Newsday - Is Digital Transformation before Security Administrative Malpractice?
Episode 4127th June 2021 • This Week Health: Conference • This Week Health
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 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell, former healthcare CIO for a 16 hospital system and creator of this week in Health IT a channel dedicated to keeping health IT staff current and engaged. Today we're joined by Dr. Justin Collier with Worldwide Technology. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our new state show sponsors for investing in our mission to develop the next generation of health IT leaders.

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We want to make this a dynamic conversation between us so that we can move and advance healthcare forward. Today we're joined by Dr. Justin Collier with Worldwide Technology. Good morning Justin. Welcome to the show. Hey, good morning. Thanks for having me. I should say welcome back to the show. This is the second time we've done News Day together.

Thanks for having me back. I guess I must not have done too terribly the first one. No, you're now a seasoned veteran, as they say. So what's new in your world? Are there things you're working on that are exciting and are, are you starting to get back face to face with some clients? Slowly, slowly. Yeah. And in fact, I'll have a, a face-to-face meeting with a fantastic sort of smaller, medium sized health system out of western Tennessee.

Tennessee's my home state, so it's always good to, to help improve healthcare locally, act locally as well as nationally. So I'm very excited for that. And you know, I would say. What is new is renewed focus on all the things that were a focus before the pandemic to some degree, but also I would say new increased focus on digital transformation.

Seeing a lot more move to embrace the technologies that. Been dabbled in for, and some of which were accelerated by the pandemic and some of which now are being accelerated by the changes in consumer expectations that have come because of all the things that we dealt with during the pandemic, all of the digital transformation that all the other brands that we deal with went through.

Yeah, it was interesting 'cause when we, well, we did so many interviews during the pandemic and one of the question carefully worded. The pandemic, and they all really stemmed around this idea of, we did a lot of things we didn't think were possible. We did things with technology we didn't think were possible.

We did things with remote work, we didn't think were possible. We stood up things in timeframes that we didn't think were possible. And so now whenever you do that, you, you break through a barrier and so now you think, Hey, maybe we can do that with technology. Maybe we can do that a. Maybe we can do it with teams that are, are functioning a little different than they did before.

This could be, I mean, from a silver lining standpoint, clearly millions of people died. It was, it was horrific event in our history. But from a moving healthcare forward, I. In terms of the experience, in terms of efficiency, in terms of safety and other things, this could be an interesting turning point for a lot of health systems in their, their strategies moving forward.

Yeah, absolutely. I would definitely call it an inflection point. I might not use this term silver lining for all the reasons that you described. I know, it's, it's such a hard, such a hard line to, to walk, to be honest with you. I mean, you know, we're, we're safer in airports today because of nine 11, but we all wish that we.

To get to that point, but sometimes outta adversity is, is how we grow and how we get better. So, alright, so let's, let's turn to the news. There's a fair amount going on. I do want to talk about cybersecurity a little bit for those who are getting a little weary of the cybersecurity conversation. I think the reality is it of and front in Scripp.

Which feels like they're getting closer to the end of that. We don't have many details as to what's going on other than the, the portals back online. Some clinicians in the newspaper have talked about the fact that they're able to access the EHR again, so that's a, a big move forward. I wanna chat about that a little bit of how that changes the conversation.

I also wanna talk a little bit about, maybe our first story is Moody's. Moody's warns that revenue risks as healthcare cyber attacks increase. And it's not only healthcare, by the way. I mean, they, they note that these attacks are happening, uh, across, we just had the meat industry attacked this past week.

So cybersecurity is, is top of mind across a lot of different areas. Lemme give you a couple excerpts from the Moody's article and then we'll go from there. Our report this week from Moody's Investors Services found that cyber risk will likely remain high. For the healthcare sector leading to the potential loss of revenue, increased expenses, and elevated scrutiny, a large amount of the sensitive patient data held by the industry will make it a rich target for attacks, particularly in the form of ransomware.

Researchers predicted still, they said for many, for many credit risk and mitigated by healthcare systems. A strong liquidity and large scale, which often allows them to continue critical patient care amid cyber related disruption. So those are the things that are mitigating the risk that they were talking about.

Moody's pointed to ransomware as a particular danger, flagging the vast amounts of healthcare providers sensitive data. As juicy prizes for bad actors, hackers assume providers will need to restore access to patient data quickly. Although the federal, uh, the FBI recommends that the victims not pay ransom.

Moody's researchers observe that ransomware offers hackers the possibility of a large payout for conducting an attack as they demand payment by for allowing files to be restored and preventing the release or sale of. And then they go on to talk about some other thing. Efforts to invest in cybersecurity.

We'll potentially get a boost at the federal level that you're gonna have, the Biden administration did in executive order and, and those kind of things. And so we have some things coming down the pike in a lot of different directions. You know, how much has

cybersecurity. Of mind conversation within health it these days? I think it depends on the organization. It's certainly top of mind in front of the conversation for every conversation that we have with our partners, with our customers, uh, clients. However you wanna, however you wanna. Perceive them. We, we really see them as partners.

It's top of mind because it has to be integral to these digital transformations in order to keep the organization secure and to keep the patient data safe. Right? So if you're talking about remote patient monitoring, if you're talking about advanced inpatient monitoring, if you're talking about IoT for hospital operations, if you're.

ai, machine learning, deep learning. Uh, if you're talking about research, anything like that that you're talking about, typically it increases your attack surface. So there's more ways for the bad actors to get in. I don't know if you saw it, it was one of those. Darkly humorous articles that, that I happened to read in the last few weeks.

But, uh, there was a major casino that was hacked through a smart thermometer in one of their fish tanks. , it's, it's, you have to laugh to keep from crying, I guess, but, but the more things are connected, the better things operate until there's a cybersecurity breach. So keeping visibility on everything that's on the network.

Keeping it secured, having defense in depth, and to the extent that you can start to employ things like ai, to combat cybersecurity threats, to be able to analyze traffic and see when things aren't looking normal, uh, aren't operating as they should or, or seem out of the norm, and then taking action on that.

Those are, I think, really key steps. The same for the app ecosystem. If you're putting an app in the hands of thousands or tens of thousands or hundreds of. Of thousands of users, you've gotta consider that that vastly increases the number of people that could potentially let a bad actor into your system and take appropriate precautions.

So every conversation that we have when it comes to technology and healthcare, has to also be a cybersecurity discussion. Yeah. It times there's. Of the agenda, part of the things that are going on, the operations that are going on on a daily basis that you're only cursory involved in, you've hired some really good people, they're managing it and they're over it, and they're doing what they're doing.

And then there come points in time where you get heavily involved if there's a breach. You get heavily involved in security. If there is a, an operational challenge that takes down the data center, you get involved in the security operations, not not only security operations, but the maintenance operations of your data center and things that are going on.

So there are times where you, you have to delve deep into an area and then come back up because obviously you can't get bogged down in any one area, otherwise, you're not effective leader across entire organization now is one. Should be, uh, completely immersed in cybersecurity. I mean, this is for, for a couple of reasons.

I think the first reason is obviously the stakes. When we look at the scripts breach, the, the stakes are high. It takes you offline for a significant amount of time. There is reputational risk, there is operational risk, there is patient safety risk for that matter. I mean, so there's a lot of risk involved.

I guess the case could be made that those risks exist at any given time. So you should always be well-versed in cybersecurity, but I, I think this is a particularly acute time because of the amount of attacks that are going on right now and the sophistication of those attacks. I would be heavily involved.

It feels also like this is an inflection point and we made the mistake before. Mu so mu was great. We, we, we, well, lemme rephrase that because I'll get in trouble for saying, MU was great. The, the, the concept of mu was great, right? We're gonna digitize healthcare. We're gonna get to the point where the medical record is digitized.

Information digitized.

Of different issues that might exist and, and it really put data to work for healthcare and those kind of things. So mu the concept was great, but we didn't step in ahead of that and really put the cybersecurity frameworks in place. And so we essentially made it really, we consolidated all of our data, we put everything online, access to more users and, and we were moving the data around a lot better and those kind of things.

but to a certain extent, we made it easier for the attackers because we didn't put the right frameworks in place. All right, so fast forward and now everybody did what was quote unquote appropriate at the time, but now it seems like we're getting ready for another level of digital transformation in healthcare, the next level of transformation, new technologies, IoT, ai, uh, ml, things you talked about.

And it feels to me like there, there's. It doesn't have to be a long pause, but there's a short pause that should happen to ensure that the, those frameworks are in place and the security measures are in place before we step on any gas pedal to really move digital transformation forward. So it's, it's for those reasons that I really feel like this should be, uh, a, a, a top of mind issue for most CIOs.

And there's, there's probably a handful of things I'd be looking at immediately, like if, if they did compromise my. How secure are my backups to make sure that we don't have to pay the ransomware? Can I pay ransom even if I wanted to? Do I have the ability to, you know, create a, a Bitcoin account for my health system and, and pay it?

I realize we're not supposed to pay it, but I think it depends on the severity as we saw with the pipeline. I mean, they decide to pay it because, because the operational. Of not paying. It was too great. Downside on the pipeline thing is they didn't actually get bailed out when they paid. So they, the, the tools the hackers provided, as I understand it, were actually slower than the recovery efforts that were already ongoing.

And so it didn't actually help them out. The other thing is hackers may or may not even have the tools to help you out. So that's, that's the thing. I mean, they can encrypt your stuff all day long. They don't even have to have the key. They don't have to keep it, they don't have to give it to you. So paying the ransom's not necessarily a great strategy.

You've gotta, you've gotta have that business continuity, disaster recovery strategy, as you mentioned, you have to have things that make ransomware a non-issue. Those aren't necessarily easy or inexpensive solutions, but they're the foolproof solutions. Things to think about. Make a point I cybersecurity.

I said, they're getting more sophisticated. He goes, no, no, no. Slow down. He goes, to be honest with you, what they're getting is really good at one attack or one approach. He goes, I wouldn't, I wouldn't, you know, give them a huge amount of credit for being overly sophisticated. He goes, there are sophisticated attacks out there.

He goes, but some of these are just straightforward. They get in, they tool around for a little while. They figure out what they're going to do and, and, and then they do it. And then they just repeat that over and over and over again. They almost have the same labor problem that we have. Hard to find great labor that can do these highly.

And so they just replicate what they've been doing over and over again. So it's interesting. You pay the ransom, which is the worst case scenario, and then you get tools back that don't even help you to recover the you wanted to recover. That is the worst case scenario. And the other thing that these criminals have figured out.

Probably because of the labor shortage that you mentioned, but they figured out that they can sell their tools, right? So they find tools that work and then they start to make those tools available. They sell the hack, so to speak, and then whoever wants to pay for that can then go out and take on, uh, new targets using those tools.

And again, they may or may not have the ability to even reverse it. They may just buy the tool that does the hack. . So there's a lot of risk there. Realistically, I think we should probably also move from calling these just hack or breaches. We should call 'em what they are, which is terrorist acts. Yeah. Uh, and act accordingly.

And if you know that your organization is a potential target for. Any kind of terrorism, doesn't that also change how you approach the situation in terms of preparedness? In my mind it should. The question we could bounce around a little bit here is how, how's this gonna change the conversation? How does it, well, let's get more specific.

How does this change:

'cause a lot of times that's the weak link. Some of the times it, it might be an internet of things. Connected device that nobody has visibility on, didn't even know it was on the network and certainly didn't secure it. You, you have to look at those types of things as preventable, but in other cases it's, it's whoever is not either not savvy enough, not educated enough, or informed enough to be able to avoid social engineering and those types of attacks where someone is tricked into.

Giving away credentials or potentially a malicious insider who has an ax to grind that doesn't have,

doesn't have their access well controlled, and you don't have a surveillance system to really watch for those unusual activities the way that you should as an organization. So I, I think the move to Zero Trust is probably a, a great one. To help, but it can't be by itself. Internet of Things. Security can't be by itself.

Firewalls, next generation. Firewalls can't be by themselves. Network segmentation can't be by all, all of the things have to be done, uh, ultimately in order to, to keep up with what essentially is an arms race. I think there's a couple words I would want my health system to be pretty common with, and one is attack surface, which you used earlier, which is with every piece of software, every piece of.

Hardware, everything that we put in that increases the attack surface and we have to protect, uh, that attack surface. And it increases complexity as well, uh, of protecting that attack surface. So attack surface threat vectors, those kind of things. I, I would want those to become common conversations because of the things I struggled with as.

The conversations go, we have five different tools which do the same thing within healthcare. And then you, they go, okay, we'll get this group of people together. And it could be clinicians, it could be, it could be anybody really. And you, you get 'em together and they go, yeah, we use this one because of this.

Well, we use this one because of this. And that one doesn't do exactly what we want it to do. Even though the overlap is is some 80 to 85%, you're still running five different systems where you have almost complete. Overlap of the functionality of a system, but that increases the attack surface in a health system.

Do you think we can change that conversation if that gets common, that concept gets common amongst physicians and clinicians. Do you think we're gonna be able to talk about reducing the number of tools that a lot of health systems have? Yeah, we absolutely have to have that conversation. It's a topic that, you know, we've, we've kind of coined the phrase at WWT.

It's, it's application and asset assurance. It's making sure that you have the right combination of tools, not more than you need. So there's an effort to simplify and it's, it's not just the right thing to do for cybersecurity, although that in my mind would be justification in itself. You can actually save a lot of money for your organization if you're really narrowing it down to the right set of tools or the right set of applications.

It is also easier to support, and we know that the workforce is not growing at the rate that we need it to, to being able to better support the things that you have also means that performance is gonna be better, right? You're gonna have a better experience for all concerns. So it is vital to have that conversation around cybersecurity, but it's not just one thing.

I do think that's a very, very important topic for any healthcare organization. Particularly as they're looking at needing to innovate as they're looking at needing to transform digitally, you've got to look at your legacy, uh, your legacy systems, your legacy hardware, your technical debt, and the sprawl of applications that you're probably dealing with.

You've gotta look at that, how you simplify that as you're innovating, as you're growing, as you're adding new things so that you're not just continuously exploding. Yeah. Absolutely. Well, I, I think this is one of those times where the, the, there's a platform to have a conversation, the whole change management structure, the steps of change or whatever, and it always starts with a burning platform.

And this, this is a burning platform. When we look at what happened to scripts and others and what's happening in across other industries. There's a, a chance to rethink this, to make the right investments, to have the right conversations that we may not have had before. And so that's why one of, one of the things I'm just thinking as a former CIO, this, this would be a conversation that I would be front and center on at this point.

No news station shows complete without a conversation around one of the tech entrance. And it turns out stories here, one most interesting. Google Launch health equity trackers to address Covid-19 disparities and got this article from the Healthcare Innovation Group, their magazine, and lemme give you an excerpt here.

So a group of healthcare and technology organizations has developed a health equity tracker, a data platform that can highlight and address the impact of Covid 19 and other diseases on the various communities. And other vulnerable populations and marginalized communities, the companies involved in the work, the SAT Health Leadership Institute, Morehouse School of Medicine, Gilead Sciences Inc.

And Google. Foundation and the CC foundation have come together on what officials call the premier health equity focused data visualization solution capable of tracking multiple conditions and determinants that have impacted COVID 19 outcomes and exacerbated health inequities Built as a forward looking scalable platform.

The health equity tracker can ingest multiple data sets ranging from social and political determinants of health. Demographics and other variables resulting in a novel comparative approach to assessing and conceptualizing health inequities. They contend at Launch The Tracker records COVID 19 cases, deaths, hospitalizations, NA nationwide across race and ethnicity, sex and age, as well as by state and county.

The tracker also measures comorbid comorbidities associated with Covid 19, including COPD diabetes. Social and political determinants of health, including the uninsured and poverty rates. Additionally, the tracker will expand in the future to include additional conditions such as mental and behavioral health, as well as more social and political determinants of health that impact vulnerable communities, including persons with disabilities.

And lower socioeconomic economic status people, officials noted. Alright. So that's generally what they're doing. This is interesting. There's part of me that's, from an IT perspective, it it's incredibly fascinating to bring in all those different data stores and then to create data visualization around this.

And data visualization is how we make.

You see? See those, those really cool? Well-designed interfaces. What you end up doing is you're storytellers, you're gonna tell a story with this data, and that becomes very powerful. I What are your thoughts on this as you hear about this? No, I think it's fantastic. I'm, I'm very hopeful that, as you say, telling the story more effectively, showing the data that sort of proves.

Out. Hopefully it will lead to the right kind of action. Ultimately, it's the action that's gonna have the impact. It's not just showing the picture, if that makes some sense. I think at the end of the day, we all sort of realize that the traditional, if you will, model of healthcare where you're essentially delivering care when people are sick or injured, doesn't really contribute that much to the total health and wellness of an individual over time, and particularly for those who are in.

Underserved or vulnerable communities. There is, you know, a lot that needs to be done to move to a a system where holistic patient wellness is really the focus. That's kind of my hope looking at this, is that it will highlight those needs to move beyond the sick care model. Yeah, no, I agree. I really like this.

I wish there was a link to go look at maybe some of the visualizations, but there wasn't. So I'm looking forward to delving into that a little further. I'm gonna hit on a couple stories high level real quick. So, increasing telehealth utilization boosts member satisfaction with health plans. This is specifically health plans and, and not healthcare providers and they, they quote JD Power and some other things with regard to this.

I guess my question around this is healthcare seems to be asking for more, uh, money in order to fund this.

They were essentially saying, if you wanna continue the momentum, you're gonna have to provide more money. And that was a message to the government. Health plans, though, have an economic model that supports telehealth. Do you think health plans are essentially gonna be the intermediary? For telehealth, so your first visit is actually gonna be with a physician that works for your payer before you get to an actual provider.

I think it's really possible if you think through it, and the payer provider hybrid systems, big organizations that had their own insurance plan as well as a health system, had it figured out a while back that the incentives were appropriately aligned for them to start being proactive to offer. These digital tools to engage in telehealth and telehealth beyond just the televideo visit, right?

To think through things like chronic disease management, population health and things like that, leveraging the best of the technologies that are out there and the, the private insurers that hadn't necessarily been in that space. They took note, they paid attention. They figured out that the patients that they ensured that were cared for in those health systems also did better.

And so they're, they're pretty savvy. They realize if they can, if they can save money by keeping people healthier, their incentives are already aligned. Frankly, if health systems that aren't hybrid systems, uh, or aren't thinking this way, aren't careful, they're gonna see a lot of their business eroded by the insurers that are getting into the wellness market.

Again, it goes back to the old sick care model of healthcare. You're, you're only gonna be successful with that for so long, and I think that time has passed at this point. There are too many others that are looking to disrupt that and to get engaged and, and understand the overall economics and how to make the incentives work.

Afford them without asking anybody else for more money, right? You've got massive insurers that are buying physician practices to be able to take care of patients more directly. They're employee and chronic disease management, remote patient monitoring, televideo visits and care coordination and, and even some interesting, interesting niche cases where you've got entities that might.

For example, have a retail pharmacy insurance focus in combination. I think you can probably figure out a couple of examples like that where there's been some mergers that, that are continuing to blur the lines where they're also providing rare disease management to keep those patients with. Very expensive, very complex conditions, better managed, better healthy, or more healthy, sorry.

And, uh, outta the hospital, preventing the complications, keeping them healthier so that they're not having to spend the money on the insurance side of the business to take care of them when they're sick, which is much more expensive. Yeah. I, this is one of those areas where I coach people around this and.

For the government money, but to explore how do we make this a viable business model Within healthcare, it's the people who are thinking within the box. They're like, Hey, if we're gonna provide this, we need this reimbursement at this level from the government, or we can't continue to do this. Those people I think, are gonna be in trouble.

The people who are stepping back and saying, okay, what, what is a viable model around this? What's one that. Associated with it, uh, 'cause they're gonna be able to sustain it, right? You can't sustain non-revenue producing, uh, model for, for too long. Otherwise you, you have challenges. So it, it either has to save significant amount of money or it has to generate some money.

And, and those are obvious things and it's, it's easier said than done, but we, we are seeing some, some players come into this and essentially say, Hey, you know what Telehealth. That's the way we're gonna establish a relationship. We're going to expand that to more WellCare and things that people are willing to pay for.

And we'll, we will see where, where it goes from there. But in terms of insurance, they're already getting paid. So to a certain extent, they have a, you know, they have a leg up. Consumer expectations have changed. We knew that they were heading in the direction of preferring health systems that had those digital tools and ways to engage, ways to interact even before the pandemic.

And then the pandemic exposed us all to all of the things that, again, all the, all the major brands we interacted with throughout the pandemic had to quickly adapt digital tools. And we gravitated towards the ones that were the easiest to use, the most pleasing to use, the most friction free. For whatever that happened to be, whether it was related to getting food or related to getting groceries or related to getting medications picked up, what, whatever those things were that we needed to do, we got exposed to how?

Businesses transform themselves to be able to make things easier or possible for us throughout the pandemic and the expectations of consumers have just increased. Why? Why can't health systems do that? And to your earlier point, I know you're a fan of Jim Collins as much as I am Bill. And so those books, I think are something that healthcare executives need to go back and reread all four of them.

He may have more now, but . Uh, at least the main four built to last Good to great. How the Mighty fall And great by choice. I think health systems have for too long assumed that their business model didn't need to adapt and evolve and they felt perhaps even entitled that it shouldn't and wouldn't. And they haven't been skating to where any puck was going to be 'cause they didn't expect the puck to move.

They forgot that they were playing the hockey. That is business. If that makes some sense. Yeah. And the, the New Yorker has a, an article coming out this weekend on the, the closing of Hahnemann Hospital in, in Philadelphia. And I, I covered it on today in health it this morning because we're recording this on Thursday, prior to release on Monday.

And the question. Is it ever okay to close a hospital once it's opened? Is it ever okay to close a hospital? And the following question, which is, will we allow creative destruction? If you bring up Jim Collins Creative Destruction and, and Clayton Christensen creative Destruction, is that allowed in healthcare?

Can we come up with a new model, a different model, and potentially supplant the existing model that's there? These are, it's. That's a, that's a tough question to answer because, because so many lives are impacted every time. While a place like Hahneman is, first of all, it's been around for a hundred years.

Second of all, it employed so many people. It was associated with Drexel, uh, school of Medicine. It was their, uh, training center for their academic medical center. And then you have the population, you have the, really, the underserved population in North Philly that was impacted as well. I mean, that's one of the.

Of really changing healthcare is are we going to allow healthcare to be changed or are we gonna step in at every turn and say, no, you can't close Hahnemann. No, you can't close Santa Clara. No, you can't close whatever the next one is really, really tough topic. What I would say is it all depends on whether or not we want to see things improve in the grand scheme of things.

And the fastest way to prevent improvement is to allow or even enable stagnation. That's true regardless of industry. That's how I view it. At any rate, now that doesn't mean that we don't step in to provide alternatives and to make sure that people are cared for. I don't think that's what that means at all.

But the other thing is I think it would be naive of us to even assume that in some way we can prevent the disruption. If that makes some sense. And we already talked about many cases where the lines are being blurred in terms of who takes care of patient. I don't, I don't think there's a way to prevent change in a sustainable way, even if we wanted to.

It's interesting, Justin, because I do a lot of interviews, so I ask people, what does healthcare look like 10 years from now? And uh, in almost every case it looks very different. People will describe it as very different 10 years. From today as it's today, and yet we, we are doing a lot of things to make sure that it doesn't change too quickly, too fast, and, and I understand that.

And actually one of, one of the other articles, 10 Reese's Big tech partnerships in healthcare. And one of the things that encourages me, we're seeing more and more. Partnerships with, with health systems, Northwestern Medicine and Google, UPMC, and Amazon and Google, uh, Microsoft and Providence. We talked about the Google one earlier, HCA and Google signed an agreement.

Ascension and Google signed an agreement. There is a sense in which there's some level of competition, but there's some sense in which healthcare is reaching out. All right. How can you help us be better in what areas can we really accelerate these things? And the articles in, in Becker's and they, they have 10 partnerships, recent partnerships with various people.

Everything from new Alexis skills, all the way to just a full on health data analytics platform, which ACA with, with, with Google. So it'll be, it seems like there's a lot of, a lot of outreach and a lot of working. In collaboration between health systems and big tech these days? Yeah, I think that's absolutely true, and I'm grateful that I can't comment on any of those individual cases for a variety of reasons.

But I will say that it can't just be a partnership between those big companies, those big tech companies, and what they offer in the health system alone. There are a lot of other partnerships that have to be looked at and a lot of other areas where assistance can be delivered. . But something that I always encourage health systems to do is look internally at what's working and what's not working.

Look across the industry for what's not working and what's working. Look across the ecosystem. So beyond just health systems, right? So look at what's working in pharma. Look at what's working for the insurers. Look at what's working for retail, pharmacy, and other adjacencies. But don't stop there. Knowing that, I think you and I would probably both agree, health systems or healthcare in general tends to be significantly behind other industries very often, whether it's adopting new technology or adapting to new technology trends or new ways of doing things.

So don't just stop with looking at the healthcare ecosystem either, but look at. All of the other industries, all of the things that are happening elsewhere, think about how those innovations can be applied to solve the challenges of healthcare and leverage partners that see across all of those industries.

I think that's probably one of the biggest values that our team provides, is that we have that visibility not only across the healthcare systems. Not only across the health ecosystem, but across all industries and being able to see globally what that looks like and bring the best of the solutions that are out there to solve the problems that that everybody's facing.

Yeah, that's that. That's a great point. One of the things as ACIO, I was always looking for partners. Actually, it might sound like there. Opposed, but they're not. I, I was always looking for a partner that had a, a healthcare vertical focus, so I could talk to somebody who understood healthcare if they were just broad.

A lot of times it, it just took too long to bring 'em up to speed on healthcare. But I also wanted somebody who had exposure across other industries because as I'm reading these stories, especially about cybersecurity and. Are there other parts of the other industries have made significant advancements in, in terms of what they're doing in cybersecurity, even digital engagement and those kind of things.

And it's, uh, easier to learn from somebody else's investment and mistakes than it is to learn with your , with your own investments and mistakes, I guess. Absolutely. You want, you want that combination exactly as you described it. You don't want a niche player that only sees healthcare. Knowing that healthcare often is behind, and that that's somewhat like running a race with blinders on, you might get to the end, but you don't have a lot of situational awareness and you don't necessarily see all the paths that you could take to be able to select the best one.

And you don't want somebody that's too broad or somebody that, that lacks the subject matter expertise either. It's, it's that sweet spot and frankly, that's why I love where I work 'cause we kind of combine those pretty nicely. Absolutely. All right. I appreciate your perspective. Anything you're tracking or looking at at this point, are you, you planning to go to himss?

You planning to go to any of the conferences? Yeah, I actually am, I've had the privilege of being on the health and safety committee for hims actually, and I'm, I'm pretty proud and happy with the direction that they've settled on with really taking a very conservative. Thoughtful, some might say sane approach to in-person attendance in terms of vaccination being, being a requirement.

So I, I feel very comfortable and confident in doing that. It's very likely that I'll attend Chime as well. But beyond that, I haven't really looked at too many other conferences. Probably will look at HLTH 'cause I know that they're gonna have the same kind of vaccination stance. So that makes me feel a little bit more comfortable and confident going, if I do decide to do that, if I, if I have the, the luxury of being able to attend that one.

Very enthusiastic about the direction that things are going. Um, seeing a lot of really good momentum around some genomic things as well as some research acceleration. Virtualization of clinical trials lately has been a hot topic where we're seeing a movement and that's. Again, across the ecosystem, whether it's the life sciences companies driving that, or some really smart research institutions, academic health centers driving that.

Lots of good things that that opened clinical trials up to a, a broader audience as well as just doing them better, I'll say. Excited about that and then seeing a lot of momentum around digital pathology, the digitization of pathology. I think as many would . Probably agree is overdue. Probably should have been looked at at the same timeframe that radiology was digitizing.

But at the time, the technology didn't necessarily exist to get us there and it does now. So seeing a lot of movement on that in Europe as well as other places, I think we'll see that continue to accelerate. So that's another exciting area to see unfold. Interesting. So digital pathology, what does that all, all entail?

What kind of things are we looking at? Instead of just having the glass slide that you have to look at under a microscope, being able to digitize that image and getting a super high resolution, you know, three D digital image of the slide. There are several FDA approved vendors that provide that. That's interesting.

Have we not been doing that? Had not been, it's relatively recent, I would say last five years or so. Again, Europe has been ahead of us to some degree, but they, they operate a little bit differently and they do things a little bit differently. Uh, so they were ahead of us. We do have several FDA approved things in the US now that are available, but it's, what's exciting is what you can do once the image is digitized.

So it's not just making it . Easier for those pathologists to read it. It makes it possible for them to read them virtually from anywhere. So obviously that improves things when you've got a, a shortage of pathologists and a shortage of pathologists that are expert in particular areas of pathology and being able to access a broader workforce to be able to address those things.

But it also lets you have backup copies, which is something that you never could do with glass slides that have tissue on them, and it lets you share those images. So whether it's for a second opinion or for a referral to a, a higher level of care or a different level of care specialty center, you think about cancer, for example, if I get diagnosed locally.

But I wanna get my care at somewhere like Moffitt Cancer Center in Florida, or Siteman Cancer Center in St. Louis. If I'm going to a different place that's expert in that kind of cancer or has a clinical trial available for me without digitization, you've got to pack up those slides, ship 'em, and hope to God they get there intact instead of just being able to practically instantaneously share them.

leveraging digital tools. Once they're digitized, that's a possibility too. So a lot of things open up and that doesn't even scratch the surface, right? Because now you've got a digital image, all of a sudden computer vision, the leveraging ai, machine learning, and deep learning to analyze things that the human eye can't even see regardless of magnification.

That becomes a possibility. So improving the workflow, finding new things, recognizing new correlations, finding new discoveries. It, it opens up a lot of pretty exciting stuff that, that's extremely exciting. Thanks for sharing that, and thanks for your service with hims. We had Karen Malone on, on Wednesday last week, and she shared a lot of the, uh, safety protocols and what they're doing.

And I feel pretty confident I, I'll be going to the conference. I'll conference clearly, it's gonna be as safe as you want it to be because you do some dumb things in, in. They're creating a pretty good environment. They're spreading things out. The booth makeup is very different. It's more of a campus environment.

There's a lot of good things that was really, I thought really well thought out. So we'll hopefully see each other there, looking forward to it. And Bill, you should join us for a networking event at WWT and Intel or co-hosting a, a nice networking event. That'll be during the Helms conference. Jenny can get you that information.

Would love to see you there. And we're gonna be taking the same kind of precautions that HEMS is taking. So hopefully there will be plenty of those safe events as well. Yeah, absolutely. All right. That's all for today. Thanks Justin. Thanks for your time. Appreciate you having me on. What a great discussion.

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