March 3, 2020: Drex DeFord stops by to do a HIMSS pre-game. We discuss President Trump's interoperability talk and Epic's second big win in recent days. Hope you enjoy.
Drex and I discuss HIMSS and Epic
Episode 188: Transcript - March 3, 2020
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: Welcome to This Week In Health IT news, where we look at as many stories as we can in 30 minutes or less, that's going to impact how it, my name is Bill Russell, CIO coach and creator of This Week In Health IT. A set of podcasts, videos, and collaboration events dedicated to developing the next generation of health leaders.
This episode is sponsored by Health Lyrics. I coached health leaders on all things health IT. Coaching was instrumental in my success and it's the focus of my work at Health Lyrics. I coach CEOs of health systems, startups, [00:00:30] CIO CTOs. If you want to elevate your game in 2020 visits healthlyrics.com to schedule a free conversation.
It's Tuesday news day and we have a special treat today, Drex DeFord the original recovering healthcare CIO joins us to talk news and do a little hinge pregame. Good morning. Welcome back.
Drex DeFord: Good morning. Thank you so much for having me. It's always a, it's always fun. It's always a good time to sit down with you.
We'll talk about the news.
Bill Russell: Well, I'll tell you directly. I stopped calling myself the recovering healthcare [00:01:00] CIO when people kept lashing back at me say so. I, I finally said, all right, I give, I give direct, says too many, too many fans. I'm not gonna not going to try to.
Drex DeFord: I can't believe. I can't believe it. I mean, I think there's a ton of us right now that are recovering CIO is recovering CXOs.
So it is what it is.
Bill Russell: Yeah. And we're both, we're both really committed to this, keeping the industry current on the news. I do it through the show. And then you launched three [00:01:30] extracts, which we talked about on the. On the, on the, on the show and it's, what what's number?
Drex DeFord: It's 48-48-48. Just text DREX to four eight, four eight, four eight.
And I sent three stories three times a week. These are the things that I think are, are hot. And if you're only reading hardly anything, because you're so busy at work, we're trying to filter it out. I'm trying to take the noise out of it. Out of the news cycle and give me the stuff that you probably really ought to know about when you're talking to peers or talking to your staff.
[00:02:00] And, and I know, I mean, I agree. I think it aligns right really closely with a lot of the work that you're doing right now. We both do a lot of coaching. We both do a lot of teaching and I think it's the beauty of being at this point in our careers where we have a ton of experience and we can see trends coming and. That's what we
Bill Russell: do.
Did. You know, what I, the thing I love is didn't have to hire like a staff person to do research for me anymore. Cause I get these text messages from you and it gives me, you know, nine [00:02:30] stories to look at every week. Now I'm still reading a lot of stuff that's out there, but, but it is, it is really helpful to have it, have it, Really curated by you and deliver it to me.
So thank you for doing that. Oh sure.
Drex DeFord: For the listeners who don't know, actually bill and I exchanged a lot of emails in the background and very often he'll send me other little tidbits that wind up showing up in three extract. So, you know, this is. This is often a crowd and curating kind of
Bill Russell: crowd [00:03:00] source.
Awesome. All right. So onto the news, I'm going to try to cover three things. I'm going to talk about hymns coronavirus. It's a significant topic, and this is going to get released today. So hopefully. we'll add to that conversation. we're going to talk president Trump on interoperability, which should be, he's going to show up at hands with you, right.
you know, a sitting president speaking at hymns for the first time we've had a former presidents speak at him, so there's not. It's not that this, venue hasn't had a dignity [00:03:30] marriage before, but this is the first sitting president. And then the last story I called was a Patriot really follow up following admin on this Epic train.
And I think that's a, you know, that's two major health systems in the last 30 days making this announcement. So it's a. Pretty big deal. And then you have three stories. What, three stories.
Drex DeFord: so I have, let me look through the show notes here. I've got, I have an article on continued, continued consumerization in healthcare and whether or not it's good or bad for patients or good or bad for hospitals. [00:04:00]
I have a story about reinventing yourself and then. Sort of a patient experience story around, you know, we talk about patients as customers, but they're still patients and they're still consumers and there's, there's two sides to that coin. And so we'll, we'll talk for just a couple of minutes maybe about that
Bill Russell: reinvent yourself or somebody else will.
That's a great title. And good for our, our,
Drex DeFord: so
Bill Russell: let's, let's start with coronavirus and hymns. Neither of us are doctors. So we're not going to [00:04:30] go into details of what people should be doing around this, but are you planning to attend?
Drex DeFord: as of today I will still attend. I'm still gonna attend.
Bill Russell: Yeah. And I feel the same way I do.
It's like a, it's like a day to day decision, because I have a lot of interviews planned, but I could easily do them the same way we're doing this. Still get the word out and capture some of the thoughts I want to, but it is kind of a day to day thing. I'm not. I'm not, you know, the first two cases in Florida brought [00:05:00] forward, but this, this conference in and of itself is 40 something thousand people from around the world.
Right. Coming together. I mean, the thought I have in my mind is, is it responsible to go ahead with the conference? Should we, should we be, even be put in this position to decide whether we should go or not?
Drex DeFord: Yeah. I mean, there's, I think for him a huge amount of financial pressure to do this, to keep the conference going now that they've announced the [00:05:30] president's going to speak, they've almost backed themselves into a corner where they can't cancel now without making.
You know, the whole situation worse, not only for him, maybe for the president. I, you know, I was, I sat on the hymns national board back in the day where the annual conference was like 95% of the work revenues of the company. And we diversified specifically because of that, we wound up buying dorm vests, which turned into hymns analytics.
We went down the media [00:06:00] road, so there's lots of media stuff has happened. We did unifications and joined with several, several other organizations so that we had other conferences at other times and other events. And other times specifically knowing that this could be a thing that could happen. I don't think we really thought about it being a pandemic situation, but you never know, right.
Another nine 11. there could be, you know, if you were doing this in Chicago, there could be a snow storm and [00:06:30] everybody cancels. There were lots of different options. So specifically spend some time building out the company to be able to take one of these hits if they ever had to take it. And I'm not sure what's going on, but we've definitely gotten to the point with hams now where the show is so big and there's so much money involved.
That canceling, it doesn't seem to be an option. And so for a lot of us now going is also not an option. I mean, I feel like [00:07:00] I, you know, I'm with you, I'm on the fence every day about whether or not I'll go or stay, but, but as of today I'm going,
Bill Russell: yeah. And my, you know, my film cruise, my daughter
Drex DeFord: I've seen her.
Bill Russell: So it's, you know, it it's, But to be honest with you, it's not just that, it's my daughter, I'm talking to vendors and I'm talking to people that are partners with China, farmers, with him who are seriously considering pulling out for the good of their employees. And I made one of the major vendors [00:07:30] that I talked to this morning, just canceled their national sales conference, which is a one time, once a year event, where they kick off their, their big sales, shindig for the year.
So. you know, you know, clearly there's a, there's a lot of concern around this and it's probably warranted. I, you know, I'll probably step further than you did. I don't think HIMS cannot do this conference and survive financially. I think they, they would have, there would be a significant. Well, back [00:08:00] to the organization, they would have to do major cuts and change things.
And it would, the other thing is if you take away a major revenue source and sort of showcases all the other areas where they're not making the money that they thought they were making, so it would, it's a major restructuring. I think the responsible thing would have been to, To pull out if they could and, re reschedule for the fall, try to do a fall or, or some aspect of that, that I realized the logistics.
I'm sure smart people sat in [00:08:30] a room and tried to figure this out and logistics around that are probably just. Incredible.
Drex DeFord: Yeah, no, I'm sure you're right. Yeah. I'm sure there was a lot of discussions and a lot of, of, sort of plea pre-planning to figure out what would be the options. How would they do it if they decided to cancel the conference and do something different, what would they do?
you know, a lot of this kind of gets down to the, when you talk about hospitals and house systems and vendors and, and others, Doing these kinds [00:09:00] of, they're not really incident, incident, response type exercises, but they're that kind of thing where you are, where you always have a backup plan, especially for major things that happen with your company or with your health system.
Would we do X without Y or what happens if we, we have to stop doing, for some period of time and how do we work under those conditions? How do we operate under those? If you haven't thought through it? In the heat of the battle is not the time to think through it because you will [00:09:30] always default to the easiest path, which is sometimes the wrong one.
And we'll see how this works out for him.
Bill Russell: You know, we saw SARS, we saw Ebola. We're now seeing a coronavirus. I think this is the new norm. I think this has to be taken into consideration. For these conferences and for travel and those kinds of things. So I don't know, they should invite you back on the board.
I'm not volunteering you for that. I know you're busy, but let's get to the next one. My job on the next one, [00:10:00] president Trump, speaking on interoperability. My job is to get you so fired up that you say that things that you normally wouldn't say on there.
Drex DeFord: But,
Bill Russell: but actually in all honesty, let's take personalities out of it for a minute.
Whether president Trump will. It will probably be somebody else's speech. I doubt president Trump has the nuance around interoperability that say a SEMA Burma or secretary ASR would have, but clearly they're [00:10:30] using the bully pulpit. They're going to get this word out about interoperability, why it's important and.
The, one of the things I've driven home on the show is this is a bipartisan issue. If you had Joe Biden speaking, he would be just as passionate. In fact, I've heard about him being just as passionate, especially around the Biden cancer initiative and how upset he was that the medical record is so hard for somebody with such a complex case to follow.
So this is a very much a [00:11:00] bipartisan issue, but I think by Trump speaking about this at him, He's, he's almost trying to take this issue and make it, you know, champion for the people. so let's start with this question, which is. Taking the personalities aside. Is it good to have a sitting president really championing a interoperability?
Drex DeFord: Yeah. Well, I mean, you and I have talked about this, quite a bit. I we're both fans of interoperability. We both think this [00:11:30] is a thing that probably should have been thought of and written into the original, meaningful use. rules. I think a lot of us kind of assumed it was going to be there. And then, you know, as we've talked about before, too, with all of these regulations, there's always some unintended consequences.
So I think given the controversy, you and I both wrote, written and talked about. Around interoperability and the conversations. This happened with Epic and the Epic clients, writing HHS [00:12:00] warning and the risks associated with interoperability rule that they did what you and I do. And that was, we went to the boss.
We had a conversation about what we're trying to do with this new interoperability rule. We wrote them a briefing paper. We may have sketched out the email and. We're trying to create a situation where the message comes from the top. We're going to do interoperability. This is good for everybody. This is going to save a lot of lives and they will [00:12:30] get the kind of press that they're looking for because the president is saying, you know, I, I, whoever the president is, you can't blame the senior folks at HHS for saying the best way to sort of broadcast this message is from the top.
That's what we all should do.
Bill Russell: I'm expecting some goofiness in the, in the auditorium. just, just knowing what I know about healthcare and knowing the political bent of, you know, you take 40,000 people from, [00:13:00] from. Art industry and put them in a room. I don't know. There'll be people who stand up and walk out.
There will be people who stand up and turn their backs, whatever it ends up being. I think it's good that the president is coming forward. I'm interoperability. I would, I've always been a proponent as you have been of, you know, that medical record following you wherever you go. interestingly, I just think Epic.
I think this is a precursor to the fact that the ONC rule is going through and [00:13:30] he will probably either announce
Drex DeFord: it right.
Bill Russell: Or it will be announced just prior to him getting on stage and he will drive it home. And he will try to take this as an election year issue. And, you know, it resonates. I mean, I, one of the most listened to shows I did this year was on my father-in-law's.
Visit to a, to a major hospital that was on Epic and his records didn't follow them. And I got a lot of emails, including from Epic on why it may not have worked the way that [00:14:00] I thought it should work and whatnot. So, this is a, this is an issue that. Epic. Didn't do a good job. Getting to the people and ONC never really did a good job getting to the people.
And I think this is, this is right for someone to take it and say, I'm going to be the champion for it. And like, or not. I, I think it's a smart move for president Trump to try to take it goes into the election year issue if he runs again, I think by just going to look at them and say, Yeah, [00:14:30] we're on the same page I think is what's gonna happen.
It'll be interesting to see what happens.
Drex DeFord: Yeah. I think if you want to, you know, you want to drive this home for me too. Other things need to happen. One is, as we find with all regulations, there's always unintended consequences. And so the important part of all of this. Interoperability rule will be to make sure that we can adjust for a fact, as we start to realize the unintended consequences.
And the second one is if you [00:15:00] really want to make interoperability work and make it
Bill Russell: way easier
Drex DeFord: for us than it ever has been before universal patient ID thing. Stop playing around with that. Let's just get that done so that we all have some kind of a something identifier, that lets these records really flip because even in the same health system, we still spend a lot of time.
The duplicating records that get accidentally registered, where I get registered two or [00:15:30] three times. And there's as much risk associated with that as there is with records moving between health systems. So there's a, there's an X couple of things that I would say need to be teed up so that we can actually make this work.
Bill Russell: You know, what's great about that dress. I disagree with that about a thousand percent, but I don't know. I might let it drop. I think the, I think it's patient centric interoperability. The problem is we think about it from a health system centric, interoperability, and from a patient centric, interoperability.
I already have a number that's unique to me. It's called [00:16:00] my phone number and you just download it to my phone. When I show up at the next hospital, I go to, I, you know, to our code, they scan it, they get my medical record. I say, They can have them for three weeks. They can have two weeks. This causes healthcare professionals to just cringe.
It's like, no, we need it for research. I'm like, great. Ask me for, for research. I might go cancer Institute. You can have my information forever, but I'm in control and I'm the one who's doing it. The reason we, I get it, I [00:16:30] mean, we had, we had a Duke finish you across our Northern California region. It costs me $600,000 to clean up.
I, I get where you're coming from. It is a duplication of records, hard to match records. That's a serious issue. And getting to a single ID seems to be the quickest way to get there. I just think there's some, some challenges with it. Plus I still think patient centric is, is the way to go.
Drex DeFord: Here's the other thing.
I don't care if we go over 30 minutes, I don't [00:17:00] actually care if we get to the, my stories, because I actually liked this conversation. And I want to tell you, I think we're on exactly the same. We're on the same path. We want the same thing, right? I've always been a big fan of personal health records, which is essentially kind of what you're talking about, except that.
You know, the way that we tried to do it in the past was clunky and difficult and hard to pull that data into that patient's record often, because there were multiple versions of that patient's record. So these things are, these, [00:17:30] these things are. tightly linked together. I believe this idea of like being able to have complete control of my medical record, have all this stuff that I, that I want being able to sign up to a website to put particular data out there about myself, so that I can be offered clinical trials and then being able to actually maybe monetize part of my record for those clinical trials.
That is a great idea and actually makes me engaged in this collection. The management of that data gives me a reason to do that. Where for most [00:18:00] people. they're not, they're not excited about doing that. They're not interested in doing that. People who have chronic problems, especially having been at a children's hospital.
Parents who have kids who have chronic problems will walk around with Bibles. Literally we call them Bibles giant books of medical records, tests that have been done. Other things that they may have to refer to their child's health people will manage it. When it's important or when we figured out how to [00:18:30] properly incentivize him for it.
So, I mean, I love this idea. We kind of now are getting to the point where we have good
Bill Russell: techs to be able to do
Drex DeFord: a personal health record kind of thing. And whether it's the Apple stuff that's happening right now, or other things I think we
Bill Russell: can get there. It's interesting. I think the government has to drive this.
Because I don't think there's any, there's no one center for Epic, Cerner or Allscripts to, you know, give all the data to apples. Right. Okay. You, [00:19:00] you can sort of curate it for, for users. I don't think there's any incentive for the health systems to do that. They sorta lose control and actually gets back to, you know, kippah is about portability.
Everyone thinks it's about security and it is about security, but it's about portability. And the concept was essentially that I would have my health record and be able to go anywhere. And, but the health systems still, I mean, I've sat in meetings. I'm sure you have too, where people like the fact [00:19:30] that we have their data.
They're going to have to come back to us. and there's a certain comfort level in that.
Drex DeFord: And
Bill Russell: you know, so I, this is why I think the government, this is why the ONC HHS, especially ONC though, has to really push this forward because there's not an incentive for anyone else to do it.
Drex DeFord: Yeah. I mean, I'm a fan of the free market, as much as the free market will work, but this is a thing that might need, [00:20:00] like you said, might need to nudge and might need a consistent long term nudge to get it, to get it going.
And like I said, with everything that has to do with the government, there are always unintended consequences. So we have to be able to react. Quickly when we realize what some of those are, all of these things sound like great ideas until we put them in motion. And then we start to realize, Oh, wait a minute.
I didn't mean for that to happen, but
Bill Russell: at Judy's right. I mean the single biggest unintended consequences
[00:20:30] Drex DeFord: I see. Right. I think people don't really understand. What they're signing up for or how this state is going to be used. And, you know, you get the likely have with everything else, 150 page in user licensing agreement that we all sign on the dotted line.
Even though we have no idea, whatever, whatever really says. And then we wind up really surprised and hurt later that they did something with our data that we gave them permission to do. Yeah.
[00:21:00] Bill Russell: yeah. You know, Judy was right. She did not handle it. Well, I think, she didn't politically, she didn't get her ducks in a row before she went out.
And before that letter became public, she should have lined up the AMA. She should have lined up her largest academic medical centers before she sent that letter out. And, but because she didn't, they didn't, they didn't support her after the letter came out. And that was one of the biggest cases that they, that the OMC made [00:21:30] was, Hey, look, these academic medical centers didn't support Epic on this.
It's not that they don't support Epic on it. It's just the way it was done. Let's get to one of your stories, which, which one do you want to start with?
Drex DeFord: Well, no, let's talk about an atrium. I mean, cause I think that is a good story.
Bill Russell: We'll get back to our show in just a minute. Galen. Healthcare is an award winning best in class healthcare, it consulting services and technology solutions from one of the areas.
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If you find yourself looking at retiring legacy healthcare applications, check out [email protected] [00:22:30] And we want to thank them for becoming a channel sponsor and supporting the work of developing the next generation of health. It leaders. Now back to our show, that's interesting to me. So, I think I've been, what's the bigger story, to be honest with you.
I've met was a long time Cerner shop from, from one end to the other and they, they chose to go the Epic path. atrium though, you know, Adrian has been growing pretty aggressive [00:23:00] leadership team, great leadership team, and, You know, they, they basically had a hodgepodge and the reason they had a hodgepodge because they had acquired a bunch of hospitals, Amy grounders, now there's a CIO and a five.
So they had Epic financials. They had,
Drex DeFord: server clinicals,
Bill Russell: and then they had acquisitions that were fully
Drex DeFord: on Epic.
Bill Russell: So that case is always the best. The HR is the one year on. The problem is if you're on 10,
[00:23:30] Drex DeFord: all of them.
Bill Russell: Yeah. Then you literally are forced into a situation. I think atrium. Was more of a case where they were forced into a situation of we've got like, we've got to get on to something here.
Drex DeFord: Yeah. I think they, you know, and some of this is also, you look at people who get hired into particular situations. So, you know, there's a pretty giant signal when our good friend Andy Crowder gets hired from Scripps health in San Diego to atrium. [00:24:00] that signal is this guys. Done a great job implementing Epic at two big health systems.
I wonder what he's going to do when he gets to atrium. Like, you know, there wasn't, this wasn't super, I mean, I think for people who,
I don't think they were sending him, he wasn't coming there to implement Cerner. So, he's. I'm sure he will have another really successful implementation. And he definitely has the playbook. You seen all ours.
[00:24:30] Bill Russell: What does this tell you about Cerner? So Cerner just lost haven't they just lost a atrium. Does this say anything about Cerner search leaderships or positioned in the market?
Drex DeFord: Man, there's just been a lot of turnover, right? I spend a lot of changes there.
I think with the, you know, the VA just slipped their go lives now from April till I think July for [00:25:00] Spokane. And then later for the Puget sound down area, they're really focused on the government as the prime on the da contract. And as the, you know, one of the subs on the DOD contract, they're spending a lot of time and energy there.
I think they're going to continue to be involved in this civilian market forever, but man, it feels like they're just, there's a lot of. There are a lot of dominoes falling [00:25:30] that are pushing them more and more toward, we may have a government EHR system, which is Cerner, and we may have a civilian EHR systems system, or collection of systems, which Cerner will be involved, but may not be as big a players.
They have been in the past when you look 10 years down the road, right. I think it's still significant in the near term. And there's a lot of things that can change, you know, I mean, our, our world changes so fast and so often it's hard to say.
[00:26:00] Bill Russell: Yeah, it's interesting. I read an article a while back that talked about consolidation in industries and when you get that it's monopolistic pressure, right?
So one of the things that happens when you get too much monopolistic pressure, cause you get organizations that have too many clients with too many to think these and they're, especially in the software area, they're not able to keep up. So innovation slows down and comes to a standstill. And, you know, this is the reason that Epic is driving towards foundation and a standard build across the board because they recognize [00:26:30] that the larger they get what they have doesn't scale and they can't, unless they get everybody to foundation, they're not gonna be able to do the innovation on top of that platform that they really want to.
Yeah. And we're getting closer and closer to Epic approaching. 40 50% market share. I don't think they'll ever, unless they come out with a new product they'll ever get the, the rural small hospitals. They're just, that's just too expensive still. And community [00:27:00] connect requires the, I don't know about you, but my experience with community connect hospitals is everyone I walk into.
It's like what community connect? We have no control whatsoever.
Drex DeFord: Yeah. I always hear that too. We're on, we're on the committee that decides. These things, but we'll watch one vote out of 15 community connect hospitals and the mothership who really actually controls all. I mean, I always hear the same thing too.
Bill Russell: So it becomes becoming a question of at what point, you know, [00:27:30] Epic gets 50% market. Sure. Do they start to sort of implode on themselves, not be able to innovate fast? No. you know, historically they have not gone to a web based DHR. And they announced it. And then they said, it's going to take us a decade to get a web based CHR and anyone who knows programming knows that that's an indication of what's underneath.
Drex DeFord: Yeah. I mean, here's an interesting idea, right? That I was [00:28:00] talking to somebody, talk with some, talking with somebody about this the other day, at some point does Epic and Cerner and others become. The foundation of the electronic health record system in that they are that place that stores the record.
Some health systems will use components of that EHR because they work really well and they like how they work. But with the interoperability rule, the capability of us [00:28:30] going back to, to best of breed. lots of innovators building really cool and interesting tools that wasn't great for this tiny niche of transplant or a heart transplant, an EHR that works really great for them that plugs into ethic and allows all that data to flow without the confusion of, you know, when you and I were kids, we had best of breed systems and everything plugged into a giant interface engine and it was a nightmare to [00:29:00] manage and we never really got the data back and forth.
All of the data. We may have gotten the important data back and forth between these systems and that's why we went to best in suite. But I wonder if we're not like everything else all the way back around to interoperability, lets us actually do the thing that we always wanted to do, which was have a bunch of niche systems that work really great.
Reduces physician burnout makes us deliver the care that we want. That all plugs back into the mothership [00:29:30] EHR. That is what ethic evolves into.
Bill Russell: All right. This is the last question. And we're going to come back, just schedule something to come back and do your three stories. Should I really want to talk about it, but we really are at the end, but my question to you is, and this is, which is I put you on the board of Epic.
So you're sitting across from, from Judy and Carl. Make the case for why they should do that, why they should develop in layers and allow someone else to own the presentation
Drex DeFord: layer, man, you [00:30:00] know, I mean, I think it's a long, complicated business conversation. I don't know if that's the right thing for them.
it may be the right thing for them to. decide that maybe they are going to be that base level layer of Maslow's hierarchy of electronic health records needs and that, and then they spin up a giant innovation fund, take care and do the care and feeding of a bunch of other small [00:30:30] companies who are actually going to do the innovation.
Specifically to all of those niches where the innovation is needed, but if they do that, they're not going to be allowed. This is a whole, I mean, you're in the VCPE world, too. There's tons of people doing this stuff right now for the interoperability roles to try to get to the point to where they can say we are the X, Y best EHR health care, the HR for this particular piece of health care.
And we can work with [00:31:00] Epic or Cerner or whoever.
Bill Russell: I would love to be able to, in that case to Judy and Carl, because I believe there is a really strong business case to be made. But as you know, I've read their contracts, I've read theirs meltdowns. Everybody else has contracts. None of them allow you to do it.
And if you try to do it, you have to pay that. For like every transaction, everything that goes on. So, interesting, interesting conversation. Direct picture. thanks for joining us. I look forward to maybe seeing you [00:31:30] next week.
Drex DeFord: I'm sure. I'll see you there. I'm sure. I'll see you
Bill Russell: there. And let's, let's definitely get something on the calendar.
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