hi and welcome if you are just joining us we're giving everyone a moment to log on and we're going to get started with a conversation today in just a minute or so hello and welcome to another mathematic webinar i am nicola owens and if you're not familiar with um massmedic we are a membership-based trade association that works to bolster the ecosystem in new england through advocacy education events like this connection and awareness today i am pleased to welcome you to a webinar hosted by triple ring it's diagnostics in the future and we're going to have a great conversation today about merging in vitro diagnostics with medical devices quick housekeeping note we will have time allocated at the end of the conversation today for questions so please feel free to feed those in any time during the conversation in the q a function at the bottom of your screen now i am pleased to introduce our moderator for today's conversation ryan mcginnis ryan is the global head of in vitro technologies and the gm for the department at triple ring thanks ryan thanks nicole good day everyone and thank you for joining us for this exciting mass medic town hall town hall conversation um i am ryan mcginnis i'm a general manager at triple ring technologies and at triple ring we stand side by side with innovators to solve hard problems launch breakthrough products and to start companies where we are a large team of doers we're engineers and scientists who build complex systems for clients so if you need help designing and building systems for med tech life sciences and health care applications please send me a note and as nicole mentioned we are going to save some time at the end of the discussion to answer questions and so as these questions come to mind please do put them into the q a pane and we'll handle it from there so on to our panel discussion it's an honor to join our experts today we have a group of professionals who in their own ways are focused on improving health care and the ways we deliver it as many of us know solving problems in modern health care requires a diversity of approaches and this group represents three efforts to understand patient and market needs to attract to address those needs and to efficiently bring solution to solutions to those who need it most i'll now ask each of the panelists to introduce themselves and we're going to start with you fanta please thank you um so my name is fonta sharif my background is in public health specifically epidemiology and biostatistics currently i am a research consultant at advisory board um so for those of you that are unfamiliar advisory board is a 40 year old syndicated and insights firm that is seated under the optum and united health group umbrella we serve over 4 000 clients across the healthcare system between health plans life sciences digital health sectors etc so we really aim to provide our clients with strategic and operational guidance to really tackle the most challenging problems in health care whether that's by making progress to value-based care to use of medical evidence etc so we really aim to help executives in the healthcare industry essentially work smarter by providing actionable strategies and practical tools to support implementation we then share our research findings with our members through reports on our website through emailed newsletters through our podcasts and we also have virtual and live events my specific team right now focuses on ways in which life sciences organizations can support ecosystem progress and that's usually through partnership and just generally having a deeper understanding of what other sectors need so this year we're really focused on how just medical products clinical decision making and purchasing will really evolve over the next decade my specific projects really revolve around disruptive therapeutics and diagnostics such as ultra high cost drugs digital therapeutics psychedelic assisted therapy biotester biomarker testing and more prior to joining the life sciences team i also worked on the cardiovascular roundtable where i champion topics such as telecar telecardiology strategy um virtual cardiac rehab artificial intelligence and cardiovascular care and healthcare uh equity measurement our end goal and mission at advisory board essentially is improved care and we always aim to do that by providing best practice research and doing market analyses prior to advisory board i was at the massachusetts department of public health for several years and i worked there as a tuberculosis epidemiologist and also worked there while i completed my mph from boston university um prior to dph i also spent a year or so at boston medical center doing research on autism diagnostic tools so because of these experiences i would consider myself having a well-rounded understanding of the clinical the business and also sometimes the political side of healthcare i personally am very passionate about healthcare and the intersection of technology as well as just infectious disease surveillance and management um so yeah that's just a little bit about me thank you for having me i'm super happy to be here yeah fantastic thank you very impressive gene can you go next please sure hi hi everybody i am um gene olive i am the chief technology officer at best buy health which is part of best buy and i can tell you a little bit about later why best buy is in health i my background is uh really focused on technology i've always been in technology and i'm an engineer by trade i spent more than 20 years in aerospace and defense working on some really neat high-tech defense systems and missile design and development programs and then went into health went over the phillips and ended up being the phillips healthcare cio and i really loved being in health i really believe in working for a company with a purpose after five years there i went to schneider electric and was leading their major business transformation across the company but it was energy management it was a great company there was a lot to do however i just felt like um it wasn't my fit so uh my dad was going through it my dad had congestive heart disease uh in the last six months of his life were really rough he was very positive wanting to live um we could see the decline but he felt like he was going to keep going forever and during the whole time he ended up with three hospitalizations uh and i i never felt that there were hospitalizations that were really necessary kept feeling like we need technology to help him he can be managing and monitoring in the home we have remote patient monitoring systems um and they just weren't there and this was during covid so two of his hospitalizations my mother couldn't even go see him can you imagine being 60 years married and you have to drop your husband off at the er and walk away from him after you've been caring for him you know most of his life so the day that my dad the day when my dad after my dad died it was we were at his funeral he was a veteran and i got a text from deborah desanzo who i'd worked with in the past said you know um you know are you looking for any new opportunities give me a call and i felt like it was it was time it was a really it was awesome to be able to go back in health and what we're doing at best by helping the mission of our company the mission of best buy is the purpose is to enrich lives through technology now best buy help kicks it up a notch right and we are going to enrich and save lives through technology and meaningful connections so we have care centers we have command control centers and we have geek squad that can help the serviceability so that the merging of all the the great things within best buy i feel is really going to help us achieve our big goal is to really to enable care at home for everyone and that everyone is really important like what fonte is saying right it's it's health equity right how can we how we can we really believe that bringing care into the home will will not only help with health equity it will help with our our physicians and our practitioners it's at really the whole ecosystem we're right at that tipping point but if we can get there and provide the right service to our customers it will be i really believe will be ahead of the game it'll be a great thing for everyone so that's kind of a little bit of my my background and my why thanks very much um and john um go ahead please let us know who you are what you are yeah i'm john martin i'm the chief medical officer of butterfly network i'm a vascular surgeon by trade and as you can tell very quickly a pet owner of many our company butterfly network has developed the world's first single pro whole body ultrasound system we put ultrasound on a silicon chip and what that does it really shatters that ceiling of ultrasound being a limited resource and makes it available essentially for everyone everywhere to be used for every situation much like jean marie's situation some of the work that we're doing is actually transforming care into the home you think about telemedicine and what we've done historically it's a teleconversation when you bring imaging into the situation it becomes a completely different conversation because when you look at when there is a diagnostic dilemma three quarters of the time it's simple imaging that answers those questions and so we want to put those imaging answers in the hands of physicians nurses nurse practitioners in every care venue butterfly was introduced in 2018 with an innovative device we've added on top of it award-winning software that really simplifies the use of the device so your focus is on actually the information that's provided not figuring out how to actually use it we've coupled with that a workflow that can integrate into health systems so it becomes a complete solution for the use of imaging and really transform the way it's used if you think about the way medicine is practiced and all of you have been involved in in some way you do a history you do a physical and then you pause and sometimes you're sent for tests sometimes they make a guess and start treatment but what happens now with butterfly it's history physical image you have much better decision making you can start definitive treatment much sooner it really is a much more efficient way to practice medicine and so that's what butterflies focused on i have a background as a practicing physician i was the president of the largest cardiology group in metropolitan washington and also was the vice president physician operations i'm the president of a large of a non-profit that's been doing free cardiovascular screening around the globe uh for people uh so i i'm as passionate as my co-co-moderators and presenters here about healthcare and and i will confess that i'm butterfly patient number one i found my own cancer with this device uh and have living proof of now what i like to say both sides of the knife of what it's like to experience healthcare and i'm very happy to join this panel uh because this very important discussion well all right thanks john yeah and even just from the backgrounds of this group it's um it's amazing um uh how the healthcare system touches us all and um we've been professionals in it for our whole careers but it's uh eventually we are also um users of it and uh and around my uh family personally we we know we have to uh manage our own health uh more than we might like to and so these are problems that that we're all working hard to solve so um i would like to jump in with some questions and discussions um and the first question is going to go to you fonta um your view of the of this world is um you know tends to be on the high level um you know 30 000 foot trends in policy markets technology approaches all these you know combined efforts what do the data tell us about the trends in healthcare access and deployment sure i'm happy to start um so of course we know that a lot of healthcare is moving into the home so as a firm we always get the question like will we transition to a world in which just brick-and-mortar lab sites are just no longer necessary will all healthcare be done from the home and i think just the truth is is that patients really want convenience that they have experienced through like telehealth and online grocery shopping amid the pandemic to really just extend to other areas of their lives even lab testing and healthcare um and it's really clear that consumer preferences are changing and that convenience really tops this list so um just basically based off of our research we just identified that there are just several trends that have really aided in accelerating at home care adoption um so first there's just a lot of advancements in home testing technology so some of the ones that we're seeing really like limit the potential for error especially if patients are collecting their own samples and then on top of that lab vendors are also just exploring different technologies such as like biometric patch sensors in lieu of at-home blood draws we're also moving forward to where we can see research that will really need to be evaluated for safety and just quality because these technologies are really working to inform practice and policy um secondly we're also seeing that there's a lot more provider involvement in home testing so we're seeing that technology and patient preferences are really shifting and this has motivated health systems to sort of create this new environment where home testing is a huge business and it really just lends credibility to home options and then on top of that at home diagnostics can honestly help tremendously with hospital capacity as we've seen through the pandemic and really just work to alleviate provider burnout um and also just being able to allow a clinical staff to work more top of license um third we're seeing that there's just increased uh affordability and accessibility of light lab tests so these can easily be administered at home sometimes paid for out of pocket they can also serve as an addition rather than a substitution to regular testing and then lastly as we know there's been a huge shift to just a general awareness of public health in one's health in general so more people today are accessing more healthcare than ever before and it's really just because of a heightened sense of awareness of one's health so moving healthcare into the home really holds many public health benefits especially for things like infectious disease like cobia 19 and very common chronic illnesses where people may have difficulty accessing traditional care um and then also just cell testing at home can really just substantially reduce or eliminate the risk of people spreading viruses as well as just be as well as it just being more convenient than traditional diagnostics um but however we're seeing that although there is very widespread interest in using technology to really monitor patients at home and through these programs there really is just no consensus on the best way to do this we're not sure different members tell us different things but ultimately all programs really work very differently than each other and success really depends on several factors such as patients level of acuity how sick they are um what their health literacy is like what their tech literacy is like their at-home environment what their families are going through and then also ultimately how clinicians interact with patients to retrieve their data yeah nice and gene i'm sure that meant much of this uh resonates with you and can you talk a bit about how this um the information that group groups like fonta are gathering has guided the strategy and that you've developed with best buy health yeah i mean she's you know she's saying exactly what we're seeing it's it is there is so much variability um within the the usage and the adoption in the systems but i think what we really know is that technology is in the home and that's you know best buy has had technology in the home for a long time but also now health is in the home so how do we connect the two and and work really work to solve the barriers of having um technology and health in the home you know primarily the one is serviceability right i mean we people are tech savvy but often times when when it's an active aging community or if it's it's community people who are who are not feeling well who are chronically ill or have issues um it's it's harder it's harder to um use it and the and the biggest problem that we're finding out there across the board is the service ability the installs making the connections if something goes wrong and then the equipment and that's where we're leveraging our geek squad um in that point of care to have that human connection i mean we really need you need to have the human connection and then and then the adoption will come and then really to benefit what we're finding with our command control uh centers where we have our nursing's on on staff and and every all that everything comes into the platform is monitored that we are actually being more proactive with being ahead of an incident then and very less reactive and the nurses actually have more time the patients um the people at home really like it because it's a personal uh care if they get it you know every day or anytime that something goes wrong they can be right there and connecting and the quality of care is far exceeds the quality of care um from what we're hearing from our patients and the results of these studies that we're doing exceeds what you get in in the hospital so i think overall those are the the big things right the adoptions and what we're trying with our our strategy to pivot is to get it that that our the consumers want this right and so in many of our studies we did a big one with umass medical and hospital at home and one of the first patients with to do hospital at home which is a little different than just managing care at home like with chronic care but hospital home you do have the nurses coming in it's much more much more managed uh was that you know the the he was an older gentleman who had covert but his son was a physician right so his son was the one that kicked it over like you know dad you know this is a good thing right we not everybody has that so it's it's a huge change but what we're finding too is that you know what care at home you move more you eat better and you sleep better and those are three factors that patients need to to get better faster and i i also think from a caregiver's perspective and that's kind of like the i feel like the caregivers are really the unsung heroes in all this and and i think about my mom everything she went through with my dad in the last six months but by the time she passed she was so exhausted i didn't really see it until we were looking at pictures after and getting everything ready for the funeral but she was so exhausted and you know having really good care at home and that ease of mind and knowing that you know if your weight goes up then you know it could be salt levels it could be excess water and everything that that having someone that tells you what's going on versus trying to guess it or trying to wait till i get there two days later and say there's a problem i think we better get dad to the hospital so i think that's aligning with our really our strategy is you know going back to leveraging technology and meaningful connections you can't do one without the other you've got to have the tech but you've got to have that human factor uh and how you deliver that human factor will be the differentiator in my opinion yeah thanks and and john this is a good spot for you to jump in and using butterfly's platform as as an example um how can or how is technology being used to address these large market trends and these unmet needs effectively well when i think about shifting to the home i kind of have in my mind four ps first of all what problem are we actually trying to solve uh you know what clinical healthcare problem are we actually trying to address in the home the second thing is people what are the patients if you will that need that problem solved and what are their characteristics and what are the people that are actually available to assist in that whether it's on-site or remotely the third thing is what products are actually available and can be used in that environment effectively to actually manage the situation and then the final thing what processes are in place to actually execute on that and so the reason i see so much variability across the globe is because you don't see consistency in all four of those that's a lot of variables that come into play and to be really good at all of those is a big challenge and i think where butterfly is stepping in is we know how important imaging role imaging can actually play in the management and let's use jean marie's situation because it's so near dear to her congestive heart failure congestive heart failure is a volume problem and people end up coming back into the hospital consistently because they become volume overloaded or you get over diaries and you're dehydrated now you can assess that historically you go to the emergency room to get a chest x-ray and they draw blood work but what's been known for quite some time is you can actually manage this with using long ultrasound imaging it is actually incredibly effective at looking at volume overload and there are a number of clinical studies that demonstrate that in fact it can reduce the amount of admissions to the hospital and you can keep people out of the emergency department and know when to discharge them from the hospital if you use lung ultrasound so we know it's an effective tool that gets to the product now the people well who can do that well interestingly enough people going into the home can learn it very quickly healthcare professionals because it's one of the easiest things to learn the butterfly device is only two thousand dollars so it's actually affordable and there's a nice connectivity into the health system so you can manage it so that process is doable and if you want to take it one step further and that is we've done clinical studies where patients been able to scan themselves to manage that information so now not only can they take their own temperature can they get their own blood pressure can they measure their own glucose but there is a future where they can measure their own volume which will keep d marie's dad in the home because they can manage that heart failure there and not go to the emergency room now those clinical studies are under an irb at this point we're working through getting to the fda but that is something this topic is about future the future is actually a lot closer than one might see and it's the role of technology to manage these specific problems in the home that's going to change the game for so many of these patients and not to mention the fact that it reduces the cost of care because those admissions are so incredibly expensive and burdening our health care system we only want people in the hospital that need that advanced level of care if we can manage it outside the hospital in the home as everyone says i'd rather sleep in my own bed eat my own food and i can be very reliable that i'm taking my own medications in that place it is the safest place to be if you don't that you aren't critically ill sorry and yeah thanks um it's very interesting so um you know in vitro diagnostics have led the way historically i would say to widely distributed medical technology you know short of maybe eyeglasses and being you know easy enough to get into the point of care and into the home and this was only accelerated through covid and the pandemic right so maybe john if we stick with you for just a bit um more complex devices following on that path to direct to consumer type stuff and even uh perhaps get a bit technical around you know what the considerations were or had to be made to address patient and end user needs um in unskilled settings or or at home um and just you know if you think about the arc of um where diagnostics has come from over the last 30 years or so there's a group their north american unit is in maine it's global access diagnostics so this is uh used to be more logic i mean they were the first ones with the uh at home pregnancy uh test kit um and so that's uh was incredibly successful that form factor is very successful we all use it for all different types of uh diagnosis how do we get these more complex devices or how do we build these complex devices to be that accessible and that easy to use yeah and i think it circles around again narrow the scope of what problem you're trying to address i think that's critically important you have to look at the cost effectiveness of the device itself is it actually do you get the bang for the buck that's there so that healthcare systems uh and the payers can actually afford to do it and it makes sense and then you have to really leverage kind of simple user interfaces so that people that aren't sophisticated in the use of even their smartphone as an example can actually utilize these devices and we've come a long way i think one of the best examples that i use as an example for butterfly because when we mentioned patients are doing their own ultrasound you kind of get this oh my gosh you know people train for years to do ultrasound i remind them that we have defibrillators now in airports gyms everywhere and that's a device that delivers electrical charge that if it hits the wrong cycle actually kills you doesn't save you and yet very easy consumers can follow the directions the intelligence built into the device is such that it's remarkably safe we use that same kind of thought process using artificial intelligence tools to make it simpler to use these devices to become safer and actually return on the investment of if it's going to be available it's going to be as good as that device was in the hospital and i think the combination of the affordability and the usability and the versatility of these devices will make that technology possible if you step back and think of 20 years ago that patients are going to be doing their own glucose you know measuring their own blood pressure you know monitoring their own heartbeat if you will in the home everybody would have said we're all crazed uh but we're not anymore and so i think the whole purpose of this and this conversation is what's actually possible um because patients are capable of doing remarkable things if the technology is made right and made affordable yeah and maybe fanta and gene if you could um i see you shaking your heads if you have thoughts along these lines as well please pitch in yeah um so as john said affordability is definitely like a huge thing so like is it affordable to those people who are most at risk for severe disease are there cost and payment models in place um also just like the sensitivity of these devices so like a major concern for patients and also health systems and pharma is reliability of some of these newer devices which in turn could also just lead to like over utilization especially if the results aren't reliable or the management systems aren't reliable patients are always going to have to come back to the hospital and that again will just defeat the purpose um and then also as john said usability for sure like how user-friendly is it how much training or education will be required of patients who are using these products at home um is it something that's easily portable does it involve equipment things of that sort um and then also i feel like a lot of patients really are very concerned about like privacy and confidentiality nowadays and like how data is stored what protocols are in place what consent looks like etc gene any other thoughts from your perspective no i think i think leveraging what everybody says right it's going to be easy to use it's going to be safe and secure bringing back to the data the data aspects right and we've got to be able to leverage um you know leverage ai machine learning to help to help be more diagnosis you know but i think it's it's there and i i love john's example on a defibrillator because i don't think people bought into one until lives were saved on a plane right like once they saw it and they believed it then they'll pull it in and i think that's what i feel that's where we are with the tipping point because the results especially the work we've done with you know our recent acquisition current health the results are there and they're phenomenal there's the way lower you know revisits to the hospital we no less our ers you know much better time to recover uh so the results are there we just gotta um get that consistency because there are so many different models and it's it's we've got to get the payers to pull this in as well and it's it's really the whole ecosystem right that everybody has something in it and i love john's four p's too and said it's it's all those the big four ps like how do you connect everybody and so that the value proposition is there and then the adoption and the ease of use is there but i think you know i think we look two to two to five maybe even two years out from now um i think we'll be way ahead of where we are we just have to get some kind of some some of these process related things player related things get get those proof points through and i think that it will be um you know much easier because everybody's different like you said like people like smartphones like like we you know you think about i think about my kids they grew up on it um but there's there is a lot of community that does not there they could have the basic level of the technology but you know you bring them in and you set them up with a you know with a with a um ipad and everything to connect in is it scary it's it's scary because you know they haven't gone to that level of technology and how do we help them and that's what you know tying it back to the human connection yeah the patient engagement problem is a big one but you guys are very well positioned for that um uh and uh it's it's gonna be essential um uh my wife is an rn she works in a coumadin clinic um and they're pushing in the uh at home uh inr technology and and these are um aged patients many of them most of them um and somewhat technology um phobic or adverse but when they you take the time you engage you train and keep at it everybody begins to love it and it makes the coumadin clinic's life a lot easier it's it's better information flowing faster reaction times to decisions and these types of things um so um i just i'm still fascinated by by best by health and how you're going to leverage the patient engagement through consumer engagement and if you have other thoughts that you would put on to that i think one of the things i'll i'll speak in her i think what's what the what best buy health is such a great example of is thinking differently one of the things we don't do a good job of in healthcare is changing you know we're stodgy people that take 17 years to adopt new technology despite the fact that the data is there because i was trained this way i'm doing fine this way and i don't need to change that's kind of the mantra in healthcare we literally have to be shoved into the future sometimes and if you think of best buy you're not thinking of the mayo clinic when you're thinking of best buy but they have an infrastructure that's uniquely set up that actually if you put that into place and thought differently wow that's a pretty effective tool because access is a huge issue it's you know we don't have enough doctors we don't have enough nurses we don't have enough time you know people wait in offices if we can bring it to them and there's an infrastructure to deliver it well let's marry what we know in healthcare to what they know when delivering a service and you got something that's really interesting i agree with you i'm intrigued as heck by it and looking forward to see where they go with this and and i think we all have to be challenged in healthcare to think differently we can't apply new technology to the old way of doing things we have to apply new technology to new way of doing things to really take advantage of where we want to go yeah nice um yeah i mean there was um the the covid pandemic was awful in so many ways but um as a driver of change um it's been very effective um and i think uh it's going to have resonant effects for decades to come so it's um there's some silver lining to it um let's see so i uh you know it's it's it is interesting to have this mix of folks on the call um and you know we as i've mentioned in the in the opening remarks we we have to take this holistic approach to health care innovation right and um font i was wondering um how have you seen organizations across industries across regulatory bodies across payers all these kinds of how are they interacting what is working what needs greater attention um well first i think we just need to sort of identify and uh emphasize the fact that value really means something different to each stakeholder so each stakeholder must be present in just determining what a value assessment framework looks like and that's where we've been seeing the most sort of interaction just to ensure that value is something that's really mutually beneficial and that risk is shared so for example like patients may view value as convenient or customer service or quality while providers are viewing value as like cost effectiveness ease of care integration or patient satisfaction for example but then we are also seeing for some of these assessment frameworks that health plans may only look at value as something that's cost effective and really looking at something that's from a safety and efficacy side but not really looking at the whole care journey so it's really pivotal that all of these groups are working together so that each viewpoint is really understood and that there's like essential collaboration and just partnership in between them um and what i've been loving a lot about just like some of the research interviews that we've done recently is just how focused our members are at really looking at like integration and really looking at a patient's whole care journey in a very like holistic way so this really means like enabling tech looking at different clinical workflows and how we can evolutionize them and some of the traditional barriers to this are really just like the lack of clinical evidence or having difficulty uh with integration throughout different health systems especially if there's a lot of like patient portability like how are we keeping track of patients especially when there's increased access to care and there's like different side of care shifts like how are we making sure that all of our patients aren't lost to follow-up and that's really where like integration comes in um and pharma also has a huge role to play in this just because like they can really see the full picture of where patients are going where they're being seen what they're being prescribed etc um and so to just alleviate some of these issues we've seen for some of the newer innovations that let's say like academic medical centers and providers they're really being a prime proponent of virtual and decentralized clinical trials we're seeing now that the idea of a key opinion later is changing a lot um and that this is really becoming more broad so that we're incorporating digital opinion leaders we're looking at other healthcare providers we're really looking at that like democratization of knowledge throughout each sector um and then also we've also just like spoken to members that really emphasize technology and want to embed it into a clinician's workflow so they'll train clinicians up front in an attempt to just sort of like standardize identification to standardize diagnoses to standardize a subsequent treatment so vendors are now like offering integration into ehrs and providing clinician decision support like through epic or through other ehr platforms so that patients who meet criteria are all being defined correctly the systems are being accurately triggered and then screening can begin so we're just seeing a lot of collaboration and partnership throughout all of these sectors and that really is like the key to making sure that a shared sense of value is really accomplished here yeah yeah interesting gene does that square with the the kind of barriers that you've seen or had to break through in order to deliver the the services you're talking about well i i think i one of the biggest things that we're seeing now is you know going back to what's probably trying to solve i think getting you know getting the taking that letting the providers and the physicians do their role which is to provide that the quality care that they have the knowledge in the disease itself and take it what was happening when we started when everybody started you know uh remote patient monitoring is that how do you set up the how do you set up the the advice is something they would always go back to the nurses or the physicians and that's not their role in this right this is where best buy is coming in to say okay let's take out the tech implications out let's provide that level of service and that level of care and then let the physicians now everybody's doing a little different sometimes we have the command control systems and some some um some of our customers in our hospital systems have their own and and that we're working back and forth on that but i think it at the end of the day really if you you keep the the patient in focus and you know solve their problem because those problems are all different right it's different if you're if you're at home with your spouse versus your your your you don't you no longer have your spouse right which takes a sense of security away you i don't think you see that you don't understand that you kind of go through it when it's just someone and then you have other factors too like you know loneliness and isolation that impact your overall health and how do we you know build in that we're looking at products that building in natural language processing that can you know help us not only is this person having health issues but they also have loneliness and depression that's also impacting um their daily life so i i think it it's very complex but i think if we can just take the almost step away and try to take the complexity out and you know use things such as like butterfly i mean you think about if you have a hospital at home patient or chronically ill patient that you that you can have like within the servicing you bring in a practitioner that can also do diagnostics with ultrasound technology that's right there that's really beneficial then trying to get the patient out get them scheduled right how how can you even get scheduled right now for for you know to have an ultrasound you've got real time on the time decision and that's you know the the faster you can see a problem like john's you know finding his own cancer i mean how amazing is that to just not want everybody to have you know these the butterfly product i know we had tried to do something like this at phillips and it wasn't it was a little bit clunkier it was not adopted as well because it wasn't like a single a single solution you know you had to have the the ipad and everything else but um yeah i think i think it is complex but at some point i think we have to put the patient at the center and try to take away the complexity and you know you know get the adoption and get the data and the data can help us solve some of the other problems that are going to be in within the system yeah i know i like the idea of breaking down complexity and building up solutions um that's something we do a triple ring every day but um i might run counter to this and maybe i'll aim this at john i mean emr talk about complexity um so comment on that um if you could please well how do you interface yeah i think i'll i'll share the same frustration all physicians do and the biggest the promise to vhr was great the unintended consequences was it took me away from my patient um and health care is a very human thing people that go into health care go into health care because they care deeply about people and it's a human connection and if you think about the vulnerability people present themselves with they want one of three things they want you to either keep me healthy uh what's wrong with me help me get better and that ehr can be an incredibly powerful tool but if that's all i'm looking at and that's all i'm engaging with i've kind of lost the human part of of healthcare and it's so important to have that kind of connection and so i think we see we can learn some lessons from the ehr so how do you deploy new technology broadly fast obviously we all know that without the federal government mandating it never would have happened that quickly but if we come upon great solutions that all of us here are talking about that really work how do we leverage the the fast learning and adoption so it doesn't take 17 years and there's some things we could have learned from the deployment of that that can help there are things the federal government or payers can help us and if we really prove let's say for an example that the use of lung ultrasound in the home reduces ed visits and hospitalizations how do we use the power of government and payers to say no do it this way because it's better and force us to adjust our health care systems to do that i think that's where the lessons of vhr are i think the other thing that we speak to is there's data that lives inside of that that we can leverage if we use it effectively to be more proactive in the way in which we manage patients to catch them to find the compliance issues to find those people that are falling off that so desperately need our help and i think getting the better side of ehr out of it is something i really look forward to and i have great hope for and i want to leverage the lessons i learned going through both an epic and a certain deployment both of which were monumental shifts in my life of practicing physician i don't think anyone has anything nice to say about epic concern you know in my world you know prior to health it's it's you know it's sap or or oracle i mean all these systems as they've added so much complexity that you you lose the value um because they take away from people's doing their day to being able to do their work one of the really cool things about butterfly is as i'm ultrasounding my patient with the screen right my hand i show them and there's this connection from the probe to me pathology real time and that is so empowering for the patient themselves to understand the disease at stake motivating for them and reassuring all at the same time and incredibly powerful for kids because they're not intimidated by that phone that it's plugged into but when that big old machine comes rolling in they're ready to run for the hills and so it's a transformational way in which to practice medicine yeah nice nice well um time flies um and i promise that we'd have a good ten minutes for q a um there are a couple of questions um and nicole i know i i was going to ask you to do it but i guess i can see what the questions are so maybe maybe i'll just run with it um and i'll just leave this open to the to the panel um so one of the questions from the audience is as affordability of innovative technology decreases accessibility increases and patients begin to utilize at home care do you foresee a reduction in the quantity of staff at traditional hospitals maybe fonte you could start somebody jump in sure um so as i think we've all been saying i think the most like pivotal and important part of this all is the human connection and i feel like that would be lost if we saw a decrease or a reduction in the quantity of staff at hospitals we already know that staff burnout is a huge issue right now and it's the reason why there's so much turnover there's not a lot of retention in staffing and in the workforce in general um so i personally do not foresee a reduction in the quantity of staff um at traditional sort of settings at all um also we know that with some of these like newer technologies that we do need humans to sort of relay the data back to to make sure that the data is still reliable so there still will always be like a human proponent to it that is necessary for the success of these technologies and the uptake of them yeah and gene uh do you imagine that uh best buy health will have uh rns and uh physicians on the geek squad oh we we do we do so we our command control not not necessarily our geek squad in the setup i i think if you could go to hospital at home um you may be able to leverage you know um rns we the hospitals have been doing that on their own but we do have our command control centers that we have um they're not that big right now i think we have about 20 nurses who are certified in every state and they they have a whole dashboard on the point of care and their serviceability and the time that they spend with patients and the end results are coming out um really great and i don't think this is about reducing reducing staff or you know needing less physicians or or nurses it's about enabling people to do what they do best and that is to take care of their patients and to spend time with their patients and take away take away the stress of you know no hospital beds i mean i mean time and time again you hear people waiting in the er for like a couple days to get up to get a bed i mean my my daughter was in the hospital for another you know she ended up in the icu and she was stuck there for like eight days because she couldn't get a bed somewhere else i mean that's just waste right that's waste in in the system so i think we will we will become smarter and leaner and eliminate the waste and let you know our yeah our you know health care practitioners who we probably need more of really be able to do their job and love their job and not be totally exhausted and stressed out to the point that they they go to do other things yeah and i think health will provide opportunities too for uh for you know if you know but to be able to do the telemedicine do these other things that will provide the other opportunities for people um who who want to you know do different career paths yeah yeah i know very interesting john i mean as as a practicing physician um how do you see the technology um you know augmenting or replacing uh people in clinical settings i i i could not embrace more new technology because it allowed me to be a person at the bedside i'm still waiting for the first person in healthcare that says i don't have enough to do uh i haven't found one yet um and so if technology can enable me to get be more efficient in what i do to be less harried and stressed um to be more thoughtful and proactive in the way of stuff as opposed to how do i get everything done then what technology will make health care better i don't see us reducing in fact i might suggest it takes us the other direction because i think new technology offers the promise of making affordable health care more affordable more efficient and less wasteful where we could invest in more people because we do need more people to do things you know you wait in the emergency room to see physicians you wait for the nurses to come nursing ratios are getting bigger and bigger i think we need more people and if we can make our devices and our care much more efficient we can afford more people and so i see it actually going the other way and i ask to see people staying in longer because they're going to love more what they do as opposed to being burned out more from what they do another question from the audience is that um you know given that fewer than 40 of us adults have a bachelor's degree and many have less education than that um how are we engineering our products to make them usable for less sophisticated patients and i think i would add to this if we can get a gene to comment um what would best buy health demand in a feature set or in a user interface on a product that's going into a health at home so um i opened it to all three of you guys to kind of answer that one um how we engineering our products and and what do those project products have to look like well for best buy health we're trying to integrate as many products as we can into our platform so you take the you take the user interface away now of course that takes time and it's such a diverse amount of products right now um but we're also working with hospitals to have you know this is my recommended set these are my three devices so you take away the need to be able to um do it yourself but it is about the user interface and it's relatively simple and there's wearables you start with the wearable right i mean we have a band but we're also working a watch and then with the watch can you have fall detection the watch will you know man will monitor a lot that that automatically goes into the platform and then i think that you know technology is everywhere and you have to also within the the patient you know enable it by what we can do with geeksword but also enable it with with caregivers with you know grandchildren whoever can help um the people that may not have that access and you know the technology is there because with we don't need to have you don't need to have wi-fi um these are data-enabled monitors that they can easily be self-installed because half the time you know the problem is connecting to the wi-fi people just don't know how to do a lot of that stuff or they forget their passwords um we all know what that's like and so i think just keeping it as simple and being ahead of the game and i think that will really um you know enable health equity because a lot of people don't have this access and we need to find a way to get them the access that they can get quality care that is affordable and sustainable for all i mean we spend so much money in the united states um on care and and we don't get the value to all the people that who really need it i think one of the advantages butterflies had is because we have unable to deliver this device across the globe i mean we put a thousand devices with the gates foundation into sub-saharan africa to places that have never had technology before which serves as a great test of how do you build it simple and easy enough for people to use it and and so we continue to to develop that our products so that and and that is through the work of human factors studies that we do in the beginning that everybody can use and i i personally kind of use the remote principle if it's easier to use than the remote at home on my tv i think we're there and i i think most of our devices have really most of the work that we've done with our device has really proven that to be the case we're the only medical device to win an apple design award and it really was based on the fact that we made it incredibly simple i literally when i do demos for my folks i hand them the device and say figure it out i actually don't even tell them and most of the time they actually can't it's that simple and you have to have that mindset because remember people that are sick or anxious to begin with they don't need the stress of of how do i figure out how to use this device because the biggest problem for payers is compliance we've got a wonderfully simple device at home that's really helpful for the management of heart failure it's called a scale that has a pretty simple user guide get on it yet people don't use it and so you have to think about these kinds of technologies that way and and make it simpler than opening a child proof cap on a pill box when you have a bad headache they got to be easy and i think if you start with your design that way you get much better compliance i think the other thing is people actually kind of like new technology if it's simple easy to use and they get positive reinforcement from it they'll use it more it's the downside of the scale because the scale tends to give you negative reinforcement nobody likes to get on and look at a big number so i'm not going to get on it i can pretend i haven't lost weight yeah yeah nice nice it goes to to fonta's comment about the value frameworks and this type of thing so fonte do you speak to patient advocacy groups or patients themselves in your research and that sort of thing how do you how do you learn or know what's required for them to adopt these these technologies unfortunately we don't speak directly to patients most of what we learn through like consumerism and stuff is basically what we learn through our member interviews so sometimes that will be with patient advocacy groups but most of the time it's through interviews with like service line leaders and people who are involved in like community engagement nice okay um let's see maybe one more question and then we'll we'll wrap up um um how about this one um uh a question about um human factors and usability rewind a decade and usability may not have been mentioned will you be doing fda submissions and if so what human factors regulatory expertise does best buy health have on staff um i think yeah gene i think this one's directed to you yeah so we do have it we have a large um customer office within best buy which has human factors which is has user design user experience um user design factors uh we also do a lot of design thinking and our whole process is uh we have a whole 5d design uh discover design develop process so we do follow um pretty pretty standards um in in overall our overall experience and i and i do think it's like just what like john said you got to make it as easy as or easier than the remote right i remember my parents first got their iphones my kids was my daughter was so upset because she's like they don't even know how to use the clicker how they're going to use an iphone but um it's just that kind of like that thought process and bringing it in so yeah we do have we do have those um those team members on on staff and because of the whole consumer experience uh with best buy there is a very high level of expertise okay and maybe real quick because we only have a few minutes left um and i'll start with you fonta um what excites you about the future um what progress have you seen from your your perch um as you study these these problems in in these spaces yeah um i think personally i'm just very excited about just precision medicine such as like pharmacogenomics and just personalized healthcare in general i think it's amazing that with like precision medicine you can have much smaller clinical trials which are just more efficient um i feel like in my opinion we just have a lot of treatments out there today that just have very like marginal efficacy but they're being applied very widely so we really need to like develop things that are really more just likely to succeed in like a smaller swath of people um and that really just like ties into how do we define value for like individuals versus like whole populations um like we've seen the partnership with like epic and uh cerner which i know that some people aren't a fan of and how they have two new partnerships to really make like genetic testing for example really accessible so embedding that interface into your ehr making sure that this new interface really can clinicians can order genetic testing within a click and patients get the results like very easy i feel like precision medicine really is the future of healthcare and it just shows through like the way we're looking at more of these devices as like prescriptive and very tailored to individuals yeah nice nice john what's exciting to you in the future in like 30 seconds i think healthcare is probably finally ready to change faster i i think that's probably what excites me the most i think what and and i think about in our world you think about in healthcare there are very few innovations that have spanned the globe um with the exception of vaccines and antibiotics almost all the new technology that we talk about here doesn't exist you know two-thirds of the world has no access to medical imaging we're gonna change that and that's gonna change now when it's happening and that's probably what excites me the most health equity is actually going to be something
2022-08-19