Etienne Nichols, Medical Device Guru

Etienne Nichols is a Medical Device Guru and Mechanical Engineer who loves learning and teaching how systems work together. He has manufacturing and product development experience, even aiding in developing combination drug-delivery devices, from startups to Fortune 500 companies, and holds a Project Management Professional (PMP) certification. Etienne has managed cross-functional teams for updating legacy products as well as developing new medical devices. His expansive knowledge, experience, and passion for medical devices are evenly matched with how much he enjoys helping customers work efficiently through the design and development process to bring safe, high-quality products to market.

Transcript

Speaker 1: 0:00

Welcome to the Latin MedTech Leaders podcast, a conversation with MedTech leaders who have succeeded or plan to succeed in Latin America. Please subscribe on your favorite podcasting platform. Apple Podcast, Spotify, Google Podcast. Amazon Music is teacher tuning. I heard radio, Pandora, or these are

Speaker 2: 0:20

Welcome to the Latin Metech Leaders podcast, a conversation with leaders who have succeeded or planned to succeed in Latin America. Today our guest is et Nichols. Yeah. I hope I'm pronouncing your name correctly.<laugh>.

Speaker 3: 0:34

Nailed it. Yep.

Speaker 2: 0:35

<laugh>, excellent. A medical device girl and mechanical engineer who loves learning and teaching how systems work together. So et thank you for being in the show today. It's a pleasure to have you here.

Speaker 3: 0:47

Yeah, great to be with you, Julio. Thanks for, thanks for having me on the show.

Speaker 2: 0:51

Awesome. Let's get started. So, et tell us about your experience or your journey to Latin America. How is it that you got involved with the regional and personal professional level?

Speaker 3: 1:01

Yeah, so on a personal note, it, you know, when I was in college, I had a, a really good friend of mine whose name was Juan. He was, uh, from Columbia. And, uh, I just remember he and I worked, you know, when you're in engineering school, you work long hours and then you get up early to go to work, you just, it's just around the clock. And we would be at his house constantly and his dad, who couldn't speak English to me, but he would always make the best milk and, and rice, I don't know what it was, but I said, someday I'm gonna go to Columbia and I'm gonna eat this in the country. Uh, so that's my personal, kind of like, where I was like, oh, Columbia, I wanna go there someday. Um, uh, professional, we have a few customers that I have personally worked with in, uh, um, in different places in Latin America. Um, one in Columbia, one in, uh, I believe in Brazil. But, uh, just a f just a few customers that I've interacted with in Latin America as

Speaker 2: 1:51

Well. Excellent. Very good. So, um, at the end, let's talk about trends that you see happening in the industry that are relevant to the business of doing studies in, in, or commercializing innovation in Latin America. Please.

Speaker 3: 2:07

Yeah, so the thing that, the thing that I go to when I think about, I mean, you almost have to look at it globally. It's not just, you know, you can focus on one country over another and Latin America, certainly, obviously it's the, there's the focus today, but if you look at it globally, what's happening, U M D R has always been, uh, or, or the, the European market has always been, you know, go there first because, uh, it's a little bit easier to get to market. And then eventually you, you bleed over into North America and, and, uh, and the rest of the world. Uh, the, that's changing with E U M D R. Um, especially with deadlines. A lot of the industry has been expecting, uh, another shift or another, uh, delay to those requirements. And I don't think that's really a safe way to go. And so it's looking like now, uh, this pendulum has shifted. So now where people may have been trying to be, you know, first in human in overseas, now it's looking, looking like, you know, America is one, one, you know, north America. Sure. But, uh, Latin America is even, is even more, um, appealing because of the, the increased timelines as far as first in human, some of these clinical trials. Um, and then also some of the, uh, uh, the trends that you see as far as, um, uh, the cost. So both timeline and costs are, are hugely appealing when you look at Latin America compared to some of the other regions in the world.

Speaker 2: 3:25

Totally. Yes. What countries, um, did you hear, or do you usually hear your clients talk about when they were thinking about early feasibility or first human trials?

Speaker 3: 3:37

Yeah, that's a good question. Um, I don't have a specific country, um, you know, that comes to mind as far as that goes. Um, it, lately I've just been hearing about the shift, uh, shift more away from the European market.

Speaker 2: 3:49

That's true, that's true. Um, and, and, and also I would say that, uh, I just met with, uh, sponsor the ceo, e o for medical device company, uh, is a company, uh, out of, um, Seattle, Washington. And, uh, it's just shocking how, um, unsatisfied he is with the FDA ID approval process for a, an early feasibility study. And then the word he used was uncertainty. Uncertainty is the enemy of a startup. You cannot have uncertainty. You, you can have risk of course, but not uncertainty. And there's so much uncertainty in Europe, of course, as you correctly said. And there's so much uncertainty in the US as well. So that's probably the reasons, the main reason why companies are looking at other places like Columbia, et cetera, to do early visibility

Speaker 3: 4:43

Work. Yeah. And, and I know, I mean, I see you, Julio is kind of the expert as far as Latin America as a whole. There's certain things that I, I know about the different regions of different things, but, um, I'd love to hear, I, I don't wanna flip this around necessarily, but I'd love to hear some of the things like you as specifically say, Hey, this region, you know, maybe Columbia, but just because, you know, that has part of my heart there, um, you know, some of the, the things as far as the uncertainty, cuz because I latched onto that word, uncertainty. Why would, uh, you know, what are, what are your thoughts as far as, uh, you know, the flip side, um, in Latin America?

Speaker 2: 5:17

Yes. Yeah. The, the way it works, the approval process, uh, the way it works in a country like Columbia, for example, and I'm Colombian as well, so I'm, I'm biased, uh, and we do most of our work in Colombia. But I've, I've analyzed pretty much the whole region, pretty much the whole region. I just finished an article about, uh, comparing the regulatory, regulatory approval process in Columbia, Mexico, and Brazil. And, uh, it, it is, I mean, if you put the three countries together, the timelines, the process, I mean the steps, the review cycles and all that, I mean, it's just obvious that Columbia is perhaps the most appealing country and the country that offers the most certainty to these companies. And that's what they're looking for, uh, without mentioning cost savings and, and, uh, patient recruitment potential because of the size of the, uh, of the country, the population. So I, I will say that, uh, Latin America is getting more and more mature, uh, countries like Columbia, like Chile are really, really making efforts to, to become, uh, knowledge economies versus, uh, commodity exporting or agriculture exporting countries. And, and knowledge economies means that you have to, to, to somehow connect, uh, your industries to the world, especially the service industry, uh, in, in, in the clinical research is a great, it's just a fantastic way of, of connecting a country to the world to high level of, of, of, uh, knowledge about innovation and all that. So, so yeah, I will say that, uh, Columbia is offering a lot more certainty, way more certainty than Europe or the United States right now.

Speaker 3: 7:07

Yeah, absolutely. Yeah, it's a good summary.

Speaker 2: 7:10

All right. So let's, uh, continue. Um, I heard that, uh, you guys did a great survey about the state of the industry. I'm just so thrilled to, to to, to have you here and to, uh, speak about it. I mean, can you elaborate on that, where you guys, uh, what you guys, uh, concluded after reading all those surveys?<laugh> answers? Yeah.

Speaker 3: 7:30

Yeah. And, and so yeah, we did do a survey. We called it the, uh, quality management and product development surgery survey, um, uh, the 2022 State of MedTech. And, uh, you, there were, there were several, several things that came out of it. I guess I should start by saying, we interviewed 519 quality professionals. Um, and so when I say 519, um, about 60% of those were quality and regulatory clinical. Um, about 26% of those were product development or engineering. And then we had a, a small sliver of manufacturing, and then, uh, about 11% worth corporate or executives. So the majority were quality and regulatory. Um, that survey, uh, it, it covered a broad range of topics and you asked about conclusions, so we'll talk about in just a minute. Um, but I also wanna say, we actually just, I think we just closed, uh, our most recent survey as well. So we, we have about 600 this time, uh, quality professionals that we have interviewed. So we're getting ready for, for next year. So that'll be coming up. Um, we'll definitely let your audience know when that's out. As far as the, uh, the conclusions, there were some interesting findings. And before I get to conclusions, one of the things that really stood out was that timing really matters. And, uh, um, to your point with Columbia, um, that's, that's the thing that I noticed when I talked to, when I looked at the, the timelines between Brazil, Mexico, and, and Columbia. Just the, uh, the speed at which you could expect to get through with Columbia was, was pretty mind boggling compared to some of the others. Um, I mean, it's almost an order of magnitude, isn't it? You know, the difference, um, so when we looked at the different classes, so, so class one, class two, class three for class three device, um, on average, well, I don't know if it's really fair to take an average, but let, let's use percentages. The bulk, 47% of, uh, uh, class three devices, um, for the FDA took three to five years to get to market. So that's actually probably a little bit, I mean, that actually might even be a little fast compared to what I was expecting. Um, about 23% of those expected, you know, they, they were around two to three years, um, but the majority are expecting to, to take longer than five years. So if you can shave a fi a year off of that, totally. Yeah. Yeah. I mean, you sha you, you now have 20% faster to market. 20% is huge. So, um, just timing, timing matters, you know, and, and we heard that from several, uh, several different tiers, um, MedTech professionals as far as, you know, the different things that we, we heard. We, um, another thing that we looked at was whether or not, uh, these medical professionals were using what kind of tools they were using, whether they're using purpose-built solutions or, um, you know, uh, just general purpose tools. It was about half and half. And when we looked at that, the ones who were not using, uh, purpose-built solutions, you know, something that was specifically built for their industry, um, timing, uh, timing was affected as well. So that was interesting. Um, let me, I'll kind of skip to the end as far as some, the, the top four things that we saw happening. So as far as, um, uh, the things that we saw was a disconnect between management and quality, the actual quality, uh, department. So there's a disconnect as far as whether or not, um, they were actually on target or excelling in quality. So management typically said, no, we're not doing well with quality. It was kind of like a, um, uh, the, the majority of them, whereas a lot of quality management said, we're doing pretty good. So there was a little bit of a disconnect there. So that was interesting. You know, something that to think about, um, when we kind of, when we kind of did a few interviews with some different people as to why might that be the case, uh, one of the thoughts was, well, management is thinking about two different things. You know, the quality may be thinking how many CAPAs are open, how many CAPAs have been closed, uh, whereas quality in the, the, the upper executives might be thinking more along the lines of something like, um, you know, how fast are we getting to market? Have we produced more revenue? And, and, you know, what's the outlook look like? So that was one of the things that we noticed. Uh, supplier management was another one. And, um, and I don't know, I, I, again, I, I love hearing from you Toolio, you know, I know you were all on our podcast. And so when I think supplier management, uh, that's one of the things that I love to, to hear about as far as, you know, the, the Latin America and how you've seen some of those supplier, um, you know, just cuz MedTech companies are gonna call it a supplier, whoever they are. But that partnership, um, across those country lines, what have you seen as far as that management?

Speaker 2: 12:18

Well, um,

Speaker 3: 12:20

Is that something I'm, I'm allowed to ask

Speaker 2: 12:22

<laugh>? No, no. Uh oh, it's a good question. I don't know the answer to be honest with you. I, I, yeah, I don't, I don't get involved. We don't get involved in, in, in quality issues with our clients. They just ask us for SOPs, and that's it. I mean, we're a US company, so we are not really, so, no, I don't, I don't have an answer for that, to be honest with you. I'm

Speaker 3: 12:48

Sorry,<laugh>. Well, so No, no, that's okay. And that's okay. I just like to ask the question. I don't mean to put anyone on the spot. I'm supposed to be the one on the spot here,<laugh>.

Speaker 2: 12:55

So,

Speaker 3: 12:57

Uh, one of

Speaker 2: 12:58

<laugh>

Speaker 3: 12:59

Anyway. Well, you know, when, when I think supplier management, you know, we're going to a remote world, you know, and, and that's inevitable. But when you talk about certain aspects of your suppliers, there are certain things that you need to be doing in person. And I'm, yeah, this is me a little bit selfishly as a, as a, as a, you know, a world traveler, traveler, not necessarily by choice. My wife has turned me into one. She, she takes me different places. And, and that's wonderful. I'm very thankful for that. Um, when you choose your suppliers, you know, one of the things you need to think about is how close are they? How can I, can I get to them? Um, you know, can I have a relationship with them? And, uh, so you don't necessarily think of a country, you know, at least I don't necessarily think, is this country a place I wanna go to for that supplier? But that actually plays into it, um, your relationship with those things. So that might be another thing to think about when you're thinking about your, your long term

Speaker 2: 13:47

Suppliers. Yeah, that, that's a great point. That's a great point. And, and, and of course, uh, we operating in Latin America, and one of the things from the get-go, we started the company, we set it up as a US corporation. We are a Florida based company. And that's also to, to give our clients that level of trust that you're, they're dealing with a local supplier, they're dealing with a US company. We're a real people in the us. We're not some remote company in Columbia with a bank account with a Swift number that takes whole page<laugh>,<laugh>,

Speaker 3: 14:22

Right?

Speaker 2: 14:23

I mean, a whole page of wiring instructions. You don't know if you're gonna get your money, these people. So, so, yeah. So, so, so, no, it's a great point. And the word that buffer between our clients and our research centers, uh, not our research center. I mean, the hospitals that we deal with are in our network of, uh, research centers, um, so they don't have to deal with foreign suppliers. So we make it easier for our clients in, in that way. Yeah,

Speaker 3: 14:51

Yeah. Yeah. So that's one of the things that, uh, you know, so supplier management just in general was one of the things that, um, we saw quite a few people really felt like was below average. So actually 75%, 75% felt like their supplier quality management program was below average, or average or below average. So that was something to think about. Um, and, um, yeah, it's just one of the things that you need to think about. Um, another thing to think about. So one of the other issues with our, you know, when, with that we found in this survey was one of the, uh, um, one of the things that people experience is if you experience a warning letter, it may take three years to reach resolution for that. Now, I'm, I come from the quality regulatory side, so I, I think a lot about the quality. Um, uh, so that's, that's one of the things that, um, again, uh, that uncertainty and start tying, tying it back to that word that you said, you know, certainty that what you have as a quality product, what you have is something that you, uh, you know, what is going to meet your expectations, um, that's important in the quality world. Um, because if you, if you don't cut corners, if things don't work out the way you expect them to and so forth, um, yeah, those, those warning letters can take a long time to resolve. Yeah,

Speaker 2: 16:09

Yeah. I'm sure. All right. So, so basically, um, the issue of time is probably the, the, the issue that we can all help in Latin America, uh, or the issue with Latin America can, can, can play a, a predominant, uh, role for the MedTech industry, uh, as you correctly found. And that's, that's also my, it's been my experience. That's usually what I hear. I mean, time, time, time. How can we start this trial faster anywhere in Latin America? Sometimes I have conversation where I have to give them the whole, my potential client, the whole framework around the different countries so that they can understand where to go and where they can get their study approved faster. So, so, yeah. Yeah. Um, the other thing that I, that I, I'm very thrilled about is your acquisition of, um, smart trials. Smart trials. Yes. That will also save time and, and, and effort in managing these smaller medical device early disability studies, which are different from pharma studies. So, uh, I think, uh, the partnership that we have and, and what we're putting together here is gonna benefit the whole industry, uh, because we're gonna, uh, uh, solve one of their pain points. One of the problem is, which is the time to take that takes a device to get to market.

Speaker 3: 17:39

Yeah. Uh, not just the time too, but like you said, the certainty. Um, the

Speaker 2: 17:43

Certainty. Exactly.

Speaker 3: 17:44

Yeah, exactly. When you have, uh, clinical trials spread over multiple locations, and, uh, you're trying to capture all that data, whether it's on paper or through, you know, just however that's being captured, um, really a solution like smart trial is, is really the way to go as far as that electronic data capture. I mean, it's just, it will increase your, your certainty and your ability to, um, just have a lot of more confidence in, in what you're actually performing. So,

Speaker 2: 18:11

Yes. Yes. And, and I guess now with the acquisition of smart trials, uh, your survey may change a little bit, may add different questions or, right, yeah.

Speaker 3: 18:23

Related

Speaker 2: 18:23

To clinical research, because, uh, it is really hot topic nowadays. Uh, the, the increase in demand that I, that, uh, that I've seen this year as being unprecedented,

Speaker 3: 18:35

I, I think something I, and I'm curious to see how it's changed. I remember one of the numbers from your articles actually was, uh, the increase, what from 2012 to 2017 was like 94% increase. Wasn't that that,

Speaker 2: 18:47

Right, exactly. Yes. And

Speaker 3: 18:48

That's five years old, so

Speaker 2: 18:50

Yeah, yeah, yeah. I mean, every, every week I, I get at least three new inquiries in our website about a new study in, in Latin America. So definitely there is, there is an issue happening in the United States. There's an issue happening Europe that is, there's a bottleneck somehow also because of Covid, uh, probably because there is, there is, um, new investors who knows<laugh> what really go this, but it's probably a combination of factors and, and, uh, certainly Latin America has become a place to, to, to

Speaker 3: 19:26

Yeah.

Speaker 2: 19:27

Help fix this issue of timing. Yeah,

Speaker 3: 19:29

Exactly. That's, that's, you know, it's funny, we, we think about the development of a, you know, a medical device and how much, uh, you know, a chunk of that clinical trial is, you know, the cost of developing that medical device. You know, some, some studies, I think it's, you know, not quite half per half, uh, the amount of cost. But you know, in the, historically it's been in the 30 to 40% range, I think, you know, that's, that's the amount of money it takes to develop a medical device, um, to put it through clinical trial. Um, if I'm not mistaken, you know, that some of the things I think I are have been read from you, though, you know, are, you know's like 60% reduction in costs as those

Speaker 2: 20:12

Clinical trials up to, yes. I would say, yeah, that's, that, that's, that's kinda accurate. Um, anywhere between 30 and 60%, I would say. Uh, I see, uh, especially in Columbia, uh, with the Columbian peso at a historic, uh, low versus the US dollar. And, um, it's just, uh, really unbeatable to, to, uh, as a country, I mean, to buy services from a hospital in Columbia, you're gonna get a, a great bargain, uh, is the second most value currency after Venezuela and Argentina, Venezuela were obvious reasons. Argentina is a country that is struggling so much to, to get ahead, and it's very, uh, yeah, unstable in many ways, economically, politically, uh, socially, uh, but inflation in Venezuela and Argentina are just, uh, really, really difficult. It's, it's, it's just funny. Um, you, you, you walk the streets of, uh, Colombia in Bogota, and, uh, there are people selling crafts on the streets with Venezuelan currency. They, they sell hats and they sell purses,<laugh>, they make animals<laugh>. You can, oh, really?<laugh>. Oh my goodness. That's how bad. It's, the issue with clinical research in Venezuela is interesting. I'm involved with a hospital in Caras, probably the largest private hospital in, in, in, in Venezuela. And, um, we are doing a study with a, uh, intervention of cardiologist, one of the top in Latin America. He's from Caras, and he works at the hospital, and we're working on a couple studies in Columbia. And, uh, he's a proctor of the sponsor for the Saudi Columbia. And we talk a lot, uh, about doing studies in Venezuela. But the issue is that Americans cannot travel to Venezuela. But, uh, Venezuela could be an ideal place for clinical research if American could get visas and travel to the country, because it's a, it's a country of over 45 million people, something like that. Uh, Columbia is 53 now, uh, and, um, it's a country that has a great infrastructure, private Ali Ali, the public infrastructure is gone. There's really no private, uh, there's no, there's really no universal healthcare system or anything like that. It's all private. You have to have money. It's dollarized. So, so yeah, prices are probably not as cheap as Columbia, but, uh, it could represent great savings for companies. And eventually the issue will be fixed. I mean, Americans will eventually be able to travel to Venezuela. And, uh, actually the pioneer of early feasibility clinical research in Latin America was Venezuela, Dr. Corrado, Caras, like 20 years ago. Yeah.

Speaker 3: 23:03

And you know, when I was first thinking about this, um, first inhuman and some of the clinical trials, uh, one of, one of the issues that I kind of thought, well, what about recruitment? You know, is it, uh, truly representative of the same type of population you might see in a, in America, um, whether it's diet based, things like that. And, um, just the abil the, the countries, you know, really impressive as far as, you know, having not been there myself, just the things that I've read and the things I've learned about it, um, it, it's, it's to a level where, you know, the same, very similar, um, different stratas of life, I guess different tier, whether it's diet or, and so forth. So, um, that kind of erased one of the biggest concerns in my mind when it came to, uh, you know, clinicals and actually was a big convincing factor, you know, in, in my mind that, that it would be a, an appealing place to go.

Speaker 2: 23:53

Exactly. Yes. Yeah. Yeah. Latin America is very Americanized nowadays and, and hospital infrastructure, the way people practice medicine and, and the lifestyle is very Americanized. And, and, uh, it's just like in the US it's a mix of cultures. Yeah. I mean, countries like, uh, Argentina, I mean, probably the, the population, uh, mix is, is, is uh, is very similar to the United States, uh, very European, uh, influence. And, uh, Colombia is a great mix. It's a little bit of everything. You have Italians, uh, Germans, uh, of course Spanish, uh, in, in Colombia you have also Asian communities. You have Middle Eastern, uh, population. So it, it kind of similar to, to the US in, in a way, and, and, and whites in the US are becoming minority<laugh>.

Speaker 3: 24:50

Yeah, it's true. It's true.

Speaker 2: 24:53

It's funny,

Speaker 3: 24:53

<laugh> it just, every, every, everything's cyclical. It's just, yeah.

Speaker 2: 24:56

Yeah. Exactly.

Speaker 3: 24:58

Um, so I'm curious about, so you heard kind of my personal anecdote at the beginning about, you know, maybe Columbia or whatever. I'm curious, um, uh, if you could tell me your quick snippet as to why, you know, I should go to Columbia? Maybe not even necessarily from a clinical standpoint. I just, um, you know, having been there, you know, the, the, a native yourself, I'd just love to hear what you have to say about it real quick.

Speaker 2: 25:18

Uh, about what, excuse me about going to Columbia.

Speaker 3: 25:20

Yeah. Just, you know, one of the, like, okay, I'm just imagining I get off the plane and I'm going to the hospital, but maybe I want to do something else. Oh, I see. What do you recommend? What should I do first? Oh,

Speaker 2: 25:32

Oh, oh, oh,

Speaker 3: 25:33

I see, I see. On a personal note.

Speaker 2: 25:34

Yeah, on a personal note, well, I, if you go to Columbia, you have to visit Bogota is perhaps one of the, the, uh, the largest metropolitan areas of, uh, Latin America with Mexico City, with, uh, Sao Paolo Buenos airs. It's kinda at the same level. Uh, you get out outta the airport, and first of all, the first, one of the best airports, if not the first, uh, there's a recent survey on this, um, is in Bogota. El Dorado Airport is perhaps the best airport in, in, in Latin America right now. And, uh, that's a lot to say, but it's, it's brand new, just impressive airport. And, um, and the highway that you see is really, really impressive. It is not, I mean, you feel that you are not in a banana republic, or you feel that you are in a real country.<laugh>, right.<laugh>. Right. And, um, of course, Bogota is a capital city. And, uh, Bogota is, uh, a place of about over 10 million people. It's a large metropolitan area, and, uh, it has one of the best hospitals in Latin America. And, uh, the reason for that is because the geographic location of the country is, is kind of privilege. Cause it's, it is the first country in South America, so it, it, it, everybody from the Caribbean travels to Columbia for medical care, for advanced medical care. Everybody from Central America, Panama, Costa Rica, Hondura, Nicaragua, they either, either choose to go to Mexico or Colombia. Right. And everybody from the south, everybody from Ecuador or Peru, uh, well, not so much Peru, but unless you're in the, uh, northern part of Peru. But, uh, Ecuador, um, Bolivia, they all travel to Columbia for medical care. So, so yeah, it's, um, I would say Bogota managing is a fascinating city. Very metropolitan, very multicultural. And, um, the other city that is up and coming is perhaps the fastest growing city in Latin, in, in Columbia, probably one of the fastest growing cities in Latin America is Barran. Barran is the largest city in the whole Caribbean basin after Miami. That's a fact that not many people know about. Wow. So yeah, it's a city of about two and a half, 3 million people, but it, the area of influence of Barran is about 10 million people. Cause it covers the whole Caribbean coast's, the largest metropolitan area next to, and it's right in the middle. Um, Santa Marta, it's a smaller city towards the north, and cor, which everybody knows about, is towards the south. But, um, Barran is the center, the economic center of the Columbia, Caribbean coast, and has a large number of hospitals. I will say probably there are about at least 10 high complexity hospitals in the city. So patient recruitment is great.

Speaker 3: 28:34

That's, that's fantastic. You know, I, um, community is one of the things that I don't think about, I don't know that we think a whole lot about in MedTech, you know, just the community in general. Um, the MedTech itself is kind of a small industry, uh, but if you go to someplace that's, you know, I don't know if you try to go to the Mayo Clinic or wherever else where you're not, you know, listened to and perhaps at whatever level you're at, what I'm curious about is, you know, the different communities within those hospitals and the ability to, to have a better relationship with those. Um, you know, you, you're kind of a, you, you, you work between the US and, uh, and, and directly with the hospital. So I'm sure you see and manage a lot of that relationship. But, um, that's one of the things that I'm interested in learning a little bit more about too in the future. Yes.

Speaker 2: 29:18

So, yes. Yes, exactly.<laugh>, and, you know, I mean, uh, I, I'm always very, they about the possibilities of bringing your technology to Latin America. There are, uh, a lot of, um, uh, there are a few hubs of innovation in the region, and medical devices are increasingly now that we can use software as a medical device, you find a lot more entrepreneurs trying, uh, to do something in this area. So it's a, it's a, it's a, it's a slowly growing industry in Latin America. I would say Brazil, Columbia, I mean, the, the top five countries in the region have the need of a software like, uh, green, like rural offers quality management system. So, so yeah, it would be fantastic to translate this offer to Spanish. I don't know, uh, if you guys have plans to do that, but that's a growing

Speaker 3: 30:09

Area. That's fantastic feedback. Um, yeah, that's, that's a really good point. I don't know that we do at the moment, but I, I need to check with my product team. I should probably keep my mouth shut until I know for sure. Um, but tho like I said, you know, if, and I'll, I'll send a link to that, um, state of 2022 report, um, and then eventually when we have our state of 2023 report release, we can, we can definitely send that your way as well. But one of the things that, that we saw that I already mentioned was, uh, just the, the companies that don't use those specific tools, um, to help them get to market, whether it's something like Green Light Guru or smart trial for their clinical trials, uh, they, they're moving slower than the ones who are, who are using those purpose-built tools. And Yeah. Uh, you know, um, I, I look at it kind of like, you know, as a mechanical engineer, if I look back at my past, I, I had the privilege to work at a company where, um, it was a hundred year old company. It was in the steel industry before I came to MedTech. Uh, we had four different ways of keeping our drawings. You know, we had, we had them on paper. The, you know, the, the, I can't remember. It's a E two, just the massive pieces of paper that people had hand drawn, which is fantastic. Um, we had microfilm, we had index ideas, and then we had solid works. You know, guys like me are like, why are we not using solid works for everything? Look, I can do what you do four days in five minutes. And, uh, it's just kind of the way the world, you know, it's always changing. And, you know, the companies that embrace that change, they, they just move faster. So. Totally. I agree. Yeah.

Speaker 2: 31:39

All right. At the end, we are close to the end of the show. Thank you so much for being here. It was a delightful conversation. I look forward to being in touch.

Speaker 3: 31:46

Yeah, fantastic. Great talking to you, Julio.

Speaker 2: 31:48

Bye-bye. Thank you.

Speaker 3: 31:50

Take care. Take care.