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June 27, 2022: Sue Schade, Principal at StarBridge Advisors joins Bill for the news. On this episode we discuss four main subjects, leading with how twelve leading hospitals are scaling back care for a variety of reasons, including financial challenges and staffing issues. Trinity Health in Connecticut suspended inpatient and outpatient surgeries on June 9 due to a staffing shortage. And Johnson Memorial Hospital is now referring both their outpatient and inpatient surgery patients to other system-owned hospitals in the area. The healthcare sector is in the midst of a perfect storm. CIOs of leading health systems are grappling with a talent shortage, budgetary constraints and conflicting enterprise priorities. How are they dealing with this? Can academic medical centers be an answer? EHR giant Epic announced that it will apply to become one of the inaugural Qualified Health Information Networks (QHIN) under TEFCA. Epic’s Care Everywhere platform exchanges 10 million patient charts every day, and Epic notes that half of those exchanges occur with organizations that use different systems.

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Today on This Week Health.

For CIOs, it's do more with less. We've all been in organizations where it's a 10% across the board cut. Right. And you're like, how can I possibly do that? And is that even rational? Should we be looking at something more targeted or variable by area as opposed to just across the board. I think what's important is that healthcare delivery organizations, healthcare systems, be looking at new models of care that can possibly be more efficient and cost less.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

All right. It's Newsday. And today we are joined by Sue Schade, principal at Starbridge advisors and Sue, welcome. Welcome back to the show.

Okay. Good morning, bill. Good to see you

Looking forward to it. You a little under the weather, but you're gonna try to brave through a 30 minute show with me. So I really appreciate that.

I, I actually feel much better. It's day 10 or 11 since I had a COVID positive test and it was mild. But as I've warn you, hopefully I will cough during this

well completely understand I had my bout with COVID about a month ago and there's one episode I did that the team was like, we edited out all your coughing that we possibly could.

There's still some in there. Mm-hmm it was yeah, we all experienced COVID a little differently. I mean, for me, I did have a little bit of the shortness of breath. And especially when I was doing the show, cause I talked so much mm-hmm I would, I would get winded after a sentence and I'd be like, I, I just can't couldn't do it.

So I, I didn't do a lot of recording that week, but I, I did a couple. We have, four stories that we're gonna hit on. One is about hospitals scaling back. And I wanna talk to you about how CIOs think entering a potentially a difficult economy. There's a story on how leading CIOs are dealing with the perfect storm in healthcare.

It's really a recap of a webinar that Patty ed Manon did with some some CIOs with John Kravitz with Craig Richfield and some others. But I like the topics that they cover so we can hit those epic says it will apply to QINs to be a qualified health information network under TECA. I think that's interesting.

And then there's another one that Scott Becker put a post out there that, I think is pretty interesting as well. And I think we could talk about what it looks like to design your environment, to be a place where people. Want to want to work and want to stay working at so a lot of this is people based, and we're gonna start with this 12 hospital skilling.

And I think this is, an interesting story and a little bit of a precursor. So here's what we have. And this is a Becker story. So it's just bullet points. Right. And what they have is Trinity health of new England hospital in Stafford, Connecticut suspended, inpatient and outpatient surgeries, June 9th due to staffing shortages Johnson Memorial hospital is now referring the majority of its patients who need outpatient surgery to Trinity health of new England Johnson surgery center, and patients who need inpatient surgery to other systems. system owned hospitals in the area, Tampa, Florida based Shriner's hospital for children's is ending inpatient care.

At its campus in Springfield mass, the hospital gave the Massachusetts department of public health 120 day notice. Beverly mass hospital announced in may. These aren't these aren't major metros. This is generally surrounding areas. Pueblo, Colorado based Parkview health system will close 25 bed inpatient.

Adult psychiatric unit, Minneapolis based Allina health combined Regina medical center in Hastings, Minnesota in St. Paul, Minnesota under one license en closed its freestanding Institute. What you're seeing is, and, and I could go on and on you're it's just more of the same. They're closing either sections of the hospital, they're closing specific services and those kinds of things.

As you hear this. I mean, this is 12 different hospitals. This is just par for the course. This is always happening. And we just don't read about it that much.

I don't think it's par for course at all. And it, I think it's very concerning. I think if couple of them look like they are maybe addressing duplicate services in a particular service area.

So maybe that's rationalizing healthcare in that community. And that's an okay thing. But when you look at some of these talks about staff shortage and that's why they're closing. And if you just go down this list, I was writing 'em down as you were going. Going over them. Some of them that I think are in less populated areas, rural areas.

I certainly don't know all the geography on some of these. And to me, that's now gonna be a lack of services. If you look at Pueblo, Colorado based park, your health system will close a 25 bed, inpatient adult psychiatric unit. Well, it says because of a decline in patients, but you know, we know we have a mental health crisis and we don't wanna see those closing here in, Pennsylvania and emergency services at emergency room tongue panic. Pennsylvania. So is that potentially an area that is now gonna be short in terms of emergency services? There's Cooney. Health in Colene Idaho, if I've said that, right. Scaling back behavioral health due to staff shortages and financial lows.

I mean, I think we should be concerned about this trend in particular for those areas.

Yeah. And one of the reasons I, I put this story is the lead is last week Drex. And I talked about being a CIO, heading into a potentially financial, financially difficult time. And I want continue on that theme and talk about because I talked to somebody yesterday who their health system let go of three executives, including the CIO.

Now there's still an ongoing concern. There's still an entity that's trying to function. And they got rid of the CIO and I'm sitting there going that's that's a drastic move. And, I'm talking to some health systems, some CIOs at health systems, and they're saying, look, we're, we're losing money, handover fist, like the volumes aren't back the cost of running this hospital has all of a sudden spiked and nothing's changing in terms of the government payments on CMS and whatnot. So generally what happens is you charge a lot for commercial payers to make up for your Medicaid. And you hope to break even on, on Medicare, if, if not a little bit better than that, if you can, if you're really efficient, maybe you can.

So that's generally how it goes. So if all of a sudden you have a lot of electric procedures going away now, all of a sudden you, you turn upside down very quickly. Actually you turn upside down. And if that goes on for many months, now you're in a boardroom or you're in an executive meeting where they're going.

All right. We've got to figure this out. We've got to reduce our cost structure in some way. And generally that's, it is closing down less used you have auctioner here Wass a pretty significant health system, but they're saying, Hey, look in bay St. Louis, Mississippi, we're closing down labor and delivery more than likely there's somebody else doing labor and.

Their numbers are low and it's that kind of conversation where you go, where's our utilization, low we're upside out. Does it make sense? You can close those down, but then it comes to it. And this is where we should probably spend our time talking. It comes to it and they go, okay, we need you to do more with less mm-hmm

And invariably, that conversation comes to you. know Do we need to continue to do all the projects we're doing. Do we need to continue to do all the services? Is there a different way of doing the services and eventually that leads to a conversation of can we cut staff at some point? I don't know. I don't, I don't wanna start with such a negative topic, but when you're the CIO and you're sort of faced with that, how do you approach that?

And because I think a lot of CIOs right now are being faced with this. and sometimes if it's a, a, well, Oiled machine they look at the whole picture and sometimes if you have maybe a less mature leadership team, they just come to you and say, cut 10%. Mm-hmm . And now all of a sudden you're sitting there going cut 10% of what everybody's busy. We have tons of work. We have tons of projects. How do you approach that?

okay. So , you've just pivoted to the broad issue for CIOs in terms of cost cutting, as opposed to what we were talking about with the services closing. Let me make one connection between these yes, for CIOs, it's do more with less. We've all been in organizations where it's a 10% across the board. Cut. Right. And you're like, how can I possibly do that? And is that even rational? Should we be looking at something more targeted or variable by area as opposed to just across the board. But, but tying it back to the first article and the cutting of services. I think what's important is that healthcare delivery organizations, healthcare systems, be looking at new models of care that can possibly be more efficient and cost less. So again, tying it back to that first article, if you think about, is there a correlation around some of these closings and an increase in virtual.

health So, I mean, you're not gonna deliver a baby. Virtually obviously though, maybe there's some kind of virtual consult there on that last example about the labor and delivery department in one area for Ashner closing. And there's probably one nearby that women and families can go to, but how do we look at access to services?

Increase in virtual health increase in different delivery methods. And I don't wanna be Pollyanna wishful thinking, but hopefully in looking at those alternative care delivery models, we can look at how can some of the costs be taken out. And as we also know, and I'm rambling a little bit on this variation in healthcare delivery is a cost. And to the extent that CIOs and their teams can help organizations from an operational perspective, take out some of that variation might also address some of the cost issues

I mean, so the biggest thing is that the clinician costs across the board, not only clinicians, administrative costs as well, but the clinician costs has gone up significantly with traveling nurses and the nurse shortage and those kind of things.

And it's hitting pretty significantly. So I would think. as you laid that out and I love the way you laid that out, we would look for all right. If a nurse now costs, let's say 20 to 30% more than they used to cost the health system, then we have to figure out a way to be more effective with that, with those nurses time to whatever that is maybe that's. Reducing the inefficiency that exists within certain workflows, maybe that's making them more effective. So they're not spending as much time in front of the EHR and they're completing notes a lot quicker. Maybe it's maybe it's the ability to handle more patients with certain technology that assists them, maybe not trying to increase their workload, but essentially, because if you increase their workload, we're just gonna create a worse shortage. Right. We're gonna burn 'em out and we're gonna create a bigger, so we've, we've gotta think really creatively.

And I like, I like that, that approach And it's it generally speaking though, by the time somebody's come to you and said, Hey, we want a 10% cut across the board. It's almost too late for some of those conversations. Not too late, you can initiate those conversations cuz if you don't address it at some point, you're gonna keep having these, Hey, 5% cut. 10% cut. 3% cut. It's just a, it's a bad cycle to get in. And so how do you start to have those conversations? Who are those conversations with? Is that at the executive level? Is that at the individual hospital level that you're having those conversations about more effective care models?

I think it's both. I think it's gotta be at the executive leadership level where hopefully the CIO is a critical member of that team. And it's also especially when you talk about variation, it's gotta be at, you got a big health system. It's gotta be at the hospital level as well. Hopefully to get to more systemness and more commonness at the health system level and less variation at each hospital.

I wanna throw one other thing in bill. Not to put you on the spot, but application rationalization is a real thing and simplifying the environment with less applications is a real thing. And when I say I wanna put you on the spot you had one of your recent podcasts talked about growing your business and the lessons.

It was a great podcast, but I think I heard you say that this week health, has 52, you're small you're eight member team, and you have 52 systems, 52 applications. Did I get that right? And I'm like, oh my gosh, bill . Yeah. Application. Rationalization's a real thing, right?

It is, it, it is. It's interesting in the startup world though, cuz. We have no servers. we have no data center and all all those kind of things. So a lot of things, you just, you spin them. And then you connect them in. They become part of the workflow. Yeah. But there's no maintenance.

There's no there's very little maintenance. There's very little in terms of the things it does. And you stitch all these, these web applications together in a way, but yes, you do create tech debt and you do create those things. Yes. You're calling me out on my, the number of applications and part of that is nobody does it all well, and you have the opportunity to do best of breed. in this cloud world, because you can get that application that just does one thing. Well, and because they have a set of APIs and whatnot, I mean, we have you fill out a form here and it copies and puts a new row into a Google sheet. And that Google sheet kicks off a workflow. And the number of people who touch it is zero.

I'll give you a great example for our Newsday show for this. What I do is I read. And then I just clip the article. Once it gets clipped, it goes into my storage from that storage. It then creates a row on the Google sheet automatically, which triggers an email that goes to my executive assistant, who then creates a list of stories.

And we haven't automated this part, but that list of stories could go out on WordPress. Just fine. That email could go to you. Who's gonna be on the show this week and say, Hey, here's the list of stories that Bill's looking at right now. If you want to talk about any of these stories, let us know.

And that's just, it's incredible to me how integrated these systems are now, even though they were written by completely different teams without integration, really in mind, because they're built on internet architecture. That's the problem we have in healthcare. They're not built on internet architecture. So when we go to connect them, it's really hard.

Yeah. There's a lot of maintenance. and then still, they're not connected, which goes back to what we're talking about in terms of clinician and staff and the complexity of the systems and having to be in and outta different systems. So it's not. This smooth workflow where everything's connected, like you just described which sounds like a real positive, at least for your firm.

Yeah, well yes, we would like to get down to fewer, fewer applications and I had BJ Moore on the show recently and he talked about simplifying. He has three mantras simplify, modernize, innovate, and I said do you think you'll change that he.

Bill. I was at Microsoft for whatever 10 years now. I've been at Providence for eight years. He goes. It's the same three things and he goes, it's, pretty much what I've done for the last 17 years. Simplify, modernize and innovate. Yep. And that's good. Yeah. It's good stuff.

πŸ“ πŸ“ All right. We'll get back to our show in just a minute. I want to tell you about the podcasts that I am the most excited about right now that I am listening to, as often as I possibly can under that is the town hall show that we launched on the community channel this week health community, and an Arizona Tuesdays and Thursdays. What I've done is I have essentially recruited these great. Hosts who are coming in and they're tapping people in their networks and having conversations with them about the things that are frontline kind of stuff. So it's, it's technical, deep dives, it's hot button issues. It's tactical challenges. it's all the stuff that is happening right there. Where you live on a daily basis. We have some braid hosts on this show. We have Charles Boise. Who's a, data scientist, Craig Richard, bill Lee, Milligan Reed, Stephan, who are all CEOs. We have Jake Lancaster Brett Oliver, who are CMIOs. We have mark Weisman who is a former CMIO and host of the CML podcast. And now a CIO. At title health and we also have the incomparable sushi shade who is fantastic. And I'm really excited about the fact that she's tapping into her network and having some great conversations as well. I'd love for you to tune into these episodes. I am learning a ton myself. You can subscribe on our community channel this week health community. You can do that on iTunes, on Spotify. On Google on Stitcher, you name it, we're out there and you can subscribe there and start having a listen to yourself. All right, let's get back to our show. πŸ“ πŸ“

Next story is how leading CIOs are dealing with perfect storm and healthcare. And they did a little bit of survey. What's the biggest challenges health systems are facing today with digital, with digital transformation to be specific and They say number one is talent shortage.

Number two is budget constraints. Number three is conflicting. Enterprise priorities is number three. And so let's hit the first, first one talent shortage CIOs from Geisinger health. Some John Kravitz main health with which is Missing Daniel's last name? What's Daniel's last Nire Nire Nire. Thank you.

Daniel Nire and Intermountain healthcare, which is Craig rich discuss the importance of roping people outside the healthcare industry to expand the experience and skill pool, talent shortage in health. It, what's your best ideas here? I mean, yes, we can go outside the industry, but there's, there's probably some other things we could do.

My best ideas, thanks for just throwing that one at me. I dunno that I have anything. Well

What I've been talking about recently is go through the jobs and determine which ones actually need a college degree, because yes, it creates and at St. Joe's I'm telling you every job we had required a college degree. And when we look back on it, we're like, you know what. That didn't really require a college degree. We could train 'em how to be an analyst on this or train 'em on this, and we're gonna send 'em to epic for this. We're gonna send not every job needs college degree, and that's one way you can open up the talent pool and increase diversity at the same time.

Yeah, bingo. I love it. other areas is just cross training within the team, the continual training to bring people up with new skills, the working on the pipeline. And that's mentioned in this article, I mean, that's not new. You always have to be working on the pipeline and taking the longer view.

I've been in organizations where I tried to launch intern programs and you've got some number of managers who are like, I don't have time for an. I was like, well, you know what? You gotta take the long view. We're gonna create pipeline here. Right. You're gonna find, you're gonna find meaningful work that interns can do, and that they're gonna learn from, and you're gonna benefit from.

So that's like a mindset you need to have when, when you're in management. I think Going outside industry going outside healthcare to bring in new talent is, is another area. There's a lot of burnout because of the pandemic. And there are nurses and doctors leaving. I hope that the reverse is true for people who.

Have suddenly maybe found a passion for working in healthcare. I mean, you often talk to people who are like, oh my God, I work at Dana far cancer Institute because know, it's my family story about cancer and how now I've wanted to leave the financial sector and, and work in healthcare. And specifically in an organization that's dealing with cancer.

So finding people that have that passion and bringing them in also just that flexibility and I'm not real current. You're probably more current than me on Where we are relative to the pandemic and we're coming back into the office in hybrid models versus all remote versus all office, which I don't think we're hearing about from anybody, but that flexibility has got to continue for people in order to really secure talent. And along with that goes, being able to recruit nationally for particular jobs.

Yeah, you happen to be a part of several academic medical centers now? I, I was not a part of an academic medical center. So one of the things I made a point was to go to the local colleges and universities and have discussions with them around what it looks like to, to develop an internship program, to develop a Some sort of flow of people coming from the colleges and universities into our organization.

It was great to get fresh eyes on, on things. And it was also it was just a great source of talent. It benefited the universities. It also benefited us greatly as well. And I assume you, you did something similar with the colleges and universities in your area.

Absolutely. I I, I wrote about this in my blog way back when it would've been 2014, we at university of Michigan health Ssystem we, for a major our major inpatient clinical go live with epic.

We had 25 yes, 250 0 in our intern program for three months over the summer doing at the elbow support. And it was an incredibly successful program. We brought 'em in and for a month, they basically were trained, learned the system, learned the specialty area, they were gonna support. And then they were go live at the elbow support for over a two month period. And it was a total win-win for the organization. And for those young people who had an opportunity to work with university of Michigan health system in epic and just a lot of bright people

That's exceptional. Let's see, they have budget constraints here. The only thing I would say about budget constraints to me is one of the things I always found limiting, and I think we're, we're starting to move away from this slowly is So our budget was July to July.

And so we would have our process and our process would start sometime in the fall. And then in the spring, we would be talking about what projects we're gonna do next year, and then we'd finalize the budget sometime in the spring for the next year, starting July, going to the following July. And then we'd start that process again.

And I realized we're making decisions almost. 18 months, maybe, maybe 14 months ahead of time, but the world could change in 14 months. The world could change in two months, I think is what we just experienced. Mm-hmm I I'd love to have much more agile budgets where it's instead of looking at things on an annual basis, we're looking at things on a, maybe a quarterly basis, or if you're really sophisticated, getting down to a monthly basis and being able to adapt and change as the year is going along as opposed to. Trying to be Nostra and I, I realized a year is not that big a deal, but you know, 18 months ahead, these are the things we should be doing. Because world is changing too rapidly. So I'd love to see some sort of agile financial models. And I think I've heard some some systems starting to adopt.

More agile budgeting processes. So we'll, we'll see.

I think they are, that's been my experience in recent interims that the CFO finance folks are recognizing the need to be more agile, more flexible, and they're shortening up those cycles. So you're absolutely, I mean, you're absolutely right. And it very much applies to technology. When you just look at the, the rapidity of new technology solutions that are being made available and new innovations. Do you wanna be on an 18 month cycle?

I was just, I was just talking to somebody who said that their back order on switches just your run of the mill switch for a hospital, go live. I think they said 18 to 20 month back order on some of the switches. They. need to put into the new facilities that they're, they're doing. Have you ever faced that kind of constraint in your career? I mean, that's, that's amazing.

No, I haven't that, I mean, that sounds like broad supply chain issues. No, I have not.

Yeah. It's it's chip shortage and, and those kinds of things that's going on. Anyway, just. it Shows the need to be agile, nimble creative in these times conflicting enterprise priorities. for me, this has always been one of the hot buttons. The invariably, when you spend, when you, well, it's the age old, when you say yes to something, you're saying no to something else.

And in healthcare, that is so true. It's like, Hey, we're gonna do the new cancer center. Therefore we're not gonna do the new labor and delivery, or we're not gonna do the new psychiatric care and you sit there and go, but we need, but we need, of course we need. And they're all good. And so when you're saying yes to something, you're saying no to something else what have you found in addressing the conflicting priorities and how do you keep them from being squarely put on the CIOs shoulder?

Governance governance, governance. Every, every organization I've been CIO, interim CIO in the past, however many years has maybe with the exception of one or two had room for improvement on governance. There's no question. And key relative to governance I think is having top executive level awareness and involvement in those decisions. If they don't know what it's being asked to do and how the it resources are being spread thin on all sorts of things that people want and they can't help or direct redirect, excuse me, to the biggest, most strategic initiatives. Then it is gonna be just the CIO trying to manage all of.


Yeah, and that's some of the coaching we give CIOs all the time. It's like, if you feel like you're choosing between this and this you have to look at the governance process because at some point that's a losing, that's a losing game. Oh yeah. The CIO decided we're not getting that should never right.

Never really be the case. So. Right. let's stop on the epic story, cuz we're almost at our time here. So epic says it will apply. To be a Qin under TECA. All right. So this is this is part of 21st century cures. There's the TECA framework, which allows for a network of networks.

If you will epic joining this is fantastic. They have care everywhere and it exchanges 10 million, some odd patient charts every day. And I think they say half of those go to non epic locations. And so this is. This is a step in the right direction and you have epic going in this direction.

Hopefully you'll see Cerner Meditech, Athena, you'll see the rest of them sort of pop in here. And then we can, I believe we can really start to make progress on this. The, the patient record from one end of healthcare to the other, being a complete medical record. Now you and I both know having been in the bowels of these EHRs, that some records come across and look really nice and fit really nicely into the workflow.

And some are not so nice, but hopefully under this framework we can get we can get a little bit more sharing going on. I mean, but does this surprise you that Epic's heading in this direction?

It does not surprise me. I was happy to see it. I actually was happy to see the article and I was hoping that you could educate me more on some of this cuz I haven't been keeping up. But I think that this demonstrates progress and without getting into what do we think about the Cerner goals under Oracle and Larry Ellison's declaration? I kind of don't wanna go there.

I, I didn't, I didn't go there with DRX last week either. It was our last story we were gonna talk about. We never got to it. Okay.

Okay. So the bottom line on this, and I know this article will be in your show notes and link is it's progress. This is what we need to be doing. Epic and all of the big EHR vendors need to be coming forward and playing as part of this. What I don't know. And again you'd need to educate me is what's they've applied.

Will they be able to be a Qin? Q H I N. Or will these coalition organizations be more likely to be those Q Qin? Q Hins? However you say that make it a word or not. So it's something we should watch and and be optimistic about my.

I've done several interviews. , probably the most comprehensive on this topic is with Mickey TPA. I did one before he was over at HHS. And then I did one after he was at HHS. And we talked about this in detail, what the TECA framework is, what, what a Qin is and those kind of things. And this is a step in the right direction. I, I think that the step further. Is patient-centric interoperability, which I've talked about a lot of times on the show and I'm hopeful for we'll see.

epic making this move is really comforting to me. I'm excited about it. Oracle. Somebody asked me you think Cerner will step up and do something like this. I'm like, well, first of all, they're not Cerner anymore. They're Oracle. And the answer to that question is we don't have enough data points to know how they're going to act yet, but you know, this will be one of many data points that we see. But the first data point was probably a poorly orchestra entry into the market with their, their announcements and pronouncements. They clearly have not done the research in terms of the failures of big tech in healthcare and how they came in loud and proud and then proceeded to make significant mistakes. So okay.

So you weren't gonna touch that and you are.

Yeah, I mean, but I I've said it on the today show and okay. it's just one of those things that somebody in marketing should know better. Somebody in anything should know better. I mean, it's not like it's not like there isn't just a. A history lesson that you could just read there. IBM Watson Microsoft and health fault. And there's just story after story. And so.

Right, right. Well, I'll tell you in the spirit of, to pivot us in the spirit of continually learning and educating me along with other people, I will check out the podcast that you just referred to, to understand the work of te and the Cubans better.

Yeah. Well, the first one, it was like, he was the professor and I was just asking him questions and okay. He has so much history. Yeah. That came before his job at HHS. And now he's just so in the thick of it, it's phenomenal. Yep. Sue, I wanna thank you for filling in. I really appreciate it. thanks for the conversation.

You're welcome.

What a great discussion. If you know someone that might benefit from our channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to show just like this one. It's conference level value every week. They can subscribe on our website They can also subscribe wherever they listen to podcasts. Apple, Google, Overcast. You get the picture. We are everywhere. Go ahead. Subscribe today. We want to thank our news day sponsors who are investing in our mission to develop the next generation of health leaders. Those are CrowdStrike, Proofpoint, πŸ“ Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst. Thanks for listening. That's all for now.


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