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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 Health Lyrics who is our Newsday show sponsor for investing in our mission to develop the next generation of health IT leaders.

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Every weekday morning we take a look at one news story and we break down for you from a health IT perspective, from ACIO perspective. And it's a great way to stay current, great way for your staff to stay current. So recommend it to some friends as well. Check it out. Subscribe wherever you listen to podcasts.

Today we are joined by Anne Weiler, who is a health tech entrepreneur, actually recovering health tech entrepreneur. I guess we'll call you an advisor to this week in health. It you have been for over a year and I'm looking forward to this conversation. Good morning Anne. Welcome to the show. Hey Bill, thanks for having me.

So one of the rotating co-host of.

I talk to a lot of people who are inside of the provider space, and you are technically outside of the provider space. So we're gonna talk a lot about different things that are going on on the periphery, things that are going on in the, in the tech community and those things. But we're also gonna touch on the, you know, we, we have to talk about vaccine distribution.

It's.

I, I think where we're gonna start though, we'll start with JP Morgan, but you did not get to attend, but I did attend Mm-Hmm. . So I, we'll, we'll do this as the, I'm telling you what went on, and then you can, you can, you can comment on it now. The JP Morgan conference for me is a chance to really sit in on some board discussions, right.

And this year it was, uh, advocate Aurora, Prisma Health, mass General Brigham Intermountain, SSM, Baylor Scott, and White Northwell Common Spirit, Ohio Health, uh, blue Shield of California Spectrum Health. That was, uh, day one, advent Health, Ascension, Jefferson Health, Providence, Henry Ford, and ProMedica was the, uh.

It's the C-E-O-C-F-O presenting to institutional investors, bond holders and, and the like. And it, they, they sort of talk about what happened last year. They talk about what's, what they're projecting to happen this year, and there was a lot to talk about. And then they also give you a snapshot into the financials.

Let's just say open with their financials than others. Some you got a full picture of their balance sheet and their, their operating, uh, margins. Others were a little coy with how they presented it, but that's their prerogative and whatnot. But for me, it's a chance to say, all right, what, what happened this year?

And as we looked at it, what happened this year is exactly what we thought. From March to March, April, may, roughly the end of May, you saw this big donut appear in everybody's financials, and it was a, it, it was as obvious as you can be. You didn't need an MBA to figure this out. You just looked at the financials and you're like, okay, this was, uh, this was the curve ball.

Everyone had to deal with it, and we got to see how they dealt with it. Now, I thought one of the, one of the bigger themes from this year was. Again, just diversification. If, if a health system was diversified going into covid, they, they weathered the storm pretty well. Now most of them weathered the storm pretty well.

I mean, you're talking about some established health systems here. They, if they, if they weren't diversified, they recognized that early on and they went out and they shored up their balance sheet. They went out and they borrowed money. They made sure they had access through throughout. Actually, everybody who was on this list received caress Act money, and that filled, uh, let's just say about three quarters of the hole, maybe, maybe maybe two thirds of the hole that was, uh, created during that time.

But the challenge was that was the, that was the gaping hole, but then the health systems had to figure out a way to get people back. And while it, it popped back pretty quickly, it's still not back percent.

Bringing you into this conversation, you know, what do they need to do? Uh, are we going to return to what it was like before? What kinds of things are people gonna do to get people back, uh, and get those volumes up? And is that just the pipe dream? Have we now moved into a different model? I, I, I hope we've moved into a different model.

You know, I, I'd be interested to know whether you saw telemedicine hitting. Were there actual revenues there? 'cause in the beginning it was being reimbursed at the same rate as in person. And so it, and you know, this is obviously I'm both a person and a pundit now. Thank you for making me a pundit. But you know, I remember trying to do an online visit.

With uw, university of Washington Medical Center here in Seattle. When, when we, when Covid started, and I think I was like 12 hours on a waiting, like all day long. Refreshing. You're waiting, you're waiting, you're bumped down, you're up, you're down. So like the volumes of telemedicine in the beginning. We're, we're quite high.

Now there's this question of is the reimbursement gonna stay at the same level? So how much was that coming into it? But when we think about like the, the levels, the, there was this, obviously elective surgery is the, the revenue driver. And so many elective s surgeries were canceled or postponed. I don't know that they're quite back yet.

And those elective surgeries are not, this is not cosmetic surgery. This is . Knee replacements, but also follow up from cancer surgeries like again anecdotal. But a friend of mine had survived colon cancer this year and the removal of his os, I can't never say that they ostomy bag was considered elective surgery.

Yeah, and that got postponed as with another wave. So it does like, I think there's gonna be a ton of pent up demand because those are the, those are the things, there's a whole bunch of like brain surgery, if it's benign. That's also elective, believe it or not. So if you stack rank these like things that are urgent, all of those thing surgeries need to happen.

And then we're gonna have this huge backlog of . The knee and hip where you know, you, you're in pain, but it's not life threatening. Yeah. So I think there, there's definitely, I think two things. One, I think we saw at the beginning, one of the things with telemedicine has been the physicians, like again, Twitter is such a great source of information.

I remember the beginning of the pandemic. Number of physicians that I follow were actually tweeting, like, oh, you can do a visit without putting your hands on the patient. And and as much as No, I'm serious. Like as much as I know, I know, I know. As much as this is true, a lot of them had to experience it.

Yeah. So I think, and then there becomes this question of this licensure thing is that if, if those restrictions. Are lifted or make it easier to do cross state telemedicine than what happens or as is now. Every health system in competition with each other, if you can get a patient from, you know, a different state.

So yeah. Things, so you brought up a lot of stuff. So first, first of all, the, you know, the, we, we need to do an education process on what elective surgeries means. Yeah. To, to the general public. When they first heard that, they were like, yeah, that makes perfect sense. Now anyone who was in healthcare was like, oh my gosh, do you realize what you just did?

And, and actually I think there's an awful lot of hesitancy to do it again. They, they have set triggers in certain states, they've set triggers and if positivity rates or, or a number of IC beds or certain things fall below, below a certain, uh, threshold, they are, they, they will institute moving the.

Elective surgeries out, uh, or the non-essential surgeries or whatever terminology you wanna call it, but health systems are doing everything they can to make sure that that does not happen again. Right? And, and, and so that, that was a huge thing, but the even more concern, so. Surgeries, drive imaging. They drive labs, they drive, they drive an awful lot of things that drive the revenue in the health system.

The second thing that drives their pipeline is ED visits. Mm-Hmm. . And the emergency rooms are still down close to 14, 15, 20% in some cases. Yep. And if that's your feeder, you've gotta, you've another feeder.

They have not come up with good strategies to get people back in the ed. There is still a fee for service world. And the reason I thought one of the themes was diversification is almost everybody's talking. We've been talking about it for the better part of a decade, if not two, in terms of moving from fee for service to more of a at risk for health, but, and nothing like an emergency like.

If you're relying this much on fee for service, you're, you have a, you're at risk essentially, what's going on. That, that reminded me. When you talked about the ed, did you see the article, the study from Boston Children's about asthma? I did not. I didn't down significantly and no . No impact, like not no greater number of children being, you know, admitted with severe complications, which kind of makes you wonder about when you think about the over.

I don't wanna say overtreatment and, and obviously any parent whose child can't breathe it, it's very scary situation. But they basically saw significant decrease in these ED visits without any, as far as they can tell, any impact on actual health. Um, John Brownstein's gonna come on the show. I'm.

Uh, he's like their data guru slash He's their, yeah, he's their chief innovation officer and an epidemiologist. Yeah. And he's, he's on the news all the time now in, in, in their market and talking about this, so it'll be, that'll, that'll give me, uh, another question to ask him. The, the other thing you talked about elective surgeries and, and let's just call it postponed procedures and.

I think it was Mark Harrison. I think it was Mark Harrison, CEO of Intermountain was the only one I heard give a number, and I think he said they attributed close to a hundred thousand deaths this year from people not getting treatment at the right time, or, or, or, or, or not coming into the ED or those kind of things.

Close to a hundred thousand deaths due to, oh, he was talking about the United, okay. I thought he was talking about like Intermountain, that No, he was, he was talking about, he was talking. I, and, and, uh, I'll have to, I'll have to go back and look at the transcript and see, see what his source is. But I mean, that number would, would not surprise me.

Uh, really at all. So telehealth, so telehealth is interesting, right?

Essentially saying, Hey, that was a really fun experiment. I did like telehealth. Boy, that was fun. But you know what, I'm bringing people back in, uh, to see 'em in the office. I have a mechanism for doing this. I have, I have real estate I need to pay for, I have staff I need to pay for. And so the incentives aren't aligned, so it's bringing people in.

That's one thing that's going on, that's going on States. 'cause we haven't seen it at the federal level to say CMS, to say, Hey, we're gonna continue to fund this mostly 'cause they don't have the money to do it. And we're seeing states start to step up. So you've seen Massachusetts and I think New York, I haven't seen another yet, but those two, Massachusetts being the most bold, essentially, is gonna backstop all the telehealth and say.

Behavior towards telehealth, and the minute they stopped doing that, everybody dropped telehealth visits. So there's like so many things going on here. It's not just funding, it's, it's, I think preference. Going back to your point about real estate, this and, but possibly what might change this time is that everybody's reevaluating the real estate, right?

Yeah. Like not just healthcare. Like look at all the office buildings that are empty. Everyone is saying, do you know, how should we be ? Thinking about this. So I really hope that that healthcare isn't making a decision for patient care based on real estate. Yeah. And that they're actually thinking about, like, if you think about it, like we're, we're in a pandemic, right?

If I had the flu, you don't want me going to a doctor's office. Like that is a perfect telehealth, uh, visit, so I'm not going in there and infecting everybody else. Right. So like, there's some really, really good cases and, and that'll free up the in-person for the things that really need to be in person.

Yeah. So, absolutely. I dunno, I I hope so. I'm, I'm hopeful, but I've seen, like, I've seen things that . You would really hope they, it wasn't just money based . Yeah. Well, if, if, if, uh, the listeners won a full breakdown on the JPM conference, I did a, uh, do an episode this Friday with Rob Dhe, former CFO for UPMC, and he goes through the finance.

Nobody better to.

Diversification and all those things. So if you want a really detailed breakdown, go ahead. You can go over there. I'm, I'm also doing a bunch of shows on today in Health It, uh, so you can go over to today in health it.com, listen to some of those where I broke down some of the themes and whatnot, and there's gonna be more of those this week that I'm still, uh, rolling out.

I do wanna get to some JP Morgan. Important question was. Did you have to pay for a Zoom call the way you had to pay for a table to sit in the lobby of a hotel? How , how did that work? Uh, you know, my, my wife charged me $800 a night during the JP Morgan conference. , I felt, I felt really at home and it just, it felt right.

Yeah. I don't think people can really appreciate how expensive that conference is to attend. It's nuts. Yeah. But everybody's there. And some of those people, the only time I'm gonna see 'em this year will be at that conference. So, you know, so they, if they do it again in person next year, I will be there in the, in the hotel on that floor, watching all those CEOs go up to the, go, up to the podium.

It'll, it'll be interest if we're in January of.

I'm hoping that conferences end up being a bit more hybrid, that you can participate without, like, there's huge benefits to being in person, but you can't always travel. Yeah, I know that I think that health, the H-L-T-F-H conference, I, it seems I didn't attend this year, but it does seem like they did a good job of going hybrid or sorry, going online.

And I can imagine them doing more hybrid in the future. 'cause they're a little bit, they're a newer conference, let's just say that. Yeah. They're, they're, uh, more tech savvy. The, yeah. But I'll be honest with you, the benefit this year. Because you're, you, the JP Morgan conference pulls you in so many different directions.

There's, there's individuals you wanna sit down and have a conversation with. There's there, you get invited to events that are right in the middle of some things that you wanna watch and whatnot. So for me, I'm, I'm always pulled in a lot of directions. The nice thing about this was I missed, and I have a list of ones that I'm, I'm still listening to, uh, a bunch of, a bunch of the presentations, and I went back and listened to 'em later.

Which is great. So I, if I sit through the, if I sit through the, the nonprofit track, I miss the CVS presentation, I miss the Walgreens, Nvidia presented, Teladoc, sent Team Nuance. I mean, those are all things I wanna attend. But you can't be in two places, so, right. Let's talk, let's talk a little bit.

It's interesting. I did a post. You'll love this post. And actually I'm gonna hit, I, I'll hit the post. 'cause I, I wanna share some of the things that, that, that people are talking about with regard to this. I said try this. Hit your state's website and try to get information on vaccine distribution. Now go to the county website, now go to your health system website, your results below.

How did it go?

When you can schedule an appointment, are you clear on the efficacy of the vaccine? Do you know which vaccine you're gonna get? Doesn't matter to you and I, I posted some things here that people are saying, and one of them is we spent $10 billion to develop vaccines and why we are not spending money to introduce the public to the vaccine.

A physician in Charleston based medical, university of South. And they said, we can do this better. Well, this, this is probably the post for me this week that got the most action and people did it. They went out. So somebody from the state of California said, Hey, that information's almost impossible to find, but I know exactly how many deaths there are in the United States.

So they're, they want you to know how many deaths there are, but they're not really helping you out on that went out. She's, uh, one of the rotating.

My state, Rhode Island still is only showing high level timeline for phase one groups. Nice visual showing phase one, so that's a plus. I asked, uh, virtual chat about over 65 most recent CDC guidelines and got a non-helpful answer. My health system website is not showing any information. We had somebody from Texas say they scheduled and got in.

And, uh, the information was readily available in my state of Florida, which I, I noted I can go to the county website, actually hit a schedule button and schedule the, the vaccine. Now, it's interesting, it's not until I get in there that it says, you know, what's your age? Oh, you're not, you're not eligible yet.

So that tells people I'm not over the age of 65, but in Florida, we're actually giving it, we're actually to the next level we're giving it to. We, we did the, uh, long-term care facilities. And nursing homes, and now we're starting to do, people over the age of 65 are starting to get lined up for the vaccine as well.

Catherine Sullivan, who is always giving me trouble, but I love the trouble she gives me 'cause she always is talking about the people that we forget about or the people that are not connected. She's, she talks about the mentally ill, and she's really trying to gimme heat on this. She's like, this doesn't take into account the mentally ill and the homeless, and how are they gonna get to it?

And I was like, Catherine, that's a great question. What do you recommend? She says, we have to figure out a way to go to them. And she's, she's not wrong. That's true. I don't know who's. I don't know if that's a public health effort or if it's a hospital effort. I actually dunno who's doing this in, but in my local park, there's no COVID test site, like just in the park.

So Wow. That, that might be a way to do it. Yep. I was reminded of, I don't know if you saw the, there was an article in New York Times yesterday and it was talking about . The trials of getting signed up and it says, I'll quote, quote this, 'cause I think it's very quite relevant to it. Buggy websites, multiple signup systems that act in parallel but do not link together and a lack of outreach are causing exasperation and exhaustion among older New Yorkers and others trying to set up vaccination appointments.

So we've got the typical health system or healthcare, you know, systems not talking to each other. And then we've got, and we're try, who we're trying to get to are, are the people who might be actually hardest to get to and it. Reminded me a little bit of a startup I've been advising called Can Do Tech, that is tech support for seniors.

And they've actually started helping seniors sign up for their covid vaccines. So like it's one thing to put something out there. The other is like, is it actually usable? And as we know, usability is not always the highest order of things in healthcare. And I know. Did anybody think through this? Like could you actually sign up as you were saying.

Um, yeah, and you, what's interesting, somebody, one of the articles talked about the, the federal government didn't set anything up. They pushed it down to the states and, you know, the, the states were sent scrambling. And I, and I thought, you know what? That's how I want it to be. I don't want the federal government to come out with a program.

My gosh, we, we'd be talking about, are you in line for the vaccine in like June of this year? By pushing it, by pushing it all the way down to the state. And one of the things I like is that a lot of the states really, they went to the health systems and said, look, what's your mechanism for reaching people?

And what they realized, I think what they realized is the health system's mechanism for reaching people is their portals and their portal signup is still. The best are about 50% of their patients. That's not of the community. That's 50% of their patients. And so that's their outreach mechanism. Yeah. And so they stepped back and said, okay, well that's not gonna be enough.

What's what? What are we gonna do next? And then they, they, but they still engaged the local health systems. And then they stepped back and said, all right, what are we gonna do at the county level? And this is why I like what Florida and Florida took a lot of heat. They had lines and some other stuff, which always happens at the beginning of something like this.

But. It's a common scheduling system and they're using Eventbrite. So they took key for using Eventbrite. But you know what we have, we've all used Eventbrite. It's really well thought out. User experience, it's really easy. You can provide them additional information. So that's what they're doing at the, at that, at that site.

I'm not trying to score political points in any direction here. I'm just saying, I live in Florida, I'm watching this sort of play out. My neighbors did call me and say, Hey, how do I get the vaccine? And, and it turns out the, the, the nursing homes and long-term clinics was the best orchestrated distribution even in the state of Florida.

And what they ended up doing was getting, because. They're like 86 years old or something like that. They ended up getting the vaccine, not from the hospital, but at the, the local long-term care clinic. Yeah. Which they, which they're signed up to, to join in for long-term care in a, in a year or so. So you, you asked me about like long-term impacts on telehealth.

I'm wondering, will this have positive long-term impacts on public health and. I, I was reminded of a comment that a ed doctor at Kaiser here in Seattle said to me a while ago, but, you know, we have, we've gotten to this point where we have often wildfires in the summer and really bad air quality. We had terrible air quality for the, basically first two weeks of September this year.

And what he said to me is he had no way of searching. The MR to find his patients that had asthma, to send them an email to say, do not exercise. Do not go outside. And I'm just wondering, like in trying to find these people who are qualifying for Covid vaccine and doing this kind of search, will we get those kinds of capabilities?

Like he wanted to proactively reach out to his patients and he couldn't, 'cause he couldn't find them. So I'm, I'm hoping that this will. What do you think? Like, is this gonna have long term? Oh, I, it absolutely, uh, it'll absolutely have long-term impact on public health. I mean, we're already seeing just a bunch of conversations start to kick in of what information do we need?

And when the pandemic started, we still had the, the massive bureaucracy on. People were just saying, look, we're in the middle of this thing. I don't have time to collect nonsense information that you need for this and this. Why don't you tell us exactly what you need and that's what we're gonna give you.

And some people started working on what are the data fields we actually need in, in, in terms of the pandemic. And so I, the same way I'm talking about that is the same way I'm thinking about public health. I think people are gonna step back and realize, first of all. Define public health a little differently than we have before in the elements of things that we need in order to be effective.

And who are the players in public health? And I'll give you the, the one example and it, this was, uh, JP Morgan conference. This is a combination of JP Morgan conference and vaccine distribution c vs. Has done close to. Vaccinations already. And Wow. They haven't done 'em in their stores. They got the contract or whatever to do 'em in long-term care facilities because they were close enough.

They had the, the distribution mechanism and they had the healthcare system relationships. And so they, they took their clinics, they went out to these long care facilities, they took the vaccine with them, and they went to all these. They said the next step for us is, and, and to be honest with you, it's probably much more effective than some of the things we're trying to do today.

And I think this is, these are the kind of conversations we'll have. So they're going to go out, or the next step is that federal government will essentially make them a distributor of the, of the vaccine. And they're just better at reaching people. Right. CVS knows how to get ahold of me. The local health system doesn't know how to get ahold of me.

I haven't been there. They don't even know I exist in this market. Yeah, that's, yeah, and it's not only that, this is, this is why we talked about new entrant. And new entrant was a, is always a topic at JMI mean, this is why the, the, the CVS is the Walmarts, the Amazons. And others and, and, and the disruptors are seeing an, an opportunity here.

I mean, the landscape has changed so dramatically that there, there are opportunities to step in and say, look, you could try to build this whole network of things out, but if you wanted to do, nobody does distribution better than Amazon. Nobody does. Uh, nobody's in every market better than CVS and Walmart and they're, they literally.

Uh, health systems grew by acquisition, right? So they're not necessarily all in the right places, but when they put a Walmart in your local location, they, they do all sorts of research on, on growth patterns in that community. I mean, they are in the right spot for, and they put in nice big parking lots and all sorts of other stuff.

And I have a feeling that public health partners will look a little different coming out of this. You know who else is in the right spot is Starbucks. I think that if the health systems wanted to get out in the community, they should look where the Starbucks, I'll take a latte and a Covid vaccine, please.

Yeah. Why not ? Well, seriously, they, they are everywhere. I mean, I, I guess the difference is that they would have to invest in the. The infrastructure did. Oh, I'm not, I'm not saying Starbucks should do it. I'm just saying like, if you, if you wanna be where the people are, that's another indicator like put your health clinic right beside a Starbucks.

Yeah. I mean, one of the first actually, which, you know, there is one in Seattle. I. In the neighborhood where we used to have our well pepper office, the, there was a Zoom Care right beside a Starbucks. Yeah. Yeah. I don't think that was a coincidence. Yeah. I don't think that's a coincidence either. Uh, vaccine, one of the things we talked about was the challenge of tracking the vaccine in the EHR and, and then getting that information out and whatnot.

And one of the stories I wanted to hit on vaccine credential initiative was launched Mm-Hmm. . And this is, you know, this is pretty interesting in that, let's see, vaccine Credential Initiative. Lemme find this one. Uh, participating organizations, which is organizations like the Care Alliance, epic, Cerner, that's, that's big news.

Microsoft and others. Participating organizations will agree to offer individuals with digital access to their vaccination records using the open interoperable smart Health Cards specification based on the W three C verifiable credentials and HL seven fire standards according to VCI. So essentially what you're talking about here is we are, we've, we've solved the first problem, which is where are you gonna track this?

And we are gonna track it in the EHR. We're gonna track it wherever we, we track it. And, uh, my guess is you're, you're, most of it's gonna be in an ehr. Okay, great. Now we need to, the person shows up for the first, first dose of the vaccine. They need to get the second dose. They don't go back to the same place.

They need to show that they're, they, they've had the first dose. We need to get that information sort of interoperable. That's what this is about. This is about using to go in, get that information, be around also on mobile. Via the Smart health cards specification and be able to move it around. It's, I'll tell you what's interesting to me is

you're hard pressed to find a place where Cerner and Epic are in collaboration, and I mean, they make announcements all the time. Make, make it appear like we're the one cases where. They, they are absolutely working for the good of the community, right? We have all the things that have happened around this, like 21st Century Cures, fire, fire, really making a, a move forward, plus the urgency of Covid coming together to create the perfect storm for all right, let's see if we can do something, if we can build a mechanism for sharing this information and getting it into the hands of the, of the patient.

I, this is a, I think this is a potential game changer. Yeah. For years we've been saying, oh, we, we can't share that information. This is too hard. But if they're able to do this, doesn't that mean we're gonna be able to do an awful lot of other things coming outta this? Um, it doesn't, I mean, I, the, I think the question is the value of the data to the.

Right, like va, it sort of feels like vaccination data is not that valuable. Are.

If it hurts your competitive advantage. Yeah, that's what I'm saying. I'm saying many, many of the protectionist data, uh, policies in the past have been because they think that the patient's data is their ip, which I, I completely disagree with, and always took that stance of like, the patient owns the data about their health and, and they give

Technology companies like Yeah. And, and doctors permission to use it. That, that the health systems actually say they own the data and they give the patient permission to see it. So I think I, I'm, I'm sort of thinking like with vaccination data, it's not that sticky. Like, we don't, you don't think, oh wow, you know, I got vaccinated at this place.

It was such a great experience. I'm gonna get all my vaccinations there. You get it wherever it's like most convenient. So it it, it will set up the technical infrastructure. I don't know if it'll change the behavior. . Well, but here's, I, I don't think it'll change the behavior either. But here's what it does set up.

So we have the, uh, transparency rule, which puts the shoppable services out there. So we have a new set of data that. We are gonna prove the ability to move this data out, move it around, and then the question becomes, the federal government keeps pushing. This is the first set of data that you're gonna have to expose via fire.

And then it's the second set, then it's the third set. And potentially what we get to is a, is a situation where I can finally move from place to place, not be really captive to where my data is being housed. I can move with my data and then you'll see different plans start to emerge within the community.

That I think is the, the hope. And again, I mean, uh, the thing I love about this is, uh, different focus and different emphasis, but c uh, uh, CMS and HHS has been consistent now for the better part of almost two decades. In terms of their desire to get the data into the hands of the patient to empower the patient.

We can argue whether it will and what we have to do to the data to get patients engaged, but they've been pretty consistent now, and I don't think that's gonna change under the next administration. I think it's the emphasis might change. The emphasis might go from creating a, a. The Republican administration to maybe Medicare Advantage for all under the Biden administration.

But at the end of the day, I don't think this, this view of how data has been locked up and needs to be freed up in order to support cures, in order to support cost reduction, I don't think that's gonna be. What's interesting is I actually remember, and I don't, I haven't even say whether they exist anymore, but there were like startups doing vaccine vaccine records for kids.

'cause it was so hard to keep track of that for parents, which seems like a FE should be a feature of AEMR portal. So, yeah, there's no question that the piece of paper is not a Good way of tracking this. Yeah, absolutely. So, so Ian, what do you, do you have a story or anything to, to, that you want to throw out there?

Um, okay. You, this may be going a little too far, but I think it's pretty interesting. This is, again, it's from a personal story, but as we're talking about vaccine rollout, a friend of mine was telling me about what was happening in France and that, so what's happening in France is it's cultural. They are sending out the notifications of you can get the vaccine, and then they're giving people like two weeks to decide.

If they would like it. And so it's, they basically, I think by the end of last year they had vaccinated 130 people, but it's a complete cultural like. Uh, it should be up to the individual to decide, and we're going to make this equitable. And instead of saying, here's your appointment date and if you can come or not, but your appointment's going away, they're like actually giving them this time, and as a result, they're not actually rolling out the vaccine.

So when we see the, the things happening unevenly in the us. I think we're doing a better job, job than that story. Yeah. We're, we're, we're, we're doing a better job. But you know this, and we're not gonna have this conversation, actually, we're coming up to the closing of the show, but this is rolling out a vaccine in the age of social media is, is another hurdle in and of itself.

I mean, the what is, what is accurate information? I mean, the number of times I have to answer questions to people that I'm like. Well, that's common knowledge. It's like, well, it's not common knowledge because half the stuff they've read or stuff reads. Yeah. Yeah, no, I think it was more that, just that you, you said you don't want a federal rollout.

That's an example of a federal rollout that was, that's not working very well. . But, but also I think goes back to the, you can design whatever program you want, but so much of it is the people are the, and the cultural aspects are the things that can screw up everything. I think that was my, my bigger point there.

Right. And so you're saying in to be culturally relevant in France. Distribute the vaccine in wine. So if they had a wine that was actually the vaccine, they would, well maybe my, maybe my cafe idea is the right one. Cafe. Cafe as well. That would be, that would be true . It's funny, and thanks again for, for joining me.

I appreciate it. And we'll, we, we will do this again in about six weeks. Sounds great. Thanks. 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. They can subscribe on our website this week, health.com, or you can go to wherever you listen to podcasts.

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