This week Luis, and I review the COVID19 pandemic and vaccine roll out in the context of digital health tools. We discuss scheduling software, coordination, Telehealth and home monitoring and the importance of capturing the data for future reporting and how this has been an essential tool and contribution to advances made in fighting the pandemic
You can also find our training modules and services available to help businesses, education facilities, and employers get their employees, staff, customers, and students back to work and school safely in the context of COVID19
Raw Transcript
Nick van Terheyden
Good afternoon and welcome everybody to the COVID insights to action discussion group. This week we’re talking about digital health tools. And I’m joined by my illustrious colleague, Dr. Luis Saldana. And we will be reviewing some of the technology that I think has contributed over the past to the COVID mitigation process. But before we do that, Luis, I’m always good to sort of catch up on what’s going on what the latest news is, I was on a meeting just recently where the somebody said, but we’ve never planned for anything more than a month out. So we were trying to sort of plan for four months out, I think, you know, things are changing. Tell us what you’ve seen so far. In in the story with vaccines, and also the variants.
Luis Saldana
Yeah, I hit again, I think, now we’re starting to see some data from various experiences with vaccines and COVID as well as variants. So you could really use the Israel experience, we’ve kind of gone back to that several times. But looking at they had a significant prevalence of the V 117 barrier, yet that we’ve seen very impressive data in terms of the populations that have been back fully vaccinated, which is the you know, they start with the older, more vulnerable populations, the hospitalizations and deaths just plummeted as when when they, you know, they reached or approached for vaccination. So really very promising. And then, of all shared was experience from UT Southwestern, as well as UC San Diego, on their experience with vaccinating their own staff, large staff, which includes frontline workers, so mostly probably frontline workers. And, and again, that data was very promising in terms of, I think the biggest thing we can say is, you’re vaccinated, your risk of a serious case of COVID that results in hospitalization and or ice, you know, getting the ICU and possible death is is almost zero, it’s very, it’s extremely low. You can never say zero, but but extremely low and matter offenses. It’s been seen so so that’s the most promising things, you see reports of infections in individuals that have been fully vaccinated. And and when you see large numbers, that’s not going to be that I don’t think any any sign of the scientists are surprised by that or taken aback, but, but the fact that they’re not going to be your illnesses is quite promising for that. I think the biggest thing is now you starting to see reams of data. That’s that, that’s, I think, the fun part of it. Because people will slice and dice the data to really get different insights. And so that’s really interesting. I’d love to hear what your thoughts on that are.
Yeah, I
Nick van Terheyden
think the University of Texas Southwest, and data is interesting, that was from a paper in the New England Journal of Medicine and, you know, really substantial in terms of numbers. I mean, I think 23,000 Plus, you know, to your point of the data, I sort of keep thinking about that we keep adding, I mean, just, you know, to the point of 3 million doses delivered, that’s 3 million people more, sort of added to the sort of data set that we can then go after and continue to follow, assuming we do, which will be part of the discussion, you know, as we go forward, how do we capture that some of the tools that sort of approach this, but I think that’s exactly right. And, you know, the evidence there, you know, as you point out the B 117. UK variant, as effective and you know, you’re right, I hear this all the time, can you assure me with undying certainty that you know, I won’t get and of course, you can’t and The best analogy I heard good friend of mine a pediatrician when he talks to his patients about vaccines, it’s like seatbelts. I can’t guarantee that were you when you wear a seatbelt, you’re not going to be in an accident and get injured. But what I can tell you is it drastically reduces Same thing with these vaccinations. And, you know, it really is close to zero, which is just fantastic news. And the rollout, I would say is picked up extraordinarily well, I mean, I think if we were talking two or three weeks ago, there was some missteps. We’d seen some, you know, mess ups, you know, secondary to the ice storm that swept across the country that really impacted it. But it’s just astounding, and I’m not seeing anywhere that’s not doing a good job, certainly in the US I know, outside of the US are some additional challenges. So I think all great news, but that sort of then rises to the the point of Okay, as we think about this, and what we’ve done to sort of gather the information, how do we approach that? What were the tools that we started to use in that process? And how do we continue to use them? And the first thing I think of, you know, right at the beginning, we had that pass, or, you know, there was a number of applications that had people entering information? What have you seen? What do you think about that?
Luis Saldana
Yeah, and I think this kind of starts our conversation around the digital health tools. And I think just in general, I think we saw, you know, we’ve been hearing about the promise of digital health and digital technologies and these things, and you really saw an explosion in a lot of this brought on by COVID. Certainly, telehealth really exploded, you talked about the apps that were used, we work with colleges and universities, a lot of them were doing symptom screening, you get a clearance to come to class, if you you know, you have no symptoms, and you can, you can get like a green light versus, you know, red light and things like that. So, so those applications and tools, I think, you know, for screening, really a lot of different ways the technologies can be used. But it’s interesting to see what the telehealth we saw this massive spike in the use of telehealth, and now it’s fallen to the level that it was before COVID. So it’s very interesting to see that the other one that I think sometimes gets kind of short trip is, is the remote patient monitoring. And that and and I think we saw a lot of that going on monitoring patients at home, rather than hospitalized to monitor those those close patients pulse oximeters, we knew pulse oximeters were very important, having to tell helpless, but you could monitor patients from outside, also hospital at home, could you bring the hospital care at home to a certain level and so so I think and I think those things, those areas are still quite promising. For us going forward in terms of remote patient monitoring and, and remote care, I think we’re all going to be trends that are really, really be worth following. And now we’re seeing we talked about vaccines, the talk about vaccine passports, Israel has this similar thing, like a green tag or something green label, I don’t know what they got to remember what they call it. But basically, that’s a ticket to go into activities, restaurants, various things, there. And then because they’re basically trying to say, the vaccine gives you freedom, and and it really encouraging using that as as kind of the carrot to get that. And we’re seeing that with travel in various countries, you’re seeing they’re going to require that. And really, you know, it’s all we’re looking at as a digital version of the vaccine card, right? We all got our if we got our, you know, two shots, we have our CDC vaccine card, but it’s not digitized. And so there’s two things that come out, it’s got to be digital. So it’s portable, and can go with you and you don’t lose it. And but then it’s got to be trust, it’s got to be trustworthy, it’s got to be something that’s verified, validated. So those two pieces, I think we’re gonna see a lot of work on solving the, the, you know, the fragmentation issues that would never currently see on that.
Nick van Terheyden
And, you know, I want to go back to the, the pass app, because the same principles apply to that. And we saw immediately what would happen, you know, in the paper process, it sort of reminds me of Hall passes, where you could get a hall pass and then you know, entrepreneurial students would create copies. So then the school would create a special colored paper and then folks would go find special colored paper and create that. And we have the same thing going on in digital and in fact, that’s very early on from a past standpoint, you go, Oh, great, I’ve got a green pass. But of course, the simplest version of that is I take a screenshot, and I can share it with somebody and suddenly I’ve got it, it’s no different to a photocopy. Right. So to your point of that verification, I think that’s going to be critical to this is how do you verify to make sure that this, you know, better physical version is valid for, you know, access and passing? And then, you know, from a vaccination standpoint, making sure it’s verifiable? And, you know, we’ve got technologies to do that. But mostly, that requires connectivity. You know, without the connectivity, there’s no ability to sort of go back to the server. So can we introduce something that, you know, I think about the credit card, where there’s a validation code, at the end of it, the last four digits are normally a checksum, imperfect, you know, unless you keep the secret, and then it’s a secret base. So I think there are some challenges here that have to be resolved. And critical to this, for me is, let’s not replicate what we do in the paper world, which is, you know, relatively insecure at this point, let’s really try and transform it into something. But importantly, if you do that with digital devices, do you now start to separate the population from a, you know, accessibility? There’s, you know, this inequity, even further amplified? And are we now saying, we’re going to have passes, but you got to have an expensive smartphone with an app? How are we going to deal with that, do
you think?
Luis Saldana
Yeah, you know, I think there’s there’s kind of two things I think I’ll say kind of, in the conversation we just did about the apps like that is the other good thing about the digitizing these is the ease of gain data out of it, that’s so critical. Because otherwise, if you’re doing this manually, and paper, getting data out of that is so manual intensive, so time intensive, it would be impractical. But actually, based on this symptom screen that you talked about, we actually found in retrospect, which, you know, again, this was a novel virus and a novel situation, we actually found the symptom screen really wasn’t that helpful. In retrospect, I think up front, CDC aribo was thinking you got to do this, you catch the the early symptomatic, very early chiamata. But actually, in looking at retrospective, looking at data, they didn’t see that it it gave a lot of benefits, similar on some of the contact tracing kind of kind of things as well, I think that’s that was another area where digital was used some in different places with with kind of mixed experiences and things but but as far as the digital divide, you’re right, that’s, that’s a big concern. The thing is, so much of the population has a smartphone, it’s it’s very high. And so, you know, and in general, that has been kind of the equalizer, so we really need to use that. Now, that leaves a generation out that they’re still that, that older Gerrish, we’re seeing that with the vaccines, they can’t get signed up for vaccines and things like that. And we have to figure that out by, you know, talking about what I was in the ER, establish scribe. So maybe you need some, you might need some tools for some populations, to help them get there to help them get through kind of these transitions. But eventually, that part of it will, will go away as you get nothing but digital natives, you know, in the population using these tools.
Nick van Terheyden
So as I think about the data extract in that that’s a, I mean, that’s what’s been driving some of the innovation as a result of, you know, the fact that we have done that, you know, and I referenced back the sort of Framingham Heart Study, which was, you know, paper based every two years, you know, go sample and now we’ve got the I Heart Study that, I don’t know if they’ve gotten to their million patients, but that’s a million patients reporting every day. And here we are, with millions now adding, and if they’re certainly contributing, at least I know, in my state, I don’t know if this is true in yours. There’s a whole automated system where there’s a text message that goes out for the post vaccination monitoring that goes into the virus, or there’s I’m right, maybe I’m saying that right, the vaccine, you know, monitoring system. So now we’re getting all this real time data are based on that. And that was simple text message, or B, you had to go to the website, but it was a custom URL that drove to the individuals extrordinary valuable, because now we start to be able to learn and understand because we still can’t say how long the immunity loss. Right,
right. Right. So
we’re,
Nick van Terheyden
we’re we’re sort of at this point of, I think, 90 days I think it’s extended a little bit. We’ve seen it additional data, but we continue to see that data. So as you think about the future, what are the key assets that we have to start to assemble? And how do we make sure that we do it and do it correctly so that we’re not capturing or missing opportunities?
Luis Saldana
Yeah, I think one thing that’s really interesting about what caused the crisis and the digital tools, is, you saw reuse, or a parallel application of tools that already existed. So like vaccine scheduling, that was technology that, you know, are using the schedule, Doctor, you know, doctor appointments, and, and things like that. So it was it created a new use case. And so I, you know, I hear a lot of people worried, well, you know, we created this, it’s gonna be useful after this, the fact I think the real or some of the value of digital is that we learn from that. And then you can visually you can imagine new, new use cases and how you use it for different things. And so I think you talked about spurring innovation. You know, I think it does kind of spur innovation, which, you know, some of that’s that kind of lateral thinking and, and you know, kind of thinking of different use cases on how you can use the same technology you you’ve developed, which usually leads to some enhancements, which comes back and probably feeds that original use case as well and makes it better. I think a big part of this, of all of this is, how do we rethink the journey through the patient, the physician visit the patient physician visit, and that comes from, I might need to go see a doctor do I know or not. So they’re making a decision there all the way to if you have to schedule when so telehealth or in person, or whatever, or send somebody out or whatever is required is schedule your labs before you come in all of those things, throughout the journey that actually will make the patient’s life easier, and then actually become seamless. And it’s not. So you don’t say this was a telehealth visit, you actually normally create a new normal of what visits like it’s technologies is baked into the processes. But not you know, it’s it’s almost not noticeable, right? It’s something that just falls right into it. That’s that’s the kind of the dream scenario or you know, Nirvana, what we, we want we want to do with the with digital technology tools.
And
Nick van Terheyden
as I think about it from an employer’s perspective, school perspective, some of this is, you know, technology that they need to think about having a, I want to say in stock, I don’t know that that’s even a relevant term these days, because I don’t think I’ve heard anybody talk about things being in stock in the recent past, because it’s all just in time, but having available tools to send people home, you know, for monitoring, for example, pulse ox is went the way of toilet paper during the crisis, because everything Oh, that’s, you know, got to get that. But the other thing that also strikes me that’s important that, you know, needs to be considered because we saw a lot of not just in COVID, but pre that was non clinical grade devices. So you could get a device that gave you a reading, you know, let’s pick Pulse ox, I don’t know if there were non clinical grade, but that, you know, making sure that it was a valid report was an essential item. And I think the FDA is now stepping in and starting to provide some oversight, they’ve got a whole digital group. But you know, as an employer, thinking about that, as part of the sort of the wellness capabilities that they can deliver out that says, you know, we’re going to help, you know, everybody doesn’t need it. I don’t think that’s what I’m seeing. But you know, maybe some groups and specifically think about the loan COVID. I mean, I don’t know what the percentages are, but they’re way higher than I ever would have expected, certainly at the beginning of this to be impacting, there’s going to be a percentage of your employees, students, whatever that are suffering from that that are going to need some help and support and I think digital enablement is going to be a big part of that
Luis Saldana
whacked out No, I think you’re spot you’re spot on there, you’ll you’ll be monitoring different things. Or you may get a daily quote, checked in digital checked in or digital questionnaire, whatever are you doing today? That’s, that’s how putting your symptoms so you can actually monitor and track those symptoms, and actually track it over time. So the doctors can actually visualize and see different patients journeys in an easier way. I always said, I think, you know, what are the big needs and digital for clinicians as a clinician myself is, is is actually aggregating all that patient generated data and and Creating a layer that makes it easy for the clinician to make decisions. And because this, it could be all over the place, do you have a continuous glucose monitor? Do you have Pulse ox Do you have, you know, all of you know, you’re monitoring blood pressure, you are monitoring suicidal symptoms that, you know, there’s been some things, you know, that word, you know, that can help them, there’s just a lot of different aspects. But how do you create a layer that helps a doctor, drill through that data in a way that they, it’s useful for them and doesn’t have them spending extra an extra hour 30 minutes reviewing data, because that’s the last thing they want. You know, in the in the current atmosphere, we’re trying to save them, save them time and energy and mental, you know, mental bandwidth.
Nick van Terheyden
And it reminds me a lot of the Fitbit discussion that took place, you know, and everybody gets their Fitbit, and of course, all the early adopters. And I’ll confess, I’m one of them, you know, I got my device, whoo, I got this number of steps. And, you know, people were taking that information into their physicians, and I don’t care how many steps you did today or yesterday. But what they do care about is the trend, right? You know, so is there a drop off? You know, you see that, and I my sort of summary of that is never a data problem. It’s always a filter problem, you filter it appropriately to give people the information. And I want to tell a story of some of the value that we’ve seen, certainly in our journey. And I remember this vividly. And I think you probably will, too. I remember the survey instrument that was used, it was a simple survey instrument in a college setting, looking at everybody that had had COVID-19. And following and tracking them getting that feedback, prior to the New England Journal of Medicine, and a number of other articles that have just essentially confirmed that I remember, just my mind was blown. Because the data showed at that time, 70%, were showing a symptom that extended for several months, in some instances, and at least two to three months in that population. And they were young, this was a college group, right? And I remember thinking, wow, think about that. First of all, you know, hats off to them, they were capturing the data. So if I had a lesson or a message, it’s don’t lose the opportunity for pulling this data in and thinking about it, you can’t always tell that it’s going to be useful, it might just sort of end up in a repository. But that became useful insights that started to guide the way that they treated and helped those folks as they came back. Oh, great, you’re now out of quarantine, you’ve recovered, but you haven’t. So providing that support. And I think that’s what needs to be sort of built into all of this is make sure you capture, even if you don’t have a full sort of understanding of where that data might end up. Don’t miss the opportunity. It needs to be built in.
Luis Saldana
Yeah, I think we were talking about use cases that before, just before the call started, I think we you know, and we’re we’re doing now, we talked about the importance of just have a workflow that just captures data. Don’t underestimate the value of a workflow that captures data as a byproduct of it. Yeah, I’m saying, you know, I think it can be very valuable, and probably one of those subtle nuances that might get missed by somebody that’s not really familiar with the workflows, and how important what you just said is that, how important the data can be, and how valuable that data is. And and you’re right about that, that that that that, that long term, that longer term data on the on young people, that was kind of the first hint of this long COVID I think we saw symptoms persisting, you know, beyond kind of the normal course of the of the disease that we said something’s going on here. So it really is quite interesting.
Nick van Terheyden
So, thinking about the the sort of next phases of this was sort of, I want to say rolling out of the spring semester, students are starting to think going home. You know, I’m pretty sure a lot of workplaces are starting to think about people coming back. I mean, I the best evidence I’ve seen of that is somebody posted the San Francisco traffic is back to misery. So that just means people are doing something so you know, things are opening up, you know, hopefully, appropriately and so forth. But as you as you think about that from an employer perspective, What what do you what would you tell folks that they’ve got to think about? as, as they look to that, you know, positive future? What should they be thinking about in terms of tools and enablement?
Luis Saldana
Yeah, I think I think that’s, you know, where we’re kind of talked about, as far as the tools to get back to work or get back to normal in the workplace. And, you know, certainly, I think we’re not at the stage where you want everybody coming back to a crowded office or an open, open workspace, that type of thing. So you really have to rethink through what you what you the visual, what do you visualize? coming back? What is this hybrid workplace, like, that’s gonna be the new term is this hybrid workplace, you may come in a couple of days. So that’s probably going to require maybe you make appointments, you set appointments for the days, you and your team may be or in that you have meetings, you schedule, I mean, so. So scheduling and open scheduling communication tools, obviously, we’ve seen, you know, the explosion of slack, zoom meetings, you know, all of these things, I think those things were will continue, though, you’ll you it’s gonna change, these are gonna become real platforms. I think that’ll that’ll allow work to get done. And and I think that’s going to be kind of the next step of this evolution. But But the other part is, you know, asking, Are you going to require vaccine? If not, which most aren’t? You want to know, if you only want vaccinated people coming back to the office, there’s still a lot of questions as we move towards move towards normal, it’s not normal now. But as well as the technologies than in the workplace, you’d have to change your setup to reduce, you know, potential transmission, your air, you know, airflow ventilation, what do you got to do as far as elevators, you know, there’s all kinds of things that think details that that need to be done. Also your your wellness, how do you keep ensure that you, you know, that the digital work, or the new workplace, and hybrid workplace isn’t going to make your workers less safe, and possibly sicker? So, so I think, though, those are things I think we’ll be, we’ll be watching for and looking at.
Nick van Terheyden
Yeah, I’m not digital wellness, wellness enablement. One of the articles I just saw recently was, I think, you know, the Gen Z, millennials, are unhappy with corporate wellness programs. And I read that thinking what they don’t want them, but actually, it wasn’t, it was all about, they’re not good enough. They’re just sort of tired and old, they need to be more innovative thinking about alternatives. You know, I’m a recent, you know, entry into yoga, it was not something I grew up with, I wouldn’t have sort of considered but I now can’t imagine life without it. It’s a huge sort of mental de stressor for me, you know, incorporating that, but then how do you deliver it? You know, can you deliver it under a sort of digital platform? You know, I know at least one company that delivers one of the mindful apps as a resource that’s available, you know, great facility, and they actually promote and push it, they talk about some of the programs and some of the regular communication. So I think that’s part of it is sort of using those tools. And then to your point, my sense of this is tracking. So one of the things that I now think about, as we’re talking about this is, gosh, if you’re going to have those programs, can you track the actual benefits of it so that people are checking in, you know, there’s an opportunity, not not for, you know, self gratification pat on the back, but actually showing the value, because now you’re showing return, which of course, the financial folks are going to say, Hey, we’re spending all this money, how can we justify it? And I think that’s one of the ways that you start to sort of approach this. So, you know, from my perspective,
I
Nick van Terheyden
always say this, you know, I’m always challenged saying the silver lining to COVID-19, because it was such an awful experience for everybody. But we have seen a number of these and it’s accelerating that hybrid work. I mean, hey, I’m I’ve not gone had to go to sign things that you know, used to be, there is no way you can do this online. Now I can sign online. So all of that enablement DocuSign, and so forth is now just sort of standard fare. And I think you’re gonna see all of that plus all the enablement of the wellness. So any closing thoughts? We got a minute or so just before we finish up?
Luis Saldana
Yeah, no, no, I think you know, I think we’re exciting new time, digital tools. Promise has been there for a while. Don’t focus on the technology, and then figure out how to solve problems with technology. Go in and say, what’s the problem I’m trying to solve here? Then you you pick the technology. That’s Gotta do that, then also, I think a real important thing that you kind of hinted at this is what a success look like, before you even implement what does success look like and that metric that experiences objective and subjective data, those types of things and and those that are successful are going to be those that can can move quickly from one project to, you know, one, one project to another and not and not let the failures or, quote failures or not, you know, not successful cases, don’t let that get in the way you learn from them, and move on.
Nick van Terheyden
Fantastic. Well, another great session. just appreciate all the discussion and input. Thanks to everybody for joining us. If you need some additional help, please do reach out, reach out to veilig health, you’ll find resources online or indeed reach out to us. We’re always happy to and please, you know, send us your questions. We’re always happy to answer them otherwise remains for me to thank you and thank everybody for joining us. Thanks
