 we're all here. So I'll just start. My name is Elaine Byrne, and I'm a guest researcher here at the University of Oslo, and I like always saying here, it doesn't physically mean in Oslo, it's my connection with them. So very warm welcome to all of you who are listening to this live and also welcome to those who are looking at this in playback. My note is a lot of interesting sessions going on. So thank you for joining this. As you will see from the title, we are looking at non-communicable diseases and looking at how DHSIS2 is helping in the management of those diseases. We'll look at three very interesting presentations today. Starting off with Caroline Bain, the Senior Program Officer from Women's Cancer and Path, who will look at the uptake on tracking breast cancer and in Peru and the data that they've collected. That will be followed by a presentation by Blaise Mofende from our DHS, his group in Rwanda, with his focus on data use implementation and documentation. And he'll look at how we can improve the monitoring and care of cancer patients, looking at enabling the information exchange between DHS2 and their cancer registry system. And then the last presentation will take us away from cancer to rehabilitation by Richard Gruth from the WHO rehabilitation program. And interesting, we'll just look at the early lessons from the development of the WHO rehabilitation digital package and that will be across a number of countries, including Nepal, Rwanda, Pakistan, Palestine and Jordan. As with the other sessions, we'll keep the questions and the Q&A until the end, but please keep posting them in the chat and on the community of practice and we'll get to as many of them at the end that we can answer. But for those who are listening also in playback, you can post your questions on the community of practice and follow up with the presenters there. Really, a thank you to the presenters for agreeing to present here. Just to let you know there'd be 12 minutes, I'll just interject at 10 minutes to let you know that you have two more minutes. And that's just really to facilitate some timekeeping and so that we have some time for questions at the end. I don't want to take any more of your time so Caroline, I'd like you if you could share your screen. If you could start the presentation on data collected uptake on tracking breast cancer patients in Peru with DHIS too. Very welcome. I'll turn off my screen just for now, Caroline, just in terms of the bandwidth. Okay, thank you. Good afternoon good evening and good morning to anyone's on the West Coast as I am in Seattle. 6am here. Yes, I was just going to say thank you very much. It's all good it's light outside at least so that's, that's very good. All right, get this slide show going. Again, thanks Elaine for the introduction. We, I did present at the last conference last September, when we were just getting started and developing and building the system but we hadn't started actually collecting data so we're very pleased to come back and to the point that we are indeed in collecting data in Peru, and my, I will just mention that yesterday my colleagues from Peru presented this in Spanish so this is kind of a review for anyone who doesn't speak Spanish and also of course for the NCD group. Trujillo is in the northern part of Peru, this is where the work is going on, it's about an hour flight north of Lima, and it's the third most populous region Liliberthad region in northern Peru. We identified the need for this digital tracking really from the national the cancer coordinator there in Trujillo was desperate to have some kind of digital tracking to make sure they didn't lose women to follow up, and could get them the treatment as quickly as possible so this system was built so that we could see women from clinical breast exam at the primary level to ultrasound and triage biopsy at secondary level and then diagnosis and treatment at the tertiary level. I'll also just mention that this work is done using a different model than you might usually use for breast cancer detection in areas where they don't have regular access to mammograms. The need that she was seeing at the local level was this weak paper based referral system where diagnosis was not evident for an abnormal clinical breast exam and the primary and secondary health level providers did not know the results or the treatment for the patients they preferred. They had that lack of a digital electric electronic system to calculate the time elapsed between first screening and then diagnosis and treatment. And that as many people may know that WHO recommends be within a 90 day window so if you can't calculate how many days it was from to your first screening to diagnosis and treatment that makes it difficult to say if you were meeting that goal. The solution is the DHS to pilot network for Trujillo, we've worked with our partners path as a coordinator and a class in Spain as the consultant helping build the system. The solution process was selecting the participating hospital and clinics to begin with, and that needed to have the clinical health providers that would do with the clinical breast exam and find the biopsy triage and have the computer skills. We wanted to make sure they had access to internet, although we did use tablets that could be uploaded later to internet system, we chose 14 facilities, and then had regular meetings with the regional cancer coordinators and path and a class to define the indicators and variables and it was just a really amazing experience of health system strength and I would say at that really excellent communication and collaboration and and just couldn't be better. And then we also improved internet access by adding routers cables access points and connectors and tablets and laptops for those 14 health establishments. And then the hosting stand by Leno they so these are just a list of the clinics and hospitals that received and the different areas. I should say that 58, there are 58 total clinics on hospitals and this health network of Trujillo. So we were just in 14 of them. The training process was originally supposed to be in person, and then when COVID hit we had to give it to an online option. And this was done virtually with zoom and noodle a five day training with four days synchronous and one day asynchronous. As you can see there were a total of 25 professionals trained. The first group was the super users from the local Ministry of Health to heal health network and path. And then the other end users from the 14 health establishments the midwives perhaps professional with midwives doctors, and then those at the pathology of the North Bay Cancer Institute. The training process was we validated the variables and DHS to pilot project and health workers started real time data entry for their patients at the different levels in October 2020. And then we had constant support from the team and from the super users and a WhatsApp group was started so they could share messages and answer questions to the full team. And now we've done the transfer over for the, excuse me to heal health network to be the managers and have the dominion. Some of the results are we did successfully implement the DHS to to track the patients through the breast cancer pathway in these 14 health establishments and the regional Cancer Institute and they do it they've received those laptops. 25 trained and they're really important result I feel is that they are doing the real time follow up with patients with abnormal breast cancer. Findings and that we now have 1091 entries our goal with the pilot was to get to 800 so we're exciting we're past that by far. And the other really important part of this is proven coordinating institutes the cancer coordinators and the local Ministry of Health is committed to sustaining this digital platform. And these are just some of the screens we can see in the reports, and just a little bit of the data there among the 41 abnormal clinical breast exams performed. Then there were 35 ultrasound triage performed on those at the secondary level, and then 17 fine needle biopsy aspirations were performed and six cancers breast cancers have been detected. And just to reiterate that for for the cancer coordinators there and the health providers at all levels it's really very exciting to be able to see and follow and track their patients through all the different levels and see if they're at the next step and if they've had treatment and and so on to be able to to see all their data quickly. So a few obstacles we found a high rate of staff turnover makes it difficult and in the IT department but also anyone who's trained and then leaves we know is it is a difficult situation. There was limited limited familiarity with tablets so that was something that people had to learn the higher learning curve for tablets laptops were not on not did not have that issue. The HHS to capture application did not allow for a date change initially so they were some problems with that that were resolved. And the first month we had some trouble getting the few of the users to input the data. And some of the strengths were local support for setting up the laptops was great and strong support from the Ministry of Health coordinators has been amazing. And I think the commitment from these professionals to incorporate the digital data entry into their data activities and I think this is a very important aspect to to mention because we're asking them to do something that they wouldn't have normally had to do when they filled out the paper forms previously those would be given to someone to enter a to enter. Anything so now this is adding a step into what they do as they're doing the clinical best exams and they're doing these different steps they are then data entering immediately so it's a new new step and we've had good uptake with that which is very exciting. And excellent communication resolving the questions and solving problems and again wonderful synergy with this whole team that put it together. So we recommend monitoring, conducting quality control activities always close coordination coordination with the IT area, Ministry of Health and strong signal internet always makes it easier for everything. And I did want to mention that the cancer coordinators at this local level and to heal, and I live at that very are very pleased with the system and actually would love to expand it to cervical cancer so it's just now only breast cancer but they would like to expand it if that was possible, and expand to the full 58 clinic and hospitals. So, that's it for me today and thank you. Gracias for listening. Thank you very much Caroline for your early morning presentation. And I'd just like to encourage other people to put questions in the chat and Caroline would be able to answer those as the other presentations are going on. So I think it shows a really kind of exemplifies what we mean designing for data use Caroline by looking at all the infrastructural issues addressing kind of internet connectivity, right up to being flexible around kind of moving training online and illustrates really the commitment of everybody involved. So what I'd like to now do is hand over to you blaze in terms of your presentation on improving the monitoring care of cancer patients by enabling information exchange between DHS to and the cancer registry system. So if you can share your screen blaze. And again, if you if you're bandwidth and you're comfortable with it it's nice to see your face while you're presenting. And if you're if your bandwidth isn't great, it may not be may not be conducive to the presentation. Yeah, you'll be okay. In case it's not she can always tell me to take it off. So very welcome blaze. Thank you very much. Thank you everyone. My name is blaze offended. Currently working in his blender. And today we shall be going through the improving and monitoring the care cancer patients by enabling machine exchange between the current stages to registry and the current that they've been using the past years. So instead of an introduction of the current data random. It was not being collected in the proper way for the past years until 2018 when they remit shaded the use of country registry, but up to the end, the global observatory for cancer had estimated that they had recorded 10,704 cases under those 7,662 diet due to cancer. And as a result, there was an initiation of investing more in, in terms of finances in terms of equipping the data management stone of cancer and wonder. And part of the things they started implementing was a five year national cancer treatment plan and wonder that started with chemotherapy services being provided at one of our centers in Wataru. And then they were also invested in two linear accelerators radio therapy machines at the new one that consists of which was actually initiated by the president himself is excellent for again. Also, there's also been a light of increased research studies by different institutes and individuals in random which has called upon a better management system that can give reliable data that can be used in such studies. So I'm going to pass you through the existing system, the way the workflow is working, which started from health hospital site, where they collected data and entered it into the calendar. The calendar works offline on the desktop version can't that they don't currently have an online version. So they will enter data from the hospital site, and then use either papers in case the site does not have computers, or they become overwhelmed and then they will have to enter the After entering the data in Canary, the data would be exported of which the data exported can only be in the format of text file, and they had to export patient data tumor and then the source of the cancer. After input, exporting the data at the hospital level, they had to send the data, either by email, or they put the information on the USB drive, which is then sent to the hierarchy of RBC. Then the data managers at RBC, which is the random medical center, would compile the files from different hospitals across London, and then put them into the final data hub of Canary that is found at the headquarters of RBC. However, upon all that whole process from the hospitals out to the national level in RBC, they had also last January, they had created the DHS to trucker system that they would also enter the same data into the system for just storage as a backup in case something would happen to the offline system of Canary. I will show you this is a data entry form of the application, the works offline, which you see here, you'll find that there is a patient record, where they put in the information, and then here is the tumor records, and then the source records, all these are downloaded from different files, that's fast download the patient records, then download the tumor records, and then the source records, so three examples submitted from hospitals and health centers across London. If you see here, this is the exports format, and then the inputs format, where you would use to export the data by hospitals, and then taken to RBC headquarters, and then input the files, input the file, which is final, into the data storage at RBC. So, upon all that, the cancer program saw that there was a need to revise what was being done, and one of the things that we had to find was that the data was compromised, it says that the information was being exchanged by email, one wrong later in an email, the data would end up in the wrong application, which is not good for the patients. There was also a possibility of data loss, if someone is moving with a flash disk, it could have been easily lost, got lost, and then the information would get lost, which would have been seen as a problem. There's also a threat of duplication, while they were compiling the Excel files. There was also time consuming, when the data was required at a house facility at the national level, it would require them to communicate to different hospitals on different sites, we should also take more time than anticipated. So, fast decision making was becoming a challenge. The fact that the system itself does not currently have an online future did not provide real time data that is better for decision making and comes to data. Also, at the hospital level, due to the lack of enough equipment, maybe computers or tablets, they were not able to continuously use the system as they preferred. So sometimes they would write the information on papers, and then transfer the data into the clinic later on, which can cause a margin of error in terms of the data that is needed. So I'm going to describe to you the application that was being designed for us, that is going to facilitate and bridge that gap. This healthcare provider enters the data into the trucker system that was redesigned to be able to create data that is acceptable in category five. Upon entering the data, it is stored onto the system, which is then converted so that it is converted by the application. So the application's job is to convert the data to be able to be accepted into the clinic system until they can finally transfer the whole program to be used only in DHS. But as of now, it is going to be working hand in hand. So the application what it shall be doing is get the data that has been entered using the trucker system, then convert it into the code that is accepted by category five. The current existing, the existing random of country, the data that is inside is coded, let's say if it is a district in Shigeli, if it's a shichiro, it is going to be named as 01 instead of shichiro. So that was, that is the goal of the application. Once the data is converted and imported by the national level, it is then entered into category five for storing and analysis. The reason the analysis is not currently being done into the DHS system is because they have not yet set up the indicators that are currently accepted by the International Cancer Association registry, which is then that shall be the next step for it. This here is the application view. Currently, the features that are working in the first version are patient tumor source. The patient part will allow you to filter, whether by date, or by location. And then you can be able to download the format. The only formats being green up is the text file, since it's the one I said that in coming five, and then you can be able to do the same criteria in tumor and source. In the future, there is a hope that the future of data filter will be allowing you to just filter one time and then be able to transfer all the three files in one word, which is expected to be done as well in the period of August. One of the challenges that we may have faced are the metadata mapping. When it comes to mapping, as I explained earlier, the system encarned uses coded metadata. So that required for us to also ensure that the metadata in the DHS data tracker system will be converted into the codes that are accepted by encarned files. So if it required the team to redesign the tracker system that was being used before to ensure that all the elements and variables are the same as can read file, so that whenever it's about to compile, it does not receive a sort of an error. The next status is that the cancer application has been designed and developed right now to the implementation phase, and it's being, the training should start as soon as the programmers have found the team. Also, the dashboard and report configurations is going to be the next phase where we can be able to create indicators and design reports that are acceptable by the International Cancer Registry Association, which is what we hope to achieve after this period in this manner where any other places using the DHS to and also have encarned file or the oncology program can be able to apply the same system once it is implemented successfully. That is it from my side and I will end with this wonderful quote from Peter Sundegard. Information is the oil of the 31st century and analytics is the combustion engine. Thank you very much place and I think it really illustrates and my heart went out to do the healthcare professionals when you're describing the initial system around registering the data for the in the cancer registry. And then you'll illustrate it clearly they need to improve that process. I think it also illustrates a very different example of where you have legacy systems in place and how you actually deal with those legacy systems. And so again keep posting there in the chat and I'm going to hand you over to boots or I hope I'm pronouncing that correctly. And who's going to take about the early lessons around what WHO rehabilitation digital package development is about. So over to you. Thank you Elaine and good day to everybody. Thank you for having us. I will present about the development of rehabilitation digital package and early lessons learned from pilot testing in further fine tuning the standards that we will be proposing from WHO. So I am working for the rehabilitation program at quarters. And I guess you can see my screen. So, just to start off with in early 2017, which was launched this initiative called the rehabilitation 2030 initiative, which aimed at raising political awareness about the largely unmet needs for rehabilitation globally and to unify the rehabilitation community to address these unmet needs and 10 areas of action on priority areas of action have been identified and agreed upon during these global meetings, of which one has been to integrate rehabilitation to health information systems. So this is actually to collect data that are relevant for rehabilitation, such as sector sector performance. So this is why we have started to develop an aggregate module for rehabilitation. And defining 14 indicators that that inform our standard set. So we have been dividing these indicators into three subsets. The first one applies to all levels of health care that do provide rehabilitation. Then there's one additional indicator for the primary health care level. And then there's a few more that apply to dedicated rehabilitation awards. In terms of analyzing the, the data we have been providing a framework, which is based on the results chain. And of course, from the rehabilitation perspective we're looking at health system strengthening. And so we have been grouping the indicators that have been selected for the standard set into the different domains of a results chain. So we have rehabilitation bed density and personnel density which sits within the input domain. We have five indicators that capture data on accessibility so these are rehabilitation service utilization data and uptake data. We have two indicators on the quality of rehabilitation services which is the availability of the individualized care plan and the length of stay in hospitals. And then we have two indicators that capture data on the coverage for people with acute and complex rehabilitation needs. We have one indicator that captures the functioning change after a rehabilitation episode which is the overall aim of rehabilitation. And then lastly we have two indicators that talk about the health system efficiency which is the rehabilitation waiting time and rehabilitation referral across the different levels of health care. And this has been configured with Oslo University as in developing this prototype with the HS2 and comes with dashboards for the different sections that we needed to provide analyzes for. There was a few data entry forms have been developed. We have data entry forms for the outpatient rehabilitation department, there's one for the inpatient rehabilitation department, and there's one for the dedicated rehabilitation ward. So, proceeding to the pilot testing so now this prototype has been finalized, and we have embarked on pilot testing early this year. And this table is providing an overview of the countries we are engaging with. And in the column to the left, you can see the first steps that are recommended in the scope of pilot testing. And as you can see all these countries have been involved but don't really follow the same order in terms of steps. And in contact with Nepal and the Wanda Ministries of Health, which has been a very learnful experience in terms of exchanging monthly reporting templates from rehab facilities, which have been paper based the HS2 reporting in the Wanda as well. We are defining the country indicator set or updating the country indicator set based on the standards that WTO is proposing. But unfortunately we have not been involved from the beginning in terms of multistakeholder engagement or reporting readiness assessments. And nor have we been involved in the adaptation of the national HS2 system or data collection, which leaves us without lessons learned in terms of data collection and managing and the use and the analysis of the data. In Pakistan, we had some consultative meetings with Ministry of Health and had a strong multistakeholder engagement in the country but unfortunately because of COVID-19 priorities have shifted and this cousin tree has not proceeded since. In Palestine, some interesting findings have been that rehabilitation is not provided in public sector so Ministry of Health has decided to expand the use of the HS2 to private sector. So they have been committed, they have proceeded with the reporting readiness assessments and they have been defining their country indicator set based on the standards we have been proposing. But what came out is that they have been asking for a case based reporting whereas our module is an aggregate module. And then in Jordan, public sector is involved, they have already made progress in terms of the different steps. Again, Jordan has asked for case based reporting system, and as well Jordan has its own electronic platform called GYRS, which leads to a few challenges. So summarizing the challenges we have from pilot testing in these countries. First of all, we have had this conflict of priorities and interests from the different stakeholders involved, such as in the example of Nepal and Luanda. And in order to meet each other's priorities some further dialogue would have been desirable and needed. We have had a request for case based reporting, as mentioned before this has been unexpected, which now gives us the challenge to develop additional case based reporting collection for these countries. We have the Jordan situation which has a different data collection software or at least is a non-HIS2 system. And discussions are now going on in terms of adapting the national electronic software to the selected country indicator set. Or to investigate interoperability and how the HIS2 can support this process. In terms of early lessons learned, it seems very important that early engagement with countries and communication is crucial to meet each other needs and to be better prepared. We have learned that to consider private sector from the start is crucial from the Palestine example as issues may arise in terms of data governance and coordination. We want to stress the fact that the pilot testing of a proposed standard set from WHO is crucial as we do value issues that arise from implementation and the implication these have in fine tuning our standards and in providing analysis guidance. So pilot testing is really shaping the final product. We need to end, we had an interesting observation from all countries who all have been selecting our subset that applies to all levels of health care, which, and it might be too early but probably we will end up from the WHO perspective with a core set of indicators that applies to all levels of health care and an expanded set that applies to primary health care and the dedicated rehabilitation ward. So I stop here and happy to answer any questions. Thank you. Thank you very much. And it's great that you're all not alone you stuck to time but most of you have gone under time so I think this is the session which has actually got a considerable time for questions. Before asking interjecting with questions I have myself, I have seen that Caroline you've been very busy on the chat answering the questions there. Do you want to add anything to the questions I know you had one around the management of the kind of tablets and how, how that was put in place, the kind of super users being trained between July and data collection in September. Then looking at the shift from paper to electronic do you want to add anything Caroline that you didn't manage to get into your responses because we have some time here for you to do so. I'm not sure if I clearly answered all their questions so. Yes, I did say they, there's a big desire to go completely digital from the local Ministry of Health there in Trujillo, and that this would take considerable more time to set that up and get all of the fields so that it's not the complete background of the women's though if they want to go paperless they'll have to add more fields to the DHS. That'll take some more time. Yeah, then the super users have been great at helping keep everyone on track I think there's a question about how the computers are working and I will say that's been a little bit of an issue that seems everything's siloed so that if you're in, if you're in maternal and child you're not going to share your computer with the cancer. So, we were hoping there would be more sharing and that we wouldn't have to purchase a computer laptop, because if there was one already at the facility they should be able to manage but I think it's also a bit of time constraint if you want to do real time at the entry you need that with you and so I can see both sides it's a tricky situation. You said it's on quite a small scale so in terms of kind of the management of that it's been small enough and it would be interesting looking at the scaling. Similar problem I think most countries would like to move away from the paper based system, but it is a kind of a bigger leap to getting a completely electronic system. There's a question there for you Blaze around availability of the app and wondering whether or not and what stage that might be available on the app store or the availability of the API to link can reach a five and yes. Do you have anything to say on that place. Yes, thank you. So yeah, that is the hope once it is complete and has been developed and implemented. Once we have fixed the few errors, after receiving the feedback from the field, we intend to share it with anyone else. That's great. Great. Any other questions I mean you can raise your hands as well if you would like. I guess I guess I'd have a question really because you've you've shown. Looking at the process from you know initially getting consensus over what the indicators would be and helping to standardize those. And by which you and the differences you found across countries so I think you gave the example of Nepal, not being able to get in there at the initial stages so then, then how do you configure with the same indicators. And I think you tried to generalize it in terms of you know best practice would be, but how do you think you know it is possible to get in at those early stages such as you have done within Jordan. And that's a good question, Elaine. Of course, while developing our digital package. Other countries had already started the process so we were not ready for Nepal, for instance, who had already been a bit further. So that has been unfortunate but in terms of, and still this experience has been learned for looking at what what what indicators that have been selected and what has been usually collected for rehabilitation in these countries, and to map against our standard so this, at least it has been a piece of the pilot testing exercise we have been found to be really useful. And will you change the indicators like when you said you're going to have a corset facility, will countries be able to configure it to change those indicators because the problem with that then you have a lack of standardization in reporting as well. Well, the thing is probably it's early to say so, but countries that are still in the process, such as Jordan and Palestine will tell us whether the indicators we are proposing are actually relevant useful and from the feedback that comes from data collection and using the use of the data, but we are not there yet. We do we did have some interesting feedback for one indicator that is on the rehabilitation waiting time because desegregation types that we were proposing didn't really fit well in terms of data collection that wasn't considered collecting the data and the desegregation types. So we have split that indicator into two. So this has been a very helpful experience in terms of fine tuning our indicator said that we propose. Other than that, other than that countries have not asked for other types, or other data elements to be collected. So it is reassuring from the double shoulder perspective that we are not proposing anything weird to countries. It is what is collected at this point. What we do realize is that our standard set goes beyond what is being reported at this point. And this is what I was trying to say with a course, a core set of indicators and an expanded set of indicators. So it's a nice process an iterative process of kind of agreeing on those indicators and then seeing within the pilot's whether or not that kind of confirms it. And the other question before I go on to the question raised by Arlene in the chat is, do you think you will look at doing a case based package or do you think it would be better to kind of stick with implementing an aggregate form first and if that kind of works. You know, it's saying well, you know, now maybe try the tracker version. Yes, and this has been a very important spin off of the pilot testing so far. So both Palestine and Jordan have requested for case based reporting. So this was interesting for us to realize that this might be a request for other countries in the future when finally launching the product. So yes, we will develop case based a case based module as well, but have decided to first conclude on the aggregate and then develop the case based based on the aggregate. That's great. Thank you very much. There and I'm just going to go back into the chat in terms of for Caroline just in terms of the cost the investment cost estimate to link up to three levels and then I'll get to your question, Aaron. So, Caroline, which is how much additional investment to increase the scope to include breast cancer screening or. Well, are you able to answer that. I think both of those are a little bit tricky. So much of the cost is people's time, you know, it's, it's really personnel time so we had a really great consultancy with the Spanish foundation, and they did all of the software and so it was really coordination on the part of path and then with the two of you. So there wasn't any extra costs to link the three systems that was from the beginning, developed into the system, and I could message directly with them if we want to get into, you know, what it cost us to do. But breast and it was always breast cancer so it's, it's linked into their system but it's not something that's within their whole it is a bit siloed in that we are just looking at breast cancer. So it's not part of a larger public health registry of health system. And then Aaron, I don't know Rebecca did you want to say anything particular around the comment you've put there about working with Rwanda. It's okay so let me go to your question Aaron, in terms of, okay sorry Rebecca can't unmute but it's fine Rebecca, I think what Rebecca has pointed out there that we are looking at working with the work with Rwanda to look at their configuration and look at a metadata package. And I'll let you come in at the end there, Rebecca if you have anything else to add on that. But to Aaron's question there is, what are the non negotiables that are needed to work a successful implementation. I work for an international surgical organization that has to have a centralized data collection system. Now do we have a tech skill to develop or deploy something like this. Okay that's a really, really interesting question. So, so, you know, what, what do we have to have in position before beginning. I'm not sure which of the presenters would like to answer that someone starting off looking maybe for kind of surgical data how did they start off and from the beginning. Dr. Caroline you want to. I can try and answer. I don't think this such thing as non negotiables because many of the aspects needed for implementation can be built and capacity building is possible, whether it's in terms of data collection management. So the analyzes the platform. What I, what I do think is the main obstacle looking from the surgical perspective is that you would need at least some agreed data elements to collect. And if there's no standards for surgery or the type of surgery even, I guess that would be an issue. Dr. Caroline, did you add anything to that. No, I, I, I think there are a lot of logistical things that need to happen. So I think, making sure, no for us it was actually that down to the equipment and they have the computers that they have the internet system, depending on where you're going and how well equipped they are already. I think that's important and then making sure that they have the ability to do the data entry as I said is sometimes a stumbling block as well so, or a barrier. But it's for us it's been a really great solution DHS to so I hope that it would be something they could use as well. And then Aaron just to add to that I mean I know there's a group in the G for Alliance that are looking as, as Vutra has pointed out, looking at developing that set of core indicators. So, so that's kind of a very, you know, kind of global level look but I think as Carolians presentation has shown, you can also approach this from a very kind of local level pilot study so I think it really depends there's different angles to this, and it would go down to you know what is actually needed at that particular level. I don't know if there's any other questions. Anyone else want to come in on this. I think I've addressed most of those questions there. Okay, so if I just kind of wrap up in the session here I think what's been really very interesting to explore and what the different presentations have, have kind of illustrated are, you know, we're looking at a very kind of local level, those kind of logistical issues and, and very broadly around, you know, what are the infrastructural issues what are the capacity issues that all need to be in place to get a system up and running. And then we can look at it from the more kind of global level about the agreement on the, you know, the level of the indicators the a standardizing those and then looking at the feedback you can get from multi countries. I think blazes presentation adds to this in terms of looking at something that's new versus bringing in a legacy system and the implications then of how do you actually integrate and make these systems interoperable. So I think it was a really interesting session. And question on where, where can we get contact information of the presenters at the on our community of practice. You'll find the blaze and Caroline and food try I don't know if you're up on the community of practice, but then you can contact them and message them through our community of practice. All the presentations are also available in on scared as well. And I think most of you put in your email addresses on those presentations.