Bloomberg Virtual Briefing

Michelle Fay Cortez:

Hi, I'm Michelle Fay Cortez, health science and medical technology reporter for Bloomberg News. Thanks so much for joining us for The Next Era in Healthcare, a virtual briefing.

Michelle Fay Cortez:

Today, we're going to be talking about COVID-19 and the impact that it's had on healthcare delivery. We're going to the front lines of medicine, business, government, and policy to see what kind of changes, what steps are being taken to make sure that consumers still have access to excellent healthcare even as this pandemic rages around us, and what lessons we've learned from this very difficult time. We're also going to look at the challenges, cost, and fragmentation that could hinder adoption and what the future might hold.

Michelle Fay Cortez:

First we'd like to thank our sponsor, Optum, for making this virtual briefing possible.

Michelle Fay Cortez:

Before we begin, we're going to do a little bit of housekeeping. If you're having any trouble with audio or visuals, please refresh your browser. This is also an interactive event and we welcome your questions. You can submit them in the Q&A box that's just above the slide show. Make sure you hit submit. And please tell us your first name and your city so that we can give you a shout out if we use your question.

Michelle Fay Cortez:

We're also going to be doing polls during this. The questions will pop up on your screens as we're talking. So please be sure to answer and hit enter so that we can hear from you. And you can connect on us on social media. Our hashtag is #nextera.

Michelle Fay Cortez:

Now we're going to have some remarks from Robert Musslewhite, the CEO of OptumInsight.

Robert Musslewhite:

Thank you for joining us. More than ever, Bloomberg live briefings are not only tremendously informative, but essential. And I'd like to take a minute to share my thoughts on today's topic, The Next Era in Healthcare. Even as we navigate one of the most challenging times in healthcare with the COVID-19 pandemic, we have an enormous opportunity in front of us to fundamentally change how people are cared for in the future. This is especially true around telehealth and virtual care. While last year only one in 10 patients participated in a virtual visit, the health system is now waking up to the fact that virtual technology is not just for times of crisis. There's broad recognition that it has multiple applications, benefits both patients and providers in countless ways, and is highly effective.

Robert Musslewhite:

This is something many of us have known for some time. A few years ago when our client, the University of Pittsburgh Medical Center wanted to expand access to in home care for cardiac patients, they deployed our Vivify remote patient monitoring technology. Here's what they discovered. One, when Medicare members enrolled in Vivify, they were 74% less likely to be readmitted to the hospital within 90 days. Two, patient compliance reached over 90%. And three, patients gave the program very high marks, giving it a 93% satisfaction rate.

Robert Musslewhite:

Today it's clear patients and providers are quickly embracing virtual technologies. In fact, Frost & Sullivan forecast a sevenfold increase in telehealth by 2025, including remote devices and wearables. Our advisory board research confirms this with about half of all hospitals expected to invest in remote technologies over the next 18 months. This rise in telehealth will have huge impact on our ability to connect people in care, especially in the home, and in underserved rural areas. It also reflects a broader need for something even more fundamental, a fully connected health system, able to leverage this new technology and vast data to its fullest potential.

Robert Musslewhite:

So if I had to describe The Next Era in Healthcare in one word, it would be connection, bringing people and technology and information together to help individuals better manage their health. This is one of our top areas of strategic focus here at Optum. We envision a health system where clinicians are fully supported with data driven insights, where health plans can seamlessly and accurately manage costs, quality and utilization, where employers can support a healthy and productive workforce, and where consumers are empowered by digital technology to live healthier lives.

Robert Musslewhite:

We know this is going to take a lot of work by everyone across the entire health system, but recently we've seen what is possible when the private sector, government, and researchers come together to advance our understanding of human health and develop new solutions to advance it. The path forward to a connected health system requires deep investments in advanced technology, the robust sharing of healthcare intelligence, intense cross system collaboration, and relentless innovation. We believe that is how we will drive better health outcomes and experiences at a lower total cost at a societal scale for years to come. Thank you and enjoy today's briefing.

Michelle Fay Cortez:

Thank you so much to OptumInsight CEO, Robert Musslewhite. And now we're onto the next section of The Next Era in Healthcare. So please join me in thanking our speakers here who are with us today. We have Dr. Amy Abernethy, FDA Principal Deputy Commissioner for Food and Drugs. We have Jason Gorevic, who is the chief executive officer of Teladoc Health. And we have Mei Kwong, who is the executive director of the Center for Connected Health Policy. Thank you guys so much for joining us.

Amy Abernethy:

Thank you for having me.

Michelle Fay Cortez:

So I think that we're going to start with Mei. Thank you so much. So we're going to start with Mei. Telemedicine has been with us for as long, really, as telephones have been with us. Doctors have always been reaching out to their patients in remote areas, we even had people on the space station get medical care, but it has been a slow ramp. So tell us when healthcare, when technology, when telehealth really started taking off, and where we were through the end of 2019 before coronavirus changed our world.

Mei Kwong:

Thank you, Michelle. So I liken COVID-19, the impact it's had on telehealth, to similar to an actor who was unknown before and suddenly was cast in a Marvel franchise movie film. So telehealth before COVID-19 had been slowly gaining traction, but it hadn't really quite reached that point where it was well-known, widespread, and greatly utilized. COVID-19 has really changed that landscape. And now it's become proliferated throughout our society here. So many more people know about it. I've been doing this for 10 years, and I had family and friends who were confused about what I did. And now they're familiar with telehealth. We're seeing it used in multiple places, in the home, in different clinics and hospitals that hadn't used it.

Mei Kwong:

And the reason for the sort of slow progression of it at first was the technology. The technology was not quite there yet, but really in the last few years, it had actually gotten to the point where you could use the technology to deliver the services in these multiple places. But the policies weren't really there to really facilitate that utilization. So you had these policies in place that really impeded and limited how telehealth could be used and where it could be used and who could use it.

Michelle Fay Cortez:

So great. Thank you for that. That segues nicely into some questions for Dr. Abernethy. Of course, the FDA's main role in our country is to ensure the safety and health and the efficiency of the medical system. But there have been regulations that have been changed in recent times, given coronavirus, to help expand the use of telehealth and to roll it out to more people. More things are being covered. The FDA is allowing things for psychiatric care and other types of things. So tell me, do you think that the FDA was a little bit slow in terms of the regulatory process? And now that you see what's happening, are you happy with what you've been observing?

Amy Abernethy:

So first of all, the COVID-19 pandemic, this is terrible for all of us, really has given us a bright spot of learning and being able to think about what works. And so, [inaudible 00:08:44] one of the bright spots [inaudible 00:08:46] health.

Amy Abernethy:

From the standpoint of the FDA, our responsibility is to protect and promote [inaudible 00:08:57].

Michelle Fay Cortez:

All right. I think that we're having a little bit of trouble here, Dr. Abernethy. We're not actually hearing you. So apologies for that. We will work it out on the technical issues on our side. But we can switch it over, I think to Jason Gorevic, while hopefully you can talk with our tech folks. To Jason Gorevic, it seems to me a lot of us have learned a phenomenal amount since coronavirus hit. There was widespread belief that we couldn't work from home, for example. And millions of Americans, millions of people all across the world have been asked to stay home. For you, it's been exactly the opposite. You guys were asked to really phenomenally step it up. So my question for you is that when did you know that your entire world is going to be upended by this, and how prepared were you to step into that chasm?

Jason Gorevic:

Yeah. So I appreciate it, Michelle, thanks for having us. And for the question, it's interesting because with a global presence, we actually have physicians on the ground in China, as well as in Europe, especially in Spain. And so we had a sort of earlier insight than many in the U.S. about the progression of the disease. At the end of January, we started being in contact with the WHO and the CDC. And we started to see the impact that this could have. We became prepared over the course of those couple of months, but I don't think anybody really understood the ramp that it would take when it finally hit the U.S. And so in the middle of March, we saw literally overnight our volume double. And last year we already did four million virtual visits over the course of the year, and that will more than double this year. So we saw daily volume more than double. And fortunately, we build our technology systems to really 10X our peak volume at any given time. And so that actually worked incredibly well. The technology held up very well.

Jason Gorevic:

What it took a little bit longer, about a week, maybe 10 days to do, was ramp up our physician capacity. And so we saw a few days of slower than expected and slower than acceptable time to connect with a physician. But by the time about eight or nine days was over, we were back to pre-COVID service levels of connecting someone with a doctor in a matter of minutes. And at the same time, we had providers in the market who all of a sudden were forced to embrace virtual care as a means of survival, quite frankly, economically, and a way to connect with their patients. And so we were able to onboard thousands of physicians onto our platform to enable them to connect with their patients over that period of time.

Michelle Fay Cortez:

It is really amazing how both pieces of this are coming together. We're seeing the consumers embrace it because they have no choice, and the doctors embrace it because they have no choice. So it's going to be so interesting to see how that plays out. Let's go back to Dr. Abernethy and see, I apologize for that technical difficulty, but if you wanted to finish up, we lost you at about when you were saying what the FDA's mandate is, in order to ensure the safety of the American population.

Amy Abernethy:

So our mandate is to protect and promote public health. And we do this really by the development of medical products. So drugs, devices, biologics, and how does it fit into this story? Practically speaking, for example, one of the things that needs to happen is clinical trials. And in clinical trials, it's important to keep patients safe, and then they need to go a series of clinical trial visits, where they interface with their clinicians. Telehealth has become a really important mechanism for remote monitoring of patients on clinical trials [inaudible 00:13:13].

Michelle Fay Cortez:

Oh, no. We seem to have lost you again. Apologies for that. So I do not know what's going on there, but so I was going to go to a poll, but I think that perhaps our technicians might be busy trying to help Dr. Abernethy's connection. So instead, we're going to go on to our next set of questions. So I was personally surprised to learn that ER visits are well suited for telehealth. I always thought if you're going to the emergency room, you need to see a doctor in an emergency, and they might need to set your arm or give you a test, something like that. But there are all these different areas that have really expanded. So maybe we'll start with Jason. You can tell us what areas are really booming when it comes to telehealth. What is an area that maybe people aren't aware that they can go to telehealth to get quick and excellent access? And then Mei, perhaps you can follow up on that.

Jason Gorevic:

Yeah, I think that's actually the most under appreciated area with respect to telehealth, is the breadth of clinical services that are available. We see clinical use cases ranging from pre and post surgical visits to oncology followup visits, all the way to telepsych, telestroke, and certainly mental health care is one of our biggest areas and fastest growing areas. Telepsych in the emergency department where someone needs a psych consult, they need to speak with a psychiatrist, but of course, every ED in the country can't staff a psychiatrist, and so that lends itself incredibly well. But it's also a longitudinal care where someone has a longterm relationship with a therapist and/or a psychiatrist in a virtual relationship for regular check ins using multiple modalities, everything from texts to chat, to phone, to video, and really using them interchangeably as necessary for both scheduled visits, as well as on demand care.

Jason Gorevic:

And so, again, I would say, we see demand today from everything from orthopedics to cardiology to oncology, certainly dermatology lends itself incredibly well. And so I would say that the truth is this has forced multiple specialties all across the spectrum to embrace virtual care. And I don't think it's going back. What we're hearing from all providers of different specialties is that telehealth is now a permanent part of their practices.

Michelle Fay Cortez:

So Dr. Abernethy, you were actually discussing this, that's one of the things I wanted to talk about, another area where there's been innovation, where telehealth is making a difference, is in the clinical trial world. So if you wanted to continue with that, but I think you're going to have to keep it short, because of the internet connection.

Amy Abernethy:

It might go away. So importantly in clinical trials, we need to keep people safe. So historically we had everybody come back for many visits, but now we're starting to see the use of telehealth to allow people to stay at their home and interface for those many different clinical trial visits via video with the clinical trial teams, allows us to collect safety data, allows us to keep patients in trials, even at a time like the pandemic and keep studying new medicines. And it's one of the places where we've seen telehealth have a huge role.

Michelle Fay Cortez:

I think it's so interesting because the issue of access is critical here. Now, obviously people who are in clinical trials, generally, these are our sickest patients and most vulnerable. And so being able to get them to be able to safely see their doctors is such a huge benefit in this time. But then there's also these other layers of issues in terms of, it's really helpful you don't have to drive to the doctor. You don't have to pay for parking. You don't have to maybe get on a bus or a subway. On the other hand, you also need to have internet access. You need to have a computer. So Mei, maybe you can talk to us a little bit about disparities in healthcare. Are we going to see that telemedicine is going to exacerbate some of these disparities that we're seeing, especially because coronavirus in particular has hit our communities of color much harder than other communities, or is it actually going to be a beneficial move? And then we can maybe go to Jason and Dr. Abernethy.

Mei Kwong:

It's actually going to be both. And I think COVID-19 has really highlighted that, in that telehealth, people can see right now, it is a great benefit. It is a great tool to provide these services to those vulnerable populations. But you do have certain segments of the population who may not have the robust enough connectivity, or maybe they don't have the devices on their end at the home, like a laptop or a smartphone. And that is a question I think policymakers are grappling with is like, how do you ensure that you do not have that digital divide there? One of the things that there is a lot of concern about, you've mentioned it, Michelle, communities of color, different cultures, seniors, who may have issues in how to utilize the technology. I know from my own experience, my parents are seniors and they've had a lot of their care switched over to telehealth now. They would probably not be able to operate the equipment if I was not there assisting them with it. So how do you address those issues?

Mei Kwong:

So there are a few things that the government has tried to address, such as the connectivity issue. In the CARES Act, there was funding to the FCC to help facilitate some of that equipment issue with providing equipment to their patients. And also they've also had a program for connectivity in which they would help rural health clinics, again, access to broadband in order to facilitate telehealth. But that is a major question now, going forward, that if we incorporate telehealth more into our health system, what do we do in addressing those issues in order to make sure nobody is left behind?

Michelle Fay Cortez:

Yeah. I'm going to switch up the question to Jason a little bit, because Mei, you touched on this issue of whether people can do telehealth, especially seniors and others, without someone there along to help them. And as Jason pointed out earlier, we are seeing a huge influx of new people trying this out. And that raises the question of stickiness. If someone tries this, how likely are they to come back? So I'm wondering what you're seeing on your end, Jason, and what you think going forward?

Jason Gorevic:

Yeah. So about 60% of our users in the first quarter were new to telehealth. They were first time Teladoc Health users, and we see with tremendous member satisfaction rates, really net promoter scores that are more like consumer digital products than they are like healthcare. We see tremendous repeat utilization, because number one, it's convenient, it's responsive, it's high quality. And number two, really, most importantly, it resolves their clinical needs and actually provides the care that they need. So we see a lot of first time utilizers coming on through this pandemic. Awareness of telehealth has massively expanded. The data I've seen is that just over a matter of a few weeks, it went from 50% consumer awareness to 75%. That's an unheard of ramp for anything.

Jason Gorevic:

And I would say that for a long time, we've always held the belief that virtual care is the great equalizer. We serve populations in commercial populations, Medicare populations, Medicaid populations. And we find that seniors today are comfortable doing FaceTime with their grandchildren. And you don't need a lot more technical knowledge to be able to use virtual care and take advantage of it than to be able to do something like that. So we believe that with smartphone proliferation comes access to the necessary base technology. And a lot of the hospital systems we're working with are providing peripherals that are very easy to use, connect via Bluetooth, or even via cell connection so that there's no configuration necessary to be able to take advantage of the technology.

Michelle Fay Cortez:

So I'm very interested to see here what Dr. Abernethy thinks about the persistence of telehealth. But before we do that, we're going to see what our audience thinks. We're going to go to a poll now to see what you guys are expecting in your own life in terms of access to the telehealth. So hopefully that poll question will pop right up on our screen.

Michelle Fay Cortez:

All righty. I do not know if it's popping up on your screen, but it's not popping up on my screen. So we will just segue straight to Dr. Abernethy and see what you think about the future of telemedicine and telehealth, if it's something that's going to be sticking with us here in the future.

Amy Abernethy:

So I suspect, as you've already heard, there has been a massive ramp up, and we are going to continue to see telehealth persisting. I also think that the jury is still out. Your question was whether or not this is going to accentuate disparities or start to relieve us of many disparities. And as I think about this from the clinical trial perspective, it increases access of people in especially rural and remote areas to clinical trials because of the increased chance that people who might not have been able to come back to the doctor where the clinical trial is being held can now participate. However, importantly, clinical trials are a space where we need to make sure that people are being kept safe, and so we need to make sure that we understand two critical things, is the role of telehealth and the clinical trials in the clinical development space something that we can maintain while also maintaining safety? And the second is, clinical trials are an important way of collecting the data to understand the safety and effectiveness of a medical product, and is the data that's collected of adequate quality to be able to serve as the information we need to make those judicious decisions? Those are two critical things that we're going to need to understand for the persistence of telehealth in the medical product development side to clinical trials.

Michelle Fay Cortez:

Yeah. I think that's a critical area as well, because we need to have consistency and high quality data. So if we can even get better results with telemedicine, then that could really expand our use of all these things, not have people go to the doctor as often. You're sick, not feeling well, you need to have people help you, that could be really an incredible advance when it comes to clinical trial work.

Michelle Fay Cortez:

So I see that you guys all did actually get the poll question and I did not. So here we go. "How has the COVID-19 pandemic changed your use of telemedicine?" So our big winner was, "I think I'll use it more, but I haven't had the chance yet." That's more than a third of you have said that. So interesting. I think that maybe we skew to healthy. Maybe the group of us just haven't needed to get that much telemedicine so far in this outbreak. And our next group was, "I have increased my use of telemedicine." That was 30%. And then a full quarter was, "I was never a regular user and I don't see it much in my future," and then 7%, "regular user before and not much has changed." So thank you all so much for jumping into that. I really appreciate that. It's very interesting to see what you guys all are thinking about it.

Michelle Fay Cortez:

So interesting. Mei, I'm wondering if you can talk to us about where we're going from here in terms of what we need from technology, what kind of new devices we need to further telemedicine? And Ellen from Massachusetts sent in a question about this. She asked how strep throat can be diagnosed with virtual medicine. It's interesting. For me that touches close to my home, because strep throat hit my family just last week. So I had a telemedicine visit and an in person visit, but what else do we need to have in order to further this industry?

Mei Kwong:

So I think really one of the important things are going to be the policies that are in place. So what we saw with COVID and what I mentioned earlier, what were the barriers to the proliferation of telehealth before had been the policies that have been in place before COVID-19. When COVID-19 hit, what you saw were a lot of governments, both on the federal and the state level, issuing waivers to [inaudible 00:26:04] some of those policies to allow telehealth to be used more widely and in more places and by more providers. Those were temporary though. So in order to encourage the use of telehealth to continue, once we can pass a pandemic, the policy makers are going to have to decide which one of those policies to keep in place, because if we revert back to pre COVID-19, then you're going to have that situation of where telehealth can only be used in limited places. And one of those limiting factors was where the patient was located when the telehealth interaction took place. Not a lot of people were paying for those services when they were taking place in the home. That changed temporarily on COVID, but you take that away, then you suddenly have people needing to go back to a clinic in order to receive telehealth services and for a narrow scope of services.

Mei Kwong:

Now, the question about strep throat, I'm not a clinician. So I think I'm probably not the best person to answer that. Maybe Dr. Abernethy or our other speaker are more suited to answer that particular question of how to use telehealth to treat it. But as far as to encourage the continued utilization of it, expansion of telehealth, you definitely need to have those policies in place. And right now that's the big question mark, because all of these relaxations were temporary. So what's going to stay around, and in what form are they going to stay around?

Michelle Fay Cortez:

I know that there is some legislation up on Capitol Hill that they're talking about putting some of these policies into place, especially for example, paying the same amount for a telehealth visit as an in person visit. So I'll ask Dr. Abernethy, have you heard about the quality of care for Americans when it comes to telehealth? Do you have any insight as to whether or not you think that this has been a good thing, and if it's something that maybe we're going to see continued telehealth, or is there still a little bit of information that needs to be gathered like it is with clinical trials?

Amy Abernethy:

So first of all, I'll put on my clinical hat. I'm an oncologist by background. And so I think about this in terms of telehealth helping me interface with my patients in a way that at a time like COVID-19, I might feel fearful that I don't have as much contact with them, especially at a time when a cancer patient needs to be seeing their doctor. And so I expect we're going to have learned a lot. I expect that that learning will persist. We will also be able to discriminate better, when does telehealth have a role and perhaps even roles that we hadn't expected before, as well as when does it really need to be the in person visit with your doctor?

Amy Abernethy:

The other thing that I think we're going to get better and more practiced at, and it goes back to your strep throat example, is how to partner telehealth with, for example, laboratory visits so that you have the laboratory data that you need also to compliment making the clinical diagnosis.

Amy Abernethy:

So I think that that story is going to be going to continue to evolve. And we have a responsibility of essentially collecting the information from the pandemic right now to tell us what are the judicious times where it's really smart to prioritize telehealth and where do we need to continue to refine it?

Amy Abernethy:

In terms of your point of potential policies for the future, CMS helps to oversee the decision making on the policy side as it relates to payment for telehealth. But I do anticipate that practically going into the future, CMS, and also all across government, we're going to stopping and looking at that information and saying, what did we learn from COVID-19 and it makes sense to persist to telehealth into the future?

Michelle Fay Cortez:

Yeah, absolutely. There's no doubt about it that the entire world is going to change because of this, and especially medicine and healthcare. And healthcare delivery has to keep up. So again, going back to Jason, who has been, your entire foundation, I know that you guys have been building for this for years and years. So for it to all come to fruition is an amazing thing. And the fact that you were able to get up to that kind of speed and ramping, that we've seen that there's supposed to be a billion telehealth visits this year. And as many as $250 billion worth of healthcare services could go virtual, helped along by this coronavirus pandemic.

Michelle Fay Cortez:

But it's also fundamentally shaking the foundation for physicians and providers. So we've gotten a bunch of questions, like, for example, John from Wisconsin and Jorge in Peru are asking questions about how is this going to affect doctors? So is it possible for them to continue with healthcare? Are they going to be able to keep doing it from their homes? Or will they have to go to an office where they can guarantee the privacy of their patients? And also, are they going to be a lone wolf or a partner in this process? Or is the individual provider just going to go away entirely?

Jason Gorevic:

Well I don't think there's a scenario where the individual provider goes away. The physicians and hospital systems that we talked to see telehealth as a compliment and a component to the overall healthcare delivery. It's a tool that improves efficiency, opens up access, and drives down the cost of care, but it's not a replacement for a physician. It's a tool that the physician can use in order to deliver care that is, quite frankly, on the consumer's terms, and in many cases, it's preferable for the physician who can manage their schedule more dynamically and not be sort of beholden to the large institutions quite as much.

Jason Gorevic:

But across the board, this is a complement. And I think one of the most important things is that telehealth isn't separate from the healthcare system. It has to be deeply integrated into it, both from a data perspective, as well as a continuity of care perspective. And we've spent a ton of time making sure that that happens by working with hospital systems, working with the large payers, working with employers and their benefit plans, working with lab companies. I'm sure Dr. Abernethy is seeing an influx of home testing, both devices as well as clinical tests, which I think really has an opportunity. And we've now seen with some of the home swabs for COVID testing, I think that that has the opportunity to really open up a new wave of what telehealth can do in a really high quality, efficacious manner. And I think the FDA has been doing tremendous work partnering with the healthcare industry to move that forward.

Michelle Fay Cortez:

Well, I have to say that coronavirus has been devastating to the entire world. We've lost millions of people, millions more infected, millions are going to be infected going forward, but there are some silver linings here, and you guys have pointed it out beautifully. We are getting innovation, we're using new technologies to reach people, hopefully in a more efficient and effective manner. Hopefully we'll be having cost-savings, getting clinical trials done more quickly and easily. So there is a silver lining here, and thank you all so much for coming, Dr. Abernethy, Jason, Mei, thank you for being with us. We really appreciate it.

Michelle Fay Cortez:

And now we are going to segue over into our second part of our briefing here, and it's going to be led by my colleague, Emma Court. And I will hand it over to you. Thanks, Emma.

Emma Court:

Hi, Michelle. We'll be continuing the conversation now, talking a little bit more about how technology is and can be leveraged as part of new models for care. Our panelists today are Sanji Fernando who's a senior vice president at Optum. He leads the artificial intelligence and analytics platforms team for Optum enterprise analytics, supporting the design and development of leading edge AI models and analytic tools for the enterprise. We also have Mari Greenberger, who is the senior director of informatics from HIMSS, a global cause-based not for profit organization focused on realizing the full health potential of every human everywhere. And Girish Nadkarni, who's a nephrologist and the clinical director of the Hasso Plattner Institute of Digital Health at Mount Sinai. He's also the Health Systems COVID Informatics Center co-chair. Thank you everyone so much for being here with us today.

Emma Court:

I thought we might start by talking a little bit about specific examples from your careers as to how technology can create change within the U.S. healthcare system. Why don't we start with Girish, and then we can move on to Mari and Sanji.

Girish Nadkarni:

Thanks, [inaudible 00:35:10], thank you, Emma. Thank you for having me on. So I'd like to give an example from the post-COVID era. So Mount Sinai was what's then called the epicenter of the epicenter of the COVID epidemic in New York City. And many of us around the healthcare system actually realized the need for data analytics and technology to improve outcomes in these patients, because first of all, this is a new disease. We didn't know very much about it. So that was an opportunity for us to learn from data. And the second of all was that there was an opportunity for predictive models to be deployed in clinical care and make a change in the hospital outcomes of these patients.

Girish Nadkarni:

That was the reason the Mount Sinai COVID Informatics Center was formed, where a number of people from the Hasso Plattner Institute of Digital Health, the Department of Medicine, the clinical decision support team came together. And what we decided to do was we decided to aggregate data from around the healthcare system in order to have all of the data of patients in one place so that we could learn from it. And then we could deploy predictive models in clinical care. Mount Sinai, very fortuitously and in a very, very forward thinking manner had put a system into place led by David Reich, who was the president of the hospital, and Matt Levin, and Robbie Freeman, where clinical models could be rapidly translated into clinical care and providers could be informed. So right now we have models running for prediction of mortality or death in patients who are going to be integrated or other outcomes. So this is a good concrete example in which electronic data can be harnessed and the power of it can actually be used to change people's lives through the hospital.

Girish Nadkarni:

But another example I also like to give is that since this is a new disease, since there's data available, we can learn more about how the disease progresses in people, what the factors for complications are. For example, under the leadership of Dr. Valentin Fuster, who's one of the cardiologists at the Mount Sinai Hospital, we looked at patients who got blood [inaudible 00:37:21] in the hospital and found that they had better outcomes as opposed to those who did not get blood [inaudible 00:37:27]. And that ties in with a lot of existing evidence that COVID may not just be a disease affecting the lungs, but it's more of [inaudible 00:37:34] disease, which affects the blood vessels and it causes clots, and that's why given blood thinners obviously, we should be testing in clinical trials, but may actually lead to better outcomes in these patients.

Girish Nadkarni:

So that's a very concrete example from the last three months by the power of data and analytics and digital health in general can be harnessed in order to change lives in a very, very short term, and people are in the hospital.

Emma Court:

Certainly a great contemporary example. How about Mari, do you want to chime in here?

Mari Greenberger:

Sure. So absolutely. Health IT, information and technology, I think, got an extraordinarily robust boost in terms of the amount of adoption and implementation when meaningfully used, which was a major overhauling policy that was enacted over a decade ago. And obviously, the use of health IT standards. So it's wonderful to have technology, but if it's not implemented correctly, the use of it can only go so far and the benefits can only go so far. So I would say how they do standards are critical. So to provide that common language and the set of expectations to enable inter-operation or the talking and receiving and communicating appropriately between systems and devices. So I would say that's number one. Obviously when you have an EHR and you implement it, you want to ensure that your market supplier is using the appropriate standards to ensure the movement and the data exchange is happening appropriately and effectively.

Mari Greenberger:

I'd also say the use of health information exchange entities or organizations, so what I mean by that, obviously health information exchange is a verb, but it can also be a noun. So these are entities that are essentially unbiased data trustees within the communities. So they can manage and provide secure digital exchange of medical behavior-