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 Thanks for joining us on this week in Health IT Influence. My name is Bill Russell, former Healthcare CIO for 16 hospital system and creator of this week in Health. IT a channel dedicated to keeping health IT staff current and engaged. Today, ed Ksky, the CIO for Stanford Children's joins us. Ed is ACIO of the year.

He is a Lifetime Achievement Award winner. He has been around and done a lot of great stuff. We talk about their EMR journey, we talk about the role of digital in covid, prioritizing projects. We talk about a lot of stuff. Uh, we close it out by talking about his role on the opioid task force. And, uh, it, it really is one of the highlights of the show.

So I hope you'll listen through, uh, to the very end of the show. I wanna take a quick minute to remind everyone of our social media presence. We have a lot of stuff going on on social media. You can follow me personally, bill j Russell, on LinkedIn. I engage almost every day in a conversation with the community around some health IT topic.

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You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there. You can also go to today in health it.com. And now onto today's show. Today we are joined by Ed Kaki, CIO, for Stanford Children's Health. Uh, good afternoon, ed. Welcome to the show. Well, thank you, bill.

Great to see you and, uh, appreciate being on this discussion. Yeah, I'm, I'm, I'm looking forward to the conversation. It's, uh. Uh, we, I've had Theresa Meadows on, we talked about some of the children's health things through the pandemic, and I, I wanna go further with that, uh, with you, but since you're a first time guest, uh, let's, let's start with, tell us a little bit about, about Stanford Children's and, and, and what you guys are doing there.

We we're actually now the largest pediatric in Northern California and.

So really within 10 minutes of every patient in the Northern California area. We've grown tremendously since I came here 12 years ago. We've gone from 600 million to $2 billion. We've tripled the size of our hospital about three years ago, and probably one of the leading research. And discovery health systems and medical schools for pediatrics in the country.

Just a hub of innovation and clinical research around pediatrics. And of course we hit in the, we sit in the middle of Silicon Valley, so there is no shortage of.

Innovation and thinking, including on our board. You know, the couple things about that that are interesting to me, one is 50 locations and we sort of heard the same from from Meadows out for worth. You know, children's hospitals have really gone retail. I mean, they are within, they're in the neighborhoods.

They're out and about. And so there's a lot of different ways to get care for your children that, that didn't exist before. The, the other thing that o obviously jumps out is, I mean, in the middle of Silicon Valley, we're, we're, we're, we're definitely gonna talk. You know, digital health and what's, what's going on there?

So, so you guys have a, a pretty significant, I, I don't know if it's called a retail strategy for you guys or, or just being, being out in the, pushing out into the neighborhoods. Right. Well, you know, bill, one of the things unique to pediatrics is that for every patient visit, it requires an adult as well, and it's a lot of productivity loss impact on the family.

And so getting closer to people in their community improves access, and it ultimately improves the quality of health status. And so when I came here 12 years ago, we were only a hospital. And I say that lately because it was a significant hospital, but in the ensuing five years, we needed to go to market more of a market strategy.

To extend access and also to leverage our specialists much more. You know, you think we have very limited world class specialists and they're not gonna be able to go out and travel to patients and trying to bring everybody into one spot doesn't work well, especially with all the traffic issues and. You know, a market strategy coupled with digital health has been a real strategy for ours for about 10 years now.

Well, I, I, I wanna go into that digital health aspect of it. We've, we've been having some, uh, great conversations on the show just around this, this whole concept of, you know, going where they are increasing access.

It's one thing we know for sure is that the Covid 19 does not spread through computer screens, or at least not to, to the person on the other side of the, uh, video call. So let's, let's go there a little bit. Let's, how has the, how has digital health supported Stanford Children's response to the pandemic?

Well, you know, let, give background, you know, we the highest. Children's hospital in the country, we have the highest severe severity of illness of of children's, a case mix index. And so many of our patients need long-term care, not just an acute episode. And so our digital health strategy was developed under a motto I came up with of in Our Care Anywhere.

So that we are already getting to know the patient before they come for care and we're keeping 'em in our care in partnership with their community Physicians, when they leave us, many times, many of them need multiple interventions, and so we wanna be able to monitor the patient's status. As real time as possible without batch meetings and appointments, but continuously, and we've actually been a leader in developing glucose monitoring.

Also now congenital heart monitoring for patients with congenital heart disease. When Covid hit. I mean, I think that at the end of the day, CIOs are change leaders. We're not technologists. We're change leaders. And one of the best things that happened to us with Covid, the silver lining, was adoption, went through the roof when there was finally a need, all the barriers went away.

And our telehealth platform had to actually be replaced because the one we were on didn't scale. And so by, by two, three months into the pandemic, we converted out our telehealth platform. And what's really cool is that it has sustained itself and actually growing. We are seeing day. We used to see 20 max and all of the providers are really interested in using it.

It helps them, as you said, it helps cross infection rates go down. And I think another really creative thing, bill, 50% of our hospital is ICU level. I mean, it's, as I said, it's highest acuity. One of the other things we did, and it wasn't, is it was our clinicians. We really innovated telehealth capabilities on the inpatient floors because patients had to be in isolation.

We've restricted access to the hospital during covid to prevent cross transmission, and basically the rounding teams. Now the.

A mobile like a cow computer on wheels enables with telehealth. So only one clinician goes in the room when they go on rounds for all these patients and it's really prevented cross infection. We haven't had one case of cross-contamination of in our healthcare workforce beginning.

Provider. So we're really practicing the ultimate in safe practice and telehealth technology has been one of the greatest tools we've deployed to, to help. Let me make sure I got this right. In our care. Anywhere. Everywhere, is that correct? No. In her care anywhere. In our care anywhere. Yeah. And I, I think that's kind of the motto of our digital health program.

And, uh, we've had a quite a history on that. We didn't invent it on time of covid. We had something to scale. Yeah. It, uh, no, I love that. As a, as a organizing principle, you know, in our care, everywhere is a, is a great organizer principle, especially . Yeah, I mean, COVID just accelerated everything that was, that was going on, and that's, that's what we have seen, you know, it's, I think just Bill too.

Just one other, I think differentiating thing, we also integrated the telehealth into our EHR. We use Epic here. As a lot of people do in Northern Cal Zone, but a lot of health systems put Telehealth on the side of Epic. We integrated it into MyChart so that the patient can log patient and family log right in to their MyChart account, schedule an appointment, and activate.

Everything's integrated in. Which is a real boon for both the family and the providers who are trying to, trying to deal with multiple technologies. Yeah. Single, single point of entry's. Great. So it, the organizing principle during the pandemic is safety and, and speed. Obviously we're, we're moving fast and we're doing it from a safety perspective, but what will, I mean, how do you, how will you guys organize and how will you determine what projects to, to do?

Well, it is a great question. We, again, I think seven years ago we formed a digital health steering committee and you know, I'm a big believer in governance and inclusion in participation. So right away we established an executive committee for is, but subcommittees under it led by business owners and in the case of digital health.

Some people thought the CIO should lead that, I did not. So I convinced our CEO that I should co-chair digital health steering, along with our chief medical officer and our executive over ambulatory care. And it really worked. That committee has stayed together and expanded now, and it's also now led by we have a dedicated director for digital health.

Our CMIO is co-leader, co-chair of that committee, the CMO, and the head of AM and I are still on the committee, but we've been going for seven years or more and evolving it. Um, the priorities come in there into the meeting. There's a lot of. As I earlier around Stanford and being in Silicon Valley, but it's a very thriving environment, and that's how we do it.

It's through participation and inclusion of our business and clinical leaders and I I don't see how you could do it otherwise. I agree. Yeah. I, so looking at priorities as.

It's, it's interesting you hear Stanford and you hear, uh, Silicon Valley and you think, oh, well, you know, you have unlimited resources, unli, you know, all the smartest people in the world, that kind of stuff. But the reality is you have limited resources, budgets, and those kind of things, but what do you, yeah.

What do you anticipate the priorities are gonna be coming out, coming out of the pandemic, whenever that is? Yeah, I think that, I mean, we've learned a lot. In the industry. It's almost embarrassing how much there's no flu season this year because of our isolation and not bringing people into clinics, but using virtual care for appointments that you can do just as easily or better on video.

So safety wise and quality wise, that's been a significant advancement. We also have a significant goal to improve access, and a lot of this, it's in really two ways. One is geo. Geographically, it's very hard to drive into Stanford from anywhere in Northern California. It takes a parent or another adult every time a child has to come for an appointment.

But I think the other thing is for people who are underserved, digital health can break the barrier of access difficulties and geo geo access difficulties. And we actually are starting a program with our foundation to uh, uh, enable technology for those that don't

reach a audience. The later things happen, the worse the outcome. So the earlier we can get upstream and screening and saying, yeah, you should come in for an appointment, or No, we don't need to. You can do this. We're seeing tremendous growth in that and much broader access for patients. Um.

They relax the interstate restrictions, so we're seeing patients from other states now that we weren't able to before because of the relaxation on that and the credentials for that. I think I mentioned the other thing that we treat very complex patients that are long term. Chronic complex, and so we need to keep 'em in our care or be a partner in their care for long periods of time, and so we can predict when their next intervention is needed.

Finally, I, I'd say this bill, one of the things that distinguishes us in our innovation and our digital health is that we literally apply it. We see a problem and. Why can't we solve that problem with technology? And because of that, we're, we're testing and iterating right in the clinical environment as opposed to a laboratory that we now gotta go pilot it in.

We're actually doing a real time. So it excites our clinicians to see improvement and we're right there improving the care process with real problems. Yeah. From a, from a technology lens, I, I mean more from an IT lens and less from a, from a healthcare lens per se. The, the, so is access one of the biggest challenges facing pediatric health, uh, patients in California today?

Yeah, definitely. I mean, there's, there's about four or five children's hospitals. I'm trying to think. There's two here, two or three in LA and one in San Diego. So, I mean, what's really interesting is I think pediatrics is only 6% of the population, so it's, it's really hard to sustain. The issue is when children need care, and most of them don't when they need it.

So restricted. Large urban area centers, children's hospitals. But where do most of the kids live? They're all over the state, and it's a big state. You know, we got 40 million people, so anything we can do to take friction out of access. That's an initial screening or continued monitoring in your home where we're capturing the data real time.

Anything that we can do like that improves access and it broadens the access to larger populations. Yeah, I, I wanna come back to some pragmatic stuff, but I wanna touch on, you know, former CIO of the year. I don't know, do we say that former or once you're ACIO of the year, you're like. Like, that's like an emeritus thing.

Yeah. Uh, well, I mean, you not only have CIO of the year, you have a lifetime achievement award. You know, you've been doing this, I, I guess that says you've been doing this a long time. You know, I guess the question is, what makes a great cio? What distinguishes the good from the great CIOs and healthcare, what.

Oh, that's a great question. Everybody asks me that. Like, what are your critical success factors? And I think, you know, the, the thing I said earlier that CIOs are really, champions have changed and too often we're put in a technology bucket and too often we put ourselves into. And you basically isolate yourself, and that's the wrong thing to do.

The best CIOs, I know, they're, they're constantly out there as an executive. They're, they know the business, they know the support services. They have trusted relationships with their colleagues and throughout the organization. They're a, they're a change leader and a developer of capability and people. I would say more importantly, they're a servant leader.

They're not here for themself. I, I can't do anything myself. It's all about the team I develop and the trusted partnerships I develop with all the business and clinical leaders. And if we're a servant, they're gonna come and ask for our help. I found this over and over again. If you have the right attitude about learning and finding out more and investigating and going out there in the business, not sitting in a office somewhere and you never see frontline business, that's the key.

I think one thing that really worked great here was we launched lean. A lean management system and I was part of launching that, and that really teaches you that you're here for others and growing capability. The team I've developed here is totally. And scalable and resilient, and we have some of the best leaders in healthcare in, in my own team right now, and that's what you wanna do because then they bring on the people that wanna work in a development environment like that.

So I, I've just been amazed at what we can do with the right kind of thinking and approach in looking out for others fundamentally. I, I, I agree with you. It's, uh, it is a, it is a role where it's, it's, it's definitely not about you. It's about how you're gonna serve, but the, the aspect of developing a, a team around you, that, that seems to be, and I've talked to a lot of CIOs now and you know, the one that are able to.

Not only identify and hire good talent because you know, even average people can do that, but develop that talent. But that, that seems to be one of those, one of those characteristics that really differentiate the, the, the good from the great CIOs that people that are able to develop the next generation of leaders that are.

Literally seven or eight or nine people that have all been through the Chime, CIO bootcamp. Our CMIO is faculty and the CMIO bootcamp and they're national leaders. Phil, I think the other thing I'd say is great CIOs have great networks. I, I can call up practically anybody in the country. And they'll take my call and vice versa.

And it's not just, chime is a great example of that. There's other groups like the CHA, children's Hospital Association, CIO Group, high C is another group I'm a member of. But we take this stuff seriously to help each other. And I, I can tell you without doubt, decisions are made between peers. They're made between a sales pitch and a client.

It's your, your reputation is your marketing arm and nothing else. . Yep. To be quite frank, it's not based on experience and we all talk, so, so having a network that you are respected him. Significant success in my opinion. Absolutely. Well, let's get back to a couple of pragmatic items. You know, regulatory is huge.

It's, it's always huge. How are you guys doing with regard to the transparency rule and Century Cures for that matter? Well, you right before it was supposed to be live, there was a delay. And now there's a lot of debate on the April date whether pediatrics should participate. There are a lot of unique privacy issues that come into play around pediatric patients.

Apple Health record doesn't even work for children today because of those privacy restrictions. One of 'em is that after the age of 12, the parent can no longer have access to the, to the health record of the patient without the consent of the patient. So we.

The data from the parent who already has access to the record. That's a great example. So, and those laws might vary by state also. So one of the things we just though did last week though, we had our as exec committee. And our CMIO, who's a i, I don't, none of these people work for me. I work for them, but she is a big proponent on, on pushing the boundaries with this.

And we are gonna go up with it in, in April for our pediatric institution, and we're gonna keep working. Our vendors and others who come in to, to promote the unique needs of pediatric data sharing, which exists out there through regulatory and other reasons. So we're doing well. We got a lot of work done.

We are anticipating challenges, but you, we wanna be on the forefront of this because. It is part of the next level of iteration and innovation. The more you can engage the patient and family in their care, the better the outcomes, and we've never not proven that. So that's the goal. So the, the transparency rule calls for, you know, shoppable services to be put out on your website, but in, in pediatrics, it's interesting because again, all these things are sort of done, you know, federal, here's the, here's the rule, here's what we'd like to do.

But it's, it's interesting how different it is.

In all of California. Yeah. I mean are, but anyway, the transparency calls for that are, are you guys, have you guys made a lot of progress on that, getting the services? We just went live last week on our first set of shoppable services and price transparency, and we really had a lot of debate around that because.

As I mentioned, we're a very high acuity, tertiary, quaternary children's hospital, so we really don't have comparable services that are easily shoppable. Now, some are and some aren't, so we took a subset of those and we, on the 19th last we went live with our first set where. You've got total price, transparency on costs, what your portion is, et cetera.

Uh, it's a new field though, and I, I can't really judge it within six days, but I suspect we'll learn some stuff there. You know, one thing, bill, and we're real proud of it, we. I, men forgot to mention it when you asked about Stanford Children's, but we were rated, uh, top 10 children's hospitals in the country by US News and World Report last, last, this last survey.

And we intend to stay in that group. Keep pushing it up. So, I mean, that's the kind of place we, and when you are that level. You have a lot of research and development and experiment and data sharing, et cetera, et cetera, that most community hospitals don't have. Yep, absolutely. Talk a little bit about your EHR journey.

No, no. Well, in our hospital we had Cerner and. Okay. In our clinics, we had put up, I think it was Next Gen, it might be the other one, but we had been acquiring all these practices for three years and we were converting 'em to an interim solution, and then the board and leadership said, Hey, 90% of Northern California is on Epic.

Enterprise because of it in four months, not two years. And we had the talent here, we were under budget and we said, let's keep going. All we're gonna do is develop inter interoperability for two years and have a fragmented system. So we put the pedal to the metal and between May and September converted the whole enterprise.

We had tremendous results. We saw a 10% uplift in net revenue just by better practices. But more importantly, we were connected nationally with every other epic enabled environment and data sharing was immediate across the country. Now, fast forward a couple years. Of course, that first year was tough.

Improved outcomes on a sustained level of more than two years using our IT and analytics and our EMR. It was a huge success and a huge win for our, I think we have a world leading clinical informatics program here. We actually have a fellowship program that, it was launched at Stanford. It was the first credentialed program in the country, and our CMIO is, is director of that.

Stanford Children's is actually the host site for it. So we're cranking out new clinical informatics leaders every year. We subsidize over 12 of 'em a year. Part-time in is here in the information services, and they're innovating in the clinical environment constantly. Our latest award was last year with.

Achieving both HIMS level. We had HIMSS level seven for inpatient and outpatient. We got that in one year after our go live. We re-certified last year and got HIMSS seven for analytics as well. So we were at the time one of only seven organizations in the world have both certifications. Wow. So it, it's a, this isn't a one-time event.

This is a continuous innovation hub here that's gonna keep going Well, after I leave someday. Yeah. It, well, I, I, yes, at some point you're gonna have to leave there, you know, you have to make room for the great talent behind you. What's. Interoperability. So you're now not an island, you guys are connected in through Epic.

Is there other, are there other aspects of, of interoperability that, that you have to look into? Or does Epic really take care of a majority of it for you? Epic takes a a huge chunk in terms of Epic sites. We also participate in.

So we are doing data sharing with others. I mean, many sites still have Cerner, for example. And we have to partner with everybody. You know, the children's hospitals are kind of like the Switzerland. They, they have to partner with everybody. Yeah. Another thing we've done though is we are a major player in data registries nationally.

I practically every major illness or disease, and we participate in both the registries and collaborative research. With other children's hospitals across the country. So there's a lot of issues there in terms of interoperability. Both the adult hospital and the children's feed their EMR data into the school of medicine, into their research database to do, uh, controlled research.

Uh, also, so there's a, now we take away the identity and all that, but a lot of research goes on with our combined data sets at the school of medicine as well. So a lot, a lot of stuff going on. And of course, we partner with vendors who are on the leading edge and trying to get things moving like Apple and Google, and.

It's a, it's a great place actually. I, I get this picture and, and I, I'll just have to ask you the question. Yeah. I mean, you're at Stanford and you're in Silicon Valley. How, how often do you have some, some fairly young kid or grad student in your office saying, I've got this great idea for healthcare, and you just start batting, batting things back and forth.

As often as I let the door open, , that's what I, but wouldn't that be the fun part of the job? These guys are, they're, they're brilliant. Well, they are. The only thing is they don't see the hole. Right. They only see a piece. So that's the hard part. But we do have an environment here to accommodate that.

Mentioned fellowship. Program we have at Children's with 12 or so MDSs every year, cranking it out. We actually have a partnership agreement with this College of Engineering, and they actually have students working in our system making improvements in processing technology, workflow, et cetera. It's called the Surf Project, Stanford University Research Foundation or something.

We also do, you know, I guess it's our environment. We're here to develop people and we do a lot of interns. If it's summer or even a year, we'll we'll take 'em in and they'll work in an area in our department, like business systems.

Analytics and analytics. They're learning as well as growing while they're working with us. So quite a bit. I, I won't even mention Silicon Valley, but we also we're here to encourage that mind too. Right. You know, because it is a academic medical center developing our future generation, so. That is, that's kind of a different role than I've had a, any, any interesting projects with AI machine learning RPA, I mean, you have Stanford in your name i'd.

I'd have to ask the question. Well, I think there's a lot of it and the Center for Biostatistics and the school is, is a partner in all this, but just at a high level, at Stanford, we have one of the largest imaging archives in the world. And we are now mining that data to look, it's amazing. You're looking for discoveries in history and how we do it.

We look at patient conditions and we can now search that entire archive and look for patients like this and what, what interventions were done and what happened. So we can look in arrears at leading practices and discover correlations. It's happening already. We're also building that into decision support tools into our Epic EMR.

Already on a nonclinical side where we.

Robotic process automation. I, I, this industry's full of new terms. Right, right. Uh, but fundamentally we are doing leapfrog improvements with minor investments with just applying principles of process and technology automation. And our biggest wins right now are in.

We have a much broader digital transformation agenda that's gonna, you know, extend throughout the enterprise and our new leadership team. We've had a lot of leadership change over the last few years, but definitely adopted it. It is top of mind in our IS exec committee and we've really stratified four domains where we are actively.

Cranking it out in, in digital transformation. The one of 'em is in the provider space. The other is patient and family. The other is business operation, and the fourth is in growth and the market and all four of those domains have active digital transformation initiatives underway right now. Gosh, you, you, you, you, you take me there.

I wanna ask like 50 more questions, but we're, we're coming up on our time here, but, and, and I'd be remiss if I didn't. I, I, ed, I, I, I, I, I'd love to hear more about the work on the opioid task force. You know, you've, you've been co-chair and have established not only a, a foundation for the conversation, but action plans for health systems.

Some things they can download and just immediate, immediately implement. Tell us, tell us more about, about the work of the team. Yeah, thank you. I'm, I'm so honored to be part of that and, uh, just in three years, I mean, we just actually we're, we're three years tomorrow when we launched , and what's really cool is.

First of all, we had 30 or 40 volunteers just show up for three years, and they're from all walks of life. They're from the vendor community, uh, our partners on the foundation and CIOs and others, and we have four five task taskforce that work under there.

The work is not for CIOs. The work is for our clinicians, those who are treating people with substance abuse problems and addiction, and in particular opiates. But one of the first things we built was a playbook and online playbook for hospitals written by clinicians, and it's, it's free. It's on our website.

And, uh, it's now being updated by already being updated by that clinical task force that we just formed, and it's made up of leading edge clinicians in a medicine. We also raised some money after the Chime seeded our cost the first year, and then we raised some money the second year and we built an Act, opioid Action Center that's a public utility website host hosted at Chime.

The playbook is hosted on there. All of our webcasts are, you can go on and listen to leading experts talk. What they're doing in this space. We're now starting up a series of podcasts and they're gonna be shorter in length, but they'll, they'll also be housed on the action center. And the first series is gonna be led by a good friend of mine, bill Spooner I worked with at Sharp for a long time.

And, uh, he really working in his community with.

It's beyond the hospital. You know, this is, this is something at a community level and hospitals, we've gotta figure out how to optimize the hospital role in the community, intervention in mental health at a broader level in addiction, more finite. And that's where some of the interoperability goals we have come into play there.

Addiction is an acute.

And the majority of care that patients get is in the community. So we really need to think about how to leverage a hospital to improve the communities they serve. And, uh, a lot of work leading edge going on there. But I'm just truly honored and I can tell we just meeting, uh, the task force. And again, 30 people showed up in the middle of all this stress and contention with Covid and that, and they all said it's even more important now because what happened when Covid hit mental health went to the wayside again, and access went down.

Our, uh, overdose mortality rate is up at least 50%. And we think it's, it may be doubled. So big problem. And again, not one that's always at the front of the line when, when it comes around the funding insurance. I fought for years for insurance funding for my son who had addiction and you know, there's issues in.

I just, honestly, it was one of the most rewarding thing things to be asked to co-lead this and move the needle. I hope. Yeah, it's, I mean, the, the work you've done is, is fantastic. I've, I've looked at the playbooks. They're, they're great. Pull 'em down and they're being updated. That's great as well. Yeah. I mean, but if, if, you know, if your program is not off the ground, it's, it's, it's a great way to kickstart it.

Uh, I was, I was reminded of how important this topic was. The Tiger Woods. What is it special or episode, I forget what they call 'em now 'cause it's not a special, it's on a, B, C. It's documentary. Documentary, yeah, documentary. I mean, and you know, we love, it's amazing 'cause we love people who have addictive personalities.

'cause they, you know, tiger Woods is addicted to golf and he performs at such a high level and we're drawn to it. But that same thing led to . You know, addictive recovery from, uh, surgeries and those kind of things. And he got addicted to, uh, drugs at certain, uh, the opioids at, at certain point in his career as well.

And it is, it's, you know, it's, it's something that, uh, really affects every community and, and, and, and every health system has a role to play in this. So I, I, I love the work that you guys are doing. I really appreciate your service to the, to the community on this. Well, and you know, the friends you make through this, it's just incredible to work with colleagues and, you know, we've got leaders from Epic and Cerner and allscripts in the room, and they're evolving their products to improve things.

Our, our associate, CMIO is now helping with the most. Adding in critical questions around opioid management in hospitals in the, in the next most wired survey. So kind of that's what we do. Fantastic. And thank you. I, I know this is a really busy time for you guys. Thank you for taking the time to sit down with me.

I, I, I really appreciate it. Well Bill, it's an honor to do that and a privilege and any anything I can help with, I appreciate it. So thanks very much for asking me to do this. Absolutely. What a great discussion. If you know of someone that might benefit from our channel from these kinds of discussions, please forward them a note.

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