Case Management in the Patagonia Health EHR

 

Transcript



John Ramsey has been with Patagonia Health since 2015, and he serves as our Senior Technical Product Analyst. He brings many years of experience in software development, and he helps us create products that drive improvements in the cost, quality, and efficiency of healthcare. He's especially passionate about supporting the public health 3.0 initiatives and helping us track social determinants of health data in our EHR. I am Amanda Girard, Marketing Associate here at Patagonia Health, and I'm going to be your moderator today. Today, we are covering what case management and care management are, and how, in the Patagonia Health EHR system, we support those things. Alright, John, I'll turn it over to you.

John Ramsey  1:53  
Thanks. Thank you. Amanda, can you hear me? Okay, I can be awesome. So I guess we could actually go back and let me just reiterate the agenda, see. So we have this agenda where we're going to go over care management, case management, and how Patagonia Health, the EHR, supports them. So we could have titled this actually, the care management and Patagonia Health beyond the EHR. So, because I'm going to talk a little bit about not just where we are, but where we're going, I'm not an expert in care management. I'm not a trainer in the application, nor a consultant for workflow. I am a little bit of all those. My role at Patagonia is as a business, Business Analyst within the product management team, product management is a department that handles so the way I look at it is where we gotta talk about it with people, is that it's, it's, it's two parts communication, maybe three parts communication and one part planning. So we engage with customers and also internal stakeholders. We look at the requirements coming in from all the different people who have ideas and things that they're looking for, with new requirements and changes that they would like.

 We put those together, we analyze them, we synthesize solutions. Then we manage that process, we prioritize, we project manage on the feature implementation, and then we communicate back out to both internally and externally, to customers, what goes on within the product. So, my experience is specifically in the building of aspects of the software. So I look a lot at not just where we've been, but where we're going, and so I won't know everything about every piece of the software, but I will know a lot about the pieces we're going to talk about. So, before I get into this, care management, case management, is a large part of the public health 3.0 effort that we're engaged in as part of a major EHR. We are looking at public health 3.0 as a guideline for our adherence, what we're trying to shoot for to be able to deliver on all the capabilities that people need in order to be able to meet their public health 3.0 needs. So that's more than just documenting the case. It's more than just documenting the patient record that is doing outreach. That's doing, building bridges to providers, that's full interoperability at different levels with agencies outside of the health department or the agency that you're working in. All of that is part of that process. So, care management and case management are often used interchangeably. And if you look up, if you Google on care management and case management, or care management versus case management, you're going to find lots of definitions. And so, so I want to go over a little bit of that, just so people can have a sense of where I'm coming from. So, people I've read in researching for this presentation, actually, I went and found definitions that range from case managers have a broader set of responsibilities to case managers have a narrower set of responsibilities. And I think partly what that means is that when people talk about case management, they're often talking about a broader range of subjects. So, for instance, you might have a case manager who's doing legal cases. They don't have anything to do with health care at all, or they're helping somebody with their finances or their job placement. So that's that it could be case management. And so in those cases, it covers a broader range than just health care. But also, in some cases, people have targeted case managers who are only doing diabetes and only doing asthma, so they're doing case management for specific programs, for a specific meeting, and the requirements for a specific program.

 So whereas a care manager is usually targeted toward integration, it's more broadly cast. It is more involved with the patient. A case manager may be working with just people who are working with the patient, but the care manager is usually working directly with the patient as well as with the providers. The Care Manager terminology, I think, grew up at the same time as the triple aim, where you probably have heard of the triple aim, where you have you're looking to improve the experience of care, you're looking to improve the health of populations, and you're also looking to reduce costs for healthcare within a community. So the care manager role, I think, grew up around the same time that became a common term, at least, that's how I associate it. The other thing I was thinking is, when I think about it, care is what you do for the patient. It's a much more patient-centric and interconnected type of activity, whereas a case is what you document. So you might be documenting the case in a case management tool, but you're doing care management. So the terminology can be interchangeable sometimes, but I just wanted to just go over some of the ways that people look at it differently. The care managers are definitely highly impactful on health care. Actually, my first experience with the care management prior to working with Patagonia Health, I worked with a community care organization that in my first connection was with a group that was run by a Duke University or Duke Medical Center, and they so there they were doing a study at the time that I got involved, and they were looking at comparing interventions after discharge from a hospital. So using the discharge ADT record feed as a trigger, they were doing multiple kinds of interventions and then looking to see what the outcomes were. 

So they tried things like letting the primary care provider know that that the person had directly that the person had exited the hospital, notifying the patient that they should go directly to their primary care provider. And there were a couple of things that they did, so they automatically generated letters as part of this study. One of the things that they did was find a care manager, and the only one, as I recall. I couldn't find the study when I was looking this up, but as I recall, the results of this study were that the only significant impact on the patient's health was that. It was measurable because the ones who were given were notified. The care manager was notified, so those cohorts were the ones that saw the improvement, and there's a good reason for that. The care manager understands that health. Environment. They're like a concierge within the environment. So their role, in addition to providing actual care, in some cases, as a nurse or provider, they act as a concierge, where they understand the healthcare environment, and they work with the patients or clients to help them get connected to where they need to be. It's a critically important aspect of this that patients probably did not study the healthcare system prior to needing help within the healthcare system, and they probably are not interested in understanding how the healthcare system works apart from getting what they need. So people will often not even seek out help if they don't know what to do, and they'll deal with difficulties and then go back to the emergency department again because they don't know what to do or they don't understand their medications. So there are several things that a care manager does that no other intervention on its own can do, because the care manager is putting together the plan and intervention and doing the interventions as needed, and helping educate the patient or the client in their specific needs.

John Ramsey  11:31  
So the the care manager does things like, well, obviously, if they're referred in either through like a hospital discharge, like I mentioned, or if they're they're new to the community, or they have some interaction with another community provider where they're referred in to the organization like the health department that had been that processing that referral, then doing some kind of screening or assessment to figure out what is needed. Then either enrolling them in programs in the health department or referring them out to programs in the community, and then tracking that process. So sometimes the care manager, even after referring out to the an outside provider, will track the progress to make sure that the patient does not have problems with that provider, and if they do that, they would either find them another one or follow up. So that whole process, depending on the situation, and it varies across within regions, across states and within regions, as far as what exactly care managers are going to do, sometimes they're providing actual services, health care services.

 Most of the time they're they're connecting people. They're acting as a counselor in some cases, as to how to do or, you know, to get them through what they need to to get connected and started with their health care. They're acting as an educator, but only as a guide, in a sense. So they're not tasked, typically, with being responsible for this person showing up to their appointment. They can help them get even they can help them get transportation. If that's a problem, they can help them do lots of things, but they're not actually doing it for them for the most part. Okay, so then that's what the care manager is about, or at least the process that care manager is using. What is the EHR doing for that? So I wanted to go over some of the things within the application that we are doing that to help support care management now, and then we'll talk a little bit about where we're going with it in the future. One of the things we've done, actually quite recently, prior to December, we people were going often to the Reports section to run their caseload reports to be able to know who they should be looking at. We now have a caseload widget, which I have here front and center on my screen. Hopefully you can see it. It is I've got it filtered on a specific program and filtered on me as the provider. It will stay that way. So when I leave and come back, it's going to be coming up with this set, if I wanted to, if I had multiple programs that I was watching, or if there were, if there were specific statuses, if I was looking only for open referral, so that I somebody had a new referral come in, then I can process that referral and then make them an active patient.

 So this is for many kinds of case management. Work, care management, case management, work. This is the place where you can drive who it is you should be looking at. In addition to that, prior to this, actually a lot of cases, you could also work with the forms themselves, within each of the widgets, depending on what programs you're working on. Sometimes you have specialized widgets, sometimes you have progress notes, sometimes you have encounter notes. All of those can be set with statuses, and then you would be looking within the widget on the dashboard to drive what you should be doing next. So any of these open forms that are assigned to me are things that need to be completed. So I could, I could use this entire dashboard as my task list when I don't have a patient already in front of me. So these are the people that I should be reaching out to. 

These are the people that I need to follow up with. This is my dashboard. Now, once I have a patient in front of me, or I've already figured out what I'm going to do for the day, and I go out and start talking to people, then I then I'm going to be working on the patient page, but this is the place where I'm going to drive my my workflow. So I should back up a little bit to to demonstrate how these people ended up on my list. So when, when somebody came in with an open referral, when somebody came in with a referral either through, let's say, somebody faxed in a form, or they called something in, or the self referred, whatever the process this person, this Meg Murry here is is set up with a service enrollment for that program with its status of open referrals. So I believe I was looking at community connections, so I was added in there as the primary provider. And now let's say, for instance, I'm only doing referral processing.

Let's say I don't do any other part of this process except just processing the referrals. So when, when this comes in, somebody could add this in when they get the referral without doing anything else, assign this to me, and then I'm going in on my dashboard, and I'm looking at the I'm going to set this to be only looking for open referrals, and I'm just going to go in and process that the patient to figure out what they maybe, Maybe my my process is only to see whether they're eligible for programs or services within the health department, or maybe I go on to do the next step, where I do an assessment and figure out what interventions we're going to do. But the point here is that this is where we set this up. We choose a program. We don't really the start date and end date are not as relevant for well, they are for referral to start with. So let's say this, this, if I do close this referral on this one, let's say I, let's say I determined that they are part of this program. So I'm going to go ahead and just say they are good to go. And this was, let's just do this, because this, let's say this came in yesterday and this going out today. 

So save that. So now that one is closed referral, and it's going to what I want to do for the person who's going to be following up on that is I'm going to do. I'm actually going to create another one and assign it to someone else and make them the primary, and make this in a status of so now that person is going to have them on their their dashboard as an active person within that program that they're going to follow up with and do the next steps, whatever they need to do next so that's how you get somebody on your caseload. That is the easy way to do that. The other thing, like I said, you could also do is follow on the specific forms. So each of these widgets that we've built for specific programs, some of them are more generic than others. So for North Carolina, there's just a case management widget that has several forms. See if I've got one that I can look at. I don't, I can go create one. So there are several different case management form is available within that widget when I go into the patient record, I'll come back to that. We have a couple of those here that we can look at. There are. I just put a few on my dashboard, naturally. I could put many of these if I was working different programs. Any of these that are available to the practice are apps that I could be using to do case management. I wanted to go over a few of the ones that follow that same workflow more fully. So one. Is community connections, which I mentioned in the when, when I was looking at the caseload app, and I was looking at what programs, so I've got community connections as the program. This is an app that we created for a hub program, a community health worker hub in Michigan, that is designed based on some material in an older, open source version of the pathways Institute program. 

So the content is, it's laid out more or less as an assessment and intervention set. So you have a set of you have this initial referral form, this process at the beginning, and you fill this out indicating their current status, whether they accepted service. There are things like provider, primary care provider, things like that, that are basic information that they're tracking how they were referred in. So this is information that's also potentially added to the service enrollment. So this is a little redundant in this case, so they could, but they want to track it on this form, and then they mark what the reasons for referral are. So they can track multiple they can just keep adding additional reasons for referral. So if they were referred in by a community provider that that asked for them to do medical needs, so let's say they have,

John Ramsey  21:34  
let's see, I think I've got a healthcare care do I do online? Do let's just do the medical care. So then I can also they use the same form actually to do follow-up. So they do a couple of follow-up fields, doing information about what they do later on with this. Once they've done that. The next thing that they do in this program is add

John Ramsey  22:11  
pathways. So if I have, if, for instance, this pathway for medical home, this form is, I can base it off of the selections that were made, or the assessments that were done. So I actually wanted let me go look at Meg.

John Ramsey  22:43  
So yeah, so I've just got this one initial referral form that was added for Meg on the 19th, and just two pathways that were added. So one of them is a social services pathway. And so you can see on this pathway I link to the specific in the incoming referral form because it's possible that she was referred in for multiple things or at multiple times. So I would be linking to this to make sure that my documentation path follows that. Here's the assessment that I did when I received it. This is the pathway that is connected to that, and I'm tracking just some key pieces of information. So in this case, this is a social service with a couple of different pathways within the pathways. The Institute material has sub-pathways. So social services is one of them, where you list all of these possible social services that you're looking into, many of these follow the social determinants of health, which is a key aspect of what a community health worker does, is to look at the things that are blocking someone from succeeding in their health care aims. So if you're helping them with making sure that they're getting basic household items, housing services, legal services, or any of these things. This is something that you're going to track, and all you really need to do is track who it is that's going to provide that for them and what the service is. In particular, you're not doing a lot of extra work on this. I'm going to come back to this for our next generation. What we're planning to do with this going forward is to be able to support these programs more fully in the future.

 Now, this forum in particular has a signature for staff and then a signature for reviewer with an assignment, so whenever you see it in the forum showing up on the dashboard, it's because it's been assigned to someone, and that's been filtered by that so this process, this workflow process, of being able to have a social worker or a community health worker working a case, filling out the forms, signing them off, they're done. This one's, let's say this one's completed, and they're they've closed it out. They've said they were finally or let's say they go ahead, the need was met, and we close this out today. I signed this. So then this is ready to go to someone else, to be assigned to someone else to be reviewed and signed off on and closed out. So that's community connections. That's one way that we're supporting a hub community health worker program that is doing a lot of social determinants of health work, connecting with people in the community. 

So they basically are just referring in, referring out, doing that work to get people connected in the community, making sure that they're connected to the health care that they need. Another thing, also coming back to referrals, referrals is a key part having a referral network, and referral processes are a key part to this kind of case management. So within the Montana home visits application, there is a feature that is specifically for the goals that they had for reporting for their grant. They have the need to be able to track not just that they referred someone out, but how many times they referred them before they were connected? So this panel represents a history where the patient was referred on the 19th. They were actually referred first on the fourth and then then on the 19th, and and then, in this case, it shows that they were connected on the 18th, but that would typically be after the last referral. So when they came in sometime after the 19th and said, Oh yeah, actually, I did finally see that dentist on the 20th, right after we talked last time, so I can indicate this and mark them as having an active relationship prior to that. In this case, for instance, I've referred them out to, I don't know why that's not showing as having a date in it, but the, let me show you what the beginning.

So when you, when I, let's say I'm going to do this again with the I uh, service providers. Mary Martin, service type is primary care physician, so I'm referring out for this. And let's say I did this yesterday, and I'm going to save this when I come they come back the next day. Then when I look at this, I say, Oh, I referred that. Did you talk to did you call the number that I gave you? No, okay, then I'm going to refer you again. And so now I've got a documentation that I've referred them twice, and then when they come in the next time, I can say, oh, okay, yeah, I did talk to them the day that we talked last time. And no, I'm, I'm, actually a patient now for that, with that with that doctor, if, on the other hand, they said that service that you're referring me to, I'm really not interested in connecting with them. I'm, you know, I'm going to wait or not do anything with that. Or potentially, when you did the review for that program. Let's say you did a an assessment, and they're not eligible for program that you normally refer people out to. The reason why we would document that is because you don't want to be constantly reassessing them if you if they're not eligible for a program, so you can mark them as ineligible, and that way you can see that that has been completed and you haven't. You don't have to worry about doing it again. So so you the three, the four statuses here are the person was assessed, and they they're ineligible for this particular service type, so we don't need to follow up on that they declined so there and then some, sometimes it would just be like, after three or four times when you have asked them and they're finally like, Yeah, I'm never going to do that. So you just say, okay, they're not going to make that connection. 

You can keep this open as a referral and just keep tracking it, and then you can finally mark them as having an active relationship with the provider partner. This actually has a report that goes with it that is specifically using the information about the referrals that process of how many times they did the referral before they got connected to be able to so, this is the demo site, obviously. So I've just got a handful and so I've got four Referrals Out to this dentist, to a dentist, and two of them got connected. And so I. This is so this is a little bit confusing at first, but the report is designed to show not only how many people are out there connected, but also the ones that got connected be, you know, subsequent to the referral. So it's possible that they got documented as saying, Oh, I'm already seeing that dentist, and you want to document that, and so you show the partnership, but that partnership didn't happen after the referral. It happened prior to the referral, so it doesn't really count toward the numbers that they are counting here. So let me try to move ahead

Patagonia Health  30:41  
a couple quick questions while you're there from she wanted to know if, if this could be signed on a cell phone, on those documents that you were signing earlier,

John Ramsey  30:52  
if they could be assigned on a cell phone? So probably not. I mean, it's, it's possible to use a device other than a desktop. Sometimes, if the browser is we're running on that device, but it's the software is not designed for that. That's something that we are looking at for, for many use cases, is enabling. You know, over the next few years, it'll be, it won't be a complete overhaul, but there are going to be places where you're going to be able to do things with device like that. So if I understand what you're asking for, you would have some limited set of things you want to be able to do from the phone. You're not filling out the whole form, but you might want to review a form and then reassign it. Is that is that kind of what's being asked,

Patagonia Health  31:42  
maybe for signing on the documents, maybe from the care providers signing off.

John Ramsey  31:50  
Yeah. So if you have, like, a supervisor who's remote or something like that, that's trying to get through their workload, and they're they're stuck in a waiting room, they can get through a lot of stuff, maybe that's so that's, that's that's something we could look into as a use case that we would try to enable a more of a mobile approach. That's one of the things that is going to come out of some of the work that we're doing. More generally, when it comes to how we're going to be developing forms going forward, there's going to be an option to that has for that the forms have more but it's not necessarily going to be fully enabled for other devices, but the ability to use other devices is going to be greater. So if you have a specific use case, what I would recommend for anybody is go ahead and make that request. 

What we will do is go ahead and save that off. We won't necessarily, you know, keep it as an open support ticket, but if you created as a support ticket, we can take that added to our our list, so that when we're looking at enabling certain things, we've got your name so we can follow up with you on the specific work case and get more details and be able to potentially use you as a pilot when we actually enable it. So that's I always recommend that you go ahead and submit if you have something like that, that you want. There's no harm in sharing a requirement or a need that you have. We don't always get to everything right away, but it's good so that we can get back to you when we need to so let me go ahead and move forward. I'm slower than I thought I was going to be, so I'm I need a little bit to move forward on some of these other things I mentioned referrals I should cover so we have the intake referral process which we are documenting in their service enrollment, and then using a caseload to manage that other people will also document that referral process, either by scanning the if there's a form, they could scan it into a bin, they could also have a referral process where they're documenting the referral in a specialized form. The on Referrals Out. We've seen where we're in Montana, they're documenting the Referrals Out. Oh, I know I was going to say so. 

I just wanted to really quickly show in their in their in the Montana forms, some of one of them is, you know, you can see the kind of thing. Each case. The management widget is a little different, and these forms are designed to capture some of the information about the person's current needs. But you can see, this is all social determinants of health kind of content. This is stuff that's, you know, it's, it's, it's not so much the fact that they have some condition. It's the things that are preventing them from actually becoming you. To help themselves to get better, that they have access to good food, the right information, and people helping them. All of those things are things that case managers are tracking within that form in particular, but that kind of information is spread throughout and customized forms. But what I wanted to get to is the referral out process. In addition to being able to document just that the referral was done, we also have referral process. When you're using encounter notes, you can easily generate letters and send them out electronically and then follow up on them using these patient referral orders.

 So you're actually referring out a kind of official letter that you can you can actually document this letter and send it out. And who we're in the transition of being able to do this outside of an encounter. For people who are not using encounter notes. There's limited capability right now to track the referral orders. It doesn't have the same capability right now to generate the letters, because the letters are often based on content within the encounter note. So we're still looking at ways to support more of that content, but eventually you'll be able to fully create the referral order and track that, and do all the normal do everything you would normally do with an encounter note outside of an encounter note, if you're using progress notes or using specialized forms to track your visits. So referrals in, Referrals Out, big deal. We are. Let's see what else I want to make sure I'm covering we have lots of different formats. Oh, patient interventions is a key concept that we are using. So we did event. We did develop this originally for some home visiting and case management programs. And then they have become useful in behavioral health, where they were upgraded to be using a more structured problem, goal, objective, intervention structure. And then now we're flipping that back into the case management, care management process. So we're going to be able to right now. 

The content in the demo site here is designed to work with behavioral health, but this content, this actual content, for treatment or care plan development, can be customized now to be anything. So if you have a set of interventions that you're doing that you want to be able to build a care plan. You can build it in here and then track the interventions. One easy way to do that is either in the see, probably the easiest way to show you is in the process. Note: When I'm looking at programs, I show you. You find out what she's already got. She's got community connections. So let me pick that I'm

John Ramsey  38:20  
uh. So I can in the progress note, I can pull the interventions right in here. And so I can either I can go and document the intervention there and then pull it in, but, or I can be adding additional notes about what I have done with the client in this visit, and then auto document the content for that intervention along with whatever my notes were in the in the note. And then I'm so what I'm doing there is I'm tracking not only across the interventions over time, but the within the note, I within the visit, I can track what interventions were addressed, so I can look at it both ways, plus the patient interventions themselves are at the high level, at least they're they're They're reportable, they're customizable, but the initial value of the patient intervention is grouped, can be grouped together and reported on, so that you can then see of the people you're working with, which ones got what interventions and what status they've been and how long it took for them to get from being created to being closed out.

 So that would be another process like so we've looked at the Community Connections, pathways, forms, where you open the form, you process it, and you add some information, and you close it if you have less metadata, additional fields that you want to add, and you can just put comments in the patient intervention. You can actually just do the same thing by building up a plan with the patient interventions. Now in the behavioral health world, we're looking at improving the treatment planner to be able to incorporate the treatment planner into the treatment plan form and then use the specialized progress notes within the behavioral health to do the same thing like we're doing with this standard progress note. So the same thing is going to be available eventually for other programs where we'll be able to within the treatment plan, use the treatment planner, this, this tool that we've got in the patient interventions, to be able to let me, let me go back and do another one that has the

John Ramsey  40:55  
like I said, one of the things about this one is that It's the content in this demo is key to the behavioral health interventions. So it's the content that the available options are, Oops, Oh, sorry. Let me see If I can find i

John Ramsey  42:18  
All right, so I'll come back to this, but that whole treatment planner can be customized to have content for case management. We have other programs like children's special health care services in Michigan, which is, it's actually, again, a simple, system where they're doing special health care services for children, and they do their plan of care, they do progress notes, they generate letters for patients. All that is the standard for lots of these programs. All right, so let me with the time that I have remaining. I do want to just quickly touch on some things we're going to do going forward.

 So let me switch back to my so the and beyond part, right? So where we're going is when I say and beyond. I wanted to kind of talk about what happens when you go beyond the kind of the the elect, the patient, medical record. So if you're thinking of the EHR as just a place to store files, where they relate to the patient, it never really was just that, from the very beginning, EHRs were designed to be about interoperability, and not just a place to store your files electronically so that you don't have to go file them somewhere physically. It's about being able to share them. Now that we've matured to the point where the world is filled with agencies that have interoperability. We're ready to be able to start really using this so you have referral networks to be able to have people electronically submit their referrals and have them show up in your EHR, on your dashboard, and have patients you can self-refer on a form. We're doing this now with the mass facts. If you've seen the mass facts, we have a mass vaccination app that is designed specifically around the idea that the patient's going to self-refer, ready for a vaccination. 

That record comes in, and they are not a patient at first because they just, they're just a random person who is just signed up for this thing and self-referred for immunization. And then you go through a process where you link them. It's so if they look like they're matched in the system, the system will say they look like there are, there's already one in here. If. I'm not going to say unmatched, if they're, if they're identified as being either an existing patient or you create a patient from the record that was created. Now you've created an impatient record, and you can do all these actions just from this dashboard. So you're taking a self-referral, and you're producing this actionable list. Now, the same thing can happen with external referrals from either self-referral or community partner referral. You wouldn't want them to just immediately go into the EHR because they're not logged in.

 They're not a authenticated user, but they can go on your dashboard as a starting point for you to then review the record, figure out where it came from, whether it's an accurate referral, or where you just want to delete it, just like you would if you got somebody leaving a message on the voicemail and it doesn't, it's not, doesn't belong there, you can just delete it. Otherwise, you bring them in as a patient, and you follow up to do that certain process of bringing them in as a patient or a client as part of the program. So that is one thing that we are going to be doing going forward. So being able to have people come in either through referral from a community partner or themselves, referring themselves in doing outreach, outreach to patients through mass communication, being able to use the information you get from a roles, from roles like a payer, or some community activity where you've got an enrollment list that is not a they're Not a patient list. 

They're not patients in the system, but they're people that you have access to their phone number or their email address to do mass communications for education outreach, to be able to move them from not being aware of their health care opportunities and getting them closer to being healthy, and be aware of how to take care of themselves, how to use the system and do all those things so that you're helping your whole community, even if you don't, even if they're not already patients on this in the system, we're also looking at better integration, like I mentioned, with patient interventions, Being able to in your treatment plan, open the treatment planner, build your plan of care using the patient interventions, process those interventions, enhanced customizations of forms around interventions, and then enhanced reporting around all that activity to be able to support care management, community health workers, outreach programs that are not necessarily even having patient names, they might just have counts where you want to document that you had a seminar or that you sent out flyers to a certain number of people in a certain demographic so you can keep track of what you're what you're trying to accomplish in the community, ultimately, to move the needle on the entire population and increase people's experience with, you know, improve people's experience with the health care system, and improve health and reduce costs overall, with the benefit of, hopefully, the Health Department and others spending less money to have a better population health and I've, I've run, I know close to my end here. So, do we have other questions I can answer?

Patagonia Health  48:38  
We've got one other and just to remind everyone that little box on the side of your screen, if you've shrunk that, you can click that red arrow, open it back up, and under the question section, you can type any questions you have. We do have one right now, John, we were showing the Montana HP program forms, and someone asked Patricia asked, can the system only be used with the Montana fee program, or can it be used by anyone?

John Ramsey  49:04  
It can be used, I think, by anybody. The sales group knows which widgets are extra cost and which ones aren't. I don't know if some of them are. It can be just added, like a caseload. The widget is not an extra cost. The Montana widget might be an extra cost. It has the word Montana on it, but I think that's actually customizable, so you could remove the label, but otherwise, the forms can be used as is. I, you know, we would love to have you look at them and either use those or as we're moving forward, we're looking at, you know, hopefully, being able to make it much easier to customize those forms so that it's easier for us to be able to provide exactly what you're using for your purposes.

Patagonia Health  49:52  
All right. Great. Well, it looks like that was all the questions we had.

John Ramsey  49:58  
Fantastic. Well, I. I'm really, actually glad you had this opportunity to talk about this, and hope everybody got something out of it. What did they learned a little bit something about the system that they didn't know, or got a sense of where we're going with some of the new features coming out in the coming year or so?

Patagonia Health  50:19  
Yeah, absolutely. If you just want to switch to the last slide, I'll share our contact information. Here we go. Alright, everybody, if you have more questions specifically for John, please reach out to him. Um, actually, that email address is going to be John R at Patagonia Health.com, um, you can also reach out to us on our website. If you'd like to see more demos, please visit our website and request one of them with us. We'd love to hear from you. Thank you for joining us today. You will be getting a follow-up email after this with the recording for you to review again as well. All right, thanks, everyone.


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