This transcription is provided by artificial intelligence. We believe in technology but understand that even the most intelligent robots can sometimes get speech recognition wrong.

 Thanks for joining us on this week in Health IT Influence. My name is Bill Russell, former Healthcare CIO for 16 hospital system and creator of this week in Health. IT a channel dedicated to keeping health IT staff current and engaged. Today, Dr. Joseph Vidar, the chairman of the board for the American Telehealth Association, joins us.

He's a Harvard professor, digital health advisor to Partners Healthcare, and we have a wide ranging discussion on telemedicine, where it's going, where it's been through Covid, OD, and uh, what we can expect into the future. I wanna take a quick minute to remind everyone of our social media presence. We have a lot of stuff going on on social media.

You can follow me personally, bill j Russell, on LinkedIn. I engage almost every day in a conversation with the community around some health IT topic. You can also follow the show I. At, uh, this week in Health it on LinkedIn. You can follow us on Twitter, bill Russell, HIT. You can follow the show this week in Health or in HIT on Twitter as well.

We've got a lot of different things going on and each one of those. Those channels has different content that's coming out through it. We don't do the same thing across all of our channels. We don't blanket posts, we don't just, you know, schedule a whole bunch of stuff and it goes out there. We're actually pretty active in, uh, trying to really take a conversation.

I. You know, in a direction that's appropriate for those specific channels. So we spend a lot of time on this. We really want to engage with you guys through this. We are trying to build a, a more broad community, so invite your friends in to follow us as well. We want to, to make this a dynamic conversation between us so that we can move and advance healthcare forward.

Special thanks to our influence show sponsors Sirius Healthcare and Health lyrics for choosing to invest in our mission to develop the next generation of health IT leaders. If you wanna be a part of our mission, you can become a show sponsor as well. The first step. Is to send an email to partner at this week in health it.com.

Just a quick note before we get to our show. We launched a new podcast today in Health it. We look at one story every weekday morning and we break it down from an health IT perspective. You can subscribe wherever you listen to podcasts at Apple, Google, Spotify, Stitcher, overcast, you name it, we're out there.

You could also go to today in health it.com, and now onto today's show. All right. Today we're joined by Dr. Joseph Caviar, the American Telehealth Association President, Harvard Professor Digital Health Advisor for Partners Healthcare. Good morning, Dr. Caviar. Welcome to the show. Great to be with you, bill.

Good to see you today. This should be a fun topic. We did a covid series for about three months, and every CIO or health system leader that came on. Just start sharing staggering statistics between, you know, the months of, I guess really March and May, that the numbers were just unbelievable. So I'm looking forward to having the conversation about, you know, where we've been and, uh, where we're going.

And now we have a new administration too. You know, what, what is, you know, potentially, you know, what, what are the things we're taking before them to, to, to move this forward? But let, let, let's step back a little bit and let's start with, uh, the ATA. So what's the purpose of the ATA and what does your work look like as the president?

Well, the ATA is, I think it's 27 or eight years old now, so it was, it's really an organization that's grown and changed as, as a telehealth marketplace has grown and changed. But our fundamental, uh, purpose is to be the sole . Advocacy group for the industry that moves the industry forward. So we represent provider groups, we represent suppliers to the, to the industry, and of course, health plans and payers as they are interested in making sure that we implement telehealth in a way that, uh, suits them as well.

So the role which, which has always been the case, but we formalized it. Now it's, it's the chairman of the board role. Okay. Back when the, when the association was formed was in an era when academic as associations had a president and then an executive director who ran things. Over the years, that executive director role in almost every association became the CEO.

And there were a couple standouts, but for the most part it was all startups, pilots, a proof of concept work. It was hard to get clinicians to frankly pay attention. Clinicians saw this either as a, you know, at worst as a bad thing, but most of the time it was a curiosity or, yeah, I'll get to that someday.

And I was asked to come back in. There were a couple of people on the board who had to resign their positions because of changes in, in . Professional

commitments that their new companies wouldn't allow them to have a leadership role at ATA. So they asked me to parachute in about a little over a year ago, and, uh, I thought, why not, right? I've done this once. It'll be kind of like, and then all of a sudden, of course, things change. So now the difference is we're in, we're in implementation mode all around the world.

Telehealth has become a . A household word, people know what it means. Patients of all almost all experienced it. Clinicians have done something, some have dived in, uh, head first. Some are dipping a toe in the water, but we've, we've all done something and health plans are of course, now forced to pay for it, at least during the public health emergency.

So it's a real thing and it's, we're learning what it means to be in implementation mode versus proof of concept or, uh. Or experimentation mode. So let's, let's put a, let's put some parameters on this When we talk telehealth, it's a broad category. And just, just so we can sort of level set with, with the listeners, Teles consults, remote patient monitoring.

Are there other categories that, that fall into telehealth? One useful way to to look at it is, uh, a two by two grid. So, uh, one. Dimension of that two by two grid is whether you're a, a clinician dealing directly with a patient or with another clinician. And so if it's directly with a patient, it's a visit.

If it's with another clinician, it's a consult. And the other side of the two by two grid is asynchronous versus real time. So real time with a patient would be a virtual visit, asynchronous with a patient would be an e-visit, et cetera. We use that grid a lot and, and then sort of over the last couple of years, people have added sort of a category underneath for remote monitoring.

It's doesn't quite fit. So to answer your question with that, with that sort of conceptual background, asynchronous, very, very important in the industry. There's now at least a dozen or so companies all the way from Hims and RO and NX and, and . Others that are forming these specialty niche telehealth companies, where you as the patient submit something about you and then someone gets back to you as, as more, more like a chat or an email or a text than a real time conversation, and that's very efficient and it's for, for the right kind of problems that's very efficient for the patient as well.

Another dimension that I think is important to point out and that falls on from that asynchronous is use of artificial intelligence, symptom checkers, things like that so that you can, as a patient start your journey working with software and then get triaged you a human being after a few things have been worked out in the context of, of that software environment.

You mentioned remote monitoring. That's an important. Thing, I guess. And then of course, as you said, virtual consults. Virtual visits. The one thing I'll say in, in sort of finishing off this, this thought is up until a year ago, they were all, I think more or less equal contenders for, for people's attention because of the way telehealth unfolded during the pandemic and the public health emergency, if you were to do a word cloud now.

Virtual visit would be 90% of it, and everything else would be these little words around the edge. And I think that's a bit of an anomaly and, but it is what it is right now. Yeah. It, it is amazing. As the pandemic unfolded, you know, I neighbors my parents just having conversations and it really did become part of the common, uh, vernacular.

I know. And, and so I've been sort of measuring, you know, Hey, how do you feel about this? It's interesting. My dad's like, I want, I want every, everything to start with it, . And my mom's like, I, I want the doctor to see me. I'm afraid if they don't see me, they're gonna miss something. Yeah. And so the, and I imagine, I mean, I'm just talking about the consumer side, on the physician side, the things probably all over the board as well, I would imagine, in terms of how they've experienced the last nine, nine months or so.

Yeah, well, you know what the, what the pandemic did, did for the field is, is, is both, like everything else is, there's, uh, two sides to the coin. So on the one hand, I, I mentioned uh, a minute ago, telehealth's the household word. Now we, we can't, can't underemphasize how important that is for moving the field forward.

When, when you don't have to spend the first 10 minutes explaining something, but you can get right to the point. Very powerful, you know, with that. Because we went into lockdown mode. We did everything that way or as much as we could. And we shoehorned some things that probably should be done in the office into a telehealth environment.

And I think the other thing that, maybe we'll see how this plays out, but maybe an unfortunate consequence is people now have in their minds merged telehealth and pandemic. So. You know, when the pandemic goes away, does that mean telehealth goes away? And of course, many, many of us both on the provider and the consumer side believe that it won't, or, but maybe we'll come back to that.

But, so those are some challenges I think, for doctors. Yeah. We, we need, we need to be proactive. And I don't see enough of this going on, unfortunately, but we need to be proactive in, in articulating what use cases. Appropriate. And if you need to touch the patient to get your work done, well, they gotta come in the office, right?

It's that simple. Whereas on the patient side, I think we just, a lot of times we need to sell it a little better. So your mom is an interesting example, but I, I have a guess that if a physician she trusted said to her. Actually I'm, I am confident that I can do what I need to do to get you well, using this tool.

She might feel a little bit better. Yeah. I mean, the physician really is one of the major drivers. Yeah. I, I do want to get into what it's going to take to, uh, maintain the momentum because momentum was huge, early, and then it sort of receded a little bit in some areas. Obvious, obviously in, uh, in behavioral health, it's still on the chart.

Yeah. Strong. Yeah. But for, for good reason. And it goes back to what you were just saying. I mean, it, you know, I guess a physical visit would help in some cases for, for behavioral health, but in a majority cases it's just, it's just a one-on-one dialogue, right? Yeah. For the most part. The physical exam is talking to the patient, in behavioral, so that works.

I mean, I think psychiatrists are supposed to do a complete exam when they first meet you. They're supposed to be ruling out medical causes for whatever your behavioral symptoms are. So maybe in the very beginning there's a need for a in-person interaction. But I think most of it, not these days, they're saying 90% is, is quite doable online.

Which is fantastic. Yeah, we, but we're, we're gonna come back to that in a minute. Let's talk about the numbers and trends that you're seeing. I mean, again, we interviewed people, actually, I'll go back to, you go back to 20 20, 20 JP Morgan conference and Kaiser presents and they have a number of telehealth visits, which is, you know, because they have the unique model.

It is it staggering. Wow. If every health system would do that, because their, their incentives are almost perfectly aligned to say telehealth makes sense. Right? So they did that. And then you had, this thing happened in the pandemic where we took down the, the walls, the barriers, the regulatory barriers. We, it, we, uh, created financial incentives to do it.

Uh, the technology was already, for the most part, there, there was some fits and starts. So everything sort of came into alignment and we saw this initial huge spike and now we're seeing it come back down. I, I but level off at a higher rate than it was before. Those are the numbers I'm seeing. Are you, what, what kind of things are you seeing?

What kind of, do you have any statistics that you generally talk about?

Yes. I think at a global level. Most providers that I talk to are doing between. 15 to 25% of their ambulatory activity by telehealth these days. Wow. It's gonna vary by a little bit by state. Be depending on how overwhelmed their inpatient environment is. It's gonna be, again, there's a, in the background of, of the thing is, is is the fact that we're still in a public health emergency.

Payers have to pay for everything. You can use Skype, you can use FaceTime. All those re regulatory relaxations are still in place. And so in Massachusetts we just had, for instance, another request from. The governor's office to do more telehealth because we're getting, we, we, sec second spike. It's not clear where it's going that, but, but there's worry that if we don't be more thoughtful, that we'll, we'll get to this point again where the hospital's clogged and we have to shut down elective surgeries and so forth.

So that variable will play into it somewhat, but I think there's another side of it where. Now that patients have experienced and, and there's this magic triad of quality, access, and convenience. And when you hit that, everyone's like, people are like, why couldn't we do this before? Why do I have to come in the, I mean, for me and my, I'm a dermatologist, so things like follow-up visits for acne or stable psoriasis or what have you.

Whereas if you have, if you have a history of skin cancer and a new changing lesion, you probably gotta come in the office. So, but it's sorting those things out and, and when you hit that, and sometimes there's travel involved. I, I had one interesting telling story. A woman whose home is probably 50 miles south of Boston.

The patient, her son, is a special needs, I think he's 20 years old, but special needs takes an army of people to get him out of the house, and she has three other kids. So the fact that we were able to take care of him without her doing all that, she was almost in tears. And so you get those things, which the reason I mention that story is because it's hard for me to believe that we'll go back to a scenario where

It's a curiosity. Again, there will be some, whether it's 10%, 20%, 25%, that is still to be worked out. And it also depends on the reimbursement environment and the regulatory environment. Yeah, and we, we'll get back to that. Let's talk a little bit about dermatology. I mean, that's your area of practice. Yes.

The. That's required, I would assume is, is something like this a, a visit that we're doing, but the, the camera has to be a fairly good quality for you to do that, that visit. Have you had, uh, instances where you started the visit via telehealth and, and had to, had to change it or. Uh, uh, has it been at a pretty high level that you've been able to complete the, the visit?

Well, in dermatology, I, I think it's pretty uniform that people will get still images first. So it turns out that smartphone cameras today are, are quite capable. They have been for, for a decade or so, quite capable of capturing high enough resolution images that could be of diagnostic quality when the person is given some guidance on how to take an image and focus.

And so actually for what we do now, uh, I don't know how long we'll get to continue this, but we have patients submit images over our patient portal and then we do a telephone call because it's the image is what it's all about for us. And the, the, the, the, the, the conversation about how we're going to make a diagnosis and formulate a care plan can be done by audio only.

You know, it, it, it's interesting sometimes the plain old telephone gets lost in the, in the shuffle here, but that's still a, a, do you have the statistics? It's still a significant number. Amount of, it varies. I think when we were at the height of our

telehealth, probably first part of May, first part of June, that time we were doing 60,000 telehealth visits a week at our system. I think 60% of those were audio only. Yeah. That, that's interesting. So the numbers are coming back. Why do you think the numbers are coming back and what are we gonna do? What can we do to send the tide a little bit?

Well, the tide, again, it, it should settle out where it makes sense. So that's the first thing is the, the reason they're coming back is because we threw everything at Telehealth and, and it, it's, it's not designed to do everything. We were in lockdown, we said, you Bill, you can't leave your house unless you're, you need to come into the ER for something dangerous.

And as you know, a lot of people avoided coming in for heart attacks and strokes and things like that. So that's a bad scenario. We right that, that's nothing to measure our success against. Just, just, just for, for the record and Sure. Everything had done via telehealth and of course it came back because as soon as we could see you in the office there, there's a probably

10 or 15% of interactions that we, we shouldn't have been doing by telehealth, we stretched to do it. And so right away you're gonna back off some, the stemming the tide part is we, we call it at, at ATA, we call it cementing the gains. And for us, that's really about some policy work we're particularly interested in.

And this is a little bit arcane, so I'll cover it fairly quickly unless you. Go into more detail, but Medicare operates under a law. So it's not a regulatory re it's, it's not their discretion. It's a law that says that if you are a Medicare recipient to get telehealth, you have to be in the health profession shortage area, which is a very narrow, geographically defined set of essentially where there are not enough doctors, the doctor has to be in a physical, uh.

So that's, that's one really important one we're working on. Then we're doing advocacy now and I think half, about half of the states. ATA is a relatively small, scrappy organization. We do a lot with, with with limited resources, but we're working with about half the states on some various state level. We just did, for instance, a very nice, had a very nice success in Massachusetts where a bill was passed that ensures that behavioral health will be paid at parity.

And for at least two years, chronic illness management and primary care will be paid at parity. So those are, those are good steps in the right direction. Where, where does that, just outta curiosity, where does that money come from? Does it come from the state budget? Well, for Medicaid it does, well, Medicaid, it comes as, you know, it's a mixed program, but, but real, the law says that payers have to pay us, so they, it's premium dollars largely.

Interesting. I, I was gonna ask you, and I will just ask you about the legislative agenda going into, into this, into the Biden administration at this point, we have a lot of things that have been eased or changed because of the public health emergency. I assume that ATA has a pretty robust agenda right now that's being discussed on the Hill.

So what, what are some of those things? Well, I mentioned our main one, which is this originating site law. We we're, we're trying desperately. When whenever legislation comes into the path of our legislators, we try to make sure that that gets entered in by one or more of our advocate representatives or senators.

As you know, the path that legislation takes these days is complicated. At best it always has been, but it's because of the . Divisions in the country, it's even more complicated. So, we'll, we'll see how that goes, but that's, that's an enormous, we use a lot of resources to try to get that done. And there's a couple of other things.

Federally qualified health centers, we feel need to have more LA latitude with how they use telehealth. That's a big gap. There are a couple of other things in that same federal agenda, and at the state level it's Medicaid and then. The biggest conundrum of all is private payers, because there's so many of them and they have so much discretion.

So are there ways that we can do, re, re repeat what we did in Massachusetts and create legal structures that require payers to pay for the activity? So that's one part of our legislative agenda. The the second is around.

Licensure. And although ATA is, pardon me, ATA does not have a, we're not in favor of national licensure. I, I personally am not either. We do believe that some either regional compacts or ways for.

For organization, for, for states that are, that are have similar, like for, for instance, I have patients who come to see me in Boston from, from from New Hampshire. If I wanna do a follow-up with them, I should be able to do it from their home. Right? I shouldn't have to go through hoops to do that. So that's the licensure side.

And the the third big area is, which we don't have a particular strong. Position in, but is, is the technology and the privacy security. Now we have a strong position in that we're very pro patient privacy and security, but we think that it's unlikely that HIPAA will get, um, attention. And the nice thing about what's happened during the pandemic is that many of the video platforms that went into the thing without a HIPAA compliance solution created one.

So, for instance, where I work, mass General Brigham, we're Epic customer. We've integrated Zoom into our, uh, platform and Zoom now as a HIPAA compliant medical vertical. And then as a backup, if people wanna use Doximity dialer they can. And so we have . Two solutions that are HIPAA compliant, which going into the pandemic, I don't think were, so a lot of that's going on in the industry and, and I think that's sort of solving itself.

Uh, how, help me to understand, uh, I, I joke that, that some of this show is just the education of Bill Russell here, right? So. The licensure has, has come up several times. And, and for, for those that aren't aware of this, essentially the states have licensure. It's at the state level, it's not at the federal level.

Therefore, you could potentially, uh, see a patient in Boston but not be able to see 'em via telehealth in from, from New Hampshire, unless there's compacts.

It's, it's not nascent. I mean, it's, it's, it's been, it, it has some good progress around it. But still, there are cases where, you know, you have a major hospital that's right on a river and across the river is a different state and they can't see somebody who's just on the other side of that river. Yep. But I've heard, I, I've now talked to several doctors I respect who say, no, it should stay at the state level.

That makes perfect sense. Help, help me to understand why that makes sense. Well, let's see. We could take the high road first and then we'll go take the low road. So the high road is that the function of the state medical board is to make sure people like me are not crooks and are not either doing awful things with our patients, either medically or sexually assaulting them or all kinds of awful things.

And once you get to be, as you know, a profession professional. And people come to you and they put their, their lives in your hands. And, and so there's got to be a self-policing organization that handles that. So oversight, oversight's the high road. It's, it's exactly, it's a quality assurance program at the state level.

And by the way. It's not always effective and, and we've all heard stories about a doctor who got kicked outta state aid to, to come up five states away with privileges there too. So just imagine with no offense to our friends at the federal government, imagine if that were administrated at the national level.

Right. It just, it's so hard. It would be too far away. Hard, yeah. Hard for me to believe that they could have any control over quality doing that. The low road is trade protectionism. And it, you know, medical practice is a, is a geographic, as a business is a geographically based mindset. You have one cardiologist per whatever, 50,000 or a hundred thousand people.

And if there are two, that means that they have to split. However many heart problems are up. And so imagine the fear that, and I work at a place where we have a pretty good brand, mass General, Brigham, Harvard, uh, people get afraid that we'll somehow, and it's, I think it's misplaced, but they get afraid that we'll somehow come in and steal all their patients by telehealth.

And so that's the, I would say, low road. Part of why state medical boards continue to exist as they're protecting at a geographic level. An industry. Yeah, I, yeah. And, and we saw in Southern California where I was, we saw that there's a ton of people driving out of Orange County, going up to LA for cancer treatment at, I mean, any number of great cancer facilities.

'cause if you have cancer, you're, you're gonna go to the, the best you could possibly go to. Now that's changed because people realize that there was a lot of traffic going up the 4 0 5 to those places. So places like City of Hope have come down and some others. Into the Orange County market. Uh, I, I wanna go through yeah.

A handful of areas and just ask you about the progress that has been made. Let's just say over the, over the course of the pandemic, and I wanna break, I wanna break this down into probably five areas. Technology, security, privacy, clinician education, patient adoption, and alignment of incentives. So let's start with technology and you, you touched on this a little bit.

We, we brought in a lot of new players in by easing the restrictions. Where, how has the technology progressed over the last, last year?

Well, let's see. Let me try to be updated or, or, or was it already there? We just No, no, it's definitely not there. It's still the reason, one of the reasons I would say, remember I went and I said 60% of our visits were audio only. It was because it was hard for those patients to get on the video. It's still too hard.

Even though you and I quickly dialed up on Zoom today and God knows it's easier than it was a year ago, it's still hard. Now. There are interesting workarounds. I think. I believe it's Doximity. There's, there's a couple of solutions where I can text. I. A link to a patient and they can click on that link and the video call launches and they don't have to do anything.

We need more, whether it's QR codes, we need more things that make it just easy, uh, for people. Two steps is probably too many, right? For a lot of people. And they get frustrated and then we just say, okay, I'll call you. And as you and I sort of said earlier, telephones work. They work all the time for the most part.

So. . That's really been the, the holy grail of video since I started in the early nineties was make it as easy as a telephone. We still have to do that, and it's reliable as a telephone. 'cause sometimes a video call drops too due to bandwidth or what have you. So it's better. It's, it's, but it's, it's still has a ways to go.

I think integration into the provider workflow, again, we, we have this wonderful. And I think we, the, the guys on our team did a fabulous job because a patient can request and launch a call through our patient portal and the doctor does it right in the context of the medical record. So he, she can look at the medical record, have a video call with a patient.

People joke that they're more, they're interacting more with their patients via their telehealth calls. 'cause they're not going back and forth between screen and patient all the time. So. That integration has to be, now we have a lot of resources and we could do that. If you're a practice of two or three doctors, it may be harder.

And so making that easy for them, integrating things like devices, whether it's a TAL care or a home blood pressure cuff, or a home pulse ox or what have you, there's still a long ways to go on that, so. There's, there's always problems to fix. We're better than we were, but we have, we still have a ways to go.

Well, I think the nice thing about the technology track is there's so much money chasing it right now, that there's just innovation upon innovation so much. Let's talk about security and privacy. I, I'm not, I.

You know what? We'll, we'll deal with that later. It, it felt like early in the pandemic. That's what we were saying. I dunno if that's still the case. No, I think it's better. I alluded to the fact that most of these players, that if they saw enough business in their future, they invested in a secure system.

Let's face it, our, our patients and consumers care deeply about their privacy, especially when it has to do with medical. Information, I'm sure you're aware from your own TRAs in the industry that people will often feel more comfortable sharing financial information than health information. So we owe it to consumers and patients to have the top level of security we can.

Um, of course that doesn't mean we'll never get hacked. pe pe healthcare organizations get hacked every day, but we try to do our best for them. And so . I think the industry knows that and, and feels like in order to move forward, they have to continue to improve this, this area. Yes. Again, we went into lockdown in mid-March and and because it was almost like that the government said it's okay, use Skype, use FaceTime, which Skype's pretty secure.

But clinician adoption has been one of the barriers. So is, have we gotten through that barrier and will we see this next generation of clinicians coming out get different kind of training in, in med school? Yes. No, we haven't gotten over that barrier. And again, a lot of it is just plain and simple. Ease of use.

Well one, one example I share is in my practice when we went back to in-person office visits in June. We were asked to add an additional half day, whatever your commitment was. I, I do. I'm currently a day and a half in the office, but whatever your commitment was, you were asked to add an additional half day.

Some of our clinicians, full-time do six half days a week, and so they were asked to do seven all of a sudden to make, to make sure we got enough telehealth visits in. And, you know, over the long run, that's not really sustainable. It's, it's. It contributes to burnout and et cetera. So I think making it easy for clinicians to participate, finding compensation models that work now, yes, again, in our system, it's easy for a clinician, for the most part to do telehealth now in the context of Epic.

But it could always be easier and the workflow could always be better. So I think that's one barrier.

I am, I think I mentioned this earlier, I'm, but this idea that not everything works for telehealth. Yes. I'm sure I mentioned it. Yep. And so we need, we need to, to roll up our sleeves as providers and think through the use cases. We, we can't expect that to just settle out. We, we need to provide guidance as clinicians.

We, we owe it to our patients. Our colleagues in the payer industry to come forward and say, these are the right things for telehealth. These things should be in the office. So those, those are two big, um, things about, about clinician adoption. I think the last one, which we touched on, but just to make sure we give it its due, is, is consistent reimbursement.

And that's still, still a challenge. I, I would think in the area of clinician burnout. I've often thought this, that, you know, one of the challenges I have in just managing my daily schedule is I go from recording a podcast to, you know, handling a sales call, to doing accounting to, and all those transitions take.

They take focus, they take, and so when you transition from, oh, I'm seeing a patient, oh, I've gotta go sit in front of the computer for 20 minutes and dictate a note. Oh, and then I've gotta go do telehealth. I, I understand that we block out hours and those kind of things. We, we all do block scheduling to try to try to manage this.

But when the, when the health system isn't adapting the operational practices to address this, that seems be one of the, one of the more, uh. I, I don't know, biggest barriers and probably contributors to, to burnout. No, I agree. It's, it's, uh, it is fascinating to, to think back, uh, a year ago and burnout was on everyone's lips.

We had special sessions and this and that, and programs and which have continued. But again, the solution of the pandemic was add on telehealth. So every clinician's doing a little bit more with, as you say, a different modality to get to get in the future. Where I, I, I don't, I'm a fan of, of, of scheduling.

So I mentioned I do my telehealth sessions on Tuesday afternoons. I'm a fan of. That as opposed to, I saw you in the office and then I went into my room and did a telehealth visit. I think that, yeah, that's inefficient and difficult at best, but, but other people may feel like that's the way they wanna run it.

And I, again, I think we should be providing people with the most seamless workflows that we can to ensure that they're productive and happy with their work. Fantastic. Thank you for taking the time to join us today. Really appreciate the work that you're doing and you know, anything we can do to keep getting the word out.

Love to, I'd love to support you in. Thanks so much, bill, for having me. It's been a pleasure. 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 this show.

It's it's conference level value every week. They can subscribe on our website this week, health.com, or they can go wherever you listen to podcasts. Apple, Google. . Overcast, which is what I use, uh, Spotify, Stitcher, you name it. We're out there. They can find us. Go ahead, subscribe today. Send a note to someone and have them subscribe as well.

We wanna thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hillrom, Starbridge advisors, Aruba and McAfee. Thanks for listening. That's all for now.