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September 2, 2022: What do the first 100 days look like in a CIO role? What if you have really big boots to fill? Craig Kwiatkowski, Senior VP and CIO at Cedars-Sinai is carrying the torch to ensure that Cedars-Sinai’s unwavering focus on providing quality, safe, equitable and high value patient care stays on track. How does a pharmacist background help you in a CIO role? How do you navigate the healthcare delivery system so that it functions smoothly between the physician, the nurse and the patient? How do you ensure precision, accuracy, logic and safety? What is Cedars-Sinai doing to make the clinician's life easier, more productive and more satisfying? How are they approaching consumers of healthcare in their market? What are they doing to transform that experience? 

Key Points:

  • Pharmacists are good at closing care gaps, developing plans, patient advocacy and navigating the healthcare delivery system
  • It’s the little things that accumulate that we need to pay attention to, sometimes more so than some big grand reveal.
  • If anyone can disrupt healthcare, Amazon can. They're willing and maybe more importantly, they can afford to try and fail.
  • Cedars-Sinai

Sign up for our webinar: Challenges and Solutions to Unmanaged Devices in Healthcare - Thursday September 8, 2022: 1pm ET / 10am PT. If we had to troubleshoot just a few devices every once in a while, our hospital systems would run as smooth as butter, right? But when missing devices, security issues and friction caused by interoperability hits, we can’t expect a smooth operation. Our webinar will answer many questions surrounding the devices integral to keeping patients healthy. 

Sign up for our webinar: Patient Room Next: Improving Care Efficiency - Thursday September 29, 2022: 1pm ET / 10am PT. Traditional patient rooms involve sitting on the table, waiting, tentative knocks on the door. We’re redefining the way we look at patient rooms. We’re reimagining the future. Hear about technological tools that have been explored and implemented for clinician effectiveness, how to step into the “Patient Room Next” future, and the progress in our Nation’s health systems regarding PRN. Bring your hospital system into tomorrow with sound advancements and peace of mind. We’re looking to advance healthcare, and we know you are too. 


This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Today on This Week Health.

I think pharmacists tend to be good at closing care gaps developing plans and patient advocacy. Navigating the healthcare delivery system, essentially sort of functioning between the physician, the nurse and the patient experience. And I think from a technology standpoint, Pharmacists were early adopters in some cases of tech maybe a little ahead of the curve.

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

All right. Today we are joined by Craig. Kowski the CIO for Cedar Sinai. Craig, how close did I come to your name on that one?

You got it. Pretty close bill. It's pretty close. no edits.

I, I appreciate that. I'm looking forward to this conversation. You're not the only pharm D that we. Have seen, take this route to the CIO chair. We're gonna talk a little bit about that. The pharmacist background and how it plays a role. We're gonna talk about stepping into the new role. We're gonna talk about some priorities. So I'm looking forward to getting into this conversation, but my listeners always forced me to start with this question, which is tell us about Cedars. Tell us about the communities that you.

Wow. Yeah. Thank you. Well again, thanks for having me. It's great to be with you. That's a big big one. I'll try to narrow it down as best I can. But I guess maybe, and a little shamelessly, I should probably start with the fact that we're all very proud here that we were recently honored with the us news and world report, number one in California and number two in the nation. And so I think we're still sort of in the halo effect of that announcement, it's terrific recognition for the organization. But more importantly, I think it's terrific recognition for the people. It's really a special place.

And I think a lot of our success ties to the fact that it's a people in first and patient first sort of orient. Maybe more to directly answer your question ties back to the history of the organization as Judaic tradition, those sort of ethical and cultural tenants that were part of its founding.

In the early 19 hundreds, small community hospital, like measured in rooms and a hospice and grew over the decades to Mount Sinai hospital merged with Cedar, Sinai, or Cedars of Lebanon in the sixties. And today it's a 900 bed community hospital, academic. Medical center the largest academic medical center west of the Mississippi which is I guess a little bit of a claim to fame of sorts.

But it's no longer just Cedar's medical center over the past. Decade or so we've grown really into a health system. And the system includes the system includes the main medical center, of course Cedar Sinai marina Delray hospital, which is 130 bed hospital over in the marina. We also have some affiliate hospitals, Huntington health in Pasadena.

Which is about 620 licensed beds in Torrance Memorial hospital in Torrance, California, which is about 440 beds. And so if you add all that math up, it's about 200 little over 200 licensed beds. And I don't remember, but over a hundred thousand emissions annually. And so that's an addition of course, to our ambulatory networks and urgent care and sort of that footprint.

The, Cedar footprint really has grown over the last couple years. You talked about Torrance, you talked about Huntington. I remember some sort. JV with Providence as well to build into a community that wasn't well served. Is that, is that still?

Your memory's good. We have JV with Providence actually in tar. We have sort of a 49, 51 ownership arrangement there. And we're excited about that. That's really helped grown our network in the valley, in that space.

We're actually with them building a new hospital on that site. And so that's been a great partnership as well.

I don't know why that one surprised me it's but it sort of did cause your, your competitors in many ways, but there was this area that wasn't served all that well. And you guys stepped up together to serve that area.

Yeah. Yeah. Well, I think we were ready in that space. We were in that space together. And so this was a way to sort of merge our mutual interests and sort of grow. And do that. And I agree it's a little bit unique or more than a little unique, I think from a Providence perspective, but we have a long history here of partnerships and looking for ways that we can serve the community.

So sometimes people get jaded and they think, why would a company do a national search and select someone from within the building? And I talked to some people who are candidates from the outside great candidates for the role that you're currently sitting in. These are real searches.

I think people think that they're just going through it, but these are real searches. They bring people in and they're very qualified. What did the process look like from your.

Hmm. Well, the search was real it's was quite real. I assure you it was a comprehensive search, a multi-step process, several rounds of interviews.

And I don't know what seemed like countless conversations on my side. And I don't know, maybe it is probably gonna sound hard to believe, but I don't remember a lot of the specifics about like, sort of the, the nuts and bolts of all the steps, but it was a long process lasted several months.

And in hindsight it was a bit of a blur. And I think frankly, because when the search was going on there, wasn't a lot of room to pause and reflect and sort of ruminate about some of those things, our teams were so, so busy delivering on all of the plant projects and priorities.

Like most organizations our demand typically outpaces our supply. So there was, it is no shortage of things to pay attention to and dealing with the pandemic and all that went along with that. So my minded focus was predominantly occupied on the ongoing work, keeping the trains running on time, so to speak.

And maybe that was a good thing in hindsight, not to look at overly caught up in the whole process. And I also tried to be very sensitive to the fact that. Not just about me. Obviously we have a wonderful team in our it department and it was important for me to function as though I already had the job while I was in the interim role.

It was important to maintain continuity stability, to continue to push things forward. Things move so quickly and there really isn't an option to. I don't know, to delay direction and decision making until the new CIO starts. And so it was really just sort of a continuation of sort of all of that work.

And I was honored to say the least to be among the candidates considered. It was stiff competition. As I learned a little later in the process. But I'm incredibly proud. I'm honored. I'm humbled to have been selected as a CIO and again, it's it's a special place.

So you replaced Darren to work in who somewhat has a, a mythical kind of. Persona around the industry. He knows everybody he's connected with everybody, but I think one of the things that's so impressive is early on his first a hundred days in the role were really quite interesting because he came in during an EHR.

We can say it now. It was a debacle back in the day. I mean, he was there for what a decade or so Darren was, but back in the day, I mean, the EHR had all sorts of issues. It was in the LA newspapers and whatnot. And Darren came in and had to wrestle that to the ground. So his first a hundred days. Or firefighting and doing that whole thing.

What does the first hundred, I mean, you were an interim already, what does the first hundred days look like for somebody who's going from you're familiar with the organization and you're already in interim. So do the first, a hundred days look very different for you? Do they look like just a continuation of what you've been.

Well, yeah, I think by comparison, my first a hundred days were different than probably Darren's first a hundred or first a thousand. For sure. The time when he joined the organization, as you described was different than sort of the. State of maturity we're at now in terms of our capabilities and lots of credit goes to Darren for getting us there.

And so I was named the interim CIO immediately really effectively, immediately upon the announcement of Darren's departure. So I feel like my first hundred days started immediately at that point, which is now. About 450 days ago. And so I was interim for several months before being named the CIO and sort of as that process worked its way through.

And so the early interim. Time period probably was more typical of what some might consider the first a hundred days, or I don't know the honeymoon period, if there is such a thing although really as an internal candidate and as an interim, I didn't think there was really sort of that much honeymoon.

And I guess regardless of what we call it I was already really knowledgeable about the. Well connected within the organization. I knew the names of folks across and within the organization had built relationships at various levels of the organization. And I had great familiarity with the culture and sometimes cultural adaptation for a new person at an organization often takes the longest to acclimate to, and just in addition to the sort of fire hose effect of all new information.

And so I was already leading a lot of the work within the application portfolio. That was my previous role. I had responsibility for really the whole application stack. And so that was more of a matter of continuing to run with the ball. Certainly an advantage for me to have that as a starting point, but by contrast of very different first 100 days than perhaps Darren hit.

Yeah, I would imagine talk a little bit about the handoff. I mean, was it sort of a sudden thing and Hey, here it is. Or did you have some time with you and Darren to hand things?

Yeah, I think we had good amount of time. And I don't know, Darren's announcement felt a little sudden in a sense, I don't know if you're ever really sort of prepared for that, but Darren and I had a great relationship, a strong relationship.

He was always very inclusive with me. And so I knew what was ahead. I knew what was going on within the organization in terms of. Strategy tactics. And it was clear what was expected of me and the teams and he and I had worked together for sort of directly for several years and I was involved directly and indirectly in the vast, vast majority of the projects going on within the it department during Darren's tenure. So I don't think there was really any there weren't really any big surprises to be had. That said, I think in any new role, I learned something new every day and that's part of the fun. And Darren and I did spend some, I don't know, more formal transitioning of items that I hadn't been as close to along with some executive leaders within the organization.

It was a very smooth process. The immediate sort of need to know learning curve. Wasn't terribly steep for me, thankfully. And Darren and I connect fairly regularly. And if I ever ever question for him, he's always willing and able and quick to assist, which is, which has been great.

Yeah, that's fantastic.

📍 📍 We'll go back to our show in just a moment. I wanted to take this opportunity to invite you to our next two webinars. On September 8th, we're gonna have challenges and solutions to unmanaged devices in healthcare. This is a significant problem in healthcare, and here we're gonna discuss the tools that are obviously integral to delivering health, but are sometimes some of the most vulnerable tools we have.

In the health system, guests are gonna come from leaders from children's of Los Angeles and Intermountain, and they're gonna share their experience in maintaining their devices on September 8th at 1:00 PM Eastern time. If you haven't figured it out yet, we do all of our webinars on Thursday at 1:00 PM.

Our second webinar will be. Patient room next, improve care efficiency. The patient room is evolving inside and outside of your four walls. What is coming next to improve clinical effectiveness through technology with guests from health systems like yours, we're gonna discuss machine vision, ambient listening, AI care, companions, and much more.

And I've been having some of the conversations around this patient room. Exciting technologies really interesting use cases. I think you're gonna wanna set aside some time for this one before both webinars check out the briefing campaigns that are being released on our channel on the conference channel around this, these conversations are gonna give you a sneak peek into the discussions that we are going to have.

You can find these episodes in register for both webinars at this week. Both webinars will be in the top right hand corner. And I look forward to seeing you there. Back to our show.

📍 📍 So you have a pharmacist background Scott Jocelyn also CIO pharmacist background. How does that help you in your new role?

it's relatively unique. I know Scott and one other at this point and I'm really proud to represent the profession in some small, small way.

I think that. It's a unique perspective in some ways as a pharmacist. It allows me to approach things as a clinician, as an operational leader and someone who does have some experience in technology, which. I don't know, tends to be a little bit more prominent or at least in days past, it was more prominent in Pharmac, I think than maybe some other professions or other areas, clinical disciplines, not to offend any of my other clinical colleagues out there.

But I think pharmacists tend to be good at closing care gaps developing plans and patient advocacy. Navigating the healthcare delivery system, essentially sort of functioning between the physician, the nurse and the patient experience. And as I said, I think from a technology standpoint, Pharmacists were early adopters in some cases of tech maybe a little ahead of the curve I was using order entry systems 30 plus years ago as a pharmacy technician. They were rudimentary, but they were there and there was other early examples of clinical decision support for IV mixture, parental nutrition, some dose allergy checking and what seemed pretty advanced at the to even more advanced capabilities around robotics and dispensing and packaging capabilities, it's always been fun stuff for me. And maybe I'm wired in that way, but I think a way to answer the question also is I think pharmacists are wired in a way in their DNA. So to speak again, these are broad generalizations speaking mostly for myself towards precision accuracy, logic safety. And I think some of those traits tend to exist in folks who work in it. I think particularly safety, understanding that the little things that we do have intended and sometimes unintended consequences and the expectation that systems solutions are delivered safely, reliably. Thought to their design accounting for the human factors and, and all of that.

And I think those things are just foundational to the work we do within technology and it, and I think there's just some natural similarities there. But you know, I admit I'm. Perhaps not the most objective voice on the topic.

well, it's interesting. I mean, only a handful of pharmacists, a bunch of emergency room physicians have gone into the CIO role.

And I guess back in the day, that would've made sense. It would be interesting to look at which background really sets you up for success in that. All right. We're gonna transition out of the honeymoon period, if you will, of the interview. One of the things I loved about talking with Darren is I could throw anything at him and he would just roll with it.

So I I'm gonna, I'm gonna do the same with you. I mean, you're CIO for the largest academic medical center, by the way. I did not know that's that west of the Mississippi that's that's really impressive. So what are the priorities right now for Cedar?

Yeah, well, thanks though. I appreciated the honeymoon. I like to get at least a little honeymoon period and but that risks being a long answer. maybe because we have so much important work that we're doing, but maybe distilled to a sentence. It ties to our mission state. Cedar Sinai has an unwavering focus on providing quality, safe, equitable, and high value patient care. And I think that's really foundational and it's understood across the organization in order to do that. As you can imagine, there's.

A number of priorities that sit under or adjacent to that. We have lots of high priority items. Things like excellence in clinical care and patient experience excellence in research and medical education, innovation integration of digital tech, advanced analytics, molecular medicine.

Talent attracting, retaining and developing staff and a number of priority areas to support growth as we continue to sort of evolve as a health system. But I think from sort of my perspective, we're sort of distilling it down even further. If it could be distilled down into a word it's people it's really about people.

It's about people as patients, people, as caregivers, people as staff we have world. Technology world class clinical capabilities, but that doesn't stop us from asking ourselves, what can we do more of? How can we improve efficiency, quality patient care experience? How can we improve the experience for our caregivers and staff who depend upon technology?

And we owe it to them to support the work they do every day. And so we ask the same certain questions, how can we make it better? How can we reduce friction? There's a number of areas that we're working at in that space, just a couple of examples on the, to the staff front.

We've got robots roving around the hospital to reduce pressure on nursing, to reduce steps, finding and delivering items needed for care, specimens, pumps, other supplies we're deploying R F I D solutions, tracking devices and equipment. Again, making things easier to find easier for the sort of the nurse and the day to day experience.

These are little things that accumulate countless times a day and there's really ways that we can improve those things. And then maybe even more broadly a big project that we're working on is the E R P sort of back office transformation I think many organizations who've spent the last decade plus implementing EMRs.

We haven't spent as much time on the back office and giving them the attention that they need. And those are critical, critical functions to support the organization. It's age old story. I think of legacy systems silos, disjointed, manual workflows, perhaps some data fragmentation and. Frankly, just a stale experience that hasn't really kept up with the times.

And so we're consolidating there a single platform and we think that that's gonna better enable, excuse me, better enable us to support processes for finance, for supply chain. Modernizing processes around human resources, employee experience analytics and, and all of those sort of good things.

But I think it, again, it's about people and it's about a commitment to deliver contemporary tools, modernize processes, and allow our staff to do what they do best.

Yeah. So let me narrow down the conversation on a handful of those things. You mentioned a handful of times there, making the clinician's life easier and more productive and more satisfying. What are some of the ways that you are addressing that, especially in light of the staffing challenges that we're having across the.

Yeah, I think it's some of the examples I mentioned, and it's really looking and we've got sort of clinicians within our it department that are embedded within operational areas.

And I think it's something that's been a longstanding sort of tenant and approach for us. And that enables us to really get in the weeds with folks, help translate and figure out how can we do things more efficiently, more effectively? How can we it's simple things. Flow sheet consolidation for nursing.

If we start off with our sort of starter set of 200 flow sheets, and it requires this sort of difficult navigation and we can get that down by a fraction of down by 80 to 90%, imagine what that does to the day to day sort of working life of the nurse.

Who's trying to navigate those things. So I think it's just the little. That really accumulate that we really need to pay attention to sometimes more so than some grand reveal or a big a big sort of showcase project, like the E R P transformation, as I mentioned, not to take anything away from that, but from the clinical standpoint, it's the drip, drip, drip of things that slow, slow down the day. The extra click says, I'm sure we've all heard about, and those are things that we need to focus on as well.

Yeah. the market you serve has always been fascinating to me. so telehealth is one of those things in academic medical center, especially with a lot of specialties has been hard to drive, but during the pandemic we saw that that expanded. How is telemedicine telehealth progressed since the pandemic at Cedars in your C.

I think the needle has moved back and forth quite a bit over the last couple years. I'm not convinced we've landed on steady state really, nor nor do I think our patient population has fully decided what they prefer.

I think we're still in. Some sort of an experimentation stage. But if I look back at the, I don't know, I guess as in the context of the question sort of before, during and after if there is such a thing as after COVID, I'm not sure when that'll be. I think we rapidly accelerated our capabilities around telehealth with COVID and we don't have really good metrics around sort of what that looked like pre COVID, cuz we weren't really tracking it well that well, and it wasn't very well deployed at that point.

And so when we accelerated, I think at our peak, we were in around about, and this is probably in the spring-ish of 2020. 40% of all outpatient business were either a telephone or a video visit roughly I think sort of split half and half with each of those modalities. And then as the clinics reopened stabilized a bit.

And I think we're today at Probably about 12 to 15% of total sort of possible outpatient volume which varies a bit by area. Internal medicine might be around 25%, most of which is video. And then some other areas that just don't lend well to in person visits are much, much smaller.

And there's some visits that are impossible to do. Sort of been a telehealth function. So my imaging and infusion and all that. So sometimes hard to sort of weed out the numerator and the denominators.

do you expand your capabilities to these partner, hospitals that you talked about Delray and Huntington, I mean, cuz you have such great specialists in the medical center.

Yeah. Yeah, we do actually. We have the sort of suite. Tools and capabilities. And as we expand we deliver that same sort of suite of capabilities to each of our affiliates as we implement our EMR. So it's all of course loaded through our EMR and we use those tools and in the background.

So talk to me a little bit about the consumer in healthcare. you're in an interesting market in that again, it is highly competitive. You have a lot of the tech companies there. I think a lot of the health startups when they. Think, oh, we're gonna do a test market that might start in San Francisco, but they're quickly down in LA doing these tests and whatnot.

How are you approaching the consumer of healthcare in your market and what are you doing to transform that experience?

Yeah. Well, we're always looking to improve our capabilities and really to ensure that patients have multimodal access tools. So if it's an in person experience we support that through technology via automated decision trees really streamlining that registration and check-in process.

We have kiosks for those who prefer self-service and. Online tools, of course, for online scheduling and E check in and so forth. And it's really I think you said it well, it's a drive to keep up with and perhaps get ahead of if we can, the patient and the consumer expectations and sort of, as we design these solutions, we work closely with.

Focus and patient experience groups to make sure that what we're designing in terms of our products meet consumer expectations and usability FA feedback. There's some work we're doing around digital first solutions that we're advancing in that space. And then maybe more recently, and again, it feels a little bit like a little thing, but it accumulates a recent example of consumer sort of trying to meet consumer expectations and experience.

We rapidly deployed electronic consent. Something that's tend to lag in healthcare where the. I don't know, the tried and true and overhead heavy paper experience paper and faxing still prevails. We've had, of course we've had electronic check-in and some basic consenting enabled for quite a while now, but these new workflows are really around allowing the patient to electronically sign procedural and other consents more like a DocuSign workflow in real time with a sort of a clinician or a caregiver, sort of walking him through it.

And as this is technology that's widely adopted in other sectors with signatures. I mean, who among us doesn't get a DocuSign once or twice a day or a. And it's, it's really, I think about keeping up with consumer expectations, staying ahead where we can, and hopefully improving some efficiency.

And in this case, saving trees in the process. And then there's a a number of other ways that from the sort of continuum of the patient journey, again, the in-house. We've got a bunch of in room technology that we've deployed to support sort of, again, that contemporary experience with we've got bedside tablets in every room that have access to the patient portal.

The, they have entertainment sort of capabilities on them, integration with the TVs, and we've got Amazon Alexa and all the rooms that are integrated. With other systems and allow communications with nursing. And so again is trying to stay ahead and at the very least keep up with with those expectations.

Yeah. my gosh it was always interesting to me. to see all the different things that were happening in the market, because every area wants to say they're the Silicon valley, but there's enough Silicon valley spillage down into Southern California that every time I turned around, there was something going on, some partnership going on that we had to be aware of or some new player coming into the market that we had to figure out what they were doing.

I mean, but at the end of the day, it really is about just having your finger on the pulse of the communities that you serve. How do they want to be served? How do they wanna partner with you in terms of healthcare and their health? And if you figure that out and you make those connections and become the trusted partner for the community, , I mean, that's the that's the secret sauce. It's not some new technology you're gonna throw or whatever. It's integrating all of it. here's my challenge to You he took over after Darren, I figured by the time he was done that all the faxes would be gone at Cedars. So over the next couple years, the challenge for you is to to get rid of all the faxes at Cedar Sinai. What do you think the possibility of that is?

I think it's well about alls, a big word, but I think we can get rid of most and did a great job chipping that away, but you know, these things are, and, and part of it ties to. Who we're faxing with or who we're communicating with. Right? Some of these are external forces outside of our sort of area of control. And we have to meet our partners and payers and whoever else with whatever their current contemporary standard is.

Yeah. All right. Well last couple questions. Probably two questions here. One, I wanna talk to you about data. There's a lot going on in the data world. There's announcements with Google and major players. There's Truves out there and those kind of things. What's Cedar's doing with regard to data and how are you thinking about it? Moving forward?

It goes without saying, but our data, we really view our data as one of our most precious assets. And so we're very thoughtful about with whom and how it's shared. I recently read and I haven't fact checked it. But healthcare data is doubling at a rate of every 73 days.

It's pretty incredible, even if it's anywhere close to that. And so I think that really just speaks to. Potential for that to be a really powerful resource. And I think Cedars has a long, long history of innovation and data is yet another way that we continue to innovate.

We've got a we've got a department of a newer department of computational biomedicine, as well as a division of artificial intelligence. That's looking to do that and their work is about. Research and discovery with a heavy dependency on data, some of which is quite unique to our patient population. And so these are folks who get up every day to develop and advance sort of solutions that have the potential to transform care.

is it hard getting the data ready for artificial intelligence and some of the, some of the use cases that you're being asked to get it ready?

perhaps I think it's more about availability access and looking at ways that we can do more in terms of self-service tools for our community, that community of researchers and folks who are accessing the data. And so I wouldn't say it's a matter of getting it ready. I think it's having.

The because we're not necessarily always teeing it up for them sort of for use case. It's more about having the capability there so that they can inReach and grab what they want when they need it. And it doesn't have as heavy a dependency on administrative overhead and a request process that allows 'em to sort of get what they need in close to real time.

I'll close you out with this question and it's, maybe an easier one, but it's a little harder in that. It's it's outside of your realm and it's we look at the world that's happening. One of the big stories has been one medical being acquired by Amazon and what that's going to mean. What do you think it is gonna mean? Cuz you're probably one of the markets where one medical does operate. What do you think that does mean?

Oh boy. There's been. There's been a lot said written about that in the past few weeks. I'm not sure everything that new or novel to add to the opinions or the speculation, but I won't let that stop me. Look, it's no secret that Amazon certainly has struggled a bit in their initial healthcare ventures with halo and Haven and PillPack and drugstore. I'm probably missing one or two. So I think it's perhaps easy for some of us to fall into the more skeptical. Here we go again reaction to one medical, but I think we'd all be wise not to underestimate them.

There are certainly wise to sort of pay attention. And if anyone I think can disrupt healthcare, Amazon can, they're willing and maybe more importantly, they can afford to try and fail. And it almost feels like a playground of sorts for them. And They paint a really compelling future state vision patient logs in gets triaged has an on-demand video visit, gets a home visit within an hour and if needed their prescriptions are on their doorstep within hour is, or the next day sounds delightful.

I mean, if you unfortunate position that you need care originally. And I think it's really the Amazon experience that so many have gotten used to. So I don't know. It's hard to know, but I do think Amazon eventually is gonna find a sweet spot in the healthcare space. And I don't know, maybe building off of an established brick and mortar practice.

Like one medical might be the way that they're able to be most successful. I think it it also could help in unexpected ways. And maybe, I don't know if this is a fair comparison, but I've heard John Mackey say it was the Amazon acquisition that enabled whole foods to rapidly pivot and scale home delivery.

As COVID took off, they simply wouldn't have had the capability or the capacity to scale without Amazon. And so some of the ways that they can help or that may find a foot. Maybe we can't even see at this point which is all the more reason why we should pay close attention. And I don't know.

I guess we'll see how it evolves in due time and in the meantime, I do like my Amazon prime membership.

Yeah, I don't know if we're gonna be seeing a addition of Amazon health or whatever they want to call it at this point. Or whatever, devolves to added to the prime membership. But it will be interesting to follow. I think organizations like Cedars are a little bit. Shielded. I mean, you have so many specialists. They're not getting into that high acuity care. They're not getting into those specialties. The academic medical centers, I think are potentially gonna be beneficiaries of the Amazon model they'll triage.

But at some point they're gonna say. Hey, we need to send these people somewhere for health and you're well established in the communities that you serve. So I think there's a big benefit there. Craig, I wanna thank you for taking some time to spend with us, spend with the community. I really appreciate it. I look forward to catching up with you again real soon, hopefully in person.

Indeed. Thank you, bell. It's been great. I appreciate you having me on today.

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