 Hi everybody, welcome back to Designing on the Frontlines. This is our seventh episode of the show. This show is brought to you by the Health Design Lab at Thomas Jefferson University Hospital and Cooper Hewitt at the Smithsonian Museum. I'm Morgan Hutchinson. And I'm Matt Fields, and we are two emergency medicine doctors joined by our team and co-sponsors from the Health Design Lab, Boncu, Rob Buglese, Christie Shine, Mary Ellen Daley, Michelle Ho and all of our students who are tuning in today. Hey guys, thanks for coming on. And also from Cooper Hewitt, Ellen Lupton and Pam Horn. It's a very important day today, Juneteenth, which in the wake of the killing of George Floyd in weeks of protesting of racism around the world makes this Juneteenth even more critical to remember our country's long battle with racism and how this battle is far from over. I was really moved by a talk on our show on June 5th by Brian Lee Jr., who talked about how we can use design as a form of protest when imagining the design of our cities, spaces and institutions. Mid-June also marks the fourth month of the pandemic and unfortunately we have seen some spikes this week. Four states have actually reported record high numbers of COVID cases and over half of the states in the US have reported increasing numbers throughout this week. We created designing on the front lines to bring together people from the world of design and medicine to reimagine how we deliver healthcare in the setting of the pandemic. And today I'm really excited to hear from our speakers. Yeah, so let's get to it. So remember, and for those of you joining us for the first time, this is meant to be an interactive discussion and we really wanna see your faces. So please turn your video on. Use the chat box to tell us who you are, where you're from and ask questions. And Christy Shine will be monitoring those questions and we'll have a Q and A session at the end. And then if you've missed any of our previous episodes, you wanna check them out? They're available online at healthdesignlab.com slash D-O-T-F-L. We've got four excellent speakers today. Norma Padrone, health economist. Yuhan Sonan, who's the director of GoInvo Designer. Dr. Emily Silverman, who's a doctor in internal medicine and the creator of the Nocturnus podcast. And Dr. James Pinkney, who's the CEO of Diamond Physicians and a physician on Chase and the Cure. We also have one themed breakout room, surprise to follow. It's gonna be a five to six minute breakout room with four to six randomly assigned co-members. And that's gonna be a lot of fun. I'm gonna turn it over to our producer and Zoom bouncer, Rob Hulisi for Music Updates. What's up everybody? It's great to see a lot of familiar faces, a lot of new ones as well this week. Every week I like to give a little talk about the music that we started at the beginning of the episode. This week, this was actually, it was pretty sweet music, but it comes from an even sweeter show. One of the things as a parent of three little very energetic girls is I love getting into calm down by sticking in front of the TV and sitting right down next to them. So, co-watching is really a huge thing for me. So whenever I find a show that we can both watch, it's amazing. So that song that you heard today came from a really fantastic show called Keepo and the Age of the Wonder Beasts. If you got kids or even if you don't, you just like watching cartoons like I do. I suggest you check it out. Amazing animation, amazing team of producers and actors and the songs are incredible. So check it out. Awesome, thank you, Rob. All right, so let's get into it. So one thing that we haven't talked about on the show is the impact of COVID-19 on the economy. Fortunately, our first guest today is a health economist and expert in healthcare research. Norma Padron, Dr. Padron has expertise in healthcare economics and healthcare research with over a decade of experience in academia and healthcare analytics. After transitioning from academia to health systems, she's currently working to accelerate the role of digital technologies and healthcare deliveries. Her focus is on the application of research principles to improve the design, implementation and evaluation of digital products to advance health. Norma, it's great to have you on the show with us today. Thank you for coming. Thank you so much. And thank you so much, everyone, from the invitation. I am going to be sharing my screen. And so there we go. So for today, I wanted to go over, sorry. I wanted to go over, rather than make it a very sort of professionally focused conversation, just sort of some reflections of things that I've learned over the years, some things that I worked on over the years. And so as many of you, I have spent a lot of time indoors. And so reflecting in terms of what time and place and space means to me, to my work. And so I will focus on that. I will be going over an article that I published earlier this year, with everything in the context of personal reflections. So once we get into the questions, I would love to kind of hear your reactions on that. So I will begin by saying that I did spend some time as Jefferson faculty in 2014, 2016. So I consider myself an adopted gang member of the Health Design Lab. And because a lot of my work has focused on, or rather has been influenced by the places that I've lived, Philadelphia holds a very special place in my heart. So here it is. So this slide says that it's a little bit about me, but really this whole presentation is about me and my reflections and my experience, which are in no small part shaped by where I'm from. So I'm from a very small town in Southeast Texas, called McAllen, Texas. And so this is, it's shoving me. And this is my hometown. And in 2009, as I was embarking to begin my PhD to become a health economist, and it was such an exciting time in my life, this article in The New Yorker came out called The Cost Conundrum. And this Texas town that I told the one that was talking about where healthcare expenditures were so high and healthcare access so low was my hometown. And so I remember just sort of getting that sense of that ominous feeling that I was embarking into this adventure to understand healthcare. And yet this is where I was from. So I've lived in, over time, in 12 different cities and four different countries. And throughout very early on, I started focusing on health and healthcare. And so in this different places and cities that I've lived, it's been very salient how both access and the experience of healthcare is so different and so marked by the places where we live. So a lot of my work has been focused on two different intersections. I have been told more than I would like to share that I need to focus a little bit more in terms of my interests, but I don't want to. And so a lot of my work in the past has focused on that intersection between public health and healthcare delivery and really partnering with local public health departments like the Department of Public Health in San Antonio and Philadelphia and Barcelona and healthcare systems and providers in terms of understanding how they design services for their patients. And the other intersection that I've been interested on over the years, and again, as I look at this publications or this work, this projects that I've done, they all were in different cities in different places. So they all have been colored by that experience, but I've been very interested in intersectional behavioral economics and population health. And all of this can become really catchy words that carry different meanings to different people. But I think like one constant of all of this work is that we always kind of converge into something like this, right? Like we end up with one map. This is a map that I built as a dashboard, an interactive tool that I built back when I was in Philadelphia and this is Philadelphia. And for example, like we know those statistics by heart. We know that, you know, on one side of the main line, the income is really, really high. Health outcomes are really positive and on the other side is really negative. And the same applies, this is Barcelona. This is the index of family income in Barcelona. This is housing inequality in Durham or Carolina where I also live. And then this is from the article that I published with some colleagues in January, at JAMA, where again sort of it is true for the US. And so in the last three months, when I think of sort of like, what does the place means to the work that I've conducted over the years? I have more questions than answers, but I think that, you know, population health and you know, behavioral economics and public health, they all seem to converge to something where we come to understand this inequalities at the geographic level. And so this is back to my hometown and this is the article that I was mentioning that I published in January with some colleagues. And so I wanted to actually, let me see if I can move this here. Yeah, I wanted to actually take you to the map itself and just sort of show you, I do invite you to rebuild this SDOH Atlas GitHub.io. I do invite you to go and play with it. We focused on these dimensions, which again, in reflecting in the last three months, sort of they hold now a very interesting meaning, but socioeconomic advantage, limited mobility, urban core opportunity, mixed immigrant cohesion and accessibility. And I'm speaking today from LA, so I can walk you through some of our thinking here in LA. So for example, poverty 26.2% of poverty, 6.3 unemployment, 26.3% of no high school per capita income minority and an advantage index, which is negative. And again, you can play with this and the reason why I call this conversation reflection says because I guess over the last decade that I've been working in this space, I used to think that I understood it that much better. And I've come now to realize, especially in light of some of the events that we've had and certainly the pandemic, just sort of what does it all mean in terms of action? And so back to just sort of some of the topics is that, you know, hometown and our place and our space means different things and it's certainly we understand that it affects health, but how do we change this numbers? I think that is what I'm hopefully gonna be spending the next decade professionally on. And so to conclude, so McKellen, which was the place, my hometown is where I spent the last three months prior to flying back to LA. With my mom, we were socially distanced, appreciating parks and sidewalks and cooking and baking like most people in this last few months. And I've gained just sort of this newly just impetus and energy towards spending the next decade of my professional trajectory, not building only the maps, but hopefully building the actions to change the maps. And so I will conclude, I will still, if I still have it Morgan, do I still have one more minute? I will conclude with, cause they did say, I was very grateful that in the invitation it said, you can share personal reflections and poetry and I felt poetry, can we do that? So I don't write poetry, but I do love reading it. And like I said, my work, I've been putting a lot of my work in perspective and I love this little poem came out recently or that I came across recently, it's called Time Pummels by Gregory Orr. So I'll just read it. Time Pummels, the whole globe with catastrophe and weather. Why it is for price, it also test poems. So what if it's old? What if it's been wept over for centuries? Notice not a single phrase is word on the page. Here they are, words arranged in hopeful lines, patient as seeds in their furrows. What is your voice if not the rain? That's all I have for you today. Thank you so much. Awesome. Thank you so much, Norma, that was really moving and I'm really excited to look at that social determinants of health atlas. That's really cool. So I'm gonna hand off now to our co-sponsor, the show, Ellen Lupton, who is the senior curator of Cooper Hewitt Smithsonian Museum, who's gonna introduce our next guest, Ellen. Yeah, great. I'm really excited to introduce Yuhan Sonin, who I got to work with on our book, Health Design Thinking, which is full of infographics and UX designs created by his company, Go Invo, which is located in Boston and is helping build the future of healthcare. The design skills in this company range from medical illustration to data visualization and UX. They design information products and even policies. So I'm really excited to hear Yuhan and the incredible range of thought and making and doing that he brings to the design of healthcare. Thank you. Welcome, Yuhan. Thank you. Thank you, Ellen. I can't live up to that at all. So let me start by saying yes, I do pretend to run a company in Arlington. I also teach in an academic institution that's also a venture capital firm in Cambridge. With ethics is situationally optional in most of industry, including healthcare at the moment, here are my disclosures. Yes, all of my genome and personal health is on GitHub, so do what you will. If you wanna get ahold of me, I will try to get back to you within two business hours, and there you can publicly shame me on Twitter. So this is a noble pursuit that we are, most of us are in, of the world of healthcare. And here we are in the declaration of Geneva some 70 years ago with an excellent way of thinking about what we should be doing for everyone in it. And yet we are bombarded by, yeah, my algorithm, my model care plans for half the US citizens, good luck trying to get into it and see how it works. We, I think we think more than it is, but we're inching towards healthcare as a human right. And yet when you use a healthcare service, you have no idea how the thing works, none, zero, typically. And that to me is a crime against patients and clinicians. Because if healthcare is so noble, if it is critical to how we operate here on the planet, we don't have a choice in this country either. I demand that healthcare be open. So look, the underpants of the internet are inherently open, right? It's also a human rights as the UN and most of us are using it right now. And if you check your phones, the devices you're on right now, most of the infrastructure of that software is open source. And yet when you go longitudinally up and down the stack of the software stack at least in healthcare, it sure as hell is not open, it's all closed. And Eric here says we have anti-open source in healthcare. So yes, we have plenty of people on high making sure that they hear, we hear the story, probably not loud enough. So where is open source healthcare sort of best suited for? Well, one is the infrastructure, these common services that we all sort of use and use again and again and again and again. And the other part is the bleeding edge of healthcare. That's the bleeding edge of science. These two places are really good for it. And you can see the infrastructure part of my whole land of Estonia is, which is sort of crazy. They have this kind of electronic goodness country wide, but their entire backbone is open source. And so, and I know the who and the UN loved to quote Estonia's experience there. They have problems too, but this is a good example to look at for infrastructure is all open. And yeah, US is getting there. The rest of the planet is making nibbles at open source. You probably heard of fire and some other techniques here that are all mostly open source. And yet here we are in the midst of craziness. And this is also a very good time to see how open source is helping everyone. NIH blasting out material all the time, the VSAC. Sounds like a condition I don't wanna have. It talks about the, these are all the definitions for the data for COVID, for instance, it's all open source and accessible, interrogatable. You're seeing it in your new streams, right? Open source, open source. Hell, if you go to GitHub, which is a repository for code, you have 32,000 repos. Holy smokes, you know, a date picker has like 5,000. So there's something good happening here. And our studio, all of the things we do internally are open source, like for kids and teenagers, understanding coronavirus.org is the graphic novella. Home care basics is translated into a couple languages. Hgraph on COVID, all open source. And what we're fighting for and continue to fight for at the state level and national level is how do patients start to co-own the data? Again, open source. And so here's an excellent coalition that's also jamming on this and even has it in their mantra. Our stuff is open source. Okay, pretty damn good. But we're not close. We're really not close because eventually a vaccine is gonna show up and guess who's gonna make a shit ton of money? It's a technical term on a taxpayer-funded exhibit, right? In pharma, about 70% of taxpayer dollars are the thing that drives development. And so maybe we don't get marching rights, but we sure as heck should have some kind of three-year limit and a percent markup on the vaccine. We have to think about this globally and as a system problem. And so as designers and engineers and healthcare wonks, there is also part of us that need to look at what are all the things we demand of the healthcare system to and how should it evolve? And yes, some of these things we as a studio have worked on here and we also have our own objectives making sure that again, patients are part of the equation by owning their data. And then one, of course, I'm channeling my Ralph Nader here. We need a sort of a health literacy agency for ourselves. And to wrap up, I think that healthcare is a public utility. It is a human right and it is way too important to be closed. And we as engineers, as designers, as clinicians, as policy makers really need to do a better job in understanding that there's not much choice here and if there is going to be involvement by us, it should sure as hell be open. I've stolen from most of these people here and if you want to hear some of my, or read some of my more ranting, go for it at opensourcehealthcare.org. Thank you so much, Yuhan. That was awesome. It was really great. I'm excited to read more about that and I love what you said about open source medicine. It's like so true and so elegant. I'm now going to go ahead and introduce our first and only breakout room of the day. This is going to be a six minute breakout room and we're going to randomly assign you to groups of four to six people. This is going to be prompted with a following question. Who has inspired you during the pandemic? This could be anybody. This could be a designer, a healthcare worker, a patient, a leader, activist, a friend, colleague, family member, anybody. Who has inspired you during the pandemic? That was an awesome breakout room, you guys. Thank you so much. We met people from Arizona, Texas, Seattle, that's where I'm from, up in Canada and then actually had my first breakout room where Bon and I were in the same room. So that was pretty cool too. Yeah, we ran out of time. Oh my gosh. I know, we did too. That was great. Thanks to Ellen Lutton for that awesome prompt. That was definitely taking it the next step. I think we're going to keep you on that assignment, Ellen. And Colleen Clark gave us some great options too for a breakout room. So you guys, man, bring the designers into those questions. So I'm going to go ahead and introduce our next speaker. I'm so excited to have Dr. Emily Silverman here. She's an internal medicine doctor and she is the creator of the podcast, The Nocturnist. Storytelling is something that is already known to be so important in the world of design, but it's something that's very underutilized in the world of medicine. There are not a lot of options for doctors and nurses to tell their stories about their patient experiences. We have plenty of great anatomy, but not a lot of The Nocturnist. And Emily Silverman, thank you so much for joining us today. I am going to share my screenway speak and I will hand it over to you. Thank you for the introduction, Morgan. And thank you everybody for having me. It's such a dynamic group of people all tackling such important problems in healthcare. So it's a pleasure to be here. I think Morgan should be sharing a couple of images in a minute and while she's getting those up, I'll just tell you a little bit about the project that I've been working on over the last really 12 weeks, which is an audio documentary series called Stories from a Pandemic. And in essence, over the last 12 weeks, we have received over 700 audio clips from healthcare workers across North America. 700 clips total amounting to 250, roughly healthcare workers across America about their experience taking care of COVID patients, dealing with COVID, the emotional impact, the logistical impact. And it's just been some of the most raw tape that I've ever heard. And so I wanna share more with you about that project and how it came to be, but in order to understand that, I wanted to walk it back a little bit and share with you the history of the organization, which is called the Nocturnus. And it's a medical storytelling community that I founded in January, 2016, when I was a medical resident at UCSF. And really the Nocturnus was born out of my personal pit of burnout and depression. I don't know if there are a lot of docs in this conference right now, but physician burnout, physician depression, even physician suicidality has been a big topic over the last few years. And I was definitely experiencing a lot of burnout when I was in residency. And I think a lot of that was related to how the human stories and the human interaction was really being stripped out of the experience of doctoring. And I was spending a lot of my time in front of the computer and not in front of my patient. And also just the brutal hours, I felt like parts of myself was falling away, like relationships and hobbies that I used to do. I just like, it was like, oh, I haven't picked up my guitar in like two years. Where did the time go? And one of the parts of myself that I felt was dying was actually my creative side, which is unfortunate because I feel like there's so much room for creativity and medicine, but I just felt like I was kind of stuck in this box of the epic checkboxes and the algorithms. And didn't really feel like I had any space to play or explore or really like process and metabolize a lot of what I was seeing unfold in front of me in the hospital, which included moments of joy and healing, but also moments of just devastation, dealing with illness and grief and things like that. So I decided that I was gonna start a live storytelling show. And so this podcast was actually a live show before it was a podcast. And so in January, 2016, I basically twisted the arms of eight of my colleagues and got them to go on stage and tell stories about their lives as doctors. And there was this electricity in the air and fast forward four years, the last live show that we did pre COVID was in January of this year, maybe February. Can't remember the exact date, but it was at the Yerba Buena Center for the Arts in San Francisco and we had an audience of 700 people a sold out theater, people coming to the theater to hear doctors stand on stage and talk about their experience. And to really speak from a place of vulnerability, I think part of what I'm trying to do with this project is shatter the illusion of the physician God or the physician hero or the physician soldier, which is a narrative that's been splashed around a lot in the media these days. And so we were kind of going along with these live shows and then we would take the stories from the live show and release them on the podcasts coupled with a conversation between me and the storyteller. And that's what we were doing. And then in March, COVID hit and we just stopped everything because we understood that the medical community needed us more in that moment than ever before. And we tried a few different things. First, we said, send us your COVID stories and we got a couple dozen stories and they were written and they were fine, but they didn't have that magic. And then we said, okay, send us audio clips. We've always been about the spoken word, send us audio clips. We got some audio clips and they were okay. And I think part of what we realized is that in the past we had asked people to craft like a perfect 10 minute story with an opening scene and conflict and stakes and a climax and a resolution. And people just didn't have time to do that because there was a pandemic. They were dealing with other issues. So we then pivoted to this diary format and that is really where things exploded. Once we launched it as a diary project over 50 healthcare workers signed up within 24 hours. And then eventually we got over 250 people to sign up and we had people send us over 700 clips. And it's, you know, today's March 15th. I'm Dr. So-and-so. I work at this hospital and this is what happened today. And basically we produced this in the style of Saturday Night Live where every week on Tuesday we would release an episode and then the clock would reset and then we would say, okay, what came in last week and what is the next episode gonna be? And so we were really just churning out these episodes based on the moment. And I think it had a really natural arc because we started with the hitting of the pandemic, the surprise and then up to the surge and then to sort of figuring things out and all the logistical issues and then the emotional fallout. And so I'm starting to get to my time but if you're interested in hearing some of this audio you can visit our website, The Nocturness. We have 10 podcast episodes that you can check out or you can interact with this, which is our story map where we have dots on the map. These are not all of our stories. We just, we curated this pretty carefully. So these dots represent all of the stories that made it onto the podcast. And you can click and you can hear voices from around the country. And I should say it's not just doctors, we also have nurses, we have a hospital chaplain, we have a medical delivery truck driver. We have all sorts of different healthcare workers who are sharing their stories, reflections and reactions to the pandemic. And we stopped after episode 10 but we are planning to launch a part two. We just don't know when that's gonna be or what that's gonna look like, but we are very committed to kind of sticking with this narrative and exploring the fallout and how this can be a portal to a better moment in healthcare. So I'll stop there. Thank you for having me. Thank you so much, Emily. That was awesome. I'm really excited to hear from you. I love your podcast. It's like, my God, just so beautiful and so well done. Totally encourage everybody to check it out. I'm now gonna turn it over to our Health Design Lab director, Dr. Bon Coop, to introduce our last speaker. Hey, I'm Bon. I'm gonna introduce Dr. James Pickney. I don't see him. Where are you? Are you on here, James? I'm below you. I'm still in your shadow. There you go, there you go. I'm still living in your shadow. You're not chasing the curious. Well, James is a good friend and he is a family physician. He's practicing. He's also an entrepreneur, one of the most creative guys that I know. He is CEO of a company called Diamond Physicians. They're based in Dallas, Texas. And here's this amazing story of how he started this company. We've had a lot of conversations together in Los Angeles in a television studio when we were doing a show called Chasing the Cure that helped patients get a diagnosis. So I was always freaking out in the back room before going on set and just having a nervous breakdown. And James was so cool, calm and collective. And I was like, I want to be like James when I grow up. And we're gonna just maybe chat, James. I wanted to get your thoughts on a few things. One is in Texas, we've been seeing an increasing number of COVID cases there and wondering how you as a physician, as a CEO of a company, how have you been adapting to that? And another question I have is, we've talked a lot about race and medicine during our conversations last year. And we currently are not only experiencing a viral pandemic, but really a racial pandemic within a viral pandemic. And what has your experience been like as a black physician during this time? So there's a couple of questions I'll throw to you and yeah. Well, thank you for that introduction, Bon. I appreciate the invite from the Health Design Lab and really excited to be on the show today. The first question, Bon, Texas is really challenging, right? Because you're mixing politics with medical policy and they don't mix. So we opened up our state in my opinion way too fast. Our numbers weren't declining. We weren't following the CDC recommendations and our governor just said, hey, look, I don't care, we're gonna open up the state in phases. And sure enough, Texas, Florida, Arizona, all three who reopened the states in my opinion too fast. I've experienced exponential growth in COVID-19 cases. We've worked 50% and each day this week we've had record numbers of COVID-19 positives and hospitalizations and hospitals are 75% capacity now. So COVID-19 is very serious and it's a pretty simple solution to stop the spread. I just need everybody to wear one of these. When we talk and we laugh and we cough, we're spewing respiratory droplets into the atmosphere and if you wear a mask and if everyone wears a mask, you're protecting yourself from everybody else. So you decrease the probability from about 19% to 3%, one to 3% if you wear a mask from infecting someone if you're asymptomatic or symptomatic carrier. So to address your second question, Bon, we had a great little chat in the breakout session just now. Our country is experiencing a lot of social injustice and we've been experiencing not only racial inequality but gender inequality and all kinds of inequality for a long time and since it's Juneteenth, it's kind of fitting that we talk a little bit about my experience, I've experienced racism as early as age 10, blatant racism being called the N word and things of that nature. And in the breakout session, I told a story about how when I was a resident at Cedar Sinai in LA, I was a surgery resident and then changed to family medicine. That's a long story. I was seeing a patient walk into the room and they literally told me to my face, I don't want any colored people on my team. I don't want a colored person taking care of me. And luckily my attending had my back and immediately said, we're not gonna tolerate any language like that. If you don't want Dr. Pinckney to be part of this team, you can check out AMA. So it's rampant in our country. I am hopeful that the unfortunate murder of George Floyd is facilitating change. I'm seeing a lot of things across the country that are inspiring and in our true reactions to this travesty and really sparking change. I mean, I've seen companies, institute policies, I've had people reach out to me. So that's a tough subject bond, but a good subject that we have to talk about. And it's something that hopefully we can move forward and we can really come together as a country and promote equality. We're all Americans here. There's not 20 different races. There's only one race, the human race. And once we realize that, we can move forward and become a better nation. Thanks, James. What's it been like, you know, you own this company and we're in this pandemic. The cases are increasing in Texas. How do you keep yourself safe, your family safe, your staff safe? What's that been like? Yeah, we've had devastating lows and PPE, so I'm literally stapling in 95s, my strap broke, I had to staple it back together. You know, from a screening standpoint, you know, we are doing PCR testing and antibody testing, but there's been so much just fraud out there, especially with antibody testing. You've had hundreds of companies jump into this pandemic and release antibody testing without evidence-based medicine, without proper data. And they just wanna make money and profit off of a pandemic. So it's been challenging sorting through all the mayhem and I've got a team, I've got eight doctors that are on our team and one of them is a board certified pulmonologist, so we've been scouring the country for the best screening tests. And I'm really happy to announce that we found a viral antigen test made by a company called Quidel who's been around for years, 30 years or so. And it's the first of its kind. They're the only test that has approved the FDA EUA approval. And you know, I don't know if anybody's had PCR testing on this call, the nasopharyngeal swab, it is miserable. I had to test myself and it's not something that you wanna do every week, it's pretty rough. PCR testing is great for symptomatic patients and still should be first line. It's got a high sensitivity, very high specificity and for all the non-positions on the call, PCR stands for polymerase chain reaction. We actually take a little bit of that viral antigen from that nasopharyngeal swab and we amplify it a hundred times and then we compare that DNA and RNA to the actual COVID-19 strains and we see if they match. With the viral antigen testing that I've discovered, we actually, they actually have the antibody on the test kit and it just takes a little bit of antigen on a nasal swab. So anterior and neary is just the front part of the nose so it's comfortable, it's not miserable. They put that in a reagent, let it cure for a minute and put it on the test kit and the antigen actually binds to the antibody and that's how you have a positive test. The sensitivities are above 90%. Specificity is 100% and I'm really excited about it. We're actually the first distributor in the country. We signed a deal with Quidel and we're launching a COVID-19 screening program for universities, for NCAA universities to get students back to school so we can reopen schools to get students back to sports so that we can have division one sports and division two sports in this country. I think it's great for morale. We've got a lot of bad things happen in the last couple months and people need a boost and a break from all the chaos and all the pain and I think sports are a great way to do that. So we're excited about the program. We have 111 universities that have signed with us and we will be doing COVID-19 testing screening for them and we really believe that this is the best test for asymptomatic individuals who are gonna be the vast majority of students as well as people returning to work. So I think when we start opening the country up, we're gonna have to have these programs and these protocols in place that we can safely reopen and make sure that we can wear our masks, our face coverings at all times and have adequate screening and we can actually beat this thing. You're doing some amazing stuff. Thanks for your leadership there, James and it's fantastic and it's so great to reconnect again. It's been a while. Yes, sir. Appreciate you, Bon. Morgan, are we out of time? Me and James? Oh, you guys, oh my God. We can talk all night long, you know? Yeah, I can talk all day. We can extend this, but we do run a day schedule around here, so I guess so. James, thank you so much. That was really, really cool to hear your own personal experience and also, wow, that is absolutely incredible. The numbers you guys are getting with sensitivity and doing the anterior swab, that's like really incredible and way better than what we have available as anywhere I've heard, so that's great. Guys, this has been a great day. All four speakers were absolutely incredible and I'm really excited to hear the questions the audience has for you guys. I'm gonna turn it over to Kristi Shine for the question-answer panel. Thank you, Morgan. So we had some great questions, pop up both in the chat box and then earlier this week from some of the friends of the show. So we'll go ahead and get started. There's a question for Emily. Emily, this question comes from Colleen Clark in our audience today. How might we, or what are the most surprising themes from the stories that you've received and how might we incorporate those into our medical practice? Yeah, that's a great question. One of the analogies that's come up recently is that we have a healthcare system that is chronically ill and COVID has been the acute on chronic insult on our healthcare system. And so really what COVID has done is unmasked a lot of the issues that were already there. And so some of what we're hearing in these audio diaries is people not feeling valued at their institution, people not feeling seen, people not feeling like they've been communicated with effectively. That's one part of it. Another theme that was really common is the healing effect of laying hands of touch and how difficult that has been in a time of social isolation. We had one clip from a hospital chaplain in Indiana who was talking about how do you minister to a grieving family from a distance and shouting Hail Mary's from a door and when you can't have a funeral, like what is that grief process like when all of the rituals around death are no longer accessible? So that was an interesting theme that came up a lot. Another theme that came up a lot is the idea of the physician hero and the way that the mass media was portraying physicians and a lot of medical students and doctors and nurses were just talking about how that didn't really resonate with them and how they felt like the inner experience of providing care to COVID patients was a lot more complex. I heard a lot of guilt come up. So for every doctor who was at home feeling guilty that they weren't in the hospital taking care of COVID patients, there was a doctor wrapped in COVID gear intubating COVID patients who was guilty that they weren't helping out at home with the kids. So people feeling guilty sort of on all different angles of this. But then there was also just a lot of beautiful moments of resilience and beautiful moments of connection and joy. I mean, even in a story of somebody holding up a cell phone and facilitating a goodbye, like it's an incredibly sad story, but there's a beauty there in that connection. So it's a mix and at some point we'll probably have to write it all up and analyze it. But for now, the best way to hear it is just to hear it. Great, thank you so much. One just further question and building on that. How might we get a larger diversity of voices involved in this conversation? And how do we make sure that we're including all of the different voices that we all need to hear, especially in the light of all of the recent events that we've had? Yeah, I think it's incredibly important that the physician workforce be diverse because people bring different perspectives to the table but also our patients are diverse. And so I think it's important that the physician workforce reflect our patient population. I remember once I was walking with our chief of medicine at the general to the elevator and he's a black man, we were standing waiting for the elevator and a black woman came up to both of us and she looked at him and she said, are you a doctor? And he said, yes, I am. And she looked like she was about to cry and she was like, I want you to be my doctor. And you could see how meaningful it was to her to see a black man in a white coat and that connection. And so I think it's incredibly important that we maximize the diversity of the physician workforce. And then as a storytelling organization, we feel really strongly that we want to highlight stories that aren't being told. And that certainly includes people who have been historically excluded. I didn't mention this in my presentation but in the wake of George Floyd's murder, we launched a new audio documentary series that's called Black Voices in Healthcare. That series is gonna be hosted by physician Ashley McMullen at UCSF and executive produced by physician Kimberly Manning at Emory University. Both are black women physicians who are leaders in the medical humanities. And we've already had over 130 black healthcare workers across the states sign up to participate in that project. So that was a really deliberate step that we took as an organization to highlight the voices of people of color. So it's something that is an ongoing iterative process and very important and I think ultimately will yield a much more interesting landscape of stories and conversations. That's great. We'll certainly look forward to that. That's wonderful. Thanks for that. Next question is from Maya Friedman and this question goes out to Yuhan. So aside from open source, the other half of the equation is getting diverse groups of people to donate data so that we're not just looking for patterns in a homogeneous data set. How does your company work through that issue? Well, that's an excellent question. One that actually all of us, which is the huge NIH funded research project is tackling now where they're not just looking for, they're looking for a representative sample of biologic, environmental and genomic data from across the US. So they're doing much different techniques than I think most people would think about in how to approach and find people across the spectrum. And so I would look actually, they can answer it better than I can just by looking at how they approach getting samples and people to participate. It's really pretty brilliant. So I would look at all of us research project, they have a specific tenant as part of their getting our tax dollars to make sure that they get a representative sample. That's great, thanks. Another question coming out into the audience and this one is coming from, let's see, we lost the chat, sorry about that. Question is coming from one of our viewers from last week actually and this question is gonna go out to James. So this is from Andrea Bistini and she wants to know, how might the recent awakening over racial equality in this country be taken into account in order to specifically improve the health of black men and black women? You know, that's a great question. You know, with the systemic oppression of black people in America for decades, it's gonna be a really hard task. There's food deserts in black and Latino neighborhoods. There's so many areas of underserved where there's just no hospitals and no access to healthcare. And one of the things that I'm doing at Diamond Physicians is building clinics in these areas to provide access to care for underserved communities. So I think impact funds are gonna be critical. We have an impact fund that we're trying to set up in the social unrest and the murder of George Floyd and all these things are actually facilitating change and companies are reaching out to us because there's actually a lot of capital out there that needs to be redirected to social impact funds. And I think that's a way that we can start facilitating change. Great, thank you so much for that. And another question, this time I'll switch over to Norma to make sure we're getting everybody's questions answered. So Norma, a question for you is, how might we incorporate creativity to drive home the public health crisis and potential solutions to it using some of the map-based techniques you talked about? So that's a really good question. I think that just speaking from my personal experience and training, it actually, it came until very late later in my trajectory and experience that I incorporated any creativity. It's almost, when I look back at it, I almost feel like, I don't know that anyone explicitly said it, but I think it was almost discouraged in some way, like as if objectivity was at odds with creativity. And so I think that I would advise and I've done so and sort of when I've interacted with students or other people that are earlier on in their training to be more intentional and mindful about incorporating that aspect, I do think that it detracts instead of becoming more objective, which it may, again, you don't lose objectivity by bringing creativity, but creativity allows a space to ask questions that you might otherwise not be willing to ask or be afraid to ask. And so it's about owning the space and owning the knowledge that you're trying to seek, the information you're trying to prove. So I will say it is not necessarily, it hasn't been my experience that universities teach it very intentionally, at least not in the economics or public health realm. I think more and more Jefferson is one of them, thanks to Bon and others, but I would just sort of leave it to students themselves and people that are requiring that training or are embarking their research projects to be mindful and intentional about it. Yeah, I love that. I love what you just said about the creativity and objectivity, not actually being at odds with one another. That's something we do try to get across in the Health Design Lab. And so we love that you support that theme and think about that in your research as well. So thank you to all of our speakers. We had so many great questions. Thank you to the audience members. Please feel free weekly to put your questions in the chat and hopefully we can get them all answered by our speakers. So I'm gonna turn it back over to Morgan. Absolutely, thank you all, Chrissy, lovely. And thank you all for your presentations and for your answers to all these questions. If you guys missed any part of this show or any of the prior shows, you can check them out at healthdesignland.com slash D-O-T-F-L. This was a great week. It's gonna be a tough act to follow, but we do have another show coming next week that you guys will hear about. We've got three excellent speakers. We have one of the founding members of the IDEO firm, Dennis Boyd. We have healthcare architect from one of the leading architecture firms, Sheila Rudder. And we have designer, Emma Greer. So I'm hoping to see you guys all then and I will send it back to Rob for some music. All right, that was awesome, everybody. Thanks to all our speakers. That was really cool. Everybody have a great weekend.