2b208d38-e325-4b3a-829a-a6705a9d8504/6-0
00:00:03.336 --> 00:00:05.739
Goldman,
an associate professor at Northwell

2b208d38-e325-4b3a-829a-a6705a9d8504/6-1
00:00:05.739 --> 00:00:10.063
Health at the Donald and Barbara Zucker
School of Medicine at Hofstra Northwell,

2b208d38-e325-4b3a-829a-a6705a9d8504/6-2
00:00:10.063 --> 00:00:14.440
and the Program Director of Reproductive
Endocrinology and Infertility Fellowship

2b208d38-e325-4b3a-829a-a6705a9d8504/6-3
00:00:14.440 --> 00:00:18.016
again at Northwell. Randy,
thank you so much for joining us today.

2b208d38-e325-4b3a-829a-a6705a9d8504/5-0
00:00:18.256 --> 00:00:19.936
Thank you so much, Jordan.
It's great to be here.

2b208d38-e325-4b3a-829a-a6705a9d8504/8-0
00:00:20.496 --> 00:00:23.902
So for our listeners,
Northwall Health is a health system

2b208d38-e325-4b3a-829a-a6705a9d8504/8-1
00:00:23.902 --> 00:00:26.839
headquartered in New Hyde Park, New York,
with 8,

2b208d38-e325-4b3a-829a-a6705a9d8504/8-2
00:00:26.839 --> 00:00:30.773
000 beds in 29 hospitals serviced by 16,
000 providers. So, Randy,

2b208d38-e325-4b3a-829a-a6705a9d8504/8-3
00:00:30.773 --> 00:00:35.412
today we're going to be speaking about
the role that data plays in enabling or

2b208d38-e325-4b3a-829a-a6705a9d8504/8-4
00:00:35.412 --> 00:00:40.286
inhibiting the proper balance of quality
of care with patient access and a variety

2b208d38-e325-4b3a-829a-a6705a9d8504/8-5
00:00:40.286 --> 00:00:42.576
of other topics. But let's start there.

2b208d38-e325-4b3a-829a-a6705a9d8504/9-0
00:00:42.896 --> 00:00:47.917
What's the role of data in your daily job
and what are some projects you're working

2b208d38-e325-4b3a-829a-a6705a9d8504/9-1
00:00:47.917 --> 00:00:48.096
on?

2b208d38-e325-4b3a-829a-a6705a9d8504/13-0
00:00:48.816 --> 00:00:53.893
I am a huge proponent of data-driven care.
And as the program director for our

2b208d38-e325-4b3a-829a-a6705a9d8504/10-0
00:00:52.376 --> 00:00:52.896
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/13-1
00:00:53.893 --> 00:00:57.363
fellowship,
I speak about evidence-based medicine and

2b208d38-e325-4b3a-829a-a6705a9d8504/13-2
00:00:57.363 --> 00:01:02.760
using data in every decision that we make,
right? If it's not grounded in evidence,

2b208d38-e325-4b3a-829a-a6705a9d8504/11-0
00:01:01.056 --> 00:01:01.216
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/13-3
00:01:02.760 --> 00:01:06.038
then it probably doesn't deserve to be
prime time.

2b208d38-e325-4b3a-829a-a6705a9d8504/12-0
00:01:05.656 --> 00:01:06.256
Mm-hmm.

2b208d38-e325-4b3a-829a-a6705a9d8504/13-4
00:01:06.038 --> 00:01:08.736
So a couple of things that I'm working on.

2b208d38-e325-4b3a-829a-a6705a9d8504/16-0
00:01:09.056 --> 00:01:14.841
are helping cancer patients to sort of
get through the door and identifying the

2b208d38-e325-4b3a-829a-a6705a9d8504/16-1
00:01:14.841 --> 00:01:20.769
need for cancer patients who should or
might want to undergo fertility treatment.

2b208d38-e325-4b3a-829a-a6705a9d8504/16-2
00:01:20.769 --> 00:01:25.758
And then on a similar vein,
identifying patients who are at risk for

2b208d38-e325-4b3a-829a-a6705a9d8504/15-0
00:01:20.936 --> 00:01:21.536
Mm-hmm.

2b208d38-e325-4b3a-829a-a6705a9d8504/16-3
00:01:25.758 --> 00:01:30.096
fertility issues in other ways,
for example, endometriosis.

2b208d38-e325-4b3a-829a-a6705a9d8504/17-0
00:01:30.456 --> 00:01:36.738
where we use the data to identify a clear
gap and need and use that data to design

2b208d38-e325-4b3a-829a-a6705a9d8504/17-1
00:01:36.738 --> 00:01:43.020
systems to get patients through the door
efficiently and to get them the care that

2b208d38-e325-4b3a-829a-a6705a9d8504/17-2
00:01:43.020 --> 00:01:43.776
they need.

2b208d38-e325-4b3a-829a-a6705a9d8504/18-0
00:01:44.576 --> 00:01:47.668
So let's tackle those one by one.
So clinical work,

2b208d38-e325-4b3a-829a-a6705a9d8504/18-1
00:01:47.668 --> 00:01:50.819
accessing fertility care among patients
with cancer,

2b208d38-e325-4b3a-829a-a6705a9d8504/18-2
00:01:50.819 --> 00:01:55.337
what are some of the problems these
patients are facing and how to use data

2b208d38-e325-4b3a-829a-a6705a9d8504/18-3
00:01:55.337 --> 00:01:57.536
to improve access for these patients?

2b208d38-e325-4b3a-829a-a6705a9d8504/20-0
00:01:58.256 --> 00:02:02.938
So Northwell is, as you know, a very,
very large health system.

2b208d38-e325-4b3a-829a-a6705a9d8504/20-1
00:02:02.938 --> 00:02:07.986
And in the last year alone,
I think there have been somewhere around

2b208d38-e325-4b3a-829a-a6705a9d8504/19-0
00:02:03.136 --> 00:02:03.616
Mmh.

2b208d38-e325-4b3a-829a-a6705a9d8504/20-2
00:02:07.986 --> 00:02:11.131
19,
000 cancer patients that Northwell has

2b208d38-e325-4b3a-829a-a6705a9d8504/20-3
00:02:11.131 --> 00:02:15.301
treated. And, you know,
a lot of people don't know this,

2b208d38-e325-4b3a-829a-a6705a9d8504/20-4
00:02:15.301 --> 00:02:17.056
but cancer treatment has

2b208d38-e325-4b3a-829a-a6705a9d8504/21-0
00:02:17.176 --> 00:02:20.766
an enormous potential to threaten
fertility. So in other words,

2b208d38-e325-4b3a-829a-a6705a9d8504/21-1
00:02:20.766 --> 00:02:25.421
the very same chemotherapy treatment that
can save your life can potentially cause

2b208d38-e325-4b3a-829a-a6705a9d8504/21-2
00:02:25.421 --> 00:02:27.776
permanent infertility, right? So there is.

2b208d38-e325-4b3a-829a-a6705a9d8504/22-0
00:02:26.816 --> 00:02:31.146
Right. So for our listeners,
basically any kind of chemotherapy that

2b208d38-e325-4b3a-829a-a6705a9d8504/22-1
00:02:31.146 --> 00:02:35.914
kills rapidly growing cells like hair
also kills rapidly growing cells like

2b208d38-e325-4b3a-829a-a6705a9d8504/22-2
00:02:35.914 --> 00:02:36.416
embryos.

2b208d38-e325-4b3a-829a-a6705a9d8504/25-0
00:02:36.736 --> 00:02:41.657
Exactly, like eggs and sperm.
That's exactly right. And, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/23-0
00:02:38.616 --> 00:02:39.136
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/25-1
00:02:41.657 --> 00:02:45.622
thankfully,
our cancer treatments are getting better.

2b208d38-e325-4b3a-829a-a6705a9d8504/25-2
00:02:45.622 --> 00:02:49.734
So, you know,
the data says that the five-year survival

2b208d38-e325-4b3a-829a-a6705a9d8504/24-0
00:02:48.856 --> 00:02:48.976
Sam.

2b208d38-e325-4b3a-829a-a6705a9d8504/25-3
00:02:49.734 --> 00:02:54.581
rate for women of reproductive age is
upwards of about 85 or 90%.

2b208d38-e325-4b3a-829a-a6705a9d8504/25-4
00:02:54.581 --> 00:02:55.976
That is incredible.

2b208d38-e325-4b3a-829a-a6705a9d8504/26-0
00:02:56.096 --> 00:02:58.822
right?
That means that the vast majority of

2b208d38-e325-4b3a-829a-a6705a9d8504/26-1
00:02:58.822 --> 00:03:03.716
young people with cancer are going to
survive. And that's an incredible thing.

2b208d38-e325-4b3a-829a-a6705a9d8504/26-2
00:03:03.716 --> 00:03:06.256
Survivorship is increasing because our...

2b208d38-e325-4b3a-829a-a6705a9d8504/27-0
00:03:05.616 --> 00:03:08.176
And that's across all types of cancer.

2b208d38-e325-4b3a-829a-a6705a9d8504/29-0
00:03:08.496 --> 00:03:13.059
Yeah, you know, of course, some, you know,
cancers have more effective treatments

2b208d38-e325-4b3a-829a-a6705a9d8504/29-1
00:03:13.059 --> 00:03:16.398
than others. And that's, you know,
a whole other, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/29-2
00:03:16.398 --> 00:03:19.513
a whole other topic.
And I think we need to, of course,

2b208d38-e325-4b3a-829a-a6705a9d8504/28-0
00:03:19.376 --> 00:03:19.616
Mm.

2b208d38-e325-4b3a-829a-a6705a9d8504/29-3
00:03:19.513 --> 00:03:24.132
our cancer treatments do need to continue
to improve as I'm sure that they will as

2b208d38-e325-4b3a-829a-a6705a9d8504/29-4
00:03:24.132 --> 00:03:27.136
our technology advances.
But where that leaves you is

2b208d38-e325-4b3a-829a-a6705a9d8504/32-0
00:03:27.456 --> 00:03:31.453
you know, this gap.
Whereas people are now thinking beyond

2b208d38-e325-4b3a-829a-a6705a9d8504/32-1
00:03:31.453 --> 00:03:35.450
the immediate sort of survivorship phase
to down the road,

2b208d38-e325-4b3a-829a-a6705a9d8504/32-2
00:03:35.450 --> 00:03:40.057
where they might decide that a new
priority is potentially having a

2b208d38-e325-4b3a-829a-a6705a9d8504/32-3
00:03:40.057 --> 00:03:44.799
biological child or a biological family.
And of course, there's many,

2b208d38-e325-4b3a-829a-a6705a9d8504/32-4
00:03:44.799 --> 00:03:47.576
many ways to build a family. But there is

2b208d38-e325-4b3a-829a-a6705a9d8504/30-0
00:03:45.856 --> 00:03:46.496
Mm-hmm.

2b208d38-e325-4b3a-829a-a6705a9d8504/34-0
00:03:47.696 --> 00:03:51.272
you know, there is a gap there.
And for several reasons,

2b208d38-e325-4b3a-829a-a6705a9d8504/31-0
00:03:49.136 --> 00:03:49.616
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/34-1
00:03:51.272 --> 00:03:55.538
one of the things that we noted as a
large gap is that in order to,

2b208d38-e325-4b3a-829a-a6705a9d8504/34-2
00:03:55.538 --> 00:04:00.744
in order to do what's called egg freezing,
which you might have heard about in the

2b208d38-e325-4b3a-829a-a6705a9d8504/34-3
00:04:00.744 --> 00:04:04.320
social media, you know,
people do elective egg freezing,

2b208d38-e325-4b3a-829a-a6705a9d8504/33-0
00:04:03.296 --> 00:04:03.616
Mum.

2b208d38-e325-4b3a-829a-a6705a9d8504/34-4
00:04:04.320 --> 00:04:07.456
very similar process for medical
indications like

2b208d38-e325-4b3a-829a-a6705a9d8504/38-0
00:04:07.536 --> 00:04:12.286
like cancer treatment.
In order to effectively have an egg

2b208d38-e325-4b3a-829a-a6705a9d8504/38-1
00:04:12.286 --> 00:04:16.392
freezing cycle,
a person has to be entered puberty

2b208d38-e325-4b3a-829a-a6705a9d8504/35-0
00:04:13.936 --> 00:04:14.096
Mm.

2b208d38-e325-4b3a-829a-a6705a9d8504/38-2
00:04:16.392 --> 00:04:21.947
already. You know, their whole brain,
ovarian axis has to be active.

2b208d38-e325-4b3a-829a-a6705a9d8504/36-0
00:04:21.376 --> 00:04:21.856
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/38-3
00:04:21.947 --> 00:04:26.696
And for young girls with cancer,
their axis is not active.

2b208d38-e325-4b3a-829a-a6705a9d8504/40-0
00:04:27.136 --> 00:04:32.133
So there was an enormous gap that we
noted when looking at the data in people

2b208d38-e325-4b3a-829a-a6705a9d8504/37-0
00:04:27.176 --> 00:04:27.656
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/40-1
00:04:32.133 --> 00:04:35.593
who were not able to get fertility
preservation care.

2b208d38-e325-4b3a-829a-a6705a9d8504/40-2
00:04:35.593 --> 00:04:40.590
There is no other program on Long Island
that offers something called ovarian

2b208d38-e325-4b3a-829a-a6705a9d8504/39-0
00:04:35.856 --> 00:04:36.496
Mm-hmm.

2b208d38-e325-4b3a-829a-a6705a9d8504/40-3
00:04:40.590 --> 00:04:43.536
tissue freezing,
where you can take an ovary,

2b208d38-e325-4b3a-829a-a6705a9d8504/44-0
00:04:44.816 --> 00:04:48.875
remove it from the body,
cut it into strips, and then freeze it.

2b208d38-e325-4b3a-829a-a6705a9d8504/41-0
00:04:46.216 --> 00:04:46.696
Mmh.

2b208d38-e325-4b3a-829a-a6705a9d8504/44-1
00:04:48.875 --> 00:04:52.872
So that in the future,
if that person has infertility and wants

2b208d38-e325-4b3a-829a-a6705a9d8504/42-0
00:04:49.336 --> 00:04:49.816
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/44-2
00:04:52.872 --> 00:04:57.118
to have a biological child,
you can actually put the ovarian tissue

2b208d38-e325-4b3a-829a-a6705a9d8504/44-3
00:04:57.118 --> 00:05:01.239
strips back into the body.
And that person can then try to have a

2b208d38-e325-4b3a-829a-a6705a9d8504/44-4
00:05:01.239 --> 00:05:04.736
biological child.
It's really an incredible technology.

2b208d38-e325-4b3a-829a-a6705a9d8504/45-0
00:05:05.056 --> 00:05:10.044
and filled a major gap in oncofertility
care. And I'm very,

2b208d38-e325-4b3a-829a-a6705a9d8504/43-0
00:05:05.136 --> 00:05:05.456
Huh.

2b208d38-e325-4b3a-829a-a6705a9d8504/45-1
00:05:10.044 --> 00:05:14.949
very happy to report that the program
opened last October,

2b208d38-e325-4b3a-829a-a6705a9d8504/45-2
00:05:14.949 --> 00:05:21.599
and we have now had seven patients come
through who have had successful ovarian

2b208d38-e325-4b3a-829a-a6705a9d8504/45-3
00:05:21.599 --> 00:05:24.176
tissue preservation procedures.

2b208d38-e325-4b3a-829a-a6705a9d8504/46-0
00:05:24.416 --> 00:05:27.188
And, you know,
something that we're quite proud of and

2b208d38-e325-4b3a-829a-a6705a9d8504/46-1
00:05:27.188 --> 00:05:29.456
really filled a major gap in fertility
care.

2b208d38-e325-4b3a-829a-a6705a9d8504/49-0
00:05:30.176 --> 00:05:33.112
Got it.
And so I know that one of the topics

2b208d38-e325-4b3a-829a-a6705a9d8504/49-1
00:05:33.112 --> 00:05:38.526
we're covering today is balancing quality
of care with patient access and how data

2b208d38-e325-4b3a-829a-a6705a9d8504/49-2
00:05:38.526 --> 00:05:42.766
is helping drive this care.
So it seems like a really innovative

2b208d38-e325-4b3a-829a-a6705a9d8504/49-3
00:05:42.766 --> 00:05:46.027
procedure.
You're having parents give consent for

2b208d38-e325-4b3a-829a-a6705a9d8504/47-0
00:05:45.056 --> 00:05:45.536
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/49-4
00:05:46.027 --> 00:05:51.376
six-year-old girls who may want to have a
kid in 20 years to undergo a procedure.

2b208d38-e325-4b3a-829a-a6705a9d8504/48-0
00:05:49.936 --> 00:05:50.336
Yep.

2b208d38-e325-4b3a-829a-a6705a9d8504/50-0
00:05:51.776 --> 00:05:56.691
Lots of interesting hypotheticals,
but how is what's the role that data is

2b208d38-e325-4b3a-829a-a6705a9d8504/50-1
00:05:56.691 --> 00:05:58.656
playing in this whole process?

2b208d38-e325-4b3a-829a-a6705a9d8504/53-0
00:05:59.536 --> 00:06:02.128
Well,
I think it's important not to

2b208d38-e325-4b3a-829a-a6705a9d8504/53-1
00:06:02.128 --> 00:06:06.088
over-promise, right?
So what do we know with the data?

2b208d38-e325-4b3a-829a-a6705a9d8504/51-0
00:06:02.896 --> 00:06:03.376
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/53-2
00:06:06.088 --> 00:06:11.200
We know that there have been about 300
live births worldwide from this

2b208d38-e325-4b3a-829a-a6705a9d8504/53-3
00:06:11.200 --> 00:06:14.800
technology.
What we don't know is really what the

2b208d38-e325-4b3a-829a-a6705a9d8504/52-0
00:06:11.296 --> 00:06:11.696
Huh.

2b208d38-e325-4b3a-829a-a6705a9d8504/53-4
00:06:14.800 --> 00:06:18.256
denominator is. In other words,
how many people

2b208d38-e325-4b3a-829a-a6705a9d8504/56-0
00:06:18.496 --> 00:06:23.396
have come through in when they are older
and want to have that ovarian tissue go

2b208d38-e325-4b3a-829a-a6705a9d8504/56-1
00:06:23.396 --> 00:06:28.114
back and have been successful with it.
And I think when you look at the data,

2b208d38-e325-4b3a-829a-a6705a9d8504/56-2
00:06:28.114 --> 00:06:31.682
it's really important to critically think
about it, right?

2b208d38-e325-4b3a-829a-a6705a9d8504/56-3
00:06:31.682 --> 00:06:35.311
A lot of people are not publishing their
negative outcomes.

2b208d38-e325-4b3a-829a-a6705a9d8504/56-4
00:06:35.311 --> 00:06:38.456
More people are publishing their positive
outcomes.

2b208d38-e325-4b3a-829a-a6705a9d8504/54-0
00:06:35.336 --> 00:06:35.816
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/55-0
00:06:38.656 --> 00:06:39.256
Mm-hmm.

2b208d38-e325-4b3a-829a-a6705a9d8504/59-0
00:06:38.976 --> 00:06:43.951
So it can in some ways overestimate the
likelihood of success when you put that

2b208d38-e325-4b3a-829a-a6705a9d8504/59-1
00:06:43.951 --> 00:06:48.118
back in the future. So that, I think,
comes to the quality, right?

2b208d38-e325-4b3a-829a-a6705a9d8504/57-0
00:06:47.056 --> 00:06:48.456
Yeah, and so...

2b208d38-e325-4b3a-829a-a6705a9d8504/59-2
00:06:48.118 --> 00:06:53.030
You need to be really honest with people
who are making a major decision about

2b208d38-e325-4b3a-829a-a6705a9d8504/59-3
00:06:53.030 --> 00:06:53.776
their child.

2b208d38-e325-4b3a-829a-a6705a9d8504/58-0
00:06:53.056 --> 00:06:53.536
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/61-0
00:06:54.656 --> 00:06:58.835
All right,
and then let's pivot to the other example

2b208d38-e325-4b3a-829a-a6705a9d8504/61-1
00:06:58.835 --> 00:07:03.092
you mentioned.
I think you said at-risk fertility for

2b208d38-e325-4b3a-829a-a6705a9d8504/61-2
00:07:03.092 --> 00:07:08.453
endometriosis, is that right?
So how are you using data to identify

2b208d38-e325-4b3a-829a-a6705a9d8504/60-0
00:07:03.136 --> 00:07:04.176
Yeah, yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/61-3
00:07:08.453 --> 00:07:10.896
gaps in care for that scenario?

2b208d38-e325-4b3a-829a-a6705a9d8504/64-0
00:07:11.616 --> 00:07:15.456
So for endometriosis,
for people who don't know,

2b208d38-e325-4b3a-829a-a6705a9d8504/64-1
00:07:15.456 --> 00:07:20.785
it's a disease that can affect
reproductive age women that causes a

2b208d38-e325-4b3a-829a-a6705a9d8504/64-2
00:07:20.785 --> 00:07:27.132
likelihood of infertility of about 50%.
And we kind of looked large scale at our

2b208d38-e325-4b3a-829a-a6705a9d8504/62-0
00:07:22.936 --> 00:07:23.216
Mm.

2b208d38-e325-4b3a-829a-a6705a9d8504/64-3
00:07:27.132 --> 00:07:30.736
community, right? In Nassau County,
there are

2b208d38-e325-4b3a-829a-a6705a9d8504/63-0
00:07:28.216 --> 00:07:28.336
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/67-0
00:07:30.976 --> 00:07:36.172
figure about a little over a million
people right in Nassau County.

2b208d38-e325-4b3a-829a-a6705a9d8504/65-0
00:07:33.336 --> 00:07:33.936
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/67-1
00:07:36.172 --> 00:07:42.132
About half of them are going to be are
women, about half of reproductive age.

2b208d38-e325-4b3a-829a-a6705a9d8504/66-0
00:07:37.536 --> 00:07:38.176
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/67-2
00:07:42.132 --> 00:07:47.633
And so that represents about 6,
000 or so women who are likely going to

2b208d38-e325-4b3a-829a-a6705a9d8504/67-3
00:07:47.633 --> 00:07:49.696
have endometriosis that are

2b208d38-e325-4b3a-829a-a6705a9d8504/68-0
00:07:49.856 --> 00:07:52.176
Around us, right? That's something that's.

2b208d38-e325-4b3a-829a-a6705a9d8504/69-0
00:07:50.976 --> 00:07:56.176
So over a quarter million reproductive
age women, 6,000 may have this condition.

2b208d38-e325-4b3a-829a-a6705a9d8504/74-0
00:07:56.416 --> 00:08:00.227
about a million people in Nassau County,
50% women, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/70-0
00:07:58.976 --> 00:07:59.296
Huh.

2b208d38-e325-4b3a-829a-a6705a9d8504/74-1
00:08:00.227 --> 00:08:04.836
about 5% incidence of endometriosis.
There's somewhere around a six end of

2b208d38-e325-4b3a-829a-a6705a9d8504/71-0
00:08:03.536 --> 00:08:04.576
Ohh, got it.

2b208d38-e325-4b3a-829a-a6705a9d8504/74-2
00:08:04.836 --> 00:08:08.032
about 6000 people with endometriosis. So,
you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/72-0
00:08:06.976 --> 00:08:07.456
Got it.

2b208d38-e325-4b3a-829a-a6705a9d8504/74-3
00:08:08.032 --> 00:08:11.105
we used those numbers and that data to
say, okay,

2b208d38-e325-4b3a-829a-a6705a9d8504/74-4
00:08:11.105 --> 00:08:15.776
we know that there should be about,
you know, this number of people who are

2b208d38-e325-4b3a-829a-a6705a9d8504/76-0
00:08:16.056 --> 00:08:19.763
treated at our system,
at our health system, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/73-0
00:08:16.576 --> 00:08:16.696
Right.

2b208d38-e325-4b3a-829a-a6705a9d8504/76-1
00:08:19.763 --> 00:08:23.672
looking at the,
like the market share that we have in the

2b208d38-e325-4b3a-829a-a6705a9d8504/76-2
00:08:23.672 --> 00:08:27.378
area and say, okay,
this number of patients, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/76-3
00:08:27.378 --> 00:08:30.950
has endometriosis.
How do you access those patients?

2b208d38-e325-4b3a-829a-a6705a9d8504/76-4
00:08:30.950 --> 00:08:34.319
How do you,
how do you use our technology and our

2b208d38-e325-4b3a-829a-a6705a9d8504/76-5
00:08:34.319 --> 00:08:34.656
data?

2b208d38-e325-4b3a-829a-a6705a9d8504/75-0
00:08:34.816 --> 00:08:35.376
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/78-0
00:08:34.896 --> 00:08:38.628
to say, you know, there are these,
this number of people,

2b208d38-e325-4b3a-829a-a6705a9d8504/78-1
00:08:38.628 --> 00:08:42.809
and we know that there's a threat to
fertility for these people.

2b208d38-e325-4b3a-829a-a6705a9d8504/77-0
00:08:38.776 --> 00:08:39.256
Mmh.

2b208d38-e325-4b3a-829a-a6705a9d8504/78-2
00:08:42.809 --> 00:08:47.698
How do you build a system using that data,
using the numbers that you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/78-3
00:08:47.698 --> 00:08:52.973
to get those patients through the door?
And so we got some grant funding to build

2b208d38-e325-4b3a-829a-a6705a9d8504/78-4
00:08:52.973 --> 00:08:53.616
a program.

2b208d38-e325-4b3a-829a-a6705a9d8504/81-0
00:08:53.936 --> 00:08:56.902
where based on diagnosis,
like using the technology,

2b208d38-e325-4b3a-829a-a6705a9d8504/81-1
00:08:56.902 --> 00:09:00.316
using diagnosis codes,
identify those patients who otherwise

2b208d38-e325-4b3a-829a-a6705a9d8504/81-2
00:09:00.316 --> 00:09:03.282
might not have been counseled about their
fertility,

2b208d38-e325-4b3a-829a-a6705a9d8504/81-3
00:09:03.282 --> 00:09:07.591
speak with their providers first so that
you're not immediately just kind of

2b208d38-e325-4b3a-829a-a6705a9d8504/79-0
00:09:06.296 --> 00:09:06.776
Mmh.

2b208d38-e325-4b3a-829a-a6705a9d8504/81-4
00:09:07.591 --> 00:09:10.837
reaching out to them and say, hey,
you know, as you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/81-5
00:09:10.837 --> 00:09:13.971
endometriosis can permanently impact
fertility as well.

2b208d38-e325-4b3a-829a-a6705a9d8504/81-6
00:09:13.971 --> 00:09:17.216
About half of people with endometriosis
have infertility.

2b208d38-e325-4b3a-829a-a6705a9d8504/80-0
00:09:17.776 --> 00:09:18.016
Mm.

2b208d38-e325-4b3a-829a-a6705a9d8504/82-0
00:09:17.776 --> 00:09:21.068
How do you build that infrastructure
based on that data to get those patients

2b208d38-e325-4b3a-829a-a6705a9d8504/82-1
00:09:21.068 --> 00:09:23.136
through the door?
We built a navigation program.

2b208d38-e325-4b3a-829a-a6705a9d8504/83-0
00:09:23.616 --> 00:09:24.096
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/85-0
00:09:24.336 --> 00:09:27.663
right? And that's really important.
We built a system,

2b208d38-e325-4b3a-829a-a6705a9d8504/85-1
00:09:27.663 --> 00:09:31.716
an easily navigable system for providers
to get their patients in.

2b208d38-e325-4b3a-829a-a6705a9d8504/85-2
00:09:31.716 --> 00:09:36.253
We use nurse practitioners largely to
kind of initially reach out to those

2b208d38-e325-4b3a-829a-a6705a9d8504/85-3
00:09:36.253 --> 00:09:39.277
patients,
kind of counsel them a little bit about

2b208d38-e325-4b3a-829a-a6705a9d8504/85-4
00:09:39.277 --> 00:09:42.120
fertility,
at the same time have the financial

2b208d38-e325-4b3a-829a-a6705a9d8504/85-5
00:09:42.120 --> 00:09:44.176
conversation because the financial

2b208d38-e325-4b3a-829a-a6705a9d8504/84-0
00:09:42.776 --> 00:09:42.936
Huh.

2b208d38-e325-4b3a-829a-a6705a9d8504/87-0
00:09:44.496 --> 00:09:47.093
part of fertility is oftentimes the major
barrier.

2b208d38-e325-4b3a-829a-a6705a9d8504/87-1
00:09:47.093 --> 00:09:49.638
And then I think equally important is,
of course,

2b208d38-e325-4b3a-829a-a6705a9d8504/87-2
00:09:49.638 --> 00:09:53.456
getting the patients through the door,
but then tracking your outcomes and

2b208d38-e325-4b3a-829a-a6705a9d8504/87-3
00:09:53.456 --> 00:09:56.867
creating that data, right?
Whenever you read something clinically,

2b208d38-e325-4b3a-829a-a6705a9d8504/87-4
00:09:56.867 --> 00:09:59.667
there's always like, oh,
but we need more data, right?

2b208d38-e325-4b3a-829a-a6705a9d8504/87-5
00:09:59.667 --> 00:10:02.518
You make the data, right?
You're seeing those patients,

2b208d38-e325-4b3a-829a-a6705a9d8504/86-0
00:10:00.136 --> 00:10:00.776
Mm-hmm.

2b208d38-e325-4b3a-829a-a6705a9d8504/87-6
00:10:02.518 --> 00:10:05.216
you're looking at those outcomes,
you're evaluating.

2b208d38-e325-4b3a-829a-a6705a9d8504/89-0
00:10:05.536 --> 00:10:09.229
the patient experience, you know,
were you happy with this?

2b208d38-e325-4b3a-829a-a6705a9d8504/89-1
00:10:09.229 --> 00:10:12.798
What could you do better?
And you build things. You know,

2b208d38-e325-4b3a-829a-a6705a9d8504/89-2
00:10:12.798 --> 00:10:16.736
things are not static.
They have the ability to grow and evolve

2b208d38-e325-4b3a-829a-a6705a9d8504/88-0
00:10:15.456 --> 00:10:15.896
Sh.

2b208d38-e325-4b3a-829a-a6705a9d8504/89-3
00:10:16.736 --> 00:10:19.936
over time.
And so we are creating the opportunities

2b208d38-e325-4b3a-829a-a6705a9d8504/89-4
00:10:19.936 --> 00:10:23.136
for that data-driven research that
everybody wants.

2b208d38-e325-4b3a-829a-a6705a9d8504/91-0
00:10:23.696 --> 00:10:26.776
So it sounds like you have a few data
challenges.

2b208d38-e325-4b3a-829a-a6705a9d8504/91-1
00:10:26.776 --> 00:10:31.150
One is identifying the appropriate
population and your data source for

2b208d38-e325-4b3a-829a-a6705a9d8504/91-2
00:10:31.150 --> 00:10:35.831
finding these patients is within the
electronic health record at Northwell.

2b208d38-e325-4b3a-829a-a6705a9d8504/91-3
00:10:35.831 --> 00:10:36.816
Is that correct?

2b208d38-e325-4b3a-829a-a6705a9d8504/90-0
00:10:36.976 --> 00:10:38.096
Yeah, yep.

2b208d38-e325-4b3a-829a-a6705a9d8504/93-0
00:10:37.696 --> 00:10:42.316
Are there any other data sources that
you've been trying to access that may

2b208d38-e325-4b3a-829a-a6705a9d8504/93-1
00:10:42.316 --> 00:10:47.056
help narrow down the field and identify
the correct people at the right time?

2b208d38-e325-4b3a-829a-a6705a9d8504/95-0
00:10:47.776 --> 00:10:50.850
Yeah, so we, you know,
speak about this often.

2b208d38-e325-4b3a-829a-a6705a9d8504/95-1
00:10:50.850 --> 00:10:55.951
And so patients are able to essentially
self-select into the program as well.

2b208d38-e325-4b3a-829a-a6705a9d8504/95-2
00:10:55.951 --> 00:10:59.940
So patients themselves can say, oh,
I heard about, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/95-3
00:10:59.940 --> 00:11:05.237
the endometriosis program at Northwell.
I would like to be a patient within this

2b208d38-e325-4b3a-829a-a6705a9d8504/94-0
00:11:01.776 --> 00:11:02.336
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/95-4
00:11:05.237 --> 00:11:07.656
program. So there's that as well. And

2b208d38-e325-4b3a-829a-a6705a9d8504/97-0
00:11:07.776 --> 00:11:12.390
providers who also know about it can sort
of bypassing anything else electronically

2b208d38-e325-4b3a-829a-a6705a9d8504/97-1
00:11:12.390 --> 00:11:15.136
can also get their patients in the door
that way.

2b208d38-e325-4b3a-829a-a6705a9d8504/99-0
00:11:15.536 --> 00:11:20.151
So it sounds like if a patient
self-selects and they hear through some

2b208d38-e325-4b3a-829a-a6705a9d8504/98-0
00:11:18.816 --> 00:11:19.296
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/99-1
00:11:20.151 --> 00:11:24.311
marketing, maybe there's a billboard,
maybe there's a radio ad,

2b208d38-e325-4b3a-829a-a6705a9d8504/99-2
00:11:24.311 --> 00:11:28.471
and they reach out to Northwell,
I guess it goes into your CRM,

2b208d38-e325-4b3a-829a-a6705a9d8504/99-3
00:11:28.471 --> 00:11:33.281
maybe it's Salesforce or something,
your customer relationship management

2b208d38-e325-4b3a-829a-a6705a9d8504/99-4
00:11:33.281 --> 00:11:36.466
portal.
And then how do you access that CRM data

2b208d38-e325-4b3a-829a-a6705a9d8504/99-5
00:11:36.466 --> 00:11:37.376
and conjoin it

2b208d38-e325-4b3a-829a-a6705a9d8504/100-0
00:11:37.616 --> 00:11:42.173
with the electronic health record so that
you're able to make sure that you have

2b208d38-e325-4b3a-829a-a6705a9d8504/100-1
00:11:42.173 --> 00:11:46.673
one standard view of the whole possible
patient population so you don't hit the

2b208d38-e325-4b3a-829a-a6705a9d8504/100-2
00:11:46.673 --> 00:11:50.216
same person different times with
different outreach campaigns.

2b208d38-e325-4b3a-829a-a6705a9d8504/104-0
00:11:49.696 --> 00:11:52.349
That is a great, great question. So,
you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/104-1
00:11:52.349 --> 00:11:55.791
how do you make it so that the patients
are not kind of, oh,

2b208d38-e325-4b3a-829a-a6705a9d8504/101-0
00:11:52.656 --> 00:11:53.136
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/104-2
00:11:55.791 --> 00:11:59.854
I've already seen this person.
You can actually do that on the back end

2b208d38-e325-4b3a-829a-a6705a9d8504/102-0
00:11:58.896 --> 00:11:59.376
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/104-3
00:11:59.854 --> 00:12:02.393
too.
So you can see if a patient has already

2b208d38-e325-4b3a-829a-a6705a9d8504/104-4
00:12:02.393 --> 00:12:05.779
seen a fertility doctor within the last,
pick a time frame,

2b208d38-e325-4b3a-829a-a6705a9d8504/103-0
00:12:04.416 --> 00:12:04.656
Okay.

2b208d38-e325-4b3a-829a-a6705a9d8504/104-5
00:12:05.779 --> 00:12:08.656
like three to five years. And then,
you know, that

2b208d38-e325-4b3a-829a-a6705a9d8504/107-0
00:12:08.736 --> 00:12:12.605
It doesn't even make it past that point.
You know, but of course,

2b208d38-e325-4b3a-829a-a6705a9d8504/105-0
00:12:11.576 --> 00:12:12.096
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/107-1
00:12:12.605 --> 00:12:16.826
the patient might have previously seen a
fertility Dr. three years ago,

2b208d38-e325-4b3a-829a-a6705a9d8504/107-2
00:12:16.826 --> 00:12:20.402
then is diagnosed with endometriosis and
wants to come back.

2b208d38-e325-4b3a-829a-a6705a9d8504/107-3
00:12:20.402 --> 00:12:24.622
So it's not a perfect system,
but there are ways to kind of look on the

2b208d38-e325-4b3a-829a-a6705a9d8504/107-4
00:12:24.622 --> 00:12:28.256
back end to see if they've already seen a
fertility provider.

2b208d38-e325-4b3a-829a-a6705a9d8504/106-0
00:12:28.736 --> 00:12:29.136
Right.

2b208d38-e325-4b3a-829a-a6705a9d8504/108-0
00:12:28.896 --> 00:12:32.735
But it's certainly not perfect and is
also very new.

2b208d38-e325-4b3a-829a-a6705a9d8504/108-1
00:12:32.735 --> 00:12:35.776
So it will be a work in progress for sure.

2b208d38-e325-4b3a-829a-a6705a9d8504/113-0
00:12:35.616 --> 00:12:40.981
And how are you planning on tracking
outcomes? I think you said you started,

2b208d38-e325-4b3a-829a-a6705a9d8504/113-1
00:12:40.981 --> 00:12:46.764
or at least I think you started maybe the
fertility access program in last October

2b208d38-e325-4b3a-829a-a6705a9d8504/113-2
00:12:46.764 --> 00:12:50.875
for little children.
So you're going to need to wait a few

2b208d38-e325-4b3a-829a-a6705a9d8504/109-0
00:12:50.416 --> 00:12:50.736
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/113-3
00:12:50.875 --> 00:12:54.428
decades to see if this program actually
is useful.

2b208d38-e325-4b3a-829a-a6705a9d8504/110-0
00:12:52.896 --> 00:12:53.056
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/113-4
00:12:54.428 --> 00:12:56.936
How are you going to do longitudinal

2b208d38-e325-4b3a-829a-a6705a9d8504/111-0
00:12:54.976 --> 00:12:55.256
Okay.

2b208d38-e325-4b3a-829a-a6705a9d8504/112-0
00:12:56.136 --> 00:12:56.336
Yep.

2b208d38-e325-4b3a-829a-a6705a9d8504/115-0
00:12:57.056 --> 00:13:01.144
tracking of outcomes over decades,
especially you're going to have these

2b208d38-e325-4b3a-829a-a6705a9d8504/115-1
00:13:01.144 --> 00:13:04.952
kids grow up, go to college, move away,
maybe come back, maybe not.

2b208d38-e325-4b3a-829a-a6705a9d8504/114-0
00:13:02.816 --> 00:13:03.136
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/115-2
00:13:04.952 --> 00:13:08.816
How are you going to track outcomes over
time and potentially space?

2b208d38-e325-4b3a-829a-a6705a9d8504/117-0
00:13:08.696 --> 00:13:12.123
It's a great question.
So right now we are tracking it

2b208d38-e325-4b3a-829a-a6705a9d8504/117-1
00:13:12.123 --> 00:13:15.551
essentially just on a dashboard.
So we have, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/116-0
00:13:14.016 --> 00:13:14.496
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/117-2
00:13:15.551 --> 00:13:18.728
all the demographic information,
how old they are,

2b208d38-e325-4b3a-829a-a6705a9d8504/117-3
00:13:18.728 --> 00:13:22.965
what their treatments are,
how many ovarian strips did they freeze?

2b208d38-e325-4b3a-829a-a6705a9d8504/117-4
00:13:22.965 --> 00:13:27.639
And fertility tracking is actually
something that our field has been doing

2b208d38-e325-4b3a-829a-a6705a9d8504/117-5
00:13:27.639 --> 00:13:30.816
for a very, very long time.
So all of our outcomes

2b208d38-e325-4b3a-829a-a6705a9d8504/122-0
00:13:30.976 --> 00:13:34.015
are tracked with the CDC and with
something called SART,

2b208d38-e325-4b3a-829a-a6705a9d8504/122-1
00:13:34.015 --> 00:13:36.680
the Society for Assisted Reproductive
Technology.

2b208d38-e325-4b3a-829a-a6705a9d8504/118-0
00:13:35.056 --> 00:13:35.536
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/122-2
00:13:36.680 --> 00:13:39.239
So we are very used to tracking those
outcomes.

2b208d38-e325-4b3a-829a-a6705a9d8504/119-0
00:13:37.336 --> 00:13:37.456
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/122-3
00:13:39.239 --> 00:13:43.503
And all I can say is that our field moves
at the speed of light, it seems like.

2b208d38-e325-4b3a-829a-a6705a9d8504/122-4
00:13:43.503 --> 00:13:47.714
And so the way that we're tracking things
now is probably not going to be that

2b208d38-e325-4b3a-829a-a6705a9d8504/120-0
00:13:46.616 --> 00:13:46.736
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/122-5
00:13:47.714 --> 00:13:51.499
we're tracking things when that
six-year-old is now 36 and potentially

2b208d38-e325-4b3a-829a-a6705a9d8504/122-6
00:13:51.499 --> 00:13:54.484
wants to have a child. But right now,
what we're doing,

2b208d38-e325-4b3a-829a-a6705a9d8504/121-0
00:13:53.936 --> 00:13:54.496
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/122-7
00:13:54.484 --> 00:13:55.816
especially for the people

2b208d38-e325-4b3a-829a-a6705a9d8504/125-0
00:13:55.936 --> 00:14:00.913
that are for the endometriosis program as
well is we basically have a dashboard and

2b208d38-e325-4b3a-829a-a6705a9d8504/123-0
00:14:00.816 --> 00:14:01.376
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/125-1
00:14:00.913 --> 00:14:05.535
we track pretty much all the things that
we can think of as being potentially

2b208d38-e325-4b3a-829a-a6705a9d8504/125-2
00:14:05.535 --> 00:14:09.742
important and looking at how we can
improve things and make it better.

2b208d38-e325-4b3a-829a-a6705a9d8504/124-0
00:14:06.096 --> 00:14:06.616
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/125-3
00:14:09.742 --> 00:14:14.541
One of the big things that I think is
super important is look at those barriers,

2b208d38-e325-4b3a-829a-a6705a9d8504/125-4
00:14:14.541 --> 00:14:14.896
right?

2b208d38-e325-4b3a-829a-a6705a9d8504/126-0
00:14:15.456 --> 00:14:18.826
there's going to be a big attrition rate
for, I mean, identifying the patients,

2b208d38-e325-4b3a-829a-a6705a9d8504/126-1
00:14:18.826 --> 00:14:21.101
I think is where we've used a lot of the
data, right?

2b208d38-e325-4b3a-829a-a6705a9d8504/126-2
00:14:21.101 --> 00:14:24.344
Identifying the patients who could
potentially benefit from this technology.

2b208d38-e325-4b3a-829a-a6705a9d8504/126-3
00:14:24.344 --> 00:14:27.714
Then you're going to have the number of
patients that actually want to be seen.

2b208d38-e325-4b3a-829a-a6705a9d8504/126-4
00:14:27.714 --> 00:14:30.747
And then you're going to have the
patients that actually decide to have

2b208d38-e325-4b3a-829a-a6705a9d8504/126-5
00:14:30.747 --> 00:14:33.611
treatment. And then later on,
you're going to have the patients who

2b208d38-e325-4b3a-829a-a6705a9d8504/126-6
00:14:33.611 --> 00:14:35.296
maybe return to use their frozen tissue.

2b208d38-e325-4b3a-829a-a6705a9d8504/129-0
00:14:35.776 --> 00:14:39.767
And so kind of looking every step of the
way at where are those barriers,

2b208d38-e325-4b3a-829a-a6705a9d8504/129-1
00:14:39.767 --> 00:14:42.410
what I found was that it's usually not
the time,

2b208d38-e325-4b3a-829a-a6705a9d8504/129-2
00:14:42.410 --> 00:14:45.753
although that is a consideration for some
patients. You know,

2b208d38-e325-4b3a-829a-a6705a9d8504/129-3
00:14:45.753 --> 00:14:50.121
they want to start their treatment for X,
Y, and Z 5 minutes ago, and they just,

2b208d38-e325-4b3a-829a-a6705a9d8504/127-0
00:14:46.016 --> 00:14:46.296
Yeah.

2b208d38-e325-4b3a-829a-a6705a9d8504/129-4
00:14:50.121 --> 00:14:54.058
this is not their priority right now.
And that's totally understandable.

2b208d38-e325-4b3a-829a-a6705a9d8504/129-5
00:14:54.058 --> 00:14:55.136
But the thing that I

2b208d38-e325-4b3a-829a-a6705a9d8504/131-0
00:14:55.296 --> 00:14:59.117
hate is when the barrier becomes
financial, right? Because a lot of times,

2b208d38-e325-4b3a-829a-a6705a9d8504/128-0
00:14:56.496 --> 00:14:56.976
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/131-1
00:14:59.117 --> 00:15:01.460
you know,
a lot of these technologies are not

2b208d38-e325-4b3a-829a-a6705a9d8504/131-2
00:15:01.460 --> 00:15:04.720
covered by insurance.
And it's a little bit different than sort

2b208d38-e325-4b3a-829a-a6705a9d8504/131-3
00:15:04.720 --> 00:15:07.114
of,
I don't want to say elective egg freezing.

2b208d38-e325-4b3a-829a-a6705a9d8504/131-4
00:15:07.114 --> 00:15:09.457
We don't really use that terminology
anymore,

2b208d38-e325-4b3a-829a-a6705a9d8504/131-5
00:15:09.457 --> 00:15:11.851
but more planned egg freezing where,
you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/131-6
00:15:11.851 --> 00:15:14.296
a patient or family has to make a
decision now.

2b208d38-e325-4b3a-829a-a6705a9d8504/130-0
00:15:14.896 --> 00:15:15.376
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/132-0
00:15:15.136 --> 00:15:18.966
about what they're going to do.
They don't always have, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/132-1
00:15:18.966 --> 00:15:23.143
thousands of dollars at the drop of a hat.
It's just not realistic. So,

2b208d38-e325-4b3a-829a-a6705a9d8504/132-2
00:15:23.143 --> 00:15:27.785
but by identifying those barriers and
using the data that we're able to collect

2b208d38-e325-4b3a-829a-a6705a9d8504/132-3
00:15:27.785 --> 00:15:31.267
in doing this has the potential to inform
policy, you know,

2b208d38-e325-4b3a-829a-a6705a9d8504/132-4
00:15:31.267 --> 00:15:34.806
hopefully improve insurance coverage for
these technologies.

2b208d38-e325-4b3a-829a-a6705a9d8504/132-5
00:15:34.806 --> 00:15:36.256
And we're getting better.

2b208d38-e325-4b3a-829a-a6705a9d8504/134-0
00:15:36.496 --> 00:15:41.592
but it's a very slow moving train. And,
you know, I think that it's our duty,

2b208d38-e325-4b3a-829a-a6705a9d8504/134-1
00:15:41.592 --> 00:15:45.904
we are a large system to not only like
use the data that we have,

2b208d38-e325-4b3a-829a-a6705a9d8504/133-0
00:15:43.976 --> 00:15:44.456
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/134-2
00:15:45.904 --> 00:15:50.674
but also to continue to track these
things to know where we need to move

2b208d38-e325-4b3a-829a-a6705a9d8504/134-3
00:15:50.674 --> 00:15:52.176
forward as a next step.

2b208d38-e325-4b3a-829a-a6705a9d8504/135-0
00:15:52.896 --> 00:15:55.486
Randy,
as we approach the end of this podcast

2b208d38-e325-4b3a-829a-a6705a9d8504/135-1
00:15:55.486 --> 00:15:59.765
episode, a final question for you.
Any words of advice to your peers across

2b208d38-e325-4b3a-829a-a6705a9d8504/135-2
00:15:59.765 --> 00:16:04.381
the country who may be intrigued by what
they're hearing in this conversation and

2b208d38-e325-4b3a-829a-a6705a9d8504/135-3
00:16:04.381 --> 00:16:08.096
may like to start a similar set of
programs at their institution?

2b208d38-e325-4b3a-829a-a6705a9d8504/137-0
00:16:08.736 --> 00:16:11.703
Yeah,
I think there's a lot of overlap and a

2b208d38-e325-4b3a-829a-a6705a9d8504/137-1
00:16:11.703 --> 00:16:15.855
lot of programs that are being built face
the same challenges.

2b208d38-e325-4b3a-829a-a6705a9d8504/137-2
00:16:15.855 --> 00:16:19.085
But whenever you're building programs
like this,

2b208d38-e325-4b3a-829a-a6705a9d8504/137-3
00:16:19.085 --> 00:16:24.094
use the resources that already exist.
All of this cannot be done in a silo.

2b208d38-e325-4b3a-829a-a6705a9d8504/137-4
00:16:24.094 --> 00:16:28.576
All of these programs that we've built
have been multidisciplinary.

2b208d38-e325-4b3a-829a-a6705a9d8504/138-0
00:16:29.056 --> 00:16:31.684
And that I think is a good piece of
advice.

2b208d38-e325-4b3a-829a-a6705a9d8504/136-0
00:16:29.176 --> 00:16:29.696
Mhm.

2b208d38-e325-4b3a-829a-a6705a9d8504/138-1
00:16:31.684 --> 00:16:35.027
Ask all the questions up front that you
could think of,

2b208d38-e325-4b3a-829a-a6705a9d8504/138-2
00:16:35.027 --> 00:16:39.745
write down what you think the challenges
will be and find ways to overcome it.

2b208d38-e325-4b3a-829a-a6705a9d8504/138-3
00:16:39.745 --> 00:16:44.103
Because at the end of the day,
what we're doing is for the betterment of

2b208d38-e325-4b3a-829a-a6705a9d8504/138-4
00:16:44.103 --> 00:16:47.208
patient care.
And when that is driving the decision

2b208d38-e325-4b3a-829a-a6705a9d8504/138-5
00:16:47.208 --> 00:16:49.656
making, eventually you'll get to the yes.

2b208d38-e325-4b3a-829a-a6705a9d8504/139-0
00:16:49.776 --> 00:16:50.416
At the end of the row.

2b208d38-e325-4b3a-829a-a6705a9d8504/140-0
00:16:51.376 --> 00:16:53.336
Well, Randy,
I'd like to thank you very much for

2b208d38-e325-4b3a-829a-a6705a9d8504/140-1
00:16:53.336 --> 00:16:54.016
joining us today.

2b208d38-e325-4b3a-829a-a6705a9d8504/141-0
00:16:54.976 --> 00:16:56.616
Thank you so much, Jordan.
It's been a pleasure.