Next, you can't just turn something on and anticipate that everyone's going to know how to use it. The institution has invested heavily out of necessity, but also because it's good for our patients. In teaching patients through different ways, we all learn differently. We've done online videos, we've done online how tos, we've invested in a dedicated helpdesk, and we've made to invest in all of those things, not just in English. Understanding that obviously Spanish for most things come second, but our patient population is very diverse. How do we ensure that we have multiple ways to teach for multiple types of learners with multiple different types of access, with multiple different types of, not just language and issues, but also hearing impairments, reading impairments, access to the Internet? Really investing in multi-disciplinary ways to teach and educate has been a critical barrier and recognizing that you can have the best product in the world, but if you can't get your patient understand how to use it, not going to be successful. In order to break down some of those barriers, we've had to invest in functions, not just how tools, one of our key areas up front was a lot of health care, especially electronic health care, goes through the online portal. That in and of itself creates a barrier. The online portal for Epec, it's my charts, is not available to everyone right now is institution and we have 63 percent of our patients and my chart, and that's up from 49 percent pre-pandemic or less than one and two had access to my chart. If now getting health care is dependent on a thing that only one of two people have who we care for, what are we going to do about that? We implemented use of text message as a key low tech, low cost way to touch patients that can help bypass my chart. Then we improve for patients that were moving to my chart. Instead of having to call and navigate through a lot of call centers to get visits, we also implemented some faster and easier online scheduling pathway is that also incorporated the use of our new telling us and technology. It wasn't just educating patients them, so recovery are realizing that in a lot of cases as many products and health care have two key customers, the provider and the patient. Now had to educate providers not just on how to use the technology, which was definitely a requirement, but also how to do their job well with the new technology. Even just basic audio, video, and interactions, how do you examine particular key areas of a patient? Creating new educational content out of our office of physicians education office, and how to examine throat, how to examine watch for respiratory changes, cardiac changes. Definitely not just how to use, but how to use it well, educational needs for both sets of your customers, the patient and the provider. Just ensuring that you think about the product is one thing, but education access to the product and education around the product, a key next aspect. Just some other topics though to recognize that the transformation is just not in page, are not just ambulatory and outpatient. We did a lot of work of optimizing the hospital. In the pandemic, no longer could people visit. How did we bring family and friends into the room? Virtually, how do we meet? Recognize that when you are in healthcare, especially large academic medical centers, you haven't teaching mission, so our med students and trainees and residents and fellows, how do we ensure broad engagement of our teaching mission across the institution and sometimes having to do that virtually? How do we acknowledge that we have certain staffing needs inside the hospital and how can we solve those through technology? Many are aware of certain things like tele sitter or virtual sitter. Instead of deploying 20 sitters to the bedside of 20 patients, deploy one person, but remotely through technology to observe 20 individuals and keep them safe, while also keeping people safe from unnecessary infectious risk. Moving from regular ICU care to enhance and then ultimately ICU care all inside of our business planning in the hospital. Telemedicine and virtual care med, you don't have to build buildings anymore to have a clinic, so we had three primary virtual only models for delivering care that went live during the pandemic. We had a team that was dedicated to providing virtual primary care for those without primary care, but who knew Hopkins through some other way. I come to Hopkins for my pulmonology care, cardiology care, but those aren't the ones who need to triage. I have cold symptoms, I'm worried it's COVID. We stood up a temporary primary care virtual only practice for those who didn't have access to their primary care. We set up a virtual only practice with our pulmonology and rehabilitation teams as well as our home care teams. Who after you left our hospital after a complicated stay with COVID, you went home with a pulse oximeter, home care nursing oversight, and then virtual only follow up with pulmonary rehabilitation that your transient tenders and back to the home was successful. The HSCRC here in Maryland has funded us for a grant for hospitalists to long-term care facility or sniff remote console programs. Patients leaving or a hospital going to long-term or skilled nursing facilities. Getting access back to our hospital for consultative questions. Is better for the patient, coordinated discharge care, but also it prevents unnecessary readmissions, emergency room use and allows patients to successfully transition back out of the hospital. All of this facilitated through virtual interactions or virtual underway interactions and all really represent new clinics that didn't need any real estate. Opportunity to expand our footprint without buying buildings. We solve new technical problems. One technical problem that our insurance plan brought to us was we need on-demand care. Not just scheduled care, but on-demand care. How did we go through that process? Well, we did an RFI for national technology solutions. We interviewed all of these customers; the users of the technology product. We identified the problem, we identified the potential leading solutions in the marketplace and then we interviewed those customers and made sure we had their internal feedback as far as what their experience was with that customer. We launched the product, we branded it, and it's now live after a pretty fast process for Hopkins. But it all is about, what technical problem are you solving? Who are the existing customers for the existing solutions, and what do they have to say? That's how a large health system goes about trying to solve new problems, is ensuring we know what the marketplace looks like, who those customers are, and what they have to say about the product. We did the same for home physical exam. Video visits exploded as you saw one of the problems, how to examine remotely. One of those ways was through education and here's how to do a good neurology exam virtually from an expert at Hopkins neurologists teaching you. But some things you just can't do without additional tools. Also I reviewed the competitive landscape for solving the explicit technical problem of how to auscultate remotely and then some other additional physical exam tools. The vendor picture here is TIDO. We chose TIDO after reviewing all the potential options out in the marketplace for remote auscultation, and TIDO comes with remote or oropharyngeal or throat examination, in which is obviously beneficial during an infectious disease pandemic. We're going to be deploying this in our emergency rooms actually first, for virtual triage. Allows some physical exam, even just onsite before we take it into the home for other complex care uses. That gets to what technical issue are you solving, who are the competitors that already either fully or partially address that problem and have you talked to the competitors, existing customers or they're potentially your future customers? What do they have to say about the existing solutions in the marketplace? Listen to the patient. In healthcare, we go back to the patient. Ultimately that if you don't have proof that patients want or need what is ultimately patient-facing, you've got a big hill to climb when trying to get a delivery system as your customer. For telemedicine, we've had 62,000 surveys to our patients for those 730,000 visits. They're rating our providers 95/100. We did targeted surveys to 2,000 patients. Nine out of 10 response on extremely likely to recommend a friends and family, and 88 percent stated that it would be moderately too extremely important to have video visits options after the pandemic. Again, another, is this going to stay? Nine out of 10 patients are saying they want it after the pandemic. These are the subjective testimonials about why. But you read through this, you look at that data. This is what cells future business planning internally for me and thinking about how to take virtual care broader into the institution, is that ultimately our primary responsibility is to our patients. When our patients are saying these things and feeding back about the objective and subjective data, that's how you sell. I have to sell our own internal strategy internally, and this data supports that strategy. Just remember, design it with the provider in mind. For sure I'm a provider. I want it to work well for me, but make sure you've touched the patients too in your business planning effort, if you're designing a solution that ultimately touches patients which many things in healthcare do. Legal regulatory, do not forget about this as a barrier and as an opportunity. But these are all the things that I'm tracking right now. This is part of my day to day. During the public health emergency, we have a number of expanded opportunities and using technology in healthcare. Some of those are explicit to Medicare and Medicaid. Some of those are explicit to low tech access, so telephone or audio only. Some of those are eliminating barriers across state lines. But recognizing that those barriers very much do exist. We are the United States in any right not delegated to the federal government is the right of the state and that includes licensing professionals, including healthcare professionals, and regulating healthcare inside of their own state borders. What is true in Maryland is not true in DC, is not true in Florida. We as a six hospital institution operate in those three states and we're soon to operate in many more to the extent that virtual care continues to expand that footprint. It's not just about physicians., as I said, there are now 250 plus billable codes from CMS, but many of those are to non-physicians, therapists, counselors, speech-language pathologists, audiologists. Just keeping in mind that the addressable market is broader than just the physician APP, and it always keep me and my insecurity. Privacy in healthcare is one of the most regulated areas of technology, and keeping in mind that the security aspect is critical to engaging with any meaningful large health system. Those are all the key topics and key questions I wanted to put out there and happy to use anytime if any remains to do whatever you think is helpful.