Absolutely! Recently I heard a profound statement "The patient will see you now" - Remote care models give more control to the patients and as long as it continues to drive better outcomes, this shift will continue. The key moving forward is continuing to find ways to increase engagement.

Emily, this is an extremely important question to be asking. We are constantly hearing from different health systems the burnout and fatigue clinicians are feeling from the pandemic. Mental Health America surveyed 1,119 healthcare workers about their mental health and well-being, and the results were resounding: 93 percent reported stress, 86 percent reported anxiety, 77 percent reported frustration, 76 percent reported exhaustion and burnout and 75 percent said they were overwhelmed. There is a lot that health systems and hospitals can be doing to help support clinicians during this time. Leadership buy in on solutions that support mental health of providers is key as well as solutions that optimize workflows to reduce cognitive burden. We are also seeing beyond solutions and companies working to address this, if leadership shows support and makes people feel valued in their position, they are less likely to feel the stress and burden of fatigue. This can be something simple as hosting office hours or writing hand written notes to employees.

With an exponential need for remote care in the home, we have seen a sudden embrace of provider health services served up via synchronous and asynchronous platforms, changes in CMS reimbursement to pay for telehealth and subsequent embrace of telehealth technology. The big question on all of our minds is whether the reimbursement changes will become permanent. Permanence would greatly support the future of remote care.

The Medi-Cal program (California's version of Medicaid) removed the following burdensome requirements for telehealth services per August 2020 program updates: 1) documentation of barriers to travel to the provider's physical site, and 2) need to document cost-effectiveness of telehealth versus in-person care. While both synchronous and asynchronous telehealth services are covered, unfortunately, Medi-Cal has not yet adopted reimbursement for RPM.

This is a very important question especially as it pertains to medical education. We are taught very little about how to communicate ideas in the public sphere during medical school and residency. This can lead to problems as we saw with some physicians and residents being punished or even losing their jobs after speaking out on social media or speaking to reporters. Organized medicine and physician representation organizations (AMA, specialty societies, state medical societies) partially help fill this education void. However, many residents and students fail to make their way to these organizations and simply start sharing ideas without any guidance. Medical schools should undoubtedly cover the ethical and moral basics. It would also be useful for schools and hospitals to have a working policy or best practice advisory on how to communicate with outside entities. Personally, what I have found to be most useful is mentorship. A lot of time and energy can be saved when you have a guide pointing out common pitfalls and mistakes.

Our system. like many others, is quite complex. Different parts of our system reacted differently, depending on unmet needs. We always have been open to working with digital health companies, however, we work in a fluid environment, so our needs changes frequently.

I agree with Adam - requirements are quite fluid. Systems are more open to implementing new tech and solutions - but they typically need to demonstrate both financial and strategic value for discussions to move quickly. Requirements change rapidly and often during the pandemic, so digital health startups must be agile in implementation.

During the pandemic, we in the ER were constantly looking for ways to decompress. Remote patient monitoring was surprisingly a strong ally in this battle. One of our biggest achievements in our ER was creating a program that allowed us to send patients home with a free pulse oximeter to monitor their condition. A predetermined program would text the patient twice a day asking to input their latest pulse oximetry reading. Once the patient hit a certain level, the program would prompt the patient to return to the ER. This entire venture was thought up and coordinated by an emergency medicine resident which is probably why the physicians/care team burden was nearly zero. It became so easy to sign people up for this program that the rate limiting step was that we didn't have enough pulse oximeters to hand out. My personal belief is that considering care team burden at the inception of the innovation is crucial. As most here may already know, many innovations fail at the adoption stage. Entrepreneurs should be thinking about barriers to adoption at the very beginning stages of their idea in order to ensure this hurdle is successfully cleared.

We have an FDA-cleared medical grade wearable solution that provides readings of SpO2, HR, HRV, respiratory rate, temperature and more every second automatically, that
detects even minor deviations from the established patient baseline through predictive algorithms driven medical intelligence. It has a clinician platform and provides smart, AI-powered notifications -100% free of false alerts -, triggering non-emergency alerts based on patient parameters helping health care providers to identify true alarms.
It classifies patients into clearly defined diagnostic categories & severities, provides predictive trends and multi-parameter baseline variations, allows Immediate & prolonged clinical response to interventions and provides effortless rapid clinical decision support.

Yes, I would say most RPM solutions are being built and implemented with the provider in mind. Without their buy-in and understanding of how to use the data in an actionable way, it becomes an ineffective tool. In addition, if the solution can actually provide analysis to streamline the data in a clean, quickly comprehensible way - even better! I would say some startups that are doing this really well that come to mind are PatchAI, Healthsnap, and Life365.

We're interested in the enhancing the user experience of virtual, telehealth care delivery. The last thing that we want to do is recreate poor analog experiences in a digital format, i.e. waiting rooms, appointment scheduling. It has been great working with existing vendors, and newcos to think thoughtfully about designing for the medium.

Policy is going to be critical here. What will happen to copays and reimbursement in the long run? These factors certainly impact patient utilization rates.

I strongly agree with Emily here. We are at an extremely exciting junction in the way care is delivered and it will be fascinating to see where policy takes us moving forward. With new players entering and quickly rising in this space, it will be interesting to see how their new care delivery is addressed alongside incumbent models.

Th pandemic has placed a disadvantage to those who did not have a preexisting relationship. Nonetheless, the emergence of virtual meetings has reduced travel and increased opportunities. Be aware it does take time to develop relationships with investors. The better VCs will be helpful and open to continuing the dialogue.

In a lot of ways, the pandemic opened a lot of doors for fundraising. While it's difficult to replace the value of in-person interaction, the virtual world has allowed these entrepreneurs to network and interface with investors at a faster and expanded rate. In addition, more investment capital is being thrown into the healthcare arena. It's also been fascinating and exciting to see so many startups, VC's, and corporates pivot into the space.

I agree with Nathan - I've met with more startups, ventures in the past twelve months than in years past. On the flip side from the health system fund perspective, we have had to reorient our thinking and how we evaluate ventures given all of the financing activity: what does the new market look like? How has the best in class shifted? What does the implementation lift look like for our team (and actually for real)? What do we gain beyond the feature set? What do we get tomorrow by investing in you today? These sorts of questions have changed how we've approached our pipeline.

Entrepreneurs have been getting more meetings in general- it's easier to find time without travel eating up VCs time so heavily. But generating evidence has been more challenging in general; activating pilots and clinical studies has tended to slow, so startups have been burning capital for longer than they expected in some cases. This has put some in a more vulnerable position while fundraising.

My observations agree with pretty much everything written above. I would add this detail: the pandemic resulted in the reassignment of many of the people previously working on health system innovation teams. Outside of telehealth and remote monitoring solutions, it seems that most startups have faced an even larger barrier to entry in the pursuit of pilots and health system customers.

From my perspective, COVID accelerated change and attitudes. Virtual care, hospital in the home, etc, will become the norm.

Lung function monitors and other wearables will likely see a boost in the next few years. The key will be how they transmit data back to the health system, who there is responsible for it, and how it impacts the care workflow.

I'm not directly familiar with what was granted EUA outside of those domains, but some really big tech focus areas that exploded were point-of-care diagnostics, at-home diagnostics, RPM and preventative medicine in terms of nutrition and mental health.

I agree with Nathan, remote patient monitoring and hospital at home are definitely here to stay. In addition, we are seeing a lot of focus on behavioral health and health equity, as COVID has put a huge spotlight on growing inequities in healthcare.

COVID-19 testing, diagnostics is also a segment that were granted EUA. One vendor example, is SalivaDirect, an open source low-cost, fast, saliva based COVID-19 test (news.yale.edu/2020/08/15/yales...), developed by Anne Wyllie and Nathan Grubaugh at the Yale School of Public Health. The SalivaDirect protocol and test is particularly useful as it can be used by smaller labs to support local testing, since samples don't have to be sent to larger testing labs, enabling more efficient turnaround and lower costs. The test was clinically validated in partnership with the National Basketball Association during the 2020 playoff bubble. COVID-19 testing will remain crucial even as our vaccine access increases, and for monitoring variants as they emerge.

In March/April of 2020, the benefit of talking to MDs in Washington, Italy, Israel, etc, was extremely helpful. We shared numerous protocols and approaches. We benefited from the experience of international colleagues when the pandemic hit the Philadelphia region. We published our experience how we maximized social media as part of our learning curve for COVID.

At Mass General Brigham, we created multiple new applications and programs to care for our patients, visitors, and MGB employees. Some examples include utilizing chatbots to triage COVID-19 symptoms early on in the pandemic (hbr.org/2020/04/how-hospitals-...), creating a custom developed daily symptom screening application for employees (COVID Pass - formative.jmir.org/2020/10/e19...) and patients/visitors (MGB Prescreen), and enabling patient vaccine eligibility checks via text message. COVID Pass, in particular, has seen over 10 million attestations across our organization since implementation. We also made the source code available to other institutions to use.

Like most other organizations, we also saw an incredible increase in our telehealth utilization and expansion during this time and created tools and programs to augment these efforts as well.

It's certainly been a busy year!