April 28, 2023: VP and CIO of Children’s Hospital of Orange County (CHOC), John Henderson shares CHOC’s 2023 priorities, current technological advancements, and more. How is CHOC expanding its population health program and reaching out to other primary care practices in Orange County? How is CHOC creating a data fabric across its network to provide population health, especially with closely aligned primary care practices that are not part of its health system? How can technology be used to provide a standardized yet personalized patient experience in healthcare call centers? What are the top three things that patients want from a digital front door in healthcare? How important is convenience in healthcare technology, and how can healthcare providers balance patient desires with internal priorities? How can automation technology help improve healthcare and why do some people fear it?
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All right. Today we are joined by John Henderson from Children's Hospital of Orange County CHOC, and John, welcome to the show.
Thank you. Welcome Bill.
I'm looking forward to the conversation. We did not get to see each other at ViVE you were, you flew in and out and it's always good to catch up. I don't know when the next time I'm gonna be in Southern California, but I served right there next to you.
So, St. Joe's, our headquarters and one of our flagship hospital was actually pretty, pretty close to the Children's Hospital of Orange County right there. And so I've been in your building many times. It's a phenomenal facility.
Thanks. Thanks. Yeah, it's, yeah. I used to have a great view right outside of my window.
We've moved offices with last few years consolidating space. So I don't get to look at it right outta my window anymore, but yeah, it's beautiful building in St. Joseph's still right there.
All right. So, one of the questions I love to start with is tell us about CHOC. Tell us what you guys are doing and what CHOC's about.
Sure. So we're in the city of Orange Southern California. We are a pediatric health system. We have two inpatient facilities. Our other hospital is down in Mission Viejo. We have over 30 plus specialty clinics in the Orange County region as well as over 30 primary care practices across Orange County.
We have over 700 physicians as part of our medical network and our organization, we have just over 5,000 associates as part of our health system. So we are really focused on not only Orange County, but our mission is really about being the leading destination for children's health.
And some of the programs we have in place, particularly our pop health program. Is really focused on not just our patient population wherever we have medical homes for our kids, but also really every pediatric patient throughout Orange County and in this region we really wanna be able to serve.
Yeah, I, it's, I love talking to the children's hospitals. You guys are doing some fun things. I wanted to focus in on what are some of the priorities? What are some of the priorities? Potentially for children's hospitals today. And what are some of the priorities for choc specifically?
Sure. So I'll say our top line strategies are really focused on expanding our population health program. We've been at this for a really long time. We started even before I joined in, in 2017, our pop health program kicked off around 2012. And so we're continuing to expand that. The focus is not only Our primary care is in our network, but really reaching out.
We have some closely aligned primary care practices. We call them closely aligned because they're not part of our health system, but we do engage with them to try and provide them with whether it's some of the best practices with our asthma and action plans any of those types of things.
We create a relationship through our pop health division to help Try to keep our kids healthy. So continuing to expand that we have over 20 agreements with local school districts where we provide access to the nurses in those schools. So if a kid comes in they're not feeling well they have access to our E M R in case they're a patient, so they can look at background history and then also be able to call in to our nurse triage line if they need additional assistance.
So continuing to grow that is a top priority for us. We're also focused on improving access and capacity. And that really leads to really a complete redesign of our specialty clinics. The whole process from How a patient calls in to get service all the way to looking at the care model and the design of how we deliver services in, in all of our specialty clinics.
So really looking to revamp that, to make that simplified, but also make sure we provide the right level of care and really making sure that whether it's the physician, whether it's the nurse in the clinic, whether it's the ma. Making sure everyone is really focused on their core competencies and working at the top of their their license or specialty.
It's interesting, I mean, you gave me two really interesting topics and I'm surprised talking to a children's hospital about pop health is really interesting. I know you guys got some grants around that a while ago. I don't know if those grants are still ongoing, but it is a challenge knitting together the data fabric that's required.
To provide population health across that community in a in a very distinct population. Talk a little bit about how you get the information across the entire network. Cuz you even talked about the fact that they're not employed physicians of CHOC, they're, you didn't call 'em affiliated, what did you call them?
Mostly aligned. Closely aligned. So how do you create that data fabric where that information flows so that you can provide population health?
So it's been a interesting journey. Really the approach we decided to take is as we created these closely aligned relationships we would create a data use agreement where we, where that practice would provide us mostly the claims data.
It's very difficult to your point, to get the clinical data and be able to, Pull that in into your own platform and make sense of it so that you can really share that and look at it consistently and clean the across. So, that was really going to require The effort was too significant.
So we said, okay, let's focus on the claims data. And we were able to get agreements to bring that data in. And that's a little bit cleaner and easy too, to kind of marry with our data. So that was the approach we took to really bring that together. And then we share information back with those practices the pop health provision does to say, okay, here's how you're performing, here's how it compares.
We think if you focus in these areas and you, some of these guidelines, it's gonna help improve that particular population that, that you're treating.
So if a child presents at a specific clinic, are you able to identify, Hey, they haven't had these shots, or they need these kinds of services at this point.
Exactly. Exactly. Yeah,
that's, I mean, that's phenomenal. So I do wanna delve into access a little bit. Access is interesting. Because access almost denotes and now clearly there's some physical aspects to it, but it almost denotes technology in a way. How is technology enabling broader access to the CHOC services?
Right, so that Access program has six technology work streams, so there's a whole component of the process. As far as how we assessed and look at where do we need to improve our process and carry design, we also outlined, okay, where's our current technology capabilities? Where are the gaps?
So we identified gaps in our referral management program. So we've identified an upgrade to, to fill those gaps. And so we're upgrading our referral management system to make that initial referral much simpler. So a specific example. We made it a little bit difficult for referring providers.
We required them to register before they could do the referral. Now, that's one barriers to entry. So with the upgrade, we'll eliminate that requirement that you actually have to register in order to do the referral, make it simple and easier. There's many other things that come with that, but that's one of the things that the referring providers felt was a barrier for them.
We also are looking at really redesigning our scheduling templates to make them simplified. You may recall from your days at St. Joe's there can be hundreds, sometimes maybe a thousand different visit types. Well, if you're going to increase access and move to self-service. You can't have a dropdown list of 300 visit types that a parent is gonna look to choose from, that's just gonna be too overwhelming.
So streamlining those scheduling visits and simplifying those is one part of it in enhancing the scheduling platform with CNA to accommodate that is another work stream. But I think then there's also call center capabilities. So we have a call center to manage our specialty clinics.
And so it's an older technology. So we are moving to a cloud-based platform that's really gonna modernize and bring our call center into the 21st century. Whether it's related to virtual assisted chats being able to do direct Direct chat with the call center agents and or escalate those calls to, to live person calls, if that's what the parent desires to do.
So given all of those different means for them to engage with us to get the services that they need enabling those types of features the ability to really perform and have workforce management for that call center so we understand the volumes, the trends. Where we need more agents where we maybe need lower staffing based upon call patterns, really being able to provide that level of service which we have been able to provide in a consistent manner.
And then I'll say the last big piece of it is really creating a, we're calling our unified digital front door which is really a mobile experience where anything that you want to, any service you need, whether you're. Shopping for services, whether you know exactly what you want we want you to be able to come through that mobile experience and be able to consume those services from us in a simple friendly manner.
And now, that's a lot to make that happen because you gotta feed data from the emr. There's that call center platform I referenced. We're also looking to introduce Salesforce CRM into the mix with our marketing group, and have that integrated. So as those calls come in, we and you, we know who you are.
We know if you're what appointments you have with us. So it gives that type of friendly experience where we don't have to ask parents the same questions over and over again. We already have those answers and help them get to where they need to be.
So you, you mentioned Salesforce crm.
Is that also what you're using for your call center or something different?
We'll be using something different. We'll be using talk desk. For the call center we did a very extensive evaluation. And they really kind of came out on top for us.
Yeah. And that's not surprising.
The call center is an interesting topic to me because when you go to a large idea, like our idea, and I think we had. Oh, at least six call centers, at least two of them were outsourced across our 16 hospitals. And most efforts that I made to say, look, let's consolidate these fell on deaf ears back in the day.
But I imagine more and more it's becoming obvious that, hey, this is the point at which people are coming in. We can be much more efficient than having all of these people answering phones all over the place. And then we can manage that workforce. We can be more efficient. We can provide multilingual services, we can provide seven by 24.
There's a whole host of things, cases I was making back in 2012 that was falling on deaf ears. I would imagine that's gained new at traction as you say.
So yes and no. Surprisingly there's still a big change management component to it cuz we do have more than just the one that I referenced.
So we have about four other call centers. And I would say today our conversations are that we'll launch with. The call center that handles probably 65% of our specialty clinics. And we'll get that going. We'll show the value and then the decentralized locations call centers we believe that will leverage that data to help with the change.
Cuz there's a sense of, well I have these agents, they are embedded in my clinic. They know my operations. How can someone else be able to serve my patient families in the same way? They don't have that knowledge and expertise. Well, that's a valid point. The thing that we want to do with this overarching program is really get to a standardization across all clinics.
So we're given the same level of service to all patients. There'll be localization that we'll have to train on so you, you have a better sense of what's available in those clinics. That's where some of these technologies that we're looking to implement. Come into play to help build that knowledge and be able to share and show that information, insights to those agents as the, as those calls are coming in for those clinics.
So it's still a little bit of a discussion point, but we feel like we're having the right discussions and we feel we're going to get to that consolidation. over time.
Yeah. It's standardization, but it's also personalization. So it's in both directions and people don't get that.
They're like, oh, you're gonna standardize the process. You're gonna make a vanilla, it's not going to, you're gonna lose that personal touch. But I've seen effective call centers that, when they call in, the prompts are there and they say, oh how's your daughter doing? Is she doing okay?
I saw she was in the hospital a couple days ago. I mean, all those props could be there. Right. To really provide that personal experience.
Absolutely. Absolutely. And you know that's really where we see this going. And that as you mentioned, the efficiency and the service level and the personalization and that experience we believe that's what's gonna get us to that level of experience.
And it's what our patients and parents and families are asking for from us.
What services. Your digital, you mentioned the digital front door. I think those are the words you used. Everybody has a little different terminology for it, but the the place where we engage our patients, what are the patients and families asking for in that digital front door?
If you had to like, rank the things that they want to see, what are like the top three?
They wanna be able to self-schedule simply and easy. They want to be able to do pre-visit. Fill out any pre-visit forms, anything we need them to do, they wanna be able to do that before they come in. So their wait time is shorter.
They're not having to fill out a piece of paper they want those things and they want easy bill pay. Yeah. And so those are the three big things that, that we hear.
It's interest, it's all convenience factors. It's interesting how much time I hear people spending on getting the medical record just right on that mobile platform.
I'm like I'm not sure. I mean, I know some people want that and they wanna see, but they only wanna see parts of it. They don't care about the full medical record on that mobile platform. What they wanna see is, I want a quick and easy, here are my medications. So if I'm, if I happen to be on vacation and I'm seeing a doctor and he goes, what are your medications?
You just pull up your phone and say, there they're there. Exactly. Or better yet, just transfer 'em to them so that they can. They can see what you're taking. It's exactly right. It really is a convenience tool. And sometimes we get wrapped around the axle when we're having conversations internally because, we want to do things that our patients aren't necessarily asking for.
No. You're absolutely right. Someone says, what's that saying? Perfection is the enemy of good enough. Yeah. Sometimes you really you, if you strive for perfection, And you got on a path of I'm gonna deliver this solution in a perfect state, then you won't ever get there because there will always be one more thing.
And so we're really looking at this as I. Let's introduce the capabilities and functions and features that our patients want and we will continue to enhance it based upon what they've been sharing with us and what they'll continue to share with us. We want this to be something that is simple and easy.
And if you look at other industries and that have really great mobile solutions, They make it really simple needs for you to interact with them, and that's really what we're trying to do.
So talk to me. I mean, CHOC will see the sickest of the sick in the, in terms of children in Orange County.
Talk to me about home-based care and the level of acuity and maybe even telehealth and not requiring them to come into the facility as often. What are you doing in those areas and how are you pushing the ball forward in those areas?
Sure. So, home health is not an area that we have really made a decision to move into.
What we have decided, though, is to really continue to grow telehealth. So during the midst of the pandemic, we were running. 25% telehealth visits in the ambulatory setting that dialed back a bit we're, we've dropped to about 18, 18.5% and we really want that to grow. So we are focused on that expansion and we're looking at different models of staffing that can really support that.
And so we're continuing to focus there. When it comes to remote patient monitoring, we have. We're running a few pilots right now. We have with diabetes, with Dexcom. We've done some with our cardiology clinic where we send devices home and we're able to monitor remotely. We want to do more of that.
The challenge we're facing though, is some of the devices are still a little bit immature in the market for PS particularly, and primarily because these kids are growing. And there's just some challenges with that. But we're continuing to look in other vendors and other products that we can leverage and try.
And one of the things about CHOC is we like to be innovative. We like to try new things. So, we've kind of taken the approach as these new products come available. We'll do a small pilot. If we think the technology is, has good benefit and we'll see if that can be something we can grow and develop further.
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I think you're gonna be the first children's CIO I've asked this question of, but we've had this physician burn, a clinician burnout, a clinician challenge finding clinicians and those kinda things. Does that permeate children's hospitals as well?
Yes, it does. We've been working, we have a physician wellness committee we have a physician wellness director.
One of our specialty neurologists physicians leads that group partner.
So, so Is it a group or is that like a person's title and role?
So it's their role, it's their title and role. But there's also a a team that she has of other physicians that are part of the wellness committee.
And so we partner with them on what do they need from us? What do they think we can do? Technology enable enablement wise to help improve their efficiency, reduce their pajama time, is what we call it after our after hours documentation time. And so that's really what's driving the changes and things that we're doing.
So for instance we are. There was a feature copy and paste, copy forward functionality that no longer exists within current E M R. And that is such a huge deal for the physicians. And so we're trying to figure out how can we make that better. We don't have a solution yet, but that's one of the things we're working on because, They brought that forward, that's a really big deal for them.
I think the other things we're looking at have to do with conversational AI and so we're looking at some, a couple of pilots that we're gonna run where our providers can document using voice. They still have to verify and approve. The content that gets generated from that conversation that they're having with the patient, where it takes that conversation, populates it into the emr, it knows to separate it from what the patient's saying versus what the doctor is it is stating about that particular visit.
So we're looking at those things to, to kind of ease that burden. We think that's gonna help. But we also know that there's other things that's gonna have to come into place. Sometimes it's also about staffing models within different clinics and specialties. And so we're also looking at those elements as well.
Yeah, it's I'm hearing so many creative things in this area. Just different types of schedules. Almost planned sabbaticals, periods of extended time away. It we're starting to treat this like I mean the only analogy I have is MASH 4 77. When they would look at 'em and say, you can only be on the front lines for so, so long, and you have to take, you have to take some time away from it.
You cannot always be in the heat of the moment. And and I've seen some organizations actually really get creative with their scheduling and with with extended time and that kind of stuff. So that, I mean, that's really encouraging. I'm looking forward to these we were excited about the ambient clinical listening and some of the, some of those devices and some of the directions it was going.
And now we're seeing such activities, such massive movement in that area. And now again it's not trained specifically on healthcare and our language and our nomenclature and that kind of stuff. But it's showing such promise these large language models are showing such promise that it will be interesting to see if we can really take a significant burden.
With that, there's always been promise, right? We're starting to see some real progress here.
Yeah. Yeah. I agree. I agree. I think we're gonna really see. That progress happen. There's, as we're looking at exploring it, there's been mixed reviews as you kind of alluded to with the maturity of the products and can they really deliver the value results?
I feel like this particular area, I think is going to pay some really good dividends in the coming years. I'd be remiss if I didn't mention Chad g p t.
Yes, you would as you'd the first person on the show in months who had
Oh, as much as I, I think it has promise, but I will tell you I also view it with skepticism.
And not because I don't think that the technology has value. But I'll use a comic theme quote. With great power comes great responsibility. Great. With this tool, so many things can go wrong, but you can also have some things go really right. And we just gotta be really careful with how we approach it and leverage it for the good that it can provide.
Yeah I'll probably save this for another time cause I can, I've been spending a lot of time in chat g p t the other day. I sat down and and wrote a program with prompts and the program worked flawlessly and I mean, I had to change the prompts a couple times to get the variables the way I wanted to and things to work.
So the, it was helpful that I had programming knowledge. But it wrote the code. I mean, it's not like I sat there and started, with with a blank screen and had to, it. It was really fascinating. So, anyway we'll see where that goes. And I guess, I look back to, 20 12, 20 13, we were rolling out.
The transcription computer based transcription services that were available back then, and the doctors were excited. But then they seemed to plateau. And not make much progress for, almost five years. And it was is this, is this all you got? Can't you do more?
Right? And it seems like we're almost on that cusp of we are gonna be able to do more. So that's the exciting piece. Let me see what direction, I don't ask CIOs about their cybersecurity policies because you can't talk about 'em anyway. 21st Century Cures is kind of an interesting area to get down, but I don't think I really want to go there.
Here's what I, what technology are you keeping an eye on right now that you believe is gonna have an impact on healthcare in the next three to five years? That, it may not be here yet, but you're looking at it going, yeah, that's it. I know we just talked about chat, c p T, but is there something else you're looking at?
So there's two things I kind of referenced already. Really just looking at some of the medical device providers. That can bring some of these devices to market for our chronic kids and to be able to really better mom to those. So that's the area that I'm most interested in.
So They're getting smaller, which they're always getting smaller. Yes. They're connecting to faster networks and getting information back to us. But they I'm trying to think what other. Things we're seeing around these device and they're getting easier to, I think that's the other thing, easy.
The biggest progress I've seen is I've seen these one button devices that used to be pretty complex that, a mom or even a kid can use.
Yeah. It you hit the nail on the heads. They're so complicated. Once you explain to the parent, here's how, here's what you need to do when you go home.
You can give them the sheet you get home and there are so many things going through your mind as you're hearing what the doctor's telling you about your child's condition, how you need to use this device. By the time you get home, you're not gonna remember any of those things. And even if it's on a sheet of paper, you're following instructions.
Trying to get this device to work. And there's always nuances, right? And so getting them to kind of the single button, the easy to use the simplification is what's been a big barrier. And I agree with you that's getting much easier and they're making the devices a bit simpler.
And no doctor wants to be a help desk
e Exactly right. Exactly right. I think the other technologies, and now these aren't new, what I'm getting ready to share, But I think particularly in healthcare the value of automation, whether it's r p a, process, orchestration, process mining, those are gonna become what I call standard capabilities that health systems just have as part of their capabilities.
There's historically, that's not been something that healthcare organizations have really paid attention to. But a lot of them are doing that now. We have a heavy focus on it creating a whole program around it. But those types of capabilities, not just from a revenue cycle perspective, but really across your entire health system.
There's so much activity that any department has to perform that I feel like those capabilities are going to become. Really standard if you're going to compete and you're going to deal with the, whether it's the changes in legislation around reimbursement you're going to have to figure out how to drive out cost but really also continue to fuel the organization.
And I feel like those capabilities are really going to be what helps you do that. Keep outta your, your tool set.
When we used to talk about automation or AI in healthcare, people would get antsy because it's like, oh, that's gonna replace me. And I saw an interesting comment the other day and somebody essentially said, you're not gonna be replaced by ai.
You're gonna be replaced by another person who's using ai. Because AI is a great, like I, I used the term minion, and I hope AI doesn't get smart enough to realize that I'm calling it a minion. Because then it's gonna come after me. But the but that's what it's great for. It's great for, hey, gimme 10 ideas.
Hey, do this, hey, do that. And it just comes back very quickly. Or looking through the entire medical record and surfacing the, the key things that you need to take a look at. That's what it's really good at, not it's good at human augmentation. And those who figure out how to use it and use it effectively are gonna be so much more effective as humans, as clinicians, as it staff, than those who aren't using it.
No, no com completely agree. It's it can really be a way an organization really shifts their operating model. And, we see that as that value you described this doesn't replace a person. I actually had that exact conversation as we were launching our program and saying, Hey, we're gonna, we're gonna go slow so we can go fast because we need to do it right.
We need to make it sustainable. And the conversation was, well, you're gonna be in these areas working on these workflows and processes and automating these. And of course, you the conversation jumps to, well, how many FTEs is that going to. Is it gonna allow us to save? And I said, well, I'm not automating an individual's entire job.
We're automating workflows. We're automating tasks. And this can be five different people performing a piece of work related to a complex workflow. I said, so it's not an individual's job, it's components. I said, you're gonna get value in productivity improvements. But it's not an individual's job that we're automated.
That's not really what this is about. We won't find a scenario where, Were able to just automate an individual's entire job. See, that's not really what you're gonna see. That was important because they didn't have an appreciation or understanding of all of this stuff works.
And I just, heard a nurse I was talking to described it as we're trying to save every nurse. I think she said three minutes. She may have said, five minutes. Five minutes per patient, per day. And she goes, at the end of the day, we just saved them an hour. And you're going, yeah that's significant.
When you have a clinician shortage and staff shortage and burnout and those kind of things, what if we could go to a, seven hour workday because, they're just much more efficient or just give them a longer break or if whatever happens to me. But I agree with you. You started this by saying, This gives us a chance to really redefine what it looks like to work in a hospital, to be to be in a health system and just redo the entire workflow and just be much more efficient with it.
Absolutely. Absolutely. And it goes even, you think about back when you're trying to get tap and go funded it was things like what you described. How much time does a provider, a physician, Spend logging into that computer all day to provide care. Well, you're gonna eliminate this many hours giving back an hour and a day cuz they don't have to log in, a hundred times.
Yeah. I love, that's a great example too, by the way, because when I got to St. Joe's, it was. A minute and something to log in, and then they went to the next room and it was a minute and something to log in again. I was like, oh my gosh. I felt for 'em. I'm like, I can't believe, first of all, I couldn't believe it took that long to log in and it did, and then I couldn't believe they had to do it over and over again all day.
Yep. Hey, let me give you this as an exit question, and this is more for, some of our vendor partners who are listening to the show. Yeah. What have you learned about dealing with vendor partners over the years and what piece of advice would you give those trying to work with a healthcare organization like yours?
I'll say the two big things. There's a difference between a vendor that is a good partner and just a vendor that sells you tech. So for the vendors that are partners what I've found is they really take the time to listen to what you're trying to accomplish and what your real problems are that you need to solve, and they try to help you solve those.
And they also then this is not, this is rare what I'm getting ready to say, but the ones that are really good at this will tell you when their capabilities can't solve your problem, you're gonna have to go somewhere else. And that's really important. And so, when you find those, you want to, you wanna continue to work with them cuz everyone's gonna tell you their capabilities can solve all your problems.
So I think the other thing is that's rarely the case. And if you have vendors that are trying to convey that then I think that's where you want them to. You wanna convey them as, look, you're not gonna be my everything for everything, so let's figure out where you're going to play, where you really do well, and let's focus on that.
I think the other thing is for business, we trying to get into healthcare or want to do more healthcare business. They need to listen more and talk less because I continue to be surprised at how much vendors don't understand healthcare and in even pediatric is even a different level of understanding.
They don't even do the research to really understand what your business model is and what kind of care you provide. They just come in trying to sell. So my advice particularly on that, is they need to do the research and really need to listen and talk less, particularly in those early stages.
Yeah I, wow I love that because the best partners I had really understood the space and they understood all the different competitors and things that we were looking at. And the ones that would look at us and go, I'm not sure you really need a DLP solution. Maybe you should, consider this.
And I'm like, yeah, but you sell dlp. They go, yeah, that's not what you're describing here. What you're describing is this. Absolutely. Yeah, that's, I mean, that's so valuable. Valuable. Well, John, I wanna thank you for your time. Always great to catch up and I look forward to to being in the same town again sometime soon.
Maybe we'll even run into each other in that same
town. Sounds good. Look forward to it. It's been a great talking to you today. 📍 (Main)
📍 I love the chance to have these conversations. I think If I were a CIO today, I would have every team member listen to a show like this one. I believe it's conference level value every week. If you wanna support this week health, tell someone about our channels that would really benefit us. We have a mission of getting our content into as many hands as possible, and if you're listening to it, hopefully you find value and if you could tell somebody else about it, it helps us to achieve our mission. We have two channels. We have the conference channel, which you're listening. And this week, health Newsroom. Check them out today. You can find them wherever you listen to podcasts. Apple, Google, overcast. You get the picture. We are everywhere. We wanna thank our keynote partners, CDW, Rubrik, Sectra and Trellix, who invest in 📍 our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.