 So we have time for questions for all the or either Rachel or any of the other speakers from this segment I think now for a couple of minutes No, I have a comment for Jessica I'm just haunted by you have the perfect population to actually do a randomized control trial where you do Offer some people less than standard of care because that's what they're already Getting and and the question is should they be getting that standard within the sort of clinic? I mean I love your service, but I think you could make a case that giving people less than the standard of care in your clinic It's acceptable because they should be receiving that standard in their primary care office or other specials. So I'm still I I don't have really a Specific recommendation, but you have the perfect pace of population to do a randomized trial would help your numbers for a little bit It would help you target. I just I hope someone in here is like yeah, I'm gonna do that with you because it's Just set up perfectly and the building the physicians as a whole are very interested in how to make Genetics more effective and reaching more patients. So they're completely open to any protocol change any Different pathway through the building for patients because they realize how few and so right now what they know is that during their short Memography conversation they're bringing up genetics because they know that they just need to get the word to the patient And that they find that even if they spend two minutes in their ten minutes saying we have a genetic counselor This is what she can do. You might want an MRI that it changes what they do So it's just about that bringing the conversation up. So they're very open to whatever we can come up with It's just finding the ability and the time and the structure to do it and I think Barbie someone has done a video about general cancer related Risk does that ring a bell to you and it might be Bettina Meiser's group Someone has done an intervention looking at a video based cancer interaction So that they might even be there's something that you could actually just taken I mean you can't use her video because it's gonna be Australian speak but You know so have a situation where one of the doctors or nurses mentioned genetics have another situation where someone in their Wait time another cohort watches a little video and I mean it just seems like it's To come through our building are already categorized by reason for appointments. So we have mirroring Waiting rooms you go through the building this side if you're there just for a yearly visit and This side if you're here for a lump alert or family history So their process is already 50 50 and then within each of those groups These are these fancy dashboards that we have even within those two groups You're either a stare or a lever Meaning you stay for three hours and get your results in person or you leave and everything's mailed to you So we already have four groups that are already Created if that makes any sense, right? So they're already that way and there's 450 to 500 a day What we're meeting about literally weekly right now is I was hired and told for a year and a half or two years your life is going to be very chaotic and problematic From trying to figure out how to manage patients So we went from me answering my own phones to me plus four full-time secretaries who do intakes and all of that And I have two students from RIT, which is a local college in town And so they're there helping go over the data and helping us create these computer programs and those kinds of things So on the docket for this fall is okay now We're at least doing our subpar job as well as we can how do we now? Do it better and do the research for it. So I think so you also have a great situation to show why they need to pay you a lot of money because They ordered a lot of tests and You need to show them the money they need to show you the money The other thing is and this is Eric go la la la la for a minute is we right now Can only be myriad and I know that sounds very silly because other parts of the country have been other laboratories We have 51% of our patients are insured by excellus and they are Heavy and big and dictate a lot and they will not approve testing to any other laboratory But myriad right now. So think about that for a minute. It's just daunting But in addition to the fact that they need to pay you a lot of money Again just like getting that into the literature, you know a lot of us will talk in cardiology about All of the downstream revenue that comes in Imaging for screening for family members from our work, but we don't actually have real data that's published that we can cite so Cute some of what's interesting is we're just the information of what do people do once they're diagnosed You know, are they what percentage are having a mastectomy what percentage are hysterectomy what how many other family members? So we started to collect I diagnosed one with the BRCA one mutation how many new patients does my building obtain and so far just in our first 40 patients that I've looked at that were BRCA one or two positive on average we gained five new family members from that one person just from our last because it's their siblings and their children and we're getting a lot of men which there are Our building has had to kind of think through the men, right We've our building has had to think through the men That come to our building Well, you know what's actually very interesting you'll laugh at this because Memography Centers have again a little old lady concept, you know, there's lots of 70 and 80 year old women who come through the doors But it's not being replenished with the 30 and 40 year olds. So our radiologists have just taken on a big Public service kind of community outreach on one of the radio stations that they're going to do this fall about sort of anecdotally how early detection and how MRI has helped and they're doing these interviews with patients from our building that are going to run on the local radio station Which then I'm thinking that's going to be even bigger than Angelina Because it's our local celebrity kind of people talking about it. So they're very open to growing changing altering The problem is I'm one mind and one person and I'm used to being part of a really big team That's what Nicole and I were talking about in the car and Jane on the way down Is my old job was a team and you always had a backup and you always had people there and you couldn't falter per se Because you had ten minds working on it in this position I'm the sole person thinking of the things and that's exhausting, right? So just to have when I said this was beneficial for me just to have the ability to talk about it and to say We're all thinking about the same things and I know my physicians are so on board with okay We have this great electronic medical record system with these four groups already. Let's just use it the best we can How to do that I need help So you need to come to our first monthly Lots of spare bedrooms so come stay with me for whatever period of time But in any any day we can run reports of anything so I can say how many people came for genetic counseling between this State in this state and then subsequently had an MRI because it's all appointment types And so you can I could just sit at my computer all day and run those things without trying to do much of anything Which sounds really ridiculous Jessica I was just wondering out of your 25 percent of your patients that you're flagging high risk Aren't there some of those people that have previously had genetic counseling and testing? Okay, let's want to make sure we weren't that far Seen me it strong in the last ten years Some of them I go I recognize that name and we'll pull them out But it right now the system is very patient emphasis They have to call and say they want to come and they have to call and say they want to be opted out And I am advocating for a little bit more proactivity that there is the ability to figure out Who's already had testing and get them out of that? generation of those letters so that's not in their Dashboard like if they already had a mutation coming in It's a question that they have to fill out But you know how people skip and pick and choose and don't necessarily answer the questions that are right there They've just put it into the patient portal so that the patient is gonna fill it out before they arrive to cut down on check-in time And so that they're not writing with good old paper and pen And so far they've had a very large uptake of this patient portal and it's only been Live for a month at this point. So I don't know how it will look, you know long-term Well, you know earlier when I was saying I wish I'd studied that phase where I first joined my group And there are all the people who'd already had genetic testing but hadn't had counseling. Don't let this go by You were talking about that I see a lot of patients where the gyns in the community order it and then say oh You know what and send them to me. So we have a large percentage of those patients But what we have is a lot of again generations. I'm watching Grandma daughter granddaughter all be tested in quick succession and then make different decisions. So that's an interesting discussion to just generationally There's so much