Aneesh Chopra Imagines a World Where Health Data Flows Freely, Securely, To the Point of Care

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 Welcome to this Week in Health It where we discuss the news, information and emerging thought with leaders from across the healthcare industry. This is episode number 11. It's Friday, March 23rd. Today, we imagine a world without clipboards, a world where the patient has access to their complete medical record, a world where data is working for you while you sleep, to diagnose problems before they happen.

A world that unfortunately doesn't exist yet, but we're closer today than we've ever been. Uh, today we talk about what makes that a reality, data liquidity and interoperability. Uh, this podcast is brought to you by Health Lyrics, a leader in moving healthcare to the cloud. To learn more, visit health lyrics.com.

My name is Bill Russell, recovering Healthcare, c i o, writer and consultant with the previously mentioned health lyrics. Today I'm joined by the Preacher on Fire in reference to his favorite topic, and you like that and the nature of, uh, the meetings that he holds. The first time we met, I was asked to be on a panel with uh, Aaron Levy from Box Lee Shapiro, formerly Allscripts now, uh, seven Wire Ventures.

Uh, and this man former c t o of the federal government, , the room was filled to capacity. My heart stopped for, for a good 20 seconds . Uh, but when Anish Chopra leads a meeting, uh, it is a community building experience. We started on, on one topic and, and soon we were feeling questions, uh, about all things healthcare.

Finally landing on, quite frankly, some of the same topics we're gonna be, uh, discussing today. Yep. And, uh, and I'm really excited to have. President of Care Journey, former first c t o of the federal government, and, uh, my good friend, Anish Chopper on the show. Good morning, Anish. Welcome to the show. Good morning, bill.

Thank you for having me and for your leadership. Uh, thanks, thanks, thanks for your leadership as well. This, this could end up being a lovefest. You one of my favorite people in healthcare, . But we're gonna get, we're gonna get, we'll get there real quick. You know, last week I had, uh, uh, Hal on the show and he was very pragmatic about this topic.

It was, it was a lot of fun. Uh, but it was really hard to do his bio. His bio goes on for days. It's the longest bio I've ever seen. . Um, I just, I , I, I met him on a, on a shuttle bus, 1997. We used to ride the bus together when he was a graduate student at M I T and I was at the Kennedy School. Very small world.

So you guys are, have been really good friends for a while. Yeah. I consider him a brother. He is a man. Yeah. This'll, this'll be, this'll be good. I, I did ask him if there was any special question I should ask you. And, and he laughed. , but , he didn't come up with one. So, um, yeah, I, the great thing about your bio is it's short.

I got it from the, uh, Washington Speakers Bureau, uh, website. So, uh, visionary technology, thought leader, president care journey, uh, chief Technology author, officer of the United States, 2009 to 12, author of innovation state. Uh, the new technologies, how new technologies can transform the government. We'll touch on that a little bit.

Uh, yeah. And, uh, it goes on to say a couple other things. You don't, you don't want me to embarrass you with your accolades? We're all good. We're all good. Let's dive in. Well, you know, and I, I, I appreciate it. Uh, let's see. So one of the things we do is, uh, with every, um, with every guest as we ask them, is there anything you're working on right now that you're, you're really excited about and.

You know, we're gonna talk about interoperability, we're gonna talk about fire, we're gonna talk about stuff. But is there, is there anything outside of, talk a little bit about care journey. What are you doing there? Yeah. Well my, uh, I would say my passion right now is making sure that we extract as much clinically relevant insight out of the data we're organizing for population health.

So we had this kind of journey in the first, uh, chapter of, uh, population health where everybody was trying to learn the language of the insurance industry. What is my spend rate per thousand or utilization rate? How is my, uh, spend for risk adjusted patients looking like? And physicians often have their eyes glaze over, like, oh, are you kidding me?

This is not a language I particularly care to learn, but the power in some of the version, uh, one of all of these, uh, population health programs is that. We had access to patient's longitudinal claims history, and if you use the same data asset, uh, and reposition it for use around clinically relevant insights, which patients should be eligible for certain care protocols that are more population based, that they haven't been, who should be enrolled in diabetes prevention, who should get a care transition visit?

These are, uh, opportunities where clinicians engage more directly because it helps 'em think about their patient population in a way that is more relevant to them. So my passion is just to grow an open community of algorithms and other methods to identify which patient segments should get which care protocols, and to help encourage folks to deploy those and measure their impact over time.

So that's what my passion is these days. Uh, that's great. That's great. And, and, uh, actually you educated me somewhat on that when I was at St. Joe's. Just the, the amount of data that we had access to, I, I really wasn't aware of, uh, until we sat down and had that meeting. So it was, it was really, uh, really helpful.

Uh, okay, so this last, um, this the, this is the last week. We're gonna deviate from the show's format. We, you know, yep. We generally have a format where we, we go back and forth on the news, we talk about leadership or tech, and then we, uh, close out with a, with a social media post. Do you have a social media post or something for this week?

Sure I can make one. We'll do that when we finish. You do what Halamka did. He just shared his last post, which works well. Um, if you haven't checked him out. Uh, David Baker and I reported from the HIMMS floor, John Halamka and I talked last week about, uh, machine learning, the role that, uh, c i o and things from HIMSS and, uh, And this will be the last week.

We just dive deep in him. So we are gonna try to make sense of a lot of stuff. So yeah, my Healthy Data blue button, 2.0 53 million Medicare patients. Uh, not a lot on Teca, but we'll talk about it. Fire. Yeah. Uh, we're gonna talk, we're gonna go back and forth a little bit on, uh, spoken Joe Biden's, uh, response.

Uh, yeah, pretty good, pretty, uh, substantive article, um, that I'm gonna pull up here from Fortune. Uh, We'll, we'll check about that. Um, and, uh, we'll talk a little about, a little bit about, uh, RA's new role, uh, shepherding, uh, yep. The VA on the open, a p i initiative. So if you are ready, let's, let's start with a quick history lesson and, uh, so you appeared on The Daily Show with John Stewart and you I did.

You've now completed the, uh, the trivia question of what guest has appeared on both the, uh, daily Show and this week in health. It. Um, , but I, I did, I did watch that he grilled you on this, uh, really on this very topic, um, on the va, on on the va. Do you remember what year that was? Uh, 2014. 2014. All right. So, um, let's talk about the state of things and, and, and, right.

Uh, well, actually, let's talk, let's go back to 2014. Yeah. Tell us what you found in the federal government on this topic of interoperability and, uh, yeah. And then I'll talk a little bit about what I found because I came into healthcare for the first time in 2011. I'll tell you what I found with my experience from other industries.

Well, I, I would say, uh, there are three things to take from government. One is the initial trajectory of moving, uh, health information exchange forward. Carried beyond just the Bush administration through the Obama years and even now through the Trump years in a manner that was harder to deviate once launched.

That is to say we built a kind of an initial use case around business to business models for health information exchange, and we put a lot of resources behind that model. Even though we started shifting the portfolio a bit in the Obama years, the, uh, new directions didn't have as much . Capital or, or investment plan behind them as the initial theory of B two B exchange.

So point number one is you launch something in the government, it has kind of a life of its own and it carries in a big, big way. Uh, point number two, the federal government can be both an enabler and a constraint on some of these issues, and we can talk a bit about that. And then the last piece that I think was the, um, lesson I wish I had learned earlier in the process.

Was that if we found a way to get through the clutter and said, let's go straight to the patient. If we had figured that out earlier, we might have a slightly different, uh, architecture for the healthcare delivery system today. So that's a little bit of a somewhat historical bummer that we, and I, I take personal blame on a lot of it because we shepherded a pretty significant $37 billion investment because it was tied to the recovery Act.

We had to get the money out the door faster. Which meant the ability to shift the allocation of those dollars down the road became more difficult. I think you and Halem, you got into some of that, which is now that we get to the final stage of meaningful use or the old meaningful use, the dollars left or less, but the change is hard, and so you've got this disconnect and we can get into all of those things if it'd be useful.

Yeah. And you know, my, my entry into healthcare, um, a couple things shocked me. One is the, uh, the patient really didn't own their medical record. That, that kind of surprised me. The second was the lack of, uh, modern architecture. Uh, you know, 2011. I'd come from other industries. I'd, I'd like to tell people, beer, beer banks and bombs, you know, so, you know, uh, Anheuser-Busch, McDonald Douglas.

I, I'd worked for, uh, you know, bank of America. I've done a lot of consulting with . Various companies and, and all those industries. There was, uh, open standards, APIs, the A T M network and those kind of things. Um, yes. And, and that didn't exist within healthcare. But the, uh, the, and, and it, it's taken a while for that to really take off.

But the other thing I didn't really appreciate is we had just gone through a heavy lift. MU was a heavy lift for . Uh, for healthcare, uh, I'm not sure that healthcare would've been digitized without mu there was, there's so many things aligned against it. It's such a complex industry, which I didn't appreciate when I first came in and, and, uh, there's, there's just a lot of things to get right and so it, it was a lot harder to get that ball rolling, uh, up the hill than I had anticipated.

The good news is, I think we are a lot farther along now, uh, than we were back in 2011, 2014. So, uh, I don't, let's, let's hit some of these, some of these announcements. Uh, uh, Sima Verma came to, uh, himss. She did, uh, my Healthy Data initiative. She did the Blue Button 2.0 initiative. Uh, do you wanna give us a little, little background on the two of those?

And, and where do you think they're gonna go? Well, let me begin by saying, uh, the announcement that she made, uh, couldn't have been more bipartisan, or maybe we would call it non-partisan. Uh, if you removed the, the Voice of CMA or the Voice of Jared and simply read that presentation, uh, Uh, without knowledge or context as to who might've delivered it, you could have imagined anyone from the Obama administration carrying that message forward.

So this is really building on progress and really pushing it further and faster in a direction that it desperately needs to go. So that's why you saw me applaud, uh, a great deal of the work that was done. Uh, the big message I would say is that the healthcare, uh, delivery interoperability strategy that I mentioned before, the B two B model.

Was built on the foundation of, uh, HIPAA authorizations where you, you may share, uh, you're allowed to share, but it doesn't compel you to share. So you could put a request in as a physician, Hey, I've got this patient. Could you send me the records? And if they chose not to respond, then you wouldn't get the data.

But they were legally allowed to respond. And so we had this framework of you might be able to share, but you didn't, you didn't have to. What CIMA is saying is that the other half of hipaa, the individual right of access, it doesn't mean you own your medical record bill. It means you're entitled to an electronic copy and in a readily producible format.

These are words that are gonna come into play in the a P I discussion. So CIMA basically said, I'm gonna pivot and embrace information exchange tied to that consumer's right. That I think is the kind of sea change that naturally is a progression of where we learned as we went, and that's the model. I think that's gonna carry lowest cost, highest data liquidity because it's a legal right to request a copy in a readily producible form.

And she built on that. That's the My Healthy data vision. The blue button 2.0 is, I would call that dog fooding. Dog fooding is you're eating your own dog food and the operations of Blue Button 2.0 is essentially an a p i for a fire based explanation of benefits resource that allows a patient to connect four years of claims history.

And an ongoing token for weekly updates to any application of their choice. So what she's encouraging the industry to do on its own and, and using the levers of, uh, MIPS and macro and all the other components she's operationalizing within C M Ss. And, and she even made the joke. It, it was Blue button 2.0, meaning it was a work in progress, uh, from the Obama administration, and she just took it into the finish line, which is what leadership is about.

Yeah, I mean, Todd Park really is the one who brought us, uh, blue Button 1.0. And, uh, Todd Park, who's, where is Todd Park these days? Is he, um, Todd, Todd is running a, a, a wonderful new company called Devoted Health. Uh, he's going to reimagine what life is like for seniors and Medicare Advantage plans. And so we're all watching and excited about what he'll do to make, uh, the care delivery model better.

He, he was one of the people that influenced me early on, I saw a couple of his speeches of how he was gonna open up data for the federal government. Yeah. It really is a model for what, what we're trying to do here today. It's, it's exciting. So are we finally at a point where the. Uh, I, I mean, that's an interesting distinction.

I, I don't own my medical record, but I have access to it electronically. Yeah. Does that, does that create a new ecosystem where the, the Apples and the Googles and, and Amazons and the others of the world, uh, can now say, Hey, the, the patient is the center of medical record, not necessarily the health system.

So now we can create, um, we talked about these ecosystems that I think will, will arise where the cloud providers will say, Hey, , If you as a patient want to give us your data, we can now add value to it, or we can now add other data to it and make it, enhance it and make it better. Um, and, you know, pharma, we could, we could participate in, uh, we can choose, we can go to our phone and say, I want to participate in, in this study in order to further this.

Yes. Uh, you know, this disease state, um, whatever we're gonna do around that, uh, are we at a point where the, the patient is finally the, the, the locus of, of, of this, the, the medical record or we're not there yet? We are closer. Uh, but what's missing right now, bill, is that delightful application that helps my mom and my dad on Medicare make the best use of that information.

So we've got the plumbing technical standards, right? We've got a legal and regulatory framework that encourages it. We've got the cloud providers and others helping to facilitate adoption and use. But that last step, Who's gonna help read my mom's, uh, Medicare blue button file and remind her when she should get care or where if she needs care, she can choose the right provider that meets the the needs that she has to have addressed.

And my personal opinion, bill, is that this is gonna look a lot like the transition from pension plans to 4 0 1 Ks where we used to have these employer, uh, fiduciaries that would take our money and make big judgements even if we might have wanted to do something else. Or someone else could have given us advice to have a better, uh, and more reliable retirement.

The move to 4 0 1 Ks gave rise to companies that didn't exist. Or if they did, they were modest, vanguard and uh, uh, fidelity and others. So I think there's gonna be a new rise of what we'll call a health information fiduciary. Who will work on the cloud platforms to do the plumbing of getting the data, but it is gonna be their last mile application that will help make sense of that information.

So I can shop smarter for supplemental plans so I can navigate the delivery system more effectively and I can access and use the preventive services to keep me healthier. Uh, a whole range of other things that we'll we'll see happen. Let's talk about, so this show, uh, originally did this show for CIOs to share with their staff so they could stay current.

Let's, let's get into a little bit more of the technical aspects. So you have Tef fca, yeah. You have Fire. What, what does a, what does a c I o tell this organization? Or what does, um, you know, what does the, the, the, the, uh, frontline staff do with tef, FCA and Fire? And, and where, where should they start? And where are we at?

So, uh, this is a conundrum, which is, uh, you can either be a supply sider, which is your job is to envision the infrastructure that you're responsible for, modernize it and prepare for the future. Uh, the other is a listener and responsiveness to the clinical leadership. I'm generally on the side of listen first, which is to say there's a signal out there that you're hearing from frontline clinicians, from physicians that are involved in these new value-based models, and they're complaining about something, about the difficulty to do their job.

And of course there's general complaint, but then there's more specific complaint. I would like to know this at this time and this way so I can make a decision without, uh, weakening my productivity. So my sense is that if you start to listen, if you're the C I O and you start listening to the customer's needs in a manner that perhaps we don't quite do today, 'cause we make a single decision, I've gotta make a big E H R decision and I gotta maintain it.

Uptime security, that's its own job. Now I'm listening and saying, well, wait a minute. I'm no longer deciding what E H R to buy now I'm thinking what application might write on top of the E H R that might delight my individual care teams or clinicians and patients to have a better experience. So think of it like a digital experience officer.

That role, that listening function, I think is the missing link today, because what their job is to figure out what it is that people need or want, and then map it back to what are the underlying data assets that we have available. And if you kind of do your job right, you serve up the data in a format that allows a random app developer on the street who can do the day-to-day app development for that doctor and not crash your secure systems, or require you to allocate limited resources.

So, You know, NIC, I'm gonna take some heat for this, but part of this is that CIOs are lazy. They've, they've had those listening tours. We've gone out and we've listened, and we were like, oh, the lift is so heavy. One of the, one of the, the benefits I had was in Southern California, you can't employ those docs.

It's a foundation model. We had a hundred different EMRs. There was no hope. Yes. I couldn't just say, well, we're just gonna implement Epic. They don't work for us. So I couldn't like, walk into their office and say, Hey, you're all going to Epic. And, and, and we've, we've solved the problem. A lot of CIOs have said, here's how I'm gonna solve the problem.

I'm gonna implement Epic. I'm gonna do community connect, and away we go. But the reality, as John pointed out last week, is, You're still gonna have to connect to a world outside of, even outside of your health system, even if you do have a little ecosystem here, you're still gonna have in your community, you're gonna have rural hospitals that have Meditech.

You're gonna have, uh, you're just gonna have a, a host of, of different E M R platforms. And so that benefit I had in California was, I didn't have the, the benefit of having an illusion that I could just dump this over to the EMR provider and say, Hey, they're gonna solve it for me. I don't have to worry about it.

Um, well, so, so in comes these technologies that just make it a lot easier to do what we were trying to do in 2011 with none of this stuff in place, which was, you know, we had to build, we first, we were building point to point, and then we tried to build this same kind of platform where we could share the data with, with APIs and whatnot.

But we were doing that lift ourselves and literally cost us about $70 million for a single health system to try to build this. These things are gonna make it so that each health system doesn't have to spend $70 million to try to build it. There's gonna be opportunities to do it outside of that. So, uh, well, let me let, let's get into the c i O role because there's a really critical decision the c i o has to make that could make that 70 million, 700,000.

And so let's just kind of hit the nail on the head. , the mega lift is that the data in each of those e H R systems is its own data model, with its own circumstance and implementation plan and all the rest. So we've got, and I've heard you talk about this before, we, we don't really have interoperability.

We've got a bunch of, uh, siloed databases that exist, happen to have different brand names in their EHRs now, meaningful use three. The one that has to be turned on by 1 1 19, and that c m s administrator, Varma said she's not moving the date. That means each vendor to remain certified has to map their data models to a minimum common data set that has a data query capability.

What that means is that heavy lift. Now, uh, now we happen to have chosen more than half the vendors who certified today have voluntarily chosen the fire. A p i mapped to the Argonaut project, and that was a quick cursory look at the 130 or so applications that are certified for the, uh, a p i requirement and meaningful use.

So over half the market voluntarily is mapping to a common industry standard. What that means if I'm c i o and I have an, uh, an accountable care network with what you said, a hundred EHRs. And I had every one of those EHRs, A P I endpoints. All I have to do is subscribe to each of those endpoints, aggregate those feeds, put them in a common data warehouse, likely in the cloud.

Then expose them through some a p i management platform. And if that happens, uh, the cost of data acquisition, normalization, exposure, security management, and the like, will look more like the internet economics. That is to say lower cost, higher liquidity. Uh, and that's the new information. It is the fact that each vendor had to do the heavy lift at every provider site to map the data, to meet the consumer.

A p I requirements. That's why we're in a better place today. That's great. I mean, that, that is, um, that actually is pretty exciting stuff. I'm going to, uh, I'm gonna jump to, uh, Joe Biden's response to some of this stuff. 'cause he's, he says, Hey, it's, uh, actually he says it in the first paragraph here. I agree with this administration stated goals.

It's not a left right issue, it's just a nope. You know, we, we, we agree. And his, his work in the, uh, um, in the Biden, uh, what is it, uh, the cancer. Cancer Initiative, uh, has really educated him on, on what's, you know, what the current state is. So here's a couple things. One is, um, yeah. Uh, you know, he states this, but the promise of electronic medical records has not materialized from one, from one major region.

Medical record companies and health providers have implemented systems that are not interoperable, so we know that already. It's interesting to have this become that elevated where we're now talking about this and, you know, my parents are now talking about this. It's, it's really. And they're, they're 80 years old and they're saying, Hey, why, uh, you know, because they are going from one system to another, and they're saying, why, why does my medical record not follow me?

So this, this is, you know, he's acknowledging something that's top of mind. Uh, even for our 80 and 85 year old. Uh, parents, um, and he goes on to say, we now have a need. We, we have now had nearly a decade to examine the consequences of how electronic health record systems have been deployed. The industry has had ample opportunity to voluntarily address the issues of interoperability and putting data in patients' hands, and they have not done.

So now it is time for something about . Do something about the data silos they have created to improve health and extended lives. Now, is he proposing something different than some of these announcements, or is he, is, is he envisioning more of a government hand in this to sort of force I. E r provider's hands?

I, I'm curious. Well, yeah, no, let me, uh, first let me disclose, I'm on the Biden Cancer, uh, advisory Committee. So just to, I'm on Team Biden. So just to be clear in disclosure for my bias, uh, what he's really saying is here's some specific steps that are, that are entirely consistent with the policy statements made by CIMA and Jared.

And he just went a step further to say, here are the explicit government actions that I would recommend. And by the way, I'm fairly confident some of those ideas are likely to be adopted on their own within the Trump administration. Yeah, so it's not about bigger government, smaller government, it's implementation guidance.

And a lot of the feedback people are hearing about, uh, the vice president, former Vice president's, uh, remarks is that he was remarkably pragmatic because the suggestions are not . Massive new, uh, bureaucracy expansions, but just tweaks, uh, instead of a 30 day requirement to gimme a copy of my data, make it 24 hours, not unreasonable.

In today's digital environment, I'm directing the N C I, the National Cancer Institute to kind of build a research data, trust and a commons so that you can facilitate the sharing from consumers to researchers. Not an unreasonable, and then the one that I'm most excited about, he notes that the Medicare Innovation Center, Which was created by the Affordable Care Act, has the legal authority to experiment with new models, to engage patients for purposes of getting better valued care.

So I actually think, uh, on all three of those things, they can be achieved with an existing law, maybe not the 24 hours that maybe an interpretation, maybe it's regulation, maybe it's an adjustment to the law, but it is very achievable and pragmatic. And that's, I think that the tone of which he took his, uh, his piece.

Yeah. And the Fortune article's great. 'cause it lists these four principles, which you've, uh, four principles and in four action steps. And I agree with you, it could easily have come out of, uh, any administration. And I'm, I'm really glad that this thing is getting the, the kind of traction, uh, that it's, that it's getting.

What do you say to the, to the physician? So every now and then, you and I post out on social media and we get the, the Yes we do. The physicians who come back and say, you know enough, you've made my life so hard. Yeah. Um, you know, for, for so long. What do you say to them? I mean, are we, are we close enough that they're gonna start to see benefit and value?

Um, or is it because some of 'em are essentially saying, let's throw in the towel. Let's go back to paper. I was much more efficient. I could actually look at the patient in the eye. Um, I mean, that's not, clearly not gonna happen, but what would you, what do you say to the physician anyway? What, what I would say to them right now is by this next phase of moving data through open APIs to consumers and hopefully repurposing them as well for clinicians inside the enterprise, that might mean an app developer they learn about, could help them do all of their job without ever having to separately log into the E H R again.

I envision a read-write a p I model that in the not too distant future physicians can do their job simply with support from AI and machine learning to help pre-populate, advise, encourage, so less of their time is spent dictating and typing, looking into a screen and more naturally engaging patients and having the systems work for them.

The the big mistake, bill, if I were to characterize this in an economics perspective. We've, this is the first time in, I would argue, most industries where a massive investment in technology, weakened productivity. And that has a lot to do with all the issues, usability, uh, the transition from fee for service to value, which means you're now doing two jobs, not one.

And the challenge right now. Is for a physician who's, who's angry about his or her job, is as much about what is their job because that itself is fundamentally changing and we wanna have an agile, nimble IT infrastructure. So as the job changes, the data can follow. I'll, I'll just give you one small example.

I know we're running low on time, but million hearts. Almost every clinician I know has endorsed the cmm, the the, the Centers for Disease Control Million Hearts Campaign. You know, if we just do four things, keep people on aspirin, lower their, manage their blood pressure, their cholesterol, and get them to stop smoking, we could produce a million heart attacks.

Almost every physician that I know raise their hand and said, sign me up. They need five pieces of information. What is the current blood pressure? Has the chase patient's cholesterol levels changed? These are very discreet, normalized values that sit in all the disparate, siloed EHRs. Imagine a small little app that a physician has that could go with consumer consent, update all that information and alert them if there's been a change.

That simple idea. They can't do today because we don't have that a p I layer. We don't have that app structure, so that physician can only do app development on when they see the patient, which may be once every few, maybe three, four months when the patient may be going to the Walmart and getting their blood pressure read at the local station or at a MinuteClinic or at a primary care doctor's office down the street.

That is what's frustrating. They wanna do the right thing clinically, but the it isn't working. We have to get there and the open a p I strategy will make it easier. Gosh, I wanted to talk about, I wanted to talk about Apple. I want to talk about Razu at the, the va, and they're, hopefully you'll, you'll come back on.

Uh, but one thing I do want to get to, if, if you give me another minute or so, is can you highlight some of the people, some of the, some of the heroes of this movement who have really moved it forward? I, I'd, I'd love to just give them a shout out for the, the work they've done over the last couple years.

Well, I would say, uh, Dr. Shafiq Rob, who was at Hackensack and now at Rush. Has personally invested, uh, a lot of effort to map his, uh, e H R to fire and to be an early test bed for app developers. Not in words, but in operations. And so I'll give him a big shout out. Uh, Dr. Will Morris at the Cleveland Clinic, Alistair Erskine at, uh, Geisinger, Stephanie Real at Hopkins, there's a portfolio of CIOs.

Who basically looked at this issue and said, lead or follow, and they're kind of in the lead camp, whether they're in the lead camp, on the engineering like Shafiq or Alistair or someone where they've actually built code or led in the form of convincing their peers and colleagues to move in a certain direction or to negotiate with where the industry should go.

Like Stephanie, this is the opportunity, and Razu is right at the top of that list as an uh, Kind of a convener in chief, which is why it was natural for the VA eight to tap him, uh, who sits on top of a Cerner ecosystem and an epic ecosystem and a relationship with many stakeholders to bring us together to move forward.

And so there are a lot of heroes. Um, I'm missing a bunch, but I would say those are the CIOs in, in the, in the community who've been driving very hard and fast. Yeah. And there's also, there's also obviously people in the, in the federal government who have, uh, really pushed things forward as well as, uh, Uh, as, as well as, you know, the, the people at Apple and Google and others that, you know, just oh, are, if we sat down to go through the full litany of, it's, it, we're gonna get to dozens of people all equally deserving of an incredible amount of work.

Uh, and I might even, you know, obviously shout out to Halamka and others who've just been incredible in their thought leadership. So I don't wanna ignore anybody in the shout outs. Uh, everyone's done a great job, but, but it's, uh, it's really a collaborative effort. There is no one. King or queen of this movement.

It's a totally democratized collaboration model as it should be. Absolutely. Well, that's all for now, Anish. Uh, thanks for being on the show. Uh, how can people follow you or, or stay up to date on, on things you're working on? Sure my Twitter handle is at Anish Chopra, and I do post a great deal of the work that I do, our company care journey.

I've got a blog that has some historical context at uh, care journey.com and, uh, I've written that book, innovative State, and so I've got a website, innovative state.com, if you wanna stay with my policy interests on open labor, market data, or other topics. So, happy to, happy to stay engaged. Sounds good. Uh, a awesome, you can, uh, you can follow me on Twitter at the patient cio, my writing on, uh, the health lyrics website or health system c i o.

Uh, and don't forget to follow the show on, uh, Twitter this week in h i t. And check out our new website this week in Health. It, uh, if you like the show, please take a few seconds, give us a review on iTunes or Google Play, and please come back every Friday for more news commentary and information from, uh, industry influencers.

That's, uh, that's all for now. Thanks. Thanks, Phil. Have a great.