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I am excited to do this show. We have Drex DeFord with us, Lee Milligan, Dr. Lee Milligan, Anne Weiler and Frank Nydham have all joined us for this end of the year episode. And we're going to, if you're not watching this on video, it's worth looking at video because we're going to do this Brady bunch style, which we don't usually do on this show.

For instance, Haven ended in January. The JP Morgan, Amazon Berkshire Hathaway thing ended in January. And that feels to me like it was a lifetime ago. And it's kinda crazy that that happened this year.

And they're just failing forward. They're saying, all right, that didn't work. What's next? What's next? And I think we're going to keep seeing that happen. I'm not sure that was the biggest moment of the year, but that was definitely one of the moments I wanted to start with. Drex, how about you? WE'll go around the room, give everybody a chance to throw one out and then we'll see what happens.

Bill Russell: That has to be true. One of the things with the insurance I thought was interesting. I'm talking to people now and they're saying heck the requirements that the insurance companies are putting around the cyber liability insurance, at this point, if you follow it, you're not going to get breached. It's like you have to stand up, dual factor authentication.

Drex DeFord: I've seen and heard more healthcare organizations than ever before tell me that they are going to self-insure because either the price tripled, the deductible tripled the, the amount of inspection in control that the insurance company wants, should something happen, is just overwhelming or they weren't able to qualify for insurance.

Bill Russell: So for the rest of you, was there a bigger story than that this year?

Drex DeFord: Is that a general purpose question for everyone?

Bill Russell: I'm throwing that to, I'm throwing it out to everybody because I think it is one of the bigger things that's going on right now. In fact, I think it's one of the top of mind issues for most healthcare organizations, is the nurse shortage and the battle for talent has gotten to be pretty, pretty robust. Let's just say that's the nice way of saying it's gotten pretty robust.

So here within our system, we have a whole group of folks we're focusing on. But we also have docs who are leaving as well. I, I was talking to one doc who's a really respected cardiologist here who was considering as, as was mentioned, just hanging it up for a little whil e and just be done for 18 months and then maybe come back at some point.

Pay is obviously huge, right? You gotta make sure you get the pay piece right. But that's not the only piece and pay alone will not keep people around. We've got to figure out a way to have a balance, true balance for folks so that they can have a real life while they're also contributing. There has to be flexibility built in so that it is kind of normal, like clocking in at eight o'clock and clocking out at five o'clock.

Bill Russell: I notice you're in your office.

Lee Milligan: I am.

Bill Russell: So was the number 15% or 17% open rate right now?

Lee Milligan: 16.1 right now.

Lee Milligan: I can't give you that exact number. I can tell you from an IT perspective, 85% of my staff is work from home right now. So we got, people have to stay on prem are networking folks, some of our folks working on the servers. Engineers, field support and then biomedical engineering. Those are kind of the main areas that are on prem. Everybody else is work from home.

Lee Milligan: Yeah, the rounding piece has been interesting. We've kind of gone back and forth on rounding, depending on what kind of, where we're at with our numbers. When the Delta surge was, was really at its peak around here, and we had 190 inpatients with COVID and 60 on, on vents. At that point, we were backing off on rounding.

Bill Russell: Interesting. Anne you did a lot of work with health systems and you saw the value of rounding and those kinds of things. Are we going to lose something from a culture standpoint of that interaction between the analysts, the technologists and the and the clinicians?

You end up in a situation sometimes where it's like, if you can't drive there and talk to them, then they don't want to talk to you. And it's very hard to run a global company that way.

I mean, thank goodness for all the clouds out there. Thank goodness from work from home. And I just think people have gotten so used to it. We've gotten good. Tons of Startups, we don't really need to be all over the place. So I don't think we ever go back again. I think that's going to be good for technology.

And at the beginning of the pandemic, you saw organizations who said, nobody can work from home. On Monday, on Wednesday, say we're sending 6,000 people to work from. And I don't think they've gotten over that habit yet. And so to Anne's point, I think there's organizations who are leaning back into their old habits saying, you have to come here and you have to work in person.

Lee Milligan: And I thought that was a really interesting conversation on one of our executive team meetings where one of our senior executives asked, asked the question, well, let's get everybody back on prem. Let's put together a team that's going to be able to kind of, create a framework to make that happen.

Drex DeFord: There's also the Box and SharePoint and you've got four or five of those things that you're dealing with too. Like trying to remember where have you put things or where did somebody send you something?

Bill Russell: Did you guys ever see the McLaughlin Group? And he used to do this show and you would try to pinpoint it. So Frank's saying, we're not going back. Drex hedged and said, yeah there's, there's some, whatever going back, Lee, are we going back or have we fundamentally changed? One of the two?

Bill Russell: Fundamentally changed. Anne going back or fundamentally changed?

Anne Weiler: Fundamentally changed. And I'll use this to talk about what I think is its still the top story of the year, which is COVID.

So I was nodding a lot about the, which you know, which communication channel do we use. But you know, our, our customers are health systems and governments sending COVID notifications, vaccine appointments, contact tracing all of this to their constituents. And those governments got up and running faster than I've ever seen.

I'm thinking also about like, the things you get about well, old people can't communicate this way and you're leaving them behind. Well, my parents are walking around with their COVID passports. They are in Canada but other COVID passports on their phones and showing them when they go to a restaurant or, or whatever.

And if not today, within the next 48 or 24 months everyone would be back because it's what we know. It's how we operate. And for one team. And you have this idea of fairness, all of our clinicians have to come onsite. Why do these people get to live at the beach and work at the beach and that kind of stuff.

They had the, where to go get COVID tests. Like the messages are still going and so I was actually prepared for it. Okay some of these customers, we have to figure out what they're going to do next. Don't. We don't. Cause they're still doing these things. And now that they're doing them, like there's absolutely, I don't see us. Why wouldn't we send flu shot notifications now that we can? We will. Most basic one. I don't know why everyone's not doing that.

And so we had a changing of the guard and changing presumably, a changing of approach and those kinds of things. So we had a minimal amount of vaccine early in the year, so that was the big story. What are we going to do with the, we didn't have like a full supply. We had people driving 200 miles to get their first shot and that kind of stuff.

I think for the first time. I can't remember a time in history where we sort of did it this way or at least tried to enable it digitally. A couple of really cool stories that you had Atrium Health, do it on one of the NASCAR speedways. So the people drove in, drove onto the NASCAR track, drove into the pit, got their shot and drove out on the pit.

Heck it's hard to get a hundred percent of my family to do anything if I tell them to do it. This was an interesting learning year. Lee, I'm going to go to you. I mean, what have we learned going through this year, since you're the only physician on the call. I, I feel safe going to you.

Drex DeFord: It's hard work too that they're doing in a system where they're not being reimbursed to do that particular kind of work, right. They don't get paid for the 20 minute, 30 minute conversation they may get into around this.

Bill Russell: It's amazing. Who has another story or another event from this year. Clearly, I mean, COVID the vaccine labor cybersecurity. These are some of the biggest things that happened this year but anything else that you think really shaped this year?

And we had to work through a lot of those issues, including kind of restructuring our conversations with patients about what to expect. And what those results might mean, but the reality is patients have a level of transparency to their own individual health that they've never had before.

Cause I asked a couple of, of the investors, what's the number one indicator of success for you? And they say someone who's done it before. So a leader who has successfully gone through the gauntlet and gotten through the other side. And so that's why someone like Glen Tullman has no trouble raising a hundred million, but somebody else might have trouble raising five million.

Bill Russell: Yep.

Drex DeFord: Because they've been around for a while. Doing some stuff yeah.

Everything I see is like, wait a minute, we've seen this idea before. I saw Jack Starter, his new thing. I'm like, I don't understand the difference between this and Iora. The money. I think that's the thing with COVID is actually the VCs suddenly went, oh, healthcare.

Bill Russell: Fantastic. Lee?

Bill Russell: Fantastic. Anne?

Anne Weiler: No, I actually don't make predictions.

Bill Russell: Is that your, is that your final answer?

Bill Russell: We're printing money. So the value of everything has gone up. A gallon of gas is now a ton more money. So I think that's one of the things that's driving is the returns that people are getting in the market and whatnot have really driven them to be a little bit more aggressive with their money.

Frank Nydam: Thank you for everybody out there. I think you've got a great service and people are learning a lot and bringing people together that probably have never talked before, so.

Drex DeFord: For sure.