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September 22, 2023: In this episode, Doug King, Senior VP & CIO at Northwestern Medicine, delves into the transformative role of technology in healthcare. As healthcare systems increasingly integrate cutting-edge technology, how will clinicians adapt? Can AI truly be a reliable "team member" in patient care? As the borders between clinical and consumer data blur, what ethical considerations should be taken into account? Doug argues that the influx of data, while invaluable, also presents the challenge of discerning "signal" from "noise." How should healthcare institutions prepare for this exponential increase in data, and what strategies can help in filtering valuable information? Lastly, when it comes to forming valuable partnerships with vendors, Doug emphasizes the importance of shared mission and culture. Listen in to explore these questions and more. 

Key Points 

  • Ethical Considerations in AI & data 
  • Data-driven decisions
  • Digital nurses 
  • Patient digital experience
  • Valuable vendor partnerships

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.

(Intro)   we spend a lot of time as CIOs talking about artificial intelligence and data insights.

Still, the most important thing we do are making sure that the lights are on and the doors are open. Those core systems have got to be Working and working well, or we never get to play in the AI and the ML space.

  Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

(main)   all right, here we are for another keynote episode and I'm excited to be joined by Doug King, CIO, Northwestern Medicine. Doug, welcome back to the show.

Thank you, Bill. Appreciate the time.

looking forward to the conversation. The last time we talked, we were we did a very short episode and we talked specifically around training and bringing in people from from the community colleges, universities, and different programs.

That was that was a great episode. We got a lot of good feedback on that. But before we get into the conversation, one of the things my team wants me to do is to make sure I ask you to tell our audience about Northwestern Medicine. Yeah, happy

to. We're an integrated academic health system partnered with Northwestern University and the Feinberg School of Medicine.

We're the third largest private employer in Illinois with over 35, 000 employees. We're very busy. We see about 1. 3 million patients every year. We have 5, 400 aligned physicians in about 200 ambulatory locations. And this year we're going to approach about 8. 5 billion in revenue. Wow,

So a lot going on and you guys are primarily in downtown Chicago or have you expanded

beyond that?

No, we are primarily in downtown Chicago and then the collar counties which is really that's where the 11 hospitals are. So, broader Cook County, DuPage, Lake County. So our span is really from downtown to about 92 miles west is our furthest location.

Fantastic. All right, I'm going to let you really steer the conversation to start because, you know, there's a lot going on in healthcare.

We can go in a lot of different directions. What are some of the priorities today as we're talking at Northwestern Medicine?

Yeah, I would say, you know, a few things. Number one, I think that the demand for data and not just data, but accurate and insightful data. Has exponentially increased over the past probably two years and it was already high two years ago.

Experience, patient experience is becoming a key focus area for Northwestern medicine as we continue to embark on, the next ten years and building out a strategy. determinants of health. Is a big one. And then really advancing care through research and getting that research to the bedside to make an impact on patient care.

But overall, we're focusing a lot on making sure that we, our core is strong. And that we continue to provide great patient care. Patients always come first at Northwestern Medicine. And then if we do that well, we'll be able to focus in on data and artificial intelligence and machine learning. And those things are really starting to come into demand.

As we continue to have success, the demand only increases.

We'll talk about the experience, but we'll start with data. And data is an interesting topic for me. So you guys are an academic medical center. You have a lot of research, probably a lot of grants and those kinds of things.

And it's somewhat distinct in the AMC's. Versus the IDNs a little bit. I mean, you have some of the same things going on, data governance and getting good quality data and applying that data to outcomes. What are some of the distinct challenges that we face in healthcare with regard to data?

You know, a the data's gotta be normalized and I think that anything within healthcare it's gotta be right. Especially when you start training models on data, you gotta be very careful to make sure that you're training them without bias and you need to validate them even outside your walls to make sure that they are being used as intended and they're continuing to provide value and just not shelfware or something that is out there spitting and chewing up operating dollars.

I think the other thing is getting the data to be clean. Because it is incredibly difficult to be able to train any type of artificial intelligence, or even have accurate data for analytics where a clinician or an operator can make a decision. And that can go all the way from length of stay, throughput, All the way to diagnosing if a patient does have sepsis or not.

If you're, you need to make sure that data is clean and it's being used in an appropriate manner. And that's very difficult. When you start talking about scale, and you start talking about systems, and getting all of those systems to feed into a single location cleaning that data. And that data cleansing process is labor intensive and it is expensive.

So, you need to do it with intention and focus.

\ talk a little bit about your journey. How long have you been on your existing EMR? And, what does it look like as it's progressed over the years? And how is it different today than it... Say was when we were doing meaningful use and just trying to figure out what to do with data.

It's been

a journey So I would say that probably about seven years ago We made the decision with our growth that part of our mission was to spread academic medicine throughout Northwestern medicine we want the patients to get the same care that you can get downtown at the academic at any of our hospitals.

And we knew that if we were going to do that, we would need to standardize our systems and our workflows as much as possible. So we embarked on a journey and we consolidated to the EPIC EMR and that ended probably about five years ago. And it was a massive effort, probably about two and a half years.

And that was replacing another EPIC install there's a Metatech in there Cerner was in there. But now that is paid dividends, and so now we have enterprise systems in EPIC. We have one PAX, we have one EMR, one ERP, and one EDW. And what that allows us to do is now that data is flowing into a single source for all of our EMR clinical data, all of our PAX imaging data.

It is incredibly beneficial to operations to the patient, and then it allows us as being the technologists, to work with the clinical side of the house or the business side to create algorithms. Because we're not worried about plugging in 15 different EMRs systems and 10 different PACs, so it allows us to, without adding to the bottom line or to the expense side of the balance sheet, actually, we can divert those resources to go develop those upper right quadrants, which is great.

It's really interesting to me because this week I've recorded a bunch of episodes. I interviewed BJ Moore at Providence, interviewed Jason Joseph over at Corwell, and now I'm interviewing you and you're all singing the same from the same sheet, which is essentially, Hey, we finally got to a foundation, single EMR, single ERP,

And there's almost an excitement of, Hey, we can now move fast. We can now do the things that, that people are like, Hey, we haven't seen the results, the promise of the technology. There's an excitement that, Hey, we can now do some things. We can now get the data to the point of care.

We can now impact the experience and other things. There's it's really a different time than it was. just a few years

ago. Yeah, I would say it is probably the best, one of the best things that we ever did as a health system. I never want to do it again. And it does, we have that, we have the foundation built and so now we can continue to grow and if you want to keep the analogy, build the house and we can go to the second story and start to really crank the dial and we can do it faster.

Not only because are we not focused on supporting a thousand other systems, and we still have a lot, I want to be clear, but when we deploy a piece of technology, we're only doing it in one ERP. We're only doing it in one EMR or one PAX. It's just the tangible benefits to those are hard to describe when you start thinking about moving PAX images and you have that ability, or if a patient can get a MRI anywhere within our health system and any radiologist can read it.

Those are things that were not possible five, six, seven years ago. So that is just done, and we don't have to continue to look at that and we can look up and to the right. The other thing I would say is we spend a lot of time as CIOs talking about artificial intelligence and data insights.

Still, the most important thing we do are making sure that the lights are on and the doors are open. Those core systems have got to be Working and working well, or we never get to play in the AI and the ML space.

We are going to talk, we'll talk AI in a little bit, but we're now building the next layer of the house, if you will.

Talk about experience a little bit. How are we approaching experience now that we have these systems in place? I guess we could talk about experience from a lot of different perspectives, the people who are just walking in, the people who are not walking in anymore, who are potentially interacting with us digitally.

What are some of the ways you're approaching the patient experience?

I would say that I think we have a lot of work to do. All health systems, and people are doing great things in kind of silos, and there are probably some that are more advanced at Northwestern, but I have not seen a healthcare provider that has nailed experience.

And when you start looking for all of the faults, but places like, we draw a lot of correlates to the airlines. You go to an airline, you open their app, and you can book a flight, pick your seat, pay for your flight. know what airport you're going to. When you get to the airport, it knows you arrived.

You can go to security, you can go to the gate and you can actually sit in your seat with largely not talking to anybody. It's very different than healthcare, but that's where we want to go to where you can book an appointment. You don't have to talk to anybody. It's when you want to have that appointment or when you want to fly to keep with the correlation.

We know when you arrive, geofencing, we know when you walk into the practice door, and we can way find you to your exam room. And if that's your preference on how you want to interact with us, that's where we want to go. But we have got to start focusing in on convenience of care. The time they want it, whether that's through telemedicine or a site visit, we need to make sure that if it's just a primary care appointment that we do that.

But then when you start talking about larger healthcare issues where you're going to have numerous encounters, we got to shrink that window of time. We need to make sure that if we have a patient cancer, or a patient that has cancer or cardiac issue, that we shrink it from time they're seeing a cardiologist to the time they're getting a surgery.

The time they're getting a biopsy, to the time the tumor is being removed. It's the right thing to do. We now have the data and the technology to do it, and so we have just got to apply ourselves to make sure that we are continuing to keep that patient in the middle. And the pressures from outside are real.

You can talk about other industries, Amazon, CVSs, Walmarts, they're coming in because they see an opportunity. And we need to make sure that we are raising the bar as providers, or we will lose.

Having been a CIO in a major city, that's one of the things that you have to be really cognizant of is

these alternative providers, because they focus in on Southern California, they focus in on Chicago, they focus in on New York, and so, while some of the outlying areas may not have to worry about the new competitors that are coming in, they're very real in those major markets, and there's a lot of them.

They're very real and they are competitors for talent. As well. So, , when you start talking about what we need to do, we need the talent and we need to be able to get the talent and then retain the talent because we're not just competing with other health systems anymore. We are competing with the digital giants that are entering our market.

And we need to make sure that we have that talent in order to achieve the objectives of the health

system. want to use the P word here. Do you have any pilots going on in this area, in the patient experience area?

Yeah, we have a few. Several of them. a few that I would highlight. One of them is that we just went live.

We're trying to leverage data in a real time way, to where if you are a patient, a new patient, trying to make an appointment, And there's no appointment available within seven days. We run that through our cloud, we understand that, and then we flag that, and we send that to a CUBE and to a practice manager, and their objective is to make sure they get that patient in seven days, because we have access issues.

And the last thing that a patient needs to hear is we can see you, but we can see you in 41 days. That's just not something that we want to do. And , we want those patients to come to Northwestern to get the care we can provide, but 40 days, 30 days, 50 days people will go to a different health system.

So we are working hard with data and real time analytics to improve that experience. The other thing that we're doing is we're revamping our app to provide that experience that I talked to you that is very similar to the airlines. And that's going to take time and work, but that's where we're headed.

Doug, talk to me about the clinician experience. I'm sure you're spending a lot of time on that. It's very top of mind for a lot of health systems. Just the pressure that's on the clinicians and Quite frankly, scarcity of certain practices and certain skills and whatnot.

kind of things are you looking at in terms of the overall clinician experience?

One of the big ones that we're really focusing on right now is virtual nursing and we're trying to understand how we can apply that technology and how we can squeeze the most out of that asset. You've seen the numbers too.

We have an aging population as a J curve, where it's going to increase 40% between the ages 60 and 90 in the next nine years. Caregivers are flat. Technology is one of the only levers we have to pull. So virtual nursing we're seeing how can we do a few things. Number one, is it possible to change the ratios?

And we're tracking that. And what are the tangible benefits? Through the pilot program we've seen a drastic drop in incidental overtime. The patient satisfaction has gone up. We have had zero attrition for eight months on the units where we have it because nursing loves it. And that's a big component of this is that have a shortage of nurses and we need to make sure that we're making their lives better with technology or the trend will continue.

People will leave healthcare. They will go to someplace else. So how can we grab technology to make sure that we're trying to make their lives better? Improve patient care and satisfaction, as well as, ideally, reduce costs. And if we hit that's the trifecta. And those are the things that we're going after.

So virtual nursing is one of the key things that we're focusing in on. The other is we're trying to apply AI and ML to try to, get disease detection state early. But you got to be careful with tech, because one of the things that we do, or we have done historically as really as an industry, is we will say, we solve that problem.

But the issue is you might have solved it at that point in time for that clinician, but you just created six more problems for ten different people downstream. So you got to watch that technology to make sure that if you are actually going to deploy something, that you're not just solving it for that one person, you're solving it through the entire system.

Because right now, asking any clinician to do one more thing is a non starter. We've got to start to leverage technology to pull tasks off of them so they can focus on patients, not the keyboard.

  All right, we'll get back to the show in just a minute. If you've been with us for any period of time this year, we've partnered with Alex's Lemonade Stand to raise money for Cures for Childhood Cancer, and we are so excited. We set a goal to raise $50,000 and we're already up over 27,000, our 26,700 for the year.

So we're close to 27,000. I'm rounding up. We went to the Vibe Conference and with your. And the help of just an amazing community, generous community. And our partners as well. We were able to raise $16,500. So thank you all for your generosity. We're gonna do it again. As you know, we did Captains Cures for Childhood Cancer, at the Vibe Conference and anyone who got their picture taken with Captain who was facing the camera we gave $1 to Alex's Lemonade.

We're heading to hymns and bringing Captain again, and we're gonna do the same thing. As you know, captain is my producer service dog. He'll be roaming the floor. If you see Captain, stop us. We would love to have your picture taken and we would love to have you participate in this campaign.

We really appreciate our partners who helped to make this possible. For this one, so far we have rubrics, so we still have a couple of spots If you want to participate, if you want your company to participate, let 'em. That they can participate in this and we will give you the details. You can shoot us a note at partner at this week,

It's real simple. If you're on the floor, you see Captain, get your picture taken. Anyone facing the camera, go ahead and post it to social media Twitter or LinkedIn. Tag this week. Health, that's how we do the county. And again, 16,505. I think we can do it. At the HYMNS conference and really make a dent in our goal to get to $50,000 for childhood cancer.

It's gonna be exciting. We appreciate our partners who stepped up during the Vibe Conference, and obviously we appreciate rubric being our first partner to step up for the hymns event. So look forward to seeing you at hymns now, back to the show.

You've taken us in this direction because you've mentioned AI and ML and actually I don't think I've done an interview this past year that hasn't mentioned AI and ML.

And I would assume an organization like Northwestern Medicine, already have AI models in place. Almost everybody has, we've had AI models, in some cases, for a couple decades. I know people don't recognize that AI goes back that far, but it actually did. But now, there seems to be a momentum to it.

How are you approaching AI? How are you Generative AI specifically and thinking about the advancements that are being made.

Generative AI conversation is very broad. The last thing we want to do is to have clinicians going to a patchy PT4, like copy and paste, and then putting it back in the EMR.

So, we're working to, on the policy side, make sure that we have that. On the other side of what we're doing and how we're leveraging it, We're working with a lot of digital giant partners we're taking our data, we're plugging it into LLMs and we're really seeing, you know, how can we do this in an efficient manner?

All the things you're hearing about right now, whether it's how can you make the inbox more efficient, how can you get a pre canned message whether it's MyChart or another EMR, back to the patient to just take that time off. We're also looking at imaging. How do we make physicians, radiologists, more efficient with images and reads, and can we take a plain film x ray, start that dictation to make them more efficient?

And we have those studies going live now, and they're going incredibly well. An example of one we've had live for probably about two years, and we continue to grow on it is with incidental or secondary findings. So you have a radiologist's final report, you might be coming in because you had a trauma case, but they notice a nodule on your lung.

those are things that can grow, and three years from now, if it's not caught and followed up on, that's a problem for the patient. So we're grabbing all of those, and we're sending them up, we're running AI and ML, and then it flags it, and it goes right to the ordering provider or that primary care for follow up.

And there's a closed loop process to make sure that patient is getting the care and the follow up that they need. so. Lots of examples, but those are a few that I would highlight. Let's

talk a little bit about governance and priority setting. I imagine, you're in Chicago, so your clinicians go to various conferences, they'll go to RS& A, they'll go to various things, and they'll come back to your office and say, you wouldn't believe what I just saw.

does Northwestern Medicine Prioritize things. How do you determine what to say yes to, what to say no to?

It's an interesting conversation because a lot of CIOs are now sitting around the table not just being told what to do, but being asked to solve problems.

And how can we apply technology, which is a great thing for our industry. But more and more, I'll sit around a table of executives and they'll say, Doug, can we do this? And my answer will be yes. Can we do this? My answer will be yes. One more time. Can we do this? My answer will be yes. And then I will respond, but we can't do all of them because we have a finite amount of resources where we can grab that data and make a true impact.

So we tie it, honestly, to our strategy. We have quality collaboratives that work across the health system, not at just a local level, to make sure that we are working on the highest priority and most valuable work possible. And so then we get it through the quality collaboratives. We also get it through what we call key initiatives that are tied to our strategic plan, and those key initiatives are set by the CEO.

And so that comes off the top. So it's CEO priorities, Northwestern system priorities, which we call key initiatives. We plan that on an annual basis. And then there's also other priorities coming from our quality collaboratives because everything that we do here Quality is the center of it. So we need to make sure that we are doing that.

And the last thing we want to do, since we do have a system for the health system, is make local based changes because they are incredibly difficult and it just creates lack of standardization. And that lack of standardization, when you try to deploy technology, is incredibly difficult to overcome and support.

Let me ask you this around, last question on AI. I think it'll be the last question on AI. Who knows? But are there specific skills? Are there new skills we're hiring or teams we're building out? to be able to address some of the technologies that are coming forward. Are we going to be building these out?

You mentioned partnerships, or do you think more of it's going to be done through

partnerships? I think it's going to be both. I think that no one's gonna be able to handle this alone. So we're looking. We talked to other health system providers, we also talked to the digital giants at the Microsofts, the Medtronics, and the people that we do a lot of business with and I think it's going to be a mixed bag of partnerships as well as providers working on their portfolios.

And this is also the big EMRs and the big ERPs because we're going to need each other to solve the problems that are coming down the pipe within healthcare. I would say that... Northwestern specifically, over the past probably two to three years, we've been very focused on getting lean and highly efficient cross training to support our systems of record, our big EMRs and our ERPs, and we've been moving assets over.

Again, without increasing cost, to focus more on the digital space. So that, AI, ML, etc. And we probably have about 15 world class AI and ML people now that are working. And the reason I say it's both is because we have all the data, but we need to be able to work across with those partners, and we need to have our technical chops so that we can do it, and then we can build a better product together.

So when I think about, is this going to be done internally, or is it going to be done with partnerships, I think the answer is both. And I think anybody trying to do this all alone internally it's not going to end well, or they will never be as good as they could have been if they don't have the right partners, and right is the key word.

I'm going to go back a little bit to the data question in terms of social determinants of health. Obviously, you're in the Chicago market. You have a lot of a lot of people coming in and out of your health system. How how are you approaching the community health? How are you approaching helping to build a healthier population in the Chicago market?

And is there a technology aspect to that?

It's a key focus of Northwestern. If you look at Life expectancy, they can be three miles away, but that zip code, you can see years difference, like five, six, seven years difference just by living three miles, but different zip codes.

One of the things that we've been doing working through quality is really gathering that data. So now we have a questionnaire for SDOH to where when a patient presents, we ask them questions about do you have problems getting food so we can identify if they're living in a food desert you know, do you have monetary issues, lots of different questions.

So now we're building that data set. And when we have that data set, now we can work with the city, we can work with other healthcare systems within the Chicagoland area to try to solve those problems. So, social determinants of health as well as, equity, all of those things are a key aspect of what we're doing.

And we have an entire community relations team that is focused on how we can improve. How can we do better in that space? Northwestern is also opening a large facility in our Bronzeville neighborhood. And that's going to be great for that community, great for Northwestern Medicine because it is currently underserved.

And we're going to put a lot of effort to make sure that we continue to grow and we continue to build, but we're doing it in an equitable manner.

Fantastic. Two closing questions. I'm going to ask you to project out five years from now. Looking at your flagship hospital, the medical center downtown, the academic medical center.

What will, if I were to walk through it today and walk back through it five years from now, what will look distinctly different? How will technology impact what facility looks like?

I think that technology in the next five years and beyond, it's gonna continue to, it's gonna be fun.

It's gonna be a wild ride. It's probably gonna be scary at times. And we're gonna get it right, and we're gonna get it wrong. So I think you're gonna probably five years walk through in here, and I'll have 15 things that I did wrong and hopefully a hundred that I did right. And that we learn, and that we share that.

Overall, I think you're going to see technology everywhere. I think you're going to start to see in the next five to ten years, the keyboard's going to start to go away, ambient listening technology's going to be everywhere. You're going to be able to understand patient flow. I think that generative AI is going to be very helpful to clinicians over the next five to seven years, to where you're going to actually be able to understand that you're looking at a patient.

But there's 100, 000 out there just like him with those histories, or her, and what is going to be happening as far as predicting them, given their bioindicators, their genetics, etc. All of that is going to be wrapped in to where the walls of the hospital might not look that different. But the data flow, and how that's impacting patient care, I think it's going to be a paradigm shift.

I think it's incredibly exciting, but I also think that clinicians, as we continue to have people coming out of nursing school and medical school that are used to technology on the cutting edge, it's going to continue, they're going to continue to push us to where everything's going to be done on the phone.

You're going to be able to engage virtual nurses that might be One mile away, or a thousand miles away. And that data is going to drive the vast majority of decisions. I would say that right now AI is on the fringe. Five years, it's not going to be the team, but it's going to be a member of the team.

And you'll see that in pockets now, maybe in imaging. I think that will be pervasive through every clinical role within a health system.

we'll likely be collecting a lot more information, I would assume. We're going to be collecting information from the patients while they're at home. We're going to be collecting information from the patients as soon as they walk in.

There's going to be a lot more, as you said, ambient listening. There's probably going to be a lot more cameras. There's going to be a lot more... Just a lot more data coming in. Is there anything we need to do to prepare for

that? I think that number one, we need to make sure that we pay attention to the signal and remove the noise.

Because there is so much data out there and you're going to start to see not just clinical data, but consumer data come in and blend that. So that I believe that we are going to be able to understand patients digitally. More than they know themselves. And that's going to come from spending habits, where they're buying, and then how that's impacting, their food, et cetera, if they allow us to do that, which is an if, and it's a question that they should be able to answer.

But as far as the data coming in, we are going to have to understand what is valuable. And what is not. And then we're going to have to make decisions because you can't, you don't want to store everything at that point, but you want to make sure that you're getting the right information that is going to inform clinical decisions.

So, A, prepare that it's only going to exponentially increase and make sure that you're understanding what the data is and what you're going to do with it before you allow it in your four walls.

Well, let's let's close with this. I'd like for you to think about. Maybe four or five of your best vendor partners, the people you interact with and you value the interaction with them as vendor partners, what what makes them a valuable vendor partner?

How did they get there? And what makes them a valuable partner to you?

I would say probably there's two key things. A, do we have the same mission? Are we going after the same things? Because if someone is focused on patient care, everything else around it, you might make a wrong decision, but it was well intended.

So if we have, it doesn't matter if you're talking about a digital giant or a small startup, if they're focused on improving patient care, we have alignment number one. Number two is culturally. We need to be able to work together if we're going to achieve any type of partnership, because any partnership has to have value on both sides.

And so if you automatically have that mission driven mindset with patient care at the center, or innovation, you're winning. And then if you have the culture, you have the ability to actually execute on that vision. So I would say those are the two things that we really focus in on when we start to think about, are we going to partner or not?

And it is much better to understand that we're not good partners and walk away. And it's better for both because then you can go find a partner that is aligned, but for us, those are the two things that I really focus in on when I start to think about, are we going to partner? Culture and mission.

Fantastic. Doug, I want to thank you. I always enjoy our conversations and I always learn something every time we get together. So thank you very much for taking the time to share your insights

with the community. Absolutely. Thank you, Bill.

  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.


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