someone may refer someone today diabetes clinical they should be going to an end to current glenna or vice versa. unnecessary referrals meaning the patient with hypothyroidism i should be about to manage with a little bit more information or guidance from a specialist that really doesn't need to go see the specialist. premature folds where if i had done before the work on the first visit the specialist wouldn't have been spent filling out that the forms and x-ray forms. then obviously things like an ability to discern the referral questions. at the san francisco general hospital we are the customer so we take the of injured patients and a large portion of medicaid patients and this exemplifies what the system was five years ago. in addition, because there are a lot of mismatches between the demand and supply are anywhere in between four or even months for the routine visits for certain specialty clinics. so, this -- i keep on pushing the wrong button. this was actually the result of the system. and this is a successful result, where someone filled out a form, faxed it over and got rec