TECHQUITY: Supporting an equitable future for health in the digital era

In recent years, the healthcare industry has witnessed a significant increase in its adoption of digital tools and technologies. But, ‘health tech’ is currently inequitably distributed amongst the affluent and as health tech expands it risks unintentionally perpetuating long-standing inequities among underserved, marginalized, and vulnerable populations.

As the healthcare and technology industries continue along the path of partnership, it is essential to prioritize matters of health tech equity, of ‘techquity’, and take meaningful action to close the digital divide.

Listen in as our healthcare experts Alexis Anderson and Eleanor Tait introduce the topic of Techquity and share industry findings and recommendations from both an industry and patient perspective. The research, conducted in partnership with the HLTH Foundation, has been designed to uncover barriers to achieving techquity, reveal current industry efforts, establish priorities for collaboration, and highlight the digital health experiences of marginalized patients. Alexis and Eleanor are also joined by guest panelists:

• Dr. Pierre Vigilance, VP Population Health at Equideum Health
• Sarah Scholle, VP Research & Analysis at National Committee for Quality Assurance (NCQA)
• Dr. Chris Gibbons, Founder & CEO at Greystone Group

As well, don’t forget to revisit this overview as Ipsos' Alexis Anderson highlights why this research is more important than ever.

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Today’s AI-generated audio transcript is offered below. Apologies in advance for inconsistencies that have been included.

0:04

Thank you for joining us for today's Ipsos webinar, Exploring the Need for Healthcare Technology Equality.

0:12

Today's guest panelists are Healthcare and Technology sector leaders and you will hear more about them shortly.

0:20

Throughout today's session, you will remain in listen only mode. However, throughout the webinar, you may submit questions online using the Q and A feature.

0:31

Our plan is to answer questions at the end of today's session. However, if time runs short, then your question will be answered by e-mail.

0:40

I also encourage you to check out the handouts we've uploaded into the webinar Control Panel.

0:48

Today's webinar is indeed being recorded and will be directly e-mailed to you.

0:54

So now without further ado it is my pleasure to introduce today's first speaker Alexis Andersson a principal with the Ipsos Healthcare Advisory Team.

1:05

Alexis you have the floor.

1:08

Alright. Thank you so much. Appreciate it. And first and foremost, just really want to thank everyone who's attended this webinar today. We're so excited to talk to you about this topic of equity. And we've got a great session lined up for today's. I'm gonna take a look at the agenda. I'll walk you through what we, what we'd like to accomplish. So first things first, I know some of you are coming to us, having spent the majority of your careers focused on equity. You're experts at this stage, and you're here, to learn from our esteemed panel members, their input, and their opinions on equity.

1:42

Others, you're joining us completely new, and you're wondering What is equity, and so you're here to learn a little bit more. And so, we welcome all of you to today's event. For that reason, I'll kick things off for the first few minutes to introduce what equity is, why it's important, and what we think makes makes for a strong equity strategy and the things that need to be considered. Next to my colleague Ellie, will introduce an ethnography video, which we conducted in partnership with the Health Foundation that personalizes this experience at equity and puts at the forefront the the experiences of people in our communities. And then for the remaining time, I'm so excited to have this this panel discussion where we'll be able to learn from our experts on what the initiate should be doing and how we need to be moving forward.

2:28

So, if we go to the next slide here.

2:32

Here are our panel members, you see them here on video, and so we're excited to have this wonderful group of experts as I mentioned, and as we transition to the panel discussion, you'll have an opportunity to hear from them on their full background and their, their introductions have been the interest of time. We'll jump right into equity. And so we know that the healthcare landscape is changing in so many ways. But one of those key features, if we go here to the next slide, is this integration of technology into the healthcare system.

3:06

And so you know, now more than ever, let's take a look at how, how technology has been integrated system.

3:13

So we know that in the last few years, particularly with Kobe, we're seeing telehealth, mobile health apps, connected health devices, wearables, patient portals. These have been slowly tricking trickling into the healthcare system for years but in recent years it has become increasingly more important.

3:28

And if we transition to the next slide here, I think, in my own mind, as I think about technology, and the healthcare system. It's a wonderful thing. We, should we, we can, and we should continue to make the health care system more efficient through the use of technology. And, of course, if you want to show them some of the other benefits from this integration of technology, We now have these new tools and methods of innovation that enable us to increase patient outcomes, enhance patient safety. As I mentioned, make the system more efficient and effective.

4:00

But at the same time and the reason why we're here today for this, this equity Webinar is we have to acknowledge that the health care system you know, barreling down these the tracks and having the train move towards this completely tech integrated world. doesn't work for everyone. And so we have to acknowledge the fact that if we're not designing and implementing health care technology in a way that works for everyone in our communities, were, in fact, creating this divide. We're making it hard for folks to access the health care system, if they need to use technology to do so. And so, to equity is this term that causes us to pause and say, Are we enabling everyone to be able to use the health care system or technology creating that barrier and worsening that digital divide.

4:48

So, if we go to the next slide here, I want to underscore the fact that this just isn't something that's focused in on health care.

4:56

And so, technology is now the super determinant of health. Your ability to access and use technology doesn't just extend to the healthcare system in your ability to engage with your physicians, your providers, you know, healthcare system itself. It's so much larger than that. So, particularly, you know, during Cove, and we saw that that use of technology enabled people to connect education, there lived environments, employee's, employment, transportation so much more. And so, with that lens in mind, at technologies, that super determinant of health now, and so it really underscores the importance even further of white equity, is something that the industry needs to focus on.

5:33

So, go to the to the snacks. And I'll walk you through what we've done in partnership with the Health Foundation, and what we have upcoming, And we'll kinda discussed equity a little bit more, in depth.

5:43

So we did three things with the Health Foundation. The first was industry expert interviews to get their input and opinions on what equity was, what's been done in the industry to date, and where we need to go. And, again, I'm so thrilled to have our panel members here today, to provide that additional context there on this, on this exact subject. Second, as I mentioned, we conducted patient focus ethnography, so thrilled to be able to introduce you to my colleague Lee, who introduced that video to us. And last, we wanted to acknowledge that equity has been a topic that's existed for many, many years. There has been groups out there who have been focused on this subject for 10 plus years at this point. So we wanted to conduct secondary research and integrate that into our findings to take into account all the wonderful work and insights that have been generated to date.

6:25

And so there's two key resources available for you. First is the path to equity, which is available here in the webinar for you to download and review. The second, is that McAfee video.

6:35

Alright, so, let's get into, I keep using this term, Equity, but what exactly is equity?

6:40

In our minds, it's the strategic design, development, and deployment of healthcare technology, to advance health outcomes and advance health equity, and it encompasses that notion that I mentioned earlier, that healthcare technology can be supported for individuals that can enhance health outcomes. But, it also has the potential to cause harm and diminish health prospects, if it's not designed and implemented in that equitable, intentional, and inclusive manner.

7:06

All right.

7:06

So, really quickly, three core elements are building blocks that I'd like you to keep in mind. First is access. Second is initial use or uptake. And the third is sustained engagement.

7:16

So first access, can someone get that mobile health app or that phone in their hands, for example.

7:22

Do they have the right WI Fi, Broadband, Internet, et cetera to be able to even use something in the first place?

7:27

Second, once you have that initial uptake and use, does that healthcare technology have the right acceptability and accommodations? For example, language settings. Accessibility features to enable you to even try to use it. And the third is sustained engagement. And so someone can have access to healthcare technology. They might know how to how to work in a bit, but do they feel? No, believe that that healthcare technology is there, to support them, and do they trust that it's doing what it says it's supposed to do. They feel comfortable sharing their data. We don't have all three of those. We can achieve equity.

8:01

So, here we go.

8:03

Sap, I want to just convey that for this webinar today, we want to acknowledge that we have this joint responsibility to ensure that we move forward with equity, and that's what we're here to do today. Last but not least, want to really quickly touch on four key pillars for the path forward in our panel members, will add more context here in a moment. We know we need collaboration transparency, inclusivity, and that overall commitment to transformation.

8:28

In terms of that commitment to transformation, I'm excited to share with you what it says and the Health Foundation doing in terms of next steps, which is an industry benchmarking initiative. So, we're going to be measuring where the industry is at with equity and establishing tangible milestones. Next steps, and a roadmap, which we're excited to watch at, towards the end of this year, beginning of next year.

8:48

So if you'd like to get involved, please don't hesitate to reach out to myself, and you'll find my e-mail right here.

8:55

And I think with that, I can hand it over to Allie.

8:59

Great. Thank you. So, when we're doing research, and especially when we're doing research around issues of inequality and inequities, it's so important to us that we include the perspectives of the patients themselves. Because, obviously, without hearing from the end users, we risk not seeing the full picture and not understanding the nuances around this issue. And, I think we could draw a parallel to the vaccine space. We know that it's not enough that we make vaccines widely available.

9:30

And, we say to the public, you know, vaccines save lives, because there are more complex demand side challenges to address, like trust in companies and governments, and social norms around vaccinations, and so, it is with ....

9:47

So, to help us understand what equity looks like on the ground, so to speak, We reached out to a small number of people across the US, who all experienced different barriers to health related technology. Barriers accessing the Internet, using technology, understanding the language, and these more intangible challenges to like trusting companies with that medical data and seeing, you know, the point in technology. Like, how does this benefit me.

10:16

We asked them to show us, in the context of their everyday lives, what health tech they're using, and what is it that's holding them back. And using this ethnography method, they filmed themselves using their cell phones, and they sent us this video footage back to give us a window into their world. So, here follows a five minute video, which we edited together from this footage to bring to life the issue of equity.

10:41

So bear with me now while I just switch my screen.

10:46

And away we go.

11:04

Now, we're recording.

11:07

Whoops, illusion.

11:10

It's not calm.

11:13

How tech savvy? would you say you are?

11:17

Mmm hmm.

11:20

OK, I was playing a game and the cat sat on the keyboard.

11:23

And blue, everything, all up really big and I couldn't figure out how to get it to go back down. ... Kids. I spent five years working for my city. And they usually, every morning, we'll take my car and drive go Woo and go shop. I live here in Western North Carolina and Smoky Mountains with my wife. My cat area has actually gotten a little bit popular because the pandemic, a lot of city folks out here to realize the internet does not work very well. We didn't have Internet via satellite. If we do need to use the Internet for anything, we usually have to go to town. Is tab?

12:23

When? I had my infection, All, my medication, they wanted to, $100 to see me, And we drove 2.5 hours just to see the doctor, and we didn't have $100, is spent. 80 of that, just in gas. And I was incarcerated in 19 98 at the age of 18 years old. And you can see our first phase. Baby. When I got out, I was given an i-phone, and I didn't really know how to use it. So I had my 14 year old niece.

13:08

Kinda show me the way, you know, later on, down the road, when I had a problem, with no medical issues or things of that nature, I was able to look things up on the Internet prior to going to a doctor. I didn't have health insurance, so I couldn't just go see a doctor for anything that I wanted. So, when I was, I would go on places like Google, before, like Community Health centers. Places where I could go, she would benefit greatly. If we were able to go ahead and contact our doctors and deal with our insurance company. But they use, a lot of times, your Social Security number and your driver's license number as a way to identify you.

13:49

And when hackers break into different things, they can get that information, went and got to call the test, and, you know, this is the error of code, And they gave me like a website that I would have to login to.

14:06

But I just felt that it was kind of, you know, creepy that.

14:11

All this other stuff is on here.

14:17

That I don't know about.

14:18

And I was kind of like, hey, I don't even remember any doctor telling me that.

14:25

So you sign in, you have to login.

14:27

And then you're having difficulties because you can't read this stuff. or you're not understanding.

14:34

You're thinking you're looking for your, you know, X rays, and we call them X-rays.

14:40

Now they call them radiologic. I've just tried to stay away from dealing with that part of it. I'd rather talk to the person. I'd rather have the paper sitting in front of me.

14:50

I do not have any health applications on my phone, because I feel that if my phone words have been compromised. So, will my health information, my own wife, she has value if language. Sometimes she doesn't use them to want to use it. But I don't do like the Beatles, meaning with doctors, and I asked for me, because you mind showing things behind the screen. That is defined as being the front of someone. We've lost the content, we've lost her interactions with human beings. With that being said, I feel that's an analogy to the youth have changed, and have improved our way of living. We definitely are missing out on a lot of stuff. And also our ability to operate as a 21st century individual, considering that technology is so imperative to everything that we do now.

15:58

And I just unmuted myself. Thank you so, so much for sharing that video with us, now, for me. So excited to hear the panel members reactions to that. And if we go to the next slide here, I think we actually ready to transition into the best part of today's webinar, which is input from our wonderful panel members were so grateful to have onboard. And so we have doctor Pierre Vigilance. We have Sara Shirley, and we also have doctor Chris Gibbons. And so I would love to kind of pivot away from the slides here, and everyone will get this copy on Monday of everyone's the link to the recording, as well.

16:33

Maybe here, I'd love to have you introduce yourself to us and talk to us about equity, and we'll go. We'll go around the room.

16:41

So good morning, afternoon, evening, wherever people are in the world. Vigilance, Philadelphia. It's a pleasure to be here. Thank you very much, Alexis, for the invitation and for the for the work that you've done in this space. Also need to thank Jana over the Health Foundation for connecting all of us to do this. I'm the VP for Population Health and Social Impact at accredited m-health and I also serve as the organization's Executive Director of the newly Formed Foundation, the Accordion Foundation, equity m-health, just very, very quickly.

17:18

As a Web three company that is considered to be very patient centric, we're looking to improve health outcomes. And we do that by creating networks that are in health care and research.

17:31

But, because of the nature of the things that we're talking about, the networks that we're looking to create a very cross sector in mind, and in membership, And they leverage, specifically, two pieces of technology. one is blockchain or distributed ledger technology. And the other is artificial intelligence. And, we used two of those in combination with this notion of network nor consortium as a service to release or make data more liquid and movable between different sectors so that people can actually gain greater insights from the engagement in different sectors and improve outcomes As a result of that data. moving more fluidly.

18:14

My background is a clinical trial, that emergency medicine, but spent a good amount of time in the public sector, including some time, either non-profit, in East Baltimore, before going into government. I used to be the health commissioner in Washington, DC, for a few years, and then I was in government. Academia, sorry for a while. As the Associate Dean for Practice at UW School of Public Health.

18:36

So my career has sort of run the gamut from little bit of time in the clinical space, all the way through to time and community, a good amount of time and community time in academia.

18:48

But always trying to connect these very disparate dots, Including the need for us to be far more diligent about how people gain access to different services. And in this increasingly digital world that we're in, it is of paramount importance.

19:05

Keep them pre pandemic, frankly as who'd been a paramount importance. To recognize the role that technology and digital inclusivity play in everyone's daily life, not just with respect to health, but with respect to all of the things that impact how your CCP educators, your ability to gain access to housing, trainings. Any number of different things that we do as a result of technology. And the need for that to be, as it's been articulated, accessible, affordable, useful, and long term.

19:40

Then Capable of changing how we gain access to a number of different things that change our health and health outcomes, just can't be understated.

19:51

So, equity to me is not just a health imperative. It's actually a life imperative, because we have a need for that to be a space where everybody can gain access for a number of different things with health being one of the outcomes that's improved.

20:07

Yeah. Thank you so so much, Peter. And I love what you just said there and had some nice life imperatives. Sarah, I'd love to have you introduce yourself next.

20:17

Thank you, and good morning, good afternoon to everyone. Really appreciate the opportunity to care about this work, and talk about it with you. I'm Sarah Edson Sholay, I'm a Vice President at the National Committee for Quality Assurance.

20:32

And I've spent no greater part of two decades, really trying to understand where their disparities in care, and ways that we could measure and evaluate healthcare organizations, and really try to promote greater attention to equity.

20:49

And at NCQA, we've made a commitment that high quality care has to be equitable, and so we're including equity in all of our programs and our measurement strategy. I think that's really important to think about technology.

21:04

Because it has such a great opportunity to expand access to care, to allow people to have access to tools that will help them, to manage their care better, and to work more effectively for a care team. To work more effectively with individuals. And to understand their needs. But, this really needs to be intentional.

21:28

Because it's a partnership in, all of healthcare, is a partnership.

21:35

That should be, aim towards meeting an individual where they are, and understanding what matters to them, And as we think about how technology can make it easier for someone with diabetes to manage their, their blood glucose, then new technology, like continuous glucose monitors can make that work better.

21:58

But we have to think about, Well, what does that mean for the individual and how well do those tools actually fit within their daily life and and how did they make make it easy for them rather than another piece of learning and challenge for them in managing their care? I think about people with kidney disease and the opportunities for home dialysis which really need to take into account.

22:27

Not just peoples, preferences, fears, concerns, barriers but also they're where they live.

22:36

And what are the what's the capacity in their in their home environment for these kinds of tools and technology and what sort of social support do they have.

22:47

So I'm really excited about the work that we're doing at NCQA, where we've developed some accreditation programs for health care organizations that challenge organizations to think about how they understand their members are there or the people that they serve. And that also challenged them to work deliberately with the community based organizations.

23:14

Who can actually help to address social needs, and where the health care organizations are actually taking an active role, and understanding social risks.

23:25

And so, I think technology really has a lot to play there in providing the information that's going guide organizations.

23:34

But with that, that lens that's focused on individuals and communities.

23:40

Yeah, thank you so much. I think you touched on some really great examples from your experiences, so appreciate that. And last, but certainly not least, Chris, I'd love to have you introduce yourself as well.

23:50

And then we'll get into some of the discussion over to you.

23:56

Thank you all for having me on this important webinar today. Chris Gibbons, originally trained as a physician in surgery and preventive medicine and spent many years on the faculty at Johns Hopkins as the Associate Director of the Urban Health Institute. There 15 years doing that. And that institute was started primarily because of the realization that the, you know, like like many academic medical centers, Johns Hopkins, the downtown campus is located in the middle of an urban inner city area, which, although Hopkins is credited as, you know, fixing the health of many nations are many people around the world. Things are so hot in their own backyard.

24:44

And at the same time, it was really unrealistic to just expect that because a hospital or a health system is there, if we get better or that the faculty would just get back on their spare time and that would make it better. So, they started this institute and charged specifically with working with under the underserved populations, along with all of the clinical units at the university to try to develop models of improving health of underserved populations and then exporting those to other other areas. Because during this, time, and, this was awhile ago, this was, you know, 20 years ago, or more, And I, when I started the job, I said, well, you know, I've been focused on these things for awhile and studied these things for awhile. They trained at Hopkins.

25:34

I know what I'm not going to do, and that's what everybody else is doing, because it ain't working.

25:41

I didn't know exactly what I was going to do, that was going to be different. But to make a long story short, I decided, at that time, this is 22, more than 20 years ago, that I thought that there would be value in looking at technology. As a way of addressing the term health disparities or inequalities wasn't even there yet, It was just minority health or community health at that time.

26:05

And, you know, it was so this, just to give you a reference of where this was.

26:09

This is not, like, now in most hospitals have technology, my boss, which is a physician, told me. He said, Chris, you're a bright young kids. You're going to do well here at Hopkins, but you gotta let this technology thing. It's not going anywhere in healthcare, but Obviously, the world changed under his feet and then, all of a sudden, they became the expert in the department in those early days on technology. But, you know, but I only reason I say that is to give you a perspective that I didn't come into this game in the last 5, 10, or even 15 years. It's been longer than that.

26:42

And two, I didn't come at it the way most of my colleagues have either because ... were being pushed on you or now the coronavirus telehealth, the remote patient monitoring. I came at it with a much broader perspective and then limited to one technology to technologies or just stuff in the hands of doctors at a very broad perspective. And so, that's brought me to some very different places than where most of my colleagues are today, and that's fine. But just to help you understand how I got to those places that give you that background.

27:13

So today, I run a digital health innovation and transformation company that I started about 12 years ago, and we build innovations for patients with a special emphasis on underserved populations, not just African American. We've had projects, an African American, Hispanic, Latino, and also American Indian Native, Native Alaskan and Rural, Underserved, Appalachian Whites, and all kinds of populations.

27:44

And we also work with health organizations, large and small, large health system, small houses and doctors practice to understand this world of technology, how to pivot and thrive.

27:56

And from our perspective, the last thing I'll say, it's not really about just being more efficient and doing things better. It is about that.

28:05

But we believe the power that technology has, it has the power to enable us to do things that were impossible.

28:12

Before, that we could, so that we can achieve things that we were not able to achieve before. And that's going to mean a change of how we think and how we do things, and that's inevitable. That's that's happening now, even as we speak. And so that's what we do.

28:31

Thank you so much, Chris. And so, to kick us off, and we just watched that video together. I would love to hear from everyone, you know, why do you think, equity? And we've touched on this a bit, but to hit it right on the nose. Why is equity important? What sticks out to you from that video is just something that you've seen from your careers as an example of why this is important, and why we need to address equity now. So, maybe I'll start with Chris, we'll work our way. Our way, backwards. OK, well, Yeah, absolutely, I mean, this is, this is not new to any of us on this panel. These kind of issues have been there for a very long time, and we've been working in, trying to reduce equity, is a new term. And that's fine. That's good, anything that will draw people's attention to the issues. But I think it's important. I mean, we're not I've always said that, you know, as you said, in the intro.

29:23

Technology, we believe strongly has the ability to help. But let's, let's, let's just be honest.

29:29

The United States has been focused on healthcare disparity for inequalities as a nationalist since 19 94 with the Public Health Service. But the report and Black and Minority Health out in Europe. They've been forgotten in Britain, particularly. They've been focused on it for much, much longer. But you're in Europe has introduced national level policies to try to address these issues.

29:51

Then came back 20 years later to measure the impact than did it again. So they've done it twice now, over 40, 50 years. Their experience is the same as our experience, no benefit, no improvement.

30:05

Sometimes, things get a little better, Next year, they get worse. So, you know, we, we've been doing this for awhile, and it hasn't worked.

30:14

But we've got, we have, they have the opportunity where technology can help us, I believe, help us accomplish some things. But if we don't do it right, will only make the disparities and inequalities bigger, faster. So I totally agree.

30:30

Sarah, What do you think that are fair?

30:33

And, well, I think that's right, and I think we really need to be intentional as we think about where technology has a role.

30:44

And, and how do we use that technology in a way that it's actually serving the purposes that, that, for all the stakeholders involved, I do a lot of work. Trying to understand, how do we understand what people's preferences and goals are? And how does that information really shape the care plan?

31:07

How does it shape how, how the care team works with individuals and how individuals manage their own health? And how do we use that information to say, Are we making a difference? Are we actually achieving something important?

31:22

Well, technology, I have to tell you in a paper based world, collecting data from individuals is just a non-starter. Using that information in clinical care tracking over time. It doesn't, it's, it's so, so hard.

31:35

Technology can help us, but only if we're really intentional about it.

31:39

It means that we have to think about the, the communication barriers of language, and not just, is the language translated, is, or the, the tools translated into the right languages, that is it language that people understand? Are we using tools that overcome other kinds of communication barriers?

32:03

Like, where the computer can speak the questions, rather than requiring somebody to read them.

32:10

And then also, how does that technology actually support?

32:17

Provide decision support to the care teams and longitudinal tracking over time?

32:23

So there are many ways that the these technology can really help people be more involved in their care and be on the same page with the care team about what they're trying to get out of it.

32:36

If we're intentional and thinking about every step along the process and bringing individuals and communities into the same space of design and development, as the care teams and the IT specialists.

32:55

Yeah. Great point, Sarah. Thank you so much pair. What are your, What are your thoughts on that? So, as I was watching the video, the first thing that struck me was the, the connectivity piece of things.

33:06

The fact that that child, the daughter, she was talking to Mom and dad, and this instance they were talking about.

33:15

Now, there was an interview, but I'm sure that tool is used for them just to be there for her just to be able to check in on them, to be able to speak to them, to be able to connect with them, and the role that technology can continues to play in our ability to connect them. And I remember carrying around a cell phone that was the size of a brick at one point, right? weighing down my scrubbed pants, the old Motorola flip phone. And we thought we were doing something with a phone that was that massive.

33:45

And what we've moved to now, with respect to Smartphones and what they have the capacity to do. But the connectivity piece of things, I think, is the big big takeaway that I'd gotten if notice connectivity with services, as we spoke about it, in the healthcare setting, but connectivity with each other.

34:04

And, that's the good and the bad of it, because it also is about connectivity with information.

34:10

And then the question is to do, the other piece that came up in the, in the conversation that you had with those people was one about preferences, as Sarah mentioned. And the preference to be in front of somebody versus dealing with somebody through a screen.

34:25

And it feeling better or different. Sometimes, when there's information just being given to you, do if you trust the source of that information, You may take, that is actionable information that you're gonna go do something with.

34:38

If you don't trust the source of that information, then you want.

34:42

So the connectivity can also be the things that are not necessarily accurate, not necessarily true, maybe not true for you, and they may not be timely either. And so we've got this challenge with connectivity being a great thing.

34:56

But connectivity, also having this potential, as we've seen in a number of different non health settings, to create opportunities for the spreading of misinformation and the spreading of of information that actually does not allow people to make good decisions that are great for them and their families. And the speed with which that information can now get across the world, is so much beyond, to Chris's point about, the beyond what we could have ever imagined. It's beyond what we could ever imagine.

35:29

We used to talk about pandemics back in 2003 was sars Cov V one and say, OK well, if a group from this particular part of the world comes to this part of the world and for a conference or whatever, then there'll be this likelihood of a spread.

35:47

Because of air traffic, The number of people moving via airplane, The group has exploded. I mean, obviously went down to encode, but exploded over the last two decades with people being able to take relatively cheap flights and spread tons and tons of things.

36:06

Communicable diseases, in this particular case, very, very easily seminary with connectivity and technology. The ability for bad things to move around very quickly is a very, very high level, so it's understandable that there was the trepidation and concern that was voiced by a few members of the people that you spoke to was around their health information, but just information in general and concerns about privacy and the preservation of that. We're also things that sort of, struck me from that conversation.

36:39

But I thought it was just interesting to sort of think about where we've come from, and the fact that we also, I think we're also somewhat guilty of, oftentimes, engaging and thinking about solving for today, versus solving for what's next.

36:58

And what's next is stuff that people throw that Star Trek, that Star Wars, that sort of F over there.

37:05

And then five years later, it's here, We're still around forever, oh, maybe we should have been paying attention to that. What's next thing?

37:13

That's the conversation we have a lot around web three, right? And a lot around technologies like blockchain and AI, that was a movie back in the day. Now, it's the reason why that pair of shoes follows you around your entire web existence. So, I think that we need to be far more adventurous.

37:35

Because what people are experiencing today doesn't know what we need to be innovating for it. to be innovative for what we're about, to be experiencing, and can imagine experiencing into the future, Which is, this is an important piece of another part that I got out of, what, what some folks are saying in that conversation.

37:56

Yeah!

37:57

I think that's an incredibly important point, and that's why even when we talk so to issues, I don't think it's appropriate, it's wrong, It's, it's, it's not.

38:08

We will not get to the solution we're all trying to get to If we don't involve patients more, that's just, start there. OK, not just involve them once iteratively over and over and over again throughout the design and development crops and going forward, OK, so that's the baseline.

38:25

However, we are also living, as Peter mentioned, in a very trends, time of transition, right? And you can look back at anytime, technology in any other sector was introduced. When you're talking about the car, the phone, the personal computer, the radio, the record play, all, this, the same thing you have actually looked at.

38:45

So, happens every time that you actually can't go just on what people say, because with, or made the car.

38:54

First, people say, well, why do we need faster horses know, They couldn't, they couldn't fathom it. And that's the, that's exactly what disruptive technology is. All these people running around talking about their products are disruptive technology. They don't know what they're talking about. Because disruptive technology or technologies that usually are small, but have such great impact, that the future of what he does can't even be envisioned, it can at the, by those people who are using it right now, And so, and so, you know, it, is about, where is the future going? And none of us have a crystal ball.

39:29

But, you know, there, the world in cycles tend to repeat themselves, so we can learn some things if we're willing to look other places, and that's one of the things healthcare typically does, or doesn't do. I think it's hurting them in this respect, right?

39:47

Absolutely, and I love that point to launch. You know, we do need to enhance our understanding of what we think patients, consumers, want, and need, but it's not just taking that and operating within that status quo. I love that point about, you know, if it's going to be disrupted. If we're actually going to maybe bridge these gaps in the digital divide, Spoke going, you know, multiple steps further, to truly be disruptive. I love, love, love that point. Sorry, I saw you nodding your head there as well. Anything to add from your perspective?

40:13

Well, I think it's, this is really an important point about understanding, um, where people are, and what their preferences are.

40:23

But, they might not be able to say, this is the solution. I think there's, there's real work to creating that solution. That you didn't know could be a solution, right?

40:32

That, and, maybe that's part of what you're, you're mentioning, Chris, that, you know, it's, it's really striking to hear people's concerns about privacy, about where their data are used. How will the data be used.

40:46

So, I don't think that should limit us from, I'm using technology. But, it's a, it's a barrier that we have to think about.

40:55

Well, how do we get over that, right? And, you know, we, we've heard these concerns about, I mean, one of the challenges that we have with, and I know you mentioned using algorithms and just the incredible opportunity to use algorithms to help us understand the wealth of data that we have.

41:20

And we also need to be skeptical and wary about some of the quality of the data that are going in there. And that's something we're working on right now, is trying to understand, how do we get better, better data about people's race and ethnicity, and identity, and in terms of sexual orientation, and gender, and also their, disability? Because we need good information.

41:44

That's going to help us use those algorithms, develop tools, but we also, it needs to be working with people in a way that they feel that their, their worries and concerns are heard.

41:58

That they're addressed and that were on their side, rather than feeling like, if I give this information, it could be used to harm me, because certainly, There are a lot of people who've experienced harm in our health care system and in our, in our country, in general.

42:16

So, there, there's skepticism as well, well deserved and it's something as we, we embark on using technology, we need to be holding that in our hands as well as we work to address equity, OK? Good.

42:37

Just very quickly to, of course, that both of you made, actually.

42:42

And sir, you just commented on this piece about privacy.

42:48

How we ask the question, how we engage people in these conversations is critical. Chris talked about the iterative and ongoing engagement of people, as opposed to what I have, colleagues who are very much appreciate referred to. We should do a focus group. And it's a singular event. Right, It's a single event. We should do. A focus group, will go towards us and we'll get some people together. We'll talk to them, will feed them, give them a gift card, something, and do a get. all the knowledge that we ever want to get so that we can go off and do this. Program, design, project, design, technology, design, you name it. But, it takes longer to listen.

43:28

It takes longer to listen, and to say, OK, we heard what you said. We're going to incorporate this into the design of our product, platform, project, et cetera.

43:37

We're going to come back and let you look at it, feel it, do it, do what you have to do with it. And we're going to listen to you again. And we're going to do it over and over again. And then we get to understand, as I think you did.

43:49

When you were talking to people, people to say things about things that inform us about their concerns.

43:57

So if I ask somebody, or you can say, would you make use of a privacy preserving piece of technology, feel like, what? Are you talking about, the answer to many people as well. Yes, of course, I would. But what does that actually mean? Well, maybe that's something that we get to by asking are, dealing with a set of products, and generating that product with people that come to find out that people are particularly concerned about. Privacy. preservation would use something in one way versus another way.

44:26

Do I think how we ask whether or not we choose to listen.

44:30

You have this issue in health services research over time where there's a strong penchant for quantitative methodologies where we can just go look through the data because that's what we're interested in. And the stories behind the data get lost, because we didn't listen to people. And we didn't source that data from the edge, if you will, from the actual person. It came to us.

44:55

Queens was scrubbed or quite dirty, but we still use it because it's in the dataset, and that's what's available to us.

45:06

Hundred percent agree, and I know we want to go to another question.

45:09

But the last thing I'll say here is, agreeing with, with, with both, both of you, know, so many things going in my head. But on this issue of sort of asking people the right questions, I've done focus groups and in-depth interviews with hundreds and hundreds, and hundreds of low-income, inner city, african american seniors in Baltimore, DC, Oakland, California, all over the place. And one, and this was years ago, so I'm not even talking about right now.

45:37

So there's even at the beginning of all, just fascinated, especially wanted to seniors, to give you an example where, you know, we were so you couldn't be peers, right?

45:49

We can't just, We talk about things as if people all understand, and use the same language when you would talk about things they look like. What do you mean, I don't even they can't even conceptualize it. So, the idea that we're asking and getting an answer, that's all we need to do, is just not there. But to specific point of privacy. I found it fascinating, where a number of people, when you sign up, you get them to the point where they can understand what technology might do in somebody's. Yeah, I would. I would like, these are, she wouldn't.

46:22

But some would then, and so, this issue of privacy, and these are this particular example of giving among african American low-income inner city, it is that the issue of privacy and security did not come up. It just did not come up in our conversation. So I asked it, right? Because I know that we think about academics. think everybody thinks about it. So I asked them, and they said something that was really fascinating, and I heard this over and over again, They say, Yeah, we have those concerns.

46:51

But let's face it, if we don't do this, we know we're going to be left further apart, right?

46:58

So the issue of privacy and security is real, and, But it is not the end all and be all that I've heard, at least in some populations that, I've heard some, if you don't get that right, you can't do anything else. No, that's not what our research that we've done has shown.

47:16

And I found that to be quite fascinating on one side of the coin.

47:21

So the only other thing is, So understanding, I think the other thing is, as Pierre was alluding to, is being able to interpret the data properly, then you gotta have a broader context. one quick example, I was involved in some large studies, many years ago at Hopkins, looking at disparities in diabetes, stroke really, and stroke outcomes developed. And I was specifically asked to be a part of this project because the NIH totally goes away. You don't have expertise in this area with underserved population as a textbook.

47:56

So we think, they put this intervention together, know, the first looking people were confusing, stroke with heart attack, that's one issue. But even in those who weren't, confusing stroke, you know, that the ideal treatment for stroke, once you have it, is to get to the emergency room as fast as possible, because you have a limited amount of time to give a very specific, powerful meditation.

48:17

And about 30% of the African Americans who knew they were having a stroke, or their family members were having a stroke, still delayed to go to the emergency room, because they first wanted to talk to a family member, or a past, or somebody else, who's important to them. And when the study team found that out, this, like, Oh, man, we've got to, we got to develop an educational intervention to teach these guys, They only got three minutes, whatever it you know, to get to that, they've gotta get there.

48:45

And I said, No, no, no, this is, this is not an educational problem.

48:50

Cultural problem with people in african American communities, you know, it's not this rugged individualism, like that We tried to portray in this country life. They have a notion of what you think they need to do, but they want to see what the people that are important to them, which might be mom of it. It might be the pastor, It might be somebody. You might not like that. They do that, but that's what they do. And then, on the combination, both things, that's what they make the decision. So, if you try to force them out of that cultural norm into where you think they need to be, it's not gonna work. It's not gonna work well.

49:23

And so, I'll stop there, but again, no absolutely saturated points. And here also what you mentioned made me think about, you know, this is kind of this Agile nature of the health care industry. We need to make a more iterative, but we also need to acknowledge faster when things aren't working. So, if we're taking an approach, or, you know, opinion, into things, and we're seeing quickly in this iterative steps, things aren't working. Being able to kind of move on faster. So that we get to the solution that does that, does work for individuals.

49:50

There's not just healthcare systems, or the cross sector infection, so Yeah.

49:57

Yeah, so true, I was gonna say I'm gonna pivot, asked to, lead to get her kind of opinion on this and sort of heard her thoughts based on what she heard from individuals. But while she's doing that, I know we've got about 10, 8 to 10 minutes left, so I'm going to come back. I wanna go round Robin. And I want to make this super tangible, if you were to give input or advice of the industry right now, what's something that you think the industry should stop doing?

50:20

Should start doing and continue doing to drive forward with equity. But I'll give you an equity in particular. So I'll give you a minute to think about that as Ali's kind of giving us her reflections. Cool, Thank you. Yes, I'm so often reminded of the phrase, you know, you can take a horse to water, but you can't make it drink. And obviously, you know, this is, this is my job, and I'm just so happy to hear you, all talk about the importance of doing research with people and listening to them. And, you know, not just kind of asking them questions on the nose, but when, when we do our ethnographic research, we're looking out for, you know, people's behaviors, people's workarounds. You know, the funny little ways they kind of come up with to work around problem that they're dealing with. And also, I think, understanding why it is that people might not want to interact with technology and what those privacy concerns are.

51:08

And we see things, you know, like, when people have had experience of fraud, for instance. Or, you know, people don't see themselves as being particularly technological. And they'd rather just speak to someone face-to-face.

51:19

And, so, I think, you know, when we, when we listened to people and when we kind of walk a mile in their shoes, so to speak, you can really understand what's going on on this sort of demand side.

51:32

Yeah, and then that can can can pave the way for better design for interventions and offerings that actually, as we say, meet people where they are, and meet those needs, that people aren't necessarily able to articulate in a kind of question and answer format, but they can sort of show you with their, with their behavior and what they're doing in their daily lives. So.

51:56

Thank you so much, and I know we've got about five minutes left, and so I know it's hard to condense somebody's. I give you a big ask for a short time, but maybe, Chris, I'll go to you first. Start, stop, and continue doing, or, maybe two things. I'll say one is a little little humility here. Understand that. Even though we're that we've been fortunate, we've been trained, we're the experts. We don't know everything, and we need to realize that. And really talk to, people, listen to, people, listen more, to, people listen more. To people then do. Something. It's kind of measure twice.

52:33

Cut once and the other thing is, you know, really involving people and recognize the ways that we act are really off putting to people. The language that we use, the terminology that we use. You know we call called patients who don't. Who patients who believe in God is as oh, that's fatalistic!

52:53

You're putting me down for my faith that I have.

52:57

So many, many, many examples of that, but I'd say those two things would be a great start.

53:05

Sarah, how about you next? So, well, Chris, Chris hasn't, it's listen and I think it's that intentional loosing listening that starts in and build a relationship of Trust.

53:19

And understanding that you, that the organizations developing and deploying technology are really trying to help not not try to just save money, not try to create, you know, a second class kind of care, But really trying to build the Trust.

53:40

And that comes from the time you spend listening, and the authenticity of the listening, and so just double down on Chris's. Listen.

53:53

All right.

53:55

Pierre, what do you think?

53:56

All right.

53:57

I'm going to try to make this quick start embracing user input in this ongoing manner into the design and creation of your programs, whatever they may be. Also, start investing in, not just cross sector things. So investing in affordable housing is nice. Investing in transportation is nice. But start investing in those sectors to build them up, so that they can actually share the accountability with you, in the health sector, for outcomes. It shouldn't just be the health sector that looks, to take care, health care, sensitive, to take care of health. Stop spreading health equity around like confetti.

54:36

It is not. Health equity is something that is, it's a goal.

54:41

And it has a particular set of things that we're trying to achieve, improving access, removing barriers to access, providing scaffolding, but this, this confetti business needs to stop, because I see very few systems also, providing the vacuum cleaner, for cleaning up the confetti after the Party is over. So stop spreading like confetti.

55:02

And continue to be engaged in the social determinant of health work, but work with your partners who do that work most effectively. Health care doesn't need to become or the things it's trying to become outside of the clinical space. I applaud healthcare for trying to do these things, but it is outside of our lane. So continue to see the value in, in partnering, and continue to innovate in that space by looking to partner with those who are outside who do that work far more effectively, because it's what they do. They don't come, housing sector, doesn't come in and try to do surgery. We shouldn't be trying to necessarily go out there and do their work.

55:45

So, I said, OK, the time here, we've got two minutes left. Any final closing comments or thoughts from the panel members? And I wanna thank you so, so much again for joining us. It's been a wonderful conversation.

55:57

I think it's exciting times, and like I said, in the beginning, the world, not just any one individual, The world has not been successful in dealing with this before for some very difficult reasons.

56:08

But I think I personally think for the first time, we have the opportunity that real opportunity of closing and eliminating some or all of these gaps we're going to have to rely on hora. But for the first time, in the history of mankind, we can get there, if we want to.

56:27

I think if systems take your three access adoption and sustained use bullets and use those in everything that they're doing.

56:38

So don't just put something out there, because it's going to be quick in the fire, and then out and done. Those three bullets, I think, are priceless. And I think that they don't just have relevance to the technology piece of relevance across sectors and the way that we engage.

56:57

And I think that long term commitment is what we should be measuring, and what we need to incentivize.

57:03

And so, the concern we have is that the incentives don't always get us to the same place in terms of how our payment is provided in our health care system, how resources are shared. Even as we're looking at health care organizations take on more of a role in social risk or social determinants, just because the money might be.

57:32

Just because that might be in the interest of the healthcare organizations, doesn't mean that they get to drive it, and they should have all the power. So, so really, be thoughtful about how to share the power and share the learning and the knowledge to support individuals and communities.

57:51

Thank you all so so much, really appreciate your time And I think with that Ellen, we're ready to close. Thank you all again. Enjoy the rest of your day.

57:59

Thank you.

58:00

Thank you.

58:03

I just would really like to thank our co-hosts, Alexis and Ellie and also to our wonderful guests for today's really dynamic, interesting discussion. Thank you everyone who joined us and stayed with us. If we didn't get to your question, we will reply by e-mail and remember by e-mail you will also receive a link to this recording, quite likely, not till Monday, however. There is the handout in the control panel that I want to remind you to download. And, of course, at anytime, we welcome the opportunity to speak with you directly. So, please feel free to reach out.

58:40

That now concludes today's webinar.

58:43

Have a wonderful Friday and weekend, everyone.