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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 podcast is brought to you by HealthLyrics. This is episode number two. My name is Bill Russell, recovering healthcare CIO, writer, and consultant with the previously mentioned HealthLyrics.

Today, I'm joined by our part time co host. And full time CEO at Mercy Children's in Kansas City. Digital transformation evangelist, and one of the most prolific social media presence in healthcare today, David Chow. Good morning, David, and welcome to the show. Thanks, Bill. How's everyone doing? Thanks for having me.

I'm excited to join this on a regular basis. I'm really looking forward to some great discussions, and most importantly for me to... Learn from you as well, Bill, and some of your incredible insights, just so I could start transforming my own organization. So extremely thrilled to be here and thanks for having me.

Yeah, that's, that's, that's mighty kind of you, but, uh, you know, clearly I'm a recovering CIO and you're an acting CIO. So I'm, I'm a lot of different perspectives. One of the things I found about being a former CIO is I can pretty much say what I want now without going through marketing or compliance or legal.

And, uh, and you guys have to be a little bit more guarded about the things you say. So we'll get a little bit of both perspectives here and it'll be kind of fun. Um, before we get to the, before we get to the program, why don't you give us a little idea of, uh, maybe some of the things you're working on these days and some of the stuff you're excited about.

Yeah, so I would say if you ask every CIO in the healthcare industry, what is their biggest focus right now? It's really, it's a tough one to grasp because every organization is going through ways to be more efficient from a financial aspect. So, I think you ask every CIO what they're focusing on. They're focusing on innovation while figuring out how to cost cut at the same time.

So, on a macro level, that is what I am trying to figure out. How do I keep the organization moving ahead and provide new solutions or even create new business models? At the same time, how do we skim down some of the fat or other things that may not be as needed, but it's required. So, macro level, that's what I'm focusing on, but from a, from a organizational, just strategy, department strategy level, there's a few.

Things I want to focus on in terms of having some huge partnerships, uh, lined up just so it allows us to move faster. So one example is we're going to have a, a big announcement with our EMR vendor Cerner where we're going to be owning the entire Cerner catalog of products. And that's a very different mindset in terms of our organization that historically likes to use best of breed products.

Now we're moving towards a Cerner preferred solution. While that may not be the best modular solution for every single department or every single problem that we're going to solve, it allows us to have that coherent, integrated platform. While at the same time move a lot quicker, you know, thinking, just thinking through organizations that have procurement challenges or having to go through contractual agreements, you know, all those things do take time.

So for us, by having the strategic alignment allows us to move faster and allows us to gain tremendous support from them. A partner like Cerner, who is also located within the Kansas City market, just like we are. Wow. Well, we'll have to get Cerner as a, uh, as a sponsor, I guess, if we're going to say Cerner this many times.

I have seen, um, I have seen a lot of health systems do exactly what you're talking about. Not a lot, but I've seen a couple really do it effectively. I know that... Memorial Hermann does a good job really focusing in on a single EMR provider, as does Adventist. And they're able to really gain some efficiencies and really drive down some costs.

Yeah, I'll be curious, maybe we'll, uh... We will definitely hit that topic again, but nothing, while you're not doing anything with blockchain yet or anything IoT or you're just just exploring those things right now. We're still exploring, right? But the challenge of things like blockchain IoT is. You really have to find a platform, so we can look into IBM, Accenture, Microsoft, all of them are developing platforms, but the problem I see that's facing a lot of healthcare IT departments is, while we're trying to maintain and keep things moving with our wide range of healthcare applications, our bread and butter is not doing new software developments, or, and that's where I really rely on partners to help us transform.

We do have a union that's playing with it. But it's more on a departmental scale versus enterprise scale. So we are like in IoT, we're exploring things with Amazon Alexa, Google Home, things of that nature. I do see a lot of potential there. I'm thinking about just, you know, voice assistance. I do see the potential to actually replace something like a nurse call system, right?

The thing that we're doing with Alexa, the thing that we're doing with Siri, Google Home, I mean, that's almost... Similar to what could be done in a patient room in terms of providing feedback or providing some sort of action that needs to happen from a clinical staff. Yes, we get into all the security requirements or even privacy requirements.

Um, but just thinking about the overall ease of use for a patient who would bedridden, uh, how easy, how nice would it be for them just to be able to speak to Alexa to get some sort of service. Um, so we are dabbling those, but I, I'm not ready to say that they're. We're going to be enterprise ready. We're going to have something proven in the next year or so.

So, we're still dabbling, just keeping, just keeping the teams engaged with what's going on in the industry and hopefully generate some new exciting ideas that they could try and bring back to the organization. Well, that'll be, that'll be fun to keep an eye on. I think we'll see some of that at HIMSS this year as well.

So, before we get started on the, uh, On the segments, you know, a couple of housekeeping items for us. So we did our first podcast last week and we got some feedback, uh, in the spirit of being, I guess, customer centric, we're going to be responsive to our audience. The first change that we're going to do is we are going to break this down into three sections, three segments, I guess, to make it easier to follow.

Uh, the first is just going to be in the news where. The co host and myself will each select a story, a relevant story from the last couple of weeks, and we'll just go back and forth and discuss those stories. The second segment is going to be sort of an either or. We're either going to talk about leadership, or we're going to talk about emerging technology.

It'll depend on You know, who's here? Um, you know, with David this week, we're going to talk about, uh, digital transformation. I think it's gonna be a fun topic, but, uh, you know, I hope to talk about voice and, um, you know, voice assisted and some of those other things in the future. I think it'll be fun. And then the final segment is more of a, you know, in the spirit of, um, Donald Trump's Newsy award that he did.

We're, we're, we're actually going to do social media awards on a weekly basis where, uh, each of the hosts picks their favorite, uh, post for the week and just highlights it and, and shares it with everybody of, uh, you know, just why they, why they believe it's worthy of, uh, of our award for the week. So we'll close out sort of on a fun note doing that.

Uh, a couple of other things. We're now on Apple iTunes, we're on Google Play. Uh, you can, uh, you can subscribe there. You could also subscribe at, uh, this week in hit. buzzsprout. com. And you can find us on our sponsor's site at healthlyrics. com as well. Uh, we'll be posting a new episode every Friday by noon Pacific time.

Uh, so please, you know, subscribe so you don't miss any episodes. We do have a lot of great co hosts lined up. Uh, as David mentioned earlier, every, uh, every four weeks, we're going to have David back here to have a conversation and look forward to that. Sue Shade will be here in a couple weeks. Ed Marks will be here in a couple months.

Charles Boise, a data science genius, I'm, uh, excited to introduce everyone to, uh, has agreed to be on as well. And, uh, my good friend, uh, David Baker, who is a CIO in a dental, uh, system now, a billion dollar dental practice, um, will be here next week. I bet you didn't know there were billion dollar dental practices, but there actually are.

So, um, Uh, we are actually so new at this point, we don't even have a website yet, but, uh, that's coming and that's probably enough housekeeping for now. So, let's go ahead and, uh, get started. Let's, let's start with your story and, uh, give us a little background and kick off the discussion for us. Yeah, so I would say, you know, last year, you've seen a trend in the healthcare, uh, space of, I'll call it mega mergers.

You're seeing lots of. Organization is trying to gain scale and, and even three years ago, um, one of the questions I will always ask myself is what is that scale or how big does the organization have to be in order to stay relevant? Is it 3 billion? Is it 4 billion? 10 billion? 25 billion? I think that's still to be determined.

But you're starting to see a lot of these mega mergers these days. Um, I mean, you're looking at deals that were announced just between, um, Advocate and Aurora in the Chicago area that was in December. I mean, we had the Ascension Health, uh, sort of announcement. So, and these are not, these are not the typical deals that you would ever expect five years ago.

I mean, even for you, Bill, you probably would not have. When you're working as a CIO, I mean, these deals are probably outrageous in terms of mind boggling and it's because we're, people are trying to play in the value space game. In order to do that effectively, you got to have scale. You got to have a large amount of population to be able to go at risk and negotiate effectively with insurance carriers.

But at the same time, you're also seeing a lot of non traditional, um, Mergers and acquisitions, you know, CVS Health getting into the retail clinic, um, with, with the insurance carrier. So, I would say that this, this article that was put out there really, um, made me think twice, and I've heard about this a few times.

Just because you have scale, um, it means better access for the patient. And hopefully, it creates, uh, sort of a, a healthcare location to where a patient can get consistent care versus. Having disparate, um, health care providers, but at the same time, you have to start thinking, does that really save money for the health care ecosystem or even as a patient?

Or does it just create more of a monopoly? So this was a very interesting article that was posted by the USA Today where the headline and the title of it was, Health Care Deals Can Make You Healthier. That may not save you money. And as everyone is aware, the healthcare GDP in the U. S. is the highest in the world.

So, do these deals actually save dollars, or is it really just going to make us healthier? Hopefully, it stays true to make us healthier, but what if that's not even the case, where it doesn't make you healthier or save money? So, where does that stand? Yeah, you know, I'd like, so, uh, yeah, so healthcare deals could make, make you healthier.

But may not save you money. It's in USA Today. Um, we're going to go back and forth in a minute. I'm going to go through each one of these premises that they do, and we're just going to give a yes or no if you think these are going to help or not. But, um, you know, at J. P. Morgan, they're sort of throwing out this number that, the number to really be at scale as a traditional health system is about 3 billion.

Uh, in revenue. I don't know where they come up with that number. I don't, but I've heard it now a couple times, uh, at previous conference and this conference as well. So, um, I think these, it's interesting because these mergers fall into two categories. You have the, the The scale plays, like you talked about, the CHI, Dignity, the Aurora Advocate, and, um, you know, even the rumored Providence Ascension, which I don't put much credence in, not that I don't think there's talks happening, I'm sure, actually, that there's talks happening, but there's no burning platform there, uh, that really would cause this one, uh, to take place, uh, because, you know, compromise is important, and when you have One of the systems struggling or needing to get to scale in order to compete in their market.

That's where you have that compromise, and neither of those systems have that. And that's a critical element in any merger. So we'll, you know, keep an eye on that one. But those are scale plays. Those are, you know, we're trying to get bigger, we're trying to get a national, uh, footprint, we're trying to leverage, uh, economies of scale with suppliers, we're trying to leverage economies of scale, uh, with, uh, with buyers.

Um, you know, these mergers are typically playing the same game, uh, with more assets and more negotiating power. But the two others that I think are really a little bit more interesting are Davida in UnitedHealthcare and CVS Aetna, and I would call those retail plays. Um, these mergers are very different.

They're potentially game changers. Um, you know, it does remain to be seen what may happen here, but I could see these players really disintermediating the traditional players and becoming Um, the one stop shop for where they go for, um, you know, the first point of care, uh, come back there for, uh, their materials and things they need, uh, for chronic disease, uh, and ongoing care.

Um, but, you know, it's interesting. I look at these scale plays and retail plays, and I'm sort of reminded of the old book wars, and I hate to, I know it's kind of cliche, but if you think of it this way, if Borders, Walden Books, and Barnes Noble had merged, that would be a scale play. But, you know, that probably would not have made any difference in the world to Amazon, because Amazon was playing a completely different game altogether.

So anyway, that's, that's sort of how I'm looking at these mergers, but going through this article, uh, I'd like to go through the list real quick and get your thoughts, you know, with, with these mergers, do you believe, uh, let's see, there's a couple of headlines here. Uh, do you think people are going to be able to get healthier?

Are these actually going to improve the health of people in our communities? Just a quick yes, no, maybe. Yes, for healthier, because it'll probably generate more awareness, especially from the, the end of the deal who are trying to keep patients out of the hospital. I agree. I think it is going to lead to healthier patients.

Just more access to care, I think, is always a good thing. Your care could come under one roof. What do you think about that? For the chronic stuff, yes. Obviously, when you need surgery or specialties, you should have to go to a hospital. Yeah, I think this is a great thing for, you know, people who are struggling with diabetes or other, um, you know, ongoing types of challenges.

You know, I think the ability to just have a single shop, that's going to be a good thing. It says you might save money or not. I guess the answer to that is yes, you might save money or not. Do you think, do you think this will lead to lower costs in healthcare, or do you think it'll increase the cost of healthcare?

I, so the way I look at it is, We're all moving to a higher deductible. So if you're not using the services, you could potentially save dollars out of your pocket. Like in some of the healthcare systems throughout the world that may have a single payer, you know, something's painful, whether it's tax dollars.

So, um, yes, you will save dollars, but if you're using the services, I think you'll still be coming out at the end with, it'll be a wash. Yeah, and I don't think maybe from any of these mergers per se, but I just... You know, as we have, uh, discussed offline before, um, I think we will start to see so many new entrants into this space.

You have, you know, Amazon and others. Who have rumored, uh, uh, you know, movements going on in this space. And I think that's going to lead to, you know, different models and, and drive some costs out of the system. Um, and let's just pick one more of the, insurer may still be able to game the system. That's probably true.

You may not have as much choice and, uh, you may not know who's profiting. Um, I'm not sure anyone understands the finances of healthcare. I don't know about you, but. I was new to healthcare about nine years ago, or eight, eight and a half years ago. And, and, uh, one of the first things I tried to figure out was the money.

So I sat down with one of the smartest, uh, two of the smartest people I know in healthcare who, uh, really understood the flow of, of healthcare. funds throughout the health system. And, uh, after I would say about eight hours of education on how money flows through the system, uh, I can honestly say that the average American has no idea who's profiting from healthcare with any given thing.

I mean, it's just, it's so complex how money moves around today. I wish, I wish it was, there was more transparency. And I think once we get more transparency, you'll see some. Uh, some interesting things there. Um, alright, let's kick to the next story real quick. So, Hancock Health pays 55, 000 to release hospital files following a ransomware attack.

This is, uh, uh, well, it's covered in a lot of places, but fiercehealthcare. com is where we pulled this story from. Let me just read a couple things real quick. Uh, Hancock Health paid 55, 000 ransom to hackers to release more than 1, 400 files and regain control. of the clinical IT systems at their regional hospital.

The decision to make the payment made the most sense from a business perspective. Hancock Health CEO, Steve Long, told the Greenfield Daily Reporter. So you get an idea. This is, you know, this isn't a major city. I wouldn't imagine, although the files impacted by the breach. were backed up and could have been recovered.

It would have taken days or weeks to restore them. These folks have an interesting business model, he goes on to say. Uh, they make it just easy enough to pay the ransom. They price it right. So these guys are good businessmen. This is interesting to me. It appears that health systems do in fact negotiate with terrorists.

Um, but that's actually my commentary. I, the um, You know, it's, it's interesting. I mean, when you look at this, are we, are we negotiating with terrorists? Are we just being pragmatic? I mean, the EHR was down. It's, it was only 55, 000 to, you know, essentially restore the system, or they were looking at, you know, maybe a week or a week and a half during a, you know, maybe a cold and flu season, or maybe a snowstorm was coming in.

Um, I mean, does this set a dangerous precedent, or is it just pragmatic on their part? What do you, what do you think? This is where I would love to be a recovering CIO, because this is the kind of stuff you don't have to worry about anymore. We can just talk about it and not have to deal with it. But it's a tough one, right?

Do you really pay? Because you do set a precedent. I mean, we have, you know, um, Hollywood Presbyterian in Southern California, where you are, probably set that precedent by paying for it last year. And so now you have these, um, hackers who are, and they're smart, they target smaller communities that probably do not have the maturity from a security aspect, um, compared to other bigger cities that may have a better maturity index, but we're still far away.

But they're targeting smaller players, and then they're charging them, um, from a business aspect, yeah, if I was a CEO, I probably would pay it, because 55, 000 is peanuts compared to the potential downtime of just, you know, one day. Uh, even having that revenue impact. So, business aspect, yes, I think it's the right thing to pay.

But from an organizational perspective, or you're saying, sorry, I said that precedence to where... People are gonna get more and more exposed, and especially things like ransomware, those things are just going to continue even more in 2018 versus 2017. I don't know what the, I don't know what the right play is in terms of whether they should pay or not, but, um, depends on the, the sort of your roles and responsibility.

I would say at the C level, definitely pay it, guaranteeing that the system can get back up within a few hours. Um, but as the c I o or the leader of technology and even security, what do you do? Most organizations do not even have a policy on this, so I think these are important discussions to have and have frank discussions in terms of with compliance and just the entire organization as far as risk tolerance, and maybe people should think about should they even have a ransomware payment policy?

I mean, how do they determine whether they're not? Because that could be a long discussion itself and Thank you. Um, these are things that organizations are starting to have to think about with the increased exposure and cyber attacks. Yeah, ransomware payment policy. That is a, that's an excellent idea.

You definitely want to have that in place before you get the note that says, hey, you're, uh, you're stuck. I, my, you know, just to close this out, my only concern on this one is, um, you know, 55, 000 sounds like one year's tuition for a college student, and you could, potentially be emboldening, uh, some people who know that they can take, you know, some, uh, Bitcoin payment, um, have it be not traceable and start to get into the, uh, get into the space.

That's my only concern with that. I don't, I don't fault, uh, the CEO for Hancock Health at all. Um, I think a case could be made for paying it. I think a case could be paid for not paying it, but, um. Again, very difficult discussions and I agree with you. There's part of me that is glad I'm a former healthcare CIO and not a current, and security is the number one reason.

Uh, uh, very difficult, uh, landscape today, especially with, uh, we're not even talking about the meltdown or Spectre. Um, thing that's going on right now, which I'm sure every CIO is keeping a close eye on. Uh, all right, let's, let's kick off the, the next segment. Uh, we're going to talk about emerging tech and, um, you, you posted something on social media last week, which I thought was good.

It just gives us a baseline for what is digital transformation. Uh, you posted it with very pretty clouds in the background, by the way, the constant realignment of technology, business models, and company culture to more effectively do business. In the digital age is how you, uh, defined it. What, what is, you know, what does digital transformation have to do with healthcare and, and how do you see it sort of, um, how do you see it playing out?

What does it look like? So if I have to sum up, it's really creating a new business model utilizing technology. Um, so how, are you creating a new business model as a, as a healthcare entity utilizing some core basic technology tools such as social, mobile? Cloud and big data. I mean, that's how I really like to define this digital transformation.

One of the overused buzzwords, but, you know, consumerism is huge in healthcare. We all want to move towards a retail like experience. That's creating a new business model. And how do you do that? So now we're starting to utilize some of these tools and to create that digital experience in a retail like market in healthcare.

So if you start transforming, really generating new business models with some of these tools, that's how I would like to define this digital transformation. They can also be something internal. It doesn't have to be external facing, right? Something as simple as revamping There's helpdesk internally to your employees where you want to have more self service so that people can log in their own ticket, reset their password, something as simple as that.

You're creating a new business model internally within your organization. Uh, as far as an IT department. So really start thinking about how you could change, um, status quo, your license technology is a good way to revamp and think about this digital transformation buzzword. Yeah, and we're doing, um, we're doing a couple, as a consultant, I'm helping a couple health systems with digital transformation, and I think the, the, the Two things I would highlight here is it's, it's not a, it can be run by IT, but it's more of a triumvirate of IT marketing and operations.

And if I had to say to healthcare, and I have, to healthcare organizations, what's the most important, um, aspect of this, I would say it's, it's really redefining operations. Uh, and the example I, I typically give is, Uh, you know, when we went to do, uh, a new, uh, patient portal, and I hate that term, but it's what we use in healthcare, uh, we went to do a new patient portal with, uh, online forms.

What we found is we had a hundred different forms that we had to consolidate. within the health system before we could even take it online. Um, and that was a significant lift from an operational standpoint. So there's, it really is different business models, different ways of doing business. Um, and then the other thing I always, uh, we always talk about is, um, you know, there's, there's an internal focus for digital transformation, and then there's an external focus, the internal, and both have at, at their core, understanding the consumer.

Your internal focus for understanding the consumer is. You know, the physicians and and the clinicians and the nurses and and and everybody who works within your system really understanding what their needs are, how they're using technology and then coming up with new ways. Like you, you mentioned, uh, you know, voice assist, uh, Google Home and, um, uh, gosh, I want to call it Alexa all the time.

Echo and, and, uh, and Siri and these other things that could be a digital version of GoogleOS. My phone, I said Siri, and my phone just went. Anyway, um, the, uh, you know, those could be digital transformation initiatives internally, but then externally, um, this is where we find that health systems need to develop a new muscle.

They, they have had patient, uh, forums to listen to their patients, but they have to take it to a new level to really understand the complete workflow and how it impacts the patient and how the patient experiences it. Um, it's really interesting. How do you think, I'm curious from your perspective, how do you, so you're, how many years now at Mercy Children's?

You're about two years into it or more than that? Almost two years, a little less than two years, about one and a half. Alright, so when you go into a new system and you want to get them sort of focused on digital transformation, thinking about new models, how does a healthcare system get started? Where do they kick that off?

Right, all these cliches, you got to understand the culture, right? You have to really understand how do you, number one, you have to navigate, and then you have to educate, and then you got to understand whether the culture is even tolerant, will be tolerant though for something, this is change. So, are they able to tolerate change and new ideas?

That's usually where I start. A lot of it is education, uh, even within just the technology department. Getting them to think differently. Getting them to think cloud first. That's a whole, that's a challenge for a lot of organizations in itself. So, just a lot of the education as far as the why. Um, but most importantly, this has, you know, as a, any, as a digital leader, or just any leader, you need to figure out how to influence the organization to think this way.

Uh, if you can't do that, you won't be able, you won't be successful. So, I am constantly out there selling new business model ideas, or again, educating people on what this really means. And then, it took about a year to start getting people to understand, okay, this is what I'm seeing throughout other industries.

This is what I feel as a everyday consumer in other sectors. Now, I want to apply that. I do want to apply that to healthcare. Now they come to me and say, okay, I think I get it now. How? Now, how do I do it? What do you think? Where should we start? But it really took a good six to eight months for me joining a new organization to understand the landscape.

Building the relationship and educating every leader to be thinking digitally, um, and I mean the biggest question I, um, Bill, you probably see a lot of the time is who should lead this, right? Is this a CEO's initiative? Should this be a marketing initiative? Should this be a CIO's initiative? I mean, it's hard to determine who should lead it, but I would say anyone who's trying to lead it has to be able to influence an organization regardless of what their title says.

Yeah, I, I think that's right. And that's, that's a, that's an excellent point and a great observation. I think, you know, the, the role of the CIO is really as a educator and making, helping the organization get ready for this kind of change. But to the extent that the CIO can partner again with marketing and the COO and, and really get on the same page, I think that becomes exciting.

And then, uh, I'm now of the mindset that, uh, you know, digital transformation is the CEO's initiative, because essentially what you're saying is we're going to create new business models. And I'm not sure you can say that that's the job of, you know, this VP or this VP. I think that's the job of the CEO is to look at their organization now in light of digital changes that are hitting them from all sides.

So, uh, well, thanks for that discussion. I, you know, next time around, we'll maybe do voice assist or blockchain. I, I'm, I'm looking forward to more of these conversations with you. Um, all right, just to close it out, favorite social media posts of the week. Uh, I'll, I'll do mine first. You can hit Twitter right now and see if you can find one.

Um, you know, I'm going to have to share this. It really has nothing to do with healthcare, but it just, it really just made me laugh. Uh, the, uh, the tweet following the crazy finish to the Saints Vikings game. If you didn't see it. You know, it is one of those games that will be replayed over and over again.

It was one on the last play of the game. Uh, you know, the Vikings quarterback, you know, threw a pass that, for all intents and purposes, should have just ended the game, and somehow the guy missed the tackle, and the Vikings... player ended up running into the end zone and the Saints lost the game. That quite, if they had run that, that play a thousand more times, I believe that they wouldn't score on one of them.

But it just, in this case, on that Sunday, Uh, they did score. And, uh, so the tweet, obviously from, uh, you know, probably a newspaper somewhere around by the name somewhere around New Orleans, the Times Picayune, uh, headline read, and this is a real newspaper, real front page. There's a picture of the, uh, the Viking player running into the end zone and the New Orleans player watching from a distance and the headline reads, Expletive, Expletive, Expletive.

And I'm not self editing. Those are the actual words on the headline. Expletive, expletive, expletive. And, uh, that is definitely not fake news. That is really telling it like it is from a New Orleans fan perspective. So I just wanted to share that. I, I really got a kick out of that. Um, uh, any, so what do you, what do you have that you, uh, want to highlight?

So I just retweeted something just because it always makes me, uh, think about organizational change. So if you just go to my hashtag, BCHOU1107, I just retweeted something about do you really want to change? So anytime you walk into your new organization as leader, you ask the department, do you want to change?

Everyone raises their hand. And then when we talk about who wants to change, really change, sort of the people start looking down, the hands start going down. And then the third question, who wants to lead change? You sort of become empty. No one wants to lead the change. So, you know, this picture always makes me laugh when I think about orientation.

I talk about Wanting to lead the change. They want to change how they behave. They want to be market leaders. They want to disrupt industry. But when they start getting, rallying the troops together, um, to go through this change, the amount of people that volunteer or as excited just starts dwindling. So it always, I always get a good chuckle every time I see this graphic or cartoon out there about change management and organizations of enterprise scale.

Yeah, that's, you know, that's a good idea. We should retweet these after the, uh, episode so people can see them. Um, so I will go out there, find that tweet and, uh, retweet it. Um, David, thank you for, uh, being on this show. Um, that's, uh, that's all for this week. Be sure to subscribe on iTunes, Google, Google Play.

Uh, read the summary. Uh, we'll post a summary on health lyrics.com website. Um, you could follow David on Twitter. Dichow 1107. You can follow me on Twitter, The Patient's CIO. Obviously connect with us on LinkedIn as well. And of course, follow the show on Twitter. This Week in HIT. If you have any feedback, please send it along to thisweekinhealthIT at gmail.

com. And that's all for this week. Thanks for joining us.

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