Oklahoma Heart Hospital and Their 11 Month Epic Implementation

Phil Sobol: Well today on the CereCore Podcast, we're pleased to talk to two healthcare leaders from Oklahoma Heart Hospital. Welcome David Miles, Chief Information Officer, and Jim Wetzel, Director of Clinical Systems. Dave and Jim have both been working in healthcare IT for decades and are truly focused on getting technology in the hands of care providers and clinicians so they can provide great care and do so efficiently. 

Dave, Jim, welcome to the CereCore Podcast. 

David Miles: Thanks, Phil. 

Phil Sobol: Well, Dave, we'll start off with you and we'd love to learn more about how you came to be the CIO at Oklahoma Heart and would love to know a little bit more about Oklahoma Heart. I understand it is a special health system and physician-owned. 

David Miles: Yeah, sure. Thanks, Phil. I started at Oklahoma Heart in November of 2020, right in the middle of the COVID Pandemic. 

Phil Sobol: Yes. 

David Miles: I certainly wasn't looking for a new role at that time. I had had some previous experience working with Oklahoma Heart. I came from Mercy Health system based out of St. Louis, who's a partner of ours here at Oklahoma Heart. I had experience doing joint projects with the leadership group here at OHH, and when they decided to make a change, obviously they called and said, "Hey, we've enjoyed working with you. We know you're an IT executive there at Mercy, and would you be interested in moving over here?" At the end of the day, after we talked back and forth, just really the opportunity to oversee all aspects of it from help desk to security to infrastructure was a lure that was too good for me to pass on. Going from an extraordinarily large organization to one that's smaller, you get a span of control that's greater. To me, that was interesting and an exciting opportunity. 

As far as Oklahoma Heart goes, it is a little bit unique. We are fully physician-owned, founded in 2002. I think the secret sauce for Oklahoma Heart is our unique approach. Our founding physicians believed in patient service and they were not happy with how patients and patients' families were being treated by the institutions that they were working at prior to founding Oklahoma Heart. They believed very deeply that they were tuned into what the patient and their families needed during the difficult time. Obviously, when you're receiving cardiac care, it's never a small thing, right? It's a big deal. Lots of nervousness, concern. So again, that caring mentality, that service mentality, all things that our founding physicians believed in very deeply. 

When Oklahoma Heart was founded, by taking that focus and taking the understanding and information and designing the physical spaces around the treatment procedures, designing the staffing models to support patients, families, that's what sets Oklahoma Heart Hospital apart from others, is that intentional focus on the patient and their families. And the last thing I'll mention is it obviously works. If you take a look at the trophy case, you can tell that it's different. I'll just say in the last three weeks alone; Oklahoma Heart Hospital has received the 2024 Community Choice Award from the readers of the Oklahoman newspaper. 

Phil Sobol: Oh, wow. 

David Miles: We've earned a spot on the 2024 Newsweek America's Best Cardiac Hospitals list. We've been recognized as a 2024 recipient of the America's Greatest Workplaces for Parents and Families from Newsweek, both North and South. We’re listed on the 24-25 high performing hospital list by U.S. News & World Report for eight separate cardiac surgery and procedures. And, lastly, Forbes listed Oklahoma Heart as one of America's best in-state employers. 

Phil Sobol: Wow. 

David Miles: So again, all of that goes to support the culture that was put in place by our founders. 

Phil Sobol: Those are outstanding accolades and certainly it's always nice to get that outside recognition. And at the same time, I have no doubt that probably the recognition that you all love seeing the most is from the patients and their families. And so that's really neat to see. 

Well, Jim, want to pivot to you real quick. You've had an interesting background as well in both pharma and biotech. What has your journey been like as the director of clinical systems, and what's unique about working at Oklahoma Heart and its place in the community? 

Jim Wetzel: Sure. Thanks, Phil. Yeah, I've taken a non-traditional journey to get to where I'm at with Oklahoma Heart today. I've been here a little over a decade. Started doing clinical research many, many years ago. Worked in and around the pharmaceutical drug development industry. I actually came to Oklahoma Heart to work with that team. Research had slowed down a bit over the last decade, and so looked to make a move, joined up with the IT team here, led the field support team for a number of years, led the development team here that we had, custom development work that we would do, and then ultimately ran the group that spearheaded the EMR. 

And so just an interesting journey, but absolutely fell in love with Oklahoma Heart from the first time I set foot on the property. Believe in the mission wholeheartedly. Like Dave said, the folks that come here are sick, their families are there. And I think we share a special place in our heart for them, and I think the reverse is true. I think that every patient is great. Every staff member is great. The level of professionals that I deal with on the IT team is incredible. I'm still learning today from them. And so it's a great journey in that sense. And then our physicians, our physicians are just a unique breed. I say that in the context of they're very professional, they're very helpful, they're very kind. And I think that goes a long way towards just a whole great organization across the board. 

Phil Sobol: That's excellent. And the position that I'm in, I get an opportunity to talk to so many individuals that are tied into these great mission-driven organizations. And so love hearing the stories. So thank you both for that. And sometimes healthcare organizations, they come to a crossroads of sorts when it comes to major technology decisions. So Dave, why don't you catch us up on some of those big technology decisions that Oklahoma Heart has been weighing, planning for and even implementing recently. What did that decision-making process look like for OHH? And was there a tipping point to move from one platform to another? 

David Miles: Sure, sure. So again, I got here in late-2020. Immediately we started taking stock in who our long-term vendor partners would be. We had a very vast vendor portfolio here in IT. 

Phil Sobol: Yes. 

David Miles: Which again- 

Phil Sobol: Very common. 

David Miles: Yeah. Yeah, most folks will tell you that's not really the best choice. There's power and leverage in consolidating your book of business behind trusted long-term partners. So we started taking a look at that right away when I got here. We looked at which applications we believed in deeply, which applications we felt had appropriate runway to last many years and appropriate investment from the vendor side. It wasn't just our EMR at that point, it was all systems across all disciplines here. But obviously the EMR is our biggest singular system. It touches almost every single staff member that works here at OHH. So that's where we started and we said, well, what is Cerner Millennium to OHH? Over the 20 years we've been an organization, again, part of the success of OHH has always been our ability to react to changes in regulatory posture from the government, changes in consumer behavior, changes in the way our physicians and staff provide care, medical technology, advancements that shift procedures from in to out, things like that. So part of our success has been our ability to respond to those quickly via enhancement in our EMR. 

At one point we had a group of 10 application developers that were doing nothing but writing custom code for EMR. But again, that comes with consequences. So we had over a million lines of custom code in Cerner. We had developed in-House tools that were so good that we were selling them to other Cerner clients. In fact, they were so good, Cerner took some of them and put them in Cerner Millennium. So while we had wonderful success doing that, the consequence was we were no longer able to scale Cerner Millennium to take new code upgrades because Cerner didn't have any idea what we had. So part of our decision to change our EMR vendor platform had to do with the fact that we could no longer scale Cerner Millennium or quite frankly, support the upgrades. So basically, the tipping point really for us to make that decision was support and maintenance, keeping its costs low. How do you get expertise in your own stack, your stack of applications? 

And to me, I looked at it and said, guys, we have gone so far off the keep it simple mentality that we can no longer do this without 200 people. So again, for us, like I said, if you were to ask me what is the key IT decision-making process look like, I would tell you keep it simple. Stick to the features and functionalities that your organization is going to use because there's bells and whistles in everything. A lot of them you won't use. So stick to the ones that you're going to use. Make your buy decision based off what's already in the product, not what they're promising you is going to be there. Don't stick a square peg in the round hole. Don't over customize your solutions, or you'll be in the same boat we were with Cerner, where you can no longer support the product without an army of people. 

And the last piece for success is make sure your organization is prepared to standardize across institutions. All your strategic business units need to do things the same way because systems don't like variation. They treat the exact same thing the exact same way, and they never make a mistake doing it. So you all as an organization have to recognize up front, we have to get to that point where we do the same thing the same way everywhere. To me, those are the linchpins of your decision-making process from an IT perspective. 

Phil Sobol: That's great insight and actually feeds right into the next topic that I wanted to ask you about. And so maybe I'll get your perspective and then Jim's after that. So as you were heading down the Epic implementation journey, did you clearly define what success would look like? Probably from first the overarching hospital perspective, and then as you talk to the providers and clinical teams, et cetera, what would it look like for them as well? And maybe I'll let each of you speak to different segments inside of the organization. 

David Miles: Sure. I mean, I can go first. That's fine. So again, we came up with a project charter. We have guiding principles for the Epic project. But again, success for this EMR project was all about maintaining efficiency. We don't want to add staff, we don't want to add cost, we don't want to do more. We want to take advantage of automation. We want to consolidate staff where it makes sense and provide those staff members with greater confidence in the role that they play. So for us, again, the ability to maintain the efficiency, both on the clinic side, which is our ambulatory side, and the hospital side was important. How quickly do we get things done? So that was always important to us was that flexibility to keep our people highly efficient. 

We're still working through some of the workflow issues, but for the most part, we're at the point where those caregivers and those using the Epic system are gaining confidence. They're doing repeatable tests, they're getting faster at it. We're very intentional about monitoring speed at this point. To us, again, that success is - Were we able to maintain the efficiency and keep the visit counts, procedure counts and everything else running as they were pre-go live? 

Phil Sobol: That's great. 

David Miles: I'll turn it over to Jim to see if he... Jim and I, we often have different opinions about things, and I'm very proud of that. Jim, you can answer the same question, bud. 

Jim Wetzel: Yeah, no, thanks Dave. I think that the resounding thing that we heard, even just prior to making the decision, was: less clicks, more revenue. I mean the two major goals. How do we get there? I used to have a saying, “people just push buttons to get past screens”. And so looking at a system that would allow us to improve the data integrity to make sure that we were getting good information in so that we could have good information out. This to me was the great reset. We ran on an EMR system for 22 years. We developed lots of bad habits and lots of good things, too. We had lots of success. But for me, this was the point at which we could say, okay, where were the problems? Can we mitigate them with this project, this implementation? And can we have a better path forward? And I think we did that. We quantified that stuff up front and we measured it along the way and even sent a synopsis recently off to some of the senior leaders to say, this is what we actually accomplished besides that new interface that you're looking at. 

Phil Sobol: Yeah. I love the idea and the concept of creating that synopsis because sometimes what is a no-brainer for us who have been close to a project, sometimes that doesn't get disseminated. And making sure that that information's in leadership's hands, in everybody's hands makes a world of difference. And quite frankly, sometimes we just needed to be reminded because it's easy to see the win and then forget about it three months, six months, 12 months later. So that's great. Well, and it's not every day that healthcare organizations go through these big transitions. 

And so Jim, we would love to just get your point of view as far as what your experience was like working through this transition. And now that you guys are on the other side of a successful Epic go live. 

Jim Wetzel: In the beginning, Dave came to me not long after signing the agreement and said, "Hey, we're going to do this in 12 months." And I looked at him and I went, "Okay then." So lots of concern, lots of trepidation early on. I think the true definition of leadership is getting people to do what they otherwise wouldn't. And so Dave, kudos to him for that. And we did it 11 months. I think there's a story there. And so the question becomes [inaudible 00:17:50]. And I don't know that there's a single recipe for that. 

But my prior experience did not include converting an EMR to another EMR, but it did two years prior include a pretty significant project. We went from a client-hosted environment to remote-hosted environment, took a major software upgrade for Cerner, and implemented bad readers all at the same time, a perfect storm of projects that were precursor to this. It was a lot of effort, a lot of coordination. I don't think any other organization would've tackled those three projects at the same time, but we're not any other organization. It gave us some sense of confidence going into Dave's one-year timeline that we would make it, and we, in fact, did. 

Phil Sobol: Oh, that's excellent. Well, Dave, we touched on this a little bit already, but wanted to dive into it a little bit further. And that's just getting your perspective and any insights for other healthcare leaders who need to justify a large technology investment or a significant technology change. And so maybe if you would go into a little bit more detail as to how you went to and engage with stakeholders, perhaps board of directors, other senior leaders in working through that decision-making process. Were there any tough conversations, holdouts in particular, and then just how did you work through that business case justification? 

David Miles: Sure, sure. Thanks, Phil. So yeah, of course, there's always spirited conversations generally with your CFO, right? 

Phil Sobol: Yep. Yep. 

David Miles: Anytime you come in and say you want to spend multi-millions of dollars on something, you have to build enough consensus among the other leaders when you approach your CFO. Although that was not the case for this project, with Epic in particular, the CFO was on board from day one. He really believes very strongly in the value of the revenue cycle, integrated revenue cycle that Epic brings. So again, that was not a battle we had to fight on this particular project, which is unusual. But from my perspective, if you're talking about large technology investments at your organization, number one is take your time, really truly understand what need are you trying to satisfy by making the investment and will making the investment actually solve the root cause of the trouble or consternation that you're having, right? 

Sometimes we throw good money after bad, and it never really solves the problem, because we haven't clearly identified why we have the problem in the first place. And when I say we, that's the collective, we not necessarily OHH, right? It's a universal truth. 

So one, take your time. Really understand - what are you solving by making the investment? Two, know where your organization needs to be, not today or not in a year when you finish the project, but in five years, in 10 years. What is the value of the investment you're making today in five years or in 10 years? And if it's not three-fold revenue today, then maybe it's not the right call for you. Maybe it's too expensive or maybe the value is not big enough. That return on investment is super important because you're spending such a significant amount of capital. 

Phil Sobol: Yes. 

David Miles: Have a long-term view. Look five years, 10 years and say, what's this investment do for me out there? What are we going to be doing with it, from a patient service or a business perspective? 

Three, choose your partners well, right? If you're fighting for support or you're fighting for enhancements or features, that's not really a long-term partner. Find those that have pride in their own product and they really, really want to invest in it and make it better. And then, like I said, always ensure that you have a well-thought-out plan for how you're going to receive service and support from your vendor. Not how they give it to you perhaps, but how their support aligns with your staffing model. Do you have dedicated people and are they capable of understanding what's good support or bad support and able to resolve issues? Because they're going to get tough. There's going to be some tough issues in there. Align your staffing with their support. 

And lastly, pay attention to the contract. Too many times we sign deals where nobody's really read through the contract with a fine-tooth comb, and you end up getting held to some contract term down the road that you're like, "Oh, I didn't even know that was there." So really take time legally to make sure you understand what you're contracting for and that you're protected in there because we get lots and lots of contracts that are less than good for us and really good for the vendor. So protect yourself. Protect your staff by making sure that your contract is structured in a way that provides value to your organization. We see too many contracts where the vendor has great terms and conditions in the contract, and what's in it for us is the customer may not be so great. So make sure you pay very, very close attention to the T's and C's. 

Phil Sobol: Well, Jim, there's always a lot of work to be done during an EHR implementation and especially one that is compressed into 11 months. If you wouldn't mind, share with our listening audience, perhaps some of the strategies that helped providers, staff, your IT team, really any of the departments involved, manage through the various phases of the implementation to not only hit the timeline, but also at the same point, continue to deliver great cardiac care to your community. 

Jim Wetzel: Yeah, sure. Thanks Phil. Well, I remember a conversation with our chief operating officer early in the process, and everyone's nervous, everyone's scared, and my comments were, we will get there. All right? It's like the space shuttle, once it starts its descent, it's going to land, and you have to trust that. It might be a bumpy ride to the bottom, but you're going to get off it and you're going to be okay. 

I think it's trust the team, trust the people, trust the process. We have many, many questions. I leaned on the vendor heavily, but I also did a lot of research in their communities and their forums and their message centers and looked to see what did other customers do? Because if we're experiencing this question, someone else might have already, so let's take a look at what they did. So we spent a lot of time doing that early on, during, and even now we're still doing that, right? We're unique in the sense of the care we provide, but not unique in the sense of the EMR, right? 

Phil Sobol: Right. Right. 

Jim Wetzel: So that was important. 

Dave had mentioned something to me, and I think he really pushed on this heavily, and I think it really helped. And that was, "Hey, think outside the box. Don't try to recreate the existing EMR. If you had a blank slate, what would the workflow look like? If you needed two more people, what would that look like?" 

So that went a long way towards, I think architecting the solutions that we needed, coming up with ways to get there without having to do custom development work with highly programmers. That was the change. That was a real change for the organization, but I think it helped a lot as well. 

Phil Sobol: That's great. Well, there's always the unexpected in healthcare technology. In my experience, it's working with folks like yourself in healthcare and technology, you know how to focus on the important things and solve problems, and most importantly, stay calm throughout that process. And so, David, I'm sure you had plans in place and support teams in place as you were going through this process, particularly into go live. And any challenges along the way or surprises when it came to that day where you flip the switch? 

David Miles: Yeah. For me, the three things that were written on my board all along were clinician involvement and workflows, training and education and interfaces. Those were the three big giant buckets that I was most concerned with, how we found success in each of those. And this was from the very beginning of the project before we had any clue what was in those three buckets, those were the three buckets. So from a surprise perspective, absolutely. We had both the right surprises and the wrong kind. So what I'll tell you is we struggled greatly with user provisioning, security and training. I mean, we're still struggling with that. And I provided that feedback to our vendor, which was, "Hey, you guys didn't tell us we should have started this months before the project started." 

And for us, again, we really didn't understand how out-of-date we were with our record keeping for our staff. We have some antiquated processes, we lack standardization. So all the things that really cripple you from an IT perspective, we found every single stinking one of those. And they were the wrong surprises, right? The kind where you got to throw people at it and you got to work through it, like you build the plane while you're trying to fly it. 

So like I said, we're continuing to work through those. One of our very first projects is going to be physician and staff onboarding. We're going to try to get to a standardized process that we then can mirror or ensure that Epic and our other systems all play nice with or backwards reengineered, so we know what the systems can support and make one process that we can follow systemically. 

So again, that was the kind of surprise that we knew was coming. Again, that bucket was on my list from the very beginning, but boy did we really struggle there. The right surprises, we did have really good clinician engagement, at least on the hospital side. It was a little less on the ambulatory side, but we didn't see a crazy skyrocket of ticket volume that go live. We saw the types of issues we expected to, so that was a pleasant surprise. For the most part, people understood the workflows. They did an excellent job of sticking to them and staying open-minded. 

And then lastly, the last bucket we had up there was interfaces. For us, that really was a non-issue. For all the nights that I tossed and turned worried about how we were going to connect 128 different interfaces and make them all work, I do have to give a ton of credit to the project team that CereCore put together for us. The interaction that Jim and others from Epic had with that group of people. We literally, I mean, I can't think of one major interface issue we had. And not only did we do the 128 that were there before, we added some that we worked on, then we're still working on some now that we knew were not going to be there at go live. But again, I cannot give enough credit to Jim and to the staff that CereCore gave us and the way they worked and their effort. It was really truly special. 

Phil Sobol: That's excellent. No, I appreciate you sharing that. Jim, any practical advice or perhaps tips for keeping teams not only connected, but motivated throughout a project like this? I know certainly a lot of times communication is key, but would love to hear from you about your approach to that. 

Jim Wetzel: I keep two boxes of Kleenexes on my desk, so that door is open. You can come in anytime. No, I mean that's true, but nevertheless, I think it's one, having sort of a tactical and technical competency that gives some sense of confidence to folks, that I'm going to be there for both men and mission for them, and that Dave is too, right? At every juncture, those are the things that we discussed at a leadership level. Those are the things that we got down to the trenches and said, "Hey guys, I see you're having this problem. Let's work through it. Let's make some good decisions here and go with it." 

From a real technical perspective, we tried to make sure that our MRN strategy was tight and right, and while we weren't merging three or four different systems, having that early on was important and knowing it and conveying it. Having our provider files tight and right and cleaned up went a long way. Getting our charge master in order prior to and during went a long way towards success. So there were little things that we tried to do, but keeping folks motivated, I don't think they had time not to be, quite frankly. It was the hyper aggressive timeline and many folks were heads down. So Dave, I don't know if you want to comment. 

Phil Sobol: That is one of the benefits of that compressed timeline for sure. Well, David, we will touch base with you, and Jim, I'd love to get your perspective on it secondarily, but healthcare technology is certainly ever evolving and changing. And I think you made mention of it as part of the thought process of moving from Cerner Millennium to Epic. And that is these are not set it and forget it type systems, right? They're ever-changing and evolving and growing as is just healthcare technology in general. So as you move past go live and start looking towards the future, what are you looking at as far as what's coming down the pipe? 

David Miles: For us here at OHH, the next iteration of healthcare technology is really for us to take our first Epic upgrade, which will be new to our IT staff and our IT analysts. So that'll be interesting. That's seven weeks post go live. There'll be many optimization projects where we evaluate whether or not we hit the mark with our build. But again, back to an earlier point, maintaining that standardization is critical. This will be the point of the project where the requests aren't coming off the rails, and we start wanting to do things differently. So it'll be critical that we maintain that standardization as we evaluate these optimization projects. 

We've got to get back into the other IT work that we paused while Epic consumed our IT group's resources. As Jim mentioned, we did it in about 11 months, but for 13 months, most of us have been focused on nothing but Epic. We've got to finish adding all the additional features that Imprivata IdG offers us. We basically put that together, but we didn't put everything in because we ran out of time. We've got to get back to that. The security of our network is critical, and managing our staff in that secure manner is critical. That's one thing we've got to get back to do. We've got data center refreshes that we paused. Our technology is aging in the rack just like everybody else's. We've got to talk about rolling out some of those bigger ticket data refreshes. 

The next huge project for us here will be evaluating a replacement for our finance, HR, supply chain system. We've got a pretty old product, the same one we put in when we were founded 22 years ago. Obviously, we need to think about the benefits that a newer system offers and decide if those make sense for us financially. I can certainly tell you they make sense for us from an effort perspective, because we do a lot of things manually that some of the newer technology in HR and accounting can handle for us. That will be a project, much like our Epic project, I assume it'll be another year-long project and a multi-million dollar one for us. All that's going on. And then the last piece is we've got to ensure that we're staying ahead of the regulatory curve in healthcare, as well as the changes that come from our insurance payers. It is really, truly amazing the amount of regulation and the amount of different things we need to do to satisfy our payers. It is definitely a lot of work and something that requires a lot of expertise to understand what the correct response should be to both of those people. So that nimble culture that allowed us to be so successful, trying to maintain that in the face of all these new systems, that's really what's next for us, Phil. 

Phil Sobol: Oh, that's great. Jim, was there anything that you wanted to share on this? 

Jim Wetzel: Yeah, I think, and Dave and I have chatted about this in the past, and that is that HL7, as delightful as it is, it is not our friend. And that is every project that we tackle, that interfaces, that EMR is three to four months in nature, multiple resources, lots of handshakes and ultimately success. But what does that landscape look like for us going forward? How do we scale doing projects and integrating all of the wearables and all the consumables and the things that are out there for patients today? So yeah, that's what I'm looking for on the horizon. 

Phil Sobol: Excellent. Well, we always love to wrap up these podcast sessions with just an open call for any final words of wisdom for healthcare leaders today. So Jim, I'll start with you, and then Dave, I'll let you finish this up if that's okay. 

Jim Wetzel: Yeah. Stay up on your technology. I think one of the big things that we could point to for success was having a very relatively recent refreshed hardware stack across the org at the desktop level. That went very smoothly. And I think we even shocked our vendor with that. That would be my advice. Don't let those PCs age to 10 years. Get new ones in there and [inaudible 00:37:24] you'll be ready. 

Phil Sobol: Excellent. 

David Miles: Yeah. So yeah, Jim's, absolutely right. Again, investment is important. Ongoing investment is important, but you got to balance all those priorities with the other needs. But for me, what I would say to other healthcare leaders is the models are changing, the traditional way that we deliver care is changing, health equity becoming more important, in particular in the payer circles. So as that gains popularity, how do you scale your business? How do you plug in new service lines to serve these other populations that traditionally have lacked healthcare availability or access to healthcare? Health equity is important in gaining and how we respond to that's important. 

The shift in care from physical spaces, to telemedicine, to at home care, which this touches a little bit on what Jim just mentioned about wearables and some of the technology now that's providing data and clinical information, that doesn't take place in a traditional physical care space. So how do you leverage your technology stack to offer those types of services? Because that's what your consumers and your patients are asking for. They'd rather be at home than in the hospital. 

And quite frankly, we'd rather you be there too. It's much safer. How do you adjust to that change from physical space to telemedicine, to virtual care, to home care? How do you make efficiency gains for procedures that traditionally were inpatient, which are now outpatient, which then subsequently could move to home care, right? Procedures that used to be a four-day inpatient stay now are a two-day inpatient stay or have moved to outpatient completely. How do you maintain revenue while you're going through those transitions? 

Obviously, the staffing, the realization that you have limited staff, both physicians, nursing, shared service staff, the cost increase for staffing has been incredible over the last couple of years. Responding to that particular dichotomy in healthcare is important. For us, we've got to build and perfect, quite frankly, consumer digital utilities and applications on your phone, on your iPad. Our patients want to take some level of accountability in their own care, and are we able to offer that to them, and are we able to make that work inside of a seamless workflow for us? 

So finding ways to make that a reality. Again, maintaining the efficiency for our caregivers and our nursing staff via mobile utilities perhaps, or other technology. That's something that today's leaders need to keep in the back of their mind. 

And then lastly, healthcare is one of the last groups that have realized that there's power in data, and how you report on that data and what you do with that data is meaningful. So as healthcare leaders, we have tons and tons and tons of data. It's incredible the amount of data that healthcare collects, but how do you take that incredible amount of data, distill it down into something that's usable to make business decisions off of, or to make clinical care decisions off of for your patient? So again, that's something that I'm very passionate about. And again, that's a big part of why I ended up here at OHH, was to build an electronic data warehouse and to run a business intelligence group that does mine data and does turn it into something useful for our department leaders and our operations leaders, and also for our financial leaders. 

So again, all of those things are going on simultaneously, and it's an interesting time to be a leader in healthcare for sure. 

Phil Sobol: Well, yes, that is very, very true. So Dave, Jim, I just want to thank you both very much. First for the time today and the insights. Always love these conversations and really appreciate you taking the time to share that. Certainly appreciated our opportunity to come alongside you all in your Epic project as well, not only to help you and your team there, but really more importantly to get to know you guys and the tremendous work that you're doing there at Oklahoma Heart. Thank you very much for being on the CereCore Podcast today.  

David Miles: I appreciate the offer. Thank you very much.