Read the Transcript: Innovation in Times of Uncertainty

The COVID-19 pandemic has presented unprecedented challenges and, at the same time, a unique opportunity to embrace digital health solutions. Responding to COVID-19 requires swift and innovative thinking, and although digital health has been on governments’ radars for decades, progress has been slow.

Is the pandemic an opportunity to address the longstanding gaps in health technology? Will it motivate governments to procure and distribute innovation more efficiently? Or will buy in become a greater challenge due to the increased uncertainty that we are all experiencing?

In this episode, Inder Singh, Founder and CEO of Kinsa, and Dr. Sacha Bhatia, Chief Medical Innovation Officer at Women’s College Hospital, join Ross Wallace to discuss digital health care amidst the pressures of a global pandemic.

Inder Singh is the Founder and CEO of Kinsa, a public health company with a mission to stop the spread of contagious illness through earlier detection and earlier response. Prior to founding Kinsa, Inder was the Executive Vice President of the Clinton Foundation’s Health Access Initiative. In this role, he helped two million people access lifesaving HIV, malaria and tuberculosis medications by negotiating lower priced drugs and diagnostics in 70 developing nations. He also holds five academic degrees from Harvard – MIT Division of Health Sciences & Technology, Harvard’s Kennedy School, MIT Sloan and the University of Michigan.

Dr. Sacha Bhatia, Chief Medical Innovation Officer and F.M. Hill Chair in Health System Solutions at Women’s College Hospital studies the appropriateness of care, digital health innovations and health service design. Dr. Bhatia leads rigorous evaluation of digital health tools to move new models and policy approaches from theory to implementation, evaluation and spread, and scale across Canada. Dr. Bhatia is an award-winning cardiologist and he received both his MD and MBA in Health Care Administration from McGill University.

Listen to the podcast episode here.


Ross Wallace: Hi everyone. My name is Ross Wallace, and I’m a Principal here at Santis Health. Today I am joined by Inder Singh and Dr. Sacha Bhatia to discuss digital health care amidst the pressures of a global pandemic. But before we dive in, let me introduce our guests.

Inder Singh is the CEO of Kinsa, a public health company with a mission to stop the spread of contagious illness through earlier detection and earlier response. Prior to founding Kinsa, Inder was the Executive Vice President of the Clinton Foundation’s Health Access Initiative. In this role, he helped two million people access life-saving HIV, malaria, and tuberculosis medications by negotiating lower priced drugs and diagnostics in more than 70 developing nations; a fascinating foundation for social entrepreneurship.

Dr. Sacha Bhatia is the Chief Medical Innovation Officer and the F. M. Hill Chair in Health System Solutions at Women’s College Hospital here in Toronto. Dr. Bhatia leads rigorous evaluation of digital health tools designed to move new models and new policy approaches from theory to implementation. In his spare time, he’s also an award-winning cardiologist, who received both his M.D. and his MBA in health care administration from McGill University.

Thank you both for joining us today.

So, Inder – if I can – I would love to start with you. I have often heard you describe Kinsa as first and foremost a public health company that’s obviously fueled by technology, but not a technology company that’s fueled by public health. Can you expand a bit on that, and talk about the core value proposition, and why it’s so important to be doing what you are doing?

Inder Singh:  Yeah. I appreciate that question. You know, I’m a public health guy, we have a public health mission, and our company is based in public health. And I think it’s just to try to emphasize that our goals are one that advance public health. We’re not trying to put tech before or at the centre of the company. If I’m being really honest, I also want to avoid certain attribution that comes with technology companies. We often use the term “disruptive innovation” in technology.

I’m not trying to disrupt my public health colleagues; I’m trying to help them. And I want us to be seen as a partner to public health institutions. So, part of it is to really re-emphasize, internally and externally, that our goals are very, very much around driving better public health outcomes. So, again, it’s a positioning thing that I think is really important for us internally and externally.

Ross Wallace: Maybe I’ll just quickly kind of build on that point for a second if I can. If you can talk a little bit about the actual technology solutions that you guys provide, and maybe I’ll ask you whether you found sort of a really interesting technological model and then looked at ways to adapt or purpose it in terms of addressing some of these challenges. Or whether it was the challenges that gripped you, and then you went and sought out some technology solutions, or whether it’s a bit more fluid and interdependent?

Inder Singh: It all started with a problem. It started with a frustration. And I’ll pose the question that I posed almost nine years ago when I started Kinsa: How do you stop an outbreak before it becomes an epidemic, or God forbid a pandemic, if you don’t know where or when it’s starting? Well, we all know today the answer to that question is you don’t. You don’t stop it. And if we need to get ahead, and prevent those outbreaks from becoming epidemics or pandemic, we need to understand where and when they’re starting, how fast they’re spreading, how severely they’re impacting people. That was the problem statement we started with.

I grew really frustrated with my prior career in public health because I saw the way the world tries to allocate money to curb infectious disease. The sad fact is that they do it with zero information, zero real-time information about where and when diseases start, and who’s being affected. Again, how do you target those vaccines, drugs and diagnostics that work to the people that most need them if you don’t know who they are? And in our world today, we have so much real-time data in so many other aspects of our lives.

We know how to get downtown fastest through Google Maps, we know what our neighbour’s house costs through Zilo, Trillia, Redfin, etc. Why don’t we have a basic understanding of what’s going around when it comes to the health situation? If we did that, it would not only help health systems and governments send the test kits in, target resources, send the virologists in to where we’re seeing an unusual outbreak.

It would also help parents and individuals say, “Oh boy, what’s going around my local area is more severe. Maybe I should take some more preventative actions”. And we find that people respond to impending threats far more acutely than they do to diffuse threats: “Go get your vaccine.” “Well, I’m going to go get my vaccine if I think there’s going to be a spike”. I’m certainly going to be more motivated to do it.

So, it’s a systemic problem and a personal problem and what we did was we tried to figure out how to get specific data. How do we talk to people within hours of symptom onset consistently – not just when their symptoms are more severe – consistently within hours of symptom onset. How do we get the missing ingredient dataset? Where and when are symptoms starting? How fast are they spreading, and how bad are they?

So, to do that we reimagined the thermometer. We took the only tool that’s in the home, the only tool that’s consistently used when illness strikes, and consistently used especially by parents whose children happen to be some of the primary spreaders of most infectious illnesses. As any parent knows, they get sick from their kids. So, we took that product and we turned into a triage tool. It connects into an app, it guides you as to when you need to see the doctor, when you need to go to the emergency room, it asks you a series of questions.

Now, aggregate data across one 1.5 million of them that are across North America, which represents roughly 4 million users, and not everyone has to have a symptom for you to see clusters of illness lighting up on a map; a beacon going off saying, “There’s an outbreak here.” Then we deconvolute the signal. We say, “Hey, this light that’s going off on the map, it’s an outbreak, and it doesn’t look like cold and flu. It’s got some anomalous attributes. Send the test kits in, send the virologists in.” That’s essentially what we created at Kinsa. You can see the data. We’ve launched a website that shows some of our signals. We’re trying to unpack them and provide even more at Healthweather.us. That’s the U.S. health weather map that we’ve created. So, that’s basically the technology that underlies the problem we set out to create. And at the core of that, is that we know before the health care system does where and when symptoms are spreading, and how fast they’re spreading.

I’ll just add one more point on that. This is probably intuitive today, but in the context of COVID-19, maybe the first family member gets sick and has mildly fleeting symptoms. They go away after a day or two. They never enter the health care system because their symptoms went away. Person #2 contracts it from Person #1 and is totally asymptomatic. Person #3 gets it, and three to fourteen days later after an incubation period, they actually show symptoms. The latest data I’ve seen is that once they get symptoms, five to eight days later they enter the health care system. This is U.S. Centres for Disease Control and Prevention data. So, they’ve finally entered the health care system – it’s weeks too late; the flame of the outbreak is becoming an inferno and its now not able to be contained. We get to see that mildly symptomatic spread early because we’re talking to people consistently within hours of symptom onset. That’s why this works. There’s no other powerful reason. It’s really simple.


Ross Wallace: Sacha – listening to Inder, he talked about the systemic-level complexities and the individual implications. If there’s a third point of the triangle, it might be the institutional level, and you’re sitting in a spot at Women’s College Hospital where you have both a hospital role in relevance in terms of the work you as well as system policy piece and a system technology and evaluation piece. Can you talk a little bit about the work at Women’s around digital health and the ways in which it impacts and interacts with those different levels?

Sacha Bhatia: Sure. So, for those of you who don’t know, Women’s College Hospital is an ambulatory, academic health sciences centre that focusses on developing new models of ambulatory care and a big focus at Women’s College is digital health care. What we subsequently – an offshoot of the strategic plan at Women’s College has been the creation of the Institute for Health System Solutions and Virtual Care (WIHV), which is an applied research institute we founded in 2013 to basically develop, implement and evaluate new models of care, often underpinned by digital technology, with the goal of improving value and improving outcomes for patients with complex chronic diseases.

The key thing that I think we’ve learned in the journey that we’ve had over the past number of years is there’s a lot of technology for technology’s sake. And what we’re interested in is really about using technology to revamp and refine and really optimize health service delivery, which is a very different philosophy to be honest. It’s not just about dropping technology into a clinical ecosystem and then just hoping that people use it. It really is about service redesign. So, we’ve really focussed our attention in the past number of years on understanding the impact of digitally-enabled service redesign on, importantly, clinical outcomes. So, we care not that technology is used, but that technology can be utilized to change clinical outcomes for patients, improve the satisfaction that they have with their health care system, and potentially to either increase capacity in the health system or reduce the unit cost of delivering services.

A big part of that has been developing clinically relevant evaluative strategies to sort of say, “You know, even though we’re using that wearable to figure out if you’ve got atrial fibrillation, what is the value of that wearable in the health care system? Is it worth is for governments, for example, or for a company or a hospital or a person to purchase that wearable? Does it actually change the trajectory of somebody’s health outcome?

So, that’s been the work that we’ve done, and over the past couple years we’ve started to work with the Ministry of Health through a funded project called the Centre for Digital Health Evaluation (CDHE), which has really been taken up a level to now ask payers – meaning insurance plans, such as the Ontario Health Insurance Plan or others – to say, “If you’re going to make a multi-million or multi-billion dollar investment in digital technology, what is the value to the health system in doing so?”. So, we’ve worked with them over the past couple of years to develop evaluation metrics and strategies to sort of provide evidence on the services they’re redesigning and providing recommendations as to how from a policy perspective they could optimize the delivery of those services.


Ross Wallace: So, you’ve both talked, I think, really interestingly about the role, relevance, and importance of digital health. And that was obviously true even before COVID-19, but Inder, if there is a disruption in the space right now, it may not be Kinsa in terms of how you want to compliment and support folks in the public health space, but certainly COVID-19 itself is a disrupter. I was wondering if I could get you both – maybe Inder we’ll start with you – to talk a little bit on how you think, probably pros and cons, the emergence and spread of the COVID-19 pandemic has changed the landscape for digital health?

Probably made it compelling and more attractive and important in some ways, but probable illuminated some of the challenges or complexities around evaluation or value at the same time.

Inder Singh: Absolutely. I think it’s been an accelerator of certain kinds of service models and technologies, right? It’s been an absolute accelerator of telemedicine. In the context of any outbreak or epidemic, you don’t want people going to the clinic, you don’t want people going to the pharmacy. Why? Because if they’re sick, they’re going to spread it to others. You want medicine that comes to you.

There are technologies that are available today that will allow the health care system to come to people. Some of these are wearable technologies, some of them are what they would put in the classification of remote monitoring technologies. I don’t like that term, because it implies someone is a patient already. We need to make sure we are going to people when they have a change in health status. Things like a connected thermometer – you aren’t a patient, you’re still in the home. You’re using it, but there’s a change in health status, and that can now ping the system to outreach to you asking, “Would you like some help?” or, “Would you like to talk to a doctor now?”, without disrupting or creating any problems with privacy.

We can control for all those kind of things. So, I think COVID-19 has been a massive accelerator of telemedicine and telemedicine tools. I think it’s highlighted the need for us to think differently and further accelerate this process of bringing health care to people as opposed to having to go to health care, and I’m excited about those opportunities. That’s a model that needs to happen, it needs to accelerate, and a pandemic brings to light how important that is. So, I think those are a couple trends that I see that truly have caused what I think is a fundamental change in the way we think about health care going forward.

Sacha Bhatia: I think, similar to Inder’s point, telemedicine or virtual care has been massively accelerated, and the pandemic has accelerated their adoption in a massive way. Prior to the pandemic, I was having to proselytize and advocate for increasing the adoption of virtual care. So, we know that prior to March of 2020, probably less than 10% – by rough estimates – of care was being provided virtually. And that’s not just in Canada. There are other pockets of excellence, or pockets where maybe they were doing it a bit more. Kaiser in the U.S. was an example. But by and large, it was a pretty niche boutique sort of tool. And then the pandemic hits, and suddenly now we’re looking at by reports and by preliminary data we have – about 70% of care, and about 90% of physicians are actually providing care virtually.

So, before we were talking about the issue being how do we get doctors to use virtual care, and now that problem is gone. So, now we’re in a different boat, which is: we’re coming at it from the opposite side of the curve, where now that the pandemic created this fantastic opportunity – if one can say there was a positive thing about the pandemic – to break down a barrier for adoption for virtual care. But, the question to me will now be: where do we go from here? What’s the right amounts of care that should be delivered virtually? And I think you’ve probably started to hear about some of the backlash around the loss of personal connection that people have with their provider, the challenges around privacy and equity, and a number of factors.

So, we now need to think a little bit about what does the steady state look like? Because I don’t think we’re going to sit at 70%+, but I don’t think we’re going to go back to 10%. So, we’re in the very weird grey zone where I’m not sure what direction our system is going to take, but I don’t think it’s going to stay where it is, and I do think it provides us an opportunity to shape it going forward.

Inder Singh: Yeah. If I might add, I think there’s certain challenges that have become very, very apparent, and certain opportunities that have become very, very apparent. Challenges are simple things, can be simple things, like, “How do I get a proper reading?”, “How do I look in your throat in a telemedicine visit?”, “How do I look in your ear in a telemedicine visit?”, “Do I trust the data coming out of any tools that are being transmitted via these telemedicine tools?”. Those are challenges. Those are fundamental challenges that we need to figure out. But there’s also these opportunities, right? Now, not just, “Can I do individual diagnosis and treatment better?”, but “How do I treat populations?”. I’ll talk to that for just a moment about some of the work that we’ve done.

When you can aggregate data on the population, to understand trends in the population, now you’re starting to think about doing real public health. Being able to respond at a population level to help prevent or attack the problem in a broader way. As an example, through this network of 1.5 million thermometers primarily in the U.S. here, we’re  able to not just see hotspots of where illnesses are occurring, we can now predict the entire flu incidence curve 12 to 20 weeks ahead of time on a city-by-city basis. Prior to this network being set up, the best we could do was three weeks out of a state and multi-state level. You had a little bit of advance warning.

Now I can tell you when the exact peak of flu season is so we can reach out to our congestive heart failure patients or to our diabetes patients, to our chronically ill and elderly saying, “Guys, you’re the ones that are going to be impacted by these acute respiratory illnesses. You’re going to be the ones that have challenges with the flu. So, maybe during these two weeks that are coming up here in eight weeks time, you should stay inside. Or maybe we can get you your medicines, your medicines for your congestive heart failure, diabetes in advance – we don’t normally refill until X time – but we can get all of that to you in advance so you can stay home”.

So, there’s these population-level things that you can start doing because you can aggregate data anonymously across the population. That’s the area that we play in. And those are the kinds of opportunities that avail themselves of this much more rapid movement that has transitioned to virtual care that is being fueled by COVID-19’s taillights.

Sacha Bhatia: Yeah. I’ll just pick up on that. I think that’s a great point that Inder made, and I think it brings into sort of an unintended consequence, that’s a pretty positive thing, which is around data and around the power we’re going to have, particularly as it pertains to consumer data. So, for a long, long time, medical data was predominantly in electronic medical records, and it was in physicians’ offices, and it was controlled by hospitals and people and providers.

With Kinsa and other wearables, whether you have a Fitbit, an iWatch or whatever, there’s more and more and more data that’s actually sitting outside of hospitals and the health care system generally.

There’s a whole host of data that was never available to the health care system that is now potentially available. It’s not completely seamless, but there’s more data out there, and if we can harvest that data, we can start to do the things that Inder is talking about across multiple diseases. Because, remember, for people with chronic diseases – diabetes, heart failure, coronary disease, mental health, those sorts of things – the amount of times they interact with the health care system is still a miniscule fraction of the amount of time they actually live with the disease. So, management is still predominantly themselves or their caregivers.

We have no insight as a health care system as to what happens when our patients leave our clinics. So, our ability to see what else is happening and to have insights allows us – potentially again when you layer on big data, AI-type analytics – allows us potentially to have some pretty powerful metrics, algorithms, processes, to whether it be detect population-level trends, but also potentially be able to predict, “Is an individual about to have an acute exacerbation of their chronic illness?” and “Can we intervene early to prevent that from happening?”. So, there’s been some work in that area.

It’s still pretty rudimentary in part because we haven’t done this at as broad a scale as what Inder and others are talking about with some of the wearables that are out there now. But the fact that now we’ve had this mass adoption, and are going to continue to have this mass adoption of this type of technology, the possibilities of this are pretty large.


Ross Wallace: Obviously one of the key steps between the generation of transformational technology and giving clinicians and patients the tools they need to deliver that care, optimize that care, revolutionize that care – often that involves the messy business of procurement. Inder, I’m going to turn to you for a second to see if you can talk a little bit about some of the challenges you’ve faced in terms of navigating through procurement complexities, and maybe even if you could pull a couple of best practices or key success factors that you think those of us who think about these procurement complexities everyday should take away in terms of how we ensure that the post-COVID-19 technology adoption landscape is supported rather than undermined by a new rather than archaic procurement system.

Inder Singh: The first problem we run into with some of these technologies is: “How are they used?” “Why should they be used?”, and “Who should be using them?”. Because they’re sufficiently different in terms of the value that they can create. A lot of these products we’re talking about are connected products. Telemedicine services, wearables, these are connected products. So, there is just a fundamental different value. I’ll give you a very transparent assessment: people often think of us [Kinsa] as just a thermometer. Well, it does far more than that.

We’re talking about a connected medical guidance system that helps you make decisions about when you see the doctor, connect into the doctor. There’s this conversation that’s going on around high temperature screenings in lobbies, in restaurants, in bars, and it’s a really thoughtful—there is a place in the world for that that is important. But we also know that those kind of situations are A) rife with errors – it’s really hard to get a good temperature reading, and B) it is too late by the time someone’s in the lobby, they’ve spread it already.

The advantage of a network like ours is that you can take it at home and can see pockets of illness spread and guide people when they’re still in the home. We’re trying to make sure that we communicate the fundamental value of the product, who should get it – and that the first challenge with procurement processes, especially at government levels, but certainly also at the health system level – why am I buying this, where do you fit in, how do I make sure I understand the value proposition. Those are challenges.

We’re faced with this really interesting situation where there’s a wall in front of us of traditional folks that work in public health and health care saying, “Well, a thermometer is this”, and we’re trying to tell you, “No, it’s not”. And there’s a whole group of people lining up behind us saying the value of this is in early detection, early warning of outbreaks. The value of in guidance to the individual. The value of this is that you can talk to underserved communities; we have such high activation and use by underserved communities that don’t have traditional access to health care, where now you can speak to them, there’s a connection point between the underserved community and the health care system that never existed before.

These are the kind of value propositions that this kind of new technology, this new product that we’ve invented avail themselves to. Let’s use it in those ways. Whereas, traditional procurement may not even think about that, it’s not their job to think about it. Their job is to figure out how to source products. So, we’re running into this, “Where do we go to?”, “Who do we speak to?”. On top of that, it is, “how do we distribute?”. Procurement reflects the existing systems that were there for many years: “I’m going to distribute this to hospitals”, “I’m going to distribute these to first-responder networks”. Great, but if you’re trying to be able to help people in their homes, how am I going to distribute product to people in their homes? Am I going to ship it to them? Do I even know who they are? Do I do random sampling? These are all the challenges that come up with these kinds of new technologies.

If we had 500,000 thermometers in Canada, we could hotspot down to precise geographic areas and know where COVID-19 was spreading three weeks in advance. We’ve proven that in the United States. We can see COVID-19 surges three weeks in advance. Could you imagine what New York City could have done with three weeks advance notice? Can you imaging what certain provinces and town could do with three weeks advance notice? There’s a Columbia research study that came out about New York City saying had they implemented their stay-at-home order one week earlier, it would have saved 36,000 lives and one billion dollars.

We saw it in New York City specifically, eighteen days in advance. So, that would have given people enough time to evaluate it, and implement the order. That’s the kind of value that’s available from these kinds of technologies. It’s the reason we want to roll out in Canada. It’s the reason we need to roll out in Canada. This is the kind of thing that’s available and we need to activate it now.

The procurement processes, the challenge with them is that they’re still reflecting traditional products—and they should, they need to do that. But there needs to be a way to think about these new kinds of technologies, how to get them put through the procurement cycle, how to distribute them so we can take advantage of the value of these new technologies. Proven value, not new value. We’re not talking about things that are being invented right now. We’re talking about things that have been out there for 8-10 years that already have a proven track record with a scientific body of literature supporting them.

Ross Wallace: So, Sacha, based on that: smarter, more thoughtful, more innovative procurement systems in Canada. Thoughts on how we build off that foundation, continuing to deliver the kind of value that Inder talked about, those sort of old-school values, while making sure we have a chance for new-school value too – how do we do that here?

Sacha Bhatia: Yeah. It’s a great point, and it’s the conundrum that I think a lot of innovative companies struggle with. In fact, part of the work we do is to create an evaluation—part of creating an evaluation framework is really also helping both governments and companies understand what the value proposition is for the technologies that they want to procure, and creating a path to procurement to companies and technologies that add value to the health care system.

The problem, I think, often in procurement for these innovative technologies is—and government tries to do the right thing, and companies try to do the right thing—but it’s often a bit of lost-in-translation thing. Understanding what the business model is for the technologies is not always easy. Say you think about drugs in the health care system. There’s a pretty clear path to how drugs get listed, both get regulated and then listed, and there’s pretty clear objectives and outcomes around a drug providing some efficacy.

For digital technologies, that’s not really clear. I think one of the issues becomes: if you build what should be the ultimate metric of success, or when do you know when a technology creates value for a health care system? You have to be able to demonstrate objectively that spending X amounts of money on this technology will objectively lead to some benefits somewhere else down the line. And I think that has to be objectively proven.


Ross Wallace: I’m going to ask you guys each one question maybe just to distill where you’ve come from through this conversation, and where you’d like to make sure you leave us. I’ll start with you, Inder, if I can. If we had the fortune of brining this group back together to converse, lets say in a year from now or two years from now, what would you be looking at in the interim? The metrics, the measurements, the indicators, to kind of gauge the progress of health systems in terms of better creating opportunities to benefit from the kind of technological advances that Kinsa represents. How are you going to know that we are individually and collectively getting better at this? What are you going to watch for?

Inder Singh: I’m going to focus on the very specific area that we work in, which is early warning. This idea of being able to create an early warning system for outbreaks. That’s the place that we believe we can play a really, really important role, and it’s particularly acutely important in a context of a pandemic; you’ve got to know where there’s going to be these outbreaks so you can get ahead of the curve. If I’m looking at that, I’m looking at A) how much focus has their been by government on this concept of early warning, because right now if I’m being really honest, in the U.S, I can’t find a U.S. agency that really has this as a focal point. They’re focussed on testing and contact tracing and treatment and isolation and vaccine development and plasma donations, but there’s not this focus on early warning. Not a concentrated focus.

So, I want to say: How many dollars are available? How many efforts are there out there? I’d want to see how many health systems are adopting these news data streams that Kinsa and others make available for purposes of early warning. Are they using them to plan where they’re going to do surgeries, or shut down surgeries? If it was us specifically, if we were part of the solution, I’d want to say: Did we reach the minimum threshold number of active users to actually do effective early warning? Are we at 500,000 or more in Canada? Right now in the United States we’ve got 1.5 million—if we had 5 million, we could hotspot down to precise geographic areas. Zip code level and population centres. Imagine what you could do if you saw an outbreak at a zip code in real time. You could contain it while it was still a flame before it became an inferno.

So, if it was us specifically, those are the metrics I’m looking at for our own work on early warning. Those are the kind of the kinds of things I’d be looking at a year from now, because I think this particular topic of early warning is essential to our response to the outbreak. It’s not an “or”: you aren’t going to give up testing and vaccines. It’s an “and”.

If we have an early warning system, all of those next steps become more efficient. We don’t need to contact trace back four weeks. Maybe we contact trace back one week because we caught it with early symptoms. Everything else becomes more efficient, and the limited resources we have, the limited vaccines that we will develop, the limited plasma that we have, we can direct to the areas that most need it. For me, I’m focussing on early warning and I want to look at results one year down the line, not just for us as a company, but for us as countries and systems.

Ross Wallace: Sacha, whether you’re wearing your hospital lens, your system lens, or even cardiology lens, how are you going to track the next year? What are you going to be looking for?

Sacha Bhatia: So, I think the next year, it’s a really interesting one. I think digital health, virtual care has become sort of the belle of the ball. I think commercially, we’re seeing a lot of big players put substantial amounts of investment into various types of virtual care models. You saw Teladoc Health in the United States merging, you’ve seen Amazon put out a wearable, you’ve seen massive amounts of fundraising and venture capital going into a number of different digital companies. I think a lot of smart money is being put into various types of digital companies.

The question now is what’s going to happen in the next year, and is this momentum going to be picked up? As there’s more commercial dollars, there is still going to be a continued need for virtual. So, until there’s a vaccine, and even when there is, I think there is still going to be an absolute need to physically distance. As a consequence, virtual care is going to continue.

The other thing is that we don’t know whether or not there will be a so-called second wave, and as a consequence there’ll be another necessity to lock down as we had. When you think about all these forces coming together, the question ultimately is, from an adoption perspective, where do we see virtual care sitting in the next year? Is it going to be 70-80%? Is it going to be 10%? I think it’s probably going to be half of the care that’s provided on average. And then I think the real pressure is going to be on the payers to sort of say: How do we fund this type of thing? How do we fund companies like Inder is suggesting, like Kinsa? How do we think about building wearables into the business model? How are we going to create a sustained ability model for this kind of work? Then, as a hospital and as researchers, we also then need to have a responsibility to say: How do we actually integrate these into our care to do it well and safely and effectively?

Ross Wallace: With that, I will bring this conversation to a close, only because I want to be respectful of your time and to thank you both, Inder and Sacha, for sharing your thoughts, your perspectives, your passion over the last few minutes.

Inder Singh: Ross, I don’t know if we still have time, but can I make a call to action for Canada?

Ross Wallace: Please.

Inder Singh: I’d like to make a call to action for Canada. Canada has an opportunity to roll out a world-class, robust early-warning system for outbreaks. To lead the world. It is a country where we could do this within months at a national level. We are currently working with five states in the United States, three major cities. We’re going piecemeal across the U.S.

We would love to do this with Canada, and we already have some corporate sponsorship to launch—Lysol is paying us to give away thermometers to underserved communities and public-school communities across Canada, but that’s not enough. If we can add to that, we could create a “healthweather.ca” just like a Healthweather.us, and do effective three-week lead time early warning for the country down to geographically precise areas that would enable early containment, saving lives and livelihoods.

That’s my challenge to citizens and to the Government of Canada. Let’s stand up what I believe is basic, necessary 21st century infrastructure for early warning of outbreaks, because this is not the last time this is going to happen. The question is not if, it’s when.

Ross Wallace: Inder, that is a gauntlet eloquently dropped. I hope we circle back with you both on the way toward that one-year out timeframe, and hope to hear more about your respective and your collective efforts to ensure that we’re optimizing the use of technology during this pandemic and beyond. So, thank you both for making this time. Thank you both for your insights and your wisdom, and I hope we’re in touch again.