NRC Health (NRC) Earnings Call Transcript & Summary

Well, hello. Welcome, everyone to NRC Health's latest webcast. And what might be our most anticipated webcast of the year, I know it's only January -- but I'm incredibly excited to continue this conversation, and you'll see why. Today's webcast is Igniting a better patient experience, something we all want to do, and it is featuring the Dr. Mike no last name necessary. And I want to say hi to you now, how are you doctor?

Doing very well, excited to talk about a topic near and dear to my heart.

It's near and dear to your heart, you will be preaching to the acquirer with everyone joining us today, and it's incredibly exciting for me because I've met you. I've actually been in that studio where you are now in the heart of New York City recording our podcast. We'll share more information on that. But we had a fantastic conversation before, during and after the record button. And Dr. Mike, you've really devoted yourself your profession, your life to improving healthcare in some very unique ways and you have an energy that I think is virtually unmatched and I think that's going to come through today. So we've had great conversations you and I. We're about to have another one. Now if you don't know, Dr. Mike, maybe some folks are googling him now. You probably do already, but he's a YouTuber. He's got a wonderful array of media where you can find him. And one of the favorite things, at least I'm speaking for myself is when, he goes out on the street and he answers questions from regular everyday New Yorkers. I've also seen your reaction videos to some YouTube clips of evolving things of a medical nature. We're going to do that today, but we're going to do it on the most recent series of webcasts that we've had. So this webcast is like the final boss of several webcasts we've done over the winter. And so I want to dig into that and of course, let you do what you do best, which is provide amazing reactions. No pressure. So the first one will come from someone that you know, I know you guys have shared panels before. We've done several pieces with Geeta Nayyar, who goes by Dr. G. She's recently written a book about this information. She's a recognized leader in healthcare information technology. She served as CMO of Salesforce for a time. And she's also been near and dear to the NRC family as we advance human understanding. And we recently talked to her, and she said something very interesting. She is, of course, a doctor, but she was also talking to a patient advocate in this interview. So let's roll the tape on this one, Doctor, and we'll get your reaction. [Presentation]

It is astonishing the number of tools we have. Simple is always better. Less is always more. Just because we can build products doesn't mean that they are the products that doctors need, and we have to, again, close that gap, ensure that whatever tools we're giving our doctors do not disrupt the actual bedside relationship with the patient and the physician because so much of medicine is becoming automated, and I think there's plenty of places where we should be automating things, but the human piece cannot be automated. And that's the biggest piece that we have missed. And that is the piece that both clearly a patient wants and the physician wants.

So she says the human piece of healthcare cannot be automated. And she also says, she kind of takes an interesting approach here that we want things to improve. We want these abilities of things that we -- that get in the way that can be automated. And this is true on both sides of the stethoscope as we say. It's true for physicians. It's also true for patients. I can attest from the patient side. But I've got a doctor in front of me, so I want to know on this piece about the human side of healthcare and automation, what's your take?

I think there's a lot of excitement about AI, rightfully so. We can use AI as a potential tool in the toolkit to better serve patients to be more accurate with our treatments, to know which patients would get better from each of our treatments. When we recommend a medication like a blood pressure one, to lower ones blood pressure into the correct range, there's several dozen of patients that we would need to treat to prevent one heart attack or one stroke. But if we can use AI's tools to better narrow down which patients would get better from the treatment, therefore, I would have less patients unnecessarily taking that medicine. So there are ways AIs and algorithms can help us, then there's ways where it becomes less human and it becomes problematic. I actually recently saw that there was a study that came out where they tested an AI system with patients that were actors. And the patients that were actors supposedly gave these AI systems that we're trying to replace doctors in this scenario with better scores. And I can only see that with an imaginary patient because no patient wants their doctor to come in and be a robot. When doctors speak robotically to patients when they stare at the computer screen and type even though they might be doing the correct thing by documenting the encounter, documenting and listening intently. The fact that they're acting robotically creates an issue for the patient's mind that this doctor is not fully caring about me as another human. And when you have that and you lose that trust, the teamwork that needs to be on the same page in order to get best outcomes, that's where you run into problems. And only when you dig in deep into that research article with the patient actors and the AI system, can you see that if the patients spoke in plain language, where they would use SARCASM when they would talk about common situations that are happening in their everyday lives. For example, to say, "I have a chest pain that's a pain in the butt. The AI systems get confused by that and start saying, is that a pain in the gluteal areas, is that a pain in the chest and you lose that human connection. I can't tell you how, so many of my patient encounters are less medical, more and more often and more human, more and more often. Because the things that actually drive the best outcomes happen as a result of things that we can do within our lifestyles, within our human capacity. There are certain ways, obviously, that medicine helps and modern medicine is amazing in that. But if we can really get our patients to have buy-in and decreased their alcohol consumption or stop smoking, we'd not only prevent unnecessary deaths by the millions, but we'd also save billions of dollars in our healthcare system.

I like how you ended that because the challenges are massive, especially on the patient side, and we're dealing with human behavior. But it is really interesting that a lot of your work is starting to go into those forays. And I want to ask you a question before the next clip, because of what you said about, some of these experiences are more human, does that bode well for us on things like social determinants of health because I've been in rooms with CEOs and Boards of Directors of very large healthcare organizations, a lot of NRC clients who really want to advance this work on social determinants of health. But the -- maybe it's visible, maybe it's invisible, the barrier is but we're over here providing acute care and people are coming to us down a one-way street. And it doesn't feel as comfortable or maybe we are having trouble investing the capital going out to them, and helping them with lifestyle things that will absolutely influence that road of them coming into us. Does that give you some hope around that? Are there other organizational barriers in the way? What do you think?

I'm hopeful that the fact that we're talking about social determinants of health would mean that they come up more often than their thought about more often during healthcare interactions, because I can prescribe the correct medicine all day long. If my patient doesn't have access, can't afford it, cannot get transportation to go secure the medicine, the fact that I gave the correct medicine is truly meaningless to some degree. And what I found is that you can't devolve social determinants of health to check boxes because everyone deals with difficulties in their life in different ways. So someone that may have certain social determinants of health can have them be completely destructive to their life and it may be destructive to their transportation. It may be destructive to their mental health. But you could only know that by being in the room and facilitating that conversation with another human, not a patient that's a checkbox to a CEO or a corporate leader. So while on an outsourcing level, meaning like if you zoom out on a macro level, yes, we can have certain factors that we put into check boxes in order to see how we deliver care. But again, we have to then target what we're doing, our conversations, our guidance, our information needs to be individualized for the patient sitting in front of us. Because I can have the same condition, the same treatment be completely different, even though the condition is the same. So it really depends on that patient, what they want, what their former experiences were, how those social determinants of, how they're impacting them, and it becomes a nuanced topic on an individual level. So macro, great, let's focus on it more. But then let's have that trickle down to the micro level as well.

We beat that drum so much on the individual level. I mean the idea of human understanding is that -- there is no one else like you, you are truly unique, and you have to build relationships at that level, and we've done a lot of talking up here but not down here. Curiously enough, to your point, about what people need to be better patients and to be able to navigate whatever their specific circumstances are. We've gone in and asked consumers in our surveys, what if a hospital provided some of this advice. Because that weird to you that it's the hospital and you're used to you see the blue square with the white age and you drive there if there's trouble. And people said, yes, like I will take the guidance. I would love the guidance because I'm out here on my own. And that actually goes right into the next clip, I'm going to show you. So on the other end of that conversation with Dr. G folks might have seen another person, this is Cheryl Marker. Cheryl is not a doctor, so like me. And she is very much invested in patient care from the patient perspective. So she dealt with a terrible illness. She was battling several chronic illnesses over the years. You see the list here. I won't even try to pronounce them or belabor that. But the biggest thing that was a common thread was just feeling unheard feeling misunderstood, really trying to understand how she could fight this battle without being completely alone. And I want to play you what she says next. [Presentation]

I think patients are turning to Google because they're not getting the resources from their healthcare providers. they're wanting to learn more about their diagnosis or their symptoms or maybe they're undiagnosed and trying to figure it out themselves. I have definitely been there. I am definitely a doctor in real person. What I found though is that you really have to find the right resources on Google because there is so much misinformation out there.

Okay. So she's talking about patients wanting to learn more, trying to figure this out. We've talked about this a lot and just this idea that have all this information but I don't know how to navigate it. And so I'm wondering the sort of wilderness of online information, and I'm ending up at the doorstep of Dr. Google. And that phrase Dr. Google, if you want to rip on that at all, I don't know if you've met Dr. Google, but they're out there, right? So we talk about this as an industry from look at all this technology and look at these new ways and AI that you've already mentioned, this empowers the patient. This empowers the consumer. We hear a very different side of it from patients like Cheryl. And what do you say to patients like that?

I say that everyone that's told you that it's a problem that you like to Dr. Google is wrong because a patient that is engaged, that is advocating for themselves. That's a patient that's ready to listen, that's ready to make change. There exists no better patient. In fact, the issues that I have sometimes in delivering care is having a patient that may be because of a mental health condition or something going on in their lives is not motivated, is not excited, and we have to actually spend time first cultivating that motivation and finding the reason for why they're going to want to take care of their health. So when you have a patient that's going on Google, that's a patient that is hungry. They want to get information. They want to do the right thing. And the only time that I feel that doctors would want to speak negatively about that is if they don't have the competency to answer those questions. So they react with this negative outcry that, oh, the patient is Dr. Google. I think that's misplaced anger. I don't think that's correct behavior. I even feel the term Dr. Google is a bit outdated. This is something I saw when I was in my residency training 10 years ago, and doctors had those mugs that said, "Where did you get your degree, Google, I went to Medschool or whatever it was. Now people don't even go to Google. They go on social media. They use TikTok and YouTube as their search engines. So it's no longer Dr. Google, it's doctor social media. And why have we seen the transition to social media because people crave getting information from humans. So even the issue of misinformation has been propagated because of the craving for human interaction. And because we've been so behind in our efforts to educate patients about their condition because we always would say that they wouldn't understand. It's too complex, and we would create complex lingo that they wouldn't understand. For all the time we spent doing that, we've lost our patients to people who are spreading misinformation that are making it simple and easy to understand. So what I've actually done across my social media platforms is study the people who are stake oil salesman. The people who are promising an alternative to the dense nonhuman focused healthcare that exists today and bring that to evidence-based medicine and the results have been phenomenal. The reason that we have billions of use our content is not because I'm the leading researcher in my field. I don't have any added knowledge that the CDC hasn't already published on their page. I just presented with the human first emphasis with a transparent thought process. And when you have that happen, patients understand. Patients like Cheryl want transparency. They want honesty. If we're not sure about which treatment will work, we have to lead with honesty. And if you have a patient that's excited about it and wants more education. My God, that's the most beautiful thing we can have as a physician.

I'm going to give you a compliment here on, I would far rather listen to you talk about this then read the CDC's website. I'm just going to put that out there right now. So I think your communication model works. And what I'm hearing to when you're thinking about Cheryl's situation, and you found a way to break through that in a very digestible entertaining format that is still incredibly informational and educational. There is rock-solid lessons in each clip that you share. And I feel like there's this void. So I think you've been able to travel across the void. I think a lot of physicians still and traditional organizations are still waiting for those patients to show up. I'm curious, before we go on to the next piece, what do you think about these sort of half steps or these attempts to fill the void with things like telemedicine or what we're seeing in urgent care or the combination there in what Amazon is working on. Because you have a pretty sturdy view of what great patient care is. Are these settings part of the solution? Do they create new problems? Because I can tell you from the consumer side, they're definitely more accessible. But from the physician point of view, what do you see there?

When used responsibly, all those avenues can be amazing facilitators of delivering great care. But I have to underscore when used responsibly. It's very easy in our current capital system that's very profit focused, which doesn't always necessarily mean that there's a problem. People are very quick to think shortcuts. If something is all natural, that means it's all safe, not necessarily. If something is for profit or automatically means it's evil. That's not always the case. We have to have some nuance there. So in our current capitalistic system, it's very easy to have a tool like telemedicine, urgent care that would fit a very specific niche and help very specific patients, start getting overused because it can become possibly more profitable. And we have to put safeguards in place and educate patients so that they don't use these very well intentioned avenues for getting care in ways that is not ideal for them. Too often, I see young people in college early in their careers, start utilizing an urgent care as their primary care doctor, which is not what the tool is intended to do. It's like, sure, you could use a screwdriver as a hammer, but it's much better and safer to use a hammer. So we need to think about it that way and educate it in that way so that patients can make the best decisions for themselves.

So we might not just have Dr. Google. We might have Dr. Urgent care, and if that doesn't work, now we're maybe going into the emergency department. I mean I think you raised a great point. And I also think that -- this gets to the issues of access, and we know that access has been incredibly a hot button issue coming out of COVID, everything being backed up, being told, you used to wait 2 weeks, now it's 2 months or 2 months is now 6 months. And this also gets us to equitable access. And so I want to go just in a moment, I'll go to our next clip. I also -- I feel a little bit like I'm in a patient care room with you, and I'm one of those patients who has a lot of questions. I don't have to be the only one asking questions. Everyone on here, and we've got hundreds, can pop in. And if you would like to ask a question that we can then cover today, we do have limited time, but we will absolutely forward this question on to Dr. Mike, and if I can cover it live, I will. But let's move on to the next piece. So Aisha Patterson also did a piece for us for NRC Health. She brought in Michelle Kang, who also survived breast cancer. They were together breast cancer survivors. They had a really, really interesting at times heartbreaking conversation, but they're both survivors, which is the best part of that, that unites them. And now Aisha has become a breast cancer advocate. She advocates for others. She specifically advocates around health equity and equitable access to care, and I want to play what she says here. [Presentation]

When we're at our lowest point, we really need compassion, we really need empathy. We need doctors to really prioritize us -- and I really like how you decide it's really hard for doctors because they have so much on their plate. And I think it's really important for us to also show up as the best versions of ourselves and be really good patients. And I think it's so important as patients that like we realize, like we are in the driver seat of our health and our doctors are in the passenger seat. We are driving the car, but they're giving us the directions. The goal is always that we can have long-term good, strong relationships with our doctor. And I think that means both of us putting gas in the tank to make that car go.

Okay. So I particularly enjoyed this clip. There's a lot of juice to this particular clip, and there's a few different perspectives. So we can take as much time as you want on this one. I really think that she's -- there's an empathy that's coming from the patient to the provider here. We need to be prioritized, but we also understand that there's so much on your plate. So Aisha does a good job and Michelle as well as saying like there's a dual struggle here on both sides. But at the same time, we want some control or at least some say, and we want to feel like this is more of a 2-way street. So hearing that, what's Dr. Mike's take on this 2-way interaction?

Very commonly, we hear 2 statements that appear to be contradictory on their face. And we believe that they can't both be true. And with this perfect example from Aisha and Michelle, these are both statements that are true. It is true that you're in charge of your healthcare. You can empower yourself to make good decisions and you can hold your doctor accountable and the healthcare systems accountable for your care to make sure that you're up to date and you're educated. At the same time, those who are sick, need empathy and guidance, and support from doctors, from the healthcare systems to help them when they're at their low. The same way that I would say you're in charge of your health in terms of keeping a healthy weight, but there are things that are completely outside of your control that can impact your weight as well. From behavioral -- learn behavioral tendencies from childhood, from genetic conditions of your metabolism, from the medications you may be taking for certain conditions that may impact your weight. So both statements are actually true and this is what I think ties so perfectly to the idea of treating patients as humans makes the highlight all come together. You have a person that you might treat one way where you'd say, "This person, we can empower them. They are normally very supportive of their care. They're very focused. They like learning. They like going on Google to learn about conditions. This is a patient that I'm going to empower to advocate for themselves. On the other hand, we can see as a provider that we have a patient who's struggling to make ends meet. That is working multiple jobs, taking care of multiple children that may have a pre-existing health condition that's leading their mental health to be in a really rough state. And then that's where we need to step in and understand, look, if I can't be there for this patient because I have to move on, and I only have 15 minutes, I'm going to make sure that someone on my team, whether it's a social worker, a patient advocate, a resident, someone else comes in and make sure that, that patient is able to get the access to the treatment that I recommended or the diagnostics I recommended. But both statements can be absolutely true, arguing whether one is more accurate than another, doesn't actually help anyone.

And I think by acknowledging the truth in both statements, and I agree with you, I really don't see the conflict there. But I also think that acknowledging the truth is there's a 2-way compassion to that of understanding both perspectives and maybe ultimately having the same shared goal. It's just that's obscured by so many other things. Before I move on from this one, I have to ask you about the driver's seat analogy because I really like it is bold to say the patient is in the driver seat. I know that if I got in front of a room of doctors, I was with doctors last week at the Governance Dispute. There will be doctors that would throw their papers up at this idea of the patient in the driver's seat. I should be in the driver seat. So, I'm not necessarily meaning you have to keep going with the automobile analogy, but it's stuck in my head. Is that the right way to think about it? Is the passenger writing -- is the patient writing shot down? Or do we throw the car analogy away altogether?

I think if you don't like the analogy that's fine as a provider, but I think it's the reality. The patient is the expert on their symptoms and their condition. There's no other way about it. That's the reality. We can be the experts on diagnostic and treatment modalities, but they are the expert on what's going on with them. There's a reason why all of our note-taking and our decisions start with the letter S. SOAP is sort of the acronym that we use when we formulate a patient visit, S stands for subjective, O is objective, A is assessment, P is plan. S is the first and most important thing in a patient encounter. We need to understand what situation the patient is experiencing, how that situation is impacting their lives. How they hope that it changes with this visit -- and unless your plan directly addresses that S, your plan is again nearly meaningless. It can be factually correct all day long. You can be the greatest AI system in the world. But if it doesn't connect and answer the questions posed in S, not going to be valuable for the human sitting in front of you.

And I really think the way that you talk about the 2 experts. I mean we've talked about we have a research tank, a think tank, within NRC Health. The human understanding institute. One of the questions we posed to people is what if there's 2 experts in the room. What if there's a physician who has the expertise that's very well understood and adherent. And then what if that patient is an expert about themselves and an expert about their care. And we once asked a question about people who love their physician, felt their physician was high quality, provided safe care, like institute of medicine stuff. And one of the most important things that a physician could do was listen. Because of this idea that -- but how can you really provide all that excellent care and be the experts you are if you don't know about me. And I've just always loved and appreciated that take -- that brings me to this idea of patient. And this is a patient who sort of speaks for himself, his reputation precedes him. I'll read a little bit about it, but a lot of NRCL clients have experience the phenomenon of e-patient date. So Dave Debronkart, he survived Stage IV kidney cancer 15 years ago. He has a fantastic story. He shared at our last hub event around how he didn't think he'd be able to see his daughter get married, and he was at her wedding, dancing with her. And this guy is incredibly passionate about patient care, and I want to get your reaction to what he says here. [Presentation]

The World Bank has a phenomenal definition of empowerment. It's increasing people's ability, people's capacity to make decisions about what they want and then take effective action. If somebody knows what they want and they can't take effective action than anything you can do as an organization to help them move in that direction is, by definition, empowering to them. And you will discover things along that journey yourself. You will discover other obstacles along the way that are further disempowering. And the thing is nobody designed it that way, right? It's just stumbling blocks that have arisen in the process.

So you might see from our reaction there. I got nervous at the beginning when he started using the World Bank as an example because Dave does love to go on tangents, but he's an excellent patient and an excellent patient advocate. And actually, what he does there and as part of the spirit of his larger approaches, he talks a lot about organization. So let's zoom out from the physician patient bond, which we know is incredibly important. And let's think about it from an organizational point of view. He's basically saying anything you could do as an organization to move patients in the direction they want to go and the direction that they're willing to take is empowerment. Now before I scoot this over to you, I get nervous about the word empowerment because we've used things like new technology or faster surge or, oh, you have a high deductible, so you have skin in the game. We've used those as excuses to say people are empowered. I feel like they're more pressured to take control of their care, but I don't know. I don't feel like they always still empowered. But when e-patient data is sort of calling on organizations to empower patients and help move them in the right direction. What is your take on that? Is that feasible? He talks about barriers, too. So I'm curious from your point of view, what stands in our way.

What I've seen is that most issues that patients face within going to access care or empower themselves to take care of themselves, happen as a result of organizational or institutional inefficiencies. Their whole times are too long. Public transportation is an option. Parking is an issue, difficulty in securing an appointment. Those are things that should be rather simple to solve given the fact that we have so much money floating within the healthcare system and yet the user interface of our hospital and healthcare system is incredibly messy. And I could say that both from being a patient trying to schedule appointments, blood work, et cetera. But even yesterday, I was in my office, in my hospital, and I had a patient that I needed to order a blood smear on. It's a test where we ask the hemopathologists to look at the blood under a microscope and tell us what kind of cells their see. It's a pretty common test I couldn't figure out how to order it on our computer ordered system Epic. So I call our lab, which I don't know the exact phone number for, so I pressed zero, get the operator and they transfer me to the lab. I was on hold for 32 minutes to get an answer that should be very quick to get an answer to. And granted, because I was able to have that going while I was doing administrative work, it was feasible. But imagine I'm trying to get that done for a patient, while they're sitting and waiting, I'm also not being able to help another patient. So now I'm delayed for the next patient. We've just created a firestorm of issues off just the fact that I can't get an answer to a simple question. So I think it needs to be thought about from a user interface standpoint more so than a true healthcare system standpoint. And that goes even speaking about the topic of transparency and pricing where, if I am trying to prescribe a medicine for a patient or a diagnostic modality, I don't know the cost of these things because they're so hidden and so differently negotiated by different insurance companies with different hospital systems that it becomes impossible to formulate a budget-friendly plan for a patient. Any other healthcare system that is not insurance base, let's say, cosmetic surgery, we can call multiple offices, compare prices for a nose job, some other procedure, liposuction and get prices and do a comparison shop. In healthcare, this is near impossible to do. And then we wonder why patients are upset with the cost of healthcare because they're not in control. The idea of empowerment is really just a hallucination in the corporation's mine because the problem empowered, I know cost of things. If I'm empowered, I'm able to have choice and things. If I'm empowered, I get my questions answered. But if I need to wait 30 minutes to get a simple question answered or I have no idea how much things cost, the idea of empowerment is really just a mirage.

I would go a step further even and say that I love the idea that it's a hallucination because every article I read about empowerment, this has become like the vein of my existence or when people talk about it in person, and they don't offer up actual tools of empowerment. They offer up maybe some possibilities. But the other thing that it does is if we can shift this to the patient, it gets us off the hook. And that's the part I really don't like. And I think your example of this mechanism, this -- the 32 minutes, like I can tell that seared in your brain and you're going to remember that wait time for years. It's how long we've been talking today and it's just too long. And then it disrupts and interrupts all those patients for the rest of the day, who've been waiting a while to see Dr. Mike. And so I think that, that's such a good point. And I think your organization will take on it is spot on. By the way, I have more clips to play. I'm going to put this on bonus round for now. But we have questions from the audience. Imagine that people have questions for Dr. Mike. So I want to go to some of those don't have video for it, but I think you'll do just fine. This first one is a topic that I know you're passionate about. So this is from Terry live from this webinar. She's saying, I worry about provider burnout. So there's the B word, burnout. How can we help our physicians to have a better work environment and a better work-life balance. So this question is from Terry and also from every organization in the U.S.

I mean, man, I am -- I want to give myself credit that I'm passionate about the topic, and I'm -- I want to help my fellow colleagues, myself even with this situation, but it's a very hard and complex question to answer. I think it starts with giving adequate time for physician visits. It's just -- it's impossible to learn who a person is to learn that subjective most important part of the visit that needs to tie into the plan without having adequate time. And that's something I've been blessed with my current situation to have more time to spend with patients to be able to learn what is actually bothering them. So many times a patient will come in with a certain complaint or written complaint of pain in a certain body part or blood pressure issues. But when we really dig down and figure out what's going on in their lives, that's issue #22 or at least it's the issue #22 causing the risk, the greatest risk to their health. So doctors do this so often where a patient comes in and says, Hey, I'm having this terrible sciatica pain, but I'm also having abdominal pain. And the doctor says, "Oh, forget about your sciatica, that's not as important. I want to make sure this abdominal pain isn't appendicitis or something. And while that could be important but you've completely neglected the reason and why the patient entrusted you their care to begin with. They came in with one complaint, and we've substituted. And it could be clinically appropriate to do so. But unless you get buy-in from the patient as to why you're doing that and get them on the same page, you're no longer empowering the patient. You're empowering yourself to spend their limited minutes with you in whichever way you see fit. And again, it could be clinically appropriate. But if subjectively, it's not well received, it's not going to be valuable. So I think we need to be really conscious of the time we give physicians to spend with patients. Because when you do that, you allow doctors to make that human connection with patients, therefore, get good outcomes. Therefore, feel refreshed after a long day because they're actually helping people as opposed to treating us like someone that is just using a prescription pad, that is just clicking check boxes on the screen and not actually benefiting and helping the patients that have real-life problems and are entrusting us to help them with that.

Your point about timing, I think, is really important because it draws a thread back to the 32-minute weight as well. And so I think burnout is a big topic. We can spend hours on it, but I think that that's a really interesting angle. I want to tie back to what you talked about at the outset about AI, it's this hot button tech issue that you get asked about a lot. Dr. Eric Topol, who's done some work for us. He spoke for the Governance Institute. Dr. Topol recently did a Ted talk and he used a phrase that I love and use the phrase keyboard liberation, if AI could just specifically like make this first on the list, maybe it'll do 1,000 great things for doctors and patients. But if you could liberate us from being these data entry specialists that we never signed up for didn't go to medical school for. He felt like that would be a big solve for some of the time issues. So I'm putting you on the spot with this, but you're used to it. So what do you think about like that specific application? Is that part of the answer here? Or is there too many other factors to that?