It's Tuesday News Day and here are the stories for the week.
Bill Russell: 00:05 welcome to This Week in Health It news where we look at as many stories as we can in 23 minutes or less. That is going to impact health it. My name is bill Russell healthcare CIO coach and creator of This Week in Health It. A set of podcasts and videos dedicated to developing the next generation of health leaders. It's Tuesday news day and we have a lot to talk about. Bunch of stories. Healthcare leaders urge full court press on social determinants. Banner health agrees to pay $6 million settlement over the 2016 breach. We'll talk about that. Uh, AMA, Walmart go toe to toe on some stuff. Uh, value based care is not moving as fast as what people think based on a, uh, uh, a report that was done HHS on cybersecurity. Uh, John Halamka spoke at a security conference, talked about some of the holes in machine learning and AI.
Bill Russell: 00:53 We'll touch on that a little bit. Uh, interesting use case, Boston children's for AI and we'll hit on that. VA launch this national artificial intelligence. Uh, we have two articles. You know, one's a, you know, predictions for 2020. I thought it was really well done. So I'm going to hit on those real quick for you. And then, uh, uh, our friends at Starbridge advisors, David munch, wrote a really good piece on the 10 steps to prepare for 2020. This is a really practical piece on how a healthcare technology professionals health it professionals, uh, can prepare for 2020. And I wanted to share that with you as well. So, uh, before we get into the news brief word about our sponsors, I want you to know that I only sponsor, uh, organization and services that I really believe in their, uh, their leadership. I believe in their products.
Bill Russell: 01:38 I believe in the value that they bring to healthcare and it's the reason that I choose to have them as sponsors. And I want to have sponsors that I believe in so that I can, uh, I can recommend them wholeheartedly to you and know that what you're going to get is a great experience and a great product. And today I'm excited to announce a new sponsor in health catalyst. And, uh, you know, in the digital age, cloud computing is an essential part of more effective healthcare and precision medicine. But healthcare organizations themselves are still facing challenges in migrating to the cloud. Currently only 8% of EHR data needed for precision medicine and population health is being effectively captured and used. And so health catalyst has written this article and uh, has written this white paper and I just want to call your attention to it and it talks about how health catalyst data platform brings healthcare organizations the benefit of a more flexible cloud computing infrastructure in the cloud.
Bill Russell: 02:35 And you can get to that white paper by visiting this week, health.com/health catalyst, and it will redirect you to a site where you can download this white paper. It is a, it's actually an ebook more than a white paper on how to accelebrate your use of data in the delivery of healthcare and precision medicine. And, uh, I highly recommend the, the, uh, the ebook. It is really well written and uh, has a lot of really good information. If you're looking to utilize the cloud and the benefits of the cloud and getting your data out into the cloud. I think this is a must read for any healthcare, uh, it professional. Uh, we also want to thank our founding channel sponsors who make this content possible, health lyrics and VMware. I, if you want to be a part of our mission to develop health leaders, go to this week, health.com/sponsor for more information.
Bill Russell: 03:22 Uh, here's our schedule through the end of the year. Friday shows will not stop for the holidays. We're going to do them straight through and straight through HIMSS. We're going to have a shows for you. I took a three week break last year. My way of taking a break this year is I've already recorded all the shows for January, so I am going to take a break in January, but I have the shows already recorded for you. Um, the, this is the last Tuesday news day episode between now and the end of the year. I will kick those off again. Uh, come January and uh, you'll look forward to our normal Tuesday, Friday schedule as normal. Um, we are going to be doing two episodes. I want to call your attention to one is our year end review, which is where I highlight some of what I think were some of the key learnings for me. I find that the more I do this show, the smarter I get because I'm interviewing such great people and I want to pull out some of those and highlight those.
Bill Russell: 04:14 And then the other is just a flat out Nielsen rating top 10. So there are the 10 most listened to podcasts for the year and I'm going to pull out an excerpt from each one and share them with you and do sort of a countdown episode so you can see which one is the uh, the number one show. Uh, the last thing I want to call your attention to really important this week, health.com/survey. This is our 2019 survey. In 2018 we did a survey and you guys completely reshaped the show and I really appreciate that feedback. I really need you to hit this this week. health.com/survey and provide me your input for next year. We have a lot of ideas floating around. I have a, a team of people I work with. I have a team of advisors as well. Um, Sarah Richardson is part of that. David Bensema was part of that.
Bill Russell: 05:01 So I have healthcare professionals who are helping me to think it through. I also have a team of, of my millennial consultants as I call them, who are helping me with this whole social media and YouTube and bringing all this stuff together. Um, but I really want your voice to be heard. I want to know what, what is resonating with you, what is not resonating with you. I want to bring that into the conversation to make sure that we do something special for 2020 okay. And finally, I know we're almost there at the news. I just want to keep doing this because it is such a great service. A quick shout out to Drex DuFords new service, 3XDrex where you got three stories texted to you, uh, three days a week to sign up, Drex to 484848. Just text Drex to 484848 as I have done.
Bill Russell: 05:46 And you get to see these stories. delivered straight to your phone and you click on them and see what Drex thinks is important. And some of them are important cause I keep pulling them up as my story, which is awesome. Uh, and right now, uh, we are doing a little different format based on your feedback. We have a 100% approval rating for the new format. So we're going to continue to do it. But essentially what I'm doing is I go through the 12, 10 today it's 12. Anyway, I'll go through the 10 stories. Uh, I'll just give you my take on it real quick and then we'll circle back and go deeper in on, uh, some of those stories. So here we go. Healthcare leaders urge full court press, press on social determinants of health. Here's the, so what on this healthcare is not incented to do social determinants of health other than from a mission standpoint, faith based organizations and organizations that are committed to the care of the community.
Bill Russell: 06:38 Uh, and those that are really supportive philanthropically have sort of a, uh, an ethical imperative to, to work with social determinants. But at the end of the day, healthcare gets paid. Um, when you're sick, it's still sick care. It's still, uh, helping you once you get to that point where you need your health restored. Um, so I, I think this, this push is great. I just don't think it's going to go anywhere until the money starts to change. The people who are incentive for this is a payer organizations. And so the healthcare organizations that are doing the most around this you're going to hear are mostly payer organizations, right? So Intermountain's doing a bunch around this. Kaiser is doing a bunch around this Geisinger's doing around this, doing a bunch of rounders. And so what are the three of them have in common? They have a strong payer organization.
Bill Russell: 07:25 Uh, they, they have an insurance organization. Their incentive to keep people healthy. They get paid whether people are healthy or sick. And uh, those are the kinds of organizations I think the people who are gonna make the biggest move in this space are going to be health tech. Uh, when you think about the large health tech players, it's Amazon and Google. It's why I keep talking about them. I know I've gotten some feedback from people saying, Hey, you're talking too much about Amazon and Google. I practically don't know what to do that within health it. Uh, the reason I do it is because, uh, they have some interesting new ways of looking at things. And when you think about the literally billion searches a day around health that Google gets and their ability to aggregate services and to present them in such a way, they are going to have a really interesting play when it comes to social determinants of health and as well as Amazon.
Bill Russell: 08:13 It's why I keep that in the back of my mind. So, um, while I appreciate healthcare leaders urging a full court press and social determinants, I only see a handful of them doing it. And the ones I see doing it, uh, are, are predominantly once with a, uh, with an insurance component. Um, and the, so what for health it is, understand the organization you work for and how they get compensated because that will determine the priorities of the organization. So as much as there may be chattering about social determinants, um, they still, you know, no money, no mission, you still have to focus in on the things that bring money into the organization. Uh, hate to be as crass as that, but it's just the reality. A second story. Banner health agrees. $6 million settlement over the 2016 breach. We'll come back with the details on this.
Bill Russell: 08:59 I think it's 3 million patient records. Actually, we'll skip the details on it. 3 million patient records were breached back in 2016. Uh, they've agreed, it's capped at 6 million. Doesn't necessarily mean they're going to pay 6 million. Uh, but their cap is 6 million. The so what on this is, the foundation for digital, the foundation of for digital is trust. The foundation for business is trust. And, uh, people expect you to have a good cybersecurity platform in place. Now that's like a no duh, kind of. Uh, so what, so I'll give you the next level. So what is, we have to be able to tell this story effectively within our organization. We have to educate the board, the subcommittees of the board. Uh, the leadership teams. Uh, we have to identify the right, uh, mix, right? So are we going to be the organization that is the most secure cause we're spending $20 million a year on it.
Bill Russell: 09:52 Are we going to be an organization that has found that balance between spending, you know, tried to be the DOD and uh, and really doing what we can to protect our, uh, our patients. So you've gotta find that right mix. But more importantly, you have to be able to tell the story effectively around cybersecurity. And we're going to continue. In fact, I think, uh, one of the shows we're doing towards the end of this year is around cybersecurity and telling that story effectively. Uh, the AMA asked Walmart to reconsider it's January EPCS requirement. I'm gonna give you the, so what on this? So, uh, this is a, uh, e-prescribing of, uh, opioids and those kinds of things. And a Walmart saying, Hey, you know what, in order for us to get ahead of this thing, we need it all to be electronic. And, uh, the AMA is fighting, stepping back because only 30 some odd percent of, uh, of the prescriptions today are electronic.
Bill Russell: 10:45 And the, you know, this is the second time that the AMA is and others, aha. AMA are stepping up and fighting on behalf of health systems, but they're fighting in a way that makes us look incompetent, right? We can't do this. We only have 36% of the prescriptions coming in electronically or the aha fighting against transparency because it's just too hard to do. Um, I think the reality is in an election year, we have to be really sensitive to these topics and how they're being portrayed out in the marketplace. Uh, the, so what for it is for the love of heaven, get ahead of this stuff. Your platform should be agile. You should be able to implement this stuff. You should be able to find the funding to do electronic prescriptions. This is like basic blocking and tackling across your health system. Get the basics done, building on top of platform thinking platform technologies so that you're ready for the next one because this is last year's problem.
Bill Russell: 11:44 There's going to be a whole new set of this year's problems that we need to be agile and effective. Uh, in order to, uh, to go after. A catalyst for platform reform finds, value based healthcare, not moving quickly enough. Uh, I highlight this story not to go into detail on it, but to just say that, uh, value based care is the future, but it is moving slowly so we continue to be fee for service. Just keep that in mind as you're building budgets. Uh, it's an important distinction. HHS, cybersecurity leaders describe the active threats on agents on the agency's radar. I will circle back to this. This is really interesting. They go into, they go into depth, they go into a lot of detail on this. Um, and it's, it's a really good article. So it's a healthcare it news article. I will come back to that.
Bill Russell: 12:26 So remind me on that. Number five. I'm going to come back to a machine learning AI, telemedicine and other technologies will pose a data security risks. Says dr John Halamka healthcare finance news. So John spoke at a cybersecurity conference and he talked about the risk of aggregating all of our data in the, uh, in the cloud. What's interesting about this is, uh, you know, John talked about the risk of aggregating the cloud. And so all of you who are cloud phobic right now are saying, yes, John. All right, I had a fight. And then John goes on to make the point that, uh, that these cloud providers have hundreds of people on their security staff looking at, uh, minute details around security and we have like a handful. And, uh, he, that makes the point of, you know, where do you think hackers are gonna go and go to try to find that data?
Bill Russell: 13:14 Do you think there's, are going to try to go at Fort Knox? Where do you think they're gonna go after the cardboard box? The answer is they're gonna go after the cardboard box. So, um, he believes as I do that the cloud is actually more secure. Uh, we have to, we still have to write our contracts correctly. We still have to architect architecture still matters in the cloud. But, um, he makes that point that, uh, as we're building out these models, cybersecurity and security has to be at the foundation of it. Of course, you speaking at a security conference. So make sense that that was his, the thrust of that conversation. Um, machine learning, AI, telemedicine. Oh, that's John's number six. Number seven, a different use case for AI. Boston children's explores automating patient provider communication. I will come back to this story cause it's, it's really interesting.
Bill Russell: 13:57 They do a good job. Um, you know, one of the things as we look at AI, AI in the clinical setting setting is going to move slow. It is, it's, you know, it's sort of replacing, uh, you know, clinical decision support models that are a little slower, if you will, with, uh, some new updated models. But at the end of the day, anything in the clinical setting will move slow because the, uh, the risk is so high. Uh, so they're looking at the, uh, how AI can be applied to patient provider communication. Great use case. It's right on the edge. It's right around the consumer experience. Very good use case. So I'll come back to that. VA, the VA launches national artificial intelligence Institute. Uh, I pulled that out as a story just because I believe that uh, many of us are gonna have a lot of questions around artificial intelligence.
Bill Russell: 14:44 It's good to set up a governance might be too strong a word, but uh, some sort of group, your organization that's looking at the various ways that AI is going to be used. I start talking about the ethics of AI. Start, start talking about the governance of AI within your organization. And maybe it is a governance body. Nobody wants another governance group, but maybe there's like a quarterly group that you could set up that is starting to explore those kinds of things. I think that's the way you can be viewed as a forward thinking leader without actually diving in and implementing everything. And uh, and you know, being the first one to hit your head against the wall. Uh, let's see a couple of articles I'm going to hit in detail Mark Tarr’s, 2020 healthcare predictions encompass health CEO. Very good. I will come back to that.
Bill Russell: 15:33 Uh, digitization, democratization, deep learning will build healthcare for tomorrow. Shez Partovi from AWS, Amazon. Um, let me just hit that real quick and then I will not come back to it because the real highlights here was that Shez gives us the three things that people are looking for Amazon to do for them. The first is to predict patient health events or diseases. So bring all their data in and give them access to some higher level computing capabilities and algorithms. That's one of the things they're doing with Amazon. The second is either personalized, customized, the consumer health journey that is the digital front door. And then the third thing is promoting interoperability. Uh, and that is the liquidity of data. So those are the three things that Shez shared with, uh, with the, on this article that people are looking to do with Amazon. And that's really what I wanted to highlight from that story.
Bill Russell: 16:24 I, Amazon also received our, uh, announced Lex, which is Alexa without the A's on either end. And it is, it is to differentiate the platform, but it's their voice platform. It's Alexa, but it's Lex and it's designed with HIPAA eligibility. So just something to keep in mind. Uh, another one was a, and this is just flat out a, uh, a press release, but I like it. Uh, RX review, which is a company I'm familiar with. I know the founders and Cerner worked together to improve prescription price transparency for millions of patients. Uh, I highlight this because, um, it hits on so many great topics, uh, Rx reviews of really good startup, been around for awhile. Uh, price transparency around prescriptions is something consumers are asking for. And then the, uh, the last thing I would say is it just accentuates that Cerner is all in and moving fast.
Bill Russell: 17:18 And, uh, so we will see how this, uh, how this plays out. This is sort of a pre announcement more than anything. They're working, they're, they're, they've, they've decided to work together. I think it's a great area to work in. Uh, so this will give the price transparency data right there to the physician so that they can, now help the patient navigate quicker. Let me see how much time we have left. Not much. All right, so let me, uh, I'm going to end up going a little over here. What did I say? Come back to set. I come back to the HHS story. Let me hit that first. Uh, HHS. It is HHS, cybersecurity. Here's the, uh, here's the two things I'll highlight from this. Somebody asked from the audience, you regulate us. Why would we talk with you? He said, imagining a question or actually he, he was, the speaker was talking about, you know, why would you share that?
Bill Russell: 18:11 And he said, yeah, you know, he shared with them that the U S sub-section code, which shows that any, any non-federal organizations that share cyber threat indicators with an inappropriate federal entity, esteemed voluntary data sharing that shared information cannot be further shared for specific regulatory purposes. He explained being that AC3 will not report any vulnerable information vulnerability information shared. I highlight that because I didn't know that. So that is good to know. And uh, it's, it's a good partnership to have. Here's some of the active threats they have on the radar, which he shared that I think is worth looking at. This article is in health it news health, a healthcare it news, a virtual private network vulnerabilities and he lists a bunch of them. The blues, Singleton pointed out there's ongoing vulnerabilities impacting windows services. Blue key vulnerabilities affects windows seven, 2008, 2003 XB and embedded versions, deja blue, eternal blue.
Bill Russell: 19:13 These are all things that are impacting the a windows environment. Uh, something to take a look at, uh, especially around RDP and other things like that. And then urgent 11, as we have shown here, the vulnerability, uh, could impact real time operating systems used for devices such as MRI machines, firewalls and printers. There are more than 2 billion such RTDs services worldwide. I like this. I, you know, when I was a CIO I had access to consulting firms, which kept me updated on these things. Some of you may or may not be updated on these things. This gave me some specifics and so I thought it was worthwhile in sharing those specifics with you. Healthcare it news is where the story is worth taking a look at the headline again, it'll be in the show notes, but HHS, cybersecurity leaders describe active threats on the agency's radar. So a use case, let's go to the use case for um, Boston children's.
Bill Russell: 20:09 Uh, this ha recently become a new focus area for leaders at Boston children's hospital as they believe that while the patient care will see benefits from AI in the clinical settings over a long period of times, it can be also used in other aspects of the organization. For example, when implemented within patient provider communication, AI and automation can eliminate the need for providers to ask routine questions in turn, fueling more meaningful connection. I just, I just wanted to highlight, uh, how, uh, I think it's cool to find those use cases that are close to the clinical setting, that are helping the clinicians that are helping the patients to very good use case. Uh, I highly recommend taking a look at that. If you know somebody at Boston children's, uh, reach out, hear what they're doing. Let me give you a Mark.
Bill Russell: 20:55 Tarr's 2020 predictions. Then we'll close with, uh, some really pragmatic things from, uh, David Munz. So here are the, here are the, I think it's like six or eight, seven, seven, uh, predictions again, Mark tarr and encompass health. Uh, the first, the use of AI and predictive analytics drive outcomes will continue but will only be successful when coupled with interventions. Um, we talked about this all the time. AI, all of these technology projects are becoming less and less technology projects and much more, uh, clinical operations projects and operations projects just flat out. And, uh, it's for that reason that I really liked digital leaders being operational experts and people who understand. So when people bring in people from outside of healthcare, I like that cause it gives us new thinking. But here's the aspect I don't like about it is I think they need to be tightly partnered with operational expertise and the operational leaders need to almost be leading.
Bill Russell: 21:54 So the people from outside the industry are helping us to see things a little different. But the operational leaders see things how things can actually be done within healthcare and that's what he's pointing out. Number two, the shift to value based care is not going away. That is true, but it's going slowly. Number three, as the population gets older, the demand to age in place and live independently longer, it will also grow a important business opportunity for a lot of health systems. Uh, best buy has ceased on this as we talked about last week. Uh, payers will continue to see the value of inpatient rehabilitation for Medicare advantage plan holders. Absolutely true. 2020 will be a transition year on the regulatory front for post acute providers. A lot of details in this one, which are, you know, payment models are changing, so forth and so on.
Bill Russell: 22:41 Uh, so we're taking a look at, here's something I did not know cause I don't follow this that closely, but Florida's repeal of its con law, um, which is the certificate of need law, which, uh, any will open up new opportunities for growth. So this law has been in place for many years and with it going away, uh, the, uh, in-depth regulatory hurdles that are, that are in Florida, uh, will, uh, dissipate and allow a lot more, uh, activity to happen within Florida, uh, and expect some heated debates surrounding the future of healthcare. No kidding. And it's an election year. But Mark is correct in identifying that because it is a significant thing. So, uh, in the election year we will talk about healthcare in ways that are not going to be comfortable for us who are in the healthcare world. All right, let me hit my friend David Munz's article.
Bill Russell: 23:39 Here we go. 10 steps view from the bridge. This is a, from the Starbridge advisors, site David Munz wrote this 10 steps to prepare for 2020 big challenges, bigger opportunities. Let's go through them real quick. And I might, I might just grab David at some point early next year and talk about some of these things. Uh, but number one, encourage innovation in normal processes. Uh, challenge the status quo respectfully. Uh, this is one of David's big themes is, uh, that we are part of a larger team and that we need to introduce things in a respectful manner. Uh, but you know, we, but we need to encourage innovation. within the new organization, it's one of the, one of our roles as a technology leaders. The second is embrace AI cautiously. Um, you know, there's a lot of stuff happening in AI. We've talked about this earlier.
Bill Russell: 24:25 Uh, you know, but you know, stand up the right groups so that you can start to have conversations around AI. Uh, again, look at the black box, look at the ethics of it. Look at, um, you know, how you're gonna apply it, how you're going to bring it into the workflow, those kind of things. Uh, number three, address unhappiness with EHRs and other it products and services, poorly implemented hit will continue to contribute to caregiver burnout if we don't make changes with a renewed sense of urgency. Uh, again, I think that's a a great point that David makes that uh, we still have a lot of stuff to clean up. We still have a lot of, we have tech debt and then we have trust debt. We have to take care of that trust debt that we've built up over the years. A number four, revisit your ERP implementation.
Bill Russell: 25:11 I've heard this over and over again and it's interesting that David brings it up. Uh, you know, we, we ignored the ERPs for so, so many years cause we were doing EHR that uh, it seems like they have gotten old stale and broken. So a lot of people are doing ERP projects right now. Uh, that has been a theme for 2019. I think it will continue to 2020. number five, implement and manage practical and pragmatic governance for data, information and knowledge. Uh, this is a theme that David continues to drive home, which is standing up the right governance early on in your tenure as a healthcare it leader, uh, is important and it just, it pays dividends over and over again. Set it up right if you don't, how to set it up, bring in an organization to help you to identify the right, right way to set it up within your organization.
Bill Russell: 26:02 Thing, I'm hearing over and over again, it's too many meetings. So identify the right cadence for governance within your organization and uh, and, and the right participants. Uh, number six, address the increasingly important social determinants of health conversation. Absolutely. You need to address that. Uh, keep in mind what I said earlier about, uh, SDOH which is, uh, uh, we have no way to pay for it yet. So while it's important to address, it's a keep in mind, what are the priorities of your organization specifically? Uh, number seven, research and outsource research outsourcing. Again, very interesting. I am hearing this over and over and over again. Um, you have organizations like BJC went to tech Mahindra. You have, uh, uh, you know, Providence bought blue tree and they are a, you know, exploring, uh, you know, aspects of really becoming an outsource partner, which is, uh, which they've been for many years, but they're exploring it in the new ways, which I think is interesting.
Bill Russell: 27:04 Um, I, I'm just hearing a lot more talk. A lot of the stuff in the data center as David points out here has become commodity type services. And when things become commodity, you are able to outsource them. Uh, number eight, protect the sake of trust with the patients and the families have placed you with absolutely. Number nine, earn your seat at the executive council. Digital services requires you to lead. It's not just support and enable. I heard that from CIOs over and over again. You know, we don't have it. I'm not sure they said this strongly, but it came off this way. We don't lead. We just, we just enable the organization. We support the organization. And, um, you know, one of the things I'm saying over and over again to the CIO leaders, I coach to the CIO leaders in the industry is people are looking to us to make meaning of the world.
Bill Russell: 27:53 How do we make meaning of the world? And so, you know, how is, how is digital going to play? What are the key digital technologies and how are they going to, how are they important? How important is cyber security and where, where, where should we be investing in cyber security? People have a million questions and they're looking to us and saying, can you answer my questions? And when we sort of abdicate that role, they go out and hire somebody who can answer those questions and, and you, you proceed to step back from that seat at the table. So it's important to know that we are being asked to make meaning of the world. And that is how you gain your seat at the table when they're looking at a merger and they say, how will our digital strategy, how will our technology, how will that play?
Bill Russell: 28:38 Not just, well, we have to bring the two EHRs together and that's complex, but how are we going to knit together the advances we've made with our patients in this community, with the advances we can make in this community? And how is our digital strategy different potentially, uh, for a rural community as it is for a, an urban community anyway, make meaning of the world for your, uh, to earn your seat at the table. Then the final one is a do a self assessment. Um, David rightfully points out, it's the end of the year. It's a great time to say, uh, to look at a lot of things, to look at your life and say, you know, am I in the right role? Am I doing the right things? Uh, you know, am I killing myself? I just had a great conversation with a former CIO, uh, who said, you know, the job was killing him and he stepped out.
Bill Russell: 29:27 And, uh, you know, it's an awful lot of, it's hard to do that and there's an awful lot of wisdom in doing that and saying, is this the right role for me? But also evaluate when you decide this is the right role for me. Get re-energized for next year. Ask yourself the questions. What is my team looking for? What are the challenges were, you know, what is our mission? Do we have a shared mission? Does everybody understand the mission and are they aligned behind it? Is the communication right? Um, that's it. We're going a little long for, uh, our last episode of the year, but, uh, you'll have a little bit more time to, a little bit more time to listen to it I guess, but at the end of the year, uh, so that's all for this week. If you want to support the fastest growing podcast in the health it space, uh, here's a few ways you can do it.
Bill Russell: 30:10 You can share with peer a sign up for insights staff meeting on the uh, on the website and uh, you can interact with our social media content, Twitter and LinkedIn predominantly post to repost our content is really helpful and uh, fill out the survey this week, health.com/survey or just send me feedback [email protected] uh, love your feedback. It's very helpful. This show is a production of This Week in Health it for more great content. You check out our website at this week, health.com or the YouTube channel. Special thanks to our sponsors VM-ware and health lyrics for choosing to invest in developing the next generation of health leaders. Thanks for listening. That's all for now.