Author, television parenting expert and practicing pediatrician Dr. Tanya Altmann puts highly engaged patient care at the center of her concierge practice by making connected health tools work for her in her everyday workflow. Listen as she gives a blueprint for providers to use an array of tools from remote ear exams to Facebook to patient email alerts on her Apple Watch. And learn how it results in highly engaged patients and their families without sacrificing time, one of a provider’s most valuable assets.
Air Date: March 23, 2016
Guest: Dr. Tanya Altmann, bestselling author, network television parenting expert, practicing pediatrician and mother of 3 boys
|0:33||First reactions to Apple’s announcement of CareKit|
|2:27||Take the new listener survey and take 3 minutes to tell us how to improve|
|4:57||Dr. Tanya’s top tips for clinicians to engage in social media|
|8:10||Using email alerts in place of a patient portal|
|11:20||What types of information do your followers find most engaging?|
|13:16||There’s a human being on the other side of this feed|
|14:34||Why do you need to engage with the family/caregiver, and not just with patients?|
|18:20||How do you react when patients’ families bring questions to you that they have googled?|
|20:27||Balance between doctor’s advice and families researching on their own|
|22:28||The #1 question Dr. Tanya’s patients are asking|
|23:14||Asking for simpler, easier ways to communicate with parents|
|24:35||Bonus question: If you could join a rock band or music artist for a day, who would it be?|
About Dr. Tanya Altmann
My guest this week is Dr. Tanya Altmann, practicing pediatrician, network television parenting expert, bestselling author and mother of 3 boys. Dr. Tanya is an American Academy of Pediatrics spokesperson, approved by the national physician organization to communicate complicated medical issues into easily understood concepts.
When parenting questions arise, Dr. Tanya has the answers—she has been quoted in hundreds of periodicals, including Newsweek, USA Today, Los Angeles Times and Parents magazine.
Dr. Tanya has a broad understanding of the most recent medical developments. In addition to her private practice, she is an Assistant Clinical Professor at Mattel Children’s Hospital at UCLA and is the Chief Medical Advisor for the Newborn Channel. Mommy Calls: Dr. Tanya Answers Parents’ Top 101 Questions About Babies and Toddlers, hit several best sellers’ lists after its release. She is also Editor-in-Chief of the American Academy of Pediatrics’ parenting book The Wonder Years and Associate Medical Editor of their best selling Caring for Your Baby and Young Child: Birth to Age 5.
Her popular parenting workshops help parents through day-to-day child rearing challenges, and she responds to concerned caregivers and blogs on controversial topics for a variety of health and parenting websites including Web MD and TODAYMoms. Entering the new era of social media, Dr. Tanya is on the Editorial Advisory Board for Sharecare, a new interactive healthcare website.
Dr. Tanya has served on the board of the National Association of Medical Communicators and the executive board of the American Academy of Pediatrics’ Committee on Communications and Media. She completed her internship and residency at UCLA, received her medical degree from the Sackler School of Medicine, and her Bachelor of Arts degree from Claremont McKenna College.
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Jared Johnson: Hello, my friends and welcome to the Health IT Marketer Podcast, the podcast that’s telling the story of innovation in health IT. I am your host Jared Johnson of Ultera Digital, your home for help with health IT influencer marketing and content marketing. This is the first and only podcast dedicated to the health IT marketing community. Welcome aboard.
Well, there’s new news from the world of Apple and I’m not just talking about the new four-inch iPhone SE. No, I’m talking about the launch of CareKit, their newest open source framework to develop apps that better self-manage our health conditions. It was a companion to ResearchKit, the platform launched a year ago for clinical research apps on iOS devices.
So Apple announced CareKit at their keynote event on March 21st. They also announced that the framework would be available to developers in April. So I’m quoting now from MedCity News’ coverage written by Neil Versel about CareKit. Neil shares in his article that Apple had developed four CareKit modules in time for this keynote address and they included these four.
First, Care Card to assist people in tracking their own care plans and action items including medication reminders. Second, Symptom and Measurement Tracker for observations of daily living and data capture from connected devices. Third, Insight Dashboard, which compares symptoms to the action items in Care Card to help assess whether treatments are working. And fourth, Connect, facilitating communication between patients and their clinicians, caregivers and family members.
Announced partners include Beth Israel Deaconess Medical Center, Texas Medical Center, Sage Bionetworks, diabetes startup One Drop, Iodine’s Start app and pregnancy startup Glow. And then on the screen, they also showed other clinical partners including University of Rochester Medical Center, UCSF, Johns Hopkins Medical Center, Parkinson’s Disease Care New York, Stanford Medicine and Emory Healthcare.
So we’ll keep an eye on CareKit and those clinical partners involved in this framework to see how mobile health and digital health progress with their help.
I also have a new listener survey up, so now is your chance to tell me what you think about the topics and guests on the program. We recently passed six months on the air and our 30th episode. So if you want to take three minutes to tell me what you think about the program, you can hit me up there. The link is bit.ly/HITPodcastSurvey2. So that’s bit.ly/HITPodcastSurvey2. The link will also be posted in the show notes for this episode. So you can find it there. But again, that is bit.ly/HITPodcastSurvey2.
Well, I’m honored to have with me as my guest this week practicing pediatrician, network TV parenting expert and bestselling author Dr. Tanya Altmann with us today. Dr. Tanya, glad you could join us today. How’s the weather out there in sunny Southern California?
Dr. Tanya Altmann: It’s beautiful and in the 80s.
Jared Johnson: Oh my goodness. All right. That sounds pretty fantastic. I know a lot of listeners would be pretty jealous of that. I also failed to mention one other role that you play in your life and that’s being a working mother. So I failed to mention that as well. But I’d love to start off just giving our listeners a chance to learn a little bit more about all the things that you’re doing. Why don’t you start off by telling us a little bit about your background, where you are now and quite frankly how you find time to do everything?
Dr. Tanya Altmann: It’s always a juggling act. But as you mentioned, my name is Dr. Tanya Altmann. I’m a pediatrician. I trained at UCLA and for 14 years I practiced in a very busy traditional pediatric office with an amazing group of doctors. I was seeing 20 to 40 patients a day.
And last year I had my third son, yes, I have three boys. I thought, “You know, I really want to do something a little different.” I love seeing families, but there’s so much available now with technology. My families are very educated. They want to be able to reach out to me more and I wonder if I can put together a type of practice where I can have fewer families but really be more available to them.
In addition to that, I also teach at UCLA. As you mentioned, I write parenting books. My new book is coming out April 5th. It’s called “What to Feed Your Baby: A Pediatrician’s Guide to the 11 Essential Foods to Guarantee Veggie-Loving, No Fuss Healthy Eating Kids.”
Jared Johnson: There are all these day to day issues and day to day questions we have as parents, so I love having that perspective on the program in addition to everything else, like you said. On this program lately we have been focusing on clinicians like yourself who are connected either with digital health technology tools or with patients and their families on social media or both.
I wanted to zero in a little bit on the social media aspect first as far as how to connect as a clinician. There’s so much talk on that. There are a lot of different schools of thought on it, but I’d love to hear what your top tip is for clinicians to engage in social media, such as what should they do and what should they avoid.
Dr. Tanya Altmann: Sure. That’s a great question. As you mentioned, a highly debated topic. I think if you talk to a variety of physicians, everyone will give you different advice and they’ll all have great advice and tips and some of it is just learning from our own experience because this is a whole new world.
So we’re all kind of learning how to navigate the world of social media, especially when it comes to our patients and families in our office. So with my families in my office, I do use email. I put it directly into the EHR, that way they can email me whenever they have any questions.
Often depending on the topic, I might write back them to them and say, “I’m going to call you in five minutes” because I feel that in many cases a, I don’t want to say face to face, but a voice to voice, a phone conversation or sometimes we’ll even use Skype as well is really needed. I don’t want to lose anything in translation when we’re just typing words back and forth.
I also use Facebook and Twitter for my practice as well as my Dr. Tanya, which is a little more of a national profile. Really with social media, I just try to share important health information for families. So it could be something like the new LEAP study that came out on the importance of getting peanut products early in a baby’s diet to help decrease the risk of peanut allergy later in life. It could be information on the new Zika virus going around or when we had the measles outbreak.
So it’s really more general information and I try not to give direct patient advice via social media. But often people will write in and ask questions and then I will try to answer it in more general terms to help teach more of my audience and then often I will recommend that they really reach out to their own pediatrician.
Jared Johnson: So it sounds like you’re recommending a mix of the communication element of social media but also acknowledging that’s not always the place to engage in health information exchanges and providing medical advice. Is that accurate?
Dr. Tanya Altmann: Exactly. I think it’s sort of that slippery slope. Someone might tweet and say, “Hey, my toddler doesn’t like to eat vegetables. What do you recommend?” Then I would say in general when I have picky toddlers, this is how I recommend getting them to eat a wide variety of vegetables, plant a garden, go grocery shopping, things like that.
So it’s not as much specific as if their tweet, “My toddler has a 103 degree fever and a cough. Is this the flu?” I might give a sentence on flu but then I will say, “Please see your own pediatrician or if your toddler has a fever over 105, a fever for more than three days, has trouble breathing or looks sick, make sure you see your own doctor.”
So you always want to cover yourself and make sure you’re giving the right advice so no one misreads it and doesn’t seek medical treatment when they might need it.
Jared Johnson: So I want to come back to social media real quick, but I had a question there when you mentioned using the email and that ties in with the EHR. Does that replace a patient portal for you, then and is that your primary means of communicating with patients?
Dr. Tanya Altmann: You know, it really is. I love my EHR. It’s a pediatric-specific EHR and I would love to use the patient portal more. However, it doesn’t have the ability to alert me through the patient portal. So therefore if somebody sends an email, it might sit there unless it’s during business hours or my laptop is open.
So what I do, and different experts have given me different opinions on this, but just to be honest since there may be other doctors listening that might want to do similar things, I have a special email that I use for my patients. And I send it directly to the EHR, any communication and I make sure that everything is followed up on.
But what happens is when I get that email, it alerts me on my Apple Watch. I have my Apple Watch set to only vibrate for patient emails, that way I can read and respond right way. For me, that’s actually one of the ways that my families prefer to communicate with me and that I prefer to get alerted whether it’s nighttime, weekends, I’m on vacation during the day just with a little tap on my wrist.
Now, all patients know the instructions and what they can email me, what they can’t, if it’s a true emergency, what number they need to call and how they need to wake me up in the middle of the night because I won’t get any email at night when I’m sleeping.
Jared Johnson: Yeah. Sorry to get in the weeds there. But I think that was very interesting, especially how you’re able to set your alerts on your Apple Watch, love hearing that as well.
Dr. Tanya Altmann: That’s why I got the Apple Watch. When it first came out, I thought, “Why would I get this? What would I use it for?” And then when I opened up my concierge boutique-type practice, I realized, “Wow, I get hundreds of emails a day. I have to be able to know the ones that are important for me to look at and respond right away.” So on my Apple Watch I get alerted for patient emails, phone calls through my office or phone calls from my immediate family. Everything else will just go straight to my cellphone and sit there.
Jared Johnson: I love that because there’s all sorts of talk about, “Hey, the Apple Watch doesn’t have that ‘killer app’ yet.” Here we are saying it’s valuable for you in your practice and patient communication simply by having email alerts. I don’t think it has to be revolutionary, but that thought of, “Hey, how do I configure this to work for myself and improve my clinical workflow and patient communication. I think that’s tremendously valuable for other clinicians to hear as well.
Dr. Tanya Altmann: I do find it tremendously valuable. The one thing that I did learn which I think is important to know is that it will only notify you when it’s on your wrist. If you take it off and it’s charging next to you on your nightstand, it will not alert you because it’s activated when it’s on your wrist.
Jared Johnson: Okay.
Dr. Tanya Altmann: It took me a few nights to realize that.
Jared Johnson: Hopefully too much didn’t get missed in there when you figured that out. Back on the social media side of it, I’m curious what types of information you do find engaging to your followers. Are they asking or more wellness tips and medical advice? I’m guessing that’s strategic in terms of what type of information you are putting out there.
Dr. Tanya Altmann: Well, I don’t know how strategic it is. Sometimes I write a blog and I’ll send that out. I might be speaking locally and so I’ll put that on my office Facebook or Twitter. But in general, a lot of it is what I am reading and information that I am finding out there, which could be written by another pediatrician or a top mommy blogger and I think, “Wow, this is a really great article.” I want to share it with my followers, with my patients, with my readers and then I send it out there.
Jared Johnson: Yeah. That makes sense. Whether you realize it or not, that is quite strategic, actually in the type of information because it is based on what type of engagement you want to have with those who are looking to you for that type of information. So unintentional strategy, something like that.
Dr. Tanya Altmann: Sure. Well, when you said strategic, once I went to a lecture on how to use Twitter and Facebook and, I guess, become “popular” and get followers in whatever your specialty is. They actually had guidelines that you should send out something every hour, like five-a-day of things that you’ve written, five a day things that other people have written.
I am so busy in a given day seeing patients, dealing with my own children, working on my books, blogs news segments that I don’t really think about how many I’ve sent out or, “Did I not even send anything out today?” It’s just more when I come across things that I find valuable or if I’m getting a lot of questions from parents on a specific topic that day, I will look for a resource and then put it out there so my families and others can get the information.
Jared Johnson: Well, if I may say so, I think that’s what makes your feed so authentic and it’s very obvious that when a topic is important to you and you know it’s going to be important to your followers and those who are connecting with you there, that’s when you’re posting more about it. I think that’s what makes it more authentic, at least from what I see there. So that’s a good thing. That’s a very good thing.
Dr. Tanya Altmann: Thank you. You can probably tell when I’m in between patients because I might push out three things at once and then you won’t hear from me for four hours.
Jared Johnson: Which again, that’s saying, “Hey, there’s a human being on the other side of this feed, right?”
Dr. Tanya Altmann: That’s life. Exactly.
Jared Johnson: Speaking of that, one of those roles like you said is connecting with and engaging with patients and their families. One reason I have brought on a couple of other pediatricians on the program lately is once I interviewed e-Patient Dave several weeks ago. I read his book, “Let Patients Help,” and I’m all for just empowering patients.
But one thing he put in his book is that first off, that we are all patients. We shouldn’t talk of that as a third-person word, but also that the patient themselves isn’t always the only person engaged and interested in and needing to be engaged with the healthcare provider.
I thought I can’t think of anyone who that’s more true of than children. The child is not going to understand a lot of what the doctor is telling them or there might be other implications or other information that needs to be conveyed to a parent or another caregiver. So in your mind, you’re the clinician. You’re the one who’s speaking with the patients and their families every day. Why is that important to consider their families when you’re talking with patients?
Dr. Tanya Altmann: Well, I think the family is very important when it comes to kids. If you’re talking about nutrition, sleep, screen time. It doesn’t only affect the patient on your table, but it affects everybody else in the house. So if the parents have good habits and they’re healthy, that’s going to trickle down to the child’s health. Also with illnesses, if I’m taking care of, let’s say, a child with strep throat, for example, I’m not going to only focus on that child.
Then I always turn to the parents and I say, “Okay, this is what you want to do in the house to decrease the chance that anyone else will get it. These are the signs that you want to look for if you or dad start to have a sore throat or a fever or if the baby seems really fussy. Those are signs that any of you might have contracted strep, then you need to call me and come into the office so we can swab you.” You always want to look beyond that patient on the table and see what else you can do to educate the family.
You know what’s interesting is now that I’m in private solo practice, everyone says, “Don’t patients bug you all the time?” You can’t share a call with anybody. But honestly, I feel that I educate my families so well, I rarely get called after hours and I have not been woken up in the middle of the night, knock on wood, since I opened my own practice eight months ago.
Jared Johnson: That’s very interesting that you say that because I know that’s definitely a concern from the clinician’s standpoint is that, “This is one other time consuming thing that I’m being asked to do and even if I do see the value of it, I still don’t know how to go about doing that and actually making it work for me.” And you’re saying at least in your experience with the new private practice that you are able to make it work for you in a similar way to email. You’re able to make that work for you.
By educating the patients and their families, then you’re actually proactively addressing a lot of their questions they would be calling you for after hours, but you have a good idea of what some of those questions are going to be and you’re able to share some of that in advance. So I think those are definitely keys to, in my mind, to engaging with not just the patient but everyone who’s involved with them.
Dr. Tanya Altmann: Exactly. Because I’m only seeing a dozen patients a day instead of 40, any very sick child or anyone that I’m concerned about, I will call them in the evening or email them at night and say, “Okay, this is what you’re going to do if X, Y and Z happens” and we come up with a plan ahead of time, that way I’m not going to sleep saying, “I hope that child doesn’t spike a high fever at night. I hope they don’t throw up again.”
I’ve already given the parents clear instructions on what we’re going to do if all these things happen that I know since I’ve been doing this for 15 years now what might potentially happen with this child and with this illness. Then I also let them know that they should call me and wake me up. Although usually I’ve helped them already and educated them so well that that’s not going to happen. But just in case, I always give them that last line, “It’s okay to call and wake me up if . . .”
Jared Johnson: That’s got to provide a lot of comfort when you do share that and say, “I’m going to do all I can.” What I’m hearing is a sense of partnership of understanding that there’s typically a need . . . not everyone wants to be involved, but I would guess a majority of patients and families that you see do have a sense of comfort when they realize that you not only want to be engaged with them to improve a child’s health, but here are some things you’re doing proactively before they even ask those questions.
I’m sure on the other end, no doubt you engage regularly with family members and patients and friends and anyone involved that come to you and they bring health information they found online. They Googled that condition and they say, “What’s this all about? Is this what my kid has?” I’m curious from your standpoint if that offends you when they research their own conditions and how you incorporate those types of questions when they do bring those questions to you.
Dr. Tanya Altmann: Sure. There is so much information available now for families that in some ways, they can be their own doctor or their own health advocate and they can Google the symptoms that their child has and a good amount of the time actually figure out what is going on and in some cases get really great instructions on what to do and how to treat their child.
Where you do need to be a little careful is there’s also a lot of not great information out there on the internet, as we know, especially when it comes to certain topics like vaccines. So I try to direct my families to my favorite sites. Once I had a mom say, “I always type in what I’m looking for and I’ll type in your name and I’ll get some article you were interviewed with or some news segment or something you wrote and then at least I know that it’s accurate if your name is attached to it.” I thought that was funny. But I have not covered every topic out there, obviously.
I like when parents call me and they have knowledge and they’re educated. It makes the conversation more interesting when you can talk to them on a different level. That said, it’s also important to remember that this is a parent who likely did not go to medical school. And even though they may think that they know everything, you still want to take a step back and sort of reeducate them and fill in the little gaps so that way you don’t find out later on like, “I actually didn’t understand that,” or, “I didn’t realize that,” or, “I wasn’t thinking about that,” or, “I thought you said the fever was okay, that’s why I didn’t call you when it was lasting seven days.”
So you always want to say even though with the flu, you may have a fever for five days. If it goes on day six or seven or it goes away and then it comes back, that’s a reason you need to come into the office and I need to actually listen to your child and check them out.
Jared Johnson: Yeah, like you said, it’s not necessarily mutually exclusive is what I’m hearing where there are many providers who follow that. There’s that meme going around with that coffee mug that says, “Please do not confuse your Google search with my medical degree.”
Dr. Tanya Altmann: Yes.
Jared Johnson: I feel like it’s not necessarily one or the other. I feel like there’s definitely a spectrum of okay yeah, that doesn’t mean you listen to everything on the internet. There is bad information out there and there’s a sentiment now that there are those such as yourself who recognize part of the way we counteract that is by, as clinicians providing good, accurate information out there.
And like you said, if you’re able to have patients or their parents actually Google something and they know with your name in their Google search terms, that it’s going to be accurate, then you’re saving yourself a lot down the road, whether or not you realize it. Being able to create that much content that is accurate and is helpful is tremendously valuable to patients and their families.
So it’s no surprise that the practice is prospering and it sounds like it’s doing great and that it’s a unique opportunity for you with the practice in the way that you’ve got it now.
Dr. Tanya Altmann: Yeah. The other way that I like to use the internet is, for example, I was skiing with my family a few weekends ago. So a family that comes to my office called me and said that their daughter had a rash. We talked about it, what it might be.
I said, “Do you have a computer in front of you? Why don’t you look up pityriasis rosea. Does this kind of look like what your teenage daughter has? Because that’s what I’m thinking based on what you described to me. It’s not dangerous. I’m going to be back in the office in two days. I can take a look at it then. I don’t think you need to rush to an urgent care. But if for some reason she starts not feeling well, having any swelling, any bruising, high fevers, then you do need to go to the urgent care and be seen, otherwise it can wait two days.”
Sure enough, they looked it and although the mom wasn’t sure, the teenage daughter was like, “Definitely, Mom, that’s what my rash looks like.” So I think it can also be a tool for us to better help our families when we’re not able to see them face to face.
Jared Johnson: So what’s the number one piece of advice or information that you give out there or the number one question you’re answering right now?
Dr. Tanya Altmann: For my own patients, I think right now in Southern California, we’re seeing a ton of fever and coughing and it’s not always the flu. So I’m doing a lot of, “Hey, my child has a cough and a fever. Could this be the flu? What do I need to watch for?” That just happens to be the variety of this week.
I think every week is different. Getting to the spring time, we’re going to be seeing a lot more rashes as we always see spring viruses with rashes that are coming. And allergies, as the trees are pollinating and the grasses are going to start soon, “Oh, my child has a runny nose and a cough. Could it be allergies? Can they go to school?”
Jared Johnson: Let’s see, winding up here, I wanted to get to our bonus question in just a moment. But in closing, if you could say one thing to the health IT community, those who are working on the technologies and the tools that are providing all of this infrastructure and making a lot of these empowered and connected initiatives possible, is there anything you’d like to say to the health IT community?
Dr. Tanya Altmann: I love all the new technology that is coming out. I use the vision screeners and the remote ear exams so parents can send me ear exams when they’re traveling. I think just coming up with simpler, easier ways for parents to communicate with their doctor on the go and also figuring out ways that doctors can get reimbursed, either if it’s from insurances or privately because I know that that’s why a lot of doctors aren’t able to adapt a lot of the new technology. They just don’t have time because they’re overwhelmed with their patient volume.
Unless you can do what I did, which is sort of take a step back and say, “I’m going to go outside of insurance now and try to do something private and different for fewer families,” but not everybody can do that. It depends on the area that you’re in and the kind of medicine you practice. I know for me that’s made my job a lot more fun and enabled me to take advantage of all the new ways to communicate with my families and all the new technology available.
Jared Johnson: All right. Well, it’s bonus question time. It has nothing to do with healthcare unless you choose to make it about healthcare. Usually this is a wide open question. It’s if you could choose to join any rock band or music group for a day, who would that be?
Dr. Tanya Altmann: And I knew you were going to ask me this and I don’t have a great answer, although I have to tell you that since I am all about listening to music with my boys and my boys are 10, 8 and 1, we’re very into Radio Disney. So I would say anything that I could do where I would be on Radio Disney would make me really cool to my own boys and my patients.
Jared Johnson: That is important, isn’t it? The brag factor.
Dr. Tanya Altmann: Definitely.
Jared Johnson: Well, Tanya, I’ve really appreciated having you on the program today. Thanks for taking a few minutes out to speak with us and appreciate having you on the broadcast and everything you do, like you said, all the technologies that you are using in your practice and all the ways that you are working to engage with patients. We love to hear about clinicians who are doing just what you’re doing. So thanks for that. If there is anyone on the podcast, if they have a question for you or would like to reach you, what’s the best way for them to do that?
Jared Johnson: All right. Hey, thanks again. I hope to speak with you again sometime soon.
Dr. Tanya Altmann: Thank you so much. I will talk to you soon.
Jared Johnson: Well, that wraps up our program this week. You may have noticed how many amazing connected clinicians we’ve had on the program in recent weeks and we have more coming up, as well as some of the industry’s top most respected CIOs and CMIOs. So tune in each week for more Health IT rock star guests.
Don’t forget to take three minutes if you have a chance and fill out that new listener survey at bit.ly/HITPodcastSurvey2. That’s bit.ly/HITPodcastSurvey2. And as always, I’m only a tweet away. Ping me @JaredPiano. In fact, you can find me just about anywhere. You can leave me a quick note on LinkedIn like I got this week from Chris Hemphill at Influence Health. Thanks, Chris for that note. I appreciated that.
Subscribe and leave a review on iTunes, on Stitcher Radio or on any other major podcasting app. Ladies and gentlemen remember, it’s up to use to tell the story of innovation in health IT. And remember, keep building your audience one gig at a time.
Until next time, I’m Jared Johnson and you’ve been listening to the Health IT Marketer Podcast. This program is sponsored by Ultera Digital Marketing Consulting, answering your questions about health IT, influencer and content marketing. For a full archive, go to HealthITMarketer.com, which I mentioned last week was recently redesigned. That’s HealthITMarketer.com. Thanks again for listening and I’ll talk to you next week.