 I want to tell you a little bit about this. This is a happy story. I don't know how many of you have seen this on the news, but this is an incredibly happy story and the only reason this is a happy story is because of well-designed systems through process re-engineering and well-trained people. Let me tell you a little bit about the story. This happened last week in New York. Planes above from the morning airport if any of you have been there. In 2015, it hit two flocks of birds. What's the likelihood of hitting two flocks of birds? Well, a plane in the U.S. with both of tens of thousands of planes that take off, a plane hits birds about almost 500 times a year, which is pretty small. And all of these planes fly on one engine, so when they hit a bird that ruins the engine, they can usually land in a local airport and everybody's fine. This is an incredibly freak accident. The two flocks of birds hit both engines and at 3,000 feet, the plane could no longer fly. So, what happened? Well, the people in the cockpit, as well as the flight attendants, were incredibly well trained and they had processes to follow. The person flying the plane initially was the co-pilot. In the U.S. and the news, you hear a lot about the pilot of this aircraft, who's the co-pilot. When it hit 3,000 feet and the plane, excuse me, the engine went out, the plane becomes a glider. And that exactly was the captain's sense of the co-pilot. I have the aircraft. And the co-pilot said that to him, you have the aircraft. Sounds simple, right? You do that type of stuff in a surgical suite, which doesn't happen to be a lot less errors. They did that. That meant the pilot was flying the plane. What was the co-pilot doing? Does anybody know? Co-pilot immediately opened the manual and said, I'm going to look at the checklist. How do I restart the engines? There was no panic. There was no worry. Everybody knew exactly what they had to do. And through this process, through these well-designed systems, they were able to actually land the plane. For a little bit more story, this is all about teamwork. It's all designed. Even without the engines working, this little propeller drops from the bottom of the aircraft and generates electricity to be able to use the flaps and to fly the actual plane. And planes fly as a glider. The pilot decided to land it in the Hudson River. Why? Because he wasn't sure if he could land the plane back at any of the airports. He also knew that through a co-pilot, we'd be boats around who could save them. So this is the first period they had teamwork. Because you know what they practiced? Men overboard drills, and they showed up and they knew exactly what to do in getting all those people. So that aircraft is a great story. There were 155 people in the airplane and all 155 people lived. There was only one serious injury. One of the flight attendants hurt her leg. Otherwise, some of these people actually walked off with their clothes and went back home. And the only reason this happened was because of teamwork and good processes. Every system is perfectly designed to achieve exactly the results it gets. Now in Burwick, there was a guru in health IT and patient safety. If you do not change your processes, if they had not practiced what they had to do on that aircraft, if you don't practice what you're going to do in your hospital and utilize your health IT and regia processes, you're just going to keep getting the same results over and over again. So you need to change your processes. Successful use of HIT is you have to develop good plans, convince people that change is needed in one, include all the stakeholders, invest in the governance and planning and the committees that you need, make sure that physicians are servicing what's important to them and make sure the patients are actually recognized and designed and used reports. Make sure you have valid scorecards to measure what you've done and how you're doing so you can continually improve as a classic hard to stick signal and important. Use the data and information to collect. Make sure it meets your strategic vision and refines your process. Monitor what you're doing and recognize what you have to integrate. Believe you with this every morning an accurate gazelle wakes up and knows it must go faster than the fastest line you will be killed. Every morning a lion wakes up and knows its outcome the slowest gazelle will start to death. It doesn't matter whether you're a lion or a gazelle, when the sun comes up you're going to start running. Thank you. Any questions? Any presentation? Thank you. As hymns and the focus of hymns broadens yearly and nationwide. Do you see hymns actually working to come up with a set of guidelines around change management or implementation to give road maps to areas and opportunities where they do need to understand the value of change management in the acquisition cycle of technology? Hymns has a variety of specialty volunteer groups that work not only in change management that Dr. Dentie talked about but in a variety of areas we emphasize change management around health IT specifically because that's where we're actually focused and we do talk we have promoted the use of clinical decision support for example around the area of change management. I can talk about our experiences at least internationally in Europe and in Asia PAC. In Europe I serve as the board liaison to the hymns Europe council. We are just organizing that group to do some of the things that we do in the US through that council. In Asia PAC we don't have a council as of yet we specifically just put on a presentation excuse me a conference for actually next month and we also we're working with a group to put on a conference in Bahrain the first week of May but we're really at our infancy stage in these areas it'll take some time to put together the structure to be able to work in that to work on specifically around health IT in these regions. The change management is incredibly important to hymns because we know that you cannot have implementation successful implementation of false IT without the type of work. Is HL7 an evolution of other health care standard initiatives like HL7 for example? Though that organization is represented at HL7's table HL7 will be represented as other STOs would be. So HL7 is actually a continuation of this standard It would be included within it Yes, it isn't as if HL7 is going to give up what they do HL7 is going to try to take HL7 standards and put it with other people's concerns around standards and other issues to make it all fit Given the issues working with DICOM and HL7 on IHE it's going to be a health care enterprise that's going to be quite a challenge if you broadly remember the people that find standards that you're working with The statement was that it's difficult enough for HL7 and DICOM to be able to set standards and interoperability around that and clearly there are more standards involved in the HISPY panel so it's very, very difficult to bring these things together Absolutely John Hollanko who is the CIO at the Bethersby Hospital in Boston is the head of the HISPY panel and he's done a wonderful job of bringing all of these different folks together It is an incredibly laborious process and you must have the patience of I don't know to be able to do that But you need to set the standards It's going to be tough It's going to be painful You're going to have various organizations who want to be able to be have their ball and play with their on their rules for their going to go away and you can't allow that to happen because you cannot have interoperability unless you have standards and it can't be one person standard I used to work for vendor and that vendor that I work for developed their own standard that they try to impose on their various organizations and it was unsuccessful for them now of course they need to address the issue around CCHT So if you set these standards a couple of things happen there are vendors too to participate and you can ensure all levels of interoperability if you have those standards