And he returned to normal coming out of this pandemic includes a big piece of returning to the normalcy we used to know at work, but so much of that is tied to who's ill who's not.
How do we know?
How are we going to track people coming and going and how are we going to change the nature of that space based on what we might know about people's conditions or potential immunity or down the road Their vaccination status, this is complicated and all we wanna do is get back to work.
Now what?
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I have two guests who are gonna have some pretty good ideas about that.
Dr. David Rhee is Microsoft's global chief medical officer and also an adjunct professor at the Stanford med school.
And Ken Ehlert is UnitedHealth group's Chief Scientific Officer.
Now you may know United Healthcare very likely your insurance company at work, statistically speaking But UnitedHealth Group also rolls up optim which is another side of the company that's in the Pharmacy Benefits and healthcare side.
They're really big.
And let me start with you, David.
You've got a new program you've launched with UHG called ProtectWell, what does it do?
Yeah, so it's important to recognize kind of what the ProtectWell program is and what it is not a large part of what it is is around for us to Mechanism for us to screen triage, provide expedited ordering of labs using digital tools to help employees understand whether or not they may be symptomatic and potentially could be folks that could be spreading infection within the workplace, intervene early allow employers the ability to potentially have tools that could screen upon entry and then in the process If an individual were deemed to be symptomatic to be able to expedite the processing for getting a lab test and that results back to the employer, that's the type of programme at a high level, you know, having an employee having an app be able to then ask answer a series of questions about whether or not they may be symptomatic.
And then in which case if they're not, the employer would screen them upon entry into the facility.
If they are having problems, a process where by this would enter into closed program for lab ordering and testing.
Okay so here is my question, this is an app I would have, I would do voluntarily sort of a questionere each day that I'm intending to go to work.
And say here so I feel, doI have certain symptoms Isn't the idea of self reporting and self identifying one of medicines big headaches going into this?
How do you turn this into accurate data versus conjecture?
Or even on my part fear of admitting something that I think says I'm sick.>> In large part the best way for us to be able to control this infection is identifying symptoms early on and other risk factors.
It could be presenting to identify individuals for whom we need to intervene early.
These are based on CDC criteria.
These are known that we, and they continue to evolve.
But the most efficient way would be to ask individuals on On a daily basis.
We've used the tool that's now being widely adopted across the world, it's called the Health Bot, and that's the technology that would be a good front end tool to allow for the symptom assessment and triage.
That is something that can be customized.
It starts off with the CDC protocols, but clearly it can be modified based on others and continue to be updated.
And what we found is that that is a tool that can also allow for high volumes of symptoms to be assessed and triage very rapidly.
And you're getting accurate, truthful data when people self report.
When we started thinking about protocol, how do we put this together?
We actually were starting with not workers in general, but actually very specifically our healthcare workers, people who are on the frontlines of medicine and how could we actually help keep them safe?
So the protocols actually were developed out for this, were actually done from a perspective of I've got somebody that's in a particular role.
Maybe they're a receptionist, maybe they're actually a physician in a room with somebody.
And they have different needs for how they interact with the patient and depth different levels of safety that needs to be kept.
So if maybe an ICU worker needs to get attached on a more frequent basis Or then say a reception worker or somebody who's cleaning the rooms afterwards.
There's different protocols that are there.
So when you're asking, what happens next.
I put my symptoms in, those are tracked, there's patterns to how that develops out.
What happens next is depending on the type of role that you're in That helps us to figure out what do we need to do next?
Do I need to order a test or is this a person that really the best thing is just stay home from work, let's check your symptoms again tomorrow and again the next day?
And maybe that's when you actually need to get the test ordered?
Okay, interesting.
So you're able to, as you guy see it, it's not as you're gonna striait the workforce and say some people They can go home.
Others are more essential at the office.
We need to treat them differently because they will keep working.
Well, yeah.
And if I take the healthcare worker, in particular, when I'm working with them, I'm looking at some of them saying Who are they interacting with?
So you know if I'm talking to my kids, and their their grandmother, who is a very high risk individual, you want to know that whoever is working with grandma is actually safe.
Those Those people might need to be tested on a very regular basis just to make sure that they're not bringing a virus in.
Because somebody like that gets sick.
It's going to have a very tragic outcome.
So when we're thinking about this, it really is about who are the ones that are highest priority to keep working and Who are the folks who are interfacing with the people that will have the most severe consequences if actually a virus is introduced?
Okay, so now we're getting up to the topic of contact tracing, which has become the topic as in the last week or two as we start to reckon with going back to work, which is imminent as of what?
Today is May 21st.
We're getting to that level where we're starting to open America back up What is the component of contact tracing?
To what degree is that happening in here, David, in terms of what protect well does, are you using the smartphone technologies that are being deployed the Bluetooth Low Energy beacons sort of thing?
Are you doing it in a different way or you're not doing it at all?
Once those individuals are identified, there may then be a second component which you're talking about, which is contact tracing.
That is not part of the protectable program.
We certainly recognize that that is a part of the overall program that we need to be implemented.
But that will be a decision that we made on a player by player basis.
Okay, so you don't have that built in vertically here.
You could interface with that, I imagine.
Potentially Yes, depending on the employers, desires and wishes.
All done, of course, in the context of what they reveal reveal is appropriate to the employees and they think it's something that we can all stand behind.
One thing that we've done at Microsoft and something that the also stands firmly behind is we, we believe in transparency.
You know, we believe in informed consent.
We wanna make sure that people understand that the data that are captured are done in a way that meets certain standards.
And so these are the types of things that we've also adopted to protect.
>.Well, let's get down to the nuts and bolts of how this would be deployed.
I think we got a pretty good idea of what it does and doesn't do it.
I understand this is going to be made free to all employers.
Does that mean all United Health Group affiliated employers or all employers can?
And no, that means all employers.
It's, you know, you, Brian on a topic like this when we're dealing with infectious disease, it's not just about you and just about me.
I'm not doing this type of tracking in order to just keep me safe.
I'm actually doing it to keep all of us safe.
So the more people that are actually downloading using and tracking symptoms, the safer all of us will be.
So it's important that this is safe for everybody and available.
To all employers.
Okay, and when will this be available to employers?
If they have an HR team, it's hearing this interview and saying, Okay, we got to look into this.
When can they start to do that?
Who do they contact?
Right now you can start Start to download that, so the employer can actually, you could, if you're an employee, you could actually go out to one of the app stores, you could go to the Apple App Store, you could go to Google Play, and download the actual apps that are used.
And the employer actually if you go and look at that, once you download those things, you can actually reach out
On the United Health Group page, you can actually get to Who do you need to actually speak to in particular, there's a there's a spot there to actually put the folks in.
But it's not required that we actually have to interface with everybody that's out there.
It's designed to be this is something that somebody can download themselves.
Get it going.
So a small employer that has five employees could actually get it up and going, put their own employees and let them start to interface themselves.
Okay, that was my next question is how much infrastructure is there here It sounds like it can be it can scale from very light and and self administered to something much bigger.
Yeah, we've been working really hard with Microsoft on this one to make it so that this really is something that can be given to everybody.
Maybe I use a different example for that one, right.
So if you had a delivery driver that would bring in packages and they're on the road all the time.
They take random drug tests, for example, would you want them to be opt in or opt out?
Or would you actually want that just to be part of what they're actually doing?
And you would answer I want that to be part of what they're doing.
And the reason is, is it is not just about them, it's about the people around them as well.
So the issue on that one really isn't about opt in and opt out as much as.
The data is there is only being used for the purposes that has been designated.
Only being used to say, this is to help identify somebody and actually get the resources that are necessary that are required so that we can keep all of us in a safer environment.
So David, that brings me interesting question on Ken's remarks there.
COVID-19 will eventually either be cured with a vaccine or it'll be a managed infection we deal with or a virus we deal with like the flu, whatever it is, we know we're going to get through this in some kind of way.
This platform seems to have the legs to do more than that.
You didn't just get into this for COVID-19 did this not Come about because COVID-19 gave you a moment and a mandate to do something that is good for healthcare generally.
This program is designed really through the philanthropic efforts of both UHG and Microsoft to be able to see what we can do to help organizations be able to have a safer return to the workplace.
And that's been the primary goal.
Now in the process of being able to capture this data, this data can be helpful in the context of understanding where outbreaks may be occurring so we can intervene earlier and it could have direct implications on public health.
These are the conversations that we wanna have up front with the employers to let them know that Would you.
And this is something that we think in an anonymized way this data could be used to have a broader impact, in terms of not just your own employees but the health of the nation.
And we believe that that's one of the sort of opportunities for us.
Start looking at how this aggregated data in an anonymized way can be used to better understand what's happening and act earlier.
And does that go beyond COVID-19 to other like chronic conditions we're dealing with year in and year out.
Well, our focus is just on COVID-19, and again, all the conversations today are specific around what we can do to help specific to that out there.
The concept of What we're doing relative to having larger groups of organisations collaborate and be able to share data for purposes that we all agree upon, it's something that could be applied as a model for other types of things.
This isn't a program specific to COVID-19 .>> It's a really good question.When we're sitting here at United Health Group we are thinking about how do we help everyone?
How do we help everyone live a healthier life, the principles of doing things where we can prevent, detect and intercept disease actually goes across all disease.
However, The thing that's different about an infectious disease versus a chronic condition like say diabetes, is that the impact on those around you like right now.
So, a technology like this very appropriate to say.
How do you and I that are in the same workplace, get to a point where we are actually keeping each other safe.
And that's an important thing to be to be thinking about and working against.
And the reason they need to be separated is, at an underlying philosophical perspective, the first case like COVID-19 or some other infectious diseases, we're working to protect each other.
In the other case, a chronic disease, Now, I'm trying to help you with your condition that requires some different thinking, allowing you to opt into that type of a program.
Maybe you don't want help with what you're eating today.
And we say, okay, I need to be a little bit more distant, but maybe you do but if you do that That's for you to ask for that type of a help.>> Yeah, interesting when you lay it out that way, it's respecting my freedom for non communicable diseases, to not seek help as much as we don't want that to be the outcome.
We do have to respect that liberty is that kind of the idea Yeah, that's the idea, it's like mom said when you're growing up.
You're right to swing your arm, stops when it hits your brother's nose.>> [LAUGH]
And so that's the infectious disease example there, but there's other things where actually it is about you and what do you need to actually manage yourself.
Viewers of this show are familiar with the fact that I'm big, big big on on signals exposing our signals.
I think it's absurd that I know way more right now about the temperature and the status of the cores and my computer's CPU.
And I can pull those up in three keystrokes.
But I won't know whats going on inside me until I see my doctor again, and I don't know when that's gonna be during all this and the best its once a year.
The absurdity of how little data were exposing from ourself.
Do you see a path down the low where this core platform however it glows on the future Is also gonna tie into lots of sensors in signals about how we're all doing beyond just self reporting.
David, do you see any of that.
If we can build those in with the same level of privacy, transparency towards other conditions that people have the ability to understand how it's going to be used, who is gonna be used by And absolutely this is the same technology it allows us to be able to do the type of data capture analysis sharing in a protected secure manner.
And we recognize that, this again is a model that can be used, but there have to be certain customizations and processes.
Put in
Depending on the type of condition you're talking about,
yeah, I just think we're wearing so many sensors now and in the near future temperature sensors I think are going to become pretty common.
A lot of us are wearing biometrics on our wrist and yet, no one's become the hub yet to use that as a way to say this person is trending this way.
Or this way.
Our dashboards are off almost the entire year.
We wouldn't drive our car that way.
And yet we do it every day with ourselves.
And so I'm always looking for platforms like this that might become the new base for us to pull in all the signals.
That seems to be a tricky one.
I wanna end on on a question about standards, which you guys are doing, obviously to very large companies that can carve out a big slice of usage on the American landscape.
But it's not a global or world standard, and others can come along with competing things.
It sounds to me like we get to the fragmentation of the electronic healthcare records, which are, what, three or four majors.
Or even pet microchips, there's three or four majors ones of those.
Sometimes it feels to me like we need one of something How do we drive toward a future of having the dashboard of Americans health or is that not needed?
Good question.
Do we need the actual dashboard, you need a dashboard for you and I definitely need one for me.
And as we're going through those things, my family needs a dashboard.
You know, and I have aging parents and I am thinking about how do we actually interact on that.
There is a need for a dashboard there.
Now the question of Doesn't need to be one, or doesn't need to be a set of components and some sharing of data back and forth according to different standards and is that really the better layer for the standards?
That might be actually See, the more?
That might be the more efficient way to actually get out and answer that question that allows us to actually give, you know different experiences to different types of patients.
Some patients are not going to work with a dashboard that sits on their phone.
The dashboard, if you will, that they need is somebody checking in with them.
So when we go into roughly a couple million homes homes in a year and actually check in on people and try to understand what's going on, a lot of those members don't have a smart phone that they're actively using with the apps in front of it and dashboards and things.
Sure.
I'm wired up and you're wired up but they're not.
Their dahsboard, we're gonna call it dashboard, is a person.
A nurse practitioner that's actually engaging with them directly grabbing those signals and actually then saying back to them, this is what needs to happen next.
You know, when you're in that zone of saying we want you to be healthier, how do we need to best interact with you?
It probably doesn't come down to just one.
As you pointed out earlier, you might have a lot of things on your computer.
And there's great things that are happening in there in terms of temperature and all those things.
But we are a little different than a computer or biological and that means our systems actually keep adapting.
Your computer isn't quite adapting on you like that.
We are though, and that really helps us to start thinking about Different time what's happening right now, if you're a type one diabetic and what your glucose level is, that matters a lot, and probably real time sensing matters.
But, you know, if you're somebody that's developing out, hypertension or something like that, that, you know, that's not something's changing minute by minute in a way that's relevant.
Yeah, that's right.
It's it's coming along in small doses and the body's adapting to it.
It's a couple of moving target where it's funny where it's funny, right?
It's, it's not like hardware and software, which kind of does what it was built to do.
Right.
We're an interesting bunch.
All right.
Thank you for your time.
Gentlemen, I've been talking to Dr. David Rhew.
Who is the global Chief Medical Officer at Microsoft and Cain Ehlert who is the Chief Scientific Officer at UnitedHealth Group.
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