Okay, now we can go ahead and get started. So I want to go ahead and introduce we have some folks who are guests. And then we have a number of folks on our panel today. So I want to go ahead and get started with people who are new to the meeting today.
I will just kind of start this, I did invite a couple of my key guests just because we were doing the roundtable on medicine. So my, my partner in crime out of Penn State, Rob Gillio, is there. He's retired pulmonologist. And I've got a strategic partner ready.net. He's the head of a utility and public sector, Craig Corbin that has a tremendous platform. So those are my kind of partners to the table.
Good. Thank you. Appreciate you doing that. Anybody else who's new today?
Well, I am new.
Yeah, well, you are gonna get introduced. Mohan. Okay. Okay. You're one of one of our presenters today. So you're gonna get seriously introduced. So I want to go ahead and share my screen. Hopefully I've got the right page. Do not don't up share, I'm gonna jump back there to this page. Okay, now I can share the screen
okay, there we go. So I want to actually I don't know if the folks from the broadband office are going to be here today, Cindy, I thought was going to be here. So we're gonna just go ahead and jump into the program today. Because we have, I got a little carried away and invited some really great people to participate on the panel today. So we have lots of people. So I want to just go and get started. And then hopefully, we'll have some time for some announcements a little bit later. So let me get up here. So get into this. So I think many of you have been on our program before, when we had Craig settles, who was a nationally recognized broadband author, expert, consultant, and telehealth advocate. And we're going to hear more from him and he can introduce himself more in just a little while. And then no stranger to us as Janet major, who as you all know, is Associate Director for innovation and digital health with the Arizona telemedicine program and the Southwest telehealth Resource Center. Next up is Lucy Howell , who's the Managing Director for the Force for Health Network. And next is Dr. Gholam Peyman. Is that correct? Dr. Peyman, who's retinal surgeon, Professor, and director of research at the U of A College of Medicine in Phoenix with the Department of Ophthalmology. And then last but not least, is Dr. Mohan Tanniru. And Mohan is an adjunct professor, excuse me, in the Division of Public Health Practice and transit translational research and the Mellon Enid Zuckerman College of Public Health at the University of Arizona, and also a senior investigator in the Global Health Initiative at Henry Ford Health Systems in Detroit. And actually, Mohan and I go back many, many years when Mohan was the head of the MIS department at the U of A. So the the focus of this program, and the reason we have all these people, is I wanted to talk about the intersection of technology and community health. And it certainly is consistent with the interest that we've had lately about, particularly telemedicine and libraries. And so I think that a lot of the work that these people were doing, will complement that work and will be a great resource for the work that we're doing. So with that, I'm going to just jump into introducing Craig and Craig if you just give us a quickie background, and then share some thoughts with us, particularly as it relates to telemedicine.
Sure. I'm Craig Settles, I'm a consultant working with cities, they want to have broadband in their in their cities. And I've been a very staunch advocate for telehealth, large part because I was saved from one a stroke because of telehealth. The mean I can actually if people have any questions, I'll come back to that the my background, but the thing I wanted to talk about quickly and getting get people in think about is me maybe, oh, eight, nine years ago, era, Arkansas had a problem where just about everybody who had a stroke in that state died. Large part was they couldn't get medical attention fast enough. And they couldn't particularly they couldn't get a particular drug that you need to get if you are a stroke patient. Because it was a rural state. The there are only at the time three neurologists in the state, they're all together at one university hospital. And they came up with this idea of linking the hospitals use using a research network, they got space on that network. And they created a telehealth telestroke. Network. The and they they they managed to have an increased in increase of patients who then were able to survive. One of the issues with the medicine is that it's one of those things that can cure you or kill you. Right? If you don't administer it correctly, it'll do the latter. And so rural doctors wanted no part of that or the liability, right. And so by pulling the PII the different clinics and hospitals together, they were able to create programs and so forth, for training to make sure that the doctors and nurses could administer the drug appropriately, that they could use the technology appropriately. And they added a US additional service, from the neurologists out to the hospitals to make sure that they were doing things correctly. And and, and so they were able to reduce the number of deaths. And, and so that by itself was great. But the other elements is they were able to create additional applications that were delivered over telehealth telehealth through their through that network. Right. And the reason I bring this up is that every state is given her has been given money for middle mile networks. And when they announced that, and that, that they were going to do that and Tia said we would like to have other applications on top of those networks. And so, you know, first thing I started talking about I also had a conversation with NTA person you know, to understand, you know, what their expectations were. And so the ability, I think four states will Arizona to take that money for middle mile. If you knew like in Wisconsin, Michigan, they've state in Wisconsin has a additional 43 $200 million additional network broadband funds. And they are also focusing a lot of that on tele on. middle mile as well. Right. So I would say that to use that middle mile to anchor a telehealth network would be a good thing. Overall, I the lesson I learned from Arkansas is, you know, start with one application that everyone can fully get behind and support and then branch out to other applications based on, you know, need and what the, you know, the future could possibly hold and, and so forth. But I think that the end at the end, to create that kind of a strategy for using the middle mile network would have significant impact in the throughout the state. And then the last point, I'll let go, and then I've asked is that I've also thought of having the equivalent of like, waystations, by so many of the rural areas, there may be two, three hours before you can get to a hospital or some sort of medical personnel. Right. So even at the hospital, you know, if the ambulance gets you in, you know, get to you in time, you know, if you have a serious issue, that could be you know, the distance between the two points could be a problem, right. And so I'm thinking if you had a, an office or a, you know, like a gigabit network and so forth, and some sort of current enclosure, right, you could stop. If I say if a stroke patient or a heart a heart attack, person would would go call it cold Code Blue. By the end, it's like you're still an hour away from the hospital, having this network of Weigh stations could be literally life saving. And I think that that incorporated with this idea of having a statewide telehealth network. This has some some value. I'll be quiet now. That's
okay. Thanks. Great. I'm gonna hold questions for now. Because I want to make sure we have plenty of time for all of our panel folks to do a presentation. So Janet, you up next.
What an idea to have a statewide telehealth medicine network.
Well, we are very fortunate
here in Arizona, that we've got people who have been doing great things and in the world of telemedicine and telehealth, right, and I'd like to take a minute to share some hopefully new resources to folks who have been participating in this call, but also carry on the conversation about the whole idea of using technology in improving community health and using technology to create public spaces where people can have private conversations about their health care. And I would like to share a few Can I share Steve
you bet, I'll stop sharing.
Okay. Okey dokey.
For those of you who I haven't met, my name is Janet major and I work with the Arizona telemedicine program. We've been here for over 25 years at the University of Arizona College of Medicine. And we are also one of several other national consortium of telehealth resource centers. And what that means is we have the opportunity to network with this national brain trust of people who are doing telehealth producing services things across the country and regionally because as many of you on this call know many of you do serve the people who live in the Four Corners area and multiple cultures and share some great pest best practices with people nationally on a regular basis. So we have a federal grant that allows us to do that in Arizona is very unique right now you know with the whole idea of of being a able to work with digital navigators and digital health navigators and health navigators and insurance navigators. Right now, nationally, there are some amazing resources being developed as well as right here in Arizona. And many of the folks who are leaders in this space are here on the call and many of the folks we have been able to network with as a digital inclusion network and people who are leaders in telemedicine and telehealth and people who've been doing this for a long time. So the really exciting and unique thing about Arizona is the fact that we have a community of community health outreach workers, community health representatives formed really based in in IHS in terms of their roots as Chows, community health outreach workers and pro mentors and the really exciting news. And what I wanted to be sure to share is now these billing codes mean that we can have the support in in our libraries and the support in our community health centers and the work that we're doing to teach people technology and it's billable. So that's going to be a game changer. And we really are leading leading the space in a way in which access has created billing codes that say, I mean, you can imagine the possibilities. If someone who lives in a rural area in southern Arizona right now in many of our libraries, people could go check out a laptop or a tablet, sign up for the opportunity to sit at a private computer. And a Community Health Outreach worker can bill for 30 minutes of their time, if the primary care provider basically writes that as a script, and the Community Health Outreach worker has self certified themselves as as a CHW underseat, w two. So there's a lot more information about that. But I do want to be sure that people are aware that this really is a great opportunity for us. And we've been working now networking with folks who are my friends and family in this space here in Arizona to create what would be hopefully a directory, and also in terms of being able to manage resource, maximize all that bandwidth and maximize all those great grants and opportunities that are out there to invest in technology and bandwidth and training. Things that have never been covered by grants before. We really do have the opportunity to network and have been working hard to create also a website to support networking is a digital inclusion network. And a couple of other great new resources I wanted to be sure to share with you include the fact that I wanted to share if you had not heard Molly and I are going to be sharing our telehealth libraries project with a national audience in Orlando next week when it's going to be nice and hot there. And it's an opportunity for us to not only talk about and share our pilot in Arizona, but to discuss lessons learned and learn from other people what they've been doing. Because it's been interesting when we first started, we had interviewed you may you may remember four or five different groups, or maybe it was like six or seven different states that were doing telehealth library pilot projects or projects. And now there are over 20. So it'd be great to catch up with others as well as share what we've learned. And our newest space in that space is to Citi and we look forward to sharing what that group is doing there. So I could spend a whole lot more time. But I think that it would be great to give other folks the opportunity to continue on this theme of being able to network and find ways in which we can maximize our resources, and get the most bang for our buck for all this incredible money that's out there right now to create a way in which we can provide improve access to health care through technology and telecommunications connectivity where we need it the most. The other thing I'd like to share is I've been doing a lot of research because we will be my team will be providing a one day training session in Nevada this week, our neighbors in Nevada, and we've networked with them quite a bit. And they have a beautiful website on their broadband directors website, which makes it very easy to find not only demographic data, but exactly what grants opportunities that are available and what's happening in that space. So it's been great to network and find out how we can organize information and share not only the networking opportunity to find great grant partners but find the goods to help us write the grants you know make it easy to be able to pull together all the data that it takes to write an award winning grant and I also look forward to final Comment. I'm usually in August, September, we hear about the next round of of DLT grants, which are also a great grant round. And as soon as we hear that, I look forward to producing another webinar specifically for writing USDA DLT grants. Thanks, Steve, for having me on the panel.
Thank you, Janet. And I'm sure that even the other folks on the panel are going to be interested in connecting with you who may not have known you in the past. So we get back there, you're not still sharing are you Janet.
So let's see, where is my
Okay, so next up is Lucy Howell and Lucy has joined us in the past and has been a great participant with us. And she is the managing director of the Force for Health Network. And Lucy, I know you have some compadres who are on this call with us today. But I'm gonna turn it over to you to give us a little background.
Thanks, Steve. Can you guys hear me okay? Yep. Okay, and I'm not a doctor, and I don't play one on TV. But that's why I like to partner with quality content creators, and also top of market players. I've been a national kind of bizdev person for the last 25 years. But the last five years, we've been able to kind of sit in and focus on something that we're super passionate about. So the force for health is a mixed media platform really focused on solving population health issues, for both individuals and community leaders that care. And since for like a competitive one of the ways that we wanted to frame that was in this concept of this gamification of healthy citizenship efforts and practices. And so that's what we call the reality health games. You know, we produce some content, we have a long online learning management system. And we can actually create leaderboards of engagement. So my partners in Pennsylvania, I'm an Arizona, I've got another strategic partner here in the in the southeast. And that's what we're here for. I think that one of the concepts that we bring to the table is this chamber of health concept. You guys call it a Telehealth Network, which is awesome. But what I've come from the chamber world, and there's too many silos still occurring in the communities, you got broadband over here, you got health over here, you got education over here, you got, you know, cybersecurity over here. There's so many broad, and I can't believe that nobody that I know and all segments know each other. Right? So there is this need to have to collaborate more efficiently. I've had a chance to have kind of one on ones with most of these key people. So I'm super confident that Arizona has what it takes to actually be a frontline leader, as we, you know, collaboratively, collaboratively come up with these ways to score a healthy community. So anyways, that's me, Rob. And Craig, I don't know if you want to say one more thing. I should probably say my partner Rob, is a retired pulmonologist and has testified on both the state and the Capitol level as to the disparities, disparities that take place in rural communities due to broadband. Go ahead, Robert, sorry.
I have, excuse me. A little bit of a cold right now. I have to say, though, thank you, Arizona, for introducing me to Ronald Weinstein. Those of you that knew him, he was my first professor in medical school at Rush Medical College where I went, and so I was introduced to telemedicine, where we hooked up a microscope and the or two rounds off as one floor up, so you didn't have to run down and read frozen sections. That's all wrong. God started you guys. I've since been involved with telemedicine with a Mississippi Flood with ground zero after Hurricane Katrina. But the real exam for me, I want you to be thinking about as you're talking about telehealth, it is you can use it for primary prevention, preventing and keeping people healthy to start with secondary prevention of not having an incident get worse when that person's having that stroke. And then tertiary prevention for long term management. So there's many levels where that middle mile can prevent and have your citizenry know how to recognize a stroke to get their health care started right away. All the way on through to managing that stroke at home with remote patient monitoring billing codes, also, I quit. I quit that. But I'm especially proud to be able to observe this group and what you're trying to accomplish.
Yeah, I think that there is a definite intersection between health and wealth. And we need everybody in the community to know that we need the private sector to know that the public, obviously Education, Health Care Technology, Craig, he can speak later when we're convincing and stuff. But he's had some tremendous successes with state offices, being able to onboard and activate with some of the incredible systems that he has. So we'll kind of table that for later, Craig. Absolutely.
Perfect. Okay, ready to move on? So Lucy. Are you sharing?
I actually could have Steve, but I'm trying to be brief and open it up and leave it for discussion. Thank you.
So let's see who's up next. So Mohan, you want to do your thing?
Okay, well, I am probably the least experienced in compared to all of you in the specific field of telehealth. But let me kind of tell you where I come from. As Steve mentioned, I was the department head of MIS at Arizona for a few years. But I've spent basically 40 years in technology. And so I have, so I'm aging myself. But the point is that I have seen a lot of technologies come into play in the business communities and of course, in some ways in healthcare. And while technologies provide a lot of opportunities to address problems, one of the challenges that I have seen both the developers of technology and the implementers and the people that strategize often fails to see the challenges or population or customers for that matter, in using the technology effectively, to accomplish the goals that we stayed for themselves or for the those that are in their, in their sphere of influence. So while I teach in it, adoption, diffusion of technology for quite some time. And in the last seven years or eight years, I have kind of transition from the purely the technology domain, to the healthcare domain. And I'm kind of shuttled between Michigan and Arizona, of course, I'm in Michigan during the hot months of Arizona. But the reality is I work with Henry Ford and other health systems here and work with a lot of nonprofits, as well as primary care clinics. And of course, I also work with some of the agencies in Arizona. But what my goal as an instructor at College of Public Health is address what he called Population Health in the digital age. And that is we need to recognize that population health is not defined by a provider. Yes, that provider of course wants to reduce readmissions and improve wellness of the patient. But ultimately, it has to be something that a patient can actually use to self manage their care, feel confident to effectively use that technology to be able to stay well and to communicate with both family and friends as well as physicians, and to a lot of projects are done with nonprofits as well as health systems. One of the things I find quotes more recently since the COVID. Everybody is moving towards telehealth, even though telehealth has been in existence for quite some time. A lot of physicians are moving towards that arena in order for be able to service the patients. Of course, you can service more patients through telehealth, then of course, they come to your office. But at the same time a lot of patients that I work with, or at least my partners work with, tend to be from underserved communities. That means they have Yes, the physician might say hey, I have doc see me and use this particular software to be able to do a consultation, but many of them don't know how to use it. Many of them have access to problems with internet communication. And sometimes they have difficulty in using that technology to build that trusting relationship they used to have with their physician before COVID. And that means now how do we actually see To make that transition to using telehealth as a viable solution, not only to educate and empower the population that sometimes has both digital divide, as well as the social and cultural divide, in terms of using the technology to build that relationship and communicate, as well as the physician population that is sometimes not quite even though yes, they can build a lot of billable hours, because you can serve as many patients and you have a coach to support that. But the reality is, they still also feel like they don't quite completely understand how can they effectively deliver the care, just using the technology when they can completely see the patient in the form that they normally will see face to face? So I think there are some challenges, both on the provider front as well as on the patient front. Yes, we can use broadband technology and we can provide the communication capabilities. But are we leveraging the community around the patient, including sometimes the family members are caregivers? How do we kind of leverage the entire ecosystem of the patient to enable them to be able to use the technology effectively? And yet how the ability for them to get the personal care when they do need to have physician interaction? So to me, it's really more about balancing act. And how do we address that issue besides technology is really what I'm looking at. And that's how I normally use the students to help in understanding of the challenges on both sides, so that we can develop community strategies. Recently, I was in on a Fulbright grant to go to Canada to do the indigenous health by how they're using telehealth among Northern Ontario province. Again, there are accessible technologies out there to use telehealth, but a lot of indigenous population that they interact with, need a lot of cultural connectivity along with technical clinical connectivity. And that is where there is a lot of missing pieces that one need to consider if you want to make this a successful endeavor to improve the wellness of the population. So those are really my general thoughts. And obviously, each case is different. And each state is different. And each condition is different. But really wanted to take a holistic view of the patient, the community, the facilities that they have access to as well as the providers, the ability to provide the care all together to see how best this technology can be useful. I will leave it at that. Thank you, Mohan.
We're gonna have time after everybody presents here to go back and have a discussion among the panelists as well as among those of you who are participating in the meeting today. So with that, Dr. Payment, and I'm going to I know you have a video you want me to share
where you can go the video the beginning wherever, whatever you like, doesn't matter. Sit here
okay, for some reason, Lucy, I can't get better view as the presenter. I don't know what's going on here.
You're presenting Steve. Yes. Showing that you're presenting? Hmm. Interesting.
So on my screen, I'm just seeing Lucy. Okay, well, anyway, Dr. Paymen. So I'm sharing the you're seeing my screen. Right, but you're not seeing me?
Yes, we're seeing both. Okay.
I don't know what's going on here. Anyway, Dr. Peymen, would you like to introduce yourself quickly, and to talk about their work you're doing and when you're ready, I will share your video.
Thank you very much. Thank also, Mr. John, and Tom, who recommended me to come over here and thank you. Thank you for letting me discuss with you some of the work that I do have done in the past. The beginning I was really reluctant to come to your meeting because I did not know my subject of my talk today, which has to do with the f4 raptors are measuring the refractive power of data has to do with the system that whatever you're doing, but in reality, when I thought about it, I came to the conclusion that whatever has to do with the medicine, it has something to do with the telemedicine. So there is really not far away from each other. In fact, what I'm doing I find out, no, not necessarily retrospectively, but I think we've been trying to talk about it. But some of the work that I'm doing is really part of the New Deal with a television buddies diagnostic, mostly, not necessarily communication. So I may have not worked with broadband, but I'm familiar nowadays, everybody familiar with communications and telecommunications, etc. So let's tell you about why I'm actually the only zealot ever retinal surgeon not anymore because I'm retired. But I've been interested in technology from beginning a part of the I practically have done some work on it in the past. Now, personally, I'm just interested in some specific areas that I'm working on. And that's one of them is reflect the power of die, how to measure it properly, and how to measure it simply. Anybody who has glasses or is TVC glasses and one had glasses, a lot of people have it. And if they don't learn it on the eyes, on their nose, basically, they are gone and seen ophthalmologists. And it takes time for the ophthalmologist or optometrist to check their vision and measure the refractive power and pay off and here on there, they ask you questions about this and taking more or less matter of time to come to a conclusion Some people cannot do that. But before I get into that, I just wanted to tell you what the scope of the refractive error is it might get a little bit of your interest in the subject because it's really interesting. In the United States, we have a by the million people who are blind actually amazed that you cannot see objects is recorded to the battlelands by 400. Or is generally speaking the measure is 2200 on a high which can see properties is 200 distance. Distance was was a person who is handicap sees only in 20 feet or a monitor. Now, the numbers are as I say they're struggling. So we're ending because the one minute lunch here and and we got 3.2 billion people are actually visually impaired. And all of them even though we know that they're just satisfied with what they are doing among their population or by the 8 million people who are actually have never been to an ophthalmologist on the sleeve, do whatever they have been doing if they can see whether or not nobody knows basically, they may not have the means of seeing you know, the problem is not necessarily multiman limited to the children that are born with the problems gradually as you know, there are children the eyes are not properly basically aligned properly and they developed on videoplayer the MS one I cannot see because they are not focusing on the on the subject but when I can see them and the other is always going to be okay or they have some diseases in general people in United States or other people, majority of people who are visually handicapped, etc. Unfortunately, they also can be treated very nicely In reality their 50% of paper and visual problems can be very easily corrected if they are diagnosed some diagnostic associated visual in the refractive power of the eye or so that's really important or that is on very often unfortunately people like people who live outside the cities, maybe Native American or the people who cannot afford to see a doctor they never have been examined by one of these units. behalf we call them phoropter. This is a big these are big units and they put the person behind it and they look through our garage and they want them to see some some visual display that's in front of them and in the distance of 20 feet for that subject hold if they want to read it, or something in front of them within about 33 centimeter are the unit is really basically big, heavy, bulky It's also expensive and not really transportable, I bounced your hand in my lab and I saw a unit for opt in someplace in a part of the room it stays there till the end of their lives basically which is really the type of person who is going to live there and give it to somebody else. The Frost is had been invented more than 100 years ago so not much has been done and I was really frustrated with that because of our people or
I was on the receiving side because I was trying to correct the refractive power because they had some problems with the retina or quality or other things or the lenses and the refractive power that was measured were never accurate so I was frustrated by subjective quality of the things and a lot of people really out there repeat so on maybe Native American they were they could not properly communicate with people visually in their party power and everybody was tired of it No, they put some lenses in front of that year they turn this knobs around that 400 Watt more than 80 lenses in each side of these machines and then turn around and say this is better or that but then they are looking at an object but they have to remember the memory if you tell them you have a fine or differentiation between a new one until it shuts off so which is all nonsense. Basically if a mark live in this moment, so the prompt there have not made progress for that reason I felt when I came to Arizona after a hurricane came other best basically together the veteran was simply hos office and laboratory everything none of I've been Tucson on I thought maybe the best thing I can do to line up some optical engineers some design in my mind to remove the phoropter because it's just basically not useful very subjective concept that there was not to remove actually replace all the lenses in any of these fracture between lenses which are basically recorded it's very cold cylindrical to cylindrical one it's very cold, which are actually can be expanded on compress to make this small, the only political lenses so having a fidelity lens, that means we don't need to have all this machinery. The second I wanted to make it automated that maybe we don't have to ask your patient hardware but they are saying we just tell them to look at this, this picture or the monetary product with a guy or gal and then they can look at it then only they will communicate with me or the docs or their or their nurse etc. What happens in that light beam goes inside hits a mirror and a part of their demeanor gets the light gets inside now and then the light comes out of it dark light that comes out it's transmitted to through the fluidic lunches to Arish sensor which is called Shy cargo says sensor does shock haven't said sensor either maybe a lot of a small little one and lunches in it which more or less measures the position of the these lights on can differentiate different normal abnormal and then we connected this via software to political answers on the machine really decides that the lens is not seeing things properly. Let me as I'm focusing on the distance on the chart I cannot the I cannot see it properly. So that automatically corrects it is right the pump to fill up the lenses in front of them my eye shadow see that basically anything increases or decreases to the degree of artifact power that my eye sees on the machine itself says it now it's corrected no communication between the doctor patient etc. No question asked on the data is obtained from the shikon system is a requirement record that is basically transmitted either to the doctor or the patient or whoever we have been responsible for that I can You can tell them to do what to do. Now at the same time I want to tell you what has to do with it telemedicine because until now these four options vary so much so heavy nobody can move it around. Now the system that they have, you can put it in anybody's house that they want basically after a surgery a lot of people the eyes are don't know if they are better or they are worse basically they are more than the doctor surgery or go home I come back about a month and the patient doesn't know myself to be avoided. Am I better or not? After all these surgeries and all these things have done, but this machine can really eventually do it if they haven't temporarily been maybe rented for a while and put it there and give them the information about the visual acuity or the information or they can be transmitted to the doctor via internet. Basically, that's one of the things I mentioned does, and the doctor looks at it and say, Well, you see that you have actually improved or is the same or worse, therefore, you should come to see me. So that's always a problem that's simultaneously solving the issue of refractory power on simultaneously having a telemedicine system. So why am I explaining to you here, because John felt that maybe that would be helpful, because I was looking for some system to move the concept of our have not only is conceptually obviously in this moment, but forward to the FDA, etc. With your mind, Steve show you the movie now. Series of what are some of the co workers behind they come on in front of the machine that in front of them on the band intro now look through the system, if you can show it, and then you will see how long it takes to check the visual I created the offer person. Once this is Shawn, the machine tells me they're done. And if I get power and measure when it comes back to the system, the company that'd be Raja calm, ICR X system is Optrex zilver ordinare. This gentleman is shot in front of it, this is what the computer sees basically. And below that you see the numbers numbers that you saw that these are frankly part of his left arm. As you see it here and again here and I wanted to write I attend the channel also to the right guy. So this is the time that takes to see the visual acuity measure the visual and I couldn't be on the person. That's what also the patience is euro to it. You don't ask any question? The machine automatically corrected that. And then the issue when I create the measurement is conquered. Oh, yeah. So we got the machine set and we went to the FDA they ask us so how are you manufacturing? Are you making it? I said we are making it and said no, you should manufacture it before we approve it for that matter to be used by other people. And that's why I was trying to bring it to your attention whether you're paying attention to that somehow financially obviously, to develop this because the fracture in tax revenues is require some investment. But this system really can be used nicely for screening of children has grown into adults for war as everyone wants to have it taken onto developing countries and communication can be done also through the internet. We are still working the internet part of it we have completed the unit. And that's what that is there. So I thought wanted to bring your attention we are having a present a system that can measure that attract the power of a very short period of time probably less than five second mark 20 seconds in case people can't see properly. So that's why there is no communication. No have to kill yourself or the pears in front of you certainly just measure the icon. Drag the power in fact better than subjective refraction. That was it. Okay. Thank you.
Okay, so now I'm going to open it up to questions
okay, so let's open it up. Any questions, comments, thoughts people have from what you heard today. theme, yes Mala.
I'd like to add to what Janet talked about, you know, telehealth and libraries. We had our first study done this week and last week, and I know this will be relevant for this group. And it's just hot off the press. In fact, I got I got an email about a report about it just about 10 minutes ago. So I'm sharing it with you This is this is a study that we are doing with Navajo Nation. And when I say we it is the State Library participating through its telemedicine program with NAU U of A, and with a grant from NIH as well. The State Library used its LSTA grant funding to provide backpack kits, telemedicine kids with, you know, things that they could use to do the vitals like the blood glucometer, the pulse oximeter, BP, cough, thermometer, weight scale, etc. And a stethoscope that can connect via the computer to a doctor remotely, and with the software that it can use. And I'm giving you this background for this group because I've already spoken about this in detail at other meetings ACBS and meetings with Janet, of course. So we already piloted this project both at Pima and at arco, but the study itself that we're doing with the Navajo Nation is the first one that we are doing of its kind in Arizona with the liver scan study that we're doing the so the first one of the first one was done at lychee chapterhouse, where we had installed fiber connectivity just a few months ago, actually, with ERate. Dollars. We have good connectivity at some of these chapter houses. Not all of them yet because we're still working on that. And the goal was to there were several goals. One was first to introduce the population in and around to the availability of the telemedicine equipment, which we have in a Tuba City for that group. So the equipment was taken from Tuba City to lychee chapterhouse, where they did this on July 5, sixth and seventh, their goal was to study a minimum of 20 levers and they got 29 participants, they surpass the expectation, they promoted this to the local population and 29 of the participants showed up and had the liver scanning done. The the goals as I said, one was to first educate the population, show them how the liver works, what risk factors are there for diabetes obese by, you know, for those that had diabetes, obesity, smoking, elevated BP, cholesterol, high cholesterol or you know, genetic influences all of those, and how they affect the liver, that was the education part of it to this population. Then the second part of it was the scan, the doctor scans the liver, the nurse practitioner helps scan the liver and the scan goes to the doctor who is remote, who looks at the scan and makes notations for the nurse practitioner to talk to the local participation participating patient. And then the nurse practitioner discusses it with with the patient, they also have to fill up a culturally sensitive questionnaire on their lifestyle. And they, they are also told about the availability of this for follow up, you know, at the Tuba City Library, because they're the equipment is made available to them if they need to do any follow ups. So we're going to do the next event July 17, to 21st at CHI Anta and the third event from July 31, August 4 at tuberosity. And both these places there is a target of about, you know, another 80 patients at least that is 14 client and 14 tuberosity. And this, this, the result of this study will be posted to NIH and used to for preventive measures for the for those who are likely to get liver cancer. So this is one of the first ones that we're doing in the state. And we've had, I should be getting pictures for our next meeting, which I'll share and of course presented Orlando as well. So back to you, Steven, any questions. I'm happy to answer.
Very quickly. Mala, would you be kind enough to post a link to that story?
In the chat, please.
We don't have a link yet, because like I said, it's just hot. off the press, I might say. But once we finish the three studies, we will be posting it both, we have to post it on the LSTA. For the LSTA. Grant, the State Library has a grant from the libraries for the libraries from IMLS, which is the Institute of Museum and Technology Services. Since we received the grant from LSDA. For a part of this study, we will be posting the results of it there as well. And certainly, on the NIH website, but it's not ready for it yet. I know that it's relevant to this group. And that is why I mentioned that it's it's one of a kind, it's a unique study that is being done. And it's another way of using telemedicine through libraries for the health of the population.
Any other questions for Mala? Or for any of our other presenters today? Any other questions, comments, thoughts that people have?
Was a quick note on everybody that said something like Dr. Mohan? You know, you're absolutely right with the fact that we have to deal with maybe a familial or an ecosystem type of approach to bridge the gap within the Digital Inclusion space, it's more than just broadband in you know, they have to know how to get to it. So totally on board there, Janet, you know, when you talked about building CHWs, and building more people, you know, one of the gaps I think, at the hospital at that library, telehealth hubs were kind of like, can we go higher and maybe trained to perhaps facilitate those private telehealth hub consultations in public? So building the ecosystem and making sure that these young folks are both taking care of themselves first preventatively, but then also, maybe growing a more diverse healthcare workforce, I think is super important. And I love that Dr. Weinstein has something to do with my partner there. Rob. The third thing was Craig settled. So of course, like telehealth matters, it saves lives. And so that's really what I want to just put on a big flag and make sure that everybody understands. It's not just utility anymore. It's not I mean, it's not just a luxury, right? It is actually a divider right now, the longer people go without Digital Inclusion than the more likely they will fall into lower class, middle class and a high cost preventable chronic disease. Okay, so I want to like make that strong and big. And then, you know, with my OPT ophthalmologists, I, first of all, then better Lasix, hello, I mean, congratulations on that when I saw that, you know, one thing that we have been focusing on for kind of telehealth and prevention in the senior space is fall prevention and fall prevention have a lot to deal with visual acuity and the ability to use the brain. And so you know, just an example of just I took away one key thing from each one of the folks and those are what I was zeroing in on, just wanted to share that. Thank you.
I have a question. Actually, I don't know if this is for Janet, or whom it might be addressed to but with respect to the telemedicine centers or hubs, if you will add a library? What disciplines I'm just curious, are you looking to have covered? So for a remote library and State Library in Tuba City? What disciplines is that? Ophthalmology is that, you know, heart medicine, you know, what types of instruments or what types of services are they looking to have hosted at these different centers?
Then you go,
that's definitely a Janet major questions.
We have a I was trying to find a picture of the kit but it's basically a box to go for the libraries that we've written the grants for now our libraries are very French Canadian like me, they are all separate but unique. They all have different resources. So it depends upon where you go, what resources are available, but what we have piloted with to the to the city being our third site, is a kid that has a digital scale blood pressure cuff, laptop With digital stethoscope software, a small set of equipment in a box to go this being used within the library space, now it's connecting people to their existing providers. It's connecting people to whoever they want to connect to, to do health care. I mean, it's not recruiting people to anyone's specific service. If someone's health care provider currently is providing services, that's really optimal. It's also to connect people to diabetes website where they can keep their own health logs, it's to apply for jobs, it's to sell their stuff on Etsy, the equipment isn't just limited to health care, but the health care packages that we put together are specifically bundled with a medical grade tent and tables and chairs so that we can send interprofessional teams out and teach people how to use these devices. And the librarians role is to manage these resources, just like all the other resources they manage. So the really critical piece of it is the local community health centers, the local community health outreach workers, volunteers, people who want to help their neighbors teach them how to do their own blood pressure. And it's interesting, because across the country is very much of a lot of different levels, and a lot of different libraries, where some library, some beautiful kiosks have been installed in some library spaces, and some really small, single, single person kiosks and other places. Um, there are some kiosks available in some libraries to give people that private space. But it's, it's interesting, because it does vary. And of course, without the telecommunication, without the telecommunications connectivity, we would not have that and and the thing that's great about this study, the work that's being done up in northern Arizona is the fact that that really is the result of getting those chapter houses connected and getting that bandwidth available. And I see that Erin has her hand up to come into his or digital navigator expert.
That's all I wanted to add that really the library's role in this is the role that libraries have had forever, helping people learn the tech and connecting to the internet and giving them a space where they can have potential private conversations and all of that. So the library itself doesn't engage in the health care or any of that side of it. It's purely the connection to the resources and the materials that they would not otherwise have access to.
And the reality is, you know, someone could prevent a five minute pre or post surgery checkup taking a three hour drive on top of that. That's why the electronic stethoscope so there's great to take someone's vitals, your clinician is not going to not listen to heart sounds and think that it's fine if you're getting a pre or post surgery follow up. And one thing that I've learned throughout the many years that I've done telemedicine is there are absolutely some specialties that learn that lend themselves well to providing those services to people in in remote areas. And that's one of the reasons our program really exists is so people can be copper miners and sheep herders and live in rural spaces and still have access to a rheumatologist or dermatologist or something that might lend itself well to a tele application and tele ophthalmology has always been really big here in Arizona, because we can cut those trips and a half by using a non mydriatic camera and screening people in their hometown. So they're only traveling if it's necessary for follow up. And I see another hand up.
Well, yeah, I think one of the studies we're doing in Michigan is providing African American population, three digital tools Fitbit and blood pressure cuff and weight scale and through her nap, provide them the ability to monitor and share that information, not for the physicians but educators. But one thing we found is that they don't necessarily go to libraries as much as they go to Community Care Centers where they interact with others socially, to build a peer net peer communication, peer networking, to get reinforcement to what they are doing and try get some encouragement. So I think the whole concept of giving these engagement facilities need not always be libraries could be any entity that is allowing people to connect and allowing them to be able to interact not only with physician but also with social groups. To me that is really one of the key things that often community engagement piece misses the radar. We often focus on physicians and patients, but it's really the patients and their community. Who will they consider as a community of trust, trust building peep personnel, we need to start building those connections as well. And whether that is telehealth or some other technology, you really need to build a social networking facility for them. So I think it's a it's a combination and which facility is the most appropriate may depend on what the nature of the population is and how they want to interact with others?
Absolutely. And I think you think about the food bank, and what an awesome place that is to reach people with diabetes education, and we do have libraries that have a community food garden right next door. So the county health department is a great place to outreach and also Cooperative Extension. They're in every single county. And I think that's how we maximize and get the most bang for but, Molly, did you have your hand up again? Are you?
Yes, actually, I wanted to add this answer. More hands question about why libraries because, again, libraries and schools are considered anchor in such community anchor institutions, for ERate purposes and have the have really good bandwidth to do this, which is important as a technology person, I know you know that already. And especially if it has video transmission, that is really important. And we need good gigabit speeds wherever possible. And that's one of the reasons why we waited almost two years to do the study at in the Navajo Nation area, because of connectivity issues. Having said that, now, there is a lot of be defunding, which is the broadband funding that is coming through the state. And a lot of the other community anchor institutions will have access to the middle mile, they may not have access to the last mile, they'll have to do it themselves. But the middle mile at least will be available. And we agree I agree. 100%. And Janet, I know it does, because we've been discussing, doing not these one off events, like I posted on on our chat that we did to start these programs both at Pima at arco and alberca. But to continue these, you know, like having a Thursday, a telemedicine Thursday, telehealth Thursday at the libraries so that we could invite the community to be there to do whatever we do that Thursday, it could be an eye test Thursday, you know, where we have lines come and do I test for kids. But at the same time, the parents who have kids that have issues can get together and the library host the event and they can talk about the issues that they are facing the social issues they face with their children with poor eyesight. The same could be said of diabetes or any other health issue, or autism or anything else. You know, so we were looking into making this available as a community event at the library. And libraries are all you know, as we all know, trusted places where the community meets. So we're hoping that we can continue this through that.
Okay, so John, and then we got to get to Kurt because he's just dancin. So John first.
Yes, I really wanted to add, I've been working with Dr payments a little bit on the information around the phoropter. It's actually an automated phoropter. And I think it's a perfect fit for the library system or community center because it does not require a physician to either activated or implement or do the testing. So wonderful library could administer the exam, which takes literally five seconds. As you saw in the video, they sit down in front of it, and within five seconds, they have a full prescription and an alert of any possible eye diseases that they may need to have taken care of and that information can be sent to their primary care.
My questions with all this explosion of telemedicine, which makes an awful lot of sense for a lot of reasons, you know, not people that are remote and triaging and so on and so on. Is there a big push in product development and technology to where you can put more and more wearables tied into Bluetooth into a laptop or your app and get a lot more information flowing? Real Time to the clinician or whoever's doing the appointment? I would imagine there's got to be a huge product development push in that space. I just curious if you could comment on any of that.
There's a lot going on in that space. So in the US Army does amazing things I remember 15 years ago seeing a dog tag that was like basically a card out of a camera that would have your entire medical record on it. And, you know, some things make it to market and some things don't. But there are people that come up with creative solutions for like, a glove that's a 12, lead EKG are things that, you know, really are very future thinking in ways that we can keep down the cost of healthcare and keep people in their hometown. The thing that's really kind of kind of raining things in a bit right now, which was really very evident it at the American Telemedicine Association is AI and the use of data and how much is too much you know, having your having your every movement monitored. For Your Health is great, but, but when you want your mountain your every movement monitored, right? So it's an interesting frontier right now. And people are coming up with amazing stuff, especially here in Arizona, we've got really amazing biomedical engineers and bio, the whole downtown Biosciences campus and you have a tech park, there are people coming up with really, really creative solutions in terms of technology, but it's got to be a solution to a problem as opposed to a really cool device looking for a marketing plan looking for a business plan. And and sometimes that seems to be the challenge, you know, small devices that connect eight different vital signs and, and then but unfortunately, then marketing that it comes with the network and the bundle and the provider and everything when you think all I want is that device. So you know, the business model is very challenging in telemedicine, telehealth, an expert, we have a local Arizona expert and that is Joe Bartholomew is a wonderful local expert on FDA approval and getting things to market.
And I think I'll just kind of add, you know, we've been working with some mixed generational kind of theme teams that we've seen teenagers help seniors connect digitally, you know, once that connection is is taking place, it's a beautiful, beautiful thing, because now the seniors or the disconnected or unconnected, can play in the transfer of information that can actually improve their health. And well, but the thing is, everybody gets up so excited about these things. And the disparities are happening where there's low economic flow, okay. And so, you know, yeah, you could talk all these different wearables and stuff, and unless somebody's gonna write the check to go ahead and put them on, and then you go up against, you know, FERPA and HIPAA, and all these different there's a line, that's doctor patient versus commercial health, you know, consumer health. So that's what we have struggled with Rob and I, we are a for profit media and digital health publishing company. Because we play in that space of, we don't want to, we want to advocate we want to kind of be free to do whatever we want to as we try and improve healthcare. I didn't see Rob leaning forward, just
excuse me, I'm just leaning forward with this. I'm so sorry. See, if I had a good library, I'd have the kit, you can look at my throat. But the truth of the matter is, you don't need a kit. For about 70 or 80% of the things you need a health literate person who knows what piece of their history and what findings on the physical with just a good history can solve a lot. And that's where telemedicine with a telephone. It's been happening since the 1920s. In some regards, you know, take two aspirin, call me in the morning, you have the camera, it's another thing you had the kit. Now that you have a kit, and you're talking about a trusted person, a digital health navigator, who's trained in the use of that kit, who was a trusted community health worker, someone from the community or from their own family that can come to that appointment. So the librarian isn't forced in opposition of trying to be a health intermediary of some sort. So it begs towards training teenagers to retired seniors, to be community health workers, digital health navigators, it begs towards training everyone to be health literate enough that they can really share information that would help that doctor come to a diagnosis. One last point here, I think that I'd like to make with is, there's a whole nother bucket of money and opportunity here that STEM education. What is more exciting to a middle school or high school students than their own body? Mind that's all they care about, how they look how they feel, how their bodies changing. They have access to a pulse ox, a thermometer, a blood pressure cuff, etcetera, saints curriculum, and experiments on their fitness or their nutrition or their activity. These stem education can get a next generation where all these devices, and the physiology and anatomy becomes unnatural. So thanks, especially libraries, great place for STEM education workshops, teacher developments and such.
Mark, what's the stem? What's the stem event? You have a medical school you've put on downtown? I don't know if they're doing that every year again. But the kids got super excited at that event.
The person I was running and it's no longer there.
Yeah, that was a great event. Because and and you're right, Robert, the kids just got super excited with with with everything that was medical related and death scopes on their friends and everything else. I mean, it really inspired them. Yeah.
What was that? What was that event? Did you have something else that you wanted to add?
Yeah, I just want to, because I know a lot. There's a lot more disparities, of course, with people of color and low income, but there's also educated people of color that don't trust the medical bill, because of the lack of trust in the issues we've had or experience with doctors and that and so to be on, I think for telehealth and to talk to somebody, they're only going to want to talk to a trusted person. So is that they're going to because of the challenges I know me personally have faced with doctors, and I've had to change doctors, because I've had to advocate for myself. And so how do we start teaching them to advocate for their health, and know that what you're feeling is wrong? And it's okay to say it's wrong, that I literally have to advocate for my 32 year old niece, because the stuff that doctors are telling her? I'm like, that don't sound right. So how do we also bring that conversation to light in regards to how to advocate for yourself when you're a person of color?
I got news for you Rica, you don't have to be a person of color to have to do that. You know, my wife has multiple health issues. And we go through doctors and all kinds of different doctors, and have to advocate for her all the time. It's interesting experience. JT, did you have a comment?
I did have several comments. But one of the comments that I wanted to, to just I think the last speaker is Sirica. You know, she brings out the point that that in our community, I'm an African American senior, with a variety of health challenges that you might expect for an urban African American, over 60 years of age. And there is a there is a there is a there is a mistrust of the medical profession among African Americans. And you don't have to look back that far in history, or even to the present time to recognize that so that that needs to be overcome, and it is something that needs to be overcome. The other thing I wanted to go back to was in the conversation about libraries. And I think the gentleman from Michigan mentioned that, you know, I think I don't know, let me put words in your mouth. Sometimes you don't see African American participation in libraries. Because we don't go to libraries, or part of that is because even in the hometown, where I grew up in Michigan, the library was not welcoming to us. It did not have the types of resources that we went to libraries for. And we had to go to bookstores to get the kinds of materials. So as you all are planning, you know, these for these different equities in broadband healthcare, telehealth, you have to understand, obviously, and I'm not saying that you don't you but there might need to be a greater attention paid to your constituencies, those persons that you would hope to serve, because things that you might take for granted in the environment in which you're familiar. And working is not the reality of some of the people that you hope to serve, and you won't see them because they won't be there.
Oh, hon. I think he's gone.
That's a very quick feedback to you, JT. We have a program called advanced the dream, hyper focus on Minority Health Disparities, and we're finding most of our activities in community activators that we're working with are tied to faith based communities. And so we're finding we're there's probably five examples of that throughout the country where it's been very successful in utilizing that faith based connectivity, instant community and trust makers. So I hear what you're saying Loud and clear, my partner and I did an implicit bias training for the state of Ohio Medicaid to see whether or not they were implicitly bias when treating African American and brown skinned women. So we hear that point loud and clear.
I think something that we need to talk about when we talk about equity, is the fact that, you know, I'm all on board, and I keep singing and dancing like many of you about the Affordable connectivity program. But is it really is it really equitable? Is there really equity if people are still paying $30? If they don't have 30 bucks, to be connected to the internet, is it really truly equitable to think that there are people who not only will never have the internet in their home, but will not own a device to use the internet in their home? And I think that that's why we really have to be forward thinking in terms of how can we create equity, we can create access to health care and improve health equity, by having the opportunity to share connected devices. And by having places like our libraries or community health centers, or food banks or health department, whoever does it, help manage these devices, I think that has to be part of our investment, if we truly want to have equity in our future. Really, so that's my wrap.
So I think that one of the things that's obvious. And of course, Janet, you know, the telemedicine program has been involved, has been around for a long time. But this now moves into a whole new realm of outreach. That creates a whole, as we know, with all technology, new technology creates whole new challenges and things we never even anticipated. And so we'll figure it out. And it's very exciting times, but it's, we still got a ways to go. So anyway, any other questions or comments for anybody? Okay, well, I think we're up sorry, somebody's gonna say something.
I was just gonna say a quick note that we have recently formed my healthy broadband executive community chat, resources and challenges. So we will be putting this on the docket once a month, and having a standalone session on this. So happy to have anybody join. And of course, you know, Steve, I'm kind of following your lead here in Arizona, but this needs to have its own conversation and why it's so important. I wish I could snap my fingers and just have the state pay for everybody to have access and bypass the whole NTI a $30 stuff, you know, it's like, how can we just get everybody connected? But anyways, I just wanted to make that note that we will be hyper focusing on my healthy broadband issues with the force for health network coming up here soon.
For President, I'm sorry. That's Lucy.
Where do we where do we find you guys?
Oh, the Forrester health.net. You know, I'm gonna go ahead and give Steve a follow up link to all of this. I'll put it in the in the chat also. Yeah, I'll put it in the chat, the force for health.com. And then I will follow up with our healthy broadband. My healthy broadband.com actually goes to our site, but I haven't published the page yet. Because we're hyper focusing in Ohio, Pennsylvania, Arizona, Florida, Illinois, and California. So Arizonans Come on. I saw the step up, and, and get to brag a little bit about this collaborations.
Well, I'm gonna stop recording. And I don't know if people want to hang around and chat. But officially our meeting is over as as of today, as of now, and thank you to all our presenters. It's very exciting to see all the exciting stuff that's happening and growing by leaps and bounds. So thank you all for, for participating today.