Health Innovators
Health Innovators

Episode · 1 year ago

3 Challenges That Require Innovators to Interlace Business and Clinical Skills w/ Erkan Hassan


Many innovators find themselves wearing blinders on either the business side or the clinical side, without catering to the overlaps between the two. But this often results in big issues, like spending unnecessary resources — or worse, building an innovation that clinicians don’t actually need or want.

In this episode, independent healthcare consultant Dr. Erkan Hassan explains 3 critical challenges that innovators need to balance:

  1. The business challenge of making sure you’re a commercial success
  2. Ensuring that you have clinical validation to prove that your innovation does what you say it does (without biting off more than you can chew)
  3. After the sale, making sure that you adapt to the health system’s workflows for long-term success

We talk about staying solution-focused vs. product-focused, the massive importance of using a patient context lens to present your clinical outcomes, how to make sure you have just the right amount of evidence, and more.


Guest Bio

As an independent healthcare consultant, Dr. Erkan Hassan couples clinical expertise and business skills to help health systems and startups. He works to identify the clinical challenges these companies face, then use evidence-based clinical data to create innovative, intelligent solutions that drive patient-centered quality outcomes.

Formally trained as clinical pharmacist, Dr. Hassan spent the first half of his career working in academic medical centers to help manage drug therapy for ICU patients. After taking the academic route and working as an associate professor, he switched gears to become the Director of Clinical affairs for an ICU telemedicine startup.

To learn more about Dr. Hassan, visit his personal website at, where you can read and subscribe to his monthly blog. You can also connect with him on LinkedIn.

Welcome to Coiq, where you learn howhealth innovators maximize their success, you're working on somethingbig, something like saving something world changing. Yet ninety five percentof health innevation fail and real lives are on the line. That's whylaunching is not enough. Commercialization is the most criticalyet overlooked stage of the innovation process through candid conversationswith health, innovators, fearly adoptors and influencers you'll learnthe five components of the COIQ early adoption strategy. So if you want tochange lives and dominate your market, why not give your innovation the bestchance to succeed? I'm your host Dcor Roxsey founder of legacy DNA, aninternational death selling author of how health innovators maximize marketsuccess and now, let's join the conversation and maximize your success.Welcome back to Ouyq listeners on today's episode I have Dr Irkon Hasan,who has been in the healthcare industry for mini decades. I know I'm tellingyour age a little bit been in health career a long time and is an independent healthcareconsultant. Welcome to the show Theain't you rock is GOI FRHAT and MelEverone. So before we get started, I always like to just kind of level setand have you do a little bit of an introduction about your background andwhat you do to kind of give our audience some context. Yeah sure that'sgreat, I am formerly trained as a CLYMICOL PHARNACIST. I got my cromicydegree, my doctor FIMS on degree and went to work at academic medicalssatisfer spent the first Alf of my career at academic medical centers,primarily working in the ICU working with the INTENSIVIS and Crebal CareNurses to Manage Tho drug therapy of these verycrittically onstable patients and went the academic route gotpromoted to associate professor the whole scyl activities, the professionalservice that tep teaching and then switch gears and was employee numberseventeen at Vysiq, which was a started company for tell he medicine for the ICU, trying toleverage a limited resource and was there we built that come back wasemployee number seventeen we built up e the product, thet solution, the the number of beads were covered aboutseven thousand ICU beds, all adult patients in the IC in the US and mymost recent title. Er was director of clinical affairs, where I wasresponsible for identifying, prioritizing, launching and growing theclinical inframatic strategy and so and again, most recent shift as anindependent consultant. What I do is I try to identify the clinical challengesthat health systems and start a company space using evidence, bace clinicaldata to sort of create innovative intelligente solutions to really drive patient centered quality outcomes, andit's really coupling my clinical expertise with business skills thatI've learned over time. I think the best way to describe this is you knowmy my fire, the belly M, my goal of reallywhat I want to do when I grow up yeah is, is my I really want to build orcreate a quality solution that really impact the quality of care for thepatient in the bed. That's that's sort of my driving fire in the belly mm.Awesome, somebody's gonna do it. You know so it's inteeresting, because there's somany factors or things to consider when...'re bringing an innovation to market,but that but healthcare is so unique a, and I think that one of those thingsthat makes it unique is that the clinical evidence is like a criticalfactor N in being able to be successful, whereas other industries don't have to you know pay attention to that. So our show is all about helping health.Innovators. You know go from an idea to full market adoption, and so I wantedto ask you, as you scan the landscape it. What are some of the biggestchallenges that you've identified when you're looking through theClinical Outcomes Lens? So that's e, really good questionICTSLE and if I may, let me step back for just go a little bit go a littlehigher with that. I mean yeah, there's actually three three parts to thisproblem MM, in my view, and I'm not sure if they're independent pillars oroverlapping men diagrams, but the three parts that I see number one isobviously the business challenge that I a company wants to be a commercialsuccess and I think that you spend you know a good part of your book on on thechallenges and we can talk we'll talk more about that Han Aminut, but butit's the business challenge of becoming a commercial success and it's either anoffchoot of that or separate pillars. A part of that because I think the othertwo parts are number one are the clinical outcoms. He SAF it, and youknow David Nash, WHO's, the Founding Dean of the Jefferson College ofpopulation, health, he just retired. As the founding dean of that has thisgreat quote, I give thim full crowded fort, I skal wit. It all the time s nooutcome, noman, no yeah and again well, come back to I'm goingto listen, Tho, three things that will come back and talk about each one ofthese a little bit more detail. I think, and then the third factor, I think,really is health system more close and really defining the roles andresponsibilities of healthcare, identifying the challenges thanhealthcare faces and and how do how do all these three interlace and really?How do you take these in terms of clinical and business skills and bridgethem together? So that's kind of how I see it from the business challenge. Youknow es Om at the business challenge aspect of so there's three parts. Idon't know if it's pillars or overlapping Ben Diagrams, but to be a commercial success. You know you and I both know there are companiesout there that build solutions looking for a problem yeah and that's reallynot the best way to do it, and- and so that's one issue with the businesschallenge- to become a commercial success. The second area, I think, isin terms of code development and I've seen many companies where they buildtheir solution or their product sort of an isolation, and I think one of thethings you need to it's a MINDSHIFP with health care because you reallyhave to build it. The way clanitions think don't have that that way,clelitions think to overlap it with the clinical presentation again you'regoing to fall short and you need to be concerned about that and that, finally,is the cinical validation so again that part of the men Diagan that we need togo talk about the ten diagram and I think one of the the best way to Summ it up,as I see in terms of the business challenge, is that a lot of companies will think of it asa product out there, and I think that's a mistakewhen it comes to health care, because what healthcare is looking for is not aproduct they're. Looking for a solution,...

Iright, you woith a thought: Ut, THAT'SNOT SOLVING! That may not be solving my problem. An Noi really need theirno isa proven solution of. How do I incorporate this into my system? Sothat's the one business challenge piece. Let's talk about the clinical outcomes.Piece of this. The clitical validation piece is very critical, no outcome, noincome, Yep and I think a lot of companies are surprised that we havethis great ligit. Let's go sell it and without the very first question you'regoing to get is show me the data because think about it. If you're a newcompany trying to get traction, no one is going to take a risk on youwithout clinical data, and you know I don't mean that it needsto be a large twothousand patient randomize climical trial, but you doneed to show a pilot to demonstrate that what you're offering really doeswhat you say it's going to do, but that does entail a number of things itentails. Writing the study protocol getting Irbi going through the anropy.It does not mean you need you. May Ave may not need to get informed consentbased on what you're really trying to demonstrate with it. But having thatarb piece of paper, I think, is very important. Getting the data analyzingthe data having go, no go decisions, identifying the metrits you're going tomeasure and and and assess for success or failure is important and again thisdoes not have to be a two year study. I think some of these can be done in veryshort periods of time. Ninety days of once, you start enrolling in getting data. So let's pause for just amoment and talk about that like whin. Does an innovator need to develop this n and how much is it? You know kind ofa progressive thing, so you're kind of touching on this, but I want to just pause and kind ofdrill a little bit deeper into it, because I hear this question all thetime. You know how much evidence and clinicalvalidation do I have to have before I go to market, how much of it can be alittle bit more ambiguous when I'm approaching someone, maybe asa partner and the way I'm going to get that evidence is going to be throughthat pilot program. So so, let's kind of just talk about when and then whatdoes that look like, because I think you're doing a great job for ourlisteners kind of framing. That is this is what you might need before you go tomarket an and it would in this context, right. We talk about sample size andthe type of type of study, and then what you would need, maybe in a pilotor in some of your first customers. My personal opinion is, if you're,going to sell the health systems and you're going to go to Oll systems anddo this unless you're going to partner with them. You need the data front kinnop that you know, especially if you're a small startup company that you're trying to get risktakers earlyadopters to or just what you're doing, Yep you have to have some Chonicavetaand Tokno the and so, for example. I think it really depends on what thesolution really is. So, for example, if you have a predictivealgorithm that says, I can predit length of Stad in the hospital or inthe Iceoyou then- and I can I can this allegistmwill predict length of stat. Well, then I need to go to a hospital and say:Will you partner with us to pilot this, so that I can and I and let me back upso I I built this out with them. I pulledback two thousand patients. I aalyze their data and I had some engineersbuild this algorithm. I know what the...

...key components are. I validated t adevelopent validated in house yeah, no outside data yep before you go to asite you're going to the first. If you go to a site to sell this out of I themthey're going to say where's. Your data show me that what you actually builthas been valigated, that it actually works, and so I think that has tohappen before you make any sales orhe. What about the structure of that? Does it need tobe a certain population o a certain sample size? Is there some specific,metrics or markers, because I think that this is also a really importantdiscussion, because there's a lot of pitfalls with this, because you know most of the peoplethat are the health inovadors are not the clinicians they're, not thinkingthe way you are, and you you know in the in what you're talking about andyour experience, they're thinking of more of the tech, and so the last thingyou want is them to do these studies but be missing. Some key parts of thedata to where it was wasted time wasted money because it's incomplete or it'snot what that those potential customers are looking forward to actually givethem assurance of you know, patience, safety and efficacy. You know excellentpoints. I think that is right on the mark and one of the biggest problems that I seeis biting off more than you should chip, and I think the first step is this iswhat we say it does. This is wha how this is, how we're going to valigatethat it does what we say it does period. That's all you're trying to do yeah. Ithink the other P don't worry about the other populations. That's growth downthe road cap. You know, I think, how large of a samplesize that's simple, tofigure out how much of a sample size. You really need that. That'sBitostatititians can tell you the sample size you need for that yeah, butdon't don't get to the point so I'll give you a good example. I was recentlyworking with a company that has an altoitthm that can predictinterventions interventions somewhere between four tosix hours before the intervent wit, the Conslon radship mutrally CCURS. Theyneed to do a clinical validation and they're like well. How do we show thatwe avoided all these interventions and the first step because they have notdone any clinical valilation, yet my responsil, you don't need to yet whatyou need to do is show when your Algerthm goes off six hours later.There actually is an intervention, and if owor them does not go off six hourslater, there is no intervention right. That's the first step and I go in armedwith that to say: Look, Miss Crirp, Mister and his health system. This iswhat we say our algorithm does. This is the data showing that ninety ninetyfive percent of the time it actually did identify these plations now what wedo with it and that gets to the worclose piece, which is the thirdpiller l t that yeah yeah. It does absolutely, but you know,makes me think of another question. You know so what you're touching on? In mymind, is you know kind of around this MVP and I know people have differentperspectives. You know they say. Oh, you can't do MVP and healthcare becauseyou know patients lives are at risks and I think it depends on how you'redefining MVP and- and so I think, what you touched on is you know for health,innovators? You don't have to if you're thinking about a product o our solution,you know, maybe you go to market with a minimal feature set, and then you doyour studies and your validation on those minimal features, and that helpsyou with the timing and the financial cost of that and being able to go tomarket rather than having you know, twenty or fifty, because you thinkthat's going to make it seem more attractive. But then it takes youlonger and it cost you more money. And...

...then you don't have any money to go tomarket youdon't have to boil the ocean rightyeah an that to it gets back to what problem are you trying to solve, and Ineed validation that what you say your algorithm does or your product does?Yes, Dosn't yeah, and so you don't need to boil the ocean, especially the firstfirst leg out, there's mad my experience after you do thepilot study. You end up with a bunch more questions than you started with,and that's, okay right. That's! Okay, like give our audience permission thatthat is: Okay, right! It's okay! You know what you need to survive, to beable to address those questions, youoritize them and then figure out,which ones really make the best business sense and worflow sense toreally go to hey. It's Dr Roxy, here with a quickreak from the conversation. Do you want your innovation to succeed to changelives to shape the future of health care? I want that for every healthinnovator, which is why I invented Coyq an evidence based framework to takeyour innovation from an idea to start up to e full market adoptions, ifyou're, not sure where you are in the commercialization process. Take thefree assessment now at Dr Roxycom back four: Don't miss out on impacting morelives just because you have a low coiq score. The free assessment is that DrRoxycom Cxl, four. That's Dr Rox IECOM backslash, SC ore, and now, let's jumpback into the conversation, so a lot of folks, you know, sell atechnology solution to a health system and walk away. What are some of thebiggest challenges that an innovator might have after asale? So that's the third pillar, okay, the third pillar, is the healthsystem more club. We can talk about that, but I've gotsome stuff on the second pillar, Sti. Okay, all right. Well, let's do it. NoW C W G Wegoto, either one liten you're, my guest, your show! Let's you decide,I think one of the otherin terms of the clemical outcome in the concalvalibation piece. I think one of the things as you dress what problem, andam I really I trying to identify? One of you have to ask what are the problems faced byhealthcare systems yeah and one of the biggest problems is assimulation and managing clinicalpresentation? Okay, let's talke more because data is scattered throughoutvarious sources, there's no one place that pulls it out together. In fact,there may be key data elements that are missing so so I've got ta gather data from allthese dispared systems gathered from a variety of scattered systems. How do Ibring it all together incorporating my solution that it makes sense to solvethe clonicians problem and take care of that patient again, my fire in thebelly? How do I improve the care of that patient laying in the bed? I'mthinking of the patient, laying in the bed and a lot of times the datapresentation, laxs patient context, Kand I'll? Give you a good example ofthat in a lot of CPOE systems. There's drugdrug interactions right as a drug guy. They do they do the drug druginteractions right and and a Clinisian will get a notification of a drug druginouraction. I read a recent paper:...

They looked at three million druginteraction, notifications, two point: eight million of them.Ninety one percent were overwridden. Why several reasons one alert, fotige and these things justkeep popping up could be could be because because the chart is not updated, so inother words, if the patient had real disease, that would pop up the drugnotification. The acute mainal failure has resolved itself, but it was nevertaken off the problem list, so the the computer still sees t e, active andPOPs it up a variety of reasons, so the question becomes. How do you fix thisand I think in my opitnon my opinion, but one one way is to provide patientcontext to it. So if you have a patient you're on warfrient and I'm addingTremetho for himself on the Thoxis Iwas an antibiotic, and I get a notificationthat this drug interaction increases, your inr bleeding tendency A. I got itand and it's interesting the studies that have looked at dismissals of drugdrug interactions, a lot of them have you have to put in a reason F whyyou're distmissing it the most common reason that the clenicians dismisseddrug drug interaction? Notifications is yes, I'm aware of that got it clickdone H, Isit! Well. What? If, as a commission, you see on thenotification, Roxy has a Warfren triumethic for HIMSELFA druginteraction, it's going to increase our inr and her most recent Ion r fromthree hours ago was two point eight and an and in that same script. So nowit gives me patient context. I now I don't have to go someplace else to lookfor it right. I all right there and what? Ifon the same screen, I cand then say: okay, cancel that order I want to. I want toorder something else, all from that same fishy context, creet. So yeahagain. So my point is data presentation. I think, as you build your innovativesolution, you need to consider data presentation and it gets into the wholerisk tratification which we can talk about later, but what I call the tensecond rule, looking I'm looking in at a screen of,and I don't care if it's twenty patients, two hundred patients or twothousand patients and you're notifying me that these twenty patients are allred alerts right well within ten seconds. I need to be able as acommission. What I want to know is who's the number one patient I want tolook at. I have to look at. Where do I need to look, and what am I supposed tolook for? So, if I don't know, if I see a Screan of fifty patients, twenty patients,whatever it may be patient thirty five, maybe the number one patient I want. Ihave Toi I donmind to go to pagient one to they're all read, but how do I knowwhere the priority is and if it doesn't meat that ten second rule, it doesn'twork in my mifd? So do you see this as something that is affecting the health innovator in theirproduct development phase to make sure that they're taking that intoconsideration? Or do you see that as something that is really importantafter the sale and making sure they have an understanding of theenvironment to make sure that they're getting the outcomes that they hope toget from their solution or both the short answer? Is it's Prett? Ithink you go out the door with it. I...

...think, if you go out, I saw let me make now. Let me give youthe La Answer, the ten second rule. I have not seen anybody that meets theten second wol. I have not seen any company out there that and small medium large companies that meetsthe ten second role, and so that's a huge advantage. If you canwalk into a place and say this is how we were Stratifie, and I can show youwho the top person need to look at us and who to look at where look and whatto look. Look at that's the ten second Rorld Triat to me, going in after the fact, becauseit goes into our third piller, which is the health health system, wor flow, andyou have to have that as part of it. So with health system workflow, and itgets back to the question you asked earlier. If I have a technology, soI've built I'm a healthcare innovator company. I've built this this thing andI have my crinical validation. I show that I can predict length of stay inthese patients right here. You Go, roxy is as head of a five hospital olsesystem. I would like you to buy this, and you say yes, I'd like to buy it andwe install it in all your five hospitals yep the outcomes, theclinical outcomes. Do not automatically transfer from one program to the other.Simply by adding on technology does not happen by simply installingand turning on a switch you maybe more, you may be more efficient, but you'renot going to be more effective and no one. No one pays you to be efficient, Otdoing the wrong thing right right, Rightjo, even though you have strongleadership acceptance, even though you have a strong project team and eventhough you have clinical Byin, these are all good starting points, but alonewill not guarantee success. Without going back to the topic of the pillar,which is health system, work, clubs, Odo hy, how do I improve the workfol?How do I streamline it? One of the biggest problems inhealthcare is those frontline clissions are very busy very, very and addingmore things for them to do without taking stuff away is not going to helpit's only going to hinder, so I think yeah later has to think about what andagain I've seen this happen with companies that say, and it's thedifference between having a product and having a solution, because the solutiones going to encompass all of these things t af all three pillars thatwe've been talking about. Yeah, it's going to say this is how you use it,and it may vary from side to siht right. We Ma have to customize it a little bit,but if you get it right, the customization should be little tweex,not manjor configuration changes right right, which is a huge pitfall, but yes,right and and so and even within a hospital. The fifth floor may do itdifferently from the third floor from the Er from the egate right, but itmight be a little bit differently, but aligning those people and process thatwhat I call the clonical transformation change. That's what you really need tohave to have it adopted and show thefrontline clinision, how it's going to make their job easier, not worse, andso simply going to a cite, in my...

...opinion, going to a Siyand, say: here'sthe technology turn it on boom. F You're going to fail, YOU MIGHT BE! Youwill fail! Yeah! Absolutely! And you know it's so critical these. You knowthe health innovators, you know put their heart in soul in their solution,their innovation and they're, going to market and an it's such a a win thatneeds to be celebrated when you get these new customers with. The factremains is that if those new customers, those earlier doctors, don't becomeraving fans, they will not help you move through the adoption curve to getthe future customers. So you might have won a few, but if that account is notmanaged in through the lins that you're talking about, then you're not going tohave raving fans, you might have sold a solution, that's not being used. Youknow CA, call six months and find out like yeah when nobody's using it. It'sall installed, or they may be using. You know a tenth of what thecapabilities are and and so what do you suggest to health innovators? You knowwhat do they need to prepare for both financially like what resources thatthey need to plan for both finances and people to be able to after the sale,support that implementation and execution all the way to gaiting theclinical validation to where it becan BEA SC, successful case study forFuture Business Yeah? So I think you're right I mean you want these initialsites to be your reference sites. You want to be able to take prospects thereand say here, call up St Joe's talk to Fouc to Dr Roxy and ask her what shethinks of the system Yep of our solution. Right Yep. I think you haveto have a conal valilation piece before you do that before you go out and theother piece that we haven't alked, about, which I think is part of this and aget, so the corniavaidation piece,the data presentation piece, the ten second role, but the other piece ofthis that I think is also important, is the reporting piece then going out without reporting, Ithink, is an error as well. Now I realize I'm dumping a lot of stuff ofstuff you have to have before you walk out the door again, you don't have toboil the ocean right right, but I think reporting to be able to assess what that what you say your solution isdoing is actually doing, and part of the reporting is also part of yourclinical validation. The metric that you've identified and I think of metricin forbing buckets, there's clinical metrics, there's financial metrics,there's operational metrixcs of how well does it operate within the systemand then therar staff and patient satisfaction, Nettrix and as Qidourl quaduble aim o tha the question as you're building yourclinical validation. You have ask you have to go through each one of thoseand and have your list and generate a list of all the possible metrics undereach one of those for categories, and there will be duplication. Right will be one metric, they willtranscend multiple categories and then there will be again: don't boil theocean, you w, you got to have your MVP netrics that are really going to getback to. This is the problem I'm trying to sile that IV identified and thesemetrics are key to showing that not not the rest of them. So you need toidentify that upfront and go out there. Now, as you build the solution.

One of the questions if a health systemis going to want, is an output reporting. How well are we doing?What's our assessment of this not only initially but overtime longitudally andwe all know what happens when a new project starts you and we also knowwhat happens. There's a lot of enthusiasm, there's, especially withpositive results, a lot of encouragement, roll it out everywhere.Let's go, but we also know what happens when you take your foot off the excelme yeap and so not having the reporting and be able to assess what happenslongetunally with your program to see that it's still working is alsoimportant as long as we're talking about reporting. Let's talk about someother things. What most people think about when we say reporting assessmentof outcomes is reporting to the c suit the buyers that this is the results ofour solution and our collaboration with you, because it is, it does have to bea partnership and a collaboration right, but these are the results to the CEAsweet. But what I submit is don't forget the front line comissions,so you want to record for lack of a better term upstream and downstream andallthe times we forget to circle back to the people that are actually doingthe work at the front line say this: is the impact you're having with thissolution and we're going to show you this? The third part of it there'stheir scart parts. The third part is I, as a health system, have boughtyour solution. Now. I want to be able to compare my Hospialato Hospital BiToosca see the Hospital d right. I want to compare how, where is my problemarea if IU get overall on at eighty percent compliance with whatever system?I'm in that doesn't tell me that hospital D is at forty percent andcounteracting the ninety percent hospital ais that so I need to findwhere my problem, artes, no and and and then. In addition, I want to know howdoes my health system compare, how O my community hospitals compared to othercommunity house with my other competitors in my area? How does myacademic sites compared to other academic sites? How S my three hundredbed hospital compared to other three hundred bid housles? I don't want tocompare myself to an eight hundred bed hospital right and how do I comparegeographically from the northeast to the southwest? How does that comparenone of that happens without a reporting mechanism, overtime that youneed t to consider and the final area is. I think the reporting that youbuild into this helps helps in terms of identifying areas for improvement,Ereas you're not doing well in for whatever reason, but areas to focus onn the future to improve compliance. Yeah yeah, absolutely I mean- andthat's just really that that's a fundamental practice. I think foranything that we do today right. You know design, build test measure and just fo for continuousimprovement in. So it's interesting to even thinkabout it from the the outcomes fieace and how important that is. I don't knowwhat your experience has been, but mine is a lot of times. Innovative CompaniesForget about the recording peace and they're, like Oh yeah, we'll have somereporting at the, but don't really think about what are the elements Ireally need to put into it. Yeah, it's definitely an afterthought in many cases, or it'sreally lean a little too lean and and not, I think what you're describing issomething that's really important to think about, even in the developmentprocess, right planning for that type...

...of data collection, and it's segmentationin you know, presentation to customers as well as to you know yourself as theinnovator to be able to see how successful it's going. I think that youknow as an elt health innovator. You know w an you're in this startup. Youknow you typically have limited resources, yeah and right. A and you'vegot this window o opportunity that you're kind of up against and so you'rekind of. Thinking of what is it that I have to have? What do I need to spendmy money on and I think the the conversation that we are having todayvery often too often gets part of the down the road and, and I think that it becomes a pitfall for success. Well, I agree with you completely and in you know, if mbpsa dirty word, I'm sorry, but it's part of Mb an my min right right right rightright exactly so, you know, as we wrap up here, you know there's so many people thatare that are listening today, that are innovators that are in the trenches orhospital systems that may be innovating within that are still even internallyexperienced a lot of the same challenges that we talked about orthey're on the receiving side of this health innovator. Bringing a solutionto them. Is there any other advice that you have for them before we wrap up wow to throw more more kimling on the fireto stoke it even further early on when we, when we first started doingthe tella medicine for the ICU solution, we could that would sell solely onclinical outcomes. You do it just on coingcal outcomes, that environment nolonger exists, and I think everyoneis hopefully, is aware that you have tosell it on clinical and financial outcomes, and you have to include thefinancial component to any project that you do with this. So if you're not looking at that, I thinkthat would be my last piece of advice. In fact, I just recently saw an articleof you know. The big thing in the news these days are how drug companies pricetheir new innovative drugs absorb an in price for these. Well, I just read anarticle and- and there are some countries in Europe that price that teprice- their new pharmaceuticals based on quilit quality life years gainedpolution. So the pricing of the drug is based onwhat impact on quality life years will impact the patients taking the drug. Sothings that have a more lifestyle changes to improve. You know: Wilprobably have less costs if based on that versus something that's the hugelife life saver kind of thing, there's, there's and obviously the FBAis looking at Rli and cost analysis in anything that they consider, especiallywith the drug aspect of it. So that would be my last piece of advice.Awesome. Well, thank you. So much for sharing your wisdom with our listenerstoday. How can folks get a hold of you if they want to reach out with reachout to you to do any type of follow up conofversations Ithank Cuankyou? Forthat? I think the easiest way is on my linkedon profile orconisson on mylinked in they will have access to my web page. I also if you look at myactivities, I post a lot of articles. I have a a monthly blod newsletter thatthey're all posted around link in that you can download, read, throw away orsubscribe to the to my monthly Blod with that as well or Kan. Thank you somuch I feel, like you know, we could...

...just have this conversation for days sowe'll have to schedule another episode, there's so much to talk about. Thankyou so much. Thank you YY! Thank you so much for listening. I knowyou're busy working to bring your life changing innovation to market, and Ivowue your time and your attention to save time and get the latest episodeson your mobile device automatically subscribe to the show on your favoritepodcast APP like apple podcast, spotify and stitcher. Thank you for listening,and I appreciate everyone. WHO's been sharing. The show with friends andcolleagues, see you on the next episode of coiq.

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