AMCHP 2005 ANNUAL CONFERENCE
DELIVERING RESULTS, IMPROVING PREGNANCY & BIRTH
February 19-23, 2005
CHRIS DYKTON: Thank you Cassie. It just seems like yesterday that we were doing this, and now we are going to start doing it again with a few changes. I see so many familiar faces, which is kind of nice but I also see a lot of new ones as well. How many people are here for the first time? I thought there were a lot of new ones. Okay we’ll be gentle. My name is Chris Dykton. I am the MCH specialist with SAIC and SAIC is the team that supports the information systems at the Maternal Child Health Bureau. And before we get going, there’s a number of us here so I’d like to introduce a number of the faces behind the scenes. You see me or hear my voice often but there are a lot of other people that work on this to make this a success. First of all, my boss, Project Director, Stephanie Olson is right here and she is going to be working on the learning lab on Monday as well as with the other two that we have, Rodg Shresta is our tech lead. He does a lot of the behind the scenes, the lead, he takes the lead on all the programming and all development of the site. And of course, Jill Robie who many of you know, is kind of my sidekick and she is the specialist in EHB at the call center, so you’re going to get to know her not only through Title V and the Block Grant but also if you do a discretionary grant application, you’re going to get to know Jill quite well. I’d like to also recognize our project officer, Mary Beth Reed who we could not do this without. She has just been such a strong support for us over the years and it helps us get our job done. And of course, Cassie, thank you for giving me this chance to scare everyone.
One of the things I want to also do at this point in time is I think a lot of people probably don’t see everything that happens in preparation for this day and what’s coming up when we release the application. But we get the feedback from you after last year’s Block Grant and then take that and review it with the bureau and there are many of you that provide many insights into things that could be improved or changed. I collect all of that stuff. Even when I’m talking to you on the phone and you’re well saying nice things and sometimes not so nice things about stuff, I’m taking notes left and right. And that all goes and is reviewed by the project officers and by Cassie and then decisions are made as to what is going to change and what is going to be developed. Then that’s developed and it goes for internal testing. It goes to DSCH for project officer testing and then we go out to the states for beta testing before we even send this out to you guys to actually use.
So I’d like to acknowledge our state testers. Libby Black of Louisiana, Sue Ricketts of Colorado, Laurie Chestnut of Kentucky, Annette Mensie and Mark Shima of Hawaii, Molly Emmonds of Oregon, and Sheila Martin of Missouri. Thank you so much. You guys all made this that much better and your frank comments are always greatly appreciated and really make me laugh a lot. Anyway, we’re going to focus on five things today and we’re going to talk about the changes in the Title V information system and the Block Grant application because it’s the year of the needs assessment. There’s certain changes to the system that reflect that and so we’re going to take a look at that. We’re going to also look at some enhancements.
There have been some changes in it because of feedback we’ve gotten that have changed the look and feel of a few places and I think that you’re going to get a real kick out of a couple of these things. And then what we’re going to do, especially for you new guys, is to review the system and the key points. And this is good for everyone since it’s been a while, about six months since we were last in the application in September. And the one thing I want to really emphasize for you new folk is to come to the learning lab on Monday. Take time to come and sit down and actually work in the application so you get a sense of what it looks like before we release it to you. We’re going to focus on the practicals then and talk about the dates and how to get started in the application and just kind of do the same thing we’ve been doing the past three years.
Okay. It’s the year of the needs assessment. Some of the requirements are going to be different this year as a result. There is new functionality to reflect these changes but basically the functioning of most of the Title V information system, the application, remains the same. Some of the requirements are different this year. What’s different? Well, for one thing you’re providing your state’s needs assessment. Now you know that in the past you’ve been able to do that. In section two of the narrative, you’ve been able to attach your needs assessment. It wasn’t required, some states did, some didn’t, others provided just an update of changes to the needs assessment. But this year you’re going to be actually uploading your stand-alone document, your needs assessment, into the system. And that’s required of all states.
You’ll be defining, as a result, seven to ten new priority needs. You’ll define new state performance measures based on those priority needs and your needs assessment. And forms that in the past have not been required are required this year. Your outcome measures on form 12, most of you have been completing that data every year, but this year you must. It’s required. And health status indicators on form 20 and 21, again, most of you have been providing that information each year, but this year it is a required. So there’s new functionality to reflect these changes. When you got into form 14 for example, where your priority needs are, the data has been cleared that you’ve had there in the past. Every year before you’ve been coming in and your priority needs were listed as you had provided, but this year they’ll be blank so you’ll be able to add your new priority needs or copy and paste from last years if there’s some that are the same. There’s a new section in the narrative for creating new state performance measures.
Copying old ones, should they continue, you’ll be able to do that and you’ll be able to create the detail sheets on those new performance measures. And the application itself, when you go to use the forms, the status checker will not be complete unless your form 12, form 20, form 21 are also complete. So, but basically the functioning of most of the Title V information system remains the same. Your registration process will be the same. Everyone will be getting a letter with your registration code and your user name and then you’ll be able to go in and register in the system and define your own password and come in. Financial forms, forms one through five including the SF424 face sheet will be there. Your program and administrative forms, forms six through ten and fourteen will be there as well. Performance measures, they’re there, the national performance measures. Your state performance measures from the last cycle are going to be there as well as the ability to write these new ones.
Your health system’s capacity indicators will be there and your narrative will be there and you’ll have your notes and everything from the past that you’ve had is still going to be there. So what we’re going to do is talk about some of the enhancements and we’re actually going to go in and look in the system while we go through this section at times. So just let me make sure I’m not missing anything here on my presentation. Good. So, what’s new? Well for one thing, there’s a new look and feel. There’s a new font, there’s new colors, the data entry layout is similar to HRSA’s electronic handbooks, if you’ve done a discretionary grant application. Has anyone worked on the, in the discretionary grant information system? Well, it’s starting to look like that because the plan in the future at some point in time is that Title V will be part of that electronic handbook. In other words your grant applications for all of HRSA including the Block Grant will go through the HRSA electronic handbooks and you’ll access the Title V information system from that point.
To get you used to it, the layout has changed a little bit to start reflecting the way that those handbooks are set up. So let's just take a look. So, does this look familiar? Does everyone know this, well, for you new people this is the registration page where you go to register. It’s also where you would login. So we’re going to login as Florida because I promised Bob Peck that we would do that, we’d use Florida this year. So we go in and this is what the new menu looks like. It’s pretty much the same in terms of the content but, as you can see, it’s a little bit different in the way it’s laid out. There’s softer colors. You have your blues and your yellows and that reflects HRSA’s electronic handbooks. You can access a form by clicking on the hyperlink title. The instructions are over on the top. You can view a form afterwards in HTML over on your right. And of course, here it tells you whether a form is required or optional. As you can see there’s all the forms and various iterations.
And then down here you can also, if you scroll all the way to the bottom, you can see the state narrative main menu, which will take you to the narrative section. So this looks quite familiar doesn’t it? So what we’re going to do is we’re just going to go in and take a look at form two. This is how a form now looks. You could see the colors are different, but the layout is pretty much the same. Well, one thing you’re going to really note here too is you have a sidebar. You can go anywhere when you’re in any one form now. In the past you’ve been able to, you’d have to save the form and once you save it, you would be taken back to the main menu. You’ll be able to navigate from form to form on the sidebar. The important thing here and the thing that’s very important to remember is you must save your data in the form. If you get happy and jump around all around these forms, you’re data is going to completely disappear when you come back to it. So please save. That’s the one thing I want to really reiterate. Save your data. But again, the form looks remarkably the same. You have the note feature here and also note feature at the field level on the side. You’re able to access the instructions up at the top if you wanted to check to see if you were doing something correctly in filling out the form. You also have access to the guidance right over on the side for this form. Again, it is not that different from what we’ve had in the past so it looks pretty much the same.
The sidebar was universally loved by the testers. The state testers all were gaga over being able to navigate quickly. You’ll have data for performance measure. You’ll have one health system’s capacity indicator piece of data. Then you want to go to the narrative and so this sidebar, it seemed to make people really happy. So we hope it makes you happy too. So, so what’s new with the need’s assessment again? There’s no change in how you provide your needs assessment. It’s a stand-alone document. It’s an attachment to section two of the narrative. There is a size limit on the attached narrative in working in the system. That’s not been set yet. And the size is the megabytes, as to how many megabytes, how many kilobytes it’s going to be. That hasn’t been set and the reason is that we’re not quite sure what it needs to be. There’s going to be further discussion and a decision will be made on that and a tech note will go out letting you know how big that file is.
Now, what this means, it doesn’t mean you have to make your needs assessment smaller than that, it just means you won’t be able to attach it yourself into the system. If it’s much larger than that, what will happen is you’ll contact us through the HRSA call center and be able to collect that document that way. And we’ll put it in the system for you. But just to make it easy for everyone to be able to upload it, we’re going to have a limit on the size of that attachment. Because once we limit that attachment, that’s going to be the size limit this year for the other attachments as well. And so we’re still looking at that but there will be a size limit on the attachment. So again, you’d want to contact the HRSA call center if you couldn’t attach that needs assessment yourself. I don’t know what were going to actually do but I would suspect that we may be contacting you, getting a sense as to how large a document your needs assessment is.
We asked the testers but it seemed so early in the process right now to having a final document ready, that there is no real size we were able to get from the testers to find out how big their documents were to determine this limit. So that’s something that’s going to be done in the next couple of months. The needs assessment is required and that’s the most important thing. You must provide it. Okay. What’s new with the narrative? Well the data page layout on the performance measure sections has changed. We’re going to take a look at it. I’m going to describe it first and then we’re going to look at it. And this is based on the experience of the state reviews, the project officers, your feedback and also some practical considerations for putting all of this information that you’re collecting in three different places in one place. You get your data from the form 11 displayed at the top of the narrative.
You have the three sections to talk about, past accomplishments, current activities, and plans for the coming year, on the same page and you’ll be able to access from that the activities on figure 4A and 4B. So we’ve talked about this. It will not only be in your data entry screen when you’re working, but your printout of your narrative will also have all of that information in the same place. The hope on this is that you’re going to be able to use trend analysis on your performance measure data in discussing in your narrative. Sometimes it off on the left hand and the right hand not knowing what each other is doing. The data is going in one place and the discussion doesn’t seem to talk about the data much. You will be able to do that and it will be just by simply putting it all in same place you’ll be able to access all of that in one place.
So let's take a look at that. So here we are on form two, so what I’m going to do is I’m going to use the sidebar and go over to state narrative main menu. So here we have the state narrative main menu and this is where you would be able to attach files for the different sections of the state narrative. We’re going to go down and take a look at National Performance Measures, and we’re going to look at the discussion of the National Performance Measures, and I’m just going to go down to Performance Measure Seven, immunization. And as you can see, it looks a little different. Right at the top is the data from Form 11 for this Performance Measure. If there were any notes associated with this, you could click the notes button and you could access the notes associated with the Performance Measure Data. Here you have the three different sections and what I’ve done here for Florida is take their narrative from last year, which I can access from up here.
And it goes to Performance Measure Seven and you can see what you wrote last year and I just happen to cut and paste that into each of these sections. You have the character count at the end of each section. You can click on activities and what this will do is it will pull up Figure 4A, which is where you list the activities supporting that measure. And here you can go down to seven and actually read what they had. So at your fingertip from one form as you’re working the form, you’ll be able to go to all these different sections and hopefully this will help you in the process of writing your narrative. We’re pretty excited about this. One of the things I wanted to do is I pulled up another screen where I’ve opened up the HTML version of the narrative itself. I’m taking you right to that section for that performance measure we were just looking at. And this is the way it would display on the HTML and the PDF version, which has the activities right there before you discuss the current activities and the plan for the coming year.
We’re hoping and the whole plan and all this work in this area was to help at the time of review, to be on the same page, to be able to discuss, at review, the data as well as the activities and what’s been going on to support a measure. Last year I had the good fortune for the first time to participate in Region Four State Review and to be a part of it. And I can’t tell you how difficult I found it, sitting there with my finger in three different sections when we were talking about something of looking for Figure 4A, 4B, looking for the narrative and then looking at the Form 11 data. It was like all over the place and I thought, and I wasn’t the only one, Mary Beth thought it, Stephanie thought it, Cassie thought, everyone thought this was such a great idea to change it to have it all in one place. What’s also changed within the narrative, the state performance measure master list has changed. Let me review what happened in the past and this drove people crazy.
Last year you had to type out the measures you were going to discuss in the narrative independent from Form 11 and where the performance measure data was, and when you wrote that out there was a new numbering system in the narrative one, two, three, four, regardless of the number of your state performance measure in Form 11. And so what ended up happening is it became a case of who’s on first with the title of your measure. Your measure could be state performance measure two could be the first measure you’re talking about and yet it was called one in the narrative. And I know at the review process, this created real problems. But someone says well, it’s your performance measure one, no, it’s performance measure two. Well, what do you mean, it’s two, it’s one. Well, it’s in the title, that’s how we had to type it in. Well, we realized that that was quite, quite a confusing mess.
So Form 11 now, you state performance measures on Form 11 will be the list, your master list. You do not need to reenter it into the discussion for the narrative. We’re going to take a look at that and we think that this will clean up and make it much easier to understand. So, what we’re going to do is we’re going to go to state narrative main menu and then come down here and take a look at the state performance measures. So if you look at the master list, which in the past you had to enter by hand, it takes you right over to the list of the state performance measures that are currently active and inactive. So you see what the list is and as you can see, in Florida, performance measure number two is inactive and this is where we get into problems in the past where we would start with performance measure one in the narrative and then the second one in the narrative was two, but it’s actually three and then four became three and five became four and it became this very difficult situation for being on the same page.
So what we’ll show you is what it looks like now when you go to the narrative for the discussion of the state performance measures. Here you have it automatically created for you, one, three, because the two is not active, four, five, six, seven, and so forth. So it seems like a simple and easy thing that’s been fixed but it’s really going to I think make your life a lot easier and it’s going to make the narrative, any kind of confusion about the discussion will go away. So what else do we have? What’s new with the narrative? The new section to defining your new state performance measures, you’ll be able to create a master list to the state performance measures for the new needs assessment cycle. In the state performance measure section of the narrative is where you’ll find this.
You can add new performance measures by creating new details sheets or copy state measures that will be continued and measures are numbered in order that you create them. And you are required only to define measures this year, providing objectives is not required, but you have the capacity to put those in. So let's take a look at that. As I mentioned here, here we have this discussion of state performance measure, but right in between these two that we had just clicked on these two links, is to create a master list of state performance measures. So here you come to a menu that allows you to add new performance measures or add new state outcome measures. You would click on add, new performance measure, and it would ask you whether or not you want to create a new measure or copy an old measure.
If we said create a new measure, we go right to the form to create the detail sheet for that state performance measure. Again, it’s the first one we’re creating, so it’s numbered number one and we have the detail sheet here to complete what our new state performance measure will be. If we copy a measure, we’re taken to out current state performance measures, the ones that are currently active and we can collect, we can click on the select box for those that we want to, that are going to continue forward. So for example, if we were continuing one, three, five, seven, you can copy as few or as many as you would like. Once you copy them, you can still come back and copy the others if you want to bring them forward, so it’s not a one-time deal. So you would just come over here and click copy and then it says you are about to do this. Do you really want to do it? And we say, okay. And right away we’ve got those measures brought forward. And as you’ll note the numbers have changed.
They’re being renumbered for the new needs assessment cycle. So one, one and two, three and four, so if you want to keep them in that order, you need to create that order in your own numbering. So just be aware of that. At this point you can come over here to view a detail sheet that exists on that measure. If you needed to edit it, if you were using basically the same measure but were changing it somehow? You could go to redefine it here. Also if you wanted to edit and add objectives for this measure, let's say it’s one that’s continuing and you have the capacity at this point in time to generate your new objectives for the five years out. You’ll be able to do that at this point. And you would just save. So it’s one stop shopping. It’s all in one place. You’ll be able to create these readily and easily. So what’s new with the narrative? The length limitations, everyone loves that part. The length limitations for the narrative sections have returned to those limits of two years ago.
Starting a new cycle, you have a handout there with the different sections and the length limitations. Of course, each section you go to will have the counter there that it will help you keep track of your character count. Three thousand characters each are allowed for the discussion of past accomplishments, your current activities and future plans. The narrative text fields are blank. You’ll be able to access your narrative from last year, but because your narrative would reflect the changes from your needs assessment you may have, you start from scratch. And there’s no need to begin your text this year with the update, the slash 2006 slash, slash 2006. That is not needed this year. It’s a fresh new document that will read straight through. So what’s new with the forms status checker? Well, there’s a new thing that’s been added called data alerts, have been added at the end of the forms status checker.
For those of you who don’t know what the forms status checker is, it’s kind of like your report card or your tracking, the way to track how you’re doing in completing the forms. At any time during your preparation of your application, you can go to the forms status checker and hit the update button and it will list if a form’s complete or if it’s not complete, what needs to be done. It’s never been saved. There’s a validation problem that exists. But it kind of gives you a sense of where you are and what needs to be accomplished. At the end of that, each section has the things need to happen in order to complete the application, but at the end there’s this extra thing called data alerts. And what it is, is its identifying anomalies that aren’t errors per say, but you may want to take a good look at. And it helps you review your data. It’s by no means meant to say something is absolutely wrong. It’s a way in which to give you a heads up that something looks a little strange that you may want to address.
And here’s three examples of data alerts that are in this data alert section. If you have a zero value for an indicator on a performance measure, it’s going to ask you if, you know if you really mean zero. It’s a legitimate data point, but it’s going to ask you, because it’s often very unusual. Are you trying to say N/A? So don’t use a number if you’re trying to say N/A. That’s what it’s trying to hint at. The other thing is have your indicators surpassed your objectives? In other words, haven’t, your future objectives are lower than what you’re currently accomplishing from your indicated data. So it’s going to ask you, are you planning declining performance planned in the future. It’s kind of a nice way to say look at your numbers. Indicators that fall short by 10 percent or more of the objectives, should you revise your objectives. It’s really important this time in the needs assessment to take a really good look at the objectives you have out. I know how many, if you look over the years when I’ve been looking at the performance measure data, I see that the future objectives often times are never touched or changed or adjusted, depending on what the real data trend is telling you.
Something to look at, make sure the objectives are true and useful in terms for achievement. So, those are the enhancements, those are the changes in the system, those are the major changes. Otherwise it’s pretty much the same. So we’re going to do a real quick review for those of you who are new, welcome to Title V. You access the application via the Internet. When you save your data, your data is stored on the HRSA server and it may be accessed there your next session. So as soon as you save it and you come back tomorrow, it’s going to be there. You must save your data. If you leave a screen without saving your data, you will lose your data. So be very careful. Similarly, use the buttons to navigate at the bottom, the save and cancel. You see me cheating up here using the back button to get around real quickly.
That’s a big no, no. Don’t do that. Use the save and cancel buttons at the bottom of the screen. You need to use Internet Explorer 6.0 or higher as your browser and coordinate with your state IT Department to make sure it’s setup properly. When you’re in the system there are time outs. Time outs are a security requirement. If there is no communication with the server from your laptop or your desktop as you’re working, you will time out of the system. I know many of you experienced users find this the bane of your existence but it is really to protect your data. At the 29-minute mark you’ll receive a warning that you are about to time out and you have to acknowledge it, by clicking the okay button and then that will continue your session. In other words it will restart the clock. And you have one minute to respond. Be careful about having multiple Internet Explorer windows open, because if you have one and you do what I do, which is work in the system and have data sitting behind the window I’m working on, the pop up box could be behind it. So be very careful.
The first thing you’re going to do is register. Each state is allowed six user I.D.’s or six users and your state identifies the users to MCHB to insure the integrity of use. February 1st an email went out from me, from Cassie, about sending the user lists. We’ve got 38 states that have sent their user lists and the deadline was yesterday. Of course, we’ll let you send them in. Please send them in when you get home because we’re going to be mailing out your registration code and your passwords by next Friday. We want that in the mail because we’re looking to have this application open up on March 1. Once you're registered and you have your password in the system, you have accessed the entry data in all sections of the application so you’re not restricted on any one section.
Save your data as you work. Use the notes icon to enter notes at both the form and field level. If you need some explanation on your data source or why the data looks a certain way, use your notes, put them in. Use the instruction link at the top to access the instructions and the guidance link at the top to access the guidance for that form. Forms. Numeric fields cannot have commas entered. You have to enter a string of numbers. Text fields have character limitations so you say it within a certain amount of space, a certain amount of characters. Only one person from your state can access a single form at any one time. In other words you can be in form two, but someone else in your state can’t be in form two. But both of you can be in there at the same time. Someone can be in Form two while you’re in Form six and someone can be in performance measure 11 while you’re in performance measure 12.
On the note fields, are not repopulated but you do have historical notes at the top for those that will remain and consistent. In other words you can cut and paste, copy and paste into the fields for this years application. Narrative. The text fields have character limits. Compose your copy in Word, Word Perfect and use your character, your word count feature in those applications to keep track of your words. Come into the application cut and paste. It seems to be that the time out issue seems to hit you hardest when you’re in the narrative. If you get caught in the narrative composing and you don’t save regularly, that’s when you might time out and get kicked out and lose your copy that you just composed fresh. So really compose your narrative offline and only edit as needed in the application itself. Do not use bullets or other special characters. You can use a dash to indicate a bullet structure.
HTML will not recognize that and will put question marks all over the place in your application, on your printed version. So do not use bullets. Hard returns do not count towards your character limits and use the character counter at the page to monitor your character use. Narrative. You may add attachments but only one attachment per section. So if you have multiple documents supporting one section of your narrative, combine them into one document and then attach them. Be consistent in the naming of your attachments and the best way to do that is identify the section, the sub section, and then the title. And this last bullet point is very important. Do not use attachments to work around the length limitations of the narrative. In other words, don’t get to the end of your text box section and say, continued in the attachment. That’s really not a good idea. Key points. Data validations. National Performance Measures two through six, the slates data from 2004 will be populated with the data entered from 2003. In other words it will be automatically brought over and you may edit as needed.
I want to go over some of the validations on these different sections because of the performance measures, the health system capacity indicator rules, operate a little differently than the outcome measures in the health status indicators this year. Your pms and health systems capacity indicators work as they’ve always worked. You can provide an actual and estimated data, which is preferred, but if that’s not possible you’re able to write a note in lieu of that for the reporting year, in other words, for that data for 2004. Now, the outcome ventures and the health status indicators, you can’t write a note in lieu of that data this year. Actual or estimated data are required for this 2004 data and a note will no accept, will not allow you to say, I can’t enter this data. So you’ve got to do that. The other thing that’s a really important thing is the reporting of certain performance measures and health status capacity indicators for the territories.
We’ve changed some things for you guys. Notes are acceptable in lieu of any data for certain pms that don’t apply to the territories and jurisdictions. I know you’ve had trouble with Medicaid and ASCHP in making sense of filling out those forms. In these cases, you will not need to put data in you can put a note instead of that if it doesn’t apply to you, so. Printing. You’re able to print your forms and narrative directly to PDF in the view version and save on your computer through the PDF writer. Now, last year we introduced the PDF writer and being able to use this PDF, have this capacity to make a PDF and there was some real unexpected reaction out in the states in the challenges with server timeouts, your capacity, our capacity, security requirements, communicating back and forth, all sorts of things that we could never put our finger on.
So one of the things I’m asking you to do is if you get a moment grab me, I’ll be here through Wednesday and talk to me about what it was like at your state. Come by our learning lab. Talk to, Stephanie, Rodg, Jill, myself, about the use of the PDF writer. We’re looking at a way to try to make that better. Often times what happened near the end is so many people were banging on the PDF writer trying to generate PDF’s that it just created these inordinately long timeouts, that it would timeout before you got your PDF. Or it would timeout from your side, but we were trying to send you the PDF but there was a timeout on your server. So there was all of these things that we had no idea we were going to run into. And that can be very stressful that last week before the 15 th of July. Talk to us about that.
We’re trying to come up with a solution for that so that by the time you’re using PDF writer, which often isn’t until late in the process like maybe June, July, that we’ll have a solution so it won’t be so cumbersome and inconsistent as it seemed to be last year. So the key dates for the 2006 application, February 25 th, next Friday or a week, two weeks from yesterday, we’re mailing out the registration letters to everyone that we have. On March 1 st, the link to the application goes live from the MCHB website. And that point, once we go live, you may register and begin work online at that time. And July 15 th is the deadline for the 2006 application and 2004 annual report as well as including your needs assessment. The URL is provided on your sheet and to get there you can go to the MCHB home page. You would select data,
Title V information system. You would take the link to the Block Grant application on the sidebar, which say state login. And once you’re there you can bookmark it and go directly to the login page in the future. Sign up today for TVIS learning lab. We don’t actually are going to sign up this year. We’re going to be there from 9:30 to 3:00 , I don’t know what room it is but it should be in your booklet. And we would love you to try out some of these new features and try out the system, get the rust off your brain if you’re an old user or if you’re a new user, come and experience it for the first time. If you don’t have time to use the learning lab, just stop by, say Hi. The HRSA call center will be your main line of support and we have business cards and the call center number and the email address is right there to use in the future. And you can always reach me if you’re running into a real jam, so don’t hesitate. Here we go again. Let’s have some fun. Thank you.