The Cybersecurity Vault - Maximizing the Digital Benefits of Healthcare with Jeff Fusile

Welcome to Cybersecurity Vault. I'm your host, Matthew Rosenquist, cybersecurity strategist and CISO at Eclipse. Today, we're going to be talking about the challenges of securing the future of healthcare and how maximizing healthcare benefits through securing data and data sharing And my guest today is Jeff Fussell, who serves as the president of ExamMed. He was the former president of Anthem Blue Cross and Blue Shield of Georgia, and he's got over 30 years experience in healthcare. So we're gonna be tapping his expertise, his insights, and where he sees the industry going, because healthcare right now, it's in the midst of a digital transformation when it comes to data, right? We used to go into our doctor's offices and see those rows of folders with the color-coded stickers. Those are all gone now, right? And the data has to move. Data about us, about patients. And with this, with this revolution in healthcare, there are growing needs and expectations of you, me, everybody. And healthcare requires the secure data sharing amongst the different providers and insurance. And, you know, wherever you go, wherever you need help, And there are tremendous benefits, but it also brings with it tremendous challenges and great risks. So we're gonna cover all of these things. We're gonna discuss emerging technologies that might fundamentally change the healthcare industry for the better. And again, wherever there's benefits, there's potential risks. Today's podcast is created in part by Eclipse, which provides an elegant capability to secure data in transit across insecure networks, between untrusted endpoints and cloud instances. Welcome, Jeff. Thank you so much for coming and talking with us today. Yes, yes. So digital transformation in healthcare, I mean, it's creating great opportunities and great benefits. But in your mind, I mean, you've got this rich history and you can see into the future much better than any of us can. What are those biggest benefits that we should all be thinking about, we should be expecting, and as an industry, we should be pursuing?

Well, I think it's— two things jump to mind when you talk about the digital transformation. One is all the information that we know today. And you think about how complicated the healthcare industry is and all of the information that's out there and available and all the training that's required to become an expert in your field. Nobody could master all the knowledge that we already know today. And so for the ability of technology to bring all of that knowledge to a person at the right point in time to make a better decision than they otherwise would have made is just going to be— it has been invaluable for people in that space. At the same time, the technology is emerging to the point where we can start to get information that we didn't know today. You know, things that are happening now where they're continuously monitoring your blood flow, continuously monitoring the chemistry in your body, continuously comparing that to other people who have had past history or will have emerging history tomorrow to, to be a better predictor of things that you should be doing today and things that you should be planning for tomorrow is really, really fascinating. Um, and challenging at the same time.

So you're talking about not only empowering people, right, those care providers at that moment in time when you have an accident or, or your, your monthly check-in or whatever, um, but also having to do that consistently for each individual that, that, you know, is in the system. And secondly, you're saying that with the all this data that can be gathered now in different ways and much more data and aggregation of that. I mean, is it going to change healthcare? You're talking about instead of going in a few times a year and getting my blood pressure taken, potentially monitoring that, you know, with my smartwatch or something else, and being able to see instead of a tiny snapshot in time, uh, intermittently, but a cohesive stream. Does that change the game for healthcare? How does that help us?

Patients? I think it will change the game for healthcare. It will certainly come slower than some would like and maybe faster than some would like, but it will change the game. You know, I always thought that if you imagine the ability to monitor— most of us get a physical maybe once a year if we're, if we're good and if we're not in a chronic situation, right? And to be able to theoretically have a physical monthly, weekly, daily. When you identify problems, you identify them so early in the event that you have such a better chance to do something. And potentially, as we bring genomics and proteomics and all the new technologies in to identify things that have the potential for emerging in 1, 2, 5, 10 years, and to have some knowledge on what I can do differently today than I would've done to mitigate those impacts is just, just, it's a game changer for healthcare.

So is this a necessary foundation for more predictive health versus, um, you know, responsive health or emergency or things of that sort? Is this a requirement?

I, I, I, you know, I don't know if requirement's the right word, but certainly an aspiration and a positive aspiration. Um, but it's going to require the stakeholders in the industry to start to work better together and to not compete with each other for the positioning of who gets to care for that patient.

And I think that's interesting. Yeah, that's interesting because you're bringing up some challenges and it sounds like there's some competition either for access or for data. And there's got to be challenges with privacy, right? With HIPAA and evolutions to that. I mean, what, what are those 2, 3, 5 challenges that you think are those barriers that we have to cross? The big barriers, maybe some earlier than others, but what are the big things that we have to deal with here to make this a reality?

Well, there's several. So the first one, and I think we've been trying to tackle this for a very long time and we're making progress, certainly slower than anybody who's been tackling it would like. And that's around the area of data consistency, data interoperability, right? Semantic data. When I put it out there, everybody knows what it is because it's formatted in a way for everybody to understand and ingest into their environment. That interoperability piece is tremendously important for everyone to start connecting and sharing. When you start saying interoperability and connecting and sharing, of course, privacy and security become front and center. And it's a very interesting dynamic, right? When you're dealing with a company, a lot of times the company will say, well, that's my data, that's my competitive asset, and I want to retain it. You can come ask me to share information, and I might tell you some things, but I don't necessarily just want to put it out there for everyone to have access to. It costs me time, effort, and money to assemble and organize. At the same time, there's a variety of spectrum from the patient's perspective. There are those who, "I don't want anybody to know anything about my healthcare conditions, right? It's private and I want it kept private. And I only want people to know that I authorized to know." And then there's people who are more on the spectrum, probably like myself, who say, "I don't care who knows. If you need to know to make me healthier, I want you to know, right? I'm not gonna change my health, and so I'm not terribly concerned about it. When you have that kind of spectrum amongst consumers, right, you can imagine it's difficult to come up with a solution that makes everybody comfortable. You know, I've often said, Matthew, I think I've shared with you once before, the idea of perfect privacy. And perfect privacy is I don't want anybody to know nothing until they need to know something, and then I want 'em to know everything. And finding that balance between knowing nothing and knowing everything. You know nothing when I'm healthy. When I'm in the ambulance on my way to the hospital, I want everybody to have access to everything about me to get me well. So it's just a difficult balancing act to serve. So it's sometimes the same person on both ends of that spectrum.

Yeah, it becomes really relative to the situation you're in. And, you know, myself, I want my, my healthcare data to be private, right? Only minimum number of people needed. But Again, if I'm in that ambulance, I may not be able to consent. I may be unconscious, but I really want that data to be shared with everybody that's about to touch me or be around me so that they have that greater picture to help me and help my health. Yeah, the privacy aspects, especially given the sheer volume of data now that can be collected and shared. And how that can be aggregated and how, you know, AI systems can start looking at it and backtracing. You talked about genomics and everything else and might be able to tie in disparate information and facts and nuggets together to be able to identify something instead of just looking at the symptoms, right? And even predict that kind of stuff. That's— it's mind-boggling to me. So let's talk a little bit about, that data. We know, you know, my healthcare watch, my Fitbit, you know, will track my heart rate and body temperature. And there's all sorts of different things there. We've got things in the home, we've got things now emerging in the car and implantables and all sorts of different things that are generating valuable health data. Is the industry looking to aggregate those? And you You'd mentioned kind of transforming raw data into something usable, right? Into information that can be shared. Is there momentum to start gathering more and more from different aspects of the healthcare industry?

There certainly is. There's, there's certainly momentum for gathering data. I think that's been going on for a very long time. We're more efficient today at gathering that data. Um, and so we tend to gather more. I think the real challenge is, is coming up with a structured way as to what you gather and why. Why you gather it so that you are focused on solving nearer-term problems at the same time you're building something for the longer term.

And do you believe that there's friction with the patients that are saying, no, I don't want other people to know my heart rate when I was running or how well I sleep at night, you know, things of that sort. Is that something that the healthcare professionals are having to deal with or is that more on the technology device side? Where does that friction sit?

Well, I think that's the friction. Certainly the providers— what we hear about from physicians is, I have a visit with a patient in January, I see them again in maybe July. I have no idea what really happened between then and now. And so they're very interested in having easy access. It can't be complicated because they have limited time, but easy access to what happened between them. Now, maybe pictures and illustrations and graphs that say It was steady, it was up high and then back down again. On the patient side, it's all over the map, right? If the doctor says to you, I want you to walk a mile a day as part of your recovery and you walk a mile a week, you don't want them to know that.

I was just going to say that. How often are patients absolutely 100% honest and forthright, you know, with their doctor when they go in? Probably not. A whole lot. They're always guarding something.

I always laugh with people and say the healthiest patients you ever have are the 3 days before their next doctor visit. They've eliminated alcohol.

That'd be incorrect. Yeah, I can imagine.

They've eaten well. They've gotten great rest, right? They even spend longer in the shower, believe it or not. And so it's just an interesting dynamic that somehow I can game the system. Right? By not being myself when I present.

If I can convince the doctor I'm healthy, well then I must be healthy. Yes.

Exactly right.

Exactly right. Oh, okay. So we've got all this technology, we've got all this data, we've got, you know, some of the challenges and obviously a lot of potential benefits. What are the risks if things go sideways, if we lose that data or if systems get manipulated or false data gets put in? Right. What are the, the big risks, the downsides for this data-enriched healthcare world that we're moving into?

Yeah, it's a, it's a great question. There's probably more than I'll ever be able to, to articulate or even think about. But the things that jump to mind for me are the obvious ones first, which would be, you know, heaven forbid someone has access to my healthcare information and they're making decisions about me without my permission. Can I have this insurance policy? Can I work for this organization? Can I be trusted to take this position because of a condition that I may have, that they may have something about? Um, that jumps out to mind immediately in, in the latest kind of world of cyber security. Then you also worry about what if somebody else were able to tap into that system? And change things that were in readings that were either making them more positive than they were, and then people not getting care, more negative than they were, and people getting things they shouldn't get. Or, you know, the ability to attack medical devices and other systems that create havoc in the environment. We saw recently the, you know, you hack into the gas pipeline, you create havoc in the economy. Right. But in the healthcare world, we're talking about tapping into people's pipelines, and that's awfully scary.

Yeah, the safety aspects. And on the cybersecurity side, we've seen where insulin pumps have been hacked, implanted defibrillators have been hacked. Right. You know, even IV pumps within, you know, emergency rooms and hospital rooms have been hacked. And that's just the tip of the iceberg, right? I mean, if you think about the medicine dispensaries, right, which are, you know, these cabinets and things that can dispense different types of medicines. If somebody can hack into that and swap out the type of medicine someone's receiving, that can also be a problem. You know, messing with somebody's defibrillator when they shouldn't be, you know, that's— you don't want somebody to go into, you know, cardiac arrest, arrhythmia, whatever. There are some serious safety concerns here. So it's not just the privacy rights, we're violating some privacy regulation there, slap on the hand. This could be in, you know, direct conflict with the ethical code, right, of do no harm. Um, and how much do you think the industry is thinking in those terms?

You know, it's a really great question. I think everybody conceptually wants to to do the right thing. I think everyone wants to avoid the potential for those things to happen to their organization, to their consumers, but resources are always limited. And I, you know, you often will hear in the IT arena, right, security tends to get the remaining money, not the initial money. And so I think, I think a lot of people, when they think about security, they think about the HIPAA legislation They think about fines from the government or a lawsuit from a consumer. They don't always think about, you know, the things that are emerging today, which is, you know, a company-wide shutdown of your ability to do what you're contractually obligated to do and expected to do and the impacts that has on your business, not just, you know, the compliance kind of side of that equation.

Yeah, we're actually seeing lots of ransomware attacks, you know, going after hospitals or, you know, ambulance companies, dispatching critical services, things of that sort, which has an impact. There was actually an attributable death in the UK, you know, several months ago, actually, I think it was last year, where the hospital was shut down because of a cyberattack and they had to reroute somebody in a ambulance, and unfortunately, the patient didn't make it to the new destination. And, you know, this potentially could be, you know, a major issue moving forward. And as you'd mentioned, in IT, a lot of times we get the scraps, right, of the budget. It sometimes takes a catastrophic event. And again, we saw the pipeline get taken down. We've seen in other countries, the electrical grid get taken down. Do you think the industry will have to have one of those catastrophic events to reallocate and reprioritize the, the safety aspects for this, uh, you know, emerging digital healthcare environment?

Um, that's a great question. You know, I, I think the honest answer there is it, it's always going to be a balancing act and a challenge, right? I, I think as things arise, um, resources get reallocated in that, in that direction. But as things calm down, they tend to kind of move back to, you know, what drives the financial machine, what makes the consumer most happy. And until consumers demand it, right, I just don't think it will ever get top priority until consumers absolutely put it in their top 3 considerations.

So we all have a role to play here, right? We should be informed, aware we should be making our voices heard with our healthcare providers and the insurance companies and everything else, expecting that not only we want all the great benefits of this new digital healthcare ecosystem, we also want it to be secure. We want it to be private. We want it to be safe. And if they don't hear from us, you know, okay. Now you had mentioned about perfect security. And I just, I have to smile every time I hear that. So tell me about what you see. Is this a reality we're gonna get to? Perfect security, perfect privacy, perfect safety? Or is this just a fantasy? I mean, where are we and where's the industry going here?

Well, I wish it were a reality. I have, I guess, an unfortunate thought that it's not a reality because in anything security related, at a minimum, you have the human element, right? And so that's a very difficult thing to create perfect security around in terms of the human element. So I don't think there will ever be perfect security, although I think it certainly can be better. I'm very intrigued by things like blockchain and other things. And what that can do in the arena. I think about it simply from my health insurance days, the idea of having a payer-provider contract that was entirely done digitally, that was done in blockchain, and any changes that are made to it are trackable and clear, right? And a technology that once you build the contract, both sides could access that contract to know what am I expecting to get paid, what am I supposed to pay, and did that transaction complete in the way we agreed to it on the front end. And actually having the contract not be something you interpret one way and I interpret one way, we wrote programs to do something and then later we disagree about how we— what we thought we meant when we put that contract in place. We could actually have a document that we can both test in our own systems and say, yes, this is doing what I expected. And now we can use it together and it can evolve. So that kind of thing is so much better than what we have today, where people have contracts on paper that are 30 years old and they couldn't find them if you begged them to find them. They couldn't find them if you paid them to find them. And they're really a big part of what's driving. So perfect security, I don't think will ever happen, but we are getting closer and closer to much better security than we've ever had before.

So with all this data, and you alluded to it when we first started talking, who owns it, right? If I go to my doctor and they take my blood pressure, they put it in some system. I never see it. I don't own it. Um, you know, my insurance carrier tends, I guess, shares it with people that I, you know, that their partners or some chain. I just, I seem so, I feel like I'm so separated from my healthcare data. In fact, sometimes it's tough for me to even find out my own healthcare data. What were the results of this test? Well, you know, did the X-ray show my arm was broken? You know, and maybe I get an email that says everything was fine. Okay, I appreciate the— but I'm also data-driven, right? So who owns this data now and who's gonna own it in the future?

Yeah, it's a great question. So, you know, under the existing HIPAA rules, Information is legally shared today for healthcare treatment, payment, and healthcare operations. It's a pretty broad swath of reasons you're allowed to share with other folks and either quote unquote HIPAA-covered entities. Who owns the data is a very interesting question. And in my career, everybody thinks they own the data. Everybody is writing their business model under the presumption that it's their data and they own it. You know, then my definition, if I were to say generally how do I think it should work, you own the information about you and I own my ability to supplement and enhance that information based on what I bring to the table. Now technically, how do you separate those things and how do you divvy up allocation of that's yours and this is mine? It's awfully complicated to do, but I do think we will move to a model someday where the patient owns their data. And I don't know whether that will sit in a set of repositories where I deem you access to it when you need it somehow, or whether it will just sit there semantically knowing that in— through blockchain and other technologies that we don't even think about yet— that I have the ability to provision you to when, when I need to. Or as you mentioned earlier, in a, in an emergency situation, people have the ability to tap into but they're logged and recorded and documented as to why they were tapping into it.

Well, you know, smart contracts can do that, right? You had mentioned blockchain before. Uh, so potentially that, that could be one of the, the game-changing emerging technologies. Um, what other emerging technologies do you really see that are, that are driving some good innovation, some good changes, not only in providing healthcare, but also in that backend in creating the data, managing it, analyzing it, storing it, being able to share it or create it into, or transform it into common formats for sharing and so forth. What is that emerging technology that we should be looking at and hoping for transformational change?

There's so many, I'll use a couple just as an example. One, to me, one is genomic data. That's becoming so much more robust these days. And I, you know, I, not just genomic data in the sense of, you know, I think of like a PKU test when you have a child born, right? We did a PKU test to make sure things are healthy. What will happen in the future if that test becomes a genetic test and you're able to understand things that may happen 30, 20, 40, years down the road. One, do you want to know, right? If you've ever done one of the popular consumer genetics tools, you know, they ask you up front, are you sure you want to know? And they ask you like 5 times, are you really sure? Are you really sure? If you check the next box, if you check the next box, you cannot unknow what we're about to tell you, right? And so there's a lot of opportunity there. But again, we're back to that, that varying consumer of, I'd like to know. Somebody else may say, I don't wanna know, I don't wanna worry about it. And there's nothing, if there's nothing I can do to make it go away, then why would I wanna know? And so that kind of technology is really challenging. So some of the things that are way far out that are fun to think about and talk about, there are people that are developing these micro devices that could theoretically float through your bloodstream. And monitor your chemical makeup in real time into perpetuity? And can you imagine when, you know, you're diagnosed with cancer today, you hear people say stage 1, 2, 3, 4, right? If that technology were to work the way I know many people hope it will, we would start talking about stage point 1, stage point 2, right? Catching things so early that that it's almost routine to care for. And that's awfully promising. At the same time, there's things that you're going to learn that you don't want to learn. And so that's awfully concerning to me.

Yeah, and you had kind of mentioned, you know, do I want to know, do I not want to know? But is it really binary? Is it just I have to solve for those two or is it a spectrum? You know, maybe I want to know some things but not everything and, You know, it almost seems like an endless gray area with infinite points within, and those would be expectations by every individual patient for a system, and a system has to support that.

I—

it just— that's mind-boggling to me.

I, I think that's exactly right, and compounded by what you might want to know about yourself might be very different than what you might want to know about your children. Ooh.

Or an elder that you're taking care of or something like that. Ah, yes.

Correct. It's really a situation.

Do you see AI playing any role in this, you know, in taking some of that data, right? You do a genetic testing and maybe modeling something from that or using AI to look at a broad dataset across a population or geography, a demographic, and start to come to some conclusions conclusions for more predictive or timely healthcare? I mean, is, is AI going to be big or is it already big in healthcare? I, I don't know.

I think it's getting bigger and it'll continue to get bigger. When I think about AI, sometimes the, the, it becomes the, it's the certainly the latest hot topic, the latest buzzword. Um, will we, will we use information in healthcare to see how one situation could be translated to impact another. We always have. We're just a lot more efficient at it now, and we're a lot— it's a lot more efficient to capture lots of data, right, to be more precise in using that data. And to me, the AI will— it will continue to proliferate, but then again, it becomes— it will be as valuable as the richness of the data set, which takes all the way back to the limitations of privacy and security and whether people are willing to put their information in and share.

Yeah, I mean, you can have the most intelligent AI system in the world, but if you're not giving it the data it needs, it's just collecting dust. That's right.

Right. That's right. Either to give it knowledge or to apply it to your specific condition down the road once it has started to gain that knowledge.

What about new healthcare devices? Right? I mean, um, you know, with COVID we all ended up being at home. I'm hearing rumblings in the industry about home devices that can also provide care to patients, not quite at the same level as being in that hospital bed, but a lot more than just in the bed with some crackers and some chicken noodle soup. Yeah. You know, are we seeing the evolution or are we going to see an evolution of devices, in-home devices to be able to help?

I would tell you right now we're seeing a proliferation, and what I mean by that is it's a little more chaotic than evolution. I think eventually we'll start to get to evolution, which to me means a maturing stream of that proliferation of devices. But I've seen devices in the home that are fantastic. I've seen where there's a central hub, kind of an Alexa-type device. Some are medically directed, some are very much like like an Alexa or other, where, you know, for an elderly patient who can't hear as well or see as well, they can simply speak the situation that they're in, and that's terrific. I've seen those same systems where they monitor people's movement. So I can see that my grandmother got out of bed at 7 like she always does. I can see she went into the kitchen. I can see she made coffee. I can see she's reading the paper, and it makes me feel comfortable to know that. Right now, is grandma comfortable with me knowing that? Right, it's a whole different question. Yes, yes, it's, it's really a whole different question. And so I, I think those kinds of technologies are interesting. We're working with a company right now, and I won't mention their name, but they have a device that looks like a little mouse for a computer, and you send it to the patient at home and they hold it to their chest and a doctor can listen to their lung flow with better quality than if you were in their office and they had their stethoscope. Wow. So imagine that conceptually that I, I hold up a stethoscope to your picture on the screen and I can hear your lungs better than I could if you were in my office. We're starting to tackle some of the things that when people say it will never be as good as it is in the office, Well, uh, I agree with that, but I also think there are some things that will be better.

Yeah, you know, I remember working with a company that, you know, had, uh, where they were using microneedles, which basically it felt like a sticker on your skin, but it was actually permeating through the barrier there, and it could sample your blood and different liquids in there. And another company that could continually monitor your blood sugar level, right, and insulin levels. And, you know, people that have to manage that now, they're pricking themselves in the finger and putting it on a, you know, a stick and trying to measure that a few times a day. Being able to constantly monitor that without the pain, right, without the inconvenience, without the stigma, that can be life-changing. And for those elderly people, you know, okay, great-grandma's, you know, having a cup of coffee this morning, that may not be as interesting as Did she take her meds on time?

Right.

Right. That, wow. You know, especially, you know, taking care of elder, that's one of the big worries and maybe taking off some of those stress points and making sure and reinforcing automatically. So you don't have to pick up the phone. The Alexa or the smart device is reminding grandma, you know, you forgot to take your pill. You need to take it right now. Right. And then prodding them. No, you still haven't taken it. Put the cake down. And go take your pills. It sounds like a very interesting revolution of innovation, potentially in our own homes.

Right. And will there be technologies down the road that if you're taking a pill twice a day, that now you take it once a week and it dispenses within twice a day? So you're the, the recollection of taking that pill happens once a week and it's much easier for people to to manage manually.

Yeah, yeah. Or even varying the dosage, right? You know, I've seen several programs where they can do that in within-home devices. 500 milligrams today, but we're weeding, you know, weaning you off. It's 400 milligrams tomorrow and 200 milligrams next week, right? And be able to do that, that fundamentally changes how medicine and care could be provided through technology.

It's very fascinating technology, and I think there's, there's a bigger comfort level with receiving care in the home, and certainly for some, a desire to not necessarily be aggregated around people, other people who are sick. And so I think we'll see things like that proliferate as we go.

So one last question here, because we're talking a lot about, uh, you know, home automation and technology that we're wearing and, and all these other things that are helping us. Um, our primary interface is are primary care physicians, right? They play a pivotal role, and I assume so even in this future model, there still is a human that's looking at the data or reviewing it or agreeing, or there's still a pivotal point. How do we help them? How is the technology evolving to make sure that they're better connected and they can make better decisions and they're not overwhelmed and spending 17-hour days and being burned out? How is technology fundamentally gonna be helping the primary care physicians?

You know, it's funny you mentioned that, Matthew. I, I spent over 30 years in healthcare and retired, um, and recently came back for that very reason, right? My observation was that very few people are developing technology to enable the doctor to provide better care. Right, run a better practice, right, and remain at that center of somebody's care, kind of the quarterback of their care. Everybody today is competing for access to the consumer, and, and while the technologies are wonderful, the services are great, they're all by definition bifurcating that patient from the core of where their care kind of comes together. And so I'm really excited about the way technology starts with telemedicine, like this meeting we're having. I can connect with you, but I don't have to be there. You may not feel well and you shouldn't be out and about coming to see me, but I can see you, right? I may be on vacation, but you really need to see me, and I can see you as a physician from somewhere else. House, right? I can retire because we're losing a lot of physicians to retirement, especially in rural communities, but I can continue to see patients to provide a transition from wherever it is I decide to retire to, right? Those types of things. But then it moves into remote patient monitoring, being able to help physicians understand that, you know, what's happening today is physicians want to move into remote patient monitoring, but they don't know how to put out an RFP. To remote patient monitoring vendors or to integrate their technology or to change their workflow, right? They need someone to help them through that. I always have said the physicians, especially primary care, what I recalled when I was in the insurance world, we spent a very small percentage of our dollars on primary care. 5% of the total spend at most went to the primary care doctors. The rest went to hospitals and specialists and drugs, medications and such. But they controlled 60% of the spend. But they didn't know how to leverage that control that they had. And so that's, that's an opportunity because it's really important that we not try to build a system that doesn't require doctors because that, that's a, that's the path to a problematic place. From a cybersecurity and other perspective. You need well-educated, smart, compassionate people at the center of any solution you create to make this thing work well.

Now, you've had over 30 years in the industry. You've retired and you decided to come back. So what are you and your company— I mean, what are you focused on? You mentioned a lot of different challenges and opportunities out there. I mean, what has motivated you to come out of retirement? What are you focusing on right now?

So, so the ExamEd company does a lot of things. The two things that motivated me are the ability to help primary care physicians remain at the center of people's care and to help them learn how to run a better practice, right, from the standpoint of caring for patients in a new and different way without completely disrupting the workflow that they know. And the second piece was a, a passion around rural healthcare, which is really a challenge. And telehealth and remote patient monitoring and getting access to specialists who may be hundreds or thousands of miles away is a fascinating opportunity for, for the rural market. And so those two things in particular enabled me to kind of combine my past experience with my desire to do more philanthropic work in that industry going forward.

And when you talk about the rural market, you're not talking just about the U.S. rural market, right? I mean, are these challenges and opportunities Do they exist all over the planet?

We were on the phone this morning with a group from Pakistan talking about how the solutions we're developing can be utilized to help in the Pakistan environment. So yeah, all over the world and bringing the same level of care, you know, not just care, but the same level of care, right? And then that world-class care to people all over the country, the world is, is is certainly a huge opportunity for everyone.

That can, again, fundamentally change healthcare as we know it at a global scale. That's amazing. That's amazing. Jeff, thank you so much for your time and your insights and coming on today and sharing with us what you see and what you're working on and what we should expect and what we should be asking for as we're all part of this next generation healthcare and our decisions today affect the healthcare and the medicine for our children and grandchildren tomorrow. So thank you very much. I'd love to have you back on and, and talk about some of these innovative new technologies as they, they come to fruition.

I would love to come back, Matthew. Thank you. It was a, it was a pleasure to chat with you.

Excellent. Thank you.