Health Innovators
Health Innovators

Episode · 1 year ago

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

ABOUT THIS EPISODE

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
https://www.erkanhassan.com/, where you can read and subscribe to his monthly blog. You can also connect with him on LinkedIn.

Welcome to Coiq, where you learnhow health innovators maximize their success. You're working on something big, something lifesaving, something world changing. Yet ninety five percent of health innovations fail andreal lives are on the line. That's why launching is not enough. Commercializationis the most critical, yet overlooked stage of the innovation process. Through candidconversations with health innovators, early adopters and influencers, you'll learn the five componentsof the COIQ early adoption strategy. So, if you want to change lives anddominate your market, why not give your innovation the best chance to succeed? I'm your host, Dr Roxy, founder of Legacy DNA and international bestsellingauthor of how health innovators maximize market success. And now let's join the conversation andmaximize your success. Welcome back, coiq listeners. On today's episode Ihave Dr Urkon Hassan, who has been in the healthcare industry for many decades. I know I'm telling your age a little bit, been in healthcare greylong time and as an independent healthcare consultant. Welcome to the show. Thank you, roxy, being you for having me all everyone. So, beforewe get star started, I always like to just kind of level set andhave you do a little bit of an introduction about your background and what youdo to kind of give our audience some context. Yeah, sure, that'sgreat. I am formally trained as a clinical pharmacist. I got my pharmacydegree in my Dr Farmson degree and went to work at academic medical centers forspent the first half of my career at academic medical centers, primarily working inthe ice you working with the intensibis and Cret a little care nurses to manageto drug therapy of these very critically unstable patients and went the academic route.Got Promoted to associate professor the whole skylar activities, the the professional service,that teaching and then switch gears and was employee number seventeen at Bisycue, whichwas a startup company for Telemedicine for the ICEU, trying to leverage a limitedresource, and was there we built that come but I was employee number seventeen. We built up the product, the solution, the the number of beds. We covered about seven thousand ICU beds, all adult patients in the IC inthe US. And my most recent title there was director of Clinical Affairs, where I was responsible for identifying, prioritizing, launching and growing the clinicalinformatic strategy, and so and and again most recent shift as an independent consultant. What I do is I try to identify the clinical challenges that health systemsand startup company space, using evidence based clinical data to sort of create innovativeintelligence solutions to really drive patient center quality outcomes, and it's really coupling myclinical expertise with business skills that I've learned over time. I think the bestway to describe this is, you know, my my fire in the belly,my my goal of really what I want to do when I grow up. Yeah, is is my I really want to build or create a qualitysolution that really impacts the quality of care for the patient in the bed.That's that's sort of my driving fire in the belly. HHHUH, awesome.Somebody's got to do it, you know. So it's interesting because there's so manyfactors or things to consider when you're...

...bringing an innovation to market, butthat, but healthcare is so unique and I think that one of those thingsthat makes it unique is that the clinical evidence is like a critical factor andin being able to be successful, whereas other industries don't have to, youknow, pay attention to that. So our show is all about helping healthinnovators, you know, go from an idea to full market adoption, andso I wanted to ask you, as you scan the landscape it what aresome of the biggest challenges that you've identified when you're looking through the Clinical OutcomesLens? So that's a really good question Roxy and if I may, letme step back for just a little bit go a little higher with that.I mean, yeah, I think there's actually three, three parts to thisproblem. Hmmm, in my view, and I'm not sure if they're independentpillars are overlapping then diagrams, but the three parts that I see. Numberone is obviously the business challenge that a company wants to be a commercial success, and I think that you spend, you know, a good part ofyour book on on the challenges and we can talk we'll talk more about thatin a minute. But it's the business challenge of becoming a commercial success andit's either an offshoot of that or separate pillars a part of that. BecauseI think the other two parts are number one, are the clinical outcomes hmm. He said it. And you know David Nash, who's the Founding Deanof the Jefferson College of population health. He just retired as the founding deanof that, has this great quote. I give them full credit for thicedealer all the time. Yeah, he's no outcome knowing them. Yep,and again, we'll come back to you. I want to list the three thingsthat will come back and talk about each one of these a little bitmore detail, I think. And then the third factor, I think,really is health system work flows. Hmmm, and really defining the roles and responsibilitiesof healthcare, identifying the challenges that healthcare faces and and how do howdo all these three interlace and really how do you take these in terms ofclinical and business skills and bridge them together? So that's kind of how I seeit. From the business challenge, you know, let's talk about thebusiness challenge aspect of M so there's three parts. I don't know if it'spillars or overlapping band diagrams, but to be a commercial success, you know, you and I both know there are companies out there that build solutions lookingfor a problem. Yeah, and that's really not the best way to doit and and so that's one issue with the business challenged to become a commercialsuccess. The second area, I think, is in in terms of code development, and I've seen many companies where they build their solution or their productsort of in isolation, and I think one of the things you need toit's a mind shift with healthcare, because you really have to build it theway clinicians think. Don't have that that way clinicians think. To overlap itwith the clinical presentation, again you're going to fall short and you need tobe concerned about that. And then finally, is the clinical validation. So againthat part of the end diagram that we need to go talk about,the Ven Diagram, and I think one of the the best way to sumit up as I see it, in terms of the business challenge is thata lot of companies will think of it as a product. M there,and I think that's a mistake when it comes to healthcare, because what ahealth care is looking for is not a...

...product, they're looking for a solutionand right you with a product that's not solving that may not be solving myproblem, and I really need for you is a proven solution of how doI incorporate this into my system? So that's the one business challenge piece.Let's talk about the clinical outcomes piece of this, the clinical validation piece,is very critical. No outcome, no income. Yep, and I thinka lot of companies are surprised that, oh, we have this great widget, let's go sell it and without the very first question you're going to getis 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 onyou without clinical data. And you know, I don't mean that it needs tobe a large, two thousand patient randomized clinical trial, but you doneed to show a pilot to demonstrate that what you're offering really does what yousay it's going to do. But that does entail a number of things.It entails writing the study protocol, getting IRB, going through the IRB.It does not mean you need, you may or may not need to getinformed consent based on what you're really trying to demonstrate with it. But havingthat at rb piece of paper, I think is very important. Getting thedata, analyzing the data, having go no go decisions, identifying the metricyou're going to measure and and and assess for success or failure is important.And again, this does not have to be a two year study. Ithink some of these can be done in very short periods of time, ninetydays of once you start and rolling in getting data. So let's pause forjust a moment and talk about that. Like when does an innovator need todevelop this and and how much is it? You know, kind of a progressivething. So you're kind of touching on this, but I want tojust pause and kind of drill a little bit deeper into it, because Ihear this question all the time. You know, how much much evidence andclinical validation do I have to have before I go to market? How muchof it can be a little bit more ambiguous when I'm approaching someone maybe asa partner, and the way I'm going to get that evidence is going tobe through that pilot program so let's kind of just talk about when and thenwhat does that look like, because I think you're doing a great job forour listeners kind of framing that is, this is what you might need beforeyou go to market and and it would in this context. Right. Wetalked about sample size and the type of type of study and then what youwould need, maybe in a pilot or in some of your first customers.My personal opinion is, if you're going to sell the hell systems and you'regoing to go to hell systems and do this, unless you're going to partnerwith them, you need the data out front. Kind Nope, you know, especially if you're a small startup company, that you're trying to get risk takers, early adopters to or just what you're doing. Yep, you haveto have some clinical data to know that. And so, for example, Ithink it really depends on what the solution really is. So, forexample, if you have a predictive algorithm that says I can predict length ofstay in the hospital or in the ICU, then and I can. I can. This algorithm will predict Lenk of stay. Well, then I needto go to a hospital and say, will you partner with us to pilotthis so that I can and I and let me back up. So Ihave built this algorithm. I pulled back two thousand patients, I analyze theirdata and I had some engineers build this...

...algorithm. I know what the keycomponents are. I validated it, I developed, in validated in house.Yeah, no, outside data. Yep. Before you go to a site,you're going to the first if you go to a site to sell thisalgorithm, they're going to say, where's your data? Show me that whatyou actually built has been validated, that it actually works, and so Ithink that has to happen before you make any sales. So what about thethe the structure of that? Does it need to be a certain population,a certain sample size? Is there some specific metrics? Are Markers? BecauseI think that this is also a really important discussion because there's a lot ofpitfalls with this because, you know, most of the people that are thehealth innovators are not the clinicians. They're not thinking the way you are andyou're, you know, in the in what you're talking about and your experience. They're thinking of more of the tech, and so the last thing you wantis them to do these stud these but be missing some key parts ofthe data to where it was wasted time, wasted money because it's incomplete or it'snot what that those potential customers are looking for to actually give them assuranceof, you know, patients, safety and efficacy. You know, excellentpoints. I think that is right. On the mark and one of thebiggest problems I see is biting off more than you should show. And Ithink the first step is this is what we say it does, this iswhat how this is how we're going to validate that it does what we sayit does. Period. That's all you're trying to do. Yeah, Ithink the other pop don't worry about the other populations. That's growth down theroad. Yep, you know. I think how large of a sample size? That's simple to figure out. How much of a sample size you reallyneed? That that's botto. Statisticians can tell you that the sample size youneed for that. Yeah, but don't don't get to the point up.So I'll give you a good example. I was recently working with a companythat has an algorithm that can predict interventions, interventions somewhere between four to six hoursbefore the intervention of the clinical invention, mctually occurs. They need to doa clinical validation and they're like, well, how do we show thatwe avoided all these interventions and the first step, because they have not doneany clinical validation yet. My response was, you don't need to yet. Whatyou need to do is show when your algorithm goes off a six hourslater, there actually is an intervention and if you more them does not gooff six hours later, there is no intervention. Right. That's the firststep and I going armed with that to say, look, Mr Mr andhis health system, this is what we say our algorithm does. This isthe data showing that ninety, ninety five percent of the time it actually dididentify these patients. Now what we do with it, and that gets tothe work closed piece, which is the third pillar. Will Get that matter? Yeah, yeah, it does absolutely, but it, you know, makesme think of another question. So you know. So what you're touchingon in my mind is, you know, kind of around this MVP and Iknow people have different perspectives. You know, they say, Oh,you can't do MVP and healthcare because, you know, patients lives are atrisks. And I think it depends on how you're defining MVP and and soI think what you touched on is, you know, for health innovators youdon't have to. If you're thinking about a product or 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 helps you with thetiming, in the financial cost of that and being able to go to marketrather than having, you know, twenty or fifty because you think that's goingto make it seem more attractive, but then it takes you longer and itcost you more money and then you don't...

...have any money to go to market. You don't have to boil the ocean, right, yeah, and back toit. Gets back to what problem are you trying to solve? AndI need validation that what you say your algorithm or your product does. Yep, does it? Yeah, and so you don't need to boil the ocean, especially the first first legout. There's made my experience. After you dothe pilot study, you end up with a bunch more questions than you startedwith. And that's okay, right, that's okay. I give our audiencepermission that that is okay. Okay, it's okay. You know what youneed to survive to be able to address those questions. You know, ploritizethem and then figure out which one's really make the best business sense and workflowsense to really go to hmm, Hey, it's Dr Roxy here with a quickbreak from the conversation. Do you want your innovation to succeed, tochange lives, to shape the future of healthcare? I want that for everyhealth innovator, which is why I invented Cyq and evidence based framework to takeyour innovation from an idea to start up to full market adoption. If you'renot sure where you are in the commercialization process, take the free assessment nowat Dr Roxycom backslash score. Don't miss out on impacting more lives just becauseyou have a low co IQ score. The Free Assessment is at Dr Roxycombackslash or that's Dr Roxiecom backslash score. And now let's jump back into theconversation. So a lot of folks, you know, sell a technology solutionto a health system and walk away. What are some of the biggest challengesthat it innovator might have after a sale? So that's the third pillar. HMM, okay, the third pillar is the health system worklow. We cantalk about that, but I've got some stuff on the second pillar still.Okay, all right, well, let's do it. which when you arewe can go to it. We can go to either one. Listen,you're my guest, your show. Let's you decide. I think one ofthe other in terms of the clinical outcome, in the clinical validation piece. Ithink one of the things, as you address what problem I am Ireally I trying to identify one of you have to ask what are the problemsfaced by healthcare systems? Yeah, and one of the biggest problems is asimulation and managing clinical presentation. Okay, let's talk more, because data Uis scattered throughout various sources. There's no one place that pulls it out together. In fact, there may be key data elements that are missing. Soso I've got to gather data from all these dispared systems, gathered from avariety of scattered systems. How do I bring it all together, incorporating mysolution that it makes sense to solve the clinicians problem and take care of thatpatient? Again, I fire in the belly. How do I improve thecare of that patient laying in the bed? I'm thinking of the patient laying inthe bed and a lot of times the data presentation lacks patient context.Okay, I'll give you a good example of that. In a lot ofCPOE systems there's drug drug interactions. Right, as a drug guy, they dothey do the drug drug interactions right and and a clinician will get anotification of a drug drug interaction. I...

...read a recent paper. They lookedat three million drug interaction notifications. Two point eight million of them, ninetyone percent were overwritten. Why? Several reasons. One alert fatigue. Iget these things just keep popping up. Could be could be because cause,because the chart is not updated. So in other words, if the patienthad renal disease, that would pop up the drug notification. The acute renalfailure has resolved itself but it was never taken off the problem list. Sothe the computer still sees the active and POPs it up a variety of reasons. So the question becomes, how do you fix this? Hmmm, andI think in my opinion, of my opinion, but one one way isto provide patient context to it. So if you have a patient you're onWarfaren and I'm adding trimethod for himself, on the oxyzols, an antibiotic,and I get a notification that this drug interaction increases your ir bleeding tendency.Yeah, I got it. And and it's interesting the studies that have lookedat dismissals of drug drug interactions, a lot of them. have got toput in a reason why you're dismissing it. The most common reason that the cliniciansdismissed drug drug interaction notifications is, yes, I'm aware of it,I gotta Click done. Uh Huh, UH, Huh. Yes, itwell, what if, as a clinician, you see on the notification Roxy hasa warfare in trimethod for himself, a drug interaction. It's going toincrease our ir and her most recent ire from three hours ago was two pointeight and and and and in that same script. So now it gives mepatient context. I now I don't have to go someplace else to look forit. Right, I have all right there. And what if, onthe same screen, I can then say, okay, cancel that order, Iwant to use, I want to order something else, all from thatsame patient context screen. So yeah, again. So my point is datapresentation. I think as you build your innovative solution, you need to considerdata presentation, and it gets into the whole risk ratification, which we cantalk about later. But what I call the ten second rule. M Looking, I'm looking at a screen of and I don't care if it's twenty patients, two hundred patients or two thousand patients, and you're notifying me that these twentypatients are all read alerts right well, within ten seconds. I need tobe able as a Commissian, what I want to know is who's thenumber one patient I want to look at, I have to look at. Wheredo I need to look and what am I supposed to look for?So if I don't know, if I see a screen of fifty patients,twenty patients, whatever it may be, patient thirty five maybe the number onepatient I want, I have to be a time to go to patient one, two, o. they're all read. But how do I know where thepride already is? And if it doesn't meet that ten second rule,it doesn't work in my mind. So do you see this as something thatis affecting the health innovator in their product development phase to make sure that they'retaking that in the consideration, or do you see that as something that isreally important after the sale and making sure they have an understanding of the environmentto make sure that they're getting the outcomes that they hope to get from theirsolution? Or both? The short answer is it's Pret I think you goout the door with it. I think if you go out I saw.Let me make now let me give you...

...the law answer. The ten secondrule. I have not seen anybody that meets the ten second rule. Ihave not seen any company out there that and small, medium large companies thatmeets the ten second rule. And so that's a huge advantage if you canwalk into a place and say this is how we were stratified and I canshow you the top person you to look at is, and who to lookat, where to look and what to look look at. UHM, that'sthe ten second rule. Tryad to me going in after the fact, becauseit goes into our third pillar, which is the health health system workflow,and you have to have that as part of it. So with hell systemworkflow, and it gets back to the question you asked earlier. If Ihave a technology, so I've built I'm a healthcare innovator company. I builtthis, this thing and I have my clinical validation. I show that Ican predict length to stay in these patients. Right here you go. Roxy isas head of a five hospital health system. I would like you tobuy this, and you say yes, I'd like to buy it. Andwe install it in all your five hospitals. Yep, the outcomes, the clinicaloutcomes, do not automatically transfer from one program to the other simply byadding on technology. Hmmm, he does not happen by simply installing and turningon a switch. You may be more you may be more efficient, butyou're not going to be more effective and no one, no one pays youto be efficient at doing the wrong thing. Right, right, right. So, even though you have strong leadership acceptance, even though you have astrong project team and even though you have clinical buy in, these are allgood starting points, but alone will not guarantee success. Without going back tothe topic of the pillar, which is health system workflows, how do Ihow do I improve the work for how do I streamline it? One ofthe biggest problems in healthcare is those frontline collisions are very busy, very veryand adding more things for them to do without taking stuff away is not goingto help, it's only going to hinder. So I think, yeah, laterhas to think about what and and again I've seen this happen with companiesthat say and it's the difference between having a product and having a solution,because the solution is going to encompass all of these things, that all threepillars that we've been talking about. Yeah, it's going to say this is howyou use it and it may vary from sight to sight. Right,and you have to customize it a little bit. But if you did itright, the customization should be little tweaks, not major configuration changes. Right,right, which is a huge pit fault. But yes, right,and and so eat. And even within a hospital, the fifth floor maydo it differently from the third floor, from the ear, from the EEDATE, right, but it might be a little bit differently. But aligning thosepeople and process. That that what I call the clinical transformation change. That'swhat you really need to have to have it adopted and show the frontline clinicianhow it's going to make their job easier, not worse. And so simply goingto a site, in my opinion,...

...going to a site and say here'sthe technology, turn it on. Boom, you're going to fail.It might you will fail. Yeah, absolutely, and you know it's socritical. These you know, the health innovators, you know, put theirheart and soul in their solution, their innovation, and they're going to marketin it's such a win that needs to be celebrated when you get these newcustomers. But the fact remains is that if those new customers, those earlyadopters, don't become raving fans, they will not help you move through theadoption curve to get the future customers. So you might have won a few, but if that account is not managed in through the Lens that you're talkingabout, then you're not going to have raving fans. You might have solda solution that's not being used. You know, call, call, sixmonths and find out like yeah, when nobody's using it, it's all installed, or they may be using, you know, a ten of what thecapabilities are and and so what do you suggest to health innovators? You know, what do they need to prepare care for, both financially, like whatresources they need, a plan for both finances and people to be able to, after the sale, support that implementation and execution all the way to gettingthe clinical validation to where it be. Can be a sick successful case studyfor future business. Yeah, so I think you're right. I mean youwant these initial sites to be your reference sites. Want to be able totake prospects there and say here, call up sat joe's talk to talk toDr Roxy and ask her what she thinks of the system, Yep, ofour solution. Right. I think you have to have a clinical validation piecebefore you do that, before you go out. And the other piece thatwe haven't talked about, which I think is part of this as and andagain. So the clinical validation piece, the data presentation piece, the tensecond role. But the other piece of this that I think is also importantis the reporting piece, and going out without reporting, I think, isan error as well. Now I realize I'm dumping a lot of stuff,of stuff you have to have before you walk out the door. But again, you don't have to boil the ocean, right, right, but I thinkreporting to be able to assess what that what you say your solution isdoing, is actually doing. And part of the reporting is also part ofyour clinical validation. The metrics that you've identified, and I think of metricsin four big buckets. There's clinical metrics, there's financial metrics, there's operational metricsof how well does it operate within the system, and then their staffand patient satisfaction metrics and as quadutil quadruple aim get to that. I thinkthe question. As you're building your clinical validation, you have to ask youhave to go through each one of those and and and have your list andgenerate a list of all the possible metrics under each one of those four categories. And there will be duplication. Right, will be one metric that will transcendmultiple categories and then there will be again, don't boil the ocean youwant. You got to have your MVP metrics that are really going to getback to. This is the problem. I'm trying to sell that I identifiedand these metrics are key to showing that. Not not the rest of them.So you need to identify that up front and go out there now asyou build the solution. One of the...

...questions, if a hell system isgoing to want is an output reporting. How well are we doing? What'sour assessment of this, not only initially but over time, longitudinally. 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 with positive results,a lot of encouragement. Roll it out everywhere. Let's go. Butwe also know what happens when you take your foot off the accelerator, Yep, and so not having the reporting and be able to assess what happens longitudinallywith your program to see that it's still working, is also important. Aslong as we're talking about reporting, let's talk about some other things. Whatmost people think about when we say reporting, assessment of outcomes, is reporting tothe sea sweet, the buyers, that this is the results of oursolution and our collaboration with you, because it is. It does have tobe a partnership and a collaboration, right, but these are the results to thesea sweet. But what I submit is don't forget the frontline clinicians.So you want to report, for lack of a better term, upstream anddownstream, and all the times we forget to circle back to the people thatare actually doing the work at the front line. Say this is the impactyou're having with this solution and we're going to show are you this the thirdpart of it. There's four parts. The third part is I, asa health system, have bought your solution. Now I want to be able tocompare my hospital a to hospital. Be To hospital, see the Hospitald right. I want to compare. How where is my problem area?If I get overall. I'm a eighty percent compliance with whatever system I'm in. That doesn't tell me that hospital D is at forty percent and counteracting theninety percent hospital a is at. So I need to find where my problemareas not and and and then, in addition, I want to know howdoes my health system compare? How do my community hospitals compared to other communityhouse with my other competitors in my area? How does my academic sites compared toother academic sites? How does my three hundred bed hospital compared to otherthree hundred bed housels? I don't want to compare myself to an eight hundredbed hospital, right. And how do I compare geographically, from the northeastto the southwest? How does that compare? None of that happens without a reportingmechanism over time. That you need to to consider. And the finalarea is I think the reporting that you build into this helps, helps interms of identifying areas for improvement, areas you're not doing well and for whateverreason, but areas to focus on the future to improve compliance. Yeah,yeah, absolutely. I mean, and that's just really that. That's afundamental practice, I think, for anything that we do today. Right,you know, design, build, test measure and just for for continuous improvementin so it's interesting to even think about it from the outcomes peace and howimportant that is. I don't know what your experience has been, but mineis a lot of times innovative companies forget about the reporting piece and they're like, oh, yeah, we'll have some reporting at that, but don't reallythink about what are the elements I really need to put into it. Yeah, it's definitely an afterthought and many cases or it's really lean, a littletoo lean, and in not I think what you're describing is something that's reallyimportant to think about even in the development process, right planning for that typeof data collection and its segmentation and,...

...you know, presentation to customers aswell as to you know, yourself as the innovator, to be able tosee how successful it's going. I think that you know, as an Elfhealth innovator, you know and you're in this startup, you know you typicallyhave limited resources. Yes, and write it, and you've got this windowof up the opportunity that you're kind of up against, and so you're kindof thinking of what is it that I have to have? What do Ineed to spend my money on. And I think the the conversation that weare having today very often, too often gets part of the down the roadand and and I think that it becomes a pitfall for success. I agreewith you completely. Any and you know, if MVP's a dirty word, I'msorry, but it's part of MVP and online right, right, right, right, right, exactly. So you know, as we wrap uphere, you know there's so many people that are that are listening today thatare innovators, that are in the trenches or hospital systems that may be innovatingwithin that are still even internally experience in a lot of the same challenges thatwe talked about, or they're on the receiving side of this health innovator bringinga solution to them. Is there any other advice that you have for thembefore we wrap up? Wow, no, to throw more, more kindling onthe fire, to stoke it even further. Early on when we whenwe first started doing the telemedicine for the ICU solution, we could that wouldsell solely on clinical outcomes. You do it just on clinical outcomes. Thatenvironment no longer exists and I think everyone is, hopefully is aware that youhave to sell it on clinical and financial outcomes and you have to include thefinancial component to any project that you do with this. So I if you'renot looking at that, I think that would be my last piece of advice. In fact, I just recently saw an article of you know, thebig thing in the news these days are how drug companies price their new innovativedrugs and absorbit in price for these. Well, I just read an articleand and there are some countries in Europe that price it big price their newpharmaceuticals based on quality, quality life years. Gained solution. So the the pricingof the drug is based on. What impact on Quality Life Years?Will it impact the patients taking the drug? So things that have are more lifestylechanges to improve it, you know, will probably have less cost if basedon that versus something that's the huge life life saver kind of thing.There's there's and and obviously the FDA is looking at Urli and cost analysis inanything that they consider, especially with the drug aspect of it. So thatwould be my last piece to advice. Awesome. Well, thank you somuch for sharing your wisdom with our listeners today. How can folks get aholdof you if they want to reach out with reach out to you to doany type of follow up connversations. Thanks. Thank you for that. I thinkthe easiest ways on my linkedin profile, ork, on as loan. OnMy linkedin they will have access to my web page. I also,if you look at my activities, I post a lot of articles. Ihave a monthly blog newsletter, the they're all posted on linkedin that you candownload, readthrow away or subscribe to the to my monthly blog with that aswell, or kin. Thank you so...

...much. I feel like you know, we could just have this conversation for days, so we'll have to scheduleanother episode. There's so much to talk about. Thank you so much.Thank you, hi, thank you so much for listening. I know you'rebusy working to bring your life changing innovation to market and I value your timeand your attention. To save time and get the latest episodes on your mobiledevice, automatically subscribe to the show on your favorite podcast APP like apple podcast, spotify and stitcher. Thank you for listening and I appreciate everyone who's beensharing the show with friends and colleagues. See You on the next episode ofCoiq.

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