In this example, we're going to be looking at how forwarding will affect our data hazards in this block of code. I've already marked the dependencies from our previous example. So we're just going to be focusing on the forwarding this time. As always, our first instruction isn't going to be dependent on any of the other instructions that we've got in this block of code. So we won't worry about any dependencies there. We'll just let this instruction run immediately. Now our add instruction is dependent on the results of our load word instruction. Since our load word instruction computes its results in the fourth cycle, they're not going to be immediately available for the third cycle of our add instruction. This means that we're going to have to wait one cycle before we can run that add instruction. So in this case, I'm going to fill that one cycle with a no op instruction. Now we have two add immediate instructions that aren't dependent on any of the other instructions that we've got here. So I'll be able to run both of those immediately. Next, I have a shift left logical instruction, which is dependent on the second add immediate instruction. But our add immediate instruction will compute its results in the third cycle, and the shift left logical will want to use those results in its third cycle. So they'll be available through forwarding. I won't have to wait any cycles after the add immediate before I can start my shift left logical instruction. Now I've got an add instruction, which is dependent on the results of the shift left logical. And again, this is going to compute its results in its third stage. So they'll be available to the add instruction in its third stage without any waiting. We can just forward those from the end of the ALU stage from the shift left logical instruction to the beginning of the ALU stage in the add instruction. Now I've got a store word instruction. It depends on both the add instruction before it, as well as the first add immediate instruction. It's been more than two cycles since that add immediate instruction ran. So I know those results have been committed back to the registers, but I'll need to use T1 in the third stage because I need to add zero to it. So I need to be sure that the results of my add instruction are available. Since the add instruction will compute its results in the third stage, those will be available for my store word instruction in its third stage as well. So I can run my store word instruction immediately. Lastly, I have that jump register instruction, and that's not dependent on any of the other instructions that I've got there. So I can run that instruction immediately as well. So in this case, I've reduced my delays to just one. I only have one no op now. So this code is going to run a whole lot faster because it's not sitting around waiting for instructions to complete before I can run new ones. I can just forward data from one instruction to the next without a whole lot of waiting. So forwarding works out really well when you have lots of ALU instructions to run.


Okay, we're back live here at HP Discover in Frankfurt, Germany. I'm John Furrier with SiliconANGLE. This is theCUBE, our flagship program. We go out to the events, extract a signal from the noise. This is day two here at HP Discover, and yesterday was a great day. A lot of interviews, almost 20 interviews, getting in the trenches, getting deep, extracting the signal from the noise. That's our purpose, that's our mission. I'm John Furrier, the founder of SiliconANGLE.com, and I'm joined by my co-host. I'm Dave Vellante of Wikibon.org. Check out all the research at the site. And we're here with Scott Weller, who's the vice president and general manager of the technology services and support group within HP. Scott, welcome back to theCUBE. Yeah, thanks, Dave. Great to be back. Here at Discover, over the pond this time for us, anyway. So, big show, 9,000 people, comparable in size to the U.S., which is impressive. So you guys are covering nearly 20,000 attendees across the two shows that you do in June and here. So, what do you guys got going on at the event? What are you spending your time doing? What are customers telling you? You know, so, as you mentioned, we were in Las Vegas about six months ago. And since that time, we've seen a lot of traction, a lot more footprint in the cloud market. And we've built up a lot of new capabilities that are being announced here. So, you know, we're all very excited about the things that our customers will see here in Frankfurt. And really, the key theme is cloud and all of the technology enablement for what we call Converged Cloud.  Can you talk about those a little bit? So, let me put, so you're talking about announcements in my business. So, let me put it in the context of the cloud announcements here. So, you know, one of the things that we did announce here were several extensions to cloud system, which is our flagship product for customers to build a private cloud. We talked about new bursting capabilities, new cloud maps, new management and security capabilities. So, that's that product. On the software side, we announced several new products, one of which is a great product for DevOps, where the target is a hybrid environment, traditional, private and public cloud. On the public cloud side, we announced our platform as a service which has been in beta for some time and several point products, if you will, for communication service providers. So, then, with that as a contact in my business, we've announced several things, one of which is a pay-as-you-go model for customers who want to deploy something like cloud system, but want to be able to make that OPEX and CAPEX trade-off. So, and there were several others. So, again, a lot of emphasis on cloud. You know, we've actually hit this part of the adopter curve where customers are just ready to go and they're out there actually buying technology products and solutions to get on that path. So, Dave Donnelly talks about his group, the EG group, an enterprise group, transforming virtually all the businesses that you guys participate in, networking servers, storage and services, specifically. So, talk about that transformation. You mentioned this pay-as-you-go model, that's pretty intriguing. I presume that's an example of how you're trying to transform the way in which you create that customer experience. Can you talk about that a little bit? Yeah. So, my business is in an enterprise group, Dave's organization, and what I would say is that the sort of the approach to bringing technology to our customers is just changing. So, what we've done is we've said, look, it really ought to start with, what is the experience that we're trying to deliver? And then that ought to set the stage for what are the, you know, the product features, the speeds, the feeds, the technical services that go around that. You know, it used to be you'd have a product and then do you want fries with that? That was sort of the model for services. Now it's really an integrated model all about what is the both the buy, sell and ownership experience for that technology? And so, yeah, I mean, I think that's been a major shift for us over the last 12 months is to create that kind of integrated model and the way we develop products and ultimately the experiences customers have with HP technology. Scott, we were hearing yesterday, obviously big data is pretty much native within all the different people we talk to from customers to system integrators and cloud providers, as well as HP. That kind of the big data DNA is now kind of native as we call it. On the converged infrastructure side, on the infrastructure side, a lot of services activity, we talked to some folks are saying, traditional IT spend is kind of hovering but cloud spend is rapidly rising and scaling. So there's a lot of effort around the services. So that's kind of interesting data point we extracted out of yesterday. And then yesterday's news was that EMC and VMware are spinning out cloud foundry, spring source and green plum in the big data analytics, essentially cloud and big data analytics are being spun out of VMware. So you kind of see the coalescing of what seems to be the industry strategy infrastructure and then developer. You mentioned DevOps. So what are you seeing from HP standpoint relative to that context around the services because customer demand seems to be high for services, yet it's still unclear what the path is is a variety of different options of private hybrid, public cloud, Amazon and recently did a deal with NetApp. So all these things are kind of going on. So how do you make sense of it from the services standpoint? Because that seems to be the action that people are planning on what to do and what are you guys doing in that area and how do you talk about that? Because DevOps seems to be developer focused more applications and then the infrastructure obviously is a lot of the software led stuff we've been hearing from Dave down the Tally's team. Yeah, so I agree completely. And in fact, I would add a third which is the whole big data information optimization piece of that. So on the DevOps side, as I mentioned, our software group is all over that and they are, I think they may be the first in the industry that's taken that step to recognize that DevOps isn't about a single target. It's like, how are you going to manage all of these workloads moving everywhere around the ecosystem? So that's one. On the infrastructure side, I would say that this model that maybe Amazon pioneered the platform as a sort of infrastructure as a service model is now ubiquitous and it's the question of it's the standard sort of supplier and partner question who's going to deliver the best experience for you. And it goes beyond just the technology but what is the service level? That's one of the key questions that people are asking is what is the service level? I'm going to get anybody who will bet their business on a technology needs to understand who will I call, what is the downtime going to look like if there is some, what does the remediation look like and so on, is there root cause analysis and so on? Or is it sort of just like, well, we were down. So that's really key. And then on the information side, I think we've gotten again to a point in the technology curve where you can make some strategic choices. There are enough suppliers out there, there are enough different models out there and even business models behind it. So I think we're at a very interesting point in time and really the buyer has all the advantage. Talk about the services option now within HP because obviously HP is huge, obviously. The services side ranges from outsourcing on one end, just like the old way and then now under technology services under Dave Donatelli, it's your blocking and tackling IT services where that's transforming for on-premise, there's a lot of activity and then as you said pay as you go. Where are the customers in their evolution? It's a migration to the cloud or a hybrid or integrated cloud where they can get the on-demand utility type computing that they're looking for, you mentioned pay as you go and where are the customers at in terms of on the scale 10 being fully adopted and zero being not doing anything because there's a lot of education seems to be involved and a lot of hand holding or white glove treatment around. How to really migrate things over and or while business is running, how do we move the value into these services, these new services, which is IT services and also he's talking about applications. Right, so I would say that there's no one characterization for even a single customer, depending on what their department is trying to do and where they are in the technology adoption curve. So a single customer can be all over that and every step along the way. What we're seeing is that there are two fundamental paths to the cloud, one is where a company realizes my developers are being teased and taunted, if you will, to find faster ways than IT can provide them a server or a pool of resources so they're going out to the Amazons and others and they're saying look, that's just not sustainable for us. We have a lot of data that we're worried about and so on. So that's a path to private cloud. Once that happens, other departments begin to realize that pool of resources are available, marketing and so on. And eventually mainstream applications can find their way through an app migration process into that environment and then eventually bursting and then onto the public cloud. So that's one path that we see all the time. The other path is a traditional outsourcing customer who says you know what, I've been outsourcing with you, I've got a few workloads that I'm just ready to take to the cloud now, help me do that migration and I leap directly to the cloud. So we're seeing customers do all of the above, all at the same time, and really again it's about what are their needs, what is their appetite and also their sensitivity to where the data is. We have customers who have data like trading sites, the data's out there, it's publicly available. The question is how quickly can you act on it and it's the output that's the key IP. Other customers, you know, they have design boundaries, they have terabytes of data in their design, they don't have the ability to just move that around. So again, it depends on what am I trying to do, what's the nature of my data set and what are my concerns about privacy and latency? Data is a real big factor because public cloud has been criticized for the lack of support around data because data has a couple of issues around security but also the scale of data, you can put it out there, you really don't want it to go away. So kind of that Amazon model doesn't really work there very well right now. It's kind of kind of colluding and evolving but the enterprise customers, they want enterprise grade cloud at public cloud prices. Kind of that's kind of where they start thinking about, okay, yeah, it's economic advantages. So talk about specifically the SLA involvement because HP has done very, very well. We were talking to David Scott in the storage side around these guarantees, he has these promotions, they're often guarantees. Is HP doing anything similar in that kind of SLA guarantee mode and in terms of around SLA and delivery because enterprise grade is one of those, it's the shark fin or the tip of the iceberg underneath the water, it has more cost involved, so that's one question. And the other question is multi-vendor because now you have multiple clouds, you have OpenStack, you have AWS and a variety of other things of your own cloud. So two questions, one, how do you deal with the enterprise grade SLA requirements and any kind of guarantees? And two, how do you handle this multi-vendor which has been a great area for HP? Right, so I think you've raised a good point and this is why outside the DevOps community a lot of the public cloud offers to date have really not been viable for real business. And so HP's cloud and especially the managed cloud offer does bring a lot of those SLAs but it begins with enterprise grade infrastructure and understanding how enterprises actually build out infrastructure which is not necessarily what is built out there from a public cloud standpoint or leveraging some of the retail anchor tenants in the way they've built infrastructure. So it starts with that and then the SLAs on top of it absolutely. In my business, our business is all about service levels and so it's understanding that you want to prevent issues to begin with, you want to preempt issues through analytics and so on. And then it comes down to understanding what is my response going to be when there is an issue and baking that into a service level agreement and that's just a run rate business for us. There's a lot of talk these days about putting mission critical applications in the cloud. Are you seeing more of that and how does that change the way in which you're supporting customers? You know, I'm not seeing that, Dave, in the traditional sense. Applications that have been built from the beginning to be self resilient, some of the search tools, Hadoop and other things that have been built that way can be made mission critical but when you take a very traditional workload and try to move it onto the cloud that is really a difficult proposition because in the end mission critical comes down to understanding unplanned downtime and understanding your response to it and most of the cloud providers just don't have an answer for that. That doesn't necessarily fit their business model and it's quite a stretch to get there. Yeah, I think it's a lot of futures marketing, right? You're seeing some of the emerging cloud providers talk about that and maybe some of the flash guys talking about how you could, in theory, you could do that Oracle of course is doing a big push for its cloud but that's a lot of software as a service. So my second question on that, Scott, is are you seeing any indication that so-called hybrid cloud and what I mean by hybrid cloud is certainly people have public and private, we know that, but if you narrowly define hybrid cloud as a federated application, are you seeing any indication that customers want to do that? So absolutely. So we may be defining hybrid cloud a little bit differently than. So what we're saying is that, look, first of all, you want the opportunity and option to deploy your workloads where they best fit the environment, they best fit the service level, the cost, and so on. And then you want the ability to move those workloads almost at will. And I think in the future what we're going to see is there going to be brokering systems that almost like energy trading that says, you know, today I'm getting a better deal over here, I'm getting a better service level over there, you know, and I'm going to move my workloads there preferentially and sort of in an automated way. So it's that ability to decide where and when and how without having to worry a lot about, okay, you know, what is the operating system, what is the operating environment, and so on, and actually sort of bring the question up a level to, you know, these sort of business questions and everything else is sort of abstracted away in that model. So what do you make of, we've been tracking Amazon pretty closely, they had the big re-invent conference last week, I don't know, I joke about it a lot, especially me, I talk about Amazon's SLAs being, hey, we'll do our best, we don't send us an email, we'll get back to you within 24 hours or something like that, but nonetheless, Amazon's being very aggressive now in the data center, we saw them at sort of the big events. What do you tell customers? What are customers telling you? Are they willing to put their data and their apps in Amazon? Is it more just the development crowd still? What are you, what are your mainstream customers telling you? So what we're hearing is that customers want that, they really have a desire and appetite to move workloads into that kind of environment. What they're unsure of is, what is a company like Amazon, and they're not the only one, but what are these companies telling them in terms of what is the experience I'm going to get? You know, what happens when there is an issue? You know, it's, there's nothing wrong with best effort. You know, best effort is a fine model, but you know, best effort doesn't work for almost every mainstream business. So those are the key questions, and I think any provider out there needs to be able to answer those questions that they're really going to be able to draw in the hardcore business community, which is huge. So, you know, I don't blame anyone for wanting to get into that market, but you know, it's not easy. It looks easy, it looks like it's just like an increment from where they are, but no, it's a huge lift. It's got my final questions, we're getting on the time limit here, but you guys have hundreds of customers with cloud system and with the cloud services, and you guys are working with customers to migrate services and build services and they consume the services. What have you guys learned around cloud? Because you know, yesterday was, the consensus was, and we've been talking about this before, is that no one customer is the same. It's like, you can boilerplate spec a customer. Their needs are different, they may have different applications, but at the end of the day, enterprise-grade infrastructure is pretty consistent. You know what it is, when you see it and it works, it has to be up, all that good stuff, industry standard servers and whatnot and so on. So what are you finding with those hundreds of customers as you guys expand out the build and the consume side of the business? Is it, are they rolling their own? Do they want to manage services in a mix of both? What are you seeing from what you've learned and what are you guys seeing happen in the next few months, a year? Yeah, so I'll share the cloud system experience, which again is our product for deploying private clouds. What sometimes happens as a customer says, and this tends to be the very large customer who have actually moved along the virtualization curve early, they'll say, you know, that's a great product. What I want to do is I want to disintegrate that product into its elements and I kind of want to roll my own. And these are the kinds of IT shops that have a lot of capability and they have a lot of design capability and also execution. But you know, so those are really the two different sets and what we're not seeing a lot of is customers saying, you know, I'm not ready for the cloud, I think we're well past that now. And so what I expect in the next year and two is that customers will start to just assume that they can do private cloud. Although it's actually, it's not an easy thing to do if you've been traditional all along, if you haven't explored virtualization and so on. But we do make it easier with these products. And but I think over time, customers are going to begin to sort of segment into, I'm not going to necessarily roll my own, I'll take a reference architecture, take a set of technology, but I'll deploy that in the way that makes sense for me. What about security in that equation? Where are we with security? You know, security is something that is always a moving target, no matter what you do. So, but as I mentioned earlier, cloud system, we've just added a lot of security capabilities. We'll continue to do that. So whether it's in our standalone software and our point solutions, you'll see that as a major, major focus for us. Any goals that you have in the services group this year you want to share with the folks out there in terms of what you guys are trying to do and for next year? Sure. So we don't talk about futures, but I'll tell you there are two areas that I'm really focused on now. One is deep analytics for preemptive work so that, you know, it's not even prevention, it's beyond prevention to preemption. So that's one area. And then the other areas as we've been talking about is service levels in the context of a bursting situation. That's something that the market hasn't really addressed and you'll see us focus in that area. Okay, Scott Weller, Vice President and General Manager of the Technology Services within the Converged Infrastructure Group and Cloud and all the great stuff with the Enterprise Grade Cloud. Thanks for coming on theCUBE. We'll be right back with our next guest after this short break.


Ladies and gentlemen, please welcome Omar Ishrak. Thank you all very much and it's a real pleasure to be here. And I'm looking forward to moderating the session, but let me start with a few things. This session is about technology, technology in healthcare. And the uniqueness of technology in healthcare is that in this situation, the actual difference that technology makes can actually be measured and seen. That's not, that's in many ways different from general technology that we all use every day in our day-to-day lives, where it's an emotional assessment of the value of technology. Here it's real. It's real, but we don't always make it real because we don't measure it in quantitative terms and we don't deploy it in quantitative terms. But the fact is that technology in healthcare always is a purpose, a very definitive purpose that's meant to help people. And this video that you just showed put in another angle to that. It said that while all of that is true, there's true emotion involved in everything that we do in healthcare. It affects people and we heard a very touching story there from Matt who I'm going to welcome here in a minute. But it is about people. It's about inspiration that we all get from helping other people and it's about making a real difference in people's lives. So, you know, we stand in healthcare in an interesting position where we apply technology expertise. You know, many of us are deep in technology. We get interested in it. We have fun with it. And that in its own right is a great experience and something that people live their lives developing and enjoying and contributing. But at the same time, it makes a measurable difference about which there is no question. And associated with all of that, this true inspiration, emotion died with it. So we live in a unique industry. The other thing that I'll say before I invite everyone over is that the confounding thing about this industry which seems to be so, you know, such a great place to work in and contribute and only do good things and valuable things is that it's viewed as a cost burden to the entire world. It's viewed as a problem. It's viewed as, you know, you're making people better but it costs more money. And I think that's because we don't look at it comprehensively. We don't look at data in a very specific way. We don't measure outcomes systematically. We don't apply the right therapy to the right patient in a systematic and disciplined way. And because we don't do that, there's a lot of variation. And that variation causes the cost to escalate and instead of healthcare being viewed as an economic driver for the world, which it should be, it's viewed as a cost burden. And I really place it on all of us in our own way to first be cognizant of that and then address it. Address both the value that we create in terms of better outcomes but also the cost that it requires to create that value. And in fact, it should be lowered with better outcomes as opposed to an inherent belief that technology simply costs money. So that's some words and we'll talk much more about that. Before I invite the panel over, I do want to recognize Joe, Joe Chiani, who launched this movement.  It's becoming, it's highly recognized right now. This is the first time it's international. And so you should be proud. You should be proud of what you've done here. And thank you, Joe, for creating this. Thank you. So with that, let me ask the panel to come on over and take a seat and then we'll start from here. Okay, so welcome to all of you. And let me spend a few minutes saying a few words about each of our panelists here. Let me start with Matt, Matt Darling, who we just saw in the video. But, you know, Matt's a serial inventor and the co-founder of Smart Ward, which is a company whose mission is to improve patient safety and job satisfaction of all clinical professionals. And I think you saw, I got a hint of what he does in the video that we just saw. By background, Matt has had a long and successful career in IT and he's worked in a range of commercial projects and also been a senior advisor to the government. You know, people often ask why healthcare, why health spends so much money on IT systems without seeing any benefit. And the answer is that, like I mentioned earlier, health is unique in that the technology will continue to change. And I think Matt has recognized that and he's built a system in Smart Ward that is flexible and that's moving along using the latest technologies and artificial intelligence, which we'll hear about soon. So welcome to the panel, Matt. Second, I have Dr. Charles Murphy, who's the Chief Patient Safety Officer at the Nova Heart and Vascular Institute in the United States. Dr. Murphy is a Duke-trained cardiothoracic surgeon and a critical care physician. And after being a cardiothoracic surgeon for 17 years, he returned to Duke as the medical director of the cardiac ICU and step-down units. He also served as a physician lead for quality with the Duke Heart Center in the Department of Surgery. He then became Associate Chief Patient Safety Officer for the Duke Health System, and he's currently the Chief Patient Safety Officer at the Nova Heart and Vascular Institute. And he continues to be active in the direct patient care in the critical care settings. I know Nova very well and it's a great institution and it's a pleasure and honor to have you here. Next, I have Franz van Helten, who's the CEO of Royal Philips, and it's a position that he's held since April 2011, and he's also the Chairman of the Board of Management and the Executive Committee. Franz is passionate about innovation, but also about entrepreneurship and business transformation, and he certainly led Philips through a lot of change. But in it, it's very clear that his dedication to leadership and healthcare technology and to make the world healthier and more sustainable, that's very clear. They've got clear goals at Philips, a very impressive one of improving 3 billion lives by the year 2025, and I think Franz himself set that goal and passionately believes in it and drives towards it. By way of history, Franz first joined Philips in 1986, and he held multiple positions in the company, including Co-CEO of Consumer Electronics. He also led the successful Philips spin-off of NXP's Semiconductors, and then he did some consultancy. He was a Senior Advisor to the Board of Dutch Financial Services Business, the ING Group, where he was responsible for the separation of the company's banking and insurance activities. Since then, Franz has been running Philips, and he's got this Accelerate program focused on customers, but the thing that I've seen the most from Franz is that he's got a real focus on healthcare and making Philips into a broad-based and dedicated healthcare company in a very impressive and forthright fashion. So thank you, thank you very much. And then finally we have Anders, and Anders and I go back a long ways. I've known Anders for many years. He's currently the, let's see, the official title is President and CEO of Clinical Care Solutions at GE Healthcare, and it's a $5 billion business with 5,000 employees worldwide. The Clinical Care Solutions provides clinicians and frontline caregivers with a variety of medical solutions, including ultrasound, which is the most important one, and monitoring technology. That's only because Anders and I worked in ultrasound for many years. That's just a joke. Monitoring technology, material infant care, anesthesia, respiratory care, and cardiology. Anders joined GE in 1998 through the acquisition of Dysonix VingMed ultrasound into GE, and he's got a lot of experience in the ultrasound industry. Traveled around the world, lived globally in Singapore, Paris, and Norway. He was named the President and CEO of the Clinical Care Solutions business in 2016, but prior to that, since 2009, he played a leading role and led the ultrasound business. I also have to mention that, you know, Anders is actually celebrating because Anders used to be the coach of the Norwegian ski team, and the Norwegian ski team has had a field as it always does in the Winter Olympics. So that's what he does. Thank you. So with that, let's get down to a discussion. And I'm going to start, actually, by, you know, reflecting on the perspective that I just gave about healthcare being a broad-based technology that's affecting patients at different stages. And I'm going to start with Franz, because Franz, you know, you see healthcare both from a consumer angle. You see healthcare in a critical care angle. You see healthcare after the patient has left the hospital. So you have a pretty good view of the entire spectrum, especially as it relates to patients and their journey through the system. So maybe a few words to your own reflection and thoughts about that. Thanks, Omar. Yeah, back to the introduction. We decided to dedicate Phillips to health technology only because there's so much to do. So we got rid of all our other businesses, but we kept hospital and consumer health technology because in our strategic vision, which we adopted several years ago, we said we need to put the patient at the heart of everything we do. And if you see health as a continuum from healthy living to preventative situations, to diagnosing first-time right to, let's say, a intervention that is first-time right, and then the transition back to the home that needs to be again seamless and safe and then help the patient recover back to a healthy life, I've now laid out a continuum thinking that is centered around people rather than around institutions. If we think of the world as institutions, then there are walls, then there are departments, then there are divisions. Even within our own companies, there are divisions. So that's, by definition, wrong. But if you take a philosophical point of view that it's us, people, that somewhere through our lives we transition from healthy to sick back to healthy, then we need to enable those transitions to go perfect. And this is where we have said we need to work much more horizontally rather than vertically. You still need to have your expertise, let's say, in ultrasound or in MR machines or in surgical equipment. But if we can enable that flow of the patient is faster, better outcomes, lower cost, in fact, embracing the quadruple aim, then you go a lot better. So what we have then, of course, discovered is that data is essential and data needs to flow easily, and we will talk about interoperability in a moment. Because along all those stages and departments and expertise that needs to be brought together, we need to have a seamless collaboration between specialists in an appropriate contextual manner. So Philips has evolved into much more a health informatics company where now over 25% of the company is around integration of data supporting care flows and care pathways and supporting and enabling people to live better. So come back to the consumer versus hospital. It is all about the person and if the world cannot afford to pay for acute care as much, then we need to put in more money and more resources around prevention and chronic disease management. And that is happening around people's homes. And then we need to adopt behavioral science and even gamification to influence how people live because then is how you influence them on maybe a different lifestyle or on medication compliance. And then we need to find ways to connect doctors to patients in new ways. And you know what, we live in a digital age so it's fascinating because now finally we can tear down all the silos and all the walls and make people more effective. So that's in a nutshell. That's good. That's a good broad overview of what we face, both the opportunity as well as the challenge of overcoming some of these barriers. Let me go to Dr. Murphy because you know while you can have a perspective I'm sure you're occupied as a clinician in the moment on an individual patient on a very specific problem and at that point how the patient was managed before or how the patient is going to be managed after is almost secondary to you because you've got to save the patient's life there and then. So how do you drift in and out of that focus and time and at the same time have time to think about you know some of this happened because you know the progression was wrong or I'm going to release the patient and then I don't know what's going to happen. So your thoughts on this whole well I'd like to share a bit of a vision to highlight some of those issues. So in health care the vision is that we'd love to see safety built into and designed into the system. So I think about human factors being incorporated and I think that's exceedingly important. We don't have that to the same level as other safety critical industries have. Number two I think that we want technology really help us provide better care so we don't want siloing of information and we don't want to have onerous burdens of documentation. We want excellent early warning systems and my teams want more time with the patient and the families. We need great teamwork and communication we need excellent clinical decision support. We need transitions and handoffs that work across that care continuum. We need increasing use of simulation so that we've practiced things before we see these things occur. We need to have monitoring across the care continuum into the outpatient world and then we need to have timely intervention so that we get better outcomes. We also, you know, ever since the Institute of Medicine report came out we need a global reporting system where we can learn from harm and near misses and I hate to say this one but we actually need for people to do hand hygiene every time and then finally, you know, I do have a vision where we do have a world with zero preventable harm based on those things and I think having that shared is very important and the nice thing for the audience is that everyone on the panel is helping that vision become a reality. Thank you. So we've heard about in many ways a need which was described very well by both France and Dr. Murphy. But you've got to fulfill the need and I'm going to turn to Matt first and then Anders but Matt, you know, as you've already sort of stated in the purpose of your own company that you need a system which changes over time because not only of new technology but because every patient is different and because, you know, there's a lot of data that's fluid today how do you in fact use that data for it to become an advantage in treatment as opposed to a handicap because you just got too much information and knows what to do with it and what's your approach towards customizing the data so that it really makes a difference in every patient who's different by themselves. Yeah, thank you. I think that there's some very complex underpinnings to the nature of the problem. What I saw was a system under stress where people were working extremely hard and yet people were not really able to deliver the care that they needed to and that was because of a fragmented information environment and in the time and motion studies we've done in our research over the last nine years we've uncovered some really amazing statistics and one of them is that the fragmentation in the information environment has led to a number of really troubling elements and one of them is that people need to work around rather than work with the system so there's a big systemic problem and that work around and I alluded to in the video around how there were records there that did not reflect the care that had been delivered and that was basically regarded by people as a necessary evil in order to get everything done so systems have to be made that people can work with instead of around and through that prism we can make improved data quality greatly. For me the necessity of workflow to provide the support so that people know what to do when and to whom without having to think too hard about it is like really vital because if we can do that then we can have accurate data and accurate data is really the key to unlocking this whole puzzle if we want to move to zero deaths by 2020 I think it's achievable but only if we have accurate data and so information systems have to be there to remove the levels of admin so if you look at a hospital it's overall resources more than 50% will go on admin and that's because of that fragmentation that I mentioned we need there have been so many fantastic ideas at this conference but the system is really really burdened with a lot of busy work it's not adding enough value and in order to see those ideas implemented we actually have to create some flex and the way we can create flexes by automating admin through you know simplifying the information environment with good IT systems and intelligence it's just built into those IT systems I assume to make it fluid so the system needs to present the information the user needs at the time you can't have the user burrowing a lot of the current IT systems represent what I would depict as a mechanization of a process so it's a computerized version of a paper thing but computers are infinitely more powerful and subtle than that if they're used correctly I'll come back to some of that but let me go to Anders next because you know we talked a lot about data about overall patient management and about the flow of the patient through a health care system but health technology in the end is technology you're inventing something or coming up with something that affects a patient in a very specific way what difference that actually makes in the overall care of that patient can sometimes get lost and that it gets so enamored with what one new type of measurement or data gives you in the quality of that that the relevance of that in the overall system can get buried so how have you learned to manage that and therefore select which technology is important which is not and how do you optimize these things it's a good way of putting it and I think goes back to a little bit of the sidewall we have single data spot data spotting and very often decisions are made too late at the point where it's too late and you have a single parameter etc. we are not able to put those parameters together so that's one area so if you want to take all the data make it liquid as much as we can and put them together if you can do that and then take a few steps back and build an artificial intelligence to make it predictive so you can early do the early warnings and I would say that's probably one of the better ones and for instance we have a project going on with Rosh which is really not a device company they are sitting basically in another side and getting a ton of clinical data well we have imaging, we have monitoring we have anesthesia a lot of different things we have this project trying to solve the mostepsis which is an individual kind of loss control in infectious disease and if we then build a backbone, a digital backbone with multi-parameters to do early predictions that's where we can put these data together to make to help the nurse basically make an early decision or an early warning today they are like 85% of all the alarms are unnecessary the nurse walks 3 to 4 miles every day so it's part of Matt's your problem they didn't have time because they were attending 85% unnecessary alarms so if you can do early prediction and put multi-parameters together we have a chance to do this drive more efficiency efficacy we will go up and it will help us in many ways so that's from the data point of view that's an example how we work and think about it how do you link that to the technology creator some new sensor or something like that that comes up are you finding a way in which you evaluate if you have to invest in one version versus the other do you have methods through which you link back to the difference it will actually make in the world before you start investing in that are those mechanisms fluid it's not so fluid but I have to thank the audience here in many ways because the real work is happening at the clinical side and there is a ton of data where each individual parameters are being investigated we have new parameters almost every day new things we want to track and trace and get data into the system every bed generates one megabyte of data every day so we're not utilizing it so how can we do that better from the investment point of view look at every single one and then try to track it back to disease or combine it so we can have more data points and that's how we will start to invest in a different way and drive productivity from that perspective I mean companies like ourselves of course we'd like to dominate but that is not the solution here so it is absolutely mandatory to have an open environment where systems integration can be achieved and where different equipment from different vendors can be interoperable and for sure hospitals need to demand that but it goes wider it goes even beyond the enterprise so interoperable interoperability very important open EMRs so that you can write and read to and from the EMR in a contextual way at the point of care again very important it needs to be patient centric because that in the end makes it relevant to the care point there are going to be multiple inventors in the world that will contribute a new piece of technology that will have to be integrated in that existing environment for it to work well and the testimony that we are sitting here with competing companies because we believe that this interoperability and systems integration effort is needed and we have all pledged as part of the patient safety movement that we will adhere to that interoperability and I think we need to lift that even higher I would like to add to this point that since the movement started here there has been a lot of discussions in our company and I think in the industry in general how we kind of missed the whole thing because we have been so device focused and very individual focused on different points so in what really happened here is that if you really look at the data and this is just take us as the proxy every day there is about 700 people dying because of patient mismanagement in some fashion regardless what is that that's one jumbo jet that we are rushing every day do we have the same awareness? No you put that data back to yourself to your families whatever you realize that there is no other question that patient safety is trumping every agenda item so that's what we have done from a leadership point of view and lifted this all up and I can't agree more this has to be an industrial kind of action to be taken and to do that maybe regulatory framework to force a little bit more this to happen think about what happened with HL7 didn't work for anyone DICOM worked in ultrasound but it took multiple years to do that it was basically forced by regulatory committees and I think maybe the movement here and scientific committees to create standards that's really what we have to do Dr. Murphy first you were going to say something? No I think I agree with the creating standards I think it's very important I think it's another brilliance of Joe is that we really do need patients and families industry providers and governments working together to solve these problems Matt another fundamental issue at stake here which is one of the first questions I had to ask myself was why has IT failed to deliver in health what has been achieved as was mentioned on the first day in things like automotive and in aviation and part of it is the ongoing complexity the continuous change 80% of what we recognise as established clinical practice today is going to change within five years and when you are building an IT system you are effectively codifying that you are codifying that information in a way that can create a terrible burden in terms of maintaining it, keeping it safe so a coefficient is needed of safety criticality on the one hand and adaptability on the other hand to keep pace so I think new technologies are emerging but they like really asking IT to deliver the same things up until now has been kind of impossible I'm going to go back to you Matt right now on that subject and the interoperability which we'll come back to and the overall leadership that's required to another subject that I've at least been very curious and interested in and have put some thought into it but the usage of artificial intelligence in healthcare that's one and you're beginning to do that but healthcare is behind other areas like in automated cars there's all kinds of different places where artificial intelligence has been used healthcare has been tended to be at least from what I've seen conservative and that is a data quality issue because of data quality well you can't build an AI like you can't get a machine to learn but in the consumer world people are using imperfect data all the time and they're doing all kinds of things it depends how imperfect it is I think it's entirely possible to do it but you need to have well defined data and these predictive algorithms around patient safety predicting sepsis predicting heart attacks you can do that hours in advance already today we do that with our with our guardian software and clinically validated with data sets from Mayo and many others and curated and flexible because I take exception that IT is always hard coded and therefore from the last century in the case but you need so AI is being used now AI could be used more so it's not black and white it's being used it could be used more there is schizophrenia certainly in Europe around patient data if you go if you're born in one province in Germany and you want to get taken care of 50 kilometers further you have to be completely re-scanned because it's so hard to move the data just from one hospital to the next that's crazy and where we entrust our financial health to the cloud already for 20 years we don't do that for health so I think we really need to grow up and make data more accessible because then I think the advancement of AI can move and we can do much more I'd like to draw a distinction which I think is very important and that's the difference between device data and data that comes from human created records which is a huge volume of the information and that's really my focus so you have standards ISO 13485 and so on and this hasn't been the case with a lot of other health IT EMR, CDSS and so on haven't been developed with the same rigor and I think that's because of this tension between making something adaptable and agile versus making it safe so in terms of kind of the question I was really trying to focus on on this sort of delivery of care which is we had a lot of time and motion studies and we found that the records that were created we had people literally following and recording creating our own record of care of what was happening and it was 10% accurate what actually made it into the official record but I have a slightly different view as to what are the hurdles because you can say technology is the hurdle I'm not so sure many hospital systems still buy technology by department and if you buy it by department you get a departmental solution department is a silo and many of the EMRs were not originally set up for patient safety, they were not set up for really patient care we need a care coordination layer in order to bring all the data from all the disparate sources together and that care coordination needs to be even to extend beyond the four walls of the hospital towards the skilled nursing facilities towards the home because care coordination is a flow and you want to avoid that something goes bad in the transition from an ICU to the general ward from the general ward to discharge that's where things go wrong and again therefore we need to think much more horizontally I think also an opportunity to take with telemedicine to take specialist outlying areas to give that expertise and I was thinking when you were talking Omar I agree more opportunity for AI particularly clinical decision support so you know one of the things we haven't talked much about the last couple days is diagnostic error but if I don't consider a diagnosis the likelihood that I'm going to provide the right treatment of that patient is very low and so there's real opportunity to improve clinical decision support let me throw out two other points that I'd like your comments on questions here that I'll go through some of them but there's two things I'll throw out and then each of you feel free to comment on it the first question that I have is to do with machine learning in other words as opposed to generic data which is then used to stratify and target certain care pathways if you then track the journey of a specific patient through the healthcare system and the uniqueness that that patient may have and then the care that's then provided deviates from the standardized care pathway in a way that's customized to that individual based on their ongoing learning even during that fairly temporary period that the machine can have that's been talked about in other areas and I think that's still early even in the consumer world but what are your thoughts around machine learning that's one question, machine learning is there as it's applied to individual patients and the care pathway deviating because of machine learning the other question that I have is non-clinical data, socio-economic data whether a person is rich or poor whether they're family or not how effective and how important will that information have to be in deciding the care pathway in addition to the clinical data if you feel free to comment on each one okay, we'll start with one I think it's a monumental challenge here we have to divide it up in pieces today we do nothing and patients die every day so we have to make certain that even just at the ward itself or in ICU or a very basic thing let's start with simple coupling a couple of parameters and track start with that before we do the whole care area from patient to individual patient we have to start with basics and see if it works we have the challenge with getting data from everywhere okay maybe we'll start in the institution start maybe in the broader area walk before you run, just get basics talk to each other first, get basics things done don't worry about all those fancy things make certain that self-driven ICU actually works first in the basic area and then expand and maybe pick a couple of care areas first and that's what we did picking one difficult example to understand what challenges we have I think that's at least what we try to do and we will need to work very closely with the clinical environment regulatory environment because many of these parameters have never been experienced these decisions are made today by individual physicians or nurses, just by experience and there is no real scientific process behind it so let's do that first, and then we could I have to say, I think our care is evolving too, now we try to surround the patient with multiple clinical experts that can use algorithms, use evidence-based practice to provide the best care to that patient at that time with that condition so I think we're evolving as well but I think this idea that we can support that with machine learning and such is very powerful and will help us even be better to me, the challenge is actually the wide end of the funnel, it's actually collecting data that is high quality to underpin all of this machine learning all of this AI that really is the challenge because the data quality is pretty poor because people have to work around the record keeping systems and this generates a systemic problem, we kind of have to solve you need to have authenticated data we need to know who is entering the data we need to know where they're entering the data who is with them when they're entering the data how long it took to complete the task and if we can do that then we can provide a level of assurance around that data so that we feed in clean information to systems so that we don't get machine learning that has a defect. And then there's lots of data and what I need is actionable data I need and it needs to be presented in a fairly simple way I mean I am busy as heck with crashing patients and I need it to sort of hammer me over the head of Dr. Murphy you need to consider this now. Yeah that went back to my earlier question to you that in the moment the doctors don't care about any of that they've got a patient to deal with and the crisis situation that they have with that patient is the everything. But also the strength of the team because my team will help me and they'll speak up and say Dr. Murphy you know we think yesterday we had presented that maybe the team would say this patient needs a tracheostomy right now and so there's that strength of teamwork as well. So I see an evolutionary path to adopt machine learning and artificial intelligence and anybody who would say you know replace doctors overnight that's not going to happen. We need the doctors to be front and center with the patient but the variance in any institution is huge one doctor versus the other even within the same institution that variance is huge. So if you can through analytics provide a faster learning curve and reduce that variance it's going to be great for patient safety if you provide clinical decision support systems with you know smart checklists and discerning the deviation from what is good so that you can pick out the patients that require that extra support then I think that is going to help tremendously to improve patient safety but also reduce cost and outcomes but it will require a data architecture in your institution that is going to be holistic because you cannot do what I've just said you know silo by silo you will not move the needle enough and here is where I think we all need to move from a transactional relationship you know you have a call for tender you buy a piece of equipment I guarantee you will prolong the status quo versus a deep partnership approach where we say okay you know let's reformulate what is your challenge okay you have quadruple aim so how can technology help with that that is a different question than that historically you may have asked as professionals around well I need a piece of kit and by the way I need some IT and then I'm going to put it all together well good luck you will propagate the past right so here we need to think of a much more wide holistic architecture in how you deliver care and then you come to the next challenge again not a technology challenge and that is change management we are all people we all have our habits we've all learned it in some way and now we need to change okay and that is again a collaborative effort where we need to say what got us here will not get us there all of these much more human sides are more fundamental than you know what is the next wave of AI or machine learning because I think it will have far more impact on what we all want to accomplish but you guys didn't answer the second question that I had the socio-economic status and certainly both France and Matt probably have a strong view on that especially with your experience in the consumer world where you must be marketing in different ways and you must have learned Elmar we need to distinguish between the healthy person who becomes sick and the chronic patient who has a known condition so to start with the letter the chronic condition we have over a million patients on COPD and sleep apnea through the cloud connected to our AI engines and we can every night see you know adherence to medication you know was the mask leaking and we can connect that to the payer and to the provider you can imagine that if you apply that to a COPD pathway then you can avoid re-hospitalization so but this is a relatively curated environment where the data that comes from the home and comes from the patient we know it has relevance and we can stratify it and then decide what needs to happen for that patient if you think about the patient who says oh I'm not exactly feeling right I'm going to google around my condition I think what we hear from many of you is that actually creates a lot extra work now I think we need to find a way to bring that into into workflow I think it's going to help eventually but I also hear people struggle with that but we do need to provide better decision support to patients and families and have that be high quality and sort of for that individual as well and I think that will help actually it will help a lot as a provider I love to have patients and families come with information absolutely and in what format an iPad that's a great question I don't have an answer for you Marta any views yeah I think the kind of things that we're talking about at the moment we have to acknowledge where we are today and today we have a huge number of expert systems and this leads to this fragmentation of this information environment you need a complete picture and the question of how to get there is sort of a vexed one but I think it does require a couple of things we need a system for people to focus on patients rather than the administration exactly and if we can do that then we basically free up the time to do all of these improvements at the moment we're kind of asking people to do things they're locked into a tactical frame it's like saying to someone devise me a strategy while they run up a hill naked and storm a machine gun post they're under constant fire they're under constant pressure strategically in that moment is incredibly difficult and there is it was Dr. Scheinman the other day who said he'd like to see patient safety at the centre of healthcare and I think when did it become not the centre and why and the answer is that this fragmentation of the information environment has actually led to admin being more than 50% of the resources that go into caring for patients in a hospital and you got to ask yourself how did that happen Omar can we switch and talk just a tad about leadership in this arena because I think that's a critical issue and I think we need literally hundreds of thousands of leaders and we need them across the spectrum the people that are in this room and we need them not only at a global level we've had some great global leaders over the last couple of days but we also need every nursing and physician unit director to also be leaders in terms of patient safety and what that means you know I'm sort of a Cousins and Pozner type of person so I think modelling the way is very important inspiring a shared vision questioning the status quo appealing to the heart are very important things and then empowering everybody else on their team to make a difference but we really need a widespread leadership to really get to the place where we have zero harm I would like to add one point on this one because maybe we are missing some components and some contributors to this I'm thinking our devices and what other regulatory bodies involved here we get out of trouble from the regulatory by being very stringent with our development and adhere to all the quality things etc etc but what happens with the equipment devices and all of that same thing on the hospital side we don't fail as a device manufacturer provider but we'll fail at the patient side so how can that be so we are missing a complete regulatory overlook of the whole pathway maybe the horizontal pathway nobody's really looking at that whole story I don't want them as part of the team to work because I think it's silenced so much across the board if we can get that operation going and that's part of the leadership you're bringing up that's the leadership challenge I think we have more because within the businesses and industries at the clinical side I think there's more than enough knowledge that we need to open that pathway so let me just pivot to a question which is linked to that you know there's many questions here I certainly can't go through all of them but there's one overriding theme across many of them which is the connection to the EMR systems and that historically there's a view that the EMR systems were customized and not interoperable and they're viewed as as an issue and none of you represent you know whole-scale EMR companies they're two big ones so what in the US in the US that's correct sorry there's a world outside of the US in the US that's very true and we are outside the US right now but but on that point can this really be done without getting the EMR companies on board in this in this table? Well I think speaking about regulation I think it needs to be mandated that all IT vendors whether it's an EMR company or us in patient you know critical care that you have open APIs so that there is no locked-in situation but you know we've been talking historically the EMR let's say was designed much more from a claim perspective and so where did we lose the patient that's where we lost the patient and the provider now as we as we see that's a hospital consolidation the bill that comes with let's say the EMR integration is huge and sad because that money is not necessarily going to better patient care and we have made it not a secret to say that we advocate for a thin layer of care coordination as in IT layer above the EMR so that every enterprise whether it's a primary care or an emergency responder or a hospital they can have their own let's say administrative environment but somewhere we need an interoperable patient care coordination in order to go across and I think that is what in your nice movie you vocalized well yeah I think over nine years of research the importance to me is very needs to be focused on evidence if you look at the there was a report done by Ostrowski at L out of MIT and they reviewed the top 103 IT projects in the US and found that there was an evidence base for the claims they made about their benefits for only two now that's a problem because you have an excellent salesmanship and poor delivery and those things you know that's a diabolical combination and it has led to a lot of money being taken away in my view from patient care well it's time to wrap up I'm going to just go around the the panelists here with a very simple question that I request you answer really in a summarized fashion and the simple question is this that you know we've talked a lot I mean if there's one big theme that came out here it's interoperability working together working as a as in changing the way in which we deal with each other not only in this panel but with providers with governments in a more holistic way I think everyone signed up to that in principle but it isn't that easy to do and so the question that I have is that in your own estimation how long a journey is this before we really move the needle in being able to work together is it a year is it five years is it ten years so you want to start Matt look I think we can start today when will you reach the end that's what I mean or reach it when it will never be an end because as data quality improves and research gets better there'll be finding you think all the time what's the difference I think that's yeah I think that's right I think that people are making steady progress at the moment but quantum quantum leaps are needed in terms of you know this element of data quality adaptability and that's how long away do you think yeah it is for sure there are systems that can triple the amount of time being spent on on patient care and the ward just by automating the admin that's been proven in research how about you and I don't know that I really can give a time frame I think it'll be a steady steady change steady journey over time but I'm optimistic and and that we can get to the goal of zero preventable harm how about you friends what do you think well I'm optimistic about healthcare systems hospital systems getting a handle on this yeah but let's face it much of the patient safety issues are not in the hospital but also outside and in emerging markets and I think I'm a little bit less optimistic about you know how fast a capacity will be rolled out in emerging markets where still you know a mother and child infant infant mortality in Africa is six seven percent you know I think it will take ten years before let's say in the sustainable development goals of nations you know we get every mother every child access to the care that they need so I make a distinction between hospitals I think we are out of the gate we are working well home let's say in developed markets awareness is growing a long journey and then in developing markets much longer much longer and so much money is needed to build it there how much you understood what you think I think we are well on the way on the journey in many ways I think we can do much more as an industry maybe we can force it more by in this industrial committees and the standards for instance and I totally agree it's going to be different by different segments of the market whether you are in the developed world developing or even private and even by nations it's going to be a little bit unfortunately different but I think the commitment starts with us and partly with the providers and everyone and I think actually patients can make a difference there if patients start to push harder on the outcome because they are not really present in many environments that can accelerate this one and I think this movement includes that and for us to put it on the top of agenda will help excellent well I could talk for a lot longer but it turns up and I want to thank each of you for contributing for a very lively and fruitful discussion I'm sure the audience enjoyed it so let's give our panelists a round of applause


Hi everybody, Joe for Jaspy's casebreaks.com with dual casebreak, a double header of 2022 Tops tier one baseball. This is a random team break number four. A lot of great stuff here. A lot of autos, a lot of relics, and a lot of big hit possibilities as well. Big thanks to this group for making it happen. Appreciate the people who bought spots straight up. And we only had to do one filler. We were able to cancel one because those full spots were moving pretty swiftly. Congrats to the people who won spots as well. I'm pretty excited that he got the official last ball mojo and he's also last on the list right here as well from a spot that he won. All 30 teams are in. Let's go. Let's roll it. Randomize names and teams three and a one four times. One, two, three, and a one, fourth and final time. After four we got Martin on the pole, down to Travis in the 30 spot. Three and a one, four times for the teams. One, two, three, and a one, fourth and final time. After four we got the Oakland A's down to the twins. All right, here we go. Martin, you got the A's and the Braves. Travis with the Red Sox, Chris with the White Sox. Martin with the Tigers, Anthony with the Cubs. Travis with the Giants. Karen with the Mets. Martin with the Blue Jays. Justin Martin with the Angels. Artie Moreno is going to sell that team, looks like. Jeremy with the Yankees. Martin with the Padres. Justin with the Brewers. Jeremy with the Orioles. Travis with the Cardinals. Chad with the Phillies. Nester with the Rockies. Adam, you got my Dodgers. Nester with the Royals. Andy with the Pirates. Matthew with the Nets. Martin with the Marlins. Rob with the Rays. Martin with the Mariners and the Astros. Rob with the Diamondbacks. Martin with the Reds. Adam with the Rangers. Jeremy with the Guardians. And Travis with the Minnesota Twins. It's alphabetized by a team. We're going to pause the video when we come back. We're going to see if there's any trades. And then we will have the break. Stick around. We'll see you on the other side. All right. Hey, welcome back ladies and gentlemen. No deals were done. So that list that you saw is now officially printed out and remains the same. Thanks for hanging with me on a Tuesday. A two Tuesday on the 23rd of August, 2022. Here's the first case right here. Second case is off to my right right here. A dual case break. Now, if you miss out on this one, don't miss out on the next one. We got another dual case break. Random team up. We got a couple of fillers for that as well. So we got full spots available. If you want to try to win spots, we got that available as well in those fillers. Good luck, everybody. We've got two autographs and one relic card inside. Sometimes we'll get an extra relic. Once in a while, we'll get an extra relic. Like this one. Got two relics. Got the hit and the redemption. Any guesses on the redemption? All right. First one out of the gate is 108 at 399, Matt Olson. Oakland A's, Martin with the A's. 321 at 399, Kike Hernandez. That'll be for the Red Sox. That's going to go to Travis. Chad guessing Julio Rodriguez. That's a good guess. That'd be nice. First auto is Emanuel Rivera, 21 out of 299 for the Royals. Nestor with KC. And the redemption. Congratulations, someone. You are due to receive a triple autograph. Wow. Is it one team or is it going to be a randomizer? B, Baltimore, Boston. Those are the only B teams. Oh, Boston. Wow. Triple autograph, all for the Red Sox. Pedro Martinez. Newly minted Hall of Famer. David Ortiz, Big Boppy, and Tech. Jason Veratek. And that's for Travis and the Red Sox. That's for the spot that he won in the filler. Yeah, that's a question I like to ask. Who's holding this redemption up? Who do you think is holding this redemption up? I feel like we've seen Pedro autographed. And I feel like David Ortiz generally signs pretty often. Yeah, Chad, I agree with you. I think it might be Tech holding things up on that. Hey, Jeremy, congrats. Nice triple relic. Or a nice triple auto, that is. A great start. There's more in the store at jaskycasebrakes.com. Oh, another extra relic. I'll take it. I'll take extra hits. We've got Giancarlo Stan, 90 out of 3.99. It's Jeremy with the Yankees. And Tyler O'Neill, a ton. That's what his autograph looks like. 322 out of 349. Just his game-use jersey, though, here. That's for Travis M. Got a Travis A and a Travis M. The Travis M with the St. Louis cartons. Your two autographs. First one, Corbin Burns, 208 out of 2.99. Tier 1 talent for the Brew Crew. Justin with the Brewers. Doctors are getting shut down by Eric Liedel last night of the Brewers. I think what time is that game tonight? It's 7-10, and Corbin Burns on the mound today. He's got a 9-5 record, 2-4-8 ERA. Who just went yard here? Ryan Mountcastle with a 3-run shot. Off of Dylan Cease, too. Noah Cindergaard, Angels Edition. 88 out of 99. Looks like the Angels are up for sale. I wonder if... I wonder if should Jaspies make a bid on future Angels ownership? Corbin Burns has that franchise valued at a little over $2 billion. I'm not sure. I think Jaspies will fall a little tiny short. I'm going to have to sell out a lot more Tier 1 dual case breaks. There's Manny Machado, 141 out of 249. And that is for Martin in the San Diego ponder. We don't want the Angels? I don't know. It's a big market, a lot of value. Big fan base. 299, you know? I don't know. Steve Garvey Dodgers, Adam with the Dodgers. And there's Josiah Gray, former Dodger, 97 out of 299. That's for Matthew and the Nationals. They never go to the playoffs? That's why owners buy teams, right? For their teams to go to the playoffs? I'll bet you that you can make that a pretty profitable franchise without going to the playoffs. 293 out of 399, Michael Brantley, Astros, it's for Martin. The game, not owners, Chad. That's been pretty clear. Look across the professional sporting landscape. Taylor McGill to 299. Michael Brantley goes to Martin and the Astros and the Taylor McGill. Tyler McGill goes to the Mets, Karen. Tori Hunter, 120 out of 199. Minnesota Twins, Travis A. with that one. Artie Moreno when he sells that team is definitely going to win the business game. How much do you think he bought the Angels for? He bought them from Disney. He bought the team for Disney for $180 million. Now the franchise is valued not that it's going to sell for this but it's valued at over $2 billion. 73 out of 399, Lorenzo Cain. It'll be a big tax bill. Is there some sort of capital gains tax on that, Chad? For the Brewers, that's going to be for Justin. There's Kyle Muller. 244 out of 299 for the Braves. That'll be for Martin. I'm sure Artie Moreno will make out just fine even after taxes. And there's Fergie Jenkins. 22 out of 199. A classic cub for Anthony in Chicago. Chad doesn't deal with the sales of professional sports teams on a day-to-day basis so he will refrain from a comment. Now does this potential sale of the Angels, does that make it more or less likely that players like Trout and or Ohtani will get traded? Those are the two big stars on that team. There's the big unit. 14 out of 399. Randy Johnson, Yankees edition for Jeremy. Tyler Glass now 292 out of 299. Rob with the raise. Ohtani's going to be a mariner so that question is just really Trout. There's Bert Bleileven. Twin's edition. 20 out of 25. Yeah, the Ohtani question is going to be interesting because I think Ohtani is only on a two-year deal. He's got an arbitration year for 2023 and then he's an unrestricted free agent in 2024, his age 29 season. Greg, what's going on? How are you? My guess is that the Angels will just let them will have to go if Ohtani doesn't sign an extension. I guess they'll go do another one-year deal on an arbitration deal, his Arb 3 year and then trade a mid-season if they're not doing well next year before he hits unrestricted free agency. Rafael Devers, 14 out of 299.  There's Lars Newtbar 10 out of 10 Silver Inc Auto. Yes Ryan, I think you got it. Yeah, we're giving away 7 cereal box spots and then Mixer spots. I think we did a I think we did one of those yesterday so you can watch that video from yesterday to get an idea. It's a local kid. He went to El Segundo High School 20 minutes north of us here in Hermosa Beach. That goes to Travis M in the cartons and then we got Al Tube 120 out of 125 Martin with the Astros. Next box. Greg saying if they trade him I highly doubt he goes to the Mariners. I don't think he gets traded this year. Maybe not until middle of 2023 I feel like. I don't know. Maybe he does get traded. Yeah, Ohtani definitely said in the last off season that he wants to be in the playoffs. He's a competitor. He wants to be in the playoffs. He wants to play the best of the best. Greg doesn't see it because he doesn't think the Angels will trade him with Indivision. Yeah, if it's a trade situation, yeah, I think the Angels will probably ask for will probably want the Mariners to overpay for Ohtani if they're going to move him into Division. I think the Mariners best shot is waiting for you know, for free agency. And then just backing up the Brinks truck. Raise, that'll be for Rob in the raise. Nelson Cruz raise edition. Logan Gilbert speaking to the Mariners 166 out of 299. Exactly, yeah, free agency is going to be where is where the Mariners will have a pretty strong shot, I agree. That'll be for Martin in the M's and we've got Randy Arsarania 141 out of 299. That'll be Rob and the raise. Right, so yeah, it'll be a pretty interesting offseason for Shoei Ohtani and the Angels. I'm sure the Angels would love to extend him. I'm sure the Angels would be like hey, you know, or maybe the ownership change does force Ohtani's hand. Juan Soto, the Nationals are also, excuse me, drinking a little coffee here. Nationals are also going through an ownership change and I think that's one of the reasons why Juan Soto was not willing to sign that extension because of the uncertainty over the ownership situation. Who knows what the commitment to the team will be, what their future philosophy is. 1 out of 25, Dylan Carlson, dual relic, a little bit of maybe the beak or the feet of the Cardinal right here, that's really cool. Travis M with the Redbirds. He has Monty Grandal 248 out of 299. That's for the White Sox Chris Lombardo White Sox and Jordan Alvarez 33 out of 50, Astros. That's going to go to Martin and Houston. Alright, a few more boxes and then another case. So if you're thinking, oh man there's not a lot of boxes left, I don't have a hit yet. Don't worry, we got another case right here. Ryan Peebles, what's going on here? Thanks Nationals, Ryan Peebles says. Padres Fan, of course. Right, and Eddie pointing out plus, Nats are known for deferring huge percentage of their contracts to later years, which a lot of players don't appreciate. Chad's thinking Otani could be he sees him getting traded this off season playing him one year with whatever team because it would be arbitration and then going to free agency. I think Otani wants to test free agency. There's early win. Nice, 128 out of 149. Old game used Jersey right here. Look at that. That's pretty cool from back in the day. Cleveland! This is for you! Jeremy Taylor with Cleveland. Speaking of the Nationals there's Mason Thompson 11 out of 2 99. Matthew Wood with the Nats and Larry Walker. Great autograph, great penmanship. That's 55 out of 175. Tier one talent auto for Colorado Nestor with the Rockies. Next one, extra relic in here. Yeah, Greg says yeah, might make more sense to trade trade Otani at this point. Get a haul, rebuild 21 out of 399 Christian Gelich, piece of his jersey Justin with the Brewers. Alex Kirilov, 174 out of 299. Twins, that's going to go to Travis A. There's Alfonso Rivas 114 out of 299 for the North Siders. Anthony with Chicago Cubs and Matt Olson 101 out of 299, Oakland A's. That's for Martin and the A's. A's edition of Matt Olson. Final box of the double header. This is just the first game. Anything at A, Otani would look great in a Philly uniform, but he's saying hang up the phone on his way to being the top prospect in the game. I mean, if you're moving to Otani I think they're going to be asking for that caliber of player. There's Juan Soto National's edition 38 out of 249. Although with not very many controllable years I wonder what, maybe you actually get Otani at a bargain. There's Reese Nair for the Padre 239 out of 299. That's going to be for Martin and the Friars. I would assume that the Padre is going to sign a Soto to a long term deal right after moving up that big crop of prospects. There's Vlad Guerrero Sr. 58 out of 125. I remember Expo's stuff goes to the Nationals. That'll be for Matthew and the Nats. All right, hey. Another case. Let's play two as Ernie Banks would say. Andrew Painter apparently debut in AA at 19 years old, struck out eight in a shutout. Wow. There's a cruise to 399. Greg's not a Brewer's guy, but they could give us some young pitching and add Otani to that lineup would help a lot. That's for the fish. Martin with the Marlins. There's Lorenzo Cain speaking of the Brewer's 206 out of 399. Excuse me. I mean, I think really anybody could use an Otani in their lineup. There's Davey Garcia 107 out of 199. Yankees that'll be for Jeremy. And there's Kyle Tucker 154 out of 299. Now, Otani's thought, I don't know what his thinking is. Maybe his opinion has changed, but but I think he prefers the West Coast. I don't know if his feelings have changed on that. I don't think there's been any reporting on that, but I think when he was being courted, initially coming to the United States there were, I don't know if he ever specifically said it, but I think the report was strong that hey, he wants to be on the West Coast. Now, actual quote from Otani last season was hey, he wants to play in the playoffs. He wants playoff baseball. So is he going to get that consistent playoff looks as a brewer? Does he want to go to Milwaukee? I don't know. 370 out of 399 C.C. Sabathia. That's for the Yankees. That's going to be Jeremy Port. Bran Laugh, 94 out of 299 for the Mets. That's going to go to Rob in Tampa Bay. Skit Alonzo, 15 out of 199. You can give who all of Bueller's money. Walker Bueller's going to be fine if that's where you're implying that. He's going to get a nice deal. He'll be fine. Karen with the Mets, Dodgers actually have a lot of money coming off the books. Oh, Otani? Yeah, Dodgers actually will have a lot of money for Otani. I think he will be just fine. Well, even after the surgery, you get a nice bargain for Walker Bueller. I think the Dodgers will retain him. It's Anthony Rizzo for the Yankees. Going to Jeremy. Louise Gill also for Jeremy. Justin Clement would like to see Otani on the east coast. And Joe Carter, 272 out of 299. Joe Carter not welcome in Philadelphia Joe Carter. Here's Toronto. Martin with the Blue Jays. Greg would love to see his giants get Otani, but he doesn't see him, see the giant trading the farm for him. But is he, is it going to require the farm or is it going to be a lot less than we think? Because his 2023 is arbitration 3. Which I'm sure the angels will pursue. And then he's an unrestricted free agent. I guess if you get assurances that from Otani that hey will avoid arbitration, sign you to an extension and maybe he'll say yeah. I think it'll be one of the fun storylines of the off season. 141 out of 399 Mike Piazza. Padres edition of Mike Piazza. Brian Peebles is a big Padres guy. What are your memories of Mike Piazza as a Padre? I'll go to Martin in the Padres. I always forget about Mike Piazza as a Padre. It was a one year deal, right? There's Mason Thompson. 54 out of 299 Nationals. Brian Peebles remembers very little. Past his prime Piazza. Well it was in 2006. Allegedly there was a little bit of a revival for Piazza according to Wikipedia. He hit 283 with 22 home runs. They won a division title that year. Got his 2000 hit as a Padre. Ooh nice Jesse Winker. He's a Winker. 6 out of 10. Nice patch, nice auto. Red legs. Martin with the reds, nice. Ryan for all of your reasons you never liked him. Yeah it would be like... I don't know what it would be like. Madison Bumgarmer maybe going to the Dodgers or something like that. I don't want to see that. Alright, next box. Yeah I do too. And then I guess he went to the A's as a free agent in late 2006. And then after not being signed to any MLB team for the 2008 season he announced his retirement in May. And there you go. What is he doing these days? Married, has kids. I don't know, doesn't say what he's doing these days. I guess he went to soccer team ownership. He owned an Italian soccer team. Didn't work out. Anyway. There's Larry Walker. 228 out of 299. Was there a... I was kind of half watching the game while I was breaking, but what did Oral Hersheiser say about the Padres? Larry Walker, Rockies, Nestor. Another Jesse Winker autograph from Martin and the Reds. Nice. Austin Riley, nice. 194 out of 299.  Braves locking up their youngsters. It's from Martin and the Braves.  I get it. He loves the organizations. They've been good to him. He loves the Dodgers, but can get a little homery at times. A lot of punch. Oh, essentially, the good thing is that if we the Dodgers lose tonight, it's good for the Brewers and it hurts the Padres. He's a Dodger broadcaster. What do you expect? 243 out of 399. Phillies, Chad O. And Luke Williams. Use the fullest, Luke. 9 out of 25. Gold ink autograph, rookie for the Phillies, Chad O. Yeah, I don't know what Oral's motivation was for that. And a dual relic in auto, David Peralta. I like how the cyan color really pops in that window. 23 out of 25. That's Rob with the diamond backs. Yeah, it does seem a little odd. I don't know. Maybe Oral Hersheiser was trying to play to a play up the... It's a Homer comment. I feel like it's just kind of playing that up. Nobody likes the Dodgers besides their fans. I know a lot of Dodgers fans around the country. There's a lot of them out there. 291 out of 399. Justin Verlander. I mean, really, there's more of... I've lived in San Diego long enough and LA long enough to know that a lot more of Padres fans consider the Dodgers arrival than the other way around. Martin with the Astros. Rogers Hornsby. 41 out of 149. That'll be for... That's Cubs, Rogers Hornsby, by the way. That goes to Anthony. Cubs, Rogers Hornsby. Rogers Hornsby played for the Cubs. I do not remember that. I definitely remember Rogers Hornsby when he was a Cardinal. I guess when I was growing up watching him as a St. Louis Cardinal from 1915 to 1926, but he played with the Cubs from 29 to 32 for whatever that's worth. The manager for the Cardinals for a couple years, too. Was he a player manager? I think he might have been a player manager as well. Anyway, it's Cubs edition. I'll go to Anthony. Another Cubs, Nick Madrigal. 116 out of 199. Do you think Nick Madrigal even moved? Do you think he lives in the same spot as he did when he was a White Sock? That goes to Anthony and the Cubs. And there's Raleigh Fingers. 17 out of 25 A's. That's going to be for Martin and the A's. All right, next box. You know, I have a feeling that in a couple years or so the NL West could look a lot like the AFC West. Because the Diamondbacks have a young crop of players coming up the ranks. That seems to be really good. There's Chris Bryant. Giant's edition to 399. That'll go to Travis A. So all the teams in the NL West could be vying for a playoff spot. Alex Kirilov. 180 out of 299 for the Twins. That's going to go to Travis A. And we've got Ajalexie. 255 out of 299 for the Rangers. Adam with Texas. Sort of a disappointing season for the Rangers. I think they were the team and their fan base were expecting a little bit more success than a 55 and 66 season. 21 and a half games back of the Astros and 10 games back of a wild card spot. Fire their manager a little while ago. 68 out of 175 Larry Walker. Colorado. Nester. Greg's a little shocked how hot his roster is on paper that they don't have a much better record. I mean 68 wins, that would put them that would put them they'd almost be winning the NL Central. 68 wins. They'd be third in the NL East. They'd be second in the AL West. They'd lead the AL Central. Second in the AL East. It's a pretty good record. Just that much hotter. But that expanded wild card system makes it pretty interesting though. The NL Atlanta's eight games ahead in the wild card spot so I think they're going to be they're going to be fine. They still have a chance to make the they still have a chance to win the division too. Philadelphia and San Diego and then one and a half games back are the Brew Crew. The NL and Aeronado to 249. Yeah, so now not that oral hersheys are coming. Yeah, Brian, I agree. Why create bulletin board material? The Dodgers already have a target on their back. Aeronado for Travis M. and the Cardinals. Tyler Gilbert for the Diamondbacks 10 out of 10. Silver, Ink, Autograph or Rob? Yeah. Just as a speaking from a non-Dodger perspective, I really like the Josh Bell edition too. Soto obviously is great. There's Donnie Baseball 61 out of 100 for Jeremy and the Yankees but getting Josh Bell was pretty solid. Definitely an upgrade in that position. All right, three boxes to go. We might as well take a look at the AL wild card race too. Tampa Bay is half game ahead in the wild card race. Toronto and Seattle currently occupy wild card spots and the Orioles two and a half games back of a wild card spot. The Twins three back from a wild card spot. White Talks four back from a wild card spot. And even Boston maybe in the mix six games back. Might be a little bit more of a stretch for the Red Sox but yeah, Giants six and a half games back of a wild card spot. I feel like there's got to be a lot of Giants Padres games in the last month of the season, right? There's got to be in the sort of division weighted schedule era there's a chip off the old block, Trevor Jones that'll be for the Brays that'll be for Martin there's Jared Kalanek for the Mariners to 199. I don't know, there could be a lot of exciting storylines by the end of the season. That extra wild card spot really makes things spicy. Eloy Jimenez 123 out of 29. Oh sorry, the Jared Kalanek goes to the Mariners, Martin and the Mariners and Chris Lombardo has the White Sox, gets the Eloy Jimenez. Here's a team that I thought would be a lot better. It looks great on paper but the White Sox are well, there are four games back of a wild card spot and three back of the division so they can still make a hot finish here but but I thought they'd be leading the division at this point a couple games back though actually a lot closer than I thought. Gotcha Greg saying we only play the Padres once but we do see the Brewers and Philly so they're a direct competition for a wild card spot. Mike, what's going on? How are you? Mike K in the house. Good to see you, there's Ernie Clement Justin's brother maybe 56 out of 399 Cleveland, this is for you Woooo goes to Jeremy Taylor, the Guardians could be Justin's brother we got Amaris Ramirez 299 Tier 1 talent auto for the Cubs Anthony we got Jared Kalanek, different uniform here 156 out of 199, maybe a different autograph too different autograph set looks like same autograph set let's take a look, variation maybe they're both breakout autographs but one must be a variation home jersey, away jersey something like that alright next one, both of those Jared Kalaneks for Martin and the Mariners ah end of C's of Padres Brian, who's our Padres guy says we've been unbelievably inconsistent offensively mostly 10 runs here, won the next, rinse, repeat well, let's see Reds and Phillies are scoreless John Tilly and the Tigers won nothing in Detroit Padres are hosting the Guardians tonight and the Dodgers are hosting the Brewers there's Mickey, Miguel Cabrera 3 out of 25 Martin and the Tigers I think he's got one or two more years left on his deal, I think he said he's going to keep going maybe the resurgence of Albert Pujols gives Miguel Cabrera a little extra juice perhaps I feel like he's chasing one more milestone he's got the 3,000 hits he's got 506 home runs hmm well no, he's got anyway, yeah, I think he's going to play some more I think he hit those milestones Jackson Coar, 132 out of 299 I think that hits milestone is that ever in doubt, maybe not Jackson Coar for Kansas City, that's for Nestor and last but not least is Jose Abreu 18 out of 149 Chris Lombardo White Sox, thanks everybody that was 2022 tops tier 1 baseball, double header a dual case break, random team number 4 we've got another double header in the store if you want to run this back I love the tier 1 a lot of potential for some nice hits some great autographs, really clean looking set great part of should be a great part of anyone's collection, their trading card portfolio should have some tier 1 in there I think some old school guys, new school guys some nice patches, good relics silver ink, gold ink sometimes boxes have bonus relics, that's nice jersey autos that triple autograph that was pretty sweet, Pedro, big poppy Jason Veratec we saw this case, but we'll show you again so that was the first case and here's the second case from the last box going backward to the first box really nice stuff ladies and gentlemen another double header in the store and there's a couple fillers for it too so if you don't want to pay full price you can try maybe chasing a spot in a filler try to win a spot for a fraction of the price there you go ladies and gentlemen great talking baseball with everybody keep breaking baseball with us all season long and through the playoffs we love to talk baseball, rip baseball all that sort of stuff, thanks for watching I'm Joe, I'll see you next time for the next break bye bye


Painting can be a stress reliever or done just as a hobby. For this week's Community Spotlight, Hattie Clotter shows us painting with a twist and how it can improve your work relationships. That's great. With the stroke of a paintbrush, painters can create their very own masterpiece. The Bemidji Eagles Club welcomed an avid group from We Love Messes to showcase their creative talents and bond with one another. Right? Yeah. This is mine. Because it puts us all kind of on the same level and it's just like organizing. Everything looks different to each individual person. So to come and hang with the team and each do a different painting and see that we're all working towards a common goal, but everybody's painting looks just a little bit different. It's kind of fascinating. You don't have to be Pablo Picasso to express your artistry. Amy Benedetti with Gypsy Canvas didn't go to school for art but has always been passionate about it. People see things every day with their eyes and they're just able to put it on a canvas and it's kind of fun. Benedetti walks you step by step and there are no such things as mistakes in acrylic painting because it will all come together in the end. Each portrait is distinctive and requires you to use your imagination to create. Painting can also be therapeutic. We're all stressed in our lives and when you paint it's just really cool to see people just release that and have fun with what they're putting on their canvas. For Rachel Lundy, this is her second painting class and she used a simple blending technique. No experience is required and that may be the beauty of it. The freedom to use a brush and canvas to tell a story, Lundy's family inspired her portrait. I picked the quote, home is where the heart is and we just moved here from Chicago with my family. So even though we moved from our original home up to Boomidji, our home is still together because there's still a whole family as one. These portraits can last a lifetime. Benedetti's motto is free your mind and the brush will follow. That's exactly what these ladies did and at the same time they improved their team building skills. For this week's Community Spotlight in Boomidji, Haiti, Clowder, Lakeland News. If you've enjoyed this segment of Lakeland News, please consider making a tax deductible contribution to Lakeland Public Television.