Hi, everyone. This is Chris Romay. I'm the Senior Vice President on the Ventures team here at MedAxiom. Welcome to this webinar sponsored by our industry partner, NextGen. We're going to give it just a few seconds for everybody to start logging in and getting their video and screens ready. So let's give it about another 30 seconds or so, and then we'll get started. And as a reminder, this presentation will be in the chat section. So anybody that is registered for this webinar can go into the chat section, click that link, and you'll have access to all the slides. So it's a couple minutes after. I think we're going to go ahead and get started. We've got an exciting panel discussion with you today, with us today. The title of the presentation is Adapting with Tech, Strategies for Cardiology Practice Challenges. To introduce the panel, well, first things next slide, if you don't mind, Brandon. There are a couple things. If anybody has any questions, there's a Q&A button at the bottom, and that Q&A button, you can input questions, and we'll be monitoring that throughout the presentation. If the panel decides that it's appropriate, we'll answer during the presentation. If not, we'll hold the questions to the end. But with that, I'd like to introduce Brandon Theophilus. Brandon is the Vice President of Market Strategy for NextGen. So let me turn it over to Brandon, if you will, introduce the rest of your panel. Thank you, and have a good presentation. Yeah, thanks, Chris. Hello, everyone. It's a pleasure to be with you, as Chris mentioned. My name is Brandon Theophilus. I'm the segment leader for NextGen across all of our specialties. We roll that up underneath what we define as market strategy. This is an exciting topic for myself and my peer and colleague, Paula, to have with us a special guest and a friend, and we'll get to that in just a second. Let me introduce who we have as our featured guest today, Pat Toomey, who's the Chief Information Officer and the Assistant Practice Administrator for one of the flagship cardiology clients on the NextGen platform, Virginia Cardiovascular Specialists, and of course, as I mentioned, we also have with us my colleague, Paula Furcron. Paula is our Director of Specialty Solutions specific to cardiology, as well. A little tidbit, she actually cut her teeth in the healthcare industry working for Virginia Cardiovascular Specialists. So when I tell you this is a flagship for us, it's not just that. It's almost like family. Our presentation today, and I know Chris had mentioned, and we will be laying a few slides into the chat feature for you to have available for yourselves. But just to set the stage for what we're going to do today, this is not going to be a death by PowerPoint. In fact, we're going to stop sharing a screen here in just a few minutes, and this is going to be a collaborative conversation where both Paula and I are engaging with Pat to discuss as Chris had mentioned, specifically challenges that cardiology practice is dealing with today and more specifically how technology is being used to help solve for some of those challenges. And of course, because Paula and I are both with NextGen Healthcare, it's going to have a little bit of a flavor around how NextGen specifically is helping solve some of these challenges for Pat and Virginia Cardiovascular Specialists, and of course, they're on the NextGen platform. So with that, if I could, I want to take just a minute for those in the audience of you that are not familiar with NextGen Healthcare and perhaps introduce you to NextGen. NextGen is focused exclusively in ambulatory healthcare. So we are not in the acute care hospital setting, in fact, we divested that business now nearly eight plus years ago. And so with our focus specific into ambulatory, you can see with some of the metrics and data points that I have in front of you, we are one of the most significant players in ambulatory care. More than 75,000 clinical locations just in the United States alone today are powered by the NextGen platform and specific to cardiology where it is a market that we have drawn a clear circle around, not only to become important for us, but we're taking market share as well. And today have greater than 2,000 cardiology and cardiovascular providers on the NextGen healthcare platform. And in total across all of the NextGen solution set, more than 146 million patients have data just within the NextGen healthcare system. On the far right-hand side of the slide in front of you, and I'm not going to focus a lot of the time here at all, but it is nice not only for us to be able to validate with some of the metrics that I have in front of you, but to see others recognize NextGen and our prominence and relevance in ambulatory healthcare. You can see the class medallions for those that are familiar, now four plus years straight in a row that NextGen has been named best in practice management. And within just the last month, I'm pleased to report that Black Book had named NextGen as the best EMR practice management and healthcare IT solution specific to cardiology relevant for today's topic. Speaking of NextGen and cardiology, we'd made an acquisition for those who are somewhat familiar with NextGen just over a year ago. It's a business that we'd acquired of a longtime partner whose focus is in the cardiology arena. And with that, we have now the added benefit of not only specialized clinical workflows specific to cardiology, but a dedicated team of implementation, service, and support personnel who are subject matter experts in the cardiology arena. For those of you who are using this technology every day to know that when you log a ticket or have to make a phone call, that you have folks on the other end who not only understand the solution, but also understand the specialty and the practice with which your organization is focused every day is a huge comfort. And it's something that we're extremely proud of. All of this for us also anchored around our mobile platform, we'll probably spend a little bit of time talking about mobile and the power of not just mobile, but now natural language processing, and even maybe dipping into a little bit of AI in ambulatory healthcare and of course, analytics and the ability to have true insight into how your practice is performing is critically important. And you can see just a sampling of not just some of the logos to include Pat's practice itself with Virginia Cardiovascular, but also some of the industry partners that we have that are fully integrated into the NextGen solution set and the relations that we get the pleasure to enjoy much like us today with our friends here at MedAxian. So with that, let me stop sharing if I could. And we'll now see if we can bring Pat into the conversation. Hello, Pat. Good to see you. Good morning. How are you, Brandon? Paula, good to see you again. Absolutely. Hey, Pat. Yes. Yeah. Brandon, when you're saying Paula cut her teeth at VCS, it's probably not far from true. It was your first job out of high school, wasn't it? It was not far after. Yeah. I was 19. I worked for VCS for about three months, about three or four months shy of 30 years before I came to the NextGen side three and a half years ago. So still have a great relationship with Pat and everybody though. I love it. And Pat, before we get into some of our further conversation here, if you wouldn't mind just telling all of us a little bit about Virginia Cardiovascular Specialists, where in the state of Virginia you all reside and serve, so on and so forth. Sure. We're basically in the greater Richmond area. We've got 37 physicians, 10 APPs, eight locations around Richmond, provide all cardiovascular services. We're the only dedicated cardiac CT scanner in the state. We have the first pet CT, cardiac pet CT in the region. Last year, we opened the first cardiac ASC in the state. And in late 2023, we received a CON to open a cath lab at that ASC that we're hopefully targeting for fall of 2024. We offer all non-invasive imaging solutions and board certified cardiologists in electrophysiology, coronary and peripheral, angioplasty, structural heart, heart failure, and women's heart disease. We see over 250 patients per year and provide the primary cardiac service providers for two of the major health systems in the Richmond area. I've been with VCS probably 15 years. We implemented NextGen probably about 12 years ago and really oversee, as you mentioned, I'm the chief information officer, so oversee operations, integrations, access, and cybersecurity for all of our clinical information systems. Yes, and while unless you want to, we weren't intending to necessarily discuss a lot about cybersecurity today. We're going to talk about the heartbeat of what you do to make your practice and VCS run even better, not necessarily put up the walls around the practice to hold those at bay. Yeah, I think we all lose enough sleep over cybersecurity. We all do. And you and I have had the chance already to have another presentation that we did a year or so ago around cybersecurity and how much that keeps all of us awake at night. Now, let's talk for a minute about the patient. And as you and I have had conversations in the past before, patients truly in the role of a consumer when it comes to making their healthcare decisions today to include the providers that they seek even for specialty care, what all are you doing at VCS as it relates to engaging with your patients and how are you making connection with those patients when they're outside the four walls of any one of your locations? Yeah, what's nice about NextGen and what we always try to do is a best of breed approach. So we're using a couple of different systems to reach patients. For patient engagement, we use Luma Health. It was a startup probably five, six years ago. We started working with them fairly early on just because of the flexibility of what they could do. We use them for our patient reminders, of course, and they start a campaign usually about two weeks out from a visit and they can keep pinging the patient until the patient actually acknowledges, yes, yes, I'm coming. And then they'll send out another reminder 24 hours before the visit. We can also use it for programmable campaigns. If we need to cancel because it snowed, which we didn't have that problem this year, or a bump, a physician, for whatever reason, can't make it to a clinic that afternoon, we can immediately, just by copy pasting that clinic visit, we can send out messages to all of those patients. We can use it for target notification, sending custom messages to groups of patients we identify in the EHR, and it's great because you can reach out to the patient where they are, whether they email, text, or still only have the landline phone and want to get a phone call. And then it's great, we can use it for post-visit feedback from the patient. We send out a survey to all of our patients, probably have about 70% actually reply. And then we can share those results with Google. For registration for the patient as they come in, we're using a pad-based system that we implemented several years ago. When we did the ROI, it was kind of based on the idea of reducing staff, and we didn't really recognize that immediately. But we were able to assign other duties to the folks at the front desk, and eventually learned that we could cover the front desk with fewer staff. One of the biggest unanticipated benefits was offering patients abilities to set up payment plans at the time of check-in. So a patient had an outstanding balance of $600. They could say, okay, I'll pay $100 today and $100 over the next five months. And instead of the patient saying, no, I can't pay that balance or being too embarrassed to talk about it with the staff, we collected $100 from, we collect the co-pay, and we have a payment plan set up. It's really continued to evolve over time, and they've developed a lot of new functionality. So now we're sending out information to patients, they're pre-registering. We have about 91% of our patients using the system to pre-register, 50 are pre-registering on their iPhones, cell phones, 50 are doing it on pads in the office. We also are taking, asking clinical histories, review of systems, and importing that directly into NextGen. During the visit, we're using it for procedure authorizations. Previously for our nuclear, we had to get an authorization, the nuclear nurses were obtaining that authorization, then we had a piece of paper we were tracking around. We now just have a pad back there. The patient signed the authorization on the pad, it's in the EHR, and we can print a copy if they want it, but otherwise it's already filed. It's really helped with improved collections because we can also use the system to verify insurance and eligibility. During the point of visits, we're collecting payments, post-visit, we can actually send out auto payment links, things like that. So it's really, and again, it's meeting the patient where they are. Post-visit, we're using the LUMA feedback reports. We can take LUMA comments, send them to the office manager if they're constructive comments we need to make changes about. But really, we're also focusing on the NextGen patient portal. We for several years have been automatically sending out summaries of our visits. There was a lot of concern patients would ask for our copy of the ECHO report, nuclear report. There's a lot of concern among clinicians that it's just the technical nature of those reports would cause too much concern. It's really become the expectation. Doctors commented about how when they're in the hospital, they'll write a note. Next time they walk in the patient room, the patient's discussing their note. So we ripped the Band-Aid off last year and are sending all clinical reports to the portal within 24 hours of the doctor signing it. So the physicians know this, the patients expect it, and the response has really been positive from both patients and the physicians. Love it. Real quick. I'm just curious because I know or I suspect that the Richmond market from a labor perspective is not any easier than any other pocket of the country when I have a chance to visit with clients in terms of finding, attracting, and retaining employees. So do you have any, or could you speak to whether it's on the pre-visit side, all the way through what you walked us on the workflows from a registration to even some of the post-visit workflows, was that able to free you up, leveraging this technology, be that Luma or the others in and around NextGen, free you up a little bit from a labor perspective? I'm just curious as to- Absolutely, all of the things that we were able to do were fractional responsibilities for our staff. So it wasn't like, okay, we've removed this position, but we have freed up nurses that were calling and reminding patients about nuclear tests. We've freed up administrative staff who prior were checking in patients, validating insurances, are now going out and getting authorizations for upcoming tests. So we're able to focus on other duties with the same number or after time, after some amount of attrition, fewer staff in some areas. I think staff always continues to grow, but the number of things we're able to do has really increased. Let's talk about chronic care management and then the other part which is so large within cardiology and cardiovascular care is remote patient monitoring as this technology continues to advance even further as well. Where's VCS on that journey as it relates to either chronic care management and or remote patient monitoring? Yeah, I mean, keep reaching the patients outside the walls of the practice. These two programs really do that. And it's how we keep the patient engaged between visits and real-time monitor chronic conditions and vitals. It really is the level of care that I think physicians have always wanted to provide, but realistically, there was no way they could provide the infrastructure to do that until CMS finally recognized this could benefit the patients. And we started looking at CCM probably about four, three, four years ago, RPM about two years ago. In both programs, we kind of look at everything, same way the practice looks at everything, ask basically three questions. Is it good for the patient? Is it good for the physicians? Is it good for VCS, the staff, the practice as a whole? And both programs were, yeah. So the big hurdle we had to overcome was staffing. How do you, where do you get the resources to run these programs? So we reached, we put out an ROI and really identified a RRFP rather, and put it, identified a partner in HealthSnap, they're a MedAxium partner now. They do a great job of assigning a nurse and then that nurse, if the patient is in one program or both programs is the same nurse who works with the patient. And so in the CCM program, they're working to make sure the patients are following the plan that the cardiologist put together, sticking with medications, exercise, diet, answering patient concerns, and then really kind of filtering, okay, is this a patient concern or is this something that the nurse can talk through the patient with or do we need to, does she need to send a message to the practice and get one of our providers involved? You know, it's hard to give real numbers on the CCM because, you know, it's hard to identify an admission that didn't happen. But, you know, we can tell the quality of questions we're getting when the patient's in and when we're able to pull the patient into the office versus, you know, if they hadn't called for three days and ended up as an admission. So we know it's working. RPM, different story. Again, same issues as above. And when that came out, it was part of the same RFP that we identified HealthSnap, started working with them. Primarily, we're sending out blood pressure cuffs, scales, and we're looking at some rhythm monitoring devices. Blood pressure cuffs are the most common. HealthSnap, one of the great things about them is they have an easy hookup. It hooks up to the cell network instead of the patient having to figure out Bluetooth and, you know, the Wi-Fi, stuff like that. It automatically finds the strongest cell network and hooks up to that. And, you know, there's a value of just real-time tracking. My dad, I remember he was about 70. He was diagnosed with hypertension and the doctor gave him a form and said, okay, fill this out and then come back and we'll go over the results. You know, go to CVS, buy a blood pressure cuff. So, you know, watching him, it was just like that fourth grade weather project I had to do where I was supposed to monitor the weather for a week. And the night before it was due, I started filling out the form, trying to remember, was it raining in the morning, sunny in the afternoon? You know, did I go outside, that kind of thing. And I remember I had dad trying to fill out the same form, you know, for his doctor, what was his blood pressure each day? Because I didn't want to get yelled at by the teacher. He didn't want to get yelled at by the doctor. But with RPM, we're seeing the blood, the HealthSnap nurses are seeing the blood pressure real time. If the patient isn't taking the blood pressure, they're reaching out to them. If the blood pressure's out of whack, they're reaching out, verifying how the patient's taking the blood pressure. Verifying patient's following, you know, diet, medication. And then if something, if it truly is an issue, those questions are coming to us. And then we're able to reach out to the patient. And if we need to intervene, we're intervening with medication change, bringing the patient in for a visit. You know, and so, you know, after year one, we asked the question, is it really working? Is there an impact? And so we looked at all of the patients who followed in the program for the 12 months of 2022. And some pretty impressive results. You know, when we started, 629 of those patients were in uncontrolled hypertension. By the end of the year, 397 were controlled. That's a 37% increase. Stage two hypertension, 57% of the patients were in stage two. It was down to 32. And just overall, all the patients, we saw a 14 point drop in systolic pressure and a seven point drop in diastolic pressure. So, you know, real numbers, real patients. So it's an impressive program. So keeps the patients involved. We're sure they're following our physician's plans. And, you know, we're seeing positive clinical outcomes. I love it. I'm sitting here chuckling. I literally just flew back late last night from spending a long weekend with my aging 80 plus year old parents and helping them navigate through their phones and some of the other technology questions they had. My brain hurt by the time I was done with this weekend. And I'm in technology for a living. So I hear everything you're saying. Reminder to our audience and Paula, don't let Pat and I dominate the conversation. You're welcome to chime in as well. But for the audience, any questions that you have, feel free to put them into the, just click on the Q&A button at the bottom of your screen. And we will see those pop up for us in the little panel that we have in front of us as well. Pat, let's talk a little bit about revenue integrity, financial performance, more importantly, technology and how that's helped VCS navigate around the revenue challenges in providing. Yeah, I mean, it's always, any business, it's always easier to try to grow business than cut costs. And so we've tried to leverage technology everywhere we can to try to do exactly that. You know, one example, we probably about five years ago implemented a PAC system. VCS never had one where, you know, burning everything to disk, carrying it around for physicians to read. So we implemented PACS, but we also realized we had some opportunity to really improve efficiency. So we work with PACS vendor, which is SciImage, our ECHO vendors, Philips and GE, and then NextGen to map discrete data directly from the ECHO machine into our NextGen templates. The physician's able to view the study in the PACS system, but signs off the report in NextGen. And using NextGen, we're able to do a couple of things. We're able to immediately generate the final report, rebuild the ECHO, summarize the findings into our procedure. So when a physician sees a patient next, they should have a review or a summary of all procedures. We're able to automatically send a copy of the ECHO report to the PCP or ordering physician, and then send a copy of the report to the patient portal. So the streamlined workflow that was, you know, all manual processes really allowed our techs to add an additional study each day for each clinic. So, you know, that more than paid for the implementation of the PACS system and increased revenue, reduced wait times for our ECHO procedures, and overall improved revenue. So, you know, improved patient care, improved revenue. So it's usually the goal. We do a couple other things. We're actually leveraging offshore staff to help with our call center. We were just overwhelmed, especially after the pandemic, even having people working from home, just very hard keeping call center staff fully staffed. So now we have 10 agents who actually daily log in from Pakistan. They're able to get access to NextGen. They're able to get access to our phone system. They can do all the things that our US-based call center are doing, and, you know, focusing very tightly with NextGen and our local IT to make sure, you know, their specific IPs are whitelisted and that all of their users are using multi-factor authentication to log into all systems. Yeah, this was fascinating. When I became aware that you have dedicated phone agents working for VCS halfway around the world, on the other side of the world in Pakistan, what was, logistically, how difficult was that for you specifically as the CIO of this business to be able to get these folks in Pakistan the access that they needed, but also give you and the rest of the organization the peace of mind? Yeah, you know, it is kind of concerning, like, you know, if you hear about some kind of cyber hack or something, it's usually Russia, China, or Pakistan, you know? So here we are opening up a IP address to Pakistan. So really bringing in our TSI, who's our NextGen hosting vendor, Eastern Data is our local IT support. So they're managing the security around our phone system and working with the, it's a US-owned company, but they have agents in Pakistan. It's actually founded by one of the doctors in another specialty practice in Richmond, and his brother is running it over in Pakistan. But we're able to work with their IT to, one, they're all dialing in from one specific IP. So we're able to make sure just traffic from that IP is allowed. Again, all users have to then sign in with a multi-factor authentication. There's one application from NextGen, and then to log into our phone system, they're logging in to another application. So really to get in, to get full access to VC information, they're going to, from a specific IP address, using their individual credentials, and then going to two levels of multi-factor authentication. So, you know, never say anything's 100% safe, but we feel we've got it about as tight as we can at this point. So, you know, and it seems to be working well. The biggest hurdle was obviously training and the specialty of cardiology. So we started off with low queues, just people verifying appointment dates, taking messages and sending them through NextGen to the clinical staff, but not really scheduling appointments or anything like that. Even that took about a week's worth of training via Zoom. Lynn Phillips, who was our senior office manager, really was key in getting that done. But, you know, we recorded that training and then are able to duplicate it with additional staff. And now we're at the point where we have them working just as our regular call center staff. So it's really been a positive product. And, you know, for a while, we were getting complaints from patients that we just weren't answering the phone. Now we're usually, you know, answering phone within a minute or two every day. Also, Pat, I don't know, maybe you can interject on how you're utilizing the nurse practitioners, right? Because you've got a good amount of nurse practitioners and are they covering the hospital? Are they helping in the clinic to open up more new patient slots for testing? Are they covering any of your testing? I think that's a focus area too that a lot of practices are trying to really pull on. MedAxiom really helped us with that. Ginger came down and, you know, really helped us figure out the system. We're using two approaches. One's exactly what you described, Paula. You know, the nurse practitioners are seeing the follow-up patients. They're seeing a lot of the patients that need to come in based on the RPMCCM messages. And offloading some of, or helping the physicians manage these return patients to free up the position for the new patients. But we're also using them in the hospital and really for the same goal, with nurse practitioners in the hospital going in, setting, teeing up the consults. Physicians are, you know, more efficient when they're in the inpatient labs and able to reduce the total amount of time they're at the hospital. So they're in the office, opening up more new patient visits, able to see more patients. And, you know, all in all, they really are more productive in the office than a day spent in the hospital. And when you have, you know, you've got a lot going on, ASCs, cath labs, things like that. So how do you relay some of that information out or do you have like a steering committee and things like that for the providers? Usually we have a couple of committees. The board is very active, but, you know, obviously tries to focus more towards strategic activities. We also have a physician's operation committee that really focuses on those more local, more operational issues day to day. So, you know, they're the ones who are really trying to focus on, you know, how do we use the APPs? What's the most efficient way to focus on that? What's the most efficient way to use our systems? You know, next gen, what do we need to change? What do we need to implement? What new systems do we need to bring in, things like that. VCS, and are you engaged in an ACO, are you collaborating with some of your referring PCPs in your market around, just curious what all you're doing there? So, VCS is one of the founding members of a local ACO, MD Value Care. You know, and really it's the collaboration, trying to figure out best way to, for independent practices to stay in practice. You know, the revenue directly from the program for specialty practice isn't that great, they're really designed to help, I think, direct more revenue towards primary care, but the benefits of maintaining strong relationship for primary care and identifying strategies overall to reduce costs are huge. I mean, you know, in addition to improving patient care and reducing costs for patient care, we're also, you know, we work together and have a, the MD Value Care has a self-funded insurance plan for employees. So, our employees actually go through instead of going directly out to, you know, Aetna or, you know, Blue Shield, where we're doing it through ACO, and really has been a positive compared to markets we've been able to help control insurance costs for our employees. So, you know, patient care improvements help keep costs down, you know, and I think working together, we, you know, Richmond's kind of unique, all of the, most of the specialty practices are independent from the hospitals, and the collaboration, you know, represented by the ACO is really, I think, a big part of the fact that so many independent specialty practices have been able to remain independent. Now, you're using, I'd said we were going to tease up and maybe discuss a little bit about AI, which of course is the buzzword all over the world, not just inside the healthcare ecosystem, but as it relates to a couple of your third-party solutions, Ultramix and SciImage, you're deploying some AI that's been able to deliver some pretty impressive clinical revenue impact, correct? Yeah, I mean, one example, we're working with Ultramix and SciImage on strain calculation. Some of our physicians wanted to have, for years, have been, you know, pushing that we really need to start calculating strain for our patients, but, you know, it's, and now I'm getting a little clinical here, but it seems to be a very subjective, takes a highly trained tech, and, you know, two techs on the same patient are not going to get the same value and just aren't going to measure it the same way. So Ultramix is a British company that actually uses AI to calculate strain, and they've been, you know, FDA approved that, you know, their AI calculation of strain is 100%, if not correct, at least 100% consistent. And so, you know, we really started looking at them. Defendable. Defendable. But started looking at, you know, the physicians were impressed with the results. So we've, so what we're doing is SciImage will, we send our echo studies to SciImage or PAX. Once the study gets there, it's immediately shipped out to Ultramix. Ultramix runs it through their AI calculation, is able to calculate the strain within 18 minutes. They're able to push a couple extra sequences in a report directly into the study in SciImage so that when the physician, by the time they open up the echo studies to read it, the strain results are there. We've modified, we worked with NextGen to modify the echo template that the physician either enters the strain results or clicks it's not available. We do have instances where it couldn't be calculated. System errors, it's taken longer than, you know, it's not there by the time the physician reads the study. But, you know, we're getting the strain results. It's proving clinically valuable to the physicians. And we're able to, you know, reliably charge for the study every time we do it. And, you know, it's a positive revenue impact. So again, positive clinical, positive revenue impacts. And that's really the result of using AI. Probably going forward, I think you mentioned, I think the next big step is going to be natural language processing. A couple different systems out there, NextGen's mobile being one of them. But, you know, it's really incredible what they've been able to demonstrate. You know, patients actually just having a conversation. You know, you can talk to the doctor about the hunting trip you went on. Did you get a deer or not? None of that goes in the record. But, you know, the discussion about, you know, the chest pain and how long it's been going on, where it's radiating from, you know, if the physician's actually, you know, discussing his review of systems with you. And, you know, that information is being mapped directly to the appropriate section in the NextGen template. So really, you know, I think once we're able to get that, and I, you know, I don't know, it's not going to be the be all and end all right away, but I think within the next couple of years, it stands the opportunity to have a profound impact on physician quality of life, productivity, and just ability to finish their work in a day. Yeah. Yeah, yeah. I've been with NextGen for over 10 years. And NextGen's mobile platform, which I mentioned in my short little commercial at the beginning of our conversation, is incredibly powerful. But our natural language processing, which we just released within the last six months, it's called NextGen Ambient Assist, is truly the most innovative solution I've seen us come out with. And it is, as you just mentioned, it has the intelligence to filter out the non-relevant conversation on its own immediately, yet capture all of the relevant information. And then immediately upon the provider hitting the end button, meaning visit is now done, it will import all of that for the provider to review in a structured format that's discrete data. It's amazing, and is only then the foundation for some really cool stuff to come further down the road. All of this, we've been very thoughtful and conservative with our release of it. So I am excited for all of you at VCS to give this a real shot. Go ahead, Paula. It's great. No, I was just saying it's great. I actually tested it with the developers as well for the cardiology language to make sure, as well as helping develop where it gets mapped to in the EHR. So it's very, I think providers are really going to like it. You can still add to it to beef it up a little bit, but it does take out some of the extra and then their hands are free. They're not staring at the keyboard on the computer. So it's a great, I think the providers are going to love it at VCS. Which is a perfect segue actually to a question that we'd had come in, Pat. When you are as the CIO, I would imagine you are inundated not just from NextGen hopefully, but from other third-party vendors with cool next great thing solutions. When you find something that you have vetted and you believe to be of high value or impact to the practice, the question is, what does VCS, how does that look? You'd mentioned your board sticks to more strategic. Do you just go to the providers and that subgroup of leadership to vet these out? What does that vetting process and then ultimate rollout look like for you at VCS? Yeah. Depending on what it is, we really look at AI. Like you said, there's plenty of vendors, a few years ago and still a little bit cardiac patch monitors. Everybody's coming out with a new one and everyone has something that do a little bit differently. So one, like you said, we look at it, we try to vet internally. Is there a payment for the approved payment for the procedure or test? But we also bring in the positions who really leave that area for the practice. For Ultramix, there were a couple of different vendors who were claiming to provide this. So it was Dr. Cabin and Dr. Chung who leads our echo department. Worked with them, set up a couple of demos, got their feedback. Did they see clinic value in it? Did we see revenue value? And then once the lead physicians for that program approved and selected it, we would take it to the board. The board would approve it. And depending on what the investment cost to enact it, we would usually take it to the shareholders depending on the value that we would have to invest. Very similar process. We've just selected a new implanted device management system. And so we involved all the EPs to evaluate. We evaluated three or four different systems, set up demos, gave them the chance to really ask the questions. Administration really vetted the cost. And then we presented to the board, board approved, board approved. And then to shareholders, the shareholders approved. So pretty deliberate process, but starts off more relaxed, but the physicians are the leads for those different technologies. Understandable. As a physician-led and physician-owned organization, those that I love dealing with the most. Quality measures. Yeah, that's what I was going into. I was like the quality measures, the MIPS measures. Are you meeting with the providers to say, hey, you're getting low on here. This is what we need to do. What is your strategy for making sure that they're hitting their marks? So historically we've done very well in MIPS. Initially, NextGen was able to end-to-end electronic quality measures. So we were able to get bonuses for our measures. So between sending out reports to a physician showing, hey, these are your patients, this is where you are. And then using the bonus points that NextGen allowed us to get, we're always able to max the quality category. That kind of became more of a challenge, especially during the pandemic. High turnover in nursing, shortage in nursing, and really that's impacted us 2022 into 2023. And so we actually claim the public health emergency exceptions for quality for those years. And we're able to, with that, max out the quality measures or get that weight assigned to other components of MIPS. But this year, quality is really going to matter because we've really got to get our scores up, I think, because everybody's been working on it. So what we've done is TSI developed a MIPS template. I've worked with TSI to kind of focus it more, and we actually broke it into two templates. We've got a nursing MIPS template and then a physician MIPS template. So for the physician template, we've put filters in so it only pops up if a patient is what NextGen refers to as treatment opportunity. And if it pops up, it identifies what measure the patient's failing, and the physician has a link to either prescribe the medication or immediately document an exception for why the patient's not going to meet that measure. So we can exclude them from the measure. So we've rolled that out. And really for the physician, and we've just finished a pilot and rolling it out, for the physicians who have been using it for the past month, we are seeing 10 point higher performance than the physicians who weren't. So yeah. For our audience, when you hear Pat and Paula or even myself mentioned TSI, TSI is that business unit that we acquired just a little over a year ago that I spoke to that has the high subject matter expertise within the cardiology arena. And specifically to Pat's point just now, that business unit, which is today known as NextGen Specialty Care, formerly TSI Healthcare, we have a team of dedicated folks who work with our specialty clients as it relates to all of these quality reporting metrics. And so Pat, when I hear that kind of marked improvement through a one month trial, I love it. Yeah, it was pretty impressive. We're early in the year. But still, I was pretty impressed when I saw those results as well. So I'm definitely a positive tool to use. Nice. Any closing comments? I want to be respectful of all of our audience time. Pat, I can't thank you enough. It's always a pleasure to get to see you and have a conversation with you, but to be able to do this and let folks learn a little bit more about VCS and hopefully a little bit more about NextGen Healthcare, I can't thank you enough. Glad to do it. It's a constant challenge, but it's what keeps it interesting. It is. It is. I guess my closing comments, Chris, and the folks at MedAxiom, I hope that you all found this to be insightful, maybe even learned a little bit about some of the cool things and really forward leaning. Truly, you can tell how much VCS is a thought leader and a care provider leader within not just the Richmond market, but I would suggest this country when it comes to providing care. As it relates to NextGen, my hope is that maybe there's something here that's piqued your interest. If not NextGen itself directly, you've also had a chance to learn how well we believe in partnering and fully integrating, not hanging on, but fully integrating even solutions that we ourselves haven't developed. We'd love the opportunity to have a conversation with you and your practice, wherever that might be, to learn a little bit more about NextGen as well. Chris, I'll hand it back over to you. Thank you, Brandon. Thank you, Pat, and thank you, Paula. We really want to thank NextGen for sponsoring this. This is a very nice format, a little bit different than typical where we are getting a death by PowerPoint. It was nice just having an open discussion and hearing about all the different solutions that you're implementing at your program, Pat. If anybody has any other questions, you can post them to me, and I'll make sure they get to either the VCS or the NextGen team. Once again, we'll thank the NextGen team, VCS, and all the MedAxium attendees. Appreciate that. Have a great day. Thank you. Have a good day.

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