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Those are the two biggies is safe automation and patient engagement, patient empowerment. And then if you, move away from the technology side or at least couple it with the technology side, it's teams, right? The care team is what's gonna make the difference and everybody working at top of license in a properly staffed environment. And I think that's a huge part of what's going on now. There's not enough nurses, there's not enough PAs, there's not enough doctors. So the ones that are staying behind are just doing more and more and more.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, a channel dedicated to keeping health IT staff current and engaged. Special thanks to CrowdStrike, Proofpoint, Clearsense, MEDITECH, Cedars-Sinai Accelerator, Talkdesk and DrFirst who are our Newsday show sponsors for investing in our mission to develop the next generation of health 📍 leaders.

All right. Today it's Newsday, and we're joined by Dr. Colin Banis, CMO for Dr. First Colin, welcome back to the show. Thanks for having me. Bill. Let's see. We've got a lot of stuff going on. We still have the Common Spirit outage. We'll talk about that a little bit.

But I think our lead for today is probably going to be this story Let's, let's go to the Becker's version of this. So, Bain Consulting did a survey, and this is right in your wheelhouse. 25% of clinicians went out of healthcare. One quarter of US physicians, advanced practice providers and nurses are considering switching careers.

And one third are considering switching employers according to newly released surveys. So they had six primary things. Of the 25% of clinicians who are thinking about exiting healthcare entirely, 89% site burnout as the main driver. Well, let's stop there for a second. 90%. Site burnout of that 25%, right?

So if the total number is 1,250 they're saying 90% of those 250 are essentially saying, Hey, it's a, it's a burnout issue. this is a serious problem for healthcare isn't it?

Yeah. That, that, that's bonkers to, to think about the amount of time and education that you've put into getting into the healthcare industry and any of those professions and then saying, You know what? I want out alltogether I think that's, It's a crisis.

Yeah. That is a, I mean, what if you're a physician saying, I want out altogether. What are you gonna do? I mean, you, you have spent an awful lot of time in training. , and whatnot are you essentially going to head in another direction outside of healthcare, or are you going to. Search for maybe a smaller practice, a physician run clinic or something to that effect.

I've seen a couple flavors of this. I think at least on the physician side a lot of them will look for things that they can use their experience and their education that, but aren't necessarily taking care of patients.

So, very similar to my journey where I decided, at least for now, to stop seeing patients. While I pursued my CMO role at DrFirst it's still in healthcare, but it's not directly in the provision of taking care of patients. I think there's a, there's a fair amount of that whether it's consulting, whether it's the vendor space, et cetera.

I've also seen folks get out of the sort of the rat race, like you mentioned, where they'll go to a smaller practice or even boutique medicine. I've seen a number of folks. Go to, boutique medicine where they insurance isn't even accepted. A lot of the stuff that is leading the burnout is sort of taken off the, the table and they can really focus on taking care of their patients. And then you'll see the occasional Yeah, I went to med school, but now I wanna be a lawyer. That's pretty rare, but I, but I have seen it

that, that that is a switch. The concierge medicine thing always was interesting to me. Now I've lived in some pretty nice areas. When I was in Huntington Beach, California.

I ran into a bunch of people that had concierge stocks and I asked them about, I'm like, Why are you willing to pay that much outta pocket for this? And they said, Look, I had a problem on a Friday night, and my docs talk to me. I can text him on a Saturday and he gets back to me. And so there is a group of people that are willing to pay for a higher level of service and really to have somebody who is thinking about them. That's the other thing they cite. They're like look, I, I did this and this, and my doctor like called me out of the blue, said, Hey, I was looking at your stuff. It's. Really you were looking, and that's what concierge medicine sort of allows for is, is time right? To actually practice medicine. The, I don't wanna say it this way, but it feels this way the old fashioned way, right? Like , we know our patients. We're looking out for them. We know their families and we're looking out for, it's really, yeah, it's a fascinating.

Yeah, you're, you're paying for access and you're paying for focus, right? The panels are smaller. just as you mentioned, you can get 'em at 24 7. So I think there's a lot of appeal on both sides.

All right, so we're, we're gonna get back to the intersection of technology and healthcare, but let me give you a few more of these. Nearly 60% of physicians, advantaged practice providers and nurse respondents say their teams are not adequately staff.

Compared to six points from clinicians at non-physician led practices such as those operated by hospitals, health systems, parent companies, or private equity. Does that speak to the size or does that speak to the leadership prowess of physicians when they're running these practices?

That's a good question. Maybe when you put the physician in the right role for some of these practices, depending on the physician, it can be a recipe for success, actually. I was more the comment on the larger health systems and the exodus there. I wonder if that's more of a commentary on the bureaucracy or the friction of practicing in those kinds of environments.

Yeah, I think you're right. I think there is an awful lot of there's more politics. There's more top down, Hey, you will see this many patients. You need to do this panel and here's the metrics for this year. And, and they're constantly turning that dial. The next one's interesting.

Top three things clinicians care about the most in their profession are compensation, quality of patient care, and workload. According to the survey of these three, they're least satisfied with compensation and then workload. And then 80% said they're satisfied with quality of patient care. We've been talking a lot about the workload. Is the compensation still going down for physicians?

I don't think it's rising commensurate with inflation or with other economic pressures. And I think especially when you sort of put that at the intersection of increasing workload, if it's not going up, it's certainly being perceived internally as, Hey, this isn't worth it.

I think the workload is probably the more concerning of the three. I'm not surprised they see the quality of patient care. That's something that they directly control or at least they perceive that they control. So I'm not surprised that they say that they think they're doing pretty well on that, but the other two are, are killing them.

Yeah. Well, I mean, it culminates in this last statement. So number six, burnout shows up throughout clinicians days with 63% saying they feel worn out at the end of the workday. I, I'm not sure that's different anywhere in our economy right now. I think everyone feels a little worn out at the end of the day.

51% saying they feel they don't have the time and energy for family and friends during their leisure time. And that's, that's a huge warning sign. And 38% feel exhausted in the morning at the thought of another workday. So that's after resting and going to. Close to 40% of 'em say I just don't want to go into work.

And to be honest with you, if this was a friend calling you and said I, I'm worn out at the end of my day. I don't have time for my family and friends and I hate going into work 40% of of the time. What would you say to that friend? I mean, you'd have to say, you should be looking at something else.

Start looking start looking either a different organization or, or a different career path. It's just so difficult because what we started with is the amount of investment that you put in to get to that point. It almost seems unfathomable to, to walk away, which makes this survey even more interesting in my mind that people really are contemplating walking.

So at the intersection of technology and healthcare, now I understand. A lot of this is not influenced. There used to be a time where we blame the EHR for everything and we would say the EHR is causing this problem. That's not what's causing this problem. There's a lot of factors. There's economic factors.

We talked about bureaucracy. There's over documentation on things. There's. There's just complexity of the job and the demands of the job. But let, let's take all those things and let's just say that's a, a large percentage of it. There is a still a percentage where we can make a difference on the technology side.

What are you seeing in the industry as things that are potentially making a difference as we say, bringing the joy back to practicing medicine, taking the mundane and the complex out of the equation.

Yeah. It's automation, right? So anything that can automate the mundane and do it safely it's to sort of free up the cognitive load to focus back on the patient as opposed to documenting.

So that, that makes me think of your ambient listening and, and documentation tools. Hopefully the assistance, I don't wanna say the one that's sitting in my kitchen cuz she'll activate, but things like that I think I have a tremendous role in terms of technology. I also think it's time to get the patient more engaged as sort of a force multiplier.

So what can I put back on the patient in terms of. Getting the med list, right. Reconciling certain data elements, helping to create portions of the note that in their own voice. And I think we're getting there to some extent with things like open notes and shared notes and we're starting to see 21st Century cures really open up all of this patient data.

But I think those are the two biggies is safe automation and patient engagement, patient empowerment. And then if you, if you move away from the technology side or at least couple it with the technology side, it's, it's teams, right? They, the care team is what's gonna make the difference and, and everybody working at top of license in a properly staffed environment.

And I think that's a huge part of what's going on now. There's not enough nurses, there's not enough PAs, there's not enough doctors. So the ones that are behind that, that are staying behind are just doing more and more, and. more

like that idea of teams. Whenever we talk about Mayo and the model of care that they have there in terms of the whole team coming together, and they do it at Cleveland Clinic as well and other health systems try to replicate it.

I think working in a team we're able to, to sustain each other, help each other in times where things are little overloaded. Plus, you don't feel as much as when you are the hero, the one person. There's an awful lot of pressure that's associated with that. and so I think the operating as team is one thing, but getting back to the technology, I agree with you.

I think it's automation. I think it's taking out the mundane, I think it's simplifying the EHR as much as possible. I think it's going to bat for the clinicians around the documentation that the government actually needs. For some of these things. We need to re evaluate that documentation on an ongoing basis of is this critical to.

Obviously the patient safety and delivery of care, first of all. But second of all is this information we need to collect. And I think we're still collecting an awful lot of information that's not necessary, and we have put too many, too many burdens around that. So if we can simplify that and go to bat for the clinicians around that, and then provide automation and some of the other tools that can help in that area that I think that's.

📍 📍 we'll return to our show in just a moment. I wanted to take a second to share our upcoming webinar. Cyber Insecurity in Healthcare, the cost and impact on patient safety and care. Cyber Criminals have shut down clinical trials and treatment studies cut off hospitals, access to patient records demanding. Multimillion dollar ransoms for their return. Our webinar will discuss it. Budgeting project priority, and in distress communication amongst other things. To serve our patients affected by cyber criminals. Join us on November 3rd for this critical conversation. You can register on our website this week, health.com. Click on the upcoming webinar section in the top right hand corner. I look forward to seeing you there.

📍 📍

All right, let's talk about the not so fun one. Ransomware attack impacted some common spirit sites, but few details released. I'm going from an SE media article. And this is pretty recent. Let's see, this is October 17th, so this is yesterday. now into its third week of Care disruptions, a new update from Common Spirit Health confirms that only a portion of its 700 care sites and 142 hospitals in 21 states have been impacted by the attack.

There's no impact to clinic, patient care and associated systems. At a rattle off Dignity Health, Virginia Mason, TriHealth, and Centura Health Facilities officials said and a statement, Patients continue to receive the highest quality of care and we were providing relevant updates on an ongoing situation to our parents, employees and caregivers.

Patient safety has been central. You get that picture. Dignity Health is made up of 12 hospitals or care facility, and then they go through and they rattle off each one of these. It appears the bulk of the impact is concentrated in CH I facilities and Virginia Mason Franciscan Health outside of VM M C.

It appears that the impact is much smaller than sensationalized reports. Note however Carter Groom first Health advisory CEO recently explained, Patients suffer when their care is delayed, disrupted, and otherwise diverted. Indisputable consequences. And then they have John Moore from Clearwater Chief Risk Officer who says, You have to really understand what's going on here and we shouldn't throw stones and glass houses so forth.

And this is a major attack for by a nation state or whatever. It shouldn't be trivialized and we should not blame the victim here and. So couple things about this and I'll, I'll say the things cuz I, I know I, when I bring people like you on, you're working with some of these health systems and some of these hospitals, so I don't wanna put you in a bad spot.

But when I read this and I've been. On the other side of attacks, not a ransomware attack, but the other side of breaches. I've interviewed people who've gone through the breaches and the ransomware attacks as well. And I do understand that right now there's an awful lot at work, right?

So the FBI is involved. We have, so it's a crime scene. We have. We are trying to restore the environment as quickly as we possibly can. We're trying to communicate what we can out there. But here's, here's the thing I do know and I'm not throwing stones in a glass house. We will know how prepared this organization was for this type of event by how long it takes them to restore.

That's, that's the telltale. If it takes them longer than four weeks to restore this, they were not prepared for this. Now, they might be prepared at these facilities, Dignity, health, and whatever, but you don't get to say that. You don't get to say, Hey we're, we're still secure over at these 10 sites, or these 50 or a hundred sites, even when you've decided to consolidate and make the fourth largest health system in the country.

Like if we were breached at our health system and I said, Hey, this is only impacting three or four hospitals and they're gonna be down for a month. You just don't get that. You, you don't get to say that. The other thing is, there's a little discrepancy here on the communication. There are people at the Common Spirit facilities that are saying, We don't know what's going on.

And communication is so critical at this point. They are, you're talking about frontline people who have to communicate with patients who are coming in for their appointments or coming in for their chemo treatments or whatever, and you're saying, Hey, I don't know when it's gonna be back up. I don't know what's going on.

And they're complaining in the newspaper now, I'm sure they're, they're, they're not supposed to be complaining in the newspaper and that kind of stuff. But they don't know what's going on. So it feels to me like. The big merger between these two organizations of Dignity Health Common Spirit, and ch I they were not fully integrated yet.

Their security practices weren't fully integrated their communication, and they had not practiced for a downtime of this magnitude. And so if you, if you put it on the scale of fully prepared and chaos, I think it's closer to the chaos than it is the fully prepared at this point, at least at this magnitude.

So that's, that's Bill Russell that does not reflect the thoughts or opinions of Colin Banis or his company at all. But I, I mean, that's former CIO looking at this from the outside and I don't know. I have talked to some people who who have worked at the organization and that kinda stuff, and they've given me some insights, but I'm not sharing any of those insights.

I'm just essentially saying just based on the articles I'm reading, that's, that's how I'm seeing this. Have you, have you gone through a ransomware or breach at any of your health systems?

I have not, and now I don't have any wood to knock on. So you've kind of jinxed me there. But sure. But now a couple, couple thoughts come to mind.

One it certainly does sound like the perfect storm of timing in terms of not having been fully integrated fortified, unified in the merger. I think that probably is a big part of it. Where a lot of the, the information is coming from is Reddit. I don't know.

But people are getting burner Reddit accounts and posting on their experience of what they think is going on there. And so, I do think it's concerning when people say your own employees are saying, We don't know what's going on. As you pointed out, I think that just sows fear and trickles down to the patient, patient experience, et cetera.

That isn't as you've pointed out on this show many times, the CISO's number one priority in, in fortifying. The other thing that comes to mind is and I've mentioned this one other time that we got together, is the importance of business continuity planning. So not just the cyber security aspect of it, but you know, if and when it does come, how are you gonna keep critical systems?

Functioning, You heard me earlier, at least on impulse power, and I will say that Dr. First is proud to, to be working with Common Spirit to get them enabled for things like e-prescribing and med reconciliation in a web-based and mobile-based format, so at least the care can continue. I think that's an important thing that often gets overlooked is the downtime of the business continuity. So that's something. We probably need to emphasize more as an industry.

the business continuity is, especially in healthcare, such a, such, such a huge aspect. But it takes, takes time, it takes planning ahead of time. And so when you're dealing with it after the fact and you haven't put those plans together, how are you gonna do How are you gonna function without the EHR for an extended period of time?

How are you gonna get those records? How are you gonna reconcile those records? The other thing that happens and people aren't, if you continue to do care, if you're able to continue to do care without the EHR and you go to paper, cuz we we had to do this a couple times at St. Joe's. In fact, prior to, prior to me getting there, there was eight outages in six weeks, which is one of the reasons I ended up in the job at St. Was to fix that problem and they were telling me on the amount of time it took them to put all that documentation back into the ehr. Post those events is, is a significant burden. We just got done talking about how much of a burden it is already on the clinicians, and now you have to figure out how to do all that.

We've got about, let's see, we got about nine to 10 minutes. We got six we got three. Three more stories. That I'm gonna hit on here. So, Instacart, this is an interesting one for me because it leads to one of the things I I mean, you're the doctor, but you would tell me, I remember when I was talking to a doctor, I'm like what do I have to do around this?

And he says, Bill, the answer to this hasn't changed in a hundred years. It's diet and exercise, right? You're what you put into your body and how you exercise your body, you're gonna determine. to a large degree, your health outside of conditions that you are dealt with at birth and those kind of things.

So this is an interesting one and another attempt to really get people healthy food. So Instacart launches, health business as it readies for ipo, Grocery Delivery Services company, Instacart has launched Instacart Health. Which it says will work to make nutritious food more accessible and address social determinants of health.

Instacart Health aims to expand the role food can play in improving health outcomes. Actually, they're not going to expand the role food can play in healthcare outcomes because it just it just does that, but they're. Really work on access to that food. The move comes as Instacart is preparing to launch an initial public offering.

Instacart was launched in coordinated in coordination with the White House in Instacart Health, White House Conference on Hunger, Nutrition and Health. Instacart ceo participated in the conference, underscoring the intersection of food and. As well as the role of private companies, Instacart has become the staple for millions of households during the pandemic.

As we know, a lot of people were calling them up and having stuff delivered. According to Instacart, one in 10 people in the United States don't have access to reliable, nutritious food. Among Instacart's new products and partnerships is fresh funds, which enables organizations of all types, to give people funds to buy nutritious food from grocery stores.

On the Instacart app. So let me ask you this. I mean, I assume you, I, I assume you like this, right? You like, like this kind of offering as a physician?

Yeah. I think this is, I think this is cool. I think this is Meals on Wheels 2.0 in terms of being able to unite something as important as nutrition with the folks who need.

it It feels very much like Uber getting into healthcare that we've been talking about over the past couple years and sort of these nontraditional entrants Into the health and wellness space. So I'm all for it

So prescribing food plans, I assume that that's been around for a while. I mean, have we done it in partnership with Meals on Wheels for those millennials out there is the Instacart of 20 years ago and actually I think they're still around. I'm sure they're still around. Yeah, they are. it's a great ministry, great outreach to the community, but. Taking meals to people that can otherwise make their own meals or have access to it what's it gonna take?

I mean, we know how important it is. What's it gonna take for this to really take off? Is it a change in how health systems get paid? For some of this work in order for this to take off. Cuz it's, it's such an important piece. I'm just curious.

Yeah, I think that's a, I think that's a huge one, right? This is your capitation or your value based care saying flip the model from episodic to keeping patients out of the hospital. I think that's a huge part of it. And this is why folks like your Kaiser's or your folks in large value based care. Contracts are successful because they, they start to focus on the upfront, the wellness, the nutrition, the exercise.

I also think back to the idea of the care team and the, the lack of potential resources. I don't think we have enough dieticians and nutritionists. They were godsend. When I was in my hospitalist role, being able to consult with them and they're stretched thin. So I I think there's a workforce shortage in terms of folks who really have the expertise to do this sort of nutrition counseling, et cetera.

Yeah, I think it would be interesting when you send people home to say, Hey, three days a. We're gonna prescribe this three days a week. You're gonna be getting meals from Instacart, and we're going be determining what those meals are. Cause I mean, essentially we send people into the grocery store, we send them home, and they may not have access.

But even if you send me to the grocery store, I'm gonna go down the wrong aisles. And pick up the wrong stuff. And as long as I'm doing that, there's a better than average chance. I'm not going to get to the other, other side of whatever deals me. The hospital needs to evolve. If I just told you that's the title of the next article, what would your thoughts be on that one?

It would almost mirror the topics we just touched on in terms of reimbursement, why the EHR is structured the way it is, why care teams are structured the way they are. And why is there such a focus on episodic care as opposed to wellness? So it, it would, it would very much touch on a lot of the topics we've already talked about.

Yeah. So the hospital needs change. He starts with this, the hospital industrial complex focus on fee for service growth and market power will decline as margin, shrink, and local mergers are killed by antitrust review. Again, that's a, that's, This is conjecture. This isn't a news article. This is this is a blog article. It's workweek.com. Blake Madden, and let's see. He goes on further. Assuming that tough operating environment continues, my guess is that hospitals will move towards risk based contracting. I agree. Especially as payers build out their clinical service assets. It's interesting The Optum United Healthcare and the others, Cigna ever north and others CVS Aetna.

When they, they start off on that, they're already getting that first dollar of pay, and now they're heading, heading into the clinical side. And it seems like that that transition's a little easier cuz they have the, the, they have the money and they already have the right business model, right? They're, they're getting paid every month by someone to keep them he healthy.

And the health systems are, are struggling to make that transition of how what it seems like people wanna pay for health. Like as a service, health as a service, that's what we want to pay for. But when the health system comes in there, they have to really change their business model. They have to stand up a. Set of practices and go to market. Now, some have done that. Intermountain has done that, going out with a significant health plan, sharp as a significant health plan. Kaiser, as you mentioned, has a significant health plan out there and and others have been able to do that on a regional regional basis as well.

And when they do that, they're, they seem to be ready to. go on to the next level. I mean, they're able to provide that high acuity care, but they're also able to have sort of a, a more uniform income and start to work on those things that are social determinants. Are you seeing, or do you feel like we're gonna see more health systems, as he says, head in that in the risk based contract?

I hate to say the word, value based care. I understand what they're saying when they say that term, but this one is just more tangible to me. Risk based contracting. We are gonna get a certain amount of the population under a risk based contract where we're responsible for their health. Do you think we're gonna see more health systems head in this direction?

I do. Although we've been saying this for. Two decades now. it feels like and while it's starting to come, it, the, the transition is slow. My CEO in my former role used to talk about this because for, for the smaller health systems, when you're not a Intermountain or a Sharp, or someone with a lot of size to maybe be able to live in both worlds simultaneously.

The analogy he would, he would always bring up, It's like standing in two boats a stride simultaneously. One boat is the fee for service and one boat is the risk based contracting, and how can you possibly keep them both afloat without you falling in. And so I do think we're gonna start to see that because I, I think something has to fundamentally change in the way that we.

Finance, healthcare. I mean, a GDP is pushing what, 20%. A lot of people considered that the tipping point for when the whole thing sort of falls in on itself. And so, I think a lot of what ails us in healthcare is of course a direct result of the way that we finance it, the way that we operate it. The notes that I write, the, the regulations that I have to follow, et cetera, etcetera. It all ties back to the dollar.

Well, and it's a different business that requires different people and different skills. At at St. Joe's we had. We had a insurance practice, insurance carrier and we ended up shutting it down and selling it off cuz we didn't run it real well. We lost money. I know at Providence one, one of the biggest losses we had in the first couple years was Providence's insurance business out of Oregon, which just, that didn't, didn't function real well.

It's a different business entire. It's, it's interesting that United and Optum are separate. Businesses. Mm-hmm. and probably run by completely different, I mean CEO at the top, but, but run by completely different operating organizations cuz they're run differently. They're, they're, they, they think differently.

CVS Aetna probably the same thing if I thought about it. And so the, the first thing if you're a healthcare organization heading in this direction is understand you're building out a new business entirely and you're not gonna be able to take. This person over here and just pop over there and say, Okay, you're now ahead of strategy for this business.

It's a different business. It's, it's really interesting. Not much from a technology standpoint here except I've talked to some of these people that are CIOs over the insurance business as well. The risk based contract business and the healthcare provider business.

Again, one of the things I will say is the analytics on the insurance carrier business is is so critical. I mean, they, it's critical on the, on the delivery side too. But on the carrier side, it's it's It's just, it's where the money's made. It's, where the rubber meets the road for them.

So obviously something you need to do extremely well. Last story, we'll just touch on this Interland 500 million investment creates image sharing network managing 80 billion images. So let's see. Interland says it's gonna purch it. Purchase life image out of Newton, Massachusetts. And this follows another acquisition of Pen Rad Technologies earlier this year in Amber Health last year.

And essentially what they're building is a national network for sharing of images across the across the board. And they're talking about this, what is it? Lose the disc. Something the dis is there. Ditch the ditch. Ditch it. Oh, ditch the disc. Yeah. Oh, ditch the disc. That's right. Ditch the disc. And so we're getting to a point where we're gonna be able to share images nationally across this. It's interesting because it looks like their strategy for getting to interoperabilities just to buy everybody in this.

Hey, more power to them. This is probably one of the most requested things that I would get hit with in my CMIO role was how come we can't see the images from the hospital across the street.

And by the towards the end of my tenure, we got to the point where you could do sort of a point to point connection between the, the pack systems. But the amount of legwork that I had to do to submit a request and someone on the, on the radiology side had to sort of go in and work their magic to bring those images across.

It just, it was so painful. And, and you know what inevitably happens is people are like, Forget it. I'll just repeat the scan and the amount of waste in repeat scans. Especially for these large academic health systems or large tertiary hospitals is mind boggling. So if you had a legitimate network that started to push these images across the ether, you bet your, you bet your dollar that folks would pay for it.

Yeah, absolutely. Would pay for it. Whereas the, I. Model seems to sort of be floundering because no one can figure out a way to, to pay for it.

Yeah, I've told my story on this a couple times on the show, but we were able to do this in radiology. With the PAC systems, we consolidated into a single system.

We went to a cloud model, we were able to share and and they could do reads pretty much anywhere in the country, even the world for that matter. Based on the VNA and other things that we had set up. Radi our, yeah cardiology, radiology, I'm sorry, radiology packs. We did cardiology. Complete failure on my part. I, I, I could not wrangle that one in and, and make that one work. And I, I'm not sure that's what they're talking about here. Those images are massive in size. So if they're able to do that, then they will really have done something and I will be I will be incredibly impressed.

Interesting business model. Do the consolidation through acquisition. Again, if you can do it, if you don't get any push. and you can stand that up then more power to you. Colin, as always, fantastic conversation. Great to talk to you and really appreciate your insight.

You know me. I love being no

Look forward to seeing you. Am I gonna see you at Chime, fall forum or any of those

Chime, fall forum. And I've been told that I might get to play golf, so I'm looking forward to that.

Wow. Well, maybe I'll see you out there. Yeah. Thanks. Thanks 📍 again, Colin.

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