Darren Dworkin continues to lead the charge for innovation in healthcare. In this Discussion, we look at the intent and impact of the latest CMS announcements and we take a look at models for innovation. Hope you enjoy.
Bill Russell: 00:07 Welcome to this week in health it where we discuss the news information and emerging thought with leaders from across the health care industry. My name is Bill Russell Recovering healthcare CIO and creator of this week in health it, a set of podcasts and videos dedicated to training the next generation of it leaders. This podcast is brought to you by health lyrics helping you build the agile, efficient and effective health it. Let's talk, visit health lyrics.com To schedule your free consultation. Our guest today is Darren Dworkin the CIO for, Cedar Sinai in Los Angeles and just an all around. Nice guy. Good afternoon Darren. Welcome to the show.
Bill Russell: 00:41 Okay,
Darren Dworkin: 00:41 good afternoon bill. How are you?
Bill Russell: 00:44 Good. I'm sort of breaking the, uh, the premise here of saying good afternoon. Most people think we record these in the morning, but I recorded them based on the schedule. And uh, you've been pretty busy so you, you, uh, you just got back from himss and we're going to talk a little bit about that. Um, but one of the softball questions I throw out to start is, you know, what, what are some of the things that you or your team are working on that you're really excited about right now?
Darren Dworkin: 01:12 Uh, there was a lot going on, uh, which I think is no different here at theaters than anywhere else. Uh, we are, uh, constantly juggling of the ongoing optimazation and maintenance work, the ongoing growth and sort of new projects and trying to squeeze as much as we can in, in terms of sort of the new and the exciting. And I would say in that last category, which is generally what people sort of want to know about, we're doing a lot of stuff really trying to understand sort of that digital frontier and really what it means to, uh, for the first time really think about moving maybe a little bit away from enterprise software and start to think ourselves as in the consumer software business.
Bill Russell: 01:56 Interesting. Well we will definitely, we will definitely circle back to that. Uh, that as part of the conversations what I wanted to do with you since it's so fresh in our minds and we ran into each other at himss is this is going to be the final show where we take a look back at himss and hopefully put the whole event to bed. But, um, now just a couple of questions around himss. It was their anyone's presence or absence that surprised you from, from this year since show.
Darren Dworkin: 02:25 Um, you know, there, there was a few pleasant things I think that uh, we're finally seeing fewer and fewer Cart vendors and sort of desktop vendors and sort of some of the, um, you know, things that used to sort of occupy a, the show floor. Um, you know, a lot of the usual suspects there. Um, and I think maybe the, the new entrance that we're starting to see is a little bit, what I alluded to is folks that are starting to think about sort of that digital frontier and sort of that consumer piece. And so we started to see a few of those folks. I will say though, um, as a CIO for a large organization that it feels like we buy almost one of everything. Um, I'm always amazed at just the sheer number of vendors that are there. And I, you know, inevitably sort of maybe by isle 6,000 or so, um, start to scratch my head and think, how could it be that all of these companies exist?
Bill Russell: 03:25 Yeah. And you're not exaggerating when you say isle 6000, I had a meeting at one end of the floor to the other end of the floor and, uh, I think I put on at least 2000 steps just doing a straight line from one end of the floor to the other. So it was, uh, it was pretty big. So some of the people that did have a presence, a Google dramatically expanded their presence. Amazon did as well. Uber, Lyft, uh, you saw a lot of those, uh, those, I mean we have the traditional epic booth is I think in the same booth and Cerner switched up their booth a little bit, but it's about the same size. But those new digital players are starting to come in. How are you, how are you viewing that? I mean, how are you either, you know, thinking about, uh, relationships with them? Cause I know you guys have done a lot of announcements around different players like apple and others. Um, although we didn't see apple there, did we?
Darren Dworkin: 04:23 I don't think apple is a big show attender.
Bill Russell: 04:26 Yeah. All right, well that's, that's just one of those that was absent. But how are you thinking about those other players that Uber's the Lyfts, the, the googles, the Amazon, I mean, do you, do you feel like they're, they're coming with solutions at this point or are they still sorta, um, just selling the things that they have saying, okay, we've got a lot of really great tools and we're looking for partners who are going to help us to figure out how to apply this stuff.
Darren Dworkin: 04:54 Well listen, it's a big group that you described. I sort of have to put them in a bunch of categories. I think the Uber lyfts are easy to pair up against each other. I think they are, uh, I get the sense they're still trying to decide do they want to be a service provider to startups that will build on their platform or do they want to build their own software tools and directly integrate? Um, I think for now the answer is probably yes as they're trying to sort of figure out what that means. And you know, since I started with them, I'll pick on them first and I'll say that they are probably winding themselves through the journey of, wow, healthcare is a really big market. Let's jump in. And then somewhere in those first early stages of the journey, one realizes that, huh, a little bit more complicated and more nuanced.
Darren Dworkin: 05:44 Uh, I've gotten to row 6,000 and realize there's a lot of people to integrate with. Uh, and I think they're going to have to make a decision soon of how deep they really want to get into the vertical or whether they want to be sort of a supplier to it. Um, you know, some of the other ones that you mentioned, uh, I think there's such big organizations that they also subdivided. So Amazon, um, you know, it's hard to talk about them as one thing. Uh, AWS and our approach towards using AWS, we're big fans and we're big users of AWS I think is sort of one category. Um, you know, Amazon has, uh, made a few moves and sort of, uh, you know, uh, it's been alluded to a bunch of moves in terms of how they may play a role in the supply chain for hall of the Big Tech vendors that are talking about disrupting.
Darren Dworkin: 06:32 I have to say, personally, I can't wait for Amazon to disrupt the supply chain. Um, I think it's one of those things that, uh, will benefit a health systems providers and ultimately patients by bringing down costs. There's an awful lot of people that touch things on their way to the patient. And there's an awful lot of costs that gets added to that. Um, you know, with no inside fantastical knowledge, I would say that Amazon would be great in the DME space. They would be great. In sort of some of those areas that, uh, traditionally, uh, you know, needed some disruption. Obviously there's lots of rumors with their PillPack acquisition and what they may do and sort of the PBM space. But I think that's sort of a, you know, a wide open. And then the third category for Amazon is around, um, you know, what they're doing with voice and Alexa and I think that sort of represents sort of another area.
Darren Dworkin: 07:24 Um, and then, you know, finally some pretty exciting from them are on medical comprehend and what they may do in sort of a NLP. So, you know, it's different strategies with different things. But what we're trying to do is get focused on the things that we can make use of right now. And probably the, you know, everybody likes the word, so I'll use it. Uh, the best disruption that we can take advantage of with Amazon right now is really leveraging as much as we can in the cloud. Um, and frankly in that area, it's not even the most exciting things. Um, some of our biggest projects in the cloud is to look at the myriad of a legacy systems we have. Um, we have to maintain for various regulatory reasons or other, uh, sort of a complicated scenarios and seeing if we can sort of move those and just reduce the cost of operating. Um, so, you know, it's, it, it varies and I, you know, similar sort of story with Google, similar story with apple, similar story with Facebook and on and on and on.
Bill Russell: 08:25 Yeah. They, they are really big companies and you have all the benefits of the scale and the resources that they're bringing, but you also have, they're big companies and they're silent. The, for all the, the appearance from the outside that it's, you know, a single entity growing in the same direction. Um, anytime you put, you know, 100,000 people in an organization, they tend to form silos and head off in different directions. So sometimes it can be hard to navigate those companies and how you get the best results out of them. I would, I mean, that's been my experience. Has that been your experience as well?
Darren Dworkin: 09:03 Absolutely. And I think that, you know, frankly, a lot of times these companies are coming to market in a, as much of an experiment, experimentation mode as early stage companies. And we sometimes just confused because they're so big and because they're so well capitalized that they must know everything. Um, and I think that, you know, they have an amazing capacity to learn and to invest resources. Uh, but you know, they're very much sort of feeling their way around the ecosystem. And I think, you know, the interesting part is that those vendors that are in health care and sort of the, you know, the anchor tenants of the himss floor that we were referring to, um, you know, they've long learned that healthcare is not one thing. And the, you know, it might be easy to say that it's this trillion dollar market that you're going to sort of enter, but you know, you start by dividing it into Pharma and payers and providers and then, you know, we love to focus on the provider side, but then you take the provider side and you put it into hospitals and sort of the rest of the system.
Darren Dworkin: 10:04 Then you take a look at hospitals and you split it all academics and you split, um, you know, sort of the community hospitals. And then if that wasn't bad enough, you have to start looking at sort of what core systems they have. And they'll have a different it approach if there are an epic shop or a Cerner shop or a Meditech shop or an Athena shop. And so, you know, the hard thing for these companies is they're used to launching businesses that move in big blocks that are billion dollars in market size and you know, can move their needle. It, you know, once you start breaking it down, I think that what they start to realize is that it's not always as interesting as it appeared and while they still maybe want to play a role, um, I think that they often realize there's maybe a better role for them to step back and have other companies sort of work on their platforms and their ecosystem.
Bill Russell: 10:50 Yeah. So you've been one of the, I'm sorry I'm going after this easy stuff to talk about, but um, you said supply chain for Amazon and I was like, yeah, a core competency. That's, if they were to ask a hundred healthcare leaders Hey, can we help you with, with this space? They would probably get a responsive yeah. If, if you, if you would attack this, that would be great. But I feel the same thing's true on the, um, the consumer experience side with Apple. And you know, you've been one of the early adopters for apple, one of the early supporters of almost just about everything they've done in terms of the watch, in terms of uh, the, the uh, medical record and, and the things they're doing, those kinds of things. Um, but if we could focus apple on the experience on being able to uh, you know, remove the friction, I mean, I think that would be the, the area for them. Would you agree with that?
Darren Dworkin: 11:47 Yeah, absolutely. And there's no doubt in my mind that, uh, you know, the expertise and prowess that they have and you know, consumer experience and understanding how to sort of delight their customers is something that we could and should take full advantage of. But at the same time, you know, you can't get lost in the fact that, you know, what apple is really good at and you know, my sense of what they want to do more of is figure out how to apply that to consumer tools. I think the rumor is of a a, what is it a Jim Cramer shared with us that apple was going to buy epic. Uh, I doubt they have an, besides the fact that epic will never sell, as you know, many of your listeners will, well, know, I don't think apple has any interest whatsoever in jumping into deep enterprise software space. I think that they recognize their gift is how to serve the consumer. And I think that they're going to add a Patina and series of functionality around that that frankly I think their personal health record is a great example of that. And you know, they'll probably continue to thrive in that area.
Bill Russell: 12:58 Yeah. When I read that for the first time they should have been smacked. All it would've taken was a simple phone call to anybody within health it and they would say, look, if you know the leaders of that company, you know, they're not going to sell. And that's number one and number two name an enterprise applications, enterprise software solution that apple really has done well with it. And you know, you just, that has not been their focus since, uh, since Steve Jobs came back it has always been on the consumer and all that experience and what can we do with the consumer. So I it, and that was fascinating. All right, let's go. Let's go back into the show. So, um, so let's start with the kickoff. So, uh, you know, Cris Ross' kickoff of the himss event I thought was, uh, was phenomenal. I mean, he shared about his, uh, I, I thought it was a great display of leadership for him to take the time in between his treatments on Stage three cancer, uh, to come in and really provide context to the work that we do within the industry. I assume you caught that, that opening event.
Darren Dworkin: 14:11 Absolutely. And Chris, a dear friend, I have to say, I'm, I was humbled to hear his, uh, his opening and I think a great reminder to all of us, frankly, of why we pursued careers in healthcare and why we sort of do what we do. Um, and just frankly, you know, the ability that he had to sort of convey his messages was, was, was quite moving.
Bill Russell: 14:38 Great context for the whole show. I have this whole heroes of healthcare thing and to have someone who, who is a hero of healthcare and is also on the other side right now, uh, and probably one of the best places in the world to receiving care. So he's very optimistic and, uh, you know, we wish him the best and, and, uh, and, uh, just Kudos on just a phenomenal job taking it off, but the next day, so I wanted to talk to you a little bit about this because you know, some of our friends are up on stage. They're talking about you had Karen Desalvo, Aneesh Chopra, governor Leavitt, Seema Verma? They took the stage and they talked about information sharing within health care and how we're ushering in a new era of innovation, uh, because of the information blocking rules, uh, that CMS had come out with and, uh, including the, including the payer data as well. And now making that available to a consumer initiated request, but making that available to the consumer. And the premise is essentially that, uh, we could now see a whole new generation of data aggregators and people who take that data and data stewards really who take that aggregated data and, uh, provide intelligence and insight onto it and provide value to the healthcare consumer moving forward. that's the premise. And I wanted to talk to you about the intent and really the impact of, of that announcement from, from your seat and from your perspective.
Darren Dworkin: 16:15 Well, first I think the, uh, the impact cannot be underestimated. Um, I think it was a big announcement and it's going to have some big effects, uh, in terms of what happens going forward. For no other reason then that, you know, all of those vendors that were on the show floor at himss are probably now going to redirect much as they did with meaningful use, a large portion of their r and d development and sort of opportunistic time, uh, towards meeting those new regs and regulations. And I think that they're not insignificant. And there's sort of a lot to do. That being said, you know, I think that I'm still trying to digest them. It's a thousand pages and I wish I could tell you that I've made my way all the way through it. I paused for a little bit and alternating between reading and skimming and reading and skimming and skipping.
Darren Dworkin: 17:11 Um, ultimately I think, you know, I, I've gotten a little bit of the gist of it and uh, thankfully, uh, lots of folks who have published some really good commentary, but you know, it, it's an interesting set of regs at a high level, frankly, as, as a consumer, I'm unbelievably pro the idea of making information available. I think it's hard to find folks in healthcare, uh, that sort of have a mission orientation and would say that it's their data and they won't share it. I think, I know there's lots of that gets sort of covered around that, but for most folks, the intention is, is pretty much there. I think the hard part's going to be what does it all mean and how do we do it? Um, and you know, I always worry about when government regulation is put in place, um, you know, it has to by definition move the needle or move one or two things forward and it ultimately, you know, can run the risk of unintended consequences as you know, sort of the implementation to finds an equilibrium.
Darren Dworkin: 18:17 So I'll give a couple of examples. You know, when, you know, in the regs they talk about releasing all data that's in any certified Emr, um, that's different data across different Emrs, and by the way, do you really need all of that data? Um, do you really want all of that data? If you've got all the data, would you even know what to do with it? Do you get to a point where maybe too much information is just as bad as not enough information? And so how are we going to sort of translate that and sort of open all of that up? Um, but you know, as a whole, um, you know, I think that Cedar's generally has tried to adopt the philosophy of we'll make information available anywhere at any time and in whatever format you want. Um, what I love in theory about this is that it takes an organization like Cedars Sinai and says that if our patients one access to our data, and increasingly we're starting to see that happen, then they ultimately have a choice of how they do that.
Darren Dworkin: 19:21 We will provide tools for them to see the data and interact with the data and hopefully they'll find our tools delightful and want to interact with our data in our tool sets. But if they don't and they want their own tool sets or they want to do different things with it, they can take their data and you know, work with that in, in different formats in different ways. There's some great altruistic ones, like I want to download my data and donate it to science for research some wonderful stuff. Um, some of them I frankly worry a little bit about and that, you know, what happens when a family member of mine, uh, decides to download their data, which paranthetically has a large amount of family history, so indirectly information on me and chooses to sell their data for whatever purpose the individual wants to use it for.
Darren Dworkin: 20:14 But they're just happy to get the data. Did I really consent to give my data? How does that work? And I think that, you know, we're going to have to figure out sort of some of those things. I'm not saying any of that that it should stop us from moving forward, but you know, I think that, um, the unfortunate part is I think there's a 60 day comment period. Um, and then there's a relatively short implementation period. This is going to be a little bit of a trial by fire. Um, and I think we're all going to have to sort of hold onto our hats a little bit is just starts to roll out.
Bill Russell: 20:48 Yeah, it's a, it's really complex. The example I always used on this for a government reg is the transparency rules. So transparency rules, but you have to publish the prices of things. And I, I was wondering how this sort of played out. So I hit a couple of sites and it's not the easiest thing to even find the numbers on them, but you know, they're there. So you find them. And, and on some of them either literally download a spreadsheet with, uh, you know, a thousand items on it and you have to determine which kind of Mri you got to see, you know, what the PR or you're going to guess to determine what's the price. And I think what people don't really grasp what a, what a consumer doesn't grasp with somebody who's not in healthcare and healthcare it doesn't grasp is the information that's in that, uh, in that medical record is extremely complex, not easy to digest for the average person.
Bill Russell: 21:45 And, uh, and it's, and it's, it's fairly nuance between, you know, this kind of Mri, this kind of Mri, this kind of Mri. And so you can't just say an MRI costs this. Um, because I mean, cause there's, you know, you know, the charge master as well as I do, there's, there's millions of items in there and, uh, and the intent of a rag and then how it gets implemented. I'm sure if you went to Sema Vermin and said, hey, there's spreadsheets out on people's websites and they sort of look like this, she'd say, all right, it's a start. And that we hear this a lot. That's the start. That's not really what the attention was but that's a start and I think what you're saying is we're going to see the same thing here, which with a lot of different interpretations of it and a lot of different implementations of, of the uh, this particular data of blocking and sharing reg.
Darren Dworkin: 22:34 Yeah. And I think it's going to be one of the sort of incremental journeys that people discover. And A, and I'll go back to apple because I really do give them lots of Kudos for what they did with apple health. What we really loved about it and ultimately the reason why we sort of raised our hand and you know, went first with them, was that, you know, there was lots of folks that were asking for their data to quote unquote download it. So we did that a while ago. We made that available at our patient portal. You can go in, you can, again, as I said, hopefully you find the experience on our port of delightful and you want to view your data within there. But if you don't you can hit the download button and away you go. But if you hit the download button, it was sort of disingenuous because we gave you an XML file and I don't think patients, you know, wake up in the morning and say, you know, what I really want is an XML file of my data.
Darren Dworkin: 23:24 Um, and so what apple health it was, it gave you a vehicle to really sort of use it. Yeah. And it was also great cause it use, you know, standard based API Apis, fire, blah blah blah blah. But you know, what it really did was it gave the consumers a taste of what they really wanted, which was I want my data and I wanted in a usable format that I don't have to figure out how to consume. Somebody has figured out how to sort of give it to me in a consumable way. And I think we're going to have to figure that out with a lot of what, um, you know, in, in sort of these regs and sort of in these pieces. I think that there was a lot of silicon valley influence in those regs. And I say that from the perspective of there was a lot of VC backed companies that I think felt like they couldn't get their applications to get data.
Darren Dworkin: 24:15 And so that became synonymous with patient rights of getting data. I'm not sure those are exactly aligned in what patients are sort of looking for. They might be but I'm not sure they are fully. Um, and as the, some of those things sort of play out, it'll be interesting to see what people really want to use. And as you know well and you know, your listeners know well you know, what will really be fascinating frankly is what percentage of patients really choose to engage in this information and what they really want. I mean, I don't know the national numbers around patient portals and we can knock them cause we can say maybe the patient portals aren't perfect, but that's just part of the problem. Part of this is that patients aren't engaging in some of the information that's available to them. So it'll be interesting to see who are the early upticks of this. And I suspect it's going to be more third parties then it's going to be patients themselves that are after some of these API connectors,
Bill Russell: 25:20 right? Because they're going to make meaning of it. Right. The old adage of mint, the mint of healthcare. So it's not like I can't get all of the information that's in mint from each one of my banks and my brokerage and everything else. But what they're able to do is pull it together and give me one view to it, uh, give me a nice budgeting charting and all that other experience. But that's what I expect and hope will happen in healthcare. Not that somebody is getting my entire medical record, but somebody who's helping me with diabetes is, you know, getting that portion of it and presenting the data in a way I can consume it. Because, you know, just, uh, you know, I'm glad that you handed people in XML file, that's a lot better than what, what the alternatives are. But you know, it used to be we were carrying around a stack of papers that it was, you know, a blue button kind of thing of here's your medical record, which he can't really do a whole heck of a lot with to Hopefully we'll get these data stewards, which are in between the, um, the health systems and the payers and the consumers that can create, I dunno, uh, just meaning from all this data that can help me to live a healthier life. I think that's, that's the, that's the goal of patient centric interoperability.
Darren Dworkin: 26:34 Yeah, I agree. And I think the inherent challenge in that, uh, well I'll say it this way, um, when that eventually gets solved and I am optimistic, we will get closer and closer to that. When we look back on the journey, uh, my opinion is that the ability to get the data, which is really what the announcement was all about, is going to have been the easy part. The really hard part ahead is how the heck are we going to normalize that data and make a what is today, um, you know, esoteric configuration that exists in each of the different systems somehow matching. And you know, the old joke in healthcare is we like standards so much. We have many of them. Um, you know, but so we're just going to have to figure out how all of that stuff is going to sort of come together.
Darren Dworkin: 27:25 But again, I don't mean this to come across as sort of negative. It has to start somewhere. Um, and so I think that this is a great place. Um, I just hope that it continues to take, uh, um, an orientation that's really about the patient being able to get their information so, they could ultimately be a custodian of their healthcare. What I worry about and there's some language in the regs are in the, in the draft regs did allude to this is there's some real interest in making these APIs rights as well. And I think, um, you know, a lot of that language feels like it was around trying to level the playing field from a vendor perspective. And I'm not sure that was a, at least in my opinion, the main um, uh, effort of what these rules really should have been.
Darren Dworkin: 28:21 I think if they stick to these idea of empowering, enabling patients, I think it will be hard to get too far off track because it's a good true north for us to focus on. Uh, but if they start to drift into everybody's system has to be open to everything from a read and write perspective. Um, you know, I start to worry about it and I just don't know how we're going to maintain not just normalization of the data but then ultimately integrity of the data as we all have to start to police what everybody is doing.
Bill Russell: 28:54 Yeah. I want to shoot, So we do this thing called soundbites and I want to shoot four quick questions to you. I'm looking at our time. We should be. All right. So the goal of this is really to have just a quick back and forth. Um, so you have an accelerator for innovation, for innovation in health care that you have at Cedars. Uh, it's been widely published and uh, you've had a fair amount of success with it. So you just opened class number five. Can you give us a little preview of what class five is a, is focused on?
Darren Dworkin: 29:29 So the best part I can tell you is we do not know yet. Um, the most fun part of the way the accelerator is sort of built a specially sort of as, as life as a CIO is I spend a ton of time as a CIO picking and being involved with leadership in core systems that, you know, to use shorthand around it. We pushed back onto the user base. The accelerator is the exact opposite. We have a great team that figures out how to take this massive funnel of companies that are applying to want to innovate in healthcare. We do all the diligence we need to do to make sure that they're all viable opportunities. And then we take those companies and they all present in about a seven minute video session to a team that we call the selection committee, which is made up of clinicians and administrators and all sorts of folks from it around Cedars.
Darren Dworkin: 30:22 And we just watched them go at it. And when they turned around, they say, I need that. I want to play with that. I get to, um, suspend my normal CIO, uh, challenges and I just get to be in the yes business. And I say, that's a great idea. You should work with them. And so we, you know, we, we really do let, um, sort of the users of the systems, whether it's in the clinical or administrative or business area, really sort of drive, you know, what, what they want to work on and where they sort of see the white space. And so to me it's the, it's the most fun thing.
Bill Russell: 30:57 Wow. So we've seen a lot of different innovation models within healthcare you have accelerators, incubators, you have internal innovation arms, you have external innovation arms. So, you know, you chose the accelerator model. Why did, why did you go that route? I mean, it's exciting what you're talking about because, you know, it's, it's uh, you know, it's, it's pool. I mean, essentially the organization, it's, it's, they're, they're telling you what they want to work on, which is a phenomenal model. But why that model versus one of the other models that's out there.
Darren Dworkin: 31:31 So first, let me start and say that, uh, what we really started with a, which was sort of ahead of the accelerator, was we have a rich history of technology transfer and really supporting our faculty and the unbelievable ideas that they have and helping them to commercialize and bring to market. You know, those, those ideas, those solutions, frankly, those sorts of health discoveries, that wonderful things that are really sort of transform how healthcare is delivered. The new part is in looking at outside innovation or innovation that was on the outside, recognizing that perhaps we didn't have an exclusivity on good ideas. How could we help those companies really sort of get to the next level? And what we really discovered in talking to them is that the best and the brightest and entrepreneurs, we're a little bit intimidated by healthcare. Um, face it, it's a little bit of a black box.
Darren Dworkin: 32:26 It's not really clear exactly what goes on. And you know, we were sort of scratching our head of why are some of the best and brightest building more social media apps and more games? There's nothing wrong with social media apps and games. The world probably does need more of them, but wouldn't it be even cooler if we got some of those folks to want to solve? Not just problems in healthcare, but problems in health care for like acute and chronic patients. I don't think we needed another band, uh, for somebody who's super well to be even more well and perhaps, you know, beat their personal bests in a marathon. Again, there's a place in the world for those things, but I'm not sure that a health system like cedar is needed the help to propel those. So we picked, we picked an accelerator because we truly wanted the companies to get this 90 day intense period to accelerate their idea and see what happens.
Darren Dworkin: 33:23 And by the way, for some companies they realize in 60 days or 90 days and oh my gosh, this wasn't a good idea at all. We need to go do something else. And you know, while it's easy to sort of talk about that sort of, you know, a at a high level sort of after the fact it's painful for the companies to go through. But you know, they turned around and they told us later and some of them are our biggest supporters and our biggest sort of mentors in, in the network that we've built that they otherwise would a toiled around for two years before they figured out it wasn't the right market. Obviously there's plenty of that, you know, we've helped sort of accelerate them and propel them by giving them direct access to, you know, quote unquote what is the wet lab of cedars and they really can sort of understand what they need to do.
Bill Russell: 34:08 So you have an investment. So Summation Is your investment arm, how should healthcare be thinking about their technology investment arms? You know, what's the end game, um, you know, standalone entities, new revenue stream. I mean, what's the purpose of the investment arm?
Darren Dworkin: 34:29 Yeah, listen, I won't, um, you know, try to sort of share why all of healthcare should sort of think through investment in sort of one way or a different way for us at Cedars. Um, we were trying to solve a couple of things. Number one, I'm going back to my, you know, story of, you know, the world has lots of social media apps and wellness apps for well people and games and things like that. You know, there wasn't a large amount of early stage VC funding for companies that were going to, you know, solve problems in the chronic acute and provider delivery market. And so you know, one of these things was providing access to capital to let some of these great ideas sort of be there. The second is we absolutely, absolutely above all else consider this to be a strategic fund and so if we see the next amazing idea but it's not something that we would use, we pass it on to other folks who are in the business of traditional venture capital or traditional private equity.
Darren Dworkin: 35:35 What we are investing in are things that we know that we're going to use and not only are we going to use them, we intend or we imagine we would be a fairly large customer of them. I think of the venture fund as an extension of our working capital just applied in a different way, in a different day and age in terms of how quickly innovation is moving through it. Right now. I wish frankly that all of our needs can get solved by going to a show like Himss and buying the best of the three vendors that has a fully baked out solution that solves all of our problems. The challenge we have is that not all the problems we have match up against those vendors. And so how do you sort of create a market for ourselves? And that's really what we looked for the venture fund to do.
Bill Russell: 36:26 Yes. Fills the gaps. So let shift gears, only slightly here, but you're looking at a lot of different companies. You're seeing a lot of different companies. You're up in silicon valley, you're talking to people. Uh, where do you see digital really transforming the patient experience, that specific area, the patient experience, uh, in the next, I don't know, 12 to 18 months, let's say.
Darren Dworkin: 36:48 Definitely blockchain. I just wanted to say that, um, know I think it's going to be in the, uh, reduction of friction of interaction maybe said sort of more simply. Um, I think it's going to be around service and I think that you know, what's happening and we're seeing it is that more and more of our patients are sort of expressing to us, listen, the care you provided was wonderful. We are grateful. We appreciate everything that sort of, you know, was delivered to us. But boy, if it didn't feel like so much like the DMV, that wouldn't be so bad. Um, and, and how could we figure out how to cover some of this service and access pieces that are often the first few steps into the healthcare journey and make those, you know, the trendy word to say as frictionless as possible, but really frankly, how do we pattern match them to make them the same for our patients as they are on the rest of their lives.
Darren Dworkin: 37:55 And so, you know, we have whole segments of patients that can't remember when they last, if ever picked up a phone to make a restaurant reservation, they might not want to call to make an appointment. They might want to be able to expect to do that sort of online. We have lots of reasons why that can't happen because we have 137 different appointment types and it depends what your prequalifications our insurance, but all of that stuff, um, candidly we have to start to approach as. That's our problem. We have to figure out how to simplify that. It will never be as easy as open table. But at the same point, there is a heck of a lot of room between open table and what it is today. Uh, calling to make an appointment in the average health care system.
Bill Russell: 38:43 Darren, thanks for coming on the show, you know, the first time we met, I think it was on a panel discussion and I was new into the health care and I thought to myself, oh my gosh, I am not gonna be able to do this job. This guy is so smart. I don't even know what I'm doing on this panel. Uh, and then we got to sit down and have coffee and I realized, uh, you know, you were like, Hey, my experience is your experience, how can I help you to be successful? And I've always appreciated that. And uh, and I'm glad to be able to share just some of that, uh, experience and knowledge with, uh, with our audience. So thank you again for coming on the show.
Darren Dworkin: 39:19 Bill. You're very welcome. A very kind of you to say and, uh, you have done your own remarkable things in paving the way for us. So I also appreciate it.
Bill Russell: 39:29 Well, thanks. So this show's production of this week in health it for more great content. You can check out the website at thisweekinhealthit.com or the youtube channel @thisweekinhealthit.com/Video. Thanks for listening. That's all for now.