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(Intro)  there's only two types of employees at Allina One. Those who care for patients, And then those who care for those caring for patients. We're doing stuff to keep systems up and keep things running so that our nurses, our doctors, our everybody can keep on focusing on the patient and caring for them.

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

📍 Today's episode is sponsored by Quantum Health, Gordian, Doctor First, Gozio Health, Artisight, Zscaler, Nuance, CDW, and Airwaves

Now, let's jump right into the episode.

  (Main) all right, it's keynote and today we are joined by Dave CIO and physician at Allina Health. Dave, welcome to the show.

Thank you, Bill. Thanks for having me. Great to be here.

looking forward to the conversation. let's start with Allina Health.

Tell us a little bit about Allina, scope and services that you guys offer to your community.

Sure. Allina Health, we're headquartered in Minneapolis and serve the Twin Cities metro area and surrounding rural areas, including western Wisconsin. We have 12 hospitals, around 100 clinics, 28, 000 employees, and roughly a 5 billion organization.

So really cross the care continuum and everything from primary care to tertiary, quaternary inpatient services, and then have home health and community services as well.

you guys are urban and rural, would sound like.

Correct.

Yeah, we have three main metro hospitals that really service there are large hospitals, service the majority of our patients, and then we have outlying smaller facilities that we support back and forth.

Beautiful area of the country. Your background.

Tell us a little bit about your background. How did you, transition from being a phlebotomist to becoming a CIO.

Yeah, it's a, it's been a winding journey and If you'd said 25 years ago, when I started as a phlebotomist at our flagship hospital Abbott Northwestern, that I'd be in administration or leadership or anything, I would have thought you were absolutely crazy.

But I started as a phlebotomist during summers of college and kind of a pre med path and started with the line event and went to medical school, came back for my internal medicine residency, stayed on a year as chief resident. Which is sort of a one part teaching, one part practicing, one part research position.

And it was during that year in particular, I started asking questions about EPIC, our EHR, which we had implemented five, six years prior to then. I wasn't part of the implementation, but really EMR was starting to mature I was sort of on the early cusp of optimization. I started asking questions like, why do we need to click here?

Why do I need to navigate to this screen to accomplish a task that should be done over here in line with something else? And a mentor of mine at the time who was one of the key informaticists during the implementation, said, Dave, those are great questions, why don't you go to join this committee and go try to fix that and go talk to this person and Soon enough, I was being sucked in on that clinical informatics space and reducing clicks and , being the complaint department, if you will hearing all the what's working and what's not.

And that was a lot of fun, but I drawing down my clinical practice over time as I took on more and more informatics work, but I started to realize, people started to point out, Dave, you seem to have an interest, you can tolerate meetings, which is a huge asset to being in this space, would you like to lead a team?

We were able to accomplish more and then they said, you want to lead another team and a few years go by and I'm chief health information officer leading informatics in some unrelated spaces. And then about three years ago boss said, do you just want to lead all IT and be chief information officer?

So that's where I sit today. And that's, it's been a great ride.

haven't seen this on a job description yet, but Ability to tolerate meetings on the CIO job description really should be there. There were days in that role that I just remember, having to get in at five o'clock to get some work done because if you're doing rounds, it could start really early, seven, eight, nine, and you just go meeting to meeting to meeting.

It's fascinating. What's the most interesting thing about being the CIO for you in that role? For

me, it's always been, it's, so I'm fascinated by technology. But I don't have any formal technology training. like to joke that most of my knowledge of IT comes from childhood playing on the Nintendo entertainment system.

And then putzing with our we had a compact computer, I think it was a 25 megahertz processor. So tinkering with the DOS system and this sort of stuff. But so learning all about IoT. The technology has just been fascinating. Five years ago, I started really digging in on, not that I'm an expert by any stretch, but trying to learn more about our data centers and more about how this stuff actually runs and how we have these redundant processes, which redundancy and high reliability just fascinate me and how we parallel processes to support everything.

So that's been. I think just learning that stuff from the teams and it's stuff you can't really just go read in a book. You got to get out there and talk to the managers and the supervisors and the frontline analysts and engineers that are working on it. And it's just tremendous hearing their stories and hearing how things work and how they're trying to make it better and these sorts of things.

So that's been a real joy and a lot of fun for me.

there a unique benefit? to having a clinical background in that role?

think so. Aside from obviously having insights on, our strategic priorities as an organization, caring for patients and these sorts of things it has helped me a lot when, so I also oversee our biomedical technician team.

We've got about 75 technicians that keep our MRIs up and running, our IV pumps, all this stuff. And it's fun to round with that team because there's all this amazing equipment that I never knew existed. They start talking about it and in the clinical side, I'm like, oh yeah, that's how we, accomplish running this test or this is how we do that procedure.

That makes total sense. And wow, that's what you need to do to keep it up and running. So that's been a big benefit. In the leadership space, I think of myself as sort of like the cheap culture person IT and my teams, because my job really is to translate. The organization's mission, our mission to patients, our mission to the community, into what they're doing every day.

And so I, often try to illuminate that with stories or with just illustrating how their work connects into that day to day and that frontline clinician space. And I sometimes tell people, there's only two types of employees at Allina One. Those who care for patients, And then those who care for those caring for patients.

And I'm generally in that latter category and that's where all my teams are. We're doing stuff to keep systems up and keep things running so that our nurses, our doctors, our everybody can keep on focusing on the patient and caring for them.

What's interesting is we have two very different paths.

every now and then I'm in a room and somebody will say, Hey what's the path to being a CIO? Do I need to know more technology? Do I need to know more healthcare? And I'll just look at them and say, yes, and neither. It really is a leadership position. It's gaining buy in, it's budgeting, it's leadership, it's culture building.

It's all these things. And somebody is does it help to have those backgrounds? Absolutely. It helps to have those backgrounds. For me, I can walk into the data center and I can actually put my hands on a router and look at routing tables and that kind of stuff. You're not going to do that, but you could go into the EHR and you could look at things and see things.

I never once logged into the EHR. I'm not even sure I had credentials to log into the EHR. And so you have benefits on that side and people will say which is better? I'm like, it depends on the institution and what they're looking for.

Absolutely. And just like any leadership position. It's critical to understand your strengths and understand your weaknesses.

And so I don't know all the ins and outs of infrastructure. I can understand it and follow along reasonably well, but I need to have experts in a cloud architecture and, data center management and IT security and application architecture, these types of things. And, there's problems that come up and my job is to help facilitate the discussions, help drive to, solving a problem understand what the risks are and then make decisions around, are we going to do something about that risk or not, and obviously managing all the funds and all the financial pieces in that.

But Where I really I think brings some value to these, tough decisions and things are where patient care could be impacted. So for example, I probably shouldn't say this. We haven't had downtime in our EHR for about three years, unplanned downtime, that is.

So we're very fortunate with a very stable system, but the last time it went down, we had to make a decision that, potentially could keep it down for three hours if we were wrong versus 20 minutes. And so what's the impact? How many patients do we have in the ORs right now? Are our ERs full? So some of those things I'm able to bring perspective that keeps those patients and our clinicians front of center in these tough decisions.

back when I was interviewing for CIO roles, people would say to me, it's you don't have a clinical background. What are you worried? I'm like, you have more clinical people here than you have technical people here. So for me, my argument was always.

You need somebody who really understands the technology. By the way, that argument hardly ever worked. So talk to me about, so you said 20 plus year Epic implementation probably comes with its own set of challenges. I would imagine it was highly customized at one point.

Absolutely. So when we implemented Epic, didn't have lots of the stuff they have, that most of the inpatient nursing tools didn't exist.

It's got digital speedometer and a CD player and these things. And then I fast forward to what today's Cadillac looks like. And it's a flat screen, beautiful, pristine. And then I show what ours looks like, which is basically that same old Cadillac with a bunch of things bolted on, like a police car with all these screens and keyboards and things.

And it's not that it doesn't work. We actually, it works very well. Some cases extremely well, but it's hard to update. We have a lot of custom code yet. We have a lot of custom configurations. We've been chipping away at that stuff for years now. And unfortunately we've gotten all the easy stuff out of the way.

So now we're working on a lot of the hard stuff. It's tough because our nurses, there's a lot of change, classic change management stuff. Our nurses don't want to necessarily do it the new way. The old way works reasonably well. So it's a challenge. But this comes into, as I start to look to the future and a lot of the digital stuff that we want to do we need to have a nice, robust foundation in our Epic platform that goes for a lot of other spaces too, but we, so we're working through continuing to draw down as much custom configuration and custom code as

possible.

was looking at there was a course for CIOs. Essentially, healthcare CIOs. And there wasn't a section on organizational change management. That, to me, seems like a significant oversight. That is a significant part of the job, isn't it? You're constantly managing change as it comes into the organization.

It's true. And so I, of course, have to manage up in my C suite, colleagues. And what we're working on, and then also need to have that communication be really crisp, and have a great team that handles this, but I think, we think in phases back in the day, we'd have like once a year EPIC upgrades, and it was like, the world stopped turning for a few days when we did that.

Now we have quarterly updates that we take them for granted. They move so smoothly. And they're so darn quick, 15 minutes, 20 minutes of planned downtime. It's amazing. But I like the clinician me, what I have my people do is What do I need to know on Monday morning when I walk in?

So if there's changes or I need to click here, do something different, send out something, we want to communicate ahead of time, but what's that email on Friday look like that tells me as a hospitalist or as a clinic doctor, what exactly do I need to know different this morning for my first patient?

And so change is, you can't, overstate the importance and change. I think you can over communicate at times. It depends on the relevance and importance of the item and how much impact it'll have, but getting crisp on what's most important and really clear on what the change will be and what you need people to do is definitely a skill.

So do you have people dedicated to communication in IT? Do you rely on maybe marketing? Or is it just another aspect of the job of the IT staff that they need to be excellent communicators.

That's a good question. My expectation is that, so we're a very project based organization. We have spaces where we're in more of a lean and agile methodology, but very project based. And so my expectation is that every project we're thinking about communication more or less on day one.

What is the level of impact going to be? How are we going to roll this out? How are we going to communicate that change? Who are the people who need to know? Because it's going to impact them, who are the people who should be aware because they may hear about it, then who doesn't need to know, and that needs to be baked into the project plan very early on.

We do work very closely with our communications colleagues especially when there's really big projects, really big impact, or when we need just that very general knowledge. So my teams, we try to focus more on the impacted users and really details of what they must know and must be done differently.

And so it's a partnership in terms of that general core, general communication and then specific.

talk to me about I don't know what the term would be in your organization. A lot of organizations call it pajama time or how are you, Addressing that pajama time challenge with clinicians.

I was going to make a joke. We don't have any, there's none. But of course there's lots, there's way more than we want. It's bad and it's only getting worse. I, know seven, eight years ago, I was starting to worry about clinician burnout. And dang, as much as we've done to try to improve that we're still struggling, there's a few different ways to go about it.

One is blocking and tackling. I press the teams very hard to make sure. That we don't have extraneous stuff in our EMR, So get rid of the clicks, get rid of extra screens. Every screen that we look at, it should be as simple as possible.

It should be like an iPhone. It's really easy to read. It's really easy to use. And this is difficult. It's a challenge. It's not that we've accomplished it, but press the teams. Ask yourself. Do we need to have the patient's name on every single spot in four places on the screen?

No. You need it in one. Do you need to have the height and weight in every single spot? No. These to types of things, and that comes down to alerts and decision support and all the rest. Let's get rid of the stuff that's distracting. It's a huge challenge and lots of folks have worked on this and are working on it.

So that's the first one. The second piece for burnout, leveraging the, novel technology and whatnot to reduce that burden and really, I think of the EMR a lot as something of a Trojan horse, it came in, it looks like this wonderful thing and it has tremendous benefits.

Don't get me wrong. I can be in my pajamas charting and looking at stuff, but I also have a delivery path or all sorts of regulatory stuff, all sorts of billing requirements, all sorts of extra stuff that. Quality projects and other things can force me to do as a physician or as a nurse or whoever.

And so that vehicle, that Trojan horse, if you will is something we've got to start peeling back those administrative tasks. As we talk about this a lot, we've got to start peeling that back. And I think we're starting to turn the tide a little bit. Some of the technological, items that are coming along really.

are making a difference and I think we have, at least in my organization, I have the message out we are not adding anything to your home screen or to anything else unless there is definite value or it's really going to improve patient safety and quality.   📍 📍 📍

This June, we're inviting you to join us. It's simple. Just visit ThisWeekHealth. com and click on the cancer ribbon to make your donation. Together, we can continue Alex's mission to make a significant impact. Every donation moves us closer to a world where no child has to face cancer. So, take a moment, click on that ribbon, and make your contribution.

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  📍 📍 So there's this assumption that everything in the EMR needs to be documented and needs to be documented for coding, needs to be documented for regulatory. And from time to time, I talk to CIOs and they're like, yeah, we're stripping some of this stuff out. We thought it was. Part of the regulation, but it's like legacy.

It's still there, but they're trying to attack it from that direction as well.

It's a huge problem. So there are rules that were passed years ago and no longer exist that say you need to document X, Y, Z. That's one thing. And then there are these myths, like no one really knows, but everyone just says, Oh, we have to do it this way.

And so what I like to do is go to the source. Find me the exact paragraph or exact sentence where the law or whatever it is says we have to do this. I just want to read it for myself and, I'm sure a lot of your listeners have done this and what you find is that it's not quite as clear as they wrote in there, or there's some ambiguity, or we can't find it at all.

And those things, Get them out of the EMR. If it's not required, if we don't have to do it, or it's not driving benefit for the patient, get rid of it and clean that stuff out. The other piece that we struggle with, or not struggle, but a push pull is with our coding colleagues. They have a love hate relationship with me because I want to support them and their coding and I want them to be efficient and I want us to get all the appropriate credit for the work that's done seeing patients, but I don't want to have to put a statement in that says I reviewed such and such.

we already clipped it somewhere. I don't want to have to put a med list in the chart, in the note, just because billing likes to see it and it makes it easier for our coding colleagues to process. We already clicked, we reviewed the medications, reviewed the allergies, all that stuff is done.

And that's a struggle, not just with that tension with coding colleagues, but also Clinicians, a lot of physicians like to have it in their note. They just do. And it's a cultural thing. It's a preference thing. And if anyone has cracked that nut, I'd love to hear it, but it's a tough one.

Are you talking about standardizing the note?

Is that what you're talking about? Yeah, that's, you're right. That's a better way to put it. Yeah. Standardizing. It's a tough one.

Yeah, it's interesting. guess at some point we're going the way, congratulations, we're 20 minutes Into This discussion.

We haven't said the words AI until right there. i noticed that. appreciate that. But we are going to talk about it because are there technologies AI and essentially some ambient listening kind of things that you're playing around with that could make some of that standardization or transfer of information between those various departments easier.

Absolutely. So of course I'm bullish on all things AI right now. Understanding there are risks and there are drawbacks and it won't deliver on all the promises or all the potential. At least in the short term. So yeah, we're very active a number of tools. I really like working with startups and early stage companies on some of their tools.

And some of them work out, some of them don't. And then we also work with large partners. So we have deployed an AI We use Nuance, we've worked with them for years, and Dragon, and then deployed their DAX product a couple years ago. Nothing against the DAX product, but it was a little bit Wizard of It was posed as an AI doing it, but it really, there's a human behind there doing most of the work, and that's all good, that's just what it was. But Gen AI has changed that, and we have somewhere between two and three hundred clinic docs, clinic providers live on their co pilot, the AI scribe, and we're seeing anywhere from a twenty five to forty five percent reduction in no time on average.

Now some docs, some providers are seeing a seventy five percent reduction, like we It's truly life changing. They used to spend 10 minutes per patient on notes, and now they're spending like, 2 minutes. That's dramatic. Others, are spending about the same amount of time, which I like to say if you need to have perfect grammar, perfect punctuation, everything just so in terms of what happened in the visit, the scribe may not work for you, but if you're willing to sort of have things be good the important parts you would adjust and edit, then it really can not change.

So those just one example, I know a lot of folks are starting to look at that, that I do think is going to draw back, peel back some of that administrative burden.

pull back from AI for a minute. I want to talk about the patient. So we talked broadly about the clinician experience with technology.

What are you doing with regard to the patient experience with technology? I assume I'm not going to walk into Allina health. facility and be handed a clipboard or is there, are there still a couple of them floating

around? You might be surprised. We like to joke that, fax, it's like us, the healthcare and the DMV that still have fax machines and everyone else has managed to get over it.

So we still have fax. We do have clipboards not every place. So it depends. It's a constant struggle between, making that sort of patient, that patient portal experience and that digital check in experience, making that as good as it needs to be, I think as healthcare we still need to get away from the redundancy that happens on asking the same questions over and over.

We've. We've made progress on that. We're attempting to be as digital forward as possible, but just candidly it's a struggle. It's hard. We put in a new digital process and, it's a little bit hurting cats. Some clinics, they just, they create a new form and they print it off and they start handing it to patients.

And it's all good. We're all just trying to do our best caring for patients. But I think there is a lot of potential. One space we are looking at, and I think a lot of these new tools will really deliver is, In the translation space. Of course, Gen AI, it's really good at translating between languages.

So why can't we just very seamlessly with the click of a button, not only have it translate between languages, but translate. Technical, medical language into layperson language. So you get your MRI report. Why can't it be translated into more common speak? That's understandable. So we're looking to deploy.

later this year, a tool that can do that and really help patients. We have all these open notes, which was,, we pulled so many, it felt like pulling teeth for so long to get open notes out there. Turns out it was a big nothing burger in terms of the, concerns. But why can't we have all these notes readable to our patients?

And so that's something I'm looking forward to. And I think we'll. drive some value and drive more engagement with patients in the hospital.

and say available in 96 languages. I'm like, wow. I remember when that used to be like, that used to be not even possible.

If not, we'll do that over the next decade kind of thing. And we're talking about languages, but It's interesting that you went down the route of complexity. I can't tell you the number of times live in Florida and after you're done talking about golf and your family, the next conversation is about, your medical visits that week and that kind of stuff.

And as I talk to these people, I say, so what's, what's the problem? What's going on? And it's complex. It's hard for them to sort of grasp and understand. when we, when I was at St. Joe's, we were playing around with actually videoing the physician and then sending the video home with the person that they could share it with other people.

But it would be interesting to also have the layman's terms of that as well. But I imagine people would be concerned. It's is the layman translation accurate enough and, or does it create potentially a liability of some kind?

Absolutely. I'm talking a lot about with our executive colleagues and our board of directors around some of the risks with some of these tools and AI, the hallucinations are real.

And I like to put up a slide that has a couple of, funny things about what, a Moby Dick analysis line. And it says that Captain Ahab was actually on a whale watching tour or something, and whichever, Gen AI came up with this just bizarre thing, and there's some, other things about unicorns when you're at the restaurant or something.

It, the potential is there. And then I asked, what if this happened in patient care? What if we were drafting a message that wasn't reviewed by someone who went straight out? And it fabricated patient data or patient information. It's really scary stuff. We're said to take the wrong medication, these sorts of things.

And I always hedge on, I don't want to scare people too much, but that is a real risk and a real potential. Now, I do think there are ways to mitigate that risk and I don't worry about that a ton, but it comes back to making sure that we Are, going slow into some of these novel technologies where risk exists, understanding the risk, freaking out and being terrified of them, but putting processes and tools in place and where appropriate human oversight to make sure that they're working as indicated.

think you and I are in agreement in terms of the impact of AI short term is over exaggerated and long term may be under exaggerated in terms of what impact. How do you prepare for that? What does it look like to put the digital foundation in place, the governance foundation, all the things that you're talking about.

how are you preparing for that?

I need to know how, cause I just imagined all the different spaces that this could be applied. And sure enough, this, a lot of these spaces we are, we're looking at, we're going to, but I need a group of people who are. expert enough that can come together and create a group that can review use cases, understand the technological landscape, understand what we have out there, and then avoid the pitfalls of too many point solutions.

Getting too distracted by the shiny object that you know, one of my leader colleagues wants to bring in and be able to smartly review those things, understand that the, specific risks that are inherent to these AI tools, weigh those, articulate those, and then we can decide if we're going to put them in or not.

And so that oversight governance, we sometimes try to stay away from that word, but governance, oversight. And these things we've got a pretty robust system in place now. Now I have been careful. We don't want to create a whole new process because we do want it to go through our usual IT intake channels.

But really there's a stop. I tell people if there's even a whiff of AI on something, it needs to go to our, call it our digital innovation group, where we have our privacy, our IT security. We have our clinical informaticists leaders, our medical director for digital innovation, and these folks, and they take that first pass.

How does this match up to our architecture? Do we actually have a platform, perhaps in our Microsoft platform or other space that could already perform this gen AI activity, these types of things? Just because. Obviously, we're healthcare, we have limited resources. We've got to focus our efforts and we've got to be very smart where we place our bets in this AI space.

All right. So Dave, if I did an inventory at, this is my quiz, but an inventory at Allina today of the number of applications, and I do want a year from now, will that number go up or down?

I dream of it going down. So we have about 600. And we started a pretty, not aggressive, but an active app rationalization.

We're always rationalizing, but over the last year, I still think we add two for every one we take out. I used to joke we need to have a rule. If you add one, you need to take two out. It's really hard. I would like to have that number at 500. I would actually, if it was 599 next year, if it was 600, I'd be happy next year.

It,

It is, all you have to do is go to HIMSS, walk the floor and look at the number of people and the number of solutions and then go to RS& A and walk around and realize, wow, this is just imaging, like this whole conference is just imaging solutions and they're just now it's creative, there's really neat things happening and things that I believe will advance the patient experience and the clinician experience and offer better outcomes.

But at the end of the day, it creates complexity for the CIO. It creates complexity for the security team and yeah it's just, it's a challenge. I'd like to close some of your personal insights lessons learned, as you look at your journey, what are some of the key lessons you've learned and you'd like to share with.

other healthcare leaders or other graduates. You and I are both graduates of Western Governors University. Oh, very good.

I think one thing that I've learned is just invaluable is be curious. Don't walk in and think that you have all the answers. It's been a real for me to, as we were talking about coming in as a physician and I say I'm just a doctor.

I don't know what's going on with, the details of this and that, but explain it to me, I'd like to learn. And, sure enough, they can explain it away there where we can start talking and having. Making sense of things. So I think having that curiosity, that interest and eagerness to learn, I think one big thing is we were talking about some preparing the workforce for change is critical.

And this is becoming ever more important, particularly, not to talk too much about AI, but, I'm seeing a lot of nerves around. Employee groups, I just saw a big nurses group saying we don't want AI and folks are worried they're going to lose their jobs and these sorts of things.

And, I know a lot of your guests have talked about how jobs will change and some jobs will go away, it's going to take time, but I'm starting to work on, and I think it's just critical on how do we start. Preparing our employees for around AI messaging and how we're approaching it and what won't be changing in the near future and reassuring nurses that you're, we still need your skills.

We still need your cognitive, emotional, and other abilities. And we want to take away that burden, take away the administration, administrative aspects. So that communication piece and that preparing the workforce, I think has just been critical. And I think those are probably a couple, just to give you.

Yeah, we can talk about those. But I want to respect your time closing question here. This is one of those forward looking. Questions, future of healthcare technology at Allina, when you look at the future of technology in healthcare couple of years out or even a fair amount out, what can technology offer the clinician experience and the patient experience?

What might it look like? What, if you were to paint a picture, what would for a civic group. You are sitting in Minneapolis right now, and there's all these people from the community, just laymen sitting there, and they said what's healthcare going to look like in five years with the technology that you're bringing to bear?

What kind of picture might you paint?

I'll go with this one. One question that I post to my teams and that I often post to folks is what would it take for a patient to have a full night's sleep in the hospital? And that's, it's just such a tough problem.

We have people coming in, we have all this beeping, all this stuff. And we're building a new tower right now at our flagship hospital. And this is the question I posed about a year ago. And, why can't we have the IV pumps not beep and alert in the patient's ear, but have it actually alert to our, the appropriate nurse out on the floor?

Or if the patient needs more water or whatnot, why can't it ping the right person? Why do we need to come in and check vitals every four hours? Why couldn't we use a radar based technology or other technology that checks these vitals without any contact whatsoever? And the patient can simply sleep and rest.

So what I'd like to see in a few years is Patients are having good night's sleep. Now there's regulatory, there's all kinds of tough problems that need to be solved, but we are alerting and communicating the right person at the right time. So classic informatics principles, and, testing and doing things in a way where it's not as invasive, it's not as intrusive, and our patients can just.

Rest and, get back to being well.

the words of the movie Jerry Maguire, you had me at sleep. Like anyone who's ever tried to sleep in a hospital. Room overnight realizes the I don't know, unless you like noises, unless you like the sounds and whatnot, it's gonna be a tough night's sleep.

And we know how important sleep is for Exactly. Your health. Yeah. If

you grew up in New York City, maybe you like it, but for most folks it's, it is impossible and yeah.

Yeah. Fantastic. Dave I appreciate it's great to meet you for the first time. I hope we, get to run into each other a little bit more and thanks for coming on the show and sharing your experience and your insights.

Yeah. Happy to Bill. And likewise, great to meet you. And yeah I'm sure we'll connect sometime at a conference or something.   📍

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