Healthcare on FHIR, MyHeathEData, BlueButton for 53 Million Medicare Patients, and a confirmation on the direction and actionable response from Joe Biden on these announcements. Today we are joined by my good friend Aneesh Chopra.
Bill Russell: 00:04 Welcome to this week in health it where we discuss the news information and emerging thought leaders from across the healthcare industry. This is episode number 11. It's Friday, March 23rd. Today we imagine a world without clipboards, a world where the patient has access to their complete medical record, a world where data is working for you while you sleep to diagnose problems before they happen, or world that unfortunately doesn't exist yet. But we're closer today than we've ever been. Uh, today we talked about what makes that a reality. Data, liquidity and interoperability. Uh, this podcast is brought to you by health lyrics, a leader in moving health care to the cloud. To learn more, visit health lyrics.com. My name is Bill Russell, recovering healthcare CIO, writer and consultant with the previously mentioned health lyrics. Today I'm joined by the preacher on fire in reference to his favorite topic. And if you like that, and the nature of the meetings that he holds a, the first time we met, I was asked to be on a panel with Aaron Levie from Box Lee Shapiro, formerly all scripts, now seven wire ventures.
Bill Russell: 01:07 Uh, and this man, former CTO with the federal government and the room was filled to capacity. My heart stopped for a good 20 seconds. Uh, but when Aneesh Chopra leads a meeting, uh, it is a community building experience. We started on on one topic and soon we were fielding questions about all things healthcare finally landing on quite frankly some of the same topics we're going to be discussing today. And uh, and I'm really excited to have him. So, uh, president of care journey, former first CTO of the federal government and uh, my good friend and Aneesh Chopra on the show can morning Aneesh and welcome to the show.
Aneesh Chopra: 01:42 Good Morning Bill. Thank you for having me and for your leadership.
Bill Russell: 01:45 Uh, thanks. Thanks. Thanks for your leadership as well that this, this could end up being a love fest you're one of my favorite people in healthcare.
Aneesh Chopra: 01:53 But we're going to get substantive.
Bill Russell: 01:56 We'll get there real quick. You know, last week I had a Halamka on the show and he was very pragmatic about this topic. It was, it was a lot of fun. Uh, but it was really hard to do his bio. His bio goes on for days. It's the longest bio I've ever seen
Aneesh Chopra: 02:12 I met him on a shuttle bus in 1997. We used to ride the bus together when he was a graduate student at MIT and I was at the Kennedy School.
Bill Russell: 02:19 Very small world. So you guys are, have been really good friends for awhile. Yeah,
Aneesh Chopra: 02:24 I consider him a brother. He is the man.
Bill Russell: 02:26 This'll, this'll be, this'll be good. I did ask him if there was any special question I should ask you and, and he laughs but um, yeah, the great thing about your bio is a short, I got it from the Washington speakers bureau websites. So visionary technology, thought leader, President Care Journey, a chief technology officer, the officer of the United States, 2009 to 12, author of innovation state. Uh, the new technologies, how new technologies can transform. The government will touch on that a little bit. Yeah. And uh, it goes on to say a couple other things. You don't, you don't want me to embarrass you with actually
Aneesh Chopra: 03:05 we're all good. We're all good. Let's dive in.
Bill Russell: 03:08 Well, you know, and I, I appreciate it. Uh, let's see. So one of the things we do is with every, um, with every guest is we asked them, is there anything you're working on right now that you're, you're really excited about? And, and, uh, you know, we're going to talk about interoperability, we're going to talk about fire, we're going to talk about stuff. But is there, is there anything outside of that? Talk a little bit about care journey. What are you doing there?
Aneesh Chopra: 03:30 Yeah, well my, uh, I would say my passion right now is making sure that we extract as much clinically relevant insight out of the data we're organizing for population health. So we had this kind of journey and the first chapter of population health where everybody was trying to learn the language of the insurance industry. What is my spend rate per thousand or utilization rate, how my spend for risk adjusted patients looking like. And physicians often have their eyes glaze over like, oh, are you kidding me? This is not a language I particularly care to learn, but the power and some of the version one of all of these population health programs is that we had access to patients longitudinal claims history. And if you use the same data asset, uh, and reposition it for use around clinically relevant insights, which patients should be eligible for certain care protocols that are more population based that they haven't been, who should be enrolled in diabetes prevention, who should get a care transition visit. These are opportunities where clinicians engage more directly because it helps them think about their patient population in a way that is more relevant to them. So my passion is just to grow an open community of algorithms and other methods to identify which patient segments should get which care protocols and to help encourage folks to deploy those and measure their impact over time. So that's what my passion is these days.
Bill Russell: 04:54 Oh, that's great. That's great. And uh, actually you educated me somewhat on that when I was at Saint Joe's. Just the, the amount of data that we have access to. I, I really wasn't aware of until we sat down and had that meeting. So it was really, really helpful. Uh, okay. So this last, um, this last week we're going to deviate from the show's format. We generally have a format where we, we go back and forth on the news. We talked about leadership or tech and then we uh, close out with a, with a social media posts. Do you have a social media post or something for this week?
Aneesh Chopra: 05:31 Sure I could make one, We'll do that when we finished.
Bill Russell: 05:33 You can do what Halamka Did he just shared his last post which works well. Um, if you haven't checked them out. Uh, David Baker and I reported from the Himss floor. John Halamka and I talked last week about uh, machine learning, the role of the CIO and things from him. And uh, and this will be the last week. We just dive deep into himss. So we are going to try to make sense of a lot of stuff. So why healthy data? Blue Button, 2.0 53 million medicare patients. Uh, not a lot on Tafka, but we'll talk about it. Fire. Yeah. We're going to talk, we're going to go back and forth a little bit on a smokey Joe Biden's a response. Uh, yeah, pretty good. Pretty substantive article that I'm going to pull up here from fortune, uh, about that. Um, and, uh, we'll talk a little about, a little bit about, uh, who's new role, a shepherding a Yay on the open API initiative. So if you are ready, let's, let's start with a quick history lesson. And, uh, so you appeared on the daily show with Jon Stewart and you've now completed the, uh, the trivia question of what guest has appeared on both the daily show and this week in health it. Um, but I, I do, I did watch it. He grilled you on this. I'm really on this very topic. And the Va, the Va, do you remember what year that was?
Aneesh Chopra: 06:54 2014.
Bill Russell: 06:56 2014. All right. So, um, let's talk about the state of things and, and, right, well actually let's talk, let's go back to 2014. So, yeah. Tell us what you found in the federal government on this topic of interoperability and a, and then I'll talk a little bit about what I found because I came in to health care for the first time in 2011. I'll tell you what I found with my experience from other,
Aneesh Chopra: 07:20 well, I would say, uh, there are three things to take. Some government. One is the initial trajectory of moving a health information exchange forward carried beyond just the Bush administration through the Obama years and even now through the Trump years in a manner that was harder to deviate once launched. That is to say we built the kind of an initial use case around business to business models for health information exchange. And we put a lot of resources behind that model. Even though we started shifting the portfolio bit in the Obama years, the new directions didn't have as much capital or or investment plan behind them as the initial theory of B Two B exchange. So point number one is you'll launch something in the government. It has kind of a life of its own and it carries in a big, big way. Uh, point number two, the federal government can be both an enabler and a constraint on some of these issues.
Aneesh Chopra: 08:20 And we can talk a bit about that. And then the last piece that I think was the, um, lesson I wish I had learned earlier in the process was that if we found a way to get through the clutter and said, let's go straight to the patient. If we had figured that out earlier, we might have a slightly different, uh, architecture for the healthcare delivery system today. So that's a little bit of a somewhat historical bummer that we, and I take personal blame on a lot of it because we shepherd it a pretty significant $37 billion investment because it was tied to the Recovery Act. We had to get the money out the door, which meant the ability to shift the allocation of those dollars down the road became more difficult. I'll give you a lamp you to guide you into some of that, which is now that we get to the final stage of meaningful use or the old meaningful use, the dollars left or less, but the change is hard. And so you've got this disconnect and we can get into all of those things if it'd be useful.
Bill Russell: 09:14 Yeah. And you know, my, my entry into health care, there's a couple of things shocked me. One is the, uh, the patient really didn't own their medical record. That, that kind of surprise me. The second was the lack of a modern architecture. You know, 2011, I had come from other industries. I like to tell people, Beers, beer, banks and bombs. Anheuser Busch, Mcdonald Douglas. I had worked for a bank of America. I've done a lot of consulting with various companies and, and all those industries. There was a open standards, Api Apis, the ATM network and those kinds of things. Um, and that didn't exist within healthcare. But the, uh, the, it's taken a while for that to really take off. But the other thing that I didn't really appreciate is we've just gone through a heavy lift. Mu was a heavy lift for, uh, for health care. Uh, I'm not sure that health care would have been digitized without mu.
Bill Russell: 10:10 You, there was, there's so many things aligned against it. It's such a complex industry, which I didn't appreciate when I first came in. And, uh, there's, there's just a lot of things to get right. And so it was a lot harder to get that ball rolling up the hill than I had anticipated. The good news is I think we are a lot farther along now than we were back in 2011, 2014. So, uh, let's, let's hit some of these, some of these announcements. Uh, Seema Verma came to himss. She did a, my healthy data initiative. She did the Blue Button 2.0 initiative. Uh, do you want to give us a little little background on the two of those and they're going to go, yeah.
Aneesh Chopra: 10:53 Well, let me begin by saying, uh, the announcement that she made that couldn't have been more bipartisan, or maybe we would call it nonpartisan. Uh, if you removed the, the voice of Sema or the voice of Jared, and simply read that presentation without knowledge or context to who might've delivered it, you could have imagined anyone from the Obama administration carrying that message forward. So this is really building on progress and really pushing it further and faster in the direction that it desperately needs to go. So that's why you saw me applaud a great deal of the work that was done. The big message I would say is that the healthcare delivery interoperability strategy that I mentioned before, the B to B model was built on the foundation of a Hipaa authorizations where you, you may share a, you're allowed to share, but it doesn't compel you to share.
Aneesh Chopra: 11:45 So you could put a request in as a physician, Hey, I've got this patient could just send me the records. And if they chose not to respond, then you wouldn't get the data. But they were legally allowed to respond. And so we had this framework of you might be able to share but you didn't, you didn't have to. What Sema saying is that the other half of Hipaa, the individual right of access, it doesn't mean you own your medical record bill. It means you're entitled to an electronic copy and in a readily produceable format. These are words that are going to come into play in the API discussion. So Sema basically said, I'm going to pivot and embrace information exchange tied to that consumers Right, and that I think is the kind of sea change that naturally is a progression of where we learned as we went.
Aneesh Chopra: 12:29 And that's the model I think that's going to carry lowest cost, highest data liquidity because it's a legal right to request a copy in a readily produceable form and she built on that. That's the my healthy data vision. The Blue Button 2.0 is I would call that dogfooding dogfooding is you're eating your own dog food and the operations of Blue Button 2.0 is essentially an API for a fire based explanation of benefits resource that allows a patient to connect four years of claims history and an ongoing token for weekly updates to any application of their choice. So what she's encouraging the industry to do on its own and using the levers of MIPS and Macra and all the other components she's operationalizing within CMS. And, and she even made the joke, it was blue button 2.0 meaning it was a work in progress from the Obama administration and she just took it in to the finish line, which is what leadership is about.
Bill Russell: 13:28 Todd Park really is the one who brought us a blue button 1.0 where is Todd park doing these days. Is He?
Aneesh Chopra: 13:35 Todd Todd is running a, a wonderful new company called devoted health. Uh, he's going to reimagine what life is like for seniors and Medicare advantage plans. And so we're all watching and excited about what he'll do to make the care delivery model better.
Bill Russell: 13:49 He was one of the people that influenced me early on. I saw a couple of his speeches of how he was going to open up data for the federal government. Yeah. It really is a model for what we're trying to do here today. It's exciting. So are we finally at a point where the, I mean that's an interesting distinction. I don't own my medical record, but I have access to it electronically, is that, does that create a new ecosystem where the apples and the googles and Amazons and the others of the world can now say, hey, the patient is the center of medical record, not necessarily the health system. So now we can create, we talked about these ecosystems and I think will arise where the cloud providers will say, hey, if you as a patient want to give us your data, we can now add value to it. Or we can now add other data to it and make it, enhance it and make it better. Um, and you know, Pharma, we could, we could participate in, we can choose, we can go to our phone and say, I want to participate in, in this study in order to further this, uh, you know, this disease state, whatever we're going to do around that. Uh, are we at a point where the patient is finally the locus of, of, of this, the, the medical record or we're not there yet.
Aneesh Chopra: 15:03 We are closer. Uh, but what's missing right now, Bill, is that delightful application that helps my mom and my dad on Medicare make the best use of that information. So we've got the plumbing technical standards, right? We've got a legal and regulatory framework that encourages it. We've got the cloud providers and others helping to facilitate adoption in use. But that last step, who's going to help read my mom's, uh, medicare blue button file and remind her when she should get care or where, if she needs care, she can choose the right provider that meets the, the needs that she has to have addressed. And my personal opinion bill is that this is going to look a lot like the transition from pension plans to 401k's where we used to have these employer, uh, fiduciaries that would take our money and make big judgments. Even if we might've wanted to do something else or someone else could have given this advice to have a better, and more reliable retirement.
Aneesh Chopra: 16:04 The move to 401ks gave rise to companies that didn't exist or if they did, they were modest vanguard and fidelity and others. So I think there's going to be a new rise of what we'll call a health information fiduciary who will work on the cloud platforms to do the plumbing of getting the data, but it's going to be their last mile application that will help make sense of that information. So I can shop smarter for supplemental plan so I can navigate the delivery system more effectively and I can access and use the preventive services to keep me healthier and whole range of other things that we'll, we'll see happen.
Bill Russell: 16:38 Well let's, let's talk about this show originally did this show for CIO is to share with their staff. So they can stay current. Let's, let's get into a little bit more the technical aspects. You have tefka you have fire. what does a CIO or what does, what does the frontline staff do with Tefca and fire, and where should they start? Where are we at?
Aneesh Chopra: 17:02 So, uh, this is a conundrum because, uh, you can either be a supply cider, which is your job is to envision the infrastructure that you're responsible for, modernize it, and prepare for the future. Uh, the other is a listener and responsiveness to the clinical leadership. I'm generally on the side of listen first, which is to say there's a signal out there that you're hearing from frontline clinicians, from physicians that are involved in these new value based models, and they're complaining about something about the difficulty to do their job. And of course there's general complaint, but then there's more specific complaint. I would like to know this at this time in this way so I can make a decision without a weakening my productivity. So my sense is that if you start to listen and if you're the CIO and you start listening to the customer's needs in a manner that perhaps we don't quite do today cause we make a single decision, I've got to make a big EHR decision and I got to maintain it.
Aneesh Chopra: 18:02 Uptime, security, that's its own job. Now I'm listening and saying, well wait a minute, I'm no longer deciding what Ehr to buy. Now I'm thinking what application might write on top of the Ehr that might delight my individual care teams or clinicians and patients to have a better experience. So think of it like a digital experience officer. That role, that listening function, I think is the missing link today because what their job is to figure out what it is that people need or want and then map that back to what are the underlying data assets that we have available. And if you kind of do your job right, you serve up the data in a format that allows a random app developer on the street who can do the day to day APP development for that doctor and not crash your secure systems or require you to allocate limited resources,
Bill Russell: 18:51 but you don't need to, I would take some heat for this, but part of this is that CEO's are lazy. They, they've had those listening tours. We've gone out and we've listened and we were like, oh, that is so heavy. One of the, one of the benefits I had was in southern California, you can employ those docs. It's a foundation model. We had a hundred different EMR. There was no hope. I couldn't just say, well, we're just going to have epic. They don't work for us. So I couldn't like walk into their office and say, Hey, you're all going to epic and, and we've, we've solved the problem. A lot of CIOs have said, here's how I'm going to solve the problem. I'm going to implement epic. I'm going to do community connect and away we go. But the reality, as John pointed out last week is you're still going to have to connect to a world outside of, even outside of your health system.
Bill Russell: 19:35 Even if you do have a little ecosystem here, you're still going to have in your community, you're going to have rural hospitals that have Meditech, you're going to have, and you just going to have a host of, of different EMR platforms. And so that benefit I had in California was I didn't have the, the benefit of having an illusion that I could just dump this over to the Emr provider and say, hey, they're going to solve it for me. I don't have to worry about it. Um, so in comes, these technologies that just make it a lot easier to do what we were trying to do in 2011 with none of this stuff in place, which was, you know, we had to build first we were building point to point and then we tried to build this same kind of platform where we could share the data with Api Apis and whatnot. But we were doing that lift ourselves and literally cost us about $70 million for a single health system to try to build this. So these, these things are going to make it so that each health system doesn't have to spend $70 million to try to build it. There's going to be opportunities to do it outside of that. So,
Aneesh Chopra: 20:37 well let me let, let's get into the CIO role because there's a really critical decision the CIO has to make that can make that 70,000,000, 700,000. And so let's just kind of hit the nail on the head. The mega lift is that the data in each of those EHR systems is its own data model with its own circumstance and implementation plan. And all the rest. So we've got, and I've heard you talk about this before, we don't really have interoperability. We've got a bunch of a siloed databases that exist, happened to have different brand names in their EHR. Now meaningful use three, the one that has to be turned on by one one 19. And that CMS, administrator Pharma said she's not moving the date. That means each vendor to remain certified has to map their data models to a minimum common data set that has a data query capability.
Aneesh Chopra: 21:35 What that means is that heavy lift is now, uh, now we happen to have chosen more than half the vendors who certified today have voluntarily chosen the fire Api map to the argonaut project. And that was a quick cursory look at the hundred and 30 or so applications that are certified for the Api requirement and meaningful use. So over half the market voluntarily is mapping to a common industry standard. What that means. If I'm a CIO and I have an a, an accountable care network with what you said, a hundred hrs and I had every one of those Ehr Api end points, all I have to do is subscribe to each of those end points, aggregates those feeds, put them in a common data warehouse, likely in the cloud, and then expose them through some Api management platform. And if that happens, uh, the cost of data acquisition, normalization, exposure, security management and life will look more like the Internet economics. That is to say lower cost, higher liquidity. Uh, and that's the new information. It's the fact that each vendor had to do the heavy lift at every provider's site to map the data, to meet the consumer API requirements. That's why we're in a better place today.
Bill Russell: 22:53 That's great. Mean. That is a, that actually is pretty exciting stuff. I'm going to, uh, I'm going to jump to a Joe Biden's response to some of this stuff cause he's, he says, Hey, it's, uh, I actually, he says it in the first paragraph here. I agree with this administration stated goals. It's not a left right issue, it's just a nope, you know, we, we, we agree. And his, his work in the, what is it? Uh, the cancer initiative has really educated him on, on what's, you know, what the current state is. So here's a couple of things. One is, um, yeah, uh, you know, he states this is what the promise of electronic medical records has not materialized from what, for one major reason, medical record companies and health providers have implemented systems that are not interoperable. So we know that already.
Bill Russell: 23:39 It's interesting to have this become that elevated where we're now talking about this and you know what, parents are now talking about this. It's, it's really, and they're, they're 80 years old and they're saying, hey, why you know, it, because they are going from one system to another and they're saying, why, why does my medical record not follow? So this, this is, you know, he's acknowledging something that's top of mind even for our 80 and 85 year old parents. Um, and he goes on to say, we now have a knee. We have now had nearly a decade to examine the consequences of how electronic health record systems have been deployed. The industry has had ample opportunity to voluntarily address the issues of interoperability and putting data in patients' hands and they have not done so. Now it is time for something about do something about the data silos they have created to improve health and extended lives. Now as he proposing something different than some of these announcements or is he, is envisioning more of a government hand in this to sort of force EHR providers hands? Uh, I'm curious.
Aneesh Chopra: 24:41 No, let me, the first one being disclosed on the Biden Cancer Advisory Committees. I'm on team Biden. So just to be clear in disclosure for my bias, what he's really saying is here's some specific steps that are, that are entirely consistent with the policy statements made by Sema and Jared. And he just went a step further to say, here are the explicit government actions that I would recommend. And by the way, I'm fairly confident some of those ideas are likely to be adopted on their own within the Trump administration. So it's not about bigger government, smaller government, its implementation guidance. And a lot of the feedback people are hearing about, uh, the vice president former vice presidents remarks is that he was remarkably pragmatic because the suggestions are not massive new bureaucracy expansions, but just tweaked instead of a 30 day requirement to give me a copy of my data, make it 24 hours, not unreasonable in today's digital environment of directing the NCI, the national cancer institute, to kind of build a research data trust and a Commons so that you can facilitate the sharing from consumers to researchers, not an unreasonable.
Aneesh Chopra: 25:49 And then the one that I'm most excited about, he notes that the Medicare innovation center, which was created by the affordable care act, has the legal authority to experiment with new models, to engage patients for purposes of getting better value care. So I actually think, uh, on all three of those things, they can be achieved with an existing law, maybe not the 24 hours. That may be an interpretation. Maybe it's regulation, maybe it's an adjustment to the law, but it's very achievable and pragmatic. And that's, I think that the tone of which he took his, uh, his piece.
Bill Russell: 26:20 Yeah. And the fortune article is great because it lists these four principles, which you've four principles. And if we're action steps, and I agree with you, it could easily have come out of any administration and I'm, I'm really glad that this thing is getting the kind of traction that is getting, what do you say to the, to the physician. So every now and then you and I post out on social media and we get the physicians who back and say, you know enough, you've made my life so hard. Yeah. Um, you know, for, for so long. What do you say to them? I mean, they are we, are we close enough that they're gonna start to see benefit and value? Or is it because some of them are essentially saying, let's throw in the towel. Let's go back to paper. I was much more efficient. I can actually look at the patient in the eye. I mean, that's not clearly not going to happen, but what would you, what do you say to the physician anyway?
Aneesh Chopra: 27:10 What I would say to them right now is by this next phase of moving data through open API Apis to consumers and hopefully repurposing them as well for clinicians inside the enterprise. That might mean an APP developer they learn about could help them do all of their job without ever having to separately log into the EHR. Again, I envision a read write Api model that in the not too distant future, physicians can do their job simply with support from AI and machine learning to help prepopulate advise, encourage so less of their time is spent dictating and typing, looking into a screen and more naturally engaging patients and having the systems work for them. That's the big mistake. Bill. If I were to characterize this in an economics perspective, we've, this is the first time and I would argue most industries where a massive investment in technology, weakened productivity and that has a lot to do with all the issues, usability, uh, the transition from fee for service to value, which means you're now doing two jobs, not one.
Aneesh Chopra: 28:16 And the challenge right now is for a physician who's angry about his or her job is as much about what is their job because that itself is fundamentally changing and we want to have an agile, nimble it infrastructure. So as the job changes, the data can follow. I'll just give you one small example. I know we're running low on time, but million hearts, almost every clinician I know has endorsed the CMS, the Centers for disease control million hearts campaign. You know, if we just do four things, keep people on aspirin, lower their, manage their blood, pressure, their cholesterol and get them to stop smoking, we can produce a million heart attacks. Almost every physician that I know raise their hand and said, sign me up. They need five pieces of information. What is the current blood pressure? Has the patients' cholesterol levels changed?
Aneesh Chopra: 29:04 These are very discreet, normalized values that sit in all the disparate silo DHRs. Imagine a small little app that a physician has that could go with consumer consent, update all that information and alert them if there's been a change. That's simple idea they can't do today because we don't have that API layer. We don't have that APP structure so that physician can only do app development on when they see the patient, which may be once every few, maybe three, four months when the patient may be going to the Walmart and getting their blood pressure read at the local station or at a minute clinic or at a primary doctor's office down the street. That is what's frustrating. They want to do the right thing clinically, but the it isn't working. We have to get there and the open API strategy will make it easier.
Bill Russell: 29:51 Gosh, I want to talk about, I wanted to talk about apple. I want to talk about Razou at the VA and there hopefully you'll you'll come back on, but one thing I do want to get to, if you give me another minute or so, can you highlight some of the people, some of the, some of the heroes of this movement who have really moved it forward. I'd love to just give them a shout out for the work they've done over the last couple years.
Aneesh Chopra: 30:13 Well, I would say a doctor Shafiq Rob, who was at Hackensack and now at rush has personally invested a lot of effort to map his Ehr to fire and to be an early test bed for APP developers. Not In words, but in operations. And so I'll give him a big shout out. A Doctor Will Morris at the Cleveland Clinic, Alistair Erskine at Geisinger, Stephanie Real at Hopkins, there's a portfolio of CIO's who basically looked at this issue and said lead or follow. And they're kind of in the lead camp, whether they're in the lead camp on the engineering like Shafique or Alster, someone where they've actually built code or led in the form of convincing their peers and colleagues to move in a certain direction or to negotiate with where the industry should go. Like Stephanie, this is the opportunity. And Razou was right at the top of that list as an, uh, kind of a convener and chief, which is why he was natural for the VA to tap him who sits on top of a Cerner ecosystem and an epic ecosystem and a relationship with many stakeholders to bring us together to move forward. And so there are a lot of heroes, um, missing a bunch. But I would say those are the CIO's in, in the, in the community who have been driving very hard and fast.
Bill Russell: 31:23 Yeah. And there's also the, there's also obviously people in the, in the federal government who have really pushed things forward as well as, uh, uh, as well as, you know, the people at apple and Google and others that, you know, oh,
Aneesh Chopra: 31:37 what's that down to go through the full litany of, we're going to get to dozens of people all equally deserving of an incredible about, of work. Uh, and I might even, you know, obviously shout out to Halamka and others who've just been incredible in their thought leadership. So I don't want to ignore anybody in the shout outs. Everyone's done a great job but, but it's uh, it's really a collaborative effort. There is no one king or queen of this movement. It's a totally democratized collaboration model as it should be.
Bill Russell: 32:02 Absolutely. Well that's all for now. Aneesh, Thanks for being on the show. How can people follow work or stay up to date on things you're working on?
Aneesh Chopra: 32:11 Sure. My Twitter handle is at Aneesh Chopra and I do post a great deal of the work that I do, our company care journey. I've got a blog that has some historical context @carejourney.com and uh, I've written that book innovative state and so I've got a website innovative state.com if people want to stay with my policy interests on open labor market data or other topics. So happy to, happy to stay engaged.
Bill Russell: 32:32 Sounds good. Awesome. You can, uh, you can follow me on Twitter @thepatientsCio, my writing on the health lyrics website or a health system CIO. Uh, and don't forget to follow the show on Twitter @thisweekinhit and check out our new website this week in health it. If you liked the show, please take a few seconds, give us a review on iTunes or Google play, and please come back every Friday for war news, commentary and information from industry influencers. That's all for now. Thanks.