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Why HCP Precision Targeting Matters Now More Than Ever

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About this webinar:

Join Komodo Health's Vivian DeWoskin, VP of Life Sciences, to learn:
  • How to prioritize and enhance HCP engagement in the current digital-only environment
  • How patient journey and payer-complete data can unlock more precise HCP targeting
  • How to leverage technology to deploy resources to areas of greatest need and measure impact

Webinar Transcript:

00:03 Vivian DeWoskin: Hi everyone, thank you for joining us today. We're gonna go ahead and get started with our webinar and discuss why HCP precision targeting matters now, maybe more than ever before, I'll go ahead and start with a brief introduction. And we'll talk through the agenda as well, my name is Vivian DeWoskin, I am VP of Life Sciences here at Komodo Health. My background in the last 10 years of my career had been spent in the life sciences as a strategy consultant, working very closely with medical and commercial teams at organizations of all shapes and sizes and stages of development. In my role here at Komodo Health, I work with much the same group of organizations and medical teams, and what I'm hoping to do over the course of the day today is share with you some of the insights that we've been learning and some of the questions that we've been hearing from medical teams as we work to navigate the new environment we've all found ourselves in these past few weeks. So I'd like to touch on a few of the objectives for today's webinar, first we'll of course spend a little bit of time discussing the impact of current realities in the world today on life sciences and on medical affairs in particular.

01:21 VD: Second, as I mentioned, we'll try and share some insights that we've gained and some options as we see them that may help our medical affairs community make some of the business decisions that you need to make right now despite the uncertainty of the times. And lastly, we'd like to use this time also to continue to gather feedback from the medical affairs community on the challenges you're facing, the solutions you're putting forward, and we'd love to continue to share that with the rest of our broader community as we go on forward from today's discussion. For those of you that joined in the last few minutes, just a couple of orders of housekeeping, all of your lines are muted, we will be using some polling questions throughout the webinar today, speaking to point number three here on the objectives, we would love to use those to gather some feedback and insights from you all, and thank you in advance for your participation. As far as an agenda, I'll start by talking a little bit about what we know to be the current reality today for medical affairs teens.

02:25 VD: Then we'll talk a little bit about some of the ways we've heard that medical affairs teams are adapting to this situation, and some suggestions and ideas that we have and that we've been working on with our customers as well as to how medical affairs can continue to support HCPs and patients in this environment. We'll end with a little bit of a discussion of open questions and looking ahead to some things we hope to learn over the coming months, and then should time allow, we will also have time for a Q&A at the very end. Again, there's a chat window open for you to submit questions along the way if you have them, and you would like us to come back to them at the end of the discussion. Alright, so let's start by talking about some of the current realities, and I think we all know that this is the year essentially that engagement has gone virtual. Major conferences are being cancelled and moved online, we just recently found out, for instance, that ASCO is going to be entirely virtual this year, and really unprecedented situation. Obviously, hospitals and physician offices are not permitting in-person visitors, and in fact, those changes may become institution-wide policy changes in the future, moving on from the current COVID-19 crisis.

03:47 VD: Additionally, it kinda goes without saying, but HCP's focus and time is rightfully directed elsewhere right now to address current issues, their day-to-day has been significantly altered as some of them are pulled to the front lines to help treat and care for patients affected by COVID-19 or simply, they've had to significantly change their own practice operations. And of course, throughout all of this, medical teams are grappling with the impact that this is having on their internal stakeholders and their own patient population and the HCPs that they engage with. Some of the things that we know were happening or that are risks today, are that there's a significant potential to the fall behind on timelines that you had planned for 2020 in engagement, education and communication. We have begun to hear now of clinical and regulatory delays becoming the norm as trials are halting recruitment or potentially pausing in getting set up and going live. As a result even of clinical trials potentially being delayed, that comes with potential delays in data releases and then therefore potentially publication.

05:06 VD: And lastly, and maybe most importantly to touch on today is that there are challenges to patients potentially in getting the right therapy or the care that they need in this environment, and there's considerable uncertainty for those patients as well as for HCPs. They're dealing with all of these changes as well, and may be in need of additional education or support as they work with you to make sure that there's a continuity of care for their patients. So before we delve a little bit further into the content, I'd like to bring up my first polling question to just get a little bit of a sense of our audience today, we're gonna start with just a couple. So the first question I'd love to hear from you is, how would you rate, personally, the effectiveness of your current HCP engagement strategy, or your pre-existing HCP engagement strategy in light of the current COVID-19 situation? And I thank you all so much for taking some time to answer. It's really appreciated. We'll let a couple of more responses come in, but it seems like it's starting to look like many of you are thinking that our strategy may be effective, it might have been effective previously, but now it's taking a turn for potentially not working in the current reality of the world today, and or maybe you're just not sure yet.

06:39 VD: Most of us are not quite sure what the next several months have in store for us, and it makes a lot of sense that we'll be thinking about these questions over time. Okay, so I'd like to move on to one more. Speaking of some of the areas of uncertainty today, what are you currently viewing as the biggest challenge or impact of COVID-19 on your team and on your strategy? We have a couple of options here. Is it trial or clinical or regulatory impacts? Budgetary or resource impacts? Not knowing where the strategy is going next, or pulling the team out of the field? And I recognize there can definitely be some other challenges which we'd love to explore, and so that option is there as well, which I see a few of you using. Again, thanks so much for all of your impact, I think it's very valuable to see how your peers and how others are facing... What challenges that they're facing and what's having the biggest impact, and we're starting to hear this loud and clear, that having the team pulled out of the field is very clearly a significant challenge, it's a disruption to the day-to-day, and it's a deviation from business as usual, to say the least. So last question, and then we'll go back to talking a little bit about what's happening and what you can be doing to address these challenges.

08:16 VD: Have your teams experienced any constraints in your operational resources? I mean, this could be come in many forms, it can simply be your teams are splitting their attention between work and home schooling for the kids, it could be budgetary, but we anticipate that a lot of teams are starting to feel a pinch in one way or another, as a result of COVID-19 as well, right when there is a significant amount of uncertainty about what to do next. Great, and it looks like we have a little bit of a distribution here where close to half of you said that your resources have been impacted in some way, and another 15% or so anticipate that there will be some impact over time, we'd love to spend a little bit of time as we go through the rest of the webinar today talking about what you may be able to do to reassess your strategy, align it to patient care, and make sure that everything that you're doing potentially with slightly constrained resources is done with patients and physicians top of mind. Okay. Alright. So what are some of the things that we've heard teams are dealing with right now or doing in order to address the challenges that we've discussed in the last few questions? 

09:45 VD: First of all, we know there's a significant amount of scenario planning happening at the moment with varying assumptions for the length of time that perhaps field teams will be out of the field and different degrees of access to HCPs over that time. Teams are assessing projects and timelines that are now at risk and re-prioritizing where they need to. It goes without saying that any engagement that is happening is switched to virtual engagement where it is even possible, and in couple... And coupled with that, we've heard that many teams are starting to seek out new or other HCPs beyond the list of individuals they already have relationships with or have identified to continue to engage with and perhaps cast a wider net as your access to individuals that you know or were previously anticipating engaging with becomes more limited. Lastly and most importantly, we hear loud and clear that medical teams first and foremost priority is on developing and implementing solutions to ensure patients get the care they need, and the critical work to deliver that care to patients is allowed to continue during this uncertain period of time.

11:08 VD: So to keep those things going, teams are asking a lot of questions, and I wanted to share a few that we are hearing from our medical affairs community and the folks that we work with on a regular basis. One of the first questions we've been getting is just, which HCPs are being pulled into the front lines right now against COVID-19? How can we know who has been effectively sidelined and is certainly not available for engagement or speaking with us because they're doing the critical work that needs to be done and they're changing their day-to-day to serve those patients who've been affected by COVID-19? We're also hearing a lot of questions about which HCPs or practices are able to provide virtual visits to their patients, telehealth, or even have the capability to have other kinds of virtual engagement or virtual meetings. When it comes to clinical trials, we're hearing questions from teams about what sites are running trials, which trials have been allowed to continue, who may be in a place to be back up and running first as you start to anticipate potential impacts to new trial starts or enrollment and timelines. And again, coming back to the patients, there is this big open question of how patients are being affected, what guidance is being given out there to HCPs on essential care versus non-essential care, and really questions about what the impact will of this will be in the long term.

12:44 VD: To us here at Komodo Health, this last bullet is an incredibly, incredibly important conversation to be having as the secondary impacts of COVID-19 on other patient care are likely to potentially be significant and perhaps long-lasting, and so we're committed to helping seek answers to those questions and to others. Komodo is a company that's at the intersection of healthcare data and technology. We build solutions for medical affairs teams on top of the journeys of 320 million US patients through the healthcare system to address our mission of reducing the global burden of disease. We reconstruct those patient journeys that I mentioned by linking thousands of different data sources together, so that we have a full picture of what patients are experiencing on the ground today. We add new data each and every day, and we think that could provide very powerful insights in the weeks and months to come as we start to see and explore secondary effects of COVID-19 on different groups of patients with different conditions in different geographies across the US.

14:05 VD: One way we think about that, and we think about it a lot here at Komodo is in terms of disease burden, our mission, as I described on the previous slide, is to reduce the Global Burden of Disease. That requires some ways to measure it, as a matter of fact. Some of you attending here today may have attended my colleague, Usha Periyanayagam's webinar on measuring disease burden about a week ago. But I'll give you a quick description of what we mean when we talk about Komodo's disease burden index, and how that can be used to monitor changes in your patient population and their care over time. So firstly, what do we mean by disease burden? This was a term that was coined first by the WHO and the Harvard School of Public Health, and refers generally to the morbidity and mortality due to disease, injury and risk factors across the globe. It really speaks to the idea that more information can be provided and known about a condition than just prevalence and incidents, which are some of the most common statistics used to describe a disease state.

15:13 VD: And the goal as well encompasses understanding the geographic distribution of patients. As we've started to see with COVID-19 in the past few weeks, not knowing where the patients are, where are the ones that require treatment or need to be tested, has hindered our ability to respond and to fight the condition. In a different way we see that as being true across all of the therapeutic areas that we work in, where we strive to get patients care where they are earlier and limit the impact and the burden to patients and the overall disease burden of that condition on the healthcare system. So here at Komodo, we use a metric we call the disease burden index, and we use that as a measure to make it easy to visualize and compare and track the burden of a particular disease across geographies, across territories and across different conditions. We see our disease burden map, which you see an image of on the left, as being a potentially. Helpful indicator of the ripple and the secondary effects of COVID-19 across other diseases in the coming months. Because the disease burden index represents what we think is the ground truth of what's happening in patient care on the ground today, viewing that disease burden map over the coming months can enable us to track and understand changes to patient care and disease as a secondary effect of COVID-19.

16:46 VD: The question then becomes, how can medical teams leverage that kind of information to inform and update their medical strategy to the new world that we're living in? You're being asked to do potentially more of different things with less time, fewer resources, no one in the field, and the question is, how do you scale the time and the resources that you do have to meet the changing needs of this current environment? So we'll talk a little bit about then versus now, and where we see some ideas and options for teams to move forward in this current world. Obviously before COVID-19, there was kind of a way of doing things or sort of business as usual when it comes to medical engagement. You may have been focused on identifying KOLs or HCPs on scientific and academic signals, you focused on finding those academic leaders. Now, we see, especially in this era post COVID-19, where scientific engagement is challenging, and clinical trials are potentially being paused, that understanding HCPs clinical practice may be more important than ever before.

18:10 VD: To understand the HCPs that are seeing, treating and managing your patients, and the relationships among that entire care network could provide the insight that you need to be able to educate and communicate with the right HCPs to take care of your patients and deliver the therapies that they need at this point in time, and it's important to be able to do so even if the realities of patient care change over time as a result of this pandemic, perhaps different HCPs will be seeing or caring for your patient population than were the HCPs that were seeing them previously, and knowing as much as you can about those HCPs, their patient population and their practice network is key to understanding what kinds of education or engagement they might require, and then being able to respond and deploy that accordingly.

19:04 VD: It also goes without saying that in-person engagement has become incredibly challenging to say the least, and that's moving to virtual, and as you start to cast a wider net for HCPs to engage with or react to clinical practice signals, you may be moving from individuals with whom you already have relationships to a new group of potential providers that you don't know as well. So over the next few slides, I would love to take you through some of the ways that medical teams we work with here at Komodo are taking these themes into account to realign their strategy and this time to disease burden, and again, keep the patient's needs front and center and ensure that that continuity of care is delivered over time.

19:56 VD: One way you can do this, this is using Komodo's platform Aperture, is to identify clinicians who are seeing the highest volume of your specific patient population, and perhaps those individuals who also have a high degree of focus on your patient population out of their entire practice. As clinical data may fluctuate during these changing times, this can keep you informed by continually looking for the individuals who are seeing and managing your patients. I previously also mentioned the value of seeing the entire Care Network for those individuals, especially if patterns of care shifts in the coming months, knowing which other HCPs are part of the network of care for your individual patient population or your individual stakeholders can give you more options to explore for engagement and for education.

21:05 VD: You might also find that you need to make different decisions based on different geographies, or you're simply anticipating like we are, that what holds true for one part of the US may not hold true for another over the next few months, medical teams are sometimes starting with a geographic region and then honing in on the specific factors that matter most within that area or territory, or again, finding the HCPs in that area or territory that are continuing to see the patients of interest. And one other way our teams are thinking about it is that as medical education, for instance, moves online, it's becoming even more important to create very specific lists of HCPs in different segments to include in different types of medical education programs that are tailored just to them, because Aperture, for instance, makes HCP's clinical experience, scientific activity and industry involvement information all available in one place, tailoring your education or messaging to physician specific patient population and knowledge area becomes very quick and efficient.

22:18 VD: In this new world, a strong digital engagement strategy that's based on segmented, relevant educational content is key as clinicians are spending their time and focus managing patients through this uncertainty. And as teams are making some of the changes that we described, there is a growing need to track the results of these activities to assess the outcomes and impact of these maybe virtual-only strategies and enable medical affairs teams to test and validate their approaches and course correct as needed. Impact reporting is something we developed at Komodo to help address this specific problem and to create compliant quantitative metrics that medical teams can use to measure the impact that they're having on their market. By connecting the approaches we reviewed on the last few slides to your engagement data, you can start to visualize some of those things over time. One potentially interesting way to use this is to simply be able to track and visualize what's happening in the market? Where is engagement continuing to take place? What kind of engagement? With what types of HCPs or in what specific geography? How are those HCPs can be...

23:42 VD: How can those HCPs be segmented? And what percent of your patient population have you been able to successfully reach through that engagement? We also don't know what the impact of COVID-19 will look like in a month or two months, but we expect some geographic areas are going to be hit harder and potentially have longer lasting repercussions than others, so being able to monitor those changes across differences and geographies can provide you and your team's valuable insights to align or re-align the resources you have to the HCPs with the patients who need it most, and having a place to monitor and visualize your engagement with HCPs over time, can enable you again, to react to this changing situation, we don't know what the rest of the year will look like from here, but certainly there's a need to keep an eye on what your teams are doing, what's effective and pivot or respond accordingly to be able to continue to provide high quality medical engagement and education to the marketplace.

25:03 VD: And lastly, as we think a little bit about things changing over time, it also becomes important to think about the use of very timely data to inform what's happening in the marketplace today. As clinical practice and as treatment pathways evolve, you will be asked potentially to respond in more or less real-time to new and different questions that HCPs are facing. Being able to know where patients are and are being seen can help you monitor those changes and respond as you need to, by getting regular alerts as to where patients are being diagnosed or being treated, you can assess whether or not the patterns of care are changing and pivot to react accordingly. The result of that is that patients could still get the therapies that they need when they need them, and field teams can still be productive engaging providers regardless of their ability to travel. So I wanna take a couple of seconds and think about what's ahead of us. We've talked a little bit about virtual engagement, which may be the new reality moving forward from the era that we're in today. There's likely going to be a long-lasting impact to patient care and outcomes, I think many of you may have already discussed as teams, how this won't just end when shelter in place ends.

26:36 VD: There is likely going to be a longer lasting impact and a long tail to patient care for those patients who have potentially missed screenings or haven't been diagnosed in the last couple of months as they've been sitting at home or who've taken drug holidays for instance, as they wait to go back to work. As a result, we think the medical affairs function will just continue to grow beyond even where it has grown to today in importance as a strategic partner to the rest of your organizations as well as to HCPs. There's going to be an increasing need to think about how to take real-time, real-world data and respond quickly to the landscape, provide timely information to clinicians and help guide them as they seek to understand what their options are for continuing to provide valuable care to patients. And in some ways, this means we're not just... We're not only flattening the curve for COVID-19, but in a sense you could think about, so to speak, flattening the curve for other therapeutic areas impacted by this pandemic.

27:48 VD: While not the same, we have to start to think ahead to the secondary impacts that other patients that we care for and that we're committed to developing life-changing therapies for are going to be impacted by this pandemic, and ways that we can minimize that negative impact to them. So I'd like to recap a few of the themes that we've discussed in the past half hour today, really we've seen the clinical practice information could matter now more than it ever has before, while always informative, this era as patient care is potentially affected by COVID-19, it becomes even more important to understand the HCPs that are seeing your patients and caring for them, especially as that may change over time. To address that, medical affairs must continue to become even more data-driven to address the changes in the marketplace while maintaining the focus on patient care and outcomes, and we've talked about ways that you can do that by reassessing your strategy and aligning it to the disease burden of your particular patient population, and then monitoring the changes to that disease burden over time and the impact your team is having on that patient population. Here at Komodo Health, we're committed to reducing global burden of disease and to helping medical affairs teams navigate through this new landscape.

29:19 VD: Because of our mission to reduce the Global Burden of Disease, we would love to be a partner to Medical Affairs to help you think through how to do that. We're currently looking at our data now at Komodo across various therapeutic areas to try to understand what the impact has been so far and is going to be on different patient populations. We are going to be continuing to share those insights with our community over time as time goes on, and we learn more about how patient care is being affected. If you have an interest to talk about your therapeutic area in particular, and how we might be able to help dress the disease burden in your patient population, we would love to have that conversation with you. So I'd like to ask for just a couple final questions before we conclude and save some time for Q&A today. We've talked a lot about measuring impact, and I'd love to know how your team is measuring your impact today, is that through CRM activity field surveys, a combination of A or B, are you already assessing disease burden or using some other metric? And I see it... It looks like there's some distribution difference across these things, right? 

30:44 VD: CRM activity, of course, is there and always has been there, surveying as well, and then a catch-all bucket of other. And we really see disease burden as being a potentially new and different and valuable way to measure the impact and realign to patient care as you move forward in this uncertain environment. So I wanna thank you all personally for joining us today and listening and providing your insights, we wanna continue to share those insights as we learn more with our medical affairs community. If you, again, would like to discuss your specific therapeutic area, how you can address some of the issues we've talked about, please feel free to get in touch with us. I now wanna take a minute to answer any questions that may have come up during the course of our discussion today, and for that, I will turn it over to Roxanne, to let me know what we have up next.

31:49 Roxanne Lopez: Thanks Vivian, we've gotten just a couple of questions and I'll go through now and give folks some time to chat additional ones in. The first one is, could I use the same clinical signals and strategies we discussed to help me prioritize PIs or sites for trials? 

32:07 VD: Yeah, thanks, Roxanne. That's a really good question. We talked a little bit about some of the potential impacts to clinical trials to timelines, to regulatory timelines. And so this one is very topical also. In fact, yes, I think here at Komodo, we work regularly with clinical development teams, as well as with medical teams who are often tasked with site identification and profiling out in the field as well to support clinical trial development and strategy, and you can use much the same sources of data and clinical information that we discussed as well to support identification of potential sites, especially if those change moving forward. So I would certainly say that the things that we talked about today are just as valuable for continuing to evaluate and refine your clinical trial strategy, or maybe your registry strategy to meet the realities of today's world.

33:09 RL: Alright, we've gotten an additional one in. "I work in a rare disease area with a very small patient population. How would something like Aperture work for me and my team?"

33:22 VD: That's a great question. So I mentioned a little bit about how Komodo and particular rare and life-threatening diseases are an area that we're concerned about, of course, right now, as we wanna make sure those patients who need care critically are able to receive it. Here at Komodo, we reconstruct the journeys of 320 million US patients, and so in much the same way that we talked about evaluating disease burden and clinical practice signals, we can do the same even for rare, ultra orphan disease areas by seeing those patients and the experience that they've gone through in the healthcare system and helping, again, realign your strategy, engagement and education to the HCPs or practice settings that matter most for that specific population.

34:14 RL: Okay, an additional question is, "Are you seeing push back from doctors in engaging with Med affairs by virtual means, or is that becoming more preferred?"

34:23 VD: I think that we're seeing a mix, and it's not necessarily that there's pushback that I've heard to engaging virtually, it's that for many physicians that's new for them, and a deviation from what they know they may not be readily equipped to do so, and many of them are understandably distracted by what's going on in their own practice and in the world today. I think that this is going to be a significant watershed moment for virtual engagement, and that we'll start to see HCPs forced to adopt some of those technologies, adopt telehealth, if they weren't already adopters of it, and start to see the significant value in virtual engagement with medical affairs teams as again, they start to face maybe new questions about patient care or about particular therapeutic areas they may not have been as familiar with, and will realize the value of continuing to maintain ongoing communication and engagement with medical teams.

35:35 RL: Are there fees associated with contacting Komodo to discuss specific TAs? 

35:40 VD: Absolutely not, no, no, no. Please reach out. We would love to hear it. We would love to discuss with you. You can reach out, I put the marketing at Komodo Health email alias right there, just to have an easy way to give you a point of contact and someone from our team will reach out. We'll set up some time to discuss with you with some members of our clinical innovations team, as well as any other individuals that routinely work in similar therapeutic areas to your own.

36:13 RL: Okay, we've gotten a question, it's a bit median a two-parter so bear with me. "I recall Komodo maintains the journey of 320 million US patients. What are the different clinical signals or metrics that Komodo gathers that inform how we calculate disease burden? W So that's part one, and then, "How do you foresee disease burden either changing or being re-defined in this new COVID-19 reality?"

36:39 VD: Yeah, so first, just speaking to the clinical information, so Komodo's data is built on a backbone patient level claims data, and we get that claims data from a variety of different sources. One of the hallmarks of our approach is that we have relationships with over 150 different US payers to directly ingest their patient level data feeds. So especially for that population of patients whose data comes to us through those payer complete partnerships that I was describing, we have truly a closed-ended view of that patient's interactions with the healthcare system. So for that set period of time that we're captured them through those means, we see every single interaction that that patient has with a healthcare provider or a healthcare organization today. We also couple that with a number of other different types of sources of clinical data such as diagnostic data. So when we think about disease burden, we are taking an approach to measuring and quantifying the degree of clinical interactions and clinical encounters that patients are having in that specific therapeutic area over time and in particular geography.

37:57 VD: It's a little bit different than measuring, say, prevalence because we were actually measuring effectively utilization of healthcare and claims associated with that particular therapeutic area at a patient level per, say, 100,000 population. So that's really how we think about the disease burden index. It's a little bit of a way... It's similar into that it... We think of it as a rate, much the way that you would think about a prevalence rate, but it really reflects the care being delivered on the ground, and where those patients actually are receiving care, if they're not receiving care, then they're not part of our disease burden index so to speak. So one thing that we think is gonna be really interesting to observe and pay very clerical attention to over time is exactly what I was just speaking of. If care is not being delivered or a patient isn't seeking it, then you actually, in some ways, see a dip in disease burden at the outset. You could anticipate that in the short term, there's some kind of decline in encounters, and actually and effectively in patients observed who are going in for maybe regular visits or treatment or procedures.

39:18 VD: What we think is that when we see that dip, that dip is gonna correspond over the long-term to a potential increase in disease burden. So for instance, over the weekend, a team of us spent some time looking into and preparing to evaluate breast cancer over time across a few different stages of disease, so to speak. One being routine screening, like mammograms, another being early stage surgical treatment, like mastectomies, and a third being drug treatment for metastatic disease. Now, you could imagine that a sharp decline in the near term in one and two in mammograms or in surgical procedures, you could see a drop in that disease burden, so to speak, for that defined patient cohort, which over time might correspond to an increase in the third, an increase in the number of metastatic breast cancer patients as cases are not diagnosed quite as early or are not treated as early. So that's some of the things that we are thinking about and how we're beginning to monitor disease burden over time.

40:31 RL: Can you speak to how health alerts get delivered, and how frequently that happens? 

40:38 VD: Yes, I'd be happy to. So Pulse, for those of you who might not be familiar with that name, Pulse is Komodo's clinical alerting solution. And I mentioned it a little bit earlier in the webinar today, as a source of some of the timeliest data that you could have to act upon in your specific therapeutic area. What we do here at Komodo is we tap into the data we're getting... That is being delivered to us on a daily and a weekly basis and provide weekly alerts or updates to pull subscribers that alert them to the fact that in the last week or two weeks, a patient that met a certain pre-defined set of criteria was seen in a given HCP's office. So for instance, for medical affairs teams, if you think about, say, you work in a condition in which diagnosis is... A delay in diagnosis could be very detrimental to your patient population, or it's a challenging diagnosis to make, you could set up some rules to receive weekly alerts on the new diagnoses with your condition or on patients that meet certain other criteria that give you a high index of suspicion for that diagnosis, and track over time where those alerts are coming from. If they're coming from the same types of HCP specialties or care settings that you already know, and then kind of anticipated, or if there's changes happening over time.

42:16 VD: And so on on a weekly basis, we provide those reports to teams, typically, in a spreadsheet format.

42:29 RL: That concludes all of the questions that we received via the Q&A so it looks like we can conclude, Vivian.

42:34 VD: Great, I wanna thank everyone again for joining us and for your thoughtful questions and participation in the polls. We would love to continue the conversation, and as I mentioned, continue to share insights as we learn things from our own data and share those back to the broader community. In the meantime, I wish all of you to remain healthy and safe and that you're able to effectively move forward with your important work in this time. Take care, everyone.

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