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>> GOOD MORNING.

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THIS PRESENTATION IS BEING

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RECORDED. 

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USE Q&A TO DIRECT QUESTIONS
TO

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SPEAKERS INCLUDING THE NAME OF

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PERSON YOU'RE DIRECTING YOUR

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QUESTION TO.

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THIS TOOL CAN BE USED DURING THE

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SESSION Q&As TO ASK THE

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SPEAKERS A QUESTION.

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QUESTIONS WILL BE CAPTURED FOR

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REVIEW BY THE WORKSHOP SPONSORS.

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IF YOU'RE NOT SPEAKING STAY OFF

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MUTE AND OFF CAMERA.

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THANK YOU. 

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>> GOOD MORNING,
AFTERNOON, OR

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EVENING, DEPENDING WHERE IN THE

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WORLD YOU'RE JOINING FROM.

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I'M DR. FERNANDO BRUNO, PROGRAM

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OFFICER AT THE CENTER FOR

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TRANSLATIONAL RESEARCH AND

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IMPLEMENTATION SCIENCE CTRIS.

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IT'S MY PLEASURE TO WELCOME YOU

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TO OUR VIRTUAL WORKSHOP

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IMPLEMENTATION RESEARCH AND NEXT

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STEPS IN DIRECT TO CONSUMER

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TELEHEALTH.

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UNDERSTANDINGLESSONS LEARNED.

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THE HEALTHCARE PROFESSIONALS

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WERE USING E-MAILS, EARLY

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VERSIONS OF VIDEO CONFERRING TO

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CONNECT, THE LAST DECADE

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WITNESSED ADVANCES IN TECHNOLOGY

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THAT TRANSFORMED TELEHEALTH INTO

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AN ESSENTIAL TOOL IN MODERN

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HEALTH CARE, UNDENIABLE

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HARDSHIPS BROAD BY THE COVID-19

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PANDEMIC ACCELERATED THIS

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TRANSFORMATION.

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WE WERE FORCED TO INNOVATE,

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ADAPT, EMBRACE METHODS OF CARE

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DELIVERY.

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BARRIERS THAT ONCE LIMITED

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TELEHEALTH SUCH AS RESTRICTIVE

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POLICIES, CROSS--STATE LICENSURE

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CHALLENGES WERE TEMPORARILY

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LIFTED, IN SOME CASES TORN DOWN

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ENTIRELY, PAVING THE WAIT FOR

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WIDESPREAD ADOPTION.

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VIRTUAL CONSULTATIONS BECAME

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COMMONPLACE, REIMBURSEMENT

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MODELS EVOLVED AND TECHNOLOGICAL

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LITERARIES SURGED.

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THIS LAID THE FOUNDATION FOR

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LASTING INTEGRATION INTO

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HEALTHCARE SYSTEMS WORD WIDE.

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HERE WE ARE STANDING ON TOP OF

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SHOULDERS OF SUCH LEGACY.

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HUMANS HAVE AN INNATE DESIRE TO

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CONNECT.

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WHEN WE FACED WITH ADVERSITY WE

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CREATE NEW WAYS OF DOING THAT.

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JUST LIKE THAT, IT WAS NO LONGER

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OPTIONAL, IT WAS ESSENTIAL.

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TODAY WE LIVE IN A WORLD WHERE

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PATIENTS CAN CONNECT WITH HEALTH

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HEALTHCARE TEAMS  USING DEVICES,

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WE TRACK DATA, STEPS, EKGs,

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GLUCOSE AND MORE FEEDING REAL

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DATA, ENABLING TRANSFORMATIVE

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AND GROUNDBREAKING  RESEARCH AND

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A.I.-DRIVEN INSIGHTS

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REVOLUTIONIZING CARE, YET THIS

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BRINGS CHALLENGES.

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HEALTH POLICIES OFTEN STRUGGLE

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TO KEEP PACE WITH THE

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TECHNOLOGICAL ADVANCEMENTS AND

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AT TIMES SO DOES RESEARCH.

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RESEARCH MUST ADDRESS

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INFRASTRUCTURE GAPS,

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PARTICULARLY IN UNDERSERVED AND

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RURAL AREAS, TO ENSURE EQUITABLE

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ACCESS.

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UNDERSTANDING USER BEHAVIOR AND

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GIVING VOICE TO ALL STAKEHOLDERS

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IS ALSO PARAMOUNT.

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WE MUST FOCUS ON IMPROVING

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LITERACY OF PATIENTS AND

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PROVIDERS, TO ENSURE TOOLS ARE

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USED EFFECTIVELY AND NO ONE IS

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LEFT BEHIND.

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THIS IS WHERE I AM

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IMPLEMENTATION SCIENCE PLAYS A

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CRITICAL CONTROL WHEN WHAT WORKS

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AND WHAT WE'RE DOING IN

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PRACTICE.

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WE NEED RESEARCH AND NEED IT NOW

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TO HELP CLOSE THIS GAP,

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UNCOVERING LESSONS LEARNED,

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TACKLE CHALLENGES AND SEIZE

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OPPORTUNITIES TO MAKE TOOLS

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ACCESSIBLE TO THOSE WHO NEED

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THEM MOST.

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THIS WORKSHOP IS A CRITICAL STEP

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TOWARDS THIS JOURNEY.

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TODAY WE'RE EXPLORING CURRENT

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STATE OF DIRECT TO CONSUMER

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TELEHEALTH, IDENTIFY KNOWLEDGE

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GAPS AND UNCOVER OPPORTUNITIES

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TO ADVANCE RESEARCH AND

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PRACTICE.

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WE'RE FORTUNATE TO HAVE THIS

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LINEUP OF SPEAKERS WHO WILL

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GUIDE US TO A RICH EXPLORATION

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OF TELEHEALTH LANDSCAPE.

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AT THE CENTER OF OF TODAY'S

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DISCUSSIONS, WE HAVE RESEARCH AS

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OUR GUIDING FRAMEWORK, AND AS

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THE BEST PART OF TODAY'S

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WORKSHOP IS YOU.

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THIS WORKSHOP IS A CONVERSATION.

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AND THE PERSPECTIVE AND

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QUESTIONS ARE KEY FOR ITS

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SUCCESS.

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SO WE ENCOURAGE YOU TO ENGAGE

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FULLY, ASK QUESTIONS, SHARE

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INSIGHTS, CONNECT WITH YOUR

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PEERS.

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YOU ARE A DIVERSE AUDIENCE OF

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RESEARCH, HEALTHCARE PROVIDERSE

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POLICYMAKERS, TECHNOLOGIST AND

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COMMUNITY LEADERS.

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ALL UNITED BY THE SHARED

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COMMITMENT TO IMPROVING

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TELEHEALTH AND HEALTHCARE

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DELIVERY.

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SO THANK YOU FOR JOINING US AT

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THIS IMPORTANT CONVERSATION.

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TOGETHER WE CAN CHART A FUTURE

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FOR TELEHEALTH AND ITS

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TRANSFORMATIVE POE ESSENTIAL.

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I'M PLEASED TO INVOLVE THE

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DIRECTOR OF CTRIS.

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TAKE IT AWAY.

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>> GOOD MORNING, GOOD
AFTERNOON,

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GOOD EVENING, I'M DELIGHTED TO

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WORK YOU TO THE WORKSHOP.

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IT'S A GREAT PRIVILEGE TO EXTEND

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THIS WARM WELCOME TO YOU ON

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BEHALF OF OUR LEADERSHIP AND

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STAFF.

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SPECIAL THANKS TO ORGANIZING

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COMMITTEE AND SUPPORT STAFF WHO

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MADE THIS POSSIBLE.

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I ALSO WANT TO THANK THE MANY

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PANELISTS AND EXPERTS WHO WILL

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BE SHARING INSIGHTS AND

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CHALLENGES AND SUCCESSES OF

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SUPPORTING TELEHEALTH-FOCUSED

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IMPLEMENTATION RESEARCH TO

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IMPROVE HEALTHCARE ACCESS AND

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OUTCOMES.

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IT'S AN HONOR TO SEE SUCH A

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DIVERSE AND ESTEEMED GROUP OF

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PROFESSIONALS, RESEARCHERS,

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PRACTITIONERS AND THE PUBLIC

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GATHERED HERE TODAY.

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AND THIS BRINGS ME TO THANKING

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YOU, ATTENDEES.

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WE KNOW YOU'RE VERY BUSY WITH

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MULTIPLE COMPETING PRIORITIES,

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SO IT DOES MEAN A LOT TO THE

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NHLBI AND CTRIS YOU AGREED TO

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JOIN US.

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THANK YOU.

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I'M EXCITED TO LEARN FROM YOU

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ALL TODAY.

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BEFORE WE JUMP IN TO THE

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WORKSHOP I WANT TO TAKE A MOMENT

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TO SHARE HOW THE WORKSHOP LINKS

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TO THE NHLBI STRATEGIC VISION. 

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NHLBI TURNED 75 YEARS OLD LAST

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YEAR AND ENGAGED PUBLIC AND

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STAFF TO REFRESH STRATEGIC

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VISION.

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THE WAY I SEE IT, TELEHEALTH

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PRESENTS AN IMPORTANT VEHICLE

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FOR ADVANCING FOUR OF THE SIX

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FOCUS AREAS THAT WERE

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ARTICULATED THROUGH THIS

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STRATEGIC VISION REFRESH

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PROCESS.

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I'LL NAME THEM BRIEFLY.

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HARNESSING DATA SCIENCE AND NEW

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TECHNOLOGIES TO DRIVE SCIENTIFIC

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DISCOVERY AND PRECISION HEALTH.

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USING NOVEL APPROACHES FOR

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ADDRESSING HEALTH DISPARITIES

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AND TACKLING BIOLOGICAL

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UNDERPINNINGS FOR HEART, LUNG,

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BLOOD DISORDERS, LEVERAGING

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POWER OF COMMUNITY ENGAGING,

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REDUCING IMPACT OF GEOGRAPHY ON

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HEART, LUNG, BLOOD AND SLEEP

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HEALTH.

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AS DR. BRUNO INDICATED,

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TELEHEALTH HAS MATURED RAPIDLY

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OVER THE LAST TWO DECADES FROM A

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CONCEPTUAL IDEA TO A CRUCIAL

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COMPONENT AND WE WOULD BE REMISS

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IF WE DIDN'T ADMIT  THE ROLE OF

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PROJECT ECHO, ECHO-TRAINED

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CLINICIANS PROVED TELEHEALTH

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CARE CAN LEAD TO OUTCOMES

217
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COMPARABLE TO CARE DELIVERED IN

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ACADEMIC HEALTH CENTERS FOR

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PATIENTS WITH HEPATITIS C LIVING

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IN RURAL AREAS.

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SINCE THEN AS WE HAVE SEEN, THE

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PANDEMIC ACCELERATED TELEHEALTH

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PROLIFERATION, AS NECESSITY WITH

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UTILIZATION RATES REMAINING

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HIGHER THAN PRE-PANDEMIC LEVELS.

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INDEED TELEHEALTH HAS BECOME

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INTEGRAL TO HEALTH CARE,

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ADDRESSING NEEDS AND

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TRADITIONALLY UNDERSERVED AREAS,

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WITH PATIENTS AND POPULATIONS

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EXPERIENCING SOCIAL RISK SUCH AS

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SOCIAL ISOLATION AS WELL AS

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CHILD CARE AND TRANSPORTATION

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CHALLENGES, FOR EXAMPLE.

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SO, TO OPTIMIZE HEALTH USE AND

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INTEGRATION FOR THINGS LIKE

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REACH, EQUITY, AFFORDABILITY,

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FEASIBILITY, IMPACT AND

239
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SUSTAINABILITY IT REQUIRES

240
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ADDRESSING QUESTIONS OF

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IMPLEMENTATION AND USE METHODS

242
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AND MEASURES FROM IMPLEMENTATION

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SCIENCE.

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INDEED TELEHEALTH RAPID

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EXPANSION INTO NEW SETTINGS

246
00:09:35,442 --> 00:09:36,543
NECESSITATED NIMBLE RESEARCH

247
00:09:36,543 --> 00:09:38,044
APPROACHES TO KEEP PACE.

248
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BECAUSE IMPLEMENTATION RESEARCH

249
00:09:38,912 --> 00:09:41,981
CAN BE COMBINED WITH

250
00:09:41,981 --> 00:09:42,949
EFFECTIVENESS RESEARCH

251
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APPROACHES, THROUGH HYBRID STUDY

252
00:09:43,950 --> 00:09:46,052
TYPES AS AN EXAMPLE UNIQUE

253
00:09:46,052 --> 00:09:48,755
INSIGHTS CAN BE MADE TO

254
00:09:48,755 --> 00:09:49,289
ACCELERATE TRANSLATION OF

255
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EVIDENCE TO  ACTION, AND

256
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OFFERINGS FRAMEWORKS, THOUGHTS

257
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AND TOOLS TO ELUCIDATE WHEN,

258
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WHERE, WHY AND HOW AND WITH WHOM

259
00:10:00,500 --> 00:10:03,303
TO LEVERAGE OR INCORPORATE

260
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TELEHEALTH.

261
00:10:03,970 --> 00:10:05,071
MOREOVER, EFFECTIVE TELEHEALTH

262
00:10:05,071 --> 00:10:06,372
IMPLEMENTATION REQUIRES

263
00:10:06,372 --> 00:10:08,541
INTEGRATION WITH EXISTING

264
00:10:08,541 --> 00:10:09,642
HEALTHCARE POLICIES, PROCESSES,

265
00:10:09,642 --> 00:10:12,512
PRACTICES, AND THIS EMPHASIZES

266
00:10:12,512 --> 00:10:14,113
THE NEED FOR CONTEXT-SPECIFIC

267
00:10:14,113 --> 00:10:15,815
STRATEGIES AND APPROACHES, AND

268
00:10:15,815 --> 00:10:18,318
SUCCESS DEPENDS ON COLLABORATION

269
00:10:18,318 --> 00:10:20,286
ACROSS DIVERSE STAKEHOLDERS

270
00:10:20,286 --> 00:10:21,187
INCLUDING CLINICIANS,

271
00:10:21,187 --> 00:10:23,323
RESEARCHERS, AND PATIENTS, FOR

272
00:10:23,323 --> 00:10:24,123
INSTANCE, PARAMOUNT IN

273
00:10:24,123 --> 00:10:26,993
IMPLEMENTATION RESEARCH. 

274
00:10:26,993 --> 00:10:32,365
I'LL MENTION ALSO THE MEDICAL

275
00:10:32,365 --> 00:10:35,068
UNIVERSITY OF SOUTHERN CAROLINA

276
00:10:35,068 --> 00:10:37,370
TO AID IN RESEARCH, GUIDANCE

277
00:10:37,370 --> 00:10:40,473
INCLUDES THINGS LIKE REFINING

278
00:10:40,473 --> 00:10:42,509
RESEARCH QUESTIONS, DETERMINING

279
00:10:42,509 --> 00:10:47,347
STUDY DESIGNS, DEFINING

280
00:10:47,347 --> 00:10:48,982
IMPLEMENTATION OUTCOMES,

281
00:10:48,982 --> 00:10:50,283
SELECTING GUIDING FRAMEWORKS,

282
00:10:50,283 --> 00:10:52,452
DEVELOPING DATA COLLECTION TOOLS

283
00:10:52,452 --> 00:10:54,754
THAT THEY MIGHT TAILOR, AND

284
00:10:54,754 --> 00:10:55,788
SELECTING IMPLEMENTATION

285
00:10:55,788 --> 00:10:56,523
STRATEGIES.

286
00:10:56,523 --> 00:10:58,591
THAT'S A RESOURCE AVAILABLE

287
00:10:58,591 --> 00:10:58,825
ONLINE.

288
00:10:58,825 --> 00:11:00,360
EVEN WITH THIS GUIDANCE THERE

289
00:11:00,360 --> 00:11:02,128
ARE SO MANY EMPIRICAL QUESTIONS

290
00:11:02,128 --> 00:11:04,330
THAT REMAIN.

291
00:11:04,330 --> 00:11:07,800
WE SEE VARIABILITY IN ADOPTION

292
00:11:07,800 --> 00:11:09,135
AND RATES ACROSS SETTINGS THAT

293
00:11:09,135 --> 00:11:12,405
POSE CHALLENGES FOR EQUITABLE

294
00:11:12,405 --> 00:11:14,274
ACCESS, EVEN WITH TELEHEALTH,

295
00:11:14,274 --> 00:11:16,643
RESOURCE LIMITATIONS ARE A

296
00:11:16,643 --> 00:11:18,578
DIRECT THREAT TO TELEHEALTH

297
00:11:18,578 --> 00:11:19,479
SPREAD, WHEREBY LIMITED

298
00:11:19,479 --> 00:11:21,781
RESOURCES CONTINUE TO EXIST AND

299
00:11:21,781 --> 00:11:27,820
TELEHEALTH INTEGRATION WITH

300
00:11:27,820 --> 00:11:30,590
EXISTING IN-PERSON WORK FLOWS

301
00:11:30,590 --> 00:11:32,859
REMAIN COMPLICATED, EMPHASIZING

302
00:11:32,859 --> 00:11:34,627
NEED FOR EFFECTIVE CARE

303
00:11:34,627 --> 00:11:35,595
MANAGEMENT STRATEGIES AND

304
00:11:35,595 --> 00:11:36,563
APPROPRIATE PAYMENT MODELS, AND

305
00:11:36,563 --> 00:11:39,198
FUTURE POLICIES WILL BE CRUCIAL

306
00:11:39,198 --> 00:11:40,400
TO SUSTAIN TELEHEALTH,

307
00:11:40,400 --> 00:11:43,036
PARTICULARLY WITH RESPECT TO

308
00:11:43,036 --> 00:11:45,004
AUDIO/VISUAL SERVICES.

309
00:11:45,004 --> 00:11:46,306
SO EVEN WITH THESE CHALLENGES

310
00:11:46,306 --> 00:11:48,841
THE OPPORTUNITIES ARE PROFOUND.

311
00:11:48,841 --> 00:11:50,243
TELEHEALTH SIGNIFICANTLY

312
00:11:50,243 --> 00:11:53,012
ENHANCES ACCESS, ESPECIALLY IN

313
00:11:53,012 --> 00:11:54,981
UNDERSERVED AREAS, RESEARCH CAN

314
00:11:54,981 --> 00:11:56,816
PROVIDE DATA-DRIVEN INSIGHT INTO

315
00:11:56,816 --> 00:11:59,018
OPTIMIZING TELEHEALTH DELIVERY

316
00:11:59,018 --> 00:12:00,787
WITH ONGOING TECHNOLOGICAL

317
00:12:00,787 --> 00:12:01,688
INNOVATIONS OFFERING NEW

318
00:12:01,688 --> 00:12:02,755
POSSIBILITIES AND ARTIFICIAL

319
00:12:02,755 --> 00:12:03,723
INTELLIGENCE AND MACHINE

320
00:12:03,723 --> 00:12:04,591
LEARNING TECHNOLOGIES ARE

321
00:12:04,591 --> 00:12:06,793
EXPECTED TO PLAY AN EVEN LARGER

322
00:12:06,793 --> 00:12:09,729
ROLE, OFFERING NEW SOLUTIONS FOR

323
00:12:09,729 --> 00:12:11,364
PERSONALIZATION AND EFFICIENCY.

324
00:12:11,364 --> 00:12:13,900
SO, AS WE EMBARK ON THIS JOURNEY

325
00:12:13,900 --> 00:12:16,002
TODAY, I ENCOURAGE YOU TO

326
00:12:16,002 --> 00:12:19,272
ACTIVELY PARTICIPATE, SHARE YOUR

327
00:12:19,272 --> 00:12:20,406
EXPERIENCES, AND CHALLENGE

328
00:12:20,406 --> 00:12:20,940
CONVENTIONAL THINKING TO

329
00:12:20,940 --> 00:12:22,342
IDENTIFY GAPS AND OPPORTUNITIES

330
00:12:22,342 --> 00:12:23,443
FOR FUTURE RESEARCH.

331
00:12:23,443 --> 00:12:25,511
LET'S USE THIS PLATFORM TO

332
00:12:25,511 --> 00:12:27,480
INSPIRE AND BE INSPIRED TO

333
00:12:27,480 --> 00:12:28,581
INNOVATE AND TO MAKE TANGIBLE

334
00:12:28,581 --> 00:12:29,782
DIFFERENCE IN THE LIVES OF

335
00:12:29,782 --> 00:12:30,984
PATIENTS AND THEIR FAMILIES

336
00:12:30,984 --> 00:12:32,085
AROUND THE WORLD.

337
00:12:32,085 --> 00:12:34,621
SO WE'RE ASKING YOU TO USE THE

338
00:12:34,621 --> 00:12:36,990
DIVERSE EXPERTISE IN THE ROOM TO

339
00:12:36,990 --> 00:12:39,626
HELP US IDENTIFY OPPORTUNITIES

340
00:12:39,626 --> 00:12:40,560
FOR ENHANCING IMPLEMENTATION

341
00:12:40,560 --> 00:12:42,695
RESEARCH THAT EXPLORES THE USE

342
00:12:42,695 --> 00:12:43,997
OF TELEHEALTH FOR HEART, LUNG,

343
00:12:43,997 --> 00:12:46,633
BLOOD AND SLEEP CONDITIONS.

344
00:12:46,633 --> 00:12:48,601
INDEED THE NHLBI STRONGLY IS

345
00:12:48,601 --> 00:12:51,237
COMMITTED TO ADVANCING RESEARCH

346
00:12:51,237 --> 00:12:53,439
THAT ACCELERATES TURNING

347
00:12:53,439 --> 00:12:55,742
DISCOVERS INTO REAL WORLD HEALTH

348
00:12:55,742 --> 00:12:57,677
IMPACTS, AND CTRIS IS THE FOCAL

349
00:12:57,677 --> 00:12:57,877
POINT.

350
00:12:57,877 --> 00:13:00,213
LET ME REMIND YOU UNDER THE

351
00:13:00,213 --> 00:13:02,515
FEDERAL ADVISORY COMMITTEE ACT,

352
00:13:02,515 --> 00:13:05,018
FACA, SIGNED INTO LAW IN 1972,

353
00:13:05,018 --> 00:13:06,452
OUR WORKSHOPS ARE NOT

354
00:13:06,452 --> 00:13:08,755
CONSTITUTED FOR YOU TO ADVISE

355
00:13:08,755 --> 00:13:11,424
NHLBI OR TO MAKE RECOMMENDATIONS

356
00:13:11,424 --> 00:13:12,692
TO NHLBI OR NIH.

357
00:13:12,692 --> 00:13:13,793
PLEASE DO FRAME YOUR INSIGHTS

358
00:13:13,793 --> 00:13:16,429
THAT YOU SHARE WITH US AS

359
00:13:16,429 --> 00:13:18,698
CHALLENGES THAT YOU'RE AWARE OF,

360
00:13:18,698 --> 00:13:21,334
AS OPPORTUNITIES FOR NHLBI TO

361
00:13:21,334 --> 00:13:22,402
EXPLORE, NOT AS RECOMMENDATIONS.

362
00:13:22,402 --> 00:13:28,107
LET'S  FOCUS ON CHALLENGES OR

363
00:13:28,107 --> 00:13:29,409
OPPORTUNITIES FOR IMPLEMENTING

364
00:13:29,409 --> 00:13:30,176
TELEHEALTH RESEARCH.

365
00:13:30,176 --> 00:13:31,844
OPPORTUNITIES YOU IDENTIFY WILL

366
00:13:31,844 --> 00:13:34,747
PLAY A ROLE AS THE STRATEGIC

367
00:13:34,747 --> 00:13:36,015
VISION IS IMPLEMENTED, AS YOU

368
00:13:36,015 --> 00:13:40,286
CAN SEE BY MY BACKGROUND, CTRIS

369
00:13:40,286 --> 00:13:41,254
IS CELEBRATING 10th

370
00:13:41,254 --> 00:13:42,055
ANNIVERSARY THIS YEAR, EAGER TO

371
00:13:42,055 --> 00:13:44,357
LEARN FROM YOU AS WE PLAN OUR

372
00:13:44,357 --> 00:13:46,759
NEXT DECADE AS A STRATEGIC FOCAL

373
00:13:46,759 --> 00:13:47,860
POINT FOR IMPLEMENTATION

374
00:13:47,860 --> 00:13:49,162
RESEARCH, COMMUNITY ENGAGED

375
00:13:49,162 --> 00:13:50,596
RESEARCH, GLOBAL HEALTH

376
00:13:50,596 --> 00:13:51,931
RESEARCH, AND HEALTH DISPARITIES

377
00:13:51,931 --> 00:13:53,533
RESEARCH, ON THIS NOTE IF YOU'D

378
00:13:53,533 --> 00:13:56,302
LIKE TO JOIN CTRIS IN

379
00:13:56,302 --> 00:13:57,270
CELEBRATION PLEASE REGISTER NOW

380
00:13:57,270 --> 00:13:59,272
OR LATER TODAY OR TOMORROW FOR

381
00:13:59,272 --> 00:14:01,207
OUR HALF-DAY EVENT THAT'S TAKING

382
00:14:01,207 --> 00:14:02,475
PLACE ON DECEMBER 11th FROM 2

383
00:14:02,475 --> 00:14:07,146
TO 6 P.M., THE LINK IS IN THE

384
00:14:07,146 --> 00:14:09,315
CHAT AND WILL POP UP A QR CODE

385
00:14:09,315 --> 00:14:10,083
AT SOME POINT.

386
00:14:10,083 --> 00:14:14,220
ONCE AGAIN, WELCOME TO THIS

387
00:14:14,220 --> 00:14:14,854
IMPLEMENTATION RESEARCH-FOCUSED

388
00:14:14,854 --> 00:14:17,356
WORKSHOP TO ADVANCE TELEHEALTH

389
00:14:17,356 --> 00:14:18,725
AND ITS IMPACT ON ACCESS FOR

390
00:14:18,725 --> 00:14:19,492
HEALTH CARE.

391
00:14:19,492 --> 00:14:21,260
I LOOK FORWARD TO THE RICH

392
00:14:21,260 --> 00:14:22,228
DISCUSSIONS AND MEANINGFUL

393
00:14:22,228 --> 00:14:23,229
CONNECTIONS THAT WILL EMERGE

394
00:14:23,229 --> 00:14:24,363
FROM OUR TIME TOGETHER.

395
00:14:24,363 --> 00:14:26,099
THANK YOU FOR YOUR COMMITMENT TO

396
00:14:26,099 --> 00:14:27,934
THIS IMPORTANT VEHICLE FOR

397
00:14:27,934 --> 00:14:29,769
ENHANCING HEALTHCARE ACCESS AND

398
00:14:29,769 --> 00:14:30,002
IMPACT.

399
00:14:30,002 --> 00:14:31,104
LET'S GET STARTED ON WHAT

400
00:14:31,104 --> 00:14:35,708
PROMISES TO BE AN ENLIGHTENING

401
00:14:35,708 --> 00:14:37,076
AND IMPACTFUL WORKSHOP.

402
00:14:37,076 --> 00:14:38,344
>> THANK YOU, DR. LEWIS,
TO GET

403
00:14:38,344 --> 00:14:39,445
US STARTED FOR TODAY.

404
00:14:39,445 --> 00:14:44,484
AND NOW IT'S MY HONOR TO INVITE

405
00:14:44,484 --> 00:14:45,485
OUR KEYNOTE SPEAKER.

406
00:14:45,485 --> 00:14:46,686
JUST WAITING FOR THE SLIDES TO

407
00:14:46,686 --> 00:14:49,622
MOVE ON.

408
00:14:49,622 --> 00:14:52,592
HERE WE ARE.

409
00:14:52,592 --> 00:14:56,796
TODAY WE HAVE DR. GARTH GRAYHAN,

410
00:14:56,796 --> 00:14:58,598
DIRECTOR OF HEALTH CARE AND

411
00:14:58,598 --> 00:15:01,033
PUBLIC HEALTH AT GOOGLE GUIDE US

412
00:15:01,033 --> 00:15:03,669
ON THE REFLECTION OF LESSONS

413
00:15:03,669 --> 00:15:05,004
FROM THE PANDEMIC.

414
00:15:05,004 --> 00:15:06,272
DR. GRAHAM, A PLEASURE TO HOST

415
00:15:06,272 --> 00:15:08,040
YOU TODAY.

416
00:15:08,040 --> 00:15:08,708
PLEASE TAKE IT AWAY.

417
00:15:08,708 --> 00:15:09,609
>> THANK YOU.

418
00:15:09,609 --> 00:15:12,345
THANK YOU FOR HAVING ME.

419
00:15:12,345 --> 00:15:14,747
I AM GOING TO HOPEFULLY GO OVER

420
00:15:14,747 --> 00:15:17,583
SOME POINTS, NOT JUST FROM THE

421
00:15:17,583 --> 00:15:20,853
PERSPECTIVE FROM SOMEONE WORKING

422
00:15:20,853 --> 00:15:23,389
IN TECH-RELATED ISSUES BUT ALSO

423
00:15:23,389 --> 00:15:25,992
A CARDIOLOGIST PRACTICING DURING

424
00:15:25,992 --> 00:15:26,826
THE PANDEMIC.

425
00:15:26,826 --> 00:15:30,596
AND WENTZ THROUGH KIND OF --

426
00:15:30,596 --> 00:15:31,998
WENT THROUGH MY OWN PERSONAL

427
00:15:31,998 --> 00:15:38,037
JOURNEY IN TERMS OF

428
00:15:38,037 --> 00:15:38,704
TELEMEDICINE, TELEHEALTH,

429
00:15:38,704 --> 00:15:40,006
INTRODUCING THAT INTO MY OWN

430
00:15:40,006 --> 00:15:41,874
PRACTICE IN TERMS OF TAKING CARE

431
00:15:41,874 --> 00:15:43,943
OF PATIENTS AS WELL.

432
00:15:43,943 --> 00:15:47,680
AND TALK ABOUT THE HISTORY OF

433
00:15:47,680 --> 00:15:49,649
TELEHEALTH, TELEMEDICINE USING

434
00:15:49,649 --> 00:15:50,950
THE TERMS INTERCHANGEABLE AND

435
00:15:50,950 --> 00:15:54,453
HOW THINGS EVOLVED FROM THE PAST

436
00:15:54,453 --> 00:15:56,989
INTO HOPEFULLY WHAT WILL BE

437
00:15:56,989 --> 00:15:57,623
POTENTIALLY OPPORTUNITIES FOR

438
00:15:57,623 --> 00:15:58,624
THE FUTURE.

439
00:15:58,624 --> 00:16:03,129
I'LL SPEND THE FIRST 7 OR 8

440
00:16:03,129 --> 00:16:03,763
MINUTES GROUNDING UP

441
00:16:03,763 --> 00:16:05,298
OPPORTUNITIES, CHALLENGES IN

442
00:16:05,298 --> 00:16:06,499
TERMS OF DISPARITIES IN

443
00:16:06,499 --> 00:16:07,700
UNDERSERVED COMMUNITIES.

444
00:16:07,700 --> 00:16:11,537
KIME 

445
00:16:11,537 --> 00:16:13,406
 I COME FROM THAT BACKGROUND,

446
00:16:13,406 --> 00:16:14,841
CHIEF OF HEALTH SERVICES

447
00:16:14,841 --> 00:16:18,377
RESEARCH AT AN ACTIVE

448
00:16:18,377 --> 00:16:19,979
INSTITUTION, AND AS A RESULT

449
00:16:19,979 --> 00:16:21,514
MINORITY HEALTH IN THE FEDERAL

450
00:16:21,514 --> 00:16:21,814
GOVERNMENT.

451
00:16:21,814 --> 00:16:23,916
SO COME WITH A LOT OF BACKGROUND

452
00:16:23,916 --> 00:16:27,787
AROUND ISSUES RELATED TO

453
00:16:27,787 --> 00:16:28,855
DISPARITIES, AND HEALTH EQUITY,

454
00:16:28,855 --> 00:16:29,956
AS REALLY THE FOUNDATION FOR

455
00:16:29,956 --> 00:16:34,160
WHAT I THINK ARE SOME OF THE

456
00:16:34,160 --> 00:16:36,996
OPPORTUNITIES WITH TELEHEALTH

457
00:16:36,996 --> 00:16:38,097
AND TELEMEDICINE, THE FIRST 6 OR

458
00:16:38,097 --> 00:16:40,499
7 MINUTES TALKING ABOUT THAT AND

459
00:16:40,499 --> 00:16:42,235
HISTORY OF TELEHEALTH, AND THEN

460
00:16:42,235 --> 00:16:46,205
CLOSE WITH WHAT I THINK WERE

461
00:16:46,205 --> 00:16:47,840
LESSONS FROM THE PANDEMIC, AND

462
00:16:47,840 --> 00:16:49,375
GOING THROUGH RESEARCH AND

463
00:16:49,375 --> 00:16:54,413
STUDIES THERE.

464
00:16:54,413 --> 00:16:55,281
NEXT SLIDE PLEASE.

465
00:16:55,281 --> 00:17:01,087
SO WHAT I SET THIS UP -- NEXT

466
00:17:01,087 --> 00:17:03,589
SLIDE PLEASE.

467
00:17:03,589 --> 00:17:07,093
WHEN I THINK OF THE EVOLUTION OF

468
00:17:07,093 --> 00:17:09,629
TELEHEALTH, I THINK ABOUT AGAIN

469
00:17:09,629 --> 00:17:11,898
WHERE WE START WITH FROM A

470
00:17:11,898 --> 00:17:16,202
PATIENT POPULATION PERSPECTIVE.

471
00:17:16,202 --> 00:17:16,969
NEXT SLIDE PLEASE.

472
00:17:16,969 --> 00:17:19,372
A LOT OF TALK ABOUT THE POLICY

473
00:17:19,372 --> 00:17:20,473
AND IMPLICATIONS, I'LL TALK A

474
00:17:20,473 --> 00:17:21,874
LITTLE BIT ABOUT, THAT REALLY

475
00:17:21,874 --> 00:17:23,509
LET'S START WITH CONVERSATIONS

476
00:17:23,509 --> 00:17:24,543
ABOUT THE COMMUNITY.

477
00:17:24,543 --> 00:17:25,745
AND WHAT ARE THE OPPORTUNITIES

478
00:17:25,745 --> 00:17:28,247
REALLY HERE WHEN WE THINK OF

479
00:17:28,247 --> 00:17:29,382
TELEHEALTH AND TELEMEDICINE.

480
00:17:29,382 --> 00:17:31,984
SO I ALWAYS THINK ABOUT THIS

481
00:17:31,984 --> 00:17:36,155
IDEA, NEIGHBORHOODS MATTER FOR

482
00:17:36,155 --> 00:17:36,389
HEALTH.

483
00:17:36,389 --> 00:17:37,590
THIS IS ONE OF THE MANY POINTS

484
00:17:37,590 --> 00:17:41,360
OF DATA THAT MANY OF YOU HAVE

485
00:17:41,360 --> 00:17:43,629
SEEN IN TERMS OF OVERUSED TERM,

486
00:17:43,629 --> 00:17:45,264
YOUR ZIP CODE MATTERING MORE

487
00:17:45,264 --> 00:17:46,232
THAN GENETICS, THE IDEA THAT

488
00:17:46,232 --> 00:17:48,301
WHERE WE LIVE IN THE UNITED

489
00:17:48,301 --> 00:17:49,302
STATES SO ESSENTIALLY DEFINES

490
00:17:49,302 --> 00:17:51,370
HOW LONG WE LIVE AND THIS IS MY

491
00:17:51,370 --> 00:17:53,806
NEIGHBORHOOD THAT I GREW UP WITH

492
00:17:53,806 --> 00:17:56,842
AFTER I MOVED FROM JAMAICA, IN

493
00:17:56,842 --> 00:18:00,913
MIAMI, SHOWING WHERE WE LIVED IN

494
00:18:00,913 --> 00:18:04,517
MIAMI, THE ZIP CODE DIFFERENCE

495
00:18:04,517 --> 00:18:06,686
FROM DRIVING 15 MINUTES MORE

496
00:18:06,686 --> 00:18:08,287
INTO MORE AFFLUENT AREAS AND

497
00:18:08,287 --> 00:18:10,089
15-YEAR GAP IN TERMS OF LIFE

498
00:18:10,089 --> 00:18:11,057
EXPECTANCY.

499
00:18:11,057 --> 00:18:12,825
WHEN WE THINK ABOUT THE KINDS OF

500
00:18:12,825 --> 00:18:15,261
THINGS THAT WE CAN ADVANCE

501
00:18:15,261 --> 00:18:16,228
AROUND TELEHEALTH AND

502
00:18:16,228 --> 00:18:17,763
TELEMEDICINE THE NEXT COUPLE

503
00:18:17,763 --> 00:18:23,235
SLIDES ARE MEANT TO ENCAPSULATE

504
00:18:23,235 --> 00:18:24,003
THE CHALLENGES, UNDERSTANDING

505
00:18:24,003 --> 00:18:26,305
GEOGRAPHIC ISOLATION THAT DRIVES

506
00:18:26,305 --> 00:18:28,274
HEALTH DISPARITIES, BUT ALSO

507
00:18:28,274 --> 00:18:29,175
UNDERSTANDING HOW THAT, AGAIN,

508
00:18:29,175 --> 00:18:35,915
IMPACTS HEALTH OUTCOMES.

509
00:18:35,915 --> 00:18:36,816
NEXT SLIDE PLEASE.

510
00:18:36,816 --> 00:18:38,985
I SPENT TIME IN RESEARCH.

511
00:18:38,985 --> 00:18:42,621
THIS IS A PAPER THAT ME AND MY

512
00:18:42,621 --> 00:18:46,225
TEAM PUBLISHED IN JAMA EARLIER

513
00:18:46,225 --> 00:18:47,193
ON, PRE-PANDEMIC ACTUALLY.

514
00:18:47,193 --> 00:18:49,028
AND WE WERE LOOKING AT WHAT WERE

515
00:18:49,028 --> 00:18:52,131
SOME OF THE FACTORS THAT REALLY

516
00:18:52,131 --> 00:18:55,735
DROVE THE DEATH RATE FROM ACUTE

517
00:18:55,735 --> 00:18:56,936
MYOCARDIAL INFARCTION TO ONE

518
00:18:56,936 --> 00:18:58,070
YEAR AND FIVE-YEAR DEATH RATES

519
00:18:58,070 --> 00:19:00,439
IN TERMS OF THE DIFFERENCES

520
00:19:00,439 --> 00:19:03,075
BETWEEN A BLACK AND WHITE

521
00:19:03,075 --> 00:19:04,944
POPULATION.

522
00:19:04,944 --> 00:19:08,347
NEXT SLIDE PLEASE.

523
00:19:08,347 --> 00:19:12,952
WE SHOWED PREDOMINANTLY WHEN YOU

524
00:19:12,952 --> 00:19:14,253
PULL ASIDE ISSUES RELATED TO --

525
00:19:14,253 --> 00:19:16,222
WHEN YOU STARTED TO SCORE IN

526
00:19:16,222 --> 00:19:17,556
TERMS OF PROPENSITY SCORES TO

527
00:19:17,556 --> 00:19:19,392
LOOK AT PARTICULARLY BLACK

528
00:19:19,392 --> 00:19:21,494
POPULATIONS AND THEN LOOK AT

529
00:19:21,494 --> 00:19:23,462
WHITE POPULATIONS, START TO

530
00:19:23,462 --> 00:19:26,899
AGGREGATE IN TERMS OF CONCEPTS

531
00:19:26,899 --> 00:19:28,234
AND DRIVERS DRIVING MORBIDITY

532
00:19:28,234 --> 00:19:29,602
AND MORTALITY, ISSUES WHEN YOU

533
00:19:29,602 --> 00:19:33,339
CONTROLLED FOR OTHER FACTORS,

534
00:19:33,339 --> 00:19:36,609
ISSUES SUCH AS HEALTH STATUS,

535
00:19:36,609 --> 00:19:37,243
CLINICAL PRESENTATION, LIFESTYLE

536
00:19:37,243 --> 00:19:39,445
FACTORS LESS OF A COMPONENT FOR

537
00:19:39,445 --> 00:19:40,646
DRIVING HEALTH OUTCOMES,

538
00:19:40,646 --> 00:19:42,381
COMPARED TO THE CONCEPT OF

539
00:19:42,381 --> 00:19:44,483
SOCIOECONOMIC STATUS.

540
00:19:44,483 --> 00:19:47,219
NEXT SLIDE PLEASE.

541
00:19:47,219 --> 00:19:48,187
SOCIOECONOMIC STATUS WAS REALLY

542
00:19:48,187 --> 00:19:50,823
A PROXY FOR THIS CONCEPT OF

543
00:19:50,823 --> 00:19:52,058
GEOGRAPHY AND ACCESS.

544
00:19:52,058 --> 00:19:55,528
WHAT WE SHOWED HERE IN THIS

545
00:19:55,528 --> 00:19:56,729
SLIDE WAS THAT YOUR PROBABILITY

546
00:19:56,729 --> 00:20:00,699
OF DYING FROM A HEART ATTACK IF

547
00:20:00,699 --> 00:20:03,836
YOU GO FROM LEFT TO RIGHT IN

548
00:20:03,836 --> 00:20:05,471
TERMS OF PROPENSITY SCORE AND

549
00:20:05,471 --> 00:20:10,443
PROBABILITY BEING ON THE Y-AXIS

550
00:20:10,443 --> 00:20:11,744
AND PROPENSITY SCORE BLACK AND

551
00:20:11,744 --> 00:20:14,480
WHITE ON THE X-AXIS, IF YOU WENT

552
00:20:14,480 --> 00:20:16,115
TO LOOKING AT PROPENSITY SCORING

553
00:20:16,115 --> 00:20:18,751
FOR POPULATIONS MORE LIKELY THAT

554
00:20:18,751 --> 00:20:23,889
YOU'RE BLACK OR WHITE, YOU SEE A

555
00:20:23,889 --> 00:20:25,858
PROBABILITY FIVE-YEAR INCREASING

556
00:20:25,858 --> 00:20:29,829
FROM .15 UP TO .45, A THREE-FOLD

557
00:20:29,829 --> 00:20:30,796
INCREASE IN PROPENSITY SCORE

558
00:20:30,796 --> 00:20:31,897
FROM FIVE-YEAR MORTALITY

559
00:20:31,897 --> 00:20:33,532
COMPARED TO BLACK OR WHITE

560
00:20:33,532 --> 00:20:33,799
PATIENTS.

561
00:20:33,799 --> 00:20:35,701
BUT WHEN YOU LOOK AT THE P-VALUE

562
00:20:35,701 --> 00:20:40,406
FOR THAT YOU NOTICE THE P-VALUE

563
00:20:40,406 --> 00:20:41,740
IS INSIGNIFICANT, 0.20.

564
00:20:41,740 --> 00:20:45,244
THIS ISSUE OF WHETHER YOU DIED

565
00:20:45,244 --> 00:20:46,979
FROM A HEART ATTACK, WHETHER

566
00:20:46,979 --> 00:20:48,948
BLACK OR WHITE, WAS NOT SO MUCH

567
00:20:48,948 --> 00:20:50,950
RELATED TO YOUR ACTUAL RACE OF

568
00:20:50,950 --> 00:20:52,451
BEING BLACK OR WHITE, THAT'S WHY

569
00:20:52,451 --> 00:20:54,553
THE P-VALUE IS NOT SIGNIFICANT,

570
00:20:54,553 --> 00:20:57,356
THAT EARLIER SLIDE IN TERMS OF

571
00:20:57,356 --> 00:20:59,792
THE SOCIOECONOMIC AND ACCESS

572
00:20:59,792 --> 00:21:00,526
FACTORS THAT DROVE THOSE

573
00:21:00,526 --> 00:21:02,328
DYNAMICS, SO IF YOU MOVE BLACK

574
00:21:02,328 --> 00:21:04,830
PATIENTS INTO A WHITE COMMUNITY,

575
00:21:04,830 --> 00:21:06,932
YOU START TO SEE SIMILAR

576
00:21:06,932 --> 00:21:10,202
MORBIDITY AND MORTALITY FROM

577
00:21:10,202 --> 00:21:12,371
M.I.s, AND SIMILARLY VICE

578
00:21:12,371 --> 00:21:16,108
VERSE A BETWEEN BLACK AND WHITE

579
00:21:16,108 --> 00:21:20,746
THE SO THIS CONCEPT OF GEOGRAPHY

580
00:21:20,746 --> 00:21:22,481
AND ACCESS WAS DRIVING HEART

581
00:21:22,481 --> 00:21:23,816
DISEASE AND MORTALITY.

582
00:21:23,816 --> 00:21:26,318
NEXT SLIDE PLEASE.

583
00:21:26,318 --> 00:21:28,287
THIS CONCEPT IS NOT SOLELY

584
00:21:28,287 --> 00:21:30,456
RELATED TO JUST ISSUE THE BLACK

585
00:21:30,456 --> 00:21:31,357
OR WHITE.

586
00:21:31,357 --> 00:21:32,758
THIS IS VERY MUCH INTERPRETED

587
00:21:32,758 --> 00:21:37,363
WHAT YOU SEE IN TERMS OF RURAL

588
00:21:37,363 --> 00:21:38,998
GEOGRAPHY, INCREASED MORBIDITY

589
00:21:38,998 --> 00:21:39,331
AND MORTALITY.

590
00:21:39,331 --> 00:21:43,369
THIS IS SOME DATA FROM THE FOLKS

591
00:21:43,369 --> 00:21:44,503
IN VIRGINIA.

592
00:21:44,503 --> 00:21:46,639
AND I'M SHOWING THIS VERY SHARP

593
00:21:46,639 --> 00:21:47,640
INCREASE IN MORBIDITY AND

594
00:21:47,640 --> 00:21:48,741
MORTALITY, WHEN YOU START TO

595
00:21:48,741 --> 00:21:50,576
LOOK AT CONCEPT OF GEOGRAPHY.

596
00:21:50,576 --> 00:21:53,679
NEXT SLIDE PLEASE.

597
00:21:53,679 --> 00:21:57,816
AND THEN MORE IMPORTANTLY, THIS

598
00:21:57,816 --> 00:22:00,119
IS ANOTHER SLIDE FROM DR. WILSON

599
00:22:00,119 --> 00:22:02,221
IN VIRGINIA, LOOKING AGAIN OVER

600
00:22:02,221 --> 00:22:04,523
THE PAST COUPLE YEARS IN TERMS

601
00:22:04,523 --> 00:22:07,126
OF LIFE EXPECTANCY THIS HUGE GAP

602
00:22:07,126 --> 00:22:09,328
BETWEEN, YOU KNOW, FOLKS LIVING

603
00:22:09,328 --> 00:22:12,064
IN ONE OF THE TWO ZIP CODES

604
00:22:12,064 --> 00:22:13,566
VERSUS THE CONCEPT OF LIVING IN

605
00:22:13,566 --> 00:22:15,434
THE MIDDLE PART OF AMERICA.

606
00:22:15,434 --> 00:22:17,836
WHAT THIS HOPEFULLY SETS UP FOR

607
00:22:17,836 --> 00:22:20,906
YOU, THIS CONCEPT OF BOTH THIS

608
00:22:20,906 --> 00:22:22,775
IDEA OF BOTH GEOGRAPHY,

609
00:22:22,775 --> 00:22:24,376
SOCIOECONOMIC STATUS, AND

610
00:22:24,376 --> 00:22:29,682
ACCESS, AND WHERE THE PROMISE OF

611
00:22:29,682 --> 00:22:30,649
TOOLS LIKE TELEMEDICINE,

612
00:22:30,649 --> 00:22:32,284
TELEHEALTH AS WE GO THROUGH

613
00:22:32,284 --> 00:22:33,719
TODAY, YOU KNOW, AND THE

614
00:22:33,719 --> 00:22:36,021
CONVERSATIONS WE'RE GOING TO

615
00:22:36,021 --> 00:22:38,090
HAVE, THINK THROUGH AGAIN THESE

616
00:22:38,090 --> 00:22:39,959
IDEAS MORE ABOUT HOW AND WHERE

617
00:22:39,959 --> 00:22:41,927
THE TOOLS THAT WE TALK ABOUT CAN

618
00:22:41,927 --> 00:22:43,662
HELP TO KIND OF BRIDGE THESE

619
00:22:43,662 --> 00:22:45,064
GAPS IN TERMS OF MORBIDITY AND

620
00:22:45,064 --> 00:22:46,398
MORTALITY.

621
00:22:46,398 --> 00:22:47,566
SO STARTING NOT WITH TECHNOLOGY

622
00:22:47,566 --> 00:22:50,236
OFT THAN WE DO BUT MORE STARTING

623
00:22:50,236 --> 00:22:53,739
WITH THE PEOPLE AND THE

624
00:22:53,739 --> 00:22:55,808
COMMUNITIES AND THE MORTALITY

625
00:22:55,808 --> 00:22:57,209
DRIVEN IN THESE COMMUNITIES

626
00:22:57,209 --> 00:23:04,450
WHETHER BLACK VERSUS WHITE,

627
00:23:04,450 --> 00:23:05,317
URBAN VERSUS RURAL, AND THOSE

628
00:23:05,317 --> 00:23:07,519
ARE THE OPPORTUNITIES.

629
00:23:07,519 --> 00:23:09,788
THESE ARE THE IDEAS OF

630
00:23:09,788 --> 00:23:10,422
PATIENT-CENTRIC CARE, REACHING

631
00:23:10,422 --> 00:23:12,458
PATIENTS WHERE THEY ARE.

632
00:23:12,458 --> 00:23:13,425
AGAIN, THINKING ABOUT THIS

633
00:23:13,425 --> 00:23:17,029
OPPORTUNITY THAT WE HAVE WHEN WE

634
00:23:17,029 --> 00:23:19,231
THINK ABOUT CONCEPTS AROUND

635
00:23:19,231 --> 00:23:24,003
TELEMEDICINE AND TELEHEALTH.

636
00:23:24,003 --> 00:23:25,771
THAT HAS DRIVEN MY INTEREST AREA

637
00:23:25,771 --> 00:23:28,407
IN THE FIELD, BUT ALSO AS I HAVE

638
00:23:28,407 --> 00:23:31,143
PRACTICED, AND I PRACTICE

639
00:23:31,143 --> 00:23:33,445
PRIMARILY AS A TELEMEDICINE

640
00:23:33,445 --> 00:23:36,749
CLINICIAN, IN ADDITION TO MY

641
00:23:36,749 --> 00:23:37,549
ROLE AT GOOGLE, YouTube,

642
00:23:37,549 --> 00:23:40,686
WHAT WE'RE DOING IN TERMS OF

643
00:23:40,686 --> 00:23:43,522
GETTING AROUND THE TECHNOLOGY

644
00:23:43,522 --> 00:23:45,824
AND GETTING PEOPLE TO ACCESS

645
00:23:45,824 --> 00:23:46,792
QUALITY HEALTH INFORMATION, I'VE

646
00:23:46,792 --> 00:23:53,132
BEEN OBSESSED WITH THE IDEA OF

647
00:23:53,132 --> 00:23:54,233
OVERARCHING PROMISE OF

648
00:23:54,233 --> 00:23:57,503
TELEMEDICINE, THIS CAPTURES

649
00:23:57,503 --> 00:24:02,975
THINKING ABOUT HOW WE CAN BRIDGE

650
00:24:02,975 --> 00:24:05,744
GAPS IN TERMS OF MORBIDITY AND

651
00:24:05,744 --> 00:24:07,079
MORTALITY IN COMMUNITIES IN

652
00:24:07,079 --> 00:24:09,048
TERMS OF RURAL COMMUNITIES, BUT

653
00:24:09,048 --> 00:24:09,581
UNDERSTANDING, AGAIN, THE

654
00:24:09,581 --> 00:24:11,650
CONCEPT IN TERMS OF WHAT'S

655
00:24:11,650 --> 00:24:12,985
HAPPENING BETWEEN DISPARITIES IN

656
00:24:12,985 --> 00:24:13,952
DIFFERENT COMMUNITIES.

657
00:24:13,952 --> 00:24:17,690
AND THIS IS WHERE WE START TO

658
00:24:17,690 --> 00:24:21,393
THINK THROUGH WHAT ARE SOME

659
00:24:21,393 --> 00:24:22,928
OPPORTUNITIES, AND REALLY IN

660
00:24:22,928 --> 00:24:25,030
PARTICULAR THE FOCUS AROUND

661
00:24:25,030 --> 00:24:27,733
PATIENT OPPORTUNITIES AND

662
00:24:27,733 --> 00:24:28,834
THINKING THROUGH, AGAIN, HOW

663
00:24:28,834 --> 00:24:30,135
TELEMEDICINE, TELEHEALTH CAN

664
00:24:30,135 --> 00:24:31,136
KIND OF TRANSFORM THAT

665
00:24:31,136 --> 00:24:31,670
LANDSCAPE.

666
00:24:31,670 --> 00:24:33,339
A LOT OF YOU HERE HAVE BEEN

667
00:24:33,339 --> 00:24:36,709
WORKING IN THIS FIELD FOR A LONG

668
00:24:36,709 --> 00:24:37,042
TIME.

669
00:24:37,042 --> 00:24:39,445
NOT ONLY ON THE GOVERNMENT

670
00:24:39,445 --> 00:24:42,514
SECTOR AND PRIVATE SECTOR BUT

671
00:24:42,514 --> 00:24:46,452
ALSO RESEARCH, REALLY, AGAIN, I

672
00:24:46,452 --> 00:24:47,653
START WITH COMMUNITIES PROBLEM

673
00:24:47,653 --> 00:24:49,621
FIRST AND THINKING THROUGH

674
00:24:49,621 --> 00:24:50,022
TECHNOLOGY.

675
00:24:50,022 --> 00:24:51,357
THIS CAPTURES I THINK THIS IDEA

676
00:24:51,357 --> 00:24:54,326
WHAT IS A PROMISE, WHAT ARE THE

677
00:24:54,326 --> 00:24:57,363
OPPORTUNITIES IN FRONT OF US,

678
00:24:57,363 --> 00:25:00,232
WHEN WE THINK THROUGH

679
00:25:00,232 --> 00:25:01,333
OVERARCHING PROMISE OF

680
00:25:01,333 --> 00:25:01,767
TELEMEDICINE.

681
00:25:01,767 --> 00:25:07,005
I ALLUDED TO THE CONCEPT OF LIKE

682
00:25:07,005 --> 00:25:07,806
TACKLING DISPARITIES AS AN

683
00:25:07,806 --> 00:25:10,642
ULTIMATE GOAL, IF NOT ONE OF THE

684
00:25:10,642 --> 00:25:12,177
MANY GOALS, AND ONE OF THE

685
00:25:12,177 --> 00:25:15,114
OPPORTUNITIES WE SEE IS AS

686
00:25:15,114 --> 00:25:19,151
BROADBAND ACCESS HAS CONTINUED

687
00:25:19,151 --> 00:25:22,087
TO BE MORE AVAILABLE TO

688
00:25:22,087 --> 00:25:25,023
COMMUNITIES, BOTH COMMUNITIES IN

689
00:25:25,023 --> 00:25:26,558
TERMS OF GEOGRAPHY, BUT

690
00:25:26,558 --> 00:25:27,960
COMMUNITIES IN TERMS OF RACE,

691
00:25:27,960 --> 00:25:30,062
AND YOU SEE MORE CHALLENGES IN

692
00:25:30,062 --> 00:25:31,697
TERMS OF ECONOMIC SIDE OF

693
00:25:31,697 --> 00:25:32,464
BROADBAND ACCESS, THAT'S AGAIN

694
00:25:32,464 --> 00:25:35,834
WHERE YOU START TO SEE THIS

695
00:25:35,834 --> 00:25:37,169
ASPECT OF THE PROMISE AND

696
00:25:37,169 --> 00:25:39,438
OPPORTUNITIES IN TERMS OF

697
00:25:39,438 --> 00:25:42,241
TELEMEDICINE, TELEHEALTH.

698
00:25:42,241 --> 00:25:45,544
NEXT SLIDE PLEASE.

699
00:25:45,544 --> 00:25:47,479
AND SO EVOLUTIONS, IT'S KIND OF

700
00:25:47,479 --> 00:25:47,913
INTERESTING.

701
00:25:47,913 --> 00:25:50,115
AND, YOU KNOW, PART OF TODAY'S

702
00:25:50,115 --> 00:25:53,285
LOOKING BACK IN TERMS OF THE

703
00:25:53,285 --> 00:25:54,186
PANDEMIC AND PRIOR TO THAT, AND

704
00:25:54,186 --> 00:25:57,890
THEN IN TERMS OF EVEN THINKING

705
00:25:57,890 --> 00:25:58,957
THROUGH AND LOOKING FORWARD,

706
00:25:58,957 --> 00:26:02,027
THIS IS A SLIDE I CAPTURED FROM

707
00:26:02,027 --> 00:26:06,098
ONE OF -- FROM THE ATA, MAKES

708
00:26:06,098 --> 00:26:08,500
YOU THINK ABOUT HOW TELEMEDICINE

709
00:26:08,500 --> 00:26:11,437
AND TELEHEALTH EVOLVED, PRIOR TO

710
00:26:11,437 --> 00:26:17,242
EVEN GETTING TO WHERE WE WERE

711
00:26:17,242 --> 00:26:19,645
WITH THE PANDEMIC WHERE YOU ARE

712
00:26:19,645 --> 00:26:23,248
EARLY INNOVATORS, EARLY

713
00:26:23,248 --> 00:26:24,583
ADOPTERS, INDIVIDUALS WHO

714
00:26:24,583 --> 00:26:26,285
STARTED TELEMEDICINE AND

715
00:26:26,285 --> 00:26:29,188
TELEHEALTH PROGRAMS, DR. SANDERS

716
00:26:29,188 --> 00:26:34,326
BACK IN THE 1980s, AND OTHERS,

717
00:26:34,326 --> 00:26:36,395
BUILDING SOME OF THOSE BUILDING

718
00:26:36,395 --> 00:26:38,831
BLOCKS AND PROGRAMS.

719
00:26:38,831 --> 00:26:41,333
BUT THE REAL RATE-LIMITING

720
00:26:41,333 --> 00:26:43,635
FACTORS, ADVANCEMENTS IN

721
00:26:43,635 --> 00:26:44,269
TELEMEDICINE AND TELEHEALTH, HAS

722
00:26:44,269 --> 00:26:47,039
CONTINUED TO BE CHALLENGES

723
00:26:47,039 --> 00:26:48,373
AROUND POLICY, PAYMENT, AND

724
00:26:48,373 --> 00:26:49,208
INFRASTRUCTURE.

725
00:26:49,208 --> 00:26:50,676
WE'RE GOING TO TALK MORE ABOUT

726
00:26:50,676 --> 00:26:53,378
THAT, HOW THAT EVOLVED DURING

727
00:26:53,378 --> 00:26:54,546
THE PANDEMIC.

728
00:26:54,546 --> 00:27:01,920
THERE WERE SOME INITIAL FUNDING

729
00:27:01,920 --> 00:27:04,790
OPPORTUNITIES, YOU KNOW, WITH

730
00:27:04,790 --> 00:27:05,991
THE RECOVERY AND INVESTMENT ACT

731
00:27:05,991 --> 00:27:09,261
PUMPING MONEY INTO THE SYSTEM

732
00:27:09,261 --> 00:27:11,430
AROUND POLICY AND INNOVATION BUT

733
00:27:11,430 --> 00:27:12,664
BECAUSE POLICY LEVERS WEREN'T

734
00:27:12,664 --> 00:27:15,701
BEING PULLED SOME FUNDING

735
00:27:15,701 --> 00:27:17,669
DYNAMIC, THOUGH ADVANCING

736
00:27:17,669 --> 00:27:20,739
RESEARCH, DIDN'T REALLY ADVANCE

737
00:27:20,739 --> 00:27:22,875
THE PRACTICE OF TELEMEDICINE AND

738
00:27:22,875 --> 00:27:23,809
TELEHEALTH OVERALL.

739
00:27:23,809 --> 00:27:25,878
A LOT OF THAT HAPPENED DURING

740
00:27:25,878 --> 00:27:28,714
THE PANDEMIC AND I'LL HOPEFULLY

741
00:27:28,714 --> 00:27:32,017
ELUCIDATE SOME KEY ONES AND HOW

742
00:27:32,017 --> 00:27:32,684
THAT INFLUENCED BEHAVIOR

743
00:27:32,684 --> 00:27:33,318
PATTERNS AS WELL.

744
00:27:33,318 --> 00:27:37,155
NEXT SLIDE PLEASE.

745
00:27:37,155 --> 00:27:39,625
SO, PANDEMIC HIT.

746
00:27:39,625 --> 00:27:44,863
NEXT SLIDE PLEASE. 

747
00:27:44,863 --> 00:27:47,366
AND THEN AS ALLUDED TO BEFORE A

748
00:27:47,366 --> 00:27:48,300
NUMBER OF THINGS HAPPENED

749
00:27:48,300 --> 00:27:49,468
SIMULTANEOUSLY ON THE POLICY

750
00:27:49,468 --> 00:27:49,668
FRONT.

751
00:27:49,668 --> 00:27:54,406
I'M SORRY, NEXT SLIDE PLEASE.

752
00:27:54,406 --> 00:27:57,910
AND A KEY TO THOSE RAPID CHANGES

753
00:27:57,910 --> 00:28:00,746
AT THE ONSET OF THE PANDEMIC WAS

754
00:28:00,746 --> 00:28:02,481
IMPROVED REIMBURSEMENT FROM

755
00:28:02,481 --> 00:28:06,985
INSURERS BUT ALSO KEY ACTIVITIES

756
00:28:06,985 --> 00:28:09,521
FROM LOOSENING OF PRIVACY AND

757
00:28:09,521 --> 00:28:12,558
HIPAA REQUIREMENTS FROM OCR.

758
00:28:12,558 --> 00:28:15,527
I WOULD ALSO -- REQUIREMENTS FOR

759
00:28:15,527 --> 00:28:16,428
TELEHEALTH AND MEDICARE PROGRAM

760
00:28:16,428 --> 00:28:19,231
ALLOWING MORE ACCESS IN TERMS OF

761
00:28:19,231 --> 00:28:21,300
PAYMENT FROM GEOGRAPHIC

762
00:28:21,300 --> 00:28:22,734
LOCATIONS, EXPANDED ACCESS TO

763
00:28:22,734 --> 00:28:24,836
TELEHEALTH, AND A LOT AROUND

764
00:28:24,836 --> 00:28:27,739
THIS CONCEPT OF WHAT HAPPENED

765
00:28:27,739 --> 00:28:29,841
WITH PROVIDER LICENSE AND

766
00:28:29,841 --> 00:28:31,276
ON-LINE PRESCRIBING AND WRITTEN

767
00:28:31,276 --> 00:28:31,510
CONSENT.

768
00:28:31,510 --> 00:28:32,811
IT'S INTERESTING WHEN YOU PEEL

769
00:28:32,811 --> 00:28:34,980
BACK WHAT HAPPENED IN TERMS OF

770
00:28:34,980 --> 00:28:36,415
PRACTICE PATTERNS, GOING IN

771
00:28:36,415 --> 00:28:37,849
PARTICULAR THROUGH WHAT HAPPENED

772
00:28:37,849 --> 00:28:38,917
IN FAMILY PRACTICE GROUPS AND

773
00:28:38,917 --> 00:28:40,485
THEN OTHERS IN TERMS OF DATA

774
00:28:40,485 --> 00:28:43,322
THAT WAS BEING COLLECTED IN REAL

775
00:28:43,322 --> 00:28:43,789
TIME.

776
00:28:43,789 --> 00:28:45,524
BUT INTERESTINGLY ENOUGH, YOU

777
00:28:45,524 --> 00:28:47,259
KNOW, YOU SAW THE PRIVATE

778
00:28:47,259 --> 00:28:47,859
EXPANSION.

779
00:28:47,859 --> 00:28:49,361
IN A COMMUNITY HEALTH CENTER

780
00:28:49,361 --> 00:28:57,336
PROGRAM FOR INSTANCE WHERE YOU

781
00:28:57,336 --> 00:28:58,537
INITIALLY SAW TELEMEDICINE

782
00:28:58,537 --> 00:29:02,040
TELEHEALTH RATES IN 15%, GETTING

783
00:29:02,040 --> 00:29:07,846
INTO THE 90s PER CENT DURING

784
00:29:07,846 --> 00:29:09,247
THE PANDEMIC, AS CLINICIANS

785
00:29:09,247 --> 00:29:12,017
STARTED TO LEARN, GRASP, GAIN

786
00:29:12,017 --> 00:29:12,784
MORE COMFORT WITH

787
00:29:12,784 --> 00:29:16,088
INFRASTRUCTURE, YOU STARTED TO

788
00:29:16,088 --> 00:29:18,557
SEE WHERE A LOT OF PRACTICE

789
00:29:18,557 --> 00:29:23,161
PATTERNS CHANGED, BUT AS THE

790
00:29:23,161 --> 00:29:24,363
PAYMENTS AND POLICY CONTINUED TO

791
00:29:24,363 --> 00:29:27,532
BE A BARRIER, DESPITE THE MANY

792
00:29:27,532 --> 00:29:28,967
CHANGES, WE'LL TALK ABOUT THAT

793
00:29:28,967 --> 00:29:29,701
AS WELL.

794
00:29:29,701 --> 00:29:32,771
SO RAPID CHANGES IN TERMS OF

795
00:29:32,771 --> 00:29:34,640
PAYMENT AND POLICY REALLY PULLED

796
00:29:34,640 --> 00:29:39,144
ON THOSE LEVERS THAT MOVED

797
00:29:39,144 --> 00:29:40,245
FORWARD A LOT DURING THE

798
00:29:40,245 --> 00:29:44,616
PANDEMIC AS WELL. 

799
00:29:44,616 --> 00:29:45,617
NEXT SLIDE PLEASE.

800
00:29:45,617 --> 00:29:46,918
AND THERE'S SOME INTERESTING

801
00:29:46,918 --> 00:29:48,120
DATA THAT CAME OUT.

802
00:29:48,120 --> 00:29:52,691
I CAPTURED A LOT FROM A REALLY

803
00:29:52,691 --> 00:29:53,358
WELL-DONE REVIEW FROM

804
00:29:53,358 --> 00:29:56,528
IMMUNOLOGIST WHO WROTE A LOT

805
00:29:56,528 --> 00:29:58,497
ABOUT JUST REVIEW GROUP, WHO

806
00:29:58,497 --> 00:30:00,265
WROTE A LOT ABOUT SOME OF THE

807
00:30:00,265 --> 00:30:01,700
DYNAMICS THAT REALLY KIND OF

808
00:30:01,700 --> 00:30:02,167
CHANGED.

809
00:30:02,167 --> 00:30:03,869
ONE OF THOSE INTERESTING THINGS

810
00:30:03,869 --> 00:30:07,606
WAS INITIALLY IN THE PANDEMIC,

811
00:30:07,606 --> 00:30:10,108
PATIENT SATISFACTION WAS SIMILAR

812
00:30:10,108 --> 00:30:11,643
WITH IN-PERSON AND TELEPHONE

813
00:30:11,643 --> 00:30:13,712
ENCOUNTERS, PARTICULARLY DURING

814
00:30:13,712 --> 00:30:14,046
THE PANDEMIC.

815
00:30:14,046 --> 00:30:18,216
AND MAYBE SOME OF THIS WAS

816
00:30:18,216 --> 00:30:19,451
RELATED TO EXPECTATIONS THAT

817
00:30:19,451 --> 00:30:21,420
PEOPLE WERE DEALING WITH THEIR

818
00:30:21,420 --> 00:30:25,357
OWN FEARS IN TERMS OF VIRAL

819
00:30:25,357 --> 00:30:27,893
EXPOSURE, BUT YOU SAW A LOT OF

820
00:30:27,893 --> 00:30:31,530
EQUAL DYNAMICS IN TERMS OF

821
00:30:31,530 --> 00:30:32,731
IN-PERSON VIDEO, TELEPHONE

822
00:30:32,731 --> 00:30:37,102
ENCOUNTERS, INITIALLY DURING THE

823
00:30:37,102 --> 00:30:38,537
PANDEMIC, AROUND THOSE AND

824
00:30:38,537 --> 00:30:40,839
PATIENT SATISFACTION AND THOSE

825
00:30:40,839 --> 00:30:42,708
RELATED TO REAL-LIFE -- IN

826
00:30:42,708 --> 00:30:48,280
REAL-LIFE ENCOUNTERS AS WELL.

827
00:30:48,280 --> 00:30:48,914
SIMILARLY, PHYSICIAN

828
00:30:48,914 --> 00:30:49,815
SATISFACTION WAS EVOLVED OVER

829
00:30:49,815 --> 00:30:52,317
TIME WITH A LOT OF PROVIDERS

830
00:30:52,317 --> 00:30:54,186
EXPRESSING MORE POSITIVE

831
00:30:54,186 --> 00:30:55,153
ATTITUDES AROUND ADOPTION OF

832
00:30:55,153 --> 00:30:55,721
TELEMEDICINE.

833
00:30:55,721 --> 00:30:56,722
I'LL GO INTO THAT SPECIFICALLY

834
00:30:56,722 --> 00:30:57,789
IN A SECOND AS WELL.

835
00:30:57,789 --> 00:30:59,658
THERE ARE A LOT OF CHALLENGES

836
00:30:59,658 --> 00:31:01,693
WITH INTEGRATION OF WORK FLOW,

837
00:31:01,693 --> 00:31:06,098
AND THEN A LOT OF CHALLENGES IN

838
00:31:06,098 --> 00:31:07,866
TERMS OF HOW TO REPLICATE

839
00:31:07,866 --> 00:31:09,601
COLLECTING CLINICAL INFORMATION

840
00:31:09,601 --> 00:31:11,236
AT HOME, LIKE BLOOD PRESSURE, OR

841
00:31:11,236 --> 00:31:13,538
OTHER KINDS OF THINGS YOU WOULD

842
00:31:13,538 --> 00:31:15,073
NORMALLY COLLECT WITHIN THE

843
00:31:15,073 --> 00:31:16,942
CLINICAL CONTEXT IN A VISIT, AND

844
00:31:16,942 --> 00:31:18,577
A LOT OF CHALLENGES WITH THAT.

845
00:31:18,577 --> 00:31:20,345
IT WAS INTERESTING WATCHING THE

846
00:31:20,345 --> 00:31:21,880
SYSTEM EVOLVE IN REAL TIME.

847
00:31:21,880 --> 00:31:25,517
I'LL SHOW YOU SOME DATA FROM

848
00:31:25,517 --> 00:31:26,685
FAMILY MEDICINE, CLINICIANS

849
00:31:26,685 --> 00:31:28,019
SHOWING HOW CLINICIANS WERE

850
00:31:28,019 --> 00:31:30,989
EVOLVING IN REAL TIME AND THEN

851
00:31:30,989 --> 00:31:31,857
EEVOLVEDDED BACK.

852
00:31:31,857 --> 00:31:35,694
INTERESTINGLY ENOUGH, A LOT OF

853
00:31:35,694 --> 00:31:38,296
STUDIES SHOWED PARTICULAR

854
00:31:38,296 --> 00:31:39,631
BENEFIT AROUND VIRTUAL VISITS

855
00:31:39,631 --> 00:31:40,966
AROUND SPECIALTY CARE, AND

856
00:31:40,966 --> 00:31:44,469
THAT'S WHERE I THINK WE'LL

857
00:31:44,469 --> 00:31:47,873
CONTINUE TO POTENTIALLY SEE SOME

858
00:31:47,873 --> 00:31:50,275
LONG LASTING IMPACT AND

859
00:31:50,275 --> 00:31:51,910
BETTER -- GOOD DATA AROUND

860
00:31:51,910 --> 00:31:54,079
IMPACTS BUT REALLY AGAIN

861
00:31:54,079 --> 00:31:58,450
SPECIALTY CARE WAS WHERE YOU SAW

862
00:31:58,450 --> 00:32:03,155
SOME OF THE MOST -- A LOT MORE

863
00:32:03,155 --> 00:32:04,156
LONG-LASTING BENEFITS IN TERMS

864
00:32:04,156 --> 00:32:05,690
OF PATIENT AND PROVIDER.

865
00:32:05,690 --> 00:32:07,325
NEXT SLIDE PLEASE.

866
00:32:07,325 --> 00:32:12,264
NEXT SLIDE PLEASE.

867
00:32:12,264 --> 00:32:14,566
AND SO, INTERESTING -- GO ONE

868
00:32:14,566 --> 00:32:15,100
SLIDE BACK.

869
00:32:15,100 --> 00:32:17,335
INTERESTING IS, YOU KNOW, HOW

870
00:32:17,335 --> 00:32:24,442
THE KIND THIS CHANGE OF MEDICINE

871
00:32:24,442 --> 00:32:25,911
EVOLVED, STATE LICENSURE WAS A

872
00:32:25,911 --> 00:32:27,145
LIMITING FACTOR.

873
00:32:27,145 --> 00:32:29,481
THIS IDEA OF STATE LICENSE AND

874
00:32:29,481 --> 00:32:32,083
BEING ABLE TO PRACTICE AND

875
00:32:32,083 --> 00:32:33,151
PROVIDE CARE ACROSS STATE LINES

876
00:32:33,151 --> 00:32:35,287
HAS AN CONTINUES TO BE KIND OF

877
00:32:35,287 --> 00:32:39,424
ONE OF THOSE RATE-LIMITING

878
00:32:39,424 --> 00:32:39,825
FACTORS.

879
00:32:39,825 --> 00:32:43,695
SO YOU SAW, YOU KNOW, 12 STATE

880
00:32:43,695 --> 00:32:45,463
BOARDS THAT ALLOWED LICENSE TO

881
00:32:45,463 --> 00:32:48,400
PRACTICE ACROSS STATE LINES BUT

882
00:32:48,400 --> 00:32:51,670
STILL THIS ISSUE OF STATE

883
00:32:51,670 --> 00:32:52,737
LICENSURE BEING A CONSTANT

884
00:32:52,737 --> 00:32:56,608
CONCEPT EVEN THOUGH SOME OF THAT

885
00:32:56,608 --> 00:32:59,244
EVOLVED DURING THE PANDEMIC, BUT

886
00:32:59,244 --> 00:33:05,250
EVEN SO STILL BEING -- AS A

887
00:33:05,250 --> 00:33:05,884
CLINICIAN WHO PRACTICES

888
00:33:05,884 --> 00:33:08,086
TELEMEDICINE, CARDIOLOGY, YOU

889
00:33:08,086 --> 00:33:12,257
SEE THAT IN REAL TIME AS YOU ARE

890
00:33:12,257 --> 00:33:14,326
LOOKING AT DIFFERENT

891
00:33:14,326 --> 00:33:16,261
TELEMEDICINE-RELATED PROGRAMS,

892
00:33:16,261 --> 00:33:16,628
IN GENERAL.

893
00:33:16,628 --> 00:33:20,665
I HAVE BEEN ONE OF THE CLINICIAN

894
00:33:20,665 --> 00:33:22,634
LEADERS OF ECHO PROGRAM IN

895
00:33:22,634 --> 00:33:24,402
MISSOURI ACROSS THE STATE OF

896
00:33:24,402 --> 00:33:25,804
MISSOURI, UNIVERSITY OF

897
00:33:25,804 --> 00:33:26,171
MISSOURI.

898
00:33:26,171 --> 00:33:27,439
AND IT'S BEEN INTERESTING HOW

899
00:33:27,439 --> 00:33:34,479
WE'VE ALSO BEEN ABLE TO LEVERAGE

900
00:33:34,479 --> 00:33:37,549
THERE THE CONCEPTS AROUND NOT

901
00:33:37,549 --> 00:33:39,417
JUST LICENSE BUT ALSO THIS IDEA

902
00:33:39,417 --> 00:33:40,619
OF UTILIZING COMMUNITY HEALTH

903
00:33:40,619 --> 00:33:43,255
WORKERS AND OTHER KINDS OF CARE

904
00:33:43,255 --> 00:33:45,991
EXTENDERS, IN TERMS OF REACHING

905
00:33:45,991 --> 00:33:46,391
COMMUNITIES.

906
00:33:46,391 --> 00:33:48,159
SO AS WE WORK THROUGH ISSUES OF

907
00:33:48,159 --> 00:33:50,829
LICENSURE I THINK ALSO THINKING

908
00:33:50,829 --> 00:33:51,897
THROUGH OTHER COMPONENTS IN

909
00:33:51,897 --> 00:33:53,331
TERMS OF EXTENSION OF CARE AS

910
00:33:53,331 --> 00:33:55,066
WELL.

911
00:33:55,066 --> 00:33:57,769
NEXT SLIDE PLEASE.

912
00:33:57,769 --> 00:34:01,539
NEXT SLIDE PLEASE.

913
00:34:01,539 --> 00:34:05,777
SO, INTERESTINGLY ENOUGH INITIAL

914
00:34:05,777 --> 00:34:07,445
GROWTH OF TELEMEDICINE OFFSET

915
00:34:07,445 --> 00:34:17,055
2/3 OF DECLINE OF IN IN-PERSON

916
00:34:17,055 --> 00:34:18,823
VISITS, PEAKED AROUND APRIL 15

917
00:34:18,823 --> 00:34:22,761
BEFORE DECLINING BUT CAP TOWARD

918
00:34:22,761 --> 00:34:24,529
WHAT WAS OCCURRING IN REAL TIME,

919
00:34:24,529 --> 00:34:27,165
ABLE TO MAKE UP FOR A LOT OF

920
00:34:27,165 --> 00:34:29,434
WHERE PEOPLE WERE LOSING ACCESS

921
00:34:29,434 --> 00:34:30,869
TO CARE, TELEMEDICINE WAS ABLE

922
00:34:30,869 --> 00:34:31,636
TO STEP IN.

923
00:34:31,636 --> 00:34:33,271
I WANT YOU TO THINK ABOUT THAT

924
00:34:33,271 --> 00:34:34,806
IN TERMS OF SOME EARLIER SLIDES

925
00:34:34,806 --> 00:34:38,977
I PRESENTED WHEN I WAS TALKING

926
00:34:38,977 --> 00:34:40,946
ABOUT HEART DISEASE OUTCOMES AND

927
00:34:40,946 --> 00:34:42,580
MORBIDITY AND MORTALITY FROM OUR

928
00:34:42,580 --> 00:34:44,549
HEART DISEASE, AND OPPORTUNITIES

929
00:34:44,549 --> 00:34:46,051
WE HAD WITH TELEMEDICINE OF

930
00:34:46,051 --> 00:34:48,053
BEING ABLE TO GET BETTER ACCESS

931
00:34:48,053 --> 00:34:52,190
IF WE CAN GET THROUGH SOME

932
00:34:52,190 --> 00:34:54,059
STRUCTURAL CONCEPTS THAT LIMIT

933
00:34:54,059 --> 00:34:55,727
BOTH MINORITY AND RURAL

934
00:34:55,727 --> 00:34:57,329
COMMUNITIES.

935
00:34:57,329 --> 00:35:00,231
BUT THIS SLIDE CAPTURES HOW

936
00:35:00,231 --> 00:35:02,701
PARTICULARLY IN FAMILY MEDICINE

937
00:35:02,701 --> 00:35:07,105
HOW THE KIND OF USE BUMPED UP

938
00:35:07,105 --> 00:35:09,407
OVER TIME, KIND OF WENT UP AND

939
00:35:09,407 --> 00:35:12,577
DOWN IN RELATION TO VIRAL

940
00:35:12,577 --> 00:35:14,446
PANDEMICS, WHEN THE VIRUS WAS

941
00:35:14,446 --> 00:35:16,648
PARTICULARLY EMERGING AND MORE

942
00:35:16,648 --> 00:35:17,515
LETHAL AND MORE PROMINENT YOU

943
00:35:17,515 --> 00:35:19,918
SAW THE SPIKE IN VISITS, AND

944
00:35:19,918 --> 00:35:21,753
SPIKE GOING BACK DOWN.

945
00:35:21,753 --> 00:35:24,723
AND SO A LOT TO TEASE APART

946
00:35:24,723 --> 00:35:27,258
HERE, THERE'S A COUPLE THINGS

947
00:35:27,258 --> 00:35:28,860
THAT WE'LL CAPTURE IN THE NEXT

948
00:35:28,860 --> 00:35:31,596
SLIDE AS WELL.

949
00:35:31,596 --> 00:35:32,697
NEXT SLIDE PLEASE.

950
00:35:32,697 --> 00:35:39,504
AND THEN WHAT YOU ALSO SAW WAS

951
00:35:39,504 --> 00:35:41,806
THAT PROVIDERS WERE GENERALLY

952
00:35:41,806 --> 00:35:44,309
VERY POSITIVE IN TERMS OF THEIR

953
00:35:44,309 --> 00:35:45,643
CAPACITY TO SEE PATIENTS, ET

954
00:35:45,643 --> 00:35:47,612
CETERA.

955
00:35:47,612 --> 00:35:50,148
A LOT OF BENEFITS SEEN IN THE

956
00:35:50,148 --> 00:35:52,117
HEALTH ARENA, YOU START TO SEE A

957
00:35:52,117 --> 00:35:56,955
LOT CONTINUE TO EVOLVE.

958
00:35:56,955 --> 00:35:59,157
STILL SOME DISCOMFORT AROUND

959
00:35:59,157 --> 00:36:03,261
SOME TREATMENT, BUT YOU START TO

960
00:36:03,261 --> 00:36:05,463
SEE A LOT OF POSITIVES AROUND

961
00:36:05,463 --> 00:36:09,100
BEHAVIOR AND MENTAL HEALTH.

962
00:36:09,100 --> 00:36:09,834
INTERESTINGLY ENOUGH POPULATION

963
00:36:09,834 --> 00:36:12,837
THAT YOU START TO SEE THE MOST

964
00:36:12,837 --> 00:36:15,006
BENEFIT WERE NOT SOME MINORITY

965
00:36:15,006 --> 00:36:16,074
AND UNDERSERVED POPULATIONS

966
00:36:16,074 --> 00:36:19,811
WHERE YOU HAVE THE MOST

967
00:36:19,811 --> 00:36:20,912
OPPORTUNITY BUT OTHER

968
00:36:20,912 --> 00:36:21,813
POPULATIONS WHO MAY HAVE HAD

969
00:36:21,813 --> 00:36:23,114
ACCESS IN OTHER WAYS WHERE THIS

970
00:36:23,114 --> 00:36:25,617
WAS A MORE CONVENIENT FORM OF

971
00:36:25,617 --> 00:36:25,850
ACCESS.

972
00:36:25,850 --> 00:36:32,957
AGAIN, KEEPING IN MIND HOW DO WE

973
00:36:32,957 --> 00:36:33,625
THINK THROUGH EXPANDING

974
00:36:33,625 --> 00:36:34,592
INFRASTRUCTURE AND TOOLS WE CAN

975
00:36:34,592 --> 00:36:37,462
DO HERE AND HOW DO WE THEN BRING

976
00:36:37,462 --> 00:36:39,864
THAT MORE TO MINORITY AND

977
00:36:39,864 --> 00:36:41,933
UNDERSERVED POPULATIONS.

978
00:36:41,933 --> 00:36:42,700
NEXT SLIDE PLEASE.

979
00:36:42,700 --> 00:36:46,438
AND THIS IS KIND OF INTERESTING

980
00:36:46,438 --> 00:36:49,274
WHEN WE LOOK AT HOW CLINICIANS

981
00:36:49,274 --> 00:36:51,242
FELT LATER ON AROUND

982
00:36:51,242 --> 00:36:55,847
TELEMEDICINE AND TELEHEALTH.

983
00:36:55,847 --> 00:36:57,348
SO POSITIVE OVERALL IN A VARIETY

984
00:36:57,348 --> 00:36:58,450
OF WAYS.

985
00:36:58,450 --> 00:37:00,518
WHAT YOU DID START TO SEE WAS

986
00:37:00,518 --> 00:37:05,557
TWO THINGS THAT HAVE KIND OF LED

987
00:37:05,557 --> 00:37:08,193
TO THE OVERALL DECLINE, A LOT

988
00:37:08,193 --> 00:37:09,794
RELATED TO REIMBURSEMENT.

989
00:37:09,794 --> 00:37:13,465
STARTED TO GET MORE ENTANGLED,

990
00:37:13,465 --> 00:37:14,566
FURTHER REIMBURSEMENT DYNAMICS,

991
00:37:14,566 --> 00:37:21,239
YOU STARTED TO SEE A LOT OF

992
00:37:21,239 --> 00:37:22,006
THESE PERCEPTIONS, CONCEPTS,

993
00:37:22,006 --> 00:37:23,208
PRACTICES REVERT AND KIND OF

994
00:37:23,208 --> 00:37:25,844
CHANGE BACK TO THE WAY THINGS

995
00:37:25,844 --> 00:37:26,277
WERE BEFORE.

996
00:37:26,277 --> 00:37:32,317
SO A LOT OF RECOGNITION FROM

997
00:37:32,317 --> 00:37:35,253
CLINICIANS THAT THE PRACTICE OF

998
00:37:35,253 --> 00:37:36,221
TELEMEDICINE, THE WAY THEY

999
00:37:36,221 --> 00:37:38,656
INTEGRATED TELEHEALTH INTO THEIR

1000
00:37:38,656 --> 00:37:40,291
PRACTICES THOUGH CHALLENGING

1001
00:37:40,291 --> 00:37:42,594
INITIALLY, EVOLVING OVER TIME,

1002
00:37:42,594 --> 00:37:45,196
OF NET BENEFIT IN GENERAL.

1003
00:37:45,196 --> 00:37:47,832
BUT WHAT YOU STARTED TO SEE IN

1004
00:37:47,832 --> 00:37:51,436
THE LAST SLIDE WAS A LOT OF

1005
00:37:51,436 --> 00:37:52,470
REGRESSION, PRACTICE PATTERNS,

1006
00:37:52,470 --> 00:38:00,345
RELATED PRIMARILY A LOT TO

1007
00:38:00,345 --> 00:38:00,945
REIMBURSEMENT, AND COMMERCIAL

1008
00:38:00,945 --> 00:38:05,583
REIMBURSEMENT, MADE IT MORE

1009
00:38:05,583 --> 00:38:06,651
CHALLENGING, TELEMEDICINE AND

1010
00:38:06,651 --> 00:38:08,319
TELEHEALTH, BUT A LOT OF THIS

1011
00:38:08,319 --> 00:38:15,560
RELATED TO NOT JUST -- NOT SO

1012
00:38:15,560 --> 00:38:17,061
MUCH THE FEELINGS OF CLINICIANS

1013
00:38:17,061 --> 00:38:18,263
BUT THE QUALITY IN GENERAL.

1014
00:38:18,263 --> 00:38:20,899
GOING BACK TO THE HISTORY OF

1015
00:38:20,899 --> 00:38:22,200
TELEMEDICINE, TELEHEALTH, A LOT

1016
00:38:22,200 --> 00:38:23,868
BOTH IN PANDEMIC AND

1017
00:38:23,868 --> 00:38:27,071
PRE-PANDEMIC, A LOT OF

1018
00:38:27,071 --> 00:38:28,439
RATE-LIMITING FACTORS BEING

1019
00:38:28,439 --> 00:38:31,309
DRIVEN BY POLICY AND PAYMENT

1020
00:38:31,309 --> 00:38:33,745
DYNAMICS, IN THE INSURER,

1021
00:38:33,745 --> 00:38:37,015
PRIVATE INSURER, BUT ALSO IN THE

1022
00:38:37,015 --> 00:38:40,919
BROADER THEME OF PUBLIC POLICY.

1023
00:38:40,919 --> 00:38:43,121
NEXT SLIDE PLEASE.

1024
00:38:43,121 --> 00:38:44,122
SO, HOSPITALS, IT'S AN

1025
00:38:44,122 --> 00:38:46,958
INTERESTING THING WHEN YOU LOOK

1026
00:38:46,958 --> 00:38:53,531
AT WHO WERE ABLE TO ADOPT, YOU

1027
00:38:53,531 --> 00:38:54,732
KNOW, TELEHEALTH AND

1028
00:38:54,732 --> 00:38:55,934
TELEMEDICINE PRACTICES.

1029
00:38:55,934 --> 00:38:58,102
IN HOSPITALS THAT WERE

1030
00:38:58,102 --> 00:39:02,941
AFFILIATED WITH -- HOSPITALS

1031
00:39:02,941 --> 00:39:04,375
AFFILIATED WITH LARGE SYSTEMS,

1032
00:39:04,375 --> 00:39:07,412
YOU KNOW, THOSE WERE THE ONES

1033
00:39:07,412 --> 00:39:11,149
THAT WERE MORE LIKELY.

1034
00:39:11,149 --> 00:39:12,016
MAJOR TEACHING HOSPITALS MORE

1035
00:39:12,016 --> 00:39:13,885
LIKELY TO ADOPT TELEHEALTH.

1036
00:39:13,885 --> 00:39:15,720
THE ONES MORE CHALLENGED WERE IN

1037
00:39:15,720 --> 00:39:18,690
RURAL AREAS, OR THOSE THAT WERE

1038
00:39:18,690 --> 00:39:20,225
INVESTOR-OWNED OR THOSE THAT

1039
00:39:20,225 --> 00:39:21,759
WERE UNAFFILIATED WITH A

1040
00:39:21,759 --> 00:39:26,130
HOSPITAL SYSTEM, HUGE

1041
00:39:26,130 --> 00:39:30,768
DISPARITIES IN TERMS OF HOSPITAL

1042
00:39:30,768 --> 00:39:34,872
DYNAMICS AND INFRASTRUCTURE WAS

1043
00:39:34,872 --> 00:39:36,741
THOUGHT TO PLAY A MAJOR ROLE,

1044
00:39:36,741 --> 00:39:38,276
AND BROADBAND ACCESS, NOT JUST

1045
00:39:38,276 --> 00:39:40,144
OF PATIENTS, WHAT'S OCCURRING IN

1046
00:39:40,144 --> 00:39:41,212
THESE COMMUNITIES.

1047
00:39:41,212 --> 00:39:42,413
SO VERY BIG DIFFERENCES IN THE

1048
00:39:42,413 --> 00:39:45,383
PANDEMIC OF THE HOSPITAL SYSTEMS

1049
00:39:45,383 --> 00:39:50,288
ABLE TO ENGAGE AND NOT ENGAGE,

1050
00:39:50,288 --> 00:39:54,292
RELATED TO ABILITY TO TAP INTO A

1051
00:39:54,292 --> 00:39:56,594
LARGER POOL AND LARGER

1052
00:39:56,594 --> 00:39:57,095
INFRASTRUCTURE OVERALL.

1053
00:39:57,095 --> 00:39:59,764
NEXT SLIDE PLEASE.

1054
00:39:59,764 --> 00:40:00,965
SO -- NEXT SLIDE PLEASE.

1055
00:40:00,965 --> 00:40:03,368
SO WHEN WE KIND OF THINK THROUGH

1056
00:40:03,368 --> 00:40:07,171
A LOT OF THIS, LET ME CLOSE WITH

1057
00:40:07,171 --> 00:40:08,973
A COUPLE TAKEHOME MESSAGES.

1058
00:40:08,973 --> 00:40:11,709
TELEMEDICINE IS NOT GOING TO

1059
00:40:11,709 --> 00:40:15,780
REPLACE IN-PERSON CARE, BUT IS

1060
00:40:15,780 --> 00:40:17,081
REALLY AN ADJUNCT NOT JUST IN

1061
00:40:17,081 --> 00:40:18,116
PUBLIC HEALTH EMERGENCIES HERE

1062
00:40:18,116 --> 00:40:22,787
BUT ALSO IN TERMS OF THAT MACRO

1063
00:40:22,787 --> 00:40:26,791
CHALLENGE I WAS ARTICULATING

1064
00:40:26,791 --> 00:40:29,560
BEFORE, AROUND, YOU KNOW, HOW WE

1065
00:40:29,560 --> 00:40:31,129
CAN REACH UNDERSERVED

1066
00:40:31,129 --> 00:40:34,532
POPULATIONS. 

1067
00:40:34,532 --> 00:40:37,368
CERTAINLY IN MY WORLD, GOOGLE

1068
00:40:37,368 --> 00:40:38,803
AND RELATED PLACES, THERE ARE

1069
00:40:38,803 --> 00:40:44,375
ADDITIONAL A.I. OTHER TOOLS.

1070
00:40:44,375 --> 00:40:44,976
FOR THE CONVERSATIONS TODAY,

1071
00:40:44,976 --> 00:40:49,080
THERE'S A LOT TO UNDERSTAND IN

1072
00:40:49,080 --> 00:40:52,784
TERMS OF WHAT THE ROLE IS,

1073
00:40:52,784 --> 00:40:53,451
TELEMEDICINE, TELEHEALTH CAN

1074
00:40:53,451 --> 00:40:54,018
PLAY IN GENERAL.

1075
00:40:54,018 --> 00:40:56,721
I WANT TO TAKE A SECOND TO TALK

1076
00:40:56,721 --> 00:41:00,458
THROUGH THIS ISSUE OF BARRIERS.

1077
00:41:00,458 --> 00:41:03,728
THERE'S A LOT PUBLISHED AROUND,

1078
00:41:03,728 --> 00:41:04,929
YOU KNOW, BARRIERS TO

1079
00:41:04,929 --> 00:41:07,231
TELEMEDICINE, TELEHEALTH, WHAT

1080
00:41:07,231 --> 00:41:09,767
IT MEANS FOR MINORITY AND

1081
00:41:09,767 --> 00:41:10,068
UNDERSERVED.

1082
00:41:10,068 --> 00:41:12,837
AT THE BEGINNING, THOSE WERE THE

1083
00:41:12,837 --> 00:41:15,173
BEST AND BIGGEST OPPORTUNITIES,

1084
00:41:15,173 --> 00:41:15,773
JUST BECAUSE OF THE MORBIDITY

1085
00:41:15,773 --> 00:41:17,775
AND MORTALITY GAP AND HOW SO

1086
00:41:17,775 --> 00:41:22,146
MANY OF THE ACCESS DYNAMICS ARE

1087
00:41:22,146 --> 00:41:23,448
DRIVING MORTALITY, HOPING TO

1088
00:41:23,448 --> 00:41:29,153
SHOW YOU IN THAT PAPER THAT WE

1089
00:41:29,153 --> 00:41:31,322
PUBLISHED IN JAMA ON HEART

1090
00:41:31,322 --> 00:41:32,290
DISEASE AND MORTALITY.

1091
00:41:32,290 --> 00:41:33,658
INFRASTRUCTURE DYNAMICS ARE AT

1092
00:41:33,658 --> 00:41:35,193
PLAY, A LOT OF PRACTICE PATTERN

1093
00:41:35,193 --> 00:41:36,694
DYNAMICS AT PLAY AS WELL IN

1094
00:41:36,694 --> 00:41:40,098
TERMS OF ACCESS FOR RURAL AND

1095
00:41:40,098 --> 00:41:40,932
MINORITY POPULATIONS.

1096
00:41:40,932 --> 00:41:43,501
AND EVEN WHEN YOU LOOK PAST DATA

1097
00:41:43,501 --> 00:41:45,470
IN TERMS OF WHERE SOME

1098
00:41:45,470 --> 00:41:47,004
INFRASTRUCTURE HAS EVOLVED, YOU

1099
00:41:47,004 --> 00:41:50,174
SEE YOU STILL START TO SEE A LOT

1100
00:41:50,174 --> 00:41:53,811
OF CHALLENGES PARTICULARLY

1101
00:41:53,811 --> 00:41:54,912
AROUND WHERE TELEMEDICINE

1102
00:41:54,912 --> 00:41:56,881
OPTIONS ARE OFFERED, ALSO

1103
00:41:56,881 --> 00:42:02,120
LANGUAGE ACCESS AND HOW WE THINK

1104
00:42:02,120 --> 00:42:04,155
THROUGH LANGUAGE BARRIERS.

1105
00:42:04,155 --> 00:42:07,291
EARLIEST TELEMEDICINE PROGRAMS

1106
00:42:07,291 --> 00:42:12,130
IN THE 1970s PIONEERED IN IHS

1107
00:42:12,130 --> 00:42:14,098
AND IN THE NEEDS OF NATIVE

1108
00:42:14,098 --> 00:42:15,833
AMERICAN POPULATION, JUST

1109
00:42:15,833 --> 00:42:18,035
BECAUSE THAT WAS WHERE THE

1110
00:42:18,035 --> 00:42:18,469
OPPORTUNITIES WERE.

1111
00:42:18,469 --> 00:42:21,105
YOU CAN START TO SEE WHEREAS

1112
00:42:21,105 --> 00:42:23,174
TECHNOLOGIES EVOLVED WE NEED TO

1113
00:42:23,174 --> 00:42:24,308
APPLY THAT IN TERMS OF

1114
00:42:24,308 --> 00:42:24,842
OPPORTUNITIES.

1115
00:42:24,842 --> 00:42:27,779
THE LAST THING I'LL SAY,JUST TO

1116
00:42:27,779 --> 00:42:32,950
FINISH EXACTLY ON TIME, IS THAT,

1117
00:42:32,950 --> 00:42:35,353
YOU KNOW, OVERARCHINGLY THE

1118
00:42:35,353 --> 00:42:38,423
POLICY AND TEAM DYNAMICS IS WHAT

1119
00:42:38,423 --> 00:42:45,096
HAS BEEN DRIVING ADOPTION

1120
00:42:45,096 --> 00:42:45,963
PRE-PANDEMIC, INTRAPANDEMIC, AND

1121
00:42:45,963 --> 00:42:47,064
POST-PANDEMIC.

1122
00:42:47,064 --> 00:42:50,368
TEAMS ARE WORKING ON ADDITIONAL

1123
00:42:50,368 --> 00:42:52,303
TECHNOLOGIC TOOLS TO ADD ON AND

1124
00:42:52,303 --> 00:42:53,871
SERVE AS ADJUNCT FOR PATIENT

1125
00:42:53,871 --> 00:42:55,473
CARE, GET PATIENTS ACCESS TO

1126
00:42:55,473 --> 00:42:57,341
CARE, THE MACRO CONCEPTS ARE

1127
00:42:57,341 --> 00:43:00,745
STILL GOING TO BE DRIVEN IN THE

1128
00:43:00,745 --> 00:43:02,513
PUBLIC POLICY SPHERE AROUND --

1129
00:43:02,513 --> 00:43:04,916
THERE'S A LOT OF LEGISLATIVE

1130
00:43:04,916 --> 00:43:07,151
ADVANCES AND REGRESSION AND

1131
00:43:07,151 --> 00:43:09,620
ADVANCES, ESPECIALLY WHEN YOU

1132
00:43:09,620 --> 00:43:12,790
THINK ABOUT LEGISLATIVE PARITY

1133
00:43:12,790 --> 00:43:13,658
AROUND TELEMEDICINE AND

1134
00:43:13,658 --> 00:43:13,958
TELEHEALTH.

1135
00:43:13,958 --> 00:43:15,526
SPOKE ABOUT A LOT OF DIFFERENT

1136
00:43:15,526 --> 00:43:17,061
THINGS HERE BUT THE CONCEPTS I

1137
00:43:17,061 --> 00:43:20,398
WOULD SAY KEEP IN MIND IS THAT,

1138
00:43:20,398 --> 00:43:23,401
YOU KNOW, THERE'S -- THERE ARE

1139
00:43:23,401 --> 00:43:26,270
AND CONTINUE TO BE

1140
00:43:26,270 --> 00:43:26,938
OPPORTUNITIES.

1141
00:43:26,938 --> 00:43:31,943
THERE ARE, YOU KNOW, SIGNIFICANT

1142
00:43:31,943 --> 00:43:32,243
CHALLENGES.

1143
00:43:32,243 --> 00:43:32,810
YOU SAW SUCH RAPID EVOLUTION

1144
00:43:32,810 --> 00:43:35,346
DURING THE PANDEMIC.

1145
00:43:35,346 --> 00:43:36,647
AND THEN SOME REGRESSION.

1146
00:43:36,647 --> 00:43:39,951
YOU CAN START TO SEE WHERE THE

1147
00:43:39,951 --> 00:43:42,220
OPPORTUNITIES HAVE THE ABILITY

1148
00:43:42,220 --> 00:43:43,888
TO BE ADDRESSED, IN GENERAL.

1149
00:43:43,888 --> 00:43:45,857
SO I WILL STOP THERE.

1150
00:43:45,857 --> 00:43:49,894
AND HOPEFULLY DID NOT GO OVER MY

1151
00:43:49,894 --> 00:43:51,095
TIME AS ALLOTTED.

1152
00:43:51,095 --> 00:43:52,396
THANK YOU.

1153
00:43:52,396 --> 00:43:55,566
>> NOT AT ALL FOR YOUR
TIME, DR.

1154
00:43:55,566 --> 00:43:55,900
GRAHAM.

1155
00:43:55,900 --> 00:43:58,302
AGAIN, THANK YOU FOR AGREEING TO

1156
00:43:58,302 --> 00:44:00,071
BE HERE WITH US TODAY AND GUIDE

1157
00:44:00,071 --> 00:44:03,774
US, SETTING THE STAGE FOR OUR

1158
00:44:03,774 --> 00:44:04,041
WORKSHOP.

1159
00:44:04,041 --> 00:44:05,710
I PARTICULARLY LIKE HOW YOU SAID

1160
00:44:05,710 --> 00:44:07,745
THAT THE IDEA OF TELEHEALTH IS

1161
00:44:07,745 --> 00:44:10,147
TO SERVE AS AN ADJUNCT.

1162
00:44:10,147 --> 00:44:11,449
NOT A REPLACEMENT.

1163
00:44:11,449 --> 00:44:12,884
BECAUSE SOMETIMES THERE'S A LOT

1164
00:44:12,884 --> 00:44:16,354
OF CONFUSION WHERE WE'RE GOING

1165
00:44:16,354 --> 00:44:18,222
THROUGH TELEHEALTH BUT IF YOU

1166
00:44:18,222 --> 00:44:19,790
ASK ANY HEALTHCARE PROVIDER THEY

1167
00:44:19,790 --> 00:44:21,192
WILL TALK ABOUT PHYSICAL

1168
00:44:21,192 --> 00:44:24,295
EXAMINATION, CONTACT WITH THE

1169
00:44:24,295 --> 00:44:25,730
PATIENT, THAT'S SOMETHING

1170
00:44:25,730 --> 00:44:26,063
UNREPLACEABLE.

1171
00:44:26,063 --> 00:44:31,502
PERHAPS 100 YEARS FROM NOW, TEN

1172
00:44:31,502 --> 00:44:32,837
YEARS FROM NOW, ADVANCEMENTS,

1173
00:44:32,837 --> 00:44:34,238
PERHAPS A HOLOGRAM IN THE SHORT

1174
00:44:34,238 --> 00:44:35,973
FUTURE THAT I'M NOT FORESEEING

1175
00:44:35,973 --> 00:44:37,742
AND PEOPLE WILL LOOK BACK AT

1176
00:44:37,742 --> 00:44:40,144
THIS VIDEO AND THINK WHAT WAS HE

1177
00:44:40,144 --> 00:44:41,779
THINKING ABOUT?

1178
00:44:41,779 --> 00:44:43,648
WASN'T HOLOGRAMS THAT YOU CAN

1179
00:44:43,648 --> 00:44:45,182
TOUCH AND EXAMINE HERE,

1180
00:44:45,182 --> 00:44:45,983
SOMETHING SO STRAIGHTFORWARD?

1181
00:44:45,983 --> 00:44:50,121
I AGREE WITH YOU, TELEMEDICINE

1182
00:44:50,121 --> 00:44:52,623
IS A GREAT ADJUNCT AND CAN SERVE

1183
00:44:52,623 --> 00:44:56,994
AS A TOOL FOR DEALING WITH

1184
00:44:56,994 --> 00:44:58,863
UNDERSERVED WHEN THEY DON'T HAVE

1185
00:44:58,863 --> 00:45:02,133
ACCESS TO CARE, NOW YOU'RE

1186
00:45:02,133 --> 00:45:03,901
ENABLING ACCESS, PARTICULARLY

1187
00:45:03,901 --> 00:45:05,102
PROVIDERS NOT AVAILABLE IN THE

1188
00:45:05,102 --> 00:45:05,970
REGION.

1189
00:45:05,970 --> 00:45:09,473
AS YOU POINTED OUT, IF THERE'S

1190
00:45:09,473 --> 00:45:10,374
NO INTERNET, NO INFRASTRUCTURE

1191
00:45:10,374 --> 00:45:12,310
TO GO HAND IN HAND WITH THE GOAL

1192
00:45:12,310 --> 00:45:13,511
OF THE TECHNOLOGY, IT WON'T

1193
00:45:13,511 --> 00:45:13,945
WORK.

1194
00:45:13,945 --> 00:45:18,349
THE SAME THING GOES FOR THE

1195
00:45:18,349 --> 00:45:20,618
POLICIES AND THE FINANCING WHICH

1196
00:45:20,618 --> 00:45:22,386
SHOW A LOT OF PROBLEMS HAPPENS.

1197
00:45:22,386 --> 00:45:23,387
THERE WERE POLICIES LIFTED

1198
00:45:23,387 --> 00:45:24,922
DURING THE PANDEMIC AND NOW ARE

1199
00:45:24,922 --> 00:45:27,124
BACK INTO PLACE, AND PEOPLE ARE

1200
00:45:27,124 --> 00:45:28,693
STILL TRYING TO GO BACK AND

1201
00:45:28,693 --> 00:45:32,797
UNDERSTAND HOW TO DEAL WITH THE

1202
00:45:32,797 --> 00:45:34,098
CROSS-STATE LICENSOR, WHAT IS

1203
00:45:34,098 --> 00:45:35,967
ELIGIBLE FOR REPLACEMENT OR NOT,

1204
00:45:35,967 --> 00:45:38,703
DEALING WITH BURNOUT FROM

1205
00:45:38,703 --> 00:45:39,470
HEALTHCARE PROVIDERS BECAUSE NOW

1206
00:45:39,470 --> 00:45:42,306
THEY GET A LOT MORE MESSAGES, A

1207
00:45:42,306 --> 00:45:43,608
LOT MORE PORTALS, COMMUNICATIONS

1208
00:45:43,608 --> 00:45:44,175
THAN BEFORE.

1209
00:45:44,175 --> 00:45:45,276
SO ALL GREAT POINTS, DR. GRAHAM.

1210
00:45:45,276 --> 00:45:48,646
I DON'T KNOW IF YOU WANT TO GIVE

1211
00:45:48,646 --> 00:45:50,281
A LAST STATEMENT SINCE I MADE

1212
00:45:50,281 --> 00:45:51,949
SOME COMMENTS BEFORE WE GO TO

1213
00:45:51,949 --> 00:45:52,817
OUR BREAK.

1214
00:45:52,817 --> 00:45:57,421
>> NO, NO I'LL JUST SAY
THAT AS

1215
00:45:57,421 --> 00:46:00,891
A PRACTITIONER, AGAIN, I WORK

1216
00:46:00,891 --> 00:46:04,962
WITH TECHNOLOGY, BUT AS A

1217
00:46:04,962 --> 00:46:06,364
PRACTITIONER YOU SEE THE

1218
00:46:06,364 --> 00:46:07,465
DIFFERENCE, WHEREAS A SPECIALIST

1219
00:46:07,465 --> 00:46:09,000
BEING ABLE TO CONNECT WITH

1220
00:46:09,000 --> 00:46:10,101
PEOPLE IN RURAL COMMUNITIES, AND

1221
00:46:10,101 --> 00:46:13,404
EVEN IN THAT ONE VISIT WE SEE

1222
00:46:13,404 --> 00:46:13,804
DIFFERENCE.

1223
00:46:13,804 --> 00:46:16,007
FOR ME WHAT WE CAN DO HERE IS

1224
00:46:16,007 --> 00:46:16,207
GREAT.

1225
00:46:16,207 --> 00:46:21,946
AS I WORK ON THE TECH PART AND

1226
00:46:21,946 --> 00:46:23,447
FROM ANOTHER VIEWPOINT, TO WHAT

1227
00:46:23,447 --> 00:46:27,385
YOU JUST SAID AND HOPEFULLY TO

1228
00:46:27,385 --> 00:46:29,687
KEEP US APART IN THE

1229
00:46:29,687 --> 00:46:30,321
CONVERSATION WE'RE TALKING ABOUT

1230
00:46:30,321 --> 00:46:35,860
SOMETHING VERY REAL IN PEOPLE'S

1231
00:46:35,860 --> 00:46:36,227
LIVES.

1232
00:46:36,227 --> 00:46:39,263
A PATIENT I SAW A COUPLE MONTHS

1233
00:46:39,263 --> 00:46:40,331
AGO, YOU TALK ABOUT SOMETHING

1234
00:46:40,331 --> 00:46:47,371
THAT CHANGES A LIVE  -- LIFE IF

1235
00:46:47,371 --> 00:46:49,006
THEY DIDN'T HAVE THAT ENCOUNTER,

1236
00:46:49,006 --> 00:46:50,641
FOR SOME THE MOST IMPORTANT

1237
00:46:50,641 --> 00:46:52,743
THING IN TERMS OF THEIR CHANCE

1238
00:46:52,743 --> 00:46:53,811
TO GUESS BETTER WITH HEALTH

1239
00:46:53,811 --> 00:46:55,613
CARE, A LOT OF REAL FACTORS IN

1240
00:46:55,613 --> 00:46:56,480
THE WORKSHOP TODAY.

1241
00:46:56,480 --> 00:46:57,882
>> THANK YOU FOR SETTING
THE

1242
00:46:57,882 --> 00:46:59,850
STAGE, DR. GRAHAM, AND JOINING

1243
00:46:59,850 --> 00:47:00,117
US TODAY.

1244
00:47:00,117 --> 00:47:04,255
WE'LL GO INTO A SHORT BREAK, AND

1245
00:47:04,255 --> 00:47:07,358
WE'LL BE BACK AT 11:55 IN

1246
00:47:07,358 --> 00:47:08,826
EASTERN STANDARD TIME HERE IN

1247
00:47:08,826 --> 00:47:09,360
BETHESDA.

1248
00:47:09,360 --> 00:47:10,161
THANK YOU, EVERYONE.

1249
00:47:10,161 --> 00:47:10,194
STAY TUNED. 

1250
00:47:12,650 --> 00:47:15,887
>> WELCOME BACK.

1251
00:47:15,887 --> 00:47:18,022
IN THE BETHESDA AREA IT IS

1252
00:47:18,022 --> 00:47:19,657
11:55, TIME TO COME BACK TO OUR

1253
00:47:19,657 --> 00:47:20,758
FIRST SESSION.

1254
00:47:20,758 --> 00:47:22,927
THE IDEA AGAIN TODAY OF THE

1255
00:47:22,927 --> 00:47:24,729
WORKSHOP IS TO FOCUS ON THE

1256
00:47:24,729 --> 00:47:26,030
DIRECT TO CONSUMER, DIRECT TO

1257
00:47:26,030 --> 00:47:27,098
PATIENT TELEHEALTH.

1258
00:47:27,098 --> 00:47:29,734
SO FOCUS IS NOT SO MUCH THE

1259
00:47:29,734 --> 00:47:31,135
PROVIDER-TO-PROVIDER COVERED IN

1260
00:47:31,135 --> 00:47:31,569
PREVIOUS WORKSHOPS.

1261
00:47:31,569 --> 00:47:34,238
AND IT IS MY PLEASURE TO

1262
00:47:34,238 --> 00:47:35,773
INTRODUCE THIS FIRST SESSION OF

1263
00:47:35,773 --> 00:47:37,408
BEYOND THE SCREEN, BEST

1264
00:47:37,408 --> 00:47:38,943
PRACTICES IN TELEHEALTH AND

1265
00:47:38,943 --> 00:47:43,214
IMPLEMENTATION RESEARCH FOR

1266
00:47:43,214 --> 00:47:43,781
LASTING IMPACT.

1267
00:47:43,781 --> 00:47:47,285
MODERATOR IS DR. MEGAN MAHONEY,

1268
00:47:47,285 --> 00:47:50,788
FAMILY ENDOWED PROFESSOR AND

1269
00:47:50,788 --> 00:47:51,289
CHAIR, DEPARTMENT OF THE

1270
00:47:51,289 --> 00:47:51,990
UNIVERSITY OF CALIFORNIA, SAN

1271
00:47:51,990 --> 00:47:52,490
FRANCISCO.

1272
00:47:52,490 --> 00:47:56,494
WE ALSO HAVE OUR THREE

1273
00:47:56,494 --> 00:47:57,428
PANELISTS, PROFESSOR AND CHAIR

1274
00:47:57,428 --> 00:47:59,864
OF THE DEPARTMENT OF HEALTH

1275
00:47:59,864 --> 00:48:01,866
SERVICES POLICY AND PRACTICE AT

1276
00:48:01,866 --> 00:48:03,801
BROWN UNIVERSITY, WE HAVE DR.

1277
00:48:03,801 --> 00:48:05,503
CHRISTINE RAY, ASSOCIATE

1278
00:48:05,503 --> 00:48:07,105
PROFESSOR OF PEDIATRICS,

1279
00:48:07,105 --> 00:48:08,006
UNIVERSITY OF PITTSBURGH SCHOOL

1280
00:48:08,006 --> 00:48:14,579
OF MEDICINE, DIRECTOR OF HEALTH

1281
00:48:14,579 --> 00:48:18,282
SYSTEMS IMPROVEMENT AT UPNC

1282
00:48:18,282 --> 00:48:20,018
CHILDREN'S HOSPITAL, PITTSBURGH,

1283
00:48:20,018 --> 00:48:21,452
ALSO DR. JUDD HOLLANDER, SENIOR

1284
00:48:21,452 --> 00:48:24,889
VICE PRESIDENT FOR HEALTH CARE

1285
00:48:24,889 --> 00:48:27,792
DELIVERY AND INNOVATION,

1286
00:48:27,792 --> 00:48:29,327
DEPARTMENT OF EMERGENCY

1287
00:48:29,327 --> 00:48:30,428
MEDICINE, AND SYDNEY KIMMEL

1288
00:48:30,428 --> 00:48:32,163
MEDICAL COLLEGE OF THOMAS

1289
00:48:32,163 --> 00:48:34,032
JEFFERSON UNIVERSITY.

1290
00:48:34,032 --> 00:48:37,101
DR. MAHONEY, PLEASE TAKE IT

1291
00:48:37,101 --> 00:48:38,636
AWAY, A PLEASURE HAVING YOU

1292
00:48:38,636 --> 00:48:38,836
HERE.

1293
00:48:38,836 --> 00:48:40,271
>> IT'S A REAL PLEASURE TO
BE

1294
00:48:40,271 --> 00:48:41,906
WITH YOU ALL TODAY.

1295
00:48:41,906 --> 00:48:43,875
THANK YOU, DR. BRUNO.

1296
00:48:43,875 --> 00:48:46,944
I KNOW THAT THIS PROMISES TO BE

1297
00:48:46,944 --> 00:48:48,780
A VERY ILLUMINATING

1298
00:48:48,780 --> 00:48:49,113
CONVERSATION.

1299
00:48:49,113 --> 00:48:50,982
I'M LOOKING FORWARD TO

1300
00:48:50,982 --> 00:48:52,850
MODERATING THIS DISCUSSION.

1301
00:48:52,850 --> 00:48:55,253
DURING THIS SESSION, WE WILL BE

1302
00:48:55,253 --> 00:48:57,989
EXPLORING AND IDENTIFYING BEST

1303
00:48:57,989 --> 00:49:03,861
PRACTICES IN TELEHEALTH, AND

1304
00:49:03,861 --> 00:49:06,631
WE'LL EXAMINE IDEAL UTILIZATION

1305
00:49:06,631 --> 00:49:08,066
SCENARIOS, LESSON LEARNED,

1306
00:49:08,066 --> 00:49:09,467
SUSTAINABLE CHANGES IN

1307
00:49:09,467 --> 00:49:11,436
HEALTHCARE DELIVERY, SHIFT IN

1308
00:49:11,436 --> 00:49:13,538
PATIENT AND CLINICIAN

1309
00:49:13,538 --> 00:49:15,173
DEMOGRAPHICS, EFFECTIVENESS OF

1310
00:49:15,173 --> 00:49:16,607
VARIOUS TELEHEALTH DELIVERY

1311
00:49:16,607 --> 00:49:16,974
SERVICES.

1312
00:49:16,974 --> 00:49:20,411
I AM REALLY HONORED TO SERVE AS

1313
00:49:20,411 --> 00:49:22,447
MODERATOR FOR THIS ESTEEMED

1314
00:49:22,447 --> 00:49:22,714
PANEL.

1315
00:49:22,714 --> 00:49:24,716
I HAVE THE OPPORTUNITY OF

1316
00:49:24,716 --> 00:49:26,884
REVIEWING A NUMBER OF THE

1317
00:49:26,884 --> 00:49:28,886
PUBLICATIONS, AND I KNOW WE'LL

1318
00:49:28,886 --> 00:49:31,622
HAVE A GREAT DISCUSSION TODAY.

1319
00:49:31,622 --> 00:49:38,229
WE'LL HAVE ABOUT 50 MINUTES.

1320
00:49:38,229 --> 00:49:40,465
I ENCOURAGE YOU TO USE THE
Q&A

1321
00:49:40,465 --> 00:49:42,233
TOOL TO CONTRIBUTE YOUR

1322
00:49:42,233 --> 00:49:46,938
QUESTIONS. 

1323
00:49:46,938 --> 00:49:52,410
I INVITE DR. HAL ANDER, RAY AND

1324
00:49:52,410 --> 00:49:55,379
MEHROTA TO JOIN AND WE'LL GET

1325
00:49:55,379 --> 00:50:05,723
INTO THE QUESTIONS. 

1326
00:50:17,769 --> 00:50:18,002
>> WELCOME.

1327
00:50:18,002 --> 00:50:20,338
>> THE FIRST QUESTION FOR
YOU IS

1328
00:50:20,338 --> 00:50:23,074
WHAT ARE THE BEST METRICS AFTER

1329
00:50:23,074 --> 00:50:26,144
HEARING FROM DR. GRAHAM'S

1330
00:50:26,144 --> 00:50:28,646
WONDERFUL PRESENTATION; HOW ARE

1331
00:50:28,646 --> 00:50:30,148
YOU THINKING ABOUT EVALUATING

1332
00:50:30,148 --> 00:50:31,282
TELEHEALTH EFFECTIVENESS?

1333
00:50:31,282 --> 00:50:36,320
WHAT ARE THE IDEAL SCENARIOS FOR

1334
00:50:36,320 --> 00:50:37,288
TELEHEALTH UTILIZATION, VERSUS

1335
00:50:37,288 --> 00:50:38,289
INPATIENT CARE?

1336
00:50:38,289 --> 00:50:41,125
AND I WILL GO AHEAD AND INVITE

1337
00:50:41,125 --> 00:50:44,629
DR. RAY TO GET US KICKED OFF.

1338
00:50:44,629 --> 00:50:45,396
>> THANKS SO MUCH.

1339
00:50:45,396 --> 00:50:48,332
IT'S A PLEASURE TO BE HERE WITH

1340
00:50:48,332 --> 00:50:49,333
THIS GROUP.

1341
00:50:49,333 --> 00:50:53,805
I THINK IN TERMS OF BEST METRICS

1342
00:50:53,805 --> 00:50:54,405
FOR EVALUATING TELEHEALTH

1343
00:50:54,405 --> 00:50:55,773
EFFECTIVENESS, I THINK AT ONE

1344
00:50:55,773 --> 00:50:58,976
LEVEL WHEN WE'RE THINKING ABOUT

1345
00:50:58,976 --> 00:51:00,044
INDIVIDUAL CLINICAL SCENARIOS,

1346
00:51:00,044 --> 00:51:00,778
HIGH-QUALITY CARE IS

1347
00:51:00,778 --> 00:51:01,913
HIGH-QUALITY CARE.

1348
00:51:01,913 --> 00:51:03,881
AND SO WHETHER IT'S OCCURRING IN

1349
00:51:03,881 --> 00:51:05,416
PERSON OR VIRTUALLY, WE WANT TO

1350
00:51:05,416 --> 00:51:06,517
MEET THOSE SAME STANDARDS.

1351
00:51:06,517 --> 00:51:11,422
AND SO WHEN WE'RE THINKING ABOUT

1352
00:51:11,422 --> 00:51:14,358
EXISTING METRICS, BEST CARE FOR

1353
00:51:14,358 --> 00:51:21,833
YOU A CUTE RESPIRATORY CARE

1354
00:51:21,833 --> 00:51:24,535
INFECTION, THEY REMAIN IMPORTANT

1355
00:51:24,535 --> 00:51:25,670
AND ESSENTIAL.

1356
00:51:25,670 --> 00:51:26,771
WE KNOW WHAT HIGH-QUALITY CARE

1357
00:51:26,771 --> 00:51:29,307
IS AND CAN START WITH THE SAME

1358
00:51:29,307 --> 00:51:29,607
METRICS.

1359
00:51:29,607 --> 00:51:34,011
I THINK THERE'S ANOTHER LEVEL

1360
00:51:34,011 --> 00:51:35,446
WHERE BECAUSE TELEHEALTH SHIFTS

1361
00:51:35,446 --> 00:51:38,149
ACCESSIBILITY OF CARE AS WE'VE

1362
00:51:38,149 --> 00:51:38,916
BEEN HEARING, THERE IS SOME

1363
00:51:38,916 --> 00:51:40,451
OPPORTUNITY TO THINK ABOUT THE

1364
00:51:40,451 --> 00:51:41,853
BALANCE OF ACCESSIBILITY AND

1365
00:51:41,853 --> 00:51:43,287
EFFECTIVENESS OF CARE.

1366
00:51:43,287 --> 00:51:45,389
AND IF WE'RE DOING -- IF WE'RE

1367
00:51:45,389 --> 00:51:46,457
REACHING A BROADER POPULATION,

1368
00:51:46,457 --> 00:51:48,226
AND WE'RE REACHING INTO

1369
00:51:48,226 --> 00:51:51,295
POPULATIONS THAT OTHERWISE WOULD

1370
00:51:51,295 --> 00:51:53,364
NOT HAVE RECEIVED CARE, THE

1371
00:51:53,364 --> 00:51:54,665
BALANCE OF REACHING THEM AND

1372
00:51:54,665 --> 00:51:56,734
ENHANCING THE QUALITY OF CARE

1373
00:51:56,734 --> 00:51:58,703
MAY LOOK DIFFERENT.

1374
00:51:58,703 --> 00:52:00,037
I'M THINKING ABOUT ADOLESCENTS,

1375
00:52:00,037 --> 00:52:02,340
IF WE CONSIDER REACHING OUT TO

1376
00:52:02,340 --> 00:52:05,610
THEM TO PROVIDE WELL CHILD CARE

1377
00:52:05,610 --> 00:52:06,611
THROUGH CHILD TELEHEALTH WILL

1378
00:52:06,611 --> 00:52:09,780
INCREASE NUMBER OF TEENS WHO GET

1379
00:52:09,780 --> 00:52:11,716
DEPRESSION SCREENING BUT MAY NOT

1380
00:52:11,716 --> 00:52:13,417
GET VISION SCREENING TO THE KIDS

1381
00:52:13,417 --> 00:52:15,286
AND HOW DO WE BALANCE THE

1382
00:52:15,286 --> 00:52:17,355
GREATER REACH WITH SOME

1383
00:52:17,355 --> 00:52:18,122
MODALITIES AND WHILE RECOGNIZING

1384
00:52:18,122 --> 00:52:19,423
OTHER THINGS MAY NOT OCCUR IN

1385
00:52:19,423 --> 00:52:21,058
THE SAME WAY.

1386
00:52:21,058 --> 00:52:24,896
SO I THINK FOR INDIVIDUAL

1387
00:52:24,896 --> 00:52:26,197
SCENARIOS, I THINK ABOUT THE

1388
00:52:26,197 --> 00:52:27,531
METRICS THAT WE ALREADY KNOW BUT

1389
00:52:27,531 --> 00:52:29,367
WHEN WE'RE THINKING ABOUT MORE

1390
00:52:29,367 --> 00:52:30,568
POPULATION HEALTH THERE'S A

1391
00:52:30,568 --> 00:52:34,405
LITTLE BIT MORE OF COMPLEXITY IN

1392
00:52:34,405 --> 00:52:36,707
THINKING OF TRADEOFFS BETWEEN

1393
00:52:36,707 --> 00:52:37,775
ACCESS AND EFFECTIVENESS AND

1394
00:52:37,775 --> 00:52:39,010
COUNTER BALANCE IF THAT PATIENT

1395
00:52:39,010 --> 00:52:40,511
HAD NOT GOTTEN THE TELEHEALTH

1396
00:52:40,511 --> 00:52:43,047
VISIT WOULD THEY HAVE GOTTEN NO

1397
00:52:43,047 --> 00:52:44,682
CARE OR AN IN-PERSON VISIT, WE

1398
00:52:44,682 --> 00:52:45,683
NEED TO RECOGNIZE AND

1399
00:52:45,683 --> 00:52:45,983
ACKNOWLEDGE.

1400
00:52:45,983 --> 00:52:47,351
I MIGHT PAUSE THERE AND COME

1401
00:52:47,351 --> 00:52:48,986
BACK TO THE IDEAL SCENARIO

1402
00:52:48,986 --> 00:52:55,960
QUESTION AFTER OTHERS HAVE A

1403
00:52:55,960 --> 00:52:59,096
CHANCE TO WEIGH IN.

1404
00:52:59,096 --> 00:53:00,898
>>  WE NEED TO ASSERT THE
SAME

1405
00:53:00,898 --> 00:53:09,440
STANDARDS OF  OF CARE WITH QUALY

1406
00:53:09,440 --> 00:53:10,975
METRICS REACHING PARITY AND

1407
00:53:10,975 --> 00:53:12,510
TAILORING ACCESS METRIC

1408
00:53:12,510 --> 00:53:13,377
ACCORDING TO MODALITIES

1409
00:53:13,377 --> 00:53:16,013
TELEHEALTH VERSUS IN PERSON.

1410
00:53:16,013 --> 00:53:20,151
AND SO I'LL TRANSITION TO DR.

1411
00:53:20,151 --> 00:53:22,887
MEHROTRA IF YOU COULD WEIGH IN

1412
00:53:22,887 --> 00:53:24,522
AS WELL.

1413
00:53:24,522 --> 00:53:27,391
>> I'M IN AGREEMENT WITH
DR.

1414
00:53:27,391 --> 00:53:27,558
RAY.

1415
00:53:27,558 --> 00:53:29,226
HOW DO I EVALUATE MY PROGRAM?

1416
00:53:29,226 --> 00:53:30,361
YOU'VE BEEN EVALUATING LOTS OF

1417
00:53:30,361 --> 00:53:32,730
PROGRAMS FOR A LONG TIME, DO THE

1418
00:53:32,730 --> 00:53:35,132
SAME METRICS FOR HEART DISEASE,

1419
00:53:35,132 --> 00:53:37,668
WE KNOW HOW TO TREAT HEART

1420
00:53:37,668 --> 00:53:37,902
DISEASE.

1421
00:53:37,902 --> 00:53:40,538
I WANT TO EMPHASIZE ALSO WHAT

1422
00:53:40,538 --> 00:53:45,676
DR. RAY SAID IT DOES RAISE

1423
00:53:45,676 --> 00:53:46,811
METRICS, EVALUATING FOR HEART

1424
00:53:46,811 --> 00:53:49,413
DISEASE WE DO NOT THINK ABOUT AS

1425
00:53:49,413 --> 00:53:52,450
OUTCOME TRAVEL TIME, BURDEN ON

1426
00:53:52,450 --> 00:53:53,451
CAREGIVERS, THOSE OUTCOMES.

1427
00:53:53,451 --> 00:53:57,254
I THINK THE GROWTH OF TELEHEALTH

1428
00:53:57,254 --> 00:53:59,056
PUSHES US IN THAT DIRECTION

1429
00:53:59,056 --> 00:53:59,790
THINKING OF PATIENT-CENTERED

1430
00:53:59,790 --> 00:54:00,057
CARE.

1431
00:54:00,057 --> 00:54:01,525
I WOULD WANT TO USE THE SAME

1432
00:54:01,525 --> 00:54:03,394
METRICS FOR ANY EVALUATION.

1433
00:54:03,394 --> 00:54:07,765
THAT WOULD BE -- I'M BASICALLY

1434
00:54:07,765 --> 00:54:14,505
ECHO WHAT DR. RAY SAID.

1435
00:54:14,505 --> 00:54:15,673
>> IT HELPS INTRODUCE NEW

1436
00:54:15,673 --> 00:54:19,310
METRICS THAT SHOULD HAVE BEEN

1437
00:54:19,310 --> 00:54:19,610
THERE.

1438
00:54:19,610 --> 00:54:20,244
DR. HOLLANDER?

1439
00:54:20,244 --> 00:54:22,680
>> IT'S WEIRD TO GO THIRD
AND

1440
00:54:22,680 --> 00:54:23,881
NOT ARGUE WITH SOMETHING

1441
00:54:23,881 --> 00:54:25,383
SOMEBODY SAID ALREADY.

1442
00:54:25,383 --> 00:54:27,852
I AGREE 100% WITH ALL OF IT.

1443
00:54:27,852 --> 00:54:29,820
I'LL ADD A COUPLE COLOR

1444
00:54:29,820 --> 00:54:31,689
COMMENTARY STATEMENTS TO IT.

1445
00:54:31,689 --> 00:54:34,291
ONE IS NATIONAL QUALITY FORUM,

1446
00:54:34,291 --> 00:54:38,796
AMONG OTHER GROUPS, MEASURE

1447
00:54:38,796 --> 00:54:43,868
FRAMEWORKS AND MEASURE, AND IT'S

1448
00:54:43,868 --> 00:54:44,468
ACCESS, COST, EXPERIENCE,

1449
00:54:44,468 --> 00:54:46,670
EFFECTIVENESS AS THE OTHER

1450
00:54:46,670 --> 00:54:47,104
DOCTORS SAID.

1451
00:54:47,104 --> 00:54:49,306
IT'S THE SAME THING WE DO FOR

1452
00:54:49,306 --> 00:54:50,274
EVERYBODY ELSE, SHOULDN'T THINK

1453
00:54:50,274 --> 00:54:55,246
OF IT  DIFFERENTLY.

1454
00:54:55,246 --> 00:54:57,214
ONE POINT ALREADY MADE, WE

1455
00:54:57,214 --> 00:54:58,949
CANNOT COMPARE TELEHEALTH TO

1456
00:54:58,949 --> 00:55:00,918
IN-PERSON CARE.

1457
00:55:00,918 --> 00:55:04,321
WE WANT TO COMPARE TELEHEALTH TO

1458
00:55:04,321 --> 00:55:05,723
THE ALTERNATIVE AVAILABLE.

1459
00:55:05,723 --> 00:55:07,258
IT'S NOT REALLY IMPORTANT TO

1460
00:55:07,258 --> 00:55:09,126
TAKE THAT DIABETIC AND SAY HOW

1461
00:55:09,126 --> 00:55:10,995
WAS THEIR VISIT ON MARCH 15,

1462
00:55:10,995 --> 00:55:13,064
IT'S MUCH MORE IMPORTANT TO SAY

1463
00:55:13,064 --> 00:55:14,265
HOW IS THEIR CARE.

1464
00:55:14,265 --> 00:55:16,567
SO IT'S REALLY ABOUT CARE

1465
00:55:16,567 --> 00:55:18,202
WITHOUT ANY TELEHEALTH VERSUS

1466
00:55:18,202 --> 00:55:21,272
WHAT WE OFTEN CALL HYBRID CARE,

1467
00:55:21,272 --> 00:55:22,039
CARE INCLUDING TELEHEALTH, SOME

1468
00:55:22,039 --> 00:55:23,707
OF THE TIME.

1469
00:55:23,707 --> 00:55:25,009
AND IT'S REALLY CRITICAL, WE

1470
00:55:25,009 --> 00:55:26,343
FUND STUDIES THAT LOOK AT IT

1471
00:55:26,343 --> 00:55:27,545
THAT WAY.

1472
00:55:27,545 --> 00:55:35,086
AND MY FINAL COMMENT, AND I DO

1473
00:55:35,086 --> 00:55:36,620
AGREE WITH WHAT ATEEV, NEW

1474
00:55:36,620 --> 00:55:38,789
OPPORTUNITY TO LOOK AT DIFFERENT

1475
00:55:38,789 --> 00:55:39,023
THINGS.

1476
00:55:39,023 --> 00:55:40,891
IF WE ANCHOR TO WHAT WE DO WE

1477
00:55:40,891 --> 00:55:42,526
LOSE THE ABILITY TO REINVENT

1478
00:55:42,526 --> 00:55:43,394
CARE.

1479
00:55:43,394 --> 00:55:46,564
CARE WE DELIVER RIGHT NOW ISN'T

1480
00:55:46,564 --> 00:55:47,865
CONSUMER-CENTRIC AND THERE ARE

1481
00:55:47,865 --> 00:55:49,834
THINGS WE SHOULD ABSOLUTELY DO

1482
00:55:49,834 --> 00:55:50,134
DIFFERENTLY.

1483
00:55:50,134 --> 00:55:52,002
SO I BELIEVE AND I'LL TAKE

1484
00:55:52,002 --> 00:55:55,306
PHYSICAL EXAM COMMENT MADE ON

1485
00:55:55,306 --> 00:55:56,841
THE EARLIER KEYNOTE, DO WE NEED

1486
00:55:56,841 --> 00:55:58,409
A PHYSICAL EXAM?

1487
00:55:58,409 --> 00:56:04,315
IF I ASK AUDIENCE FOR SHOW OF

1488
00:56:04,315 --> 00:56:07,284
HANDS, WHO HAS NOT TOUCHED IN AN

1489
00:56:07,284 --> 00:56:08,786
EXAM, 80% WOULD GO UP.

1490
00:56:08,786 --> 00:56:11,122
WE HAVE A FALLACY IN-PERSON CARE

1491
00:56:11,122 --> 00:56:12,890
IS WILDLY DIFFERENT BECAUSE OF A

1492
00:56:12,890 --> 00:56:14,825
PHYSICAL EXAM.

1493
00:56:14,825 --> 00:56:15,426
I CHALLENGE CARDIOLOGY

1494
00:56:15,426 --> 00:56:19,363
COLLEAGUES TO SAY ON A ROUTINE

1495
00:56:19,363 --> 00:56:19,997
SCHEDULED APPOINTMENT HOW MANY

1496
00:56:19,997 --> 00:56:21,432
TIMES HAVE YOU FOUND A NEW

1497
00:56:21,432 --> 00:56:22,766
MURMUR ON A PATIENT, THE ANSWER

1498
00:56:22,766 --> 00:56:24,468
IS NEVER ON EVERY WOULD BE.

1499
00:56:24,468 --> 00:56:27,671
WHAT IS IT WE NEED TO DO FOR

1500
00:56:27,671 --> 00:56:28,472
PATIENTS, NOT WHAT HAVE WE

1501
00:56:28,472 --> 00:56:30,307
ALWAYS DONE AND YOU WHO DO WE DO

1502
00:56:30,307 --> 00:56:32,042
IT WITH TELEMEDICINE.

1503
00:56:32,042 --> 00:56:33,244
MY FINAL THOUGHT, ANALOGY I USED

1504
00:56:33,244 --> 00:56:35,012
TO NOT LIKE THAT SOMEONE ELSE

1505
00:56:35,012 --> 00:56:37,648
MADE, THAT I NOW LOVE,

1506
00:56:37,648 --> 00:56:38,916
TELEMEDICINE IS THE ELEVATOR.

1507
00:56:38,916 --> 00:56:40,551
NOBODY ASKED HOW IS THE ELEVATOR

1508
00:56:40,551 --> 00:56:42,653
RIDE UP TO THE FIFTH FLOOR TO

1509
00:56:42,653 --> 00:56:44,955
GET TO MEDICAL CARE.

1510
00:56:44,955 --> 00:56:46,323
THE TELEMEDICINE PLATFORM SHOULD

1511
00:56:46,323 --> 00:56:48,726
BE SEAMLESS, SHOULD BE THE

1512
00:56:48,726 --> 00:56:48,993
ELEVATOR.

1513
00:56:48,993 --> 00:56:50,794
AND ECHOING THE COMMENTS OF THE

1514
00:56:50,794 --> 00:56:52,096
OTHER PANELISTS, IT'S ABOUT THE

1515
00:56:52,096 --> 00:56:56,033
CARE YOU'RE GETTING FOR THE

1516
00:56:56,033 --> 00:56:57,134
CONDITION YOU HAVE.

1517
00:56:57,134 --> 00:57:00,070
>> IF YOU DON'T MIND
JUMPING IN,

1518
00:57:00,070 --> 00:57:01,305
WE'RE IN AGREEMENT.

1519
00:57:01,305 --> 00:57:02,740
ONE THING I WOULD HIGHLIGHT FOR

1520
00:57:02,740 --> 00:57:04,375
THE AUDIENCE IS A BIT OF A

1521
00:57:04,375 --> 00:57:04,708
PARADOX.

1522
00:57:04,708 --> 00:57:05,776
I'M WITH YOU.

1523
00:57:05,776 --> 00:57:07,811
HOW OFTEN DOES THE PHYSICAL

1524
00:57:07,811 --> 00:57:09,847
EXAM -- IS IT CRITICAL FOR

1525
00:57:09,847 --> 00:57:10,481
DIAGNOSIS AND MANAGEMENT?

1526
00:57:10,481 --> 00:57:12,349
I AGREE MOST OF THE TIME IT

1527
00:57:12,349 --> 00:57:12,583
ISN'T.

1528
00:57:12,583 --> 00:57:15,119
WHEN WE ASK PEOPLE IN NATIONAL

1529
00:57:15,119 --> 00:57:17,221
SURVEYS WHAT DO YOU THINK OF THE

1530
00:57:17,221 --> 00:57:18,355
TELEHEALTH VISIT, LIKE IT WAS

1531
00:57:18,355 --> 00:57:20,324
OKAY, BUT I DIDN'T GET A

1532
00:57:20,324 --> 00:57:21,659
PHYSICAL EXAM SO I'M NOT SURE I

1533
00:57:21,659 --> 00:57:24,595
GOT THE RIGHT QUALITY OF CARE.

1534
00:57:24,595 --> 00:57:25,996
THAT MIGHT CHANGE OVER TIME BUT

1535
00:57:25,996 --> 00:57:28,532
I DO WANT TO -- I'M WITH YOU BUT

1536
00:57:28,532 --> 00:57:29,867
WANT TO ACKNOWLEDGE ALSO THE

1537
00:57:29,867 --> 00:57:32,803
AMERICAN PUBLIC MAY NOT AGREE

1538
00:57:32,803 --> 00:57:33,037
WITH US.

1539
00:57:33,037 --> 00:57:34,672
>> AND OF COURSE THERE'S
ALSO

1540
00:57:34,672 --> 00:57:37,074
THE OPPORTUNITY FOR THE PATIENT

1541
00:57:37,074 --> 00:57:38,709
TO CONDUCT A SELF-EXAM DURING A

1542
00:57:38,709 --> 00:57:40,144
TELEHEALTH VISIT AS WELL.

1543
00:57:40,144 --> 00:57:41,779
SO WE CAN MAYBE STRIKE A BALANCE

1544
00:57:41,779 --> 00:57:44,615
WHERE WE HAVE THE BEST OF ALL

1545
00:57:44,615 --> 00:57:45,950
WORLDS.

1546
00:57:45,950 --> 00:57:46,317
>> ABSOLUTELY.

1547
00:57:46,317 --> 00:57:49,753
I MIGHT ADD WE CAN NARRATE THE

1548
00:57:49,753 --> 00:57:51,388
EXAM WE'RE SEEING AS WE SHALL

1549
00:57:51,388 --> 00:57:52,489
VISUALIZING A PATIENT, WE

1550
00:57:52,489 --> 00:57:55,659
ACTUALLY DO A LOT OF EXAMS, I

1551
00:57:55,659 --> 00:57:57,161
KNOW ALL OF THE PANELISTS AGREE

1552
00:57:57,161 --> 00:57:59,964
WE'RE DOING A LOT OF EXAM AS WE

1553
00:57:59,964 --> 00:58:01,065
ARE SEEING PEOPLE THROUGH

1554
00:58:01,065 --> 00:58:03,033
TELEHEALTH, BUT IT MAY NOT -- WE

1555
00:58:03,033 --> 00:58:04,568
MAY NEED TO MAKE IT MORE

1556
00:58:04,568 --> 00:58:06,403
APPARENT TO THE PATIENT THAT I

1557
00:58:06,403 --> 00:58:10,107
SEE THIS ABOUT YOUR EYES, THIS

1558
00:58:10,107 --> 00:58:13,010
ABOUT YOUR BREATHING, TO HELP

1559
00:58:13,010 --> 00:58:15,846
SATISFY THAT ISSUE THAT YOU

1560
00:58:15,846 --> 00:58:16,046
RAISE.

1561
00:58:16,046 --> 00:58:17,481
>> SINCE THIS PANEL IS
ABOUT

1562
00:58:17,481 --> 00:58:19,350
RESEARCH, THIS IS A GREAT

1563
00:58:19,350 --> 00:58:23,887
OPPORTUNITY TO DO RESEARCH AND

1564
00:58:23,887 --> 00:58:25,055
TO WHAT COMPONENTS OF THE

1565
00:58:25,055 --> 00:58:26,023
PHYSICAL EXAM ARE IMPORTANT.

1566
00:58:26,023 --> 00:58:27,024
WHEN WE TALK ABOUT THIS

1567
00:58:27,024 --> 00:58:29,293
CLINICALLY I DON'T HAVE TO GET

1568
00:58:29,293 --> 00:58:31,161
THE DIAGNOSIS RIGHT, I'M AN E.R.

1569
00:58:31,161 --> 00:58:33,664
DOC, I CAN'T MISS SOMETHING BAD,

1570
00:58:33,664 --> 00:58:33,864
RIGHT?

1571
00:58:33,864 --> 00:58:36,066
AND SO WE TEND TO THINK IN

1572
00:58:36,066 --> 00:58:37,201
TELEMEDICINE IF I SEE SOMEBODY

1573
00:58:37,201 --> 00:58:38,602
AND NEED TO SENDS THEM TO THE

1574
00:58:38,602 --> 00:58:39,937
E.R. I HAVE FAILED.

1575
00:58:39,937 --> 00:58:40,704
THAT'S NOT TRUE.

1576
00:58:40,704 --> 00:58:41,905
I'VE ONLY FAILED IF I NEED TO

1577
00:58:41,905 --> 00:58:44,074
SEND THEM TO THE E.R. AND I

1578
00:58:44,074 --> 00:58:45,943
DON'T BECAUSE PRIMARY CARE

1579
00:58:45,943 --> 00:58:48,012
DOCTORS ALL THE TIME SEND PEOPLE

1580
00:58:48,012 --> 00:58:53,484
TO THE E.R., OUTOF ORDER

1581
00:58:53,484 --> 00:58:54,585
OUTPATIENT TESTS, THE RIGHT

1582
00:58:54,585 --> 00:59:05,062
THING IS GETTING TO THE NEXT

1583
00:59:06,630 --> 00:59:07,931
ACTIONABLE STEP, THE DIFFERENCE

1584
00:59:07,931 --> 00:59:08,866
BETWEEN BRONCHITIS AND SINUSITIS

1585
00:59:08,866 --> 00:59:10,334
MAY NOT MATTER TO THE PATIENT.

1586
00:59:10,334 --> 00:59:12,770
>> ONE LAST POINT AND
WE'LL GET

1587
00:59:12,770 --> 00:59:14,471
TO THE NEXT QUESTION.

1588
00:59:14,471 --> 00:59:16,807
JUDD RAISED A POINT THAT I

1589
00:59:16,807 --> 00:59:18,876
WANTED TO EMPHASIZE WHICH IS

1590
00:59:18,876 --> 00:59:20,978
THAT -- I BUILD UPON, WHICH IS

1591
00:59:20,978 --> 00:59:22,579
THAT RIGHT NOW WE DO A LOT OF

1592
00:59:22,579 --> 00:59:25,683
WORK ON VIDEO AND PHONE VISITS

1593
00:59:25,683 --> 00:59:27,284
IN THE CONSTRUCT OF THE ZOOM

1594
00:59:27,284 --> 00:59:28,519
CALL RIGHT NOW.

1595
00:59:28,519 --> 00:59:29,687
THERE IS THIS BURGEONING

1596
00:59:29,687 --> 00:59:31,255
INDUSTRY OF A NUMBER OF DEVICES

1597
00:59:31,255 --> 00:59:32,556
PEOPLE CAN BRING TO THE HOME,

1598
00:59:32,556 --> 00:59:35,292
SOME WILL WORK, SOME WILL BE NOT

1599
00:59:35,292 --> 00:59:37,027
SO HOT.

1600
00:59:37,027 --> 00:59:39,797
BUT THAT QUESTION THAT JUDD

1601
00:59:39,797 --> 00:59:41,532
RAISED, WHICH IS THAT A

1602
00:59:41,532 --> 00:59:43,067
CARDIOLOGIST MAY FEEL VERY, VERY

1603
00:59:43,067 --> 00:59:44,468
UNCOMFORTABLE MANAGING A PATIENT

1604
00:59:44,468 --> 00:59:46,236
WITH HEART FAILURE IN A CURRENT

1605
00:59:46,236 --> 00:59:47,104
SITUATION WITH VIDEO VISIT.

1606
00:59:47,104 --> 00:59:50,607
BUT IF THERE WAS A PHYSICAL EXAM

1607
00:59:50,607 --> 00:59:52,676
OF JUST A ONE-LEAD TELLE THING

1608
00:59:52,676 --> 00:59:55,312
ON THE PHONE AND VISUAL

1609
00:59:55,312 --> 00:59:57,181
STETHOSCOPE, WHAT THEY JUDGE AND

1610
00:59:57,181 --> 00:59:59,149
WHAT THE PATIENT JUDGES TO BE

1611
00:59:59,149 --> 01:00:00,784
SUFFICIENT QUALITY MAY BE

1612
01:00:00,784 --> 01:00:01,452
EXTREMELY DIFFERENT.

1613
01:00:01,452 --> 01:00:09,193
SO WE HAVE TO THINK ABOUT

1614
01:00:09,193 --> 01:00:10,761
TELETODAY AND TELE IN A COUPLE

1615
01:00:10,761 --> 01:00:12,062
YEARS MAY BE DIFFERENT HOW WE

1616
01:00:12,062 --> 01:00:12,996
JUDGE THAT QUALITY.

1617
01:00:12,996 --> 01:00:16,633
>> THAT'S WHAT WE WANT TO

1618
01:00:16,633 --> 01:00:17,134
ENCOURAGE, CONVERSATION.

1619
01:00:17,134 --> 01:00:17,868
SO THIS IS GREAT.

1620
01:00:17,868 --> 01:00:19,803
I WANT TO LET YOU KNOW THERE ARE

1621
01:00:19,803 --> 01:00:21,472
ALREADY A NUMBER OF QUESTIONS

1622
01:00:21,472 --> 01:00:23,307
THAT ARE COMING IN, AND SO I'LL

1623
01:00:23,307 --> 01:00:25,142
PROBABLY JUST JUMP TO THAT AND

1624
01:00:25,142 --> 01:00:27,678
PICKING UP ON DR. HOLLANDER'S

1625
01:00:27,678 --> 01:00:30,114
AND EVERYBODY'S POINT AROUND

1626
01:00:30,114 --> 01:00:32,149
ELEVATOR BEING TELEMEDICINE JUST

1627
01:00:32,149 --> 01:00:35,018
ONE MODALITY, AND DR. HOLLANDER,

1628
01:00:35,018 --> 01:00:36,787
ONE OF OUR RECENT PUBLICATIONS

1629
01:00:36,787 --> 01:00:38,188
YOU HIGHLIGHT THERE'S AN ARRAY

1630
01:00:38,188 --> 01:00:40,057
OF MODALITIES THAT FALL WITHIN

1631
01:00:40,057 --> 01:00:41,358
THIS REALM.

1632
01:00:41,358 --> 01:00:46,063
WE HAVE LIVE AUDIO VIDEO, WE

1633
01:00:46,063 --> 01:00:48,265
HAVE ASYNCHRONOUS CARE, NEAR AND

1634
01:00:48,265 --> 01:00:54,371
DEAR TO ME IN PRIMARY CARE, AND

1635
01:00:54,371 --> 01:00:55,372
REMOTE PATIENT MONITORING WHICH

1636
01:00:55,372 --> 01:00:57,441
ATEEV MENTIONED AS WELL.

1637
01:00:57,441 --> 01:00:58,075
THE QUESTION FROM THE AUDIENCE

1638
01:00:58,075 --> 01:01:00,244
HOW DO YOU THINK THE

1639
01:01:00,244 --> 01:01:02,379
RELATIONSHIP WITH PATIENTS

1640
01:01:02,379 --> 01:01:04,681
SHOULD BE MANAGED, CONSIDERINGED

1641
01:01:04,681 --> 01:01:10,154
THESE MODALITIES, IS THERE

1642
01:01:10,154 --> 01:01:14,458
RELUCTANCE TO TELEHEALTH DUE TO

1643
01:01:14,458 --> 01:01:16,093
RUSHED IMPLEMENTATION AND WHAT

1644
01:01:16,093 --> 01:01:17,728
STRATEGIES CAN REENGAGE THOSE

1645
01:01:17,728 --> 01:01:19,596
WHO DO HAVE SOME MISTRUST OF

1646
01:01:19,596 --> 01:01:21,765
THESE MODALITIES AND HOW DO WE

1647
01:01:21,765 --> 01:01:24,501
GET THEM TO ENGAGE?

1648
01:01:24,501 --> 01:01:27,905
>> WELL, I THANK YOU FOR
THAT

1649
01:01:27,905 --> 01:01:28,906
INCREDIBLY SIMPLE QUESTION.

1650
01:01:28,906 --> 01:01:31,175
I CAN SAY THIS, YOU KNOW, I HAVE

1651
01:01:31,175 --> 01:01:33,577
A UNIQUE EXPERIENCE BECAUSE WE

1652
01:01:33,577 --> 01:01:34,344
LAUNCHED OUR FIRST TELEMEDICINE

1653
01:01:34,344 --> 01:01:36,113
PROGRAM IN 2015, LONG BEFORE

1654
01:01:36,113 --> 01:01:36,613
COVID.

1655
01:01:36,613 --> 01:01:38,182
AND THEN BECAUSE JEFFERSON HAS

1656
01:01:38,182 --> 01:01:40,584
GROWN FROM ALMOST THREE

1657
01:01:40,584 --> 01:01:41,919
HOSPITALS INTO 32 NOW, I'VE HAD

1658
01:01:41,919 --> 01:01:44,855
THE EXTREME PLEASURE OF HAVING

1659
01:01:44,855 --> 01:01:48,459
TO RELAUNCH IT MULTIPLE TIMES AS

1660
01:01:48,459 --> 01:01:49,626
WE ADDED ADDITIONAL HOSPITALS

1661
01:01:49,626 --> 01:01:51,128
AND APPLY LEARNINGS FROM THE

1662
01:01:51,128 --> 01:01:53,530
FIRST TO THE SUBSEQUENT ONES.

1663
01:01:53,530 --> 01:01:57,034
A COUPLE PIECES OF TRUE DATA, WE

1664
01:01:57,034 --> 01:01:58,335
KNOW IN SCHEDULED VISITS BETWEEN

1665
01:01:58,335 --> 01:02:01,638
A PATIENT AND THEIR PRIMARY

1666
01:02:01,638 --> 01:02:03,607
PROVIDER ARE SPECIALIST, ABOUT

1667
01:02:03,607 --> 01:02:06,009
70% OF THE DECISION TO DO

1668
01:02:06,009 --> 01:02:08,078
TELEMEDICINE IS THE PROVIDER

1669
01:02:08,078 --> 01:02:09,947
SAYING YOUR NEXT VISIT CAN BE

1670
01:02:09,947 --> 01:02:10,714
TELEMEDICINE.

1671
01:02:10,714 --> 01:02:13,684
WE TALK A LOT ABOUT

1672
01:02:13,684 --> 01:02:15,786
PATIENT-CENTRIC CARE BUT A

1673
01:02:15,786 --> 01:02:18,388
TELEMEDICINE VISIT IS DRIVEN BY

1674
01:02:18,388 --> 01:02:20,691
THE PROVIDER WHO CAN CLEARLY SAY

1675
01:02:20,691 --> 01:02:21,458
GET YOUR HEMOGLOBIN A1 CROSS

1676
01:02:21,458 --> 01:02:24,394
COUNTRY CHECKED  A1c

1677
01:02:24,394 --> 01:02:28,465
CHECKED AT THE LAB AND WE'LL

1678
01:02:28,465 --> 01:02:29,766
TALK VIA TELEMEDICINE.

1679
01:02:29,766 --> 01:02:34,171
THINK ABOUT OUR HEALTH SYSTEMS.

1680
01:02:34,171 --> 01:02:36,139
WE'RE AT CAPACITY, NOT A LOT OF

1681
01:02:36,139 --> 01:02:37,441
OPEN APPOINTMENTS FOR THE

1682
01:02:37,441 --> 01:02:40,210
RHEUMATOLOGIST TO SEE YOU TODAY.

1683
01:02:40,210 --> 01:02:41,745
HE SEES YOU ON YOUR SCHEDULED

1684
01:02:41,745 --> 01:02:43,580
VISIT WHEN YOU'RE WELL BUT NOT

1685
01:02:43,580 --> 01:02:45,782
WHEN YOU HAVE AN ACUTE FLARE.

1686
01:02:45,782 --> 01:02:47,751
WE NEED TO FIGURE OUT WHAT ARE

1687
01:02:47,751 --> 01:02:48,952
THE WAYS WE CAN ENGAGE PATIENTS

1688
01:02:48,952 --> 01:02:51,889
TO TAKE CARE OF THEIR ACUTE

1689
01:02:51,889 --> 01:02:53,790
PROBLEMS ON SYSTEM IF YOU

1690
01:02:53,790 --> 01:02:55,859
EXCLUDE E.R. URGENT CARE AND

1691
01:02:55,859 --> 01:02:59,663
RETAIL CLINICS IS LARGELY BUILT

1692
01:02:59,663 --> 01:03:00,797
ON CHRONIC CARE MODEL.

1693
01:03:00,797 --> 01:03:02,332
AND SO I'M NOT ONE OF THESE

1694
01:03:02,332 --> 01:03:05,536
PEOPLE BUT THE THREE OF YOU

1695
01:03:05,536 --> 01:03:06,169
PROBABLY HAVE IN-BOX

1696
01:03:06,169 --> 01:03:07,204
DIFFICULTIES, RIGHT?

1697
01:03:07,204 --> 01:03:08,572
WITH PATIENTS REACHING OUT TO

1698
01:03:08,572 --> 01:03:09,540
YOU.

1699
01:03:09,540 --> 01:03:11,875
SO IF WE HAVE GOOD ASYNCHRONOUS

1700
01:03:11,875 --> 01:03:13,176
WAYS OF COMMUNICATING WITH

1701
01:03:13,176 --> 01:03:14,711
PATIENTS, THAT COULD SAY, YES, I

1702
01:03:14,711 --> 01:03:16,346
NEED TO SEE YOU, NO, I DON'T

1703
01:03:16,346 --> 01:03:18,115
NEED TO SEE YOU, EVEN IF I DO

1704
01:03:18,115 --> 01:03:20,617
SEE YOU I'M LIKELY TO SEND YOU

1705
01:03:20,617 --> 01:03:22,352
TO URGENT CARE OR E.R. BECAUSE

1706
01:03:22,352 --> 01:03:24,021
YOU NEED LABS AND X-RAY, THAT

1707
01:03:24,021 --> 01:03:25,856
WOULD GO A LONG WAY.

1708
01:03:25,856 --> 01:03:28,725
I COME BACK TO CONCEPT OF

1709
01:03:28,725 --> 01:03:30,360
LEVERAGING TELEMEDICINE FOR

1710
01:03:30,360 --> 01:03:31,328
ACTIONABLE NEXT STEPS, AND

1711
01:03:31,328 --> 01:03:33,530
PEOPLE WILL CALL IT A.I. OR

1712
01:03:33,530 --> 01:03:34,731
PREDICTIVE ANALYTICS BUT WHERE

1713
01:03:34,731 --> 01:03:38,468
IS THE RIGHT SPOT FOR YOUR CARE

1714
01:03:38,468 --> 01:03:42,506
NOW AND THAT CAN BE DONE

1715
01:03:42,506 --> 01:03:43,106
ASYNCHRONOUSLY.

1716
01:03:43,106 --> 01:03:43,840
>> EXCELLENT ANSWER ON THE

1717
01:03:43,840 --> 01:03:44,608
PATIENT SIDE.

1718
01:03:44,608 --> 01:03:47,344
I WANT TO ADD ON THE PROVIDER

1719
01:03:47,344 --> 01:03:49,413
SIDE THAT QUESTION OF RELUCTANCE

1720
01:03:49,413 --> 01:03:50,948
AND REENGAGEMENT, WE HAVE -- I

1721
01:03:50,948 --> 01:03:53,784
WORK IN A PRIMARY CARE NETWORK,

1722
01:03:53,784 --> 01:03:55,886
55 PRACTICES THAT MADE THIS

1723
01:03:55,886 --> 01:03:57,654
RAPID TRANSITION TO TELEHEALTH,

1724
01:03:57,654 --> 01:04:00,190
AND THERE'S A SUBSET OF OUR

1725
01:04:00,190 --> 01:04:02,426
CLINICIANS WHERE I DO SEE WHAT I

1726
01:04:02,426 --> 01:04:04,428
THINK ARE TELEHEALTH WHIPLASH,

1727
01:04:04,428 --> 01:04:09,266
WHERE THEY WENT ALONG AND DID IT

1728
01:04:09,266 --> 01:04:12,769
BUT NOW THEY ARE NOT SO FEELING

1729
01:04:12,769 --> 01:04:13,470
POSITIVE TOWARDS TELEMEDICINE

1730
01:04:13,470 --> 01:04:16,073
NOW THAT THEY HAVE MORE OF A

1731
01:04:16,073 --> 01:04:16,740
CHOICE.

1732
01:04:16,740 --> 01:04:18,275
SOME IS IN IN RAPID TRANSITION,

1733
01:04:18,275 --> 01:04:26,416
IT WAS A RAPID TRANSITION, THE

1734
01:04:26,416 --> 01:04:27,284
STAY-AT-HOME PEOPLE WERE OFFERED

1735
01:04:27,284 --> 01:04:28,819
FOR TELEHEALTH THINGS WE

1736
01:04:28,819 --> 01:04:30,887
WOULDN'T NORMALLY OFFER, WE

1737
01:04:30,887 --> 01:04:33,857
DIDN'T HAVE ABILITY TO TRANSFER

1738
01:04:33,857 --> 01:04:35,859
TO IN-PERSON, WRAPPED IN

1739
01:04:35,859 --> 01:04:37,127
UNCERTAINTY AND ISOLATION OF THE

1740
01:04:37,127 --> 01:04:37,694
PANDEMIC.

1741
01:04:37,694 --> 01:04:40,831
AND SO I HEAR FROM SOME DOCS

1742
01:04:40,831 --> 01:04:43,467
THAT THEY DON'T LIKE TELEHEALTH

1743
01:04:43,467 --> 01:04:45,969
BECAUSE IT IS ISOLATING, AND I

1744
01:04:45,969 --> 01:04:46,870
FIND THE OPPOSITE.

1745
01:04:46,870 --> 01:04:48,271
BUT I THINK BECAUSE IT'S A GREAT

1746
01:04:48,271 --> 01:04:50,140
WAY TO CONNECT IN THE HOME, BUT

1747
01:04:50,140 --> 01:04:51,675
I THINK WE NEED TO LISTEN TO

1748
01:04:51,675 --> 01:04:54,745
THOSE DOCS AND MAKE SURE THAT WE

1749
01:04:54,745 --> 01:04:56,813
REENGAGE THEM AS WELL AS THE

1750
01:04:56,813 --> 01:04:57,814
QUESTION ABOUT REENGAGING

1751
01:04:57,814 --> 01:04:59,483
PATIENTS.

1752
01:04:59,483 --> 01:05:01,118
BUT THINKING ABOUT HOW WE MAKE

1753
01:05:01,118 --> 01:05:02,619
IT FEEL SAFE AND COMFORTABLE FOR

1754
01:05:02,619 --> 01:05:04,821
DOCS WHO MAY BE BURNED OUT ON

1755
01:05:04,821 --> 01:05:07,557
TELEHEALTH TO COME BACK AS WELL.

1756
01:05:07,557 --> 01:05:10,394
>> ONE THING I WANTED TO
BUILD

1757
01:05:10,394 --> 01:05:13,664
UPON HERE WAS THE MODALITY IN

1758
01:05:13,664 --> 01:05:17,934
JUST THE SYNCHRONOUS VERSUS

1759
01:05:17,934 --> 01:05:18,402
ASYNCHRONOUS THING.

1760
01:05:18,402 --> 01:05:19,903
ONE OF THE THINGS THAT HAS

1761
01:05:19,903 --> 01:05:22,773
ALREADY COME UP IS THAT IN MANY

1762
01:05:22,773 --> 01:05:24,074
AREAS, CLINICAL CARE FROM

1763
01:05:24,074 --> 01:05:25,509
CARDIOLOGY TO RHEUMATOLOGY TO

1764
01:05:25,509 --> 01:05:26,510
MENTAL HEALTH PROFESSIONALS,

1765
01:05:26,510 --> 01:05:28,545
PRIMARY CARE, WE JUST DON'T HAVE

1766
01:05:28,545 --> 01:05:29,880
ENOUGH CLINICIANS.

1767
01:05:29,880 --> 01:05:32,616
AND SO WHEN WE ENGAGE THE DOCS,

1768
01:05:32,616 --> 01:05:35,352
I ALSO -- WHAT IS THE MODALITY?

1769
01:05:35,352 --> 01:05:36,920
BECAUSE THIS IS AN INHERENT

1770
01:05:36,920 --> 01:05:39,489
PROBLEM WITH VIDEO AND PHONE

1771
01:05:39,489 --> 01:05:39,723
VISITS.

1772
01:05:39,723 --> 01:05:42,359
I JUST -- OUR HEALTH SYSTEM, ALL

1773
01:05:42,359 --> 01:05:45,195
HEALTH SYSTEMS ARE NOT LIKE A

1774
01:05:45,195 --> 01:05:46,630
LOT OF CARDIOLOGISTS, SITTING

1775
01:05:46,630 --> 01:05:49,032
AROUND, YOU GOT ME MORE ACCESS,

1776
01:05:49,032 --> 01:05:51,234
I CAN TREAT PEOPLE IN -- YOU

1777
01:05:51,234 --> 01:05:53,503
KNOW, DR. GRAHAM IN HIS OPENING

1778
01:05:53,503 --> 01:05:55,605
PLENARY HIGHLIGHTED WHY I GET

1779
01:05:55,605 --> 01:05:56,873
EXCITED, IMAGINING THE PEOPLE ON

1780
01:05:56,873 --> 01:05:58,975
THE CALL GET EXCITED, I WANT TO

1781
01:05:58,975 --> 01:06:00,377
ACKNOWLEDGE THAT IF WE'RE GOING

1782
01:06:00,377 --> 01:06:03,046
TO IMPROVE ACCESS IN THE WAY WE

1783
01:06:03,046 --> 01:06:06,116
REALLY WANT TO, JUST DOING VIDEO

1784
01:06:06,116 --> 01:06:08,085
AND PHONE VISITS DOESN'T IMPROVE

1785
01:06:08,085 --> 01:06:09,519
PRODUCTIVITY OR EFFICIENCY.

1786
01:06:09,519 --> 01:06:13,457
SO WHEN I THINK ABOUT THE FUTURE

1787
01:06:13,457 --> 01:06:16,827
OF TELEHEALTH, WHAT GETS ME MOST

1788
01:06:16,827 --> 01:06:17,828
EXCITED ABOUT REALLY FULFILLING

1789
01:06:17,828 --> 01:06:20,330
THE PROMISE THAT WAS DR.

1790
01:06:20,330 --> 01:06:22,199
GRAHAM'S HIGHLIGHT, I GET A LOT

1791
01:06:22,199 --> 01:06:26,436
MORE EXCITED AND I'M REALLY

1792
01:06:26,436 --> 01:06:28,105
INTERESTED IN TELEHEALTH

1793
01:06:28,105 --> 01:06:28,772
MODALITIES, APPLICATIONS THAT

1794
01:06:28,772 --> 01:06:29,873
IMPROVE PRODUCTIVITY.

1795
01:06:29,873 --> 01:06:32,809
WHAT I MEAN BY THAT IS THAT

1796
01:06:32,809 --> 01:06:34,144
RHEUMATOLOGIST THAT JUDD

1797
01:06:34,144 --> 01:06:36,213
MENTIONED CAN NOW MANAGE MORE

1798
01:06:36,213 --> 01:06:37,748
PATIENTS AND THEREFORE HAVE IN

1799
01:06:37,748 --> 01:06:40,584
HER PANEL THE ABILITY TO REACH

1800
01:06:40,584 --> 01:06:43,019
THAT PATIENT IN THAT RURAL

1801
01:06:43,019 --> 01:06:45,856
COMMUNITY OR THE COMMUNITY IN

1802
01:06:45,856 --> 01:06:47,724
MIAMI WHERE ACCESS WAS DIFFICULT

1803
01:06:47,724 --> 01:06:48,158
BEFORE.

1804
01:06:48,158 --> 01:06:51,194
AND SO THAT MEANS THINGS THAT

1805
01:06:51,194 --> 01:06:52,429
ARE ASYNCHRONOUS WE CAN GO INTO

1806
01:06:52,429 --> 01:06:54,598
THOSE IF YOU WANT, HAPPY TO JUMP

1807
01:06:54,598 --> 01:06:56,333
IN, BUT WANTED TO MAKE THE

1808
01:06:56,333 --> 01:06:57,567
LARGER POINT AS WE THINK ABOUT

1809
01:06:57,567 --> 01:07:00,804
THE FUTURE OF TELEHEALTH

1810
01:07:00,804 --> 01:07:01,938
THINKING ABOUT PRODUCTIVITY AND

1811
01:07:01,938 --> 01:07:03,874
THOSE APPLICATIONS MAY ALLOW US

1812
01:07:03,874 --> 01:07:06,409
TO FULFILL THE GOALS THAT DR.

1813
01:07:06,409 --> 01:07:10,380
GRAHAM REALLY ARTICULATED SO

1814
01:07:10,380 --> 01:07:10,580
WELL.

1815
01:07:10,580 --> 01:07:12,482
>> ONE THING WE DIDN'T
TOUCH ON

1816
01:07:12,482 --> 01:07:15,318
SINCE PART OF TODAY IS ABOUT

1817
01:07:15,318 --> 01:07:16,520
IMPLEMENTATION SCIENCE, WE NEVER

1818
01:07:16,520 --> 01:07:23,960
IMPLEMENTED IN A WAY ANY

1819
01:07:23,960 --> 01:07:25,028
 NORMAL

1820
01:07:25,028 --> 01:07:29,199
SYSTEM WOULD IMELEMENT. --

1821
01:07:29,199 --> 01:07:30,400
IMPLEMENT HEALTH CARE.

1822
01:07:30,400 --> 01:07:32,469
WHEN I SHIFTED SEVEN YEARS AGO I

1823
01:07:32,469 --> 01:07:33,703
HAD TEN MINUTES OF ORIENTATION,

1824
01:07:33,703 --> 01:07:35,906
HOW DO I DO THIS, WRITE AN

1825
01:07:35,906 --> 01:07:36,940
ORDER, AT MY COMPUTER.

1826
01:07:36,940 --> 01:07:38,441
I KNOW HOW TO DO IT BECAUSE I

1827
01:07:38,441 --> 01:07:40,076
HAD PEOPLE NEXT TO ME WHO KNEW

1828
01:07:40,076 --> 01:07:42,412
HOW TO DO IT.

1829
01:07:42,412 --> 01:07:45,448
WHEN WE ALL STARTED DOING

1830
01:07:45,448 --> 01:07:47,083
TELEMEDICINE IN MARCH OF 2020,

1831
01:07:47,083 --> 01:07:49,419
WHAT WE DID NOT HAVE IS ANYBODY

1832
01:07:49,419 --> 01:07:51,922
NEXT TO US WHO KNEW HOW TO DO

1833
01:07:51,922 --> 01:07:52,355
IT.

1834
01:07:52,355 --> 01:07:54,324
NOR DID MOST INSTITUTIONS HAVE

1835
01:07:54,324 --> 01:07:55,659
ANY TRAINING PROGRAM WHO COULD

1836
01:07:55,659 --> 01:07:57,961
TEACH PEOPLE HOW TO DO IT.

1837
01:07:57,961 --> 01:07:58,829
THE OLDER PEOPLE, THEY DIDN'T

1838
01:07:58,829 --> 01:08:01,364
LIKE IT.

1839
01:08:01,364 --> 01:08:07,804
THEY MAY HAVE BEEN

1840
01:08:07,804 --> 01:08:08,405
TECHNI-PHOBES, YOUNGER PEOPLE

1841
01:08:08,405 --> 01:08:12,642
ARE NO CLINICAL EXPERIENCE AND

1842
01:08:12,642 --> 01:08:13,343
WERE UNCOMFORTABLE IN

1843
01:08:13,343 --> 01:08:14,811
TELEMEDICINE, AND PEOPLE IN THE

1844
01:08:14,811 --> 01:08:16,146
MIDDLE OF THEIR CAREER WHO WOULD

1845
01:08:16,146 --> 01:08:17,747
HAVE EXPERIENCE AND UNDERSTAND

1846
01:08:17,747 --> 01:08:19,316
HOW TO DO THINGS DIDN'T KNOW HOW

1847
01:08:19,316 --> 01:08:20,183
TO DO THINGS.

1848
01:08:20,183 --> 01:08:21,818
SO WHEN YOU ASK THE PERSON NEXT

1849
01:08:21,818 --> 01:08:25,121
TO YOU WHAT TO DO, THEY JUST

1850
01:08:25,121 --> 01:08:26,356
MADE UP SOMETHING AND WHEN THEY

1851
01:08:26,356 --> 01:08:31,027
COULD ONLY DO THE MADE-UP

1852
01:08:31,027 --> 01:08:32,028
SOMETHING, THEY WERE COMFORTABLE

1853
01:08:32,028 --> 01:08:33,563
BECAUSE THE ALTERNATIVE WAS

1854
01:08:33,563 --> 01:08:34,865
PLACING THE LIFE AT RISK BY

1855
01:08:34,865 --> 01:08:36,499
SEEING PEOPLE IN PERSON AND

1856
01:08:36,499 --> 01:08:37,767
NEVER LEARNED TO GET COMFORTABLE

1857
01:08:37,767 --> 01:08:39,369
AND LEARN THE RIGHT WAY TO DO

1858
01:08:39,369 --> 01:08:39,536
IT.

1859
01:08:39,536 --> 01:08:41,538
THERE ARE GOOD WAYS TO DO

1860
01:08:41,538 --> 01:08:43,640
PHYSICAL EXAMS ON TELEMEDICINE.

1861
01:08:43,640 --> 01:08:44,541
WE'VE TRAINED THOUSANDS OF

1862
01:08:44,541 --> 01:08:47,677
PEOPLE ON HOW TO DO BELLY EXAMS

1863
01:08:47,677 --> 01:08:49,112
FOR ACUTE ABDOMINAL PAIN AND

1864
01:08:49,112 --> 01:08:50,180
PICKED UP EVERYTHING YOU COULD

1865
01:08:50,180 --> 01:08:52,816
IMAGINE AND TO THE BEST OF MY

1866
01:08:52,816 --> 01:08:54,251
KNOWLEDGE HAVE MISSED NOTHING

1867
01:08:54,251 --> 01:08:56,019
THAT WE SHOULD HAVE FOUND OVER

1868
01:08:56,019 --> 01:08:57,420
TEN YEARS OF EXPERIENCE.

1869
01:08:57,420 --> 01:08:58,955
I'M SURE THERE'S ONE OR TWO IN

1870
01:08:58,955 --> 01:08:59,189
THERE.

1871
01:08:59,189 --> 01:09:01,057
WE DON'T KNOW ABOUT.

1872
01:09:01,057 --> 01:09:03,460
BUT WE'VE DONE REALLY WELL.

1873
01:09:03,460 --> 01:09:05,128
BUT PEOPLE DON'T HAVE THAT

1874
01:09:05,128 --> 01:09:05,395
TRAINING.

1875
01:09:05,395 --> 01:09:07,931
AND SO IF YOU TRAINED ON HOW TO

1876
01:09:07,931 --> 01:09:10,367
EXAMINE SOMEONE IN PERSON, IT'S

1877
01:09:10,367 --> 01:09:11,868
DIFFERENT ON VIDEO.

1878
01:09:11,868 --> 01:09:14,404
SO AN OPPORTUNITY FOR STUDY IS

1879
01:09:14,404 --> 01:09:17,140
HOW DO WE EXAMINE PEOPLE VIA

1880
01:09:17,140 --> 01:09:18,441
VIDEO TO GET ENOUGH INFORMATION

1881
01:09:18,441 --> 01:09:20,844
TO GET TO THE APPROPRIATE

1882
01:09:20,844 --> 01:09:22,846
ACTIONABLE NEXT STEP WITHOUT

1883
01:09:22,846 --> 01:09:28,084
PLACING QUALITY AT RISK.

1884
01:09:28,084 --> 01:09:30,253
>> KRISTIN, DID YOU HAVE A

1885
01:09:30,253 --> 01:09:30,487
COMMENT?

1886
01:09:30,487 --> 01:09:32,355
>> JUST AGREEING.

1887
01:09:32,355 --> 01:09:35,525
OH, ONE ON THE PREVIOUS POINT,

1888
01:09:35,525 --> 01:09:37,394
WHICH WAS ABOUT THE ASYNCHRONOUS

1889
01:09:37,394 --> 01:09:40,363
AND THE VALUE OF THOSE.

1890
01:09:40,363 --> 01:09:43,300
I 100% AGREE AND OFTEN SEE OR

1891
01:09:43,300 --> 01:09:45,702
HEAR CONVERSATIONS ABOUT USING

1892
01:09:45,702 --> 01:09:46,503
TELEHEALTH TO INCREASE

1893
01:09:46,503 --> 01:09:48,338
AVAILABILITY WHEN IT REALLY ONLY

1894
01:09:48,338 --> 01:09:49,105
INCREASES ACCESS.

1895
01:09:49,105 --> 01:09:51,708
IT DOESN'T CHANGE OUR CAPACITY.

1896
01:09:51,708 --> 01:09:55,545
AND SO I WANT TO SET THAT --

1897
01:09:55,545 --> 01:09:59,482
EMPHASIZE THAT.

1898
01:09:59,482 --> 01:10:00,583
ALSO SHARE ENTHUSIASM THAT

1899
01:10:00,583 --> 01:10:02,352
THERE'S SO MANY MODELS, AND I

1900
01:10:02,352 --> 01:10:04,087
THINK OUR BEST FUTURE HEALTHCARE

1901
01:10:04,087 --> 01:10:05,522
SYSTEM WILL INVOLVE STITCHING

1902
01:10:05,522 --> 01:10:06,790
THOSE ALONG SO THE PATIENT, YOU

1903
01:10:06,790 --> 01:10:08,825
KNOW, ENTER AT THE DOOR THAT'S

1904
01:10:08,825 --> 01:10:10,093
MOST ACCESSIBLE TO THEM, ARE

1905
01:10:10,093 --> 01:10:12,862
HANDED UP TO THE LEVEL THAT THEY

1906
01:10:12,862 --> 01:10:15,732
MOST NEED BASED ON RECOGNITION

1907
01:10:15,732 --> 01:10:18,034
OF CLINICAL SCENARIOS AS DR.

1908
01:10:18,034 --> 01:10:18,668
HOLLANDER NOTED.

1909
01:10:18,668 --> 01:10:21,304
SO I THINK THAT IT'S NOT AN

1910
01:10:21,304 --> 01:10:22,839
EITHER/OR BUT THE SYSTEM WHERE

1911
01:10:22,839 --> 01:10:24,674
YOU USE THE LOWEST TOUCH

1912
01:10:24,674 --> 01:10:27,010
NECESSARY TO DELIVER THE HIGHEST

1913
01:10:27,010 --> 01:10:28,812
QUALITY CARE.

1914
01:10:28,812 --> 01:10:31,481
>> AND THAT GETS TO THE
COMMENT

1915
01:10:31,481 --> 01:10:33,083
MADE EARLIER, JUDD, ABOUT THE

1916
01:10:33,083 --> 01:10:35,418
UNIT OF ANALYSIS SHOULD BE THE

1917
01:10:35,418 --> 01:10:39,055
CARE JOURNEY AND NOT JUST THE

1918
01:10:39,055 --> 01:10:39,589
ONE VISIT.

1919
01:10:39,589 --> 01:10:42,692
AND HOW A PATIENT IS ABLE TO

1920
01:10:42,692 --> 01:10:46,262
ACCESS CARE THEY ARE RECEIVING

1921
01:10:46,262 --> 01:10:48,131
WHEN IT PERTAINS TO DIABETES OR

1922
01:10:48,131 --> 01:10:49,199
HYPERTENSION OUTCOMES, ET

1923
01:10:49,199 --> 01:10:49,432
CETERA.

1924
01:10:49,432 --> 01:10:50,533
I'M GOING TO TRANSITION THE

1925
01:10:50,533 --> 01:10:51,835
CONVERSATION BECAUSE THERE ARE A

1926
01:10:51,835 --> 01:10:54,571
NUMBER OF QUESTIONS RELATED TO

1927
01:10:54,571 --> 01:10:55,438
IMPLEMENTATION SCIENCE AND

1928
01:10:55,438 --> 01:10:56,039
IMPLEMENTATION RESEARCH WHICH

1929
01:10:56,039 --> 01:10:58,308
REALLY IS THE THEME OF OUR PANEL

1930
01:10:58,308 --> 01:10:58,508
TODAY.

1931
01:10:58,508 --> 01:11:01,811
MAYBE WHAT WE SHOULD DO IS JUST

1932
01:11:01,811 --> 01:11:03,413
REVIEW WHAT ARE THE TELEHEALTH

1933
01:11:03,413 --> 01:11:05,648
DELIVERY METHODS THAT ARE PROVEN

1934
01:11:05,648 --> 01:11:09,886
TO BE EFFECTIVE, WHAT ARE BEST

1935
01:11:09,886 --> 01:11:11,187
PRACTICES, AND ATEEV WAS

1936
01:11:11,187 --> 01:11:13,690
POINTING TO THE NEED FOR WORK

1937
01:11:13,690 --> 01:11:19,629
FLOW TO ENSURE THESE ARE

1938
01:11:19,629 --> 01:11:21,398
IMPLEMENTED EFFECTIVELY ACROSS

1939
01:11:21,398 --> 01:11:21,831
MODALITIES.

1940
01:11:21,831 --> 01:11:23,233
WHAT SHOULD BE RETAINED OR NEED

1941
01:11:23,233 --> 01:11:26,770
TO BE DEVELOPED, WHAT NEEDS TO

1942
01:11:26,770 --> 01:11:34,978
BE IMPLEMENTED FOR FUTURE

1943
01:11:34,978 --> 01:11:36,279
HEALTHCARE DELIVERY?

1944
01:11:36,279 --> 01:11:36,479
ATEEV?

1945
01:11:36,479 --> 01:11:37,781
>> KRISTIN AND JUDD RUN A
BIG

1946
01:11:37,781 --> 01:11:39,249
PROGRAM, I'M MORE ON THE

1947
01:11:39,249 --> 01:11:40,016
RESEARCH SIDE.

1948
01:11:40,016 --> 01:11:44,487
CAN I PASS THE BATON ON THAT

1949
01:11:44,487 --> 01:11:45,488
QUESTION?

1950
01:11:45,488 --> 01:11:47,223
>> SURE, DO YOU WANT TO
TAKE IT?

1951
01:11:47,223 --> 01:11:48,458
>> YOU CAN GO FIRST.

1952
01:11:48,458 --> 01:11:50,627
I'M POINTING TO YOU.

1953
01:11:50,627 --> 01:11:53,563
>> I THINK ONE THING THAT
IS

1954
01:11:53,563 --> 01:11:57,734
MOST IMPORTANT IN THINKING ABOUT

1955
01:11:57,734 --> 01:11:59,369
TELEHEALTH IS JUST HOW MANY

1956
01:11:59,369 --> 01:12:03,406
MODALITIES OF CARE FALL UNDER

1957
01:12:03,406 --> 01:12:05,375
THIS UMBRELLA, THERE IS

1958
01:12:05,375 --> 01:12:06,176
ASYNCHRONOUS AND SYNCHRONOUS,

1959
01:12:06,176 --> 01:12:08,211
AND YOU CAN GO INTO DETAIL ON

1960
01:12:08,211 --> 01:12:08,411
THOSE.

1961
01:12:08,411 --> 01:12:12,415
BUT I THINK EVEN WITHIN LIVE

1962
01:12:12,415 --> 01:12:14,684
INTERACTIVE TELEMEDICINE THERE'S

1963
01:12:14,684 --> 01:12:16,019
DIFFERENCES IN WHETHER

1964
01:12:16,019 --> 01:12:16,753
PERIPHERALS ARE AVAILABLE,

1965
01:12:16,753 --> 01:12:18,555
WHETHER IT'S HAPPENING IN THE

1966
01:12:18,555 --> 01:12:20,657
CONTEXT OF AN ONGOING CARE

1967
01:12:20,657 --> 01:12:23,026
RELATIONSHIP, WHETHER THERE IS

1968
01:12:23,026 --> 01:12:24,928
CONTINUITY OF RECORD AND PEOPLE

1969
01:12:24,928 --> 01:12:26,229
HAVE ACCESS TO EHR.

1970
01:12:26,229 --> 01:12:29,933
I THINK THAT WHEN WE'RE THINKING

1971
01:12:29,933 --> 01:12:31,868
ABOUT THE IMPLEMENTATION

1972
01:12:31,868 --> 01:12:33,369
QUESTION, IT'S NOT TELEHEALTH

1973
01:12:33,369 --> 01:12:35,305
YES/NO BUT TELEHEALTH IN THIS

1974
01:12:35,305 --> 01:12:36,206
CONTEXT, TELEHEALTH IN THAT

1975
01:12:36,206 --> 01:12:38,374
CONTEXT, THAT WE NEED TO BE

1976
01:12:38,374 --> 01:12:39,809
THINKING ABOUT TO IDENTIFY WHAT

1977
01:12:39,809 --> 01:12:41,544
THE BEST WAYS AND WHAT ARE THE

1978
01:12:41,544 --> 01:12:44,280
MODELS THAT ARE EMERGING THAT

1979
01:12:44,280 --> 01:12:47,283
ARE SHOWING IN THE MOST PROMISE

1980
01:12:47,283 --> 01:12:49,786
THAT WE CAN LIFT UP.

1981
01:12:49,786 --> 01:12:52,956
SOME KEY THINGS ARE -- THAT ARE

1982
01:12:52,956 --> 01:12:54,724
EMERGING ARE NOT NECESSARILY IN

1983
01:12:54,724 --> 01:12:56,693
THE TECHNOLOGY ITSELF.

1984
01:12:56,693 --> 01:12:59,095
I THINK COMMUNICATION SKILLS AND

1985
01:12:59,095 --> 01:13:00,597
THE EXAM SKILLS, THE TRAINING,

1986
01:13:00,597 --> 01:13:02,065
ALL OF THOSE I THINK ARE

1987
01:13:02,065 --> 01:13:04,601
ESSENTIAL THAT WE MAKE SURE

1988
01:13:04,601 --> 01:13:05,902
WE'RE UNDERSTANDING AND

1989
01:13:05,902 --> 01:13:07,437
ILLUMINATING BEST PRACTICES.

1990
01:13:07,437 --> 01:13:09,405
ONE EXAMPLE OF A STUDY I FOUND

1991
01:13:09,405 --> 01:13:10,807
REALLY POWERFUL THAT I THINK IS

1992
01:13:10,807 --> 01:13:12,775
THE TYPE OF WORK WE NEED IN

1993
01:13:12,775 --> 01:13:14,444
TELEHEALTH WAS A STUDY THAT CAME

1994
01:13:14,444 --> 01:13:15,745
OUT OF KAISER IN THE LAST YEAR

1995
01:13:15,745 --> 01:13:19,916
OR SO WHERE THEY WERE LOOKING AT

1996
01:13:19,916 --> 01:13:21,918
IMPACT OF VIRTUAL ROOMING

1997
01:13:21,918 --> 01:13:24,954
PROCESSES WHERE THEY HAD M.A. OR

1998
01:13:24,954 --> 01:13:30,460
R.N. ROOM PATIENT VIRTUALLY,

1999
01:13:30,460 --> 01:13:33,863
SCHEDULED APPOINTMENTS, NOT ONLY

2000
01:13:33,863 --> 01:13:36,366
THAT NO-SHOW RATE BUT REDUCED

2001
01:13:36,366 --> 01:13:39,335
NEW-SHOW RATE MORE FOR THOSE WHO

2002
01:13:39,335 --> 01:13:41,004
WERE DISADVANTAGED POPULATIONS,

2003
01:13:41,004 --> 01:13:46,442
WHETHER IT WAS LANGUAGE OR 

2004
01:13:46,442 --> 01:13:49,279
MINORITIZED RACE AND ETHNICITY.

2005
01:13:49,279 --> 01:13:50,480
IDENTIFYING OPPORTUNITIES THAT

2006
01:13:50,480 --> 01:13:55,552
IMPROVE ACCESS OR EFFECTS  E--

2007
01:13:55,552 --> 01:13:56,619
EFFECTIVENESS FOR ALL BUT

2008
01:13:56,619 --> 01:13:58,821
ESPECIALLY THOSE NOT WELL SERVED

2009
01:13:58,821 --> 01:13:59,522
BY TRADITIONAL HEALTHCARE SYSTEM

2010
01:13:59,522 --> 01:14:03,293
IS ONE OF THE PLACES I GET MOST

2011
01:14:03,293 --> 01:14:04,494
EXCITED ABOUT.

2012
01:14:04,494 --> 01:14:06,930
>> SO I'M GOING TO ADD BUT
BEGIN

2013
01:14:06,930 --> 01:14:08,731
WITH A COMMENT THAT WE SHOULDN'T

2014
01:14:08,731 --> 01:14:10,633
HOLD TELEMEDICINE TO A HIGHER

2015
01:14:10,633 --> 01:14:12,902
STANDARD OF CARE THAN IN-PERSON

2016
01:14:12,902 --> 01:14:13,369
CARE, RIGHT?

2017
01:14:13,369 --> 01:14:15,038
IT SHOULD BE ITS OWN THING.

2018
01:14:15,038 --> 01:14:16,372
I THINK THAT'S IMPORTANT.

2019
01:14:16,372 --> 01:14:18,575
AND THEN I THINK WE'VE FAILED

2020
01:14:18,575 --> 01:14:20,877
THE WORLD IN SHOWING

2021
01:14:20,877 --> 01:14:22,212
TELEMEDICINE'S EFFECTIVENESS

2022
01:14:22,212 --> 01:14:24,180
BECAUSE WE HAVEN'T DEMANDED THE

2023
01:14:24,180 --> 01:14:26,516
SAME THING WITH NEW DEVICES AND

2024
01:14:26,516 --> 01:14:30,420
NEW TOYS THAT WE DEMAND WITH NEW

2025
01:14:30,420 --> 01:14:30,753
DRUGS.

2026
01:14:30,753 --> 01:14:32,622
SO, IF, FOR EXAMPLE, YOU'RE A

2027
01:14:32,622 --> 01:14:34,357
START-UP PHARMA COMPANY AND YOU

2028
01:14:34,357 --> 01:14:36,526
HAVE A VERY PROMISING MOLECULE,

2029
01:14:36,526 --> 01:14:38,828
YOU DON'T GET TO SAY, HERE,

2030
01:14:38,828 --> 01:14:39,929
JUDD, USE THIS, WE THINK IT'S

2031
01:14:39,929 --> 01:14:41,231
COOL AND IT'S GOING HELP YOUR

2032
01:14:41,231 --> 01:14:44,100
PATIENTS AND HAVE A RETURN ON

2033
01:14:44,100 --> 01:14:44,400
INVESTMENT.

2034
01:14:44,400 --> 01:14:45,635
YOU HAVE TO PROVE IT.

2035
01:14:45,635 --> 01:14:47,937
IF YOU'RE A REMOTE PATIENT

2036
01:14:47,937 --> 01:14:49,138
MONITORING COMPANY, YOU COULD

2037
01:14:49,138 --> 01:14:50,039
SAY, YOU KNOW, BLOOD PRESSURE

2038
01:14:50,039 --> 01:14:51,541
EVERY ONCE IN A WHILE IS GOOD SO

2039
01:14:51,541 --> 01:14:52,976
WE'LL DO IT EVERY MINUTE OF THE

2040
01:14:52,976 --> 01:14:54,177
DAY AND HERE IS A DEVICE YOU

2041
01:14:54,177 --> 01:14:56,479
COULD DO IT EVERY MINUTE OF THE

2042
01:14:56,479 --> 01:14:58,748
DAY, WITH NO PROOF THAT IT

2043
01:14:58,748 --> 01:15:00,583
ACTUALLY GENERALLY CHANGES THE

2044
01:15:00,583 --> 01:15:03,353
OUTCOME FOR PATIENTS TO DO MORE

2045
01:15:03,353 --> 01:15:05,555
OF SOMETHING THAT WORKED LESS.

2046
01:15:05,555 --> 01:15:10,360
AND SO, I THINK THAT WE HAVE AN

2047
01:15:10,360 --> 01:15:12,862
OBLIGATION TO REQUIRE START-UPS

2048
01:15:12,862 --> 01:15:14,297
IN THE DEVICE TELEMEDICINE

2049
01:15:14,297 --> 01:15:20,503
INDUSTRY TO -- WHEN  WHEN THEY E

2050
01:15:20,503 --> 01:15:22,272
RAISING MONEY ARE THE SAME

2051
01:15:22,272 --> 01:15:24,574
STANDARDS AND PHARMA, TO DO

2052
01:15:24,574 --> 01:15:26,342
CLINICAL TRIALS TO IMPROVE YOUR

2053
01:15:26,342 --> 01:15:28,645
TOY MAKES IMPACT ON PATIENTS.

2054
01:15:28,645 --> 01:15:30,313
HEALTH SYSTEMS DON'T HAVE BIG

2055
01:15:30,313 --> 01:15:30,680
MARGINS.

2056
01:15:30,680 --> 01:15:33,883
BUTTER 

2057
01:15:33,883 --> 01:15:35,652
BUT -- BUT THERE ARE SOME

2058
01:15:35,652 --> 01:15:37,954
THINGS, I'LL GIVE AN EXAMPLE

2059
01:15:37,954 --> 01:15:39,389
SOMETHING WE LAUNCHED ALMOST BY

2060
01:15:39,389 --> 01:15:39,789
MISTAKE.

2061
01:15:39,789 --> 01:15:41,257
SOMETIMES YOU JUST GET LUCKY.

2062
01:15:41,257 --> 01:15:45,395
WE BUILT A BEAUTIFUL NEW

2063
01:15:45,395 --> 01:15:46,262
BUILDING, $800 MILLION, WHEN

2064
01:15:46,262 --> 01:15:48,698
THEY DESIGNED IT, I HATE TO

2065
01:15:48,698 --> 01:15:50,233
THINK THIS IS RECORDED, LET'S

2066
01:15:50,233 --> 01:15:52,302
SAY THEY RAN OUT OF SPACE TO PUT

2067
01:15:52,302 --> 01:15:53,970
PEOPLE WHO WOULD CHECK OUT THE

2068
01:15:53,970 --> 01:15:54,237
PATIENTS.

2069
01:15:54,237 --> 01:15:56,039
AND SO THEY SAID CAN YOU COME UP

2070
01:15:56,039 --> 01:15:57,440
WITH A SOLUTION?

2071
01:15:57,440 --> 01:15:59,375
AND A COUPLE TEAMS SAT TOGETHER

2072
01:15:59,375 --> 01:16:01,277
IN A ROOM, WHITE BOARDED IT,

2073
01:16:01,277 --> 01:16:03,146
CAME UP WITH A CONCEPT OF

2074
01:16:03,146 --> 01:16:04,047
VIRTUAL CHECKOUT.

2075
01:16:04,047 --> 01:16:05,882
NOW IN EVERY SINGLE ROOM THAT

2076
01:16:05,882 --> 01:16:13,656
YOU GO INTO, THE WORK FLOW FROM

2077
01:16:13,656 --> 01:16:14,891
THE KIOSK, TO THE PHYSICIAN,

2078
01:16:14,891 --> 01:16:16,092
THERE'S A WHITE BOARD, WHEN

2079
01:16:16,092 --> 01:16:20,697
YOU'RE READY TO GET DRESSED,

2080
01:16:20,697 --> 01:16:23,666
 HIT

2081
01:16:23,666 --> 01:16:24,667
THE BUTTON, WE'VE DONE 70,000

2082
01:16:24,667 --> 01:16:26,402
THINGS APRIL, IT WASN'T

2083
01:16:26,402 --> 01:16:27,337
PRE-PLANNED, SOMEBODY MAKES THE

2084
01:16:27,337 --> 01:16:28,271
FOLLOW-UP APPOINTMENT ON THE

2085
01:16:28,271 --> 01:16:28,504
SCREEN.

2086
01:16:28,504 --> 01:16:31,341
NOT ONLY THAT, THIS WEEK IT'S

2087
01:16:31,341 --> 01:16:32,542
LAUNCHING PATIENT PREFERRED

2088
01:16:32,542 --> 01:16:35,578
LANGUAGE, SO OF THE 22 PEOPLE WE

2089
01:16:35,578 --> 01:16:38,014
HAVE DOING CHECKOUT FOR THE SIX,

2090
01:16:38,014 --> 01:16:39,649
SEVEN HUNDRED PATIENTS WE'RE

2091
01:16:39,649 --> 01:16:41,617
SEEING A DAY, THEY WILL KNOW

2092
01:16:41,617 --> 01:16:42,819
WHAT THEIR PRIMARY LANGUAGE IS

2093
01:16:42,819 --> 01:16:45,822
AND IF WE HAVE SOMEBODY WHO IS

2094
01:16:45,822 --> 01:16:46,956
BILINGUAL IN SPANISH THEY WILL

2095
01:16:46,956 --> 01:16:48,725
JUMP THAT PATIENT TO THE FRONT

2096
01:16:48,725 --> 01:16:51,127
OF THEIR QUEUE.

2097
01:16:51,127 --> 01:16:52,862
WE SAY TRANSLATORS, THEY CHECK

2098
01:16:52,862 --> 01:16:55,398
OUT BY SOMEBODY WHO SPEAKS THEIR

2099
01:16:55,398 --> 01:16:56,165
LANGUAGE, LOOKS LIKE THEM, MAKES

2100
01:16:56,165 --> 01:16:57,033
THEIR APPOINTMENT.

2101
01:16:57,033 --> 01:16:58,034
OUR DATA WHICH WE'RE BEGINNING

2102
01:16:58,034 --> 01:17:00,870
TO LOOK AT SHOWS AVERAGE TIME TO

2103
01:17:00,870 --> 01:17:02,839
APPOINTMENT BEING MADE IN THE

2104
01:17:02,839 --> 01:17:04,374
BUILDING WHETHER VIRTUAL

2105
01:17:04,374 --> 01:17:06,476
CHECKOUT OR NOT IS NOW ONE DAY,

2106
01:17:06,476 --> 01:17:07,543
AND IN OUR SYSTEM WHEN YOU GO

2107
01:17:07,543 --> 01:17:11,047
HOME AND WE SAY MAKE APPOINTMENT

2108
01:17:11,047 --> 01:17:12,382
WITH CARDIOLOGY OR WHOEVER, IT'S

2109
01:17:12,382 --> 01:17:15,318
15 DAYS WHICH WE KNOW CORRELATES

2110
01:17:15,318 --> 01:17:17,954
WITH NO-SHOW RATES AND THINGS OF

2111
01:17:17,954 --> 01:17:18,221
THE SUCH.

2112
01:17:18,221 --> 01:17:21,023
SO A REALLY SIMPLE THING THAT

2113
01:17:21,023 --> 01:17:22,225
WOULD NEVER GET MEASURED IN

2114
01:17:22,225 --> 01:17:25,094
TERMS OF IS THERE VALUE TO CARE

2115
01:17:25,094 --> 01:17:27,263
HAS CHANGED OUR IN-PERSON VISITS

2116
01:17:27,263 --> 01:17:28,798
BECAUSE WE FOUND A DIFFERENT WAY

2117
01:17:28,798 --> 01:17:31,334
TO DO HYBRID CARE.

2118
01:17:31,334 --> 01:17:34,504
I THINK, YOU KNOW, PATIENT

2119
01:17:34,504 --> 01:17:38,474
SATISFACTION IS THROUGH THE ROOF

2120
01:17:38,474 --> 01:17:39,876
WITH IT AND WASN'T EXPERIENCE.

2121
01:17:39,876 --> 01:17:41,644
>> WONDERFUL TO THINK
ABOUT CARE

2122
01:17:41,644 --> 01:17:42,612
TRANSITION RELATED TO

2123
01:17:42,612 --> 01:17:43,713
INTERVENTION AND HEALTH EQUITY

2124
01:17:43,713 --> 01:17:44,714
ASPECT OF IT.

2125
01:17:44,714 --> 01:17:48,317
AND IT IS INTERESTING THAT IT

2126
01:17:48,317 --> 01:17:50,286
WASN'T DESIGNED IN ADVANCE,

2127
01:17:50,286 --> 01:17:51,320
PROACTIVELY, BUT ACTUALLY WAS

2128
01:17:51,320 --> 01:17:54,090
JUST A CONSEQUENCE OF THE

2129
01:17:54,090 --> 01:17:54,957
CONSTRAINTS BEING PRESENTED.

2130
01:17:54,957 --> 01:17:57,059
THAT RELATES TO THE NEXT

2131
01:17:57,059 --> 01:17:58,361
QUESTION COMING IN FROM ONE OF

2132
01:17:58,361 --> 01:18:00,463
THE MEMBERS OF OUR AUDIENCE

2133
01:18:00,463 --> 01:18:01,164
TODAY.

2134
01:18:01,164 --> 01:18:03,866
SO, IT SAYS THANKS FOR A GREAT

2135
01:18:03,866 --> 01:18:06,602
COMMENT, OUTLINING THE GOALS AND

2136
01:18:06,602 --> 01:18:10,306
PRACTICE BETWEEN RESEARCH AND

2137
01:18:10,306 --> 01:18:11,407
CLINICAL PRACTICE.

2138
01:18:11,407 --> 01:18:13,176
AND THEN THAT TELEHEALTH SHOULD

2139
01:18:13,176 --> 01:18:21,818
BE TAILORED TO MEET THE GOALS OF

2140
01:18:21,818 --> 01:18:22,685
ALL SETTINGS, AND KEEP

2141
01:18:22,685 --> 01:18:23,085
INTEROPERABILITY.

2142
01:18:23,085 --> 01:18:24,587
AND WHAT IS THE OPPORTUNITY TO

2143
01:18:24,587 --> 01:18:25,855
INTEGRATE RESEARCH INTO THE

2144
01:18:25,855 --> 01:18:27,723
DESIGN OF TELEHEALTH?

2145
01:18:27,723 --> 01:18:31,861
AND WHAT SHOULD WE CONSIDER AS

2146
01:18:31,861 --> 01:18:32,862
WE INTENTIONALLY INTEGRATE A

2147
01:18:32,862 --> 01:18:34,597
DESIGN FEATURE IN THE

2148
01:18:34,597 --> 01:18:36,899
IMPLEMENTATION OF TELEHEALTH AND

2149
01:18:36,899 --> 01:18:38,100
WHAT ARE THE CHALLENGES RELATED

2150
01:18:38,100 --> 01:18:39,302
TO THAT?

2151
01:18:39,302 --> 01:18:40,770
YOU GOT INTO THIS, JUDD, A

2152
01:18:40,770 --> 01:18:43,473
LITTLE BIT BUT I WANTED TO OPEN

2153
01:18:43,473 --> 01:18:46,309
TO THE ENTIRE PANEL.

2154
01:18:46,309 --> 01:18:49,278
>> ONE THING I WOULD JUST
-- IN

2155
01:18:49,278 --> 01:18:50,046
TERMS OF IMPLEMENTATION SIDE,

2156
01:18:50,046 --> 01:18:51,914
BUILDING ON THE QUESTION, WE'VE

2157
01:18:51,914 --> 01:18:53,449
DONE WORK REMOTE PATIENT

2158
01:18:53,449 --> 01:18:56,385
MONITORING FOR HIGH BLOOD

2159
01:18:56,385 --> 01:18:56,652
PRESSURE.

2160
01:18:56,652 --> 01:18:58,588
THE QUESTION WAS WHAT ARE THINGS

2161
01:18:58,588 --> 01:18:59,789
YOU GET EXCITED ABOUT, THAT'S

2162
01:18:59,789 --> 01:18:59,956
ONE.

2163
01:18:59,956 --> 01:19:03,259
I THINK IT'S A REALLY GOOD

2164
01:19:03,259 --> 01:19:04,293
MODEL, BETTER MODEL MANAGING

2165
01:19:04,293 --> 01:19:05,261
HIGH BLOOD PRESSURE.

2166
01:19:05,261 --> 01:19:09,131
BUT I THINK WHEN I SAY THAT, I

2167
01:19:09,131 --> 01:19:11,200
HAVE TREPIDATION BECAUSE WHEN

2168
01:19:11,200 --> 01:19:13,936
YOU GO AND TALK AND SAY, HOW DO

2169
01:19:13,936 --> 01:19:15,338
YOU ACTUALLY DO THIS, LIKE WHO

2170
01:19:15,338 --> 01:19:18,274
THE HECK IS ACTUALLY GETTING THE

2171
01:19:18,274 --> 01:19:20,276
BLOOD PRESSURE MEASUREMENT, WHO

2172
01:19:20,276 --> 01:19:21,577
REACTS TO THAT INFORMATION, WHAT

2173
01:19:21,577 --> 01:19:22,578
HAPPENS IF IT'S REALLY HIGH

2174
01:19:22,578 --> 01:19:24,413
BLOOD PRESSURE IN THE MIDDLE OF

2175
01:19:24,413 --> 01:19:26,315
THE NIGHT, WHO RESPONDS?

2176
01:19:26,315 --> 01:19:28,251
OH MY GOSH, THERE'S SO MUCH

2177
01:19:28,251 --> 01:19:28,518
VARIATION.

2178
01:19:28,518 --> 01:19:31,320
AND SO WE THINK ABOUT

2179
01:19:31,320 --> 01:19:32,388
IMPLEMENTATION SCIENCE RESEARCH,

2180
01:19:32,388 --> 01:19:35,458
THESE ARE THE KINDS OF

2181
01:19:35,458 --> 01:19:35,892
QUESTIONS.

2182
01:19:35,892 --> 01:19:37,226
THEY SOUND BORING BUT THEY ARE

2183
01:19:37,226 --> 01:19:37,760
REALLY IMPORTANT, OF

2184
01:19:37,760 --> 01:19:41,030
UNDERSTANDING WHAT IS THE

2185
01:19:41,030 --> 01:19:42,231
NUANCES, HOW DO YOU IMPLEMENT

2186
01:19:42,231 --> 01:19:44,534
SUCH A PROGRAM BECAUSE SMALL

2187
01:19:44,534 --> 01:19:45,868
CHANGES CAN MAKE BIG DIFFERENCE

2188
01:19:45,868 --> 01:19:48,170
IN IMPACT OF HIGH BLOOD

2189
01:19:48,170 --> 01:19:48,738
PRESSURE.

2190
01:19:48,738 --> 01:19:50,907
SO -- AND OUTCOMES WE LOOK AT.

2191
01:19:50,907 --> 01:19:54,510
SO, THAT WAS JUST ONE ASPECT OF

2192
01:19:54,510 --> 01:19:54,710
THAT.

2193
01:19:54,710 --> 01:19:59,348
ANOTHER THING THAT I WANTED TO

2194
01:19:59,348 --> 01:20:01,217
EMPHASIZE THE QUESTION MADE ME

2195
01:20:01,217 --> 01:20:02,852
THINK ABOUT WAS JUDD MADE THE

2196
01:20:02,852 --> 01:20:04,253
POINT ABOUT REMOTE PATIENT

2197
01:20:04,253 --> 01:20:05,354
MONITORING, YOU CAN JUST SORT OF

2198
01:20:05,354 --> 01:20:06,122
DO IT.

2199
01:20:06,122 --> 01:20:07,456
IT DRIVES ME CRAZY THAT YOU CAN

2200
01:20:07,456 --> 01:20:09,659
JUST DO SOMETHING LIKE THAT AS

2201
01:20:09,659 --> 01:20:13,930
OPPOSED TO A NEW MOLECULE. 

2202
01:20:13,930 --> 01:20:15,698
THE TITLE OF THIS OVERALL THING

2203
01:20:15,698 --> 01:20:17,733
IS DIRECT TO CONSUMER.

2204
01:20:17,733 --> 01:20:19,402
ONE THING WE'VE NEGLECTED HERE A

2205
01:20:19,402 --> 01:20:21,804
BIT IS THAT BEYOND -- WE'VE BEEN

2206
01:20:21,804 --> 01:20:23,439
HEALTH SYSTEM FOCUSED GIVEN THE

2207
01:20:23,439 --> 01:20:26,509
NATURE OF THE PANEL OF WHAT'S

2208
01:20:26,509 --> 01:20:30,913
HAPPENED AT JEFFERSON, UPMC.

2209
01:20:30,913 --> 01:20:33,449
BUT THERE ARE HUNDREDS AND

2210
01:20:33,449 --> 01:20:35,751
HUNDREDS OF START-UPS OUT THERE

2211
01:20:35,751 --> 01:20:37,687
THAT DO A TELEMEDICINE-ONLY

2212
01:20:37,687 --> 01:20:38,921
MODEL, NOT WHAT FERNANDO WAS

2213
01:20:38,921 --> 01:20:40,423
TALKING ABOUT HYBRID OR ADJUNCT,

2214
01:20:40,423 --> 01:20:41,591
THIS IS A TELEMEDICINE-ONLY

2215
01:20:41,591 --> 01:20:43,292
MODEL.

2216
01:20:43,292 --> 01:20:46,028
AND THEY ARE PROVIDING CARE TO

2217
01:20:46,028 --> 01:20:46,729
PROBABLY MILLIONS OF PATIENTS,

2218
01:20:46,729 --> 01:20:48,331
AMERICANS IN THE UNITED STATES,

2219
01:20:48,331 --> 01:20:50,399
AND WE DON'T KNOW, WE DO NOT

2220
01:20:50,399 --> 01:20:55,538
HAVE GOOD DATA ON WHETHER THEIR

2221
01:20:55,538 --> 01:20:56,572
PARTICULAR MODEL IS HELPFUL, HOW

2222
01:20:56,572 --> 01:20:58,774
DOES IT BUILT WITH EXISTING

2223
01:20:58,774 --> 01:21:00,576
HEALTHCARE SYSTEM, WHICH ARE

2224
01:21:00,576 --> 01:21:01,577
WORKING AND NOT WORKING.

2225
01:21:01,577 --> 01:21:03,346
WE SHOULD NOT HAVE AN

2226
01:21:03,346 --> 01:21:04,780
EXPECTATION THE STARTUPS WILL

2227
01:21:04,780 --> 01:21:06,482
EVALUATE THEMSELVES.

2228
01:21:06,482 --> 01:21:07,850
THEY DON'T HAVE INCENTIVE, THEY

2229
01:21:07,850 --> 01:21:08,484
DON'T HAVE TO.

2230
01:21:08,484 --> 01:21:10,119
SO THIS IS ANOTHER AREA OF

2231
01:21:10,119 --> 01:21:12,521
RESEARCH THAT I'M REALLY

2232
01:21:12,521 --> 01:21:13,823
THINKING ABOUT WHICH IS WE MAY

2233
01:21:13,823 --> 01:21:16,025
LIKE 'EM, WE MAY NOT LIKE 'EM,

2234
01:21:16,025 --> 01:21:17,159
BUT WE NEED TO UNDERSTAND WHAT

2235
01:21:17,159 --> 01:21:19,128
IMPACT THEY ARE HAVING.

2236
01:21:19,128 --> 01:21:21,864
SO WANTED TO THROW OUT ANOTHER

2237
01:21:21,864 --> 01:21:22,932
AREA AND THINKING ABOUT WHAT

2238
01:21:22,932 --> 01:21:25,668
ROLE THEY HAVE IN THE OVERALL

2239
01:21:25,668 --> 01:21:28,537
CARE THAT PATIENTS ARE

2240
01:21:28,537 --> 01:21:30,072
RECEIVING.

2241
01:21:30,072 --> 01:21:32,141
>> AND THE IMPLEMENTATION

2242
01:21:32,141 --> 01:21:36,212
SCIENCE OPPORTUNITY AS WELL. 

2243
01:21:36,212 --> 01:21:37,947
I'LL MOVE TO ANOTHER QUESTION

2244
01:21:37,947 --> 01:21:39,815
THAT IS VERY INTERESTING TO ME

2245
01:21:39,815 --> 01:21:42,118
AS WE THINK ABOUT OTHER

2246
01:21:42,118 --> 01:21:45,755
PROVIDERS, WE'VE BEEN TALKING

2247
01:21:45,755 --> 01:21:48,257
ABOUT PHYSICIANS, WHAT ABOUT THE

2248
01:21:48,257 --> 01:21:50,292
ADVANCED PRACTICE PROFESSIONALS,

2249
01:21:50,292 --> 01:21:51,661
NURSES, SOCIAL WORKERS, OTHER

2250
01:21:51,661 --> 01:21:54,930
MEMBERS OF THE CARE TEAM, AND

2251
01:21:54,930 --> 01:21:58,634
WHAT IS YOUR EXPERIENCE WITH THE

2252
01:21:58,634 --> 01:22:00,736
UPTAKE AND INTEREST AND

2253
01:22:00,736 --> 01:22:02,805
ENGAGEMENT IN TELEHEALTH

2254
01:22:02,805 --> 01:22:04,674
MODALITIES, AND THESE -- AMONG

2255
01:22:04,674 --> 01:22:06,542
THESE TEAM MEMBERS?

2256
01:22:06,542 --> 01:22:07,543
>> SO I HAVE PRETTY GOOD

2257
01:22:07,543 --> 01:22:08,844
EXPERIENCE WITH THAT.

2258
01:22:08,844 --> 01:22:09,545
I DON'T HAVE IMPLEMENTATION

2259
01:22:09,545 --> 01:22:11,681
SCIENCE ON IT BUT I DO HAVE

2260
01:22:11,681 --> 01:22:12,782
PATIENT SATISFACTION SCORES.

2261
01:22:12,782 --> 01:22:14,750
AND IT TURNS OUT WHEN WE FIRST

2262
01:22:14,750 --> 01:22:17,153
LAUNCHED OUR PROGRAM TEN YEARS

2263
01:22:17,153 --> 01:22:18,454
AGO, WE ACTUALLY WERE, YOU KNOW,

2264
01:22:18,454 --> 01:22:19,889
PROBABLY A LITTLE ARROGANT FOR

2265
01:22:19,889 --> 01:22:21,190
AN ACADEMIC HEALTH SYSTEM AND

2266
01:22:21,190 --> 01:22:22,291
THOUGHT EVERYBODY'S GOING TO

2267
01:22:22,291 --> 01:22:24,493
WANT TO SEE AN E.R. DOC WHO IS

2268
01:22:24,493 --> 01:22:25,695
WELL VERSED FROM AN ACADEMIC

2269
01:22:25,695 --> 01:22:26,128
MEDICAL CENTER.

2270
01:22:26,128 --> 01:22:27,663
UNTIL ONE OF OUR EARLY SURVEYS

2271
01:22:27,663 --> 01:22:30,933
WAS HOW MUCH DO YOU CARE IFS AN

2272
01:22:30,933 --> 01:22:33,569
E.R., PRIMARY CARE DOC OR NURSE

2273
01:22:33,569 --> 01:22:35,004
PRACTITIONER, WE ONLY CARE IF

2274
01:22:35,004 --> 01:22:37,506
SOMEBODY ANSWERS THE VIDEO RIGHT

2275
01:22:37,506 --> 01:22:37,873
AWAY.

2276
01:22:37,873 --> 01:22:38,808
WHAT'S THE IMPORTANCE OF

2277
01:22:38,808 --> 01:22:42,078
SOMEBODY ACADEMIC OR NOT, THE

2278
01:22:42,078 --> 01:22:43,412
IMPORTANCE WAS LIKE NOTHING.

2279
01:22:43,412 --> 01:22:45,347
AND SO WE LEARNED, OKAY, WE'RE

2280
01:22:45,347 --> 01:22:49,985
SPENDING A LOT OF MONEY ON E.R.

2281
01:22:49,985 --> 01:22:53,923
DOCS 24/7, MOST COMPLAINTS ARE

2282
01:22:53,923 --> 01:22:55,024
HANDLED BY NURSE PRACTITIONERS

2283
01:22:55,024 --> 01:22:59,962
ACROSS THE COUNTRY.

2284
01:22:59,962 --> 01:23:00,863
WE STARTED TRANSITIONING,

2285
01:23:00,863 --> 01:23:02,932
PATIENT SATISFACTION SCORES, WE

2286
01:23:02,932 --> 01:23:03,666
HAVE METRICS, ARE BASICALLY THE

2287
01:23:03,666 --> 01:23:05,000
SAME BETWEEN THE TWO GROUPS WITH

2288
01:23:05,000 --> 01:23:06,102
THE EXCEPTION OF COST.

2289
01:23:06,102 --> 01:23:08,437
SO I THINK IT'S REALLY IMPORTANT

2290
01:23:08,437 --> 01:23:12,007
TO EXTEND IT TO NON-PHYSICIANS.

2291
01:23:12,007 --> 01:23:14,944
WE HAVE RECENTLY LAUNCHED

2292
01:23:14,944 --> 01:23:17,513
INPATIENT TELEMEDICINE, LARGELY

2293
01:23:17,513 --> 01:23:18,514
WITH VIRTUAL NURSING AND

2294
01:23:18,514 --> 01:23:21,150
TELESITTING, WE'VE HAD THAT FOR

2295
01:23:21,150 --> 01:23:21,684
A WHILE.

2296
01:23:21,684 --> 01:23:23,452
AND THIS IS REALLY IMPORTANT

2297
01:23:23,452 --> 01:23:26,388
WHEN YOU EVALUATE IT BECAUSE

2298
01:23:26,388 --> 01:23:30,025
THERE'S GOOD ROI MODELS FOR HARD

2299
01:23:30,025 --> 01:23:32,094
AND SOFT RELATED TO NURSING, WE

2300
01:23:32,094 --> 01:23:36,065
THINT  -- DIDN'T SHOW THEM IN TE

2301
01:23:36,065 --> 01:23:37,700
PILOT PHASE BECAUSE EVERYBODY

2302
01:23:37,700 --> 01:23:39,535
WITH EXPERIENCE DOING VIRTUAL

2303
01:23:39,535 --> 01:23:40,736
NURSING SAID NURSES HAVE TO BE

2304
01:23:40,736 --> 01:23:43,038
OFF SITE AND NOT TIED, BEING

2305
01:23:43,038 --> 01:23:44,807
ABLE TO PULL TO THE UNIT.

2306
01:23:44,807 --> 01:23:46,876
WE THOUGHT, WELL, WHAT A GREAT

2307
01:23:46,876 --> 01:23:49,278
WAY TO BEGIN, IF NURSES KNOW THE

2308
01:23:49,278 --> 01:23:50,279
VIRTUAL NURSES, THEY WILL BE

2309
01:23:50,279 --> 01:23:50,946
MORE COMFORTABLE.

2310
01:23:50,946 --> 01:23:52,081
YOU KNOW WHAT THEY ARE?

2311
01:23:52,081 --> 01:23:53,949
HALF THE TIME PULLED BACK TO THE

2312
01:23:53,949 --> 01:23:55,684
UNIT BECAUSE SOMEBODY'S OUT

2313
01:23:55,684 --> 01:23:56,118
SICK.

2314
01:23:56,118 --> 01:23:58,420
AND SO VIRTUAL NURSE PROGRAM IS

2315
01:23:58,420 --> 01:24:00,689
AT RISK BECAUSE OUR INITIAL

2316
01:24:00,689 --> 01:24:02,958
ASSESSMENT WAS FLAWED BY THE WAY

2317
01:24:02,958 --> 01:24:03,626
WE IMPLEMENTED IT.

2318
01:24:03,626 --> 01:24:06,562
AND SO WE HAVE NOW DECIDED THAT

2319
01:24:06,562 --> 01:24:07,463
YES, YOU'RE RIGHT, IF WE'RE

2320
01:24:07,463 --> 01:24:08,998
GOING TO CONTINUE DOING IT THIS

2321
01:24:08,998 --> 01:24:10,566
WAY SHOULD GIVE UP THE PROGRAM.

2322
01:24:10,566 --> 01:24:12,034
BUT WE PROBABLY SHOULD HAVE DONE

2323
01:24:12,034 --> 01:24:13,369
IT THE WAY EVERYBODY IN THE

2324
01:24:13,369 --> 01:24:14,570
WORLD RECOMMENDED FROM THE

2325
01:24:14,570 --> 01:24:16,338
BEGINNING, RATHER THAN THINKING

2326
01:24:16,338 --> 01:24:18,174
WE'RE SMARTER THAN THEM.

2327
01:24:18,174 --> 01:24:21,110
AND SO I THINK THAT'S TRUE

2328
01:24:21,110 --> 01:24:23,345
IMPLEMENTATION SCIENCE, RIGHT? 

2329
01:24:23,345 --> 01:24:25,181
IF YOU DID A RANDOMIZED

2330
01:24:25,181 --> 01:24:26,182
CONTROLLED TRIAL HOW TO

2331
01:24:26,182 --> 01:24:27,149
IMPLEMENT IT MIGHT HAVE SAVED

2332
01:24:27,149 --> 01:24:30,586
THE TROUBLE OF DOING WHAT WE

2333
01:24:30,586 --> 01:24:31,854
DID.

2334
01:24:31,854 --> 01:24:32,154
>> GREAT.

2335
01:24:32,154 --> 01:24:34,156
KRISTIN, YOU HAVE EXPERIENCE

2336
01:24:34,156 --> 01:24:36,959
WITH ALLOWED HEALTH

2337
01:24:36,959 --> 01:24:37,526
PROFESSIONALS, PARTICULARLY

2338
01:24:37,526 --> 01:24:38,160
AROUND TELELACTATION, BUT

2339
01:24:38,160 --> 01:24:39,328
ANYTHING YOU WANT TO COMMENT ON?

2340
01:24:39,328 --> 01:24:41,831
>> I CAN SPEAK TO BOTH OF
THOSE.

2341
01:24:41,831 --> 01:24:45,734
FIRST IN THE CLINICAL SETTING,

2342
01:24:45,734 --> 01:24:47,870
PRIMARY CARE WHERE I PRACTICE WE

2343
01:24:47,870 --> 01:24:48,704
HAVE TEAM-BASED CARE, WORKING

2344
01:24:48,704 --> 01:24:51,907
SIDE BY SIDE WITH PHYSICIANS AND

2345
01:24:51,907 --> 01:24:53,209
NURSE PRACTITIONERS AND PAS,

2346
01:24:53,209 --> 01:24:56,378
SOCIAL WORKERS IN PERSON.

2347
01:24:56,378 --> 01:24:57,913
WE FOUND THE SAME CLINICIANS,

2348
01:24:57,913 --> 01:25:01,083
EVERYONE IS HAPPY TO MEET OUR

2349
01:25:01,083 --> 01:25:03,052
PATIENTS' NEEDS AND ENGAGE

2350
01:25:03,052 --> 01:25:03,953
VIRTUALLY.

2351
01:25:03,953 --> 01:25:06,989
I THINK THAT MORE IMPORTANT THAN

2352
01:25:06,989 --> 01:25:09,859
THE DEGREE ON THE CLINICIAN SIDE

2353
01:25:09,859 --> 01:25:13,028
IS I THINK TELEHEALTH CAN BE

2354
01:25:13,028 --> 01:25:15,431
TRICKY AND ONE NEEDS TO BE

2355
01:25:15,431 --> 01:25:17,066
TRAINED AND COMFORTABLE WITH THE

2356
01:25:17,066 --> 01:25:21,770
UNCERTAINTY THAT COMES WITH NOT

2357
01:25:21,770 --> 01:25:25,407
HAVING THE PATIENT IN THE ROOM.

2358
01:25:25,407 --> 01:25:27,610
I THINK EXPERIENCE DOES MATTER,

2359
01:25:27,610 --> 01:25:28,310
EXPERIENCE OR TRAINING, OR

2360
01:25:28,310 --> 01:25:31,313
GETTING PEOPLE TO THE LEVEL

2361
01:25:31,313 --> 01:25:34,183
WHERE THEY FEEL YESTERDAY TO

2362
01:25:34,183 --> 01:25:35,584
MAKE THESE DIAGNOSIS AND DECIDE

2363
01:25:35,584 --> 01:25:37,219
WHEN THEY NEED TO ESCALATE CARE

2364
01:25:37,219 --> 01:25:41,624
BRINGING A PATIENT IN, IN

2365
01:25:41,624 --> 01:25:41,857
PERSON.

2366
01:25:41,857 --> 01:25:47,963
MORE THAN DEGREES THAT IS

2367
01:25:47,963 --> 01:25:48,731
IMPORTANT.

2368
01:25:48,731 --> 01:25:50,366
GOING BACK TO PROVIDING CARE

2369
01:25:50,366 --> 01:25:51,267
IMPORTANT FOR THAT CONDITION, IF

2370
01:25:51,267 --> 01:25:53,535
YOU WERE IN PERSON OR VIRTUALLY

2371
01:25:53,535 --> 01:25:55,304
DOING THE SAME SORT OF MANEUVERS

2372
01:25:55,304 --> 01:25:59,575
THAT ARE NECESSARY FOR THAT

2373
01:25:59,575 --> 01:26:01,410
DIAGNOSIS, I THINK SIMILARLY IF

2374
01:26:01,410 --> 01:26:02,645
SOMEONE IS NOT COMFORTABLE

2375
01:26:02,645 --> 01:26:05,381
CARING FOR THIS AGE GROUP OR

2376
01:26:05,381 --> 01:26:07,449
THIS CONDITION, IN PERSON, THEN

2377
01:26:07,449 --> 01:26:09,084
THEY MAYBE SHOULD ALSO PASS ON

2378
01:26:09,084 --> 01:26:11,820
THAT TELEHEALTH PATIENT.

2379
01:26:11,820 --> 01:26:16,692
SO I THINK IT'S THAT IN-PERSON

2380
01:26:16,692 --> 01:26:18,193
STANDARD APPLIES AND I THINK

2381
01:26:18,193 --> 01:26:20,796
EXPERIENCE MATTERS IN WHAT I'VE

2382
01:26:20,796 --> 01:26:23,198
SEEN BUT WE CAN ALSO TRAIN

2383
01:26:23,198 --> 01:26:25,634
PEOPLE AS DR. HOLLANDER HAS VAST

2384
01:26:25,634 --> 01:26:26,302
EXPERIENCE IN.

2385
01:26:26,302 --> 01:26:28,270
THE OTHER PIECE ABOUT OTHER

2386
01:26:28,270 --> 01:26:31,206
PROVIDERS, ON OUR SOCIAL WORK

2387
01:26:31,206 --> 01:26:32,641
AND CARE COORDINATOR SIDE, THE

2388
01:26:32,641 --> 01:26:35,144
BILLING MODEL IS NOT THERE

2389
01:26:35,144 --> 01:26:41,617
DEPENDENTING ON PAYMENT

2390
01:26:41,617 --> 01:26:43,919
STRUCTURE. 

2391
01:26:43,919 --> 01:26:46,322
ON THE TELELACTATION SIDE, DR.

2392
01:26:46,322 --> 01:26:50,359
MEHOTRA  WAS PART OF THIS, WE

2393
01:26:50,359 --> 01:26:51,794
LOOKED AT RANDOMIZING PATIENTS

2394
01:26:51,794 --> 01:26:55,764
TO HAVING ACCESS TO

2395
01:26:55,764 --> 01:26:57,599
TELELACTATION SERVICES.

2396
01:26:57,599 --> 01:27:00,769
AND HAVE FOUND PARENTS ARE --

2397
01:27:00,769 --> 01:27:02,104
NURSING PEOPLE ARE HAPPY TO

2398
01:27:02,104 --> 01:27:03,739
CONNECT AND RECEIVE SERVICES,

2399
01:27:03,739 --> 01:27:05,374
NOT EVERYONE USES IT WHICH MAKES

2400
01:27:05,374 --> 01:27:08,344
SENSE BECAUSE NOT EVERYONE HAS A

2401
01:27:08,344 --> 01:27:10,212
NEED FOR LACTATION CONSULTANT,

2402
01:27:10,212 --> 01:27:11,947
AND MANY PEOPLE CAN RECEIVE

2403
01:27:11,947 --> 01:27:13,148
ACCESS IN PERSON.

2404
01:27:13,148 --> 01:27:15,751
SO, WE'RE FINDING AS AN

2405
01:27:15,751 --> 01:27:19,855
AUGMENTED OPTION IT IS SOMETHING

2406
01:27:19,855 --> 01:27:22,024
THAT CAN BE USEFUL FOR NURSING

2407
01:27:22,024 --> 01:27:23,325
PEOPLE AND LACTATION CONSULTANTS

2408
01:27:23,325 --> 01:27:24,526
IN GENERAL FEEL LIKE THEY CAN

2409
01:27:24,526 --> 01:27:26,595
PROVIDE THE CARE THAT THEY NEED

2410
01:27:26,595 --> 01:27:31,367
TO BE ABLE TO PROVIDE.

2411
01:27:31,367 --> 01:27:33,068
>> A NUMBER OF THINGS YOU

2412
01:27:33,068 --> 01:27:36,038
HIGHLIGHTED AROUND THE NEED FOR

2413
01:27:36,038 --> 01:27:38,073
TRAINING AND HOW THAT IS

2414
01:27:38,073 --> 01:27:41,276
DIFFERENT WHEN WE'RE TALKING

2415
01:27:41,276 --> 01:27:43,579
ABOUT TELEHEALTH PERHAPS, AND

2416
01:27:43,579 --> 01:27:46,181
THE NEED FOR POTENTIALLY THE

2417
01:27:46,181 --> 01:27:47,616
LIMITATION AND NUANCE AROUND

2418
01:27:47,616 --> 01:27:49,251
SUPERVISION IN THIS MODALITY

2419
01:27:49,251 --> 01:27:51,086
VERSUS IN PERSON THAT PRESENTS A

2420
01:27:51,086 --> 01:27:52,187
CHALLENGE AND PARTICULARLY

2421
01:27:52,187 --> 01:27:53,088
AROUND BILLING AND PAYMENT WHICH

2422
01:27:53,088 --> 01:27:54,923
THERE IS A QUESTION FROM THE

2423
01:27:54,923 --> 01:27:57,359
PANEL RELATED TO THAT SO I'D

2424
01:27:57,359 --> 01:28:00,295
LIKE TO GET TO THAT.

2425
01:28:00,295 --> 01:28:03,799
BEFORE THAT, ATEEV, DID YOU HAVE

2426
01:28:03,799 --> 01:28:04,900
A COMMENT?

2427
01:28:04,900 --> 01:28:05,768
>> THE QUESTIONER DIDN'T
HAVE

2428
01:28:05,768 --> 01:28:07,169
THIS INTENT BUT IT HIT A PET

2429
01:28:07,169 --> 01:28:07,870
PEEVE OF MINE.

2430
01:28:07,870 --> 01:28:09,271
I HAD TO GET IT OUT.

2431
01:28:09,271 --> 01:28:12,341
I'LL PUT IT OUT, WHICH IS

2432
01:28:12,341 --> 01:28:14,610
THERE'S STILL THIS ONGOING

2433
01:28:14,610 --> 01:28:16,178
CONVERSATION ABOUT

2434
01:28:16,178 --> 01:28:17,179
NON-PHYSICIANS AND PHYSICIANS,

2435
01:28:17,179 --> 01:28:18,580
AND REALITY IS THAT RIGHT NOW IN

2436
01:28:18,580 --> 01:28:20,449
THE UNITED STATES A QUARTER OF

2437
01:28:20,449 --> 01:28:23,719
ALL VISITS ARE PROVIDED BY

2438
01:28:23,719 --> 01:28:24,086
NON-PHYSICIANS.

2439
01:28:24,086 --> 01:28:26,488
AND THAT RATE IS GROWING REALLY

2440
01:28:26,488 --> 01:28:28,891
RAPIDLY, IN THE NEXT 10 TO 20

2441
01:28:28,891 --> 01:28:30,626
YEARS MY SENSES LOOKING AT

2442
01:28:30,626 --> 01:28:31,827
WORKFORCE NUMBERS MAJORITY OF

2443
01:28:31,827 --> 01:28:33,162
OUTPATIENT VISITS WILL BE

2444
01:28:33,162 --> 01:28:33,996
PROVIDED BY NON-PHYSICIANS.

2445
01:28:33,996 --> 01:28:34,930
WE'RE ALREADY SEEING THAT IN

2446
01:28:34,930 --> 01:28:36,732
MANY RURAL COMMUNITIES IN THE

2447
01:28:36,732 --> 01:28:37,066
UNITED STATES.

2448
01:28:37,066 --> 01:28:40,035
SO THIS IS THE REALITY.

2449
01:28:40,035 --> 01:28:42,304
I DON'T THINK THERE'S THAT MUCH

2450
01:28:42,304 --> 01:28:44,406
OF A DIFFERENCE IN TERMS OF

2451
01:28:44,406 --> 01:28:45,941
TELEHEALTH AND I THINK WE JUST

2452
01:28:45,941 --> 01:28:50,079
HAVE TO THINK ABOUT THESE

2453
01:28:50,079 --> 01:28:52,714
TEAM-BASED MODELS AS KRISTIN

2454
01:28:52,714 --> 01:28:52,981
DESCRIBED.

2455
01:28:52,981 --> 01:28:54,383
THERE ARE SOME QUESTIONS WHAT

2456
01:28:54,383 --> 01:28:55,551
THE OPTIMAL STRUCTURE OF THOSE

2457
01:28:55,551 --> 01:28:57,853
TEAMS IS BUT IT'S GOING TO BE

2458
01:28:57,853 --> 01:29:00,722
TEAMS AND I REALLY GET THE PET

2459
01:29:00,722 --> 01:29:02,591
PEEVE WAS THE SORT OF THINKING

2460
01:29:02,591 --> 01:29:05,994
ABOUT A CAGE PHYSICIAN IN ONE

2461
01:29:05,994 --> 01:29:08,197
CORNER, PHYSICIAN IN ONE CORNER,

2462
01:29:08,197 --> 01:29:09,598
NURSE PRACTITIONER IN THE OTHER

2463
01:29:09,598 --> 01:29:10,365
AND I GET FRUSTRATED BECAUSE

2464
01:29:10,365 --> 01:29:12,134
IT'S GOING TO BE A TEAM-BASED

2465
01:29:12,134 --> 01:29:16,705
CARE AND IT'S ALREADY HAPPENING.

2466
01:29:16,705 --> 01:29:19,141
  

2467
01:29:19,141 --> 01:29:20,542
>> THAT RELATES TO NEXT

2468
01:29:20,542 --> 01:29:25,581
QUESTION, DRIVERS OF TELEHEALTH

2469
01:29:25,581 --> 01:29:26,615
IMPLEMENTATION, I WOULD ASK

2470
01:29:26,615 --> 01:29:31,620
INCLUDING LET'S SAY PHYSICAL

2471
01:29:31,620 --> 01:29:33,589
THERAPISTS OR OTHER SPECIALTIES,

2472
01:29:33,589 --> 01:29:34,990
DISCIPLINES WHERE REIMBURSEMENT

2473
01:29:34,990 --> 01:29:37,392
AND PAY PARITY ARE NOT ENTIRE IN

2474
01:29:37,392 --> 01:29:38,994
PLACE IS MY UNDERSTANDING.

2475
01:29:38,994 --> 01:29:41,230
BUT PLEASE CORRECT ME IF THAT'S

2476
01:29:41,230 --> 01:29:41,663
NOT CORRECT.

2477
01:29:41,663 --> 01:29:45,501
AND SO THE QUESTION IS, IS

2478
01:29:45,501 --> 01:29:53,041
INSURANCE PAYMENT DICTATING THE

2479
01:29:53,041 --> 01:29:57,012
EXPANSION OF TELEMEDICINE NOW?

2480
01:29:57,012 --> 01:29:57,546
>> YES.

2481
01:29:57,546 --> 01:29:59,948
I MEAN, MY SENSE -- GO AHEAD,

2482
01:29:59,948 --> 01:30:00,382
KRISTIN.

2483
01:30:00,382 --> 01:30:02,684
>> I WANT TO NAME ONE
CHANGE

2484
01:30:02,684 --> 01:30:04,319
THAT WAS HUGE AND CONTINUES TO

2485
01:30:04,319 --> 01:30:05,754
BE HUGE FOR PRIMARY CARE TO

2486
01:30:05,754 --> 01:30:08,924
CONTINUE TO BE ABLE TO OFFER

2487
01:30:08,924 --> 01:30:09,224
TELEHEALTH.

2488
01:30:09,224 --> 01:30:11,693
AND THAT'S THE -- YOU KNOW,

2489
01:30:11,693 --> 01:30:13,629
MULTIPLE CHANGES HAPPENED WITH

2490
01:30:13,629 --> 01:30:16,031
PANDEMIC BUT ABILITY FOR PRIMARY

2491
01:30:16,031 --> 01:30:19,868
CARE PROVIDERS TO BILL MEDICAID

2492
01:30:19,868 --> 01:30:20,869
AND MEDICARE AND COMMERCIAL

2493
01:30:20,869 --> 01:30:23,372
INSURERS WHEN THE PATIENT IS AT

2494
01:30:23,372 --> 01:30:25,874
HOME WITHOUT RURAL LIMITATIONS

2495
01:30:25,874 --> 01:30:27,976
OR TRANSPORTATION BARRIERS IS

2496
01:30:27,976 --> 01:30:29,711
HUGE, ESPECIALLY IF SOMEONE

2497
01:30:29,711 --> 01:30:31,680
PRACTICES IN URBAN AREA WHERE

2498
01:30:31,680 --> 01:30:34,216
PATIENTS ARE GEOGRAPHICALLY

2499
01:30:34,216 --> 01:30:35,083
CLOSE BUT TEMPORALLY IT TAKES A

2500
01:30:35,083 --> 01:30:37,252
LONG TIME TO GET TO MY CLINIC SO

2501
01:30:37,252 --> 01:30:41,757
MAKING SURE WE PRESERVE THE

2502
01:30:41,757 --> 01:30:44,726
OPPORTUNITY FOR PEOPLE, I THINK

2503
01:30:44,726 --> 01:30:46,161
THAT THIS IS INCREASINGLY

2504
01:30:46,161 --> 01:30:47,863
SEEMING LIKE IT'S BECOMING BAKED

2505
01:30:47,863 --> 01:30:52,501
IN BUT I WANT TO NAME THAT'S SO

2506
01:30:52,501 --> 01:30:55,904
IMPORTANT, AND I THINK ONE THING

2507
01:30:55,904 --> 01:30:58,974
THAT CONTINUES TO -- THERE ARE

2508
01:30:58,974 --> 01:31:01,343
ADDITIONAL POLICY AND PAYMENT

2509
01:31:01,343 --> 01:31:02,344
ISSUES THAT ARE IMPORTANT AND

2510
01:31:02,344 --> 01:31:03,779
EVOLVING, I CAN LET OTHER PEOPLE

2511
01:31:03,779 --> 01:31:05,948
SPEAK TO THOSE BUT ALSO

2512
01:31:05,948 --> 01:31:06,982
UNCERTAINTY HOW WE GET

2513
01:31:06,982 --> 01:31:09,251
EXTENSIONS FOR A PERIOD OF TIME

2514
01:31:09,251 --> 01:31:11,553
SHIFTS HOW PEOPLE FEEL ABOUT

2515
01:31:11,553 --> 01:31:12,988
REALLY THINKING RESOURCES AND

2516
01:31:12,988 --> 01:31:14,957
SCHEDULES AND WORKFLOWS INTO

2517
01:31:14,957 --> 01:31:16,391
MORE TELEHEALTH SPACES.

2518
01:31:16,391 --> 01:31:19,561
SO THOSE ARE SOME FACTORS THAT

2519
01:31:19,561 --> 01:31:21,630
AS THEY EVOLVE OFFER

2520
01:31:21,630 --> 01:31:23,065
OPPORTUNITIES TO STUDY WHAT'S

2521
01:31:23,065 --> 01:31:24,600
THE IMPACT WHEN THESE CHANGES

2522
01:31:24,600 --> 01:31:26,768
HAPPEN, IF THEY ARE STATE

2523
01:31:26,768 --> 01:31:28,003
DEPENDENT, PLAN DEPENDENT, WE

2524
01:31:28,003 --> 01:31:31,740
CAN LEARN FROM NATURAL VARIATION

2525
01:31:31,740 --> 01:31:33,642
HAPPENING AS DIFFERENT PAYERS

2526
01:31:33,642 --> 01:31:36,478
AND STATES MAKE DIFFERENT

2527
01:31:36,478 --> 01:31:37,012
CHANGES.

2528
01:31:37,012 --> 01:31:38,747
>> NOW YOU HIT MY PET
PEEVE.

2529
01:31:38,747 --> 01:31:40,282
I AGREE WITH EVERYTHING YOU

2530
01:31:40,282 --> 01:31:40,482
SAID.

2531
01:31:40,482 --> 01:31:42,184
KICKING THE CAN DOWN THE ROAD IS

2532
01:31:42,184 --> 01:31:44,486
A KILLER, I WILL SAY.

2533
01:31:44,486 --> 01:31:46,121
LIKE I CAN'T TELL YOU THE NUMBER

2534
01:31:46,121 --> 01:31:47,756
OF E-MAILS I GOT IN THE LAST

2535
01:31:47,756 --> 01:31:50,192
MONTH SAYING SHOULD I CANCEL ALL

2536
01:31:50,192 --> 01:31:52,461
MY JANUARY TELEHEALTH

2537
01:31:52,461 --> 01:31:52,794
APPOINTMENTS?

2538
01:31:52,794 --> 01:31:54,429
AND NOW OUR OFFICIAL STANCE IS

2539
01:31:54,429 --> 01:31:57,065
DO NOT TILL WE TELL YOU TO DO

2540
01:31:57,065 --> 01:31:57,766
SOMETHING BECAUSE EVERYBODY

2541
01:31:57,766 --> 01:32:00,235
HEARS FROM A FRIEND SOMETHING'S

2542
01:32:00,235 --> 01:32:02,337
GOING AWAY, AND IT'S CRAZY.

2543
01:32:02,337 --> 01:32:05,040
IT RESULTS IN A LOT OF WORK

2544
01:32:05,040 --> 01:32:06,141
THAT'S UNNECESSARY.

2545
01:32:06,141 --> 01:32:08,543
THE SECOND THING THAT'S REALLY

2546
01:32:08,543 --> 01:32:11,713
IMPORTANT IS GEOGRAPHY.

2547
01:32:11,713 --> 01:32:13,248
AND WE'VE HINTED.

2548
01:32:13,248 --> 01:32:14,916
IT'S SO RUTHLESSLY UNFAIR TO BE

2549
01:32:14,916 --> 01:32:16,451
FUNDING THINGS IN RURAL AREAS

2550
01:32:16,451 --> 01:32:18,086
AND NOT URBAN AREAS.

2551
01:32:18,086 --> 01:32:20,489
I KNOW MY FRIENDS FROM HRSA ARE

2552
01:32:20,489 --> 01:32:21,690
ATTENDING TODAY AND I UNDERSTAND

2553
01:32:21,690 --> 01:32:23,458
THAT'S THEIR MISSION AND THERE'S

2554
01:32:23,458 --> 01:32:25,727
NOTHING THEY CAN DO ABOUT IT,

2555
01:32:25,727 --> 01:32:27,596
BUT REALITY IS MANY, MANY MORE

2556
01:32:27,596 --> 01:32:29,464
PEOPLE LIVE IN URBAN AREAS AND

2557
01:32:29,464 --> 01:32:30,932
THEY HAVE THEIR OWN CHALLENGES.

2558
01:32:30,932 --> 01:32:32,434
THEY MAY NOT HAVE A CAR.

2559
01:32:32,434 --> 01:32:34,303
THE BUS MAY BE BROKEN DOWN IN

2560
01:32:34,303 --> 01:32:36,371
PHILADELPHIA, WE'RE ON THE EDGE

2561
01:32:36,371 --> 01:32:37,906
OF A STRIKE, CAN THEY GET THERE?

2562
01:32:37,906 --> 01:32:40,108
I LIKE TO SAY THERE'S FEWER

2563
01:32:40,108 --> 01:32:42,110
DOCTORS IN RURAL AREAS, NO

2564
01:32:42,110 --> 01:32:44,479
DOUBT, BUT THERE'S FEWER

2565
01:32:44,479 --> 01:32:45,714
APPOINTMENTS AVAILABLE IN URBAN

2566
01:32:45,714 --> 01:32:48,250
AREAS, NO DOUBT.

2567
01:32:48,250 --> 01:32:49,651
AND I KNOW IF NOTHING ELSE IN

2568
01:32:49,651 --> 01:32:51,620
THE WORLD OF MEDICINE THAT PICKS

2569
01:32:51,620 --> 01:32:53,488
GEOGRAPHY AS A CONDITION FOR

2570
01:32:53,488 --> 01:32:54,489
FUNDING OR EVER DID.

2571
01:32:54,489 --> 01:32:57,326
I THINK WE HAVE TO GET PAST

2572
01:32:57,326 --> 01:32:57,859
THAT.

2573
01:32:57,859 --> 01:33:00,295
AND, YOU KNOW, AGAIN NOT AGAINST

2574
01:33:00,295 --> 01:33:02,664
ANY ONE AGENCY BUT WE HAVE TO

2575
01:33:02,664 --> 01:33:06,301
LOOK BROADLY AND NOT HAVE THINGS

2576
01:33:06,301 --> 01:33:07,636
FIT INTO RURAL-ONLY FUNDING

2577
01:33:07,636 --> 01:33:11,006
OPPORTUNITIES OR WE'RE ACTUALLY

2578
01:33:11,006 --> 01:33:11,840
TOTALLY INEQUITABLE BY DEPRIVING

2579
01:33:11,840 --> 01:33:19,114
URBAN PATIENTS OF THE CARE.

2580
01:33:19,114 --> 01:33:20,515
>> JUDD, OKAY, I'M WITH
YOU

2581
01:33:20,515 --> 01:33:22,084
ABOUT KICKING THE CAN.

2582
01:33:22,084 --> 01:33:24,386
IT'S DRIVING EVERYBODY CRAZY AND

2583
01:33:24,386 --> 01:33:25,153
NEGATIVELY IMPACTING TELEHEALTH.

2584
01:33:25,153 --> 01:33:26,788
WHERE I GET A BIT WORRIED ABOUT

2585
01:33:26,788 --> 01:33:28,857
WHAT YOU SAID IS I FULLY

2586
01:33:28,857 --> 01:33:30,492
ACKNOWLEDGE THE BARRIERS IN

2587
01:33:30,492 --> 01:33:33,795
URBAN AREAS.

2588
01:33:33,795 --> 01:33:36,965
BUT I WORRY ALSO ABOUT

2589
01:33:36,965 --> 01:33:39,668
ASSUMPTION THAT IF WE OFFER

2590
01:33:39,668 --> 01:33:41,336
TELEHEALTH TO EVERYBODY, AND

2591
01:33:41,336 --> 01:33:45,707
MAKE IT OPEN, IT'S GOING TO

2592
01:33:45,707 --> 01:33:46,842
ADDRESS THE DISPARITIES THAT DR.

2593
01:33:46,842 --> 01:33:50,412
GRAHAM AND SO MANY OTHERS HAVE

2594
01:33:50,412 --> 01:33:52,280
HIGHLIGHTED, LET'S JUST STICK

2595
01:33:52,280 --> 01:33:54,483
WITH RURAL/URBAN DIVIDE.

2596
01:33:54,483 --> 01:33:56,585
EVIDENCE THAT I SEE IF YOU JUST

2597
01:33:56,585 --> 01:33:57,753
OFFER IT TO EVERYBODY, MORE

2598
01:33:57,753 --> 01:33:59,421
PEOPLE WILL USE IT IN URBAN

2599
01:33:59,421 --> 01:34:04,793
AREAS AND WE'RE GOING TO WIDEN

2600
01:34:04,793 --> 01:34:06,762
DISPARITIES, NOT NARROW THEM.

2601
01:34:06,762 --> 01:34:10,031
AND THAT REALLY BOTHERS ME QUITE

2602
01:34:10,031 --> 01:34:10,799
A BIT.

2603
01:34:10,799 --> 01:34:12,300
IT BOTHERS ME A TON.

2604
01:34:12,300 --> 01:34:16,805
I THINK A LOT ABOUT THE NEED FOR

2605
01:34:16,805 --> 01:34:20,142
RESEARCH ON HOW DO YOU ENSURE --

2606
01:34:20,142 --> 01:34:29,017
I'M NOT SAYING TAKE  IT WITH A

2607
01:34:29,017 --> 01:34:34,923
TAKE IT AWAY FROM URBAN AREAS,

2608
01:34:34,923 --> 01:34:40,228
BUT I'M CONCERNED ABOUT WIDENING

2609
01:34:40,228 --> 01:34:40,529
DISPARITIES.

2610
01:34:40,529 --> 01:34:41,530
>> MY PUSHBACK, I AGREE
WITH

2611
01:34:41,530 --> 01:34:43,064
YOU, WE SHOULD CHOICE THE GAP.

2612
01:34:43,064 --> 01:34:45,133
BUT THE ONE WAY WE SHOULDN'T

2613
01:34:45,133 --> 01:34:47,969
CLOSE THE GAP IS BY DEPRIVING

2614
01:34:47,969 --> 01:34:50,705
OPPORTUNITIES FOR TELEMEDICINE

2615
01:34:50,705 --> 01:34:54,009
CARE TO PEOPLE WHO ARE LESS

2616
01:34:54,009 --> 01:34:54,376
BIASED AGAINST.

2617
01:34:54,376 --> 01:34:56,511
SO, I WANT TO BE CAREFUL THAT

2618
01:34:56,511 --> 01:34:59,281
THE GOAL IS NOT GAP CLOSURE, THE

2619
01:34:59,281 --> 01:35:01,216
GOAL IS OPTIMAL CARE FOR BOTH

2620
01:35:01,216 --> 01:35:07,389
PATIENT POPULATIONS OR FOR ALL

2621
01:35:07,389 --> 01:35:07,656
PATIENTS.

2622
01:35:07,656 --> 01:35:10,892
>> I WORRY WHEN WE GROUP
INTO

2623
01:35:10,892 --> 01:35:11,526
RURAL/URBAN.

2624
01:35:11,526 --> 01:35:13,428
THERE'S AN URBAN BUCKET WITH

2625
01:35:13,428 --> 01:35:14,930
SUBPOPULATIONS AND EXPERIENCES

2626
01:35:14,930 --> 01:35:16,798
IN THERE.

2627
01:35:16,798 --> 01:35:17,999
MORE INNER CITY URBAN

2628
01:35:17,999 --> 01:35:19,534
POPULATIONS ARE VERY DIFFERENT

2629
01:35:19,534 --> 01:35:21,036
FROM THE SUBURBAN RINGS THAT

2630
01:35:21,036 --> 01:35:23,371
OFTEN ARE IN THE SAME

2631
01:35:23,371 --> 01:35:23,672
POPULATION.

2632
01:35:23,672 --> 01:35:26,641
SO WHEN WE LOOK AT ACCESS TO

2633
01:35:26,641 --> 01:35:30,278
EMERGENCY ROOM VISITS OR PRIMARY

2634
01:35:30,278 --> 01:35:31,913
CARE VISITS, THERE'S OFTEN

2635
01:35:31,913 --> 01:35:32,781
VARIATION, LOW UTILIZATION IN

2636
01:35:32,781 --> 01:35:36,551
THE MIDDLE OF THE MOST URBAN

2637
01:35:36,551 --> 01:35:38,053
CORRIDORS, THINGS LIKE GREAT,

2638
01:35:38,053 --> 01:35:39,721
CARE GOES DOWN AGAIN, SO MAKING

2639
01:35:39,721 --> 01:35:41,790
SURE THAT WE'RE SENSITIVE TO

2640
01:35:41,790 --> 01:35:43,625
THOSE NUANCES I THINK IS REALLY

2641
01:35:43,625 --> 01:35:48,797
IMPORTANT AS WE'RE THINKING

2642
01:35:48,797 --> 01:35:49,631
ABOUT ACCESS THROUGH TELEHEALTH

2643
01:35:49,631 --> 01:35:51,967
>> IT'S LIKE WE MAKING THE

2644
01:35:51,967 --> 01:35:53,401
DIVISION BETWEEN RURAL AND URBAN

2645
01:35:53,401 --> 01:35:54,603
AS IF THERE'S A DIFFERENCE AS

2646
01:35:54,603 --> 01:35:57,572
FAR AS HEALTH EQUITY AND ACCESS

2647
01:35:57,572 --> 01:36:00,942
TO DIGITAL MEANS, WHEN TO YOUR

2648
01:36:00,942 --> 01:36:02,244
POINT, KRISTIN, THERE ARE

2649
01:36:02,244 --> 01:36:06,948
POCKETS OF LOW DIGITAL LITERACY

2650
01:36:06,948 --> 01:36:08,717
WITHIN URBAN ENVIRONMENTS, AND

2651
01:36:08,717 --> 01:36:10,552
OPPOSITE TRUE IN RURAL AREAS.

2652
01:36:10,552 --> 01:36:12,087
AS WE THINK ABOUT INDIVIDUALS

2653
01:36:12,087 --> 01:36:15,223
WHO HAVE LOW DIGITAL LITERACY OR

2654
01:36:15,223 --> 01:36:16,691
LIMITED ENGLISH PROFICIENCY,

2655
01:36:16,691 --> 01:36:18,660
SOME OF THESE GROUPS THAT ARE

2656
01:36:18,660 --> 01:36:20,562
POTENTIALLY BEING LEFT OUT IN

2657
01:36:20,562 --> 01:36:22,697
THE TELEHEALTH REVOLUTION, WHAT

2658
01:36:22,697 --> 01:36:25,901
ARE SOME OF THE STRATEGIES,

2659
01:36:25,901 --> 01:36:27,002
RECOMMENDATIONS, AND ALSO

2660
01:36:27,002 --> 01:36:29,604
OPPORTUNITIES AND OPPORTUNITIES

2661
01:36:29,604 --> 01:36:30,505
FOR IMPLEMENTATION RESEARCH THAT

2662
01:36:30,505 --> 01:36:37,045
COME TO MIND TO THIS PANEL?

2663
01:36:37,045 --> 01:36:40,148
>> I'LL LAY THE STAGE AND
WOULD

2664
01:36:40,148 --> 01:36:42,751
LOVE FOR KRISTIN AND JUDD TO

2665
01:36:42,751 --> 01:36:43,084
HIGHLIGHT.

2666
01:36:43,084 --> 01:36:44,853
WE ALL RECOGNIZE WE NEED TO

2667
01:36:44,853 --> 01:36:47,355
JUST, AGAIN, JUST OFFER TO

2668
01:36:47,355 --> 01:36:49,558
EVERYBODY, IT JUST DOESN'T WORK.

2669
01:36:49,558 --> 01:36:51,927
WE'LL HAVE TO ADDRESS SOME OF

2670
01:36:51,927 --> 01:36:53,461
THE DIGITAL LITERACY, AND MY

2671
01:36:53,461 --> 01:36:54,563
EXPERIENCE BOTH CLINICALLY AS

2672
01:36:54,563 --> 01:36:56,431
WELL AS LOOKING OUT THERE IS

2673
01:36:56,431 --> 01:36:58,700
THAT CLINICIANS ARE DOING WHAT

2674
01:36:58,700 --> 01:37:00,368
MAKES SENSE, COMMON SENSE.

2675
01:37:00,368 --> 01:37:02,470
LIKE, HEY, LET'S TRY A PILOT

2676
01:37:02,470 --> 01:37:02,904
VISIT.

2677
01:37:02,904 --> 01:37:04,973
HEY, LET ME HAVE A TELEHEALTH

2678
01:37:04,973 --> 01:37:06,508
COORDINATOR WHO CAN REACH OUT

2679
01:37:06,508 --> 01:37:07,576
AND SET THAT UP.

2680
01:37:07,576 --> 01:37:09,477
HEY, MAYBE I'LL GIVE YOU A

2681
01:37:09,477 --> 01:37:11,646
DEVICE TO HELP YOU DO THIS.

2682
01:37:11,646 --> 01:37:13,848
AND A VARIETY OF OTHER TOOLS.

2683
01:37:13,848 --> 01:37:15,417
AND ALL OF THOSE MAKE SENSE TO

2684
01:37:15,417 --> 01:37:17,018
ME, AND I THINK IF I WAS IN

2685
01:37:17,018 --> 01:37:18,753
THEIR SHOES I WOULD DO THAT.

2686
01:37:18,753 --> 01:37:22,290
I DON'T KNOW ABOUT A LOT OF

2687
01:37:22,290 --> 01:37:24,159
EVIDENCE THAT CAN SAY, HEY, THIS

2688
01:37:24,159 --> 01:37:25,794
THING WORKS BETTER THAN THIS

2689
01:37:25,794 --> 01:37:27,329
OTHER THING.

2690
01:37:27,329 --> 01:37:29,097
AND THAT DOES SEEM LIKE A

2691
01:37:29,097 --> 01:37:30,498
RESEARCH GAP.

2692
01:37:30,498 --> 01:37:32,033
I'D BE CURIOUS WHAT KRISTIN AND

2693
01:37:32,033 --> 01:37:33,702
JUDD, DO YOU AGREE OR DO YOU

2694
01:37:33,702 --> 01:37:35,136
FEEL LIKE WE HAVE THE EVIDENCE

2695
01:37:35,136 --> 01:37:36,738
TO KNOW TO INFORM A HEALTH

2696
01:37:36,738 --> 01:37:38,106
SYSTEM OTHER INDIVIDUAL PRACTICE

2697
01:37:38,106 --> 01:37:42,978
ON WHAT TO DO?

2698
01:37:42,978 --> 01:37:45,080
>> I THINK THERE IS SOME
DATA IN

2699
01:37:45,080 --> 01:37:50,018
SOME OF THOSE SPACES, AND I

2700
01:37:50,018 --> 01:37:52,821
THINK THERE ARE -- THERE'S SOME

2701
01:37:52,821 --> 01:37:55,457
THINGS WE NEED TO DO BECAUSE --

2702
01:37:55,457 --> 01:37:56,725
WE SHOULD ALWAYS HAVE

2703
01:37:56,725 --> 01:37:57,058
INTERPRETERS.

2704
01:37:57,058 --> 01:38:01,863
WE SHOULD HAVE ALL OUR

2705
01:38:01,863 --> 01:38:02,831
PATIENT-FACING PORTALS AND

2706
01:38:02,831 --> 01:38:03,698
SELF-SCHEDULING AVAILABLE IN

2707
01:38:03,698 --> 01:38:04,165
MULTIPLE LANGUAGES.

2708
01:38:04,165 --> 01:38:05,667
I KNOW WE'RE FAR FROM DOING

2709
01:38:05,667 --> 01:38:05,900
THAT.

2710
01:38:05,900 --> 01:38:07,435
BUT I DON'T THINK WE NEED DATA

2711
01:38:07,435 --> 01:38:09,204
TO PROVE THAT.

2712
01:38:09,204 --> 01:38:12,507
THE NEXT LEVEL OF -- I KNOW

2713
01:38:12,507 --> 01:38:14,242
WE'RE ALL AWARE WE NEED TO DO

2714
01:38:14,242 --> 01:38:15,210
THOSE THINGS.

2715
01:38:15,210 --> 01:38:22,917
THE NEXT LEVEL OF DIGITAL

2716
01:38:22,917 --> 01:38:23,818
NAVIGATORS AND THOSE

2717
01:38:23,818 --> 01:38:26,454
SELF-ROOMING PROCESSES, THERE IS

2718
01:38:26,454 --> 01:38:28,089
NEED FOR ADDITIONAL DATA, AND AS

2719
01:38:28,089 --> 01:38:29,924
I MENTIONED THERE'S SOME STUDIES

2720
01:38:29,924 --> 01:38:30,692
SHOWING THAT.

2721
01:38:30,692 --> 01:38:32,127
IT'S PROBABLY THE SORT OF THING

2722
01:38:32,127 --> 01:38:35,864
WE WANT TO SEE MULTIPLE STUDIES

2723
01:38:35,864 --> 01:38:36,965
ACROSS MULTIPLE SETTINGS BEFORE

2724
01:38:36,965 --> 01:38:38,400
EVERY HEALTH SYSTEM ELIMINATED

2725
01:38:38,400 --> 01:38:41,836
VESTS HUGE AMOUNT OF EXTRA

2726
01:38:41,836 --> 01:38:43,605
PERSONNEL IN BUT I THINK THOSE

2727
01:38:43,605 --> 01:38:44,706
ARE THE QUESTIONS WE SHOULD

2728
01:38:44,706 --> 01:38:50,178
PRIORITIZE IN TERMS OF LOOKING

2729
01:38:50,178 --> 01:38:52,180
AT REPLICABLE STRUCTURES AND

2730
01:38:52,180 --> 01:38:53,815
PROCESS THAT ALLOW FOR

2731
01:38:53,815 --> 01:38:54,582
SCHEDULING, ATTENDANCE, QUALITY

2732
01:38:54,582 --> 01:38:55,550
OF CARE DURING THE VISIT.

2733
01:38:55,550 --> 01:38:59,921
I THINK THE OTHER THING IS WE'RE

2734
01:38:59,921 --> 01:39:01,356
THINKING ABOUT EQUITY AND

2735
01:39:01,356 --> 01:39:02,557
TELEHEALTH BROADLY IS

2736
01:39:02,557 --> 01:39:03,958
REMEMBERING THAT EQUITY ISN'T

2737
01:39:03,958 --> 01:39:04,859
NECESSARILY EVERYONE GETTING THE

2738
01:39:04,859 --> 01:39:06,161
SAME BUT IT'S EVERYONE GETTING

2739
01:39:06,161 --> 01:39:07,462
WHAT THEY NEED.

2740
01:39:07,462 --> 01:39:08,797
SO FOR DIFFERENT POPULATIONS

2741
01:39:08,797 --> 01:39:10,065
THAT WILL LOOK DIFFERENT.

2742
01:39:10,065 --> 01:39:14,169
I THINK WE'RE KIND OF AT A

2743
01:39:14,169 --> 01:39:16,805
TELEHEALTH EQUITY 1.0, MAYBE 2.0

2744
01:39:16,805 --> 01:39:19,874
LOOKING AT IS USE OF THIS

2745
01:39:19,874 --> 01:39:20,809
MODALITY THE SAME ACROSS

2746
01:39:20,809 --> 01:39:23,111
POPULATIONS AND WE WANT TO LOOK

2747
01:39:23,111 --> 01:39:25,180
AT HOW IS THIS MODALITY LAYERING

2748
01:39:25,180 --> 01:39:26,915
ON TOP OF OTHER MODALITIES AND

2749
01:39:26,915 --> 01:39:28,450
ARE PEOPLE GETTING THE CARE THEY

2750
01:39:28,450 --> 01:39:29,017
NEED.

2751
01:39:29,017 --> 01:39:30,351
THAT'S A LOT HARDER.

2752
01:39:30,351 --> 01:39:32,420
SO IT MAKES SENSE THAT WE

2753
01:39:32,420 --> 01:39:34,055
DON'T -- WE CAN'T ALWAYS DO THAT

2754
01:39:34,055 --> 01:39:35,156
BUT SHOULD BE LAYERING DIFFERENT

2755
01:39:35,156 --> 01:39:39,828
STUDIES ON TOP OF EACH OTHER TO

2756
01:39:39,828 --> 01:39:40,729
UNDERSTAND GIVEN THAT PATIENTS

2757
01:39:40,729 --> 01:39:42,163
HAVE DIFFERENT NEEDS FOR

2758
01:39:42,163 --> 01:39:44,365
CLINICAL CARE BASED ON THEIR

2759
01:39:44,365 --> 01:39:45,533
DIFFERENT HEALTH CONDITIONS, AND

2760
01:39:45,533 --> 01:39:48,069
THAT THEY HAVE DIFFERENT ACCESS

2761
01:39:48,069 --> 01:39:50,572
TO IN-PERSON CARE, THEIR NEED

2762
01:39:50,572 --> 01:39:52,207
FOR SUBSPECIALTY CARE OR SORRY

2763
01:39:52,207 --> 01:39:53,374
FOR TELEHEALTH CARE MAY VARY AND

2764
01:39:53,374 --> 01:39:54,943
WE WANT TO MAKE SURE THEY ARE

2765
01:39:54,943 --> 01:39:55,910
GETTING WHAT THEY NEED.

2766
01:39:55,910 --> 01:39:57,979
AND I THINK WE NEED TO

2767
01:39:57,979 --> 01:40:00,815
PRIORITIZE A RANGE OF

2768
01:40:00,815 --> 01:40:02,884
POPULATIONS FOR THAT.

2769
01:40:02,884 --> 01:40:04,119
>> TO ATEEV'S POINT, THE
SHORT

2770
01:40:04,119 --> 01:40:05,754
ANSWER TO YOUR QUESTION IS

2771
01:40:05,754 --> 01:40:06,755
ABSOLUTELY YES.

2772
01:40:06,755 --> 01:40:08,256
THERE'S A GREAT OPPORTUNITY FOR

2773
01:40:08,256 --> 01:40:10,992
MORE RESEARCH IN THAT AREA.

2774
01:40:10,992 --> 01:40:12,961
I CAUTION, AND I KNOW THE

2775
01:40:12,961 --> 01:40:14,629
QUALITY OF YOUR STUDIES SO I

2776
01:40:14,629 --> 01:40:16,131
KNOW YOU KNOW THIS, NOT

2777
01:40:16,131 --> 01:40:17,232
EVERYBODY PATIENT IS GOING TO

2778
01:40:17,232 --> 01:40:19,334
GET THE SAME SOLUTION THAT WORKS

2779
01:40:19,334 --> 01:40:20,668
FOR THEM.

2780
01:40:20,668 --> 01:40:22,137
IT MAY BE PREDICTIVE ANALYTICS

2781
01:40:22,137 --> 01:40:23,905
WHETHER YOU NEED WHAT WE CALL A

2782
01:40:23,905 --> 01:40:24,672
TELEHEALTH COORDINATOR TO REACH

2783
01:40:24,672 --> 01:40:26,975
OUT AND DO A PRACTICE VISIT THE

2784
01:40:26,975 --> 01:40:31,212
DAY BEFORE OR JUST A FIRST VISIT

2785
01:40:31,212 --> 01:40:33,748
AND MAYBE A BOT COULD CALL AND

2786
01:40:33,748 --> 01:40:35,950
PROVE YOU CAN LOG ON AND DO YOUR

2787
01:40:35,950 --> 01:40:37,018
MICROPHONE AND AUDIO VISIT, OR

2788
01:40:37,018 --> 01:40:38,219
MAYBE INSTRUCTIONS WITHIN THE

2789
01:40:38,219 --> 01:40:39,320
PORTAL MESSAGE THAT COULD WORK

2790
01:40:39,320 --> 01:40:41,523
FOR SOME PATIENTS BECAUSE THEY

2791
01:40:41,523 --> 01:40:43,491
ARE SAVVY ENOUGH WITH SOME

2792
01:40:43,491 --> 01:40:43,825
INSTRUCTIONS.

2793
01:40:43,825 --> 01:40:47,428
I THINK THERE'S GOING TO BE --

2794
01:40:47,428 --> 01:40:49,297
KRISTIN RISING HAS DONE A LOT OF

2795
01:40:49,297 --> 01:40:51,599
WORK AT JEFF, A PORTFOLIO OF

2796
01:40:51,599 --> 01:40:52,967
OPTIONS THAT WILL WORK FOR

2797
01:40:52,967 --> 01:40:53,401
DIFFERENT PATIENTS.

2798
01:40:53,401 --> 01:40:55,770
WHETHER OR NOT WE CAN BE SMART

2799
01:40:55,770 --> 01:40:57,505
ENOUGH TO PREDICT THAT, TO HAVE

2800
01:40:57,505 --> 01:40:59,240
A HIGHER LIKELIHOOD OF THE

2801
01:40:59,240 --> 01:41:01,543
OPTION THAT PATIENT A GETS,

2802
01:41:01,543 --> 01:41:03,077
BEING THE RIGHT OPTION, OR

2803
01:41:03,077 --> 01:41:05,480
GIVING A PORTFOLIO OF OPTIONS, I

2804
01:41:05,480 --> 01:41:07,348
THINK IS A TOTALLY RIPE

2805
01:41:07,348 --> 01:41:09,317
OPPORTUNITY FOR RESEARCH.

2806
01:41:09,317 --> 01:41:11,719
>> AND IF I COULD JUST --
I

2807
01:41:11,719 --> 01:41:12,720
SHOULD HAVE PROVIDED THE CONTEXT

2808
01:41:12,720 --> 01:41:15,890
IN WHICH I WAS THINKING ABOUT

2809
01:41:15,890 --> 01:41:16,691
THIS QUESTION.

2810
01:41:16,691 --> 01:41:19,060
THE FEDERAL GOVERNMENT AS PART

2811
01:41:19,060 --> 01:41:29,604
OF THE  AFFORD AND CONNECTIVITY

2812
01:41:34,309 --> 01:41:35,043
PROGRAM PROVIDED LIKE $7

2813
01:41:35,043 --> 01:41:35,543
BILLION.

2814
01:41:35,543 --> 01:41:37,445
I WOULD HAVE BEEN SUPPORTIVE OF

2815
01:41:37,445 --> 01:41:41,282
IT, AT LEAST MY EVIDENCE,

2816
01:41:41,282 --> 01:41:43,351
UNFORTUNATELY I DON'T SEE AN

2817
01:41:43,351 --> 01:41:45,320
ASSOCIATION BETWEEN THAT PROGRAM

2818
01:41:45,320 --> 01:41:46,621
AND MORE TELEHEALTH USE.

2819
01:41:46,621 --> 01:41:48,289
SO THERE'S A LOT OF REASONS WE

2820
01:41:48,289 --> 01:41:48,923
HAD THAT PROGRAM.

2821
01:41:48,923 --> 01:41:50,592
I WANT TO ACKNOWLEDGE THAT.

2822
01:41:50,592 --> 01:41:52,126
IF IT'S JUST ABOUT TELEHEALTH

2823
01:41:52,126 --> 01:41:55,063
IT'S ONE EXAMPLE WHERE I'VE NOT

2824
01:41:55,063 --> 01:41:57,232
SEEN EVIDENCE THAT'S THE KIND OF

2825
01:41:57,232 --> 01:41:58,333
PROGRAM THAT'S MOST EFFECTIVE.

2826
01:41:58,333 --> 01:42:00,301
THIS IS ONE EXAMPLE OF WHY THIS

2827
01:42:00,301 --> 01:42:01,502
TYPE OF RESEARCH IS NECESSARY

2828
01:42:01,502 --> 01:42:06,007
BECAUSE WE JUST SHOULDN'T MAKE

2829
01:42:06,007 --> 01:42:06,341
ASSUMPTIONS.

2830
01:42:06,341 --> 01:42:09,310
>> ABSOLUTELY.

2831
01:42:09,310 --> 01:42:09,677
>> EXCELLENT.

2832
01:42:09,677 --> 01:42:11,145
I THINK WE'RE WINDING DOWN AND

2833
01:42:11,145 --> 01:42:14,549
COMING TO THE END OF A LIVELY

2834
01:42:14,549 --> 01:42:17,518
DISCUSSION, THIS HAS BEEN

2835
01:42:17,518 --> 01:42:18,286
INSIGHTFUL AND STIMULATING.

2836
01:42:18,286 --> 01:42:22,757
I WANT TO CLOSE ALLOWING THE

2837
01:42:22,757 --> 01:42:24,392
PANELISTS TO GIVE FINAL THOUGHTS

2838
01:42:24,392 --> 01:42:25,960
WHAT YOU'RE EXCITED ABOUT IN THE

2839
01:42:25,960 --> 01:42:28,796
NEXT YEAR OR FIVE YEARS AS FAR

2840
01:42:28,796 --> 01:42:33,501
AS TELEHEALTH AND THE

2841
01:42:33,501 --> 01:42:35,603
OPPORTUNITIES OF IMPLEMENTATION

2842
01:42:35,603 --> 01:42:36,905
RESEARCH STARTING WITH ATEEV

2843
01:42:36,905 --> 01:42:37,105
FIRST.

2844
01:42:37,105 --> 01:42:39,007
>> YEAH, I THINK THE

2845
01:42:39,007 --> 01:42:40,642
INTERSECTION BETWEEN A.I. AND

2846
01:42:40,642 --> 01:42:42,710
TELEHEALTH IS REALLY AN

2847
01:42:42,710 --> 01:42:43,111
INTERESTING SPACE.

2848
01:42:43,111 --> 01:42:44,345
AGAIN, BUILDING OFF THAT IDEA OF

2849
01:42:44,345 --> 01:42:48,616
HOW DO WE USE TECHNOLOGY TO MAKE

2850
01:42:48,616 --> 01:42:49,918
OUR CLINICIANS MORE PRODUCTIVE,

2851
01:42:49,918 --> 01:42:50,752
THERE'S OPPORTUNITIES THERE,

2852
01:42:50,752 --> 01:42:52,620
THIS IS SOMETHING IN THE

2853
01:42:52,620 --> 01:42:54,355
AFTERNOON WE'LL DISCUSS MORE.

2854
01:42:54,355 --> 01:42:57,191
BUT THAT GETS ME EXCITED ABOUT

2855
01:42:57,191 --> 01:43:00,695
WHERE WE'RE HEADED.

2856
01:43:00,695 --> 01:43:02,463
>> THANK YOU.

2857
01:43:02,463 --> 01:43:05,099
>> I'M EXCITED ABOUT
THINKING

2858
01:43:05,099 --> 01:43:06,401
ABOUT HOW WE UNDERSTAND THE

2859
01:43:06,401 --> 01:43:10,138
CONTINUUM OF CARE, HOW WE HAND

2860
01:43:10,138 --> 01:43:11,773
PATIENTS OFF FROM ASYNCHRONOUS

2861
01:43:11,773 --> 01:43:12,740
TO SYNCHRONOUS TO IN-PERSON CARE

2862
01:43:12,740 --> 01:43:16,044
AND DO THAT IN A WAY THAT MEETS

2863
01:43:16,044 --> 01:43:17,245
PATIENTS' NEEDS AS SEAMLESSLY AS

2864
01:43:17,245 --> 01:43:17,779
POSSIBLE.

2865
01:43:17,779 --> 01:43:20,081
I'M EXCITED ABOUT THINKING ABOUT

2866
01:43:20,081 --> 01:43:21,082
THE MORE LONGITUDINAL PATTERNS

2867
01:43:21,082 --> 01:43:23,718
OF CARE SO NOT THE TELEHEALTH

2868
01:43:23,718 --> 01:43:26,087
VERSUS IN-PERSON VISITS ON THEIR

2869
01:43:26,087 --> 01:43:28,890
OWN BUT OVERALL ONE OF MY

2870
01:43:28,890 --> 01:43:30,725
COLLEAGUES STATED LOOKING AT A

2871
01:43:30,725 --> 01:43:31,926
PRACTICE WHERE THERE IS

2872
01:43:31,926 --> 01:43:33,661
TELEHEALTH AND IN-PERSON CARE

2873
01:43:33,661 --> 01:43:34,862
VERSUS IN-PERSON ONLY AND HOW

2874
01:43:34,862 --> 01:43:36,831
DOES THAT CHANGE THE CARE THAT

2875
01:43:36,831 --> 01:43:38,466
PEOPLE RECEIVE.

2876
01:43:38,466 --> 01:43:40,568
AND THEN CONTINUING TO

2877
01:43:40,568 --> 01:43:41,869
PRIORITIZE SESSIONS OF EQUITY

2878
01:43:41,869 --> 01:43:43,771
AND AS WE'RE THINKING ABOUT

2879
01:43:43,771 --> 01:43:48,209
THESE QUESTIONS.

2880
01:43:48,209 --> 01:43:49,610
>> I'M A SIMPLE GUY,
EXCITED THE

2881
01:43:49,610 --> 01:43:52,580
NIH IS HAVING A PANEL LIKE THIS.

2882
01:43:52,580 --> 01:43:54,115
I'VE SEEN WHAT RESEARCH IS

2883
01:43:54,115 --> 01:43:55,750
NECESSARY, AND TO ME THAT'S

2884
01:43:55,750 --> 01:43:58,386
ACTUALLY THE MOST EXCITING THING

2885
01:43:58,386 --> 01:43:59,821
THAT'S HAPPENED IN THE RECENT

2886
01:43:59,821 --> 01:44:01,356
PAST.

2887
01:44:01,356 --> 01:44:01,956
>> EXCELLENT.

2888
01:44:01,956 --> 01:44:02,991
WELL, THANK YOU ALL.

2889
01:44:02,991 --> 01:44:05,393
AND SINCE WE HAVE SOME TIME I'LL

2890
01:44:05,393 --> 01:44:08,796
SHARE WHAT I'M EXCITED ABOUT AS

2891
01:44:08,796 --> 01:44:11,866
A PRIMARY CARE DOCTOR, THINKING

2892
01:44:11,866 --> 01:44:16,204
ABOUT BURNOUT AND THE WORKFORCE,

2893
01:44:16,204 --> 01:44:16,771
EXCITED WHAT TELEHEALTH CAN

2894
01:44:16,771 --> 01:44:20,742
OFFERED FER OFFER TO THE FRONT

2895
01:44:20,742 --> 01:44:21,776
LINE CLINICIAN, TEAM-BASED

2896
01:44:21,776 --> 01:44:23,478
MODELS ACCESSIBLE TO PATIENTS,

2897
01:44:23,478 --> 01:44:25,346
GIVING OUR PATIENTS MORE

2898
01:44:25,346 --> 01:44:25,780
OPPORTUNITIES.

2899
01:44:25,780 --> 01:44:26,748
I'M CONCERNED ABOUT THOSE

2900
01:44:26,748 --> 01:44:27,749
PATIENTS WHO ARE FALLING THROUGH

2901
01:44:27,749 --> 01:44:30,718
THE CRACKS AS WE TALK ABOUT

2902
01:44:30,718 --> 01:44:32,587
LIMITED DIGITAL LITERACY, AND

2903
01:44:32,587 --> 01:44:33,654
LIMITED ENGLISH PROFICIENCY.

2904
01:44:33,654 --> 01:44:35,723
AND I THINK A LOT OF THOSE

2905
01:44:35,723 --> 01:44:37,258
SOLUTIONS HIGHLIGHTED IN THIS

2906
01:44:37,258 --> 01:44:40,528
PANEL ARE VERY PROMISING AREAS

2907
01:44:40,528 --> 01:44:42,697
TO INVESTIGATE WHEN WE THINK

2908
01:44:42,697 --> 01:44:43,798
ABOUT IMPLEMENTATION RESEARCH.

2909
01:44:43,798 --> 01:44:45,767
SO WITH THAT, I JUST WANT TO

2910
01:44:45,767 --> 01:44:47,201
THANK THE PANEL.

2911
01:44:47,201 --> 01:44:48,102
THIS WAS GREAT.

2912
01:44:48,102 --> 01:44:51,806
AND I'LL TURN IT OVER TO OUR

2913
01:44:51,806 --> 01:44:53,441
FACILITATORS FOR THE NEXT STEPS.

2914
01:44:53,441 --> 01:44:54,876
THANK YOU VERY MUCH.

2915
01:44:54,876 --> 01:44:58,146
>> THANKS, ALL.

2916
01:44:58,146 --> 01:45:04,252
>> THANK YOU.

2917
01:45:04,252 --> 01:45:06,921
WE HAVE A LOT OF WORKSHOPS LIKE

2918
01:45:06,921 --> 01:45:07,688
THESE.

2919
01:45:07,688 --> 01:45:11,192
IT'S NOT JUST THIS ONE, DR.

2920
01:45:11,192 --> 01:45:11,526
HOLLANDER.

2921
01:45:11,526 --> 01:45:12,960
WHEN WE HAVE MORE ABOUT

2922
01:45:12,960 --> 01:45:14,929
TELEHEALTH AND OTHER TOPICS I'LL

2923
01:45:14,929 --> 01:45:17,098
START FORWARDING THEM TO YOU.

2924
01:45:17,098 --> 01:45:19,734
EVEN BACK IN 2022 WE HAD ALSO

2925
01:45:19,734 --> 01:45:21,069
THE FEDERAL PARTNERS PROGRAM

2926
01:45:21,069 --> 01:45:27,075
WHICH WAS A WORKSHOP ENGAGING

2927
01:45:27,075 --> 01:45:28,709
NIH AND HHS AND OTHER

2928
01:45:28,709 --> 01:45:31,879
DEPARTMENTS IN THE U.S.

2929
01:45:31,879 --> 01:45:32,780
GOVERNMENT DISCUSSING

2930
01:45:32,780 --> 01:45:33,414
PROVIDER-TO-PROVIDER TELEHEALTH

2931
01:45:33,414 --> 01:45:34,715
AND A LOT OF PUBLICATIONS THAT

2932
01:45:34,715 --> 01:45:35,817
CAME FROM THAT MEETING.

2933
01:45:35,817 --> 01:45:37,351
PERHAPS I'LL SHARE THOSE IN THE

2934
01:45:37,351 --> 01:45:38,686
CHAT COMING ALONG.

2935
01:45:38,686 --> 01:45:40,988
NOW WE HAVE A BRIEF BREAK, A

2936
01:45:40,988 --> 01:45:44,125
BREAK OF ABOUT 45 MINUTES OR SO

2937
01:45:44,125 --> 01:45:45,760
TO GET LUNCH.

2938
01:45:45,760 --> 01:45:47,895
ON THE WEST COAST, PERHAPS

2939
01:45:47,895 --> 01:45:49,730
MID-BREAKFAST, I'M NOT SURE.

2940
01:45:49,730 --> 01:45:51,466
WE'LL RETURN WITH THE SMALL

2941
01:45:51,466 --> 01:45:52,867
GROUP DISCUSSIONS.

2942
01:45:52,867 --> 01:45:56,037
SMALL GROUP DISCUSSIONS,

2943
01:45:56,037 --> 01:45:59,107
EVERYBODY WILL BE DIVIDED INTO

2944
01:45:59,107 --> 01:46:01,409
THE GROUP THEY CHOSE WHEN THEY

2945
01:46:01,409 --> 01:46:02,310
REGISTERED.

2946
01:46:02,310 --> 01:46:02,944
JOINING VERSUS VIDEOCAST YOU

2947
01:46:02,944 --> 01:46:05,346
WON'T BE ABLE TO JOIN THE SMALL

2948
01:46:05,346 --> 01:46:07,115
GROUPS, ONLY THOSE WHO

2949
01:46:07,115 --> 01:46:08,416
REGISTERED AND ARE JOINING VIA

2950
01:46:08,416 --> 01:46:09,050
ZOOM.

2951
01:46:09,050 --> 01:46:11,819
IF YOU ARE REGISTERED AND YOU'RE

2952
01:46:11,819 --> 01:46:13,121
WATCHING NOW VIA VIDEOCAST, IT'S

2953
01:46:13,121 --> 01:46:15,523
A GREAT MOMENT TO JOIN VIA ZOOM.

2954
01:46:15,523 --> 01:46:18,159
IF YOU ALREADY JOINED VIA ZOOM,

2955
01:46:18,159 --> 01:46:20,828
OUR SUPPORT TEAM IS GIVING US

2956
01:46:20,828 --> 01:46:22,997
ADVICE TO NOT LOG OFF, JUST STAY

2957
01:46:22,997 --> 01:46:25,199
MUTED WITH YOUR CAMERA TURNED

2958
01:46:25,199 --> 01:46:27,935
OFF AND WE'LL SEE EACH OTHER AT

2959
01:46:27,935 --> 01:46:29,270
1:40 P.M. EASTERN TIME.

2960
01:46:29,270 --> 01:46:31,085
SEE YOU IN A LITTLE BIT.

2961
01:47:31,089 --> 01:47:35,493
>> WE HAVE FOUR GROUPS LED
BY

2962
01:47:35,493 --> 01:47:37,995
AMAZING PANELISTS AND MODERATORS

2963
01:47:37,995 --> 01:47:38,463
TODAY, TRANSFORMATIVE

2964
01:47:38,463 --> 01:47:40,198
TECHNOLOGIES, SHAPING THE FUTURE

2965
01:47:40,198 --> 01:47:44,135
OF REMOTE CARE, I'LL START WITH

2966
01:47:44,135 --> 01:47:44,669
YOU.

2967
01:47:44,669 --> 01:47:45,970
WE'LL START WITH THE OFFICE OF

2968
01:47:45,970 --> 01:47:46,504
DISEASE PREVENTION AT THE

2969
01:47:46,504 --> 01:47:47,538
NATIONAL INSTITUTES OF HEALTH.

2970
01:47:47,538 --> 01:47:50,308
SO, BOB, CAN YOU GIVE US A QUICK

2971
01:47:50,308 --> 01:47:52,543
SUMMARY OF WHAT WERE SOME HIGH

2972
01:47:52,543 --> 01:47:55,747
YIELD, IF ANYONE IN THE GROUP

2973
01:47:55,747 --> 01:47:57,081
ALSO WANTS TO ADD MORE COMMENTS

2974
01:47:57,081 --> 01:47:59,050
TO THE CHAT PLEASE GO AHEAD.

2975
01:47:59,050 --> 01:48:00,485
WE'LL CALL EACH GROUP, STARTING

2976
01:48:00,485 --> 01:48:01,919
WITH YOU, BOB.

2977
01:48:01,919 --> 01:48:03,554
>> THANK YOU, FERNANDO.

2978
01:48:03,554 --> 01:48:05,289
WHAT A GREAT GROUP FROM AROUND

2979
01:48:05,289 --> 01:48:06,190
THE WORLD, PEOPLE DOING ALL

2980
01:48:06,190 --> 01:48:10,795
KINDS OF WORK NOTE  -- NOT JUST

2981
01:48:10,795 --> 01:48:12,096
HEALTH CARE BUT ANCILLARY

2982
01:48:12,096 --> 01:48:13,765
GROUPS, FOOD AND BEVERAGE

2983
01:48:13,765 --> 01:48:15,500
INDUSTRY, A BUNCH OF

2984
01:48:15,500 --> 01:48:17,168
PERSPECTIVES TO BRING TO BEAR.

2985
01:48:17,168 --> 01:48:18,369
FOR FOLKS TO KNOW THE MAIN

2986
01:48:18,369 --> 01:48:20,104
OBJECTIVE IN OUR GROUP WAS TO

2987
01:48:20,104 --> 01:48:22,607
TRY TO HIGHLIGHT RECENT AND

2988
01:48:22,607 --> 01:48:23,674
UPCOMING INNOVATIONS IN

2989
01:48:23,674 --> 01:48:27,111
TELEHEALTH SUCH AS A.I., REMOTE

2990
01:48:27,111 --> 01:48:29,647
MONITORING, AND INTEGRATION IN

2991
01:48:29,647 --> 01:48:30,515
EXISTING HEALTHCARE SYSTEMS.

2992
01:48:30,515 --> 01:48:32,150
OF COURSE WE TOUCHED A LOT ON

2993
01:48:32,150 --> 01:48:33,317
A.I.

2994
01:48:33,317 --> 01:48:35,553
A.I. CAME UP FREQUENTLY AS A

2995
01:48:35,553 --> 01:48:36,320
THEME.

2996
01:48:36,320 --> 01:48:37,855
AND ESPECIALLY WITH INTEGRATION

2997
01:48:37,855 --> 01:48:39,590
WITH TELEHEALTH.

2998
01:48:39,590 --> 01:48:43,094
HOW IT MIGHT DECREASE THE BURDEN

2999
01:48:43,094 --> 01:48:45,096
ON CLINICIANS, TOOLS AROUND

3000
01:48:45,096 --> 01:48:46,130
SUMMARIZING VISIT DATA OR

3001
01:48:46,130 --> 01:48:48,766
PUTTING NOTES IN THE EMRs, BUT

3002
01:48:48,766 --> 01:48:50,168
ALSO EMPOWERING PATIENTS, HAVING

3003
01:48:50,168 --> 01:48:51,202
THAT ADDITIONAL INFORMATION

3004
01:48:51,202 --> 01:48:53,037
ABOUT PATIENTS TO TAKE CARE OF

3005
01:48:53,037 --> 01:48:54,005
THEMSELVES.

3006
01:48:54,005 --> 01:48:56,774
WE TALKED ABOUT WEARABLES, MANY

3007
01:48:56,774 --> 01:48:59,877
CAPACITIES, NOT JUST SMARTWATCH

3008
01:48:59,877 --> 01:49:03,815
BUT FOR SLEEP APNEA, PROMOTE

3009
01:49:03,815 --> 01:49:04,782
WOMEN'S HEALTH, UNDERSTAND

3010
01:49:04,782 --> 01:49:05,116
CONDITIONS.

3011
01:49:05,116 --> 01:49:06,951
ONE OF THE THINGS THAT I THINK A

3012
01:49:06,951 --> 01:49:08,920
THEME FOR ME THAT CAME UP

3013
01:49:08,920 --> 01:49:12,089
THROUGH ALL THESE CONVERSATIONS

3014
01:49:12,089 --> 01:49:15,393
AROUND HOW A.I. AND POTENTIALLY

3015
01:49:15,393 --> 01:49:17,161
WEARABLES, REMOTE PATIENT

3016
01:49:17,161 --> 01:49:19,330
MONITORING, AND OTHER TOOLS CAN

3017
01:49:19,330 --> 01:49:21,966
BE A CHALLENGE IS REALLY AROUND

3018
01:49:21,966 --> 01:49:24,936
THE QUESTION, IS MORE DATA

3019
01:49:24,936 --> 01:49:26,571
BETTER, AND WHETHER THAT DATA IS

3020
01:49:26,571 --> 01:49:27,438
GOING TO THE CLINICIANS, AND

3021
01:49:27,438 --> 01:49:29,173
THEY HAVE TO MAKE DECISIONS ON

3022
01:49:29,173 --> 01:49:31,509
WHETHER TO ACT ON IT OR NOT, OR

3023
01:49:31,509 --> 01:49:32,410
WHETHER THAT DATA IS GOING TO

3024
01:49:32,410 --> 01:49:33,678
PATIENTS AND THEY HAVE TO

3025
01:49:33,678 --> 01:49:34,479
UNDERSTAND WHETHER IT'S

3026
01:49:34,479 --> 01:49:36,214
MEANINGFUL OR NOT OR USEFUL.

3027
01:49:36,214 --> 01:49:38,950
SO REALLY THE THEME ABOUT MORE

3028
01:49:38,950 --> 01:49:40,618
DATA COULD BE COOL BUT WILL IT

3029
01:49:40,618 --> 01:49:43,221
ACTUALLY BE JUST INTERESTING OR

3030
01:49:43,221 --> 01:49:44,755
WILL IT BE USEFUL.

3031
01:49:44,755 --> 01:49:45,857
I THINK ONE INTERESTING MODEL

3032
01:49:45,857 --> 01:49:47,725
FOR HOW WE THINK ABOUT THAT WAS

3033
01:49:47,725 --> 01:49:50,995
WE HAD A BRIEF DISCUSSION ABOUT

3034
01:49:50,995 --> 01:49:55,399
PAIN AND HOW WE START TO SCALE A

3035
01:49:55,399 --> 01:49:57,368
PATIENT'S PAIN, ON A 1-10, AND

3036
01:49:57,368 --> 01:49:58,636
USUALLY AS ONE OF OUR

3037
01:49:58,636 --> 01:50:01,305
PARTICIPANTS SAID I CAN ALWAYS

3038
01:50:01,305 --> 01:50:02,273
ANTICIPATE THEY ARE COMING TO

3039
01:50:02,273 --> 01:50:04,942
SEE ME, PAIN IS A 7, 8, OR 9.

3040
01:50:04,942 --> 01:50:06,511
THE QUESTION WHAT DOES THAT MEAN

3041
01:50:06,511 --> 01:50:07,545
FOR THE INDIVIDUAL, PEOPLE WERE

3042
01:50:07,545 --> 01:50:09,747
ASKING WHAT'S A 7 OR 8?

3043
01:50:09,747 --> 01:50:11,682
IS THERE A WAY TO QUALIFY THAT A

3044
01:50:11,682 --> 01:50:11,983
LITTLE BIT?

3045
01:50:11,983 --> 01:50:14,886
AND PARTLY THIS WAS THE VALUE OF

3046
01:50:14,886 --> 01:50:16,854
IS THAT DATA USEFUL TO US, WHAT

3047
01:50:16,854 --> 01:50:19,257
DO WE DO TO ACT ON IT AND ARE

3048
01:50:19,257 --> 01:50:20,992
THERE WAYS TO QUALIFY, MAKE IT

3049
01:50:20,992 --> 01:50:26,597
MEANINGFUL  AND PERSONAL, ALL

3050
01:50:26,597 --> 01:50:27,832
DATA ISN'T NECESSARILY BETTER,

3051
01:50:27,832 --> 01:50:29,000
IF IT'S ACTIONABLE, HELPS

3052
01:50:29,000 --> 01:50:31,202
IMPROVE THE CARE WE DELIVER AND

3053
01:50:31,202 --> 01:50:32,737
HELPS CONNECT PATIENTS BETTER TO

3054
01:50:32,737 --> 01:50:34,138
THE CARE THEY NEED.

3055
01:50:34,138 --> 01:50:37,742
SO THOSE ARE A FEW OF MY

3056
01:50:37,742 --> 01:50:38,009
TAKEAWAYS.

3057
01:50:38,009 --> 01:50:39,744
WE HAVE A COUPLE SLIDES, GREAT

3058
01:50:39,744 --> 01:50:41,178
CHAT, GOOD DISCUSSIONS ON A

3059
01:50:41,178 --> 01:50:42,613
VARIETY OF THINGS.

3060
01:50:42,613 --> 01:50:44,248
IS THERE ANYBODY FROM THE SMALL

3061
01:50:44,248 --> 01:50:45,583
GROUP WHO WANTED TO HARP ON A

3062
01:50:45,583 --> 01:50:47,518
POINT I MAY HAVE LEFT OUT?

3063
01:50:47,518 --> 01:50:50,922
I'D LOVE TO HEAR ANY OTHER

3064
01:50:50,922 --> 01:50:51,188
THINGS.

3065
01:50:51,188 --> 01:50:53,558
>> I WROTE DOWN IS MORE
DATA

3066
01:50:53,558 --> 01:50:53,991
BETTER.

3067
01:50:53,991 --> 01:50:55,293
>> YEAH.

3068
01:50:55,293 --> 01:50:57,161
>> BECAUSE I THINK WE'RE
ALL

3069
01:50:57,161 --> 01:50:58,029
GUILTY OF THAT.

3070
01:50:58,029 --> 01:51:00,665
I SEE SO MANY PEOPLE WE GO

3071
01:51:00,665 --> 01:51:01,499
CONFERENCES, TAKE PHOTOS EVEN OF

3072
01:51:01,499 --> 01:51:03,734
THE SLIDE OF THE SPEAKERS, OH,

3073
01:51:03,734 --> 01:51:05,169
THIS IS AMAZING, AND WE NEVER

3074
01:51:05,169 --> 01:51:06,304
LOOK AT THAT DATA AGAIN.

3075
01:51:06,304 --> 01:51:08,205
I THINK MANY TIMES WE COLLECT SO

3076
01:51:08,205 --> 01:51:10,074
MUCH DATA AND THAT GOES

3077
01:51:10,074 --> 01:51:10,341
UNNOTICED.

3078
01:51:10,341 --> 01:51:13,277
SO THIS QUESTION OF LIKE WHO IS

3079
01:51:13,277 --> 01:51:14,478
ACCESSING IT, THE PHYSICIAN,

3080
01:51:14,478 --> 01:51:18,516
MEDICAL TEAM, IS IT THE PATIENT,

3081
01:51:18,516 --> 01:51:19,617
YOU KNOW.

3082
01:51:19,617 --> 01:51:20,217
>> ABSOLUTELY.

3083
01:51:20,217 --> 01:51:21,485
I'LL JUST SAY WHILE WE'RE

3084
01:51:21,485 --> 01:51:23,788
WAITING, WE CAN MOVE ON TOO,

3085
01:51:23,788 --> 01:51:25,456
DOES THIS DATA HELP TO BRIDGE

3086
01:51:25,456 --> 01:51:26,624
THE EQUITY GAPS WE'VE BEEN

3087
01:51:26,624 --> 01:51:27,825
TALKING ABOUT SO MUCH.

3088
01:51:27,825 --> 01:51:29,894
IT WAS HIGHLIGHTED VERY NICELY

3089
01:51:29,894 --> 01:51:31,329
THAT EQUITY DOESN'T MEAN

3090
01:51:31,329 --> 01:51:32,663
EVERYBODY GETS THE SAME THING,

3091
01:51:32,663 --> 01:51:34,065
PEOPLE GET WHAT THEY NEED.

3092
01:51:34,065 --> 01:51:37,335
AND ARE THERE WAYS WE CAN --

3093
01:51:37,335 --> 01:51:38,970
A.I., WEARABLES OR OTHER

3094
01:51:38,970 --> 01:51:41,405
TECHNOLOGIES CAN HELP GET THEM

3095
01:51:41,405 --> 01:51:41,806
THERE.

3096
01:51:41,806 --> 01:51:47,211
>> IT'S A QUESTION OF LIKE
ARE

3097
01:51:47,211 --> 01:51:49,080
WE COLLECTING DATA BECAUSE WE

3098
01:51:49,080 --> 01:51:53,250
CAN OR IS THERE A PLAN  FOR THAT

3099
01:51:53,250 --> 01:51:53,751
DATA?

3100
01:51:53,751 --> 01:51:55,419
>> DOES IT HAVE MEANING.

3101
01:51:55,419 --> 01:51:55,720
>> YEAH.

3102
01:51:55,720 --> 01:51:56,420
>> THANKS FOR THE
OPPORTUNITY TO

3103
01:51:56,420 --> 01:51:57,421
REPORT OUT.

3104
01:51:57,421 --> 01:51:58,589
A GREAT WORKSHOP.

3105
01:51:58,589 --> 01:52:02,760
THANK YOU FOR THIS, FOR YOUR

3106
01:52:02,760 --> 01:52:03,427
WORK, FERNANDO.

3107
01:52:03,427 --> 01:52:05,396
>> MOVING ON NOW TO OUR
SMALL

3108
01:52:05,396 --> 01:52:07,264
GROUP 2, TELEHEALTH POLICY AND

3109
01:52:07,264 --> 01:52:11,402
EQUITY, BRIDGING GAPS IN ACCESS

3110
01:52:11,402 --> 01:52:13,938
AND CARE, I CALL THE CHIEF FOR

3111
01:52:13,938 --> 01:52:14,905
HEALTH COMMUNICATION INFORMATICS

3112
01:52:14,905 --> 01:52:18,309
RESEARCH BRANCH HERE AT NCI OF

3113
01:52:18,309 --> 01:52:19,176
THE NIH.

3114
01:52:19,176 --> 01:52:19,844
ROBIN, WELCOME.

3115
01:52:19,844 --> 01:52:20,645
>> THANK YOU.

3116
01:52:20,645 --> 01:52:21,846
I'VE BEEN HAVING AUDIO ISSUES,

3117
01:52:21,846 --> 01:52:24,682
CAN YOU HEAR ME?

3118
01:52:24,682 --> 01:52:26,017
>> NO PROBLEMS.

3119
01:52:26,017 --> 01:52:28,085
IF THERE'S PROBLEM WE'LL LET YOU

3120
01:52:28,085 --> 01:52:29,220
KNOW.

3121
01:52:29,220 --> 01:52:30,354
>> GREAT.

3122
01:52:30,354 --> 01:52:31,589
QUICKLY, I THINK YOU CAN

3123
01:52:31,589 --> 01:52:33,457
IMAGINE, ALREADY KNOW MANY OF

3124
01:52:33,457 --> 01:52:38,796
THE SOCIAL DETERMINANTS OF

3125
01:52:38,796 --> 01:52:40,898
HEALTH THAT WOULD AFFECT ACCESS,

3126
01:52:40,898 --> 01:52:44,168
AND EQUITABLE ACCESS AT THAT TO

3127
01:52:44,168 --> 01:52:44,969
TELEHEALTH SERVICES.

3128
01:52:44,969 --> 01:52:48,439
AND SO WE CERTAINLY IDENTIFIED

3129
01:52:48,439 --> 01:52:49,874
EVERYTHING FROM TRANSPORTATION

3130
01:52:49,874 --> 01:52:53,277
AND EDUCATION AND FOOD

3131
01:52:53,277 --> 01:52:56,213
INSECURITY TO FINANCIAL

3132
01:52:56,213 --> 01:52:58,015
RESOURCES, FAMILY INCOME,

3133
01:52:58,015 --> 01:52:59,617
BROADBAND ACCESS, DEFINITELY WAS

3134
01:52:59,617 --> 01:53:02,586
PART OF OUR CONVERSATION.

3135
01:53:02,586 --> 01:53:04,555
BUT THEN I THINK, YOU KNOW, A

3136
01:53:04,555 --> 01:53:06,290
NEWER COMPONENT THAT WE THINK

3137
01:53:06,290 --> 01:53:09,260
ABOUT RELATED TO HEALTH LITERACY

3138
01:53:09,260 --> 01:53:13,964
IS DIGITAL LITERACY, RIGHT?

3139
01:53:13,964 --> 01:53:16,033
THINKING ABOUT HOW PATIENTS, YOU

3140
01:53:16,033 --> 01:53:17,568
KNOW, REALLY PERCEIVE THIS

3141
01:53:17,568 --> 01:53:19,670
TECHNOLOGY, ARE THEY ABLE TO USE

3142
01:53:19,670 --> 01:53:22,273
IT, DO THEY HAVE AN E-MAIL

3143
01:53:22,273 --> 01:53:23,507
ADDRESS THAT ALLOWS THEM, YOU

3144
01:53:23,507 --> 01:53:26,010
KNOW, TO EVEN GET THE LINK TO

3145
01:53:26,010 --> 01:53:27,411
LOG IN TO THE TELEHEALTH

3146
01:53:27,411 --> 01:53:28,512
ENCOUNTER, FOR EXAMPLE.

3147
01:53:28,512 --> 01:53:31,048
AND THEN MAKING SURE PATIENTS

3148
01:53:31,048 --> 01:53:34,318
HAVE ACCESS TO THE DEVICES,

3149
01:53:34,318 --> 01:53:36,954
SOFTWARE, EQUIPMENT, WHATEVER

3150
01:53:36,954 --> 01:53:40,658
TECHNOLOGY IS NEEDED TO ACCESS

3151
01:53:40,658 --> 01:53:41,425
THOSE TELEHEALTH SERVICES.

3152
01:53:41,425 --> 01:53:44,462
AND SO WE SPENT THE REST OF THE

3153
01:53:44,462 --> 01:53:46,664
TIME THINKING ABOUT OBVIOUSLY

3154
01:53:46,664 --> 01:53:51,368
WHAT STRATEGIES, WHAT RESEARCH,

3155
01:53:51,368 --> 01:53:53,571
WHAT COMMUNITY PARTNERSHIPS CAN

3156
01:53:53,571 --> 01:53:55,706
BE FACILITATE AND LEVERAGED TO

3157
01:53:55,706 --> 01:53:57,141
IMPROVE ACCESS TO TELEHEALTH

3158
01:53:57,141 --> 01:53:58,576
SERVICES, TO ADDRESS THESE

3159
01:53:58,576 --> 01:54:01,212
SOCIAL DETERMINANTS OF HEALTH.

3160
01:54:01,212 --> 01:54:03,814
AND OUR GROUP REALLY HAD LOT OF

3161
01:54:03,814 --> 01:54:05,015
THOUGHT AND INTERACTION, FOR

3162
01:54:05,015 --> 01:54:08,319
EXAMPLE, AROUND WORKING WITH

3163
01:54:08,319 --> 01:54:11,489
PUBLIC LIBRARIES OF THOSE BEING

3164
01:54:11,489 --> 01:54:13,457
REALLY STRONG COMMUNITY, YOU

3165
01:54:13,457 --> 01:54:15,993
KNOW, POINT OF CONTACT FOR FOLKS

3166
01:54:15,993 --> 01:54:18,395
TO COME IN AND ACCESS BOTH THE

3167
01:54:18,395 --> 01:54:20,464
INTERNET, TO ACCESS ACTUAL

3168
01:54:20,464 --> 01:54:22,233
COMPUTER SERVICES, BUT ALSO AS

3169
01:54:22,233 --> 01:54:24,301
YOU KNOW LIBRARIES CAN PROVIDE

3170
01:54:24,301 --> 01:54:26,036
TRAINING SERVICES AND CLASSES

3171
01:54:26,036 --> 01:54:27,805
ABOUT WHAT IS TELEHEALTH, WHAT

3172
01:54:27,805 --> 01:54:30,007
IS YOUR EHR PORTAL AND HOW DO

3173
01:54:30,007 --> 01:54:31,842
YOU ACCESS THAT.

3174
01:54:31,842 --> 01:54:36,380
WE TALKED ABOUT FAITH

3175
01:54:36,380 --> 01:54:37,648
ORGANIZATIONS, FAITH MINISTRIES,

3176
01:54:37,648 --> 01:54:40,417
SCHOOLS WHO OFTEN SERVE AGAIN AS

3177
01:54:40,417 --> 01:54:41,385
A RESOURCE HUB IN OUR

3178
01:54:41,385 --> 01:54:44,355
COMMUNITIES AND HOW THOSE COULD

3179
01:54:44,355 --> 01:54:46,657
BE LEVERAGED TO ACCESS

3180
01:54:46,657 --> 01:54:47,491
TELEHEALTH SERVICES.

3181
01:54:47,491 --> 01:54:51,362
WE ALSO TALKED A LOT ABOUT

3182
01:54:51,362 --> 01:54:52,263
TECHNICAL ASSISTANCE AND

3183
01:54:52,263 --> 01:54:54,331
TRAINING FOR PATIENTS AND THEIR

3184
01:54:54,331 --> 01:54:56,300
CAREGIVERS ON HOW TO JUST LEARN

3185
01:54:56,300 --> 01:54:57,835
HOW TO USE TELEHEALTH.

3186
01:54:57,835 --> 01:55:00,237
WHAT DOES THE EHR PORTAL OFFER

3187
01:55:00,237 --> 01:55:01,005
ME?

3188
01:55:01,005 --> 01:55:02,873
HOW DOES A TELEHEALTH ENCOUNTER

3189
01:55:02,873 --> 01:55:03,307
WORK?

3190
01:55:03,307 --> 01:55:05,743
CAN WE WORK THROUGH SOME OF THE

3191
01:55:05,743 --> 01:55:07,111
BUMPS AND BUGS OF GETTING FOLKS

3192
01:55:07,111 --> 01:55:10,214
LOGGED ON SO THEY ARE READY TO

3193
01:55:10,214 --> 01:55:12,516
GO WHEN THE PROVIDER IS PRESENT

3194
01:55:12,516 --> 01:55:14,251
IN THE VIRTUAL ROOM.

3195
01:55:14,251 --> 01:55:18,522
SO THINKING ABOUT TELEHEALTH

3196
01:55:18,522 --> 01:55:20,057
COORDINATORS, TELEHEALTH

3197
01:55:20,057 --> 01:55:20,591
NAVIGATORS.

3198
01:55:20,591 --> 01:55:22,259
AND THEN AGAIN UNDERSTANDING

3199
01:55:22,259 --> 01:55:24,094
PATIENT PREFERENCES AND

3200
01:55:24,094 --> 01:55:25,529
SATISFACTION WITH DIFFERENT

3201
01:55:25,529 --> 01:55:26,997
ROUTES OF DELIVERING TELEHEALTH,

3202
01:55:26,997 --> 01:55:29,033
WHETHER ON COMPUTER OR

3203
01:55:29,033 --> 01:55:30,334
SMARTPHONE OR AUDIO ONLY.

3204
01:55:30,334 --> 01:55:34,171
BUT THEN REALLY GETTING INTO

3205
01:55:34,171 --> 01:55:34,705
USABILITY, COMFORTABILITY,

3206
01:55:34,705 --> 01:55:35,906
SATISFACTION, YOU KNOW, SO WE

3207
01:55:35,906 --> 01:55:38,008
CAN MEET PATIENTS WHERE THEY

3208
01:55:38,008 --> 01:55:38,175
ARE.

3209
01:55:38,175 --> 01:55:39,977
AND I THINK, YOU KNOW, THEN

3210
01:55:39,977 --> 01:55:41,612
THINGS WE TALKED ABOUT THIS

3211
01:55:41,612 --> 01:55:45,015
MORNING RESONATED WITH US AROUND

3212
01:55:45,015 --> 01:55:47,318
FOCUSING ON OUTCOMES, HOW DOES

3213
01:55:47,318 --> 01:55:48,118
TELEHEALTH IMPROVE OUTCOMES

3214
01:55:48,118 --> 01:55:50,487
RELATED TO IMPROVEMENTS IN

3215
01:55:50,487 --> 01:55:52,690
NO-SHOW RATE, ACCESS IN

3216
01:55:52,690 --> 01:55:55,059
SPECIALTY CARE, HOW DOES IT COME

3217
01:55:55,059 --> 01:55:57,494
COMPLEMENT IN PATIENT OR

3218
01:55:57,494 --> 01:55:58,395
IN-PERSON SERVICES.

3219
01:55:58,395 --> 01:56:00,497
AND JUST DEEP DIVES IN THE DATA

3220
01:56:00,497 --> 01:56:02,099
TO HELP US UNDERSTAND

3221
01:56:02,099 --> 01:56:04,869
DISPARITIES, MAYBE WE NEED TO BE

3222
01:56:04,869 --> 01:56:11,275
WORKING WITH EHR COMPANIES AND

3223
01:56:11,275 --> 01:56:11,876
TELEHEALTH DIRECT-TO-CONSUMER

3224
01:56:11,876 --> 01:56:12,977
COMPANIES TO SEE WHO IS

3225
01:56:12,977 --> 01:56:15,045
ACCESSING TELEHEALTH AND WHO IS

3226
01:56:15,045 --> 01:56:17,114
NOT ACCESSING TELEHEALTH.

3227
01:56:17,114 --> 01:56:19,850
AND I THINK WITH THAT I'LL

3228
01:56:19,850 --> 01:56:21,151
PROBABLY -- OH, OF COURSE ONE OF

3229
01:56:21,151 --> 01:56:23,354
THE BIGGER POINTS WE TALKED

3230
01:56:23,354 --> 01:56:27,191
ABOUT IS HOW TO IMPROVE THE

3231
01:56:27,191 --> 01:56:28,592
CROSS--STATE-LINE ISSUES WE SEE

3232
01:56:28,592 --> 01:56:32,463
RIGHT NOW AND EVERYBODY CAME

3233
01:56:32,463 --> 01:56:34,965
BACK TO FLEXIBILITY, NATIONAL

3234
01:56:34,965 --> 01:56:40,804
POLICIES, DOING EDUCATION AND

3235
01:56:40,804 --> 01:56:44,174
OUTREACH TO POLICYMAKERS ARE

3236
01:56:44,174 --> 01:56:44,808
IMPORTANT, AND IMPROVING

3237
01:56:44,808 --> 01:56:47,912
REIMBURSEMENT AND WE HAD

3238
01:56:47,912 --> 01:56:50,447
DISCUSSIONS ABOUT IMPROVING OUR

3239
01:56:50,447 --> 01:56:51,749
OFFERING OF LANGUAGE TRANSLATION

3240
01:56:51,749 --> 01:56:52,716
SERVICES FOR TELEHEALTH USE AND

3241
01:56:52,716 --> 01:56:56,020
MAYBE HOW COULD YOU USE

3242
01:56:56,020 --> 01:56:57,021
TECHNOLOGY TO TRANSLATE IN REAL

3243
01:56:57,021 --> 01:56:57,221
TIME.

3244
01:56:57,221 --> 01:57:00,391
I KNOW THAT COULD BE PART OF OUR

3245
01:57:00,391 --> 01:57:02,359
CONVERSATION LATER THIS

3246
01:57:02,359 --> 01:57:02,626
AFTERNOON.

3247
01:57:02,626 --> 01:57:04,995
WITH THAT I WANT TO MOVE, I KNOW

3248
01:57:04,995 --> 01:57:06,864
WE'RE SHORT ON TIME BUT THOSE

3249
01:57:06,864 --> 01:57:08,165
WERE GREAT CONVERSATION STARTING

3250
01:57:08,165 --> 01:57:10,134
POINTS IN OUR GROUP.

3251
01:57:10,134 --> 01:57:12,002
>> THANK YOU, ROBIN AND
GROUP 2.

3252
01:57:12,002 --> 01:57:14,405
I WAS ALSO THINKING HERE THAT

3253
01:57:14,405 --> 01:57:17,574
NOT ONLY THE HEALTHCARE

3254
01:57:17,574 --> 01:57:20,644
PROFESSIONALS ALSO HAVE THE

3255
01:57:20,644 --> 01:57:23,714
CHALLENGE WITH ELECTRONIC

3256
01:57:23,714 --> 01:57:27,084
MEDICAL RECORDS YET EXPECT

3257
01:57:27,084 --> 01:57:28,953
PATIENTS USING PLATFORMS TO

3258
01:57:28,953 --> 01:57:29,853
FULLY UNDERSTAND THEM WHEN EVEN

3259
01:57:29,853 --> 01:57:31,689
THOSE NOT USING THEM DAY, IT

3260
01:57:31,689 --> 01:57:34,091
SEEMS LIKE YOUR GROUP DISCUSSED

3261
01:57:34,091 --> 01:57:34,959
THIS PROCESS OF CAPACITY

3262
01:57:34,959 --> 01:57:35,225
BUILDING.

3263
01:57:35,225 --> 01:57:40,331
I LIKE WHAT YOU SAID ALSO

3264
01:57:40,331 --> 01:57:41,966
TAPPING INTO THE CAREGIVER, ARE

3265
01:57:41,966 --> 01:57:43,600
CARE GIVERS HELPING TRAIN AND

3266
01:57:43,600 --> 01:57:44,835
BRINGS TO MIND SOMETHING I

3267
01:57:44,835 --> 01:57:46,370
STARTED IN UNITED STATES

3268
01:57:46,370 --> 01:57:48,238
SCHOOLS, HERE IN VIRGINIA, WE

3269
01:57:48,238 --> 01:57:49,873
ALSO HAVE IT, WHICH IS DIGITAL

3270
01:57:49,873 --> 01:57:53,043
CITIZEN IS ONE OF THE COURSES

3271
01:57:53,043 --> 01:57:53,911
NOW THEY OFFER FOR CHILDREN,

3272
01:57:53,911 --> 01:57:57,314
WHEN THEY ARE IN FIFTH GRADE,

3273
01:57:57,314 --> 01:57:59,183
ABOUT TEACHING THESE FIFTH

3274
01:57:59,183 --> 01:58:04,989
GRADERS HOW THEY BECOME

3275
01:58:04,989 --> 01:58:07,725
PEOPLE -- THEY TALK ABOUT

3276
01:58:07,725 --> 01:58:09,493
PHISHING, SCAMS, PROFILES,

3277
01:58:09,493 --> 01:58:10,160
SHARING INFORMATION, PERHAPS

3278
01:58:10,160 --> 01:58:12,096
SOMETHING WE CAN FOCUS ON

3279
01:58:12,096 --> 01:58:14,198
CAPACITY BUILDING.

3280
01:58:14,198 --> 01:58:15,833
NOW GIVEN THE LAST QUESTION,

3281
01:58:15,833 --> 01:58:18,135
BACK TO YOU, ROBIN, WHEN WE

3282
01:58:18,135 --> 01:58:19,336
DISCUSSED THIS CHANGING POLICY

3283
01:58:19,336 --> 01:58:20,771
THAT YOU ARE PROPOSING OBVIOUSLY

3284
01:58:20,771 --> 01:58:22,840
ALL THESE CHALLENGES ARE

3285
01:58:22,840 --> 01:58:23,273
MULTI-FACTORIAL.

3286
01:58:23,273 --> 01:58:25,909
AND WE TALK ABOUT CHANGING

3287
01:58:25,909 --> 01:58:27,011
POLICIES, CREATING MORE

3288
01:58:27,011 --> 01:58:29,213
FLEXIBILITY OF THE POLICIES, HOW

3289
01:58:29,213 --> 01:58:31,215
CAN THE RESEARCH ACTUALLY INFORM

3290
01:58:31,215 --> 01:58:32,316
THESE POLICIES, WHAT WAS

3291
01:58:32,316 --> 01:58:34,284
DISCUSSED IN YOUR GROUP IN TERMS

3292
01:58:34,284 --> 01:58:37,287
OF NEXT STEPS IN RESEARCH?

3293
01:58:37,287 --> 01:58:39,223
>> YEAH, I THINK -- WELL,
WE

3294
01:58:39,223 --> 01:58:42,793
RANGE ON A LOT OF TOPICS,

3295
01:58:42,793 --> 01:58:44,228
LEVERAGING DATA, USING DATA

3296
01:58:44,228 --> 01:58:45,529
THAT'S AVAILABLE SO THAT'S MAYBE

3297
01:58:45,529 --> 01:58:48,465
DATA WE HAVEN'T TAPPED INTO

3298
01:58:48,465 --> 01:58:49,900
FULLY YET TO REALLY UNDERSTAND

3299
01:58:49,900 --> 01:58:51,001
THE PROBLEM, RIGHT?

3300
01:58:51,001 --> 01:58:53,070
THAT'S ALWAYS AN IMPORTANT FIRST

3301
01:58:53,070 --> 01:58:53,837
STEP.

3302
01:58:53,837 --> 01:58:56,907
AND THEN I THINK THERE WAS THESE

3303
01:58:56,907 --> 01:58:58,108
PIECES AROUND DO WE STOP AND

3304
01:58:58,108 --> 01:59:01,745
REALLY DO MAYBE SOME OF THE

3305
01:59:01,745 --> 01:59:03,380
QUALITATIVE, IF YOU WILL, WORK

3306
01:59:03,380 --> 01:59:06,550
OR USABILITY WORK WITH PATIENTS

3307
01:59:06,550 --> 01:59:08,318
AND CAREGIVERS, AND PROVIDERS,

3308
01:59:08,318 --> 01:59:11,722
TO REALLY UNDERSTAND THEIR

3309
01:59:11,722 --> 01:59:13,123
PREFERENCES, THEIR SATISFACTION,

3310
01:59:13,123 --> 01:59:13,857
THEIR USABILITY.

3311
01:59:13,857 --> 01:59:15,859
YOU KNOW, REALLY THAT

3312
01:59:15,859 --> 01:59:16,493
PATIENT-CENTERED APPROACH TO

3313
01:59:16,493 --> 01:59:20,297
FIGURING OUT WHAT WORKS FOR THEM

3314
01:59:20,297 --> 01:59:22,733
AND DOING THE -- DELIVERING

3315
01:59:22,733 --> 01:59:23,500
TAILORED INTERVENTIONS AND

3316
01:59:23,500 --> 01:59:24,701
PROGRAMMING AFTER THAT.

3317
01:59:24,701 --> 01:59:26,003
CERTAINLY FOR THE LARGER POLICY

3318
01:59:26,003 --> 01:59:28,572
PIECE, I THINK WHERE WE CAN

3319
01:59:28,572 --> 01:59:32,142
COLLECT, FOR EXAMPLE, YOU KNOW,

3320
01:59:32,142 --> 01:59:33,877
USE DATA, QUALITY METRICS, YOU

3321
01:59:33,877 --> 01:59:35,879
KNOW, REALLY CHANGING I WOULD

3322
01:59:35,879 --> 01:59:38,182
ARGUE SOCIAL NORMS AROUND

3323
01:59:38,182 --> 01:59:40,250
TELEHEALTH, I THINK THAT FEEDS

3324
01:59:40,250 --> 01:59:43,220
TO WHAT POLICYMAKERS NEED AS THE

3325
01:59:43,220 --> 01:59:44,088
EVIDENCE THAT TELEHEALTH IS A

3326
01:59:44,088 --> 01:59:50,527
GOOD THING AND THAT WE NEED TO

3327
01:59:50,527 --> 01:59:52,830
CONTINUE IMPROVING THE

3328
01:59:52,830 --> 01:59:53,397
FLEXIBILITY'S REIMBURSEMENT,

3329
01:59:53,397 --> 01:59:55,065
LICENSURE ISSUE, ET CETERA, TO

3330
01:59:55,065 --> 01:59:57,367
MAKE THIS MORE WIDESPREAD, MORE

3331
01:59:57,367 --> 01:59:58,802
SCALABLE, MORE ACCESSIBLE.

3332
01:59:58,802 --> 01:59:59,136
>> PERFECT.

3333
01:59:59,136 --> 02:00:00,571
THANKS SO MUCH, ROBIN.

3334
02:00:00,571 --> 02:00:01,572
I APPRECIATE IT.

3335
02:00:01,572 --> 02:00:03,040
THANK YOU, GROUP 2.

3336
02:00:03,040 --> 02:00:08,078
NOW WE MOVE FOR THE REPORT FROM

3337
02:00:08,078 --> 02:00:09,513
GROUP 3, INFRASTRUCTURE AND

3338
02:00:09,513 --> 02:00:11,148
TECHNOLOGICAL CHALLENGES, PEOPLE

3339
02:00:11,148 --> 02:00:13,117
WERE HIGHLY ENGAGED, WE BARELY

3340
02:00:13,117 --> 02:00:14,218
FELT MOTIVATED TO COME BACK TO

3341
02:00:14,218 --> 02:00:15,452
THE MAIN ROOM BECAUSE WE WANTED

3342
02:00:15,452 --> 02:00:20,457
TO STAY THERE.

3343
02:00:20,457 --> 02:00:24,194
I INVITE DR. LOK SAMSON, HHS

3344
02:00:24,194 --> 02:00:26,430
OFFICE OF ASSISTANT SECRETARY

3345
02:00:26,430 --> 02:00:29,032
FOR PLANNING, PLEASE FEEL FREE

3346
02:00:29,032 --> 02:00:31,201
TO SHARE YOUR PERSPECTIVES.

3347
02:00:31,201 --> 02:00:33,937
>> OUR GROUP DUG INTO
TELEHEALTH

3348
02:00:33,937 --> 02:00:34,705
INFRASTRUCTURE AND TECHNOLOGICAL

3349
02:00:34,705 --> 02:00:35,906
BARRIERS.

3350
02:00:35,906 --> 02:00:40,377
WE HAD A GOOD USE CASE FOR

3351
02:00:40,377 --> 02:00:42,913
PEDIATRIC TELEREHAB, THERE WAS

3352
02:00:42,913 --> 02:00:44,982
INFRASTRUCTURE VARIANTS IN TERMS

3353
02:00:44,982 --> 02:00:46,316
OF EQUIPMENT, EXERCISE

3354
02:00:46,316 --> 02:00:47,317
EQUIPMENT, AFFORDABILITY FOR

3355
02:00:47,317 --> 02:00:49,153
PATIENTS, BUT ALSO ESPECIALLY

3356
02:00:49,153 --> 02:00:52,089
FOR PEDIATRICS, ALL THE DEVICES

3357
02:00:52,089 --> 02:00:54,458
ARE NOT REALLY DESIGNED FOR

3358
02:00:54,458 --> 02:00:55,058
CHILDREN.

3359
02:00:55,058 --> 02:00:57,027
THERE ARE PRIVACY AND LIABILITY

3360
02:00:57,027 --> 02:01:00,564
ISSUES WITH HAVING CHILDREN

3361
02:01:00,564 --> 02:01:04,368
DIRECTLY USE THESE APPS,

3362
02:01:04,368 --> 02:01:07,204
CONNECTED TO EXERCISE EQUIPMENT,

3363
02:01:07,204 --> 02:01:09,606
AND WORK-AROUND USING PARENT'S

3364
02:01:09,606 --> 02:01:10,374
PHONE, PARENT'S ACCOUNTS, THIS

3365
02:01:10,374 --> 02:01:13,577
MIGHT BE A TEENAGER THAT HAS THE

3366
02:01:13,577 --> 02:01:14,978
EQUIPMENT, HAS A PHONE THAT

3367
02:01:14,978 --> 02:01:19,483
CAN'T USE THEIR OWN PHONE.

3368
02:01:19,483 --> 02:01:21,785
THERE WERE ALSO SPECIAL

3369
02:01:21,785 --> 02:01:23,987
POPULATIONS WHERE THERE MIGHT BE

3370
02:01:23,987 --> 02:01:27,157
HESITANCY TO USE INTERNET AND

3371
02:01:27,157 --> 02:01:29,560
OTHER TECHNOLOGIES, AND MIGHT

3372
02:01:29,560 --> 02:01:31,428
NEED SPECIAL EXEMPTIONS FROM

3373
02:01:31,428 --> 02:01:35,365
RELIGIOUS LEADERS TO USE THESE

3374
02:01:35,365 --> 02:01:36,900
KINDS OF TELEHEALTH

3375
02:01:36,900 --> 02:01:38,535
TECHNOLOGIES.

3376
02:01:38,535 --> 02:01:41,805
IN TERMS OF AFFORDABILITY SOME

3377
02:01:41,805 --> 02:01:42,573
WORKAROUNDS IN GETTING INTERNET

3378
02:01:42,573 --> 02:01:44,408
ACCESS AT LEAST FOR RESEARCHERS

3379
02:01:44,408 --> 02:01:47,945
WHO HAVE GRANTS MIGHT BE TO

3380
02:01:47,945 --> 02:01:49,780
OFFER A SIM CARD, ESPECIALLY IN

3381
02:01:49,780 --> 02:01:51,982
RURAL AREAS WHERE THERE'S NO

3382
02:01:51,982 --> 02:01:54,084
BROADBAND ACCESS.

3383
02:01:54,084 --> 02:01:57,454
SO THESE EXAMPLES GIVE A FLAVOR

3384
02:01:57,454 --> 02:01:58,555
OF THE ON-THE-GROUND BARRIERS

3385
02:01:58,555 --> 02:02:00,591
PATIENTS ARE FACING WHERE

3386
02:02:00,591 --> 02:02:01,758
TELEHEALTH COULD HAVE A LOT OF

3387
02:02:01,758 --> 02:02:04,494
IMPACT ESPECIALLY IN RURAL AREAS

3388
02:02:04,494 --> 02:02:07,097
WHERE PEOPLE DON'T HAVE THAT

3389
02:02:07,097 --> 02:02:11,001
BROADBAND ACCESS.

3390
02:02:11,001 --> 02:02:12,336
ADDITIONAL WORKAROUNDS EXAMPLES

3391
02:02:12,336 --> 02:02:14,705
INCLUDED PATIENTS GOING TO THE

3392
02:02:14,705 --> 02:02:17,207
SCHOOL TO ACCESS EQUIPMENT AND

3393
02:02:17,207 --> 02:02:18,041
THE INTERNET.

3394
02:02:18,041 --> 02:02:19,376
AND I GUESS THE QUESTION HERE

3395
02:02:19,376 --> 02:02:20,911
WAS FROM THE GROUP, WHAT KIND OF

3396
02:02:20,911 --> 02:02:23,347
RESEARCH DO WE NEED, WHO DOESN'T

3397
02:02:23,347 --> 02:02:26,216
HAVE ACCESS, WHAT DO WE REALLY

3398
02:02:26,216 --> 02:02:28,819
KNOW ABOUT THESE SPECIAL GROUPS.

3399
02:02:28,819 --> 02:02:31,788
THERE WAS ALSO POLICY

3400
02:02:31,788 --> 02:02:33,690
LIMITATIONS, ESPECIALLY IN TERMS

3401
02:02:33,690 --> 02:02:37,294
OF EQUIPMENT, OFTEN HALF THE

3402
02:02:37,294 --> 02:02:40,163
TOOLS USE A MULTI-PAYER APPROACH

3403
02:02:40,163 --> 02:02:42,232
TO THEIR RULES, AND THERE ARE

3404
02:02:42,232 --> 02:02:44,101
LIMITS ON WHAT AMOUNT OF GIFTS

3405
02:02:44,101 --> 02:02:46,069
PATIENTS CAN RECEIVE EVEN IN THE

3406
02:02:46,069 --> 02:02:47,804
FORM OF EQUIPMENT.

3407
02:02:47,804 --> 02:02:50,440
SO THIS SORT OF BRINGS SORT OF

3408
02:02:50,440 --> 02:02:54,811
TELEHEALTH AND THE INTERSECTION

3409
02:02:54,811 --> 02:02:56,013
WITH HEALTHCARE POLICIES

3410
02:02:56,013 --> 02:02:56,480
TOGETHER.

3411
02:02:56,480 --> 02:02:58,315
ONE THOUGHT ALSO WAS THAT IN

3412
02:02:58,315 --> 02:03:00,050
TERMS OF INTERNET ACCESS, WHAT

3413
02:03:00,050 --> 02:03:03,787
DO WE KNOW ABOUT THE IMPACT OF

3414
02:03:03,787 --> 02:03:05,222
THE BROADBAND AFFORDABILITY

3415
02:03:05,222 --> 02:03:06,757
CONNECTIVITY PROGRAM THAT

3416
02:03:06,757 --> 02:03:07,524
RECENTLY ENDED.

3417
02:03:07,524 --> 02:03:09,926
AND, YOU KNOW, ARE THERE -- IS

3418
02:03:09,926 --> 02:03:11,795
THERE RESEARCH THAT CAN TELL US

3419
02:03:11,795 --> 02:03:13,630
IF IT IMPROVED ACCESS OR IF

3420
02:03:13,630 --> 02:03:15,399
THERE'S STILL OPPORTUNITIES TO

3421
02:03:15,399 --> 02:03:19,136
IMPROVE ACCESS FOR SPECIAL

3422
02:03:19,136 --> 02:03:19,670
POPULATIONS.

3423
02:03:19,670 --> 02:03:24,041
IN TERMS OF THE SECOND QUESTION

3424
02:03:24,041 --> 02:03:27,144
WE EXPLORED INTEROPERABLE DATA

3425
02:03:27,144 --> 02:03:28,245
EXCHANGES, AN AREA WITH

3426
02:03:28,245 --> 02:03:31,181
DISCUSSION ABOUT LIMITED ACCESS

3427
02:03:31,181 --> 02:03:32,516
TO DATA FROM WEARABLES,

3428
02:03:32,516 --> 02:03:36,253
CHALLENGES IN PULLING DATA

3429
02:03:36,253 --> 02:03:38,889
ACROSS DIFFERENT VENDORS,

3430
02:03:38,889 --> 02:03:40,490
ESPECIALLY FOR RESEARCH, AND

3431
02:03:40,490 --> 02:03:41,825
WITH CHANGES IN TECHNOLOGY AS

3432
02:03:41,825 --> 02:03:43,360
THE MARKET CHANGES THERE'S

3433
02:03:43,360 --> 02:03:45,662
REALLY NO CENTRAL PLATFORM FOR

3434
02:03:45,662 --> 02:03:49,833
DATA SHARING, WHICH MAKES IT

3435
02:03:49,833 --> 02:03:52,102
CHALLENGING FOR RESEARCHERS AND

3436
02:03:52,102 --> 02:03:53,637
ALSO PARTICIPANTS WHO MAYBE

3437
02:03:53,637 --> 02:03:54,971
HAVING DIFFERENT DEVICES WANT TO

3438
02:03:54,971 --> 02:03:57,474
USE THE INFORMATION FOR THEIR

3439
02:03:57,474 --> 02:03:59,343
OWN CARE.

3440
02:03:59,343 --> 02:04:03,847
ONE AREA WE DISCUSSED WAS

3441
02:04:03,847 --> 02:04:04,648
ELIMINATING CONTEXT ESPECIALLY

3442
02:04:04,648 --> 02:04:06,383
WITH WEARABLE DATA.

3443
02:04:06,383 --> 02:04:08,018
IT'S DIFFICULT TO INTERPRET THE

3444
02:04:08,018 --> 02:04:09,753
MEANING OF THE WEARABLE

3445
02:04:09,753 --> 02:04:12,155
INFORMATION WITHOUT KNOWING WHAT

3446
02:04:12,155 --> 02:04:13,590
MEDICATIONS OR LIFESTYLE CHANGES

3447
02:04:13,590 --> 02:04:15,459
A PATIENT MIGHT BE UNDERTAKING.

3448
02:04:15,459 --> 02:04:18,962
AND THAT MAKES IT HARDER FOR

3449
02:04:18,962 --> 02:04:22,666
CLINICIANS TO USE THAT

3450
02:04:22,666 --> 02:04:24,868
INFORMATION.

3451
02:04:24,868 --> 02:04:25,535
LET'S SEE.

3452
02:04:25,535 --> 02:04:29,706
THERE ARE ALSO SORT OF

3453
02:04:29,706 --> 02:04:33,210
TECHNOLOGICAL LIMITATIONS, JUST

3454
02:04:33,210 --> 02:04:37,681
MAKING DATA USEFUL FOR PATIENTS,

3455
02:04:37,681 --> 02:04:39,216
PATIENTS REQUIRED TO WEAR THE

3456
02:04:39,216 --> 02:04:40,951
DEVICE FOR THREE DAYS TO

3457
02:04:40,951 --> 02:04:42,052
ESTABLISH A BASELINE SO SOME

3458
02:04:42,052 --> 02:04:44,054
QUESTIONS IS THERE A NEED FOR

3459
02:04:44,054 --> 02:04:46,556
TRIALS OF REMOTE PATIENT

3460
02:04:46,556 --> 02:04:48,325
MONITORING, WITH CURRENT TOOLS

3461
02:04:48,325 --> 02:04:49,960
ON THE MARKET MIGHT BE

3462
02:04:49,960 --> 02:04:50,861
INSUFFICIENT RIGHT NOW TO

3463
02:04:50,861 --> 02:04:52,696
DETERMINE WHAT REALLY WORKS.

3464
02:04:52,696 --> 02:04:54,264
BUT THERE ARE GROWING

3465
02:04:54,264 --> 02:04:55,265
OPPORTUNITIES, ESPECIALLY WITH

3466
02:04:55,265 --> 02:04:59,302
NEW DEVICES, SUCH AS BIOCHEMICAL

3467
02:04:59,302 --> 02:05:01,571
PATCHES FOR MONITORING THAT

3468
02:05:01,571 --> 02:05:04,641
WOULD BETTER SUPPORT CORRELATION

3469
02:05:04,641 --> 02:05:06,176
BETWEEN THE WEARABLE INFORMATION

3470
02:05:06,176 --> 02:05:11,181
AND OUTCOMES THAT THAT'S WHAT

3471
02:05:11,181 --> 02:05:12,082
CLINICIANS WANT.

3472
02:05:12,082 --> 02:05:12,883
>> THANK YOU.

3473
02:05:12,883 --> 02:05:14,050
I SEE SIMILARITIES ON WHAT

3474
02:05:14,050 --> 02:05:16,920
YOU'RE SAYING AND WHAT ROBIN

3475
02:05:16,920 --> 02:05:19,256
JUST SAID ALSO ABOUT THE

3476
02:05:19,256 --> 02:05:20,490
FLEXIBILITY OF POLICIES, A LOT

3477
02:05:20,490 --> 02:05:26,196
OF THINGS THAT BOB HAS SPOKEN

3478
02:05:26,196 --> 02:05:27,164
ABOUT HOW MUCH COLLECTION OF

3479
02:05:27,164 --> 02:05:28,598
DATA IS USEFUL.

3480
02:05:28,598 --> 02:05:29,933
FOR YOUR PARTICULAR SMALL GROUP

3481
02:05:29,933 --> 02:05:31,902
SESSION, A LOT OF THIS WILL BE A

3482
02:05:31,902 --> 02:05:34,738
SEGUE TO THE NEXT SESSION AFTER

3483
02:05:34,738 --> 02:05:36,473
WE FINISH THIS REPORT-BACK WHICH

3484
02:05:36,473 --> 02:05:38,575
WILL FOCUS ON mHEALTH AND

3485
02:05:38,575 --> 02:05:44,181
REMOTE MORE 

3486
02:05:44,181 --> 02:05:45,382
REMOTE MONITORING AND DATA

3487
02:05:45,382 --> 02:05:46,917
ANALYSIS, ALSO WHEN DATA ARE

3488
02:05:46,917 --> 02:05:47,484
COLLECTED FROM MULTIPLE

3489
02:05:47,484 --> 02:05:51,221
PLATFORMS THAT DON'T SPEAK WITH

3490
02:05:51,221 --> 02:05:54,391
ONE ANOTHER HOW CAN WE

3491
02:05:54,391 --> 02:05:54,658
INTEGRATE.

3492
02:05:54,658 --> 02:05:56,259
WE APPRECIATE GROUP 3 FOR THE

3493
02:05:56,259 --> 02:05:56,526
FEEDBACK.

3494
02:05:56,526 --> 02:05:57,227
>> THANK YOU.

3495
02:05:57,227 --> 02:05:59,863
>> WE MOVE NOW TO OUR LAST

3496
02:05:59,863 --> 02:06:02,065
GROUP, SMALL GROUP 4, ENHANCING

3497
02:06:02,065 --> 02:06:06,436
PATIENT ENGAGEMENT AND

3498
02:06:06,436 --> 02:06:08,605
SATISFACTION THROUGH TELEHEALTH.

3499
02:06:08,605 --> 02:06:10,574
NOW THE DIRECTOR FOR PRACTICE

3500
02:06:10,574 --> 02:06:13,443
IMPROVEMENT, CENTER FOR EVIDENCE

3501
02:06:13,443 --> 02:06:17,047
AND PRACTICE IMPROVEMENT AT

3502
02:06:17,047 --> 02:06:19,349
AHRQ. 

3503
02:06:19,349 --> 02:06:21,218
PLEASE TAKE IT AWAY.

3504
02:06:21,218 --> 02:06:24,321
>> WE HAVE A SMALL GROUP,

3505
02:06:24,321 --> 02:06:26,122
EVERYBODY REALLY ENGAGING WITH

3506
02:06:26,122 --> 02:06:27,924
DISCUSSIONS AND PLEASE CORRECT

3507
02:06:27,924 --> 02:06:29,993
ME, FEEL FREE TO JUMP IN IF I

3508
02:06:29,993 --> 02:06:31,828
MISSED ANYTHING.

3509
02:06:31,828 --> 02:06:35,165
OUR TARGET TO LOOK AT STRATEGY

3510
02:06:35,165 --> 02:06:36,099
FOR PATIENT ENGAGEMENT AND

3511
02:06:36,099 --> 02:06:39,636
SATISFACTION IN TELEHEALTH WHICH

3512
02:06:39,636 --> 02:06:43,340
WE ALL FEEL CRITICAL, ESSENTIAL

3513
02:06:43,340 --> 02:06:45,308
TO ENGAGING THE PROVIDERS,

3514
02:06:45,308 --> 02:06:46,042
HEALTHCARE SYSTEMS, ENGAGING

3515
02:06:46,042 --> 02:06:50,013
PATIENT AND COMMUNITY TO MAKING

3516
02:06:50,013 --> 02:06:51,781
SURE HOLISTIC APPROACH AND

3517
02:06:51,781 --> 02:06:54,284
PATIENT PERSON-CENTERED CARE FOR

3518
02:06:54,284 --> 02:06:57,587
THE PATIENT, WE LOOK AT THE

3519
02:06:57,587 --> 02:07:03,727
USING TELEHEALTH, ENHANCED

3520
02:07:03,727 --> 02:07:05,462
PATIENT ENGAGEMENT AND

3521
02:07:05,462 --> 02:07:06,096
SATISFACTION, INCLUDING

3522
02:07:06,096 --> 02:07:07,130
PATIENT-CENTERED ENGAGEMENT, WE

3523
02:07:07,130 --> 02:07:10,634
FEEL IS THE KEY, ALSO LEVERAGE

3524
02:07:10,634 --> 02:07:12,569
PARTNERSHIPS WITHOUT SIDE

3525
02:07:12,569 --> 02:07:13,303
SERVICES, PARTNERS, FOR EXAMPLE,

3526
02:07:13,303 --> 02:07:17,073
VIA 

3527
02:07:17,073 --> 02:07:23,013
SEE -- V.A. HAS BEEN DOING TO

3528
02:07:23,013 --> 02:07:23,914
MAKE SURE BROADBAND INTERNET

3529
02:07:23,914 --> 02:07:25,749
ACCESS IS AVAILABLE TO THOSE

3530
02:07:25,749 --> 02:07:30,453
WITH CHALLENGES, DO NOT HAVE

3531
02:07:30,453 --> 02:07:32,556
RESOURCES TO ACCESS TELEMEDICINE

3532
02:07:32,556 --> 02:07:34,391
AND ENGAGE PARTNERS TO COLLECT

3533
02:07:34,391 --> 02:07:38,595
PATIENT SURVEYS, INTERVIEWS TO

3534
02:07:38,595 --> 02:07:40,096
GET PERSPECTIVES TO FIND METHODS

3535
02:07:40,096 --> 02:07:41,665
FOR CARE BEST FIT FOR PATIENT

3536
02:07:41,665 --> 02:07:46,369
AND POPULATION HAS BEEN

3537
02:07:46,369 --> 02:07:46,836
EVIDENCE.

3538
02:07:46,836 --> 02:07:49,239
WE ALSO GOT SUGGESTED USING

3539
02:07:49,239 --> 02:07:50,874
DIGITAL PLATFORM TO ADDRESS HIGH

3540
02:07:50,874 --> 02:07:56,279
PATIENT LOAD AND SOMETIMES LACK

3541
02:07:56,279 --> 02:07:58,648
OF PROVIDERS IN DIFFERENT AREAS,

3542
02:07:58,648 --> 02:08:03,253
LESSONS FROM INDIA SHARED, LOOK

3543
02:08:03,253 --> 02:08:04,054
AT DIGITAL INFRASTRUCTURE

3544
02:08:04,054 --> 02:08:07,390
LACKING IN NOT ONLY INDIA BUT

3545
02:08:07,390 --> 02:08:08,491
ALSO IN UNITED STATES, MANY

3546
02:08:08,491 --> 02:08:10,894
TIMES DESPITE A LOT OF

3547
02:08:10,894 --> 02:08:13,964
INVESTMENT ALREADY HAPPENING IN

3548
02:08:13,964 --> 02:08:16,399
THE FIELD.

3549
02:08:16,399 --> 02:08:18,234
WE LOOK AT QUESTIONS ABOUT

3550
02:08:18,234 --> 02:08:19,102
TELEHEALTH PLATFORMS, WHAT ARE

3551
02:08:19,102 --> 02:08:20,971
MOST AVAILABLE TO THE PATIENTS

3552
02:08:20,971 --> 02:08:25,342
AND HOW CAN THIS BE OPTIMIZED,

3553
02:08:25,342 --> 02:08:27,744
WE REALIZE V.A. HAD EXPERIENCE

3554
02:08:27,744 --> 02:08:33,717
WORKING WITH LOCAL COMMUNITY

3555
02:08:33,717 --> 02:08:36,052
ACCESS POINTS TO FACILITATE.

3556
02:08:36,052 --> 02:08:44,527
AGREEMENTS WITH LIBRARIES,

3557
02:08:44,527 --> 02:08:46,997
COMMUNITY CENTERS, TO

3558
02:08:46,997 --> 02:08:48,031
SYNCHRONIZE CONNECTIONS WITH

3559
02:08:48,031 --> 02:08:49,899
PROVIDERS ADDING SATISFACTION

3560
02:08:49,899 --> 02:08:53,303
AMONG VETERAN PATIENTS, REDUCING

3561
02:08:53,303 --> 02:08:57,340
TRAVEL BURDEN, AND WE FOUND

3562
02:08:57,340 --> 02:08:59,976
ONLINE PORTALS TO FACILITATE

3563
02:08:59,976 --> 02:09:02,479
MEDICATION RENEWS MAKING

3564
02:09:02,479 --> 02:09:05,649
APPOINTMENT, MESSAGING

3565
02:09:05,649 --> 02:09:07,951
PROVIDERS, EVEN SHARING IMAGES

3566
02:09:07,951 --> 02:09:09,319
AND HEALTH DATA HIGHLIGHTED BY

3567
02:09:09,319 --> 02:09:12,856
THE PATIENTS, WE NEED TO ALSO

3568
02:09:12,856 --> 02:09:19,663
OPTIMIZE APPROACHES FOR THESE

3569
02:09:19,663 --> 02:09:20,964
WITH DIAGNOSIS

3570
02:09:20,964 --> 02:09:23,166
MAKING SURE THEY GET TREATMENTS

3571
02:09:23,166 --> 02:09:25,335
THROUGH SYSTEM MAKING SURE WE

3572
02:09:25,335 --> 02:09:27,470
DON'T MISS ANY PATIENT, ADDING

3573
02:09:27,470 --> 02:09:28,204
PREVENTION COMPONENT.

3574
02:09:28,204 --> 02:09:32,942
AND ALSO HOW TO PROVIDE CARE TO

3575
02:09:32,942 --> 02:09:36,312
IMPROVE ACCESS TO CARE USING

3576
02:09:36,312 --> 02:09:37,514
TELEMEDICINE AND OTHER

3577
02:09:37,514 --> 02:09:38,948
TECHNOLOGIES, SOMETHING OUR

3578
02:09:38,948 --> 02:09:47,057
GROUP ALSO VERY INTERESTED TO

3579
02:09:47,057 --> 02:09:52,295
TALK ABOUT.

3580
02:09:52,295 --> 02:09:53,396
LEVERAGING TEAM-BASED APPROACH,

3581
02:09:53,396 --> 02:09:55,799
PRIMARY CARE PROVIDERS, OTHER

3582
02:09:55,799 --> 02:09:58,902
NURSE SPECIALTIES, AND OTHER

3583
02:09:58,902 --> 02:10:01,204
PROVIDERS IN ORDER TO HAVE

3584
02:10:01,204 --> 02:10:02,272
PROVIDER HOLISTIC APPROACH CARE

3585
02:10:02,272 --> 02:10:04,908
TO THE PATIENT, THAT'S ALSO

3586
02:10:04,908 --> 02:10:08,611
SOMETHING WE HAD SOME

3587
02:10:08,611 --> 02:10:09,179
DISCUSSIONS ABOUT.

3588
02:10:09,179 --> 02:10:12,615
NEXT WE TALKED ABOUT ADDITION TO

3589
02:10:12,615 --> 02:10:14,884
PROVIDER HOW THE SYSTEM CAN

3590
02:10:14,884 --> 02:10:16,753
TAILOR COMMUNICATIONS TO REACH

3591
02:10:16,753 --> 02:10:19,355
OUT DIVERSE PATIENTS, WE USED

3592
02:10:19,355 --> 02:10:22,425
EXAMPLES ALSO FROM V.A., THEY

3593
02:10:22,425 --> 02:10:23,960
HAD THE SOCIAL NEEDS SCREENING

3594
02:10:23,960 --> 02:10:25,495
WHICH HELPS ASKING THE PATIENTS

3595
02:10:25,495 --> 02:10:28,364
FIRST AND TRY TO IDENTIFY

3596
02:10:28,364 --> 02:10:30,166
DIFFERENT VETERANS, WHAT THEY

3597
02:10:30,166 --> 02:10:33,436
NEED, THEIR BARRIERS IN ORDER TO

3598
02:10:33,436 --> 02:10:35,939
OVERCOME THE DIGITAL DIVIDE,

3599
02:10:35,939 --> 02:10:41,111
THEN PROVIDE THEM WITH DIFFERENT

3600
02:10:41,111 --> 02:10:42,412
CONSULT FOR EDUCATION AND LOAN

3601
02:10:42,412 --> 02:10:44,914
DEVICE TO HAVE ACCESS TO CARE,

3602
02:10:44,914 --> 02:10:48,084
APPLICATION TO ACCESS HEALTH

3603
02:10:48,084 --> 02:10:50,520
CARE PORTALS BEST.

3604
02:10:50,520 --> 02:10:54,557
THERE ARE PILOT STUDIES FOR

3605
02:10:54,557 --> 02:10:55,859
DISABILITY AND APPROPRIATENESS

3606
02:10:55,859 --> 02:10:57,494
TO UNDERSTAND PATIENT STANDARD

3607
02:10:57,494 --> 02:11:04,400
FOCUS HAS BEEN IMPLEMENTED IN

3608
02:11:04,400 --> 02:11:06,269
V.A. AND IN OTHERS.

3609
02:11:06,269 --> 02:11:07,904
ONE PARTICIPANT MENTIONED IN

3610
02:11:07,904 --> 02:11:09,906
INDIA THERE ARE OVER 200

3611
02:11:09,906 --> 02:11:10,673
LANGUAGES SPOKEN SO MAKING IT

3612
02:11:10,673 --> 02:11:13,276
VERY IMPORTANT TO HAVE A DIGITAL

3613
02:11:13,276 --> 02:11:17,113
PLATFORM PROVIDE A LANGUAGE TO

3614
02:11:17,113 --> 02:11:19,182
EVERYBODY WHO CAN UNDERSTAND AND

3615
02:11:19,182 --> 02:11:20,183
ACCESS HEALTHCARE SERVICES IN

3616
02:11:20,183 --> 02:11:22,051
THIS CASE.

3617
02:11:22,051 --> 02:11:26,189
SOME OF THE TOOLS PROVIDED BY

3618
02:11:26,189 --> 02:11:31,461
V.A. INCLUDING HEALTH PORTAL,

3619
02:11:31,461 --> 02:11:34,864
ATLAS PROGRAM, INDIAN NATIONAL

3620
02:11:34,864 --> 02:11:36,733
PROGRAM, WHICH IS NATIONAL

3621
02:11:36,733 --> 02:11:40,236
PROGRAM SUPPORTED BY INDIAN

3622
02:11:40,236 --> 02:11:40,637
GOVERNMENT.

3623
02:11:40,637 --> 02:11:46,042
AND ALSO CURRENT APP USED IN

3624
02:11:46,042 --> 02:11:48,444
WAKE FOREST SO PATIENTS CAN

3625
02:11:48,444 --> 02:11:49,112
ACCESS THAT.

3626
02:11:49,112 --> 02:11:50,747
WE DISCUSSED THE ROLE OF

3627
02:11:50,747 --> 02:11:52,048
CAREGIVERS, V.A. HAVE GREAT

3628
02:11:52,048 --> 02:11:55,218
EXAMPLES IN THIS CASE, VERY

3629
02:11:55,218 --> 02:11:56,986
ENGAGING PROVIDERS, AND THEIR

3630
02:11:56,986 --> 02:11:58,054
CAREGIVERS OF THE PATIENTS, THEY

3631
02:11:58,054 --> 02:11:59,155
WILL BE INVOLVED IN THE

3632
02:11:59,155 --> 02:12:01,791
BEGINNING OF THE CARE AND TO

3633
02:12:01,791 --> 02:12:03,326
HELP WITH DIGITAL NAVIGATION OF

3634
02:12:03,326 --> 02:12:06,830
THE PATIENTS, WE ALSO DISCUSSED

3635
02:12:06,830 --> 02:12:08,565
ABOUT HIPAA ISSUES, MAKING SURE

3636
02:12:08,565 --> 02:12:09,766
PERMISSIONS AND CONSENT ARE

3637
02:12:09,766 --> 02:12:10,767
AVAILABLE FOR THE CAREGIVERS IN

3638
02:12:10,767 --> 02:12:13,436
ORDER TO BE PART OF THE

3639
02:12:13,436 --> 02:12:14,671
HEALTHCARE SYSTEM.

3640
02:12:14,671 --> 02:12:21,377
THERE ARE A LOT WE HAVE JOINED

3641
02:12:21,377 --> 02:12:25,849
IN DISCUSSION, LET ME KNOW. 

3642
02:12:25,849 --> 02:12:27,817
>> THANK YOU, GROUP 4.

3643
02:12:27,817 --> 02:12:29,452
THIS WORKSHOP IS MEANT TO BE A

3644
02:12:29,452 --> 02:12:32,188
CONVERSATION TO HEAR ABOUT YOUR

3645
02:12:32,188 --> 02:12:32,822
CHALLENGES, OPPORTUNITIES OF

3646
02:12:32,822 --> 02:12:35,458
RESEARCH, I THINK THE SMALL

3647
02:12:35,458 --> 02:12:36,359
GROUP DISCUSSIONS WERE

3648
02:12:36,359 --> 02:12:37,660
PHENOMENAL TO ACHIEVE THAT GOAL.

3649
02:12:37,660 --> 02:12:40,964
THANKS TO ALL FOUR GROUPS.

3650
02:12:40,964 --> 02:12:42,265
WE ORIGINALLY HAD 15-MINUTE

3651
02:12:42,265 --> 02:12:43,366
BREAK HERE.

3652
02:12:43,366 --> 02:12:46,202
BECAUSE OF TECHNICAL CHALLENGES

3653
02:12:46,202 --> 02:12:48,071
DURING THE SPLIT OF THE SMALL

3654
02:12:48,071 --> 02:12:50,273
GROUPS, WE ARE GOING TO REDUCE

3655
02:12:50,273 --> 02:12:53,443
THIS TO FIVE MINUTES AND WE'LL

3656
02:12:53,443 --> 02:12:55,078
COME BACK AT 3:05 EASTERN TIME.

3657
02:12:55,078 --> 02:12:55,912
THANK YOU, EVERYONE.

3658
02:12:55,912 --> 02:12:57,847
SEE YOU IN FIVE MINUTES.

3659
02:12:57,847 --> 02:13:00,717
OR SIX ACTUALLY, YOU HAVE ONE

3660
02:13:00,717 --> 02:13:03,519
MORE MINUTE. 

3661
02:13:03,519 --> 02:13:04,053
THANK YOU, MODERATORS.

3662
02:13:04,053 --> 02:13:06,556
APPRECIATE IT.

3663
02:13:06,556 --> 02:13:12,595
 

3664
02:13:12,595 --> 02:13:22,639
 

3665
02:19:37,513 --> 02:19:38,314
>> WELCOME BACK, EVERYONE.

3666
02:19:38,314 --> 02:19:41,284
IT'S TIME TO MOVE TO OUR SESSION

3667
02:19:41,284 --> 02:19:43,452
2, BUT THE DAY IS NOT OVER.

3668
02:19:43,452 --> 02:19:45,388
WE STILL HAVE MORE THINGS TO

3669
02:19:45,388 --> 02:19:48,190
SHARE AFTER SESSION 2 SO DON'T

3670
02:19:48,190 --> 02:19:51,027
GO AND LOG OFF AFTER THAT.

3671
02:19:51,027 --> 02:19:53,996
SESSION 2 IS mHEALTH, REMOTE

3672
02:19:53,996 --> 02:19:55,531
MONITORING, DATA ANALYSIS,

3673
02:19:55,531 --> 02:19:58,067
INNOVATIONS DRIVING TELEHEALTH

3674
02:19:58,067 --> 02:19:59,468
RESEARCH AND PATIENT OUTCOMES.

3675
02:19:59,468 --> 02:20:02,238
I'M WAITING FOR THE NEXT SLIDE

3676
02:20:02,238 --> 02:20:07,376
SO YOU GET TO SEE OUR WONDERFUL

3677
02:20:07,376 --> 02:20:09,578
PANELIST AND MODERATOR.

3678
02:20:09,578 --> 02:20:14,383
I INVITE DR. DAVID, VICE

3679
02:20:14,383 --> 02:20:16,218
PRESIDENT OF HEALTH CARE AT

3680
02:20:16,218 --> 02:20:18,287
MICROSOFT TO MODERATE THE

3681
02:20:18,287 --> 02:20:25,995
SESSION, AND JOINING HIM THREE

3682
02:20:25,995 --> 02:20:27,530
WONDERFUL PANELISTS, DR.

3683
02:20:27,530 --> 02:20:30,700
KHETEHROP, UNIVERSITY OF

3684
02:20:30,700 --> 02:20:34,403
MICHIGAN MEDICAL SCHOOL. 

3685
02:20:34,403 --> 02:20:38,574
WE HAVE JOSEPH KVEDOR, EDITOR IN

3686
02:20:38,574 --> 02:20:42,011
CHIEF OF NPJ JOURNAL AND

3687
02:20:42,011 --> 02:20:42,545
PROFESSOR OF DERMATOLOGY,

3688
02:20:42,545 --> 02:20:44,714
HARVARD MEDICAL SCHOOL.

3689
02:20:44,714 --> 02:20:50,052
WE INVITE DR. LOK SAMSON, HEALTH

3690
02:20:50,052 --> 02:20:51,921
POLICY ANALYST, HHS OFFICE OF

3691
02:20:51,921 --> 02:20:54,156
THE ASSISTANT SECRETARY FOR

3692
02:20:54,156 --> 02:20:55,424
PLANNING AND EVALUATION, THANK

3693
02:20:55,424 --> 02:20:58,928
YOU VERY MUCH FOR JOINING US,

3694
02:20:58,928 --> 02:21:00,229
AND FOR THOSE WATCHING US, AND,

3695
02:21:00,229 --> 02:21:01,764
DAVID, PLEASE TAKE IT AWAY.

3696
02:21:01,764 --> 02:21:02,531
>> THANK YOU.

3697
02:21:02,531 --> 02:21:06,035
IT'S A PLEASURE TO BE HERE, TO

3698
02:21:06,035 --> 02:21:11,941
MODERATE THIS PANEL WITH SOME

3699
02:21:11,941 --> 02:21:13,409
ESTEEMED EXPERTS IN THE FIELD,

3700
02:21:13,409 --> 02:21:14,810
IN THE SPACE FOR QUITE SOME TIME

3701
02:21:14,810 --> 02:21:16,879
AND I'M GOING TO USE THE

3702
02:21:16,879 --> 02:21:18,080
OPPORTUNITY TO ASK SOME

3703
02:21:18,080 --> 02:21:21,150
QUESTIONS ABOUT SOME OF THEIR

3704
02:21:21,150 --> 02:21:23,252
EXPERIENCES AND OBSERVATIONS.

3705
02:21:23,252 --> 02:21:25,755
JOE, YOU'VE BEEN LOOKING A LOT

3706
02:21:25,755 --> 02:21:28,290
AT TECHNOLOGIES THAT WE'VE SEEN,

3707
02:21:28,290 --> 02:21:29,024
WEARABLES, PATCHES.

3708
02:21:29,024 --> 02:21:30,359
I'D LOVE TO GET YOUR TAKE IN

3709
02:21:30,359 --> 02:21:32,695
TERMS OF WHAT ARE WE SEEING OUT

3710
02:21:32,695 --> 02:21:35,164
THERE THAT'S NEW, THAT IS

3711
02:21:35,164 --> 02:21:37,700
PROMISING, WHAT ARE THINGS WE

3712
02:21:37,700 --> 02:21:38,467
ANTICIPATE?

3713
02:21:38,467 --> 02:21:42,972
WILL WE EVER HAVE NON-INVASIVE

3714
02:21:42,972 --> 02:21:43,539
GLUCOSE MEASUREMENTS WITH

3715
02:21:43,539 --> 02:21:45,174
WEARABLE, I'D LOVE TO GET YOUR

3716
02:21:45,174 --> 02:21:46,242
TAKE, WHAT'S POSSIBLE AND WHAT

3717
02:21:46,242 --> 02:21:50,746
COULD BE POSSIBLE? 

3718
02:21:50,746 --> 02:21:52,281
>> WELL, THANK YOU TO THE
FOLKS

3719
02:21:52,281 --> 02:21:54,250
FROM THE NIH FOR INVITING ME,

3720
02:21:54,250 --> 02:21:55,351
I'M DELIGHTED TO MEET YOU.

3721
02:21:55,351 --> 02:21:57,953
I DON'T KNOW THAT YOU HAVE AS

3722
02:21:57,953 --> 02:22:00,389
MUCH WISDOM TO IMPART HERE AS

3723
02:22:00,389 --> 02:22:01,991
YOU HAD HOPED.

3724
02:22:01,991 --> 02:22:04,193
I FIELD, IN MY OPINION, IS

3725
02:22:04,193 --> 02:22:04,427
STALLED.

3726
02:22:04,427 --> 02:22:08,831
WE DID NOW A GOOD 15 YEARS OF

3727
02:22:08,831 --> 02:22:12,635
MONITORING STEPS AND NOW WE'RE I

3728
02:22:12,635 --> 02:22:14,270
THINK STRUGGLING WITH SLEEP.

3729
02:22:14,270 --> 02:22:16,572
ONE THING THAT'S A BREAKTHROUGH,

3730
02:22:16,572 --> 02:22:18,541
IN MY OPINION, I'LL GIVE JUST A

3731
02:22:18,541 --> 02:22:22,044
QUICK ANECDOTE OF MY OWN HEALTH,

3732
02:22:22,044 --> 02:22:24,480
I HAD HEART VALVE REPAIR DONE IN

3733
02:22:24,480 --> 02:22:24,780
JUNE.

3734
02:22:24,780 --> 02:22:27,616
DURING THE POST-OP PERIOD I HAD

3735
02:22:27,616 --> 02:22:29,385
ATRIAL FIBRILLATION, NOW I'M ON

3736
02:22:29,385 --> 02:22:30,386
AN ANTICOAGULANT NOW.

3737
02:22:30,386 --> 02:22:32,221
MY DOCTOR SAID TO ME, WELL, IF

3738
02:22:32,221 --> 02:22:34,523
YOU GET YOURSELF A WATCH THAT

3739
02:22:34,523 --> 02:22:36,392
WILL TRIGGER WHEN YOU HAVE

3740
02:22:36,392 --> 02:22:37,359
ATRIAL FIBRILLATION WE MIGHT

3741
02:22:37,359 --> 02:22:40,563
TAKE YOU OFF THE ANTI-COAGULANT.

3742
02:22:40,563 --> 02:22:42,631
THAT'S MAINSTREAM FOR A

3743
02:22:42,631 --> 02:22:43,999
WEARABLE, CONSUMER DEVICE, TO BE

3744
02:22:43,999 --> 02:22:46,368
RECOMMENDED TO ME BY A

3745
02:22:46,368 --> 02:22:46,702
CARDIOLOGIST.

3746
02:22:46,702 --> 02:22:48,671
I THINK WE HAVE MADE SOME

3747
02:22:48,671 --> 02:22:51,841
STRIDES, THERE'S STILL THAT GAP

3748
02:22:51,841 --> 02:22:55,611
BETWEEN MEDICAL DEVICES, HARD

3749
02:22:55,611 --> 02:22:56,278
CORE AND CONSUMER WEARABLES, IT

3750
02:22:56,278 --> 02:22:59,982
WAS MENTIONED IN ONE OF THE

3751
02:22:59,982 --> 02:23:01,951
BREAKOUT GROUPS VAST SEA OF DATA

3752
02:23:01,951 --> 02:23:03,352
BUT NONE CONNECTS, I THINK

3753
02:23:03,352 --> 02:23:04,119
THAT'S A CHALLENGE.

3754
02:23:04,119 --> 02:23:05,554
BUT ONE OF THE THINGS THAT WE DO

3755
02:23:05,554 --> 02:23:11,894
SEE A LOT OF NOW IN TERMS OF

3756
02:23:11,894 --> 02:23:14,396
SUBMISSIONS TO THE JOURNAL IS

3757
02:23:14,396 --> 02:23:15,130
MULTI-MODAL ARTIFICIAL

3758
02:23:15,130 --> 02:23:16,065
INTELLIGENCE, GETTING DIFFERENT

3759
02:23:16,065 --> 02:23:19,668
DATA STREAMS, COLLECTING THEM

3760
02:23:19,668 --> 02:23:21,437
AND GETTING MORE POWER IN THE

3761
02:23:21,437 --> 02:23:23,172
FINE TUNING OF THE MACHINE

3762
02:23:23,172 --> 02:23:24,573
LEARNING BECAUSE OF THE RICHNESS

3763
02:23:24,573 --> 02:23:25,374
OF THE DATA.

3764
02:23:25,374 --> 02:23:28,644
SO, I GUESS IT'S A BIT OF A TALE

3765
02:23:28,644 --> 02:23:29,879
OF TWO CITIES TYPE ANSWER.

3766
02:23:29,879 --> 02:23:31,280
I SEE A LOT OF PROMISE BUT A

3767
02:23:31,280 --> 02:23:33,349
LITTLE BIT OF STALLING IN THE

3768
02:23:33,349 --> 02:23:34,116
ACTUAL TECHNOLOGY.

3769
02:23:34,116 --> 02:23:37,419
>> YEAH, SO ON THE POINT
OF THE

3770
02:23:37,419 --> 02:23:39,488
ATRIAL FIBRILLATION NOW WE HAVE

3771
02:23:39,488 --> 02:23:42,024
TECHNOLOGIES THAT CAN DETECT IT,

3772
02:23:42,024 --> 02:23:44,660
IN THE PAST MAYBE WE DIDN'T HAVE

3773
02:23:44,660 --> 02:23:47,129
THAT CAPABILITY.

3774
02:23:47,129 --> 02:23:48,697
ARE WE FINDING THIS IS -- THE

3775
02:23:48,697 --> 02:23:50,232
CONCERN AT THE TIME WAS THIS WAS

3776
02:23:50,232 --> 02:23:51,467
GOING TO FLOOD DOCTOR OFFICES

3777
02:23:51,467 --> 02:23:53,202
WITH INDIVIDUALS SAYING THIS IS

3778
02:23:53,202 --> 02:23:55,604
JUST, YOU KNOW, I'VE GOT A-FIB

3779
02:23:55,604 --> 02:23:57,139
OR I'VE GOT SOMETHING I'M

3780
02:23:57,139 --> 02:23:58,440
WORRIED ABOUT.

3781
02:23:58,440 --> 02:23:59,542
HAVE WE SEEN THAT?

3782
02:23:59,542 --> 02:24:01,610
OR WAS THAT CONCERN THAT WAS

3783
02:24:01,610 --> 02:24:03,045
JUST MAYBE A LITTLE OVERHYPED?

3784
02:24:03,045 --> 02:24:04,780
>> I THINK A LITTLE
OVERHYPED.

3785
02:24:04,780 --> 02:24:05,781
THAT'S MY OPINION.

3786
02:24:05,781 --> 02:24:07,416
I DON'T HAVE DATA BUT I WILL

3787
02:24:07,416 --> 02:24:08,517
TELL YOU PEOPLE HAVE LIVES.

3788
02:24:08,517 --> 02:24:09,985
THEY ARE NOT SITTING AROUND JUST

3789
02:24:09,985 --> 02:24:11,253
WAITING FOR THEIR WATCH TO GO

3790
02:24:11,253 --> 02:24:11,687
OFF.

3791
02:24:11,687 --> 02:24:13,222
THEY GOT OTHER THINGS TO DO.

3792
02:24:13,222 --> 02:24:15,925
AGAIN, I JUST THOUGHT IT WAS

3793
02:24:15,925 --> 02:24:17,593
INTERESTING THAT MY OWN

3794
02:24:17,593 --> 02:24:19,562
PHYSICIAN WHO ISN'T PARTICULARLY

3795
02:24:19,562 --> 02:24:22,831
TECHY, SHE'S JUST A REGULAR GOOD

3796
02:24:22,831 --> 02:24:24,700
OLD CARDIOLOGIST, SAID THIS WAS

3797
02:24:24,700 --> 02:24:26,435
A TURNING POINT FOR HER.

3798
02:24:26,435 --> 02:24:32,374
I THOUGHT THAT WAS MEANINGFUL. 

3799
02:24:32,374 --> 02:24:37,947
>> ANYTHING ON YOUR END,

3800
02:24:37,947 --> 02:24:39,248
SACHIN,LOK?

3801
02:24:39,248 --> 02:24:40,249
WE'LL START WITH SACHIN.

3802
02:24:40,249 --> 02:24:42,451
>> SURE, THANK YOU.

3803
02:24:42,451 --> 02:24:46,989
WE HAD SIMILAR EXPERIENCES AS

3804
02:24:46,989 --> 02:24:49,224
WHAT JOE IS MENTIONING, CONCERNS

3805
02:24:49,224 --> 02:24:51,527
ABOUT FOLKS BEING FLOODED WITH

3806
02:24:51,527 --> 02:24:53,596
FALSE ALARMS IS OVERSTATED.

3807
02:24:53,596 --> 02:24:55,464
IT'S ONE OF OUR RESEARCH

3808
02:24:55,464 --> 02:24:57,433
PROJECTS, 7,000 APPLE WATCHES

3809
02:24:57,433 --> 02:25:01,136
AND BLOOD PRESSURE CUFFS WENT TO

3810
02:25:01,136 --> 02:25:02,471
UNIVERSITY OF MICHIGAN PATIENTS,

3811
02:25:02,471 --> 02:25:04,440
WITH ENTIRE PROTOCOL SET UP, IF

3812
02:25:04,440 --> 02:25:06,508
I HAD ABNORMAL HEART RHYTHM

3813
02:25:06,508 --> 02:25:09,244
ALARM ON THE WATCH OR CUFF, WE

3814
02:25:09,244 --> 02:25:10,579
HAVE THIS PATHWAY.

3815
02:25:10,579 --> 02:25:13,749
WE FOUND, NUMBER ONE, PATIENTS

3816
02:25:13,749 --> 02:25:15,284
REALLY, NUMBER ONE, ENJOYED

3817
02:25:15,284 --> 02:25:15,851
UNDERSTANDING THEIR HEALTH

3818
02:25:15,851 --> 02:25:18,754
BETTER EVEN IF IT WAS A FALSE

3819
02:25:18,754 --> 02:25:19,421
ALARM.

3820
02:25:19,421 --> 02:25:21,190
I THINK THE VALUE OF A DEVICE

3821
02:25:21,190 --> 02:25:24,893
THAT DOES SOME RETURN OF

3822
02:25:24,893 --> 02:25:27,062
INFORMATION, ENGAGES THE

3823
02:25:27,062 --> 02:25:27,863
PATIENT'S HEALTH, POTENTIALLY

3824
02:25:27,863 --> 02:25:29,832
MUCH MORE IMPORTANT THAN THE

3825
02:25:29,832 --> 02:25:30,699
RISK OF OCCASIONALLY THOSE

3826
02:25:30,699 --> 02:25:31,934
PATIENTS GETTING A BIT ALARMED

3827
02:25:31,934 --> 02:25:34,003
BY IT AND GO SEE THEIR DOCTOR.

3828
02:25:34,003 --> 02:25:37,373
TURNS OUT THAT ACTUALLY IS

3829
02:25:37,373 --> 02:25:40,442
PROBABLY A GOOD INTERACTION

3830
02:25:40,442 --> 02:25:43,612
ANYWAY. 

3831
02:25:43,612 --> 02:25:47,349
VERY FEW FALSE ALARMS -- WE

3832
02:25:47,349 --> 02:25:50,853
PUBLISHED THAT RATE, BUT I THINK

3833
02:25:50,853 --> 02:25:53,155
I WOULD SECOND THE EXPERIENCE

3834
02:25:53,155 --> 02:25:55,691
WHICH IS THE POSSIBLE BENEFIT OF

3835
02:25:55,691 --> 02:25:56,759
JUST BEING CONNECTED WITH YOUR

3836
02:25:56,759 --> 02:25:57,593
HEALTH IN AN OBJECTIVE WAY,

3837
02:25:57,593 --> 02:26:01,497
WHETHER OR NOT IT'S A CLINICALLY

3838
02:26:01,497 --> 02:26:04,233
MEANINGFUL OBJECTIVE OUTCOME,

3839
02:26:04,233 --> 02:26:08,270
FAR OUTWEIGHS POTENTIAL RISKS OF

3840
02:26:08,270 --> 02:26:10,039
FALSE ALARMS.

3841
02:26:10,039 --> 02:26:10,639
>> YEAH, LOK, YOUR
THOUGHTS?

3842
02:26:10,639 --> 02:26:11,774
>> CAN YOU HEAR ME?

3843
02:26:11,774 --> 02:26:12,841
>> YES, WE CAN.

3844
02:26:12,841 --> 02:26:15,444
>> JUST THINKING IN TERMS
OF THE

3845
02:26:15,444 --> 02:26:17,246
MEDICARE SPACE, SEEING A LOT OF

3846
02:26:17,246 --> 02:26:18,547
UPTAKE OF REMOTE PATIENT

3847
02:26:18,547 --> 02:26:19,548
MONITORING ESPECIALLY DURING THE

3848
02:26:19,548 --> 02:26:19,815
PANDEMIC.

3849
02:26:19,815 --> 02:26:23,352
I THINK THAT REALLY IS GOING TO

3850
02:26:23,352 --> 02:26:24,453
ACCELERATE PEOPLE'S INTEREST IN

3851
02:26:24,453 --> 02:26:26,889
PARTNERING WITH THEIR HEALTHCARE

3852
02:26:26,889 --> 02:26:31,794
PROVIDER, IN UNDERSTANDING THEIR

3853
02:26:31,794 --> 02:26:33,095
CLINICAL VITAL SIGNS.

3854
02:26:33,095 --> 02:26:34,096
SO I HAVEN'T DONE MUCH RESEARCH

3855
02:26:34,096 --> 02:26:36,699
IN THIS AREA BUT IT SOUNDS LIKE

3856
02:26:36,699 --> 02:26:41,336
THERE'S AT LEAST HEALTHCARE

3857
02:26:41,336 --> 02:26:41,670
INTEREST.

3858
02:26:41,670 --> 02:26:43,305
>> ONE THING I'M SEEING,

3859
02:26:43,305 --> 02:26:44,139
EXTRAORDINARY, WE'RE MAKING

3860
02:26:44,139 --> 02:26:45,607
SIGNIFICANT STRIDES IN TERMS OF

3861
02:26:45,607 --> 02:26:48,677
OUR ABILITY TO CAPTURE NEWER

3862
02:26:48,677 --> 02:26:51,513
TYPES OF INFORMATION AND WITH

3863
02:26:51,513 --> 02:26:56,218
THIS DIFFERENT SENSORS OUT THERE

3864
02:26:56,218 --> 02:26:56,952
BECOMING MORE NON-INVASIVE, WE

3865
02:26:56,952 --> 02:26:58,654
CAN IDENTIFY THINGS IN THE PAST

3866
02:26:58,654 --> 02:27:00,422
WE COULDN'T ENVISION SUCH AS

3867
02:27:00,422 --> 02:27:02,224
RIGHT NOW STARTING WITH GLUCOSE,

3868
02:27:02,224 --> 02:27:04,159
OF COURSE STARTING TO SEE THAT.

3869
02:27:04,159 --> 02:27:06,595
BUT ALSO THINGS SUCH AS SERUM

3870
02:27:06,595 --> 02:27:08,430
LACTATE, AND PERHAPS EVEN OTHER

3871
02:27:08,430 --> 02:27:09,765
TYPES OF BIOCHEMICALS WHICH

3872
02:27:09,765 --> 02:27:10,833
COULD REALLY CHANGE THEIR

3873
02:27:10,833 --> 02:27:12,034
PERCEPTION IN TERMS OF WHETHER

3874
02:27:12,034 --> 02:27:14,236
OR NOT WE CAN MONITOR PATIENTS

3875
02:27:14,236 --> 02:27:15,771
AT HOME, AND AS WE START

3876
02:27:15,771 --> 02:27:18,173
THINKING MORE ABOUT THIS CONCEPT

3877
02:27:18,173 --> 02:27:19,575
OF MONITORING PATIENTS AT HOME

3878
02:27:19,575 --> 02:27:22,878
WE'VE GOT PROGRAMS LIKE HOSPITAL

3879
02:27:22,878 --> 02:27:26,815
AT HOME, I'M CURIOUS, FROM YOUR

3880
02:27:26,815 --> 02:27:27,716
PERSPECTIVES, MAYBE YOU, SACHIN,

3881
02:27:27,716 --> 02:27:30,219
HAVE YOU SEEN THESE TYPE OF

3882
02:27:30,219 --> 02:27:31,086
PROGRAMS TAKING OFF MORE?

3883
02:27:31,086 --> 02:27:32,921
WHAT DO YOU SEE AS THE

3884
02:27:32,921 --> 02:27:34,623
CHALLENGES, WHAT ARE THE

3885
02:27:34,623 --> 02:27:36,325
ADVANTAGES, THE BENEFITS?

3886
02:27:36,325 --> 02:27:38,994
>> YOU KNOW, AS AN

3887
02:27:38,994 --> 02:27:41,296
ANESTHESIOLOGIST, I LOVE HAVING

3888
02:27:41,296 --> 02:27:42,231
ABOUT 40 PARAMETERS CONSTANTLY

3889
02:27:42,231 --> 02:27:43,599
ABOUT MY PATIENTS.

3890
02:27:43,599 --> 02:27:46,435
I DO LIVER TRANSPLANT

3891
02:27:46,435 --> 02:27:48,103
ANESTHESIA, IF I DON'T HAVE AN

3892
02:27:48,103 --> 02:27:49,171
ECHO PROGRAM I THINK I'M HANDS

3893
02:27:49,171 --> 02:27:51,373
OFF WHEN IT COMES TO MONITORING.

3894
02:27:51,373 --> 02:27:54,343
YOU'RE SEEING SOMEONE WHO IS

3895
02:27:54,343 --> 02:27:56,512
VERY, VERY DATA RICH FOCUSED.

3896
02:27:56,512 --> 02:27:57,279
THE HOSPITAL'S PROGRAMS WHAT

3897
02:27:57,279 --> 02:28:00,916
THEY HAVE DONE FOR IDENTIFY

3898
02:28:00,916 --> 02:28:03,418
IS -- THE UPTAKE IS DRIVEN BY

3899
02:28:03,418 --> 02:28:04,853
CAPACITY CONSTRAINTS ONLY.

3900
02:28:04,853 --> 02:28:12,961
IF YOU'RE IN AN ENVIRONMENT

3901
02:28:12,961 --> 02:28:14,129
WHERE FINANCIAL DRIVERS

3902
02:28:14,129 --> 02:28:16,999
ENCOURAGE US BECOMING FLEXIBLE

3903
02:28:16,999 --> 02:28:18,233
AS CLINICIANS AND OUR TENDENCY

3904
02:28:18,233 --> 02:28:19,501
TO OVERORDER TESTS EVEN IF

3905
02:28:19,501 --> 02:28:20,769
SOMEONE IS IN THE HOSPITAL

3906
02:28:20,769 --> 02:28:21,937
TRANSLATE TO LETTING THEM GO

3907
02:28:21,937 --> 02:28:25,808
HOME AND HAVE THE SAME THINGS.

3908
02:28:25,808 --> 02:28:27,876
CAPACITY CONSTRAINTS CAUSE

3909
02:28:27,876 --> 02:28:29,278
INNOVATION, WHAT WE'RE FINDING.

3910
02:28:29,278 --> 02:28:32,247
THE PANDEMIC WAS ONE EXAMPLE OF

3911
02:28:32,247 --> 02:28:32,581
IT.

3912
02:28:32,581 --> 02:28:34,116
IN THE POST-PANDEMIC WORLD WE

3913
02:28:34,116 --> 02:28:35,551
STILL SEE VALUES IN THE

3914
02:28:35,551 --> 02:28:37,519
OUTPATIENT SETTING BUT WE

3915
02:28:37,519 --> 02:28:38,153
OBVIOUSLY HAVE A

3916
02:28:38,153 --> 02:28:39,121
HOSPITAL-AT-HOME PROGRAM LIKE

3917
02:28:39,121 --> 02:28:45,727
EVERYBODY ELSE, AND IT'S RAMPING

3918
02:28:45,727 --> 02:28:47,396
UP, BECAUSE WE'VE GOT CAPACITY

3919
02:28:47,396 --> 02:28:48,730
CONSTRAINTS AT UNIVERSITY OF

3920
02:28:48,730 --> 02:28:50,866
MICHIGAN SO INVESTMENTS ON A

3921
02:28:50,866 --> 02:28:54,236
YIELDING VALUE, WHERE WE DON'T

3922
02:28:54,236 --> 02:29:01,810
SEE  CONSTRAINTS DISCOMFORT

3923
02:29:01,810 --> 02:29:02,678
DOESN'T LEAVE ROOM.

3924
02:29:02,678 --> 02:29:04,112
FOR THE RURAL PATIENTS WE SEE A

3925
02:29:04,112 --> 02:29:06,181
FAIR AMOUNT OF VALUE THERE, THE

3926
02:29:06,181 --> 02:29:07,149
TREES BEHIND YOU REFLECT WHAT

3927
02:29:07,149 --> 02:29:09,451
MOST OF MICHIGAN IS LIKE, A LOT

3928
02:29:09,451 --> 02:29:10,752
OF PATIENTS ARE DRIVING FROM

3929
02:29:10,752 --> 02:29:12,187
THREE OR FOUR HOURS, AND THEY DO

3930
02:29:12,187 --> 02:29:13,956
FIND SOME VALUE IN MAYBE GETTING

3931
02:29:13,956 --> 02:29:15,891
DISCHARGED A DAY OR TWO, THE

3932
02:29:15,891 --> 02:29:17,860
ONLY PLACE WE'RE SEEING CAPACITY

3933
02:29:17,860 --> 02:29:19,962
CONSTRAINTS NOT DRIVING THAT

3934
02:29:19,962 --> 02:29:21,396
INNOVATION ADOPTION BECAUSE OF

3935
02:29:21,396 --> 02:29:23,465
OUR TENDENCY TO JUST NOT WANT TO

3936
02:29:23,465 --> 02:29:26,602
BE WITHOUT THE DATA THAT WE'RE

3937
02:29:26,602 --> 02:29:27,402
USED TO.

3938
02:29:27,402 --> 02:29:29,137
>> IN TERMS OF A NATIONAL

3939
02:29:29,137 --> 02:29:31,940
PICTURE, ARE YOU SEEING ANY

3940
02:29:31,940 --> 02:29:33,742
PATTERNS EMERGE RELATIVE TO

3941
02:29:33,742 --> 02:29:35,611
ADOPTION OF DIFFERENT PROGRAMS

3942
02:29:35,611 --> 02:29:38,013
WHETHER HOSPITAL AT HOME, REMOTE

3943
02:29:38,013 --> 02:29:39,548
MONITORING, TELEHEALTH, THINGS

3944
02:29:39,548 --> 02:29:41,516
LIKE THAT?

3945
02:29:41,516 --> 02:29:42,618
>> WE'VE MONITORED
NATIONAL

3946
02:29:42,618 --> 02:29:45,354
TRENDS FOR MEDICARE TELEHEALTH.

3947
02:29:45,354 --> 02:29:47,489
IT'S DROPPED FROM THE PANDEMIC

3948
02:29:47,489 --> 02:29:49,858
HEIGHT, IT'S STILL A MUCH LARGER

3949
02:29:49,858 --> 02:29:51,260
USE OF TELEHEALTH THAN

3950
02:29:51,260 --> 02:29:51,827
PRE-PANDEMIC.

3951
02:29:51,827 --> 02:29:55,030
I THINK IT REALLY IS SHOWING

3952
02:29:55,030 --> 02:29:59,501
THERE'S INTEREST IN HAVING THIS

3953
02:29:59,501 --> 02:30:00,035
MODALITY.

3954
02:30:00,035 --> 02:30:01,036
HOSPITAL AT HOME PROGRAM HAS

3955
02:30:01,036 --> 02:30:02,571
BEEN WELL RECEIVED BY PATIENTS.

3956
02:30:02,571 --> 02:30:04,239
I THINK THERE'S INTEREST ON THE

3957
02:30:04,239 --> 02:30:06,174
HILL TO CONTINUE THE PROGRAM.

3958
02:30:06,174 --> 02:30:08,310
THE ISSUE ALWAYS WITH THE

3959
02:30:08,310 --> 02:30:08,877
MEDICARE-FUNDED PROGRAMS IS

3960
02:30:08,877 --> 02:30:11,413
WHETHER OR NOT IT'S GOING TO

3961
02:30:11,413 --> 02:30:12,047
INCREASE SPENDING.

3962
02:30:12,047 --> 02:30:14,182
SO I THINK THAT'S WHAT EVERYONE

3963
02:30:14,182 --> 02:30:17,352
IS TRYING TO UNDERSTAND IS THIS

3964
02:30:17,352 --> 02:30:19,321
IN THE NET SCHEME OF THINGS

3965
02:30:19,321 --> 02:30:21,290
GOING TO INDUCE MORE UTILIZATION

3966
02:30:21,290 --> 02:30:23,592
OR WILL IT LEAD TO DIFFERENT

3967
02:30:23,592 --> 02:30:25,694
WAYS IN WHICH PATIENTS ACCESS

3968
02:30:25,694 --> 02:30:26,895
THE HEALTHCARE SYSTEM.

3969
02:30:26,895 --> 02:30:28,196
>> YEAH, IT'S A GOOD
POINT.

3970
02:30:28,196 --> 02:30:30,933
IN FACT, I THINK THERE ARE MANY

3971
02:30:30,933 --> 02:30:32,801
STUDIES THAT SHOW UTILIZATION

3972
02:30:32,801 --> 02:30:33,568
INCREASES, BUT THEN AGAIN THE

3973
02:30:33,568 --> 02:30:35,003
SAME POINT COULD BE MADE THAT A

3974
02:30:35,003 --> 02:30:36,972
LOT OF PEOPLE WANT TO SEE THEIR

3975
02:30:36,972 --> 02:30:37,639
DOCTORS NOT NECESSARILY FOR

3976
02:30:37,639 --> 02:30:40,142
HEALTH CARE BUT TO HAVE A

3977
02:30:40,142 --> 02:30:41,443
CONVERSATION, AND TO FEEL

3978
02:30:41,443 --> 02:30:42,744
CONNECTED WITH THEM.

3979
02:30:42,744 --> 02:30:45,347
SO I THINK THE QUESTION IS, IS

3980
02:30:45,347 --> 02:30:48,250
THIS SOMETHING THAT DO YOU FEEL

3981
02:30:48,250 --> 02:30:49,651
RIGHT NOW ECONOMICS ARE IN FAVOR

3982
02:30:49,651 --> 02:30:51,954
OF THESE TYPE OF PROGRAMS?

3983
02:30:51,954 --> 02:30:53,622
IS THE ROI THERE?

3984
02:30:53,622 --> 02:30:56,558
DO WE SEE A POSITIVE PATH

3985
02:30:56,558 --> 02:30:59,127
TOWARDS GREATER REIMBURSEMENTS

3986
02:30:59,127 --> 02:31:00,495
AROUND THESE CATEGORIES?

3987
02:31:00,495 --> 02:31:01,596
>> IT'S REALLY
INTERESTING.

3988
02:31:01,596 --> 02:31:04,900
EVERY YEAR WE SEE DIFFERENT

3989
02:31:04,900 --> 02:31:06,401
STUDIES, SHOWING SLIGHTLY

3990
02:31:06,401 --> 02:31:07,469
DIFFERENT RESULTS.

3991
02:31:07,469 --> 02:31:09,938
MED PAC FOUND TELEHEALTH MIGHT

3992
02:31:09,938 --> 02:31:12,207
INCREASE SPENDING, BUT IN THEIR

3993
02:31:12,207 --> 02:31:13,408
MOST RECENT REVISED REPORT THEY

3994
02:31:13,408 --> 02:31:14,943
HAVE FOUND IT ACTUALLY REDUCES

3995
02:31:14,943 --> 02:31:16,044
SPENDING SOMEWHAT.

3996
02:31:16,044 --> 02:31:17,813
THERE'S BEEN OTHER STUDIES THAT

3997
02:31:17,813 --> 02:31:19,881
HAVE SHOWN SPENDING INCREASES

3998
02:31:19,881 --> 02:31:22,484
MIGHT BE BECAUSE PATIENTS ARE

3999
02:31:22,484 --> 02:31:23,285
ADHERING TO TREATMENT BETTER,

4000
02:31:23,285 --> 02:31:25,787
GETTING THE CARE THEY REALLY

4001
02:31:25,787 --> 02:31:27,322
NEEDED, AVOIDING SOME OF THE

4002
02:31:27,322 --> 02:31:27,990
E.D. VISITS.

4003
02:31:27,990 --> 02:31:31,026
I THINK IT'S ALL A MATTER OF

4004
02:31:31,026 --> 02:31:32,794
PERSPECTIVE, HOW YOU LOOK AT THE

4005
02:31:32,794 --> 02:31:33,762
PROBLEM, PERHAPS REFLECTING ALSO

4006
02:31:33,762 --> 02:31:36,198
A SHIFT IN HOW HEALTHCARE MIGHT

4007
02:31:36,198 --> 02:31:37,599
BE DELIVERED MOVING FROM IN

4008
02:31:37,599 --> 02:31:39,501
PERSON TO HYBRID MODEL OF CARE

4009
02:31:39,501 --> 02:31:41,703
WHICH MIGHT MAKE MORE SENSE

4010
02:31:41,703 --> 02:31:44,306
UNDER A VALUE-BASED CARE PAYMENT

4011
02:31:44,306 --> 02:31:44,606
ARRANGEMENT.

4012
02:31:44,606 --> 02:31:45,941
>> , YEAH ABSOLUTELY.

4013
02:31:45,941 --> 02:31:49,111
LOOKING AT THE OUTCOMES THAT

4014
02:31:49,111 --> 02:31:50,212
MATTER, READMISSIONS, MORTALITY,

4015
02:31:50,212 --> 02:31:52,147
AND REALLY FOCUSING ON THOSE AS

4016
02:31:52,147 --> 02:31:53,615
OPPOSED TO SIMPLY WHETHER OR NOT

4017
02:31:53,615 --> 02:31:55,751
YOU'RE HAVING MORE TELEHEALTH

4018
02:31:55,751 --> 02:31:57,786
VISITS MAKES A LOT OF SENSE.

4019
02:31:57,786 --> 02:31:59,654
JOE, YOU PROBABLY GET A LOT OF

4020
02:31:59,654 --> 02:32:00,856
PEOPLE SUBMITTING STUDIES IN

4021
02:32:00,856 --> 02:32:01,723
THIS AREA.

4022
02:32:01,723 --> 02:32:03,158
WHAT ARE YOU SEEING RELATIVE TO

4023
02:32:03,158 --> 02:32:04,359
THE TYPE OF RESEARCH THAT'S

4024
02:32:04,359 --> 02:32:06,328
BEING DONE IN THIS SPACE?

4025
02:32:06,328 --> 02:32:09,698
>> I WAS GOING TO COMMENT
ON

4026
02:32:09,698 --> 02:32:13,201
JUST SORT OF UNDERSCORE WHAT

4027
02:32:13,201 --> 02:32:16,071
SACHIN SAID, I REMEMBER BEING AT

4028
02:32:16,071 --> 02:32:18,740
SOME SORT OF PANEL, INNOVATORS

4029
02:32:18,740 --> 02:32:19,741
SOMETHING OR OTHER, PROBABLY TEN

4030
02:32:19,741 --> 02:32:21,410
YEARS AGO WITH A FEW OF THE

4031
02:32:21,410 --> 02:32:24,179
EARLY, EARLY PIONEERS IN THE

4032
02:32:24,179 --> 02:32:24,880
HOSPITAL-AT-HOME ARENA.

4033
02:32:24,880 --> 02:32:27,516
THEY TRIED TO SELL IT ON

4034
02:32:27,516 --> 02:32:28,617
CAPACITY CHALLENGE, TRIED TO

4035
02:32:28,617 --> 02:32:32,220
SELL IT ON YOU WOULD USE FEWER

4036
02:32:32,220 --> 02:32:32,487
RESOURCES.

4037
02:32:32,487 --> 02:32:37,592
AND ALL IT REALLY TOOK OFF WE

4038
02:32:37,592 --> 02:32:38,393
STARTED REIMBURSING, A HUGE

4039
02:32:38,393 --> 02:32:39,928
DANGER OF GOING AWAY IF WE DON'T

4040
02:32:39,928 --> 02:32:40,896
CONTINUE TO REIMBURSE.

4041
02:32:40,896 --> 02:32:44,866
I JUST WOULD MAKE THAT COMMENT

4042
02:32:44,866 --> 02:32:46,968
BECAUSE THERE'S -- IF WE COULD

4043
02:32:46,968 --> 02:32:48,470
GET TO A VALUE-BASED MODEL

4044
02:32:48,470 --> 02:32:51,006
THAT'S A DIFFERENT CONVERSATION

4045
02:32:51,006 --> 02:32:51,973
BUT UNTIL WE DO, PEOPLE JUST

4046
02:32:51,973 --> 02:32:53,308
WANT TO BE PAID FOR WHAT THEY

4047
02:32:53,308 --> 02:32:53,575
DO.

4048
02:32:53,575 --> 02:32:55,477
I DON'T KNOW IF IT'S GOING TO

4049
02:32:55,477 --> 02:32:56,711
SAVE MONEY.

4050
02:32:56,711 --> 02:33:07,255
THE OTHER QUICK COMMENT ON THIS

4051
02:33:08,056 --> 02:33:09,624
AREA, A GOOD CASE THAT EVERY

4052
02:33:09,624 --> 02:33:11,726
OTHER INNOVATION THAT COMES INTO

4053
02:33:11,726 --> 02:33:13,361
HEALTH CARE WE DON'T ASK IF IT

4054
02:33:13,361 --> 02:33:17,299
PAYS MONEY, WE ASK IF IT'S WORTH

4055
02:33:17,299 --> 02:33:21,336
THE COST. 

4056
02:33:21,336 --> 02:33:23,338
WE MIGHT BE PUSHING TELEHEALTH

4057
02:33:23,338 --> 02:33:25,841
TO TOO MUCH TO ASK IF IT SAVES

4058
02:33:25,841 --> 02:33:26,641
MONEY.

4059
02:33:26,641 --> 02:33:28,577
>> CAN WE SAY IT REDUCE
COST,

4060
02:33:28,577 --> 02:33:31,413
WHAT DOES THE LITERATURE SAY?

4061
02:33:31,413 --> 02:33:34,049
>> AGAIN, THERE HAVE BEEN,
AS

4062
02:33:34,049 --> 02:33:35,250
LOK SAID, THERE'S CONFLICTING

4063
02:33:35,250 --> 02:33:35,484
STUDIES.

4064
02:33:35,484 --> 02:33:38,220
I THINK IT DEPENDS WHAT YOU ASK.

4065
02:33:38,220 --> 02:33:40,889
THE ONE I USED TO CITE WAS ONE

4066
02:33:40,889 --> 02:33:42,257
THAT SHOWED DURING THE PANDEMIC,

4067
02:33:42,257 --> 02:33:44,793
AND THIS IS A LITTLE -- EVEN

4068
02:33:44,793 --> 02:33:47,429
THIS IS MAYBE A BACK-HANDED

4069
02:33:47,429 --> 02:33:54,669
CONCLUSION, BUT DURING THE

4070
02:33:54,669 --> 02:33:56,972
PANDEMIC PRIMARY CARE -- ACCESS

4071
02:33:56,972 --> 02:33:58,840
TO PRIMARY CARE DIDN'T INCREASE

4072
02:33:58,840 --> 02:33:59,708
BECAUSE PEOPLE WERE DOING MORE

4073
02:33:59,708 --> 02:34:00,142
TELEHEALTH.

4074
02:34:00,142 --> 02:34:01,910
IN OTHER WORDS, IT DIDN'T ADD TO

4075
02:34:01,910 --> 02:34:02,544
COST.

4076
02:34:02,544 --> 02:34:03,345
I DON'T KNOW.

4077
02:34:03,345 --> 02:34:07,249
I THINK, AGAIN, IT'S A VERY HARD

4078
02:34:07,249 --> 02:34:08,683
PROBLEM TO STUDY.

4079
02:34:08,683 --> 02:34:10,452
THERE'S NO RANDOMIZED TRIAL I'M

4080
02:34:10,452 --> 02:34:11,219
AWARE OF.

4081
02:34:11,219 --> 02:34:17,125
IT'S ALWAYS DONE ON AN

4082
02:34:17,125 --> 02:34:17,592
EPIDEMIOLOGIC BASIS.

4083
02:34:17,592 --> 02:34:19,761
>> DO YOU THINK THERE'S

4084
02:34:19,761 --> 02:34:21,396
SUBPOPULATIONS WE CAN SAY THIS

4085
02:34:21,396 --> 02:34:23,365
HAS BEEN BENEFICIAL, COST

4086
02:34:23,365 --> 02:34:24,799
EFFECTIVE, SAVING MONEY,

4087
02:34:24,799 --> 02:34:25,867
IMPROVING OUTCOMES, AND MAYBE

4088
02:34:25,867 --> 02:34:28,737
OVERALL IF WE LOOK AT IT, IT

4089
02:34:28,737 --> 02:34:33,675
MIGHT GET A MIXED BAG?

4090
02:34:33,675 --> 02:34:35,844
>> WELL, SO, MY ANSWER
ISN'T

4091
02:34:35,844 --> 02:34:38,380
PARTICULARLY DATA DRIVEN, IT'S

4092
02:34:38,380 --> 02:34:40,348
MORE EXPERIENCE DRIVEN.

4093
02:34:40,348 --> 02:34:41,883
BUT THINGS THAT ARE RELATIVELY

4094
02:34:41,883 --> 02:34:42,984
TRANSACTIONAL, TELEHEALTH IS

4095
02:34:42,984 --> 02:34:46,254
GREAT FOR I NEED MY REFILL ON MY

4096
02:34:46,254 --> 02:34:51,526
MEDICINE, I SEE PATIENTS -- I'M

4097
02:34:51,526 --> 02:34:52,160
A DERMATOLOGIST, ACNE,

4098
02:34:52,160 --> 02:34:53,028
PSORIASIS, ECZEMA PATIENTS THAT

4099
02:34:53,028 --> 02:34:55,030
ARE STABLE AND NEED MED REFILLS.

4100
02:34:55,030 --> 02:34:57,199
THAT'S A GREAT USE FOR

4101
02:34:57,199 --> 02:34:58,333
TELEHEALTH.

4102
02:34:58,333 --> 02:35:05,273
SO THERE ARE WAYS TO CARVE OUT

4103
02:35:05,273 --> 02:35:05,774
HIGH-YIELD INTERACTIONS.

4104
02:35:05,774 --> 02:35:06,708
SOMEONE WHO HAS A BRAND-NEW

4105
02:35:06,708 --> 02:35:07,809
DIAGNOSIS OF CANCER I MIGHT WANT

4106
02:35:07,809 --> 02:35:09,244
TO SIT WITH THEM IN PERSON AND

4107
02:35:09,244 --> 02:35:11,112
TALK TO THEM ABOUT THAT.

4108
02:35:11,112 --> 02:35:14,716
SOMEONE WHO HAS A COMPLICATED --

4109
02:35:14,716 --> 02:35:16,918
AGAIN, TRANSPLANT PATIENTS, ALL

4110
02:35:16,918 --> 02:35:17,686
THESE OTHER COMPLICATIONS MIGHT

4111
02:35:17,686 --> 02:35:19,421
MAKE MORE SENSE TO HAVE THEM

4112
02:35:19,421 --> 02:35:20,188
COME IN.

4113
02:35:20,188 --> 02:35:21,957
AGAIN, IT DEPEND HOW YOU ASK THE

4114
02:35:21,957 --> 02:35:22,224
QUESTION.

4115
02:35:22,224 --> 02:35:25,961
AND I'M NOT AWARE OF RESEARCH

4116
02:35:25,961 --> 02:35:28,296
THAT'S DONE THOSE CARVE-OUTS

4117
02:35:28,296 --> 02:35:29,164
EFFECTIVELY.

4118
02:35:29,164 --> 02:35:31,266
MAYBE THE OTHERS ARE.

4119
02:35:31,266 --> 02:35:34,336
>> GREAT COMMENTS THERE.

4120
02:35:34,336 --> 02:35:36,805
LARGELY, THIS IS ALL BASED ON

4121
02:35:36,805 --> 02:35:38,807
CAPTURING DATA, PRESENTING IT TO

4122
02:35:38,807 --> 02:35:40,775
A CLINICIAN, TO THE PATIENT, YOU

4123
02:35:40,775 --> 02:35:42,944
KNOW, EITHER THE CLINICIAN

4124
02:35:42,944 --> 02:35:44,045
MAKING A RECOMMENDATION TO

4125
02:35:44,045 --> 02:35:46,014
PATIENTS, THE PATIENT LOOKING AT

4126
02:35:46,014 --> 02:35:47,549
THAT INFORMATION AND RESPONDING

4127
02:35:47,549 --> 02:35:49,284
TO IT.

4128
02:35:49,284 --> 02:35:50,619
IT'S BEHAVIOR CHANGE.

4129
02:35:50,619 --> 02:35:54,556
BEHAVIOR CHANGE AT BOTH PATIENT

4130
02:35:54,556 --> 02:35:55,757
AND CLINICIAN LEVEL.

4131
02:35:55,757 --> 02:35:57,092
LET'S TALK FIRST ABOUT THE

4132
02:35:57,092 --> 02:35:57,525
PATIENT.

4133
02:35:57,525 --> 02:35:58,727
THERE WAS AN ORIGINAL FEELING

4134
02:35:58,727 --> 02:35:59,928
YOU COULD CAPTURE THE DATA AND

4135
02:35:59,928 --> 02:36:02,364
THEN PEOPLE COULD LOOK AT IT,

4136
02:36:02,364 --> 02:36:04,099
MOTIVATED TO WANT TO GET

4137
02:36:04,099 --> 02:36:04,699
IMPROVED HEALTH.

4138
02:36:04,699 --> 02:36:06,534
AND I'D LOVE TO GET YOUR

4139
02:36:06,534 --> 02:36:07,002
THOUGHTS.

4140
02:36:07,002 --> 02:36:08,470
HAS THAT COME TO BE TRUE?

4141
02:36:08,470 --> 02:36:10,005
IS IT NOT TRUE?

4142
02:36:10,005 --> 02:36:15,277
ARE WE SOMEWHERE IN THE MIDDLE?

4143
02:36:15,277 --> 02:36:16,711
>> CERTAINLY THAT'S BEEN
THE

4144
02:36:16,711 --> 02:36:18,346
ANECDOTAL SUCCESS STORIES THAT

4145
02:36:18,346 --> 02:36:22,384
WE'VE ALL RUN PROJECTS OR WE'VE

4146
02:36:22,384 --> 02:36:23,485
PROVIDED DEVICES, YOU KNOW,

4147
02:36:23,485 --> 02:36:24,753
MENTIONING EARLY CONNECTED

4148
02:36:24,753 --> 02:36:26,888
PARTICIPANTS TO HEALTH, HUNDREDS

4149
02:36:26,888 --> 02:36:28,089
OF E-MAILS FROM PARTICIPANTS

4150
02:36:28,089 --> 02:36:30,525
SAYING THIS TRANSFORMED MY LIFE.

4151
02:36:30,525 --> 02:36:34,663
I WAS CONNECTED, NOW I'M DOING

4152
02:36:34,663 --> 02:36:36,331
THIS, DOING THAT.

4153
02:36:36,331 --> 02:36:37,999
THERE'S A SELECTION BIAS PROBLEM

4154
02:36:37,999 --> 02:36:41,036
IN THE COMMENTS, WHEN YOU LOOK

4155
02:36:41,036 --> 02:36:42,137
AT RIGOROUSLY DONE STUDIES WHEN

4156
02:36:42,137 --> 02:36:44,005
THEY PROVIDE HALF WITH DEVICE,

4157
02:36:44,005 --> 02:36:45,874
DON'T PROVIDE THE OTHER HALF

4158
02:36:45,874 --> 02:36:48,410
WITH THE DEVICE, CHANGING STEP

4159
02:36:48,410 --> 02:36:50,245
COUNTS, CHANGING ACTIVITY

4160
02:36:50,245 --> 02:36:52,113
LEVELS, CHANGING WEIGHTS ARE

4161
02:36:52,113 --> 02:36:54,849
NON-RESILIENT TO TIME.

4162
02:36:54,849 --> 02:36:57,352
I CONTINUE TO BE SADDENED BY THE

4163
02:36:57,352 --> 02:37:00,422
LACK OF CLARITY IN THAT MESSAGE.

4164
02:37:00,422 --> 02:37:03,825
I THINK OF PLACES WHERE WE'RE

4165
02:37:03,825 --> 02:37:06,428
SEEING VALUE IN THIS, WHERE

4166
02:37:06,428 --> 02:37:08,096
THERE'S CLEAR EFFICACY IN THE

4167
02:37:08,096 --> 02:37:12,467
INTENSE VERSION OF THAT CLINICAL

4168
02:37:12,467 --> 02:37:13,001
INTERACTION.

4169
02:37:13,001 --> 02:37:13,868
CARDIAC REHAB, PULMONARY REHAB,

4170
02:37:13,868 --> 02:37:16,938
AND DUE TO INCONVENIENCE OF THAT

4171
02:37:16,938 --> 02:37:20,008
INTENSE VERSION, DESPITE ITS

4172
02:37:20,008 --> 02:37:22,877
EFFICACY YOU DON'T SEE -- ACCESS

4173
02:37:22,877 --> 02:37:23,945
ISSUES, BOTH HAVE MASSIVE ACCESS

4174
02:37:23,945 --> 02:37:26,514
ISSUES, ALL THESE FORMS OF

4175
02:37:26,514 --> 02:37:26,981
REHAB.

4176
02:37:26,981 --> 02:37:28,783
AND BECAUSE OF JUST

4177
02:37:28,783 --> 02:37:30,118
INCONVENIENCE ISSUES, YOU KNOW,

4178
02:37:30,118 --> 02:37:33,822
DRIVING TO THE PLACE, YOU KNOW,

4179
02:37:33,822 --> 02:37:36,024
AFTER USUAL FOURTH VISIT, HAVING

4180
02:37:36,024 --> 02:37:37,559
THE PHYSIOLOGIST TELLING YOU

4181
02:37:37,559 --> 02:37:40,295
YOU'RE WALKING TOO FAST, PLACES

4182
02:37:40,295 --> 02:37:42,397
WE'VE SEEN LIKE WITH TECHNOLOGY

4183
02:37:42,397 --> 02:37:44,132
IN THE PAST IF YOUR COMPARATOR

4184
02:37:44,132 --> 02:37:45,367
IS NOTHING THESE TECHNOLOGIES DO

4185
02:37:45,367 --> 02:37:46,134
WELL.

4186
02:37:46,134 --> 02:37:49,170
AND LET'S BE HONEST, NOTHING IS

4187
02:37:49,170 --> 02:37:51,172
A VERY VALID COMPARATOR BECAUSE

4188
02:37:51,172 --> 02:37:53,041
THAT'S THE DEFAULT BEHAVIOR.

4189
02:37:53,041 --> 02:37:54,142
MY BACKGROUND IN ELECTRONIC

4190
02:37:54,142 --> 02:37:56,010
HEALTH RECORDS, WE USED TO -- 20

4191
02:37:56,010 --> 02:37:57,545
YEARS AGO WOULD SAY OUR

4192
02:37:57,545 --> 02:37:59,981
COMPETITOR ISN'T THIS COMPANY OR

4193
02:37:59,981 --> 02:38:02,250
THAT COMPANY, IT'S PAPER.

4194
02:38:02,250 --> 02:38:03,351
IT'S FORMIDABLE.

4195
02:38:03,351 --> 02:38:05,720
IT'S WINNING.

4196
02:38:05,720 --> 02:38:06,521
AND CLINICIANS ARE NATURALLY

4197
02:38:06,521 --> 02:38:07,522
THERE.

4198
02:38:07,522 --> 02:38:09,691
TELEHEALTH IS IN THE SAME SPOT

4199
02:38:09,691 --> 02:38:10,358
NOW.

4200
02:38:10,358 --> 02:38:11,793
WE KEEP TRYING TO CONFIRM

4201
02:38:11,793 --> 02:38:13,762
TELEHEALTH TO SEEING YOUR

4202
02:38:13,762 --> 02:38:14,329
CARDIOLOGIST.

4203
02:38:14,329 --> 02:38:15,830
THAT'S NOT VALID.

4204
02:38:15,830 --> 02:38:18,700
TELEHEALTH POTENTIALLY TO -- OR

4205
02:38:18,700 --> 02:38:20,235
REMOTE PATIENT MONITORING

4206
02:38:20,235 --> 02:38:22,103
OPTIONS COMPARING TO NOT GETTING

4207
02:38:22,103 --> 02:38:24,072
CARDIAC REHAB TYPICALLY DOES

4208
02:38:24,072 --> 02:38:25,173
WIN, WITH LOWER UTILIZATION

4209
02:38:25,173 --> 02:38:26,474
RATE, THAT'S A GREAT STORY WE

4210
02:38:26,474 --> 02:38:28,009
SHOULD BE TOUTING MORE

4211
02:38:28,009 --> 02:38:29,077
EFFECTIVELY, HOW HAVE KNOWN

4212
02:38:29,077 --> 02:38:30,645
INTERVENTIONS BUT BECAUSE OF

4213
02:38:30,645 --> 02:38:31,813
CHALLENGE IN GETTING THEM THEY

4214
02:38:31,813 --> 02:38:33,515
CAN'T GET THEM IN THE IN-PERSON

4215
02:38:33,515 --> 02:38:36,117
SETTING, AND THESE ARE VALID

4216
02:38:36,117 --> 02:38:36,651
OPTIONS.

4217
02:38:36,651 --> 02:38:38,186
THAT'S A NEW TYPE OF PATIENT

4218
02:38:38,186 --> 02:38:43,558
YOU'RE HELPING THAT YOU'RE NOT

4219
02:38:43,558 --> 02:38:44,259
HELP OTHERWISE.

4220
02:38:44,259 --> 02:38:45,894
>> YOUR POINTS ABOUT
HAVING

4221
02:38:45,894 --> 02:38:46,628
THESE PROGRAMS WHICH INDIVIDUALS

4222
02:38:46,628 --> 02:38:48,830
ARE CONNECTED TO THE PROVIDERS

4223
02:38:48,830 --> 02:38:49,731
AND HAVING THAT MOTIVATION TO

4224
02:38:49,731 --> 02:38:52,667
ACT ON IT BECAUSE YOU KNOW YOUR

4225
02:38:52,667 --> 02:38:53,768
PROVIDER IS LOOKING AND

4226
02:38:53,768 --> 02:38:57,939
OVERSEEING WHAT YOU'RE DOING,

4227
02:38:57,939 --> 02:39:00,675
BEHAVIORAL ECONOMICS BEHIND IT,

4228
02:39:00,675 --> 02:39:04,078
CARDIAC AND PULMONARY REHAB ARE

4229
02:39:04,078 --> 02:39:04,846
EXCELLENT EXAMPLES.

4230
02:39:04,846 --> 02:39:07,682
LOK, HAVE YOU SEEN PROGRAMS LIKE

4231
02:39:07,682 --> 02:39:09,317
THIS HIGHLY EFFECTIVE, HIGHLY

4232
02:39:09,317 --> 02:39:10,318
ENGAGING, THINGS PATIENTS AND

4233
02:39:10,318 --> 02:39:12,053
CONSUMERS WHEN THEY SEE THE DATA

4234
02:39:12,053 --> 02:39:14,155
OR WHEN THEY ARE RESPONDING TO

4235
02:39:14,155 --> 02:39:16,758
WRITTEN MESSAGES THEY ARE MORE

4236
02:39:16,758 --> 02:39:18,193
LIKELY TO DO THE THINGS

4237
02:39:18,193 --> 02:39:22,030
NECESSARY TO GET TO BETTER

4238
02:39:22,030 --> 02:39:23,131
HEALTH?

4239
02:39:23,131 --> 02:39:25,967
>> I'M GOING TO PUNCH ON
THAT

4240
02:39:25,967 --> 02:39:26,401
ONE.

4241
02:39:26,401 --> 02:39:27,969
>> MAYBE, JOE, YOU SEE
STUDIES

4242
02:39:27,969 --> 02:39:30,672
OR PERSONAL EXPERIENCE.

4243
02:39:30,672 --> 02:39:31,773
>> YEAH, PERSONAL
EXPERIENCE.

4244
02:39:31,773 --> 02:39:33,842
WE STUDY THIS PROBLEM TEN YEARS

4245
02:39:33,842 --> 02:39:34,209
AGO EXTENSIVELY.

4246
02:39:34,209 --> 02:39:37,445
TWO OR THREE KINDS OF INSIGHTS,

4247
02:39:37,445 --> 02:39:40,748
ONE IS THAT TO YOUR POINT, IF

4248
02:39:40,748 --> 02:39:42,283
PEOPLE ARE SELF-MOTIVATED BY

4249
02:39:42,283 --> 02:39:43,685
DATA, THEY DO REALLY WELL.

4250
02:39:43,685 --> 02:39:50,258
THIS WAS IN THE BEGINNING WE

4251
02:39:50,258 --> 02:39:51,359
CALLED THEM QUANTIFIED

4252
02:39:51,359 --> 02:39:53,194
SELF-PRESENTERS.

4253
02:39:53,194 --> 02:39:53,795
GET TOGETHER, HAVE MEETINGS,

4254
02:39:53,795 --> 02:39:55,196
TALK ABOUT THINGS THEY WERE

4255
02:39:55,196 --> 02:39:55,830
MEASURING.

4256
02:39:55,830 --> 02:39:57,265
THAT'S SUCH A NARROW SLICE OF

4257
02:39:57,265 --> 02:39:58,132
THE POPULATION.

4258
02:39:58,132 --> 02:39:58,967
USUALLY BECAUSE THEY CARE ABOUT

4259
02:39:58,967 --> 02:40:00,902
ALL KINDS OF OTHER THINGS ABOUT

4260
02:40:00,902 --> 02:40:06,374
THEIR HEALTH TOO. 

4261
02:40:06,374 --> 02:40:07,308
SADLY, WEARABLES WORK WELL FOR

4262
02:40:07,308 --> 02:40:08,877
THEM BUT NOT THOSE OF US THAT

4263
02:40:08,877 --> 02:40:09,711
CARE ABOUT PATIENTS.

4264
02:40:09,711 --> 02:40:10,745
THE SECOND PHENOMENON WHEN WE

4265
02:40:10,745 --> 02:40:12,046
STARTED TO DO IT WITH

4266
02:40:12,046 --> 02:40:17,352
CLINICIANS, THIS IS EARLY DAYS,

4267
02:40:17,352 --> 02:40:22,290
IF THE PATIENT BOTHERED TO GET

4268
02:40:22,290 --> 02:40:26,861
ALL THIS INFORMATION COLLECTED,

4269
02:40:26,861 --> 02:40:28,963
AND THE DOCTOR DIDN'T KNOW OR

4270
02:40:28,963 --> 02:40:30,398
DIDN'T LOOK, IT WAS

4271
02:40:30,398 --> 02:40:30,732
DEMOTIVATING.

4272
02:40:30,732 --> 02:40:32,467
THEY CHECKED OUT AND WOULD TELL

4273
02:40:32,467 --> 02:40:34,636
US IN FOCUS GROUP WHY AM I

4274
02:40:34,636 --> 02:40:35,136
BOTHERING?

4275
02:40:35,136 --> 02:40:37,372
IT'S ABOUT THEIR HEALTH.

4276
02:40:37,372 --> 02:40:39,440
BUT THIS WAS GLUCOSE MONITORING,

4277
02:40:39,440 --> 02:40:41,309
PATIENTS WITH DIABETES.

4278
02:40:41,309 --> 02:40:42,977
THEY STILL WOULD SAY, THE DOCTOR

4279
02:40:42,977 --> 02:40:46,347
DOESN'T SEEM TO CARE, I'M OUT.

4280
02:40:46,347 --> 02:40:48,750
OR THE OTHER PHENOMENON, AND

4281
02:40:48,750 --> 02:40:52,287
THIS I'LL EXIT AFTER THIS, THE

4282
02:40:52,287 --> 02:40:53,688
OTHER PHENOMENON WAS IF PEOPLE

4283
02:40:53,688 --> 02:40:54,556
WOULD CHANGE BEHAVIOR BECAUSE

4284
02:40:54,556 --> 02:40:56,090
THEY KNEW SOMEONE IN THE

4285
02:40:56,090 --> 02:40:57,625
PRACTICE WAS LOOKING AT THE

4286
02:40:57,625 --> 02:41:01,029
DATA, SO YOU CALL IT THE

4287
02:41:01,029 --> 02:41:01,896
SENTINEL OR HAWTHORNE EFFECT,

4288
02:41:01,896 --> 02:41:04,532
THAT'S VERY REAL.

4289
02:41:04,532 --> 02:41:06,601
YOU CAN MOTIVATE CERTAIN COHORTS

4290
02:41:06,601 --> 02:41:09,003
OF INDIVIDUALS BY GIVING THEM A

4291
02:41:09,003 --> 02:41:10,271
DEVICES AND JUST HAVING --

4292
02:41:10,271 --> 02:41:12,206
SENDING THEM A MESSAGE FROM THE

4293
02:41:12,206 --> 02:41:14,375
NURSE IN THE PRACTICE EVERY SO

4294
02:41:14,375 --> 02:41:17,211
OFTEN YOU'RE DOING GREAT OR YOU

4295
02:41:17,211 --> 02:41:19,414
COULD DO BETTER THEY ONE THEIR

4296
02:41:19,414 --> 02:41:19,647
GAME.

4297
02:41:19,647 --> 02:41:21,149
THESE THINGS HAVE A ROLE.

4298
02:41:21,149 --> 02:41:23,351
I THINK FINDING -- I DON'T KNOW

4299
02:41:23,351 --> 02:41:25,420
OF ANY KIND OF -- YOU HAVE TO

4300
02:41:25,420 --> 02:41:27,822
FILL OUT 10 OR 15 QUESTIONS LIKE

4301
02:41:27,822 --> 02:41:30,124
THE PHQ OR WHAT HAVE YOU, I

4302
02:41:30,124 --> 02:41:32,527
DON'T KNOW OF ANY SURVEY LIKE

4303
02:41:32,527 --> 02:41:34,596
THAT, TEN QUESTIONS LONG, THAT

4304
02:41:34,596 --> 02:41:36,264
WILL PUT YOU IN THE ONE OF THE

4305
02:41:36,264 --> 02:41:37,365
THREE GROUPS.

4306
02:41:37,365 --> 02:41:39,434
IF WE DID WE COULD FINE TUNE

4307
02:41:39,434 --> 02:41:40,535
THIS FROM A CLINICAL

4308
02:41:40,535 --> 02:41:41,069
PERSPECTIVE.

4309
02:41:41,069 --> 02:41:43,605
>> YEAH, IDENTIFICATION OF
THE

4310
02:41:43,605 --> 02:41:45,473
RIGHT PATIENTS, YOU KNOW,

4311
02:41:45,473 --> 02:41:47,775
PATIENT ACTIVATION MEASURES,

4312
02:41:47,775 --> 02:41:49,310
THINGS LIKE THAT, YEAH,

4313
02:41:49,310 --> 02:41:50,178
OFTENTIMES IT'S DIFFICULT TO

4314
02:41:50,178 --> 02:41:52,347
KNOW WHO WILL RESPOND BEST.

4315
02:41:52,347 --> 02:41:54,682
WE SEE A SIMILAR STORY WITH

4316
02:41:54,682 --> 02:41:58,219
CLINICIANS, SUPER EAGER AND

4317
02:41:58,219 --> 02:42:00,288
ACTIVE, WANT TO PARTICIPATE,

4318
02:42:00,288 --> 02:42:02,056
OTHERS SAY IT'S TOO MUCH

4319
02:42:02,056 --> 02:42:03,458
INFORMATION, MAYBE TOO MUCH

4320
02:42:03,458 --> 02:42:03,725
LIABILITY.

4321
02:42:03,725 --> 02:42:05,093
CURIOUS WHAT YOUR THOUGHTS ARE,

4322
02:42:05,093 --> 02:42:06,961
OPEN TO THE GROUP.

4323
02:42:06,961 --> 02:42:09,030
WHAT ARE YOU SEEING, HAS THAT

4324
02:42:09,030 --> 02:42:09,263
CHANGED?

4325
02:42:09,263 --> 02:42:15,937
DO PEOPLE FEEL NOW WITH THE FACT

4326
02:42:15,937 --> 02:42:17,672
THESE ARE MORE UBIQUITOUS, OR

4327
02:42:17,672 --> 02:42:19,007
ARE THEY STILL FEELING THIS IS

4328
02:42:19,007 --> 02:42:26,114
NOISE AND MAYBE TOO MUCH EFFORT?

4329
02:42:26,114 --> 02:42:26,781
>> A BELL-SHAPED CURVED.

4330
02:42:26,781 --> 02:42:27,982
I POINT TO MY STORY.

4331
02:42:27,982 --> 02:42:29,617
TEN YEARS AGO I WOULD NOT HAVE

4332
02:42:29,617 --> 02:42:31,252
HAD A CARDIOLOGIST TELL ME TO

4333
02:42:31,252 --> 02:42:34,322
GET A SMART DEVICE, I'M SURE,

4334
02:42:34,322 --> 02:42:34,689
RIGHT?

4335
02:42:34,689 --> 02:42:35,990
WE'RE GETTING THERE.

4336
02:42:35,990 --> 02:42:40,795
BUT, YEAH, THERE'S A LOT OF

4337
02:42:40,795 --> 02:42:41,796
FOLKS AT CONFERENCES,

4338
02:42:41,796 --> 02:42:42,664
EVANGELIZING, I DON'T WANT TO

4339
02:42:42,664 --> 02:42:44,198
SEE ALL THAT INFORMATION.

4340
02:42:44,198 --> 02:42:45,867
I'M WORRIED ABOUT THE LIABILITY,

4341
02:42:45,867 --> 02:42:49,270
TOO BUSY, WHICH TO ME IS SAD

4342
02:42:49,270 --> 02:42:52,006
BECAUSE BEING A DOCTOR IS ABOUT

4343
02:42:52,006 --> 02:42:52,840
COLLECTING INFORMATION, ABOUT

4344
02:42:52,840 --> 02:42:53,741
YOUR PATIENT TO HELP THEM.

4345
02:42:53,741 --> 02:42:54,842
IF YOU CAN ONLY COLLECT IT WHEN

4346
02:42:54,842 --> 02:42:56,611
THEY ARE THERE AND YOU GET THAT

4347
02:42:56,611 --> 02:42:58,346
NARROW SLICE WHEN THEY ARE IN

4348
02:42:58,346 --> 02:42:59,781
THE OFFICE, THAT'S SUCH A NARROW

4349
02:42:59,781 --> 02:43:00,748
VIEW OF THEIR LIFE.

4350
02:43:00,748 --> 02:43:02,750
I THINK IT'S TOO BAD WE CAN'T

4351
02:43:02,750 --> 02:43:04,519
FIGURE OUT A WAY TO MAKE THIS

4352
02:43:04,519 --> 02:43:07,455
MORE ACTIONABLE SO THAT DOCTORS

4353
02:43:07,455 --> 02:43:08,556
DON'T FEEL SO OVERWHELMED BY

4354
02:43:08,556 --> 02:43:10,825
REAMS AND REAMS AND REAMS OF

4355
02:43:10,825 --> 02:43:12,060
NORMAL RESULTS AND SO FORTH.

4356
02:43:12,060 --> 02:43:13,261
>> YEAH, YEAH.

4357
02:43:13,261 --> 02:43:14,595
>> I THINK THERE'S LESSONS
WE'VE

4358
02:43:14,595 --> 02:43:16,531
SEEN IN THE CLINICAL REALM THAT

4359
02:43:16,531 --> 02:43:18,866
WE HAVE TO LEARN HOW TO ADAPT TO

4360
02:43:18,866 --> 02:43:23,271
THE NEXT SET OF DATA STREAMS.

4361
02:43:23,271 --> 02:43:24,172
YOU KNOW, AMBULATORY BLOOD

4362
02:43:24,172 --> 02:43:26,307
PRESSURE MEASUREMENT USED TO BE

4363
02:43:26,307 --> 02:43:27,742
A CLINICAL INTERACTION, WE GIVE

4364
02:43:27,742 --> 02:43:29,811
YOU A PARTICULAR TYPE OF CUFF,

4365
02:43:29,811 --> 02:43:31,112
CYCLE FOUR TIMES A DAY.

4366
02:43:31,112 --> 02:43:32,113
THOSE DAYS ARE GONE NOW.

4367
02:43:32,113 --> 02:43:34,315
ARE YOU SEND PEOPLE HOME WITH A

4368
02:43:34,315 --> 02:43:36,484
BLOOD PRESSURE CUFF, THEY PICK

4369
02:43:36,484 --> 02:43:38,453
ONE UP, AND WHETHER THEY BRING A

4370
02:43:38,453 --> 02:43:40,955
PRINTOUT, SHARE THE APP WITH

4371
02:43:40,955 --> 02:43:42,857
YOU, CGMs ARE DOING THE SAME

4372
02:43:42,857 --> 02:43:43,624
THING, RIGHT?

4373
02:43:43,624 --> 02:43:45,259
PROVIDERS HAVE JUMPED ON THAT

4374
02:43:45,259 --> 02:43:48,863
TRAINEE EFFECTIVELY BECAUSE WE

4375
02:43:48,863 --> 02:43:55,036
RECOGNIZED  DICHOTOMY BETWEEN TE

4376
02:43:55,036 --> 02:43:57,205
NARROW MOMENT, DIFFERENCE

4377
02:43:57,205 --> 02:43:57,972
BETWEEN HYPERTENSION TODAY,

4378
02:43:57,972 --> 02:43:59,841
WHITE COAT VERSUS AT HOME, SO

4379
02:43:59,841 --> 02:44:01,776
WE'VE GOT PHYSIOLOGY WE'VE

4380
02:44:01,776 --> 02:44:02,443
ESTABLISHED SCIENCE OF THE VALUE

4381
02:44:02,443 --> 02:44:03,778
OF THE HOME DATA.

4382
02:44:03,778 --> 02:44:06,080
SO WHAT'S MISSING RIGHT NOW IS

4383
02:44:06,080 --> 02:44:07,915
PROVIDING CLINICIANS WHAT'S THE

4384
02:44:07,915 --> 02:44:10,752
VALUE OF THAT HOME ACTIVITY, THE

4385
02:44:10,752 --> 02:44:13,187
VALUE OF THE HOME SLEEP HOUR,

4386
02:44:13,187 --> 02:44:15,923
WE'VE GOT MORE DATA POINTS.

4387
02:44:15,923 --> 02:44:17,558
WE HAVEN'T SAID COMPARED TO THIS

4388
02:44:17,558 --> 02:44:20,528
GOLD STANDARD IT MIGHT BE BETTER

4389
02:44:20,528 --> 02:44:23,030
THAN TAKING THE PATIENT'S BLOOD

4390
02:44:23,030 --> 02:44:24,732
PRESSURE THAT DAY, BETTER THAN

4391
02:44:24,732 --> 02:44:30,671
I'M MANAGING A HEART FAILURE

4392
02:44:30,671 --> 02:44:32,306
PATIENT. 

4393
02:44:32,306 --> 02:44:33,441
IT'S A FINE ART.

4394
02:44:33,441 --> 02:44:34,575
WHERE WE'VE GIVEN THEM EVIDENCE

4395
02:44:34,575 --> 02:44:36,611
ON THE VALUE OF THE HOME DATA

4396
02:44:36,611 --> 02:44:37,912
STREAM, THAT MORE INTENSE DATA

4397
02:44:37,912 --> 02:44:39,213
STREAM, THEY HAVE ADOPTED AND

4398
02:44:39,213 --> 02:44:41,082
CHANGED PRACTICE ON THE CLINICAL

4399
02:44:41,082 --> 02:44:41,282
SIDE.

4400
02:44:41,282 --> 02:44:42,517
WE HAVEN'T GIVEN IT TO THEM FOR

4401
02:44:42,517 --> 02:44:43,951
THE OTHER STREAMS OUT THERE YET.

4402
02:44:43,951 --> 02:44:44,719
>> THAT'S FAIR.

4403
02:44:44,719 --> 02:44:46,687
>> ONE OF THE PROGRAMS
WE'VE

4404
02:44:46,687 --> 02:44:48,890
SEEN WHERE IT'S BEEN SORT OF

4405
02:44:48,890 --> 02:44:51,959
UNDERVALUED AND PERHAPS MAYBE

4406
02:44:51,959 --> 02:44:54,595
OVERHYPED HAS BEEN TELEHEALTH.

4407
02:44:54,595 --> 02:44:55,363
SPECIFICALLY DURING THE PANDEMIC

4408
02:44:55,363 --> 02:44:57,131
A LOT OF INDIVIDUALS FELT THIS

4409
02:44:57,131 --> 02:44:59,767
WAS HERE TO STAY, WE'RE GOING TO

4410
02:44:59,767 --> 02:45:03,037
ACTUALLY NOW BE DOING MUCH MORE

4411
02:45:03,037 --> 02:45:05,673
HYBRID, BUT WE'VE SEEN A SHIFT

4412
02:45:05,673 --> 02:45:07,441
TO MORE IN-PERSON AND MAYBE

4413
02:45:07,441 --> 02:45:09,177
TELEHEALTH HAS BECOME LESS OF

4414
02:45:09,177 --> 02:45:10,611
THE CONVERSATION TOPIC.

4415
02:45:10,611 --> 02:45:15,850
AND LOK, FROM A NATIONAL

4416
02:45:15,850 --> 02:45:16,951
PERSPECTIVE CURIOUS, ARE YOU

4417
02:45:16,951 --> 02:45:18,052
SEEING TELEHEALTH SORT OF

4418
02:45:18,052 --> 02:45:19,587
STABILIZE WITH A CERTAIN NUMBER

4419
02:45:19,587 --> 02:45:21,355
OF SITES DOING IT CONSISTENTLY?

4420
02:45:21,355 --> 02:45:23,191
OR IS THERE A CONTINUOUS

4421
02:45:23,191 --> 02:45:23,524
DECLINE?

4422
02:45:23,524 --> 02:45:25,993
WHERE ARE WE AT IN TERMS OF

4423
02:45:25,993 --> 02:45:26,894
TELEHEALTH ADOPTION?

4424
02:45:26,894 --> 02:45:29,330
>> I THINK IN TERMS OF THE

4425
02:45:29,330 --> 02:45:30,731
ACTUAL UTILIZATION IT SEEMS TO

4426
02:45:30,731 --> 02:45:34,869
HAVE  STABILIZED BUT WHAT'S

4427
02:45:34,869 --> 02:45:37,104
CONCERNING IS THE NUMBER OF

4428
02:45:37,104 --> 02:45:38,739
PROVIDERS WILLING TO OFFER, THE

4429
02:45:38,739 --> 02:45:39,407
DETERMINING FACTOR WHETHER

4430
02:45:39,407 --> 02:45:42,677
SOMEONE HAS A TELEHEALTH VISIT.

4431
02:45:42,677 --> 02:45:45,079
NOT THE PATIENT REQUESTING IT.

4432
02:45:45,079 --> 02:45:47,915
PROBABLY BECAUSE OF UNCERTAINTY

4433
02:45:47,915 --> 02:45:49,217
WITH THE TELEHEALTH FLEXIBILITY

4434
02:45:49,217 --> 02:45:49,884
CONTINUING, PROVIDERS NOT

4435
02:45:49,884 --> 02:45:52,420
WILLING TO INVEST IN CHANGING

4436
02:45:52,420 --> 02:45:53,855
THEIR CLINICAL WORKFLOW,

4437
02:45:53,855 --> 02:46:01,162
INVESTING IN VIRTUAL HEALTH

4438
02:46:01,162 --> 02:46:04,532
CLINICS, TO STAFF DIFFERENTLY,

4439
02:46:04,532 --> 02:46:06,067
THEY HAD TO DO IT IN THE

4440
02:46:06,067 --> 02:46:07,835
PANDEMIC FOR THEIR OWN SAFETY AS

4441
02:46:07,835 --> 02:46:08,236
WELL.

4442
02:46:08,236 --> 02:46:12,106
I'D LOVE TO HEAR, JOSEPH, YOUR

4443
02:46:12,106 --> 02:46:15,042
PERSPECTIVE ON THE GROUND.

4444
02:46:15,042 --> 02:46:15,943
>> I'LL GO.

4445
02:46:15,943 --> 02:46:20,882
SO I FOLLOW THE DATA SOURCE

4446
02:46:20,882 --> 02:46:26,420
CALLED FAIR HEALTH, THEY HAVE A

4447
02:46:26,420 --> 02:46:29,690
TELEHEALTH TRACKER.

4448
02:46:29,690 --> 02:46:30,057
FAIRHEALTH.ORG.

4449
02:46:30,057 --> 02:46:31,225
BEFORE THE PANDEMIC, THE TOTAL

4450
02:46:31,225 --> 02:46:35,396
PERCENTAGE OF CLAIMS COMING IN

4451
02:46:35,396 --> 02:46:38,499
TO THAT DATA SOURCE,

4452
02:46:38,499 --> 02:46:39,033
SELF-INSURANCE CLAIMS, FOR

4453
02:46:39,033 --> 02:46:41,969
TELEHEALTH, 0.19% OF ALL THEIR

4454
02:46:41,969 --> 02:46:42,203
CLAIMS.

4455
02:46:42,203 --> 02:46:45,039
THAT'S AUGUST OF 2019.

4456
02:46:45,039 --> 02:46:47,975
BY I THINK JUNE OR SO OF 2020,

4457
02:46:47,975 --> 02:46:50,645
IT WAS UP TO ABOUT 7%.

4458
02:46:50,645 --> 02:46:53,381
THAT'S THE SIZE IT GOT FROM THIS

4459
02:46:53,381 --> 02:46:54,248
PARTICULAR DATA STREAM.

4460
02:46:54,248 --> 02:46:58,719
AND THEN IT WENT DOWN IN JANUARY

4461
02:46:58,719 --> 02:47:05,960
OF 2021 TO ABOUT 4.5 OR 5%,

4462
02:47:05,960 --> 02:47:07,461
STABLE THERE, 80% IS BEHAVIORAL

4463
02:47:07,461 --> 02:47:08,262
HEALTH.

4464
02:47:08,262 --> 02:47:11,632
YOU CAN TAKE HOME THE REAL

4465
02:47:11,632 --> 02:47:16,570
WINNER FROM A PATIENT 

4466
02:47:16,570 --> 02:47:19,073
PERSPECTIVE HAS BEEN BEHAVIORAL

4467
02:47:19,073 --> 02:47:19,874
HEALTH.

4468
02:47:19,874 --> 02:47:21,509
I TALKED TO PRACTITIONERS, MANY

4469
02:47:21,509 --> 02:47:24,345
DO A VERY LARGE CHUNK OF THEIR

4470
02:47:24,345 --> 02:47:25,446
PRACTICE THIS WAY.

4471
02:47:25,446 --> 02:47:29,850
AND I THINK IT'S EXTENDED ACCESS

4472
02:47:29,850 --> 02:47:31,686
BUT THERE'S STILL A SHORTAGE,

4473
02:47:31,686 --> 02:47:32,787
THERE'S STILL NEED, STILL ALL

4474
02:47:32,787 --> 02:47:35,856
KINDS OF CHALLENGES.

4475
02:47:35,856 --> 02:47:38,826
BY AND LARGE IT'S BEEN FOR THE

4476
02:47:38,826 --> 02:47:40,127
BEHAVIORAL HEALTH PATIENTS AS

4477
02:47:40,127 --> 02:47:40,461
WELL.

4478
02:47:40,461 --> 02:47:43,397
I THINK THAT'S THE STANDOUT

4479
02:47:43,397 --> 02:47:44,031
WINNER.

4480
02:47:44,031 --> 02:47:45,499
EVERYTHING ELSE IS NIBBLING

4481
02:47:45,499 --> 02:47:47,268
AROUND THE EDGES.

4482
02:47:47,268 --> 02:47:49,337
I LIKE -- I'LL UNDERSCORE THE

4483
02:47:49,337 --> 02:47:52,640
POINT YOU MADE, WHICH IS IF MY

4484
02:47:52,640 --> 02:47:53,407
INSTITUTION DOESN'T HAVE A LONG

4485
02:47:53,407 --> 02:47:54,809
RANGE GUARANTEE THAT WE'RE GOING

4486
02:47:54,809 --> 02:47:56,210
TO GET PAID FOR STUFF THEY ARE

4487
02:47:56,210 --> 02:47:57,545
NOT GOING TO MAKE A HUGE

4488
02:47:57,545 --> 02:47:59,080
INVESTMENT IN A NEW CHANNEL.

4489
02:47:59,080 --> 02:48:02,049
IT'S A WHOLE NEW CHANNEL.

4490
02:48:02,049 --> 02:48:03,784
IT'S NOT JUST ME DUCKING INTO AN

4491
02:48:03,784 --> 02:48:05,553
OFFICE TO DO A VIDEO VISIT

4492
02:48:05,553 --> 02:48:06,420
BETWEEN PATIENTS.

4493
02:48:06,420 --> 02:48:09,924
IT'S A NEW CHANNEL, IT HAS TO BE

4494
02:48:09,924 --> 02:48:10,891
MANAGED THAT WAY.

4495
02:48:10,891 --> 02:48:12,259
WE KNOW THAT'S COMING UP.

4496
02:48:12,259 --> 02:48:13,461
BIG DRUM ROLL.

4497
02:48:13,461 --> 02:48:15,196
BUT OUR FRIENDS IN CONGRESS HAVE

4498
02:48:15,196 --> 02:48:17,732
TOWARDS THE END OF THE YEAR HAVE

4499
02:48:17,732 --> 02:48:18,833
TO DO SOMETHING OTHER WE'LL FALL

4500
02:48:18,833 --> 02:48:25,306
BACK TO THE DAYS OF 1834, WHICH

4501
02:48:25,306 --> 02:48:26,741
IS VERY, VERY RESTRICTIVE.

4502
02:48:26,741 --> 02:48:28,376
>> HOW ABOUT ABILITY TO DO

4503
02:48:28,376 --> 02:48:29,243
TELEHEALTH ACROSS STATE

4504
02:48:29,243 --> 02:48:31,545
BOUNDARIES, IS THAT SOMETHING WE

4505
02:48:31,545 --> 02:48:32,913
ANTICIPATE IS GOING TO --

4506
02:48:32,913 --> 02:48:33,514
>> NO.

4507
02:48:33,514 --> 02:48:35,683
>> WHAT'S GOING TO HAPPEN
THERE?

4508
02:48:35,683 --> 02:48:38,319
>> NO, I DON'T THINK SO.

4509
02:48:38,319 --> 02:48:40,287
I JUST THINK THAT'S HOPELESS,

4510
02:48:40,287 --> 02:48:43,024
ALMOST HOPELESS.

4511
02:48:43,024 --> 02:48:46,861
STATE MEDICAL BOARDS ARE SO

4512
02:48:46,861 --> 02:48:48,262
ENTRENCHED, NOT INTERESTED,

4513
02:48:48,262 --> 02:48:49,263
DON'T SEE THE WORLD PERHAPS

4514
02:48:49,263 --> 02:48:51,432
OTHERS SEE THE WORLD.

4515
02:48:51,432 --> 02:48:52,533
AND THEY CONTROL OBVIOUSLY

4516
02:48:52,533 --> 02:48:53,868
WHETHER SOMEONE GETS TO PRACTICE

4517
02:48:53,868 --> 02:48:57,138
IN THEIR STATE. 

4518
02:48:57,138 --> 02:49:00,441
>> I WANT TO POINT OUT A
GROUP

4519
02:49:00,441 --> 02:49:02,076
THAT'S BENEFITED FROM

4520
02:49:02,076 --> 02:49:02,943
TELEHEALTH, THOSE WITH

4521
02:49:02,943 --> 02:49:05,446
DISABILITIES, 1 1/2 TO 2 TIMES

4522
02:49:05,446 --> 02:49:07,314
MORE LIKELY TO USE TELEHEALTH

4523
02:49:07,314 --> 02:49:08,315
THAN PEOPLE WITHOUT

4524
02:49:08,315 --> 02:49:09,183
DISABILITIES, A HIDDEN

4525
02:49:09,183 --> 02:49:09,617
POPULATION.

4526
02:49:09,617 --> 02:49:11,585
>> IT'S A WONDERFUL POINT,
YEAH.

4527
02:49:11,585 --> 02:49:12,486
>> ARE THERE TECHNOLOGIES
THAT

4528
02:49:12,486 --> 02:49:16,190
WE'RE SEEING THAT CAN HELP

4529
02:49:16,190 --> 02:49:17,725
INDIVIDUALS WITH DISABILITIES

4530
02:49:17,725 --> 02:49:20,795
THAT FOR INSTANCE THEY HAVE

4531
02:49:20,795 --> 02:49:21,896
VISUAL, HEARING, MOTOR, HOW IS

4532
02:49:21,896 --> 02:49:29,170
THE TELEHEALTH EXPERIENCE FOR

4533
02:49:29,170 --> 02:49:30,538
THOSE WITH DISABILITIES?

4534
02:49:30,538 --> 02:49:32,673
>> THERE ARE -- I THINK --

4535
02:49:32,673 --> 02:49:34,141
YOU'RE RIGHT.

4536
02:49:34,141 --> 02:49:36,343
DISABILITY IS A BROAD SPECTRUM.

4537
02:49:36,343 --> 02:49:38,746
MY OWN CASE, MOST OF THE PEOPLE

4538
02:49:38,746 --> 02:49:40,381
THAT I SEE BENEFITING, THIS IS

4539
02:49:40,381 --> 02:49:44,819
MY OWN PRACTICE, ARE PEOPLE WHO

4540
02:49:44,819 --> 02:49:48,756
HAVE PHYSICAL DISABILITIES, HARD

4541
02:49:48,756 --> 02:49:50,324
TO GET OUT OF THEIR APARTMENT,

4542
02:49:50,324 --> 02:49:51,459
HARD TO GET IN.

4543
02:49:51,459 --> 02:49:53,527
ONE WOMAN JUST THANKED ME TEN

4544
02:49:53,527 --> 02:49:55,496
TIMES BECAUSE SHE HAS A SPECIAL

4545
02:49:55,496 --> 02:49:56,630
NEEDS CHILD, IT'S HARD FOR HER

4546
02:49:56,630 --> 02:49:57,498
TO GET OUT.

4547
02:49:57,498 --> 02:49:59,800
EVERY TIME THEY GO SOMEWHERE

4548
02:49:59,800 --> 02:50:04,071
THEY HAVE A WHOLE CAVALCADE OF

4549
02:50:04,071 --> 02:50:05,473
THINGS HAPPENING.

4550
02:50:05,473 --> 02:50:06,373
VISUAL AND AUDITORY, I'M NOT AS

4551
02:50:06,373 --> 02:50:09,410
UP TO DATE ON WHAT'S GOING ON.

4552
02:50:09,410 --> 02:50:11,178
MAYBE MY COLLEAGUES ARE.

4553
02:50:11,178 --> 02:50:11,779
>> YEAH.

4554
02:50:11,779 --> 02:50:13,714
I CAN SHARE THAT.

4555
02:50:13,714 --> 02:50:15,916
WE HAVE SEEN QUITE A BIT OF

4556
02:50:15,916 --> 02:50:17,785
ADVANCEMENT IN TERMS OF

4557
02:50:17,785 --> 02:50:19,386
TECHNOLOGIES TO HELP THOSE WITH

4558
02:50:19,386 --> 02:50:22,123
DISABILITIES ON ALL FRONTS FOR

4559
02:50:22,123 --> 02:50:22,790
CONNECTED CARE, EVERYTHING FROM

4560
02:50:22,790 --> 02:50:25,326
OF COURSE YOU HAVE THE ABILITY

4561
02:50:25,326 --> 02:50:27,061
TO HAVE THE VOICE TRANSCRIPTIONS

4562
02:50:27,061 --> 02:50:30,464
WHERE YOU CAN SEE THE WORDS,

4563
02:50:30,464 --> 02:50:32,433
TRANSLATED IN DIFFERENT

4564
02:50:32,433 --> 02:50:32,800
LANGUAGES.

4565
02:50:32,800 --> 02:50:35,002
LANGUAGES TRANSLATION IS

4566
02:50:35,002 --> 02:50:35,302
CHALLENGING.

4567
02:50:35,302 --> 02:50:36,637
IN MEDICAL TRANSLATION, NOT AS

4568
02:50:36,637 --> 02:50:39,974
ACCURATE, MAY NOT MEET THE

4569
02:50:39,974 --> 02:50:45,446
STANDARDS OF ACCEPTABILITY IN

4570
02:50:45,446 --> 02:50:45,746
TELEHEALTH.

4571
02:50:45,746 --> 02:50:47,414
IN ENGLISH THERE'S BEEN SOME.

4572
02:50:47,414 --> 02:50:51,552
THERE'S BEEN SOME WORK FOR THOSE

4573
02:50:51,552 --> 02:50:53,187
WITH VISUAL DISABILITIES,

4574
02:50:53,187 --> 02:50:54,522
DECREASED VISION, WE'VE EVEN

4575
02:50:54,522 --> 02:50:55,489
SEEN SOME SCENARIOS WHERE

4576
02:50:55,489 --> 02:50:59,026
INDIVIDUALS HAVE BEEN ABLE TO

4577
02:50:59,026 --> 02:51:02,630
HAVE INDIVIDUALS WITH SIGN

4578
02:51:02,630 --> 02:51:03,697
LANGUAGE TRANSLATORS, TELEHEALTH

4579
02:51:03,697 --> 02:51:07,368
IN, THERE HAVE BEEN OF COURSE

4580
02:51:07,368 --> 02:51:08,836
A.I.-BOTS THAT ARE NOW STARTING

4581
02:51:08,836 --> 02:51:10,971
TO BECOME HELPFUL AS WELL.

4582
02:51:10,971 --> 02:51:13,674
I THINK EVEN INDIVIDUALS WITH

4583
02:51:13,674 --> 02:51:15,242
DISABILITY, DUE TO STROKE, NOT

4584
02:51:15,242 --> 02:51:19,980
ABLE TO SPEAK AS WELL, CLEARLY,

4585
02:51:19,980 --> 02:51:21,482
THOSE CONNECTIONS WOULD BE

4586
02:51:21,482 --> 02:51:22,483
INTERPRETED SO INDIVIDUALS CAN

4587
02:51:22,483 --> 02:51:24,618
BETTER UNDERSTAND WHAT THEY ARE

4588
02:51:24,618 --> 02:51:26,387
SAYING.

4589
02:51:26,387 --> 02:51:29,056
SO A LOT OF MOVEMENT, HOPEFULLY

4590
02:51:29,056 --> 02:51:32,960
LYNN CREASE ACCESSIBILITY.

4591
02:51:32,960 --> 02:51:33,661
WE -- INCREASE ACCESSIBILITY.

4592
02:51:33,661 --> 02:51:35,129
LET'S GO TO THE CHAT.

4593
02:51:35,129 --> 02:51:37,531
A QUESTION FOR YOU, LOK, I'LL

4594
02:51:37,531 --> 02:51:38,432
READ IT.

4595
02:51:38,432 --> 02:51:40,701
YOU MENTIONED THAT THERE'S SOME

4596
02:51:40,701 --> 02:51:43,571
STUDIES THAT SHOW REDUCTION IN

4597
02:51:43,571 --> 02:51:44,438
SPENDING, OTHERS SUGGEST

4598
02:51:44,438 --> 02:51:45,940
INCREASE IN SPENDING.

4599
02:51:45,940 --> 02:51:47,808
WHAT'S YOUR ASSESSMENT WHETHER

4600
02:51:47,808 --> 02:51:51,345
TELEHEALTH HAS BEEN COST

4601
02:51:51,345 --> 02:51:53,747
BENEFICIAL OR COST EFFECTIVE IN

4602
02:51:53,747 --> 02:51:54,949
OTHER WORDS FROM SOCIETAL

4603
02:51:54,949 --> 02:51:56,383
PERSPECTIVE HAS THE VALUE BEEN

4604
02:51:56,383 --> 02:51:58,352
WORTH THE COST AND IN WHAT

4605
02:51:58,352 --> 02:51:58,786
SETTINGS?

4606
02:51:58,786 --> 02:52:01,322
>> I THINK THAT'S AN
EXCELLENT

4607
02:52:01,322 --> 02:52:01,889
QUESTION.

4608
02:52:01,889 --> 02:52:03,390
AS A HEALTH SERVICES RESEARCHER

4609
02:52:03,390 --> 02:52:05,326
I THINK WE PROBABLY DON'T HAVE

4610
02:52:05,326 --> 02:52:06,894
THE RIGHT DATA TO ANSWER THAT

4611
02:52:06,894 --> 02:52:10,831
FULLY FROM A PATIENT PERSPECTIVE

4612
02:52:10,831 --> 02:52:13,033
BECAUSE THE PATIENT COST, THEIR

4613
02:52:13,033 --> 02:52:15,502
TIME, LOST OPPORTUNITIES FOR

4614
02:52:15,502 --> 02:52:16,737
WORK, HOSPITAL, ESPECIALLY IF

4615
02:52:16,737 --> 02:52:18,973
YOU HAVE DISABILITIES TO GET IN

4616
02:52:18,973 --> 02:52:20,474
AND OUT OF THE HOUSE.

4617
02:52:20,474 --> 02:52:24,612
AND I THINK WE TALKED EARLIER

4618
02:52:24,612 --> 02:52:26,146
ABOUT TELEHEALTH IS MEETING

4619
02:52:26,146 --> 02:52:27,348
POTENTIALLY UNMET NEED.

4620
02:52:27,348 --> 02:52:28,882
WE DON'T HAVE THAT DENOMINATOR

4621
02:52:28,882 --> 02:52:30,985
WHO ISN'T GETTING THE CARE THEY

4622
02:52:30,985 --> 02:52:32,620
NEED AND ARE NOW GETTING IT.

4623
02:52:32,620 --> 02:52:38,726
SO I THINK WE NEED TO HAVE THAT

4624
02:52:38,726 --> 02:52:39,827
BROADER SOCIETAL PERSPECTIVE TO

4625
02:52:39,827 --> 02:52:41,462
HELP US UNDERSTAND THE VALUE TO

4626
02:52:41,462 --> 02:52:44,665
SOCIETY, NOT JUST TO A PAYER.

4627
02:52:44,665 --> 02:52:46,100
>> FANTASTIC.

4628
02:52:46,100 --> 02:52:46,500
GREAT.

4629
02:52:46,500 --> 02:52:48,068
THANK YOU, LOK.

4630
02:52:48,068 --> 02:52:49,270
IF OTHERS HAVE QUESTIONS, PLEASE

4631
02:52:49,270 --> 02:52:51,438
FEEL FREE TO ENTER THEM INTO THE

4632
02:52:51,438 --> 02:52:53,641
CHAT Q&A AND I'LL GET TO
THEM AS

4633
02:52:53,641 --> 02:52:55,376
WE GO THROUGH THE CONVERSATION.

4634
02:52:55,376 --> 02:52:58,112
I WANT TO SHIFT GEARS AND TALK

4635
02:52:58,112 --> 02:53:00,080
ABOUT SOME OF THE INFORMATION

4636
02:53:00,080 --> 02:53:02,383
THAT IS CAPTURED AND HOW

4637
02:53:02,383 --> 02:53:03,250
POTENTIALLY WE CAN BETTER

4638
02:53:03,250 --> 02:53:04,918
UNDERSTAND AND INTERPRET THIS.

4639
02:53:04,918 --> 02:53:06,520
JOE, YOU ALLUDED TO THIS WHEN

4640
02:53:06,520 --> 02:53:10,924
YOU TALKED ABOUT THE A.I. AND

4641
02:53:10,924 --> 02:53:11,225
MULTI-MODAL.

4642
02:53:11,225 --> 02:53:12,793
TELL US ABOUT WHAT YOU MEANT BY

4643
02:53:12,793 --> 02:53:12,993
THAT.

4644
02:53:12,993 --> 02:53:14,895
LIKE YOU SAID A.I. IS GOING TO

4645
02:53:14,895 --> 02:53:16,997
BE POTENTIALLY A VERY HELPFUL

4646
02:53:16,997 --> 02:53:18,432
TOOL IN THIS SPACE.

4647
02:53:18,432 --> 02:53:21,168
WHAT ARE YOU SEEING, WHERE DO

4648
02:53:21,168 --> 02:53:22,803
YOU SEE IT GOING?

4649
02:53:22,803 --> 02:53:24,872
>> WELL, I'LL TRY NOT TO

4650
02:53:24,872 --> 02:53:26,173
DOMINATE BECAUSE IT'S SUCH A FUN

4651
02:53:26,173 --> 02:53:27,474
TOPIC, SO MUCH GOING ON.

4652
02:53:27,474 --> 02:53:30,678
I'LL TRY TO BE SUCCINCT AND

4653
02:53:30,678 --> 02:53:31,011
THOUGHTFUL.

4654
02:53:31,011 --> 02:53:34,848
HARD FOR ME.

4655
02:53:34,848 --> 02:53:37,017
ANYWAY, IN 2015 I PUBLISHED A

4656
02:53:37,017 --> 02:53:44,024
BOOK "INTERNET OF HEALTHY

4657
02:53:44,024 --> 02:53:48,962
THINGS," FIRST CHAPTER IS MADE

4658
02:53:48,962 --> 02:53:52,066
UP, A VIRTUE CARE AGENT NAMED

4659
02:53:52,066 --> 02:53:55,669
SAM KNOWS ME, GUIDES ME AROUND,

4660
02:53:55,669 --> 02:53:57,771
KNOWS IF I'M TAKING A WALK AT

4661
02:53:57,771 --> 02:53:59,173
LUNCH BECAUSE OF MY SMART

4662
02:53:59,173 --> 02:54:00,407
PEDOMETER THAT I'M ALSO WALKING

4663
02:54:00,407 --> 02:54:02,176
TOWARDS A PLACE WHERE I NORMALLY

4664
02:54:02,176 --> 02:54:03,677
GET A COOKIE AND HE SAYS MAYBE

4665
02:54:03,677 --> 02:54:04,978
YOU DON'T WANT THAT COOKIE,

4666
02:54:04,978 --> 02:54:07,948
YOU'RE TRYING TO LOSE WEIGHT FOR

4667
02:54:07,948 --> 02:54:09,183
YOUR DAUGHTER'S WEDDING.

4668
02:54:09,183 --> 02:54:16,490
IT'S FANSFUL  BUT -- FANCIFUL BT

4669
02:54:16,490 --> 02:54:17,891
IT'S NOW HAPPENING, TEN YEARS

4670
02:54:17,891 --> 02:54:19,660
SINCE I WROTE AND PUBLISHED.

4671
02:54:19,660 --> 02:54:21,495
SO MUCH HAS HAPPENED WHERE YOU

4672
02:54:21,495 --> 02:54:26,333
CAN TAKE MULTIPLE DATA STREAMS,

4673
02:54:26,333 --> 02:54:28,669
I'M NOT A COMPUTER OR DATA

4674
02:54:28,669 --> 02:54:29,536
SCIENTIST, BUT MAKE THEM MAKE

4675
02:54:29,536 --> 02:54:32,906
SENSE HOW THE ALGORITHMS WORK

4676
02:54:32,906 --> 02:54:34,675
AND YOU HOW THEY GENERATE

4677
02:54:34,675 --> 02:54:35,776
INSIGHTS AND PREDICTIONS ABOUT

4678
02:54:35,776 --> 02:54:38,045
THE FUTURE.

4679
02:54:38,045 --> 02:54:40,147
NOW WITH TEXT-TO-SPEECH AND ALL

4680
02:54:40,147 --> 02:54:41,648
OTHER THINGS, THIS CHARACTER I

4681
02:54:41,648 --> 02:54:43,751
ENVISIONED TEN YEARS AGO, SAM,

4682
02:54:43,751 --> 02:54:47,688
IT'S A REALITY FOR CERTAIN

4683
02:54:47,688 --> 02:54:48,989
PEOPLE, CERTAIN SITUATIONS.

4684
02:54:48,989 --> 02:54:50,858
SO TO ME THAT'S THE THING.

4685
02:54:50,858 --> 02:54:53,060
WHEN WE TALK ABOUT WEARABLES

4686
02:54:53,060 --> 02:54:55,229
BEING SCARY TO DOCTORS BECAUSE

4687
02:54:55,229 --> 02:54:58,065
OF NORMAL RESULTS OR MEANINGLESS

4688
02:54:58,065 --> 02:54:59,299
RESULTS, BUT FOR COMPUTERS

4689
02:54:59,299 --> 02:55:01,368
THAT'S A WONDERFUL THING.

4690
02:55:01,368 --> 02:55:03,437
THE MORE DATA, THE MERRIER.

4691
02:55:03,437 --> 02:55:05,506
THE MORE NUANCED DATA, THE

4692
02:55:05,506 --> 02:55:06,640
MERRIER.

4693
02:55:06,640 --> 02:55:07,808
AND I MEAN WEARABLES, MOBILE

4694
02:55:07,808 --> 02:55:10,444
PHONE DATA, WHERE YOU DID YOUR

4695
02:55:10,444 --> 02:55:11,545
PURCHASING, IF YOU USE A CREDIT

4696
02:55:11,545 --> 02:55:13,614
CARD FOR LUNCH AND YOU CAN MATCH

4697
02:55:13,614 --> 02:55:16,016
THAT AGAINST THE GEO TAGGING OF

4698
02:55:16,016 --> 02:55:18,952
YOUR PHONE, YOU THINK ABOUT THE

4699
02:55:18,952 --> 02:55:19,286
POSSIBILITIES.

4700
02:55:19,286 --> 02:55:24,024
AS I SAID, THIS IS HAPPENING

4701
02:55:24,024 --> 02:55:24,291
NOW.

4702
02:55:24,291 --> 02:55:25,426
IT'S PRETTY EXCITING.

4703
02:55:25,426 --> 02:55:26,760
THAT'S THE REALITY.

4704
02:55:26,760 --> 02:55:28,829
ON THE RESEARCH FRONT I'M NOT A

4705
02:55:28,829 --> 02:55:36,837
COMPUTER SCIENTIST.

4706
02:55:36,837 --> 02:55:38,906
SO MANY INVESTIGATORS ARE TRYING

4707
02:55:38,906 --> 02:55:41,408
TO MAKE THIS -- WHAT WE TALKED

4708
02:55:41,408 --> 02:55:43,610
ABOUT EARLIER, WHICH IS DATA

4709
02:55:43,610 --> 02:55:46,780
FROM A FITBIT DOESN'T EVEN

4710
02:55:46,780 --> 02:55:50,384
RECOGNIZE DATA FROM A

4711
02:55:50,384 --> 02:55:51,051
SMARTWATCH, SAMSUNG IS

4712
02:55:51,051 --> 02:55:53,320
DIFFERENT, ET CETERA, HOW TO

4713
02:55:53,320 --> 02:55:54,788
MARRY THOSE DATA STREAMS SO THEY

4714
02:55:54,788 --> 02:55:56,123
CAN BE COMPARED TO ONE ANOTHER.

4715
02:55:56,123 --> 02:56:01,562
I THINK THAT'S THE FRONTIER.

4716
02:56:01,562 --> 02:56:02,763
SOMETHING LIKE FHIR, SMART ON

4717
02:56:02,763 --> 02:56:03,964
FHIR FOR HEALTH DATA BUT WE

4718
02:56:03,964 --> 02:56:05,299
DON'T HAVE SOMETHING LIKE THAT,

4719
02:56:05,299 --> 02:56:08,068
THAT I'M AWARE OF ANYWAY, AT

4720
02:56:08,068 --> 02:56:11,672
LEAST IN WIDESPREAD USE FOR

4721
02:56:11,672 --> 02:56:12,539
WEARABLES DATA.

4722
02:56:12,539 --> 02:56:13,207
>> SACHIN?

4723
02:56:13,207 --> 02:56:15,709
>> IT'S INTERESTING, FROM
A

4724
02:56:15,709 --> 02:56:16,810
PARTICIPANT PERSPECTIVE, WE'VE

4725
02:56:16,810 --> 02:56:19,012
SEEN THIS WHEN TRYING TO PROVIDE

4726
02:56:19,012 --> 02:56:21,615
DEVICES TO FOLKS.

4727
02:56:21,615 --> 02:56:24,852
I GOT A FITBIT, I DON'T WATCH A

4728
02:56:24,852 --> 02:56:27,087
WATCH, I DON'T WANT TO WEAR YOUR

4729
02:56:27,087 --> 02:56:31,191
FITBIT, A CALL TO ADJUST OUR

4730
02:56:31,191 --> 02:56:31,525
METHODOLOGIES.

4731
02:56:31,525 --> 02:56:35,863
I THINK WE -- YOU KNOW, EVERY

4732
02:56:35,863 --> 02:56:37,498
CLINICAL TRIAL TRIES TO CREATE

4733
02:56:37,498 --> 02:56:38,932
THE MOST HOMOGENOUS PATIENT

4734
02:56:38,932 --> 02:56:40,367
POPULATION OR OUTCOME TO MEASURE

4735
02:56:40,367 --> 02:56:44,538
THE EXACT SAME WAY, THAT SENSE

4736
02:56:44,538 --> 02:56:47,374
OF CONTROL BELIES REALITY OF

4737
02:56:47,374 --> 02:56:49,676
CLINICAL CARE, PARTICIPANT

4738
02:56:49,676 --> 02:56:50,978
EXPERIENCE, AND MOST IMPORTANTLY

4739
02:56:50,978 --> 02:56:56,650
PARTICIPANT PREFERENCE. 

4740
02:56:56,650 --> 02:56:57,317
WE'LL CONTINUE MAKING STEP

4741
02:56:57,317 --> 02:57:00,287
COUNTS ON THE FITBIT LOOK THE

4742
02:57:00,287 --> 02:57:03,991
SAME AS APPLE WATCH, CONVERSION

4743
02:57:03,991 --> 02:57:06,793
FACTOR, BUT EXPERIENCE TAUGHT US

4744
02:57:06,793 --> 02:57:09,196
THAT'S AN ENDLESS PATH,

4745
02:57:09,196 --> 02:57:11,798
ASYMPTOTIC, STILL CHALLENGE TO

4746
02:57:11,798 --> 02:57:15,536
GET A CERTAIN RECORD TO LOOK

4747
02:57:15,536 --> 02:57:19,806
READABLE IN EPIC, DESPITE

4748
02:57:19,806 --> 02:57:21,675
STANDARDS, RIGHT?

4749
02:57:21,675 --> 02:57:25,078
WE'RE LOOKING FOR

4750
02:57:25,078 --> 02:57:25,946
PERTURBATIONS IN A PATIENT

4751
02:57:25,946 --> 02:57:28,348
EXPERIENCE, WE WANT TO USE

4752
02:57:28,348 --> 02:57:29,449
POPULATION NORMS COMPARING GROUP

4753
02:57:29,449 --> 02:57:33,487
TO GROUP FEED BUT WE SHOULD

4754
02:57:33,487 --> 02:57:35,055
FOCUS ON WITHIN PATIENT CHANGES,

4755
02:57:35,055 --> 02:57:37,524
YOUR CONTROL CHART, HERE IS A

4756
02:57:37,524 --> 02:57:39,092
CLEAR INFLECTION POINT, RESTING

4757
02:57:39,092 --> 02:57:41,595
HEART RATE HAS BEEN AT THIS

4758
02:57:41,595 --> 02:57:42,996
POINT, YOU'RE NOW OFF.

4759
02:57:42,996 --> 02:57:44,431
YOUR ACTIVITY LEVEL HAS BEEN

4760
02:57:44,431 --> 02:57:47,501
HERE, YOU'RE OFF THE BASELINE.

4761
02:57:47,501 --> 02:57:49,236
IT'S AN AREA OF METHODOLOGIC

4762
02:57:49,236 --> 02:57:50,904
APPROACH WHICH WE HAVEN'T

4763
02:57:50,904 --> 02:57:53,407
INVESTED ENOUGH ENERGY IN

4764
02:57:53,407 --> 02:57:54,374
VALIDATING FOR ADOPTING BECAUSE

4765
02:57:54,374 --> 02:57:56,577
IT REQUIRES US TO ADMIT THE

4766
02:57:56,577 --> 02:57:58,111
DIRTINESS OF THE WORLD BUT FAR

4767
02:57:58,111 --> 02:57:59,846
MORE REALISTIC IN TERMS OF

4768
02:57:59,846 --> 02:58:01,949
ADDING VALUE TO AN AVERAGE

4769
02:58:01,949 --> 02:58:03,016
CLINICIAN EVIDENCE BASE, FAR

4770
02:58:03,016 --> 02:58:04,351
MORE LIKELY TO BE WHAT PATIENTS

4771
02:58:04,351 --> 02:58:05,652
USE, BECAUSE THEY ARE GOING TO

4772
02:58:05,652 --> 02:58:06,787
KEEP THE DEVICE THEY WANT, THEY

4773
02:58:06,787 --> 02:58:10,257
HAVE A LOT OF REASONS TO WANT

4774
02:58:10,257 --> 02:58:10,791
IT.

4775
02:58:10,791 --> 02:58:13,060
IT'S OUR JOB AS SCIENTISTS TO

4776
02:58:13,060 --> 02:58:16,330
SAY BASED ON DATA EXTREMES FROM

4777
02:58:16,330 --> 02:58:17,664
YOUR DEVICE THESE SALIENT CHANGE

4778
02:58:17,664 --> 02:58:18,532
DEMONSTRATION SOMETHING IS ABOUT

4779
02:58:18,532 --> 02:58:19,833
TO HAPPEN AND THEREFORE WE DON'T

4780
02:58:19,833 --> 02:58:22,235
KNOW WHAT'S ABOUT TO HAPPEN BUT

4781
02:58:22,235 --> 02:58:23,670
SOMETHING'S UP, LET'S HAVE YOU

4782
02:58:23,670 --> 02:58:25,872
BRING -- LET'S BRING YOU IN.

4783
02:58:25,872 --> 02:58:28,575
THAT HETEROGENEITY OF DATA

4784
02:58:28,575 --> 02:58:32,312
SOURCES IS AN OPPORTUNITY FOR

4785
02:58:32,312 --> 02:58:35,616
THE NIH TO REALLY EMBRACE THAT

4786
02:58:35,616 --> 02:58:37,718
HETEROGENEITY AND, YOU KNOW,

4787
02:58:37,718 --> 02:58:39,686
EVALUATE THE VALUE OF USING A

4788
02:58:39,686 --> 02:58:41,989
PATIENT AS THEIR OWN CONTROL

4789
02:58:41,989 --> 02:58:42,756
OVER TIME.

4790
02:58:42,756 --> 02:58:47,894
BECAUSE THAT'S -- WE ASK OUR

4791
02:58:47,894 --> 02:58:50,631
PATIENTS, HAVING DIFFICULTY, HOW

4792
02:58:50,631 --> 02:58:51,832
DIFFERENT IS THAT NOW?

4793
02:58:51,832 --> 02:58:59,072
I'VE GOT PATIENTS WITH A BMI 60

4794
02:58:59,072 --> 02:59:03,210
BARELY MOVING AND 18 WHO ARE

4795
02:59:03,210 --> 02:59:05,078
MARATHON RUNNERS, OUR PATIENTS

4796
02:59:05,078 --> 02:59:08,248
AREN'T DOING THE SAME ACTIVITY

4797
02:59:08,248 --> 02:59:08,515
LIFESTYLE.

4798
02:59:08,515 --> 02:59:10,350
THERE'S A METHODOLOGY AT WORK TO

4799
02:59:10,350 --> 02:59:11,318
MAKE US ADOPT WHAT THEY ARE

4800
02:59:11,318 --> 02:59:15,155
LIVING ON A DAILY BASIS.

4801
02:59:15,155 --> 02:59:16,256
>> YOU'RE TALKING, I MEAN,
THE

4802
02:59:16,256 --> 02:59:18,792
END RESULT OF WHAT YOU'RE

4803
02:59:18,792 --> 02:59:19,960
TALKING ABOUT IS DIGITAL TWINS,

4804
02:59:19,960 --> 02:59:23,597
YOU CAN BE YOUR OWN CONTROL

4805
02:59:23,597 --> 02:59:24,798
GROUP FOR ANYTHING.

4806
02:59:24,798 --> 02:59:27,734
>> ONE OF THE THINGS THAT
I

4807
02:59:27,734 --> 02:59:29,169
THINK I'VE SEEN OVER THE PAST

4808
02:59:29,169 --> 02:59:30,604
SEVERAL YEARS IS THAT THERE'S

4809
02:59:30,604 --> 02:59:32,005
BEEN A TRANSFORMATION IN TERMS

4810
02:59:32,005 --> 02:59:34,107
OF UNDERSTANDING OF WHAT A.I.

4811
02:59:34,107 --> 02:59:36,276
CAN AND CANNOT DO.

4812
02:59:36,276 --> 02:59:38,145
THE ORIGINAL THOUGHT FOR MANY

4813
02:59:38,145 --> 02:59:40,347
FOLKS IS THAT A.I. ARE A SERIES

4814
02:59:40,347 --> 02:59:42,315
OF ALGORITHMS THAT ARE JUST

4815
02:59:42,315 --> 02:59:43,884
SIMPLY APPLIED AT SCALE.

4816
02:59:43,884 --> 02:59:45,052
AND WE'VE NOW RECOGNIZED THAT

4817
02:59:45,052 --> 02:59:47,621
A.I. CAN DO MUCH MORE THAN THAT,

4818
02:59:47,621 --> 02:59:49,489
SPECIFICALLY WHEN YOU

4819
02:59:49,489 --> 02:59:51,091
INCORPORATE MACHINE LEARNING TO

4820
02:59:51,091 --> 02:59:53,560
NOW BE ABLE TO TAKE UNSTRUCTURED

4821
02:59:53,560 --> 02:59:55,729
FORMS OF DATA AS WELL AS

4822
02:59:55,729 --> 02:59:56,396
STRUCTURED FORMS AND CONVERT

4823
02:59:56,396 --> 03:00:01,768
INTO THINGS THAT ARE

4824
03:00:01,768 --> 03:00:02,469
UNDERSTANDABLE, TEXT, VOICE,

4825
03:00:02,469 --> 03:00:05,505
IMAGE, VIDEO, AND OF COURSE WITH

4826
03:00:05,505 --> 03:00:06,807
THE VAST AMOUNT OF QUANTIFIABLE

4827
03:00:06,807 --> 03:00:09,443
DATA THAT'S COMING IN THROUGH

4828
03:00:09,443 --> 03:00:12,079
DEVICES, PUTTING THEM INTO SOME

4829
03:00:12,079 --> 03:00:12,779
MANNER THAT'S UNDERSTANDABLE,

4830
03:00:12,779 --> 03:00:14,014
BUT WHAT I THINK WHAT WE'RE ALSO

4831
03:00:14,014 --> 03:00:15,782
STARTING TO SEE IS THE NEED FOR

4832
03:00:15,782 --> 03:00:18,085
US TO CREATE DATA

4833
03:00:18,085 --> 03:00:18,952
INFRASTRUCTURES THAT SUPPORT

4834
03:00:18,952 --> 03:00:19,853
MULTI-MODAL DATA.

4835
03:00:19,853 --> 03:00:20,821
THAT MEANS THAT UNDERSTANDING

4836
03:00:20,821 --> 03:00:25,859
HOW YOU TAKE THE DATASETS FROM

4837
03:00:25,859 --> 03:00:27,928
THESE SOURCES AND CURATE THEM,

4838
03:00:27,928 --> 03:00:30,330
ANNOTATE THEM, AND ALLOW US TO

4839
03:00:30,330 --> 03:00:31,765
BE ABLE TO UNDERSTAND

4840
03:00:31,765 --> 03:00:34,167
LONGITUDINALLY HOW THEY ARE

4841
03:00:34,167 --> 03:00:35,368
ASSOCIATED WITH OUTCOMES, AND

4842
03:00:35,368 --> 03:00:37,571
THOSE TYPE OF DATASETS ONCE WE

4843
03:00:37,571 --> 03:00:39,973
ACTUALLY HAVE THEM BUILT, THAT

4844
03:00:39,973 --> 03:00:41,374
YOU HAVE POPULATED WITH THE

4845
03:00:41,374 --> 03:00:43,443
APPROPRIATE DATASETS CAN LEAD US

4846
03:00:43,443 --> 03:00:47,380
TO WAYS THAT WE CAN BE FAR MORE

4847
03:00:47,380 --> 03:00:48,281
PREDICTIVE, AND THERE ARE THREE

4848
03:00:48,281 --> 03:00:50,884
THINGS THAT CAN BE DONE ONCE YOU

4849
03:00:50,884 --> 03:00:53,320
HAVE THESE DATA INFRASTRUCTURES.

4850
03:00:53,320 --> 03:00:55,722
FIRST COULD BE WRIST

4851
03:00:55,722 --> 03:00:59,793
STRATIFICATION, TO IDENTIFY

4852
03:00:59,793 --> 03:01:03,697
HIGH, MEDIUM LOW STRATA.

4853
03:01:03,697 --> 03:01:05,265
SECOND IS COHORTING, LOOK

4854
03:01:05,265 --> 03:01:07,234
LONGITUDINALLY ACROSS A TIME

4855
03:01:07,234 --> 03:01:07,467
PERIOD.

4856
03:01:07,467 --> 03:01:09,302
THIRD IS PREDICTION, AND WE'RE

4857
03:01:09,302 --> 03:01:12,272
NOW STARTING TO SEE WITH THINGS

4858
03:01:12,272 --> 03:01:16,643
SUCH AS EKG HOW WE MIGHT BE ABLE

4859
03:01:16,643 --> 03:01:18,612
TO PREDICT FIVE-YEAR MORTALITY.

4860
03:01:18,612 --> 03:01:19,579
THESE ARE EXTRAORDINARY.

4861
03:01:19,579 --> 03:01:25,519
WE'RE NOT TALKING ABOUT EKG,

4862
03:01:25,519 --> 03:01:26,520
CARDIAC RISK FACTORS.

4863
03:01:26,520 --> 03:01:30,791
I'M SAYING A TAKE A LOOK AT YOUR

4864
03:01:30,791 --> 03:01:33,460
EKG AND FIGURE OUT YOUR

4865
03:01:33,460 --> 03:01:34,494
LONG-TERM MORTALITY, SHORT AND

4866
03:01:34,494 --> 03:01:34,828
LONG.

4867
03:01:34,828 --> 03:01:37,330
AS WE GET INTO POWER OF A.I., WE

4868
03:01:37,330 --> 03:01:39,599
CAN ENVISION HOW THIS COULD BE

4869
03:01:39,599 --> 03:01:40,834
APPLIED WITH WEARABLES DATA,

4870
03:01:40,834 --> 03:01:42,469
WITH THE FITNESS DATA, WITH

4871
03:01:42,469 --> 03:01:45,872
ACTIVITY, THE SLEEP, I MEAN, THE

4872
03:01:45,872 --> 03:01:46,673
GENERALIZABILITY AROUND YOUR

4873
03:01:46,673 --> 03:01:48,275
OVERALL HEALTH IN TERMS OF

4874
03:01:48,275 --> 03:01:50,143
INCORPORATING THAT INTO THIS

4875
03:01:50,143 --> 03:01:51,011
MAKES THE DATASETS FAR MORE

4876
03:01:51,011 --> 03:01:53,079
ROBUST BUT IT'S ALL DONE IN

4877
03:01:53,079 --> 03:01:54,214
CONTEXT OF NOT ONLY WHAT'S

4878
03:01:54,214 --> 03:01:56,283
HAPPENING AT THAT MOMENT BUT

4879
03:01:56,283 --> 03:01:57,551
ALSO OUTCOMES ASSOCIATED WITH

4880
03:01:57,551 --> 03:01:58,218
THAT LONGITUDINALLY.

4881
03:01:58,218 --> 03:01:59,719
AND I THINK THAT'S ONE OF THE

4882
03:01:59,719 --> 03:02:00,921
EXCITING THINGS BECAUSE WE'RE

4883
03:02:00,921 --> 03:02:02,889
NOW STARTING TO SEE SYSTEMS

4884
03:02:02,889 --> 03:02:05,192
BEING BUILT THAT ALLOW US TO

4885
03:02:05,192 --> 03:02:07,828
MAKE THESE LARGE

4886
03:02:07,828 --> 03:02:08,595
GENERALIZATIONS.

4887
03:02:08,595 --> 03:02:10,230
IT'S AN EXCITING TIME.

4888
03:02:10,230 --> 03:02:11,464
THE NEXT QUESTION ABOUT

4889
03:02:11,464 --> 03:02:13,066
RESEARCH, WHERE IS IT THAT WE'RE

4890
03:02:13,066 --> 03:02:14,601
HEADING IN TERMS OF RESEARCH?

4891
03:02:14,601 --> 03:02:15,702
WHAT IS THE OPPORTUNITY?

4892
03:02:15,702 --> 03:02:18,004
IS THE RESEARCH IN TERMS OF MORE

4893
03:02:18,004 --> 03:02:21,942
SENSORS, IN TERMS OF A.I., IS IT

4894
03:02:21,942 --> 03:02:23,310
IN TERMS OF MULTI-MODAL,

4895
03:02:23,310 --> 03:02:26,746
ENGAGEMENT, IS IT ALL OF THE

4896
03:02:26,746 --> 03:02:27,180
ABOVE?

4897
03:02:27,180 --> 03:02:28,081
YOU KNOW, DEMONSTRATING ROI?

4898
03:02:28,081 --> 03:02:30,250
MAYBE I'LL START WITH YOU, LOK,

4899
03:02:30,250 --> 03:02:32,118
I'D LOVE TO GET YOUR TAKE IN

4900
03:02:32,118 --> 03:02:35,589
TERMS WHERE DO YOU SEE RESEARCH

4901
03:02:35,589 --> 03:02:36,723
HEADING, WHAT ADVICE DO YOU HAVE

4902
03:02:36,723 --> 03:02:38,058
FOR RESEARCHERS IF THEY ARE

4903
03:02:38,058 --> 03:02:39,826
INTERESTED IN TAKING ADVANTAGE

4904
03:02:39,826 --> 03:02:40,894
OF ALL THIS OPPORTUNITY?

4905
03:02:40,894 --> 03:02:42,662
>> SO I WAS GOING TO SAY
WITH

4906
03:02:42,662 --> 03:02:45,065
OPPORTUNITY COMES GREAT RISK AS

4907
03:02:45,065 --> 03:02:45,398
WELL.

4908
03:02:45,398 --> 03:02:47,701
USUALLY IT'S FLIPPED THE OTHER

4909
03:02:47,701 --> 03:02:48,134
WAY.

4910
03:02:48,134 --> 03:02:50,670
ONE OF THE CHALLENGES I THINK

4911
03:02:50,670 --> 03:02:52,038
ESPECIALLY WITH THE WEARABLE

4912
03:02:52,038 --> 03:02:54,641
DEVICE DATA IS THIS IS NOT A

4913
03:02:54,641 --> 03:02:55,642
REPRESENTATIVE POPULATION.

4914
03:02:55,642 --> 03:02:57,143
AND YOU WANT TO GENERATE

4915
03:02:57,143 --> 03:02:58,712
RESEARCH FINDINGS THAT COULD BE

4916
03:02:58,712 --> 03:03:02,282
APPLIED ESPECIALLY TO THE

4917
03:03:02,282 --> 03:03:03,183
UNDERSERVED, THOSE WITH SPECIAL

4918
03:03:03,183 --> 03:03:03,617
NEEDS.

4919
03:03:03,617 --> 03:03:04,651
I THINK THAT'S ONE OF THE

4920
03:03:04,651 --> 03:03:06,119
CHALLENGES WITH THE A.I.

4921
03:03:06,119 --> 03:03:07,654
APPLICATIONS, WE WANT TO MAKE

4922
03:03:07,654 --> 03:03:14,828
SURE WE'RE NOT CREATING BIAS

4923
03:03:14,828 --> 03:03:15,362
THROUGH MACHINE LEARNING

4924
03:03:15,362 --> 03:03:16,263
APPLICATIONS BECAUSE OF WHERE

4925
03:03:16,263 --> 03:03:18,798
THE DATA IS COMING FROM.

4926
03:03:18,798 --> 03:03:19,966
ALSO THINKING ABOUT THE

4927
03:03:19,966 --> 03:03:21,835
DIFFERENT TIMES OF DATA,

4928
03:03:21,835 --> 03:03:23,003
WEARABLE DATA CURRENTLY ISN'T

4929
03:03:23,003 --> 03:03:24,771
CONSIDERED HEALTH CARE DATA.

4930
03:03:24,771 --> 03:03:26,840
RESEARCHERS REALLY DON'T HAVE

4931
03:03:26,840 --> 03:03:30,777
ACCESS TO IT EXCEPT THROUGH

4932
03:03:30,777 --> 03:03:32,312
SCRAPING IN VARIOUS WAYS.

4933
03:03:32,312 --> 03:03:33,980
I DON'T WANT TO TALK ABOUT THOSE

4934
03:03:33,980 --> 03:03:35,382
DIFFERENT METHODS.

4935
03:03:35,382 --> 03:03:37,384
WE HAVE TO THINK HOW IS IT

4936
03:03:37,384 --> 03:03:38,785
PATIENTS WANT THIS DATA TO BE

4937
03:03:38,785 --> 03:03:42,822
USED FOR THEIR OWN HEALTH, FOR

4938
03:03:42,822 --> 03:03:43,490
PARTICIPATING POTENTIALLY IN

4939
03:03:43,490 --> 03:03:46,026
RESEARCH, AS WELL AS WHAT THEY

4940
03:03:46,026 --> 03:03:49,663
WANT TO CONTRIBUTE TO THE

4941
03:03:49,663 --> 03:03:50,397
HEALTHCARE ECOSYSTEM.

4942
03:03:50,397 --> 03:03:51,965
>> YEAH, YOU BRING UP A
GOOD

4943
03:03:51,965 --> 03:03:52,165
POINT.

4944
03:03:52,165 --> 03:03:54,567
WE HAVEN'T TOUCHED ON THE WHOLE

4945
03:03:54,567 --> 03:03:57,437
CONCEPT OF BIAS IN THE DATASETS.

4946
03:03:57,437 --> 03:04:00,140
YOU KNOW, TO TRY TO CREATE THESE

4947
03:04:00,140 --> 03:04:03,743
MODELS WE DO NEED MORE

4948
03:04:03,743 --> 03:04:04,644
GENERALIZABILITY BUT WHO IS

4949
03:04:04,644 --> 03:04:06,379
PARTICIPATING IN HOW WE CAPTURE

4950
03:04:06,379 --> 03:04:09,115
THE DATA, AND WHAT CAN WE DO TO

4951
03:04:09,115 --> 03:04:10,450
ADDRESS THOSE ISSUES AROUND

4952
03:04:10,450 --> 03:04:14,487
BIAS?

4953
03:04:14,487 --> 03:04:15,188
LOK, YOUR THOUGHTS THERE?

4954
03:04:15,188 --> 03:04:17,557
>> I THINK THIS IS
PROBABLY

4955
03:04:17,557 --> 03:04:18,658
WHERE THERE'S OPPORTUNITY FOR

4956
03:04:18,658 --> 03:04:20,060
RESEARCH WHERE YOU MIGHT WANT TO

4957
03:04:20,060 --> 03:04:22,929
DO A CLINICAL TRIAL IN AN

4958
03:04:22,929 --> 03:04:23,797
UNDERSERVED POPULATION, PEOPLE

4959
03:04:23,797 --> 03:04:27,334
WHO ARE CURRENTLY NOT WEARING

4960
03:04:27,334 --> 03:04:28,935
DEVICES, FIND OUT WHAT WORKS FOR

4961
03:04:28,935 --> 03:04:32,238
THEM, HOW DOES IT FIT INTO THEIR

4962
03:04:32,238 --> 03:04:32,505
LIFESTYLE.

4963
03:04:32,505 --> 03:04:34,107
IF I'M A CLEANER I'M RUNNING UP

4964
03:04:34,107 --> 03:04:35,175
AND DOWNSTAIRS ALL DAY, I DON'T

4965
03:04:35,175 --> 03:04:36,509
NEED TO COUNT MY STEPS.

4966
03:04:36,509 --> 03:04:41,648
BUT MIGHT HAVE SOME JOINT

4967
03:04:41,648 --> 03:04:42,515
ISSUES, CHOLESTEROL ISSUES, SO

4968
03:04:42,515 --> 03:04:44,384
WE'RE REALLY TRYING TO MAKE THE

4969
03:04:44,384 --> 03:04:50,090
DEVICES WORK NOT ONLY FOR

4970
03:04:50,090 --> 03:04:51,391
RESEARCHERS AND HEALTH CARE

4971
03:04:51,391 --> 03:04:53,560
SYSTEM BUT FOR THE PERSON TO

4972
03:04:53,560 --> 03:04:56,896
MOTIVATE THEIR BEHAVIOR CHANGE.

4973
03:04:56,896 --> 03:04:59,499
>> SACNIN, YOU DO A LOT OF

4974
03:04:59,499 --> 03:05:00,800
RESEARCH, WHAT ARE YOU SEEING

4975
03:05:00,800 --> 03:05:01,768
NOW AND AHEAD?

4976
03:05:01,768 --> 03:05:03,970
>> YOU KNOW, I THINK WE'RE

4977
03:05:03,970 --> 03:05:07,007
SEEING AN EVOLUTION HERE,

4978
03:05:07,007 --> 03:05:08,675
HISTORICAL PERCEPTIONS ON

4979
03:05:08,675 --> 03:05:10,410
UNDERSERVED POPULATIONS NOT

4980
03:05:10,410 --> 03:05:13,279
BEING INTERESTED OR ABLE TO

4981
03:05:13,279 --> 03:05:15,215
PARTICIPATE IN THESE TRIALS.

4982
03:05:15,215 --> 03:05:16,783
THOSE PERCEPTIONS HAVE BEEN

4983
03:05:16,783 --> 03:05:17,984
PROVEN TO BE INVALID.

4984
03:05:17,984 --> 03:05:20,954
THE NIH HAS DONE NEAT WORK, THE

4985
03:05:20,954 --> 03:05:23,356
RULE STUDY, NIH FUNDED THAT

4986
03:05:23,356 --> 03:05:25,658
STUDY IN CARDIOVASCULAR

4987
03:05:25,658 --> 03:05:26,493
MEDICINE, MOVING BEYOND LIKE

4988
03:05:26,493 --> 03:05:30,130
FRAMINGHAM HEART STUDY, A

4989
03:05:30,130 --> 03:05:31,331
CURATED HOMOGENOUS POPULATION

4990
03:05:31,331 --> 03:05:32,766
HANDING OUT DATA PLAN GIFT CARDS

4991
03:05:32,766 --> 03:05:33,633
TO FOLKS.

4992
03:05:33,633 --> 03:05:36,836
THE FOLKS THAT WERE IN THE

4993
03:05:36,836 --> 03:05:37,670
MISSING FROM THE HISTORICAL

4994
03:05:37,670 --> 03:05:38,905
STUDIES ARE NOW IN THERE.

4995
03:05:38,905 --> 03:05:42,742
IN OUR STUDY OF THOUSANDS OF

4996
03:05:42,742 --> 03:05:44,511
PARTICIPANTS THAT WE ENROLLED,

4997
03:05:44,511 --> 03:05:46,813
MICHIGAN HAS A RELATIVELY

4998
03:05:46,813 --> 03:05:48,114
NON-DIVERSE PATIENT POPULATION

4999
03:05:48,114 --> 03:05:52,385
SO WE ASKED MORE -- HAD SPECIFIC

5000
03:05:52,385 --> 03:05:54,921
ENROLLMENT TARGETS TO MAKE SURE

5001
03:05:54,921 --> 03:05:58,191
SAMPLE SIZES WERE ADEQUATE FOR

5002
03:05:58,191 --> 03:05:59,726
INFERENCE AT INDIVIDUAL LEVEL

5003
03:05:59,726 --> 03:06:02,228
AND SAW GREAT UPTAKE, GREAT

5004
03:06:02,228 --> 03:06:02,529
INVOLVEMENT.

5005
03:06:02,529 --> 03:06:05,532
BUT WHEN YOU ENGAGE COMMUNITY

5006
03:06:05,532 --> 03:06:07,600
PARTNERS, I THINK MISTRUST IS

5007
03:06:07,600 --> 03:06:07,934
THERE.

5008
03:06:07,934 --> 03:06:11,671
WHAT WE'RE AT NOW IS DATASETS

5009
03:06:11,671 --> 03:06:13,440
ARE OUT, THERE "ALL OF US" US

5010
03:06:13,440 --> 03:06:16,810
HAS TEN OR TWENTY THOUSAND

5011
03:06:16,810 --> 03:06:19,212
FOLKS, DIVERSE POPULATIONS.

5012
03:06:19,212 --> 03:06:20,947
I THINK OUR DIGITAL DIVIDE

5013
03:06:20,947 --> 03:06:24,350
CLOSURE IS MOVING FASTER THAN

5014
03:06:24,350 --> 03:06:26,119
OUR HEALTHCARE DIVIDE CLOSURE.

5015
03:06:26,119 --> 03:06:31,891
SO THE DISPARITIES IN HEALTHCARE

5016
03:06:31,891 --> 03:06:33,760
OUTCOMES BY RACE,

5017
03:06:33,760 --> 03:06:34,360
SOCIOSOCIOECONOMIC STATUS ARE

5018
03:06:34,360 --> 03:06:36,729
WIDE BUT GETTING DATA REGARDING

5019
03:06:36,729 --> 03:06:38,465
DIVERSE POPULATIONS, UNDERSERVED

5020
03:06:38,465 --> 03:06:43,937
POPULATIONS IS GETTING NARROW

5021
03:06:43,937 --> 03:06:45,805
RAPIDLY SO I'M QUITE OPTIMISTIC

5022
03:06:45,805 --> 03:06:48,408
BECAUSE I THINK WE'RE DOING

5023
03:06:48,408 --> 03:06:49,843
BETTER WITH RESEARCH THAN WITH

5024
03:06:49,843 --> 03:06:52,712
HEALTH CARE IN THIS AREA.

5025
03:06:52,712 --> 03:06:55,648
>> IF I'M A RESEARCHER, I
WANT

5026
03:06:55,648 --> 03:06:57,383
TO EXPLORE AN UNADDRESSED

5027
03:06:57,383 --> 03:06:58,718
QUESTION, ONE THAT'S PRESSING,

5028
03:06:58,718 --> 03:06:59,686
IMPORTANT, WHAT WOULD YOUR

5029
03:06:59,686 --> 03:07:01,121
RECOMMENDATION BE?

5030
03:07:01,121 --> 03:07:01,855
WHERE SHOULD I FOCUS?

5031
03:07:01,855 --> 03:07:10,430
WHAT ARE SOME AREAS I SHOULD

5032
03:07:10,430 --> 03:07:11,297
LOOK AT?

5033
03:07:11,297 --> 03:07:13,066
>> START WITH JOE.

5034
03:07:13,066 --> 03:07:13,967
>> WHAT'S PUBLISHABLE?

5035
03:07:13,967 --> 03:07:16,603
>> THIS IS MY OWN BIAS,
FOR

5036
03:07:16,603 --> 03:07:16,903
SURE.

5037
03:07:16,903 --> 03:07:18,838
ONE THOUGH I THINK THAT WE

5038
03:07:18,838 --> 03:07:20,540
TALKED ABOUT THIS SEVERAL TIMES,

5039
03:07:20,540 --> 03:07:21,841
WITH THE PSYCHOLOGY OF GETTING

5040
03:07:21,841 --> 03:07:25,378
PEOPLE TO ENGAGE WITH THEIR DATA

5041
03:07:25,378 --> 03:07:26,980
AND CHANGE THEIR BEHAVIORS.

5042
03:07:26,980 --> 03:07:28,982
IT'S STILL A BIG GOOSE EGG.

5043
03:07:28,982 --> 03:07:30,483
WE HAVEN'T FIGURED THAT OUT.

5044
03:07:30,483 --> 03:07:40,994
I LOVE IT WHEN I GET MULTI---

5045
03:07:41,194 --> 03:07:44,430
DIFFERENT GROUPS TOGETHER DATA

5046
03:07:44,430 --> 03:07:45,298
SCIENTISTS, WEARABLE EXPERTS

5047
03:07:45,298 --> 03:07:46,399
TRYING TO SOLVE STUFF.

5048
03:07:46,399 --> 03:07:50,470
WE DIDN'T TALK ABOUT IT, BUT

5049
03:07:50,470 --> 03:07:51,337
JUST TO POINT AT LARGE LANGUAGE

5050
03:07:51,337 --> 03:07:53,206
MODEL IS THE THREE WORDS ON

5051
03:07:53,206 --> 03:07:56,176
EVERY SUBMISSION THESE DAYS.

5052
03:07:56,176 --> 03:08:06,719
IT'S BECAUSE PEOPLE SEE SO MANY

5053
03:08:08,154 --> 03:08:12,725
NICHE SETS, BUT THEY STILL HAVE

5054
03:08:12,725 --> 03:08:13,693
HALLUCINATIONSES, IF YOU CAN

5055
03:08:13,693 --> 03:08:15,895
SOLVE THAT THAT'S GOING TO MOVE

5056
03:08:15,895 --> 03:08:18,298
US A DECADE FORWARD QUICKLY.

5057
03:08:18,298 --> 03:08:19,732
THOSE ARE TWO AREAS THAT NEED A

5058
03:08:19,732 --> 03:08:20,833
LOT OF WORK.

5059
03:08:20,833 --> 03:08:24,771
MULTI-MODAL AS I SAID THAT'S A

5060
03:08:24,771 --> 03:08:26,172
BIG ONE.

5061
03:08:26,172 --> 03:08:28,508
RETRIEVAL, AUGMENTED GENERATION

5062
03:08:28,508 --> 03:08:28,942
IS THOUGHT.

5063
03:08:28,942 --> 03:08:31,144
AGENTIC A.I. IS HOT.

5064
03:08:31,144 --> 03:08:33,646
I DON'T MEAN TO BE BLABBERING

5065
03:08:33,646 --> 03:08:35,114
OFF JARGON BUT THOSE ARE THINGS

5066
03:08:35,114 --> 03:08:37,383
WE SEE A LOT OF.

5067
03:08:37,383 --> 03:08:39,886
>> WE'RE CLOSING ON TIME.

5068
03:08:39,886 --> 03:08:41,187
WE'VE GOT ANOTHER QUESTION HERE,

5069
03:08:41,187 --> 03:08:51,464
DO YOU THINK A.I. WILL HELP WITH

5070
03:08:51,464 --> 03:08:52,999
EHR SYNCHRONIZATION, NAVIGATING

5071
03:08:52,999 --> 03:08:54,934
VARIOUS EHRs ARE A NIGHTMARE

5072
03:08:54,934 --> 03:08:56,569
FOR PHYSICIANS, OPEN TO THE

5073
03:08:56,569 --> 03:08:56,936
GROUP.

5074
03:08:56,936 --> 03:08:58,304
WHAT ARE YOUR THOUGHTS THERE?

5075
03:08:58,304 --> 03:08:59,505
>> I DON'T THINK IT'S A

5076
03:08:59,505 --> 03:09:00,173
TECHNOLOGY PROBLEM.

5077
03:09:00,173 --> 03:09:03,610
I THINK IT'S A BUSINESS MODEL

5078
03:09:03,610 --> 03:09:05,845
PROBLEM. 

5079
03:09:05,845 --> 03:09:07,547
PEOPLE THAT ARE IN THAT BUSINESS

5080
03:09:07,547 --> 03:09:09,315
WANT TO BUILD WALLS SO YOU DON'T

5081
03:09:09,315 --> 03:09:10,516
SWITCH RECORD SYSTEMS AND SO

5082
03:09:10,516 --> 03:09:13,519
THEY DON'T TALK TO ONE ANOTHER.

5083
03:09:13,519 --> 03:09:18,825
>> DO WE FEEL THAT SOME OF
THE

5084
03:09:18,825 --> 03:09:22,228
CURRENT WORK UNDERWAY AROUND

5085
03:09:22,228 --> 03:09:23,029
FHIR STANDARDS, STANDARDIZATION,

5086
03:09:23,029 --> 03:09:24,697
IS THAT GOING TO MAKE PROGRESS

5087
03:09:24,697 --> 03:09:29,002
OR IS IT --

5088
03:09:29,002 --> 03:09:30,570
>> AT SOME POINT.

5089
03:09:30,570 --> 03:09:32,772
I REMEMBER WHEN DICOM WAS THERE,

5090
03:09:32,772 --> 03:09:34,407
IT DIDN'T WORK, NOW IT WORKS.

5091
03:09:34,407 --> 03:09:37,944
LIKE THE CHEESE MOVES.

5092
03:09:37,944 --> 03:09:41,514
RIGHT NOW, EPIC AND CERNER OF

5093
03:09:41,514 --> 03:09:44,150
THE WORLD DOESN'T WANT TO GIVE

5094
03:09:44,150 --> 03:09:47,253
AN INCH BUT MAYBE ZY  SOMEDAY TY

5095
03:09:47,253 --> 03:09:48,121
WILL BE YESTERDAY'S THOUGHT,

5096
03:09:48,121 --> 03:09:50,623
SOMETHING ELSE THEY WILL FIGHT

5097
03:09:50,623 --> 03:09:50,857
OVER.

5098
03:09:50,857 --> 03:09:53,026
>> I'LL CLOSE WITH A TOPIC
THAT

5099
03:09:53,026 --> 03:09:54,560
COULD BE ANOTHER THING WE COULD

5100
03:09:54,560 --> 03:09:58,865
SPEND AN HOUR ON. 

5101
03:09:58,865 --> 03:10:04,203
MASS GENERAL BRIGHAM, WHERE JOE,

5102
03:10:04,203 --> 03:10:05,405
YOU WORK, SACHIN, MICHIGAN

5103
03:10:05,405 --> 03:10:08,241
MEDICINE, AND 48 OUR HEALTH

5104
03:10:08,241 --> 03:10:11,811
SYSTEMS ARE WORKING TOGETHER ON

5105
03:10:11,811 --> 03:10:13,379
THE TRUSTWORTHY RESPONSIBLE A.I.

5106
03:10:13,379 --> 03:10:14,580
NETWORK, TRAIN.

5107
03:10:14,580 --> 03:10:16,883
ONE OBJECTIVE IS TO HELP SYSTEMS

5108
03:10:16,883 --> 03:10:21,254
DEAL WITH THE AMOUNT OF A.I.

5109
03:10:21,254 --> 03:10:22,789
COMING THEIR WAY, TRY TO

5110
03:10:22,789 --> 03:10:24,223
DISTRIBUTE WORKLOAD BY WORKING

5111
03:10:24,223 --> 03:10:25,625
WITH OTHER SITES TO NOT ONLY

5112
03:10:25,625 --> 03:10:28,928
CHOOSE WHAT A.I. IS APPROPRIATE

5113
03:10:28,928 --> 03:10:31,531
TO MEASURE BUT ALSO STANDARDIZE

5114
03:10:31,531 --> 03:10:34,067
ON IMPLEMENTATION AND ON THE

5115
03:10:34,067 --> 03:10:34,400
MEASUREMENTS.

5116
03:10:34,400 --> 03:10:36,803
IF SITES COULD DO THAT, EACH

5117
03:10:36,803 --> 03:10:39,005
SITE DOING IT FOCUSED ON A

5118
03:10:39,005 --> 03:10:39,505
PARTICULAR QUESTION, OR

5119
03:10:39,505 --> 03:10:44,677
PARTICULAR A.I., WE MAY BE ABLE

5120
03:10:44,677 --> 03:10:46,079
TO CAPTURE THAT INFORMATION

5121
03:10:46,079 --> 03:10:48,281
WITHIN EACH SITE, AND THEN BE

5122
03:10:48,281 --> 03:10:51,384
ABLE TO CREATE FEDERATED A.I.

5123
03:10:51,384 --> 03:10:52,285
OUTCOMES REGISTRY.

5124
03:10:52,285 --> 03:10:57,090
SO THROWING TO THE GROUP,

5125
03:10:57,090 --> 03:10:59,625
BECAUSE OF THE FACT REGISTRIES

5126
03:10:59,625 --> 03:11:01,594
ARE A VALUABLE WAY TO STIMULATE

5127
03:11:01,594 --> 03:11:03,463
RESEARCH AND GATHER INFORMATION

5128
03:11:03,463 --> 03:11:06,399
IN A STANDARDIZED MANNER ACROSS

5129
03:11:06,399 --> 03:11:10,236
SYSTEMS WHILE MAINTAINING DATA

5130
03:11:10,236 --> 03:11:10,803
PROVENANCE THROUGH FEDERATED

5131
03:11:10,803 --> 03:11:12,505
MECHANISMS PERHAPS THAT COULD BE

5132
03:11:12,505 --> 03:11:14,841
ANOTHER AREA, AND SO FINAL

5133
03:11:14,841 --> 03:11:18,811
THOUGHTS ON THAT, DUMB IDEA,

5134
03:11:18,811 --> 03:11:25,351
SMART IDEA, INTERESTING IDEA?

5135
03:11:25,351 --> 03:11:32,058
>> I THINK IT'S A FABULOUS
IDEA.

5136
03:11:32,058 --> 03:11:33,426
>> CERTAINLY A LOT OF

5137
03:11:33,426 --> 03:11:34,427
OPPORTUNITY FOR RESEARCHERS AS

5138
03:11:34,427 --> 03:11:36,496
WE LOOK INTO THIS SPACE.

5139
03:11:36,496 --> 03:11:39,665
I WANT TO MAYBE GIVE ONE FINAL

5140
03:11:39,665 --> 03:11:40,433
OPPORTUNITY, FINAL CLOSING

5141
03:11:40,433 --> 03:11:41,868
THOUGHTS, WHERE ARE WE HEADING

5142
03:11:41,868 --> 03:11:45,171
IN THE FUTURE, ANY

5143
03:11:45,171 --> 03:11:47,707
RECOMMENDATIONS, WE'LL GO LOK,

5144
03:11:47,707 --> 03:11:48,908
SACHIN, AND JOE.

5145
03:11:48,908 --> 03:11:51,411
>> JUST TO GO BACK TO THE
POLICY

5146
03:11:51,411 --> 03:11:54,680
QUESTION, LOOKS LIKE THE HILL IS

5147
03:11:54,680 --> 03:11:55,548
CONTEMPLATING EXTENDING MEDICARE

5148
03:11:55,548 --> 03:11:56,783
TELEHEALTH FLEXIBILITY FOR

5149
03:11:56,783 --> 03:11:59,185
ANOTHER TWO YEARS, SO I GUESS

5150
03:11:59,185 --> 03:12:02,789
WE'RE PUNTING THIS ISSUE DOWN

5151
03:12:02,789 --> 03:12:06,526
THE ROAD.

5152
03:12:06,526 --> 03:12:06,993
>> OKAY.

5153
03:12:06,993 --> 03:12:09,862
POLICY-WISE, MORE PUNTING.

5154
03:12:09,862 --> 03:12:10,096
SACHIN?

5155
03:12:10,096 --> 03:12:13,866
>> CONTINUED EFFORTS IN

5156
03:12:13,866 --> 03:12:14,534
DECENTRALIZED AND NON-HEALTHCARE

5157
03:12:14,534 --> 03:12:17,804
SYSTEM BASED EFFORTS TO EVALUATE

5158
03:12:17,804 --> 03:12:19,238
THESE TECHNOLOGY, MEETING

5159
03:12:19,238 --> 03:12:20,106
PATIENTS WHERE THEY ARE, WHICH

5160
03:12:20,106 --> 03:12:22,375
DOESN'T HAVE TO WALK THROUGH OUR

5161
03:12:22,375 --> 03:12:24,076
ACADEMIC MEDICAL CENTER FRONT

5162
03:12:24,076 --> 03:12:26,813
WALL, FRONT DOOR IS THE KEY.

5163
03:12:26,813 --> 03:12:29,415
>> ABSOLUTELY.

5164
03:12:29,415 --> 03:12:29,582
JOE?

5165
03:12:29,582 --> 03:12:31,617
>> AGAIN THE IDEA OF OMNI

5166
03:12:31,617 --> 03:12:33,386
CHANNEL CARE, DEVELOPING IT OUT.

5167
03:12:33,386 --> 03:12:36,422
IT'S NOT UNLIKE WHAT SACHIN,

5168
03:12:36,422 --> 03:12:37,957
IT'S A DIGITAL FRONT-DOOR

5169
03:12:37,957 --> 03:12:38,191
CONCEPT.

5170
03:12:38,191 --> 03:12:40,159
WE'RE SO POOR AT THAT RIGHT NOW.

5171
03:12:40,159 --> 03:12:42,762
IT'S SAD, THERE'S SO MANY OTHER

5172
03:12:42,762 --> 03:12:43,996
INITIATIVES DOING SO MUCH BETTER

5173
03:12:43,996 --> 03:12:46,399
THAN WE ARE, I HOPE WE CAN GET

5174
03:12:46,399 --> 03:12:46,599
THERE.

5175
03:12:46,599 --> 03:12:48,134
>> IT'S BEEN A PLEASURE
HAVING A

5176
03:12:48,134 --> 03:12:49,569
CONVERSATION WITH ALL THREE OF

5177
03:12:49,569 --> 03:12:49,969
YOU.

5178
03:12:49,969 --> 03:12:52,939
THANK YOU ALL FOR LISTENING IN.

5179
03:12:52,939 --> 03:12:54,373
WE'RE GOING TO CLOSE OUR PART OF

5180
03:12:54,373 --> 03:12:57,343
THE SESSION AND HAND IT BACK TO

5181
03:12:57,343 --> 03:12:58,044
THE FACILITATORS.

5182
03:12:58,044 --> 03:12:59,312
AND WE'RE BACK ON TIME.

5183
03:12:59,312 --> 03:13:01,514
SO THANK YOU ALL FOR YOUR TIME

5184
03:13:01,514 --> 03:13:02,415
AND LOOKING FORWARD TO HEARING

5185
03:13:02,415 --> 03:13:05,618
THE REST OF THE PROGRAM.

5186
03:13:05,618 --> 03:13:06,652
>> THANK YOU.

5187
03:13:06,652 --> 03:13:08,421
>> THANK YOU VERY MUCH FOR
EVERY

5188
03:13:08,421 --> 03:13:10,056
ONE OF THESE SESSIONS,

5189
03:13:10,056 --> 03:13:11,324
PHENOMENAL DISCUSSION.

5190
03:13:11,324 --> 03:13:13,993
NOW WE MOVE FOR SOME CLOSING

5191
03:13:13,993 --> 03:13:14,961
REMARKS BY DR. MENSAH.

5192
03:13:14,961 --> 03:13:16,829
AGAIN, DON'T GO AWAY.

5193
03:13:16,829 --> 03:13:23,002
WE HAVE MORE.

5194
03:13:23,002 --> 03:13:23,836
>> ALL RIGHT.

5195
03:13:23,836 --> 03:13:26,973
THANK YOU, FERNANDO.

5196
03:13:26,973 --> 03:13:30,109
WHAT A REALLY FANTASTIC

5197
03:13:30,109 --> 03:13:31,611
PRACTICAL MEANINGFUL SUBSTANTIVE

5198
03:13:31,611 --> 03:13:32,011
WORKSHOP.

5199
03:13:32,011 --> 03:13:34,046
WE CAN'T THANK YOU ENOUGH.

5200
03:13:34,046 --> 03:13:38,084
BUT AS WE BRING THIS WORKSHOP TO

5201
03:13:38,084 --> 03:13:43,022
A CLOSE, I'D LIKE TO REFLECT ON

5202
03:13:43,022 --> 03:13:48,060
THE STIMULATING DISCUSSIONS,

5203
03:13:48,060 --> 03:13:49,028
INVALUABLE INSIGHTS, PRACTICAL

5204
03:13:49,028 --> 03:13:50,997
TAKEHOME MESSAGES AND UNIQUE

5205
03:13:50,997 --> 03:13:51,931
OPPORTUNITIES YOU HELPED US

5206
03:13:51,931 --> 03:13:54,700
IDENTIFY FOR US IN THE CENTER

5207
03:13:54,700 --> 03:13:56,469
FOR TRANSLATIONAL RESEARCH AND

5208
03:13:56,469 --> 03:13:58,538
IMPLEMENTATION SCIENCE, CTRIS,

5209
03:13:58,538 --> 03:14:00,840
AND EVEN MORE BROADLY FOR ALL OF

5210
03:14:00,840 --> 03:14:03,676
US AS COLLEAGUE OF NHLBI AND ALL

5211
03:14:03,676 --> 03:14:04,644
OF NIH.

5212
03:14:04,644 --> 03:14:07,046
SO FIRST, I WANT TO EXTEND MY

5213
03:14:07,046 --> 03:14:10,349
DEEPEST GRATITUDE TO EACH OF YOU

5214
03:14:10,349 --> 03:14:12,852
FOR YOUR CONTRIBUTIONS TO THIS

5215
03:14:12,852 --> 03:14:13,286
IMPORTANT WORKSHOP.

5216
03:14:13,286 --> 03:14:14,787
THIS IS A REALLY BUSY TIME OF

5217
03:14:14,787 --> 03:14:17,123
YEAR FOR ALL OF YOU.

5218
03:14:17,123 --> 03:14:19,325
SO WE REALLY, REALLY APPRECIATE

5219
03:14:19,325 --> 03:14:22,094
YOU TAKING THE TIME TO PREPARE,

5220
03:14:22,094 --> 03:14:25,598
AND TO CONTRIBUTE TO MAKING THIS

5221
03:14:25,598 --> 03:14:27,767
WORKSHOP SO SUCCESSFUL.

5222
03:14:27,767 --> 03:14:29,302
YOU KNOW, OUR JOURNEY INTO

5223
03:14:29,302 --> 03:14:34,006
UNDERSTAND THE CURRENT USE OF

5224
03:14:34,006 --> 03:14:34,607
DIRECT-TO-CONSUMER TELEHEALTH

5225
03:14:34,607 --> 03:14:36,876
AND LESSONS LEARNED, THAT

5226
03:14:36,876 --> 03:14:39,645
JOURNEY HAS BEEN ENLIGHTENING,

5227
03:14:39,645 --> 03:14:41,147
HAS BEEN INSPIRING, AND HAS EVEN

5228
03:14:41,147 --> 03:14:46,986
BEEN MADE MORE RICH BECAUSE OF

5229
03:14:46,986 --> 03:14:47,853
YOUR CONTRIBUTIONS.

5230
03:14:47,853 --> 03:14:49,488
THE CHALLENGES, ESPECIALLY THE

5231
03:14:49,488 --> 03:14:51,457
OPPORTUNITIES THAT YOU'VE HELPED

5232
03:14:51,457 --> 03:14:53,993
US IDENTIFY WILL GO A VERY, VERY

5233
03:14:53,993 --> 03:14:57,029
LONG WAY AS WE EXPLORE OVER THE

5234
03:14:57,029 --> 03:15:00,232
NEXT THREE TO FIVE YEARS AND

5235
03:15:00,232 --> 03:15:03,002
ESPECIALLY THE DECADE AHEAD, HOW

5236
03:15:03,002 --> 03:15:06,906
NHLBI CAN HELP LEVERAGE THE

5237
03:15:06,906 --> 03:15:08,774
TECHNOLOGICAL ADVANCEMENTS,

5238
03:15:08,774 --> 03:15:10,610
COUPLED WITH TRULY MEANINGFUL

5239
03:15:10,610 --> 03:15:12,345
ENGAGEMENT OF THE COMMUNITIES WE

5240
03:15:12,345 --> 03:15:15,982
SERVE, TO REALLY BEND THE CURVE

5241
03:15:15,982 --> 03:15:19,485
TOWARDS TRULY TRANSFORMATIVE

5242
03:15:19,485 --> 03:15:21,454
CHANGE IN DIRECT-TO CONSUMER

5243
03:15:21,454 --> 03:15:22,855
TELEHEALTH FOR ADVANCE ALSO

5244
03:15:22,855 --> 03:15:23,889
HEALTH FOR ALL.

5245
03:15:23,889 --> 03:15:26,993
DISCUSSIONS TODAY UNDERSCORED

5246
03:15:26,993 --> 03:15:29,128
THE CRITICAL IMPORTANCE OF

5247
03:15:29,128 --> 03:15:31,097
HEALTH EQUITY, PARTICULARLY IN

5248
03:15:31,097 --> 03:15:32,732
RURAL AND UNDERSERVED AREAS, AND

5249
03:15:32,732 --> 03:15:36,569
AS WE HEARD EVEN IN URBAN

5250
03:15:36,569 --> 03:15:38,204
CENTERS, THERE ARE UNDERSERVED

5251
03:15:38,204 --> 03:15:40,272
POPULATIONS FOR WHOM WE

5252
03:15:40,272 --> 03:15:41,807
SHOULDN'T FORGET.

5253
03:15:41,807 --> 03:15:44,443
IT'S CLEAR THAT WHILE TELEHEALTH

5254
03:15:44,443 --> 03:15:46,412
HOLDS TREMENDOUS PROMISE FOR

5255
03:15:46,412 --> 03:15:51,651
BRIDGING GAPS IN CARE, WE MUST

5256
03:15:51,651 --> 03:15:53,519
REMAIN VIGILANT ENSURING THESE

5257
03:15:53,519 --> 03:15:55,187
SOLUTIONS ARE INCLUSIVE AND

5258
03:15:55,187 --> 03:15:57,156
EQUITABLE FOR ALL COMMUNITIES,

5259
03:15:57,156 --> 03:15:59,592
THAT YOU WE DON'T NEED TO WIDEN

5260
03:15:59,592 --> 03:16:02,428
DISPARITIES THAT SEVERAL OF YOU

5261
03:16:02,428 --> 03:16:05,831
MENTIONED TODAY. 

5262
03:16:05,831 --> 03:16:07,566
I'M VERY PARTICULARLY ENCOURAGED

5263
03:16:07,566 --> 03:16:09,568
BY INNOVATIVE IDEAS AND

5264
03:16:09,568 --> 03:16:12,071
POTENTIAL SOLUTIONS THAT EMERGED

5265
03:16:12,071 --> 03:16:12,738
FROM THE SESSIONS.

5266
03:16:12,738 --> 03:16:15,675
IN THE INTEREST OF TIME I WILL

5267
03:16:15,675 --> 03:16:18,077
NOT COMMENT ON SESSION 2 OR THE

5268
03:16:18,077 --> 03:16:20,746
REPORT-BACK FROM THE BREAKOUT

5269
03:16:20,746 --> 03:16:22,581
SESSIONS SINCE THOSE ARE FRESH

5270
03:16:22,581 --> 03:16:26,519
IN YOUR MIND SINCE WE JUST HAD

5271
03:16:26,519 --> 03:16:27,820
THOSE SESSIONS BUT I'LL COMMENT

5272
03:16:27,820 --> 03:16:29,221
ON A FEW THEMES FROM THE

5273
03:16:29,221 --> 03:16:29,455
MORNING.

5274
03:16:29,455 --> 03:16:32,625
WE BEGAN WITH DR. BRUNO AND DR.

5275
03:16:32,625 --> 03:16:34,593
LEWIS, WHO SHARED WITH US THE

5276
03:16:34,593 --> 03:16:36,696
REAL IMPORTANCE OF THIS WORKSHOP

5277
03:16:36,696 --> 03:16:38,764
WITHIN THE CONTEXT OF THE

5278
03:16:38,764 --> 03:16:42,702
STRATEGIC VISION GOALS AND

5279
03:16:42,702 --> 03:16:43,703
OBJECTIVES OF THE NATIONAL

5280
03:16:43,703 --> 03:16:49,575
HEART, LUNG AND BLOOD INSTITUTE

5281
03:16:49,575 --> 03:16:50,476
ESPECIALLY CENTER FOR

5282
03:16:50,476 --> 03:16:52,211
TRANSLATION RESEARCH.

5283
03:16:52,211 --> 03:16:53,879
WE JUST CELEBRATED OUR TENTH

5284
03:16:53,879 --> 03:16:56,382
ANNIVERSARY AND DR. LEWIS

5285
03:16:56,382 --> 03:16:58,350
INVITED YOU ON DECEMBER 11.

5286
03:16:58,350 --> 03:16:59,785
AFTER THAT CELEBRATION, AS WE

5287
03:16:59,785 --> 03:17:01,954
BEGIN TO CHART THE FUTURE OF THE

5288
03:17:01,954 --> 03:17:05,257
NEXT DECADE, WHAT WE'VE HEARD

5289
03:17:05,257 --> 03:17:07,660
FROM YOU TODAY IS GOING TO BE

5290
03:17:07,660 --> 03:17:07,893
CRUCIAL.

5291
03:17:07,893 --> 03:17:09,628
IN THE OPENING KEYNOTE

5292
03:17:09,628 --> 03:17:12,465
PRESENTATION WE HEARD FROM GARTH

5293
03:17:12,465 --> 03:17:14,967
GRAHAM WHO TOLD US NEIGHBORHOODS

5294
03:17:14,967 --> 03:17:17,069
MATTER FOR HEALTH.

5295
03:17:17,069 --> 03:17:19,271
MEANING WHERE WE LIVE HAS AN

5296
03:17:19,271 --> 03:17:23,642
IMPACT ON OUR HEALTH, AND THAT

5297
03:17:23,642 --> 03:17:24,844
TRUE PATIENT-CENTRIC CARE

5298
03:17:24,844 --> 03:17:28,013
REQUIRES REACHING PATIENTS WHERE

5299
03:17:28,013 --> 03:17:28,581
THEY ARE.

5300
03:17:28,581 --> 03:17:29,448
SO THERE ARE TREMENDOUS

5301
03:17:29,448 --> 03:17:31,083
OPPORTUNITIES FOR US.

5302
03:17:31,083 --> 03:17:33,285
HOW DO WE USE THE SEVEN DOMAINS

5303
03:17:33,285 --> 03:17:38,524
HE SHARED WITH US TO TRULY

5304
03:17:38,524 --> 03:17:44,563
TRANSFORM HEALTH OF PATIENTS AND

5305
03:17:44,563 --> 03:17:45,431
COMMUNITIES THROUGH

5306
03:17:45,431 --> 03:17:46,999
DIRECT-TO-CONSUMER TELEHEALTH

5307
03:17:46,999 --> 03:17:50,569
AND IMPLEMENTATION  RESEARCH.

5308
03:17:50,569 --> 03:17:52,538
HOW DO WE USE IMPLEMENTATION

5309
03:17:52,538 --> 03:17:54,473
STRATEGIES TO ENSURE OVERARCHING

5310
03:17:54,473 --> 03:17:55,741
PROMISE OF TELEMEDICINE IS MADE

5311
03:17:55,741 --> 03:17:57,143
REAL FOR PATIENTS OR PROVIDERS

5312
03:17:57,143 --> 03:17:59,345
AND ALSO FOR THE HEALTHCARE

5313
03:17:59,345 --> 03:18:01,013
SYSTEM AS A WHOLE.

5314
03:18:01,013 --> 03:18:05,284
HOW DO WE USE MULTI-CHANNEL

5315
03:18:05,284 --> 03:18:06,051
COMMUNICATION SCIENCE AND

5316
03:18:06,051 --> 03:18:07,253
DISSEMINATION RESEARCH TO ENSURE

5317
03:18:07,253 --> 03:18:11,624
THAT THE THREE TAKEHOME MESSAGES

5318
03:18:11,624 --> 03:18:14,260
HE SHARED REACH ALL AUDIENCES.

5319
03:18:14,260 --> 03:18:16,662
MANY EXAMPLES HE SHARED ABOUT

5320
03:18:16,662 --> 03:18:18,731
EVOLUTION OF TELEHEALTH AND

5321
03:18:18,731 --> 03:18:20,933
EXPERIENCES FROM MANY CLINICAL

5322
03:18:20,933 --> 03:18:24,737
PRACTICES DURING THE COVID

5323
03:18:24,737 --> 03:18:26,739
PANDEMIC, ESPECIALLY AROUND

5324
03:18:26,739 --> 03:18:27,573
PATIENT-PROVIDER RELATIONSHIPS,

5325
03:18:27,573 --> 03:18:29,341
THESE WILL ALL BE INVALUABLE AS

5326
03:18:29,341 --> 03:18:31,510
WE EXPLORE THE RESEARCH

5327
03:18:31,510 --> 03:18:31,844
OPPORTUNITIES.

5328
03:18:31,844 --> 03:18:34,079
SO WE THANK DR. GRAHAM FOR

5329
03:18:34,079 --> 03:18:35,815
GETTING US STARTED.

5330
03:18:35,815 --> 03:18:40,419
IN SESSION 1, AND RELATED SMALL

5331
03:18:40,419 --> 03:18:41,520
GROUP DISCUSSIONS, I THINK THEY

5332
03:18:41,520 --> 03:18:43,022
WERE FANTASTIC.

5333
03:18:43,022 --> 03:18:45,858
WE WENT BEYOND THE SCREEN AROUND

5334
03:18:45,858 --> 03:18:48,894
LEARNED ABOUT BEST PRACTICES IN

5335
03:18:48,894 --> 03:18:49,428
TELEHEALTH, IMPLEMENTATION

5336
03:18:49,428 --> 03:18:51,664
RESEARCH THAT CAN HAVE LASTING

5337
03:18:51,664 --> 03:18:51,897
IMPACT.

5338
03:18:51,897 --> 03:18:55,067
SO BIG THANK YOU TO MEGAN AND

5339
03:18:55,067 --> 03:18:58,003
KRISTIN AND THE TEAM AND JOHN

5340
03:18:58,003 --> 03:19:01,106
FOR THE WORK AND THE EXCITING

5341
03:19:01,106 --> 03:19:01,340
SESSION.

5342
03:19:01,340 --> 03:19:05,578
BUT REALLY WE HAD THE

5343
03:19:05,578 --> 03:19:07,213
OPPORTUNITY TO EXPLORE HOW WE

5344
03:19:07,213 --> 03:19:08,781
REINVENT CARE AND DO THINGS

5345
03:19:08,781 --> 03:19:09,949
DIFFERENTLY, NOT CONTINUE TO DO

5346
03:19:09,949 --> 03:19:12,017
THINGS THE SAME WAY.

5347
03:19:12,017 --> 03:19:14,320
WE HEARD THE CAVEAT THAT TO

5348
03:19:14,320 --> 03:19:16,088
THINK OF TELEHEALTH AS THE

5349
03:19:16,088 --> 03:19:17,790
ELEVATOR, FIRST TIME I HEARD

5350
03:19:17,790 --> 03:19:21,594
THAT EXPRESSION, BUT WHAT ARE

5351
03:19:21,594 --> 03:19:23,462
THE REAL PROMISING PRACTICES

5352
03:19:23,462 --> 03:19:26,198
AMONG THE TELEHEALTH MODALITIES

5353
03:19:26,198 --> 03:19:27,633
ESPECIALLY AS TELEHEALTH IS

5354
03:19:27,633 --> 03:19:31,437
LAUNCHED AND WE'RE LAUNCHED

5355
03:19:31,437 --> 03:19:32,638
MULTIPLE TIMES.

5356
03:19:32,638 --> 03:19:38,244
HOW DID WE ADDRESS ISSUES OF

5357
03:19:38,244 --> 03:19:39,445
RELUCTANCE, REENGAGEMENT,

5358
03:19:39,445 --> 03:19:40,446
TELEMEDICINE, WHAT STRATEGIES

5359
03:19:40,446 --> 03:19:43,582
CAN WE DEVELOP AND TEST TO

5360
03:19:43,582 --> 03:19:44,683
SUPPORT PROVIDERS?

5361
03:19:44,683 --> 03:19:46,752
IMPORTANTLY, HOW DO WE SUPPORT

5362
03:19:46,752 --> 03:19:48,053
TRAINING AND CAREER DEVELOPMENT

5363
03:19:48,053 --> 03:19:50,923
AND HOW WE BUILD THE FUTURE

5364
03:19:50,923 --> 03:19:52,124
GENERATION OF CLINICIANS, NOT

5365
03:19:52,124 --> 03:19:55,628
JUST PHYSICIANS BUT ALL

5366
03:19:55,628 --> 03:19:56,295
CLINICIANS, AND

5367
03:19:56,295 --> 03:19:58,397
CLINICIAN-SCIENTISTS, TO HAVE

5368
03:19:58,397 --> 03:20:00,332
EXPERTISE AND EXPERIENCE TO USE

5369
03:20:00,332 --> 03:20:01,567
TELEHEALTH APPROPRIATELY.

5370
03:20:01,567 --> 03:20:03,836
HOW DO WE SCALE UP THESE

5371
03:20:03,836 --> 03:20:04,803
PROBLEMS AND PRACTICES?

5372
03:20:04,803 --> 03:20:08,107
FOR EXAMPLE, WHAT WE HEARD

5373
03:20:08,107 --> 03:20:09,108
ABOUT, PATIENT CHECKOUT

5374
03:20:09,108 --> 03:20:10,409
ROUTINES, PATIENT PREFERRED

5375
03:20:10,409 --> 03:20:12,711
LANGUAGE SELECTION, AND OTHER

5376
03:20:12,711 --> 03:20:14,780
INNOVATIVE HYBRID ROUTINES ARE

5377
03:20:14,780 --> 03:20:16,782
IN CARE TRANSITIONS, HOW DO WE

5378
03:20:16,782 --> 03:20:19,818
BEST KNOW ABOUT THE REAL WORLD

5379
03:20:19,818 --> 03:20:20,586
DATA FROM STAND-ALONE

5380
03:20:20,586 --> 03:20:22,755
TELEHEALTH, AND IMPACT ON HEALTH

5381
03:20:22,755 --> 03:20:23,222
OUTCOMES.

5382
03:20:23,222 --> 03:20:25,424
I HAVE FIVE PAGES OF NOTES BUT

5383
03:20:25,424 --> 03:20:29,762
I'M GOING TO STOP AND SHARE MY

5384
03:20:29,762 --> 03:20:30,763
NOTES WITH FERNANDO, HONESTLY

5385
03:20:30,763 --> 03:20:37,336
THIS HAS BEEN A FANTASTIC

5386
03:20:37,336 --> 03:20:42,041
SESSION, SESSION, SINCERE

5387
03:20:42,041 --> 03:20:52,518
THANKS, BOB, ROBIN, LOK AND

5388
03:20:53,919 --> 03:20:55,587
SINCHAN, REALLY TERRIFIC.

5389
03:20:55,587 --> 03:20:56,121
EXPLORE OPPORTUNITIES IN

5390
03:20:56,121 --> 03:20:56,922
TELEHEALTH RESEARCH.

5391
03:20:56,922 --> 03:21:00,326
I HOPE WE ALL KEEP CHALLENGING

5392
03:21:00,326 --> 03:21:02,194
CONVENTIONAL THINKING AND WORK

5393
03:21:02,194 --> 03:21:04,263
TOWARDS TRANSLATING THE ADVANCES

5394
03:21:04,263 --> 03:21:07,666
WE'VE HEARD ABOUT TODAY INTO

5395
03:21:07,666 --> 03:21:08,968
TANGIBLE HEALTH IMPACTS THAT

5396
03:21:08,968 --> 03:21:11,170
WOULD ENABLE OUR COMMUNITIES TO

5397
03:21:11,170 --> 03:21:12,571
THRIVE.

5398
03:21:12,571 --> 03:21:15,441
ESPECIALLY WHEN IT COMES TO

5399
03:21:15,441 --> 03:21:19,278
IMPROVED ACCESS TO HIGH-QUALITY

5400
03:21:19,278 --> 03:21:20,245
HEALTH CARE THROUGH

5401
03:21:20,245 --> 03:21:21,547
DIRECT-TO-CONSUMER TELEHEALTH.

5402
03:21:21,547 --> 03:21:23,115
AGAIN, A TRULY WONDERFUL

5403
03:21:23,115 --> 03:21:23,382
WORKSHOP.

5404
03:21:23,382 --> 03:21:25,617
I'LL TURN IT OVER TO FERNANDO TO

5405
03:21:25,617 --> 03:21:28,554
THANK ALL OF YOU AND ESPECIALLY

5406
03:21:28,554 --> 03:21:31,523
THE ENTIRE TEAM THAT MADE THIS

5407
03:21:31,523 --> 03:21:32,992
WORKSHOP POSSIBLE, ALSO TO SHARE

5408
03:21:32,992 --> 03:21:35,461
WITH US SOME NEXT STEPS.

5409
03:21:35,461 --> 03:21:39,999
ON BEHALF OF NIH, NHLBI, AND OUR

5410
03:21:39,999 --> 03:21:42,701
CENTER, CTRIS, WE THANK YOU.

5411
03:21:42,701 --> 03:21:43,802
FERNANDO, I'LL TAG YOU.

5412
03:21:43,802 --> 03:21:47,172
>> THANK YOU VERY MUCH,
GEORGE.

5413
03:21:47,172 --> 03:21:49,141
JUST WAITING FOR THE OPPORTUNITY

5414
03:21:49,141 --> 03:21:57,383
TO SHARE MY SCREEN, IF I CAN DO

5415
03:21:57,383 --> 03:21:58,884
THAT, SUPPORT TEAM.

5416
03:21:58,884 --> 03:22:04,023
I JUST ADDED MY SCREEN HERE SO I

5417
03:22:04,023 --> 03:22:08,093
CAN SHARE IT.

5418
03:22:08,093 --> 03:22:08,627
ALL RIGHT.

5419
03:22:08,627 --> 03:22:10,696
THIS BRINGS US TO A CLOSE,

5420
03:22:10,696 --> 03:22:13,232
NOTHING BETTER THAN HAVING OUR

5421
03:22:13,232 --> 03:22:16,001
DIRECTOR, DR. MENSAH, BRINGING

5422
03:22:16,001 --> 03:22:19,471
THESE WISE WORDS, SO MUCH RICH

5423
03:22:19,471 --> 03:22:20,239
CONVERSATION FOR TODAY.

5424
03:22:20,239 --> 03:22:21,607
IT WOULDN'T BE ENOUGH IF WE

5425
03:22:21,607 --> 03:22:24,076
DON'T THANK ALL OF YOU WHO

5426
03:22:24,076 --> 03:22:25,377
STAYED WITH US THROUGHOUT THIS

5427
03:22:25,377 --> 03:22:28,113
TIME, THOSE WHO MIGHT BE

5428
03:22:28,113 --> 03:22:29,081
WATCHING AFTER THIS WORKSHOP

5429
03:22:29,081 --> 03:22:31,850
TOOK PLACE BUT THOSE WHO MADE

5430
03:22:31,850 --> 03:22:33,585
THE WORKSHOP POSSIBLE.

5431
03:22:33,585 --> 03:22:35,354
I SEND MY GREAT THANK YOU AND

5432
03:22:35,354 --> 03:22:37,856
ACKNOWLEDGMENT TO THE NHLBI

5433
03:22:37,856 --> 03:22:38,857
WORKSHOP SUPPORT TEAM FOR THE

5434
03:22:38,857 --> 03:22:41,493
SAKE OF THE TIME I WON'T SAY

5435
03:22:41,493 --> 03:22:42,327
EVERYBODY'S NAME BUT THEY ARE

5436
03:22:42,327 --> 03:22:43,228
ALL HERE.

5437
03:22:43,228 --> 03:22:48,367
WITHOUT THEM THIS WOULD NOT HAVE

5438
03:22:48,367 --> 03:22:49,701
BEEN POSSIBLE.

5439
03:22:49,701 --> 03:22:50,469
ALSO, THE ADVERTISING AND

5440
03:22:50,469 --> 03:22:53,072
SPEAKING ABOUT THE EVENT AND

5441
03:22:53,072 --> 03:22:54,273
INFORMATION TECHNOLOGY TEAM AND

5442
03:22:54,273 --> 03:22:57,076
OBVIOUSLY TO ALL OF OUR SPEAKERS

5443
03:22:57,076 --> 03:22:59,111
AVAILABLE HERE TODAY, THANK YOU

5444
03:22:59,111 --> 03:23:00,746
FOR ACCEPTING OUR INVITATION,

5445
03:23:00,746 --> 03:23:02,281
FOR ENGAGING SUCH A RICH

5446
03:23:02,281 --> 03:23:02,981
CONVERSATION.

5447
03:23:02,981 --> 03:23:09,822
THANK YOU TO THE CTRIS

5448
03:23:09,822 --> 03:23:10,689
LEADERSHIP AND SHOUTING OUT, I

5449
03:23:10,689 --> 03:23:17,729
WANT TO GIVE THE SPOTLIGHT TO

5450
03:23:17,729 --> 03:23:19,598
PADMA WITHOUT WHOM I COULDN'T

5451
03:23:19,598 --> 03:23:21,767
SURVIVE THE PLANNING.

5452
03:23:21,767 --> 03:23:22,801
THANK YOU.

5453
03:23:22,801 --> 03:23:24,536
REGARDING NEXT STEPS, AS GEORGE

5454
03:23:24,536 --> 03:23:27,372
WAS MENTIONING THERE'S THE CTRIS

5455
03:23:27,372 --> 03:23:28,373
TEN-YEAR ANNIVERSARY WHICH WE

5456
03:23:28,373 --> 03:23:31,543
SHARED THE LINK FOR YOU TO

5457
03:23:31,543 --> 03:23:31,910
REGISTER.

5458
03:23:31,910 --> 03:23:33,512
TODAY ALSO MARKS THE END OF THE

5459
03:23:33,512 --> 03:23:35,914
WORKSHOP, TO US IT'S JUST THE

5460
03:23:35,914 --> 03:23:36,315
BEGINNING.

5461
03:23:36,315 --> 03:23:41,053
WE ARE GOING TO COMPILE THINGS

5462
03:23:41,053 --> 03:23:43,722
THAT HAPPENED TODAY INTO AN

5463
03:23:43,722 --> 03:23:44,923
EXECUTIVE SUMMARY AVAILABLE ON

5464
03:23:44,923 --> 03:23:46,758
THE WEBSITE WITHIN THE NEXT

5465
03:23:46,758 --> 03:23:47,092
MONTH.

5466
03:23:47,092 --> 03:23:48,060
HOPEFULLY SOME PUBLICATIONS ALSO

5467
03:23:48,060 --> 03:23:50,162
IN WHICH WE CAN COMMENT MORE

5468
03:23:50,162 --> 03:23:52,131
ABOUT WHAT WAS DISCUSSED TODAY.

5469
03:23:52,131 --> 03:23:54,733
AND BEFORE THE END, I WANT TO

5470
03:23:54,733 --> 03:23:57,369
ALSO SHARE SOMETHING CTRIS IS

5471
03:23:57,369 --> 03:24:00,772
ALREADY LEADING IN REGARDS TO

5472
03:24:00,772 --> 03:24:03,275
TELEHEALTH, WE'RE HAVING A

5473
03:24:03,275 --> 03:24:04,143
FUNDING OPPORTUNITY, DIFFERENCE

5474
03:24:04,143 --> 03:24:07,346
IN THE WORKSHOP FOCUS TODAY,

5475
03:24:07,346 --> 03:24:08,780
THIS ONE ON PROVIDER-TO-PROVIDER

5476
03:24:08,780 --> 03:24:09,615
TELEHEALTH, PARTICULARLY THOSE

5477
03:24:09,615 --> 03:24:10,849
IN NEED IN RURAL AREAS.

5478
03:24:10,849 --> 03:24:14,353
SO AS LONG AS YOU HAVE AN IDEA

5479
03:24:14,353 --> 03:24:18,490
FOR A PROJECT THAT DEALS WITH

5480
03:24:18,490 --> 03:24:20,359
RURAL AREAS BENEFITING,

5481
03:24:20,359 --> 03:24:22,861
PROVIDING COMMUNICATION, LIKELY

5482
03:24:22,861 --> 03:24:23,762
RESPONSIVE TO THIS NEWEST

5483
03:24:23,762 --> 03:24:24,530
OPPORTUNITY HERE.

5484
03:24:24,530 --> 03:24:28,133
HAVE YOU MY CONTACT THERE.

5485
03:24:28,133 --> 03:24:32,337
ALSO IMPORTANT HIGHLIGHT ROBIN

5486
03:24:32,337 --> 03:24:33,405
VANDERPOOL, SHE'S THE

5487
03:24:33,405 --> 03:24:34,006
REPRESENTATIVE FOR NCI, SO WE

5488
03:24:34,006 --> 03:24:40,312
CAN ALSO CONTACT HER.

5489
03:24:40,312 --> 03:24:42,147
SCAN THE QR CODE ABOUT THIS

5490
03:24:42,147 --> 03:24:43,916
NOTICE OF SPECIAL INTEREST ON

5491
03:24:43,916 --> 03:24:44,116
CTRIS.

5492
03:24:44,116 --> 03:24:47,186
BEYOND THIS IF YOU HAVE A

5493
03:24:47,186 --> 03:24:48,086
PARTICULAR PROJECT ON TELEHEALTH

5494
03:24:48,086 --> 03:24:51,690
OR SOMETHING THAT HAS TO DO WITH

5495
03:24:51,690 --> 03:24:54,092
IMPLEMENTATION RESEARCH REACH

5496
03:24:54,092 --> 03:24:54,393
OUT.

5497
03:24:54,393 --> 03:24:56,495
WE'RE OPEN TO HEAR YOUR IDEAS

5498
03:24:56,495 --> 03:24:57,496
AND HAVE TECHNICAL INFORMATION

5499
03:24:57,496 --> 03:24:59,998
CALLS WITH YOU, IN WHICH WE CAN

5500
03:24:59,998 --> 03:25:01,767
BETTER ASSIST WITH YOUR

5501
03:25:01,767 --> 03:25:02,034
RESEARCH.

5502
03:25:02,034 --> 03:25:03,302
AND WITH THAT I THINK THAT

5503
03:25:03,302 --> 03:25:05,137
BRINGS US TO THE ACTUAL CLOSE,

5504
03:25:05,137 --> 03:25:07,339
AND I WILL SHARE THIS SLIDE FROM

5505
03:25:07,339 --> 03:25:08,874
THE SUPPORT TEAM WHO IS ALSO

5506
03:25:08,874 --> 03:25:11,610
ASKING YOU TO PLEASE TAKE A

5507
03:25:11,610 --> 03:25:13,745
MINUTE AND RATE AND GIVE

5508
03:25:13,745 --> 03:25:14,947
FEEDBACK FOR THIS WORKSHOP.

5509
03:25:14,947 --> 03:25:16,081
IT'S BEEN WONDERFUL TO HOST ALL

5510
03:25:16,081 --> 03:25:16,682
OF YOU.

5511
03:25:16,682 --> 03:25:18,250
THANK YOU VERY MUCH FOR STAYING

5512
03:25:18,250 --> 03:25:21,920
WITH US.

5513
03:25:21,920 --> 03:25:31,920
>> THANK YOU ALL.