Alright, let's get started.
Good morning.
Welcome to the 2023 Federal Health at Home Technology Summit.
My name is Šeila Selimović, and I work at the Department of Health and Human Services,
the administration for strategic preparedness and response and the Biomedical Advanced Research
and Development Authority, BARDA.
Some may recall the 2021 Federal Wearables Summit where we discussed issues surrounding
wearable physiological monitors.
Today, we are expanding that topic to at-home health technologies much more broadly.
We hope today's discussion will prompt people to engage more with this topic to be curious
and to continue to learn about it.
A few housekeeping items before we launch the the meeting officially.
Please send any questions and comments to fed.summit@hhs.gov; all of your meeting invitations
should have that e-mail.
The chat and audio functions in teams have been disabled, so please communicate with
us and reflect on the sessions via e-mail.
We will have a 1/2 hour break, but people can call into any session using the same link
that you've used to connect this morning.
With that, I would like to welcome Dr. Gary Disbrow, who is the director of the Biomedical
Advanced Research and Development Authority, and Dr. Ryan Vega, the Chief Officer of the
Office of Healthcare Innovation and Learning at the Department of Veteran Affairs.
Dr. Disbrow, welcome.
Great.
Thanks.
Šeila, I really appreciate it and good morning everybody.
And as Šeila mentioned, welcome to Federal Health and at Home Technology Summit.
I want to thank all participants for attending our USG Partners partners from the private
sector, healthcare providers and end users of these innovative technologies.
This conference is organized by ASPR, BARDA and our government partners at HRSA, the VA
Office of Healthcare, Innovation and Learning, and the National Institute on aging at NIH.
I appreciate the collegial spirit of our USG partners to bring innovative technologies
forward to improve healthcare for all Americans.
Since its inception, the Division of Research, Innovation, and Ventures, or DRIVe, has invested
in bringing innovative technologies for health assessment and monitoring to the home.
I work closely with and supported the mission of the BARDA DRIVe Early Notification to Act,
Control and Treat, or ENACT program, with the desire to develop new solutions to detect
infection as early as possible.
As part of the ENACT program's evolution, DRIVe created its current Bringing Laboratory
Testing to the Home program, which supports the development of novel platform technology
and reliable at-home alternatives to traditional central laboratory testing.
In response to the coronavirus pandemic and to better prepare us for the future, DRIVe
and BARDA's detection, diagnostics and device infrastructure divisions are partnering with
companies to develop novel pathogen sensing technologies for rapid, accurate and affordable...
Has been and will continue to be- to develop medical countermeasures that develop the technologies
to detect early infections and limit the spread of pathogens.
We and other government agencies have an even broader interest in leveraging health at home
to revolutionize diagnostics and chronic disease management, leading to a healthier population
and a more resilient healthcare system.
The USDA agencies will share with the public considerations for developing these health
home technologies and the role of federal agencies can play in advancing development
of these innovative technologies.
I hope you'll find today's meeting engaging and I encourage all to actively participate
in the discussions.
We really need your input to move these programs forward, so I'm now gonna hand it off to Ryan
Vega, who is the Chief Officer for the Office of Healthcare Innovation and Learning in the
VA Office of Discovery, Education, and Affiliated Networks.
Off to you, Ryan.
Thanks, Gary.
And echo your comments.
I really appreciate everyone across the federal government and their collegiality and putting
this on this topic is important for many reasons, not just in the VA, but as healthcare struggles
with continual challenges on the supply side, the two, or the top two items that keep CEOs
and healthcare up at night are staffing and finance and finance driven by the challenges
with staffing more and more care as the opportunity to move outside of the walls of the traditional
hospital to meet patients where they are and to create a new sense of connection between
patients and the health systems or the individuals that care for them, technology's going to
play a fundamentally important role in helping us get there and helping us reimagine what
traditional healthcare looks like.But that doesn't come without the challenges and the
opportunities we'll have to wrestle with challenges around security and privacy.
We'll have to wrestle with challenges of how these technologies integrate into the workflows,
not just for providers, but for health systems themselves.
The way that we pay for these types of solutions and these new models of care will have to
be tested, will have to be stressed, will have to be proven.
And we also have to resist the challenge to go back to the way things were pre-pandemic.
We have to continue to push forward.
We have to continue to embrace, sometimes, the discomfort on the provider side of enabling
these new technologies to allow our patients to have more control, to have more engagement
and more autonomy over their own health care.
I'm really excited for today, and again really appreciate everyone being here.
I think these types of convening forms and these types of events are vital for us to
continue to learn from one another, and to continue to come together to push American
healthcare innovation forward.
Sandeep?
Hey everyone.
There you go.
Sorry.
Hey, everyone.
Thanks, Ryan.
And thanks, Gary.
Good morning, good afternoon.
Good evening.
Welcome to the to the Health at Home Summit.
My name is Sandeep Patel.
I'm the director of BARDA DRIVe and I was speaking to you from my home in Washington,
DC.
So first off, I'd like to thank and share my deep gratitude to all the speakers and
the organizers - you heard from Ryan at the VA Office of Healthcare Innovation and Learning,
and we also have the National on Aging at NIH,and others that have helped organize this.
So this is a fantastic star-studded lineup.
I'm really excited for this, for the conversation, and of course thanks to all of you oarticipants
for tuning in to today's session.
So let's dial the clock back three years.
In early March as coronavirus was spreading, the lockdown started, CMS - the Center for
Medicare Medicaid Services - put out a series of guidances and expanded flexible telehealth
policies to allow Medicare beneficiaries to receive telehealth services from any location.
Previously, it was mostly directed in rural environments, but this opened up telehealth
in homes across the country, and other payors followed suit.
This also included emergency department visits, nursing facility discharge visits, home visits,
physical occupational speech therapy.
I myself had just recovered from an ACL reconstruction on my knee, and I was doing physical therapy
virtually early in the pandemic.
Clinicians also could suddenly practice medicine across state borders, which created entire
new opportunities for telehealth business models.
So like a light switch, in March 2020, we flipped on nationwide telemedicine services.
And so this led to vast improvements or increases in utilization.
So I think GAO found that telehealth services increased by an order of magnitude by 10X
among Medicare patients.
Another survey found 60% of participants said that telehealth was more convenient than in-person
medicine, 40% said they continue using it after the pandemic.
More than 60% wanted expanded telehealth service options overall, but telemedicine, I would
argue, was still fundamentally incomplete at the time.
You know, at the time if you had suspected coronavirus infection or needed to be tested,
you still had to go into a central facility and get swabbed and tested.
That, of course, is now changed with the introduction and availability of home testing, thanks in
part to my colleagues across BARDA and, and, and FDA and others who made that happen, as
well as our industry partners.
But if you were diabetic, you had to go to a central lab to get your A1C's measured.
If you had kidney disease, you.
I still had to go to a central lab to get your creatinine levels measured.
If you're on dialysis, you still had to go into a dialysis facility to receive care.
And what we were most worried about the time as you all can recall, I'm sure, was to stop
community spread of the virus, yet we had a system that the often the most vulnerable
patients had to go into places that put them at the greatest risk of infection.
So what was at the time, and still is, missing is health at home technologies that I would
argue is sort of the missing puzzle piece in this.
And so if we get back on the the WayBack Machine and go even further back to the 60s, the introduction
of Medicare, Medicaid actually introduced, and we'll help ramp up the use of hospital-based
care.
And in the US, prior to that, hospitals were were being formed, but way back in the 19th
century, the predominant modality of care was at home.
That of course switched to the hospital, and now we're back in a situation where emerging
technologies such- such as at home diagnostics,analytical devices, health monitoring tools, they're
putting health at home back on the agenda, right?
So we hear this everywhere.
And, and what's interesting about this is that these at-home testing devices, I mean
they have the opportunity to become real game changers - in things like preventative care,
chronic disease management - but also to help us detect infection early to avoid community
spread like we saw in the pandemic.
Everything from basic telemedicine services of audio/video communication modalities - talking
to your doctor - but also what we're talking about in terms of emerging technologies of
novel ways to do lab testing at home, of doing early detection, health monitoring and things
like that.
But I also think it's wrong for us to think about health and home technologies as just
a way to recreate the clinical visit we're all familiar with in the home.
So first off, most people - or many people in the US, I should say, sorry - don't have
ready access to clinical care.
So health at home technologies have the opportunity to actually expand care.
In a Pew survey, I think it was 2/3 of rural residents mentioned that healthcare access
was a problem.
You know, many folks across the country don't have access to primary care physicians.
Another survey found that 40% of US counties are trauma center deserts where more than
50% of the population has to travel more than an hour to reach a hospital equipped to handle
traumatic injuries.
So we really have an access-to-care problem, and telemedicine, telehealth, and health at
home technologies are an opportunity to plug that into and kind of introduce that to a
population didn't have access.
Secondly, health and other technologies, I think offer us an opportunity to to reengineer
and enhance the clinical experience and think about it very differently than we do right
now.
As Ryan mentioned, these technologies have an opportunity to actually increase patients
empowerment over their own health access to their data.
It can help them manage complex health conditions, disabilities, in entirely new ways right now.
At-home physiological monitoring also gives us opportunities to develop a check engine
light systems for- for our own health, right where we might come up with new ways to sort
of flag issues of concern and seek- and seek care in different ways.
Communication technologies obviously can enable new ways to communicate with clinicians, but
also with other patient groups, again to improve sort of different modalities of care.
But we have a lot of challenges to solve and you're going to hear a lot about these today.
We have access issues, Internet connectivity, unfamiliarity - especially among elderly patients
- to some of the technologies.
We have design and usability issues, there's still a struggle to access, and the design
of these tools itself may not be optimal, and we have opportunities to improve that.
There are data reliability issues that can hinder trust, particularly among clinicians,
in the utility of these technologies in- in current standards of care, but to enhance
them as well.
There are of course new risks of fraud that we have to manage and mitigate as a result
of this.
And we have a business model problem, right?
This is entirely- this introduces entirely new ways to again to manage care, to get information,
to- And you know, we need to think about the- the business model, innovation and the reimbursement
structure that's gonna help facilitate that in the right way for the benefit of patients
at the end of the day.
And what you're gonna hear today, too, is that multiple federal agencies - the VA, NIH,
DoD, many others - have really come together working with the private sector to advance
some of these technologies from an investment perspective, from a care delivery perspective,
from a reimbursement policy and other perspectives that should come to bear on to this.
So I think it's important for us to come together as a community to learn from one another,
to understand the pain points for patients, clinicians, payers, caregivers, technologists,
regulators, so we can collectively advance the field forward in a way that benefits our
own health and the health of the population today in the future, and from my perspective,
to make us more resilient against future pandemics and other health emergencies.
So I want each and every one of you - my goal for today, my ask of everyone is - to come
away today learning something new to find someone you wanna talk to afterwards and to
have one idea, one action, that you can kind of take away from the meeting that in your
spheres of influence - and trust me, all of you have your own spheres of influence to
push to advance the field forward.
We want to hear from you, as Šeila mentioned, so you can submit questions.
I think through the Q&A on teams, but correct me if I'm wrong on that, you can send inquiries
to Fed.Summit@hhs.gov.
So I will stop there.
Enjoy the meeting.
Thank you very much.