Empowering Patient-Centered Research Through Technology and Engagement

How do clinical research funders operate? Why do patient-centered outcomes matter so much and improve the quality of research? And how is patient-led research being applied to clinical care? We will learn all that and more in this episode of Research in Action with Greg Martin, Chief Officer for Engagement, Dissemination, and Implementation at the Patient-Centered Outcomes Research Institute (PCORI).   www.oracle.com/health www.oracle.com/life  www.pcori.org/   --------------------------------------------------------   Episode Transcript:   00;00;00;00 - 00;00;21;14 How do clinical research funders operate? Why do patient centered outcomes matter so much and improve the quality of research? And how is patient led research being applied to clinical care? We'll find all that out and more on this episode of Research in Action.   00;00;21;16 - 00;00;45;16 Hello and welcome to Research in Action, brought to you by Oracle Life Sciences. I'm Mike Stiles and today our guest is Greg Martin, chief officer for engagement, dissemination and implementation at the Patient Centered Outcomes Research Institute, referred to as PCORI. Greg's been with the organization 12 years or so, and prior to that spent time as manager of State government affairs for the American Academy of Family Physicians.   00;00;45;19 - 00;01;05;09 And we're going to be talking about no big surprise here, patient centered outcomes. So, Greg, we really appreciate you being with us. Well, thank you, Mike. It's a real pleasure and an honor to be here with you. I've listened to some of the podcasts and greatly benefited from the insights and the advice that you're bringing to folks through this, through this series.   00;01;05;09 - 00;01;23;29 So really just a real pleasure to be a part of it. Yeah, the show is really picking up steam and audience and getting some legs under it. All right. I guess let's start off by just having you describe your specific role at PCORI. What's your primary goal every day? And kind of also tell us about the overall purpose of PCORI.   00;01;24;02 - 00;01;46;12 Yeah, that's a great question. You know, and I always kind of joke around with folks that, you know, my mom does the classic two Bobs question from office space here. Remember that movie when I asked you about my job? What what exactly, son, would you say it is that a chief officer for engagement, dissemination and implementation does and it's a limited it's an uncommon title.   00;01;46;12 - 00;02;15;27 But the way I simplify it is that, you know, I get to work with a great team that is focused every day on how it is that people can be involved in the work that PCORI does as a funder, how they can be involved in the work that PCORI has funded and also how they can use in their everyday lives the evidence that property is funded and that last bit they're around evidence that that's why we're here.   00;02;15;28 - 00;02;57;06 PCORI is a clinical research funder. We were authorized by Congress. And interestingly though, even though we were authorized by Congress, we are an independent nonprofit and we're solely federally funded to do one thing, really, which is to fund patient centered comparative clinical effectiveness research or C.R. for short and C.R. as a specific type of research that's looking at intervention and approaches to health and care that are common in practice in the US health care system that stacks those interventions are approaches up against each other to really try and figure out what works best for whom.   00;02;57;08 - 00;03;19;14 But that patient centricity part in our name we take very seriously and we apply that to the C.R. We fund because it's not just about what works best for whom. It's about what works best for home according to their preferences. And that's where you get to the patient centricity. We all want to be healthy. We all want to live well, but we also want to do it in our own way.   00;03;19;14 - 00;03;48;06 We have slightly different definitions and that gets to that, that personalization of care, where we want to understand, given the options, what what should I reasonably expect will happen to me or what can I reasonably expect may come out of this for my loved one? That's the Cory Sweet spot. That's where we sit. And so I work with a great team that finds ways for people to be involved in that work, both again, what we're doing as a funder and the work that we fund.   00;03;48;09 - 00;04;12;23 Where does your passion for this work come from? Was there something you saw long ago in your work at the Academy of Family Physicians that kind of grew your interest in patient centered outcomes and how important that is? Yeah, that that's a great question, Mike. You know, and it's not something that's born from any single source. You know, I think all of us bring different lenses, different perspectives, different experiences to the table.   00;04;12;23 - 00;04;50;07 And one of the reasons why I'm so honored to have this job with PCORI is the fact that we recognize that and we in a way celebrate that and experiences that brought me to this to this point include, you know, that time working for American Academy of Family Physicians. It was a great time with them thinking through and working on issues related to the primary care workforce, health system delivery, health system design, how we pay for health care, how we pay for the myriad of services that make a difference in people's lives.   00;04;50;09 - 00;05;16;14 Prior to that, I've been with the National Conference of State Legislatures and working with state legislators and legislative staff of all stripes, thinking through how it is that we design and arrange systems of care to meet the needs of the people. And then that's the professional lens. But also, candidly, on the on the personal side, we all approach health care as patients, as families, as carers for people.   00;05;16;14 - 00;05;47;17 And we see and we live and we experience the multitude of ways in which our system works or does not. And we see the ways in which questions that we have those dilemmas around the decisions that we're faced with in our health and care and our families. Health and care have answers or don't. Those are the things that really drive me every day when I wake up and I think, okay, how can we advance the ball just a little bit to make life a little bit better for the next person?   00;05;47;19 - 00;06;07;27 Yeah, there's no one that doesn't touch and there's no one who's not affected by the system, the success of it or the shortcomings of it, whichever those may be. But research and especially research that involves the general public, that's not easy. What what does bakery do to create and foster engagement with patients and communities that really work and that matter?   00;06;07;29 - 00;06;41;00 It's no one simple answer. You know, we tend to think of it in terms of recognizing and appreciating the different contexts in which people exist and thinking through, okay, how is it that we can create an approach to engaging individuals from this community or this community itself in a way that's humble, responsive, resonant with the way in which they live their lives and they experience care.   00;06;41;02 - 00;07;14;20 And we also think about it in terms of a few different domains of activities that we can pursue that can foster an environment or an ecosystem where we can start breaking down these silos and breaking down these barriers that may have traditionally existed between research and community, between patients and investigators, between all other members of the health sector payers, insurers, employers, purchasers of care, clinicians of all stripes, hospitals and health systems, etc..   00;07;14;22 - 00;07;46;04 So as we've figured out the array of different tools that we should have at our disposal at the quarry and that we encourage others to develop, we want them into some some domains, some buckets, one of which is you've got to fund the practice of engagement. You know, engagement does require resources. When we first set out at the quarry over a decade ago, we heard clearly from investigators, traditional researchers and enthusiasm for getting closer to community.   00;07;46;04 - 00;08;18;17 But we heard clearly that they didn't have support through their institution and that our requirements may be some sort of unfunded mandate. We also heard clearly from patients and communities a likewise enthusiasm and a likewise concern that they didn't have structural support for their engagement and research. And so you've got to you've got to think about how it is that you are going to resource financially the venues, the forums, etc., for communities to come together with investigators.   00;08;18;19 - 00;08;46;24 You've also got to think through what are the facilitators for driving meaningful and effective engagement. So that's creating different tools and resources. And PCORI has many of these available on our website that we encourage others to use. But also as you look at these, you'll see that many of them are community generated themselves. Sometimes the best and most durable solutions are those that bubble up from the participants themselves.   00;08;46;26 - 00;09;12;04 There's also another domain of work that is really this notion of convening that you really need to think through how it is. We can bring people together because there's no substitution for the human touch, there's no substitution for human interaction and thinking through what are the different modalities that we can support people in bridging diverse perspectives in a complex space.   00;09;12;06 - 00;09;44;12 How can we help them see where it is that they may be using different language to say the same thing or the same language to mean different things? Quite common for us to all just talk past each other when we're really driving towards the same goal, but then also thinking through and this is where we've done a lot of work ourselves, thinking through how it is that we can substantively and meaningfully bring our community partners into our work itself, helping us to make better, more responsive decisions to what are the needs of the ground level.   00;09;44;15 - 00;10;12;17 So for Pachauri, for example, that means that we have multi-stakeholder advisory panels, we have application review panels that also are multi-stakeholder, that include investigators and statisticians and clinicians and patients. So really thinking critically about how can we bring people into the fold and have democratization in a sense of our work. Yeah, I really love the way you've laid that out in buckets.   00;10;12;17 - 00;10;58;00 It makes the Pickering's work crystal clear. But I do want to give our listeners a better sense of of why patient centered outcomes matter so much and how that then improves the quality of research. Do you have any success stories or anything that illustrates how enhanced patient engagement tangibly influenced the outcome of research? Yeah, for sure. I mean, let's start with the theoretical model, and it's really that as we create these opportunities for meaningful engagement, again, that word meaningful being so important, that is reflective of the community, it will serve to influence research, to be patient centered, to be relevant, to be useful, which will in turn help to make the research in the forthcoming   00;10;58;00 - 00;11;33;28 evidence understandable to and accessible to the public. And when people see themselves and their priorities reflected, it helps to establish the trust of and acceptability of the findings, which will also help to foster the successful uptake and use of research results and if you go through the course portfolio, you'll see lots of examples of this. And there's one that's actually quite recent where I can say that we're quite honored to see the announcement just this week of an organization called The Accelerated Cure, and they focus on multiple sclerosis.   00;11;34;00 - 00;12;00;10 They've received engagement award funding from a quarry to help really build capacity within their organization, in their community to understand how they can be partners more fully in comparative clinical effectiveness research, how they can identify what are the outcomes that should be measured, that are meaningful and relevant to them, and how to construct the questions that are meaningful to them.   00;12;00;13 - 00;12;27;29 They'd also received early BigQuery funding to support their people powered research network. And so all of these activities together they brought together, they needed together and they recently received it was announced this week over $4 million award from the Congressionally directed medical research program to continue to study different approaches. Online technology facilitated approaches to addressing fatigue and multiple sclerosis.   00;12;28;02 - 00;12;53;13 So it's a very granular example, but also how when we do work through our own funding mechanisms here, of course it can cascade out in many ways that benefit the broader system. Likewise, we've supported awards to, for example, the Bladder Cancer Action Network, where they again started off with engagement funding. Again, that resourcing to identify what matters to them in their community.   00;12;53;16 - 00;13;17;23 And we saw that translate forward into the quarry funded comparative clinical effectiveness research looking at interventions for bladder cancer. So those are just two two crisp examples of how this can all come together and advance in a way that is meaningful and responsive to community. I get that you want patients to have a seat at the research table right from the beginning.   00;13;17;23 - 00;13;44;04 Preferably tell us what's hard about that and then also tell us where the big opportunities and getting it right lie. Yeah, I mean, one of the first and foremost is really finding who are those activated, engaged patients who are ready and able to sit at the table. And oftentimes, I think it's not necessarily as hard as some people may perceive.   00;13;44;04 - 00;14;20;23 One of the best things that we've heard from many folks is to look within their own community, to look in their own backyard and figure out who are their neighbors, who are who are those organizations and individuals that are geographically proximal to them and do that hard work of the cold call of the picking up the phone, of going to where patients are going to, where people who are addressing the condition you're interested in, going to them and approaching them with some humility and with the open heart and the open mind.   00;14;20;23 - 00;14;44;28 Unknown We've seen that be actually a strikingly successful approach over a long period of time for initiating the relationship. Likewise, there are also national and international organizations that represent patients, and they're always worth reaching out to and identifying who are folks that may be within the organization or within their broader networks that are interested in this topic as well.   00;14;45;01 - 00;15;17;17 Again, that's initiating the relationship. Then you have to focus on developing and sustaining the relationship, and that comes through a lot of baseline principles that we previously articulated in what we referred to as our engagement rubric. It's about identifying what's your core learning agenda, How do you learn from each other? Because each party around the table brings important expertise, important lens, important perspective that give a holistic picture of what happens in American health care.   00;15;17;19 - 00;15;42;11 How is it that you will foster trust? And again, we all know that trust is based on that mix of deeds, matching words. And so it's everybody coming together in a forthright and transparent manner that fosters trust. And it's about reciprocity as well, making sure that each side is returning to each other and in bidirectional dialog and bidirectional exchange.   00;15;42;14 - 00;16;08;16 And so these are all factors that that support us and support the research partnership coming together. You know, what we talk about here a lot is technology and how it gets applied to life science research. What is bakery's approach to deciding what technologies to leverage and when and how? Well, in a lot of ways this a research funders are deciding when and where and how happens at the applicant level.   00;16;08;16 - 00;16;47;25 And so it's really the applicant teams that are coming to us with evidence based approaches that are in practice either for engaging a community or for addressing care. And so as a funder, of course, we work with our application review teams to ensure that the evidence underlying those approaches is valid. It's robust, but we see a lot of creative approaches on that engagement side, and I think there was no more clear example of how technology can be facilitative of engagement then the recent pandemic.   00;16;47;27 - 00;17;27;20 We saw so many creative approaches for fostering and nurturing connectivity and connection and for fostering and nurturing relationships with so many novel approaches, whether it was, I think, of often of a brilliant researcher out of New England, Sherman Naji, who did some really fabulous work using photo voice method for engaging African immigrant communities during the time of social distancing, we looked at some of the creative approaches to using engagement methods through some standard platforms that we're all used to now, whether it be teams or Zoom or so on.   00;17;27;23 - 00;17;59;22 We also see some of these approaches moving over into the care questions that are arising in the work periphery fund. So now let's shift over to some of the some of the clinical effectiveness research. There was a project that we funded several years back that was with a really great investigator, author Michael Constantino, and it was looking at different approaches for helping to match patients with therapies.   00;17;59;25 - 00;18;24;00 So if we think about the mental health crisis in this country and we think about the DA of providers, of clinicians in mental health and we think about what we've all probably seen in in our own lives or our lives of our loved ones, of how there's the challenge in finding a therapist that really meshes with you because, you know, mental health care is such a personal close thing.   00;18;24;00 - 00;18;50;16 You really got to find the right person that can help you. What this project did was it looked at a novel app that allows patients to put in what are the things that they value most out of their care, what are the outcomes that are most important and meaningful to them? And it facilitates them finding available therapists that match with their care preferences and their preferred outcomes and have really fabulous evidence.   00;18;50;16 - 00;19;11;00 And I'm really delighted that the team came to us for an award to implement this evidence and further clinical settings, and we're continuing to see some great results for this one. And I'd encourage folks to take a look at it on our website. Great. We'll definitely put that website in the show notes and make sure everybody has access to that so they can check it out.   00;19;11;02 - 00;19;35;05 Obviously, new technology, new tech capabilities seems to be coming along faster, more frequently. What are some of the technology advancements that intrigued you the most or stand to have the biggest possible impact on your work? Boy, that's another great question, Mike. I mean, you're just with a bunch of them today. You know, I think we're going to talk about technology advances.   00;19;35;05 - 00;20;00;28 I mean, let's just put it on the table. It's front and center of everybody right now. And that's that's the burgeoning use of artificial intelligence and large language models. And I think like most, it's an area that we continue to be intrigued by and that we're taking a long, hard look at how it can be used robustly. And, you know, we're taking the long, hard look at it, because this, of course, is clinical research.   00;20;00;28 - 00;20;33;20 And we want to make sure that the application of new technologies such as Iot get it right. So one of the first steps that we've done is we've actually started offering through our Methods Research program. That's a funding track that we have that supports the improvement of the actual underlying methodology for conducting research. We started issuing funding to support our understanding in the field to understanding of how these tools may be deployed within the clinical research enterprise.   00;20;33;20 - 00;20;58;06 And so we have a growing portfolio over there that I think is really going to yield a lot of excellent information and good guidance not only for PCORI but for the broader research enterprise in terms of how to appropriately deploy novel tools at the right moment to the right ends. Do you worry any about AI being potentially overhyped or over promising?   00;20;58;06 - 00;21;18;04 I mean, how do you kind of keep a measure on what's realistic to expect and what's not? Yeah, I mean, that's that's that's a great question. You know, and that's one of the things that I think we're all going to struggle with a bit. You know, there's a lot of interest, a lot of enthusiasm for AI. Certainly there is a lot of investment in the space.   00;21;18;04 - 00;21;49;11 And certainly like everyone else, we look forward to seeing how this continues to evolve, shape up and roll out. For now, we're continuing to be just laser focused on that core message, message and that core mission of ours of funding comparative clinical effectiveness research that really aligns with community preferences. And so while these tools may prove to be effective facilitators of comparative clinical effectiveness research, we remain focused on the questions that matter to communities.   00;21;49;11 - 00;22;28;06 What are the things that people are wrestling with? Well, it's right there in your title, Disseminate, and nothing good happens here if patients and other stakeholders aren't reached and educated. So how do you make sure people and health care providers get the results of research so that it can actually be used in clinical care? Yeah, I mean, we've all heard that data point over the years that it's a 17 year gap from bench to bedside, as they say that from the time that new evidence hits the streets to the time that it is commonly accepted in practice at 17 years, which I think we all agree is way, way, way, way, way too long for   00;22;28;06 - 00;22;51;14 us to be getting new information into the hands of those that need it and to get it into into play. Yeah, it's uninspiring. It is uninspiring, is putting it very, very diplomatically simply. But we can do better. And so we're trying we're trying a bunch of different approaches here at Quarry. Some of them were directed in our authorizing line.   00;22;51;14 - 00;23;19;06 I give actually a lot of credit to Congress in this aspect to have the foresight to task us, to challenge us with 90 days from the completion of our research and our acceptance of the findings to getting the evidence out there for the public 90 days. So as soon as we have accepted the final research report from every project that we find, we get that evidence up there as a publicly facing abstracts.   00;23;19;06 - 00;23;44;05 So people know, so people know within 90 days and we have that full research report, that full accounting for what happened in the research we funded up on our website within a year. That's the entirety of the of the scientific legacy of that project. That's great, but that's not enough. It's not enough to rest on that. It's not enough to rest on publication in the peer reviewed journals, which are a fabulous resource for clinicians.   00;23;44;07 - 00;24;14;27 So we've come up with additional mechanisms, one of which is, of course, like I was talking about earlier, relative to funding engagement, funding dissemination. So we've created funding opportunities for both the investigators that we funded as well as for interested communities to seek support to disseminate the core funded evidence to their community through a mode, through a language, through in a context that makes sense to their community.   00;24;14;29 - 00;24;40;11 I mean, we as one organization cannot be everything to everyone. We cannot know how to speak to everyone in the way that is most resonant to them. And we're honored that we have community partners coming forward that say, yes, we see ourselves in this evidence and we want to share it more broadly. But as any of us with an email inbox understand and Mike, I'm sure you understand this too, that email inbox is just growing and growing and growing.   00;24;40;11 - 00;25;03;19 And so simply disseminating and resting on that isn't necessarily enough. We're all just bombarded with information all day, so there needs to be a little bit more intentionality. Yeah, that's actually where I was going. The challenge of what we're talking about here, especially on the health care provider side, you know, based on other folks we've interviewed on the podcast has been that these providers there nose to the grindstone, busy.   00;25;03;19 - 00;25;26;07 So how can you even know or measure whether they're taking the time to digest research conclusions, much less pass that information on to patients? boy. That's right. That's right. You know, and this is actually where some of my some of our background comes into play as well as I think about the sad, exact message that I used to hear from family physicians back when I was with the American Academy.   00;25;26;07 - 00;25;55;29 I think about also what I heard frequently as a question from state legislators back when I was with the national conference. Folks want to understand how this has worked in other places so that way they can assess what are the implementation risks. And it's not necessarily a financial risk or a health and safety risk. It's a risk to taking their notes away from that grindstone that they are on.   00;25;56;02 - 00;26;21;04 So, you know, states want to know what other states have implemented this. Clinicians and systems want to know what other systems have implemented this. How did it look in their practice? And well, somebody's got to make the first move. You know, when we have high quality evidence that's not only dissemination worthy, but implementation ready, we do actually have opportunities to fund the uptake of evidence here at the Corry.   00;26;21;05 - 00;27;11;11 I mentioned earlier the award to Michael Cosentino for therapist matching. We've had a range of other awards to implement high quality evidence in additional clinical settings. And so that's where we start to go from beyond the more controlled clinical research setting to understanding how do we approach adaptation with fidelity to the evidence. So thinking through, what are some of those learnings from implementation science that we blend with the evidence itself and then apply an implementation practice When we talk about and think about the effect of data sharing and just that information flying back and forth in a more fluent manner so that we can speed learnings in research, it feels like a key element.   00;27;11;11 - 00;27;47;24 There is incentives for few people do anything unless they're incentivized to do it. What incentives are working or might work to help further encourage data sharing? Yeah, that's a great question. I mean that that's been one of the really sticky wickets, I think for the health system overall and not just in the US, but I think more broadly globally is that we have competing incentive systems and it really does require a broader, more fulsome conversation I think across the different participants within the health sector.   00;27;47;24 - 00;28;22;20 It's it's not just health systems hanging on to data, it's not just researchers in academia or elsewhere hanging on to data. It's not patients understandably concerned about how their data may be used. It's not individual clinical sites concerned about their data. It's everybody concerned about that. And so how do we foster conversations that can help us understand what would be the incentives that could actually bring folks to bring more data to the table in a more facilitated and accountable approach?   00;28;22;23 - 00;29;03;09 One of the things that we have tried here at PCORI is we did develop a large distributed data network. So we have been supporting for several years an initiative called P Cornet Patient-centered Outcomes Research Network. It's again a distributed data network that consists of several self-defined clinical research networks. So these are networks of systems and sites that have decided on their own to come together in partnership to work on data sharing through a common data model to support clinical research.   00;29;03;11 - 00;29;36;09 And in true bakery fashion, we require that they also have very robust patient and community engagement. So that way what we're doing is we're bringing together a somewhat novel incentive structure where we are bringing researchers, health systems and patients and communities and clinicians to the table together to think about data, use the context for data use, and to also give them a large degree of autonomy over when and when not to participate in any particular project.   00;29;36;11 - 00;29;57;13 Well, I'm sure that Peccary doesn't do all this on its own. I mean, you've already kind of laid out some of the partnerships, you've got some valuable partnerships and collaborations. Can you tell us about some of those, the main ones and kind of what each brings to the mission? Yeah, well, you're never going to hear an engagement guy talk about a main partnership versus some other partnership.   00;29;57;16 - 00;30;21;17 Who's your favorite Exactly? I mean, you know, everyone brings something really unique and valuable to the table and some may kind of roll their eyes. And Craig, don't say that. But really, when you dig in with folks, man, that's one of the things that I got to tell you, Mike, I just love about this job is getting to see this country and see this system through different eyes each and every day.   00;30;21;21 - 00;30;42;26 And so, you know, I think about organizations and individuals that we work with that bring that patient lens. And that really is the true north for us. How do we orient everything towards outcomes that are meaningful to patients and families and carers? But I also think about clinicians of all stripes, whether they are primary care docs, subspecialty physicians, nurses and so on.   00;30;43;02 - 00;31;12;12 Everybody brings a unique aspect and lens. Likewise with health systems, whether they're for profit or nonprofit or public, whether they're religiously affiliated, whether they're rural or urban. We think, think about the employers. You know, I often think that employers as purchasers of health benefits are one of the often overlooked critical components of the American health care system. I mean, 155 million of us, the most meaningful moment in our journey with the health system is probably open enrollment.   00;31;12;15 - 00;31;39;06 We think about the insurers and they bring a valuable lens as well in terms of the financing and the conduct of care in the system. And so it's really that blend of all of those perspectives that really gives us that criticality. And that's where we find that that value. And so I always encourage folks to think about who you have at the table, but also take a step back and ask each other who is not at the table, you know, who is not at the table.   00;31;39;06 - 00;32;02;14 That can bring an important perspective that will help round out our understanding and maybe help us figure out where are, again, those sticky wickets that we need to get past. Well, let's take a technology provider like the Oracles of the world. One, what can it do better or how can it bring maximum effect to a partnership like yours of a truly wants to improve health care and play a role in that?   00;32;02;16 - 00;32;26;19 Yeah. Yeah. Well, I would say that private partner like Oracle plays a very important role and has a very unique perspective from several of those lenses that I just mentioned. And if we think back to earlier in the conversation when I was talking about everybody brings a unique perspective that's informed by multiple areas in which they've lived and they've experienced, Oracle is no different.   00;32;26;25 - 00;32;50;03 We think about the corporate footprint that Oracle has as an employer and as a purchaser of health benefits. That's a valuable perspective from my seat and understanding how Oracle is considering its community. I also think about Oracle, as, you know, one of the largest I.T. and data services companies in the country, and that's a very unique and valuable lens.   00;32;50;03 - 00;33;24;20 And there's a techno logical knowhow that I think would be of benefit to anyone in research and thinking through what are the partnerships that may emerge there that also encourage Oracle to think about, again, who's not at your table presently as you're on this journey in better understanding and better supporting the improvement of health care in the United States and perhaps even globally, who are those partners that would help support on individual projects as well as enterprise wide and to keep that open door and keep that open seat at the table.   00;33;24;22 - 00;33;53;06 I'm going to ask you a loaded question just to see how diplomatic you are. You describe the health care system and you and you talk about the many, many players and components of it and the stakeholders. Is health care too decentralized within the health system? We approach it as it is as it presently exists, and recognize that people are approaching it with good faith and good cheer.   00;33;53;09 - 00;34;18;23 I truly believe that. I think also they will especially do so when you center your work around the patient. I think, again, the the way that we have health care arranged in this country as a system or probably more accurately, a non system, 56, you know, semi sovereign jurisdictions, each doing it their own way with a federal policy overlay.   00;34;18;26 - 00;34;38;04 It's not that it's too fragmented, it's that we just need to be thinking of what are the bridges that we can build between and amongst each other. And that's hard work. It's incredibly complex. And I think that's why some people may may back away for it. They may sometimes criticize me as being too Pollyannish about it. But I do think that people want to come together.   00;34;38;04 - 00;35;03;18 They want to come together and have their experience recognized, their experience honored, and their experience bridged to that experience of others. So that way they can move forward together. And I think so long as we continue to to work together and try and find those partnerships and those relationships, the better off the system will be and the better off we'll be able to provide patient care.   00;35;03;20 - 00;35;50;19 Well, now I'm really going to unleash your inner Pollyanna, because whether it's possible right now or not, describe what the perfect world of aligning research patients and providers around research outcomes looks like to. Yeah, well, to me, you know, I think that when you can have ongoing longitudinal relationships, that's a key word here, relationships where there is an open door and an open pathway for community to come forward with their concerns, with their dilemmas, where They are having challenges to researchers that are accustomed to working with community and are engaging of community, and where a funder is ready to support that partnership.   00;35;50;21 - 00;36;19;12 And when the applications are rigorous to fund those applications to support a deeper understanding the human condition and scientific knowledge in medical care, the better off will be. To me, I think there is real opportunity for this country to continue to move forward on that pipeline where the ideas and the questions are not borne of the ivory tower, but they're born of the real experience of people living their lives day to day.   00;36;19;14 - 00;36;44;22 We've got listeners, fortunately, that kind of run the gamut all across your stakeholder spectrum. So before we go, what's the most important message you would like for them to hear and hopefully remember? Well, in the spirit of what I just offered, where it is, you know, the notion of evidence needs, if we want to say it that way, the dilemmas that people are facing, The Corey's doors open.   00;36;44;24 - 00;37;06;26 I want to learn those questions. We want to learn what those questions are, what those needs are, what those concerns are. So I hope that people will take this whole conversation as a conversation, as an opportunity to reach out to us, you know, to let us know that they are there, that they're interested. We would love to have them involved and engaged in our work.   00;37;06;29 - 00;37;27;00 We'd love to have them involved and engaged in the work that we fund. We'd love to have them using evidence that we have funded. So please, you know, for all of the listeners out there in podcast land, give us a holler. Get in touch with us. We want to hear from you. Yeah, well, if they do want to learn more about Pachauri or you, what's the best way for them to do that?   00;37;27;03 - 00;37;54;11 Yeah, well, I think that's always important to add. You know, our website is really easy. So Pachauri taught PKO or I talk now if you really want to drill it on the website a little bit, there's the tab on there that says Engage with US. And that's an invitation. That is an open invitation, and you'll find links in there and descriptions and information about all the different ways that you can come and be a part of this work that we do.   00;37;54;14 - 00;38;12;19 You can also reach out to me directly. Greg Martin It's a plain enough name. Our emails are just G. Martin at the Corey talk. Feel free to give me a holler. Great. We got it. And we appreciate that. And for our listeners, don't forget to subscribe to Research and action. Obviously, one of the smarter podcasts out there, as you just heard.   00;38;12;21 - 00;38;42;00 And if you want to learn more about how Oracle can accelerate your own life sciences research, just go to Oracle dot com slash life dash sciences and we'll see you next time on Research in Action.