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64 - Consents in the Age of COVID-19: Using Digital Solutions to Protect Your Patients and You

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“...this is an unprecedented time for everybody. We all have our expertise in different areas and our experience in different areas and now's the time to be talking about our approaches, what we're doing, sharing our ideas, and really, really working together to try to get through this and to put practices and patients in the best positions possible.”

It is business as unusual right now. Patients everywhere have been told that treatments have been put on hold and have been left in limbo. Thankfully, there has been a surge in interest in using digital technology to keep some semblance of normal for patients seeking treatment. Thanks to applications such as Zoom, clinics are able to conduct consults or relay testing results. And thanks to new innovations making consents available online, clinics are able to get patients ready for treatment, while remaining in good legal-standing.

On this special episode of Inside Reproductive Health, Griffin talks to Jeff Issner and Taylor Stein of EngagedMD, a company that has developed an application that not only provides digital consent forms, but also goes the extra mile in patient education. Dr. Steven Katz of REI Protect joins in the discussion, offering his perspective on risk mitigation and ensuring your practice reduces liability in any way it can during these unprecedented times. 

This episode was recorded during a live webinar. Watch it here. In the coming weeks, we will continue to provide webinars with updated information on relevant topics. Learn more about our upcoming webinars at FertilityBridge.com.

Please note that all information included in this podcast is not legal advice and is simply to provide fertility clinics with information on the use of digital consents. Before using any advice in this podcast episode, please consult with your legal team.

Find Jeff Issner and Tayor Stein at Engaged MD by visiting Engaged-MD.com.
Learn about Dr. Katz and his services at REI Protect at REIProtect.com.

Need help navigating marketing through this unprecedented time? Check out our COVID-19 Toolkit from Fertility Bridge. 

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Welcome to the Coronavirus Business Response Series of Inside Reproductive Health. Here, you'll be updated on the latest insights on managing and owning a fertility business or IVF center during the COVID-19 pandemic. We put out free podcasts, webinars and articles as soon as new topics arise, so make sure to subscribe to stay updated. The best way to help us in return is to share this episode with someone in the fertility field that would find it useful. Now here's the founder of Fertility Bridge and the host of Inside Reproductive Health, Griffin Jones

JONES  0:52  
Centers are really all across the board with what they're doing now and I imagine that will continue to change as certain restrictions both from CDC and WHO and ASRM guidelines change and local regulations change in terms of shelter in place and all of that will affect what fertility centers are doing, what kinds of treatment at different times, and there might not be one perfect legal precedent for anyone to follow right now. And again, there's no legal advice here, but I wanted to bring on some people that do have experience with helping with consent. So I have Dr. Stephen Katz on. Dr. Katz is an REI also owns a company called REI Protect, which helps REI practices with insurance that's exclusive to the field of fertility. And I have Jeff Eisner and Taylor Stein on who are the principals of EngagedMD, many of you know them for their learning modules and for their consenting platform. So, there's a few things that we're figuring out together with all of you on and that's what do we need to consider when we're having people consent? And there are some of you that had been having people sign consents when they come into the office for just about everything that you do consents for. And in many cases, that's just no longer an option. So how do we do that digitally now? So gentlemen, welcome. Thank you for coming on. Dr. Katz, perhaps I start with you and just say, you know, what are you seeing in terms of how practices are consenting right now and what do they need to think about? And I know that's broad, but we'll chisel away from there.

KATZ  2:48  
Well, I think the consent processes we've talked about, Griffin, is critically important before the COVID-19 pandemic during and certainly afterwards. The majority of programs across the country, the vast majority, are following the ASRM guidelines. And so they're not starting new cycles per se, and therefore ,I think, the need to consent for new cycle starts has somewhat diminished. But the importance of consenting for medical care during the pandemic has, of course, risen to the top. So for clinics that are providing essential care--essential we’ll define for just this discussion--with no new cycles are certainly presenting consenting and important consent for the issues surrounding the pandemic. So offices must have a consent--paper or video as we're going to talk about--talking about the risks of fertility care during the pandemic. A couple of good examples of information that needs to be part of that consent: We don't know the future. We don't know, necessarily, the effect of pregnancy moving forward. We don't know specifically about the possibility that care could be canceled at any time, whether it’s due to an escalation of the pandemic, the COVID-19 virus entering the medical office in which you're having your care, orders from the state government in which you live in. Those are really important aspects in the current consent portfolio, because patients are sometimes choosing to pursue fertility care under the realm of it being essential, but there are risks--those risks I just mentioned. Most importantly, they can start a cycle, but it may be canceled early, middle, or late stage before the opportunity for fertilization could occur. So what am I seeing across the board? I'm seeing focus on informed consent relative to the pandemic.

ISSNER  5:07  
I'll just second that. We've seen a flooding of COVID consents come into our team to upload for digital signature. Of course, it's a totally different world! We're trying to do things as remotely as possible. Points Dr. Katz mentioned have been on pretty much every single concept we've seen. The risk of cancellation has definitely been at the forefront and just understanding there's a lot we don't know right now. And there is a chance that things can change rapidly and we may need to cancel your cycle in the middle of things just because of unforeseen circumstances.

JONES  5:38  
Is that mostly what the consent is, is talking about, Jeff? And I want to preface this for everyone that Jeff was really adamant before--we had a call about the webinar, just to talk about that he didn't want to come off as suggesting--you know, is providing any kind of advice or suggesting what a clinic should do. And I told them that was totally fine. It's not going to stop me from being curious, which is just generally, are these consents mostly focused on the possibility of stopping, or some of them not stopping, but here are what the ASRM guidelines say. and we might be doing something different in this case. What are these consents generally dealing with that you're being asked to upload?

ISSNER  6:22  
Yeah, we've seen a wide range, a wide array. And just to be clear, I'm not a lawyer--don't want to provide legal advice. But I do think it's important or in a unique position, and that we see a lot of different centers approach us. More than happy to share a summary of what we're seeing in these consents and I've taken a significant amount of time to kind of read through these just to get a sense of what people are talking about. I think Dr. Katz really hit the nail on the head. It's really important for clinics, it seems, to state that it's a situation in flux. Review the current guidelines, understand what the current risks are, what we know and what we don't know. I think every consent that I've seen has talked about what prior data does support in terms of febrile illness and any pregnancy that may occur, and very clearly states that we don't know a lot of things. The risks are unclear. We don't have enough data to actually clearly state what may or may not happen. Dr. Katz mentioned about the risk of transmission. Unfortunately, if you do proceed with care, even at a point where we relax social distancing in the future, and we're back to normal, I think it's important to realize that COVID is likely going to be around for a long time and there is a risk of transmission and it's going to be a long time before we actually know all the fine details about what those risks entail. I'd say all those things have been on top of the risk of cancellation in pretty much every single consent form I've seen.

JONES  7:44  
So and again, Jeff is talking about a summary. It doesn't mean and that's just a summary of what they're being given. It doesn't necessarily mean that what they're being given is always what is the best that they could be using. I think that's important to reinforce. So we have--we're talking about the ASRM guidelines now as well as just what the risk of COVID-19 might be. Dr. Katz--I do want to ask Dr. Katz is, are you seeing anything from insurance companies regarding this? Is there any guidance from insurance companies? Are there any warnings for insurance companies for those centers that are still doing treatment right now, at this time?

KATZ  8:29  
Griffin, in our program, 100% of our members’ constituents are all following the ASRM guidelines to some degree.

JONES  8:38  
Well, but to some degree Dr. Katz means that some are not following it to some degree. They're broad guidelines and there are some people that are saying, Okay, well, we're still going to do checklist testing. We're still going to have folks come through. And then others have said, You know, we're going to do--they're over 38 we're going to proceed with--we're gonna do retrievals and then we'll do freeze-alls. So there is a big range of things that are happening.

KATZ  9:07  
Yes. And I see the smile on your face. And there is. I mean, there's an interpretation of the guidelines going on. What I can say is, to my knowledge, programs are not starting new stimulation cycles, but plenty of them are finishing cycles and doing telemedicine interviews and depending on the particular situation, getting prepared to start new cycles when that day comes. Relative to the discussion that Jeff was so prominent on, I think programs also have to prepare to come out of this. So the COVID-19 consent has to have language, either now or in the short-term future, about we're back to a new normal. COVID-19 is still around. So we need to make sure that you're informed about COVID-19 once the new normal comes back. So I think what we'll talk a little bit about later in this webinar is the fact that it's very possible that some areas of the country go back to a new normal. The guidelines are more limited or less limited for certain areas of the country: Wyoming, Arkansas, Oklahoma, Arizona, versus Manhattan. So we have to be able to, as a group, be prepared for some areas of the country to go back to providing maybe full care versus some of the areas of the country not being able to do so under potentially orders of government. Still the consent process, it has to be forward thinking. Okay, we're potentially in Arizona, we now can start ew cycles, those consents have to portray that informed risk.

ISSNER  11:06  
It reminds me, it's very different in many aspects, but it reminds me a lot of consenting for Zika virus. This is the new normal, people need to be aware of everything that's and they need to be informed about in order to properly go through with treatment.

STEIN  11:20  
Yeah, I just want to touch on one more thing that Dr. Katz alluded to and we can get into this a little bit more later, if there's interest and time. A big concern that we've been hearing from practices over the past couple weeks, things have ebbed and flowed. But there's a lot of concern that when they do get back to seeing patients, whether it's regionally or across the board, that they're going to be overwhelmed because of pent up demand. And there's a real concern that at that point, physicians and their staffs already were overwhelmed in many cases and had a difficult time giving proper informed consent. And a lot of staff members have been furloughed or laid off at various clinics. And so combining that with a huge rush of patients, when things come back up, it's really important that you've thought through that process and what's going to happen and what you can do in the meantime, to sort of alleviate some of that pain because you can't cut corners when it comes to patient education and consent and discussion about financials and carrier screening and all the things that have to go into every cycle no matter what, just because you're overwhelmed and short-staffed. So we've been hearing a lot of clinics thinking about what they can be doing to prepare and happy to talk about that a little bit. But I'm also interested from the group if your practice has thought about this, and if you have any ideas. But Griffin, I'll let you pace things, but if there's time, I think that would be interesting discussion for the group.

JONES  12:50  
Yeah, I think for those of you that heard Taylor's question, if you can just answer that in the replying to all panelists and attendees, that would be really helpful just to see in the chat. If you can kind of share that with the group of what are you doing to stay engaged with your patients while they wait for the office to reopen? I’m kind of curious, I would just like to see, have you stopped doing IVF egg retrievals? For those of you on the call, we can’t see who is answering the poll questions. But about three quarters saying that they have stopped and we've got 32 yeses we have stopped, so that’s 82% have stopped, and seven said they have not stopped, so 18% have not stopped retrievals. So I do think this is really important for people to consider because at some point might be things for different people. Others might start when others stop and others might stop as others begin. We have one question from Dr. Lunder, which is what would be the regional determinants for a practice for change, to change the type of treatments they are okay to do? Number of COVID cases in the region, status of PPE supply, or the health system in the region? I'm not sure that this is a question we can answer. Dr. Katz, do you want to take a stab at it?

KATZ  14:15  
Sure. I'll take a stab at it. I think there'll be a direction from your state government. Some cities like St. Louis in Missouri took the lead over the entire state government in Missouri, but most of the time, it's the governor of the state that will determine the rules and regulations of that state. Yes, I think if I'm taking a stab at it, it will be the slope of the curve in COVID-19 cases and other related aspects that may allow a loosening of the regulation.

JONES  14:47  
Thank you for that. I do have a question for Taylor and Jeff, which is the way that I've been approaching this--from our response, from Fertility Bridge’s responsibility--we need to help people pack their new patient waiting list as much as possible to convert them to video consults. For those that are doing checklist testing, they'll either do that now or later if they're not. And we need to have that waiting list of patients that are ready to go to treatment as much as possible and that will involve not having a short staff that is rushing through consents at a later time. So to the extent that people can do some of those consents now--and we talked about carrier screening as something that can be done before all operations return to normal--having these consents done digitally is important because in many cases, we're not even allowing the partner into the office anymore. So for those that have kind of resisted doing consents digitally before now, the impetus is upon us. In normal times, what's, I guess, describe the process of someone coming around to doing consents digitally for the first time in normal times. And then maybe, we compare that to the speed at which it has to now--or is happening now?

STEIN  16:01  
Yeah, Jeff, let me let me take the first part of that question and then Jeff, you can fill in the details. So there are a number of things as the folks who work at practices know better than then even we do, that are done at the office normally, but with the right technology can be done remotely. We have been moving that stuff, some of that stuff, into the home over the years, but it's always been in support of in-practice consultations, because that's been the standard. And before COVID-19, we had not seen a big move to Zoom conferencing for consultations in the fertility world. It's something that a lot of other specialties have adopted, but fertility, we haven't seen much of it. And so we've been taking a microscope to this and talking to practices and hearing what they're doing in sort of rethinking the flow ourselves and there is a lot that can be moved to the home in coordination with video visits. So not only do we have the electronic form signing capability and the video consenting, there are folks like Semaphore and other carrier screening companies that are trying to rethink their processes to enable carrier screening to go on without the patient and partner needing to come into the office. We've heard things like increased use of mobile phlebotomy for example, and we're helping to support them with consenting processes. And a big part of that is because oftentimes, it can take up to two weeks from when you actually do the draw, to getting the results, to having your genetic counseling consultation, to them being able to start, so being able to push that earlier can help ease the burden when the offices do reopen. And Jeff, I'm going to pass this off to you to talk some more about other things that we've heard and things that that we're working on to help support.

ISSNER  18:03  
In terms of actually implementing an e-signature solution--so well, let's talk about informed consent a little bit more globally. We still need to educate with relevant information, we still need to provide an opportunity to answer questions, and we need to still get these documents signed, so I'll touch on those three things differently. And the three ways that we've talked about it at EngagedMD and the way that we're supporting our practices hopefully, it will be helpful to everybody. So let's start with educating with relevant information. We've been providing educational materials in the form of video to make sure that patients do have access to all of these resources and they can do it on their phone safe at home. Zoom and telehealth solutions are a great way to have those consults to round out that information and to ensure that questions are answered and then, of course, getting the consents signed themselves. There's digital e-signature tools that are available to use. People are already doing a lot of this before COVID, like you said, COVID was an impetus for fast change for a lot of clinics trying to react to all this. Big thing that people need to work through is just this change in mentality and how do you actually go digital with all of these paper consent forms? I think the most common question that we receive is, Well, people are doing this remotely, how can we be certain that the right people are signing at the right time.

JONES  19:19  
That’s always the biggest question with e-sign, isn't it? And I remember you talking about this Jeff in Dr. Katz's meeting a few weeks ago. And as you were talking about it, I was thinking my assistant signs almost everything for me. We recently just did the Payroll Protection Program and that application for the bank and I signed that--if it's something of that gravity. But if it's like counter signing a client change order, or you know--my assistant is the one doing a lot of that signing, and maybe that isn't the best practice and maybe the attorneys on here are scoffing, but I think that is something that happens. So please do talk about that some more, because I think that is a concern that a lot would have.

ISSNER  19:58  
Yeah, definitely. So you know, we've explored this issue very thoroughly, of course, as we try and improve the way that you can electronically sign. And it all comes down to risk mitigation at the end of the day, but there are many great mechanisms that are in place to authenticate with an electronic signature system. So you can take a look at your consents and understand what are the more sensitive ones, what are the less sensitive ones? The less sensitive ones you may not need the same level of authentication as the more sensitive ones. For the more sensitive ones, some of the things that we try and recommend practices implement are dual factor authentication through a text message authentication to each person's mobile phone, you can do government ID authentication, so people actually have to take pictures of their IDs themselves and those are validated against a government database. So just because it's digital doesn't mean that it can't be a successful and secure way to obtain signatures. Thorough process has been put in place to ensure that the right people are signing the right documents. 

JONES  21:00  
Dr. Katz,  Do you have anything to add?

KATZ  21:03  
I can't really say enough about digital consent. If we think back to the latter part of the 20th century, in the last three decades or so, our offices used to hand patients consent forms, pieces of paper that said, Go home and read it and if you have any questions, feel free to come in, and let's discuss. And I was always afraid that patients really didn't even read them. They got bored with it, and they signed it, and they brought it in, and that was the end. And so when complications developed and they even went to court trials, patients would always say they really, really didn't have a good understanding of what they were doing. And so now with the ability to look at video consents, digital consents, have the comprehension questions, it gives all of us a peace of mind that patients actually have a more thorough understanding of the procedures, the risks, the complications, the possible outcomes. So I think with the pandemic ongoing, the ability to transition to digital consents as the norm is really monumentally important. And I'm hoping that all those listening would keep that in mind, this is a perfect opportunity to transition. Jeff wrote a nice paper on our website about the security behind e-signatures. And I think a lot of our programs have really accepted that because you're right, Griffin, as of a few months ago, people were really questioning the validity of these signatures. And I think we're really moving in the right direction as it relates to informed consent.

JONES  22:47  
So we have a poll question right now which is to what extent do you use digital consents at your practice? Dr. Katz, Jeff, and Taylor, we had four options. Which is to what extent do you use digital consent in your practice? We have yes for all of them, Yes to most, some, but not most. And then No, none of our consents are digital. So all, most, some, none. What do you think the breakout is? 

STEIN
I'm going to guess that this is a very forward thinking group. And I'm going to say that 80% are either Yes, all or Yes, most

JONES 23:28  
80% Yes, most is Taylor's guess. Dr. Katz and Jeff?

ISSNER  23:32  
I'll be a little bit more pessimistic. I'll go with around 45% are Yes, all or Yes, most and then the rest fall under No, none or No, some.

KATZ  23:48  
Okay. So I'll keep it straight with how I'm going to say each one of those circles is going to get 25%. I think 25% none, 25% some, but not most, and so on, I think it's pretty close to split.

JONES  24:04  
Pretty close to in between Dr. Katz and Jeff! Taylor, you're way too optimistic!

STEIN  24:09  
Hey, you can't lose by being optimistic!

JONES  24:13  
I don't know--you guys brought your audiences, too! If this were the Fertility Bridge audience, of course it would be all forward thinking! But we are all across the board. And we had 22% say Yes to all, 22% say Yes to most 34% say Some, but not Most, and 22% are Not using digital consents at all.

KATZ  24:35  
So for the people not using digital consents at all. If I could add something, I know practices are incredibly busy at this time, but it's also a good time to consider transition to at least most consents going digitally. If that's the pearl I could leave today. Please at least look at it. I think it's vital for enhanced informed consent, it's vital for better risk management and really, it's better for patient care. The more they know, the more the patient's feel comfortable, the better the outcome, the better the pregnancy rate.

JONES  25:14  
Yeah, Dr. Katz, that really resonated with me when you mentioned that in your meeting a few weeks ago of if you had to defend one's understanding of what they signed, when they can just point to several pieces of paper with medical jargon and say, you know, how could I have possibly understood that? They just had me initial and we moved on! Versus a digital trail that involves video that's broken up to two modules--it’s very clear how that would be seen. And you use the example of a jury and I'm just picturing we're using a civil jury. Well, that's made up of people like me. That's made up of lay people and if one had to persuade one of those groups, which is how one would have the better understanding, it's clearly the digital model that maybe has a model that has video and not just the same digital, or the same consents that we've all had to sign that have several pages and terminology we're really not familiar with. 

**COMMERCIAL**

Hi everyone, it's Griffin. This is the break in the show where normally, I do a little commercial for our small engagement. And we do have a small engagement that's relevant to the COVID-19 business response. If you're cutting marketing. if you're trying to bring back your people as quickly as possible. If you're trying to build a cache of treatment ready patients. We do have that, but I would rather use this break to just ask if you find this useful if you would share it with a colleague, either via email or on social media. We're doing everything we can to put out as many webinars, articles, free podcasts, all free resources to include as many people from the field as we possibly can to give you resources on how to manage and operate a fertility business or an IVF center during this time. And it's changing so quickly. 

So if you find this useful, I would really appreciate it if you would please share it with a colleague via email or via social media and help us grow the audience, but only if you find it valuable, and hopefully you are. Back to your program.

JONES  27:23  
So I want to add another question here and that's something that Taylor was wondering, I believe. It might have been Jeff, but I believe Taylor had asked how many folks are using consents that  are related to COVID-19 specifically, so I'm launching this poll right now, which is have you created or are using your own consents for treatment or testing or visits that are specifically related to COVID-19? 

STEIN  27:54
Yeah, and Griffin while these are coming in, I just want to mention--so Jeff alluded to the fact that, you know, a lot of practices have developed these and have asked us to upload them. And we've spoken with them about their consents and we've seen commonalities. Jeff is writing up a short piece about what we're seeing and summarizing some of that information. And I believe we've even gotten some Oks from practices to share what they've developed--their consents. And so, Jeff, I don't know how or when this is going to be made available, I think it's going to be on our website. I'm not sure when, but if people are interested in sort of what we're seeing from the across the board point of view, we'll make that available to you.

ISSNER  28:41  
And we've had some practices who are gracious enough to say yes, if you do have other clinics that are in need right now of just some common language or just what we've put together, at least, it’s a sample of what clinics are doing. I think it's well-written personally and is very comprehensive. We can definitely share to anybody who reaches out a sample template of what one of these COVID consents looks like if you don't have one already,

JONES  29:07  
And are you noticing that some of them already are using a template? I could certainly see someone asking, Hey, John, what are you using? and some being circulated already. You said you’re noticing some commonalities, but does it look synoptic? 

ISSNER  29:22  
Yeah, I've seen a couple that are similar, so there's definitely some sharing going on. And I think, you know, of course, there's network effects too. They are, generally speaking, different though. I think the people who have been really forward about this and want to get something online as quick as possible have reached out to their counsel and have gotten something written up as soon as possible. So we're just doing our best to aggregate those best practices.

JONES  29:45  
Awesome. The folks that have answered now, a half said Yes, they created their own, 14% said that they are using consents created by others and 30% do not have consents specifically related to COVID-19.

KATZ  30:02  
So, Griffin, I would say if a practice does not have a COVID-19 consent, that should be a very high priority, because we're really working in an unknown situation. And that's really what informed consent is about. So Jeff and Taylor, thanks for supporting them. I'm happy to give some information as well. I think every one of our programs has a COVID-19 consent in place.

JONES  30:30  
We did get a comment from Lisa who is an attorney that says to be cautious about posting any templates that you don't revert liability back to you also. I want to emphasize that again, but you might want to plaster that everywhere!

ISSNER  30:44  
Definitely appreciate that! And that is very top of mind. As Griffin kicked off our webinar, there will be disclaimers everywhere.

STEIN  30:52  
And we are in contact with our lawyers to make sure that whatever we do, we're either fully disclaiming or not sharing things that would be inappropriate or you know, would make us potentially liable. We're always very cognizant of ensuring that we're not seen as providing any sort of legal or expert advice that we're not qualified for.

JONES  31:18  
So we can make this really meta and have a consent that someone has to watch to release our liability and have a video module explaining that that they have to watch before they sign the consent we could tie everything full circle.

STEIN  31:34  
Absolutely! I like it.

JONES  31:36  
So I'm gonna have our panelists sort of conclude with their thoughts about this. One person asked me if I have contact info for EngagedMD. I do and I can leave these guys contact info. We can disperse that in the response. Jeff and Taylor really did not want to sell EngagedMD. They really did not want to make it a commercial for EngagedMD. They told me that beforehand and they're always good about that. But we have like an agreement from five years ago that I'm an authorized reseller of EngagedMD. I don't know where that contract is. But I know we signed one and so if you all use Engaged MDafter this because of this, or because you ever heard me talk about on the podcast, you have to say Griff told me about it. I'm using you guys because Griff was the person that directed us to it or Fertility Bridge did, and make sure that I get that commission. So as a disclaimer, they're not promoting themselves and I'm only doing it because it's so relevant here. But we will send that contact info out in the follow-up email. So just please make a note of that, Megan. Gentlemen, how would you want to conclude?

ISSNER  32:47  
I'm happy to provide my closing thoughts. The same thing that we've told our team--we're really listening and we're I think uniquely positioned in that we have a platform to provide information and to help out during this time. So we're open to hearing any other thoughts. We're trying to create as much content as we can to help support clinics through this downtime. But would love if people have other ideas on how we can support the industry, please don't hesitate to reach out. We'd love to have the conversation and provide as many tools as we can during a time that is really hard for everybody.

STEIN  33:18  
Dr. Katz, I'll give you the last word. I'll just say very briefly, that I think this is an unprecedented time for everybody. We all have our expertise in different areas and our experience in different areas and now's the time to be talking about our approaches, what we're doing, sharing our ideas, and really, really working together to try to get through this and to put practices and patients in the best positions possible. It's ever-changing. But there's a lot of ideas and a lot of really smart people in this field. So I'm sure that if everybody works together and is collaborative, we’ll look back and say that it was a really creative time for the field.

JONES  34:04  
Well, speaking of creativity, we did have a question from Chelsea that asked, What about something like Zoom to virtually witness consents that aren't available to us electronically? It sounds like they're in the process of getting signed up and they're in the process of converting to digital, but in the meantime, have you ever heard of something like that? Using Zoom to virtually witness consents?

STEIN  34:25  
So it's actually really interesting. It's a great idea. It's actually something we've been talking about internally, how to take these telehealth systems and use them, not just in their generic form, but to support fertility specific workflows, like witnessing consent. And actually, we've developed, sort of, our own internal teleconferencing tool that we can use the technology if it makes sense to support workflows like that. So it's still not clear yet what those ideal workflows will be, but witnessing consent is definitely one of the ones that we've talked about. And I think it's a great idea. If you can figure out a way to do it with Zoom with like a screen share, then I think that is a great sort of way to do it using the existing services. So I do think, yeah, that's the kind of thing getting creative and doing that. 

JONES  35:25
How would you conclude Dr. Katz?

KATZ  35:26  
Well, Griff, I have two thoughts. The first one is, I really want to say thank you. Thank you to you, thank you to Taylor, thank you to Jeff, for all that you're adding to the safety of the fertility world. All three of you bring incredible expertise and all of us really greatly appreciate it. We don't take it for granted. And as we're all saying, the pandemic will end. How it ends and when it actually ends, we don't know yet. But I urge all the practices here on this webinar, and all that you're in contact with, to be prepared. Be prepared to come out of this. We talked a lot about that today. Make sure your informed consents are all set to go and really put some thought. It will not be business as usual. And so please be prepared for the safety of your patients and the safety of your practice.

JONES  36:21  
Now is the time to make this conversion to digital. We saw that a quarter of you are not doing any digital consents right now. Now is the time. And about 40% of you didn't have any COVID-19 specific consent, and now is the time for that as well. It is business as unusual and will be for some time. Taylor, Jeff. Dr. Katz, thank you all so much for coming on the webinar. That was really helpful. We have another webinar this time next Tuesday. I'm just trying to keep them coming every Tuesday 4pm Eastern. We're going to do one on finance next week. Dr. Adamson, Dr. David Adamson has agreed to do that with me as well as someone else who doesn't know that they're doing it with me yet. And then, because there are so many players in the finance space that I want to hear from, we're probably going to do two because I don't want to have four or five guests on one webinar. So we got finance, part one coming next week finance, part two will come after that. And gentlemen, thank you so much for coming on and contributing. 

STEIN
Thank you. Thanks for having us. And thanks, everybody, for participating.

KATZ  37:23  
Thank you.

JONES  37:24  
Thanks, guys.

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