How Cambridge Health Alliance's 30-Language AI Revolution is Changing Healthcare Forever

[0:16]  Welcome back to another episode here on the hard podcast. Our next guest says the communities who've had the least are leading the future of healthcare and now they're just waiting for innovation. However, we're building it ethically with what we have, says Dr. Hannah Galvin. Doctor, appreciate you joining us here on the Heart and Hustle podcast. I've got to ask you right into the first question. You got one foot in tech and one in pediatrics. What's the connective tissue between those two worlds?

[0:41]  Yeah, I love it. Thanks for having me, Eron. Uh, it's great to be here. Yeah, so it's there's a lot of connective tissue. Uh we are using tech to move pediatrics and other specialties uh uh along kind of at the speed of light here. Uh at Cambridge Health Alliance um we're using generative AI. We're starting to look at agentic AI. Um and we're doing it all with an equity lens. Um Cambridge Health Alliance is the only public health system in Massachusetts. Almost 50% of our patients uh don't speak English as their primary language. And as we're using these new innovative tools, we want to make sure that we're serving all of our patients, all of our patients at different age groups throughout the life cycle, uh, and across care settings, and that we're doing it, uh, in a way that has an eye toward, uh, equity and to, um, serving patients where they are. Um so uh it's it's really important that um we are not just using the technologies because we're they're they're out there but we are understanding what our patients need and then using the right technologies at the right times in the right settings uh to meet our patients needs.

[1:49]  I ask you what moment in early on in your career actually made you realize equity and care wasn't optional but it was actually more personal.

[1:57]  Yeah. You know, when I uh was in high school, I I uh spent some time at a um clinic, a I spent some time uh in both an emergency room that served a vulnerable population, a Children's National Health uh emergency room in DC, um which uh is where I grew up. I grew up in Washington DC with a lot of very underserved and ethnically diverse populations. And I also worked at a at a clinic that was a stand-up clinic uh in a church basement once a a week where we uh sort of uh popped up this clinic for homeless um and and uh at risk individuals who did not have health insurance um and uh just provided free care and uh it's where I learned to you know uh to take a history and perform vital signs and I watched as doctors volunteered their time every week to take care of these vulnerable populations and realized that um and really learned from these doctors that uh that that is what medicine is about, right? Is is serving the most vulnerable and um and providing not just medical care but providing um other uh uh uh providing for their other needs. So we would give food. We had a food pantry there. Um and uh that was those were some of my early experiences in medicine. And I think that informed uh all that I do today as well.

[3:20]  And tell us a little bit about the organization you're with today.

[3:23]  Yeah, so Cambridge Health Alliance is uh the only public health system in Massachusetts. It's Harvard Safety Net uh health system. Our mission statement is equity and excellence for everyone every time. We have uh three hospitals, two acute care hospitals and a behavioral health hospital. We have a a very large behavioral health footprint. understanding that behavioral health is part of of one's overall health care. Um, as I said, uh almost 50% of our population does not speak English as as their primary uh language. Um, we uh are an academic uh health system. Um, but we are also a safety net health system. And so we sort of uh bridge that um sort of chasm of uh working on um advancing um sort of the the cutting edge of academic medicine, but also right we have a a really uh strict bottom line, right? We we are um uh really challenged with uh our budgets and uh serving a patient that a patient population that is about sort of uh an 85% public pay mix. So how do we do that? We uh pride ourselves on being very innovative. Um but uh at the same time we need to prioritize what are um the uh most important um areas to invest in. um that will have the best outcomes and the highest value for our patients.

[4:54]  Ask you Hannah, before you get into this world of just healthcare,

[4:57]  what did you want to do? Where did you want to where do you always see yourself here? Is this like you just following in the footsteps of family or you just realized at early like wait a minute I got to do something about healthcare and and you just loved it.

[5:08]  Yeah. No, I I I my parents were not doctors actually. Both my parents worked for the federal government. Um and um I think I sort of picked up some of that um I would say uh desire and and understanding that we kind of uh all um exist in this this country and this culture to sort of uh help and serve one another uh from them and um from from sort of as I said growing up in DC and and understanding that um you know I think uh my my sort of perspective is that uh The goal of uh government in this country is uh to serve uh that and serving sort of uh the the those who um can um who are struggling the most is is um is is what the goal of um of anyone who who has uh more in this country um is and should be. And so I think that's what I picked up um early on. I I think I wanted to be a teacher because those were the people who I think made a huge difference in my life as a young child. Um but I uh figured out pretty early on that I wanted to go into healthcare. I think around 9th grade or so when I started to learn about biology and that really interested me um and research um and uh and and bi biological research uh and I spent a lot of time uh interested in that and that's when I started working in in health clinics and volunteering in health clinics and and I really just fell in love with it. I fell in love with the um idea of serving and and caring for patients. Um, and so I knew right away when I went to college that I wanted to be a physician and that I wanted to serve underserved communities. And so that's been a theme throughout my journey. Um, that uh that those were the populations that I felt called uh to care for and um and to serve. Uh I did not um know at the time that I really wanted to have so much of a technical uh bent although all you know during my childhood and growing up I was always sort of a techy kid right I I sort of grew up in the computer age and um uh I was always the kid that my friends parents turned to to sort of help fix their computers and things like that. And so in college and medical school I got campus jobs work study jobs uh on the tech side of things. So I wrote websites, I worked uh at the help desk um and and things like that. Um and uh al so in medical school as well I was doing tech work. So when I got out of residency that was right around the time of meaningful use and it turned out that uh right they were looking for doctors who had a technical background who could help with the roll out and implementation of electronic health records. And they tapped me because it just came easily to me. that wasn't a computer science major. Uh that that hadn't been a major interest for me in college or medical school, but uh it happened to come easily to me. And so they tapped me and then I realized all of the amazing s systemwide changes that we can make and the systemwide advancements that we can make using technology. Um and that's really where uh the two kind of married.

[8:23]  When I think about technology, as you mentioned, growing up during those times of computers, same right. And um I think if I wasn't doing what I was doing, maybe tech would be what I'd be doing. I just realized yesterday I bought these uh I bought a new um a new mic, wireless mic.

[8:39]  And first of all, the way that these wireless mics look like now compared to what they used to look like. It's crazy, right? But I'm sitting here with all these gadgets and I'm buying new computers and I'm building a PC. Mind you, never in a million years would I thought I would have built a PC? I used to make fun of people like, "You built a PC? What do you mean?" Realizing no, the benefit of it actually is right. Right. So, I'm getting into this world of technology and realizing um if people are not doing tech, like if you're not going to go to school for healthcare, technology is one of those things that are not going away. The advancement is there. I was talking to a young girl and she says, "Yeah, the only thing I could take was technology." And I'm like, "That's great."

[9:12]  That is so good. That means you have a job for life.

[9:15]  That's right. That'll serve you well. Right. Exactly. And it's just continuing to advance, right? There's Yeah.

[9:21]  And we talk about technology in the healthcare. I feel I speak to a lot of leaders in the healthcare and the nonprofit space. Technology seems to while it is here, it seems to kind of lack in those organizations. Is there anything that you're kind of excited to see down the pipeline? I mean, we talk about AI. Is that something that you guys are looking towards? How is healthcare advanced? Let's talk about the last 5 years. How do you see healthcare um advancing in the last 5 years and what does it look like for the next five years? Yeah, you know, so I think right um even certainly 10 years ago it was all about implementation and it was about optimization and right uh integration and innovation and and now right it's about automation right so now we're sort of in this age of automation uh with AI and um even in the past five years or even I would say right in the past one to two years right we've gone from uh looking first at sort of predictive AI I and and what predictive AI could do to then starting about two two to three years ago to generative AI and now we're really moving into agentic AI and what agentic AI can do for you and sort of automating tasks and and um taking tasks off people's plates to uh continue to let people work at the top of their license but also to um allow processes to run um more efficiently quickly and improve patient experience of care so people aren't waiting on hold with uh scheduling centers a as much because they can take care of more through a chat agent um and so so I would say that's where we're moving is into much more automation um and there are pros and cons to that right um we all have experienced I think in the past probably 10 years uh other industries moving into automation right uh you call um you're a cable company and the cable companies have sort of automated uh uh right um uh voice agents that that answer and that is great because they uh can route you to the right place and uh they can answer some of your questions and uh they spend less money maybe on um people to answer the phone and those people can be doing other things or cross range to do other things to help you out, but also people get frustrated when you know an automated voice agent answers the phone and right doesn't understand you. Same thing with banks, you know, things like that. And so we have to be careful as we implement some of those tools into health care to make sure that we are actually caring for our patients appropriately and that patients um right that there's no miscommunication with that and that everyone is cared for safely as we implement those tools. most importantly that everyone is cared for safely and so um so I would say that is how I see what has happened over the last several years 5 years so

[12:25]  that's good and and you kind of mentioned that uh like chat agent picking up on its own I was in the airline industry during pandemic where everything was kind of shifting and realizing that we're starting to implement some of these things you know um when you chat with us so now a lot of your answers were really sorry a lot of your questions were actually answered before you even got to a live agent So, you never had to get to the live agent. Like, that's how good it is. And I think what people Oh, man. I just actually had to someone really good uh write me yesterday. So, when I spoke to this lady, she was so afraid of AI. And when I say AI, I'm talking about chat GPT. Like, that's the most basic of the basics, right? So, she was when I got on a call with this coaching on this coaching call and this lady was like, "No, I would not use AI." And I'm saying, "But what you're doing is you're paying a company, right, all these thousands of dollars." And I can imagine that they're using AI to build your brand and really their voice because it's not your voice. So I'm showing her how to actually take some of these things and put in her voice. And this was like a week and a half ago. Yesterday she texted me on a Sunday. She says, "Hey, I just want to let you know, thank you so much for all the insight that you've given me. I think I'm overusing it." But it's like you really can't overuse it. It is truly there to help you and and to as you mentioned just allow us to do things a little faster, things that we do tend especially in healthcare things that take us um take time away from us

[13:47]  instead of actually being able to work with that patient. Why can't we automate that?

[13:51]  Because let's be honest, Hannah, I know you didn't go to to college and to a nice university to sit here and do admin work and all this paperwork. It's like no, that's not what I wanted to do. I that's not I I hate this. Right. So, I think it's a great place and I'm I'm loving that you're in the healthcare space and you can see the vision because there's still some people. My mom's in the healthcare place and I says, "Mom, have you ever used chat GPT?" And she's like, "What is that?" I'm like, "Oh my god." So, you know, it's not everyone's not adapting to it. There's still some challenges, but I feel like when people are actually utilizing it, they're educated around it that it's making a difference in their lives and also in their work lives. And I'm I'm happy, Hannah, that you guys are kind of in that space, especially you because of the tech background, in the space of seeing how it really does become a benefit and how we could serve more people in our communities in 30 different languages probably. Yeah.

[14:37]  Right.

[14:38]  Yeah. And I I would say, right, it really can be a benefit and and you know, the American Medical Association is actually um starting to call AI um augmented intelligence, right? because it's it's helping to augment the things that we are doing which which is uh I think a really great term for it. Um but but it has to be used carefully right and it and when we think about how we are using it here at Cambridge Health Alliance one of the things we start looking at is um first starting with efficiencies and how can it um as you say take away some of that administrative work. So we have implemented uh a generative AI tool uh uh integrated with our electronic health record um to uh help providers write notes. So we were we were early on in that and we've we've had that implemented now for a year and a half or more, right? To take some of that burden off of providers. There is little safety risk to that because providers are reading the note over and making sure that whatever the generative AI tool drafted is um is correct, right? And and and actually happened in the in the visit. We are um using an AI tool. We're we actually are development partners with a few companies and we're developing a tool that is a medically context uh uh that that that is a translation tool that is um uh appropriate for the medical context. So if you look at some of the translation tools that are out there like Google Translate, they're very good translation tools, but they're not trained on on medical data. and so um and and medical terminology. And so when you try to use them for medical translation, they're not as good and maybe not appropriate to use for sort of patient discharge instructions and things like that. So we're working with a company um and helping to train the model um in in sort of medical context uh language translation. Um we are also um uh a development partner with a company that will translate our phone trees um right for our patients with many many different languages um and and specifically our top three or four languages um and we are uh using radiology uh an AI tool for radiology for triaging radiology studies where it's not reading the radiology study although we have tools that help with that as well that's really sort of standard of care these days but we'll take a look at all the radiology studies in a radiologist's queue and say, "Hey, this one needs to be looked at first because this patient has something that is really, really significant." Where AI hasn't been used or tested significantly yet is in like making a diagnosis, right? So people are there's a lot of anecdotal reports right now of people sort of typing their symptoms into chat GPT and it spitting out a diagnosis. Um and there have been a number of studies where um people have used chat GPT or similar sort of large language models in um answering boards questions, medical boards questions or with clinical vignettes. But there aren't studies out there um showing how that works in real life like in the clinical space um and actually seeing patients. And so we are starting a study where we're going to look at chat GPT and a few other large language models and how safe they are um in answering medical questions in real life. Um which I think is really important to look at because you want to make sure that when you're using these tools, you're using them safely.

[18:14]  Hey, real quick. Have you enjoyed the podcast? We first want to say thank you and we also just want to give you a little insight of what we're up to at Francis. Some don't even realize that we're working with organizations to help them use AI to create that real human communication experiences where that's actually supporting your your families, those patients or the entire community. We're actually creating tech that connects. Check it out. Francis.ai.

[18:40]  Correct. Yeah, people are using them. I spoke to someone that said her daughter is using tattoot more as a therapist. So, uh, yeah, it's happening.

[18:48]  It's definitely happening. And we're also hearing reports of people who are using it as a therapist and it's not giving great information, right? It's telling the patient, you know, people things that that make them more depressed or make them suicidal. And so, we want, right, I think they are fantastic tools, but we also want to have guard rails up to make sure that people are able to use them safely. Um and and so it's, you know, that's my job as the chief health information officer is to make sure that we have good governance around these tools. We want to be on the cutting edge and we want to innovate and we also want to make sure that we are using the tools safely and not uh and and right as a doctor never doing harm. That's part of the hypocratic oath, right? And so that's a it's a it's a tricky balance to walk to to walk in this really like new and and innovative area where we've never been before. You know,

[19:38]  how patients accepting this? Like are they responding to the AI tools as in they've appreciated? Are they still kind of concerned? I mean, you you being a part of that, what does that look like?

[19:47]  I think many patients are very excited about them. You know, every time I go in and see a because I practice as well, right? every time I go in and see a patient and I use the tool to record the visit and and it helps me write my note. They love it because I can make better eye contact with them. Um, right, I'm not looking at my computer the whole time. And especially for our patients who don't speak English, it's really helpful to be able to get those nonverbal cues, right? And and and take, you know, look look at them where whereas otherwise, right, I'm sitting here and like typing on my screen at the same time, you know, that I'm in the visit. And so, um, so I think patients do really like that. And I think there's also a healthy skepticism too to make sure that um you know they understand what's happening. So I think it depends on the tool right the the notwriting tool has been relatively well accepted and I think that as we look at different tools for different um different purposes. I think that patients want to understand they want transparency into what tools are being used and and rightfully so and how those tools are using their data. And we have a really um robust governing process that includes understanding the model but also understanding the security of the tool and how data is being used and maintaining the patients privacy. And I think it's really important to be transparent with patients about how their their data is being used um and how the tool works and and we try to do that

[21:07]  and it's important oh sorry just to to add right I think it's important to do that in order to maintain trust because trust is so key to the patient provider relationship and to to the the the um the provision of healthcare.

[21:21]  Okay. And and so hearing that from the patient side, but I always feel like when you're implementing something new in a company, you definitely get that push back. But it seems like you guys have a couple of different AI tools out there that I can only imagine there was some push back. What was the push back? And are those same push back still happening or are they realizing, oh wow, wow, was I pushing back? This is actually really great

[21:40]  from patients. You mean?

[21:42]  Oh, no. Just your staff, your team staff. Yeah. Um I think that there um I I think that for the most part the sto the tools that we have implemented have not received a lot of push back

[21:55]  um because uh we have vetted them so carefully before we've introduced them to the organization and then the communication plan with the organization has been um really uh robust right helping helping uh um the organization understand why we are using the tools the fact that they were vetted um and um and and providing that understanding and and then the fact that we put in place a pilot first to test the tool u make sure that it was validated internally validated with our patient population before scaling the tool. So we haven't received a lot of push back in that regard. I think that if anything um many of our uh staff may want to try out many new tools that we may sort of uh uh lock down a little bit and say whoa whoa whoa we have to vet that a little bit more before we can sort of let that loose. Um so if anything I think people are more excited to move forward with AI uh than than we're quite ready to to do and we want to put some guard rails around it.

[22:58]  I love it. Yeah, you guys are definitely ahead of the game. There's not a lot of people that speak so highly of AI and implemented so many things in such a short amount of time. And I wouldn't while people think it's a short amount of time, AI has been around for a very long time and you know that. It's just that we're now calling it that sexy word everyone Yeah. talking about

[23:14]  life cycle. Yeah.

[23:15]  It it's been like uh I mean I'm pretty sure you're into music, but when we talk about underground music and then all of a sudden that underground music artist becomes, you know, this pop icon. It's like I've been listening to that person, right? So you probably already had

[23:27]  Exactly. Exactly. I love it. Do you think do you think there's a misconception in health that healthcare leaders have about data sharing that actually drives you nuts because I think that's also really important when talk about data.

[23:39]  Yeah. Yeah. I think that's that that's a great uh sort of um other area to sort of talk about. Uh yeah, I I do and this is a lot of the work that that I lead nationally is around interoperability and data sharing. And I think that one of the misconceptions we have is that sharing data indiscriminately and the more data that we share uh the better off we are right so um we have been building this ecosystem of uh data sharing now for probably about the past 15 years and in many ways it's really great right the the benefits of this are right to be able to care for our patients better as they travel to different uh parts of the country, right, or to different health systems. And if I see a patient in Massachusetts and then they go to California and being able to access their their data in different places and to be able to provide that care um to decrease costs because I don't have to repeat tests because I can see that they got a CT scan already, right? So there are a lot of benefits to this and I think that has led us in many ways to say the more data that you can access the better. But I think there's nuance here that we often don't consider. And I think that um I may have maybe more insight to some of this nuance because of the populations that I work with and have worked with my entire career.

[25:02]  But what we know is that for many people, having all of their data shared um can cannot be a good thing. And I'll give you an example. So, I was doing street medicine for a number of years and I would see patients uh on the van on the the the van where we we um uh saw patients and and and uh provided clinical care and we would often need to need to send them over to the emergency room if they, you know, had acute trauma, things like that. And I remember seeing one young man about 21 years old and he had been hit by a truck. I needed to send him the emergency room to get a CT scan. And and he said, "I I I can't go to the emergency room because they're going to see in my chart that I have a history of of opiate abuse and they're going to immediately say you're just seeking drugs and and you know, dismiss me." And that is the experience unfortunately of many many many people in our health system. And they understandably have mistrust of our health care system. And when their data precedes them, they don't want to seek care and and that becomes a real barrier to care. And that's very, you know, it's higher that medical mistrust is higher in ethnic and racial minorities and sexual minorities. And there's a lot of data on that, a lot of studies to show that those those uh individuals who have medical mistrust are less likely to seek care or less likely to comply with um recommended care, less likely to seek out preventative care. and and there's a lot of historical context for that um as well and it's very understandable what happens when we as the health IT industry say let's just open up data share and that's such a good thing without having that context is um we are um then creating a system in which many of those people who have medical mistrust have to say well that doesn't include me so I'm either going to opt not to go get care because I'm worried about the data that precedes me or I'm going to tell my organization, shut that data sharing off, right? And if I do that, I'm shutting all my data sharing off. So now I go to the emergency room

[27:10]  and if I'm somebody who has data that I consider sensitive or don't want shared, uh, right? Whether that that may be protected by state law, um, right? And so the organization doesn't share it or I may not want it shared. Now, my meds, my allergies, right? uh information that would be helpful to have shared doesn't get shared. And so we're we're creating inadvertently disparities in care. And so I lead a collaborative of about 300 uh experts across North America. And what we are doing is trying to enable um computable consent and the technology and infrastructure to allow patients to have more choice over how their data is shared. It's called the shift collaborative. Um and we are trying to um promote interoperability, allow this the the PA patients who might otherwise not share any of their data to share most of their data, but also say, hey, you know, there's maybe some piece of my data that I'm sensitive about that I I don't want to share and how they can do that and understand how they can do that safely.

[28:17]  Wow, that's actually really good. I think that's a lot of insight that people probably don't know and that's amazing that you guys are working on that space. I I think it's it's cool. I think it's cool what you're doing the space that you're in. Um you could have made different, you know, choices in life to go do different things and you're still when you talk about teacher, you know, sometimes you have this idea of teacher where you're really teaching out here, right? Look what are you doing today? You're just doing it at a different level and I I truly love it. But how do you get these tech partner? You talk about tech so much is like how do we get these tech partners to really buy in when your budget can't even compete? I think that's why people don't look into innovate because they just feel like, well, we don't have the budget.

[28:52]  Yeah. I think it's I think finding your value ad, right, is important. For us at Cambridge Health Alliance, we have a a very special patient population, right? We have a particularly diverse patient population um with uh that's ethnically diverse that is uh racially diverse that that has particularly diverse language needs and we make the case to our tech partners that yeah you can pilot in lots of different places but you can't pilot you haven't piloted and you haven't developed somewhere that offers the diversity that we offer and so pilot with us. And not only do we offer that diversity, but we're also academic, right? And so we have the experience of publishing of and and and and doing these types of pilots and innovating, right? Um uh with you. And so I think finding your niche and finding your value ad, right? We're not just asking them for something and asking them to say, you know, hey, hey, uh uh provide us with something as a safety net. We're saying we can offer something back to you, which is to provide you with um with uh an opportunity that you may not have in some of your other early development partners.

[30:14]  Okay, I love that. I love that. And as we start to close it up here, uh ask some questions for our leaders. What would you say to a healthcare exec who's actually afraid of AI but not afraid of inequity? I'm pretty sure you hear this and and probably have these conversations often, but it it's it's happening. What how how would you kind of help these individuals

[30:33]  who's not in a afraid of inequity but is a is afraid of AI?

[30:37]  Afraid of AI. Yeah.

[30:38]  Well, I would say that that first of all, I think that AI can offer a lot of solutions to inequity first of all and and that I if someone's not afraid of inequity, I I would say there are a lot of reasons that we should we should be attuned to inequity in everything we do, right? that that if we are um if we are not attuned to inequities, uh we are not um uh serving um all of our stakeholders appropriately. And so um and and even at a less diverse organization than Cambridge Health Alliance, um you're not going to be uh attuned to your stakeholders if you're not thinking about where we can um uh mitigate inequities and mitigate bias, right? That's really important. But if someone is afraid of AI, I would say it is healthy to have right and appropriate to have a healthy fear I think and a healthy uh um uh I think um caution around AI, but AI is the future here. And and if that holds you back, then you know you're going to be like some of those uh leaders and and and and organizations that that are still on paper, right, while everybody else is on the on the EHR. So So I I think that's it's the wave of the future. You got to get there and you got to figure out how to get there safely and how to get there with appropriate guardrails.

[32:07]  They might end up like Blockbuster. Who knows?

[32:09]  I know, right? Yeah. Yeah. You you're going to get um you're going to get sort of uh um outrun in your market, right? It's it's a market imperative at this point um to to be using AI and so um so yeah, exactly.

[32:23]  I just love the way that you just reframe innovation so it actually serves people not just KPIs. I mean just listening to you I I hear that right and kudos to you for just thinking outside the box in a sense. Um but I appreciate it. We're here to the blind question. So are you excited for this blind question?

[32:38]  I'm excited for the blind question. Let's hear it.

[32:40]  Had to spruce it up just a little bit for you as well. But what's one mistake you've made in the name of animation and what did it actually teach you about leading with purpose?

[32:49]  Oh, it's a great question. What's one mistake I made in the name of animation? Um, I would say that um I did not push hard enough. Um, I I did not value myself and the organization. um high enough when pushing for and advocating for development contracts. Um so right uh in in devel in in um negotiating contracts with vendors right uh at times um I have not sort of driven a hard enough bargain for the organization and I have learned from that about the value that we bring and um and have learned to negotiate harder and learned that uh uh we are um we bring significant value and uh to sort of play play hard ball more at the at the negotiating table. Um so that's what that's what I've learned.

[33:58]  Love it. How do you thinking really early this morning? That's how we do it here, you know.

[34:02]  Exactly. Exactly.

[34:04]  Hannah, what is your blinding question? I know we were uh through email. You said you were so excited. You had a blind question. You prepared for this. So what is that blinding question you have for our next leader?

[34:12]  Yeah, I do. It's about interoperability. And my question is imagine that you're talking to a group of residents 10 years from now in 2035 and we have finally solved interoperability both the technical side and the human side and they ask you what was the real breakthrough moment when data finally started to flow seamlessly between systems and what was the fundamental change that happened? What would you tell them about what finally all started to click for us?

[34:42]  Got to go back to that data. Huh? make sure she had to throw that in there.

[34:46]  Bring that in there. So, yeah, that's my blind question.

[34:49]  And I appreciate it. And and for those that are still watching, where could we uh follow you individually, but even the organization? We wanted to know more about what you guys are doing at the organization if we could just kind of get some more of that information for those listeners.

[35:00]  Absolutely. So, you can you can uh find uh Cambridge Health Alliance at uh challiance.org. Um, you can follow me at uh Hgalanmd on Twitter or um but I I I'm not a big sort of Twitter poster. You can follow Shift uh that's better. I post a lot through Shift at um httpsshiftinop.org and all of our socials are posted on our website as well. And so that's the best place to find our socials and that's that's really probably the best place to follow me.

[35:35]  I love it. Well, Hannah, thank you so much for your time. It has truly been a pleasure to just get more insight from the technology side of healthcare, right? We don't we speak to healthcare leaders that are are doing it front line uh but never that individual that's part of technology and seeing how we're growing cuz a lot of people have been living in fear for a very long time because of technology and the way we as you mentioned a little earlier, we don't get that eye contact, right? We it's hard when we don't speak certain languages. Um, and I I feel like you're definitely the person that is leading charge in this way and I can imagine that you're really going to make some global impact. So, I appreciate all the time that you had with us today. Guys, if you're still watching, make sure that you guys do like and subscribe and uh listen, we're just so fascinated with all the leaders that we have here in the healthcare nonprofit space. But this one right here, this has been Hannah. My name is E Frain, the heart and hustle. We'll catch you guys on the next one. Flavors.