S1E15 Transitions of Care: Data Integration, Standardization (ft. BJ Evans, Stonerise Healthcare)

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BJ Evans
But you I think you nailed it, Jordan. Faith is always an important part of everything we do. And you know.

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BJ Evans
Always tell people that I pray like everything depends on God and I I work like it all depends on me and it seems to work out.

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Jordan Cooper
Alright, well that’s. You know, I always ask I like to show different sides of people. I think showing you know, just like you wanna have a holistic patient record and understand everything about your patients. Our listeners also like to have a holistic view of the guests. So just throwing that in there to get to the main substance of today’s talk. I’d like to talk about the vision you had for Dana, Data integration at STONERISE and then we can go from there about how it was implemented.

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BJ Evans
Sure.

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BJ Evans
So it started the back in 2018, the owners of Stonerise approached me about coming in as a consultant, so I was doing consulting back in 2018 and what they wanted, they had a very clear vision of of what they were building at Stonerise, which was an integrated post acute care network. So it wasn’t just skilled nursing. It wasn’t just.

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BJ Evans
Home health IT wasn’t therapy, it was. It was all of those things. So if you think of an acute care system that has many different branches, the the owners of Stonerise had that vision for post acute.

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BJ Evans
And.

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BJ Evans
They felt like that.

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BJ Evans
The technology that they currently had, although it was robust and it it served the needs of each of the silos within the network.

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BJ Evans
Uh, the transitions of care were difficult. The holistic view of a patient was difficult. So we started out evaluating the business and saying, OK, that’s the vision for the business. How do we align the technology with the business, the vision of the business? And initially, you know, my thinking was, well, a single EHR makes a lot of sense.

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BJ Evans
To do that. But as I dug into the different offerings in the space, there was no one EHR that.

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BJ Evans
Really.

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BJ Evans
Was a real a top tier solution for the different lines of business or lines of service within the STONERISE network, so that that led us down the pathway of looking at.

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BJ Evans
You know, third party systems data integration platform.

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BJ Evans
To connect all of our internal Ehrs, but also provide us a platform to connect to our external partners and also consolidate all the data that we had internally so that we could really drive strategy forward.

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Jordan Cooper
What were some of the benefits owners were hoping to accrue through their data integration strategy?

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BJ Evans
So first, first and foremost, it was ease of transitions of care. So most of the time we we learned that most of the time that.

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BJ Evans
Patient declined patient mistakes, things of that nature.

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BJ Evans
Happened when a patient is.

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BJ Evans
Transit.

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BJ Evans
So that’s where when medication errors happen, that’s when you know you’ll you’ll sometimes see significant decline and obviously in post acute care.

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BJ Evans
There’s a rehospitalization penalty during that transition of care. If that patient kicks back into the hospital in a certain period of time, so.

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BJ Evans
That’s where we seem to have the disconnect because it was a lot of manual process. They would hand the the patient to discharge sheet or hand them a CD or hand them something and then.

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BJ Evans
When they arrived at the next care setting, you know all of that data had to be reentered. There’s there’s chances for mistakes. There’s chances for Miss entry. So. So the idea was we’ve got to make seamless transitions of care, and we needed a platform. Help us do that. Like I said, both internally and externally.

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Jordan Cooper
All right, so you were looking for a seamless transitions of care in order to reduce errors, reduce redundancy?

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Jordan Cooper
What were some of the processes that you discovered that were able to facilitate that seamless transition of care?

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BJ Evans
So, so probably the top processes was.

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BJ Evans
Basically, the ability to receive CCD continuity of care documentation from the acute care setting into that next step, whether it be home health or or.

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BJ Evans
Skilled nursing facilities to be able to ingest that into the EHR and give our nursing teams visibility of what happened in the acute care setting, what what kind of medications were gonna be needed, what what kind of other conditions exist for the patient. You know, because oftentimes a patient may be coming into a post acute care setting post surgery and and that becomes kind of the major focus.

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BJ Evans
Well, they may be diabetic. They may have other underlying health conditions that also need to be focused on and and really gaining that understanding increases the, the, the quality of care that we could deliver. So that that was that was really big and then for us, you know a very simple way to think of it. You know many of our patients that came into our skilled nursing facilities ended up going home with our home health and.

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BJ Evans
You know, we were one brand, one company STONERISE and initially when that patient transitioned from skilled nursing to home health, we had to reregister them. So we had nurses going to their home. The first visit on the intake visit, they’re entering all the same information that we had in the skilled nursing facility and and you know a lot of times patients would say I thought you all were stone rising, didn’t we give them all this information so.

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Jordan Cooper
Right.

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BJ Evans
You know, if you think maybe 10 years ago in acute care setting where every time you went to the doctor, they ask you for the same information it was, it was kind of that similar feel and we were trying to overcome that and give the the patient a level of comfort that, hey, we are one company. We do operate across a single platform.

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Jordan Cooper
So then you you you looked at and then you implemented well began implementing the Inter systems integration engine. Were you able to?

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Jordan Cooper
I I what outcomes did you see? I mean to what and what extent did you finish that implementation? Where were you in that process?

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Jordan Cooper
Yeah.

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Jordan Cooper
Mm-hmm.

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BJ Evans
So we were able to to build our first sets of interfaces with some of our EHR partners and ingest data and begin to build the algorithms for the matching. So we were actually doing patient matching and creating an API. So that was kind of stepping number one was creation of an MPI stonerise Master Patient index once once we knew we had had the technology in place and had the data governance around that in place.

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BJ Evans
Then we could really start bringing in more data, but that that was the beginning and that’s that’s as far as we got before we were actually pushed.

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Jordan Cooper
Right. So I wanna transition this conversation to to that topic. Now your implementation was interrupted by the acquisition of Stonerise by Communicare. Now many of our listeners are CIOs and other health IT leaders and health systems across the United States. Many of them have seen or are actively experiencing mergers and acquisition.

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Jordan Cooper
Uh experiences?

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Jordan Cooper
A with their own organizations. I’d like to ask you, BJ, about the experience of preparing for an acquisition, what that was like and what could have made it go smoother.

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BJ Evans
You know.

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BJ Evans
But it it really depends upon the the perspective of the.

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BJ Evans
Of the company that is.

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BJ Evans
The buyer.

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Jordan Cooper
Mm-hmm.

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BJ Evans
So.

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BJ Evans
There’s there’s multiple kind of approaches and I’ve done M&A. This is my first foray in the health care M&A work, but I’ve done a M&A in other industries quite a lot, so.

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Jordan Cooper
Umm.

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BJ Evans
There’s some fundamental questions that have to be answered up front, you know.

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BJ Evans
The first and foremost, are we going to integrate?

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BJ Evans
Systems or bring the purchased entity onto existing systems on day one? Or are we going to leave the purchased asset or entity as is for certain period of time with the transition which was the approach that Communicare took with sunrise. They left all the systems in place for certain period of time. Give them a chance to.

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BJ Evans
Evaluate.

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BJ Evans
The way we did business because unlike many of the acquisitions that communicate had done in the past, stone rise was a very profitable entity, very solid healthy company.

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BJ Evans
And they wanted to see how we did business, so.

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BJ Evans
They left it intact for a certain period of time, and then they’ve slowly transitioned the stone rise facilities onto their systems onto their platforms. So as far as preparation goes, you know, having all of your documentation, all of your systems documented, I think one of the one of the challenges that it always faces is we like to be doers, not documented.

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Jordan Cooper
Mm-hmm.

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BJ Evans
Having strong documentation is really important, and frankly it’s it’s it’s imperative for cyber security. It’s imperative for compliance. So they, you know, strictly speaking about healthcare organizations need to have good discipline in documentation of their systems of how they govern data of what their data standards are. And then.

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BJ Evans
Once the decision is made on the philosophy for integration.

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BJ Evans
You take that documentation and you put together a plan.

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Jordan Cooper
Should BJ prior to your experience in healthcare, you were working in IT in the energy business, is that correct?

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Jordan Cooper
And you.

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BJ Evans
Correct. Yeah, mainly mining. But mining and oil and gas and and and.

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Jordan Cooper
So.

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BJ Evans
You know, heavy industry, capital intensive industry.

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Jordan Cooper
You mentioned that you had been through a few emanates before the show. Communicators acquisition of Stonerise Healthcare is familiar with learning from other industries. Many of our listeners will be familiar with Lean Sigma, which of course came out of the automotive industry, that was Toyota car manufacturing. Many of our listeners may be aware of a tool Gawande checklist manifesto which came out of the Michigan Keystone project where Peter Pronovost was the Pi on that project for quality.

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Jordan Cooper
Improvement projects in hospitals in Michigan and that was all based upon pilots in airlines doing checklists to make sure airplanes are safe before flying BJ, are there any lessons that health care may be able to learn from your experience in mining, in petroleum and other Heavy Industries?

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BJ Evans
Process.

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BJ Evans
Yeah, it’s so.

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BJ Evans
So the Heavy Industries that I’ve worked in.

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BJ Evans
You know, compliance is #1 no harm.

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BJ Evans
Both to workers or the environment is kind of priority #1.

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BJ Evans
Uh.

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BJ Evans
And and then.

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BJ Evans
When you look at those industries.

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BJ Evans
The.

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Jordan Cooper
Mm-hmm.

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BJ Evans
Pressure of the down cycles because those are very cyclical industries where Healthcare is really been on an upward trajectory.

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BJ Evans
Distantly right. From revenues from from from volume.

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BJ Evans
The discipline within the heavy energy industries is.

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BJ Evans
You’re gonna have ups cycles. You’re gonna have down cycles and and you must have discipline, cost discipline and process efficiency discipline in order to withstand and be a survivor whenever the the price of your commodity that you’re extracting is low, right, so.

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BJ Evans
I think that there is.

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BJ Evans
In healthcare, there’s a lack of discipline.

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BJ Evans
In terms of.

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BJ Evans
Long javidi of process.

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BJ Evans
There’s a.

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BJ Evans
There’s a.

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BJ Evans
A struggle at times to standardize.

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BJ Evans
And with standardization, gain efficiency and and I think in heavy industry you know our.

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BJ Evans
Our focus was always ensuring that given the the.

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BJ Evans
Man or oils, or the basin of oil or gas that we were trying to work in given the characteristics of that within that basin, we wanted to be the low cost provider and that requires a tremendous amount of discipline and it requires a tremendous amount of technology because if you’re not innovating, if you’re not, if you’re not aligning the technology with your business, then technologies overhead.

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BJ Evans
But if if you’re really spending your technology.

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BJ Evans
Dollars in a strong and very well thought out way that aligns with your business strategy, which for example in in heavy industry have extraction it was cost most of the top compliance and cost.

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BJ Evans
And and production.

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BJ Evans
You know, we we had to ensure that we did things the same way every time in order to bring a level of predictability to to the to the.

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Jordan Cooper
So BJ, I appreciate you sharing lessons from other industries. You mentioned process and compliance.

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Jordan Cooper
Improving discipline in healthcare, something else relating to healthcare from other industries is there’s more of an orientation in healthcare around meeting consumer demands. Consumerism in general is a theme has been emerging across healthcare in the United States and also you’re a consultant. So you have exposure to different healthcare delivery systems across the country. Can you speak to the changing expectations of consumers?

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Jordan Cooper
Related to data integration and availability in healthcare.

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BJ Evans
Sure. I you know, I’ve always likened it to.

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BJ Evans
Kind of the different generational definitions like Gen X, Gen Z, millennial, I think as as we see this transition that we’re in right now where obviously the baby boomers are the largest consumer of healthcare services, right? And then?

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BJ Evans
Next is going to be Gen X Gen X is much more comfortable working with technology than baby boomers.

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BJ Evans
And and I I don’t want to lump any. I don’t wanna, you know stereotype anyone but that in general is the case so.

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BJ Evans
I foresee that what’s gonna happen is the expectation curve for data integration. The expectation curve for.

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BJ Evans
The ability to control and access our own health data is really going to steepen over the next 10 to 15 years as Jen X begins to be more consumers of health care service.

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BJ Evans
And and you know, I experience it in my own life. I’m going to share a very personal detail here, Jordan. But my youngest son has epilepsy, and it’s been a struggle. It started when he was about 14. He’s 17 now and we I’m not going to mention the health systems that we’ve worked with, but we’ve worked with a couple different health systems to address his needs. And one of those health systems is not very well integrated. The other health systems vary.

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Jordan Cooper
Mm-hmm.

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BJ Evans
Well integrated and I can tell you that I I have a sense of comfort and A and a sense of confidence in the health system that’s integrated that I can communicate with his care team immediately versus the one that you call and it takes you know weeks to talk to anyone and.

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BJ Evans
It so I think that consumer expectation we’re going to see a steep climb in that as my generation becomes greater, consumers of health, health care.

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Jordan Cooper
I appreciate you sharing that personal anecdote. BJ, I think it brings uh, your point home to our listeners that data integration is something that is very much aligned with consumerism and a general trajectory in health care. We are approaching the end of this podcast episode, so I would like to ask you a final question, BJ, you, as I mentioned, our listeners are leaders in health it across the country.

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Jordan Cooper
Ohh what?

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Jordan Cooper
Advice would you give to them?

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Jordan Cooper
Regarding a moving towards a improved data integration in their own organizations.

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BJ Evans
I think the foundation Jordan is when and where possible.

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BJ Evans
Have strong data standards, data governance. I think that that’s the beginning. That’s the starting point, if you will look at your systems, look at how your capturing data. You know one thing I found across EHR is there’s a lot of room for non standardized data or free text data that becomes very difficult. And I’m not saying anything that these that your audience doesn’t understand. But I I think if you can look for opportunities to standardize.

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BJ Evans
Across all of your different silos, I think that’s A and at least starting to defining.

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BJ Evans
Water translation would look like and what your standard would be that’s that’s that really step number one and and and in order to do that.

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BJ Evans
You have to get your fighters on board. You have to get your nurses on board.

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BJ Evans
A really strong chief Medical Information Officer that gets the the need for, for.

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BJ Evans
Accurate, timely data is really, really important. We were we were working down that path. We had very strong support from our our Chief Nursing Officer. We had very strong support medical officer.

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BJ Evans
But just getting them to understand why it’s important because you have to think they’re. They’re wound in such a way that they.

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BJ Evans
Are focused on the patient in front of them in a lot of cases, and how do I help this person, which is great technology, people, you know, aren’t really wound that way oftentimes. And and we’re thinking, well, what’s next? How do we, how do we, you know, make this?

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BJ Evans
Uh.

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BJ Evans
More streamlined, more efficient.

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BJ Evans
Umm so I I think.

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BJ Evans
Finding people who can speak both of those languages is really important and really focusing on the data standards.

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Jordan Cooper
Well, thank you. Appreciate that. This has been BJ Evans, former CIO of Stonerise Healthcare and the founder of Principal Advisor 828 advisors. BJ I’d like to thank you very much for joining us today.

0:21:41.880 –> 0:21:42.440
BJ Evans
Thanks Jordan.

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