Today on This Week in Health IT.

All of my military experience taught me the idea of servant leadership and the best way that you can recognize your value as a leader is when you recognize that the people you're leading are so much more talented than you are.

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 in Health IT. 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 developing the next generation of health IT leaders.

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All right. Today we are joined by Daniel Barchi the CIO for New York Presbyterian and CIO of the year. CHIME CIO of the year. Daniel, welcome back to the show and congrats on the CIO of the year honor.

Great. Thanks so much for having me Bill and it's true what people say. It's just a reflection of the team. So we've got a great team doing it here in New York Presbyterian and Weill Cornell and Columbia, and they've made so much happen.

Yeah. And we're going to talk a fair amount about leadership. We're gonna talk telehealth because I think it's interesting. You guys have a pretty good program prior to the pandemic you had to scale up and I'm curious on, how the platform scaled up for you and those kinds of things. So we'll talk telehealth I want to talk AI and automation.

The last time you were on the show, we talked to AI and I want to hit on that a little bit, but let's start with. Let's start with New York Presbyterian. Tell us about the system first, and then we'll go from there.

Sure. Well, I'm really proud to be part of this great academic medical center. We're about a $9.5 billion enterprise with 11 campuses in New York city. And around this Metro area, outstanding care delivered by Weill Cornell physicians and Columbia doctors who practice at all of our hospitals. We've been around for more than 250 years. And everything we do is about serving all patients and planning on being here for the next 250 years. I'll say a moment about serving all patients. It's something we're very proud of. We are both a destination medical center and that people travel all around the world to get here, but people also come from all around New York city and we serve everybody. So it's not just a throwaway statement to say that we serve all new Yorkers.

We're located in all of the areas. We have clinics everywhere. We have outreach programs. We've been accountable care network, reaching out to all new Yorkers. We serve more underserved new Yorkers than just about anybody. So we're proud of the fact that we're delivering a world-class medicine and we're delivering it to everyone.

And during the pandemic that really became essential to provide those services. You guys ended up you have a strong partnership with Hospital for Special Surgery and partnered with them, opened up, open up a fair number of almost I mean, I don't know the exact numbers, but you opened up a lot of ICU capacity, a lot of additional rooms and those kinds of things. Talk, talk a little bit about that.

Sure. I'm proud of the way that our team responded to the pandemic. You're right. Hospital for Special Surgery is a partner of ours and we are a co-located between 68 and 71st street on the upper east part of Manhattan. So they're close by. During the pandemic we were really closely aligned in terms of making beds available, sharing beds caring for patients jointly as well as the collaboration that we did with other hospitals in the city with the New York City government and the New York state government to load balance patients as much as we can.

That's another example where we were serving all New Yorkers. There were some really hard hit parts of our city. We have one of the leading hospitals in Queens and in Brooklyn. We were serving patients there. Everyone was following just how bad things got on the evening news in Queens and our our team there did a remarkable job caring for patients.

We were able to create additional ICU capacity by turning our cafeterias and other open spaces into additional beds. We're able to double and triple ICU beds into our ORs and pack use. And so we were focused on nothing but care for all of these patients. And then after we got through the worst of the pandemic, when we were focused on vaccinations, this is more of our outreach.

One of the things I will always be proud of in my career is the way New York Presbyterian thought to put a mass vaccination center, not in one of the tonier parts of Manhattan. But in Washington Heights. In an armory adjacent to our Columbia University Medical Center. And by being in Washington tonight's we were in the community that we wanted to serve.

And so instead of vaccinations going to who had the greatest access or who had the ability to log on and make appointments or get through a call center, we were in the community. So we were accessible to people who otherwise might not have gotten the appointments. And this is where technology played a role.

It would have been easy to say, okay, just we open our doors at 6:00 AM every morning. And we take as many people as we get, but we didn't want to create lines and unnecessarily create demand that we couldn't keep up with every day when we were doing three, four, 5,000 a day, but we were limited to that.

So we made everybody get an appointment online through our EMR. So that did a couple of things. One, it got many, many people registered in our portal that were never registered before. So now we have more than 1.1 million active patients in our EMR portal. Right. Which is industry leading. And it's great because now we have a great symbiotic relationship with our patients were using all of the access that we have. But by making the patients available in the portal, and only in the portal, we prevented people who just had the time from getting on the phone and waiting and calling until they were able to get through. But it also allowed us to target who got those appointments.

So early on, we put 5,000 appointments on for a Saturday. And by noon on Friday, they'd be all gone. And then we'd put 5,000 appointments online for a Sunday and they'd be gone in 20 minutes on a Saturday. And so over time, what we started saying. Who do we want to serve? Who do we want to make sure are getting appointments that are not.

So we started saying instead of first come first serve any of our patients on the portal. We said, what are the parts of the city that are not getting the appointments right now? Or who are the underserved minority who are not getting appointments? Or we have too many English speakers, not enough Spanish speakers in the community that we're serving.

How do we make the right zip codes available? So what we would do is put a certain amount of appointments online. But open it up by zip code to certain amounts so that we were able to keep appointments open for people who otherwise might not have been able to get through. And in the numbers showed it, we were committed to both the city and the state and making sure that we had a diverse balance sheet of who's getting the appointments.

And every day we were able to say this is who came in. These are Spanish speakers, these are English speakers. This is the race and ethnic breakdown. And we were able to tweak it day by day to better serve the population of New York instead of only serving one population.

So Daniel, was that part of your portal logic, or did you guys have to break it apart and recode it in order to do some of that specific geo-targeting for appointments?

That's fantastic. During the peak of the pandemic, I talked to some CIOs and they, they said they were learning a lot from you. So during that peak, you were actually communicating out. And now people may not even remember, but at the peak of this thing, New York was inundated. I mean, the numbers were, were extremely high. I'm sure you were working ridiculous hours trying to keep that up. But even during that timeframe, you were sending out emails, maybe not, Hey, this is what you should be doing more along the lines of, Hey, this is what we're doing.

We're in the middle of this thing. This is what we're doing. Prepare. Cause at that point we thought we really thought this was going to sweep the entire country just like it did New York. Now that didn't play out that way in a lot of cities. But in some it did.

We were in the command center for a week or two, and then shortly thereafter, we had our first COVID positive patient, but we start coming. If you recall, we all recall starting in China and then moving into Europe and it was really bad in Italy and we were focused on what are Chinese hospitals doing?

What are Italian hospitals doing? How should we start to prepare? So, as we were winding down our command center, we were starting to say how do we bring capacity online? And we knew that we were going to be a major epicenter in New York city. And so I started sharing with our colleagues nationally.

So I'd send emails every couple of days to 30, 40 different CIOs letting them know the steps we were taking. And then when we started getting our first patients and, and started seeing the number spiking, it almost started being like a report from the front about what was happening, the choices we've made, the ICU bed planning, how we'd maximize the use of ventilators, what we were trying to order in.

Which shortages we were having. So it was a technology and an operational and a community response message that I was trying to share with my colleagues nationally. And I was also trying to give them the insight. The sadness of running the streets of New York city of night, when I would go home after being at work all day and just being able to run up and down the avenues, not even looking left and right crossing streets and not worrying cause there was no single car on the road. The surreal experience running down sixth avenue and through Times Square with not a soul around. It was a lot to share and I felt it was important to document it. So they would know both what they were going to experience and any kind of preparation that could make themselves.

Wow. I assume new York, it may not be completely back. I was talking to somebody and they said they, they, they felt like a lot of the restaurants didn't make, not a lot, but a large percentage of the restaurants didn't make it. Just because you know that the numbers went down for such a long period of time.

But I'm hearing now that, it's starting to come back. My production person lives in New York city. And she's going to restaurants now. I guess Broadway's open again. So is it starting to feel like Christmas in New York city?

It feels back. I'll be honest with you. Aside for masks, if knowing nothing else from the past couple of years, I showed up one day on the streets and just walked around.

So it certainly feels like it's back, although we're very thoughtful about what's coming up. The next variant to come through and how we need to plan for this winter as well.

I want to talk about leadership and I pulled this off the internet. So it says about you, he served as Brigade Commander while at the US Naval Academy and was twice awarded a Navy commendation medal for superior leadership. What did you learn about leadership at the navel academy?

All of my military experience taught me the idea of servant leadership and the best way that you can recognize your value as a leader is when you recognize that the people you're leading are so much more talented than you are.

So think about it. I was really proud of what I was able to accomplish at Annapolis. I went out into the fleet, got to my first shift, a cruiser. As a 22 year old officer and I found myself in charge of 30 people who had been sailors anywhere from one year to 25 years. And so I was their boss. And so I was the 22 year old, very junior officer.

And I had a Chief Petty Officer who this guy was old. I mean, couldn't believe how old this guy was. He looked like he'd been at sea his entire life. He must've been like 41. So in my perspective, this guy, now that seems relatively young. But what I recognized was I don't have much to teach this guy about sonar and torpedo maintenance.

He knows more than I will ever know on these topics. My job is to say, Hey chief, look I'm the anti-submarine warfare officer here on the ship and I'm your boss, but what do you need? What's the focus? What does our crew need? What can I do for you? And so recognizing early on that the leader didn't need to be the one with the answers.

It's the one who makes the resources available that has the vision that can communicate the larger strategy and then protect the team so they can do their job. That was a great learning experience at 22. And I think that I've used it almost every day of my entire career.

Did you show up at the academy with that sort of approach and philosophy, or is that something that the Naval academy has a leadership style that they teach and develop in the people that graduate from there?

No. I showed up as an 18 year old person at the Naval academy. Just so excited about what was about to happen without any great insight about what was to come, but I'll share another experience. It was a formative experience. Everybody has the images of heads being shaved, running around and sweating and getting yelled at and firing rifles and everything that you do.

And even meals are very intense. And while you're trying to shove down some food, people are yelling at you and asking you questions that you need to know the answers to. And at one meal, I recall one of the senior midshipman, and remember I was 18. This person, he was probably 22 years old at the time, but seemed wise to the ways of the world.

He asked me a series of questions, and then I gave my responses and then he opened himself up and allowed us to ask a question or two. So we would get insight from him. And I asked him a question and he didn't know the answer. And he said, Barchi, I don't know. I'll find out, I'll get back to you.

And I thought this guy didn't have to sell me anything. He could have bluffed his way through. He could have told me to be quiet. He told me he could have told me I was wrong, asked the question, but here's the senior person in the most leadership inbalance. And he was the one who was like, admitting to me that he didn't know.

And he was going to get back to me with the right answer. And that was 30, 35 years ago. And I still remember that. And so recognizing that as the leader, you don't need to be the one with the perfect answer and communicating and being honest is way more important than just having the pithy response so.

Are you able to maintain that level headedness, even CHIME CIO of the year, Weill Cornell and New York Presbyterian. I mean, you're in the epicenter of New York city and that isn't it hard to maintain that sort of level headedness of, you know, it's okay for you to say. Hey, I've been a CIO for quite some time. I don't know. I'm going to figure.

It's not hard at all. And here's why. I'm humbled every day by the things that I find that we've missed. So I'll give you a good example. We were focusing on our ORs today and there was something that really surprised me that we hadn't done a better job of maintaining and I'm disappointed in myself and the fact that our team didn't do a better job of staying up on this one. I need to work with one of our senior leaders to figure out why we didn't do a better job at serving her and that campus.

And so you can't go around confident in everything you do. When you recognize that every day there are opportunities to improve. And quite frankly, I'm responsible for a great portfolio here. I feel fortunate to lead our team and the analytics and the pharmacy team some of our operations. And so it's, it's really interesting the kind of things that I get involved in. But I'm also working with world-class physicians and surgeons and nurses who have deep, deep clinical knowledge. And I've got only a smattering just by having worked in healthcare for years. So even if I was on the absolute top of my game, I'm still serving that nurse or that doctor who just knows a vast majority about clinical things. And so I need to go to them and say, doctor, what do you need when you're doing this kind of case? What do you need analytics to improve the quality and the outcomes in this area? What do you need? So there's never a case where I'm the one with all the answers. I'm often the one asking questions. So I learn more. So we're better able to serve the customers.

Last question on leadership when you're hiring for a leadership role. And I realized all of the roles are a little different, but let let's say, somebody who's going to be one level below you. A VP within the organization, they're going to have a team of people underneath them. Is there a question you ask in the interview to try to identify that their their capacity to lead or their philosophy of leadership?

I don't think so. For years I've tried to ask standardized questions because we're always told to be a good interviewer. You need to ask everybody the same set of questions and see how they respond.

But most of the times I've ever talked to people about roles or jobs, whether it's to work on my team or help them find other opportunities, they get to be conversations. And I feel like you get to know the person. It's never technical skills. It's never their specific subject area knowledge. It's more their vision and their ability to communicate.

I think that leaders need to be able to communicate really well to share the vision from the CEO, from the COO, from the board of directors, to the members of the team or to tell stories because when you're dealing with a lot of bad news and we're often dealing with bad news, bad patient outcomes, things that we needed to do, limited resources long hours of work, you need to be able to tell the story about why it's important.

So I think that my sense when I'm talking to people about a role is how can they communicate? Can they be honest in what they're saying? I think those are important things to focus on.

All right. I'm going to, I'm going to flip over to telehealth because I think you'll give us an interesting perspective.

So you guys had a platform leading into the pandemic and that was in place for a number of years prior to the pandemic. Was it just a matter of scaling that platform up or was it more complex than that to make it ready for the quite frankly, the, I don't know what it was 5, 6, 7 fold increase?

Thanks for asking and in that way. I'll start by saying that because we've got a great technology team it's easy for me to simplify and say, oh yeah, it was simply a question of scaling up, and I could say it that way, but there's a lot of great people in our innovation team and our IT team that made it all happen from a technical point of view, to integrate, to make it easy for the physicians and the patients to use. That said most of what we had done was incremental. And this is a theme throughout a lot of what we do. I'm not a fan of creating the perfect plan and then putting the business plan around it, getting approval, and then flipping a switch and hoping everything goes well.

And they, did a telemedicine visit with one of our 80 doctors who's was in a conference room, a hundred or 200 feet away. And so they deliver the medicine in that very simple way. We learned from it. We did those firsthand. And we asked some how it went. We asked the physicians how it went. We tweaked it a little bit.

Then we did the next 20. Then we did the next 50. After a little while we'd done a thousand of these and found out it's kind of efficient. We can have the physicians really remote. The patients like it. Then we turned it into a program to allow patients to do from their phones at home. Then we partnered with Walgreens and put kiosks in a local drug stores and we're allowed patients to do it from there.

And I'm trying to figure out how to ask this question about sustaining telehealth. And I think what I want to ask is where do you think it's most appropriate to sustain the use of telehealth at a system like yours? In a center city location?

And ahead of time, I wouldn't have been able to tell you exactly where we would have done telemedicine. Well, I probably say, would have said psychiatry and that's true. Psych lends itself really well to tele-medicine because there was no laying on of hands, but we've also found out that it works well in a physical therapy.

And you would think, physical therapy, but in many ways, it's the ability of the physical therapist to communicate to the patient. The patient does the movements on his his own self or her own self. And so you really don't need that laying on of hands. So physical therapy is one of those areas where it's come out well, cardiology, certainly their imaging studies and labs that need to be done.

But for that initial consult with the cardiologist, either pre or post all of the labs and the workup, that conversation with the cardiologist can happen conveniently with the physician and the patient, wherever they are. And then I mentioned earlier that we're a destination health system. So people come around from around the country because we're the national leader in transplant medicine, especially in cardiac transplants.

And so a lot of the followup care, you wouldn't want somebody. Who's got a, had a heart transplant. From another region to have gone home to another state and then a week or two later to come back in simply to have a conversation with the physician or for the physician to check their incision or just do some basic follow-up.

And so even being easier on the patient by not traveling, that's a great area and you wouldn't have thought that in complex care, that works well. The last thing I'll say is it also helps us with equity in delivery of care to all new Yorkers, because we need to make sure that people have the technology and the tools to be able to access it.

But the ability to do outreach to diabetics or people who might wait months for a neurology consult, if they're getting into a practice but if we can have our neurology fellows to see a number of patients just on a Tuesday and a Thursday afternoon and a clinic, and actually be doing outreach to pay to new Yorkers calling up and saying, Mr. Russell, I understand that you're waiting to see a neurologist. I'm Dr. Smith from New York Presbytery. Do you have a couple of minutes to talk right now? Can can you do a video visit with me right now? Can you show me how your hand movement works? Those kinds of conversations and having done initial followup prevents people from waiting months.

So more and more, I think telemedicine will find its niche. Right down to about 20% for us.

You know, Daniel, we keep talking about access and equity. Do we have a picture of the lack of bandwidth access to good computers and that kind of stuff within the communities that you serve? That we can partner with the state and identifying those areas to bring them.

I would assume between healthcare and education, because we sent so many students home that we would have a much better picture of that, at least that problem set that we're looking at rigt now.

We do. I'm actually, impressed by the way that we hear New York Presbyterian with Columbia and Weill Cornell, and then New York city have responded in trying to figure out how best to serve all of our communities and the specificity that we've been able to get to by neighborhood and access.

And then by working with communities access organizations, our accountable care network, our outreach, and then local churches, we're able to get to even more patients. And then by starting to do telemedicine and other visits in schools and in senior centers, we can reach even more. So. It's not perfect and we have a long way to go to make broadband and technology accessible to everybody. And we can't let there be a digital divide when we can make everything happen on your smartphone, through our portal. That's great. But if you don't have access, it's no good. So it's still that last mile piece, even in this, and we're working hard to close it.

Is 5G still too far away to be the potential last mile solution for some fo this?

5G will help. But I'd say it's less about the latest cutting edge or the latest high speed and more broadband access for everybody. So I'd be more concerned about smartphones in the hands of all new Yorkers or everybody having normal wifi to New York city housing authority buildings than it would be about the latest cutting edge access. And one of the things that 5G was touted on early on was the ability to download a movie right before you get on a plane, but that's not how we watch movies anymore. And getting on a plane is not a concern to all of our patients in New York City that want basic healthcare and access.

And then there was the gosh, a physician in another country being able to do you know, robotic surgery via 5G from a distant location and then forgive me for being simplistic, but, perhaps we can just wire it instead of being 5G and it being on wifi why not just have the tactile surgery and that physician wired up to the network.

So I think in many ways, advanced technology is always looking for the next application. There are so many things that we can solve with the core technology that we have today before we are looking for the next cutting edge solution.

Fair enough. Makes sense. I'd like to revisit a topic we discussed and you can split these two apart, but I'm going to talk AI and automation, sort of in the same breath here.

Your system has some great wins in the area of automation, especially on the administrative side. Have you expanded on some of those use cases for automation on the administrative side or the administrative tasks?

And we were proud of what we did early on. Then we started to move into the clinical space and we've done this over the past couple of years, we started using machine learning and artificial intelligence to make predictions about when people would go home and assign them an estimated date of discharge.

And then start comparing the estimated date of discharge versus how their stay is currently looking. So if you feel like you were in here for a hip replacement, you're supposed to go home on Thursday at noon, and it's Wednesday at noon, and we have not ordered a physical therapy consult form from you, our AI system is coming through the records and saying patient Russell in bed 1, 2, 3 has not had a physical therapy consult and sending that alert to the doctor. So not clinical cause we're not saying this blood type or this type of care, but it's administrative, but in the clinical space. And so that's where we're getting to next.

So AI and ML is starting to enter the clinical space, making recommendations to physicians. Now more recently we've started applying it even more clinically. So we do hundreds of thousands of images every year, and a lot of those are coincidence. So if I go in for a chest x-ray cause I was in a soccer injury and I broke a rib or two, you're capturing a lot of clinical care going on in my chest. You're also capturing an image of my heart. So we're starting to apply machine learning, looking at those coincidence images that might not be in there for a cardiology consult, but start to say, while patient Barchi was in there for his broken ribs, machine learning looked and said, it looks like a thickening of some of those arteries or the tissue around his heart and making a recommendation from there. So I think that's the next phase where AI and ML are just in the background, making recommendations.

Administrative side, we've talked about clinical side of you started to touch on. And I also want to talk about within IT. Cause I think there's probably a fair amount that we can do in that area. But going back to the clinical we're looking at, and I don't know if you're experiencing this there, but most of the CIO's I'm talking about they're looking at this clinical worker shortage. Specifically the nursing shortage that's projected over the next two to three years.

Do you think there's an oper, I mean simplistically, we look at it and say, oh, automation, AI, this is going to be one of the things that sort of steps in here and makes it easier or more productive for those clinical workers. Is that too simplistic a way of looking at this? Do we still have a lot of bias and data challenges to get through before we can see those kinds of wins in that space?

We really do. At the end of the day, healthcare is delivered by our physicians and by our nurses and there no way to replace them. And why would we want to replace them? They're the ones who are providing the care for the patients. They've got the clinical experience and the insight. I do think more and more than technology, AI, ML, other advanced analytics will make their days easier.

Give them what they need more quickly. Our goal is to make more care frictionless. So frictionless for the patients, making online appointments, doing followup, getting the results they need and making the care for our physicians, nurses frictionless. The tools that they need, the data that they need at the moment.

Best practice alerts that fire at the right time, so that they don't have to go digging through data so that their interaction with the patient can be all about that patient and the patient care, not the physician looking through old data, trying to draw conclusions by looking through old records.

And so I don't think that there's any way to replace at the bedside, those physicians and nurses that deliver good care. I'd like to maximize their time at the bedside by making technology do more of what they would otherwise not have that time to do.

Yeah it's going to be interesting to keep an eye on that space.

We've been looking at some really interesting clinical automation solutions and they're really, really fascinating. So it'll be interesting to stay on that. One other area of promise is AI and automation on the IT administrative side, the idea of any work going on in that area?

One of the things I'm proud of is the way that we've started to create a better front door to care for our patients. Literally making it easier for people to get in, see our physicians and get great care. And one of the ways that's a challenge if you're not able to make an appointment online is to get through any phone system.

And this is true, no matter what industry you're working with. Airlines, hotels, healthcare. And we have 15 million inbound calls every year to our medical centers through all of our operators. And one of the things we've started to do is work with a company called Syllable that uses AI to defray a number of those calls.

So it uses AI, asks questions, patients answer and it makes decisions about where to route the patients that otherwise our operators are doing. And it's a challenge because any large academic medical center has hundreds of front doors that you can call. You can call Dr. Russell's office, or you can call Dr. Smith's office. You can call this hospital or that hospital. There are plenty of phone numbers. And unless every one of those people answers the phones knows everything. It's likely they're going to get routed a number of different places. But if you have an AI based telephony system that's answering and knows the answers and where you needed to be routed, or you're able to defray and reduce the number of calls and redirects just by applying this technology in the past couple of months. Where we've done it at the call centers where we've applied it, we've been able to reduce by 60%, the number of inbound calls that we have. So that's an example of making the care better for our patients. More frictionless for our patients. But also reducing the amount of people that we need answering the calls.

It's so interesting. You keep talking about this incremental, incremental, and I used to use the term with my staff. I used to always use the term better. I want everything to be better tomorrow than it was today. It doesn't have to be great.

Doesn't have to be perfect. Just let's make everything better than it was yesterday. And if we do that 365 days a year, by the end of the year, we're going to have made some progress. And when you give some of those numbers, that's a significant time savings for people. I mean, you reduce that friction and your patients, they start to feel it and start to experience it in a different way. And it's not, I think I like that, that idea of incrementalism or just better. Better by the day gets you to where you want to get to I think.

I like the way you put that. I'm a fan of college football. I saw an interview with college football coach this season, and his mantra was 2% better every day. It's not asking his players to get twice as good in a week but 2% better every day is reasonable to ask. And like you just said Bill, if every one of us is trying to improve what we do, make the experience better, improve our quality and reduce our bad outcomes and improve our better outcomes everyway, we're going to continue to improve.

So switching gears. Last two questions here. I'd like to offer our vendor partners a little help on working in healthcare and CIO's really have a ton of responsibility. And as a group, they don't like when people waste their time.

And you'll have to pardon this, but you have a reputation as someone that doesn't suffer fools lightly. So, meaning that you don't have patience for vendors or partners that don't have their stuff together or don't do their homework before they come in. And all of us have had that experience. If you're in that chair and you're trying to run real fast, you're managing a lot of people. I guess my question would be, what would you tell vendors that are calling on healthcare CIOs?

I would say that healthcare CIOs are not often the best people to call on because we often have limited resources as our teams are working very hard. And in many cases, we're trying to optimize the tools that we have my recommendation.

And I share those freely with anybody who asks is, know who your customer is. So in many cases, the healthcare CIO is not the best person to be making that sale to. So it might be the CFO who has the vision to know, oh, you're telling me this tool or product could save us X cost on expenses or would increase our revenue by a certain amount. Or maybe it's the Chief Patient Experience Officer. Or maybe it's the Chief Nurse.

Or maybe it's a board member or the CEO who has vision for where we need to go next. So CIO's are often a place where the answer can be no, because it seems like it's competing with the technology portfolio. But thinking only about the technology portfolio misses the opportunity to maximize the benefit of a new idea or new product or new technology for the larger system.

And quite frankly, I might be a person whosay no, that doesn't seem like it's a good use of time or our energy or our dollars. But if our CFO comes to me and says, I just talked to my partner out at this other health system and she's the CFO out there. And she said that they're doing this thing.

Let's investigate it. If our CFO's interested. Good. I'm happy to do it. Or if our Chief Nurse says this would really help, I'm interested. So think about who you're targeting and go to them first.

I'd say quality focused on outcomes for our patients. I think that over time, we're going to be expected as health systems to standardize what we do. We're proud to be one of the leading health systems nationally, but the expectation should be that any patient anywhere goes into a hospital and they have outstanding outcomes. And measuring ourselves nationally against one another is the right thing to do so we're always improving quality. So we could be improving volumes or throughput or revenue, or even patient experience scores. All of them are good, but at the end of the day, we're health systems that are designed to make patients better and have good outcomes. And I think coming out of the pandemic and looking into the future, quality is going to be the north star that keeps driving us.

And it's important whether you're the CEO or COO, you're an IT leader like me or the finance leader or the Chief Nurse, all of us are focused on that experience of the patient that they come out of the experience in a better spot. And it's quality that drives that. So I think that's top of mind.

Great. Thanks for everything that you do to Bill. And it's good speaking with you.

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