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0	4860	Hi everyone. Today we're going to be talking about redefining patient safety in the digital era.
5300	10680	My name is Dina Mendelsohn. I'm Director of Health Policy and Data Governance at ElectroLabs.
11160	15520	And I'm Jen Goldsack. I'm the Executive Director of the Digital Medicine Society.
15520	21640	When Diane Diller, a woman featured in a 2019 Washington Post news article,
21640	27340	downloaded the privacy tracking app Ovia, she used it for much the same reason as the app's
27340	32550	10 million other viewers, to track her pregnancy and the health of her baby.
33060	37640	She did not intend for that information to be shared with her employer, but that's exactly
37640	43200	what happened. Think about what's involved with making a baby. Think about how you feel if your
43200	48640	boss got the details. It's not just embarrassing for women, it puts them at risk for pregnancy
48640	55680	discrimination and adverse effects in the workplace. But first, some level setting.
56320	60480	Jen will walk you through exactly what we're talking about when we talk about biometric
60480	67100	monitoring technologies. She'll also explain why, despite a whole DEFCON talk designed to
67100	72000	point down the safety risks of these products, we still believe that these technologies are
72000	79500	critical for patient care and clinical research. Jen will also cover our biometric ethics portion
79500	86540	before talking it to me to discuss the shaky ground for data rights in the United States.
86540	91680	After that, we'll get to the fun stuff, if you consider serious safety violations to be fun.
92040	97480	Fantastic. Thanks, Dina. So let's dive in and think about why healthcare is different in the
97480	102200	digital age and why digital health at all. If we look at the financial information,
102200	108300	we see huge possibilities, huge promise, and a lot of noise in Silicon Valley about the value,
108300	114080	the financial value of this new and emerging industry. And in fact, even throughout the
114080	119100	course of the pandemic, the first half of 2020 yielded some of the greatest investments in
119100	125540	digital health. So is it all about the money? Absolutely not. I think that the financial
125540	130500	investments that we've seen are a product of and perhaps an indicator for, but certainly aren't
130500	136500	the reason that we're passionately pursuing the safe, effective, ethical, and equitable use of
136500	142560	digital health technologies. Let's think about the healthcare environment that we've been in
142560	146980	for the last few decades. Let's think about some of the persistent and pervasive problems
146980	154840	that as a community, and not just as an industry, as a whole population that we face as a result of
154840	162880	these challenges in healthcare. So in 2018, US household spending topped a trillion dollars.
162880	167780	We know that healthcare spending writ large here in the US is over $3 trillion,
168400	173160	but kitchen table conversations, what folks were individually being asked to write a check for
173160	180380	to preserve their own health was over $1 trillion. Let's put that into context. $3 trillion,
180380	185620	total healthcare spending here in the US, it's more than the GDP of France. This is an enormous
185620	192020	industry and we are paying a price for it that we cannot afford. And despite all of this
192020	199020	investment, our workforce here in the US is dying higher rates than any other developed country.
199020	203680	We're paying out of the nose for healthcare and we are not getting high quality in return.
203680	208940	In fact, the number one reason that most Americans file for bankruptcy is healthcare
208940	214080	costs. And the other week I learned it's the number two reason cited these days in divorce
214080	219360	proceedings. It's the stress and the strain and the financial implications of a healthcare system
219360	225640	that is absolutely unsustainable. And despite all of this, we still have these catastrophic
225640	231720	diseases and illnesses that we are in no place to try and treat. There is not a single disease
231720	239080	modifying treatment available for Alzheimer's and there's certainly no cure. Interestingly,
239080	244380	for folks who don't know, the gold standard that we use in evaluating Alzheimer's, whether it's a
244380	248660	loved one that you're helping get treatment for, or whether it's in a clinical trial setting,
248660	254840	is a document for the ADAS blog. It's a 30 something page paper document that physicians
254840	261720	fill out. It's a blunt instrument that's helping us preserve the status quo. And in the absence of
261720	267120	technology, we're really going to struggle to make progress. And the challenge is, even when we do
267120	275480	have terrific interventions and treatments for chronic diseases, such as diabetes, one in four
275480	279960	diabetics in the US ration their insulin because they can't afford to pay for it. This is an
279960	287100	unsustainable status quo that we're in today. We have our warfighters coming home from service
287690	294120	and due to PTSD that we cannot treat when they're in rural areas. There's a really terrible
294120	300820	maldistribution of folks who can help them and the patients in need. Our American heroes are
300820	307060	dying for preventable reasons. And finally, even the clinicians who are at the front lines
307800	313180	have suicide rates at the highest possible level. This is a system that is broken for absolutely
313180	318000	everyone involved. And so I would say to you that we're not here to talk about technology today
318000	322300	because it's cool. We're not here to talk about technology because there's a ton of money in it.
322300	327240	We are passionate about the use of these technologies to try and solve these problems.
327240	331400	They're not going to be a silver bullet, but we believe that they can make a difference.
331440	337120	So what we want to discuss today with this idea of a new definition of patient safety is for all
337120	343080	of the promise that these technologies have, there are new risks that we need to be eyes wide open to
343080	348220	to make sure that we aren't creating a new laundry list of difficulties in the digital era of health
348220	354400	care. So let's actually talk about for a hot second what we mean when we talk about digital
354400	362600	health. As I said, the industry is enormous. At some point we envisage digital health being a bit
362600	366880	like computers in business. They're going to be ubiquitous. So if we're talking about a three
366880	371200	trillion dollar industry, where are we putting the different digital components? So we would
371200	376360	offer up a definition that the use of digital and the support of improved lives or improved health
376360	380960	all fits into the bucket of digital health. And that includes things like communications
380960	386180	technologies, record keeping systems, so on and so forth. Within that, there's a more specific
386180	393900	category of digital medicine products, which both measure and intervene in the service of health.
393900	401340	So that may be sensor technologies, that may be algorithms, that may be different tools and
401340	408380	solutions that support the administration of active molecules and traditional devices.
408380	413220	And then there's a very specific subset of the field that we would describe as digital therapeutics,
413220	418440	where the software itself is the intervention. That's a new and rapidly growing field and I
418440	423660	think an important component for us to keep in mind. For the purposes of mine and Dina's thought
423660	429120	today, we are going to focus on biometric monitoring technologies or biometrics. And we define those
429120	434760	specifically as connected digital medicine tools and ones that rely upon a sensor for data capture
434760	439320	and a single or a suite of algorithms for processing that information
439320	444020	to give us measures of a person's health status.
445300	451420	And why are we so interested in these biometrics? This is a great visual that I like to show.
451480	456440	If we think about how we deliver health care in current state, if we think about how we do
456440	461320	clinical research, we're relying on these really isolated data snapshots that you see at the top
461320	467020	of the graph. The possibility created by these biometric monitoring technologies is that we can
467020	474440	have a much greater, a much more holistic look at a patient's lived experience with and without
474440	479260	disease, with or without a given treatment. And that's why we're so keen to focus on this,
479260	484180	because we see this as sort of the tip of the sphere in really addressing some of those really
484180	491080	pressing health care challenges that I shared with you earlier. And this is a bit of a silly
491080	497760	cartoon, but I don't... because it's important to have some levity. But I wanted to talk about
497760	506740	how decision making actually works in health care today. Oftentimes we think about a risk-benefit
506740	512460	analysis. It's wrong to say that we don't tolerate risk. It's wrong to say that we don't tolerate
512460	518080	safety issues. And I think chemotherapy might be a really good example. For anyone who has
518080	524040	battled cancer themselves or has sort of been on the journey with a loved one, we all know that the
524560	532220	side effects of chemotherapy is often awful, from hair loss to devastating sort of sickness to
532220	537920	weight loss, so on and so forth. There is a risk-benefit calculation that goes into the
537920	542280	approval and prescription of those drugs. If we are in a fight to save your life, we are going
542280	547880	to tolerate some safety issues, some quality of life issues, because there's a lot at stake.
548080	553680	Now, we would never apply that same risk-benefit to a treatment for a common cold, for example. We
553680	557640	can't treat a common cold, which we could. We might be having more luck for coronavirus, but
557640	562360	there are certainly some drugs out there that can help you with the symptoms of a snotty nose, of a
562360	568900	sore throat. We would not tolerate any safety issues from those sorts of drugs. Why? Because
568900	574520	the risk of the cold is low. Few people are going to have any more serious issues than some pretty
574520	579180	unpleasant symptoms for a few days. So it all comes down to that risk-benefit. The benefit of
579280	584700	a chemotherapy is we can save your life. So we tolerate higher risks. The benefit of a common
584700	588980	cold drug is a little more comfort for a few days. We aren't going to expose you to any additional
588980	594720	safety risks. And so I thought that might be a really good way just to sort of ground our
594720	601980	conversation of decision-making in healthcare and why and how we might tolerate safety risk
601980	608840	to an individual. And so Dina and I are going to be handing off to each other. I'm going to talk
608840	616440	briefly before I hand back to Dina about biomedical ethics. This is a huge topic,
616440	623680	an emerging and important topic. And certainly I'm not an expert, but there are some themes that we
623680	628720	should all be aware of. And there is some groundwork that we should have a common understanding of
628720	632700	before we think about how digital affects healthcare.
633220	639860	So for healthcare practice to be considered ethical, it has to sort of reflect four
639860	646220	principles. The first is autonomy, where individuals have autonomy of thought and
646220	650380	intention when they're making decisions. And a really good example of this is in the informed
650380	655320	consent process. So if you're entering into a search, you need to know all of the risks and
655320	659820	potential benefits. You need to truly understand them. And then you're asked to provide a written
659820	666140	consent. This is also the same for anyone who's had surgery, for example. You always have an
666140	671220	informed consent before you go into surgery. You need to know the risks and you need to knowingly
671220	679340	opt in to participating in healthcare. Justice, I think, is really important. It helps us think
679340	685100	about the burdens and benefits being distributed equally. So let's think about that in the context
685100	691020	of digital. Let's think about if we start to implement the use of these biometric monitoring
691020	698320	technologies, are we ensuring justice for folks who don't have access to broadband? Are we ensuring
698320	705080	justice for folks who can't purchase them out of their own pocket? And then how about, you know,
705080	711240	when we start to do research using these things, if we find great outcomes using digital technologies,
711240	716640	can those be broadly applied to the full population if we aren't able to get everyone
716640	723200	access to these tools? Beneficence, which is a word I often stumble over, so I nailed it today.
723200	729340	That's like a sort of net good and a bit of a sore point for me right now. The intent of
729340	734140	doing good for the individuals and populations involved. So for example, wear your mask during
734140	740100	COVID. That is a nice move there. It's a pretty sensible no-brainer, in my opinion at least.
740100	747420	And then the last one, crikey, another one I often stumble over, non-maleficence doesn't harm
747420	754240	the individual or others in society. And this goes back to that really important principle of harm in
754240	759140	the context of benefit. This is never a black and white decision and we always have to think about
759140	766120	context. Again, there are some examples from COVID I'm sure sort of come quickly to mind for folks.
766120	773920	And the way this is codified in the training of physicians at least is the Hippocratic Oath. So
774420	780860	all graduating physicians swear the Hippocratic Oath when they finally get done with and declare
780860	785620	victory on their passage through medical school. What's important to know about the Hippocratic
785620	791740	Oath is it never actually says, but first do no harm. That is not present in the Hippocratic Oath.
791740	796100	And I think I'm going to probably bore everyone, but it's really important. It comes back to this
796100	803680	idea of risk-benefit and that's codified in the Hippocratic Oath. It's much closer to the ethical
803680	809920	principles than it is first do no harm. And something we follow at the Digital Medicine
809920	814560	Society and something I know that Dina and I talk about often is the great work done by Iron
814560	822820	Recovery. Members of this community have really thought carefully about the new risks associated
822820	829280	with security when we're starting to use connected devices either for monitoring or
829280	836260	for healthcare intervention. And what we'll talk a little bit about today is if this community has
836260	843560	extrapolated a vision for harm and a risk-benefit analysis to include security considerations,
843560	848560	what are the other considerations that we need to be thinking about as we move into this digital
848560	853220	era of healthcare? And with that, Dina, I'll hand it back to you.
853580	859160	Thanks, Jen. I'm going to dive right into Health Policy 101, where we're going to start first by
859160	864660	explaining the difference between privacy and data rights, so we don't lose anybody from the top.
866560	871100	What we've always thought about is privacy tended to be something as a yes or no.
871100	875460	Can you have this information? Yes, you can have it. No, you can't have it.
875460	880560	But as we get further into data rights and data governance, we start to realize that the
880560	887500	question isn't as much yes or no, but it's more about context and who. So, when we talk about
887500	893200	data rights as opposed to privacy, the choice to share or not to share our data is context-specific
893200	898520	and varied by the individual. A woman may feel comfortable having her reproductive health staff
898520	903140	share information with her partner or her healthcare provider. She probably won't feel
903140	907340	comfortable having that information shared with her boss. Or maybe she will. Maybe that's something
907340	912820	that should be up to her. And so that's why we're moving the conversation from one that uses the
912820	919800	word privacy to one that's talking about data rights. As it is, our healthcare system has
919800	925880	strong protections for patient biospecimens like blood or glucose data. But protections are murkier
925880	930680	when it comes to digital specimens. The same can be said of data created by health apps,
930680	935100	fitness trackers, and all the other kinds of biomeths that we're talking about today.
935520	941020	Now, as Jen said a bunch of times, and I'll reiterate, wearables, health apps, and in-home
941020	948380	sensors offer great promise for portable, accessible, equitable, high-quality care.
948640	953480	But in the modern era, data rights have become a safety issue that extends beyond the body.
953980	960020	The digital health information that folks generate may threaten both their health and their financial
960020	964340	welfare. And that's why we think it's so important that we're talking about it today.
967180	974080	In the United States, legal protections are limited for data rights. U.S. laws do not have
974080	979580	explicit regulations that give consumers full control over how their data is collected, used,
979580	985360	or shared. There also really aren't rules about when we have to delete that information and what
985360	991800	exactly that means. Instead, data rights are limited to a pathway of protection, which is
991800	996660	basically a combination of the HIPAA privacy rule, which was never intended to be a comprehensive
996660	1004860	health privacy law, the FTC Act Section 5, which was drafted a long time before biomeths came
1004860	1011260	around, and state laws, which are effectively the ultimate pathway of protection for consumers
1011820	1016320	because you really don't know what protections you have unless you're a legal expert or an
1016320	1024700	extremely well-informed consumer. So now we're moving on to redefining safety in the digital
1024700	1030060	era. And first, I'm going to give a kind of broad description of all the different
1030060	1036820	safety issues that Jen and I are concerned about. We've seen enough headlines to know
1036820	1042540	that there's a problem with how our data is being collected, used, and shared. When we see headlines
1042540	1048720	like these, for many of us, it feels wrong. It feels gross. Jen and I want to explore that feeling
1048720	1055620	and have more technologists, clinicians, lawmakers, and the public talking about why this feels wrong.
1055740	1061680	The answer is that it feels wrong because it's not safe. Women's jobs are not safe when their
1061680	1067480	employer has access to their pregnancy information or plans to become pregnant. We're not safe when
1067480	1073500	our insurer makes life or death decisions about our access to care based on data that may not even
1073500	1079380	be right. In this section of the talk, Jen and I will walk you through a handful of data risks and
1079380	1085280	related harms, not to say that technology is bad or should be avoided, but to start the conversation
1085280	1095000	around data rights as an issue of patient safety. Connected health technologies have the power to do
1095000	1100400	more than embarrass. The data it creates can impact how individuals experience day-to-day
1100400	1108160	living and the world around them. When you share information, either passively or actively,
1108160	1115140	you create information about yourself. One key way that data is used is by data brokers or data
1115140	1121820	aggregators. Certainly not all data manipulation accomplished by data aggregators is harmful.
1122500	1129600	However, data packets as a sort of health score can affect individuals' access to insurance,
1129600	1135220	while the algorithms behind those scores are hidden and could include inaccurate information.
1136020	1140740	Now, some of you may be thinking in your head that the Affordable Care Act means that these
1140740	1145840	scores don't affect our access to insurance, but that's really only limited to health insurance.
1145840	1149980	When you think about all the different ways that a person might want to financially protect
1149980	1155240	themselves or their family, that includes life insurance, disability insurance,
1155240	1160280	and long-term care insurance, to name a few. And all of those are allowed to use information
1160280	1166460	created by these data aggregators. For decades, we've allowed insurers to determine our access
1166460	1172140	to insurance based on genuine medical information. Now, assumptions based on
1172140	1178220	unconsented data from opaque algorithms are changing how traditional underwriting is done,
1178220	1183000	making it challenging for some to purchase insurance at a price that they can afford,
1183000	1185940	or even being denied insurance at all.
1187580	1192660	I don't need data can also impact lending and housing decisions. Studies
1192660	1198280	from the American University Center for Digital Democracy and the National Bureau of Economic
1198280	1203580	Research both report that consumer health data can be combined by data aggregators
1203580	1209800	and used to profile and discriminate in the context of employment, education, insurance,
1209800	1216640	social services, criminal justice, and finance. Clinicians and researchers may not be aware of
1216640	1222960	how digital data can result in discrimination in these areas. Neither may you. But this type
1222960	1231720	of data manipulation can be done as a proxy to circumvent the U.S. Equal Credit Opportunities
1231720	1237080	Act. And it's not something that's going to be done transparently. However, it happens.
1237080	1240680	And that's a serious safety risk that we should all be aware of and consider.
1243140	1247340	Additionally, geolocation information can be used for surveillance.
1247700	1252680	Wearables that measure physical activity use technology that identify an individual's precise
1252680	1258780	movements. While this data is rich information for legitimate use, it can also be used for
1258780	1262260	surveillance. And this is particularly problematic for people of color
1262260	1266720	who are disproportionately the subject of undisclosed surveillance, data collection,
1266720	1273700	and monitoring. There's other ways, of course, that even well-intended technology
1273700	1280200	can cause tangible harm to users. Have you ever had that trouble falling asleep,
1280200	1285260	trying to relax and to rest, and all you can think about is the fact that you can't fall asleep?
1285260	1290940	You keep checking the clock and you're still awake? Now, imagine an insomniac using a sleep
1290940	1297440	sensor to address sleep issues who, instead of getting helpful data and perhaps better rest,
1297440	1302940	instead spends the night anxious and losing sleep over sleep data and ended up worse than
1302940	1309600	they started. There's actually a term for this kind of harm. It's called othosomnia.
1309780	1315200	And I'm pretty excited I just pronounced it right. Technology can also cause clinical harm.
1315260	1321760	Known as e-iatrogenic harm, this type of injury can occur when errors in the data collection
1321760	1328980	by biomeds goes unnoticed. And finally, I'll point out that the use of technology in a trial
1328980	1335300	can inadvertently skew results. How participants are recruited over technology can be deeply
1335300	1341600	problematic, as can be technology used as an incentive to participate in a trial.
1341600	1346900	Similarly, deploying technology that cannot measure all participants with equal accuracy
1346900	1352540	will skew data results, even if it appears as if there's an appropriate sample miss.
1354540	1359900	And finally here, some people, including former president candidate Andrew Yang,
1359900	1364920	think that solutions to tech companies profiting off of individual data and collecting and sharing
1364920	1370600	it freely is to make that data cost something and give individuals a cut of the money.
1371600	1376660	While that does play into the idea of data rights and giving individual control,
1376660	1381660	this practice, which is commonly called data, or this idea, which is commonly called digital
1381660	1388560	dividends, for data rights advocates like me, this amounts to pay for privacy. Survey after
1388560	1393720	survey shows that consumers want more control over their private information, and they don't
1393720	1401000	want their information monetized. Yet ideas like this keep coming up. When digital dividends was
1401000	1407080	on the docket in Oregon in 2019, and I was serving as senior policy counsel for Consumer Reports,
1407080	1412600	I wrote to lawmakers on behalf of Consumer Reports to explain why we oppose such a bill.
1412700	1418780	In essence, data dividends turn the basic right of privacy into a luxury out of reach for lower
1418780	1425180	income individuals. Further, those who sell their data would receive compensation for something that
1425180	1431980	can't realistically be appraised, or is lost fully reimbursed. Now I'm going to turn it to Jen,
1431980	1438940	who can help us think more about the safety risks with data rights. Fantastic. Thanks, Dina. And I
1438940	1447360	think in terms of recognizing the broad swath of risks associated with sort of data rights
1447360	1453440	and safety, I always turn to you as the expert on this. So appreciate you taking the lead there.
1453440	1457760	I want to talk about some of the other principles that we touched on too.
1457980	1463740	And I think a lot about equity and access. And I've got two graphs up there on the screen.
1463740	1467200	They're a little small, so let me explain them to you. The one on the left is from the Dartmouth
1467920	1475600	Atlas of Health. And this is an example of a specific health outcome. So red is good.
1475860	1480740	In this case, that means that individuals with diabetes are actually getting the necessary
1480740	1487220	vision screening to make sure that their diabetes doesn't actually lead to vision impairment and
1487220	1491920	ultimately blindness. So we can see up there in New England, they're doing a great job.
1491920	1498340	And in certain areas of the Midwest, dark green color is where that kind of screening is not
1498340	1504080	happening at all. Individuals with diabetes are not getting high quality care. On the right hand
1504080	1510240	side, you can see a map of households without internet. And there it's the red color that's
1510240	1516040	showing that there is not great internet access and blue that there is. So let's think about,
1516040	1521080	there's a really interesting new product on the market for the IDXDR, which is a tool that doesn't
1521080	1526300	require a physician. It's a simple camera. It takes a picture of your retina and it looks to
1526300	1532380	see whether diabetes patients are struggling with imminent risk of their vision. If we're relying
1532380	1537240	on the internet to administer that, we can see that in New England already, they have great
1537240	1542280	outcomes and that's the place with some of the best internet. Yet, if you look at Texas, they're
1542280	1547560	suffering with some really poor health outcomes and most of those households don't have internet.
1547560	1553000	So I come back to this idea of, are we going to use these digital tools to ameliorate some of the
1553000	1558580	disparities in access to care, some of the disparities in health outcomes, or are we going to
1558580	1563940	unfortunately widen that gap between the healthy and the sick, between the rich and the poor?
1563940	1569160	That's something that we have to keep front of mind and I would argue is a safety issue.
1569900	1575280	We also intentionally, because otherwise I think it gets overwhelming very quickly,
1575280	1579880	focused on violence. But I do want to draw attention to the fact that this digital era of
1579880	1586840	health goes well beyond those remote monitoring technologies that rely on those either fixed
1586840	1593260	point or wearable sensors. There's been instances of using sort of care decision tools
1593260	1600540	that were actually incorporating bias into care outreach. There have been other instances
1601540	1609080	where we're actually defining whole new tracks of data as being important to health. And I'll
1609080	1613520	give you an example. There was this phenomenal study that was done by some researchers at
1613520	1620480	Microsoft. 15% of pancreatic cancer patients can be identified by nothing more than their web
1620480	1628160	searches. Dina summarized the pretty loose and pretty narrow privacy regulations. Certainly
1628160	1633200	nothing extends to your browser history. Let's think about how this plays out. This is phenomenal
1633200	1638560	if we think about your only hope in beating pancreatic cancer being an early diagnosis.
1638560	1644000	If we can harness that information, this is a huge win. It's great for saving lives. But let's
1644000	1648480	think back to some of the examples that Dina shared with us. What if instead of this information going
1648480	1652960	to your doctor or someone who would reach out to you to say, hey, I think you're at risk and I
1652960	1658280	think we can save your life if we act now, what if instead it goes to an employment agency? What if
1658280	1663160	instead it goes to a life insurance company? What if instead it goes to a mortgage lender?
1663380	1669000	There is the possibility here of phenomenal improvements in the way that we care for humans
1669000	1675940	and the cost at which we do it. There is also really quite terrifying risk about how we use
1675940	1682980	this information and the harms that individuals could suffer. And I have a bit of a flair for
1682980	1689980	the dramatic and I'm very willing to cop to that one. But I don't think it's an overstatement to
1689980	1696480	think about these violence and in fact digital health writ large. Are we going to weaponize it
1696480	1703420	or are we going to use it as a tool? Are we going to use it as a way to do low-cost outreach to
1703420	1708700	deliver personalized medicine to be as inclusive as we ever have been in the history of healthcare
1708700	1714440	and hopefully better? Or are we going to use it to double down on the surveillance economy?
1714440	1720380	Are we going to use it to increase the disparities in care across different races, across different
1720380	1726980	socioeconomic status? And I think that means in order to address this, we one, have to be
1726980	1732860	very intentional and two, as we discussed, we really do need to think about a new definition
1732860	1739260	for patient safety in the digital era. And the definition of patient safety that the World Health
1739260	1744380	Organization has proposed is up here on your screen. It's a lot of text, but what you can see
1744380	1750580	is we're thinking mostly about the absence of preventable harm, reducing risk wherever possible,
1750840	1756880	and collective notions given current knowledge, resources available, and the context of pain.
1757060	1762520	So in fact when we talk about redefining patient safety, I think this definition holds up quite
1762520	1767220	well. What we really need to do and what was done very well by the Hippocratic Oath,
1767220	1772020	the Connected Medical Devices, and I am the Cavalry, is thinking about what is given current
1772020	1777720	knowledge? What are our resources available? And what is the context of care? As we move from data
1777720	1783940	in a manila folder in a file cabinet, delivered in a healthcare environment to the use of these
1783940	1789180	environments, the use of search histories, the dependence on the internet to get information
1789180	1794820	and to administer cures, how do we use our current knowledge about the risk? How do we
1794820	1800360	use the resources available and how do we think about the context of care being now 24-7 because
1800360	1805460	it's tracking your Google searches, because it's tracking your smartwatch? It's not necessarily
1805460	1811560	that this definition needs to change, but we need to think about how we advance what we know
1811560	1820180	in this community about harms due to connectivity to the internet. And we'd love to learn from you
1820180	1825680	guys during the Q&A about your thoughts, your ideas, and any feedback on anything we've missed
1825680	1833440	and how we can advance this agenda to saving lives, to reducing preventable harms as we move
1833440	1839100	into this digital era of health. Thank you so much. And Dina, thank you for being such a wonderful
1839100	1843180	co-presenter. I look forward to some great discussion. Thank you. This has been great.