This week on the Future Ear Radio podcast I’m publishing a panel discussion that I moderated in March for the Future of Hearing Health Virtual Conference, which was hosted by Hearing Health & Technology Matters. The panelists for this discussion, going clock-wise in the picture are Brent Edwards, PhD (Director of The National Acoustics Lab), Ryan Kraudel (VP Marketing at Valencell), Kevin Seitz-Paquette, AuD (Director of Phonak’s Acoustic Research Center), and Annette Mazevski, PhD (Manager of Technology Assessment at Oticon).
The purpose of this panel was to discuss some of the major innovation the devices within the hearing health industry are experiencing, ranging from hearing aids to consumer hearables. We discuss a number of topics throughout this conversation, including:
- Artificial Intelligence-based hearing solutions
- Biometric sensor integration and sensor fusion
- The role and impact of the Big Tech (Apple, Amazon, Google, Facebook, etc) on hearing health
- Bluetooth connectivity and proliferation
- Interconnected healthcare solutions
- The potentially rising status of hearing care providers in the broader healthcare ecosystem
- The trajectory of online and remote services.
A phenomenal discussion with a super panel of guests. This is one of the best Future Ear Radio episodes to date, in my opinion!
Takeaways:
- The conversation around AI-based solutions got particularly interesting when we started to delve into ways that AI might enable totally new opportunities inside the actual clinic. There are some obvious ways (which we discuss) as to how AI can provide a better experience for the patient, but it’s really interesting to think about how AI can support the clinician.
- The more that I’ve become familiar with biometric sensor integration and the data science that resides behind it, the more that I understand that the really important aspect of sensors is that each data point being captured helps to tell a much more complete story. This is effectively “sensor fusion” in a nutshell, which is to say that you start combining all these different inputs that are being captured by the hearing device and then compile them together into various outputs. For example, understanding the inertial data (the patient’s motion) + the biometric data (their heart rate) + the acoustic data will tell a totally different story than each metric in isolation. There are so many possibilities that can be built on creating actionable insights off this data.
- One of the biggest questions as it relates to the hearing health industry is how Big Tech fits into this whole equation. Will they largely be enablers or are they threats? As we discuss, there are unique things these companies can do to enable this industry in a variety of ways. For example, Apple has largely ushered in a behavioral change with AirPods where it’s socially acceptable to wear things like AirPods for extended periods of time. Or the way that Apple Health can serve as a data repository for all types of wearable data, third-party hearing aids & hearables included. As Brent mentions and I agree, I’m not sure Big Tech has any interest to go beyond generalized solutions with hearing health (i.e. FDA grade medical devices).
- One of the most interesting topics that we discussed was the idea of hearing care providers being in a position where their status in the broader healthcare ecosystem has the potential to be elevated. We talk through why this at length, but suffice to say, the “interconnectedness between healthcare providers” that the hearing aids of tomorrow and experts in servicing/delivering said devices might enable is tantalizing to think about.
- As Brent mentions, we’re largely seeing a regression of remote service utilization and adoption back to pre-pandemic levels. which is low. That said, we may have been given a glimpse of the future and these services have yet to really be innovated on in ways that are uniquely conducive to the online channel (i.e. Microsoft buying Nuance, which will surely bring new functionality to be used with Microsoft Teams for telehealth purposes). Remote services might not be at parity with face-to-face interactions with patients, but this notion will likely be challenged in coming years.
- Stay tuned for next week’s episode, which will be the other panel I moderated at this conference which is entirely focused on innovation and change happening around the economics of hearing health.
-Thanks for Reading-
Dave
EPISODE TRANSCRIPT
Dave Kemp:
Hi everyone, Dave here, I just wanted to hop on and say the episode you are about to hear was a panel discussion that I moderated back in March for the Future of Hearing Healthcare Virtual Conference that the group over at Hearing Health Matters put on. Really, really good conversation… I just listened back to it and really found it enjoyable, so I hope you enjoy this episode!
Dave Kemp:
Hello, and welcome to our panel discussion here today for The Future of Hearing Health Virtual Conference. My name is Dave Kemp. I am the Director of Business Development at Oaktree Products. I also cover emerging technology pertinent to the hearing health industry with my blog and podcast, Future Ear. And I’m so excited for this panel discussion today because we’re going to be discussing the future of hearing devices and to kick things off, I’m going to let each of the four panelists introduce themselves kind of going one by one. So we’ll start with you ladies first, Annette.
Annette Mazevski:
Thanks, Dave. My name is Annette Mazevski. I am the Manager of Technology Assessment at Oticon. I’ve been there almost 10 years now. I do a lot of work related to the testing and some of the validation behind the scenes for our hearing aid products. I also do a lot related to verification and I have both my AUD and my PhD. So I guess you can say I’m a little bit of a glutton for punishment and I’m not sure. And my other interests outside of hearing aids happened to be related to the aging population, particularly related to working memory cognition and listening effort.
Dave Kemp:
Awesome. Well, thanks for being here Annette, Ryan.
Ryan Kraudel:
Yeah, thanks for having me, Dave. Good to be here with everyone. I’m Ryan Kraudel. I head up marketing for a company called Valencell and Valencell makes the biometric sensor technology that goes into bearable devices of all kinds. So the easy way to think about it is the green blinking lights on the back of a smartwatch or a fitness band that’s very likely Valencell technology. And those sensors are of course measuring things like heart rate and heart rate variability and a bunch of other biometric signals from the body of the wear of the device. And most people think about wearables as smart watches and fitness bands, but as we’ll get into more here in this discussion, this type of sensor technology is getting embedded into a broad range of different devices and use cases including hearing aids and hearing health use cases.
Dave Kemp:
Awesome. Brent.
Brent Edwards:
Thanks, Dave. Great to be here with everyone. I’m Brent Edwards, I’m the head of the National Acoustic Laboratories down in Australia. I’ve spent all my career except for right now working in the hearing aid industry. I was the head of research and technology at Resound and at Starkey. And I worked as CTO and a couple of Silicon Valley hearing device startups. So looking forward to the discussion.
Dave Kemp:
Perfect. And last but not least Kevin.
Kevin Seitz-Paquette:
Dave, I’m happy to be here with all of you. I am Kevin Seitz-Paquette, I’m the Director of the Phonak Audiology Research Center. We’re more affectionately known as PARC. We are in the Chicago area and our focus within Phonak is to provide some pre-market validation and claims substantiation studies to accompany our products and demonstrate how they benefit the user but then also to conduct some studies on emerging technology to prove out the feasibility or the promise of some new technology or signal processing strategy. So we do a little bit of work across the entire bandwidth. I’m happy to bring that point of view today to this discussion.
Dave Kemp:
Fantastic. Well, I’m so happy that all of you were able to join. I just think this is going to be a fantastic conversation really exploring the innovation that’s happening with all of the different devices that fill this industry. And I think that I say all the different devices because there really are a wide variety of them. And so I figure as a way to sort of kick the conversation off given that we have Brent Edwards here with us who has done a lot of research throughout his career on sort of the segmentation of devices.
Dave Kemp:
I recently read your market track 10 piece of research, Brent, and in that I thought you did a great job of sort of breaking down the different types of devices who those devices are typically catered for. And so I thought to set the stage and allow for us to kind of dive into specific devices we could start with kind of a high level overview of some of the findings that you had throughout that piece of research.
Brent Edwards:
Sure. Happy to talk and apologies if my video is a little lag, it’s a long way from Australia to promise. So one thing that was quite interesting about market track last year of market track 10 was this was the first time that we included questions about OTC hearing aids, over the counter direct to consumer hearing aids.
Brent Edwards:
And some of what we found is reinforced what I think a lot of us have thought for a while. And that’s the value that the audiologist brings to the treatment and the relationship with the client when asking people either with hearing aids or those who have hearing loss, but don’t have hearing aids, what they think be a value that a professional brings to being successful with the hearing aid. Most people said that there were quite important. And when asked the next time you get a hearing aid, would you rather just get it yourself direct to consumer? Most people said no.
Brent Edwards:
So there’s been a lot of angst around what’s going to happen when the OTC legislation or the FDA defines OTC and gives us the regulations. And what I’ve argued for a while is that it’s not going to cannibalize the traditional model because people who are the traditional client patient that audiologists see need help. They’re not going to be very successful on their own. They need a lot of guidance. They need a lot of counseling. They need a lot of encouragement and understanding of this help. What is ultimately a healthcare issue.
Brent Edwards:
And this is part of the issue when people look at hearing aids, they think, Oh, it’s a consumer product. I can build the same thing and sell it at Walgreens or best buy and be just as successful, maybe for someone with a mild loss or even negligible loss, but have hearing difficulty, not if you’ve got moderate to more hearing loss, I think you really need a healthcare professional to help you there. The data is showing that.
Brent Edwards:
And so where OTCs and hearables, I think will have a big impact is providing a solution for the large market of people out there who are not refusing to see audiologists for some reason, refusing to get hearing aids, they need hearing help for whatever reason they’re rejecting the traditional path to help and hearables and OTC hearing aids will be solutions for that group because they meet different unmet needs of that segment.
Dave Kemp:
Yeah, that was one of the big takeaways I had too. When I was reading your your piece was that there was all of the survey respondents indicated that ultimately they a high portion of them. I think it was in the eighties, 80 percentile said that they would prefer to go and see a hearing healthcare professional especially those that have been fit with the hearing aid. They said that they would be fit again with a professional.
Dave Kemp:
So I think it speaks to the value of the professional. And I do think that there’s a strong case to be made that the professional should be integral in that. And I’m curious though, with the OTC side with that lower end where they really are not seeing a professional in your opinion, how does the professional factor in to that end? Is it something where it’s just in time that they become someone that as they graduate into higher degrees of into severity or is there an opportunity for the provider to be a little bit more involved with the lower losses, if you will.
Brent Edwards:
Yeah. So that’s a great question. First of all audiologists see a lot of people with negligible measurable hearing loss coming into their clinics. Hearing Australia, the largest service provider in Australia, something like 30% of the people who come to their clinics have less than a 25 DB hearing loss. So you would say they’re not eligible for a hearing aid, but they’re showing up asking for hearing help.
Brent Edwards:
So what’s going on? They need a solution. The question is a lot of people are wondering should as an audiologist or as a hearing care provider, should I be offering hearables or an OTC product to the people who come in, I recommend a hearing aid. They say, no. I’m going to argue that if they say no to your recommendation, they’ll probably say no to an OTC product as well, because the people who really need OTCs, aren’t coming to see you in the first place. So they’re not even walking through the door.
Brent Edwards:
Hearables, it’s unclear because of the brand recognition there that it might be something that fits into the ALD category. But if you think about the different market segments, people transition from one segment to another, you could start with a normal audiogram, but abnormal difficulty as you age, you will start to get more and more hearing loss, you’ll move into different segments and eventually, you’ll be in your seventies and you’ll be in the classic market segment for the traditional hearing aid and audiologists.
Brent Edwards:
So I do think you might get hearing help earlier. It will have all those downstream effects and benefits on cognition and balance and so on. And you’re in the game, you’re getting more accepting of technology, whether that’ll accelerate, whether you see an audiologist and get a traditional hearing aid or not remains to be seen.
Dave Kemp:
Yeah, no, I think that’s really well said. So why don’t we start by looking at the hearing aid end of the spectrum. Right? If we’re looking at this as sort of just a degree of sophistication of the devices, let’s start with the most sophisticated being the hearing aids. And let’s talk a little bit about some of the recent innovations that’s taken place at places like Oticon and Phonak.
Dave Kemp:
So starting with you Annette what is currently going on inside Oticon I know that you recently came out with the Oticon more, it uses Deep Neural Networks. So that might be a good segue into talking about this sort of recent wave of implementation of artificial intelligence. It seems like there’s a million different names for that machine learning and Deep Neural Networks, obviously there are different facets of that, but it in everybody uses AI as kind of the catch phrase. But I’m curious to hear about the way that your all kind of looking at innovation right now and what’s on the docket at Oticon?
Brent Edwards:
Sure. Thanks, Dave. So as you were asking about artificial intelligence, there’s definitely a lot of different subsets that can make up what is artificial intelligence. And with that in the hearing industry or in the field of audiology in general, we can look at not just machine learning, but there’s also natural language processing and robotics. And then the subset underneath machine learning happens to be Deep Neural Nets. And I’ll get to that in just a second.
Brent Edwards:
But the one thing I do want to stress, because I know that there could be some concerns about artificial intelligence and the applicability behind it. But if you think about everything that is around you even right now, we’re actually using artificial intelligence quite a bit. So if you have an Alexa at home, or if you have Google Home, I mean, that’s part of natural language processing. If you’re using your autocorrect when you’re sending a text message, that’s artificial intelligence at play there as well.
Brent Edwards:
With our Deep Neural Net… And actually just going back a little bit just to the machine learning Oticon has been using artificial intelligence for quite a while ever since the Synchro days. And we were using that with the life learning tool that that was in the Synchro product back about 15 years ago. With all that said, as things have evolved with our hearing fitness app, and now we’re at Deep Neural Nets, what we’re trying to do and what the hearing is essentially trying to do is help in those situations where it’s not just about solving the noise problem, but rather looking at complex listening environments and how to best differentiate all the different sounds that you have within those environments.
Brent Edwards:
And one of the best examples, or one of the best analogies that I like to use, especially when it comes to Deep Neural Nets is if you’re playing the game of chess. So as you’re talking about a Deep Neural Net, or as a Deep Neural Net is trying to learn, you have essentially an input and you also have an output and it’s those hidden layers in the middle that’s trying to figure out how you’re getting to that end point. So in the game of chess, what you’re actually trying to do is ultimately capture the King. Right? And so you have all these different types of combinations and permutations that you’re starting from at the beginning to get to that end point. So over time it’s learning and is receiving all this input. And by the end of it, again, the goal here is to capture the King.
Brent Edwards:
And so that’s kind of an example outside of the hearing industry or outside of audiology that might give you a better idea visually of what potentially a Deep Neural Net might be doing within the actual sound scene, though, again, as you’re looking at all of these different environments and all these different sounds, I should say, within the environment, the goal there is to not just make sure that you can place where everything is, but you’re also able to maintain and keep everything balanced within the environment and also keep it accurate as possible.
Brent Edwards:
So it has that first layer and essentially taking pretty basic pieces of information from the sound environment. And then it’s going through, again, those hidden layers in providing you with that output, again, to maintain the index integrity within the environment. So it’s pretty robust, it’s definitely different than what we’ve done in previous generations.
Dave Kemp:
Yeah, no, I think that’s really cool because I think that the more that you can lean on the device itself be in real time, making adjustments sort of invisible to the user, but that the user’s patient experience that their overall experience is just that much better. I think is a net benefit. And so I guess staying along this line of thought, talking about AI and obviously there’s a number of different devices today that tout different aspects to this. I’ll let anybody here jump in, but how do we think that AI in general. What is the next few years look like? What possibilities have we just scratched the surface on or are we moving into those directions? I mean, what are the tangible ways in which you think that this will kind of manifest itself in the products on the market, whether it be hearing aids or on the more consumer end of the market, curious of how you all are thinking about this in terms of the general direction of how AI applications are making their way to your level devices. Go for it, Brent.
Brent Edwards:
Okay. I think our whole world is going to be machine learning in some way in every single product that we use. The breakthroughs that are happening is extraordinary. Another example in our field is a San Francisco startup called Whisper AI. These are a group of machine learning people from Facebook and Amazon. They don’t know anything about hearing or speech or signal processing. They just applied AI to massive amounts of speech data to develop a hearing aid. There was a press release last week that Google is applying massive resources to developing a hearable again, using machine learning.
Brent Edwards:
So it’s going to become commonplace in devices where it’s really interesting, I think is in the clinical side. So AI is about taking information and coming out with sort of decisions. And you think about what the audiologist does. There eventually will be an AI component in the clinical treatment pathway, whether that’s taking demographic data and trying to determine risk, maybe it’s this elusive hidden hearing loss. Who knows what but I’m sure there’s a lot of opportunity for AI to make its way in as an assistant as a something that the clinician uses to improve it and enhance the treatment of their client and provide more personalized care.
Dave Kemp:
Very interesting. Go for it, Kevin.
Kevin Seitz-Paquette:
I think another area that it might be tempted to sort of sleep on and miss out is there’s the AI and machine learning that’s going to be brought in directly into a hearing technology or into diagnostics and be very tangible and obvious to the professional who’s using these devices. But we all know, I think we’ve all had plenty of either excitement or eye-rolls at how interconnected hearing aids and hearing devices are with all of the other technology that patients use in their daily lives. And there’s a lot of really interesting functionality that’s even today already be exposed directly or indirectly to the hearing aid.
Kevin Seitz-Paquette:
And I think that’s going to be a huge future direction as well, where there’s maybe not so much sense in having a near level device running some really sophisticated algorithm when you’ve got a strong connection to essentially a supercomputer in your pocket at all times. And even just to look at some examples that exist today, they’re already hearing aids today that I can act as like a gateway for your Google Assistant or Siri, where you can ask questions and get information back. And that’s just sort of a taste of some of the features that will be exposed to your patients, whether you even realize it or not, because it’ll just be the nature of having that connection between the device that your mobile device and the phone.
Dave Kemp:
Ryan.
Ryan Kraudel:
Yeah. I’ll just jump in with our perspective from a sensor standpoint. We’re heavily utilizing data science broadly and machine learning in particular and applying that to these biometric data sets and that has enabled us to make significant advancements in what can be determined from the same signals in the same sensors that we’ve been putting into wearable devices for 10 years now. And the latest example of that being the ability to measure blood pressure with the same type of sensor. We never would have gotten to be able to measure blood pressure as accurately as a cuff without the combination of the biometric sensor data and applying machine learning techniques to identify those features that line up with the blood pressure readings.
Ryan Kraudel:
And so it’s critical to what we do every day and getting more and more critical that data science team and our organization is the fastest part of our company, fastest growing part of our company.
Dave Kemp:
Yeah. All the conversations I’ve ever had with you that always just might take away is it’s like the data science aspect to it is really what’s allowing for new metrics to be captured. Just like you said, with the blood pressure readouts now it’s not as if you’re capturing new data, it’s just that you’re able to assess it in more efficient ways by leveraging the data science that goes behind it. Annette it looked like maybe you have one more point to this as well.
Annette Mazevski:
Yeah. I just wanted to add going back to Brent’s comment about the interaction between the patient and hearing care professional in their office or in their clinic or wherever they are. I mean, this can be actually twofold because in terms of artificial intelligence, you can actually take it a step further and provide enhancements to the actual office as well. There’s a lot of things in terms of efficiencies that you can do in the front part of the office, as well as the back part of the office. But on top of that, when the patient’s wearing the devices out and about, if you’re looking down the road, for example, this could also be related to the sensors that Ryan was discussing that you could have this information as being more or less gathered or that’s being received by the hearing aid.
Annette Mazevski:
And that can actually depending on privileges you can have that be sent back to the hearing care provider, and then they can actually keep track if the patient is willing to have that, to see if there is something all right, if there is an issue related to how often they’re adjusting their volume control, for example, or changing programs and these different types of environments that they’re in. So as things are getting smarter and as things continue to progress, these are some of the things that could definitely be considered down the road.
Dave Kemp:
Yeah. I definitely want to come back to some of those points that you just made, because I think it will tie into when we talk to some of the different remote services aspect of things and some of the innovation that’s happening there, I think it ties in really nicely to what you mentioned. But this does now conclude the live portion of the panel. So for the remainder of the panel, you can go to the YouTube link that we will send out where you will be able to review the rest of this.
Dave Kemp:
So I do want to actually now go to sensors because we obviously have Ryan here, who’s extremely knowledgeable about this space. So Ryan, can you share with us first off why the ear is such a great place to capture biometric data, and then can you then speak to the type of data that’s being captured today and then maybe even go one step further and say, what’s on the horizon for where you think this is going next?
Ryan Kraudel:
Yeah. How much time do we have?
Dave Kemp:
Well, just try to kind of keep it at a high level, but.
Ryan Kraudel:
Yeah. I’ll summarize pretty quickly. So just to kind of set the stage around what’s going on from a sensors in a wearable standpoint, as for anyone who’s watching the space, you see this convergence going on of consumer wearables and true health and medical devices. And what’s interesting is what’s going on at the ear is sort of at the forefront of that convergence and both from the consumer hearable side, as well as the hearing health device side of things.
Ryan Kraudel:
And there’s three things that are primarily driving that from a sensor standpoint. One is the ear happens to be one the best places on the body to measure biometric signals with this optical sensor technology that has come to dominate wearable devices. And there’s a variety of different reasons for that mostly physiological, that’s just human physiology of the ear and the way the body moves. It makes it a great place to measure biometrics.
Ryan Kraudel:
So you can get a great signal off of the ear and which enables you to do things and get depth in that signal that you can’t get on other places on the body, including the wrist. People love to wear things on the wrist, but it’s a pretty terrible place to measure biometrics. So that’s one thing the ear is a great place.
Ryan Kraudel:
Second thing is the long-term wearability, particularly of hearing aids and hearing health devices. That enables a deeper picture, a bunch of broader picture of how an individual’s body is responding to what they’re doing throughout their daily activities. And so that is also different certainly more so on the hearing aid side versus the consumer hearables side of things. And that’s an advantage from this standpoint as it relates to hearing health devices.
Ryan Kraudel:
But third, and probably most importantly in terms of what’s driving this is the co-morbidities associated with hearing loss and the, all of the top causes of death around the world are associated with or correlated to hearing health. So you look at the comorbidities associated with hearing loss three X higher risk of falls, three X higher risk of cardiovascular disease, five X risk of dementia. Those are all correlation, not causation, of course, but to the extent with the sensor technology, you can get an earlier picture of those potential disease states and have people taking evasive action earlier the better and then also making it easier for them to manage on an ongoing basis.
Dave Kemp:
Yeah, no, I think you summarized that really well. So Kevin, I know that with Phonak, you guys are using some pretty cool uses of the inertial sensors. I know with the accelerometer in some of the new hearing aids that you have I think it ties into the broader theme of sensor fusion, but can you talk a little bit about how you all are using those accelerometers and what that’s more or less enabling for those patients that have them?
Kevin Seitz-Paquette:
So going back to the earlier portion of this panel, we had talked a little bit about how one of the hardest jobs of a good hearing aid and also one of the most important is to be able to be proactive and predict what the user is going to need in terms of the the auditory signal that it’s providing. And to be able to be act as seamless as possible. So it’s not like a burden to have to walk through different acoustic scenes and make all kinds of adjustments that the hearing it should be able to do that on it.
Kevin Seitz-Paquette:
And so what we’ve started to do now with our latest products, Paradise, which was launched the end of 2020, we’re actually using an accelerometer to understand if the user is in motion or seated. And we’re combining that with what we know from the acoustics of the environment to try and help make better decisions about the way the microphone searing should behave.
Kevin Seitz-Paquette:
So if somebody is not in motion and it’s a really noisy environment, chances are they’re in what would be more of a typical, if there is such a thing as typical, conversation in a noisy environment. And we know in that case that directional microphones provide a great deal of benefit, but if you then think about the same patient walking through a noisy shopping mall and trying to have good awareness of what’s going on around them, maybe awareness of what a spouse or a friend is saying and talking as they’re walking next to them the acoustics would tell that same hearing aid, like, okay, let’s zero in as tight of a beam former right in front of me, as possibly as we can. And that would probably be one of the worst things that can happen to that patient in that environment when they’re trying to be aware.
Kevin Seitz-Paquette:
So the accelerometer in this case actually allows us to understand no this person is in motion. And in that context, even in a noisy place, one of the most important things is for them to have awareness from all around. So we can open that beam former up and really allow allow closer to an omni-directional signal to come through. It also allows for some sort of fun kind of convenience site features like being able to control the hearing aid with a tap. So if you have patients that have poor dexterity and that’s also something that’s pretty prevalent within the population of typical hearing aid users is poor dexterity or poor feeling in the fingers and finding those buttons might be difficult.
Kevin Seitz-Paquette:
So it’s probably maybe a smaller feature, something more along the lines that convenience factor, but it could be a really important feature for the right type of patient to be able to just smack their ear and make a change as opposed to finding the button.
Dave Kemp:
No. I think those are great, great examples. And I know Brent wants to chime in here on this topic as well. So go ahead, Brent.
Brent Edwards:
I think Dave. And I really love the way that technology is advancing and what Phonak has done. It’s really clever and great engineering, but what what’s interesting from a patient perspective is we’re starting to see technology that not just about their hearing loss, but is also about their lifestyle. So you have certain features and technologies that are really about, again, it’s not about your hearing loss per se. It’s more about convenience about enabling other things in your life that you can do. And it’s also starting to broaden to other comorbidities and other aspects of healthcare. I know Phonak talks a lot about balance, the high correlation between hearing loss and balance, that it raises the interesting question of what role does the audiologist play when it comes to other healthcare issues that are related to hearing loss.
Brent Edwards:
So if someone who’s seeing you has a five times more likelihood of having a severe fall, should you do anything about it? We don’t have an answer to that yet, but I think we’re going to be answering that over the next few years.
Ryan Kraudel:
Yeah. And I’ll just throw in back to that point around sensor fusion as it relates to biometrics, this is something that we heavily utilize in the integration of this kind of technology into all kinds of different devices, but as it relates to hearing health devices and hearables more broadly, you can do some interesting things with sensor fusion that identify what the individual is doing, or provide some ideas of what the individual is doing and whether or not the biometric signal is a good thing or a bad thing.
Ryan Kraudel:
So just as an example, if someone’s heart rate is spiking and you see a lot of movement from the accelerometer, maybe someone’s climbing a set of stairs or going for a walk or jog, and that’s not necessarily a bad thing, but if someone is sitting still and their heart rate is spiking, that’s a very different situation that should require a very different response.
Dave Kemp:
Yeah. Kevin, did you have something?
Kevin Seitz-Paquette:
Yeah, I was just going to come at the same question from the point of view of the provider. And I think I can only speak from the point of view of an American audiologists. I don’t know what the situation might be like in other countries, if we have international members of the audience. So bear with me if this sounds totally off base for your market but at least in the U.S., I think hearing care providers have really struggled to present themselves as members of a broader healthcare community. I think a lot of patients, I mean, at least I know my family members who were at the age where they need to start thinking about hearing aids until I ended up in audiology, that the feeling among those family members was more like the people who sell hearing aids, they’re slick sales people, they’re charlatans, but they’re not necessarily healthcare providers in the same way that an optometrist is thought of as an eye doctor.
Kevin Seitz-Paquette:
And I can’t help, but wonder if, as sensors that have broader functionality and that support healthcare decision-making outside of just hearing healthcare come into play in devices that audiologists and hearing dispensers are recommending and using. If that won’t provide the opportunity to say, “Look, I’m a member of your healthcare team. I specifically am helping you with your hearing and your quality of life as it relates to communication, but the devices I’ve provided you are also helping your cardiologist or your physical therapist or whoever else it is, who is relevant, and to really elevate the status of the hearing care professional to something that hasn’t really been achieved thus far.”
Dave Kemp:
Yeah, I think it sort of ties in my mind at least to Annette’s point earlier where part of what’s so exciting in my opinion about the general direction of things is this combination of ubiquity of like smartphones and the connectivity that comes along with it. And now what we’re seeing is sort of this phase of the implementation of data capture. And I think there’s lots of different kinds of data that you can capture. Right? You can capture the data that’s actually being the acoustic data that’s being captured through the hearing aids, which tells a story lot of the different biometric data that’s captured through the sensors that Ryan’s company makes and on and on, and the sensor fusion that goes along with it, because these things in isolation might be telling you one thing. But when you see the fuller picture, it’s a totally different story.
Dave Kemp:
And I think what’s really exciting about this is that it presents an opportunity, like you said, Kevin, I think to be part of a broader healthcare ecosystem. And I think that there’s a huge opportunity here that’s building for the provider of the future to be a liaison of the data that they’re capturing and help to I guess, communicate at large.
Dave Kemp:
Here’s kind of all the different contexts clues that I’m getting about this particular person and in some HIPAA compliant fashion, be able to share that with fellow doctors that are part of that team, whether it be the general physician or it be with the cardiologists, like you said. I just think that as a device that’s kind of a all day worn device, that’s capable of capturing more and more things, I think it’s becoming increasingly more compelling for the broader healthcare system. So what do you want to tie on to that Annette?
Annette Mazevski:
Yeah, because I mean, there’s definitely going to be more of an opportunity for a multidisciplinary approach. And if we’re talking about something like a little off topic here, for example, with tinnitus you have like a pretty defined category of individuals that you might also be in collaboration with be it a psychologist or a dentist or even physical therapist. And so this is another way of opening up not just the field of audiology and everything that is done within the field of audiology, so other individuals, but they can actually see how those interactions between their fields and what we do be represented as well.
Dave Kemp:
Yeah, I think that’s the way I’m thinking about this as well. So changing directions a little bit here the big companies, the big tech Titans are seemingly more and more relevant every single day to this industry, as Brent mentioned earlier. We just saw Google announced that this project Wolverine, and a lot of these things, you have to sort of caveat and say that there’s always these moonshot projects that seem to be going on in some of them manifest some of them don’t. But I do think that we’re seeing a increasing amount of attention, whether it be from Apple, Google, Facebook Labs. So there seems to be this focus on this industry and being able to use a lot of the innovation that Silicon Valley is infamous for and applying it in different ways.
Dave Kemp:
And so I’m curious to sort of get your thoughts maybe we’ll start with you Brent, as to how you see those companies either presenting their own solutions. Or do you think that they’re more of ecosystem enablers? For example, Apple Health being home to maybe the data repository that a lot of this information resides on. What’s your thoughts as to how we should all be thinking about these companies?
Brent Edwards:
Sure. I think the vision for the future and what everyone is racing to is a world where every person is wearing something on their ear all day long. Right now, Simon Carlile who is at Google X, did replace me at Starkey as a head of starting to hearing research center gave a presentation this weekend at AAS, and he cited the astounding fact that there’s over 350 audio related startups in Silicon Valley. And $1.4 billion in venture capital invested into it. So audio is huge right now because everyone’s realizing it’s a very easy way, a frictionless way of interacting with someone with through hearing and speech. So they’re all driving to a world where everyone’s wearing an ear level device to hear your texts, emails ask Siri, whatever.
Brent Edwards:
In that world, As you start to have hearing difficulty, there’ll be a feature that is the speech enhancer. Something that really is designed has hearing aid features, but they don’t call it a hearing aid. And that’s the gateway to hearing help. Look, Airpods pros have those already. You can put your audio gram on your iPhone and your AirPods will do multi-band compression. We’re in transparency mode. So they’re functioning as hearing aids and at NAL, we’ve done some measures of the gain and compression that they do.
Brent Edwards:
And the fitting prescription is very weird they don’t use NL2. But they’re functioning like open fit, hearing aid with a mild amount of game. So Google, Amazon, Facebook, they don’t want to serve as the person with moderate to severe hearing loss, but they want to give people solutions. And so they’re going to produce ear level products for the whole market. They’re going to layer on that some solutions for a mild amount of hearing loss. And that’ll be most people’s entryway into hearing help, but I’m still a firm believer that hearing loss is a medical condition. You need some medical treatment when it’s severe enough. And I don’t think any of those giants want to get into that area where you have to deal with bone conduction and red flag conditions and all the issues that audiologists deal with every day.
Dave Kemp:
Right. The actual implementation of a FDA grade medical device. I think you’re right there. What about the rest of you? How are you thinking about Apple, Google, Facebook, any number of one of these companies? I mean Brent points $1.4 billion in venture. So these are large numbers and these are big, very deep pocket companies. Annette?
Annette Mazevski:
Well Brent, you should reach out to Apple and ask them what’s going on because they should probably be using at all to just want to throw that out there.
Brent Edwards:
I just may have.
Annette Mazevski:
But it’s nice that to think about are to consider simply because we know that people are constantly listening to something throughout the course of the day, especially if you’re at home, you’re probably listening to maybe some music or a podcast. We’re constantly on meetings, Zoom or Teams or whatever. So there’s constant usage of our ears. And so with that introduction with the earbuds or any type of on your devices like that the utility is key. And so, I think in terms of the decision-making that each of these companies are using it’s giving the general population an introduction to what this is going to be like to constantly be wearing something on our ears first and foremost.
Annette Mazevski:
But the second thing that also to be considered for the longterm is if you’re actually supporting the health, if you will, of the auditory system, this can actually go back to the discussions that we were having about, ways of kind of prolonging the introduction of dementia or some type of cognitive decline if we’re constantly from this point of view, having some type of auditory stimulation.
Annette Mazevski:
And the important thing with that also is… I’m sorry, I just lost my train of thought. The importance behind that is that prevention is key. And we know right now, like within the United States, I think there’s roughly like 45, 46 million individuals who are older than the age of 65. That’s going to double essentially by 2050.
Annette Mazevski:
And so this is something that that category of individuals who will be older than 65 by 2050, there’s, now’s the time for that introduction of using earbuds and in other types of solutions for listening.
Dave Kemp:
Yeah. No, I agree. Kevin, did you have a point you wanted to make?
Kevin Seitz-Paquette:
Yeah. It follows a similar train of thought as to what Annette was just saying, but I think anything that gets people thinking about or treating their hearing loss earlier than they would have ordinarily is probably not a bad thing. And there’s probably some good downstream effects for hearing care professionals as well, even though that that may represent a device sale that you won’t get to make, it also represents a patient who’s now trying to do something and is empowering themselves deal with the hearing loss that ordinarily may have just tried to shove it under the rug and forget about it.
Kevin Seitz-Paquette:
And so I think that the most important thing that we can do as hearing professionals right now, as these devices and new functions from the big kitchen table kind of names like Apple and Google is to really think about when you’ve got that patient who shows up at your clinic, who’s been using AirPods for five years to deal with their hearing difficulty and now they’re coming to you saying, “I think I’ve got a hearing loss and I’m having more and more trouble managing it.”
Kevin Seitz-Paquette:
What does that conversation look like? And how do you take the experience and what they’ve already learned about their own preference and needs for device from the AirPods and apply that to something that you can use, or how do you simply determine even that maybe whatever they figured out from Apple or Google maybe you agree that that’s appropriate, but how do you then offer them the service of counseling and communication strategies and the other professional support that’s so important that goes along with any technological solution?
Kevin Seitz-Paquette:
So I do think even though change’s always scary, and we’re certainly at the cusp of a pretty major overhaul in this industry. And so even though that is a little bit anxiety inducing, I think there’s a pretty great amount of opportunity presented to the professional community as well, to really change the way we think about how we practice and how we treat patients and manage your hearing loss.
Dave Kemp:
Agreed. Ryan, did you have something you want to say?
Ryan Kraudel:
Yeah, I so agree with what everyone said so far. I’ll just maybe take that one step further and get into the, how a little bit this might play out. And we certainly see this in other areas of wearables where if you take user experiences like what Apple has initiated with the atrial fib detection and the irregular heart monitoring. I could see something similar playing out with hearing health, where they have a one sensor that is constantly monitoring the heart rate, looking for irregular heart rate patterns. And when it identifies a problem, it initiates a prompt to take an ECG reading. You could see something similar playing out over longer periods of time, of course, as it relates to hearing health, but based on hearing patterns, voice patterns, device settings, those types of things looking at at how those patterns play out over time and initiating a prompt to see a hearing health professional, and help dial in that that hearing health device for their specific needs.
Ryan Kraudel:
So that’s just one possibility, but you can start to see not just Apple, but you can start to see consumers getting conditioned to that user experience of wearing something on their body that they use for other things, but that is monitoring for health conditions that then prompts them to that there may be an issue that they need to go see a professional about.
Dave Kemp:
Yeah, I think that’s probably a really good way to think about it is that look at what Apple is doing with its own wearables, and maybe use that as sort of a baseline of where things might ultimately go particularly for some of the non-Apple products that still sort of fit into these niches. I look at a lot of these new age wearable companies whoop aura level’s. All these new sort of companies that have come about in, I think the big thing that they’ve realized is that capturing data is just one aspect of the what makes these devices compelling.
Dave Kemp:
What makes them really compelling is when you can turn it into actionable insight, whether that be helping them to see, okay, I need to do this and creates a sort of lifestyle or behavioral change or it might be something that is around your health and it can be a preventative health use case. And you think about the patient demographic for hearing aids. And that’s where for me, the sensor integration gets really, really exciting is to think about just as you mentioned there, hearing aids of tomorrow, being able to alert you that you have a potential threat to your health. It’s capturing so much data, it’s created a baseline and longitudinal data set, it’s just benchmarking against itself to see I’ve now registered something that is an anomaly to your data.
Dave Kemp:
And I think that’s where this can get really interesting. And again, I think this ties into the broader sort of healthcare ecosystem that I think hearing aids would then play into, which is I do wonder, like what does that do in terms of the perception that say a cardiologist has, or any one of the different specialties where they already are looking to outfit their patient with a heart rate monitor of some sort. Does that then change the conversation to include potentially a hearing aid as being that device, given the high compliance that you would have with it all day wear, and maybe that patient fits the bill of somebody that might have hearing loss.
Brent Edwards:
We talk about the interconnectivity of devices and the internet of things. I think what we may be seeing, given what you said is the interconnectivity of healthcare providers. So if the audiologist sees something wrong with the sensor data, from the hearing aid they’re not going to solve it themselves, they’re going to print out that data, give it to the patient, say, you might want to go talk to a cardiologist, your GP, a balanced person, and make referrals and maybe know who to send them to.
Dave Kemp:
I think that’s spot on Brent. I think that the provider wouldn’t be well-suited to try to tackle the cardiologist’s job. But I think that given that if there is a device that needs to be worn I think that the the hearing aid professional really is in an interesting position right now because of the, as Ryan described it, it is such a good place for that capture. And you think about the fact that it’s all day wear. So it’s exciting to think about it. And I think that’s a really good way to frame it as the interconnectedness of healthcare which kind of dovetails into one of the last topics that I wanted to talk about. I know that we’re getting close to the hour here but that’s remote services.
Dave Kemp:
And obviously we were kind of joking at the beginning of this about how it’s been now one year since really since the start of the pandemic or at least in the U.S. when things started to really shut down. I know like the NBA, for example, it was the one year anniversary on Sunday. And so here we are a year later and if nothing else, I think that we can now recognize that there has been a huge aha realization amongst the general population that we’ve all sort of undergone this behavioral change, where we’re all now pretty acclimated with Zoom and all these different virtual type settings. And I know that the initial uptake of remote services there was a spike at the beginning of the pandemic and then sort of fizzled out.
Dave Kemp:
But I do think that at large within the healthcare ecosystem, remote services and tele-health is really kind of coming into its own. And there just seems to be so many great applications for remote services in this industry that it seems obvious that it has to play some sort of role as we head into the future. So I want to get everybody’s thoughts on how they see remote services really kind of taking hold in this and obviously maybe there’s some limitations. So I’d be curious if there are any in your mind where it’s going to be really hard to solve that and therefore it’s always going to warrant that particular element for an in-person visit, but in general, what’s everybody think about the the trajectory of remote services? Maybe we’ll start with you Brent.
Brent Edwards:
Yeah. So at NAL, we’ve done a lot of research into the benefits of remote care and one, we surveyed attitudes of patients and audiologists towards them. And what we’ve found is if you’ve never experienced tele-health, you really don’t like it. You think it’s going to hurt your relationship and the care you get. If you’ve experienced it, you flip. You actually realize it does help with that relationship. And it does give you excellent care. We’ve also done a sort of a balanced studies comparing complete face-to-face services versus where you substitute a visit with your own care. Again, same patient outcomes, same benefits, and the largest service provider in Australia during COVID pivoted to tele-health immediately. And we got data on that showing again, the same patient outcomes in terms of satisfaction with their devices and with their quality of life.
Brent Edwards:
However, what we’re seeing… In Australia, we spent almost two months since we’ve had a COVID case. So we’re back to normal-ish down here and tele-health is disappearing. So people are reverting right back to face to face and not using the tools anymore that are being developed. And that’s really disappointing but perhaps not surprising given that we are creatures of habit and we’d like doing what we’re used to doing. And so I haven’t heard of any place where telehealth has accelerated, like we would have thought it would over the past year. And my concern is we’re going to go back to the old way, even though all this technology is sitting there waiting to be used.
Dave Kemp:
Yeah. I mean, I think that I’ve seen some data that suggests that’s definitely what’s happened in the hearing health industry and I think at large it’s happening to a degree. And I wonder if what we’re seeing is sort of like what it’s going to look like in 10 years and that we’re sort of resetting back down to the bottom and then it will be a gradual uptake again, but going again off of what, and that was saying sort of the beginning of the conversation, this idea of that real time relay, and maybe it’s more asynchronous.
Dave Kemp:
It doesn’t necessarily have to be like live interfacing with the professional, but this ability to capture information and then be sharing it and not necessarily done just automatically, but that opportunity where it’s, I’m in a a challenging situation that I frequent all the time, the conference room, a noisy pub, whatever it might be being able to capture that in some sense, and be able to more or less kind of replicate that acoustic environment for your professionals so that they can see, okay, here’s the way that we’re going to need to compensate for that. I think, again, just it dramatically enhances the value of the provider.
Dave Kemp:
And I think that’s going to be the name of the game across the next, like 10 to 15 to 20 years is in a world where devices themselves become rather commoditized. And you’ll have premium level features and you’ll have other more commodity features. The value of the provider I think, is going to be on the service, the expertise and their knowledge. And so it’s a matter of how do you make that extensible as possible and really make that be able to be amplified.
Dave Kemp:
So going back to your point Annette, I mean, how are you all thinking about this in terms of enabling those sorts of remote things that in the past had been sort of people having to replicate it just by describing it?
Annette Mazevski:
Well, I mean, the first thing that I kind of want to address is that I bet nobody here or even in the audience would have figured that the proof of concept for remote care, remote audiology would be a pandemic. So when we’re talking about the utility, I mean, yes, it’s been successful. Yes. There is a decline because some people just want to have that face-to-face interaction, but I think there’s two things to look at here. The first is that if the patient is coming in for like a checkup, if you will maybe that is something that can be done remotely. And I think it really revolves around the triage for for the particular visit, because if there is something, for example, wrong with the hearing aid, chances are a professional should be taking a closer look at that, because even if it’s something as small as the dome is stuck or there’s wax, or maybe like the microphone is blocked, or the battery is or the sensor is flashing.
Annette Mazevski:
So there’s something that’s going on there that might not be very easy to resolve remotely and in that face-to-face interaction might be all it takes to resolve that issue. I’m not saying that that will happen all the time, but again, I think it also depends on the scenario that you’re dealing with. But on the the second part of that though, I think is based off of preferences. So when we actually were talking about our remote care products, in my head, I’m from upstate New York, so I’m thinking nobody wants to go out when there’s six feet of snow on the ground. I mean, well, maybe the people from Buffalo or Syracuse, but like everybody is if the roads are bad, they’re older they might not want to be dealing with ice conditions.
Annette Mazevski:
I was thinking actually the winter time a lot of people you might see an uptake of remote care in the North, but the funny thing is, and I never thought about this because I have never lived in the South, but if you’re in Arizona, for example, in the dead of summer, it’s pretty warm there. And they might people might not want to leave for the same reasons because it’s just too hot. So I think when it comes to remote audiology and remote here in general, there’s time and a place for it. And I think there are really smart solutions in very specific use cases. And I think that’s actually what needs to be addressed. When are those use cases coming up and how to best proceed?
Dave Kemp:
Agreed Kevin, Ryan. Any thoughts?
Kevin Seitz-Paquette:
I was just going to add in I think the COVID pandemic definitely taught the industry how great remote care can be for instances like what Annette was just talking about, where there’s six feet of snow on the ground and you can’t get out of the house. I mean, there’s instances where visits in-person are just not possible. I think any audiologist or hearing care professional at this point who has tried remote care has probably figured out from some level of experience that even if they don’t feel like it’s perfect and they don’t have a great workflow for it yet that the functionality is there and they could probably make it work.
Kevin Seitz-Paquette:
But ironically enough, this pandemic that taught everybody that lesson in this hard way completely prevented the industry and the patients who see us from realizing that secondary benefit that you had mentioned, Dave, which is the ability to go out and rather than try to remember two weeks ago when I was at my favorite restaurant, what specifically was difficult about it?
Kevin Seitz-Paquette:
That’s the other big possible advantage for Telecare and audiology is being able to, as opposed to trying to remember, tell the person go out to eat and call me from the restaurant and we’ll make some changes and figure it out while you’re there in the moment. And the COVID pandemic completely blocked anybody from being able to realize that type of benefit.
Kevin Seitz-Paquette:
So it’s unfortunate, but hopefully now that well, not now that things are getting back to normal, but with an optimistic eye to the future in some vaccines coming online, I have things can get back to normal. My sincere hope is that we start to see people once they’ve had that sort of correction to get back into their old ways of doing things and feeling comfortable again and confident that they will start to then think about the new ways that they can apply remote care when it’s not an absolute necessity but it’s just a factor to help them provide better care to the patient.
Dave Kemp:
Well said. So as we sort of come to the close here why don’t we just go around we’ll start with you, Ryan. Obviously we’ve talked a lot about sensors and your world, but just in general, what are you excited about? What do you get really excited about with this space into the next few years that you want to share that maybe we haven’t covered?
Ryan Kraudel:
I am really excited, really passionate about obviously essential technology, but also that, that technology becoming more and more ubiquitous and becoming more and more just behind the scenes in devices that people already wear and collecting this data, applying them to machine learning. But where I get really excited is getting to the point where we can get into predictive models of being able to identify when someone is headed down the wrong path in any form of health and wellness and help them avert going down that bad path through the use of devices and sensor technology and AI and machine learning, and a bunch of the other things we’ve talked about here. I think that’s where you’re really going to start to see a huge public health impact for these types of devices and scenarios.
Dave Kemp:
Yep, I agree. How about you, Brent?
Brent Edwards:
So I’ve been involved in innovation and technology my whole career. So for me, that’s a little bread and butter. What I’m excited right now is innovation and service provision. Because we really haven’t seen much advancement in how people get hearing health. And we’re seeing a ton of new models coming out. You’ve got the blended service model, like from companies like Lively. You’ve got cell fitting, we’re going to have direct to consumer. We talked about the service is not just about hearing. It can be about other healthcare issues. To me, that’s really exciting. The business model of our field is going to be changing dramatically over the next couple of years and that’s opportunity for everyone including new technologies and new solutions.
Dave Kemp:
Well said. Kevin?
Kevin Seitz-Paquette:
I think we’re really turning a corner where ear level devices are truly going to support quality of life in a more holistic sense. I think everybody in the audience can attest to the fact that hearing aids for as long as they’ve been around has supported quality of life when it comes to communication and social connection. But I think with the advent of some of the new technology, that’s starting to show up in ear level devices, whether it’s in traditional hearing aids or from companies like Apple and Google we’re really about to see a really holistic idea of the patient come into view for hearing care professionals. And it’s really going to give us a way to expand the way that we see our services and our expertise spitting into the patient’s life and into their own health going forward.
Dave Kemp:
Love it. And Annette.
Annette Mazevski:
I feel that hearing aids or anything, ear level. They’re just a piece of the puzzle, especially when you talk about the overarching discussion related to health for any individuals. But I think that in combination with hearing aids, with the interactions that people will have with service providers, the way that we’re utilizing the hearing aids in general especially with sensors, it’s going to provide so much more information in a more robust way. And when you think about it like that in my opinion, you have these individuals who might be a little bit more keen on what they’re learning, not just about their hearing, but about their bodies as a whole.
Annette Mazevski:
And that can actually give them more freedom if you will, if they want to stay living at home for longer because that there’s this big push right now for aging in place. And there’s a number of different reasons why there’s that push now? But this is one of those ways as Ryan is going back to his discussion about sensors. I mean, this is another way of being able to keep tabs without necessarily constantly being bombarded by appointments or visits or going from one place to another to be able to just make sure that they’re on top of everything that they need to be health-wise.
Annette Mazevski:
And that actually goes back to Kevin’s point about quality of life as well. So I think it’s just exciting actually to think about everything that is on the horizon and making sure that we’re being able to use all the technology available to to best represent a patient’s best life.
Dave Kemp:
Yeah, no, I think you all hit the nail on the head. This has been such a good conversation. I know I subscribed to Brent’s theory that I think we’re moving toward a point where just about everybody’s wearing things in and around their ears. And for me, I think one of the most exciting things when you look at just the sheer proliferation of all these different in-ear devices, is that at a certain point people stop looking at each other’s ears. It’s like what and I think that that direct result is that maybe the stigma kind of starts to die. Is there a stigma that’s warranted when nobody even knows why anybody’s wearing anything in their year? It’s like there’s a hundred different things that you could be doing with it. And it seems like that list of things just continues to grow.
Dave Kemp:
And so as the world of audio expands and as the world of the sensor fusion and all the cool things that we talked about today, I think it just increases the amount of reasons people want to have different things in their ears and kind of to Brent’s point it’s like hearing augmentation, it could be the key feature of the device, or it might just be like a secondary benefit.
Dave Kemp:
I saw Qualcomm’s state of play report. They cited 40% of the survey respondents that they surveyed said that they were interested in having conversational enhancement as a feature for their devices. And another market research firm, Future Source found it to be 60%. So there seems to be this huge demand that’s building right now. And I think that as we kind of highlighted throughout this conversation, some of that might be geared toward hearing aids. Some of it might be geared toward more consumer type devices that might just have this all as a sort of additional benefit. But regardless, I think that this has been a fantastic conversation really, really enjoyed all the different input and insight that you all shared. So this now concludes our future of devices panel here at the Future of Hearing Healthcare Virtual Conference.
Dave Kemp:
Thanks everybody.
