Health Innovators
Health Innovators

Episode · 2 years 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 learn how health innovators maximize their success. You're working on something big, something life saving, something world changing. Yet ninety five percent of health innovations fail and real lives are on the line. That's why launching is not enough. Commercialization is the most critical, yet overlooked stage of the innovation process. Through candid conversations with health innovators, early adopters and influencers, you'll learn the five components of the COIQ early adoption strategy. So, if you want to change lives and dominate your market, why not give your innovation the best chance to succeed? I'm your host, Dr Roxy, founder of Legacy DNA and international bestselling author of how health innovators maximize market success. And now let's join the conversation and maximize your success. Welcome back, coiq listeners. On today's episode I have 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 grey long time and as an independent healthcare consultant. Welcome to the show. Thank you, roxy, being you for having me all everyone. So, before we get star started, I always like to just kind of level set and have you do a little bit of an introduction about your background and what you do to kind of give our audience some context. Yeah, sure, that's great. I am formally trained as a clinical pharmacist. I got my pharmacy degree in my Dr Farmson degree and went to work at academic medical centers for spent the first half of my career at academic medical centers, primarily working in the ice you working with the intensibis and Cret a little care nurses to manage to 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, which was a startup company for Telemedicine for the ICEU, trying to leverage a limited resource, 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 in the US. And my most recent title there was director of Clinical Affairs, where I was responsible for identifying, prioritizing, launching and growing the clinical informatic 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 systems and startup company space, using evidence based clinical data to sort of create innovative intelligence solutions to really drive patient center quality outcomes, and it's really coupling my clinical expertise with business skills that I've learned over time. I think the best way 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 quality solution 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 many factors or things to consider when you're...

...bringing an innovation to market, but that, but healthcare is so unique and I think that one of those things that makes it unique is that the clinical evidence is like a critical factor and 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 wanted to ask you, as you scan the landscape it what are some of the biggest challenges that you've identified when you're looking through the Clinical Outcomes Lens? So that's a really good question Roxy and if I may, let me 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 this problem. Hmmm, in my view, and I'm not sure if they're independent pillars are overlapping then diagrams, but the three parts that I see. Number one 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 of your book on on the challenges and we can talk we'll talk more about that in a minute. But it's the business challenge of becoming a commercial success and it's either an offshoot of that or separate pillars a part of that. Because I 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 Dean of the Jefferson College of population health. He just retired as the founding dean of that, has this great quote. I give them full credit for thice dealer 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 things that will come back and talk about each one of these a little bit more detail, I think. And then the third factor, I think, really is health system work flows. Hmmm, and really defining the roles and responsibilities of healthcare, identifying the challenges that healthcare 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 bridge them together? So that's kind of how I see it. From the business challenge, you know, let's talk about the business challenge aspect of M so there's three parts. I don't know if it's pillars 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 looking for a problem. Yeah, and that's really not the best way to do it and and so that's one issue with the business challenged to become a commercial success. 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 product sort of in isolation, and I think one of the things you need to it's a mind shift with healthcare, because you really have to build it the way clinicians think. Don't have that that way clinicians think. To overlap it with the clinical presentation, again you're going to fall short and you need to be concerned about that. And then finally, is the clinical validation. So again that 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 sum it up as I see it, in terms of the business challenge is that a 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 a health care is looking for is not a...

...product, they're looking for a solution and right you with a product that's not solving that may not be solving my problem, and I really need for you is a proven solution of how do I 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 think a 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 get is show me the data. Because think about it, if you're a new company trying to get traction, no one is going to take a risk on you without clinical data. And you know, I don't mean that it needs to be a large, two thousand patient randomized clinical trial, but you do need to show a pilot to demonstrate that what you're offering really does what you say 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 get informed consent based on what you're really trying to demonstrate with it. But having that at rb piece of paper, I think is very important. Getting the data, analyzing the data, having go no go decisions, identifying the metric you'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. I think some of these can be done in very short periods of time, ninety days of once you start and rolling in getting data. So let's pause for just a moment and talk about that. Like when does an innovator need to develop this and and how much is it? You know, kind of a progressive thing. So you're kind of touching on this, but I want to just pause and kind of drill a little bit deeper into it, because I hear this question all the time. You know, how much much evidence and clinical validation do I have to have before I go to market? How much of it can be a little bit more ambiguous when I'm approaching someone maybe as a partner, and the way I'm going to get that evidence is going to be through that pilot program so let's kind of just talk about when and then what does that look like, because I think you're doing a great job for our listeners kind of framing that is, this is what you might need before you go to market and and it would in this context. Right. We talked about sample size and the type of type of study and then what you would 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're going to go to hell systems and do this, unless you're going to partner with 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 have to have some clinical data to know that. And so, for example, I think it really depends on what the solution really is. So, for example, if you have a predictive algorithm that says I can predict length of stay in the hospital or in the ICU, then and I can. I can. This algorithm will predict Lenk of stay. 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 up. So I have built this algorithm. I pulled back two thousand patients, I analyze their data and I had some engineers build this...

...algorithm. I know what the key components 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 this algorithm, they're going to say, where's your data? Show me that what you actually built has been validated, that it actually works, and so I think that has to happen before you make any sales. So what about the the the structure of that? Does it need to be a certain population, a certain sample size? Is there some specific metrics? Are Markers? Because I think that this is also a really important discussion because there's a lot of pitfalls with this because, you know, most of the people that are the health innovators are not the clinicians. They're not thinking the way you are and you'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 want is them to do these stud these but be missing some key parts of the data to where it was wasted time, wasted money because it's incomplete or it's not what that those potential customers are looking for to actually give them assurance of, you know, patients, safety and efficacy. You know, excellent points. I think that is right. On the mark and one of the biggest problems I see is biting off more than you should show. And I think the first step is this is what we say it does, this is what how this is how we're going to validate that it does what we say it does. Period. That's all you're trying to do. Yeah, I think the other pop don't worry about the other populations. That's growth down the road. Yep, you know. I think how large of a sample size? That's simple to figure out. How much of a sample size you really need? That that's botto. Statisticians can tell you that the sample size you need 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 company that has an algorithm that can predict interventions, interventions somewhere between four to six hours before the intervention of the clinical invention, mctually occurs. They need to do a clinical validation and they're like, well, how do we show that we avoided all these interventions and the first step, because they have not done any clinical validation yet. My response was, you don't need to yet. What you need to do is show when your algorithm goes off a six hours later, there actually is an intervention and if you more them does not go off six hours later, there is no intervention. Right. That's the first step and I going armed with that to say, look, Mr Mr and his health system, this is what we say our algorithm does. This is the data showing that ninety, ninety five percent of the time it actually did identify these patients. Now what we do with it, and that gets to the work closed piece, which is the third pillar. Will Get that matter? Yeah, yeah, it does absolutely, but it, you know, makes me think of another question. So you know. So what you're touching on in my mind is, you know, kind of around this MVP and I know people have different perspectives. You know, they say, Oh, you can't do MVP and healthcare because, you know, patients lives are at risks. And I think it depends on how you're defining 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 or solution, you know, maybe you go to market with a minimal feature set and then you do your studies and your validation on those minimal features and that helps you with the timing, in the financial cost of that and being able to go to market rather than having, you know, twenty or fifty because you think that's going to make it seem more attractive, but then it takes you longer and it cost 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 to it. Gets back to what problem are you trying to solve? And I 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 do the pilot study, you end up with a bunch more questions than you started with. And that's okay, right, that's okay. I give our audience permission that that is okay. Okay, it's okay. You know what you need to survive to be able to address those questions. You know, ploritize them and then figure out which one's really make the best business sense and workflow sense to really go to hmm, Hey, it's Dr Roxy here with a quick break from the conversation. Do you want your innovation to succeed, to change lives, to shape the future of healthcare? I want that for every health innovator, which is why I invented Cyq and evidence based framework to take your innovation from an idea to start up to full market adoption. If you're not sure where you are in the commercialization process, take the free assessment now at Dr Roxycom backslash score. Don't miss out on impacting more lives just because you have a low co IQ score. The Free Assessment is at Dr Roxycom backslash or that's Dr Roxiecom backslash score. And now let's jump back into the conversation. So a lot of folks, you know, sell a technology solution to a health system and walk away. What are some of the biggest challenges that it innovator might have after a sale? So that's the third pillar. HMM, okay, the third pillar is the health system worklow. We can talk about that, but I've got some stuff on the second pillar still. Okay, all right, well, let's do it. which when you are we can go to it. We can go to either one. Listen, you're my guest, your show. Let's you decide. I think one of the other in terms of the clinical outcome, in the clinical validation piece. I think one of the things, as you address what problem I am I really I trying to identify one of you have to ask what are the problems faced by healthcare systems? Yeah, and one of the biggest problems is a simulation and managing clinical presentation. Okay, let's talk more, because data U is 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. So so I've got to gather data from all these dispared systems, gathered from a variety of scattered systems. How do I bring it all together, incorporating my solution that it makes sense to solve the clinicians problem and take care of that patient? Again, I fire in the belly. How do I improve the care of that patient laying in the bed? I'm thinking of the patient laying in the 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 of CPOE systems there's drug drug interactions. Right, as a drug guy, they do they do the drug drug interactions right and and a clinician will get a notification of a drug drug interaction. I...

...read a recent paper. They looked at three million drug interaction notifications. Two point eight million of them, ninety one percent were overwritten. Why? Several reasons. One alert fatigue. I get these things just keep popping up. Could be could be because cause, because the chart is not updated. So in other words, if the patient had renal disease, that would pop up the drug notification. The acute renal failure has resolved itself but it was never taken off the problem list. So the the computer still sees the active and POPs it up a variety of reasons. So the question becomes, how do you fix this? Hmmm, and I think in my opinion, of my opinion, but one one way is to provide patient context to it. So if you have a patient you're on Warfaren 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 looked at dismissals of drug drug interactions, a lot of them. have got to put in a reason why you're dismissing it. The most common reason that the clinicians dismissed drug drug interaction notifications is, yes, I'm aware of it, I gotta Click done. Uh Huh, UH, Huh. Yes, it well, what if, as a clinician, you see on the notification Roxy has a warfare in trimethod for himself, a drug interaction. It's going to increase our ir and her most recent ire from three hours ago was two point eight and and and and in that same script. So now it gives me patient context. I now I don't have to go someplace else to look for it. Right, I have all right there. And what if, on the same screen, I can then say, okay, cancel that order, I want to use, I want to order something else, all from that same patient context screen. So yeah, again. So my point is data presentation. I think as you build your innovative solution, you need to consider data presentation, and it gets into the whole risk ratification, which we can talk 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 twenty patients are all read alerts right well, within ten seconds. I need to be able as a Commissian, what I want to know is who's the number one patient I want to look at, I have to look at. Where do 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 one patient 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 the pride 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 that is affecting the health innovator in their product development phase to make sure that they're taking that in the consideration, or do you see that as something that is really important after the sale and making sure they have an understanding of the environment to make sure that they're getting the outcomes that they hope to get from their solution? Or both? The short answer is it's Pret I think you go out 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 second rule. I have not seen anybody that meets the ten second rule. I have not seen any company out there that and small, medium large companies that meets the ten second rule. And so that's a huge advantage if you can walk into a place and say this is how we were stratified and I can show you the top person you to look at is, and who to look at, where to look and what to look look at. UHM, that's the ten second rule. Tryad to me going in after the fact, because it 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 system workflow, and it gets back to the question you asked earlier. If I have a technology, so I've built I'm a healthcare innovator company. I built this, this thing and I have my clinical validation. I show that I can predict length to stay in these patients. Right here you go. Roxy is as head of a five hospital health system. I would like you to buy this, and you say yes, I'd like to buy it. And we install it in all your five hospitals. Yep, the outcomes, the clinical outcomes, do not automatically transfer from one program to the other simply by adding on technology. Hmmm, he does not happen by simply installing and turning on a switch. You may be more you may be more efficient, but you're not going to be more effective and no one, no one pays you to be efficient at doing the wrong thing. Right, right, right. So, even though you have strong leadership acceptance, even though you have a strong project team and even though you have clinical buy in, these are all good starting points, but alone will not guarantee success. Without going back to the topic of the pillar, which is health system workflows, how do I how do I improve the work for how do I streamline it? One of the biggest problems in healthcare is those frontline collisions are very busy, very very and adding more things for them to do without taking stuff away is not going to help, it's only going to hinder. So I think, yeah, later has to think about what and and again I've seen this happen with companies that 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 three pillars that we've been talking about. Yeah, it's going to say this is how you use it and it may vary from sight to sight. Right, and you have to customize it a little bit. But if you did it right, 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 may do it differently from the third floor, from the ear, from the EEDATE, right, but it might be a little bit differently. But aligning those people and process. That that what I call the clinical transformation change. That's what you really need to have to have it adopted and show the frontline clinician how it's going to make their job easier, not worse. And so simply going to a site, in my opinion,...

...going to a site and say here's the technology, turn it on. Boom, you're going to fail. It might you will fail. Yeah, absolutely, and you know it's so critical. These you know, the health innovators, you know, put their heart and soul in their solution, their innovation, and they're going to market in it's such a win that needs to be celebrated when you get these new customers. But the fact remains is that if those new customers, those early adopters, don't become raving fans, they will not help you move through the adoption 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 talking about, then you're not going to have raving fans. You might have sold a solution that's not being used. You know, call, call, six months 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 the capabilities are and and so what do you suggest to health innovators? You know, what do they need to prepare care for, both financially, like what resources 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 getting the clinical validation to where it be. Can be a sick successful case study for future business. Yeah, so I think you're right. I mean you want these initial sites to be your reference sites. Want to be able to take prospects there and say here, call up sat joe's talk to talk to Dr Roxy and ask her what she thinks of the system, Yep, of our solution. Right. I think you have to have a clinical validation piece before you do that, before you go out. And the other piece that we haven't talked about, which I think is part of this as and and again. So the clinical validation piece, the data presentation piece, the ten second role. But the other piece of this that I think is also important is the reporting piece, and going out without reporting, I think, is an 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 think reporting to be able to assess what that what you say your solution is doing, is actually doing. And part of the reporting is also part of your clinical validation. The metrics that you've identified, and I think of metrics in four big buckets. There's clinical metrics, there's financial metrics, there's operational metrics of how well does it operate within the system, and then their staff and patient satisfaction metrics and as quadutil quadruple aim get to that. I think the question. As you're building your clinical validation, you have to ask you have to go through each one of those and and and have your list and generate 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 transcend multiple categories and then there will be again, don't boil the ocean you want. You got to have your MVP metrics that are really going to get back to. This is the problem. I'm trying to sell that I identified and 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 as you build the solution. One of the...

...questions, if a hell system is going to want is an output reporting. How well are we doing? What's our assessment of this, not only initially but over time, longitudinally. And we all know what happens when a new project starts you and we also know what happens. There's a lot of enthusiasm, there's, especially with positive 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 accelerator, Yep, and so not having the reporting and be able to assess what happens longitudinally with your program to see that it's still working, is also important. As long as we're talking about reporting, let's talk about some other things. What most people think about when we say reporting, assessment of outcomes, is reporting to the sea sweet, the buyers, that this is the results of our solution and our collaboration with you, because it is. It does have to be a partnership and a collaboration, right, but these are the results to the sea sweet. But what I submit is don't forget the frontline clinicians. So you want to report, for lack of a better term, upstream and downstream, and all the times we forget to circle back to the people that are actually doing the work at the front line. Say this is the impact you're having with this solution and we're going to show are you this the third part of it. There's four parts. The third part is I, as a health system, have bought your solution. Now I want to be able to compare my hospital a to hospital. Be To hospital, see the Hospital d 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 the ninety percent hospital a is at. So I need to find where my problem areas not and and and then, in addition, I want to know how does my health system compare? How do my community hospitals compared to other community house with my other competitors in my area? How does my academic sites compared to other academic sites? How does my three hundred bed hospital compared to other three hundred bed housels? I don't want to compare myself to an eight hundred bed hospital, right. And how do I compare geographically, from the northeast to the southwest? How does that compare? None of that happens without a reporting mechanism over time. That you need to to consider. And the final area is I think the reporting that you build into this helps, helps in terms of identifying areas for improvement, areas you're not doing well and for whatever reason, but areas to focus on the future to improve compliance. Yeah, yeah, absolutely. I mean, and that's just really that. That's a fundamental practice, I think, for anything that we do today. Right, you know, design, build, test measure and just for for continuous improvement in so it's interesting to even think about it from the outcomes peace and how important that is. I don't know what your experience has been, but mine is 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 really think 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 little too lean, and in not I think what you're describing is something that's really important to think about even in the development process, right planning for that type of data collection and its segmentation and,...

...you know, presentation to customers as well as to you know, yourself as the innovator, to be able to see how successful it's going. I think that you know, as an Elf health innovator, you know and you're in this startup, you know you typically have limited resources. Yes, and write it, and you've got this window of up the opportunity that you're kind of up against, and so you're kind of thinking of what is it that I have to have? What do I need to spend my money on. And I think the the conversation that we are having today very often, too often gets part of the down the road and and and I think that it becomes a pitfall for success. I agree with you completely. Any and you know, if MVP's a dirty word, I'm sorry, but it's part of MVP and online right, right, right, right, right, exactly. So you know, as we wrap up here, you know there's so many people that are that are listening today that are innovators, that are in the trenches or hospital systems that may be innovating within that are still even internally experience in a lot of the same challenges that we talked about, or they're on the receiving side of this health innovator bringing a solution to them. Is there any other advice that you have for them before we wrap up? Wow, no, to throw more, more kindling on the fire, to stoke it even further. Early on when we when we first started doing the telemedicine for the ICU solution, we could that would sell solely on clinical outcomes. You do it just on clinical outcomes. That environment no longer exists and I think everyone is, hopefully is aware that you have to sell it on clinical and financial outcomes and you have to include the financial component to any project that you do with this. So I if you're not looking at that, I think that would be my last piece of advice. In fact, I just recently saw an article of you know, the big thing in the news these days are how drug companies price their new innovative drugs and absorbit in price for these. Well, I just read an article and and there are some countries in Europe that price it big price their new pharmaceuticals based on quality, quality life years. Gained solution. So the the pricing of 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 lifestyle changes to improve it, you know, will probably have less cost if based on 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 in anything that they consider, especially with the drug aspect of it. So that would be my last piece to advice. Awesome. Well, thank you so much for sharing your wisdom with our listeners today. How can folks get ahold of you if they want to reach out with reach out to you to do any type of follow up connversations. Thanks. Thank you for that. I think the easiest ways on my linkedin profile, ork, on as loan. On My linkedin they will have access to my web page. I also, if you look at my activities, I post a lot of articles. I have a monthly blog newsletter, the they're all posted on linkedin that you can download, readthrow away or subscribe to the to my monthly blog with that as well, or kin. Thank you so...

...much. I feel like you know, we could just have this conversation for days, so we'll have to schedule another episode. There's so much to talk about. Thank you so much. Thank you, hi, thank you so much for listening. I know you're busy working to bring your life changing innovation to market and I value your time and your attention. To save time and get the latest episodes on your mobile device, 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 been sharing the show with friends and colleagues. See You on the next episode of Coiq.

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