Dr. Carrie Nelson Spills the Tea on Telehealth Patient Safety & Quality

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[00:01:17] Welcome to the High Tea with Grace podcast where we spill the tea on HIT.

[00:01:23] Today I'm honored to welcome Dr.

[00:01:25] Carrie Nelson, Chief Medical Officer of Key Care.

[00:01:28] Dr. Nelson, thanks for joining us.

[00:01:31] Thank you, Grace.

[00:01:32] Happy to be with you.

[00:01:33] So let's start by having you tell us about the career path that brought you to your

[00:01:38] current role at Key Care.

[00:01:40] Well you bet.

[00:01:41] Yes, happy to.

[00:01:42] I'm a family physician by training and I think like a lot of physician leaders,

[00:01:47] we didn't envision going into any leadership roles.

[00:01:50] I just thought I would come out of medical school and practice medicine for the rest

[00:01:55] of my days.

[00:01:56] And I did that for quite a number of years.

[00:01:59] I was in full time practice for about 13 years in my own practice that was with

[00:02:04] two other women in the community where I live.

[00:02:07] Yeah, we had our own practice.

[00:02:09] There was a day when doctors actually had their very own practice.

[00:02:13] But I wound up getting captivated by some of the information that was coming out from

[00:02:20] the Institute of Medicine in the late 90s, which was around, you know, the two areas

[00:02:24] human report and the crossing the quality chasm.

[00:02:26] And it just resonated for me based on everything I'd seen that we had a huge

[00:02:32] opportunity to improve the quality and the safety of the care that we were delivering.

[00:02:36] So I started stepping into some leadership roles primarily just by raising my hand

[00:02:40] for projects and whatnot.

[00:02:42] And that led me down a path to where I took on successive leadership roles leading

[00:02:47] quality, safety and population health.

[00:02:50] And did that for a good long time.

[00:02:52] And I had a stint as a residency program director for a while as well, but also

[00:02:57] still deeply involved in clinical care and leading on those on those topics.

[00:03:03] But ultimately, I so most of my career was really within the traditional health

[00:03:09] care system, starting quality and safety programs.

[00:03:13] And my most recent role in health care system was at Advocate Aurora Health here in

[00:03:18] the Midwest. I live in Chicago, and so it's a 27 hospital system.

[00:03:23] I came in through the population health arm when we first signed our first value

[00:03:28] based contract and they had a clinically integrated network that was really well

[00:03:32] positioned to be able to see where we could take it to the next level on

[00:03:36] improving value and quality and cost.

[00:03:39] And so I then started that work and added quality and safety to my to my

[00:03:48] responsibilities while I was there and and was there for about 11 years

[00:03:53] overseeing those areas.

[00:03:55] We went through the pandemic then, and I thought, oh, my goodness, all these

[00:03:59] years of leading health care transformation and I'm seeing us transform

[00:04:04] in a rapid clip that has never happened before.

[00:04:07] And I got excited about the possibilities of learning from that experience and

[00:04:11] then being able to, you know, translate that into a more accelerated pace of

[00:04:17] change. Unfortunately, that didn't happen as it didn't happen for many

[00:04:22] other health systems.

[00:04:22] It just is it's a hard business we're in.

[00:04:25] And I came to the conclusion that health care systems were going to need

[00:04:30] really strong partners from the outside if we were really going to

[00:04:33] transform care.

[00:04:34] So that led me to working in health care, I.T., digital digital care models.

[00:04:40] And I joined Keycare here just last fall as their chief medical officer.

[00:04:45] That's often awesome.

[00:04:46] So give me a little bit of information about Keycare and like what

[00:04:50] Keycourt care is so people have an idea.

[00:04:52] Sure.

[00:04:53] So Keycare is a young a young company and it was founded by a

[00:05:00] physician, Lyle Berkowitz, who I've known for a number of years, but

[00:05:03] not really been in touch with until more recently.

[00:05:06] And he's an internist out of Northwestern.

[00:05:09] He's got a lot of experience in improving health care models, innovation,

[00:05:15] I.T. innovation.

[00:05:17] And he was successful in working with Epic to get them to sell first

[00:05:25] to their only ever startup and the only virtual health care provider.

[00:05:30] They sold us an instance of Epic.

[00:05:32] So Keycare has its own instance of Epic.

[00:05:35] We have providers, predominantly physicians that are seeing urgent

[00:05:40] care and virtual primary care on the Epic instance that we have.

[00:05:47] But on the behalf of health systems and we have 16 health systems

[00:05:50] contracted today and are delivering really the wraparound that's needed

[00:05:56] because we know there's a tremendous amount of people that are

[00:06:00] tremendous primary care shortage.

[00:06:01] It's only getting worse and and really helping them to serve their

[00:06:05] communities more fully 24 7, 365 and 50 states.

[00:06:11] Wow.

[00:06:11] So interesting because, you know, telehealth used to be from the outside in, right?

[00:06:15] They would refer you to a telehealth provider.

[00:06:17] So to be from the inside out is a very unique model and it's very new.

[00:06:21] I don't think people realize that, you know, telehealth has for

[00:06:24] historically just been like, oh, you need telehealth.

[00:06:27] Go to that company that does telehealth.

[00:06:29] But so health systems are now able to then you're saying kind of

[00:06:32] have it be in house and in a sense through a partner.

[00:06:35] Exactly.

[00:06:36] You know, as someone deeply involved in health care transformation,

[00:06:39] what do you see as the most significant benefits of telehealth?

[00:06:43] Generally speaking, particularly in the terms of, you know,

[00:06:47] patient safety and the quality of care, knowing that's such a passion of yours.

[00:06:52] Absolutely. Yeah, I wouldn't be doing this work if I didn't believe

[00:06:54] firmly in the ability to deliver high quality safe care through this modality.

[00:06:59] And there's lots of evidence that's been coming out and people are studying this.

[00:07:03] And we had the boon of the pandemic that provided a huge volume of experience

[00:07:07] that we can now look back on and say, what what did we learn?

[00:07:10] What did we see there around safety and quality?

[00:07:13] And so I'll quote a couple of different articles.

[00:07:16] JAMA has had a number of publications on this topic

[00:07:20] in which Mayo Clinic studied about 2000 patients.

[00:07:25] And this was published in September of 22.

[00:07:28] And they looked at what they called diagnostic concordance.

[00:07:31] And so was the diagnosis made over telehealth

[00:07:35] concordant to the diagnosis that was for the same patient

[00:07:39] within 90 days in the in-person brick and mortar setting?

[00:07:42] And they found it was highly correlated.

[00:07:44] So, you know, people are concerned about diagnostic accuracy

[00:07:47] as one component of the quality and safety.

[00:07:49] And I can first say diagnostic accuracy is a problem everywhere in health care.

[00:07:54] I know that from my years of leading on patient safety.

[00:07:58] But the truly, you know, a lot of concordance.

[00:08:00] And so there's it just goes to show that so much of what we do in health care,

[00:08:05] you can get a decent exam over telemedicine.

[00:08:08] You can take a good history and be completely focused on that person.

[00:08:12] Right. So in my own office for years, the years, the many years

[00:08:16] I practiced for at least 25 years overall, you know, I'd have a knock on the door.

[00:08:20] You know, the ER is on the phone or I'm running late

[00:08:22] and I'm getting distracted.

[00:08:23] I'm getting, you know, approached by the nurse or the MA

[00:08:28] about a patient phone call in the telehealth environment.

[00:08:31] You're completely focused on that person.

[00:08:32] And so that's one advantage. Right.

[00:08:36] You know, another study, I'll quote, is another another

[00:08:40] JAMA article that looked at whether or not people with telehealth

[00:08:46] in addition to in addition to the brick and mortar care

[00:08:48] versus those that just had their care in brick and mortar

[00:08:51] had any differences in the quality.

[00:08:53] And they found that those that had telehealth

[00:08:56] coupled with brick and mortar care had higher rates of medication adherence,

[00:09:01] higher rates of screening, higher rates of of the appropriate

[00:09:05] labs that might need to be done for their chronic condition.

[00:09:07] So it's remarkable.

[00:09:09] It's you know, it's not something that can live out in isolation

[00:09:13] and achieve those results.

[00:09:14] It really does need to be, you know, an integrated part of the care model

[00:09:19] to enable that kind of an impact.

[00:09:21] And that's interesting.

[00:09:22] It's the same virtual care that where it's a sweetener, you know, it's like

[00:09:27] it's meant to complement, like you said, not necessarily replace.

[00:09:31] And, you know, a lot of the criticism, oh, it's subpar compared to in person

[00:09:35] because you can't there's so much you can't see in person.

[00:09:37] But when I think of every virtual care visit I've had, they got

[00:09:41] and they hit the nail on the head, you know, and anyone that says that

[00:09:44] pretty much we could say they hit the nail on the head.

[00:09:46] And if they didn't, you do have the ER to go to. Right.

[00:09:49] So that is something interesting that I think about all the time.

[00:09:51] Like, you know, I just wonder, you know, are there situations

[00:09:55] where they're not getting that quality?

[00:09:56] And what is that? Because I'm not hearing many of those stories.

[00:09:58] Most of my friends are just saying, oh, it was an air infection.

[00:10:00] I'm just so glad I didn't have to take them in for them.

[00:10:02] It was no matter what, you know, it has if it looks like it sounds

[00:10:07] like it probably is it right.

[00:10:09] So I want I'd love to hear your voice

[00:10:11] and your thoughts on the recently announced joint commission accreditation.

[00:10:16] You know, what is that related to patient safety and quality, et cetera?

[00:10:21] And how will it impact this virtual care space, you know, as it relates to that?

[00:10:26] Yeah, I am just getting to look at those parameters

[00:10:30] and preview the information that they're putting out there.

[00:10:33] So I don't have a lot of depth on it just yet.

[00:10:36] You know, it was announced, I think, last week.

[00:10:38] And I finally, you know, they have something on their website

[00:10:40] where I can download the preliminary information around it.

[00:10:43] But let me just say that I'm a firm believer in that external validation

[00:10:47] of the quality of the work. Right.

[00:10:49] I think we all need somebody to say, you know, here's some standards

[00:10:53] we want you to adhere to and then see how we measure up to those standards.

[00:10:57] So UREC has had an accreditation for some time

[00:11:00] and NCQA is also developing an accreditation for telehealth.

[00:11:03] So there's a trend in recognizing the

[00:11:07] that this is a permanent part of our health care system.

[00:11:10] And despite, you know, some of the chatter out there

[00:11:13] and the wake of, you know, Optum closing down their telehealth

[00:11:17] and Walmart doing something similar, some challenges we've seen with some of,

[00:11:22] you know, the competitors that we have in our environment.

[00:11:25] I think there's still a strong belief that we've just scratched

[00:11:29] the surface of what's possible here.

[00:11:31] So we better start really understanding how to set it up

[00:11:34] in a way that is, you know, evidence based,

[00:11:37] that adheres to a standard and that, you know, we can start

[00:11:42] to measure ourselves along those lines.

[00:11:44] Yeah, it does seem that an accreditation process would kind of set the tone

[00:11:48] for the whole industry so that the quality safety complaints

[00:11:52] or whatever else that's happening outside of, you know, with around town

[00:11:56] would be lessened likely.

[00:11:58] And the quality of care and the quality of output is just better.

[00:12:03] You know, overall, it does seem that way.

[00:12:05] You know, you're a population health guru, right?

[00:12:07] You've worked in the population health space, value based care space, et cetera.

[00:12:11] I'd love for you to talk about it, about telehealth as value based care,

[00:12:15] you know, particularly how, you know, using telehealth

[00:12:19] simply just increases access to care, right?

[00:12:22] For underserved populations and more.

[00:12:24] And how do you feel that virtual care models can address

[00:12:28] some of these health care disparities and improve overall population health

[00:12:31] given your experience in this space?

[00:12:33] Would love to hear your insight on this.

[00:12:34] And I'm sure everyone's waiting on bated breath to hear it.

[00:12:38] Oh, you're very kind, Grace.

[00:12:40] So, you know, the literature goes back way, way back.

[00:12:45] Barbara Starfield in particular was a researcher that showed

[00:12:48] the incredible value that primary care brings to a community

[00:12:51] and that where primary care is strong and invested in in a given community,

[00:12:57] you see better outcomes and lower costs and better quality of life.

[00:13:00] So the fact that we're seeing, you know,

[00:13:04] the challenges of adequate primary care in our communities is, you know,

[00:13:09] it worries me as to what the future of being able to achieve those outcomes

[00:13:14] are, you know, with population health goals.

[00:13:17] And so, in fact, there was a mill bank publication recently

[00:13:21] that showed 100 million Americans are without a usual source of care.

[00:13:27] Yeah, it's really something and it's it's rural, but it's not just rural.

[00:13:31] You know, it's also inner city. It's it's everywhere.

[00:13:34] And more and more primary care docs are really not even staying in,

[00:13:37] you know, the brick and mortar primary care setting.

[00:13:39] They're they're doing different things.

[00:13:41] And so if we're going to solve this problem,

[00:13:44] we need to make sure that access is easier.

[00:13:47] And so we have these we have value based care solutions.

[00:13:51] We have situations where we're working with

[00:13:55] health systems to do annual wellness visits.

[00:13:58] There's a lot more that we can do beyond that, including,

[00:14:02] you know, care transition visits.

[00:14:03] I think there's a lot of value that can be brought to the population

[00:14:07] health equation by the through the use of telemedicine resources.

[00:14:12] Interestingly, my daughter in law is a family doctor and,

[00:14:15] you know, there are certain things that only can be seen in brick and mortar.

[00:14:19] And one of the things she said to me when I was talking to her

[00:14:22] about the work we do, she said, I would love to have somebody

[00:14:25] take all my annual wellness visits.

[00:14:27] She says, I just don't see the value of what I'm really doing

[00:14:31] in person in that setting.

[00:14:33] And and there are people that are waiting to be seen.

[00:14:38] Another example I would provide relates to chronic condition care. So.

[00:14:44] I know in my own practice, you know, and we know from the

[00:14:47] from the literature, it takes a long time, much longer than it should

[00:14:50] in terms of getting a person's blood pressure under control

[00:14:53] from the type of diagnosis to actually getting it in control.

[00:14:57] The data shows it's like two and a half years.

[00:14:59] It's just insane.

[00:15:01] And I can think back to my, you know, my practice and I would see a patient

[00:15:04] I'd make a medication dosage change.

[00:15:06] I'd say I'd want to see you back here and say two to three weeks

[00:15:08] or maybe a month.

[00:15:09] And they go to the desk and it'd be three months before they could get in.

[00:15:12] So that's one of the factors, you know.

[00:15:15] And so we can create sort of a focused factory around this

[00:15:18] where we're titrating medicines, we're getting more patient engagement.

[00:15:23] We're getting correct measurement of blood pressure at home,

[00:15:26] where it's actually more accurate and we can really deliver on

[00:15:30] getting to those health outcomes that have really eluded us for too long.

[00:15:35] So interesting and such a thoughtful response.

[00:15:37] I appreciate that.

[00:15:39] Can you speak to the role of data and analytics also

[00:15:42] in optimizing telehealth services?

[00:15:44] You know, they have to meet these rigorous standards of care,

[00:15:47] you know, contribute to value based care objectives.

[00:15:49] So, you know, tell me a little bit about that role of data

[00:15:51] and analytics in this space now.

[00:15:53] Gosh, it's so important.

[00:15:54] I'm really glad you're raising it.

[00:15:56] I think it's been underappreciated in a lot of the telehealth models

[00:16:00] that we've seen through the standalone model that are out there.

[00:16:08] The one thing I'll say with our solution is we have Epic.

[00:16:11] And so Epic has a tremendous amount of analytics capacity.

[00:16:16] We have the data that we have is so rich and it's interesting for a startup.

[00:16:21] You know, a lot of times the data isn't quite there,

[00:16:23] but we are very heavy on data.

[00:16:26] We can understand, you know, antibiotic stewardship.

[00:16:28] We can see the kinds of conditions that our providers are treating.

[00:16:32] We can identify conditions that would be an unusual telehealth condition

[00:16:37] and then create follow up programs to make sure that that person's OK

[00:16:40] and that they got the care they needed.

[00:16:42] We just have a tremendous ability to slice and dice the data

[00:16:47] in ways that will truly demonstrate the kind of impact that we're having

[00:16:50] and call out things that we need to be learning and improving upon.

[00:16:55] That's just critical to health care in general.

[00:16:58] So interesting.

[00:16:59] I think your background is just so fascinating, having that value based

[00:17:03] care at health care delivery, value based care kind of population health.

[00:17:08] And then now this technology element.

[00:17:10] What innovations with that background in mind,

[00:17:13] what innovations do you foresee shaping the future of telehealth now and virtual care?

[00:17:17] You know, we see all these this news about Optum closing down.

[00:17:21] It's virtual care and and Walmart Health not doing it anymore.

[00:17:25] And folks are saying in the industry is telehealth dead, like is telehealth dead?

[00:17:29] And what do you think?

[00:17:30] What do you think about all of this?

[00:17:32] What is the future of telehealth to you?

[00:17:35] Well, I think we're at a critical turning point, right?

[00:17:37] So I do believe the model of telehealth that lives in isolation

[00:17:43] that can't be viewed by the regular source of care,

[00:17:47] the providers that are in the brick and mortar.

[00:17:49] That model is just not going to help us realize the potential that is really here

[00:17:55] when all of the information lives in a silo and cannot be shared.

[00:17:59] You know, that just isn't going to work.

[00:18:01] And so that aspect of telehealth, I do believe, is dying.

[00:18:04] I mean, the evidence is there in the in the news every day.

[00:18:09] We're at a turning point, though, to where we can now

[00:18:13] start with a model that's more fully integrated with the brick and mortar.

[00:18:17] It needs to be hybrid, right?

[00:18:18] As you said early on in this conversation, it's a sweetener.

[00:18:22] It's not something that can replace all kinds of care.

[00:18:25] But how do we free up our our precious primary care providers

[00:18:29] to provide the kind of care that's only that can only be delivered in person

[00:18:34] and then offload some of the care that can be best delivered over virtual models

[00:18:40] and then be able to see, you know, we've seen some data where we've got patients

[00:18:44] that in a given health system, they've had over five visits with us

[00:18:48] in the space of about three months.

[00:18:50] That needs to be delved into.

[00:18:52] Are they do they have a chronic condition that is not under control?

[00:18:56] Do they have a recurrent problem that really needs to get them

[00:18:59] navigated back to their primary source of care?

[00:19:01] So that's work we're doing today to be able to augment

[00:19:06] the brick and mortar

[00:19:09] I window to what's really going on with these folks

[00:19:13] in a way that can get them redirected back to their primary care

[00:19:16] when it's really needed.

[00:19:18] People shouldn't need telehealth more than a couple of times a year at the most.

[00:19:22] And if they're repeatedly using it

[00:19:25] for an urgent care condition, you have to really wonder, is it an access problem?

[00:19:29] You know, all of those things are questions

[00:19:31] that we can answer with the data that we have.

[00:19:34] Interesting, interesting.

[00:19:35] It's my last kind of industry question before we dive into your personal life

[00:19:40] and doing some more personal questions about leadership and more is,

[00:19:44] you know, what strategies do you feel the industry should be advocating for

[00:19:48] to maintain the highest standards of care?

[00:19:50] You know, we're talking about the accreditation.

[00:19:52] What are some of the strategies that they need to be thinking about,

[00:19:54] you know, to promote its widespread adoption while also keeping things

[00:19:57] super safe and super high quality?

[00:19:59] And what are those strategies that the industry should generally be keeping in mind?

[00:20:04] I think there needs to be transparency of information, right?

[00:20:07] So when we work with health systems,

[00:20:09] I want to feel proud to share with them our quality outcomes.

[00:20:13] I want and if they're not OK, I want to have a conversation about that as well.

[00:20:17] If we have a patient safety incident, I want to, you know,

[00:20:20] full disclosure has to include working with that health system

[00:20:23] to let them know that this this kind of thing happened

[00:20:26] in what we learned from it and what we're doing to prevent it from happening again.

[00:20:30] I mean, safety issues are everywhere in health care.

[00:20:31] There's no reason to think we won't have them in telemedicine.

[00:20:35] We'd be blind, right?

[00:20:37] And so, yeah, that full transparency is really essential.

[00:20:40] I do believe, as you mentioned, the accreditation.

[00:20:42] I do think we've got to make some adaptations, some of the NCQA

[00:20:47] measurement methodologies and how they how they define

[00:20:50] numerators and denominators and the requirements for for certain measures.

[00:20:55] Sometimes that doesn't really lend itself to telehealth

[00:20:58] being supportive of achieving those measures.

[00:21:02] I also think we've got to make sure that we solve

[00:21:04] bandwidth problems that are in some of these communities.

[00:21:08] We've got to get to telehealth permanency.

[00:21:11] So those are the things that, you know, are going to just open the door

[00:21:14] for more and more innovation.

[00:21:15] But I'd be foolish if I didn't say AI

[00:21:20] AI is also going to be a game changer, more at home testing.

[00:21:23] Right. There's even Pap smear testing that can be done at home.

[00:21:28] I know. How about that? Right.

[00:21:30] It's not it's not what you think.

[00:21:31] It's entirely different.

[00:21:33] But there is I can imagine us all having a kit in our home

[00:21:37] that enables us to look in an ear over a telehealth methodology,

[00:21:41] be able to do a strep test, be able to do a urine,

[00:21:44] be able to do some of the common things that we know

[00:21:47] would benefit from additional testing when people may be in a rural area

[00:21:50] and can't get to a site where that's available.

[00:21:54] But AI, we're looking at all of those possibilities,

[00:21:56] from the standpoint of just making the work more efficient

[00:21:59] for the physicians that we're working with, but also collecting

[00:22:02] blood pressure measurements and understanding, you know, based on

[00:22:05] a person's voice, you know, what is their what is their mood?

[00:22:08] Is there are they really, you know,

[00:22:11] more depressed than they're trying to portray to us?

[00:22:13] You know, those those technologies are just going to be game changers

[00:22:17] increasingly in opening the doors for what's possible.

[00:22:21] So interesting. Thank you for sharing this very fascinating.

[00:22:24] I'm sure everybody's lots of comments.

[00:22:26] Feel free to write a question in the comment.

[00:22:29] We'll share it with Dr. Nelson.

[00:22:30] She would love to answer it for you.

[00:22:32] So, you know, we try to really try to understand what drives women

[00:22:35] in health care, IT, like amazing leaders like yourself

[00:22:37] that have held so many different types of leadership positions.

[00:22:41] You know, what are things that you do in your career

[00:22:43] that help you work your best and make a difference and keep going

[00:22:46] despite obstacles coming your way?

[00:22:48] Hmm. Yeah.

[00:22:50] You know, I learned early on one of my first experiences

[00:22:53] in trying to lead a change initiative in my own practice with people

[00:22:57] that, you know, I was friends with.

[00:23:00] I was shocked at the amount of resistance I got.

[00:23:02] And that was like the most pivotal learning experience for me as a leader

[00:23:08] that, first of all, expect resistance.

[00:23:10] It's not personal.

[00:23:13] It's human nature.

[00:23:14] And we just have to keep moving through it, just keep moving through it.

[00:23:18] So it's persistence and patience in all of those things.

[00:23:22] And and then really hearing, you know, what people,

[00:23:25] what their concerns are, what their sources of resistance are.

[00:23:28] And then working to overcome them together.

[00:23:31] I don't think that I think that's been said probably many, many times,

[00:23:34] but it's not to be underestimated as to how much fortitude

[00:23:38] it really takes to keep that going.

[00:23:40] So that would be like my number one thing.

[00:23:43] And then also, I would just you know, I really have a

[00:23:45] I put a high value on relationships.

[00:23:47] And, you know, Stephen Covey talks about the speed of trust

[00:23:51] and how much those relationships can help you move mountains

[00:23:55] if they're really on solid ground.

[00:23:57] So those would be a couple of things that are top of mind.

[00:24:02] I love that. I love that.

[00:24:04] Do you have any advice for women looking to get in health care and health IT?

[00:24:08] Like, what could you tell your younger self getting into the industry

[00:24:11] that you kind of wish somebody had told you about the space?

[00:24:15] Yeah, I think, you know, it's

[00:24:17] it's probably overestimated how difficult it is to step into leadership roles.

[00:24:22] Honestly, it's about raising your hand and showing up.

[00:24:25] Most people don't do those two things.

[00:24:28] You raise your hand and you show up and you have you.

[00:24:31] You don't be afraid to have a voice and and you'll start to get attention.

[00:24:36] People will appreciate that you're at least trying,

[00:24:40] even though you're still on your own learning curve.

[00:24:43] You know, that is that is the thing that I remember the most is being young.

[00:24:47] I was in my you know, probably in my early 30s

[00:24:50] when I first started stepping into, you know, those kinds of forums

[00:24:54] and being sort of surprised that that it was welcome

[00:24:58] more so than than I would have anticipated.

[00:25:01] So that's a big one.

[00:25:02] And then look for your look for your allies, look for your mentors.

[00:25:07] I don't think I've had a lot of women mentors,

[00:25:10] but I definitely have a lot of allies.

[00:25:12] And and sometimes you just need to vent a little bit to some of those allies

[00:25:16] and then come back to the game.

[00:25:18] Other times, it's really about, you know, helping you strategize,

[00:25:22] you know, working through a given problem.

[00:25:24] So those would be the things that I think about.

[00:25:28] Well, thank you for showing up. We appreciate that.

[00:25:30] Then we get to learn from you.

[00:25:32] So that's fantastic. Thank you.

[00:25:33] So to finish this conversation off right.

[00:25:36] Where can our listeners find you online?

[00:25:38] Well, certainly LinkedIn, Kari Nelson, MD.

[00:25:41] And you can go to our key care website,

[00:25:44] keycare.com and I believe it's dot com.

[00:25:47] I should double check that.

[00:25:49] I think it's keycare dot org, actually.

[00:25:51] It is keycare.org.

[00:25:53] Thank you. I don't typically go to our own website.

[00:25:55] I hope you can edit that part out right now.

[00:25:58] We're all good. We're all good.

[00:26:00] Good, good. Yeah.

[00:26:02] So in our Lyle Berkowitz, our CEO is real active as well.

[00:26:06] And he's he's a voice to definitely follow on those platforms.

[00:26:10] Yeah. Dr. Lyle is a longtime friend of mine,

[00:26:12] and he's the one that pointed me in your direction.

[00:26:14] He's like, you have to interview her.

[00:26:16] She's amazing. And I believe it.

[00:26:18] I believe it. You have been amazing.

[00:26:20] So before I forget, did you happen to bring tea with you?

[00:26:23] I did bring tea.

[00:26:25] I'm so glad you offered me. Tell me about your mug.

[00:26:28] Yes. Oh, this I don't know this mug I've had for a long time,

[00:26:30] but I just love that it's so colorful and it just kind of

[00:26:34] it's funny how the receptacle can that you're drinking something out of

[00:26:37] can really brighten up the whole experience.

[00:26:39] It really does. It is so colorful.

[00:26:41] It's like green and multicolored and happy.

[00:26:45] And it's even got flowers on the inside.

[00:26:48] Oh, I love it because then I'll spill all over my my keyboard.

[00:26:52] I know. I know the funny thing about having tea with me is that

[00:26:55] you end up talking the whole time and I can drink my tea,

[00:26:57] but you can't drink the tea until afterwards.

[00:27:00] So that's great. What kind of tea are you drinking?

[00:27:03] This is a ginger tea.

[00:27:04] I am an herbal tea person.

[00:27:07] Yeah, I have my coffee first thing in the morning.

[00:27:09] I never miss that.

[00:27:11] But then later on, I'm all about, you know, trying not to have the caffeine.

[00:27:15] A good night's sleep is a thing that is really another

[00:27:18] pointer for people that are on a leadership journey.

[00:27:21] And so, yeah, I try to keep the caffeine out of the later part of my day.

[00:27:24] Oh, I love that. Well, that's too good.

[00:27:26] Thank you so much for joining us, Dr. Nelson.

[00:27:28] It was great having you here.

[00:27:29] Thank you so much, Grace. It's been a real pleasure.

[00:27:32] And thanks to you folks for joining us, too.

[00:27:34] Check out the Hi Tea with Grace podcast.

[00:27:37] The interview is with a Steve Nelson today. Cheers.

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