOR OF INNOVATION OFFICE WITHIN DIVISION OF EXTRAMURAL RESEARCH, AT NHLBI, IN THIS ROLE SHE OVERSEES PROGRAMS AND ACTIVITIES DESIGNED TO ACCELERATE BIOMEDICAL PRODUCTS. MARTIN, OVER TO YOU. >> THANK YOU, AND GOOD AFTERNOON. I HOPE EVERYONE HAD A GREAT LUNCH. I'M MARTIN MENDOZA FROM HHS OFFICE OF MINORITY HEALTH, TOGETHER WITH MY CO-CHAIR DR. KATHLEEN ROUSCHE FROM THE NHLBI OFFICE OF INNOVATION WE'RE DELIGHTED TO WELCOME YOU TO THE SESSION ON FEDERAL PARTNERSHIPS FOR UNDERSERVED POPULATIONS. WE'LL HEAR FROM SEVERAL FEDERAL AGENCIES INCLUDING NIH, AHRQ, HRSA, FDA, OASH, IHS, CMS, NSF AND BARDA. TO KICK THINGS OFF I'M PLEASED TO WELCOME OUR FIRST SPEAKER, DR. ELISE BERLINER, DIRECTOR FOR TECHNOLOGY ASSESSMENT, AGENCY FOR HEALTH CARE RESEARCH AND EQUALITY, AHRQ, EVIDENCE EVALUATION OF DIAGNOSTIC DISEASE MANAGEMENT TOOLS. >> I'D LIKE TO REALLY THANK YOU FOR INVITING ME TO SPEAK AT THIS WONDERFUL CONFERENCE. THEY WORKED SO HARD, YOU CAN TELL. THIS IS AN AMAZING CONFERENCE. I'M HONORED TO BE PART OF IT. NEXT SLIDE. I'M GOING TO TELL YOU ABOUT WHAT WE DO AT AHRQ. WE DO EVIDENCE REVIEWS, A SUMMARY OF OVERALL EVIDENCE, ALL THE SPEAKERS HAVE BEEN TALKING ABOUT THEIR LIKE REALLY WONDERFUL INDIVIDUAL STUDIES, AND WHAT WE DO IS TAKE ALL THOSE STUDIES AND PUT THEM TOGETHER INTO A CRITICAL APPRAISAL OF EVIDENCE, SYNTHESIZE AND SUMMARIZE MULTIPLE EXISTING STUDIES. AND SO I'M GOING TO TELL YOU ABOUT TWO OF THOSE REPORTS RELEVANT TO THIS TOPIC WE'VE DONE RECENTLY. A LOT OF OUR FINDINGS ACTUALLY ARE SIMILAR TO ISSUES THAT HAVE BEEN RAISED THROUGHOUT THIS CONFERENCE, BUT MAYBE WE ALSO HAVE SOME NEW INSIGHTS THAT WE CAN SHARE. NEXT SLIDE. SO BEFORE I GET INTO THE EXAMPLES, I JUST WANT TO TALK ABOUT HOW OUR REVIEWS ARE USED. SO, OUR REVIEWS ARE USED BY A RESEARCH FUNDER. SO TO HELP PRIORITIZE RESEARCH AGENDAS, AND EACH OF OUR REVIEWS HAS AN EVIDENCE GAP SECTION SO WE HOPE RESEARCHERS AND FUNDERS PAY ATTENTION TO WHAT THE GAPS ARE AND THEN BUILD THE BODY OF EVIDENCE. THEY ARE USED BY GUIDELINE DEVELOPERS TO MAKE CLINICAL PRACTICE GUIDELINES. WE WORK WITH GUIDELINE DEVELOPERS A LOT. THEY ARE USED BY POLICYMAKERS, IN PARTICULAR FOR COVERAGE ASSISTANCE SO I'VE HEARD PEOPLE TALKING ABOUT COVERAGE AND SO I'LL TELL YOU ABOUT WHAT THE EVIDENCE LOOKS LIKE FROM OUR POINT OF VIEW AND SOME ISSUES RELATED TO COVERAGE. SO NEXT SLIDE. AUTOMATE-ENTRY PATIENT--GENERATED HEALTH DATA FOR CHRONIC CONDITIONS PUBLISHED LAST MONTH. WE REVIEWED USE OF PGHD FOR PREVENTION AND TREATMENT OF 11 CHRONIC CONDITIONS AND REVIEW FOCUSED ON HEALTH OUTCOMES INCLUDING MORTALITY, QUALITY OF LIFE, SYMPTOM IMPROVEMENT, OUTCOMES NOT MEASURED IN MANY STUDIES BUT THOSE ARE THE OUTCOMES THAT PAYERS ARE LOOKING FOR SO WHEN YOU TALK ABOUT WANT BE INSURANCE REIMBURSEMENT, MEASURING THOSE OUTCOMES IS CRITICAL BUT THEY ARE MISSING FROM MOST STUDIES. WE LOOKED AT 114 STUDIES USING 118 DEVICES, 26 MOBILE APPS, FOUND POSSIBLE POSITIVE BENEFIT FOR HEART FAILURE, CORONARY ARTERY DISEASE, BLOOD PRESSURE, OBESITY. FOR OBESITY THERE'S LACK OF EFFECT. THERE'S A BENEFICIAL EFFECT ON TIME TO CARDIAC ARRHYTHMIA BUT IT'S UNCLEAR WHAT THE IMPACT OF THAT IS ON HEALTH OUTCOMES. IF YOUR SMART WATCH IS MEASURING ARRHYTHMIA EVENTS NOT DETECTED ANY OTHER WAY THAT MIGHT OVER TREATMENT, SO THIS IS WHY IT'S REALLY IMPORTANT TO LOOK AT HEALTH OUTCOMES AND NOT JUST THESE INTERMEDIATE OUTCOMES SUCH AS TIME TO CARDIAC ARRHYTHMIA. AND THE EVIDENCE IS UNCLEAR FOR FIVE OTHER CONDITIONS, COPD, DIABETES PREVENTION, SLEEP APNEA, STROKE, PARKINSON'S DISEASE. HERE IS THE DATA ON BMI DIFFERENCE. YOU CAN SEE THAT ABOUT HALF THE STUDIES HAD A WEIGHT LOSS, HALF HAD A WEIGHT GAIN, NONE OF THE STUDIES HAD A DIFFERENCE OF MORE THAN 5% OF BODY WEIGHT WHICH IS CONSIDERED THE MINIMALLY CLINICALLY SIGNIFICANT DIFFERENCE. NEXT SLIDE. HYPERTENSION IT LOOKS DIFFERENT. HERE YOU CAN SEE THAT THE MAJORITY OF STUDIES ACTUALLY HAD A POSITIVE EVENT BUT THE LINES SHOW TWO 2 MILLIMETERS OF MERCURY WHICH IS CONSIDERED MINIMAL CLINICALLY SIGNIFICANT DIFFERENCE BUT YOU CAN SEE THAT VERY FEW STUDIES WORKED AS WELL AS WHAT DR. HARRISON SHOWED IN THE BARBERSHOP HYPERTENSION STUDY SO YOU HAVE TO PUT THIS IN CONTEXT AND WE WERE JUST LOOKING AT PGHD HERE BUT WE CAN LOOK AT ALL DIFFERENT KINDS OF WAYS OF COMMUNITY INTERVENTION FOR HYPERTENSION AND SEE WHICH ONE WORKS THE BEST. SO NEXT SLIDE. ONE ISSUE NOT MENTIONED IS DEVICES. EACH ONE OF THE STUDIES PRESENTED HERE HAD AMAZING -- HAD INDIVIDUAL DEVICE THAT WHEN WE LOOK ACROSS STUDIES EVERY SINGLE STUDY IS USING A DIFFERENT DEVICE, MANY STUDIES USE DIFFERENT DEVICES. WE LOOKED AT HOW SIMILAR DEVICES WERE TO DEVICES THAT ARE CURRENTLY ON THE MARKET. SO FOR BLOOD PRESSURE ACTUALLY MOST OF THE DEVICES WERE SIMILAR, FOR OTHER THINGS, LIKE ACCELEROMETERS, PEDOMETER, DEVICES ON THE MARKET NOW ARE DIFFERENT OR VERY DIFFERENT THAN DEVICES USED IN THE STUDY. SO THAT'S AN ISSUE WE HAVE TO PAY ATTENTION TO WITH THE BODY OF EVIDENCE, THE FACTS THESE DEVICES ARE RAPIDLY CHANGING AND HOW DO WE ACCOUNT FOR THAT. RESEARCH GAPS, LESS THAN 20% OF ENROLLED PATIENTS WERE CORONARY ARTERY DISEASE WERE FEMALE, 9 OUT OF 114 RURAL POPULATIONS, A NEED TO ENROLL DEMOGRAPHICALLY DIVERSE POPULATIONS. OTHER ISSUES, HIGH VARIABILITY, LEVELS OF ADHERENCE, ACCESS TO TECHNOLOGY, INTERNET ACCESS, PATIENT WILLINGNESS TO SHARE DATA, ISSUES OF PRIVACY, SECURITY, PROVIDER INFRASTRUCTURE TO RECEIVE DATA AND INCORPORATE REVIEW OF THE DATA INTO THE WORKFLOW AND IS THAT BILLABLE TIME. I WANT TO TALK ABOUT ANOTHER REPORT, CHARACTERISTICS OF EXISTING ASTHMA SELF-MEDICATION EDUCATION PRACTICES, SO THIS WAS A REVIEW OF 14 OF THESE PACKAGES FOR ADULTS, ADOLESCENTS, CHILDREN AND PARENTS, DESIGNED FOR USE IN SCHOOLS, COMMUNITIES, HEALTH CARE FACILITIES OR PATIENT HOMES, MOST PRIMARY STUDIES, FOCUSED ON COMMUNITIES WITH LARGE MINORITY POPULATION, LOW SOCIOECONOMIC STATUS, SO FINDINGS MOST PACKAGES WERE PAPER BASED, FOUND THIS UPTICK OF TECHNOLOGICAL TOOLS, ASTHMA APPS AND ONLINE DELIVERY OF PACKAGES IS SLOW AND POORLY SUSTAINED. YOU WANT TO BRING TECHNOLOGY BUT HOW MUCH ACCESS DO PEOPLE HAVE, SOMETHING WE NEED TO WORK OUT AS A COMMUNITY. AND THEN ANOTHER ISSUE THAT ACTUALLY I HAVEN'T HEARD TALKED ABOUT HERE IS PACKAGES ARE GENERALLY AVAILABLE IN ENGLISH AND SPANISH BUT NOT IN OTHER LANGUAGES. SO LIKE I KNOW IN MY KIDS' SCHOOL HERE IN SUBURBS OF WASHINGTON, D.C., WHEN THEY SEND HOME PAPERS THEY ARE IN LIKE A LOT OF LANGUAGES THAN JUST ENGLISH AND SPANISH. THAT'S AN ISSUE. FUTURE RESEARCH NEEDS, NEED TO INVEST IN TECHNOLOGICAL PLATFORMS, EXPAND THE REACH OF PACKAGES IN A VARIETY OF WAYS INCLUDING WEB-BASED APPS, LITERALLY, EDUCATORS AND PROVIDERS, SOCIAL DETERMINANTS OF HEALTH INFLUENCE USE AND EFFECTIVENESS OF THESE PACKAGES. WE NEED TO REPORT ECONOMIC FACTORINGS SUCH AS HOUSING STATUS, SO ALL THOSE THINGS ARE THINGS THAT WERE WELL DISCUSSED AT THIS CONFERENCE BUT HERE IS SOMETHING THAT I HAVEN'T HEARD. YOU NEED TO REPORT ASTHMA SEVERITY AND COMORBIDITY AND USE STANDARD MEASURES OF ASTHMA CONTROL SO WHEN WE LOOK ACROSS STUDIES EVERYBODY IS USING DIFFERENT MEASURES AND THAT MAKES IT REALLY HARD OR IMPOSSIBLE TO SYNTHESIZE ACROSS STUDIES. I PUT NEEDS, CHALLENGES, BARRIERS AND OPPORTUNITIES, SEVERAL WE DISCUSSED. WE NEED TO IMPROVE RECRUITING OF DIVERSE POPULATIONS, SO THAT WE'VE HEARD A LOT. WE NEED RIGOROUS STUDIES THAT LOOK AT HEALTH OUTCOMES OVER LONGER TIMELINES, SOMETHING I HAVEN'T HEARD MUCH OF TODAY. WE NEED ATTENTION TO IMPLEMENTATION ISSUES, PATIENT ADHERENCE, PROVIDER WORKFLOW, PATIENT HEALTH LITERACY, ACCESS TO TECHNOLOGY. WE TALKED ABOUT THAT. WE NEED NEW FRAMEWORK FOR EVIDENCE GENERATION TO KEEP UP WITH RAPIDLY EVOLVING TECHNOLOGY, SOMETHING WE HAVEN'T TALKED ABOUT BUT NEED TO TALK ABOUT. THE BARRIERS TO PROGRESS, I TOTALLY UNDERSTAND LIMITED FUNDING FOR CLINICAL STUDIES, WORKING AT AHRQ IT'S LIKE HEARTBREAKING HOW MANY IDEAS WE HAVE AND HOW LIMITED OUR FUNDING IS. AND THERE ARE PRACTICAL BARRIERS BUT OPPORTUNITIES, I CAN'T STRESS THIS ENOUGH, DEVELOPMENT AND USE OF COMMON DATA ELEMENTS, STUDY RESULTS CAN BE SYNTHESIZED TOGETHER TO BUILT A BODY OF KNOWLEDGE HARMONIZATION OF DATA DEFINITION ACROSS THE HEALTH SYSTEM INCLUDING PATIENT CARE QUALITY REPORTING AND QUALITY IMPROVEMENT, IF WE HAVE THAT THEN THAT WILL ENABLE THE WHOLE LEARNING HEALTH CARE SYSTEM THAT WILL ENABLE QUALITY REPORTING, QUALITY IMPROVEMENT, AND RESEARCH. SO REALLY IMPORTANT. I KNOW NIH (INDISCERNIBLE) HAS COMMON DATA ELEMENT TASK FORCE, IT'S REALLY CRITICALLY. THE OTHER OPPORTUNITY, COLLABORATION WITH PATIENT GROUPS TO ENSURE RESEARCH MEETS THE NEEDS, I DID THAT IN LESS THAN 15 MINUTES SO THANK YOU. >> THANK YOU FOR THE INTERESTING TALK. I'M WONDERING IF WE HAVE QUESTIONS IN THE CHAT BOX. IF NOT I HAVE ONE FOR YOU. SO YOU TALKED ABOUT PATIENT ADHERENCE. CAN YOU EXPAND UPON THAT A LITTLE BIT MORE? >> YEAH, SO I THINK THAT'S ACTUALLY AN ISSUE THAT A LOT OF PEOPLE HAVE TALKED ABOUT AT THIS CONFERENCE. WE MEASURE ADHERENCE BASED ON LIKE WITH THE DEVICES, DEVICES MEASURE HOW MUCH TIME SOMEBODY'S USED THE DEVICE. BUT WHEN WE THINK ABOUT ADHERENCE, A LOT OF PEOPLE HAVE TALKED ABOUT THIS WELL, WHAT ARE ALL THE SOCIAL FACTORS, COMMUNITY FACTORS, PATIENT FACTORS THAT LEAD TO THAT. EVEN THE DEVICE FACTORS. ONE TOPIC DISCUSSED IS SLEEP. WE HAVE A DRAFT REPORT ON SLEEP APNEA AND CPAP DEVICES. COMPLIANCE IS LOW. DO WE NEED TO WORK WITH THE PATIENT, HAVE BETTER COMPLIANCE OR DO PEOPLE DESIGNING DEVICES NEED TO DESIGN DEVICES PEOPLE USE? I THINK THAT A LOT OF PEOPLE ON THIS CONFERENCE HAVE REALLY DISCUSSED THAT ISSUE A LOT. >> I THINK YOUR SYSTEMATIC REVIEW METHOD IS FANTASTIC. I WAS CURIOUS IF I OR OTHER FOLKS AT THE CONFERENCE HAVE IDEAS FOR ANOTHER SYSTEMATIC REVIEW HOW CAN WE SUGGEST THAT TOPIC FOR YOU? >> IF YOU GO TO OUR WEBSITE, WWW.EFFECTIVEHEALTHCARE.AHRQ.GOV , A BUTTON SAYS SUGGEST TOPIC FOR RESEARCH. ANYBODY CAN SUGGEST A TOPIC. WE WOULD LOVE TO HAVE ANYTHING YOU GUYS THINK IS IMPORTANT. WE HAVE A BUDGET SET ASIDE AT AHRQ, BASED ON THE PUBLIC NOMINATIONS, ALSO FOR THOSE WHO ARE IN OTHER GOVERNMENT AGENCIES WE DO WORK WITH OTHER GOVERNMENT AGENCIES THROUGH INTERAGENCY AGREEMENTS WHERE OTHER AGENCIES FUND US TO DO TOPICS RELATIVE TO THE OTHER AGENCY'S WORK. I ENCOURAGE EVERYBODY TO TAKE A LOOK AT OUR WEBSITE. >> THANK YOU SO MUCH, DR. BERLINER. NOW WE'RE GOING TO MOVE TO OUR NEXT TALK, THAT IS BY DR. CHRISTINE LEE. DR. LEE IS STRATEGIC RESEARCH ENGAGEMENT LEAD, OFFICE OF MINORITY HEALTH AND HEALTH EQUITY, IN THE OFFICE OF THE COMMISSIONER, AT THE FOOD AND DRUG ADMINISTRATION. SO HER PRESENTATION TODAY IS COLLABORATION TO ADVANCE HEALTH EQUITY. >> SO NICE TO BE HERE, SO NICE TO SEE YOU AGAIN MARTIN, VIRTUALLY AT LEAST. SO NEXT SLIDE PLEASE. THIS IS OUR DISCLAIMER SLIDE, THIS PRESENTATION REPRESENTS PERSONAL OPINIONS OF ME AND DOES NOT NECESSARILY REPRESENT THE VIEWS OR POLICIES OF THE AGENCY. I HAVE NO CONFLICTS OF INTEREST TO DECLARE. NEXT SLIDE PLEASE. WHO ARE WE? WHAT DO WE DO? HERE SUR A SLIDE THAT SHOWS OUR MISSION. ALSO A LITTLE BIT ABOUT WHAT WE DO AT THE CONSUMER PROTECTION AGENCY. BUT OUR MISSION AS FDA IS THAT WE'RE RESPONSIBLE FOR PROTECTING THE PUBLIC HEALTH BY ASSURING THE SAFETY, EFFICACY, AND SECURITY OF HUMANS AND VETERINARY DRUGS, BIOLOGICAL PRODUCTS, MEDICAL DEVICES AND OUR NATION'S FOOD SUPPLY, COSMETICS AND PRODUCTS THAT EMIT RADIATION. NEXT SLIDE PLEASE. A LITTLE BIT ABOUT OUR OFFICE. THE FDA OFFICE OF MINORITY HEALTH AND HEALTH EQUITY WE HAVE A MISSION AND VISION STATEMENT. MISSION IS TO PROTECT -- PROMOTE AND PROTECT THE HEALTH UNFORTUNATELY DIVERSE POPULATIONS THROUGH RESEARCH AND COMMUNICATIONS THAT ADDRESS HEALTH DISPARITIES. OUR VISION IS ONE TO CREATE A WORLD WHERE HEALTH EQUITY IS A REALITY FOR YOU WILL. FIRST GOAL TO IMPROVE REGULATORY SCIENCE BY INCREASING DATA AVAILABLE, IMPROVE DATA QUALITY TO DETERMINE HOW MINORITIES REACT TO MEDICAL PRODUCTS, AND INCREASE TRANSPARENCY AND ACCESS TO AVAILABLE DATA. OUR GOAL NUMBER 2 IS TO STRENGTHEN FDA'S ABILITY TO RESPOND TO MINORITY HEALTH CONCERNS. AND THIRD GOAL TO PROMOTE HEALTH AND SAFETY COMMUNICATION TO MINORITY POPULATIONS WHO OFTEN EXPERIENCE LOW HEALTH LITERACY AND/OR SPEAK ENGLISH AS A SECOND LANGUAGE. NEXT SLIDE PLEASE. WE DO HAVE TWO ARMS. WE HAVE THE RESEARCH AND COLLABORATION ARM AND WE ALSO HAVE THE OUTREACH AND COMMUNICATION ARM. AND THE RESEARCH AND COMMUNICATION ARM WE DO SEVERAL ACTIVITIES WHICH INCLUDE INTRAMURAL RESEARCH, EXTRAMURAL RESEARCH, PARTICIPATION IN CENTERS OF REGULATORY SCIENCE AND INNOVATION, BAAs, OTHER RESEARCH OPPORTUNITIES, SUPPORT INTERNSHIPS AND FELLOWSHIPS, ENGAGE IN ACADEMIC COLLABORATION, AND ALSO SEEK STAKEHOLDER INPUT. WE HAD COMMUNICATION ARM INITIALLY THAT ACTIVITIES INCLUDE ADDRESSES CULTURALLY AND LINGUISTICICALLY TAILORED PROGRAMS AND INITIATIVES. SUPPORTING HEALTH EDUCATION MATERIALS, SOCIAL MEDIA, NEWSLETTERS AND e-ALERTS, MAINTAINING OUR WEBSITE, AND COORDINATING HEALTH EQUITY LECTURE SERIES AND WEBINARS. ALSO ENGAGING IN STAKEHOLDER MEETINGS, SYMPOSIUMS AND EXHIBITS. HERE ARE SOME EXAMPLES OF OUR EXTRAMURAL COLLABORATION AND RESEARCH PROJECTS. AS YOU CAN SEE HERE WE USE SEVERAL MECHANISMS TO ENGAGE WITH THE RESEARCH COMMUNITY. THESE INCLUDE INTERAGENCY AGREEMENTS, EXAMPLE IS WORK WITH VETERANS AFFAIRS ADMINISTRATION, BEYOND CLINICAL CLINICAL TRIALS INVESTMENT IN REAL WORLD EVIDENCE AND ARTIFICIAL INTELLIGENCE, WE ALSO HAVE RCAs, RESEARCH COLLABORATIVE AGREEMENTS. AND WE HAVE AN RCA UNDERRING BARRIERS TO ENROLLING DIVERSE PARTICIPATION INTO CLINICAL TRIALS. WE ALSO ENGAGE IN LEADING WORKSHOPS, JUST FINISHED A WORKSHOP IN FEBRUARY, IN WHICH IT WAS COLLABORATING TO REALLY ADVANCE DIVERSITY AND HEALTH EQUITY FOR DIABETES AND CHRONIC KIDNEY DISEASE AND CLINICAL TRIALS. WE WORKED WITH CERCIs. CHARACTERIZING POPULATION-SPECIFIC CLINICAL PROFILES, AND ALSO WORKED WITH BAASs, BROAD AGENCY ANNOUNCEMENTS. AN EXAMPLE IS SOCIAL LISTENING FOR PATIENT PERSPECTIVE ON CHRONIC PAIN AND SUPPORT FELLOWSHIPS AND INTERNSHIPS, I'LL TALK ABOUT THIS VERY BRIEFLY. AN EXAMPLE OF A FELLOWSHIP, THIS IS A POSTDOCTORAL FELLOWSHIP IN GENOMIC SCIENCE AND HEALTH EQUITY IN WHICH THE FELLOW WILL WORK ON SICKLE CELL PROJECT WITH THREE P.I.s. WE HAVE ALREADY STARTED ACCEPTING APPLICATIONS, EXPECT THE APPLICATION PROCESS TO CLOSE RELATIVELY SOON, SO IF ANYONE IS INTERESTED PLEASE APPLY. NEXT SLIDE PLEASE. A LITTLE BIT OF POSTDOCTORAL FELLOWSHIP IN GENOMIC SCIENCE AND HEALTH EQUITY, AS MENTIONED EARLIER, IT'S FELLOWSHIP WITH THREE THREE P.I.ss, WITH THE FDA AND NIH. THE FELLOW PURSUES GENOMIC RESEARCH RELATED TO TRANSFUSION SUPPORT FOR SICKLE CELL DISEASE, WHICH IS A HEALTH DISPARITY CONDITION THAT AFFECTS AFRICAN AMERICANS IN THE UNITED STATES PRIMARILY. SUCCESSFUL CANDIDATE WILL COMPLETE A RESEARCH PROJECT TO PRODUCE REFERENCE REAGENTS TO OPTIMIZE TRANSFUSION SUPPORT FOR A PATIENT WITH SICKLE CELL DISEASE. NEXT SLIDE PLEASE. AND ANOTHER EXAMPLE OF OUR EXTRAMURAL COLLABORATION RESEARCH PROJECT AS MENTIONED BRIEFLY EARLIER THROUGH OUR INTERAGENCY AGREEMENTS, IAAs. THIS RESEARCH PROJECT REALLY COLLABORATES WITH NOT ONLY THE V.A. BUT ALSO CDER TO UNDERSTAND SUBGROUP DIFFERENCES WHEN IT COMES TO DOACs. A LITTLE BIT ABOUT THIS STUDY, WE'RE LOOKING TO UNDERSTAND WHETHER OR NOT THERE'S DIFFERENCES IN OUTCOMES. FOR DOAC TREATMENT AMONG SUBGROUPS INCLUDING AFRICAN AMERICANS, HISPANICS,ATIONS. THIS IS TO UNDERSTAND IF THERE'S POPULATION WITH ORAL OR ANTICOAGULANT TREATMENT. NEXT SLIDE PLEASE. EXAMPLE OF OUR CERSI COLLABORATION, CENTERS OF EXCELLENCE, A STUDY WITH UCSF, PEDIATRIC ASTHMA OUTCOMES. THE OBJECTIVE IS TO INVESTIGATE ASSOCIATION OF LEAD PARAMETERS AND TYPES OF ASTHMA OUTCOMES, IDENTIFY POPULATION SPECIFIC ELIGIBILITY FOR BIOLOGIC THERAPIES IN MINORITY PEDIATRIC POPULATIONS. NEXT SLIDE PLEASE. AND THOSE ARE ALL THE SLIDES I HAVE. THANK YOU FOR YOUR TIME. THANK YOU, IT'S BEEN A PLEASURE. >> THANK YOU SO MUCH, DR. LEE, FOR A GREAT PRESENTATION. SO YOU JUST TALKED ABOUT THE DIRECT ANTICOAGULANT TREATMENT PROJECT, TELL US MORE ABOUT THE RESEARCH. >> ABSOLUTELY. THE VETERAN HEALTH ADMINISTRATION HAS A HUGE ELECTRONIC HEALTH CARE RECORD RESOURCE. USING THIS LEVERAGING THE AMOUNT OF DATA IN THE V.A. WE'RE REALLY ABLE TO PULL OUT POPULATION DIFFERENCES, WHICH HAS ALWAYS BEEN A PROBLEM WHEN IT COMES TO ANALYSIS BUT GIVEN POPULATION, MILLION UPON MILLIONS, WE'RE ABLE TO REALLY POWER ENOUGH FOR THESE SUBGROUPS ANALYSIS DIFFERENCE THIS IS EXACTLY WHAT WE'RE DOING, WORKING WITH V.A. TO UNDERSTAND IF THERE'S ANY SUBGROUP POPULATION DIFFERENCES, WHEN IT COMES TO DIRECT ORAL ANTICOAGULANTS. >> THANK YOU, DR. LEE. I'M LOOKING IF WE HAVE ANY QUESTIONS IN THE CHAT BOX. IF NOT, I HAVE ANOTHER QUESTION FOR YOU. SO CAN YOU PROVIDE MORE INFORMATION ABOUT THE ASTHMA STUDY YOU TALKED ABOUT AND SPECIFICALLY WHAT WAS MEASURED? >> ABSOLUTELY. SO ACTUALLY CLINICAL BLOOD PARAMETERS WERE MEASURED INCLUDING IgG PARAMETERS, LYMPHOCYTES, MONOCYTES, BLOOD PARAMETERS WERE MEASURED TO SEE IF THERE'S ANY DIFFERENCES IN SUBGROUP POPULATIONS WHEN IT COMES TO THESE TYPES OF BLOOD PARAMETERS, AFFILIATED, AND ASSOCIATED WITH SEVERE ASTHMA OUTCOMES. >> THANK YOU, DR. LEE. AND IF NO OTHER QUESTIONS, I'LL ASK ONE FINAL QUESTION. SO IN YOUR GOAL THAT YOU LISTED FOR YOUR OFFICE, YOU TALKED ABOUT THAT YOU GUYS -- YOUR OFFICE LOOKS TO IMPROVE REGULATORY SCIENCE BY INCREASING CLINICAL TRIAL DATA AVAILABLE ON RACIAL AND ETHNIC MINORITIES, COULD YOU TALK ABOUT WAYS THAT FDA OHMT GOES ABOUT THAT? >> OH, ABSOLUTELY. WHEN WE LOOK AT CLINICAL TRIAL DATA AND WE GO TO DIRECT TRIAL SNAPSHOTS, YOU CAN EASILY SEE THERE IS LESS ENROLLMENT FOR CERTAIN POPULATIONS INTO CLINICAL TRIALS, SO A LOT OF RESEARCH IN THE PRE-MARKET SPACE IS LOOKING AT WHAT ARE THE BARRIERS TO ENROLLING DIVERSE POPULATIONS INTO CLINICAL TRIALS, AND WHAT WE'RE TRYING TO GET AT WHEN WE TALK ABOUT BARRIERS IS TO UNDERSTAND REALLY SPECIFIC SUBGROUP LEVEL BARRIERS, SO INSTEAD OF SAYING BROAD STATEMENTS SUCH AS IT MIGHT BE SEXISM OR BREAKING IT DOWN TO LIKE WHAT ARE THE SPECIFIC BARRIERS FOR THIS GROUP, AND THEN UNDERSTANDING ALLOWS US TO INVESTIGATE AND PUT RESOURCES INTO WHAT ARE SOME INTERVENTIONS THAT MIGHT BE SPECIFIC TO THIS POPULATION, AS WE KNOW A ONE-SIZE-FITS-ALL MENTALITY RARELY WORKS. >> THANK YOU, DR. LEE. AND WE DO HAVE A FEW MORE MINUTES, SO I WILL KEEP ASKING MY QUESTIONS. >> OH, SURE. >> IF THAT'S OKAY. AND SO ONE OF YOUR OTHER GOALS YOU LISTED WAS TO STRENGTHEN FDA ABILITY TO RESPOND TO MINORITY HEALTH CONCERNS. AND, YOU KNOW, SO OBVIOUSLY WE'RE IN THE MIDDLE OF A PANDEMIC. I'M JUST CURIOUS CAN YOU TALK ABOUT WHAT FDA AND/OR YOUR OFFICE HAVE DONE TO RESPOND TO THE MINORITY HEALTH CONCERNS WHEN IT COMES TO THE PANDEMIC? >> YES, ABSOLUTELY. I THINK THAT COMES TO ACTUALLY BOTH THE PRE-MARKET AND POST-MARKET SIDE. GIVEN THAT WE ARE REGULATORY AGENCY A LOT OF WORK WE DO DO HAS TO ALIGN WITH OUR REGULATORY MISSION. SO ON THE POST-MARKET SIDE, DOING POST-MARKET RESEARCH, AND UNDERSTANDING ANY SORT OF SUBGROUP POPULATION DIFFERENCES WHEN IT COMES TO COVID OR ANY OF THE TREATMENTS, THAT IS INCREDIBLY IMPORTANT. ON THE PRE-MARKET SIDE, UNDERSTANDING HOW WE CAN ENCOURAGE MORE DIVERSE POPULATIONS TO ENCONTROL IN COVID -- ENROLL IN COVID CLINICAL TRIALS. >> THANK YOU, DR. LEE. THANK YOU FOR AN EXCELLENT PRESENTATION. >> THANK YOU, DR. MENDOZA. SO NICE TO SEE YOU AGAIN. >> YOU TOO. OKAY. NOW WE'RE GOING TO GO TO OUR NEXT PRESENTATION, FROM DR. DOUGLAS KELLY. DR. KELLY IS DEPUTY DIRECTOR FOR SCIENCE AND CHIEF SCIENTIST AT CENTER FOR DEVICES AND RADIOLOGICAL HEALTH, ALSO FROM THE FDA. TODAY HE'S GOING TO TALK ABOUT SECRET OF MED TECH SUCCESS, HOLISTIC APPROACH. >> CAN YOU HEAR ME OKAY? >> YES. >> GREAT. YOU SEE MY SCREEN, SECRETS OF SUCCESS? >> YES. >> GREAT. OKAY. THANKS FOR INVITING ME. MY BACKGROUND, I HAVE A LOT OF SLIDES SO I'LL RIP THROUGH THEM HERE. BACKGROUND ABOUT MYSELF, I'M TRAINED IN CELL BIOLOGY, M.D., BUSINESS SCHOOL, BECAME A PARTNER WITH A PROFESSOR, INDIVIDUAL CAPITAL BUSINESS 30 YEARS BEFORE I GOT APPROVED BY JEFF HER MAN AT CDRH. PART OF MY MANDATE IS FIX THE MEDTECH INNOVATION ECOSYSTEM, DIRECT APPLICATIONS ON THINGS WE'VE HEARD TODAY. I WAS ASKED TO GIVE A TALK, THE SECRETS FOR SUCCESS IN MEDICAL TECHNOLOGY TO TARGETED POPULATIONS. THAT SECRET IS, WAIT FOR IT, IT'S COMMUNICATION. AND ACTUALLY PERFECT EXAMPLE WAS PREVIOUS PRESENTATION THAT I THINK WAS BY PAUL HESS, WHO TALKED ABOUT TAKING ANTI-HYPERTENSIVE THERAPY TO BARBERSHOPS BECAUSE THAT'S WHERE THE TARGETED POPULATION WAS. THAT TOOK LISTENING AND COMMUNICATION, BUT THE OTHER THING ABOUT COMMUNICATION THAT'S SUPER IMPORTANT WHEN YOU'RE STARTING A PROJECT IS REALLY UNDERSTANDING WHAT YOUR RISKS ARE, INDIVIDUAL CAPITAL BUSINESS THAT'S 90% OF WHAT YOU'RE WORKING ON. CAN YOU MANAGE OR ELIMINATE THEM? AND STAKEHOLDER INPUT, THAT SPEAKS TO THE GOING TO BARBERSHOPS THING, YOU GOT TO GO WHERE YOUR CUSTOMERS ARE, WHERE YOUR PATIENTS ARE WHAT YOU'RE WORRIED ABOUT. AND ALSO HELPS YOU WITH YOUR FUNDRAISING BECAUSE YOU HAVE TO TALK TO EVERYBODY ABOUT IT AND ULTIMATELY HOW DO YOU EXIT, SELL YOUR COMPANY, TAKE IT PUBLIC? SOUNDS FUNNY FOR A GUY FROM THE FDA TO TALK ABOUT THESE THINGS BUT OUR PUBLIC HEALTH MISSION IS REALLY BRINGING SAFE AND EFFECTIVE MEDICAL DEVICES -- >> I DON'T THINK YOUR SLIDES ARE ADVANCING. >> THEY ARE NOT? OKAY. >> NOT ADVANCING, NO. DO YOU HAVE POSSIBLY HAVE TWO SCREENS? >> YEAH, I DO. HOLD ON. >> NO PROBLEM. ONE SECOND HERE. I'M GOING TO SWITCH SCREENS. >> OKAY. >> DO YOU SEE MY CROWDED SCREEN HERE? >> YEP, I SEE THE PRESENTATION, YEP, ON TOP OF A FEW OTHER THINGS, YES. >> OKAY. LET'S JUST DO THIS. WE'LL GET THROUGH IT. HERE WE GO. >> OKAY. >> THAT'S BETTER. OKAY. YEAH, PUBLIC HEALTH MISSION, DELIVERING THERAPIES, DIAGNOSTICS TO PATIENTS THAT ACTUALLY NEED THEM,S NOT ENOUGH TO MAKE IT THROUGH THE FDA. THEY HAVE TO MAKE IT SO THEY ACHIEVE WIDESPREAD ADOPTION AND AFFECT PUBLIC HEALTH. THAT'S PART OF MY MISSION HERE AT FDA. IN THAT YOU HAVE TO UNDERSTAND YOUR TECHNOLOGY, YOUR PATENTS, COOL (INDISCERNIBLE) ARE NOT THE MOST IMPORTANT THING. IT'S WHETHER YOU COMMUNICATE YOUR IDEA TO THE PROPER PEOPLE, PROVIDERS, PROFESSIONAL SOCIETIES, FDA, PAYERS, INVESTORS, POTENTIAL EMPLOYEES AND CONSULTANTS. LET'S TALK ABOUT PATIENT AND PATIENT ADVOCATES. ARE THEY INDEPENDENT OR WHAT WE CALL COIN-OPERATED, INDUSTRY AFFILIATED? YOU WANT TO WORK WITH INDEPENDENT PATIENT GROUPS SO YOU KNOW WHAT THE BIAS ARE AND THEY ARE TRUSTED AND THEY ARE GOING TO TELL YOU TO YOUR FACE WHETHER OR NOT THEY THINK WHAT YOU HAVE IS VALUABLE OR NOT. PATIENT PREFERENCES ARE SUPER IMPORTANT. WE HAVE AN OFFICE OF STRATEGIC PARTNERSHIPS, MICHELLE TARVER, SAID OF OUR PATIENT SCIENCE DIVISION, AND THIS IS THE BULK OF HER WORK. IT'S SUPER IMPORTANT. EVERYBODY ELSE IN FDA IS CALLED PATIENT PREFERENCES, IN THE BUSINESS WORLD IT'S CALLED MARKETING, WHAT IS THE RISK/BENEFIT TOLERANCE OF YOUR PATIENTS WHICH YOU'LL FIND IS PROFOUNDLY DIFFERENT DEPENDING ON ETHNIC COMMUNITY, DEMOGRAPHIC, YOUNG PEOPLE VERSUS OLD, STAGES OF DISEASE, ET CETERA. YOU WANT TO KNOW WHAT PATIENT PREFERENCES ARE BECAUSE FEATURES ARE EXPENSIVE TO DEVELOP AND MAYBE WHAT YOU THINK, THE THINGS YOU THINK ARE IMPORTANT, AREN'T. ENDPOINTS IN CLINICAL STUDIES, ANOTHER PLACE PEOPLE FORGET YOU MAY HAVE AN IDEA FOR A CLINICAL TRIAL BUT YOUR PATIENTS, TARGET PATIENT GROUPS MAY NOT VALUE ANY INFLUENCE, MEANS YOU'RE DESTINED NOT TO HAVE RAPID UPTAKE OR ANY UPTAKE ONCE YOU FINALLY GET THROUGH APPROVAL AND GET COVERAGE. AGAIN, AS I MENTIONED, THIS BENEFIT/RISK ANALYSIS IS IMPORTANT. THERE'S LOTS OF THERAPIES OUT THERE WHERE PEOPLE ARE FAR MORE RISK TOLERANT TO ADVERSE EFFECTS IF THEY THINK THERE'S A CHANCE OF SUBSTANTIAL IMPROVEMENT IN THEIR HEALTH CARE. AND IN TERMS OF ADVOCACY, THE REASON TO TALK TO PATIENTS SO YOU CAN HAVE ADVOCACY WHEN YOU GO TO PAYER TECH ASSESSMENT FORUMS, MEETINGS AT CMS, WHERE YOU HAVE GROUPS OF CLINICIANS AND SCIENTISTS WHO OPINE WHETHER OR NOT YOUR INVENTION, YOUR TECHNOLOGY IS ANYTHING INTERESTING TO THEM, WHETHER IT MEETS REASONABLE AND NECESSARY DEFINITION FOR CMS AND WHETHER IT MEETS DEFINITION OF USEFUL FOR PAYERS. HAVING PATIENTS SPEAK UP FOR THEMSELVES IN A WAY THAT IS TAKEN SERIOUSLY AND IS SCIENTIFIC AND RIGOROUS, THERE'S ALMOST NOTHING MORE IMPORTANT FOR GETTING YOUR TECHNOLOGY ADVANCED. PROFESSIONAL SOCIETIES ARE HUGELY IMPORTANT, YOU NEED TO KNOW WHO THESE PEOPLE ARE. THEY CONTROL-CPT CODING, YOU NEED A CODE TO GET PAID. CONTROL GUIDELINES, IT'S GREAT IF YOUR TECHNOLOGY CAN BE INCORPORATED INTO PRACTICE GUIDELINES YOU MEANS YOU'RE STATE OF THE ART, WHICH MEANS A DOCTOR IS NOT USING YOUR TECHNOLOGY IN THAT PATIENT ENCOUNTER, THEY MAY BE COMMITTING MALPRACTICE. TWO FUNCTIONS, PROFESSIONAL SOCIETIES. IT'S ABOUT MEMBER PRACTICES, MAKING SURE THEY ARE DOING WELL, IT'S ALSO ABOUT PATIENT WELL-BEING, SOMETIMES THESE ARE IN CONFLICT BUT THEY DO MANAGE BOTH. YOU NEED TO UNDERSTAND PROFESSIONAL SOCIETY'S LEADERSHIP AND HIERARCHY, INEVITABLY SOMEBODY WHO SPENT THEIR CAREER HATING WHAT YOU'RE WORKING ON AND MAYBE THE NEXT PEOPLE IN LINE TO BE THE PRESSMAN OF SOCIETY, YOU NEED TO KNOW THAT BEFORE YOU START MAKING YOUR BIG PUSH. BUT IT'S ALSO GOOD TO COLLECT ALLIES IN THE SOCIETIES. YOU NEED TO UNDERSTAND WHAT VARIOUS PRACTICES LOOK LIKE, URBAN, CLINIC, BIG HOSPITAL VERSUS PRIVATE PRACTICE, AND WHAT WORKFLOW LOOKS LIKE, WHO IS INVOLVED, NURSES AND ALLIED HEALTH PROFESSIONALS THAT THEY HIRE, WHO IS GOING TO BE USING THIS, WHO HAS THE TERM, USED IN PRACTICE, THERE HAVE BEEN TONS OF DEVICES, NURSES DON'T LIKE IT, IF IF NURSE DOESN'T LIKE IT, I DOESN'T GET USED. PROFESSIONAL SOCIETY, COMPETITORS, THERE'S THE CASE SEVERAL YEARS AGO WHERE ENDOSCOPISTS DID AN APPENDECTOMY, THE PATIENT WALKED OUT, DIDN'T HAVE EXTERNAL WOUNDS. FDA IS A STAKEHOLDER YOU HAVE TO DEAL WITH. THE DEAL WITH THE FDA COMMUNICATION TRANSPARENCY AROUND TRUST ARE KEY, IF YOU START WITH A BAD RELATIONSHIP IT'S GOING TO BE LONGER AND WORSE FOR YOU. YOU SHOULD HAVE A LOW THRESHOLD FOR INTERACTION FOR FDA, GET TO KNOW YOUR REVIEWER WELL. THE SECRET HERE, THIS IS OUR MISSION AT CDRH, IT'S LIKE THE DIFFERENCE BETWEEN LONG DISTANCE RELATIONSHIP AND LIVING WITH SOMEBODY, YOU LIVE WITH SOMEBODY YOU HASH STUFF OUT RIGHT AWAY AND YOU LONG DISTANCE MISUNDERSTANDING CAN OCCUR. THINK ABOUT EVIDENCE PORTFOLIO FOR STAKEHOLDERS, PAYERS WANT TO SEE DURABILITY OF EFFECT, VERSUS WHAT FDA WANTS TO SEE. YOU MAY GET A FAST WAY THROUGH THE FDA WITH TOOL INDICATION AND HAVE TO DO NO OR A FEW PATIENTS IN A CLINICAL STUDY, THAT MAY NOT BE ENOUGH FOR PROFESSIONAL SOCIETIES OR FOR PAYERS. YOU SPEND MORE UP FRONT, IT COULD SAVE YOU TENS OF HUNDREDS OF MILLION OF DOLLARS IN YEARS OF TIME BY DEVELOPING COMPREHENSIVE EVIDENCE PORTFOLIO. ON THE PAYER SIDE, THEIR CLINICAL DATA HAS TO INCLUDE THEIR DEMOGRAPHIC AND SEVERAL CATEGORIES IT HAS TO FIT INTO. AND SOME ARE EASY, THINK ABOUT NEEDS OF POPULATIONS, THESE RELATIONSHIPS AND YOUR ABILITY TO COMMUNICATE WIDER TECHNOLOGY IS INTERESTING CAN HAVE HUGE COMPETITIVE ADVANTAGES FOR YOU. YOU HAVE TO MAKE IT TO THEIR NEEDS EARLY. INVESTORS, ANOTHER THING TO REMEMBER, LOWER VALUATION, IF YOU CAN DE-RISK BEFORE YOU RAISE MONEY IT'S GOOD, YOU GET TO KEEP MORE OF THE COMPANY, SELL LESS OF IT. MORE WORK CHEAPLY EQUALS HIGHER VALUATION AND COMMUNICATE WITH THEM, SIZING THEM UP TRYING TO FIGURE OUT DO THEY WANT THE SAME THING I DO. IT'S GOOD TO LOOK DEEP IN YOUR OWN SOUL AND FIGURE OUT WHAT IT IS YOU WANT TO DO WITH THE COMPANY AND MAKE SURE INVESTORS AGREE WITH YOU. YOU CAN'T MAINTAIN MAJORITY OWNERSHIP IN A COMPANY. BUT IT'S OKAY IF YOU'RE ALIGNED WITH INVESTORS. FIND A GOOD LAWYER, DOING SOMETHING IN DIAGNOSTICS MAKE SURE YOUR LAWYER HAS EXPERIENCE IN DIAGNOSTICS. DON'T LET SOMEBODY LEARN ON YOUR DIME. IF YOU NEED TO FIND ANOTHER LAWYER DON'T WORRY ABOUT HURTING THEIR FEELINGS AND WARM INTRODUCTIONS ARE CRITICAL. IF THE LAWYER ISN'T IN YOUR TOWN GO TO LIKE A TOWN IN MINNESOTA, SAN DIEGO, BAY AREA, BOSTON OR HERE WHERE A LOT OF GUYS DO THAT. EMPLOYEES ADVISE CONSULTANTS. MY PARTNER HAD THE RULE OF THE KILLER BEES, ONLY HIRE PEOPLE YOU KNOW ARE SMARTER THAN YOU, THE As. THEY WILL HIRE As. IF YOU HIRE Bs, THEY WILL HIGH Cs. KILLER BEES ARE LIKE CANCER, DIFFICULT TO GET RID OF. SURROUND YOURSELF WITH PEOPLE WHO HAVE DONE IT BEFORE. DON'T BE AFRAID TO ASK ABOUT EXPERIENCE AND CREDENTIALS OF THOSE ADVISING YOU AND DON'T LISTEN TO PEOPLE WITHOUT A TRACK RECORD OF SUCCESS OR SERIAL FAILURES. THESE PEOPLE NEED TO KNOW YOU HAVE A VISION, CONVICTION IS THE HARDEST THING YOU'LL EVER DO OTHER THAN HAVING KIDS. FLEXIBILITY TO CHANGE WHEN CIRCUMSTANCES WARRANT SO YOU WANT TO BE STEADFAST BUT KNOW WHEN ONE THING IS CONSTANT, EVERYTHING CHANGES. SO, YOU HAVE TO HAVE A LOW EGO. AGAIN, YOU HAVE TO HAVE ABILITY TO ALIGN YOURSELF WITH SUCCESSFUL PEOPLE AND KEEP YOUR EYES ON THE PRIZE. YOUR PRIZE IS WIDESPREAD PUBLIC ADOPTION OF YOUR PRODUCT. EVERYTHING ELSE IS JUST WINDOW DRESSING. YOU GOT TO THINK HOLISTICALLY, THINK ABOUT THE FDA, PAYERS, PATIENTS, AND YOUR PATIENT ADVOCATES, THINK ABOUT PROFESSIONAL SOCIETIES, THINK ABOUT EVERYBODY THAT YOU'RE GOING TO HAVE TO DEAL WITH ALONG THE WAY, INCLUDE THEM EVERY DAY, ALL DAY, FOR THE REST OF THE TIME YOU'RE WITH THAT COMPANY. AND THEN YOU HAVE TO LISTEN TO PEOPLE WHO DON'T AGREE WITH YOU AND HAVE PEOPLE CALLING YOU AN IDIOT FROM THE TIME YOU START THIS. EVERYBODY USED TO SAY TO ME THAT MUST BE VENTURE CAPITALIST, PEOPLE CALL ME AN IDIOT EVERY DAY UNTIL MY PUBLIC GOES PUBLIC. >> THREE MINUTES. >> THAT'S THE NATURE OF THE BEAST. YOU GOT TO KNOW YOU CAN'T DO IT ALL YOURSELF. IT DOES TAKE A VILLAGE. YOU HAVE TO INCLUDE THAT IN YOUR EGO CHECK. PETER GABRIEL WROTE ALL THESE THINGS WERE ONCE JUST DREAMS IN SOMEBODY'S HEAD, FROM MERCY STREET. AND YOU CAN MAKE YOUR OWN. THAT'S IT. THANKS SO MUCH. ANY QUESTIONS IN OUR THREE MINUTES? >> THANK YOU, DR. KELLY, FOR A FANTASTIC TALK. WE HAVE A QUESTION IN THE CHAT BOX. SO, COULD YOU PROVIDE PERSPECTIVE FOR OPTIMIZING PRODUCTS FOR UNDERSERVED POPULATIONS, SO LOW COST DEVICES AND THIS IS SUSTAINABLE? >> YES, BECAUSE THE -- I'M GETTING AN ECHO. NO WORRIES. YEAH, BECAUSE IN GENERAL I GUESS INSURANCE IS GOING TO PAY FOR A LOT OF THIS IN THESE UNDERSERVED POPULATIONS. AND I GUESS I WOULD FOCUS MORE ON MAKING SURE YOU HAVE A DEVICE THAT'S GOING TO BE COVERED BY INSURANCE THAT YOUR CUSTOMERS TYPICALLY ARE SERVED BY, AND I THINK YOU SHOULD BE LESS FOCUSED ON DEVELOPING LOW COST DEVICES THAN DEVICES THAT ACTUALLY HAVE A BIG IMPACT. YOU KNOW, SAME AS FOR ANYBODY ELSE BUT MAKE SURE COMMUNICATION, COMMUNICATING WITH THOSE PATIENTS, PREFERENCES WILL TELL WHAT YOU THEY REALLY WANT. AND DON'T GO IN WITH PRECONCEIVED IDEAS. LISTEN TO WHAT THEY ARE SAYING. THAT'S WHY THE BARBERSHOP EXAMPLE FOR HYPERTENSION IS ABSOLUTELY BRILLIANT. IT'S A BRILLIANT THING. THEY REALLY DID LISTEN TO THEIR CUSTOMERS, THEY KNEW WHERE THEY WOULD GO, WHO THEIR TRUSTED PARTNERS WERE, WITH BARBERS. I'LL USE THAT EXAMPLE FOR THE REST OF MY LIFE FOR OTHER THINGS. I GUESS FOCUS LESS ON BEING UNDERSERVED THAN JUST LISTENING TO THEM, GO OUT AND TALK TO THEM. YOU CAN'T DO IT FROM INSIDE A LIBRARY. IT'S GOING OUT AND TALKING TO THEM. AND THEIR PHYSICIANS TO FIND OUT WHAT THEIR PHYSICIANS THINK AND PLACES WHERE THEY PRACTICE. >> WE HAVE TIME FOR ONE MORE QUESTION. SO I'LL ASK YOU, DR. KELLY. WHAT-- HOW DO MEDTECH COMPANIES START, HOW DO THEY TYPICALLY FAIL? >> NOT THINKING ABOUT THE ENTIRE JOURNEY LIFE CYCLE FROM PRODUCT CONCEPTION THROUGH TO COMMERCIALIZATION. AND THERE'S A TON OF COMPANIES THAT WILL MAKE IT THROUGH THE FDA FINE, AND THEN FIND OUT -- THAT'S WHEN THEY TALK TO PAYERS, PAYERS TELL THEM I NEED A FIVE YEAR DURABILITY STUDY, YOU COULD HAVE STARTED THAT FOUR YEARS AGO AND YOU'D HAVE A YEAR TO GO. THEN YOU CAN'T RAISE MONEY AND THERE'S A FIRE SALE. THIS IS A BIG POINT OF CONTENTION FOR US AT FDA BECAUSE A NUMBER OF COMPANIES WE SPEND EFFORT AND RESOURCES WORKING ON TO GET THEM THROUGH THE FDA NEVER MAKE IT INTO COMMERCIAL LIFE, AND THAT DOESN'T SERVE OUR PUBLIC HEALTH FUNCTION. >> THANK YOU SO MUCH, DR. KELLY, FOR A WONDERFUL PRESENTATION. >> THANK YOU, MARTIN. I APPRECIATE IT. >> OKAY. WE'RE GOING TO OUR NEXT SPEAKER, WHO IS DR. LEITH STATES. DR. STATES, ACTING DIRECTOR OFFICE OF SCIENCE AND MEDICINE AT HHS, TODAY HIS PRESENTATION IS TALKING ABOUT INCREASING ACCESS AND UTILIZATION OF EMERGING TECH IN UNDERRESOURCED AGING POPULATIONS. WELCOME, DR. STATES. >> THANK YOU, MARTIN. SO, LET ME START BY SAYING I DON'T HAVE 74 SLIDES LIKE DOUG. I WILL TRY TO DRAW MINE OUT AS LONG AS I CAN. BUT I WOULD LIKE TO START ON A SIMILAR NOTE FROM THE STANDPOINT OF BIG THANK YOU TO NHLBI FOR THE INVITE TO SPEAK, THIS IS WONDERFUL, JUST THE VARIETY I'VE HEARD IN THE DISCUSSION SO FAR. THIS IS A GREAT VENUE. I APPRECIATE Y'ALL FOR PUTTING IT TOGETHER. SO, JUST TO GIVE YOU A QUICK BIT OF BACKGROUND ON WHO I AM, OUTSIDE OF HAVING THE ACTING DIRECTOR TITLE AT THE MOMENT, MY DAY JOB IS AS CHIEF MEDICAL CENTER AT OASH, MY TRAINING BACKGROUND IS IN PREVENTIVE MEDICINE AND OCCUPATIONAL MEDICINE. AND IN TERMS OF MY AGE AS A CIVILIAN FEDERAL EMPLOYEE, I'M PROBABLY WHAT YOU CALL A TODDLER RIGHT NOW. ABOUT 2 1/2 YEARS IN TO BEGINNING A SECOND LIFE OUTSIDE OF THE MILITARY SO I AM LEARNING NEW THINGS EVERY DAY. LIKE DOUG SAYS, OR I HEARD HIM TALK IN THE PAST, I LOVE SURROUNDING MYSELF WITH PEOPLE THAT KNOW MORE THAN I DO ABOUT A LOT OF THINGS. FOR TODAY, WE'LL BE LOOKING AT A PROJECT THAT'S REALLY BECOME QUITE MEANINGFUL TO ME SINCE I BECAME INVOLVED WITH IT IN JULY OF THIS PAST YEAR. SO, IT'S BEEN HIT IN PREVIOUS TALKS, COVID-19 IS EXPOSED, WIDEN, OTHERWISE DISRUPTED A LOT OF EXISTING INEQUITIES IN CARE. THE WORK WE'VE DONE REALLY FOCUSES ON AGING IN RURAL POPULATIONS, BOTH OF WHICH HAVE SUFFERED HIGHER RATES OF MORBIDITY AND MORTALITY COMPARED TO THE REST OF THE POPULATION, AGING AND RURAL POPULATIONS. I'D LIKE TO RELATE WHAT WE'VE DONE AT A COLLABORATIVE GROUP TO INFORM, CHARACTERIZE, GIVE A GREATER VOICE TO A VARIETY OF STAKEHOLDERS IN THIS AREA. SO WITH THE ROADMAP, IT'S STRAIGHTFORWARD. HITS SOME BACKGROUND, LOOK AT WHAT ARE RFI DEVELOPMENT PROCESS HAS BEEN LIKE, EMERGING THINGS THAT HAVE COME OUT IN OUR INITIAL ANALYSIS, OUTPUTS WE PUT TOGETHER SO FAR AND THEN LOOKING AT NEXT STEPS. NEXT SLIDE PLEASE. SO NO SLIDE DECK, ESPECIALLY PUBLIC HEALTH, WOULD BE COMPLETE WITHOUT A TOUCH OF EPIDEMIOLOGY. SO SCOPING THE ISSUE AT HAND, GENERALLY POPULATION 65 AND OLDER, 95 MILLION BY 2060, THOSE 65 AND OLDER AT GREATEST RISK OF HOSPITALIZATION AND MORTALITY FROM COVID INFECTION. AND LOOKING AT THE GRAPH AT THE RIGHT YOU SEE THAT AS THE AGE GROUP GOES UP SO DOES THE HOSPITALIZATION. OVER THE COURSE OF COVID-19, THAT RISK HAS BEEN WORSE FOR RURAL COMPARED TO URBAN COMMUNITIES. AND REALLY THE LAST POINT I WANT TO HIT HERE IS THAT RAPID TECH ADOPTION AND HEALTH CARE DELIVERY PRESENTED NEW OPPORTUNITIES TO ROAD TEST. I KNOW THE STATEMENT, YOU KNOW, AN EXPERIMENT IN NATURE IS DIFFICULT ONE BUT KIND OF DOES GIVE US THIS UNCANNY LOOK AT SOMETHING THAT WE HOPE FOR WHICH IS A RAPID ADOPTION OF TECH INTO RURAL AND OTHER COMMUNITIES THAT NEED IT MOST TO HELP DEVELOP EVIDENCE BASE AND SEE ABOUT THINGS LIKE TELEPHONE VERSUS VIDEO TELEHEALTH, INTRICACY OF REMOTE PATIENT MONITORING WITH REGARDS TO OUTCOMES AND GENERATING EVIDENCE BASE IN GENERAL. WE'VE GOT MULTIPLE ISSUES IN THE SETTING OF A PUBLIC HEALTH CRISIS THAT'S REALLY PRIMED THE PUMP, WHERE OUR COLLABORATIVE EFFORTS BEGAN. SO NEXT SLIDE PLEASE. SO, IT TAKES A VILLAGE. AND IT REALLY DID WITH THIS WORK. IT STARTED AS AN OUTGROWTH OF A SERIES OF DISCUSSIONS BETWEEN ACL, OSTP, AND I WAS READ IN AS KIND OF THE POINT PERSON TO HELP BRING IN SOME OTHER POTENTIAL FOLKS FROM HHS AND OTHER SPOTS. SO YOU'LL SEE AHRQ LISTED HERE, USDA, SCC, NHLBI WITH OTHERS THAT INFORMED THE CONTEXT AND DESIRED OUTPUTS OF WHAT WE WERE LOOKING FOR FOR THE RFI, HOPING TO SHAPE THAT WOULD BE RELEASED OUT TO A WIDE STAKEHOLDER NETWORK. DEVICE DEVELOPMENT TO CAREGIVER INTERPRETATION, COMMUNITY-BASED ORGANIZATIONS. SO, THAT'S THE BALANCE WE TRIED TO STRIKE. IT WAS A HARD BACK AND FORTH WITH OUR LEADERSHIP AND THEN THE FORMER ASSISTANT SECRETARY FOR HEALTH BUT WE EVENTUALLY GOT TO A TABLE SLAP ON THINGS. WE WERE ABLE TO GET IT POSTED INTO THE FEDERAL REGISTER IN NOVEMBER OF 2020. NEXT SLIDE. SO, THE NOTICE WAS OPEN. YOU CAN SEE THE TITLE THERE. IT WAS OPEN FOR A PERIOD OF A MONTH FROM END OF NOVEMBER TO END OF DECEMBER. WE HAD 60 UNIQUE SUBMISSIONS FROM A VARIETY OF DIFFERENT SECTORS, VIEWED OVER 2500 TIMES. AND WE WERE ABLE TO GET AN INITIAL ANALYSIS WITH A REVIEW COMPLETED BY FOLKS SOURCED FROM OASH AND ACL IN SHORT ORDER AFTER WE HAD CLOSING OF THE FRN. SO, I STRIKE THE POINT HERE THAT WE WERE ABLE TO KIND OF DRAW FOUR BUCKETS WE THOUGHT CONVEYED A NOT NECESSARILY POWERFUL ON ITS OWN BUT AT LEAST IT HELPED COLOR WHAT THE VIEWPOINT, THE VOICE OF THE STAKEHOLDER COMMUNITY IS. SO IT ISN'T EXHAUSTIVE REVIEW FROM OUR RFI SUBMISSIONS BUT IT IS INTENDED TO GIVE A CATEGORIZED SNAPSHOT OF WHAT WE'VE LEARNED SO FAR. NEXT SLIDE PLEASE. OKAY. WE HAVE FOUR BUCKETS. FIRST I'LL HIT IS CARE PLANS AND MODELS. SO THE FIRST ONE WAS KIND OF A COMBINATION OF TECH WITH HOME SUPPORT TAILORED TO PATIENTS DEEMED TO BE A POSITIVE DRIVER FOR PERFORMANCE OUTCOMES THROUGH REALTIME DATA CAPTURE, ANALYSIS, MONITORING, A KEY STAT THAT WAS PROVIDED BY SOME OF THESE RFI RESPONDENS AT LEAST 20 OF THOSE 60 AND OLDER NEEDING LONG TERM CARE WERE GOING TO NEED IT MORE THAN FIVE YEARS. AND USE CASE THAT WAS MENTIONED, YOU'LL SEE THERE'S A LITTLE BIT OF CLERICAL ERROR ON MY PART THERE. THE ACTUAL USE CASE WAS A HIGH TOUCH, HIGH TRUST, HIGH VOLUME INTERACTION WITH LONG-TERM POST-ACUTE CARE PROVIDERS THAT COULD SERVE AS CARE EXTENDERS, LOOKING AT A MODEL THAT MAY FACILITATE VALUATION OF APPLYING NOVEL TECH IN THAT SETTING TO IMPROVE OUTCOMES AND COMMUNICATION WITH THE REST OF THE CARE DELIVERY TEAM. AND YOU'LL SEE -- ACTUALLY IT'S NOT PRESENT IN THIS POLICY CONSIDERATION BUT THAT REIMBURSEMENT SHOULD CONTINUE TO SUPPORT REMOTE PATIENT MONITORING AND CHRONIC DISEASE MANAGEMENT AFTER ENDING OF THE EMERGENCY DECLARATION. NEXT SLIDE PLEASE. SO, NUMBER TWO, DIGITAL HEALTH LITERACY. THE SERVICE GENERALLY DESCRIBED HERE WAS, YOU KNOW, DIGITAL EDUCATION FOR FALL PREVENTION OR FALL RISK PREDICTION OR HEALTH MANAGEMENT AND SOCIAL CONNECTEDNESS. THE STAT WE PULLED HERE IS THAT 46% REDUCTION IN HEALTH CARE RESOURCE UTILIZATION OBSERVED AT 30 DAYS FOR PATIENTS PROVIDED WITH A DIGITAL EDUCATION TOOL, COMPARED TO THOSE WHO DID NOT. AND THAT PERCENTAGE OF REDUCTION WAS OBSERVED AT 45, 60, AND 90 DAYS TO BE INCREASING OVER TIME. THE USE CASE THAT WE CITE HERE IS APP PLATFORM THAT WOULD ALLOW PATIENTS TO HAVE OWNERSHIP OF RISK STRATIFICATION, PATIENT GUIDED ACCESS TO TREATMENT PLANS, OTHER DIRECT SUPPORT AND TARGETED EDUCATION MATERIALS. LET ME TAKE A MOMENT. IF IT SEEMS LIKE I'M BEING BLAND WITH MY DESCRIPTIONS, IT'S BY REQUEST IN SOME INSTANCES FROM THE RESPONDENTS, JUST TO NOT DIVULGE NAMES OR NAMES OF PLATFORMS, ERRING ON THE SIDE OF VAGUE DESCRIPTION TO ENSURE I HONOR THEIR TRUST. THE GENERAL POLICY CONSIDERATION HERE IS TO HIGHLIGHT THE PERCEIVED GAP BETWEEN MEDICARE COVERAGE AND WHAT INDIVIDUALS OR INSURERS PAY FOR POST-DISCHARGE CARE TECHNOLOGY, WITH A SECOND PIECE HERE OF OVER THE COURSE OF THE PANDEMIC IT'S BECOME ABUNDANTLY CLEAR THAT TELEPHONE TELEHEALTH HAS BEEN JUST AS OR MORE IMPORTANT THAN VIDEO TELEHEALTH FOR MANY COMMUNITIES, ESPECIALLY RURAL AND AGING. ACKNOWLEDGING THE FACT THAT BANDWIDTH, INFRASTRUCTURE DEVELOPMENT IS NOWHERE NEAR COMPLETE IN THOSE COMMUNITIES, SO TELEPHONE COVERAGE IS A NECESSARY BRIDGE. AND I KNOW THAT'S AN ONGOING POINT OF DISCUSSION FOR CMS BUT IT'S FRAUGHT WITH POTENTIAL FOR FRAUD, BUT THAT WAS SOMETHING BROUGHT UP BY THE COMMUNITY. NEXT SLIDE. REMOTE HEALTH CARE DELIVERY, COMBINE BOTH METRIC MONITORING WITH A.I.-DRIVEN FEEDBACK, ACTIVE DELIVERY OF TELEMEDICINE OR IN-PERSON SERVICES. ONE OF THE STATS PROVIDED HERE WAS THAT IN A 2019 SURVEY OF U.S. CAREGIVERS, 64% WERE ALREADY USING SOME DIGITAL TOOL TO MANAGE THEIR CAREGIVING RESPONSIBILITIES, AND OF THOSE 64%, 40% WERE LOOKING FOR MORE TO IMPROVE THEIR ENGAGEMENT AND ABILITY TO INTERACT WITH THE REMOTE CARE TEAM OR WITH PATIENTS THEMSELVES. SO THE USE CASE HERE, IT'S PRETTY LIGHT. BUT I THINK IT'S NECESSARY TO TAKE THE OPPORTUNITY TO HIGHLIGHT CAREGIVERS AT THIS POINT, GIVEN THEIR ROLE AS PART OF THE INTEGRATED CARE TEAM ENSURING THAT REMOTE PATIENT MONITORING AND TELEHEALTH FUNCTION TO SUPPORT CARE HAPPENS IN THE BEST MANNER POSSIBLE. THEY STILL FREQUENTLY GET LEFT OUT OF THE CARE TEAM DISCUSSION, AND THAT'S RECURRENT THEME THAT WE HEARD, FOCUS ON THE CAREGIVER, BRING THEM IN THE SPOTLIGHT. THIS ISN'T A CARE TEAM DEVOID OF CAREGIVER EXHAUSTION, CAREGIVER TOOLS, AND JUST A LENS THAT CARRIED THEM AS AN IMPORTANT PART OF THE PUZZLE. SO TO THAT END, POLICY CONSIDERATION WAS CITED, CITED MEDICAID BIFURCATION OF RPM AND TELEHEALTH. SO OBVIOUSLY TECH SOLUTIONS ARE BY NATURE GOING TO BE INTEROPERABLE AND INTEGRATED, THE OBSERVATION WAS THAT THERE IS NOT A SUFFICIENT MARRIAGE OF REIMBURSEMENT OR ACKNOWLEDGMENT OF THE SYNERGISTIC UTILITY THESE PROVIDE, SO IT MAKES IT VERY HARD TO DEVELOP THOSE AS A SUSTAINABLE OPTION FOR PROVIDERS TO HAVE IN THEIR CARE DELIVERY TOOL KIT IF REIMBURSEMENT DOESN'T KEEP UP. NEXT SLIDE PLEASE. REMOTE HEALTH MONITORING, SO WE FELT THIS WAS A NECESSARY CALLOUT. IT'S NOT TO CONTRADICT THE LAST SIDE WHERE I SAID RPM AND TELEHEALTH SHOULD BE CONSIDERED TOGETHER. BUT TO HIGHLIGHT ADVANCEMENTS IN THESE TECHNOLOGIES GENERALLY. AND SERVICES MANY RESPONDENTS DESCRIBED WERE BEHAVIORAL WITH CLASSIC LIFESTYLE MODIFICATION OR MEDICATION REMINDERS TO AVOID POLYPHARMACY, WEARABLES AND IMPROVED UTILITY FOR SLEEP TRACKING, CARDIOVASCULAR FITNESS, A WHOLE SLEW OF THINGS WITH REGARDS TO JVP MONITORING OR RESPIRATORY RATE FOR FOLKS WITH COPD AND CHF. THE STAT THAT WAS PROVIDED HERE IS A BIT PROVOCATIVE BUT STILL AN INTERESTING TAKE. SO THEY MENTIONED THAT ONE OF THE RESPONDENTS DID THAT LIFETIME HEALTH EXPENDITURE IS OVER 350,000 PER CAPITA. LIFETIME SMARTPHONE COSTS OVER $75,000 PER CAPITA. AND THE TAKEHOME FROM THEM WAS, WELL, PERHAPS THERE'S A WAY TO LEVERAGE THOSE DUAL EXPENDITURES TO INCENTIVIZE PREVENTIVE CARE BUY-IN FROM PATIENTS AS SMARTPHONE UTILITY AND HEALTH CARE PROVISION IS INCREASING. OBVIOUSLY THAT IS NOT NECESSARILY IN THE REALM OF POSSIBILITY AT THE MOMENT, CONSIDERING TYPES OF EVIDENCE THEY CITED BUT I THOUGHT IT WAS INTERESTING OBSERVATION. >> THREE MINUTES LEFT. >> OKAY. AND THE POLICY CONSIDERATION HERE WAS KIND OF THE PERCEIVED LACK OF EXPANDED RPM USAGE FOR FQHC, RURAL HEALTH CLINICS, CMS, HEALTH AGENCIES, LACK OF FIRM VALUATION METHODOLOGY FOR A.I. APPLICATION, THE IDEA OF JUST BECAUSE IT'S NOT IN-PERSON VISIT DOESN'T MEAN IT DOESN'T COST AS MUCH AT LEAST IN THE SHORT THEY WERE. TERM. A QUICK LOOK AT DELIVERABLES, GOT AN HHS BLOG OUT IN FEBRUARY WHICH HELPED DESCRIBE THINGS TO THE COMMUNITY, ENGAGED WITH RESPONDENTS A BIT, YESTERDAY WE WERE ABLE TO GET A PIECE OUT. IT GOES INTO A BIT OF THE TIE-IN WITH THIS ACROSS THE HHS LANDSCAPE AND MAYBE PROVIDES MORE INFORMATION THAN I'M ABLE TO GO INTO HERE. SO AS YOU'RE ABLE, PLEASE FEEL FREE TO TAKE A LOOK, AND SEE WHAT ELSE MIGHT BE OF INTEREST THERE FOR YOU. NEXT SLIDE PLEASE. WHAT ARE WE DOING NOW? ARE WE GOING TO CONTINUE TO GET OUR ANALYSIS UP AND RUNNING AGAIN? HOPEFULLY WITH MORE OF A MODIFIED DELPHI MODEL WITH SECOND ROUND REVIEWER ANALYSIS. WE'RE ACTIVELY ALIGNING OUR INSIGHTS FROM RFI WITH AGENCY INTERESTS, PRIORITIES, WE'RE WORKING WITH THE CMMI MODEL TEAM ON THEIR USE OF FLEXIBILITIES IN MEDICARE ADVANTAGE TO INCREASE UTILIZATION OF NOVEL TECH IN AGING POPULATIONS SO WE'RE HOPING TO HAVE OUR LESSONS LEARNED INFORM SOME UPCOMING WEBINARS WITH SMALL TO MID-SIZE M.A. CONTRACT ORGANIZATIONS, AND THE LAST TWO BULLETS I ALREADY HIT. SUFFICE IT TO SAY WE'VE BEEN THANKFUL TO BE WORKING WITH A VERY SMART GROUP OF PEOPLE THAT'S HELPED US MOVE, WORK ALONG, AND DID IT WITH A SMALL BUDGET. APPRECIATE THE THOUGHTS. NEXT SLIDE. APPRECIATE YOUR TIME. IF YOU LIKE, REACH OUT BY E-MAIL AND WE'RE LOOKING FOR ENGAGEMENT AND LOVE TO HEAR FROM YOU. >> THANK YOU, DR. STATES. IN THE INTEREST OF TIME WE'RE GOING TO GO AHEAD AND JUMP RIGHT TO OUR NEXT PRESENTATION, BUT IF HAVE YOU QUESTIONS FOR DR. STATES YOU HAVE THE OPPORTUNITY TO ASK THEM AT THE PANEL AT THE END OF THE SESSION. SO NEXT SPEAKER TODAY IS DR. WILLIAM ENGLAND, DR. ENGLAND IS DIRECTOR FOR OFFICE -- ADVANCEMENT OF TELEHEALTH AND HEALTH RESOURCES AND SERVICE ADMINISTRATION AT HRSA. SO DR. ENGLAND'S PRESENTATION IS TITLED HRSA'S OFFICE FOR ADVANCEMENT OF TELEHEALTH PROGRAMS, TO IMPROVE RURAL AND UNDERSERVED ACCESS TO CARE WITH TELEHEALTH. >> THIS IS NOT THE TYPE OF PRESENTATION OR TYPE OF CONFERENCE THAT HRSA TYPICALLY PARTICIPATE IN. WE'RE NOT A RESEARCH ORGANIZATION. WE'RE A DELIVERY OF CARE ORGANIZATION. BUT AS DR. COLLINS MENTIONED THIS MORNING, WHEN YOU'RE LOOKING FOR DOING STUDIES AND IF YOU WILL RECRUITING PATIENTS, CONSIDER FQHCs. WE ARE THE AGENCY THAT ADMINISTRATION FQHCs SEARCHING 30 MILLION PEOPLE, UNDERSERVED OR MEDICAID, DELIVERY OF CARE, NOT RESEARCH, BUT HAPPY TO PARTNER WITH OTHER ORGANIZATIONS THAT MAY BE FOCUSED ON RESEARCH. WE'RE HAVING SIGNIFICANT DISCUSSIONS NOW WITH AHRQ, WITH DR. BERLINER, FOR EXAMPLE. LET ME JUMP INTO WHAT WE'RE DOING. WE HAVE AN OFFICE FOR ADVANCEMENT OF TELEHEALTH, FOR 30 YEARS, BUT WE'VE SEEN WAY MORE ADVANCE IN TELEHEALTH IN THE LAST YEAR, NOT SURPRISINGLY, THAN THE ENTIRE PREVIOUS 25 YEARS. SO VERY EXCITING FOR OUR OFFICE. IN TERMS OF WHAT IS TELEHEALTH, WE HAVE A DEFINITION ON OUR WEBSITE. WE'VE TAKEN ALL ASPECTS OF TELEHEALTH FROM ALL KINDS OF DEVICES. THERE ARE SOME SPECIAL DEFINITIONS THAT MAY BE NEEDED FOR CERTAIN PURPOSES, BUT IN GENERAL WE CONSIDER EVERYTHING WITHIN OUR DOMAIN AND OUR MAIN PURPOSE IS TO TRY TO HELP ALL THE PEOPLE THAT ARE USING TELEHEALTH. NEXT SLIDE. TRADITIONALLY OUR MAIN BENEFIT WE MEASURED WAS TRAVEL TIME, WE'RE HOUSED CURRENTLY IN OFFICE OF RURAL HEALTH POLICY WHICH AGAIN FOCUSING ON SPECIAL POPULATIONS THAT HAVE HIGH NEEDS WE'LL MAKE SURE THEY ARE TAKEN CARE OF. WE'RE IN THE OFFICE OF RURAL HEALTH POLICY, TELEHEALTH HAS LARGELY BEEN A RURAL ISSUE PRIOR TO THE PANDEMIC. WE MEASURE REDUCED TRAVEL TIME, REDUCED TRAVEL MILES AS OUR MAIN BENEFIT OF TELEHEALTH. NEXT SLIDE. JUST A SENSE OF TELEHEALTH AT HRSA, WE HAVE BEEN ENCOURAGING ALL PROJECTS, ALL PROJECT OFFICERS TO WRITE TELEHEALTH INTO FUNDING OPPORTUNITIES, AT LEAST MENTION THIS IS AN APPROPRIATE USE OF YOUR GRANT FUNDS. PRE-PANDEMIC YOU CAN SEE THE NUMBER OF GRANTS, THIS IS OUT OF MAYBE AWARDS NOW TO MAYBE 5,000, OR MAYBE I THINK IT'S MORE LIKE 4,000, INCREASING RAPIDLY, HOW MANY OF THEM ARE TOUCHING TELEHEALTH. THE LARGEST COMPONENT, LARGE RED SPIKE ON THE RIGHT, THAT IS OUR HEALTH CENTER PROGRAM, WHICH ALWAYS MENTIONS TELEHEALTH TO HEALTH CENTERS IN THEIR GRANTS. NEXT SLIDE. JUST A QUICK LOOK AT WHERE TELEHEALTH IS BEING USED IN OUR GRANTS, PRIMARY CARE IS NUMBER ONE. IF YOU LOOK AT THE MENTAL HEALTH, SUBSTANCE USE, THE NEXT TWO, PUT THOSE TWO TOGETHER, BEHAVIORAL/MENTAL HEALTH IS THE HIGHEST USER OF TELEHEALTH, MENTIONED SOMEWHAT BY PREVIOUS SPEAKERS. NEXT SLIDE. THE BARRIERS TO ADVANCING TELEHEALTH HAVE SHIFTED MAGICALLY. REIMBURSEMENT HAS BEEN THE NUMBER ONE ISSUE SINCE THE '90s. SINCE MEDICARE DEVELOPED REIMBURSEMENT STRATEGIES. AND THAT HAS CONTINUED TO BE THE ISSUE UNTIL THE PANDEMIC WHEN THE CARES ACT AND OTHER LEGISLATION CHANGED THE REIMBURSEMENT RULES, WAIVED REIMBURSEMENT RULES, CREATED PARITY AND REIMBURSEMENT WAS NO LONGER AN ISSUE. LICENSURE, CROSS--STATE LICENSURE IS AN ISSUE BUT THE PANDEMIC WAIVED THOSE RULES AND ELIMINATED THAT ONE. TELEPRESCRIBING, THERE WERE ISSUES WITH TELEPRESCRIBING, CARES ACT, AGAIN, RULES WERE WAIVED FOR PANDEMIC. CREDENTIALING HAS BEEN AN ISSUE. THAT'S A BIT OF AN ISSUE BUT WE'VE GOT GREAT WORK AROUND THESE FOR THAT. BROADBAND YOU COULDN'T ADDRESS, EMERGING AS THE NUMBER ONE CHALLENGE IN DELIVERING EQUITABLE HEALTH CARE AND WE KNEW THERE WAS INEQUITY IN BROADBAND BUT TOO A LARGE EXTENT TELEHEALTH PRIOR TO CONSUMERS WAS NOT DIRECT TO PATIENT HOMES BECAUSE THAT WAS NOT REIMBURSABLE, WE WERE CONNECTING FACILITIES, ONLY LOOKING AT RURAL CLINIC TO MEDICAL CENTER CONNECTIONS, THEY WERE PRETTY GOOD, THROUGH UNIVERSAL SERVICE OF PROGRAMS WE WIRED ALL THE CLINICS BUT IT WASN'T IN YOUR PURVIEW TO WORRY ABOUT PATIENTS IN HOME CARE. NEXT SLIDE. SO AGAIN I'VE ALREADY MENTIONED THIS. MANY RULES WERE CHANGED IN THE PANDEMIC. MOST IMPORTANT TO HRSA WAS FEDERALLY QUALIFIED HEALTH OFFICERS, RURAL CLINICS WERE ALLOWED TO BE PROVIDERS. PRIOR TO THE PANDEMIC AND WAIVERS THEY COULD ONLY BE CONSUMERS OF TELEHEALTH. THAT MADE A HUGE DIFFERENCE FOR FQHCs TO PROVIDE TELEHEALTH DIRECTLY TO PATIENTS AT HOME. THEIR USE OF TELEHEALTH, I THINK I HAVE A SLIDE ON THAT IN JUST A SECOND. NEXT SLIDE. JUST A QUICK LOOK AT CLAIMS COMING IN FOR TELEHEALTH, NO SURPRISE, IT ROCKETED UP THOUSANDS OF -- TENS OF THOUSANDS OF PERCENT AT THE BEGINNING OF THE PANDEMIC, IT BEGAN TO DECLINE. IT STARTED PICKING UP AS WAVE TWO HIT. UNFORTUNATELY WE DON'T HAVE A GRAPHIC THAT EXTENDS INTO THIS SPRING BUT WE'RE -- IF WE LOOK AT HEALTH CENTERS, OUR PART OF THE WORLD, TELEHEALTH WAS ABOUT I THINK LESS THAN .4% OF ALL THEIR USE, CLINICAL SERVICES, PRE-PANDEMIC BY EARLY MAY LAST YEAR ALL OF THE VOLUNTARILY REPORTING CENTERS WERE USING HALF CENTERS, HALF OF VISITS, UP FROM WAY LESS THAN 1% NOW TELEHEALTH. STARTING TO KLEIN DECLINE AS PEOPLE COME IN, STILL 24%, INCLUDING BASELINE, HAS HUGELY CHANGED. AS DR. STATES JUST MENTIONED, NOW THE CRITICAL ASPECT IS FIGURING OUT POST-PANDEMIC WHAT IS THE REIMBURSEMENT STRATEGY, WHAT DO WE WANT TO CONTINUE? NEXT SLIDE. QUICK LOOK AT MY OFFICE, THESE ARE GRANT PROGRAMS MY OFFICE RUNS. WE HAVE A VARIETY OF THINGS FROM RESEARCH CENTERS TO CENTERS OF EXCELLENCE TO LICENSED PORTABILITY WE'RE STUDYING AND NETWORK GRANTS. ALL OUR GRANTS ARE AVERAGE HIGHS, GRANTS.GOV, WE HAVE A NOFO ON TECHNOLOGY SHORTLY, AND WE'LL HAVE A COUPLE -- THAT'S THE ONLY ONE WE HAVE COMING UP FOR THE REMAINDER OF THIS YEAR. BUT WE'RE ENCOURAGING ANYONE TOUCHING TELEHEALTH TO MAKE SURE IF THE KEY WORD THAT CAN BE SEARCHED IN ABSTRACT OF ANY GRANT OPPORTUNITY, THERE'S LOTS OF THINGS IN TELEHEALTH YOU CAN SEE AT GRANTS.GOV. NEXT SLIDE. SO THIS IS OUR BIGGEST SINGLE PROGRAM, WE'RE DELIVERING CARE THROUGH A NETWORK GRANT PROGRAM, WE ALSO HAVE, NEXT SLIDE, TWO RESEARCH CENTERS THAT THEN STUDY ALL THE DELIVERY OF CARE THAT WE'RE DOING WITH OUR GRANTS, AND THEY STUDY OTHER THINGS AS WELL. THEY HAD 13 PUBLICATIONS LAST YEAR. WE PREVIOUSLY HAD ONE. WE FUNDED THE SECOND CENTER LAST FALL FOR THE FIRST TIME SO IT'S NEW FOR US TO BE PUTTING THIS MUCH MONEY INTO RESEARCH AND RESEARCH CENTERS, AND WE'RE TALKING TO AHRQ WHAT CAN WE DO TO HELP YOU, WHAT IS NEEDED IN THE WORLD OUT THERE? NEXT SLIDE. WE HAVE TWO CENTERS OF EXCELLENCE, PROTOTYPING CENTERS, DELIVERY CENTERS AND RESEARCH CENTERS, THE TWO CENTERS, ONE AT UNIVERSITY OF MISSISSIPPI, ONE AT MEDICAL UNIVERSITY OF SOUTH CAROLINA, CAN DO ANYTHING IN TELEHEALTH SO THESE ARE REALLY GREAT TOOLS TO ALLOW US TO EXPERIMENT WITH TELEHEALTH. NEXT SLIDE. WE'RE FUNDING COMPACTS TO SOLVE THE MULTI-STATE TELEHEALTH PROBLEM, IN PARTICULAR WE RECEIVED EXTRA FUNDING FOR THESE UNDER THE CARES ACT, AND HAVE DEVELOPED A COOL TOOL FOR AUTOMATIC CREDENTIALING, UNDER THE PANDEMIC WE CAN GET A PHYSICIAN PREVENTION AT A NEW HOSPITAL IN A MATTER OF MINUTES, USUALLY IT WOULD HAVE TAKEN AT LEAST DAYS IF NOT LONGER. NEXT SLIDE. THE MAIN THING TO LEAVE WITH YOU IS TELEHEALTH RESOURCE CENTERS. THESE ARE OUR EXPERTS, THE FIELD FOLKS, COOPERATIVE AGREEMENT WITH TELEHEALTH NETWORK PEOPLE WHERE WE SAID WE WANT YOUR EXPERTISE TO HELP EVERYBODY ELSE. SO WE'LL CREATE A NEW PROGRAM TO FUND YOU, TO BECOME T A TO EVERYONE ELSE, TELL THEM HOW WE STARTED A SUCCESSFUL TELEHEALTH PROGRAM AND THE GOVERNMENT WILL PAY YOU TO GIVE OUT FREE ADVICE. THERE'S 14 OF THEM. THEY ARE OUR ARMY OF HOW WE HELP THE WORLD WITH TELEHEALTH, AVAILABLE TO ANYONE IN THE FEDERAL -- ANYONE, PERIOD, NOT IN THE FEDERAL SPACE, ONLY IN THE UNITED STATES HOWEVER, AND TERRITORIES, TO HELP WITH TELEHEALTH PROGRAMS. ANYTHING YOU WANT TO ASK THEM, HAVE AT IT. THAT'S WHAT THEY ARE FOR. NEXT SLIDE. THEY PRODUCE LOTS OF WEBINARS, CONFERENCES. WE'RE UP TO ABOUT PROBABLY FOUR TO FIVE WEBINARS PER MONTH ON TELEHEALTH TOPICS, ALL FREE AND OPEN TO THE PUBLIC. THEY RUN CONFERENCES. THERE'S ONE ACTUALLY GOING ON NOW. THERE WILL BE ONE GOING ON MANY WEEKS OVER THE NEXT SEVERAL MONTHS. NEXT SLIDE. THEY PUBLISH TOOL KITS, FACTSHEETS, GUIDES FOR IMPLEMENTING TELEHEALTH. NOT SURPRISINGLY THEIR WORKED PICKED UP 100O% WHEN THE PANDEMIC STARTED. WE GOT MORE FUNDING TO HELP WITH THAT. TWO SPECIAL SIZE, ONE IN POLICY, ONE IN TECHNOLOGY. POLICY CENTER, AS THEY MOVE OUT AND CHANGE THEIR RULES, WE HAVE A LIVE SITE THAT TRACKS THAT. AND 50-STATE GUIDE ON TELEHEALTH. NEXT SLIDE. ONE THEM MAINTAINS A GREAT LIBRARY. I DID A QUICK SEARCH ON HEALTH EQUITY AND FOUND NINE MATCHES IN THE LIBRARY. THESE ARE AUTOMATICALLY TELEHEALTH. THEY REVIEW EACH STUDY AND PUT THE ONES THEY THINK ARE INTERESTING IN THE LIBRARY. NEXT SLIDE. WE SET UP A NEW HHS WEBSITE, TELEHEALTHHHS.GOV LAST SPRING TO TELL PROVIDERS WHAT YOU NEED TO KNOW ABOUT TELEHEALTH AS WE GO INTO THIS PANDEMIC. THEY HAVE VERY HIGH TRAFFIC, WE'LL CONTINUE THAT FUNCTION. WE HAVE THE GATEWAY, RHI HUB, ALL THINGS RURAL, WHICH TELEHEALTH HAS ALWAYS BEEN A SIGNIFICANT PART OF WHAT THEY PUBLISH, TOOLS FOR WHAT YOU MAY WANT TO KNOW. NEXT SLIDE. LASTLY, WHERE WE'RE GOING NOW HEALTH CENTERS PUT OUT $6 BILLION IN FUNDING FROM AMERICAN RESCUE PLAN, NOTABLY MENTIONING TELEHEALTH, APPROPRIATE USE OF THOSE FUNDS. NEXT SLIDE. $7 BILLION IN THE CONSOLIDATED APPROPRIATIONS ACT FOR TELEHEALTH, MUCH CONNECTING DIRECT TO CONSUMERS, WE'RE EXCITED, TELLING OUR GRANTEES TO MAKE SURE YOUR PATIENTS KNOW THEY CAN PLUG INTO SOME OF THESE PROGRAMS. FOCUSED ON UNDERSERVED POPULATIONS, TRIBAL, MINORITY COMMUNITIES, PILOT PROGRAM, ET CETERA. THESE ARE -- SO WE'RE WATCHING THESE THINGS. WE DON'T HAVE FUNDING IN THEM BUT WE'RE WATCHING BECAUSE IT SO IMPACTS OUR CLIENTS. NEXT SLIDE. >> THREE MINUTES LEFT. >> THERE ARE SO MANY FEDERAL PROGRAMS FUNDING BROADBAND, IT'S REALLY HARD TO KEEP TRACK OF. MANY ARE LAUNCHING IN THE NEXT FEW WEEKS OR THIS SUMMER, BILLIONS OF DOLLARS FOR BROADBAND. THE CONGRESSIONAL RESEARCH SERVICE PUBLISHED A REALLY GOOD GUIDE BACK IN JANUARY, THERE'S ANOTHER ONE IN MARCH, SO WE SORT OF ARE USING THAT, FROM WHAT I UNDERSTAND, FOR BROADBAND FUNDING THAT AFFECTS HEALTH CARE GO TO CRS AND GOOGLE BROADBAND SUPPORT PROGRAMS. JUST A RESOURCE. THIS IS MY CONTACT INFORMATION. AND HAPPY TO TAKE ANY QUESTIONS, IF WE HAVE A MINUTE LEFT. >> THANK YOU SO MUCH, DR. ENGLAND. WE DO HAVE ONE QUESTION IN THE CHAT BOX. IT'S-- THE QUESTION IS ISN'T REAM WITH USER. GOING TO BECOME AN ISSUE AGAIN AS SOME PAYERS ARE GOING TO STOP PAYING FOR TELEHEALTH? >> THE ANSWER IS ABSOLUTELY. REIMBURSEMENT IS GOING TO BECOME A VERY HOT TOPIC OF DISCUSSION, WHAT THINGS REIMBURSEMENT SHOULD BE MAINTAINED. IT'S NOT -- STATE MEDICAID PROGRAMS HAVE ALREADY MADE DECISIONS AND SAID WE'RE GOING TO MAKE THIS PERMANENT, SOME SAID WE'RE NOT GOING TO MAKE IT PERMANENT. WE'VE SEEN A COUPLE STATES WHERE THE COVERAGE POST-PANDEMIC MAY BE LESS THAN THEY HAD PRE-PANDEMIC, BECAUSE THEY ARE SO UNDER WATER IN TERMS OF COST. SO IT'S VERY -- YES, THIS IS A VERY POPULAR TOPIC THAT IS GOING TO BE DEBATED ON THE HILL FOR SURE AND IN EVERY FEDERAL AGENCY THAT TOUCHES TELEHEALTH OVER THE NEXT YEAR OR TWO. SO, YEAH, YOU CAN'T ANSWER THE QUESTION WHERE WE'RE GOING TO GO. WE KNOW IT'S GOING TO BE A LOT OF DISCUSSION. >> THANK YOU SO MUCH, DR. ENGLAND. OKAY. WE'RE GOING TO JUMP INTO OUR NEXT PRESENTATION, THIS IS GOING TO BE A JOINT PRESENTATION FROM THE INDIAN HEALTH SERVICE. WE HAVE DR. SUSY POSTAL FROM IHS HEADQUARTERS, AND DR. CHRIS FORE, FOUNDER AND DIRECTOR OF IHS TELEBEHAVIORAL HEALTH CENTER OF EXCELLENCE. THEIR TALK TODAY IS INDIAN HEALTH SERVICE IMPROVING ACCESS TO CARE THROUGH A TELEHEALTH INITIATIVE. WELCOME, DR. POSTAL AND DR. FOR E. >> FOR TIME'S SAKE I'LL PRESENT AND DR. FORE WILL HELP ANSWER QUESTIONS. I WANT TO SAY THANK YOU TO THE COMMITTEE FOR ALLOWING US WITH THIS OPPORTUNITY TO PRESENT AND SOME OF THE PRESENTATIONS, ALL HAVE BEEN EXCEPTIONAL BUT I CAN DOVETAIL ON COMMENTS MADE AND APPRECIATE THE CONCERNS RELATED TO TELEHEALTH IN RURAL AREAS. I START CAN DISCLAIMER THAT THIS PRESENTATION IS CURRENT AS OF THIS TIME. IT'S DEVELOPED FROM WEBINARS. AND OTHER PRESENTATIONS AS WELL AS OUR IHS WEBSITE AND LITERATURE. NEXT SLIDE PLEASE. I'D LIKE TO START FIRST AND FOREMOST BY ADDRESSING IHS'S MISSION, INDIAN HEALTH SERVICE MISSION TO RAISE PHYSICAL, MENTAL, SOCIAL AND SPIRITUAL HEALTH OF THE AMERICAN INDIAN AND ALASKA NATIVE TO HIGHEST LEVELS. NEXT SLIDE PLEASE. WE SUPPORT THE INDIAN HEALTH SERVICE IS DIVIDED INTO 12 PHYSICAL AREAS OF THE UNITED STATES. THEY ARE SEPARATED ON THIS MAP. WE SUPPORT MEMBERS OF 574 FEDERALLY RECOGNIZED AMERICAN INDIAN AND ALASKA NATIVE TRIBES AND DECENDANTS, ELIGIBLE FOR SERVICES PROVIDED BY THE INDIAN HEALTH SERVICE. AS YOU KNOW, THE IHS IS PART OF THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, AND WE PROVIDE APPROXIMATELY 2.6 MILLION NATIVE AMERICANS CARE, WE DELIVER CARE TO 5.6 MILLION AMERICAN INDIAN AND NATIVE ALASKA POPULATIONS. WE HAVE 51 HEALTH CENTERS, 24 HEALTH STATIONS, LEAKS VILLAGE CLINICS, SCHOOLS, 12 OF THEM, AND REGIONAL TREATMENT CENTERS WE HAVE SIX. NEXT SLIDE PLEASE. SO I'M GOING TO GO IN ORDER WITH WHAT OTHERS HAVE DONE WITH BARRIERS AND CHALLENGES. I WOULD RECOGNIZE FROM THE WORK THAT WE'RE DOING, THE CHALLENGES AND BARRIERS, THE AMERICAN ACADEMY OF PEDIATRICS IN MARCH OF 2021 ADDRESSED CHARACTER FOR THE AMERICAN INDIAN AND ALASKA NATIVE CHILDREN AND ADOLESCENTS. I PROVIDED THIS INFORMATION IN THE LAST SLIDE OF A REFERENCE BUT THEY RECOGNIZE INEQUITIES OF THE AMERICAN INDIAN AND ALASKA NATIVE YOUTH RELATED TO TOXIC STRESS, MENTAL HEALTH, ISSUES RELATED TO SUICIDE, SUBSTANCE USE DISORDER, AND MORE, INJURY, VIOLENCE, CHILDHOOD OBESITY AND MORE. TURN THE SLIDE TO THE NEXT ONE. SO, ONE THING TO NOTE IS THAT WAS SUBJECT MATTER EXPERTS, DR. FORE AND I WANTED TO ALSO ADDRESS HISTORICAL TRAUMA AND YOU CAN FIND IN THE LITERATURE DR. MARIA YELLOW HORSE BRAVEHEART FROM UNIVERSITY OF NEW MEXICO, PROFESSOR, ADDRESSES HISTORICAL TRAUMA AND BEFORE I GET INTO THE HEALTH CONCERNS TO RECOGNIZE THE CUMULATIVE EMOTIONAL AND PHYSIOLOGICAL WOUNDING OF ONE'S LIFETIME FROM GENERATION TO GENERATION FOLLOWING LOSS OF LIFE, LAND, VITAL ASPECTS, AND ONE THING TO NOTE IS WHEN MEETING WITH SUBJECT MATTER EXPERTS TO RECOGNIZE HOMELANDS AS YOU HEARD FROM PREVIOUS PRESENTATIONS, FOOD DESERTS. VERY REMOTE RURAL CHILDREN ARE REMOVED FROM HOMES AND ASSIMILATED TORD BOOING -- TO BOARDING SCHOOLS. WHEN WE ADDRESSED AMERICAN INDIAN AND ALASKA NATIVE WITH LEADING HEALTH CONCERNS, IT IS SIGNIFICANT TO NOTE THE AMERICAN INDIAN AND ALASKA NATIVE FREQUENTLY CONTEND WITH ISSUES THAT PREVENT THEM FROM RECEIVING QUALITY MEDICAL CARE, AND THESE ISSUES INCLUDE CULTURAL BARRIERS, GEOGRAPHICAL ISOLATION, INADEQUATE SEWAGE DISPOSAL AND LOW INCOME. SOME LEADING CAUSE OF DISEASE, HEART DISEASE, CANCER, UNINTENTIONAL INJURIES, DIABETES MILLITUS, AND MENTAL HEALTH, SUICIDE, OBESITY, SUBSTANCE ABUSE, TEEN PREGNANCY, LIVER DECEMBER, HEPATITIS, SUDDEN INFANT DEATH SYNDROME. BORN TODAY THEY HAVE A LIFE EXPECTANCY 5.5 YEARS LESS THAN THE U.S. ALL RACE POPULATION. AND THEN I'M GOING TO TALK ABOUT COVID. THEN THE PANDEMIC HIT, AND ONE THING TO NOTE IN THE MORBIDITY AND MORTALITY WEEKLY IN DECEMBER IS THAT THEY ADDRESSED THE -- YOU'RE FINE RIGHT THERE, YES. THE DATA FROM 14 STATES IN DECEMBER OF 2020, DEMONSTRATED AGE ADJUSTED COVID-19-ASSOCIATED MORTALITY AMONG AMERICAN AMERICAN INDIAN/ALASKA NATIVE .8 HIGHER. OUR PATIENTS ARE IN RURAL AREAS, WITH LOW BANDWIDTH AND YOU HEARD THAT FROM OTHER PRESENTATIONS. ONE SUBJECT MATTER EXPERTS WHEN DEVELOPING THIS PRESENTATION MENTIONED THERE IS NO WRONG DOOR CONCEPT. IF PATIENTS REQUEST CARE AND TELEHEALTH IS A TOOL THEN FIGURATIVELY SPEAKING THE PATIENT IS KNOCKING ON THE DOOR AND WE WANT TO PROVIDE THAT CARE. TELEHEALTH HAS BEEN CRITICAL IN PROVIDING NECESSARY SERVICES TO THE AMERICAN INDIAN/ALASKA NATIVE POPULATION. YOU'VE HEARD FROM OTHERS WITH THE USE OF TELEHEALTH WHEN YOU'RE IN RURAL AREAS ABOUT 75 TO 80% OF OUR TELEHEALTH HAS BEEN UTILIZING AUDIO ONLY OR TELEPHONE. AND THAT'S DUE TO THE LOW BANDWIDTH CONSTRAINTS OF INDIAN COUNTRY BUT LOOKS FAVORABLE UPON OUR POPULATION AND HEALTH CARE PROVIDERS AND STAKEHOLDERS, AS YOU HEARD IN DR. ENGLAND'S PRESENTATION IT'S PROVIDING RESOURCES AND BROADBAND, YOU'LL HEAR MORE ABOUT THAT WITH OUR CHALLENGES. NEXT SLIDE PLEASE. SO, IN MARCH 27, ONE THING TO NOTE IS WE STARTED GEARING UP AT THE PUBLIC HEALTH EMERGENCY, AND WE ALLOWED THE EXPANSION OF USING TELEHEALTH UTILIZING NON-PUBLIC-FACING APPLICATIONS. WE ALREADY HAD A PUBLIC HEALTH, A TELEHEALTH APPLICATION MEETING, I'M NOT PUSHING ONE BUT UTILIZED THAT AND THEN RAMPED UP TO GET THAT OUT THERE TO ALL OF OUR HEALTH CARE PROVIDERS. NEXT SLIDE PLEASE. SO WITH IMPLEMENTATION ON APRIL 8th, WHICH IS LITERALLY A YEAR AGO, WE EXPANDED THE USE OF TELEHEALTH USING CISCO MEETING TO ALL PROVIDERS. NEXT SLIDE PLEASE. WE FORMED THIS TELEHEALTH WORKING GROUP AND WE ALSO FORMED A -- I WANT TO SAY A CAMPAIGN TEAM WE COULD PROVIDE OUTREACH, PROVIDE OUTREACH TO PATIENTS, AND THESE ARE JUST SOME OF THE ACCOMPLISHMENTS WITH -- I KNOW YOU HEARD OF THE AMERICAN MEDICAL -- AMA, AMERICAN MEDICAL ASSOCIATION TELEHEALTH IMPLEMENTATION PLAYBOOK. OUR TOOLKIT WAS SPECIFIC TO THE CULTURE, COMMUNITY, FOR THE INDIAN HEALTH SERVICE FEDERAL TRIBAL AND URBAN, THAT'S AVAILABLE. WE DID MARKET RESEARCH TO SEE WHAT OTHER PLATFORMS ARE OUT THERE THAT COULD COMPLEMENT CISCO MEETING, CREATED LISTSERV TO SHARE PILOTED THINGS AND ALSO HAD TO LOOK AT DOCUMENTATION, WHEN DR. ENGLAND WAS TALKING ABOUT REIMBURSEMENT, WE WANT TO MAKE SURE PEOPLE ARE DOCUMENTING PROPERLY AND I'LL PROVIDE THOSE METRICS AS WELL. SO THAT IT COULD BE REPORTABLE AND REIMBURSABLE. NEXT SLIDE PLEASE. AND ALONG THE COMMUNITIES, WHEN I GET TO COMMUNITY STRATEGY TO ADDRESS ONE MORE THING, WE'RE CURRENTLY IN THE PROCESS OF REQUEST FOR PROPOSAL WE COMPLETED, WE'RE LOOKING AT A TELEHEALTH PLATFORM THAT'S CLOUD BASED, THAT COULD COMPLEMENT CISCO MEETING SO WE'RE IN THE PROCESS OF REVIEWING THOSE RIGHT NOW. WITH THE COMMUNITY STRATEGIES, ONE THING TO NOTE IS HOW COULD WE EXPAND TELEHEALTH, AND WE NOTED WE DID TOOL KITS, PROVIDED OUTREACH WITH WEBINARS, WE HELD DOCUMENTATION STANDARDIZATION MEETINGS, WE WANTED TO LOOK AT RESOURCES AND ALSO WANTED TO REACH OUT TO CHAMPIONS. WHAT WERE THEY DOING IF THEY HAD A TABLET OR WE PROVIDED A TABLET TO THEIR FACILITY, OR EQUIPMENT THAT THEY COULD PROVIDE TELEHEALTH TO THEIR PATIENT POPULATION, ONE OF THE CREATIVE IDEAS WAS THEY WERE USING IT WHERE ONE ROOM WAS A PROVIDER, THE OTHER ROOM WAS THE PATIENT DURING THE SURGE, AND THEY DIDN'T HAVE TO DON AND DOFF EQUIPMENT, PPE, THEY COULD SEE PATIENTS AND PROVIDE IT SAFELY. SO WE DO WANT TO ADDRESS THAT. WE ALSO HAVE TO LOOK AT STRATEGIES WHERE PATIENTS MAY NOT HAVE COMPUTERS, THEY MAY NOT HAVE INTERNET, MAY NOT HAVE ELECTRICITY. IS THERE A CHAPTER HOUSE WE COULD WORK WITH THIS TO PROVIDE THIS RESOURCE AS WELL. NEXT SLIDE PLEASE. SO THESE ARE THE METRICS THAT I WAS MENTIONING, WHEN WE TALK ABOUT OUTCOMES, OUR OUTCOMES IS LOOKING AT IMPROVING ACCESS, PROVIDING ACCESS TO CARE, ESPECIALLY DURING THE PUBLIC HEALTH EMERGENCY. THIS IS INDIAN HEALTH SERVICE ONLY. OUR ELECTRONIC HEALTH RECORD IS RPMS, A SPINOFF FROM THE VISTA, BUT WHEN WE LOOK AT CODING, DOCUMENTATION OF SERVICE CATEGORIES OR CPT CODINGS, HCPCS, 80% USING AUDIO ONLY. BLUE IS VIDEO. NEXT SLIDE PLEASE. SO THIS IS A FEDERAL AND TRIBAL URBAN PROGRAM, AS YOU CAN SEE SOME OF THE URBAN PROGRAMS ARE TRIBAL PROGRAMS MAY HAVE COMMERCIAL OFF THE SHELF PRODUCTS NOT USING RPMS. THERE'S MORE VIDEO USE, 35% IS TELEHEALTH ENCOUNTERS, 65% IS AUDIO ONLY. NEXT SLIDE PLEASE. THE TELEHEALTH WORK GROUP, WHAT WE DID IS WE LOOKED AT HOW COULD WE REACH OUT TO PROVIDERS, AND DETERMINE EXPERIENCE USING TELEHEALTH. WE SENT OUT A PROVIDER SURVEY AND ASKED WHAT'S THEIR EXPERIENCE, IF YOU CONSIDER USING TELEHEALTH, IF YOU WERE ALREADY USING TELEHEALTH, WE HAD 375 RESPONDENTS WHICH WE FELT WAS A GOOD TURNOUT OF RESPONDENTS. YOU CAN SEE EVERYONE PRETTY MUCH STRONGLY AGREES, OR AGREES THAT TELEHEALTH IMPROVED ACCESS, IMPROVED HEALTH OF PATIENTS AND PATIENTS SEEMED SATISFIED. NEXT SLIDE PLEASE. WHEN ASKED WHAT SERVICES WOULD BE VALUABLE, YOU CAN SEE THE LIST OF SERVICES, SPECIALTY SERVICES FROM BEHAVIORAL HEALTH WHICH WE HAVE A VERY -- A GREAT CENTER OF EXCELLENCE, DR. FORE HELPS TO LEAD. >> THREE MINUTES LEFT. >> SPECIALTY CARE -- THANK YOU. AND MORE. AND WHEN ASKED ABOUT THE THINGS TO IMPROVE OR VALUABLE PLATFORMS, ADDRESSING PLATFORMS. NEXT SLIDE PLEASE. AND THAT SEGUES INTO IMPROVEMENT. THE PLATFORM, INFRASTRUCTURE, THE BROADBAND USE, AND THE EQUIPMENT. NEXT SLIDE PLEASE. THIS IS JUST A WORD CLOUD BASED ON WE DID A QUANTITATIVE AND QUALITATIVE SURVEY TO OUR PROVIDERS. AND WE ASKED THEM, YOU KNOW, WHAT QUALITATIVELY COULD WE DO TO IMPROVE TECHNOLOGY AND THE ONES BIGGER WERE MENTIONED, NEXT SLIDE PLEASE SO COLLABORATION WITH PARTNERS, ONE THING TO NOTE, I TRULY ENJOYED LISTENING TO THE PRESENTATIONS. WE'VE HAD A LOT OF COLLABORATION WITH OUR FEDERAL PARTNERS, REACHING OUT TO OUR TRIBAL AND URBAN PARTNERS WITH TELEHEALTH, BUT THE FCC, FEDERAL COMMUNICATIONS COMMITTEE WITH DR. ENGLAND AND HRSA, DEPARTMENT OF COMMERCE, THEY HAVE THE NATIONAL TELECOMMUNICATION AND INFORMATION ADMINISTRATION, RECEIVED OVER $1 BILLION TO HELP IMPROVE BROADBAND ACCESS, AND ASPR AS WELL AS HHS TELEHEALTH WORK GROUP TO LOOK AT WHAT SORT OF THINGS WE COULD KEEP WHEN THE PUBLIC HEALTH EMERGENCY ENDED IN TERMS OF THE FLEXIBILITY. WE TRULY APPRECIATE ALL THE SUPPORT FROM STAKE HOEDERS. DR. FORE, ANYTHING ELSE YOU'D LIKE TO ADD? >> YOU COVERED IT WELL. THANK YOU. WE'RE GOING TO MOVE TO THE NEXT PRESENTATION. IF YOU HAVE QUESTIONS DR. FORE, AT THE END OF THE SESSION. >> IT'S MY PLEASURE TO INTRODUCE THE SECOND SPEAKER FOR THIS SESSION, LIEUTENANT COMMANDER, CURRENTLY DEPLOYED, KIND ENOUGH TO SUBMIT A VIDEO RECORDING TODAY. IT'S FOCUSED ON USING DATA TO IMPROVE QUALITY IN MEDICAID AND CHIP. WITH THAT I'LL ASK DAVE TO PLEASE ROLL THE RECORDING AND WE CAN WATCH CHANEL'S TALK TOGETHER. >> OVER IT'S LAST YEAR CMS USED ADMINISTRATIVE DAD TO DEVELOP VARIOUS INNOVATIVE DATA PRODUCTS AND TOOLS THAT PRESENT STATE AND NATIONAL LEVEL INFORMATION FOCUSED ON MEDICAID AND CHIP POPULATION. NOW THAT CMS HAS RELEASED RESEARCH READY ANALYTIC FILES, CMS AND OTHERS USERS OF THESE DATA ARE ABLE TO USE THIS INFORMATION TO IMPROVE UNDERSTANDING OF THE DIVERSE POPULATIONS SERVED BY STATE MEDICAID AND CHIP PROGRAMS. AND HIGHLIGHT OPPORTUNITIES FOR QUALITY IMPROVEMENT. TODAY I WILL DESCRIBE TWO RECENTLY RELEASED INNOVATIVE CMS DATA PRODUCTS THAT HIGHLIGHT ADULT AND CHILDREN LIVING WITH SICKLE CELL DISEASE ENROLLED IN MEDICAID AND CHIP. MATERIALS WERE DEVELOPED IN COLLABORATION WITH THE CENTERS FOR DISEASE CONTROL AND PREVENTION, AND MATHEMATICA AND CAN BE USED BY STATES AND STAKEHOLDERS TO BETTER UNDERSTAND THE MEDICAID AND CHIP POPULATION WITH SICKLE CELL DISEASE. BUT FIRST BEFORE I GO INTO THOSE PRODUCTS I WOULD LIKE TO HIGHLIGHT SOME OTHER DATA PRODUCTS THAT CMS HAS PRODUCED THAT HIGHLIGHT THE HEALTH CHARACTERISTICS AS WELL AS DEMOGRAPHIC CHARACTERISTICS AMONG OUR OVERALL MEDICAID AND CHIP BENEFICIARY POPULATION. IN MARCH 2020 CMS RELEASED THE FIRST MEDICAID AND CHIP BENEFICIARY PROFILE, PROVIDING OVERVIEW OF THE CHARACTERISTICS, HEALTH STATUS, ACCESS, UTILIZATION, EXPENDITURES AND EXPERIENCE OF CARE OF BENEFICIARIES. IT HIGHLIGHTS TWO SPECIAL POPULATIONS IN DEPTH, PEOPLE ELIGIBLE FOR MEDICARE AND MEDICAID, CHILDREN WITH SPECIAL HEALTH CARE NEEDS. THIS SHOWS A SCREEN SHOT FROM THE BENEFICIARY PROFILE FOR MEDICAID ENROLLMENT AND EXPENDITURES IN 2016. FOCUSING ON THE TOP SECTION OF THE FIGURE, PERSONS WITH DISABILITIES 64 OR LESS ARE 15%, 39% OF EXPENDITURES, $19,000 PER BENEFICIARY. IN ADDITION TO BENEFICIARY PROFILE RELEASED LAST MARCH, CMS RELEASED BENEFICIARIES AT A GLANCE INFOGRAPHIC, HIGHLIGHTING SELECTED INFORMATION FROM THE BENEFICIARY PROFILE IN A TWO-PAGE FORMAT, INCLUDING MEDICAID EXPENDITURES BY BENEFICIARY CATEGORY, SELF-REPORTED HEALTH CONDITIONS FOR ADULTS AND CHILDREN, AND INFORMATION ON BENEFICIARY EXPERIENCES IN GETTING NEEDED CARE. THIS SLIDE SHOWS MULTIPLE INTERESTING DATA POINTS, FOR EXAMPLE, IN 2018 THE TOTAL MEDICAID AND EXPENDITURES $616 BILLION, 18% INROLLED IN MEDICAID AND CHIP. IN 2017 AMONG MEDICAID BENEFICIARIES, 10% AGE 65 AND OLDER. I WOULD LIKE TO NOTE THE 2021 UPDATE FOR THE BENEFICIARY PROFILE AND INFOGRAPHIC ARE COMING SOON. CMS IS COMMITTED TO RAISING AWARENESS. IT IS CURRENTLY A NATIONAL SICKLE CELL DISEASE SURVEILLANCE SYSTEM DOES NOT EXIST. TO ADDRESS THIS GAP AND IMPROVE THE QUALITY OF CARE FOR PEOPLE LIVING WITH SICKLE CELL DISEASE, CMS USED THE 2017 ANALYTIC FILES, ALSO KNOWN AS TAF TO PRODUCE NATIONAL AND STATE LEVEL ESTIMATES ON PREVALENCE OF SICKLE CELL DISEASE AMONG ADULTS AND CHILDREN ENROLLED IN MEDICAID AND CHIP. IN JANUARY 2021, CMS RELEASED THE GROUND BREAKING MEDICAID AND CHIP SICKLE CELL DISEASE REPORT, THE REPORT IS THE FIRST EVER COMPREHENSIVE NATIONAL AND STATE LEVEL PORTRAIT OF SICKLE CELL DISEASE AMONG ADULTS AND CHILDREN ENROLLED IN MEDICAID AND CHIP WHO ARE UNDER AGE 76, ALSO PROVIDES DETAILED INFORMATION ON VARIOUS DEMOGRAPHICS, HEALTH, HEALTH CARE UTILIZATION CHARACTERISTICS AMONG MEDICAID AND CHIP BENEFICIARIES WITH AND WITHOUT SICKLE CELL DISEASE. AS SHOWN ON THIS SLIDE, THE SICKLE CELL DISEASE REPORT INCLUDES THE FIRST TAF DERIVED NATIONAL ESTIMATES ON ANTIBIOTIC PROPHYLAXIS IN CHILDREN, WITH SICKLE CELL DISEASE WHO ARE ENROLLED IN MEDICAID AND CHIP. ANTIBIOTIC PROPHYLAXIS IS RECOMMENDED TO DECREASE RISK OF INVASIVE PNEUMOCOCCAL DISEASE, OUR ANALYSIS SHOWS 11% OF MEDICAID AND CHIP BENEFICIARIES AGE 15 MONTHS TO 4 YEARS WITH SICKLE CELL DISEASE HAVE 300 OR MORE DAYS OF ANTIBIOTIC PROPHYLAXIS IN 2017. TO OUR KNOWLEDGE, THE SICKLE CELL DISEASE REPORT IS THE FIRST EVER HHS-PRODUCED DETAILED REPORT OF SOLELY USING TAF DATA TO HIGHLIGHT SICKLE CELL DISEASE, ALSO THE FIRST PRESENTATION OF TESTIFYAF DERIVED ESTIMATES FOR ANTIBIOTIC PROPHYLAXIS AMONG CHILDREN WITH SICKLE CELL DISEASE ENROLLED IN MEDICAID AND CHIP. IN COMMEMORATION OF NATIONAL SICKLE CELL DISEASE AWARENESS MONTH, CMS DEVELOPED THE INAUGURAL AT A GLANCE INFOGRAPHIC. THIS WAS RELEASED DURING THE SEPTEMBER 15, 2020, WHITE HOUSE SICKLE CELL DISEASE ROUNDTABLE. THE INFOGRAPHIC HIGHLIGHTS SELECTED INFORMATION FROM THE REPORT, IN A TWO-PAGE FORMAT. FOR EXAMPLE, OUR ANALYSIS IDENTIFIED 41,995 BENEFICIARIES WITH SICKLE CELL DISEASE, REPRESENTING A NATIONAL PREVALENCE OF 74 PER 100,000 BENEFICIARIES OF WHOM 91% LIVED IN URBAN COMMUNITIES IN 2017. TRANSCRANIAL DOPPLER SCREENINGS WERE OBSERVED AMONG 37% OF CHILDREN AGE 2 TO 16, IN 2017. AND NEARLY 6 IN 10 CHILDREN UNDER THE AGE OF 2 RECEIVED A PNEUMOCOCCAL VACCINATION IN 2017. HYDROXY UREA USE OBSERVED AMONG 16% OF CHILDREN, 10% OF ADULTS, WHO RECEIVED 18 DAYS. THE SICKLE CELL DISEASE INFOGRAPHIC INCLUDES INFORMATION ON RECOMMENDED PREVENTIVE CARE IN CHILDREN. MORE THAN HALF THE CHILDREN WERE AND WITHOUT SICKLE CELL DISEASE HAD ONE HEALTH SCREENING AND DENTAL EXAMINATION. HOWEVER WHEN SHOWN BY AGE CATEGORY WE SEE GREATER DETAILS FOR OPPORTUNITIES FOR TARGET IMPROVEMENT. BOTH REPRESENT IMPORTANT STEP TO ADVANCE OUR UNDERSTANDING OF THE NATIONAL PREVALENCE AND IMPACT OF SICKLE CELL DISEASE. THERE'S NO NATIONAL SURVEILLANCE SYSTEM. WE LOOK FORWARD TO PARTNERING WITH YOU IN ADVANCING QUALITY OF CARE FOR MEDICAID AND CHIP BENEFICIARIES INCLUDING THOSE WITH SICKLE CELL DISEASE. THANK YOU FOR YOUR TIME. IF YOU HAVE ANYTHING TO ADD, FEEL FREE TO ADD. IF THERE ARE QUESTIONS, PLEASE TYPE THEM IN THE CHAT. >> I'M EXCITED TO BE PART OF TODAY'S FORUM. THE AGENCY THOUGHT IT WAS IMPORTANT TO HIGHLIGHT THE POPULATION. THIS IS OUR FIRST WE'VE USED OUR MEDICAID ADMINISTRATIVE DATA TO PRODUCE THESE TWO DATA PRODUCTS ON. AS MORE STATES SUBMIT TO THE SYSTEM THOSE DATA ARE REVIEWED FOR DATA QUALITY FOR THE ALGORITHM FOR MED CARB BENEFICIARIES APPLIED A FIVE-YEAR LOOKBACK AND NOW HAVE ENOUGH DATA TO DO ANALYSIS WITH THE THREE-YEAR LOOKBACK. WE'RE NOT QUITE AT FIVE BUT WE'RE GOING TO GET THERE. THIS IS AN EXCITING TIME TO DO THIS RESEARCH. >> CONGRATULATIONS ON YOUR WORK. >> I DON'T SEE ANY QUESTIONS BUT YOU CAN TYPE THEM IN THE CHAT FOR OUR BREAKOUT SESSION A LITTLE BIT LATER IF ANY QUESTIONS COME UP. WE HAVE DR. TANYA CAMPOS JOINING US. IT PRESENTS A RISK IN THE MOTHER AND CHILD. CONTRIBUTING FACTORS ARE OBESITY, AGE, DIABETES, IT IMPACTS UNDERREPRESENTED POPULATIONS, NOT ONLY DOES IT PRIMARILY IMPACT PREGNANT POPULATIONS WHERE THERE ARE CHALLENGES WITH CLINICAL TRIAL RECRUITMENT AND DRUG DEVELOPMENT, IT ALSO KILLS PERSONS OF COLOR, THREE TIME MORE AFRICAN AMERICAN DYING FROM PRE-CLAMPA. THERE ARE SEVERAL CHALLENGES IN PREECLAMPSIAS TREATMENT. I'LL TRY TO LIST THEM AT A HIGH LEVEL HERB. HERE. CLINICAL MEASUREMENTS HAPPEN AFTER THE DAMAGE IS DONE. IT'S TOO LATE TO IDENTIFY WOMEN WHO WOULD MOST LIKELY BE HELPED. THEY DON'T REALLY PROVIDE SENSITIVE DIAGNOSIS OF THE PATIENT 15 YEARS. ACTUALLY HELPING PATIENTS ACROSS MULTIPLE DISEASE CONDITIONS IN ANYONE ORGANIZATION IS TYPICALLY ABLE TO ACHIEVE. WE HAVE SEVERAL THERAPEUTIC ADVANCES, CLINICAL TOOLS, GUIDANCE DOCUMENTS, NUMEROUS LETTERS OF INTENT TO THE F.D.A. QUALIFICATION PROGRAM THAT'S BEEN APPROVED AND ONE THAT'S BEEN QUALIFIED. BUT AT ITS CORE, THE BIO MARKERS CONSORTIUM, WE HAVE 60 PLUS MEMBERS FROM VARIOUS NIH INSTITUTES, FDA, SEVERAL BIOTECH DEVICE COMPANIES AND PHARMACEUTICAL COMPANIES. AND WE COME TOGETHER TO IDEATE AND FORMULATE PLANS HOW COMPLEX PROBLEMS COULD BE SOLVED. WHILE A CONSORTIUM LIKE THIS COULD ACHIEVE A LOT OF DIFFERENT THINGS, WITHIN THE BIO MARKERS CONSORTIUM OUR GOAL IS TO FOCUS ON MEANINGFUL MEASUREMENTS. WHAT THAT MEANS IS, WE PUT TOGETHER THESE CROSS STAKEHOLDER EFFORTS THAT CAN IDENTIFY, VALIDATE AND QUALIFY BIO MARKERS. THESE CAN THEN BE USED BY DRUG DEVELOPERS IN THEIR CLINICAL TRIALS. THEY HAVE DE-RISKED THEIR INVESTMENT. THIS BOLSTERS AND ACCELERATES DRUG DEVELOPMENT PATHS. THIS SLIDE, I KIND OF JUST WANT TO TAKE A SECOND TO SHARE WITH YOU THE PHILOSOPHY THAT HAS REALLY EMPOWERED SUCH PARTNERSHIPS. SO WE BRING TOGETHER ACADEMICS, INDUSTRY, FDA, NIH AND PATIENT ADVOCACY GROUPS. AND ALL THESE STAKEHOLDERS HAVE DIFFERENT INTERESTS AND NEEDS. OUR ACADEMIC COLLEAGUES ARE INTERESTED IN PUBLICATIONS, RESEARCH FUNDING, EXPANDING THEIR EXPERTISE. OUR INDUSTRY COLLEAGUES ARE INTERESTED IN CREATING A PRODUCT, SHARING RISK WITH OTHER COMPANIES AND REDUCING COSTS AND EXPANDING EXPERTISE. AND F.D.A. AND NIH AND PATIENT ADVOCACY GROUPS ARE REALLY INTERESTED IN COMMUNICATING THE NEEDS, PUTTING THE BROADER PICTURE IN PLACE AND BUILDING CONSENSUS. THE BEST KIND OF PARTNERSHIPS, CREATE KNOWLEDGE, BENEFITING AND SUPPORTING THE MISSIONS OF EACH OF THESE STAKEHOLDERS. ON THE NEXT COUPLE OF SLIDES WE WILL SHOW YOU HOW THIS TYPE OF A PARTNERSHIP IS BEING LEVERAGED FOR PREECLAMPSIA. THERE ARE SEVERAL EXISTING COHORTS OF PREGNANT WOMEN, STARTING FROM FIRST, SECOND, THIRD TRIMESTER WITH WELL PHENOTYPED -- THERE ARE ALSO SEVERAL DIAGNOSTIC KITS AND IMAGING BIO MARKERS USED IN THE EUROPEAN UNION AND LOTS OF NEWLY ESTABLISHING BIO MARKERS. NOW WE CAN PUT THESE TOGETHER, WE CAN TEST THESE SAMPLES WITH THESE KITS. AND THROUGH SYSTEMATIC EVALUATION OF THE DATA IN OUR DIVERSE PATIENT POPULATION THAT IS REPRESENTATIVE OF THE UNITED STATES, WE CAN GENERATE ROBUST DATA FOR REGULATORY FILING. THESE DATA CAN SERVE TWO PURPOSES. THIS DATA COULD BE USED FOR RISK STRATIFICATION OF PATIENTS. SO WE CAN USE THE DATA TO SUPPORT THE FACT THAT PATIENTS WHO HAVE THESE BIO MARKERS IN EARLY PREGNANCY ARE HIGH-RISK AND THEREFORE THESE BIO MARKERS CAN BE USED FOR DRUG DEVELOPMENT. AND THE SAME DATA COULD BE USED BY THE DEVICE COMPANIES TO FILE FOR CLEARANCE FOR THEIR DEVICES TO BE USED IN CLINICAL CARE. WE ARE ABLE TO LEVERAGE OUR NETWORK OF PUBLIC AND PRIVATE SECTOR PARTNERS. WE HAVE COLLEAGUES AND INSTITUTES AT NIH AND OTHER INVESTIGATORS WHO HAVE WELL DEFINED COHORT. WE ARE WORKING WITH FIVE DEVICE COMPANIES RIGHT NOW WHO ARE WILLING TO SHARE THEIR KITS OR ASSAYS FOR USE IN THIS. WE HAVE ACCESS TO A NETWORK OF INVESTIGATORS THAT HAVE THE KNOWLEDGE BASE AND THE WHEREWITHALL TO ANALYZE THESE, THE DATA COMING OUT OF THIS IN AN INDEPENDENT MANNER. AND WE WORK REGULARLY AND CONTINUOUSLY WITH FDA BOTH WITH THE BIO MARKER QUALIFICATION PROGRAM WITHIN CDR AND DEVICE PROGRAM AT CDRH WHO ARE ABLE TO HELP US WHILE WE ARE PUTTING TOGETHER OUR STUDY DESIGN SO THAT WE ARE NOT WAITING UNTIL WE HAVE A FULL REGULATORY PACKET READY BEFORE WE GET THEIR FEEDBACK. SO ALL OF THESE THINGS HELP US REDUCE THE TIME IT TAKES TO GENERATE DATA FOR REGULATORY FILING. INCREASES THE TRUST THIS IS BEING DONE WELL BECAUSE OF THE MULTIPLE STAKEHOLDERS AND SUPPORTS EACH STAKEHOLDER WHETHER DEVICE COMPANIES FOR FILING, THE INVESTIGATORS FOR PUBLICATIONS OR NIH, AND NIA BECAUSE IT MOVES THE NEEDLE FORWARD FOR FINDING CURES FOR COMPLEX DISEASES. HOPEFULLY IF I HAVE DONE MY JOB TODAY YOU ARE EXCITED ABOUT WHAT WE DO. AND WHERE WE ARE RIGHT NOW IS WE HAVE, THE PROPOSAL I SHARED WAS RECENTLY APPROVED AND WE HAVE JUST EMBARKED UPON A PROJECT DESIGN PHASE. WE WELCOME YOU TO JOIN US, IT'S A PUBLIC PRIVATE PARTNERSHIP, EVERYONE IS WELCOME. TO START TO PUT SOME MEAT ON EACH OF THE ITEMS I SHOWED YOU ON THE SQUEE MA. WE CAN ONLY LAUNCH IF THEY ARE ABLE TO RAISE FUNDS. ONCE THE PROJECT DESIGN IS COMPLETED SOMETIME WE WILL BE ON A FUNDRAISING MISSION TO GET FUNDING FOR THESE PROJECTS AND IF YOU THINK YOU OR SOME ORGANIZATION YOU KNOW SHOULD BE INVOLVED, WE WILL BE HAPPY TO TALK WITH THEM AS WELL. THESE ARE TWO WAYS YOU CAN JOIN US IN MOVING THIS FORWARD. JUST MY LAST SLIDE, THIS PUBLIC PRIVATE PARTNERSHIPS ARE COMPLEX. IT'S NOT VERY STRAIGHT FORWARD. ANSWERS, SO IN THE 15 MINUTES TODAY WHAT I HAVE SAID HAS RAISED MORE QUESTIONS, PLEASE FEEL FREE TO CONTACT US. WE CAN ANSWER QUESTIONS HOW THESE PARTNERSHIPS ARE STRUCTURED. AND SPECIFICALLY ABOUT THIS PROGRAM OR ANY OTHER PROGRAM. WITH THAT, I COULD TAKE ANY QUESTIONS. >> THANK YOU, SO MUCH, TANYA FOR THE WONDERFUL PRESENTATION. WE HAVE ABOUT A MINUTE. THERE'S ONE COMMENT IN THE CHAT I WILL LET YOU RESPOND TO. PLEASE PROVIDE PREDIAGNOSTIC TO WOMEN WITH LUPUS TO ASSIST IN PREGNANCY. AN IDEA FOR A FUTURE -- >> YEAH, I WAS GOING TO SAY. IT'S INCREDIBLY IMPORTANT AREA TO ACTUALLY BE ABLE TO PREDICT RISK BEFORE A WOMAN IS PREGNANT. IN THIS PARTICULAR INSTANCE, WE ARE LOOKING AT PREGNANCY COHORT. BUT ABSOLUTELY IF WE COULD STRATIFY AND IDENTIFY THOSE WOMEN BEFORE TO ASSIST WITH PREGNANCY OR PREECLAMPSIA BEFORE IT DEVELOPS IS BETTER. WE ARE WORKING CLOSELY WITH NHLBI ON SOME OF THESE ISSUES. THANK YOU. >> IS IT AS EASY AS EMAILING YOU TO ENGAGE? >> YEP. >> WONDERFUL. WE WILL SEE YOU AT THE BREAK OUT ROOM, OR THE PANEL DISCUSSION IN A BIT. ALL RIGHT, OUR NEXT SPEAKER IS DR. WENDY NELSON. DEPUTY DIVISION DIRECTOR WITH THE NATIONAL SCIENCE FOUNDATION. THE TOPIC OF WENDY'S TALKED TO IS USING TECHNOLOGY TO MAKE HEALTH SMARTER IN UNDER-SERVED COMMUNITIES. WENDY? >> THANK YOU. THANKS FOR HAVING ME. CAN I GET THE NEXT SLIDE, PLEASE? I REALLY WANT TO TALK ABOUT THIS. LIKE ALL MY SISTER AGENCIES HERE, WE AREN'T ACTUALLY DOING THE WORK OF IMPROVING HEALTH, WE ARE PROVIDING THE TOOLS. THIS IS MY MOM, 80 YEARS OLD ON HER ELECTRIC BICYCLE, I THOUGHT WAS A GREAT IDEA. I'M ALL FOR TECHNOLOGY. IT JUST ABOUT KILLED HER. IT'S WAY TOO FAST, BY THE WAY. I THOUGHT KNOBBY TIRES WOULD BE GOOD. WE ARE TALKING ABOUT TECHNOLOGY, IT COULD BE USEFUL IN MULTIPLE WAYS BUT IT'S NOT MAGIC. NEXT SLIDE, PLEASE. I THINK WE THINK ABOUT NOW, REGARDLESS OF WHERE PEOPLE ARE WHEN THEY ARE UNDER-SERVED WE THINK OF THE INTERNET OF THINGS AND THERE'S TECHNOLOGY COMING ALL OVER. WE NEED TO THINK ABOUT THIS. I WORK IN A WORLD THAT'S PRIMARILY DEALING WITH THE COMPUTING AND ENGINEERING COMMUNITY THAT ARE DRIVING ADVANCES ACROSS INDUSTRIES, ACROSS SECTORS. AND I THINK WE ARE SEEING ALL SORTS OF CHANGES THAT WE SHOULD BE ABLE TO SCALE TO PEOPLE THAT ARE UNDER-SERVED IN THIS COUNTRY. NEXT SLIDE, PLEASE? THE REQUIREMENTS WE FIND. NEXT SLIDE. I THINK IT DOVE TAILS WITH MANY THINGS YOU HAVE HEARD ALREADY. ACCESS IS A BIG THING FOR US. WE WORK A LOT, WE DO A LOT OF RESEARCH ON NETWORKS. BUILDING OUT NETWORK CAPABILITY. WE KNOW THERE AREN'T TOWERS IN RURAL AREAS. WE KNOW THAT'S AN ISSUE IN TRIBAL AREAS. THEY ARE NOW BUILDING THEIR OWN TOWERS. BUT WE NEED TO BE ABLE TO BUILD TECHNOLOGY THAT WILL HELP PEOPLE AND IT WILL BE DESIGNED TO MAXIMIZE ACCESS EVEN LIMITED TELLERS. SO WE REALLY NEED TO THINK ABOUT THAT, FIRST OFF, THAT FUNDAMENTAL ACCESS. NEXT SLIDE, PLEASE? WE NEED TO BE USER-CENTERED AND ACCESSIBLE. I HAVE A WHOLE RESEARCH COMMUNITY THAT HAS MADE, REALLY HAS BEEN THE BACKBONE OF LETTING THE WEB BE SO USABLE THAT YOU CAN SIT WITH YOUR PHONE AND YOU CAN'T GET YOUR TEENAGER OFF IT. THESE ARE USABLE, THEY ARE UNDERSTANDABLE, THEY ARE DESIGNED FOR USE. THEY ARE DESIGNED TO CONTINUE TO HAVE PEOPLE USE. WE HAVEN'T BROUGHT THAT INTO HEALTH YET. WHAT I WANT PEOPLE TO THINK ABOUT, THERE ARE WHOLE COMMUNITIES, HUMAN FACTORS AND HUMAN-CENTERED COMMUNITY, WHAT ARE THE COLORS AND IMAGES AND WHAT DO PEOPLE RESPOND TO. TIMING OF ASSESSMENT. YOU NEED TO BALANCE BATTERY WITH DATA COLLECTION. HOW MUCH DATA DO YOU NEED, HOW MUCH WILL PEOPLE RESPOND TO, AT WHAT POINT DO YOU BIAS. SHOULD YOU BE FRIENDLY? THERE IS LITERATURE WHAT WORKS BEST. HOW DO WE OPTIMIZE IT FOR ENGAGEMENT. I'M NOT ENDORSING iPHONES BUT WHEN YOU THINK OF iPHONES THE FIRST TIME YOU PICK IT UP, IT SAYS HELLO AND THEN HALLO AND THEN BON JOUR. WE NEED TO MAKE THINGS TRUSTWORTHY. WE HAVE SEEN THIS IN SO MANY AREAS OF HEMth. HEALTH. PATIENT PERSPECTIVE AND HEALTHCARE PROVIDERS AND THEIR WHOLE ADMINISTRATIONS. WE NEED TO BE ABLE TO DEAL WITH PROBLEMATIC DATA IN REAL-TIME. RIGHT NOW WE COLLECT RESEARCH DATA, THEN WE ADJUST IT, HR'S, YOU KNOW, THERE'S BEEN STUDIES LOOKING AT PATIENTS CORRECTING THEIR OWN DATA, IT SEEMS TO BE VALUABLE. BUT WE DON'T HAVE REAL-TIME SOLUTIONS TO CORRECT PROBLEMATIC DATA AND WE REALLY NEED TO START IMPLEMENTING THOSE. WE NEED TO THINK OF BIASES. WE HAVE A WHOLE COMMUNITY THAT SPENDS TIME, THAT ARE REALLY THINKING ABOUT HOW DO YOU DEAL WITH THE BIASES HERE. THE DATA YOU PUT IN BRINGS THE BIASES WITH IT. WE UNDERSTAND BIASES OFTEN WITH HUMANS, BUT I THINK IN TECHNOLOGY IT HAPPENS SO MUCH FASTER. WE ALSO NEED TO UNDERSTAND WHAT IS THE DATA REPRESENTING, ESPECIALLY IN UNDER REPRESENTED GROUPS. WE MAKE ASSUMPTIONS AND THEY MAY NOT BE RIGHT. I KNOW WHEN I'M DOING NIH RESEARCH I TALKED ABOUT SIGNALS AND NOISE. BUT IT TURNS OUT, NOISE IS NOT NOISE ANY MORE. WE CAN NOW BETTER ANALYZE DATA TO FIND OUT THAT NOISE REALLY IS A SIGNAL. IT MAY BE A DIFFERENT SIGNAL. WE NEED TO THINK OF CAUSE AND EFFECT WITHOUT HAVING TO RUN RANDOMIZED TRIALS FOR EVERYTHING. NEXT SLIDE. I THINK ONE OF MY THINGS TOO, THINKING ABOUT UNOBTRUSIVE SENSING. OOPS, THAT'S ALL RIGHT. WE NEED TO MAKE OUR SENSING UNOBTRUSIVE. WE ALSO NEED TO BE CONTEXT AWARE. YOU KNOW, WE OFTEN -- MY WATCH WILL OCCASIONALLY TELL ME TO GET UP AND WALK. IT WILL TELL ME RIGHT NOW, IS THIS THE APPROPRIATE TIME? IT CAN CHECK MY CALENDAR AND TELL ME NOW IS NOT THE TIME TO GET UP. THERE TELL ME AFTER THIS MEETING YOU NEED TO GO OUT FOR AN EXTRA LONG WALK BECAUSE YOU HAVE BEEN SITTING TOO LONG AT WORK TODAY. WE CAN'T BOTHER PEOPLE AND SAY HOW IS THE AIR QUALITY IN YOUR FACTORY. WE MIGHT BE ABLE TO MEASURE THESE THINGS. WE NEED TO THINK ABOUT THE CONTEXT AND PEOPLE'S REAL LIVES. NEXT SLIDE, PLEASE. WE NEED TO BE CENTRALIZED. WE HAVE A MILLION AND ONE WAYS TO APPROACH PEOPLE. I KNOW MY PROVIDER HAS AT LEAST TWO DIFFERENT SYSTEMS THEY USE. SOMETIMES THEY TEXT, SOMETIMES THEY TELL ME TO GO TO THEIR HUB. EITHER ONE, I'M NOT REALLY INTO GETTING TEXT MESSAGES FROM MY PROVIDER, BUT THEIR HUB ISN'T AS USEFUL AS IT COULD BE. HOW DO WE THINK OF DIGITAL DEVICES ACTING AS A HUB? WHAT INFORMATION DO PEOPLE WANT TO GET AND GIVE? I THINK WE CAN THINK A LOT ABOUT PATIENT-GENERATED DATA. PEOPLE LOVE TO GIVE INFORMATION. THERE'S NEW INITIATIVES HAVING PEOPLE SEND PHOTOS OF QUESTIONS THEY HAVE. ALL SORTS OF THINGS. BUT WHAT ABOUT A TO ASK TO DO LIST. I HAVE SEEN THAT IN SOME SYSTEMS. IT'S WORKED REALLY WELL IN OTHER AREAS. WHY AREN'T WE THINKING OF THIS? AND HOW AND WHY DO WE MESSAGE. THAT'S NOT WHAT WE ARE THINKING ABOUT NOW. NEXT SLIDE, PLEASE? NEXT SLIDE, I WANT TO TALK ABOUT BRIDGING THESE ECOSYSTEMS. I THINK MY AGENCY, THE NATIONAL SCIENCE FOUNDATION REALLY CAME TO HEALTH NOT BECAUSE THAT'S OUR MISSION. OUR MISSION IS REALLY TO IMPROVE FUNDAMENTAL SCIENCE ACROSS THE U.S. BUT WHAT WE WERE SEEING IS, MEDICINE DID AMAZING THINGS. PSYCHOLOGY, NEURO SCIENCES. WE HAD MATHEMATICS OFTEN NOT ENGAGED WITH OTHER PARTS OF THE SCIENCES. I HAVE BRILLIANT COMPUTING RESEARCHERS WHO ARE DOING TONS OF INTERESTING AND EXCITING WORK. BUT THEY ARE NOT AT ALL CONNECTED WITH BIOMEDICAL RESEARCHERS, TEAMS, NONE OF THAT. NOT PUBLIC HEALTH. THEY ARE SOLVING PROBLEMS THEY THINK ARE PROBLEMS OFTEN BASED ON THEIR OWN EXPERIENCES, BUT NOT SOLVING THE PROBLEMS YOU AND I WOULD LIKE TO SEE THEM SOLVE. NEXT SLIDE, PLEASE. WE STARTED SMART HEALTH RGS AN INITIATIVE BETWEEN N.S.F. AND NIH, N.S.F.5320, IF YOU WANT TO LOOK AT IT. SMART HEALTH IS A WAY TO BRIDGE BETWEEN MULTIPLE DISCIPLINES AND STAKEHOLDERS. SO IT'S REALLY LOOKING AT THE ECOSYSTEM AND HOW DO WE BRIDGE THAT. THEY ARE A PAIN IN THE BUTT OFTEN. BUT ALL GOOD THINGS TAKE A LOT OF WORK. AND I THINK SOME OF THE PROBLEMS WE ARE TRYING TO SOLVE AND THE TARGET OF THIS MEETING, WHICH WE ALL KNOW IS CRITICAL, THESE ARE WICKED PROBLEMS. THESE ARE HARD PROBLEMS. WE CAN'T JUST, YOU KNOW, WE CAN'T JUST IMPROVE ONE THING AND EVERYTHING WILL GET BETTER. WE REALLY NEED TO THINK ABOUT THIS IN A COMPREHENSIVE WAY. WE REALLY NEED TO ACCESS WHOLE DIFFERENT SKILL SETS. YOU WANT TO USE A.I. TO ANSWER QUESTIONS? I WAS LISTENING WITH THE C.M.S. DATA. YOU KNOW, I HAVE FOLKS THAT LOVE TO PLAY WITH DATA AND CAN ANSWER ALL SORTS OF QUESTIONS THAT YOU DIDN'T EVEN THINK YOU COULD ASK. BUT YOU NEED TO HAVE PEOPLE WORKING TOGETHER. I GET TO, AND TRAINING IMPACT FOR TRAINEES. I THINK THE WAY WE BUILD THESE COMMUNITIES IS THROUGH OUR STUDENTS AND THROUGH PEOPLE THAT WERE BRINGING UP THROUGH OUR RESEARCH AND HEALTHCARE COMMUNITIES. TRAINING. WHEN YOU BRING PEOPLE TOGETHER TO TRAIN IN NEW WAYS, IT'S AMAZING. AND THIS IS WHERE WE GET IMPACT. NEXT SLIDE, PLEASE. SO I JUST WANT TO SHOW YOU A COUPLE PROJECTS WE FUNDED IN OURS. THE FIRST I THINK IS AN INTERESTING ONE. WHEN COVID HIT, BALTIMORE, OBVIOUSLY WENT TO BALTIMORE CITY, YOU KNOW, WENT TO REMOTE LEARNING FOR STUDENTS. AND WHAT THEY FOUND IS THE MAJORITY OF THEIR STUDENTS, EVEN IF THEY HAD SOMETHING THEY COULD USE FOR COMPUTING LIKE AN iPAD TO ACCESS, THEY HAD NO WI-FI. SO THEY HAD TO USE THE FAMILY MINUTES. FAMILY MEDIA MINUTES FOR MANY THINGS. THEY ACTUALLY COULDN'T TELEWORK BECAUSE THEY DIDN'T HAVE ACCESS TO INTERNET. WE SHOULD BE BEYOND THIS. IT DOESN'T MEAN BEYOND THIS, WE SHOULD BE AT A BETTER PLACE WITH WI-FI, I KNOW THE F.C.C. IS WORKING ON THIS. THIS IS LOOKING AT COULD YOU SHARE WI-FI. THEY TOOK WI-FI FROM PUBLIC BUILDINGS, FROM SCHOOLS AND THEY SHARED IT WITHIN THE COMMUNITY. VERY LONG LOW COSTS, VERY EASY TO SET UP. AND CREATED A MESH ROUTING SYSTEM FOR THIS IS A SMALL PROJECT, VERY SMALL, 175,000, BUT THEY SERVED 200 FAMILIES IN THE BALTIMORE CITY AREA AND STILL GETTING THEIR WI-FI. I THINK IT'S A REALLY INTERESTING IDEA. NEXT SLIDE, PLEASE. SHE WAS INTERESTED BECAUSE SHE LOOKED AT HOW DO SENIORS IN UNDERSERVED COMMUNITIES, HOW DO THEY STAY ENGAGED. HOW DO THEY CONTINUE TO BE ENGAGED IN THEIR COMMUNITIES, ESPECIALLY AS WE THINK ABOUT COVID. THEY ARE USING THE SENIORS AS EDUCATORS AND VOLUNTEERS IN THIS PROJECT. SO THEY ARE ACTUALLY WORKING ACROSS THIS. THEY ARE CONNECTING WITH SOCIAL SCIENCES, THEY ARE DOING COMMUNITY ENGAGEMENT. BUT WHAT THEY CREATED IS A WAY FOR SENIORS TO STAY CONNECTED BUT FOR EVERYBODY TO STAY CONNECTED WITH SENIORS, WHICH I THINK WE ALL UNDERSTAND TO BE AN IMPORTANT THING. NEXT SLIDE. THIS HAS A LOT OF CITIZEN SCIENCE. I THINK WE THINK OF THE GOOD PARTS OF HAWAII. TURNS OUT THEY USE -- ALL OVER. THERE'S A LOT OF CHEMICALS RUNNING DOWN INTO PEOPLE'S WATER AND RURAL HAWAII HAS A HIGH RATE OF CESSPOOL USE WHICH SEEPS INTO THE GROUND. IF YOU ARE INTERESTED IN ENVIRONMENTAL HEALTH, THIS IS A BIG ONE. THEY FIGURED OUT A WAY TO MAKE IT EASY FOOR PEOPLE TO START TO COLLECT RAIN WATER OFF THE ROOFING MATERIALS. AND FROM THE GROUND. AND TO USE THIS TO CREATE NEW WAYS OF DOING RAPID TESTING FOR ALL SORTS OF CONTAMINANTS. THEY ARE DOING OUTREACH IN THE HOSPITALS AND ALL OVER. AS A WAY OF NOT ONLY BEING ABLE TO ASSESS IT AND ASSESS IT WELL BUT AS A WAY OF INCREASING KNOWLEDGE OF THE CONCERNS THIS CAN CAUSE. NEXT SLIDE. THIS ONE IS A REALLY INTERESTING ONE. THIS OUT OF U.S.C. I THINK THIS ONE IS USING BEACONS IN THE HOME TO UNDERSTAND FAMILY DYNAMICS. SO NOT PINGING PEOPLE, NOT TEXTING PEOPLE, NOT DOING ALL THAT. BUT REALLY USING COMPUTING AND ENGINEERING TO MEASURE THE DYNAMICS. WHAT PEOPLE ARE EATING, HOW THEY ARE EATING IT AND WHO IS EATING TOGETHER TO SEE IF YOU CAN CREATE MODELS THAT COULD HELP YOU UNDERSTAND, DO WE JUST NOT ASK PEOPLE ABOUT THEIR FOOD OR THEIR ACTIVITY. COULD WE REALLY START TO UNDERSTAND THEIR EATING BEHAVIOR. NEXT SLIDE, PLEASE. I BELIEVE THIS IS MY LAST SLIDE. SO I THINK, WHAT I THINK IS THERE'S REALLY AN EFFECTIVE RESEARCH AREA FOR SERVING UNDERSERVED COMMUNITIES THAT COMES OUT OF THIS BASIC AND APPLIED SERVICES SCIENCES RELAY RACE. WE HAND OFF TO EACH OTHER. NEXT SLIDE, PLEASE. THAT'S ALL I'VE GOT. SO THANK YOU. I DID SEE THERE WAS A QUESTION. THERE IS A QUESTION, CAN I ANSWER THE QUESTION? >> YEAH, IF YOU CAN SEE IT. >> I THINK THIS IS MICHAEL WAS TALKING ABOUT BEING A COMPUTER ENGINEER. AND THERE'S A COMMUNICATION BARRIER. MICHAEL, I CAN'T TELL YOU HOW HONESTLY UNDERSTANDING I AM ABOUT THAT. WHEN WE FIRST STARTED WORKING ACROSS HEALTH AND COMPUTING, I REMEMBER SAYING SOMEBODY ASKING IN A MEETING CAN WE DO DISSEMINATION ON THIS PROJECT. I SAID NO, THIS IS AN EARLY STAGE PROJECT. SHE SAID YOU HAVE RUINED MY CAREER. I WAS USING THE N.I.H. IT TURNED OUT IN COMPUTING THERE WAS A VERY DIFFERENT DEFINITION. PILOT WORK WAS CONSIDERED DISSEMINATION RESEARCH. WE HAD MULTIPLE PLOW OUTS, IT TAKES A LONG TIME TO GET THAT LANGUAGE RIGHT. BUT WE CAN DO IT. WE JUST HAVE TO WORK AT IT. I WILL GRAB YOUR EMAIL AND EMAIL YOU. >> THANK YOU, WENDY. IN THE INTEREST OF TIME WE NEED TO MOVE ON BUT WE WILL HAVE TIME LATER ON FOR MORE DISCUSSION. NEXT UP IS HILARY WALL AT THE CENTERS FOR DISEASE CONTROL AND PREVENTION. HILARY'S PRESENTATION IS USING SELF MEASURED BLOOD PRESSURE MONITORING FOR UNDERSERVED POPULATIONS AND BEYOND. CHALLENGES AND OPPORTUNITIES. HILARY? >> GREAT, THANKS SO MUCH. THANK YOU, EVERYONE. I'M REALLY THRILLED TO BE WITH YOU TODAY AND THANK YOU TO NHLBI FOR PULLING THIS MEETING TOGETHER. I WAS URGENTLY PULLED BACK TO CDC'S COVID RESPONSE SO I HAVEN'T BEEN ABLE TO LISTEN TO ALL THE PRESENTATIONS BUT THE ONES I HAVE HAVE BEEN REALLY STELLAR. THERE ARE COMMON THEMES YOU WILL HEAR REITERATED IN MY PRESENTATION. NEXT SLIDE, PLEASE. TODAY, I WILL PROVIDE SOME CONTEXT FOR SELF-MEASURED BLOOD PRESSURE MONITORING AND THE ROLE IT PLAYS IN NATIONAL INITIATIVES LIKE MILLION HEARTS. I WILL REVIEW HOW MILLION HEARTS HAVE USED IT AS A STRATEGY IN COMMUNITY HEALTH CERTAINTIES. AND THEN WE WILL WRAP UP WITH CHALLENGES, POTENTIAL SOLUTIONS AND ASSOCIATED RESOURCES FOR THOSE WHO MAY BE INTERESTED. NEXT SLIDE. MILLION HEARTS. IT'S A LARGE NATIONAL INITIATIVE CO-LED BY CDC AND CENTERS FOR MEDICARE AND MEDICAID SERVICES GOAL OF PREVENTING ONE MILLION HEART ATTACK, STROKES AND OTHER CARDIOVASCULAR EVENTS IN FIVE YEARS. BLOOD PRESSURE CONTROL IS A MAJOR ATTRIBUTOR TO THOSE PREVENTABLE EVENTS AS YOU CAN IMAGINE. WE HAVE SET OUR NATIONAL TARGET OF 80% FOR THE GOAL. THIS IS AN AUDACIOUS GOAL. AS MANY OF YOU KNOW IF WE USE 130/80 AS OUR THRESHOLD, ALMOST ONE IN TWO ADULTS HAS HYPERTENSION AND ONLY ABOUT ONE OUT OF FOUR HAVE THEIR CONDITION CONTROLLED. SO WE HAVE A LOT OF ROOM FOR IMPROVEMENT. TO MAKE PROGRESS TOWARDS THAT 80% TARGET, MILLION HEART SUPPORTS A HANDFUL OF EVIDENCE-BASED STRATEGIES FOR BLOOD PRESSURE CONTROL AND SELF-MEASURED BLOOD PRESSURE MONITORING IS ONE OF THEM. NEXT SLIDE, PLEASE. SMDP IS THE MEASUREMENT OF BLOOD PRESSURE BY AN INDIVIDUAL, IDEALLY WITH THEIR OWN UPPER ARM DEVICE OUTSIDE OF THE CLINICAL SET, INCLUDING AT HOME. IT IS SOMETIMES REFERRED TO AS HOME BLOOD PRESSURE MONITORING BUT I PREFER THE TERM SELF MEASURED BLOOD PRESSURE MONITORING, WE WANT TO SUPPORT ITS USE REALLY WHERE EVER IT FEELS COMFORTABLE AND CONVENIENT FOR THE INDIVIDUAL. FOR EXAMPLE, MAYBE THEY TRAVEL A LOT. OR IF THEY WORK ODD HOURS, WE WANT TO SUPPORT WHERE EVER THEY FEEL COMFORTABLE TAKING THEIR BLOOD PRESSURE APPROPRIATELY. WHAT I'M NOT REFERRING TO WHEN I SAY SMBP IS TAKEN AT A KEY -- KIOSK LIKE PHARMACY OR GROCERY STORE. OR WEARABLE SENSORS OR CUFFLESS MONITORS. ESPECIALLY WHEN COMBINED WITH CLINICAL SUPPORT, SMBP IS AN EVIDENCE-BASED STRATEGY FOR LOWERING BLOOD PRESSURE AND IMPROVING CONTROL IN PEOPLE WITH HYPERTENSION. MOREOVER, THIS IS SOMETHING WE HAVE HEARD THROUGHOUT MANY PEOPLE'S PRESENTATIONS, THE COVID-19 PANDEMIC REALLY HIGHLIGHTED THE CRUCIAL NEED TO COLLECT INFORMATION ON THIS EXTREMELY IMPORTANT VITAL STATISTIC WHEN IN-PERSON CLINICAL VISITS ARE NOT POSSIBLE. SO KIND OF, ESSENTIALLY A LOT OF BROAD APPLICATION HERE. NEXT SLIDE. SO TO ME, THE REAL CRUX OF THE SMBP SECRET SAUCE, IF YOU WILL, I LIKE TO REFER TO AS PATIENT CLINICIAN FEEDBACK LOOP. YOU CAN SEE ON THIS SLIDE. IDEAL SMBP STARTS WITH CLINICAL TEAM, PATIENTS TO SELECT AND USE THEIR OWN DEVICE, PROPER CUFF SIZE, VERY IMPORTANT. PROVIDING A PROTOCOL WITH FREQUENCY AND DURATION FOR MONITORING AND INSTRUCTING THE PERSON HOW WHEN THE TEAM RECEIVED THOSE, IN A LOW FASHION, ASYNCHRONOUS TELEHEALTH I'M TALKING ABOUT, THEY CAN TAKE THEM, INTERPRET AND USE THEM TO COMMUNICATE BACK ADVICE AND WE CAN START THE FEEDBACK LOOP OVER AGAIN. NEXT SLIDE, PLEASE. SO THAT DIAGRAM, I SHOWED YOU, ACTUALLY CAME FROM LAST YEAR'S SURGEON GENERAL'S CALL FOR ACTION TO CONTROL HYPERTENSION. I AND OTHERS IN MY DIVISION, THE DIVISION FOR HEART DISEASE AND STROKE PREVENTION AT CDC HELPED WRITE THIS CALL TO ACTION WITH THE SURGEON GENERAL. IT WAS INTENDED TO BE A NATIONAL RALLYING CALL FOR THIS ISSUE. NOT SURPRISINGLY, SMBP IS ONE OF THE STRATEGIES HIGHLIGHTED WITHIN IT. NEXT SLIDE. THE REAL REASON SMBP WAS INCLUDED IN THE CALL TO ACTION IS BECAUSE OF ITS STRONG EVIDENCE BASE. SMBP WITH CLINICAL SUPPORT HAS A FOUNDATION OF NUMEROUS SYSTEMATIC REVIEWS AND META ANALYSES AND INCLUDED IN U.S. PREVENTIVE SERVICE TASK FORCE RECOMMENDATIONS FOR HYPERTENSION SCREENING, REALLY AS A WAY TO CONFIRM NEWLY DIAGNOSED HYPERTENSION. IT'S RECOMMENDED BY THE CDC COMMUNITY PREVENTIVE SERVICES TASK FORCE FOR HYPERTENSION MANAGEMENT. AND SMBP IS ALSO INCLUDED IN NUMEROUS INTERNATIONAL AND DOMESTIC CLINICAL GUIDELINES INCLUDING THE 2017 AMERICAN COLLEGE OF CARDIOLOGY AND AMERICAN HEART ASSOCIATION HYPERTENSION MANAGEMENT GUIDELINE. NEXT SLIDE. BUT YOU KNOW, UNFORTUNATELY MOST OF THE AVAILABLE EVIDENCE HAS NOT SPECIFICALLY FOCUSED ON UNDERSERVED POPULATIONS. SO IN 2017, OUR MILLION HEARTS TEAM COLLABORATE WORLD THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS OR NACH. NINE CENTERS FROM KENTUCKY, NEW YORK AND MISSOURI TO BETTER UNDERSTAND THE BARRIERS OF IMPLEMENTING SMBP WITH A SPECIFIC HEALTH CENTER POPULATION. YOU KNOW, ARE THERE DIFFERENT BARRIERS THAT HEALTH CENTER PATIENTS MIGHT EXPERIENCE, OR THE STAFF, AS THEY ARE IMPLEMENTING IT, THAT KIND OF INFORMATION. PARTICIPATING HEALTH CENTERS WERE IN RURAL, SUBURBAN AND URBAN SETTINGS AND HAD PATIENT POPULATIONS OF MIXED RACES AND ETHNICITIES. THROUGHOUT THAT UPPER, ABOUT 1400 PATIENTS WERE RECOMMENDED SMBP AND ABOUT 800 SUCCESSFULLY COMPLETED AT LEAST ONE CYCLE OF MONITORING. AND WE WERE ABLE TO GET BACK A NUMBER OF DIFFERENT QUALITATIVE INDICATORS FROM PARTICIPANTS TO ASSESS THEIR KNOWLEDGE AND ATTITUDES ABOUT SMBP. UNFORTUNATELY WE DIDN'T HAVE THE FUNDING TO FOLLOW THESE PATIENTS LONG ENOUGH TO DETERMINE ITS IMPAKTS ON HEALTH OUTCOMES BUT WE WERE ABLE TO CULL A LOT OF REALLY USEFUL INFORMATION X NEXT SLIDE. THERE WERE TWO MANUSCRIPTS PUBLISHED YES INDEED HEALTH CENTERS AND THEIR PATIENTS ARE BOTH ABLE TO AND WANT TO IMPLEMENT SMBP BUT THOSE EFFORTS ARE NOT WITHOUT BARRIERS THAT MUST BE OVERCOME. THAT PROJECT, IT WAS IN NINE HEALTH CENTERS ACROSS THREE STATES. NEXT SLIDE, WE ARE -- OUR COLLEAGUES AT HRSA AND THE DEPARTMENT OF HEALTH AND HUMAN SERVICES OFFICE OF MINORITY HEALTH ARE NOW UNDERGOING AN EFFORT TO IMPLEMENT SIMILAR WORK. BUT ON STEROIDS. THEY RECENTLY AWARDED $90 MILLION TO ALMOST 500 HEALTH CERTAINTIES. IT WILL FOCUS ON USING SMBP AND ASSOCIATED TECHNOLOGY IN ADDITION WITH OTHER STRATEGIES TO IMPROVE HYPERTENSION CONNELL TROLL. I KNOW WE ARE LOOKING FORWARD TO SUPPORTING THAT THROUGH YOUR EFFORT. NEXT SLIDE. AT CDC, SMBP IS NOT NEW, IT'S BEEN AROUND SEVERAL DECADES BUT CDC STARTED CHAMPIONING IT ABOUT TEN YEARS AGO. AND OTHER ORGANIZATIONS LIKE THE AMERICAN MEDICAL ASSOCIATION, AND THE AMERICAN HEART ASSOCIATION HAVE LONG BEEN CHAMPIONS OF IT AS WELL. WE HAVE ALL REALLY CONTRIBUTED TO THE FIELD. WE CREATED LOTS OF TRANSLATIONAL WORK. THERE'S GUIDANCE ON ALL SORTS OF ASPECTS OF SMBP. AND THROUGHOUT ALL OF THE WORK THAT'S BEEN DONE IN THIS AREA, THERE ARE A NUMBER OF BARRIERS THAT REALLY FLOAT TO THE TOP WHEN THINKING ABOUT USING SMBP IN UNDERSERVED POPULATIONS. SO FIRST OF ALL, BLOOD PRESSURE MONITOR AVAILABILITY COULD BE AN ISSUE. COVERAGE IS VARIABLE, UNFORTUNATELY. AND WE DID A RECENT COVERAGE ANALYSIS A FEW YEARS AGO THAT SHOWED THERE WAS LOTS OF ROOM FOR IMPROVEMENT ACROSS-THE-BOARD, WHETHER MEDICARE, MEDICAID, OTHER PUBLIC PLANS, PRIVATE PLANS. LOTS OF ROOM FOR IMPROVEMENT. SOME PLANS WERE DOING WELL. THEY WERE COVERING MONITORS THE WAY THAT ONE WOULD WANT THEM TO. OTHERS WERE ONLY COVERING MANUAL MONITORS AND CUFFS AND IT'S KIND OF A NIGHTMARE BUT WE ARE GETTING THERE. RECENTLY WE HAVE SEEN GOOD PROGRESS IN THE MEDICAID SPACE, WHICH IS NICE. LAST YEAR CMS ACTUALLY PUBLISHED THEIR BLUEPRINT FOR VALUE BASED INSURANCE DESIGN ON THE MARKETPLACE EXCHANGES WHERE THEY CALLED OUT SMBP MONITORS AS ONE OF A HANDFUL OF ITEMS THAT SHOULD BE AVAILABLE TO BENEFICIARIES WITH NO COST SHARING WHICH IS GREAT. I THINK THAT'S A BABY STEP IN THE RIGHT DIRECTION. AND SOME CLINICAL SETTINGS LIKE COMMUNITY HEALTH CENTERS HAVE ACTUALLY CIRCUMVENTED COVERAGE ISSUES ALL TOGETHER BY IMPLEMENTING DEVICE LOANER PROGRAMS. THE HEALTH CENTER PURCHASES A GROUP OF DEVICES THAT THEY THEN LOAN OUT TO PATIENTS FOR PERIODS OF TIME. AND THEN GET THEM BACK FROM PATIENTS WHEN THEY HAVE USED THEM. SO THAT CAN BE A GREAT INTERIM SOLUTION, THOUGH NOT NECESSARILY THE LONG-TERM SOLUTION WE WOULD LIKE TO SEE. DEFINITE CHALLENGE FOR HEALTH CENTER POPULATIONS IS CUFF SIZE. DATA FROM THE NATIONAL HEALTH AND NUTRITION EXAMINATION SURVEY SHOWED AMONG PEOPLE WITH HYPERTENSION, AMONG ALL PEOPLE WITH HYPERTENSION, 54% EVER OF MEN AND 38% OF WOMEN NEED AT LEAST A LARGE ADULT CUFF. SMALL CUFF, STANDARD ADULT, CUFF, MEDIUM, LARGE AND BEYOND. THAT'S A BUNCH OF PEOPLE WITH HYPERTENSION WHO NEED TO HAVE A LARGER THAN STANDARD THAN LARGE ADULT CUFF. OUR WORK WITH N.A.C.H. WE FOUND 50% OF PARTICIPATING HEALTH CENTER PATIENTS NEEDED AN EXTRA LARGE CUFF FOR THEIR DEVICE. SOMETIMES THESE NON STANDARD CUFFS COULD BE DIFFICULT TO FIND. THAT'S AN ISSUE THAT NEEDS TO BE ADDRESSED AS WE ARE THINKING OF UNDER-SERVED POPULATIONS. DEVICE VALIDITY CAN ALSO BE AN ISSUE. I WANT TO BE CLEAR, ALL DEVICES, ALL SMBP DEVICES SOLD IN THE U.S. HAVE MET F.D.A. STANDARDS AND MET APPROVALS BUT THE AMERICAN MEDICAL ASSOCIATION HAS OVER THE LAST FEW YEARS LED AN EFFORT FOR THE U.S. BLOOD PRESSURE VALIDATION DEVICE LIFTING OR VDL. IT DOES AWAY WITH CONCEPT OF EQUIVALENTS WHERE A NEW DEVICE IS DEEMED AS SAFE AND EFFECTIVE AS PRED CAL DEVICE AS LONG AS CHANGES MADE WERE NOT DEEMED SUBSTANTIAL. IT TAKES THE FDA APPROVAL AND TAKES IT UP ANOTHER LEVEL. IDEALLY WE WOULD LIKE TO SEE MORE DEVICES POPULATE THAT VDL BUT NEED MORE WORK WITH SPECIFIC POPULATIONS LIKE PREGNANT WOMEN FOR EXAMPLE. THERE HAS BEEN SOME WORK BUT WE NEED TO SEE AS A STANDARD PROCESS, DEVICES ARE VALIDATED WITHIN THE GENERAL PUBLIC AND CERTAIN SUB POPULATIONS. ANOTHER THING IMPORTANT TO THE TECHNOLOGY TALK IS CREATING THAT PATIENT CLINICIAN FEEDBACK LOOP I MENTIONED SO THAT IT'S REMOTE, INTEROPERABLE AND STANDARDS BASED. RIGHT NOW, MANY, THE CLINICAL SETTINGS, SOME HAVE SORT OF COBBLED TOGETHER A HEALTH I.T. SOLUTION SO THEY CAN EASILY GET PATIENT GENERATED HEALTH READINGS INTO THEIR ELECTRONIC HEALTH RECORD BUT IT'S NOT SYSTEMATIC OR A SOLUTION WE CAN APPLY SORT OF UNIVERSALLY OR TO MANY ACROSS THE COUNTRY. SOME PATIENTS, INTERNET IS AN ISSUE, SOME BRING PAPER READINGS OR PAPER LOGS AT THEIR NEXT IN-PERSON VISIT. THAT'S REALLY WHAT WE ARE TRYING TO WORK AROUND. WE WANT HYPERTENSION MANAGEMENT TO TAKE A STEP OUTSIDE OF TRADITIONAL PATIENT VISIT. SO THE CURRENT FAST HEALTHCARE, FIRE STANDARDS THEY ARE FOCUSED ON GETTING DATA OUT OF ELECTRONIC HEALTH REPORTS WHERE A LOT OF NATIONAL AND FEDERAL ATTENTION IS CURRENTLY FOCUSED. HOW DO PAYERS IN PARTICULAR, HOW DO THEY GET DATA OUT OF ELECTRONIC HEALTH RECORDS IN AN INTEROPERABLE AND STANDARDS BASED WAY. WE THIS IS BLOOD PRESSURE DATA AND BEYOND, HOW DO WE PUT DATA INTO ELECTRONIC HEALTH RECORDS IN THAT INTEROPERABLE STANDARDS BASED WAY. RIGHT NOW, I AND OTHER COLLEAGUES AT CDC ARE CURRENTLY ENGAGED IN A EFFORT WERE PROGRAMMATIC HELLEth INSTITUTE AND COLLEAGUES AT NIH, ONC, OHRQ, HRSA AND OTHERS TO REALLY UNDERSTAND THE FULL LAY OF THE LAND WHEN IT COMES TO HEALTH I.T. AND SMBP AND WE ARE GOING TO BE MAKING AND IMPLEMENTING RECOMMENDATIONS FOR ADVANCING THIS HEALTH I.T. LANDSCAPE OF SMBP, THE FEEDBACK DIAGRAM MAKE IT'S APPEAR VERY SIMPLE BUT THERE ARE MULTIPLE PATHWAYS CAN YOU ACTUALLY TAKE AS YOU ARE TRYING TO GET PATIENT GENERATED READINGS IN THE E.H.R. AND INFORMATION BACK TO THE CLINICAL TEAM TO THE PATIENT. SO IT'S COMPLICATED. SO THAT FINAL REPORT AND RECOMMENDATION WILL BE AVAILABLE IN A FEW SHORT MONTHS. WE ARE ALL SORT OF CHOMPING AT THE BIT WAITING FOR IT. FEDERAL COLLEAGUES AND I WILL GET TOGETHER TO FIGURE OUT HOW TO TRANSLATE THAT FOR OUR INDIVIDUAL AGENCIES AND WHAT ARE THE NEXT LEVERS WE CAN APPLY TO MOVE THE FIELD FORWARD. LASTLY, IT'S JUST THE UTMOST IMPORTANCE HOW RURAL AND LOW SOCIOECONOMIC STATUS COMMUNITIES GAIN RELIABLE ACCESS TO HIGH-SPEED INTERNET. THAT'S ACROSS-THE-BOARD. NEXT SLIDE. SO I WANT TO GO THROUGH THESE, BUT IF PEOPLE ARE INTERESTED IN SMBP THERE ARE TONS OF GREAT, GREAT RESOURCES THAT ARE AVAILABLE. NOT ONLY FROM CDC AND MILLION HEARTS BUT ALSO THE NATIONAL ASSOCIATION OF COMMUNITY HEALTH CENTERS AND THE AMERICAN MEDICAL ASSOCIATION AND AMERICAN HEART ASSOCIATION HAVE AN INITIATIVE TARGET B.P., THEY HAVE PUT OUT SOME REALLY STELLAR MATERIAL. I WOULD ENCOURAGE YOU TO EXPLORE THESE WEBSITES. NEXT SLIDE. I'M NOT REALLY A SENTIMENTAL OR SQUISHY PEOPLE, TOUCHIE FEELY PERSON BUT THESE TWO VIDEOS CAME OUT OF THE WORK WITH N.A.C.H. AND COMMUNITY HEALTH CERTAINTIES. THEY SHOWCASED TWO TRULY AMAZING PATIENTS WHO DID IMPLEMENT SMBP. THE FIRST ONE, D'ANGELO'S STORY IS A YOUNG AFRICAN AMERICAN MAN USING SMBP TO CONTROL THINKS BLOOD PRESSURE. HE LIVES WITH HIS MOTHER STILL, SHE MAKES A REALLY GREAT CAMEO, IT'S A HEART WARMING VIDEO AND SHOWS HOW A PERSON IN REAL LIFE CAN IMPLEMENT THIS AND MAKE CHANGES BASED ON WHAT THEY OBSERVE THEMSELVES. NATALIA'S STORY IS A REAL TEARJERKER AND IT HIGHLIGHTS A SPANISH-SPEAKING WOMAN'S JOURNEY TO CONTROL HER BLOOD PRESSURE AND THE ROLE SMBP PLAYED IN DOING SO. I WOULD ENCOURAGE YOU TO TAKE A LOOK AT THOSE. NEXT SLIDE. IF YOU ARE INTERESTED IN THIS TOPIC, I WILL PUT A PLUG IN FOR A QUARTERLY QUALIFY, THE SMBP FORUM. WE HAVE ABOUT 500 MEMBERS FROM ALL DIFFERENT SECTORS, PUBLIC HEALTH, CRITICAL MEDICINE AND EVERYWHERE IN BETWEEN, PAYERS. THESE FOLKS JOIN THE QUARTERLY CALL TO DISCUSS ALL SORTS OF SMBP RELATED ISSUES. WE HAVE SPEAKERS WE BRING ON EVERY QUARTER TO EVERY CALL. SOMETIMES A REAL FOCUSED TOPIC WE ADDRESS. THEY ARE VERY WELL ATTENDED AND THEY TEND TO BE VERY INTERESTING. I WOULD INVITE ALL INTERESTED FOLKS TO REGISTER. NEXT SLIDE, WITH THAT, I WILL SAY THANK YOU FOR YOUR ATTENTION AND I AM HAPPY TO TAKE ANY QUESTIONS YOU MIGHT HAVE. >> THANKS FOR THE EXCELLENT PRESENTATION, HILARY. WE LOOK FORWARD TO THAT FINAL REPORT. PLEASE SEND IT ALONG WHEN IT'S RELEASED. >> I WILL. >> PLEASE TAKE A COUPLE SECONDS. THERE'S ONE COMMENT I WILL HAVE YOU ADDRESS. MOST BLOOD PRESSURE MONITORS HAVE FALSE NEGATIVE IMPACT, HOW TO PROPERLY USE THEM. DUE TO COVID-19 PHARMACIES HAVE DISLOCATED THEIR BP UNITS TYPICALLY LOCATED IN GROCERY STORES AND LOCAL PHARMACIES. >> I'M NOT SURE WHAT THE QUESTION IS. THE PHARMACIES ADDRESS BLOOD PRESSURE KIOSKS, JUST TO BE HONEST I'M NOT A HUGE FAN OF THOSE. THE VALIDATION STUDIES ARE TL*T NOT THERE TO SHOW THESE ARE REALLY ACCURATE WAYS FOR PEOPLE TO TAKE THEIR BLOOD PRESSURE. I TALK ABOUT CUFF SIZE, MANY OF THOSE KEY -- KIOSKS HAVE PLASTIC CUFF THAT DOESN'T MOVE, THIS IS THE SIZE IT IS. STUDIES SHOW, IT JUST DOESN'T, I TALKED TO YOU ABOUT DATA FROM ED HAINES, A STANDARD CUFF DOESN'T MEET PEOPLE'S ARM SIZES FOR PEOPLE WITH HYPERTENSION. THAT'S WHAT THAT PLASTIC TUBE TENDS TO BE. SO THERE'S A WHOLE LIST OF ISSUES. CALIBRATION. I COULD GO ON AND ON. PHARMA SMART KIOSKS DO HAVE GOOD SCIENCE BEHIND THEM, GOOD PUBLICATION BEHIND THOSE. THEY ARE PRETTY POPULAR IN CANADA AND STARTING TO GAIN POPULARITY IN THE U.S. SOME HAVE THE ABILITY TO DOWNLOAD A PERSON'S BLOOD PRESSURE VALUE. THEY ARE IMPROVING OVER TIME. RIGHT NOW FOR ME, THAT'S NOT THE GO-TO ANSWER FOR SOME OF THESE COMMUNITIES THAT HAVE BROADBAND ACCESS. IT'S NOT THE BEST STOP GAP. IT COULD POTENTIALLY BE MORE ROBUST BUT AT THIS POINT IT'S NEVER MY GO-TO SOLUTION. >> UNDERSTOOD. THANK YOU SO MUCH. OKAY, NEXT UP IS SHAYLA, SALEMOVICH, BIOLOGIST AT BARDA, TALKING ABOUT DERIVING THE PUSH FOR CULTURAL CHANGE, ADDRESSING RACIAL BIAS AND DEVELOPING DIAGNOSTICS. SEILA? SELIMOVIC. >> THANK YOU, THANK YOU FOR THE INTRODUCTION KATHLEEN. HOPE EVERYONE CAN HEAR ME. NEXT PAGE, PLEASE. PART OF HHS. NEXT. AND WITHIN ASPR WE HAVE THE BIOMEDICAL ADVANCE RESEARCH AND DEVELOPMENT AUTHORITY. YOU MAY HAVE HEARD OF US HERE AND THERE OVER THE LAST YEAR OR SO. WE DEVELOP AND MAKE AVAILABLE COUNTER MEASURES, THINK VACCINES, THINK DIAGNOSTICS, THINK THERAPEUTICS THAT ADDRESS HEALTH SECURITY THREATS. AND WE DO THAT BY PARTNERING WITH THE PRIVATE SECTOR FOR THE MOST PART TO DRIVE-IN NOVATION OF THE RESEARCH AND REALLY DEVELOP PRODUCTS THAT CAN GO DIRECTLY OR POST DIRECTLY INTO PATIENT'S HANDS INTO MEDICAL CARE PROVIDERS HANDS. NEXT. SO I WANTED TO HIGHLIGHT THIS SLIDE THAT SHOWCASES OUR 59 F DA* A APPROVALS LICENSURES AND CLEARANCES. NEXT, MANY GOVERNMENT PARTNERS AND NEXT SLIDE, MANY INDUSTRY PARTNERS. EVEN THOUGH WE ARE A SMALL ORGANIZATION OF, I THINK ABOUT 200 OR SO STAFF, WE DO HAVE CRITICAL CONNECTIONS WITH BOTH OTHER PARTS OF THE GOVERNMENT AS WELL AS THE INDUSTRY. WHICH MEANS I THINK WE REALLY ARE WELL POSITIONED TO SHOWCASE ANY CULTURAL CHANGE WITHIN OUR ORGANIZATION AND THEN REALLY, TRY TO DISSEMINATE IT. WITHIN BARDA WE HAVE FIVE DIVISIONS. RESEARCH ADVENTURES IS ONE. I CONSIDER THE INNOVATION ARM OF BARDA. NEXT. THIS IS HOW WE ALL OPERATE. SO WE ARE FOCUSED ON AMBITIOUS HEALTH SECURITY CHALLENGES AND STRESS AND WE ARE PRIMARILY INTERESTED IN BREAK THROUGH SOLUTIONS FROM BIOMEDICAL TO HEALTH SECURITY CHALLENGES. THE ENTREPRENEURIAL WORLD. AND EMERGED WITH THE BEST PRACTICES OF THE FEDERAL GOVERNMENT WORLD. AND IT'S REALLY IMPORTANT TO US THAT AS WE SUPPORT NEW TECHNOLOGIES, WE ALSO WORK WITH OUR PARTNERS, WITH OUR PARTNER COMPANIES BY STREAMLINING THE CONTRACTING POLICIES AND BY MAKING AVAILABLE ACCELERATOR SERVICES AND GUIDANCE SERVICES THAT HELP THEM LAUNCH THEIR BUSINESSES. NEXT. HERE ARE SOME SUBSET OF DRIVE PROGRAMS. SUPPORTS TECHNOLOGY SUCH AS WEARABLE SENSORS AND DATA ANALYTICS THAT COULD PROVIDE EARLY DETECTION OF INFECTION. YOU COULD IMAGINE THIS HAS BEEN VERY USEFUL OBVIOUSLY DURING THIS PAST YEAR. SIMILARLY, SOLVING SEPSIS PROGRAM IS FOCUSED ON INTERVENTIONS TO REDUCE INSURANCE DENTS, MORBIDITY, MORTALITY AND COST OF SEPSIS. THE NEXT IS BRIDGING THE INTERSECTION BETWEEN SCIENCE AND BUSINESS WORLD. I THINK YOU CAN SEE KIND OF A PATTERN HERE. THESE ARE ALL TOPICS THAT CARRY A LOT OF VALUE FOR EVERYBODY. BUT CERTAINLY ALSO FOR UNDER REPRESENTED COMMUNITIES. NEXT. THAT POINT I WANT TO HIGHLIGHT THE DRIVE TEAMS, THE BRAINS OF THE PROGRAM. IF YOU CLICK ONCE MORE, MAYBE NOT. SORRY. LET'S GO BACK. I WANTED TO HIGHLIGHT THREE COLLEAGUES SPECIFICALLY. TEAM MEMBERS HERE IN DRIVE WHO HAVE REALLY HELPED ME A LOT THROUGH DISCUSSIONS OVER THE PAST YEAR, TO REALLY UNDERSTAND SOME OF THE CHALLENGE AND POTENTIAL SOLUTIONS TO ADDRESSING RACIAL BIAS IN DIAGNOSTIC DEVELOPMENT IN OUR WORK IN GENERAL. I REALLY WANTED TO THANK THEM SPECIFICALLY BUT ALSO THE ENTIRE DRIVE TEAM IN REALLY MAKING THIS PRESENTATION TODAY POSSIBLE. NEXT. SO WE HAVE A PLEDGE IN OUR DIVISION THAT HIGHLIGHTS THINGS LIKE DRIVE FOR EQUITY AND INCLUSIVE, DIVERSITY, AUTHENTICITY AND CIVILITID. IT'S ALL DIFFERENT PARTS OF OUR CULTURE. THIS IS VERY IMPORTANT TO US. IT'S ENSHRINED IN OUR DIVISIONAL PLEDGE. IT'S SOMETHING WE REALLY TRY TO MODEL EVERYDAY AS WE WORK WITH OUR GOVERNMENT COLLEAGUES, AS WELL AS WITH OUR PRIVATE SECTOR PARTNERS. NEXT HOW DO WE ACTUALLY PARTNER WITH THESE CONTROVERSIALS? WE HAVE A CONTRACT MECHANISM THAT IS PART OF OUR EASY, BROAD AGENCY ANNOUNCEMENT. THESE ARE CONTRACTS UNDER 750,000 THAT REALLY SUPPORT, REALLY EMERGING DISRUPTIVE IDEAS. AND SO WE ALSO PROVIDE A SIMPLIFIED APPLICATION PROCESS. THE ORIGINAL APPLICATION IS ONLY ABOUT 2,000 WORDS. ALL OF THIS, I HOPE, HIGHLIGHTS THE FACT THAT OUR PARTNERING MECHANISM WORKS ESPECIALLY WELL FOR COMPANIES THAT MAY NOT NECESSARILY HAVE A NETWORK BACKING THEM. A NETWORK THAT MAY HAVE TAUGHT THEM HOW TO WRITE GRANT PROPOSALS OR HOW TO FIND APPROPRIATE CLINICAL PARTNERS OR HOW TO COMMERCIALIZE A PRODUCT. I THINK OUR CHOICE OF THIS PARTICULAR FUNDING VEHICLE AND THE WAY IT'S SET UP IN OUR DIVISION WORKS EX CEPTION ALLEY WELL FOR BUSINESSES AND BUSINESSES WHO MAY NOT NECESSARILY HAVE AN ENTIRE NETWORK AND ACTUALLY THE PRIVILEGE OF HAVING BEEN EXPOSED TO THESE DIFFERENT PIECES OF WORKING WITH THE GOVERNMENT. ADDITIONALLY WE TRIED TO REVIEW PROJECT APPLICATIONS WITHIN 30 DAYS. OUR PROJECTS ARE OFTEN DEVELOPED AND FULLY SIGNED WITHIN 60-120 DAYS. AGAIN, WE UNDERSTAND THAT BUSINESSES, ESPECIALLY SMALL BUSINESSES REALLY WATCH OUT FOR THE TIME LINE, IT MAY COST THEM MONEY. EVERYTHING WE DO REALLY IS IN THE INTEREST OF SUPPORTING BUSINESSES AND ESPECIALLY SMALL BUSINESSES. NEXT. ONCE MORE. GO QUICKLY BACK. SORRY FOR ALL THESE ANIMATIONS. IF YOU CAN GO BACK ONE. I WANT TO HIGHLIGHT WE PROVIDE GUIDANCE THROUGH THE PROCESS. BUT ALSO ONCE A PROJECT HAS BEGUN, AGAIN, WE WILL HAVE -- OUR DIVISION HAS ACCELERATED ACROSS THE NATION. THESE ARE POTENTIALLY THIRD PARTIES FUNDED BY US THAT PROVIDE ALL SORTS OF EXPERTISE, SUCH AS SMALL BUSINESSES. PEOPLE JUST STARTING OUT MAY HAVE QUESTIONS ABOUT WHO TO PARTNER, HOW TO FIND CLINICAL TRIAL PARTNER. HOW TO WRITE A CLINICAL TRIAL PROTOCOL. HOW TO COMMERCIALIZE A PRODUCT, ETC., ETC. AGAIN, EVERYTHING WE ARE TRYING TO DO HERE, REALLY IS SET UP TO HELP SMALL BUSINESSES SUCCEED AND AGAIN, ESPECIALLY I WOULD SAY SMALL BUSINESSES THAT MAY NOT NECESSARILY HAVE THE BENEFIT OR THE PRIVILEGE OF A LARGE NETWORK THAT TEACHES THEM THESE THINGS. NEXT. ANOTHER PART OF OUR CULTURE IS ACTUALLY NEW CHANGE TO THE SCIENTIFIC REQUIREMENT. SO, THIS IS SOMETHING THAT HAS BEEN THAT'S ACTUALLY BEEN FORMED IN MY THINKING BASED ON SOME RESEARCH RESULTS THAT SHOW THAT SOME COMMONLY AVAILABLE MEDICAL DEVICES SUCH AS THE PULSE OXIMETER DO NOT PROVIDE SAME RESULTS WITH INDIVIDUALS WITH DIFFERENT SKIN COLOR. IN MY MIND, THAT'S JUST NOT OKAY. IN ORDER TO AVOID DOING RESEARCH THAT DOES NOT EQUALLY TAKE INTO ACCOUNT DIFFERENT BIOLOGICAL OR PHYSICAL OR OTHER CHARACTERISTICS. WE NOW IN ENACT REQUIRE ALL CLINICAL STUDIES, NOT JUST CLINICAL TRIALS BUT CLINICAL STUDIES MUST HAVE AN EQUITABLE DISTRIBUTIONS. INCLUDE EVERYTHING FROM BIOLOGICAL SEX TO PERHAPS SKIN COLOR, IF IT'S AN OPTICAL DEVICE. MAYBE BODY WEIGHT. CERTAINLY AGE AND SO ON AND SO ON. BUT ADDITIONALLY, YOU KNOW, SOMETHING THAT WE ARE ALSO CONSIDERING IS REQUIRING IN THE PRELIMINARY DATA, PROOF OF CONCEPT DATA WHEN PEOPLE APPLY. WE ARE INTERESTED IN EXPLORING WHETHER IT'S KNOWN IF THIS WORKS EQUALLY WELL FOR ALL. WHAT PRELIMINARY DATA HAVE POTENTIAL PARTSNERS HAVE APPLICANTS KLEKED THAT SHOWS WHETHER THE TECHNOLOGY WORKS OR NOT. ONE THING WE ARE TRYING TO CHANGE IS A CHANGE IN THINKING AND A CULTURE CHANGE. I BELIEVE THAT WE CANNOT SOLVE THE PROBLEM OF RACIAL BIAS BY OURSELVES. BUT I DO BELIEVE THAT JUST THE FACT THAT WE ARE TRYING, THAT WE ARE PROMPTING INDIVIDUALS TO THINK ABOUT THESE ISSUES, YOU KNOW, ACTUALLY WORKS. THEY MIGHT CHANGE THEIR ATTITUDES AND THEIR THINKING. NEXT. ONE MORE, PLEASE. THANKS. ANOTHER THING THAT I THINK SHOULD BE OBVIOUS, BUT NONETHELESS IS NEW SOMETIMES, IS THE FACT THAT AS FUNDERS, AND THEN POTENTIALLY RESEARCHERS SHOULDN'T MAKE ASSUMPTION ABOUT WHAT INDIVIDUAL COMMUNITIES WANT AND NEED. WE REALLY NEED TO ASK THEM. OR IN OTHER WORDS, THE PARTNERSHIPS THAT WE WORK WITH SHOULD CONSIDER ASKING THEIR COMMUNITY, THEIR USERS, WHAT KIND OF TECHNOLOGY DO THEY WANT. HOW DOES THE TECHNOLOGY MESH WITH THEIR LIVES. WE NEED TO UNDERSTAND CULTURAL NORMS, GENERAL CONCERNS. I'M SHOWING AS A SHOWCASE A PRODUCT THAT ONE OF OUR PRODUCTS SONICA HAS. A WEARABLE SENSOR, ROUGHLY BAND-AID SIDE BETWEEN THE CLAVICLE. EVEN DIFFERENT COLORS MAY NOT LOOK EXTREMELY NATURAL. WHAT I LIKE IS THE COMPANY WAS STILL, YOU KNOW, THINKING ABOUT THE FACT THAT DIFFERENT INDIVIDUALS WOULD WOULD HAVE DIFFERENT SKIN COLOR MAY WISH TO HAVE A SENSOR THAT, YOU KNOW, DOES NOT SHOW AGAINST THEIR SKIN. SO, AGAIN, IT'S NOT PERHAPS THE MOST IDEAL SOLUTION IN TERMS OF COLOR SELECTION. BUT NONETHELESS I THINK IT'S IMPORTANT OUR PARTNERS AND US REALLY THINK ABOUT HOW DOES A PARTICULAR TECHNOLOGY FIT INTO A PERSON'S LIFE. WHAT ARE THEIR NEEDS? ARE THERE AESTHETIC NEEDS? BIOLOGICAL NEEDS? WHATEVER ELSE. NO ASSUMPTIONS, WE NEED TO TALK TO THE COMMUNITIES AND ASK WHAT THEY ARE LOOKING FOR. NEXT SLIDE. >> THREE MINUTES LEFT. >> THANK YOU. SO IN SHORT, WE ARE REALLY TRYING TO DEVELOP TECHNOLOGIES THAT WORK FOR EVERYBODY. IN TERMS OF TELEHEALTH, I THINK IT'S A FASCINATING APPROACH, BUT AGAIN, WHO DOES IT ACTUALLY WORK FOR? DOES IT WORK FOR PEOPLE WHO DON'T HAVE SMARTPHONES WHICH THERE ARE 20 OR SO OR MORE MILLION INDIVIDUALS IN THIS COUNTRY. DOES IT WORK FOR PEOPLE IN MAYBE RURAL COMMUNITIES WHO DO NOT NECESSARILY HAVE BROADBAND OR RELIABLE CELL SIGNAL? I DON'T KNOW. IT'S SOMETHING WE CERTAINLY NEED TO THINK ABOUT. WE ALSO NEED TO THINK ABOUT INDIVIDUALS LIVING IN URBAN AREAS VERSUS RURAL AREAS. THEIR ACCESS TO MEDICAL CARE. IF YOU CLICK ONCE MORE, AND ONCE MORE, THANKS. ANOTHER THING ON THE TOP OF MY MIND IS THE COST OF TECHNOLOGIES THAT WE HELP SUPPORT. I TOOK A SCREEN SHOT FROM GOOGLE SEARCH THAT INDICATES PRICES. THE COST OF SOME OF THE COMMON PHYSIOLOGICAL SENSORS THAT, YOU KNOW, WE MIGHT BE USING AS PART OF OUR RESEARCH PROJECT. I WOULD ARGUE THEY ARE SOMEWHAT PRICEY. SHOULDN'T WE BE RESPONSIBLE TO HELP DEVELOP TECHNOLOGIES THAT COME IN DIFFERENT PRICE POINTS FOR INDIVIDUALS WITH DIFFERENT FINANCIAL NEEDS. AND THEN, YOU KNOW, LAST BUT NOT LEAST, I HAVE HERE THIS IMAGE OR SKETCH OF TATTOO INK SENSOR. THERE ARE INDIVIDUALS WHO DO NOT NECESSARILY WANT TO OR WANT TO CARRY A CELL PHONE OR HAVE ACCESS TO A CELL PHONE. WHY DEVELOP TECHNOLOGY THAT REQUIRE THAT KIND OF DATA SHARING OR DATA UPLOAD. THESE ARE ALL CONCERNS AGAIN ABOUT USER NEEDS AND DIFFERENT USER COMMUNITIES I THINK WE ABSOLUTELY HAVE TO TAKE INTO ACCOUNT. NEXT SLIDE. SO THAT'S IT FOR MY PRESENTATION. IF YOU WOULD LIKE TO FOLLOW-UP NOW, I WOULD LOVE TO HEAR YOUR QUESTIONS. OTHERWISE PLEASE FEEL FREE TO REACH OUT TO US AT THE DRIVE WEBSITE AND ENACT EMAIL. THANK YOU. >> THANKS, SEILA FOR THE INFORMATIVE OVERVIEW, THE NUMBER OF PARTNERSHIPS, OVERVIEW. I WOULD ASK THE AUDIENCE IF YOU HAVE ANY QUESTIONS, ASK THROUGH CHAT FOR THE PANEL DISCUSSION. WE HAVE ONE FINAL TALKER, BEFORE THE DISCUSSION, IT'S OUR PLENARY DISCUSSION. I WILL HAND IT OVER TO MARGARET. >> HELLO, GOOD AFTERNOON,ER ONE. THANK YOU SO MUCH FOR STICKING AROUND FOR THE LAST BUT NOT LEAST TALK. WHICH I WOULD LIKE TO INTRODUCE, MY PLESZ PLEASURE TO INTRODUCE CHRIS AUSTIN FROM NIH. THIS IS DR. AUSTIN'S LAST OFFICIAL DAY AT NIH AND GIVE HIM A WARM WELCOME AND WILLINGNESS TO SPEND THIS DAY AND BEST WISHES FOR HIS NEXT VENTURE IN THE PRIVATE SECTOR. WITH THAT, I WOULD LIKE TO TURN IT OVER TO CHRIS AUSTIN. THANK YOU. >> ALL RIGHT, MARGARET, THANK YOU. THANK YOU FOR HAVING ME AND THANK YOU FOR STICKING THROUGH THIS. YOU HAVE BEEN THROUGH A LOT TODAY. I APPRECIATE IT. SOMEHOW I THINK THIS IS APPROPRIATE THAT THIS SHOULD BE MY LAST OFFICIAL ACT AS NCAST DIRECTOR GIVING A TALK ABOUT WHAT NCATS DOES. THIS IS SPECIFICALLY OF COURSE FOCUSED ON THE TOPIC OF THIS WORKSHOP WHICH IS HOW DO WE GET MORE DIAGNOSTICS AND TREATMENTS. HOW DO WE GET MORE INTERVENTIONS TO MORE PATIENTS MORE QUICKLY. HOW DO WE CHANGE THE SYSTEM IN A WAY THAT WILL GET INTERVENTIONS DEVELOPED AND DEPLOYED. AND AS YOU HAVE HEARD THROUGH THE COURSE OF THIS WORKSHOP, NOT JUST TO THE USUAL SUSPECTS BUT TO FOLKS WHO HAVE OFTEN BEEN LEFT OUT OF THE WONDERS OF SCIENCE AND MEDICINE. I WILL RUN THROUGH A FEW EXAMPLES OF THE KINDS OF THINGS THAT WE ARE DOING IN THIS SPACE. AND OF COURSE, IN 15 MINUTES THAT'S REALLY ALL I CAN DO. I WANT TO GIVE A SENSE OF REALLY HOW DIFFERENTLY WE ARE THINKING OF SOME OF THESE PROJECTS. THIS IS A PROJECT THROUGH RADx-rad. SCANNING FOR COVID-19. WE ARE AWARE THOSE WHO HAVE PETS, DETECTION OF SCENT, NOT VISION, BUT SCENT IS THE MOST PERVASIVE METHOD OF SENSING IN NATURE. YET WE RARELY USE THEM IN THE DIAGNOSIS OF DISEASE. THIS PROCESS IS REVERSE ENGINEERING A BIO MIMIC NOSE, IN THE SENSE OF SMELL FOR DIAGNOSIS OF COVID-19. THIS, SO A NUMBER MIGHT GIVE ONE EXAMPLE. A DEVELOPMENT OF A HAND-HELD MICROCHIP DEVICE FOR DOING G.C. GASTROMOTOGRAPHY OF BREATH FOR COVID-19. IT'S COMPLETELY PORTABLE. IT'S NON INVASIVE. IT'S SOMETHING THAT ANYBODY CAN DO IN ANY RURAL URBAN, AS LONG AS YOU HAVE THIS DEVICE. AND IMPORTANTLY, THE STUDY THAT IS GOING TO BE DONE HERE FROM THE VERY BEGINNING IS GOING TO ENROLL 50% MEN, 50% WOMEN. VERY WIDE AGE GROUP, 25% WILL BE AFRICAN AMERICAN, AT LEAST THAT'S OUR TARGET. -- MUTED. FOR SOME REASON I GOT MUTED. CAN YOU GUYS STILL HEAR ME? >> YES, WE CAN HEAR YOU NOW. >> OKAY. WERE YOU ABLE TO HEAR ME BEFORE? >> JUST FOR A FEW SECONDS NOT, BUT OTHERWISE, YES. >> YEAH, I DON'T KNOW WHAT HAPPENED. LET ME JUST DO THIS. SCREEN SHARING, OKAY. SORRY. HE JUST GOT A WEIRD MESSAGE. NEXT ONE, THESE ARE EXOSOMES. LIPID BASED WE LEARNED ABOUT AS CELLULAR GARBAGE. TURNS OUT EXOSOMES HOLD RNA IN PROTEIN BUT WE HAVE BEEN STUDYING THEM PARTICULARLY FOR RNA'S THAT WHETHER ONE COULD USE EXOSOMES DETECTED IN SALIVA, WHICH IS OF COURSE A SIMPLER, MORE ACCEPTABLE, COMFORTABLE FOR THE PATIENT, COULD BE INSTITUTED ANYWHERE, YOU DON'T NEED TO BE A HEALTH PROFESSIONAL, YOU COULD BE A COMMUNITY HEALTH WORKER OR THE PATIENT THEMSELVES. AGAIN, LIKE THE OTHER ONE, ALL THESE STUDIES THAT WILL BE DONE LOOKING FOR, LOOKING TO DETECT SARS-COV-2 VIA EXOSOMES IN THE SALIVA WILL INTENTIONALLY REFLECT THE CLINICAL SITES. IT'S BEEN POINTED OUT BY OTHER PEOPLE IN THE WORKSHOP, WE OFTEN START OFF ON THE WRONG FOOT BY RECRUITING SITES WHICH DON'T HAVE POPULATIONS, UNIFORM, A REPRESENTATIVE POPULATION OF THE UNITED STATES. IF YOU DO THAT, IF YOU CHOOSE THE WRONG SITES THERE'S REALLY NO WAY YOU WILL BE ABLE TO RECRUIT THE KIND OF DIVERSITY YOU WANT. AGAIN HERE, IT'S NOT ONLY GENDER DIVERSITY BUT ETHNIC AND RACIAL DIVERSITY AND ETHNIC DIVERSITY, LOOKING AT PEDIATRIC POPULATIONS. SOMETHING WE HAVE DONE ALSO TO DEMOCRATIZE AND MAKE IT ACCESSIBLE TO ANY COMMUNITY IS SOMETHING CALLED CURE ID. A MOBILE APP YOU COULD DOWNLOAD FROM THE APP STORE OR GOOGLE PLAY. WE DEVELOPED WITH THE FDA TO ALLOW HEALTHCARE WORKERS ANYWHERE AROUND THE WORLD TO REPORT NOVEL USES OF EXISTING DRUGS. THAT IS REPURPOSING. WE ORIGINALLY REGENERATED THIS FOR USE MAINLY IN PARTS OF THE WORLD THAT EXPERIENCE NEGLECTED TROPICAL DISEASES. SO A DEVELOPING WORLD. IT'S CERTAINLY BEEN USEFUL FOR THAT. BUT IT JUST SO HAPPENED WE DEBUTED THIS APP A MONTH BEFORE COVID STARTED. SO VERY QUICKLY, IT WAS A COVID APPLICATION WAS ADDED. COVID MODULE WAS ADDED TO THE MOBILE APP. IN THE EARLY DAYS OF THE PANDEMIC, THOSE TERRIBLE DAYS WHERE WE WERE SEEING TENS OF THOUSANDS, OR EVEN HUNDREDS OF THOUSANDS OF PATIENTS, AND WE HAD REALLY NO IDEA, CLINICIANS HAD NO IDEA HOW TO TREAT THESE PATIENTS. THIS SORT OF REAL WORLD INFORMATION IN REAL-TIME FROM CLINICIANS ALL OVER THE WORLD WAS INVALUABLE FOR IDENTIFYING, REPURPOSING CANDIDATES THAT WERE THEN TESTED IN CLINICAL TRIALS. ANOTHER THING WE DID EARLY ON, AND THEY ARE STILL DOING IS TO DEVELOP A REALLY BREAK THROUGH ENCLAVE OF ELECTRONIC HEALTH REPORTS. WE WOULD HAVE WANTED TO KNOW WHAT ARE THE AGES, ETHNICITIES, THE RACIAL MAKE UP, THE MALE/FEMALE MIX OF PATIENTS WHO WERE GETTING SICK OF AND DYING FROM COVID. AND WE HAD NO WAY TO KNOW THAT. WE HAD NO SYSTEM IN THIS COUNTRY TO FIND THAT OUT IN ANY KIND OF REAL-TIME. QUICKLY BUILDING ON WORK WE HAD DONE THROUGH THE C.T.S.A. AND CENTER FOR DATA HEALTH. AND THE INTERNAL NCATS IT AND SECURITY AND HUMAN SUBJECTS, POLICY FOLKS HAD DONE ABOUT THE LAST THREE YEARS WE WERE ABLE TO DEVELOP IN THE COURSE OF ABOUT THREE MONTHS THIS QUITE REMARKABLE ENGRAVE THAT NOW HAS -- ENCLAVE THAT NOW HAS DATA. IT SAYS ON THE NEXT SLIDE, FROM OVER 50 SITES THAT ARE CTSA SITES AS WELL AS CTR SITES, WHICH ARE CLINICAL TRANSLATIONAL RESEARCH CENTER SITES OF THE IDEA PROGRAM, SUPPORTED BY NIEHMES. THIS HAS AN UNPRECEDENTED NUMBER OF PEOPLE, 5 MILLION PATIENTS, 1.2 MILLION OF THOSE HAVE A COVID DIAGNOSIS. WE HAVE EHR'S GOING BACK TWO YEARS ON COVID ON ALL OF THEM, AND WE GET THEM UPDATED EVERY COUPLE WEEKS OR SO. PROVING TO BE INCREDIBLY VALUABLE FOR NOT ONLY UNDERSTANDING COVID BUT THE POST-ACUTE SYMPTOMS, LONG COVID SYNDROME. APPARENTLY THIS IS LIKE ANY GOOD N.I.H. PROJECT, AVAILABLE TO RESEARCHERS FROM AROUND THE WORLD, QUALIFIED RESEARCHERS GO THROUGH A DATA ACCESS COMMITTEE AND OVER 100 PROJECTS FROM 300 DIFFERENT INSTITUTIONS. YOU WOULD ENCOURAGE YOU TO HAVE A LOOK AND APPLY FOR ACCESS. IT'S THERE FOR YOU TO USE. I WANT TO STRESS HOW WONDERFULLY REPRESENTATIVE THIS ENCLAVE IS, THE CONNECTION IS, -- COLLECTION IS TO THE U.S. POPULATION. THE TOP ONES, LOOKING AT MALE FEMALE DISTRIBUTIONS. IF YOU LOOK AT THE BOTTOM YOU ARE LOOKING AT RACE AND ETHNICITY. YOU WILL SEE THE REALLY ROBUST REPRESENTATION OF BLACK AND HISPANIC AND ASIAN POPULATIONS THAT MIRRORS AND WE COMPARED TO THE NUMBERS IN THE "NEW YORK TIMES" ON A REGULAR BASIS ON THEIR SITE. AND THEY REALLY ARE REPRESENTATIVE OF THE U.S. POPULATION. THIS IS WHAT WE NEED AND WHAT WE NEEDED WHEN THIS STARTED. THE GREAT THING ABOUT THIS, DISEASE AGNOSTIC, WE CAN TURN THIS PLATFORM NOW TO ANY OTHER DISEASE AND WE HOPE TO BE ABLE TO DO THAT ONCE COVID IS OVER. ONE OF THE FIRST THINGS WE DID WITH THIS AS YOU MIGHT IMAGINE IS DEVELOP MODELS OF PATIENT DISEASE COURSE SEVERITY AND WITHOUT GOING THROUGH THIS, WE GENERATED A LOT OF COMPLICATED HEAT MAPS AND THINGS THESE KINDS OF PROGRAMS DO. THIS IS ALL PUBLISHED NOW. SO YOU GET ON THE WEBSITE, YOU CAN GET ALL THOSE DATA. SOMETHING THAT HAS REALLY BECOME TO THE FORE DURING COVID THAT'S BEEN QUITE WONDERFUL FOR US TO SEE IS THE FOCUS ON COMMUNITY ENGAGEMENT. YOU HEARD THE LAST SPEAKER TALK ABOUT THIS. FROM NCATS POINT OF VIEW, TRANSLATION IS ONLY SUCCESSFUL IF IT GETS TO WHERE PEOPLE LIVE. PEOPLE DON'T LIVE IN CLINICAL TRIALS. THEY LIVE IN A COMMUNITY. SO UNLESS THEY GET TO THE COMMUNITY WHERE PEOPLE LIVE, AND ALL PEOPLE, ALL KINDS OF PEOPLE LIVE IN ALL KINDS OF COMMUNITY, WE HAVE FAILED. LET'S JUST BE -- I PUT IT REALLY AS FRANK AS THAT. I THINK WE HAVE TO REALIZE WE HAVE FAILED IN OUR MISSION UNLESS WE DO THAT. SO ALL OF THE C.T.S.A. PROGRAM HUBS HAVE ROBUST AND VERY LONG-STANDING COMMUNITY ENGAGEMENT, DISSEMINATION, RESEARCH PROGRAMS, THIS HAPPENS TO BE A FEW FROM INDIANA, ARKANSAS, THE WHAMMY NETWORK AND UNIVERSITY OF NEW MEXICO. SOMETHING YOU MAY HAVE HEARD ABOUT BEFORE, WHICH IS A REAL LEADING PLATFORM FOR TELEMEDICINE. A DIFFERENT KIND OF TELEMEDICINE. ECHO DOESN'T LIKE TO CALL ITSELF TELEMEDICINE. SOMETHING AT THE UNIVERSITY OF NEW MEXICO HUB. IT REALLY IS A NOT ONE-ON-ONE TRADITIONAL TELEMEDICINE. IN THIS CASE, THE TREATING PHYSICIAN, USUALLY OFTEN IN A RURAL SETTING OR UNDER-SERVED SETTING RETAINS RESPONSIBILITY FOR MANAGING THE PATIENT. BUT THEIR HELP IN DOING THAT BY DOCTORS OR OTHER HEALTHCARE PROFESSIONALS WHO HAVE KNOWLEDGE AND EXPERTISE. THIS HAS GROWN OVER THE LAST TEN YEARS BY JUST LEAPS AND BOUNDS. AND I'M JUST SHOWING YOU THE U.S. MAP. THESE ARE UNITED STATES HUBS AND SO-CALLED SUPER HUBS THAT DO A LOT OF COORDINATION. AND THIS IS NOW A TRULY GLOBAL INITIATIVE TO HELP DISSEMINATE KNOWLEDGE OF HOW TO TREAT, DIAGNOSE AND TREAT DISEASE, NO MATTER WHERE YOU LIVE. SO USING THE EXPERTISE THAT LIVES IN ALL KINDS OF PLACES, BOTH THE FANCY ACADEMIC PLACES THAT ALL OF US KNOW AND LOVE, AND MANY OF US HAVE BEEN OR FROM. BUT ALSO FROM THE MORE REMOTE SITES. WHAT'S BEEN PARTICULARLY GRATIFYING AND NOT SURPRISING TO ANY OF US WHO HAVE EXPERIENCE IN THOSE MORE REMOTE PLACES IS A LOT OF THE INSIGHTS, THEY ARE BILATERAL INSIGHTS. THE INSIEGTSES ARE COMING FROM THE SPECIALTY CENTERS BUT JUST AS MUCH COMING TO THE SPECIALTY CENTERS FROM THE MORE REMOTE SITES. THIS IS -- AFTER A SORT OF TYPICAL LOGO RHYTHMIC GRAPH WHERE THE USE HAS GONE UP JUST RIDICULOUS IN THE LAST YEAR AND A HALF. THERE WAS A HUGE INCREASE, OF COURSE, DUE TO COVID. WE ARE HOPING THIS CONTINUES ONCE COVID IS OVER. ANOTHER THING WE HAVE BEEN DOING THROUGH THE C.T.S.A. PROGRAM OUT OF SCRIPTS, TOPEL AND HIS PROGRAM THROUGH THEIR C.T.S.A. HAS MANY PROGRAMS ON DETECTION, DIAGNOSIS AND EVEN TREATMENT OF DISEASE THROUGH MOBILE TECHNOLOGIES AND AS YOU ALL KNOW, PROBABLY, THAT GROUP IS VERY PROLIFIC, DEVELOPED A NUMBER OF VERY LARGE NUMBER OF WEARABLE SENSORS TO DETECT COVID-19. WE ARE INTERESTED IN MAKING SURE THIS CONTINUES AND GETS REIMBURSED AND GETS SIS -- DISSEMINATED TO ALL THE PARTS OF THE WORLD WHO NEED IT. THAT'S THE WORK WE WILL HAVE TO DO NOW THAT SOME OF THESE HAVE BEEN DEVELOPED. IN RURAL HEALTH, NCATS AND NHLBI HAVE PARTNERED WITH OTHER INSTITUTES, MINORITY HEALTH AND HEALTH DESPAIRITIES AMONG THEM ON RURAL HEALTH. AND WE CO-RUN THE RURAL HEALTH MEETING THAT'S HELD EVERY YEAR. AND LAST YEAR THE RURAL HEALTH SEMINAR, WHICH I HOPE YOU WILL TAKE PART IN ON RUE ROLL CALL HEALTH -- RURAL HEALTH DAY. THE WEEK BEFORE THANKSGIVING EVERY YEAR. TO BRING ATTENTION TO THE PARTICULAR ISSUES OF PEOPLE WHO LIVE IN RURAL PARTS OF THE COUNTRY AND THE WORLD. I'M SURE YOU ARE ALL AWARE, I HOPE YOU ARE. THE INCIDENCE AND PREVALENCE OF CHRONIC AND ACUTE DISEASE IN THE WORLD AND MORE MORTALITY AND MORBIDITY ARE WORSE IN RURAL SETTINGS AND DESERVE OUR ATTENTION. ONE OF THE THINGS WE HAVE BEEN DOING TOGETHER WITH AGAIN, NHLBI BUT OFFICE OF DISEASE PREVENTION AND THE OFFICE, IN BUILDING ONE, ALONG WITH CDC AND HRSA IS THIS PATHWAY TO PREVENTION PROGRAM. BASED ON TELEHEALTH GUIDER PROVIDER TO PROVIDER COMMUNICATION. THIS IS SOMETHING THAT I DID PERSONALLY, WHEN I WAS WORKING IN A HOSPITAL IN REMOTE ALASKA A NUMBER OF YEARS AGO. AND WAS ABSOLUTELY CRITICAL FOR US TAKING GOOD CARE OF PATIENTS. IF YOU ARE INTERESTED, WHICH I HOPE YOU WILL BE, WE ARE SO DEVOTED AND EVANGELISTIC TO THIS TOPIC, WE CREATED A NUMBER OF RESOURCES AND TO ILLUSTRATE THE POTENTIAL FOR COMMUNITY ENGAGEMENT AND RESEARCH AND OUTREACH THAT, AND THE POTENTIAL THESE KIND OF APPROACHES HAVE. WE HAVE DEVELOPED, OF COURSE, A WEB PRESENCE TO TELL PEOPLE ABOUT THIS. BECAUSE WE ARE, WE THINK THERE IS A LOT THAT CAN BE DONE TO IMPROVE HEALTH OF UNDERSERVED POPULATIONS THROUGH THIS KIND OF METHOD. THAT IS IT FROM ME. I HOPE IT GAVE YOU A TICKLER OF THE KINDS OF THINGS NCATS HAS DONE. AS YOU HEARD FROM MARGARET, I ONLY HAVE SEVEN MORE HOURS AT NIH. BUT AS I TOLD EVERYONE, MY VENUE OF ACTIVITY MAY BE CHANGING FROM NIH TO FLAGSHIP PIONEERING IN BOSTON. BUT MY INTEREST AND DEVOTION TO TRANSLATIONAL SCIENCE TO THE PUBLIC WON'T CHANGE ONE IODA. I LOOK FORWARD TO WORKING WITH ALL OF YOU JUST WITH A DIFFERENT EMAIL ADDRESS AFTER TOMORROW. THANK YOU, MARGARET, FOR INVITING ME. >> THANK YOU SO MUCH FOR YOUR COMMENTS AND YOUR EXCELLENT PRESENTATION AS YOU MOVE ONTO YOUR NEXT ACT ON THE WORLD STAGE, AS IT WERE. >> THANK YOU. >> WE DON'T HAVE TIME FOR A QUESTION AT THE MOMENT. IF YOU HAVE A BIT OF TIME TO STAY FOR THE PANEL DISCUSSION WE HAVE A QUESTION THAT I THINK KATHLEEN HAS FOR YOU. IF IT WORKS FOR YOU. OR IF YOU NEED TO PACK UP, THAT'S FINE TOO. OVER TO YOU, KATHLEEN. >> THANKS, MARGARET. THANKS FOR A WONDERFUL PRESENTATION, CHRIS. AND BEST OF LUCK TO YOU, HUGE LOSS TO NIH. I WAS CURIOUS ABOUT THE RADx-raD INITIATIVE. SH THERE'S A LOT OF TALK ABOUT COMMON DATA ELEMENTS. AND CAN YOU TALK A LITTLE ABOUT THE EXPECTATIONS FOR THESE PROJECTS AND WHAT THAT'S GOING TO FEED INTO AS FAR AS BEST PRACTICES? >> THAT'S A REALLY GOOD QUESTION. I CAN START AND TAKE A SHOT. I DON'T KNOW IF SUSAN IS ON THE LINE. SHE HAS BEEN DRIVING THIS BUT I'VE BEEN PRIVILEGED TO BE INVOLVED IN THAT AS WELL. THERE'S REAL CONCERN THAT TOWER OF BABEL BEING CREATED WILL SHARE DATA, COMPARISON AND DISSEMINATION OF THOSE TECHNOLOGIES WITH EVERYONE USING THEIR OWN DATA FORMATS AND THEIR OWN LANGUAGES, ETC., ETC. WHAT HAPPENED WITH RADx THERE WAS SUCH A DESIRE TO GET THE TECHNOLOGIES FUNDED THAT THE CDD'S AND THE DATA HUB, ACTUALLY CAME AFTER TO A GREAT DEGREE THE FUNDING OF THE INDIVIDUAL PROJECTS. NORMALLY ONE WOULD DO IT THE OTHER WAY AROUND, YOU WOULD FIGURE OUT THE CD'S AND STRUCTURE OF THE DATA AND ALL THAT. ONCE YOU HAVE DONE THAT YOU PUT OUT THE INDIVIDUAL GRANTS. THE COVID INITIATIVE AND NEED FOR NOVEL DIAGNOSTICS SIMPLY DIDN'T ALLOW THAT. SO WHAT'S HAPPENING NOW IS THROUGH THE WORK OF SUSAN'S OFFICE IN THE OFFICE OF DATA SCIENCE STRATEGY, PATTY BRENNAN AT N.L.M. NCATS. NLHBI, ALL ARE WORKING ON NOT ONLY A DATA HUB, WHICH WOULD BRING ALL THE DATA TOGETHER FROM ALL OF THESE PLATFORMS. SO ONE MIGHT COMPARE THEM, A LITTLE BIT LIKE THE TISSUE CHIP DATABASE, EVIDENCE DATABASE WE HAVE. SOME MAY BE FAMILIAR, THE SAME ISSUE HELD. AND A WORK ON ELEMENTS OF VOCABULARY, ONTOLOGY, COMMON DATA ELEMENTS. AND JUST TO SOME DEGREE, THE PROJECTS ARE A WORK IN PROGRESS. SO WE ARE HOPING THAT AS THE PROJECTS DEVELOP, IT'S REALLY A RADx-rad THAT CAME LAST THAT WE SHOULD BE, HOPE YOU ARE OKAY WE ME USING THIS WORD, IMPOSE THOSE COMMON DATA ELEMENTS. THAT VOCABULARY SO WE ARE ALL SPEAKING THE SAME LANGUAGE WHEN ALL THESE GET DONE. IT'S A VERY IMPORTANT ISSUE. FRANKLY, I THINK IT'S A GREAT OPPORTUNITY FOR THE NIH. BECAUSE OFTEN, ALL THE INSTITUTES GO IN VARIOUS DIFFERENT DIRECTIONS AND THEY TRY TO COLLABORATE AND COORDINATE BUT IT'S A BIG ORGANIZATION. IT'S KIND OF HARD TO DO THAT SOMETIMES. WHEREAS WITH COVID, THIS IS AN ALL-HANDS-ON DECK. WE CAN THINK ABOUT DOING THIS THE RIGHT WAY AND ESTABLISHING PROCEDURES AND WAYS OF DOING THESE PARADIGMS WE CAN THEN USE FOR OTHER DISEASES. >> THANK YOU. MARGARET, DID YOU WANT TO MOVE OVER TO THE PANEL DISCUSSION? >> YES. WE CAN MOVE ON OVER TO THE PANEL DISCUSSION. >> THANK YOU VERY MUCH, CHRIS. >> FOR THIS PANEL DISCUSSION, WE WILL HAVE MARTIN MENDOZA AND KATHLEEN AND -- THIS IS AN OPPORTUNITY TO ASK QUESTIONS WE HAVE FROM THE FEDERAL PANEL SESSION. SO FEEL FREE TO PUT QUESTIONS IN THE CHAT AND I THINK WE WILL START WITH MARTIN. YES, IF YOU COULD. >> THANKS, MARGARET. THANK YOU TO OUR PANELISTS. SO FOR THIS PANEL, WE ARE GOING TO HAVE DR. BERLINER, DR. KELLY, DR. STATES, DR. ENGLAND, DR. FOSTAL AND DR. FORE. DR. LEE HAD A PREVIOUS ENGAGEMENT SO SHE WON'T BE ABLE TO JOIN THE PANEL. I WANT TO START WITH A QUESTION FOR DR. POSTAL AND FORE FOR THEIR PRESENTATION. CAN YOU PROVIDE AN UPDATE IF THE I.H.S. IS SHIFTING OVER TO A CENTER OR NEW EHR SYSTEM, OR NEW E.H.R. SYSTEM, IF SO, HOW CAN A NEW SYSTEM ALLOW OR ENABLE PUBLIC HEALTH OR RESEARCH PARTNERS TO PARTICIPATE IN TRIBAL CARE RESEARCH? >> CAN YOU HEAR ME OKAY IN >> YES. >> HI THERE. SO THAT'S A GREAT QUESTION, AND THANK YOU FOR ASKING. I DID PUT IN THE CHAT THE INDIAN HEALTH SERVICE, AS I SHARED USING THE RESOURCE AND PATIENT MANAGEMENT SYSTEM NOW. THROUGH H.I.T. MODERNIZATION PROJECT AND EFFORTS. CONFER THE DECISION WAS MADE. IT WAS SENT OUT APRIL 1st THAT THE INDIAN HEALTH SERVICE IS LOOKING TO DO A FULL REPLACEMENT OF OUR ELECTRONIC HEALTH RECORD. SO THERE IS AN H.I.T. MODERNIZATION TEAM THAT WILL BE ADDRESSING THIS IN THE SENSE OF WE HAVE A REQUEST FOR INFORMATION NOW OUT FOR VENDORS TO REPLY BACK TO, THAT COMES DOWN ON THE 19th. WE WILL BE SETTING UP A PROJECT MANAGEMENT OFFICE AND CONTINUING WITH THE H.I.T. MODERNIZATION EFFORTS. AND COLLABORATING WITH OTHER FEDERAL AGENCIES TO LEARN >> THANK YOU. >> THIS IS CHRIS. THE DATA PIECE, THAT COULD BE FAIRLY COMPLICATED FOR OUR AGENCY. SOVEREIGNTY IS A BIG ISSUE FOR THEM. THAT COMES INTO PLAY FOR THEM HERE. ALSO BECAUSE OUR COMMUNITIES ARE QUITE SMALL, BEING ABLE TO DE-IDENTIFY DATA CAN BE A CHALLENGE. DR. POSTAL TALKS ABOUT THIS A LOT. HAVING TO HAVE A CERTAIN NUMBER OF PEOPLE BEFORE WE CAN INCLUDE THAT JUST BECAUSE WITHOUT THAT, THE LARGER POOL OF FOLKS, IT WOULD BE VERY EASY TO IDENTIFY INDIVIDUALS IN A GIVEN DATA SET. EVEN IF IT'S "DE-IDENTIFIED". WE RECOGNIZE THAT THERE'S A NEED TO GET DATA AND ANALYZE AND HELP PEOPLE MOVE THE LITERATURE FORWARD. HOWEVER, THERE ARE OTHER THINGS AT PLAY THAT MAKE THAT MORE KHAL CHALLENGING FOR OUR AGENCY, THAN PERHAPS OTHERS. >> THANK YOU VERY MUCH, DR. POSTAL AND DR. FORE. THE NEXT QUESTION I HAVE HERE IS FOR DR. BERLINER. YOU DESCRIBED TWO OF THE REPORTS SYNTHESIS YOU WORKED ON IN YOUR PRESENTATION. ARE YOU ABLE TO TELL US ABOUT ANY UPCOMING REPORTS REVIEWS YOUR GROUP IS CURRENTLY WORKING ON AND WHEN WE CAN EXPECT TO SEE THOSE? >> YEAH, SO I MENTIONED, WE HAVE ONE ON SLEEP APNEA THAT I WOULD REALLY ENCOURAGE EVERYONE TO TAKE A LOOK AT. IT'S POSTED AS A DRAFT REPORT. WE ARE ALSO WORKING ON A WHOLE BUNCH OF REPORTS ON TELEHEALTH. SO WE ARE GOING TO BE STARTING A REPORT THAT WAS REQUESTED BY THE HRSA OFFICE OF WOMEN'S HEALTH ON TELEHEALTH FOR WOMEN. LOOKING AT USING TELEHEALTH FOR FAMILY PLANNING AND DOMESTIC VIOLENCE. AND WE ARE STARTING A REPORT NOW ALSO ON TELEHEALTH DURING COVID-19. WE HAVE A LOT, I WOULD REALLY ENCOURAGE EVERYBODY TO LOOK AT THE EFFECTIVE HEALTHCARE WEBSITE. WE POST ALL OUR REPORTS AND PROTOCOLS FOR USE. WE WOULD LOVE TO HAVE EVERYBODY'S INPUT. >> THANK YOU SO MUCH, DR. BERLINER. MY NEXT QUESTION IS FOR DR. KELLY. DR. KELLY, CAN YOU TELL US A BIT ABOUT WHAT HELP F.D.A. CAN OFFER WITH PROJECTS TO HELP THESE START-UPS BECOME A COMPANY? >> YEAH, WELL, WE HAVE A WHOLE OFFICE OF -- SORRY. WE HAVE A WHOLE OFFICE OF E SENTENCELY ESSENTIALLY PARTNERSHIPS AND PATIENT SCIENCE. REALLY, I GUESS, WHAT WE ARE LOOKING FOR WITH SMALL COMPANIES IS TO COME TO US EARLY AND TO JUST ENGAGE, SO WE CAN KIND OF POINT YOU IN THE RIGHT DIRECTION. THE WORST THING IS FOR A SMALL COMPANY TO TRY TO THINK OF ALL THE ANSWERS THEMSELVES. TRY TO THINK ABOUT THE FASTEST WAY TO THE F.D.A. AS OPPOSED TO THE WAY THAT DEVELOPS THE BEST BODY OF EVIDENCE NOT JUST THE FDA BUT THE PAYERS AND PROFESSIONAL SOCIETIES AND ALL THE OTHER STAKE HOERLDS BECAUSE THEY ARE LOOKING AT A WHOLE BODY OF EVIDENCE, NOT JUST WHAT WE NEED FOR F.D.A. LIKE I SAID BEFORE IN MY TALK. I THINK HOLISTICALLY, IT MAY COST YOU A LITTLE MORE UP FRONT BUT IT WILL SAVE YOU ON THE BACK END. THE DEFAULT FEETS FEATURED, THEY GET THROUGH THE F.D.A. WHEN THEY COULD HAVE STARTED A STUDY FOR THEIR F.D.A. STUDY AND ROLLED IT OVER TO ANSWER A BUNCH OF QUESTIONS FOR STAKEHOLDERS AND SHORTENED THE TIME BY A LOT. YOU COULD SAVE A LOT OF TIME. WHEN YOU COME TO THE F.D.A., PART OF THE PROGRAM THAT WE HAVE AND THROUGH A NEW PROGRAM WE ARE POSING CALLED THE T.L.P.C. ADVISORY PROGRAM, YOU WOULD BE ABLE TO GET THAT HELP, BRING THOSE STAKEHOLDERS TOGETHER UP FRONT, EVALUATE THE RISK UP FRONT AND DECIDE, SOME PEOPLE WILL LOOK AT ALL THE RISK THEY HAVE, AND SAY THIS DOESN'T MAKE ANY SENSE TO ME. IT'S TOO RISKY. THAT'S FINE. I WOULD RATHER HAVE THEM FAIL EARLY THAN INVEST $150 MILLION IN A PROJECT AND FAIL LATE. I GUESS WHAT WE ARE ASKING IS PRIMARILY TALK TO OUR FOLKS, GET A SENSE OF WHAT WE ARE LOOKING FOR AND WHAT OTHER PEOPLE ARE LOOKING FOR AND HELP YOU PUT IT ALL TOGETHER IN A MORE STRATEGIC PLAN. >> THANK YOU SO MUCH, DR. KELLY. MY NEXT QUESTION IS FOR DR. STATES. DR. STATES, COULD YOU TELL US A BIT ABOUT WHEN DO YOU ANTICIPATE RESUMING ANALYSIS WITH THE H.H.S. R.F.I. PARTNERS? >> YEAH, NO PROBLEM. I THINK, YOU KNOW, WE HAD SOME BEST LAID INTENTIONS THAT GOT DISRUPTED BY THE AMOUNT OF E.O. VOLUME THAT'S COME OUT WITH THE CHANGE OF ADMINISTRATION. SO WE ARE LOOKING FORWARD TO BEING ABLE TO GET SOME CLARITY ON PEOPLE'S BANDWIDTH. AND PART OF THAT IS, WE ARE RELYING ON THE KINDNESS OF OUR FRIENDS. THAT ALREADY HAVE FULL PLATES. WE ARE HOPING IN THE NEXT COUPLE MONTHS AS PEOPLE START TO, YOU KNOW, TURN THINGS OVER TO THE POLITICALS THAT HAVE COME ON BOARD WE WILL START TO HAVE A BIT MORE OF THE USUAL BANDWIDTH AND PORTFOLIO MANAGEMENT WE HAD PRIOR TO THE DUSTING UP. SO THAT'S THE SHORT ANSWER THERE. HOPEFULLY BY MID-YEAR FOR THIS YEAR. >> THANK YOU SO MUCH, DR. STATES. MY NEXT QUESTION IS FOR DR. ENGLAND. SO DR. ENGLAND. IT APPEARS THAT INEQUITIES AND ACCESS TO CARE AND INEQUITIES IN ACCESS TO BROADBAND INTERNET ARE CORRELATED. CAN YOU TALK ABOUT HOW AGENCIES LIKE THE F.C.C. AND H.H.S. ARE WORKING TOGETHER TO SOLVE THAT PROBLEM? >> YES. IT IS -- YOU ARE ABSOLUTELY CORRECT. THE CORRELATION IS DEFINITELY THERE. AS I MENTIONED, PRIOR TO THE PANDEMIC, DIRECT TO CONSUMER TELEHEALTH WAS SIMPLY NOT ON OUR TELEHEALTH RADAR BECAUSE IT WASN'T REIMBURSABLE. NOW THAT IT IS, AND RECOGNIZING WE GOT TO WORRY ABOUT PEOPLE WHO DON'T HAVE ACCESS, WE HAVE BEEN DISCUSSING WITH THE F.C.C., IN FACT THE DEPARTMENT OF HEALTH AND HUMAN SERVICES, THE F.C.C. AND THE DEPARTMENT OF AGRICULTURE, OR U.S.D.A. SIGNED AN M.O.U., I BELIEVE ABOUT SEPTEMBER 1st LAST YEAR WE WOULD WORK TOGETHER AND SHARE DATA ON THESE ISSUES. BECAUSE THEY ARE SO CORRELATED. H.H.S. WANTS TO BE THE USER OF BROADBAND, F.C.C. AND U.S.D.A. ARE PROVIDERS OF BROADBAND. WE ARE STARTING THAT. WE HAVE JUST A FEW PROJECTS WE ARE ACTUALLY COOPERATING AND WORKING TOGETHER, WE WILL BE SEEING A LOT MORE OF THAT. WE ARE DISCUSSING A LOT RIGHT NOW, THE BILLIONS COMING OUT IN BROADBAND AND HOW WILL THAT AFFECT TELEHEALTH? IN FACT, WE HAVE OUR OWN SMALL STUDY, WE ARE LOOKING AT THAT VERY CAREFULLY IN A FEW COMMUNITIES. SO YEAH, IT'S NEW ON OUR RADAR, CERTAINLY NOT NEW ON THE F.C.C.'S RADAR. BUT HAVING US WORK TOGETHER IS NEW AND VERY EXCITING. >> ABSOLUTELY. THAT WILL CONCLUDE THE FIRST HALF OF OUR PANEL. I WILL THROW IT OVER TO MY CO-CHAIR, DR. ROUCHER FOR THE SECOND HALF OF OUR PANEL. >> THANKS SO MUCH, MARTIN. SO I HAVE, LET'S SEE, I DIDN'T, I DON'T THINK THERE IS SMIG ANYTHING IN THE CHAT RIGHT NOW. I HAD A COUPLE QUESTIONS. THEY ARE KIND OF GENERIC FOR ANYBODY WHO CARES TO ANSWER. THE FIRST IS ON METRICS. WHAT DOES SUCCESS LOOK LIKE. HAVE YOU DEFINED METRICS EARLY ON IN THE PROGRAM TO COLLECT THE DATA TO SEE IF YOU HAVE COMPLETED THE GOALS OF YOUR PROGRAM. I WOULD LIKE TO START WITH DR. AUSTIN TO ANSWER, YOU USED THE TERM "IMPOSE" ON INNOVATORS. THIS IS IMPORTANT, IF WE AS FEDERAL AGENCIES IN OUR PROGRAMS DON'T BUILD THIS IN THAN THE SITES WE FUND DON'T HAVE THE BANDWIDTH, AND THEY ARE NOT SUPPORTED TO COLLECT THE INFORMATION WE NEED. SO IT'S REALLY IMPORTANT TO THINK ABOUT METRICS VERY EARLY ON. SO WITH RESPECT TO THE C.T.S.A. INSTITUTION AND SPURRING INNOVATION PROPS IN UNDERSERVED POPULATIONS, HAVE YOU BEEN ABLE TO TRACK THE DATA? YOU KNOW, AS FAR AS THAT GOES? >> YEAH. IT'S A CRITICAL QUESTION. THANK YOU FOR ASKING IT. OUR APPROACH TO THIS IS TO ULTIMATELY IMPOSE. BUT TO DO IT IN THE WAY, I THINK A GOOD BOSS DOES. THAT IS A GOOD BOSS WILL HEAR FROM ALL OF THE PEOPLE IN THE ORGANIZATION -- AND EVENTUALLY SOMEBODY HAS TO MAKE THE DECISION. BUT YOU DON'T MAKE A DECISION IN A VACUUM. YOU ASK THE PEOPLE DOING THE WORK, HERE IS THE PROBLEM WE HAVE TO SOLVE. WE CAN TELL YOU WHAT TO DO BUT THAT'S A CLASSIC, WASHINGTON RESPONSE. WE ARE GOING TO JUST GO TELL YOU WHAT TO DO WHICH OFTEN HAS UNINTENDED CONSEQUENCES. WHAT WE FOUND IS THAT THE COMMUNITY NOW REALIZES THIS IS A PROBLEM AND IT'S IMPEDING THEIR OWN WORK. SO WE HAVE GONE TO THEM IN THE N.G.C. IS AN EXAMPLE, MASSIVE EFFORT. THE REASON WE WERE SUCCESSFUL THERE, I WOULD SAY TWO THINGS. ONE, WE HAD QUITE LITERALLY 1,000 COLLABORATORS ON THAT PROJECT. THAT'S HOW MANY, TALK ABOUT TEAM SCIENCE. AND FROM ABOUT 100 DIFFERENT INSTITUTIONS, NOT ONLY INFORMATICS PEOPLE BUT CLINICIANS AND USERS OF THE DATA BEFORE WE SET IT UP. THE OTHER THING WE DID IS WE SAID, YOU KNOW, ULTIMATELY, WE'RE NEVER GOING TO GET EACH INDIVIDUAL SYSTEM AT EACH INDIVIDUAL INSTITUTION TO BE THE SAME. YOU ARE ALL AWARE. YOU ALL KNOW, EVEN EPIC IS NOT EPIC, EVERY INSTALL AT EVERY INSTITUTION, EVEN FOR A COMMON PROGRAM, THEY ARE ALL DIFFERENT. SO WE PUT A HUGE AMOUNT OF EFFORT INTO HARMONIZATION. SO WE WERE ABLE TO HAVE, WITH THESE FUNDAMENTAL PRINCIPLES, WE WERE ABLE TO SAY INSTITUTION, IF YOU USE AN OLD MOP MODEL OR ACT OR WHATEVER MODEL YOU USE TO SEND US THE DATA YOU HAVE AND WE WILL DO THE WORK TO HARMONIZE IT IN A COMMON MODEL, THAT'S WORKED REALLY, REALLY WELL. IN DOING TWO THINGS. ONE, IT ESTABLISHES A LIGHT LEVEL OF COORDINATION FOR SAMENESS. UNIFORM CHARACTERIZATION OF DATA AT THE INSTITUTION. THEN TO SAY BEYOND THAT, YOU ALL DO THAT LIGHT LEVEL OF HARMONIZATION AND WE WILL DO OUR PART AS WELL. WE ARE GOING TO WORK WITH YOU IN A TYPICAL MOVE, WE ARE GOING TO ASSUME WHEN WE HARMONIZE, WE WILL GET IT WRONG. BECAUSE THAT'S THE OTHER THING THAT HAPPENS. YOU HARMONIZE AND COME UP WITH AN ANSWER THAT IS IRRELEVANT WHAT WENT INTO IT. AND THAT'S THE OTHER THING THAT I THINK IS CRITICAL HERE. IT DOES TAKE SUBSTANTIAL EFFORT. I'M NOT GOING TO MINIMIZE THAT. BUT WHAT'S BEEN STRIKING TO ME, AT LEAST IN COVID, IS THAT PEOPLE HAVE BEEN WILLING TO DO THIS, INFORMATICS PEOPLE, I THINK THEY ARE SO DARN TIRED OF BEING DATA JANITORS, IT'S MUCH EASIER TO NOT MAKE THE MESS IN THE FIRST PLACE. AND I THINK THAT'S A VERY GOOD DEVELOPMENT. AND SO THERE, EVERYBODY IS WORKING ON THE SAME SIDE NOW. >> KATHLEEN, YOU ARE MUTED. >> THANK YOU, CHRIS. APPRECIATE IT. BEST OF LUCK TO YOU. I WOULD LIKE TO OPEN UP THE FLOOR IF ANYONE ELSE HAS QUESTIONS ON THE METRICS QUESTION. >> YEAH, KATHLEEN. HILARY WALL. FOR SOME OF OUR MORE CLINICALLY ORIENTED LIKE SMBP WHAT'S IMPORTANT FOR US IS TO WORK FOR CMS AND CLINICAL QUALITY MEASURED DEVELOPERS TO MAKE SURE IF WE ARE USING PATIENT-GENERATED DATA, IF WE ARE ENCOURAGING PATIENTS TO BE ACTIVE PARTICIPANTS IN TELEMEDICINE AND THEY HAVE ALL SORTS OF TECHNOLOGY MONITORS AT HOME WE ARE ENCOURAGING THEM TO USE, WE NEED TO GET THOSE METRICS. HYPERTENSION CONTROL, CLINICIANS ARE INCENTIVIZED TO USE THOSE PATIENT-GENERATED DATA IN THE CLINICAL QUALITY MEASURES FOR BLOOD PRESSURE CONTROL. THERE'S BEEN A DISCONNECT THERE. WE ARE MAKING PROGRESS. BUT WE NEED TO DO SOME MORE WORK IN THAT AREA. >> THANKS, HILARY. ANY FINAL COMMENTS? OKAY. THE OTHER QUESTION I HAD, WE DON'T HAVE TIME TO ANSWER IT BUT I THINK WE NEED TO THINK OF IT AS A GROUP AND HOW WE ARE GOING TO TACKLE IT, THAT ISSUE THAT'S BEEN BROUGHT UP EARLIER OF SUSTAINABILITY. WE CAN SET UP THESE PROGRAMS AND WORK WITH THE COMMUNITY BUT WHEN THOSE FEDERAL FUNDS GO AWAY THERE HAS TO BE SOMETHING IN PLACE SO THAT PROGRAM CONTINUES. WITHOUT THE FEDERAL SUPPORT. SO IT'S REALLY IMPORTANT TO THINK ABOUT THAT EARLY ON ALSO. SO, I WOULD LIKE TO THANK ALL OF OUR PANELISTS THIS AFTERNOON. WELL DONE, THANK YOU FOR PARTICIPATING. REALLY, REALLY APPRECIATE IT. AND I WILL HAND IT OVER TO MARGARET. THANK YOU SO MUCH. >> THANK YOU, VERY MUCH. AGAIN, I WOULD LIKE TO ECHO KATHLEEN'S COMMENTS. THANK YOU FOR ALL THE SPEAKER, SESSION CHAIRS, PLENARY SPEAKERS AND THEZ ABOUT TO LEAVE NIH WHO STILL HAD TIME TO JOIN US. I HAVE A FEW SLIDES. I KNOW EVERYONE IS TIRED END OF THE DAY. THESE ARE HIGHLIGHTS, KEY POINTS WE IDENTIFIED THE PAST COUPLE DAYS. WE WILL WRITE-UP A WORKSHOP SUMMARY REPORT WITH THE OPPORTUNITIES AND CHALLENGES THAT WERE DISCUSSED. SO JUST BRIEFLY, THE COVID PANDEMIC HAS HIGHLIGHTED LONG STANDING CHALLENGING ISSUES REGARDING SOCIETAL HEALTH INEQUITIES AND ACCELERATED SOME OPPORTUNITIES. SO HERE WE IDENTIFIED SOME, INCLUDING REVIVAL OF TELEMEDICINE. REACHING PEOPLE REMOTELY AND TESTING TECHNOLOGY MORE RAPIDLY SUCH AS THROUGH THE RADx. [READING SLIDE] HOW THOSE COULD BE LEVERAGED OR REENGINEERED FOR UNDERSERVED COMMUNITIES AND TECHNOLOGY HOW IT NEEDS TO BE USABLE, HOW COULD IT BE IMPLEMENTED AND USED BY THE COMMUNITIES THAT IT IS CREATED TO SERVE. AND THERE WERE COMMON CHALLENGES AND OPPORTUNITIES IDENTIFIED ACROSS THE PRESENTATIONS. ALSO TECHNOLOGY MAY INCLUDE OTHER IMPORTANT AREAS THAT AFFECT HEALTH EQUITY. HEALTH FOOD, ACCESS, FOOD STORAGE. HEALTH/ADDRESS HEALTH DISPARITIES. ALSO TRUST WAS VERY IMPORTANT FROM THE UNDER REPRESENTED GROUPS WHICH IS NEEDED AND MUST BE CULTIVATED ON A PERSONAL LEVEL TO ACHIEVE EQUITY IN CARE, AND LACK OF TRUST IS A BARRIER IN DATA COLLECTION AND HOW CAN WE BEST MANAGE THAT. AND METRICS ONCE WE CREATE PROGRAMS HOW COULD THEY BE ASSESSED FOR DEPLOYMENT AND EFFECTIVE WAYS OF IMPROVING COMMUNITY HEALTH. AND THEN ON DAY TWO FOR FEDERAL PARTNERSHIPS WE DISCUSSED SOME POTENTIAL AREAS WE CAN PARTNER FOR MANY PUBLIC AND PRIVATE ENTITIES THAT COULD IMPROVE THE NATION'S HEALTH, ADDRESS HEALTH DESPAIR ISPARITIES AS PART OF THEIR CORE MISSION. WE CAN LEVERAGE RESOURCES TO HELP SUSTAIN, WITH SUSTAINABILITY THAT WAS DISCUSSED AND UTILIZATION OF NOVEL TECHNOLOGIES AND HOW TO RETAIN OR REPURPOSE EXISTING INFRASTRUCTURE SUCH AS RADx INFRASTRUCTURE INTRODUCED EARLIER TODAY. NEXT SLIDE, PLEASE. WITH THAT, I WANTED TO MENTION, THE NEXT STEPS ARE THAT WE PLAN TO CONTINUE THESE DISCUSSIONS WITH OUR STAKEHOLDERS AND WE ALSO PLAN TO PUBLISH A WORKSHOP SUMMARY REPORT. SO THAT WILL HELP TO SUMMARIZE EVERYTHING DISCUSSED AND IDENTIFY THESE KEY OPPORTUNITIES AND CHALLENGES AND BARRIERS AND HOW WE CAN SOLVE THEM. AND NEXT SLIDE. AND I WANTED TO JUST EXTEND AGAIN A THANK YOU. THE GRAPHIC THAT WE USED WAS ACTUALLY A KEY GRAPHIC HERE THAT ILLUSTRATES THESE PARTNERSHIPS AND ALSO THE PUZZLE PIECES AND HOW THEY CAN ALL FIT TOGETHER SO WE CAN WORK TOGETHER AND FIND WAYS TO LEVERAGE EACH OTHER'S RESOURCES. SO I WANTED TO THANK EVERYONE AGAIN. AND HOPE EVERYONE HAS A GREAT DAY AND WE HOPE TO BE IN TOUCH SOON. THANK YOU.