News Day – CIO-CMIO Talk Burden, AI, and Advancing Innovation Post COVID

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Bill Russell / Dr. Mark Weisman

News Day Bill Russell and Mark Weisman share stories

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June 30, 2020: Welcome to another episode of Tuesday Newsday. Today Dr. Mark Weisman, creator of the CMIO podcast joins host Bill Russell for a back to back presentation of the latest news impacting health IT. CMS announced big news in burden reduction for doctors and as Dr Weisman points out, with less regulation there’s many more valuable things that doctors can be doing with their time. Bill discusses the cloud’s most recent digital transformations. Dr. Weisman sheds light on a phenomenal patient portal-based, self-triage and self-scheduling tool that was designed and implemented in under 2 weeks! Tune in for the results. And find out which technologies really took a big leap forward during COVID.

Key Points From This Episode:

  • CMS announce the creation of the Office of Burden Reduction and Health Informatics.
  • The new sophistication of ER charts – what else can we see?
  • A revolutionary patient portal-based self-triage and self-scheduling tool can be developed at lightning speed.
  • The promising future of conversational AI in healthcare.
  • Bill shares his new favorite word “nudge” and what it means in AI.
  • Did you know tele-health can literally be done in the ED?
  • How do we make places safer to give people more peace of mind?
  • Mark shares ideas for improving broadband connectivity issues in rural areas so no one gets left behind
  • Should nurses be allowed to refill prescriptions?
  • New legislature in Idaho making it even easier for healthcare providers to engage in telehealth services.

Tuesday Newsday – CIO-CMIO talk burden, AI and Advancing Innovation Past Covid

Episode 273: Transcript – June 30, 2020

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: Welcome to This Week in Health IT. It’s Tuesday Newsday where we look at the news that will impact health IT today. Mark Weisman from the CMIO podcast is in the house. We’ll do a little back and forth on the news. My name is Bill Russell, healthcare CIO, coach and creator of This Week in Health IT, a set of podcast videos and collaboration events dedicated to developing the next generation of health leaders.

A reminder, we’re now doing three shows a week instead of five. We’ll be closing out the code series in [00:00:30] June, and we’re doing no live show this month. We will come back with a live show next month, where we’re going to talk about bringing people back to work. And some of the things that health systems are struggling with as we venture into that area.

Special shout out to Drex DeFord for his service, three extracts where you get three stories texted to you three days a week. To Sign up just text DREX, that’s D R E X two four eight four eight four eight. It’s a great resource if you’re trying to stay current. This episode, and every episode since we started the COVID-19 [00:01:00] series has been sponsored by Siruis Healthcare. It is their commitment to making this content available that has made these episodes possible during the pandemic. Special, thanks to Sirius for supporting the show’s efforts during the crisis.

All right, let’s get to the news. Mark Weisman creator of the CMIO podcast is with us. Good morning, Mark. Welcome to the show. 

Mark Weisman: Good morning Bill. Thanks for having me. Normally I’m on the East coast where I work and live in Maryland. I happened to be in your old neck of the woods. I’m in orange County today. It is early. It is [00:01:30] 6:00 AM for me here. 

Bill Russell: I am so sorry when I scheduled this, I assumed you were on the East coast. 

Mark Weisman: I happen to have to come out for some family who are sick, so I’m helping out but  I’m good. 

Bill Russell: Well, thanks for doing this. You are one of the shows that I listen to everyday. I get up with a goal to consume some content of some kind in the form of a podcast. I realized about, I don’t know,  six months into this, that I was a hypocrite. I wanted everyone to [00:02:00] listen to my podcast, but I wasn’t listening to anybody else’s podcast. So I started to incorporate it into my daily schedule and I love your podcast. So you’re doing two shows. You do a new show, just like this, and you do an interview interview show, but you also hold down a full time job. So sometimes you’re not as consistent as you would like to be. 

Mark Weisman: I’ve missed a little bit recently, the COVID crisis, as well as, like many CMIOs did, they said here, go take this telehealth thing and go do something. And so [00:02:30] that’s created a lot of work that I suddenly got thrown into. So I’ve missed a little bit here and there but we’ll get back on track. I’m a big fan of your show. Obviously I listen every week and I appreciate being on.

Bill Russell: Well, I’ve looked forward to doing this. So we have a few stories each of us, and we’re just going to take turns, going back and forth. So it’s going to be the same kind of news story. You know, I do a, So What, at the end of it every story.

So  you know, for the ones you introduce, I I’ll expect a So What [00:03:00] from you for the ones that I introduce. I’ll try to do So What and we’ll go from there. So I’ll get us started, CMS. S This is from healthcare IT news. CMS creates a new office of burden reduction and health informatics. let’s see, what did I say here?

The centers for Medicare and Medicaid services have formed the new office of burden reduction and health informatics and outgrowth of its patients over paperwork initiative, whose mission is eliminating red tape in healthcare documentation and official state permanently embeds a culture of burden [00:03:30] reduction across all platforms of the CMS agency, which is, you know, welcome just to give people an idea of some of the things they did. The patients over paperwork initiative was formed in 2017 by CMS with priority of reducing the regulatory burden and enabling providers to concentrate on the patient care, which is all great you know, in terms of its objective, officials say that their initiative could save 6.6 billions and 42 million of unnecessary burden hours through 2021.

And that’s pretty close, right? So we’re not doing [00:04:00] this 10 year projection where we’re going to save $6 billion. It’s 2021, among the unnecessary obsolete and burdensome conditions of participants. CMS has targeted, it has eliminated 235 data elements from the 33 items. On the outcomes and assessment information set, Oasis assessment instrument for home health, it is established within the quality payment program, a consolidated data submission experience for different performance categories of MIPS.

So that closure is no longer needed to submit data in [00:04:30] multiple systems. CMS also eliminated 79 measures through modernizing proposals in advance. So now what this aims to do really is to expand that and have it be an overarching element of all the programs that are being looked at by CMS You know, again from a directional standpoint, I like this and I like the stuff that’s coming out of CMS, but from a physician standpoint, how are you looking at these [00:05:00] kinds of things?

Mark Weisman: They’re definitely helpful. The biggest change of course, is coming up in January with the way that we get paid. We no longer have to count the little elements in our note. How many review of systems did I get? I was looking at a providers data, their signal report out of Epic, and it tells us all right, how many characters does this doctor have? This doctor had over 16,000 characters in their note on average, it’s about 8 to 10,000 characters, more than anyone else [00:05:30] in their specialty.

That’s not regulatory burden there. That’s just the doctor style and they’re copying everything forward from the last notes and overtime. The notes have become huge. He has 85 more minutes a day spent in the EMR on notes than his colleagues. So, yeah, we’ve got to get to this. There’s more valuable things that we can be doing with our time.

So I’m excited to see more efforts around the burden reduction. 

Bill Russell: Yeah. You know, [00:06:00] I love the fact that you brought up the signal that the ER charts have gotten much more sophisticated in letting us see, get visibility, into how people are utilizing the systems.  And we can identify what of that is actually a government burden.

What of that is actually style or approach and you know, my, so what on this is. Absolutely. If we learned nothing else through COVID, we were collecting data that now people look at it and go, why are we even collecting this data? It didn’t help us during the pandemic. I talked to Dale [00:06:30] Sanders during the pandemic and he was talking about how they just needed to almost completely overhaul how they collected information.  They were asking for too much information, there was too much burden at a time where there was just not enough time to collect it. So they just had to get that  data down to that that was very, you know, specific and important for the crisis that we were in. You know, again, great movement, great direction.

So what, what’s the next story? What do you have for us? 

Mark Weisman: So  I’m going to talk about a story out of [00:07:00] Jamia. The title here is rapid design and implementation of an integrated patient, self triage, and self scheduling tool for COVID-19. And this one, he was recently in their June 2020 edition here. I’ll read you a couple of key points here.

So this came out of the university of California, San Francisco, and within two weeks they were able to stand up this self triage and self scheduling tool. It made it available to all primary care [00:07:30] patients. And this is obviously an academic institution. The fact that they split this up in two weeks, we can comment on later.

That’s amazing but asymptomatic patients were asked about exposure history and then provided some relevant information but the symptomatic patients were triaged and they had 4 different categories of merchants, urgent non-urgent self care, and then connected to the appropriate level of direct scheduling or telephone hotline.

And it goes in and talks about the utilization. In two weeks time, [00:08:00] they had over 1100 patients using this tool and they were, there was like 20 of those who are symptomatic, about 24% were emergent 24% urgent,  12% non-urgent, 40% were self care. So they came to the conclusion, hey, we think we’ve reduced to the person to person interaction that would be required to get the self care patients, to do self care  that burden was relieved off the health system.

[00:08:30] And then those who were really sick were able to get into care, which is what they really wanted to do. So Bill, in the past, when I’ve looked at chatbots and  self triaging type tools, the legal department, their eyes just get so big. They’re like, you mean a computer is going to be telling us how to do this kind of healthcare.

How do you as a CIO, bring these new technologies and get them adopted, get the C suite to go. Yeah, this is okay. The CIO or CMIO has not run off [00:09:00] the deep end on us here. What do you think? 

Bill Russell: You know, what’s interesting is, I’m always on the front end of the curve, right? So I was moving our health system to the cloud in 2011 in a big way.

I mean, getting rid of the data centers, moving it to the cloud. When you live on that side you pick up a handful of things that you have to do. You have to have champions, right? You’re not going to. I mean, that kind of system wide rollout is possible during a pandemic. It’s possible during a crisis [00:09:30] because people are stepping back and going, we have to do something. The crisis itself creates the demand and the driver for doing it. It’s beautiful. And that’s why we have so much digital transformation over those three months, because there was no work. To be done in terms of moving the culture, the culture moved because of the pandemic, but if you’re going to move a culture, generally what you’re going to do is you’re going to step back and you’re going to get champions.

You’re going  to have to build the case. You’re going to have to introduce people to the technology [00:10:00] and you’re also going to have a fairly, I mean, you can’t minimize the amount of time that you’re have to put in up front, because if you minimize that time upfront, eventually you’re not going to build the foundation to take it system wide.

And I’ve done a lot of initiatives where, you know, we got the champions, we got people, they got excited about it, but we skipped a few steps. And then when we wanted to go broader and scale it, we  fell  on our face. So it’s  really important to have [00:10:30] that. You know, the business case obviously needs to be solid.

Don’t even start unless you have a business case. A business case and healthcare being around quality outcomes, cost, you know, the quadruple lane kind of things. But once you have that, build out, get your champions, get them on board. There’s always early adopters that you can work with. Get it working in a practice.

Daniel Barchi did a great job of this at New York Presbyterian. He got a champion. And what they did is , you came in, [00:11:00] you came into their ED and you know could end up going through the ED process and the cost was X, which was pretty high. Or they gave them the option of going over into this room and doing tele-health literally in the ED.

Going into this room and doing tele-health drove the cost down for those individuals. And they were able to triage. Now, some of those people, they just said, yeah, go right back over to the ED and get in line. But the number was not as high as you think it was. I think I vaguely remember him saying that, you [00:11:30] know, 60% of which were taken care of via telehealth, even though they came into the ED fo r care.

So it’s interesting. My next story is on chat bot as well. So I don’t know. I keep coming back to as a physician, but you know, as a CMIO, how do you get things adopted? 

Mark Weisman: Similarly, it’s finding that position champion who’s going to support you and you need people out there who have the same belief [00:12:00] and are interested in that technology.

Or you will hit a lot of resistance out there. I’ll give you the, so what on this story. The so what is that health systems are putting these tools in place that, digital front door, they’re capturing these patients and then making that seamless transition to the provider and as CMI’s and CMO’s we want that transition to happen to be on our health systems website, not on someone else’s.

So if you haven’t adopted this kind of technology, there is a business case [00:12:30] and a reason, because your competitior is in town, they are doing it.

Bill Russell: Yeah. So let me, you know, instead of going down this path of, I had a chat bot, a conversational technology story here, and it was screeners navigators, and nudgers the future of conversational AI in healthcare. By the way, I think there’s a great future for this. And I like the terms, screeners, navigators, and nudgers for conversational technologies, right? [00:13:00] Because we are not going to be able to impact the health of a community until we’re able to nudge behavior. I actually love that word nudge. Right when I’m standing in line at McDonald’s. I need someone to nudge me to say, are you sure, let me give you the statistics of a 52 year old man who eats multiple big Macs a week and what that does to your blood sugar levels and those kinds of things. I need nudges, right?

Navigation is another thing that chatbots do [00:13:30] well and screening is another thing that they do well  but I’m going to ask you a question. I’ll lead it off, which is, what technologies really took a big leap forward in COVID? Okay. So chatbots I think are the obvious one. We’re talking about that.

I’ll give you another one. I think it’s, and I’m going to record a podcast on this and it’s going to get released on Monday and it’s actually yesterday, because we’re recording this ahead of time. Now I gave away the illusion, but anyway we’re recording this ahead of time. The other one is thermal [00:14:00] imaging.

And  as I’ve talked to these people, as I’m getting ready for this podcast, I got excited about what we could do with thermal imaging and to make places safer and to give people more peace of mind. I think that’s what technology you’re going to see. Proliferate, not only within hospitals. I think you’re going to see that at sporting events.

I think you’re going to see it at office buildings and other places as well. What technologies do you think took a big leap forward? 

Mark Weisman: I think it’s [00:14:30] the use of the technology that we already had that’s taken a big leap forward in terms of being able to interact with patients in between their in-person healthcare visits.

Just be … the 2 way communication systems ttwoat have taken off, whether it’s the patient portal or use of text messaging, where reaching out, touching people and checking on them, hey, you’ve got COVID, we’re following up on your symptoms today. Are you still doing okay outside of our hospital? [00:15:00] We don’t want you here.

And that’s just been a different message and a different paradigm. So that technology, the adoption of that technology has really taken off and it’s about time. So this is a good thing. 

Bill Russell: So all forms of tele-health really took off. Yeah absolutely they really did. I think the other thing that’s going to take off is a software defined  fill in the blank, software defined networking, software defined lands.

I think what we learned in the pandemic which we [00:15:30] weren’t ready for is, I don’t think any of the disaster scenarios that I had, had us moving this quickly. I mean even an earthquake, you’re in Orange County, I don’t want to, you know, I studied the disasters for Orange County and earthquakes are obviously the biggest one and even though you have to move rapidly, it’s a different set of things that would happen versus a pandemic. And we had to change the fundamental structure of our network, how we interact with patients. All sorts of things that [00:16:00] I think will give us a new understanding, but in order to change rapidly, it has to be software, if it’s hardware we saw constraints, we saw a lot of our hard work comes out of China, unfortunately. You know, you end up with those constraints at the very time that you need the hardware the most. So software defined  is something that’s going to take a big leap forward. All right  what’s your next story?

Mark Weisman: So my next story, I’ve actually got just a few that all relate to the same topic around tele-health and I thought [00:16:30] we touched on this article, it actually comes off of the US Senators website and there have been some congressional hearings around tele-health and this Senator, Chairman Lamar Alexander was talking about the temporary changes in the federal policy that made tele-health explode like it has. And talking about how the federal government should permanently extend policy changes that allow physicians to be reimbursed for a telehealth appointment, wherever the patient is [00:17:00] located, including the patient’s home and extending the payment model around that.

Senator Tina Smith is quoted in healthcare IT news on June 19th. And what she was talking about is about the need to continue the audio only tele-health type visit because there’s a segment of our population that doesn’t have access to broadband. They live in rural communities. [00:17:30] They tend to be poor.

They can’t afford a hundred dollar broadband bill a month. And so she comments that based on a Pew research study, that was from last year, it identified that it is minorities that tend to get hit the most by these kinds of policies. They tend not to have the broadband more than white people do.

And so what are the implications of [00:18:00] cutting off audio only telephone visits? What are they going to do to a minority population that needs access to care. And we will periodically say, hey, we don’t want you coming into our waiting room. You have underlying conditions that we think it’s not safe. If you got exposed, you’d get really hurt.

So we need to be thinking about that. And I know this is a touchy subject when you start talking about racial disparities, but there’s a reality here. There are patients out there that will not [00:18:30] be able to get access. And I know you’ve touched on tele-health a bunch of times in your podcast here.

What do we do as a country? What do we do as CIO’s and CMIO’s to help the political process along here? I could give you a quick story. Bill. When I was at Sentara in Virginia, nurses in Virginia were not allowed to refill prescriptions. [00:19:00] The law said it must be signed by a doctor. And I had never had any reason or desire to get involved in politics, but I was like, this is silly nurses can refill on a patient who has been on Lipitor for five years and has heart disease.

They do chronic disease management. They do education. We should allow nurses to sign prescriptions just for refills of chronic meds. I had a patient who was a state Senator, I asked him, can we change the law? He said sure, change the law. [00:19:30] So as a CMIO, we tend to dump the politics. We don’t want to be too political but in a case like this, what do you think? Should CEO’s and CMIO’s step in and give their technology expertise to congressional leaders around what we need to do to keep this  going?

Bill Russell: So if I were sitting in the CIO chair right now, I would be collecting , massive amounts of data on how telehealth works within your organization. How much of it was voice [00:20:00] only, how much of it was video ?  What  modalities work best, what  service lines work the best. And I would break that down by, I would have my data science team all over this right now.

So that’s the first thing, cause you have to build the case internally for some additional investments as well. So if a CIO is listening right now or if a CMIO is listening right now, if your data  analytics team isn’t crunching the numbers backwards and forwards on tele-health within your organization, you’re missing the boat.

The second thing is, [00:20:30] there’s regional groups. We all have them. In Southern California there’s a group called Chiefs and it was all the CIOs. For the various health systems from San Diego up to, and including, LA County and even out a little further into some of the other counties, but essentially we got together on a quarterly basis. That’s the kind of group that you could get together and say, look we want to impact what’s going on in Californi a, here’s the data I’ve brought together. Do you have data as well to support this? Here’s what congressional leaders [00:21:00] need. They need the story and they need the data just like your CIO needs. They need the story, they need the data. Don’t think that they’re thinking about this every day of the week, they have to think about this, they have to think about the riots, they have to think about COVID, they have to think about whatever. It’s your job to build the story for them. If this is the most important thing for you, give them the words, give them the data and don’t take pride of ownership when they stand up on the floor and are sharing your data, by all means just cheer and applaud.

Two things need to happen in [00:21:30] telehealth. One is broadband access, to defining the haves and the have nots in the United States. We need to address this in a big way. The FTC is addressing this in a big way and I think we just need to continue to push that. The other is, we need to really do the analysis around this.

And again I’m not going to throw out the numbers cause I’ll get in trouble here but the sisters were always saying to me, cause we were doing a lot of technology pushes and they were saying, we’re leaving people behind. What about people? What about the disenfranchise? What about, [00:22:00] and you know, we did some analysis and I know this has been thrown around as an anecdote, but the data would support it, that the people who don’t have a home, the homeless and others have smartphones. Their lifeline to the world is through smartphones and 4G. So if you’re defining any technology, you need to make it. If you really want to reach that pop now, there’s going to be some that have to go somewhere to interact with the health system.  I understand . They’re going to have to go to a library. They’re going to have to go to a [00:22:30] center. In Chicago, they’ve put these medical kiosks in all these places where the homeless go for dinner and lunch and those kinds of things. But we have to be thinking about how our technology needs to be able to work across 4G for the foreseeable future.

And we’ve got to address broadband because at the end of the day, the biggest telehealth workstation is going to be this. And you know, right now it’s about 400 bucks. I mean, the iPhone is about 400 bucks. It used to be, you know, the price kept [00:23:00] going up and this one’s 1200 bucks, which is crazy, but you know, a homeless person isn’t buying this, but a homeless person is buying, you know, a used version or something.

And they have a really nice phone on a 4G network. We’ve got to build our technologies to work on it. I’m sorry, I’ve been talking so much about telehealth recently. I just went off on that, but I think we have to build the case for them. We have to help our senators help our congressmen.

And this is happening at both levels. It’s happening at the state, the state of Idaho just [00:23:30] passed something where they’re essentially, the allowances that have been going on, they’re going to continue to fund them in the state of Idaho. And the conversation, as you pointed out, is definitely going on in DC,  bipartisan but again we have to load them up. We can do that through Chime too, Chime has people there. We can just give them our data and have them go and load them up. That’ll work. 

Mark Weisman: Yes that’s my So What. Get the data, look at your data. We looked at our data and we’re seeing what you would [00:24:00] expect. We have connectivity issues in rural areas and the minorities are being disenfranchised and being left behind. So as CMI’s, we do have an obligation to treat everyone and make sure they have access to care. 

Bill Russell: You know, I just did a podcast with, it actually hasn’t aired yet, with the CIO, for the health system of the Cherokee nation. And they covered almost the whole state of Oklahoma. And he addressed this specifically.

At [00:24:30] the end of the day we have to do all sorts of things because, you know, we provide tele-health in our clinics. So people actually come into the clinic and we provide tele-health right there in the clinic. You said, because you know, quite frankly, the whole state of Oklahoma is still not covered by cell coverage. Just hard to believe in today’s day and age. But that is absolutely the case. He told the story … if somebody had to drive 30 minutes to get a cell signal so that they could have a conversation with their doctor.  

Mark Weisman: So I wrote to Verizon and have been talking with them a [00:25:00] little bit and said, hey, we’ve got coverage issues in our area. What can we do? How can we use some of the steps to see money? Can we get a cell tower put in some way. Trying to think out of the box a little bit cause we have dead zones and their initial response has been, we have the best coverage everywhere. This one guy wrote to me and  said, look, I coach softball in your area and when I’m on the softball field I have no problem in getting cell [00:25:30] reception. I didn’t write back to him, but I wanted to so badly say, I’m so glad that you have coverage while you’re on the softball field but my doctors who are trying to treat cancer patients can’t connect and they’re not on the softball  field. That’s why the softball  field is in the middle of town. They live on a farm.

So I think our vendors need to take a step down from the arrogance here and understand the position that doctors are in. We are [00:26:00] trying to treat patients who are very sick who cannot get access to care. We need you to step up and help us out here. 

Bill Russell: Absolutely Mark. I appreciate what you’re saying. The hard part of that though, is if I work at Verizon, my job is to make money. That I’m not a mission. I mean, the sisters would be horrified with me saying this, but Verizon is not a, you know, a public service kind of thing. At least it’s not a utility, at least not yet. And [00:26:30] the reality is they’re looking at it going, alright, am I going to put a 4G tower in that remote place in Virginia? Or am I going to put 5G all over New York City? 

Mark Weisman: No doubt. And that’s where regulation, and I’m not one who always says, we need regulation as a doctor. I want a less regulation, but in order to protect those who can’t protect themselves, there is no way the poor farmer in the middle of a field is going to be able to convince Verizon, they need a cell tower, or we have to figure out all the [00:27:00] technologies that can get help to these remote areas.

Bill Russell: Yeah and this is absolutely where the government has to step in. You know, if I were at the FTC  overseeing that, the deal between Sprint and T-Mobile … I think those are the two that just came together. Part of that for me, would have just been, okay, look, you guys can come together, but if you come together you have to put a cell tower there, there, there, there and there. You know, I literally told them, this is where you need to put cell towers. You need to expand your coverage. I want to see this, I know you show this [00:27:30] map is completely covered, but that map does not indicate how much density you can actually handle in those locations. And we want to build that out.

And the next time Verizon, because Verizon is going to come and ask to buy something and that’s when they have the most sway over  these organizations and then the FTC has money to spend and get governments to do these kinds of initiatives. And this is where the government shines. They absolutely have to fill in the gaps because the free [00:28:00] market system doesn’t make sense. Building a tower for a place that only has a thousand people that live within, you know, a 20 mile radius of it. Right. So, hey Mark, you know, as always, I didn’t get through all the stories  .We’ll get better at it.

If you’re open to it, I’d love to have you on again, and we’ll keep doing this format from time to time. You can bring your best stories from your show. I’ll bring you a couple from mine and we’ll try to do this again. Thanks a lot for doing this.

Mark Weisman: Thanks Bill. I had a great time. 

Bill Russell: Alright [00:28:30] that’s all for this week’s special. Thanks to our sponsors vmware Starbridge Advisors, Galen Healthcare, Health Lyrics, Sirius healthcare and Pro Talent Advisors from choosing to invest in developing the next generation of health leaders. This shows is the production of This Week in Health IT. Check out our website thisweekinhealth.com and check out the YouTube channel as well.

If you want to support the show the best way to do that is share with a peer. Also share the CMIO podcast with peer as well. It’s a great show and they lean more on the  medical informatics side, as you would imagine. And I’m picking up and learning a lot from [00:29:00] it. So I highly recommend the show as well.

Please check back every, you know. We are now dropping the show every Tuesday, every Wednesday and every Friday  and that’s going to be our schedule moving forward. So thanks for listening. That’s all for now.