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If you make it easier for somebody to pay a bill or you reduce the anxiety around paying a bill, which is an unfortunate necessity in this kind country that's something that a patient has to think about, but a health system's job is to help reduce that anxiety around that, short of completely revolutionizing the payment system, which I don't think a single health system is going to be able to do in the next couple of years.
Thanks for joining us on This Week Health Keynote. 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 our Keynote show sponsors Sirius Healthcare, VMware, Transcarent, Press Ganey, Semperis and Veritas for choosing to invest in our mission to develop the next generation of health leaders.
All right. Today we are joined by Patrick Woodard, who is the Vice President and Chief Digital Officer at Methodist LeBonheur Health. Patrick, welcome to the show.
Thanks Bill. Thanks for having me. It's great to be here.
Well, I'm looking forward to this conversation. You've written some interesting articles we will delve into those. Are the one from health system, CIO read the one from modern healthcare, and we will talk rural health care, but that's not necessarily what your role is today. It's just a passion. Tell us about your system and the area your system covers and your role at.
Absolutely Methodist LeBonheur is a six hospital system based in Memphis, Tennessee. We serve Memphis in the surrounding area. We have around a hundred clinics or so serving primarily in urban Catchment area, LeBonheur children's has a nice partnership with St. Jude's hospital in Memphis, Tennessee as well. And so we get a fair amount of interesting cases, both from St Jude's and then the large surrounding area around them. Area I came on about a year ago, seven and nine months ago as chief digital officer kind of recognizing that the system is looking to improve the way that we deliver care, both in the area.
And for those that maybe are not directly in. Exact vicinity, but those that may have a relationship with us at some point, and we want to really maintain and enhance that relationship over time. So that's my role. That's what I'm very lucky to get, to be able to do for a health system in an area that certainly has a patient population that needs a lot of healthcare.
And since I'm a Cardinals fan, do you have the team down there? The Memphis Redbirds down there as well? Of course, you're probably not a fan. Are you at this point?
Well, I got here at the end of baseball season. So I suppose it's about time for me to get into that.
Then the baseball season, a fantastic, eh I was reading the press release on you coming in. It's interesting. Cause I'd like to talk a little bit about the role because especially stepping into the role, the press release reads. Dr. Woodard will help transform our digital health technology so we can integrate user-friendly and interactive platforms to expand patient engagement. Since Ron senior vice president and chief information officer as a board certified internal medicine physician, Dr. Woodardbrings incredible perspective through the combined skills. And he goes on to talk about you a little bit. And it says, Woodari well develop and implement digital health strategies to unite that unite industry, best practices with real-time evidence-based care. These are, I mean, these are press release right. So these are big statements and aspirational statements. Where do you start when you see those aspirational statements?
You start with looking at what the timeframe for success is, right? I mean, you're not going to get all that done in six months. You're probably not even going to get all that done in six years, but hopefully you can get fairly close to it. Health systems are increasingly complex, large organizations with many moving parts and in many cases, investments that have been made over a course of years that are good investments that you want to keep .In other areas that there has been an enormous growth and innovation in a particular area. And maybe it's time to adopt some of that technology into your current tech stack and what you're offering for your clinicians and consumers as part of that, really looking at what does that whole platform look like? That's kind of. The approach that we're taking right now is saying there's so much good innovation and technology that's now becoming available and becoming more widespread. It's been tested. It's one of those kinds of things where it's, it's beyond beta and it's, we're starting to see real world impacts for clinicians and for patients. But not all of these integrate really well. In fact, this morning, I was talking with a startup that has a really great product actually, but they want you to use their own platform.
So a doctor would actually not touch the EMR. Except sometimes. Right? So now we're going to ask a clinician who's busy, maybe has 30 patients a day, or they're working in a hospital and may have to see 25 30 patients in an ICU. And we're going to ask them to switch between two systems. Sure. The technology is great, but how are we going to be able to start to integrate that into their workflow in a way that makes sense?
And doesn't actually increase the work burden on an individual clinician. So thinking about it from that perspective, saying. What's the right platform for us to be successful over the next 3, 5, 10 years. How do we want to be able to create a kind of composable layer at the application layer or the platform layer so that we can start taking some of those innovative technologies without creating additional fragmentation?
We do want to be innovative it's in our mission statement. We do want to be able to help our clinicians care for patients, help patients feel connected to their health. And we want to make sure that it's something that makes sense and fits into their day. Their work. And we want people to feel good to come to work every day.
People come to work to do a good job every day, and they don't want to have to fight with the systems that they have. So it's our job to make sure that the platforms are in place so that we can take those kinds of innovative elements and really grow from there.our shades of my life back in:
And on all the requests came in of, Hey, can you make this seamless? Can you move the data in and out? Can you can we bring in innovators? Can we partner with colleges and universities to have them innovate on top of our platform? But the reality is. for me anyway, we had to go back to the basics and say, all right, we have a data layer.
How do we share that data? We have a workflow layer. How do we create that workflow? We have a. There's just a whole, whole bunch of things. And, it's not as simple as just going out to a store and buying a bunch of digital tools, plugging them in. And then all of a sudden you have a digital platform.
You really do have to look at how health IT interacts with where the people are interacting with the technology. You're referring a lot to the clinicians, but also the patients. How do you prioritize what projects you're looking at?
It's a good question. And one that I think probably won't ever be answered because as soon as you answer it, one way, it needs revision. Right? One of the ways that I think about it is every, every person who's coming, requesting, something wants to enhance the way that they're working. And most of the time, in fact, I'd say almost all the time, there is a patient benefit. There you have to balance how big of a benefit it is, and it maybe it's important for one patient or for a million patients.
Or maybe it's so it's critical enough to the way that a clinician works, that you're balancing. There needs among those against what might have a patient impact. I think the one thing that I really truly do love about healthcare is that everything that you can do in healthcare can track back to a patient at some point.
So even something that doesn't necessarily feel like it's a patient benefit, like patient financial services, it doesn't feel like it has a positive impact on the health of a patient. But if you make it easier for somebody to pay a bill or you reduce the anxiety around paying a bill, which is an, it's an unfortunate necessity that in this kind country that's something that a patient has to think about, but a health system's job is to help reduce that anxiety around that, short of completely revolutionizing the payment system, which I don't think a single health system is going to be able to do in the next couple of years. So taking those kinds of thoughts into account and saying, how are we impacting the way the patient feels because I don't know. There's that old quote. They don't remember what you say. They don't remember what you do. They remember how you made them feel. And ultimately, I feel like a lot of the health system job is to help people feel better. Right. like it's part of how are you feeling today? Right? It's it's what a health system is obligated to do for the patients in this community.
Give me an idea of what areas you're focusing in on digital right now. If you thought about digital solutions there there's so many points I just came back from HIMSS and came back from ViVE there's. So many point solutions that are out there, but are, is there any one area that you're focusing on right now?
I'd say kind of going back to the platform conversation we're at the place where we want to be able to. level out the playing field so that when we want to make a huge leap in, in a particular area we're able to do so there certainly are plenty of. Exciting applications of technology that impact patients.
I'm thinking about companies like current health, which is now part of best buy. The ability to extend the reach of a health system into the home, thinking of some novel applications of a tool like that in an ed. So to be able to extend the ability of our, platform or our health system platform into kind of a semi ambulatory area. So for example, that's code, is there a way to extend the ability to monitor a patient outside of the ED? Cause they're not, maybe they're not necessarily checked in yet or they're triaged, but they haven't seen a physician. Is there a way to monitor them, make sure that they're doing okay. So that we can kind of have that pre alerting for patients who are in the hospital, but not really technically in the hospital yet.
Things like that. Hospital at home of course is of interest. Not just to Methodist the Bonner, but to health systems around the country. And that's another area that we're looking at in particular. Again, this goes to keeping people in their homes, helping them be healthy in a way. Keeps them out of the hospital, keeps a bed open for us, but more importantly, it keeps them where they're more where they're comfortable.
If you ask me, would I rather be cared for at my house or in the hospital? I mean, if, if it's going to be just a safe, why would I want to be away from my home away from my family, those types of things. So those are the areas that we're really actively exploring and then kind of on a longer-term basis is what is that relationship with the consumer look like over time? And this is, I think one of those that we have to architect what the actual goal is, right? Is it that we want to have longitudinal relationships with the hospital? I actually would say no ideally a patient's relationship with the hospital is limited to a single encounter once, maybe twice in their entire lifetime.
So how are we promoting. Primary care, ambulatory and outpatient relationships so that they, the patients feel comfortable not needing to come to the health into the health system or into the hospital.
Yeah. When you think about the patient experience and you sort of envision it a couple of years out, what do you see that? I mean, you talked about the home, maybe receiving care in the home. How do you see that relationship between the health system and the patient and the patient experience changing over the next couple of years?
It is going to be. More continuous in the sense that right now care is primarily episodic. You go to your clinic, visit, you see your primary care, they set up a follow-up appointment.
You'd come back in two months or whatever. And in that intermediary period, there's not a whole lot that happens. I mean, maybe your doctor will, let's say you're diabetic. And your doctor asked you to have a blood sugar diary or a blood pressure diary, something like that. And if you're a good patient who is really co ncerned or involved in your health, you'll do that. And then you'll come back. And that's, I think the closest that most, that many health systems are getting to more of a continuous relationship, but again, that's probably on paper. So thinking about how we can turn episodic care into continuous care so that we can improve the outcomes for those patients is the way that I think about the necessary evolution of health system or health care delivery over the next several years.
I don't know that it'll be. Across every disease state. And I don't know that every health system will have adapted it in the next three years, but I think we'll be making progress towards that. That's I think where we have to go. And one of those elements, I think that'll be really challenging is healthcare has always kind of had a data problem.
Some of it's been access to data, and I think if we're moving towards more continuous care, the challenge may be having access to too much data and not knowing what's actually relevant. So that'll be a problem with. It will be a good problem to have, but it'll be a problem that we'll need to solve when we get into it.
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When you think about the clinician, so the clinician generally interacts with technology at the EHR some PACS systems and other significant systems that we have within healthcare. How does maybe a digital approach or an internet architecture sort of change. that paradigm or where do you infuse digital within the clinicians daily life and their experience?
It's a really good question. And it's a question that I haven't really necessarily landed on my final answer on. I think there's a couple of different ways that you can think about it. I think epic and Cerner and some of the EMR shops I'd like to think about. We're going to do everything for clinicians all the time.
Let's bring that all into the single EMR layer and we're going to do that. And we're going to be the house, the home for the physician or the clinician. I think there's another school of thought that has a lot of validity, which is that maybe there's a world in which a physician never touches the EHR.
But interacts with it indirectly. So as an example, to take a product like an ambient listening product, that here's a visit is able to do the documentation and then puts that into the EHR. The data is still able to be abstracted charges are still able to be dropped, but the physician maybe is only interacting enough to be able to say, like, what are my patient's vital signs or Hey EMR, please bring up my 10, most recent blood sugars. For example, I think that has a lot of validity as well. The common thread in both of those is that the EHR still is acting kind of, as you mentioned a moment ago, as that data layer there has to be that source of truth in there.
But does it necessarily have to be the same UI that the clinicians interacting with? I don't, I don't know. And I think the other element that we want to, that I think is important to think about that. Again, I don't necessarily have the answer for this one yet is the relationship layer between the health system, the clinician and the patient.
Because there's a lot of communication that occurs between a health system and a patient, not all of which is clinical, but much of which may still have relevant like clinical relevance. So for example, if a patient reminder it's important for me a clinician to know that the patient got their reminder and said, yes, I'll be there because now they're not in the clinic and maybe I need to be concerned that something happened and they didn't show up versus if they didn't get a reminder or they did get a reminder and said, no, I can't be there. That's a different situation altogether. Or that same. Repository for yes, they got their bill.
Yes. They've been paying their bill and all of a sudden something changed and now they're no longer paying their bills that may have clinical relevance. Right? What may have changed in their life that financially, that may also now have health impacts. Those are kind of broader longer-term questions that are potentially relevant to a patient's care, but may not be relevant to put in the electronic medical record.
So how does that relationship layer interact? And I think that's a question that needs to be explored a little bit further. I have some thoughts of kind of how they all need to interface, but I don't, I don't necessarily know the answer of what's the real version of that. And how much do you serve up to a physician?
I don't think many clinicians are going to necessarily want to know that the patient received a bill yesterday, but there are some elements in there that are, that may be clinically valuable.
it's interesting because I've heard a lot of different health systems say, ah, we're going to implement a Sierra. A customer relationship management solution effort, others say, well, we're going to use the EHR as, as CRM, but as you noted, there's a bunch of data to. Fit in the EHR, like, like it would into a CRM, but on the flip side, if you implement another platform and another system, now you have data that you have to move back and forth.
Then you have to create the linkages between the two. I'm not sure this Has been solved anywhere at this point. I think you people have to sort of choose and when they choose it, it's indicative of a lot of the choices we have to make. As we head down this digital path of are we going to focus in on the the The patient experience, the clinician experience, or are we going to look at the cost?
There's just a lot of trade offs that the system costs to the system. Is there a value that's being created by putting all these things in place? I think just generally people would listen to this conversation, then they go, well this is easy. Just do what Amazon does. This is easy. Just do it. Just do what Google does. siteI want to go to, I want to go to your health systems web. I have one box there and say tell me about my medical history and everything pops up for me. Nice, nicely and securely everything else. But there's a lot of moving parts behind the scene to make all that work.
I think that vision is right. I would just go on the record to say that I think the vision of having that kind of seamless interface is the right vision to have it's just to your point, the moving parts behind the scenes, the same chat box, where I asked what my next appointment is should also be the same one where I can say I'm having chest pain, but those route completely differently on the back end. And there needs to be somebody there to answer those types of things when they occur.
Yeah. I'm having chest pain. You don't want to go to your call center. I need to set up an appointment for next week. Goes to your call center. But yeah, I mean, there's, there's sophisticated workflows. That's what I've found with all these technology projects. I don't know about you, but I found that they start with somebody going, Hey, I found this really cool technology. And you go, okay, well, let's look at it and you look at it and you sort of say, okay, I, a great example is we did Workday at our health system and took us a year and a half to implement Workday.
And people are like, Workday is a cloud service. Well, I wouldn't take you a year and a half to implement a cloud solution because we redid all of our job descriptions. We redid all of our we, we, we went through it today, massive HR project, which touched every employee, every associate within the health system, I had to have conversations, some had to be Bri graded and the job descriptions had to be cut down.
Just because over time we had this massive bloat of stuff. And then when we brought in workday, They just looked at us and said, you shouldn't bring your old stuff into the new platform, or you're going to end up with a mess and the new platform. And it was really, it was our consulting partner and it was also Workday who looked at us and said, look, this will work a lot better for you if you do this work going into it. But that it ends up being a significant operational left, not necessarily a technology list.
I think that's a really important point. And I think that's where the technologists have an important role to play in kind of a teaching or kind of educational aspect in that the technology may be hard, but by and large, that's not the hard part of a successful project.
It's the operational. Changes that are necessary. and the end adoption of the product or the project that are what make or break a technology projects, success. I think your example was perfect and helping think through some of the necessary challenges along the way, without saying like, no, we don't want to do this. It's how can we help you be successful? Here are some questions you may have to answer is an important way to frame the frame the argument.
All right. You've written some interesting articles on rural health care. where does that, that background of that passion come from?
It's a good question. So I grew up in Nevada. And if you spend any time outside of Las Vegas, I grew up in Reno. Outside of Reno, it's just vast nothingness for long periods of time, but then there's people out there. And long ago I used to work for a Senator. I did during a summer internship thing, and it was during med school when they, I thankfully didn't have to just answer phones that they gave me a rural health project and said, Hey, can you think about what the Senator may want to do for rural health that might be beneficial in the state of Nevada? And of course, I didn't know any. So I spent the entire summer effectively researching a bunch of stuff and really became connected to the challenges that patients that I have seen in hospitals in Nevada who live three, four hours away who want to feel healthy and want to be healthy, but it's not realistic to leave your ranch for eight hours to go to a 15 minute doctor's visit. That kind of is where it all started. I think I can remember a number of different patients that I had while working as a hospitalist in Nevada, that the stories are just incredible. I remember very distinctly, a 90 year old woman who had fallen off the back of a pickup. Feeding her cattle broke her pelvis.
Didn't come into the hospital for two days. And when I asked her why now, why come into the hospital? Now? She said it's because she was worried that if she came in sooner, her husband would go sell off her cattle. And her, her cattle were her girls. They were her friends and she didn't want to leave her cattle behind cause she was worried that her husband might go solve her kettle cause she's 90. So those types of patients who are very passionate. Connected to the land, don't deserve to have less access to their health care offerings. And yet are out here in the middle of nowhere with nothing really to help them.
I think there've been a lot of changes that make me excited about the next couple of years. I think COVID shift in tele medicine payment has opened a lot of doors for companies to be able to care for patients in rural environments. I think COVID demonstrated that people are more willing to answer the telemedicine call, if you will and be comfortable with that. And I think we've made a lot of progress in things like broadband in rural communities, but I think we have a long way to go and, and thinking about ways that we can augment the care that's given out there in rural and frontier environments that enable people to be healthy and live the life that they want to live in a rural. Idyllic environment without necessarily having to spend their entire day in a car for just to go pick up a prescription medical medicine or something like that.
So how long ago did you work for the Senator? Was that a long time ago?
This was, it was right after college. during my first summer in med school.
What were the challenges back then? I assume we didn't have great broadband back then. I assume a telemedicine wasn't really an option, but what are some of the other challenges that we had back then? And I sort of want to contrast it with where we're at now.
Yeah. So it'll be, I like this exercise. I think it'll be instructive. so broadband was a big deal. I mean, this was, I don't know, in the early two thousands, mid two thousands. So broadband did exist, but not really out there, which is still true today. Access to care was a big challenge. So residency slots tend to. Lend themselves to where physicians practice around 80, 80% of physicians will stay in the community that they completed their residency in.
So if you're thinking that if I go to New York city to do my residency, there's an 80% chance I'm going to stay there. That means that there's only a 20% chance that I'm going to go back to Austin. Which is not a big time. The telemedicine was one of those things that was starting to be a topic, but it was more facility to facility type care.
And if you don't have a facility, then you can't do facility to facility care. So that was a big one. And then This is also still true. The kind of adjunct care that people need in rural areas largely doesn't exist. There may be like a doctor in the, and this is true. I've actually worked in some rural clinics, but there may be a doctor who comes in once a month to do specialty care.
Maybe they have like one cardiology clinic day a month. So that's, that's great. But. Let's say the patient needs alcohol counseling or smoking cessation counseling or clinical social work. Those types of things, those by and large don't exist and are, tend to be centered in urban areas. We're around where health systems are.
And then of course there are a huge, vast areas of pharmacy deserts and both primary care and pharmacy deserts have become worse over the last 15 years or so. Not better. So I think those are interesting challenges.
If you can contrast that to today, I mean, do we have I mean, what you're describing is what'd you call Austin, Nevada would have like a doc, a location, like a primary care doc there, a cardiologist would come around once a month and likely if you were going to do telemedicine. The person would come into that location and actually do tele-medicine. Is that closer? My not getting the picture yet.
No, I think that's close. And I, I mean, maybe they have a primary care doctor and I think virtual care has opened up a fair number of options for patients out in rural America. But if you're over 65 and you live in rural America, there's only a 60% chance you have a smartphone. There's only about a 60% chance you even have internet That can support a virtual visit. So those two things added together mean that virtual care in theory is an option, but not for you. So you're still kind of stuck with the same situation you have before. There are, there have been some really reassuring changes in terms of residency positions.
I actually worked out in a small town in Nevada. During COVID and they had a residency spot. They had four residents who are out there and I talked to them and four of them, all four of them actually plan to stay in a rural community. It may not be in Nevada and some of them were from other states kind of in the Midwest.
And we're hoping to go back to two places like that, which I think is, is phenomenal. But so I think those are really positive aspects. And I think we still have a little bit of way to go in terms of just access to. Care just in terms of w can I see a physician? Because if I can't, if I don't have internet in my house, and if I don't have a smartphone that can do a virtual visit, then I'm not, then that's not really accessible to me. So there's still some work that needs to be done there.
You said, you said pharmacy desert, and it's interesting every now and then I read some stats off where it says CVS, Walgreens, and Walmart is within five miles of 90. 7% of the population. It, do they not all have pharmacies in those or is that a misleading stat?
I think it may be a misleading stat. And I don't know the numbers right off the top of my head, but I'd be curious if it's related to where there are population centers because 20% of the population does live in rural America.
Well, that's yeah, it could be a proximity to a majority of the population, not necessarily. So would say there's large swaths of land within Nevada where I'm not going to pass a Walmart. I'm not going to pass. Actually there's the same thing in Florida. I just drove to Orlando. There's large swaths where I won't pass a Walmart. I won't pass a CVS or Walgreens. I might pass a dollar tree, a dollar general or something to that effect. And then it's mostly convenience stores. Gas stations and convenience stores.
Absolutely. I mean, this is not a Nevada problem. It's not a Florida problem. This is a rural American problem. It's true. And probably all 50 states at somewhere. I think. That's kind of what gets me excited about it and trying to think about ways that we can solve that. You're right. Actually about the dollar tree and dollar general hired a chief medical officer last summer. I'll be really curious to see what they're doing there. Moves like that. I think have a lot of potential to your point. I think there are some interesting partnerships with companies like village MD and I think Walgreens and then CVS of course has their minute clinics, but those tend to be in urban areas. So there is potential for them to be in other areas. It hasn't quite grown to that yet.
Yeah. That'll be interesting to see. So I always, I try to close these conversations with this question. what's the question I didn't ask that you were expecting I would ask her what's the question I should have asked that you'd like to chat about.
I think it might be, what's the biggest challenge you're seeing, getting where you're going today. Right. Something like that. That would be the question I would have maybe expected that I didn't hear.
Yeah. I mean, because, because where you started, you just came into a new system and I try to sort of communicate that in the beginning. I mean, when I came into the new system there was high expectations of me. Hey, you're going to build these digital highways. You're going to build these great patient things. You have page, we're going to connect patients with the clinicians in different ways. And then I came in and found we had upwards of 12 call centers and we had different systems and all the call centers.
And we had it just, it just went on and on. I'm like, okay, before we build highways between these things, Something. So w I mean, what's the challenges as you see it to get from here to the vision of communication and, and interaction with the patient and the clinician on a more ongoing basis.
I think there are certainly what you described is true. I think at every health system, I think the bigger challenge for everyone working in health it today is there is so much, and I kind of mentioned this before, but there's so much good. There's so many good concepts. I also was at HIMSS and at ViVE, and I saw some really great technology that I would love to be able to use, to care for patients or to be able to help keep them at home.
Those types of things but when you're forcing me into a proprietary platform as a health system, I have to make a decision. Do I want cool technology that might have a good application, but it's going to increase the number of applications that I have to support and doesn't necessarily integrate well into our clinical systems of record, or do I want to wait until the company has decided that they want to only be a hardware company and now they don't have to have the proprietary platform.
And I think. That is the biggest challenge that I'm facing today. And I think this is not just me. I think this is true for many folks is that, that layer of interoperability that we all have as health systems, we all have a set of goals, but they largely exist around reducing the number of applications we have to support, reducing the cost of it, improving the value that we're getting out of the investments that we're making.
And then. I think there is a little bit of conflict from startups or tech vendors in that the more that they can keep within their ecosystem, the more that their bottom line or their shareholder value is, is grown. So there's a bit of a conflict there, but the more I think that we can create a level of interoperability will ultimately benefit everybody.
It's kind of, one of those rising tides will lift all ships kind of things. Where if I know that your platform will interrupt with. Well, without my platform, we don't have to spend this much time evaluating your proprietary telemedicine platform because I already have one. So. I liked the concept. Let's put it in.
Right? Those types of things will be made a lot easier by just, and some of this is regulatory, right? We don't necessarily have the right standards in place across the entire pot potential of, of data that could be interfaced, right? Things like DICOM have been around for a long time. And those I think have demonstrated really good success in being able to share data other areas.
I still have a fair amount of growth in terms of, of that. even companies that I think are doing this well, I would take epic and their care everywhere platform, I think does it pretty well, but I think ask a bunch of clinicians who've used it. There's still a lot of information there that doesn't necessarily go where you want it to go, or maybe there's too much information.
So there's, that's a challenge that I think is on everyone's plate to solve, not just the health systems and not just vendors, but. Over time, we'll get there, but it's something that everybody should keep top of mind.
Absolutely. Patrick, I want to thank you for your time and thank you for sharing your experience with us. Appreciate it.
I really appreciate it, bill. Thanks for having me on.
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