iEX 2020 - Opening and Fireside Chat with Dean Kamen and Dr. Ken Kizer

iEX 2020 - Opening and Fireside Chat with Dean Kamen and Dr. Ken Kizer

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Joe Grace: Good afternoon. Good afternoon, it's a lot easier to talk without a mask, but we're being safe here at the Press Club, so I want to make sure that you understand, we're taking all the precautions. My name is Joe Grace, I'm here to welcome you to the 2020 VHA Innovation Experience. This is an exciting time, we have some incredible speakers here today. We're going to hear from the leadership, we're going to hear from the providers, we're going to hear from veterans, we're going to hear from innovators, we're going to hear from industry. And my privilege is I get to be the captain.

Now, as a Naval Academy graduate and a veteran myself, I'm a nuke submariner by training. We try to keep things on the down low, but today we're going to bring out all of that innovation, all that experience. We're going to bust a little bit on our army friends, we've got some air force speakers so make sure everybody's comfortable, but more than anything we're going to talk about the veteran.

And we're going to talk about what we do to make their lives better. How do we help the mission, how do we help what they're trying to achieve and how do we fill their experience with a better way of life? It's going to be exciting. We have with us the executive director of the VHA Innovation Experience, Dr. Ryan Vega.

Now, I'm from New Orleans, he's from New Orleans, Paul Tibbetts is from New Orleans. If you ask where we went to school, we'll tell you our high school, they all went to Jesuit. So, we've got a Jesuit contingent here bringing you LSU Tigers and a bunch of other technologies. Dr, Vega has been some of the vibrant experience and excitement that's coming out of the VHA, but the veterans health experience, this whole innovation, this is the way of life for the VA, it's something that they're known for across the country.

And we're going to have some really amazing speakers today, we're going to talk about some innovations that will truly make a difference for our veterans, their service members, and their families and caretakers. We hope that you'll join use for this experience, and we're looking forward to that moment. I'd like to turn it over to Dr. Vega who's going to give you a quick introduction on our experience for today.

[silence] Dr. Ryan Vega: This is about telling our story, and I think it's i- it's sort of eye opening when you hear some of the comments from Innovation Experience as people sort of say, "VA is really doing that?" And what better way than to show them. Speaker 1: Coming here reminds me of who my family is, renews me, reinvigorates me, and gives me that energy I need to go back and- and fight the hard fight of innovation.

Speaker 2: It's just really though provoking, and there's just a lot of things that I think we're learning that we help, you know, diffuse through our own networks. Speaker 3: The innovation experience is a gathering of incredibly brilliant, incredibly resilient, and incredibly passionate VA employees along with their academic and, you know, and industry partners that are designing solutions in real time to change and save veterans lives. Dr. Ryan Vega: Greetings, I'm Ryan Vega.

And on behalf of the entire VHA Innovation team, welcome to the 2020 Innovation Experience. I'm standing here in the ballroom of the National Press Club. Now, ordinarily this room would be filled with people, the energy around the event palpable, but these are not ordinary times and, yet, VA is not an ordinary place to work. Our workforce is not an ordinary workforce, and our mission is no ordinary mission. This year has been filled with so many challenges we have all shared, but events like this remind us what we can accomplish when we share a common goal and unite to deliver more together. The innovative spirit of this organization helped advance and design new ways to deliver care and service during this ongoing pandemic.

From telehealth, to ride share programs, to 3D printing, we are redefining what it means to be an innovative organization. And that spirit is driven by all those who work in VA, by those who partner with VA, and by those who lead VA. We have been so fortunate to have leaders who do not just support an innovative culture, they embrace it.

In a little while you will hear from one such leader. Dr, Steve Lieberman, the acting Under Secretary for health on many of the incredible innovative efforts going on in VA. But, first, it is my distinct honor to introduce another senior leader to kick off the 2020 VHA Experience. Someone who exemplifies the role of servant leadership, a veteran herself, our acting Deputy Secretary Miss. Pam Powers. Pam Powers: Ryan, it's really good to see you again, and thank you for that kind introduction.

Welcome everyone, this is really exciting. It's hard to believe that it was just two years ago that I was standing on this very podium to launch the 2018 Innovation Experience Conference. I was about 45 days into serving as VA Chief of Staff, and if you didn't see that, if you did see that you might've realized I was a little nervous, but I was really excited to be part of this incredible organization. Back then the word virtual wasn't used very much and now it's use virtually all the time, but change is the nature of things.

I remem- remember when the planes hit the world trade centers and the pentagon, the refrain we heard over and over is, "Everything's changed." And it had. And this year COVID-19 also forced change upon us.

Some of the most fundamental aspects of our world, national and community cultures have shifted dramatically, more than anyone could've ever imagined. So, here we are, again, in a world changing before our eyes, meeting virtually to talk about change. But we're not just here to talk about how we've responded to change, but we must be more forward looking than that. We're here to talk about how we can initiate change, how we can work together at VA to deliver more for veterans, and by extension to all Americans. That's what the VHA Innovation Ecosystem is, and this conference is all about. And this year's theme, delivering more together, isn't a platitude it's what we've been doing and it's what we'll continue to do to serve those who have served us.

Innovation at veterans affairs isn't anything new, the VHA Healthcare System has steadily evolved as a national laboratory for over a century. Again and again, I'm amazed at something new I hear about from our researchers, or by all of the, that the innovation ecosystem is doing, by lowering costs, improving health outcomes, enhancing the care veterans receive. There's no story that needs to be told more in this nation, of the VA Innovation and what it means to veterans and America. And your story is being told in no- no small way by all the accolades VHA innovators are receiving for their work.

This year's conference comes just weeks after VA employees won Gears of Government Presidents Awards for innovations that save veterans lives by de-prescribing over prescribed medications, or we do see Opioid overdose stuff, and preventing hospital acquired pneumonia. In this month VA connected care and 3D printing leaders were nationally recognized with the coveted Samuel J. Heyman Service to America Awards, otherwise known as the Sammies. VA has a long history of those game changing accomplishments, and there are more to come.

And, frankly, there aren't enough awards to go around, but we cannot miss this point, all the work and the intellectual and capital investments we make in innovation ecosystem aren't about the complexity of the network or national recognition. They're about how good work helps each individual veteran, and all your good work helps. It's about delivering more together for veterans, and there are many examples. It's veteran focused design, custom orthotics for a veteran just learning to walk after his injury, or individualized prosthetics for a veteran who lost a limb. I saw innovation first hand when I visited at Seattle just a few short weeks ago.

It's thermal imaging mats wired to telehealth platforms, measuring the temperature of a veterans foot at home, preventing amputation so she never needs custom prosthetics. It's Telewound Care saving a rural veteran, the risk of travel without com- compromising his high quality health care, it's Telerehabilitation that checks and adjusts a veterans wheel chair function, or telelactation support for a veteran who's a new mother. It's biomarker testing that provides early detection of subtle psychological disfunction in a veteran with post-traumatic stress disorder, or it's virtual reality therapy for veterans with mental health conditions.

And these are just a few of the ways that VHA Innovation Ecosystem and all of you are imagining the future, but in the final analysis the measure of the success resides with the veterans we serve. And if their trust is a fair measure of success you are on the right track, and this year when COVID was at it's worst the monthly average of veteran trust in VA out-patient health care topped 90%, and much of that was telecare. And telehealth has become a lifeline for veterans in this changing world that we live in, and it's no small part to the kind of innovation that you- your works provides, not just in developing innovative solutions, but in building the trust and restoring hope in our veterans, with our veterans.

And it's exciting, it's promising, but here's what's more exciting, these next three days are about accelerating even more innovation. Outcomes for veterans that- that we and the nation can be celebrating in months and years to come. Imagining the imag- unimaginable, anticipating change, adapting to and taking full advantage of the immense opportunities change offers us, it's exactly what this innovation ecosystem is all about, and exactly what this conference is all about. So, to Dr. Clancy and Dr. Vega, and to everyone partnered with, associated with, supporting and participating in this VHA Innovation Experience, we all y- owe you a virtual round of applause, and a standing ovation.

But we owe you so much more, so on behalf of Secretary Wilkie and all the veterans and families your work touches, and whose lives you change for the better, congratulations and thank you. It is my incredible honor and really great pleasure to help launch this year's virtual conference. Enjoy these next few days, learn from each other, and continue to innovate. Thank you. Joe Grace: Welcome back, it's good to be here.

I decide to wear my navy mask this time to bring a little bit more spirit to the game. I'm here with Dr. Vega.

So, Ryan, this is incredible, and you're an internal medicine doc. What have you seen and I know in your time at VCU, and people say that your superpower is that you're innovative, and that's one of the great things you do. What energy are you bringing to this, and what do you think about the way the VA's approaching this? Dr. Ryan Vega: Yeah, well, as an internal medicine doc, if you would ask surgeons they would say that my superpower is certainly not brevity, but I think we're changing that, I think we're seeing innovation scale at a pace traditionally not accepted, or commonly fought about. We're seeing solutions spread from medical center to medical center, not in decades but literally in weeks and months, and so when you were the CIO at Navy, what are some of the things that you saw about innovation that really helped catalyze new efforts and advances I care? Joe Grace: Well, I think one of the reasons we've seen that is, when I was back with navy medicine we were taking a lot of casualties during the war, and the innovation that came out in prosthetics, the innovation that came out in traumatic brain injury, the things that we worked on and saw that the medics in combat, core men in the field were bringing back ideas of innovation that we had never seen before.

As that transferred over to the VA and VHA, we've seen monumental changes in innovation, a lot of that due to injuries and catastrophic casualties that we've had, but it's brought about a whole new sense of innovation, I was really excited to hear Miss. Powers talk about some of those innovations with our foot temperature readings and some of the other things that we're doing for home health care. Where do you see this going? Dr. Ryan Vega: Yeah, I think you're seeing the new era, the new dawn of what healthcare is going to look like, what we want it to look like. We were heading in this direction already, but COVID really accelerated this, and I think what's important is that while it's easy to celebrate the past and say, "We did a lot of great things." Most people want to know, "What are you doing with me tomorrow?" Joe Grace: Right.

Dr. Ryan Vega: And I think what you're hearing, what you're seeing for is, really, VA being a forward leaning, a progressive organization, in not only the adoption of digital health, but pioneering what this work's going to look like for all Americans. Joe Grace: Well, I hope what you can see if you're watching this out of your home or our of your living room, you're basement, wherever you may be, if you're on your boat you don't want to tell anybody, innovation is the spirit of the VA right now, and the VHA is doing som incredible things. I think we're going to hear from Dr. Lieben- Lieberman right now, and he's going to brin another perspective of this.

Ryan, you might want to do an introduction for us. Dr. Ryan Vega: That's right, you're going to hear from Dr. Lieberman, and some of the great things that we've been accomplishing over the past year, whether it was responding to the pandemic or even research advance to help not just veterans, but Americans at large. Joe Grace: Dr. Lieberman, over to you, sir.

Dr. Steve Liebe...: Good afternoon, I am Steve Lieberman, your acting Deputy Under Secretary for health. And I also want to welcome you to the 2020 virtual conference on the innovation experience in VA. This is going to be a exciting program that you will be experiencing. So, innovation is at the core of what we are all about in VA, it's been that way for a long time now. It just takes one employee, one front-line employee to come up with an idea, Miss.

Pamela Bellino at the VA in Boston saw the benefit of having reversing agents on our code carts when somebody had an arrest a breathing arrest, from Opioids. And she came up with the idea, "What if we also put it on our automated external defibrillator carts? Wouldn't that be a good idea?" And so she did and it started to result in saving lives at Boston. And then slowly but surely, through the innovation network this spread throughout VA and now is a gold standard in this country, and has spread outside of VA. Dr.

Shannon Monroe, a nurse came up with the idea that we really need to look at the benefit of oral hygiene, the simple act of brushing your teeth when you're in the hospital, and was able to demonstrate the benefits of doing this to reduce the instance of hospital acquired pneumonia. This led to saving much complications for veterans and saving lives, and this spread throughout our healthcare organization, and led spreading outside of our organization. These are just two examples of our wonderful employees in our organization, who have made a difference for veterans health care and health care in this country. This is a great example of how VA id a learning organization, we learn from both good things and also s- when things don't go the way we intend, and we spread it that's the way this innovation network works, and that's the way we carry out our activities in VA. Similarly, as you know, VA is invested fully in becoming a high reliability organization, and this is also important where staff feel comfortable to come forward and say, "I see something that I don't like, and so I'm going to stop the line.

I'm going to say, time out, before a veteran is harmed, and come up with an innovative way to improve things for veterans care." we have a, and organization that has adjust culture, where our staff feel comfortable also coming forward and coming up with ideas, creative ideas making a difference in veterans lives. All of this has been so important in the last year. 2020, as you know, has been the most challenging year in healthcare in about 100 years, I know it's been the most challenging year for my, for me in my profession. And VA has been a leader in this country in the approach, as most of you know, when we first heard about the first cases in Wuhan China, we started working on what our plan was going to be, we started to think creatively, "How are we going to deal with this, should it reach our shores?" And sure enough it did reach our shores, and we started thinking, "What's going to be the best way to protect our veterans and staff?" And so, we began screening at all of our entrances, before anybody else was doing it in healthcare. And similarly we started restricting visitation to our community living centers, and our spinal chord injury u- units, and anywhere where there was considered to be high risk for veterans.

We started to pivot to increasing our options for in-person appointments. And so, we started to grow our telephone appointments, we grew it by 73%. We started to increase communication with veterans through secure email messaging, growing that four million this year, and that about an increase of about 33%. And then we also, as you know, grew our telehealth, and in particular our anywhere to anywhere telehealth. So, most commonly, if the veteran is now receiving many appointments at home, and we increased that by over 1,40% in the last year, and that's just wonderful. We also have reinvented the way we hire people and we used to take months to hire people, as you know, and at most of our Vas we were able to, though some ingenuity, through some innovation, we're able to get the speed to hiring down to seven days, and in some places in some positions, down to three days, three days.

And so we have hired well in excess over 50,000 of new staff since the beginning of COVID was here in March. And similarly, as a result to that, we now have more staff and we've been able to open more beds to take of veterans as well as civilians as a part of our fourth mission. We've able to creatively open up units in post-operative recovery areas gastrointestinal endoscopy suites, and doing whatever is needed.

We never, despite how busy we have gotten with COVID, we have never had to turn a veteran away from one of our Vas that takes care of acute care patients, because we didn't have enough beds. We are now have shown the country that VA is a leader, that we can back up the healthcare system in this country, in so many ways by sending staff out to private healthcare systems to help them, by providing them with supplies, by helping Indian country with what is needed. And, again, accepting both veterans and civilians into our healthcare systems, helping our nursing homes across the country when they have been challenged.

Using our creative ways on how to best approach this and evolving and changing as we learn and go through this. So, this has been wonderful. We also, certainly under the leadership of Dr. Rachel Ramone, are a leader in research in this country, and this has been particularly important during COVID.

We are out there as participating gin the vaccine trials, in all the medication trials, and I really thank Dr. Ramone and her team for focusing research on what is most important to veterans, and really making a difference every day. And then I want to thank Debra Sheer and her team, for working with us on partnerships which are so, so important. One of the speakers during this conference will be Dean Cayman, who's been a true friend and partner to VA during COVID. Through his innovation talents, and working with us, we've been able to think of creative ways to procure additional personal protective equipment that matters to us in VA, that we need to ensure that our staff remain safe during this pandemic.

And he's also been working with us as well as the Manchester VA, to look at how we can align in, to improve innovation in medical care and technology in VA, and so there'll be more exciting things to come out about this, and hopefully you'll hear more about this when he presents later in this conference. Another area where the importance of Vas partnership with the public world is, are accessing telehealth through local area stations, which also more commonly known as our Atlas Program. And this is where we partnered with organizations including the veterans of foreign wars, American legions, Phillips, and Walmart.

And what we did is, we developed petti- through getting feedback with veterans we set up rooms in different locations where veterans can be safe and securely talk to their healthcare providers and primary care mental health, social work, and nutrition and not have to pay for it. And this has been really important in rural parts of the country. We initially put a pause on this because of COVID, but now it's coming back bigger and better and this is going to be a way for them to get care in rural parts of the country, and this is so important. And so we thank all of our partners in this really important program. Innovation has been equally important throughout the COVID pandemic.

I- in our 3D printing we thank Dr. Beth Ripley as well as Dr. Ryan Vega for their innovation in this area, and we had been working so hard in this area long before COVID, but this really sh- COVID, during the COVID era, truly showed what we are made of and how agile we could be with 3D printing. How we could quickly switch to focus our efforts on 3D printing of our personal protective equipment, such as masks, testing materials such as swabs. And then we truly have had our staff in the field come forward and tell us about challenges that they faced and how they dealt with that. So, for example, at Richmond Virginia the- the- the doctors there saw a risk of during the incubations of patients because of getting close to the patients, concerns about tran- potential transmission of COVID to the staff.

And what they developed was a clear box to go around the upper part of the veteran that the anesthesiologist could safely incubate the patient with. And then at the Puget Sound VA, our eye specialist were able to continue their examinations which were viewed as high risk, by developing shields so they could get close to the patient with their sophis- Developing shields so they could get close to the patient with their sophisticated equipment, and be able to get examine that veteran's eyes, that was something that our staff came up with the need, and then came up with a solution, And then finally, at the Charleston VA, they were hearing from veterans that when they were putting on their masks to pro, protect themselves from COVID-19, that those with hearing aids were damaging their hearing aids. And so, this facility came up with a solution of how to put a cover on the hearing aids so they would still work, but they wouldn't get damaged when they were wearing face masks. These are all exciting innovations that have gone on, and I expect they will kinda get shared around the country, in the coming months, so that all of our veterans and all of our facilities can benefit from these wonderful innovations. So, it's really been a pleasure for me to highlight for you, some of these high priorities that we've been working on in VA, in the last year again, these are challenging times. I can't thank all of you enough for your contributions to the innovation in our organization, and for what you've been doing every day in the fight against this pandemic.

I also want to thank Dr. Carolyn Clancy, who will be speaking to you later in this conference. Dr. Clancy, as you know, is our Dean, who is in charge of our discovery, education, and affiliate networks. She has just been so instrumental as we have moved forward in all of these endeavors.

And then finally I want to show my appreciation and gratitude to Dr. Ryan Vega, and him and his team for making sure that this innovation network effort just continues to grow and grow and be successful, and thank him for keeping this important conference going, despite the pandemic. So, thank you all. Keep doing the great things you are doing, and really enjoy and learn from this conference.

[silence]. Joe Grace: So, Ryan, what's up? You don't have a New Orleans mask? You're not supporting our team and the Saints? Dr. Ryan Vega: Not today. I I'm taking a break today.

And I think, you know, I'm still a little bit nervous about how this season's gonna unfold. It's got a lot of injuries, a lot of banged up players, You know, but I'm pretty confident that we'll turn it around. Joe Grace: Well, I gotta tell you, when we talk about the Saints, or we talk about the saints in the VA, these are the folks that are doing innovation. You know, public private partnerships make up a lot of what we're trying to do, whether it's a [inaudible 00:28:51] that you work together, whether it's the VA people bringing it forward, whether its an industry partner bringing this in, that really makes the difference. Dr. Ryan Vega: I think so, I think so Joe, I think the whole theme of this

year is delivering more together, I think really embracing the idea of how we come together, not just as a VA community, but as a community at whole, to really advance and scale some of these incredible innovation efforts. And the two folks coming up next, with these are individuals that I think define- Joe Grace: Right. Dr. Ryan Vega: What innovation really is all about.

Joe Grace: We have Chris Minks, who's going to be talking to us about some of his great stuff that he's been doing. And then, we're also gonna have Dean Kamen, who's going to be talking to us from DEKA. Dr. Ryan Vega: Yap.

Joe Grace: And Chris is not going to be with us in the room here, he's gonna be coming in via vid, video. And Dean is here with us, but, you know, that excitement of industry has to bring that in, and just like you have some kind of infomercial late at night, wait, there's more. This is gonna be exciting. Dr. Ryan Vega: That's right. And I think what you're going to see in here, particularly when we get to the fireside chat, when you hear from Dr.

Ken Kizer, the former under secretary, as well as Mr. Dean Kamen, you're really gonna hear this idea that innovation's not just about the shiny object. Right? It's about how we transform the experience, how we really recreate the meaning of value. So, I'm really excited to dive in. Joe Grace: I am too. And we've got a special announcement that they're going to be bringing, but one of the thing that you haven't seen at home is that Dean has been riding around in his iBot, which is again, an innovative wheelchair that puts the patient, puts the member, the veteran, up at eye level with those that they're talking to, and it's always been a little bit of a difficulty with someone in a wheelchair, they feel like they were talked down to.

And this exciting innovation- Dr. Ryan Vega: Yeah. Joe Grace: Brings them up to eye level, we've watched him kinda move in that machine around the office and around the studio here it's really been exciting. So with that let's go over to Chris, who's coming to us via live video. Chris Meek: Thank you for the introduction.

[inaudible 00:30:51] person today. [foreign language 00:30:53] That's Latin for love of country leads. That's why we're all here today, and that's why we all do what we do. Good afternoon everyone. I'm Chris Meek, the co-founder and chairman of SoldierStrong.

I'd like to thank you for attending this important event. I have the great pleasure of introducing you with one of America's great innovators today, from drug infusion pumps for insulin, the Segway, the iBot, to LUKE arm, and many, many more. Thinking this are one of America's great minds. But before we talk about the technical advancements in the science, I want to tell you a story. For me, it's the story of life, all of this is so important in the first place.

It's a story of , embracing disruptive innovation healthcare is more than a nice title. It's a critical mission for our nation right now. More than 19 years have passed since September 11, 2001, the memories of that day in the care of those who have [inaudible 00:31:43], is an ever present driver of our work.

I was running fluctuating operations with Goldman Sachs that morning rounds here on either that day or sitting in my mind forever. I saw 2977 Americans murdered that day. Never seen people jumping from 104 stories because that is their best option.

I can tell you to call it at least three women's dresses. I never forget the one who was holding her dress down when she jumped so no one saw her undergarments, sitting or digging deeper variants. I didn't realize for years how effective I've been but experienced that day. What I knew that day is how much I had to first responders, and for those who have served a year since, for me and a handful of friends and colleagues, from astronomers I wanted to give back to those who serve. We could have known when we started how things would work out certainly would have guessed it, I can tell all of you the lessons we've learned, perhaps the biggest is the need for innovation in healthcare, not just marginal evolutionary innovation, but truly revolutionary innovation that solves the hardest problems, treats the toughest conditions and restores our nation's veterans to fully healthy lives. I mentioned started in 2009, the request for marine, asked me for tube socks and baby wipes to make things more comfortable in the Ford operating bases in Afghanistan.

Since then, we've shipped over 75,000 pounds of supplies to 73 units in Iraq and Afghanistan. This mission to help our service members grew and evolved into our current mission. Tell America's military veterans take their next steps forward.

As the wars in the Middle East calm down, our veterans face challenges at home that must be addressed. So strongly addresses these challenges in the variety of ways. We've donated more than $3.8 million and state-of-the-art medical devices

individual veterans, in the VA medical centers across the country. These devices include hyper advanced busters, specialized rehabilitation, and our signature device, the soldier suit. We've donated 24 soldier suits to date and Dr. Bailey if you happen to your explosive will be next week in New Orleans VA. Each soldier suit allows Paralyzed Veterans to view once impossible to stand and walk here.

Our mission with this program is to address the visible wounds of war with revolutionary medical equipment that literally helps veterans take their next dashboard. One of our soldiers whose donations back in 2016, once the Denver VA hospital, in addition to serving spinal cord injured veterans of the Denver area, the VA used the suit in the mental health study, the results of that study remarkable. It turns out it's standing eye level with the world again transformed Paralyzed Veterans brain health, in addition to the physical benefits is one veteran said, seeing people in the eye instead of the belly button is awesome. The Denver study found these brain health benefits extend all the way through reduction in Paralyzed Veterans considering or attempting suicide. These powerful results that's the secret soldier strong that our model of providing revolutionary technology to our veterans could perhaps be applied to the challenges of post traumatic stress and better suicide. The evolution of SoldierStrong in providing care packages now being Paralyzed Veterans standing walk, continuing some new exciting ways for 10th anniversary last year.

We've all began to help address the invisible wounds of war they're so common, it's so difficult to address the new program called Strong line. The mission of Strongline is to reduce the number of veteran suicides that plagued the country. More Vietnam era veterans were lost to suicide in the years following war, were lost in combat. The post 11 generation is on a similar trajectory, unless something's done to change that. Research done in department defense found single biggest factor in suicide ideation or attempt by veterans is untreated post traumatic stress.

We've partnered with leading medical researchers, in four major universities to provide revolutionary virtually based [inaudible 00:35:27] treatment has shown exceptional success in clinical trials. So the strongest working in the VA innovation ecosystem to deploy and improve this cutting edge therapy so to reach every veteran who needs it. Last fall, we've done the first of these protocols to seconds VA have since donated to a total of 14 VA hospitals. Our goal is to have 20 delivered by the end of the year. Now I'd like to show you some of the capabilities that already exists and provide a small window into ongoing research, It's exciting new field short video.

Open video please [silence]. Speaker 4: The year To put that in perspective, we've lost more Vietnam veterans to suicide than all the names listed on the Vietnam wall. The most common underlying factor is untreated post traumatic stress.

And now the post 911 generation is on the same trajectory. Speaker 5: We are in the middle of a long overdue national conversation about veteran suicide. A Virtual Reality isn't a technology that VA developed, But we partnered with the University of Southern California, a nonprofit called SoldierStrong and applied VR, to help veterans with PTSD and pain management. Virtual Reality allows them to relive, reimagine those traumatic events in a controlled setting. Under the care of clinicians, we found that giving veterans a chance to process those emotions can be an effective treatment for PTSD.

Speaker 6: I think it's hard for people to imagine the enormity of the challenges that people face when they come back from war and adjusted to civilian life. We can activate emotions in a very deep way in the ER, helping a patient go back and confront and process very difficult emotional memories. Speaker 7: You experience something that's horrific, that your body doesn't know how to comprehend, when you don't address it, it just manifests in this horrible thing and you end up locked in a room hating the world and nobody's coming after you. And I didn't want to be that person. Talk therapy after talk therapy, it wasn't working I was like [inaudible 00:37:39] what, what am I gonna do? Virtuality was a Godsend. Speaker 6: The partnership between USC soldier strong, and the DS innovation ecosystem has been essential for breaking down barriers to care.

And making this tiff more accessible to those veterans who can really benefit from. Speaker 4: SoldierStrong was founded by a 911 survivor who was at Ground Zero during the attacks. Chris Meek's experiences that day inspired a desire to give back to the men and women who serve. So this transmission is to help our nation's heroes take their next steps forward. Their signature work focuses on transforming lives for seriously injured veterans by pairing them with revolutionary medical devices. The soldier suit allows Paralyzed Veterans to get out of a wheelchair and walk again, The LUKE arm replaces the old prosthetic arm with one that provides a full range of motion.

And now strong mind VR treatment accelerates the treatment of PTS while reducing the stigma of seeking treatment, opening the possibility for life saving intervention for our heroes. We owe an enormous debt to our nation's veterans. Soldiers strong commitment to delivering revolutionary advancements to care for our service members is a small but significant part of honoring our shared obligation to those who have secured our freedom. As long as lingering wounds of war, affect our veterans SoldierStrong will be there to partner with the VA's innovation ecosystem. Chris Meek: Our story is one of continuing embrace disruptive change in health care, you saw in the video and more importantly, you can see it in the lives our programs touch. That's why I'm so proud to be with you today and share a new commitment, to continue our track record of embracing disruptive change in healthcare.

Working with the VA's innovation ecosystem, we are proud to partner with Dean Kamen, his revolutionary iBot, to deliver more mobility, more opportunity and more quality of life for people who so desperately need it. Dean talk about the science of ways I cannot, as you hear from one of America's great minds, I want you to remember this is so much more than a science project. You are now part of a revolutionary change in the real lives of our citizens.

Knowing America has done more, more work to empower revolutionary change in health care than Dean. I know you will find it a great treat to hear from him. It's my privilege to introduce you to Dean Kamen. Dean. Dean Kamen: Great to be here.

And Chris, I am in and I bought. I don't know if you can see but I'm walking up the stairs, getting on stage to where... I hope people that have not seen an iBot will see it do, something very important. It'll let me stand up, get to about six feet tall five inches than I have in real life.

And I hope that the whole VA community can recognize how important standing up looking somebody in the eye really is. Over the years we've been able To deliver iBots to a number of disabled veterans, this is the newest generation, we launched it with an FDA approval, late last year. And the first half dozen we delivered to veterans including a number of Medal of Honor recipients just a couple of weeks ago, Greg Gadson, 82nd, Airborne, left both of his legs in the Middle East, left Manchester, with our newest iBot. And you could see in his face what the value of independence and access the iBot can deliver. I wanna make a statement here that I don't know.

Protocols for an institution like the VA, I'm alone, I can take this up. It turns out in a very fortuitous way the COVID situation created a unique opportunity. My day job of developing products does not normally include bringing PPE's into the United States. But when the VA started having trouble doing that I leveraged some of our connections started bringing in PPE's, in the process now we've delivered over 1000 tons of them. But in that process, I got to meet some really neat, very passionate people at the VA, including Deborah Shear who's in this room today, and started talking to her about making more iBots available to more veterans. Turns out that we're very good with my 800 engineers at developing technology, but our company doesn't have sales, marketing and distribution, we normally give that to our big partners.

But when you're dealing with something like an iBot, which fortunately there's such a small market for the big guys aren't that interested. And as I explained all of that to Deborah she said, There ought to be a way that we could partner directly with the VA to make these available. After I was introduced through her to so many in need people here we decided, we... my little company is going to donate the next 50 of these devices into a program that with partnership and support of the VA, we're hoping they will be spread around the country, so that veterans that might otherwise not even be aware of this capability will be able to see it, try it, understand it.

And for those for whom it's appropriate, we'll find ways to get them iBots. So I'm really excited to say that, this is the first time we've said it publicly, we've met a bunch of people here at this event, and we are just so excited that, that there were so many very, very senior people inside this organization, that are all, all about innovation and all about delivering real solutions, real disruptive solutions to veterans. It's wonderful for me to see it, it'd be news, my confidence in government, in America. And I'm happy to be here, and my understanding grace, unless you have some terrible question to embarrass me with, we're supposed to have a fireside chat with Dr. Kizer. So I'll shut up and let you guys take over.

Chris Meek: Or is it from my side- Joe Grace: I'm sorry a technical [inaudible 00:44:38] that has been Just incredible. And when I was brought back to active duty, I was running a public company, it was brought back to active duty as the CIO for the US. I got a chance to experience the innovation, the passion, the incredible people that you've been describing. These medics, these corpsmen, these doctors, these seal soldiers, air and the marines, and all those [inaudible 00:45:00] Dean has brought this in, and given us an opportunity to see how incredible, how incredible it is, to work with these people.

Now we have a chance after seeing you demo, your technology there, and thank you so much for what you've given to our veterans. That is such a great tribute to your work and the innovation that you have. We're gonna have a sit down discussion with Dr. Ken Kizer. As you know, he was the former Undersecretary of health for the VA. He's been the chief transformation officer for Atlas since 2019.

And I'd like to give a shout out to the Atlas team that's been supporting Dr. Vega here during this presentation, they've done an amazing job, so to that entire team well done. But Ken Kizer is no, no newbie to innovation and transformation as he made, ran, one of the biggest healthcare systems in the world, brought that innovation into the VA, and today is gonna be able to share some of those thoughts within in a fireside chat. So Dean, Ken over to you all.

Ken Kizer: Thank you, Joe. And we're probably... we socially distance. So I'm gonna take my mask off. Ken: And since you are sitting down, I'll sit down. Ken Kizer: All right.

Hell of a deal that way to begin here. So good, I'm Ken Kizer, Dean Kamen. We're going to take a little time this afternoon and talk about innovation and how you can operationalize innovation, hopefully we'll get to that point.

But I want to first turn to a conversation we were having earlier about, what is innovation all about? And in what spaces is particularly hard to bring about. So maybe you could share a few thoughts about how should we think about innovation? Dean Kamen: So I think the first thing we should do is destroy two myths that the public associates with innovation. One of them is it's all about invention, it's about creating something.

It's a Gizmo, it's technology. That's not true I'll explain that in a minute. The second myth about innovation is, you know, it's always about success, [inaudible 00:47:06].

I think, to me, innovation is mostly about failure, and more failure, and more failure, until you finally create something that's never been done before, by finding all the ways it couldn't have been done before. Back to the first part, I think, again, a lot of people think innovation, let those technical guys do it, I'll run my day job, I'll do my business. You can invent something but it's a science fair project, unless it gets properly promoted, in a large scale to enough people that it becomes part of the way we live, and work and play. And since organized societies are always very reluctant to change, organized societies have a lot of inertia, organized societies have a lot of people that love the status quo that are afraid of risk and change, that once the, the thing the invention might actually exist, getting it to become an accepted transition to a new world in innovation is really, really hard. Ken Kizer: So where is it hardest to innovate? What sectors Do you find are the most difficult? Dean Kamen: I'm glad you bring that up, because as hard as innovation is in any field, consumer products, people innovate the new game or the hula hoop is, the problem with innovation, as I said, which is that it's always accompanied by failure, says, Okay, what if you want to innovate in a space where failure is simply not an option. And I can only think of three places like that.

The military, we can't afford a failure, we lose our country. In health care, you know, we all love innovation, but I'm sure if you were going into the hospital tomorrow for a routine procedure, the last thing you'd want to hear from some doc is I got a great new idea. And the third place where innovation is really a tough sell is in government, because you got a massive public commitment, people need stability in their lives. And governments, medical institutions and the military are places where tolerating real substantial risk and failure is a very, very, very real issue. Ken Kizer: Having been a real doctor, once upon a time and talking to real patients, I can assure you, they don't want to hear that.

Well, we were innovating with something and it didn't work and sorry, it just doesn't fly. So let's move the conversation to talk about innovation in healthcare. And hopefully, we'll come around to innovation in government health care, which are two of the areas where it's the most difficult to innovate. So, just with a little bit of preface here, I think you'd probably agree that healthcare is different than consumer products, or IT or many other areas where innovation happens. It's more complex, there, there's, as we've discussed, less tolerance for errors.

There's a usually very indirect connection between the payer and the patient and the provider of services, you know, it's a more roundabout connection, which also kinda affects how things get picked up and, having been in this space for longer than I'd like to think now. But we've been talking about disruptive innovation in healthcare for at least the last 20 plus years. As really the solution to the disproportionately rising healthcare costs, the unsatisfying outcomes that too often we see in health care, the unsatisfying patient experience. I mean, we could go down the list. And people say, Well, we just need innovation.

And the market has responded and, and one could argue that there is perhaps an overabundance of innovation in healthcare today. But it hasn't produced the dramatic transformative change that we would like to see, nor has it really bent the cost curve, and indeed, in many cases, innovation said made the, costs go up more because they've increased utilization. So why is that? What, what, what are your thoughts about, what do we need to do differently in healthcare innovation? Dean Kamen: Well, some of what I think we need in healthcare innovation is not what I can do. I know it's necessary, but it's not my field of expertise, which is policy changes. We've already mentioned that both of us a couple of times, that one of the reasons real innovation, particularly in healthcare is hard, is because since innovation is associated with risk and failure there is an extra burden. ... patient is associated with risk and failure is an extra burden to be extra careful, when you're introducing innovation in health care.

And I'm sympathetic to the particularly cautious situations that you have to deal with when you're innovating, you know? When I bought, would be a really bad device, if it would fall down with a disabled person in it. So you have to build very, very, very robust systems. One of the places where I'm not that sympathetic to why innovation isn't as commonplace and moving as quickly in health care as in other industries is because policies. There are a lot of perverse incentives that still exist in the health care system. A doctor can't be paid for not having to do a procedure that a patient didn't need because we used preventative care in the first place.

A hospital is gonna have trouble staying open and paying its bills if its beds aren't full of patients that were brought in to do the next procedure. Basically, our entire health care system isn't a health care system, it's a sick care system, and almost all of the money going into it is to cover the cost of chronic treatments. Very little of what we spend in this country in health care is in preventative care. Very little is a- available in curative care. All of the- the big entities are very, very well aware that the- the large, long-term economic future is in creating a treatment for something that, sadly, will stay with many patients for a lifetime. I think we need to find ways to fully incentivize the innovations that will prevent the disease from occurring in the first place, or once you have a condition, finding a way to cure it, not treat it on a chronic basis.

But just look at the percentage of money that is spent in prevention, cure, or- or maintenance in chronic conditions, and I'll give you two examples of two government agencies that deal with that. One is health care, the FDA, and the other is aviation, for instance, the FAA. The FAA is there to make sure every plane that takes off lands without an incident.

And all the money goes into preventative care. You take airplanes apart every... relatively frequently, every, you know, annually. You put multiple engines on an airplane, so even if one fails, the other one'll keep you going. It's expensive, but it's a lot better than, "Oh, the engine failed, the plane crashed, and now we're gonna pick up the pieces of 300 people." When you look at the percentage of money that gets spent preventing a problem from ever happing- happening in- in aviation, for instance, how the FAA looks at what they do, versus let's say our health care system, I would only tell you that we take way better care of our airplanes that we take care of our people.

And it shows. Ken Kizer: You- you raised a number of things there that- that I'd like to come back to. And- and payment is- is certainly one of 'em.

And an example that comes to mind that we've talked in- in other sessions today, about the COVID pandemic, and- and all of the effects that's had on the- the health care system, and- and... system at large. But let's talk about telehealth. Telehealth as an innovation. In 1999 or '98 I hired the first health care system telehealth officer, certainly in the United States, if not the world.

And VA did a number of things over the years, it increased its- its use of telehealth. But it really didn't become a mainstay of treatment, even though it didn't have some of the- the payment barriers that exist in- in the private sector. But along comes COVID, and within a matter of two or three weeks, we see this dramatic increase in telehealth.

Not just in the VA, but- but elsewhere as well. Now, a lot of that was driven in the private sector by changes in payment policies. But it shows that when we want to innovate and when the right forces are at play, it can happen. And- and we saw more progress in- in literally two months than in almost 20 years previous. Thoughts on that? Dean Kamen: So my- my thoughts on that are, again, pretty straightforward. People will tell you, companies will tell you, governments will tell you, they're always willing to invest in- in a better future, they're willing to invest in innovation.

But deep down, innovation, again, it's risk, it's uncertain, it's change. And most people learn to be very risk-averse over their lifetime. And that's not a bad thing. But what I have found over my lifetime is, people are way more willing to accept change if they're running away from something they're afraid of. Fear is a much better motivator for change than opportunity. And the fears around dealing with COVID in a one-on-one basis in person, I think that the fear drove people to adopt something that was already there, could already be delivered, but the status quo and the inertia and the risk aversion of our culture, of our government, of our companies was making the adoption of telehealth very slow.

Then, introduce that fear factor, and suddenly we've accelerated the ability to weigh the risks and benefit of- of change, and we saw, essentially, a disruptive change. The good news is, you generally don't unring the bell. Once people see that step into the unknown, and they land in a place they like, and they light it up, and now it's known, they don't wanna go back.

So I think one of the- the benefits of having come through the trauma, or hopefully coming through the trauma of COVID, is we're gonna see enormous, enormous changes in the ability of the clinical community to interact with patients all over the country more effectively, more efficiently, patients that were in remote places that really couldn't access in person, even when there wasn't a- a- a COVID situation, are gonna be beneficiaries as well. We are gonna move the- the- the health care system in the same way we've moved every other big industry in this... in this country and in this world, to a more efficient by adopting the technologies of- of the cloud. Ken Kizer: You know, in- in some ways, it's such a- a no-brainer. You know, if you're a- a senior with a- a few medical conditions, and you need to go in for a- a checkup, you can either get in your car, battle traffic, find a parking spot, go to the waiting room, wait for a while, and then get seen, or you can punch in a phone number and sit in your easy chair at- at home, and- and get seen.

I mean, it seems like that's not a hard decision. I think a lot of people have actually figured that out, and I agree that- that we're gonna see a lot of this virtual care stick going forward, although we have to kind of find the right balance. But- but you raised this- this point you know, there's a lot of things that- that drive innovation, and- and we'll come back to some of the other things.

But let's just stay on the payment vein for a moment, because, you know, payment is an- an issue. One of the other companies, and I- I don't know if it's been talked about or not, but one of the participants in the innovation ecosystem has to do with preventing diabetic foot ulcers. And it has shown Podometrics a company, and I think it's okay to- to say it, hopefully, it's okay to name it. But it's one of the stars, if you will, of the innovation ecosystem.

Dramatic results as- as far as preventing amputations, preventing hospitalizations, preventing emergency room visit, preventing outpatient care visits. But the issue is how- how do we get payers to embrace this new technology, which really is a- a quantum step forward in how to treat this very common, very costly, very devastating condition. Dean Kamen: Again, I think it's, an innovation is required here, but it's not an innovation of physics and engineering and the stuff I and my 800 people do. It's gotta be an innovation in policy.

And I think we all talk about it, and they keep talking about it over the last few administrations, health care reform. And then you look at the bills they talk about. It's not health care that they're reforming, it's health payment they talk about.

Health care reform would be moving towards doing better technology to prevent the disease in the first place, or to cure it when it happens, we're building an organization now to manufacture replacement human organs. That will change health care. But all the changes that they're talking about don't- don't deal with the fundamental issue, which you sort of got to when you said payment, which is, a market economy only works when somebody's paying for something after they determine what value it has, and what the alternatives look like. Our health care system, for various reasons, whether it's government, or insurance companies, or employers, has created a situation where the patient, the one that gets the product or service, is not the customer.

We are the recipient. And when you're the recipient of something that you're directly paying for, you're not the customer evaluating the alternatives, we have a health care system in which the average citizen has only two modes: I'm feeling healthy now, whatever health care costs, I don't wanna buy any of it, I don't wanna pay for it, whether it's my insurance premium, I don't want it. And once I'm sick, I have a slightly different attitude: I want everything you can possibly give me, and I don't care what it costs. Neither of those statements is amenable to a market economy. So we either have to create a way to bring the market economy back to health care innovation and all the players and stakeholders in it, or we have to come up with a different system to incentivize the right kind of behavior, because right now, I'll back to, we have the most perverse incentives you can possibly imagine for the people that pay for, people who deliver, and people who receive health care.

Ken Kizer: I- I have that conversation about why you need health insurance with my older daughter frequently, who's healthy, vigorous single, it's like, you know, "Why do I have to keep paying this premium?" 'Cause it's not cheap. And, anyway. Let's- let's shift a- a little bit, and- and talk about scale. You know, one of the- the issues, and- and it could apply to the example that- that we just talked about. But how do we actually, at this point, that's an innovation that works.

It's... there's, you know, published literally, in- in the refereed peer-reviewed literature. We know it works. How do we now get it out, and- and, you know, take it to scale, so that it now becomes the norm in treatment, as opposed to where we are right now? Dean Kamen: Again, I would say, one of the innovations that we desperately need, and I- I think the- the Veteran's Administration could- could lead this charge, is to say, "Let's look at the overall cost of dealing with whatever this clinical condition is, whether it's chronic or episodic, and let's look at the entire cost of the alternative ways to deal with it." And once you look at the patient, and look at the best way to give the patient the best outcome, and look at all the different places you can participate in creating the solution, pick the best one. Pick the best value.

Right now, we don't do that. As an example an iBOT may in- in itself cost more than a wheelchair. But if an iBOT eliminates the need to have lifts and special vans, if an iBOT eliminates the need to modify your house with ramps, if an iBOT eliminates the need to move out of your house, to move to assisted living, because you can't get in and out of your house or your bedroom or your bathroom, and you looked at it and said, "Wow, if- if a veteran had an iBOT the overall cost to the VA would be way lower, the outcome and the quality of life for the veteran would be much higher." But if you have a system that says, "We go and we buy the most cost-effective solution to this particular aspect of a problem," and we parse that into all the different silos in our health care system, you end up spending a lot of money on a lot of different things and end up with a very, very low overall quality outcome. I think our health care system, if it were driven by efficiency, effectiveness quality of life, patient outcomes, if it were incentivized properly, we would spend less money, and we would get better outcomes across almost every set of conditions you could imagine.

Ken Kizer: That brings to mind a- a specific example of- of something I- I dealt with well over 20 years ago, when- when I was at the- the VA. And it's this whole issue that- that preventive measures typically don't pay off until some years down the road. And- and there's a specific reason why I want to dwell on this for a- a moment, that I'll ask you about. But, and so, in whenever it was, in the- the mid, latter-mind '90s, the- the statins, the group of drugs that lower cholesterol, came on the market. And many of the managed care plans weren't adopting them, weren't putting them on their formulary, their- their preferred drugs. For me, it was about a 20-second decision that, yeah, of course, it's gonna...

but one of the big differences was that- that VA has its patients for a long time. So you see the benefit over years, which may not manifest. Whereas if you're in a typical managed care plan that turns over every two or three years, you pay for something that was at that time a relatively expensive drug, but you don't see the benefit, somebody else is gonna see the benefit years later. So with that as- as kind of the preface, this what- what I wanna ask you about is- is how do we invest in innovation in government in particular? Because many of the things that the innovation ecosystem is doing right now is not gonna have a payoff for many years down the road, in some cases, it won't be that many, but, you know, it's- it's not gonna be next month, or six months, and you have more patients than you can take care of, and that's costing...

How do you make that balance between, I'm gonna invest in- in, let's just say, the innovation ecosystem, but if you're another health care system, it might have a different name, but, you know, same idea. But the payoff isn't gonna be down the road. How do I have that conversation with the CFO that says, "You really gotta invest in this program." Dean Kamen: So, once again, I'm not here to to pander to- to the Veteran's Administration, but even at a dinner we had last night with the guy that's running this innovation program, you know, Ryan, I...

it was so refreshing to see senior people, doctors, that- that get that issue, that part of me said, you know, I was... just this fortuitous way I ended up having the opportunity to participate reminded me... again, I'm not an economist but I would tell you- Ken Kizer: And I'm glad of that, by the way. Dean Kamen: Well, but I mean, economists come up with all sorts of... I mean, there are people that- that think business and capitalism will solve all our problems. Look at our political situation now.

And there are people that think capitalism is awful, and it will solve none of our problems, and, you know, big, bad industry. I think they're both completely naïve and wrong. I think there are categories of human behavior that are properly incentivized by the competition of business, and- and an economy that has a strong capitalistic, you know, aspect is great. But then you look at educating kids takes a generation. No business wants to invest over that. That's why we have good public education, and it's critical to our future.

No individual company wants to build tunnels and bridges that will last for 50 or 100 years. There are investments that you make, critical investments in infrastructure and education and health care, that I think, as an organized society, can't be justified by the ever-shortening cycle that Wall Street and business has in product development. But it's critical to our society. And it's those things that I think government needs to step up and say, "We're going to invest in basic research, the NIH, and the- the National Science Foundation, and public education."

And again, not to pander to- to the VA, but you have this enormous group of patients that a

2021-01-02 18:35

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