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Today on This Week Health.

(Intro)  I think that's part of what's driving all this burnout is this feeling that you're just constantly stretched beyond your capacity and that somebody might suffer because of it. And I think that anxiety is something that we have to figure out how to alleviate and provide people confidence in.

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📍 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. I'm joined by Dr. Neal Patel, CIO Health IT at Vanderbilt University Medical Center. Neal, welcome back to the show. Thank you for having me. looking forward to the discussion. Anytime we get to talk about Vanderbilt, I'm excited.

I'm a huge basketball fan, especially college basketball is something I follow and I'm always curious whether Vanderbilt's going to have a good season this year or not. Do you have any, know this is why you came on the show to talk about predictions on Vanderbilt basketball. How does it look?

it's gonna be 50 50, but I've been very impressed with Jerry Stackhouse has been doing so excited about this season, and if we can just pull off beating Kentucky and or Tennessee once, the season will be made.

I did a project. It was a two and a half year project up in Ann Arbor, and Ann Arbor is just steeped in the University of Michigan and people would tell these stories and there's a Bo Schembechler story and it goes, it went something like this as Bo Schembechler about, coaching at Michigan, he said the good news is you only have to go one in 12.

And they're like, what do you mean you only have to go 1 in 12? Yeah, you just have to beat Ohio State. You beat Ohio State, you can keep your job for as long as you want. It's crazy. All right. Hey, let's start all of these interviews out the same way. Give us an overview of Vanderbilt University Medical Center, the scope of the work that you're doing and the breadth of the services that you guys

provide.

Sure. Vanderbilt is really the top academic medical center here in the Southeast. We are a closing in on 7 billion corporation. Now we have a main academic medical center right outside downtown Nashville. School of Medicine, School of Nursing, the usual suspects. A on site children's hospital that I'm happy to be a big part of as being a recovering pediatric critical care physician.

We have a psych hospital online, a VA hospital that's adjacent on the property, obviously not part of us, but we staff it. And we've had three community hospital acquisitions over the past two years that has extended our reach beyond Nashville into other surrounding counties.

Yeah, what is your geographical reach now?

basically all of Middle Tennessee, our catchment area touches all contiguous states of Tennessee, mainly because of our tertiary and quaternary offerings. We are one of the largest transplant centers in the country, and we are the most productive heart transplant centers in the world.

And this past month according to the numbers, we did the most heart transplants that we've ever done. And so lot of folks from around the region come to Vanderbilt for tertiary and quaternary care. We have an NCI Cancer Center. Obviously, a lot of research goes on here, being a top 10 NIH funded research university.

A lot of good things on multiple fronts. But in Nashville, we're also the only level one trauma center and the largest provider of indigent care in middle Tennessee. We are the safety net for the region as well. And an important mission that Vanderbilt tries to adhere to as best we can.

Wow, that's, I don't know why that surprises me. The only level one trauma center in Nashville, but it sort of does. Alright, so think where we're going to go is we're going to take a look back at 2023. We're getting close to the end of the year. I'd love to hear a little bit about that. forward into 2024.

And then there's three topics that want to hit on with you. One is preparations for AI. I realize you're already using AI, but just preparations for what we're seeing this mass of new solutions and whatnot. I want to talk about the clinician experience and the patient experience a little bit.

So That's my objective. I want to state my objective up front because a lot of times what happens is we get into conversations and I don't finish the the conversation.

Let's start,

back at 2023. Tell us about one or two projects that the team's been able to accomplish for the university with regard to technology.

For

the Medical Center and I just have to qualify that because we're now separate from the Vanderbilt University in terms of infrastructure but nonetheless last year at this time was scary, Bill. tHe Margins were not looking good. We were in the red.

described all of healthcare at this time last year.

It was pretty bad. So really the first half of 23 was spent on doing everything we could to batten down the hatches on expense management. And the leadership here made a strong bet that we were not going to lay off anybody. The goal was to batten down the hatches, get rid of all expenditures that didn't contribute to our mission as best we could.

We had a hiring freeze and Lo and behold, between that and a couple of good things happening late into the fiscal year for us, which ended at the end of June we were able to come in at a 0. 5 percent margin and in the black which was great for us because it did not look promising at Christmastime.

In support of that, Our group in Health IT was asked to take on a few challenges. Our leadership believes strongly that technology is one of the answers to deal with some of the upfront headwinds that we face. Staffing shortage, clinician burnout, as well as improving patient flow and patient experience through the concept of creating more self service so that we're not people power dependent in areas that we don't have to be so that we can leverage our labor in the most optimal way.

So we embarked on a couple key initiatives. One everybody has been dabbling in this concept called virtual care or virtual nursing within the hospital. anD we actually put together a formal project with a pilot that we were able to launch in June of this year. And over the past several months, we have been working diligently with our operations team and it has borne some of the correct improvements and metrics.

And in my opinion, establishes a new type of foundational element that we will need for care of all patients in the future. So I have just gotten approval to expand that throughout the rest of the hospital over this coming year. And some of the data that has been very helpful and kudos to our operational teams who have been collecting proactive data with METC.

Rather than just the gee whiz, isn't this cool thing? We, our patient satisfaction scores are, have risen. We've been measuring nursing workload using a validated metric called the NASA TLX and our physical labor on the unit workload has decreased. And we're finding a lot of intangible benefits in terms of just teamwork and the ability to extend different use cases beyond nursing.

As of today, actually, we just are leveraging our pharmacy calling into the room and we have a meds to beds program for patients that are being discharged. We'll deliver their discharge medications to them so they have them in hand and are educated about them before they leave. And now we're going to leverage the virtual cameras to do the education virtually, as well as have our access center virtually call in and do all of the follow up appointments.

And do that in a more personalized manner. So

While they're still in the bed you're doing all of those things through essentially what we're doing right now. exactly.

So think about what we accomplished in the ambulatory space, but now we do it within the setting of the hospital.

And we can do it 24 hours a day. And because obviously the care is there. And what we found from patient reports is that the patients actually prefer interacting with the virtual care provider because the sole focus is the patient instead of the care provider multitasking, checking the IU bag, doing the other things while they're talking to the patient.

And so it's it's yielding a different type of Interaction, which is having, I think, a synergistic effect in terms of the perception of the family who knows now that their loved one is going to be looked in on periodically because it's by camera. It's not based on just a person physically being able to do it and not being too busy as well as the ability of the bedside providers to know that they have a helping hand just to call away who could look in on any room on their floor.

It's an interesting cultural change that has, it's a change in the way. that we've operated in the hospital and specifically around nursing. curious, from a metric standpoint, where do you find the satisfaction comes from? And where do you find the savings in time and productivity come from?

what we have found, the satisfaction comes from, we're actually cataloging how many times the virtual care provider is able to provide coaching opportunities to the bedside. Provider, because we know that our experience level is lower and lower because of the attrition in the field. And we've cataloged a lot of coaching.

We've cataloged a lot of safety checks and findings because the virtual care provider could check the contents of the room against the orders in a more diligent manner instead of the on site care provider having to rush from room to room. And just that peace of mind has allowed a sense of relief.

And I think that's part of what's driving all this burnout is this feeling that you're just constantly stretched beyond your capacity and that somebody might suffer because of it. And I think that anxiety is something that we have to figure out how to alleviate and provide people confidence in. I was on another podcast at one time and I gave the example of how much relief you have when you can actually now when you reverse have a camera that shows you where you're going, instead of trying to crane your head over your shoulders and look behind you like we were all taught to drive, and it just.

Gives you a sense of just, oh, okay, I have a little bit greater safety net.

it's just a little easier I do wanna delve into the technology a little bit. is it as easy as, Hey, we just popped a camera in every room. In a way we went, probably not there. There probably was a lot of work that the team had to put into it.

There's a lot of workflow changes, there's a lot of those kinds of things. But let's focus in on the technology a little bit. WhAt does it look like? Is it a platform?

Yeah, no, we went with a vendor platform from care. ai. It is a camera that actually is mounted right above the patient TV.

So it's not in the ceiling, which I thought was an important feature. More on the implementation cost and timeline. Because we didn't have to go into the ceiling, we actually could deploy these cameras in the shortest amount of time without having to close the room off because we're oversubscribed in terms of hospital rooms.

And when you go into the ceiling and try to pull power up there, it's a problem. But you readily have power right behind the TV. And so we plopped this camera right on the wall above the TV. And the camera is on a swivel mount that actually points upward when not in use. So this sense of comfort that you're not being spied upon is also a nice feature.

And it swivels downward when it is in use. So little things like that made a difference in terms of our speed to execution. And then we work closely with the change management because we're formally doing a pilot with evaluation of metrics we created an area right near the floor where the virtual care providers could be so that we worked out all the logistics before trying to go full enterprise wide with a more different virtual setting.

The key pieces of this really come down to coordinated interactions with our operational leaders and the bedside staff. And we found interesting things that we didn't anticipate. For example, when a virtual care nurse wants to go, make a call, there's the concept of a knock where their name appears on the TV screen and their audio comes on saying, may I check in on you before the cameras turned on.

At nighttime, when the patients were sleeping, they didn't want to intrude and wake them up. They just wanted to. Peek in on them just like a bedside provider would poke their head through the door and we had to interact with the vendor to make some of these slight adjustments in the platform. And right now, we're pleased that we've been able to make those changes.

And when our bedside providers saw that we, as a technology team, were being responsive to their needs and their requests, they That back and forth partnership and a sense of control and engagement markedly improved.

. It's really interesting to me how these things have moved forward so rapidly. Are there AI, I mean you said it's CARE AI, so are there AI aspects to this, are you Monitoring falls, you're monitoring hand washing, all that kind of

Not yet. We're doing the basic rudimentary levels that doesn't involve any AI yet. There is an ambient sensor that does not do video, but does monitor can monitor for movement and those types of things, but we haven't leveraged that yet. We want to get the basics done because that's of primary importance.

And then we'll eventually decide when to move on to that. I think you're going to find AI in almost everything these days, but that's probably just in the spelling of things, not actually in terms of the

technology. I appreciate your perspective. I was just at the health conference and I'm telling you what, people have changed their names.

It's just, everywhere. there was a toilet manufacturer that was an AI toilet. And but, I did hear an interesting use case. Remote monitors, remote sensors and monitors that can, capture a whole bunch of vitals now that aren't connected. They're remote.

They're actually, you put it like five feet away from the bed or in the home use, you could put it five feet away from their favorite chair, those kinds of things. And it takes those readings throughout the day. And I was talking to a clinician about it. I'm like what's the practical application of this in the acute care setting?

And he goes, Nighttime. And I thought, yeah, that's right. Because, we keep waking people up in the middle of the night. And hard to imagine, but it feels to me like the amount of change that's going to go on in the hospital, in the acute care setting over the next five years could be as much as we've seen over the last 20 to 30.

Oh, I absolutely agree and that actually is a nice segue into the second area that we are embarking upon. I'm, as I'm a pediatric critical care physician by training, so data is important. Having a sense of the physiologic status of every patient is important. And again, going back to our burnout issue and clinician overwork issue, I think our areas that are the most tapped right now are our acute care floors and our emergency department.

And my hypothesis is part of it is because they have the least access to information that tells them that their patient's okay. The ICUs, obviously highly tech, lots of continuous data. ORs, lots of continuous data. Recovery rooms, et cetera, lots of continuous data. And so we are actually looking at wearable monitors.

And we're hopefully in the next four to six weeks doing a pilot. As most large health centers have, our emergency department is oversubscribed. We have named beds in the hallways, gurneys all lined up, because that's where the patients will go, and waiting at times four to six to eight hours. And unfortunately, those beds were not designed to have a monitor.

They don't even have electricity by them, oftentimes. We have to use battery powered things. But now the technology has gotten so much better and so we're working with a company called Massimo to see if we can leverage some of their wireless, non tethered monitors that's attached to the patient, but doesn't have all the wires and need the power and runs on battery and that can transmit and distribute that data to places where the Clinicians can have access to it without having to walk up to the bedside, and our feeling is that we can increase a level of safety for these non traditional beds, and get data points not just to prevent deterioration, but also hopefully to determine that maybe some patients are stable enough not to need a telemetry bed upstairs, and maybe improve the throughput in the right direction.

And our hope is then to see maybe even patients in the waiting room who are at a certain level after triage who can't even get a physical site can still have a level of monitoring. And I think those types of things are going to become more ubiquitous because the price of technology and the capabilities have so markedly improved in the past five years.

have you set up a place where the nurses go to, to do this remote care, or are they just doing it remote, like, like I am right

now,

remote? Right now, we've done it in specific areas. We do have the concept of a command center more for patient throughput and management, but we anticipate leveraging that.

We are leveraging that for virtual sitting. For patients who need a constant presence within the room should they be for a fall risk or suicide ideation or those kinds of things. But we also are going to then now begin to move toward physiologic monitoring and those types of spaces as well.

So a lot, this is a segue into the stuff that we're working on now to get started and we'll be the work of this next coming year.

Alright, so that gave us some idea of priorities for 2024 or I assume there's. If you're like every other CIO there's a hundred priorities, but what drives your priorities at Vanderbilt?

Is there a strategic process that sort of boils it all up for you? And then you say, okay, these are the top 10 that we're going to focus on. We

try to, obviously we go through a rigorous process. At the end of the day, it's where operations and leadership has decided to put their bets.

Because every new project requires a funding mechanism and we go through a total cost of ownership of an idea or a project and then determine that if this is worth it, then that's going to be an approved TCO that then gets added as a variance to our budget. So by definition, it's prioritized by where you're putting your chips in that regard and that the operational buy in has to be there up front rather than IT deciding that this is what we're going to do.

ThAt's been helpful in that regard. Right now, we know the focus is on staffing and labor, primarily. What can we do to leverage the staff that we have in the best way possible, so that we don't have people leave and have to replace them? And we know that there's not enough people at the bedside, so how can we automate the things that need to be automated?

So that's the number one driver. The second driver is patient satisfaction. So trying to move as many things to self service as we can. We actually were proud to have hit our one millionth patient on our patient portal in the Middle Tennessee area, which was a exciting feat which is amazing because we've been, when we switched over to the EPIC platform just about six years ago, we only had 250, 000 patients.

On our patient portal that at that time had been homegrown and just the growth of Nashville the pandemic and everything and everybody becoming more and more comfortable with technology. it's been an incredible boom in that area. So we're trying to leverage that and in a manner of trying to reduce labor costs.

We are have just launched virtual for front desk and our ambulatory sites. So that you can actually go from your patient portal, doing all your pre visit work online, which is available lots of places. Say you're here when you're close to your appointment and go all the way through without ever having to go to the front desk of a clinic and do all that tedious standing in line work.

And so we are working through those processes and by Thanksgiving, all of our adult clinics will be transitioned to a virtual front desk option. And our qualitatively, our patient satisfaction has markedly improved because they feel like. They're going to get on a plane. They don't have to talk to anybody.

They can just go sit down and wait to be called in the clinic.

Yeah, that's no small deal because remember when we tried to do that at St. Joe's, we had to get All the different intake processes and forms, and we had to, it was more of an operations project than it was a technology project.

Absolutely. Absolutely. We have a wonderful young physician leader Chetan Iher, and he is Individual who holds a foot in both camps. He's my team as a clinical director of informatics, and he is an associate chief of staff on the ambulatory side. And he served as the glue to get operations and technology and plant services, because you have to do all kinds of changes in terms of configurations and I think the existential crisis that we're in now is bringing all the stakeholders that used to have a difficult time getting in the same room and collaborating.

Everybody's all in. And that's why I'm excited about where we're at in terms of our ability to execute. and make change where it would have been so much difficult, more difficult five years ago.

So you're talking about reducing friction for the patient. So I'll go down the patient experience side.

What are we doing to engage them in their health? how are we making them active participants in their health?

I think there are several ways that we need to go. We're not where, by any stretch of the imagination, where we need to be. We know that certain service lines have much greater engagement with the patient when they're not in front of us, obviously.

Cancer is the highest, OB GYN obviously. And the capabilities of what's possible through the patient portal is growing ever more. And we're beginning to leverage that in Just the engagement with what we call nudges to remind the patient of something periodically, just to know that we care and that we may not actually have it right because maybe they've done something that our system doesn't know, but we try to do it in the least intrusive way possible, and we have, whether it's from your annual flu shot to a wellness visit, To very disease specific things like within diabetes to get your hemoglobin A1C checked, but even with our pediatric patients, right?

There's something esoteric as a patient with Crohn's disease, making sure they get their zinc level checked. Just doing things that is not a blanket one size fits all, but cohort by cohort, creating mechanisms by which we can provide that nudge to know that. Vanderbilt is here and checking in on them, and that has been very well received overall.

The second part, I think, is we are leveraging patient reported outcomes, what we call PROMs, into every one of our clinics so that as now that they're more comfortable with electronic check in and what we call a paperless environment, they can now start to self answer questions of their status along different metrics that are validated by specialty.

And that also helps with that engagement that their progression and their outcomes are being tracked in real time instead of just a static marker of I'm better, I'm worse.

And I assume your telehealth is still in place. We had to rush and put it in place for everything. Back in the pandemic I assume the usage, just like everybody else's, it was extremely high during the pandemic, but it's leveled out for you.

It

has. It has. What we what's funny is certain areas, our behavioral health is still 65 percent telehealth. Wow. But other areas, obviously people prefer to be in person, so it's a service by service metric that you can follow. But what's most interesting is, Last February, we had a significant ice event with the plunging cold here in Tennessee.

And in the old days, that was just a lost day of revenue for the medical center because there was no clinic visits, right? All of a sudden, everything just got flipped over to telehealth and we saw probably 75 percent of our appointments that day. So the fact that this infrastructure is in Allows us to leverage it in a variety of ways.

Even if it's not consistently used, it's there as a backdrop for a variety of use cases, which I think is cool.

Yeah, I'm going to come back to you next year because it's interesting. We're doing in the acute care setting, we're introducing all this tele visit aspect to it. If the patient satisfaction remains the same, or if we start to see them go Hey, this is less personal.

Because they go to Vanderbilt obviously the excellent care that is provided. But a lot of them go there because their doctors practice there. And it's a relationship that they have. And I'm wondering if we're going to have to strike that balance between efficiency, effectiveness and the personal touch.

No, I absolutely agree with you. And I think It's amazing how much better we have all gotten, and I think healthcare is going to benefit what people have learned in their personal or work life. Look at what you and I are doing right now. We wouldn't have thought about doing this conversation in this manner pre pandemic, right?

But yet we now persist with doing it. And we've developed a relationship through this manner more than we've ever seen each other in person. And I think there's an expectation, and especially with Millennials and Gen Zers coming up, this is actually preferred in many ways. And so I think we're going to have to deal with generational issues as well at a variety of levels as we move forward.

I'm going to ask you a blanket statement, and you can break it down because you're going to have to, but what are, what's top of mind for doctors right now? Physicians specifically? And I realize, that could vary by practice, but I'll just, I'll leave it basic. You can answer it however you want.

What we hear and what I hear from my colleagues is, how do I do everything I'm supposed to do? And how do I do everything that I want to do? Yeah. So

we have to give them ways to get the work done that they're being asked to, which is a pretty heavy burden in a more efficient manner.

You and I were in a room with a bunch of the organizations that are going down this AI notes path and those kind of things. And I'm glad they're going first. They're going through the learning panes, what's going to work, what's not going to work. What does the patient expect when they get a note that was generated by AI and that kind of stuff.

Are their physicians happy with it or not? What kind of things are we doing to help those clinicians to, lift some things off of their plate? So I

do think that we have to re look at what is expected of individuals, because a lot of stuff flows downstream.

When hospital systems make cuts in support staff or other sorts of things, some of the work that still needs to get done then falls to the people that are still there. And so just simple little things can feel grating at times. And so what we're trying to do with our providers is really look at what things They shouldn't have to do, right?

Or what things can be set up for them better. And I think part of the burden on us technology folks is our systems are crappy in many ways.

Thank you for

your honesty. That's how I got into this game, right? was a physician first. And then I complained about the systems not working well, and they made me come to committee meetings.

This is what happens when you go to too many committee meetings, is that you get assigned tasks to help fix it. So here I am 26 years later. But I do think that we would all say that, right? We're never happy with whatever workflow we're given if it's clunky. And now the expectation is even higher.

Because in our personal life, things work a little bit better, right? You get into a car and our GPS works better. Uber app works a hell of a lot better than some of the apps that we give our doctors to navigate the health system and, or our patients. I think the focus now that everybody's on electronic health records and workflows.

The next five years need to be spent on how do we make it as efficient as possible. And here's where I think the promise of AI can be useful. And I was excited to see, obviously many people, many health systems have the EPIC platform, which we're on. Is leveraging generative AI and trying to look for ways to T information up in the right way.

So not to replace, the human but more make them more efficient by not having to have them hunt and poke and think that they have gotten to all the information that they need that's necessary for them to do their job. And how can we do that? In a dynamic way, and I think that's where these new technology with the large language models and other sorts of technologies can potentially be very helpful as we move forward.

But again, the devil's absolutely in the details, and we have to make sure that it's safe to do so and that we're not misleading. Setting up things that can lead to bias and potentially lead to erroneous decisions. But I do think that there's a heck of a lot of people looking at it and are going to do it with great diligence and we're happy at Vanderbilt to be a part of that.

Yeah, and design construct is that of a co pilot. not an actual pilot. and this is why Microsoft is brilliant because they have multiple products now named co pilot.

It's better than Clippy, right?

Exactly. It is better than Clippy. Let's talk about preparations for AI.

I'm sure You, like every other health system, has had AI in some aspects, either machine learning maybe not generative just yet, maybe just embarking on that, but What does it look like to prepare the organization, prepare them culturally, to educate them, to put the right policies, procedures, guardrails in place?

There's a lot to consider, even though we've already had it in place. We've already had AI there. This is a new world. It feels like more people have access

to it now. No, absolutely. And I think the first job starts with education and education has to come from the top down.

And I'm not saying from the IT top. do think that we have to have a institutional understanding of what we're going to be leveraging this tool for, because it's not a single tool. Everybody calls it AI, but. That's a giant basket of all kinds of things. I was asked to begin to do an inventory across the enterprise along with our chair of Department of Biomedical Informatics.

What are all the active AI things going on? And we had to clearly spend some time coming up with what is, what's in the inclusion criteria of what defines AI. Is it a predictive algorithm? Is that AI? All the way up to, as you said, the most avant garde generative AI or image AI and such. So we have to educate on not doing harm, and so we quickly, as soon as the OpenAI and ChatGPT stuff came out about, and the multiple models that started to come out afterwards, was we created a framework within a contained Azure environment where we could leverage, people can go and dabble and play.

But in a contained manner where our Vanderbilt data did not accidentally go out and train external models, because obviously we have an important responsibility to the privacy of our patients with our data. So we try to set up a framework, not to restrict, but actually create safe. Playgrounds for people to investigate, to evaluate, and now we have a governance process by which we can leverage a container environment for people to then to go do more advanced work with large data sets should they wish in a approved but methodical manner with the infrastructure that can scale, but that one That inadvertently can't get taken advantage of and have inappropriate actions be taking place.

So that's the first level. Second level, unlike in years of the past, a health system can't develop this stuff by themselves, right? And the technology companies, there's a plethora of them. So we're doing a significant amount of due diligence in that space of major domains where interest areas are to begin to look at the players in a methodical manner and create short lists of ones that we want to begin to evaluate quickly in areas that are a priority for the medical center.

So that second approach is more on the clinical operational side. The first approach of having spaces that are safe is really more for our research enterprise where they can go out and make the new discoveries that

It's interesting to me because was just in a room with a bunch of CIOs and I said, what percentage are you on the cloud?

And a bunch of them say, 25, 30%. is what they're on the cloud. I said did you have a stated strategy for getting in the cloud? They said, no, we didn't, but it just happened. Like we went to the, we went to this SaaS model, we went to this SaaS model, went to, and all of a sudden now we're 25 30 percent in the cloud.

It feels to me like this AI movement might take the same path. We're seeing large systems like Epic, you're seeing it in ServiceNow you're seeing it in everything. They're starting to incorporate it and we could get down the road in a couple of years, like two years, and people are just using it as part of their everyday in and out job.

It's amazing.

In some ways I was talking to some people and I love analogies. If I can find a sports analogy, that's my favorite, but in this one, I'll use something that's in our everyday lives. If you think about it, automatic transmission is ai, right? You don't have to think about when you're gonna have to shift the gear.

And with respect to speed and everything else, the car just automatically does it for you. Downshifting or up shifting, that's ai, right? It took over a human action that you didn't have to spend time doing, and that frees you up to do other important things while you're driving, like text and other sides of things, right?

Yeah. So anyway. Yeah,

when people ask me to define it, I always say it's a system that can learn. It can be self learning, it can be program learning, but it can learn. So it can actually get smarter and better as it goes along. And I think that's the thing that distinguishes it from an algorithm.

Because we've had algorithms. Oh my gosh, we've had algorithms since the start of a computer. But. But these models we're talking about, oh, we need to train them. You're worried about the data, that the Vanderbilt data, it's like, how is it going to be used? How is it going to train these models?

And, we're training computers to be very specific in very specific areas to take away that burden. It's really fascinating. And I keep using that definition because as I walk through the health conference and I go from booth to booth, I'm like, That's not AI.

That's AI. And it'll be really interesting to see. I'm going to close with this question and it's a good closing question. So I'm going to close with, what are you thankful for?

We're at the end of 2023. What are you thankful for?

fiRst and foremost, if you look at all around the world, I'm thankful for. My family being safe, I'm thankful for being in an environment that I can have impact and I'm thankful for having partners and colleagues that I can trust to do good things.

I am thankful that you took the time to come on the show, and I'm thankful for the work that you and the team at Vanderbilt University Medical Center are doing. Neal, It's been great to have you on the show, and it's been great to hang out with you a couple times this year. Hopefully we can do it again next year.

Thank you, Bill. All the

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