Webinars

^{Michael Kalinowski}: Hi there and welcome to another LigoLab webinar. It's a nice sunny day here in Southern California and we're talking to a couple of friends from the Midwest from Goldfinch Laboratory. We're going to talk about how this little dynamo of a laboratory has grown from the ground up into a very successful multi-specialty operation.

My name is Michael. I'm happy you have joined us and taken some time out of your busy day. Now let's introduce the experts of our discussion today.

Dr. Jared Abbott and Dr. Tiffany Milless. Jared, we'll start with you. Tell us a little bit about you and and Goldfinch. 

_{Jared Abbott}: Thank you, Michael. I have been practicing pathology for over 17 years now. I did a pathology residency and a dermatopathology fellowship at Mayo Clinic in Rochester and have practiced in Iowa for many years.

Two years ago, almost to the day, on February 1st, 2023, three friends and colleagues of mine decided to open our independent practice based right here in Iowa. For those who don't know, the goldfinch is the state bird of Iowa, and we wanted a nod to our roots but we certainly didn't want to geographically limit ourselves with our naming and branding.

We wanted to be a solution for multiple states. We started with our roots in dermatopathology and we've expanded into other subspecialty service lines and also had a digital pathology journey. So we can talk about that as well, but thank you so much for having us and we look forward to the conversation. 

^{Michael Kalinowski}: Thank you very much. Dr. Milless, please tell us a little bit about yourself. 

^{Tiffani Milless}: Great. Thanks, Michael. I'm Dr. Tiffany Milless and I, like Jared, was also a medical gypsy and traveled around until I ultimately found my forever home here in Iowa. I went to college at Notre Dame and then back to Ohio for my MD at the University of Toledo College of Medicine.

I did a pathology residency in anatomic and clinical pathology at Yale New Haven Hospital in Connecticut. And then I did a Durham Path Fellowship at MD Anderson in Houston and came to Iowa. I have been practicing with my current partners for my entire career, which is going on for 12 years.

And as Jared mentioned, almost to the day we’re celebrating the second anniversary of starting Goldfinch. Jared and I decided to participate in a webinar, among other celebratory activities, and it has been a wild ride. We hope to share a little bit about that with all of you today, and we promise not to censor it too much.

So we had our private and our public celebrations that we were able to do this weekend and then yesterday at the lab and it's been a happy past few days. 

^{Michael Kalinowski}: We've promoted this webinar over the last couple of weeks and we've had a really good response because I think people are really interested in this story.

How do you go from starting from scratch to being a successful laboratory? What was the vision? Maybe start with Jared. What was the vision? And what ultimately told you and Tiffany that it was time to do this?

_{Jared Abbott}: I guess the vision was to do something different and better than the standard pathology product that we'd observed over the years and there were two elements to that. One is a subspecialty focus. And the other one was a technology focus, and this one especially had its roots in our backgrounds as dermatopathologists. We felt that patients in Iowa and other states, whether rural or urban, whether seen by a plastic surgeon, a dermatologist, or a family practitioner, deserve to have a very high level of expertise in diagnosing their conditions.

We wanted to start a company that would be focused on this kind of subspecialty model where we could bring together the best minds for the best diagnoses. And, because we've all noticed over the last 25-plus years that the complexity and the demands of medicine and pathology have grown exponentially, I think it's harder and harder to be a super generalist in this era with all of the different demands upon your knowledge and skills.

Certainly, generalists are out there and do a great job, but I think even a lot of them focus on certain areas and they self-select and sub-specialize themselves over time. We've noticed that as well, so we wanted to lead the way in making things sub-specialty-focused.

The other thing was the technology focus. We wanted to be independent and have a lot of autonomy and control where we could invest in new processes. So one of the things we'll talk about today was one of our first decisions, and that was selecting LigoLab as our LIS laboratory information system provider.

We wanted a lab information system that allowed us to have a completely barcoded and paperless system from the time that the case was accessioned to the time it was sent over an interface to a client, and we've achieved that. With considerable work we did it. 

The other focus was digital pathology. Our number one goal rested upon having an effective, seamless, high-quality digital pathology solution where we could bring in subspecialists from all over the country or even the world to work on our cases, and we've done that as well. 

^{Michael Kalinowski}: Tiffany, how much of that original idea has become reality, and what hurdles and successes did you experience along the way? 

^{Tiffani Milless}: The cool thing is it went so smoothly. We didn't really have any hardships or hurdles. Just kidding. I just wanted to watch Jared laugh at that answer.

No, I think Jared's description of our vision and what we wanted to do here was perfect. I want to always bring this back to the people listening to this webinar to keep it relevant. I'm guessing that if you're listening to this, you're sitting in a position where maybe you're considering doing something like this.

When I put myself back in that time, I feel like there are two buckets of pathologists, two buckets of administrators, and two buckets of business leaders, and from there it goes to the sufficers and optimizers. Jared and I and our partners are tireless optimizers. We’ve worked together for long enough to know that about each other.

We had this little urge eating away at us to do better and ultimately I think that snowballed into a lot of big ideas. I think we knew as we deliberated on decisions like which LIS system to choose and what laboratory billing (lab RCM) company to work with. All these things. We deliberated so much because we knew what we wanted, and we wanted amazing. 

And so the framework was really critical. I think we'll touch upon the theme of scalability and the theme of customization a lot in the next few minutes as we walk through this, but I feel like that was a big part of our vision, like Jared said, multiple states, multiple specialties.

We don't just want to globally process specimens. We're going to do a lot of different things. And so we really needed a laboratory information system software partner that could expect the unexpected because that's exactly what we expected. I think even then our minds were blown by all the different things that we wound up experiencing and all the troubleshooting and where we've gone.

It was not predictable, but I think that's exactly what we wanted. We wanted the kind of business, the kind of lab, the kind of medical care, that can pivot on a dime and without hesitation, react decisively to what's coming in the latest in clinical care, the latest in technical advances within pathology, and the latest in what our clients need and what they tell us.

So I think that's really been a constant theme. We want constancy is our ability to change and pivot. 

^{Michael Kalinowski}: One thing that stuck with me from an earlier conversation was how Goldfinch likely would not have been able to realize the success they've realized to this point with an out-of-the-box anatomic pathology software/LIS pathology scenario.

If you look at marketing material from various laboratory information system vendors you always read about customization and customizable pathology LIS systems. What did you see from LigoLab that resonated on the customization front?

^{Tiffani Milless}: It was such a hard decision and maybe Jared could speak to this too, but we struggled with this, the question of building the lab of next year that we want, building the lab of the next five years that we want, and building the lab of our 10-year vision.

We are a completely self-funded lab. We sacrifice so much. We were extremely conscientious with our dollars. We did not have a giant hedge fund writing checks to us so that we could just spend it willy-nilly on our dream purchases here.

So being very cost-effective was clear, but we needed to build something that could seriously grow because we didn't do this with a crazy vision of explosive growth. And so that was hard. We agonized because there were some really cool out-of-the-box LIS lab products.

And even in the early days, Jared, you remember, we were like, what if we had just done that? It would have been easier because partnering with LigoLab is a lot of work. As you start, you're continually communicating and the LIS system implementation doesn't end on the day that you start processing samples.

It was this extensive conversation, I would say, with so many of the people at LigoLab and with ourselves of okay, now we need to make this change. Now we need to make this change. Now we need to make this efficiency. And for me, I feel like we didn't even know what was possible. We did a lot of manual and paper processes previously, and we did a lot of what I'm going to call them stupid things at the beginning because we didn't know what was possible to program with LigoLab.

Even this past week, I was like, what, LigoLab’s LIS system can do that and I don't have to do it manually every single day? Cool! My mind is blown again!

It happens all the time. It continually pays off because for Jared and I right now the blessing of success has also meant that we have the limitation of our time, and so LigoLab has time and again shown me that it saves me time signing out a case, CPT coding it, the lab billing, so many things, the QA, the cancer synoptics.

There are so many parts of it that save time, and that is our most valuable asset as pathologists, business owners, and actual practice managers. We do it all. And so the more I have to fiddle around with, the less I can make these big decisions that have evolved into big lab growth.

^{Michael Kalinowski}: Jared, can you give us a little understanding of the integration between the laboratory information system and the digital pathology solution? I'm guessing you spent just as much time doing the due diligence on a digital pathology partner as you did with LIS software vendors. 

_{Jared Abbott}: Yes, Dr. Milless spearheaded our digital integration, so I'll let her give you all the details. I don't want to steal her thunder because she did a really magnificent job at that. But, I'll just say, there are three components. One is the hardware. One is the viewage imaging and management software. And the third one is your LIS system. All three of those things need to be harmonious and require quite a bit of upfront work.

We were able to get all the relevant stakeholders at the table over the course of literally months to make that happen. I will say one thing just to build on our journey with LigoLab at the very beginning. I think most pathologists, myself included, think of LIS system software in the parts that we touch.

What's the sign out experience like? And honestly, that's how I came to LigoLab. I really liked how it reduced the number of clicks and secretarial work that I had to do in order to sign out a case and it also allowed us to build on really cool modalities that saved us some administrative costs.

We were able to add ICD-10 coding and CPT coding to our diagnosis. So we don't have to send our cases to a lab billing coder to do that. That's a big benefit. And it also reduces the time between the sign-out and final payment which is also important.

But the other thing, I didn't even realize when you think about flow itself and how your anatomic pathology LIS manages all that because that’s where LigoLab has shined. LigoLab’s LIS software solution allows us to track the metrics of every step in the process.

How long embedding is taking? How long does microtomy take? Where is the case if we're trying to look for it? Help us manage some send-outs. What cases at what company are getting extra testing? All that sort of thing. And that's really where it's customizable and an out-of-the-box LIS software solution can be very clunky and end up requiring a lot of manual paperwork in order just to keep track of what's going on.

LigoLab, with LIS lab customization, can do that. And that's been super helpful for us. Whenever you're thinking about a lab, think about laboratory workflow management and the processes of the lab itself, and less about the pathologist sign-out experience. Look at a bigger world because that's where a lot of business success happens.

^{Tiffani Milless}: I would agree with that. I would add to that I feel like one of the lessons we learned for those on this webinar who are considering maybe doing something crazy, is people are your biggest asset. They can also be your biggest hindrance and your biggest problem if you don't find the right team and create the right relationships and partnerships.

One of the ways that Jared and I feel successful today is that we feel like we have a great team behind us. And part of that was when we were building out and customizing LigoLab. We sat with the cutters and the accessioners and not just sat with them, we did it with them. We experienced this 360 product that they have to offer and we did it ourselves and learned what we can do at the embedding station that makes it easier and quicker. 

One of the biggest costs that we have is our payroll and we don't want to just have people doing silly manual repetitive activities when they don't need to be.

As Jared said, LigoLab has really shined in being able to create lean processes and save us in that way. I also feel like it has helped us with recruitment. We all know there is such a shortage of trained lab professionals, and we do a lot of on-the-job training, and we get so much young, bright talent because they really enjoy the workflow and they see this kind of high-tech, great IT product that we have.

It's all integrated. Our digital workflow is integrated. And that’s made it easier for us to recruit top-notch pathologist talent. One of their first questions always is “What LIS system do you have?” and “What image viewer do you have?” We use Lumea. They are fully integrated. There's a single sign-on.

It's a really slick, fun, easy, seamless process, and people enjoy that. It’s something that they value because the pathologist's experience is really critical when you're asking someone to do your cases and work with you. They're not going to do it with some clunky, time consuming situation.

_{Jared Abbott}: Tell everyone about the critical integration of viewer imaging software and the LIS system and the goals from that process. 

^{Tiffani Milless}: I feel like we really deliberated about, do we want to invest in this. Jared and I are definitely cost-conscious. We self-funded our lab and we continue to self-fund. When we make these decisions, they're not made lightly. And sometimes it does feel a bit like a splurge. We think we don't deserve this. We're just pathologists. We should just power through and do the hard work and some sort of silly manual thing.

But I feel like every step of the way it has paid off. And as Jared mentioned, we decided to invest in LigoLab and LigoLab can fully integrate with the image viewing software. What happens is Lumea is the company that we chose as our digital image viewer, and they also store the images.

There is an integration between LigoLab and Lumea, and in that way, I can open up my queue or my list of cases in LigoLab, and I see the list, and LigoLab can just auto-open case by case automatically. It opens a new case in my web-based Lumea viewer.

Everything is barcoded because LigoLab requires that. It's a wonderful safety and operability feature. We see our slide and we view it. It's so intuitive, it's so amazingly fast, and it can be done from any workstation, so I can use it at the lab, I can use it on my laptop at home, my desktop at home, and while traveling You view the case, you render your diagnosis, and then you're just right there in LigoLab.

You go and enter it and everything is completely done. You can insert microscopic images. It could not be more seamless and all the feedback that we've gotten from the subspecialty pathologists that we've hired has been very positive. So we only do Dermpath, but our other pathologists do other specialties. All the feedback is that they just really love the experience.

I see that Dennis has asked a question.

Has the use of digital pathology proved to be as beneficial as you originally anticipated? 

I would say beyond. I thank God that we took that leap because originally at the time that we first decided this, it was me begging everyone to just try it, just trust me. I believe it's the future. Let's do this, come on guys.

Even I was a little nervous. This is a big investment. I hope I don't lead them astray, but it was essential because Jared and I mentioned earlier, I think it's really important if you are considering starting something like this, you have to get behind your vision and your core values. Get that down and maybe get a one-year, five-year, and 10-year plan of what things are going to look like.

For us, we live in Iowa. It's a very rural state. And as always, we're really dedicated to bringing expertise from world-class cancer centers, which is where we trained. Jared trained at Mayo. I trained at MD Anderson, and our partners also trained in excellent places.

We believe that our patients, even though they live in rural Iowa, deserve that same level of care. And that's a big part of why we live here, why we practice. And so we took a risk that going digital would continue to make that mission happen. And absolutely, I think we were able to recruit a world-class breast pathologist, a world-class GU pathologist, and a world-class GI pathologist, and we can provide the turnaround time and the expertise.

I also think we deliver on the personal feeling because we are still in that community and we deliver that kind of really customized, personal, highly communicative service that we always have. The digital pathology makes that connection between people in New York City or other big cities possible and they're providing the care right here in rural Iowa or whatever other rural state our patients are from. So that has been essential. 

_{Jared Abbott}: So I would just piggyback on that and talk a little bit about the business case of digital pathology. This is a bit of a moving target for a lot of people. I would say you have to have a good reason and model to have it succeed because it is very costly.

The hardware is costly. The LIS software and digital pathology solutions are costly. The integration project is costly in time and to a degree money. All of that is upfront costs. And so the question is what is your return on investment? And for us, it's mainly been on bringing us into service lines that we otherwise couldn't access.

I think a lot of groups around America talk about how it's very hard to recruit pathologists. I think it's doubly hard to recruit subspecialty pathologists. And I think it's triply hard to recruit subspecialty pathologists to places like Iowa which we love living in, but I think sometimes if you've never been here, it might be intimidating and we're a small state.

I think that really has opened up whole new worlds and new business opportunities for us that we couldn't otherwise access. The other thing is I will point out that, because of the integration, it doesn't slow me down and make signing out cases take forever and ever. If you didn't have integration, you would spend a lot of time doing administrative work. Our goal is always to have our time spent on medical work and really focusing on the cases and our patients and not on clicking boxes and opening up random windows here and there and writing things down.

And that has really been more efficient once you have that integration done. So I would say it's definitely a learning curve. We've all been trained on glass microscopy, but digital is something you do pick up pretty quickly. 

^{Tiffani Milless}: As promised at the beginning, I promised that this wouldn't be overly censored content.

And so Jared's getting nervous right now, but I am going to share a real fail for us. And it's related to Dennis's question that I see in the chat about laboratory revenue cycle management (lab RCM). 

The question is “Do you use the lab revenue cycle management system from LigoLab or another lab RCM vendor?” 

We haven't really even nailed this down yet so I'm just going to touch on something that I feel like we're still working through. As Dennis knows, and maybe you guys know, LigoLab has the lab RCM module that you can add on with their LIS software. And we really deliberated on that. We're learning it was very unique that we started from the ground up and by from the ground up, that means that on our first day, I believe we had four blocks. So I think we all went home that day feeling a bit panicked. 

What have we done? Where have we gone with our successful careers of stability and pride? Now we own a four-block lab. But no, we had faith and we persisted.

Nevertheless, we felt at the beginning that there were so many balls in the air and that we were pulled in every direction. We were doing everything and thought maybe we should attempt to stick with our core skill set and abilities and outsource lab billing. We felt concerned that if we were to do the LigoLab RCM module it would require too much of our staff and ourselves being responsible for laboratory billing, we felt nervous about that.

So we went with an outside lab billing company to start with, and it was a failure. We learned a lot from it, and again, we were faced with the decision of what to do. We've only been open two years, so it says a lot that we've already changed, but we decided to go with another outside lab billing company, and this one, we almost doubled down on our original decision because this outside lab billing company does even more, and it's even more costly, but it's even more of them doing almost all of the work and less in house for us. 

There are a lot of pros and cons, but for me, if I had it to do over again, I probably would have done the LigoLab RCM module, especially starting from scratch, because it's very apparent to me two years in that you're building better be very integrated into everything you do.  

From the minute a specimen enters your doors, you better have the whole process, including the process of somebody writing you a check at the end, because if you think you can just do all your SOPs about the lab itself and once the case is signed out, you're done, then you're going to be pretty sad about what your finances are going to look like.

I think LigoLab intends to be a full 360 solution. And if their laboratory billing solutions are anything like the rest of their platform, it would be great to integrate that. We could have learned from day one when we were a four-block lab rather than learning as a 400-block lab. It's a lesson learned, but we do not currently use it. So that's my long answer and my full disclosure of things we're still working through and learning. And I'm humble enough to admit that. 

_{Jared Abbott}: And your answer about laboratory billing really gets into a greater issue, which is the most precious resource our lab and any lab has is its people. And finding the right people is really challenging. And so one thing you know, if you bring lab billing in-house, you'll need a lot more hiring and a lot more training. And that's a challenge.

We've really found a great team that we work with and are very blessed to have them. But that wasn't easy or straightforward or fast. It took a lot of time and a lot of effort, and a certain degree of turnover, but we're really satisfied with it.

I think in terms of LigoLab, it's allowed us to be more what I would call laboratory delivery-based focused on our HR and less what I'd call admin or secretarial focused because a lot of the paperwork is included in our work.

We've put together systems that are pretty efficient in terms of shuffling paper and faxing things. 

Tiffany, can you talk about a really critical part of the process, which is reporting…how our solutions with laboratory LIS to EMR integrations all work together?

^{Tiffani Milless}: Yeah, absolutely. And you reminded me to say one other thing, Jared, and that is, one of our favorite things about LigoLab is when you buy your LIS system, you're basically getting a long-term relationship with multiple people. They're definitely not going to toss you off.

Oh, I'm the salesperson. Now you're tossed off to the real people that are far less adequate. Michael was part of the team that sold us LigoLab, and here we are today, two years in, we still get Michael, and when we have a problem, Michael actually still cares and is ready to help.

Another favorite at LigoLab is Petros, who has come to Iowa. He gives us his cell phone. We try very hard not to bother him, but we do bother him all kinds of times. And one of the things that he told us during implementation was, if ever you have paper in your process, you have failed.

LigoLab isn't meant to have extraneous paper that's going on. It's meant to be a full LIS system software solution. It took us two years to really fully understand and believe that. We just didn't have faith because we came from a very paper-heavy kind of old-school way. 

Indeed, paperless is ultimately the best flow. So the point that I wanted to share is that as we have churned through and found the wonderful team that we have today, I think we've learned that there's no front and back office as a lab company, as a lab business. There's the lab and there's the lab.

I think originally we thought there's the lab and then there's the office. And we need to hire for both and we had a bit of a segmentation in our mind that is blown. I now think the administrative staff, our office manager, and our operations director, are lab people. There is no separation.

It's consistent with what LigoLab is, which is a 360 solution. We don't have people that only know about one little paper process. Everybody knows the whole process and knows what's going on in the lab. That's exactly how we do everything. That has been really powerful. 

One of the things that we wanted to touch upon is making this very relevant. I think that we wanted to talk about like scalability and growth and I think that would be a good place to go next because I don't think we really talked much about how LigoLab scaled with us.

For those of you considering all of this, be patient with yourselves. It would be hard not to start small. If you're starting something from the ground up likely you're sitting in a place where you feel like you already might have a potential client base or referral source or something but maybe you're on the fence about whether it's enough or not.

That's where we were. And that's probably a common place to be seated because people have come to me about this before asking what do you do if you have just onesie or twosie clients, but not enough to start your own brick-and-mortar lab?

I think that's the perfect place that we find ourselves in now because we're digital and we have this beautiful, I mean we've spent two years customizing this and optimizing this experience and creating lean workflows, that I think are finally very financially feasible.

Before you really full out start, I think it's valid to say, start small, bring in the couple clients you do have, and find a lab like ours, put a little personal plug in here that's gonna do some slide prep for you that's digital, and do a TC/PC split on that, and see how that feels and try that out before you take the leap that we did and investing the money that we did. That kind of infrastructure takes years to build out. Start with just some digital slide prep options that are out there now. 

^{Michael Kalinowski}: I like where you're headed here. Scalability. What are some of the success metrics that mean a lot to you? As I recall, you went from six blocks on the first day or day one of service to now daily 400 and north of 400. 

^{Tiffani Milless}: Yeah. We're really proud of that. I'll let Jared answer this one mostly, but I feel like to me, people are the greatest resource. We found that people can make or break you, and if you're a pathologist or an administrator watching this webinar, thinking I can do it, start by realizing you won't be able to do anything if you don't think you can build a team.

Do whatever you are doing now and give up on this dream because the team-building part of it was critical. And I feel like the success we have today is because we have a great marketing person, we have a great IT person, and we have a great operations person. 

We have all these people and I can lean on them and they've got it. I can be a pathologist. I'm a great pathologist. And I've done my best at doing all of this other stuff and I feel like I had a great vision and that's it. I want to have the humility of realizing that I'm not a great accessioner, I'm not a great night accessioner, but I'm grateful to have a great night accessioner. I'm not a great lab billing expert, but I'm lucky to have one. 

The team is what I'm really proud of today and the block count and the partnerships because I think today versus at the very beginning, I can sit and say, we have partnered with LigoLab and Lumea, and these partnerships have been everything to us and have created this kind of scaffold of support and connection.

That has really also paid off monetarily and so we had to be very deliberate and that was also built from the ground up and it's overlaid with our LIS system and our IT infrastructure, and it's overlaid with our brick and mortar lab infrastructure and everything else. It all has been critical and I hold it as a very valuable part of our success today.

_{Jared Abbott}: No, I think that hits on one of the core values and assumptions of our laboratory, which is the real value that's brought is not in moving the glass or generating lots of reports, the value is entirely based in relationships. And from day one, we are relationship builders.

We make connections, we listen to our clients, and we give them what they need. Sometimes that's a real challenge because everybody wants disparate things. And that's again, back to the customization, the LigoLab LIS system. Some of our clients want pictures in every report, and it's a nifty LIS system to include color images in the reports.

Some don't. Then, those people don't get them. Some people want bidirectional interfaces. Some people want unidirectional interfaces. Some people want an old-school fax. We do it all, and LigoLab can do it all. That's really important. For us, you know, we try to build relationships with our clients, and our LIS software vendors and partners while moving forward.

I think one stereotype of pathologists is that we try to hide in the basement and stay away from people and we really are the opposite of that. We try to break down barriers and establish connections with people. And I think our core ethic is to build teams and integrations and networks that deliver better care together because that's really one of the fundamental principles of pathology, diagnostic work combined with clinical input, that benefits patients. 

So it all comes together. At the forefront of that is communication, both on a personal level and also on an electronic level, so I think that's what we're most proud of. We've been able to do that effectively, even though sometimes it feels like it's a shocking amount of work and it is, but it's worth it again. 

^{Michael Kalinowski}: Did you guys have a good chance to talk a little bit about serving the underserved and how you've been able to realize and support core values?

^{Tiffani Milless}: I feel like just a tiny bit, but I wanna say it again 'cause it's really at the heart of what we do. In Iowa, I feel like our whole state was really at a turning point of how do we improve access to care, which was at a critical level of shortage and inadequacy.

How do you improve that without compromising quality of care? There were a couple of models and they were going to be polar opposites. We can just really blow people out of the water and provide so much access to very low-quality care, and we can just embrace the fact that we're going to have a two-tier system of medical care in this country.

If you live in a big city on one of the coasts, you're going to get this level. And if you live in middle America in a rural town, you're getting this level. But you'll have access. Congratulations. And hopefully, it'll be good enough for you. 

We felt passionately that this wasn't the way we wanted to go.

Jared is in a lot of leadership positions in CAP, and I am in leadership in our state medical society. Through a lot of those discussions and engagement in that way, we really voiced concern about that, and hopefully, our now pretty thriving lab business is a big part of the solution for diagnostics that doesn't compromise the quality of care to provide access, and it's been solely based on getting the right people to the right places and technology can do that without having them jump in a car and drive out there. LigoLab and Lumea, and all the amazing people along the way who have believed in that vision that we had are also part of it.

We have some great technologists as well as business partners that are just feeling so excited about how this solution is going to make a big difference in people's lives. And that is really what has made our job meaningful and has been the biggest measure of success to us…seeing that and feeling that.

If anybody has a family member or a personal cancer story, they know how important that is. And to think that some people were going to have to settle for, old school, you know what, this is 1985-level of care, but, sorry, you live in a small town. What do you expect? You're lucky to have care.

That would be devastating for us. We didn't accept that. And I'm most proud that we can offer the same quality of care we would expect for ourselves and our family members to every single one of our patients, even ones that live far from a big town. And we have all kinds of cool IT reasons why that can happen. That's the best part of the Goldfinch story for me. 

^{Michael Kalinowski}: Jared, anything you'd like to add? 

_{Jared Abbott}: Nope, I can't beat that. 

^{Michael Kalinowski}: All right. I'll open it up to questions. Jared, I’ll start with you. 

So you guys just celebrated the anniversary on February 1st. Where do we see things in the next three to five years? Seems like you guys have a plan. Seems like you guys know the value of technology and the value of relationships being the difference makers as we move into the future. Fair to say that these are two areas we're going to keep an eye on, for the next three to five years as Goldfinch continues to project this level of success?

_{Jared Abbott}: Yeah, I think we didn't start this thing to be small or even medium-sized. We have a big vision and we want to keep growing. I think our previous growth has brought challenges and our next level of growth will certainly bring challenges as we add people and technology, so I think that process is only going to accelerate. 

As we build partnerships and networks throughout the state we just keep hearing more and more people who want a better anatomic pathology solution. We just need to listen to them and see how we can potentially deliver that to them in all sorts of different settings, whether it's hospitals, surgery centers, clinics, and different specialties, we can bring this LIS model with digital pathology to more and more places.

^{Tiffani Milless}: And it's funny I'm sounding a little bit like a LigoLab and Lumea commercial, but I feel like our five-year plan and how we really want to enact this vision is very tech-dependent and it's very people-dependent too, which it sounds like two opposite things, but it's the partnerships and the relationships that have mattered will matter even more.

Some of the bigger, cooler things that we've done and hope to do on the horizon would not be possible with the cheap, out-of-the-box lab information system solution that we even, I'm embarrassed to say, considered a couple years ago. I think when we go into some of these big meetings with people and they say, could you do this? Could you do this? Could you do this? We feel pretty confident. Yes. And you know why? Because we've done this and this. 

These are all weird, odd, strange, unique situations and we’re able to deliver on that. That's because of the IT infrastructure that we've built out and the people both in-house and in LigoLab and Lumea. Everybody that we have works in some of the connections we have with the EMRs and we know we can interface and our clients can order cases exactly the way they want.

They can get their reports exactly the way they want and we know we can deliver on all the LIS system customization. So that has been really powerful. It really gives us that confidence to go in and we don't feel like we're over-promising when we say, Oh yeah, I'm sure we can do that.

Can you get this very particular report that we need, that we'll have this and that? And we'll say, oh yeah, we can do that. I think that. LigoLab has been an essential partner and when we've ever had an issue or had a concern, I know that ultimately, although I don't want to ever do this, I can just email Suren (LigoLab’s CEO) and he will actually respond to this little lab in Iowa and the issue that we're having because our success is their success.

Lucky for you guys, we didn't stay as a four-block lab. I don't think that would have been good for LigoLab either. We knew that it was going to be us growing together. That would be better for everybody. I still feel that today. And so anybody listening no that LigoLab really was the real deal for us and they continue to deliver what they promised. Make sure that you invest in the lab you want, not in the lab that you think you can afford because that's going to limit you and you'll be dissatisfied quickly. 

^{Michael Kalinowski}: Regarding laboratory information system implementation, It takes everybody. It takes time, it takes resources, so by all means choose the best LIS for your business because you don't want to go through it again if you made a mistake. Credit to you both for having that vision. 

One last one for me. We have something at LigoLab called the CSI program and it's an opportunity where we have people who fully understand the LIS software and its functionality make themselves available on-site to labs like Goldfinch to see where they can find maybe a little bit more efficiency improve a workflow, tweak this, tweak that. Give me a sense of that experience and how valuable it was for you guys and your business. 

^{Tiffani Milless}: It was so valuable. It's been really an intense, crazy two years, I'm not sure if we've conveyed that clearly enough, but it was almost like at every turn, we knew that, you know what, if I just stay at work two hours later tonight, and I do a deep dive into this little crevice of the business, be it physical or virtual, I will uncover a whole bunch of stuff, and then we're gonna go and change this and do that. 

There was no limit to how much we could get in there and improve and do better. And like I said, we're optimizers, all four of us owners are. It was so valuable when we were able to have that onsite person from LigoLab come in and really look under the hood over here for solutions to the entire workflow and streamlining things and making it lean. They really worked with all of our staff.

Sometimes that's hard, and even for us, we were the visionaries, and even then, we're still learning. Wait, we don't have to do that? Are you sure? Is that safe? Will it for sure work? Sometimes we just have to let go and have some trust, and that has been so cool.

Those are the fun moments when just last week, I was like, wait. You can fix that, and I don't have to remember to do that each time? Cool! So yeah the LigoLab team, I feel like they are so invested in their product, and each of the people I interact with are really passionate. They want to make it better, and they know it well, and intimately, and they look at our workflow, and they say, You know what we could do, and you know what we did in this situation at this lab? That kind of innovation on the part of the LIS software vendors and improving our product has been just amazing and fun.

If they offered that to us every single year, I would for sure take them up on it because we get so much out of it. 

^{Michael Kalinowski}: Awesome. All right. I'm conscious of the time. So we'll start wrapping up here.

Tiffany and Jared, thank you so much for your time and for what you brought to the table today. 

If there's anybody that's a little shy that has a question that they want to ask, but are not taking the opportunity right now, go ahead and use the QR code on your screen. I'll make sure Tiffany and Jared get it. 

Alos, I'm guessing most people are aware of this but Executive War College is coming up at the end of April and LigoLab is not only going to be there, it's going to be there with its biggest team ever.

If you want to pre-arrange a one-on-one meeting with LigoLab while you're in New Orleans, please take advantage of this QR code and set something up. 

With that, any final thoughts from Tiffani and Jared? 

^{Tiffani Milless}: I would just say that I feel like Jared and I owe a lot of what we've built to the people that have advised us and supported us and trusted in us and so if anyone listening is in the position of considering something like this, we're so happy to talk privately and share with you our experiences.

Pathology is a small world, so we really want to support others in the way that we were supported. Please don't hesitate to get in touch with us. 

_{Jared Abbott}: We're eager to have more conversations. And, one thing actually, at the very beginning of this, I wish we would have done a site visit for a place that was utilizing LigoLab. We didn't just because there was so much else going on. And I regret that. So if you are in a situation consider yourself invited to Iowa if you'd like to come and kick the tires with us and look at what we're doing. We'd be happy to host.  

^{Michael Kalinowski}: That is a very Midwestern thing to say and do, Jared!

Thank you all for both participating and attending and stay tuned for more webinars in the near future.