Building the innovative learning health system with Aaron Miri


This week I’m joined by Aaron Miri, the Chief Information Officer for Dell Medical School and the University of Texas Health Austin.

In our discussion, Aaron talks about the complexity within the healthcare ecosystem and how they leverage innovation in atypical ways. He outlines his view of building the learning health system including the hospital that Steve Jobs would have built.

Aaron talks about how healthcare is complex, but how he navigates the challenges of siloed data, legacy systems and established processes to focus on the patient. Lastly, he discusses the importance of policy and his congressionally-appointed role on the US Health and Human Services Health IT Advisory Committee (HITAC).


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Podcast Episode

Episode Transcript

Tim Crawford:               Hello, and welcome to the CIO In The Know podcast where I take a provocative but pragmatic look at the intersection between business and technology. I’m your host, Tim Crawford, a CIO and strategic advisor at a AVOA.

Tim Crawford:               This week I’m joined by Aaron Miri, the Chief Information Officer for Dell Medical School and the University of Texas Health Austin. In our discussion, Aaron talks about the complexity within the healthcare ecosystem and how they leverage innovation in atypical ways. He outlines his view of building the learning health system, including the hospital that Steve Jobs would have built. Aaron talks about how healthcare is complex, but how he navigates the challenges of siloed data, legacy systems, and established processes to focus on the patient. Lastly, he discusses the importance of policy and his congressionally appointed role on the US Health and Human Services Health IT Advisory Committee.

Tim Crawford:               Aaron, welcome to the program.

Aaron Miri:                   Thanks very much for having me.

Tim Crawford:               Aaron Miri, you’re the CIO of Dell Medical School at the University of Texas at Austin. To get us started, why don’t you tell us a little bit about yourself and your role there at CIO?

Aaron Miri:                   I appreciate the question. I’m CIO for Dell Medical School and for UT Health Austin, that’s the clinical practice of Dell Medical School. I’ve been over here about a little over a year now. We are in Austin, Texas, which is also coined Silicon Hills. We are surrounded by a number of Fortune 10 giants, so we collaborate extensively across the entire ecosystem of technology. Our mission here at UT is really to inspire and to drive the next generation of leaders thought leadership and progressive teaching and making sure that we turn out some of the best students, in our case, some of the best medical professionals possible in addition to delivering some of the best outcomes for our patients that we serve.

Tim Crawford:               This is a really important space to be talking about healthcare. That is whether you’re talking about the start of the ecosystem in medical school or the outcome in terms of the provider world and everything in between. Innovation tends to play a pretty significant role these days in healthcare, and it has for some period of time. What’s your take on the importance of innovation today in that ecosystem? Also, where do you think tech giants and startups play in that?

Aaron Miri:                   Yeah, great question. So to answer the question about innovation, I believe it is front and center and incumbent upon us to innovate or die. In healthcare, particularly, you probably see it on the news every single night about the terrible outcomes and life expectancy issues in this country as compared to other countries in the world. Healthcare here in America is fantastic, but we’ve been doing the same thing for way too long. So you have these new programs and these giants such as University of Texas, Austin that are saying, “Okay, enough, let’s innovate. Let’s change the way we deliver care. Let’s change the way we teach how to deliver care, and let’s really put our money where our mouth is.” In our case, we built a brand new building, ambulatory building that has no patient waiting rooms because we wanted to force the issue to make sure that patients are seen at the right place at the right time with the right caregivers to deliver care to them.

Aaron Miri:                   We did these things that are very atypical of a giant healthcare institution. So you’re seeing these big bets being placed. Now, where does that place technology in the spectrum? Obviously, technology is the equivalent of the central nervous system of the human body. It’s great if you have great lungs and great brain and a great heart. But if your CNS, your central nervous system, is not firing, your body’s not going to move. It’s the same way with it in healthcare in that it must be working at 110% for the rest of the body to move. As you innovate the care delivery models, it has to be lockstep. That’s where the tech giants must play.

Tim Crawford:               I find it really interesting how you’re talking about those big bets. But when I think of the ecosystem, you’ve got a pretty wide swath of folks that are involved in that ecosystem. You’ve got new entrance, whether that be the new physicians that are coming through medical school, new nurses, new practitioners, clinicians. But what about also the folks that have been practicing medicine for some period of time? How are you evolving? Just kind of that pace and that inertia that exists within healthcare today?

Aaron Miri:                   I think there is an obvious dichotomy in the industry with those who are practitioners for a long time and those who are new. I often say this, that the medical students of today impress me because they really believe that health care should be like Star Trek, right? Where you can basically beam in a new organ or you have this tri-quarter that can read your vitals in like 10 seconds or less. I mean, it’s amazing. The reality of it is that we’re just not there with technology. But it’s amazing also, to me, that where the established practitioners are that bring such a fantastic awareness and a calmness to the environment that it allows these go-getter, over-eager, over-zealous, young practitioners to sort of stop and go, “Hey, actually, what’s the best bet here?” Right? “How do we not try to, not build Star Trek, but how do we build ourselves the road to get to Star Trek?” Right?

Aaron Miri:                   Once you mix the two together, you come up with a really good symbiotic balance. The way I do it is I’m a big believer in getting out there and rounding and forming committees of folks or talk through complex issues. If you bring the best and the brightest of the young zealot with the established, “I know how this is done,” together, you get a great balance and you get a great outcome from that when you’re choosing technologies. It is about partnership, and it’s about communication and it’s about transparency at the end of the day.

Tim Crawford:               That’s great. I was thinking about that balance because I’ve often said that you need fresh eyes and you need wise eyes.

Aaron Miri:                   Yes, great way of saying it.

Tim Crawford:               The combination of the two together bring some magic to it. But as you think about the future, someone once said that you’re building the hospital that Steve Jobs would have built. What was meant by that, and why is that important?

Aaron Miri:                   Yeah, that’s a great question. That’s a prior life of mine by a writer named Carmine Gallo from The Wall Street Journal. That’s actually his words. What he was referring to was building the learning health system. What has happened in healthcare is that we realized we were building these silos of data, electronic medical records, different types of modalities of care, but they weren’t really talking to each other. More importantly, we were just experientially delivering care. We actually weren’t learning from, “How well did Aaron receive care, and what’s his outcome after the fact?”

Aaron Miri:                   When you look at a learning health system, it’s a complete cycle of communication, learning, iteration, and modification of your workflow and your processes. The hospital Steve Jobs would have built is one that’s simple. It’s one that’s intuitive. It’s one that learns from prior behaviors and prior datasets, and it’s constantly telling you or evolving your workflows and giving you actionable information on what to do. All of us now in the healthcare domain are trying to build this learning health system and the Catch 22 has been that the IT systems that were built for healthcare some time ago were never really designed to be that interoperable as say an Apple iPhone is with the app store apps that run on it. So we have this push and pull going on right now where we’re trying to force a square into a round hole, but we’re getting there, and I think regulation will help us get there as well.

Tim Crawford:               Regulation will help you. That’s interesting. As I think about this though, replacing those big systems, whether you’re working in healthcare or working in another industry, replacing those big systems is a pretty disruptive change to go through, and it can be incredibly costly. When I think about healthcare, I also think about just some of the cost structures and how cost kind of flows through from the payers and from government organizations all the way through to the providers and ultimately to the physicians. How does that play a role in this? Then I also want to kind of move into talking about value-based care and innovation too.

Aaron Miri:                   Yeah, I think it all plays to the importance of it though. What we have to keep front and center is that it’s about the patient, right? It is a complex machine of what healthcare is, and it’s very easy to get lost in the discussion about payers and payer mix and payer strategies or “Oh, what’s the latest gizmo on the market to be able to deliver care?” But you get what you measure, and what worries me and worries my colleagues is that sometimes when you look at some of the measurements that are out there for quality or patient satisfaction, you begin to deviate away from what actually happened to Aaron. How did Aaron do in the course of care across the entire continuum of care? What I mean by that is not everything takes place in the four walls of a hospital.

Aaron Miri:                   Things happen at home. Things happen on the go. Things happen at school. So to the degree of it, how are we measuring and actually assessing how is Aaron doing over the continuum of care? What we’re trying to do now as we look at things that we try to measure is we’re trying to package and say, “Okay, these 10 measures actually tell you that Aaron isn’t depressed. These 10 measures tell you that Aaron maybe has another issue. He is unaware of that he’s presenting for.”

Aaron Miri:                   The good news is that a lot of research has been done around patient reported outcomes and all these other tools that are out there to try to suss out and go, “Okay, this is really what’s happening with Aaron.” Because today it’s very episodic. My knee hurts. I come in to get my knee checked out, but I may be depressed. I may also have a backache I’m not telling you about. How do we actually take care of Aaron and not take care of the ailment? That’s what we’ve got to move to and that’s where I believe the industry is began to migrate towards.

Tim Crawford:               I could ask you a whole series of questions about precision medicine, and I’m sure that conversation would be absolutely fascinating.

Aaron Miri:                   For a followup, that would be a followup podcast.

Tim Crawford:               Yeah, absolutely, absolutely. This is something that I think applies across industries. It’s not just specific to healthcare, but frankly healthcare affects all of us personally as well as professionally. As a kind of dive into that maybe just a little bit, value-based care, innovation, and then you also have this concept that you’ve talked about social determinants to improve care. Where do these fit in to that conversation?

Aaron Miri:                   I think they’re critically important. I’ll give you some examples of things that we’re doing here at the University of Texas at Austin. First of all, we have phenomenal partners in the community here. As I said earlier on, this is Silicon Hills. There’s a number of technology giants here that really want to help healthcare. I believe that there’s an altruistic aspect of healthcare where you can actually see where rubber meets the road, and you can see populations of people getting better. In partnership with a number of tech startups and giants, we are doing things like measuring air quality. We’re looking at… Austin, Texas is a good open source map of all the rideshare information, so who’s getting dropped off where? Who’s using the scooters? Right? You’d be amazed at how many people present in our musculoskeletal clinic that thought they could ride a scooter, and they really can’t, and they end up getting ankle sprain.

Aaron Miri:                   It’s amazing how much data is out there that if you actually measure it, you’re able to get in front of some of these issues before they present. It turns healthcare, instead of being reactionary, into preventative. What does value-based actually mean? It means, quite simply, let’s actually take care of Aaron in a way that’s meaningful, holistic, and takes care of the total Aaron. Total Aaron being anywhere that I have been, anything that I am feeling, and making sure that we’ve got you every step of the way. And so whether it’s questionnaires, whether it’s sampling, things like the data, the air quality, and those other things I was telling you about, whether it’s making sure we look at your complete records from your school-based records to your flu shots, to your immunization, to making sure that we’re taking into account everything. That’s what that is about, and it takes away this episodic nature that we’ve gotten into.

Aaron Miri:                   When it comes to social determinants. Social determinants are exactly that. It is what are you eating? Do you live in a house that has adequate cooling and heating, and particularly here in Texas, cooling is important. Another thing here important in Texas is air quality, right? Do you have a good air filters at your house to make sure that if you are allergic to pollen, that it is filtered out? It’s all these other dynamics that take partnerships across the entire ecosystem. Again, that’s what we’re doing. We’re partnering with all of these different folks that have these different datasets that stitch together a complete picture of what’s really going on with you. So when you show up, I already have an inkling of… You know what? I know you said your knee hurts, but I know these 10 other things hurt for you. We’re going to take care of you at the same time with those. That’s where the industry has to get to.

Tim Crawford:               But that seems very ideal in a lot of ways. Much of this data might exist, but actually tapping into it seems challenging. How are you kind of getting over some of those hurdles of bringing the different data elements together in a meaningful way?

Aaron Miri:                   Yeah, great question. Healthcare traditionally has been siloed, and the reason for such is that there wasn’t too much incentive to share information in the past. I don’t believe there’s any, generally speaking, that folks want to hoard the data so that they don’t share. That’s kind of goes against the grain as to what healthcare is about, but there wasn’t incentive to do it, so systems weren’t designed for that. They weren’t common constructs like API, application programming interfaces, or those types of mechanisms built in healthcare programming that you have in other industries.

Aaron Miri:                   Now you’re having this push for software to be modernized using those non-classical techniques that are more mainstream now to be able to share information readily and easily. You have folks like Apple that have the Apple Health Kit for folks to be able to download their medical record and take it with them on the go. You have these other players that weren’t there traditionally. That’s making data easier to get to. The other thing about it is that there is a phenomenal partnership in the healthcare community amongst, particularly, the CIO and medical community. When I reach out to my peers in Austin, they are more than happy to share, connect, and make sure we get over issues.

Aaron Miri:                   I’ll give you a real-world example. I have a surgeon who presented to me. He said, “Aaron, I have an 84-year-old patient. I know I’ve operated on her three times before in her life because I operated on her in another hospital system that happens to be across town from us.” He said, “We don’t have a way to get their data, her data. So they’re literally faxing me hundreds and hundreds of pages for what I need to be able to read about her prior surgery.”

Aaron Miri:                   It refreshes my mind and I looked at him, I said, “That’s crazy. Why? What faxing? Why?” So I pick up the phone, called my peer. The other organization said, “Hey, this isn’t right. I don’t know why we don’t have an interface between us. Let’s get this done.” Within two days, our teams knocked it out, and sure enough there was no more faxing between that institution and us. That’s the will that it takes. That’s the partnership that it takes. That’s the, “You know what, this isn’t right. We’re going to make this right and we’re going to fix it.” That’s the attitude that we have to approach things with.

Tim Crawford:               Wow. I mean that’s impressive. That’s incredibly impressive. But that I wonder how that scales on a broader level, and I want to bring in one of your other roles that we haven’t talked about yet, and that is that you also serve in a policy capacity on the US Health and Human Services Health IT advisory board. Can you talk a little bit about your role on the board, and then also how that might apply or how that might help us get over some of these hurdles that we’re talking about, like data sharing?

Aaron Miri:                   Yeah, a great question. I am a firm believer that policy is such an important element that we as technologists must intertwine ourselves with. The policy makers in DC, and even at the state level here in Texas, who I talk to routinely want to do the right thing. But a lot of them did not come from this industry, from healthcare. So it’s incumbent on us as technologists to be able to explain to them that this is what happens if you turn this lever, if you change reimbursement policy this way. This is how it affects, or how technology is not ready to accept and adopt that. I’ve been doing the policy roles for quite some time. I served on the prior policy committee, which is called the Health IT Policy Committee. We were really focused on meaningful use and some of the statutes of the ARRA, the American Recovery and Reinvestment Act that was established in ’07.

Aaron Miri:                   Then in 2015, a new bill was signed into law by president Obama called 21st Century Cures. In that established what’s called the Health IT Advisory Committee, which is this board you’re speaking of, where they were asking for the top dozen, two dozen folks across the country that served all domains from technology to physicians to insurers to come talk about some of these challenges and say, “How can we move the ball forward?” I was congressionally appointed to this committee, so I was voted in by Congress. We talk about a lot of these issues as to what’s going to happen with the fact that it’s hard to get information between the two. How do we alleviate and also incentivize information sharing? How do we create and construct an information superhighway to allow folks to share information?

Aaron Miri:                   Because one of my other passions is helping rural America. So how do we make sure that the hospital in rural America can connect as easily as me in Austin, Texas can. So that’s what this committee is about. We’re working through those dynamics, and you’re about to see finalized into rule several very important policy considerations around information blocking around the trust exchange framework, which is this superhighway I was speaking towards and a number of other dynamics that will incentivize, as well as penalize if you refuse to share information, which will change the face of healthcare altogether.

Aaron Miri:                   What’s happening now at the policy level is all of us are trying to educate the lawmakers. Saying, “Okay, this is great concept, all the right intent, but makes sure we are aware of the hurdles.” I’ll give you an example of a hurdle. Privacy and security, state law often differs from federal law. If you look at very progressive states like California or Washington or others, they have very strict state laws and strict breach notification laws as opposed to what federal regulation states. How do you reconcile those two? Those are the kinds of things that we bring up, we talk through, and we make folks aware of so that we don’t steam ahead with a giant dump truck and then run off the ground because we weren’t thinking ahead. That’s the point of the committee.

Aaron Miri:                   For anybody listening that’s involved with technology, involved with healthcare, get involved. Get involved at a state level, get involved at a federal level. It’s free. You’re not compensated. This is really doing it for the right reasons, but it’s important because the work you do will affect everybody in this country.

Tim Crawford:               No, that’s great. I know that there have been some specific efforts to create almost like data exchanges at a state level where you could share data, but that hasn’t necessarily taken off for a number of reasons. I think partly who’s driving it and partly the motivations behind it and compensation and the cost and the rest.

Aaron Miri:                   You’re right. If you look at some of the very successful HIE, health information exchanges, like Indiana, right? A colleague of mine who serves on the policy committee, John Kansky, who’s the CEO of the Indiana Health Exchange, fantastic guy, brilliant. He has brought together a stakeholder group of all the hospitals and academic medical centers in Indiana and surrounding areas to consider and talk and work through things much like we’re doing at a federal level. They’ve been able to do some things in the Midwest that are just super impressive.

Aaron Miri:                   If you’d heard about the Regenstrief Institute attached to IU, that is a phenomenal progressive data analytics type organization that looks at the healthcare data and derives phenomenal value out of what they are able to derive from that data. When you able to share information, you have institutes like Regenstrief pop up. That’s the beauty of it, right?

Aaron Miri:                   The hope is that with an information super highway that now crosses the country, we can tether together everybody and create many Regenstrief Institutes to make sure that we’re successful across the entire country. Because there’s no shortage of issues we’ve got to solve in healthcare. There’s no shortage of patients that are going to be coming to the front door. People are only getting older and more complex in terms of their conditions. The only way to get in front of this is with data.

Tim Crawford:               Yeah. The upside of this is we save lives. I mean it’s a pretty dramatic change. It’s not making a buck here or saving 50 cents there. We’re saving lives.

Aaron Miri:                   And you’re meaningfully saving lives. It’s not like some, back of the napkin, how many covered lives did we save? We truly helped a population of… One of the populations that I’m focused on right now, pediatric asthmatic children, right? How do we make sure they’re not having a condition or an episode at school, right? That’s altruistic. There’s no compensation for that. That’s the right thing to do. That’s why we’re in healthcare. This is what we’re supposed to be doing.

Aaron Miri:                   Yes, healthcare is a business, right? You have to keep the front doors open to make sure you take care of people. But that’s why it’s not for profit because you’re not looking to try to make a buck. You’re trying to break even to keep the doors open, but everything else goes back into the community. How can we take care of people and make sure they’re not getting sicker?

Tim Crawford:               Yeah. You’ve talked about the community, and one of the things you mentioned is privacy. I wanted to kind of delve into that. I think I’d be remiss in not asking you about the role of privacy, especially in healthcare data, but also cybersecurity, regulatory, and compliance requirements. I mean, this world is getting incredibly more complicated, especially in heavily regulated industries like healthcare. How are you approaching that? As I’ve had conversations with other guests on the podcast, we talk about the customer, and we talk about trust of data. I’m curious your perspective on how these different components come into play when you’re talking about healthcare data.

Aaron Miri:                   No, great question. Privacy to me is a very, very important topic, and something I’ve said numerous times in numerous forums is, “Don’t be creepy with your technology.” What do I mean by that? Don’t be creepy. It’s a mantra that I follow in my life as a CIO and as well as a speaker in all these different forums I’m in, that I’m trying to remind folks that you have to be transparent. You have to be collaborative. You have to talk to people in a language that’s simple. I mean, look at the EULAs, the end user license agreements, of all the software that you use. If you were to look at those things, you would be scrolling for days. They use language in there that even somebody like you and I, we’ve read more business contracts in our lifetime than we probably care to even admit, when you look at those sometimes like, “What are you actually telling me in this EULA?” Right? Yet you want me to accept responsibility for whatever.

Aaron Miri:                   We have to simplify the way we educate and we partner with our patients, and make sure that people understand: What does it mean to opt in or opt out of something? that means you are willingly giving me your data to do with that which I shall do, right? You have to partner with people, and that takes time. And that takes deliberate thought, and that takes effort. That’s why for so long I believe that a lot of these technology vendors, not just in healthcare, but across the entire all spectrums, all industries, have just sort of said, “Lawyers, you write this EULA. I’ll put it up there, and people will hit accept because they won’t read it,” and you’re good to go.

Aaron Miri:                   You find yourself in this quagmire now as a patient or a consumer of these technologies saying, “What did I just agree to?” Right? “Why are you reselling my data to China or to Russia? What’s going on here?” In healthcare, it’s even more gray. One of the areas that I have been highlighting to Congress directly is about these gray areas that are not a covered entity, meaning they don’t deliver traditional healthcare services, and thus they fall out of the auspice and protection of HIPAA.

Aaron Miri:                   One of those companies, a lot of them are the genetic companies out there, like 23andMe and others. I don’t mean to disparage them. I’m not trying to do that, but they fall under a gap in our current regulation, where if there is a breach or they want to sell your data to whomever, they can. Now they promise they won’t, and they will do everything they can to maintain integrity of it, but they don’t actually… They’re not covered by the law, so there is no recourse for the Office of Civil Rights or other federal agency to investigate them as they would a hospital if I were to misplace your records.

Aaron Miri:                   So we have to also modernize our policy leaders to make sure that the privacy angle is covered under all domains of healthcare and that these new technology startups that are doing some really fabulous things operate in the same conditions as a covered entity. Once you do that, once you have a level playing field, that will begin to get consumer trust back into the spectrum. Because today, I mean, I must have four or five credit agencies monitoring me because I’ve had breaches with my credit card companies, with my movie company, all sorts of things. It’s inevitable that you’re going to have the same in healthcare as all these technology players start playing in there, but if they’re not covered by the same rules and regulations, we’re all going different speed limits down that highway.

Tim Crawford:               I see this playing out in other spaces too, especially in research and when you talk about healthcare and research and sharing of data and how people want to share data, health data, but then on the other hand, have a trust concern and rightfully so, especially when you hear about breaches happening on a regular basis, not just in healthcare but in other spaces where your own personal data is. I hazard to use the word, but you feel violated that your personal data is being misused in some way that you did not intend it to be.

Aaron Miri:                   This is true. I would say with research though, what I appreciate so much about research is how careful the IRBs are at universities, in particular here at UT, we have a phenomenal oversight and compliance arm that really spends a lot of time with our researchers, our PIs, in making sure that all the Is are dotted, Ts are crossed, that consent is given in a way that makes a lot of sense to the patients, particularly their human trials, and that people understand what they’re doing. But the cohorts, the populations of people, are a lot smaller, right? You look at populations of 100 patients versus 10,000 that walk in your door over a month. So it’s little bit easier to have a rigor around. But your point is well made in that research is not immune to what the clinical enterprise is going through.

Aaron Miri:                   More to the point, with the research is that, again, you have to make sure you know who you’re sharing information with, particularly when you’re collaborating with numerous researchers. I’ll share a public story by the University of Texas System. If you Google it, there was a recent sister institution, part of the UT System that had to expel several researchers because they were actually taking IP and data and shipping it to a foreign country. They were accredited, PhD, true researcher, but they were acting as a foreign agent. So the other dimension in research is that we have foreign espionage that occurs, and you have to be vigilant. You have to stay on top of it, and you have to know where the crown jewels are.

Tim Crawford:               As we kind of wrap on this because this has been a fascinating conversation. I can see so many parallels between what you’re experiencing and what you’re doing and what you’re driving in healthcare to other industries, non-healthcare related industries. I mean, there’s so many parallels, but as we wrap on this episode, I want to ask you just what excites you most when you think about where you’re going from here and the impact that you’re having, which has already been phenomenal. Where do you go from here? What excites you most?

Aaron Miri:                   I love this question. To me, the role of the CIO has never been more exciting, particularly in healthcare, but I think across all industries. You have a chance. We set at the nexus. This role, sits at the nexus of the entire business of every business line, of every product, of every service line of anything that you’re doing. We are the central nervous system to make this thing go. If you screw it up, you screwed up big. But if you hit it out of the park, boy, you can make a home run. That’s the most exciting thing is to be able to innovate, ideate, learn from people who are just absolutely brilliant and truly try to push the envelope.

Aaron Miri:                   I mean, I pinch myself every single day. I’m at UT. We just won a Nobel Prize. Professor Goodenough just won the Nobel Prize for his lithium battery design. We have these people here that are rocket scientists, literally. And I get to be around them and learn from it and go, “Okay, how can I apply their genius to healthcare? How can I apply their equations, their ideas, in all the different colleges back to healthcare?” I think everybody has that opportunity wherever you are, whatever industry you are, which is take the best of the best, apply it, and watch the business succeed because of it. That’s why being a CIO is successful.

Tim Crawford:               That’s a great call to action. Aaron, thanks so much for being part of the program today.

Aaron Miri:                   Thank you so much for having me. Appreciate it.

Tim Crawford:               For more information on the CIO In The Know podcast series, visit us online at, or you can find us on iTunes, Google Play, and SoundCloud. Don’t forget to subscribe, and thank you for listening.

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