The Future of Healthcare, with Duncan Weatherston

Speaker A: Welcome to the MetricStack podcast. Today's guest is Duncan Weatherston, the CEO at Smile Digital Health. In his current role, Duncan works closely with healthcare organizations to strategically tackle persistent data collection and sharing challenges. Today we'll chat with Duncan about how Smile CDR is moving the needle on the adoption of a standard for healthcare information interoperability. That's a mouthful. It's called FHIR and it's for fast healthcare interoperability resources. I'm Lauren Thibodeau and I'm joined by my co host Alan Villa. Welcome to the show, Duncan.

Speaker B: Thank you for having me. Looking forward to chatting.

Speaker C: Welcome to the show, Duncan. And maybe first to just set the stage, uh, and for our audience, can you give us a little bit of a sense of what Smile CDR's vision and mission is? Sure.

Speaker B: So Smile CDR is a health data platform that, that is focused on better global health and transformation of healthcare globally. We started out in Ontario, Canada as uh, a company that had a background in implementation of population health and other sort of large data solutions for healthcare. And over the years we've realized that there's a global challenge around access to care, around the use of information for the effective delivery of care, and really ultimately around the patient and consumer engagement with healthcare. One of the things that we think future holds for all of us is this motion towards a Internet of health that is very similar to the other things that we expect on the Internet. And I think as we cut the conversation today, sort of elaborate a bit on, on some of these ideas.

Speaker A: Fantastic. Yeah, the Internet of health. Interesting to imagine that. And so why then, if we're moving towards this vision, is adopting an interoperability standard for healthcare information so important?

Speaker B: I think so. It's, if you think about the way the Internet grew there, there were lots of networks at the start of the Internet. There were a number of companies competing to get access to everybody's dollars, I guess really at the time for the ability to connect computers together. What merged out, emerged out of all of that is this standard called the Internet. Right. There's, there's a networking standard called TCP ip. There's a set of capabilities that we assess as instrumental to the Internet. Things like mail or web searchings to a lesser extent, but, but certainly critical in our, in our. I think when you think about healthcare, we have finally got a approach which starts to mirror some of that success that happened in the early days of the Internet. The fire standard that we think is going to be driving value is an open standard. It's uh, published by a group called HL7, who are a, uh, standards body with a global footprint. It has participation from people all around the world. It's got the hallmarks of a future standard in that it is aligned with the way that we do things on the Internet today. And I think the net effect of this is we finally have common mechanism that we can use for sharing information that presages the creation of all the capabilities that healthcare is going to need to be transformed. And I think the reason why I think this, this sort of footprint is important is it provides us with a semantic baseline that we can all use for exchanging information. When I say you have condition A, the recipient of that information has to understand what condition A is and how it works. Or if I say I've given you medicine B, the recipient of that information needs to understand what that means. And historically we've had a hard time with that type of semantic interoperability. One of the things that happens with this standard is we have the ability to really well define the terminologies and the other mechanisms by which we identify the constituent components of a healthcare interaction. I think by standardizing on this and coming up with a common vernacular, coming up with a common mechanism for exchange, with how having some very, very well structured conversations around things like cardiology or oncology or whatever happens to be, we create the capability for us to start really thinking on higher order solutions and problems that we haven't had heretofore. So I think the opportunity with the, with this sort of normalization and standardization process is really setting the baseline for all future communications in healthcare, which is at its core, table stakes for digital transformation in healthcare.

Speaker C: So, Duncan, let's pause there because I'd love to get more into how you measure it and what's next. But you know, this idea of the Internet in the early days, and we're only finally getting to this idea that a health standard or even defined terms are something that are needed to move this forward. But obviously this is a really thorny issue. Health data throughout the world has been a thorny issue. What other reasons have been blocks in taking so long until we're at this point today?

Speaker B: So, I mean, I think if you look at the character of health information, first of all, the pathway by which health information was put into automation in the IT environment was driven by clinical use cases or driven by, you know, patient use cases. There's a bunch of user interfaces that describe how you interact with health data. And the value prop in a hospital setting in the early days was Very clear. Right. The ability to automate a workflow or the ability to automate a particular form or the ability to have a historical record when the patient shows up again in your hospital was a huge win. And so the focus was on creating those capabilities for the clinical consumers. And I think the same is true for patient systems. If you think about the way your data is stored for, you know, your watch information or your phone information that's tracking your motion or whatever it happens to be, it's driven by the value prop it brings to the table as a user interface and an experience.

Speaker C: And so obviously this, this started with a clinic or a hospital first, but then it has to grow. That, that semantic model has to grow and be adopted by larger and larger ecosystems.

Speaker B: Absolutely. So if you think about the origins, though, each of the hospitals sort of implemented their own, took their own workflows and implemented the automation, and each of the of the participants took their workflows and implemented automation. What they weren't thinking was how are other people going to consume this information? They were thinking, how do I optimize for the workflows and the process I have in my location? And so we have this situation where automation blossomed across healthcare, but in very siloed and unique implementations everywhere. And at some point people realized there was an opportunity to start exchanging and they ran into the problem that they'd all built their own systems in their own ways and they didn't have a good way to communicate. And of course, if you picture a heterogeneous environment where everybody is trying to demonstrate the value of their own solutions, what happens is you end up with conflict. You know, do it my way, do it my way, here's the right way. And you end up with a scenario where we really don't have an easy pathway to the exchange of information because there's lots of good reasons for the good decisions people made for their interfaces and their implementations. And so that was the, that was the baseline that we all came to in the, and think of this, this all happened, you know, this value of automation happened since the 80s. That was long before the Internet. So the idea of this exchange was, was kind of nascent even, you know, in, in, in the 2000s. And they, they'd been building these systems for 20 years at that point. So it wasn't as if there, there was a nice green field where we could all start with this collaborative view from the start. They didn't even have the opportunity to collaborate when they were first building these systems. So then comes the last 25 years of implementation, and we've had these constant attempts to find ways to say, here's how I have my information stored. I will send you what I know, and then you can receive it and then you can do something with it. And that's how we've managed the idea of interoperability all along. But that's not how the Internet works. It's not how mail works. Right. I don't have Mail system one, Mail system two, and Mail system three, and figure out how to translate from one to the other. I did for a while. In the early days of the Internet, each of the large players had their own internal mail systems. But we realized the value of standardization in mail very quickly. Healthcare is finally, at that point, we realize the value of standardization. Everywhere you go, you see these grassroots movement coming up with, here's how we're going to share information in our region. And it turns out this new standard, fhir, is probably the best way to do it. It's the most comprehensive mechanism for interoperability we've developed to date. And I should know, I've been working on it since the late 90s. So very, very confident that we're going to find a way with this new standard to, uh, finally all talk the same language.

Speaker C: Yeah. I mean, if there was one area in the world where you needed to have trust in the data and trust in the definitions, it's got to be healthcare. Right? So, yeah, absolutely. And I mean, we think about semantics a lot, we think about trust a lot. And I mean, this exhibits all over in every single domain, but healthcare especially, this is one where you've got to get it right.

Speaker B: I agree. And the other piece, to answer your question, um, obviously there's a lot of privacy and sensitivity in health information, and so it doesn't have a natural sharing characteristic. Right. I mean, some things are obviously shared. If you're walking down the street in a cast, everybody knows that you did something to your leg and they'll ask you and you'll talk to them about it. On the other hand, if you're perhaps having a mood disorder or if you've had something which you consider more personal, for whatever reason, there's less conversation. I don't think it's to our benefit, but that's just the way society is. Right. And so you have this one, which is this policy and regulatory strategy around the use of health information due to the deeply personal characteristics of it. And then the second piece you have is this structured information and its unique values in each of the instances and so getting past the policy and technology hurdles really has been a multi decade journey. But like I said, I think we're finally there.

Speaker A: That'll be incredible to see that kind of the light at the end of the tunnel you've been working on for years.

Speaker B: Yeah, absolutely.

Speaker A: Yeah. So we're here talking about moving the needle and what you're really uh, part of your mission is supporting and driving the adoption of this standard. Is that the metric we're talking about moving the needle on today? And how do we even measure adoption of this interoperability standard standard or this fire standard?

Speaker B: Yeah, it's an interesting question. I don't personally think of the adoption of the standard as the metric. I think of it as the. I mean it is a metric. In order for us to be successful in our transformation of healthcare, we have to have a semantic interoperability framework in which we can do new things. But I really like, I mean I've kind of had, with my, my team, I've had a conversation saying I think 2024 is the year of the. So what like so what if I've got health data all categorized. So what if I've got interoperability? So what if I can semantically things. That's where healthcare transformation happens. Right. So the metrics are things like reduction in costs for complex health systems. Right. So for. If you think about a, a health system that has payer, a uh, provider, several providers, primary care, the, the effect of a uh, well managed information ecosystem should be that the cost of the delivery of care goes down, the accuracy of the engagement increases, the connectivity and the level of information available to patients increases and you end up with something which moves towards, I mean I think which everybody's talked about for a long time, but more of a wellness system than a sick system. So I think the metrics are the improvement in care and I think there's lots of well defined quality measures that we study today. You know, in the cases of hospitals they've got very, very clear pathways in terms of, you know, readmissions and um, adherence to process. I think we can define metrics around cost, I think we define metrics around patient satisfaction, I think we can define metrics around access to care that will really be the guidelines in terms of moving the needle. I think this is the really critical point. If you look at every other industry, there may be some that haven't, but all the major industries, finance, shopping, music, they've all made this Internet leap and their businesses have been transformed. The before and after are related in terms of the services that the consumers interact with, but the way they're delivered, the expectations of service levels, the expectations of patient consumer engagement in these other businesses are very, very different. And that's the needle we're trying to move.

Speaker C: So is there a standard or a certification that we can measure that governments or healthcare providers or clinics are adopting? Is there something that says, yes, we have adopted this standard and we now work and define and share data this way?

Speaker B: Yeah, there's some really excellent work that's been done by a variety of organizations in the us. There's a quality measures group, the ncqa, who do a great job of defining quality measures. They have a group, Sequoia, who are working with the ONC, who are the US's national organization governing this type of thing, who are building out a set of guidelines about how to scale and do interoperability at, you know, at national levels. And they've got very clear metrics for success within their organizations. I think if you take it to the next step, beyond that, there's a number of other metrics which are being defined by hospitals and clinicians and academic groups are interested in this. And I think that's where we're going to start to see the really interesting definitions that we can, that we can, we can aspire to. So we, in the short run over the next few years, we have some very strong measures for how are we doing better in hospitals, how are we doing better at primary care, how are we doing better at. And then they're used to, in, in many cases to govern payment or to govern evaluation of success in the clinical setting already. I think that's the baseline and we can, we can use those to govern are we being effective. But I think what we get out of what we're doing is the opportunity to create new ones that are far more reflective of the transformation we're trying to go after.

Speaker C: Yeah, I think that's, I think that's really interesting. And I like the idea of the, the outcomes that benefit humanity. Benefit, cost reduction, benefit, just efficiency in general. The data person in me, I see this knowledge graph where we have some very, very strong connective tissue between certain terms, either measures or dimensions. And then you've got some outliers and you want to almost get rid of those, um, outliers so that everything is tighter and more interoperable. So as you're talking, that's sort of what gets me very excited. This huge knowledge graph that you're really trying to wrangle and control into something that everybody can, I Agree.

Speaker B: And I think, you know, the, the interesting piece about healthcare is that the measure, uh, of satisfaction is, is very demonstrable.

Speaker C: Right.

Speaker B: I mean, there, there's other, other industries have, you know, are you a happy customer in healthcare? We can tell if you're healthy or not. Right. Do you have a disease? Has your disease been managed? Are you living longer? Are you having, you know, fewer interactions with the health system? Whatever happens, we can come up with some very concrete numbers that tell us in, in demonstrable ways that we're being successful at our objectives. And then we can have some softer ones which we engage with their enjoyment of the process and their feeling of safety and you know, those types of, those types of more ephemeral outcomes. I think one of the value props is we can start tying ephemeral outcomes to concrete data and we have the systems coming online to be able to do a really, really good job of that. If you look at what we're going with, AI and ML.

Speaker A: Yeah, very cool. Uh, so you mentioned kind of a global mandate that you're looking at. Are there pockets geographically that have already where you're seeing glimmers of adoption, where you're seeing a, uh, before and after picture already of some early wins here?

Speaker B: Yeah. So I think, first of all, let me talk about something which is near and dear to my heart because I was involved in the Internet in the early days. I was involved in a lot of little communities that were trying to do interesting things on this novel technology. And what we saw was that lots of these sort of initiatives bubbled up and we had all kinds of innovation and engagement and everybody was really excited and we were doing interesting things of late. I'm seeing this in healthcare. I'm seeing it everywhere. You know, I was just at a conference last week and one Utah cropped up as, as an example of this. And so in Utah, they're pulling together this entire effort to link providers, payers, patients, the community together and come up with an interesting way to finally use these open standards to collaborate meaningfully and deliver value. I'm seeing, for example, in the Pacific Northwest some really interesting stuff between the hospital and health systems. They're doing interesting, like doing these exactly similar sorts of engage ones. I'm seeing in the Southeast, similar efforts and all over the place.

Speaker C: Right.

Speaker B: Uh, you just see these really innovative groups in Michigan. There's some really interesting stuff bubbling up and coming up with ways to use these new technologies to transform care in their region. But all of them are aware that they're participating in this global effort and can see how they're going to tie into everybody else. And it's that character of engagement which was around in the early days of the Internet I'm finally seeing in healthcare. And to me that's why I think that the Internet of healthcare is finally upon us because those characteristics enabled the nchat common standard uptake with, with, with local community activism and interest, broad global applicability of things. It's, it's amazing time. This is a great time to be involved in this and we're really starting to see the momentum swing towards the things that we want to do. In terms of success stories. I've seen innumerable success stories because there's some early adopters of these. One of our clients, you know, started off with a challenge around their use of information and, and, and, and as a consequence of engaging with this approach, now all of their clinics internationally are involved sharing information. They have a consistent approach regardless of where them your full history and your full clinical engagement is there. And it's in this open standard that allows them to build really cool applications very quickly as they choose to do it. And as a consequence, I mean this is a us, there's a portion of this which is a US based company and their stars ratings went up very substantially and they end up with a huge revenue boost as a consequence of it. So they end up with more informed care, easier to build applications. They have global coherence in their information sources and they're making more money and their patients are coming out better. I can't imagine a better outcome than that. I've seen that sort of thing a few times now with other participants.

Speaker C: So I'm. Yeah, I mean the, the, the excitement is, is palpable. Right? I mean you, it's, it's like we've hit this tipping point and all of a sudden, you know, everybody's interested in consuming and building upon this. What about the, what about the early days? Because this is really almost a study in how do you get a big, big, you know, international idea across the finish line or to that tipping point? What about the early days? What, what sort of battles did you have to fight? What, what didn't work? You know, is there any advice for somebody that is trying to raise a standard and push it forward?

Speaker B: So I think the early days of this, again we're the beneficiaries. One of the things that we have going for us is other people have done this first. So I think the early days for healthcare, they did a great job. If you look at the HL7 standard, HL7 version 2 standard, which was developed in the early 90s and sort of thought about in the late 80s, that was pretty prescient. Right? They did a good job of building out these things. And so where are the inheritors of uh, this new standard is the fourth or fifth depending on how you want to count it. Try at ah, at really creating international footprint. And so I think the struggles have been managed many times over the years by you know, like I said, I started this in the 90s and I wasn't, you know, I wasn't there at the start. There were old hands already doing this when I started. Right. So when we talk about struggles in this, this is a multi decade struggle for a very, very complex problem. I think, you know, there aren't many other environments where standardization is so critical to success as this one. And so I think anybody who wants to just look at what's happened, you can look at the iterations we've done on standards because those were the struggles. You can look at the iterations we've done on semantic interoperability because that was the struggle. You can look at the challenges that we had around policy alignment because that was a struggle. You can look at the challenge we had around the monetization of silos. Of the silos. Right. The problem is that some silos are, are making money being silos and if you knock down the silo then that revenue pattern goes away. So you have to find new ways to incent people to participate where they don't see it as a loss or they see it as a win. All of those things were challenges we had to overcome as an industry. And we've had some very, very brilliant minds pushing. And uh, I have to credit the people at hhs, cms, ONC for their visionary approaches. I have to look at some of the national governments and the regional governments like in Canada, Info A and Ontario and British Columbia and all the problem has kind of got together. Australia has done remarkable work. New Zealand is in the process of doing amazing things. If you look at Europe, there's been a standard and an approach model there for the last 20 years that's been very, very refreshing. They've engaged in how do we do interoperability. This is, this really is the consequence of a broad international effort with a good vision in heart which is trying to improve healthcare for everybody. I think, you know, there's no one lesson to learn here, there's dozens.

Speaker A: If somebody else wanted to fast track, we don't have decades for These things and other issues, I mean, how do you, uh, looking back now, and having been immersed in this for a couple of decades yourself, does it really just take time or is there something that could be done to accelerate in other domains, like carbon capture, uh, others where standards may be needed?

Speaker B: So I think the model I would use for any of these is the Internet. I think it was the best example of broad collaboration in recent times. There was this notion that you could do something interesting by sharing information. And then everybody thought, how do I connect to this and how do I expose some value? And if you look at the way they did it, they had a kind of guerrilla strategy and that anybody could participate and contribute value. They had an approach where they had these things called requests for comments, which gave us a loose standardization pathway that anybody could propose an idea for others to consider. And then if, if enough people considered it, you know, invariably a standards group formed and we did something interesting with that standards group. We moved forward and made it more concrete. I think the openness of the Internet, its ability to have different networks form and then join and add value, was an interesting lesson to learn. I think all of those are what's driving the success this time around. That, all of the, all by seeing that replication of pattern with healthcare, that's what's driving my optimism. I think anybody who wants to think about how do you take a standardization approach should look at what made the Internet successful. Because the Internet has very strong standards. We to use TCPIP to collaborate and we've all agreed on what that is. You have to use HTTP to view stuff. We've all agreed on what that is. We have to use SMTP to exchange mail. We've all agreed on what that is. Those are very strong, well established standards, but they didn't get formed by somebody laying down the law. They got formed through collaboration, they got formed through adoption, they got formed through iterative implementation and they got formed. I mean, the first ideas of really sort of public engagement were in the late 80s and it wasn't until the mid 2000s that we'd finally everybody agreed this was the way we're going to forward. Right? So even in the most successful standard I've ever seen and the most interesting implementation path I've ever seen, it took 15 years for us to get to success. So I think, you know, the two decades that I've been playing in two and change, decades that we've been playing in healthcare kind of mirror that. Uh, you know, from the time we really started thinking about doing implementation, I Don't think there is a way to fast track a global realization beyond that. I think that those are the timelines you have to play with.

Speaker C: No, I mean, even that sentence, you know, how do you, how do you fast track a global standard? Because it's. That sentence doesn't compute. Right. So. So, so, Duncan, what? So, so bring it back to Smile, Uh, cdr. What's. What's next for. For Smile cdr.

Speaker B: So I would actually change our name to Smile Digital Health Now. And so the CDR is a component of what we do. It's a clinical data repository, but our vision. Okay, so what's next for us? Here's, here's how I see healthcare going. And I think it's, it's, it's something I can defend because I've seen other industries go there and I think I can point to, say, look, other people doubted that was going to be the case, and it works. I think that the pattern of use is actually driven by cell phones.

Speaker C: Right.

Speaker B: I think, or devices that are going to, you know, whatever, replace the cell phones as we go forward. But the idea is that you should have a personal relationship, uh, with your care. Right? The same way you have a personal relationship with your finances. The same way you have a personal relationship with your music. The same way you have a personal relationship with your preferences in shopping and all the things you do along those lines, all those battles have been fought. We know what happens. Eventually consumers get the ability to control their own destiny through interactions with their own system, and they get a better outcome. So that's what I think the world has to get to. I think when you get up in the morning, you should be able to look at your phone and see your health account the way you see your bank account. You should know, how am I doing? What's next? What are the risks I'm facing? What are the headwinds? Where am I going? And all of that should be driven by something which is uniquely and personally yours. I think in order to get there. The reason why I think that's so important is at that point, everybody who has a phone can have healthcare care. And that's 80% of the population on the planet has access to a phone. 90% now. And of that 90%, all of them need care. There isn't one of us who isn't a patient eventually. So this is an opportunity for us to provide a tool and a vehicle to create accessibility, level the playing fields and implementation for everybody. And that, that, that pathway is critical and we know it works. We've seen it for banking, we've seen it for everything else. We know we can get there. I think way we see this is the ground. The baseline is get the information. Because in order to do stuff, stuff electronically, information is the, is the lifeblood. You know, that's information is a new oil, I think was said in the 2000s. Right. Um, it is the thing that we run on. Once I've got the information, I can start to do automation. If I know definitively what your problems are and what's wrong with you, and I've got it in a structured, semantically clear format, I can start to run automation against it. If you have this condition and those circumstances and you're in, you know, in this environment and whatever, I can start to provide you very clear. Your next step should be I can provide you with all the outcomes that you, that you need to know in order to improve your care. And that can be clinical, it can be lifestyle, it could be economic. There's tons of things that we can provide you with that and that's personal. You can, you can engage with it. I think Smile wants to start that second tier already. We've, we've got, we've got a clinical reasoning platform that allows us to start providing clinical decision support, quality measures, care gaps, evaluation to anybody who's interested. And I think the future is about taking all of the clinical practice guidelines that exist and providing a pathway for automation of those. So now I can take the wisdom of 200 years of medicine, apply it to a common pattern of information and start to get real advice for people and clinicians and others. The really interesting thing, the thing that I think is the, is the golden moment for us is the advent of large language models and transformers. If you think about one of the challenges that you have as a patient is you want to talk to somebody who understands your problems, can give you reasonably good advice on what to do next and assure you whether or not this is unusual or normal, whatever happens to be. If I take the confluence of medical knowledge, large language models, patient data, and I merge it together into an engagement pathway, I can create a system which allows you on your phone to get the assurance you need about your care, your quality and what you're doing to, to, to cover that first mile, to cover the things that cause you anxiety as a patient, I can take that, that and I can package it in a way that when you interact with a clinician, the bulk of the work they do, trying to assess what you're here for in the first place and what you really challenges can get alleviated and they can come in with a very clear understanding of what your problem is. And we can have a mechanism where you can communicate that relatively quickly. Say we think it's this. Yes. It's that anything you want to add and anything you add can get back into the record. So the next time around you've got it. Think about the amount of effectiveness you get out of that conflation of ideas. All the ideas we fill forms pre filled for you because your information's available, that's yours and you're managing it. All of your concerns and constraints metabolized into something that you can consume as a patient and something your clinician can consume as a professional. The ability for that to be shared with your care team, your family. Notifications, engagement we are at the Cinderella moment for health data and health information. I think Smile Digital Health wants to be part of that. We want to drag everybody with us and, or encourage others to run with us and tell everybody what we're trying to do and make everybody see the value and the opportunity here. Because the opportunity is to bring 7 billion people, people who are today getting varying levels of care all up to the same high quality level. What that does. The amazing thing about this, about this really good news story from my perspective is when you increase the number of consumers you drive down the cost of individual consumptions, right? Like the number of the. If you're, you know that is old economic model, right? When you've got a big demand the supply can increase in the cost per unit can decrease. We need that in healthcare. Our costs are through the roof. If I can increase the number of people consuming care, create the efficiencies and scalability you get from a global marketplace, I can drive down the cost for all the things that we think was expensive today. Freeing up head space and market room for us to do even more innovative and interesting things that uh, get iterated into this global community and, and by making life better everywhere, I can increase the economy everywhere. So we can we have this. When I say I mean we I mean obviously it's a vision. I'm saying it for my. I think it's collectively a thing that we're all going to try and do. We can, we can transform the, the social landscape through healthcare in ways that we haven't been able to in other methods. And once we get there think about the benefits.

Speaker C: Right?

Speaker B: It's just, it is, it is it like when I say we have, we're having our Internet moment, Healthcare's Internet moment. It's gonna be profound and global and really, really transformative. Smile wants to be a ground zero that we think that we can change and we can participate and we can really sort of, uh, benefit everybody else as a consequence of what we're trying to accomplish. And, you know, I think other people say, yeah, but you're gonna do well out of it as well, probably. I hope so. But the. The vision, the goal here is the transformation, right? If, at the end of the day, If I were 75, 80 years old, which is coming up pretty quickly for me, if, you know, if I were to get there and I look back and say, you know, I bucks but look at healthcare today, that'd be a win, right? That if we can get that transformation to happen. I was. I was there in the early days of the intern. I had a business. I didn't make anything out of it. I love that I got to play in that, and I participate in that and have, you know, engage with it and drive people. And that entire experience was a awesome time in my life. I would love to have that again on something even more meaningful.

Speaker C: Duncan, thank you so much. This has been a, uh, masterclass in how to raise a standard. I think you said it as well. This is the Cinderella moment. Moment. So, everybody, Duncan Weatherston, CEO of Smile Digital Health. Thank you so much, Duncan. This has been great.

Speaker B: Thank you so much for your time. I really appreciate it. It's a pleasure to talk.

Speaker A: If you enjoyed today's conversation about metrics and data, uh, be sure to check out Metric hq, our online resource for the metrics that matter most to you and your business.