August 6, 2021: At a global level, people should have a right to their privacy, to their data access and to control and protection over their data. But when we put the medical record in the hands of the consumer, of the patient, of the individual, they’re going to have a lot of questions. How do we equip them to be able to handle it? Jim St. Clair, Chief Trust Officer at Lumedic explains patient centric interoperability and why it’s so important. Why should providers pursue it? What are the challenges with getting to where we want with patient driven interoperability? And what use cases are we going to enable?
Laying the Groundwork for Patient Initiated Interoperability with Jim St. Clair
Episode 432: Transcript – August 6, 2021
This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.
[00:00:00] Bill Russell: [00:00:00] Thanks for joining us on This Week in Health IT influence. My name is Bill Russell, former healthcare CIO for 16 hospital system and creator of This Week in Health IT, a channel dedicated to keeping health IT staff current and engaged. Today we are joined by Jim St. Clair. He is the Chief Trust Officer for Lumedic, which is a patient centric data exchange platform.
[00:00:25]Special thanks to our influence show sponsors Sirius Healthcare and Health Lyrics for choosing to invest in our [00:00:30] mission to develop the next generation of health IT leaders. If you want to be a part of our mission, you can become a show sponsor as well. The first step is to send an email to [email protected]
[00:00:40]I want to take a quick minute to remind everyone of our social media presence. We have a lot of stuff going on. You can follow me personally Bill J Russell on LinkedIn. I engage almost every day in a conversation with the community around some health IT topic. You can also follow the show at This Week in Health IT on LinkedIn. You can [00:01:00] follow us on Twitter Bill Russell HIT. You can follow the show This Week in HIT on Twitter as well. Each one of those channels has different content that’s coming out through it. We don’t do the same thing across all of our channels. We don’t blanket posts. We’re actually pretty active and trying to really take a conversation in a direction that’s appropriate for those specific channels. We really want to engage with you guys through this. We are trying to build a more broad community. So invite your friends to follow us as well. We [00:01:30] want to make this a dynamic conversation between us so that we can move and advance healthcare forward.
[00:01:36]Today we are joined by Jim St. Clair. He is the Chief Trust Officer for Lumedic, which is a patient centric data exchange platform. Jim, welcome to the show.
[00:01:46] Jim St. Clair: [00:01:46] Thank you very much Bill. It’s a pleasure to be here today.
[00:01:48] Bill Russell: [00:01:48] Is it a pleasure? Cause if people aren’t watching this, if they’re listening in the podcast, you got to get this picture of the Zoom meeting and he’s got the the beach background. He’s got sort of a beach [00:02:00] shirt on. He doesn’t look like he’s happy to be here.
[00:02:03] Jim St. Clair: [00:02:03] Yeah, this is a, this is a limited edition, Tommy Bahama pirates of the Caribbean shirt that I picked up at Disney world.
[00:02:11] Bill Russell: [00:02:11] Really?
[00:02:12] Jim St. Clair: [00:02:12] Yes it is. And it was really cool. And I mean, I, I forked over the extra money for it just because it is based on the original, was it 1966 pirates of the Caribbean ride? The first ride when Disney World opened when magic kingdom opened.
[00:02:27] Bill Russell: [00:02:27] Wow. But my daughter’s a [00:02:30] huge fan. I’m going to have to I mean, that’s a Christmas gift idea starting to float around in my head. Of course it’s only the middle of June, but that’s how much lead time I need for Christmas ideas.
[00:02:40] Jim St. Clair: [00:02:40] Oh, there you go. Well that’s perfectly fair. I have my wife’s birthday is next week and so I’m starting to panic as to what I have to get slated.
[00:02:46] Bill Russell: [00:02:46] So I need six months lead time. You’re working on one week.
[00:02:51] Jim St. Clair: [00:02:51] Yeah, I do better under pressure.
[00:02:53] Bill Russell: [00:02:53] Golly patient centric data exchange platform. Let’s talk about patient center. [00:03:00] I mean, we’re going to talk about patient centric interoperability. What is patient centric interoperability and why should providers really want to pursue that?
[00:03:08] Jim St. Clair: [00:03:08] Absolutely. And the first thing is I want to give you credit. So in our first conversation, We were talking around an exchange on LinkedIn. And you had mentioned the fact that 49 out of 50 states still own patient information in the EHR. And I have brought that up now in conversation four or five times, and it’s been kind of a philosophical game-changer in there. So [00:03:30] putting things in the context of patient control of data and where we stand between a combination of globally with things like the general data protection act regulation, excuse me GDPR and the Pan-Canadian trust framework and the new EU guidance on data governance acts.
[00:03:50] And then here in the US the history of HIPAA. And now of course, the 21st Century Cures act. I think it’s been a little mixed, but we are getting more of what I see [00:04:00] is a resurgence of the concept of being in control of your information and the rights and access that you have to that information and how the patient should be at the center of it.
[00:04:10] And I think it’s also really cool that we’re getting into the world of wearables and Apple Health kit and other technologies to allow you to collect information about yourself. What Lumedic is really concerned about is enabling that with technology and standards and architecture, that, that empower you as the patient, to be able to better manage your information, make you a [00:04:30] better consumer and hopefully ultimately improve the care giving experience.
[00:04:36] Bill Russell: [00:04:36] Yeah. And I just want to let people know this is not a paid spot. So you and I, I have you on just because I want to talk about patients centric interoperability. It happens to me what new medic does. And so from time to time, you’ll hit on that. And I appreciate that, but I’m going to immediately take us in a different direction because the worldwide developer conference was this week.
[00:04:54] Jim St. Clair: [00:04:54] Yes it was.
[00:04:54]Bill Russell: [00:04:54] Big announcement, Apple has ramped up their sharing capabilities and now with [00:05:00] their Apple Health record, you can now choose to share that with family members, with other family members to who might be a part of your care circle or some entity like that. And you can also choose to share it with other doctors or a healthcare fiduciary, if you will.
[00:05:19] I mean, is this just a sign of what’s going on in the policy and regulatory world and in the technology architectural world that’s enabling this? [00:05:30] That all this activity is happening now.
[00:05:32] Jim St. Clair: [00:05:32] I think it is. And for me, my personal concern belonging to several foundations and consortia and ISO and Itripoli where we’re looking at standards for that it’s admirable and it’s applaudable to be able to start sharing your health information with family members. To assign health information, access to family members to get them involved. I think that there have been historical complaints about caregivers and how family members, as [00:06:00] caregivers in conjunction with care teams had limitations under HIPAA and others for access to information.
[00:06:07] So it’s exciting to see that be realized whether it’s compelled by regulation, like the 21st century cures act or just good marketplace things. What I and the sort of international consortia that I participate in represents are saying, hey, that’s all great, but there should be frameworks and standards for that sort of information exchange and that ability to extend access and [00:06:30] authorization to that data using available tools and architectures and standards and policy that, that not only fulfill that idea that I can get access to my aging mother’s medical records to assist with their caregiver and their care teams but that there is a process and standards in place for being able to authorize that and have a security framework, quite frankly.
[00:06:52]Bill Russell: [00:06:52] We’re going to talk about use cases because I think there are some powerful use cases, but what’s the problem? You talk about the standards bodies. You talk [00:07:00] about security. You’re talking about privacy. But I mean to be honest I mean, this is a pretty heavy lift for Apple I would think because a lot of the data in the medical record is not standardized.
[00:07:12] And it’s put in by people who did not study to be data entry clerks. They actually studied a lot longer to not be data entry clerks. And they’re really not that great. And to be honest with you, it ends up all ends up in the notes, or it all ends up in different types of formats. There’s not a lot of standards per [00:07:30] se, I mean, there are snowman and other things, but there’s not a lot of standards per se. That’s driving how we input the data into the record. So what are the challenges with getting to where we want to get to with patient driven interoperability?
[00:07:44] Jim St. Clair: [00:07:44] Absolutely. And I am blessed to be able to offer perspectives from my work around other physicians and folks in the industry to kind of comment on this concept of identity.
[00:07:54] And I think so much we’ve historically looked at identity in the context of privacy and security and what [00:08:00] I have access to in terms of my information, but we’ve also, and I think when the 21st used to mean in 2021 started to get into more about what identity is. And we must recognize we’re in the middle of Pride month, as an example, how people choose to identify themselves, essentially their persona, what they manifest for identity.
[00:08:20] Even like for instance, challenges in telehealth, where there are aspects of people’s identity they may be willing to share with a provider, but they’re not going to share in a telehealth engagement at home because [00:08:30] no one else in the family knows about it. And problems with data entry.
[00:08:35] Just as an example, that’s come up in the last 24 hours, 17 states in the U S have driver’s license that allow you to put X to identify your gender beyond male or female. On the other hand, you go into an epic dropdown menu and there’s no X, and then you have to get more specific into how you identify gender and how that information is shared either between you and your provider, how that provider shares it with somebody else who comes back and says [00:09:00] how it’s okay to share that and whether or not you’ve authorized that kind of sharing. So just the concepts of the patient identity and what they wish to share about their identity and information not only is hard in most traditional encounters, capturing that information in electronic records is difficult. And I think you’ve also spoken to the fact that these are people that are not designed to be nor set out their career to be data entry clerks. And then add to that challenge is around the data entry platform that they may have there’s rooms for [00:09:30] error there’s rooms, for requirements, for correction there’s rooms for having to determine if authorization in sharing information is good or bad as part of the engagement that, that paints a very challenging picture as to how identity factors into the care coordination and caregiving for an individual.
[00:09:47]Bill Russell: [00:09:47] I’m looking at this Apple announcemen. Clearly Apple is concerned about privacy. They say the data is encrypted in transit and at rest. Users have granular control over which types of data [00:10:00] to share and with whom. And then they spend an awful lot of time on making sure the person who is holding the phone is and accessing the phone is the person who owns the phone as well. Those are some of the key elements aren’t they?
[00:10:17] Jim St. Clair: [00:10:17] Yeah, absolutely. Those are all applaudable. I mean, unfortunately in my work and some of the international standards bodies I don’t see Apple representatives, so I can’t always say to how they derived [00:10:30] some of their architectural approaches but certainly the concept around ensuring that the right person has the device, that that person has access to the right data. Those are all headed in the right direction for what we’re trying to do conceptually.
[00:10:43]Bill Russell: [00:10:43] There’s a whole bunch of, it’s just that people don’t take into account when you think about this. Certain industry luminaries who have spoken out maybe in caution, again I wouldn’t say against this, but cautionary about this, that hey, when we put [00:11:00] the medical record in the hands of the consumer, of the patient, of the individual, they’re going to have a lot of questions.
[00:11:06] And they’re going to be ill equipped to answer those questions. And maybe this is beyond the scope of this conversation but that is part of the challenge, right? We’ve just given them a deluge of information about them. They’re going to find some things that are correct. Some are incorrect.
[00:11:21]They have five addresses listed and they really live at this one and whatnot. You could, you could end up creating an awful lot of traffic back to the clinician, the clinician’s [00:11:30] office, the front desk, the HIM department, and all that, as we do this. Do health systems, I mean, is that one of the things that slows them down in the adoption of this?
[00:11:40]Jim St. Clair: [00:11:40] I think it does. And I realized that you said it may be outside the scope of this conversation, but I also think it’s heading that way inevitably, which is to really begin to examine how much a person is in charge of their health information now and how much tools like what we have or what Apple have give the ability [00:12:00] to be in charge of their information going forward. Especially again, in reference to the 21st Century Cures Act, you can walk in to see your doctor right now, look over their shoulder at your medical record and demand that certain things be corrected or just plain taken out.
[00:12:14] I think it was an article in Medscape, I was reading last week about the challenges this is creating where someone has a substance use disorder that has been diagnosed and is medically diagnosable under a CPT code or others. And they’ve said, I just want to take it out of my record. The difficulty [00:12:30] that the provider has legally as well as ethically to say, well how do I address this? How do I balance my liability as a provider with the legal right, that this individual has to correct their information. And that’s getting off the reservation a little bit, but I just want to tug on that thread that I think as a society, as an information society, we are more and more being enabled and empowered with information at our device or on our laptop, et cetera. And how we handle that is going to become an individual responsibility. That individual responsibility has probably been something [00:13:00] that’s been abstracted out from a lot of our healthcare practices for social cultural reasons, as well as for business and process reasons. And I think just tools from Apple and from ourselves and others are beginning to point back to what to do about that.
[00:13:12] Bill Russell: [00:13:12] All right. So Lumedic. Let’s talk about use cases. Why is this a good thing? What use cases are we going to enable with patient centric interoperability?
[00:13:20] So at a high level, I think that certainly myself, the team at Lumedic and the standards and consortia bodies, we participate in, [00:13:30] believe at a global level that people should have a right to their privacy and to their data access and control and protection over their data.
[00:13:37] As we talk about this right now, there’s a, there’s a headline out that the commissioner in the EU is re-examining more cases for Facebook and Google and how they’re using individual EU citizens data. And whether that fits within the regulatory framework. We don’t really have a lot of parallels for that within the US. Some examples like with the CCPA in [00:14:00] California.
[00:14:00] And some work the Commonwealth of Virginia, some other laws that have come around. But just considering the fact that people should be in charge of their own data or have protection of their data and consent to how their data is used is kind of a fundamental belief we have that we share with lots of folks on a global basis.
[00:14:16] Add to that within the us healthcare industry specifically as we have talked about so far, this concept that patients can now face or now have access to their records and be directly involved with sharing their records, sharing their [00:14:30] information with other family members. How you put the individuals at the center of that and in charge of that conversation and facilitating that sort of information exchange we think is is kind of a fundamental right.
[00:14:42]I can care for for my father and my mother who lived in another state because they bring me into their care circle. I can now participate in looking at that information, seeing the feedback, seeing potentially some notes that the doctors given, because sometimes we’re calling our parents, not my [00:15:00] parents specifically, in this case with but we’re calling our parents and they’re battling with dementia. They live across the country. Andwe struggle with that. We can’t be at the visit. Of course today with telehealth, we might be able to be at the visit, but if we’re not there, we’re able to get at least some feedback when they said, well they prescribed me some new medications. And it’s like, well, which medications do you know, dad?
[00:15:22] And it’s like, no, I don’t remember. Right. I think it’s the blue pill. I think it’s the green, I don’t know which one it is. And so you know, that the [00:15:30] choice for us is to uproot in California and move to Pennsylvania. Or figure out or hire a caregiver or, I mean, there’s a lot of challenges in doing that.
[00:15:39]This is one of those use cases where the individual does know the best, I don’t know, care circle they want. Because it’s not only family members. They might want somebody across the street or a friend who’s going to get to help them with their health, be a part of their care circle.
[00:15:56] Jim St. Clair: [00:15:56] That’s well said. And I think what you’ve seen so far in some of the [00:16:00] changing models is that that person may or may not be related. Just like you said, someone across the street, someone they trust within a social media circle. Someone that to them represents a trusted element for part of their data exchange and how they facilitate their care. And so what we’re looking at now, and I think the mechanisms behind Apple’s platform, certainly the mechanisms on our platform is there’s what we call cryptographic trust mechanisms, which is I may or may not know this [00:16:30] person, or maybe they’re a family member or maybe they’re not, but I’m going to grant them a verifiable way that you, as the provider can share information with them that is auditable, that is trusted, that helps address the issue of liability because I consider them important as part of my care plan. And I think when you get into certain aspects of social determinants of health, when it comes to the community other sources of housing, security, et cetera, That may involve [00:17:00] people that again, are our friends may not be friends, acquaintances, folks, that factor into how a care plan is delivered.
[00:17:08] And there needs to be a way that that person can be trusted both in terms of who is receiving the information and how the information is being shared.
[00:17:15]Bill Russell: [00:17:15] Social determinants, I think is one of the biggest arguments for, we need a system above the EHR, a system that collects more information than just the medical episodes that we have in our lives, because we know that 80% [00:17:30] social determinants, education, socioeconomic, all the decisions that we make in the grocery store, et cetera that attributes to health even more than our medical visits in a lot of cases. And you almost need a more comprehensive record that tells the whole story of who I am.
[00:17:49] Jim St. Clair: [00:17:49] What a wonderful example. And in having a comprehensive record as to who I am, that’s going to contain a range of sensitive aspects or data points that [00:18:00] in certain combinations, you’d be willing to share with one party, but not with another party. Obviously the housing that your local housing agency that’s managing your housing, doesn’t need to know your whole clinical record.
[00:18:12] Conversely, there may be aspects of your housing security and where you live, that you’re very hesitant to share with your provider except under certain circumstances. So enabling that ability for you to be selective and sharing that information or enabling a family member to share that information [00:18:30] are kind of paramount to your holistic care plan.
[00:18:32] Bill Russell: [00:18:32] Jim, I was thinking of one more use case, and this is sort of an odd one, but it is with all the malware, with all the ransomware that’s going on right now. I sorta want a copy of my medical record digitally just in case my health system happens to get ransomed and doesn’t pay the ransom and my medical record goes away.
[00:18:51] Jim St. Clair: [00:18:51] So it’s a very different model than we have in the US but some of the consortia that I’m involved with such as My Data Global envisions a world where you have a [00:19:00] trusted data vault that your information resides and then from there, you share that as necessary depending on the interactions.
[00:19:07]And I think to your example about ransomware, where fundamentally, it’s getting into sensitive data. Either preventing an organization from access to that sensitive data or to threaten them with releasing that sensitive data that they control, be it health or be it electronic records for colonials pipeline, et cetera.
[00:19:27] And being able to take [00:19:30] that under your control in some way, or before ransomware, it takes it out from a central location, you have access to that information or moreover are able to have that information move to your control, are probably great strategies going forward. I’m involved with some groups that are working on the NIST standards or looking to implement the new standards for zero trust architecture and zero trust architecture as a principal that no one device on the network trusts another device on the network. Well, [00:20:00] how do I enable that framework of trust where two devices are able to communicate, but recognize when a threat or ransomware’s coming in. And the principle, I think applies here as well when you’re trying to share your own personal data.
[00:20:12] Bill Russell: [00:20:12] All right. So, Jim you’ve mentioned these groups. Give us an idea of some of the groups that are working on this and where they fit. Cause they’re not all working on the same things. They all have sort of their area of specialty. What are some of the groups you’re working with?
[00:20:24] Jim St. Clair: [00:20:24] Sure, absolutely. I’m sure everyone’s familiar with ISO and IEEE as standards bodies on a [00:20:30] parallel effort. I’m involved in a couple of groups from HL7 that look to be able to adopt some of the concepts that we’re working on from an identity standpoint. The Lennox Foundation includes such organizations as the Hyperledger Fundation, the Linux foundation for public health and both of those have software development consortia for things like decentralized identity platforms, cryptographic exchange. Overseas or activities such as the [00:21:00] Sovereign foundation, which is a global global foundation that enables that exchange of what we call self sovereign identity and self sovereign identity architecture.
[00:21:10] My Data Global, Human Colossus Foundation. A new organization called ID Union, which is specifically in Germany and expanding to the rest of, the rest of Europe over time and the EU. All of these are involved in either similar technological efforts or [00:21:30] standards development, or consortia around principles and enablingnew policy.
[00:21:35] Bill Russell: [00:21:35] You said Hyperledger. Nothing like more than blockchain has gone through the complete hype cycle. I mean, it went straight up and then straight down in terms of people don’t want to talk about it in healthcare but it really does have some, if you think about the immutable record and the concepts and the architecture around blockchain, it really does lend itself well to, again, the protection of the identity, [00:22:00] just the whole mechanism port was almost designed for this exchange. Why hasn’t it really taken off?
[00:22:06]Jim St. Clair: [00:22:06] Absolutely. Well one more organization. I would plug within the Linux Foundation as the Trust Over IP foundation of which we are a steering committee member. Trust Over IP takes the attitude that while there’s lots of talk about blockchain and healthcare specifically, blockchain is what we call a utility within the layer and much like the OSI model there is a layer one for that utility around [00:22:30] blockchain, layer two for certain other communications protocols, layer three is the W3C worldwide web consortium verifiable credential model. And I think it hasn’t taken off because in some cases it’s a square peg round hole. I’ve been involved in blockchain and healthcare for about four years.
[00:22:46] And if you address a conversation in healthcare, around how Bitcoin or Ethereum is going to solve a problem, it tends to turn the audience off. That’s different than applying architectural standards into a layered [00:23:00] approach that shows how they aligned to the way NIST recommends you do something. The way that an ISO standard recommends you do something.
[00:23:07] And the Trust Over IP foundation to me is one of the first attempts to build that architectural framework. That makes sense to everybody that isn’t just, hey, let’s throw some blockchain at the problem. Takes a interoperable, architectural approach to doing things. And that being a new effort, we’re celebrating our first birthday this month is why I think [00:23:30] there is still some maturity and standards that haven’t caught up with, perhaps the maturity in technology, in the industry.
[00:23:36]Bill Russell: [00:23:36] I think the closing question that I apologize, not having more time. Clearly I can generate another 15 questions that you and I could talk about for the next hour. I think the question is, okay, I’m a provider. I believe in this. I have a couple of approaches that I can go. I can say our portal is enough. That’s patient centered. Something it’s patient engagement of some kind. [00:24:00] That’s that’s one level of sort of engagement. On the other side. I could say, all right now, I’m willing to go all in here and I want to get a platform for patient centered centric interoperability.
[00:24:11]What’s the path that a healthcare system could take to really, to enable this for their community.
[00:24:19]Jim St. Clair: [00:24:19] I’ve been in the game for a long time in terms of technology and consulting, whether public sector, healthcare and others and I’m never been one just to say, Hey, just buy the software.
[00:24:29] That’s [00:24:30] always an ultimate outcome. But the first thing is really taking a look at the process flows and how you want to be able to use it. And being all in is great. I would still recommend say a, a framework or an approach around say 21st Century Cures Act compliance or I want to make sure my populations SDOH information is included.
[00:24:49] And then look to how do we incorporate standards with that? And then finally, a software solution. And I could offer more details privately and separately about how our approaches to doing that. [00:25:00] But it has to be, I think, built on a framework of standards and mature technologies that at the end of the day, we’ll meet security compliance needs that will meet legal and regulatory requirements, et cetera.
[00:25:12]Bill Russell: [00:25:12] Who’s driving that kind of conversation within the health system? Is it on a clinical level? Is it a CEO? Is it a CIO? Because when I think about that, I agree a thousand percent. You don’t start with technology. You always start with what’s the problem set? What are we trying to solve? What’s the measure for having solved [00:25:30] that problem. And then let’s put it, put an architecture and a plan together for solving that problem. I agree with that. That makes perfect sense. But who kicks that conversation off?
[00:25:40] Jim St. Clair: [00:25:40] Great question. I think it varies a bit from organization to organization, and I don’t have a perfect answer. I can say within Lumedic we created, what’s known as the Lumedic Exchange, which is a free membership model open consortium that has participation from Providence Health systems healthcare professionals some of the IT and [00:26:00] revenue cycle professionals, as well as organ organizations outside of healthcare such as MasterCard, HireRight and others, where we meet and discuss these as process flows and use cases to adopt a consortium driven approach to how to approach these problems. So it’s no one particular opinion or one particular office or an IT centric approach or a clinical centric approach. We try and get all of those participants at the table and come up with joint use cases together.
[00:26:27] Bill Russell: [00:26:27] Is there. And I said, my last [00:26:30] question two questions ago but is there a problem if my local health system in a media market has a patient centric interoperability approach but I’ve traveled in my lifetime and gone to different places. Is there a challenge where, you know, if we don’t adopt this nationally, that is going to have limited impact or limited use cases for the individual?
[00:26:53]Jim St. Clair: [00:26:53] I think that we’re both aware of not just interoperability challenges, but the ability for getting your [00:27:00] information in Topeka, Kansas, when you’ve just moved from New Orleans and how that, how that data exchange takes place. I would like to think that certainly post COVID and post pandemic we seem to have a lot more folks relocating and resettling in different ways that will lend itself towards the demand of saying, I want to get all of my data from wherever it was into a central place. Or I want to be able to pull my information from Topeka now that I live in new Orleans or whatever that case [00:27:30] is. And I think that’s going to result in some market demand for information we haven’t had before and hopefully work out what some of those problems might be, whether or not it a solution is adopted locally or nationally.
[00:27:41] Bill Russell: [00:27:41] Jim thanks for coming on the show. I reserve the right to call you back whenever I want to really go in depth into some of these architectures.
[00:27:48] Jim St. Clair: [00:27:48] You bet. I’ll be watching for the interoperability bat signal to flash.
[00:27:51] Bill Russell: [00:27:51] Okay. Sounds good. Thanks. Take care.
[00:27:54] Jim St. Clair: [00:27:54] Thank you Bill. Have a great day, sir. Thank you.
[00:27:57]Bill Russell: [00:27:57] What a great discussion. If you know someone that might benefit from our [00:28:00] channel, from these kinds of discussions, please forward them a note, perhaps your team, your staff. I know if I were a CIO today, I would have every one of my team members listening to this show. It’s conference level value every week. They can subscribe on our website thisweekhealth.com or they can go wherever you listen to podcasts, Apple, Google, Overcast, which is what I use, Spotify, Stitcher. You name it. We’re out there. They can find us. Go ahead. Subscribe today. Send a note to someone and have them subscribe as well. We want to [00:28:30] thank our channel sponsors who are investing in our mission to develop the next generation of health IT leaders. Those are VMware, Hill-Rom, StarBridge Advisers, Aruba and McAfee. Thanks for listening. That’s all for now.