Ep86: The Power of AI to Optimize Data and Transform the Patient-Physician Partnership w/ RJ Kedziora

[Music] Well, welcome back everyone to the show, the pursuit of health, podcast. I'm your host, Dr. Eric Vekke, and today we're going back into AI, but with someone with years of experience. We're joined today by Richard, RJ Ketziora. He's the co-founder of ASTENDA Solutions, with over 25 years in healthcare technology, RJ has been at the forefront of using AI and data analytics to solve real problems in healthcare delivery. He has been a contributor on multitude of research publications about the clinical applications of AI in evidence-based medical literature. His company specializes in custom software solutions that help healthcare organizations work more efficiently while improving patient experiences. From automated image analysis to clinical decision support systems, his work focuses on making healthcare smarter and more responsive to patient needs. In this discussion, we focused on the history and the evolution of AI in healthcare and the positive side helping us elase some of our fears about the concerns, not saying that they're not real, but helping us truly understand how things can move in a positive direction and not focus on the fears, but on the constructive aspects of AI in healthcare. So sit back for a conversation that will go on, I know, for decades in the future, who was someone who has a very strong background experience and a really good heart in what they're doing from a standa RJ Ketsiwar. Is the foundation that we are building AI on when it comes to healthcare and digital health? The correct foundation, have we built that strong enough yet there? When we do with things like factors of time, provisions, the way that notes are being taken now, focusing on quantity, money, versus quality, all these kind of things. Are we building on that or should we be building it on something else? I think right now, we don't have a choice. We have the data that we have and it's a powerful set of information that's been gathered together over decades now that we're using to inform the large language models of the chat to feed teas of the world. To enable this technology, you need vast amounts of data of information to train the systems to learn. So for better or worse, we do have to go with what we have right now. What I find fascinating about it is it's based on us as humans and so there's good and bad in that because it's using data that we created. So very often I see in healthcare and in other fields this idea that it has to be perfect for us to use. Well, we as humans are not perfect. We're very valuable. I can speak for myself little than all humanity. I know I can make mistakes. So as we're starting to use the large language models of generative AI systems out there, they're not perfect, but think of what they are currently capable of doing and how they can make it better for us today. Yes, I think we're in a good position. There's a lot to be excited about. There's a lot to be cautious about. But yeah, we need to move forward and quickly. And I think some of the things you've talked about is that perhaps AI can help us get back some of that time or those values and that foundation of healthcare that is more human based and interactive and free us up to do that instead of take that away. That's kind of been the push I hear, which I think is a good direction versus just saying, I'm just going to keep this going and maybe make us more efficient and see more patients in the same amount of time because I've got another tool now to just keep crunching and moving forward. You haven't taken that approach. I think the AI system that's we're starting to implement them, allow doctors, healthcare professionals to return to what they wanted to do in medicine is help people. I've lived through the implementation of electronic medical records and that sort of had the opposite effect. How many of your colleagues complain about having to click the 30th, the 40th checkbox to make sure that the billing is correct or that you get credits for everything that you've done. You didn't get into this to click boxes and check things and stare at a computer screen. So, you know, particularly one of the biggest things taking off in AI these days is the idea of ambient listening of the computer, the technology listening to the conversation and taking notes and recording that, which is powerful because now you can turn to that patient and you can interact with them and have a much more empathetic conversation with them and really understand their situation. I worked with a doctor years ago and some diabetes management projects and he made a point of going to the lobby and getting the patient and walking that patient back to the exam room, not just meeting the meeting exam room, which is, you know, usual behavior. And that's understandable. You're seeing lots of patients, you have limited time, it might take a few minutes to actually do that. And I asked a wine, he's like, I learned so much about that individual by that 30-second walk from the waiting room. How did they get up out of the chair? How did they walk? What is their behavior? Using an AI helps us get back to that world. That's a very ponyant image and I agree with that entirely. It's kind of like they don't live in their room. The power base of welcoming into my space versus our space. Now all these dynamics, the unspoken part that only humans really can do and giving some time for that. Because I think you mentioned this, the EMR. Very few physicians are happy with that are and maybe we had some hopes aspirations that it would free up and do some things, but it really crunched that. And I'm concerned with my students and some of my colleagues that what it does is create bad habits. And those bad habits are short of visits, shorter notes that really don't say much. They don't even seem to know how to write a note anymore that really tells us anything about the patient. And the students are then seeing this as a model. And I'm concerned about perpetuating that and then putting AI on top of that saying, "No, no, no, that's not the way I should learn to do this." So I'm concerned about who teaches the AI. This is what a real note that has some humanity in it, whether you walked them from the waiting room or not, tells me about that, will AI be able to get us back to that kind of foundation? I would like to think so that yes, it will. Your opening question that was around, do we really make use of that data we have in your question? It speaks to that. Of like, yes, the EMR has proliferated some bad habits, copying a lot of notes. So is all of the data out of their grade? No, it's not. But there's extensive lab data, medication data that can be very meaningful. And it is a cycle of where it's going to improve over time. This is the worst it's ever going to be. It's just going to get better. But one of the things, too, to remember, that's one of those myths of AI that it's not empathetic, that it's cold, it's harmless. Because it is not intelligent, it's not thinking like you and I are, it's not doing reasoning. But time and time again in studies, it has proven to be empathetic. And when patients and individuals view the messages that are generated out of the system very often, they're viewed more favorably than the ones that cut from their physician. Right. And that's not a knock against the physicians. Because we're human, we're overwhelmed, we're tired. You need to see that 20th patient during the day and you only had seven minutes and now you've got to go home, rush through dinner and record all your notes from from the day. I think let's load answering thousands of emails from patients. The computer, the technology, the AI doesn't get tired. And it can show that empathy, which is a powerful opportunity. So we can start incorporating that back into the visit. Yeah, I think that's important. Some of my patients will tell me that too. If I spend my average time with them and they'll say, look, you know, this was great. You spent more time with me than 90% of the physicians I've been with. You'll listen to me more than 90% of the physicians I've been with. And I feel that's kind of sad. I don't see that as a compliment in some ways. I see it as a comment on the system that we have. And I'm really concerned that AI would look more empathetic with us because we have developed those bad habits. As I say, holding our hand on the door knob as we're speaking, we're already halfway out the door. And I think that's why the comparison when people say, well, at least that gave me some time and didn't seem to be more empathetic. I'm hoping what this does is gets us back to do that. Let's the AI help us administratively, intellectually connect the dots, be a tool, be a adjunct, but get us away from that handle on the door knob and make us look more empathetic or give us a chance to go back to that and not forget that that's what's been missing. It's going to give you that opportunity. One, you know, we were talking about ambient listening, no taking email communication, but elevate that capability. So how much research data comes comes out every day, every year. We can't keep up with the knowledge as you're working with a patient. I'm sure you've got frustrated as a patient as sometimes when you're trying to diagnose a troublesome condition. You know, decades ago, my mother-in-law passed away from Lupus, took years to diagnose that. It still does, because of how it presents. And so AI presents another opportunity here to marry together that data from, you know, the encounter that you were talking through, being aware of all of the information in the medical record system can surface the current research data, can generate questions to ask and try and get to the root causes of what that patient might be experiencing. I think today it's very much focused towards the physician, that type of system. And then you as an individual, as a trained medical professional, can make the decision of asking that question or how do you actually want to frame it. But it helps you. It's AI is artificial intelligence, but I think of it very much as augmented intelligence. How do we help you be better if you're in rural America versus an academic medical center? You're going to have a different experience that access to different resources. And this has been helped a lot, playing. Yeah, and I think as long as we take that approach, I think it could work. As long as we don't have a administrator, say, well, now you can double your volume of patients and you can bump your RVUs. And that's what most people are afraid of. I'm not. I worked on the system where at this point in my career, I'm not worried about that anymore. Nobody's going to tell me what to do anymore. But my young colleagues are, and they see this, and they're concerned. And I want the system to see AI to eyes like yours, because I've been really convinced to say, look, there's a tool that you can go back to some of that and get that back again. If you choose, use this tool wisely, guide it wisely. I am a believer that it could bring us back to a more solid foundation again. But how did we, you know, how did RJ get here into the health space? Yeah, it started way before the health space. So I was fortunate to grow up to the '80s. And my parents got me an IPM PC during, during one of the early, you know, desktop computers out there. I started programming in like seventh grade. I played lots of games, don't get me wrong. But I loved the ability to like make something happen. And so I went to college in the early '90s, got a computer science degree, and had visions of getting a PhD in artificial intelligence. That's sort of people forget that AI has been around for all these years. It's not something that just came about in the late last few years here. But I got a job offer. And it was like, do I take on more debt pursuing that PhD or do I go out in the world in early living? And I did go out in the world. But all of the projects through the '90s that I worked on had some component of AI or data analysis related to it. AI really all comes down to the idea of data. And as we got into early 2000s, I started a current company in 2003, a stenda focused on digital health. So I'm for development data and AI. And it was about giving back. It's like, how can I make a difference in the world? I'm not a medical doctor. I don't play one in TV. But I get the opportunity through my work to work with doctors, PhDs, other companies, helping them develop tools and technologies to improve patient care or better understand how their medical device is used. Clinical decision, support algorithm. So I can make a difference as a company. We can make a bigger difference in helping people take these products to a market, which is fascinating. And some days I work with small companies and some days with big companies. And small companies just go, go, go, go. And the big companies are like, hold on, there's a process. And you try and balance that out between them. But that's the fascinating thing of health care. It's the last domain to really embrace data. Technology has always been-- health care is very much embraced technology from an early stage. You just think about X-rays and MRIs and all of these different things. But data is a different question. We've all looked at the chicken scratch of days of just a year. Can we actually understand what the physician or nurse is writing on paper now? And that was one of the emphasis for the Electronical Medical Record Systems to actually be able to capture the data and make meaningful use of it. Yeah, there was our veterans doing that. Yeah. We were fortunate to work with some of the Department of Defense Systems here, the VA systems in those early years when it would be just like, here's our data. Good luck. Whereas now it's a little more structured, little more formalized, or definitely newer methods. And that's still there is definitely an element of good luck in the world of health care data. Well, it sounds like this on degree with all of us who are clinicians. And I consider people working in this space as passionately if you have finding a calling, sort of speak, that your clinician's in your own right. I mean, we're not physicians, but we're all looking at the clinical aspects of what we do and how can help others. That to me is the definition of a clinician. So it makes sense. And with that experience that you've had, we throw these terms around, I've had, you know, looked them up myself as I was really starting again to this space, but could you define for the audience what is digital health? What is that in your terms? How long's it been around? You said it's the '90s. And kind of how has that evolved over the past few decades in the time frame that you talked about. I'm still thinking Max Headroom. I can't get out of my head if you remember that show. Anyway, once looked at up, look Max Headroom up, that was just to me the beginning of that sense of AI and that image. I think that burned negatively into some of our minds. But what is digital health? Why is that a thing and how does it different than AI or is it the same thing and how is it evolved over the past few decades? Max Headroom brings back some memories. Yeah. Digital health at a very high level. Yeah. The application of technology to improve your health and all of us, I think of it. It covers a lot of ground. Today I look at it as the intersection of wearable technology. So it could be your Apple Watch or Ring. There's many competitors on the market. Samsung has a watch that are on the market, the Woop Health Band. There's a lot of these tools and technologies that are tracking information about you as an individual or your individual physiology. That's that idea of digital health. And probably before that is the idea of apps. We all also have apps on our phones. And the mobile phones really brought those into the forefront. If you go back even prior to that, there was applications, the electronic medical records. They had aspects of clinical decisions to support algorithms. Now how can we look at the labs, the medications, the patient might be on to better understand their current condition than is this medication working? So digital health has changed and morphed over those years from the early stages of just electronic. We got some early data. Let's do some decision support rules to the mobile app, to now wearables and AI. And that evolution has taken it from very a clinician focused inside four walls to today where it's much more personalized. How do I as an individual make a difference in my health? So much of my health happens outside of the four walls of a doctor's office or a hospital. And that's what this is empowering. And so digital health is that journey from that doctor, I think to the patient as they want to take care of themselves. It's interesting. There's this idea of digital therapeutics that came around. I think the term was formalized. Probably in the late 20 teams kind of thing. But if you look at the marketplace, there's probably 350,000 digital health applications that you go to the IOS app store. There's hundreds of thousands of these applications. Do they work? Yes. No. There's this idea of a digital therapeutic. And I think if it is a difference between you go to the pharmacy and there's like vitamins and minerals, you buy over the counter. That's the idea of a digital health application. There's some evidence they work. They might actually work. But there are then prescribed medications that there is extensive research, FDA review, approval of these four diagnosis treatment of a particular disease or condition. That's what a digital therapeutic is. It's that elevated level of research that has been done around it. Then FDA cleared. I thought five, six years ago this was sort of the future. It's taking its time into developing and really taking off and a lot of the challenge in the idea of digital therapeutics is reimbursement. So where you and I might pay a few dollars for a digital health app, if anything, a lot of the day was a digital therapeutic would be prescribed by a physician and then paid for by an insurance company, which would allow companies to make it much better, I have a much bigger. You're a revenue base in terms of application, because it does take a lot of effort and time to get something through FDA or beyond approval. Here in the US, we haven't tied the approval to the reimbursement rates. And there's some recent legislation changes and billing codes that are trying to make an impact, but it's early days still from that. But yeah, the future looks bright for the idea of wearables and data and personalized health. And I think it's a really nice summary, 'cause it does show how it took us out from the institutions, the hospitals, the clinics, and into the place where people live. And you've also used the idea that, you know, we all caught on to this during the pandemic, telehealth exploded, but you made comments that digital health and digital therapies really are different from telehealth because of accessibility. - They are. We have here in the US, if not globally, we have an obesity challenge. Significant percentage of the populations are already in the beats. GLP ones are making a difference, but if you go off them, one, if you can afford them to begin with, and then two, they're not a long-term solution, they're not changing behavior, they're temporary solutions. We have a mental health crisis. There's not enough people, medical professionals, to provide the care. My wife was for a long time a pediatric nurse manager in the field, a greater field of the area. As her patients needed assistance of mental professionals, it's fairly easy to find them in Philadelphia. But you go two hours west into rural Pennsylvania and it gets a lot harder to find those professionals. There just aren't enough out there. And that's where these digital health applications can level that playing field, can make these things more accessible for people that aren't living in a major metropolitan area, or might not even have the funds or insurance to be able to go to a provider. You can, in some cases, these applications are free, and others, more reasonable cost. And smart phones, proliferate. It's sad to see people on the streets, Philadelphia, many major cities have these challenges. But interestingly, a lot of those people do have smart phones. And be able to access these tools and technologies. It's not universal. There are challenges, but it's getting better and better. And now with the added end of the end, these solutions are just getting better, more accessible. Think of a person that's having got for a bit of diagnosis of cancer. And they leave the office. Personally, I would forget everything that was set. And OK, now I need to go home and do this research. So using the AI, I can actually go and be like, can you explain this to me like I'm five years old? Like what does this mean to me? You absolutely need to confirm everything it says with your physician. But it's an opportunity to explore and better understand the challenges you're facing. Mental health is a big one. More and more companies are trying to push into this area using the AI. I would not recommend using chat GPT or the similar ones, Gemini, Rocks, out there for your mental health. They're not designed for it. It may demonstrate some capability as you're using it, but they're not meant for it. There are other systems out there that have been designed, that have been cleared to be used for mental health. And those are the ones that if you do need the assistance, talk to your physician, and I'm sure they can help you guide you in a good direction. But we are seeing them interestingly. People using chat GPT for mental health needs to explore their daily life as a diary, as somebody that's talked to. Interestingly, if you remember the movie, "Hero from like 2015 or so," that it is a boyfriend, a girlfriend, and significant other that you can talk to. It's their own challenges, but it's an interesting area to take advantage. Would you say then one of the litmus tests that I want to speak for you of something that would be a good digital health or digital treatment should be that it should be accessible, equitable, and empowering? Should those be like the elements of what is a good digital health tool? Yes, absolutely, because that's the beauty of it. They're scalable. They can help it much wider segment of the population if you are a startup, or if you're an R&D group in an organization, cast a wide net when you're running those early clinical trials and trying to get that user feedback and incorporate patients and persons that are challenged by whatever you're trying to address. Into that conversation, I do design and develop systems with doctors, with PhDs, with nurses, but you always need that patient voice in the room, is that the person you're trying to help. What are their challenges? And it's great to be able to talk one on one with individuals, but that also has this challenge. There's just so much information available on the internet that topped here universities and health systems reporting out there to be able to learn and educate about that, which is an awesome experience. I get the sense that, and maybe you'll see it from the developer side or the clinician side, but do you get the sense that patients demand or their response to this is positive? Can you use an example, for example, of a totally someone who benefited and kind of how this is going out in the patient space or the public? - Yeah, you're starting to see a lot of anecdotal reports, but particularly I use the example of Lupus a few minutes ago. It's difficult as challenging to diagnose because it prevents in different ways. And it's not one consistent set of symptoms. And so as you may have a particular health system or a challenge kind of thing, throw it in a charity meeting and see what it comes back to explore the possibilities. It's a second opinion, but yes, still continue talking to your physician, train medical professionals about what it says. Just don't blindly take its advice because it is not a doctor. I know open AI is sort of dancing around that line and saying, yes, go out there and use it for healthcare, but it's not designed for healthcare. Yeah, I'm fortunate, I don't have diabetes. I get a number of new sensors around the market to look at blood glucose information for people without diabetes. You should not use those sensors if you have diabetes. That's an important caveat they're designed for people without diabetes. But I can look at my blood glucose and see what's going on. And from a clinical perspective, I know after I need a meal, I should go for a 10, 15 minute walk. It's gonna make a difference in how my body responds to that food I've eaten. And so I was able to run that experiment very easily. You know, I'm wearing one of these sensors, eat a particular meal that is just going sit in the couch. The next evening eat the same meal, the left servers, and then go for a 10, 15 minute walk. And you can see the difference in your blood glucose. That 10, 15, I didn't run, I didn't do anything crazy. Just go for a walk after and it makes a noticeable difference. It's a powerful teaching moment for individuals, for myself. And I think, you know, it's interesting, one of our guests is upcoming is somebody you probably very interested in. He's designing a whole entire app to change the behavior of certain, literally in the blood community, some of the health behaviors he's concerned about, and he's designed something for people to kind of like weight watcher style, keep track of several elements of this thing. On a daily basis and create this way they can track what they're doing and see the impact and being control of it in their hands. And it's really fascinating to see what data is going to come out of that. He's very curious to see if it really not only shows us aspects of this that we were not recording, we weren't aware of because that we weren't looking for a whole bunch of structural reasons in that community, but also will the community feel empowered now by that? Would that fall under digital health or digital treatment? Yeah, health treatment, it's there's an interesting boundary there. I think an interesting aspect of where health in America is not globally asked to go is that idea of personal accountability. Right now, I guess I can get out of the doctor and that's sort of how the whole health system is geared. Unfortunately, slowly changing, we've definitely seen it slowly move towards violence and the wearables and the idea of remote monitoring and telehealth is pushing it in that direction of more personal accountability. But this technology, the AI, is what's enabling that to happen. It's speaking to the patient at the level that they want to engage with it. I have a sibling that's at MIT studying quantum physics. I don't understand the first thing about quantum physics and she published a paper, like again, no idea what it was and chat to BT and explained to me like a five year old, what the heck this is and it did. And I was like, okay, now I get it. You can do the same thing in health care. It's like, okay, here's what I'm saying. Here's this data, help me better understand this. What does this mean for me? And if you don't understand it, okay, explain it to me like I'm fine. And once you get that, okay, explain it to me like I'm at a high school college or a doctor to get the most out of that data. It's that opportunity to engage when the individual is ready to engage at the level they're comfortable. It's a powerful opportunity. And I see that, you know, what a lot of what I do is teaching And I see that as a teaching tool for patients, really to make them have the to really learn about their own, so they can come in prepared as more of an equal in that conversation, the partner and the healthcare dialogue or their journey instead of, you know, tell me what I have to do and what's wrong, doc. But, you know, look, let me bring some stuff in that I didn't realize was relevant before. I was having a conversation with a patient the other day about this and preparing for this discussion. And literally, do you see that ambient language kind of listener model come in and kind of ever sort of interrupt in the middle of the conversation and go, "Hey, guys, I just thought something. Can I add something to this conversation? I mean, is it going to get there?" It's not there yet, but I think it will be. I recently bought a device that monitors eege, it's an eege, you know, whole monitoring. It's a monitor with my brainwaves. If I take this information now and bring it to my physician, love my physician, great individual, but if I bring in my eege, for the last month, what is he going to do with it? Particularly in like the 10 minutes that, you know, I may have with them to bring, you know, my routine clinical visit. Little on lactate, my HRD data, heart rate variability data. Hey doc, what do you think of all this? That's really challenging in that moment. Did they, you know, did they have the education the knowledge they might? Do they have the time to engage with all the content? Probably not. But the AI, the technologies does have that opportunity to look at this, to understand that one, I can do it at home, but two, now I can formulate just like a doctor would use AI to look at a summary of the chart, pre-visit, to better understand going into that woman. I, as an individual, a patient can do the same thing. Okay, here's what I want to talk to my physician about today, and what are some questions that I need to ask them? What are some of the things I need to bring with me? It's to be better prepared for that in Canada. So yeah, a powerful opportunity, multiple ways, multiple angles, but yeah, as more and more wearables and technologies and people want to just measure information, and dropping it on the provider's doorstep definitely makes it challenging the AI can assist in that. It's going to be in the near future. It is going to be irresponsible to not use AI as part of that clinical encounter. There are definitely challenges. This is not a drop in the bucket. It's not happening next week, but next year, the year after, it's changing everything about how we interact with the world, including the medical profession. It doesn't get tired. It knows the research. Yeah, and I think for everyone, patients to understand, because of all the time constraints, the structures, the economics, all those things, we don't always are able to grab the latest information that's out there and give it to our patients on the spot or even perhaps ever, because we may not be aware of it. We do what we we fall back, physicians fall back more than they want to on their patterns and how they were trained and not always able to keep up with all this wonderful stuff that's out there. Then the biases that come in and well, their thoughts and stuff like that. It's very interesting to see what would happen. When AI gives another, at least, angle on this at the physician and the patient that that triumvirate can look at and say, "Okay, I didn't realize that that was available. What do you want to do, Mrs. Jones?" You can tell I'm very pro AI. I think that's obvious, but you do have to put out those cautionary notes. I'm like, "Okay, mental health, there's a role here, but don't use the shadow to be teased." It's not the time for that. Likewise, as physicians start using this more and more, and just people in general, it's going to be interesting because I think an under-appreciated challenge right now is its impact on critical thinking skills. It's like, "Okay, yes, we can all float the ambient listening, access to research. The idea of a second opinion or servicing questions during encounter." Yes, I think at some point it's going to be irresponsible to not use it. What does that mean in terms of our critical thinking capabilities? Do we just stop thinking about it? "Oh, they said this. Okay, here you go. In particular, I see it a lot in the news media, the legal profession where they're just like submit a case report to dock it to the court. It's like, wait a minute, there's like three made-up case citations here because they didn't check it. Rule number one with AI today is double check what it says because odds are they might have made up something. You do have to check it. I think that under-appreciated risk right now is the idea of critical thinking. What does that mean? For all of you, added, let alone healthcare." A lot of us were concerned with a lot of these kind of things, whether it was, as you mentioned, books or computers that we would stop critical thinking. There has been an element where, because of perhaps texting and not thinking and everything flooding us on Instagram, people have to relearn a lot of people working on that, how to understand what sources are, what they mean, how to think about it. Bring that into the room. I would basically say that family looked at. That's interesting that it brought that up. I'll make some phone calls on your behalf. Why don't we look into this together? Let's not act on this yet. Let's look a little further to make sure this is legit because if that's true, that could be great, but let's give her time, frame, not 10 months from now but in a week. Let's go look at this little closer before we jump. Does that sound reasonable? It does. I like thinking of this from a historical perspective too, because where we have this challenge today with AI and the idea of critical thinking, the same thing happened when books became more readily available with the printing press with calculators. Reading is going to destroy our ability to remember information. Calculators are going to destroy our ability to do math. We still teach math today. We still all do math. Do we use calculators? Yes. Does AI destroy our ability to think? No. Do we have to adapt to it? Yes. That'll take some time. Is there something that you see that you've run into, whether it be hospitals or at the policy level that are trying to make this? What are some of the things that are slowing down us going towards some of the benefits that AI could have? What are the things we should be looking for that we should all be advocating to help solve? I think there's two large categories. One, the FDA and the idea of them being the sole group organization, the validating systems that make sure that they are safe and effective. They have a very challenging job to do. They can't handle what they have now. How do we is industry? There are various different groups. Chai is one of them that comes to mind that are trying to make an impact in this area. How can we test these systems and engender trust in them, understanding what their limitations are? Okay. Company XYZ put out a system. It is intended for use in this population. It's using this model. It has these bi-instincts. So that use a physician or where what they are can make the informed decision. This makes sense for my population, for this particular individual. So the FDA is definitely one of those challenges. Likewise, legislation in terms of getting this out there and understanding it very closely tied to it. But also interoperability. The ability of these health systems to exchange data. Bingo. I can go anywhere in the world and access the money in my bag of account. Yes, finances and money is simpler than my healthcare data. But it's 2025. I should be able to go anywhere and get my data. Even have an uncle that's not doing so great here in the fed up area. They'll go to different healthcare systems for whatever reason. They're not really sharing data as much as they should be. That's a challenge today. I know the current administration, I think last month, put out some new ideas and that open it up and create this patient ecosystem of data. The laws are on the books. They're very interesting. They put this proclamation out there like, "Oh, we're going to make this so much better." The laws are on the books. HIPAA, whichever one sort of is historically used as the reason to not share information, whereas designing two-share information. Correct. You want to protect the personal health information of the individual and the new legislation does still talk about that of protecting the information. But yeah, it's sort of had the opposite impact. But we need to set the ecosystem, the technology exists. I think this is the key and a lot of what I do and what has helped me in my career over the years is technology is important. The technology exists to exchange health information, but there's so much about the people and the processes in place to be able to do that exchange of data. As we engage with the health system and are helping a particular company integrate with the electronic medical record system, the thing that usually takes the longest is just getting the access to rights to permissions, signing off on business associate agreements, and have rights to that data. It's not the technology that takes time. It's the people and the processes. I have an analogy. Again, it came to mind. I work in the field of sudden cardiac death prevention in youth. We believe that the common that could solve this is the EKG can really pick up things. It's a very powerful tool and perhaps analyzed by some AI analysis even. Then there's the history part and you put the two together and you're going to get close to 100% as your filter, your screen to pick up people who might be at risk. One state is approved the questionnaire that standardized. So everybody has to ask the same question in New York. And Florida has mandated the EKG, but none of them have done both. And it makes no sense. And this is what I mean. You're talking about the human part of this, the logic, the common sense, that if you ask the patients, they would say, do both please. But somebody else has decided not to. And it's that kind of analogics, exponentially throughout the whole system that creates the inability for AI to do what it could do. Is that true? That's absolutely the case. And the data's in there. It's in the health systems. It's stored electronically. How do we exchange them with each? And there's lots of challenges. Yes, the technology exists, but there's still challenges with doing that and understanding the data. But the AI has exist to start making an impact of that use of that data. It's all about the patient. At the end of the day, it's about the patient in improving health and wellness. Yeah. And ultimately, it's this idea as we finish up with this concept, of building it again around the people it was meant to serve. And I would go say, all of us are population and our health and really getting engaged in that. This kind of conversation that we're having for people to listen to. Okay, doesn't sound as scary as I thought. It is something that actually I could be part of and should be part of. And then I don't have to be afraid that somebody else is going to impose it on me or anything, whatever a physician or that. And I think that's very much of the work that you've done. And I know in a stand-up, you know, you try to take these things from the ground level ideas and manifest them towards the, so they benefit the person who it's supposed to be. And that's a really, you know, lotty goal there. But, you know, what's your advice to patients that we've kind of think about this and how to manage it from AI revolution in healthcare? What should the patient be doing? I think first and foremost, you as an individual have friends to your data. A lot of people don't realize that, but you do. You go to your health system, you doctor, and they need to be able to give you your data in an electronic way to make use of it. So that's step one. Like, start having that conversation. It's going to cause a ground swell. It's, you know, that ground roots effort. More and more people get out there and start asking for their data to make use of it. Then we'll start seeing more meaningful impact in the world. I think it's that personal accountability, too, comes into play. Ask for it. And that's an opportunity there. Tip is, you're right to do that, not to prevent that, which is how it's been misused to some degree. And to explain what extend it does with that, is it for, is it small and big companies? Yeah. We help other companies, whether it's a startup organization, where, typically, it's an R&D group within a larger organization. Or ideas help flush out the technology, actually design it. We're very fortunate. Our several employees, myself, companies have put our names on patents because we've been so much part of the creation process. Yeah. I feel like, yeah, it makes sense. We don't own anything. It's always our customer who owns the rights to the software, the data analytics, the platforms that we help create. They own everything, but we're there to support you and make that good. It means going to the FDA and getting review and approval. We can assist in that process. I have some PhDs on staff that can help a lot of what we do then goes to a clinical trial. Because it's one thing to sit around and room with a bunch of people and come up with an idea and develop a system. You have to make sure it works. So then things go very often good at clinical trial. And then get publications out there. One of my developers and such. They're interestingly about a year ago. It's not like a couple of years out of school, I've got his name on a period you've learned or article. I don't think you've probably realized what that meant, but that's a big deal. But he was part of that analysis effort and figuring out what to create and analyze the data to make sure it's good. So much to talk about this. And we're just nacing. We're beginning this journey together. But I think the point you've made for all of us is don't be afraid. Let's make this together. This journey. In conversations in the doctor's office with patients about it now, they're bringing it up. One patient literally, father said, look, I have an aortic aneurysm. They said, they don't have a gene for it. How do I know if my daughter is going to be affected? And I said, well, we're going to keep that out there. But AI is listening to us. And if we keep talking maybe somewhere in Brazil, your gene is found. But we don't know it yet. They're going to make that link. And then they're going to come back at us and say, here, actually. There is the gene. And that's going to be our future and our world bringing the different elements of AI together. And they kind of smile and they said, you think we could be in that world someday and not be so afraid? That's it. Yeah. And that's, I said, yeah, because I've heard RJ talk about it that way. So I did. And I really think that that's the energy bring to everyone. Please listen to a lot of RJ's work and at a stand-up. And he lists a lot of things there. But the last question, what does the pursuit of health mean to you, RJ, in this work? What does the pursuing health mean with what technology digital health AI? I have a goal of living to 100 plus with a good quality of life. And that's a key part of that with a good quality of life. And it's interesting for the longest time. I said, I'm going to live to 100. And then someone was like, why only 100? And they were absolutely right. 100 plus with a good quality of life. I don't want to retire anytime soon. I'm nowhere near retirement age. But it's like, I'm constantly, what's that new challenge? What's that new opportunity to help people to make a difference? And the longer I can do that, the better off life will be for everybody. Hmm. Absolutely. And your energy seems to be channeled in that direction. But thank you so much for this. We will keep an eye on the book and your work out there. And if we have fears about AI and what we can do, we know we should just step in and be part of it and definitely reach out to you and kind ask clinically, what should we do about this? And I think that's a lot of questions. We should hopefully just keep our eyes on this all together through people who have been in the field like you have for the right reason. So thank you very much for sharing this conversation. It's going to be very important and one that's going to keep going on and on and on. I hope. So thank you again for joining us here. Thank you. Have a great time. Well, once again, having a guest with so much experience, expertise and also someone who I consider in many ways once again to be a clinician, someone who is using their skill set, their experience and their caring in the service of others in healthcare. RJ Kitsur has definitely done this for many years and you can see the importance of having his opinion, his eye on this as so many others in the field. We hear so many negative things about AI and concerns. Instead of being afraid and fearful, he helps us be empowered about where this could go and where it is going. And it's good to know that people like RJ are in this space. I look forward to your feelings and comments. Really, what does this make you sense about AI? You can be reached at Eric Fettke, MD, that's ERIC FETHKE.com and this is a space which you can leave some of your comments, but also give us some feedback on whatever format you listen to our podcast. Again, it's very important as we continue to do this now in our fifth year. We really are excited to be entering that time with you and it is growing because of the interests that you are all having as well as the issues that we are facing today that we should all be part of. So until next time, I'm Dr. Eric Fettke, your host here at the Pseudof Health Podcast, wishing you well in all your pursuits.