HealthIMPACT Live Presents: Keynote Case Study: Integrating Chronic Care Digital Health Platform into Large Safety-Net Hospital System
Originally Published: Nov 15, 2021
YouTube Video: https://www.youtube.com/watch?v=mdpEyA_BdpQ
Join this fireside chat with Keith Reynolds, Chief Operating Officer from Welldoc and Dr. Karyn Singer, MD MPH, AVP of Chronic Disease and Prevention from New York City Health and Hospital System (NYCHH), to discuss their journey integrating digital health into the care model and the direct impact this had for patients. NYCHH estimates that half of their patients with diabetes are unable to achieve their glycemic targets. NYCHHC integrated a digital health solution into their existing program in order to tackle this problem and improve self-management among a diverse population living with diabetes. In this session, the speakers will dig into the challenges and lessons learned from integrating digital health into their chronic care model.
In this fireside chat, we will discuss:
Karyn Singer, MD MPH, New York City Health and Hospital System (NYCHH), AVP of Chronic Disease and Prevention
Keith Reynolds, COO, Welldoc
Shahid Shah, Publisher and Chief Editor, Medigy.com, Moderator
Transcript
Shahid N. Shah: Welcome to the second day a health impact audience so we've got a jam packed first session for you guys talking about a really, really important topic, and that is chronic care management, you know there's a lot of discussion about technology in chronic care.
But there aren't a lot of people pulling this off in safety net environments and doing it away that our friends at well Doc you know.
I have been doing with evidence and proof with tools and technologies that have FDA approval, so there are a lot of tools and technologies that are out there that don't we have not gone through the clearance process, but I know that Keith and the team, especially a well kept thought that that was very, very important, and that is getting evidence from the Community and from actual users, before taking it out into the world, this is going to be a really informal fireside chat with Karen and keep that Karen comes from the New York City health in a hospital system and, as many of you note big city.
But you may not be aware that an enormous amount of the safety net goes to 400 New York City safety net help goes through that system so without I just love for Karen introduce yourself will do the same thing with Keith and then i'll pop in some questions go for Karen.
Karyn Singer, MD: Right good afternoon everybody I’m really thrilled to be here today to share our experiences and health and hospitals with a health app, Blue Star. My name is Karen Singer. I’m an internist by training and preventive medicine trained and I have been in health and hospitals.
After residency training, I went back and have been back for about six years and currently almost a year, and my role, which is the ADP of chronic disease and prevention which helps to oversee chronic disease and prevention initiatives and we run the data for the system, specifically around diabetes, hypertension obesity, smoking cessation, and we're now expanding into several new arms as well.
Shahid N. Shah: yeah that's great and welcome Karen. I think that from from the audience's perspective, as you listen to what Karen is talking about.
These aren't blue sky ideas, this is stuff that they're doing today, and so, hopefully, these kind of create some questions in your mind, or you want to get some follow up she'll be open to do that as well. Keith tell us a little bit about yourself.
Keith Reynolds: Great great good afternoon Shahid, and good afternoon everyone, thank you for being here Karen, thank you for presenting along with us and having this fireside chat certainly appreciate it. My name is Keith Reynolds and I’m the chief operating officer here at WellDoc. I’ve been here a little over a year, but i've spent over 26 years in the healthcare industry.
Shahid N. Shah: Perfect so let's start off a little bit, can you tell us about the NYC H and H. We'll just call it H and H going forward. What is the diabetes program, why did you guys entertain even looking at something like to start?
Karyn Singer, MD: Sure, so I’m going to tell you. I’m going to take a step back if that's okay. First just to tell you a little bit about our system because you're absolutely right we're a huge city. We are the largest municipal safety net system in the country. We serve over a million unique patients every year, and our system across the five boroughs. We have 11 hospitals and 70 Community clinics and larger diagnostic and treatment centers and our patients are really very diverse from all all parts of the world, all walks of life and it's really a pleasure working at health and hospitals.
In terms of diabetes for the patients who are engaged in primary care we currently have about 66,000 patients in our registry, which is a process that system. And 66,000 patients with diagnosed diabetes, who are 18 to 75 years old, so it's quite a large number of that number, I can tell you that 65% of the remainder, who are not in control a little bit more than half having a Wednesday greater than nine. The remainder either have an agency between eight and nine or haven't had a measurement on record in the past year. Which through coven was a much larger number, and then we were able to really get people in and bring it down as people felt more comfortable writing public transportation and coming into their hospital in clinic to get their blood work done. So why do we want to do a diabetes program because we have of 66,000 if you take a third we've got a little over 20,000 patients who are uncontrolled. And about half of those have an agency greater than nine so we've got a good amount of patients tend to 11,000 who really.
We want to focus on in terms of outreach and really help them to get their diabetes under control and there's a number of ways to do that, but we've had experienced in the past with a text based messaging initiative actually it's been going on for nine years and health and hospitals and it's been incredibly successful. It's specifically for insulin hydration so it's much more focused but 80% of our patients reach their goal, which is the optimal insulin dose and patients feel we've had.
Karyn Singer, MD: Over the years, many, many patients give feedback and we've done studies on it.
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Karyn Singer, MD: They feel much more connected to the health care system into their clinical teams and that engagement really helps them reach that goal, so we were really looking for other digital.
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Karyn Singer, MD: interventions that could help folks get to their goal when they're not within the four walls of authentic which is 20 minutes every three months or so so that's That was a long answer, but I don't know if that answered in a big picture.
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Shahid N. Shah: Oh no that was perfect so tell us a little bit about what is special about the safety net part of your health and hospitals that might be different than other groups might be doing in other areas, so what is unique and specific to your challenges.
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Karyn Singer, MD: Sure, so I think there are some things that are similar tall safety net hospital that's right we have.
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Karyn Singer, MD: About 25 to 30% of our patients don't have insurance and our most recent check about 44% have medicaid and then the remainder have medicare or dual eligible so large percent of our patients are uninsured or publicly ensured.
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Karyn Singer, MD: That you know there's a whole slew of things so.
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Karyn Singer, MD: Again there's a very big range within our population of resources so socioeconomic status insurance status as I just mentioned.
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Karyn Singer, MD: health literacy and some of our patients have very, very high health literacy, some may have come from another country and we're doctors or nurses there themselves and some or other health care professionals.
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Karyn Singer, MD: and some have very low health literacy, some of our patients don't aren't literate not just health literate but literate.
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Karyn Singer, MD: So we have a wide variety The other thing I can say is, as we stand the five boroughs we have multiple languages as a first language.
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Karyn Singer, MD: So I just, I can tell you I literally just put in an order three days ago for a very large order for brochures and handouts for our patients for 14 different languages.
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Karyn Singer, MD: Far and away English and Spanish are the top two like on an order of 10 full but we definitely have.
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Karyn Singer, MD: You know 13 other languages that are regularly spoken at our different facilities and it depends on the different specific pocket, but I think that those are some of the things, and along with that, in terms of technology and.
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Karyn Singer, MD: Some of our patients have smartphones and have regularly utilize Apps and some of our patients don't some of our patients may have plans that last month and some may not.
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Karyn Singer, MD: Some may have a smartphone but have a difficult time, you know utilizing the Apps that are on it, I think that that's true.
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Karyn Singer, MD: large portions of the population, but that's definitely the case of our population, so you kind of have to suss out who may be able to engage in this but, in my experience it's growing more and more every day.
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Shahid N. Shah: No, I love the fact that you didn't have all the answers but you're saying this is worth doing anyway right and so.
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Shahid N. Shah: You got to get it started, you have to know in order to get things started you're going to learn things throughout the process.
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Shahid N. Shah: And that's why you know, having a great partner like Oh well, Doc allows you to adapt, as you need to but tell us a little bit about Karen did you start this.
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Shahid N. Shah: As the experiment and weren't sure where you wanted to go or did you have some objectives or outcomes are specific things that you wanted to accomplish where do you fit in that spectrum.
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Karyn Singer, MD: Sure, so we definitely had some specific metrics some specific things that we wanted to hit I mean number one was to help our patients.
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Karyn Singer, MD: You know, lower than a one see but I mean you can just say that, but what does that mean so.
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Karyn Singer, MD: People know.
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Karyn Singer, MD: What are their sugars, so that they're tracking them in a way that they can look in a systematic way.
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Karyn Singer, MD: Oh every morning my sugars look like this, but if I check it after dinner or after lunch, you know, can I look at it in a way that makes sense, where i'm not just writing it in a straight line on a piece of paper.
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Karyn Singer, MD: Can I.
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Karyn Singer, MD: Can I get feedback a pretty immediately, you know when you write your glucose number on a piece of paper you're not getting any kind of immediate feedback, but while Doc does that.
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Karyn Singer, MD: and medication adherence So if you choose as a patient to put your medications into the APP.
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Karyn Singer, MD: The APP can remind you when to take your medications which is also huge Those are some of the things I think there are other tips.
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Karyn Singer, MD: Like if your sugar is high, the APP may say that's a little high maybe you should go for a walk around the block or if it's low, so you get that kind of immediate feedback of oh I I thought this was a fit number.
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Karyn Singer, MD: Maybe I was wrong, so I should lower it more and we've actually gotten that feedback feedback from patients.
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Shahid N. Shah: That sounds great, then you know, one of the things that a lot of diabetics, especially the ones that are that are recently became diabetic they went from pre to post diabetic.
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Shahid N. Shah: They often ask why is my number, the way that it is, how are you able to work with well Doc and and your patients to try to help them understand that it is either their time of day, or the activity or or lack of activity or food, how do you get the wise answered for the patients.
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Karyn Singer, MD: yeah I mean I think that's a really interesting question, because we have these two measurements there's one that's.
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Karyn Singer, MD: it's not static but it's an average and then there's one that goes up and down every day and even just figuring out what does this mean what are these two numbers mean together, like a one see and the glucose.
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Karyn Singer, MD: can be a little confusing and it just not straightforward at first so.
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Karyn Singer, MD: The APP what it helps to do is, as you put in your finger stick, it will give you direct feedback and will tell you okay.
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Karyn Singer, MD: I can see that it's high after i've eaten something so even though it's completely normal I you know I told my doctor every day I check it in the morning and it's perfectly fine.
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Karyn Singer, MD: it's 100 you know it's 100 when I wake up or or maybe it's 160 and you thought that was fine, but this will tell you it's not.
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Karyn Singer, MD: So there's various ways that it can be fine in the morning and.
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Karyn Singer, MD: You know if you're checking postprandial finger sticks, it will give you immediate feedback about that or there's lots of scenarios in which.
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Karyn Singer, MD: You can find your pattern about when your glucose goes high and it will help you to understand that pattern and then hopefully.
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Karyn Singer, MD: Bring that down by changing your diet or taking your medication or speaking with your doctor about it or doing exercise, which is a big one that's a super critical that our patients with diabetes into an exercise when they can so all of those things the APP encourages patients to do.
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Shahid N. Shah: Now I love it, and in fact i've grown right before I bring in Keith can you comment, a little bit about whether any of the patients that you're working with or on a continuous glucose monitor cgm and what is the future of that tech look like from from your perspective as a practitioner.
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Karyn Singer, MD: So some of our patients are on cgm and most of them are not on cgm because right now there's kind of stricter coverage map questions or parameters around cgm but definitely every day, more and more of our patients my patient just get a depth combi their day.
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Karyn Singer, MD: And I think and leave Ray I mean those are the two that that, of course, that we're seeing, but I think that those are.
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Karyn Singer, MD: There, helping to supplement patients who are using the APP for more than the glucose.
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Karyn Singer, MD: Because again what the APP does is it will give direct feedback and will help you with medications and understanding that it can integrate the glucose readings with feedback, but what does that look like.
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Karyn Singer, MD: I mean there's more and more evidence coming out every day that cgm are useful and broader and broader scenarios, so I have a feeling that will continue to see more cgm I hope.
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Shahid N. Shah: yeah and that's great the reason why I asked that is that there are some digital health programs that say, well, this is not worth doing until you get a cgm you're clear.
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Karyn Singer, MD: No, no, no.
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Shahid N. Shah: wait for the cgm start now get it going and and it's going to be helpful.
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Karyn Singer, MD: immediately to know the minority of our patients are the minority, the minority of our patients are all who have diabetes are on cgm and it can supplement with with blue star but.
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Karyn Singer, MD: know the majority of our patients who want to start to not have cgm and it's useful very useful for them, so no it's not.
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Karyn Singer, MD: A prerequisite, and in fact the cgm you know if it's tracking the glucose people may not realize the value add of the APP, but there is value out of the APP and the feedback and the other components so it's putting those together.
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Karyn Singer, MD: So I think either way they consume energize.
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Karyn Singer, MD: But without cgm it's that's what it was built, you know it's built for patients without cgm as well, so it's definitely helpful excellent.
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Shahid N. Shah: So, can you tell us now, so you guys have been doing this for a long time, and you know i've been an admirer from far I know you guys, for a number of years because you're driven by evidence and you're driven by.
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Shahid N. Shah: The pardon the expression shit that works.
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Shahid N. Shah: Right, I mean it's not just stuff that's out there.
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Shahid N. Shah: let's give.
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Keith Reynolds: us a try and see you.
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Shahid N. Shah: know you had to go through things that work so when Karen and the team came to you from health and hospitals with their outcome requirements with their needs.
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Shahid N. Shah: Was that par for the course for you guys was there anything special about those outcomes, how would you create that request from Karen key.
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Keith Reynolds: yeah I think generally, we were really excited about the opportunity here, if you think about everything that Dr singer just said.
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Keith Reynolds: The complexity of their population diverse needs that they have some of the challenges that are posed.
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Keith Reynolds: To that community, we thought it was a terrific opportunity to really test out our technology in the most difficult population to reach and see what type of results that we could generate.
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Keith Reynolds: And it's been really exciting to see that and the impact that we've been able to have on individuals, a couple things that Dr singer said that kind of jumped out at me said in the beginning 20.
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Keith Reynolds: Individual spend about 20 minutes, with their physician about a quarterly basis it's roughly about a an hour a year that they spend with their doctor.
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Keith Reynolds: Think about how long people are on their smartphone in general it's about 80,000 minutes a year, which equates to about four hours a day.
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Keith Reynolds: If we can carve out a little bit of time to help an individual manage their health care and lower.
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Keith Reynolds: Their a one see that's a huge success and that's kind of how we look at that, how do we fit into the.
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Keith Reynolds: Life flow if you will, of the individuals using our solution, so if they're in checking their bank account or they're using it for navigation.
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Keith Reynolds: They are going to be in that on that phone using it for their health care as well we're starting to see really health care and smartphone merged together in a really elegant fashion.
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Shahid N. Shah: yeah and then what's what's what I love about blue Star and one of the reasons you guys obviously gave that name is sort of like a GPS is sort of like if you need help.
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Shahid N. Shah: You can press the start button and get your help, so what what what's interesting about your solution is that.
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Shahid N. Shah: It does similar to GPS and the sense that it calls you when necessary, rather than you having to just watch, you know every term direction, etc, etc, and I think that's what you mean is that.
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Shahid N. Shah: they're already on their phone they're already doing these things if you can get them to be intervention.
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Shahid N. Shah: Not there have to think about the intervention, but the intervention or the nudging is happening in some routine way.
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Shahid N. Shah: That that is actually ideal so when you when you heard the requirement from health and hospitals, the way that it was.
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Shahid N. Shah: What What was it that you liked about the way that they wanted to implement this was it more or less difficult for you guys to get started, now that you've been doing this for a while, what does that deployment process look like.
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Keith Reynolds: Well, to answer your question, but again what got us excited about it, one the population that we were.
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Keith Reynolds: seeking out to serve, but then the integration with the delivery system was really exciting, if you think about it, we don't want digital health to live in isolation.
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Keith Reynolds: We want to be able to support that patient when they're not in the office, we want to be able to help them understand the complexity of their condition and how to manage that and live a healthier life.
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Keith Reynolds: And that's all the things that Dr singer mentioned.
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Keith Reynolds: But the real opportunity here, then, is taking all that rich data that we have out of our application and integrated back into the delivery system so that the care team, where the health care provider.
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Keith Reynolds: Has actionable insights they can actually see what is going on with that patient, how are they doing, but their diet or exercise.
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Keith Reynolds: How are they doing with their medication adherence all the things that go into managing one scare.
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Keith Reynolds: Now, or exposed to the health care provider where maybe before the patient would come in, they would answer a couple questions tell the provider you i'm doing great.
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Keith Reynolds: But when they go to get the right one, see results it's showing less than that so really arming the providers with that actionable information that was really interesting part of this overall project and being integrated into the healthcare ecosystem.
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Shahid N. Shah: No that's great and and when you think about the safety net side, I mean obviously when when we think of digital health, we always think of phones and we always think of the fact that.
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Shahid N. Shah: You know, obviously, if you have a phone, you have a data plan etc so talk a little bit about what happens when, if you don't have a data plan, if you don't have all of the heavy phone requirements is well useless, or is this still useful, even without all that.
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Keith Reynolds: yeah I would say it is not useless one our.
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Keith Reynolds: Application works both online and offline so if somebody doesn't have a data plan or They ran out of data and they connect to wi fi.
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Keith Reynolds: The application still provides that real time coaching and feedback and then it syncs up when that individual is within wi fi.
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Keith Reynolds: range, in addition, if somebody doesn't have a smartphone, but they do have access to a computer, we have a web based portal that individuals.
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Keith Reynolds: Can utilize and it is the same experience that one would get within our mobile application, so we are trying to make sure we meet that Member where they are that patient where they are and provide them with accessibility, via a web portal or mobile applications used on or offline.
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Shahid N. Shah: perfect and so Karen if we talk brass tacks here what we're saying is you know, in the last.
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Shahid N. Shah: Think about this 10 or 15 years ago there were these questions about should we do digital health and is any of this going to be that's all gone right, we know that this stuff is all useful, so the brass tacks come.
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Shahid N. Shah: Really, in terms of integration implementation deployment, what did that look like, for you guys.
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Shahid N. Shah: talk to us about timing talk to us about was it easy to start with the deployment process, what did the what was the integration that you had to work on talk about the hard stuff because it can't be all that easy.
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Karyn Singer, MD: Right, so we actually did a pilot study first at two of our sites with about 300 patients, and this was pre coven So this was 2018 or so.
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Karyn Singer, MD: and basically what we did, then was, we set up champions at each of the sites and we had regular calls, I mean first initially starting we're following the same model for phase two, by the way, because it works so well in Phase one.
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Karyn Singer, MD: So we we spoke to the leadership at each of those hospitals and they chose champions, who would be real advocates for patients who know.
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Karyn Singer, MD: You know who can pick out the types of patients who may benefit from this both based on their Agency but also based on their technology savvy or they're owning have a smartphone and being able to have an APP.
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Shahid N. Shah: On the personality profile, who is this.
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Shahid N. Shah: champion, is it a nurse, is it some administrator what Who are these champions.
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Karyn Singer, MD: So we leave that to the facilities, because each facility has very different resource breakdowns, but it can look very different in each facility so currently.
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Karyn Singer, MD: We now have clinical pharmacist at each of our 11 acute hospital sites in 2018 we didn't have them fully across the board so right now clinical pharmacists, are some of those champions nurses for sure we have population health teams at some of our sites.
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Karyn Singer, MD: So, and it could be a provider who's also helping to lead the charge but it's not usually a provider who's getting folks to sign up for the out.
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Karyn Singer, MD: Although i've i've signed patients of mine up for the definite it takes two seconds, if you have a patient who's technologically savvy if you just give them the qr code.
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Karyn Singer, MD: Well, I can get into that in a minute, because actually it's quite easy to sign somebody up to the APP if they're familiar with technology.
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Karyn Singer, MD: But initially when we did the pilot we really worked with the sites to help them develop their processes and workflows and.
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Karyn Singer, MD: Although we had overall kind of standard suggestions as a we it was really blue star based on their experience with other sites.
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Karyn Singer, MD: We also have to mold that to each site, because their resources may be different.
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Karyn Singer, MD: One of the things that we're finding so in the pilot we had 300 patients enrolled and we saw an average a Wednesday reduction of over 1% which is great because that's clinically relevant.
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Karyn Singer, MD: Now we're actually have expanded to actually seven sites so five hospitals and then seven diagnostic and treatment centers clinics.
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Karyn Singer, MD: And what we're finding is each of the teams looks so different and each site, I mean there's one location we're 10 people show up to every meeting.
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Karyn Singer, MD: it's a I mean they're really owning this they're really excited about it, but the resources are different across the system and time allocation can always be that.
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Karyn Singer, MD: That site actually is interesting because their Internet connection sometimes difficult sometimes it's difficult so to actually get the patient to download the APP while they're on site has been a little bit of a challenge that we found.
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Karyn Singer, MD: But in terms of building that I mean it's that hasn't really honestly changed from past other than the webinars rather than in person meetings we just really we've got weekly meetings we meet with the champions, we hear what's going on.
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Karyn Singer, MD: At their sites, we hear barriers, we try to you know stamp out the barriers, we get them whatever materials they need, and again when I say we.
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Karyn Singer, MD: it's our team, but also blue star blue star has been amazing a partner in this they've turned things around very quickly and so we've really been able to troubleshoot a lot of those issues things that didn't come up necessarily in the pilot because.
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Karyn Singer, MD: Using has come up The other thing that i'll say is the other thing that's new since the pilot is my chart so in.
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Karyn Singer, MD: We were starting the role to epic across our system and in December 2019 we completed the role, meaning all facilities and all 70 clinics are now on epic.
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Karyn Singer, MD: And so we have the patient portal my chart which i'm sure you're familiar with, and our there's a secondary.
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Karyn Singer, MD: Secondary but a different initiative to try to get more and more folks signed up to my chart.
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Karyn Singer, MD: And as we've been able to do that we actually realized that even the Tele health, we can send patients a link.
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Karyn Singer, MD: Through the portal, if I discussed with my patient look, this is an APP that I think would be really helpful for you are you interested, can I send you the link.
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Karyn Singer, MD: They said yeah and i've done that, and i've enrolled patients and they downloaded the APP I can see on the portal they downloaded the APP and they're using it so it's a that's a brand new methodology for rolling enrolling patients, which has been quite helpful.
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Shahid N. Shah: yeah.
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Karyn Singer, MD: I think I don't know if that answered your.
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Shahid N. Shah: Question it did know this, that was perfect I think really the difficult part is and Keith you know this from the software side is, we want to stamp out variation Karen kept saying there each site is different.
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Shahid N. Shah: there's unique people you know people are in healthcare that's what makes healthcare so unique is, it is the people at each site what What about that variation variability troubled you, if at all, or are you guys able to handle that level of difference between sites and other places.
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Keith Reynolds: yeah I think one, we have a standardized solution that everybody's using and that has gone through FDA clearance, so we didn't have to.
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Keith Reynolds: necessarily change the solution to meet individual needs, because the solution is very flexible itself and it's also available in Spanish, which was really important for this population.
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Keith Reynolds: But what I would say, as far as the implementation and looking to gain awareness and activation within the platform is, you have to approach this as a true partnership and understand that the assets that you have available and how best to utilize those assets in order to.
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Keith Reynolds: drive that activation and engagement in the platform so in health and hospitals situation they have physical assets, they have great care teams healthcare professionals.
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Keith Reynolds: That could actually educate the patient on the use of the application so identifying champions was a huge win.
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Keith Reynolds: Their trusted advisors of the patient and then, how do you look at utilizing other modes of communication as well, to be able to meet the patient, where they are.
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Keith Reynolds: So my chart and sending links that's a great example.
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Keith Reynolds: Using text messages think about emails even direct mail and outbound phone calls, you have to really be able to use multiple modes of communication to be able to be successful in driving that activation I like to say there's no real silver bullet.
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Keith Reynolds: In order to drive that experience, you have to to utilize and run really essentially a campaign against it over time to maximize your results.
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Shahid N. Shah: yeah what I was thrilled to hear Keith is that you know the Karen team are mentioning they have about 50% user engagement that's a much higher number.
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Shahid N. Shah: than his usual you've already she's already seen some early success signals come from this so carrie you can talk a little bit about the early success success signals.
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Shahid N. Shah: But maybe, what I want to do in the last few minutes that we have is talk to the audience about what you learned through this process.
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Shahid N. Shah: about what worked really well on your way in what you thought worked about, as well as you want it to.
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Shahid N. Shah: What you thought did not work at all, like you had to adjust quite a bit and maybe some lessons that you could share with the audience about what they shouldn't do.
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Shahid N. Shah: To maybe repeat some of the calling it failures is bad, but you know we all make mistakes or.
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Shahid N. Shah: Some things you didn't think would happen happened during the thing so talk about what are the success six success signals you saw and then, how would you do things differently if at all, in the future if you're going to run to your other sites.
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Karyn Singer, MD: Care, so I think I think the biggest takeaway is that digital technology works for our population.
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Karyn Singer, MD: And that's huge I mean patients really the paint for the for the patients who love it they really love it and it's really working.
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Karyn Singer, MD: But I think that that's another the next kind of step, which is, you have to do the right patient selection, so what we found was that of the 50% of patients who weren't very engaged in the pilot they weren't really the folks who are actively using other Apps prior to enrollment.
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Karyn Singer, MD: And they weren't, for whatever reason, I mean I could populate as to why but they weren't active APP users, a lot of them.
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Karyn Singer, MD: Their first language wasn't necessarily English or Spanish, which again is fine, but some of them were actually not.
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Karyn Singer, MD: proficient enough potentially in English because we asked them afterwards and they said I it was you know I couldn't understand necessarily.
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Karyn Singer, MD: In the APP, so I think picking the right patients.
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Karyn Singer, MD: it's really key here because they'll just take it in fly with it, I mean, I had the qr code on my desk and I said in fact i'm seeing her this Saturday or a Wednesday was 9.6 I said here's a nap.
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Karyn Singer, MD: She like just put it on her phone right then in there and I can tell you her a Wednesday, because I took a sneak peek and it's definitely below eight now so.
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Karyn Singer, MD: Whether it was the APP we're going to talk about it Saturday, but the point is.
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Karyn Singer, MD: The right patient selection is really key to really utilizing this resource well and, as I said, I think that's growing more and more and more.
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Karyn Singer, MD: But if someone has a good amount of hesitation or you have to download the APP for them, it might not be somebody who is going to use it actively or there might be somebody who really wants to but needs.
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Karyn Singer, MD: extra training on site with the champion or with somebody on site, who can like show them the ins and outs, because some of the other feedback that we got was I just didn't know quite what the next step was once I opened the APP.
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Karyn Singer, MD: Even though it's very easy to use, but it's just takes a little bit of training for somebody who may not be used to utilizing Apps.
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Karyn Singer, MD: So I think that's the big takeaway and yeah again it's just patients election patients election don't you know our patients.
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Karyn Singer, MD: are really thriving who are using it over 1% agency production and our 300 patients in the pilot phase it's too early in the stage to say what the results are but.
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Karyn Singer, MD: we're really excited about continuing to work with Star and seeing how it goes.
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Shahid N. Shah: yeah that's great and then the last minute Karen just maybe you want to add an acute if there's anything you want to add with this statement that.
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Shahid N. Shah: you're never going to get 100% of all patients to do anything doesn't matter what it is, but a 50%.
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Shahid N. Shah: Engagement rate 40% engagement 60 is perfectly reasonable so don't try to create a program which is looking for 100% success because that doesn't it doesn't doesn't exist, so in the last minute just give a little bit of commentary around that idea start.
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Shahid N. Shah: And it's okay to not hit 100% is that all right.
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Karyn Singer, MD: I mean.
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Keith Reynolds: Go ahead, Dr Sarah.
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Karyn Singer, MD: I would say sure it's okay like you're you're never going to get 100% I agree with you.
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Karyn Singer, MD: But we could do better than 50 if we choose the right patients, we have over 10,000 patients in our system, who have who have a one see greater than nine in another 10,000 greater than eat so.
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Karyn Singer, MD: I think we could do we can do better than 50% in the next iteration but yeah somewhere in the middle.
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Shahid N. Shah: I love it keep last word.
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Keith Reynolds: yeah I would say you want to set your expectations high and always shoot for that hundred percent However, if you can impact small portion of a diabetic population, there is a significant Roi that is achieved by.
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Keith Reynolds: Managing your condition appropriately, so I agree with you, he.
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Keith Reynolds: can't.
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Keith Reynolds: not do something, because it doesn't hit 100% of the population, because of the benefits that it has for everybody, using the solution, but you always want to shoot as high as you can and Dr singer I agree with you, I think we can go above 50%.
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Shahid N. Shah: All right, fantastic well, this was a great decades day, thank you both for joining us here.
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Shahid N. Shah: And i'm sure our audience will have plenty of questions for you guys afterwards, so please reach out to the audience members.
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Shahid N. Shah: and connect with either Karen or keep the about what they talk to you about here, and thanks for signing off for a health impact on our side and we'll see you at the next session.
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Keith Reynolds: Thank you very much.
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Karyn Singer, MD: Thank you.
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Shahid N. Shah: Alright, so Emily that we all we went about over by about a minute and a half right.
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Emily Raisch: that's just a common, especially that was just it just fine but that's that's human error, they tend to err a little bit i've had a couple run early but mostly they go they get there, and we can figure out visiting editing wise, we can do to make that a little bit.
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Shahid N. Shah: By the way, this was perfect because it has got all the opinions in there.
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Shahid N. Shah: We got a good discussion going and now what you guys want to do, and this is, you know for Marina and and others at well Doc you want to take this and you know when you look at the blog post.
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Shahid N. Shah: Now you want to kind of add on take you know, a quote and add the blog post for the proof and evidence, so the numbers.
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Shahid N. Shah: weren't that important during the call, but the opinions got in, so I think this this was great it was very conversational so perfect so keep anything you wanted to add.
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Keith Reynolds: I would just like to thank Dr singer you did an awesome job.
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Keith Reynolds: You know our solution inside and out and we're able to speak really well to it, so thank you very much for that and it's terrific having a partner like you and being able to.
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Keith Reynolds: share the stage or the virtual stage here so greatly appreciate it, and so he did a very nice job you also know, the solution and lead the conversation, so thank you yeah.
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Emily Raisch: Perfect Thank you.
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Emily Raisch: And one last thing Karen just so, you know as a we as a hospital our health system.
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Emily Raisch: person, if you have anybody on your team that you want to invite to either view this session or just take part in the conference as well.
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Emily Raisch: They can get a free pass on so I can send you information or if they just login as hospital or health system exact they should be able to to join, so we love this as a continued learning opportunity, and if you have anybody you want to invite.
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Karyn Singer, MD: I will i'll take you up on that i'll send a sense of names your way I just also want to say I.
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Karyn Singer, MD: i'm so sorry I didn't prepare with water my mouth was getting super dry, so I had this really disgusting blue history, I don't know if you can edit that out, I just felt like my mouth was getting dry so.
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Emily Raisch: Oh no yeah it always happens if you're doing used to talking that much anymore so it's totally normal i'll see you.
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Emily Raisch: Again we're not have Hollywood but i'll see you do it.
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Marina Dorotheo (Welldoc): Right.
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Marina Dorotheo (Welldoc): Our new where I just getting used to seeing people in each other's home, so I think we're all okay with it.
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Shahid N. Shah: So kelsey and Marina The only question that I didn't get to that would have been good for us to so the way that you can add to this either as a linkedin post.
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Shahid N. Shah: After a week or so goes by, you can actually do a very short and even if Karen is willing to do it as part of her linkedin is to say.
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Shahid N. Shah: hey loved working with well Doc here's what we're planning next right because that was the only question that was on the list that we didn't get.
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Shahid N. Shah: To ask, which is how are you going to take this forward, but all the other all the other info got in here and can be elaborated and blog posts so.
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Marina Dorotheo (Welldoc): And we're Dr singer kelsey and i'll draft something for you as well, so you can post it from your linkedin or, if you want to pass it along to New York health and hospitals post as well, so we'll make sure that we prepare that for you as well.
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Shahid N. Shah: So, by the way, Dr sager if you think about that patient you're going to see on Saturday it'd be awesome if you can get either a picture with her.
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Shahid N. Shah: a quote from her that if she's willing to share that on to the well Doc or or as part of this discussion, because you mentioned a patient and then, if you say a week later hey guys here's the patient that.
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Shahid N. Shah: That Dr singer was mentioning here's the benefit she got from her, she loves using well Doc that part will go 10 times further than what even carrying a soggy.
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Marina Dorotheo (Welldoc): yeah we may have some hipaa stuff.
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Shahid N. Shah: yeah, no, no, you have to ask permission, obviously, obviously.
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Shahid N. Shah: You have to ask permission, so I was saying Karen could ask and say some patients, by the way, I do blog post sorry a podcast a patient focused podcast.
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Shahid N. Shah: Patients love to come on and either complain love they love complaining more than admiring Apps but.
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Shahid N. Shah: They are absolutely willing to do so, and they some patients were surprised like this guy shared a dental visit the other day showed us the actual tooth and said here's what happened to me at my dentist i'm like dude that's a little key my right.
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Shahid N. Sha