Speaker 1: So we've heard throughout the conference how important it is
Speaker 1: that we impact patients. How we get patients medicines they need,
Speaker 1: how we bring them access to clinical trials. If you
Speaker 1: take that stake out, hold a group out of the equation,
Speaker 1: I think the next most impactful relationship you could possibly
Speaker 1: have to influence that goal of bringing medicines to patients
Speaker 1: and bringing trials to patients is the site sponsor relationship.
Speaker 1: So we're going to focus our panel on solutions to
Speaker 1: address some of the challenges that get in the way
Speaker 1: day to day when we're trying to work together as
Speaker 1: sponsors and sites. Now we've had some very lively panel
Speaker 1: prep calls, and one of the things I was thinking
Speaker 1: about as I'm watching the Olympics and Paralympics the last
Speaker 1: couple of months was how to referee and how to
Speaker 1: rain this in a little bit. And one of the
Speaker 1: things that struck me as a data of a couple
Speaker 1: of field hockey players and just watching those sports was
Speaker 1: how in the Olympics and the Paralympics they use cards
Speaker 1: to communicate, right, whether it's a challenge card or a
Speaker 1: penalty card or whatnot. So today, and I apologize for
Speaker 1: all of the innovative technology suppliers are going to get
Speaker 1: a cringe when we talk about doing this.
Speaker 2: We're going to use physical cards.
Speaker 1: We've got a stack of green and a stack of
Speaker 1: red cards, and we're going to challenge our panel today
Speaker 1: that as we raise a challenge, they take a red card,
Speaker 1: but that when a challenge is presented, we then have
Speaker 1: to present solutions to that challenge and we get awarded
Speaker 1: some green cards. And the goal by the end of
Speaker 1: this panel will be that we have an overwhelming amount
Speaker 1: of green cards to show rather than red and pull
Speaker 1: them up maybe in the final few minutes in a
Speaker 1: very analog dashboard of red and green. So with that,
Speaker 1: and coming off of some of the panels that we
Speaker 1: heard earlier this morning, we spoke a lot about people
Speaker 1: and a lot about the next generation. I think it
Speaker 1: was in Deirdre Bivard's closing comments. I think she spoke
Speaker 1: a little bit about how we bring in the next
Speaker 1: generation of professionals.
Speaker 2: So I wanted to start with people for our panel.
Speaker 1: And maybe we could start with Lisa, maybe you could
Speaker 1: jump in on this one first, and then we'll probably
Speaker 1: have everyone way on and this one as such a
Speaker 1: hot topic. But when we think about the challenge that
Speaker 1: we're presented with at sites as it pertains to people
Speaker 1: to acquiring and retaining people. How do you see that
Speaker 1: challenge and what are some of the solutions that you
Speaker 1: think are out there that we could put into practice.
Speaker 2: To address it.
Speaker 3: Thank you, Dennis so Lisa KINI great to meet everybody.
Speaker 4: I work for the START Center for Cancer Research, and
Speaker 4: that is a network of sites, so heavily steeped in
Speaker 4: the challenge of keeping good people at sites. I've also
Speaker 4: worked in organizations that are academic health centers that are
Speaker 4: also doing clinical.
Speaker 3: Care combined with the work of research.
Speaker 4: And I don't think that any of you are unfamiliar
Speaker 4: with the fact that research is perpetually unique, right, and
Speaker 4: we're research and we do it differently, and it requires
Speaker 4: a different level of leadership and leaders who really understand
Speaker 4: the challenges of the people who are working at the sites.
Speaker 3: And I don't have any quick solutions.
Speaker 4: I've got a lot of long, longer term, longer horizon solutions.
Speaker 4: It really is just give the people a place where
Speaker 4: they can do research and they're supported in the specific
Speaker 4: activities that they need to do to do research. So
Speaker 4: really focus on retention and I think you get a
Speaker 4: group of people in research that are really passionate about
Speaker 4: the science and also the care delivery. That's the people
Speaker 4: that you have at the sites, and they want to
Speaker 4: be there, right And I know there's a lot of
Speaker 4: great jobs in industry and people who are great at
Speaker 4: that and want to do that will find their way there.
Speaker 3: A lot of people who work at the sites.
Speaker 4: Want to be there and just want an infrastructure and
Speaker 4: a leadership team that supports them. And so it requires
Speaker 4: having the middle management team that really understand what the
Speaker 4: work of the CRC is and how that's different from
Speaker 4: the data manager and how that's different from the pharmacy
Speaker 4: tech and they're getting really specific about what the job
Speaker 4: needs to be. We're not good at measuring what their
Speaker 4: units of service are right and knowing what each job
Speaker 4: needs to be and reassessing that as the protocol has changed.
Speaker 3: The protocols are changing, and so it's just keeping finger
Speaker 3: on that pulse.
Speaker 4: So I'd say great managers role delineation a lot of ways,
Speaker 4: a focus on retention more so than recruitment, and thinking
Speaker 4: through career levels and how we can move pharmacy techs
Speaker 4: up a ladder and how we can move research coordinators
Speaker 4: up a ladder and also not let the jobs get
Speaker 4: so big for those patient care facing people that we
Speaker 4: forget that they have an impossible job. So like this
Speaker 4: constant assessment of what's the highest and best use of
Speaker 4: our licensed team, what's the highest and best use of
Speaker 4: our research experience team, and calling away all the junk
Speaker 4: that they don't need to be doing and finding the
Speaker 4: right role to do that. So splitting the roles very finely,
Speaker 4: focusing on retention, focusing on career ladders, making sure you
Speaker 4: have managers who get research and who want to support
Speaker 4: a team of people that want to do research.
Speaker 1: So a very deliberate focus on career path thing and
Speaker 1: career development, really elevating the role of folks at the site.
Speaker 1: I think that earns a green card to give out
Speaker 1: that oh wow stage if I try.
Speaker 5: So.
Speaker 1: What struck me is that there's also a parallel opportunity
Speaker 1: for potentially and Eileen, I think if you could explain
Speaker 1: a little bit perhaps in your role insite partnerships, how
Speaker 1: as a sponsor we may parallel some of the same
Speaker 1: solutions that Lisa was kind enough to share.
Speaker 6: Sure, so as a as a sponsor, you know, obviously
Speaker 6: working with the sites, you want to have a nice
Speaker 6: relationship and you want to really listen to your sites
Speaker 6: and try to make adjustments where you can to make
Speaker 6: the burden on the sites less and whatever, you know,
Speaker 6: way you can do that in terms of having a
Speaker 6: system with a single sign on if that's something you
Speaker 6: know that that is something that we hear a lot
Speaker 6: from sites that there's just so many systems and so
Speaker 6: many processes and how can we you know, how you know,
Speaker 6: can't you make this easy for us? So I think
Speaker 6: not only CSL Barn, but I think a lot of
Speaker 6: the pharmaceutical companies are looking to try to take that
Speaker 6: burden and lessen it for the sites.
Speaker 1: Tracy, if I could ask you, yeah, Bearinger, are you
Speaker 1: creating roles?
Speaker 2: Are you taking similar approaches? How are you upscaling your
Speaker 2: workforce to support sites?
Speaker 5: It's actually not necessarily upskilling, but it's reflecting on the
Speaker 5: points that have been made both from a site perspective
Speaker 5: and from a sponsor perspective. It's really listening and working together.
Speaker 5: We've spoken a lot about co creation with patients, but
Speaker 5: we're actually also focusing on co creation with sites. So
Speaker 5: taking the time to get the feedback, really understanding what's
Speaker 5: important to them and seeing whether or not by implementing
Speaker 5: certain solutions, we're actually addressing the core like the personal
Speaker 5: problem that people have with the personal challenge that they
Speaker 5: have could be as simple as identifying a single point
Speaker 5: of contact for support questions. But it's also recognizing that
Speaker 5: there isn't a one size fits all because the sites
Speaker 5: are all very unique, their focus is slightly different, their
Speaker 5: management is slightly different, and so we actually have to
Speaker 5: look at what's the as far as we can can
Speaker 5: we actually take it to that level where it is
Speaker 5: a site specific solution within you know, the broad range
Speaker 5: of what we can do.
Speaker 1: Excellent, So please take a couple of cards and share
Speaker 1: them with Eileen as well. Chris sites site specific solutions.
Speaker 1: I see nodding quite a bit as Tracy was describing that,
Speaker 1: what's your your reaction to that, as as someone who
Speaker 1: works at a site, someone who has oversight over the
Speaker 1: research at Sydney Kimmel, how does that resonate with you?
Speaker 3: Sure?
Speaker 7: Thank you so, Kristin Hermann, Executive director of the Clinical
Speaker 7: Trials Office at Sydney Kimmel Comprehensive Cancer Center, And I
Speaker 7: would say you know, I've been to the cancer center
Speaker 7: at Sidney Kimmel for the last two years, and when
Speaker 7: I started in the position, we had forty percent turnover annually,
Speaker 7: and that will crush us, and it will crush your trials.
Speaker 7: They're not going to get done. And so you know,
Speaker 7: that was the immediate concern and the fire that we
Speaker 7: needed to fight. And within eighteen months we had that
Speaker 7: turnover down to thirteen percent, and so that's a big difference.
Speaker 7: But retention is the key indicator right over time, and
Speaker 7: so we're still looking at that retention.
Speaker 3: But some of the.
Speaker 7: Things I think that we're really helpful. You had touched
Speaker 7: on previously about these generational differences, the differences in the
Speaker 7: folks that we are hiring and recognizing who they are
Speaker 7: and what their background is and what they care about,
Speaker 7: and so you know, this youngest generation perhaps doesn't maybe
Speaker 7: even think that retirement's going to be a reasonable option
Speaker 7: for them, and so thinking that they're going to want
Speaker 7: to work overtime for you is maybe, you know, not.
Speaker 3: A reality.
Speaker 7: While we have some of our staff who've been with
Speaker 7: us longer and very much you know, maybe that's like
Speaker 7: our clinicians that are kind of mid career, our managers
Speaker 7: that are mid career, who really are going to want
Speaker 7: to be moving up. And so I think taking the
Speaker 7: consideration who you're hiring and what their interests are, and
Speaker 7: then customizing the job to a degree and the opportunities
Speaker 7: to their needs. So whether they're desiring to go back
Speaker 7: to school and you can kind of highlight those opportunities,
Speaker 7: whether they're looking for specific experiences. There will be people
Speaker 7: who want to go back to school and get an MBA,
Speaker 7: and then I want to put them on connecting them
Speaker 7: with our finance folks and our contracts folks. They still
Speaker 7: may be a data manager, but they can learn a
Speaker 7: whole lot more about the business internally and then help
Speaker 7: them to sit in on sponsor meetings, help them sit
Speaker 7: down on budget negotiation. And so I think developing people
Speaker 7: that way and customizing the opportunities to their interests isn't
Speaker 7: a real opportunity. And so I kind of say, you know,
Speaker 7: I think that there are additionally opportunities, you know, sponsor
Speaker 7: and site, especially academic site opportunities that I think we
Speaker 7: have yet to explore. This kind of like symbiotic desire
Speaker 7: to keep our trials staffed and recognizing that there will
Speaker 7: be people looking to build their careers both in academia
Speaker 7: but also an industry, and so how can we share better?
Speaker 7: How can we know that as an academic center, we
Speaker 7: are primed to educate and train people, but we all
Speaker 7: do better when we know a little bit more about
Speaker 7: each other. And so, you know, we did have somebody
Speaker 7: on our team who started as a coordinator. She ended
Speaker 7: up going to industry. She worked as a monitor and
Speaker 7: she decided that you know, she had experience there that
Speaker 7: she liked, but she really missed the patient interaction. And
Speaker 7: she came back and it has been so valuable to
Speaker 7: us to have her insider industry experience on our team.
Speaker 7: That's improved the quality of our monitoring visits, our documentation,
Speaker 7: and so I think that there's also an opportunity for
Speaker 7: us to explore that further.
Speaker 1: So the common theme I think we hear please take
Speaker 1: a card. I think that's an excellent solution is really
Speaker 1: creating persons specific approaches right tailoring some of the experience. Chris,
Speaker 1: I want to bring you into this because I think
Speaker 1: the thread that I heard through that was the experience
Speaker 1: at the site, whether that's a sponsor creating that experience,
Speaker 1: by being more site centric, whether that's the leadership at
Speaker 1: the site or the site network, providing professional development and
Speaker 1: things that create a better employment experience. What are some
Speaker 1: things from your perspective if you could share a little
Speaker 1: bit about your role then that you see that might
Speaker 1: create a more positive work experience at the sites.
Speaker 2: Yeah. Sure, So.
Speaker 8: I am Chris mcnairm, the director of Data Science also
Speaker 8: at the Singe Chemical Comprehensive Center, and so in the
Speaker 8: clinical trial space, my team leads the clinical trial analytics
Speaker 8: and the reporting groups. But I think one of the things,
Speaker 8: you know, I think kudos to Christen when when she
Speaker 8: came in, was how can we take all of these
Speaker 8: pain points from the staff, right, and you know, automate
Speaker 8: some of them, right. Nobody wants to spend their days
Speaker 8: chasing people down through emails and manually filling out, you know,
Speaker 8: word documents that they have to chief back through. So
Speaker 8: it was basically tell us what you are doing repetitively
Speaker 8: on a day today. And this is kind of between people,
Speaker 8: but also between our different disease groups. Why are we
Speaker 8: reinventing the wheel between all of our different disease groups
Speaker 8: from study feasibility to startup to all of these different pieces,
Speaker 8: and so it was really going back to see, you know,
Speaker 8: what can we create so that people don't have to
Speaker 8: spend their day doing these manual, repetitive tasks and can
Speaker 8: actually spend it doing things that they enjoy. And I
Speaker 8: think one of the things for us that you know,
Speaker 8: I don't think this solution has to be the sexiest
Speaker 8: thing is in the world, as long as it gets
Speaker 8: the job done. And so we've been able to automate
Speaker 8: a ton of just the you know, normal day to
Speaker 8: day operations just using you know, data capture and you
Speaker 8: know reporting software, and I think that's been kind of
Speaker 8: a huge relief to the folks that have been involved.
Speaker 8: And then I think it starts to create this feed
Speaker 8: forward loop. I think initially, you know, change is kind
Speaker 8: of hard for everybody. So even if it's like we're
Speaker 8: trying to make your life easier by getting you know,
Speaker 8: these papers out of your hand, it's a little bit
Speaker 8: of book. Have always used this paper? Why why you're
Speaker 8: taking this paper away from me? But I think once
Speaker 8: you kind of change that mindset, then people will come
Speaker 8: to us more to kind of proactively say, hey, I'm
Speaker 8: doing this thing. It's kind of a pain point for me.
Speaker 8: It seems similar to other processes that we've automated. Can
Speaker 8: you help us fix this? So I think that's been
Speaker 8: very helpful and I think also rewarding for the team
Speaker 8: to kind of see what they've built be used on
Speaker 8: the day to day.
Speaker 1: Well, I have a question for the panel, but I
Speaker 1: think this is for everyone on the panel. How are
Speaker 1: those sorts of situations being surfaced back to sponsors? I
Speaker 1: bet Tracy or Eileen, you'd love to hear where a
Speaker 1: site has figured out how to do that and share
Speaker 1: it with every site you work with. But has anyone
Speaker 1: had that experience? Is anyone having that dialogue within their
Speaker 1: relationships to share those sorts of things.
Speaker 5: I'm going to say for our part, we sometimes hear
Speaker 5: it a little more randomly. Ad hoc. We systematically get
Speaker 5: feedback on the challenges, but we are yet to see if,
Speaker 5: for example, we start to see in the uptick in
Speaker 5: let's say there is a challenge associated with the use
Speaker 5: of technology, and we maybe see this consistently coming back
Speaker 5: from our sites. If we see next time round that
Speaker 5: this is scoring higher in the trial experience, survice that
Speaker 5: we will regularly be sending out we already know. Yes,
Speaker 5: there's certain things that we would expect maybe to see
Speaker 5: based on what we're doing. But I think it's going
Speaker 5: to be an interesting thing if we not necessarily made
Speaker 5: any changes, do we then have the mechanism or it's
Speaker 5: worth us taking it back to say, Okay, we need
Speaker 5: to put in place the mechanism for following up if
Speaker 5: we've got this let's say, unprecedented change coming back in
Speaker 5: the feedback, because it may not be anything that we've done,
Speaker 5: it may be something that they've done on the site themselves.
Speaker 5: So I think it's a feedback loope that we need
Speaker 5: to systematically put in place to make sure that we're
Speaker 5: actually recognizing the actions that not just that we're taking,
Speaker 5: but also that the sites are taking.
Speaker 3: I think from my standpoint, it's really tempting to.
Speaker 4: Find an automated solution that's going to fix your problem,
Speaker 4: right because we've got a ton of problems, and it
Speaker 4: would be so easy to say, if we just had
Speaker 4: this system, this problem will go away, and times out
Speaker 4: of ten, in my experience, there's an issue with the
Speaker 4: with the functional process right where just something that is
Speaker 4: not sexy at all is broken and you've just got
Speaker 4: to like roll your sleeves up and resist the urge
Speaker 4: to find a thingy that'll fix it, and just say,
Speaker 4: how are we going to fix the process and kind
Speaker 4: of do the hard work of getting the functional process
Speaker 4: ready to go.
Speaker 3: Once you really know that.
Speaker 4: Your functional process is working, then yes, absolutely automate. But
Speaker 4: I think you really need from the site standpoint at
Speaker 4: least to kick tires on is tech really going to
Speaker 4: fix this?
Speaker 3: Or do we have some hard work to do that's.
Speaker 4: Going to require change and multiple departments at the table
Speaker 4: and a little bit of arm wrestling for us to
Speaker 4: decide here's how we're going to do it. And in
Speaker 4: those cases like our drug accountability platform, I think is
Speaker 4: probably the best one where we were sure, sure sure
Speaker 4: that we had a solution that would really help us
Speaker 4: as the site and then we've you know, deployed that
Speaker 4: at all of our sites and we love it in
Speaker 4: our pharmacists are all always perfect when it comes to
Speaker 4: audits and monitors, you know, because we've got a very
Speaker 4: fit for purpose solution. But it took us several years
Speaker 4: of ground lane to go, Okay, now we're ready to
Speaker 4: put this on a flywheel.
Speaker 8: Yeah, I just want to echo those sentiments to about
Speaker 8: needing to have a standard process across all of your
Speaker 8: different pieces, right, because I think you made a great
Speaker 8: point about no amount of technology in the world is
Speaker 8: going to fix a process that is not standard and
Speaker 8: is not working already.
Speaker 5: Right.
Speaker 8: You need a place where you say, here's our process,
Speaker 8: and here is the exact area where this technology is
Speaker 8: actually going to help us. Otherwise you're just going to
Speaker 8: have a different technology for every single different problem that
Speaker 8: comes up, which is just not going to work for
Speaker 8: the entirety to site.
Speaker 3: Yeah.
Speaker 7: So, and I can add to that because Chris and
Speaker 7: I have worked on specific projects and I'm imagining he's
Speaker 7: thinking about specifically clinical trial matching platforms, which we've explored
Speaker 7: and are about. But we recognized after meeting with several
Speaker 7: vendors that we actually had our own work to do
Speaker 7: before we were primed to really take advantage of the
Speaker 7: technology that exists there just in our own process, and
Speaker 7: that taking on the technology, you know, really that wasn't
Speaker 7: going to solve our process issue.
Speaker 3: We need to solve our process issue first.
Speaker 7: And kind of figure out those customized roles and how
Speaker 7: they're doing the work today and then be able to
Speaker 7: kind of exploit that knowledge base and primate for the technology.
Speaker 1: That's fascinating. I think it makes me wonder and cringe
Speaker 1: a little bit as a sponsor just when we impose
Speaker 1: technology on a site hearing that feedback, you know, how
Speaker 1: well do we know and are we listening to hear
Speaker 1: what that might.
Speaker 2: Do to their processes of their day to day.
Speaker 1: Aileen, I don't know if through your work in site partnerships,
Speaker 1: if you've had those dialogue you mentioned single sign on earlier,
Speaker 1: are there any solutions maybe to how you've seen this approach,
Speaker 1: you know, in terms of technology of sites.
Speaker 6: In terms of technology, I have had feedback from sites
Speaker 6: obviously about all of the technology that sponsor imposes upon sites.
Speaker 6: And the thing is to continue to listen to the
Speaker 6: sites and obviously there are certain things that we have
Speaker 6: to have in place, but there are definitely ways that
Speaker 6: we can improve how we're deploying them to the sites
Speaker 6: and what we're requiring of the sites, and sponsors should
Speaker 6: continue to look for solutions with vendors to make these
Speaker 6: processes and technologies easier on the sites whenever possible.
Speaker 7: Yay, love that comment.
Speaker 1: So any tech solutions providers face you know in the
Speaker 1: audience please take heed to that. One of the things
Speaker 1: that struck me, h listening to presentation yesterday about a
Speaker 1: topic that's near and dear to me is it was
Speaker 1: around vendor qualification and around thinking differently about how we
Speaker 1: do that and centralizing that I was it struck me
Speaker 1: as very analogous to when we go out we qualify sites,
Speaker 1: and we do pssbs and you know, pre study visits.
Speaker 2: And all of these things are there areas there If.
Speaker 1: I could challenge the panel to think about where there
Speaker 1: might be opportunities to streamline, whether it includes technology or
Speaker 1: process changes.
Speaker 6: I think definitely. I've had I've heard multiple complaints from sites.
Speaker 6: You know, we were just working on the study with you,
Speaker 6: Why do you need to do another qualification visit? I know,
Speaker 6: you know, one thing is an soop where if we're
Speaker 6: you know, if we recently worked with the site, then
Speaker 6: the PSB visit on site can be waived. So that's
Speaker 6: one of the ways. But I think there are ways
Speaker 6: for technology to help with ps PSBs and site qualification visits,
Speaker 6: and I think sponsors should explore them a little more.
Speaker 4: We put a lot of thought at start into the
Speaker 4: study what we would say the study activation process, but
Speaker 4: I think we think of that as a lot at
Speaker 4: an earlier point, right, is not just like SIV is
Speaker 4: the few things leading up to SIV is the study
Speaker 4: activation process. But as soon as we have interest from
Speaker 4: a sponsor and a potential protocol, having a fullsome conversation
Speaker 4: about what systems do you intend to use from your
Speaker 4: lab vendor, from EDC, any other e things that might
Speaker 4: be in the cards, let's talk about that early on. Right,
Speaker 4: we have to be flexible and as a site, we
Speaker 4: work with hundreds of sponsors and we need to be
Speaker 4: able to use.
Speaker 3: Their systems and technologies. We get that.
Speaker 4: And also if we are clear at the jump about
Speaker 4: what it's going to take, what those systems are, and
Speaker 4: we have some back and worth conversation at an earlier
Speaker 4: stage than I think most of us are used to that,
Speaker 4: it can really grease the skids for a successful study activation.
Speaker 3: And you're not sitting there in the.
Speaker 4: SIV with all of these surprises and like bombs going
Speaker 4: off and gashing them the teeth, you know what's happened
Speaker 4: where it can just make for like a much more
Speaker 4: seamless process. So again I don't have any fancy solution
Speaker 4: but it's really about thinking about all of these things
Speaker 4: earlier on. I think the presence of all of the
Speaker 4: new technologies requires us to have a deeper conversation.
Speaker 3: At the PSSB.
Speaker 4: We call it the discovery call, which is even preempting
Speaker 4: the pss B to say, what are we really talking
Speaker 4: about here? In terms of operations, we get the science
Speaker 4: and our people are connected on the science, but operationally
Speaker 4: our PK team wants to know what vendor you're going
Speaker 4: to use to pick up the kits. Do you have
Speaker 4: that information for us or not? And if not, can
Speaker 4: you please chase that down so we could clear all
Speaker 4: of this now. And that's been really key for us
Speaker 4: in terms of making it, you know, a seamless integration,
Speaker 4: in terms of getting that site study activated.
Speaker 1: Earlier decision making and earlier communication around those key vendor
Speaker 1: decisions sounds like a potential solution.
Speaker 7: Yeah, And I would say, you know, echoing what Eileen said,
Speaker 7: if you don't have to send someone to come do
Speaker 7: the tour of the facility again for the you know,
Speaker 7: second third or fourth time in the last two years.
Speaker 7: I mean, you know, the question is like what's the value?
Speaker 7: So many of the things have not changed, the rooms
Speaker 7: haven't changed, the equipment hasn't changed, and are you sending
Speaker 7: someone who's even qualified.
Speaker 3: To evaluate what's there.
Speaker 7: We're taking detailed, high resolution photographs and providing them, and
Speaker 7: so just thinking about like that takes time away from
Speaker 7: a coordinator who could be enrolling a patient. And so
Speaker 7: you know that time is preparation time, and I just
Speaker 7: think that there are opportunities to kind of cut the
Speaker 7: fat on things that aren't essential and to gather the
Speaker 7: information which is so common across so many of our
Speaker 7: different sponsors and CROs that we work with. And so
Speaker 7: you know, I think you had touched on before, Dennis.
Speaker 7: You know this potential opportunity to kind of partner with
Speaker 7: someone who can collect that information and then disperse it
Speaker 7: and then we're only really answering questions that are really
Speaker 7: pertinent to a specific trial at hand, and kind of
Speaker 7: that big picture qualification of our site can really already
Speaker 7: have been accomplished and not be this kind of repetitive burden.
Speaker 7: Our staff turns over, right, we know that, and so
Speaker 7: when they turn over and this is a new person
Speaker 7: trying to address the PSSV, it's going to take longer.
Speaker 7: And so I just think we can make the most
Speaker 7: of the information that we already have and make it available.
Speaker 1: So I think that's a call to action for any
Speaker 1: tech or other innovators in the crowd. It sounds like
Speaker 1: there's a solution opportunity there out in the market that
Speaker 1: would satisfy both sponsors and.
Speaker 7: Talk to me.
Speaker 2: Yeah, there you go.
Speaker 5: Yeah, I was going to say, just to add to that,
Speaker 5: I think it's a very clear example of where I mean,
Speaker 5: if I think of it from a sponsor's perspective, sponsors
Speaker 5: all would like to be the sponsor of choice, right,
Speaker 5: It's a common it's a common theme, but then we
Speaker 5: still go out with an approach that reflects us selecting sites.
Speaker 5: And so how do you switch that mindset around. It's
Speaker 5: like you tackle that as a common problem, but you
Speaker 5: know it's a shared probably.
Speaker 7: And I've utilized all of Chris's skill set to kind
Speaker 7: of help us approach that, right. And so when we
Speaker 7: start looking at activation, we have dashboards and metrics, and
Speaker 7: we're kind of looking at those and evaluating not just
Speaker 7: our own performance, but also the sponsors that we work
Speaker 7: with to say, hey, we want to prioritize this trial
Speaker 7: because we know we can get this contract and budget
Speaker 7: done with them and we can start in rolling patients.
Speaker 7: And so we really are keeping that in mind as
Speaker 7: we prioritize the work that we're doing. Who do we know,
Speaker 7: as you know, when we work with your legal it's
Speaker 7: going to take a lot longer than most other folks,
Speaker 7: and so you know, that's really a way for us
Speaker 7: to kind of streamline things and also put a little
Speaker 7: pressure on to say, hey, this is kind of taking
Speaker 7: longer than some other sponsors that we work with, and
Speaker 7: so what might we be able to do to kind of,
Speaker 7: you know, break down some of those roadblocks.
Speaker 4: Yeah, I think the idea of preferred sponsor, preferred site,
Speaker 4: I mean, it's it's a great idea and at the
Speaker 4: end of the day, to me, it just means templatizing
Speaker 4: a lot of the steps in the process right so
Speaker 4: that you can manage, my exception, don't have to do
Speaker 4: the same thing over and over again. And it can
Speaker 4: take some time to get that set up at the
Speaker 4: front end, to make sure that you've got to mutually
Speaker 4: agreed upon template for name the document that you need
Speaker 4: to get going right, whether that's the CTA or your
Speaker 4: budget or your treatsfer agreements or whatever it might be.
Speaker 4: But once you've got that setup and you've got that
Speaker 4: kind of common understanding checked off of like we know
Speaker 4: how you work, you know how we work, we've got
Speaker 4: the points of contact, it really can make things.
Speaker 3: It just avoids so many headaches.
Speaker 8: I think the idea of like the templatizing things to
Speaker 8: steal your word, I think makes a ton of sense.
Speaker 8: But I think there's also an opportunity to even standardize
Speaker 8: and templatize across sponsors, right because you know you mentioned
Speaker 8: before its sites are working with so many different sponsors.
Speaker 8: Like it's great to have you know, some some priority
Speaker 8: sponsors that you know you work with and work with well,
Speaker 8: but that only goes so far if you're going to
Speaker 8: reinvent the wheel over and over again for other sponsors
Speaker 8: for the same things, for study feasibility, for all of
Speaker 8: these other downstream pieces. And so I think there's still
Speaker 8: an opportunity to kind of close the gap between the
Speaker 8: different sponsors so that you're decreasing the amount of variability
Speaker 8: and customization that exist it's across each of those different sponsors.
Speaker 8: I think one of the issues from a site perspective
Speaker 8: is that it's really really hard to be proactive and
Speaker 8: kind of find you know. I know this is a
Speaker 8: solutions based off, but it's hard to do that a
Speaker 8: lot of time when you're constantly being reactive to all
Speaker 8: of these different things that are being thrown at you
Speaker 8: all the time. So I think the more you can
Speaker 8: kind of take away those pieces up front, the more
Speaker 8: we can focus on, you know, getting a standard process
Speaker 8: in place so we can find solutions for all these
Speaker 8: other other issues.
Speaker 1: So I can't play guitar for those who are in
Speaker 1: the keynote, I can't play guitar or do anything like that.
Speaker 1: But what if, right, what if as sponsors we came
Speaker 1: together and agreed upon a set of standards and templates
Speaker 1: for some of these very common things. I think if
Speaker 1: we could do that as sponsors, I'm sure there's innovative
Speaker 1: solutions providers out there that would figure out a way
Speaker 1: to surface that in a really clever way.
Speaker 2: So excellent, excellent.
Speaker 1: I want to we haven't talked about DCTs, and I
Speaker 1: feel like you should just talk about DCTs at every
Speaker 1: one of these conferences. So I wanted to ask, as
Speaker 1: we have sponsors and sites here, because as a guy
Speaker 1: who heads clinical outsourcing for a sponsor. I'm constantly in
Speaker 1: the tug of war of do you do it, which
Speaker 1: provider do you work with? How do you apply it?
Speaker 1: And I'm interested as we have a site, so we
Speaker 1: have sites perspective, site networks perspective, and sponsor perspective. Is
Speaker 1: that something that when we look at those enabling capabilities,
Speaker 1: how do we do that in a way that's patient
Speaker 1: centric that kind of satisfies all the things we talk about.
Speaker 1: We're trying to reduce burden, increase access and diversity to
Speaker 1: a trial, but not due harm to some of our
Speaker 1: stakeholders at sites, or increase burden or increase the burden
Speaker 1: of technology and some of the challenges we've spoken about
Speaker 1: during this panel. I'm just curious, Tracy, perhaps you'd like
Speaker 1: to jump in on that one.
Speaker 5: So we've obviously had several different variations of decentralized approaches
Speaker 5: embedded into our carials, and I think so it goes
Speaker 5: back to what I said initially, we have to we
Speaker 5: have to actually understand what the impact is on the trail.
Speaker 5: We don't just do it for the sake of doing it.
Speaker 5: In some cases there are contractual limitations or oversighte limitations
Speaker 5: that a site may not want to use the mobile
Speaker 5: nurses that we've contracted. You know, it may not make
Speaker 5: sense and therefore you're limited in the uptake of the
Speaker 5: remote visits in a particular trial. I think we have
Speaker 5: to look at it very much again, case by case.
Speaker 5: Now the approach for us would be certainly, don't make
Speaker 5: the assumption that don't make the assumption either way the
Speaker 5: site that the sites don't want to do it or
Speaker 5: do want to do it can do it. Are unable
Speaker 5: to actually talk about what is possible see the extent
Speaker 5: to which the technology that we use to support it
Speaker 5: can be embedded with in the technology that's already used
Speaker 5: on site. The scheduling is an obvious one for me,
Speaker 5: because if you're scheduling within an app at the same
Speaker 5: time as scheduling within your regular scheduling system, it's pain.
Speaker 5: But also look at is ultimately, if the goal of
Speaker 5: a decentralized approach is to reach a different patient population,
Speaker 5: is that even the way that we should be doing it.
Speaker 5: And yes, in some cases it may extend the reach
Speaker 5: of the existing sites and it may be something that
Speaker 5: they want to do. But in other cases, let's accept
Speaker 5: the population that we've got and then look for other
Speaker 5: ways to embed DCT approaches to reach that missing part
Speaker 5: of the patient population. So I think it's be very
Speaker 5: flexible and actually understand what the limitations are and you know,
Speaker 5: what are.
Speaker 2: The goals of the site, and have that dialogue. I
Speaker 2: think I'm interested in that dialogue.
Speaker 1: And I think Lisa goes back to what you said
Speaker 1: about early engagement, about hey, we're thinking about this approach.
Speaker 1: Does that idea of asking and kind of inquiring what
Speaker 1: is the existing infrastructure, you know, and how can we
Speaker 1: leverage it versus impose a new solution?
Speaker 3: Thens That's right.
Speaker 4: So I think we're in a situation where the technology
Speaker 4: outpaces the readiness of the site to fully apply that
Speaker 4: technology and not just apply it, but integrate it. And
Speaker 4: so I think the question it's not like how good
Speaker 4: is the tech? The text very very good, the idea
Speaker 4: behind the tech is very good. The sites would love
Speaker 4: to see this work, and all they can see.
Speaker 3: Are the red cards. Right, are all the reasons right?
Speaker 4: You're immediately going to get like fifteen reasons why this
Speaker 4: is going to be really really hard. And I think
Speaker 4: that's the interesting conversation is to say, what is it
Speaker 4: going to take to make this clinic ready and what
Speaker 4: people would you need to add to.
Speaker 3: Your team rate.
Speaker 4: So it's like, here's this great tex site, figure it out,
Speaker 4: and then the sites are trying to figure it out
Speaker 4: in their spare time on top of the job that
Speaker 4: they're already doing. So I think having like a real
Speaker 4: assessment of these are the five to six things that
Speaker 4: would need to be present at your site, whether that
Speaker 4: is people, whether that is an org structure setup, whether
Speaker 4: that's a plug in to somebody who's going to help
Speaker 4: people troubleshoot.
Speaker 3: Whatever it is.
Speaker 4: To what degree are these five to six things that
Speaker 4: we think must be present at your site for this
Speaker 4: to work?
Speaker 3: To what degree can you do that?
Speaker 4: And what is a true readiness assessment and how far
Speaker 4: away are you from readiness?
Speaker 3: And what can we help you do to make.
Speaker 4: Ready for this Because there's some scaffolding that you've got
Speaker 4: to build if you're really going to deploy it and
Speaker 4: have it work.
Speaker 3: And right now, the.
Speaker 4: Feeling, at least at the sites is like, here you go,
Speaker 4: we built it, tell us how goes you know exactly?
Speaker 8: I think there's also potentially, as I'm kind of hearing
Speaker 8: you guys, talk through this. There is also kind of
Speaker 8: a potential opportunity analogous to you know, right now, there's
Speaker 8: a lot of focus on like for patient treatment, show
Speaker 8: me other patients like me that have been treated just
Speaker 8: like with a certain you know, treatment and responded well
Speaker 8: due to like having a specific criteria, right, is there
Speaker 8: an opportunit tunity for the same thing you're talking about
Speaker 8: meeting kind of both an organizational and kind of technology
Speaker 8: stack already at the ready to use some of these
Speaker 8: different approaches. So is there an ability to kind of,
Speaker 8: you know, for lack of a better term, been institutions
Speaker 8: together to say, okay, these are similar functioning institutions with
Speaker 8: you know, similar technologies and organization structures. It's worked very
Speaker 8: well for organization X. You guys are very similar, so
Speaker 8: we think that it's also going to work well for you.
Speaker 8: So that again you're not siloing these discussions for each
Speaker 8: individual site and you're kind of learning as you're going.
Speaker 5: In some ways, I actually think that's probably the only
Speaker 5: pragmatic way. You know, I like to see you can
Speaker 5: figure it out site by site, but you can't. It's
Speaker 5: not pragmatic. But rather than just saying okay, here's an approach,
Speaker 5: see what you can do with it if you can
Speaker 5: at least start to figure out how it might look
Speaker 5: in a couple of the setups that you're working with,
Speaker 5: and then offer that as a It's almost like an
Speaker 5: add on to here's the protocol that tells you what
Speaker 5: you can do remotely on what you can't. At least
Speaker 5: if you've had that dialogue and you've got some co
Speaker 5: created approaches that might work, then I think that's a
Speaker 5: step ahead of where we are today.
Speaker 3: Yeah, I think the rapid cycle feedback loop. You know
Speaker 3: that we had a.
Speaker 4: Great experience and at start this was at another organization
Speaker 4: with a vendor that was doing how managoring, you know,
Speaker 4: using all kinds of slick stuff and all of these
Speaker 4: like plug ins and a tablet, and they provided full
Speaker 4: infrast structure to troubleshooting, you know, is this working or not?
Speaker 4: And we had the mutual goal of let's fail fast.
Speaker 4: If it's not going to work, let's try something different.
Speaker 4: And we had the right level of project support to
Speaker 4: really be successful at implementing it, which we ultimately were,
Speaker 4: despite the skepticism of most of the clinicians involved, because
Speaker 4: they put the people they really partnered in terms of
Speaker 4: people and support with us to do it.
Speaker 5: That actually just makes me think of we did have
Speaker 5: an example of where we were looking at a particular
Speaker 5: monitoring and the question was, you know, if the alarm
Speaker 5: goes not quite physically, who's answering it? Yes, And they said, well,
Speaker 5: we don't actually know what we have to do. And
Speaker 5: I said, okay, you need to talk to the sites
Speaker 5: about that because and they did. And actually it was
Speaker 5: a very positive outcome because as long as they knew,
Speaker 5: you know, they were quite they were excited about the science,
Speaker 5: excited about where it would go, and as long as
Speaker 5: they understood that there wasn't expectation that they had to
Speaker 5: handle this.
Speaker 3: You know, they knew how to respond to the patients, etc.
Speaker 5: But it's exactly that it's making sure that that conversation
Speaker 5: is happening.
Speaker 1: So much around communication and around having that dialogue. I
Speaker 1: think if there's one takeaway, I think that's you know,
Speaker 1: that's what I'm getting from this panel discussion. We've had
Speaker 1: a great discussion within the panel around the challenges and
Speaker 1: some of the solutions. I did want to make the
Speaker 1: audience aware if there's any questions anyone has, we do
Speaker 1: have mic set up, so please, you know, feel free
Speaker 1: to engage, wave your hand or you know, shout at me.
Speaker 1: There's a bright light in my eyes.
Speaker 2: But but but.
Speaker 1: Do please, you know, engage with our panel, race questions,
Speaker 1: race challenges. We won't autograph them. Well, we might autograph them,
Speaker 1: but you'll get a card if you do. So if
Speaker 1: any of those pop up, we'll grab them.
Speaker 2: We already have a.
Speaker 9: Brave volunteer, Marcy Kravit is it on and the can
Speaker 9: you hear me all right, Rusty Kravit from Anado.
Speaker 3: So it's an interesting topic.
Speaker 9: And I'm going to SCRs next week as well too,
Speaker 9: so interesting to hear the site's perspective. But in terms
Speaker 9: of tracy, you said, you know to talk to every
Speaker 9: site like you just can't do it right, So who
Speaker 9: in the sponsor company is doing some of this intelligence gathering?
Speaker 9: Like what are the challenges going to be?
Speaker 3: Okay, now I know it.
Speaker 9: So before the study starts, we're already building in sort
Speaker 9: of mitigation strategies. So the cras right, they don't have
Speaker 9: the capacity. I'm understanding sponsors now have like site engagement
Speaker 9: type of teams, But how are the sponsors thinking about
Speaker 9: this sponsor site engagement at scale to get that rapid
Speaker 9: feedback about Okay, this is what we're going to have
Speaker 9: to wrap around the technology to make it successful.
Speaker 5: I'll just give you a quick review of what we've done.
Speaker 5: So actually, when I say we can't get all of
Speaker 5: that feedback, I don't think that's actually a fair statement.
Speaker 5: We can probably gather it.
Speaker 3: We do have site facing roles.
Speaker 5: Those sites facing roles, so we've actually established a site
Speaker 5: engagement academy specifically focusing on it's more on the soft
Speaker 5: skills for site facing roles within the organization to really
Speaker 5: get to know the sites they're working with to understand
Speaker 5: their challenges. So the conversation you hope happens, it will
Speaker 5: you know, we'll start to see the update, we'll see
Speaker 5: what comes out of that. But then at the same
Speaker 5: times we have to have we have implemented Global Insights
Speaker 5: system solution, just a mechanism for sharing insights and so
Speaker 5: obviously then you hope that the conversations that are happening
Speaker 5: with the sites make it into their way into the
Speaker 5: insights system. We have to think about how we communicate
Speaker 5: it internally so that it gets back to the individuals
Speaker 5: that can actually take action on it. And so it's
Speaker 5: slowly building up that understanding skill set in terms of
Speaker 5: the empathy building and the mechanisms by which they can
Speaker 5: share and action the insights that they gather. And then
Speaker 5: we want to obviously see those actions within any clinical,
Speaker 5: any protocol and the in the way that we actually
Speaker 5: approach implementing that at a site. But it's going to
Speaker 5: be taking some time. But that's why I say you
Speaker 5: have to start somewhere in terms of getting some learnings
Speaker 5: and implementing them.
Speaker 3: But a couple of things that we're.
Speaker 6: Doing, Yeah, I definitely feel like, you know, sponsors have
Speaker 6: gotten very good at getting patient advocacy boards in touch
Speaker 6: with protocol development, and I think we should move along.
Speaker 6: And I think an idea would be to have like
Speaker 6: a group of sites who can give feedback as well,
Speaker 6: you know, is this going to work, what way, what
Speaker 6: parts of this protocol can be decentralized? Things like that,
Speaker 6: And I think having site partnerships or site engagement can
Speaker 6: relate also help bring the feedback from the site to
Speaker 6: the sponsor so that they know, you know, what ways
Speaker 6: we can really help these issues.
Speaker 1: I can speak for Jazz and that we have dedicated resources.
Speaker 1: We've created fairly recently a global Patient Site Engagement.
Speaker 2: Group, although they are overwhelmed with the task. I think
Speaker 2: for a lot of the reasons we've described.
Speaker 1: I will say, if there was someone out there developing
Speaker 1: a solution that could help with integrating those insights from
Speaker 1: the site perspective, similar to what we do sometimes with
Speaker 1: some of the solutions I saw the exhibit Hall four
Speaker 1: with patient input of patient insights, that would be a
Speaker 1: valued add to the market.
Speaker 3: I'd also add, just.
Speaker 7: For sites for cancer sites, in particular, the Association of
Speaker 7: American Cancer Institute's the AACI, we have a list ser we
Speaker 7: have a conference, the Clinical Research Innovation Conference, once annually,
Speaker 7: and these types of issues surface there and so we
Speaker 7: are discussing kind of commonality shared commonalities with troubleshooting, whether
Speaker 7: it's a vender issue or a sponsor issue, or just
Speaker 7: your site's issue. But we are having those conversations there,
Speaker 7: and so if there's interest in kind of gathering a forum,
Speaker 7: that may be an opportunity.
Speaker 2: I see a gentleman by the microphone and the work.
Speaker 2: Do you have any preferences or bust case scenarios?
Speaker 3: A house sponsors can reimburse you besides paying a lot
Speaker 3: and immediately, wait, what was the last part of that
Speaker 3: is besides obviously paying fast and well, I'm not.
Speaker 7: Sure if this is specifically reimbursement. I think it ties
Speaker 7: to reimbursement, but amendments. For example, when we receive an amendment,
Speaker 7: it can be weeks even months a year. I've seen
Speaker 7: in cases where we don't have a budget for that amendment.
Speaker 7: That adds a new cohort and all different visits, and
Speaker 7: so there's a lot of risk that we face in
Speaker 7: doing that. And so we have this challenge of deciding
Speaker 7: do we take on the risk of maybe we don't
Speaker 7: even know what the expenses are, but also a billing
Speaker 7: compliance risk and not knowing what we should be billing
Speaker 7: a patient versus what will be reimbursed. And so, you know,
Speaker 7: my one solution there is that if you're going to
Speaker 7: send an amendment, we very much want to open that cohort.
Speaker 3: We really do. We want to.
Speaker 7: Enroll patients, and in fact, we have patients primed in
Speaker 7: many cases to enroll, but we do need to understand
Speaker 7: how we're going to get paid, and that has been
Speaker 7: a significant challenge for us.
Speaker 3: I would also add.
Speaker 7: You know, in some ways acknowledging what you're paying us
Speaker 7: for it really helps a lot.
Speaker 10: From Dennis, So, going back rewriting a bit, I'm the
Speaker 10: executive director of the Site Council. We've over three thousand
Speaker 10: side members, including Jefferson help. By the way, you may
Speaker 10: not be aware and be happy to help find sites
Speaker 10: personnel to support your engagement operations and.
Speaker 2: We won't charge for it.
Speaker 10: And if you don't work with I cruinly recommends you
Speaker 10: don't need the ko well input anymore. You need the workhorse,
Speaker 10: and you need especially need the coordinators. The coordinators know
Speaker 10: what's going on totally. They'll tell you the truth, so
Speaker 10: focus on them, and if anybody wants to pursue anything that.
Speaker 5: I'm around, I was actually just going to make a
Speaker 5: comment to that, because we're we're doing a very large
Speaker 5: internal systems rollout which we know will impact our sites,
Speaker 5: and so there is the document exchange element of it.
Speaker 3: We love it and when that's good to know. Actually,
Speaker 3: but when we.
Speaker 5: Originally started to look at it from a patient and
Speaker 5: site engagement perspective, which is the team that I am
Speaker 5: responsible for, I said that we have to get the coordinators,
Speaker 5: specifically the coordinators and we now have a panel of
Speaker 5: coordinators that they basically, I mean, we can't do much
Speaker 5: about the system, but it is good to get the
Speaker 5: direct feedback the system to the from the site advisory
Speaker 5: panel to the vendor. But what it does do is
Speaker 5: it makes us more aware of what we should be
Speaker 5: thinking about when we communicate and roll it out.
Speaker 3: Yeah, I think it starts.
Speaker 4: We have kind of set up our org chart to
Speaker 4: be responsive to the way the sponsors org charts are designed, right,
Speaker 4: and so you've got your site engagement people and we
Speaker 4: have our sponsor engagement people, and these exact conversations are
Speaker 4: the ones that are going there to have where we
Speaker 4: had one sponsor who we were running their entire portfolio
Speaker 4: of a specific mechanism of action and we simply could
Speaker 4: not work with the lab interface that they had in place.
Speaker 4: And so that's where the intent is that this is
Speaker 4: a forum where those types of you know, just operational
Speaker 4: roadblocks are surfacing so that we can be connected into
Speaker 4: the right person on the sponsor side and say what
Speaker 4: can we do about this? And again respecting that you've
Speaker 4: got a lot of sites to work with, we have
Speaker 4: a lot of sponsors to work with, and so at the.
Speaker 3: End of the day, we have to be flexible.
Speaker 4: Whatever we're designing on our side has to be able
Speaker 4: to plug into one hundred different flavors of doing it.
Speaker 4: But having the forum in place and having the right
Speaker 4: people on each side of the table to say a right,
Speaker 4: how are we going to tackle this one has been
Speaker 4: a strategy that's worked well for us.
Speaker 3: Yeah, I see that.
Speaker 1: We have one more question, but we're also winding down
Speaker 1: to the last two minutes of the shop clock, so
Speaker 1: we'll take that question. We'll try to keep it brief,
Speaker 1: and then if I could ask each of the panel
Speaker 1: members following that question to think about one call to
Speaker 1: action maybe to put out there so it's something we
Speaker 1: can start doing or stop doing to solution some of
Speaker 1: the challenges.
Speaker 3: Very likely, Please thank you.
Speaker 11: I'll be quick. So, first of all, great panel, very
Speaker 11: interesting discussion. I'm Karina adit sanchio and feasibility something you mentioned, Kristin.
Speaker 11: I actually started my career as a research coordinator, eventually
Speaker 11: moved to the sponsor side because of lack of career
Speaker 11: growth opportunities on the site. How could the sponsor help
Speaker 11: sites essentially ensure attention with staff by supporting these career
Speaker 11: growth opportunities that you're mentioning. Is there anything that the
Speaker 11: sponsor can do the support?
Speaker 8: I think ultimately a lot of that, unfortunately, is kind
Speaker 8: of internally, right. I think if you don't have a
Speaker 8: really good leader, obviously it's going to be kind of
Speaker 8: hard for people to see their value right and you know,
Speaker 8: see their value at the institution. But also you need
Speaker 8: a leader that is going to work hard internally to
Speaker 8: create those steps, which you know personally from an academic
Speaker 8: institution perspective can be very difficult. So I think just
Speaker 8: keeping that communication open. It could be different at different institutions,
Speaker 8: but I think a lot of that has to be
Speaker 8: kind of introspectively pushed at an institutional level.
Speaker 7: I would also say, maybe we look, we've seen things
Speaker 7: like clinical fellowships, and is there an opportunity for research
Speaker 7: support staff type of fellowship with you know, working with
Speaker 7: a sponsor to kind of gather some information expertise and
Speaker 7: then coming back. I think that there's an opportunity for that. Likewise,
Speaker 7: for people who are enrolled in say like our Masters
Speaker 7: of Clinical Research programs at Jefferson and some fellowships there,
Speaker 7: and so you know, some collaboration in that way.
Speaker 1: I think we had a wonderful conversation. We're down to
Speaker 1: our last few seconds. I want to thank our panel
Speaker 1: and please thank you for sharing some solutions from the
Speaker 1: audience as well.
Speaker 3: Thank you everyone, and thank you, thank you, thank you, Dennis,
Speaker 3: thank you.