Making the EHR Transition with Andrew Cooper
Episode 39423rd April 2021 • This Week Health: Conference • This Week Health
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This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

 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's show is a little bit for you, a little bit for me. I'm expanding my network here in southern southwest Florida.

And, uh, I met Andrew Cooper, who's the, uh, executive director over at NCH, which is one of the hospitals here in Naples, Florida. They're getting ready to do an epic implementation across their entire footprint, and we kept, caught up with him, have a great conversation around what they're doing, how they're planning for that, how they are thinking through that kind of implementation, especially during the middle of the Covid Pandemic that is going on.

So great conversation. Hope you enjoy. Special thanks to our influence show sponsors Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you wanna be a part of our mission, you can become a show sponsor as well. The first step.

Is to send an email to partner at this week in health it.com. 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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And now onto today's show. This afternoon we have Andrew Cooper with us. I've started to do my networking around the, the city that I moved to a year ago. I moved to Naples, Florida, and Andrew is the executive director of IT at NCH here in Naples, Florida. Andrew, welcome to the show. Great. Thank you. Glad to be here.

Yeah, but we, we connected through Sarah Richardson and. How are you connected with Sarah? So Sarah worked for, uh, NCH for, and actually hired me into my original position here. Wow. Well, Sarah is a, an advisor to this weekend in health. It, she's been with us helping us to guide our growth and direction for a couple years.

It sounds like she was integral in, uh, in, in your growth and direction as well. Absolutely. Yeah. She was the, the key factor in why I chose to come here to Naples. I'm trying to figure out why she left Naples. I, well, I guess she went to Southern California. We, we went in opposite directions. I went from Southern California to Naples.

She went from Naples to Southern California. I don't know. Absolutely. I think it's a win-win. Either direction we go . Yeah, yeah, probably there are. There are worse places to be in the country for, for sure. So tell us a little bit about NCH. Sure. So NCH is Naples Community Hospital. We're a healthcare system two hospital system.

Based in Naples, Florida, we have a large ambulatory presence, uh, throughout Collier County and Southern Lee County as well. So a very prestigious organization, a high quality, high marks in almost everything that we do. So it's a very exciting organization to be a part of. Yeah, absolutely. So what, what's, what was your path to get to the executive director of it at NCH?

Oh, so it's, you know, I, we could go back, you know, 10, 15, 20 years here, but essentially I started my professional career off in banking and was hired right after an EF five tornado. I. I wiped out a, a, a couple community, uh, banks in the area that I lived in. So I started working for them as an intern. Long story short, they offered me a full-time job.

I completed school there, uh, and graduated as their AVP over it. Um, really? I'm sorry, a five tornado. So that must have been in the Midwest, I assume? Yes. Yep. That was in Nebraska and EF five tornado, which if people don't know, tornadoes is the strongest of tornadoes. And so yes, obviously it was life altering for quite some peop, quite some people, yeah, no kidding.

At an f fi tornado. So compare and contrast an F five tornado and, uh, hurricane Irma. Ooh. So I would, on any given day, I would live through a hurricane again before I would live through a, uh, tornado. At least with a hurricane. You have general, uh, idea of when it's going to come at you and, you know, kind of

You know, there's still a lot of unknowns with it, and hurricanes are not fun by any means, but you have a lot more time to plan and prep. Whereas, uh, a tornado, you can have a matter of seconds to get into the basement. And, you know, truly down here in, at least in southern Florida construction, everything is designed to withstand a hurricane.

And you just can't really do that for a tornado. So a hurricane doesn't surprise you. But you know, the, the, the movie Twister really is true. An F five could come up out of nowhere and. Just take a left turn and head towards your town. Yep. And it essentially will level ev F five will level everything in its path.

Well, I, I remember the, uh, I don't know if it was an F five, but the h or the tornado to hit Joplin actually moved the hospital. Think about this. It moved the hospital off its foundation and it only moved it a couple of inches, but it was enough to condemn the building. Yep. Absolutely. That's amazing. I, I, I can't imagine the, the power of attorney.

I'm sorry, I got, got sidetracked there a little bit. So, so you were in banking, how, how'd you get into healthcare? So, while I was in banking, I did a lot of mergers, acquisitions and really had gotten to a point where I had optimized. I kind of done everything I needed to do for that organization and quite frankly, I was getting a little bored.

And so my mentor at the time Rec recommended that I go back and get my master's degree, focus on my C-I-S-S-P. And then she said, you know, healthcare really needs individuals like me, and so. She really pushed me to look at healthcare. So I took that opportunity, joined a small, uh, 115 bed hospital in south central Missouri after the bank, was there for a short time, became a director of information security for a, uh, level one Indi Indigent Care Hospital in Memphis, Tennessee.

urced our IT department as of:

Wow. Yeah, so I, you know, I, I did an insource. That's not as easy as what people think. I, I inherited an insource in that. They, and, and we're talking a, a sizable, you know, 10 year outsource to, uh, Del Pro. And then, and then the CIO before me started the insource. And then I had to insource. You have to build everything from scratch.

I mean, you know, job classifications, you have to build the career paths. You have to build, you know, processes, procedures. You know, just, it was amazing how much you have to do on an insource that I, I don't think people would be, I think people would be surprised how much you have to do. And, and of all that list, I think writing 80 some job descriptions was the hardest part.

Just trying to just create them all, keep track of all of them. But yeah, you know, it really gave us, gave us an opportunity to look back and say, what do we as a leadership team wanna do different within it? And kind of build that groundwork from, from the start. And I, I will say, in the short amount of time that we've been in source, we've really built a fantastic team.

Well, so you're, you're in healthcare now. What's the equivalent to an EHR project in, in banking? Is there an equivalent? So in banking they use what's referred to as a core system. So that is your, your main banking software that has everything that interfaces in and out of it. And I have been through seven, we'll call it mergers or conversions, uh, on banking software and banking's quite a bit easier than an EHR conversion.

When you look at changing out the technology, um, is it, is it real? Why, why is that? Well, a, you don't have to worry about. Radiology images and how large those are, and trying to figure out how those are going to live and everything. And you know, in banking it's, it's a lot more black and white. You know, you have credits, you have debits, you have check.

Today, you probably don't have near as many check images coming in, but it is, you know, you're not dealing with the full, the full body, the full human. Aspect in, in the banking environment. So a lot, a lot more data elements, a lot more images, a lot more distinct systems. I mean, that's one of the things I've done.

I did work at Bank of America and some other places, and then when I got into healthcare I was, I was shocked to find, you know, 900 different applications at our health system. And then you start digging in and you realize there is a bunch of redundancy obviously, but. Each there, there was software written for such specific tasks within healthcare.

It really was kind of amazing, right? Yeah, absolutely. And I, and I think really in, in, in banking too, you had a, they were using technology a lot longer. They had been using technology a lot longer. then healthcare, you know, and so you really were, had processes and you had really were applications, which we, we healthcare are, are getting there very, very rapidly.

June timeframe with a June of:

So it would be a very quick implementation. Wow. That is that. Well, so it's two hospital system. Do you have, do you have, uh, clinics and, and a lot of outpatient as well? Yeah, we have, we have about 40, 40 plus ambulatory facilities. You know, overall we have about 7,000 users. In our environment, it's a combination of medical staff, employees, contractors, et cetera.

Are, are, you rely, I, I assume you're relying on a, a vendor or contractors to help you to do this. So we are actually the, the EHR vendor is obviously going to help us quite a bit with the implementation, but overall we are only pulling a very small subset of contractors. I want to say in just of quick count, four or five means really to augment us where we need to be augmented.

So what we're planning on doing is implementing a kind of an out of the box EMR, which, you know, or is kind of a new technology or a new term, but really what's being delivered to us is gonna be about 95 or 95%, 95 to 98% pre-configured when it comes to us. And then we just do the personalization that we need on top of that.

So are, and you can say the vendor, I assume you're going to epic. Yes. Yep. We are converting from Cerner to Epic, so you're gonna stay as close to foundation as you possibly can. Stay true to. Foundation is one of our guiding principles and one of the things that we talk about with the executive team every single time, and it's truly because it feeds, feeds analytics, it feeds training, it tests, scripts, everything that we are planning on doing is built into the foundation system.

Wow. That's. . That's really fascinating. So what, what is the challenge of trying to stay as true to foundation as possible? Do you find you're being pulled to try to customize all the time? So, you know, we, we really haven't gotten into those workflow walkthroughs and started to talk about where we need to deviate from foundation yet.

But we are coming from a completely customized EHR and that that's, that's not a reflection of the vendor that is truly just us as an organization over the 20 plus years that we've used that technology, that we have customized it. And so I, my personal opinion is I think the biggest challenge is going to be getting away from.

Customization in general and having to adapt workflows and, and things that we as an organization do to match what the, what is recommended in the software. Right. So that, that's really changing the culture. I mean, there, there's a cultural mindset that comes with customization that we did a, a significant EHR build out and whatnot.

And the number of times you hear, yes, but we're different. And I'm sitting there going, how different can we be? There are thousands of hospitals across the country. Uh, now I understand if we're doing, you know, something you, you know, Mayos or UCLA medical center ask, you know, we're, we're doing academic kind of stuff, but the, the general community hospital or integrated delivery network, it really shouldn't ha, I mean, this is me talking, I'm, I'm not putting words in your mouth, but it really shouldn't have to, to.

Go too far outside the, the, the standard build, uh, I guess if you can, if you can pull it off there, there's a case to be made that you should be able to run the hospital with as close to a standard build as possible. A absolutely. And that, that's why it's part of our guiding principle. So the, the foundation system is built off of the best practices of all organizations that are using Epic.

And so, you know, whether that's Cleveland Clinic or Mayo or you know, even other local organizations here that may be using Epic, you know, all that information, all their, their best practices go into that foundation system for us to leverage. So I. Yeah, I, I think we're really excited about that 'cause we've really, we've really felt some of the struggles with the, the system that we've customized over time.

So I, I talked to some people that when they did, when they went, went through this process, they ended up putting their staff on the EHR project and then they backfilled for the existing system. And I've seen, I've talked to others that essentially brought in. Migration to the new system and their team continued to do what they were doing.

Which, which direction did you go? So we, we are actually pulling individuals into the IT department. So we are growing by about 35 to 45 individuals within the IT department to take on the conversion to Epic and truly. Epic has given us that staffing guide of how many positions do we need during the interim long term as well.

And really the interim to long term, there was maybe just a few positions in there and we know over time that there's, you know, individuals that are gonna choose to leave us. And so instead of pulling contractors in that are gonna take all that knowledge the minute they walk out the door, we actually just bumped up our, uh, FTE count during the implementation.

To ensure that we could cover everything. Why really people are gonna leave Naples. I don't know what's going on. Did, did you set some, uh, goals for this, uh, to sort of guide the project of, in terms of, uh, success metrics, KPIs, those kinds of things? So, we are originally, when we, we were planning the project and everything, we looked at, you know.

Very high level, improve quality, improve patient satis, patient satisfaction, physician satisfaction. We looked at those, we're currently in the process of going back and tying the metrics to that. I mean, really it's, it is a comparison of what can we get out of our current system as opposed to what we can get out of the, the new system.

And so as we build out our governance structure, they're, each of the subcommittees will have their key metrics that they track and report back to the EHR governance at the highest level. Governance committee in, in the project. What, what, what was the primary driver to go to Epic? I mean, what was the deciding factor?

So really some of the, we've had a lot of challenges, and again, a lot of this is because of the customization that we've done over time. And, you know, we, we didn't necessarily always acquire the appropriate modules that we needed in our current system. And so we would do a lot of custom build. And so we really wanted to take a step back and say, how do we kind of set ourselves up for better success, uh, long term?

And we, we did a side by side between basically a complete new install of Cerner, converting to Epic. And really as we got into it, looked at it. You know, converting to Epic for us was the right decision because it has the, the completely integrated revenue cycle. Today, our ambulatory revenue cycle is on a completely different system and there's some manual entry and stuff that has to occur from that, you know, data analytics and was very important to us.

bout your projects going into:

So this is pretty much all encompassing and it is, this is on the strategic plan for the organization as our CEO has said. This is . One of, if not the top project for the next 18 months. Obviously it was a few months ago when we talked about it for the organization. And so our current environment entered into what we refer to as break fix regulatory only mode as of March 1st.

So we won't even be investing, uh, a lot of. Time into building, building that system. Obviously we have to maintain it. If there's regulatory changes, we have to do that. But truly the focus starting, um, as of April 1st will be building the Epic system out and doing the conversion. So this, this is Bill Russell hitting you up for some free information.

So what are you gonna do for me? The, the consumer are, I mean, I, I assume you're gonna use Epic tools. I'm gonna, I'll be seeing my chart. And are, are there any other things you're thinking in terms of the digital landscape for consumers in the market? So the big, the biggest thing that we're doing, you know, out of the gate is, uh, really that patient engagement.

And I, I'll be the first one to say that not too long ago I had to go see my primary care physician and they handed me the clipboard that was like 12 pages longer, the same information that I had just completed. You know, a few what felt like a few weeks ago. And so, you know, being able to pull that into the MyChart, into the, the patient portal, get that information when it's convenient for me as the consumer is, is on our roadmap.

Doing the online scheduling, being able to schedule appointments, not have to call into the facilities. You know, there's a lot of cool things that we'll be able to do long term with integrated devices and stuff like that, but really out of the gate is kind of like for like, where can we make the biggest

The biggest impact changes, and then phase two will be kind of the optimization, pulling in some of that other cool technology. Yeah. I, I hate to do this to you, but my, my father-in-Law actually went to one of your competitors over on Pine Ridge, and their experience was actually from a digital standpoint, it was actually pretty, pretty good.

I was kind of, I was, I was kind of surprised. I mean, obviously they're, they're already an epic shop. And a lot of it is based on that, that epic foundation. So you guys, you, you guys will be able to catch up, talk about interoperability on that side as well. So I, I assume a majority of the health systems in Southern Florida are, are on Epic.

Am am I correct? So there's actually, uh, a big shift that's occurring right now from Cerner to Epic. And interestingly enough, the one that you're referring to is on Cerner. They're on a Cerner platform. Are they really? Today, our, our, our neighbors to the North are on Epic. And so, you know what Advent Health from Orlando is in the process of converting, you know, Lakeland Health.

There are several organizations here within Florida that are in the process of converting onto the Epic platform. I, you know, I, that's interesting. I I, I didn't ask what EHR if they were on, but it just felt like it was . It, it, it was pretty, it was pretty smooth. I was kind of surprised. So what about HIE, what about, what about information exchange?

I mean, uh, do, is there a, a good strategy to move information around in, in this market? Yeah, absolutely. And that's interestingly enough. Tomorrow we have our executive kickoff, um, for our team, and one of the main topics is interoperability and. You know, with Epic there's multiple different ways to do that interoperability.

But when we set out, set out, um, initially to start talking about this conver talking about the conversion, which at this point has been almost two years since we started talking about it, um, it was the number one thing that we talked about is if we can't share information freely in the community and with other.

Healthcare organizations, there's no point in us doing that. So we've really doing the conversion. So we've absolutely have it at the forefront. It was included in our contract for day one. And there again, there's many different ways to do it, you know, for us. And you know, Mayo, it it, I know it's well known that Mayo's on Epic.

We refer a lot of patients there. We can send information back and forth real easily. And then even organizations that aren't on Epic, we're able to leverage either direct connections or through an HIE to share that information as well. How so? You know what, what, what information did you add to bring across from the, from the old platform?

Is it the, the traditional Pammy stuff, or are you bring trying to bring as much across as possible? So you, you're hitting on all the stuff that I've actually talked about multiple times this week internally for the organization and this, we've not actually set our true data migration plans yet. And so that is one of the next big things for us to figure out.

And, you know, really. The, the stance that we are taking is we have a brand new, nice, neat, shiny system. And the last thing we wanna do is take information and, and again, this is not a reflection of the system, but the, the data that's been put into that system over 20 plus years, and convert that into nice new, uh, system.

So we're working to get a, a, a group together to be able to determine the quantity of information that we're going to move over. And then, and we are going to leverage some of that HIE. A functionality to be to make sure that we can put stuff into a holding tank and actually have it ingested into Epic at the right time.

But we're also doing that coupled with a full enterprise archival platform. So all of our legacy systems are gonna move into that archival platform. So our physicians aren't going to have to go to three or four different applications to find all the information on the patient. They'll go to one and it'll all be listed there.

So we've already signed that contract and we will kick that project off this summer in advance of the conversion. Yeah, just outta curiosity. Your enterprise archive, uh, solution is what? Uh, it is Triam. Okay, cool. Well, I, it, it'll be interesting. We'll have stuff to talk about a year from now, . Absolutely.

We're really excited about this. Yeah. It'll be, it'll be interesting. So talk to me about your, so I'm gonna change. And keeping them trained. Obviously, retention, you know, I've heard this a couple times now, it is beautiful down here, but retention in Naples is, is hard for a lot of different businesses. You know, what kind of, what kind of things have you put in, in place to, uh, keep your staff engaged, keep 'em trained in those kind of things?

uilt our new IT department in:

We have individuals that are, that are in California. We have, we've just extended an offer to somebody who's actually going to be living in Jamaica, and so we're really excited about that. Being able to leverage, leverage the entire population and not force individuals to move here. We, we do have. Staff that have to be here on site and the organization just made some major announcements with some changes and it actually impacts all, all employees with some changes on benefits and, and raises and stuff like that to, to help keep them engaged because it has been, it is been a challenging year and for everybody in healthcare.

And so our organization is really taking some steps too. Really improve the employee engagement as we continue to move forward from a training standpoint. So this has been something that has been built into our, our plans from day one. And you know, I can't think of a single time that we have turned down a request for someone to go off to training or you know, to attend something, assuming that it makes sense for their position.

While we were, uh, still with Cerner, we had what Cerner refers to is their, uh, just blanking on the name, but basically an all you can eat, uh, training program where our staff could go and take classes. And our, our staff took fantastic classes and, and learned a lot on the Cerner system from an epic standpoint.

Obviously they'll have to go through that, uh, certification process and everything. But you know, we really look at opport any opportunity, whether it's ServiceNow or other applications to. Make training credits and really continue to advance our team's ability. Yeah. And that, that sort of gets to my next question, which is, are there, are there areas where the, the staff has to learn new skills or new tools that you're, that you anticipate over the next year and a half?

Yeah, so, absolutely. You know, we have between last week and next week, we have about 30 to 45 individuals. Moving into the IT department and, and so what we as an IT leadership have decided to do is actually go back and reorient our entire team. So all the new individuals are learning at the same time as our staff.

And you know, it's simple things like WebEx and teams and ServiceNow and X matters that we use for paging and . You know, simple, simple, everyday use items like that on top of all the, all the epic training and, and all the new third party training that that team's gonna have to go through as well. Wow. So is orientation very different in a covid world?

So for us, you know, really? Yeah. We used to do quite a few meetings. Meetings in person. 'cause again, we have people that are here. Locally, but we've gone down to probably, I'd say less than 10% that are on site on a routine basis. And so what we've actually learned is it's much easier if either everybody's virtual or everybody's in the room.

The hybrid approach becomes really, really difficult, especially, you know, as people are having Z conversations and stuff like that. So being virtual has really allowed us to be, I think, be a lot more productive schedule meetings a lot quicker. And then we've been able to, or orient people a lot quicker than we've been able to.

Yeah. So your, your covid journey probably wasn't as challenging as others if you, you, you had a fairly sizable head start in terms of the remote work aspect that everybody had to do. So that I, I would, I assume that that jump for your health system was, was not all that challenging for the IT organization?

For it? No. 'cause even the, you know, the other. 30, 40% that were onsite employees were still working from home on a, on a routine basis, whether it was one or two, three days a week. So they were going kind of through that rotation process. So they were kind of used to it. You know, the, I think the biggest thing is, is we just made sure that everybody had the hardware, the, the, the web cameras, the monitors, everything that they needed that they didn't necessarily have if they, uh, were not a hundred percent virtual before that.

Did, did you do MS teams or are you a, you're a WebEx shop? So we, we use WebEx for the bulk of our meetings when it involves people outside of just it. We do have teams as well that we use for it, but we, we find that people use WebEx or is it maybe a little bit easier to use WebEx for non-technical people?

Yeah. Well, I, if you say so, I find Zoom to be the easiest to use. But you know, when, when Covid first started, it wasn't the most secure platform out there. So obviously they, they've made some, uh, great strides since then to shored up. You know, I, I mean, just talking about Covid, I mean, I mean, was there, you know, outside of work from home, we had a lot of, uh, different things that went on in the hospital.

Was there anything, anything, any interesting requests that you got as, as the leader of it? Around, you know, helping to keep frontline staff safe or anything to that effect? Y yeah, and you know, I, first, I wanna start by saying that our team, our, the IT team, the entire organization, uh, feel we did a fantastic job with responding to covid.

And, you know, there were items, for example, in Cerner, there's a banner bar, and it just gives basic information on patients and . There was a lot of custom build that our team had to do to say whether or not the, the patient was positive or if they had been tested and all that information. So it shows up at the top to be able to keep people, both keep our patients and keep our, uh, employees safe.

I. You know, there were at, at one point there were triage tents that are outside in the emergency department, parking lots that our team had to equip, you know, had to put workstations and, and make sure all that equipment and everything is out there and functioning. You know, we had drive through testing and so the IT department had to put information or put systems together and stuff to be able to make it.

Efficient processes out there in the drive-through, and even myself, there were for about a two week period, I was the IT representative that worked out in the drive-through so that we could help work those processes. I was here on site and so, you know, really the, the list of requests that we got during C-O-V-I-D, you know, is so long that I couldn't probably isolate many items, but, you know, our team was able to.

Our team was able to come up with something to support every single request. Uh, when was our search or did we have multiple surges? Because it, I, I, to be honest with you, I'm living here and people have asked me like, you know, when was your search in Southwest Florida? And I'm like, I think it was when everybody else's was, but it wasn't obvious to me.

ge at one point? So summer of:

And of course, you know, it's ebbed and flowed, um, through there, but we, we never got near the level that we were last summer. Yeah, we, we were, yeah, we, we could go down there, but this is an IT show, so I'm not gonna ask you about stats and and those kind of things. Are, are you guys participating in the vaccine?

I assume you're part of the vaccine rollout in, in southwest Florida, as are the other health, I assume. Yeah, absolutely. So our, uh, first initial. Shipment was earmarked for healthcare professionals. So we, we, I think we had about roughly 5,000 vaccinations in the first shipment for, for healthcare workers focus.

hat. And we've had around the:

So I imagine a lot of that's going through like Publix, the grocery stores, the, the pharmacies. Which just, you know, truly have more facilities, more, more capacity to take on some of, some of those vaccination efforts. Yeah, yeah. ab ab, absolutely. So we'll have to see where that, where that goes. I mean, you know, you guys are, are doing an EHR plan as, you know, COVID iss hitting your ramping up things for, you know, work from home and, and other types of initiatives to support.

I, I, you, I, I'm just curious, you know, what, what do you think the, the lasting impact of, of Covid is gonna be on the way that your health IT team operates? So, we were, interestingly enough, we, my, my boss and I were talking about this just the other day 'cause. In the middle of, you know, an EHR conversion and all this fun stuff, we as an organization have acquired another facility and are moving one of our operation facilities into this new, to this new building.

And the conversation was, what space do you need for it? And I said, I personally had no intention of bringing more staff to be on site and really, you know, want to continue that virtual. Um, I know as we start to kick off a lot of the epic stuff, typically it would be an in-person. But we're doing a lot more of it virtually, and we're, we're seeing we get much better present participation from the organization because we are doing it virtually.

You know, I think it, it really drove home that customizing an application is not the best thing for organizations to do because again, we, we were paralyzed during covid and had to custom build everything because we had customized our environment so much and. Just today we were talking to Epic about here's all the different things that they were able to offer during Covid for people who had been aligned to that foundation system.

So I think there were a lot of really good lessons learned that we may not have been as stringent on with the Epic implementation if we hadn't gone through Covid. Well, I, you know, I'm looking forward to seeing how things transpire for you guys. There's an awful lot of exciting things that come with doing an EHR project and an awful lot of.

Challenge, I guess is is the right word. You know, having done these before in three different states, it's, you know, there's just a lot of conversations, a lot of moving parts, and. You know, it's an exciting time. It's an exciting time for the team, but there's an awful lot of work ahead of you. You know, I congratulations on, on moving it forward, but, you know, I, I just, I have some empathy for what you're gonna be going through over the next couple months as well.

Well, I, you know, I appreciate that and I will say, you know, a lot of the physicians said we would rather take the pain of doing an EHR conversion to know that it's gonna set us up for long-term success. And I, I think we as an organization, we're . All very excited for this conversion. And so us as a team, we, we will make it through as we always do.

Absolutely. Well, you know, good luck and I noticed you have black hair and you know, you see mine's all gray , so we'll, we'll catch up with you again next year and, you know, see that, you know, talk about the implementation, how it went and some of the lessons learned. I think it'll be a great conversation.

Absolutely. Well, thank you Andrew. Thanks for your time. Thank you. 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. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to this show.

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