Mega-Mergers are the talk of the town we explore the implications to health. Also, are we negotiating with terrorists when we pay ransomware? May want to set a policy before it happens to your health system. Finally, beyond the buzzword of Digital Transformation.
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Bill Russell: 00:09 Welcome to this weekend, help it where we discussed the news, information and merchant thought with leaders from across the healthcare industry. This podcast is brought to you by health lyrics. This is episode number two. My name is Bill Russell, recovering to healthcare cio, writer and consultant with the previously mentioned health lyrics. Today I’m joined by our part time cohost and full time CEO at mercy children’s in Kansas City, digital transformation evangelist and one of the most prolific social media presence in healthcare today. David Chow. Good morning, David, and welcome to the show.
David Chou: 00:44 Thanks, Bill. How’s, how’s everyone doing? Thanks for having me. I’m excited to join this, uh, on a regular basis. I’m really looking forward to some great discussions and most important for me to learn from you as well, Bill and some of your incredible insights just so I can start transforming my own organization. So extremely thrilled to be here and thanks for having me.
Bill Russell: 01:04 Yeah, that’s, that’s, that’s my kind of view. But, uh, you know, clearly I’m a recovering cio and you’re an acting cio. So I’m looking forward to our conversations from a lot of different perspectives. One of the things I’ve found about being a former cio is I can pretty much say what I want now without going through marketing or compliance or legal and uh, and you guys have to be a little bit more guarded about the things you say. So we’ll get a little bit of both perspectives here and it’ll be kind of fun. Um, before we get to the. Before we get to the program, why don’t you give us a little idea of, uh, maybe some of the things you’re working on these days and some of the stuff you’re excited about.
David Chou: 01:41 Yeah, so I would say yes, every cio in the healthcare industry was their biggest, biggest focus right now. It’s really, it’s a tough one to grasp because every organization is going through ways to be more efficient from a financial aspect. So I think, yes, every cio where they’re focusing on, they’re focusing on innovation while figuring out how to costco at the same time. So on a macro level, that is what I am trying to figure out. How do I keep the organization moving ahead and provide new solutions or even create new business models, but at the same time, how do we skin down some of the fat or other things I may not be as needed but it’s required. So macro level, that’s what I’m focusing on. But for me and for me organizational, just strategy, department strategy level, there’s a few things I want to focus on in terms of having some huge partnerships.
David Chou: 02:33 I’m lying that’s just so allows us to move faster. So one example is we’re gonna have a big announcement with our emr vendor, cerner where we’re going to be owning the entire center catalog of products and that’s a very different mindsets in terms of our organization that historically is to use the products. Now we’re moving towards a center prefer solution. While that may not be the best modular solution for every single department or every single hole, um, problem that we’re going to solve, it allows us to have that coherent, integrated platform while at the same time move a lot quicker. You know, thinking, just thinking through organization that have procurement challenges or having to go through contractual agreements and all those things do take time. So for us by having this strategic alignment allows us to move faster and allows us to gain tremendous support from a partner like cerner who was also located within the Kansas City market, just like we are.
Bill Russell: 03:33 Wow. We’ll have to get cerner as a sponsor. I guess if we’re going to say sir this many times I have seen, I have seen a lot of health systems do exactly what you’re talking about. Not a lot, but I’ve seen a couple of really do it effectively. I know that uh, Memorial Herman, uh, does a good job really focusing in on a single emr provider as does adventist and they’re able to really gain some efficiencies and really drive down some costs. Um, yeah, I’ll, I’ll be curious. Maybe we’ll, uh, we’ll, we’ll definitely hit that topic again, but nothing while you’re not doing anything with blockchain yet or anything Iot or you just, just exploring those things. Right now
David Chou: 04:16 we’re still exploring. The challenge is things like blockchain Iot is you really have to find a platform so we can look into ibm, accenture, and Microsoft, all of them are developing platform, but the problem I see that’s facing a lot of healthcare it apartment is while we were trying to maintain and keep you moving with our wiring to healthcare applications work, our bread and butter is not doing new software development or that’s where I really rely on partners to help us transform. We do having either that’s playing with it but more on a mental scale versus enterprise scale, so we are like in Iot, we’re exploring things with Amazon Alexa, Google home and things of that nature. I do see a lot of potential there. I’m thinking about just for voice assistance, I do see the potential to actually replace the nurse call system. Right. That’s the things that we’re doing with Alexa.
David Chou: 05:11 Siri, Google home. I mean, but that’s almost similar to what could be done in a patient room in terms of providing feedback or providing some sort of action that needs to have from a clinical staff. Yes. We get into all the security requirements or even privacy requirements, but just thinking about the overall ease of use for patients who are bedridden, how easy, how nice would it be for them just to be able to speak to Alexa to get some sort of service. Um, so we are dabbling those, but I’m not ready to say that there were going to be enterprise ready. We’re going to have something proven in the next year or so, so we’re still dabbling and just keeping, just keeping them engaged with what’s going on in the industry and hopefully generate some new exciting idea that they could try and bring back to the organization.
Bill Russell: 05:59 Well, that’ll be fun to keep an eye on it. I think we’ll see some of that at himss this year as well. So before we get started on the, uh, on the segments that, you know, a couple of housekeeping items for us. So we did our first podcast last week and we got some feedback, uh, in the spirit of being, I guess customer centric. We’re going to be responsive to our audience. The first change that we’re going to do is we are going to break this down into three sections, the three segments I guess, to make it easier to follow. The first is just going to be in the news where a, the cohost and myself will each select a story, a relevant story from the last couple of weeks, and we’ll just go back and forth and discuss those stories. Uh, the second segment is going to be, um, sort of an either or.
Bill Russell: 06:42 We’re either going to talk about leadership or we’re going to talk about emerging technology. It’ll depend on, you know, who’s here, um, you know, with, with David this week, we’re going to talk about a digital transformation I think is going to be a fun topic. But, uh, I, you know, I hope to talk about voice and um, know voices assisted in some of those other things in the future. I think it’ll be fun. And then the final segment is more of a, you know, in the spirit of Donald Trump’s, a newsy award that he did were, were we’re actually going to do social media awards on a weekly basis where each of the host picks their favorite posts for the week. It just highlights it and shares it with everybody, you know, just why they, why they believe it’s worthy of, of our award for the week. So we’ll close out, sort of on a fun note doing that.
Bill Russell: 07:28 A couple of other things. We’re now on apple itunes. We’re on Google play. Uh, you can, uh, you can subscribe there. You can also subscribe at a this week in, hit that buzzsprout.com. And you can find us on our sponsor site at health lyrics that come as well. Uh, we’ll be posting a new episode every Friday by noon Pacific time, uh, so please be sure to subscribe so you don’t miss any episodes. We do have a lot of great coast lined up, uh, as David mentioned earlier, every, uh, every four weeks we’re gonna have David back here to have a conversation and look forward to that. A sushi shade will be here in a couple of weeks at marks, will be here in a couple months. Uh, Charles boicey a data science genius I’m excited to introduce everyone to, uh, has agreed to be on as well. And my good friend David Baker, who is a cio in a dental system now, a billion dollar dental practice, um, will be here next week. I bet you didn’t know there were a billion dollar dental practices, but there actually are. So, um, uh, we are actually so new at this point. We don’t even have a website yet, but, uh, that’s coming in. That’s probably enough housekeeping for now. So let’s go ahead and, uh, get started. Let’s start with your story and give us a little background in and kick off the discussion for us.
David Chou: 08:51 No, last year you’re seeing a trend in the healthcare space of, I’ll call them mega mergers. You’re seeing lots of organization is trying to gain scale and even three years ago, one of the questions that always ask myself is what does that scale or how big does it have to be in order to stay relevant? If it’s a 3 billion, 4 billion, 10 billion, 25 billion, I think that’s still to be determined by your side. I see a lot of these mega mergers these days. Um, I mean like, you know, deals that we’re now just between advocate and a roar in the Chicago area. That was in December. I mean we had the ascension health sort of announcements. So, and these are not, these are not the typical deal is that you would ever expect five years ago. I mean even for you bill, you probably would not have expected this when you were working as a cio because I mean these fields are probably outrageous in terms of my room and it’s because we’re.
David Chou: 09:48 People are trying to play in the value space game and in order to do that effectively, you got to have scale. You got to have a large amount of population to be able to go at risk and negotiate with the insurance carrier, but at the same time you’re also seeing a lot of nontraditional mergers and acquisition, you know, cvs health getting into the retail clinic, um, with what the insurance carrier. So I would say that this, this article that was put out there really, um, made me think twice. I’ve heard about this a few times just to get gas scale. It means better access for the patient. Hopefully it creates a sort of a, a healthcare locations to where patient can get consistent care versus having disparate health care providers. But at the same time you, you have to start thinking that really saved money for the health care ecosystem or you as a patient or does it just create more of a monopoly. So this was a very interesting article that was posted by the USA Today. Whereas the headline and the title of it was, healthcare deals can make you healthier but may not have saved you money. And as everyone is aware, the health, the healthcare GDP in the US is the highest in the world. So do these deals actually saved dollars or is it really just going to make us healthier? Hopefully this stays true to make us healthier. But what? That’s item in case where it doesn’t make you healthy or save money, what does that stand?
Bill Russell: 11:23 Yeah. So healthcare deals could make make you healthier, but may not save you money. It’s a USA Today. We’re going to go back and forth in a minute. I’m going to go through each one of these premises that they do and we’re just going to give a yes or no if you think these are going to help or not. But um, you know, at JP Morgan, they’re, they’re sort of throwing out this number. The number to really be at scale as a traditional health system is about $3,000,000,000 in revenue. I don’t know where they come up with that number. I don’t. But I’ve heard it now a couple times a previous conference in this conference as well. So, um, I think these, it’s interesting because these murders fall into two categories. You have the scale place, like you talked about the Chi, dignity, the Aurora advocate, and um, you know, even the rumored providence ascension, which I don’t put much credence in.
Bill Russell: 12:15 Not, not that I don’t think there’s talks happening, I’m sure actually that there’s talks happening, but there’s no burning platform there, uh, that, that really would cause this one, uh, to take place, uh, because compromise is important and when you have one of the system’s struggling or needing to get to scale in order to compete in their market, that’s where you have that compromise and neither of those systems have that. And that’s a critical element in any merger. So we’ll keep an eye on that one, but those are scale place. Those are, you know, we’re trying to get bigger. We’re trying to get a national footprint. We’re trying to leverage economies of scale with suppliers are trying to leverage scale, uh, with, uh, with ehrs. Um, you know, these murders are typically playing the same game with more assets and more negotiating power. But the two others that I think are really a little bit more interesting, or Davita and united healthcare and cvs, Aetna and I would call those retail place.
Bill Russell: 13:14 These murders are very different. They’re potentially game changers. Um, you know, it does remain to be seen what may happen here, but I could see these players really disintermediating the traditional players and becoming a one stop shop for where they go for the first point of care, a comeback there for their materials and things they need for chronic disease, uh, and ongoing care. Um, but, you know, it’s interesting, I looked these scale place in retail place and I’m sort of reminded of the old book wars and I hate to, I know it’s kind of Cliche, but if you think of it this way of borders, Walden books in Barnes and noble had merged. That would be a scale play, but you know, that probably would not have made any difference in the world to Amazon because Amazon was playing a completely different game altogether. Um, so anyway, that’s, that’s sort of how I’m looking at these murders, but go through this article. Uh, I’d like to go through the list real quick and get your thoughts, you know, with, with these murders, do you believe, uh, let’s see, there’s a couple headlines here. Uh, do you think people are going to be able to get healthier? Are these actually going to improve the health of people in our communities? Just a quick yes. No, maybe
David Chou: 14:31 yes, for healthier because it will probably generate more awareness, especially from the Dao who are trying to keep patients out of hospitals.
Bill Russell: 14:39 I, I agree. I think it is going to lead to healthier patients. I’m just more access to care I think is always a good thing. Uh, your care could come under one roof. What do you, what do you think about that?
David Chou: 14:52 For the chronic stuff? Yes, but obviously when you need surgery or specialties, you still have to go to the hospital.
Bill Russell: 14:57 Yeah, I think is a great thing for people who are struggling with diabetes or other, um, you know, ongoing, uh, types of challenges, you know, I think the ability to, to just have a single shop, that’s going to be a good thing. It says you might save money or not. I guess the answer to that is yes, you might save money or not. Do you think you think this will lead to lower costs in healthcare or do you think it’ll increase the cost of healthcare?
David Chou: 15:24 I said the way I look at is we’re all moving to a higher deductible. So you’re not using the services you could potentially save dollars out of your pocket or because some of the healthcare system throughout the world and that may have a single payer know some something’s painful, whether it’s tax dollars. So, um, yes, you will say dollars. They’d be using the services. I think you’re still be come out at the end with. It’d be a wash,
Bill Russell: 15:48 I think maybe from any of these murders per se, but I just know as we have discussed offline before, um, I think we will start to see so many new entrants into this space. You have the, you know, the Amazon and others who have rumored, uh, uh, you know, movements going on in this space and I think that’s going to lead to, you know, different models and, and drive some costs out of the system. Um, and let’s just pick one more than some of the others were the insurer may still be able to gain the system. That’s probably true. You may not have as much choice and, uh, you may not know who’s profiting. Um, I’m not sure if anyone understands the finances of healthcare. I don’t know about you, but there was a, uh, I was new to healthcare about nine years ago, our eight, eight and a half years ago.
Bill Russell: 16:40 And, and, uh, one of the first things I tried to figure out what is the money? So I sat down with one of the smartest, uh, two of the smartest people I know in healthcare who, uh, really understood the flow of funds throughout the health system. And, uh, after I would say about eight hours of education on how money flows through the system, uh, I can honestly say that the average American has no idea who’s profiting from healthcare with any given thing. I mean, it’s just, it’s so complex how money moves around today. I wish, I wish there was more transparency and I think once we get more transparency, you’ll see some, uh, some interesting things there. Um, alright, let’s kick the back story real quick. So Hancock health pays 55,000 to release hospital files following a ransomware attack. This is a, a while. It’s covered in a lot of places, but fiercehealthcare a.com is where we pulled this story from.
Bill Russell: 17:34 Let me just read a couple of things real quick. Uh, Hancock health paid $55,000 ransom to hackers to release more than 1400 files and regained control of the clinical it systems at their regional hospital. The, the decision to make the payment made the most sense from a business perspective. Hancock health CEO Steve Long told the Greenfield daily reporter, so you get an idea. This is, you know, this isn’t a major city, I would imagine, although the files impacted by the breach, we’re backed up and could have been recovered. It would have taken days or weeks to restore them. These folks have an interesting business model. He goes on to say, uh, they make it just easy enough to pay the ransom. They price it, right? So these guys are good businessman. This is interesting to me. It appears that health systems do in fact negotiate with terrorists.
Bill Russell: 18:21 Um, but that’s actually my commentary. I the, the um, you know, it’s, it’s interesting. I mean, when you look at this, are we, are we negotiating with terrorists? Are we just being pragmatic? I mean that the EHR was down it, it was only $55,000 to, you know, essentially restore the system in or they were looking at, you know, maybe a week or week and a half during a, you know, maybe a cold and flu season or maybe a snow storm was coming in. Um, I mean, does this set a dangerous precedent or is it just pragmatic on their parts? What do you, what do you think
David Chou: 18:58 I would love to be a recovering cio because we did just talk about it and not have to deal with it. It’s a tough one, right? If you really pay, because you just had a question. I mean we have a Hollywood Presbyterian in southern California where you are probably set that precedent by paying for last year and so now you have these hackers who are, and this is why they target smaller communities that probably do not have the maturity from a security aspect, but compared to other bigger city that may have a better material, but we’re still far away, but it’s getting smaller players and then they’re charging them a visit that’s like, yeah, that was a ceo. I probably would pay $55,000. It’s peanuts compared to the potential downtime of just one day. Uh, even having that revenue impact. So business aspect, yes, I think it’s the right thing to pay.
David Chou: 19:54 But from an organizational perspective, you’re saying, sorry, I set that precedence where people are going to get more and more exposed and especially things like ransomware, it, those things are just going to continue even more in 2018, 2017. I don’t know though. I don’t know what the right players in terms of whether they should pay enough, but depends on the of roles and responsibility. I was sad to see a level, definitely pay it. It’s guaranteeing that the system can get back up within a few hours. Um, but as the cio or the leader of technology and security, what do you do? I mean, most organizations do not even have a policy on this. So I think these are important discussions to have and have frank discussions in terms of what compliance and just the entire organization as far as risk tolerance and maybe people should think about, should I even have a ransomware payment policies? How do they determine whether or not. Because that can be a discussion itself. And, um, these are things that organizations are starting to have to think about what the increase exposure in cyber attacks,
Bill Russell: 20:57 payment policy. That is a, that’s an excellent idea. You definitely want to have that in place before you get the note that says, Hey, you’re a, you’re stuck. My, just to close this out, my only concern on this one is $55,000. Sounds like one year’s tuition for college student and you could potentially be emboldening. Uh, some people who know that they can take some bit coin payment. I’m not, have it be not traceable and start to get into the, uh, get into the space. That’s my only concern with that. I don’t, I don’t fault the CEO for Hancock Health at all. Um, I, I think a case could be made for paying it. I think a case could be paid for not paying it. But I’m again, very difficult discussions and I agree with you. There’s part of me that is glad I’m a former healthcare cio and not occurrent insecurity.
Bill Russell: 21:49 Security is the number one reason a very difficult landscape today, especially with the way we’re not even talking about the meltdown or specter thing that’s going on right now, which I’m sure every cio is keeping a close eye on. Uh, all right, let’s kick off the next segment. We’re going to talk about emerging tech and, um, you, you posted something on social media last week, which I thought was good. It just gives us a baseline for what is digital transformation. Uh, it, you posted it with very pretty clouds in the background by the way, the constant realignment of technology, business models and company culture to more effectively do business in the digital age is how you defined it. What, what is, you know, what does digital transformation it has to do with healthcare and how do you see it sort of, um, how do you see it playing out? What does it look like?
David Chou: 22:44 It’s really creating a new business model utilizing technology. So how are you creating a new business model as, as a healthcare entity, utilizing some core basic tech technology tools such as social, mobile, cloud, and big data. That’s what, that’s how I really liked to defy this digital transformation, overused buzzwords, but consumerism is huge in healthcare. We all want to move towards a retail experience that’s created a new business model and how do you do that? Um, so now we’re starting to do a live some of these tools and to create that digital experience in a retail market in healthcare. So we started transforming really generating new business models, um, with some of these tools that that’s how I would like to define digital transformation. They can also be something, you just have to be external facing, right? Something as simple as revamping experienced help desk internally to your employees where you want to have self more self service so that people can log into their own ticket and reset their. Something as simple as that. You’re creating a new business model internally within your organization as far as an it department. So really started thinking about how you could change. I’m status quo. You’re licensed technology is a good way to revamp and think about this digital transformation buzzword.
Bill Russell: 24:06 As a consultant. I’m helping a couple of health systems with digital transformation. And I think that the two things I would highlight here is, it’s not a, it can be run by it, but it’s more of a triumvirate of it marketing in operations. And if I had to say to healthcare to healthcare organizations, what’s the most important aspect of this? I would say it’s really redefining operations. And the example I typically give is a, you know, when we went to do a new patient portal, and I hate that term, but it’s what we use in healthcare. Uh, we went to the new patient portal with a online forms. What we found is we had 100 different forms that we had to consolidate within the health system before we can even take it online. Um, and that was a significant lift from an operational standpoint. So there’s, it really is different business models, different ways of doing business.
Bill Russell: 25:05 And then the other thing I always, we always talk about is, um, you know, there’s, there’s an internal focus for digital transformation. And then there’s an external focus. The intro in both have at their core, understanding the consumer, your internal focus or understanding of the consumer is, you know, the physicians and the clinicians and the nurses and everybody who works within your system really understanding what their needs are, how they’re using technology, and then coming up with new ways like you, you mentioned, uh, uh, you know, voice assist, a Google home and um, uh, gosh, I want to call it Alexa all the time. Hey, echo and, and, uh, in Syria and in these other things that, that could be a digital my phone. I said Siri in my phone just went anyway. Um, the uh, you know, those can be digital transformation initiatives internally, but then externally, this is where we find that health systems need to develop a new muscle. They, they have had patient forums to listen to their patients, but they have to take it to a new level to really understand the complete workflow and how it impacts the patient and how the patient experiences that. Um, it’s really interesting. How do you think, uh, I’m curious from your perspective, how do you. So you’re, how many years now at uh, at mercy children’s, you’re about two years into it or more than that?
David Chou: 26:32 Almost two years. No less than two years.
Bill Russell: 26:36 Alright. So when you go into a new system and you want to get them sort of focused on digital transformation, thinking about new models, how does a healthcare system get started? Where did, where did, where did they kick, kick that off.
David Chou: 26:49 You have to really understand how you deal with navigating and then you’ve got to understand whether the culture is even tolerance for something this has changed. So are they able to tolerate change and new ideas? That’s usually where I start a lot of his education, even within just the technology departments, getting them to think differently to, to, to, to think cloud first. That’s a whole, that’s a challenge for a lot of organizations and itself. So just a lot of the education as far as the why. Um, but most importantly that this has any, as a digital leader or any leader, you need to figure out how to influence the organization to think this way. You can’t do that. You won’t be able to, you won’t be successful. So I am coffee out there selling new business model ideas or can educating people on what this really means.
David Chou: 27:44 And then it took about a year to start getting people to understand, okay, this is what I’m seeing throughout other industry. This is what I feel as a everyday consumer in other sectors. Now I want to apply that. I do want to apply that healthcare. Now they come to me and says, okay, I think I get it now. How now is, how do I do it? What do you think? Where should we start? But it really took a good six to eight months for me joining a new organization to understand the landscape, building the relationship and educating every leader to be thinking digitally. Um, and I mean, the biggest question I believe you probably see a lot of time is who should lead this, right? Is this a CEO’s initiatives? Should this be a marketing initiatives? To this be a cio is initiative and really it’s hard to determine who should lead it, but I would say anyone who’s trying to lead it has to be able to influence. I don’t want to mention, regardless of what their title says.
Bill Russell: 28:35 That’s an excellent point and a great observation. I think the role of the CIO is really as a educator and making, helping the organization get ready for this kind of change, but to the extent that the CIO can partner again with marketing and the coo and really get on the same page, I think that becomes exciting. And then, uh, I, I now have the mindset that, uh, you know, digital transformation is the CEO’s initiative because essentially what you’re saying is we’re going to create new business models and I’m not sure you can say that that’s the job of vp or vp. I think that’s the job of the CEO is to look at their organization now in light of digital changes that are hitting them from all sides. So, uh, well thanks for that discussion. I, you know, next time around we’ll maybe do voice assist or blockchain.
Bill Russell: 29:29 I’m looking forward to more of these conversations with you. I’m all right. Just to close it out. Favorite social media posts for the week. I’ll do mine first. You could hit twitter right now and see if you can find one. Um, the, you know, that I’m going to just share this. It really has nothing to do with healthcare, but it just, it really just made me laugh. Uh, the, uh, the tweet following the crazy finish to the saints vikings game. If you didn’t see it, um, you know, it is one of those games that will be replayed over and over again. It was one on the last play of the game. Uh, you know, the Vikings quarterback, you know, through a past that for all intents and purposes should have just ended the game and somehow the guy missed a tackle and the vikings player ended up running into the end zone.
Bill Russell: 30:14 And the saints lost the game that quite, if they had run that, that play a thousand more times, I believe that they wouldn’t score on one of them, but it just, in this case, on that Sunday, uh, they did score. And uh, so the tweet obviously from a, you know, probably a newspaper somewhere around if by the name somewhere around New Orleans, the Times Picayune a headline read and this is a real newspaper, real front page, there’s a picture of the, uh, of the Viking player running into the end zone and the New Orleans player watching from a distance and the headline reads, expletive, expletive, expletive, and I’m not self editing. Those are the actual words on the headline expletive, expletive, expletive, and uh, that is definitely not fake news that is really telling it like it is from, uh, New Orleans fan perspective. So I just wanted to share that. I, I really got a kick out of that. Um, uh, any. So what do you, what do you have that you want to highlight?
David Chou: 31:17 Just because it always makes me to my Hashtag B, h o u, one, one zero seven. I just retweeted something about do you really want to change? So every time you walk into the department, do you want to change? I don’t want raises their hand. And then when we talk about who wants to change really changed, sort of the people started looking down, the hand starts going down. And then the third question, who wants to lead change? You sort of become an empty. No one wants to lead the change. So this picture always makes me laugh when I think about innovation that talk about wanting to lead the change. They want to change how they behave, they want to be market leader, they want to disrupt industry. But when they started getting rallying the troops together to go through this change, the amount of people that volunteer or as excited just starts dwindling. So I would get a good chuckle every time I see this graphic and a criterion out there about change management and organization of enterprise scale.
Bill Russell: 32:13 Yeah, that’s a good idea. We should retweet these after the episodes that people can see them. Um, so I will go out there, find that tweet and retweet it. David, thank you for being on this show. Um, that’s, uh, that’s all for this week. Be sure to subscribe on itunes or Google play a read the summary post a summary on health at [inaudible] dot com website. You could follow David on twitter, uh, De Chao Eleven. Oh, seven. You can follow me on twitter or the patient’s Cio, uh, obviously connect with us on Linkedin as well. And of course follow the show on twitter this week in hit. If you have any feedback, please send it along to a this week in health it. And she mailed that come and
Speaker 3: 32:57 it’s all for this week. Thanks for joining us.