Innovation On All Fronts: Shifting Solutions to Meet the Needs of the Patients | LSI USA '24

Lisa Carmel  0:03  
Good morning. We are very, very excited to be the first panel of the day. And we have an amazing panel here for you today. We are speaking on innovation and how do you leverage all of that, that innovation to bring in shift solutions to better meet the patient. We have a variety of voices here we feel that makes for the best panel, Healthcare Center of Excellence, a strategic venture capitalists, a startup, and we'll be discussing some of the issues and in some of the opportunities in front of us, my name is Lisa Carvel, I lead a strategic partnerships at Baronets and bear next is a medtech. med tech innovation solutions firm. We deliver end to end innovation. My other job my passion is I am on the leadership for med tech women. I'm on a chair of the advisory board. And in the past few years I've co chaired the Med, med tech women annual summit med tech vision. We'll go around and go down the line and introduce ourselves.

Janani Reisenauer  1:26  
Good morning, everyone. It's a pleasure to be here. I'm Dr. Janani Reisenauer. Our I'm a thoracic surgeon, and interventional pulmonologist and Chair of innovation for surgery at Mayo Clinic. It's a pleasure to be here.

Amanda DePalma  1:39  
Good morning, everyone. I'm Amanda DePalma. I lead marketing for ultrasound at Siemens Healthineers. And I spend a lot of my time with medtech women on the board and work closely with Lisa and also as the chair of the women's executive network at Adva men so it's great to see everybody. Thanks for getting up early to be here.

Ashley Seehusen  2:00  
Hi, I'm Ashley Seehusen. I am a venture partner at Sante Ventures. I also run our portfolio. We call them our seedling company. So it's early stage investment. Basically, if we have a thesis, we're not finding what we want to invest in, we'll go out and start the company.

Maria Artunduaga  2:15  
Good morning, everybody. I'm Dr. Maria    Artunduaga, decision scientist turned CLT. Semi we are building hardware and software for respiratory health. Happy to be here.

Lisa Carmel  2:25  
All right, so we are going to kick this off talking about some of the issues and hurdles that we're seeing and, and shifting those solutions to meet patient. Patient needs. With Dr. Rice now we're here from the main. Yeah,

Janani Reisenauer  2:40  
so I think the last two to three years as we've emerged out of COVID have really been an interesting time, there was a rapid resurgence of telemedicine, remote monitoring devices, delivering information and solutions directly to the patient as the consumer as opposed to the healthcare institution, which is historically it's a change from from historical trends, which was industry goes to the healthcare institution, and then they disseminate it to the providers, and the patients are just the subjects or the volunteers. So it's a little bit of a culture change and a culture shift. We're currently in a in a technological revolution. And some of the interesting issues that arise is how do these different players get a seat around the table? How does industry and healthcare institutions find a way to work together to bring the best interests of what's best for the patient to the patient, and also let the patient potentially have a seat at the table. And then lastly, in a world where social media is at your fingertips, and patients do have access to all of these technologies on their own, who is the best person to help them make decisions in terms of what that accessibility should be to the patient as the consumer as opposed to the provider?

Lisa Carmel  3:51  
Does anyone else want to jump in? Sure. Yeah.

Maria Artunduaga  3:54  
Yeah, thank you. So one of the main obstacles that I have also witnessed specially I really like to tell the story about my grandmother. They are unique story of samurai. It's a type of technologies that we are actually using to monitor, monitor and manage patients with chronic diseases. In the case of respiratory particularly, we are still relying a lot on technologies that are not adequately monitoring or understanding, for example, how the longest functioning, we are still, for example, relying on devices that are have very poor appearance like 60 to 70% every other week. And we are making a lot of these patients to do like forceful and very difficult maneuvers to try to understand how they are doing. In the case of my grandmother I tell the story about her is because we have firsthand that we have witnessed firsthand the problem that we have technologies for respiratory patients, we do a lot of questionnaires, we are basically most of our medical decisions on subjective data. So I'm really bullish about the idea of taking of capturing the data in a very different or innovative fashion and that's one of the things that we are doing with some I

Ashley Seehusen  5:03  
O, I think it's also changing the way we look at companies that we're potentially going to invest in. So a lot of things are moving to the patient's home, how are they reimbursed? adherence, as you say, is like a huge thing of, if it's not an implantable? are they actually going to use it? How long are they going to use it for? Who's going to pay for that? So it's changed the way we looked at startup companies, the technologies that we're considering, and it's kind of a slow evolution.

Amanda DePalma  5:27  
And I think from a manufacturer, product development standpoint, the way that we have to think about ease of use, and if we're developing technologies, and as many of you out there are developing technologies as healthcare moves out of the acute care setting and into clinics and home care. How do we think about usability of our systems so that, whether it's in the case of ultrasound, and still a clinician that needs to capture that image, but not one that has been trained and uses ultrasound all the time? Or if it's a patient or a caregiver? How do we make our technology such that you're gonna get the same result every time? It's a big consideration as we see the shift in healthcare?

Janani Reisenauer  6:12  
I think it also, it's an interesting point, because now if the responsibility to some degree is on the patient to wear a device or to monitor whatever, how, how responsible, does that make the healthcare institution from a malpractice standpoint, is it's a really important consideration. And then does compliance factor into that as well. We did a study where we asked patients to go home on it with a device after surgery, and about 50% of the patients decline the study up front, for a variety of reasons. One, the whole big brother concept, they're holding their smartphone in their hand, and they're telling you, I don't want this device, though, to tell me where I'm going to be at all times. So that was part of it, too, is they felt like it was invasive and cumbersome. And they didn't want to be in their mind, it was if you think I'm healthy enough to go home, then I'm healthy enough to go home, I shouldn't have to wear all this other stuff. So although there is that aspect of the patient populations that are wearing rings, and watches and and other devices, and like that added degree of security, others are not. So can you really force a patient population to do that? Or is that their Choice when they're no longer in the hospital?

Ashley Seehusen  7:20  
Can I ask you a question? Sure. What do you guys do with all the data you get? This is one of the things that I've always worry about is like, oh, yeah, we have all this like data that the physicians can monitor patients from remotely. And I'm like, Well, who does that? And if you have hundreds of patients, how do you possibly sift through all of that of who's really in trouble and who's not?

Janani Reisenauer  7:39  
Yeah, it's a really hard question. Because I think it's easier if you're capturing a watch, that's just capturing three data points, like morning, afternoon, evening, they put it on and they turn on something or other. But if it's continuous waveform monitoring, where you're getting terabytes and terabytes of data, and you've got, even if you've got 30 patients out there wearing a device that's capturing natural waveforms all throughout the day, you need somebody and maybe it's not even as somebody, you need a supercomputer to really sit there and evaluate all of that. And that's where data and all these other interesting aspects come in to quickly and rapidly filter that data as to what's a real red flag versus not. And that's a bit of a challenge. I don't know that. I think that everybody recognizes that that's an unmet need. But how we're going to accomplish that is still yet to be determined.

Lisa Carmel  8:27  
You know, another issue that when we were discussing this earlier, we were talking about funding issues, and for startups in new innovation, and one of the areas that we're seeing is so many startups are bringing this novel, disruptive or AI solutions, and, you know, trying to help them figure out how they can, you know, deliver, they can help facilitate better patient meet the Meet the patient needs, but how are they going to get paid? And thus, how are they then going to get funded? And do you want to speak to the funding? Lovely,

Maria Artunduaga  9:04  
thank you, Lisa, for bringing that up. So we have a very innovative approach that nobody has ever tried before. We already have seven patents. But five years ago, when to start a company I started asking a lot of questions to respiratory patients trying to understand why is it that I lost my grandmother, what was the main reasoning about that? It's very hard to get investors or anyone right from the private market to really give you you know, any sort of investment on something that it's risky, innovative and has never been tried before. So at least for us, and one of the reasons why I'm a cheerleader leader for all things going on the red pants is that we've been successfully raised almost 2 million from SBIR show. It's been a long journey we were talking about just like five months ago. It takes about a year to get your, your disbursement but more importantly, I don't know if my company will, will be actually alive today if you were in for from for knowing that lauric Grande, so it's something that it takes time, but it's actually very helpful. And at least for me as a CEO, it has made me a better executive, Principal, investigator, etc, etc. Because I really need to think about how I put together a technology, how I validated what type of naked valuation or results that I need to bring to the table to start talking to the investor so that they finally are convinced that we have something that is useful for patients.

Lisa Carmel  10:29  
You know, I was gonna say we were initially were talking about some of the issues, and we're going to move into some of the opportunities, innovations, and so forth. But before we do, Ashley, do you have any advice? For Maria, when you're when you're out in front with a, you know, how, how does she get? How does she how is she going to better attract venture investment?

Ashley Seehusen  10:53  
I think part of it is thinking about the back end of it to have, like, Are you always thinking about Zeo patch, right, where, initially they were they were looking at her arrhythmias. But it wasn't until they really have the business model on the back end, where they were delivering decisions port, I think initially, and then diagnostics later, etc. And may have built this whole service model. And the service model is what makes the patch really different. And, you know, I think I, we see a lot of continuous monitoring technologies. Some of them are really differentiated, like yours, and some of them are not. The ones that stand out are the ones that have thought through that back end, and how they're actually going to deliver care. And in some ways, I feel like someone should just figure that out, and then offer that service to all of you guys, which would be amazing. And I'd invest in that. So.

Lisa Carmel  11:48  
Okay, did everyone hear that? All right. So now we'll shift gears. And we'd like to go down the line here and talk about new innovations that you might be investing in launching or observing in this space that you that you think or, again, addressing patients needs shifting the solutions to the patient's needs. And who wants to go first?

Janani Reisenauer  12:20  
So I'll answer that, I guess personally and professionally. So personally, being a thoracic surgeon and an interventional pulmonologist, there's a huge arms race in the lung cancer world right now looking at novel innovative ways to deliver treatment for patients with lung cancer. So that's a that's a personal career and research interests of mine. And it's it's right along the landscape of the next three to five years, there'll be a lot of interesting innovation coming out of that. In my role as innovation chair for the department of surgery, however, I think there's also a huge push on how we're going to start incorporating data and AI to give better, safer treatment for patients who are going to be undergoing surgery. Mayo Clinic is in the process of building a brand new innovative facility, which we hope will go live and about 10 years. So there's a lot of investment and research going into how do we outfit this new facility to meet the best to continue to serve as a category of one health care institution. And like I said, part of that is data and AI digitization of the operating rooms and what that looks like for surgical patients, more intelligent, listening in the clinic setting to capture patient's needs, incorporating healthcare disparities and recognition of an individual patient's social factors and how they recover in their homes with their families. So it's a big, broad answer. But all of those things are pretty exciting to us.

Amanda DePalma  13:45  
Yeah, and I think from an industry standpoint, as we think about the same things, and but for us, it's so it's imperative that we partner with clinicians who are that touchpoint to the patient to understand what are the clinicians need to better treat provide better care for patients. And it's so important when we hear words like AI and all the buzzwords right now, at the end of the day, if if I'm not solving a problem for Dr. Eisenhower to make it easier for her to see more patients to diagnose patients faster. It doesn't matter what AI algorithm we're using. And so from an industry standpoint, we're really thinking about what are those algorithms that are going to improve workflow that are going to we've got an algorithm that we're working on that will reduce the false negatives from a breast cancer perspective, right? So you reduce anxiety for the patient because you don't have a negative a false negative reading. You allow a focus on the patients that are more likely to have a true positive reading. So you can move patients through faster and you can get those patients that need that next step of care faster. So it's just for us it's really thinking About what do our clinicians need to take better care of that patient make your lives easier? Because there's so much technology right now, I think you said we're in a technology revolution. So it's so easy to want to do everything. That's cool. And but if it's not making a difference in your ability to care for patients, it will I don't think it'll ever see the light of day. Yeah,

Ashley Seehusen  15:22  
I think to kind of follow on to that, too, is, is we're trying to figure out how to look at the entire ecosystem, right? So it's not just the new big fun device, it's how does that fit into the flow of surgeons and nurses, etc? What data does that bring to the table? What else is required to monitor that? You know, how do you diagnose diagnose something? How do you continue to monitor after surgery, etc. So it's sort of figuring out the entire ecosystem of an opportunity, and really digging into the new corners and the new things that we're figuring out to make patient experience and physician experience as best as it possibly can be.

Maria Artunduaga  16:00  
I'm really bullish about the hospital home programs, it has been already demonstrated that it's cost effective, frees up beds, alternative source of revenue for hospitals, decreases a hospital infections, patients obviously like to be being, you know, manage at home than staying at a hospital. And in order for us to do that, again, I go back to the matter, right, remote diagnostics, I'm bullish about it, because you could you have the ability to incorporate AI. So in order for us to train a lot of predictive models, you will require a lot of that are coming from the actual patients. So either wearables patch, etcetera, etcetera, that actually motor physiological parameters are super important, then you can, you know, easily train your algorithm algorithms, and, obviously, the backend, right, like interoperable interoperability API's, and how we actually create a good enough insights for clinicians to actually act upon that data. So I really like it. And

Ashley Seehusen  17:03  
I think the other thing, the other missing piece here, too, is CMS and reimbursement of how do we get them in line with these things that bring better patient care, we know that they work, we know that it improves lives, but if it's not reimbursed, how is the company going to make money, so who's going to acquire it, and therefore who's going to find find the startup that's doing it if we don't have reimbursement on the other end?

Janani Reisenauer  17:28  
I think going back to all of that remote monitoring, it's something that we haven't quite figured out yet. Because if you have a technology that can do those things, but you don't have clinical decision making and judgment behind it, at the end of the day, it's no different than a Sleep Number bed, which I don't sit on their board or anything. But it's it's fantastic technology, but you open the app, and it tells you your your sleep score is this and do this and do that. And I look at it, and I'm like, Well, who are you to tell me you're not a doctor, you know. So it really is important to tie it back to well, what does that mean? Right? We can tell you all kinds of stuff. But what does that mean? And who should be the one telling you what it means and what you should do about it?

Amanda DePalma  18:11  
Sorry, we laugh because we know somebody on the board there.

Ashley Seehusen  18:16  
Yeah, I was gonna say I feel like we're kind of in the wild wild west of hey, here's a bunch of data. Yeah.

Lisa Carmel  18:24  
Well, so Ashley, I was gonna say is, is there anything in your portfolio that you want to share something you're particularly excited about?

Ashley Seehusen  18:34  
No. I think we're, I think we're still figuring it out. Right. Of you know, a lot of what we invest in, in the sort of traditional on the medical device side is the is traditional medical device. We are seeing this bigger overlap between medical device and what we call health tech. So we have we have three different verticals. So we do med tech, health, tech and biotech. But what we're seeing is sort of this creeping back and forth between health tech and med tech and, like med tech that has a health tech components pretty interesting. But we're still trying to figure it out.

Unknown Speaker  19:06  
What about AI?

Ashley Seehusen  19:08  
I had to so it's interesting. We do our IPs, like I'm looking at Elizabeth who's one of our venture fellows, like ai, ai, excuse me, do a lot of research in it, etc. We talked about it a lot. We have one specific AI play right now called Clarity AI, which takes a mammogram and gives uses AI to give a score on likelihood of progression. It's been really interesting. It's been definitely not our most straightforward project, but it's pretty cool. Yeah,

Lisa Carmel  19:44  
I was gonna say, tying two themes here. We design and develop, you know, med tech innovations, and pretty much I would say every other call is about a new AI either, and an acquisition target. or a startup, and they're trying to figure out how are we going to make money? How are we going to get reimbursed? And

Ashley Seehusen  20:06  
that's always the hard part. Yeah,

Amanda DePalma  20:08  
I mean, I think AI is definitely a, it's kind of a, it's a buzzword right now. And it goes back to are you what problem are you solving? At the end of the day, however you solve that it could be AI. I mean, frankly, automatic calculations have been behind a lot of imaging and other technology. For years, it's been back there helping to calculate measurements. And so I don't think AI for the sake of AI is, is going to help our clinicians or patients, it's what is the problem that we're looking to solve. And in some of the things I see that are most difficult right now, if you look at health, workforce shortages, if you look at just not enough beds in the hospital to take care of the patients, solve the problem, you know, make sure that you're talking with your clinicians and that your understanding their pain points, and then what are the problems that you're solving? And how do you solve that? Maybe it's AI, maybe it's something else that you're using to solve it. But AI for the sake of AI? I feel like I don't know, because I'm on the other end of it. But I feel like you must be inundated with everybody talking about their AI. But what matters to you when we're talking to you about

Janani Reisenauer  21:15  
AI? Yeah, it's an interesting question. Because sometimes people say, Oh, we're using AI to do this or AI to do that. And that's great. But like, could you have done the same thing with a large data set review and multivariate regression analysis? And gotten the same answer, you know, so like, what is really AI telling you that, that retrospective data, and anecdotal evidence and years of clinical practice isn't telling you? So I think that is an important question and distinction between AI and automation that you bring up as a really important question, too, because I don't know that AI is really going to solve the workforce shortages and the hospital bed shortages. But is automation play a role there? So I think everything has its place, and everything has its niche, but there's not going to be one easy button for all of the problems. And I think just understanding what's the right solution for the right problem is is an important question to answer.

Lisa Carmel  22:06  
Is there are there any exciting opportunities that you wish or, or unmet needs, things that you're looking at, that you're hoping AI is going to be, is going to facilitate or out? Yeah,

Janani Reisenauer  22:18  
I think that, that better smarter decision making is, is something that AI is going to be helpful, it's not going to replace physician decision making, it's not going to replace anything, but I think of it almost as a virtual assistant, when you need it to and utilizing AI to determine what somebody's expected length of stay is going to be whether they're going to need a rehab facility to go home to versus are they going to be able to go home? Do you think they're going to need to go home with a drain or not? Or this or that to help help the patient understand what at home recovery is going to be like? There's some there's some interesting aspects there. And then also, how AI plays a role within the surgery itself is an interesting question. There's a lot of devices out there that incorporate AI into surgery, but what's really going to change? Like if that device wasn't there? Would I have done the surgery any differently? Those are the those are the questions that I think are interesting. And we'll have to see. Ya.

Lisa Carmel  23:20  
I was gonna say we also see the training burden. And and basically, I think, you know, when you're designing or coming with a new technology, we're hearing Oh, my God, if you could just, I just don't want it. Look at one more screen. Just give me one less cream to look at one less step. Let's see. We are we have have a little bit of time here. I was gonna say, I know, Maria. Yeah. You're out in front as a startup here with a novel technology. Do you? Do you have any? We were we can talk to the startups in the audience actually, all the way down here. And give some advice to the startups that are here. I think there's like 300 startups in the here. And everyone's got a different perspective. I think we got plenty of time we can talk through. And we might I don't know if we're taking questions, but if you'd like to go through and everyone give some advice to the startups that we have in the audience,

Maria Artunduaga  24:33  
yeah, I get this question a lot. We've done fairly well. Hey, Maria. Maria. I'm sorry. Yeah, sorry. That's a question that I get asked a lot. I'm sorry. This way. We have done fairly well over the past few years. Raising funds from from the federal government especially. We outsource most of our platform development to Latin America to Colombia, where I'm from originally we have 14 People there. I would have to say the two things I do things that I highly recommend it's to obviously we very persistent or stillborn, I always call that to be my superpower. Be very stubborn, be resourceful. Always try to get a yes. Regardless of like, if they obviously say no us most, most of the times, find another way to figure out the problem and to get to the right solution. And obviously, being very resourceful in a way that creative, right the way how you not only are you innovating with the technology, you're creating or your product, but how you solve the issues or problems every single day, relying on our good net network of founders, like I have a lot of chats on WhatsApp for people that I have on my like, literally my phone, that I can text with questions. It's something extremely important to because putting together I'm like building a startup coming from the scientific clinical world to me, something completely new. And honestly, it's something that you learn day by day entirely from gossip. Like, really, that's, that's how you, you do these things? Do you I don't know a lot of things day by day, I always listen to other people do a lot of qualitative research and customer discovery, and come up with a solution after talking to at least three to four people. So that's what I do. Yeah.

Ashley Seehusen  26:19  
Let me just add on to that. I'm just like being a CEO as a really hard, hard job as a founder and just surrounding yourself with people who are supportive, and realizing it's really hard. And you know, when the buck stops with you, and you know, you need people to talk to, because it's not always going to be or your team, etc. Because sometimes you're the one who needs to make that decision. So yeah, sorry.

Maria Artunduaga  26:43  
I remember when we were talking a few years ago, right? Yeah,

Ashley Seehusen  26:47  
I would say from my perspective, just really thinking through I think we keep talking about what's the problem you're solving for who and then I think who's going to pay for it? And making sure that's really clear in your pitch deck. So you should be answering that question like in your first couple of slides. And making sure that that you understand that you understand your value proposition. And it's very, very clear. Raising money is hard. So don't give up.

Amanda DePalma  27:15  
I'll speak from a strategic standpoint, I think, if you're looking for potential exit funding partnership from a strategic, make sure you do your research, understand the business priorities of that strategic. So for example, at Siemens Healthineers, we're looking at cancer care pathways, we're focused on CV neuro. If you're not playing in those spaces, at a meeting like this, don't waste your time trying to reach out to me just because I have a Siemens Healthineers badge. If you are though, reach out, but tell me what problem you're solving and tell me how you can do that differently. at a big company. Innovation gets stifled, we need startups in our ecosystem, to be able to truly innovate and think boldly take those chances. But tell me how that helps our business and helps us solve problems for our customers. For the strategics out there be that voice, I mean, I just I think we all owe each other in the ecosystem, being that voice for someone is share your experience, share what you know, make connections help people connect here. I think it takes all of us working together to fix our healthcare system and solve these difficult problems that we're trying to solve.

Janani Reisenauer  28:25  
I think from from our standpoint, you know, I'm lucky to work at a healthcare institution that has some of the best and brightest minds in the world working at the number one hospital, and there's a wealth of information there. And there is a passion to partner and there's a passion to work together. I think people are less enthusiastic about just trying a product in the or, or trying a product in the clinic because we get inundated with those requests every day. And it's it's a lot harder to be invested and passionate and render an opinion where, you know, somebody comes to you and says, Oh, I've got this really great device, would you be willing to try it and five or 10 patients and let us know what you think and give us iterative feedback. I mean, that's, that's fine. But like, there's a lot of people that want those requests. And it's hard for us to take time out of our practice in our day to be invested in those where we really feel like we're co collaborating co developing with you learning our IP and our expertise to really make this a problem, the answers on unmet need. That's when we also feel like we have skin in the game and stake in the game to make sure that the device or the product is successful. So I think it's important to reach out for that clinical expertise early and seek a partnership early and mayo is very interested in exploring those opportunities and very eager to do that.

Lisa Carmel  29:40  
Do you want to talk a little bit about the Mayo Clinic bears surgical innovation summit?

Janani Reisenauer  29:46  
Yes. Thank you for the reminder. So we have an annual innovation summit conference that's now in its third year. We're officially in the potty training phase. We're no longer a baby anymore. We're a toddler. But but we do invite startups investors strategics, alike, who are innovating, in, in surgical innovation. We're fortunate to have over 300 members from industry present last year, we have approximately 70 ad surgeons and attendance from our department of surgery. And really the goal is to understand how we can strategically work together and CO develop together and do important first inhuman work together as well, if applicable, one of the highlighted segments of last year specifically is we had co presentations between a male surgeon and a startup who sought each other out early, and then through the involvement of our Mayo Clinic ventures group, were able to actually execute a deal and are now working together to bring products to the market. So that was a really exciting component of that program. And we hope to continue that and thank you for cheering that steering committee on the on the industry side, and we will, we'll be doing it again this year in November.

Lisa Carmel  31:02  
You know, I think this ties to why we were bringing a lot of the people here on this stage because all of us are can interconnected. And we're either a part of the leadership of, of med tech women, or we're partnering with the mayo, Scott Pentel Henry pack of LSI are also on the steering committee, as is med tech innovator to try and identify startups that we think could would be ideal candidates to for the male to consider and partner so for the startups in the room, lean in and look to get involved with some of those organizations, whether it's med tech women med tech color. And if you'd like to hear more about the Mayo Clinic and their surgical innovation summit, if you're in the room or listening, you know, please reach out to Dr. Rice in our near Goldenberg and or any of the steering committee here. And let's see, I think we are close to being at time. Are we taking questions? Or are we not doing questions? We're almost out of time.

Audience Question  32:35  
What's the best way to find the investment pieces for the warranty? The Insert features?

Amanda DePalma  32:47  
So let me repeat the questions. And I think your recording, the question was, What's the best way to find the interest of the large strategics oftentimes on the website, I think if you go to the website, you'll often see the business areas of focus or if you go to the investor, slide decks, they'll talk about their areas of focus in the quarterly earnings release. So typically, in the larger companies, you'll be able to find that on the website and aligned to those.

Audience Question  33:15  
Yes, do exactly this. Come listen. Yeah. And hear these conversations and then meet?

Amanda DePalma  33:21  
Yeah. And Scott. No, that's that's very, I think I said that last year. And I'm sorry, I didn't repeat it this year. It's super important. These meetings are the best place to meet up it. That's why Scott has this meeting. It's to bring the ecosystem together with the startups, the investors, the strategics, the clinicians, because it's these conversations and this ecosystem that we're here to meet. So be at meetings like this and listen and get up on stage. We'll come to your pitch as well. I mean, that's, that's why we're here. So

Lisa Carmel  33:54  
thank you, and round of applause for these amazing panelists.