>> GOOD MORNING.
THIS PRESENTATION IS BEING
RECORDED.
USE Q&A TO DIRECT QUESTIONS TO
SPEAKERS INCLUDING THE NAME OF
PERSON YOU'RE DIRECTING YOUR
QUESTION TO.
THIS TOOL CAN BE USED DURING THE
SESSION Q&As TO ASK THE
SPEAKERS A QUESTION.
QUESTIONS WILL BE CAPTURED FOR
REVIEW BY THE WORKSHOP SPONSORS.
IF YOU'RE NOT SPEAKING STAY OFF
MUTE AND OFF CAMERA.
THANK YOU.
>> GOOD MORNING, AFTERNOON, OR
EVENING, DEPENDING WHERE IN THE
WORLD YOU'RE JOINING FROM.
I'M DR. FERNANDO BRUNO, PROGRAM
OFFICER AT THE CENTER FOR
TRANSLATIONAL RESEARCH AND
IMPLEMENTATION SCIENCE CTRIS.
IT'S MY PLEASURE TO WELCOME YOU
TO OUR VIRTUAL WORKSHOP
IMPLEMENTATION RESEARCH AND NEXT
STEPS IN DIRECT TO CONSUMER
TELEHEALTH.
UNDERSTANDINGLESSONS LEARNED.
THE HEALTHCARE PROFESSIONALS
WERE USING E-MAILS, EARLY
VERSIONS OF VIDEO CONFERRING TO
CONNECT, THE LAST DECADE
WITNESSED ADVANCES IN TECHNOLOGY
THAT TRANSFORMED TELEHEALTH INTO
AN ESSENTIAL TOOL IN MODERN
HEALTH CARE, UNDENIABLE
HARDSHIPS BROAD BY THE COVID-19
PANDEMIC ACCELERATED THIS
TRANSFORMATION.
WE WERE FORCED TO INNOVATE,
ADAPT, EMBRACE METHODS OF CARE
DELIVERY.
BARRIERS THAT ONCE LIMITED
TELEHEALTH SUCH AS RESTRICTIVE
POLICIES, CROSS--STATE LICENSURE
CHALLENGES WERE TEMPORARILY
LIFTED, IN SOME CASES TORN DOWN
ENTIRELY, PAVING THE WAIT FOR
WIDESPREAD ADOPTION.
VIRTUAL CONSULTATIONS BECAME
COMMONPLACE, REIMBURSEMENT
MODELS EVOLVED AND TECHNOLOGICAL
LITERARIES SURGED.
THIS LAID THE FOUNDATION FOR
LASTING INTEGRATION INTO
HEALTHCARE SYSTEMS WORD WIDE.
HERE WE ARE STANDING ON TOP OF
SHOULDERS OF SUCH LEGACY.
HUMANS HAVE AN INNATE DESIRE TO
CONNECT.
WHEN WE FACED WITH ADVERSITY WE
CREATE NEW WAYS OF DOING THAT.
JUST LIKE THAT, IT WAS NO LONGER
OPTIONAL, IT WAS ESSENTIAL.
TODAY WE LIVE IN A WORLD WHERE
PATIENTS CAN CONNECT WITH HEALTH
HEALTHCARE TEAMS USING DEVICES,
WE TRACK DATA, STEPS, EKGs,
GLUCOSE AND MORE FEEDING REAL
DATA, ENABLING TRANSFORMATIVE
AND GROUNDBREAKING RESEARCH AND
A.I.-DRIVEN INSIGHTS
REVOLUTIONIZING CARE, YET THIS
BRINGS CHALLENGES.
HEALTH POLICIES OFTEN STRUGGLE
TO KEEP PACE WITH THE
TECHNOLOGICAL ADVANCEMENTS AND
AT TIMES SO DOES RESEARCH.
RESEARCH MUST ADDRESS
INFRASTRUCTURE GAPS,
PARTICULARLY IN UNDERSERVED AND
RURAL AREAS, TO ENSURE EQUITABLE
ACCESS.
UNDERSTANDING USER BEHAVIOR AND
GIVING VOICE TO ALL STAKEHOLDERS
IS ALSO PARAMOUNT.
WE MUST FOCUS ON IMPROVING
LITERACY OF PATIENTS AND
PROVIDERS, TO ENSURE TOOLS ARE
USED EFFECTIVELY AND NO ONE IS
LEFT BEHIND.
THIS IS WHERE I AM
IMPLEMENTATION SCIENCE PLAYS A
CRITICAL CONTROL WHEN WHAT WORKS
AND WHAT WE'RE DOING IN
PRACTICE.
WE NEED RESEARCH AND NEED IT NOW
TO HELP CLOSE THIS GAP,
UNCOVERING LESSONS LEARNED,
TACKLE CHALLENGES AND SEIZE
OPPORTUNITIES TO MAKE TOOLS
ACCESSIBLE TO THOSE WHO NEED
THEM MOST.
THIS WORKSHOP IS A CRITICAL STEP
TOWARDS THIS JOURNEY.
TODAY WE'RE EXPLORING CURRENT
STATE OF DIRECT TO CONSUMER
TELEHEALTH, IDENTIFY KNOWLEDGE
GAPS AND UNCOVER OPPORTUNITIES
TO ADVANCE RESEARCH AND
PRACTICE.
WE'RE FORTUNATE TO HAVE THIS
LINEUP OF SPEAKERS WHO WILL
GUIDE US TO A RICH EXPLORATION
OF TELEHEALTH LANDSCAPE.
AT THE CENTER OF OF TODAY'S
DISCUSSIONS, WE HAVE RESEARCH AS
OUR GUIDING FRAMEWORK, AND AS
THE BEST PART OF TODAY'S
WORKSHOP IS YOU.
THIS WORKSHOP IS A CONVERSATION.
AND THE PERSPECTIVE AND
QUESTIONS ARE KEY FOR ITS
SUCCESS.
SO WE ENCOURAGE YOU TO ENGAGE
FULLY, ASK QUESTIONS, SHARE
INSIGHTS, CONNECT WITH YOUR
PEERS.
YOU ARE A DIVERSE AUDIENCE OF
RESEARCH, HEALTHCARE PROVIDERSE
POLICYMAKERS, TECHNOLOGIST AND
COMMUNITY LEADERS.
ALL UNITED BY THE SHARED
COMMITMENT TO IMPROVING
TELEHEALTH AND HEALTHCARE
DELIVERY.
SO THANK YOU FOR JOINING US AT
THIS IMPORTANT CONVERSATION.
TOGETHER WE CAN CHART A FUTURE
FOR TELEHEALTH AND ITS
TRANSFORMATIVE POE ESSENTIAL.
I'M PLEASED TO INVOLVE THE
DIRECTOR OF CTRIS.
TAKE IT AWAY.
>> GOOD MORNING, GOOD AFTERNOON,
GOOD EVENING, I'M DELIGHTED TO
WORK YOU TO THE WORKSHOP.
IT'S A GREAT PRIVILEGE TO EXTEND
THIS WARM WELCOME TO YOU ON
BEHALF OF OUR LEADERSHIP AND
STAFF.
SPECIAL THANKS TO ORGANIZING
COMMITTEE AND SUPPORT STAFF WHO
MADE THIS POSSIBLE.
I ALSO WANT TO THANK THE MANY
PANELISTS AND EXPERTS WHO WILL
BE SHARING INSIGHTS AND
CHALLENGES AND SUCCESSES OF
SUPPORTING TELEHEALTH-FOCUSED
IMPLEMENTATION RESEARCH TO
IMPROVE HEALTHCARE ACCESS AND
OUTCOMES.
IT'S AN HONOR TO SEE SUCH A
DIVERSE AND ESTEEMED GROUP OF
PROFESSIONALS, RESEARCHERS,
PRACTITIONERS AND THE PUBLIC
GATHERED HERE TODAY.
AND THIS BRINGS ME TO THANKING
YOU, ATTENDEES.
WE KNOW YOU'RE VERY BUSY WITH
MULTIPLE COMPETING PRIORITIES,
SO IT DOES MEAN A LOT TO THE
NHLBI AND CTRIS YOU AGREED TO
JOIN US.
THANK YOU.
I'M EXCITED TO LEARN FROM YOU
ALL TODAY.
BEFORE WE JUMP IN TO THE
WORKSHOP I WANT TO TAKE A MOMENT
TO SHARE HOW THE WORKSHOP LINKS
TO THE NHLBI STRATEGIC VISION.
NHLBI TURNED 75 YEARS OLD LAST
YEAR AND ENGAGED PUBLIC AND
STAFF TO REFRESH STRATEGIC
VISION.
THE WAY I SEE IT, TELEHEALTH
PRESENTS AN IMPORTANT VEHICLE
FOR ADVANCING FOUR OF THE SIX
FOCUS AREAS THAT WERE
ARTICULATED THROUGH THIS
STRATEGIC VISION REFRESH
PROCESS.
I'LL NAME THEM BRIEFLY.
HARNESSING DATA SCIENCE AND NEW
TECHNOLOGIES TO DRIVE SCIENTIFIC
DISCOVERY AND PRECISION HEALTH.
USING NOVEL APPROACHES FOR
ADDRESSING HEALTH DISPARITIES
AND TACKLING BIOLOGICAL
UNDERPINNINGS FOR HEART, LUNG,
BLOOD DISORDERS, LEVERAGING
POWER OF COMMUNITY ENGAGING,
REDUCING IMPACT OF GEOGRAPHY ON
HEART, LUNG, BLOOD AND SLEEP
HEALTH.
AS DR. BRUNO INDICATED,
TELEHEALTH HAS MATURED RAPIDLY
OVER THE LAST TWO DECADES FROM A
CONCEPTUAL IDEA TO A CRUCIAL
COMPONENT AND WE WOULD BE REMISS
IF WE DIDN'T ADMIT THE ROLE OF
PROJECT ECHO, ECHO-TRAINED
CLINICIANS PROVED TELEHEALTH
CARE CAN LEAD TO OUTCOMES
COMPARABLE TO CARE DELIVERED IN
ACADEMIC HEALTH CENTERS FOR
PATIENTS WITH HEPATITIS C LIVING
IN RURAL AREAS.
SINCE THEN AS WE HAVE SEEN, THE
PANDEMIC ACCELERATED TELEHEALTH
PROLIFERATION, AS NECESSITY WITH
UTILIZATION RATES REMAINING
HIGHER THAN PRE-PANDEMIC LEVELS.
INDEED TELEHEALTH HAS BECOME
INTEGRAL TO HEALTH CARE,
ADDRESSING NEEDS AND
TRADITIONALLY UNDERSERVED AREAS,
WITH PATIENTS AND POPULATIONS
EXPERIENCING SOCIAL RISK SUCH AS
SOCIAL ISOLATION AS WELL AS
CHILD CARE AND TRANSPORTATION
CHALLENGES, FOR EXAMPLE.
SO, TO OPTIMIZE HEALTH USE AND
INTEGRATION FOR THINGS LIKE
REACH, EQUITY, AFFORDABILITY,
FEASIBILITY, IMPACT AND
SUSTAINABILITY IT REQUIRES
ADDRESSING QUESTIONS OF
IMPLEMENTATION AND USE METHODS
AND MEASURES FROM IMPLEMENTATION
SCIENCE.
INDEED TELEHEALTH RAPID
EXPANSION INTO NEW SETTINGS
NECESSITATED NIMBLE RESEARCH
APPROACHES TO KEEP PACE.
BECAUSE IMPLEMENTATION RESEARCH
CAN BE COMBINED WITH
EFFECTIVENESS RESEARCH
APPROACHES, THROUGH HYBRID STUDY
TYPES AS AN EXAMPLE UNIQUE
INSIGHTS CAN BE MADE TO
ACCELERATE TRANSLATION OF
EVIDENCE TO ACTION, AND
OFFERINGS FRAMEWORKS, THOUGHTS
AND TOOLS TO ELUCIDATE WHEN,
WHERE, WHY AND HOW AND WITH WHOM
TO LEVERAGE OR INCORPORATE
TELEHEALTH.
MOREOVER, EFFECTIVE TELEHEALTH
IMPLEMENTATION REQUIRES
INTEGRATION WITH EXISTING
HEALTHCARE POLICIES, PROCESSES,
PRACTICES, AND THIS EMPHASIZES
THE NEED FOR CONTEXT-SPECIFIC
STRATEGIES AND APPROACHES, AND
SUCCESS DEPENDS ON COLLABORATION
ACROSS DIVERSE STAKEHOLDERS
INCLUDING CLINICIANS,
RESEARCHERS, AND PATIENTS, FOR
INSTANCE, PARAMOUNT IN
IMPLEMENTATION RESEARCH.
I'LL MENTION ALSO THE MEDICAL
UNIVERSITY OF SOUTHERN CAROLINA
TO AID IN RESEARCH, GUIDANCE
INCLUDES THINGS LIKE REFINING
RESEARCH QUESTIONS, DETERMINING
STUDY DESIGNS, DEFINING
IMPLEMENTATION OUTCOMES,
SELECTING GUIDING FRAMEWORKS,
DEVELOPING DATA COLLECTION TOOLS
THAT THEY MIGHT TAILOR, AND
SELECTING IMPLEMENTATION
STRATEGIES.
THAT'S A RESOURCE AVAILABLE
ONLINE.
EVEN WITH THIS GUIDANCE THERE
ARE SO MANY EMPIRICAL QUESTIONS
THAT REMAIN.
WE SEE VARIABILITY IN ADOPTION
AND RATES ACROSS SETTINGS THAT
POSE CHALLENGES FOR EQUITABLE
ACCESS, EVEN WITH TELEHEALTH,
RESOURCE LIMITATIONS ARE A
DIRECT THREAT TO TELEHEALTH
SPREAD, WHEREBY LIMITED
RESOURCES CONTINUE TO EXIST AND
TELEHEALTH INTEGRATION WITH
EXISTING IN-PERSON WORK FLOWS
REMAIN COMPLICATED, EMPHASIZING
NEED FOR EFFECTIVE CARE
MANAGEMENT STRATEGIES AND
APPROPRIATE PAYMENT MODELS, AND
FUTURE POLICIES WILL BE CRUCIAL
TO SUSTAIN TELEHEALTH,
PARTICULARLY WITH RESPECT TO
AUDIO/VISUAL SERVICES.
SO EVEN WITH THESE CHALLENGES
THE OPPORTUNITIES ARE PROFOUND.
TELEHEALTH SIGNIFICANTLY
ENHANCES ACCESS, ESPECIALLY IN
UNDERSERVED AREAS, RESEARCH CAN
PROVIDE DATA-DRIVEN INSIGHT INTO
OPTIMIZING TELEHEALTH DELIVERY
WITH ONGOING TECHNOLOGICAL
INNOVATIONS OFFERING NEW
POSSIBILITIES AND ARTIFICIAL
INTELLIGENCE AND MACHINE
LEARNING TECHNOLOGIES ARE
EXPECTED TO PLAY AN EVEN LARGER
ROLE, OFFERING NEW SOLUTIONS FOR
PERSONALIZATION AND EFFICIENCY.
SO, AS WE EMBARK ON THIS JOURNEY
TODAY, I ENCOURAGE YOU TO
ACTIVELY PARTICIPATE, SHARE YOUR
EXPERIENCES, AND CHALLENGE
CONVENTIONAL THINKING TO
IDENTIFY GAPS AND OPPORTUNITIES
FOR FUTURE RESEARCH.
LET'S USE THIS PLATFORM TO
INSPIRE AND BE INSPIRED TO
INNOVATE AND TO MAKE TANGIBLE
DIFFERENCE IN THE LIVES OF
PATIENTS AND THEIR FAMILIES
AROUND THE WORLD.
SO WE'RE ASKING YOU TO USE THE
DIVERSE EXPERTISE IN THE ROOM TO
HELP US IDENTIFY OPPORTUNITIES
FOR ENHANCING IMPLEMENTATION
RESEARCH THAT EXPLORES THE USE
OF TELEHEALTH FOR HEART, LUNG,
BLOOD AND SLEEP CONDITIONS.
INDEED THE NHLBI STRONGLY IS
COMMITTED TO ADVANCING RESEARCH
THAT ACCELERATES TURNING
DISCOVERS INTO REAL WORLD HEALTH
IMPACTS, AND CTRIS IS THE FOCAL
POINT.
LET ME REMIND YOU UNDER THE
FEDERAL ADVISORY COMMITTEE ACT,
FACA, SIGNED INTO LAW IN 1972,
OUR WORKSHOPS ARE NOT
CONSTITUTED FOR YOU TO ADVISE
NHLBI OR TO MAKE RECOMMENDATIONS
TO NHLBI OR NIH.
PLEASE DO FRAME YOUR INSIGHTS
THAT YOU SHARE WITH US AS
CHALLENGES THAT YOU'RE AWARE OF,
AS OPPORTUNITIES FOR NHLBI TO
EXPLORE, NOT AS RECOMMENDATIONS.
LET'S FOCUS ON CHALLENGES OR
OPPORTUNITIES FOR IMPLEMENTING
TELEHEALTH RESEARCH.
OPPORTUNITIES YOU IDENTIFY WILL
PLAY A ROLE AS THE STRATEGIC
VISION IS IMPLEMENTED, AS YOU
CAN SEE BY MY BACKGROUND, CTRIS
IS CELEBRATING 10th
ANNIVERSARY THIS YEAR, EAGER TO
LEARN FROM YOU AS WE PLAN OUR
NEXT DECADE AS A STRATEGIC FOCAL
POINT FOR IMPLEMENTATION
RESEARCH, COMMUNITY ENGAGED
RESEARCH, GLOBAL HEALTH
RESEARCH, AND HEALTH DISPARITIES
RESEARCH, ON THIS NOTE IF YOU'D
LIKE TO JOIN CTRIS IN
CELEBRATION PLEASE REGISTER NOW
OR LATER TODAY OR TOMORROW FOR
OUR HALF-DAY EVENT THAT'S TAKING
PLACE ON DECEMBER 11th FROM 2
TO 6 P.M., THE LINK IS IN THE
CHAT AND WILL POP UP A QR CODE
AT SOME POINT.
ONCE AGAIN, WELCOME TO THIS
IMPLEMENTATION RESEARCH-FOCUSED
WORKSHOP TO ADVANCE TELEHEALTH
AND ITS IMPACT ON ACCESS FOR
HEALTH CARE.
I LOOK FORWARD TO THE RICH
DISCUSSIONS AND MEANINGFUL
CONNECTIONS THAT WILL EMERGE
FROM OUR TIME TOGETHER.
THANK YOU FOR YOUR COMMITMENT TO
THIS IMPORTANT VEHICLE FOR
ENHANCING HEALTHCARE ACCESS AND
IMPACT.
LET'S GET STARTED ON WHAT
PROMISES TO BE AN ENLIGHTENING
AND IMPACTFUL WORKSHOP.
>> THANK YOU, DR. LEWIS, TO GET
US STARTED FOR TODAY.
AND NOW IT'S MY HONOR TO INVITE
OUR KEYNOTE SPEAKER.
JUST WAITING FOR THE SLIDES TO
MOVE ON.
HERE WE ARE.
TODAY WE HAVE DR. GARTH GRAYHAN,
DIRECTOR OF HEALTH CARE AND
PUBLIC HEALTH AT GOOGLE GUIDE US
ON THE REFLECTION OF LESSONS
FROM THE PANDEMIC.
DR. GRAHAM, A PLEASURE TO HOST
YOU TODAY.
PLEASE TAKE IT AWAY.
>> THANK YOU.
THANK YOU FOR HAVING ME.
I AM GOING TO HOPEFULLY GO OVER
SOME POINTS, NOT JUST FROM THE
PERSPECTIVE FROM SOMEONE WORKING
IN TECH-RELATED ISSUES BUT ALSO
A CARDIOLOGIST PRACTICING DURING
THE PANDEMIC.
AND WENTZ THROUGH KIND OF --
WENT THROUGH MY OWN PERSONAL
JOURNEY IN TERMS OF
TELEMEDICINE, TELEHEALTH,
INTRODUCING THAT INTO MY OWN
PRACTICE IN TERMS OF TAKING CARE
OF PATIENTS AS WELL.
AND TALK ABOUT THE HISTORY OF
TELEHEALTH, TELEMEDICINE USING
THE TERMS INTERCHANGEABLE AND
HOW THINGS EVOLVED FROM THE PAST
INTO HOPEFULLY WHAT WILL BE
POTENTIALLY OPPORTUNITIES FOR
THE FUTURE.
I'LL SPEND THE FIRST 7 OR 8
MINUTES GROUNDING UP
OPPORTUNITIES, CHALLENGES IN
TERMS OF DISPARITIES IN
UNDERSERVED COMMUNITIES.
KIME
I COME FROM THAT BACKGROUND,
CHIEF OF HEALTH SERVICES
RESEARCH AT AN ACTIVE
INSTITUTION, AND AS A RESULT
MINORITY HEALTH IN THE FEDERAL
GOVERNMENT.
SO COME WITH A LOT OF BACKGROUND
AROUND ISSUES RELATED TO
DISPARITIES, AND HEALTH EQUITY,
AS REALLY THE FOUNDATION FOR
WHAT I THINK ARE SOME OF THE
OPPORTUNITIES WITH TELEHEALTH
AND TELEMEDICINE, THE FIRST 6 OR
7 MINUTES TALKING ABOUT THAT AND
HISTORY OF TELEHEALTH, AND THEN
CLOSE WITH WHAT I THINK WERE
LESSONS FROM THE PANDEMIC, AND
GOING THROUGH RESEARCH AND
STUDIES THERE.
NEXT SLIDE PLEASE.
SO WHAT I SET THIS UP -- NEXT
SLIDE PLEASE.
WHEN I THINK OF THE EVOLUTION OF
TELEHEALTH, I THINK ABOUT AGAIN
WHERE WE START WITH FROM A
PATIENT POPULATION PERSPECTIVE.
NEXT SLIDE PLEASE.
A LOT OF TALK ABOUT THE POLICY
AND IMPLICATIONS, I'LL TALK A
LITTLE BIT ABOUT, THAT REALLY
LET'S START WITH CONVERSATIONS
ABOUT THE COMMUNITY.
AND WHAT ARE THE OPPORTUNITIES
REALLY HERE WHEN WE THINK OF
TELEHEALTH AND TELEMEDICINE.
SO I ALWAYS THINK ABOUT THIS
IDEA, NEIGHBORHOODS MATTER FOR
HEALTH.
THIS IS ONE OF THE MANY POINTS
OF DATA THAT MANY OF YOU HAVE
SEEN IN TERMS OF OVERUSED TERM,
YOUR ZIP CODE MATTERING MORE
THAN GENETICS, THE IDEA THAT
WHERE WE LIVE IN THE UNITED
STATES SO ESSENTIALLY DEFINES
HOW LONG WE LIVE AND THIS IS MY
NEIGHBORHOOD THAT I GREW UP WITH
AFTER I MOVED FROM JAMAICA, IN
MIAMI, SHOWING WHERE WE LIVED IN
MIAMI, THE ZIP CODE DIFFERENCE
FROM DRIVING 15 MINUTES MORE
INTO MORE AFFLUENT AREAS AND
15-YEAR GAP IN TERMS OF LIFE
EXPECTANCY.
WHEN WE THINK ABOUT THE KINDS OF
THINGS THAT WE CAN ADVANCE
AROUND TELEHEALTH AND
TELEMEDICINE THE NEXT COUPLE
SLIDES ARE MEANT TO ENCAPSULATE
THE CHALLENGES, UNDERSTANDING
GEOGRAPHIC ISOLATION THAT DRIVES
HEALTH DISPARITIES, BUT ALSO
UNDERSTANDING HOW THAT, AGAIN,
IMPACTS HEALTH OUTCOMES.
NEXT SLIDE PLEASE.
I SPENT TIME IN RESEARCH.
THIS IS A PAPER THAT ME AND MY
TEAM PUBLISHED IN JAMA EARLIER
ON, PRE-PANDEMIC ACTUALLY.
AND WE WERE LOOKING AT WHAT WERE
SOME OF THE FACTORS THAT REALLY
DROVE THE DEATH RATE FROM ACUTE
MYOCARDIAL INFARCTION TO ONE
YEAR AND FIVE-YEAR DEATH RATES
IN TERMS OF THE DIFFERENCES
BETWEEN A BLACK AND WHITE
POPULATION.
NEXT SLIDE PLEASE.
WE SHOWED PREDOMINANTLY WHEN YOU
PULL ASIDE ISSUES RELATED TO --
WHEN YOU STARTED TO SCORE IN
TERMS OF PROPENSITY SCORES TO
LOOK AT PARTICULARLY BLACK
POPULATIONS AND THEN LOOK AT
WHITE POPULATIONS, START TO
AGGREGATE IN TERMS OF CONCEPTS
AND DRIVERS DRIVING MORBIDITY
AND MORTALITY, ISSUES WHEN YOU
CONTROLLED FOR OTHER FACTORS,
ISSUES SUCH AS HEALTH STATUS,
CLINICAL PRESENTATION, LIFESTYLE
FACTORS LESS OF A COMPONENT FOR
DRIVING HEALTH OUTCOMES,
COMPARED TO THE CONCEPT OF
SOCIOECONOMIC STATUS.
NEXT SLIDE PLEASE.
SOCIOECONOMIC STATUS WAS REALLY
A PROXY FOR THIS CONCEPT OF
GEOGRAPHY AND ACCESS.
WHAT WE SHOWED HERE IN THIS
SLIDE WAS THAT YOUR PROBABILITY
OF DYING FROM A HEART ATTACK IF
YOU GO FROM LEFT TO RIGHT IN
TERMS OF PROPENSITY SCORE AND
PROBABILITY BEING ON THE Y-AXIS
AND PROPENSITY SCORE BLACK AND
WHITE ON THE X-AXIS, IF YOU WENT
TO LOOKING AT PROPENSITY SCORING
FOR POPULATIONS MORE LIKELY THAT
YOU'RE BLACK OR WHITE, YOU SEE A
PROBABILITY FIVE-YEAR INCREASING
FROM .15 UP TO .45, A THREE-FOLD
INCREASE IN PROPENSITY SCORE
FROM FIVE-YEAR MORTALITY
COMPARED TO BLACK OR WHITE
PATIENTS.
BUT WHEN YOU LOOK AT THE P-VALUE
FOR THAT YOU NOTICE THE P-VALUE
IS INSIGNIFICANT, 0.20.
THIS ISSUE OF WHETHER YOU DIED
FROM A HEART ATTACK, WHETHER
BLACK OR WHITE, WAS NOT SO MUCH
RELATED TO YOUR ACTUAL RACE OF
BEING BLACK OR WHITE, THAT'S WHY
THE P-VALUE IS NOT SIGNIFICANT,
THAT EARLIER SLIDE IN TERMS OF
THE SOCIOECONOMIC AND ACCESS
FACTORS THAT DROVE THOSE
DYNAMICS, SO IF YOU MOVE BLACK
PATIENTS INTO A WHITE COMMUNITY,
YOU START TO SEE SIMILAR
MORBIDITY AND MORTALITY FROM
M.I.s, AND SIMILARLY VICE
VERSE A BETWEEN BLACK AND WHITE
THE SO THIS CONCEPT OF GEOGRAPHY
AND ACCESS WAS DRIVING HEART
DISEASE AND MORTALITY.
NEXT SLIDE PLEASE.
THIS CONCEPT IS NOT SOLELY
RELATED TO JUST ISSUE THE BLACK
OR WHITE.
THIS IS VERY MUCH INTERPRETED
WHAT YOU SEE IN TERMS OF RURAL
GEOGRAPHY, INCREASED MORBIDITY
AND MORTALITY.
THIS IS SOME DATA FROM THE FOLKS
IN VIRGINIA.
AND I'M SHOWING THIS VERY SHARP
INCREASE IN MORBIDITY AND
MORTALITY, WHEN YOU START TO
LOOK AT CONCEPT OF GEOGRAPHY.
NEXT SLIDE PLEASE.
AND THEN MORE IMPORTANTLY, THIS
IS ANOTHER SLIDE FROM DR. WILSON
IN VIRGINIA, LOOKING AGAIN OVER
THE PAST COUPLE YEARS IN TERMS
OF LIFE EXPECTANCY THIS HUGE GAP
BETWEEN, YOU KNOW, FOLKS LIVING
IN ONE OF THE TWO ZIP CODES
VERSUS THE CONCEPT OF LIVING IN
THE MIDDLE PART OF AMERICA.
WHAT THIS HOPEFULLY SETS UP FOR
YOU, THIS CONCEPT OF BOTH THIS
IDEA OF BOTH GEOGRAPHY,
SOCIOECONOMIC STATUS, AND
ACCESS, AND WHERE THE PROMISE OF
TOOLS LIKE TELEMEDICINE,
TELEHEALTH AS WE GO THROUGH
TODAY, YOU KNOW, AND THE
CONVERSATIONS WE'RE GOING TO
HAVE, THINK THROUGH AGAIN THESE
IDEAS MORE ABOUT HOW AND WHERE
THE TOOLS THAT WE TALK ABOUT CAN
HELP TO KIND OF BRIDGE THESE
GAPS IN TERMS OF MORBIDITY AND
MORTALITY.
SO STARTING NOT WITH TECHNOLOGY
OFT THAN WE DO BUT MORE STARTING
WITH THE PEOPLE AND THE
COMMUNITIES AND THE MORTALITY
DRIVEN IN THESE COMMUNITIES
WHETHER BLACK VERSUS WHITE,
URBAN VERSUS RURAL, AND THOSE
ARE THE OPPORTUNITIES.
THESE ARE THE IDEAS OF
PATIENT-CENTRIC CARE, REACHING
PATIENTS WHERE THEY ARE.
AGAIN, THINKING ABOUT THIS
OPPORTUNITY THAT WE HAVE WHEN WE
THINK ABOUT CONCEPTS AROUND
TELEMEDICINE AND TELEHEALTH.
THAT HAS DRIVEN MY INTEREST AREA
IN THE FIELD, BUT ALSO AS I HAVE
PRACTICED, AND I PRACTICE
PRIMARILY AS A TELEMEDICINE
CLINICIAN, IN ADDITION TO MY
ROLE AT GOOGLE, YouTube,
WHAT WE'RE DOING IN TERMS OF
GETTING AROUND THE TECHNOLOGY
AND GETTING PEOPLE TO ACCESS
QUALITY HEALTH INFORMATION, I'VE
BEEN OBSESSED WITH THE IDEA OF
OVERARCHING PROMISE OF
TELEMEDICINE, THIS CAPTURES
THINKING ABOUT HOW WE CAN BRIDGE
GAPS IN TERMS OF MORBIDITY AND
MORTALITY IN COMMUNITIES IN
TERMS OF RURAL COMMUNITIES, BUT
UNDERSTANDING, AGAIN, THE
CONCEPT IN TERMS OF WHAT'S
HAPPENING BETWEEN DISPARITIES IN
DIFFERENT COMMUNITIES.
AND THIS IS WHERE WE START TO
THINK THROUGH WHAT ARE SOME
OPPORTUNITIES, AND REALLY IN
PARTICULAR THE FOCUS AROUND
PATIENT OPPORTUNITIES AND
THINKING THROUGH, AGAIN, HOW
TELEMEDICINE, TELEHEALTH CAN
KIND OF TRANSFORM THAT
LANDSCAPE.
A LOT OF YOU HERE HAVE BEEN
WORKING IN THIS FIELD FOR A LONG
TIME.
NOT ONLY ON THE GOVERNMENT
SECTOR AND PRIVATE SECTOR BUT
ALSO RESEARCH, REALLY, AGAIN, I
START WITH COMMUNITIES PROBLEM
FIRST AND THINKING THROUGH
TECHNOLOGY.
THIS CAPTURES I THINK THIS IDEA
WHAT IS A PROMISE, WHAT ARE THE
OPPORTUNITIES IN FRONT OF US,
WHEN WE THINK THROUGH
OVERARCHING PROMISE OF
TELEMEDICINE.
I ALLUDED TO THE CONCEPT OF LIKE
TACKLING DISPARITIES AS AN
ULTIMATE GOAL, IF NOT ONE OF THE
MANY GOALS, AND ONE OF THE
OPPORTUNITIES WE SEE IS AS
BROADBAND ACCESS HAS CONTINUED
TO BE MORE AVAILABLE TO
COMMUNITIES, BOTH COMMUNITIES IN
TERMS OF GEOGRAPHY, BUT
COMMUNITIES IN TERMS OF RACE,
AND YOU SEE MORE CHALLENGES IN
TERMS OF ECONOMIC SIDE OF
BROADBAND ACCESS, THAT'S AGAIN
WHERE YOU START TO SEE THIS
ASPECT OF THE PROMISE AND
OPPORTUNITIES IN TERMS OF
TELEMEDICINE, TELEHEALTH.
NEXT SLIDE PLEASE.
AND SO EVOLUTIONS, IT'S KIND OF
INTERESTING.
AND, YOU KNOW, PART OF TODAY'S
LOOKING BACK IN TERMS OF THE
PANDEMIC AND PRIOR TO THAT, AND
THEN IN TERMS OF EVEN THINKING
THROUGH AND LOOKING FORWARD,
THIS IS A SLIDE I CAPTURED FROM
ONE OF -- FROM THE ATA, MAKES
YOU THINK ABOUT HOW TELEMEDICINE
AND TELEHEALTH EVOLVED, PRIOR TO
EVEN GETTING TO WHERE WE WERE
WITH THE PANDEMIC WHERE YOU ARE
EARLY INNOVATORS, EARLY
ADOPTERS, INDIVIDUALS WHO
STARTED TELEMEDICINE AND
TELEHEALTH PROGRAMS, DR. SANDERS
BACK IN THE 1980s, AND OTHERS,
BUILDING SOME OF THOSE BUILDING
BLOCKS AND PROGRAMS.
BUT THE REAL RATE-LIMITING
FACTORS, ADVANCEMENTS IN
TELEMEDICINE AND TELEHEALTH, HAS
CONTINUED TO BE CHALLENGES
AROUND POLICY, PAYMENT, AND
INFRASTRUCTURE.
WE'RE GOING TO TALK MORE ABOUT
THAT, HOW THAT EVOLVED DURING
THE PANDEMIC.
THERE WERE SOME INITIAL FUNDING
OPPORTUNITIES, YOU KNOW, WITH
THE RECOVERY AND INVESTMENT ACT
PUMPING MONEY INTO THE SYSTEM
AROUND POLICY AND INNOVATION BUT
BECAUSE POLICY LEVERS WEREN'T
BEING PULLED SOME FUNDING
DYNAMIC, THOUGH ADVANCING
RESEARCH, DIDN'T REALLY ADVANCE
THE PRACTICE OF TELEMEDICINE AND
TELEHEALTH OVERALL.
A LOT OF THAT HAPPENED DURING
THE PANDEMIC AND I'LL HOPEFULLY
ELUCIDATE SOME KEY ONES AND HOW
THAT INFLUENCED BEHAVIOR
PATTERNS AS WELL.
NEXT SLIDE PLEASE.
SO, PANDEMIC HIT.
NEXT SLIDE PLEASE.
AND THEN AS ALLUDED TO BEFORE A
NUMBER OF THINGS HAPPENED
SIMULTANEOUSLY ON THE POLICY
FRONT.
I'M SORRY, NEXT SLIDE PLEASE.
AND A KEY TO THOSE RAPID CHANGES
AT THE ONSET OF THE PANDEMIC WAS
IMPROVED REIMBURSEMENT FROM
INSURERS BUT ALSO KEY ACTIVITIES
FROM LOOSENING OF PRIVACY AND
HIPAA REQUIREMENTS FROM OCR.
I WOULD ALSO -- REQUIREMENTS FOR
TELEHEALTH AND MEDICARE PROGRAM
ALLOWING MORE ACCESS IN TERMS OF
PAYMENT FROM GEOGRAPHIC
LOCATIONS, EXPANDED ACCESS TO
TELEHEALTH, AND A LOT AROUND
THIS CONCEPT OF WHAT HAPPENED
WITH PROVIDER LICENSE AND
ON-LINE PRESCRIBING AND WRITTEN
CONSENT.
IT'S INTERESTING WHEN YOU PEEL
BACK WHAT HAPPENED IN TERMS OF
PRACTICE PATTERNS, GOING IN
PARTICULAR THROUGH WHAT HAPPENED
IN FAMILY PRACTICE GROUPS AND
THEN OTHERS IN TERMS OF DATA
THAT WAS BEING COLLECTED IN REAL
TIME.
BUT INTERESTINGLY ENOUGH, YOU
KNOW, YOU SAW THE PRIVATE
EXPANSION.
IN A COMMUNITY HEALTH CENTER
PROGRAM FOR INSTANCE WHERE YOU
INITIALLY SAW TELEMEDICINE
TELEHEALTH RATES IN 15%, GETTING
INTO THE 90s PER CENT DURING
THE PANDEMIC, AS CLINICIANS
STARTED TO LEARN, GRASP, GAIN
MORE COMFORT WITH
INFRASTRUCTURE, YOU STARTED TO
SEE WHERE A LOT OF PRACTICE
PATTERNS CHANGED, BUT AS THE
PAYMENTS AND POLICY CONTINUED TO
BE A BARRIER, DESPITE THE MANY
CHANGES, WE'LL TALK ABOUT THAT
AS WELL.
SO RAPID CHANGES IN TERMS OF
PAYMENT AND POLICY REALLY PULLED
ON THOSE LEVERS THAT MOVED
FORWARD A LOT DURING THE
PANDEMIC AS WELL.
NEXT SLIDE PLEASE.
AND THERE'S SOME INTERESTING
DATA THAT CAME OUT.
I CAPTURED A LOT FROM A REALLY
WELL-DONE REVIEW FROM
IMMUNOLOGIST WHO WROTE A LOT
ABOUT JUST REVIEW GROUP, WHO
WROTE A LOT ABOUT SOME OF THE
DYNAMICS THAT REALLY KIND OF
CHANGED.
ONE OF THOSE INTERESTING THINGS
WAS INITIALLY IN THE PANDEMIC,
PATIENT SATISFACTION WAS SIMILAR
WITH IN-PERSON AND TELEPHONE
ENCOUNTERS, PARTICULARLY DURING
THE PANDEMIC.
AND MAYBE SOME OF THIS WAS
RELATED TO EXPECTATIONS THAT
PEOPLE WERE DEALING WITH THEIR
OWN FEARS IN TERMS OF VIRAL
EXPOSURE, BUT YOU SAW A LOT OF
EQUAL DYNAMICS IN TERMS OF
IN-PERSON VIDEO, TELEPHONE
ENCOUNTERS, INITIALLY DURING THE
PANDEMIC, AROUND THOSE AND
PATIENT SATISFACTION AND THOSE
RELATED TO REAL-LIFE -- IN
REAL-LIFE ENCOUNTERS AS WELL.
SIMILARLY, PHYSICIAN
SATISFACTION WAS EVOLVED OVER
TIME WITH A LOT OF PROVIDERS
EXPRESSING MORE POSITIVE
ATTITUDES AROUND ADOPTION OF
TELEMEDICINE.
I'LL GO INTO THAT SPECIFICALLY
IN A SECOND AS WELL.
THERE ARE A LOT OF CHALLENGES
WITH INTEGRATION OF WORK FLOW,
AND THEN A LOT OF CHALLENGES IN
TERMS OF HOW TO REPLICATE
COLLECTING CLINICAL INFORMATION
AT HOME, LIKE BLOOD PRESSURE, OR
OTHER KINDS OF THINGS YOU WOULD
NORMALLY COLLECT WITHIN THE
CLINICAL CONTEXT IN A VISIT, AND
A LOT OF CHALLENGES WITH THAT.
IT WAS INTERESTING WATCHING THE
SYSTEM EVOLVE IN REAL TIME.
I'LL SHOW YOU SOME DATA FROM
FAMILY MEDICINE, CLINICIANS
SHOWING HOW CLINICIANS WERE
EVOLVING IN REAL TIME AND THEN
EEVOLVEDDED BACK.
INTERESTINGLY ENOUGH, A LOT OF
STUDIES SHOWED PARTICULAR
BENEFIT AROUND VIRTUAL VISITS
AROUND SPECIALTY CARE, AND
THAT'S WHERE I THINK WE'LL
CONTINUE TO POTENTIALLY SEE SOME
LONG LASTING IMPACT AND
BETTER -- GOOD DATA AROUND
IMPACTS BUT REALLY AGAIN
SPECIALTY CARE WAS WHERE YOU SAW
SOME OF THE MOST -- A LOT MORE
LONG-LASTING BENEFITS IN TERMS
OF PATIENT AND PROVIDER.
NEXT SLIDE PLEASE.
AND SO, INTERESTING -- GO ONE
SLIDE BACK.
INTERESTING IS, YOU KNOW, HOW
THE KIND THIS CHANGE OF MEDICINE
EVOLVED, STATE LICENSURE WAS A
LIMITING FACTOR.
THIS IDEA OF STATE LICENSE AND
BEING ABLE TO PRACTICE AND
PROVIDE CARE ACROSS STATE LINES
HAS AN CONTINUES TO BE KIND OF
ONE OF THOSE RATE-LIMITING
FACTORS.
SO YOU SAW, YOU KNOW, 12 STATE
BOARDS THAT ALLOWED LICENSE TO
PRACTICE ACROSS STATE LINES BUT
STILL THIS ISSUE OF STATE
LICENSURE BEING A CONSTANT
CONCEPT EVEN THOUGH SOME OF THAT
EVOLVED DURING THE PANDEMIC, BUT
EVEN SO STILL BEING -- AS A
CLINICIAN WHO PRACTICES
TELEMEDICINE, CARDIOLOGY, YOU
SEE THAT IN REAL TIME AS YOU ARE
LOOKING AT DIFFERENT
TELEMEDICINE-RELATED PROGRAMS,
IN GENERAL.
I HAVE BEEN ONE OF THE CLINICIAN
LEADERS OF ECHO PROGRAM IN
MISSOURI ACROSS THE STATE OF
MISSOURI, UNIVERSITY OF
MISSOURI.
AND IT'S BEEN INTERESTING HOW
WE'VE ALSO BEEN ABLE TO LEVERAGE
THERE THE CONCEPTS AROUND NOT
JUST LICENSE BUT ALSO THIS IDEA
OF UTILIZING COMMUNITY HEALTH
WORKERS AND OTHER KINDS OF CARE
EXTENDERS, IN TERMS OF REACHING
COMMUNITIES.
SO AS WE WORK THROUGH ISSUES OF
LICENSURE I THINK ALSO THINKING
THROUGH OTHER COMPONENTS IN
TERMS OF EXTENSION OF CARE AS
WELL.
NEXT SLIDE PLEASE.
SO, INTERESTINGLY ENOUGH INITIAL
GROWTH OF TELEMEDICINE OFFSET
2/3 OF DECLINE OF IN IN-PERSON
VISITS, PEAKED AROUND APRIL 15
BEFORE DECLINING BUT CAP TOWARD
WHAT WAS OCCURRING IN REAL TIME,
ABLE TO MAKE UP FOR A LOT OF
WHERE PEOPLE WERE LOSING ACCESS
TO CARE, TELEMEDICINE WAS ABLE
TO STEP IN.
I WANT YOU TO THINK ABOUT THAT
IN TERMS OF SOME EARLIER SLIDES
I PRESENTED WHEN I WAS TALKING
ABOUT HEART DISEASE OUTCOMES AND
MORBIDITY AND MORTALITY FROM OUR
HEART DISEASE, AND OPPORTUNITIES
WE HAD WITH TELEMEDICINE OF
BEING ABLE TO GET BETTER ACCESS
IF WE CAN GET THROUGH SOME
STRUCTURAL CONCEPTS THAT LIMIT
BOTH MINORITY AND RURAL
COMMUNITIES.
BUT THIS SLIDE CAPTURES HOW
PARTICULARLY IN FAMILY MEDICINE
HOW THE KIND OF USE BUMPED UP
OVER TIME, KIND OF WENT UP AND
DOWN IN RELATION TO VIRAL
PANDEMICS, WHEN THE VIRUS WAS
PARTICULARLY EMERGING AND MORE
LETHAL AND MORE PROMINENT YOU
SAW THE SPIKE IN VISITS, AND
SPIKE GOING BACK DOWN.
AND SO A LOT TO TEASE APART
HERE, THERE'S A COUPLE THINGS
THAT WE'LL CAPTURE IN THE NEXT
SLIDE AS WELL.
NEXT SLIDE PLEASE.
AND THEN WHAT YOU ALSO SAW WAS
THAT PROVIDERS WERE GENERALLY
VERY POSITIVE IN TERMS OF THEIR
CAPACITY TO SEE PATIENTS, ET
CETERA.
A LOT OF BENEFITS SEEN IN THE
HEALTH ARENA, YOU START TO SEE A
LOT CONTINUE TO EVOLVE.
STILL SOME DISCOMFORT AROUND
SOME TREATMENT, BUT YOU START TO
SEE A LOT OF POSITIVES AROUND
BEHAVIOR AND MENTAL HEALTH.
INTERESTINGLY ENOUGH POPULATION
THAT YOU START TO SEE THE MOST
BENEFIT WERE NOT SOME MINORITY
AND UNDERSERVED POPULATIONS
WHERE YOU HAVE THE MOST
OPPORTUNITY BUT OTHER
POPULATIONS WHO MAY HAVE HAD
ACCESS IN OTHER WAYS WHERE THIS
WAS A MORE CONVENIENT FORM OF
ACCESS.
AGAIN, KEEPING IN MIND HOW DO WE
THINK THROUGH EXPANDING
INFRASTRUCTURE AND TOOLS WE CAN
DO HERE AND HOW DO WE THEN BRING
THAT MORE TO MINORITY AND
UNDERSERVED POPULATIONS.
NEXT SLIDE PLEASE.
AND THIS IS KIND OF INTERESTING
WHEN WE LOOK AT HOW CLINICIANS
FELT LATER ON AROUND
TELEMEDICINE AND TELEHEALTH.
SO POSITIVE OVERALL IN A VARIETY
OF WAYS.
WHAT YOU DID START TO SEE WAS
TWO THINGS THAT HAVE KIND OF LED
TO THE OVERALL DECLINE, A LOT
RELATED TO REIMBURSEMENT.
STARTED TO GET MORE ENTANGLED,
FURTHER REIMBURSEMENT DYNAMICS,
YOU STARTED TO SEE A LOT OF
THESE PERCEPTIONS, CONCEPTS,
PRACTICES REVERT AND KIND OF
CHANGE BACK TO THE WAY THINGS
WERE BEFORE.
SO A LOT OF RECOGNITION FROM
CLINICIANS THAT THE PRACTICE OF
TELEMEDICINE, THE WAY THEY
INTEGRATED TELEHEALTH INTO THEIR
PRACTICES THOUGH CHALLENGING
INITIALLY, EVOLVING OVER TIME,
OF NET BENEFIT IN GENERAL.
BUT WHAT YOU STARTED TO SEE IN
THE LAST SLIDE WAS A LOT OF
REGRESSION, PRACTICE PATTERNS,
RELATED PRIMARILY A LOT TO
REIMBURSEMENT, AND COMMERCIAL
REIMBURSEMENT, MADE IT MORE
CHALLENGING, TELEMEDICINE AND
TELEHEALTH, BUT A LOT OF THIS
RELATED TO NOT JUST -- NOT SO
MUCH THE FEELINGS OF CLINICIANS
BUT THE QUALITY IN GENERAL.
GOING BACK TO THE HISTORY OF
TELEMEDICINE, TELEHEALTH, A LOT
BOTH IN PANDEMIC AND
PRE-PANDEMIC, A LOT OF
RATE-LIMITING FACTORS BEING
DRIVEN BY POLICY AND PAYMENT
DYNAMICS, IN THE INSURER,
PRIVATE INSURER, BUT ALSO IN THE
BROADER THEME OF PUBLIC POLICY.
NEXT SLIDE PLEASE.
SO, HOSPITALS, IT'S AN
INTERESTING THING WHEN YOU LOOK
AT WHO WERE ABLE TO ADOPT, YOU
KNOW, TELEHEALTH AND
TELEMEDICINE PRACTICES.
IN HOSPITALS THAT WERE
AFFILIATED WITH -- HOSPITALS
AFFILIATED WITH LARGE SYSTEMS,
YOU KNOW, THOSE WERE THE ONES
THAT WERE MORE LIKELY.
MAJOR TEACHING HOSPITALS MORE
LIKELY TO ADOPT TELEHEALTH.
THE ONES MORE CHALLENGED WERE IN
RURAL AREAS, OR THOSE THAT WERE
INVESTOR-OWNED OR THOSE THAT
WERE UNAFFILIATED WITH A
HOSPITAL SYSTEM, HUGE
DISPARITIES IN TERMS OF HOSPITAL
DYNAMICS AND INFRASTRUCTURE WAS
THOUGHT TO PLAY A MAJOR ROLE,
AND BROADBAND ACCESS, NOT JUST
OF PATIENTS, WHAT'S OCCURRING IN
THESE COMMUNITIES.
SO VERY BIG DIFFERENCES IN THE
PANDEMIC OF THE HOSPITAL SYSTEMS
ABLE TO ENGAGE AND NOT ENGAGE,
RELATED TO ABILITY TO TAP INTO A
LARGER POOL AND LARGER
INFRASTRUCTURE OVERALL.
NEXT SLIDE PLEASE.
SO -- NEXT SLIDE PLEASE.
SO WHEN WE KIND OF THINK THROUGH
A LOT OF THIS, LET ME CLOSE WITH
A COUPLE TAKEHOME MESSAGES.
TELEMEDICINE IS NOT GOING TO
REPLACE IN-PERSON CARE, BUT IS
REALLY AN ADJUNCT NOT JUST IN
PUBLIC HEALTH EMERGENCIES HERE
BUT ALSO IN TERMS OF THAT MACRO
CHALLENGE I WAS ARTICULATING
BEFORE, AROUND, YOU KNOW, HOW WE
CAN REACH UNDERSERVED
POPULATIONS.
CERTAINLY IN MY WORLD, GOOGLE
AND RELATED PLACES, THERE ARE
ADDITIONAL A.I. OTHER TOOLS.
FOR THE CONVERSATIONS TODAY,
THERE'S A LOT TO UNDERSTAND IN
TERMS OF WHAT THE ROLE IS,
TELEMEDICINE, TELEHEALTH CAN
PLAY IN GENERAL.
I WANT TO TAKE A SECOND TO TALK
THROUGH THIS ISSUE OF BARRIERS.
THERE'S A LOT PUBLISHED AROUND,
YOU KNOW, BARRIERS TO
TELEMEDICINE, TELEHEALTH, WHAT
IT MEANS FOR MINORITY AND
UNDERSERVED.
AT THE BEGINNING, THOSE WERE THE
BEST AND BIGGEST OPPORTUNITIES,
JUST BECAUSE OF THE MORBIDITY
AND MORTALITY GAP AND HOW SO
MANY OF THE ACCESS DYNAMICS ARE
DRIVING MORTALITY, HOPING TO
SHOW YOU IN THAT PAPER THAT WE
PUBLISHED IN JAMA ON HEART
DISEASE AND MORTALITY.
INFRASTRUCTURE DYNAMICS ARE AT
PLAY, A LOT OF PRACTICE PATTERN
DYNAMICS AT PLAY AS WELL IN
TERMS OF ACCESS FOR RURAL AND
MINORITY POPULATIONS.
AND EVEN WHEN YOU LOOK PAST DATA
IN TERMS OF WHERE SOME
INFRASTRUCTURE HAS EVOLVED, YOU
SEE YOU STILL START TO SEE A LOT
OF CHALLENGES PARTICULARLY
AROUND WHERE TELEMEDICINE
OPTIONS ARE OFFERED, ALSO
LANGUAGE ACCESS AND HOW WE THINK
THROUGH LANGUAGE BARRIERS.
EARLIEST TELEMEDICINE PROGRAMS
IN THE 1970s PIONEERED IN IHS
AND IN THE NEEDS OF NATIVE
AMERICAN POPULATION, JUST
BECAUSE THAT WAS WHERE THE
OPPORTUNITIES WERE.
YOU CAN START TO SEE WHEREAS
TECHNOLOGIES EVOLVED WE NEED TO
APPLY THAT IN TERMS OF
OPPORTUNITIES.
THE LAST THING I'LL SAY,JUST TO
FINISH EXACTLY ON TIME, IS THAT,
YOU KNOW, OVERARCHINGLY THE
POLICY AND TEAM DYNAMICS IS WHAT
HAS BEEN DRIVING ADOPTION
PRE-PANDEMIC, INTRAPANDEMIC, AND
POST-PANDEMIC.
TEAMS ARE WORKING ON ADDITIONAL
TECHNOLOGIC TOOLS TO ADD ON AND
SERVE AS ADJUNCT FOR PATIENT
CARE, GET PATIENTS ACCESS TO
CARE, THE MACRO CONCEPTS ARE
STILL GOING TO BE DRIVEN IN THE
PUBLIC POLICY SPHERE AROUND --
THERE'S A LOT OF LEGISLATIVE
ADVANCES AND REGRESSION AND
ADVANCES, ESPECIALLY WHEN YOU
THINK ABOUT LEGISLATIVE PARITY
AROUND TELEMEDICINE AND
TELEHEALTH.
SPOKE ABOUT A LOT OF DIFFERENT
THINGS HERE BUT THE CONCEPTS I
WOULD SAY KEEP IN MIND IS THAT,
YOU KNOW, THERE'S -- THERE ARE
AND CONTINUE TO BE
OPPORTUNITIES.
THERE ARE, YOU KNOW, SIGNIFICANT
CHALLENGES.
YOU SAW SUCH RAPID EVOLUTION
DURING THE PANDEMIC.
AND THEN SOME REGRESSION.
YOU CAN START TO SEE WHERE THE
OPPORTUNITIES HAVE THE ABILITY
TO BE ADDRESSED, IN GENERAL.
SO I WILL STOP THERE.
AND HOPEFULLY DID NOT GO OVER MY
TIME AS ALLOTTED.
THANK YOU.
>> NOT AT ALL FOR YOUR TIME, DR.
GRAHAM.
AGAIN, THANK YOU FOR AGREEING TO
BE HERE WITH US TODAY AND GUIDE
US, SETTING THE STAGE FOR OUR
WORKSHOP.
I PARTICULARLY LIKE HOW YOU SAID
THAT THE IDEA OF TELEHEALTH IS
TO SERVE AS AN ADJUNCT.
NOT A REPLACEMENT.
BECAUSE SOMETIMES THERE'S A LOT
OF CONFUSION WHERE WE'RE GOING
THROUGH TELEHEALTH BUT IF YOU
ASK ANY HEALTHCARE PROVIDER THEY
WILL TALK ABOUT PHYSICAL
EXAMINATION, CONTACT WITH THE
PATIENT, THAT'S SOMETHING
UNREPLACEABLE.
PERHAPS 100 YEARS FROM NOW, TEN
YEARS FROM NOW, ADVANCEMENTS,
PERHAPS A HOLOGRAM IN THE SHORT
FUTURE THAT I'M NOT FORESEEING
AND PEOPLE WILL LOOK BACK AT
THIS VIDEO AND THINK WHAT WAS HE
THINKING ABOUT?
WASN'T HOLOGRAMS THAT YOU CAN
TOUCH AND EXAMINE HERE,
SOMETHING SO STRAIGHTFORWARD?
I AGREE WITH YOU, TELEMEDICINE
IS A GREAT ADJUNCT AND CAN SERVE
AS A TOOL FOR DEALING WITH
UNDERSERVED WHEN THEY DON'T HAVE
ACCESS TO CARE, NOW YOU'RE
ENABLING ACCESS, PARTICULARLY
PROVIDERS NOT AVAILABLE IN THE
REGION.
AS YOU POINTED OUT, IF THERE'S
NO INTERNET, NO INFRASTRUCTURE
TO GO HAND IN HAND WITH THE GOAL
OF THE TECHNOLOGY, IT WON'T
WORK.
THE SAME THING GOES FOR THE
POLICIES AND THE FINANCING WHICH
SHOW A LOT OF PROBLEMS HAPPENS.
THERE WERE POLICIES LIFTED
DURING THE PANDEMIC AND NOW ARE
BACK INTO PLACE, AND PEOPLE ARE
STILL TRYING TO GO BACK AND
UNDERSTAND HOW TO DEAL WITH THE
CROSS-STATE LICENSOR, WHAT IS
ELIGIBLE FOR REPLACEMENT OR NOT,
DEALING WITH BURNOUT FROM
HEALTHCARE PROVIDERS BECAUSE NOW
THEY GET A LOT MORE MESSAGES, A
LOT MORE PORTALS, COMMUNICATIONS
THAN BEFORE.
SO ALL GREAT POINTS, DR. GRAHAM.
I DON'T KNOW IF YOU WANT TO GIVE
A LAST STATEMENT SINCE I MADE
SOME COMMENTS BEFORE WE GO TO
OUR BREAK.
>> NO, NO I'LL JUST SAY THAT AS
A PRACTITIONER, AGAIN, I WORK
WITH TECHNOLOGY, BUT AS A
PRACTITIONER YOU SEE THE
DIFFERENCE, WHEREAS A SPECIALIST
BEING ABLE TO CONNECT WITH
PEOPLE IN RURAL COMMUNITIES, AND
EVEN IN THAT ONE VISIT WE SEE
DIFFERENCE.
FOR ME WHAT WE CAN DO HERE IS
GREAT.
AS I WORK ON THE TECH PART AND
FROM ANOTHER VIEWPOINT, TO WHAT
YOU JUST SAID AND HOPEFULLY TO
KEEP US APART IN THE
CONVERSATION WE'RE TALKING ABOUT
SOMETHING VERY REAL IN PEOPLE'S
LIVES.
A PATIENT I SAW A COUPLE MONTHS
AGO, YOU TALK ABOUT SOMETHING
THAT CHANGES A LIVE -- LIFE IF
THEY DIDN'T HAVE THAT ENCOUNTER,
FOR SOME THE MOST IMPORTANT
THING IN TERMS OF THEIR CHANCE
TO GUESS BETTER WITH HEALTH
CARE, A LOT OF REAL FACTORS IN
THE WORKSHOP TODAY.
>> THANK YOU FOR SETTING THE
STAGE, DR. GRAHAM, AND JOINING
US TODAY.
WE'LL GO INTO A SHORT BREAK, AND
WE'LL BE BACK AT 11:55 IN
EASTERN STANDARD TIME HERE IN
BETHESDA.
THANK YOU, EVERYONE.
STAY TUNED.
>> WELCOME BACK.
IN THE BETHESDA AREA IT IS
11:55, TIME TO COME BACK TO OUR
FIRST SESSION.
THE IDEA AGAIN TODAY OF THE
WORKSHOP IS TO FOCUS ON THE
DIRECT TO CONSUMER, DIRECT TO
PATIENT TELEHEALTH.
SO FOCUS IS NOT SO MUCH THE
PROVIDER-TO-PROVIDER COVERED IN
PREVIOUS WORKSHOPS.
AND IT IS MY PLEASURE TO
INTRODUCE THIS FIRST SESSION OF
BEYOND THE SCREEN, BEST
PRACTICES IN TELEHEALTH AND
IMPLEMENTATION RESEARCH FOR
LASTING IMPACT.
MODERATOR IS DR. MEGAN MAHONEY,
FAMILY ENDOWED PROFESSOR AND
CHAIR, DEPARTMENT OF THE
UNIVERSITY OF CALIFORNIA, SAN
FRANCISCO.
WE ALSO HAVE OUR THREE
PANELISTS, PROFESSOR AND CHAIR
OF THE DEPARTMENT OF HEALTH
SERVICES POLICY AND PRACTICE AT
BROWN UNIVERSITY, WE HAVE DR.
CHRISTINE RAY, ASSOCIATE
PROFESSOR OF PEDIATRICS,
UNIVERSITY OF PITTSBURGH SCHOOL
OF MEDICINE, DIRECTOR OF HEALTH
SYSTEMS IMPROVEMENT AT UPNC
CHILDREN'S HOSPITAL, PITTSBURGH,
ALSO DR. JUDD HOLLANDER, SENIOR
VICE PRESIDENT FOR HEALTH CARE
DELIVERY AND INNOVATION,
DEPARTMENT OF EMERGENCY
MEDICINE, AND SYDNEY KIMMEL
MEDICAL COLLEGE OF THOMAS
JEFFERSON UNIVERSITY.
DR. MAHONEY, PLEASE TAKE IT
AWAY, A PLEASURE HAVING YOU
HERE.
>> IT'S A REAL PLEASURE TO BE
WITH YOU ALL TODAY.
THANK YOU, DR. BRUNO.
I KNOW THAT THIS PROMISES TO BE
A VERY ILLUMINATING
CONVERSATION.
I'M LOOKING FORWARD TO
MODERATING THIS DISCUSSION.
DURING THIS SESSION, WE WILL BE
EXPLORING AND IDENTIFYING BEST
PRACTICES IN TELEHEALTH, AND
WE'LL EXAMINE IDEAL UTILIZATION
SCENARIOS, LESSON LEARNED,
SUSTAINABLE CHANGES IN
HEALTHCARE DELIVERY, SHIFT IN
PATIENT AND CLINICIAN
DEMOGRAPHICS, EFFECTIVENESS OF
VARIOUS TELEHEALTH DELIVERY
SERVICES.
I AM REALLY HONORED TO SERVE AS
MODERATOR FOR THIS ESTEEMED
PANEL.
I HAVE THE OPPORTUNITY OF
REVIEWING A NUMBER OF THE
PUBLICATIONS, AND I KNOW WE'LL
HAVE A GREAT DISCUSSION TODAY.
WE'LL HAVE ABOUT 50 MINUTES.
I ENCOURAGE YOU TO USE THE Q&A
TOOL TO CONTRIBUTE YOUR
QUESTIONS.
I INVITE DR. HAL ANDER, RAY AND
MEHROTA TO JOIN AND WE'LL GET
INTO THE QUESTIONS.
>> WELCOME.
>> THE FIRST QUESTION FOR YOU IS
WHAT ARE THE BEST METRICS AFTER
HEARING FROM DR. GRAHAM'S
WONDERFUL PRESENTATION; HOW ARE
YOU THINKING ABOUT EVALUATING
TELEHEALTH EFFECTIVENESS?
WHAT ARE THE IDEAL SCENARIOS FOR
TELEHEALTH UTILIZATION, VERSUS
INPATIENT CARE?
AND I WILL GO AHEAD AND INVITE
DR. RAY TO GET US KICKED OFF.
>> THANKS SO MUCH.
IT'S A PLEASURE TO BE HERE WITH
THIS GROUP.
I THINK IN TERMS OF BEST METRICS
FOR EVALUATING TELEHEALTH
EFFECTIVENESS, I THINK AT ONE
LEVEL WHEN WE'RE THINKING ABOUT
INDIVIDUAL CLINICAL SCENARIOS,
HIGH-QUALITY CARE IS
HIGH-QUALITY CARE.
AND SO WHETHER IT'S OCCURRING IN
PERSON OR VIRTUALLY, WE WANT TO
MEET THOSE SAME STANDARDS.
AND SO WHEN WE'RE THINKING ABOUT
EXISTING METRICS, BEST CARE FOR
YOU A CUTE RESPIRATORY CARE
INFECTION, THEY REMAIN IMPORTANT
AND ESSENTIAL.
WE KNOW WHAT HIGH-QUALITY CARE
IS AND CAN START WITH THE SAME
METRICS.
I THINK THERE'S ANOTHER LEVEL
WHERE BECAUSE TELEHEALTH SHIFTS
ACCESSIBILITY OF CARE AS WE'VE
BEEN HEARING, THERE IS SOME
OPPORTUNITY TO THINK ABOUT THE
BALANCE OF ACCESSIBILITY AND
EFFECTIVENESS OF CARE.
AND IF WE'RE DOING -- IF WE'RE
REACHING A BROADER POPULATION,
AND WE'RE REACHING INTO
POPULATIONS THAT OTHERWISE WOULD
NOT HAVE RECEIVED CARE, THE
BALANCE OF REACHING THEM AND
ENHANCING THE QUALITY OF CARE
MAY LOOK DIFFERENT.
I'M THINKING ABOUT ADOLESCENTS,
IF WE CONSIDER REACHING OUT TO
THEM TO PROVIDE WELL CHILD CARE
THROUGH CHILD TELEHEALTH WILL
INCREASE NUMBER OF TEENS WHO GET
DEPRESSION SCREENING BUT MAY NOT
GET VISION SCREENING TO THE KIDS
AND HOW DO WE BALANCE THE
GREATER REACH WITH SOME
MODALITIES AND WHILE RECOGNIZING
OTHER THINGS MAY NOT OCCUR IN
THE SAME WAY.
SO I THINK FOR INDIVIDUAL
SCENARIOS, I THINK ABOUT THE
METRICS THAT WE ALREADY KNOW BUT
WHEN WE'RE THINKING ABOUT MORE
POPULATION HEALTH THERE'S A
LITTLE BIT MORE OF COMPLEXITY IN
THINKING OF TRADEOFFS BETWEEN
ACCESS AND EFFECTIVENESS AND
COUNTER BALANCE IF THAT PATIENT
HAD NOT GOTTEN THE TELEHEALTH
VISIT WOULD THEY HAVE GOTTEN NO
CARE OR AN IN-PERSON VISIT, WE
NEED TO RECOGNIZE AND
ACKNOWLEDGE.
I MIGHT PAUSE THERE AND COME
BACK TO THE IDEAL SCENARIO
QUESTION AFTER OTHERS HAVE A
CHANCE TO WEIGH IN.
>> WE NEED TO ASSERT THE SAME
STANDARDS OF OF CARE WITH QUALY
METRICS REACHING PARITY AND
TAILORING ACCESS METRIC
ACCORDING TO MODALITIES
TELEHEALTH VERSUS IN PERSON.
AND SO I'LL TRANSITION TO DR.
MEHROTRA IF YOU COULD WEIGH IN
AS WELL.
>> I'M IN AGREEMENT WITH DR.
RAY.
HOW DO I EVALUATE MY PROGRAM?
YOU'VE BEEN EVALUATING LOTS OF
PROGRAMS FOR A LONG TIME, DO THE
SAME METRICS FOR HEART DISEASE,
WE KNOW HOW TO TREAT HEART
DISEASE.
I WANT TO EMPHASIZE ALSO WHAT
DR. RAY SAID IT DOES RAISE
METRICS, EVALUATING FOR HEART
DISEASE WE DO NOT THINK ABOUT AS
OUTCOME TRAVEL TIME, BURDEN ON
CAREGIVERS, THOSE OUTCOMES.
I THINK THE GROWTH OF TELEHEALTH
PUSHES US IN THAT DIRECTION
THINKING OF PATIENT-CENTERED
CARE.
I WOULD WANT TO USE THE SAME
METRICS FOR ANY EVALUATION.
THAT WOULD BE -- I'M BASICALLY
ECHO WHAT DR. RAY SAID.
>> IT HELPS INTRODUCE NEW
METRICS THAT SHOULD HAVE BEEN
THERE.
DR. HOLLANDER?
>> IT'S WEIRD TO GO THIRD AND
NOT ARGUE WITH SOMETHING
SOMEBODY SAID ALREADY.
I AGREE 100% WITH ALL OF IT.
I'LL ADD A COUPLE COLOR
COMMENTARY STATEMENTS TO IT.
ONE IS NATIONAL QUALITY FORUM,
AMONG OTHER GROUPS, MEASURE
FRAMEWORKS AND MEASURE, AND IT'S
ACCESS, COST, EXPERIENCE,
EFFECTIVENESS AS THE OTHER
DOCTORS SAID.
IT'S THE SAME THING WE DO FOR
EVERYBODY ELSE, SHOULDN'T THINK
OF IT DIFFERENTLY.
ONE POINT ALREADY MADE, WE
CANNOT COMPARE TELEHEALTH TO
IN-PERSON CARE.
WE WANT TO COMPARE TELEHEALTH TO
THE ALTERNATIVE AVAILABLE.
IT'S NOT REALLY IMPORTANT TO
TAKE THAT DIABETIC AND SAY HOW
WAS THEIR VISIT ON MARCH 15,
IT'S MUCH MORE IMPORTANT TO SAY
HOW IS THEIR CARE.
SO IT'S REALLY ABOUT CARE
WITHOUT ANY TELEHEALTH VERSUS
WHAT WE OFTEN CALL HYBRID CARE,
CARE INCLUDING TELEHEALTH, SOME
OF THE TIME.
AND IT'S REALLY CRITICAL, WE
FUND STUDIES THAT LOOK AT IT
THAT WAY.
AND MY FINAL COMMENT, AND I DO
AGREE WITH WHAT ATEEV, NEW
OPPORTUNITY TO LOOK AT DIFFERENT
THINGS.
IF WE ANCHOR TO WHAT WE DO WE
LOSE THE ABILITY TO REINVENT
CARE.
CARE WE DELIVER RIGHT NOW ISN'T
CONSUMER-CENTRIC AND THERE ARE
THINGS WE SHOULD ABSOLUTELY DO
DIFFERENTLY.
SO I BELIEVE AND I'LL TAKE
PHYSICAL EXAM COMMENT MADE ON
THE EARLIER KEYNOTE, DO WE NEED
A PHYSICAL EXAM?
IF I ASK AUDIENCE FOR SHOW OF
HANDS, WHO HAS NOT TOUCHED IN AN
EXAM, 80% WOULD GO UP.
WE HAVE A FALLACY IN-PERSON CARE
IS WILDLY DIFFERENT BECAUSE OF A
PHYSICAL EXAM.
I CHALLENGE CARDIOLOGY
COLLEAGUES TO SAY ON A ROUTINE
SCHEDULED APPOINTMENT HOW MANY
TIMES HAVE YOU FOUND A NEW
MURMUR ON A PATIENT, THE ANSWER
IS NEVER ON EVERY WOULD BE.
WHAT IS IT WE NEED TO DO FOR
PATIENTS, NOT WHAT HAVE WE
ALWAYS DONE AND YOU WHO DO WE DO
IT WITH TELEMEDICINE.
MY FINAL THOUGHT, ANALOGY I USED
TO NOT LIKE THAT SOMEONE ELSE
MADE, THAT I NOW LOVE,
TELEMEDICINE IS THE ELEVATOR.
NOBODY ASKED HOW IS THE ELEVATOR
RIDE UP TO THE FIFTH FLOOR TO
GET TO MEDICAL CARE.
THE TELEMEDICINE PLATFORM SHOULD
BE SEAMLESS, SHOULD BE THE
ELEVATOR.
AND ECHOING THE COMMENTS OF THE
OTHER PANELISTS, IT'S ABOUT THE
CARE YOU'RE GETTING FOR THE
CONDITION YOU HAVE.
>> IF YOU DON'T MIND JUMPING IN,
WE'RE IN AGREEMENT.
ONE THING I WOULD HIGHLIGHT FOR
THE AUDIENCE IS A BIT OF A
PARADOX.
I'M WITH YOU.
HOW OFTEN DOES THE PHYSICAL
EXAM -- IS IT CRITICAL FOR
DIAGNOSIS AND MANAGEMENT?
I AGREE MOST OF THE TIME IT
ISN'T.
WHEN WE ASK PEOPLE IN NATIONAL
SURVEYS WHAT DO YOU THINK OF THE
TELEHEALTH VISIT, LIKE IT WAS
OKAY, BUT I DIDN'T GET A
PHYSICAL EXAM SO I'M NOT SURE I
GOT THE RIGHT QUALITY OF CARE.
THAT MIGHT CHANGE OVER TIME BUT
I DO WANT TO -- I'M WITH YOU BUT
WANT TO ACKNOWLEDGE ALSO THE
AMERICAN PUBLIC MAY NOT AGREE
WITH US.
>> AND OF COURSE THERE'S ALSO
THE OPPORTUNITY FOR THE PATIENT
TO CONDUCT A SELF-EXAM DURING A
TELEHEALTH VISIT AS WELL.
SO WE CAN MAYBE STRIKE A BALANCE
WHERE WE HAVE THE BEST OF ALL
WORLDS.
>> ABSOLUTELY.
I MIGHT ADD WE CAN NARRATE THE
EXAM WE'RE SEEING AS WE SHALL
VISUALIZING A PATIENT, WE
ACTUALLY DO A LOT OF EXAMS, I
KNOW ALL OF THE PANELISTS AGREE
WE'RE DOING A LOT OF EXAM AS WE
ARE SEEING PEOPLE THROUGH
TELEHEALTH, BUT IT MAY NOT -- WE
MAY NEED TO MAKE IT MORE
APPARENT TO THE PATIENT THAT I
SEE THIS ABOUT YOUR EYES, THIS
ABOUT YOUR BREATHING, TO HELP
SATISFY THAT ISSUE THAT YOU
RAISE.
>> SINCE THIS PANEL IS ABOUT
RESEARCH, THIS IS A GREAT
OPPORTUNITY TO DO RESEARCH AND
TO WHAT COMPONENTS OF THE
PHYSICAL EXAM ARE IMPORTANT.
WHEN WE TALK ABOUT THIS
CLINICALLY I DON'T HAVE TO GET
THE DIAGNOSIS RIGHT, I'M AN E.R.
DOC, I CAN'T MISS SOMETHING BAD,
RIGHT?
AND SO WE TEND TO THINK IN
TELEMEDICINE IF I SEE SOMEBODY
AND NEED TO SENDS THEM TO THE
E.R. I HAVE FAILED.
THAT'S NOT TRUE.
I'VE ONLY FAILED IF I NEED TO
SEND THEM TO THE E.R. AND I
DON'T BECAUSE PRIMARY CARE
DOCTORS ALL THE TIME SEND PEOPLE
TO THE E.R., OUTOF ORDER
OUTPATIENT TESTS, THE RIGHT
THING IS GETTING TO THE NEXT
ACTIONABLE STEP, THE DIFFERENCE
BETWEEN BRONCHITIS AND SINUSITIS
MAY NOT MATTER TO THE PATIENT.
>> ONE LAST POINT AND WE'LL GET
TO THE NEXT QUESTION.
JUDD RAISED A POINT THAT I
WANTED TO EMPHASIZE WHICH IS
THAT -- I BUILD UPON, WHICH IS
THAT RIGHT NOW WE DO A LOT OF
WORK ON VIDEO AND PHONE VISITS
IN THE CONSTRUCT OF THE ZOOM
CALL RIGHT NOW.
THERE IS THIS BURGEONING
INDUSTRY OF A NUMBER OF DEVICES
PEOPLE CAN BRING TO THE HOME,
SOME WILL WORK, SOME WILL BE NOT
SO HOT.
BUT THAT QUESTION THAT JUDD
RAISED, WHICH IS THAT A
CARDIOLOGIST MAY FEEL VERY, VERY
UNCOMFORTABLE MANAGING A PATIENT
WITH HEART FAILURE IN A CURRENT
SITUATION WITH VIDEO VISIT.
BUT IF THERE WAS A PHYSICAL EXAM
OF JUST A ONE-LEAD TELLE THING
ON THE PHONE AND VISUAL
STETHOSCOPE, WHAT THEY JUDGE AND
WHAT THE PATIENT JUDGES TO BE
SUFFICIENT QUALITY MAY BE
EXTREMELY DIFFERENT.
SO WE HAVE TO THINK ABOUT
TELETODAY AND TELE IN A COUPLE
YEARS MAY BE DIFFERENT HOW WE
JUDGE THAT QUALITY.
>> THAT'S WHAT WE WANT TO
ENCOURAGE, CONVERSATION.
SO THIS IS GREAT.
I WANT TO LET YOU KNOW THERE ARE
ALREADY A NUMBER OF QUESTIONS
THAT ARE COMING IN, AND SO I'LL
PROBABLY JUST JUMP TO THAT AND
PICKING UP ON DR. HOLLANDER'S
AND EVERYBODY'S POINT AROUND
ELEVATOR BEING TELEMEDICINE JUST
ONE MODALITY, AND DR. HOLLANDER,
ONE OF OUR RECENT PUBLICATIONS
YOU HIGHLIGHT THERE'S AN ARRAY
OF MODALITIES THAT FALL WITHIN
THIS REALM.
WE HAVE LIVE AUDIO VIDEO, WE
HAVE ASYNCHRONOUS CARE, NEAR AND
DEAR TO ME IN PRIMARY CARE, AND
REMOTE PATIENT MONITORING WHICH
ATEEV MENTIONED AS WELL.
THE QUESTION FROM THE AUDIENCE
HOW DO YOU THINK THE
RELATIONSHIP WITH PATIENTS
SHOULD BE MANAGED, CONSIDERINGED
THESE MODALITIES, IS THERE
RELUCTANCE TO TELEHEALTH DUE TO
RUSHED IMPLEMENTATION AND WHAT
STRATEGIES CAN REENGAGE THOSE
WHO DO HAVE SOME MISTRUST OF
THESE MODALITIES AND HOW DO WE
GET THEM TO ENGAGE?
>> WELL, I THANK YOU FOR THAT
INCREDIBLY SIMPLE QUESTION.
I CAN SAY THIS, YOU KNOW, I HAVE
A UNIQUE EXPERIENCE BECAUSE WE
LAUNCHED OUR FIRST TELEMEDICINE
PROGRAM IN 2015, LONG BEFORE
COVID.
AND THEN BECAUSE JEFFERSON HAS
GROWN FROM ALMOST THREE
HOSPITALS INTO 32 NOW, I'VE HAD
THE EXTREME PLEASURE OF HAVING
TO RELAUNCH IT MULTIPLE TIMES AS
WE ADDED ADDITIONAL HOSPITALS
AND APPLY LEARNINGS FROM THE
FIRST TO THE SUBSEQUENT ONES.
A COUPLE PIECES OF TRUE DATA, WE
KNOW IN SCHEDULED VISITS BETWEEN
A PATIENT AND THEIR PRIMARY
PROVIDER ARE SPECIALIST, ABOUT
70% OF THE DECISION TO DO
TELEMEDICINE IS THE PROVIDER
SAYING YOUR NEXT VISIT CAN BE
TELEMEDICINE.
WE TALK A LOT ABOUT
PATIENT-CENTRIC CARE BUT A
TELEMEDICINE VISIT IS DRIVEN BY
THE PROVIDER WHO CAN CLEARLY SAY
GET YOUR HEMOGLOBIN A1 CROSS
COUNTRY CHECKED A1c
CHECKED AT THE LAB AND WE'LL
TALK VIA TELEMEDICINE.
THINK ABOUT OUR HEALTH SYSTEMS.
WE'RE AT CAPACITY, NOT A LOT OF
OPEN APPOINTMENTS FOR THE
RHEUMATOLOGIST TO SEE YOU TODAY.
HE SEES YOU ON YOUR SCHEDULED
VISIT WHEN YOU'RE WELL BUT NOT
WHEN YOU HAVE AN ACUTE FLARE.
WE NEED TO FIGURE OUT WHAT ARE
THE WAYS WE CAN ENGAGE PATIENTS
TO TAKE CARE OF THEIR ACUTE
PROBLEMS ON SYSTEM IF YOU
EXCLUDE E.R. URGENT CARE AND
RETAIL CLINICS IS LARGELY BUILT
ON CHRONIC CARE MODEL.
AND SO I'M NOT ONE OF THESE
PEOPLE BUT THE THREE OF YOU
PROBABLY HAVE IN-BOX
DIFFICULTIES, RIGHT?
WITH PATIENTS REACHING OUT TO
YOU.
SO IF WE HAVE GOOD ASYNCHRONOUS
WAYS OF COMMUNICATING WITH
PATIENTS, THAT COULD SAY, YES, I
NEED TO SEE YOU, NO, I DON'T
NEED TO SEE YOU, EVEN IF I DO
SEE YOU I'M LIKELY TO SEND YOU
TO URGENT CARE OR E.R. BECAUSE
YOU NEED LABS AND X-RAY, THAT
WOULD GO A LONG WAY.
I COME BACK TO CONCEPT OF
LEVERAGING TELEMEDICINE FOR
ACTIONABLE NEXT STEPS, AND
PEOPLE WILL CALL IT A.I. OR
PREDICTIVE ANALYTICS BUT WHERE
IS THE RIGHT SPOT FOR YOUR CARE
NOW AND THAT CAN BE DONE
ASYNCHRONOUSLY.
>> EXCELLENT ANSWER ON THE
PATIENT SIDE.
I WANT TO ADD ON THE PROVIDER
SIDE THAT QUESTION OF RELUCTANCE
AND REENGAGEMENT, WE HAVE -- I
WORK IN A PRIMARY CARE NETWORK,
55 PRACTICES THAT MADE THIS
RAPID TRANSITION TO TELEHEALTH,
AND THERE'S A SUBSET OF OUR
CLINICIANS WHERE I DO SEE WHAT I
THINK ARE TELEHEALTH WHIPLASH,
WHERE THEY WENT ALONG AND DID IT
BUT NOW THEY ARE NOT SO FEELING
POSITIVE TOWARDS TELEMEDICINE
NOW THAT THEY HAVE MORE OF A
CHOICE.
SOME IS IN IN RAPID TRANSITION,
IT WAS A RAPID TRANSITION, THE
STAY-AT-HOME PEOPLE WERE OFFERED
FOR TELEHEALTH THINGS WE
WOULDN'T NORMALLY OFFER, WE
DIDN'T HAVE ABILITY TO TRANSFER
TO IN-PERSON, WRAPPED IN
UNCERTAINTY AND ISOLATION OF THE
PANDEMIC.
AND SO I HEAR FROM SOME DOCS
THAT THEY DON'T LIKE TELEHEALTH
BECAUSE IT IS ISOLATING, AND I
FIND THE OPPOSITE.
BUT I THINK BECAUSE IT'S A GREAT
WAY TO CONNECT IN THE HOME, BUT
I THINK WE NEED TO LISTEN TO
THOSE DOCS AND MAKE SURE THAT WE
REENGAGE THEM AS WELL AS THE
QUESTION ABOUT REENGAGING
PATIENTS.
BUT THINKING ABOUT HOW WE MAKE
IT FEEL SAFE AND COMFORTABLE FOR
DOCS WHO MAY BE BURNED OUT ON
TELEHEALTH TO COME BACK AS WELL.
>> ONE THING I WANTED TO BUILD
UPON HERE WAS THE MODALITY IN
JUST THE SYNCHRONOUS VERSUS
ASYNCHRONOUS THING.
ONE OF THE THINGS THAT HAS
ALREADY COME UP IS THAT IN MANY
AREAS, CLINICAL CARE FROM
CARDIOLOGY TO RHEUMATOLOGY TO
MENTAL HEALTH PROFESSIONALS,
PRIMARY CARE, WE JUST DON'T HAVE
ENOUGH CLINICIANS.
AND SO WHEN WE ENGAGE THE DOCS,
I ALSO -- WHAT IS THE MODALITY?
BECAUSE THIS IS AN INHERENT
PROBLEM WITH VIDEO AND PHONE
VISITS.
I JUST -- OUR HEALTH SYSTEM, ALL
HEALTH SYSTEMS ARE NOT LIKE A
LOT OF CARDIOLOGISTS, SITTING
AROUND, YOU GOT ME MORE ACCESS,
I CAN TREAT PEOPLE IN -- YOU
KNOW, DR. GRAHAM IN HIS OPENING
PLENARY HIGHLIGHTED WHY I GET
EXCITED, IMAGINING THE PEOPLE ON
THE CALL GET EXCITED, I WANT TO
ACKNOWLEDGE THAT IF WE'RE GOING
TO IMPROVE ACCESS IN THE WAY WE
REALLY WANT TO, JUST DOING VIDEO
AND PHONE VISITS DOESN'T IMPROVE
PRODUCTIVITY OR EFFICIENCY.
SO WHEN I THINK ABOUT THE FUTURE
OF TELEHEALTH, WHAT GETS ME MOST
EXCITED ABOUT REALLY FULFILLING
THE PROMISE THAT WAS DR.
GRAHAM'S HIGHLIGHT, I GET A LOT
MORE EXCITED AND I'M REALLY
INTERESTED IN TELEHEALTH
MODALITIES, APPLICATIONS THAT
IMPROVE PRODUCTIVITY.
WHAT I MEAN BY THAT IS THAT
RHEUMATOLOGIST THAT JUDD
MENTIONED CAN NOW MANAGE MORE
PATIENTS AND THEREFORE HAVE IN
HER PANEL THE ABILITY TO REACH
THAT PATIENT IN THAT RURAL
COMMUNITY OR THE COMMUNITY IN
MIAMI WHERE ACCESS WAS DIFFICULT
BEFORE.
AND SO THAT MEANS THINGS THAT
ARE ASYNCHRONOUS WE CAN GO INTO
THOSE IF YOU WANT, HAPPY TO JUMP
IN, BUT WANTED TO MAKE THE
LARGER POINT AS WE THINK ABOUT
THE FUTURE OF TELEHEALTH
THINKING ABOUT PRODUCTIVITY AND
THOSE APPLICATIONS MAY ALLOW US
TO FULFILL THE GOALS THAT DR.
GRAHAM REALLY ARTICULATED SO
WELL.
>> ONE THING WE DIDN'T TOUCH ON
SINCE PART OF TODAY IS ABOUT
IMPLEMENTATION SCIENCE, WE NEVER
IMPLEMENTED IN A WAY ANY
NORMAL
SYSTEM WOULD IMELEMENT. --
IMPLEMENT HEALTH CARE.
WHEN I SHIFTED SEVEN YEARS AGO I
HAD TEN MINUTES OF ORIENTATION,
HOW DO I DO THIS, WRITE AN
ORDER, AT MY COMPUTER.
I KNOW HOW TO DO IT BECAUSE I
HAD PEOPLE NEXT TO ME WHO KNEW
HOW TO DO IT.
WHEN WE ALL STARTED DOING
TELEMEDICINE IN MARCH OF 2020,
WHAT WE DID NOT HAVE IS ANYBODY
NEXT TO US WHO KNEW HOW TO DO
IT.
NOR DID MOST INSTITUTIONS HAVE
ANY TRAINING PROGRAM WHO COULD
TEACH PEOPLE HOW TO DO IT.
THE OLDER PEOPLE, THEY DIDN'T
LIKE IT.
THEY MAY HAVE BEEN
TECHNI-PHOBES, YOUNGER PEOPLE
ARE NO CLINICAL EXPERIENCE AND
WERE UNCOMFORTABLE IN
TELEMEDICINE, AND PEOPLE IN THE
MIDDLE OF THEIR CAREER WHO WOULD
HAVE EXPERIENCE AND UNDERSTAND
HOW TO DO THINGS DIDN'T KNOW HOW
TO DO THINGS.
SO WHEN YOU ASK THE PERSON NEXT
TO YOU WHAT TO DO, THEY JUST
MADE UP SOMETHING AND WHEN THEY
COULD ONLY DO THE MADE-UP
SOMETHING, THEY WERE COMFORTABLE
BECAUSE THE ALTERNATIVE WAS
PLACING THE LIFE AT RISK BY
SEEING PEOPLE IN PERSON AND
NEVER LEARNED TO GET COMFORTABLE
AND LEARN THE RIGHT WAY TO DO
IT.
THERE ARE GOOD WAYS TO DO
PHYSICAL EXAMS ON TELEMEDICINE.
WE'VE TRAINED THOUSANDS OF
PEOPLE ON HOW TO DO BELLY EXAMS
FOR ACUTE ABDOMINAL PAIN AND
PICKED UP EVERYTHING YOU COULD
IMAGINE AND TO THE BEST OF MY
KNOWLEDGE HAVE MISSED NOTHING
THAT WE SHOULD HAVE FOUND OVER
TEN YEARS OF EXPERIENCE.
I'M SURE THERE'S ONE OR TWO IN
THERE.
WE DON'T KNOW ABOUT.
BUT WE'VE DONE REALLY WELL.
BUT PEOPLE DON'T HAVE THAT
TRAINING.
AND SO IF YOU TRAINED ON HOW TO
EXAMINE SOMEONE IN PERSON, IT'S
DIFFERENT ON VIDEO.
SO AN OPPORTUNITY FOR STUDY IS
HOW DO WE EXAMINE PEOPLE VIA
VIDEO TO GET ENOUGH INFORMATION
TO GET TO THE APPROPRIATE
ACTIONABLE NEXT STEP WITHOUT
PLACING QUALITY AT RISK.
>> KRISTIN, DID YOU HAVE A
COMMENT?
>> JUST AGREEING.
OH, ONE ON THE PREVIOUS POINT,
WHICH WAS ABOUT THE ASYNCHRONOUS
AND THE VALUE OF THOSE.
I 100% AGREE AND OFTEN SEE OR
HEAR CONVERSATIONS ABOUT USING
TELEHEALTH TO INCREASE
AVAILABILITY WHEN IT REALLY ONLY
INCREASES ACCESS.
IT DOESN'T CHANGE OUR CAPACITY.
AND SO I WANT TO SET THAT --
EMPHASIZE THAT.
ALSO SHARE ENTHUSIASM THAT
THERE'S SO MANY MODELS, AND I
THINK OUR BEST FUTURE HEALTHCARE
SYSTEM WILL INVOLVE STITCHING
THOSE ALONG SO THE PATIENT, YOU
KNOW, ENTER AT THE DOOR THAT'S
MOST ACCESSIBLE TO THEM, ARE
HANDED UP TO THE LEVEL THAT THEY
MOST NEED BASED ON RECOGNITION
OF CLINICAL SCENARIOS AS DR.
HOLLANDER NOTED.
SO I THINK THAT IT'S NOT AN
EITHER/OR BUT THE SYSTEM WHERE
YOU USE THE LOWEST TOUCH
NECESSARY TO DELIVER THE HIGHEST
QUALITY CARE.
>> AND THAT GETS TO THE COMMENT
MADE EARLIER, JUDD, ABOUT THE
UNIT OF ANALYSIS SHOULD BE THE
CARE JOURNEY AND NOT JUST THE
ONE VISIT.
AND HOW A PATIENT IS ABLE TO
ACCESS CARE THEY ARE RECEIVING
WHEN IT PERTAINS TO DIABETES OR
HYPERTENSION OUTCOMES, ET
CETERA.
I'M GOING TO TRANSITION THE
CONVERSATION BECAUSE THERE ARE A
NUMBER OF QUESTIONS RELATED TO
IMPLEMENTATION SCIENCE AND
IMPLEMENTATION RESEARCH WHICH
REALLY IS THE THEME OF OUR PANEL
TODAY.
MAYBE WHAT WE SHOULD DO IS JUST
REVIEW WHAT ARE THE TELEHEALTH
DELIVERY METHODS THAT ARE PROVEN
TO BE EFFECTIVE, WHAT ARE BEST
PRACTICES, AND ATEEV WAS
POINTING TO THE NEED FOR WORK
FLOW TO ENSURE THESE ARE
IMPLEMENTED EFFECTIVELY ACROSS
MODALITIES.
WHAT SHOULD BE RETAINED OR NEED
TO BE DEVELOPED, WHAT NEEDS TO
BE IMPLEMENTED FOR FUTURE
HEALTHCARE DELIVERY?
ATEEV?
>> KRISTIN AND JUDD RUN A BIG
PROGRAM, I'M MORE ON THE
RESEARCH SIDE.
CAN I PASS THE BATON ON THAT
QUESTION?
>> SURE, DO YOU WANT TO TAKE IT?
>> YOU CAN GO FIRST.
I'M POINTING TO YOU.
>> I THINK ONE THING THAT IS
MOST IMPORTANT IN THINKING ABOUT
TELEHEALTH IS JUST HOW MANY
MODALITIES OF CARE FALL UNDER
THIS UMBRELLA, THERE IS
ASYNCHRONOUS AND SYNCHRONOUS,
AND YOU CAN GO INTO DETAIL ON
THOSE.
BUT I THINK EVEN WITHIN LIVE
INTERACTIVE TELEMEDICINE THERE'S
DIFFERENCES IN WHETHER
PERIPHERALS ARE AVAILABLE,
WHETHER IT'S HAPPENING IN THE
CONTEXT OF AN ONGOING CARE
RELATIONSHIP, WHETHER THERE IS
CONTINUITY OF RECORD AND PEOPLE
HAVE ACCESS TO EHR.
I THINK THAT WHEN WE'RE THINKING
ABOUT THE IMPLEMENTATION
QUESTION, IT'S NOT TELEHEALTH
YES/NO BUT TELEHEALTH IN THIS
CONTEXT, TELEHEALTH IN THAT
CONTEXT, THAT WE NEED TO BE
THINKING ABOUT TO IDENTIFY WHAT
THE BEST WAYS AND WHAT ARE THE
MODELS THAT ARE EMERGING THAT
ARE SHOWING IN THE MOST PROMISE
THAT WE CAN LIFT UP.
SOME KEY THINGS ARE -- THAT ARE
EMERGING ARE NOT NECESSARILY IN
THE TECHNOLOGY ITSELF.
I THINK COMMUNICATION SKILLS AND
THE EXAM SKILLS, THE TRAINING,
ALL OF THOSE I THINK ARE
ESSENTIAL THAT WE MAKE SURE
WE'RE UNDERSTANDING AND
ILLUMINATING BEST PRACTICES.
ONE EXAMPLE OF A STUDY I FOUND
REALLY POWERFUL THAT I THINK IS
THE TYPE OF WORK WE NEED IN
TELEHEALTH WAS A STUDY THAT CAME
OUT OF KAISER IN THE LAST YEAR
OR SO WHERE THEY WERE LOOKING AT
IMPACT OF VIRTUAL ROOMING
PROCESSES WHERE THEY HAD M.A. OR
R.N. ROOM PATIENT VIRTUALLY,
SCHEDULED APPOINTMENTS, NOT ONLY
THAT NO-SHOW RATE BUT REDUCED
NEW-SHOW RATE MORE FOR THOSE WHO
WERE DISADVANTAGED POPULATIONS,
WHETHER IT WAS LANGUAGE OR
MINORITIZED RACE AND ETHNICITY.
IDENTIFYING OPPORTUNITIES THAT
IMPROVE ACCESS OR EFFECTS E--
EFFECTIVENESS FOR ALL BUT
ESPECIALLY THOSE NOT WELL SERVED
BY TRADITIONAL HEALTHCARE SYSTEM
IS ONE OF THE PLACES I GET MOST
EXCITED ABOUT.
>> SO I'M GOING TO ADD BUT BEGIN
WITH A COMMENT THAT WE SHOULDN'T
HOLD TELEMEDICINE TO A HIGHER
STANDARD OF CARE THAN IN-PERSON
CARE, RIGHT?
IT SHOULD BE ITS OWN THING.
I THINK THAT'S IMPORTANT.
AND THEN I THINK WE'VE FAILED
THE WORLD IN SHOWING
TELEMEDICINE'S EFFECTIVENESS
BECAUSE WE HAVEN'T DEMANDED THE
SAME THING WITH NEW DEVICES AND
NEW TOYS THAT WE DEMAND WITH NEW
DRUGS.
SO, IF, FOR EXAMPLE, YOU'RE A
START-UP PHARMA COMPANY AND YOU
HAVE A VERY PROMISING MOLECULE,
YOU DON'T GET TO SAY, HERE,
JUDD, USE THIS, WE THINK IT'S
COOL AND IT'S GOING HELP YOUR
PATIENTS AND HAVE A RETURN ON
INVESTMENT.
YOU HAVE TO PROVE IT.
IF YOU'RE A REMOTE PATIENT
MONITORING COMPANY, YOU COULD
SAY, YOU KNOW, BLOOD PRESSURE
EVERY ONCE IN A WHILE IS GOOD SO
WE'LL DO IT EVERY MINUTE OF THE
DAY AND HERE IS A DEVICE YOU
COULD DO IT EVERY MINUTE OF THE
DAY, WITH NO PROOF THAT IT
ACTUALLY GENERALLY CHANGES THE
OUTCOME FOR PATIENTS TO DO MORE
OF SOMETHING THAT WORKED LESS.
AND SO, I THINK THAT WE HAVE AN
OBLIGATION TO REQUIRE START-UPS
IN THE DEVICE TELEMEDICINE
INDUSTRY TO -- WHEN WHEN THEY E
RAISING MONEY ARE THE SAME
STANDARDS AND PHARMA, TO DO
CLINICAL TRIALS TO IMPROVE YOUR
TOY MAKES IMPACT ON PATIENTS.
HEALTH SYSTEMS DON'T HAVE BIG
MARGINS.
BUTTER
BUT -- BUT THERE ARE SOME
THINGS, I'LL GIVE AN EXAMPLE
SOMETHING WE LAUNCHED ALMOST BY
MISTAKE.
SOMETIMES YOU JUST GET LUCKY.
WE BUILT A BEAUTIFUL NEW
BUILDING, $800 MILLION, WHEN
THEY DESIGNED IT, I HATE TO
THINK THIS IS RECORDED, LET'S
SAY THEY RAN OUT OF SPACE TO PUT
PEOPLE WHO WOULD CHECK OUT THE
PATIENTS.
AND SO THEY SAID CAN YOU COME UP
WITH A SOLUTION?
AND A COUPLE TEAMS SAT TOGETHER
IN A ROOM, WHITE BOARDED IT,
CAME UP WITH A CONCEPT OF
VIRTUAL CHECKOUT.
NOW IN EVERY SINGLE ROOM THAT
YOU GO INTO, THE WORK FLOW FROM
THE KIOSK, TO THE PHYSICIAN,
THERE'S A WHITE BOARD, WHEN
YOU'RE READY TO GET DRESSED,
HIT
THE BUTTON, WE'VE DONE 70,000
THINGS APRIL, IT WASN'T
PRE-PLANNED, SOMEBODY MAKES THE
FOLLOW-UP APPOINTMENT ON THE
SCREEN.
NOT ONLY THAT, THIS WEEK IT'S
LAUNCHING PATIENT PREFERRED
LANGUAGE, SO OF THE 22 PEOPLE WE
HAVE DOING CHECKOUT FOR THE SIX,
SEVEN HUNDRED PATIENTS WE'RE
SEEING A DAY, THEY WILL KNOW
WHAT THEIR PRIMARY LANGUAGE IS
AND IF WE HAVE SOMEBODY WHO IS
BILINGUAL IN SPANISH THEY WILL
JUMP THAT PATIENT TO THE FRONT
OF THEIR QUEUE.
WE SAY TRANSLATORS, THEY CHECK
OUT BY SOMEBODY WHO SPEAKS THEIR
LANGUAGE, LOOKS LIKE THEM, MAKES
THEIR APPOINTMENT.
OUR DATA WHICH WE'RE BEGINNING
TO LOOK AT SHOWS AVERAGE TIME TO
APPOINTMENT BEING MADE IN THE
BUILDING WHETHER VIRTUAL
CHECKOUT OR NOT IS NOW ONE DAY,
AND IN OUR SYSTEM WHEN YOU GO
HOME AND WE SAY MAKE APPOINTMENT
WITH CARDIOLOGY OR WHOEVER, IT'S
15 DAYS WHICH WE KNOW CORRELATES
WITH NO-SHOW RATES AND THINGS OF
THE SUCH.
SO A REALLY SIMPLE THING THAT
WOULD NEVER GET MEASURED IN
TERMS OF IS THERE VALUE TO CARE
HAS CHANGED OUR IN-PERSON VISITS
BECAUSE WE FOUND A DIFFERENT WAY
TO DO HYBRID CARE.
I THINK, YOU KNOW, PATIENT
SATISFACTION IS THROUGH THE ROOF
WITH IT AND WASN'T EXPERIENCE.
>> WONDERFUL TO THINK ABOUT CARE
TRANSITION RELATED TO
INTERVENTION AND HEALTH EQUITY
ASPECT OF IT.
AND IT IS INTERESTING THAT IT
WASN'T DESIGNED IN ADVANCE,
PROACTIVELY, BUT ACTUALLY WAS
JUST A CONSEQUENCE OF THE
CONSTRAINTS BEING PRESENTED.
THAT RELATES TO THE NEXT
QUESTION COMING IN FROM ONE OF
THE MEMBERS OF OUR AUDIENCE
TODAY.
SO, IT SAYS THANKS FOR A GREAT
COMMENT, OUTLINING THE GOALS AND
PRACTICE BETWEEN RESEARCH AND
CLINICAL PRACTICE.
AND THEN THAT TELEHEALTH SHOULD
BE TAILORED TO MEET THE GOALS OF
ALL SETTINGS, AND KEEP
INTEROPERABILITY.
AND WHAT IS THE OPPORTUNITY TO
INTEGRATE RESEARCH INTO THE
DESIGN OF TELEHEALTH?
AND WHAT SHOULD WE CONSIDER AS
WE INTENTIONALLY INTEGRATE A
DESIGN FEATURE IN THE
IMPLEMENTATION OF TELEHEALTH AND
WHAT ARE THE CHALLENGES RELATED
TO THAT?
YOU GOT INTO THIS, JUDD, A
LITTLE BIT BUT I WANTED TO OPEN
TO THE ENTIRE PANEL.
>> ONE THING I WOULD JUST -- IN
TERMS OF IMPLEMENTATION SIDE,
BUILDING ON THE QUESTION, WE'VE
DONE WORK REMOTE PATIENT
MONITORING FOR HIGH BLOOD
PRESSURE.
THE QUESTION WAS WHAT ARE THINGS
YOU GET EXCITED ABOUT, THAT'S
ONE.
I THINK IT'S A REALLY GOOD
MODEL, BETTER MODEL MANAGING
HIGH BLOOD PRESSURE.
BUT I THINK WHEN I SAY THAT, I
HAVE TREPIDATION BECAUSE WHEN
YOU GO AND TALK AND SAY, HOW DO
YOU ACTUALLY DO THIS, LIKE WHO
THE HECK IS ACTUALLY GETTING THE
BLOOD PRESSURE MEASUREMENT, WHO
REACTS TO THAT INFORMATION, WHAT
HAPPENS IF IT'S REALLY HIGH
BLOOD PRESSURE IN THE MIDDLE OF
THE NIGHT, WHO RESPONDS?
OH MY GOSH, THERE'S SO MUCH
VARIATION.
AND SO WE THINK ABOUT
IMPLEMENTATION SCIENCE RESEARCH,
THESE ARE THE KINDS OF
QUESTIONS.
THEY SOUND BORING BUT THEY ARE
REALLY IMPORTANT, OF
UNDERSTANDING WHAT IS THE
NUANCES, HOW DO YOU IMPLEMENT
SUCH A PROGRAM BECAUSE SMALL
CHANGES CAN MAKE BIG DIFFERENCE
IN IMPACT OF HIGH BLOOD
PRESSURE.
SO -- AND OUTCOMES WE LOOK AT.
SO, THAT WAS JUST ONE ASPECT OF
THAT.
ANOTHER THING THAT I WANTED TO
EMPHASIZE THE QUESTION MADE ME
THINK ABOUT WAS JUDD MADE THE
POINT ABOUT REMOTE PATIENT
MONITORING, YOU CAN JUST SORT OF
DO IT.
IT DRIVES ME CRAZY THAT YOU CAN
JUST DO SOMETHING LIKE THAT AS
OPPOSED TO A NEW MOLECULE.
THE TITLE OF THIS OVERALL THING
IS DIRECT TO CONSUMER.
ONE THING WE'VE NEGLECTED HERE A
BIT IS THAT BEYOND -- WE'VE BEEN
HEALTH SYSTEM FOCUSED GIVEN THE
NATURE OF THE PANEL OF WHAT'S
HAPPENED AT JEFFERSON, UPMC.
BUT THERE ARE HUNDREDS AND
HUNDREDS OF START-UPS OUT THERE
THAT DO A TELEMEDICINE-ONLY
MODEL, NOT WHAT FERNANDO WAS
TALKING ABOUT HYBRID OR ADJUNCT,
THIS IS A TELEMEDICINE-ONLY
MODEL.
AND THEY ARE PROVIDING CARE TO
PROBABLY MILLIONS OF PATIENTS,
AMERICANS IN THE UNITED STATES,
AND WE DON'T KNOW, WE DO NOT
HAVE GOOD DATA ON WHETHER THEIR
PARTICULAR MODEL IS HELPFUL, HOW
DOES IT BUILT WITH EXISTING
HEALTHCARE SYSTEM, WHICH ARE
WORKING AND NOT WORKING.
WE SHOULD NOT HAVE AN
EXPECTATION THE STARTUPS WILL
EVALUATE THEMSELVES.
THEY DON'T HAVE INCENTIVE, THEY
DON'T HAVE TO.
SO THIS IS ANOTHER AREA OF
RESEARCH THAT I'M REALLY
THINKING ABOUT WHICH IS WE MAY
LIKE 'EM, WE MAY NOT LIKE 'EM,
BUT WE NEED TO UNDERSTAND WHAT
IMPACT THEY ARE HAVING.
SO WANTED TO THROW OUT ANOTHER
AREA AND THINKING ABOUT WHAT
ROLE THEY HAVE IN THE OVERALL
CARE THAT PATIENTS ARE
RECEIVING.
>> AND THE IMPLEMENTATION
SCIENCE OPPORTUNITY AS WELL.
I'LL MOVE TO ANOTHER QUESTION
THAT IS VERY INTERESTING TO ME
AS WE THINK ABOUT OTHER
PROVIDERS, WE'VE BEEN TALKING
ABOUT PHYSICIANS, WHAT ABOUT THE
ADVANCED PRACTICE PROFESSIONALS,
NURSES, SOCIAL WORKERS, OTHER
MEMBERS OF THE CARE TEAM, AND
WHAT IS YOUR EXPERIENCE WITH THE
UPTAKE AND INTEREST AND
ENGAGEMENT IN TELEHEALTH
MODALITIES, AND THESE -- AMONG
THESE TEAM MEMBERS?
>> SO I HAVE PRETTY GOOD
EXPERIENCE WITH THAT.
I DON'T HAVE IMPLEMENTATION
SCIENCE ON IT BUT I DO HAVE
PATIENT SATISFACTION SCORES.
AND IT TURNS OUT WHEN WE FIRST
LAUNCHED OUR PROGRAM TEN YEARS
AGO, WE ACTUALLY WERE, YOU KNOW,
PROBABLY A LITTLE ARROGANT FOR
AN ACADEMIC HEALTH SYSTEM AND
THOUGHT EVERYBODY'S GOING TO
WANT TO SEE AN E.R. DOC WHO IS
WELL VERSED FROM AN ACADEMIC
MEDICAL CENTER.
UNTIL ONE OF OUR EARLY SURVEYS
WAS HOW MUCH DO YOU CARE IFS AN
E.R., PRIMARY CARE DOC OR NURSE
PRACTITIONER, WE ONLY CARE IF
SOMEBODY ANSWERS THE VIDEO RIGHT
AWAY.
WHAT'S THE IMPORTANCE OF
SOMEBODY ACADEMIC OR NOT, THE
IMPORTANCE WAS LIKE NOTHING.
AND SO WE LEARNED, OKAY, WE'RE
SPENDING A LOT OF MONEY ON E.R.
DOCS 24/7, MOST COMPLAINTS ARE
HANDLED BY NURSE PRACTITIONERS
ACROSS THE COUNTRY.
WE STARTED TRANSITIONING,
PATIENT SATISFACTION SCORES, WE
HAVE METRICS, ARE BASICALLY THE
SAME BETWEEN THE TWO GROUPS WITH
THE EXCEPTION OF COST.
SO I THINK IT'S REALLY IMPORTANT
TO EXTEND IT TO NON-PHYSICIANS.
WE HAVE RECENTLY LAUNCHED
INPATIENT TELEMEDICINE, LARGELY
WITH VIRTUAL NURSING AND
TELESITTING, WE'VE HAD THAT FOR
A WHILE.
AND THIS IS REALLY IMPORTANT
WHEN YOU EVALUATE IT BECAUSE
THERE'S GOOD ROI MODELS FOR HARD
AND SOFT RELATED TO NURSING, WE
THINT -- DIDN'T SHOW THEM IN TE
PILOT PHASE BECAUSE EVERYBODY
WITH EXPERIENCE DOING VIRTUAL
NURSING SAID NURSES HAVE TO BE
OFF SITE AND NOT TIED, BEING
ABLE TO PULL TO THE UNIT.
WE THOUGHT, WELL, WHAT A GREAT
WAY TO BEGIN, IF NURSES KNOW THE
VIRTUAL NURSES, THEY WILL BE
MORE COMFORTABLE.
YOU KNOW WHAT THEY ARE?
HALF THE TIME PULLED BACK TO THE
UNIT BECAUSE SOMEBODY'S OUT
SICK.
AND SO VIRTUAL NURSE PROGRAM IS
AT RISK BECAUSE OUR INITIAL
ASSESSMENT WAS FLAWED BY THE WAY
WE IMPLEMENTED IT.
AND SO WE HAVE NOW DECIDED THAT
YES, YOU'RE RIGHT, IF WE'RE
GOING TO CONTINUE DOING IT THIS
WAY SHOULD GIVE UP THE PROGRAM.
BUT WE PROBABLY SHOULD HAVE DONE
IT THE WAY EVERYBODY IN THE
WORLD RECOMMENDED FROM THE
BEGINNING, RATHER THAN THINKING
WE'RE SMARTER THAN THEM.
AND SO I THINK THAT'S TRUE
IMPLEMENTATION SCIENCE, RIGHT?
IF YOU DID A RANDOMIZED
CONTROLLED TRIAL HOW TO
IMPLEMENT IT MIGHT HAVE SAVED
THE TROUBLE OF DOING WHAT WE
DID.
>> GREAT.
KRISTIN, YOU HAVE EXPERIENCE
WITH ALLOWED HEALTH
PROFESSIONALS, PARTICULARLY
AROUND TELELACTATION, BUT
ANYTHING YOU WANT TO COMMENT ON?
>> I CAN SPEAK TO BOTH OF THOSE.
FIRST IN THE CLINICAL SETTING,
PRIMARY CARE WHERE I PRACTICE WE
HAVE TEAM-BASED CARE, WORKING
SIDE BY SIDE WITH PHYSICIANS AND
NURSE PRACTITIONERS AND PAS,
SOCIAL WORKERS IN PERSON.
WE FOUND THE SAME CLINICIANS,
EVERYONE IS HAPPY TO MEET OUR
PATIENTS' NEEDS AND ENGAGE
VIRTUALLY.
I THINK THAT MORE IMPORTANT THAN
THE DEGREE ON THE CLINICIAN SIDE
IS I THINK TELEHEALTH CAN BE
TRICKY AND ONE NEEDS TO BE
TRAINED AND COMFORTABLE WITH THE
UNCERTAINTY THAT COMES WITH NOT
HAVING THE PATIENT IN THE ROOM.
I THINK EXPERIENCE DOES MATTER,
EXPERIENCE OR TRAINING, OR
GETTING PEOPLE TO THE LEVEL
WHERE THEY FEEL YESTERDAY TO
MAKE THESE DIAGNOSIS AND DECIDE
WHEN THEY NEED TO ESCALATE CARE
BRINGING A PATIENT IN, IN
PERSON.
MORE THAN DEGREES THAT IS
IMPORTANT.
GOING BACK TO PROVIDING CARE
IMPORTANT FOR THAT CONDITION, IF
YOU WERE IN PERSON OR VIRTUALLY
DOING THE SAME SORT OF MANEUVERS
THAT ARE NECESSARY FOR THAT
DIAGNOSIS, I THINK SIMILARLY IF
SOMEONE IS NOT COMFORTABLE
CARING FOR THIS AGE GROUP OR
THIS CONDITION, IN PERSON, THEN
THEY MAYBE SHOULD ALSO PASS ON
THAT TELEHEALTH PATIENT.
SO I THINK IT'S THAT IN-PERSON
STANDARD APPLIES AND I THINK
EXPERIENCE MATTERS IN WHAT I'VE
SEEN BUT WE CAN ALSO TRAIN
PEOPLE AS DR. HOLLANDER HAS VAST
EXPERIENCE IN.
THE OTHER PIECE ABOUT OTHER
PROVIDERS, ON OUR SOCIAL WORK
AND CARE COORDINATOR SIDE, THE
BILLING MODEL IS NOT THERE
DEPENDENTING ON PAYMENT
STRUCTURE.
ON THE TELELACTATION SIDE, DR.
MEHOTRA WAS PART OF THIS, WE
LOOKED AT RANDOMIZING PATIENTS
TO HAVING ACCESS TO
TELELACTATION SERVICES.
AND HAVE FOUND PARENTS ARE --
NURSING PEOPLE ARE HAPPY TO
CONNECT AND RECEIVE SERVICES,
NOT EVERYONE USES IT WHICH MAKES
SENSE BECAUSE NOT EVERYONE HAS A
NEED FOR LACTATION CONSULTANT,
AND MANY PEOPLE CAN RECEIVE
ACCESS IN PERSON.
SO, WE'RE FINDING AS AN
AUGMENTED OPTION IT IS SOMETHING
THAT CAN BE USEFUL FOR NURSING
PEOPLE AND LACTATION CONSULTANTS
IN GENERAL FEEL LIKE THEY CAN
PROVIDE THE CARE THAT THEY NEED
TO BE ABLE TO PROVIDE.
>> A NUMBER OF THINGS YOU
HIGHLIGHTED AROUND THE NEED FOR
TRAINING AND HOW THAT IS
DIFFERENT WHEN WE'RE TALKING
ABOUT TELEHEALTH PERHAPS, AND
THE NEED FOR POTENTIALLY THE
LIMITATION AND NUANCE AROUND
SUPERVISION IN THIS MODALITY
VERSUS IN PERSON THAT PRESENTS A
CHALLENGE AND PARTICULARLY
AROUND BILLING AND PAYMENT WHICH
THERE IS A QUESTION FROM THE
PANEL RELATED TO THAT SO I'D
LIKE TO GET TO THAT.
BEFORE THAT, ATEEV, DID YOU HAVE
A COMMENT?
>> THE QUESTIONER DIDN'T HAVE
THIS INTENT BUT IT HIT A PET
PEEVE OF MINE.
I HAD TO GET IT OUT.
I'LL PUT IT OUT, WHICH IS
THERE'S STILL THIS ONGOING
CONVERSATION ABOUT
NON-PHYSICIANS AND PHYSICIANS,
AND REALITY IS THAT RIGHT NOW IN
THE UNITED STATES A QUARTER OF
ALL VISITS ARE PROVIDED BY
NON-PHYSICIANS.
AND THAT RATE IS GROWING REALLY
RAPIDLY, IN THE NEXT 10 TO 20
YEARS MY SENSES LOOKING AT
WORKFORCE NUMBERS MAJORITY OF
OUTPATIENT VISITS WILL BE
PROVIDED BY NON-PHYSICIANS.
WE'RE ALREADY SEEING THAT IN
MANY RURAL COMMUNITIES IN THE
UNITED STATES.
SO THIS IS THE REALITY.
I DON'T THINK THERE'S THAT MUCH
OF A DIFFERENCE IN TERMS OF
TELEHEALTH AND I THINK WE JUST
HAVE TO THINK ABOUT THESE
TEAM-BASED MODELS AS KRISTIN
DESCRIBED.
THERE ARE SOME QUESTIONS WHAT
THE OPTIMAL STRUCTURE OF THOSE
TEAMS IS BUT IT'S GOING TO BE
TEAMS AND I REALLY GET THE PET
PEEVE WAS THE SORT OF THINKING
ABOUT A CAGE PHYSICIAN IN ONE
CORNER, PHYSICIAN IN ONE CORNER,
NURSE PRACTITIONER IN THE OTHER
AND I GET FRUSTRATED BECAUSE
IT'S GOING TO BE A TEAM-BASED
CARE AND IT'S ALREADY HAPPENING.
>> THAT RELATES TO NEXT
QUESTION, DRIVERS OF TELEHEALTH
IMPLEMENTATION, I WOULD ASK
INCLUDING LET'S SAY PHYSICAL
THERAPISTS OR OTHER SPECIALTIES,
DISCIPLINES WHERE REIMBURSEMENT
AND PAY PARITY ARE NOT ENTIRE IN
PLACE IS MY UNDERSTANDING.
BUT PLEASE CORRECT ME IF THAT'S
NOT CORRECT.
AND SO THE QUESTION IS, IS
INSURANCE PAYMENT DICTATING THE
EXPANSION OF TELEMEDICINE NOW?
>> YES.
I MEAN, MY SENSE -- GO AHEAD,
KRISTIN.
>> I WANT TO NAME ONE CHANGE
THAT WAS HUGE AND CONTINUES TO
BE HUGE FOR PRIMARY CARE TO
CONTINUE TO BE ABLE TO OFFER
TELEHEALTH.
AND THAT'S THE -- YOU KNOW,
MULTIPLE CHANGES HAPPENED WITH
PANDEMIC BUT ABILITY FOR PRIMARY
CARE PROVIDERS TO BILL MEDICAID
AND MEDICARE AND COMMERCIAL
INSURERS WHEN THE PATIENT IS AT
HOME WITHOUT RURAL LIMITATIONS
OR TRANSPORTATION BARRIERS IS
HUGE, ESPECIALLY IF SOMEONE
PRACTICES IN URBAN AREA WHERE
PATIENTS ARE GEOGRAPHICALLY
CLOSE BUT TEMPORALLY IT TAKES A
LONG TIME TO GET TO MY CLINIC SO
MAKING SURE WE PRESERVE THE
OPPORTUNITY FOR PEOPLE, I THINK
THAT THIS IS INCREASINGLY
SEEMING LIKE IT'S BECOMING BAKED
IN BUT I WANT TO NAME THAT'S SO
IMPORTANT, AND I THINK ONE THING
THAT CONTINUES TO -- THERE ARE
ADDITIONAL POLICY AND PAYMENT
ISSUES THAT ARE IMPORTANT AND
EVOLVING, I CAN LET OTHER PEOPLE
SPEAK TO THOSE BUT ALSO
UNCERTAINTY HOW WE GET
EXTENSIONS FOR A PERIOD OF TIME
SHIFTS HOW PEOPLE FEEL ABOUT
REALLY THINKING RESOURCES AND
SCHEDULES AND WORKFLOWS INTO
MORE TELEHEALTH SPACES.
SO THOSE ARE SOME FACTORS THAT
AS THEY EVOLVE OFFER
OPPORTUNITIES TO STUDY WHAT'S
THE IMPACT WHEN THESE CHANGES
HAPPEN, IF THEY ARE STATE
DEPENDENT, PLAN DEPENDENT, WE
CAN LEARN FROM NATURAL VARIATION
HAPPENING AS DIFFERENT PAYERS
AND STATES MAKE DIFFERENT
CHANGES.
>> NOW YOU HIT MY PET PEEVE.
I AGREE WITH EVERYTHING YOU
SAID.
KICKING THE CAN DOWN THE ROAD IS
A KILLER, I WILL SAY.
LIKE I CAN'T TELL YOU THE NUMBER
OF E-MAILS I GOT IN THE LAST
MONTH SAYING SHOULD I CANCEL ALL
MY JANUARY TELEHEALTH
APPOINTMENTS?
AND NOW OUR OFFICIAL STANCE IS
DO NOT TILL WE TELL YOU TO DO
SOMETHING BECAUSE EVERYBODY
HEARS FROM A FRIEND SOMETHING'S
GOING AWAY, AND IT'S CRAZY.
IT RESULTS IN A LOT OF WORK
THAT'S UNNECESSARY.
THE SECOND THING THAT'S REALLY
IMPORTANT IS GEOGRAPHY.
AND WE'VE HINTED.
IT'S SO RUTHLESSLY UNFAIR TO BE
FUNDING THINGS IN RURAL AREAS
AND NOT URBAN AREAS.
I KNOW MY FRIENDS FROM HRSA ARE
ATTENDING TODAY AND I UNDERSTAND
THAT'S THEIR MISSION AND THERE'S
NOTHING THEY CAN DO ABOUT IT,
BUT REALITY IS MANY, MANY MORE
PEOPLE LIVE IN URBAN AREAS AND
THEY HAVE THEIR OWN CHALLENGES.
THEY MAY NOT HAVE A CAR.
THE BUS MAY BE BROKEN DOWN IN
PHILADELPHIA, WE'RE ON THE EDGE
OF A STRIKE, CAN THEY GET THERE?
I LIKE TO SAY THERE'S FEWER
DOCTORS IN RURAL AREAS, NO
DOUBT, BUT THERE'S FEWER
APPOINTMENTS AVAILABLE IN URBAN
AREAS, NO DOUBT.
AND I KNOW IF NOTHING ELSE IN
THE WORLD OF MEDICINE THAT PICKS
GEOGRAPHY AS A CONDITION FOR
FUNDING OR EVER DID.
I THINK WE HAVE TO GET PAST
THAT.
AND, YOU KNOW, AGAIN NOT AGAINST
ANY ONE AGENCY BUT WE HAVE TO
LOOK BROADLY AND NOT HAVE THINGS
FIT INTO RURAL-ONLY FUNDING
OPPORTUNITIES OR WE'RE ACTUALLY
TOTALLY INEQUITABLE BY DEPRIVING
URBAN PATIENTS OF THE CARE.
>> JUDD, OKAY, I'M WITH YOU
ABOUT KICKING THE CAN.
IT'S DRIVING EVERYBODY CRAZY AND
NEGATIVELY IMPACTING TELEHEALTH.
WHERE I GET A BIT WORRIED ABOUT
WHAT YOU SAID IS I FULLY
ACKNOWLEDGE THE BARRIERS IN
URBAN AREAS.
BUT I WORRY ALSO ABOUT
ASSUMPTION THAT IF WE OFFER
TELEHEALTH TO EVERYBODY, AND
MAKE IT OPEN, IT'S GOING TO
ADDRESS THE DISPARITIES THAT DR.
GRAHAM AND SO MANY OTHERS HAVE
HIGHLIGHTED, LET'S JUST STICK
WITH RURAL/URBAN DIVIDE.
EVIDENCE THAT I SEE IF YOU JUST
OFFER IT TO EVERYBODY, MORE
PEOPLE WILL USE IT IN URBAN
AREAS AND WE'RE GOING TO WIDEN
DISPARITIES, NOT NARROW THEM.
AND THAT REALLY BOTHERS ME QUITE
A BIT.
IT BOTHERS ME A TON.
I THINK A LOT ABOUT THE NEED FOR
RESEARCH ON HOW DO YOU ENSURE --
I'M NOT SAYING TAKE IT WITH A
TAKE IT AWAY FROM URBAN AREAS,
BUT I'M CONCERNED ABOUT WIDENING
DISPARITIES.
>> MY PUSHBACK, I AGREE WITH
YOU, WE SHOULD CHOICE THE GAP.
BUT THE ONE WAY WE SHOULDN'T
CLOSE THE GAP IS BY DEPRIVING
OPPORTUNITIES FOR TELEMEDICINE
CARE TO PEOPLE WHO ARE LESS
BIASED AGAINST.
SO, I WANT TO BE CAREFUL THAT
THE GOAL IS NOT GAP CLOSURE, THE
GOAL IS OPTIMAL CARE FOR BOTH
PATIENT POPULATIONS OR FOR ALL
PATIENTS.
>> I WORRY WHEN WE GROUP INTO
RURAL/URBAN.
THERE'S AN URBAN BUCKET WITH
SUBPOPULATIONS AND EXPERIENCES
IN THERE.
MORE INNER CITY URBAN
POPULATIONS ARE VERY DIFFERENT
FROM THE SUBURBAN RINGS THAT
OFTEN ARE IN THE SAME
POPULATION.
SO WHEN WE LOOK AT ACCESS TO
EMERGENCY ROOM VISITS OR PRIMARY
CARE VISITS, THERE'S OFTEN
VARIATION, LOW UTILIZATION IN
THE MIDDLE OF THE MOST URBAN
CORRIDORS, THINGS LIKE GREAT,
CARE GOES DOWN AGAIN, SO MAKING
SURE THAT WE'RE SENSITIVE TO
THOSE NUANCES I THINK IS REALLY
IMPORTANT AS WE'RE THINKING
ABOUT ACCESS THROUGH TELEHEALTH
>> IT'S LIKE WE MAKING THE
DIVISION BETWEEN RURAL AND URBAN
AS IF THERE'S A DIFFERENCE AS
FAR AS HEALTH EQUITY AND ACCESS
TO DIGITAL MEANS, WHEN TO YOUR
POINT, KRISTIN, THERE ARE
POCKETS OF LOW DIGITAL LITERACY
WITHIN URBAN ENVIRONMENTS, AND
OPPOSITE TRUE IN RURAL AREAS.
AS WE THINK ABOUT INDIVIDUALS
WHO HAVE LOW DIGITAL LITERACY OR
LIMITED ENGLISH PROFICIENCY,
SOME OF THESE GROUPS THAT ARE
POTENTIALLY BEING LEFT OUT IN
THE TELEHEALTH REVOLUTION, WHAT
ARE SOME OF THE STRATEGIES,
RECOMMENDATIONS, AND ALSO
OPPORTUNITIES AND OPPORTUNITIES
FOR IMPLEMENTATION RESEARCH THAT
COME TO MIND TO THIS PANEL?
>> I'LL LAY THE STAGE AND WOULD
LOVE FOR KRISTIN AND JUDD TO
HIGHLIGHT.
WE ALL RECOGNIZE WE NEED TO
JUST, AGAIN, JUST OFFER TO
EVERYBODY, IT JUST DOESN'T WORK.
WE'LL HAVE TO ADDRESS SOME OF
THE DIGITAL LITERACY, AND MY
EXPERIENCE BOTH CLINICALLY AS
WELL AS LOOKING OUT THERE IS
THAT CLINICIANS ARE DOING WHAT
MAKES SENSE, COMMON SENSE.
LIKE, HEY, LET'S TRY A PILOT
VISIT.
HEY, LET ME HAVE A TELEHEALTH
COORDINATOR WHO CAN REACH OUT
AND SET THAT UP.
HEY, MAYBE I'LL GIVE YOU A
DEVICE TO HELP YOU DO THIS.
AND A VARIETY OF OTHER TOOLS.
AND ALL OF THOSE MAKE SENSE TO
ME, AND I THINK IF I WAS IN
THEIR SHOES I WOULD DO THAT.
I DON'T KNOW ABOUT A LOT OF
EVIDENCE THAT CAN SAY, HEY, THIS
THING WORKS BETTER THAN THIS
OTHER THING.
AND THAT DOES SEEM LIKE A
RESEARCH GAP.
I'D BE CURIOUS WHAT KRISTIN AND
JUDD, DO YOU AGREE OR DO YOU
FEEL LIKE WE HAVE THE EVIDENCE
TO KNOW TO INFORM A HEALTH
SYSTEM OTHER INDIVIDUAL PRACTICE
ON WHAT TO DO?
>> I THINK THERE IS SOME DATA IN
SOME OF THOSE SPACES, AND I
THINK THERE ARE -- THERE'S SOME
THINGS WE NEED TO DO BECAUSE --
WE SHOULD ALWAYS HAVE
INTERPRETERS.
WE SHOULD HAVE ALL OUR
PATIENT-FACING PORTALS AND
SELF-SCHEDULING AVAILABLE IN
MULTIPLE LANGUAGES.
I KNOW WE'RE FAR FROM DOING
THAT.
BUT I DON'T THINK WE NEED DATA
TO PROVE THAT.
THE NEXT LEVEL OF -- I KNOW
WE'RE ALL AWARE WE NEED TO DO
THOSE THINGS.
THE NEXT LEVEL OF DIGITAL
NAVIGATORS AND THOSE
SELF-ROOMING PROCESSES, THERE IS
NEED FOR ADDITIONAL DATA, AND AS
I MENTIONED THERE'S SOME STUDIES
SHOWING THAT.
IT'S PROBABLY THE SORT OF THING
WE WANT TO SEE MULTIPLE STUDIES
ACROSS MULTIPLE SETTINGS BEFORE
EVERY HEALTH SYSTEM ELIMINATED
VESTS HUGE AMOUNT OF EXTRA
PERSONNEL IN BUT I THINK THOSE
ARE THE QUESTIONS WE SHOULD
PRIORITIZE IN TERMS OF LOOKING
AT REPLICABLE STRUCTURES AND
PROCESS THAT ALLOW FOR
SCHEDULING, ATTENDANCE, QUALITY
OF CARE DURING THE VISIT.
I THINK THE OTHER THING IS WE'RE
THINKING ABOUT EQUITY AND
TELEHEALTH BROADLY IS
REMEMBERING THAT EQUITY ISN'T
NECESSARILY EVERYONE GETTING THE
SAME BUT IT'S EVERYONE GETTING
WHAT THEY NEED.
SO FOR DIFFERENT POPULATIONS
THAT WILL LOOK DIFFERENT.
I THINK WE'RE KIND OF AT A
TELEHEALTH EQUITY 1.0, MAYBE 2.0
LOOKING AT IS USE OF THIS
MODALITY THE SAME ACROSS
POPULATIONS AND WE WANT TO LOOK
AT HOW IS THIS MODALITY LAYERING
ON TOP OF OTHER MODALITIES AND
ARE PEOPLE GETTING THE CARE THEY
NEED.
THAT'S A LOT HARDER.
SO IT MAKES SENSE THAT WE
DON'T -- WE CAN'T ALWAYS DO THAT
BUT SHOULD BE LAYERING DIFFERENT
STUDIES ON TOP OF EACH OTHER TO
UNDERSTAND GIVEN THAT PATIENTS
HAVE DIFFERENT NEEDS FOR
CLINICAL CARE BASED ON THEIR
DIFFERENT HEALTH CONDITIONS, AND
THAT THEY HAVE DIFFERENT ACCESS
TO IN-PERSON CARE, THEIR NEED
FOR SUBSPECIALTY CARE OR SORRY
FOR TELEHEALTH CARE MAY VARY AND
WE WANT TO MAKE SURE THEY ARE
GETTING WHAT THEY NEED.
AND I THINK WE NEED TO
PRIORITIZE A RANGE OF
POPULATIONS FOR THAT.
>> TO ATEEV'S POINT, THE SHORT
ANSWER TO YOUR QUESTION IS
ABSOLUTELY YES.
THERE'S A GREAT OPPORTUNITY FOR
MORE RESEARCH IN THAT AREA.
I CAUTION, AND I KNOW THE
QUALITY OF YOUR STUDIES SO I
KNOW YOU KNOW THIS, NOT
EVERYBODY PATIENT IS GOING TO
GET THE SAME SOLUTION THAT WORKS
FOR THEM.
IT MAY BE PREDICTIVE ANALYTICS
WHETHER YOU NEED WHAT WE CALL A
TELEHEALTH COORDINATOR TO REACH
OUT AND DO A PRACTICE VISIT THE
DAY BEFORE OR JUST A FIRST VISIT
AND MAYBE A BOT COULD CALL AND
PROVE YOU CAN LOG ON AND DO YOUR
MICROPHONE AND AUDIO VISIT, OR
MAYBE INSTRUCTIONS WITHIN THE
PORTAL MESSAGE THAT COULD WORK
FOR SOME PATIENTS BECAUSE THEY
ARE SAVVY ENOUGH WITH SOME
INSTRUCTIONS.
I THINK THERE'S GOING TO BE --
KRISTIN RISING HAS DONE A LOT OF
WORK AT JEFF, A PORTFOLIO OF
OPTIONS THAT WILL WORK FOR
DIFFERENT PATIENTS.
WHETHER OR NOT WE CAN BE SMART
ENOUGH TO PREDICT THAT, TO HAVE
A HIGHER LIKELIHOOD OF THE
OPTION THAT PATIENT A GETS,
BEING THE RIGHT OPTION, OR
GIVING A PORTFOLIO OF OPTIONS, I
THINK IS A TOTALLY RIPE
OPPORTUNITY FOR RESEARCH.
>> AND IF I COULD JUST -- I
SHOULD HAVE PROVIDED THE CONTEXT
IN WHICH I WAS THINKING ABOUT
THIS QUESTION.
THE FEDERAL GOVERNMENT AS PART
OF THE AFFORD AND CONNECTIVITY
PROGRAM PROVIDED LIKE $7
BILLION.
I WOULD HAVE BEEN SUPPORTIVE OF
IT, AT LEAST MY EVIDENCE,
UNFORTUNATELY I DON'T SEE AN
ASSOCIATION BETWEEN THAT PROGRAM
AND MORE TELEHEALTH USE.
SO THERE'S A LOT OF REASONS WE
HAD THAT PROGRAM.
I WANT TO ACKNOWLEDGE THAT.
IF IT'S JUST ABOUT TELEHEALTH
IT'S ONE EXAMPLE WHERE I'VE NOT
SEEN EVIDENCE THAT'S THE KIND OF
PROGRAM THAT'S MOST EFFECTIVE.
THIS IS ONE EXAMPLE OF WHY THIS
TYPE OF RESEARCH IS NECESSARY
BECAUSE WE JUST SHOULDN'T MAKE
ASSUMPTIONS.
>> ABSOLUTELY.
>> EXCELLENT.
I THINK WE'RE WINDING DOWN AND
COMING TO THE END OF A LIVELY
DISCUSSION, THIS HAS BEEN
INSIGHTFUL AND STIMULATING.
I WANT TO CLOSE ALLOWING THE
PANELISTS TO GIVE FINAL THOUGHTS
WHAT YOU'RE EXCITED ABOUT IN THE
NEXT YEAR OR FIVE YEARS AS FAR
AS TELEHEALTH AND THE
OPPORTUNITIES OF IMPLEMENTATION
RESEARCH STARTING WITH ATEEV
FIRST.
>> YEAH, I THINK THE
INTERSECTION BETWEEN A.I. AND
TELEHEALTH IS REALLY AN
INTERESTING SPACE.
AGAIN, BUILDING OFF THAT IDEA OF
HOW DO WE USE TECHNOLOGY TO MAKE
OUR CLINICIANS MORE PRODUCTIVE,
THERE'S OPPORTUNITIES THERE,
THIS IS SOMETHING IN THE
AFTERNOON WE'LL DISCUSS MORE.
BUT THAT GETS ME EXCITED ABOUT
WHERE WE'RE HEADED.
>> THANK YOU.
>> I'M EXCITED ABOUT THINKING
ABOUT HOW WE UNDERSTAND THE
CONTINUUM OF CARE, HOW WE HAND
PATIENTS OFF FROM ASYNCHRONOUS
TO SYNCHRONOUS TO IN-PERSON CARE
AND DO THAT IN A WAY THAT MEETS
PATIENTS' NEEDS AS SEAMLESSLY AS
POSSIBLE.
I'M EXCITED ABOUT THINKING ABOUT
THE MORE LONGITUDINAL PATTERNS
OF CARE SO NOT THE TELEHEALTH
VERSUS IN-PERSON VISITS ON THEIR
OWN BUT OVERALL ONE OF MY
COLLEAGUES STATED LOOKING AT A
PRACTICE WHERE THERE IS
TELEHEALTH AND IN-PERSON CARE
VERSUS IN-PERSON ONLY AND HOW
DOES THAT CHANGE THE CARE THAT
PEOPLE RECEIVE.
AND THEN CONTINUING TO
PRIORITIZE SESSIONS OF EQUITY
AND AS WE'RE THINKING ABOUT
THESE QUESTIONS.
>> I'M A SIMPLE GUY, EXCITED THE
NIH IS HAVING A PANEL LIKE THIS.
I'VE SEEN WHAT RESEARCH IS
NECESSARY, AND TO ME THAT'S
ACTUALLY THE MOST EXCITING THING
THAT'S HAPPENED IN THE RECENT
PAST.
>> EXCELLENT.
WELL, THANK YOU ALL.
AND SINCE WE HAVE SOME TIME I'LL
SHARE WHAT I'M EXCITED ABOUT AS
A PRIMARY CARE DOCTOR, THINKING
ABOUT BURNOUT AND THE WORKFORCE,
EXCITED WHAT TELEHEALTH CAN
OFFERED FER OFFER TO THE FRONT
LINE CLINICIAN, TEAM-BASED
MODELS ACCESSIBLE TO PATIENTS,
GIVING OUR PATIENTS MORE
OPPORTUNITIES.
I'M CONCERNED ABOUT THOSE
PATIENTS WHO ARE FALLING THROUGH
THE CRACKS AS WE TALK ABOUT
LIMITED DIGITAL LITERACY, AND
LIMITED ENGLISH PROFICIENCY.
AND I THINK A LOT OF THOSE
SOLUTIONS HIGHLIGHTED IN THIS
PANEL ARE VERY PROMISING AREAS
TO INVESTIGATE WHEN WE THINK
ABOUT IMPLEMENTATION RESEARCH.
SO WITH THAT, I JUST WANT TO
THANK THE PANEL.
THIS WAS GREAT.
AND I'LL TURN IT OVER TO OUR
FACILITATORS FOR THE NEXT STEPS.
THANK YOU VERY MUCH.
>> THANKS, ALL.
>> THANK YOU.
WE HAVE A LOT OF WORKSHOPS LIKE
THESE.
IT'S NOT JUST THIS ONE, DR.
HOLLANDER.
WHEN WE HAVE MORE ABOUT
TELEHEALTH AND OTHER TOPICS I'LL
START FORWARDING THEM TO YOU.
EVEN BACK IN 2022 WE HAD ALSO
THE FEDERAL PARTNERS PROGRAM
WHICH WAS A WORKSHOP ENGAGING
NIH AND HHS AND OTHER
DEPARTMENTS IN THE U.S.
GOVERNMENT DISCUSSING
PROVIDER-TO-PROVIDER TELEHEALTH
AND A LOT OF PUBLICATIONS THAT
CAME FROM THAT MEETING.
PERHAPS I'LL SHARE THOSE IN THE
CHAT COMING ALONG.
NOW WE HAVE A BRIEF BREAK, A
BREAK OF ABOUT 45 MINUTES OR SO
TO GET LUNCH.
ON THE WEST COAST, PERHAPS
MID-BREAKFAST, I'M NOT SURE.
WE'LL RETURN WITH THE SMALL
GROUP DISCUSSIONS.
SMALL GROUP DISCUSSIONS,
EVERYBODY WILL BE DIVIDED INTO
THE GROUP THEY CHOSE WHEN THEY
REGISTERED.
JOINING VERSUS VIDEOCAST YOU
WON'T BE ABLE TO JOIN THE SMALL
GROUPS, ONLY THOSE WHO
REGISTERED AND ARE JOINING VIA
ZOOM.
IF YOU ARE REGISTERED AND YOU'RE
WATCHING NOW VIA VIDEOCAST, IT'S
A GREAT MOMENT TO JOIN VIA ZOOM.
IF YOU ALREADY JOINED VIA ZOOM,
OUR SUPPORT TEAM IS GIVING US
ADVICE TO NOT LOG OFF, JUST STAY
MUTED WITH YOUR CAMERA TURNED
OFF AND WE'LL SEE EACH OTHER AT
1:40 P.M. EASTERN TIME.
SEE YOU IN A LITTLE BIT.
>> WE HAVE FOUR GROUPS LED BY
AMAZING PANELISTS AND MODERATORS
TODAY, TRANSFORMATIVE
TECHNOLOGIES, SHAPING THE FUTURE
OF REMOTE CARE, I'LL START WITH
YOU.
WE'LL START WITH THE OFFICE OF
DISEASE PREVENTION AT THE
NATIONAL INSTITUTES OF HEALTH.
SO, BOB, CAN YOU GIVE US A QUICK
SUMMARY OF WHAT WERE SOME HIGH
YIELD, IF ANYONE IN THE GROUP
ALSO WANTS TO ADD MORE COMMENTS
TO THE CHAT PLEASE GO AHEAD.
WE'LL CALL EACH GROUP, STARTING
WITH YOU, BOB.
>> THANK YOU, FERNANDO.
WHAT A GREAT GROUP FROM AROUND
THE WORLD, PEOPLE DOING ALL
KINDS OF WORK NOTE -- NOT JUST
HEALTH CARE BUT ANCILLARY
GROUPS, FOOD AND BEVERAGE
INDUSTRY, A BUNCH OF
PERSPECTIVES TO BRING TO BEAR.
FOR FOLKS TO KNOW THE MAIN
OBJECTIVE IN OUR GROUP WAS TO
TRY TO HIGHLIGHT RECENT AND
UPCOMING INNOVATIONS IN
TELEHEALTH SUCH AS A.I., REMOTE
MONITORING, AND INTEGRATION IN
EXISTING HEALTHCARE SYSTEMS.
OF COURSE WE TOUCHED A LOT ON
A.I.
A.I. CAME UP FREQUENTLY AS A
THEME.
AND ESPECIALLY WITH INTEGRATION
WITH TELEHEALTH.
HOW IT MIGHT DECREASE THE BURDEN
ON CLINICIANS, TOOLS AROUND
SUMMARIZING VISIT DATA OR
PUTTING NOTES IN THE EMRs, BUT
ALSO EMPOWERING PATIENTS, HAVING
THAT ADDITIONAL INFORMATION
ABOUT PATIENTS TO TAKE CARE OF
THEMSELVES.
WE TALKED ABOUT WEARABLES, MANY
CAPACITIES, NOT JUST SMARTWATCH
BUT FOR SLEEP APNEA, PROMOTE
WOMEN'S HEALTH, UNDERSTAND
CONDITIONS.
ONE OF THE THINGS THAT I THINK A
THEME FOR ME THAT CAME UP
THROUGH ALL THESE CONVERSATIONS
AROUND HOW A.I. AND POTENTIALLY
WEARABLES, REMOTE PATIENT
MONITORING, AND OTHER TOOLS CAN
BE A CHALLENGE IS REALLY AROUND
THE QUESTION, IS MORE DATA
BETTER, AND WHETHER THAT DATA IS
GOING TO THE CLINICIANS, AND
THEY HAVE TO MAKE DECISIONS ON
WHETHER TO ACT ON IT OR NOT, OR
WHETHER THAT DATA IS GOING TO
PATIENTS AND THEY HAVE TO
UNDERSTAND WHETHER IT'S
MEANINGFUL OR NOT OR USEFUL.
SO REALLY THE THEME ABOUT MORE
DATA COULD BE COOL BUT WILL IT
ACTUALLY BE JUST INTERESTING OR
WILL IT BE USEFUL.
I THINK ONE INTERESTING MODEL
FOR HOW WE THINK ABOUT THAT WAS
WE HAD A BRIEF DISCUSSION ABOUT
PAIN AND HOW WE START TO SCALE A
PATIENT'S PAIN, ON A 1-10, AND
USUALLY AS ONE OF OUR
PARTICIPANTS SAID I CAN ALWAYS
ANTICIPATE THEY ARE COMING TO
SEE ME, PAIN IS A 7, 8, OR 9.
THE QUESTION WHAT DOES THAT MEAN
FOR THE INDIVIDUAL, PEOPLE WERE
ASKING WHAT'S A 7 OR 8?
IS THERE A WAY TO QUALIFY THAT A
LITTLE BIT?
AND PARTLY THIS WAS THE VALUE OF
IS THAT DATA USEFUL TO US, WHAT
DO WE DO TO ACT ON IT AND ARE
THERE WAYS TO QUALIFY, MAKE IT
MEANINGFUL AND PERSONAL, ALL
DATA ISN'T NECESSARILY BETTER,
IF IT'S ACTIONABLE, HELPS
IMPROVE THE CARE WE DELIVER AND
HELPS CONNECT PATIENTS BETTER TO
THE CARE THEY NEED.
SO THOSE ARE A FEW OF MY
TAKEAWAYS.
WE HAVE A COUPLE SLIDES, GREAT
CHAT, GOOD DISCUSSIONS ON A
VARIETY OF THINGS.
IS THERE ANYBODY FROM THE SMALL
GROUP WHO WANTED TO HARP ON A
POINT I MAY HAVE LEFT OUT?
I'D LOVE TO HEAR ANY OTHER
THINGS.
>> I WROTE DOWN IS MORE DATA
BETTER.
>> YEAH.
>> BECAUSE I THINK WE'RE ALL
GUILTY OF THAT.
I SEE SO MANY PEOPLE WE GO
CONFERENCES, TAKE PHOTOS EVEN OF
THE SLIDE OF THE SPEAKERS, OH,
THIS IS AMAZING, AND WE NEVER
LOOK AT THAT DATA AGAIN.
I THINK MANY TIMES WE COLLECT SO
MUCH DATA AND THAT GOES
UNNOTICED.
SO THIS QUESTION OF LIKE WHO IS
ACCESSING IT, THE PHYSICIAN,
MEDICAL TEAM, IS IT THE PATIENT,
YOU KNOW.
>> ABSOLUTELY.
I'LL JUST SAY WHILE WE'RE
WAITING, WE CAN MOVE ON TOO,
DOES THIS DATA HELP TO BRIDGE
THE EQUITY GAPS WE'VE BEEN
TALKING ABOUT SO MUCH.
IT WAS HIGHLIGHTED VERY NICELY
THAT EQUITY DOESN'T MEAN
EVERYBODY GETS THE SAME THING,
PEOPLE GET WHAT THEY NEED.
AND ARE THERE WAYS WE CAN --
A.I., WEARABLES OR OTHER
TECHNOLOGIES CAN HELP GET THEM
THERE.
>> IT'S A QUESTION OF LIKE ARE
WE COLLECTING DATA BECAUSE WE
CAN OR IS THERE A PLAN FOR THAT
DATA?
>> DOES IT HAVE MEANING.
>> YEAH.
>> THANKS FOR THE OPPORTUNITY TO
REPORT OUT.
A GREAT WORKSHOP.
THANK YOU FOR THIS, FOR YOUR
WORK, FERNANDO.
>> MOVING ON NOW TO OUR SMALL
GROUP 2, TELEHEALTH POLICY AND
EQUITY, BRIDGING GAPS IN ACCESS
AND CARE, I CALL THE CHIEF FOR
HEALTH COMMUNICATION INFORMATICS
RESEARCH BRANCH HERE AT NCI OF
THE NIH.
ROBIN, WELCOME.
>> THANK YOU.
I'VE BEEN HAVING AUDIO ISSUES,
CAN YOU HEAR ME?
>> NO PROBLEMS.
IF THERE'S PROBLEM WE'LL LET YOU
KNOW.
>> GREAT.
QUICKLY, I THINK YOU CAN
IMAGINE, ALREADY KNOW MANY OF
THE SOCIAL DETERMINANTS OF
HEALTH THAT WOULD AFFECT ACCESS,
AND EQUITABLE ACCESS AT THAT TO
TELEHEALTH SERVICES.
AND SO WE CERTAINLY IDENTIFIED
EVERYTHING FROM TRANSPORTATION
AND EDUCATION AND FOOD
INSECURITY TO FINANCIAL
RESOURCES, FAMILY INCOME,
BROADBAND ACCESS, DEFINITELY WAS
PART OF OUR CONVERSATION.
BUT THEN I THINK, YOU KNOW, A
NEWER COMPONENT THAT WE THINK
ABOUT RELATED TO HEALTH LITERACY
IS DIGITAL LITERACY, RIGHT?
THINKING ABOUT HOW PATIENTS, YOU
KNOW, REALLY PERCEIVE THIS
TECHNOLOGY, ARE THEY ABLE TO USE
IT, DO THEY HAVE AN E-MAIL
ADDRESS THAT ALLOWS THEM, YOU
KNOW, TO EVEN GET THE LINK TO
LOG IN TO THE TELEHEALTH
ENCOUNTER, FOR EXAMPLE.
AND THEN MAKING SURE PATIENTS
HAVE ACCESS TO THE DEVICES,
SOFTWARE, EQUIPMENT, WHATEVER
TECHNOLOGY IS NEEDED TO ACCESS
THOSE TELEHEALTH SERVICES.
AND SO WE SPENT THE REST OF THE
TIME THINKING ABOUT OBVIOUSLY
WHAT STRATEGIES, WHAT RESEARCH,
WHAT COMMUNITY PARTNERSHIPS CAN
BE FACILITATE AND LEVERAGED TO
IMPROVE ACCESS TO TELEHEALTH
SERVICES, TO ADDRESS THESE
SOCIAL DETERMINANTS OF HEALTH.
AND OUR GROUP REALLY HAD LOT OF
THOUGHT AND INTERACTION, FOR
EXAMPLE, AROUND WORKING WITH
PUBLIC LIBRARIES OF THOSE BEING
REALLY STRONG COMMUNITY, YOU
KNOW, POINT OF CONTACT FOR FOLKS
TO COME IN AND ACCESS BOTH THE
INTERNET, TO ACCESS ACTUAL
COMPUTER SERVICES, BUT ALSO AS
YOU KNOW LIBRARIES CAN PROVIDE
TRAINING SERVICES AND CLASSES
ABOUT WHAT IS TELEHEALTH, WHAT
IS YOUR EHR PORTAL AND HOW DO
YOU ACCESS THAT.
WE TALKED ABOUT FAITH
ORGANIZATIONS, FAITH MINISTRIES,
SCHOOLS WHO OFTEN SERVE AGAIN AS
A RESOURCE HUB IN OUR
COMMUNITIES AND HOW THOSE COULD
BE LEVERAGED TO ACCESS
TELEHEALTH SERVICES.
WE ALSO TALKED A LOT ABOUT
TECHNICAL ASSISTANCE AND
TRAINING FOR PATIENTS AND THEIR
CAREGIVERS ON HOW TO JUST LEARN
HOW TO USE TELEHEALTH.
WHAT DOES THE EHR PORTAL OFFER
ME?
HOW DOES A TELEHEALTH ENCOUNTER
WORK?
CAN WE WORK THROUGH SOME OF THE
BUMPS AND BUGS OF GETTING FOLKS
LOGGED ON SO THEY ARE READY TO
GO WHEN THE PROVIDER IS PRESENT
IN THE VIRTUAL ROOM.
SO THINKING ABOUT TELEHEALTH
COORDINATORS, TELEHEALTH
NAVIGATORS.
AND THEN AGAIN UNDERSTANDING
PATIENT PREFERENCES AND
SATISFACTION WITH DIFFERENT
ROUTES OF DELIVERING TELEHEALTH,
WHETHER ON COMPUTER OR
SMARTPHONE OR AUDIO ONLY.
BUT THEN REALLY GETTING INTO
USABILITY, COMFORTABILITY,
SATISFACTION, YOU KNOW, SO WE
CAN MEET PATIENTS WHERE THEY
ARE.
AND I THINK, YOU KNOW, THEN
THINGS WE TALKED ABOUT THIS
MORNING RESONATED WITH US AROUND
FOCUSING ON OUTCOMES, HOW DOES
TELEHEALTH IMPROVE OUTCOMES
RELATED TO IMPROVEMENTS IN
NO-SHOW RATE, ACCESS IN
SPECIALTY CARE, HOW DOES IT COME
COMPLEMENT IN PATIENT OR
IN-PERSON SERVICES.
AND JUST DEEP DIVES IN THE DATA
TO HELP US UNDERSTAND
DISPARITIES, MAYBE WE NEED TO BE
WORKING WITH EHR COMPANIES AND
TELEHEALTH DIRECT-TO-CONSUMER
COMPANIES TO SEE WHO IS
ACCESSING TELEHEALTH AND WHO IS
NOT ACCESSING TELEHEALTH.
AND I THINK WITH THAT I'LL
PROBABLY -- OH, OF COURSE ONE OF
THE BIGGER POINTS WE TALKED
ABOUT IS HOW TO IMPROVE THE
CROSS--STATE-LINE ISSUES WE SEE
RIGHT NOW AND EVERYBODY CAME
BACK TO FLEXIBILITY, NATIONAL
POLICIES, DOING EDUCATION AND
OUTREACH TO POLICYMAKERS ARE
IMPORTANT, AND IMPROVING
REIMBURSEMENT AND WE HAD
DISCUSSIONS ABOUT IMPROVING OUR
OFFERING OF LANGUAGE TRANSLATION
SERVICES FOR TELEHEALTH USE AND
MAYBE HOW COULD YOU USE
TECHNOLOGY TO TRANSLATE IN REAL
TIME.
I KNOW THAT COULD BE PART OF OUR
CONVERSATION LATER THIS
AFTERNOON.
WITH THAT I WANT TO MOVE, I KNOW
WE'RE SHORT ON TIME BUT THOSE
WERE GREAT CONVERSATION STARTING
POINTS IN OUR GROUP.
>> THANK YOU, ROBIN AND GROUP 2.
I WAS ALSO THINKING HERE THAT
NOT ONLY THE HEALTHCARE
PROFESSIONALS ALSO HAVE THE
CHALLENGE WITH ELECTRONIC
MEDICAL RECORDS YET EXPECT
PATIENTS USING PLATFORMS TO
FULLY UNDERSTAND THEM WHEN EVEN
THOSE NOT USING THEM DAY, IT
SEEMS LIKE YOUR GROUP DISCUSSED
THIS PROCESS OF CAPACITY
BUILDING.
I LIKE WHAT YOU SAID ALSO
TAPPING INTO THE CAREGIVER, ARE
CARE GIVERS HELPING TRAIN AND
BRINGS TO MIND SOMETHING I
STARTED IN UNITED STATES
SCHOOLS, HERE IN VIRGINIA, WE
ALSO HAVE IT, WHICH IS DIGITAL
CITIZEN IS ONE OF THE COURSES
NOW THEY OFFER FOR CHILDREN,
WHEN THEY ARE IN FIFTH GRADE,
ABOUT TEACHING THESE FIFTH
GRADERS HOW THEY BECOME
PEOPLE -- THEY TALK ABOUT
PHISHING, SCAMS, PROFILES,
SHARING INFORMATION, PERHAPS
SOMETHING WE CAN FOCUS ON
CAPACITY BUILDING.
NOW GIVEN THE LAST QUESTION,
BACK TO YOU, ROBIN, WHEN WE
DISCUSSED THIS CHANGING POLICY
THAT YOU ARE PROPOSING OBVIOUSLY
ALL THESE CHALLENGES ARE
MULTI-FACTORIAL.
AND WE TALK ABOUT CHANGING
POLICIES, CREATING MORE
FLEXIBILITY OF THE POLICIES, HOW
CAN THE RESEARCH ACTUALLY INFORM
THESE POLICIES, WHAT WAS
DISCUSSED IN YOUR GROUP IN TERMS
OF NEXT STEPS IN RESEARCH?
>> YEAH, I THINK -- WELL, WE
RANGE ON A LOT OF TOPICS,
LEVERAGING DATA, USING DATA
THAT'S AVAILABLE SO THAT'S MAYBE
DATA WE HAVEN'T TAPPED INTO
FULLY YET TO REALLY UNDERSTAND
THE PROBLEM, RIGHT?
THAT'S ALWAYS AN IMPORTANT FIRST
STEP.
AND THEN I THINK THERE WAS THESE
PIECES AROUND DO WE STOP AND
REALLY DO MAYBE SOME OF THE
QUALITATIVE, IF YOU WILL, WORK
OR USABILITY WORK WITH PATIENTS
AND CAREGIVERS, AND PROVIDERS,
TO REALLY UNDERSTAND THEIR
PREFERENCES, THEIR SATISFACTION,
THEIR USABILITY.
YOU KNOW, REALLY THAT
PATIENT-CENTERED APPROACH TO
FIGURING OUT WHAT WORKS FOR THEM
AND DOING THE -- DELIVERING
TAILORED INTERVENTIONS AND
PROGRAMMING AFTER THAT.
CERTAINLY FOR THE LARGER POLICY
PIECE, I THINK WHERE WE CAN
COLLECT, FOR EXAMPLE, YOU KNOW,
USE DATA, QUALITY METRICS, YOU
KNOW, REALLY CHANGING I WOULD
ARGUE SOCIAL NORMS AROUND
TELEHEALTH, I THINK THAT FEEDS
TO WHAT POLICYMAKERS NEED AS THE
EVIDENCE THAT TELEHEALTH IS A
GOOD THING AND THAT WE NEED TO
CONTINUE IMPROVING THE
FLEXIBILITY'S REIMBURSEMENT,
LICENSURE ISSUE, ET CETERA, TO
MAKE THIS MORE WIDESPREAD, MORE
SCALABLE, MORE ACCESSIBLE.
>> PERFECT.
THANKS SO MUCH, ROBIN.
I APPRECIATE IT.
THANK YOU, GROUP 2.
NOW WE MOVE FOR THE REPORT FROM
GROUP 3, INFRASTRUCTURE AND
TECHNOLOGICAL CHALLENGES, PEOPLE
WERE HIGHLY ENGAGED, WE BARELY
FELT MOTIVATED TO COME BACK TO
THE MAIN ROOM BECAUSE WE WANTED
TO STAY THERE.
I INVITE DR. LOK SAMSON, HHS
OFFICE OF ASSISTANT SECRETARY
FOR PLANNING, PLEASE FEEL FREE
TO SHARE YOUR PERSPECTIVES.
>> OUR GROUP DUG INTO TELEHEALTH
INFRASTRUCTURE AND TECHNOLOGICAL
BARRIERS.
WE HAD A GOOD USE CASE FOR
PEDIATRIC TELEREHAB, THERE WAS
INFRASTRUCTURE VARIANTS IN TERMS
OF EQUIPMENT, EXERCISE
EQUIPMENT, AFFORDABILITY FOR
PATIENTS, BUT ALSO ESPECIALLY
FOR PEDIATRICS, ALL THE DEVICES
ARE NOT REALLY DESIGNED FOR
CHILDREN.
THERE ARE PRIVACY AND LIABILITY
ISSUES WITH HAVING CHILDREN
DIRECTLY USE THESE APPS,
CONNECTED TO EXERCISE EQUIPMENT,
AND WORK-AROUND USING PARENT'S
PHONE, PARENT'S ACCOUNTS, THIS
MIGHT BE A TEENAGER THAT HAS THE
EQUIPMENT, HAS A PHONE THAT
CAN'T USE THEIR OWN PHONE.
THERE WERE ALSO SPECIAL
POPULATIONS WHERE THERE MIGHT BE
HESITANCY TO USE INTERNET AND
OTHER TECHNOLOGIES, AND MIGHT
NEED SPECIAL EXEMPTIONS FROM
RELIGIOUS LEADERS TO USE THESE
KINDS OF TELEHEALTH
TECHNOLOGIES.
IN TERMS OF AFFORDABILITY SOME
WORKAROUNDS IN GETTING INTERNET
ACCESS AT LEAST FOR RESEARCHERS
WHO HAVE GRANTS MIGHT BE TO
OFFER A SIM CARD, ESPECIALLY IN
RURAL AREAS WHERE THERE'S NO
BROADBAND ACCESS.
SO THESE EXAMPLES GIVE A FLAVOR
OF THE ON-THE-GROUND BARRIERS
PATIENTS ARE FACING WHERE
TELEHEALTH COULD HAVE A LOT OF
IMPACT ESPECIALLY IN RURAL AREAS
WHERE PEOPLE DON'T HAVE THAT
BROADBAND ACCESS.
ADDITIONAL WORKAROUNDS EXAMPLES
INCLUDED PATIENTS GOING TO THE
SCHOOL TO ACCESS EQUIPMENT AND
THE INTERNET.
AND I GUESS THE QUESTION HERE
WAS FROM THE GROUP, WHAT KIND OF
RESEARCH DO WE NEED, WHO DOESN'T
HAVE ACCESS, WHAT DO WE REALLY
KNOW ABOUT THESE SPECIAL GROUPS.
THERE WAS ALSO POLICY
LIMITATIONS, ESPECIALLY IN TERMS
OF EQUIPMENT, OFTEN HALF THE
TOOLS USE A MULTI-PAYER APPROACH
TO THEIR RULES, AND THERE ARE
LIMITS ON WHAT AMOUNT OF GIFTS
PATIENTS CAN RECEIVE EVEN IN THE
FORM OF EQUIPMENT.
SO THIS SORT OF BRINGS SORT OF
TELEHEALTH AND THE INTERSECTION
WITH HEALTHCARE POLICIES
TOGETHER.
ONE THOUGHT ALSO WAS THAT IN
TERMS OF INTERNET ACCESS, WHAT
DO WE KNOW ABOUT THE IMPACT OF
THE BROADBAND AFFORDABILITY
CONNECTIVITY PROGRAM THAT
RECENTLY ENDED.
AND, YOU KNOW, ARE THERE -- IS
THERE RESEARCH THAT CAN TELL US
IF IT IMPROVED ACCESS OR IF
THERE'S STILL OPPORTUNITIES TO
IMPROVE ACCESS FOR SPECIAL
POPULATIONS.
IN TERMS OF THE SECOND QUESTION
WE EXPLORED INTEROPERABLE DATA
EXCHANGES, AN AREA WITH
DISCUSSION ABOUT LIMITED ACCESS
TO DATA FROM WEARABLES,
CHALLENGES IN PULLING DATA
ACROSS DIFFERENT VENDORS,
ESPECIALLY FOR RESEARCH, AND
WITH CHANGES IN TECHNOLOGY AS
THE MARKET CHANGES THERE'S
REALLY NO CENTRAL PLATFORM FOR
DATA SHARING, WHICH MAKES IT
CHALLENGING FOR RESEARCHERS AND
ALSO PARTICIPANTS WHO MAYBE
HAVING DIFFERENT DEVICES WANT TO
USE THE INFORMATION FOR THEIR
OWN CARE.
ONE AREA WE DISCUSSED WAS
ELIMINATING CONTEXT ESPECIALLY
WITH WEARABLE DATA.
IT'S DIFFICULT TO INTERPRET THE
MEANING OF THE WEARABLE
INFORMATION WITHOUT KNOWING WHAT
MEDICATIONS OR LIFESTYLE CHANGES
A PATIENT MIGHT BE UNDERTAKING.
AND THAT MAKES IT HARDER FOR
CLINICIANS TO USE THAT
INFORMATION.
LET'S SEE.
THERE ARE ALSO SORT OF
TECHNOLOGICAL LIMITATIONS, JUST
MAKING DATA USEFUL FOR PATIENTS,
PATIENTS REQUIRED TO WEAR THE
DEVICE FOR THREE DAYS TO
ESTABLISH A BASELINE SO SOME
QUESTIONS IS THERE A NEED FOR
TRIALS OF REMOTE PATIENT
MONITORING, WITH CURRENT TOOLS
ON THE MARKET MIGHT BE
INSUFFICIENT RIGHT NOW TO
DETERMINE WHAT REALLY WORKS.
BUT THERE ARE GROWING
OPPORTUNITIES, ESPECIALLY WITH
NEW DEVICES, SUCH AS BIOCHEMICAL
PATCHES FOR MONITORING THAT
WOULD BETTER SUPPORT CORRELATION
BETWEEN THE WEARABLE INFORMATION
AND OUTCOMES THAT THAT'S WHAT
CLINICIANS WANT.
>> THANK YOU.
I SEE SIMILARITIES ON WHAT
YOU'RE SAYING AND WHAT ROBIN
JUST SAID ALSO ABOUT THE
FLEXIBILITY OF POLICIES, A LOT
OF THINGS THAT BOB HAS SPOKEN
ABOUT HOW MUCH COLLECTION OF
DATA IS USEFUL.
FOR YOUR PARTICULAR SMALL GROUP
SESSION, A LOT OF THIS WILL BE A
SEGUE TO THE NEXT SESSION AFTER
WE FINISH THIS REPORT-BACK WHICH
WILL FOCUS ON mHEALTH AND
REMOTE MORE
REMOTE MONITORING AND DATA
ANALYSIS, ALSO WHEN DATA ARE
COLLECTED FROM MULTIPLE
PLATFORMS THAT DON'T SPEAK WITH
ONE ANOTHER HOW CAN WE
INTEGRATE.
WE APPRECIATE GROUP 3 FOR THE
FEEDBACK.
>> THANK YOU.
>> WE MOVE NOW TO OUR LAST
GROUP, SMALL GROUP 4, ENHANCING
PATIENT ENGAGEMENT AND
SATISFACTION THROUGH TELEHEALTH.
NOW THE DIRECTOR FOR PRACTICE
IMPROVEMENT, CENTER FOR EVIDENCE
AND PRACTICE IMPROVEMENT AT
AHRQ.
PLEASE TAKE IT AWAY.
>> WE HAVE A SMALL GROUP,
EVERYBODY REALLY ENGAGING WITH
DISCUSSIONS AND PLEASE CORRECT
ME, FEEL FREE TO JUMP IN IF I
MISSED ANYTHING.
OUR TARGET TO LOOK AT STRATEGY
FOR PATIENT ENGAGEMENT AND
SATISFACTION IN TELEHEALTH WHICH
WE ALL FEEL CRITICAL, ESSENTIAL
TO ENGAGING THE PROVIDERS,
HEALTHCARE SYSTEMS, ENGAGING
PATIENT AND COMMUNITY TO MAKING
SURE HOLISTIC APPROACH AND
PATIENT PERSON-CENTERED CARE FOR
THE PATIENT, WE LOOK AT THE
USING TELEHEALTH, ENHANCED
PATIENT ENGAGEMENT AND
SATISFACTION, INCLUDING
PATIENT-CENTERED ENGAGEMENT, WE
FEEL IS THE KEY, ALSO LEVERAGE
PARTNERSHIPS WITHOUT SIDE
SERVICES, PARTNERS, FOR EXAMPLE,
VIA
SEE -- V.A. HAS BEEN DOING TO
MAKE SURE BROADBAND INTERNET
ACCESS IS AVAILABLE TO THOSE
WITH CHALLENGES, DO NOT HAVE
RESOURCES TO ACCESS TELEMEDICINE
AND ENGAGE PARTNERS TO COLLECT
PATIENT SURVEYS, INTERVIEWS TO
GET PERSPECTIVES TO FIND METHODS
FOR CARE BEST FIT FOR PATIENT
AND POPULATION HAS BEEN
EVIDENCE.
WE ALSO GOT SUGGESTED USING
DIGITAL PLATFORM TO ADDRESS HIGH
PATIENT LOAD AND SOMETIMES LACK
OF PROVIDERS IN DIFFERENT AREAS,
LESSONS FROM INDIA SHARED, LOOK
AT DIGITAL INFRASTRUCTURE
LACKING IN NOT ONLY INDIA BUT
ALSO IN UNITED STATES, MANY
TIMES DESPITE A LOT OF
INVESTMENT ALREADY HAPPENING IN
THE FIELD.
WE LOOK AT QUESTIONS ABOUT
TELEHEALTH PLATFORMS, WHAT ARE
MOST AVAILABLE TO THE PATIENTS
AND HOW CAN THIS BE OPTIMIZED,
WE REALIZE V.A. HAD EXPERIENCE
WORKING WITH LOCAL COMMUNITY
ACCESS POINTS TO FACILITATE.
AGREEMENTS WITH LIBRARIES,
COMMUNITY CENTERS, TO
SYNCHRONIZE CONNECTIONS WITH
PROVIDERS ADDING SATISFACTION
AMONG VETERAN PATIENTS, REDUCING
TRAVEL BURDEN, AND WE FOUND
ONLINE PORTALS TO FACILITATE
MEDICATION RENEWS MAKING
APPOINTMENT, MESSAGING
PROVIDERS, EVEN SHARING IMAGES
AND HEALTH DATA HIGHLIGHTED BY
THE PATIENTS, WE NEED TO ALSO
OPTIMIZE APPROACHES FOR THESE
WITH DIAGNOSIS
MAKING SURE THEY GET TREATMENTS
THROUGH SYSTEM MAKING SURE WE
DON'T MISS ANY PATIENT, ADDING
PREVENTION COMPONENT.
AND ALSO HOW TO PROVIDE CARE TO
IMPROVE ACCESS TO CARE USING
TELEMEDICINE AND OTHER
TECHNOLOGIES, SOMETHING OUR
GROUP ALSO VERY INTERESTED TO
TALK ABOUT.
LEVERAGING TEAM-BASED APPROACH,
PRIMARY CARE PROVIDERS, OTHER
NURSE SPECIALTIES, AND OTHER
PROVIDERS IN ORDER TO HAVE
PROVIDER HOLISTIC APPROACH CARE
TO THE PATIENT, THAT'S ALSO
SOMETHING WE HAD SOME
DISCUSSIONS ABOUT.
NEXT WE TALKED ABOUT ADDITION TO
PROVIDER HOW THE SYSTEM CAN
TAILOR COMMUNICATIONS TO REACH
OUT DIVERSE PATIENTS, WE USED
EXAMPLES ALSO FROM V.A., THEY
HAD THE SOCIAL NEEDS SCREENING
WHICH HELPS ASKING THE PATIENTS
FIRST AND TRY TO IDENTIFY
DIFFERENT VETERANS, WHAT THEY
NEED, THEIR BARRIERS IN ORDER TO
OVERCOME THE DIGITAL DIVIDE,
THEN PROVIDE THEM WITH DIFFERENT
CONSULT FOR EDUCATION AND LOAN
DEVICE TO HAVE ACCESS TO CARE,
APPLICATION TO ACCESS HEALTH
CARE PORTALS BEST.
THERE ARE PILOT STUDIES FOR
DISABILITY AND APPROPRIATENESS
TO UNDERSTAND PATIENT STANDARD
FOCUS HAS BEEN IMPLEMENTED IN
V.A. AND IN OTHERS.
ONE PARTICIPANT MENTIONED IN
INDIA THERE ARE OVER 200
LANGUAGES SPOKEN SO MAKING IT
VERY IMPORTANT TO HAVE A DIGITAL
PLATFORM PROVIDE A LANGUAGE TO
EVERYBODY WHO CAN UNDERSTAND AND
ACCESS HEALTHCARE SERVICES IN
THIS CASE.
SOME OF THE TOOLS PROVIDED BY
V.A. INCLUDING HEALTH PORTAL,
ATLAS PROGRAM, INDIAN NATIONAL
PROGRAM, WHICH IS NATIONAL
PROGRAM SUPPORTED BY INDIAN
GOVERNMENT.
AND ALSO CURRENT APP USED IN
WAKE FOREST SO PATIENTS CAN
ACCESS THAT.
WE DISCUSSED THE ROLE OF
CAREGIVERS, V.A. HAVE GREAT
EXAMPLES IN THIS CASE, VERY
ENGAGING PROVIDERS, AND THEIR
CAREGIVERS OF THE PATIENTS, THEY
WILL BE INVOLVED IN THE
BEGINNING OF THE CARE AND TO
HELP WITH DIGITAL NAVIGATION OF
THE PATIENTS, WE ALSO DISCUSSED
ABOUT HIPAA ISSUES, MAKING SURE
PERMISSIONS AND CONSENT ARE
AVAILABLE FOR THE CAREGIVERS IN
ORDER TO BE PART OF THE
HEALTHCARE SYSTEM.
THERE ARE A LOT WE HAVE JOINED
IN DISCUSSION, LET ME KNOW.
>> THANK YOU, GROUP 4.
THIS WORKSHOP IS MEANT TO BE A
CONVERSATION TO HEAR ABOUT YOUR
CHALLENGES, OPPORTUNITIES OF
RESEARCH, I THINK THE SMALL
GROUP DISCUSSIONS WERE
PHENOMENAL TO ACHIEVE THAT GOAL.
THANKS TO ALL FOUR GROUPS.
WE ORIGINALLY HAD 15-MINUTE
BREAK HERE.
BECAUSE OF TECHNICAL CHALLENGES
DURING THE SPLIT OF THE SMALL
GROUPS, WE ARE GOING TO REDUCE
THIS TO FIVE MINUTES AND WE'LL
COME BACK AT 3:05 EASTERN TIME.
THANK YOU, EVERYONE.
SEE YOU IN FIVE MINUTES.
OR SIX ACTUALLY, YOU HAVE ONE
MORE MINUTE.
THANK YOU, MODERATORS.
APPRECIATE IT.
>> WELCOME BACK, EVERYONE.
IT'S TIME TO MOVE TO OUR SESSION
2, BUT THE DAY IS NOT OVER.
WE STILL HAVE MORE THINGS TO
SHARE AFTER SESSION 2 SO DON'T
GO AND LOG OFF AFTER THAT.
SESSION 2 IS mHEALTH, REMOTE
MONITORING, DATA ANALYSIS,
INNOVATIONS DRIVING TELEHEALTH
RESEARCH AND PATIENT OUTCOMES.
I'M WAITING FOR THE NEXT SLIDE
SO YOU GET TO SEE OUR WONDERFUL
PANELIST AND MODERATOR.
I INVITE DR. DAVID, VICE
PRESIDENT OF HEALTH CARE AT
MICROSOFT TO MODERATE THE
SESSION, AND JOINING HIM THREE
WONDERFUL PANELISTS, DR.
KHETEHROP, UNIVERSITY OF
MICHIGAN MEDICAL SCHOOL.
WE HAVE JOSEPH KVEDOR, EDITOR IN
CHIEF OF NPJ JOURNAL AND
PROFESSOR OF DERMATOLOGY,
HARVARD MEDICAL SCHOOL.
WE INVITE DR. LOK SAMSON, HEALTH
POLICY ANALYST, HHS OFFICE OF
THE ASSISTANT SECRETARY FOR
PLANNING AND EVALUATION, THANK
YOU VERY MUCH FOR JOINING US,
AND FOR THOSE WATCHING US, AND,
DAVID, PLEASE TAKE IT AWAY.
>> THANK YOU.
IT'S A PLEASURE TO BE HERE, TO
MODERATE THIS PANEL WITH SOME
ESTEEMED EXPERTS IN THE FIELD,
IN THE SPACE FOR QUITE SOME TIME
AND I'M GOING TO USE THE
OPPORTUNITY TO ASK SOME
QUESTIONS ABOUT SOME OF THEIR
EXPERIENCES AND OBSERVATIONS.
JOE, YOU'VE BEEN LOOKING A LOT
AT TECHNOLOGIES THAT WE'VE SEEN,
WEARABLES, PATCHES.
I'D LOVE TO GET YOUR TAKE IN
TERMS OF WHAT ARE WE SEEING OUT
THERE THAT'S NEW, THAT IS
PROMISING, WHAT ARE THINGS WE
ANTICIPATE?
WILL WE EVER HAVE NON-INVASIVE
GLUCOSE MEASUREMENTS WITH
WEARABLE, I'D LOVE TO GET YOUR
TAKE, WHAT'S POSSIBLE AND WHAT
COULD BE POSSIBLE?
>> WELL, THANK YOU TO THE FOLKS
FROM THE NIH FOR INVITING ME,
I'M DELIGHTED TO MEET YOU.
I DON'T KNOW THAT YOU HAVE AS
MUCH WISDOM TO IMPART HERE AS
YOU HAD HOPED.
I FIELD, IN MY OPINION, IS
STALLED.
WE DID NOW A GOOD 15 YEARS OF
MONITORING STEPS AND NOW WE'RE I
THINK STRUGGLING WITH SLEEP.
ONE THING THAT'S A BREAKTHROUGH,
IN MY OPINION, I'LL GIVE JUST A
QUICK ANECDOTE OF MY OWN HEALTH,
I HAD HEART VALVE REPAIR DONE IN
JUNE.
DURING THE POST-OP PERIOD I HAD
ATRIAL FIBRILLATION, NOW I'M ON
AN ANTICOAGULANT NOW.
MY DOCTOR SAID TO ME, WELL, IF
YOU GET YOURSELF A WATCH THAT
WILL TRIGGER WHEN YOU HAVE
ATRIAL FIBRILLATION WE MIGHT
TAKE YOU OFF THE ANTI-COAGULANT.
THAT'S MAINSTREAM FOR A
WEARABLE, CONSUMER DEVICE, TO BE
RECOMMENDED TO ME BY A
CARDIOLOGIST.
I THINK WE HAVE MADE SOME
STRIDES, THERE'S STILL THAT GAP
BETWEEN MEDICAL DEVICES, HARD
CORE AND CONSUMER WEARABLES, IT
WAS MENTIONED IN ONE OF THE
BREAKOUT GROUPS VAST SEA OF DATA
BUT NONE CONNECTS, I THINK
THAT'S A CHALLENGE.
BUT ONE OF THE THINGS THAT WE DO
SEE A LOT OF NOW IN TERMS OF
SUBMISSIONS TO THE JOURNAL IS
MULTI-MODAL ARTIFICIAL
INTELLIGENCE, GETTING DIFFERENT
DATA STREAMS, COLLECTING THEM
AND GETTING MORE POWER IN THE
FINE TUNING OF THE MACHINE
LEARNING BECAUSE OF THE RICHNESS
OF THE DATA.
SO, I GUESS IT'S A BIT OF A TALE
OF TWO CITIES TYPE ANSWER.
I SEE A LOT OF PROMISE BUT A
LITTLE BIT OF STALLING IN THE
ACTUAL TECHNOLOGY.
>> YEAH, SO ON THE POINT OF THE
ATRIAL FIBRILLATION NOW WE HAVE
TECHNOLOGIES THAT CAN DETECT IT,
IN THE PAST MAYBE WE DIDN'T HAVE
THAT CAPABILITY.
ARE WE FINDING THIS IS -- THE
CONCERN AT THE TIME WAS THIS WAS
GOING TO FLOOD DOCTOR OFFICES
WITH INDIVIDUALS SAYING THIS IS
JUST, YOU KNOW, I'VE GOT A-FIB
OR I'VE GOT SOMETHING I'M
WORRIED ABOUT.
HAVE WE SEEN THAT?
OR WAS THAT CONCERN THAT WAS
JUST MAYBE A LITTLE OVERHYPED?
>> I THINK A LITTLE OVERHYPED.
THAT'S MY OPINION.
I DON'T HAVE DATA BUT I WILL
TELL YOU PEOPLE HAVE LIVES.
THEY ARE NOT SITTING AROUND JUST
WAITING FOR THEIR WATCH TO GO
OFF.
THEY GOT OTHER THINGS TO DO.
AGAIN, I JUST THOUGHT IT WAS
INTERESTING THAT MY OWN
PHYSICIAN WHO ISN'T PARTICULARLY
TECHY, SHE'S JUST A REGULAR GOOD
OLD CARDIOLOGIST, SAID THIS WAS
A TURNING POINT FOR HER.
I THOUGHT THAT WAS MEANINGFUL.
>> ANYTHING ON YOUR END,
SACHIN,LOK?
WE'LL START WITH SACHIN.
>> SURE, THANK YOU.
WE HAD SIMILAR EXPERIENCES AS
WHAT JOE IS MENTIONING, CONCERNS
ABOUT FOLKS BEING FLOODED WITH
FALSE ALARMS IS OVERSTATED.
IT'S ONE OF OUR RESEARCH
PROJECTS, 7,000 APPLE WATCHES
AND BLOOD PRESSURE CUFFS WENT TO
UNIVERSITY OF MICHIGAN PATIENTS,
WITH ENTIRE PROTOCOL SET UP, IF
I HAD ABNORMAL HEART RHYTHM
ALARM ON THE WATCH OR CUFF, WE
HAVE THIS PATHWAY.
WE FOUND, NUMBER ONE, PATIENTS
REALLY, NUMBER ONE, ENJOYED
UNDERSTANDING THEIR HEALTH
BETTER EVEN IF IT WAS A FALSE
ALARM.
I THINK THE VALUE OF A DEVICE
THAT DOES SOME RETURN OF
INFORMATION, ENGAGES THE
PATIENT'S HEALTH, POTENTIALLY
MUCH MORE IMPORTANT THAN THE
RISK OF OCCASIONALLY THOSE
PATIENTS GETTING A BIT ALARMED
BY IT AND GO SEE THEIR DOCTOR.
TURNS OUT THAT ACTUALLY IS
PROBABLY A GOOD INTERACTION
ANYWAY.
VERY FEW FALSE ALARMS -- WE
PUBLISHED THAT RATE, BUT I THINK
I WOULD SECOND THE EXPERIENCE
WHICH IS THE POSSIBLE BENEFIT OF
JUST BEING CONNECTED WITH YOUR
HEALTH IN AN OBJECTIVE WAY,
WHETHER OR NOT IT'S A CLINICALLY
MEANINGFUL OBJECTIVE OUTCOME,
FAR OUTWEIGHS POTENTIAL RISKS OF
FALSE ALARMS.
>> YEAH, LOK, YOUR THOUGHTS?
>> CAN YOU HEAR ME?
>> YES, WE CAN.
>> JUST THINKING IN TERMS OF THE
MEDICARE SPACE, SEEING A LOT OF
UPTAKE OF REMOTE PATIENT
MONITORING ESPECIALLY DURING THE
PANDEMIC.
I THINK THAT REALLY IS GOING TO
ACCELERATE PEOPLE'S INTEREST IN
PARTNERING WITH THEIR HEALTHCARE
PROVIDER, IN UNDERSTANDING THEIR
CLINICAL VITAL SIGNS.
SO I HAVEN'T DONE MUCH RESEARCH
IN THIS AREA BUT IT SOUNDS LIKE
THERE'S AT LEAST HEALTHCARE
INTEREST.
>> ONE THING I'M SEEING,
EXTRAORDINARY, WE'RE MAKING
SIGNIFICANT STRIDES IN TERMS OF
OUR ABILITY TO CAPTURE NEWER
TYPES OF INFORMATION AND WITH
THIS DIFFERENT SENSORS OUT THERE
BECOMING MORE NON-INVASIVE, WE
CAN IDENTIFY THINGS IN THE PAST
WE COULDN'T ENVISION SUCH AS
RIGHT NOW STARTING WITH GLUCOSE,
OF COURSE STARTING TO SEE THAT.
BUT ALSO THINGS SUCH AS SERUM
LACTATE, AND PERHAPS EVEN OTHER
TYPES OF BIOCHEMICALS WHICH
COULD REALLY CHANGE THEIR
PERCEPTION IN TERMS OF WHETHER
OR NOT WE CAN MONITOR PATIENTS
AT HOME, AND AS WE START
THINKING MORE ABOUT THIS CONCEPT
OF MONITORING PATIENTS AT HOME
WE'VE GOT PROGRAMS LIKE HOSPITAL
AT HOME, I'M CURIOUS, FROM YOUR
PERSPECTIVES, MAYBE YOU, SACHIN,
HAVE YOU SEEN THESE TYPE OF
PROGRAMS TAKING OFF MORE?
WHAT DO YOU SEE AS THE
CHALLENGES, WHAT ARE THE
ADVANTAGES, THE BENEFITS?
>> YOU KNOW, AS AN
ANESTHESIOLOGIST, I LOVE HAVING
ABOUT 40 PARAMETERS CONSTANTLY
ABOUT MY PATIENTS.
I DO LIVER TRANSPLANT
ANESTHESIA, IF I DON'T HAVE AN
ECHO PROGRAM I THINK I'M HANDS
OFF WHEN IT COMES TO MONITORING.
YOU'RE SEEING SOMEONE WHO IS
VERY, VERY DATA RICH FOCUSED.
THE HOSPITAL'S PROGRAMS WHAT
THEY HAVE DONE FOR IDENTIFY
IS -- THE UPTAKE IS DRIVEN BY
CAPACITY CONSTRAINTS ONLY.
IF YOU'RE IN AN ENVIRONMENT
WHERE FINANCIAL DRIVERS
ENCOURAGE US BECOMING FLEXIBLE
AS CLINICIANS AND OUR TENDENCY
TO OVERORDER TESTS EVEN IF
SOMEONE IS IN THE HOSPITAL
TRANSLATE TO LETTING THEM GO
HOME AND HAVE THE SAME THINGS.
CAPACITY CONSTRAINTS CAUSE
INNOVATION, WHAT WE'RE FINDING.
THE PANDEMIC WAS ONE EXAMPLE OF
IT.
IN THE POST-PANDEMIC WORLD WE
STILL SEE VALUES IN THE
OUTPATIENT SETTING BUT WE
OBVIOUSLY HAVE A
HOSPITAL-AT-HOME PROGRAM LIKE
EVERYBODY ELSE, AND IT'S RAMPING
UP, BECAUSE WE'VE GOT CAPACITY
CONSTRAINTS AT UNIVERSITY OF
MICHIGAN SO INVESTMENTS ON A
YIELDING VALUE, WHERE WE DON'T
SEE CONSTRAINTS DISCOMFORT
DOESN'T LEAVE ROOM.
FOR THE RURAL PATIENTS WE SEE A
FAIR AMOUNT OF VALUE THERE, THE
TREES BEHIND YOU REFLECT WHAT
MOST OF MICHIGAN IS LIKE, A LOT
OF PATIENTS ARE DRIVING FROM
THREE OR FOUR HOURS, AND THEY DO
FIND SOME VALUE IN MAYBE GETTING
DISCHARGED A DAY OR TWO, THE
ONLY PLACE WE'RE SEEING CAPACITY
CONSTRAINTS NOT DRIVING THAT
INNOVATION ADOPTION BECAUSE OF
OUR TENDENCY TO JUST NOT WANT TO
BE WITHOUT THE DATA THAT WE'RE
USED TO.
>> IN TERMS OF A NATIONAL
PICTURE, ARE YOU SEEING ANY
PATTERNS EMERGE RELATIVE TO
ADOPTION OF DIFFERENT PROGRAMS
WHETHER HOSPITAL AT HOME, REMOTE
MONITORING, TELEHEALTH, THINGS
LIKE THAT?
>> WE'VE MONITORED NATIONAL
TRENDS FOR MEDICARE TELEHEALTH.
IT'S DROPPED FROM THE PANDEMIC
HEIGHT, IT'S STILL A MUCH LARGER
USE OF TELEHEALTH THAN
PRE-PANDEMIC.
I THINK IT REALLY IS SHOWING
THERE'S INTEREST IN HAVING THIS
MODALITY.
HOSPITAL AT HOME PROGRAM HAS
BEEN WELL RECEIVED BY PATIENTS.
I THINK THERE'S INTEREST ON THE
HILL TO CONTINUE THE PROGRAM.
THE ISSUE ALWAYS WITH THE
MEDICARE-FUNDED PROGRAMS IS
WHETHER OR NOT IT'S GOING TO
INCREASE SPENDING.
SO I THINK THAT'S WHAT EVERYONE
IS TRYING TO UNDERSTAND IS THIS
IN THE NET SCHEME OF THINGS
GOING TO INDUCE MORE UTILIZATION
OR WILL IT LEAD TO DIFFERENT
WAYS IN WHICH PATIENTS ACCESS
THE HEALTHCARE SYSTEM.
>> YEAH, IT'S A GOOD POINT.
IN FACT, I THINK THERE ARE MANY
STUDIES THAT SHOW UTILIZATION
INCREASES, BUT THEN AGAIN THE
SAME POINT COULD BE MADE THAT A
LOT OF PEOPLE WANT TO SEE THEIR
DOCTORS NOT NECESSARILY FOR
HEALTH CARE BUT TO HAVE A
CONVERSATION, AND TO FEEL
CONNECTED WITH THEM.
SO I THINK THE QUESTION IS, IS
THIS SOMETHING THAT DO YOU FEEL
RIGHT NOW ECONOMICS ARE IN FAVOR
OF THESE TYPE OF PROGRAMS?
IS THE ROI THERE?
DO WE SEE A POSITIVE PATH
TOWARDS GREATER REIMBURSEMENTS
AROUND THESE CATEGORIES?
>> IT'S REALLY INTERESTING.
EVERY YEAR WE SEE DIFFERENT
STUDIES, SHOWING SLIGHTLY
DIFFERENT RESULTS.
MED PAC FOUND TELEHEALTH MIGHT
INCREASE SPENDING, BUT IN THEIR
MOST RECENT REVISED REPORT THEY
HAVE FOUND IT ACTUALLY REDUCES
SPENDING SOMEWHAT.
THERE'S BEEN OTHER STUDIES THAT
HAVE SHOWN SPENDING INCREASES
MIGHT BE BECAUSE PATIENTS ARE
ADHERING TO TREATMENT BETTER,
GETTING THE CARE THEY REALLY
NEEDED, AVOIDING SOME OF THE
E.D. VISITS.
I THINK IT'S ALL A MATTER OF
PERSPECTIVE, HOW YOU LOOK AT THE
PROBLEM, PERHAPS REFLECTING ALSO
A SHIFT IN HOW HEALTHCARE MIGHT
BE DELIVERED MOVING FROM IN
PERSON TO HYBRID MODEL OF CARE
WHICH MIGHT MAKE MORE SENSE
UNDER A VALUE-BASED CARE PAYMENT
ARRANGEMENT.
>> , YEAH ABSOLUTELY.
LOOKING AT THE OUTCOMES THAT
MATTER, READMISSIONS, MORTALITY,
AND REALLY FOCUSING ON THOSE AS
OPPOSED TO SIMPLY WHETHER OR NOT
YOU'RE HAVING MORE TELEHEALTH
VISITS MAKES A LOT OF SENSE.
JOE, YOU PROBABLY GET A LOT OF
PEOPLE SUBMITTING STUDIES IN
THIS AREA.
WHAT ARE YOU SEEING RELATIVE TO
THE TYPE OF RESEARCH THAT'S
BEING DONE IN THIS SPACE?
>> I WAS GOING TO COMMENT ON
JUST SORT OF UNDERSCORE WHAT
SACHIN SAID, I REMEMBER BEING AT
SOME SORT OF PANEL, INNOVATORS
SOMETHING OR OTHER, PROBABLY TEN
YEARS AGO WITH A FEW OF THE
EARLY, EARLY PIONEERS IN THE
HOSPITAL-AT-HOME ARENA.
THEY TRIED TO SELL IT ON
CAPACITY CHALLENGE, TRIED TO
SELL IT ON YOU WOULD USE FEWER
RESOURCES.
AND ALL IT REALLY TOOK OFF WE
STARTED REIMBURSING, A HUGE
DANGER OF GOING AWAY IF WE DON'T
CONTINUE TO REIMBURSE.
I JUST WOULD MAKE THAT COMMENT
BECAUSE THERE'S -- IF WE COULD
GET TO A VALUE-BASED MODEL
THAT'S A DIFFERENT CONVERSATION
BUT UNTIL WE DO, PEOPLE JUST
WANT TO BE PAID FOR WHAT THEY
DO.
I DON'T KNOW IF IT'S GOING TO
SAVE MONEY.
THE OTHER QUICK COMMENT ON THIS
AREA, A GOOD CASE THAT EVERY
OTHER INNOVATION THAT COMES INTO
HEALTH CARE WE DON'T ASK IF IT
PAYS MONEY, WE ASK IF IT'S WORTH
THE COST.
WE MIGHT BE PUSHING TELEHEALTH
TO TOO MUCH TO ASK IF IT SAVES
MONEY.
>> CAN WE SAY IT REDUCE COST,
WHAT DOES THE LITERATURE SAY?
>> AGAIN, THERE HAVE BEEN, AS
LOK SAID, THERE'S CONFLICTING
STUDIES.
I THINK IT DEPENDS WHAT YOU ASK.
THE ONE I USED TO CITE WAS ONE
THAT SHOWED DURING THE PANDEMIC,
AND THIS IS A LITTLE -- EVEN
THIS IS MAYBE A BACK-HANDED
CONCLUSION, BUT DURING THE
PANDEMIC PRIMARY CARE -- ACCESS
TO PRIMARY CARE DIDN'T INCREASE
BECAUSE PEOPLE WERE DOING MORE
TELEHEALTH.
IN OTHER WORDS, IT DIDN'T ADD TO
COST.
I DON'T KNOW.
I THINK, AGAIN, IT'S A VERY HARD
PROBLEM TO STUDY.
THERE'S NO RANDOMIZED TRIAL I'M
AWARE OF.
IT'S ALWAYS DONE ON AN
EPIDEMIOLOGIC BASIS.
>> DO YOU THINK THERE'S
SUBPOPULATIONS WE CAN SAY THIS
HAS BEEN BENEFICIAL, COST
EFFECTIVE, SAVING MONEY,
IMPROVING OUTCOMES, AND MAYBE
OVERALL IF WE LOOK AT IT, IT
MIGHT GET A MIXED BAG?
>> WELL, SO, MY ANSWER ISN'T
PARTICULARLY DATA DRIVEN, IT'S
MORE EXPERIENCE DRIVEN.
BUT THINGS THAT ARE RELATIVELY
TRANSACTIONAL, TELEHEALTH IS
GREAT FOR I NEED MY REFILL ON MY
MEDICINE, I SEE PATIENTS -- I'M
A DERMATOLOGIST, ACNE,
PSORIASIS, ECZEMA PATIENTS THAT
ARE STABLE AND NEED MED REFILLS.
THAT'S A GREAT USE FOR
TELEHEALTH.
SO THERE ARE WAYS TO CARVE OUT
HIGH-YIELD INTERACTIONS.
SOMEONE WHO HAS A BRAND-NEW
DIAGNOSIS OF CANCER I MIGHT WANT
TO SIT WITH THEM IN PERSON AND
TALK TO THEM ABOUT THAT.
SOMEONE WHO HAS A COMPLICATED --
AGAIN, TRANSPLANT PATIENTS, ALL
THESE OTHER COMPLICATIONS MIGHT
MAKE MORE SENSE TO HAVE THEM
COME IN.
AGAIN, IT DEPEND HOW YOU ASK THE
QUESTION.
AND I'M NOT AWARE OF RESEARCH
THAT'S DONE THOSE CARVE-OUTS
EFFECTIVELY.
MAYBE THE OTHERS ARE.
>> GREAT COMMENTS THERE.
LARGELY, THIS IS ALL BASED ON
CAPTURING DATA, PRESENTING IT TO
A CLINICIAN, TO THE PATIENT, YOU
KNOW, EITHER THE CLINICIAN
MAKING A RECOMMENDATION TO
PATIENTS, THE PATIENT LOOKING AT
THAT INFORMATION AND RESPONDING
TO IT.
IT'S BEHAVIOR CHANGE.
BEHAVIOR CHANGE AT BOTH PATIENT
AND CLINICIAN LEVEL.
LET'S TALK FIRST ABOUT THE
PATIENT.
THERE WAS AN ORIGINAL FEELING
YOU COULD CAPTURE THE DATA AND
THEN PEOPLE COULD LOOK AT IT,
MOTIVATED TO WANT TO GET
IMPROVED HEALTH.
AND I'D LOVE TO GET YOUR
THOUGHTS.
HAS THAT COME TO BE TRUE?
IS IT NOT TRUE?
ARE WE SOMEWHERE IN THE MIDDLE?
>> CERTAINLY THAT'S BEEN THE
ANECDOTAL SUCCESS STORIES THAT
WE'VE ALL RUN PROJECTS OR WE'VE
PROVIDED DEVICES, YOU KNOW,
MENTIONING EARLY CONNECTED
PARTICIPANTS TO HEALTH, HUNDREDS
OF E-MAILS FROM PARTICIPANTS
SAYING THIS TRANSFORMED MY LIFE.
I WAS CONNECTED, NOW I'M DOING
THIS, DOING THAT.
THERE'S A SELECTION BIAS PROBLEM
IN THE COMMENTS, WHEN YOU LOOK
AT RIGOROUSLY DONE STUDIES WHEN
THEY PROVIDE HALF WITH DEVICE,
DON'T PROVIDE THE OTHER HALF
WITH THE DEVICE, CHANGING STEP
COUNTS, CHANGING ACTIVITY
LEVELS, CHANGING WEIGHTS ARE
NON-RESILIENT TO TIME.
I CONTINUE TO BE SADDENED BY THE
LACK OF CLARITY IN THAT MESSAGE.
I THINK OF PLACES WHERE WE'RE
SEEING VALUE IN THIS, WHERE
THERE'S CLEAR EFFICACY IN THE
INTENSE VERSION OF THAT CLINICAL
INTERACTION.
CARDIAC REHAB, PULMONARY REHAB,
AND DUE TO INCONVENIENCE OF THAT
INTENSE VERSION, DESPITE ITS
EFFICACY YOU DON'T SEE -- ACCESS
ISSUES, BOTH HAVE MASSIVE ACCESS
ISSUES, ALL THESE FORMS OF
REHAB.
AND BECAUSE OF JUST
INCONVENIENCE ISSUES, YOU KNOW,
DRIVING TO THE PLACE, YOU KNOW,
AFTER USUAL FOURTH VISIT, HAVING
THE PHYSIOLOGIST TELLING YOU
YOU'RE WALKING TOO FAST, PLACES
WE'VE SEEN LIKE WITH TECHNOLOGY
IN THE PAST IF YOUR COMPARATOR
IS NOTHING THESE TECHNOLOGIES DO
WELL.
AND LET'S BE HONEST, NOTHING IS
A VERY VALID COMPARATOR BECAUSE
THAT'S THE DEFAULT BEHAVIOR.
MY BACKGROUND IN ELECTRONIC
HEALTH RECORDS, WE USED TO -- 20
YEARS AGO WOULD SAY OUR
COMPETITOR ISN'T THIS COMPANY OR
THAT COMPANY, IT'S PAPER.
IT'S FORMIDABLE.
IT'S WINNING.
AND CLINICIANS ARE NATURALLY
THERE.
TELEHEALTH IS IN THE SAME SPOT
NOW.
WE KEEP TRYING TO CONFIRM
TELEHEALTH TO SEEING YOUR
CARDIOLOGIST.
THAT'S NOT VALID.
TELEHEALTH POTENTIALLY TO -- OR
REMOTE PATIENT MONITORING
OPTIONS COMPARING TO NOT GETTING
CARDIAC REHAB TYPICALLY DOES
WIN, WITH LOWER UTILIZATION
RATE, THAT'S A GREAT STORY WE
SHOULD BE TOUTING MORE
EFFECTIVELY, HOW HAVE KNOWN
INTERVENTIONS BUT BECAUSE OF
CHALLENGE IN GETTING THEM THEY
CAN'T GET THEM IN THE IN-PERSON
SETTING, AND THESE ARE VALID
OPTIONS.
THAT'S A NEW TYPE OF PATIENT
YOU'RE HELPING THAT YOU'RE NOT
HELP OTHERWISE.
>> YOUR POINTS ABOUT HAVING
THESE PROGRAMS WHICH INDIVIDUALS
ARE CONNECTED TO THE PROVIDERS
AND HAVING THAT MOTIVATION TO
ACT ON IT BECAUSE YOU KNOW YOUR
PROVIDER IS LOOKING AND
OVERSEEING WHAT YOU'RE DOING,
BEHAVIORAL ECONOMICS BEHIND IT,
CARDIAC AND PULMONARY REHAB ARE
EXCELLENT EXAMPLES.
LOK, HAVE YOU SEEN PROGRAMS LIKE
THIS HIGHLY EFFECTIVE, HIGHLY
ENGAGING, THINGS PATIENTS AND
CONSUMERS WHEN THEY SEE THE DATA
OR WHEN THEY ARE RESPONDING TO
WRITTEN MESSAGES THEY ARE MORE
LIKELY TO DO THE THINGS
NECESSARY TO GET TO BETTER
HEALTH?
>> I'M GOING TO PUNCH ON THAT
ONE.
>> MAYBE, JOE, YOU SEE STUDIES
OR PERSONAL EXPERIENCE.
>> YEAH, PERSONAL EXPERIENCE.
WE STUDY THIS PROBLEM TEN YEARS
AGO EXTENSIVELY.
TWO OR THREE KINDS OF INSIGHTS,
ONE IS THAT TO YOUR POINT, IF
PEOPLE ARE SELF-MOTIVATED BY
DATA, THEY DO REALLY WELL.
THIS WAS IN THE BEGINNING WE
CALLED THEM QUANTIFIED
SELF-PRESENTERS.
GET TOGETHER, HAVE MEETINGS,
TALK ABOUT THINGS THEY WERE
MEASURING.
THAT'S SUCH A NARROW SLICE OF
THE POPULATION.
USUALLY BECAUSE THEY CARE ABOUT
ALL KINDS OF OTHER THINGS ABOUT
THEIR HEALTH TOO.
SADLY, WEARABLES WORK WELL FOR
THEM BUT NOT THOSE OF US THAT
CARE ABOUT PATIENTS.
THE SECOND PHENOMENON WHEN WE
STARTED TO DO IT WITH
CLINICIANS, THIS IS EARLY DAYS,
IF THE PATIENT BOTHERED TO GET
ALL THIS INFORMATION COLLECTED,
AND THE DOCTOR DIDN'T KNOW OR
DIDN'T LOOK, IT WAS
DEMOTIVATING.
THEY CHECKED OUT AND WOULD TELL
US IN FOCUS GROUP WHY AM I
BOTHERING?
IT'S ABOUT THEIR HEALTH.
BUT THIS WAS GLUCOSE MONITORING,
PATIENTS WITH DIABETES.
THEY STILL WOULD SAY, THE DOCTOR
DOESN'T SEEM TO CARE, I'M OUT.
OR THE OTHER PHENOMENON, AND
THIS I'LL EXIT AFTER THIS, THE
OTHER PHENOMENON WAS IF PEOPLE
WOULD CHANGE BEHAVIOR BECAUSE
THEY KNEW SOMEONE IN THE
PRACTICE WAS LOOKING AT THE
DATA, SO YOU CALL IT THE
SENTINEL OR HAWTHORNE EFFECT,
THAT'S VERY REAL.
YOU CAN MOTIVATE CERTAIN COHORTS
OF INDIVIDUALS BY GIVING THEM A
DEVICES AND JUST HAVING --
SENDING THEM A MESSAGE FROM THE
NURSE IN THE PRACTICE EVERY SO
OFTEN YOU'RE DOING GREAT OR YOU
COULD DO BETTER THEY ONE THEIR
GAME.
THESE THINGS HAVE A ROLE.
I THINK FINDING -- I DON'T KNOW
OF ANY KIND OF -- YOU HAVE TO
FILL OUT 10 OR 15 QUESTIONS LIKE
THE PHQ OR WHAT HAVE YOU, I
DON'T KNOW OF ANY SURVEY LIKE
THAT, TEN QUESTIONS LONG, THAT
WILL PUT YOU IN THE ONE OF THE
THREE GROUPS.
IF WE DID WE COULD FINE TUNE
THIS FROM A CLINICAL
PERSPECTIVE.
>> YEAH, IDENTIFICATION OF THE
RIGHT PATIENTS, YOU KNOW,
PATIENT ACTIVATION MEASURES,
THINGS LIKE THAT, YEAH,
OFTENTIMES IT'S DIFFICULT TO
KNOW WHO WILL RESPOND BEST.
WE SEE A SIMILAR STORY WITH
CLINICIANS, SUPER EAGER AND
ACTIVE, WANT TO PARTICIPATE,
OTHERS SAY IT'S TOO MUCH
INFORMATION, MAYBE TOO MUCH
LIABILITY.
CURIOUS WHAT YOUR THOUGHTS ARE,
OPEN TO THE GROUP.
WHAT ARE YOU SEEING, HAS THAT
CHANGED?
DO PEOPLE FEEL NOW WITH THE FACT
THESE ARE MORE UBIQUITOUS, OR
ARE THEY STILL FEELING THIS IS
NOISE AND MAYBE TOO MUCH EFFORT?
>> A BELL-SHAPED CURVED.
I POINT TO MY STORY.
TEN YEARS AGO I WOULD NOT HAVE
HAD A CARDIOLOGIST TELL ME TO
GET A SMART DEVICE, I'M SURE,
RIGHT?
WE'RE GETTING THERE.
BUT, YEAH, THERE'S A LOT OF
FOLKS AT CONFERENCES,
EVANGELIZING, I DON'T WANT TO
SEE ALL THAT INFORMATION.
I'M WORRIED ABOUT THE LIABILITY,
TOO BUSY, WHICH TO ME IS SAD
BECAUSE BEING A DOCTOR IS ABOUT
COLLECTING INFORMATION, ABOUT
YOUR PATIENT TO HELP THEM.
IF YOU CAN ONLY COLLECT IT WHEN
THEY ARE THERE AND YOU GET THAT
NARROW SLICE WHEN THEY ARE IN
THE OFFICE, THAT'S SUCH A NARROW
VIEW OF THEIR LIFE.
I THINK IT'S TOO BAD WE CAN'T
FIGURE OUT A WAY TO MAKE THIS
MORE ACTIONABLE SO THAT DOCTORS
DON'T FEEL SO OVERWHELMED BY
REAMS AND REAMS AND REAMS OF
NORMAL RESULTS AND SO FORTH.
>> YEAH, YEAH.
>> I THINK THERE'S LESSONS WE'VE
SEEN IN THE CLINICAL REALM THAT
WE HAVE TO LEARN HOW TO ADAPT TO
THE NEXT SET OF DATA STREAMS.
YOU KNOW, AMBULATORY BLOOD
PRESSURE MEASUREMENT USED TO BE
A CLINICAL INTERACTION, WE GIVE
YOU A PARTICULAR TYPE OF CUFF,
CYCLE FOUR TIMES A DAY.
THOSE DAYS ARE GONE NOW.
ARE YOU SEND PEOPLE HOME WITH A
BLOOD PRESSURE CUFF, THEY PICK
ONE UP, AND WHETHER THEY BRING A
PRINTOUT, SHARE THE APP WITH
YOU, CGMs ARE DOING THE SAME
THING, RIGHT?
PROVIDERS HAVE JUMPED ON THAT
TRAINEE EFFECTIVELY BECAUSE WE
RECOGNIZED DICHOTOMY BETWEEN TE
NARROW MOMENT, DIFFERENCE
BETWEEN HYPERTENSION TODAY,
WHITE COAT VERSUS AT HOME, SO
WE'VE GOT PHYSIOLOGY WE'VE
ESTABLISHED SCIENCE OF THE VALUE
OF THE HOME DATA.
SO WHAT'S MISSING RIGHT NOW IS
PROVIDING CLINICIANS WHAT'S THE
VALUE OF THAT HOME ACTIVITY, THE
VALUE OF THE HOME SLEEP HOUR,
WE'VE GOT MORE DATA POINTS.
WE HAVEN'T SAID COMPARED TO THIS
GOLD STANDARD IT MIGHT BE BETTER
THAN TAKING THE PATIENT'S BLOOD
PRESSURE THAT DAY, BETTER THAN
I'M MANAGING A HEART FAILURE
PATIENT.
IT'S A FINE ART.
WHERE WE'VE GIVEN THEM EVIDENCE
ON THE VALUE OF THE HOME DATA
STREAM, THAT MORE INTENSE DATA
STREAM, THEY HAVE ADOPTED AND
CHANGED PRACTICE ON THE CLINICAL
SIDE.
WE HAVEN'T GIVEN IT TO THEM FOR
THE OTHER STREAMS OUT THERE YET.
>> THAT'S FAIR.
>> ONE OF THE PROGRAMS WE'VE
SEEN WHERE IT'S BEEN SORT OF
UNDERVALUED AND PERHAPS MAYBE
OVERHYPED HAS BEEN TELEHEALTH.
SPECIFICALLY DURING THE PANDEMIC
A LOT OF INDIVIDUALS FELT THIS
WAS HERE TO STAY, WE'RE GOING TO
ACTUALLY NOW BE DOING MUCH MORE
HYBRID, BUT WE'VE SEEN A SHIFT
TO MORE IN-PERSON AND MAYBE
TELEHEALTH HAS BECOME LESS OF
THE CONVERSATION TOPIC.
AND LOK, FROM A NATIONAL
PERSPECTIVE CURIOUS, ARE YOU
SEEING TELEHEALTH SORT OF
STABILIZE WITH A CERTAIN NUMBER
OF SITES DOING IT CONSISTENTLY?
OR IS THERE A CONTINUOUS
DECLINE?
WHERE ARE WE AT IN TERMS OF
TELEHEALTH ADOPTION?
>> I THINK IN TERMS OF THE
ACTUAL UTILIZATION IT SEEMS TO
HAVE STABILIZED BUT WHAT'S
CONCERNING IS THE NUMBER OF
PROVIDERS WILLING TO OFFER, THE
DETERMINING FACTOR WHETHER
SOMEONE HAS A TELEHEALTH VISIT.
NOT THE PATIENT REQUESTING IT.
PROBABLY BECAUSE OF UNCERTAINTY
WITH THE TELEHEALTH FLEXIBILITY
CONTINUING, PROVIDERS NOT
WILLING TO INVEST IN CHANGING
THEIR CLINICAL WORKFLOW,
INVESTING IN VIRTUAL HEALTH
CLINICS, TO STAFF DIFFERENTLY,
THEY HAD TO DO IT IN THE
PANDEMIC FOR THEIR OWN SAFETY AS
WELL.
I'D LOVE TO HEAR, JOSEPH, YOUR
PERSPECTIVE ON THE GROUND.
>> I'LL GO.
SO I FOLLOW THE DATA SOURCE
CALLED FAIR HEALTH, THEY HAVE A
TELEHEALTH TRACKER.
FAIRHEALTH.ORG.
BEFORE THE PANDEMIC, THE TOTAL
PERCENTAGE OF CLAIMS COMING IN
TO THAT DATA SOURCE,
SELF-INSURANCE CLAIMS, FOR
TELEHEALTH, 0.19% OF ALL THEIR
CLAIMS.
THAT'S AUGUST OF 2019.
BY I THINK JUNE OR SO OF 2020,
IT WAS UP TO ABOUT 7%.
THAT'S THE SIZE IT GOT FROM THIS
PARTICULAR DATA STREAM.
AND THEN IT WENT DOWN IN JANUARY
OF 2021 TO ABOUT 4.5 OR 5%,
STABLE THERE, 80% IS BEHAVIORAL
HEALTH.
YOU CAN TAKE HOME THE REAL
WINNER FROM A PATIENT
PERSPECTIVE HAS BEEN BEHAVIORAL
HEALTH.
I TALKED TO PRACTITIONERS, MANY
DO A VERY LARGE CHUNK OF THEIR
PRACTICE THIS WAY.
AND I THINK IT'S EXTENDED ACCESS
BUT THERE'S STILL A SHORTAGE,
THERE'S STILL NEED, STILL ALL
KINDS OF CHALLENGES.
BY AND LARGE IT'S BEEN FOR THE
BEHAVIORAL HEALTH PATIENTS AS
WELL.
I THINK THAT'S THE STANDOUT
WINNER.
EVERYTHING ELSE IS NIBBLING
AROUND THE EDGES.
I LIKE -- I'LL UNDERSCORE THE
POINT YOU MADE, WHICH IS IF MY
INSTITUTION DOESN'T HAVE A LONG
RANGE GUARANTEE THAT WE'RE GOING
TO GET PAID FOR STUFF THEY ARE
NOT GOING TO MAKE A HUGE
INVESTMENT IN A NEW CHANNEL.
IT'S A WHOLE NEW CHANNEL.
IT'S NOT JUST ME DUCKING INTO AN
OFFICE TO DO A VIDEO VISIT
BETWEEN PATIENTS.
IT'S A NEW CHANNEL, IT HAS TO BE
MANAGED THAT WAY.
WE KNOW THAT'S COMING UP.
BIG DRUM ROLL.
BUT OUR FRIENDS IN CONGRESS HAVE
TOWARDS THE END OF THE YEAR HAVE
TO DO SOMETHING OTHER WE'LL FALL
BACK TO THE DAYS OF 1834, WHICH
IS VERY, VERY RESTRICTIVE.
>> HOW ABOUT ABILITY TO DO
TELEHEALTH ACROSS STATE
BOUNDARIES, IS THAT SOMETHING WE
ANTICIPATE IS GOING TO --
>> NO.
>> WHAT'S GOING TO HAPPEN THERE?
>> NO, I DON'T THINK SO.
I JUST THINK THAT'S HOPELESS,
ALMOST HOPELESS.
STATE MEDICAL BOARDS ARE SO
ENTRENCHED, NOT INTERESTED,
DON'T SEE THE WORLD PERHAPS
OTHERS SEE THE WORLD.
AND THEY CONTROL OBVIOUSLY
WHETHER SOMEONE GETS TO PRACTICE
IN THEIR STATE.
>> I WANT TO POINT OUT A GROUP
THAT'S BENEFITED FROM
TELEHEALTH, THOSE WITH
DISABILITIES, 1 1/2 TO 2 TIMES
MORE LIKELY TO USE TELEHEALTH
THAN PEOPLE WITHOUT
DISABILITIES, A HIDDEN
POPULATION.
>> IT'S A WONDERFUL POINT, YEAH.
>> ARE THERE TECHNOLOGIES THAT
WE'RE SEEING THAT CAN HELP
INDIVIDUALS WITH DISABILITIES
THAT FOR INSTANCE THEY HAVE
VISUAL, HEARING, MOTOR, HOW IS
THE TELEHEALTH EXPERIENCE FOR
THOSE WITH DISABILITIES?
>> THERE ARE -- I THINK --
YOU'RE RIGHT.
DISABILITY IS A BROAD SPECTRUM.
MY OWN CASE, MOST OF THE PEOPLE
THAT I SEE BENEFITING, THIS IS
MY OWN PRACTICE, ARE PEOPLE WHO
HAVE PHYSICAL DISABILITIES, HARD
TO GET OUT OF THEIR APARTMENT,
HARD TO GET IN.
ONE WOMAN JUST THANKED ME TEN
TIMES BECAUSE SHE HAS A SPECIAL
NEEDS CHILD, IT'S HARD FOR HER
TO GET OUT.
EVERY TIME THEY GO SOMEWHERE
THEY HAVE A WHOLE CAVALCADE OF
THINGS HAPPENING.
VISUAL AND AUDITORY, I'M NOT AS
UP TO DATE ON WHAT'S GOING ON.
MAYBE MY COLLEAGUES ARE.
>> YEAH.
I CAN SHARE THAT.
WE HAVE SEEN QUITE A BIT OF
ADVANCEMENT IN TERMS OF
TECHNOLOGIES TO HELP THOSE WITH
DISABILITIES ON ALL FRONTS FOR
CONNECTED CARE, EVERYTHING FROM
OF COURSE YOU HAVE THE ABILITY
TO HAVE THE VOICE TRANSCRIPTIONS
WHERE YOU CAN SEE THE WORDS,
TRANSLATED IN DIFFERENT
LANGUAGES.
LANGUAGES TRANSLATION IS
CHALLENGING.
IN MEDICAL TRANSLATION, NOT AS
ACCURATE, MAY NOT MEET THE
STANDARDS OF ACCEPTABILITY IN
TELEHEALTH.
IN ENGLISH THERE'S BEEN SOME.
THERE'S BEEN SOME WORK FOR THOSE
WITH VISUAL DISABILITIES,
DECREASED VISION, WE'VE EVEN
SEEN SOME SCENARIOS WHERE
INDIVIDUALS HAVE BEEN ABLE TO
HAVE INDIVIDUALS WITH SIGN
LANGUAGE TRANSLATORS, TELEHEALTH
IN, THERE HAVE BEEN OF COURSE
A.I.-BOTS THAT ARE NOW STARTING
TO BECOME HELPFUL AS WELL.
I THINK EVEN INDIVIDUALS WITH
DISABILITY, DUE TO STROKE, NOT
ABLE TO SPEAK AS WELL, CLEARLY,
THOSE CONNECTIONS WOULD BE
INTERPRETED SO INDIVIDUALS CAN
BETTER UNDERSTAND WHAT THEY ARE
SAYING.
SO A LOT OF MOVEMENT, HOPEFULLY
LYNN CREASE ACCESSIBILITY.
WE -- INCREASE ACCESSIBILITY.
LET'S GO TO THE CHAT.
A QUESTION FOR YOU, LOK, I'LL
READ IT.
YOU MENTIONED THAT THERE'S SOME
STUDIES THAT SHOW REDUCTION IN
SPENDING, OTHERS SUGGEST
INCREASE IN SPENDING.
WHAT'S YOUR ASSESSMENT WHETHER
TELEHEALTH HAS BEEN COST
BENEFICIAL OR COST EFFECTIVE IN
OTHER WORDS FROM SOCIETAL
PERSPECTIVE HAS THE VALUE BEEN
WORTH THE COST AND IN WHAT
SETTINGS?
>> I THINK THAT'S AN EXCELLENT
QUESTION.
AS A HEALTH SERVICES RESEARCHER
I THINK WE PROBABLY DON'T HAVE
THE RIGHT DATA TO ANSWER THAT
FULLY FROM A PATIENT PERSPECTIVE
BECAUSE THE PATIENT COST, THEIR
TIME, LOST OPPORTUNITIES FOR
WORK, HOSPITAL, ESPECIALLY IF
YOU HAVE DISABILITIES TO GET IN
AND OUT OF THE HOUSE.
AND I THINK WE TALKED EARLIER
ABOUT TELEHEALTH IS MEETING
POTENTIALLY UNMET NEED.
WE DON'T HAVE THAT DENOMINATOR
WHO ISN'T GETTING THE CARE THEY
NEED AND ARE NOW GETTING IT.
SO I THINK WE NEED TO HAVE THAT
BROADER SOCIETAL PERSPECTIVE TO
HELP US UNDERSTAND THE VALUE TO
SOCIETY, NOT JUST TO A PAYER.
>> FANTASTIC.
GREAT.
THANK YOU, LOK.
IF OTHERS HAVE QUESTIONS, PLEASE
FEEL FREE TO ENTER THEM INTO THE
CHAT Q&A AND I'LL GET TO THEM AS
WE GO THROUGH THE CONVERSATION.
I WANT TO SHIFT GEARS AND TALK
ABOUT SOME OF THE INFORMATION
THAT IS CAPTURED AND HOW
POTENTIALLY WE CAN BETTER
UNDERSTAND AND INTERPRET THIS.
JOE, YOU ALLUDED TO THIS WHEN
YOU TALKED ABOUT THE A.I. AND
MULTI-MODAL.
TELL US ABOUT WHAT YOU MEANT BY
THAT.
LIKE YOU SAID A.I. IS GOING TO
BE POTENTIALLY A VERY HELPFUL
TOOL IN THIS SPACE.
WHAT ARE YOU SEEING, WHERE DO
YOU SEE IT GOING?
>> WELL, I'LL TRY NOT TO
DOMINATE BECAUSE IT'S SUCH A FUN
TOPIC, SO MUCH GOING ON.
I'LL TRY TO BE SUCCINCT AND
THOUGHTFUL.
HARD FOR ME.
ANYWAY, IN 2015 I PUBLISHED A
BOOK "INTERNET OF HEALTHY
THINGS," FIRST CHAPTER IS MADE
UP, A VIRTUE CARE AGENT NAMED
SAM KNOWS ME, GUIDES ME AROUND,
KNOWS IF I'M TAKING A WALK AT
LUNCH BECAUSE OF MY SMART
PEDOMETER THAT I'M ALSO WALKING
TOWARDS A PLACE WHERE I NORMALLY
GET A COOKIE AND HE SAYS MAYBE
YOU DON'T WANT THAT COOKIE,
YOU'RE TRYING TO LOSE WEIGHT FOR
YOUR DAUGHTER'S WEDDING.
IT'S FANSFUL BUT -- FANCIFUL BT
IT'S NOW HAPPENING, TEN YEARS
SINCE I WROTE AND PUBLISHED.
SO MUCH HAS HAPPENED WHERE YOU
CAN TAKE MULTIPLE DATA STREAMS,
I'M NOT A COMPUTER OR DATA
SCIENTIST, BUT MAKE THEM MAKE
SENSE HOW THE ALGORITHMS WORK
AND YOU HOW THEY GENERATE
INSIGHTS AND PREDICTIONS ABOUT
THE FUTURE.
NOW WITH TEXT-TO-SPEECH AND ALL
OTHER THINGS, THIS CHARACTER I
ENVISIONED TEN YEARS AGO, SAM,
IT'S A REALITY FOR CERTAIN
PEOPLE, CERTAIN SITUATIONS.
SO TO ME THAT'S THE THING.
WHEN WE TALK ABOUT WEARABLES
BEING SCARY TO DOCTORS BECAUSE
OF NORMAL RESULTS OR MEANINGLESS
RESULTS, BUT FOR COMPUTERS
THAT'S A WONDERFUL THING.
THE MORE DATA, THE MERRIER.
THE MORE NUANCED DATA, THE
MERRIER.
AND I MEAN WEARABLES, MOBILE
PHONE DATA, WHERE YOU DID YOUR
PURCHASING, IF YOU USE A CREDIT
CARD FOR LUNCH AND YOU CAN MATCH
THAT AGAINST THE GEO TAGGING OF
YOUR PHONE, YOU THINK ABOUT THE
POSSIBILITIES.
AS I SAID, THIS IS HAPPENING
NOW.
IT'S PRETTY EXCITING.
THAT'S THE REALITY.
ON THE RESEARCH FRONT I'M NOT A
COMPUTER SCIENTIST.
SO MANY INVESTIGATORS ARE TRYING
TO MAKE THIS -- WHAT WE TALKED
ABOUT EARLIER, WHICH IS DATA
FROM A FITBIT DOESN'T EVEN
RECOGNIZE DATA FROM A
SMARTWATCH, SAMSUNG IS
DIFFERENT, ET CETERA, HOW TO
MARRY THOSE DATA STREAMS SO THEY
CAN BE COMPARED TO ONE ANOTHER.
I THINK THAT'S THE FRONTIER.
SOMETHING LIKE FHIR, SMART ON
FHIR FOR HEALTH DATA BUT WE
DON'T HAVE SOMETHING LIKE THAT,
THAT I'M AWARE OF ANYWAY, AT
LEAST IN WIDESPREAD USE FOR
WEARABLES DATA.
>> SACHIN?
>> IT'S INTERESTING, FROM A
PARTICIPANT PERSPECTIVE, WE'VE
SEEN THIS WHEN TRYING TO PROVIDE
DEVICES TO FOLKS.
I GOT A FITBIT, I DON'T WATCH A
WATCH, I DON'T WANT TO WEAR YOUR
FITBIT, A CALL TO ADJUST OUR
METHODOLOGIES.
I THINK WE -- YOU KNOW, EVERY
CLINICAL TRIAL TRIES TO CREATE
THE MOST HOMOGENOUS PATIENT
POPULATION OR OUTCOME TO MEASURE
THE EXACT SAME WAY, THAT SENSE
OF CONTROL BELIES REALITY OF
CLINICAL CARE, PARTICIPANT
EXPERIENCE, AND MOST IMPORTANTLY
PARTICIPANT PREFERENCE.
WE'LL CONTINUE MAKING STEP
COUNTS ON THE FITBIT LOOK THE
SAME AS APPLE WATCH, CONVERSION
FACTOR, BUT EXPERIENCE TAUGHT US
THAT'S AN ENDLESS PATH,
ASYMPTOTIC, STILL CHALLENGE TO
GET A CERTAIN RECORD TO LOOK
READABLE IN EPIC, DESPITE
STANDARDS, RIGHT?
WE'RE LOOKING FOR
PERTURBATIONS IN A PATIENT
EXPERIENCE, WE WANT TO USE
POPULATION NORMS COMPARING GROUP
TO GROUP FEED BUT WE SHOULD
FOCUS ON WITHIN PATIENT CHANGES,
YOUR CONTROL CHART, HERE IS A
CLEAR INFLECTION POINT, RESTING
HEART RATE HAS BEEN AT THIS
POINT, YOU'RE NOW OFF.
YOUR ACTIVITY LEVEL HAS BEEN
HERE, YOU'RE OFF THE BASELINE.
IT'S AN AREA OF METHODOLOGIC
APPROACH WHICH WE HAVEN'T
INVESTED ENOUGH ENERGY IN
VALIDATING FOR ADOPTING BECAUSE
IT REQUIRES US TO ADMIT THE
DIRTINESS OF THE WORLD BUT FAR
MORE REALISTIC IN TERMS OF
ADDING VALUE TO AN AVERAGE
CLINICIAN EVIDENCE BASE, FAR
MORE LIKELY TO BE WHAT PATIENTS
USE, BECAUSE THEY ARE GOING TO
KEEP THE DEVICE THEY WANT, THEY
HAVE A LOT OF REASONS TO WANT
IT.
IT'S OUR JOB AS SCIENTISTS TO
SAY BASED ON DATA EXTREMES FROM
YOUR DEVICE THESE SALIENT CHANGE
DEMONSTRATION SOMETHING IS ABOUT
TO HAPPEN AND THEREFORE WE DON'T
KNOW WHAT'S ABOUT TO HAPPEN BUT
SOMETHING'S UP, LET'S HAVE YOU
BRING -- LET'S BRING YOU IN.
THAT HETEROGENEITY OF DATA
SOURCES IS AN OPPORTUNITY FOR
THE NIH TO REALLY EMBRACE THAT
HETEROGENEITY AND, YOU KNOW,
EVALUATE THE VALUE OF USING A
PATIENT AS THEIR OWN CONTROL
OVER TIME.
BECAUSE THAT'S -- WE ASK OUR
PATIENTS, HAVING DIFFICULTY, HOW
DIFFERENT IS THAT NOW?
I'VE GOT PATIENTS WITH A BMI 60
BARELY MOVING AND 18 WHO ARE
MARATHON RUNNERS, OUR PATIENTS
AREN'T DOING THE SAME ACTIVITY
LIFESTYLE.
THERE'S A METHODOLOGY AT WORK TO
MAKE US ADOPT WHAT THEY ARE
LIVING ON A DAILY BASIS.
>> YOU'RE TALKING, I MEAN, THE
END RESULT OF WHAT YOU'RE
TALKING ABOUT IS DIGITAL TWINS,
YOU CAN BE YOUR OWN CONTROL
GROUP FOR ANYTHING.
>> ONE OF THE THINGS THAT I
THINK I'VE SEEN OVER THE PAST
SEVERAL YEARS IS THAT THERE'S
BEEN A TRANSFORMATION IN TERMS
OF UNDERSTANDING OF WHAT A.I.
CAN AND CANNOT DO.
THE ORIGINAL THOUGHT FOR MANY
FOLKS IS THAT A.I. ARE A SERIES
OF ALGORITHMS THAT ARE JUST
SIMPLY APPLIED AT SCALE.
AND WE'VE NOW RECOGNIZED THAT
A.I. CAN DO MUCH MORE THAN THAT,
SPECIFICALLY WHEN YOU
INCORPORATE MACHINE LEARNING TO
NOW BE ABLE TO TAKE UNSTRUCTURED
FORMS OF DATA AS WELL AS
STRUCTURED FORMS AND CONVERT
INTO THINGS THAT ARE
UNDERSTANDABLE, TEXT, VOICE,
IMAGE, VIDEO, AND OF COURSE WITH
THE VAST AMOUNT OF QUANTIFIABLE
DATA THAT'S COMING IN THROUGH
DEVICES, PUTTING THEM INTO SOME
MANNER THAT'S UNDERSTANDABLE,
BUT WHAT I THINK WHAT WE'RE ALSO
STARTING TO SEE IS THE NEED FOR
US TO CREATE DATA
INFRASTRUCTURES THAT SUPPORT
MULTI-MODAL DATA.
THAT MEANS THAT UNDERSTANDING
HOW YOU TAKE THE DATASETS FROM
THESE SOURCES AND CURATE THEM,
ANNOTATE THEM, AND ALLOW US TO
BE ABLE TO UNDERSTAND
LONGITUDINALLY HOW THEY ARE
ASSOCIATED WITH OUTCOMES, AND
THOSE TYPE OF DATASETS ONCE WE
ACTUALLY HAVE THEM BUILT, THAT
YOU HAVE POPULATED WITH THE
APPROPRIATE DATASETS CAN LEAD US
TO WAYS THAT WE CAN BE FAR MORE
PREDICTIVE, AND THERE ARE THREE
THINGS THAT CAN BE DONE ONCE YOU
HAVE THESE DATA INFRASTRUCTURES.
FIRST COULD BE WRIST
STRATIFICATION, TO IDENTIFY
HIGH, MEDIUM LOW STRATA.
SECOND IS COHORTING, LOOK
LONGITUDINALLY ACROSS A TIME
PERIOD.
THIRD IS PREDICTION, AND WE'RE
NOW STARTING TO SEE WITH THINGS
SUCH AS EKG HOW WE MIGHT BE ABLE
TO PREDICT FIVE-YEAR MORTALITY.
THESE ARE EXTRAORDINARY.
WE'RE NOT TALKING ABOUT EKG,
CARDIAC RISK FACTORS.
I'M SAYING A TAKE A LOOK AT YOUR
EKG AND FIGURE OUT YOUR
LONG-TERM MORTALITY, SHORT AND
LONG.
AS WE GET INTO POWER OF A.I., WE
CAN ENVISION HOW THIS COULD BE
APPLIED WITH WEARABLES DATA,
WITH THE FITNESS DATA, WITH
ACTIVITY, THE SLEEP, I MEAN, THE
GENERALIZABILITY AROUND YOUR
OVERALL HEALTH IN TERMS OF
INCORPORATING THAT INTO THIS
MAKES THE DATASETS FAR MORE
ROBUST BUT IT'S ALL DONE IN
CONTEXT OF NOT ONLY WHAT'S
HAPPENING AT THAT MOMENT BUT
ALSO OUTCOMES ASSOCIATED WITH
THAT LONGITUDINALLY.
AND I THINK THAT'S ONE OF THE
EXCITING THINGS BECAUSE WE'RE
NOW STARTING TO SEE SYSTEMS
BEING BUILT THAT ALLOW US TO
MAKE THESE LARGE
GENERALIZATIONS.
IT'S AN EXCITING TIME.
THE NEXT QUESTION ABOUT
RESEARCH, WHERE IS IT THAT WE'RE
HEADING IN TERMS OF RESEARCH?
WHAT IS THE OPPORTUNITY?
IS THE RESEARCH IN TERMS OF MORE
SENSORS, IN TERMS OF A.I., IS IT
IN TERMS OF MULTI-MODAL,
ENGAGEMENT, IS IT ALL OF THE
ABOVE?
YOU KNOW, DEMONSTRATING ROI?
MAYBE I'LL START WITH YOU, LOK,
I'D LOVE TO GET YOUR TAKE IN
TERMS WHERE DO YOU SEE RESEARCH
HEADING, WHAT ADVICE DO YOU HAVE
FOR RESEARCHERS IF THEY ARE
INTERESTED IN TAKING ADVANTAGE
OF ALL THIS OPPORTUNITY?
>> SO I WAS GOING TO SAY WITH
OPPORTUNITY COMES GREAT RISK AS
WELL.
USUALLY IT'S FLIPPED THE OTHER
WAY.
ONE OF THE CHALLENGES I THINK
ESPECIALLY WITH THE WEARABLE
DEVICE DATA IS THIS IS NOT A
REPRESENTATIVE POPULATION.
AND YOU WANT TO GENERATE
RESEARCH FINDINGS THAT COULD BE
APPLIED ESPECIALLY TO THE
UNDERSERVED, THOSE WITH SPECIAL
NEEDS.
I THINK THAT'S ONE OF THE
CHALLENGES WITH THE A.I.
APPLICATIONS, WE WANT TO MAKE
SURE WE'RE NOT CREATING BIAS
THROUGH MACHINE LEARNING
APPLICATIONS BECAUSE OF WHERE
THE DATA IS COMING FROM.
ALSO THINKING ABOUT THE
DIFFERENT TIMES OF DATA,
WEARABLE DATA CURRENTLY ISN'T
CONSIDERED HEALTH CARE DATA.
RESEARCHERS REALLY DON'T HAVE
ACCESS TO IT EXCEPT THROUGH
SCRAPING IN VARIOUS WAYS.
I DON'T WANT TO TALK ABOUT THOSE
DIFFERENT METHODS.
WE HAVE TO THINK HOW IS IT
PATIENTS WANT THIS DATA TO BE
USED FOR THEIR OWN HEALTH, FOR
PARTICIPATING POTENTIALLY IN
RESEARCH, AS WELL AS WHAT THEY
WANT TO CONTRIBUTE TO THE
HEALTHCARE ECOSYSTEM.
>> YEAH, YOU BRING UP A GOOD
POINT.
WE HAVEN'T TOUCHED ON THE WHOLE
CONCEPT OF BIAS IN THE DATASETS.
YOU KNOW, TO TRY TO CREATE THESE
MODELS WE DO NEED MORE
GENERALIZABILITY BUT WHO IS
PARTICIPATING IN HOW WE CAPTURE
THE DATA, AND WHAT CAN WE DO TO
ADDRESS THOSE ISSUES AROUND
BIAS?
LOK, YOUR THOUGHTS THERE?
>> I THINK THIS IS PROBABLY
WHERE THERE'S OPPORTUNITY FOR
RESEARCH WHERE YOU MIGHT WANT TO
DO A CLINICAL TRIAL IN AN
UNDERSERVED POPULATION, PEOPLE
WHO ARE CURRENTLY NOT WEARING
DEVICES, FIND OUT WHAT WORKS FOR
THEM, HOW DOES IT FIT INTO THEIR
LIFESTYLE.
IF I'M A CLEANER I'M RUNNING UP
AND DOWNSTAIRS ALL DAY, I DON'T
NEED TO COUNT MY STEPS.
BUT MIGHT HAVE SOME JOINT
ISSUES, CHOLESTEROL ISSUES, SO
WE'RE REALLY TRYING TO MAKE THE
DEVICES WORK NOT ONLY FOR
RESEARCHERS AND HEALTH CARE
SYSTEM BUT FOR THE PERSON TO
MOTIVATE THEIR BEHAVIOR CHANGE.
>> SACNIN, YOU DO A LOT OF
RESEARCH, WHAT ARE YOU SEEING
NOW AND AHEAD?
>> YOU KNOW, I THINK WE'RE
SEEING AN EVOLUTION HERE,
HISTORICAL PERCEPTIONS ON
UNDERSERVED POPULATIONS NOT
BEING INTERESTED OR ABLE TO
PARTICIPATE IN THESE TRIALS.
THOSE PERCEPTIONS HAVE BEEN
PROVEN TO BE INVALID.
THE NIH HAS DONE NEAT WORK, THE
RULE STUDY, NIH FUNDED THAT
STUDY IN CARDIOVASCULAR
MEDICINE, MOVING BEYOND LIKE
FRAMINGHAM HEART STUDY, A
CURATED HOMOGENOUS POPULATION
HANDING OUT DATA PLAN GIFT CARDS
TO FOLKS.
THE FOLKS THAT WERE IN THE
MISSING FROM THE HISTORICAL
STUDIES ARE NOW IN THERE.
IN OUR STUDY OF THOUSANDS OF
PARTICIPANTS THAT WE ENROLLED,
MICHIGAN HAS A RELATIVELY
NON-DIVERSE PATIENT POPULATION
SO WE ASKED MORE -- HAD SPECIFIC
ENROLLMENT TARGETS TO MAKE SURE
SAMPLE SIZES WERE ADEQUATE FOR
INFERENCE AT INDIVIDUAL LEVEL
AND SAW GREAT UPTAKE, GREAT
INVOLVEMENT.
BUT WHEN YOU ENGAGE COMMUNITY
PARTNERS, I THINK MISTRUST IS
THERE.
WHAT WE'RE AT NOW IS DATASETS
ARE OUT, THERE "ALL OF US" US
HAS TEN OR TWENTY THOUSAND
FOLKS, DIVERSE POPULATIONS.
I THINK OUR DIGITAL DIVIDE
CLOSURE IS MOVING FASTER THAN
OUR HEALTHCARE DIVIDE CLOSURE.
SO THE DISPARITIES IN HEALTHCARE
OUTCOMES BY RACE,
SOCIOSOCIOECONOMIC STATUS ARE
WIDE BUT GETTING DATA REGARDING
DIVERSE POPULATIONS, UNDERSERVED
POPULATIONS IS GETTING NARROW
RAPIDLY SO I'M QUITE OPTIMISTIC
BECAUSE I THINK WE'RE DOING
BETTER WITH RESEARCH THAN WITH
HEALTH CARE IN THIS AREA.
>> IF I'M A RESEARCHER, I WANT
TO EXPLORE AN UNADDRESSED
QUESTION, ONE THAT'S PRESSING,
IMPORTANT, WHAT WOULD YOUR
RECOMMENDATION BE?
WHERE SHOULD I FOCUS?
WHAT ARE SOME AREAS I SHOULD
LOOK AT?
>> START WITH JOE.
>> WHAT'S PUBLISHABLE?
>> THIS IS MY OWN BIAS, FOR
SURE.
ONE THOUGH I THINK THAT WE
TALKED ABOUT THIS SEVERAL TIMES,
WITH THE PSYCHOLOGY OF GETTING
PEOPLE TO ENGAGE WITH THEIR DATA
AND CHANGE THEIR BEHAVIORS.
IT'S STILL A BIG GOOSE EGG.
WE HAVEN'T FIGURED THAT OUT.
I LOVE IT WHEN I GET MULTI---
DIFFERENT GROUPS TOGETHER DATA
SCIENTISTS, WEARABLE EXPERTS
TRYING TO SOLVE STUFF.
WE DIDN'T TALK ABOUT IT, BUT
JUST TO POINT AT LARGE LANGUAGE
MODEL IS THE THREE WORDS ON
EVERY SUBMISSION THESE DAYS.
IT'S BECAUSE PEOPLE SEE SO MANY
NICHE SETS, BUT THEY STILL HAVE
HALLUCINATIONSES, IF YOU CAN
SOLVE THAT THAT'S GOING TO MOVE
US A DECADE FORWARD QUICKLY.
THOSE ARE TWO AREAS THAT NEED A
LOT OF WORK.
MULTI-MODAL AS I SAID THAT'S A
BIG ONE.
RETRIEVAL, AUGMENTED GENERATION
IS THOUGHT.
AGENTIC A.I. IS HOT.
I DON'T MEAN TO BE BLABBERING
OFF JARGON BUT THOSE ARE THINGS
WE SEE A LOT OF.
>> WE'RE CLOSING ON TIME.
WE'VE GOT ANOTHER QUESTION HERE,
DO YOU THINK A.I. WILL HELP WITH
EHR SYNCHRONIZATION, NAVIGATING
VARIOUS EHRs ARE A NIGHTMARE
FOR PHYSICIANS, OPEN TO THE
GROUP.
WHAT ARE YOUR THOUGHTS THERE?
>> I DON'T THINK IT'S A
TECHNOLOGY PROBLEM.
I THINK IT'S A BUSINESS MODEL
PROBLEM.
PEOPLE THAT ARE IN THAT BUSINESS
WANT TO BUILD WALLS SO YOU DON'T
SWITCH RECORD SYSTEMS AND SO
THEY DON'T TALK TO ONE ANOTHER.
>> DO WE FEEL THAT SOME OF THE
CURRENT WORK UNDERWAY AROUND
FHIR STANDARDS, STANDARDIZATION,
IS THAT GOING TO MAKE PROGRESS
OR IS IT --
>> AT SOME POINT.
I REMEMBER WHEN DICOM WAS THERE,
IT DIDN'T WORK, NOW IT WORKS.
LIKE THE CHEESE MOVES.
RIGHT NOW, EPIC AND CERNER OF
THE WORLD DOESN'T WANT TO GIVE
AN INCH BUT MAYBE ZY SOMEDAY TY
WILL BE YESTERDAY'S THOUGHT,
SOMETHING ELSE THEY WILL FIGHT
OVER.
>> I'LL CLOSE WITH A TOPIC THAT
COULD BE ANOTHER THING WE COULD
SPEND AN HOUR ON.
MASS GENERAL BRIGHAM, WHERE JOE,
YOU WORK, SACHIN, MICHIGAN
MEDICINE, AND 48 OUR HEALTH
SYSTEMS ARE WORKING TOGETHER ON
THE TRUSTWORTHY RESPONSIBLE A.I.
NETWORK, TRAIN.
ONE OBJECTIVE IS TO HELP SYSTEMS
DEAL WITH THE AMOUNT OF A.I.
COMING THEIR WAY, TRY TO
DISTRIBUTE WORKLOAD BY WORKING
WITH OTHER SITES TO NOT ONLY
CHOOSE WHAT A.I. IS APPROPRIATE
TO MEASURE BUT ALSO STANDARDIZE
ON IMPLEMENTATION AND ON THE
MEASUREMENTS.
IF SITES COULD DO THAT, EACH
SITE DOING IT FOCUSED ON A
PARTICULAR QUESTION, OR
PARTICULAR A.I., WE MAY BE ABLE
TO CAPTURE THAT INFORMATION
WITHIN EACH SITE, AND THEN BE
ABLE TO CREATE FEDERATED A.I.
OUTCOMES REGISTRY.
SO THROWING TO THE GROUP,
BECAUSE OF THE FACT REGISTRIES
ARE A VALUABLE WAY TO STIMULATE
RESEARCH AND GATHER INFORMATION
IN A STANDARDIZED MANNER ACROSS
SYSTEMS WHILE MAINTAINING DATA
PROVENANCE THROUGH FEDERATED
MECHANISMS PERHAPS THAT COULD BE
ANOTHER AREA, AND SO FINAL
THOUGHTS ON THAT, DUMB IDEA,
SMART IDEA, INTERESTING IDEA?
>> I THINK IT'S A FABULOUS IDEA.
>> CERTAINLY A LOT OF
OPPORTUNITY FOR RESEARCHERS AS
WE LOOK INTO THIS SPACE.
I WANT TO MAYBE GIVE ONE FINAL
OPPORTUNITY, FINAL CLOSING
THOUGHTS, WHERE ARE WE HEADING
IN THE FUTURE, ANY
RECOMMENDATIONS, WE'LL GO LOK,
SACHIN, AND JOE.
>> JUST TO GO BACK TO THE POLICY
QUESTION, LOOKS LIKE THE HILL IS
CONTEMPLATING EXTENDING MEDICARE
TELEHEALTH FLEXIBILITY FOR
ANOTHER TWO YEARS, SO I GUESS
WE'RE PUNTING THIS ISSUE DOWN
THE ROAD.
>> OKAY.
POLICY-WISE, MORE PUNTING.
SACHIN?
>> CONTINUED EFFORTS IN
DECENTRALIZED AND NON-HEALTHCARE
SYSTEM BASED EFFORTS TO EVALUATE
THESE TECHNOLOGY, MEETING
PATIENTS WHERE THEY ARE, WHICH
DOESN'T HAVE TO WALK THROUGH OUR
ACADEMIC MEDICAL CENTER FRONT
WALL, FRONT DOOR IS THE KEY.
>> ABSOLUTELY.
JOE?
>> AGAIN THE IDEA OF OMNI
CHANNEL CARE, DEVELOPING IT OUT.
IT'S NOT UNLIKE WHAT SACHIN,
IT'S A DIGITAL FRONT-DOOR
CONCEPT.
WE'RE SO POOR AT THAT RIGHT NOW.
IT'S SAD, THERE'S SO MANY OTHER
INITIATIVES DOING SO MUCH BETTER
THAN WE ARE, I HOPE WE CAN GET
THERE.
>> IT'S BEEN A PLEASURE HAVING A
CONVERSATION WITH ALL THREE OF
YOU.
THANK YOU ALL FOR LISTENING IN.
WE'RE GOING TO CLOSE OUR PART OF
THE SESSION AND HAND IT BACK TO
THE FACILITATORS.
AND WE'RE BACK ON TIME.
SO THANK YOU ALL FOR YOUR TIME
AND LOOKING FORWARD TO HEARING
THE REST OF THE PROGRAM.
>> THANK YOU.
>> THANK YOU VERY MUCH FOR EVERY
ONE OF THESE SESSIONS,
PHENOMENAL DISCUSSION.
NOW WE MOVE FOR SOME CLOSING
REMARKS BY DR. MENSAH.
AGAIN, DON'T GO AWAY.
WE HAVE MORE.
>> ALL RIGHT.
THANK YOU, FERNANDO.
WHAT A REALLY FANTASTIC
PRACTICAL MEANINGFUL SUBSTANTIVE
WORKSHOP.
WE CAN'T THANK YOU ENOUGH.
BUT AS WE BRING THIS WORKSHOP TO
A CLOSE, I'D LIKE TO REFLECT ON
THE STIMULATING DISCUSSIONS,
INVALUABLE INSIGHTS, PRACTICAL
TAKEHOME MESSAGES AND UNIQUE
OPPORTUNITIES YOU HELPED US
IDENTIFY FOR US IN THE CENTER
FOR TRANSLATIONAL RESEARCH AND
IMPLEMENTATION SCIENCE, CTRIS,
AND EVEN MORE BROADLY FOR ALL OF
US AS COLLEAGUE OF NHLBI AND ALL
OF NIH.
SO FIRST, I WANT TO EXTEND MY
DEEPEST GRATITUDE TO EACH OF YOU
FOR YOUR CONTRIBUTIONS TO THIS
IMPORTANT WORKSHOP.
THIS IS A REALLY BUSY TIME OF
YEAR FOR ALL OF YOU.
SO WE REALLY, REALLY APPRECIATE
YOU TAKING THE TIME TO PREPARE,
AND TO CONTRIBUTE TO MAKING THIS
WORKSHOP SO SUCCESSFUL.
YOU KNOW, OUR JOURNEY INTO
UNDERSTAND THE CURRENT USE OF
DIRECT-TO-CONSUMER TELEHEALTH
AND LESSONS LEARNED, THAT
JOURNEY HAS BEEN ENLIGHTENING,
HAS BEEN INSPIRING, AND HAS EVEN
BEEN MADE MORE RICH BECAUSE OF
YOUR CONTRIBUTIONS.
THE CHALLENGES, ESPECIALLY THE
OPPORTUNITIES THAT YOU'VE HELPED
US IDENTIFY WILL GO A VERY, VERY
LONG WAY AS WE EXPLORE OVER THE
NEXT THREE TO FIVE YEARS AND
ESPECIALLY THE DECADE AHEAD, HOW
NHLBI CAN HELP LEVERAGE THE
TECHNOLOGICAL ADVANCEMENTS,
COUPLED WITH TRULY MEANINGFUL
ENGAGEMENT OF THE COMMUNITIES WE
SERVE, TO REALLY BEND THE CURVE
TOWARDS TRULY TRANSFORMATIVE
CHANGE IN DIRECT-TO CONSUMER
TELEHEALTH FOR ADVANCE ALSO
HEALTH FOR ALL.
DISCUSSIONS TODAY UNDERSCORED
THE CRITICAL IMPORTANCE OF
HEALTH EQUITY, PARTICULARLY IN
RURAL AND UNDERSERVED AREAS, AND
AS WE HEARD EVEN IN URBAN
CENTERS, THERE ARE UNDERSERVED
POPULATIONS FOR WHOM WE
SHOULDN'T FORGET.
IT'S CLEAR THAT WHILE TELEHEALTH
HOLDS TREMENDOUS PROMISE FOR
BRIDGING GAPS IN CARE, WE MUST
REMAIN VIGILANT ENSURING THESE
SOLUTIONS ARE INCLUSIVE AND
EQUITABLE FOR ALL COMMUNITIES,
THAT YOU WE DON'T NEED TO WIDEN
DISPARITIES THAT SEVERAL OF YOU
MENTIONED TODAY.
I'M VERY PARTICULARLY ENCOURAGED
BY INNOVATIVE IDEAS AND
POTENTIAL SOLUTIONS THAT EMERGED
FROM THE SESSIONS.
IN THE INTEREST OF TIME I WILL
NOT COMMENT ON SESSION 2 OR THE
REPORT-BACK FROM THE BREAKOUT
SESSIONS SINCE THOSE ARE FRESH
IN YOUR MIND SINCE WE JUST HAD
THOSE SESSIONS BUT I'LL COMMENT
ON A FEW THEMES FROM THE
MORNING.
WE BEGAN WITH DR. BRUNO AND DR.
LEWIS, WHO SHARED WITH US THE
REAL IMPORTANCE OF THIS WORKSHOP
WITHIN THE CONTEXT OF THE
STRATEGIC VISION GOALS AND
OBJECTIVES OF THE NATIONAL
HEART, LUNG AND BLOOD INSTITUTE
ESPECIALLY CENTER FOR
TRANSLATION RESEARCH.
WE JUST CELEBRATED OUR TENTH
ANNIVERSARY AND DR. LEWIS
INVITED YOU ON DECEMBER 11.
AFTER THAT CELEBRATION, AS WE
BEGIN TO CHART THE FUTURE OF THE
NEXT DECADE, WHAT WE'VE HEARD
FROM YOU TODAY IS GOING TO BE
CRUCIAL.
IN THE OPENING KEYNOTE
PRESENTATION WE HEARD FROM GARTH
GRAHAM WHO TOLD US NEIGHBORHOODS
MATTER FOR HEALTH.
MEANING WHERE WE LIVE HAS AN
IMPACT ON OUR HEALTH, AND THAT
TRUE PATIENT-CENTRIC CARE
REQUIRES REACHING PATIENTS WHERE
THEY ARE.
SO THERE ARE TREMENDOUS
OPPORTUNITIES FOR US.
HOW DO WE USE THE SEVEN DOMAINS
HE SHARED WITH US TO TRULY
TRANSFORM HEALTH OF PATIENTS AND
COMMUNITIES THROUGH
DIRECT-TO-CONSUMER TELEHEALTH
AND IMPLEMENTATION RESEARCH.
HOW DO WE USE IMPLEMENTATION
STRATEGIES TO ENSURE OVERARCHING
PROMISE OF TELEMEDICINE IS MADE
REAL FOR PATIENTS OR PROVIDERS
AND ALSO FOR THE HEALTHCARE
SYSTEM AS A WHOLE.
HOW DO WE USE MULTI-CHANNEL
COMMUNICATION SCIENCE AND
DISSEMINATION RESEARCH TO ENSURE
THAT THE THREE TAKEHOME MESSAGES
HE SHARED REACH ALL AUDIENCES.
MANY EXAMPLES HE SHARED ABOUT
EVOLUTION OF TELEHEALTH AND
EXPERIENCES FROM MANY CLINICAL
PRACTICES DURING THE COVID
PANDEMIC, ESPECIALLY AROUND
PATIENT-PROVIDER RELATIONSHIPS,
THESE WILL ALL BE INVALUABLE AS
WE EXPLORE THE RESEARCH
OPPORTUNITIES.
SO WE THANK DR. GRAHAM FOR
GETTING US STARTED.
IN SESSION 1, AND RELATED SMALL
GROUP DISCUSSIONS, I THINK THEY
WERE FANTASTIC.
WE WENT BEYOND THE SCREEN AROUND
LEARNED ABOUT BEST PRACTICES IN
TELEHEALTH, IMPLEMENTATION
RESEARCH THAT CAN HAVE LASTING
IMPACT.
SO BIG THANK YOU TO MEGAN AND
KRISTIN AND THE TEAM AND JOHN
FOR THE WORK AND THE EXCITING
SESSION.
BUT REALLY WE HAD THE
OPPORTUNITY TO EXPLORE HOW WE
REINVENT CARE AND DO THINGS
DIFFERENTLY, NOT CONTINUE TO DO
THINGS THE SAME WAY.
WE HEARD THE CAVEAT THAT TO
THINK OF TELEHEALTH AS THE
ELEVATOR, FIRST TIME I HEARD
THAT EXPRESSION, BUT WHAT ARE
THE REAL PROMISING PRACTICES
AMONG THE TELEHEALTH MODALITIES
ESPECIALLY AS TELEHEALTH IS
LAUNCHED AND WE'RE LAUNCHED
MULTIPLE TIMES.
HOW DID WE ADDRESS ISSUES OF
RELUCTANCE, REENGAGEMENT,
TELEMEDICINE, WHAT STRATEGIES
CAN WE DEVELOP AND TEST TO
SUPPORT PROVIDERS?
IMPORTANTLY, HOW DO WE SUPPORT
TRAINING AND CAREER DEVELOPMENT
AND HOW WE BUILD THE FUTURE
GENERATION OF CLINICIANS, NOT
JUST PHYSICIANS BUT ALL
CLINICIANS, AND
CLINICIAN-SCIENTISTS, TO HAVE
EXPERTISE AND EXPERIENCE TO USE
TELEHEALTH APPROPRIATELY.
HOW DO WE SCALE UP THESE
PROBLEMS AND PRACTICES?
FOR EXAMPLE, WHAT WE HEARD
ABOUT, PATIENT CHECKOUT
ROUTINES, PATIENT PREFERRED
LANGUAGE SELECTION, AND OTHER
INNOVATIVE HYBRID ROUTINES ARE
IN CARE TRANSITIONS, HOW DO WE
BEST KNOW ABOUT THE REAL WORLD
DATA FROM STAND-ALONE
TELEHEALTH, AND IMPACT ON HEALTH
OUTCOMES.
I HAVE FIVE PAGES OF NOTES BUT
I'M GOING TO STOP AND SHARE MY
NOTES WITH FERNANDO, HONESTLY
THIS HAS BEEN A FANTASTIC
SESSION, SESSION, SINCERE
THANKS, BOB, ROBIN, LOK AND
SINCHAN, REALLY TERRIFIC.
EXPLORE OPPORTUNITIES IN
TELEHEALTH RESEARCH.
I HOPE WE ALL KEEP CHALLENGING
CONVENTIONAL THINKING AND WORK
TOWARDS TRANSLATING THE ADVANCES
WE'VE HEARD ABOUT TODAY INTO
TANGIBLE HEALTH IMPACTS THAT
WOULD ENABLE OUR COMMUNITIES TO
THRIVE.
ESPECIALLY WHEN IT COMES TO
IMPROVED ACCESS TO HIGH-QUALITY
HEALTH CARE THROUGH
DIRECT-TO-CONSUMER TELEHEALTH.
AGAIN, A TRULY WONDERFUL
WORKSHOP.
I'LL TURN IT OVER TO FERNANDO TO
THANK ALL OF YOU AND ESPECIALLY
THE ENTIRE TEAM THAT MADE THIS
WORKSHOP POSSIBLE, ALSO TO SHARE
WITH US SOME NEXT STEPS.
ON BEHALF OF NIH, NHLBI, AND OUR
CENTER, CTRIS, WE THANK YOU.
FERNANDO, I'LL TAG YOU.
>> THANK YOU VERY MUCH, GEORGE.
JUST WAITING FOR THE OPPORTUNITY
TO SHARE MY SCREEN, IF I CAN DO
THAT, SUPPORT TEAM.
I JUST ADDED MY SCREEN HERE SO I
CAN SHARE IT.
ALL RIGHT.
THIS BRINGS US TO A CLOSE,
NOTHING BETTER THAN HAVING OUR
DIRECTOR, DR. MENSAH, BRINGING
THESE WISE WORDS, SO MUCH RICH
CONVERSATION FOR TODAY.
IT WOULDN'T BE ENOUGH IF WE
DON'T THANK ALL OF YOU WHO
STAYED WITH US THROUGHOUT THIS
TIME, THOSE WHO MIGHT BE
WATCHING AFTER THIS WORKSHOP
TOOK PLACE BUT THOSE WHO MADE
THE WORKSHOP POSSIBLE.
I SEND MY GREAT THANK YOU AND
ACKNOWLEDGMENT TO THE NHLBI
WORKSHOP SUPPORT TEAM FOR THE
SAKE OF THE TIME I WON'T SAY
EVERYBODY'S NAME BUT THEY ARE
ALL HERE.
WITHOUT THEM THIS WOULD NOT HAVE
BEEN POSSIBLE.
ALSO, THE ADVERTISING AND
SPEAKING ABOUT THE EVENT AND
INFORMATION TECHNOLOGY TEAM AND
OBVIOUSLY TO ALL OF OUR SPEAKERS
AVAILABLE HERE TODAY, THANK YOU
FOR ACCEPTING OUR INVITATION,
FOR ENGAGING SUCH A RICH
CONVERSATION.
THANK YOU TO THE CTRIS
LEADERSHIP AND SHOUTING OUT, I
WANT TO GIVE THE SPOTLIGHT TO
PADMA WITHOUT WHOM I COULDN'T
SURVIVE THE PLANNING.
THANK YOU.
REGARDING NEXT STEPS, AS GEORGE
WAS MENTIONING THERE'S THE CTRIS
TEN-YEAR ANNIVERSARY WHICH WE
SHARED THE LINK FOR YOU TO
REGISTER.
TODAY ALSO MARKS THE END OF THE
WORKSHOP, TO US IT'S JUST THE
BEGINNING.
WE ARE GOING TO COMPILE THINGS
THAT HAPPENED TODAY INTO AN
EXECUTIVE SUMMARY AVAILABLE ON
THE WEBSITE WITHIN THE NEXT
MONTH.
HOPEFULLY SOME PUBLICATIONS ALSO
IN WHICH WE CAN COMMENT MORE
ABOUT WHAT WAS DISCUSSED TODAY.
AND BEFORE THE END, I WANT TO
ALSO SHARE SOMETHING CTRIS IS
ALREADY LEADING IN REGARDS TO
TELEHEALTH, WE'RE HAVING A
FUNDING OPPORTUNITY, DIFFERENCE
IN THE WORKSHOP FOCUS TODAY,
THIS ONE ON PROVIDER-TO-PROVIDER
TELEHEALTH, PARTICULARLY THOSE
IN NEED IN RURAL AREAS.
SO AS LONG AS YOU HAVE AN IDEA
FOR A PROJECT THAT DEALS WITH
RURAL AREAS BENEFITING,
PROVIDING COMMUNICATION, LIKELY
RESPONSIVE TO THIS NEWEST
OPPORTUNITY HERE.
HAVE YOU MY CONTACT THERE.
ALSO IMPORTANT HIGHLIGHT ROBIN
VANDERPOOL, SHE'S THE
REPRESENTATIVE FOR NCI, SO WE
CAN ALSO CONTACT HER.
SCAN THE QR CODE ABOUT THIS
NOTICE OF SPECIAL INTEREST ON
CTRIS.
BEYOND THIS IF YOU HAVE A
PARTICULAR PROJECT ON TELEHEALTH
OR SOMETHING THAT HAS TO DO WITH
IMPLEMENTATION RESEARCH REACH
OUT.
WE'RE OPEN TO HEAR YOUR IDEAS
AND HAVE TECHNICAL INFORMATION
CALLS WITH YOU, IN WHICH WE CAN
BETTER ASSIST WITH YOUR
RESEARCH.
AND WITH THAT I THINK THAT
BRINGS US TO THE ACTUAL CLOSE,
AND I WILL SHARE THIS SLIDE FROM
THE SUPPORT TEAM WHO IS ALSO
ASKING YOU TO PLEASE TAKE A
MINUTE AND RATE AND GIVE
FEEDBACK FOR THIS WORKSHOP.
IT'S BEEN WONDERFUL TO HOST ALL
OF YOU.
THANK YOU VERY MUCH FOR STAYING
WITH US.
>> THANK YOU ALL.