Hello, and thank you for joining us for today's Heart Rhythm Society's Imagineer Showcase. My name is Amber Soller. I'm a nurse practitioner and the arrhythmia services program coordinator at Cone Health in Greensboro, North Carolina. I'm excited to be joined today by David Fagan, who is the chief digital health officer and vice president for information technology at Boston Scientific. We're very excited about hearing about the MyLatitude patient app. David. Thank you so much. Incredible pleasure to have you join this virtual session. And we're thrilled to share some of our capabilities, some of our solutions at HRS. So thank you. I'm going to start with a little bit of an introduction to digital health at Boston Scientific as if the last two months haven't happened. And then after that, we're going to go deep into COVID and a post-COVID world. But two months ago, we were defining digital health as really the broadest application of information technology, the utilization of analytics, big data, cloud, internet of things, mobile technologies and apps, social media to really deliver engaging and personalized solutions that drive health care efficiency. And our goal was to use digital health to connect our devices, our data, our clinical insights into offerings that really exceeded the patient, physician, and health system expectations and modernized and industrialized health care by resolving all of those hassles and frictions. And in many ways, it was a play for efficiency and improved outcomes and patient engagement. And then COVID came. And when the pandemic turned into what it is now, we realized that digital had moved from a nice to have patient engagement, small efficiency gains and improved outcomes to an absolutely critical capability that drives safety, that's critical to health care continuity, and that's honestly critical to business continuity. So we were very fortunate that we had been building these capabilities for the last three and a half years. And we'll share some of those capabilities with you. And those are the same capabilities that are going to be incredibly critical to us in a post-COVID future. A lot of the things we were doing, practically all the things we were doing, we're still doing in terms of digital and connectivity, but we're shifting focus. We are now really very acutely focused on what we call tele-everything, tele-mentoring, tele-health, tele-service and support, tele-triage of patients, tele-monitoring, obviously. And we're doing all these things because we believe that health care is going tele-first. What we mean by that is that every interaction, whether it's a physical interaction in person with a physician or a salesperson interacting with a physician or a physician to physician interaction is all going to be preceded by a tele-interaction, a digital virtual remote interaction, whether it's a simple text message or whether it's a full-blown tele-health visit wearables, monitoring your health and so forth, health care is going tele-first. And what you realize when you start thinking about tele-first care is that the role of data becomes even more important than it was. And we've been talking about data for as long as data has been around. But when you think about what you need to enable a tele-health interaction, you need data. You need to understand the patient, the record, the situation the patient is in, what their wearable device is telling them. You can't have a high quality tele-interaction without data that engages patients, that remotely connects clinicians to their patients. But also every one of these tele-interactions actually creates data. When you have a physical interaction, you know, usually nobody's really capturing that data, the exchange, but every tele-health, tele-interaction creates valuable data. And what we see is that that combination of digital and data really feeds off of each other to create and drive innovations. And that's really our strategy going forward. How do we leverage data optimally for those tele-interactions and how do we make sure that we capture the data created by those tele-interactions so we can deliver optimal care? The one example that we wanted to talk through, obviously very relevant to this group, is the MyLatitude patient app that's now commercially available. And it's appropriate for all Boston scientific implanted devices on the Latitude system. And it's basically a supplement to our communicator and to our implanted device. We do everything from education and information sharing and some other features that we'll go through in a second. The main purpose of the app was really to provide patients that peace of mind, to help them get comfortable with their device, that it's on, that it's working, that it's functioning as it should. And also to make absolutely certain that those patients are getting the best possible care by being monitored. And the app really helps us with that. It really helps us drive compliance for remote monitoring. But there's the other side. There's the patient side and, you know, obviously as important and sometimes more important, there's the clinician side. And for the clinician, we leverage this platform, this mobile app, to reduce the burden on clinicians that would otherwise have to be answering calls about the remote setup, about the system, about even the device that they have implanted, so that the clinicians can really focus on the essential care. And one of the key things that we learned from this process was, yes, of course it's about the patient and giving them the peace of mind, but it's also about their loved ones. It's about their sisters and their daughters and their spouses who can now check in to make sure that their loved ones are staying monitored and are in good health and in good compliance with their monitoring as well. So before we go a little bit deeper into this particular digital application, it's important to understand that this application is evolving continuously over time. We're always adding features. We're always learning. We're always adding more functionality. And the way we're able to do that is really because we've developed this digital innovation capability. We have stood up what we call digital health studios across the company, and this is one of those digital health studios. What do we mean by a studio? Well, imagine a small, you know, four, six, eight person startup that's working as a startup, but within Boston Scientific, within this very large medical technology organization. That enables us to go incredibly fast, be very nimble, be very agile, while still ensuring compliance with the quality, regulatory, security, privacy, all those things that being a 10 plus billion dollar company enables. The way we do this is we have small teams. We have a product manager, a leader who ensures those lean startup agile development principles and balances the physician needs, the customer needs, the business needs. We embed design, user-centered design is absolutely critical, starting from a deep understanding of what the user is going through and what their needs are, and also engineering, so that the designer can identify an issue, understand the issue, literally lean over to the engineer, said, hey, how can we solve this problem? The engineer writes the lines of code and develops the feature, and this circle, this build, measure, learn circle, continuously iterates, starting with the most important feature, getting a product out the door called the MVP, or the minimally viable product, and then gradually learning and building out more and more capability, and that's what I'll talk through in the next few minutes. So one of the things that we are really proud of is our approach to user-centered design in building digital health, and I'll just share one example here of the learning that we had with the MyLatitude patient app. When we started, and typically when folks start in digital health, they think of patients, well, we're going to build something for the patient, and what we learned very quickly, there's no such thing as the patient. There's a huge, huge variety of different patients with different expectations, different conditions, and we were going to, you know, release some features, and initially we thought, hey, these patients, they're going to all want to use this data, and they're going to engage with the data, and they're going to change their behaviors based on the data that they see. We really envisioned this user as a data, as a tool, right? They're going to use this data as a tool, and what we learned very, very quickly was that there are individuals that are completely ambivalent. They, you know, give me the data, don't give me the data. I'm not going to either change any of my behavior, and it's not really going to affect me, but we also found a large portion of these very specific patients who had a lot of anxiety, who didn't know if their device was working, who weren't sure that that it was doing what it was supposed to be doing, and we realized there's an incredible opportunity to reduce their anxiety and give them just enough data to make them feel comfortable, and obviously simultaneously reduce the burden on the clinicians, and of course, we found individuals who are really data-averse. They say, I don't want the data, don't show me the data, The data is only going to make me more anxious. Just just keep it from me. I trust my doctor and I don't want to I don't want to hear anything about that. And so when you roll out, you realize there are two critical things. First of all, every patient is different and you really have to be careful with what you share. And obviously, you also have to consider the incredibly critical role that the physician continues to play in these interactions. And so whenever we roll anything out, it's always with a full engagement of the physicians. So as we've this is a few screenshots of the app. And as we rolled out features, we learned more and more. We learned about what information we can share. How do we educate? How do we encourage people to to set up their communicator? And how do we even troubleshoot any kind of issues they might have with their remote monitoring? And what else can we do to really help those purposes? One of the one of the most interesting anecdotes is how we there was a desire to put a battery status indicator because obviously, at some point your battery runs out and you need a new device. So we put a little like on and we said, oh, your battery status is okay. Or at least that's what we were testing. Your battery status is okay. And we thought, well, what could go wrong with that? And immediately the feedback from patients was, well, why is it just okay? Why isn't it great? What do you mean my battery status is okay? So it was it was a it was an incredible, quick learning, obviously, before we rolled anything out. But something so simple, and still requires extensive user centered design and insight in order to really get it right, and accomplish the goals of reducing anxiety, and reducing the burden on physicians. Perhaps the most exciting clinical component that we've been able to drive is what we call push notifications. Push notifications are when we push out notifications to the patient that their communicator is not connected. Well, what does that mean? That means they are not being monitored. That means events could get missed. And it means they're not receiving the best possible care. And now you're talking about a relatively simple feature, but huge clinical impact. And 71% of the patients that we've actually informed, that their communicator is disconnected, whether it got unplugged, or maybe they put in a new Wi-Fi router, the vast majority of those 71% of those patients have resolved those connectivity issues. And again, that is a meaningful clinical impact and improvement to their lives. And we're very, very proud of that. Again, not the most complicated feature, easy to use, but really important clinical impact. So now I'll just give you a sense of this was a very deep dive into my latitude. But we're really producing solutions in digital health across BSC, whether it's to enable remote access, the HeartConnect programmer enables that tele-programming so that we don't actually have to send clinicians and reps to help program the devices. We're working to reduce the cost of care, again, as critical as ever. Improving outcomes, we are looking into obviously how we can do and what we can do for the pandemic to slow the spread, identify early indications. A lot of things that we're working through the heart logic, heart failure diagnostic is available today. It's an incredible predictive algorithm to really avoid negative outcomes and thereby improve outcomes. Again, huge benefit in terms of costs and patient care. And obviously, we're working to continuously engage patients in their care, in their care journey as well. So let me just conclude that all of these things would just not be possible without the collaboration of physicians who we work with, the patients who we care for, the health systems that we work with. Again, when you're trying to go agile and lean and iterate and learn, it really takes a collaboration to drive transformative care. So thank you very much for your time today. And I think I'm about ready to take questions. Thank you so much, David, for that presentation. I think as clinicians, we're all excited about where this app space can go in the future as we strive to help take care of patients in new and better ways. And as you pointed out, COVID has kind of forced us into this virtual world. And so having new tools to manage patients differently, we're all really excited about. I think as an AHP, one of the questions that I have and one that a lot of people are going to have after they listen to this presentation is, you know, how do we get started? And what's your plans to message to clinicians and to clinics and to patients that this technology is available and that it's available for all patients on Latitude? And just your plan for how do we roll this out in a way that's meaningful across the country? Yeah, that's a great question, Amber. Thank you. We're already rolling it out. The app is absolutely available for patients. They download the app and then they need to register, obviously, so that we can confirm that they're our patient and have our device and make that connection to their monitoring data. And for physicians and clinicians, we strongly encourage them to have those discussions with the Boston Scientific Reps who can absolutely guide them through the process. So I think the need is there, the value is there. Probably our biggest learning and what we're seeing is that the loved ones of the patients that we serve in particular are incredibly enthusiastic about this. The ability for them to monitor remotely, to be more engaged in their care is an incredible draw for this type of application. And we're here to help. We are. We're advertising it. We're rolling out and we're really seeing significant impact and even some improved monitoring compliance. So we're excited about that. Perfect. And I think, like I said, as clinicians, we're really excited about it too. And we absolutely agree with the caregiver aspect. As we've done more and more virtual health visits and have caregivers' ability to enroll in MyChart or these patient portals as well, I think this is our new normal. And so it's on us to really just let patients know that this technology is available and let their families know. So that's really great. I think, you know, EP has been a front runner in virtual health, right? I mean, we've got Apple Watch and we've got Cardi and we've done remote monitoring and virtual health really for over a decade. And so while this might be new to cardiology in general or some primary care practices, this is really what we do. But we still hear a lot of pushback, you know, that patients don't have access to the technology. And even if they have access, perhaps they're not willing or able to use it. And I just wanted to see if you could share a Boston Scientific perspective on that, on, you know, can anybody use this or, you know, do you have concerns about age groups' ability to use this app? Well, it's so important. I spoke about it during the presentation, this idea of user-centered design. If your user, you know, is a 80-year-old, that's different than a user who's a 50-year-old. And all of those things, if you saw the app, you know, very clear, crisp, very simple. We have not seen any really significant broad barriers with adoption of these apps. And honestly, the industry has moved quite a bit because of Facebook, because everyone talks to their grandchildren on Facebook. And there's honestly an expectation that you are going to be engaging with patients in this virtual way. And all of that was before COVID. I think what has happened, especially on the telehealth side in general, there were a lot of barriers. There were people who didn't really understand, well, what button do I press? How do I schedule time? Do I get to talk to my own physician or not? Will it get reimbursed? Is the physician available? Are they interested in connecting with me virtually? And, you know, I'll be the first to say that tele-visits are not for everyone and obviously not for everything. But I believe and I have seen an incredible reaction when people realize how broadly applicable it is and how much you can actually get done virtually. I think that's honestly something we've all learned just as employees trying to get back to work and having virtual HRS meetings. It can be very, very productive. Is it as good as being in person? Maybe not, but it is incredibly convenient. And now that we've removed so many of those anxiety barriers, fear barriers, reimbursement barriers, scheduling barriers, you know, physicians not being sure that they can really deliver optimal care barriers, what you're going to see is what you have already seen is an incredible acceleration of adoption. But what you are only at the very beginning of seeing is the innovation, right? Because this data plus digital innovation is going to create opportunities for tele-first care that we haven't even really imagined yet. And that's just going to explode adoption. I agree. And like I said, we're really excited about it. And I think, you know, one of the interesting things to think about is where this technology goes in the future. You know, one of the late breakers this year at HRS was using a smartwatch to remind patients about their need to take anticoagulation and the significant increase in adherence using that technology, which is really, it makes total sense, right? And so as you think about this app and how you can integrate it with devices in the future and what that looks like, where do you see this going, you know, to keep patients involved in their care and on our team? Yeah, no, absolutely exciting approaches. And again, I think that's that beginning of that innovation. I'll give you a sense of where Boston Scientific is going strategically. There is so much opportunity to really create optimal tele-first care in deep clinical verticals, heart rhythm broadly, atrial fibrillation specifically. And that's really not just engaging with patients, but really enabling and giving the tools to the care providers for shared decision-making, for optimal care pathway journeys, for algorithms that can help you understand and identify. Again, there's just too much data for any physician to fully understand in real time, all the data that's coming at them. So you need tools and we are starting to develop and build out those tools for physicians to really be heroes, to deliver the best care they possibly can on a really, on a global basis across the care journey. So that's a little bit of a strategic seed and we are building out those solutions today. Perfect. Well, thanks so much for sharing about this app. And like I said, we look forward to seeing where it goes in the future. Thanks everyone for joining us today. My pleasure. Thank you.

MyLatitude app

remote monitoring

data

tele-interaction

patient preferences

digital health solutions