Making Healthcare Affordable and Accessible, Globally | LSI USA ‘23

Transcription

Scott Pantel  0:08  

I want to welcome you to our stage. And thank you for coming all the way out to spend some time with us, Elisabeth. And I think it's a nice tie in, we have somebody from our industry up here talking about something that's important to them. And I had the privilege of having a brief lunch this afternoon. And one of the things that came out of it was how important it was for you and your career to be involved in something that can make a difference. And so that that's beautiful. Tell, please tell us about yourself and your journey at Siemens, and then we'll get into some specific questions.

Elisabeth Staudiner  0:40  

Right, so as it was mentioned, in the introduction, Elisabeth Staudinger from Siemens Healthineers. And I've spent actually, my entire working career with first Siemens, and then later, Siemens Healthineers. And sticking around with one company for 25 years may sound a bit exotic, especially in the circle that we have kind of joining us tonight, the same time, I can tell you, it's been very, very far from being boring by any means. So in the 25 years I've spent with Siemens, Siemens Healthineers, I've lived in six different countries. And I've had the opportunity to work in very different areas, also of the business, which is something I always aspire to, yeah. And which also made me stick around, and maybe to comment on this piece doing something which is meaningful. Right? When I was graduating from college, I was clear about two things. The first one was, I wanted to work for a global player. So I was interested in having this global scale of doing things and making a difference. And the second thing I was sure of is I wanted to go somewhere where a company which does things which which matter in a way which matter to society which matter to mankind. And Siemens as this engineering infrastructure giant to me seems like a good fit. After a few years working in different parts of the business, I had a chance to join the healthcare division within Siemens in those days. And to me, that was really then the moment when I said, Okay, I've arrived. Yeah, I'm now in exactly the space where I want to be, and where I can be part of something and contribute to something which truly matters.

Scott Pantel  2:48  

That's great. I saw today, one of the things that jumped right out to me was that you came in, I think, late last night. And this morning, early in the morning, I see you are taking meetings already with innovators here who are who are doing things that matter trying to do big things, any observations from the meetings you had today, or any general observations about this meeting that we've pulled together here?

Elisabeth Staudiner  3:14  

Well, for me, it's the first time joining LSI. And I wanted to make sure I take full advantage of being here. So it's not only about joining a session like the one tonight, but I said now I want to really learn what's going on here and also connect so I had back to back meetings throughout the day, I met with 10 Different companies. Some of them already do have connections to Siemens Healthineers. Others might be interesting companies to team up with work with with look into. And it's been fascinating to see the range of different topics people are working on, beginning from Metaverse, digital topics to people trying to look for ways of making tumor treatment more effective, all the way to imaging and other types of procedures, surgery settings, robotics in that space, hugely fascinating range of topics. And I had the opportunity to speak to 10 I'm sure there is many, many more equally fascinating ideas which are represented in this meeting this time. 

Scott Pantel  4:31  

That's great and we'll come back to this idea of how to how to get in touch with the big strategics. But I wanted to talk about I know that Siemens Healthineers is not a mega m&a machine. However, you have had some significant transactions, especially recently with a Varian deal, and I'm imagining that you're always open to other ideas. Tell us about the Varian deal. Why Varian? How did it work? I know the timing was very unique as well.

Elisabeth Staudiner  4:58  

Yeah, so Well, I mean, we have a continuous flow of smaller acquisitions we're doing and partnerships we enter into. But the opportunity for us to team up with Varian was truly transformative for Siemens Healthineers. And if you look at the story of this transaction, and it was about a $17 billion acquisition that we made, it was the most expensive acquisition Siemens had made in its entire history, which spans more than 150 years. So for us, it was really something very, very significant, very big. So how did it all start? Right, or what what made the stars aligned that the two companies ultimately ended up coming together? So the whole story started unfolding in 2020. You all know, 2020 was the year when COVID hit. But that was not the main kind of trigger of the two companies engaging in deeper conversations were to do together. It was for Siemens Healthineers, it was two years post our IPO becoming an independently listed company separate from the larger Siemens universe. And so two years into this independence, we had proven that we kind of say what we do, and that we deliver on the story we had laid out. At the same time, we had also said we would, after establishing ourselves, start venturing into adjacent fields and looking for expanding the markets we can we can cover and people were kind of waiting for. So what would they be doing next? So what what are the plans? What are the ideas and Varian, on the other hand was at the end of finishing a transformation from being a more diversified company to being a company purely focused on cancer? Yeah, with that ambition of creating a world without fear of cancer. And it's very, it was kind of strategizing from their end about what to do and how to develop further. And it became very clear when you work in this space of cancer and fighting cancer, and Varian is a company, which is the world market leader when it comes to radiation therapy. So the place where you try to destroy the tumors in the body. And they realized, without imaging, there is no way they can really live up to their aspiration. Yeah, because imaging helps you identify exactly where is the tumor, and then you can radiate it. And the closer you move these technology technologies together, the more impact you can have. And this is essentially what brought the two companies together, both of us looking from our perspective, it became clear if we make one step, which is bring together these two companies, we can really make two leaps, a leap in cancer care, and the leap also in relevance when it comes to making a difference to how healthcare is delivered globally. And it was this kind of broader vision that brought the two companies together. What is really interesting, and, in hindsight, a bit of a fun fact. I mean, the discussions and negotiations started in 2020. Yeah, in the midst of the COVID pandemic, everybody had to stay put, nobody was going anywhere. And we were kind of making this 17 billion transaction. Yeah, the biggest in the history of Siemens overall happen without anybody ever meeting in person? Yeah, throughout the entire process.

Scott Pantel  9:06  

So 150 year old company, the biggest transaction, the history German company, conservative, I'm gonna guess a little bit zero personal interaction. So the party afterwards, when did you finally meet and how did that party go?

Elisabeth Staudiner  9:20  

So our we close the transaction, it's almost exactly two years ago, so 21. So also in those days, we spent a lot of time thinking about the change management around it, how can we bring the people together the teams together. However, a lot of that happened virtually as well. But over the years now, we have found, fortunately had the opportunity to connect and meet in person. It's been a wonderful, full journey I have in the past two years.

Scott Pantel  9:50  

That's great. Really fascinating story. Tell us a little bit. Maybe we'll go higher level. What is your view on the broader M&A landscape, there's a lot going on in the markets. What's your long term view for m&a? Generally speaking.

Elisabeth Staudiner  10:08  

I think if you look at medtech, there is a lot going on, there is a lot of things which still can be improved can be discovered new clinical procedures to be established. There is a lot of people who are interested in that space. And if you take these factors together, I think it's very likely. And it's also what I would expect that we will continue to see a good flow of ideas emerging, people coming together, say we want to try to make this work, which then ultimately will lead into companies being acquired partnerships, new things being tested together. So I'm quite optimistic about this space. And the fact that also this meeting here has been growing year over year over year, and I believe, please, from what I hear, it's been the, by far the largest meeting ever, is testament to the interest and the need, that is there when it comes to looking for the next ideas and about innovating in med tech.

Scott Pantel  11:22  

That's great. Thank you. And you met with 10 innovators today, they were the lucky 10 You're with a with a company that has 70,000 employees. And so for all the the CEOs that say how do I get access to a Siemens Healthineers? How do I get access to an Elizabeth? I know that's an almost an impossible question. But any guidance you would have for everybody except the 10, that we're lucky enough today,

Elisabeth Staudiner  11:50  

I would say meetings like this one here, a beautiful opportunity. Because it is this place where you have the different parties, you need to come together you have the people who founded the startups who have ideas, they want to realize you have the investment community, you have companies like us who are interested in understanding which interesting ideas might be there. You have people from the ecosystem around these companies just we had the patent kind of dimension just here as our sponsors for for the night. So meetings like this one are a good opportunity. And there is other meetings in other parts of the world which create maybe additional opportunities. And on top of that, of course, you can always look for additional ways of reaching out trying to make direct contact, attend the relevant trade shows is maybe another place to look here where there is companies who are already in the market and typically also in place where you can meet and link up.

Scott Pantel  13:07  

Tell us about the this business opportunity funnel, which was a that was news for me today. And a piece of information that I don't think is generally known about tell us about why how it works at Siemens Healthineers.

Elisabeth Staudiner  13:22  

I mean, for anybody who has tried to link up with one of the large med tech players, you might have found it tedious. Yeah, you might have found, well, do these people really care? Right? And I can tell you, we do care, right. And we do make sure in a very systematic way that we consistently look at what is happening around us. We have a dedicated team in Siemens Healthineers, which continuously is screening companies is responding to people who reach out to us who check with the respective businesses. Is this something you find interesting, you want to follow up on? And from the top leadership team, so the board and also the next level? In the company every month, we get a summary of all the companies that there was a touch point, as well as what is the essence of what the company and the people are working on? And what was our assessments or was it an opportunity which was passed on to one of the businesses because they found it really interesting? Is it something we are looking at more from a corporate technology point of view? Is it something we have even moved towards being a real project, which might end up in investment acquisition whatever, or what's the opportunity declined? And I just checked last month reports there were about 30 companies on that list. Joe, if you take that times 12. So there's easily 350 companies we'll look at seriously, every year.

Scott Pantel  15:10  

I think if we give a nudge, we can get 300 more applications over the weekend possibly? Well, that's great. And it's the fact that you're you have I think you said the top 15 executives in the company are all taking a look at this report that says a lot about Siemens Healthineers. Let's shift gears a little bit we've had, we have a tremendous theme and innovators here that are discussing this broad idea of the digital transformation of medtech. And I understand that you are responsible at Siemens Healthineers. For the digital sort of strategy, what is what does that mean to Siemens? And tell us a little bit about that?

Elisabeth Staudiner  15:47  

Well, digitalization is a huge opportunity for every part of life and especially also for for health care. And if you look at the importance and the many different ways how you can tackle that thing, it's also clear that this is not a task, you delegate to one part of the company, digitalization and the work on these ideas need to happen in every business. So it's a really an effort where every business leader needs to think about and see well, how can I utilize the opportunities to just stay ahead and stay on top of the possibilities that are available. At the same time. I mean, I in my role, I there is two more central teams that make available for the businesses. One is what we call our AI factory. A team based out of Princeton with very, very impressive supercomputing power, we've nicknamed our supercomputer, Sherlock. And Sherlock can do an incredible amount of computations every second. And there is a second angle. And this is a team of about three and a half 1000 software engineers based out of Bengaluru where we have an Innovation Campus, also working across all the businesses that we have in in Siemens Healthineers. So as I said, it's not one place in the company which can solve this problem. And there is many, many nuts to crack when you look at digitalization. And I wanted to use the opportunity tonight to highlight one idea, which is at the core of how we look at our opportunity of adding to digitalization in Siemens Healthineers. And this is this vision of creating a digital twin of a person a patient. And what you can envision here is like a long term model of an individual which collects information on that person beginning from genome data, blood tests results, imaging is the history of your health. And this model that you create can then be used to guide treatment can be used to select the most promising therapy, it can help you maybe diagnose issues or disease captured very early. And then your treatment options are just so more impactful. And it's can also help you stay healthy so that you never become a patient in the best scenario.

Scott Pantel  18:53  

That's fascinating. And I know one of the other things that is a major issue in our industry right now. It's just is workforce shortages. Do you see how do you see is that something that you're thinking about is we're gonna have some help with AI to solve some of these problems or what is your what is your thinking about that?

Elisabeth Staudiner  19:10  

You're totally right workforce shortage is one of the biggest challenges and COVID really let this challenge come to the surface. There is not enough qualified people to do most jobs are all jobs that are necessary to deliver high quality health care and make health care accessible to people around the globe. And digitalization can be a very powerful lever to help address that. Be it by making work more efficient. If you support a radiologist in reading imaging exams and have parts of the process being automated, you can use the scarce resource, you have to do the most meaningful work and work on those cases, which really need attention. to maybe give you a number, there is about 870 million chest X rays, which are performed globally every year. So essentially, one out of 10 people on this planet, getting a chest X ray, every year 80% of these chest X rays are totally normal. Because this is not something where people go because they have a challenge. It's a checkup. It's a routine type of procedure in many parts of the world. And it's boring work. And as a radiologist, if you sit there reading chest X ray after chest X ray, which is non eventful, makes it tired, yeah, it makes you maybe not wanting to do this job if you if you have a choice. So if you now envision you can kind of train an AI algorithm to screen through all these images and only pick up those which are somehow suspicious. And then as a radiologist, you focus on the interesting cases. First of all, if you move out 75% of the whole workload, right, you focus the resources you have on the remaining 25. It multiplies the capacity you have available in the system. So this is one very concrete example where AI can and will make a huge difference. A second area and that was also part of the conversations I had today. A lot of people are working and thinking how can we use this idea of the virtual reality augmented reality in training physicians, and thereby, again, multiplying capabilities faster. And there's very, very interesting and promising concepts around this topic out there. 

Scott Pantel  22:12  

Yeah, that's right. We have some some really terrific companies working in that space, any other any other areas that you think are obvious opportunities that you'd like to highlight,

Elisabeth Staudiner  22:23  

I mean, there is maybe a third dimension, which, which also is a huge opportunity. And this is using digital means to connect the patient with the care team. And that can go two ways. One way can be that the patient through digital means can link up with a physician or with somebody else who can support without having to go to where the expertise is. And this allows you to decentralize access to medical expertise and experience. The other way is that you maybe try to bring the infrastructure closer to where the patients are, by, for instance, again, in our space as a company are very active in the imaging space, you put the imaging device where the people are, but you can have the experts who operate the device who interpret the information coming off the scanner can be in a totally different location. And this is another way of connecting patients to care teams. And this is most likely the most powerful technology to really drive this topic of providing better access to care, regardless of whether it's in this country in the United States are also in other countries where you have fundamentally underserved populations still today.

Scott Pantel  24:03  

How far do you think we are in this digitalization idea? Were you having this conversation? These conversations five years ago? Are we just getting started? How far along are we are we just scratched the surface? Where do you see us headed?

Elisabeth Staudiner  24:17  

I would say we have very much just scratched the surface. We sometimes like to think of this in three horizons. First horizon, being exploration trying to establish what is it what we could do with these new possibilities, trying testing playing around finding also our ground on how to approach things. And I would say we are now maybe reaching that phase we are approaching the end of this exploration phase and entering a second horizon about operate opera rationalization So the space where we begin to see a real impact from these digital opportunities and solutions. And then if you really think in a long term, far out horizon, I think once we've moved through this, okay, making the ideas, we've now explored land and work, there is this vision that one day, we will be able to connect a lot more complex information than we are able to connect today, be it around the genome be at around this buzzword of proteomics, which holds a huge promise. But with today's computing power and technology, you can barely scratch the surface of what is possible. So if we look at where we are today, I think we're still pretty much at the beginning of this revolution.

Scott Pantel  25:59  

Thank you. So let's shift gears a little bit. You're based in Shanghai, you're you have very much a a global journey in your career. And we have this meeting with it's very much largely US focused audience increasingly increasing exposure outside the US but largely US. But companies are starting to think about how they get into international markets, we have a panel tomorrow talking about market access in China share some of your perspective, what what should companies be thinking about, as they consider their more global strategy

Elisabeth Staudiner  26:37  

that they may be shared this Asian perspective, because that's the space I've been very close to, for the past 10 years. If you look at Asia, this is 50% of mankind. So there is 50% of the people on this planet live in Asia. And this makes it very clear there is a demand here, these people want healthcare want to have an opportunity to live long and healthy lives. The population in Asia is aging. So also in Asia, we are seeing a significant rise of especially non communicable diseases, be it neuro vascular disease, cardiologic, diseases, diabetes, cancer, all of these diseases are on the rise, and people will need better treatment options. And now comes the important piece. If you look at the cost that is spent on health care, in the United States, it's around $10,000. I think that's the lower limit. But that's roughly the range per person. And here, if you go to China, 1.4 billion people, definitely an interesting market. By those dimensions, the average spend per person and year is $500. And if you then go to India, the number is 60. So as you're thinking about your business models, and thinking about the economics of your ideas, you will most likely have to adjust the way to viability based on on these boundary conditions. So what you can expect huge procedure volumes. However, the money per procedure, you will have to somehow make it work with much less, if you really want to use the scale that Asia may present. That's what makes it very difficult to really have a close look and understand what are the procedures, how are they being performed? What is the money available per procedure? Or how much are people able to spend, and then you have someone need to adjust your approach accordingly. But the really neat thing is the procedure volumes. So you will have multiples of number of cases, which also makes it faster to prove an impact of whatever you're working on

Scott Pantel  29:28  

It's really interesting. And so that's sort of a description of the opportunity and some of the challenges. Let's shift a little bit to the responsibility. We have 3 billion people in the world who really don't have access to health care. What is Siemens Healthineers? What are your priorities? What do you think our priorities should be as a community here when we think along those lines?

Elisabeth Staudiner  29:53  

I mean for us it is extremely important that access to Healthcare is not decided by who you are or where you live, right. And we've also captured that in the way how we describe our purpose, where we say we want to pioneer breakthroughs in health care for everyone everywhere. And we're very serious about that. Because as you said, 3 billion people spread around the planet who today do not have meaningful access to health care. And as we're approaching this challenge, digitalization is, of course, a very powerful lever on that journey. But I believe you have to think beyond that. And for us, we believe this is a challenge, which one company alone cannot solve. So it's about bringing together people who can help with parts of the puzzle and what is needed. So we also engage with multinational organizations with foundations with people who are focusing on specific aspects of providing better access to care making it more accessible, affordable, and available. One very important aspect, actually, is this topic of education. So it's not only about money, it's not about oh, you build a hospital here, you put equipment here. If you don't have experts, and professionals who know what to do with this infrastructure, there is not much you can do. And even more, so if you have a population, which doesn't really understand how they can benefit from these possibilities. It also doesn't help. Yeah, and that's why this aspect of education and building of awareness is a topic we believe is one key enabler. And also a place where we spend time and money on exploring how we can just make a difference there.

Scott Pantel  32:24  

Jumping, jumping back to one of the original statements that you made, and obviously the mandate of Siemens Healthineers. Living in a world without fear of cancer. Will that happen in our lifetime? Where are we at in that journey? And what's your long term vision for that?

Elisabeth Staudiner  32:46  

I think there has been if you look at the history of of cancer, and if you look at survival rates for many types of cancer 30 years ago, 40 years ago, 50 years ago, and if you look at today, where many cancers actually are more a chronic disease, especially when you catch them early. I think we've come a long way. At the same time, I mean, there is still types of cancer, which we don't know yet, how to really solve and how to address them. And I believe there will still need to go a lot of effort, a lot of bright minds a lot of thinking a lot of energy in further advancing the possibilities to deal with cancer, treat cancer and make it truly something which maybe you can make go away completely. Or if that's not possible, something which becomes a disease, you can just manage, like we've learned to manage other types of diseases. Whether this will happen in our lifetime. I'm not certain. But uh, definitely, I'm certain that also within our lifetime, we will see significant progress in the possibilities of dealing with cancer.

Scott Pantel  34:18  

Elisabeth, welcome to LSI, USA 23. Are you going to cure cancer? So look, we've we've covered a broad range of topics, and I'd like to open it up for questions. If that's okay with you. Does anybody have a question? Or something that's on their mind? Aside from how are we going to cure cancer, let's think of something a little more practical. Somebody's got to have something out there. Manny, we can always count on something from you.

Manny Villafana  34:52  

You grew up a couple of things that are very important that is how much is being spent on healthcare various countries, and the challenge for any American challenge for any American company, American entrepreneur, etc, is how do we make a product that we know it costs us a lot of money to get it through all the regulatory the r&d, etc, and yet make it available to a country like India to a country like China? I mean, that puts a lot of burden on us how to get there? Do you think there is a possible way that these countries including the USA, let's face it in our country, we can sell our products because we have the monies, major portion of the payment coming from the Medicare and the health care system of our country? Do you think these countries are able and willing to contribute a their fair share for the care of their constituents? They're there, their their population, like that this China instead of spending, as you said, is, I think you said it was 800 dollars? Could they just, you know, make it 2000 3000 $5,000? Okay, I mean, part of the reason we can't get to those countries is because, as you say, there is no money, and they're only spending a small amount of money on there. But yet, the same country, they're spending a gazillion dollars on an armaments, and, you know, military, etcetera, etcetera, we got, that's how we have to handle that. That's how we have to handle getting into these countries. India, I must say, I am very unfamiliar with also, I mean, do know that it's a very difficult market, again, to, from a money point of view. So what I'm really trying to say is, will we ever see these countries spend as much as they're spending on their military to take care of their own population, the health needs of our of their own population?

Elisabeth Staudiner  37:28  

Let me maybe answer this from from two angles. The first angle is that healthcare expenses in these countries are rising continuously. So every year as their economies grow, an over proportionate part of this money flows into health care, because every government on this planet has an interest of making health care available to its citizens. However, you have to start from where you are, right. And then as the economies grow, yeah, and we've seen very positive development in that regard, both in China, as well as in India, more money becomes available, and typically, healthcare expanded expenses over the past years have grown faster than the economy's overall, which clearly proves that point. Yeah, that there is a demand, there is a desire and as ability to pay goes up, people are willing to spend the extra money that is available on having better health care services for for themselves. So in that regard, it's a matter of time of seeing these expenses grow. And both countries that you you mentioned have very aggressive programs, with very different approaches, but both targeting towards providing better services to the populations. In India, the model works through a kind of low level type of insurance scheme, where you make more and more procedures available to anybody in the country at a comparatively low money. And in China, there is very aggressive and very strict teaching and comprehensive plans. The government's also is funding to reach certain levels of healthcare, infrastructure and availability of health care in their countries. So this is the first part of my answer. The second part is that it's very important to understand that this average number per life in a country does not mean that there isn't segments in a market where there is a totally different ability to pay. So in India, you have a middle class which has emerged over the years, which very much is able to pay significantly more for high quality medical treatment. While there may be five or 600 million people who essentially maybe don't have access to anything, there may be 200 million people who are very much able and willing to pay for high quality care, high quality, innovative and technology, technologically advanced services. And you will find this even more so in China. China is a country where the people truly value technology and innovation. And if they believe that a new approach or a new methodology is beneficial to them, they will find the money to pay for that.

Guest Question  41:11  

I really, really appreciated your discussion. I'm the Chief Medical Officer for VITTA medical solutions, we're actually under NDA with Siemens, Yun La said to say hi, and reach out to you. The reason I'm I have a question for you is we have an AI solution for aortic wall strength. And with our rush in the medtech industry towards AI, do you as a leader see any risks? I mean, we struggle with bias data drift, I'd love to hear from from one of the true leaders. What what Siemens thinks what the what the future holds for this rush to embrace AI?

Elisabeth Staudiner  41:48  

AI in the area of imaging is a very natural place to go. Yeah. Because for decades, I mean, imaging people have been working on how can we use the information coming out of an x ray or an MRI scanner, and use computers to extract as much information as possible. And then the AI built on that foundation and look for ways of how can we make the evaluation of the images faster, more accurate, less error prone, more predictive, more efficient? When that whole rush around AI imaging started, I mean, there was this buzz, everybody was talking about it. The radiologists community themselves were very a bit careful. Yeah. Because there was a bit of worry, well, will this make us obsolete? And is this going to replace radiologists? And now, a few years Yeah, into that journey, I think it's become very clear that AI is a huge opportunity in that space, that if it does anything, it elevates the role of the radiologist because radiologists can focus on those areas where their expertise matters, and not on stuff, which is tedious or can be done in an automated fashion. So it's very clear, there is no way around deploying AI in the imaging space. Another learning and I believe that's very important, especially for smaller companies looking at that space, is that you also need to think about how does whatever algorithm you have for the idea you have? How does it seamlessly integrate into the workflow? Yeah, because if the AI speeds things up, but the person wanting to use it needs to a know it's there, then maybe go to a different workstation to kind of enter a different way of analyzing or reading the image, you kill all the efficiencies you may have created. So when you look at artificial intelligence, especially in imaging, it's not a standalone thing. It's something which needs to be embedded deeply into the natural workflow of how people do things. And if you do this, well, then you can create very, very meaningful impact.

Audience Question  44:39  

You talked about basically the idea that imaging would ultimately move upstream even towards the patient eventually and maybe before moving to the patient. Imaging today is in cardiology. It has to move to specialty care to primary care before reaching the patient and there are many modalities. I mean, I'm from ultrasound. So of course ultrasound has already moved to specialty care. We have many specialties that are using ultrasound for a company like Siemens or other big companies moving a modality like this, whereas you originally had a customer, which was the radiologists moved to specialty care to primary care. What about the market access? What about the Salesforce organization that needs to be shifted towards these new clinicians? How do you foresee an evolution to move to these markets?

Elisabeth Staudiner  45:35  

I think it is, what you're describing is a very important aspect. Yeah. And it's something we are also discussing internally, a lot, because you have a regulatory environment, which sometimes limits the possibilities of branching out to other specialties, which you don't have to take as set in stone. But if you want to shift it, you really need to invest time and effort in creating a case, educating the regulator's showing how it could improve the quality of care for for patients. And then once you have the opportunity, or the possibility to deploy imaging broader than in the specialty of Radiology, you also have to think about how do you reach these customer groups. And there is different models here, depending on how big the opportunity is. And it may be that you team up with companies who already do have access to this group of clinicians or this specialty, and try to somehow collaborate and team up and kind of join join forces. If it's a big enough opportunity, it may of course be attractive and interesting to have dedicated people trying to capture these new spaces in the in the market and open up additional opportunities for for deploying these technologies. But it's not trivial. I think you're raising a very important point. Because sometimes you feel well, everybody's emetic. But in reality, you have to be quite precise. Yeah. Who is who with what, how often discussing which types of topics. And when you go this deep, you realize that everybody has opportunities and strengths. And there is also places where you may have limitations. And just having something which sounds like a convincing value proposition doesn't automatically lead to this also being adopted.

Scott Pantel  48:10  

All right. Well, Elizabeth, thank you so much for sharing your insights with us and joining us. I want to thank everyone for spending their evening with us. If you have any questions or want to say hello, I'm sure Elizabeth would welcome you. And with that, enjoy the rest of your evening. Thank you again for being here.

Elisabeth Staudiner  48:26  

Thank you very much, Scott. I have really enjoyed the conversation.