Jordan and Kristi discuss the emotional and operational pressures facing healthcare workers, and how AtlantiCare is addressing them. By leveraging technology–especially AI and ambient note-writing–providers can spend more time with their patients.
Jordan Ruch of AtlantiCare describes the emotional and operational pressures facing healthcare workers, and how AtlantiCare is working to address them. By leveraging technology–especially AI and ambient note-writing–providers can spend more time with their patients. Jordan also explores the impact of AI in healthcare as a whole, from streamlining workflows to population insights.
Jordan is the CIO of AtlantiCare, an award-winning integrated healthcare system.
---------
00:22- In the News
07:22 - Jordan’s journey
15:36 - How AI reduces burnout
23:45 - Building buy-in
28:43 - Rapid fire
---------
Find Kristi on LinkedIn
More about Accruent
Subscribe on Apple Podcasts
[00:00:00] Kristi: Hello and welcome to Beyond Built. I'm Kristi Flores, and today we'll be talking with Jordan Ruch. He's the CIO of Atlanticare, where he's leading the company's incredible efforts to build a more connected, secure, and scalable health data infrastructure. It's great to have you here today, Jordan.
[00:00:20] Jordan: Thanks, Kristi, I'm happy to be here.
[00:00:22] Kristi: We like to start every episode with a segment we call in the news. Today we're looking at something impacting every health system. Right now, the state of healthcare workforce, a new survey found that 55% of America's healthcare workers are considering leaving their jobs, and the biggest reasons, burnout.
[00:00:44] Emotional fatigue. Inadequate compensation or benefits. And limited opportunities for education and growth. And eight in 10 say they feel taken for granted. Now, I've spent quite a bit of time in hospitals recently visiting my dad, and during those hours especially, I was kind of prepping for this time with you, Jordan.
[00:01:04] I really kind of observed the, the teams behind supporting my dad. And I saw the strain of the healthcare teams, you know, the mental, the physical, the emotional load they carry every day. It made those numbers feel really real and reinforced just how inces in sit. It made me, it made those numbers feel very real and reinforce just how essential their work is. Jordan, what are you seeing firsthand when it comes to burnout and what's driving it?
[00:01:35] Jordan: Yeah, I think particularly when, um, we have an experience with a family member, it becomes real. So first of all, I hope your dad's okay. It can be stressful and a, a really hard time for the, for the family members involved as well. Um, but that's really, like you say, that's when it becomes really important that we're doing everything we can to make care, you know, efficient and safe.
[00:01:59] And at Atlanticare based on the headline. We're really seeing what mirrors the national story. So there is a significant sustained staffing pressure, documentation burden shows up in our data as one of the top burnout drivers. So a lot of my work has been focused on addressing that documentation burden.
[00:02:25] If you look at the, the way we operate today. Um, it's not really sustainable. So we have workforce shortages. We have a lot of regulatory pressures. We have a somewhat upside down financial environment in healthcare. So there's many reasons why we need to change. Um, and in my work in, in technology and healthcare, another big reason is the work we're forced to ask our providers to do in the EHR is in some ways, and you probably saw this with your dad, coming between the providers and the patients. You'll see the nurse, or you'll see the doctor focusing on the documentation or on the computer rather than focusing on the patients.
[00:03:12] And that from a healthcare IT perspective, I can tell you a hundred percent, that's not our intention, but unfortunately that's the reality. Um. And if you look at the studies, providers spend twice as much time on electronic documentation and clerical tasks compared to providing direct patient care. And the same is really true for nursing.
[00:03:35] Nurses devote more than half their time, um, on a shift to EHR data entry and retrieval. And 30% of their time looking for supplies and equipment. So that only leaves 20%, uh, at the bedside. So our goal at Atlanticare, and my goal is to completely disrupt that paradigm and simplify the interactions with the EHR.
[00:03:59]
[00:03:59] Jordan: And that's exactly what we're trying to do.
[00:04:02] Kristi: I can say Jordan, that's, uh, it's an inspiring and I'm sure very motivating mission for you and the team because it, it will make a, a clear impact on so many. I've seen that interaction with the data and, and there's so many providers that help patients, right? We often think the data is a connecting force to make sure that patient gets a well-rounded experience, but sometimes it can mean that they dedicate more time to that data gathering in engagement than maybe that care piece. So those numbers are, are really staggering and um, but I'm sure motivates you every day.
[00:04:38] Jordan: It is, it certainly does. I mean, we're,
[00:04:40] we basically laid out all of the time spent in the EHR, um, and the amount of time spent for each task in the EHR, you know, how much time are our providers spending in order entry, how much time charting? And based on those timings we created focus areas for areas in the system where providers are spending the most time. And we have a clear strategy to address each of them.
[00:05:08] Kristi: One of the, the topics that was highlighted in the article was just the pressure to upskill with the, the rise of ai. How do you see that impacting nurses and practitioners?
[00:05:19] Jordan: Yeah, I think for the most part we try to frame AI, at least for the time being as augmentation. Um. Rather than replacement. But for our providers, we have hundreds of providers across 26 specialties that are using ambient ai as an example for note generation. So we were one of the first organizations to deploy ambient note writing in our ambulatory settings.
[00:05:47] And in the last year and a half, we've generated over a hundred thousand notes. Using the Oracle clinical AI agent, or CAA, and our results of that have been really amazing. So we measure two main metrics. One is the amount of time spent in the EEHR overall. So how much time from logging into logging out, adjusted per patient does a provider spend in the, in the EHR, and then how much time do they spend in documentation? Amount of time total per patient spent in documentation. And what we've seen after implementing that technology is time in the EMR went down by 28% overall, and time and documentation went down 40%. So.
[00:06:35] Kristi: Wow.
[00:06:36] Jordan: Really significant numbers and you know, the impact of that efficiency is amazing. Uh, and it's why we're working hard on expanding that.
[00:06:45] Later this year, we go live with that same technology in our emergency departments and following our emergency departments. We're focused on nursing and and inpatient care. So I mean, the overall goal is what you would expect it to be. It's to reduce the amount of time spent in the EHR and for our providers to be able to spend more time with our patients.
[00:07:08] Kristi: Well, there's clearly a a lot of opportunity to, to help and transform. I you're well on your way, but let's dig into the conversation and, and what I'd love to start with, Jordan, is a little bit about your journey. So how did you become the CIO of Atlanticare?
[00:07:25] Jordan: I've spent over 25 years in healthcare it, um, across community hospitals and integrated systems and academic medical centers primarily working at the intersection of strategy and large scale transformation. I started as a programmer, um, and worked my way up to project manager.
[00:07:49] From there, I started leading some of those major large scale transformation projects and really found a passion in doing that. And essentially I've been doing that same work, with a different title, for my entire career. So project management is really important to IT. as you probably know. But a lot of my experience is really in project management and project execution.
[00:08:15] Kristi: It's incredible how important that skill is in, in technology and just across the business, right? There's so many large scale projects, um, and then I know that you've been leading a multi-year initiative and so to, to keep track of that and really build out a plan is I'm sure incredibly important part of your success.
[00:08:34] Jordan: Yeah, I think the, I, I go back to those project management skills often, and you know, the CIO role has definitely been different than a project manager role. It's not the same thing, but a lot of what we. Are trying to do and trying to accomplish as, as an organization are really broken down into work streams and projects so that that experience does come in handy.
[00:09:01] Kristi: I, I agree. Well, let's talk a little bit about your responsibilities kind of day-to-day. What DOES your day-to-day look like today, Jordan?
[00:09:10] Jordan: I lead technology, data in our IT operations. So everything from cybersecurity to our core infrastructure, our EHR strategy, um, our EHR training programs. Uh, a lot of it is partnering with operations and our clinical leaders. To ensure that our technology supports care delivery, um, and obviously financial performance practically from a IT perspective, that means guiding our Powered by Oracle program, which is a a multi-year project we'll, we'll talk a little bit more about, but a lot of my, a lot of my time is around making sure that we have the resources that we need to make that program successful. So governance, adoption policies, and strategic oversight for all, all things technology.
[00:09:53] Kristi: And I know one of the, uh, the major initiatives, Jordan, that you've been leading at Atlanticare is, is really this response to some of the challenges we mentioned, but it's your vision 2030. Can you walk us through what that initiative entails?
[00:10:10] Jordan: I'd be happy to. Vision 2030 is our strategic plan, and it is designed to redefine healthcare delivery in our region and and beyond. So most of it is, is done around innovation, workforce empowerment, and community centered care. But the program itself sits on four pillars. So serving the community, workplace excellence, accelerating transformation, and growing market share.
[00:10:38] And Vision 2030 really is what drew me to Atlanticare. The people are are why I'll stay. But Vision 2030 really did draw me in to Atlanticare. It's unique in the healthcare space because it has a defined target for what we're trying to accomplish with a direct impact to the community that we serve.
[00:11:00] So like taking some examples from the serving community pillar. The targets are to reduce unsheltered homelessness by 20% and expand life expectancy in the region by five years. So there aren't a lot of healthcare organizations that make those directly part of everyone's targets and directly part of all of our goals.
[00:11:25] We all know what the end, uh, end stage and what our goals are. So each of those four pillars has goals similar to, you know, what I mentioned for serving community, and it just helps us be aligned to our goals and objectives in a way that I think sets Atlanticare apart.
[00:11:47] Kristi: It Sounds like it. I, I think what, uh, when you, When you look at teams and people and obviously already being part of the healthcare industry, I think that purpose is pretty clear. I love to hear that Atlanticare is even raising the bar on homelessness and life expectancy goals. Um, and I, I can imagine that's pretty inspiring to work towards as an employee there.
[00:12:06] Jordan: It is absolutely, and I mean, you know, in IT, A lot of my team members could work in really any industry. Um, I find that people that decide to work in healthcare usually are spoken to by, by that type of mission and, and how important the work is. So, um, you know, I, I fall into that category as well. Uh, I'm really passionate about what we're doing.
[00:12:26] Kristi: I can tell. All right. For this big kind of 2030 vision, tell us a little bit about how you operationalize such a big multi-year transformation. What frameworks or practices helped you break it down into these manageable stages?
[00:12:45] Jordan: Yeah, it's a lot. So we, we structured our work into seven waves over roughly 27 months. And those waves are sequenced across clinical revenue cycle. ERP and HCM programs as well as infrastructure. So we essentially took all of what we were trying to accomplish, all the systems we were replacing, all the workflows, we were improving and aligned them and grouped them together to have the least impact on the organization. So if you think about training, right, we're training nearly every member of the workforce, um, 6,700 people or so. And because of that, we wanted to organize the program in a way where you don't go for two hours of training for one wave and then the next wave come back for four hours of training and the next wave come back for six hours of training.
[00:13:47] 'Cause that would really have a big impact on the workforce. So we've really designed the work and structured the activations into groupings that allow us to focus on a particular area in a, in a particular go live. So our clinical go lives are focused in a wave, and our enterprise resource planning go lives are focused in a wave. That has helped us really build enterprise governance, uh, a across the program.
[00:14:18] Kristi: I can imagine. You've gotta be sensitive to pulling the teams out from their day-to-day work, um, and that patient care. So I'm sure it's a, it's a balance, but I like the approach of focused efforts and the transformation over time.
[00:14:34] Jordan: Yeah, the last thing we wanna do is, you know, pull people off a nursing unit and not have a clearly defined plan for why they need to go to training and what, what they're there to. Uh, learn about and, and have them understand how it really impacts their work. So, you know, just as we talked about in the beginning, a lot of it is centered around making their work easier and their, their time in the system more efficient.
[00:15:02] We start the training with just describing that, saying, here's your workflow today. Here's how we're making improvements. We've, you know, we've listened to the feedback, we've looked at how much time you spend in this part of the system, and here's the improvements systematically that we're making.
[00:15:18] Kristi: I know when we work with our customers, but I also know a lot of people in the healthcare industry, and I can imagine it's gotta be gratifying to hear we heard you and this is what we're doing and this is the impact we're gonna make. All getting to that greater goal of just providing better and, and faster care to your patients.
[00:15:35] Jordan: Yep.
[00:15:35] Kristi: All right. I know AI is making a lot of headlines. Um, I know it's an important topic for you as well. Where do you see that emerging technology making an impact so far, and how are you using it with patient engagement and reducing burnout?
[00:15:53] Jordan: We're applying AI in three lanes. So first, as I mentioned, is with documentation. So ambient note writing is around, you know, it's pretty prevalent in the marketplace now. But that's really only the tip of the iceberg, you know, documentation. Is kind of well suited to, to use AI to sort of generate a draft note and have a provider review it and make sure everything's correct.
[00:16:21] But there's a whole lot more that we're planning on. And workflow assistance is kind of the second area. So if you think about AI running in the background while the work is happening, making sure that. Everything is following protocol and everything is following guideline. Um, based care, the tool can suggest chart insights.
[00:16:49] The tools can suggest orders, the tools can suggest the best workflow to follow, uh, you know, given a patient and how they're presenting. So a lot of the really powerful innovation coming really soon. Is around really that workflow assistance layer of ai.
[00:17:11] Kristi: AI.
[00:17:12] Jordan: And I think the last area is around population insights. So documentation, workflow assistance, and population insights. A lot of the early use cases of AI while have, have they been focused in, in documentation, a lot of the things we're working on now are, are related to population insights. So trying to harvest the data from registries and identify care gaps in our community and use the technology to help close those care gaps.
[00:17:46] So if we, using a practical example, if we have someone who's scheduled for an appointment, um, but they don't have reliable transportation, transportation, the right time to find that out is not when they don't show up to the appointment. Right. So if we, if we're able to look at that public information and look into those registries, identify those barriers.
[00:18:10] We would be able to set up transportation prior to that appointment if that's something that is going to, you know, impact someone's ability to, to make an appointment on time. So each of the programs that we are deploying within Hi, within AI are governed and measured.
[00:18:29] One of the things that's unique in healthcare is we're very risk averse. So we don't just take a new product and deploy it. We, it goes through a pretty rigorous change management process and testing process internally before we deploy it. So a lot of our evolving use of the technology has been building out that governance and building out those testing programs and scoring rubrics that we use as an organization to determine where we want to invest.
[00:19:00] And, you know, once we determine where we wanna invest, we need to make sure it's safe before it's implemented. When you're, you know, visiting a healthcare institution and, you know, it may, it may not feel like when you visit a bank or when you shop on Amazon, but there's a, there's a lot of reasons for that. One of those is that we take our patient safety incredibly seriously, and it takes us a little bit longer to get those, those latest and greatest technology innovations on the unit. Um, you know, because of that, that those extra steps that go into validating and, and testing,
[00:19:37] Kristi: I can see where you have to balance that governance. Um, but it, it also seems like you're doing an incredible job with deploying innovation, um, and balancing what you need to, to ensure that patient is really the center of what you're doing. So it's inspiring Jordan.
[00:19:54] Jordan: I appreciate that.
[00:19:57] Kristi: Now you've, um, with this big project, there's always a lot of lessons learned. If you could start over again, how would you approach it differently or what would you do differently?
[00:20:09] Jordan: I think meaningful progress showed up pretty early within our first two waves. The ambulatory note writing example that I gave with the 40% reduction in, in documentation time, that was in the first wave. So I think scaling that paradigm into the whole 27 month program is something that we could have done with a little bit more intention in Waves one and two.
[00:20:39] Now we've, we've planned to do that already in Waves three through seven, but. If I could do it all over again, I would even for the early waves, predefine all of those metrics and predefine what good looks like and how we're approaching and measuring that way before activation. So we have a, um, we have a daily activation safety huddle whenever we're going live with one of the waves and we go through all the metrics.
[00:21:10] But in our first couple waves, as we were planning for those meetings, you know, in the weeks before go live, we really had to spend a lot of time coming up with all of those metrics, making sure that we knew where those, uh, sources of truth were and we could automate 'em into a dashboard. I think if I could do it all over again, I would've started that work, you know, many months before the actual golis, so that by the time you go live.
[00:21:38] You're essentially just referencing the dashboards and materials that you've already built out and agreed upon with the operational leaders. So over index on your activation metrics so that during the time of activation you can just kind of focus on the, the needs of the change instead of building out the monitoring, if that makes sense.
[00:22:02] Kristi: It does. Wow. That's great advice. And it sounds like you're already kind of adapting your process to improve it in these upcoming waves.
[00:22:12] Jordan: I think that's a big one. If you go around to leaders who are part of major changes in an organization, whether they're leaders of that change or they are impacted by that change. There's one thing that's always in the top five of things that they would do better next time. And it's communication.
[00:22:30] Kristi: Mm-hmm.
[00:22:31] Jordan: So we can always do a better job communicating. So I, I've never experienced a transformation project where people are like, oh, okay, that's enough. Like, I get the timeline. I know what's changing. I've never seen an organization kind of reach that point where you just communicate to the point where everyone really knows and understands why we're going through all of this effort. But it's a super important area that, you know, everyone, everyone could do a better job.
[00:22:58] Kristi: And it's for someone who leads communication both internal and external for our company, I can, uh, I can appreciate that too. It's, it's hard sometimes you get so close to it that you forget how important some of the pieces are to share and then sometimes it's just, it's hard to know exactly how to get the communication channels and timing right. It's always an evolving and, and an area for good input.
[00:23:22] Well, we've talked a lot about the technical pieces, the different waves, and the activation, which I think is so thoughtful in how you're deploying it. But the other piece of this, Jordan, is really the cultural piece. I know when we drive major initiatives at Accruent or Fortive, and other businesses. It's not easy.
[00:23:39] And then you've got this backdrop of having a lot of your teams a bit strained and burned out. So how did you kind of build the buy-in, um, from the get go and kind of early in the process?
[00:23:52] Jordan: Yeah, culture is really important and, and buy-in is really important. I've found that making the voice of the customer heard and part of the solution and have the solutions focused on the voice of the customer is really. One of the things that, that helps a lot. So listen to the feedback in, in, in healthcare's case, go to the units, talk to the nurses.
[00:24:19] Talk to the managers, understand what their pain points are, understand what's not working well, understand what you can do to make their lives easier, and then organize your program around it. Organize your initiatives around the voice of the customer. Um. By doing that, not only do you get buy-in because they see that you're listening, they see that you're identifying the pain points, not in a boardroom, but you're identifying the pain points on the nursing unit and where the work happens, it's you're automatically, um, bought in.
[00:24:56] So from a project execution standpoint, my advice would be to get that buy-in, listen to the customer. Don't just take the data on its face value, go round, get in the department and listen to the feedback directly from the, the workers to inform the priorities.
[00:25:15] Kristi: we call it going to gemba, which is go where the real work happens and, and get that feedback. And I think not only does it build that true understanding of the pain points and problems to solve, but it builds so much empathy for the teams working on it, right, to get out of the board rooms, get out of the office, and just, uh, deeply understand, um, how you can improve things.
[00:25:35] Jordan: If I round for an hour, I'll learn more than in a, in a week of meetings, so.
[00:25:42] Kristi: So true.
[00:25:43] Jordan: Yeah.
[00:25:44] Kristi: It's amazing. I love that you've got your teams out there and connected to what's happening.
[00:25:49] Jordan: Okay.
[00:25:49] Kristi: We've talked about kind of VOC and I know you've got a couple customers. You've got your nurses and clinicians and physicians and the operating teams, but you also patients, how does this change in transformation that you're building?
[00:26:03] How does it look like from the patient's perspective and what will they see that's different? Jordan
[00:26:09] Jordan: Our patients expect their interactions with healthcare to be like their interactions with. Banks or with retail, you know, very convenient at your fingertips. And we have a lot of work to do in healthcare. What it looks like from a patient perspective is a seamless ability to schedule appointments and to see your results and communicate with your care team. But not only that, I think we need to help you navigate the next steps. Even, even people that are relatively sophisticated in healthcare and healthcare delivery when, you know, faced with a loved one in, in the hospital or with a health issue, can very easily get overwhelmed by the amount of information and the, the lack of a perceived coordination of next step.
[00:27:04] So I think what it looks like from a patient perspective is that. We will, as the provider, help you navigate those next steps. Make sure that there aren't questions that go unanswered and there, there is not uncertainty into, um, what the next steps are and how they should be executed. So many patients express frustration with appointment scheduling and, and making appointments quickly. Which is another big area that this transformation will help with because if we make the whole system more efficient, if we integrate our EHR and ERP platforms and in doing so, have a infrastructure that is more efficient, all of those incremental changes, making documentation more efficient.
[00:27:55] Making order entry more efficient, making the time to hire someone more efficient. All of those incremental improvements add up to a more efficient system overall. And what that's gonna look like to patients is when you try to get a neurology appointment, it's not gonna be 10 months from now, it's gonna be a week from now.
[00:28:16] Kristi: Amazing. I think that's an incredible kind of area to focus on and you know, as you think about the burden of being sick and you know, having to work through that, just the extra burden of trying to figure out those next steps can really be overwhelming. So I love that you're thinking about the efficiency, the convenience, like how to streamline this.
[00:28:36] So, you know, it takes some of the burden of this experience off the patients. All right, Jordan, let's shift into our rapid fire segment. These are quick questions, quick answers. Are you ready?
[00:28:51] Jordan: I am ready.
[00:28:52] Kristi: Okay. What's your favorite innovation and why?
[00:28:57] Jordan: Crispr. Crispr if you, if you haven't heard about it, is a tool that is derived from bacteria, but it's essentially something that scientists have engineered. As a gene editing system. So it's like molecular scissors. I could listen to podcasts about CRISPR all day, every day. I find it absolutely fascinating. I think it's tied to the future of medicine. I think it's one of the most fascinating inventions in, in my lifetime. I also love that it was derived from nature and, you know, now it's being used to, to cure genetic disorders and, and many other things.
[00:29:36] Kristi: Awesome. Well, I haven't heard of it, but I will look it up. I think it's safe to say you're, you're in the right industry, Jordan.
[00:29:44] Jordan: I think so.
[00:29:45] Kristi: What's in one innovation you wish would go away?
[00:29:49] Jordan: The time change for Standard Time and Daylight Savings Time, it drives me crazy. It's that or the imperial system of measurement, but I think daylight saving time is probably the the one that I think should go away. That is not an innovation.
[00:30:04] Kristi: I am with you on both of those. Every time it rolls around twice a year, I question.
[00:30:12] Jordan: Yeah. Why?
[00:30:13] Kristi: Well, what's the number one thing organizations should be doing that they're not?
[00:30:19] Jordan: I think investing more in communications. These large initiatives are really well thought out, and the team has gone into a lot of planning and talking to operations and learning, learning what needs to change and why it needs to change. But I think early on, investing more in communications is, is one thing that almost every organization should do.
[00:30:41] Kristi: Especially overseeing communications, it's incredible the impact it can make when you've got clear communication and consistent with all of your key stakeholders. So, I'm with you there, Jordan.
[00:30:52] Jordan: Yeah.
[00:30:53] Kristi: Well, what's one thing we wouldn't know about you by just looking at your LinkedIn profile?
[00:30:58] Jordan: I have an amazing wife and three perfect kids. , I think my LinkedIn job history goes back to a certain point, but my first job was a paper route, um, followed by a busboy at a rib house. So if there's any listeners who are looking to break into the busboy market, a rib house is probably not the right place. Uh, it's very messy. Um, so I think my last piece of advice would be to, if you're gonna be a busboy, find something that is cleaner.
[00:31:30] Kristi: Well, I also had a paper route, Jordan and I worked my way through hospitality, so as a dishwasher and a, I did busing and hostess. So it sounds like we've got some additional topics that we could connect on.
[00:31:43] Jordan: That's right. We could clear a table like nobody.
[00:31:46] Kristi: Absolutely. I oftentimes think that the work that I did then, and I was a server at one point as well, was sometimes the hardest work that I did in, in all of my kind of work experience, the, the stress and pressure of some of those those roles gave me a lot of, uh, appreciation for what I get to do every day here.
[00:32:05] Jordan: It's really hard work. It, it really is. I was a server also and I think it's underappreciated how, how hard that work is. 'cause it's very much about culture and it's very much about connecting with people and anticipating their needs. That is not easy work.
[00:32:23] Kristi: I know. I, I feel like it gave me a lot of good skills for my whole life. So for those project managers out there, for anyone in the hospitality industry, we appreciate you and, and it can build a lot of great skills.
[00:32:35] Jordan: A hundred percent.
[00:32:36] Kristi: As we wrap up here, I just, I wanna thank you tremendously.
[00:32:40] I love leaning into different industries and different leaders and work that they're doing. There's an incredible amount of, um, work that you're doing and, you know, I mentioned. My recent experience with my dad and just seeing how complex it can be to be a patient, but just how grateful I am to the, the teams that provide care to patients out there and.
[00:33:06] The teams behind the scenes, including you and your team that have so much passion to improve the patient experience and to improve life expectancy and homelessness in your community. I, I know that, um, I'm incredibly grateful. I'm sure our listeners today have been inspired by what you're doing and taking technology just to improve, um, different parts of the healthcare system.
[00:33:30] So thank you for everything that you're doing. Thank you for joining us today, and let's stay in touch.
[00:33:36] Jordan: Sounds good. Thanks so much.
[00:33:38] Kristi: You bet.