HC2HC Event – Stephanie Lahr with Monument Health

Bill Russell 00:00:03 Today in health, it, Bill Russell 00:00:04 Another one of our interviews and action. Bill Russell 00:00:05 This comes from the healthcare to healthcare event, which I was a guest Bill Russell 00:00:09 at from the serious health care team. Bill Russell 00:00:11 It was in Montana. Bill Russell 00:00:13 And I was able to sit down with a handful of CEOs. Bill Russell 00:00:16 And I'm going to share those with you here shortly. Bill Russell 00:00:19 My name is bill Russell. Bill Russell 00:00:20 I'm a former CIO for a 16 hospital system and creator of this week in health. Bill Russell 00:00:24 It. Bill Russell 00:00:24 A channel dedicated to keeping health it staff current and engaged. Bill Russell 00:00:28 I hope you're enjoying these interviews and action. Bill Russell 00:00:31 We were able to do these interviews at the health conference, the Bill Russell 00:00:34 chime conference, and now the healthcare to healthcare event. Bill Russell 00:00:37 I've really enjoyed doing them. Bill Russell 00:00:39 , just a reminder. Bill Russell 00:00:40 We're going to get back to our normal programming where I take Bill Russell 00:00:42 a new story, break it down. Bill Russell 00:00:44 And talk about why it matters to health. Bill Russell 00:00:46 It. Bill Russell 00:00:47 We're going to be doing that as soon as the interviews are done we have Bill Russell 00:00:51 done 10 from the chime conference eight from the health conference and Bill Russell 00:00:55 we have five from the healthcare to health care conference so i hope you Bill Russell 00:00:59 enjoy another one of these interviews Bill Russell 00:01:01 alright. Bill Russell 00:01:01 Another interview from the healthcare to healthcare conference, this Bill Russell 00:01:03 is a, a severally conference. Bill Russell 00:01:05 It's an invitation only event by serious healthcare. Bill Russell 00:01:08 And so we're talking with Dr. Bill Russell 00:01:10 Stephanie LAR again, it's been a while since we've talked as it Stephanie Lahr 00:01:14 has been always great to talk to you. Stephanie Lahr 00:01:15 That always Bill Russell 00:01:16 great. Bill Russell 00:01:16 Um, so we're in your neck of the woods. Bill Russell 00:01:19 And now we're we're in Montana, but, but you classified it Bill Russell 00:01:22 as your neck of the woods. Stephanie Lahr 00:01:23 Yeah, well, I, yeah, I was saying I live in rapid city, Stephanie Lahr 00:01:26 South Dakota, which is about 725 miles from here, but it's a day's drive. Stephanie Lahr 00:01:30 So, you know, out west, if you can get there in a day, it's Stephanie Lahr 00:01:33 local, I did grow up here. Stephanie Lahr 00:01:35 Now Bill Russell 00:01:36 you grew up in Montana now you're at monument health. Bill Russell 00:01:38 Yep. Bill Russell 00:01:39 So, uh, we haven't talked in a while. Bill Russell 00:01:41 What's due at monument health. Bill Russell 00:01:41 Well, you guys. Stephanie Lahr 00:01:44 Yeah. Stephanie Lahr 00:01:44 Um, gosh, there's so much fun stuff happening right now. Stephanie Lahr 00:01:48 Um, you know, I think as we are coming through COVID, we are, um, we're, we're Stephanie Lahr 00:01:54 still faced with a number of challenges. Stephanie Lahr 00:01:56 I think there are some new things that have really come out of it that Stephanie Lahr 00:01:59 we're all experiencing, particularly as it relates to, um, staffing Stephanie Lahr 00:02:03 shortages, uh, the, the expense of, of those, um, resources, burnout, you Stephanie Lahr 00:02:09 know, and those things extend into. Stephanie Lahr 00:02:11 Technical teams. Stephanie Lahr 00:02:12 They extended to our clinical teams. Stephanie Lahr 00:02:14 All of our teams are kind of stretched and, and dealing with Stephanie Lahr 00:02:19 challenging issues right now. Stephanie Lahr 00:02:20 And so I feel like that is such an amazing opportunity for technology Stephanie Lahr 00:02:25 to be able to come in and help relieve some of the burdens. Stephanie Lahr 00:02:28 And I'll say, you know, I mean, I think right now my number one goal Stephanie Lahr 00:02:33 is to bring back the joy to medicine. Stephanie Lahr 00:02:36 And, and I don't mean that just for my clinical. Stephanie Lahr 00:02:39 I mean, really for everyone who is involved in the care delivery, um, Stephanie Lahr 00:02:44 you know, part of the system, we need to bring the joy back to their work. Stephanie Lahr 00:02:48 And I think that, you know, looking at technology right now, we're Stephanie Lahr 00:02:52 right, for those opportunities, there's automation opportunities, Stephanie Lahr 00:02:56 there's efficiency opportunities. Stephanie Lahr 00:02:58 And, and we're also at a point where we have some great Stephanie Lahr 00:03:00 foundational systems in place. Stephanie Lahr 00:03:02 So now we can start building on that, um, foundation. Bill Russell 00:03:07 You talked about bringing the. Bill Russell 00:03:09 Back to medicine, but you're one of the reasons I like talking to Bill Russell 00:03:11 you is you have to be pragmatic. Bill Russell 00:03:13 It's not like some of the larger health systems or, you know, I, when I was Bill Russell 00:03:18 CIO, I had 750 people reporting into me. Bill Russell 00:03:20 You don't have 750 people. Bill Russell 00:03:22 And, uh, we also had an innovation budget, those kinds of things. Bill Russell 00:03:26 And there are those health systems that are doing that, but Bill Russell 00:03:28 you have to be very practical. Bill Russell 00:03:30 Talk about some of the, some of the practical ways that you're trying Bill Russell 00:03:33 to bring joy back to medicine. Stephanie Lahr 00:03:36 So, um, I think, you know, one of the great things Stephanie Lahr 00:03:39 about being an organization, my size Bill Russell 00:03:44 decision Stephanie Lahr 00:03:44 making is very, we're very flat. Stephanie Lahr 00:03:46 Um, I can have great conversations with all of our executive leadership, Stephanie Lahr 00:03:51 um, our physician leadership and, and really come to some conclusions Stephanie Lahr 00:03:55 and execute on those things quickly. Stephanie Lahr 00:03:57 So that makes it easier, um, in some respects, but, you know, I think things Stephanie Lahr 00:04:02 that we're looking at right now, we've, we've created some really strong. Stephanie Lahr 00:04:06 With vendors like nuance, for example, where we're leveraging ambient clinical Stephanie Lahr 00:04:11 intelligence, um, and allowing our providers and to have that relationship, Stephanie Lahr 00:04:16 bring that intimacy back to the relationship with the patients. Stephanie Lahr 00:04:21 Exactly. Stephanie Lahr 00:04:21 Yes. Stephanie Lahr 00:04:21 Not sit with our backs to the patient's sitting at the computer. Stephanie Lahr 00:04:24 Um, and it's not, it's not a tool that everyone needs, but we've Stephanie Lahr 00:04:28 identified a way to be able to sort of, um, select providers that we Stephanie Lahr 00:04:32 think that that is a great tool for. Stephanie Lahr 00:04:34 And so. Stephanie Lahr 00:04:35 Rolling that out to them. Stephanie Lahr 00:04:36 We, um, are looking at automation in a variety of other respects. Stephanie Lahr 00:04:41 You know, we're, we're working on a really great project to be able to, um, take some Stephanie Lahr 00:04:47 of our clinical workflows, um, monitoring what's happening throughout the hospital. Stephanie Lahr 00:04:52 I think you've maybe even talked to the, the CEO of that company recently Stephanie Lahr 00:04:56 artist's site, um, but had some really exciting conversations with my, um, Stephanie Lahr 00:05:00 health system board and our finance and investment committee, even just this. Stephanie Lahr 00:05:05 And there's a real understanding at that board level, that Stephanie Lahr 00:05:09 transformation is not optional. Stephanie Lahr 00:05:11 We are going to have to do something and we, and we won't know exactly what the Stephanie Lahr 00:05:16 right fit is going to be until we do it. Stephanie Lahr 00:05:18 So we're just going to jump in and we're going to start doing some of those things. Stephanie Lahr 00:05:21 And I, and again, I think that's one of the great things about being our Stephanie Lahr 00:05:23 size is that we can just do that. Stephanie Lahr 00:05:26 The Bill Russell 00:05:27 artist's eye conversation was interesting. Bill Russell 00:05:29 And it's interesting that I'm talking to you about it because when people hear AI, Bill Russell 00:05:32 computer vision and those kinds of things, No large academic medical center out of Bill Russell 00:05:37 LA or know that's what they're thinking, but you're implementing that there. Bill Russell 00:05:40 And how does that lead to again, I'm just going to keep coming back to Bill Russell 00:05:44 this, bringing joy back to medicine. Stephanie Lahr 00:05:47 Yeah. Stephanie Lahr 00:05:47 So I think it does it in two ways. Stephanie Lahr 00:05:49 One, um, it allows us to gain an understanding of what's happening Stephanie Lahr 00:05:56 within our walls and within the health. Stephanie Lahr 00:05:59 That to a level of granularity we don't have right now. Stephanie Lahr 00:06:02 Right. Stephanie Lahr 00:06:02 All of the documentation, all of the data points that we have Stephanie Lahr 00:06:06 are actually, you know, sort of representations of the real information. Stephanie Lahr 00:06:11 But for example, when a document comes out of an exchange between a Stephanie Lahr 00:06:15 patient and a provider, that's not truly what that conversation was. Stephanie Lahr 00:06:20 It's a representation of it. Stephanie Lahr 00:06:21 Any box that I check in the EA. Stephanie Lahr 00:06:23 That's not actually when it happened and what happened. Stephanie Lahr 00:06:27 It's a representation of that created typically after the fact. Stephanie Lahr 00:06:31 And I think one of the things that's really awesome about technology like Stephanie Lahr 00:06:34 artist's site is it's going to allow us to have a much more granular, Stephanie Lahr 00:06:38 real time understanding of what's happening so that then we can look Stephanie Lahr 00:06:42 at processes and improve them, reduce friction and create efficiency. Stephanie Lahr 00:06:46 And then the other piece for me, when we talk about the joy of Stephanie Lahr 00:06:49 medicine, you know, there's a lot of statistics out there that talk about. Stephanie Lahr 00:06:53 You know, an ICU physician spends 14% of their time with a patient. Stephanie Lahr 00:06:57 An ICU nurse spends 34% of their time with the patient that other Stephanie Lahr 00:07:01 big percentage of the time is on administrative and other kinds of Bill Russell 00:07:05 tasks specialists who also practice medicine. Stephanie Lahr 00:07:08 Exactly. Stephanie Lahr 00:07:09 And, and we can flip those ratios and get them spending 15% of time Stephanie Lahr 00:07:14 on the administrative tasks by automating them in the background. Stephanie Lahr 00:07:17 Again, if I had an exchange with you and we can turn that into a doc. Stephanie Lahr 00:07:22 Or if I can understand that the patient is moved from here to here Stephanie Lahr 00:07:26 and this person needs to be notified, why would I ask a person to do that? Stephanie Lahr 00:07:30 Why would I ask a nurse to be managing those things? Stephanie Lahr 00:07:32 We've done it because it's been the easy answer. Stephanie Lahr 00:07:35 Oh, the nurses right there have them do it. Stephanie Lahr 00:07:37 We we've come to a breaking point. Stephanie Lahr 00:07:39 We can't ask them to do one more thing. Stephanie Lahr 00:07:41 And in fact, given the staffing shortages, if we're going to ask them to do one more Stephanie Lahr 00:07:45 thing, it has to be something clinical. Stephanie Lahr 00:07:47 So we're gonna have to take some of the other stuff off the Bill Russell 00:07:48 plate. Bill Russell 00:07:51 Specifically, let's talk about the nursing shortage. Bill Russell 00:07:53 Cause it's, it's one of the things I'm hearing. Bill Russell 00:07:54 I'm also hearing an it shortage by the way, I'm hearing it for sure. Bill Russell 00:07:57 Challenge to hire those. Bill Russell 00:07:58 So let's go in those two directions. Bill Russell 00:08:00 So nursing shortage, um, I assume that's hitting you where you're at. Bill Russell 00:08:04 Absolutely. Bill Russell 00:08:05 Are you having this issue? Bill Russell 00:08:07 I'm hearing this over and over again where people are leaving Bill Russell 00:08:10 to become traveling nurses. Bill Russell 00:08:11 They're making five times what they're making locally. Bill Russell 00:08:15 They're going to go do that for a year or to pay for their kid's education. Bill Russell 00:08:18 Then there. Bill Russell 00:08:19 And worked for you and you're going to take them back because there's Bill Russell 00:08:21 a nursing shortage where you're at. Bill Russell 00:08:23 How, how are you guys thinking about that problem? Stephanie Lahr 00:08:25 Well, I think the number one thing that we're thinking Stephanie Lahr 00:08:28 is how do we make our place, the place that people want to work? Stephanie Lahr 00:08:35 Um, the money is only one part of why a person chooses to work in a certain place Stephanie Lahr 00:08:41 or go down a path with their career. Stephanie Lahr 00:08:43 And so our differentiator to your point, we're a not-for-profit community health. Stephanie Lahr 00:08:49 We're not going to pay the most. Stephanie Lahr 00:08:51 Um, but we can look at other things that make us attractive, Stephanie Lahr 00:08:56 make us a great place to work. Stephanie Lahr 00:08:58 Um, that can be other things that our, our HR teams and Stephanie Lahr 00:09:01 experienced teams are working on. Stephanie Lahr 00:09:03 But again, I feel like that's then a big burden on my shoulders, which I'm Stephanie Lahr 00:09:06 happy to take on to sort of say what would differentiate us, what would make Stephanie Lahr 00:09:11 a nurse say, gosh, when I go work at Monmouth, I get to spend all my time with Stephanie Lahr 00:09:16 the patients cause all these other, so, I mean, I think it's all tied together. Stephanie Lahr 00:09:20 One, we may need fewer nurses possibly over time. Stephanie Lahr 00:09:24 If we can really start automating some of these processes, but even if we don't, Stephanie Lahr 00:09:29 even if we need the same number there. Stephanie Lahr 00:09:31 Much happier doing the work that they spent, all of their Stephanie Lahr 00:09:35 clinical time training to do. Stephanie Lahr 00:09:37 Nobody went to nursing school or medical school. Stephanie Lahr 00:09:38 So they could be like, I'm going to be the queen or the king of the EHR. Stephanie Lahr 00:09:42 This is going to be fabulous. Stephanie Lahr 00:09:43 They did it because they want to be interacting with patients. Stephanie Lahr 00:09:45 Okay. Stephanie Lahr 00:09:45 It's Bill Russell 00:09:45 interesting to hear you talk about one of the things you've Bill Russell 00:09:49 done is building community remotely. Bill Russell 00:09:52 I've been talking to CEOs about this, and to be honest with you, one of the things Bill Russell 00:09:55 I've been saying is I'm, I would have struggled to make this transition to. Bill Russell 00:09:59 You know, seeing everybody through a screen, I like walking into their office. Bill Russell 00:10:03 I like talking to them. Bill Russell 00:10:05 I like the informal conversations. Bill Russell 00:10:06 It was, ah, it was, uh, it was part of the reason I love the job is, is the Bill Russell 00:10:12 community that you're able to build, bringing people together that people Bill Russell 00:10:15 used to make fun of, you know, the birthday parties and that kind of stuff. Bill Russell 00:10:18 But I love that stuff. Bill Russell 00:10:19 That was, that was great stuff. Bill Russell 00:10:20 But you've made you seem to have made that transition, so I'm sure Bill Russell 00:10:25 you love the face to face, but, but how are you able to make that. Stephanie Lahr 00:10:29 Yeah, I, I do love the face-to-face, but I think we can do a Stephanie Lahr 00:10:33 lot of those things in different ways, but get a lot of the same fun out of it. Stephanie Lahr 00:10:39 So, um, you know, my team we've had a real focus and this does get Stephanie Lahr 00:10:43 to, you know, the shortages of it. Stephanie Lahr 00:10:45 People I'm now competing with health systems in New York and Ohio, and wherever Stephanie Lahr 00:10:50 that may allow a person to stay in rapid. Stephanie Lahr 00:10:53 But work for them remotely. Stephanie Lahr 00:10:55 And so that has really changed Bill Russell 00:10:56 the landscape. Bill Russell 00:10:57 I can hire in 48 states now. Bill Russell 00:10:59 And I'm Stephanie Lahr 00:10:59 like, wow, I know I said, which two are the ones you're not cut? Stephanie Lahr 00:11:02 I was hoping maybe we'd be one of them. Stephanie Lahr 00:11:03 We're not, um, or actually I should say we are, they can hire in our state. Stephanie Lahr 00:11:07 And so one of the things, you know, I've worked hard on, Stephanie Lahr 00:11:11 I I'm a very social person. Stephanie Lahr 00:11:13 I needed the social interaction, even if we couldn't be in person. Stephanie Lahr 00:11:16 So, um, my team and I have created. Stephanie Lahr 00:11:20 To be able to do that. Stephanie Lahr 00:11:21 Even still virtually we have, um, fun all hands meetings. Stephanie Lahr 00:11:25 We play games, which help people get to know each other. Stephanie Lahr 00:11:29 It helps people take some of the, um, the intensity off of the work. Stephanie Lahr 00:11:34 Um, and you know, th there are just like, you can do a comedy show virtually. Stephanie Lahr 00:11:39 There are ways you have to do it a little bit different, but it's actually Stephanie Lahr 00:11:42 pretty fun and a way to be creative. Stephanie Lahr 00:11:44 I'll give one example last year, over the holidays. Stephanie Lahr 00:11:46 What we used to do was we had a. Stephanie Lahr 00:11:49 Who would go to people's offices and kind of like create a little bit of havoc Stephanie Lahr 00:11:53 and be, you know, uh, uh, decorated. Stephanie Lahr 00:11:56 And then that person would gather all that stuff up and go and take it to a Stephanie Lahr 00:12:00 new office and elf that person's office. Stephanie Lahr 00:12:02 So last year during COVID, I was like, well, we still want to do this. Stephanie Lahr 00:12:06 How can we do this? Stephanie Lahr 00:12:07 So what we did instead is we put together eight boxes of Elfin fun. Stephanie Lahr 00:12:12 And during our all hands meetings, we would like the publishers clearing. Stephanie Lahr 00:12:17 Show up at somebody's doorstep, you know, in our region, it's not hard to do and Stephanie Lahr 00:12:22 close enough for our teams to be together and we'd knock on their door and we Stephanie Lahr 00:12:26 would deliver them their Elfin package, and then they could do it within their Stephanie Lahr 00:12:29 home office or whatever they wanted. Stephanie Lahr 00:12:31 You just have to be creative. Stephanie Lahr 00:12:33 You know, we still, we can still be very personally connected. Stephanie Lahr 00:12:36 I'm very excited to get back to the point where we can be doing more together. Stephanie Lahr 00:12:40 I think hybrid is absolutely. Stephanie Lahr 00:12:42 I'm going to be the ideal. Stephanie Lahr 00:12:44 I will have a lot of people who like being home at least a good part of the time. Stephanie Lahr 00:12:48 And that again, creates retention, um, opportunity. Stephanie Lahr 00:12:51 But I think we're, we're going to want to have a blend and we have a lot of Stephanie Lahr 00:12:54 fun trying to think outside of the box on how to do some of those things. Stephanie Lahr 00:12:57 I'm going Stephanie Lahr 00:12:58 to Bill Russell 00:12:58 come back to you on Montana trivia. Bill Russell 00:13:01 But before that, w it's interesting. Bill Russell 00:13:03 I was at the health conference and the health conference. Bill Russell 00:13:06 They really strive to have a, um, representation of male, female. Bill Russell 00:13:11 And they weren't able to even get close this year. Bill Russell 00:13:14 And one of the things we heard a stat, I think it was yesterday. Bill Russell 00:13:17 You heard a stat of the number of women who are leaving the workforce and they Bill Russell 00:13:21 were, they're given a choice and they chose their family and they're doing that. Bill Russell 00:13:28 But I mean, you, the pandemic was challenging for you too. Bill Russell 00:13:31 I mean, you're, you're at home a CIO doctor and. Bill Russell 00:13:37 Your kids are like right in the other Stephanie Lahr 00:13:38 room doing their thing was like, when are we going Stephanie Lahr 00:13:41 to talk about the math homework Bill Russell 00:13:43 and eight year old, they respected your office. Bill Russell 00:13:45 And, Stephanie Lahr 00:13:46 um, I mean, you know, she respected, I don't know about that. Stephanie Lahr 00:13:50 Actually. Stephanie Lahr 00:13:50 It was, it was actually maybe a kind of fun for them to my eight year Stephanie Lahr 00:13:54 old in particular, um, not, not shy. Stephanie Lahr 00:13:57 So he's known to sort of peek in on meetings at times and want to say hello Stephanie Lahr 00:14:02 and, you know, get to know the team. Stephanie Lahr 00:14:04 A lot of my. Stephanie Lahr 00:14:06 No, it was my kids. Stephanie Lahr 00:14:07 Right. Stephanie Lahr 00:14:07 And they probably know them better now than they did before. Stephanie Lahr 00:14:10 They maybe saw them at a team picnic twice a year. Stephanie Lahr 00:14:12 Now they actually see them quite often. Stephanie Lahr 00:14:15 And that's been something we've reciprocated if it's we've made Stephanie Lahr 00:14:17 it okay for others as well. Stephanie Lahr 00:14:19 Right. Stephanie Lahr 00:14:19 We all just had to kind of navigate our way through. Stephanie Lahr 00:14:22 Um, and you know, it's been a lot at times I was happy for Stephanie Lahr 00:14:26 the schools to open up again. Stephanie Lahr 00:14:28 Um, but I do think it has been nice to. Stephanie Lahr 00:14:31 Make it okay. Stephanie Lahr 00:14:33 To understand that people have these lives outside of their work Stephanie Lahr 00:14:37 and they can blend if they need to. Bill Russell 00:14:40 Yeah, my wife and I we're actually we're in the opposite joy. Bill Russell 00:14:44 Our youngest is 21 and in college. Bill Russell 00:14:47 So when the pandemic hit, she was forced home and you know, the pandemic Bill Russell 00:14:52 has some silver linings and one of them is just being with family. Bill Russell 00:14:55 Yeah. Bill Russell 00:14:56 One of the things I remember a saying in the middle, I'm like, man, I'm Bill Russell 00:14:59 glad our kids aren't that age, that little age where it's like, I need to Bill Russell 00:15:03 get out and need to all those things. Bill Russell 00:15:05 On the Stephanie Lahr 00:15:05 flip side, I will add just given your earlier comment Stephanie Lahr 00:15:08 about women leaving the workforce. Stephanie Lahr 00:15:09 This is a really concerning issue to me as I think about, um, you know, women Stephanie Lahr 00:15:14 as, as a constituency of our workforce, whether we're talking about in medicine Stephanie Lahr 00:15:18 or, or anywhere and maintaining that diversity and, um, and thought process. Stephanie Lahr 00:15:25 3 million women left the workforce, um, in the United States. Stephanie Lahr 00:15:30 And, you know, during this time period. Stephanie Lahr 00:15:32 And so as we look at nursing shortages and you know, it shortages and all Stephanie Lahr 00:15:37 of the things that we're seeing, 3 million women left the workforce. Stephanie Lahr 00:15:42 And I think we're going to have to dig in and understand I had the luxury of Stephanie Lahr 00:15:48 finding a way to be able to balance both. Stephanie Lahr 00:15:51 But what that tells me is we've not set our infrastructure. Stephanie Lahr 00:15:55 To support that more broadly. Stephanie Lahr 00:15:57 And I was very fortunate to have a situation that I could make that Stephanie Lahr 00:16:00 work, but a lot of women apparently didn't feel like they could. Stephanie Lahr 00:16:04 And I think we're going to have to walk through that as we recover Stephanie Lahr 00:16:07 from, this is how do we, um, reinvent and reframe some of how we do work. Stephanie Lahr 00:16:13 Some things, obviously a nurse cannot bring their child to the hospital Stephanie Lahr 00:16:17 while they're providing beds. Stephanie Lahr 00:16:19 But maybe our organization could be providing childcare directly or Stephanie Lahr 00:16:23 more directly at this point, right? Stephanie Lahr 00:16:25 Yep. Stephanie Lahr 00:16:26 That would be an option. Stephanie Lahr 00:16:27 Or, you know, maybe we need to have childcare at the hospital Stephanie Lahr 00:16:30 in the middle of the night. Stephanie Lahr 00:16:31 Maybe we have a single mom who would be happy to take the night shift, Stephanie Lahr 00:16:34 but there, you know, all, there's all kinds of ways that we might need Stephanie Lahr 00:16:38 to just be thinking about it, but we can't just absolutely absolutely Bill Russell 00:16:44 types of license plates are there in the state of Montana. Bill Russell 00:16:48 And just on your slide, you don't remember. Stephanie Lahr 00:16:49 No, I totally know. Stephanie Lahr 00:16:50 It's two hundred and thirty two hundred thirty, one hundred and thirty different Stephanie Lahr 00:16:54 license plates in the state of Montana. Stephanie Lahr 00:16:55 Literally, as you drive down the highway, you will think you're seeing a whole Stephanie Lahr 00:16:59 bunch of different states represented. Stephanie Lahr 00:17:01 No, just look closely. Stephanie Lahr 00:17:02 It's probably yet another of the Montana license plates, which I think is fine. Stephanie Lahr 00:17:06 It's 230 license plates. Stephanie Lahr 00:17:08 There's less than a million people. Stephanie Lahr 00:17:10 So you know what I mean? Stephanie Lahr 00:17:11 Like you kind of really, you can have a pretty unique Stephanie Lahr 00:17:13 license plate and that's pretty Bill Russell 00:17:14 interesting. Bill Russell 00:17:17 Just Stephanie Lahr 00:17:17 crusted over a million people in the last census. Stephanie Lahr 00:17:19 And we can Bill Russell 00:17:20 look in every direction and we don't see all that many Bill Russell 00:17:22 people where we're at a distance from one end of Montana to the other, Stephanie Lahr 00:17:27 uh, on I 90, I think it's right around 515 miles on interstate 90, Bill Russell 00:17:33 90 starts. Bill Russell 00:17:34 I 90 starts where Stephanie Lahr 00:17:36 I, 90 starts in Boston finishes in Seattle. Stephanie Lahr 00:17:39 Wow. Stephanie Lahr 00:17:40 And, uh, funniest story. Stephanie Lahr 00:17:41 I, I, before I lived, um, in rapid, I lived in Coeur d'Alene. Stephanie Lahr 00:17:46 Another, I like to live on nine 90 apparently. Stephanie Lahr 00:17:49 Um, and, uh, uh, there used to be a joke that you could make it from Stephanie Lahr 00:17:53 Boston to Seattle without stopping if you made the light in Wallace, Idaho. Stephanie Lahr 00:17:59 So Wallace Idaho was like the last place that I, 90 was kind of Stephanie Lahr 00:18:03 formalized, tiny little town, um, mountain town, and there was a stop. Stephanie Lahr 00:18:08 Uh, they're on for many, many years, about 15 years ago, or so they Stephanie Lahr 00:18:12 finally fixed that, but yeah, that Bill Russell 00:18:13 was, and you used to live in Montana. Bill Russell 00:18:15 So for many years though, they did not have a speed limit on some of these roads. Stephanie Lahr 00:18:19 Yeah. Stephanie Lahr 00:18:19 I still get asked that people are like, wow, it's so cool at Montana. Stephanie Lahr 00:18:22 Doesn't have a speed limit. Stephanie Lahr 00:18:24 Well, it was three years from 1998 to 2001, um, didn't last, super long. Stephanie Lahr 00:18:30 And actually there was a speed limit. Stephanie Lahr 00:18:32 It was called reasonable. Stephanie Lahr 00:18:34 So for me, I type a overachieving. Stephanie Lahr 00:18:37 Don't want to break the rules kind of person. Stephanie Lahr 00:18:39 It was actually really stressful because I didn't know which line to be in. Stephanie Lahr 00:18:43 I would see a police Bill Russell 00:18:44 officer on the major highway doing 35, Stephanie Lahr 00:18:47 like, oh, is this okay? Stephanie Lahr 00:18:49 Yeah. Stephanie Lahr 00:18:49 Um, so for me personally, I'll, I'll take a speed limit any day, but Stephanie Lahr 00:18:53 yeah, it didn't, it didn't last long. Stephanie Lahr 00:18:54 The, the statistics that went along with the outcome of that were not favorable. Stephanie Lahr 00:18:58 Stephanie, thank you for your time. Stephanie Lahr 00:19:00 Great to talk to you again. Bill Russell 00:19:01 Don't forget to check back as we have more of these interviews Bill Russell 00:19:04 coming to you, that's all for today. Bill Russell 00:19:06 If you know of someone that might benefit from our channel, Bill Russell 00:19:08 please forward them a note. Bill Russell 00:19:09 They can subscribe on our website this week, health.com or wherever you listen Bill Russell 00:19:13 to podcasts, apple, Google, overcast, Spotify, Stitcher, you get the picture. Bill Russell 00:19:17 We are everywhere. Bill Russell 00:19:19 We want to thank our channel sponsors who are investing in our mission to Bill Russell 00:19:21 develop the next generation of health. Bill Russell 00:19:24 VMware Hill-Rom Starbridge advisors, McAfee and Aruba networks. Bill Russell 00:19:29 Thanks for listening.