Keynote: Generative AI, Work-Life Balance, and Navigating Vendor Relations with Scott MacLean
Episode 1298th September 2023 • This Week Health: Conference • This Week Health
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Today on This Week Health.

(Intro)   people want to interact with their healthcare like they do with the travel industry. Everything else they do on their smartphone these days. so we're trying to reduce that friction of again, through this integrated digital health platform of how people want to interact with us, . 

Thanks for joining us on this keynote episode, a this week health conference show. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A set of channels dedicated to keeping health IT staff current and engaged. For five years, we've been making podcasts that amplify great thinking to propel healthcare forward. Special thanks to our keynote show. CDW, Rubrik, Sectra and Trellix for choosing to invest in our mission to develop the next generation of health leaders. Now onto our show.

  (Main) All right, here we are for another keynote episode. We're joined with Scott MacLean, CIO for MedStar Health. Scott, welcome back to the show. Thanks, Bill. I'm glad to be


you. it's been a while. we've done a, an interview in action, which is those short 10 minute interviews from one of the conferences, I think it was the ChimeFall, it was a ChimeFall Forum, or was it Vive?

I don't remember

which one. I think it was Vive 22, so it's been a little while.

Yeah, it has been a while, and nothing's really changed since then, right? So we can just, you know, tell people listen back then. No, it's it's been a pretty eventful eventful couple of years. Let's start with where I start with all of these.

Tell us about MedStar Health. Give us a little background on MedStar.

Sure. We are a 10 hospital system in the Baltimore, Washington DC region. We also have an extensive ambulatory network over 300 locations. Our desire is to be in your backyard and be available for providing healthcare where you need it.

We're affiliated with Georgetown University Medical School, a teaching affiliate there, and as well have a research operation trying to Take the discoveries that we find and apply them as quickly as possible to to the bedside. And then I partner with other leaders in the organization around innovation analytics digital health.

And we have lots of exciting things happening in, in those areas. We're about 4, 000 physicians, 8, 500 nurses 7. 5 billion in annual revenue. And I'm sure on this. we'll talk about some of the economic issues that are impacting us.

start with priorities. It's interesting, CIO for a system of that size and that geography, it's you know, I joke that the CIO job, it is hard to prioritize cause

You could start the day talking about oncology. You could end the day talking about cafeteria services. I mean, and everything in between, but are there specific priorities that you guys are focused in on right now as a health system that you're trying to drive forward with technology?

Sure. I think foundationally we make an investment every year in our infrastructure and shoring up, making sure. These days, networks, wired, wireless, and cellular networks are everything for delivering all of our applications. Anything that we want to do, whether it's things like the EHR, the ERP system, telephony these days, and then on higher order applications that consumers use our digital front door all of our analytics platforms require solid infrastructure.

right, that's shrouded in our security practices. And so there's a lot of emphasis on that even in challenging economic times. We are we've outsourced our infrastructure operations and so we just went through a transition with that including a data center move that we're happy that's all completed and behind us.

We've invested a lot like others in the EHR platform over the last Decade. And so we have solid footing. They're always continuing to optimize that for our clinicians. And then in the digital space, we have what we call an integrated digital health platform. And this is more than just a portal, right?

This is a place where consumers who are not even affiliated with us yet multichannel.

So they might find a telehealth example, urgent care, primary care, specialty, whatever it might be that's needed. And that also has a CRM element to it. So we're tracking our consumers and what their wishes are and, they want to be interacted with. And I think I've said before, this was proven out during the vaccine.

OVID vaccine came out in late:

I'd love to dive into two of those areas. One being the access, the patient experience, and talking a little bit about that.

I want to start with infrastructure. It's interesting that you bring that up. I just read Cleveland Clinic just launched a hospital with 5G over Wi Fi. I thought that was interesting. You know, software defined seems to be leading the day these days in terms of the infrastructure.

What kind of innovations are you seeing in that? space, and what are they bringing to healthcare?

Sure. Well, I mean, I think it's a journey for all of us, both in terms of proving out the technology and also the expense and partnering with organizations that can help us do it. So, we've talked about the 5G connectivity versus Wi Fi, and I think that that may be applicable for us in some of our remote locations.

that can be served better by a 5G connection than using some other connectivity methodology there. And we are putting up a new hospital at MedStar Georgetown University Hospital. It's coming online this fall. And we've partnered with one of the carriers for 5G service within that building through distributed antenna system.

And I think we have yet to see how some of those discoveries will come about to bring about some innovative applications using that 5G service in that building.

is interesting to me in that it's not pervasive yet, even in the major cities, it's not pervasive.

And in the case of Cleveland Clinic, they're launching it with a small hospital, like a very small footprint hospital there. And what they're trying to figure out is, does it bring benefits with regard to you can prioritize traffic over it a lot better than you can just an internet traffic line and that kind of stuff.

So they're sort of trying it out. And I think that's where we are in this stage of 5G, aren't we? I mean, it's sort of like until it gets pervasive, And until it's, you know, across all of the homes in our market, we have to be careful picking, you know, winners in this technology. Because the technology platforms can change move along.

I think that's right, Bill. And I'm not the world's best expert in this, but there are different levels of 5G as well. And so not every place is going to have the super connectivity that is available through that. But I think there is the ability to deliver that, and that may have some specific applications within healthcare and, around perioperative service line, things like that.

Interestingly, we were in Alaska in mid June, and those cities along Southeast Alaska very well outfitted with 5G. I was surprised how good the connectivity is up there. So the carriers nailed Southeast Alaska, at least with 5G.

Well, is MedStar primarily urban, or do reach out into some rural areas as well?

It's both. We have our largest hospitals are in Washington, D. C. and we have four in Baltimore but we also have clinics across the central Maryland northern Virginia. So, we reach into some less densely populated areas

as well. So access is important. I mean, you have some specialties within that within your health system that are needed in the rural areas and whatnot.

I assume they are. accessible via telehealth and whatnot. has your telehealth evolved since the pandemic? I assume you had that spike like everybody else. How has it evolved?

Sure, our telehealth program is situated within our Innovation Center and so our Chief Innovation Officer oversees that program.

He's done a really good job with it. And like many other people, we had a low number of e visits per day pre pandemic. probably numbered in the 30s which spiked to 4, 000 or plus during the pandemic. And then I believe it's leveled off around 1, 500. Like many people, we've discovered that it's applicable and works well for certain interactions, behavioral health being one of them that I think people really have felt that's worked well.

And then others were necessity during pandemic, but since then. It's not that helpful to have a e visit for physical therapy, at least in my own personal experience. And some of the the interactions that require a touch, obviously, that, that's less useful.

I don't know, my personal trainer does virtual, like if you go away to a hotel, it's like it, You know, take a video of the equipment and then he will walk you through things.

I haven't done that yet, by the way. use going away as an excuse not to do that. So, Maybe there's more dedicated people.

It's never harmful to have some sort of interaction with any type of clinician, but you do miss some of the stretching and things that physical therapists can do on site.

So talk to me about the patient experience. What are you striving for? What are you hearing from the patients, the community, that they would like to see from MedStar and you're trying to deliver with technology?

Sure, and here I want to give a shout out to our Chief Digital Transformation Officer. He and his team have done the research and work in preparation for how we're trying to interact with consumers.

And it's what you're probably hearing from other organizations, which is that people want to interact with their healthcare like they do with the travel industry. Everything else they do on their smartphone these days. And so we're trying to reduce that friction of again, through this integrated digital health platform of how people want to interact with us, whatever kind of question they may have, how they want direction to get to a care channel.

And we, continue to develop that, that integrated digital health platform to interact with our patient portal to provide a seamless experience there. And you know, a lot of what's behind just this technology, just like anything else is the process and the people that we have. If you think about a very large ambulatory operation, there's a lot of scheduling that has to happen and being able to expose those physician and other schedules appropriately,

that not everything can be just done by the patient themselves. There are sometimes some clinical screening questions that go into those. So we're trying to optimize that in a way that makes it easy as possible for consumers and patients to, to interact with it. And then when there are needed interventions that we would use technologies to optimize those those questions that need to be answered clinically.

If a patient is listening to this, somebody who's not necessarily in the healthcare space sometimes they wonder, it's like, why is it so hard to do scheduling online? I can book an airline, I can book this, and they always talk about the Amazon experience, like, why can't I do that in healthcare?

Now I understand this technically why it's so hard and operationally why it's so hard, but I'd love for you to explain. Why is it difficult to expose those schedules and probably specifically with the specialties?

Sure. Well, just to comment generally, \ think we are trying to respond to what patients want to do online and, but also keeping in mind that there are clinicians who are also human beings on the other side of it, right?

Who practice probably in more than one location. And also have disruptions in their lives, whether it be another patient emergency or personal thing that happens in their life where, the physician needs to have more open space to do something different. So, we've gone through and continue to work with our physician community to be able to.

Build schedules that work for them that can then match up to consumer needs. So that's a very complicated algorithm, to get all those spaces correct. Standardizing visit types something that fits into an algorithm for a consumer to interact with versus how it's been done manually for many years.

In the specialty space I think it's not helpful for either the patient or the to have a mismatch, right? And so if it's oncology, orthopedics neurosciences, some of these more complex interventions, the Clinicians obviously want to understand what the issue is and make sure that the patient is getting to the right type of physician and right type of appointment.

And so that's where traditionally there's been a conversation, , at least with some sort of staff person at the clinic or the physician themselves about matching those up. And so we're looking at ways that we can again, find where we can make standards and make automated responses versus where some of those conversations have to take place.

Yeah. And

that's generally what I try to describe to people. It's not a, it's not a technology exercise, it's a, an operational exercise. A specialist has office hours, they have rounding, they have surgery, they have all those different things, they have to squeeze that into a schedule, and then we're saying, oh, and by the way, can you do some, some telehealth visits and some other things, it's just

Not as easy a calculus as what people think it is to just, oh, just expose their calendar. You know, let me make an appointment. There's a lot that goes

into it. It can work, Bill. In my own experience, the reason I was in Alaska, I did the Anchorage Marathon in mid June.

And, it's 18 weeks of training and preparation. And during that time, I had some issues with my feet and stuff. And, needed to have a consult with an orthopedist, and so it was a conversation, but that conversation mostly took place electronically via text and other tools with the orthopedic surgeon's office, and he practices in different places, and I was able to be seen sooner if I drove further, so I picked the one where I could be seen sooner, and, made the drive out to see where he was practicing that day, so it can match up and

Let's talk about the clinician experience.

So a lot's been made about the clinician experience. Burnout and those kind of things and even safety, I was just reading a couple articles this week of the growing concern of violence against healthcare workers and those kind of things. Does technology play a role in some of that response to the safety that we're concerned about for these people who are trying to deliver care?

Yes, and we we're concerned about all of our associates and patients and visitors and the burnout issue is across the board, the safety issues are important for all of the associates that are working in our facilities and our patients and visitors, so I think you know over the years, everyone's doing interventions within the EHR to try to optimize and make clinical workflows easier, so we invest a lot in those kind of things, and then Thank you.

Workplace violence prevention is very important to us culturally. We've this year came out with a new standard policy about patient and visitor behavior, and you can see that on our public website. There's a video about it explains it. And and then also we've invested in Technology, security, various video technology and response, panic response buttons, those kinds of things to help support our staff and to get help when they needed to manage situations.

There's also been de escalation training and those kinds of things.

It's alarming that there's more and more of this that's going on. And it's not something that we haven't been talking about for a decade or so. We've been putting things in place all along the way and we have would assume at your health system like ours.

We had tests, we had dry runs of different scenarios and those kinds of things to prepare for for violence if it does happen in the space. I want to switch the conversation, talk a little bit about data. There's a lot going on in the world of data. There's a belief that...

We're now able to turn a lot more of our data since meaningful use. We did this a long time ago. Now we're able to use our data more to drive better outcomes in care, to assist in the process, to get information to the clinician at the point of care that could help them to make diagnosis, quicker, more accurately, those kinds of things.

Talk a little bit about your work with data and what. MedStar is doing in that space?

Sure, I think back to when David Blumenthal was the ONC chair and he talked about adopting technology, meaningfully use it, and then getting better outcomes. And I think sometimes we're impatient. With the amount of money and time that's been invested about getting those better outcomes.

I also think if you think back to pre CPOE and EMAR days, we would not want to return to that, right? Pre the interventions we have for medication reconciliation, we have come a long way on. better outcomes, safer care because of those technologies that have been put in place. happily we have a lot of data and I think there's great opportunity.

It's the next step in all that we've done around automation and capturing data. Now the opportunity is to use it well. And I think one of the conversations we've been having, and also with our technology partners is margins are so thin. And not for profit healthcare, particularly that it's hard to employ the data scientists and people who are analytics experts that perhaps our for profit technology partners have.

If you think about the investment that an Amazon or a Google can, or Apple can put into these kinds of things, Microsoft versus what a not for profit healthcare can. So we're looking for opportunities to partner better with our. EHR and ERP vendors are around this type of use, and I really think, Bill, the holy grail is turning those data into useful information that can be fed back at the point of care.

That we can tee up various, just like we have with clinical decision support, we can have more sophisticated decision support in our transactional systems where that can be applied right away. And I think this is just a matter of time in terms of getting our genomics data. We know that there are specifics about us as individuals that various drug therapies can work better or not depending on who we are.

And I think this is a matter of categorizing and loading our systems, organizing data in a way that it can be better used. And of course, I mentioned research earlier, being able to take the latest discoveries, both in teaching and research, that we're learning and apply them. It's one of these things where it's not going to happen overnight, but I think in another We're going to be in a lot different place because of the progress made there.

  All right, we'll get back to the show in just a minute. If you've been with us for any period of time this year, we've partnered with Alex's Lemonade Stand to raise money for Cures for Childhood Cancer, and we are so excited. We set a goal to raise $50,000 and we're already up over 27,000, our 26,700 for the year.

So we're close to 27,000. I'm rounding up. We went to the Vibe Conference and with your. And the help of just an amazing community, generous community. And our partners as well. We were able to raise $16,500. So thank you all for your generosity. We're gonna do it again. As you know, we did Captains Cures for Childhood Cancer, at the Vibe Conference and anyone who got their picture taken with Captain who was facing the camera we gave $1 to Alex's Lemonade.

We're heading to hymns and bringing Captain again, and we're gonna do the same thing. As you know, captain is my producer service dog. He'll be roaming the floor. If you see Captain, stop us. We would love to have your picture taken and we would love to have you participate in this campaign.

We really appreciate our partners who helped to make this possible. For this one, so far we have rubrics, so we still have a couple of spots If you want to participate, if you want your company to participate, let 'em. That they can participate in this and we will give you the details. You can shoot us a note at partner at this week,

It's real simple. If you're on the floor, you see Captain, get your picture taken. Anyone facing the camera, go ahead and post it to social media Twitter or LinkedIn. Tag this week. Health, that's how we do the county. And again, 16,505. I think we can do it. At the HYMNS conference and really make a dent in our goal to get to $50,000 for childhood cancer.

It's gonna be exciting. We appreciate our partners who stepped up during the Vibe Conference, and obviously we appreciate rubric being our first partner to step up for the hymns event. So look forward to seeing you at hymns now, back to the show. 📍 you've described an interesting organization structure. As we were going through this, you talked about chief digital officer, chief innovation officer talk a little bit about that structure and how you operate together to bring. Innovation and technology into MedStar.

And I would add to that we have a VP of performance improvement and analytics.

I work with those three other leaders the four of us have the bulk of. what happens with technology within MedStar Health. I think it starts with, like anything else in these jobs, with good relationships, right? So I have effective relationships with those leaders and communicate regularly about initiatives.

And, like most companies, we have a five year strategic plan and an annual operating plan that guides us on what the priorities are for getting initiatives accomplished. And I think we look to governance structures to be able to make the best decisions on priorities, knowing that everything that we're doing, whether it's, I mentioned telehealth in the innovation space, they also are doing robotic process automation over there digital front door, our analytics program, all of these things run on the same.

technology stack, that my team is running. so we do have to be coordinated, communicate regularly with each other, and then also be able to provide visualizations to our executive leaders when decisions have to be made about what happens first.

What what governance groups would you sit on?

I assume the IT... Technology projects and those kind of things. Just describe some of the governance organizations that you're a part of.

I think it's evolving for us. Traditionally, we have had a combination of leaders who deal with infrastructure investments, and that's more limited me, my boss, the CIO, the CFO, the CTO.

We have an IT security committee that deals with all the protections around information security. And then when it comes to other clinical and administrative projects, we have various committees that govern our E H R and our E R P systems. And I think. As we continue to get pressed on economics and resources are more limited, we will probably look at things this fiscal year as more overall.

And that's going to involve most of our, senior executive leaders looking at all the projects at the same time.

With the countless vendors that are calling you saying AI, AI, generative AI, will there be \ an AI governance or will there be an IT governance that, that would go through?

Sure. I think that the three principles around that first is where we're embracing the technology. We believe it's useful and want to find the right use cases for it. We know that there probably some protections that need to take place if not policy standards and helping people understand that these generative Algorithms are voraciously eating everything that we'll put into them.

So caution around putting PII or PHI into them, any personal information. And then we may get to some some additional technical controls around that. We want to be able to move at the pace that people are again, where we're in academic and research organization, which we're trying to discover the right ways these should go forward.

We don't want to miss opportunities. And we also. Want to be wise about it. So I think that it's a, at the moment it's interdisciplinary. It's IS, it's compliance or legal with some clinical input.

Are there just hypothetically here, I'm not not really asking specifically, are there specific use cases that you're looking at that you're going?

I see some promise in these different areas for generative AI

specifically. Yeah, I think that on the administrative side, it's a little less complex, right? There's the, if people are trying to generate documents and people have cited ability to create better ways of presenting information by using generative AI.

And assuming again, we're not feeding any company information into the engine, that seems like a pretty useful use case. On the clinical side, there are issues around it, right? Accuracy issues, PHI issues, and finding the promise of how that can be used again, With different iterations of the engines that might come into a protected environment, right, that could be used with our rich data set to be able to generate some of the decision support that we talked about earlier.

You brought up, I see a lovely picture of your family behind you over your shoulder, and you talked about running a marathon and those kind of things. I found That the worst time health wise in my life was when I was a CIO, like when I was working in healthcare. was the time I really let myself go.

It was just a very challenging and difficult time. Talk about how you balance those things and how you prioritize your whole life as opposed to just your work life.

It's a great question, Bill, and I think it's important for all of us as individuals and people are different.

ng and I knew particularly in:

by myself and you know, use various podcasts and books on tape and ways that I wanted to think through things as I was out there. So that worked for me and it relatively healthy and I didn't get super injured during the prep or during the race. So I think finding those things and my wife and I try to, have a regular good diet and sleep schedule.

And our kids are now grown and out of the house. We're trying to do that empty nest thing and be healthy.

For us we're there now. It's actually easier to be healthy when you're empty nest rather than, running to, this event and that event as things, as life sort of happens talk a little bit about your involvement with QIIME. Talk about the things that you guys are doing there and your involvement

t. So since I became a CIO in:

I'm working on the policy steering committee. Which is great because we're close to D. C. and the folks that are working there. And I think that the organization has and is evolving as the role of the CIO changes. I think you know we have tried to also expand the organization to involve our applications leaders technology and security leaders.

s now I think I went to it in:

the world becomes more digital and has these needs and healthcare transforms like other businesses have to be useful in the online space. So I think the future is bright. We've continued grow in terms of our membership, our international involvement. The offerings that we have in addition to the fall forum that we've always had the the spring event now is Vive as partnered with health.

And I think that's that's been successful the last couple of years. We're optimistic about that.

I'd love to hear more about your policy work. What do we need from DC? What do we need from the capital in order to be more effective as health IT leaders in the industry?

Sure. It's I think there's two sides of this.

One is we have an agenda every year that we're always advocating for. And one of the perennial things that we're looking for is a unique patient identifier across the country. We think that would be very helpful for safety and systems interoperability. We talk a lot with the federal government about cyber security and how we can support health care providers in that.

There is always a discussion around, we talked earlier about bandwidth and more rural areas of the country and how we can help deliver appropriate care by utilizing technologies and in those remote spaces. And then we deal with what the government comes up with. Various changes and security and privacy rules.

, they'll be looking further into generative AI regulations. So we get in the conversation with the legislature and the federal branch around those things. And we have really top notch leaders working specifically in Washington with those groups who are knowledgeable and are able to represent us and whenever there's a chance to comment on a rule making.

Process we, we generate letters for that and have a whole process that I think works really well to vet those and as representative of the membership and what we want to communicate with DC. We just

did a webinar on rural healthcare and I'll be honest, I learned a ton. Like I, I didn't realize how ignorant I was of the challenges they face.

And one of the things they pointed out is. The rural broadband pays for up to, I think, like 50 or 60 percent of their cost of broadband. And I asked them, how important is it for that to continue? They said, oh, it's absolutely critical. We wouldn't have it otherwise, yeah. Yeah, it's foundational.

But there was an article that talked about, that's not in stone for whatever. It has a lifespan on it. It will have to come up for discussion, but it's so important for them, what the capital does, because they rely on those dollars. They rely on those initiatives.

Just like we talked about with the economics of not for profit healthcare, this is obviously true for government spending and how we're allocating resources that are limited. And I think it's it's sausage making, right? It's difficult. But I think it's important for us to advocate and help influence and make the right decisions for the top priorities.

Okay, exit question. Let's go in a little different direction. What have you learned about dealing with vendor partners? What do you look for in a vendor partner? Just over the years, you've been doing this for a while. What advice would you give them in working with a CIO, in approaching a CIO and having conversations with a CIO?

Sure, and it fits in with our conversation about QIIME and the work there. I always tell vendor partners that my, my first role out of college when I graduated from electrical engineering, I worked for GE. And so I was on the vendor side, right? And I understood what it was like to approach a customer and what, you What questions you might ask.

And I think fundamentally it comes down to relationship. as CIOs, we know what's out there generally. We're not going to get surprised by someone cold calling and saying, Hey, I have this thing that you can buy. So I think. Over time, different needs come about.

And I, the way I work is generally we, I have some excellent vice presidents who over technology and applications and security that they are scanning the market. They're looking at things. And when it's time for us to do an RFP or bring some new technology and they're generally bringing it forward.

So I think working those relationships within the organizations and being patient about the right timing. And again there's the possibility. I think people always fear that they're going to miss out on some RFP, but we think very carefully when we do an RFP about who to invite and are always scanning the market for that.

I think it's interesting how many vendor partners are like, we need to get in front of the CIO. And in my position, I was like, it probably wasn't as important to get in front of me as it was my lieutenants. Cause. They were deciding, hey, here are the security When it got down to the specific technologies, they were the ones who were saying, this is the technology we want in security, these are the technologies we want in the software defined data center, in the networking space and whatnot.

It wasn't like I was weighing in that deeply that I was going, oh no, we're not going with that one, we'll go with this one. I mean, now, every now and then, they'd come to me and say, hey, this one or this one, we can go either way. Which one's more in line, but for the most part that those teams, but again, it's hard to convince vendor partners.

that, they're like, no, I got to get in front of the CIO. Well, and you're going to talk to the CIO and they're going to say, you should talk to

this person. Right, right. And, sometimes that's helpful, of finding out who in your organization. But it's such a world where you can find org structures and contact information out there pretty easily.

And I think you're exactly right, Bill. It's Working the organization, understanding the experts in each type of technology that we oversee and then they'll bring that forward. And I get a kick out of it. We're a Oracle Health shop have been for Over 20 years, and the number of people I have soliciting Epic analysts for me is just, it's kind of funny, right?

So it's really hard to respond to emails and phone calls, but particularly when someone's trying to sell me Epic people when I don't need them is

one of my friends who, he was a vendor partner of mine back in the days, about, 10, 12 years ago we joke, my name's Bill, his name is Jeremy.

I call him Jerry, he calls me Phil. I said, because I got so many emails that said, Hey, Phil, we really appreciate it. I'm like, man, if you don't even know my name,

it's hard to even politely decline, right? Cause then you get in an email loop or a phone loop with people when you're just saying, Hey, this isn't the time or whatever.

Yeah, I agree. Scott, Hey, I really appreciate your time and I appreciate you sharing your experience with the community. Thank you very

much. Thank you, Bill. It's great seeing you.

 I love the chance to have these conversations. I think If I were a CIO today, I would have every team member listen to a show like this one. I believe it's conference level value every week. If you wanna support this week health, tell someone about our channels that would really benefit us. We have a mission of getting our content into as many hands as possible, and if you're listening to it, hopefully you find value and if you could tell somebody else about it, it helps us to achieve our mission. We have two channels. We have the conference channel, which you're listening. And this week, health Newsroom. Check them out today. You can find them wherever you listen to podcasts. Apple, Google, overcast. You get the picture. We are everywhere. We wanna thank our keynote partners, CDW, Rubrik, Sectra and Trellix, who invest in our mission to develop the next generation of health leaders. Thanks for listening. That's all for now.



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