Maximizing CareSelect Imaging for value-based care

Hello everyone and thank you for joining today's webinar, Maximizing
Imaging for Value Based Care.

My name is Brittany, Chairman with Optum and I will be your host today.

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Presenting today, we have Doctor Dana Smetherman, who is the Chief Executive Officer of the American College of Radiology.

She is a diagnostic radiologist who specializes in breast imaging and previously served as the Chair of the Department of Radiology and Associate Medical Director for the Medical Specialties at Oxnard Medical Center in New Orleans.

Also joining us today is Doctor David Delaney, Senior Vice President and General Manager for Clinical Decision Support at Optum Insight.

David is responsible for the utilization management businesses including the Inter Qual and Care Select portfolios.

He practiced for 14 years as an intensivist at Beth Israel Deaconess Medical Center where he also held a faculty teaching appointment at Harvard Medical School.

And lastly, I'd like to introduce our other featured presenters, Dr. Ehab Kamel, who is Chair of the Committee on Appropriateness

Criteria at the American College of Radiology, Dr. Greg Mogul, who's a physician Advisor for the clinical decision support businesses at Optum Insight and Elizabeth Sobel, a Senior Product Manager for the Care Select Portfolio at Optum Insight.

And now I'll pass it off to Doctor Smotherman to kick off today's session.

Thank you, Brittany, and thank you to my team of colleagues from the ACR and Optum for for joining today.

And I also want to thank Optum for hosting this webinar.

I really appreciate their commitment to continuing the development of  this decision support tool to make it easier and more helpful to users.

I'm also excited to have the opportunity to listen to some of the users who are out there on this webinar to hear your ideas about how AUC and clinical decision support can be improved.

So why are we here today?

Well, the ACR and Optum joined forces back in, in I think 2012 in an exclusive partnership really united by a shared mission to enhance patient care.

The appropriate this criteria or appropriate use criteria for the ACR have actually been along.

I've been around longer than that, dating all the way back to 1993.

And from the beginning, we really wanted to have evidence based criteria developed by multidisciplinary groups of subject matter experts that that basically could guide referring physicians and non physician providers to ensure that the most appropriate advanced imaging tests are performed for patients to optimize their care to reduce unnecessary radiation exposure and really guide them through the process so that they can get the answer to the clinical questions.

We're here today to help you reimagine the Care Select Imaging Tool.

This is what brings those ACR pervious criteria to the point where physicians and non physician providers are actually ordering the studies right there at that moment when they're ordering the examination.

We've heard a lot of feedback and and heard a


lot of questions from users like many of you on this call and we're really excited to discuss how we can leverage this solutions capabilities to meet your unique needs, take care of your patients and advanced value based care goals.

So I'm going to kick it over to my colleague Dr. Delaney, and he is going to take it from here.

Great.
Thank you, Doctor Smotherman, and I want to thank both you and Doctor Kamel from that ACR to be here with us today to talk about Cara Select. I also want to thank all of you who are attending spending your time for this discussion today. I've I've looking at just kind of my general temperature
toward care select.

I believe it is more relevant today than it ever has been in the past. The the reason why we started this collaboration with the

ACR so long ago remains even more vital.
I mean, consider this, advanced imaging continues to grow over one in three Ed visits, adult Ed visits order ACT and about 25% of those are not medically necessary or have a low diagnostic yield.

So the need to really optimize the use of advanced imaging and also reduce burden, administrative burden around ordering these tests is more important today than ever before. When I think back when I first emerged as a freshly minted critical care physician back of the turn of the Millennium, some of the most important calls I had actually were from a radiologist early on calling to ask me, you know, get clarification of what I was trying to order, what I was trying to achieve.

And I, I learned so much early on in those calls and, and get quickly matured with the guidance of some really outstanding radiologists to become really proficient and know what and how to order.

And when I talk to people today, I, I just think the volume of studies coming through, most radiologists don't have time to make those calls and, and to be available.

And, and that's like, you know, even for staff physicians, let alone many community physicians ordering very high volumes.

And so, you know, our hope is that this can be a tool to help lift the IQ of general ordering physicians to order more selectively, specifically and get the
right results that they they're looking for.

So really excited to have you here on the call today.
And with that, I will hand it over to Doctor Mogul.

Thank you very much, Doctor Delaney.
Those were excellent and important comments.

And I I'd like to talk a little bit about exactly why what Doctor Delaney said is now more true than it's ever been.

As a practicing radiologist, I, I live in this space and as someone who's been involved with decision support since the the aughts, I I really appreciate Doctor Delaney's comments.
And I think those people on the call who are in imaging recognize those matters to be true as well.

There is less time than ever for us to interact, unfortunately, live with our colleagues.

Not to mention the the incredible growth of teleradiology and
other virtual forms of support where a lot of that
trust and connection that many of us grew up on
is a little bit more frayed than it's been in
the past.

So putting putting control in the user's hands is more

important than ever.

Nothing about the overarching amount of inappropriate imaging is going
down.
As Doctor Delaney pointed out, the both the costs in
terms of financial costs and diagnostic costs remain as serious
as they've ever been and only increasing.
Largely attempts to control inappropriate imaging have focused on straight
volume reductions.
And while volume reduction in imaging has had a varied
route of success, it it has led to a push
back, which is understandable in the form of prior authorization.

If if all one has to do is image less
patients, then payers will continue to increase the tools they're
using to ensure that that that patients are imaged more
appropriately.
Unfortunately, the traditional means of using prior authorization to improve
imaging appropriateness have not really worked as well as we
all would have hoped.

It is largely a lose, lose proposition even for the
payers, for the providers and for the patients.

And so they're clear costs on both sides, but there
are also invisible costs that where there is a loss
of trust between providers and patients and then at the
departmental level, a loss of efficiency in scheduling scans that
are ordered and then not carried out.
So there's evidence all over the board to suggest that
better decision making based on appropriateness at the time of ordering is the only win win way to go.

And that's really what we're here to talk about and
what care Select does really most powerfully.
Now we're discussing today value based care, which is an
appropriately important and hot trend.
But the reality is it's it's more than just a meme.
This is affecting every single aspect of healthcare.
As all of you know, I won't, I won't beat
this into submission.
The numbers speak for themselves.
And there is no, no, there are no serious watchers
who believe that the future of healthcare, even in the
very near term, isn't going to be based more on
shared risk and outcomes based reimbursement.

This is where decision support really shines the brightest.
I believe the the costs and benefits are really a
show a strong bias towards the use of appropriateness testing
at the time.

There at the time of ordering shared savings with reduced
unnecessary imaging and then even reduced false positives, reduced downstream imaging costs.
And as well as we'll present later in the presentation,
a significant impact on areas of imaging that were not
traditionally covered by by mandates, inpatient imaging and pediatric imaging
all falling within the larger rubric of volume based care.
And so given I think what we've hopefully done here
is laid out the the map of risk and the
map of benefit and appropriateness for using CDs at the
point of care.
I'm going to turn it over to my colleague, Elizabeth
Zobel, who is the product manager for Care Select and
she will take it from here.
Elizabeth all.

Right.
Thank you, Doctor Mogul.
All right, I'm going to talk about some best practices
and a few use cases.
So over the years, evolving industry trends and challenges have

shaped and refined our best practices for achieving success with
care select imaging.

So rather than being required to implement CDs across all
care areas, we're now able to focus on addressing the unique issues and needs of each organization, thereby advancing our
progress toward value based care.
So organizations that are realizing the most value and the
most success today are those that engage organizational leadership or
awareness into challenges and needs regularly and promote consistent involvement
of the CDs Governance committee.
That along with collaborating closely with customers with care, select
for feedback and escalation combined to show the most success.
So if you're not sure where to start, I would
encourage you to start with collaborating with your customer success
representatives.

And if you're not sure who that is, we do
have a customer community portal.
And I would suggest that you you start with one
of those two things to reach out.

We're certainly here to help make recommendations as to how
to engage with your organizational leadership, how to promote consistent
involvement of ACDS governance committee.
All of those things are very important.
So customer engagement, beginning with sales and implementation care, select customers have access to a variety of support and strategic
resources.
Our strategy team partners closely with customers to provide exceptional
consultative support, foster opportunities and direction throughout their imaging CDs
journey.
So whether you're engaging regularly with your with our strategy
team or your opening tickets to our customer community Porter,
just remember that there's a larger team of folks that
are there to support you, including technical consultants, our product
team, our mapping team, clinical content team or senior strategist
as referenced before in our implementation team.

All of these folks are helping on the back end,
whether you see their faces or hear the voices or
not, and are available as resources to help support your
journey.
We're highlighting a few notable use cases here.
These represent trends across our customer base that we've seen
over the past few years.
Some of you may be familiar with these stories already,
but it's important to note that these stories show continued
success.
So these didn't just happen at some point in time,
but they continued to show success for these organizations.
These use cases are also helping to drive our Rd.
maps.
So by developing tools that support these initiatives, we're enabling
others to more easily replicate these.

So I'm just going to briefly highlight each one of these.

We've got some additional information that we can share with
you after including links to webinars that we previously hosted
that go into more depth and detail about each of
these stories.

So University of Michigan, this is a prior off successstory.
So we've got a few of these with different customers,
but basically they were able to leverage use of decision
support and the result of that to drive an agreement
with with a private payer to bypass prior authorization.
Carl Health has seen success in reducing their inpatient MRI volumes.
This is for a a very strategic area of MRI.
So they've seen success there and continue to show success
in in that initiative.
And then Cone Health was able to reduce inappropriate imaging
order by significant percentage while they're ordering volumes continue to
increase.
So increase in in imaging order ordering volumes all together
for them likely increasing patient volume during that time as
well.
But their appropriateness was improved, indicating that they're likely getting
to the the right imaging order the first time.
All right.
So as mentioned before, both the ACR and Care Select
have received feedback and questions from from customers over time.
And we want to address a few of the more
commonly asked questions here in our presentation today.
So I'm going to start with how, how does my
feedback drive content development?
And this does come to us in several forms.
But this I think captures what most of those are
really getting to the root of which we we gather
information, we gather feedback and categorize that feedback into themes.
We didn't identify common trends that lead to actions so
that that feedback can then be shared with the ACR
or other AUC authors.
Updated appropriate use criteria is then published by the ACR
and others.
Our team then takes that newly published information, whether it's
new topics or updates to existing topics and we review
for of it, review for available updates.

NOTE Confidence: 0.8193926215171814

00:16:43.720 --> 00:16:47.367
The care select clinical content team then creates the content
so that it's in a usable format, incorporates that into
release versions.
Customers update to the latest content release, and then content
use and feedback is analyzed and the cycle repeats itself.
So at this point, I'm going to pass it over
to Doctor Kamel for a few moments to talk about
at least an an ACR content topic for us today.
Well.
Thank you very much.
As was mentioned earlier by Doctor Madeline, we have a
shared mission to improve patient care and we have been
aligned since 2012 as was mentioned earlier.
So we continue to be actively listening to users feedback
and we have developed more pediatric content and making specific
actions to address the gaps in pediatric content in particular.

To that end, we now have three pediatric channels developing
pediatric content that we are devoting more resources to the
development of these contents.
We have 9 pediatric documents in development currently and these
are including different and important topics such as giant bleeding,
abdominal pain and chest pain and a full list is
available on the AC website.
Also that we are working on the adult side to
incorporate pediatric content into existing adult documents when it is
appropriate, when the clinical presentation and or imaging recommendations are similar now.

So we're including now pediatric content into existing adult documents.

We're also prioritizing new content development based on customer feedback

received from Optimum and other resources.

As far as overall clinical topics, we've been busy over

the last five years.

We have over 60 new topics that have been developed

over the years.

Since 2020, we have 11 topics, increase that to 18

topics in 2021-2022.

Over the recovery we have 6 topics 20/23/13 and last

year we have 14.

Actually coming up today is the April release.


We have 11 new topics and there are 49 new
topics in Provost.

So our teams have been busy generating these topics and

again it shows the alignment and like the shared mission

that we have to deliver by the patient care.
So this is just a summary of the please you
are content as far as pediatric expansion and other clinical
finance.

Thank you.

Thank you, Doctor Kamel.


All right, I'm going to pass this back over to
Doctor Mogul.

Thanks, Elizabeth, and thanks Doctor Kamel.

Excellent points.

I want to address one of the most common things
that I hear as.

A physician advisor to optim on this product as a
radiologist who has been as I said in decision support
for a long time well before there was PAMA.

And I suspect many of you who are attending this
call who've been interested in the issue of appropriateness in
imaging, which has existed again decades before PAMMA, recognize that
we are at an inflection point to reimagine and re
envision almost in a way that we did before PAMMA,
what direction we could go here.
I I've worked both as a member and a fellow
of the college on appropriateness criteria from the outside as
well as from the inside.
And I can say without a doubt, the flexibility and
response and teamwork that's happening between the content team at

Care Select and the team that's producing the content at
the ACR is truly bidirectional.
We have developed methods to really return the the objective
data of 10s of millions of of decision support events
to the college and the college independently makes appropriateness criteria.
And yet there is a lot more input that the
college can receive than in the days of either publishing
them on the web or publishing them in books.
And I think this is something that benefits everyone, every
radiologist and every ordering clinician.
So PAMMA certainly drew a lot of water, if you
will, and deservedly got a lot of attention and started
many, many debates.
And the the reality is that PAMMA was in response
to the serious problem that we described at the beginning
of the call, that problem of of overuse and inappropriate
use of advanced imaging, which no one is arguing has
gone away.
The solutions of PAMA were however quite broad, attempting to
introduce decision support in between every single order for every
single condition and they were quite rigid understandably to establish
an entire sort of economy and infrastructure of decision support.
So broad and rigid was was worthy deemed necessities.
And now in this, in this uncertain and pause period

for PAMA, I think we have the opportunity to be
the opposite and that is to be focused and flexible
and focused and flexible deployment of decision support inside your
health system is going to be different than inside any
other health system.

And that is what the team that Elizabeth told you
about before from content creators to to customer success, etcetera.

This is where we've lived for the last 15 years
in that long and fruitful relationship looking at how you
deploy, how you use decision support to solve the unique
problems that you have.

And in this in this pause, I think that it's
an opportunity to really look closely at where your most
serious problems are and to look closely at whether something
like alerts need to be used where communication and education
is a more appropriate tool.
And it's working in partnership in, in that way that
I think will really allow imaging decision support and imaging
appropriateness to move back into the center from being simply
a compliance tool to actually changing how you and your
health system use medical imaging in the entire environment of
care that you deliver.
And so, you know, I, I, I want to just
go through some practical examples for those of you who,
who maybe haven't been using the system much lately.
I think it's, it's important to remember that by preparing
for Pamela, you have already done the hard work of
deploying Care Select into your ecosystem, into your EMR.
Care Select works as a very powerful feedback tool for
you as leaders and for you as individual users.
And so having done the hard work of putting it
in the system, now small investments in, in tuning it
to answer the problems and questions that you have problems
and questions which may not have been part of PAMA.
As Doctor Kamel just explained in pediatric care, pediatric decision
support fell outside the, the, the mandate of the mandate
of PAMA, which was specifically for Medicare outpatient populations.
So here are here, you know, the, the, the existential
question about decision support that is existed for a long,
long time has been doesn't work.
And it's a it's a fair question and it's the
first question, IE do clinicians change their orders?
We have been able to show unquestionably that the answer
is yes.
From the earliest days of the Medicare demonstration project around
2010.
Getting to this answer has been difficult, largely because of
structural matters in the EMR, the ability to follow patients
through a care journey as opposed to simply at a
specific point of order.
But all efforts that have been made to to demonstrate
that have been increasingly successful in demonstrating it.

Clearly there was a fundamentally important paper that occurred that
was published about four years ago that that showed that
the impact of being shown decision support alerts produces a
clear statistically significant change in behavior of providers over time.

Now in many cases studies that are done in this
area look at one particular order and see if the
provider changes their behavior on that particular order.

And that has what that is what has been much
more difficult to demonstrate historically.
But what we showed unequivocally is that after a series
of of alerts being shown to a provider and it
has more to do with the frequency of those alerts
being shown, provider behavior changes permanently.
The in, in more recent times, we've been able now
to demonstrate increasing a core data that shows that providers
do change at the time of display.
And this significantly occurs around primary care populations and and

physician extenders and of course also trainees.
This makes perfect sense.
Specialists order a relatively narrow range of studies for a
relatively narrow range of indications, and interrupting specialist workflows to
try and get small advantages may not be a good
strategy.
But providing information to individuals who order studies infrequently but
at great volumes because of the number of people who
who do work in primary care and especially with the
rapid turnover that we see in our current healthcare system,
the continual re engagement of the right thing to do
at the point of care compared to prior authorization is
a far more powerful tool.
So for instance, just some examples.
These are examples pulled from our current data.

This the the first I'd like to show you is
an order for an abdomen pelvis with and without contrast.
I personally as a radiologist don't see this ordered a
lot, but as we go through our data, it is
ordered incredibly frequently and it is the number one order
that we change it when ordered in some of these
primary care and training settings.

Now is it ordered?
Is it ordered by mistake?

That is absolutely possible.
Most electronic medical record order systems pulled it.
When you pull down the menu, there are sometimes upwards
of five or ten different versions of contrast enhancement and
there is, it's hard enough for radiologists to know this.


And the the time that it takes to protocol studies,
the time that radiologists aren't spending in reviewing the studies
that are ordered and then going back and changing that
or contacting the the clinician can be addressed at the
point of care.
And this is a case where we see this happening
all the time.
This is a significant reduction in radiation obviously with and
without is 2 scans.
As you know, we also see studies moved from a
quote higher, more advanced imaging technology like CTRMRI to a
less advanced imaging technology or a less expensive imaging technology
such as ultrasound or plain film.
And those those are, those are always welcome along every
side of the equation, the pure cost equation, the pure
appropriateness equation, etcetera.
Occasionally we're asked a question saying, well, you know, we
have patients who have had a head CT ordered and
then you're recommending an Mr.
and clearly that's a more expensive and perhaps a less
available study.

And you know our response to that is that in
the end appropriateness will always be the best way to
go patients.

And this is a very common reason that we recommend
moving from a head CT to a brain MRI is
this patient with this indication is going to get that
brain MRI eventually if, when, when they get the right
care.
And so making the appropriate modality change earlier in the
patient's care in each case will always improve the outcomes
for the patient and the health system.
So there's there's also a category that I'm not showing
here, which is a category of an original imaging order
for a reason.
And the imaging order is changed to do not image.

This isn't, this is in some ways one of the
most important things that we do.
And this is where we really want to partner with
you and your health system because we know it's of
no use to anyone.

When someone legitimately decides they need to use imaging and
all you tell them is no, you're wrong.

And our system is built now to help provide alerts

when imaging isn't appropriate, when imaging of any kind isn't


appropriate in your system, the way to manage that patient


may be slightly different.




And we can in this post PAMA environment, we can




configure those alerts so they're most useful to your providers.




This is that flexibility that I was talking about before


to remind everyone the the sort of the the mechanistic



underpinnings of our system.



This is an example of how when a provider orders


that with and without contrast, they're provided with the evidence
for the recommended change.



00:32:00.120 --> 00:32:04.200
We do not, we, we do not automatically change.


We, we offer the provider a single Click to change




the study to the more appropriate and off and we


back every single decision support event.




And that's, as we said, 10s of millions of decision



support events with a very specific explanation of the ACR




criteria that underlie them.



So, so this remains, you know, I think still the



most relevant and important way to approach the problem of




inappropriate imaging, which is done at the point of care,


00:32:36.689 --> 00:32:40.576
which is done with and reducing the burden of prior
authorization.

So I'm going to turn this back over to Elizabeth,
who I think was we just have a couple more
slides to talk about practical strategic deployment and then we'll
be happy to answer some questions.

So Elizabeth, you want to take the slide back from
here?

Sure.
Thank you.

All right, next question here that we are commonly asked,
how can I strategically use care select to solve a
specific imaging problem.
So we kind of touched on this topic a little
bit about the the need to address certain imaging scenarios


that may not be all imaging in all care areas.




And what this does is it's it allows you focused
analysis.

So if you're using our tools kind of help identify
those opportunities and and then to gauge success of that,
this makes it a little bit easier.
If you've got a focused area where you want to
impact change, this also can provide you with an overall
reduction in alert.

So we, we do hear feedback there.
Alert fatigue is real too many clicks.
I would like, you know, to see less feedback and
only see feedback where, where it's necessary.

So we'll, we'll talk a little bit in a, in
a few slides about some, some future features and functionality
that will have in the tool that will address this



and then improving alert response with additional details.



So just what Doctor Mogul was talking about as an




example where imaging is not recommended that we potentially provide




additional detail and they're letting the ordering clinician know what
they should consider doing.




So at this point, what we recommend in order to
do this is collaborate with your, your care select representative
and for now you can do this likely in your
EHR.
We do recognize that that can be burdensome and it's
maintenance on your team and we would like to take

control of that and and have some of that maintenance,
some of those requirements fall to our team.

And again we'll talk about that as we get to
the future direction of our product slide.
But we do want to offer at that point you
know your ability to choose scenarios based on multi criteria
where you want to show these alerts, how you want
to address these specific problems.
One very commonly one that comes up and it is
a part of that Carl's success story is inpatient MRI.


So we're hearing that from a lot of customers.

But again, that requires the ability to do things slightly
different than how you may have implemented in the past
to meet the requirements of the mandate and the next.
We got just a few items here that come up
occasionally.

How do I optimize my bill to address the following?

It takes too many clicks to complete the workflow.
Again, this is not something new that we hear at
this point.
A couple of recommendations is that utilize preference list or
or however your EHR terms those kind of pre built
orders for for common orders.
So reducing the number of clicks that the ordering clinician
may have.
Consider reducing feedback to strategic cases where you want to
see change.

So again, not just everywhere for all care areas and
all scenarios.
And then review your current configuration option with your care
select representative.
Again, this is something that we're starting to change our
recommendations here where before it was to me a very
specific requirement.
And now what we want is for you to be
able to address the initials initiatives and any problems that
you're facing as an organization.
So being sure to share that information with your Care
Select representative, have those conversations to say how could we
better be doing this?
I don't see much change in appropriateness or reduction in
imaging volumes.
This is related to the slide that that Doctor Mogul
just went over.
This is data that we in, in some scenarios now
are starting to have visibility into more of the, the
change in appropriateness.
So whether it's change across the board or it's changed
within the orders there that are being placed, one thing
that we do recommend is that when you're, when you're
looking at appropriateness, if you're looking at your data is
are you, are you looking at everything?
Because I think it's sometimes the comment is related to
that.
Like I don't see a positive trend for my organization
as a whole.
But have you identified an area where you, where you
really want and need to see change?
And then are you focusing on that to see that
change is happening?
Because you, you definitely can see and we, we see
it across the board for all customers.
We do see changes, but they're usually in very specific
areas.
So kind of identifying where it is that you want
to see change and then following that through and in
making sure that your configuration aligns with what you want
to impact.
So again, those conversations, that engagement that you have with
our team is very important just to make sure that
there, there's not something that we can be doing slightly

different that will have a larger impact.
And then the third item here is I sometimes find
it difficult to find the indication.
The reason for exam one suggestion here is just to
evaluate again your build.
So, so many HRS offer a common indication grouping.
If that's the case for yours, evaluate that.
So those are typically built based on what is common
across many organizations.
But we understand that what might be common for most
may not be common for you.
So bringing forward those indications, making them easier to find
for your providers is something that we can help you
do and consider localization.
Localization as a whole is not something that we've highly
recommended in the past and we certainly don't recommend that
a lot of this be done.
However, again, we understand that for your organization you may
have have specific needs here and certainly localization is beneficial
to us in our ability to analyze use of content.
So if we're taking those topics back to folks like
the ACR, then us having data to support those conversations,
it's much easier for us to get at that if
you have performed some localization.
Another recommendation here is that you just have a process
within your organization to make sure that you're reviewing these
requests to make sure that they're good for the organization
versus potentially just good for for one person.
But this can certainly be helpful if the report that
it's difficult to find the indication that they're looking for
is because it doesn't exist.
All right, so I'm going to talk a little bit
about the future direction.
So some things that we have on our road map
and that we're kind of mapping out internally.
CDs folks, this is specifically for an Epic integration.
Some of you on the call may be very familiar
with that, but this is the migration.
So an update to the integration where we're moving to
CDs folks and FIRE, which as you are probably aware is that the healthcare industry standard integration and interoperability technology that is one thing that we're working on today also

expanding the capabilities for strategically displaying the alert.

So again, addressing to need the initiative for, you know,

I, I have a problem here, I want to address
the specific thing.
So do you want to address it for certain providers
or for certain care areas?
But that ability to not just turn on alerts for
all, but more specifically determine where you want to turn
those on and maybe what you want to show in
that alert.
So maybe there's additional information around.
Moving an order from an inpatient setting to an outpatient
setting, something along that.
So certainly, you know, any, any scenarios that you have
any initiatives that your organization have that that seem to
be related to that, we would encourage you to share

feedback with your care select point of contact.

The more information we have there, the better.

But certainly that's something that you know, we we prioritized

in our road map and a few other things that

are upcoming is leveraging the fire integration, which is going

to provide opportunities for additional features and functionality with our

tool, including our ability to pull additional information about the

that patient order, so that patient, their chart, etcetera, content

experience.
So we've talked a little bit about Doctor Kamel talked
earlier about some upcoming changes, so pediatric content that's going
to be expanded and then some other topics.
Of course, that's just part of the content evolution, but
also is there something else about the content that that
would be helpful?
So you know, for us that that doesn't just mean
that we, we have different content or we have additional
content, but it means that we also have the tools
to support it.
And then lastly, but certainly not leastly, and this is
not in any particular order, I should say, is administrative
automation reduction.
So when we talk about things like prior auth and,
and your ability to, to be able to go out
and, you know, currently get those prior auth agreements, what
can we do within our tool, within our products that
help you achieve those more easily so that the burden
is not solely on your organization to go out and,
and find these opportunities.

So we're looking to see what else we can do again to better help help support those initiatives.