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 Today, on this week in health, it is healthcare. Too complicated? Yes, that's the issue. Healthcare is not one industry. As we've said, it's at least three and probably more like seven. Every time you turn around there's some other layer you learn about. Within an industry, there's a lot there and anybody who's trying to tackle it all.

It's gonna be in trouble.

It's Newsday. My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of this week in Health IT at channel dedicated to keeping Health IT staff current and engaged. Special thanks to Sirius Healthcare Health Lyrics and Worldwide Technology, who are our new state show sponsors for investing in our mission to develop the next generation of health IT leaders.

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It's simple to sign up. You just go to this week, health.com, click on subscribe. It's a great way for you to stay current. It's a great way for your team to stay current and a great foundation for you and your team to have conversations. So go ahead and get signed up today. Former Health Tech startup founder and leader, Anne Weiler joins us on the Newsday Show.

Anne, welcome back to the show. Hello, great to be here. Looking forward to this conversation, we're gonna tap into your health tech startup experience and leader. But I wanna start with your Twitter post from yesterday. This is a picture, picture of a dumpster that you put out there. Share with us a a little bit of the story about the tweet from yesterday.

Well, I was going to pick up a prescription yesterday at my local pharmacy, and it is a . Seattle chain of pharmacy, so it's not a global chain. And I was walking by the dumpster and there was a sticker on it that said, no HIPAA trash bags in dumpster . And it made me wonder, is there a special HIPAA trash bag?

And I was like sort of parsing the sentence, is it HIPAA trash or is it HIPAA trash bags? And then I started, you know, of course I thought it was pretty funny. I assumed that with Amen is don't put, you know, personal health information in the dumpster. But then it also made me think like, what, what was in that dumpster before they put this little sticker on it.

Yeah. And, and how, how effective is the little sticker on the, you know, by the time you're carrying the bag out there, you're at the dumpster, are you thinking. You know, I should go through this trash to look for any HIPAA trash to make sure I don't put it in the dumpster. Yeah. Um, anyway, that's, uh, but, but, and it also goes to the point I, I used to frequently make, although, you know, I'm not downplaying any sort of cyber attacks, but that, like for years, whenever you would read the top HIPAA breach stories, there's a lot of human error in HIPAA breaches.

So, uh, you know, this is one exactly here and it's also tough, right, because I didn't really think about the fact that. In a pharmacy. Well, of course you think about the fact that it's PHI in a pharmacy, but like the person who's taking out the trash may not understand that. Yeah. I mean, I'm reading some of the responses this, there, there's only, you know, I can only take so much Twitter a day, but when it's the funny stuff, I could take a ton of it.

It's just a circles, you know, so somebody said, you know, Hey, this sticker may have saved CVS $2.5 million, which of course, uh, I doubt the sticker would've, but they, they have that issue. Then somebody, somebody said. They also had trouble reading it and they thought you meant HIPAA professionals in the trash.

And there's a picture of a person flying through the air, hitting the top of the trash can and falling into the dumpster. And, uh, they talk about throwing away . HIPAA professionals. I . Anyway, just some of the stuff just cracks me up. Alright, well we're not gonna spend too much time on Twitter today. We've got a bunch of interesting stories.

You know, we can start with the Johns Hopkins one. So we have Johns Hopkins develops epic embedded tool to better support Telehealth patients. I found this one interesting. I'll give a couple of the excerpts. So talked about the tool. Johns Hopkins Medicine developed a tool aimed to automatically identify patients likely to need telehealth technical assistance.

According to an editorial in the Harvard Business Review by four members of Johns of the Johns Hopkins teams, the tool is embedded in the Epic EHR. The tool can be used by either a central IT support team or frontline clinicians. And what it does is it creates a score. So the score which increases based on the risk a video visit will be unsuccessful, is based on patient's digital health interactions such as the patients not having an active account in MyChart, not having completed the systems, each check-in process.

In the previous seven days and not having had a video visit appointment in the past three months, the score is automatically calculated based on stored EHR data and displayed as a column that can be added to a provider's or clinic staff members' scheduled views. And that's also in the articles.

Interesting use of technology, interesting use of building out the algorithm. You selected this story, so I'm curious what, what, what are your thoughts on it? Well, I, yeah, I thought the use case was really interesting. I was thrilled that they were doing this kind of segmentation because when I was working with healthcare and hospitals, there wasn't that idea of like different types of patients.

So I loved the, the fact that they were identifying that. What concerned me a little bit was there are good reasons why somebody doesn't have , an account in MyChart. Right? That was one thing, and then the other was how much effort did they put into this as opposed to making the telemedicine visits like released seamless and easy?

So the beginning, or I guess about a year and a half ago, I was doing some consulting and I did a bunch of research with seniors. On communication and how they talk to their adult children and, and the adult children and how they talk to the seniors and stuff. And, and this was at the very beginning of the pandemic.

The seniors I was talking to were, granted, they were high functioning, but they were, they were doing Zoom presentation for travel slideshows instead of going to the community center. And they had picked that up. And so I, you know, on the one hand, love the idea of segmenting your users and understanding that they're not all the same and they're gonna need varying levels of help.

In fact that, you know, it looks like they reacted because they were trying to provide this help to everyone. And some people were like, , you know, go stuff it like, I, I think I can do this, right? You're, you're interrupting my business day where I'm on Zoom all day. I can, I can do this tele, but you know, you kind of wanna look at what are they also doing to make the telemedicine process easy, not just this sort of pro, you know, it, it was, it seemed a little bit of the, let's not waste.

You don't wanna waste the clinician's time, but you know, let's make sure everybody shows up for their visit. And I, I love that aspect of it and the idea that people have differing needs, but I also would like to see what are they learning that is actually improving the, the telemedicine process. Yeah.

I'm wondering if there's better data points. You know, MyChart account is one, and we already touched on that. Using their E check-in process being another, and then having had a video visit in the past three months. Yeah, I guess those are all indicators of their ability to be tech savvy, but they could also be, I don't know, indicative of their.

Indifference towards, uh, a lot of things. You know, quite frankly the value of a MyChart account to me, and I have four of them, I think , right. And I, I really only, I really only check it the week following the actual visit. Right. And that's, that's about it. If I thought about it, I guess I could do the check-in ahead of time.

So anyway, I'm not sure that that's indicative. There's probably some better. Metrics. I'm just not sure how to get 'em, you know? Mm-Hmm. . Yep. Because you, you, you wouldn't wanna make a generic, as you were stating earlier, you wouldn't wanna make a generic assumption based on age. Right? Somebody over the age of whatever is going to have, uh, a higher probability of a unsuccessful video visit.

But there's probably some stats to back that up, don't you think? Yeah. There, there probably are. So, yeah, I agree with you. I think it's this first step and it's a great first step. and with that first step of data, I mean, this is the thing, right? You have to get data, you have to look at it, and then you have to continually iterate.

So I think the question is how much are they iterating? And, and the, the question of causation correlation, yeah. I haven't, I haven't logged into MyChart. I. In three months . But I think I can do a video visit and it is exactly the same as you. Right? Or haven't had a video visit 'cause it didn't need one.

'cause I'm healthy . Well, where, so I, I actually, uh, you know, I've interviewed some people. I actually helped my neighbors with various video visits and whatnot. You know. Where do you think these things fall down? It's interesting to me because my neighbor's video visit fell down. Because, you know, he was using an AOL browser.

I mean, literally Wow. That's what he was using. And so he struggled, but we, we got through and it would've fallen down again because the clinician was 17 minutes late to the appointment. Yeah. And I wonder, yep. You know how many of those are happening and.

I mean, based on your experience, based on what you're maybe hearing from your friends, neighbors or whatever, where do you think the the best opportunity to improve the telehealth workflow and visit is in order to ensure that the, the, the connections are being made and it's not a technical issue anymore?

Well, you know, the first thing I thought when you related that story was. Using AOL as a browser is probably the best indication that you need help on your data. , seriously, it's like, what is your browser? Okay. It's probably those, how are you going to connect questions, right? Yeah. Do you have your own computer?

No. I'm gonna use my neighbors. Or what browser are you using? And do you know? If you don't know what browser you're using, that's probably another good indication that there's a, a problem. I, I think you're absolutely right. The weight, I mean, I haven't done . A telemedicine visit since this, the beginning of the pandemic and it was the the wait time where, and that's, I think that's the problem with technology in general or even being on hold for a health system is at what point do you know that you're actually still actively on hold?

I think those services that call you back when they're ready, those are some of the best ones because you don't have to listen to whole music. Keep refreshing, hoping you're not losing your internet connection. Like all of those things that can go wrong, I think sadly, I think a, a lot of it is actually the technology and we spent a lot of time on the real time video and not on the things around it, right?

That like help you understand. And I still see this, I'm still amazed how hard it is sometimes to get into a call, you know, a video call or a zoom call. It's, there's just like these little bits of friction and I think every time you have one of those bits of friction. Then, you know, there's the risk of people abandoning it and then yeah, the doctors running late, which we all know happens.

Yeah, that's an interesting one. That's a question of staffing and that's where video visits, the doctors should never be late. 'cause if you have a pool of people, you should be able to optimize for who's available. You should have people only doing telemedicine for example. Right. But it's, you know, it's specialist.

It's a follow-up visit. So it's gotta be that person. You know, as I was thinking about that one, . Because I have, I have thought about it a bunch. If we were gonna optimize for that, there should be . Whatever the equivalent of waiting music is for a video visit. And actually I don't think it's waiting music.

I think it's an active presentation on some aspect of their information. And this is where we get to the end of one, the personalized experience, their hold music, if you will, is a presentation on their case or their symptoms. I mean, not specifically, but on things they can be doing and that kinda stuff.

Look at those, those companies that made so much money doing the the waiting room video. Right. This one you could like, yeah, you could do it for an end of one because you know who the person is. Exactly. And, and the other thing is, Hmm, I'm gonna go do that. I'm, I'm wondering, I'm wondering how hard it would be.

Let's do that, bill. Let's create this business. Oh, here we go. Now we're off. Um, now we're starting a new company. No, but just kidding. I, uh, I'm also thinking there's gotta be some way to, you know, uh, you're on a Zoom call and, well, we, we now know that Zoom was the number one used. Platform for telehealth visits based on.

Data that's been collected, millions of records and whatnot. So Zoom was number one. There has to be a way when you're on hold to have something up there that says your physician is, you know, you'll be seen by the physician in 15 minutes. You know those call trees where they say, Mm-Hmm, you're the next caller online, or that kind of stuff.

Yeah, there are I, I don't know how to do that, to be honest with you. 'cause the schedule for these specialists is so dynamic. Yeah. I don't know. But anyway, it's good Problems to solve is making the experience better, getting as much feedback from the user community as you possibly can. Mm-Hmm. . And then looking at the tools that, that are possible.

Yeah. Around that. I'm gonna get back to is healthcare too big and too hard for big tech firms? We covered that last week on the Newsday show, but I do wanna talk to you about it since you are. Strategically positioned in Seattle and will give us a different perspective than Che gave us from the the healthcare perspective.

But before we get there, I wanna talk about growing a startup. So there's, there's two stories this week. One is ZF just raised another $24 million to expand their digital health services and zf, great company. And we've had their CEO on the show as well. Great conversation. And we also have fast growing Cincinnati startups celebrates exit following acquisition by Texas based firm.

And so that is. Halo Health. Let me hit the story real quick. They were acquired by, is it hire Simpplr? S-Y-M-P-L-R. So they're bringing all those technologies together. And it's interesting to me as I was reading this and the, the conversation I wanted to have with you is growth strategies. Mm-Hmm. . So I'm, I'm looking at Halo Health and I've talked to some people around Halo Health.

They said great company, started by a physician. They did a lot of listening, lot of listening to their end user community, and the first iteration was just mediocre at best. And they just kept listening, iterate, iterate, iterate. They ended up getting a fair, uh, a pretty sizable user base. Uh. And then found their exit merged with another company that has complimentary products and they're bringing it in.

That's one path. The other path is isth, which is, I mean, they also have a, a good client base, but I'm looking at this and one of the things that ZF did early on is they were part of Providence. They were then spun out of Providence and they really used Providence's. Investment arm to really get the word out about them.

And they have a ton of investors. Mm-Hmm. . I'm looking at this investor slide. It's incredible. Providence Cone Health, Nebraska Medicine. UPMC. Novant Memorial Care. Christiana Care Advocate Aurora, who led the last round Banner. Health Freighter, Stanford Health. Memorial Hermann, Cleveland Clinic, atrium Health, these are significant health systems.

And I'm wondering, you know, if you're doing a startup and you're looking at this, what comes first clients or the right investor? I mean, how do you think about that? I. Well, I think clients, but in healthcare, because you can't fail fast, having a , the right investors is also really helpful. And I know because they needed to be embedded in Epic, they had to have the right partners.

Like they could not have done what they were doing with the technology if they hadn't been so closely aligned with Providence. It was Providence that gave them their first Epic integration. So. If you're talking about like that path, like the only way you can get really anywhere with Epic is to go through the health system.

So the question is, is the health system the investor, or is the health system the customer? And I think either of those is fine because so, so does the health system become your advocate to Epic? Yeah. Yeah. That's the only way you can get anywhere with Epic book. Even then , even then, it's hard . Yeah. If you're looking at this Providence, UPMC, atrium, Cleveland Clinic, I mean Stanford Advocate, Aurora, I mean, these are significant epic clients.

Yeah. The thing to understand is that the investment group in a health system and the people, the clinicians, or the IT group or whoever's gonna use your stuff may or may not be aligned. So you think that. The investors will give you this ticket to get deployed there. And that's not actually true, but a lot of them, and it makes sense, right?

A lot of them are like, yeah, we think this is a good investment, but our clinicians have to buy in on their own. So sometimes it doesn't actually get you anywhere, and you have to know that. And I've also had situations where. We're talking to the, the buyer and then somehow the investment group gets wind of it and it totally just derails doing the sale for those, you know, healthcare entrepreneurs out there listening.

Someone gave me some very good advice that I got a little too late 'cause this had already happened, which was you tell the investment group, you give them a a document with warrants and the warrants are for them. Hitting certain milestones of deployment and maybe it's a warrant for deploying, maybe it's a warrant for Epic integration.

Maybe it's a warrant for doing a case study and you give them options or stock or whatever, however you wanna do it, for hitting those warrants. They still are a customer, but then they've actually got this, you know, momentum to deploy. And then at that point you can take, you know, if they wanna invest as an investor, you can do that.

The problem is, you know, the problem I ran into was they come, wanna come in as an investor and then the people who are . Wanting to spend the money with. You wanna wait and see if you're gonna get a better deal, if they maybe don't even have to pay for it, if they invest, and then suddenly everything gets derailed.

So it's like, in the beginning it seems like, wow, this is amazing. You know, we've got this potential client and the potential investor and it can go in a different direction. There. There you go. I think for, for zf, like they absolutely had to have those two things together. In order to, to get where they got with, you know, getting completely embedded in Epic.

You know, maybe my thinking wasn't right. Uh, the two things I wanna say here, but whenever we invested in a company and somebody said, Hey, we should get that for free. I'm like, maybe you don't understand how a company works. Yeah, I know, right? The investment money. The investment money comes over here and it gets used for growth and those kind of things, but operations is how they keep.

Functioning, and that's the money they get from actually implementing the, the thing. If every one of these health systems looked at Zel and said, Hey, we invested in you, we want this stuff for free. Right? They'd be gone. Right. So that's one thing. The second is I had a conversation with ACEO who remain nameless large academic medical center, and I asked the person about how a, a startup would enter their organization and he said, there's two paths.

One path is we invest in you. In which case we will make all the introductions within the health system to the right people so that you have every opportunity to close a deal within our health system. The other path is you do not accept an investment from us, in which case. Good luck. I mean, I mean, you can still sell to us, but you have to find the people, set up the meetings and do all that stuff.

Does that sound fair? I mean, keep in mind on the other side, so what it's, it's totally, you're getting hammered with a million of these. It's up to them. It's, it's totally up to the health system. I think the important thing to know is when you're talking to them, understand how the dynamic works because there are systems where.

If the investors, I like, I hate to say this, but I saw this very clearly. If the investment group liked it, the clinicians like purposely didn't like it. , , like, so, so you just gotta know, you know? Yeah, yeah. I, I would never assume that this side of the organization and this side of the organization are in alignment because, well, yeah.

I mean, you worked in a health system, but yeah, it's just, yeah, I, I would say that certainly revenue is always, revenue will get you investment. Investment will not necessarily get you revenue. Yeah. And I've talked to enough, um, of the investment side of the people who, uh, don't have a huge amount of respect for it.

And I've talked to a bunch of it people who don't have a huge amount of respect on the other side. I mean, I'm not, I'm not talking outta school here. I think everybody who's listening to this would go, yeah, I've seen it too. And, and there are exceptions. There are organizations that run really well and they're tightly knit together.

With their investment, and I would say a lot of those are the smaller ones. The smaller ones can't have those two arms. Have any light between them because yeah, they, they don't have a ton of money to invest in operations or a ton of money to invest on the investment side so that they have to be in alignment.

And so there's just a lot more conversation and direction that goes on there. I'm gonna come back to big tech firms in a minute. Let's talk about this traveling nurses story. So, mm-Hmm. , this was interesting. Uh, you chose it as well. After traveling, nurses quit. Hospital blames lack of EHR familiarity. Four out of six Intensive care unit nurses quit just one day after arriving at Providence St.

Joseph Hospital in Eureka, California this past week. The reason, according to the hospital officials quoted in the local outlet the time standard concerning a lack of familiarity with the hospital's electronic health record. The primary reason was that they were not familiar with our EMR system, A system that is used by many hospitals said the person on site.

Providence St. Joe's currently has Meditech as its EHR, and will be transitioning to Epic later this month. Explain the person who was quoted in this. They say education was quickly developed. The situation reflects a rapidly changing deployment of healthcare workers from all sources to respond to the Covid 19 pandemic.

I'm curious what, what jumped out at you at this article? Besides the fact that I was the CIO for this hospital, that. What jumped out at me was a few things. One, one, which is, you know, the very real complexity of the technology that you know, and it does a lot like, I'm not saying, you know, it should be as easy as, you know, consumer technology was that, you know, it's hard to just jump in and start using an interface that you've never seen before.

So that that was one. But the other was it really felt like they were kind of blaming the nurses a bit. It was a lot of blame. And actually the articles that I sent you, they all were like various points of people saying, this is hard and this is so and so's fault. And so it, you know, when you were reading about it, it's like no one helped the nurses.

There was just an assumption that they knew the CMR. So that's the one side of it. The other side of it is like this. That's like the epics. This is why you should use Epic everywhere. Everyone will know how to use it. This is why there should be no choice. So it's kind of an interesting thing because that is true about standardization.

But the other piece is it seems like a nurse should be more valuable than the emr. So couldn't they have found somebody to fill in the click the buttons so that the nurse could do the nursing? That was, it was multiple points of kind of like so many things going on in such a small article that seems so simple, from, from the outset.

That was what was interesting to me. Okay. So I mean, for starters, Eureka, California is as small as you think it is. Yeah. And that hospital is as small as you think it's. You know, so saying, okay, we're gonna have the equivalent of a scribe for these nurses that we're bringing in. And by the way, these nurses aren't gonna be there for a long time.

It's, it's covid surge production. So they're probably only gonna be there for 30 days. Right. So the, and I think what the nurses assumed is, you know, I know Epic. I can get around in Epic. I'm sure you know, whatever. They showed up and they saw Meditech and they were just like, oh my gosh, by the time I learned this, I'm gonna be outta here.

And this makes, yeah, this, this makes, makes no sense. Sure. But when you were reading it, it was like they just got thrown in. That was the part that I, I totally get them saying, oh, forget it. But it was also like, there was just like an assumption that they knew something that there's no good reason for them to have necessarily known.

It's like the situation of what do you want? Do you want a nurse or do you want a nurse who's also, well-versed in Meditech in the middle of nowhere. That's, that's sort of the, that's what I was sort of thinking. I'm, I'm, I'm going. This is, this is a hard thing. Plus. Alright, so read a couple more things into this.

One is they're getting ready to go to Epic in the next 30 days. So what normally would happen is you'd have your CNIO who's on top of this, who's essentially making sure that everybody's trained, that's getting dropped in. You have a surge that's going on across a lot of markets and they're now multiple EHR.

And so that CI o's a little overwhelmed and that team's a little overwhelmed. And oh, by the way, they're doing a major implementation, which I think is gonna, if I remember correctly, is a big bang across all the St. Joseph hospitals, which is essentially about $8 billion worth of revenue and covers three significant markets.

Yeah, they're gonna be doing so that, that CNIO is probably completely overwhelmed. Uh, and this is one of the problems we get when we say, Hey, we're gonna get to scale. And scale is great 'cause they're gonna get to a single EHR. But when you get so big, sometimes the problems are bigger than the or, or the, sometimes the smaller problems or the problems of a hospital of this size just gets overlooked.

Mm-Hmm. . But then what happened? They didn't have enough nurses. , that's, that's sort of a, then they didn't have enough nurses. Yeah. I, what, what about that whole concept of, I've been asked several times, why didn't you make the decision to go to Epic all those years ago at at Providence St. Joe's? And you know, I could be convinced either way at this point.

Or stay on Meditech, which essentially saved us a bajillion dollars. I mean, and when I say a bajillion dollars, I mean literally about $750 million. So, wow, not, not a small amount of money to stay on Meditech, and Meditech really ran the hospital pretty well, but now you fast forward to a pandemic where you're dropping people in who are likely familiar with Epic, and you're like, Hey, doesn't this seem apparent that we really should have gone to Epic way back when?

So I'm, I'm not taking a lot of blame here. I'm just saying. It's interesting. I believe that that case you made earlier where, you know, if everyone was on Epic, we wouldn't have this problem is probably one we're gonna hear. Let's see. All right. We're finally at, is healthcare too hard for big tech firms?

I'll let you comment on this however you want to. Okay, so what I, again. For me, the articles, there was a lot in the tone of the articles and it felt like there was a lot of gloating going on, of, it's too hard. And I thought, I'm sure you saw the editorial that, that Aaron Martin wrote where he was like, we should not be happy about this.

Like we need their, you know, horsepower and thinking and all of this stuff. But I found that the article was a bit of gloating of. See, it's really hard and we do things that are really hard, and I don't think anybody is saying that healthcare is not hard and that we expected all of these large tech companies just to solve it immediately.

But do we need large tech in healthcare? Yes. Now the question is how. So there's the, we're gonna actually deliver care. That's an interesting model. There's the, we're gonna partner and we're gonna lend our expertise and we're gonna try and help you make sense of all this data that you have. I think that's a great example.

I. Google's a funny one in that like, when Dr. Feinberg left and then suddenly everybody's scrambling to say, no, no, we're still here. We still have Health . There's all these people who have, you know, invested careers in it. And they're like, no, no, we're still here doing things and Karen Gustavo's gonna be presenting at, uh, at the health conference as well as three or four other Google people are, are, you know, so they're not getting, no, I suspect if you looked at, you know, the amount that these large tech companies are investing.

In healthcare still, you know, it's probably more than a lot of healthcare companies, , you know, so I get it. I get it, I get it. You know, you've been whoever, whoever has been slogging it out here in health OT for a long time without help with bad tools, with all of these things. And the big tech comes in and says, look, look, we're gonna save the day.

And then they don't. And there's some gloating, but like I, I kind of, I'm very much with Aaron Martin on this one, which is like, we need all of these things to work together. We need to figure out how Now is healthcare too complicated? Yes. That's the issue. The issue for big tech is like the complicated sale, the who are you selling to and where is the value proposition.

And that, you know, the pharma, like healthcare is not one industry. As we've said, it's like at least three and probably more like seven. When you look at, you know, every time you turn around there's some other layer of, you know, like that you learn about, like within an industry. You think pharma is the drug companies?

No, but it's actually the PBMs. So there's just. There's a lot there and anybody who's trying to tackle it all is gonna be in trouble. And then I think the, the, the issue isn't that the technology is that hard. It's that the business models are screwed up. Exactly. And there's no incentive. To share data. So like, data sharing's not hard if you actually wanna do it.

Yep. And so, so we, we've talked about this. I mean, so you, you come up with this great idea. You and I just came up with this great idea. We're gonna do this thing in telehealth. One of the first barriers we're gonna get to is, all right, how are we gonna integrate with Epic? All right, so we have a choice. We can sign their agreement.

Their agreement essentially says, Hey, you're signing away any intellectual property that you have, and you're, that's your, your first head scratcher. Like, why, why would I do that? I mean, yeah. We haven't even gotten the company off the ground. And then it's like, well, if you wanna access to all the people who are on Epic, this is what you're gonna do in order to get into App Orchard and to share this data.

And then you sit there and go, well, there has to be another way. And so you explore all the different ways that you can do it, including fire and, and other things. But you still have to get information back into that EHR that says, Hey, it's 15 minutes to whatever it is. Getting information out of the EHR is one level of complexity.

Getting it back in is like. Times five because we, we are really cautious about what we put back into that EHR. You know, we sit there and we go, okay, so we're down that path. Then you have the age old problem of what's your revenue stream? Where are you gonna make money? Right? Right. So, so you're either gonna sell to health systems and that's how you're gonna make money.

But one of the things we've learned is going directly to consumers, best of luck. 'cause they think insurance should pay for everything. And so now you step back and go all. How do we get any money outta consumers? And a lot of people end up throwing up their hands and going, all right, I'm just gonna go sell to health systems because, uh, or sell to the carriers, to the insurance carriers because, you know, they, they already have a revenue stream and we could just tap into that so that the business model is, is so complex and, you know, and I don't think, you know, we're talking about our small startup that you and I just started.

I'm not sure it's any easier for Google, apple, Microsoft, and others. It is having gone from a small company to a big company, the thing that is a lot easier is people will talk to you when you're at a big company, . Right. Even if you have nothing for them that meets their needs, they're willing to talk to you to see if you might Yeah.

The lack of risk now. So, but that's an interesting point, which is. The problem with the big company is they don't wanna get outta bed unless it, like, it's gonna be X size immediately. But going back to our little idea there, if somebody in one of those big companies, Google, for example, who have a large ads business, were to say, oh, hey, you know, they have YouTube, they have the video, they have an ads business, and they were to say, Hey, we're gonna plug this into the, I don't know what they have, whether they have a telemedicine thing, but.

That's where to plug it in. Actually, with that one, somebody should just take this idea and run. 'cause you could do a lot without actually plugging into Epic. All you have to do is be like the interstitial in front of the telemedicine visit and you don't have to know everything to begin with. You don't have to have it personalized.

Think about the waiting room one. They're not personalized. The only thing they know is you're sitting in an orthopedic surgeon's office. But the problem is big tech, they do come in with some attitude of this is we're gonna solve it. These people are dumb. Which, you know, I think is sort of the blowback that we're seeing in that article, right?

Of yeah. That they came in and said they were gonna solve it. So I think big tech chipping off at like things over time they could become much bigger. Problem is big tech doesn't wanna take chip off at a small thing. Right. It's a $4 trillion market. They are, and I say this to people all the time and, and this article even ends with this, you know, should one of the big tech firms buy a hospital system?

The answer to that is no. And we know that. We, and we know that they're not going to because it opens them up to a whole new level of regulatory oversight. Yeah. Into just, I mean, just about any other business. That's why go Google got out of their personal health record. That's why Microsoft got out of their personal health record.

'cause they're like, the government came in and said, Hey, if you're gonna store this data, we wanna see everything you're doing. And they're like, okay, we're out . It's like, well, and then, and then the other part is look at, you know, the. Litigious. If you think that the, whoever you're going to sue has money, you're more likely to do it.

And so any sort of malpractice, imagine the malpractice insurance they would have to have. Right. Well, and that's the thing that happened just this past week is that essentially the FDC said that the. Information blocking rule set up penalties for, it has penalties for health systems for not sharing data, but they're now essentially saying that the breach rules now cover third parties.

So the breach rules only covered healthcare providers and now it covers third parties. So, right. Think of it this way, apple. Now, if they have a major breach of health records, they could be open to those fines. Of, you know, I, I don't know what, whatever it is per record, and Apple probably has more records than, I don't know, than United Healthcare.

I thought about it. Those are big fines. Uh, you know, a again, I think each one, and, and Aaron Martin made this point in his post. It's why I covered it on the Today Show. I thought it was really well thought out. He said, Hey, each one of these still has a play in healthcare, and they're all looking at something.

If you look at Amazon, it's, it's, it's really that, uh, PBM space and the pharmacies is the area where they're making, uh, a lot of inroads as well as durable goods and that kind of stuff, and that's gonna be good in and of itself. We could talk about. Amazon Health all we want, but just that piece is gonna carve off a nice little segment for them.

Google still has their deals with Mayo. They still have their deals. Mm-Hmm. with, uh, Ascension and they signed a deal with Common Spirit, so they still have those deals. Underway. Microsoft, of course, has a deal with every health system in the country, right? And they will continue to do that. And then Apple, you know, apple backed out of a really small piece of what they were doing, and it was used in this article to say Apple might be backing out.

Apple continues to say that healthcare, they anticipate healthcare being one of their strongest plays, and I don't think we've seen anything from them other than. We are going to be the ones that figure out how to get data from the individual, from the human body into the ecosystem. Whoever wants to pick that up, right?

If it's health system's, great. If it's, uh, third party's great. We are gonna be the advocate for the patient who wants to be monitored, I think is what we're hearing. Yep. Wow. So I rambled enough to, to close it out, didn't I? You did . That was a lot of stuff we covered today and it is always great to talk to you.

I think this back and forth is gonna continue with big tech and healthcare. The, the health conference is coming up. I think we'll learn a lot more from that because we'll have a lot of interesting players present where they're going. So again, thank you for your time. Really appreciate it. Thank you. What a great discussion.

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