We're happy you could join us today, we will be hosting David Lindeman. And if you do have questions for David and his guest presenter Dr. Courtney Lyles as they go through their talk, please put those questions in the chat, and we will field those a little later in the hour.
So today, the talk is entitled "Technology Innovation for Older Adults and the Unexpected Consequences of the Pandemic". David Lindeman, PhD is the director of Citris Health. Lindeman has worked in the fields of healthcare and long-term care for nearly 40 years. His current focus is working with researchers, entrepreneurs, and investors on the incubation, startup, evaluation, and scaling of technology-enabled healthcare solution, including initiatives that address critical health challenges through mobile and cloud sensors, Telehealth, robotics, assistive technologies, and data analytics. Last year, he was appointed by the governor to the California Commission on Aging. As a colleague and a friend to OLLI, David is also the co-convener with myself and Professor George Brooks on the Aging Research and Technology summit, which is now scheduled for Fall 2022. Thank you all for joining us, and please, here is David Lindeman. Thank you very much, Susan, for that very kind introduction. And again, welcome. Good morning
to everyone who's listening today. And a special thank you to Osher, in terms of OLLI's program here at Berkeley, which is so outstanding in terms of bringing you information. I'm delighted to be here as part of that today, and to share with you some of our lessons that we have seen through the last year and a half, and even more importantly, what it means for us going forward. I'm delighted to be joined by our great colleague Courtney Lyles, who I will introduce shortly, who is both an adjunct faculty member here at Berkeley and at UCSF, a faculty member who has been doing outstanding innovative work in this space as well. So today, we'd like to take you through a few different items to share with you this background. And as Susan suggested,
we'll also be looking forward to a dialogue in the exchange with you at the end, through questions that you may have in the chat. So, the agenda for today will be, first I will lead off and share with you some of the observations we've had of what has occurred during Covid-19, and both the opportunities and challenges that we've seen from a technology perspective in this area. We'll then turn to a key area that both Courtney and I are passionate about, which is Telehealth. And looking at some of the models and programs that we are both engaged in here, and have Courtney give you some of the updates in that area, followed by my presenting some of the Telehealth projects that we've been engaged in at Citris here at UC Berkeley. And following that, Susan has asked for a few points to be shared with you, as she has said about some of the major issues that are going on here in California. And I will mention our master plan on aging, and some of the other new technology and policy developments we see in that area.
So without further ado, I'd like to start taking us through. Again, Susan provided background, I'd just like to confirm for you that I am responsible for a number of programs, but my passion is around gerontology and looking at projects that can help all of us as older adults move in this area. And we do that through Citris, and our Citris Technology and Aging program. And Courtney, again, not only adjunct professor and an innovator at the School of Public Health here at Berkeley, but working out of the departments of medicine, epidemiology, and biostatistics at the Zuckerberg San Francisco General Hospital, has been an innovator in this space and has used data and innovative technology solutions to reach all different types of populations. We just came from a wonderful meeting yesterday of looking at collaboration and how we work across disciplines, how we bring different expertise to this area. And as you'll see today, how we are going to have some wonderful opportunities moving forward in the future. One quick point for those of you are not familiar with Citris. Citris and the Banatao Institute, which actually stands for
the Center for Information Technology Research in the Interests of Society. We are actually a 20-year old organization that brings together not only multiple disciplines, but multiple campuses. We're responsible from our Berkeley home, bringing in individuals and faculty and researchers and students from UC Davis, UC Merced, and UC Santa Cruz. And our goal is to take technology, particularly information technology is the focus of Citris, and making sure that it can help as a channel, as a conduit to helping all areas of society. While I run the health program, we have programs that are now looking at climate and resiliency, robotics that benefit people, individual ways that technology can help our workforce, even into issues on how do we engage more people in this space, particularly women into technology. And how, ultimately, do we even impact policies? So, I'd like to now move into some of the issues around what we have learned and seen over the last 18 months. But in that context,
I will share that we work on a whole range of new technology solutions, and some very basic technology solutions that really do help not only older adults, but all elements of our population. Not just individuals, but families. The workforce, particularly the healthcare workforce, in this space. And how we can better use technology to improve not only our health, but our
well-being. So, what happened during Covid-19? Well, working with a number of colleagues, we have a great deal of anecdotal information of what did happen and what didn't happen during Covid. And what's intriguing is that these five areas - smart buildings/smart homes, the use of Telehealth, changing how we get information through wearables, even virtual reality and robotics - all of a sudden started coming into their own. And behind it all, the use of data. I have the term "artificial intelligence" or machine learning there, but it's really machine intelligence, and how we use information from these different devices. So,
why did this occur in this regard? Well, I think everybody listening today knows the obvious. We went into lockdowns, we had issues related to how could we communicate with each other, we had isolation, we had to come up with new ways to not only have individuals reach others, but how we help ourselves. So, one of the interesting things that our colleagues, particularly at several of the larger technology companies, noted that the idea of a smart home with everything connected came into its own. This has been starting with everything from smart security cameras and being able to monitor things within a home, but this has really expanded remarkably over this last year and a half. And again, the idea of how these different types of technologies can be connected, and support people where they are. Another area that was significant in terms of its change was the idea of wearables. The fact
that Fitbit was picked up by Apple, and the fact that we have these different types of devices now that collect information and can share it remotely, became ever more important. Not only for us as individuals, but particularly in healthcare, getting information to individuals who need it, whether it's a family member or provider. We saw tremendous growth in this type of use across all elements of society, but particularly for those of us who are older. What was intriguing, though, is that we also saw the true advent of different, new technologies that we had not seen before really catching on fully. And virtual reality or VR,
or even augmented reality, AR, have become into their own, not just for being able to communicate or entertainment, but literally for its devices to help in issues such as pain management. There are several new VR devices that when used with individuals, have already been proven to reduce pain by 25%. So, we saw a great deal of change in that area. But surprisingly to some of us, we even saw the issue around robotics - and when we talk about robotics, we're speaking about not only Robbie the Robot or something tangible that will move in a space - but also the use of data that drives different devices of this sort. So we did see these different mechanisms that started coming into their own, particularly in buildings, whether it be assisted living or other residential settings where people had to stay separate. And we saw a number of companies move forward with movable devices that you see on the screen, that could actually carry material for individuals and deliver them. We've seen it in hospitals, we've seen it in hotels growing, but now we're beginning to actually see the ability of this, of robots, to be very more practical.
Another example is a company that came out of our programs here at Berkeley called "Safely You". I think a number of you are familiar with it, but "Safely You" is now one of the gold standards in falls prevention. And the program, that was started and founded by George Netscher, really did an amazing job of using cameras with artificial intelligence data backend, that could monitor individuals and ensure privacy and security, but get information about a fall, but even more importantly, prevention of falls, to the proper people, so that we could make sure that people would be safer. Wonderfully, this program has had tremendous success, and has actually been accepted now as one of the primary gold standards in assisted living here in California, supported by the Department of Social Services because it results in not only fewer falls, but fewer visits to an emergency room. And to show how far it's gone, it is now actually being covered by insurance companies. So, we're very excited about these types of issues. And again, I consider this a part of robotics, but also data science, as things that we have seen really coming through to help people, particularly because we had to do with the deal with isolation, remote areas, and connecting people during this challenging last 18 months. I'd like to now turn into the
fifth area, that I think is really exciting and we're seeing huge changes, and that's Telehealth. And to do so, I'd like to turn the program over to Courtney, who will share some background on Telehealth and how her programs have been really been game changers here in California, and beyond. So, I'll stop sharing my screen, and let's turn it over to Courtney. Wonderful. Thank you so much, David, and thank you all for having me. I'm gonna talk a little bit about Telehealth today, but I'm gonna come at it from a lens on equity. And so, I would love to talk about sort the ability to implement something like Telehealth at scale, and then the ability to ensure that it's working for everybody. So, the way in which I've thought about the last year and a half, or a little longer than a year and a half given Covid, is that it's really been a moment of progress and opportunity, and I think that's what David really just highlighted really well, and also some gaps and challenges specific to digital and digital modalities in the time of Covid. I think there's a lot of things happening
across multi-levels that brings us to where we're at today. Um, we've seen high interest among all sorts of patients and community members in using their their digital tools and wearables, trackers, like we just went over. And we have community organizations that have been doing community work, and have been able to mobilize for Covid in ways that are frankly, truly heroic and amazing. The same at the healthcare delivery system level, who've really restructured and tried out Telehealth in a completely different way than they were trying it out prior to the pandemic. And then we have industry coming to the table with resources, and in a policy environment, we're actually trying to build infrastructure for everybody to have access to digital tools. But on the flip side, I think there's a lot of other things that are coming into into view during this past year and a half that I think we really need to pay attention to if we really want to have an equitable rollout of Telehealth and other digital strategies moving forward. And that has to do with everything from individual level
motivations and trust, to structural disinvestment in our communities, thinking about healthcare system variation, about how they were able to implement Telehealth and what Telehealth looked for them on the ground, the industry really thinking about health equity and the equitable rollout of their products, and all the way through, better policy mandates to improve the strides that we've been making over the past year. So this is sort of, in a snapshot, I would say we're really out of crux. And now is the moment, I would say, to take what we've learned with Telehealth and to move forward into the future. At the patient level, I just thought I would show a little bit of data about where we're at. So, this is pre-Covid data on Telehealth from a national accelerator called Rock Health, which was one of the few groups doing sort of national surveys of different digital technologies. And this was 2017 data, but I think it's really interesting to think about in the pandemic world, because you can see here that they had an overall national survey sample who was using telemedicine around 2017, and then they did oversampling of four groups that are shown across the columns at the top. So, chronically ill seniors, a group that they call vulnerable
individuals - so, people who are Medicaid health insurance or are low-income - the worried well, which was sort of more activated young people who were looking for trackers and wearables, and then just an overall aging adult population. And you can see, specific to telemedicine, some pretty wide variation in who had access to telemedicine prior to the pandemic, with some of these groups having really low uptake in use. Those patterns are really similar for some other things on this graph, like wearables. But I wanted to also just call your attention to
the fourth row there, about searching for online health information, and really make the case that, yes, there's variation of what we were doing with Telehealth pre-pandemic, but actually everybody is interested in using tools and online tools to improve their health. And so, we're in this situation, in this pandemic situation, where we've launched an entire new modality of care, and we have high interest in people trying out things, but actually probably differential ability and differential structures in place to allow everybody to use it in the same way. So, when I think specifically about things like Telehealth, I think about all of the three things that I'm guessing this group has thought a lot about before. It is actually a
multi-level scenario to allow all patients to access Telehealth. We actually have to have the right devices and the right data, which is actually not universal across our country, and then we need the skills to be able to use the types of technologies that we're offering. And all three of these came into play during the pandemic, especially at the safety net healthcare delivery system where I'm based at San Francisco General Hospital. And I wanted to underscore this point that the skills piece of this is. We know nationally, for example, how many people own smartphones and how many people are online - and I think the pandemic's shone a light on actually a significant group and a significant group of older adults who actually are not online and not able to access technology - but the skills piece is something that there's less data available at a national level. And so,
this is just data from San Francisco about sort of who's online, and both who reports basic digital literacy skills in being able to use their technology in a way, like searching for websites and those types of tasks. And you can see here, there are some subgroups even within a tech-connected city like San Francisco, who actually have some pretty big gaps. And so, this is the group that I think, when we think about Telehealth rollout, where a majority might be able to use it, but there's actually a pretty sizable proportion of people who need additional systems and supports to be able to use what we're offering. And then I wanted to set the stage about the clinical side, right. I'm based in a healthcare delivery system, like I just mentioned, I'm a health services researcher, but I've been based in primary care in a healthcare system. And there's actually a lot that's gone on, on the other side of how we've offered Telehealth to patients over the pandemic. I would argue,
actually, that clinicians and systems face the same kinds of barriers to offering Telehealth at scale that patients do. And while many, many systems like UCSF Health and others, who had some Telehealth happening before the pandemic, were able to largely scale up their practice, places like where I work at San Francisco General actually had to consider all of these conditions to be able to deliver Telehealth at scale. And specifically, video-enabled Telehealth at scale. So, many of them didn't have EHR workstations with cameras to be able to offer a video visit to patients. They also needed to worry about the platform in which they were going to offer to patients, which they had not purchased and used a video platform prior to the pandemic.
And then they had to completely readjust workflows and develop new roles on teams to be able to support patients and being able to do this. And I think those differences in how Telehealth has been rolled out during the pandemic are actually also relevant for what we saw pre-Covid. So, the same way I showed you data pre-Covid about what patients were doing and how they were thinking about it, there were also differences by systems and how they've been thinking about Telehealth prior to the pandemic. And so, this is community-based health centers, so not the large academic medical systems, but federally-qualified health centers and other centers that care for some of the most underserved patients. And a lot of them were actually, again, prior to the pandemic in 2016, not ready, and
either about to implement but not ready to implement. There's a large proportion here of people who were not already piloting and not already using Telehealth prior to the pandemic, and some of the major reasons are in those workflow and skill-based situations that I mentioned. So, it's very parallel to the patient side, which there's technical barriers, there's workflow issues, there's a lot of things to work out.
And so, the fact that we actually offered Telehealth at scale, especially across multiple community health centers, is actually remarkable, given that there was a huge variation before Covid came upon us to be able to do this and meet patients where they are. And then, of course, safety net systems have unique barriers. So, I don't think I'll belabor this point, but they just really need products and solutions that are going to work for their patient population, many of whom speak languages other than English. The staffing ratios are smaller in safety net healthcare delivery systems, and so there's not as much wiggle room to deliver one-on-one technical support, to be able to deliver Telehealth at scale.
So, this creates a situation of a multi-level factorial thing that both patients - it's not just all patient barriers and it's not just all provider and system barriers, right. There's actually many things that that lead to a graph like this. And the most important thing on this graph that I think I want to call your attention to is this light grey bar at the bottom. So, this is 41 community health centers and safety net delivery systems in San Francisco in the middle of the pandemic, and the grey bar shows how many video visits they were able to deliver as a part of their overall care. You can see it increased, but barely increased, during the pandemic. So, these delivery systems shifted to primarily audio and telephone visits, which is the darker blue bar shown here. And so, when they say Telehealth in these delivery
systems, it means almost exclusively telephone visits with patients, without an ability to see them on the video screen. And they did some video, but because of these multi-factorial barriers, they were not able to stand up video visits at scale, and the way that some other healthcare systems have been able to. Okay, hopefully that's not too much doom and gloom, but I think it is actually the real state of where we're at and the specific types of challenges that are there. So, I wanted to focus the last few minutes just on opportunity here. So,
if this is the state of Telehealth and this is sort of where we're at, especially thinking about groups who might have more barriers on getting on, where would we move forward? So, I really feel strongly that technology is going to get us to a vision of this as the future. So when I think about my work and health equity, what I'm really thinking about is the second panel at the bottom. So, not offering the exact same thing, like Telehealth or a rollout of Telehealth, that we assume will be workable and usable for every person that we're offering to, which is sort of the top bar, but really allowing the technology itself to be tailored and flexible to meet people where they are. And this includes language ability, digital skill ability, device variation, all the things that we know that technology actually can overcome relatively easier than other modalities. And how can we get to this as the future? The other opportunity areas -- I just wanted to underscore this, this is a busy slide. but the bottom line of this slide is that,
again, interest is not the barrier. So in that same delivery system, San Francisco General, that I showed you a minute of that did less than 3% video visits over the entire pandemic, 65% of our patients are interested in doing video visits. So, again, we have a high interest among our patients in doing this, and the barriers are really in those multifactorial barriers that I showed you earlier, about data and devices and skills and confidence and being able to use them. And then similarly, I think our systems are finally ready to offer Telehealth at scale. Clinicians in our safety net setting, who faced many barriers to standing up Telehealth during the pandemic, still realize and still are likely to continue both telephone and video visits into the future, because they realize that this is the patient-centered and convenient way for many of their patients to access care. So, we have the interest. We have, frankly, the change in workflow and the change in mentality about doing this at scale. And how can we harness that moving forward?
And then lastly, I'll say, this is very related. I would say telemedicine is very related to other things we're offering in healthcare. And so, I don't want to present this without giving you an idea that we've learned a lot from patient portal access. We've been accessing patients to sign into their health record for a long time now, in some systems like Kaiser for almost 20 years, and in other systems at least five or so years. And so, we actually know that the disparities and the
inequities in who uses patient portals is actually very similar to what we've seen in Telehealth over the past year. That people have to really be supported with both in-person relationships with their doctor and digital relationships, and that it's not a substitute of one or the other, but actually are likely to be used in combination moving forward. Patients have to perceive both the right types of visit to use Telehealth moving forward, and they have to have technical support to be able to use it, specifically for those who face additional communication barriers. And so, I think the last thing that I'll put out is, we've been thinking a lot about these frontline experiences, and we've been putting out a lot of tools over the last year. So, this is a toolkit that we've put forward on telemedicine for health equity, that's done in partnership with an amazing organization called the Center for Care Innovations, that works with a lot of healthcare delivery systems and federally-qualified health centers, mostly in California but also nationwide. And so, it has a lot of really frontline,
so how do we get there, how do we overcome these barriers that I'm talking about? It really tries to break down the telemedicine rollout piece with an eye towards equity. So at the leadership level, and thinking through which platforms we're rolling out, how do we choose the right platforms that are the easiest to use, that have offered the best language access, that actually fit into the needs of more types of patients than all of those who are just more digitally native and ready to use things out of the box? How do we support the teams to be able to do this, to make sure it's a routine part of their job and can flow into how they've been trained? How do we support patients in doing this, which I spent a lot of time talking about. And then the exciting part, this remote patient monitoring, helping people support their chronic diseases over at home. I think all of that, and what I want to leave you all with today, is that I think that's coming in the future, but we really need to be getting these fundamentals right to be able to optimize these solutions. So, the overarching strategies from that toolkit are really using our data more effectively, really understanding who is taking up these strategies, which groups are having barriers, and really meeting them where they're at with questions that are actually better suited for how to offer the right modalities. So, whether or not we're offering a home blood pressure monitoring digitally-enabled device, or just a video visit with patients, we have to know that they're interested, that they have the right devices, and that they have the right support to be able to use that device. And then of course,
I'm being healthcare-system focused here, because that's where I am and that's where I sit, but clearly we're not going to be able to do this by ourselves. There are so many other resources that we need to be able to do this, in terms of connecting people to the right thing at the right time. And these are some really amazing programs where we need to be able to have people have access to the devices and skill-building situations when it's the right moment for them, and when they're interested in actually moving to the next level. So, I think that's all. My main talk is, I really wanted to leave you with a little bit
of the challenges, just to lay out the actual facts about where we're at, but hopefully show you that when we have a multi-factorial or multi-level view of something like a huge technology change for our healthcare system like Telehealth, that we actually can think about moving the needle, when we think about it not just being a patient-level issue or not just being a system-level issue, but actually it's a multi-level issue that we've made a lot of strides on, and I hope are going to capitalize on standardizing this work moving forward. And there's some resources, I'm sure we'll post the slides. But there's a lot of other people who've been working in this space, and I think if you're interested, especially in the workflow piece, I think there's a lot to do and a lot to share. Courtney, thank you very much. We've got a variety of questions that have come in from members in the chatroom, and I'm going to move on from the last one and then go back up. Um, are doctors being paid by insurance companies by the same rate for video visits? Is it comparable? And one of our members says that she sees in her SS receipts that it's a lesser payment. What's your thought about that?
Maybe I'll start, David, but I'd love for you to chime in too. For a long time during the pandemic, there was an emergency payment that was passed, so it was covered at the exact same rate as other strategies. And now we're moving into, that's what I'm talking about, that next phase of Telehealth, where I think there will be different reimbursement based on different types of modalities. And so, I think you're correct and that we're moving into that next phase.
And frankly, there's tons of policy conversation about what those reimbursement rates are going to look like into the future, and actually, we've settled on a few right now. But I don't think that that conversation is going to be done yet, because we have to think about the audio-only visit, the telephone visit that I mentioned, also video visits, and how they work together for different specialties and different types of care. And I think that has forced the needle on a conversation that frankly, we've been talking about for decades in Telehealth. And I think we're actually going to need to be really, really thoughtful about that moving forward, if we want to think about the blend of this with in-person visits moving forward. There has been,
I could add, a significant effort to try and extend this payment schedule beyond 2022, where it's been put at this point. And there's legislation at the federal level, there's some at the state level, and it is, as Courtney says, a strong debate. Because we've seen Telehealth, while ramped up dramatically, it has pulled back and plateaued across all different systems, because people still do like to be face-to-face. And unfortunately, the reimbursement side, unless we do have equal or comparable funds, clinicians or systems may reinforce in-person visits, because they may, with our fee for service system, they can gain more resources or revenue. Versus a program like Kaiser who has embraced this fully, because they're trying to do not only good healthcare, but they're paid on a per capita basis. And that way, they're being more efficient as well. Has there been any effectiveness on research to see, um,
to sort of compare the in-person visits with the Telehealth visits, the video visits specifically? Courtney. Yeah, that's a good question. There has been a lot of pre-pandemic from places like Kaiser and the VA, the two largest systems that stood up Telehealth at scale, I would say. And in those situations, there's a lot of evidence that the same quality of care is delivered. I will tell you, though, that it is not as developed as other research, because there's so many questions about the use cases that we that we did Telehealth for during the pandemic, that we were not doing Telehealth for prior to the pandemic, given the emergency situation. So there's a lot more that we need to learn. But the last thing I'll say is that it's very similar, again, to patient portals, and sort of sending an email to your doctor versus coming in-person to your doctor. There was a lot
of research in that prior to the pandemic. And what I've taken out of that like, 15 or 20 years of research, is that it's complicated. Sometimes when you find a new visit, you find another clinical issue -- you watch somebody at home and you see that they might be almost falling down, or that it's not a safe environment, and then you want to bring them in to talk about that or to make some adjustments. And so, just because you're offering up more, sometimes you find more need
in the population. And so, I think it's very difficult to tease those things apart, and we need to be instead, I would say, thinking about this as the patient-centeredness way to do care, which is true regardless of the clinical outcomes. This is the right way to offer patients the right modality, and to allow flexibility for them to blend their visits. And then we can figure out, I would say, some of the workflows and some of the differences in nuances, and allow clinical teams to bring people back in person, but trying to really realize that this is the right patient-centered approach, and then how do we support it moving forward? You know, I think one of the classic examples that comes to mind is how many physicians would have patients coming in concerned about the onset of dementia or Alzheimer's, and many of those doctors would say, I watch how they walk into the office. You know, that everything had to do with their gaits and
pace and stance and all of that. We, in fact, also had a project called Gait, where we worked with undergraduates and OLLI members on developing a wearable for this. But I think it's a good example of what you miss by just having somebody face forward on a screen, you miss the whole person.
And that might be a downside to being patient-centric, when in fact what they want is, they also want the doctor to be able to use their medical expertise on the full, the whole body. I fully agree. And when I say patient-centric, I actually think, and I see a chat comment about it too, I think patients actually want some input. And I think we're coming to that new normal of what this is going to look like. And I think to approach it to say, it's only for certain clinical conditions, is probably the wrong way. I feel like it might put us in a box, where if we think about what does the clinician want and need and what does the patient want and need, and then how can we bring those together, I think that's a much better way of thinking about what it looks like. Because I think it's something much more like 25-40%.
It's not relevant for all visits, but it is relevant for a pretty large proportion of visits, I would say, depending on what the needs are and what needs to be discussed that day. So, how do we figure out what that balance will be? Great, thank you. The two other questions that came in during the time that you were speaking -- I know you have to leave at 11:15, and I know that David has a response to both of these questions, but I'd love your input. One has to do with cyber security, if you're having a wired home and you're having a wired body, and the surveillance aspects make people very nervous. And so, do you see that as a barrier to people adopting the technology in the way that would make Telehealth most effective? Um, Courtney's on mute, but I'm happy to jump in on that. And I can say that, very much so, it's top of mind for all of us. It's critical, privacy and security is central to all use of
technology, particularly with our own personal data, our personal health information. However, we're seeing a tremendous success in encryption and ability to protect information, even using the new, new technologies such as blockchain to share health information. Is it all foolproof? No. But we are seeing major efforts put forward in that area. In fact, what we do see in Europe and
other countries is a lesser concern about that, as people realize sharing information, being able to share your own personal health information with providers immediately can actually lead to more prevention and helping individuals. However, it is an issue, there's no simple answer. I'd love to hear Courtney's take on it. But it's absolutely critical, and not only should those of us who are in this field always put that first, but we think that it's good for all of us as users to always be considering that in what we do put in for information out as we use new technology devices. Yeah, of course. I agree with what David just said. I would say that at a fundamental level,
I think the trustworthiness is on us to make sure that we're doing the best that we can do with the platforms and the solutions that we're designing. I think that onus is on us, and we should reframe the conversation about, do patients trust into, are we being trustworthy with how we're doing it and how seriously we're taking it? And then the second point I want to make about that is, though when you think about it from a patient-provider interaction standpoint, to underscore what David just said, patients tend to be very trusting about what the right thing is to move their medical situation forward, and what to share with their doctor. So, it's complicated. We think about the institutions and other levels of it, but when we start from
a place of, what is the best interaction that I need to have for my clinical care, I think people have more openness about what is the right balance between what we're doing and what the privacy and security needs are. Great, thank you Courtney. I think we may have time for one more question, and I don't know if this is one you can speak to, but it's about the vision issues, and whether or not there's technology innovations for people who are suffering from macular degeneration, vision, blindness, etc. Is that a question for you, Courtney? I mean, I could try. I'm not an expert in that area in any way, shape, or form, but I will say that we have a long way to go about with the accessibility of our solutions. Um, I mentioned language access quite a bit, which I know more about, which is a real barrier for the Telehealth platforms that we've offered. And the ability to add in medical interpreters who are often used in-person in the seamless ways into an online format, some vendors can do that, others have to use the phone, and then the video for the other. And the same, I'm guessing, is the situation for that where
there are existed devices that can sit on top of your computer to help with low vision and other issues. But have we optimized our healthcare system platforms to be able to do that? I would say we probably have not, is my guess. And how do we start from a design place of thinking about patients who have accessibility and communication needs as the universal design principles for what we do, is something that I'm really passionate about, because it generally makes it better for everybody if we start from from those places. So, I think there's a long way to go. And because there's these blend of services, I haven't seen the industry start from a place of those, necessarily, in how they've been designing. And we were obviously doing emergency things during the pandemic, but I think moving forward, we really need to shift how we would be thinking about it. Great. Alright, well, David, we need to leave you enough time, so Courtney, thank you very much.
Thank you so much. I'm so sorry I have to drop off early. This has been really fun. Well, please consider OLLI as a place where, if you need to do a focus group, our members have quite a lot of experience with Telehealth, and many insights about that. But thank you. Thank you for joining us today. David, it's all yours. And I'll add my thank you to Courtney and her wonderful work, and to give you that big picture about where we're going in this space. And you'll now hear me echo many of the statements and positions that she shared with you, because those of us working in this field have begun to see some very common strategies. In the remaining time, I'd like to share a more concrete example around Telehealth, and show you what we've been working on here at Citris and with colleagues in the field, and then wrap up with some of the issues, as Susan has suggested or asked for, about where we're going next, some of the big issues that we see impacting not only the use of tele-technology in general, but how it will impact us over the decades to come.
So first, I'll just go back to picking up on examples that started from our perspective in Telehealth. Uh, Citris and our colleagues, particularly at UC Davis, have been engaged in Telehealth for over 20 years. They established the California Telehealth Network, which connects people throughout the state. But during the pandemic, we were given the opportunity by an anonymous donor to jumpstart two programs. That is, Courtney nicely said, we wanted to look
at individuals who were at greatest risk, who did not have resources, to make sure that we could see how we could bring Telehealth, and even more importantly, the internet, to individuals. We created two programs, Lighthouse for Older Adults, where we worked on everything from not only getting technology in people's hands and doing training, but how do you even get basic internet in through broadband, and then again, how do you make sure people can use this and afford it over time? We also created a program called Activate, which has been our collaboration working with community health centers in Merced, and now expanding through the Central Valley of California on bringing Telehealth solutions to individuals, especially agricultural workers who were at even greater risk during the pandemic, in creating new mechanisms to use Telehealth to really support individuals where they live. We've also been doing work, as you can see on this slide, work with other colleagues throughout not only the state, with West Health down in San Diego, but looking at major programs that are starting to really address this issue. AARP recently took over program Oats, which is a basically a digital health training program out of New York City, with the goal of reaching 100,000 people this year. So we're seeing these major efforts in terms of starting to address this, both from an equity perspective and from a societal perspective.
So, I'll just take you quickly through a few of our lessons learned as we experienced our work in the Lighthouse program. And this is a program that we did not just from the university, but with individuals and organizations who are experts in working and serving and enabling and engaging older adults, particularly Eskaton, a northern California senior living organization based out of Sacramento and now moving to the East Bay, but also Front Porch, which merged with Covia. Many people here may know Covia. Front Porch is now the sixth largest senior living organization in the country. But with them, we created a program called Lighthouse, where we
wanted to improve the health and well-being of older adults, particularly in affordable housing communities. And the importance here is that, most affordable housing communities do not even have internet, much less ability to use technology, and most residents do not have resources to afford it. So we created a program, and are still in process, that started at the end of last year and is now moving to full fruition with six buildings, to look at how we could do some of the things that Courtney was talking about. Doing a multilingual digital literacy training program done by peers, evaluating the outcomes, and taking that program ideally to other organizations, not only throughout California, but the state. We created a new way of approaching this. As Courtney said, it's when we're looking at it, you need to involve the person who's going to use it, both a resident as well as a staff person. And we created a very rapid program last year
right at the holidays, to reach people. As you know, many people were isolated, depression, other issues were critical, and we created a way to bring internet into the buildings, provide basic devices, a tablet in this case, and then making sure they could be connected. And finally, working with individuals, including other residents, to train each other. And we're now trying to reach multiple buildings, as I said, with many more individuals as we move forward. So, what did we learn? Well, we realized again that you do need to engage individuals. This is the core around technology overall. We also know that it's going to need, as Courtney
was saying, the issue of doing it in multilingual perspectives, the problem with certain things, Google Translate can be effective. But when you have, in the buildings we're in, 10 different languages being spoken, it can be extraordinarily difficult. So, how do we have technology that will be able to address these issues? Similarly, we realize that each person is different. Each building was different. All of us have different perspectives on whether we're digital natives or
have real concerns about using technology, so we had to deal with those issues. And second, the digital divide, that Courtney spoke to so eloquently, is huge. The issue is that these buildings, the owners often do not even have or haven't had the resources to put internet in.
Many of the buildings are very old. There's also the ongoing costs, who's going to pay for internet connectivity, particularly if you're on a fixed income. And you have just infrastructure issues, it's not just rural problems of getting the internet and getting broadband to other people, but we have buildings in cities that have the worst possible connectivity issues. So we have major challenges in this space. So, coming out of this, we're in a process now of being able to systematize this. We're looking at different ways to go forward. The key issue still will be, who's going to pay? So as we look at the new infrastructure on Build Back Better, internet is core. And a number of us are going to make sure that we focus on not just schools,
not just rural areas, but getting internet to older adults. And this is going to be critical, and we're working with a number of federal and state agencies here. As Susan nicely said, I'm not only on the state California Commission on Aging, where we are looking at the legislation in that area and supporting it, but we're also working with the different departments, with governors, a strong support to how we keep this as a high priority. So again, key lessons, you have to engage individuals. We need solutions that can really address the problems and barriers
for many folks in our society, particularly in affordable housing, and we need to be able to create an affordable system going forward, then one that will be easily accessible. So, this is a repeat of some of those key things that you can see on the screen. Again, just barriers, dealing with multiple languages, creating new digital literacy programs that can be sustainable, and making sure that funding comes as we go forward.
And I'll just wrap up with a few key points. As we're looking at all technology solutions for aging, well beyond those that we've covered today, I think there's several things that some of you have heard before, but Courtney and I would like to reinforce. There are fundamental issues, and they start with number one: inclusive design. We must always have individuals do it at Berkeley and Citris and other organizations. We have some of the best examples of organizations working with OLLI, in terms of how you do include individuals. I can't say enough about some of the programs that OLLI helped, really a number of our technologists, clinicians understand that what individuals want, we really must start at that point. Second,
we need to look at digital literacy. It doesn't matter that we have internet or broadband if people cannot use it or understand how to use it. We need new ways to train individuals. So, I just call out this new program that OATS and AARP are doing to reach so many individuals. This is still going to be the key issue, because the technology is constantly changing and we have to find ways to help individuals do it, and in fact make the technology itself easier to use. And that's where we're going to see changes, such as more with voice, Alexa is really getting uptake in certain ways. It's not perfect, but those are the types of devices, Google Home and others, that will work in this area. And to the question about macular degeneration and other
vision issues, assistive devices overall, but particularly hearing and vision, are going to be seeing some major changes going forward. Just in the last month, we finally heard from the federal government that they have approved the new over-the-counter hearing solutions, which are going to be game changers for those of us who have hearing impairment. Um, we are going to be seeing so many new devices that are just in the hundreds of dollars instead of the thousands of dollars, that can be adjusted and be very sensitive to improving hearing. We hope to see some similar issues in terms of vision space, but clearly this is a huge area that we're going to need more and more support. And finally, I'd like to close with what I think is still underlying all of this. And where, by good fortune, being in Silicon Valley and the work that's going on not only at UC Berkeley, where we have now some of the best data scientists in the world, but actually a whole division of data science. We're going to see the use of data and data analytics continue to drive all this,
because all the technologies we've talked about require this type of information and how we use it. So, I use the terminology of "machine intelligence" to be an overview for artificial intelligence and machine learning. But we are seeing some amazing ways to link data together. What happened, as you saw, in the pandemic with the results of how we are able to address issues around dealing with Covid, bringing in genomic data through Jennifer Doudna at Berkeley, where she just received again a Nobel prize, to diagnostic technology -- and this is where Telehealth, we can do things at distance -- and wearables, and even how social media will be used to bring information together. So, final points real quickly, since we're getting close on time. We have some great opportunities in the state of California, we are fortunate to be in a leading state in this space. Our state department on aging was charged with creating a master plan
on aging for these next 10 years, and we're making sure that technology is a major part of that, and that we will be tracking it. But again, it's technology as a tool, not as an end and a solution itself. But in the list I share with you, these are all the different ways we expect to see how technology can improve everyone's well-being, but particularly those of us who are older, and we will be working on that to really make sure that our state and both public and private puts that first and forward, as we go forward. And the last example was created this year: the idea of a single, common database that will be able to share information. And this is the fact that,
as you all know, all of us get information or need services or participate in all these different areas, but information currently cannot be shared, and can be very different, and we do not have the benefit of having all that information, particularly social determinants of health. Well, state of California a year from now is challenged with trying to create a connected system. So, stay tuned. I'm on that advisory group, and I'm very intrigued to see how we can do that. But
again, it shows what we can do in this area, and some of the benefits that we expect to see in the years to come. And with that, I'd like to thank you. And I know we only have a few minutes, but we will also be available, Courtney and I will always be delighted to speak with folks and work with Susan and OLLI to answer any of your questions. David, thank you very much. This has been just chock full of information. And you know, around some of the innovations and some of
the other issues that are political as well, one of the things I just want your personal opinion about, is that so much of this is requiring an infrastructure. And how do you regard, has the private sector stepped up in the way one might imagine, or do we need to ask more of the private sector? Um, so that some of these really huge issues around the internet and around digital literacy have the benefit of a private-public partnership. What's your thoughts? That's a great question, Susan. And as you can imagine, I think industry has been very forceful on this. We're seeing dramatic changes, particularly in the issues around reaching older adults. And with technology, it has been a game changer in the last year. Amazon just hired one of our colleagues who is really leading the charge in that space, we're seeing a new attention in that area. Obviously, there's a financial interest, it's a business interest,
but that in turn is helping bring this to more individuals. On the other hand, there's still disparity, we have this digital divide on all levels, and because it's a business decision, often there are a number of individuals who do not have have that. Furthermore, while there's an interest and a support for this type of training, that's still been secondary at this point. I think what we're seeing is a combination of public sector and our government, and particularly with the potential for the huge amount of resources that could go in to help build out the rest of the internet, particularly the last mile getting things to individuals, and there will be along with it the need for this training, we'll see a greater push there. And I think again, we
will see, there'll be a push-pull from both areas. But I found it amazing how there's much greater interest. And I think we will all see, it's a silver lining, if there is one out of a pandemic, that this has opened the door for a number of these. As we said, it's not just Telehealth, but it's all these other ways that we need to look for solutions where technology can improve things for all of society. David, thank you. You are a most valued colleague, and I look forward
to the year ahead when we begin our planning for the Aging Research and Technology summit with our colleagues on campus and within the UC system. I want to thank the members who came today, and I think we're all much better informed. We're still skittish about the cyber security issues, I think many of us look at what's happening with the European Union and some of the regulatory things that they've put together, but at any rate, we are moving forward. And thanks for helping us take those next steps. Thank you.
2021-11-12