[00:00:00] Stacey Richter: Episode 446, "Hey, Let's Not Talk About EHRs". Today, I learn a lot from Dr. Spencer Dorn.

To listen to this episode or read the show notes with links mentioned, visit the episode page.

This show is about getting or not getting patient outcomes and getting them in an efficient or not efficient way that is in alignment or not in alignment with the values of clinicians trying to care for their patients in the best way that they can.

And I'm beginning this conversation with this preface, lest anyone lose track of the ends which we seek, which are quadruple aim type goals. I'm starting here so that we don't get confused between what is a goal and what is a means to achieve a goal. Because today we're sort of going to talk about technology, but we're really not going to talk about technology.

And if we're not going to talk about technology, then of course, because go big or go home on this show, we're not going to talk about the mother of all healthcare technology, EHR systems, electronic health records. Ah, so cryptic, but let's proceed. I want to dig in here because this is really important, actually, to everybody, including, and especially, anyone buying healthcare services such as employers.

It's also a level set for anyone involved in or about the purveyance of said healthcare services. Here's my first point. Conversations about technology may be unduly focused on technology, and this includes EHRs. I saw a tweet recently by Joshua Liu that struck me because it really mirrors my own experience working with clinical teams.

Joshua wrote, "let me show you why studies evaluating the same tech can have very different outcomes. Why the very same tech implemented with different workflows and people can lead to wildly different results.” I'll link to a great and pretty funny actually visual that Joshua Liu made about this in the show notes, but the point is this.

Technology is not a thing unto itself. It is not a magic pill like those gelatin caps that you can buy at toy stores and when you toss them in the bathtub, they expand into surprisingly large foam dinosaurs. I mean, you can buy any given healthcare, digital technology, anything, and what doesn't pop out of the box along with purchase are any sort of "why" for an end user to actually use the thing. or implementation plans, processes, change management, empowered people who are bought in, adequate training, adequate staffing levels, and ongoing communication. So, look, here's the point. Unlike the bass, it's not all about the tech. There are people, there are processes. I say all this to say, it's weird to me, and Dr. Spencer Dorn, my guest today, said pretty much the same thing. It's weird to me how we evaluate technology, and this includes EHRs and patient portals, which we talk about today, and even AI, which we will talk about in a shorter episode that will air in September. But it is so very, very common to talk about tech like it exists in a vacuum and is an end unto itself.

For example, you hear often enough people talking about optimizing the EHR. Maybe instead, the title of the conversation should be optimizing the patient doctor encounter, or optimizing patient health, or optimizing the ability of clinicians to work together as a team. Tech is certainly a vehicle to achieve these goals.

But whether said tech is a force of good or bad, or something in the middle, or succeeds or fails, isn't inherent in the tech itself. As Dr. Dorn says, there is no intrinsic property of the technology that determines the outcome. It's how we use it, how we implement it, how we put it into daily practice, is really, ultimately, the arbiter of what happens and how it impacts lives.

I'd also add, just to be a bull in the china shop, even if the tech itself has some glitches, someone decided to make everyone use it in its current form. So, yeah. Therefore, first takeaway from this show is going to be don't ascribe any given technology a label of good or bad or even neutral. This, by the way, is Kranzberg's first law of technology.

Which of course comes up, because you know me, I cannot miss any opportunity to nerd out over something like Kranzberg's First Law of Technology. And that wraps up takeaway one. Technology by itself is not good or bad or even neutral. Reference Kranzberg's first law of technology. Thank you, Melvin Kranzberg.

Second major takeaway is that if you're thinking about the ultimate impact of people and processes that have some technology in their midst, technology such as an EHR system, the ultimate impact will not be a black or white binary. Let's just acknowledge that we as humans love binaries, especially polarized binaries, because it's very tidy.

Putting things in clear boxes removes ambiguousness that our lizard brains just do not like. But I'm keeping in mind what Tom X. Lee, MD, said on episode 445 last week. Most things in life, IRL, are somewhere in the gray murky middle. And if we understand that, we can make that middle space productive. 

Dr. Lee called it the productive middle. Here's how I'd put it. Don't be an edgelord. It's generally not a fact based place to be, but also, it's not productive. Dr. Spencer Dorn and I discuss all of the above and he makes some great points and he's very articulate. 

Dr. Spencer Dorn, my guest today, is a gastroenterologist practicing in North Carolina. He spends his time doing a few different things. That includes taking care of patients. He also helps lead a large academic practice. And lastly, Dr. Dorn works in healthcare IT and clinical informatics. So therefore, the perfect guest to talk about this whole topic with today. 

This is a really interesting conversation, so I hope you listen to it. 

My name is Stacey Richter. This podcast is sponsored by Aventria Health Group.

Dr. Spencer Dorn, welcome to Relentless Health Value. 

[00:06:14] Dr. Spencer Dorn: Thanks for having me. 

[00:06:15] Stacey Richter: You had written a post on LinkedIn, which I was captivated by actually, and you were talking about Kranzberg's laws of technology, specifically the first law of technology. Let's start there. 

[00:06:28] Dr. Spencer Dorn: Yeah, I think in general, we have very polarized views about technology.

On one side, there's often people who think technology is magical and it's going to make our lives perfect. And on the flip side, we have people who react the opposite way, that technology is destructive and is pushed making everything worse. And I just love this first law of technology that Melvin Kranzberg, who was a historian at the, at Georgia Tech University, coined.

What he says is technology is neither good nor bad, nor is it neutral. To me, that really speaks to the essence and the heart of technology. It's really up to us as humans to determine the effects of these technologies, not up to the technology itself. 

[00:07:11] Stacey Richter: Yeah, the way that I interpret it is technology can affect society, can affect people, in ways that extend beyond whatever the original purpose was, so you can have the same technology, but it can lead to different outcomes in the broadest sense of the word, depending on where and how it's used and who you are and how you perceive it, right? Like the context starts to really matter here. 

[00:07:35] Dr. Spencer Dorn: A hundred percent. I think that's what he's getting at. There's no intrinsic property of the technology that determines the outcome. But it's how we use it, how we implement it, how we put it into daily practice. That's really ultimately the arbiter of what happens and how it impacts our lives. 

[00:07:51] Stacey Richter: There's nothing intrinsic in the technology itself. It's how it's used, it's who's using it, right?

And it can be both good and bad at the exact same time. And I do agree with you, it's actually a mistake. And I think we go down a lot of false pathways when we almost start to anthropomorphize the technology itself. Like it's got some kind of intent or something like that, because it doesn't. It's all how it's deployed and how it's used.

So let's just go to the, the mother of all debates. Let's talk about EHRs. And I want to talk about EHRs, again, not from the, let's have a fist fight perspective that often happens when you bring up the EHR word. But how does it go right? Like, how do EHRs in the context of Kranzberg, where they're not good, bad or neutral, they're used in the context with which they're used and that can be good, bad or neutral, but how does it go right with an EHR system?

[00:08:47] Dr. Spencer Dorn: Yeah, so I'm just old enough to have started practicing and certainly med school and training in the pre-EHR days, the paper based days. And there were clearly some major challenges in those days that the EHR answers. Most fundamentally, EHRs help empower us with information at the point of care. 

So in the old days, if I saw you in clinic, Stacey, and I said, hey, what's going on? And you said, well, I just saw this doctor last week, and don't you remember we met three years ago? I would have to just rely on the information you could report back to me about what happened in those visits. Or if you said I had this test done a couple years ago that showed this, we would not have any information readily available.

What EHRs do, the main positive, really their main function clinically is to bring that information together from different visits, different tests, different encounters at different points in time and pull it all together and put it in one place so that I could see it as your physician so that we could do it together. So I think that's probably the most fundamental benefit of EHRs is that they empower us with information. 

[00:09:58] Stacey Richter: So if I'm thinking about this from the standpoint of a patient or if I'm thinking about this from the standpoint of who's ever paying for this whole shebang, right, which is going to be a self-insured employer or a taxpayer really, I could think it's easy enough to extrapolate the advantages there, right? Like I don't have to have duplicate testing because the first instinct of a clinician or a physician who can't see the results of a test is to order a test. So if they can find the earlier one, then you don't have to have duplicate testing, which is expensive. And also, I mean, maybe invasive or time consuming.

I could definitely see the value, maybe diagnostic. You know, you can get a better diagnosis because if all the information may be available, then the diagnosis can come faster. 

[00:10:44] Dr. Spencer Dorn: Yeah, I think you can make your, you're making better decisions because you have a more complete information set in front of you.

So whether it be ordering the right tests or just knowing more about the person so that you can make the right diagnosis. Having the information in front of you allows you to make better decisions. And then of course there are other enhancements that around clinical decision support and other tools that can help us as clinicians.

[00:11:12] Stacey Richter: Well that sounds like a very valid, meaningful use. 

[00:11:15] Dr. Spencer Dorn: I like your pun there. 

[00:11:16] Stacey Richter: Thank you. However, you do not have to go very far. To find someone who could come up with some very valid points which would indicate that all of what we just talked about may or may not be happening in real life. Do you want to talk about the counter? 

[00:11:38] Dr. Spencer Dorn: Yeah, so the counter to the information, EHRs empower us with information. They also overwhelm us.

Right? So we have too much information to make sense of. I love this quote from E.O. Wilson, we're drowning in information while starving for wisdom. Right? Where there's just so much information that we can't sift through and find the meaningful signals within it. So for example, the average patient record is over half the length of Hamlet, which is Shakespeare's longest work. It comes from a University of Pennsylvania study. Who has time to look through all this information and make sense of it? And we know that the information is often duplicated, more than half of each clinical note in an electronic health record is simply copied over from the prior notes.

We know there are many errors within records. There are wrong diagnoses, there are duplicated medications. So, while we are empowered with all this information, we're also overwhelmed by it and have trouble making sense of it. So I think going back to Kranzberg Law, it's neither good nor bad nor neutral. Here we have a clear example that EHRs empower us with information. Yet, they also overwhelm us with information. 

[00:12:55] Stacey Richter: Yeah, the whole drinking from a firehose thing. I love the quote that you mentioned, the, you're drowning in information but starving for wisdom. I think that actually really sums up a lot of the, some combination of diatribe, rant, informed commentary on how clinicians are interacting with the EHRs. And then just also the whole, it takes 90 clicks to do something that everybody knows is the right thing to do for a patient. So just how difficult the user experience is probably bears mentioning. 

[00:13:30] Dr. Spencer Dorn: Yeah, so I think the first, you know, benefit and challenge of the EHR as we discussed is more information.

The second benefit and challenge of the EHR is how it affects us as people, right? And how digital technology brings us together, but it also pushes us apart. So the EHR brings patients and doctors together in many ways, most notably through patient portals, which you mentioned, meaningful use that was an outgrowth of meaningful use.

If you see your physician and she checks some tests, you could quickly see those tests yourself when you get home once they're performed. If you have a question for your physician a few days later, you could send your physician a message saying: “Hey, I forgot to mention this during the exam. What do you think of this?”

So those are examples of how EHRs bring patients and clinicians together. But as you mentioned, they also push us farther apart. Because we're stuck pointing and clicking and typing and doing all this kind of busy work while people are right in front of us. So instead of looking you in the eye, your clinician may be, yeah, clicking away.

That's kind of, again, the flip side of this coin. The EHRs in some ways bring us closer together. But, there are kind of this elephant in the room that get in the way of interactions as well. 

[00:14:52] Stacey Richter: You know, I was just going to say that it's such a paradox because exactly like you said that vis-a-vis an EHR patient portal, patients are brought closer to the clinicians and physicians.

Clinicians, theoretically, should have access to what each other are doing, but at the same time, exactly like you said, like tangibly, you've got this big monitor that's sitting in between the doctor in the room and the patient in the room that is literally a barrier in between the two of them. It is an obstacle in between the two of them.

I have also heard so many times relative to the clinician to clinician interaction that everybody used to hang out at the nurse's station or everybody used to hang out in the room downstairs with the radiologist or in the lounge, the doctor's lounge. There was a lot of opportunities to connect human to human.

And since the advent of the EHR, they're like, we don't need the doctor's lounge, get rid of it because everybody can just interact online. 

[00:15:51] Dr. Spencer Dorn: Yeah, that's totally so, right. That's a really great point. It's not just how clinicians and patients interact with each other. EHRs also affect how healthcare workers interact with one another.

And in some ways, digital technologies, including EHRs, bring healthcare workers closer together, right? A perfect example of that would be something like an e-consult. You saw your physician, your physician said, you know, I really, Stacey, want to get a gastroenterologist input. I don't think you actually need to see a gastroenterologist, let me send them an e-consult and they send me an e consult and within a, you know, a few minutes I can give her back recommendations that she can call you with.

So we're closer together as a physician community because of the EHRs in some ways and that we can communicate very easily. The flip side of that is, like you said, we don't see each other as much anymore. We don't hang out at the nursing station. We hang out in our work rooms banging on computers. When I round with fellows, not to sound like a old grumpy doctor, but when I round with fellows on our inpatient wards, they're busy on their phones.

And kind of using their thumbs a lot. They're not like scrolling through TikTok. What they're doing is they're communicating with the other inpatient teams as we're seeing patients. We saw a patient, we say, okay, this is what we should do. And they get on their phone and they quickly send a message to a resident or to another fellow saying, this is what we recommend.

And that's amazing. It's great that we can communicate so easily, but we don't bump into each other in the hall and sit down and actually start chatting about a case or just chatting about anything. And I think in many ways it leads to a sense of isolation and disconnection from our broader healthcare community. That, I think, is kind of, in some ways, a problem. 

[00:17:41] Stacey Richter: Brought together in some ways, but pushed apart in others, I think is the theme of what I am hearing. That technology has an amazing capability to enable connectivity between potentially geographically distant individuals or just asynchronously, even. Like, I can do something a year ago and you can see it now, right? So like across time and space, a computer and, and EHR systems and their attendant APIs and bells and whistles, right, can, can bring people together. But it also, if we're thinking about a human-to-human relationship, can push people Apart. And I think this is not just a problem with EHR systems, right?

Like I think we have a tendency to finger wag EHR systems because they are so front and center to many who work in any healthcare delivery networks lives, right? But , we're facing the same exact thing writ large in society. Like, for example, I was having a conversation with someone the other day just about how nobody calls each other anymore.

I mean, picking up the phone and calling someone right now is almost the equivalent of, you know, 15 years ago, just like driving over to someone's house and ringing their doorbell unannounced. You have to schedule a meeting. Maybe that happened during the pandemic or whatever, where everybody was having like Zoom cocktail hours, but like you almost need a computer sitting in the middle of the human-to-human interactions and that has consequences. 

[00:19:12] Dr. Spencer Dorn: Yeah, I think that's an important point. These problems are not unique to medicine. These are reflected in our broader life. And you mentioned before radiology rounds. So, you know, in the good old days, and I say that with air quotes, when we had images to review, we would walk down to the radiology workroom and we would look at the images with a radiologist.

Bob Wachter wrote this in his really good book that I think is about 10 years ago was published called "The Digital Doctor". He called that the canary in the coal mine. The first thing to go with digitization was residents, attending physicians, teams no longer walked to radiology rounds because they could see the images themselves on their computer monitors.

Now maybe that's fine. Maybe that's a good thing in some ways. But if you ask some older doctors a lot of magic happened in those radiology rounds. There's a lot of learning, a lot of benefit to reviewing an image with an expert. Helps you understand kind of better what's going on with someone. And you know, that's a similar example.

You mentioned the Zoom cocktail hours during the pandemic. Those fell away as we got back to things and we're back to this asynchronous kind of text based world, which again has some benefits, but there are some downside and these are not unique to healthcare per se. 

[00:20:32] Stacey Richter: The themes that I'm hearing coming up here, and one we've said explicitly, you're drowning in information but starving for wisdom. the other one is just technology can bring us together, but it also can push us apart, and we really need to be aware of that. Healthcare fundamentally is a relationship based endeavor, like patients will not take the advice of anybody who they do not trust. And you have to have a relationship to engender that trust. So there is a really important human connectivity here from a physician and patient standpoint.

[00:21:09] Dr. Spencer Dorn: Just reflecting on the theme so far, one is information from EHRs and other digital systems empower us and also overwhelm us. And two, technology brings us together yet also pushes us further apart. But it's about the us part, right? Humans are not just information. We're not just packets of information that must be processed and analyzed so we come to a decision.

The whole point of what we're doing, the whole point of healthcare, is to help people live healthier, happier lives. And while some of it we can do in a kind of detached, aloof, impersonal manner, my strong belief is that deeper healing comes from those deeper connections that unfortunately sometimes EHRs get in the way of.

[00:21:54] Stacey Richter: The other bit of this that I'm really hearing loud and clear is how the technology is deployed can make all of the difference. You can have a technology which is great or maybe a little bit less great, but then also it's how it's deployed. It's how it's been socialized. It's how people use it. Sometimes I feel like in healthcare, as well as elsewhere, there's an underestimation about what an excellent deployment looks like or excellent change management.

And if you forget that part, then it's just like any change, it's not going to go well. And then we blame the technology, not the change management or the operations relative to the deployment or the usage of that technology. 

[00:22:40] Dr. Spencer Dorn: A hundred percent, the technology does not exist in isolation. And going back to Kranzberg's law, it's how we use it that really makes the difference.

So for instance, there's a study I love quoting that looked at six or seven different health systems. And how many times a physician had to click to order Tylenol. So at one health system in the emergency department, physicians had to click 14 times to order Tylenol, which sounds crazy. But then at another health system, using the same EHR, physicians had to click 61 times.

Like, that's 61 times. That's absurd. What's the difference? The difference is the first health system, figured out a way to limit the number of clicks to 14, which is way too many, I guess, tolerable. The second health system didn't optimize the configuration of their EHR, so their poor doctors are stuck clicking 61 times on average.

So that's just one simple example of how even the same electronic health record deployed in different places could have vastly different experiences based on the work that different groups do to optimize their systems. And this extends so much beyond just pointing and clicking. One of the real challenges of electronic health records is that it shifted who does the work.

So in the old days, when a physician wanted a test ordered, they would go to their front desk staff and there would be a secretary or a scheduler or some administrative person there And they would say, you know, George, can you please order a CT scan with oral contrast for Ms. Jones? And with electronic health records, what happens is all of a sudden the physician, there is no George anymore, or George is doing something else.

The physician is entering orders themselves. So, part of the challenge, is that an EHR problem or is that a systems problem? All of a sudden we've shifted work to physicians that previously someone else was doing. And if we don't increase the support that physicians are having, they're going to get overwhelmed with these types of tasks.

So another example would be patient portals like we discussed earlier. In the old days, if you had a question for your doctor, you called the office. A secretary transcribed a little note and then at the end of clinic, the doctor saw all the notes and said, oh, I have to call back Ms. Jones, I have to call back Mr. Smith. And they would pick up the phone and call them. That wasn't so great by the way. That took a lot of time at the end of the clinic day. What's new now is that patients can directly contact their physicians by, you know, through an email like service. And we've opened the floodgates. So now it's so much easier for people to contact us, which is in many ways a great thing.

And it's much easier for me to respond to an email than to pick up the phone and try and call you. But again, the downside is we didn't adapt our systems of care enough. So often physicians are stuck dealing with all these messages on their own without or not support. And they've all of a sudden have way more work to do as a consequence.

So the point is that it's not the EHR that's the billing, it's really more us. We need to look in the mirror and say, how do we configure our EHRs? Cause we have some agency there. And then how do we configure our teams, our systems of care to manage and process this new way of working? 

[00:26:08] Stacey Richter: Yeah, if we're thinking through just kind of the implications here and the major themes, we've got the empower slash overwhelm, you know, two sides of the same coin. We've got what's it doing to the human relationships, the impact there. But you added more, in what you just said. 

So the first thing that you brought up was this. How are we configuring it? And if we're thinking about this from a very short term perspective, it could be very efficient just to not worry about it and then wind up with the situation downstream where a doc's gotta click 61 times to order Tylenol. And we wonder why doctors are walking out, so this is just, I think, a perfect example of the consequence of not really having great operations.

I mean, maybe we could sum up as sort of a potential crisis of operational excellence or for those who do it well, a potential accelerant. Again, it's not good or bad. It's how the whole thing is used. 

[00:27:03] Dr. Spencer Dorn: Exactly. I would say, so the third point I would say is digital technology can make us more productive.

I can respond to your question in an asynchronous patient portal message much faster than the time it would take me to pick up the phone, call you, hope you actually pick up your phone and have a conversation. So in some ways, EHRs make us more productive, allow us to do more. Yet on the flip side, they also make us less productive because we're doing all this unnecessary pointing and clicking.

There's a whole batch of pointless notifications that every clinician in America is getting about things that they really don't need to know about. And then there's a lot of work that someone else used to do that's now being shifted onto the physician's plate that oftentimes the systems of care are not adjusted to allow them to manage this new work flow. 

[00:27:57] Stacey Richter: Indeed, but if we think about this not from a, from a short sighted, potentially, very short term, what is efficient standpoint, this sounds great, right? Like I can fire, I forget the name that you used, I can fire George. I can fire George. Cause I can just have the, it's just like how all of the administrative assistants got fired because boss can type his own letters or her own letters, right? So, you know, it's, if I'm just thinking about this from a spreadsheet jockey standpoint, this sounds like a cost saving maneuver that I can get rid of people and doc can just do it themselves. Not taking into consideration that if it takes 61 clicks for your highest paid very valuable staff members to be doing this work.

I mean, this is where the working at the top of your license thing came from. Because this is very administrative types of things that do not constitute operational excellence in most people's worlds. But I think you also bring up what I would consider maybe the last point in all of this, that expectations start to shift in the process.

Like in the olden days, if somebody called the doctor's office and the doc got back to them two and a half days later, they'd probably be like, all right, doc's busy, fine, two and a half days, not that big a deal, or maybe that's fast. Now, if like 20 minutes go by and there's not a return message or text, everyone's tapping their watch. So I think the goalposts also start to move. 

[00:29:20] Dr. Spencer Dorn: Yeah, I think, and again, this is not unique to medicine. This is reflected in our broader society. We live in a one click, deliver next day or deliver same day world, right? We live in a world where you can watch pretty much any movie that's been created, listen to any song that's ever been recorded instantly.

So, this is just, again, healthcare in part, this is a consequence of digitizing healthcare, but more broadly, this is just related to how we live our lives outside of healthcare. And you know, we're going through some growing pains as we try to adapt to this new system and new way of doing things. 

[00:30:00] Stacey Richter: I like that term growing pains, and I think a big takeaway for me through this conversation again goes back to a recognition that first time is usually not right.

So we are fundamentally changing the practice of medicine. We are fundamentally changing what value means. We're fundamentally changing the way in which medicine kind of happens on any number of fronts, both how it's delivered, also how it's paid for, and just what good looks like. Just there's so many sea changes that, that have happened.

And yet you often find a situation where whatever the first deployment was, there doesn't seem to be a very, very concerted effort to really sit down, evaluate what happened, do some kind of retrospective. And then fix it so that incrementally there is improvements and there's a recognition that that's how you make sure that you're embracing Kranzberg's first law of technology, right? And that the technology actually is deployed in such a way where the context is a good one. 

[00:31:10] Dr. Spencer Dorn: Yeah, I think, I think that's totally accurate. I think there was a mad rush to implement these systems spurred on by meaningful use dollars, if you alluded to in the HITECH Act. And so there was a major push to implement these systems that people didn't really know what to expect, right?

It was hard to predict what the full consequences would be. And because change is so hard in healthcare, mainly because people, individuals don't like the change behaviors. And then when we get large, massive groups of individuals together, it's even harder to change. We kind of got stuck in these patterns that probably weren't the best patterns to adopt.

And many health systems are trying to make this better, but it's hard to undo some of the changes that are not serving us well now. Or it's hard, at least as you said, to incrementally improve upon some of our systems to move us in the direction that would be better for everyone. 

[00:32:12] Stacey Richter: Back to Kranzberg. It's not good. It's not bad. It's not neutral. It's how it's used, how it's deployed, how it's operationalized. And then I think most importantly, as we step into new terrain here, what the plan is to incrementally improve when we find an issue. And I think, you know, the EHR case study is a really, really good one that if we think to ourselves, okay, we're going to deploy this. The end. 

We're not throwing our backs into necessarily the improvement process as much as we've thrown our backs into the, let's just get this stood up and maintained area, then we could wind up finding ourselves at odds with, you know, where the net starts to veer on the negative side relative to what is possible.

[00:32:57] Dr. Spencer Dorn: That's why we need to look beyond the headlines and beyond this cloud of hype and also excessive pessimism and we just need to move towards the middle ground and carefully consider what are we gaining? What are we losing? To me, that is what it ultimately comes down to with technology is a clear eyed assessment of how is this going to make things better?

How is this potentially going to make things worse? So that we can take agency, make good decisions, build systems around our technology to mitigate the possible downsides and maximize the potential benefits and kind of proceed that way. We have, like, like we discussed, almost one to two decades experience doing this with EHRs, let's make sure we apply some of our learnings to this next wave of technology. 

[00:33:46] Stacey Richter: And that is probably a really good place to wrap up this conversation because that was so well said. 

Dr. Spencer Dorn, if someone is interested in learning more about your work besides LinkedIn, which I would highly recommend anyone listening should follow Dr. Spencer Dorn on LinkedIn, but is there anywhere else that you would refer people? 

[00:34:05] Dr. Spencer Dorn: We're very proud of the work we're doing in the UNC Department of Medicine. You could visit our website. A phenomenal group of people doing phenomenal work, so I would, anyone who's interested in our work, just check out the UNC Department of Medicine website, and you could find me on there if you have specific questions you want to connect with me about.

[00:34:21] Stacey Richter: Dr. Spencer Dorn, thank you so much for being on Relentless Health Value today. 

[00:34:24] Dr. Spencer Dorn: Thank you, Stacey. 

[00:34:26] Shawn Gremminger: This is Shawn Gremminger, President and CEO of the National Alliance of Healthcare Purchaser Coalitions. If you like this podcast, I strongly recommend subscribing and leaving a review.