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January 10, 2020: Welcome to this edition of Tuesday Newsday where we look at as many stories that are going to have an impact on health IT as we can in 23 minutes or less! In today's show, we have eleven exciting stories to cover. We talk telemedicine reaching into space, drones delivering emergency care services, cancer-detecting AI which outperforms humans, and more! Our final talking point is an article about hospital mergers. We cover that piece in some depth because it generated some amazing engagement on LinkedIn. New research has found that the quality of care at hospitals acquired during a recent wave of deal-making in the US either stayed the same and in some instances actually got worse. Get your weekly update of the biggest stories in tech and health today!

Key Points From This Episode:

  • Challenging the idea of ‘magic hands’ with a telemedicine call reaching from earth to space.
  • New trials involving drones transporting supplies between hospitals in the UK.
  • How Partners HealthCare is helping move treatment out of hospitals and into communities.
  • New cancer-detecting AI that raises questions around AI’s role in healthcare.
  • Developments in Germany involving state sponsorship of digital health apps.
  • What Aaron Piercer is doing for EHRs with his new venture, Vital Software.
  • How CVS Health’s Transform Oncology Care is providing cheaper and more accurate care.
  • A plea to prepare homes more adequately to enable the elderly to die in peace at home.
  • Advances in healthcare cost transparency as New York launches a price comparison website.
  • The necessity to start testing AI more rigorously before implementing it.
  • Quality issues arising from hospital mergers and the need for transparency during them.
Transcript

This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Welcome to this week in Health IT News, where we look at as many stories as we can in 23 minutes or less that's going to impact health it. My name is Bill Russell Healthcare, CIO, coach and creator of this Week in Health. It a set of podcast videos and collaboration events. I. Dedicated to developing the next generation of health leaders.

It's Tuesday Newsday and I am ready to get going. I've got 11 stories. I actually had 20, I had to break it down. Uh, 11 stories. That's why I'm talking so fast. Wanna get through as many of 'em as possible. We have, uh, telemedicine reaching into space. We have drones delivering emergency care services. We have a story which got a lot of buzz on LinkedIn, uh, this week with a post, which I'm gonna go through, uh, hospitals, merch, but quality didn't approve.

That was a Wall Street Journal article. Uh, we have AI ethics washing. We have, uh, New York just launched a healthcare price comparison site and, uh, a lot of other things. Uh, exciting. Uh, week of news. Actually, it's a couple weeks of news since we haven't. This episode is sponsored by Health Lyrics. I coach health leaders on all things health.

It, uh, coaching was instrumental in my success and it is the focus of my work at Health Lyrics. I've coached CEOs of health systems, startups, uh, CIOs, CTOs. If you want to elevate your game in 2020, visit health lyrics.com and schedule a free. Consultation. Uh, thanks. Special thanks to Drex to Ford for, uh, three X Drex his service that helps me to do research.

Uh, what happens is you get three stories texted to you three days a week, and to sign up it's pretty easy. Just text drex. Four. Eight four. 8 4 8. DREX to 4 8 4 8 4 8. Uh, all right. You ready for the news? Uh, as you know, we're doing things a little different in November. You gave me some feedback, and what I do now is I introduce 10 stories quickly give you my take, then we circle back and go a little deeper on a few of those stories.

We'll see if we can do that. We've got 23 minutes. Clock has started. Here we go. Uh, space, the final frontier of tele telemedicine. So, uh, two months into a six month stint in the International Space Station, one of the astronauts developed a blood clot in one of the large veins, in his necks, in his neck.

Uh, they reached nasa, reached out to Dr. Steven Moll, MOLL, professor of Medicine. Uh, at the University of North Carolina who specializes in blood clots and uses very various anticoagulants, blood thinners. And, uh, Dr. Ma is also the founder of the Clock Connect Outreach Project. And, uh, even though it says in article, even though make this to the Space Station, he did provide the longest, uh, distance telemedicine con consultation to date.

Helping to make the decision on how to treat the blood clot. Uh, you know, what's the so what on this story? It is, uh, tra traditional boundaries for telehealth are going to start to fall by the wayside. Uh, Dr. Klasko talked about this on the show and he said, uh, he referred to 'em as magic hands, that we still have this, uh, this tradition in the, uh, uh, in the field.

That, uh, there is magic in the hands of the physician. And the reality is that there is a whole bunch of things that can be done remotely. And, uh, after those traditions sort of fall by the wayside, we start to explore things that can be done remotely that we didn't think could be. Uh, so the, so what is, look beyond the traditional boundaries, uh, to, uh, unleash the limitations that, uh, are currently exist within most health systems around telehealth.

Uh, second story, I started with two fun stories. I don't know why, uh, NHS could use drones to transport lifesaving blood and chemotherapy. This is a, uh, daily mail story. Uh, and here's, here's what's going on. So the nhs, uh, could start delivering, uh, these, uh, uh, blood samples chemotherapy kits using drones, uh, under a groundbreaking new proposal partnership before Councils has launched a bid to carry out the first UK trials using unmanned aerial vehicles, UAVs to transport.

Uh, taking you to the skies to deliver the kits would dramatically transform the way emergency services operate with it. Also hoped, uh, with it also hoped drones could be used at serious incidents involving police and fire services. Uh, the So what on this is, I, I don't really know, to be honest with you.

I just think this is really cool and, uh, I would like to work on one of these projects. Uh, but in all seriousness, uh. On this, uh, my question is, who's looking at this in the US and is there a possibility, uh, could this be a major change in the way we imagine emergency services? I, I think it's a, an interesting story.

I thought it was cool. Only reason I'm highlighting it is, uh, just to expand, uh, the thinking of people out there. Again, this is under trial. It's not, they're not doing it yet. So we, uh, see what the results are. Fashion, something like this in the States could be interesting. Alright, let's get this a little bit more, uh, down to earth, a little bit more Practical Partners.

Healthcare aims to bring care closer to home. Lower costs. This is healthcare finance news. Um, here, here's the gist of it. Uh, partners Healthcare in Massachusetts, it's investing 400 million. To open up four state-of-the-art outpatient centers that will offer a wide range of new healthcare options to better meet patients, uh, changing needs.

And, uh, you know, the so what on this is, uh, moving care outta the hospital is, um, and into the community is, uh, an excellent strategy. Uh, we are starting to compete on convenience, which is great. Uh, this is a win for patients and a strategy that many health systems have. Started to employ or will employ in the, uh, in the near.

So, um, you know, this happening, this is.

Let's just call it an interim step and, and, uh, a good step. And the next step obviously is, uh, care, uh, closer to where people live and where they work, uh, so that we go to the next level of convenience. Uh, 'cause quite frankly, if you don't make care convenient, uh, people aren't going to take advantage of it.

And so primary care will still be outta reach for a significant number of people. Uh, the fourth story, uh, Google AI beats doctors at breast cancer detection. Sometimes. It was interesting to, to see this article play out on social media. Uh, a lot of people posted it to say, see, AI is beating doctors. A lot of doctors actually read the article and said, see?

AI isn't finding everything, and is that really acceptable? Um, it's, uh, you know, here's, here's some of the, the highlights of this Google Health Research unit said that it developed an artificial intelligence system that can match or outperform radiologists at detecting breast cancer according to new research.

But doctors still beat the machines. In some cases. The model developed by an international team of researchers caught cancers that were originally missed and reduced false positive cancer flags for patients who didn't actually have cancer. According to the paper published on Wednesday in the Journal, uh, nature.

Data from thousands of mammograms from women in the uk and the US was used to train the AI system, but algorithms isn't, uh, but the algorithm isn't yet ready for clinical use. The researcher said the model is the latest step in Google's push into, uh, into healthcare. Uh, the alphabet company has developed similar systems to detect lung cancer, eye disease, and, you know.

We have to be careful here. So really what I wanna say is that AI is the future. AI may one day beat clinicians on detection at every level. Okay? The reality is we still need clinicians. This is a partnership in the delivery of care. Um. You know, for the clinicians who are saying, no, no, no, it'll never be there, it probably will get there.

Uh, we were saying that about an awful lot of things and, uh, technology just continues to progress. And the reality is if AI reduces the cost of care by reducing the labor needed, uh, and improves the quality by detecting previously overlooked cancers, uh, this is what we want. This is the aim in putting it out there.

You know, the key I think, is to map out what the future looks like with a partnership between machines and clinicians, and to identify that future, map that future out, and start to talk about it, uh, not. Not push it aside that it'll never happen and, and act as if it'll never happen and not push it too quickly.

We need to put this, these things through the same kind of trials that we do, uh, drugs and other things to make sure of their, uh, efficacy. Anyway, uh, let's go on to uh, number five. Germany introduces digital supply act to healthcare. Healthcare IT news. Put this out there. Um, there's proposed Germany. And was passed by Par Parliament in November.

Under the new legislation, doctors will be able to prescribe digital health apps to patients which can be reimbursed by the country's statutory health insurance app Providers will have to prove to the Federal Institute for Drugs and Medical Devices that their apps can improve patient hair, uh, patient care.

I love that. They'll have to prove that, but if they prove it. It gets funded, which is, uh, you know, it's actually the best of both worlds on both sides. Also, doctors will be able to receive money for providing online consultation to patients with statutory insurance. Doctors will be allowed to provide information about video and online consultations on their websites, whereas before they had only been able to discuss these in private conversations.

Uh, the legislation also aims to phase out the use of paper by promoting ePrescriptions. Germany also plans to bring the EHR for patients with statutory church by 2021. Um, the, so what is. While we don't really have a growing listenership overseas, we really do focus on US healthcare. So I'm not reporting on that, uh, for the, for the German audience.

Um, but I am reporting on that because our second highest city for downloads in the past year. Was in and around the Washington DC area. And, uh, I, I cover the story in hopes that regulators are listening. And I just wanted to say that these seem like very good ideas, sound and good ideas, uh, things we should fund, uh, fund, uh, within Medicare and things we should figure out how to fund, uh, through, uh.

Anyway, just a good idea. Wanted to, uh, amplify great thinking, which is the, uh, which is the mission statement of this show. Uh, number six, mint Founder launches EHR solution for hospital emergency departments. Uh, med Gadget. Uh, earlier this year, mint founder Aaron ER's newest venture vital software, came out of stealth mode and raised $5 million.

Talks about who he raised it from. Uh, it started in 2017. Vital aims to bring consumer approach to personal finance management championed by mint to emergency departments by enhancing the electronic health record. According to the company's website, vital sits on top of the existing EHR for faster, easier view of the ed.

We use artificial intelligence to predict admin hours in advance, reduce length of, and save with an improved. Uh, vital solutions consist of both patient and clinician interfaces, intake, medical information, and context regarding their visit to the ed. While software does not handle billing. Patients can be, can also upload, upload their insurance card.

All this information is captured and presented through the clinician portal, which includes a risk level and patient colored, uh, color coded in red and green. So what, um, by the way, this, I all, for all intents and purposes, press release. I cover it because I use mint and I like mint and, uh. You know, the so what for this is simplification automation, AI experience, improved throughput, uh, seems like a winning combination.

If I were sitting in the, uh, CIO chair, um, which from time to time I do in an interim capacity, uh, you know, this is probably worth a look see at himss and if I was in the. Uh, investment officer for one of these, uh, investment arms within the health systems might be worth a look, uh, in terms of investing as well.

Uh, just saying it seems interesting. Uh, again, simplification automation, AI experience, improve throughput, uh, remains to be seen if they'll be able to achieve those things. Uh, but it looks like it works with every major, uh, every major EHR and, uh, I looked at some of the, uh, screenshots that were showing.

Um, it's worth looking at anyway. Uh, worth a lookee as they say. So the next story, CVS Health launches transform oncology care programs to help improve patient outcomes and lower over overall costs. Uh, this, this is absolutely a press release CVS Health today announced. Transform oncology care anchored on its first of its kind.

Precision medicine strategy for payers. The program uses genomic testing results at the point of, uh, at the point of prescribing to help patients start on the best treatment, uh, faster, and in addition, matches eligible patients to clinical trials. Transform oncology care also uses company's local footprint and unique assets to improve patient outcomes and lower overall cost at every point in the cancer care journey.

So out this, I. Uh, I wanna share this because this is an important movement, uh, through a potential new competitor for a lot of health systems. And, uh, CVS is gonna do a lot of interesting things. This is one of those things, precision medicine with local delivery. It's a great model. Probably one you want to keep an eye on, probably one you may wanna replicate as you design your programs around precision medicine.

Uh, I, I think it's interesting. Worth, um, worth exploring. Number eight story. More Americans are dying at home than in hospitals. The New York Times article, uh, this article's worth a read if you get a chance to, uh, look it up. So more Americans are dying at home than in hospitals for the first time in over a half century, more people in the United States are dying at home than in hospital hospitals.

In Boston, in 1912, about two thirds of the residents died at home. By the 1950s, the majority of Americans died in hospitals, and by the 1970s, at least two third did. Uh, Americans have long said that they prefer to die at home, not in an institutional setting. Um, you know, this is people's desire. About 45% of older people have, uh, you know, this is people's desire.

However, I. Um, the article goes on to talk about are we really prepared? Have we, uh, set up, uh, healthcare in that way? Have we prepared families in that way? And have we, you know, done the proper things to prepare? About 45% of older people have, have completed advanced directives, which often specify the doctors.

Uh. That doctor should not take extreme measures to prolong life. Uh, if you haven't done that, you should absolutely do that and figure out ways to encourage, uh, people within your, uh, health system to fill out their advanced directives. Um. Don't wanna be guessing at those things at the end of life. Uh, you know, the other thing is they talk about we're sending very, very sick people and complicated patients home under the care of their families and who are not trained to deliver care.

And this is a tremendous burden we are putting on families. Uh, good article. The so what for this is, um. What are we doing to provide support for those families and, uh, a higher level of care in the home? Uh, I think this is the year to figure this out. A lot of health systems may choose to partner and that's great, but 2020 is the year to figure this out.

How are we going to, uh, take home care to the next level? Uh, provide. Uh, everything all the way up to an ICU out of the home. Uh, that being the extreme and, uh, you know, different ways of people, uh, supporting the families that are providing the care and supporting the people that are, um, that are receiving care in the, in the home towards their end of life.

Something that's the so what for that story. So let's go to story number nine, New York to launch healthcare price comparison site, uh, Becker's Healthcare, uh, New York plans to develop a consumer friendly healthcare price comparison website in 2020. It's, uh, NY healthcare compare.com will provide cost, quality and volume data broken down by hospital.

It will provide info about financial assistance options, uh, for, uh, for surprise billing. Uh, it will be developed by the Department of Health and Financial Services. So what transparency, uh, is we should be doing? Transparency. Transparency. A

stand. Um, you know, you're gonna have to be able to provide this type of information. You're either gonna provide it through the state or you're gonna provide it through your own website. Uh, I prefer to use it as a competitive advantage in the marketplace that you serve and start to provide some of this information.

Uh, New York is the second state, first state being Vermont that has, uh, provided this kind of thing. I think you're gonna see this, uh, proliferate pretty quickly across the states. It's not a bad idea.

You know, my, uh, coaching to health, it is to, uh, get this work done. Uh, and really as you're doing the work, do it from a patient perspective. Think about it from a patient. What would you like to have and not from a business preservation perspective, how little do we have to provide, uh, and to continue to provide opaque, uh, pricing and to obfuscate.

Uh, really the intention of what, uh, the OC is trying to do, uh, with regard to transparency, again, transparency is good. We want transparency in every other aspect of our lives. We should be providing it, uh, within healthcare, uh, especially around costs that are so great to a lot of, uh, families.

AI and.

Here's what they had to say. 2018 saw major advancements in ai. It also saw high profile illustrations of what can go wrong. And, you know, all these illustrations, Tesla crashed and autopilot, uh, killing the driver. Uh, a self-driving uber crash, killing the pedestrian that was in, uh, Phoenix, uh, commercial face recognition that performed terribly in audits on dark-skinned people.

Uh, but the tech giants continued to. To customers including law enforcement. So.

The author wrote a resolution to stop treating AI like magic and treat it, uh, and take responsibility for creating, applying it, and regulating it ethically. And the good news is, in 2019, that actually happened in a big way. And lots of organizations set up AI ethics guidelines, AI conferences had sessions around ethics, and there was a lot of talk about the subject.

Uh, Karen came back this year to write this article and to say, now it's time to move beyond talk. And get to implementable less vague AI guidelines. And, uh, she talks about we've fallen into this trap of AI ethics washing. And the best example is Google formed an AI ethics board with no actual veto power over questionable projects and with, uh, con controversial members.

And once a backlash ensued based on those controversial members, it led to immediate dissolution of the, uh, ethics board. Without a replacement, presumably, uh, you know, she does go on to note that there's been great progress at the grassroots level from community groups, policy makers, and, uh, tech employees themselves.

Uh, why do I highlight this? Well, AI is all the rage in healthcare and, uh, um, you know. AI is not magic. Uh, we need to put it through the paces. We need to treat it like a clinical device that it's, uh, it is, it is providing input to the care of a patient. And, uh, we need to understand how it's making those conclusions.

Uh, is there, uh, data bias in it? Remember that we put EHRs in place to improve workflows and to data for government regulations for billing. A lot of the data in the EHR. Has a billing bias and, um, you know, and, and things to that effect. We have to identify the bias. We have to know how AI is making decisions and we, we have to put it through its paces before we see it in the clinical setting.

It's one of the reasons that I've been saying on this show that the implementation of AI in clinical settings will take some time. Uh, we're gonna see AI in a lot of other settings within healthcare, and it's gonna bring great efficiencies and we should be, uh, playing with it and advancing it. But in the clinical setting, we should be treating it almost like a drug.

How are we putting it through that level of, uh, rigor and testing? We'll get back to our show in just a minute. As you know, health Catalyst is a new sponsor for our show and a company. I'm really excited to talk about. In the digital age, cloud computing is an essential part of an effective healthcare and precision medicine strategy, and we've talked about it many times on the podcast, but healthcare organizations themselves are still facing huge challenges in migrating to the cloud.

Currently, only 8% of EHR data needed for precision medicine and population health is being effectively captured and used. That's 8%. One of the things I like about Health Catalyst is that they are committed to making healthcare more effective through freely sharing what they have learned over the years.

Uh, they published a free ebook on how to accelerate the use of data in the delivery of healthcare and precision medicine. You can get that ebook by visiting this week, health.com/health catalyst. And, uh, you know, this is a great opportunity to learn how a data platform, uh, brings healthcare organizations the benefits of a more flexible computing infrastructure in the cloud.

I wanna give a special thanks to Health Catalyst for investing in our show, and more specifically for investing in developing the next generation of health leaders. Now back to our show. All right, so the last story is, uh, we're gonna try to do something a little new this year. That we use the turn of the year to try new things on the show.

And one of the things we're doing is we're gonna start to post these stories during the week on, uh, LinkedIn, Twitter, get the conversation started out there, uh, pull that information in, and then, uh, include it as part of our conversation on the air. Um. Not gonna quote anybody unless I know it's okay to quote 'em.

Uh, but uh, you know, so I posted a couple of our stories this week to get started and this story got the most interaction and it is a Wall Street Journal story. It is hospitals merged, but quality didn't improve. Uh, I think the title says it all, but, uh, here's. Here's essentially what happened. Uh, new research published by the New England Journal of Medicine looked for evidence of quality gains using four widely used measures of performance.

At nearly 250 hospitals acquired in deals between 2009 and 2013. The analysis did not find an improvement in quality. Said this study's authors, and so I pushed, uh, I put a story or I put this out there on uh, LinkedIn. And, uh, here's all I said. A merger brings cultural disruption, personal uncertainty, and technology change.

Are we surprised by this finding? It was really fascinating to me to see, uh, the comments, you know, uh, at, at the ground level. Uh, you could see the, uh, confusion. There's, uh, there's individuals talking about, uh, going through a merger or been through a merger. Hard to figure out. Who to talk to, how to get support.

Um, don't really know where we're going as a whole. Uh, and this is not like weeks after a merger. This is years after the merger. It's still confusing for people to find basic things like support on the EHR. Very interesting to me. Um, you know, uh. Said successful mergers are cultural matches. I believe that's true.

I believe they are cultural matches. Uh, but I also believe that, uh, that simplifies it a little too much. I mean, there's an awful lot of complexity in bringing these things together, uh, as we have seen, uh, some other comments. FTC wants to hear that mergers will reduce costs and improve quality. So it's no surprise they often hear that.

Uh, prior research has shown a consistent association between merger events and resulting reductions in cost, improvements in quality. Um, I, you know, again. I hope that's the case. And uh, one of the articles that was written recently, rod Hockman wrote a piece worth reading and he notes that he believes this year we will start to see the, uh, the fruits of those mergers and acquisitions, uh, that really have come down over the last couple of years.

And he believes we will start to see those quality improvements and access to care, uh, start to increase. Um, and, uh, you know, and that's, that, that's really exciting. Um. You know, another person writes, entities feel compelled to merge when they fall short on quality and financial, uh, positive bottom lines.

Instead of self-reflection for needed improvements, merging is thought to consolidate resources in hopes of providing synergies, but miss the major first step looking for the weak links. So many mergers fail for one reason. Uh, junk in, junk out. Uh, the we use for data.

You know, an argument could be made that when you take two, uh, organizations that are not financially viable or that are producing poor quality results, uh, I'm not sure why anyone would think that, um, that bringing those two together would, uh, would produce, uh, positive results. But that's the case that's made.

And it, uh, a lot of times these mergers go through even when the two entities don't have a. Quality or, or, uh, profitability within their own system. And now we're expecting them to do it across the board. Uh, you know, a couple other interesting comments. Um. Many hospitals being acquired not, are not in a financially sustainable position.

One argument is that this is better to maintain some services at a location than to have a hospital go under completely. Uh, service rationalization is happening across the board, not just in struggling hospitals being acquired. Uh, it's the new norm. The scale at which some systems are taking this on is absolutely daunting.

I think that is true. I think that is, uh, uh, you know, we've seen some systems take on an awful lot of acquisitions, which is an awful lot of EHR consolidation, uh, to, to do in, just in and of itself. And then you have others, uh, that need to be, uh, in there. Um, you know, Drex, Deford mentioned earlier on the show, uh, chimed in and just talked about how there's a land grab going on and there's a, there's a fear of missing out sort of mentality.

Um. You know, and there's, uh, a reasonable belief that if we centralize HR and IT and the rest of these things, that there will be efficiencies. Um, but he goes on to say that every m and a is complicated. Uh, this is a great discussion that goes on here. Uh, worth taking a look at out on LinkedIn, uh, on my personal LinkedIn account.

If we're not connected, feel free to send me a LinkedIn request and you can start to follow some of these things. You could also follow the show at, uh, this week in health it on LinkedIn as well. We'll be posting them there. Um, here's one of the things I will say about, uh, mergers and acquisitions. I've been through both sides.

I've been the, uh, uh, larger entity in acquiring. I've been the, uh, smaller entity that got acquired and had to put together a nine, uh, spent nine months putting together a plan of bringing two fairly large organizations together, uh, before, uh, leaving. Severance. Um, so I've been on both sides of this, and we discuss this in detail.

There's a episode probably about a year and a half ago with where we sort of roleplay what we would do as two CIOs, uh, in this, uh, in this endeavor. I will say this, uh, I've seen this done really well. I've, uh, one of the ones I'm looking forward to, I hope we hear again from, from JP Morgan was, uh, mercy and Bot course, and the CEO got up there and he just, uh, first of all, he was transparent and he was honest.

Um, when they, you know, when you talk about this and you go into organizations and you say, no one's gonna lose their job. They know you're lying. Um, so you just don't, don't do it. Just stop doing it. It's, it's disingenuous. Uh, one of the things I liked about the CEO who got up at Mercy and, uh, SCOs when he was talking about their merger, um, he says, you know, we spend, uh, months trying to come up with an EHR decision.

He goes, it's obvious to everyone in the organization when we spend six to nine months, uh, involving everyone in a decision that's already a foregone conclusion. We lose credibility right out of the chute. And he said, you know, we went in there and we said, in one month we're gonna make a decision on the EHR.

We're gonna make a decision on the ERP solution. We're gonna make a decision on, you know, fill in the blank, whatever the other ones were. He goes, you know, everyone knew we were going to Epic. We're going to Epic. There's no reason to, you know, to now there's nuances to that, you know, which build you're gonna go to, which all that stuff do you do new build and whatnot.

But, uh, I, I liked his approach. Can lose credibility right outta the ch in how you handle this. You can use lose credibility by not being transparent, by telling people things that they know are not true. Where a merger of equals, please stop saying that no one believes it. No one from the, you know, the, uh, the hourly employee, the part-time employee to your executives.

No one believes a merger of equals. So, um, I think transparency, honesty, uh, I think understanding the complexity that you're stepping into when you take an organization that has 1800 applications and another one that has 2000 applications, uh, there is. The amount of tech debt that exists within those two organizations alone that they would have to deal with if they didn't merge is significant, is a three to five year project.

You take the two and move them together, you're now talking about a significant amount of tech debt. Um, I think boards need to be educated on tech debt and understand it, and I think, uh. Not only boards, but also, uh, leadership needs to understand that because a lot of times it is the, uh, it brought in after the fact we've decided to merge.

Will you make sure there's no, uh, nothing in the closet that will make this merger, uh, not worthwhile? And if you sit there and start talking about tech debt, they'll say, nah, that's not a reason for not bringing these two things together. But the reality is, uh, you could be talking about, uh, millions, hundreds of millions of dollars.

Uh, complexity outages, uh, security breaches, uh, and you know. Again, fear of missing out. We've gotta push through these things. Uh, interesting article, interesting conversation. I, I really enjoy doing this. I hope that you'll start to participate in these conversations. I have started posting stories and we'll continue to post stories, uh, because I really want to get the conversation going, uh, back and forth between us.

That's all for this week. Special thanks to our sponsors, VMware and health lyrics for choosing to invest in developing the next generation of health leaders. This show is a production of this week in Health It. For more great content, you can check out our website this week, health.com, or the YouTube channel.

If you wanna support the show, the best way you can do that is to share it with a peer. Send an email, let them know that you value the show and you get a lot outta the show, uh, and that they should, uh, should take a listen. That helps immensely. Uh, we'll be back again on Friday with another interview from, with an Industry influencer.

Thanks for listening. That's all for now.

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