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  Today on Keynote

(Intro)  There's things that you think you understand by listening to your colleagues, by rounding, all kinds of things, but once you're in hospital bed for a couple months until you have experienced the kind of emotions that go with it, you don't know what to do.

how am I going to navigate this experience? You just, you don't get it.

  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 I'm excited to be joined by Chris Ross, CIO for Mayo Clinic. Chris, welcome back to the show. Thanks,

Bill. It's great to be with

you again. I'm looking forward to it. I apologize for my voice. I'm a little under the weather, but You're gonna be doing most of the talking.

So I think that'll work out fine Okay Chris, it's was doing some research. I mean your career spans almost three decades You don't look that old but healthcare technology government Give us an idea of what drew you to the intersection of technology and healthcare?

Oh man,

And at the time, I was kind of an entrepreneur. I look like a, real corporate guy in my suit and tie. But I've spent about half my career in, khakis and a polo shirt trying to You know, bootstrap companies and that just didn't fit for me. And I said, I really don't think so. He said yeah.

Come interview. Anyway. And I did, and one thing led to another and they offered me the job of the CIO, of the behavioral health unit at United Health and Behavioral Health was of interest to me. And I went down that rabbit hole and I'm happy I did. And I haven't come out yet.

pretty amazing that the number of people who've said, I stumbled into it.

They got there. How much does that background in startups and whatnot, how does that influence your approach to being a CIO, your approach to technology and your work at Mayo?

There's a lot of things that I've managed that aren't amenable for startup life. Our world is bifurcated like it is for many CIOs, but I tell my team that we have two jobs.

One is to run and maintain technology with full fidelity, full quality, full safety, full reliability for a really good hospital. And the second is to help drive innovations at Silicon Valley speed and to acknowledge and manage the turbulence between those two because they do touch. So on that sort of Silicon Valley innovation side, I think having lived through startup world, I think helps me understand the perspectives of the teams who are doing the work in that space, and sometimes to give some helpful guidance, don't over engineer, work on first viable first product demo iterate as fast as you can, isolate your iterations from production when you get close to it, those kinds of things I think are helpful.

So sometimes I think our teams are surprised when they see this corporate guy in a suit show up and be able to understand their world a little bit. Hopefully that's helpful.

That is accurate, Mr.

Russell. Wow.

How would you describe your leadership style and how has it evolved as we've gone through a pandemic, as we've come into this I know we've been doing AI for a while, but it just feels like this AI age. We're like at the dawn of the AI age in healthcare. How has your leadership style evolved?

So it's a great question. So I think my natural inclination matches the Mayo culture pretty well. The idea of servant leader, the idea that you want to assemble a team that's smarter than you are, that you want to give them power, that you want to push decisions as low in the organization as possible.

All that sort of matches for me, and that sort of fits a Mayo. Consensus driven ethos. I think the place where my leadership has been challenged in the last couple of years is twofold. One is when we went to a work from home environment. The way that you communicate with people just has to change.

So I do a lot more electronic meetings. I do a lot more small gatherings. Our communications team's been helpful. I do a Coffee with Chris session every two weeks, and I get together a group of 25 people who sign up, and we just chat. And that helps me learn a lot about what's happening close to the work, and I get feedback that people feel like, Hey, I got a chance to talk to the CIO and, tell 'em what's on my mind is useful.

And that's replacing the hallway conversations that we used to have. So I've had to change that that my communication style needs to change. The second is gen AI and other things have put us in an era of hypercharged change. I have not experienced a technology environment like this since the early 90s when the internet emerged for general use.

feels like we're in that same sort of space.

was in a room last week with at least one CIO from one of the larger health systems. We have Northwell, you UPMC, you have Intermountain who are making this big move over to Epic. You went through that. would you be telling them if you were in front of them today in terms of that journey?

I think if we had a magic trick in our Epic conversion, it was Make the clinical and business decisions first, and have the technology match those clinical decisions, as opposed to having the technology impose those clinical decisions. Mayo operates in the Midwest, centered in Rochester, Minnesota, in Jacksonville, Florida, and Phoenix, Arizona.

And we had operated those somewhat separately. The idea was, we kind of were a holding company that was using a common brand and a common ethos, but not common governance, to more of an operating company. And that predated me, and that predated, that goes back three CEOs when we started that, under Dr.

Dennis And there was a lot of effort to get clinical standards the same in all of our locations. And when we started our project, we were probably 80 percent done with that clinical convergent, we call it practice convergent. We got that done about 80 percent and the last 20 percent were kind of imposed by the EHR.

The thing is, very few clinicians love their EHR. They tolerate it, and it has something to do with the technology, but it has much more to do with the fact that the EHR is a, thing that imposes the rules of an institution. on clinical practice. You're kind of boxed in of what you can and can't do.

And sometimes people want to push against that cage, and they feel like they're pushing against the EHR, in some cases they are, but in many cases they're pushing against the rules of the institution, or the rules of payers, or the rules of regulators, that all gets instantiated as part of this EHR. I think understanding that these things frame the way that medical practice happens and they can be, they will never be loved they can be resented. So making sure that the clinicians feel like they are driving the change and that they got to decide how clinical practice happens in advance of a conversion project I think is really key.

It's interesting the number of discussions we had. regarding ambient listening and those kinds of technologies. Are we at the cusp of maybe a change in the way the clinicians and maybe even administrators interact with these core systems and maybe data natural language kind of format?

I think so. The voice technologies are really impressive. We're doing trials with four vendors, different clinical settings. And the ability to listen in and then generate at least a basic note is impressive. So, the one thing we know from clinicians is that they would like to have medicine be more about conversation and less about record keeping.

Voice will help. So yeah, Bill, I think in five years, clinicians will be talking a lot more and using that as part of the record and less clicking boxes and selecting choices.

always, for me, brings up question of data management, data governance. don't know if we went into these journeys anticipating how we were going to use all this data down the road.

And now we're getting to that point where we're interacting with the data in different ways. It's being used in a lot of different ways. I would assume at Mayo, there was a lot of foresight. discussion of how data was going to be used in the progress of care and in the clinical setting and those kinds of things.

How has the approach to data as a critical asset in healthcare, how is that informing or how is that really playing out at Mayo? I guess this is the question.

In those days we talked about big data, but now we would say multi modal data environment. We built a Hadoop based repository for data that we called Unified Data Platform. That did that, and it replicated most, if not all, of the data that was coming out of our EHR and other things, and we were creating longitudinal patient records.

That data is also leveraged by Mayo Clinic Platform which is a separate entity within Mayo. That is building collaborative tools for a broad market. That's being run by the president of the platform is our friend Dr. John Halamka, who we recruited to come to Mayada Run platform. We made this big bet on modern, internet oriented, non SQL, late binding, big data, use whatever words you want to try to create this idea of a longitudinal record with strong metadata management so that we could understand patient journeys in much more sophisticated ways.

I think we were lucky. We built a lot of things where now a lot of generative AI researchers are looking for multi modal data. They want to look at images, plus genomics, plus text, plus orders, right? And we have much of that, not all of it in place. It's helping our researchers go faster better.

Yeah I'm curious your build versus buy. It was kind of funny, I saw in June, I saw big announcements with Google and AI. And then by September, I saw big announcements from, everything you do is a big announcement, by the way. A big announcement with Microsoft, and we're, going to go to Copilot do some testing with that as well.

curious, your build versus buy, Obviously, you're partnering with key players in the industry. Is there ever that pull towards? Building some of those capabilities or training AI models within Mayo?

Absolutely. I think that works out in multiple places. One is, do we want to build a large language model or do we want to tune an existing large language model?

And the answer is yes. We want to do a little bit of both, and I think, that's appropriate experimentation. The other is, a little bit of back to the future, on premise specialty high performance computing versus cloud computing, and what we're trying to do right now is to get the economics on that worked out and the price transparency worked out on that, so that the right compute goes into the right environment, but, we really made a commitment to Google.

To build, to take advantage of their platform as a service capabilities in healthcare. Sure, we're storing our data there, but it's not renting servers, it's really buying into their healthcare data engine, for instance, and all the tools that they have for ingest and enrichment of data, and then presentation of data as a set of FHIR services.

We don't want to build any of that, as long as we've got someone that's really committed to it, like Google is, to provide a real healthcare data environment to its customers. But we will still struggle with BuildBy. There's a lot of people at Mayo who have lots of energy to build things, algorithms and other attributes.

And we're trying to equip them.

yeah that's always the challenge of being a CIO is you're surrounded by extremely smart people, high energy, who really know their space well, and they might be at the forefront of some things and they're saying, Hey there's nothing really out there that's doing this.

And then you as the CIO have to. become coach, a partner, a whatever.

a good example for us is in our Mayo Clinic cloud environment on GCP, we have a couple of attributes. We've got an AI factory and we've got a software factory for runtime. And the AI factory is where people go for research. And boy, do we get lots of feedback from our customers about, did we get the tooling right?

Are the access models right? Can I go quickly enough? Can I get access to what I want? Our product managers in those spaces, especially our product manager for AI Factory, They got to be on their toes because it's an extremely capable customer set.

Talk to me about, your organization and your structure.

Give me an idea of some roles that exist today that maybe didn't exist three years ago. Roles that Mayo's hiring for.

Mayo as a whole, we're building out Mayo Clinic platform, which is a set of capabilities that we will curate to provide electronic. Healthcare support and analytic support kind of to the world.

And then the last thing is, we've, some ways it's a new role, in some ways it's not, but we've rebadged almost all of our frontline leaders as service delivery managers. So their role is to deliver a service or to deliver a product. We still have some other leadership tag roles that provide.

Process support in the back, but the place where we're really leading is this transformation into a product and service oriented. IT organization.

Give me an idea. It's, assume that you're a remote workforce now in a lot of ways. how are you maintaining the the interaction with the IT staff and this is more of a personal question for me.

I when I was a CIO, We were all in the building. We were all interacting with the clinical staff. it was just a constant back and forth. And was a good environment for collaboration and sharing and those kind of things. How do you maintain that in this remote world?

It is really dang hard, Bill. Our population, we are fully remote if you're not needed for patient care. Or, on site support for patient care, you're working at home across kind of all disciplines at Mayo. Our population falls into three groups. One is they love working at home. Oh my God, let me keep doing this forever.

The other is, boy, I hate working at home. I really miss being with my colleagues. I miss walking the halls. I miss seeing patients. And then there's a hybrid group. I like working at home, but I'd like to be on site from time to time. And I don't know, we haven't done a poll, but my guess is the majority fall in that last group.

They would love to have some on site, but they enjoy the lifestyle and other things that come with work at home, which has some advantages. So we're working really hard on maintaining culture as well. When we went to work from home, we also went FHIR from anywhere. At this point last measure, 13 percent of our staff work more than 100 miles from one of our facilities.

And we picked 100 miles because, that's driving distance. a lot of people who work in Mayo for a couple years now have never been on one of our campuses. And I think every healthcare organization has that. You don't know it until you've walked the campus kind of feeling, and that's particularly true at Mayo.

We're trying to create a lot of electronic experiences. Our organization wrestles with should every new employee who is hired remotely have an on site experience at the beginning of their tenure so they get the feel? That's expensive. And then a lot of it is how do you do that team member to team member?

Because me or one of my managers talking to our team is important, and it sets the table, but it's it's necessary but not sufficient. What's really sufficient is getting team members to talk to each other, and to work with each other in a virtual space. So a lot of that happens through Teams chat, Teams groups get togethers, we have lots of self organized groups that join together virtually.

The fact that we're not geographically centered, so I can have a manager that has staff in Florida, Arizona, Rochester, and the world, or the U. S. It's hard for them to bring everybody together. So I think we're gonna be living in an electronic collaboration space supplemented with affordable face-to-face experiences.

I don't think I would've predicted this by the way. I thought we would go more hybrid, and the more and more I talk to CIOs, they're like, look I can't bring people back. There will be a revolt. the culture has changed, not just within healthcare. But within all of IT, it's just, it's an expectation.

It's funny because again, we have a very differentiated group. I've got people who beg me, can I please have a cubicle or an office in one of our buildings? I really want to put on my dress clothes. I really want to show up. That's what really made me feel like I was part of Mayo Nation.

And yeah, there's other people who are, you make me come in, I'm gone. That's going to be hard to traverse.

is going to be and actually I was talking to some CIOs and they gave up the real estate. if their whole team did come back, they wouldn't have a place for their whole team to come back.

So we've really adapted to a new model.

Yep. We absolutely did that. We're in, we're still in the process of kind of divesting ourselves of some real estate. 📍

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So if someone were to come on site and visit with you, and they wanted to see where AI is being used at Mayo you talk about big AI, little AI, and those kinds of things.

where might they see AI being used, and where would it surprise them that it's been being used for decades

now? They'd be surprised that we've been doing computer based coding for decades, and that almost everything associated with claims management on both the provider and payer side is computer mediated at this point.

And in some ways it's a little bit of an arms war, algorithms are battling each other to either maximize reimbursement or minimize reimbursement but a lot of that's going on. The second little AI thing that you would see would be voice transcription. We've really moved away from human transcription now for five, six years.

And our clinicians are dictating their notes in ways that wouldn't before. There are a number of small guidances that exist within our practice. In radiology, for example, there can be a heads up that this, patient likely has a pulmonary embolism, so let's put that at the top of the list.

They actually put a little exclamation point next to that case so that the radiologists get to it more promptly. And there's a number of sort of calculators and supporting tools and so on. We're using it to guide radiotherapy for a variety of cancers. We started with head and neck in collaboration with Google and we're moving into other spaces.

So that A radiologist, sorry, a radiation oncologist can spend less time sort of treatment planning and more time in other parts of the sort of treatment life cycle. A whole bunch of instances like that. we don't have is a, Dr. Google, a giant algorithm in the sky that anyone can talk to for any purposes.

Now, are we aspiring to that? Are we doing some works, projects around that? Absolutely. And we've created a group actually within our strategy unit. to prioritize some AI projects. We had 300 and some submissions. We got it down to about a dozen sponsored projects. And we'll begin to see those accelerate into practice more and more.

You asked about build by. I think we're going to buy algorithms from a lot of places. I think they're going to be embedded in medical devices. The algorithms that we're building for radiation oncology and radiology. Our target is most likely to distribute and commercialize those to manufacturers of equipment.

So I think you're going to see it seep in everywhere, just like it is, our lives as administrators. I use Copilot all the time to summarize long and complex email chains. What's the gist of this? I use it to summarize Teams meetings and we create minute notes that are generated by Teams.

I just think we're going to see this accretion of lots of little things. The water is going to come up, and we'll notice that it's up to our chin at some point.

After we finish this interview, I will pop it into some software, and it'll essentially, it'll do the transcription. And it will then kick off an automation, which will summarize the whole thing, identify the top five quotes from you, identify, and by the way, I used to have a person that I hired that would do that, and it would be, 24 to 48 hours after this interview.

Now it'll be like 15 minutes after this interview. We will have that information. And it really changes. Especially on the administrative side the way we interact with this information because there is this onslaught of just information that just keeps coming across our desk. I'm curious, when I was CIO, I used to say to people, I received 250 emails a day.

Is that pretty close for you?

It's gotta be more than that now. Hundreds a day, literally.

it's just hard to keep up. shared a lot about your personal journey with cancer. You've written a book with Marks and you've done a couple of talks. Give us, just an idea of how that has changed your approach to IT, to technology, and, I don't know, has it really changed your thinking in terms of the patient journey and how technology can improve the patient journey.

It really has, Bill. I had colorectal cancer stage three, twice some long journeys to that. And. There's things that you think you understand by listening to your colleagues, by rounding, all kinds of things, but once you're in hospital bed for a couple months until you have experienced the kind of emotions that go with it, you don't know what to do.

how am I going to navigate this experience? You just, you don't get it. And I've had a lot of clinician friends say, boy, my perspective really changed once I had a health incident. my conclusion to that is you get lots of think time when you're doing chemotherapy, for example. And my think time was, I really feel like I want to help make a difference.

And making this stuff better, and so it really doubled down my interest in continuing to do the work do. I didn't have the temptation of, step away, instead I leaned in more. I wish that I could put hands on projects all the time where I could personally make those decisions about product design.

It would be more patient centric. In the role that I am in, it's more of an orchestrator than an inventor. But I am trying to communicate to my team all the time that, we have the privilege of saving lives. And making lives better, but also the case that, we need to think about things like, how do we move from process orientation to service and product, and how can we do that in IT, and how can that lean into the rest of healthcare?

One of the things that Ed and I have written about and talked about is this, a lot of times when you find something in healthcare that doesn't work very well, It's because you run into these invisible glass walls, process optimization put in place. We've done so much to improve safety and quality in healthcare that we've become potentially too rigid.

And I say why can't I have this? We don't do it that way. Why don't we do it that way? We do it because we're protecting patient safety, but we're now at the point where it's also really potentially making for a bad patient experience. So I think now that we've really mastered process.

We need to take that thinking and move it into how do we think about healthcare as a series of curated and managed services and products, rather than a set of interlocking but not well integrated processes. Each of those processes is perfect, but when strung together creates an imperfect patient experience.

Again, sorry, long answer and maybe a little bit abstract, but that's what I'd like to do for the next five plus years of my career, is see if we can morph healthcare. Maybe with some support from technology away from pure process automation optimization into things that are more centered on our patients, our clinicians, and the relationship between patient and clinician.

I was talking to a clinician this past weekend and we were discussing that their team has looked at flow sheets in a meeting. They said, why do we do flowsheets? And I'm like, why do you do flowsheets? How could you even question that? And he's look, there's nothing that says we have to do flowsheets.

He goes, and once we got to that point, it changed. We started pushing on certain things that we normally wouldn't push on because we could see different ways that this could be a lot better.

Absolutely.

Alright, looking ahead, what emerging trends do you believe are going to have the most significant impact on healthcare in the next, I used to say next decade, but gosh, it seems kind of silly to think what's going to happen in the next decade.

could be talking about what's going to happen at the end of this year.

The things that we know will be a big deal over the next A couple decades even is demographic changes, we know that the percentage of people who are aged compared to the people who are working life and the people who are be supporting people with medical needs as there's going to be a mismatch.

And we got to figure out that problem that's not changeable. It's climate change. It's going to happen. The second thing is a shortage of clinical staff. The, pandemic really hurt us. nurse shortages are a really big deal. There's not enough people entering the profession, etc.

There's lots of places where there's, beds that are empty because we don't have staff and we know about the log jam that health care organizations are having because they can't discharge people to the next level of care. There's not a caregiver at home. There's not a facility that's able to take them.

It's a real problem. so we have to worry about that. For our Chief Administrative Officer, focusing on automation that will help us address issues related to those ratios is a really big deal, so we want to support her everywhere we can.

Shorter term, I think we've talked about a couple of them. I think we're going to see more and more voice in healthcare and more conversation and less clicks in the next five years. I think clinicians will feel that things are different. I think our EHR vendors need to be thinking differently about what the EHR looks like and, our EHR vendor is Epic and we've had some, fantastic and frank conversations with them about that.

When we went from paper letters and the phone calls to emails. It felt like it really accelerated the world, and it's just as I was coming into the working world, that's what was happening. I think we're at another inflection point like that, and I sometimes worry, is it going to make our working life even more intense?

you don't have that person to do that summarization. The work is on you, Bill, you and your computer, to summarize this meeting, right? Is that going to make your life, and my life, and other people's lives, way more intense? Because the work is getting concentrated and it's accelerating.

I worry about that a little bit.

Are you concerned at all about the regulations that are going to be coming down the pike in terms of AI and potentially that will slow it down significantly? Yes.

I think it's really a worry. I think we want to see where ONC is going.

I think they understand this. But, healthcare is going to be regulated. If AI is going to be regulated, healthcare is going to be high on that list. So yeah, if the FDA software is a medical device, regulations become more onerous. It's going to be a problem. We are not going to see the innovations we hope

for.

Yeah, 950 pages. Chime just came out with a cheat sheet. It's 19 pages. It's complex regulations. close with this. I'd love to discuss it a little bit with you. I interviewed Shez Partovi. Used to be with Common Spirit, went to Amazon, then went to Philips. He's innovation over at Philips.

And we were talking about this same kind of question, what's the future look like? And he was talking about a dialogue. He was talking about essentially that the patient's going to be able to have a dialogue with their medical record. And say, hey that last visit with the doctor.

He did this and you might be in my chart and it'll respond back to you and said, Hey, this is what was prescribed to you. And you might say tell me about that medication that was prescribed to me. What is that for? And you just have this dialogue. We're already seeing that with clinicians and some of tools and technologies that are out there.

It's interesting when we get into this idea that the patient will be having a dialogue. with the medical record, not necessarily the doctor, but the medical record, and it will be responding. And when we were talking about it, he's look, this is not chat GPT just coming back. These are medically trained models that are coming back with validated answers to these patients, but it's speaking to them on their terms and those kind of things.

And I asked him, when do you think we would see something like this? He said a lot sooner than you think. And do you feel like that future is maybe not right around the corner, but pretty close?

I think for leading organizations, it's six to 12 months away. Wow. I think the real issue is going to be.

The fidelity of the answer that comes from the models. Can we tune them appropriately? Can we deal with hallucination? All the rest. And we have some stuff, that's to be announced. We've got a lot of stuff we're working on. But the question is really going to be if we can get to high fidelity, we'll get there.

We already have a little bit of this in our website is very popular. People come to MayoClinic. org to look for medical answers. And our aspiration is to enrich that experience. That when people come to our website and they want to say, I was just diagnosed with this really difficult condition.

What's my options? That we can give them an even better navigation than they have through our website. It's pretty good today. It's all right. People are going to expect from all of their media experiences, whether it's Google search. or interaction with Amazon, they're going to want to have a conversation.

Oh, why do I want to buy this product on Amazon? Tell me more. And the metaphor of search and of following link to link that we've all learned over the last 30 years, I think is going to change into conversational interfaces for many things. I'm super impressed with what the search engines have brought online and, ChatGPT sort of sprung into the public view, what, 15 months ago?

Maybe less than that, in the point where it really became commonly known. So I think the next year is going to be even faster than the last year.

my son's about 25 years old, Deloitte consultant and whatnot. He sends me stuff. Actually, he's 30 years old. Man, I'm losing time here.

What am I thinking? But he sent me this thing, this Arc web browser. And he said, Hey, you got to check this thing out. So I put it in there and I put Chris Ross, Chief Information Officer, Mayo Clinic. And then it has a button that says, search the web for me. And then it came back with title, experience, education, affiliations, timeline.

Background, leadership, strategy, partnerships, convergence, innovation. And it categorizes all these things, has quotes in here from you. Even has your personal journey, cancer survivor patient perspective, challenges, and those kind of things. And then it has the 15 sites that it hit. All I did was hit search the web for me, and it created its own web page about Chris Ross that summarized all those things for me.

world is changing like under our feet at this point. With that as the backdrop final question, what message do you have for aspiring IT professionals who wish to make a meaningful impact in healthcare?

Oh, man. One it is, come join the healthcare community, there's lots of people from big tech who maybe feel like they've run their course of selling advertisements or, doing algorithms for social media and now they want to put their talents elsewhere.

Thank you, please come join healthcare, we can do more. I think anyone who arrives in technology today, should be really clear that they are not creating anything of permanence, that almost everything that they're going to do is going to be ephemeral. And so if they want to build some asset, they need to understand that asset is going to be destroyed by some other idea very quickly.

So don't get tied to any idea or believe that you're building a monument to yourself by building something. Just understand that This ephemeral thing that you have, this soap bubble, is going to have value for the moment that exists. And when it pops and is replaced by something else, you might see some of the DNA of your idea move on, hopefully, if your idea is a good one.

But be prepared for unbelievable speed and change. Don't hang on to anything. Always be thinking about the thing that you are now learning will be replaced. So what's the next thing that you should be leaning into? Understand statistics and data, at least at a fundamental level, because the work we're going to be doing is less around code wrangling and much more around data wrangling.

At least when I run into sort of college age. Young people heading in that direction. That's the advice I want to give them. A lot of them are coming up, they're in like high school and they're doing like robotics. And their end state is, I'm going to build a thing. And they're excited about the thing.

And that's super cool. But when you go further along, you have to really understand that robot is intended to self destruct. So be prepared for that kind of emotionally and logically. It's just sandcastles on the beach. That's all it is. And the tide is going to come in and it's going to change what you've got.

It's great news because you can build another sandcastle .

And I'm glad that the networks I installed in St. Louis when I was starting out are still not there because they would be on ArcNet and Token Ring and yeah, I just glad things are evolving. It's a good thing. Chris always great to catch up with you.

to thank you for giving us time. Yeah, it's great to be with

you, Bill. Thanks so much for joining us.   📍

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