In 2013, the American Board of Preventive Medicine (ABPM) officially recognized clinical informatics as a board-certified subspecialty. With this board certification, the ABPM raised informatics to the ranks of other subspecialties (such as addiction medicine and medical toxicology), and in doing so, made a statement: Informatics is not just a nice-to-have background for some physicians, but rather an invaluable role for any care team. Clinical informaticians serve as liaisons between other clinicians and IT professionals, a much-needed bridge if health systems want technology that is not only state-of-the-art, but that actually effectively serves real humans.
On today’s episode of In Network's Designing for Health podcast feature, Nordic Chief Medical Officer Craig Joseph, MD, chats with Margaret Lozovatsky, MD, chief health informatics officer for Novant Health. They discuss Dr. Lozovatsky’s background as a pediatrician, how that led her to become a CHIO, and what she’s learned working on both sides of the EHR. They also discuss structuring governance to drive best practices, having a continuous improvement mindset after implementation, and the dangers of being too clever in the design process.
In Network's Designing for Health podcast feature is available on all major podcasting platforms, including Apple Podcasts, Amazon Music, Google, iHeart, Pandora, Spotify, and more. Search for 'In Network' and subscribe for updates on future episodes. Like what you hear? Make sure to leave a 5-star rating and write a review to help others find the podcast.
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[03:59] Leading a GROSS program
[09:38] Having a continuous improvement mindset
[15:29] Structuring governance to drive best practices in the EHR
[18:28] When designs become too clever
[25:25] Reducing clicks with We Matter
[28:41] Things so well designed, they bring Dr. Lozovatsky joy
Dr. Craig Joseph: Thank you for joining us, Dr. Lozovatsky. So you're the chief health information officer of a large, multi-hospital healthcare system. Is it safe to assume you've always wanted to be the chief healthcare information officer, or is that something you grew into? How did you get to this magic place?
Dr. Margaret Lozovatsky: Great question. Like most informaticists, as you might guess, this was not on my radar as I was growing up and thinking about career options or even as I was going through my medical training. I finished medical school and did my residency in pediatrics. And during my time in residency, we were implementing electronic medical records. And because I have a computer science undergrad, which at the time I had no idea how I was going to use, people quickly realized that I was the go-to person because I knew how to talk to the IT folks and get their problems fixed. And I knew how to explain what the clinical need was. And so my interest in this field really started during that time. But I, of course, had no idea where it was going to go. And I got my first job at Northshore University Health System, which is an organization that's known for their technology and at the time had a very forward thinking CMIO. And I immediately reached out and said that I'm really interested in doing this work. To which the response was, well, there's a lot to learn. And he amazingly sort of took me under his wing and mentored me and helped me understand the complexities of electronic medical records of all the clinical technologies that we use. And a couple of years out of residency, I was asked to lead in-patient optimization and to lead an organization wide documentation optimization project. So I very quickly learned about compliance and billing and all the different complexities that go into designing our technologies. We successfully launched that project across the system and were able to standardize documentation and that really got me interested in thinking through how can we use technology to be an enabler for our clinicians rather than a hindrance, as it's often seen. And that's where my career started. I then took a role as an ambulatory medical director. I am a pediatric hospitalist, so I've never practice in the ambulatory setting, but it was a gap in my knowledge. And so it was a great opportunity for me to really understand the full workflow design development across the complicated health system. I've had several roles since then as I grew in my career doing similar work, and that is what brought me here to Novant. I am now the CHIO as you mentioned. I lead a multidisciplinary team of clinical informatics. We have about 80 people total on the team. We have a large physician and APP builder program and we have a wellness informatics team, inpatient ambulatory informatics, and we also have what I call reporting informatics. So folks that function as liaisons for the data analytics teams that are similar to all the clinical workflow and this has been a really amazing opportunity to develop and design what informatics can do and to really take the lead in setting the strategy for clinical technologies from a clinicians perspective.
Dr. Craig Joseph: So what I've heard, and I want to make sure Jerome emphasizes this, is that pediatricians with computer science backgrounds are brilliant and successful at their work and pretty much all aspects of life. So we're just going to want to write that down and make sure that Jerome gets all of that later.
Dr. Jerome Pagani: I believe this is an example of selection bias, so...
Dr. Margaret Lozovatsky: I think he's right. I mean, I really appreciate that perspective.
Dr. Jerome Pagani: I'm outnumbered, so.
Dr. Craig Joseph: You are. And yeah, valor and yeah, all of that. Well, so one of the reasons that we wanted to talk to you is that your CEO gave an interview where he said some gross things. That's a little pun because he talked about a program, GROSS, meaning getting rid of stupid stuff. And that's it’s a key part of design is to is to not throw things into the mix that don't belong there at all. My understanding is that you've, that's been a very successful program that you've led and that you've kind of shifted the name or really was never called getting rid of stupid stuff in the beginning. So tell us about that and how did it start and where are you now and how do you judge how you're doing?
Dr. Margaret Lozovatsky: That's a great, great question. So our CEO has always been very forward thinking in understanding the importance of making an efficient workflow for our clinicians so that they can focus on patient care. And the GROSS program is one example of the work that was inspired by that leadership, and it was actually started before my time at Novant Health. It was started by Dr. Jason Conley, who is our Associate CMIO of ambulatory and is on my team. And at the time the thinking was that there is a lot of things that are in our technologies that do not make sense from a clinical perspective, which really goes back to what I was saying about the fact that it's very important for us to have clinicians in the conversations when we design our technologies because they truly understand how they're being used and they understand the clinical needs. And so we started this program with just opening up an email and a Teams chat, and people started sending us ideas of stupid quote unquote stuff. And the team was very successful in getting rid of a lot of the things that were suggested. More than 50% of the suggestions were actually taken and completed. And what has happened with that program is we have evolved it to cover all aspects of our clinical technologies and we now call it We Matter. And that stands for workflow efficiency in epic making thoughtful reductions. And the reason that we renamed it is because we wanted to have a little bit more of a positive spin on it. The things that were put in the system often had a reason back when they were put in the system, and so we also want to be respectful of our colleagues that spent a lot of time developing those tools. A great example of that is during the height of the pandemic, we put a lot of alerts in the system that were really critical because we had reporting needs and some of those were urgent and so we needed to ensure that we were collecting certain data. As we took a step back, we started reviewing some of the alerts that were in our system. And so as part of this We Matter program, the team has done a reassessment of the tools that existed, and they have successfully saved almost 100,000 hours of clinician time within the last year and a half. And we calculate each alert as 3 to 5 seconds, which is the standard put forth by Epic. And we do think that that's about the time that it takes. And so that's how we have calculated the hours that have been saved. The team continues to do this work. We continue to calculate the amount of time that we're saving and we continue to take feedback from our clinicians across the system.
Dr. Craig Joseph: So you say about 50% of the suggestions were accepted or acted upon, which by my calculations means 50% were not. Did you, how did you make that determination that this was something that was essential and or important to do or collect or to have the doctor do? And then how did you get, I think, a key part where a lot of people fall down is reporting back to the doctor or a clinician who said this is something that it's extraneous and explain to them why, why it's actually important.
Dr. Margaret Lozovatsky: Yeah, a really good point. I always refer to that as the blackhole that people talk about, where their requests go. And so we are very intentional to not have that blackhole exist. And we do have a feedback loop for all of the things that come through this program and all of our other requests. And I can talk a little bit about some of the governance structures we've put in place. But for this program, specifically, the determinations were made with clinicians at the table. And so there were suggestions about things that are in the system that may have had regulatory reasons, that may have had a quality impact. And so as we gave feedback to folks that requested it, we were very honest and upfront with them When we had situations, we couldn't remove something. And then there were things that were education. And we find that a lot as people put in requests it’s because they may not be using the tools in a way that they were intended. And so sometimes it's education on the workflow designed and tools that they may be able to use to meet their needs that already exist. We actually find that about 50% of our requests overall tend to be education, and that's why it's so important to have clinical informatics on the table because they can immediately address it upfront before these requests go to the technical teams and before we spend a lot of time and energy building things that may not be necessary.
Dr. Jerome Pagani: Margaret, you mentioned that a lot of the things that you found weren't, it wasn't necessarily that they had not been very intentionally thought through, but they served a purpose at one point in time and as things that evolve, they no longer served a purpose. So this reminds me of the principle that we talk about, about needing to have a continuous improvement mindset. And it sounds like you're saying that's absolutely critical for making sure that even really well-intentioned things end up being useful or retired.
Dr. Margaret Lozovatsky: Yeah, and that is absolutely true. I think in all aspects of what we do, it's important to have a culture where people understand that because sometimes we create tools that are fantastic at the time that we design them. And five years later there are clinical guidelines, changes, there are workflow changes, there is updates in our technologies that no longer make those tools usable. And people are really tied to what they developed. They believe that whatever was built, and this goes for both technology teams and our clinicians, we're all creatures of habit after all. But it's really important as a team to understand that none of this is personal. And if we don't have a continuous improvement mindset, we're not going to evolve in our technologies or really in our ability to care for patients.
Dr. Craig Joseph: While some things were well designed at the beginning and became less usable or functional near the end, other times maybe not so much. Maybe it wasn't great at the beginning, or the folks that designed it didn't really understand what the workflows were going to be. And one of the things that we talk about is making sure you have the right experts, who's the actual expert? How do you deal with clinicians? I don't want to say the word surgeons, but how do you deal with clinicians who kind of come in with the idea of, hey, I have a solution for a problem that I'd like you to implement instead of, Hey, I have a problem, I wonder how you might help.
Dr. Margaret Lozovatsky: Craig that never happens.
Dr. Craig Joseph: Not in this organization, not in Novant, but in other organizations, not any organizations you've ever been at, but other organizations where your friends have been at, I'm sure it's happened there.
Dr. Margaret Lozovatsky: I mean, maybe in other places, our clinicians are all super reasonable and come with great ideas.
Dr. Craig Joseph: And we for the record, believe everything you're saying.
Dr. Margaret Lozovatsky: That's fair.
Dr. Craig Joseph: Now answer the question for other people.
Dr. Margaret Lozovatsky: You know, this, of course, happens all the time. People come to us with solutions and often vendors are very good and coming to clinicians and selling them a product and promising them that it's going to do all the things that the clinician needs. I usually try to take the conversation back to what is the problem we're trying to solve, and we find that often people pause because they already have in their mind what they think is the solution and they haven't even thought about what the problem is. And so that's really the approach that we take from our clinical informatics team. First and foremost, it's important to have clinicians at the table that understand their area of practice, and I think that's critical. Having decision making be as close to clinical care as possible. I always say I'm a pediatrician, I'm not a cardiologist, and so I'm not going to tell cardiologists how to practice medicine. Yet what clinical informatics brings to the table is helping to guide the conversation. So when a cardiologist, and I'm picking on cardiology, but name any specialty, when a cardiologist comes to us and says I have the solution that's going to solve my problems, we always take the approach of what problem are you trying to solve? What do we have today in our environment that may already address your problem? What are options in our current technology suite that may address your problem? Because we all know finances are tight everywhere right now. This is something that every organization needs to consider. And we talk about prioritizing and we talk about what are the options out there. Sometimes what they're bringing to us is exactly the right solution, that does happen. But we need to walk through all the appropriate evaluations to get to a place where we're implementing tools that truly, again, are going to enable our clinicians and not going to get in the way of their ability to care for patients.
Dr. Craig Joseph: So you keep saying the word clinical informatics, and as far as I'm aware, isn't that just a doctor who likes to play computer games?
Dr. Margaret Lozovatsky: Well, yeah, it's all of us major geeks. This is something that is a huge point of education, and it's a point of education for all of our colleagues that we continue to work on. And so when I talk about clinical informatics, I describe us as liaisons between the technology teams and the clinical teams. And I also like to highlight that it is now a board-certified specialty. It is recognized as a medical subspecialty, so, much like I would not go to a cardiologist for a fractured foot, I may not go to a pediatrician to solve a technology problem. Now, does the pediatrician need to be at the table with informatics? Absolutely. But I think that partnership is really important. And this, again, takes us back to the discussion of who really should be driving the technology changes at the organization. It has to be a partnership between our technology colleagues who are experts in their field and clinical informatics, who really understands the clinical needs and workflow and technology so that together they can drive the strategy and direction of where that technology goes.
Dr. Jerome Pagani: You mentioned the who. Why don't we touch a little bit on the how? So as you said, you get feedback from your clinicians regarding performance of the EHR, but in addition, you also analyze the best practice alerts in your system. So how do each of those work and how do you integrate them or choose between which one to go with?
Dr. Margaret Lozovatsky: We do both. We have structured our governance in a way that really drives some of the best practices that we need to get to. And this actually took some time. This was an evolution over several years to get us to a place where we have a venue for our clinicians. And so what we developed, we lovingly call DLTs here at Novant Health. Dimensions is our brand for clinical technology. So that includes our EHR and the 400 systems that are interfaced with our EHR that people often don't think about. And so the DLT stands for Dimensions Leadership Triads, and we have one for all of our specialty areas that includes physician leaders, nursing leaders and informatics. And of course, in some areas we bring in pharmacy and respiratory therapy and occupational therapy, you name the area. And we structured those teams to ensure that, again, decisions are made as close to the care as possible and then we escalate those decisions if they cross specialties to our physician advisory council and our nursing and ancillary advisory council. And then we have a strategic counsel that is made up of clinical leaders across the system for some of the larger decisions. And so that's really where this goes.
Dr. Jerome Pagani: So you mentioned that having a continuous improvement mindset culture is really essential, but sometimes CHIOs run into a problem of having senior execs that think once a technology is implemented, that's done and they can move on to the next initiative. How do you deal with that and find ways to keep the technology working and keeping your clinicians happy?
Dr. Margaret Lozovatsky: I find that getting to the goals we're trying to achieve helps with collaboration amongst all senior executives. If you think about the strategic direction of the organization, that really helps to bring the conversation back to that. And if we feel that, for example, we are going to endanger patients, we're not meeting our safety and quality goals or we're not meeting our goals with retention and recruitment, then most of our executives and any executives really understand that we need to shift some of the work that we're doing with the technologies that support that. And so to me, building this culture of continuous improvement starts with understanding the goals and strategic direction of the organization and then bringing people together so that we can collaborate to get to those.
Dr. Craig Joseph: So talking about clinical informatics and informaticians, you've said sometimes that we can be too smart, too clever for ourselves, and I'd like to know what you meant, and specifically I'd like you to explain how you destroyed the integrity of your previous employer's tech stack by trying to be too clever. We’d like details, names, dates, and locations, if you would.
Dr. Margaret Lozovatsky: To be fair, it was me trying to stop them from being too clever. But yes, that is a good story. So the reason I say that sometimes we can be a little too clever in our design is that as clinical informaticians, we really try to ease the burden of our clinicians and we usually really understand the workflow in great detail. And so sometimes we build tools that are meant to drive our users in a particular direction and we build all the details to get them there. What I often bring up is that unfortunately, our patients don't follow textbooks. This is true when I take care of those patients, and it's also true when I try to do things in the EHR, and when we become too restrictive, we actually create more problems for ourselves. And the example that you brought up was a situation where we EHR design that really tried to predict and understand what reports each of our users needed to see. And so the views were limited based on your specialty and your role. And it really was meant to be helpful because we didn't want clinicians to see the information that's irrelevant to them. And with all the best intentions, what ended up happening is you would have a nurse sitting next to a pharmacist having different views, trying to figure out why they can't see what they perceive to be much better for them. And what I had shared with our technology teams is again, best intentions sometimes lead us to having challenges in the clinical spaces, and clinicians are smart people. They can figure out what data they need and what data is not relevant to them. And sometimes we may not predict the kind of patients they're seeing. For example, I have a situation where I was admitting a patient for EMT because that particular EMT didn't have privileges at our hospital and they didn't have access to any of their tools. And so the comment was made that if we open it up to everyone, we will destroy the integrity of the system.
Dr. Craig Joseph: And that did happen, I believe, and the hospital went bankrupt because of you. Is that accurate?
Dr. Margaret Lozovatsky: Yeah. That's usually what happens when I try to make change.
Dr. Craig Joseph: Alright. Maybe that, maybe I got the story slightly wrong. So the tech stack didn't fall down. And the hospital is still in business.
Dr. Margaret Lozovatsky: It is still in business and in fact, there were several people that hugged me in the hallway when we opened up all the tools for them because they were so happy.
Dr. Craig Joseph: I think I've told you that I had a similar story when I worked for this electronic health record vendor based in Verona, Wisconsin, and for the, speaking of pediatrics, we had documentation templates that we were creating for the two-month checkup and the four-month checkup and the six-month checkup. And I, I did this. I wanted to be helpful. And so if you were about four months old, if the patient was four months old, I hid the two-month documentation templates and the six-month documentation templates because clearly this was a four-month-old and that's all you needed. And apparently, per your patients don't sometimes follow the rules, five-month-olds would sometimes come in need of either a four month check or a six-month check, and sometimes neither of those was apparent. And what from the user's standpoint, from the clinician standpoint, that is what we call a bug, right? It was for my last patient, it was right there. And now it's not there anymore. And little did they know that was by design. And so I'm definitely a believer that we can be too smart for ourselves and we need to kind of tone it down sometimes because we have the tool, we want to use the tool, we want to make it easy as we can. But sometimes patients don't follow the rules or EMTs don't follow the rules by not having privileges at every hospital we want them to have privileges at.
Dr. Margaret Lozovatsky: Yeah. And the reality is that we understand the clinical challenges when we do this, but it's also important to talk about the maintenance of a system that has so many restrictions, it's just unwieldy over time and then you continue to create more and more challenges.
Dr. Craig Joseph: So you've mentioned that sometimes when a tech leader tries to make decisions for or on behalf of clinicians, it doesn't work out great. You've also mentioned that the opposite is true, that when a clinician tries to make tech decisions for themselves or for other colleagues, it doesn't, often it doesn't work out as well as it could. You kind of need that that middle ground, and that's the sweet spot that clinical informatics can play.
Dr. Margaret Lozovatsky: Yeah, I think clinical informatics truly is the middle ground and the liaison between the clinicians and the technology folks. And it's a partnership. There are expertise that both sides have. Our clinicians are very good at taking care of patients. They don't necessarily focus on all of the background and complexities of the technology, particularly the infrastructure and the cybersecurity considerations and all of the things that go into creating a solution that is functional in our clinical environment. And likewise, our technology leaders are really good at understanding the complexity of those solutions, and they are not the experts in the clinical care and nor should they be. So the partnership between the two, which really is that clinical informatics sweet spot, is critical for us to be successful so that we can truly create technology solutions that can be adopted, accepted by our clinicians and can actually be helping them care for our patients.
Dr. Craig Joseph: So clinical informatics is not going to be taken over by ChatGPT. That's what I'm hearing you say.
Dr. Margaret Lozovatsky: I mean, who knows?
Dr. Craig Joseph: So you're not making a prediction at this point regarding ChatGPT versus clinical informatics professionals. I want to, I want to note that and suggest that maybe your board certification will be stricken from the record.
Dr. Margaret Lozovatsky: I mean, pediatricians with a computer science degree are safe, the others, I don't know.
Dr. Craig Joseph: Okay. Let's see. I think that we've hit that very well and we want to make sure that we strike from the record me saying that you might be stricken from the record. It's very confusing.
Dr. Jerome Pagani: Meta strike. So there was an article published recently that mentioned that your We Matter initiative reduced clicks within the hour by 26 million clicks. Besides ruining clinicians practice time for playing Candy Crush, does this have an actual impact on their lives?
Dr. Margaret Lozovatsky: Oh gosh. So since that article has been published, we have actually gathered data that is up to date today, and we are at 67 million since the beginning of 2022. And so I'm very proud of the success that the team has had. And yes, our clinicians do have more time to play Candy Crush or perhaps to see more patients or to be able to take time in the EHR to do other things. And what we have found very interesting, as we have looked at our data, often we find that clinicians that are spending less time in documentation in orders and addressing the alerts are actually spending about the same amount of time in the EHR. And what we have found is a couple of things. One of them is that they will see more patients, which is fantastic because it opens up our access and helps them be able to be more efficient. But we have also found that their level of satisfaction goes up. And in getting into more details of that data and interviewing our clinicians, what has been really interesting is that it's because they are doing things that they enjoy in the system and what they enjoy is really learning about the patients, spending time thinking through the diagnosis. They feel less like they're in the hamster wheel trying to catch up all day and they feel like they're able to actually take care of patients and provide better quality of care.
Dr. Jerome Pagani: That has to have a huge impact on their overall wellbeing and burnout rates.
Dr. Margaret Lozovatsky: Yeah, absolutely. And that is why we have really taken this concept of wellness informatics to heart. So we have a team that we call wellness informatics. And the reason we call them that is when you think about the Stanford model of fulfillment, there are three different aspects. One of it is personal resilience. The other one is culture of wellness. And the third one is efficiency. And so what we hear from our clinicians often is that all of those aspects are important. And we have a wonderful wellness team At Novant Health that focuses on the personal resilience and the culture of wellness. And they really have fantastic events. And what the clinicians say is when they come back to their clinic, they then still face the challenges of the every day. And so that efficiency bucket is where wellness informatics comes in, because we want to make sure we're addressing all aspects of burnout. And that is something that we hear attributed to technology more often than not. So we really feel that informatics plays a critical role there.
Dr. Jerome Pagani: So at the end of the podcast, we like to ask everybody the same question, which is to think about two or three things that are so well designed, and they could be outside of healthcare but so well designed that they bring you joy to interact with.
Dr. Margaret Lozovatsky: I love that question. And I'm going to give you two examples. And one of them is actually in healthcare. But I'm going to start with the one that's outside of healthcare. Several years ago, funny enough, when I was taking a physician builder class, one of the gentlemen told me that his daughter designs an avocado peeler that is an all-in-one tool. And I came home, mentioned this to my husband, and he found it and purchased it. And it is brilliant. It is really, truly brilliant. It's one piece of equipment that peels, takes the pig out, slices it for you, does all the things. Now, how many times have you struggled with an avocado?
Dr. Jerome Pagani: Every time. That's how many times. Every time.
Dr. Margaret Lozovatsky: And the simplicity of it, I think, is what makes it so great. But it is a pleasure to use every single time.
Dr. Jerome Pagani: I want this thing. This sounds amazing.
Dr. Craig Joseph: This was built by an Epic employee or this a colleague of yours that was in the class?
Dr. Margaret Lozovatsky: It was an informaticist, it’s his daughter, and I would have never heard of it if he didn't just randomly share this tidbit with me. But yes, it gives me pleasure to use it every time. And I do not touch avocados without it anymore.
Dr. Jerome Pagani: We'll make sure to put a link to that product in the show notes. So other folks, I'm sure, who have experienced the same struggles we have with avocado will be able to access that as well.
Dr. Margaret Lozovatsky: I love that and I am sure everybody will enjoy it as much as I do. The second example I want to talk about is something that's near and dear to me as a pediatrician, and that was the management of hyperbilirubinemia. I've spent most of my career working in the nursery and the way that I like to describe this process of figuring out bilirubin management is that you measure these values every few hours on all of your patients, and you have to figure out to analyze each value how many hours old the baby is at that point. And so I have these great memories of being post-call sleep deprived and sitting there in my fingers trying to figure out how many hours the baby is. And then you would on paper, write out every value and how many hours. And the best part about that is then your partner would come in and do the exact same thing. And so the level of inefficiency here for something a computer can easily do was just impressive. And of course, every nurse would do the same thing and they change shifts every 8 hours, etc., etc., etc. And so when I started in informatics, this was very early in my career. I was determined to solve this problem, mostly because it impacted my clinical care every day. And the first thing that we did is we built a simple report that just calculated the number of hours. Completely easy to do. And we put it in the EHR. And the next thing we did is we actually linked into the decision support tool that told the clinician exactly what they need to do. And so we took something and we did sometimes studies that took 2 to 3 minutes each time and we made it 5 to 10 seconds. And that tool in several organizations ago, we implemented in the nursery and we started measuring adoption. We had 100% adoption, but we also measured that we were saving well over 100 hours of physician time in a month. And that's assuming people only do this once. But we know it's being done five, ten times. So I think that number is exponentially larger. And that was really an early iteration of actually taking the bilirubin curve and putting it into Epic. And I, along with many other pediatricians, worked with Epic based on what we had done at that institution to bring that to the EHR today. So it is now existing in our EHR environment and I can truly say I love using it every time I will volunteer to admit those hyperbilirubin babies just so I can use the curve.
Dr. Craig Joseph: That's great. And I think you've actually underplayed how difficult it is to do without your tool, because not only do you need to see the bilirubin results in the hours of age, but you also need to know the gestational age in order to determine what you're supposed to do with those numbers. And it's so complicated. And I've not only taken care of those kids, I had one of those kids and you're right. That tool is, that's exactly what a computer is really good at. And why are humans trying to do it?
Dr. Jerome Pagani: That's a fantastic contribution that clinical practice.
Dr. Craig Joseph: I mean, it's not as good as the avocado.
Dr. Margaret Lozovatsky: Obviously.
Dr. Craig Joseph: But I mean, it's okay. I mean, it's not embarrassing. Sorry, Jerome, you were saying.
Dr. Jerome Pagani: Was I?
Dr. Craig Joseph: Thank you so much for a very entertaining talk. We've learned a lot. Again, I think the key thing that everyone should take home is that if you're a pediatrician and you have a computer science background, you're a pretty cool person. But there's other things are important, too, apparently, about governance, about having clinical informaticians, about making sure that the details are all taken care of. And I certainly appreciate learning all of that from you today.
Dr. Margaret Lozovatsky: Well, thank you for having me.