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 Welcome to This Weekend in Health, it influence where we discuss the influence of technology on health with the people who are making it happen today. Tressa Springman, CIO of LifeBridge Health joins us. That is out of Baltimore, Maryland. And we talk, uh, about a lot of things actually. We bounce around a lot.

I love having conversations with Ressa, but we spent a, a fair amount of time talking about digital and digital projects and how you get digital projects done as the CIO. So great conversation. I. My name is Bill Russell, former healthcare, C-I-O-C-I-O, coach, consultant, and creator of this week in Health.

It a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders. I wanna thank Sirius Healthcare for supporting the mission of our show. Their weekly support of the show this year has allowed us to expand, uh, our service offerings to the community. And for that we are incredibly thankful.

The only change you're gonna see on that channel next year is that the Newsday episodes are now gonna be duets. We're gonna have a series of about six guests that come through and talk, talk about the news with me. So instead of just me talking about the news, . It's gonna be conversational with different people with different perspectives.

We're gonna have a physician, we're gonna have CIOs, we're gonna have former CIOs, uh, and we're gonna have a startup, uh, a former CIO, our CEO of a startup. Be one of those guests as well so we can talk about the news from different perspectives. I think that you guys have responded really well to that and given us great feedback that.

That you appreciate that dynamic of going back and forth on the news. Uh, so we're gonna continue to do that. But you've also told us that you love the, uh, the Newsday show. And so what we're going to do is we're gonna be launching a new podcast, a new channel in and of itself called Today in Health. It.

and this is where I'm gonna talk about the news, but I'm gonna do it in much shorter segments. So what you're gonna get is we're gonna release a show every day of the week. So uh, Monday through Friday weekday, every weekday we're gonna release one show. It's gonna be five to seven minutes in length, and we're gonna cover one news story.

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So thanks again for your support over the years. Again, we wanna get this content into as many hands as possible, so share it with your friends, and we really appreciate your support now onto our discussion. Alright, so today we have Tressa, Springman, the CIO for LifeBridge Health with us. Good morning Tressa.

Welcome back to the show. Hey, bill, great to see you, and thanks for having me again. I, I'm looking forward to the conversation. There's always things happening and I, it sort of struck me. We've had you on the. We've done this. I actually got some emails from my listeners that they want me to start with this question.

Hey, give us a little background about your system, and we may have covered it before, but for those who just joined us, give us a little background on LifeBridge. Yeah, happy to do it. LifeBridge Health is an integrated delivery network. We've got five acute care hospitals. They're all in Maryland. A number of them are near Baltimore, but we also have one in.

Carroll County, which is relatively rural. We have a few nursing homes. We've got over 30 urgent care sites. A few thousand physicians of whom about 600 are employed. We have a for-profit entity that has a lot of joint ventures, whether it's outpatient pharmacy, physiotherapy, we have hospice, we have home care.

We really have something across the continuum. But you know, bill, as a lot of people kind of count hospitals and certainly our hospitals are a very proud element of our continuum. And, uh, as I said, we've got, uh, five acute care hospitals. Are, are, are you the, so you're, you're the CIO of all of that. You're the technology leader for all of that.

Yeah, yeah. I'm the technology leader for all of that. I also am responsible for HIM, the medical records function. I also am responsible for our telehealth construct, and that was even pre covid, but of course that's kind of gone on steroids. I have a couple of teams that manage call centers. One is in Manoa and one is in Jerusalem.

That compliments very nicely with our digital strategy, and I I know you, um, were interested in talking a little bit about that today as well. Yeah. The, uh, so the, the NI what's interesting, we didn't have any nursing homes where I was the CIO does that, is that a different, uh, suite of technology products than you would've say in the hospital?

Yep. It sure is. Just like the Cerners and Epics of the world, the long-term care community really has consolidated on a tool called Point Click Care, and they're kind of the, you know, big gorilla in town and it is very different technology. The same is true with hospice. Hospice has just a handful of key EMR vendors and

Again, they've got just some really unique needs based on the environment and the, the care that they serve in, in their own patient community. You know, just, just for fun, I, I asked this question for CIOs from time to time. How many applications total do you have across your continuum? I don't know. , , I probably should be able to answer that, but considering the probably 25 contracts that are

On my desk to review because end of calendar year's always a good deal. Yeah. Oh, I, I'm sure it's over 400 and yet the 80 20 rule always applies. I'm always looking for a platform play because it's really those key platforms that are the accelerants to the organization and most of the time. And I, I think the, the platforms that I would focus on include your, your EMR and all their boundary systems.

Yeah. Your ERP and all of those boundary systems, your office and office productivity and collaboration, like O 365 or Google, and then . The whole advent of digital health and looking for a platform there, and integration with CRM, everything that is very consumer facing, which is a real new pivot for healthcare.

Yeah, we've, we had upwards of like 900 applications. How, how do you keep track of this? So we. I had my, we had ACFO for it. I mean, when you have a 200 some odd million dollar budget, that's what you end up doing. And that, that CFO role, he put together a calendar, he put together a contracts calendar for throughout the year and it kind of cracked me up 'cause.

I was looking at it, I'm like, oh my gosh. We were renew at least like 10 contracts every month at, at a minimum, 10 contracts every month, which gives you and I, I mean, we could just have a full-time. Part of the CIO role being contract negotiation to a certain extent. Do you guys, what, what do you do to manage your, your portfolio of, of contracts?

Yeah. We actually have a system that helps us do that so. We scan and index all our contracts and the index includes renewal dates when they're coming up, et cetera. Your point's a good one, which is there are weeks when I feel as though I am nothing more than an extension of the legal team because there's always quite a bit of activity going on in that space and quite a bit of opportunity too.

So that's a usually a very. Depends on your own culture, but for me, in this culture, it's been a very large part of my job. What's interesting, I just finished, I, I finished a pro, part of my work is consulting. I just finished a project talking to some health systems about their, their structure. And, uh, at least two, uh, at least two, maybe three of the academic medical centers have now added legal, uh.

Legal portion. Uh, a person reports into the CIO either because they're generating so much intellectual property, they're doing contracts, those kind of things, but they have a full-time legal person in the IT department. Yeah, we're not structured that way, but I have a person too, and she's wonderful and she really straddles innovation and it because, uh, of all the nuances of the risk.

They that, that those kinds of acquisitions surface and really the need to have legal counsel that is very comfortable and familiar, the whole IT security proposition and limitations of liability and how much insurance, and I mean, it's become a very real thing and a very specialized role. So although ADDIE doesn't report to me.

She's a shared resource and I fill most of her days. . Yeah. It's, it's interesting, I, I, a lot of times we dealt with outside counsel and so for me it was helpful because I could always, when you're dealing with outside counsel, you have a. Of people so you can pull in the right person for the right thing.

You're probably wondering if I'm ever gonna get to some of the stuff I sent you over in the email, so I'm gonna No, no, no, no, no, no, no, no, no. You know, I, this is what I like about talking with you, truss. I mean, we can, we can go in a lot of different directions based on what's going on in the world. But one of the things I did want to talk to you about again, is a little bit the structure.

Uh, do you guys have a Chief Digital Officer at LifeBridge? We do. Okay. And does that, does that report into you or is it separate? That is me. Oh, it's you. Okay. So you're C-I-O-C-D-O. Well, so Bill, I think everyone is really working through this, right? Yeah. When we think of digital, and let's start with that definition, what does that mean to your organization and, and how do you wanna accelerate it?

We've been on that journey ourselves. We've been working on a digital strategy and what is the best organizational structure for that and how to support where we are today and where we need to grow. I think you, you've been ACIO one might argue that the, the digital ecosystem, and let's just for argument's sake say it's anything that is smartphone enabled and complimented by the web.

It's really about the audience and the support structure. And so if we're digitizing a tool for employees and you already have a team that's supporting HR and payroll and OC Health and your employees that having tools that are just using different technology and maybe are smartphone enabled, fit nicely into that.

And frankly, I want those associates to grow into the world of new technology. Not bifurcate a legacy team and then a digital team. The same is true with our providers, with our nurses, with our doctors. I have clinical teams. I have. They know them, they work with them, they understand them, and they wanna grow in the digital space too.

The real unique entrant here is the consumer as the user, and it's everything from setting up a support structure. So if that consumer has a question about the tech that we've given them. I have the same service center capability to help them as Amazon might, but also having a group that's very consumer tuned on healthcare.

One of our tiniest departments usually is marketing. Yep. Right? Marketing is usually the small department, and yet now we have the advent of the very discerning consumer in the healthcare space, and we've got to develop. A capability to put these tools directly in their hands and then do a good job supporting them.

So in our organization, like many, we've been navigating this question about is it ACDO? Is it part of innovation? Is it part of marketing? And at the end of the day, the only thing in our philosophy that differs is who that end user of the technology is. It's the consumer and it's just a new user group. I mean, 20 years ago, you and I, we automated all of our back office function and we dealt with all the administrative people in our health systems 15, 10 years ago.

Oh my goodness. We know how to do the same with our clinical users, and many of us hadn't even done much interaction with clinical users until CPOE and the EMR, et cetera, and here we are. We're just a new user community. So how do we do that and do it well? I participated in a forum recently, I believe it was by the Chartist Group, and interestingly enough.

The leading indicators for CIOs, and this was across all industries, they asked across all industries what is the CEO's priority for it? And the number one priority in this survey was to lead digital business and digital transformation initiatives. That's what the CEOs across all industries are looking for from it.

So I think we're all. Trying to accelerate it and maybe approach it differently, but 10 years from now, how can it not be supported out of. The function of an organization that understands the technology. This is really, I'm, I'm gonna camp on this for a little bit 'cause I think it's really interesting to me.

It's so, uh, when I was CIOI had to the, it was interesting because marketing and strategy we're making a play for, we own digital because we are the ones who are closest to the consumer. So they wanted the budget and they wanted to select the technologies and whatnot. So that was a, a place where I had to partner.

And by the way, I essentially, I was the CD within the organization and I, I didn't mind plays like that 'cause it meant people were. They had ideas, they had solutions. You just had to, you had to figure out a way to organize them. And once you organize them, then you were gonna get the great solutions.

People excited about moving it into the organization, those kind of things. But marketing was, was the interesting thing to me in that they, they really wanted a strong say in that operations wanted a say in digital, but only because, uh, it was so integral to, I mean, everything we do is digital now, right?

And so operations was sitting there going, look. This is gonna touch supply chain, it's gonna touch our physicians. It's gonna touch, it's gonna touch every aspect. So they wanted a piece of it. They didn't want to own it, but they, they wanted a, a seat at the table and to, to participate. What, I mean, what does that, what does that look like?

And by the way, I, I, I have found very few marketing departments in healthcare. And I've worked with a lot of healthcare systems. I, I think it's the weakest department in most health systems. And now I said that, you didn't say that. Don't get mad at Tressa. Get mad at me. But generally speaking, they, they haven't, they haven't built this muscle.

They haven't flexed this muscle of really engaging the community in a way that usually it was get the ad at the football stadium in the baseball stadium, get some billboards. Send out the mailers, those kinds of things. That's what it was for decades. And then all of a sudden, digital came along and they had to create, they had to develop a whole new set of skills.

And I think that's evolving, but it's still one of the, one of the areas I think was, was weakest. But anyway, the question is, who do you partner with on this? Who is, who are the key partnerships for you? Definitely our chief clinical officer and our chief marketing officer, and I am really, really lucky.

Our chief marketing officer came to healthcare, came to our organization. This is his first healthcare job, so of course he thinks we're backward and archaic. He's been in the consumer space. I think he was with Target, he was with some banks. He could completely do this, but you know, the, as when, when we talk about digitizing the consumer experience, that his purview is SEO, search engine optimization, CRM, campaigns, all the right things, I think he would be very effective at leading, uh, a lot of those digital activities.

And in fact, he does. I think he would not say I'm the chief digital officer, and I think he'd like to continue to grow that function. But very quickly that digital experience creeps into operations, whether it's online bill payment or whether it's scheduling an appointment, or whether it's having a digital remote, patient monitoring post discharge.

To, to know how your care experience and your pain were, and very quickly you get into a purview that marketing's not interested in. 'cause they're all on the sell end of this. They're not necessarily in the operational end of this. And so, like I, we very historically have been in a cross continuum position for that.

Look, I, I think it's more about the individual than where it's placed, but just like population health. Just like telehealth at some point, this, these places that we need to go in healthcare to take care of our communities ultimately. And over time, if, if they don't back in to becoming the focus of the IT structure, then I think you really need to challenge yourself on what's your IT structure doing for you.

I mean, let me, let me go one step. There's a lot of health systems that have created digital teams and, and let's define those as people who come into work every day, and their job is to focus on digital initiatives. That is to focus on where the consumer meets the healthcare organization or. Or overlaying a set of tools for clinicians to interact with those patients.

And it's not just, obviously, it's not just patients. There's other communities, uh, clinician to clinician communication, those kind of things. But there's a group that comes in every day and says, I'm gonna focus in on enhancing the patient or physician experience through digital tools. And that's their role.

That's their full-time job. Do you have people that it's their full-time job, that when they come in in the morning, that's what they're thinking about? So we have a number of them, but they are not in a centralized team, and I believe through recent discussions and our own roadmap planning that they will be consolidated into a probably pretty small but mighty team and it will be a consumer IT team as I a a digital consumer team.

As I've mentioned, we already have teams that have great relationships with our clinicians and great relationships with hr, AP our, our associates at large, and those are the individuals that I will. Uh, they come in already Bill and think about how to make the payroll or the supply chain or, or the nurse's day better.

I, I don't know why I would wanna set up a separate structure for that. They already have the user relationships and they, and many of the application vendors, the digital solution oftentimes is just an extension. Of the core product anyway. Yeah. But it's this digital consumer space where it's a gap where we don't have a service center for them to call, where we don't have people who are coming in from retail or other industries who know that digital first and, and really smoothing those friction points are really what allow you to, to grow your, develop your customer base and then keep them.

And keep them in a loyal fashion because the technology choices you're offering aren't creating such friction and frustration that they go elsewhere. So again, we have a few people in the organization who have, um, been very involved in our early digital projects, and over the next 60 to 90 days, we're gonna be probably centralizing them, consolidating them, giving them a name.

Again, I, one of, I went through this exercise a couple of years ago, one of those self-reflections where you are really digging into what are you good at and what do you like and how do you come up with a personal mission statement that really is an archetype for what you like and what you're good at.

And I did it way too late in my career bill, but basically. I am an ideas to outcome architect. I love to take a concept or an idea and figure out how to fit it into a culture 'cause there aren't any right or wrong. It's just what's gonna work. And I don't think digital is, the digital consumer is no different than my, the idea to outcome I had to implement so that we had an effective population health support structure or telehealth support structure.

This is just that next thing idea to outcome architect. That's brilliant, by the way. I love that. Well, you know, it was one of those like team building and you go work with people offsite and you use some of those very cool tools and, and really try to make very precise what your passion is and actually what other people think you're really good at.

And then you gotta put it in, in a talking point for your elevator speech. But. I, I embrace that. It's really what I like to do, but, but it also means that what I am not as good at is really just day-to-day operations because I like to build things. I'm a builder and, um, a convener and taking something that.

Is maybe fragmented and evolving and really giving it governance and structure and legs and getting it implemented. And then I like to move on to the next thing. So again, very similar to where you would position digital. Uh, that probably means that wouldn't position me for a lot of. Like physicians and other organizations who, who want someone who's really good at just driving the train.

Well, you got to, you got to exercise that, uh, capability a fair amount over the last , the last nine months, ideas to architect probably at, at, at a pace and speed at which you haven't been asked to do it before. What's, what, what are the kinds of digital projects? I, I mean, we could talk about work from home and, and telehealth.

We probably will touch on telehealth. What, what other digital projects were in high demand, uh, as a result of the pandemic for you guys? Yeah, it's interesting because there are four things that I talked to my staff about right now, really to keep them updated on what's going on with this pandemic and the category.

The four categories are capacity, staffing, visitor management, and.

I think a lot of what we were doing, bill just became highly accelerated from a digital perspective, and part of it was just out of necessity. People were afraid. So whether it was all the social distancing, visitor restrictions, et cetera, or the stay at home, the work from home, never waste a good crisis and really necessity is the mother of invention and we've seen it.

Now we. Uh, make no bones about it. We're making some significant technology investments in the security of that work from home structure. So this, this isn't a big windfall for us. We just need to make some investments in other areas. But this crisis has catalyzed so many things for us that frankly. Had been considered in the past.

It just became an accelerant. The, so it was, it was capacity, a visitor management vaccine. What was the fourth one? Staffing. Staffing. Okay. Staffing. Yeah. I mean, look, a lot of us have seen clinicians retire or because of their own health, not be, withdraw themselves from the community. And with full census and length of stay because of how long it takes to really manage a serious COVID patient to discharge compared to what they're used to.

Our clinicians are just exhausted. And, and does, does technology play a role in, in helping to, uh, address the staffing burden for the health system? It can, it can, in many ways if people. Are using tap and go to get in and out of their systems.

It we're having discussions now, bill, now that we're seeing another really high wave here of Covid in Maryland, where early on we got iPads deployed. We, we really tried to lean to this concern about visitors and visitor restrictions and isolation. Not being able to be with loved ones during a very, uh, challenging physical time for our patients.

But now we're thinking about it a little differently because what we learned is this was a huge burden for bedside caregivers. They couldn't just do their clinical job. We expected them to be the tech and guest service at the bed also. So now we're really rethinking that and we're coming up with different ways to continually pull the non-value added non-clinical work off the bedside caregivers.

Yeah. Uh, you know, we've, we've accelerated a deployment of an in-room engagement platform again, so that if the room's cold. The patient is letting facilities know to come fix it instead of it always ending up right in the, the nurse's lap to try and deal with it. So it's just accelerated a lot of things.

What, what does, what does vaccine, I mean, you, you have it as one of your categories. What, what is, is there preparation? Is there a tracking? Is there, I mean, what, what kind of things are you looking at? Yep. All the above. So. Let's see. In fact, I have a meeting at noon to talk about vaccine preparedness, but actually early on it's gonna be very critical that we have the right analytics in place and reporting where there can be complete visibility.

When we get those or early aliquots, who's getting 'em? What was their reaction? How did they do? And making sure while it's early and in short supply, that they're going to the bedside caregivers who are willing to have them, uh, them being the vaccine. Right. So, yeah, I would say for the last month we've had a lot of vaccine planning in Maryland.

I'm really proud of what the state here is doing, and I've, I've spoken before about how we leverage our, um, state health information exchange. Crisp, crisp here in Maryland happens to also be. And I'm not gonna get the term correct here, bill, but it's there. We use a tool called inet. And INET is, it ultimately ends up that there are various state connectors for immunization tracking that loops all the way back to national tracking.

And so it's really been a nice federation. About how do we get our own EMRs that are sending vaccine data to our state, HIE, to make sure there's a complete line of sight. So once we start actually getting the doses on site, that we've already got the interfaces in place, that we have the core content in our EMM r Ready, because as.

Depending on what vaccine, it's one, it's two, it's 21 days apart, it's 28 days apart. So it's everything from updating the content in our EMR preparing training and understanding that the initial tip of the spear is gonna be healthcare workers. And a lot of organizations aren't using their core EMR for their associates.

They might have an occupational health EMR. So there's a lot of work to support. Mass vaccination workflow and then ultimately making sure that there is a good line of sight. No surprise, and I know you've heard this, it's a bit of a head scratcher, but in an already crazy pandemic time where is is trying to enable the organization, there have been tremendous reporting requirements put on, on, on healthcare and

Whether it's vents or ICU capacity or everyone wants to know, and it's all kind of flowing down on the shoulders of what be some pretty small but mighty teams. Right. I, somebody asked me about, and you can correct me, your CIO in the chair, and I said, I, I really don't have any sympathy for these large health systems.

'cause generating these reports is not all that difficult to be honest with you. I mean, they have fantastic teams. They're already tracking two thirds of the information. They were already tracking about a third of it. Was new. And I understand that takes some time. You have to vet that, you have to get that in integrated into the clinical workflow.

But the large health systems with money and teams, I didn't really have much sympathy for, uh, the medium size. I do have some sympathy for, 'cause you have to prioritize so many things and it's very difficult. Uh, but the smaller health systems, I don't even know how they function. They're, they, I mean, they have to, they have to do that reporting.

It's changing. They have to do cybersecurity. They, I mean, they have to do all the things that a large health system have. And then you had these added requirements. So for them, I had, I had a lot of sympathy, but I mean, that was sort of, sort of my take on it. I, so where am I wrong? I'm, where am I wrong? I'm not gonna on you, I'm not gonna push back on you.

You know, it's not been a crisis for us. We're a mid-market health system, and really large health systems, they solve it once and they can address it for many, many different hospitals. So. I think your perspective is a healthy one and it's very worrisome. It's like many of these other initiatives asking ourselves, how do we keep healthcare local when, what's the same catalyst bill that drove a lot of physicians away from independence and into our corporate EMR structure.

It just came too com It became too complex. It was fraught with, um, risk and they couldn't keep up with it. I wanna go back to something you said. So essentially you guys have, uh, a registry for vaccines in the, in the state of Maryland. That's essentially what you, you've set up. That sounds very effective to me.

Well, actually each state has it. It's called the IIS network. I'm sure I've gotten it wrong. So for those who are connected to this, I apologize, but. There is a national vaccine registry and each state has it's, it's like this great network diagram where each state has an IIS and a connector locally to the National Immunization Network.

And in Maryland it's called, and it's actually sponsored through our state, HIE Crisp. So.

Again, the, the United States as a whole, this is an area from a public health perspective where they're pretty well positioned now. It's just like kids vaccines. It doesn't mean that's they're gonna get their kids vaccinated, but in terms of a nice local, state and national network, it's already been in place in Maryland.

The value there is that if your child is

It presents, let's say they have an acute episode of some sort and they present in a hospital via ambo, unconscious. That ER physician, if needs be, can access our state HIE to see was there a recent vaccination? Was this a reaction to something? Because for us it's, it's all accessible and available because of the HIE and the reverse is true, which is this child was not immunized for that.

So it's just another essential data element. I think it was largely put into place, right, for children and school-aged children. But in the case of this pandemic, it's really going to. Be incredibly beneficial. Are, are you guys working with market, like your marketing teams? One of the things, I just had a conversation with somebody who's outta state and it's a epidemiologist, and they, they were, they were talking about how much misinformation there is out there and how important it's to get the right information out and we think, oh, they'll get that through.

The people who are trusted most about health is the doctors. Is your health system, uh, marketing and, and team working on how to get the message out from you to the community? I. What message, message, uh, the message about vaccines. This vaccine is, nothing has ever been as politic. I can't, this is the craziest politicization.

If you are, if you're on the progressive end, you might not get the vaccine because you're like, well, this is, was developed under the Trump administration. I've heard this by the way it's developed under the Trump administration. I don't trust, if you're on the conservative end, you might not take it for various reasons.

Uh, I, I wouldn't say conservative end. I would say the right wing end you'd say, Hey. Issue here. I'm not doing the vaccine. And then you have the, the never vaxxers and all those other things. Right. How I, I mean, is there a role to play for the health system to get the message out? So along those lines, yes.

For example, we actually able, we're able to get some grant funding and we've got mobile delivery of covid testing in some disadvantaged neighborhoods and. We have added to that the offer of vaccinations for the children in those areas. That's fantastic. I think there's always an opportunity to try and educate the, the reality though is the issue isn't always education bill.

It's trust and. Or mistrust and where does that mistrust stem from? And you're right, sometimes the healthcare organization, um, is perceived to be the most trustworthy by the recipient, my doctor, my nurse. But, but in other neighborhoods it's not. And that's where faith-based networks, it, it's like any other circumstance where there's, there's got to be an understanding of trust.

I tell you what you're observing. Spot on. I was in a conversation with, um, a gentleman last week and he said, is it really? I mean, are you guys really busy? Like, he totally felt that all news was fake news. And when I was sharing how full the hospitals in Maryland were now, and a month ago, they were not.

He just really challenged me on it. He's, he's like, you're not kidding me, are you? I mean, I just thought all of that was like fake news and I'm like, no, this isn't fake news. It's, it's getting really tight out there. So you are right and it is sad and people need to

get comfortable with where those trusted sources are at. My observation would be that healthcare needs to do a whole lot more in this space. A lot of our clinicians. At least at LifeBridge are fantastic about putting themselves out there to the public, but many are just so bright and so scientific that, that they don't connect the dots for people.

But I do, I do think it's, it's about trust and it's about believing that source of information. Well, Tessa, you are the consummate professional. I took you way off the questions I was gonna ask you. I do, I do want to add, I, I want to pull us back to health it to to close out what do, and I've been asking a bunch of CIOs this, and the fascinating thing to me is I'm getting different answers from each of 'em.

What do you think will be the lasting impact on health it as a result of the pandemic? I hope it's choice for a number of years we have. Appropriately recognized the role and the importance of the care provider. And now's no different. We do everything we can to make sure that our clinicians are very efficient, whether it's through voice recognition or ambient listening tools, et cetera.

But sometimes I think maybe it has been, I. At the choice of not offering the best solution to the patient or the family. And I believe that some of these innovations and technology are going to continue to allow the patient, the consumer, their family, to have more choices about how they wanna engage in their healthcare, and I think it will make them happier.

It will lead to better health compliance. And the telehealth circumstance has proven that if it gets reimbursed, in many ways it's not about the technology because certainly the telehealth technology has by and large not been the problem and our ability to continue to offer choices to the patients in our community.

To engage with us, engage in the median and means, which is of most comfort, whether it's in person or phone or video, as long as it's clinically appropriate, just that ability to offer choice. Yeah, absolutely. Theresa, thanks. Thanks again for your time. I know that you guys are, are really busy. Just so people know, this is being filmed the week of Thanksgiving.

It's not gonna the of Thanksgiving. When it airs in December, they might go, oh, well things aren't that bad in whatever. So I just wanna mark it with, with, we are actually recording this, getting ready for Thanksgiving. Have any exciting plans for Thanksgiving? Nope. Nope. Um, pretty traditional except a lot smaller and yeah, definitely we, we have a few folks who will be

They're local, they're friends, and they'd otherwise be alone. So we will be wearing masks, I guess, except when we're eating our Turkey. But yeah, my fingers are just crossed. We, we are very full and we've got a lot of activity going on, and yet I remind my team and myself and certainly to, to you and your family Bill, we have, uh, much to be grateful for.

So. Um, as this cloud seems to be around us, just being thankful for what we have and making the best of it is, I think important. Yeah. Thanks. Thanks for the time. I'm really curious to know what you call this, 'cause we really have been all over the, uh, carousel . Yeah. The, the title will be interesting. Yeah.

I, I mean we, we, we could, we could title it digital or we could title it. I, I, I have no idea what, where. We'll, title we'll see. But Tessa, thanks again for your time. I, I really appreciate it. Well, always a pleasure, bill. Have a great day and happy Thanksgiving. What a great conversation. That's all for this week.

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