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[00:00:00] Today on Keynote

(Intro)

We're all going to have to mature to have a comfort in a gray zone, understanding your best ETA, Bill, if you're running our hyperscaler. I think we'll be up in two hours, and at three hours, I'm not saying, Bill what the heck. You're saying, I gave you my best estimate, now it's not that,

My name is Bill Russell. I'm a former CIO for a 16 hospital system and creator of This Week Health, where we are dedicated to transforming healthcare one connection at a time. Our keynote show is designed to share conference level value with you every week.

Now, let's jump right into the episode.

(Main) Alright, it is Keynote and today we are joined by Dr. Andrew Rosenberg, CIO for Michigan Medicine. Andrew, it is always a pleasure to have you on the show. Yeah, you too, Bill. Thanks. looking at your study. By the way, it is the perfect study. It should be like, if we were going to rebuild the game Clue, that's what the study would look like.

Tons of books, great furniture. [00:01:00] Love it. Are you still teaching? Is that still one of the things you're doing?

Yeah. Yeah. I in fact just two weeks ago, I gave a very big lecture to School of Public Health, Clinical Informatics. I was asked to give an AI lecture on AI and health to undergrads at the University of Michigan.

I thought that's a pretty broad topic. So I had to divide the topic and do, let's just define health. and healthcare, defined AI, and then I very quickly got into just example after example with lots of pictures, and it was great. It was an hour and a half lecture, and the questions were really great, as you would expect from undergrads, but I still teach, I I stopped practicing critical care about a year and a half ago, and I miss that personally, deeply, but I still will go up in the ICU and Do a sort of senior guest rounds and I'm also part of our critical care journal club.

So I stay very involved in that.

it's impossible to do it all. Isn't it? Yeah. all the physicians who I know that are [00:02:00] CIOs. They have this dilemma, and a lot of them choose to continue to practice because they love it. That's why they got into the field.

But at some point, they just look at it and go man, there's just so many demands for your time. It's sometimes hard to keep that up. Yeah, the best who

I Think. Two people I know perhaps better than some of the other physician CIOs is Jeff Farenti at Duke and Mike Pfeffer at Stanford.

They both are still practicing. Jeff, in particular, is a neonatologist. And what they'll say, and it makes a lot of sense, they say they have great teams, they have incredible trust, so the reality is they can delegate day to day work and it works. And For me, I needed to do five to six weeks of critical care to be competent in our advanced cardiac surgical ICU.

And I just couldn't find five or six weeks in addition to everything else I wanted to do. So I had to make that separation, but they seem to do it well. Maybe they're just, incredibly better doctors and CIOs than I am.

Those are two incredible incredible [00:03:00] leaders. a lot of stuff going on in Michigan new buildings, new consolidation of systems and whatnot.

Give us an idea of the journey. think anytime you're putting a building in, that's top of mind. But anytime you're doing a consolidation, that's top of mind. I'm not sure what's top of mind. What do you focus on? What does it look like bringing health systems together and building a new building?

Yeah, I think what's going on at Michigan is not uncommon at the large health systems right now. We're seeing probably about a 10 year trend, and I think we're starting to see the near end of this massive wave of consolidations across U. S. healthcare. And we at Michigan Medicine are certainly part of that.

We have two excellent parts of our regional health system, U of M Health West, U of M Health Sparrow. We have deep partnerships and affiliations across the state. And you can see it, whether it's what happened with Beaumont and Corwell or Henry Ford is in our own area. [00:04:00] You can see it with, Advocate, Aurora, Atrium there are just so many of these examples.

I would say, for me at least, and I think the other CIOs share this, there have been some new ways of thinking at scale that we previously didn't have to. And if I had to put it on a simplified timeline, I would say, The contemporary healthcare, CIO, has been mostly defined by the EHR implementations from the 2000 and tens to the 2018, so roughly a decade.

We had COVID and we had the disruptions of COVID, but. What overlaps that now is the consolidations. For example, you're seeing a lot of new EPIC implementations as either consolidated health systems are trying to rationalize their EHR, and from my knowledge, they mostly, if not exclusively, are rationalizing to EPIC, maybe some are to Oracle, but I don't know that [00:05:00] many.

Or,

systems within systems are rationalizing and integrating or consolidating along strategic applications and platforms and infrastructure. That's been the work that is shaping up what the current CIOs have been doing. And we are deeply in that work right now.

interviewed your peer over at Corwell.

So Jason Joseph was on. I And we spent a lot of time on this topic because he was right in the center of bringing those two institutions together. And it was interesting. It was very intentional. It was to say from the get go, it's intentional to say we are a new company. We're not going to take the old names of either of the two companies.

We're going to become a new company. And that permeated their thought process. We're going to get to a single instance of the EHR. We're going to get to a single ERP. But one of the things he said to me was, man, it took a lot of time. It took longer than I think anyone anticipated to consolidate all those things.

It took multiple years to get through all [00:06:00] that. And now we're thinking differently about what we could potentially do, but you have to go through that, arduous cycle of getting all those things consolidated, which is a lot of conversations and a lot of decisions on what to do and other things.

It's a really good example, and I'm trying to think of examples that other people would want to hear about or know about so that we can learn from each other. Jason and I are actually quite close. Here's the irony, I'm speaking fairly unfiltered, so there's a little bit of vulnerability here, if you will.

is perhaps one of our most, what you would call biggest competitors in the healthcare market in the state of Michigan. I think we're doing our consolidations almost as diametrically opposed as one can find, and I talk to Jason a lot, and I don't mean that in a snarky way. I think that there's no one right way, but I tend to use Jason's teachings to me, the examples of Corwell to try to help inform what we're doing.

Yet [00:07:00] Michigan Medicine as a massive academic, as the premier public institution tied to the large public university and a role in the state that's different, even though we're both non profits, we have different roles. Our approach is much more of the consensus and relationship and integration and trying to find the balance where what does the community, the previous group, the local practices need so that they are as self actualized as possible and are part of this wonderful regional and network that we're trying to achieve that's not only healthcare, but there's also some degree of our linkage to academics and in our approach and our philosophy and our cultures.

are extremely different in showing up in how we do this consolidation. So the irony is, I keep pointing to our own, colleagues in leadership, this is what Corwell [00:08:00] did these are what their rough expenses were, this is how quickly they did it, and I use those as examples to try to help us move forward, yet we're not going to do it the way Corwell did because of the way we work with our community.

So it would be a wonderful business case report, 5 or 10 years down the road, to take a look at two premier health systems in the same state, look at what they did, and then look at the outcomes that were achieved, the ROI, the total cost of ownership, the work efficiency, whatever metrics one might choose, it would be a wonderful business case study that the U of M Ross Business School should do.

Yeah, it's, it really is fascinating. I remember when Epic came in to St. Joe's and had a conversation with us and essentially told us we weren't ready. Really, it was a, our culture wasn't ready to make the transition. And I appreciated them laying it out. Like you're not willing to make these decisions or move forward.

And it's just culture, but [00:09:00] understanding our culture informed how we moved forward. And did the right thing for us. I'd love to explore with you the CIO role, right? Yeah. We've had digital explode. We've had AI explode. I've seen, I think we have a chief AI officer over at Cleveland Clinic. Now we've seen AI officers pop up and whatnot.

How are you? How are you viewing the of the CIO today, how are you seeing that integration of AI, digital, and whatnot, or , are these different disciplines now?

When you've been sitting in a seat long enough, you start to have different opinions about the exact same question.

I remember vividly 10 years ago, scoffing at the idea of digital. I thought it was a platitude or as a marketing, or it was meant to be sound really cool, but it didn't land well when we were all just struggling to get.

basic enterprise, I would call them systems of record, implemented, right? There was nothing transformative. There was nothing [00:10:00] innovative. We were innovating, but in a way we were still doing it around our run portfolio as opposed to grow or transform and around our systems of record, as opposed to differentiation or innovation.

Now, I think the word digital is exactly the right word. I think it encompasses a series of both. pragmatic, practical, concrete, and nuanced issues that we deal with. And you mentioned a few. I think the modern leader of technology for a large health system should be a chief digital Because technology, and especially IT within technology, is only a component of where the business needs to change the way it works, and how to shift the way it works.

And the person leading that needs to understand how people type, Versus speak or where they can start to speak instead of type to relieve burden and improve efficiency. But it means they [00:11:00] understand what a nursing flow sheet is and what a doctor's note looks like in the OR versus a clinic. And they understand why digital pathology is different than a CT.

They have to understand the business. They have to understand prior auth and where. Payers are going with the speed they're using ML and AI, and where the work has to change, it's not about removing jobs, it's about shifting work. AI fits into that, but AI, I think many of us would agree, is a layer that cuts across all of it.

It's not this individual, unique thing, and if anyone tries to unitize it and make it its own division, it will fail in the same way that I would argue today. If anyone tries to hold on to IT, how many times have we all come across someone who just bought a SaaS with their credit card and are working with it?

We have about 12 scheduling systems right now, at least four of them. Two of them I've only learned about in the last three [00:12:00] months are classic, SAS that several small units bought because they were not included in the large enterprise scheduling that we do with one Stafford agenda. So digital is, I think, the right term and the challenge for us in the role.

Some are in organizations that accept it right away. Some of us are trying to articulate it, what it should be. But I do think the Chief Digital Officer is the right role going forward where technology is enabling things. And one might argue, ironically, that we go back to having a CTO run the IT portfolio of IT services and products and infrastructure, especially now with more and more cloud work that I hope we can talk about.

And the Chief Digital Officer It's helping to coordinate and orchestrate all of the new business things, AI being one of them burden reduction and efficiency being another, communications and how people will [00:13:00] work in the next five and ten years, and where opportunities are for things like precision health and new data types like sensor and genomics.

That's what the CDO should be doing.

We had this conversation a little while ago when Ascension hired. their CDO and the CIO reported into the CDO. And it's interesting because I think that the CDO was more of a chief strategy officer, more of a chief business strategy officer is how it was described to me.

And that's almost what you're describing here. It's somebody who really has a deep understanding of the technology, but that's not their focus. Their focus is on the operation, on enhancing. The use of the technology and utilizing technology to enhance the outcome of the organization, either quality metrics, financial metrics, efficiency metrics, whatever they happen to be.

Yeah, Bill, we've been part of these conversations. I've been part of these conversations ever since I became a CMIO and especially a CIO. And you can tell when you're in one of those [00:14:00] conversations when you hear things like this. I remember years and years ago, remember CIO magazine, literally the magazine, right?

Or what was it, healthcare, IT news the paper. Okay. And you would see these titles sometimes even on the cover, how to be a strategic CIO. Right there. You hear this conversation. I remember years ago, I hope Janet Guptil sees this. We were at Scottsdale Institute. I was A new CIO, I think, yeah.

And there was a really good panel of chief innovation officers, and they were really good, they were impressive. And the instant whoever was leading the panel said, okay, any questions? I just bolted up to the microphone and Andrew Rosenberg, Michigan medicine. And I was being a little snarky, but I said, I think the CIO.

includes innovation, includes digital, includes data, includes quality, includes and I did it to try to challenge this. It wasn't the value of that I wake up thinking of [00:15:00] operations and run and keeping the lights on, whereas they wake up thinking of where we need to go. It comes down to then whose budget controls whose, because otherwise you're just diffusing out.

related, but not necessarily perfectly aligned work. So right now, whether it's the chief AI officer, the chief innovation officer, the chief disrupt the chief transformation officer, the chief strategy officer, the chief analytics officer, the chief data officer, All of those roles are overlapping.

And one could say, yeah, roll it all up to a chief digital officer. I don't know of many places where that would happen. Because it's more of a political reflection of an organization and its culture, not any perfectly aligned one. But from my point of view, because the formal technology in many ways is becoming more simplified it's similar to the point of whoever would build their own iPad today.

The differentiation and the value is in how you use the [00:16:00] apps. And maybe even you build your own app, but no one would build their own iPad. No one would build their own Word document management system at this point. It's how do you use commodity systems of record to innovate? But in that regard the CTO of the future.

really is looking at contemporary and modern methods to achieve infrastructure, services, and products. But the Chief Digital Officer should not be a strategy officer. I think it's very deliberate. The Chief Digital Officer should have a really good understanding of how the place works. It's almost a combination of a Chief Operating Officer and a traditional CIO together.

But, with the lens of where digital and technology enablement will help new work. That's where I think this role is.

could stay on this topic for a while, but some of the things you just said lead into. cloud, right? So cloud is this acknowledgement that we can't do anything special in [00:17:00] our data center that is going to fundamentally differentiate us.

And we're adopting these new models. Are you guys thinking about the cloud? The last we spent a lot of time on the cloud, the last interview I did with you, because you guys were right on the cusp of that journey.

Yeah, so we've done some really cool things. We're by no means the first, or even in the absolute top five percent, but we're very quickly be in the next five percent, and at the scale we're doing some massive stuff.

So we Did an enormous number of RFPs. We have a really robust wide area network architecture that we're building out with at and t with a lot of redundancy. We have a co-LO data center with Digital Realty to work with us. We are partnering with Microsoft Azure, though. We also have landing zones with AWS and GCP, but Azure is our strategic partner to get out [00:18:00] of the data center business.

And within two years, maybe even faster, ideally faster, we will be out of our secondary data center entirely. We'll be moving sector to the cloud. And we'll be moving full Epic onto Azure, full Epic. At the scale and at the size that we're doing, all of that prep work I've talked about before, we have all of the.

Now steps moving forward. We're in final contracting with Azure and the system integrators in order to do that work. We're working with AHEAD and Optimum. Excellent partners to do this work. And that's not me shilling for them. That's me giving specific details of what we talked about.

That was what we're looking for. Now we're moving forward with those partners. That's a very complex, incredibly important Partnership, like we did when we, this would be if you and I were in 2009, I would have said the same thing that we're working with Epic and Deloitte to do this [00:19:00] incredibly complex thing that we did so well.

I have the same mindset now, and that's still in many ways, while we're going to do some cool, innovative things, I still think we're still just talking about run And systems of record, to be frank, so that we can use Fabric to do really cool precision health and connect with many more groups so that we can bring in our affiliates and partners into this complex system of consolidated work so that we can actually do it cost efficiently.

I was really skeptical about the cost of cloud. Now, I'm much more reassured that it's probably going to be neutral at worst, and I think we have opportunities to distinctly show where we can add savings, whereas many of my peers, and I talk to them a lot, have said, I don't necessarily see the ROI yet.

So we're going to stay tier three, tier four, separate hot data center. And I get that we're at least getting out of the secondary data center [00:20:00] business. We have a really good primary data center, but we're going to do this comprehensive move. We have identity issues to work through. We have security, we have software defined networking issues, all of which are new to us.

We have. Upskilling of our talent we have so many pieces to do, but we're moving at pace now. It's not cloud first, cloud smart, it's to me contemporary strategic enterprise platforms in order to do all the new work that we all know we need to be doing and to do it as efficiently as we can.

give me a learning from this, something that as you were moving into it, you recognized that maybe you didn't know as you were going into it.

I remember the phase I skipped as a CIO, cause we did this cloud migration, is I didn't bring the IT organization along. And so my biggest resistance. came from the IT organization. I did a good job throughout the entire organization, [00:21:00] except my own team. I didn't explain to them how their jobs were going to change and how we were going to skill them and all that stuff.

It's such a, it's so obvious now, I can't believe I missed it, but it is.

This is that, really holding back on trying to not throw out Old, tired cliches and platitudes, but one that immediately came to mind is this is a great question that shows benefiting from people like you and others where we learn and we stand on the shoulders of giants is the cliche, but it came to mind.

We started three years ago telling our people what we were going to do repeatedly. I've been in front of the entire IT group. Half a dozen times easily saying, this is what we're planning to do. This is where the future is going. Here are all sorts of cloud education certifications that you can do.

They may not be perfect. This was by the way, before we had selected our hyperscaler, because in our selection, I got to tell you, the hyperscalers are actually all really [00:22:00] good. The differentiation, what I found were fairly nuanced. We had the luxury. Of having certainly two, maybe even three, really potentially good choices for our hyperscaler.

But, some of our staff said we want to wait to see which one before we get into the training. And I said, do the training and do the training. And some did not avail themselves of it. It's not a big problem, because now they are. They were the people who said, no, I want to wait. Is it this one or that one?

No, it's this one. Great. I'll start working on that. That's actually not going to be our problem. People are actually excited and , I don't want to dismiss or under emphasize the importance of what you brought out. We just did that one reasonably to very well. Not that we don't have people with angst and worry.

I have great confidence if I went in front of the roughly 900 people in our group and said, how are you generally feeling about where we're going with cloud? The vast majority would say, we've been anticipating this. We're, if [00:23:00] anything, they're eager. They are probably very understandably we have no doubt where we're going, what we're doing and why.

Our challenge is how do we do that and all the stuff we need to do. It would be a very, tactical issue, not a strategic or existential at all. The learnings, I would say, would be two. And partly, we're not there yet enough for me to really feel confident yet, but I think I've heard this from our vendor partners enough that I think it's true.

We did an unusually detailed service design document with an enormous amount of work that we did with Deloitte and NetApps. To do app server mapping for exactly what are our workloads that we're looking to move into the hyperscale or not, we have Epic and we have.

Two petabytes of operational data. Nope, it was, these are the VMs, this is the size of the data, these are the [00:24:00] INO per day, per week, this is what we think we're going to need because the hyperscalers, they want that level of granularity because then they give us much better actionable data for cost, for discounts, for timelines.

Our system integrators have a really good idea of exactly what we're looking to not the general. The amount of effort we put in, and we will publish, on what it took to get those levels of detail slowed down our process by probably a year from what I thought it would have been. I thought we would have been where we are now a year ago, but I suspect that level of pre work will pay off.

That's one learning. The level and details of our service design document and what we did that others should be able to leapfrog us by at least a year to just get right to that. So that they can use excellent work for us, for example, with EPIC. EPIC's cloud whitepaper is still unique in the country at the level of detail and its specifications that help [00:25:00] both the hyperscaler and the system integrators to know at least what's needed to do EPIC workloads.

The GRAFs, things like that, the latency issues with our networking. The challenge will be our 150 other associated applications. We don't have those white papers. We don't necessarily know where all of the plugins work in that large ecosystem, that's an example talking to Jason. Corwell did that super well.

We'll learn from them. Those would be two immediate, and then the third would be what is the local business driver to be doing this work? I've struggled with that. Because I did not lead with, oh, we want to save money, so we're going to move to the cloud. I think that's potentially absolutely wrong.

If we don't do it right, we could easily spend more money. Was it the security imperative, or was it the business continuity imperative? For us, ultimately, we had a 23 year old Tier 1 secondary data center that needs a [00:26:00] very large capital refresh in three years, and I used that. I just leveraged that.

Do we want to spend X number of millions of dollars to upgrade HVAC, electrical, and even then, not have the electric, the power and size to run, that others would say, we, we don't have that issue. Our primary data center is not that case. So each organization is going to have to look at the variety of business use cases, business speed, we don't really need business speed that a startup software company would need to use cloud.

We're a huge legacy of organization running 55 to 60 petabytes of total data. We're not about to just suddenly port that all up to the cloud and feel great. So the business case for why to do this work is a very local. nuanced and specific one, but I would say the menu of options is fairly constrained to roughly six or 12 [00:27:00] choices.

You have to find those that really matter for your organization, where the CEO, the CFO, the regents, whomever can see the value. Ours saw the value of getting out of a old data center from a business continuity point of view and to some degree a modernity point, contemporary IT work point of view.

Yeah, you haven't lived until you're sitting in front of the board having a conversation about needing a new data center and all the equipment in the data center. And essentially they say, what are we going to get when we're done? And you're describing it and the board member looks at you and goes, So you're telling me we're getting a new roof.

Yeah, when you're done, it's going to run your systems and all that, it's, so that's challenging. I do want to hit the business continuity. It's been interesting. We recognize this right out of the get go. We were in Southern California, so we had a lot of conversations about if we move things to the cloud, if we move these workloads to the cloud.

What does that mean if we lose connectivity to those [00:28:00] clouds? And you mentioned your network and all those things. It's a different way of thinking about continuity and disaster recovery when equipment is not in the building where the surgeries are happening. a different way of thinking. I'd love for you to just expound on that a little bit of what that thought process or that journey was like.

A few thoughts come to mind. One is I don't know where the also the old adage of you are never going to get fired hiring IBM fits into this question. I think this is new enough work that I really don't have. Certainly not personal experience, but knowing a lot of our colleagues around the country, I don't know that many where I would point to say they have a lot of experience at the scale we're going to move to know what it means to have outages in a hyperscaler predominant architecture versus an on prem.

But I would say a few things. One, AWS had a node outage. [00:29:00] I think it was three Christmases ago, where while it was occurring, I texted our CEO. As it turns out, I think it was over Christmas because I was out of the country. And I said, Hey, we have this outage. We know what it's from. We have both private and public confirmations from AWS.

I said, pay attention to this one. Our workloads were not so disrupted by it, but I said pay attention to how fast AWS corrects this. Because it's not going to be that we're going to have the outages. What it really is going to be is how fast they correct it versus how fast we would. And I think it's going to be very important because As more and more we get to these dependencies on not us, and you see it with SAS right now, you see it with others, I think the key is how deep do we investigate those firms to see their continuity and their response rate.

I experience this deeply as many did with Nuance. What was that? Five years ago? Six years ago? With non [00:30:00] Petya? And we were without transcription until we got on a separate vendor, or look at ChangeHealth, or whatever. How do we continue to look at these strategic vendors and their business continuity and their recovery times?

Because One could just look at several of our wonderful colleagues who went through hell when they got truly locked down with ransomware, and publicly, they're down for six to eight weeks. Privately, they're really not functional for a half a year. The costs are enormous. So I think the first thing when it comes to business continuity is to say, here's our due diligence around not just our strategic vendors, but here are Redundant architectures WAN architecture that I'm talking about will be much better than the one we currently have even with on prem.

And what we've had some outages that have been due to the fact that we still have some single threading in our region, in our

The physical network.

Physical network. [00:31:00] The scale of the redundancy, by the way, and the cost to doing that is a business continuity item that I think most of our organizations haven't really thought through and now will.

And then the second one, to the cloud, the challenge that I think we're going to have is, when we had the most recent CrowdStrike outage, Within a few minutes, I was able to talk to people who were in our data center. We know what it is, and we are physically fixing it. Our ETA to this recovery and then that level of recovery will be about an hour and a half to three hours, and I had just perfect confidence.

We don't have that level of communication with our hyperscalers when we have an outage, like we do locally, and that's going to be a change that we're all going to mature around. How do we get notified about those? Microsoft Variable ETAs versus, we're not telling you anything, client, until we have absolute assuredness because we don't want to be perceived as giving you bad information.

We're all going to have to mature to have a comfort in a gray [00:32:00] zone, understanding your best ETA, Bill, if you're running our hyperscaler. I think we'll be up in two hours, and at three hours, I'm not saying, Bill what the heck. You're saying, I gave you my best estimate, now it's not that, and we'll evolve to that over time.

Yeah I do remember, I don't know if it was the same outage, but Amazon had an S3 outage on their storage, their block storage had issues. And I remember following that, it was really interesting. They posted this stuff on the website almost immediately hey, we know what it is, here's the issue.

Here's how we're re architecting it. Here's when it will come back up. And I remember at the time thinking, that's the model, like that's the communication model for, they have to let the world know. They have to let Netflix users know. It's

Right. And that's my point.

Amazon. has their act together. Microsoft has their act together. HP, Evergreen, Dell, these really big hyperscalers, they're big and professional and they have their act together, but I still think that level of [00:33:00] Extra communication and comfort with communicating uncertainty, I suspect, will still have to mature even more.

An example, which is unrelated, but I still think a good one. When Epic was starting to really get a lot of clients, and we'd start to say, what about this, what about that? I remember having a conversation with Carl and Sumit years ago. We were looking at UCC, we were looking at another vendor, great vendor, we were all going to be happy.

We were within days of finalizing that contract. And then UGM comes out and Epic says, oh, we're going to UCC. And I said, why aren't you telling us? Where your roadmaps are. And the answer was understandable at the time, but I think they've matured enormously since then. If we don't meet our deadlines, if we don't meet their expectations, we have clients who are really unhappy with us.

I said what about your clients who are great partners who get unhappy when you don't indicate? Epic is showing, and has been for the last five or six years, where they are, where they know they'll be in a year, and then what they're thinking about. [00:34:00] With no expectation that what they're thinking about will happen or time.

I think that's an example of a co maturation. I suspect as we go more and more hosted. Whether it's hosted, oh by the way, Epic does a great job hosting too. As we mature, I think, to your point about business continuity, the hyperscalers are going to have to mature to a level of current discomfort to say, here's our best estimate, but we're not going to be held to it, but we're giving our best effort. And thank you. That's enough because that's what we did locally.

Yeah. It's managing expectations. Yeah. Andrew, the last time we talked we ended up doing a two part series cause you and I can talk. both talkers and we We love this topic. And there's so much more to talk about. I didn't even get to broach the future with you. And I love our conversations about the future. We will have to do this again Early next year, I'd love to circle back we're just at the start of our normal conversations

hey, let me do this. Let me put a [00:35:00] teaser for part two. In case you haven't seen Wicked, go see Wicked. It's an exceptionally well done movie.

It was really good. I was impressed.

Yeah, and I understand why they had to do it in two parts, my daughter's a music theater and my whole family's a big music theater.

Here's the teaser. The future is all about three things that come together. And I'm really spending more and more of my time, and when I go back to being an academic professor, I will be doing this even more. New data types. Think multimodal data. Sensor, genomic, pharmacogenomic data. True big data. The new analytics and data management needed to manage that type of data But interestingly, the infrastructure and technological enablement to make those two work shine that lens on problem areas of healthcare.

And that's where we'll see new advances in healthcare where that digital mindset will be working together to help that happen. That's the topic I would love to talk about.

Oh, absolutely. Andrew, I want to thank you for your [00:36:00] time. And man I hope you get a little bit of a break over the holidays, cause the speed appears to only be increasing in healthcare technology.

Yeah. Thanks Bill. Appreciate it.

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