I want to echo the Ranking Member for her comment. We want the best care for our parents and theyve earned it. Im hearing an opportunity in the next 2030 years to affect the debt. Like some of you, i have a personal experience to this. I do have a mother and [laughs] shes 89. Shes very tech savvy, this aging in place is a new phase for her. My wifes mother is younger and has been diagnosed with alzheimers. Im very excited about what you are doing with the va. You have a Perfect Laboratory to answer some of these questions that youre hearing typically about cost, acceptability. Sometimes in denial about need. Secondly, you have a medical staff that might be less than receptive potentially to some of these new technologies or not. Maybe its a perfect lab to develop these. I would like to get your experience about cost, general experience and medical staff that you deal with. We have an example of a device that would be in place in veterans home. Im not going to turn it on. This monitors the blood pressure, weight, or temperature. We provide those devices. A device like that cost about 350 and can be repurpose. The cost of using a device like that about 1,600 a year. When i talk about the cost savings i didnt translate the bed days of care and hospital admissions. Last year for the patients we started last year, they had a 54 decrease in hospital bed days of care, numbers of days in the facility. That translate into a significant cost savings. I think its important that devices dont exist alone. They are part of the system, for us we have home telehealth coordinators. About every hundred we have one Care Coordinator. People smarter than me have published about this data, and we had inquiries from all over the world where people want the results. Some of the problems that other people have experienced is not having the Care Coordinator available or selecting the wrong group of patients. There are four diseases for which these are extremely helpful, one is con con Heart Failure and congestive with the fluids back up. Its an incredible important sensor for when someone is start to ing to deteriorate. When the data is conveyed thats a very important piece of information. Another one is copd. Lung disease, chronic obstructive pulmonary disease. For beauty of the device is we do not have to get in the car and travel but the intervention can be made based on the result thats available. I also wanted to mention ptsd which is a very important condition for us. People are able to track symptoms. Another one that i wanted to mention is diabetes. Blood can be monitored. Its a crucial role in communicating with the patient, communicating with the Healthcare Team to make sure interventions happen appropriately. Thank you for the thorough answer and thank you all for contributions. Thank you. Thank you very much for holding this very important hearing and i want to focus on an aspect of security which perhaps hasnt been mentioned so far, and that is the security of the data and the information that is collected, and perhaps begin with you, if you could tell us what specific steps have been taken and what more has to be done to make sure that the personal information, confidential and medical information can be kept secured. Well, were in the mist of a data crisis right now in the United States. You all know about 80 million records that were stolen and the ie ten ie ten the theft associated with them. That includes Insurance Companies for which this data was, in fact, stolen but also includes Healthcare Providers and management of Electronic Medical records, so the good news is that awareness has been heightened in the past four to six months. Awareness has been increased but should have been heightened years ago. Years ago. Its not encrypted. Is yours . I dont have any data, thank god. Ours is encrypted, yes, sir. Do you recommend that data do encrypted to provide that kind of assurance . We certainly recommend for privacy our journey started in the early 2000 decade, the technology that was available to ensure privacy and security has changes and so some of rules and requirements reflect what was available then. Some of our care into the veterans home, for instance, is using devices or technology that was required at that point. There are newer means to conduct those kinds of visits but were migrating that way without compromising security. We have an an ongoing controversy about the 40mile rule. Should apply to clinics or the clinics that provide the care that a veteran needs. The clinic may not be able to provide the care that is needed, so then is able to go to a Public Health provider. What im wondering is whether the telehealth Programs Fund hospitals, 100 plus hospitals to the hundreds of clinics would fill a gap that would enable for more veterans to go to clinic to get the care that they need. How much of that potential have we explored and actually fulfilled in i hope my question is xre it is, sir. Part of the telehealth that we call clinical video, provider sees a patient and a lot of folks are familiar with skype or facebook. Not skype, im sorry. Provide care continues, so those clinical visits can happen from one of our parent hospitals to those Community Patient clinics. They can happen from one clinic to another. Theyre also happening into the patients home. With space is a challenge, were also looking at exploring ways to providers not take up space to be able to provide this kind of care. But we have probably about 12. 7 of our patients engaged in clinical video telehealth or other telehealth. Theres a large opportunity for expansion. We are we are working down the barriers that we see in expanding this as an option. I can tell you that someone wrote in the mid90s, wrote that the Biggest Barriers are not the technologies, theyre the administrative burdens, and what we often refer to is the fact that our nation has a Healthcare System thats excellent but its based on hospitals. On thirdworld countries telehealth has taken off in an incredible way to provide access to patients that have smart phones. Its our foal that we will get to the point where it can be provided timely in a way not clunky, its easy for the provider and veteran to be able to have that care. And you 1220 . 12. 7. Thank you. Thank you all for your excellent work. Thank you. Senator, welcome. Thank you, and thank you all. A very critical topic that we will face in our lives sooner or later. At the va you focused on various telehealth purchase. I want to expand that a little bit. In a state like arkansas we face a couple of challenges that are relevant here, one is a small member of providers, second is also the sometimes slow nature of Broadband Services in rural areas like east arkansas, mountains. How much of the telehealth challenges do you think are going to revolve around that kind of infrastructure limitation, how much is going to revolve around the resistence to change that we all have a as natural human instinct . Thats a good question. I think theres a requirement for multiple parts administratively from the patients perspective. We can tell you stories of eldery patients that coached younger providers in a way that has been very positive for everybody. We use device connection, we use the interactive voice responses and then we use the web browses. The interactive voice responses is how people do their banking, they put their number in the phone and what they want to do with what accounts and so forth. You can do by pushing buttons or voice recognition. The Device Connections can be through the telephone system, just a regular telephone system. Its sometimes pots, plain old telephone system. So we have some devices that are rolling out that has builtin antennas that allow for that kind of connection, but sometimes the technology is a barrier, but its in my experience that so many of veterans that have grandchildren at a distance are becoming more familiar with the face time and the skype and so forth, so they are engaged in the incredible convenience of not having to travel to figure whats going on, to move around to have an appointment and see a provider and be done and not have to engage in all that whole process. Very positive about it as well. You developed a perspective of challenges on the one hand and con sum ear preferences on the one hand . I have looked into the role of carriers. To provide discounts for seniors and, but at this point theres not a Standard Program across all the carriers in the United States that would make Internet Access affordable for many people of lower income, so that is an opportunity. It seems to me we can do a lot more with. The average cellular plan 50 to 60 a month. Internet service plan at 60 a month. Youre out 120 a month, which is beyond the means of many people of lower income. I believe theres an opportunity to work with the carriers and come up with a better idea. I would say for the record the importance of rural broadband. Absolutely. Provide cost from the up front but the savings we can ashie through government and medicare and society as a whole are no doubt substantial. On some of the work youve done, i have no doubt that there are incentives seeing that seniors are rapidly growing. So there are strong market incentive. Are there strong legal barriers for aging in place to develop, that we could address as congress . Legal barriers . Well, i mean, just looking at the environment for aging in place which is the home and Building Code and looking at the new housing for older adults is being designed. Theres nothing that requires smooth thresholds, nothing requires sink heights if youre, in fact, in a wheelchair. It would be to talk to organizations that lobby on behalf of builders and look at what are the barriers and barriers at the state level in 50 states one way or the other to enabling use of standards, even if you move into the house, if is your home able to age with you, thats the question. Great. Thank you you all again. Thank you very much, im very glad you brought up the issue of broadband because thats a real issue of my state as well. I was thinking about some of the sensors and other devices would simply not work in some parts of the state of maine. We need to do more work on. Im just going to ask a couple of other questions. I noticed that you did do the cost comparison that all of all of us are interested in and youve talked about the cost of the set up with the 2,000 and monthly fee of 59 and if my math is right, when you look over at the two and a half years if you had nursing home, its more than 300,000, and so i think this does have very important cost implications for us, and one of the issues i think we as Congress Needs to work with the administration on is what is reimbursable to Healthcare Providers under the medicaremedicaid programs because a lot of times well pay for consequences for unchecked diabetes, but we wont pay for the ongoing consultation that prevents the person from having the complainingations complication. I see many of you nodding. I have one more question to ask you, that is, your testimony you mentioned that i think your motherinlaw didnt want to wear that Emergency Alert pendant. How did you find out about the alternative ways of keeping her safe by the use of sensors, putting them all over the house to make sure shes eating, door, i dont think most people would even know where to begin, how did you get the advice you needed on what you should purchase for her and what was available . I think approach was to find an adviser that could help us. Honestly we started groping in the dark, if you would, explored a couple of things that werent successful and we really reached out and visited with other people that had solutions that did work. Lets find somebody that really knows and understands technology and sort of guide us through this process. My advice is to find a trusted adviser and they can help you identify what technologies are appropriate. Different technologies are appropriate in different circumstances, and so i think in our case rereached to reached out to our Home Security folks and they helped on zero in on things that spoke to the needs that my motherinlaw had. When we couldnt get her to per a pendant we needed to be alerted when she fell. Having the sensors if she was up and about and didnt reach point a to point b it would send alerts, hey, you need to go check on her. So that was very helpful to be able to reach up and have that resource. Thank you. And my final is for dr. Mccarthy, that is you mentioned that you were doing telemedicine from 900 sites. Is that correct on that . I believe thats the correct figure, yes. I guess my real question is s this happening from your clinics and your va hospital or its not individual outside providers that youre contracting with . It could include that but thats primarily va driven. Some of the sites would be clinics or other parts of the country as a network, but also and again, i think the cost savings that youve quoted of 2,000 per veteran per year, when you start multiplying you get into real numbers very quickly. This has been a very interesting hearing. I want to call on the senator for any questions she might have. I dont have if i believe questions, but i do think that we need to go back and see how we began describe distributing scooters. When i began talking about scooters, we actually found one woman who worked in my office whose grandmother had three. In many cases they are needed. How do we get approval for all those to be paid by the medicare programs and what do we need to instead of paying for those pay for sensors that would be Cost Effective and healthy. And more quickly free market in this country comes with products that can be brought to scale, that they can present to the medicare system for possible reimbursement, that would result in these savings, i think the more quickly we could really turn this thing. I urge all of you to continue to reach out and the private partnerships with your companies in the university of maine, partners with the university of missouri and i know the va has a lot of commercial partners, the more quickly we can get the technology to the point that you dont have to have most of us dont have a trusted tech advisor. Most americans dont even know where to find a trusted tech advisor. If you look up on line for a trusted tech advisor youre [laughs] and so the more quickly we can do that, the more quickly we can do some progress in this area. I really appreciate the hearing. I learned a lot of. All of us are motivated and i think all of you if your work and thank you for a good hearing. Thank you very much, i think your comments are very well taken. This commission has held meetings on scams. I want to thank all of your witnesses for being here today. Dr. Kim, i love the fact that you have involved the students at the university of maine and taking them. It is incredible that it came up with 50 different ideas. That should keep them busy for quite sometime. Each of our witnesses has contributed to our understanding of this issue and thank you for taking the time to testify before us today. Committee members will have until friday may 22nd to submit questions to any of our witnesses or additional materials for the record. I want to thank senator and also members of the committee have parented as well as the committee staff, most of all thank you to our witnesses. This hearing is now adjourned. [inaudible conversations] while congress is on break this month we are showing book tv programs that are normally seen on weekends on cspan2. Tonight starting at 8 00 eastern, the dark net inside the digital underworld and steven how music got free, end of an industry and turn of the century. It all start tonight at 8 00 eastern on cspan2. Follow the cspan city store as we travel outside the washington bellway to communities across america. The idea behind the city tour is to take programming American History television and book tv out on the road to produce pieces that are a little bit more visual and provide a window into the cities the viewers wouldnt normally go to. They also have rich histories. A lot of people have heard history of the big cities like new york, la, chicago, but what about the smaller ones like albany, new york . Whats the history of them . We will hit 95 cities in april 2016. Most of the program is event coverage. These are shorter, they take you to a home. Historic time. We partner to explore culture of various cities. The key industry is cable operator who contacts the city. Its the cable industry bringing us there. You really want viewers to identify with these people that were talking about. Its an experience where we are taking people on the road to places where they can touch things, see things and learn about its not just the local history. If somebody is watching, it should be enticing enough that they can get the idea of the story, but also feel as this is just in our backyard, lets go see it. We want viewers to get a sense, oh, yeah, i know that place just from watching one of our pieces. The cspan mission believes in what we do in the road. You have to be able to communicate the message about this network in order to do this job. Its done the one thing that we wanted it to do which is build relationships with the city and Cable Partners andgater gather great programming. Watch to see where we are going next, see our schedule. Work being done in congress on helping medical innovation, republican senator joined democratic senator Michael Bennett and others in forum. Its about 90 minutes. Good afternoon. Today we are going to spend the next hour and a half talking about advancing medical innovation for a healthier america. United states has been a Global Leader in medical innovation for decades, yet tens of millions of americans have neither cures nor effective treatments for their diseases, patients with alzheimers, parkinsons. We have about 10,000 known diseases that have been defined that have names and have science and symptoms but for those 10,000 we only have 500 treatments. We have a lot of to do. U. S. Has invested over time, 20 years