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June 10, 2022: Staffing and hiring is a real challenge for health systems right now. Chad Brisendine, VP/CIO at St. Luke's University Health Network shares his insights into this shortage crisis. What other big challenges are facing St Luke’s? How are they improving patient check-in and the overall patient experience? Does Chad spend time with the university to talk about their curriculum and what they should be focused on? What is it about the Microsoft tool suite that brings massive benefits to health IT departments? How does a mid-size health system think in regard to their innovation investments? What can they do to de-risk these investments?

Key Points:


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Today on This Week Health.

We tend to focus on things that will make a great experience that need to be connected and integrated. We don't allow there to be dysfunction. So I don't mind if we have a third-party, but the experience has to be connected. And it can't feel disjointed to the patient. And the same goes for our physicians. And if we can't, then can't make that work.

Thanks for joining us on This Week Health Keynote. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health 📍 leaders.

All right. I'm excited today to be joined by Chad Brisendine the CIO of St. Luke's University Health network. Chad, it seems like every time we talk my dad was in your hospital. My dad spent the night at one of your hospitals last night. And he's out today doing fine, but I appreciate the work that you're doing. And welcome back to the show.

I'm just glad you remembered to call me after talk to me after he has a great experience, you always seem to be doing well. And we're glad to have him and thanks for having me on the show.

I mean, it's getting to the point now where my mom doesn't even doesn't even call she just texts. Hey, your dad's in the hospital. He'll get out tomorrow morning. I'm like, it really is becoming that routine that it's not a big deal, but he

had our Anderson campus again.

Yeah, he was at Anderson and gosh, every time they go there, they just tell me that the construction that's going on there and whatnot. So you own a fair amount of property on that site, don't you?

Yes, we do. We have about a little over 500 acres. They're split up into two parcels, two 50 and two 50, but a really, really, really beautiful. We started out with a hospital there and we expanded it into an ambulatory surgery center and we have.

A whole walking park and we actually have an organic farm there, which distributes all of our fruits and vegetables to all of our hospital cafeterias and just a really great innovative campus with a really, and we build. And a 2010, so it's a fairly new campus, really beautiful.

And it just keeps growing with the community. At one point, there was a NAD in the EDS now being repurposed, and they're building a new ed two a and I guess all that was sort of in the plan, right. As it, as it grows.

Yeah. We have it kinda modular if you've been to enough hospitals with your background in mind no one ever thought about a hospital getting bigger and this, this is all been part of we think it's going to keep growing, but we wanted to start out small and eventually it can be however big we want it to be because of the way that they kinda modulate thought about designing it. And so it's really, really great.

There was a couple of times as CIO, I got lost in, in our hospitals. And I thought, man, that is a bad commentary, but, but they, they have grown over the years and like this building is connected to this building. This is connected to this and you just make a couple of wrong turns and you're sitting there going, this doesn't look like it's going to take me where I want to go.

Yeah, I think that was always the fun part of orientation for people taking new people to the hospitals. Let's see if we can get this person lost the next time

they were. And actually that, that church would've played on me as well. They ended up routing me down, down into the basement and around cause he said, oh, the conference room was down there. And that in my head, I'm thinking there's no conference room in the basement of this house.

When you disrupt up on the mezzanine floor you're in a bad spot.

I don't know what was going on. All right. So standard opening question. Tell us about St. Luke's

St. Luke's phenomenal organization. I've been here since 2009. It is a 18,000 employees, strong 3000 plus. Physician integrated delivery network across what we call the Lehigh valley, which you're very familiar with because your family's from here. And we are north of Philly about an hour, and we are west of New York city by two hours and a really, really great organization.

And we've been just expanding by 20% year, over year, over year. So that's been. No, a fun run. When I first got here in 2009, to give you a perspective on growth. We were 800 million in revenue and we're just sort of pass 3 billion in the last, whatever 13 years.

3 billion man. That's, that's amazing. When I, when I described the Lehigh valley to people, I used to say Bethlehem steel, no one really knows that because it went under so long ago.

But now I say Lehigh, Lafayette, and there's so many great colleges there. Moravian college. Amongst Muellenberg had bunks others. And eventually when I rattle off one of those colleges, they'll go, oh yeah, I know somebody who went to, to one of those schools. So those are all right there,

Lafayette. We have about to Devin and details, but we have 13 colleges all the way from D one to D three in the area, and we have internships slash co-ops in it and all of them. So it's really great that we have some much capabilities really, for those, a lot of it, computer science tech back now and engineering in the area. So we're very fortunate.

You have partnerships our relationships with all 13 of them from an it perspective. I assume that that creates a pretty good pipeline of it. Talent into your origin.

No question. I was actually just meeting with one one of them. We've got our interns summer interns in right now. So we hired juniors and seniors through the summer and through other parts of the year where they can each one of my directors in it takes one to two colleges, mostly one, and they all take at least two candidate for the areas. And then we, we tend to try to focus in on what we're trying to hire, like skillset wise. So it's a, it's a good process between HR and it to really create momentum. It's great for the students. And we really look for kids in their junior and senior year that are local, that want to stay local that are looking at health IT.

Do you spend any time with the colleges and universities to talk about their curriculum and their programming and what their, their training on?

Yeah, we do, depending on the school, but yeah. Different schools are very interested in. Modifying what they have. And, with your background see is a very evolving, evolving space.

And we talk about what we hired that aren't we hire people that don't have college degrees that have CS backgrounds, and we talked to them about what we're really looking for in those candidates. And so it's a good, good partnership between the school.

Not to tangent here, but that this whole staffing and hiring thing is a, a challenge right now for a lot of health systems.

One of the things I've been talking to people about is when, when you go through your list of IT jobs at St. Luke's, do you how many of those jobs require a college degrees? Of most of them, I would assume require a college degree.

We don't require college degrees.

Oh, really? So you, you feel like in almost in a lot of cases, you can train them to do the job that you're bringing them into this.

Yeah. I mean, it's preferred, but it's not required. I mean, I always try to, like, I like a blended team, right. A team that has a lot of different skills. So some of our teams are really, I mean, If it's fully a development team, you would expect there to be just pure developers on there, but even product people, sometimes that make sense to not be a developer, right.

You, I experienced, you don't necessarily need to be a developer. You can have learn that, learn that trait. So I really like blended teams is what I call them. And if you really look at some of our epic team a nurse right next to computer science right next to an analytics person, or they're all working together and huddling on problems and solving things together, even though they may all be epic.

Certified is that's kind of the dream team is what I call it. When you move, you're really mashing up these resources.

So, what, what are the biggest challenges facing let's talk about your healthsystem. What's the biggest challenges facing your house system right now?

Boy, I think it's the same one, everybody of this, as I'm talking to folks, but I mean, we're all getting kind of hammered with us, inflation, supply chains and issue. Although we're managing extremely well. And just the with inflation comes, salary costs comes or demand and increased in salary. And government hasn't been paying us more money. I mean, they did give us some money, obviously in the early days to help us out. And I think payer fair contracts are lagging inflation and it's, it's I think the challenge across every one of us is we're, we're seeing some downtime, I think across the industry, I think we're always used to see, it would be like, oh, we have a bad year and some organization will do well.

And some organizations wouldn't do well unless, and you could probably educate me better. Cause I know you've talked to, it's not a Fox, but I really see everybody really struggling. Right.

Yeah, on the today show, we just reported on some of that, the news station we were talking Kaiser, a billion dollar loss common spirit, half billion Providence, and these are operating losses. This is doesn't include the fiscal year, first quarter. Oh, I mean, these, these are large

organizations, billion dollars in revenue kind of

advocate. Aurora was a quarter of a billion, 250 million operating loss and whatnot. So but one of the things I talked about, talk about. For them, they have so many levers that they can absorb those kinds of punches.

When you get to a certain size health system and they're losing just $10 million a month, that's that that's cause for alarm, they don't have as many levers to pull and that kind of stuff. Talk about the winds. I mean, we have an interesting environment we're coming through a pandemic.

We have some rough storm, rough seas, I guess, as it were from a financial standpoint. So uncertainty with what the government's going to do with the public health emergency and those kinds of things. But we still have to get things done. What are some of the wins that you would point to over the last, last couple of years?

I think some people have described it the pandemic was more of a change agent than anything in the last whatever 20 years I've been in healthcare since 99. And we've moved the ball fast and every conversation, there was a lot less friction for the CIO is what I call it with senior leaders when we're talking about things and more, I think leaders in the organization stepping up when we need digital within spaces. And so I think one of the things we did. We came out with our digital strategy playbook about nine months ago. And it's just kind of a refresh of our it strategic plan. We just changed the name of it, to be honest.

And I know you've seen many pieces of that. So I think that's one of the positive things and we have some leaders very engaged on what that is. And so that's a positive we saw some flaws in our systems, if you will and areas where we knew we needed more digital systems of record, but we didn't have them, or we hadn't invested in those.

So. Those kinds of got brought to the top. I would just say like, I was just at the hospital the day. So we, we opened up a new hospital on the blue river you're familiar 4 76 carbon. It's a great, great hospital, 108 acres. And I was up there visiting today and it's we just opened up five months ago.

And within five months, we're already having to expand the ER, add more inpatient beds. But what excited me the most was that there's six pieces of technology that St Luke's is either the first or the second implementer. Now I'm not even talking about the product vendor. I'm talking about the capability in the country to deploy.

And it excites me that our senior leaders we're actually meeting with an organization that we're a partner of. I won't mention on the call. But there are health care organization, very large healthcare integrated delivery network in central Pennsylvania, you can look them up and we're partners with them and they were onsite and we were going through it.

And to hear our president, our COO talking about these technical capabilities as if they were the CIO was just amazing for me. So I think just seeing them not only go from pilot, but really try to get execution and really understand how those things are helping solve true business problems was it was a really kind of three hours of.

Very delightful for me to just hear them talking. And instead of me pushing and it's just that creates other problems as we don't bill when you get very engaged leaders, but I would rather have the issue of pullback and then try to push forward. And it's just, it's really great in health care to see that moment.

📍 📍 All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. 📍 📍 Not to give people another clue, but I did sit through a conversation that you and John Kravitz were having around the patient experience and patient check-in and that kind of stuff. And you guys were talking about some really fun stuff that you were doing. Give us an idea w what, what areas are you leaning in on?

And you're saying, Hey new hospitals sitting up on a 476 what are the things that you're saying, Hey, it is it consumer experience Is it clinician experience. Is it connecting the two? What what are you leaning in?

I really think it is the physical, physical with the digital. I really think that's our play right now that we're really bringing things together and making the experience better.

Whether that's from an outpatient workflow perspective whether that's making things more virtual altogether, whether that's from a console or. Bringing, bringing digital capabilities to our patients like there at the hospital. For example, we have this thing called tech connect and it's literally people, instead of having a gift shop, we don't have a gift shop anymore.

We have a bar genius bar. You can go in there and get technology, but also those people that are work that facility Round on our patients every day, they make sure they understand the technology, both the ones that we have capable in the hospital, as well as make sure that they're connected when they leave.

And so really making sure that not only did they have that experience that your dad has when he comes to a great campus, but making sure that stays beyond just going to your next physician appointment when you get there, that there's an experience in between. That experience that we can connect digitally.

And then when you come back to the physical, that that experience is great again, that the workflow process is great. And then when you go back to the you're not in our physical walls anymore, how do we keep you connected there too? So it's really that whole digital, physical, digital, physical kind of workflow.

if you will

Yeah. So you, you talked about a digital, I think the words you use where digital system of record is that accurate? Yep. So is that, so we have the the medical record and we can talk about that as the system of record, but you're talking about something that is the source of source of truth for the digital experience, the digital transactions that are happening at your house with some, is that, is that close?


So is that a system? Is that a suite of systems? I know you're one of those guys who's gone all in with Microsoft. whenever somebody asks me, it's like what else is some of you feel like has gone all in with Microsoft? At you, I think that's a fair, fair assessment.

Is, is it something where you're looking at a suite of tools like Microsoft offers or is there a specific platform that you're looking at?

Yeah, I think the answer, it, we use epic as our core system of record. As you know that clinically, we also have dynamics, which is a Microsoft 365 product. We have the health for cloud, which is an integration platform in there.

We use another company called Kensai and we use the full capability of the power platform. And we're continuing to expand all those capabilities together. And as bill, it's not ever one system, it's a system of systems kind of coming together and that's, that's our play. And I know other people are doing it with other competitors very similar in the space, but that's our.

why have you decided again, I think I'm fair and saying this. Why have you put so many eggs in the Microsoft basket? What have you found as you sort of headed down that path?

Well, it's like a saying that you should have five different EMR.

But that's not a good idea cause we, we had hundreds.

Yeah. So at some point you kind of wake up and realize that there's a lot of redundancy and things and the more redundancy you can take out. The less integration you have the better data you can manage data quality better. There's just a lot of redundancy and non-necessary work that can be done.

And that work can be moved more towards solving business problems, doing the frontline work versus kind of doing the middle integration layers and all that kind of stuff. So simplification and technology, architecture stack has been one of the core fundamentals for us moving from.

You talk about fundamentals and fundamental principles, which lead to the decisions on what what are some other fundamental principles you talk about slim simplification of that stack.

I assume that helps with training of people with reducing the number of tools you're using and those kinds of things. Are there other fundamentals that you're looking at right now that you, you just look at healthcare and you say, Hey we need to do these things in order to be prepared for what's next.

Yeah. I mean, we're always challenged with finances in IT so it's always got an economic side of it that as well is when you get scalability and then you get value there as well. So it's again, if you're not paying for five EMRs or three EMRs or two EMRs now, unfortunately it's just like early days, EMR, you wish it had all the capabilities to date it doesn't.

So that's an evolving over time, depending on the use case. Where you can really get to as far as how much configuration, if you want to call it versus true development or customization, but

how do you determine if you're going to wait for that? So Epic's one of those things that they have a roadmap. Microsoft has a roadmap, so to look at it and you go, well, okay, we're going to wait two, three years. Or do you allow a new system to come in because. In healthcare, we have our propensity to plant new systems all over the place until it becomes sort of unmanageable.

over time

Yeah, I wish I wish I had the best. I know what the best answer is, but I have a, another answer. The best answer is we know what processes in healthcare really should be differentiated and which one should be competitive advantage. And we really truly understand that in the business. And we determine the ones that are the transformational, and we make sure that those are.

The system that we can get in place to fastest to, to create that transformation. And as we go further into the stack where they're less transformational, we tend to rely on systems of record. And a, what I would just say is in the space, it's just a very evolving we don't have a pure1 Business architecture, if you will, yet in healthcare that I think is fundamental that we need.

But it is evolving, I think, into the business architecture side of healthcare. And I know you have a background in all that bill and so I would just say it's we tend to focus on. Things that will make a great experience that need to be connected and integrated. We don't allow there to be dysfunction.

So I don't mind if we have a third-party, but the experience has to be connected and it can't feel disjointed to the patient if it's patient facing and the same goes for our physicians. So we can make that experience good, common UI, or at least an optimal UI. that's Workable, EGS, SSO integration, et cetera, technical integrations, then won't allow that.

And if we can't, then can't work can't make that work.

Yeah. So I remember back in the day, I, I actually had this St Luke's app on my phone and would look at it. And you were constantly doing some really cool things around that he had a, you essentially broke apart part the parts and put it back together. Is that one of the areas that you consider an area for differentiation? is it experience, is it digital experience at this point? Is that one of the areas of different.

Yeah, it's definitely a digital experience.

And, and how are you doing that?

Well, I think that we have looked at some of our business processes that we think are transformational and we've made those customers where we believe that helps our patients stay better connected to us digitally.

And where we have it, we use epic and core Microsoft foundational capability. We're a third party vendor foundational, but where we need to create that custom development bill you've been in our stuff we, we're not, we don't shy away from that, but we're very thoughtful about where we might do that.

How are you able to maintain that code over time? Because that's one of the things that happens and the app goes back a couple of years. Now, do you end up with a lot of tech debt or do you just adopt the new things as they're coming down? If they come down from one of your platform vendors.

We just adopt from the platform vendor over.

Yeah, that would, that makes sense. Hey, you missed the interview this past week, a couple of weeks back, actually, with, with Joel vanco and Jeff Sterman, we had a great conversation on innovation investments and would love to have you there. But since, since I have you here, I want to talk a little bit about that $3 billion health system.

You do have innovation investments that you guys look at. And as, as did the, there two health systems, but I put you guys in the category of mid-sized health systems. and they both agreed with me that that would be a, an accurate assessment. When you get into the larger health systems, they tend to invest in maybe things that we considered venture and early stage and that kind of stuff.

And they can, can, they can afford to make those kinds of mistakes, but the mid-size. you're not able to make as many mistakes, I guess, with your, with your investments as some of the larger ones, just because you just don't have as much leeway. How do you de-risk those investments?

How do you, well, let's start with, how do you think about your innovation investments? How do you go about doing it?


been having a lot of conversations on this lately, because we did this pretty, pretty regularly and. When we I have a director of innovation reports to me and he, he laid out a really good framework for us.

In 2015, we kind of had two paths. One was project innovation where we pilot things, we could change management. We learned about technical capabilities, that kind of stuff. And D we have funding set up aside for that. And we have thoughts where we're investing in, in Chances and pilots and startups and partnerships will we'll make in those spaces.

Then we have the investment side, which is the side you're talking about. And what we said is we're going to go as a mid-size organization. I need to create some wins. So I'm going to go less risky from the beginning and work my way down to the bottom edge of that. And We, we don't have a big team as bill, when it comes to this or mid-size organization.

I don't have union mentioned some of the other organizations that I know are spending hundreds of millions of dollars and we're spending quite a bit. And if you looked at our total portfolio, like if you and I both had a thousand dollars, you'd look at this as, Hey, we can buy some Bitcoin.

You know what I mean? Every now and then, but we're not gonna buy that much Bitcoin. Especially where it's at right now. Maybe we should buy some more. Whatever we're going to take some very low calculated risks. That's not going to get a lot of so much momentum from the investment committee that they're like beating up the CIO every time that I come into the meeting, but more that it was more of a strategic play for us.

So we started out with later stage venture, private equity and then we did well and we've moved down a cycle to more of your. B rounds And now we're focused more on Seed to A and we have partnerships across all of them. And we actually have some direct company investments as well. Although we're not trying to create a massive fund where there's a hundred, a hundred direct investments or anything like that.

We're not trying to create a an additional chief investment office or officer, if you will, with an organization. What we've said is we need to align this with innovation because we get. Great relationships and partnerships with the startup world and with earlier stage companies and at multiple stages.

And in some cases we may be ready to tackle an early stage or startup company based on where, where it's at and whether our organizational alignment hits. that in some cases, it may make sense for us to follow them on through these organizations. And if you look at them a lot of, and I hate to say a lot of them are redundant, right?

If, if you get to a C level venture fund, they all have a a telemedicine company or two or three depending. But depending on the play with it. And so we, we get to learn, we get to learn as those companies grow and we get to have deeper relationships with those organizations. And that's really what it's been for us.

Although I have been reporting out positive financial returns on our investment portfolio and that always looks good. My CEO calls it to CB fund which has chapters. And then we've been doing well in that fund and that, that has been thoughtful with a lot of internal teams to help.

And that's not just me. It's been our legal. Chief legal counsel, COO CFO. A lot of those folks have been a part of our due diligence process to make sure that we do it right and do it well.

But that's part of your investment portfolio, right? As an organization.

But it's in Penn bill just to make, make this clear. It's been about strategic innovation alignment.

Yeah, that's what I was going to ask. So you're having conversations on the strategic side, you're looking at building out an experience for your for your clinicians or an experience for your patients or whatever,

or somebody has a great problem. And they're like, Hey, let's talk to St. Luke's about this. And then all of a sudden. Well, we need to do this. This has great ROI, or we didn't think about this problem. Let's do this. And so it's really the external ideas coming into the organization is where we've benefited the most. And so we do calls with these private equity venture firms, and we're very connected with them. Speed dial. All these conversations. And we do that. Not only just what the ones we do direct investment with, but just in general, that world is very there's a lot of tight relationships within that world. And they tend to pass good companies around to each other and have conversations with folks that are really interested in early stage. And so I think it's been really great for us.

The title of the CIO information officer are, you are you've mentioned earlier that you don't have another investment officer, but is there like an innovation investment officer that's part of your role?

It's been a great learning experience for me and I just having to learn about all that and I've, I've had some good external mentorship including board level mentorship as well as we've gone through it. And so It's not just me alone. Multiple people helping me.

We've got great, phenomenal people on our board that are investment people, their investment officers. They've done this in multiple areas and have helped us navigate and have conversations and internal, and we've got great. Great organizational risk takers to look at things and really know what the right answer is when we need to do it. And so it's kinda a really collaborative internal and external.

Do you have a do you have a digital officer or is that another role that you end up playing? Yeah. So give me an I, there's not a question, but give me an idea of your direct reports. I mean, so CIO, you have what reporting into.

Well, you're going to go in the it side and then

on the it side for now.

Okay. Yeah. So for it, I have communications, I have innovation, I have operations. I have security and I have finance strategy and I have informatics medical informatics.

Wow. Okay. And your it organization is, is how big at this point


Wow. That's that's actually, if I thought about it, it's comparable to what, but we were as a six and a half billion dollar organization, but it's comparable because we have this almost the same amount of employees. We had 18,000. Staff across St. Joe's all those hospitals. And you have about that many staff across your hospitals. It's just a different

California taxes baby

the other thing about it is you take one of our, one of our hospitals could literally have five times the amount of volume. that your hospital would but some of ours were pretty small. We were in Eureka, California. that didn't get a lot of volume up there, so you have different things going on. Where do you think CIO is, are going to be focused in, on over the next year, two years in terms of of their role and innovation in the it space?

Yeah, I can, can I answer that in a two parts? I think there's always the role of what are we doing with our back office in it. And I think a lot of the conversations I have bill, which we've implemented epic con Microsoft Azure. And I think a lot of CEO's are going to be either implementing or working on their plans for the cloud or trying to figure out what's next for their infrastructure. So I think. Near and dear

man, you, you do stay ahead. By the way. I think you were one of the first two in the country to put your now people have said, oh, we did the R, but you did your ops. Your operations are on Microsoft Azure for epic. So I think you were one of the first

and I heard one, there was a payer. I mean, if you look at health side, talk to the senior epic folks that think. They said as a payer organization, I'm dead not, I don't know how big it was. That was on. And then we had there was another hospital that was right before us. And then we, we finished up our full production, everything 20 out of 20 environments in 2021.

So we've been fully on, but I think, I mean, all the conversations I've been having with folks are just around the cloud and learning from that. And we've been sharing a lot on that with other.

What makes you be first or second? I mean, generally speaking, most CEOs are like, eh, you know what, let five people, 10 people go before us. Let's see how it works out. And then we'll do it.

I just had a lot of beliefs that there's, it was, there was a lot of reasons why we should be early and I was looking at ways to wait. We were kind of at a pivotal point. Did we go up the coast? Do we go to a third party? Do we replace the system, the data center and a good momentum from the team?

I think we all thought we needed to be in the cloud. We manage our own infrastructure. We do it really well. And we taught our teams, very Microsoft centric when it comes to tech stack and when it comes to engineering side of the world. So we felt comfortable, I think migrating there and our team.

I give you a quick example. Move some servers in 29, we had, before we got to epic 2019, we'd moved like internet servers out there. My chart, other things they're in a pandemic all of a sudden my chart blows out of the water on Monday when vaccines would come our team scaled it up in like seconds to whatever the capacity was like five X, the capacity was, they were like, all right, we gotta get epic on there.

Cause we keep growing by 20% and we do this like, so eventually it became their momentum. Then it became my moment. I was just, yeah. Kind of planted the seed and maybe began moving down the momentum. And we had a lot of the strategic work done with Microsoft to get us there from a security and all kinds of it.

My, my we, haven't talked about security by my team went all in on security with Microsoft and a bunch of other stuff that we didn't talk about. But you know, like you said, I'm, I'm all in on Microsoft and. I've talked to a lot of other CEOs about why E five licenses make a lot of sense.

So I just recommend if CEO's are on here or other organizations around here, I'd say take a deeper prodder look of what you could do, application rationalization on within your organization, within whatever stack you can do that in. And there's more than just epic. Out there. And I'm not going to say Microsoft or someone else.

I'm just going to say you should look at everything. And really, I think there's a, there's an opportunity there. The second thing I would, I would say kind of, kind of coming out and what's next. We have about seven areas where we're making kind of digital Dai digital innovation investments in, or we're more strategic on.

And I would just say AI, you've been, we've been talking about that for three years we've, we've been making slow, slow progress just like everyone else. And I think we're continuing to pivot on that. I'm seeing some really exciting use cases when it comes to computer vision and some, some other things that are maybe more in the imaging or image processing side of the world, maybe than just the EMR itself.

So I'm pretty excited just to kind of see what unfolds between now and the next time. Have this conversation, cause it's a pretty interesting from more of an innovation standpoint. And then I would say from a strategy standpoint it's really to try to take the power of what we built by Microsoft and keep expanding it.

And I hate to say that, but just keep eating up other pieces of software in the company that we have and then, and where we have holes continue to fill those in with strategic partnerships like we have and start up companies where, I mean, there's a tremendous amount of innovation going on, right. And many areas right now, and I'm very excited to continue to work with our, our startup companies.

And you really do have an application rationalization as a core fundamental belief. It's part of your, part of your ongoing strategy. I mean, if it can be, if it can be swallowed up the better, and I think that's how you're able to do something.

And with the team that you have, you have the agility of the cloud, you have just the fewer applications you have, the less complexity, the easier it is to share data so forth and so on.

We're not scared to work with the new company that has a piece of software either. So it's like I tell my team, we may be adding 40 pieces of new software and taking out 20, sorry.

Okay. Maybe 20 of the capabilities we're adding are way beyond that. So it's just this constant moving in and out. But as you and I both know the fundamentals underneath the stack are changing for all companies and that's really changing no what I've called dumb applications to really smart ones that make.

We thought could solve the problem in the past, but now can be solved. And that's, what's been exciting to me now, too, is to see these either the organizations take their existing software and make it smarter, where it actually solved the problem even more efficient than what it was trying to do in the past or a new company coming in to actually solve the problem that was never solved, that it should have been solved in the past. And I hate to put that all in so many words, but it's pretty exciting times.

Fantastic chat as always. Great to catch up with you. Appreciate your time. And. Keep up the great work and keep my dad healthy.

We will keep her dad healthy and great standing. Thanks for coming.

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