A Utah hospital is leveraging text messaging to help schedule mammogram appointments for thousands of its patients. Since April 2019, the hospital has used the Dialog Health platform to send mammogram recall reminder text messages to more than 12,000 patients. The two-way texts have been successfully delivered to about 96% of recipients. The text messages inform patients that it is time to schedule their annual mammograms and provide the mammography department's phone number for patients to call to schedule the appointments. Initiating the call only requires patients to click the number in the text. "Thanks to text messaging, hospital staff have spent significantly less time making phone calls and sending letters to mammography patients," says Brandon Daniell, president and co-founder of Dialog Health. "More importantly, thousands of patients have been reminded about the need to schedule their mammograms and provided a simple, efficient way to make their appointments." Recall programs that inform patients when it's time to get their annual mammogram are an effective method of increasing patient compliance with guidelines. Such programs can also help drive patient volume to a mammography department. Since 96% of all U.S. adults own cell phones that can receive text messages, and consumers are generally accustomed to receiving and interacting with texts, two-way texting is a communication resource that can be an immediate asset to any organization looking to enhance the performance of a recall program. As of January 2020, only 29 recipients of the Utah hospital's mammogram recall reminder texts had opted out of receiving texts from the hospital — well below 1% of all recipients. This further demonstrates the willingness of consumers to communicate via text message with trusted organizations. "By embracing the speed, convenience, and ubiquity of texting, healthcare providers can increase patient engagement and participation in their care, which benefits patients, staff, practitioners, and the healthcare system as a whole," Daniell says.

2020 was a year like no other. Healthcare providers confronted inconceivable and often rapidly evolving challenges, many of which tested their abilities to execute fast, efficient responses. Other challenges required more measured coordination and execution. Essential to an effective response to all of the unexpected developments was communication between stakeholders —those within and outside of organizations. At Dialog Health, we were pleased that our two-way text messaging platform helped so many healthcare providers communicate about a wide range of vital care, safety, and operations issues in 2020. Here are 11 of the creative ways we saw our clients leverage texting to navigate largely unchartered waters in 2020, with many of these ways continuing into 2021. 1. Explain COVID-19 protocols The pandemic forced healthcare providers to introduce or make substantial changes to safety policies and procedures that affected patients, staff, visitors, and vendors. Text messaging helped inform and remind these stakeholders about such changes, which included the introduction of "no handshake" policies, revisions to patient pre-screening and screening policies and procedures, requirements concerning the wearing of personal protective equipment (PPE), and revised waiting room policies. 2. Issue infection prevention and control rules and reminders Infection prevention and control has taken on even greater importance during the public health emergency. We saw our clients use text messaging to emphasize infection prevention and control recommended practices and rules, including those concerning hand hygiene, PPE, hand sanitizer, and social/physical distancing. 3. Conduct COVID-19 pre-screening In addition to informing stakeholders about changes to pre-screening policies and procedures, healthcare organizations used text messaging to help them actually perform pre-screening. For example, two-way text messaging was used to ask patients if they were feeling well on the day of their appointments and to remind patients that they should reschedule appointments if they were not feeling well or taking care of someone who was ill. As another example, providers used text messaging to direct patients to fill out screening surveys to help determine whether they were potentially exposed to COVID-19. 4. Cancel and reschedule appointments Using text messaging to cancel and reschedule appointments is nothing new. What is new is the scale of which texting was used to do so during the pandemic. When organizations like practices and ambulatory surgery centers were required to significantly scale back or temporarily cease operations, texting informed the many affected patients about the need to cancel their appointments. When the time came to resume operations, text messaging served as a highly effective and efficient way of reconnecting with those patients who had their appointments cancelled, with such text messages providing instructions for how patients could reschedule their appointments (e.g., phone call, form, portal). Providers also used texting to include information about new safety measures or include a hyperlink to a page on the organization's website that detailed such measures. 5. Provide updates on safety protocols Throughout the pandemic, healthcare organizations changed and strengthened their safety protocols to reflect evolving regulations and recommendations. Text messaging was used to keep patients current on the steps staff were taking to best ensure safety and reduce risk. These messages were sent to help encourage patients to keep their appointments. In addition, the texts helped provide comfort to patients and encourage them to schedule or reschedule appointments, with texting often playing an integral role in recall campaigns. 6. Support telehealth and virtual care Healthcare providers leaned heavily on the usage of telehealth and virtual services last year as a way to replicate face-to-face appointments, deliver care, and improve access while allowing patients to reduce their risk of exposure to COVID-19. Telehealth also helped reduce exposure risk for staff. Many organizations with telehealth programs — some of which were launched during the pandemic — made text messaging an integral part of their programs. Texting was used to inform patients about and encourage patients to take advantage of telehealth services, remind patients about telehealth appointments, and initiate telehealth consultations. Medalliance Medical Health Services, a diagnostic and treatment center in New York, is one such organization that used text messaging to support its telehealth program. As David Alejandro, the organization's marketing and community relations director, noted, "We send daily links via text that direct patients to our telehealth platform. Patients can then receive follow-up care and answers to their pressing questions in real time. The ability to text with patients has really made delivering care much easier." 7. Update and coordinate on COVID-19 vaccine distribution Once COVID-19 vaccines received emergency use authorizations, healthcare providers began informing staff and eligible recipients about developments and plans concerning availability and distribution. Text messaging was used in numerous ways as part of these efforts, including surveying stakeholders about their willingness to receive the vaccine, providing links to information and education, and coordinating the vaccine administration. 8. Contact tracing Contact tracing is an essential step to help limit the spread of COVID-19. Healthcare providers leaned on text messaging to support their contact tracing efforts. Organizations sent automated text surveys to patients 7 days and 14 days following an in-person visit to their facility to ask whether patients had developed COVID-19 symptoms. Two-way texting provided a contactless, streamlined approach to determine whether contact tracing was necessary. 9. Support open enrollment With many organizations adopting telecommuting and reducing on-site, face-to-face interactions, engaging employees in open enrollment had the potential to prove more difficult in 2020 than in years past. Text messaging helped healthcare providers overcome barriers to engagement as they sent texts to inform and remind staff about open enrollment dates, direct employees to self-service web portals, provide education about benefits, and share contact details of the benefits representative. 10. Update and coordinate with family members To reduce exposure risk, healthcare organizations implemented restrictions on the ability for family members to wait inside a facility while a patient was receiving care. Providers used texting to keep family current on patient progress and inform them when patients were ready for discharge. An example of when such text messaging was particularly helpful was ambulatory surgery centers communicating with family members who would be driving patients home following their surgical procedures. 11. Improve staff morale As Greater Good Magazine reported, "In half a dozen studies with over 10,000 respondents, they found that people were experiencing worse mental health problems than before the pandemic — high symptoms of stress, anxiety, depression, and post-traumatic stress disorder. Up to half showed serious signs of depression (depending on the study), while up to 35% showed serious anxiety." Healthcare organizations leveraged texting to support their staff. As an example, our client Lovelace Health System in New Mexico sent periodic texts that shared uplifting messages and inspirational quotes. Serena Pettes, the health system's vice president of marketing and business development, stated, "Sending texts to our employees via the Dialog Health platform during COVID-19 has been an easy, quick, and effective way to provide support, encouragement, and guidance during a challenging time." Dialog Health President and Co-Founder Brandon Daniell noted, "While we may not have envisioned clients using our text messaging platform to deliver emotional and inspirational words of encouragement, we could not be prouder that they are doing so." Text Messaging Further Cements Its Value Prior to 2020, adoption of text messaging as a central communication tool was on the rise among healthcare providers. The pandemic and developments around it further spurred usage of texting because it's fast, effective, and affordable. A large majority of all text messages are read within just minutes of their delivery, and almost all text messages are read on the day they are received. Texting also helps organizations support efforts to limit in-person communication and thus reduce the spread of the novel coronavirus. There's every reason to believe that organizations will continue to find creative ways to leverage text messaging to help them overcome challenges and take advantage of opportunities in the future. As Daniell toldSalientValue, "With the usage of smartphones and texting showing no signs of slowing down, we anticipate the demand for a service like the one we provide will continue to grow even after the worst of the pandemic is behind us."

Brandon Daniell, president and co-founder of Dialog Health, will be serving on a panel at the 7th Annual ASC and Healthcare Management Virtual Symposium. This complimentary virtual event for ambulatory surgery centers (ASCs) and other health entities will take place on Wednesday, Nov. 18, 2020. It will feature presentations from 9:00 AM – 3:15 PM EST and live Q&A with speakers from 3:30 – 4:30 PM EST. Daniell's session on "Emergency Communication Lessons Learned From Covid-19 and Best Practices for Improvement" is scheduled for 10:00 – 10:45 AM EST. Joining Daniell on the panel will be Chris Kralik, administrator for AMSURG, and Serena Pettes, vice president of marketing and business development for Lovelace Health System. Other sessions will discuss topics including revenue cycle management, OSHA enforcement, private equity, and information technology. To register, click here. To view the agenda, click here.

When speaking with prospective clients about our two-way texting platform, a question we are often asked is, "How does your platform help our older patients since they don't typically text?" This is a common myth we hear a lot. While it's true that not all people text, text messaging is used by people of all ages. Here are just a few statistics and quotes that show why texting is likely to be a viable and effective method of communicating with many older patients. 1. 95% of U.S. adults ages 50-64 own a cellphone, with 79% owning a smartphone. Source: Pew Research Center 2. 91% of U.S. adults 65 and older own a cellphone, with 53% owning a smartphone. Source: Pew Research Center 3. Among those ages 50-69, text messaging is the technology tool most used to stay connected. Source: AARP 4. "… notably, the assumption that older individuals rely less on technology than others may be increasingly inaccurate." Source: AARP 5. 58 million adults age 50-plus are interested in technology that can enrich their lives or make it easier. Source: AARP 6. "Text messaging technology can help improve medication adherence rates in older Medicare patients by up to 14%." Source: Patient Engagement HIT coverage of Journal of Medical Internet Research study 7. "When asked how they would like to be reminded about upcoming appointments, 48% of [14,000 survey] respondents said they prefer text message. That's compared with 29% who said they prefer a phone call and 21% who prefer an email reminder. The percentage of patients who preferred appointment-reminder text messages hovered close to the 50% mark across age groups … 54% among those ages 45-54, and 47% among respondents ages 55-64. Thirty-four percent of patients age 65 and older … said they prefer text message appointment reminders, an especially important data point since these older patients are often assumed to be less likely to embrace technology." Source: Phreesia The Truth: Older People Text. A Lot. A text messaging platform like Dialog Health is not intended to replace all other communication methods. Rather, it helps reduce reliance on more time-consuming methods while improving response rate and engagement, amongst other benefits. Organizations should communicate with patients via the method(s) that patients prefer. For some, that will be via email, phone or mail. But for most, including many of those who are older, texting is likely to be the method of choice.

Brandon Daniell is one of several healthcare business leaders discussing the short- and long-term impact of COVID-19 on their companies in an article for SalientValue. SalientValue is a bi-weekly newsletter distributed by VERTESS, a healthcare merger and acquisition (M&A) advisory firm. Joining Daniell in sharing responses are leaders from a variety of companies, including an infection control consulting firm, managed services provider, developer of a drug shortage management platform, and medical supplies and equipment. To access the article, click here.

We'll cut to the chase: This is the time when the value and effectiveness of text messaging really shines. Throughout the nation, ambulatory surgery centers, medical practices, and other healthcare organizations that greatly reduced or temporarily ceased operations during the pandemic have reopened and are working to catch up on patient care services and treatments. For those organizations that leverage text messaging, resuming operations will prove more streamlined, safer, and ultimately successful. And in a mobile-led world where patient engagement has become an essential strategy, text messaging is a necessity. Here are 10 of the ways providers can use texting with patients, staff and vendor partners to their advantage during this transitional period. 1. Rescheduling canceled appointments Texting is a simple, yet effective way of reconnecting with those patients who had their appointments cancelled due to stay-at-home orders and social distancing guidelines. Such text messages would provide instructions for how patients can reschedule their appointments (e.g., phone call, form, portal). It can also include information on new safety measures or a hyperlink to a page on the organization's website that details such measures. More than 97% of phones can access text messaging and the mobile internet. Including hyperlinks is a useful way to engage patients by supplementing information in the text. Including the organization's phone number here is also an effective way to further engage with patients and encourage them to reach out with questions. Leveraging text messaging to communicate about an organization's ability to accommodate patients is a highly efficient and cost-effective means of maximizing revenue and getting an organization back on track financially. 2. Scheduling new procedures Following outreach to those patients who had their appointments scheduled, it's time to shift focus to scheduling patients in need of treatment who were identified during the shutdown but could not be scheduled. Organizations should use texts to help ensure optimization of available space on the patient schedule, which some organizations may expand (e.g., add weekend or evening hours) to accommodate the patient backlog and demand. Text messaging should also be used to drive recall campaigns, such as those for colorectal screenings and annual physicals/wellness visits. Consider that not every outbound phone call staff members make is answered, but almost every inbound call to an organization during hours of operation is answered. Texting is a great way to inform patients that they need to call an organization. As noted, the text can put the organization's phone number at their fingertips. 3. Availability of telehealth services For those organizations already running or planning to develop telehealth programs, text messaging is the most effective way to communicate with a majority of patients and encourage them to take advantage of these virtual services. Nearly all consumers already own mobile phones. Most mobile phones can access the internet and include a camera, and all can receive and interact with text messages. There is little to no learning curve for patients as most know how to use their phone for texting, and most have used videotelephony programs (e.g., FaceTime, Skype, Facebook Messenger). There is no need for someone to have wi-fi, a computer, speakers, or even be at home to access telehealth services through their mobile phone. After scheduling a telehealth appointment, organizations can send a text message that includes the direct hyperlink to initiate the consultation and the time when the patient should click the hyperlink. Once the link in the text is selected, a web browser or default videotelephony app will automatically open and the camera on the phone should activate. This makes telehealth simple for patients and helps further optimize the billable time for telehealth visits. 4. Providing safety directions to patients While efforts to "flatten the curve" seem to be working, the risk of contracting COVID-19 remains high in many areas of the country. Organizations should use text messages to explain to patients the safety directions they are expected to follow for their appointment. This may include changes to check-in and discharge procedures, wearing of personal protective equipment (PPE), and new waiting room policies. 5. Discussing safety directions If an organization wants to speak with patients to review these directions, a text can inform patients about this need and then include the phone number from which the organization staff member will be calling and the time of day patients should expect the call. This will increase the likelihood that patients answer a call from a number they may have otherwise not recognized. 6. Reminding patients about appointments Texting patients is a proven way to reduce cancellations, no-shows and no-goes. Prior to an appointment, organizations should send a text that reminds patients about their scheduled treatment. The text can also include a reminder or information about required preparation for the treatment (e.g., fasting), directions to the organization, safety policies, and the organization's phone number if patients have questions. This is also a good time to tell patients that if they are not feeling well, they should reach out to cancel their appointment. 7. Informing staff and vendors about new policies and procedures As with patients, organizations should use texting to tell staff and vendors who will be coming to the organization about changes to policies and procedures, such as those concerning pre-screening, screening upon admission, vendor check-in and wearing of PPE. Such an effective use of mass texting capability can also serve to remind staff and vendors about the need to avoid traveling to the organization if they are not well. 8. Increase top-line revenue As discussed, using texting for appointment-related messages reduces cancellations and no-shows. Not only can you more effectively identify which patients plan to keep their appointment, but staff also can identify patients who need to cancel or reschedule. That gives staff a chance to fill that appointment slot with other patients. Organizations can also send well-worded and polite texts reminding patients of their payment responsibility — either upcoming or overdue — and the manner in which they can pay for treatment. Include a link to an online bill pay website, if you offer such a payment mechanism. This approach to securing payment is familiar to most people, since many other industries already use texting for payment prompts, including most major credit cards and many banks. 9. Keeping stakeholders current on changes During these uncertain times, policies and procedures in place one day may need to change for the next. Text messaging is a fast, effective way of keeping stakeholders current on rules and expectations. Mass texting is also valuable in the event that an organization must quickly inform stakeholders of a significant development, such as a visitor testing positive for the novel coronavirus. 10. Boosting staff morale While most text messages sent by organizations will concern safety and business matters, there is another beneficial way to use the technology: providing emotional and inspirational support to staff during this unprecedented and uncertain time. Sending an uplifting text message can have a positive impact on mental health. There's No Better Time to Add Text Messaging Capability Text messaging is a proven method for engaging patients, enhancing outcomes, improving staff productivity, and strengthening workflow, among other benefits. As text messaging has become the preferred communication method for a growing number of Americans, healthcare organizations should evaluate how they can incorporate two-way text messaging as a communication platform or further expand its existing use as a way to more effectively navigate the challenges of the current health crisis. Organizations interested in adding text messaging should schedule a demo of the Dialog Health platform, text or call (877) 666-1132 or email info@dialoghealth.com.

Brandon Daniell, president and co-founder of Dialog Health, explains how hospitals and health systems can use text messaging to improve employee engagement, communication, education, and satisfaction as they work to navigate the COVID-19 pandemic in a new column for Becker's Hospital Review. In "8 ways for hospitals to use text messaging for employee engagement," Daniell discusses how hospitals are leveraging texting to their staff to help make the gradual transition back to more typical operations streamlined and successful. Ways highlighted in the piece include mass announcements, surveys, details on insurance benefits, and ongoing COVID-19 updates. As he concludes in the column, "As text messaging has become the preferred communication method for a growing number of Americans, hospitals and health system should evaluate how they can incorporate two-way text messaging as a communication platform or further expand its existing use during this transitional period." Access Daniell's column in Becker's Hospital Review.

As ambulatory surgery centers (ASCs) begin to gradually reopen and resume operations, they will need to engage and effectively communicate with patients about a wide range of issues. In a new Becker's ASC Review column, titled "Reopening patient communications under COVID-19: 8 messages for ASCs," Brandon Daniell, president and co-founder of Dialog Health, shares examples of text messages ASCs should send to patients during this period. The messages — which are based upon actual texts sent by Dialog Health ASC clients — speak to matters such as rescheduling delayed procedures, scheduling backlogged surgeries, new safety protocols, changes to visitor rules, and patient collections. Daniell also explains why texting is the most efficient and effective platform for such communications. Access Daniell's column on COVID-19 ASC patient communications. Becker's ASC Review, part of the Becker's Healthcare family of publications, features general business, legal and clinical guidance on topics relevant to outpatient surgery, including joint-ventures, development and expansion, and regulatory and compliance issues.

As the coronavirus continues to spread in the United States, Brandon Daniell, president and co-founder of Dialog Health, shares examples of messages ambulatory surgery centers (ASCs) should share with those individuals who come their facilities. In "Coronavirus communications from ASCs: 7 critical messages," Daniell identifies messages that should be directed toward patients and their family, staff and vendors to help improve safety and better engage these individuals in preventive measures. Daniell then explains why texting is the most efficient and effective platform for such mass communication. Access Daniell's column on coronavirus communications. Becker's Clinical Leadership & Infection Control, part of the Becker's Healthcare family of publications, provides guidance and analysis on clinical quality, patient safety, infection control and accreditation issues.

Brandon Daniell, president and co-founder of Dialog Health, discusses how gastroenterology (GI) practices and ambulatory surgery centers can use two-way text messaging to improve the performance of patient recall programs for EndoEconomics. In his column "Electronic Engagement: GI centers should leverage technology to improve patient recall," Daniell shares what makes texting such an effective communication platform for GI. He also includes insight from TJ Berdzik, senior financial analyst and manager of financial analytics at Physicians Endoscopy (PE), the publisher of EndoEconomics. Berdzik discusses how some PE facilities have effectively used texting for GI pre-procedure communications. As Daniell concludes, "Two-way texting is a communication resource that can be an immediate asset to any GI facility. By embracing the convenience, speed and ubiquity of two-way texting, GI practices and surgery centers can increase patient engagement, which is a benefit to patients, staff, gastroenterologists and the healthcare system as a whole." Access the Daniell's column in EndoEconomics by clicking here. Download a PDF of the column here. EndoEconomics is a journal focused on issues faced by the GI medical community.

FRANKLIN, Tenn. April 3, 2020 – Dialog Health, a two-way texting platform that enables information to be pushed to and pulled from patients, caregivers and healthcare facility staff, announces it is expanding support for organizations interested in leveraging text messaging to establish and expand their telehealth programs. "Text messaging should be part of any telehealth program," said Brandon Daniell, president and co-founder of Dialog Health. "It is the most effective way to communicate with a majority of patients and encourage them to take advantage of available telehealth services. The telephone is a ubiquitous telehealth tool at a time when telehealth is fast becoming crucial. A text can turn the mobile phone into a powerful telehealth tool." As a result of social distancing and rules limiting face-to-face interactions during the COVID-19 pandemic, telehealth has taken on greater importance in the delivery of care. Furthermore, some federal privacy regulations have been relaxed and payment policies broadened to encourage increasing access to telehealth services. Healthcare providers nationwide can now deliver a wide range of billable services via telehealth, including the Medicare annual wellness visit, virtual home health visits, post-discharge follow-up appointments, and initial patient assessments. "But as practices and other facility types are finding, there are technical, accessibility and engagement challenges that often accompany the launching of telehealth services," Daniell says. "To address these challenges, organizations can turn to text messaging." Texting is advantageous for numerous reasons. Two way-texting platforms are SaaS products only requiring internet access, so facilities do not need to invest and set up new hardware. Nearly all consumers already own mobile phones. Most mobile phones can access the internet and include a camera, and all can receive and interact with text messages. There is little to no learning curve for patients as most know how to use their phone for texting, and most have used videotelephony programs (e.g., FaceTime, Skype, Facebook Messenger). There is no need for someone to have wi-fi, a computer, speakers, or even be at home to access telehealth services through their mobile phone. Organizations can send text messages that include hyperlinks to initiate telehealth consultations (see Image #1). A texting system like Dialog Health informs a provider when a patient receives the text. Once the link in the text is selected, a web browser or default videotelephony app will automatically open and the camera on the phone should activate. As the demand for telehealth services has surged in recent weeks, Dialog Health has received numerous requests from organizations interested in pairing text messaging with their telehealth programs. To meet these needs, Dialog Health has expanded its customer service and support team to help with setup, messaging and inserting links. One such organization that has partnered with Dialog Health to strengthen its telehealth program is Medalliance Medical Health Services, a diagnostic and treatment center in Bronx, N.Y. "Dialog Health has helped us stay connected with our patients and keep them informed during this critical time," says David Alejandro, marketing and community relations director. "We send daily links via text that direct patients to our telehealth platform. Patients can then receive follow-up care and answers to their pressing questions in real time. The ability to text with patients has really made delivering care much easier." "Facilities are looking for ways to help ensure high quality of care during these challenging times," Daniell says. "Telehealth and texting are two solutions that organizations should strongly consider." Organizations interested in adding text messaging to their telehealth program should visit the Dialog Health website, email info@dialoghealth.com or call (877) 666-1132. About Dialog Health Dialog Health Inc. is a U.S.-based company that provides a two-way texting platform to organizations which they can leverage as a communication and engagement channel. Two-way texting is a convenient, fast, effective and affordable communication resource for stakeholder engagement. For more information, visit www.dialoghealth.com, call (877) 666-1132 and follow Dialog Health on LinkedIn.

During this pandemic, we're helping clients communicate about safety and business matters. On the safety side, texts address new precautions, screening procedures and general wellness guidance, among others. On the business side, texts are going out that address issues including patient appointments (scheduling and rescheduling), staffing assignments and virtual leadership meetings. By leveraging texting, providers are getting these timely, relevant messages into the hands of stakeholders in a fast and highly efficient manner. We are also helping clients send another type of message: those that provide emotional and inspirational support to their staff during this unprecedented and uncertain time. Here are a few examples of such texts our clients are sending to help lift the spirits of their team members: "Sometimes we are tested not to show our weaknesses but to discover our strengths" – John F. Kennedy. As you know we have been tested these past few weeks, but it's the confidence we have in our team that assures us we will return from this stronger and better than before. Until that time, please know we are wishing you and yours good health. "The pessimist sees difficulty in every opportunity, the optimist sees opportunity in every difficulty." – Winston Churchill. As we enter another week of challenges, we want to acknowledge our amazing staff during this difficult time. We encourage you to take this opportunity to focus on positive, knowing that we are doing everything we can to get back to normal. We look forward to seeing you all again. During this challenging time, we want you to know that we are appreciative of everything you do and the sacrifices that have been made. Your selflessness is a reflection of our patient care and represents the best of our centers. We look forward to coming back together as soon as possible, but in the meantime, we wish you good health. "Resilience is the capacity of a system, enterprise, or person to maintain its core purpose and integrity in the face of dramatically changed circumstances." – Andrew Zolli. We know that in the months to come we will be able to look back and take pride in how our entire team responded to this unprecedented crisis. Please know that we are thinking of you and wishing you all good health during this time. We are in this together. We know that during this time of uncertainty and anxiety, many of us may be struggling. Whether it's due to self-isolation, lack of time with loved ones and/or the simply watching the news, please know that you are not alone and it's okay to not be okay. If you are in need of assistance or if our team can be of a resource for you, please don't hesitate to reach out. We are here for you. Your mental health is important and we encourage you ask for help if needed. As we enter another week of challenges with the COVID crisis, we encourage you to take this opportunity to embrace the time with your family and or loved ones, to find ways to help others, and take time for yourself, knowing that we will get through this period. Know that we are grateful for each of you and proud of your continued commitment to our centers. While we may not have envisioned clients using the Dialog Health platform to send such uplifting messages, we could not be prouder that they are doing so. As we have said before, we will get through this. Together. We just need to stay compassionate, connected and safe.