But I wanted to say just for planning for the annual meeting, because this is the last time we're meeting before the annual meeting. Because we were scheduled to meet on November 11, which doesn't make a lot of sense since one, it's a holiday and two, it's two days before the annual meeting. So anywho. So I think we want to try to recruit some folks. I think at the annual meeting, maybe we can use our time together to kind of talk about our like our projects for the year, you know, so we're going to kind of lay out which pips are due and when in the timeline for those. And then think about, you know, the big projects of maintaining the pips, doing the self assessment questions, and then right now the book and then we can talk about I know you had sent me some emails about thinking about some other things that we might want to tackle. So maybe we could talk about those in the annual meeting. That would be great. And Beth has pulled together additional information that is super helpful to help to guide the good discussion. Okay. Um, the other thing I just want to throw out there and it may not make sense or it may make sense or I don't know. But so the so I'm part of the medical education committee for ACM. And they've been restructuring things quite a bit, you know, they sent a quote out, which I think is probably parallel for triple AP, but like, that they used to have, like, 60 or so like live trainings and courses and things like that. And now they just have like two or three, because the the demand has really shifted, you know. And so I think we've been seeing that with the addictions in their treatment course. And I think we've been seeing that, you know, with some of the other things. And so technically, you know, we've been the continuing professional development committee. So we haven't necessarily, I don't know, it's always been this gray area, they were kind of like independent entities. But I'm just wondering if we should, as part of the professional development committee sort of think strategically about live in person courses as part of professional development. And, you know, is that a good use of like staff time and resources? Is that what our membership wants? You know, versus other things that that they might want? And so is this so I guess we can have that conversation. But I guess my larger question is whether or not this committee is the right place to have that question. Well, I think the conversation Oh, yeah, go ahead, Dr. Sabrina. I think the committee should be should be part of that. I think both both courses actually were were down in terms of registration. And, you know, we had come to the conclusion on the course side that it was because we have so much available. There's so much available everywhere. But even within triple AP, we've got PCSS, which allows them to take all sorts of things. So I think I think meeting of the minds would be good in terms of thinking of the future of the courses and what other things we can do in CPD. Do we want to invite the course directors to the CPD meeting? Yeah, I think that would be really helpful. See if they can I don't know. I don't know if it might make sense to maybe you all get together and talk during the annual meeting, and kind of come up with a plan and then invite them to one of these calls, partly just because there's so much going on with the annual meeting and multiple meetings at the same time. And I don't know how feasible it is for them to join this meeting. But then it also just gives time, you know, obviously for you to kind of to get a roadmap. Is it is it John Mariani is the advanced psychopharmacology and then Sanjit is the addiction center treatment. So maybe I'll try to reach out to them at the board meeting and just kind of Yeah, see if if they can join and if they want to or whatever I think that makes sense. I think that the CPD meeting itself at the annual meeting should be trying to explain to everybody what the committee does and try to recruit people. And so they'd be so Christina and I and john for AAP, Sanjit uh, Levens, and Harisco. Right, Stephanie. So and they are right now. There is a kind of conversation going on with them about how they're going to restructure, especially a to try and do this. So AAP did is doing a co occurring focus this year, they did more on the like the pharmacology. Yeah. And then same thing trying to think about how can the ATT, which is more basic foundational course, compliment as well, but switch years. So that's kind of what they're thinking about. The other thing too, that we had to stress to a TT is the numbers are down for the in person. But the numbers are, are still when you look at the on demand by afterwards still pretty strong. Okay, that's good. And so it's still our biggest revenue generator just because of that. And so a P is going to be interesting too, because the number is down right now we're at about 80 people have registered and we have a week to go. But then it's going to be interesting to see how many people then obviously purchase on demand because we're still having people purchase the 2023 a TT. Well, the other thing and I know they know this, but the other thing is the, the fact that this is a, an exam year, like a study year, right? So I think it's in October, right? It's coming up in like two weeks or something. So, you know, again, structuring, structuring the ATT for the exam years, and then the advanced one for the other year or whatever, and maybe like alternating or something makes me make sense. And then the other thing is, you know, thinking with this is could you take them together and create a certificate course, right? So if you have, and there's just add like a psychothoracic, psycho, psychosocial, did I get that right? Psychopharmacology? No, John, John, Dr. Mary, John Mariani is the main one that's kind of trying to spearhead that. And I think he'd focus it on some sort of psychopharmacology certificate. So the whole part of CPD, I think would make sense for their involvement in that. Yeah, so I guess if it's, if it's going to be a certificate, then, you know, would that be something that this the continuing professional development group would, you know, want to kind of help oversee or how did that work? Certificates are tricky, because I know, like ACM has been talking about this or whatever, and to actually do a certificate is, there's a lot of like, challenges or whatever, you can't just like, be like, okay, here's a certificate. So they were talking about like, having it be like a badge, when you completed things that we were like, well, that's, nobody wants a badge, that's like, a lame name or whatever. But to actually be like a certifying course is I don't know, that might be beyond here. But well, we could look good looking, because there are a lot of specialties that do that. Yeah. A distinction and somebody else I worked with recently just went through it. I'll dig back and see if I can find information on it. But there's a big difference between offering a certificate of completion for completing a set curriculum, and actually certifying someone. Yeah. So that's a good point. Maybe it would be like a certificate of completion. That would make more sense. Yeah. Versus like, actually, like certifying people to be like, competent and knowledge or something like that. And it's just a way we can, it's a way we can just take what we're doing and package it different ways to, you know, that's, I think that's what we're trying to think about. Yeah, how do we how do we package things in different ways? It's just once a year, and you're done. And what else because we have all these cycle therapy. What is it that that is that what it's called the psychotherapy series? Yeah, psychotherapy, right? Sorry, my mind just drew a blank for some reason. But are there any of those that we can pull in? Because we've got really good content from that as well. Yeah, yeah, there's some really good lectures in there. So the psychotherapy series. And I think obviously, having the input of this committee, like Dr. Severino said is important. We don't want to keep them completely separate, because there's clear overlap, you know? Well, yeah. And especially if, if it's, if it's under that guise of professional development, like lifelong learning kind of thing, then it would make sense to kind of have it underneath it. And so then, but then we would probably want the, the course directors to kind of come and, you know, share things with this committee, which I don't know if they want to do that or not. But I think it makes sense to be thoughtful about it. Well, and even if they can't make it, you have Beth and I that are involved that we can provide updates as well. You can have a small liaison or yeah. Yeah, so I think we should add that to kind of our course director. Are you the course director? Or no, I'm a co director. Okay. Oh, perfect. Okay. So you can represent then. So maybe like, you know, for our sort of standing topic areas that that we cover, it would be, you know, like the the self assessment exam, it would be the pips, it would be the like courses or certain, you know, certificate of completion courses, kinds of thing. I think those might and then the end of the book. Yeah. So those maybe would be our four areas. And we don't want to go too far out. That's a lot. Yeah. I mean, we may draw in people getting the book if that's part of the well, so people could. Yeah, I mean, I wonder if we could do because we are putting the like, questions and stuff like board exam style questions in the book. And so I wonder if maybe if they we can somehow build something in where if they complete those, and that could be part of that certificate of completion, you know, you do X, Y, and Z things. I think the thing with the certificate of completion is we just have to make sure that people don't put on their, you know, on their CVs that like their American Academy of Addiction and Psychiatry certified addiction, something or whether like we have to just be careful about how people Yeah, use that to say that they're certified or whatever. There's such a shortage of addiction specialists that right now, lots are being filled by virtually anybody. Yeah. And so even just a certificate of completion could make them stand out a bit as well as make them feel more comfortable about actually treating addictions. Yeah, I think so. And I think that that's the right way to use it is that, you know, I've had some additional, I put forth some additional training in this, but you don't want people using it kind of like a true addiction credential when applying for jobs and things like that. In place in place of like the actual credentials, which we want people to get do but you know, the other thing we talked about with the book that you're working on is then doing some webinars that we could pay for the book and break it down because that could be really Yeah, yeah, we could get the chapter authors to maybe if they you know, want to do a webinar or whatever kind of over overseeing that that would be great. I like the idea that I don't think we should throw out the idea of putting together a series of review articles for the journal. Mm hmm. I think, I think that that's a cool idea. I think we just would need a champion to take that on because it's not going to be a small thing to like, Oh, no, kind of write these review articles. Yeah, yeah. Is that something we should also try and coordinate with the research committee? I would say more with the trainee the whatever the trainee committee is. Yeah, the education committee, education committee. Yeah. Okay, they're actually meeting, I think on Friday. Yeah. You could ask them if they would want to take that on. Because I think you could pair trainees with like senior mentors to do those. Which would be really cool. All right. Um, okay. So course tracking. Let's see. Let's open this up. Okay. Yeah, so so it doesn't go in links, Beth. It doesn't let me access those because when I when I'm logged into Microsoft through my work account, it doesn't let me have access to them. So for example, in the agenda, there's a link to the CPD activity report, it won't let me access that. Do you mind just pulling it up then and sharing your screen? Sure. It hasn't. It hasn't changed since the last meeting. Okay, so then do we need to review it? No, no, probably not. I'm going to actually go I left it in there. Because one of the things that I want to do for our in person meeting is go in and add the start and end dates of all the courses. So we have a good tracking of when things are starting and when things are due and when to start. Okay, revising. Is that thing is the basis of the board review book? No, no. No, no. They're separate. Okay, it's also the share the triple AP SharePoint's not letting me into the question sign up. I know I've been into it before. I don't know why it doesn't want me to do it now. So I think it's got something to do with the email that you're signed in under like it. It probably is recognizing you by your other email address and not by your work email address. It's signed it's it's in by my work email address. I don't know if maybe you have my gmail if you have me signed up in these as gmail. Can you just open up the question sign up and then share your screen and we can go hang on one second. I was trying to see if I could fix you. Okay. I'm signed in under the C Marienfeld at health.ucsd.edu Okay, let's see. So, Bill, you sent your questions. Thank you for that. Let's see if I can open up the ones you sent. There we go. So, the ones. So, let's see. Bill, the ones you sent on Google Drive. It's also not letting me in using my Marian Feld at Gmail account. Let me try my health account. I'm sorry. I was having a hard time signing into the meeting on my computer. I can try and send them a different way. Could you send it to or either just attach the document to the email or send it to marianfeld at gmail.com. Beth, were you able to open his questions? I was. I'm just putting them in a chat right now. Okay. Oh, cool. There we go. All right. Never mind. I got it from the chat. Do you want me to resend it to you, Carla? No, I think I can open the one that Beth just sent, I think. Okay. Yeah. That worked. Thank you, Beth. Okay. So, let's see. So, you're a 21-year-old college student without his friends and over the course of several hours drank four beers along with your health insurance. Are we reviewing all the questions now? Well, we were talking about maybe just making this be like kind of a working meeting. Oh, okay. So, I was going to just maybe we can just glance at them and see if there's anything. Sure. Sure. Yeah. And Beth, I need to figure out how to get switch over my email to my work email. Okay. Despite ultimately having a 0.15 blood alcohol. So, instead of ultimately we should probably put, you know, well, I guess it doesn't really matter. His friends indicated that he seemed very awake and alert to them and not highly intoxicated. What is the mechanism of action by which caffeine and the Red Bull drinks maintained his wakeful and alert state despite being significantly intoxicated? Awesome. It looks like there might be a missing answer choice here for number three. I don't, yeah, I don't know if there was, if it was. We could just make one up and say like, I don't know if I accidentally put a three in there, but just put activation of the mu opioid receptor. There you go. So Beth, do you want to add that on there? So activation of the MU dash opioid receptor. That is an incorrect answer. Yeah. Awesome. I think we also need a rationale. Yeah. So we need to have an explanation of why that one is correct and the other ones are incorrect. Okay. So first for the blockade of the adenosine receptors, that is going to be the Fred, Fred home one, right? And then don't mean transport is increasing the brain. Don't increase in the brain after human. Okay here we go. So rationale from the standpoint of that adenosine receptors exist in the brain that's what's the caffeine how it acts in terms of to increase the wakeful state? So for every question we need five answer choices and And does what each each answer choice need a rationale for what's incorrect or correct? Yeah so we can I don't know why the formatting's being all funky here rationale or whatever it is or explanation right so so caffeine so you could put caffeine caffeine acts to maintain wakefulness by blockade of the alpha one and alpha two alpha adenosine receptors and then you have to say what the other why the other ones are wrong so so enhance that up yeah so if you want to do that so you could say um GABA is enhanced you know by blah blah blah not caffeine or whatever um or what you could say there's a reduction in GABA based on caffeine or yeah so you just want to put like an explanation in there for why the other ones are wrong right so caffeine does not act on the mu opioid receptor you know glutamate is inhibited by blah blah blah not caffeine whatever so so you just want to put those in there and then 53 year old male Bill I think we should say glutamate neurotransmission not just okay otherwise that's good okay uh 53 old male with a 20-year history of alcohol use disorder presents to his internist um personally I've been trying to eradicate stigmatizing language and so I would say let's not put medication-assisted treatment since it's kind of an outdated term and naltrexone is the treatment it's not an assistance to the treatment so I would just say um medication treatment with naltrexone when I use MAT I usually say medications for addiction treatment instead of medication okay that's anyway okay that's just my pet peeve um yeah so they're working on that thanks therapy and discusses some options so 12-step is not is considered a mutual help program not a therapy um should be 12-step facilitation so it could be 12-step facilitation would be a therapy or you could put you know some form of non you know medication treatment or something like that so wait I'm confused so so 12-step is a mutual help I mean 12-step facilitation is is a is a is considered a psychotherapy so wouldn't that be then which is fine stage regarding the effectiveness of 12-step facilitation for alcohol use disorder 12-step facilitation which is what tsf is right right so I don't know what where's the issue there are you just saying including I'm sorry so you're just saying okay in the question piece itself you're saying put 12-step facilitation yeah got it the patient asks us interns which of the following statements regarding the effectiveness of a 12-step facilitation disorders is accurate um and I misspelled pharmacotherapy I see um is more effective than that for promoting controlled drinking The only question here is the patient asks which form of therapy would be better. Um, which of the following statements regarding. I would say, let's see. I can take out the patient ask his internist and just say, which of the following. Yeah, I just, it's because it's, it's not that there's any is better, I guess, is the answer. And so that's why it's saying he's asking which one would be better. But really, well, I'm just saying I can, I could, I could remove it or say equally effective. What do you think would be better? So I would say his is, you know, ask his internist if. If, you know, 12 step facilitation is. If is, I would just leave out that last effective. Yeah, that's what I'm thinking. Just leave out the last sentence. Because then you ask the question, which, yeah, there you go. So just take it out is accurate. Yeah. All right. Something like that. There you go. Okay. All right. A tribal leader of the Choctaw Nation in Southeast Oklahoma attends an open forum to discussion sponsored by several. The best treat alcohol use disorder on the Choctaw Nation reservation indicates that he thinks treatment model where experienced clinical and research teams work with local leadership to adapt evidence based treatments to local culture trained to learn. Greatest impact on addressing AUD and STDs in general, what type of collaborative strategy for evidence based. Training trainer, research sessions, institutional pairing. I didn't know the answer to that one. That sounds. Oh, I didn't either. Cool. Awesome. Are all of these, is this like an accurate. I mean we really only need like one reference right you've got the bottom one is probably included the Hillary bottom one is probably included in Hillary's review in the top. Correct. So, take it off. Okay, so delete that one. I mean this one's an HIV clinics is this relevant. Do we need this one. I bet you could just do Connery and Savick. Yeah, that's because it is true as a study guide. People don't want to read multiple multiple so in the first two questions look through and see if you can get it down to. Because if a review article talks about evidence evidence against two or three of the choices we don't need. We don't need as many references as, as the choices. But I think they're good questions. Yeah. All right, well, we can I can pare down those. Yeah, and the other ones are okay I think but yeah, it's fine I can, I can pare down. Yeah, no, I mean, yeah, it's okay. I think that's but I think we just need a rationale for each of these and then otherwise I think they're good. What did you put again for the number three answer for the first question. Oh, I just randomly put agonism of the new opioid receptor, I can document to everybody. So what I did and then so they just need a rationale. Okay. Okay. And then, Beth, I'm going to stop my sharing here. And then we can go through the alcohol, or the tobacco pip in a sec but do you mind flashing up where we're at with the self assessment questions, because Michael needs those pretty soon right, Dr. Getty. Yeah, we talked last week so by the seventh if at all possible would be great. Okay, so where are we at in terms of those questions and who submitted them and stuff. Oh, we got. I haven't updated this yet this afternoon so we got three from Dr hands right. Let me. What do the colors mean. So if they're yellow and crossed out there, they were promised and never received and then folks just kind of stepped away. Green and bold have been through the editorial process, green and purple are with Dr. Go with Dr. Getty. And he rejected my questions. What did he not like about that. He actually put comments so I can share those with you. Let's do it. So I'll get a, I'll get a, I'll get a second look at my questions from him too right. Yes. That's good. So we can look through those. Um, that so. So how many do we need and in what areas then. Oh, I haven't gotten Dr barman, or the other forensic incarcerated questions, or the sorry the legal I'm sorry I can't read across the lines. We need more for alcohol and opiates under evaluation. That with that yellow cross out means. Yeah, that means somebody promised those questions and didn't come through. Let's see here. These are, these are like fellows who volunteered and then I think they got the item writing materials and kind of went like, Oh, let me work on those to alcohol and opioid screening in toxin withdrawal. We want to change the colors and stuff then. I'll fix this but just for my. Yeah, I will say that the, the materials are are a bit intimidating when you get all of them. Fortunately, you would think that the residents would have a little more time on their hands. I'll volunteer for more but apparently I need to learn how to write them better. Let's look at the comments and and see before I volunteer. Okay, I'll send those right after this call. We were just swapping questions back and forth. Thanks for joining. So my emails to Dr. Oleg are going through for some reason, I keep getting a Microsoft message that they're delayed. So I was trying to reach out and find out, based on your comments, should I wait for edits for the first couple that were submitted or not? So I'll keep trying. So what was the question? Should we, do we want to try to contact Dr. Oleg? Yeah, if the email doesn't go through by the end of the day, I'll just give her a call tomorrow. Just pick up the phone. It's a weird Microsoft thing. Let me make sure I've got the, so it's P-O-O-R-V-A-N-S-H-I dot A-L-A-G at T-T-U-H-S-C dot E-D-U. Maybe, should we just double check? Here, I'll type it in here and make sure you've got the, oh, you should have got that. Oh, it's the same email that all the, like the meeting invites go out to, and those have all been fine. It's just been. Interesting. If there's some kind of a weird server thing going on. Okay. Okay. So were you able to pull up the other questions or? Which other, I'm sorry, which other questions did you? Oh, I thought you were pulling up the ones that, for the comments that he had sent. Oh, I'll just, I'll email them to you when I. Oh, okay. So we're not going to try to. We can't. Oh, we can't. Sure. Hang on a second. Let me see if I can. Okay. Sorry. I didn't realize. Otherwise we can go and look through the tobacco pip and kind of, kind of see if there's any group feedback on it. Beth, I'm going to try and sign in again. I forwarded your email to my work computer. So if it'll work. Okay. So let's see. So this one, so the STEM, Henry just got off work. He pours himself a glass of beer. His partner arrives and asks him if he would like to join him. Henry responds. I think I should really just, Oh, wait. When tonight, when dessert arrives, he thinks. May not do any harm to have his usual glass of Moscato, though. He feels conflicted about it. He eventually gives him thinking it won't make much of a difference if I have a glass or two. What does Henry's initial response exhibit based on the screening criteria in the cage screener? Individual has felt you should cut down loss of control has noticed increased criticism. It's been caught and assumed. Okay. So it's not big. So it's because it's a, it's not a clinical context. So that's the problem with the question. That was his comment. Okay. Cause I think we could, so you can send that back to me, but I think we could go up and just say, you know, the patient is talking to his doctor about his alcohol use and how he was trying to cut back, but then he finds himself at dinner and decides a one or two drinks is okay. Right. So we could just, I can just shift that around to where it's like what the patient is reporting to the doctor. Yeah. That's it. Yeah. Okay. And then, so that would be helpful. Is it useful to do these as a group or do you want to just send them to me and I'll go through or yeah. Go down to the comment on that one. The vignette is not necessary for the question and wording of the question is potentially unclear. It does offering treatment options equally equal offering the same options to all. And the principle of justice is open to multiple interpretations. So this one might be trickier. What's the original vignette? So these are ones that I took from the, from the book, from the study book. So it's a 47 year old African-American male who works for six days a week in construction and a 23 year old female Latinx patient both present to an opioid treatment program seeking maintenance treatment for their opioid use disorder. Which of the following of principles of biomedical ethics is most likely to be used when offering treatment options equally among patients with substance use disorders? Yeah. So I guess. If you got rid of equally just treatment options among. Well, I think the idea of justice as a principle is that you provide equal treatment despite people's different backgrounds is what they're trying to get at. But what he didn't like in the wording is he didn't know what equal meant. Yeah. So maybe we could just stay that out, say that explicitly then. Yeah. Cause I think it's an important point. All right. I can, I think I can fix that one. All right. So if you, if you send those to me, Beth, I'll, I'll fix them with his comments and stuff and try to salvage those. And so that we have them and then maybe just let us know kind of how many were short for the test. Okay. Sounds good. Thank you. Okay. Awesome. So then let's go through the PIP, the nicotine PIP. So I already, I'm at the part now where, so I've gone through the beginning and I sent comments and stuff. I'm trying to remember, is this the, does this have the comments part on? Okay. So I think I went through all of the beginning stuff and I had sent comments, right? Beth, did you get those? Yeah. So I, I think I replied to you and I said, I incorporated everything except it was breaking one of the clinical quality measures into two separate measures because it like, it fundamentally affects the layout of the entire PIP. Okay. So in general, we can just, for the future, not include two different variables in the quality measures. I don't know where I can see them, but for now it's okay. How do I, how do I get to that from here, Beth? Go to content and then they should be in stage A. Okay. Okay. Okay. So statement of need. Yeah. So one of them is the, So I think it's this one, because it's saying, did you assess the readiness to change, which is one thing? And then the second thing, did you document if there's change in motivational level? And so we'll just leave it as two things. But in general, if we try to catch stuff like that earlier on, because it's better to, those are kind of two separate things. And this one is two. Yeah. Did you document advice to quit? Did you document at least brief counseling? And then did you provide information on local and national resources? I'm wondering if we should, yeah, did you document it? Yeah. Because the other option is like, you know, we could just decrease this into one thing. Like did you provide information on local national community resources or something like that? Well, I think the brief counseling is the most important thing. So I wouldn't get rid of that. So maybe you could put, after providing advice to quit, did you document at least brief counseling and provide information on resources? We could do that way. And then it's not quite so many. Does that mess it up if we do that, Beth? No. How do I put comments on again? You can't. This is actually a live version in the OMS. It's hidden from everybody, but it's live. Okay. Would that work for you guys? What do you think about that? So you said, did you document? Because the advice to quit, I know with the five As, some people want just the three As and then it can become really confusing, you know? So because some of those things have changed over the last few years. So I'm with Dr. Serrano, the brief counseling is the most important part. I would just restrict to that. Okay. So we put then just, did you provide at least, or did you document that you provided at least brief counseling and information on resources? Yeah. So then it goes from three to two. So there's some improvement there. Beth, is that clear? Yeah. I can put it like in the text or I can put it in the... Because we also want to keep in mind how much time do clinicians really have to do those kinds of interventions, right? So we could do that. And then for this one, are we okay? So we did you assess readiness to change and document if there's a change? I think that one's okay, even though it's kind of two things. Yeah. They just have to meet both criteria to meet the CQM. Okay. All right. And then we kind of changed the resources around a little bit. Clinical tools. The statement of need was updated. So this, okay. Just wondering like the references for the statement of need, like we could, oh, actually there's still this formatting shift. I don't know if it matters, but it goes from like this one to this. Five, six, seven, eight, and then 11. It goes from like regular size to subscript. But also we seem to have, oh, I'm sorry. Nevermind. Oh, I see what you're saying. Aren't they? Oh, you're right. You see what she's saying, Beth? Yeah. And also they're formatted differently. So like we should probably just have the formatting be the same for all of them. Okay. It looks like there's two different, you know, formatting. I don't know what, do you guys use EndNote or what do you use, Beth? This is actually native in the LMS itself, so it doesn't support anything like that. What I mean for the document though, like the initial one, because this is not, it's not like a linked reference. They just gave me the references on a Word document, so. So I wonder, okay, so, but so I think we need to make sure that it's formatted properly before it's like uploaded. So what would we use, a APA or? Yeah. So that they're all the same throughout the whole thing. So it's actually different here in the PDF too. But it doesn't look like they're consistently documented. So Beth, in that Word document, could we redo the references either using APA or EndNote or whatever, and then make it the same for all the documents in the PIP? Yep. Okay. That's just weird because, I don't know, I have to figure out what happened there. Yeah, so that, because then, then it would be the same, like here and then here and then, you know, they'll all be the same as in here. So whatever formatting thing you do for here, also there's like a random nine hanging out down here, and a random two here, and a random 12 here. So like, we can just go and fix some of the, these things so that it looks professional and consistent. So, do you know what, and like here, like there's like double spacing or 1.5 spacing whereas these are all like single spaced. Yeah, they probably paste them in and some have formatting, some don't. Yeah. So we need to go through and format them all. Yeah. Does that make sense, Beth? It does. Yeah. Okay. It doesn't sound like fun, but okay. All right. So, okay. And then the patient chart data. So I haven't, let's see, gone through here. Okay. So pull five patient charts with whom you've had a conversation about putting, assess your performance. Just make sure that this is downloadable, looks like it is. So I'm guessing this is all standard for lots of them. So I'm not gonna proofread it because it's not specific to this. Okay, I'm just gonna make up stuff in here. Yes. This one probably needs to include, well, let's see, are we only supposed to be doing chart audits on patients who do have a tobacco use disorder? No. Actually. Isn't it we're supposed to be screening for tobacco use disorder as CQM? So in this case, this clinical measure needs to be changed to did you document tobacco use? This needs to add nicotine in here, and then it also needs to be as relevant, right? Because if you screen somebody and they said no, then you're not gonna be adding it to their problem list or treatment plan. Does that make sense? You're on mute, Kevin. I was gonna say you could put in parentheses after tobacco use disorder, if applicable. Yeah. So you could put, did you document, parentheses, if applicable, tobacco use. I would put tobacco use, comma, tobacco use disorder, comma, or nicotine use disorder in the patient list or problem treatment plan. Does that make sense, Beth, if we update it to there? Yes. So if you, Beth, if you modify a clinical measure, you've got to go in and manually change it here? I do, yep. Sorry. It's just that it doesn't make sense to say, like if the person doesn't have a diagnosis, then you wouldn't be documenting it. Or I guess you could just leave it as NA. I don't know. No, I think if applicable, the only thing I would debate is whether to put at the very beginning, did you document tobacco slash nicotine use and or use disorder. Yeah, okay. Maybe reword what I put there then. I put something in the chat and you wanna. Yeah, oh. I'm sorry to ask you this question that light, but is there any options to reinforce positively if people don't use any nicotine? That would be a different CQM. Okay. We'd have to add that one on. And I think that might be kind of hard at this point. Oh, for patient care. OK, I'm just going to click through these to, like, I don't know, just putting stuff here just to make sure. Okay, so, all right, chart audit. Okay. Our peer comparisons are among those other people using the PIP. Your comparison. I think it's other people using the PIP, right? Yeah, it is. Yep. Okay. Yep. Oh, oops. Patience. Okay, submit. Let's see. Please indicate why you think you did or did not perform. And just putting in whatever. So OK, look at the chart, take into account your pleasing. So then, OK, let's say I'm just going to do, oh, it's 1 o'clock. OK. So we probably should go, but just, I don't know, put 3. OK, and submit. OK. So then once I do this, then it has to go into the other thing. OK. So I guess for the other folks on here, so Beth re-sent out the link to this. And so if you have some time to kind of click through it and give her any feedback if things don't work, I'll see if I can go. I think it might be making me wait a month or something to do the next one, right? But I think you can manually, Beth, push her through, right? Yep, I can do that. OK. Can you manually push me through, and then I'll try to go through and see if anything else doesn't work or is weird? I will do that. All right, cool. Thank you, guys. See you at the annual meeting. Thank you. Thanks, Carola. Bye.

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