This Week Health

Drex DeFord on Amazon/Berkshire/JP Morgan’s Health Haven, AI, and Clinical Workflow

Drex DeFord drops in to discuss Amazon's broad push into healthcare with the Haven announcement and an AI partnership with Beth Israel Lahey. Plus we discuss Eric Topol's new book on Artificial Intelligence.

Transcript

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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. My name is Bill Russell, recovering Healthcare, c I o and creator of this Week in Health. It a series of podcasts and videos dedicated to training the next generation of IT leaders Today we're cover A Stories in a very short period of.

Wanna start your health IT project on the right track. Wanna turn around a failing project? Let's talk. Visit health schedule your free consultation. Our guest today is the original health recovering healthcare, c i o, and uh, indie consultant Drex to Ford. Good morning Drex and welcome to the show. How you doing?

Thanks for having me. Um, it's always fun to hang out with you and kind of go through the news of the day. Yeah, it's got it, it is gonna be fun and fast and furious. You're, you're like one of my go-to people for, uh, talking about the Silicon Valley, uh, Seattle based ventures and what it means for healthcare.

I mean, um, the thing I love about it is you live in that world. You live in the startup world, and you have the, uh, healthcare c i o background, so, Translate it for us, which is great, but the luckiest guy on the planet. Before we get there though, the softball question, and which I always throw out is, uh, is there anything you're working on that you're excited about and that you want to share or talk about?

Um, man, is there something that I'm excited about? You know, I mean, I, I'm, I'm always excited about everything , n d a that you can talk about. Yeah, I know, and that's, I think that's, that's part of the challenge for me. I'm always excited about everything that I work on, and I am lucky enough, knock on wood, that I kind of continue to be in this.

I get to work on the things I wanna work on and I don't work on the things I don't wanna work on. So I like all the stuff I do. I have a lot of companies, not a lot. I have a handful of companies under retainer. I do some special project work. Uh, right now I'm doing work, uh, with a health system that's going through a whole process of an IT review, but a lot of it is focused on governance and innovation center development and all of that.

And that's a lot of fun. It's really interesting. Yeah, there's a lot of that innovation center work I saw, um, uh, children's LA is doing, uh, just, just kicked off their stuff around pediatrics and really gamification of healthcare. So that's, that's pretty exciting. Yeah. There's, there's, uh, you know, the thing I would probably say about innovation centers in healthcare is that my experience so far is that when you've seen one, you've seen one, they're all done differently.

They all have different goals and different intentions in what they're trying to do. And so, um, It's a very interesting, broad design of, uh, of innovation centers in healthcare. Well, that's, that's what I liked about Children's LA focusing in on gamification because, uh, by doing that, they can really become the center that you go to for the gamification of health for, for children.

Uh, and I'm sure some other children's hospital are dabbling in it, but when you try to be too broad, You just, you, you don't attract the right resources and, and the right, uh, energy around it. So I, I, I like that focus. I, I don't know. Do you, do you, uh, recommend that, uh, innovation centers try to focus in a little bit more?

Or, or do you. Do you go a broad route? Yeah, I think, you know, a lot of it depends on what do they wanna try to get out of the innovation center. So there are places like Cedar S Healthcare Accelerator that actually has a regular rotation of early stage company sort of classes that come through every . 10 weeks or 12 weeks.

And, um, they're, they're really looking for early stage companies who have really great ideas that they can use to help solve problems at Cedar-Sinai. But then you have other organizations that really are just getting started and trying to get their legs and figure out where they're going. And I think you're exactly right, like a startup company or like any company, If you focus too broadly, um, you definitely lose momentum.

So I love that. C H L A is definitely going down this path of we're gonna focus on this and we're gonna get really good at this, and that may turn into a whole bunch of different things, including a new company for them, or, uh, just being, having an area of expertise that no one else has. But that's good.

If you only have limited resources. Focus is always important no matter. What your organization is. All right, so I had your friend Wess Wright on the show, and I noticed you, you didn't make fun of him on the, uh, on the LinkedIn post, the way he made fun of you on the LinkedIn post for bobbing your head just like that when I'm talking.

So, so just be careful as we start. Start going back and forth here. Don't give Wess any, any ammunition to come at you. All right, Wess. It doesn't matter. I mean, we've known, we've known each other since we were, uh, you know, since we were young captains in the Air Force. And so, yeah, he has so many ticks and quirks that I can make fun of that I just don't, and then he picks on me for all of my, all my weird takes.

Well, that's, I do get into this though sometimes when somebody's like going the right direction, I'm like, yeah, yeah. That's, it's good. Alright, well let's, let's, let's get, uh, it's a rapid fire here. So, JP Morgan, Amazon, Berkshire has finally named their joint venture. Um, so they have named it Haven, right? Uh, it's, uh, you know, the ventures led by Dr.

Atul Gwane. Hired in June. Um, lemme see. Here's another, uh, you know, essentially here's the quote. You know, we want to change the way people experience healthcare so that it is simpler, better and lower cost. Gowane said in the statement, we'll start small, learn from the experience of patients and continue to expand to meet their needs.

And, uh, and we've talked, I mean, not you and I specifically, but we've talked on the show about this before, that he's a great hire for this. He's very pragmatic. He will start small. He is very analytical, so he will look at all sorts of numbers before he even determines what, what path they will go down.

And, uh, I, I think by hiring him into this role, they've really increased their odds of doing something that's gonna be pretty transformative. I think everybody just assumed it's these three companies would come together and do something transformative, but that's not always the case. We've seen large companies do.

Things in healthcare before, but I think by putting him in place, they've really increased their odds. So what, what are your, uh, hey, what's your thoughts on the name? What's your thoughts on, uh, where this is at or where it's going? Uh, so what's the name of the original? What, what did we used to call it? JP Morgan.

Amazon Chase. What I mean, what I, you know, I guess my initial reaction is, thank God we don't have to say that anymore. I know. Now we can just say haven. We can just say Haven. How long will people take before we have to say, oh, you know, Haven, JP Morgan, Amazon, Berkshires. Right? . Maybe they've even made it more complicated in the near term.

Um, but I, you know, I, I'm with you. I think, uh, Atul Gwane, it was a great choice, uh, to leave the organization. Uh, you know, all the things that you've written, Ricky's written and all the things that you see him, uh, when you see him present or, or see him, uh, uh, talk in the past, even before joining the company.

Um, very practically oriented, very good, I think solid stuff. And so, um, It's been a year and all we have so far is Haven Now. I'm sure there's been a lot of work that has gone on in the background and I'm sure ultimately they will wind up generating things. I think a piece at a time I. Ultimately we'll figure out they were actually building a great big jigsaw puzzle a piece at a time.

But I'm looking forward to the first pieces coming out because I think better, faster, cheaper, safer, easier access healthcare for patients and families is absolutely what we're all after. And it's definitely what they're after. Sure. So, but if you're a C E O, I'm gonna put you, I'm gonna promote you. So if you're a C E O in Seattle, I mean, you're talking a lot of employees in Seattle or New York City, a lot of employees in New York City.

Um, And probably some other cities if I really thought about it. But those two cities specifically, if you're a c e o of a health system there, what would you be doing today? I mean, are you, are you concerned that this might change the patterns of people seeking health? Um, I think that, you know, as an employer, you're probably so continue to be so wrapped around the axle with the current arrangements that the, that you have and trying to manage healthcare costs.

Working with whoever your third party, you know, your provider is your insurance company, your, um, you know, whatever arrangement you've created as an employer that you're looking, I think, at Haven and saying, you know, I hope they come up with something, but I don't know that as an employer you're probably spending a huge amount of time thinking about what's coming from Haven.

I think, I think they're probably hopeful that something great is gonna come out and ultimately it's going to. Impact. Impact the cost that they have to pay to provide healthcare to their employees. I just don't know if they've spent a lot of time really thinking about the, the details of, uh, what that might be.

If I'm, I'm guessing, yeah, so if I'm, if I'm a c e O in New York, or if I'm, uh, uh, I guess Providence in Seattle or UW in Seattle, I'm putting a team together. I'm, I'm calling them up. I'm saying, Dr. Gwane, I'd love to work with you. Putting a team together, I'm saying, look, they're dedicated to you and we're gonna, we're gonna come up with a model that works specifically for your program that helps your people live healthier lives that keeps them, uh, healthy and and vibrant.

And at work, I guess is what we're looking for. Um, and not to be too cynical about it, but, um, but essentially it is an employer program. And, uh, really if you do, if you're able to do that, what you cut out is the insurance carrier. You don't cut out the health system. You don't change the health system, but whoever's able to partner with them, you know, that's, that's an awful lot of of people.

There's an awful amount, a lot of lives there. So I, I'd, I'd be trying to figure out how to. Sort horn in is what I'd be doing. Hi. I think you're right. I sort of took it from the, your question from the perspective of a large employer in Seattle, and not necessarily the health systems, but you're right. If I was a health systems, I would definitely be trying to figure out how do I get in that game early and make sure that I'm a part of that and not somebody who gets left out.

Now, if you're a children's hospital, for example, you're Switzerland in all situations and so, um, you've got. Unique, interesting specialty care that can only be provided by that organization. Still, you need to get involved in the game early. Makes a big difference and proves that you really wanna save dollars and, and make, uh, make healthcare more cost effective for patients and families and employers.

This, this is gonna be the hard thing about going rapid fire. I, I, I wanna follow up on that, sorry. But if I have follow up, then you're gonna follow up. Uh, so, so next story. Uh, assessing e H r use during hospital morning rounds. So there was a study, I actually pulled this from your feed. So there was a study that was done and they.

Uh, mixed method of, of collecting information. And what they determined was that, uh, across the analysis was that there's, as people are rounding, that these are, these are the three things they found. High degree of variance in the ways teams use EHRs during morning rounds. Number two was pervasive use of workarounds at critical points of care.

Third thing was EHRs are not used for information sharing and frequently impede intra care team communication, I'm sorry, in a fourth one, system design and hospital room settings do not adequately support care team workflow. Um, so interesting findings. I, to be honest with you, that none of those findings really surprise me.

Um, So, you know, what, what can we be doing? What are we doing? What can we be doing to, uh, to address this specifically, do you think? Uh, I, you know, I thought the same thing when I read the article. I don't know that any of those things, um, surprise me. I think the real sort of takeaway in that is, Our inability in healthcare to yet create clinical standard work around the use of the electronic health record.

So, You know, to sort of turn a phrase, we've kind of paved a cow path instead of sort of sort of saying, we're going to do everything a different way. So now that we're using EHRs and that means we're gonna change the way we do morning rounds so that we can integrate the E H R more effectively and not do workarounds, that creates a whole group of risk in and of itself for patients and families.

And, uh, none of us really want that, but I think we've still sort of got this weird situation where we have, um, Uh, we have clinicians and others who are unwilling to change and unlearn the habits that they already have about how they do morning rounds and other clinical. Provision of care too. But in this instance, particularly around morning rounds, they're unwilling to sort of change their ways of doing it to integrate the E H R more effectively.

And then I think the other part of that is sometimes the E H R doesn't work very well to be able to facilitate the work that they're trying to do too. So it's really sort of two different pieces of this. One is a management engineering effort to make sure that we're using the E H R as much as we can.

Changing the E H R and doing the informatics stuff that we need to do to make sure that the right data is available when it needs to be used in morning rounds. Yeah. This is one of those things that it really showcases the leadership of the health system because this is not just, I, it's a team sport, like you said.

It's not just it. It's, uh, You know, standardizing clinical workflows and standard standardizing, uh, clinical terminologies, uh, practices, uh, data sharing. Uh, it, it's, it's all those things. It's embedding it into those rounds. Um, you know, and a couple of CIOs have talked about embedding analytics in those rounds, but also embedding workflow people in those rounds so that they're constantly, uh, adapting.

Um, The E H R and identifying those workarounds that could lead to, uh, care gaps because they are, they are potential care gaps. And, uh, and you know, these are the kind of things we're trying to eliminate. So it is, it's uh, it's, it's complex. You could always tell the really well run healthcare organizations because you really have to fire.

It's, if you're firing on two of those four cylinders, it, it shows. I. . Yeah. And, and mistakes happen and other challenges occur. I mean, I think one of the best things I ever did as a C I O was the least technology thing I ever did as a C I O. And that is, you know, we had, uh, a group of really amazing workflow specialists that were part of our team and really spent all their time in the field figuring out how to help clinicians.

Learn how to change their workflow to use the tool more effectively. But at the same time, they brought back the information that they needed to tell the technologist about how to adjust the tool to take better advantage of the workflow. And, you know, it's a people process technology thing, as we've said a million times.

Uh, if they all work together, it's a beautiful thing. And if you just try to pull on one handle really, really hard, it just, it just doesn't work right. Yeah, and I'll take the last word on this, which is I, I tell CIOs all the time on this one, if you're not doing this well, your clinicians are gonna be cynical.

And then when you start talking about digital and transformation, they're just gonna look at you like, are you kidding me? You didn't do the last one. Well, right. This is like, you know, this is like we used to say, the data center has to always be on every time they turn on the, I mean, that's what this is.

Now you're. Your workflow has to work for people. You have to be constantly improving it, making them more efficient. Uh, this is a story I do want to get your, uh, your take on. I mean, you're, you're right in their backyard. And I guess we're visiting Amazon again. A a w s Uh, and Beth Israel Deaconess have done a, uh, uh, I guess they, Amazon has given Beth Israel a $2 million investment slash grant, uh, to work with them on artificial intelligence and where it can be used in the hospital to provide more efficiency.

Um, this is, this is really interesting. I'm not even sure what question I want to ask here other than, uh, is, is this the new norm? Are we gonna see these kinds of, uh, plays as these players? They have these great tools. They're trying to figure out what to do with them. Are we gonna see more of this? Uh, you know, I think companies like Amazon have, um, a lot there, there, there's a lot of profit there, right?

And there's the potential for more profit, and they're really in a great situation to be able to sit down with an organization that they consider cutting edge, um, like Beth, uh, Beth Israel, Lahey, and sort of create this kind of program for them. Really this kind of runs the gauntlet of innovation or the, the, not the gauntlet, but the, I guess, spectrum of innovation.

From one end, you probably have, uh, Beth Israel Wahe saying stuff like, you know, these are my requirements, these are chronic problems that I have, that I think AI or other a w s capabilities might be able to help me with. Can you help me figure out how to solve that problem? And on the other end really is Amazon saying we have some super cool tools.

That do really interesting things, but we're trying to figure out how they might actually help you in healthcare. And, and then there's a spectrum in between there where there's, you know, lots of overlap. So if they work really well together and I think they spend the energy and the resources, um, effectively, they may be able to camp, come out of this.

Um, with some pretty, with some pretty good products. So from the Amazon perspective, do we develop something that other healthcare systems can use and then we can sell that. And on the Be Beth Israel Leahy side, they get to solve problems earlier than other people are able to solve them in a market that is super competitive and has already sort of in a, in many ways gone across the bridge from, uh, fee for service to value.

Really one of the leaders in the country in this. So they're ahead of the game already. I think this is one of the benefits of, of John Halamka going into the innovation role, right? And leaving the, uh, uh, information role, uh, to the side. It gives him more time to focus and his data's already out on a w s so it, they were an obvious partner.

With, uh, with these guys. I, I do. Since we're talking about ai, I want to touch on one of your former colleagues. So, Eric Topol is coming out with a new book, deep, uh, deep Medicine, how Artificial intelligence can make Healthcare Human Again. And, you know, people keep talking about, uh, you know, AI is the buzzword.

Well, you know, I was on a panel once and, uh, It was just Aaron Levy asked me, he goes, you know what, what's a buzzword that, that you, you know, that you, you hate? And I said, there isn't a single buzzword I hate. 'cause they're a buzzword for a reason. And the reason is 'cause everyone's talking about 'em. So why is everyone talking about artificial intelligence?

And this Eric Topel says these things. Artificial intelligence is the single most important opportunity to. All the major things wrong with healthcare today. Uh, according to Eric Topel, a world renowned cardiologist, geneticist, digital medicine researcher and author, he's not the only one who said that this week, um, you had, uh, ed Marks did a, um, interview of Toby Cosgrove, and he said the exact same thing.

Ed. Ed said, Hey, you know, what's the number one thing you think is gonna really impact healthcare? And he said, artificial intelligence, hands down is going to change the industry. And so you have. He's not, I mean, Eric might be, you could point at him and say, you know, he looks at a lot of forward thinking things, but Toby Cosgrove is a pretty pragmatic mm-hmm.

guy who's saying, Hey, I'm spending some time in Silicon Valley. I'm seeing these things. This is the real deal. Uh, this is really gonna transform things. So what, um, you know, what's been, what's been your take so far? What are you, what are you seeing or, or what's your feeling on this? Uh, you know, I'm a big fan of, um, I'm a big fan of Topos and, uh, the more that I look at early stage companies and, uh, and look at the artificial intelligence work they're doing, which.

There's sort of a whole spectrum of conversations around artificial intelligence. That's another whole part of this is that, you know, what they're really doing at this point is, um, machine learning and deep learning. So sort of a subset of what we think of as the larger AI concept or idea. And N L P, which has been around for a while, N L P.

Absolutely. And so unfortunately, or maybe fortunately, I think it's being AI's being talked about sort of in this big, um, AI will solve world hunger. Kind of perspective, but I think it's more the concepts of N L P and deep learning and, and machine learning. That there are lots of individual examples that I'm sure are gonna be in Dr.

Topples book, uh, where AI can make a difference or. The components of AI can make a difference, can sort of change the game, uh, create an augmented, um, support for, uh, clinicians and business operators and others that help them work on the really, really hard things and help them move faster on the things that are more routine, uh, all the way through offloading complete pieces of work to an AI or a.

A support system that is a component of ai. And, and I think we're gonna get there. I mean, I think this is just a little bit of progress at a time. And, um, you know, I read something the other day that says every time we get to something that is artificial intelligence, we don't call it our artificial intelligence anymore.

We call it Siri, or we call it, you know, something else. We never actually get to ai. And I think I'm probably okay with that. I think there's a lot of, uh, A lot of interesting stuff that can happen in little practical pockets that can make us better in healthcare. What do you think about it? Well, there's, there's a couple things.

He, he said in this, uh, there's a Forbes article, actually, it's a promo piece for the, uh, Nvidia conference, which he's speaking at. But, uh, he does talk about the book. He said, um, Uh, first thing he said, I think, which we've, we've, I think we all agree on at this point, is, uh, that the data needs to be owned by the individual.

And, and actually he makes an interesting point, which I hadn't really articulated before, which was it's better for the individual to own the data from a security standpoint. 'cause if you have. If you have, you know, 5 million patients with data, it's a lot harder to get at it than if you have a single repository with 5 million patients in it.

You know, I mean, a hacker gets in and they're in, they have 5 million patients. And so he's talking about the attack vectors, which was an interesting way of looking at. Um, the second thing he goes is same thing you're saying, which is shares the concerns. Um, You know about AI because a lot of it has been long on promise and short on implementation and validation, uh, which is true, but he, he also follows that up by saying, this is a great opportunity for people to work together to get that validation and implementation.

And I, and the last point he makes, Which is more of a policy thing. He said, you know, the UK is way ahead of the US and the reason is because, uh, not only have they engaged in planning, but also because they're already starting implementation on those ideas into in the real world. And he said the US has no AI healthcare strategy and there hasn't been national planning at this point.

And it really shows. You know, when we think ai, we think Amazon, Google, uh, Microsoft, we, we think those big players and Nvidia and others, uh, of I B M, but we don't think, um, we don't think US policy, we don't think people coming together and helping us to put together a, a track. But that's happening in China.

It's happening in the uk, it's happening in these other countries. They're laying the foundation to really leapfrog the US if we don't. Get that foundation in place. Yeah. Yeah. I mean, if you look at, if you do look at as sort of like a national policy, where do you wanna put the time and the effort and the energy research dollars, all those kinds of things into a program, into an AI program?

I think, you know, our tendency here seems to be more, leave it to the free market, let the free market sort it out, as opposed to China. Or other countries who are much more focused on, these are the things we wanna solve today, this is the, the place that we wanna go. And kind of back to our earlier conversation about when you have limited resources, you need to focus.

Uh, I think that's something that we're, you know, we, we have a problem with focus and a lot of that is just built around the way the. The economics of our country work. Yeah. And I'm not sure, I'm not sure what it looks like, um, but at this point we can look at those other countries to see what they're putting in place.

The last, uh, we're gonna go over time, I apologize, but last That's okay. The, the, the last story, I just wanna point it out because there's been a lot of talk about transparency and, uh, there's a story about St. Luke's revenue cycle. And how they've, um, how they've gone about the whole transparency, transparency thing, because they got ahead of it.

In, uh, October of 2015. They put out a, a pricing tool. And with that pricing tool you get these bundles. And with these bundles, they actually give you the ability to prepay. And if you prepay, there's a discount off the, the services and, um, You know, you and I were talking earlier of the, the chargemaster. I mean, putting the Chargemaster out on the website is the, it's the silliest thing.

I mean, I've, I, I was in healthcare. I had to, I had to reconcile a whole bunch of chargemasters, um, as part of a team. And I can honestly tell you, it really does take a team of experts to figure out the charge master how, how is putting the charge master out on a website? Transparency in terms of pricing.

uh, that, that is a great question. I, that was more of an than anything. But what do you, what do you think, I don't have an answer to that. Do you think there's more health Systems's gonna gonna take this? I mean, I, I love the fact that St. Luke's digitized this whole process and their patients now have the ability to get transparency on their app, I mean, on their, uh, their mobile app.

Uh, do you think that's gonna be more the norm? Do you think We'll see that? Uh, you know, I think it's, I think it's great and I, I hope it does become more, more of the norm. It would be nice to know what things cost before you win in for them. They're taking the things that are probably the easiest to understand, the easiest math to do.

I know you need two of these kinds of, Um, X-rays and I know you need this kind of surgery and it usually takes about this long and use this as, uses this many instruments and whatever. I think they talk about rotator cuff in there as being one of the surgeries. But if, if you can do the math and kind of figure that out and kind of be able to stick to that 'cause you've got good standard clinical work and all your surgeons do this work and exactly the same way and you really know how much it's gonna cost, then I mean those are great and those are definitely the places to start.

A lot of this. It's just about getting started. You know, do something. You don't have to solve all the problems with the move to value-based care. Just do something. Just start somewhere. And that's what they've done. And I think that when you put enough of these things together, you're gonna wind up with some really great relationships with, um, Maybe haven or others Right.

To, to take advantage of work that, that you're doing ahead of everybody else. Yeah. It's, it's somebody, well, A C I o asked me, he said, you tell me who's the player in the market, who is, who's the doing the best in terms of digital? I struggled. I mean, I could, I really struggled to come up with it, but when I, when I had some time to sit back and think about it, it's like, you know, everybody has done

Something, right? They've identified some experience. They want to fine tune. They've identified one thing, and so this is a great example. I wouldn't necessarily point St. Luke's and say they are the digital frontrunner. They've taken this one thing and they're potentially leading the industry in terms of how they're addressing it.

And I think we're seeing that all over the place. You have like, somebody has figured out, you know, expecting mothers and somebody's figured out, uh, how to do a check-in process. Just everybody's doing something a little bit and it's almost the health system that's able to aggregate all those things and reduce the friction is probably the one you're gonna look at and say.

They got it. They, yeah, they figured it out. Yeah. I mean it's, it's focus. So deciding what you need to work on and working on that. And then the second part of it really is, um, I guess ego or organizations that have a lack of ego that are willing to say, I don't have to invent all this crap here. I actually can learn from other people.

And so the third part of that really is plagiarism, right? Which is the most sincere form of flattery. So being able to go to all those other places where all this other work has been done and saying, how do I integrate that into a single digital strategy that supports where I want my organization to go, and what creates better, faster, cheaper, safer, easier access.

That'll be the winner. Those will be the guys who will be acquiring. Everybody else know Drex. I had 15 more stories we were gonna talk about, but we're at, we're out time. So yeah. Thank you. I do wanna thank you for coming on the show. Uh, always appreciate it. I assume people can follow you on LinkedIn.

They can follow you on Twitter as well. Absolutely at at drex to Ford. At Drex Ford. Great. Uh, this show is production of this week in Health It. For more great content, you can check out the website at this week in health it.com or the YouTube channel at this week in health it.com/video. Thanks for listening.

That's all for now.

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