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 Welcome to this Week in Health It, it's Newsday. My name is Bill Russell. Former healthcare CIO for a 16 hospital system and creator of this week in Health. IT at channel dedicated to keeping health IT staff current and engaged. Special thanks to Sirius Healthcare Health lyrics and Worldwide Technology.

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It'll go to the, to the entire team. We'll take a look at it, reach out to these people and, uh, see if there's a good fit to, to bring their knowledge and wisdom to the community as well. Welcome to this Week in Health It Newsday. Today, Dr. Justin Collier joins us as we explore the news. My name is Bill Russell, former Healthcare CIO for a 16 hospital system and creator of this week in Health it a channel dedicated to keeping Health IT staff current and engaged.

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Bill j Russell. I do one post a day and cover one news story. In addition, I do a daily podcast on that one story that you can find on today in Health it, which is on Apple Podcast, Google, Google, Spotify, Stitcher, really everywhere that you listen to podcasts. You can check it out on this week, health.com.

Dr. Justin Colliers in the house. Justin, welcome to the show. Thanks for having me. Yeah, my pleasure to be here. This is your first time on the show, so Yeah, I'm, I'm looking forward to the conversation, but since this is your first time on the show. Can you, you know, give the community a little bit of your background, where you come from, what your area of expertise is?

Yeah, sure. So I am a dual boarded physician. Physical medicine and rehabilitation was my primary specialty. And clinical informatics is my subspecialty. Uh. I've been with Worldwide Technology now for the past three years as one of their, uh, chief Healthcare advisors. I have the blessing to work with two other fantastic physicians and an absolutely rockstar nurse doing a lot of fun, transformative things for, uh, all parts of the healthcare ecosystem, which is pretty great.

And then before that, I spent, uh, a decade at HCA and seven and a half of those years as a Division CMIO for them. What's, what's the biggest difference being with a, uh, a consulting type, uh, organization versus being at H-A-H-C-A for, for a decade? Because I've done both and I'm, I'm curious your, your thoughts and I'll give you some of my thoughts.

Yeah. So the fantastic thing to me about the job I have now, well, there's a bunch, you know, of course, fantastic culture. Both organizations are, are well known for their culture. , but you know, with worldwide just being on the, the top 100 best places to work for the 10th year in a row, which I think may be a record, it was pretty fantastic to, to move to worldwide.

But I get to help more than one health system at the same time instead of just helping one get better. And so that's been, that's been a really great thing and I get to see the work that we do across all the other sectors we serve. And bring those innovations into healthcare faster. Um, so that's been, been really rewarding.

Yeah, that's, that's the thing. I, you know, that's the thing I really like, the thing I like about being in a health system is you get to go really deep and solve very specific problems. The thing I like about being a consultant is, is a handful of things. One is you do get to work with a lot of different health systems.

You get smarter every day 'cause you're visiting several health systems. Potentially several a week or or whatnot. And so you're seeing some really neat things happen and it, you almost act as the. A cross pollinator, I'll say for the industry, because you're going from place to place saying, Hey, I've seen that before.

Here's, here's a good idea. So I, there's, there's part of me, I, I understand the draw to, to each, but I, I, I really do. I, I, I, I enjoy the consulting side of it. It just feels like you get to work with more people and see more things. That's my, my take on it. I don't know. I'm not asking you to comment on it.

EHR usability score. Uh, 57.6, which researchers, they gave a grade of an f. Lemme tell you a little bit about the study. EHR usability has been found to be a source of frustration for physicians, but less is known about perceived usability among nurses. The study team comprising researchers from Yale School of Medicine, Mayo.

University of Virginia School of Nursing, American Nurses Association in Stanford School of Medicine sought to change that. And, you know, as they went out, they found that there was a, a fair amount of frustration with the build. You know, I posted this this morning. Does that surprise you at all that, that you get that kind of grade from a, a study of nurses on EHR usability?

Yeah. Sadly, I would say no. It doesn't surprise me. I think it's been known throughout the industry for quite a while. I think, you know, probably any user of any EHR probably would rate the usability as an F in almost all cases. It's, it's unfortunately just kind of the nature of the beast, uh, if you will.

But it's good to see it studied. You know, I would, I would definitely like to see a similar study done for the allied health professions. You know, physical therapy, occupational therapy, speech therapy. And, and others. What do you think can be done? I mean, part of this is just the nature of software, right?

So this is, this is still written on. A, a code base that is fairly old. It's, it's very specialized towards healthcare. A lot of clicks still in it. And one of the challenges is it's being compared to the other things that people use. Right? And so the other things we use keep getting a. More and more sophisticated, easier and easier to use.

You know, we, we can pick up our phone and say, give me directions to fill in the blank. And it gives you directions. And, and so the rest of our world, the rest of the technology that we're using is getting easier and easier. And so with every day that the EHR just feels a little. Clunkier, even if it was state-of-the-art, the day it was installed, it's, it's maybe not keeping up to the, to the standards of usability that's going on.

So you sort of have that perception issue, but what, what are some mistakes do you think that health systems make that, that lead to the nurses being frustrated with the EHR? So I, I think the systems that do the best job. I'll frame it that way. So maybe best practices rather than, rather than pitfalls.

Obviously the other side of the coin is not doing those things well, but I think the systems that do best. Are the ones that have nurses on the informatics team, nurses who have been at the bedside and understand the workflows personally, that makes a huge difference. And then the second step is engaging all of the stakeholders during the build process so that they are part of that decision making.

Uh, certainly that that helps quite a bit in terms of, of adoption as well as potentially improving the usability. Third thing that really makes a difference too is not stopping with installation or implementation or, or the build. It's, it's going back and doing continuous cycles of optimization, so continuing to improve that.

And then the, the fourth thing is not actually in the EHR at all. It's making sure that you have the right surrounding technologies that can improve the workflow overall. For the nurse, uh, and doing as much as you can of that work to, you know, automate manual work, manual processes, improve the overall workflow, leveraging all the best technologies you can.

Not surprised by the usability score. I may be a bit biased as a former rn, but most of my work around EHR Automation and optimization Optimization has had nursing as stakeholders. This, that's what you were just discussing, discussing, but physician workflows and user experience has always taken center stage.

Physicians typically are the most vocal about their complaints and have senior leadership's ear on what they need out of the EHR. Compared to nursing, nurses are rock stars. They deliver care, juggle the complexities of managing family and care team expectations. Quarterback, the patient experience while subsequently spending the lion's share of the time in the EHR.

The great news is that the promise of ai, ambient clinical listening and enhanced digital capabilities is beginning to move the needle on end user experience for many of our clinical applications. And I guess that tees up a question of are, are, are you seeing some of those technologies and what technologies are you seeing that's augmenting the experience within the, within the EHR.

So a lot of it has to do with performance of the systems. So making sure that you've got good hardware that's gonna perform well, that you've got the right network and the right wifi support so that those are not barriers. You certainly don't wanna laggy system, even if it's. Especially if it's not particularly usable, you don't want to add friction to the system.

Things like roaming sessions can be nice so that when the nurse has to change computers, she can pick back up or he can pick back up wherever they were last in the system. You know? And again, technologies, I think like ai, ambient listening, things are coming in that. Regard speech recognition, things like that I think are significant.

And then I think automating other manual processes that are part of the nurses day in day out are really important as well. Um, so what are the tasks that can be managed for them that allow them to have more time at the bedside with a patient, which is why they went into healthcare. You, you know, we spent a lot of time on this.

I mean, it, it was interesting. We, we had a badging process, uh, badge in, badge out, and it would move the virtual machine with them. And I think at one point they had to actually, they badge in, badged out, but it would drop them at a, at a home screen. And one of the things they kept telling us is, look, when I leave that room and I go to.

They badge out one machine badge into the new machine and they're landing exactly where they left off. Yeah. Those roaming sessions are powerful. Yeah. And, and so there's, there's an awful lot of things, and, and part of me is like, you know, you just, there has to be a, a constant dialogue, I think going on around the build.

Is this working for us? Are we doing the right things? What things would benefit you? I.

Joe Webb, who I'm not familiar with, but it looks like a technologist really at heart. He, and he talks about the, the latency that you were talking about. It frustrates everyone, including patients performance tuning and high availability in the backend. Data systems should be considered with all implementations.

Yeah, I, I would say one really cool thing that's come out recently or relatively recently that a lot of people haven't necessarily adopted in the healthcare industry that we're seeing really accelerate a lot of things in other industries is GPU acceleration for virtual desktops that actually can significantly enhance the performance.

I. Something that, you know, PC gamers have known for a long time. You know, if you get get some GPU support, you get better performance. Um, imagine how long it's taken us to figure it out that, uh, you could accelerate your virtual desktops that way, but it can be a really powerful improver. Well, that, that makes perfect sense.

I mean, a virtual desktop is essentially just. D delivering the screen captures for the most part, that, that, that virtual sessions running in a data center, you know, miles away. And really all you're delivering across the line is, is the, uh, pixels that go up on the screen. And so, yeah, GPU that, that's interesting.

I, I hadn't really thought that one

in. Of course Drex weighs in. Let's see what Drex has to say. I was, I was talking to CMIO last week. He admitted that their EHR strategy was to , was to suck less his words. Once I cleaned up my coffee off the desk that I just spit on the desk, I asked him for more. In his words, they can't help it. None of the EHRs are great and the current models make clinicians do a lot of clicking and typing.

Then working late to do more clicking and typing. Cutting and pasting, which is loosely translated, the EHR sucks, can't make it better. The goal, according to this CMIO is to make it suck less. I'm not sure that's, you know, what's interesting to me? Uh, because I, I mean, you do this, I do this. I sit down with CMIOs, I sit down with CIOs, the tools within the, so.

Have figured out the EHR, they've customized it. They, they put in the build that they wanna have and they're very efficient in it. And you can look at the other doctors and sort of compare them across their, their use of the EHR and, and those kinds of statistics that are, are built into a lot of the EHRs.

Back when we were doing it in 20. 13, 20 14, we actually had to build a, uh, data repository, bring all the log files in, do some, some big data, data analysis, and we were able to create the same thing. But today in Epic, you, that's available and, and within some of the other Cerner and other, the larger players, you can get that data.

I would. Very helpful. How would you feel as a, a physician if I showed up and say, said, Hey, we're here to help you with the ehr. Notice you've been having some challenges, you know, let's talk through those. I, I'd assume you'd respond pretty good to that. Yeah, and I think it's the right strategy and, and I wanna say it was Jamia that a few years ago I had published a study that showed time and training the amount of time physicians spent during that training process.

Actually getting trained on the EHR as well as the amount of time physicians spend with doing customization upfront and periodically on an ongoing basis. Those are two real keys to improving. Efficiency of use of EHR and the comfort of using those EHRs. So I think, I think training upfront, but to your point, when you see somebody that's struggling, that's spending way more time, especially after hours reaching out to those folks and saying, Hey, there are ways that we can help you, let us help you get better.

But let us help you with the customization, let us help you with additional training, tips, tricks, things like that. And especially if you can do it in a peer-to-peer way, that makes a tremendous difference as well. You know, pair them up with some sort of an EHR mentor of sorts who is, you know, a similar specialty if you can, who's performing at, you know, the opposite end of the spectrum.

Yeah. You know, to be honest with you, I was surprised that this story got this much traction in on my LinkedIn post only because the, at, at our health system, the, the chief nursing information officer was a pretty prominent person. A pretty, I mean, she was at the table, she was at the executive table, she was very, uh, much a part of the build.

The nurses were pretty much center stage and, and she constantly reminded us that the nurses are gonna spend more time in the EHR than anyone else. And so the build, we spent a lot of time with the nurses to get the build right. And so I was kind of surprised to see this. And, and I assume your experience is there, there are other, other health systems that have gotten this right because they, they really do include their, the nurses early and often and they, they're a part of governance going forward and they make sure that the, the system really serves the nurses.

I, I, I thought that was the norm. Is, is I guess why I.

So I would, I would say even if you're doing all the things right that you can, as the health system, that doesn't necessarily fix the underlying platform that you're operating on, if that makes some sense. And I think it's really that underlying platform that's getting the F, it's not necessarily the support because I would, I would say a majority of organizations are doing a good job in terms of trying their best to engage the nurses and, and to serve them.

Call to the EHR vendors though. Yeah, well, the HR vendors, and it could also be to the, the infrastructure that's behind it. I, I know we had some performance issues early on in, in my tenure, and we had to re-architect the, uh, platform that our, uh, EHR ran on. It was fairly expensive to do, but gosh, was it worth it?

Because you can't have lag. Its, its death to, to the experience of anyone. Yeah, we do a lot of that work for our, our partners, but we really do consider our customers to be partners. You know, our, our mission is the same as theirs. You know, it's to improve the health and wellness in the us. Very excited about that.

Interesting. So you ready to go on to the next story? Yeah, we can. All right. But we can stay here. I, I think I'll throw out one closing thought on that article. The biggest challenge. ER and EHR usability is that the regulations around documentation were written in the paper era and haven't been updated.

I think that's probably one of the biggest underlying problems. Yeah, and that really, that came to the, that came to the fore during Covid. I mean, people were like, we have to move faster. We're just not gonna give you this info. I mean, the government was saying, give us this and this, and they're like, you don't need it.

We're not giving it to you. Is what we need to do, uh, because they had to move so quickly. And I think it, it's sort of shone a light on the fact of, you know, what information do you really need in order to be effective, uh, in terms of monitoring the, the progress of really care and care outcomes, as well as building the right infrastructure to respond to public health needs and those kind of things.

We'll get back to our show in just a minute. This episode of Newsday is brought to you by Worldwide Technology and Intel WWTs Advanced Technology Center is like no other testing and research facility with more than a half billion dollars of equipment, including solutions from key partners like Intel Corporation.

And it's virtual as well. So you can access it seven by 24 to learn more and get insights into all that it offers. Go to wwt.com/start-now. So we will go into, uh, the next story. And this is, this is what we've been following for a while. There's, there's just a lot of movement in this area and what I'd this means to physicians, what technology.

When I look forward to the future, I see a very different trajectory. Who needs a hospital when you can prevent and treat conditions from the comfort of your own home? The global burden of disease is largely vascular with heart attacks and strokes, the biggest cause of death around the world, and therefore preventable with better understanding of risk factors, rates of traumatic injury are falling and will continue to decline as we introduce driverless cars and robot workers for risky tasks.

I mean, it's.

The, the move towards, you know, disease prevention, specifically obesity and diabetes and other things. You know, I, I wish I could see an end in sight to that. That technology's gonna be bring around, but does the nature of the hospital change as a result of the pandemic? I mean, people received care in the home.

We had some. Chronic conditions being monitored in the home. We had CMS start to reimburse some chronic care in the home. Do, do we think that that's the first step that we are going to see more home-based care? I think it's absolutely already been happening, happening more, it possibly in pockets, especially for the payer provider health systems whose incentives are aligned a little bit differently than the the typical.

Fee for service model, if that makes some sense. The hospital at home movement was already under underway. It was already progressing. I think Covid and the pandemic accelerated a lot of things that will continue even, you know, and not necessarily a post covid world. 'cause it looks like that may never happen.

But in a a, a future world, I'll, I'll phrase it that way, I think, I think it's just gonna continue to accelerate. Things that the pandemic did thrust to the fore are things like virtual visits and doing more in the home to create capacity at the hospital for things that had to be managed more acutely, if that makes some sense.

Um, say even, even some of the covid Care ultimately was, uh, delivered as a hospital at home type service for good reason. It was a better and safer model. And if you really think through it, it's impossible to get a hospital acquired condition if you're being cared for in your home. And so there's a lot of reasons to think that that may be a better model for a lot of, uh, conditions.

Talk to me about the nature of surgery. I mean, you're, you're a physician, so you're, you're gonna have a better view of this than me, but I live in Florida, so I'm around a lot of people that are getting surgeries, and it, it's interesting to me, I, you know, orthopedics, a gentleman got a, I think it was a hip replacement and he was playing golf three weeks later.

Now, when my mom got her hip replacement a while ago, it was a significant rehab process for a. My father and I were talking about the stents He has put in his, uh, his heart and he's had, uh, two open heart surgeries, but since a certain timeframe, they avoid that like the plague. At this point, they will, you know, crack open the chest as a very, as a last resort, and he's telling me of all these surgeries his friends are having where, you know, hey, they're going in through here, they're going in through here, and they, they can do so much in the heart and so much inside.

And it's all about the recovery time. It's all about really reducing the, the recovery time. Obviously if you break open the chest, I think my dad's recovery was, was significant. Coming back from that, is the nature of surgery gonna continue in this direction where we're really doing surgery from the, from the inside out almost?

Yeah, absolutely. I think, I think the technology's definitely headed that way. And I think one of the other things too, you know, kind of ties into our other. Our other discussion, one of the other things that's accelerating is not just the technology but the prevention. If that makes, if that makes sense.

It, it, it certainly seems to, to me that the more you can prevent or stave off the need for these interventions on the front end, the better it is for all concern. So seeing a lot of trend in that direction as well. But definitely the surgery techniques are changing and improving all the time. And the components that are used, if it's something like a hip or knee replacement, those are improving all the time.

The devices are improving all the time. Seeing a lot of neat things happen too with other implantable things, things like pacemakers that now are being made to do more than just the pacemaking, if that makes sense. So adding more features when you have to have an intervention to prevent having to, uh, have multiple surgeries.

Well, let's talk about, you know, one of the stories here is three M launches. New social determinants of health platform and social determinants of health platforms are, are interesting to me in that, you know, it's it all right? So surgeries are gonna become less and less of a big deal, or at least recovery from surgeries are gonna become less and less of a big deal

when you start talking about prevention and wellness. And I'm seeing more and more health systems start to talk about this really under the, the banner of, uh, health equities and, and bringing health to the communities that they serve. You know, again, diabetes and, and obesity and those kind of things.

What are you seeing in that area where technology is helping to start to identify and help people to live healthier lives? So I think one of the big things that we see having a big impact, uh, are those health systems that are very . Forward and future leaning when it comes to having digital engagement with their patients.

Um, providing a a truly holistic digital strategy has really made a difference in terms of being able to deliver education. Health literacy is one of those big social determinants, truly understanding what it is that you are facing from a health standpoint, how to be well, how to. Avoid complications.

Just just having that information, accessibility and the ability to understand and consume that information, I think is a, is a huge intervention with tremendous power. Access to care is another one that technology is really driving. So moving more toward that virtual care model really helps with people who have transportation challenges.

You know, it can definitely keep them, uh, from having missed appointments. That could be very, very important. A lot of the move toward remote patient monitoring makes a huge difference too, particularly for a lot of those chronic conditions that you mentioned. Being able to better understand. How the patient is living and how their disease is impacting their health and wellness on a daily basis, not just those few measurements of data that you might get if they saw the physician two or three times in a year.

You know, think about how much better you can make medication dosing decisions, for example, by truly understanding how the patient's doing, not just understanding how they're doing. In that episo episodic way where they're just visiting you very infrequently. You know, and in, in many cases, patients are really nervous when they go see the doctor.

And so the, the data that you get may not even be that great or they live really well. They, you know, live right for the two or three weeks leading up to a physician visit. 'cause they want to impress the doctor at how great they're doing. But that doesn't necessarily reflect how they're really doing on an ongoing basis.

So that better understanding that better ability to manage and then to also be proactive. You know, leveraging things like AI to really understand and be able to get predictive of who's having challenges, who's heading the wrong direction, and being able to intervene much earlier makes a tremendous difference as well.

So let's, let's you and I brainstorm in the last couple minutes we have here. Let's brainstorm on. You, you brought up a lot of interesting points of prevention engagement. Well, actually, lemme just give you the case. A lot of people put on 10 to 15 pounds during covid lot, lot less exercise, lot less travel.

You, you name it. We just, you know, we, we were less outside of the home during, during Covid. Now I just interviewed Sarah Richardson, who lost 15 during, I don't.

Back in the day, we were talking to physicians about bringing some of this data from these monitors, and it could be simple monitors, like a scale that it has an IP address and communicates up and bringing that into the ER. Could be Fitbit data, that kind stuff. Generally speaking, physicians look down their nose at that concept.

They're like, look, I, I, I don't need 55 more readings to look at. With that being said, when we talk about engagement and getting in front of these things in a preventative way, if, if you were to see my weight going up 15 pounds over a 12 month timeframe, isn't that an opportunity for a health system or a care provider to, to intervene?

A hundred percent. And, and there's another side to that too, that a lot of people don't necessarily think through, and that's presenting the data back to the patient themselves. To truly engage them in their health and wellness. If I can show you, Hey, when you do these things, it impacts your blood pressure in this way, or it impacts your condition, whatever it may be.

In this way, that's not . To your benefit. When you do these other things that are what we're really recommending, you can actually see the improvement. I think that helps tremendously. Just being, being aware of what's going on with your health in a more data-driven way has a huge impact in terms of those behavioral choices, and those are

Even more impactful. A lot of studies have shown that those behavioral choices we make every day are vastly more impactful than the traditional healthcare that you can get. If that makes, if that makes sense to you. It certainly does to me. Yeah. So, so my question is, does, does the primary care models shift?

And let me, lemme tell how I'm thinking about this. Obviously primary care physician. , but it's almost like I want my primary care physician to be a telehealth provider. I want, and, and it could be with my local, my local health system, but I want somebody that this week I can get on the, you know, have an appointment with is, you know, they're doing 10 minute appointments and they're just going zoom, zoom, zoom, zoom.

Andre seeing a lot, their panel be larger. They're interacting with with me more. I heard Jonathan Bush, who is a part of Firefly Health and they said the average, because they have a model similar to this and they said the average interaction that their patients had with a physician last year was 62.

And I thought, yeah, that's good. That means I'm engaged. We always said we want them to be more engaged, so there's so part of me wants. Instead of having to set up that visit, which by the way, I have to get a new primary care doctor, and it's like two and a half months till I can get in to see the primary care doctor because they have to do a complete panel and all these other things.

I, whatever they're going to do. And so for two and a half months, I'm just gonna wait until I can see that primary care doctor. That's a, that's a broken model to me. Seeing the, seeing the, uh, the telehealth doctor.

The other thing is the thing you, you talked about AI and machine learning, but they almost become a part of that team of the, the virtual care provider who's triaging all my stuff, the primary care physician, and then AI is taking all that data, right? So the internet of things, the internet of health things, and it's bringing all that stuff in.

So I might have Livongo devices, I might have a scale, I might have an Apple watch. It's bringing all that data in and the machine is crunching that data and providing insights to either my virtual care doctor or my primary care doctor that they can communicate back to me how, I mean, first of all, does that make sense?

And second of all, if it makes sense, how hard is it to transition a health system to that kind of, of model of care?

So a couple of things I'll share is. I don't think it's an either or model. I think it's an AND model for sure. It's all of those things working in concert, I. We're seeing a trend where the types of interactions also include asynchronous communication as well, right? And other ways AI can be leveraged, including conversational AI or what most people know as chatbots.

Those text conversations that in some cases can be automated to make it. Easier for the humans to pay attention to what only humans can do. So I think that's another method of engagement. Get answers about medications, get answers about side effects, get answers about the conditions that you have or the things that are impacting your wellness very easily in an automated way, but it still feels.

More warm and human because it's a text message, like we all text back and forth with all of our friends, loved ones, family, coworkers all the time. And so it still has that human interaction feel to it. That's another component, you know, email and other, other messaging, communications. It doesn't always have to be a video visit, but incorporating all of those things together in a, uh, a more holistic model.

An interesting sort of side note too, is we're also seeing an expansion of the direct primary care or more dedicated models of health management that are out there, just different from the traditional system. Some of them incorporate all of these things very tightly and really are focused on that, that wellness, wellness picture.

You know, Chen, Chen Med is an example that a lot of people have been exposed to in terms of the way that they approach the, the Medicare population very directly with a very preventive mindset, but incorporating a lot of these same types of things that we've been talking about. So I do think a lot is changing, but I think the answer is not to throw out the baby with the bath water.

It's to, so to speak, it's, it's really to incorporate all the new tools and make them part and parcel of the overall experience. There will always be things that require human interaction and to some degree, that's much better. In terms of just your general sense of wellbeing as well, it's hard to feel cared for, for example, if you're on a video meeting like we're having today, versus when there's actually that, that true contact in person.

So it's, it's not either or. It's and, yep. Uh, although Justin, I feel, I feel cared for.

It's the physician in you that, that has, you know, gives, gives me a calm and whatnot. So I do feel cared for through this Zoom call just for the record. I appreciate that. I appreciate that. Hey, just outta curiosity, we're end of April here. The vaccines out there and whatnot are, are you seeing your life get closer to what it was prior to the pandemic or you, you still see that a little ways out?

I am hopeful that it will be this year and, and certainly sooner would be better from my perspective, I think, I think there is, and, and better for all concerned. I think there's a, a serious loneliness and disconnecting sort of pandemic that's also sort of coincided, uh, with the Covid pandemic. I see it getting potentially better soon.

I'm still being cautious, still doing the, the recommended things, but I do see it probably returning to more in-person interactions in the, in the relatively near term. Yeah. I've, I've officially been on two flights in the last year. Not that I'm complaining. I, I traveled way too much prior to. To see the family and, and actually one of those trips was to see my entire family.

So that's been good. Are, are you finding that the, the requests to get on a a plane are increasing or, some of my, most of my healthcare clients are still saying, Hey, no contractors on site where they still have not opened up, so there's no reason for me to get on a plane. Are you seeing the same? I haven't been on a plane yet, so I, I will say that, but I do think.

We're starting to see a shift where in-person meetings are preferred, and it kind of makes intuitive sense. You know, when all you had for months and months and months were video meetings and in some cases nonstop video meetings all day every day. That's. Not gonna be your favorite way to interact. So if I had to put on my futurist predictive hat, I think we're gonna see the pendulum swing in the opposite direction for a while, and then it'll probably settle to a happy medium.

I do think that in, you know, in the longer term, it's gonna be less travel overall than what we had pre pandemic, more virtual interactions and. Frankly, that allows a lot more efficiency as well. You know, it's certainly faster to see multiple different teams over video like this than it is to only see, uh, one a day with the old model.

But I, I think as soon as things are truly, you know, sort of safe and quote unquote reopened. I think we're gonna see that pendulum swing much in the opposite direction. Very, very in-person focused and probably more than it was, uh, before for at least a time. Yeah, yeah. 'cause we miss each other. We , we actually want to be in the same room.

I, I do miss a lot of my colleagues and we just did the chime. Forum, you know, I got see him, I gotta chat with him. Gotta do video, face, face with, but yeah, it just, not the same thing. Justin. Hey, thanks, thanks for coming on the show. I really appreciate it. Thanks for, uh, sharing your wisdom with the community.

It's, it's always appreciated. I don't know how much it was wisdom, but , I'm certainly happy to, happy to share some thoughts. Wait, wait. Wisdom of years, you know, after, after doing things for a couple of years, seeing a lot of different health systems. Yeah. It, it is wisdom. So I, I appreciate it. What a great discussion.

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