Newsday: A Deep Dive on Big Tech Healthcare Partnerships
Episode 24121st November 2022 • This Week Health: Newsroom • This Week Health
00:00:00 00:39:13


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 Today, on this week Health, I've talked to friends about this sort of idea of happy years. We're, we're all in this. Healthcare business because we want to serve and we're usually, for the most part, optimistic and we want the best things to happen. And so when we have m and a on the vendor side, we have m and a on the provider side.

We want all the right things to happen, and I think a lot of times when it comes together, they anticipate all these good things are going to happen. As Mike Tyson says, everybody has a plan until they get punched in the face.

It's Newsday. My name's Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week Health, A channel dedicated to keeping health IT staff current. And engage. Special thanks to CrowdStrike, Proofpoint, Clearsense, Meditech, Cedar-Sinai Accelerator Talkdesk, and Doctor First, who are our Newsday show sponsors for investing in our mission to develop the next generation of health leaders.

Alright, it's Newsday, and today I am joined by the incomparable Drex Ford. Joining us from, it looks like home. You're home. Oh yeah. I'm not on the road. Yeah, I'm not on the road today, so I'm kind of amazing. Wow. Although you have quite the schedule from now until Christmas time, it sounds like. I do. I'll see you next week at Chime.

I. Yes. And, uh, yeah, couple weeks later I am in Toronto. A couple weeks after that, I'm in Boston for the cybersecurity conference there, and then I'm going down to Southern California to visit some customers and, uh, partners. And so yeah, it's gonna be a busy rest of the year for sure. All right, well, you, you brought it up.

So cybersecurity is an area where you spend a fair amount of time. . So what I thought I would do is, let's see, couple stories out there that I always like to talk to you about. We have the pixel, so patient Sues Advocate, Aurora. We also have the megapixel issue at WakeMed as well. Why is this happening? By the way, there was also an article where I think Congress is actually asking Zuckerberg for more information on

What's actually going on here? So this is really escalating this pretty quickly, and not necessarily security, but more about privacy for the most part. Yeah. Yeah. When I wrote about this, I don't know, fairly early on in the summer, I think when the news first broke that healthcare organizations were using this megapixel thing on their portals and on their websites.

And extensively in my mind, this is probably something that the marketing team did on their own, or somebody got bullied into putting it on the website without really running it through sort of all the security privacy channels with the, the idea being. We need to gather information on who's using the portal and how they're using the portal, because it'll help us build better accessibility for patients and families, which is a noble cause.

But the problem sometimes is just that when you use these kinds of tools, they do things that you didn't expect for them to do. And in this case, and maybe gather data, it's alleged that it's, you know, that data's being shared with advertisers and other things, and so. It's obviously not a great situation and I think we haven't seen the end of it.

And uh, this will probably wind up being stuff that's reported to the HHS Wall of shame and there will be investigations. And obviously, like you said, Congress is already asking about it. And then you see what we always see now anytime there's a breach, anytime there's some kind of significant public event involving patient privacy or data privacy.

The lawyers immediately get involved. There's lawsuits and class action lawsuits and all of that. So undoubtedly, that's just the we're, I feel like we're in the early stages of this. The sort of nutshell of the story is. Check and make sure that you're not running megapixel on your website or on your portals.

And if you are, then you've maybe got some explaining to do or some work to do. Some explaining to do. Yeah, that's a good rundown of what's happening. Megapixel is essentially a marketing tool that gives you a ton of information on what people are doing on your websites, which is fine if you're selling widgets, but if you're taking medical appointments and people are putting in their condition and that kind of stuff, that's the stuff that's getting transferred over.

At least it's getting transferred over. To meta, the question is . Is, is there really a violation here, but you know that that will play out and we'll see what's going on. I guess my question, I, I spent the weekend with a bunch of security officers for some larger health systems. Mm-Hmm. , and a couple of small health systems, and it was a phenomenal conversation.

But gosh, the attacks are coming from everywhere. I mean, there's another story in here about nation state attacks, and I'm not gonna go into that per se, except I think the question I want to ask you is . What denotes a nation state attack? So let's say a crime family, I think that's what they're called.

Crime family from Russia attacks a health system and extracts ransom. And they're doing it for financial gain. Is that considered a nation state attack? Yeah. This is where it gets, uh, it gets fairly muddy, fairly fast, right? We spend a lot of our time at CrowdStrike on the dark web. Uh. Doing all the things that you do to surveil adversaries and learn about their tactics and their techniques, and one of the things that we've seen, especially over the last couple of years is that what used to be fairly clear definitions between nation states and ECR syndicates, or what we refer to as spiders, and then.

Don Nation states, the difference has kind of continued to blur over time because you have weird situations. Not weird, it's just the situation that it is like North Korea who's clearly a nation state, but also starving for money, and so they have ECR groups there that work for the government that are doing ransomware data, exfiltration, all those kinds of things, and being obviously being

Paid for by the government. In fact, that would be nation state. In many cases though, you have eime actors who are homed in countries like . Russia who may or may not actually be affiliated with the Russian government. Now, there's sort of always this conversation about if there are bad actors doing ECR stuff in Russia, of course the Russians know about it and therefore they have at least given some kind of tacit approval for that operation happen in their country, which makes them, you can do this, but when the time comes and the government asks you to do something for us, you of course are gonna have to return the favor.

It does get muddy. It does get blurry in countries like North Korea pretty tightly lash together in many other situations. It's, it's hard to say that, uh, that ePrime actors are actually also working for a nation state. They're usually in it for the money. Did you see the Zelensky Ukraine president's deepfake?

Did you see that deepfake that they made? I assume it was Russia since that's who they're at war with, but essentially it was the president saying, Hey, I was wrong. We should lay down our arms. Nobody should have to Yeah. Go home essentially. Did you see that thing? Yeah. Looked pretty good, huh? It, it did. I mean, now that the professionals were looking at it going, well, look, this is, this edge doesn't match and this doesn't match.

But if I'm looking at it, you look at it on your phone. Yeah, exactly. Doing a lot of like right. Yeah, the fake thing is probably one of the things that scares me the most. We're gonna veer off of cybersecurity, but I, I will say this, that I've got a, a host of topics. You and I are at Chime. I'm gonna do a conference interview.

It's not gonna air on this channel. It'll air on our this week health conference. This is our longer form, and what I'm gonna do is take some of the topics that we talked about on our, uh, CISO retreat. We've got a hospital at home security, reducing the digital footprint from a privacy standpoint, data retention policies.

Data retention policies was an interesting conversation to me. Cloud API, visibility, internet of medical things, business continuity, resiliency automation. These were the topics that were top of mind for security officers, and that's what you and I are gonna dive deep on. I'm gonna give you the, I don't know.

The equivalent of the SATs was on this stuff. Actually, what I, you give me the list and I'll add probably another 20 things to it. I mean, oh, okay. There's so many things right now. God bless the cybersecurity pros and healthcare right now, because, not that they're not working hard, I mean, they are killing themselves.

It's just . There's so many other challenges from the outside and from the inside people, process, policy, stuff that they have to wrestle with to try to keep their organization safe. So yeah, that'll be great. It'll be great fun. Alright, we'll get back to our show in just a minute. We have a webinar coming up on December 7th, and I'm looking forward to that webinar.

It is on how to modernize the data platform within healthcare, the modern . Data platform within healthcare, and I'm really looking forward to the conversation. We just recorded five pre episodes for that, and so they're gonna air on Tuesday and Thursdays leading up to the episode. And we have great conversation about the different aspects, different use cases around the modern data platform and how agility becomes so key and data quality and all those things.

So great conversation. Looking forward to that Wednesday, December 7th at one o'clock. Love to have you join us. We're gonna have . Health system leaders from Memorial Care and others, CDW is going to have some of their experts on this show as well. So check that out. You can go to our website, this we call, top right hand corner.

You'll see the upcoming webinars. Love to have you be a part of it. If you have a question coming into it, one of the things we do is we collect the questions in the signup form because we want to make sure that we incorporate that into the discussion. So. Hope to see you there. Now, back to the show and we're, we're purposefully not gonna talk about the common sphere ransomware attack.

'cause I, I haven't seen any new information. There's no public new information. I, there's obviously people talking in the industry of the things they know and that kinda stuff. There's no, there's really no nothing public that I've, I've seen that we can really latch onto. So we'll skip over that one. I'm gonna go over to the Becker's Health it and CIO report.

I get this. Pretty often in my email, I wanna look at a couple of these stories. Oracle Cerner, to close two Kansas City area campuses. That was predictable, right? I mean, I was a Cerner customer for a lot of years, and it's just interesting to see kind of the whole evolution of Cerner getting the military contracts and the VA contracts and then being acquired by Oracle.

And they've had a lot of really good things to say about what they wanna do to try to improve healthcare. But as we both know, as many of the folks who are watching and listening know, healthcare is super complicated. And so if you don't really come at it from the background of understanding it. It's easy to say good things, but it's hard to keep those commitments and I hope they can, but they're definitely talking a good game.

Yes. Yeah. I mean we, we will see how it plays out, but the conversations before a merger, and keep in mind, I went through a merger with a two very good companies and the things that were said prior to a merger and the things that actually happened. It couldn't have been more different if, if we like scripted it to be completely different.

So I'm sure that'll get me in trouble with somebody. But at the end of the day history, I now have history on my side to tell the story of what actually happens in m and a. And the funny thing is, as a leader, you're put in a really weird position when those things happen. And I'm the leader of the acquired entity.

And they're saying, oh, this is what's gonna happen culturally. It's gonna look like this. This is how we're gonna come together. And so that's the story. You're, until that's not the story, and the story is the complete opposite. And people are like, well, you lied. It's like, well, we were hopeful like everybody else.

Yeah. But at the end, I only lied because I was lied to maybe was the, no, I, I don't, I'm not sure. Somebody may have to know they're lying, but I, I, it didn't feel to me like the people who were talking to me. Felt like they were lying. It's the combination of two great companies and we're gonna take the best of both cultures.

And this isn't about consolidating operations and all that stuff, but I think that sometimes, I've talked to friends about this sort of idea of happy years we're, we're all in this. Healthcare business because we want to serve and we're usually, for the most part, optimistic. And we want the best things to happen.

And so when we have m and a like this on the vendor side, we have m and a on the provider side. We want all the right things to happen. And I think a lot of times the m and a, when it comes together, they anticipate all these good things are going to happen. As Mike Tyson says, everybody has a plan until they get punched in the face.

And the reality of like, wait a minute, these things aren't gonna fit together. Like I kind of thought they were gonna fit together. We did due diligence, but due diligence is way different than the actual putting together of things. And so as you get into the devil in the details, you start to find out that it's gonna be harder than it looks.

And maybe some of the things we wanted to happen aren't gonna be able to happen. And the further you get into it, the more, the more challenges that you find maybe. So maybe it's all part of that you are optimistic in the beginning and then over time you start to understand it's, it's harder than, all right.

You and I are gonna read the tea leaves here. So there's, okay, Becker says an Article nine big tech healthcare partnerships. And so we're gonna look at the partnerships and talk about what we think it means. So here are the nine. So number one. Let's start with this one. Amazon Pharmacy will be the exclusive home prescription delivery services for Florida Blue members.

The insurer said on October 25th, this one was predictable, right? So Amazon's strength is moving stuff from point A to point a, point B, so supply chain, it's delivery all the way down to the home. And so they're gonna have a pretty compelling offering to go to . Payers to say, Hey, look, we can reduce the overall cost if nothing else, by reducing the logistics and the shipping.

Around getting these drugs there and they, they can generally do it next day, if not same day in some cases. So what can we read into this? Is this going to be a, a trend across the country? I think when you find pieces of our healthcare business that can be turned into. A utility, you know, plug in and drug delivery can happen.

I don't have to have my own warehouse. I don't have to have my own pharmacist. I don't have to have my own labeling system. I don't have to have my own mailing system. I don't have to deal with all of that. You'll find those things will probably be the first things that stop being done by purely healthcare people because.

If they're automatable, you can turn 'em into a commodity, and I think that's what you're seeing here is that these guys are a. Amazon big company, they can negotiate for the very best prices. That doesn't mean they're necessarily gonna pass all those on to the consumer, but that means good, good margins for them to be able to continue to sort of grow and expand the business.

And I think you'll see more and more of that kind of stuff over the next several years in healthcare. And it'll just be a bite at a time that. It comes outta healthcare. Yep. Death by a thousand cuts is what they refer to it as. So University of Rochester Medical Center, selected medical imaging IT company sectors Cloud-based service built on Microsoft Azure, October 17th to provide imaging throughout the company's system.

Six hospitals and nine urgent care centers. So Sectra, cloud-based . Imaging platform. I think they, yeah. Anyway, it's, this is an interesting selection. Do you think we're gonna see people start rethink their imaging solutions, especially with digital pathology and other things, uh, coming to bear with the cost of, with the agility of cloud and the ubiquitous

Access to cloud and the cost of storage is, is pretty good in cloud. It's competitive. At this point, you think we'll see more systems rethink their imaging strategy. Yeah, and I think it may be, it sounds like in that story, this is sector running on Azure. Yeah, I think there's some, so there's the sort of, this used to be an on-premise solution and now we're gonna run it in the cloud.

I think we'll see more and more born in the cloud native solutions that will come to market, that will be, this is how we're built, we're designed to be a subscription model. And can, you can just . Buy it like that out of the gate. You don't have to do any sort of, you know, dances or back flips to make it work in Azure or make it work in Amazon.

It'll just be, this is the service that we're offering. I think we'll see more of that. Interesting. So the next one is consumer based. So I'm curious to this one. So Samsung partnered with virtual primary care provider, HealthTap to bring primary care capabilities to Samsung Smart TVs. What do you think? I mean, the consumer play, I, I don't know how this, here's how this makes money.

One is Samsung sells TVs, so if this sells additional TVs, that's how they make money. But. General Outside of that, if Samsung, this is service, what, what are they trying to do? What are they gonna, what are they gonna Virtual? Primary care provider, health tech. Oh, interesting. So it sounds to me like this is, the deal is maybe structured something like.

Okay, Samsung, we wanna do an exclusive deal with you. We're gonna provide our app, you're gonna put it on your tv, and you're gonna be able to sell TVs with our app on. It may make people buy your tv, probably not, but the deal that we're gonna, the deal might look something like every time we have somebody who uses our service.

Through your tv, you're going to get some slice of the pie. The deal for Samsung to be motivated to do this, and for Health Tab. Is that the right name? A health tap Like, like health tap tapping the kegs. Yeah. Yeah. Okay. I know, I know who they are. I got it. But this may be their way to enter a new market in a new way.

So that'd be my guess. Yeah. That that makes the most sense. This is a health tap initiated conversation with them to say, Hey, put this out there. Yeah. That makes, that makes a lot of sense. Microsoft partnered with GSK, Glaxo Smith Klein. Consumer health spinoff ion to make it easier for people who are blind, have low vision or difficulty with reading to access information on packaging LA labels.

Wow. That has not enough information for us to comment on, does it? No, probably not. Unless somehow Microsoft partnered with them. Yeah. How are they doing this? Is this, is this somehow tied into Microsoft special capabilities that you'll have if you're using Microsoft? Um. Laptops or Microsoft tablets, or you'll be able to see, somehow see this stuff.

There you go. The companies will work together to expand the functionality of Microsoft Seeing. AI app, a free mobile app for the visually impaired community to provide more detailed labeling information for HA on consumers across the UK and us. I didn't even know that existed. Did you know that existed?

No, I didn't. But I mean, it totally makes sense, right? That there are apps that help low vision and blind people be able to read things that they obviously wouldn't be able to read otherwise. But if you really had. Again, something really specific like the label on a prescription bottle, and you were able to train your tool to really understand this.

This is what AGSK bottle looks like, and you know exactly how all the letters and numbers are shaped that the accuracy could go through the roof, and that may be the arrangement. Next one, JDRF, juvenile Diabetes Research Foundation. UHHUH is using AWS Cloud technology to further research into . Juvenile diabetes from where you sit.

So we've, we've got AWS, we've got Google, we've got soft, obviously some of the big players in terms of the cloud game. Who's winning the overall, the big cloud business in healthcare right now? So some of this, again, goes back to probably the how do you define cloud? The, oh, let's just define it this way.

Who's gaining the most revenue? From healthcare right now with their cloud business. My gut tells me that it's probably Amazon. Amazon's probably making more headway in organizations that are transitioning to the cloud or doing other stuff with, even with companies like Epic and and other EHRs moving to the cloud, as opposed to in my head, what is

A lot of Microsoft Cloud is certainly Azure and there's work being done there, but a lot of Microsoft Cloud also is sort of Office 365, so everybody's in the Microsoft Cloud because of Office 365, but I don't know. I see, I see. Azure feels like they're making and they're making good announcements and good progress every day when I talk to CIOs and CISOs, I hear.

AWS conversation more often than I hear anything else. Yeah, I, I'm surprised by that, but I, and I'm hearing both and, and I think Microsoft's winning. You think AWS is winning? I think Microsoft's winning, but I think AWS is gaining ground, and I'm not for the same reason. I, I think we're hearing it more and more.

The next, the next art, the next story of Google Cloud unveiled a new software program that uses AI for medical imaging diagnostics, and has begun collaborating with Hackensack Meridian Health to improve cancer detection. So that's the space Google wants to play in. They're not going after. I wanna host more of your cloud stuff.

Yeah, I want to host more of your stuff. It's more of a, a data play, more of a very targeted, uh, play around artificial intelligence, machine learning. and, and really their, their abilities to do things with the, uh, tools that they've developed over the years. So that to be super interesting, that whole part of the business around

Radiology imaging and MRIs and other things where you can have AI look at those images and pick up things that a radiologist might not. I mean, even super skilled radiologists, there's a lot of studies that are limited, but show that, uh, that the AI sometimes can do a lot better job in detecting things early.

So I find that fascinating that that's a place that we're going ultimately, and it, it could be good because with a shortage of radiologists. This means radiologists are left working on the really, really hard, difficult to understand and see and diagnose stuff, and the AI's picking up a lot of the easy stuff that that's then work that they don't have to do except just to check it and say, yep, that's right.

Everybody's talking about hospital at home health at home. A market watch article states that in-home hospitalizations saves five to $7,000. Per episode and with the economy where it's at, and the pressures that are on health systems, this is an important topic. On December 1st, join us for a webinar with a panel.

They're gonna be able to share how they stood up a successful program and work through the complex requirements for helping patients recover in a comfortable and familiar setting. You could register on a website this week, Go to the upper right hand corner. We have current webinars and upcoming webinars.

You can register right there and, uh, . You could also, in that registration, put any questions you have and we will try to address those questions during the webinar. We love doing that and love having you be a part of the conversation. So I look forward to seeing you there. All right. I'm gonna, I'm gonna skip the last three, but essentially, I.

You, you have some stuff around mental health investments. You have some partnerships around addiction treatment and let's see, telemedicine platform. So there's, there's three more in there. I want to take you into the board room now. I want to take you into the leadership room. So the difference is board is the executive leadership team of a major health system today.

So again, this is all hypothetical and I'm gonna create a a, a major health system. So we came through the pandemic. And, uh, the numbers were skewed for the better part of two years, and now we are, and we can argue the definition, it really doesn't matter. We're in a recession. And the reason I know is 'cause I go to my store and sometimes it has eggs and sometimes it doesn't.

And when they do have 'em, they're like two and a half times the cost that they were prior to the pandemic. And so regardless of if it is a recession or not, people are experiencing a recession. And so when people experience high prices and, uh, uncertainty around their jobs and that kinda stuff, they tend to act in a certain way.

And historically, when we are in a recession, people delay care don't go because they're, they don't want to get that surprise bill or anything to that effect. All right, so we have these two macro trends happening and now we're in the executive leadership team discussion. And let's just say we are way behind in terms of our financial picture, and we're looking at a shortfall of, I don't know, I, I mean, I'd have to, it's too many details here, but essentially, let's just say we're 300 million behind and that's a significant number for us.

And now . We have to come up with ways to write this ship, and I, I sort of wanna go back and forth with you as if we're having this conversation as e executive leaders, because there's gonna be a traditionalist in that room who's gonna say, Hey, we're 300 million behind. We know how to deal with this.

Everybody submit your cuts, right? Yeah. So that, that's the traditional approach that's gonna happen. Where do you go if you're the CIO? Where do you go with that conversation? This is the, yeah. You're giving me PTSD. I've definitely been through this before. I know we've, we've all been in that room drex.

It's uh, I've definitely been this through this before too, and it's a lot of times this, you know, probably people aren't gonna like that. I say this, some people aren't gonna like that. I say this, the willingness to say everybody takes a 10% cut shows me that there's a pretty massive lack of educated leadership in how.

Spending occurs in that organization and what is valuable spending and what is less valuable spending. There are things that you've made obligations to contractually. You may be in a situation where in your organization there is, you are part of the organization. There's no way for you to cut 10%. And when it comes to information services.

I think there's always a good case to be made that the reason that we run all of the stuff that we run in information services is, is to support everybody else in the organization. And so let's sit down with everybody else in the organization and let them tell information services what it is they don't want us to do anymore for them.

Stop doing that and then we'll stop paying that bill. I'm gonna be the guy or, or gal or sitting across from the CIO going, but wait a minute. In those other organizations, it has led to greater efficiencies, better outcomes, whatever in every other industry. In our industry, it's led to higher workloads. We have to bring on more people, more dissatisfied engineers.

We haven't been able to tie any of our outcomes, per se, to the investment in technology. And it seems like every time I look over your building's getting bigger and bigger, and there's more and more people in it. Yeah. Terrible governance process we have here at our healthcare organization telling me that we are making decisions to invest in information technology without a business plan That.

Goes back to the true owners of those information technology projects, the clinical business and research operators. If they're convincing you to spend more money on information technology that doesn't give them a return, then shame on us and the executive cabinet. Shame on us for not having a governance process or a business justification process.

I love, I I love where you went there. Yeah. Straight to governance. There has to be. I'm sorry, I sort of stepped outta character here, but there has to be transparency. If there isn't transparency going into this, you're screwed. Yeah. Like people can't, they cannot make that statement of, I don't know what you're doing over there, but I.

Gosh, it seems like you guys have have nothing but money. It cannot be, this cannot be perceived. The spending and information services cannot be perceived as being disconnected, feels done in a smoky backroom that nobody understands except the people that are in the backroom. It has to be all above board and very transparent.

I mean, as an independent consultant, I probably spent half my time working with organizations. Who our work wound up being largely governance work because of exactly that. It's the inability to prioritize and also do long range planning around these investments, right? I don't want to buy something and put it in.

Part of that also has to be not just the initial upfront investment, but how many FTEs do I need to run it after the fact? How much return is the. Leader, the owner of that project over the chief medical officer or somebody in operations, how much do they expect to get? And can we plan that into future budgets?

Right? So we hold them responsible for. The return that they expect to get because we're making not just a one year investment information technology, we're making a five year, we're planning a five-year investment in information technology, all CapEx and opex. But we're also telling the person who's getting the technology, this is what we're expecting to extract from your budget.

Because you've decided to implement technology or that you're, we're gonna hold you to responsible for higher revenues. 'cause we're implementing information technology. So if that all doesn't come together, then it does feel like, oh, we just keep throwing money over to the wall to those information services guys and they keep building out their empire and.

Yeah, but we're only running this stuff that we're running because somebody else wants us to run it there. There's still some, let's see, what's the, what's the right word here? There's still some misnomers and just things that aren't clearly understood. Even if there is great governance, it's like, Hey, we're gonna stop this project.

tions I got going through the:

Hey, we're gonna be, we're gonna be reducing our size of our organization by 10, 20%. We'd like to reduce our, it, our data center by 10 to 20%, or our, it, the, the good news is essentially with cloud you have. Potentially a better opportunity to do that than we had in the past. Yeah. I think there's also this sort of interesting situation that we find that, and, and I used it too as ACIO, when you had to buy things and install them and run them in your own data center or on your own, on your own campus.

Those were easy things to cut and say, can you make that last one more year? And so you don't spend that money for one more year. And the impact of that is kind of hard sometimes to determine other than. End users complain 'cause their machines run slower and they're not able to get to the applications the way they would like to and all of that impact.

But when you convert those things to software as a service or cloud kinds of infrastructure, you've converted from sort of like, I have to pay for this once every year. And it's always up for debate to a. This is a utility bill that I have to pay every month or I have to pay. It's just, it's a contract.

It's a thing I have to pay every year now. So it's really not up for debate. It's, we're contractually obligated to do that. And so that thinking for me, once I sort of at some point in my CIO career had that revelation that I can make people who are really undisciplined about this process. I can force them to be disciplined by building out infrastructure or cloud or other things in this way.

Made a world of difference in our sort of strategic planning about where we were going and how fast we were gonna go there. Yeah. We didn't have a story to really go off of for this one 'cause there's no media sitting in these conversations that are going on. But we know these conversations are going on and uh, we know there's frustrated people on both sides of this.

Essentially saying, look, we can't cut people from this side of the house. We can't cut people from that side of the house. We can't cut people from that side of the house. We're already struggling to keep up with the demands that are in front of us on all sides. It doesn't matter if it's administrative, clinical, it related, it's they're we're struggling to keep up on all sides and an economic downturn or a another bad year in healthcare.

Leads us to make some pretty challenging decisions. And we're, we'll, we'll be talking about this more, I think, in the coming months, but I, I wanna be as pragmatic and hopeful as we possibly can around this. I mean, there's, the work isn't diminishing, I guess there's. Still work to be done in healthcare.

There's work for us to continue to improve on the clinician experience, imp improve on the patient experience, apply data in a way that we know is possible to really transform healthcare and potentially push that data and those, those findings all the way out to the consumer and change behaviors.

There's so many great things that are just right around the corner. We just, we just have another one of these . Things that we see every so often in healthcare, which is that bump that you have to get through. I think it's the two, the thinking about the, there's still a lot of organizations that are really involved in their sort of three year and five year strategic plans.

Right. Well, that's a good thing to plan for. You also need to plan for all of the contingencies to turn the dial back a little bit if you need to and whether, whatever you call that agility. Or not having a five-year plan, but maybe having a one-year plan or just trying to figure out the, you need to know what those things are that are legitimately things you can turn the dial back on and you don't get into the, everybody cut 10, because that just creates a huge number of unintended consequences that you don't want.

So you have to be. I mean, I would say I plead with you, please, executive cabinet, be more responsible than that, and understand if you're going to turn the dial back as much as you can, what are the consequences of turning that dial back? Some of them are much more drastic than others. Some of them introduce a lot more risk, not just cybersecurity risk.

I talk about that all the time. But risk to the business, risk to your employees, risk to your clinicians. Those are things you have to measure twice and cut once. Yeah. Especially in this time where we're talking about, it's hard to get cybersecurity talent. It's hard to get it talent, hard to get clinicians clinical.

Yeah, absolutely. So it's, uh, yeah, this, this is a, it's definitely challenging times. Drex. I look forward to. Seeing you in, where are we going? We're going. San Antonio. San Antonio. Yes. For the Chime event, look forward to seeing some people. Hopefully some good idea Sharing. And conversations around that time as well.

So look forward to catching up with you. All right, be good. Thank you. What a great discussion. If you know of someone that might benefit from our channel from these kinds of discussions, please forward them a note. Perhaps your team, your staff. I know if I were ACIO today, I would have every one of my team members listening to a show just like this one.

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