ASP SUMMIT 2023 Webinar 4 "Health Technology Assessment role on MD Reprocessing efficiency"

Ajouté : 2026-05-30

[00:00:03][Music] [Music] talk in [Music] the [Music] so oh good afternoon everyone to our fourth ASP Summit 2023 webinar series 4 um my name is j Ms and I'm the senior manager for the ASP region um on the educational part so it's my big pleasure to continue to with this four series program uh featuring these five webinars and under the topic efficiency in medical device for processing the road ahead um so before we get introduced uh to our hosts and moderator for today I just want to to give you with um um some tips don't forget this is not our last webinar from this series we're going to have again uh a round table like always uh in January with all our speakers that I will speak later on so as I was telling um regarding the housekeeping um um don't forget that uh for you have a better experience um we we'd like you to to switch off any nonenal uh applications on your device that may be taking away from you your internet bandwidth like the Outlook or the browse windows for example and if by any chance you face any kind of um video disturbance please refresh your window or uh just disconnect and connect again to make sure um you you come back to the session and you attend everything today webinar will starting with a 40 minute presentation followed by 10 minute Q&A session we'll conclude the webinar with the key takeways as always and we'll introduce you uh for the next round table webinar um that will take place in January this webinar will finish in one hour to respects everybody agenda and if for if you have any questions for the presenter or the moderator um during the session please make sure you use the the chat box that you it will appear on your right of the screen or if you are with the mobile on the bottom of the screen in order to make the presentation part of this webinar also more interactive we will have several Life Pools um from our speaker um and we want to ask you to and invite you to invest few seconds provided to vote in order to engage yourself during this presentation one last point this webinar will be recorded and the link of the replay will be given to you um as as also for the regist that uh did register but cannot be live uh today so uh before um um and and after the uh when you received the recording you also received h a certificate link and a survey as always so it's now my pleasure to present our moderator for today so welcome Dr Carlos the ones that have attended other webinars you know him for sure so um is our scientific director for the ASP Summit webinars and it's my pleasure to continue to have him on board and with this I end over uh to you Dr Carlos thank you very much J uh so um hello everyone so it's a huge pleasure to be here again with you and uh on this series of webinars um uh uh today uh we are as always uh having an important attendance and thank you very much for being with us most of you as always are from the infection prevention control nurses and Physicians and the uh um the central the contamination centers services and um well we uh have uh on our country uh distribution we have uh most of the attendees from the Middle East and uh uh also from Europe and uh other continents and so thank you very much once again for being with us and I I'm sure that you will um appreciate today's webinar sorry for today it's my pleasure to announce our speaker uh which is uh someone that you already know because he talked with for us on the previous webinars uh so uh engineer Jonathan art uh which is the head of the technological innovation Health technology assessment in the Poly Clinic universitario campus biomed at Rome in Italy and uh well um it's uh Jonathan is uh as a degrees in electronic engineering and biomedical engineering also is a senior Hospital management staff at is the really the medical director's office uh of the uh campus biomedical and he uh has a lot of experience on these fields from Health technology assessment uh budgeting budgeting cost tracing healthare operations operating room management clinical performance and outcome indicators and uh is also involved in hospital layout and workflow design so it's my huge pleasure to have uh engineer Jonathan for the talk for today which will the role of el technology assessment uh in another perspective which is the efficiency of medical devices reprocessing so thank you very much uh engineer Jonathan for being with us and the stage is you are thank you very much thank you Carlos thank you J and like to thank ASP once again for inviting me to wrap up these very interesting uh webinar series and so I have the privilege of speaking after experts in their fields and adding my uh insights about how all these elements can be combined uh through the health technology assessment methodology ology so today we will speak we will give a brief introduction on health technology assessment we will talk about HTA and its role uh in reprocessing medical devices seeing how and which applications there can be in the efficiency of reprocessing and also have a look to the future or present and see how technology is of assistance in improving efficiency so to begin there our first poll let me see where I can start the poll okay the question is uh what does Health technology assessment provide does it provide economic evaluations does it provide outcome evaluations does it provide clinical and technological analysis or does it provide evidence for decision making so it would be very interesting for to see which none of these answers are wrong I'll give you a hint um I'll leave this poll open a few more seconds and as I said I'll close the poll now none of these answers are wrong but the one which accounts for all of the previous is providing evidence in decision making as we will see sharing results and close so let's go forward hold on the slide is stuck oh okay now okay let's uh have I won't read through the whole definition of Health technology assessment by the European commission but what I'd like to stress is that Health technology assessment summarizes information about medical economic social and ethical issues related to the use of Health technology assessment and by Health technology we intend drugs devices and procedures and this means that we can include reprocessing in our scope so how health technology assessment works is seeing how a new technology in our case we can read that as changes to reprocessing procedures in order to assess whether they work better equally well or worse than the existing Alternatives and this means that Health technology assessment does this by including aspects such as cost implications or impact on the organization systems and so on and so in in order to perform this it means that HTA is a multi-disciplinary process which reviews the medical economic organizational social and ethical issues related to the health technology being examined and what health technology assessment does is provide uh policy makers with evidence-based information so they can make informed decisions so it's uh it's an approach for um giving evidence-based making evidence-based decisions uh in this uh classic definition is HTA as a bridge between knowledge and decisions and I think this is very effective in in focusing on this particular aspect so just to review how um how complex or anyway how comprehensive and multi-dimensional HTA is we can review the domains these are the domains defined by the core model so we have current use we have technical we have safety and we have cost Effectiveness that means cost and economic aspects ethical aspects organizational aspect uh patient and social as well as legal so HTA is always made possible by the collaboration between professionals healthc Care Professionals from with multiple backgrounds and multiple skills another definition which is brings us a bit closer to how HTA can be uh useful as a tool in appraising the reprocessing of medical devices is that of hospital-based HTA which means performing HTA activities tailored to the hospital context to inform managerial decisions on different types of Health Technologies it includes the processes and methods used to inter produce HTA reports for hospitals so this means that also in the classic classic definition of HTA which has a macro level which is a national or multinational policy level a meso and micro level we are acting on a meso or micro level in in order to focus our attention on reprocessing that said we should keep these definitions in mind as we uh look closer into the the more specific aspects now but the the key is always to keep in mind that we need to have evidencebased information to provide to the decision makers because every decision comes at a cost and provides an advantage or disadvantage so these need to be weighed out by the decision maker so the next question I'll ask you is what role can HTA play in the reprocessing of medical devices and so the first question is does it help in reducing reprocessing time does does it help in reducing reprocessing costs does it help in making evidence-based decisions or does it help in reducing resources involved okay I see the answers are pretty mixed I see you're considering time considering costs and also as we say time is money and in general making evidence-based decisions according to what I just said is the right answer although the others aren't wrong so I'll close the poll now and I'll share the results so none of you answered reducing resources but also as we'll see further ahead reducing resources means in since efficiency is a ratio between input and output if reducing resources while keeping the same output uh I'm able to do that that also means increasing efficiency but we'll look at that closer and later so let's go on to the next slide okay here it is so one of of the uh ways to uh improve reprocessing or manage reprocessing in general is to manage properly manage the equipment used for reprocessing so in this slide we can see a chart that shows all the steps which need to be uh performed and considered with a multi-disciplinary approach in order to have appropriate effective and um efficient uh reprocessing performed so this is in general uh these steps but let's consider them regarding steam cleaners uh low temperature sterilizers uh washer disinfectors and everything you know better than me is involved in reprocessing of instruments so the first step is a preliminary analysis of clinical needs and in by this case clinical needs are effective and efficient um sterile reprocessing at all levels setting evaluation impact of technology and requisites for tenders so this means how much space do we have how much do we need to uh what volumes do we need to produce and so on and also what staff do we have to operate the equipment so then there's a market analysis and consultations so obviously as for everything there are always several alternatives on the market um so then there's a choice of procurement procedure the uh offers are analyzed and the final decision is made and then the procurement and Logistics act in acquiring the technology which then needs to be installed and put into use so this as you can see involves considering the the type of Technology the institutional and organizational context the structure in which we are acting the people who are involved and the procedures that we need to carry out so let's look at the next slide where we can see how we can improve efficiency so uh taking further steps into the management of the equipment so we have we can with equip the equipment can be required it can be replaced it can be upgraded and then it can be deined in order to buy new equipment so you also need to take into account planning and budgeting in order to do this and uh especially important are maintenance programs um because the uh the equipment the sterilization or reprocessing equipment in general which we acquire is only as effective as the maintenance is because if they break or we have long time between uh we have a long downtime then it's as if we didn't have that equipment it's also important to consider vendor versus outside contracts and in general our experience is that vendor contracts are always better uh than outside contracts which may only result in uh false economy so then uh the proper use and we'll have a closer look at that later on meaning the instructions for use which means using the equipment properly the equipment is only as efficient as it is used efficiently because we may have very efficient uh sterilizers or cleaners but if we don't load them or to their and maximize their productive capacity then again we are reducing efficiency and what's important because we are aiming at improving efficiency is to find indicators of efficiency so we can monitor it and try to set goals to improve it so uh what we what is very useful is to consider meantime between failures in maintenance and aborted Cycles which means how reliable the equipment is so this uh is another graph which shows us the complexity of everything which uh participates in defining the efficiency in uh reprocessing so the first step which is the acquisition which can be on purchase or loan or other forms we had a closer look at but then we have all these steps which go from uh transportation of the instruments to cleaning disinfection inspection Packaging sterilization transport again storage and use each one of these steps has its own efficiency margins or efficiency issues so in in in order to try to improve efficiency it's important to break the process down and uh look at each one of these and see if there is anything that can be done to reduce waste of time uh resources in general of any type so as we saw in the definition of health of hospital-based HTA this is tailored to each hospital to each institution because no two hospitals are alike so now we've reached our third topic which is efficiency in MD reprocessing and applications so the question I'll ask you now is in improving efficiency which factors should be assessed inputs outputs or both so we consider the ratio of inputs and outputs um that's good mathematics because the ratio depends on the numerator and the denominator so I have I'm pleased to see that there is 100% answers on the third choice so we'll end this and share the results and move on to the presentation seems like this hold on okay so here we can uh consider the inputs and outputs through the um do we have a question here should we address this at the end no we address it at end okay we'll address it yeah uh in uh so uh to speaking in technical terms what we are considering and reprocessing are operations management problems so we look at this uh reprocessing as a process with an input which depends on the productive assets facilities equipment staff customers which means defining what volume what time and what and when and how and where the uh reprocess instruments need to be delivered which includes considering Transportation because hospitals uh are laid out over large areas materials considered energy consumed which as we'll see is a big issue and how we share information and so all these inputs go into our reprocessing cycle which we looked at before which has all those complex Parts uh in that closed Circle and so we consider the process flow how the work progresses how the process is designed and scheduled and how Al so it's controlled as uh it gets carried out and how it can be improved meaning the topic of this uh webinar series which is efficiency in R processing and then we have our outputs which is uh how at what quality at what speed at what volume and at what costs are reprocessing happens so this is how we should be looking at what happens in our Central sterilization departments so the context uh the challenges which are posed by the contingent contingencies that that we all know and that we all face are in general increased operating room volumes and so the uh sterilization departments struggle to keep up with the with the request by the operating rooms and also uh pressure to reduce uh turnover times which means also reducing time between uh between operations and then also instrument design complexity increases so we have uh different protocols and more complex and delicate instruments to reprocess this is this is thanks to technological Improvement which provide tremendous clinical outcomes and advantages but pose a challenge on sterilization departments so as I uh just uh said a few words on before is the importance of ifus so these are in the words of FDA and in the words of the uh C cdcs reprocessing methodology which mean considering uh the staff responsible training the equipment used and how it's maintained and the access to the manufacturer instructions are key in the efficient in Effectiveness first of all and then in the efficiency of our processes and so the recommendation is to review written reprocessing instructions regularly to ensure they comply with the scientific literature and the manufacturer's instructions this is particularly important and also compare reprocessing instructions provided by manufacturer and the sterilizer manufacturer and resolve conflicting recommendations by communicating them because this type of problem does happen and as we know for patient safety and risk management uh reprocessing is a very serious issue so how um optimiz how uh efficiency can be achieved by set optimization in general what is mostly practice and also published in literature and also is being done in the institution I work for is focusing on set optimization optimizing instrument sets means as we will see uh reducing volume uh resources used and also increasing the quality of the reprocessing so in the first study I'm showing you um within the mother set of 10023 instruments they separated um a a subset of harder to clean instruments which uh allowed the staff to focus proper attention and the needed attention on these instruments reducing bioburden in incidents which means first of all safety and second of all means reducing delays for the operating room so uh separating instruments from level of cleanability can be one effective approach in set optimization in this other approach uh which is response to lean management patient safety performance Improvement and quality and safety criteria which I won't go into specifically uh was achieved through the reduction of the inventory which means that uh transformation the transforma the bill to order process uh a very high number 58,000 unnecessary instruments were removed uh this was was worth $500,000 of unused sets and this produced uh High very high reduction in instrument assembly time because the unused instruments were not uh going through the whole reprocessing cycle including assembly at the end it reduced the inventory as we can see and so the and as well as reducing the assembly Time by uh to only 20 minutes it also reduced the setup time in the operating room because as you know before surgeries performed the the the table needs to be set up with the with the instruments and so on average the number of instruments per Set uh this was made a made possible with a reduction of uh an average of 59 sets final starting from 52 sets so this means higher safety higher availability diversification higher quality lower costs and also reliability because it means focusing the efforts on the instruments which are really needing needed and not dispersing it where unneeded another example which is once again a set optimization an example of set optimization was through uh um converting head and neck trays to thyroidectomy and P parathyroidectomy trays this reduced weight which is also means uh reducing the strain on the backs of The Operators of the Departments which means less incidents uh less um less wear on professional figures and also less sick days so that's s Al Another aspect of productivity and so the preparation time went from 8 minutes to 3 minutes and the weight decreased from 27 pounds to 10 pounds and so according to how um the costing is calculated in this institution each the new tray saved um $31 in the reprocessing cost considered um all the costing involved so as we as I said this reduces cost physical strain preparation time decontamination time and processing time streamlining the activity and increasing operating room efficiency this is I think the last example which uh had a recursive use of mathematical models so uh mathematical model was used to reduce uh the the content of a set and then the result of the mathematical model so uh so that is the passage from A to B then the mathematical model set was proposed to the clinicians who increased it to C which is still lower than a and then the mathematical model was applied again and so in the end the final uh tray hit is D starting from a and once again as this was calculated I think in a Canadian hospital this uh produces Savings of $25,000 annually so surgeons nurses and managers looking to streamline surgical trays should consider this combined mathematical and clinician review approach but whether we use mathematical models or not this is once again proof that there is in general room for improvement in uh in the reduction of instruments with within the within the trays and there therefore achieving efficiency in this other slide we can see how all the the steps consider how many steps there are in defining uh efficiency in in um the reprocessing of medical devices and how uh HTA with its multi-dimensional approach can help face each one of these steps and find areas of of improvement so we'll now go into our last topic which is current issues and advances in the rep processing of medical devices the question I ask you is how can new technologies help to improve efficiency in medical device reprocessing can The Help by tracking data by making predictions by assisting operators or by automating processes I'll give you a spoiler all these answers are correct but it's interesting to see what potential you see in these different applications of technology so none of them are wrong but it it'll be interesting to see where your choices go so I'll just wait a few more seconds I'll close the poll I don't see any more answers coming in so what you most I'll share the results um most of you said automating processes and then second is tracking data and then equal tied at third place are making predictions and assisting operators so we'll have a look at all these applications now here it is okay this is the context that uh in all Industries are in the world including the healthcare industry and one of the current issues which has improved over the past year but which we are still bearing the scars of is the cost of electricity so we all know how these the cost spiked due to geopolitical uh reasons but this has given us a warning which is how easy it is for things to change very quickly and become extremely unstable and on the verge of being unsustainable so although now we were able to write out the Peaks that you can see we had in the summer of 2022 going to almost going towards the pre crisis values we should always beware that things can change very rapidly so it's always a good and safe idea to not allow our process to be dependent on scarce resources or resources which could be become very expensive very quickly and another problem we have been facing we faced and we have not yet written out is are the supply chain disruptions once again these are due the these have been experien due to the combination of the covid pandemic and ongoing uh geopolitical instability and we can see in this chart how also the supply chain depends on many factors ranging from Transportation prices inventory and labor each one of these can can be um put uh into a stressful condition by uh external causes which as uh Health Care suppliers we need to face because we need to as healthc care suppliers guarantee the continuity of services because we are providers of essential Services which cannot be interrupted because that is what healthare is so this has given new surge towards circular economy models which has been the topic of the previous webinar series just to show how ASP is careful uh to current issues and this means finding ways to retain value so as we can see as we are building extraction manufacturing assembly retail this is not destroyed with use we try to reuse redistribute refurbish remanufacture ufacture and finally recycle this means relying Less on energy or supply chain or raw material shortages as much as possible so it's it's important to keep this in mind so that said we are now we can now consider how uh novel Technologies can help in uh improving efficiency and also safeguarding us from the dangers we just saw so uh software is a has been for years well established as a medical device as we can see here and it's used in image analysis it's used in uh monitoring it's used in wearable devices it's used in robotic devices and so um this is all very promising in direct health care but as we said reprocessing isn't directly direct Health Care although it is in the health care cycle so let's see how uh Ai and software improvements can be useful in this context um uh artificial intelligence and machine learning have made it possible to improve uh the planning in the operating room which means making predictions accurate uh using using machine learning on Big Data to predict and schedule and prioritize and reschedule surgery appointments um and therefore ranking the backlog and and managing the the schedules in general um this means that there is a potential for the same type of application and prediction in the reprocessing cycle because the reprocessing cycle needs to meet the operating room schedule and provide and synchronize the sets on time uh and correctly for for the specific procedures being scheduled also we can see how uh in terms of automation software has uh tremendously uh autom automated lots of the steps in the reprocessing of devices from reception to to the tracking and traceability um data collection document collection and also all the steps uh the hand all the handovers from delivery to reception and washing so U autom means saving saving time it means reducing human error it means collecting data which can be used for the previous applications of managing and making predictions and therefore in general streamlining processes and and improving efficiency um the most no one of the most novel applications in in software and artificial intelligence is that of the the capability of uh recognizing instruments laid out on a table and therefore identifying the content and guiding the operator in assembling the sets and therefore reducing human error saving time and also uh being able to apply a type of traceability which does not rely on data Matrix which we know wears out or RFID which we know is expensive and time consuming and this means uh building the inventory automatically and having the updated information on all the possible um optimizations of the inventory such as the set optimizations we we looked at earlier and this means uh allowing uh through a checklist allowing safety and reliability and traceability and accountability in the process so the question then we can pose as is being posed at all levels about artificial intelligence is to what extent does artificial intelligence take the place of human intelligence and so as has being said by all the governments who are posing uh questions on how to regulate artificial intelligence the answer is artificial intelligence is a good thing to be adopted as much as it is uh supporting human intelligence but never taking the place of human intelligence and with that uh we are at our takehold messages and then I'll be glad to answer your questions so uh applying um the applying HTA to efficiency we we saw how HTA is a valuable tool uh in addressing the reprocessing of medical devices um we saw how reprocessing efficiency depends on effective management of productive assets from equipment managing to Staffing to planning and to the instruments themselves which means also managing the instruments themselves properly means retaining invent uh inventory value which means acquiring economic efficiency as opposed to how productive efficiency can be obtained by increasing the output reducing costs materials and time involved and then to finish this we saw how technological advances in a context of potential instability can help in providing data and reducing human a so with this I'll finish and we can go to the questions and answers thank you engineer Jonathan we are just in time thank you very much for being so so rigorous in in this aspect and uh I have here some some questions uh uh I'm going to do it quickly so the first question is um uh I think it's interesting because it's an non organizational issue so which areas should be represented in the else technology assessment department so this is a general organizational question uh which areas of the hospital in fact well uh I'd say every area every area which is involved in defining health care or anything related to choice of Investments uh which are healthcare related so typically we have clinical engineering we have the pharmacy we have the doctors and nurses involved because they know how the products work and we have the pro procurement office and the management in general and then this also involves but it's not so so frequent at uh Hospital based level uh the patient patients are involved because as we know they are stakeholders in this process and also legal aspects because there may be certain Technologies which are uh especially critical or Cutting Edge or Innovative and so everything needs to be taken into account yeah and do you think the infection prevention and control teams are are are are also very important to be there yes yeah I included infection when I mentioned doctors and nurses but as an organism the infection and control department is very important because we know uh the clinical risk implications of infectious infection management and also how this touches onto organizational aspects procedures education so uh the infection control Department itself applies uh I'd say an HTA approach because they consider how people behave they consider what devices they use or what chemical agents they use uh how data is collected how data is analyzed so absolutely the infection control Department is as we might say covers has has a full range of the hospital and and covers every every aspect okay and especially what goes on in the sterilization Department which is what we're interested in now uh I have here uh some questions related with um econom the econ economics of uh HTA so um uh for example uh I we have here one question besides the inventory cleaning and maintenance that you cover during the presentation which other factors are taking into account for the MD you processing economic evaluation uh by by the on the global process of real technology assessment oh well all the economic factors that we can which which mentioned and that we can think of are involved as we know as we saw now the cost of electricity and water are not so much of an issue what is in my opinion very important also for providing quality instruments to the surgeons who are operating on the patients is maintenance because uh if you ask around generally um surgeons are more surprised if they have a pair of scissors which cut properly rather rather than having them not cut it's they they are more surprised that way so what I think is very important is to have highly efficient and highly maintained instruments because this means first of all uh delivering high quality health care and lowrisk health care to patients and also performing preventive maintenance on these instruments which may appear to be a cost is always lower than replacing the instruments when it's too late for for maintenance to be performed so what's key in this is to have the correct inventory the correct dimension of the available instruments so that you can uh afford you can allow for instruments to be sent out to do preventive maintenance without having to close down a set so it's it's about having enough instruments which is an investment uh but in the end I believe it is uh it has a very good return of investment to have enough instruments to be able to perform proper maintenance yeah and that brings us to whereas I may add sorry the tendency is seems also I mean if a system is not properly controlled and with data the tendency will be to have more instruments than necessary in order to compensate for reprocessing efficiency so we saw the example of the Virginia Mason Institute where they found an incredible number I think 58,000 instruments which were sleeping so they had instruments which were not being used and so that Not only was probably caused by purchasing in order to um not not have the the process efficient but also so that was a useless investment but then it also became a cost because you had all these instruments in the trades going around and requiring labor and energy and time and cost so I gave a very long answer to your question but I hope yeah and that's that's an interesting point because sometimes uh if there is no such an inventory of the the existing uh devices the tendency is to satisfy for example to satisfy the the surgical teams and buy more and more because uh they want it and uh yeah so the the the management is is is something that is um is very important and I I was telling you that that brings us to the um to the uh necessity of extending the lifetime of um the instruments also and so uh uh how do you consider that specifically on the reprocessing and stabilization uh process and uh taking into account also the sustainability issues okay well one thing we all know which I didn't say but I think it's important to say at this point is in extending the the lifetime of the instruments which means retaining in inventory value means also uh choosing the appropriate uh reprocessing methods which obviously needs to be done as I said according to the ifus by the manufacturer of the instrument and the equipment being used but retaining value means reducing uh the chemical or thermal stress on the instruments and therefore choosing for instance low temperature sterilization when possible because when we know that this will extend the lifetime of instruments particularly if we consider the cost of the process and the investment and the the lifetime and how long uh how long the instruments will function and in this particular issue the comparing steam sterilization with with other processes uh regarding taking into the consideration uh the exposure of the instruments to the Steam and and the consumption of water and energy yes yeah I mean it has been proved by uh economists who know how to make these calculations much better than I do and all this data is published and it shows how uh low temperature is more cost effective than than steam sterilization which obviously needs to be used in certain conditions but all these depend on the specific conditions of the hospital considering volumes considering quantities considering time and so on so it's always a choice of allocation which which needs to be tailor made as I said for Hospital based HTA yeah so thank you very much I we don't have the time for more questions if you have additional questions you can send us uh send them to to us and we will provide the answers after the webinar so uh I'm going to to give the the talk to to Jean but I wish you a merry Christmas and I wish you that you start the new year without uh any important issues and hope that the uh year of 2024 should be uh better than this this one so thank you very much thank you car and we'll see you in January at the round table yeah yeah thank you byebye thank you both um and thanks again engineer R for the insightful presentation I hope it was really beneficial for our audience and thanks again Dr paos for moderating the webinar don't forget the next webinar as we already disclosure it will be on January 25th at same time the topics is the as you know the efficiency on medical device representing to Road dead it was the topic of this webinar series and we will count with with all the speakers that have been participated H during this year starting with Professor Franchesco vener uh Mr Manuel Valente Mr vter M and engineer art that is present today with us so registration will be open soon stay tuned uh for the upcoming um Communications as a reminder uh for everyone today webinar have been recorded as you know and we will you will receive an email with a replay link in few hours as well with a short feedback survey that we really uh want you to invest at least two minutes of your time in order to we can continue to improve our webinar series to make it more fruitable and for you and more interesting also uh please make sure you you uh invest that time to to to give your opinion how can we improve um this series for we can continue to refresh knowledge and and share some expertise on the topics that are relevant for you so uh with uh we could not say uh and close this webinar without saying uh season greetings to all of you and your families uh and of course Happy New Year we will see each other in on January 25th and uh thank you again for your attendance and participation today uh will take um this opportunity to to invite you to come for the round table and um and um yeah and that's it for today so H happy and merry Christmas to you and all your families and we close it for [Music] today [Music] here [Music] [Music] the [Music] he he