Ritu: Hi everyone. Welcome to the Big Unlock Podcast. My name is Ritu Oberoi. I’m the managing partner here at Damo Consulting and co-host of the Big Unlock Podcast. A very warm welcome to all our listeners to Season Seven. Today we are very thrilled to have with us Andrew Porter. He serves as a key leader at Wayne General Hospital, where he’s driving forward initiatives focused on operational excellence, patient-centered care, and sustainable growth for a community-based health system. Andrew has been instrumental in advancing strategic priorities that strengthen access, improve outcomes, and enhance workforce resilience. Looking forward to a very in-depth and engaging conversation. Welcome, Andrew. Thank you.

Andrew: Thank you for having me.

Ritu: Would you like to add anything to that introduction, or shall we get started?

Andrew: I’m on y’all’s time. I’d just like to say it’s a privilege and an honor to get to chat with you all today, and for your listeners to get to know us here at Wayne General Hospital a little better. I’m excited about what we get to talk about today.

Ritu: We usually like to start with an origin story — asking our guests how they got into healthcare, and particularly into this intersection of healthcare, administration, and tech. If you can tell us a little about your background and how you came to this role, we’d love to hear that.

Andrew: Of course. It’s a winding path of how I ended up here, so I’ll give y’all the short elevator version. I actually started working here at Wayne General when I was still in high school — my first job was here as an ER tech. I did that through high school and into college. I initially went the clinical route in my education. I’m a PA by trade and practiced emergency medicine — I continue to do that to an extent even now. I did some teaching and education along the way, earned my doctorate in medical sciences with a focus on healthcare administration, and then the opportunity came along to return to my hometown to practice emergency medicine. I was able to bring that education and administrative leadership skill set with me, and the rest is history. My board of trustees put faith in me to be the CEO here at the hospital, and here we are today.

Ritu: Thank you for sharing that. You have this professional triad of clinical experience, administrative experience, and a strong commitment to academics. Which part is your personal favorite?

Andrew: I had an accounting professor once who described it beautifully using the analogy of a three-legged stool. Professionally, I have a clinical component, an academic component, and an administrative component — and for me personally, each one of those legs makes the other stronger. Continuing to work on the front lines in healthcare gives me a much better sense of the needs of the community and the pulse of my staff. There are so many times that being in the emergency department, interacting with staff at that level, allows me to catch something that could turn into a significant cultural or logistical issue before it becomes a larger problem. The adjunct teaching keeps me sharp on what the research is showing and where best practices are headed in five to ten years. Having that academic hat on makes me a better administrator. I know the practical challenges, but I also bring the academic perspective to the table. Together, all of that helps me drive our system using best practices, while keeping today’s financial challenges in mind, maintaining a strong strategic plan, and staying nimble — because the healthcare world today is essentially completely different from what it was a year ago.

Ritu: I like that analogy — it really helps visualize exactly what you’re saying, that you have to keep all three things in balance and each one makes the others stronger. Thank you for sharing that. Andrew, I wanted to hear more about Wayne General, because you operate in this challenging community hospital environment. What specific operational or financial levers have had the biggest impact in maintaining both quality and sustainability? We’ve been hearing from other health system C-suite leaders that it’s always a resource crunch and you’re constantly having to do more with less. Beyond AI, what’s top of mind and how do you face those challenges?

Andrew: A little more detail about our organization: we are the sole community hospital for our area, serving a population in excess of 50,000 people given our rural geography and how far our reach extends. We’re county-owned — which may be unique to some listeners — meaning we are actually a political subdivision of Wayne County. Even though we don’t receive any taxpayer funding, we have been financially sustainable for many, many years. At the end of the day, the reality is that we really try to embrace the idea that we’re the people’s hospital. We are owned by the people of Wayne County. We have the nonprofit designation, and I describe it to people this way: 365 days a year, our goal is high-quality patient care. We’re not a for-profit organization answering to shareholders — we answer to the people. But to meet those needs, you have to have money, so at the end of the day it’s still a business. It’s a unique business model, but you still have to get cash in the door. For small hospitals like ours, there’s been so much transition since COVID. We went through an EHR transition during that period, which is always a very big undertaking for a smaller health system. Navigating how that intertwines with the revenue cycle has been a big challenge. For a small community hospital leader, the name of the game right now is being conservative with finances, valuing our independence, and keeping the financial side right up there with patient care — because to offer a high level of patient care, we have to be in a good financial situation.

Ritu: Absolutely. Taking that further — where do you see the most practical near-term opportunities for AI and automation? How far along are you on that journey? We hear a lot about ambient documentation, voice agents, and digital front door technologies, since clinicians are still cautious about AI for diagnostics and clinical decision-making. Where is Wayne General with those technologies?

Andrew: About a year ago, I very distinctly remember having conversations of the nature of: we don’t want to get left behind. So we took a hard look at where our pain points were — but we weren’t going to go out and try to fix problems with AI that didn’t exist. We said: let’s look at the issues we’re actually having and see if AI might be part of the solution. A good example is the ambient documentation and AI-assisted documentation space — that was one of the first areas we went down that path, and it’s been very positive for us. We’ve had it active in a substantial way for about two months now, so it’s still a little early to have a complete picture of the financial implications around improved documentation. I will tell you, the timeliness of documentation has absolutely improved. But for me, the biggest factor has been provider satisfaction. Even some of our later-career providers — who are sometimes resistant to new technology — have tremendously embraced the use of AI for documentation assistance. I would argue that has added longevity to certain providers, and while I don’t yet have a way to quantify this, I believe it’s also improving the patient experience. Instead of the provider feeling rushed to get back to the keyboard and complete documentation, medicine now becomes more what it was intended to be — an intimate, conversational interaction between the patient and their physician or provider focused on the patient’s needs that day.

Andrew: So AI-assisted documentation is what comes to mind first as something we’ve implemented and are seeing really positive early results from.

Ritu: I was having a conversation a few months ago with one of our C-suite guests, and they mentioned that one important benefit of ambient documentation is that doctors are vocalizing more — and that’s great for patients because they love to hear more. Because the system is capturing everything in the background, providers are actually saying things out loud that they might otherwise have just thought, and that really helps.

Andrew: That’s a great point, and putting my clinician hat on — it’s so easy to see a patient and say something like, “I think you have pneumonia, we’re going to run a couple of tests and get a chest X-ray,” and then move on. With ambient documentation, you’re naturally encouraged to be more detailed in that conversation because you know it’s going to be populated into the note. The conversation becomes: “Here’s my concern about what we may be dealing with. I’m going to order X, Y, and Z tests. Here’s what I’m looking for. This is the initial treatment plan.” And the way I have my AI-assisted documentation tool set up, every time I go into the room it timestamps it — which is an additional encouragement to make sure that every 30 minutes, every hour, or whatever is appropriate, I’m reassessing the patient and providing updates to them. So while it may not have been the original intent, it also increases accountability — making sure you’re having those detailed, appropriate conversations with the patient and their family and checking in on them regularly. Personally, those have been some of the real positives for me.

Ritu: Going along those same lines, you mentioned some of those physicians were from an older generation and more resistant to technology. Let’s talk about change fatigue and the barriers to digital transformation. How did you break down those barriers and get everyone on board?

Andrew: For us, one of our more experienced clinicians had actually heard that this technology was becoming available. We let him do a little research, look at different vendors, and participate in the selection process — and then we let him be the first user for a couple of months. He really became our champion. The sell was easy after that because when this particular person — someone who hates technology and wishes we could still do everything on paper — starts telling his colleagues, “This is as close to charting on paper as we’re probably ever going to come again. It’s decreased my workload. I’m not staying hours after my shift or coming in on my days off” — that carries a lot of weight. So for other organizations, finding that champion early on and giving them real buy-in to the project was really key for us.

Ritu: Basically, have the change driver be someone who has a personal stake in the change and can genuinely influence others around them.

Andrew: And realizing that the right agent of change may not be the first person who comes to mind. It doesn’t need to be the newest graduate clinician. It probably needs to be someone more senior, because your senior medical staff will have those long-standing relationships with colleagues, and the trust they carry operates on a different level.

Ritu: Looking ahead, what do you believe will differentiate the community hospitals that thrive from the ones that struggle to survive? Resources are always going to be scarce. What are the key factors that will keep Wayne General — and community hospitals in general — on the path to sustainability?

Andrew: We have a saying in medicine: you often don’t want to be the first to do something, and you don’t want to be the last. For us, that meant while we may not be the very first to try something, we do want to stay on the cutting edge. If we see a product or solution that has worked for others and makes sense for us, we’re going to consider going down that path. The AI vendor market has opened up so many opportunities for relationships and solutions. One thing we’ve been very fortunate with is our relationship with Eko Health, who make the Eko stethoscope. We’ve partnered with them on various research projects using their Sensora AI tool for heart murmur detection, and that’s been a great relationship. That gets into the space of how we use AI to increase access to care — bringing a level of technology and sophistication to a population that historically would have been years behind what could be offered in a large metropolitan area. We’re passionate about bringing that cutting edge of care when it makes financial sense and when we have the capabilities to support it. We’re proud of that relationship and look forward to the research that will come out of that partnership.

Ritu: As you’ve explored AI on your own — and you mentioned you’re always doing research — what do you feel are some of your personal favorite areas you’d like to know more about? And where do you think the biggest change in healthcare is headed in the next year or so? Crystal ball?

Andrew: Putting my administrator hat on — something is going to have to change in the revenue cycle space: coding, billing. There has to be some relief at some point for our hospitals, because the current model is enormously complex. I’ll be very honest — I by no means fully understand the revenue cycle, let alone a layperson trying to make sense of it. And just the timing alone — how long it takes from when a patient is seen to when the facility receives payment — you’re often looking at 30 to 60 days at minimum. I really hope that health systems and payers can come together and find solutions with AI in coding, billing, and that whole arena. That would be huge for everyone. So while it may not be a crystal ball prediction with a definitive endpoint, that’s Andrew’s hope for what will happen.

Ritu: That’s a tough one because it involves so many players and everything is so fragmented. To build something that can communicate across all of them — that’s the barrier we’ve been hearing about from everyone. Everything is so siloed. Unless there are protocols that allow components to talk to each other — maybe with agents from each side communicating and speeding up the process — maybe that’s the future.

Andrew: That would be incredible.

Ritu: Maybe that is the future. It’s been a great conversation. Thank you so much for joining us on the Big Unlock Podcast. It’s been a pleasure having you as our guest. Thank you so much, Andrew.

Andrew: Thank you. It’s been an honor.

Ritu: Hi everyone. A very warm welcome to all our listeners to the Big Unlock Podcast, Season Seven. Today we are very happy to have with us Dr. Bharat Sutariya, who leads Oracle Health’s clinical AI strategy. My name is Ritu, and I am the managing partner at Damo Consulting and co-host of the Big Unlock Podcast along with Rohit. Today Rohit is not here, so I’ll be in conversation with Dr. Sutariya. Dr. Sutariya is a senior healthcare leader at Oracle Health, shaping the next generation of digital platforms and how data and AI are transforming care delivery at scale. At Oracle Health, Dr. Sutariya is focused on enabling a more connected, intelligent healthcare ecosystem, and his work sits at the intersection of platform modernization, interoperability, and the emerging role of AI in re-imagining healthcare delivery. With that, I’ll hand it over to Dr. Sutariya. Welcome to the podcast. Thank you for being our guest today.

Bharat: It’s a pleasure, and thank you for the warm welcome. I look forward to our conversation.

Ritu: Thank you so much. If you’d like to add anything beyond the introduction, we’d love to hear.

Bharat: Sure. I’ve been fortunate to be at the intersection of healthcare and technology for over 25 years. I’m an emergency physician by training and practiced for 26 years — initially in Detroit, where I trained at the Detroit Medical Center and led much of the digital transformation there. Then I moved to Cerner for 17 years, did a short stint with Deloitte, and joined Seema’s executive leadership team at Oracle Health a couple of years ago. I’ve had the opportunity to witness healthcare’s journey from paper-based practice, through read-only systems, to heavy EHR documentation, and now — what I would say is the most exciting era — where we are on the verge of delivering the vision we’ve always had: allowing clinicians to practice better, patients to generate better outcomes, and the healthcare ecosystem to reach a more sustainable path. I am more bullish and excited than ever.

Ritu: Thank you, Dr. Sutariya. We always love to start with an origin story, and doctors’ origin stories are really fascinating. We always ask: what led you to tech? Being a doctor is such a full-time job — how do you manage to combine your interest in technology and medicine? Tell us a little more about that.

Bharat: What led me to tech is a relentless focus and impatience to improve healthcare — all the way back to residency, when I simply would not tolerate the green-screen CRT machines delivering lab reports, the printers not working, things just not functioning. I’ve always had very little patience for things that don’t work, and I believe patients and providers deserve better. I’ve always looked at technology as the most scalable answer to that problem. That’s what got me into technology from the early days of residency, then leading tech transformation at Detroit Medical Center, and onward from there.

Ritu: Tell us a little more about your time at Cerner, because you had a front-row seat to both the promises and limitations of large-scale EHR systems. They were supposed to make things better, but interoperability — which was always promised — was never fully there. What lessons do you bring to Oracle Health, and how do you think you can improve on that?

Bharat: I had the pleasure of working with Neal Patterson, Cerner’s founder, for nearly 15 of my 17 years there. He always stated that healthcare is too important to stay the same — meaning it needed to evolve, and faster. That was always the focus at Cerner. Cerner started as a lab company, grew into an inpatient EHR, and then into an enterprise EHR over the years. What most people don’t appreciate is this: if we had taken the way people practiced on paper 20 to 25 years ago and simply made it electronic, EHRs would actually be quite efficient. But what we don’t often talk about is 20 to 25 years of regulatory compliance, new evidence in medicine, and the overburdening of data — all of these movements stacked on top of EHRs, combined with EHRs becoming increasingly administrative. That is what led to the burden people talk about. It’s not the EHR alone. Take E&M coding, for example — it’s quite burdensome, and many times clinicians perceive that burden as coming from the EHR, when in reality it’s the E&M coding system, the medico-legal documentation requirements, or some other external task. All of it gets compounded into an EHR issue. That’s why I’m excited about the future, because I think we have much better answers going forward.

Ritu: Thank you for that insightful answer. Oracle Health is now representing a shift toward a more unified, platform-centric model. What fundamentally changes when healthcare moves from fragmented systems to a single data and workflow layer? And what do you think will get harder before it gets easier?

Bharat: There has been quite rapid adoption of AI and modern technology over the last couple of years in particular, and we made a different bet than most of the industry. The industry largely took a bolt-on approach — keep the legacy foundational EHR and bolt AI on top of it. That’s the industry norm. At Oracle, we took a different approach: AI is too important and transformative a tool to treat that way. In addition, we had the opportunity — because of Oracle’s full stack — to leverage everything from the foundational database and Oracle Cloud OCI infrastructure, through the AI layer, to the modern application layer. So we decided to reconstruct not just the EHR, but the entire healthcare tech ecosystem across provider, payer, and life sciences, to achieve a connected ecosystem vision. For us, AI is embedded into the EHR — or you could say the EHR is embedded inside the AI. There is no bolt-on. While that requires significant resources to build what the market has had for three or four decades of legacy EHR, we’re taking the bigger bet to transform the whole thing. That does require investment, but it gives us a significant advantage to innovate without legacy constraints. The industry’s bolt-on approach is having early success, as is ours, because we are still scratching the surface of what AI can bring to medicine. Where you will see differentiation going forward: we’ve already deployed AI agents on top of our legacy Millennium EHR, but we’ve just released a brand new Oracle Health ambulatory primary care EHR that is AI-embedded, cloud-first, and truly native. It looks and behaves radically different — with far fewer menus and clicks, because AI is always present as your companion with a human in the loop. The biggest movement for us is transitioning from a system of record — which is what most EHRs have been — to a true system of orchestration and workflow. That is the transformation we are leading toward.

Ritu: I totally agree. The bolt-on approach can only lead to incremental change. If you’re looking for transformational change, you have to build with AI first in mind. That’s something we’ve talked about in our voice agent webinars — companies expect more from AI but don’t see that transformation because they’re using it as a bolt-on solution, which only delivers that incremental 10 to 20% productivity gain. AI can let you do things fundamentally differently. So what are your thoughts on invisible AI versus clinician-facing tools? We’re hearing a lot about ambient and how doctors feel free to just talk directly to the patient without the documentation burden in between. Where is the real value creation happening today?

Bharat: The biggest near-term value is in reducing what I would call high-volume friction — the tasks that typically cause clinician burnout: documentation, chart review, ordering, and all the follow-up tasks. What we’ve now demonstrated with Oracle Health’s clinical AI agents, each built for these specific purposes, is that when you deploy them with access to the full chart context, you do significantly reduce that burden. We’ve seen it in time saved, clinician satisfaction, a reduction in pajama time, and even better patient interactions — because clinicians now have more face-to-face time rather than hiding behind a keyboard. And for us, outcomes aren’t only about process measures like time saved. We’re also tracking truly clinical and financial outcomes: did patient care improve? Was the provider able to see more patients efficiently? Was the patient happier with the interaction? Those things that really matter are where we’re now transitioning. Even in these early days, focusing on high-volume friction, AI has already been tremendously helpful.

Ritu: Would you say ambient has been one of the most successful use cases of AI so far? And where do you see it going further?

Bharat: Absolutely. Ambient as an assistive technology in healthcare delivery is probably the single best technology I’ve seen in my 25-plus-year career in terms of rapid adoption — and not just rapid adoption by one or two physician groups, but across the board. Every physician group you give access to embraces it, and they use it with a high degree of sustained adoption. That’s because it adds real value. It captures documentation fairly accurately and keeps the human in the loop — the draft is presented to the clinician, who validates it before committing it to the chart. But while many startups in the industry consider that the endpoint, at Oracle Health we view it as the beginning and the foundation. For example, our ambient agent, while creating the note draft and listening to the conversation between provider and patient, is constantly monitoring that conversation. Did the physician say something about orders? “Mrs. Jones, I’m going to order X, Y, Z lab tests for you. I’m going to renew your prescription.” The agent extracts the clinician’s intent and queues up orders, prescription refills, and follow-up tasks — including referrals and prior authorizations. If Mrs. Jones needs a knee replacement, the agent understands in that moment who the payer is, whether prior authorization is required based on eligibility and coverage criteria, and if so, it retrieves the authorization criteria, pulls all the relevant information from the chart, fills it automatically, and presents it to the clinician for review. If more work is needed, it goes to the queue. The ambient conversation is directly connected to the automation of a significant downstream task, done more accurately. That’s our journey — millions of agents spinning off in the background based on that ambient conversation, continuing the care journey forward.

Ritu: So you’re saying it’s going to move beyond just being a note-taker to actually taking the next step — listening and acting on what’s discussed?

Bharat: It’s already there. It’s already happening.

Ritu: Most health system CIOs and CMIOs we speak with are now genuinely overwhelmed by the pace of innovation — something new seems to emerge every single day. How should they think about sequencing platform modernization, AI adoption, and operational transformation without creating decision fatigue within their organizations?

Bharat: Let me offer a few key points. First, start with the end in mind. Be clear about the outcomes you’re trying to achieve, and recruit the right solution for that. Second, don’t look at AI as a collection of a hundred individual vendors. Look for a partner who can help you establish a platform and services framework capable of solving hundreds of problems over many years. Those are the two axes I think are most important. What I see in the marketplace — even within our customer base and beyond — is that tens, sometimes hundreds, of startups and AI companies are approaching health system leadership from every direction with different point solutions. Each of them genuinely has something to offer and can solve a specific problem. But the challenge is: how do you bolt ten or twenty different AI startups into your ecosystem? Every model requires data, which means you’re extracting and sending data to various external environments and then managing the cybersecurity, data privacy, and compliance implications of each one. AI has already proven itself enough that every health system should accept it is part of their journey. So you might as well embrace it and start forming a trusted partner framework — identifying which partner or set of partners can help you establish an AI infrastructure within your organization, connected to both your clinical and enterprise systems, to achieve clinical, operational, and financial improvement. Think from a partnership perspective. Then think with purpose — what are the highest-impact starting points? What has already been proven in the marketplace? Adopt that, but don’t wait for the next wave to perfectly emerge. Some degree of experimentation and piloting is important in this space, and in AI the pilot cycle is measured in days and weeks, not months or years, because that’s how efficiently you can deploy an AI agent and get to outcomes.

Ritu: Do you see a tension there? In most industries, the mantra is innovate fast and fail fast. But in healthcare it’s almost the opposite — you have to play it safe and not take chances. How do you reconcile those two?

Bharat: You raise an important point. In virtually any other industry, a parts-per-million error rate might be acceptable. In healthcare, it is not. So you absolutely must have guardrails — and that’s exactly why you need a trusted partner and platform with appropriate governance built in. While you may be doing early adoption of innovation, you need the right guardrails, the right governance, and the right metrics to ensure absolute patient safety. You also need to be able to test high-risk scenarios in a non-production environment. But here’s the opportunity: there is so much improvement to be made on the operational side of healthcare that you can safely deploy AI to solve a significant number of operational problems and gain efficiency before you move toward higher-stakes clinical applications. That gives everyone a meaningful runway to get started in a big way.

Ritu: Where we’re seeing most implementations right now is in the digital front door — before the patient even reaches the clinical setting. But do you think the guardrails and safety factors you described will keep humans in the loop longer? AI is progressing so rapidly — we’re already hearing about AGI, and we saw with Project Strawberry that some organizations are pausing releases to give the industry time to assess vulnerabilities. Do you think the human-in-the-loop model can hold, or will AI leapfrog that?

Bharat: That’s where careful governance and guardrails are essential, because no one can afford to simply wait. The question is how do you keep moving forward while doing so safely. I think establishing clear frameworks helps — for example, if something is purely administrative and doesn’t directly impact patient care or patient safety, it could potentially be automated. That’s the invisible AI piece. You just need the right metrics to confirm it’s achieving the intended outcome. You can do that very safely on the operational end. But the moment you inch toward anything that assists — not even makes — clinical decisions, then transparency becomes paramount. The AI must show why it’s drawing a particular conclusion, and it should be assistive and presenting facts with full transparency to the clinician rather than acting autonomously. For example, in our new EHR, every time a physician logs in, an AI-driven summary is immediately generated — one that knows the patient, knows the reason for the visit, knows the physician, and has access to the entire longitudinal record. It constructs a concise summary a clinician can consume in one to two minutes, versus clicking through fifteen tabs over ten minutes on a complex patient. But critically, we’ve embedded metadata tags throughout that summary. Anywhere there is critical information, the clinician can hover over it and see exactly where it came from — and with one click, the source document loads with the relevant text highlighted. That’s AI driving clinical efficiency in a way that’s also transparent and safe. We’re fortunate to have the full Oracle Health AI infrastructure stack combined with three to four decades of clinical system development experience. We understand the clinical significance of every data element and its metadata. A lab value isn’t just a lab value — we understand what abnormal, high, and low mean, the standard deviations, and the source context, because we’ve been living with that data on the Cerner side for decades. Combined with Oracle’s capabilities, that puts us in a stronger position to deploy AI safely.

Ritu: You made very good points — retrieval-augmented generation with traceability back to the source, and the importance of context because you have so much surrounding information to interpret each value accurately. That was a very insightful answer. Time has flown by and we’re almost at the end of the podcast. What are your predictions for the next year? If we had this conversation again in a year, what would we be talking about?

Bharat: I think we’ll be talking about the next chapter — moving away from documentation and truly into orchestration. That’s the big shift. And AI shouldn’t be creating work; AI needs to do the work. I think we’ll see more successful examples of that. At the end of the day, all of this only matters if our clinicians and patients feel they’ve gotten time back, are doing fewer repetitive tasks, and feel there’s a safer path toward better healthcare. That’s the north star. Health systems should feel they can operate a better care delivery model. Providers should feel they’re delivering safer, better care while remaining personally satisfied — not overburdened. And patients should feel that the health system they’re visiting, powered by AI, is delivering a genuinely better experience. That’s the north star we’re working toward.

Ritu: Thank you so much, Dr. Sutariya. It’s been an absolute pleasure having you on the podcast. Thank you for making the time to speak with us today.

Bharat: It’s my pleasure. Thank you for a great conversation.

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Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hi everyone. A very warm welcome to all our listeners to Season Seven of the Big Unlock Podcast. My name is Ritu, and I’m your co-host along with Rohit, who is missing from the podcast today. We are very happy to have with us Linda Stevenson. She’s the Chief Information Officer at Fisher Titus Health, where she leads enterprise technology strategy for a community-based health system. She has over 30 years in healthcare IT, and has worked across organizations like Cleveland Clinic, Cerner, and regional hospitals. Her work has focused on integrating core systems, particularly EHR and telehealth. She’s especially passionate about advancing innovation in rural and community health systems where resources are constrained but impact is critical. We are really looking forward to our conversation today. Welcome once again, Linda, to the podcast. Thank you for being here.

Linda: Thanks for having me.

Ritu: I gave an introduction, but feel free to add anything you’d like or if you feel I missed anything.

Linda: I’ll give you a little background on me and my organization. Fisher Titus Health is a rural healthcare organization in northwest Ohio, in a town called Norwalk. We’re a 100-bed hospital facility — not a large hospital, but we offer a lot across the full span of a patient’s life, all the way from birth to end-of-life care, including nursing home care, skilled nursing, and home health. We also have a large physician practice group, so we really do span a wide range of care delivery areas. I talk about doing more with less — that’s what happens in rural healthcare. We are technically a rural healthcare organization, and our job is to figure out how to do things for less money but still achieve the same outcomes and access the same technologies as larger organizations. I love being in rural healthcare because I get to work on very challenging and creative solutions. And as of the beginning of March, I am now also the COO of the organization, handling not only the technology group and cybersecurity, but also all of our ancillary services, facilities, and environmental services.

Ritu: Wow. Congratulations — that’s great to know. As I was reviewing your profile, I realized you have somewhat of an unconventional background for someone in this position. We would love to hear your origin story — what brought you into healthcare and how you got to where you are today. I remember when we spoke, one thing really hit me: you said you have to reach out and ask for things, you can’t just sit back and wait for people to tell you what to do. You have to be confident in your own abilities. Tell us a little bit more about that.

Linda: I started in healthcare as a biller, typing bills on a typewriter back in the day, before all the automation we have now. I found that my passion was asking questions — I was always asking why in that department. The technology team noticed that and said that’s the making of a good analyst, and brought me into technology for the first time very early in my career. I had no computer background from an education standpoint — my degree was in business management. I used to joke it was a useless degree, but I found it certainly helped me later in my career as I moved into project management and building stakeholder relationships across the organization. From those early analyst days, I moved into project management, data security, and then progressively larger EMR implementations. I worked on the Epic implementation when it initially rolled out at Cleveland Clinic, and then had the privilege of working for Cerner — Cerner at the time, not Oracle Health — for three and a half years, really learning what the vendor side looks like through their IT Works division. And here I am as CIO years later. I always tell people: if you’re not sure, say yes. Every single opportunity I said yes to, even when I was afraid or thought it might not be my job — every single time, it opened another door and taught me something new that got me to where I am today.

Ritu: That reminds me of something I read — just jump into the pool and figure the rest out as you go.

Linda: That’s exactly how the COO role came about. The gentleman in that role was retiring, and I just went to my boss, the CEO, and said: put my hat in the ring. I have no idea what I’m doing, but I’ll figure it out.

Ritu: Awesome. So Linda, you’ve seen the full stack of hospital operations — from billing all the way to IT leadership. How has that shaped your view of what a CIO should prioritize today? Should it be innovation? Cost control? Operational reliability? Tell us about your priorities and how you balance these competing demands.

Linda: The easy answer is: yes, it’s all of that. I don’t think we can choose one thing, and I think that’s both the challenge and the beauty of what we get to do. At the bottom line, it’s about partnership — partnering with all the other leaders, whether nursing, finance, or operations, to understand the challenges they face. In some areas the challenge might be optimization or productivity improvement. For example, our therapy departments are struggling to recruit right now. They simply cannot find therapists. So how do we use technology to allow the therapists we do have to work faster while still delivering the same quality, so they can see more patients? It’s not about wanting to reduce headcount — we can’t even find people to hire. In other areas, the question is how to cut costs, through things like application rationalization: really honing in on using the solutions we already have better and getting the most out of our investments. And then there’s automation — some of it is simply about making lives better, whether that means giving patients better access to care or giving providers tools to reduce stress and burnout in their day. It really is all of it, and you just have to understand your audience.

Ritu: You’ve talked about bringing Fisher Titus back to Most Wired status. How do you ensure that’s based on measurable clinical or operational outcomes rather than chasing shiny objects? At VIVE, we heard everyone going after AI just to make it look good.

Linda: I’m a very practical person. About two years ago when everyone was still asking “what’s your AI strategy,” I’ve been around this industry long enough to know that AI is just another tool. We’ve had lots of tools — cloud was a buzzword for a while, EMR was a big thing. Lots of things come and go. Yes, this one might be a bit more impactful than some we’ve seen in the past, but the way I look at it: I don’t have an AI strategy. I have a strategy. The organization has a strategy, and we have a technology strategy to support it. That strategy may or may not involve AI — it depends on the need. I look at it from a practicality standpoint, going back to what we just discussed: partnering with leaders in each area to ask, what problem are you trying to solve? Then we look at whether there’s an AI solution, and whether it brings productivity improvements, cost savings, time savings, patient satisfaction improvements, or quality care improvements. All of those are measurable. That’s the conversation we have: here’s what we’re trying to solve, here are some options, and here’s what we think we can achieve.

Ritu: What we’ve heard from other C-suite leaders is that this has to be cross-functional — you have to build buy-in and partnership across the organization. Are you finding the same at Fisher Titus? And how are you tackling AI literacy, given that every couple of days there’s a new release and it’s hard for anyone to keep up? You said you’re not chasing shiny objects but focusing on strategy — yet you still have to know what’s out there. How does anyone keep up with this pace of innovation?

Linda: You try, right? There are a couple of factors. On one hand, our leaders need AI education to help them understand the basic things they can already be doing to make their lives easier — whether it’s ChatGPT, transcription tools, or other things that can lighten their administrative load. They often don’t grasp those as readily as they understand a vendor coming in and saying “I can solve all your problems with this new scribe solution.” So there’s a parallel track: here’s how you can help yourselves, and here are some broader things we can bring to the organization. At the same time, we have to temper the vendor conversations. Every vendor comes in with shiny objects, and I have to help them understand our strategy. We’ll look at what they offer, but it may or may not fit into the direction we’ve chosen, because we want integration across the whole — we don’t want 30 different scribe solutions or 20 different quality solutions. Vendors are generally receptive to that once you explain the why. You have to spend time on the why — educating them on how powerful these tools can be when done well, versus just buying something random.

Ritu: I think buy-in is the key. Once you have that trust, things move forward. Without it, it gets really difficult.

Linda: And isn’t that the key — trust? They need to trust us and we need to trust them. That’s something we’ve been building for years. It’s not a new thing.

Ritu: You’ve worked both inside health systems and with vendors like Cerner, so this question feels very pertinent. Where do you think the industry still overestimates interoperability, and where are we still fundamentally constrained by vendor ecosystems? Most of these ecosystems remain fairly closed, and now everyone is asking how AI is going to suddenly change that. We heard the recent announcement from Epic about building AI agents into their workspace. What are your thoughts?

Linda: All the EMR vendors are building AI agents — they all have it at various stages of development. The ERP vendors are doing the same. Interoperability has been a conversation since about 2008 when Meaningful Use first started coming out. It’s frustrating because Fisher Titus has engaged with every opportunity to be interoperable where possible. We’re connected to CommonWell, to everything through the HIE — all of it. But that doesn’t mean the information flowing through is in a form that clinicians can actually use. That’s where we still struggle. As a rural healthcare organization it’s especially challenging, because unlike a large integrated system like Cleveland Clinic or Mayo Clinic that has all specialties and services within their own walls, we don’t. We refer a lot, so interoperability is critical for continuity of care. But not all information flows through traditional interoperability channels. A great example: maternity records. A delivery record or a nine-month care plan for a patient is not coming through on a CCDA. We still fax paper records back and forth to outside OB physicians. Interoperability still has a long way to go.

Ritu: That’s what we’ve been hearing from everyone. Even with telehealth — we expected it to drive deeper EHR integration, but we’ve still seen patchwork systems and ongoing problems with embedding telehealth into core clinical workflows. What has your experience been?

Linda: It’s very patchworked. We try to connect wherever possible. I’m actually on the board of directors for Ohio’s state HIE, and I’m very proud of the work Ohio has done — building a really robust HIE that goes well beyond just sending CCDAs, including data exchanges for population health initiatives and supporting state Medicaid. The more you can get involved at the state level, the more you can help shape the bigger picture. Working with fellow CIOs and leaders to ask what we can all do better — that’s where the real conversation needs to happen. And then taking that up to the federal level, so we can ask for exactly what we need rather than having proposals come from people who have never actually worked in healthcare.

Ritu: We’ve been hearing from other health systems and CIOs that they’re driving innovation through internal innovation arms or venture studios. Does Fisher Titus do any of that?

Linda: No. At a rural hospital you generally don’t see that. My entire IT team is 35 people — covering help desk, technology, clinical analysts, informatics, trainers, cybersecurity, everything. That’s our scope. We’re not doing a lot of in-house development. We work through vendor partnerships, and I strongly believe in developing strong relationships with those vendor partners to drive innovation.

Ritu: Linda, we saw that you recently submitted a brief for the Senate Health Committee. Tell us more about that — we would love to hear about your role.

Linda: What a wonderful experience that was. Last summer I had the privilege of going to the Senate Health Committee to talk about rural healthcare, cybersecurity, and the risks facing all of us. Every healthcare organization is exposed to this ongoing onslaught of cyberattacks. But rural healthcare has such small budgets and limited resources that it’s really hard to keep up and protect ourselves — and all organizations are connected through us in one way or another. We’re a link in a chain, and if we’re weak, the entire healthcare chain is weak. I was really trying to highlight that challenge: the difficulty of recruiting cyber professionals, the cost of managing third-party vendor risk. It was a great opportunity to speak up, and actually I’m going back to Washington this week to speak with the Healthcare Sector Cyber Working Group at an all-hands meeting. I’ll be on a panel there talking about these ongoing challenges.

Ritu: That’s great — really important work. I read the briefing you submitted and thought it was very well written. You made some really strong points. I’ve been watching a show called The Capture, and it’s shown how easy it is to use deepfakes to get into systems. Just like you said — once they find the weakest link, that’s all they need. The entire chain has to be strong.

Linda: One of the things I focus on so much is connection and networking, because who in this day and age can do it alone anymore? There’s just too much. Connecting with people like you, with my peer groups, and with CHIME — who also supported me through that Senate Health Committee process — those relationships are invaluable. Vendor relationships too. As leaders we have to stick together to raise the tide for all.

Ritu: Exactly. Time always goes by fast and we are almost at the end. Any forward-looking final thoughts you’d like to share? Where do you think this is all headed, and where do you think we’ll be a year from now?

Linda: I think it goes faster than we think it will, and it’s really hard to keep up. A year from now the conversation will look very different — we’re already starting to see the shift in what AI can actually deliver and what it will actually cost. My final piece of advice: take a deep breath. Think it through. Don’t rush into a million shiny objects. Stick to your strategy and focus on where technology will genuinely benefit you. And don’t forget to take care of yourselves — when we work at this pace, it’s really important to stop, regroup, and refocus on your own health.

Ritu: Thank you, Linda. It’s been a pleasure having you on the show. Thank you so much.

Linda: Thank you. Great to see you.

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Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hi everyone. Welcome to our Big Unlock Podcast. My name is Ritu and I’m the co-host of the podcast. Really happy and excited to have Dr. Ruchi Garg here with us today. This is Season Seven of our Big Unlock Podcast — a very warm welcome to all our listeners. We are really inching towards 200 episodes, so we are very excited. It’s been going on for a while and we are always happy to bring you fresh perspectives. Dr. Ruchi Garg is our guest today. She’s the Chief Medical Officer at Fairview Park Hospital, where she’s deeply engaged in delivering high-quality, patient-centered care in a community hospital setting. She’s a gynecological oncologist with a demonstrated history of working in the higher education industry, and her work reflects a strong commitment to advancing care delivery through thoughtful adoption of technology and process innovation. She’s particularly passionate about addressing physician burnout and enhancing care access for diverse and underserved populations. Today she’s joining us on the Big Unlock Podcast to share her insights on the evolving role of clinicians in shaping the future of healthcare. Really happy to have you here with us, Dr. Garg. Welcome.

Ruchi: Thank you for having me, and thanks for that generous introduction. I look forward to a wonderful conversation today.

Ritu: Our listeners always love to hear an origin story. Now that we’re coming up on 200 episodes, we still hear such interesting things when we ask people how they got into healthcare and into this intersection of healthcare and technology. We’d love to hear what your inspiration was, what led you into healthcare, and what keeps you going. What motivates you?

Ruchi: It’s interesting — I always tell a funny story about what got me into healthcare. Being of Indian origin, growing up we used to laugh that Indians always become either engineers or doctors. In 10th grade, I still remember doing a summer electrical physics course, learning all about circuitry, and it dawned on me in the middle of that summer that I was not going to be as good an engineer as my dad — so I decided to become a doctor.

Ritu: By the process of elimination!

Ruchi: Well, I was mathematically inclined, a STEM child — and thinking about how I could make a bigger impact on the world. My family has always believed that you don’t have to follow your parents’ pathway; you have to build upon it and contribute more. That’s really what led both my brother and me into medicine. Going through medical training, I actually never thought I was going to be a surgeon and a GYN oncologist. I thought I was the child who was going to faint at the sight of blood, and there are some funny stories from medical school. But I loved my surgical rotation — I loved the immediacy of impact you can have on a patient’s life. The more complex the surgeries were, the more I loved them. I remember going through the hepatobiliary rotation and doing Whipple procedures — massive pancreatic or liver resections — and I loved every minute of those six-to-eight-hour surgeries. Then I went through the GYN oncology rotation and I was hooked. GYN oncologists are definitely a unique breed. We love to work hard and play hard, and it’s a unique subspecialty because you get to stay with your patient throughout their entire journey. I’ve had patients as young as eight years old, unfortunately, and as old as 96. I’ve done prophylactic surgeries and prevented cancers in high-risk patients. I’ve diagnosed cancers, done surgeries, treated patients through chemotherapy, and also held their hand when they’ve passed. That’s what attracted me to GYN oncology — we’re trained to do all of it: prophylactic surgery, complex surgeries, chemotherapy, end-of-life care, and building that relationship with our patients.

Ritu: Thank you — it’s very inspiring to hear. The amount of effort and work you put in is incredible. I’m always in awe when I talk to physicians. It really feels like a calling that goes way beyond a profession. So let’s talk about the favorite topic at the moment — at HIMSS you couldn’t walk more than a few steps without hearing about AI. In your current role, what do you see happening? We hear a lot about physician burnout and clinicians walking away from the field. Can you share a personal story where AI really moved the needle and helped you reclaim some time, or a particularly successful implementation that makes you feel this is a pivotal moment?

Ruchi: Let me step back a little to explain why I got hooked on health tech. The real taste came during COVID. I was in private practice in Northern Virginia at the time — a very busy practice that also did academic training with fellows and some research. We couldn’t skip a beat when COVID came because cancer didn’t stop. Within a week I was able to set up a telehealth program in my practice. Fortunately there were companies that had already been advertising, and we connected with them so our patients continued to get care. We also had our own chemotherapy suite, and those patients needed vitals monitored — but as you can imagine, they were a very vulnerable, high-risk population during COVID and we didn’t want to bring them into the office unnecessarily. I connected with a startup doing remote patient monitoring at the time, and we deployed monitoring tools to these patients so their vitals could be transmitted from home. We then did telehealth visits with those patients. The only reason they had to come into the clinic was for labs and infusions — really minimizing visits. The patients liked it because it was convenient and they didn’t have to come in for every single thing in their care paradigm. I was involved with a similar monitoring program at the cancer center after that and built upon it. But when AI technology really took over, there was so much more we could do. That’s where my interest in streamlining healthcare, building efficient protocols, having a more standardized approach, and intertwining that with day-to-day care using AI — that’s when the wheels really started turning. I was fortunate enough to partner with a company called Resa. Initially they were a space-agnostic, AI-based prior authorization company. Within two months of being brought on as an advisor, we had many long conversations and realized that oncology was where we could make the biggest impact. The company shifted their focus to that space, because with an oncology patient you’re getting prior authorizations for every step along the way — prophylactic surgery, major surgery, CT scans, chemotherapy, and then if the cancer comes back, repeat chemotherapy, immunotherapy, radiation therapy. One patient, huge impact. And the prior authorization process has become really cumbersome. Fifteen or seventeen years ago when I started practicing, I would do a peer-to-peer review with an insurance company maybe once a month, if that. By the last few years of my practice — before I took on a full-time administrative role a couple of years ago — I was doing at least one or two peer-to-peers every week.

Ritu: Oh wow.

Ruchi: That’s quite burdensome, and it delays care. It adds anxiety for the patient and tension between the clinical team and the patient, because patients think you’re not doing your job — when in reality you’re working within the constraints to get things approved so they’re not stuck with a huge bill at the end, while also managing all your other patients. The buck doesn’t stop with one patient. That’s where these kinds of technologies are making a big difference and will continue to do so. But the key is that the company listened to me as a clinician. We can’t just throw technology around without having the voice of the clinician and the frontline folks involved in shaping it.

Ritu: Absolutely. I think a recurring theme is that COVID really normalized telehealth and kickstarted this whole wave, making it so much easier for people to accept virtual visits and remote monitoring like you’ve described. Great example — thank you for sharing. I was also asking about particularly successful AI implementations in your community hospital. Other than the oncology company, what has your experience been with ambient or voice agents?

Ruchi: I’m part of Fairview Park Hospital, which is a smaller facility within the larger HCA system. HCA has taken a very centralized approach to deploying AI technologies so they can do it in a controlled, standardized manner with guardrails around data protection and cybersecurity — a very thoughtful approach. What has been done so far is AI-based ambient listening for physicians. My physician services group doctors who are using this technology — mainly my surgeons — each say it has saved them about an hour and a half to two hours every day.

Ritu: That’s huge.

Ruchi: That’s huge. You can see how much burden that takes away — not just the physical strain, but also the accuracy. If you’re waiting until the end of the day to do your notes, you’re going to miss things. We don’t have time built in between patients to do documentation, so a lot of it happens at the end of the day. With ambient listening, documentation happens in the moment, which allows for more accurate notes and a faster turnaround. I was very intentional that my notes had to be done before I left for the day, but not every physician is able to do that — and even for me, there was probably at least 1% of the time I missed it. Then there’s a delay in care because the next day is already full — you’re just playing catch-up. There’s a lot of opportunity to build beyond that layer. Ambient listening can go deeper: AI can then fill in the orders that need to follow — the follow-up orders, the prior authorization forms, the request for surgery, the request for a CT scan. All of that becomes a faster and more accurate turnaround, even though it’s not fully deployed yet. I’m a hundred percent sure that’s the future.

Ritu: A lot of companies are working on exactly that — integrating it into the workflow rather than keeping it as a point solution. With agents, each one can just fire off and handle the next step. My next question is about your leadership role. When you’re leading clinical teams through change — whether it’s new technology, new protocols, or new care models — we hear a lot about responsible and trustworthy AI. What’s your approach to building trust that gets you true adoption rather than passive compliance? You can’t just dictate from tomorrow you’re going to use this. How do you actually convince physicians, who are already resistant to change and incredibly busy, to learn something new and integrate it into their workflow?

Ruchi: It really goes back to partnering with clinicians — or whoever the end user is. If it’s a provider solution, partner with the providers. If it’s a nursing solution, partner with the nurses. Understand the workflow and the user space, and focus on decreasing the burden. When you come from the perspective of making them better and more efficient, and showing how it’s also going to help the patient more — that’s the approach that works. Compare it to the EHR rollout, which is the prime example of what you’re describing. It was something everyone just had to swallow. It wasn’t built with clinicians in mind, and everybody talks about death by a thousand clicks. When I came into my role, one of the concerns my clinical informatics team brought to me was that clinicians weren’t discontinuing telemetry orders — the cardiac monitoring — when patients no longer needed it. They were good at ordering it but not at discontinuing it, so we were running out of telemetry boxes. I asked them to walk me through the workflow. It was one click to order telemetry. It was four clicks across four screens to discontinue it. That’s why it wasn’t getting discontinued until a physician needed the box for their own patient. It seems like a silly example, but when you add up those extra three clicks throughout the day for various things, that’s where you get the barriers to adoption. That’s how we have to think about AI platforms too. If we get doctors used to the fact that their notes are done, and they just need to review and take ownership of them — great. But then asking them to also sit down and enter all the follow-up orders when the technology could easily handle that — the human mind is going to want more, and that’s exactly the direction we need to go. We have to show how it benefits both the clinicians and the patients and keeps removing the burden.

Ritu: We’ve been hearing a lot about successful AI implementations for digital front doors, ambient documentation, and things somewhat removed from the actual practice of medicine. But now we’re slowly seeing a move toward AI doing more diagnostically — passing medical exams, with millions of people around the world turning to ChatGPT with their full health histories and getting back diagnoses. What are your thoughts on this trend? Where do you draw the line between what the physician does versus what AI can do? Should the human in the loop stay, and what’s the time horizon for that to change?

Ruchi: The writing is on the wall. We can keep denying it, but there is low-hanging fruit and standardized protocols that AI is already trained on. Do patients really need to see a doctor to be diagnosed with a URI and get an antibiotic prescribed? But if someone has had three or four infections in two months, you want the next level of critical thinking — and yes, AI will get there. With ambient listening, the AI is getting trained on clinical reasoning. As physicians make corrections and talk through their thinking, the AI is getting that deeper-level training. The writing is on the wall. The question is: who’s going to take the liability? That’s where medicine is hung up right now. It would be very easy to deploy AI decision-making in primary care settings, for example. But if the AI is hallucinating or producing an incorrect diagnosis — because there is a lot of gray zone, which is what we call differential diagnosis — who takes ownership of a bad outcome? Is it the AI company that gets sued? We live in a litigious society. Or is it the doctor who holds the malpractice insurance? I always say that doctors are not allowed to be human. We’re not allowed to make human errors, because if an error leads to a bad outcome, you face the consequences. AI removes some of the human factor but introduces other kinds of glitches.

Ritu: I totally agree. It’s a very evolving field. At HIMSS and VIVE, we heard a lot about health deserts — communities with no access to care. If AI can provide some care in a rural community, is that better than no care at all? It’s an interesting question and we’ll have to closely watch what happens.

Ruchi: Exactly — you hit the nail on the head. That’s where we’re going to have to show the benefit and deploy it. I’m a robotic surgeon by training too, and the robot was initially created by the Department of Defense to operate in remote settings and war zones. Very soon the question became: if the doctor isn’t at the bedside, who takes the liability? Even though that capability existed from the beginning, it never got deployed that way — the surgical team had to be in the room. Even now, robotics can perform basic, standardized surgeries like gallbladder removal or appendectomy. But again, who takes the liability?

Ritu: Dr. Garg, as usual this goes by really fast and we are almost at time. Thank you for being on our show today. Any last thoughts for our listeners or anything you’d like to leave them with?

Ruchi: The biggest thing is that the future is here. We cannot be afraid of it — we have to embrace it. That’s what I tell my physician colleagues: let’s look at the positives we can take away. There are definitely negatives and things to worry about. AI can talk very sweetly, but it does take away the human factor. There will be a generational difference in adapting to and accepting that — millennials versus baby boomers. But as physicians and as people in healthcare, we have to lead that and not sit back and let it define us the way we did with the EMR, or the way we let the payer-insurance system and the political environment around healthcare shape us. Let’s not let that happen with AI technology.

Ritu: That’s great advice. You have to embrace the change and be part of it so you can contribute to it and shape it for the greater good. Thank you, Dr. Garg — it was a pleasure having you on our show today.

Ruchi: Thank you for having me.

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Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hi everyone, a very warm welcome to our listeners for Season Seven of the Big Unlock Podcast. My name is Ritu and I’m the co-host of the podcast. We are very excited to have with us today Dr. Ed Lee. Dr. Ed Lee is a physician and healthcare executive leading clinical innovation at Nala, where he focuses on bringing AI into real-world care delivery. He was with Kaiser Permanente for a long time, and we have some very good questions about that for you today, Dr. Lee. At Nala, he’s working at the forefront of ambient AI and clinical co-pilots, helping translate cutting-edge models into tools that actually work in everyday workflows. With that introduction, welcome once again to the podcast, Dr. Lee.

Dr. Lee: Hey Ritu, thank you so much for having me. I appreciate it and I’m looking forward to the conversation.

Ritu: Thank you for being our guest today — really excited to ask you some interesting questions. Let’s get started. We all know that Kaiser Permanente operates as a fully integrated system: payer, provider, and care delivery. How did that structure shape your perspective on what good looks like in clinical workflows, and how did it influence your thinking when you were building tools at Nala?

Dr. Lee: I thoroughly enjoyed my time at Kaiser Permanente. That’s where I actually learned how to be a real practicing clinician — seeing patients, having a large panel of patients to take care of over decades. It taught me how important it is to use technologies that allow clinicians to focus on their patients. At the end of the day, what we want to do is deliver high-quality, personalized care, and quite often technology can get in the way of that unintentionally. What we want to do now, with that understanding, is build technologies that bring the human side of care back to healthcare — removing the friction that technology may have introduced between patients and clinicians, decreasing the administrative burdens that clinicians face, and really making patients the forefront of what we do every day.

Ritu: Great answer. That leads directly into my next question. From all your time at Permanente, what did you learn about the human side of adoption? Because that’s what we’ve been hearing from most of our guests recently — driving clinicians to change behavior versus resisting change, even when the technology is objectively better. AI is passing all these tests, beating doctors on benchmarks, and yet behavioral change is really hard. How did you grapple with that?

Dr. Lee: One of the things I always mention is change management. The change management piece is often the hardest part of implementing new technologies — it’s not the technology itself. The technology can often speak for itself. But making sure clinicians understand the why is critical. Clinicians are very scientific and results-driven; they’re looking for evidence about why things should be done. If you don’t come in with that mindset, and if you don’t involve clinicians from the very beginning of a new technology project, you’re often destined to fail. AI has been around for a short time relative to the grand scheme of how technology has been implemented in medicine, but the impacts are starting to be quite evident. You mentioned how AI can sometimes answer test questions better than human physicians and clinicians. But I still feel the AI out there is really there to augment the clinician and the experience clinicians have with their patients — not to replace them. It’s still up to the clinician to incorporate the information AI brings into the conversation. That human-in-the-loop component always needs to be there to make sure we’re doing the right thing for our patients.

Ritu: That was the conversation we were having six months to a year ago. But now, as we’re seeing more and more co-pilots doing more — going beyond drafting notes and actually suggesting clinical context — how do you maintain clinician trust and ensure that judgment isn’t subtly being outsourced to the system because it’s just so easy? Even in our world of writing code, we’re seeing how easy it becomes to just sit back and let the AI keep generating. The more you engage with it, the easier it gets to let it handle everything. What are your thoughts on that?

Dr. Lee: The easy thing isn’t necessarily always the right thing. What we see with AI-generated outputs is that sometimes they can be very convincing. I’ve done it myself — I’ve plugged things into ChatGPT and it sounds so well-written that it feels like it has to be the truth. But we know that current LLMs are essentially word prediction models generating text, and while they are quite often correct and often bring new insights into the way I’m thinking about clinical scenarios, what you get is based on what you put in. It often requires a clinician’s expertise to put in the right prompt and bring in all the right factors to get the right output back. That’s where I have some concerns about these tools being available to all patients directly — they may not understand all the factors that need to go into the system to get the right output. And without clinician expertise to filter, interpret, and apply it to a real-world scenario, you may run into situations where the output sounds very convincing but isn’t exactly what you need because of what went into it.

Ritu: Are you seeing that a lot? We’d love to hear about it in the context of Nala. A lot of the narrative around Nala’s tools focuses on saving physician time. But what are some of the less obvious yet most strategic forms of ROI that health systems should be paying attention to? As you’re saying — if easy isn’t always right, you can’t just focus on whether ambient is saving the physician eight minutes or sixteen minutes. What are some of the other metrics we should be looking at?

Dr. Lee: It’s a great question. Early on, physicians were reporting saving an hour or even a couple of hours a day, and that’s what the data was showing at the time. Since then, multiple studies have come out showing that the time savings per encounter is actually smaller than that, and some clinicians aren’t necessarily having less after-hours time. I think it varies from clinician to clinician — some are saving an hour a day, cutting into the pajama time they would otherwise be doing. But what I’ve found myself in using Nala and other ambient and AI tools is that it gives me agency. What I mean is that I’m now able to budget my time the way I want to in the care of my patients. I could rush through my day, compact it more using the AI tools available and finish early — or I could invest the time I want to invest in my patients and develop those relationships and be more thoughtful about the care I deliver. So the time I could be saving in the global context of patient care time could be more, but I choose to invest that time into developing relationships with my patients. One of the ROI points that was talked about in the past was time savings, but now a lot of the conversation has shifted toward cognitive load, cognitive burden, and the joy and meaning that clinicians can get from using these tools that they otherwise would not have. Burnout has been shown to decrease because of these tools, and it’s not necessarily related to time saved. It’s because clinicians are now doing what they went into medicine to do in the first place — not working on a computer or acting as a transcriptionist, but being a caregiver, a clinician, a scientist, bringing in evidence and applying that knowledge to improve the lives of the patients they work with. That’s where I see some of the biggest gains from using this type of technology.

Ritu: That’s a great answer and it allows us to unpack a lot more. I remember reading somewhere that because of ambient, doctors are actually articulating more — because they know that whatever they say is going to be registered. Because of that, patient satisfaction increases because patients feel the physician is being more communicative. So it’s not just about the time spent, but actually increasing communication with the patient and resulting in a more meaningful interaction.

Dr. Lee: It’s a really insightful observation, because it may not have been one of the things we expected when we first deployed this type of technology. But as time has gone on and experience has been gained, it really is a win-win situation. Patients do feel more engaged in the conversation and get more explanation from the clinician — and it’s sort of a byproduct of the clinician wanting the ambient technology to hear what they’re saying so it gets captured in the note. They don’t have to write it later, but the patients gain almost as much as the clinicians do through the process of making the technology work for both sides.

Ritu: Exactly. So that leads into the next question: if ambient is just the first layer, what does the next phase of AI co-pilots in healthcare look like, and how far are we from that reality?

Dr. Lee: Next steps are happening right now, even as we speak. You mentioned ROI earlier, and I think there are different ways of looking at it. There are the human factors and softer components — decreased burnout, increased retention, recruiting strong clinicians who are looking for organizations that have this technology ready and deployable. But also looking at diagnosis capture and coding, making sure those financial components — which are critically important within the healthcare system — can be captured accurately and justifiably. Accurate documentation is very supportive of those goals, and surfacing the right diagnoses, CPT codes, and ICD-10 codes are things that are happening now and continuing to be built up. Beyond that, chart summarization is being incorporated into documentation to make it more complete. There’s so much in a patient’s chart — sometimes decades of information — and being able to distill it down and surface the key points pertinent to the conditions being addressed, so the clinician can see that at the point of care, is happening now. Then transitioning that into clinical decision support — and I think that’s something clinicians would really be enthusiastic about adopting, as long as the trust factor is there. What I mean by clinical decision support is having AI surface potential diagnoses, treatment options, diagnostic tests, and orders at the point of care — or even before or after — and having all that happen seamlessly throughout the entire process: seeing the patient, documenting, entering orders, and surfacing clinical information that allows the best care to occur.

Ritu: That captures what I was going to ask next. In one of your earlier answers you mentioned friction, and I wanted to ask: in real clinical settings, where do you think AI still falls short, and what needs to happen for it to become truly invisible infrastructure? I think you’ve kind of answered that — to be truly invisible, it has to do more than just the ambient piece and get into all these other areas you’ve described.

Dr. Lee: I think it does, and the word friction is almost visceral to me — it’s just things that get in the way of what you really want to get done. The clinician’s goal is to provide the best care for the patient, but things have been introduced into the system between the patient and the physician over time through technology that technology can actually help remove. Some of the tools being developed now are amazing, but if something isn’t built into the workflow — if it adds five extra clicks per patient — clinicians just aren’t going to use it. So it’s not only what a tool can do, it’s how it does it and how it’s incorporated. It really needs to be thoughtful in terms of usability so that clinicians can actually adopt it. You can put a tool out there, but as the saying goes, hope is not a strategy. The strategy should really be around understanding the needs of the clinician and their workflows, and building tools into those workflows so that the technology is truly seamless and can be adopted and scaled easily. I talked about the change management piece earlier — it all comes back to that.

Ritu: Thank you, Dr. Lee. Throughout these questions we’ve gotten your perspective as a clinician, but we also like to ask about your origin story on the podcast — how you got into healthcare, how you got into this intersection of technology and healthcare, and how you came to understand both sides. Our listeners would love to hear more about that.

Dr. Lee: Thanks for asking. Early on in my childhood I thought I wanted to be a doctor. I had older siblings who went into medicine and I saw the gratification and satisfaction they had in their work, so it was an easy path for me when I was thinking about the intersection of science, healthcare, and being able to help patients. That’s how I first got into medicine. I actually thought I was going to be purely a clinician my entire career — that’s what I went into medical school and residency thinking I would do. But along the way, I was fortunate to have mentors who allowed me to think beyond that and exercise my interests outside of direct clinical care. I was always interested in doing things more efficiently using technology and incorporating that into the practice of medicine. Early on in my career at Kaiser Permanente, I was fortunate to be involved with different technology products and projects that led me down a path where I saw the magnitude of how technology could affect healthcare in the present and into the future. When the AI boom happened, I saw that magnified significantly, and that’s why I decided to embark on my work with Nala — an innovative, agile company really improving the lives of clinicians using these tools. I wanted to bring this type of technology to all clinicians because the burden of clerical and administrative tasks hinders our ability to provide the best care possible. If we can have technologies like Nala and other AI-powered tools, I think the healthcare system can not only improve how we deliver care and the quality of care, but also the cost of care — because we’ll be providing care that is more proactive and less reactive, which is better for patients and economically better in the end as well.

Ritu: Thank you for sharing that, Dr. Lee. That’s always very inspiring for our listeners. What you talked about — proactive versus reactive — we’ve been hearing a lot, especially in the context of wearables and the constant stream of information coming in that’s going to change the nature of doctor’s visits. People are already uploading their entire blood reports to ChatGPT and other AI platforms and wanting answers. Medicine is going to change very quickly. We’re almost at the end — it’s always great to hear your insights. Any closing remarks or advice you would have for our listeners, and what are your predictions for the next one to three years?

Dr. Lee: I thoroughly enjoyed the conversation — thank you. As I think about it, at the end of the day AI is just technology. I don’t mean “just” to diminish it, but it is technology, and I’ve always believed that technology in healthcare is really there to improve how we care for our patients. If we do this right, it shouldn’t feel technical — it should feel more human. It should give clinicians time, attention, and presence back. And I think that’s what patients remember, and what clinicians remember as well. At its best, healthcare is human, and I think AI should help us get back there.

Ritu: Great answer. Thank you so much, Dr. Lee. We really enjoyed our conversation. Thank you for being our guest.

Dr. Lee: Thanks so much, Ritu. Appreciate it.

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Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hi everyone. My name is Ritu, and I’m the managing partner at Damo Consulting and co-host of the Big Unlock Podcast. A very warm welcome to all our listeners for this next episode of Season Seven. Today we are really excited to welcome back Dr. Schoenberg to our podcast. He’s been on season three, episode 94. He’s the co-founder of Amwell and a pioneer who helped bring telehealth into the mainstream of US healthcare. Under his leadership, Amwell became a foundational platform for health systems and payers navigating the shift to virtual and hybrid care. Dr. Schoenberg is a physician by training and has operated at the intersection of clinical care, technology, and large-scale healthcare transformation. He is now focused on his next venture, Eileen.ai, exploring how AI can further reshape care delivery and decision-making. With that introduction, I’ll hand it over to you, Roy. Thank you so much for joining us today.

Roy: Thank you for having me, and thank you for the very kind introduction. I learned things about myself — this is great.

Ritu: Good to know. It was really good to see you at HIMSS and hear more about Eileen, and I’m sure today we’re going to hear much more since it’s been launched now. But we’ll start with the first question about Amwell. Amwell invested early in building a platform model for virtual care, but many health systems are still struggling to operationalize telehealth beyond siloed use cases. Looking back, what do you think were the biggest mismatches between how you envisioned platform adoption and how health systems actually implemented it? And if you were doing this all over again, what would you do differently to close that gap?

Roy: That’s a good couple of loaded questions. At the very highest level, the notion of delivering care over technology can be looked at in two ways. One, you can look at it as just another channel for the same encounter to take place — over a technological channel. Or you can look at it as more of a switchboard that allows you to completely reshuffle how services are acquired and delivered. Model number one is: I am your doctor, we have a follow-up appointment, and it’s going to be carried out through telehealth rather than in the office. That creates convenience and some level of efficiency, and I think that’s the majority of how health systems are utilizing this technology today. The vision behind it, though, is to give it wings — instead of just executing the same thing through technology, maybe we can democratize the availability of services at a much larger scale. To give you an example, if you happen to live in Boston where I live, cancer care is very available — Dana-Farber, Mass General. But the knowledge of those clinicians could be made available to oncology patients or even primary care physicians in West Texas or North Dakota or other places that don’t have those large cancer centers. If we created the supportive logistical framework to allow skills to flow over technology to the end of the earth, you are rewriting the healthcare experience altogether. Obviously, there’s a lot of muscle memory in healthcare that makes this challenging — health insurance, medical licensure, credentialing, and a variety of other elements that stand in the way of market forces fueling this. I still think it is inevitable. If there’s anything I would say, I think we — like many others — underappreciated how protective the healthcare system is of itself from those kinds of changes. But I think the train is out of the station. Post-COVID, the understanding that healthcare will be redistributed through technology is bigger than ever. So we’re very proud of where we got.

Ritu: You’re absolutely right. COVID normalized virtual health and telehealth, and now with AI we’re really hoping to see this taken to the next level and become truly transformational. Along the same lines, Amwell was built as a platform, but now with AI-native companies emerging, do you think the future still belongs to platforms? Or will it belong to more vertically integrated AI-driven solutions coming into healthcare?

Roy: We used to have conversations about cloud versus server farms fifteen years ago, and that conversation completely disappeared. At this point, nobody in their right mind is going to operate a server farm. I think the conversation about platform versus vertically integrated is also going to become hindsight very quickly, because people are going to care more about how the transition of any one patient takes place between different elements of care. AI will probably become the surrounding technology — the most accessible healthcare interaction you’re going to have, even for follow-up care, will come through AI just because of the economics of it. The magic will be in how AI works in concert with other vertical systems for follow-up care, diagnostics, hospitalization, and so on. There’s a lot of focus right now on whether AI can be a doctor — is it smart enough, does it know enough. The narrative is that if it can be as knowledgeable as a doctor, of course we’ll go to AI because it’s very accessible. But I think that’s a bit of an underestimation of the complexity ahead of us. There’s a lot of sentiment around seeing a doctor in person, and you can trivialize AI by calling it just a chatbot, which doesn’t give any level of reassurance. The groundbreaking event still ahead of us — the one that will dramatically change how healthcare operates with AI — is when payers introduce an insurance product that requires you to interact with AI first if you sign up for it. A little bit like what they tried with HMOs in the eighties, where the PCP was the gatekeeper. That didn’t go well for a lot of different reasons — it was not popular and felt too restrictive. But what they tried to do was control the entry point of a patient into the healthcare system, and if done effectively, potentially control consumption and referrals. The same logic applies to AI. If we can ensure patients first interact with a very knowledgeable technology that is guided by what we know is economical and high quality, we have an opportunity to influence their healthcare journey. But it’s not going to be by convincing patients that AI is better than a doctor. It’s going to be because if they choose the product that requires them to use AI, they will save a lot of money. It may sound cynical, but cost is a very powerful influence on how people consume healthcare. My sense is that it won’t be black and white — it’ll be a product that says the more you use AI, the more you save. A shared savings model. And it will have to be designed smartly, saying there is AI, and if the sky falls you can break the glass and see a clinician, then return to AI. But my bet is that that is how AI will begin to dominate our experience as patients.

Ritu: That’s a great perspective, and we do see it heading in that direction. With ChatGPT and OpenAI, health is now one of the most queried topics — I think 30 to 40% of all queries on ChatGPT right now are about health. And they’re not necessarily doctor-related questions; they’re questions from people who want to be prepared for the doctor’s appointment, asking the chatbot what they should ask their doctor. It’s really interesting that patients are going there first, and only in extreme cases seeking access to a clinician. If AI can handle everything else, then why not?

Roy: That’s exactly right.

Ritu: Okay, great. Now we can start talking about Eileen, which we were so curious about — such an interesting product. What insight or frustration from your experience at Amwell led directly to founding Eileen? And what is the problem you’re solving that is so fundamentally different from telehealth? Because this is also remote and also involves talking to patients virtually, but what’s the biggest mindset shift, and can you tell us more about Eileen?

Roy: The motivation to build Eileen had nothing to do with Amwell or telehealth directly, but there is a corollary. There’s a similarity in the challenge: you need to socialize and get people comfortable experiencing a certain dimension of their healthcare through technology. With telehealth, the place of service changed and the mode of interaction changed. With Eileen, it’s the visceral connection that you need in healthcare — that connection is now going to be furnished by AI instead of by people. It all started with a very interesting academic conversation about the role of AI in healthcare. There was a big group at the table talking about how it’s going to change the way information is analyzed, packaged, and communicated — reminders, scribing, all the things we know AI can do. To keep the dinner interesting, I took the contrarian approach and said I think AI has a role in changing the interface between technology and people in healthcare. Specifically, the most challenged population in terms of healthcare and technology are seniors. There’s clearly a need there because the reality of caregiving is very daunting. We have more and more seniors as a part of the population — doubling and tripling in size over the next decade — and at the same time the number of caregivers available to them is going in the wrong direction. People don’t want to do senior care. It doesn’t pay much and it’s emotionally and physically draining. So we have a real problem in caregiving, and the thinking is maybe AI can step into that growing void and become supportive to seniors. Now that part alone isn’t terrifically creative, because there’s a whole world called age tech designed to do exactly that — thousands of applications, all with their hearts in the right place, trying to support senior self-sufficiency. They come in wonderful shapes and sizes: chatbots, talking orbs, talking pill boxes. All wonderful designs. But the general sentiment is that because of the love-hate relationship between seniors and technology, most of these technologies die on the vine. They either don’t create adoption or they don’t create staying power — they create fatigue and eventually just never get utilized. So the nut hasn’t been cracked. Eileen steps in and says something really simple: if technology is to have a regular, influential role in the life of a senior, then maybe our first order of business is not to tell them what to do, but to establish a regular presence in their daily lives — something that is going to be sought after, something that is going to be part of their regular daily routine that they would want to interact with. If we are successful in creating technology that has that staying power in their daily lives, then through that technology we can communicate medication reminders, dietary reminders, and all the rest. But the trick is that staying power in the life of someone doesn’t come from reciting a medication list. Staying power — putting technology aside — comes from people that know you. Familiarity, intimacy, the ability to talk about your kids and grandkids, to talk about where you come from and your joys and frustrations and relationships and likes and dislikes. So, the goal is: how do you get AI to become that intimate? That’s actually a much bigger technological challenge than people give it credit for. People talk to ChatGPT and think, oh, it feels like a casual conversation, like I’m talking to someone. But for that technology to actually understand where you come from, to know the names of your grandkids, to know whether your dog got into trouble with the neighbor — that requires a completely different level of orchestration. First of all, because it’s not written anywhere. AI is really wonderful when you can feed it a lot of information, but nobody wrote the book about my dad. If AI is supposed to know everything about my dad, there’s really nothing for it to acquire that information from. And secondly, with seniors specifically, AI is designed to respond to prompts. Even the term prompt engineering tells you about the choreography — we write something in, AI comes back. We know that’s not going to work with seniors, because if we wait for seniors to prompt, we’re going to be waiting a very long time. So the whole way AI typically operates doesn’t work here. Eileen was designed to address those challenges — to become a very intimate, very engaging, knowledgeable partner in the life of the senior. One that initiates the relationship itself, doesn’t wait for the senior to download an app or log in or pair with the internet. It uses the phone to call them, the way their kids and family are supposed to. And the magic that happens during the call is that it doesn’t talk about healthcare — it talks and remembers and carries a conversation about what the senior wants to talk about, about the things that excite them or that they spend time on. It has intimate knowledge and a deep commitment to learning what they are interested in and curious about, what makes them laugh, and what they can’t tell anybody else and want to talk about. These are the things Eileen focuses on, because its purpose is to have staying power — regular, daily staying power in their lives. And then it is humble enough to understand that if it achieves that, it’s just a cog in the wheel — a mouthpiece to other technologies that can handle medication reminders, symptom monitoring, anxiety and depression tracking, and all the other things healthcare technology knows how to do. But this one creates the staying power. That’s what Eileen is all about.

Ritu: I remember when you told us about it earlier, I was struck by that very different approach — it’s not a wearable, not an app, not some high-tech device. It’s just a regular phone call, like you would receive from anyone. I thought of my mom and how she interacts with technology, and yes — she loves to get phone calls. That’s something she would actually do. It really makes a lot of sense for the senior age group you’re targeting.

Roy: We think about the simplicity of getting a phone call, but there’s also an eye on how you make this technology available to people. If we’d come up with something that requires installation, internet setup, or a technological learning curve, both the economics and the availability of the product would have completely changed. What we want is to reach a position where if you’re a family increasingly struggling with the heavy lift of being there for your parents who may live far away, and you want something to share that burden with you, we can offer the ability to activate Eileen today and she would start calling tomorrow morning. Anything that doesn’t use the phone — that doesn’t use a staple the senior is already familiar with — would require a completely different kind of orchestration, a completely different cost structure, and would make it significantly less useful to the people who need it most. There’s a lot of thinking behind why we ended up with this seeming contradiction where the backend of Eileen is rocket-science AI — really science fiction kind of AI — whereas the front end of Eileen doesn’t even need Wi-Fi.

Ritu: That’s a really interesting way to think about it. And I remember you also mentioned family groups — that Eileen will actually call family members to learn more about the senior. Is that right?

Roy: If the goalposts here are so much about intimacy and knowing the senior’s reality, and we’ve acknowledged that’s not documented anywhere, then one of the wonderful things about AI is we can say: the people who know the senior are the son and daughter, sometimes the grandkids, maybe a neighbor, maybe a spouse. The way Eileen starts serving a senior is by autonomously reaching out to those people who are close to that senior and carrying out regular conversations with them over the phone to learn about that senior’s reality. It has a very nonchalant, disarming way of doing it — you don’t have to schedule meetings or fill out forms. It just calls and says, when you have a minute, let’s chat. Then it begins building an understanding of the senior’s reality, and once it crosses a certain threshold where it has enough context, only then does it begin calling the senior directly on a regular basis. And at the end of the day, it reaches back out to the son and daughter and says, hey, I spoke to your dad a couple of times today — he was really upset about something, or he’s grumpy but that’s his usual way and everything is fine. We’re at the very early stages of this, but the framework and the approach — this very different mixture of technologies coming together on the different sides of Eileen — seems to be attractive, interesting, and plausible. And as I mentioned at the very beginning, we have to go there, because we are facing a caregiving meltdown. We’ve got to find a way for technology to help us.

Ritu: We usually start with an origin story, but we didn’t do that today. With a few minutes left, I’d love to ask what brought you into healthcare, and with Eileen I can see you really resonate with this topic. How did you get into this intersection of healthcare and technology?

Roy: I used to be a clinician. I did the whole training and thought for a long time that being a practicing clinician was the way I’d go. But I was actually dabbling with technology since I was twelve years old. I stayed home from school — I had pneumonia or something — and my dad got me a Commodore 64, which people don’t even remember existed. I think it had 5K of memory. So since then I’ve been programming and building things. After training and becoming a physician and practicing, what really interested me about technology is that if you build it right, you have the ability to change the lives of people much more widely than even a very successful practice. And the other piece is that healthcare today requires clinicians to be highly specialized, doing the same thing over and over and getting really good at it. But the mission of healthcare — advancing the wellbeing of people — becomes very siloed and myopic when you only do one procedure extremely well every single day. Technology became a different pathway to realizing the same mission: to continually rethink how we can advance the wellbeing of people and make the healthcare experience less painful. Technology today just has a bigger wingspan than some standards of practice. I’m not saying it’s better or worse — I think we need both. But I found my passion in health tech, and it’s the gift that keeps on giving.

Ritu: We’re almost at the end, Dr. Schoenberg. It’s been wonderful chatting with you. Do you have any closing thoughts or predictions for where you see AI going within the next year?

Roy: I’ll just say this: I think we’re very young in this. We get very excited about what AI can do, and I’m pretty sure that, not unlike other technologies, there’s going to be a long period of maturation — mistakes will happen and there will be things we’ll have to worry about. But the entrance of AI as a surrounding system for our healthcare experience is an inevitability. If we know we’re going to get there, you’ve got to put one foot in front of the other and start walking. That’s exactly what we’re doing. It’ll take a village — we need the brainpower and creativity of many people. But we couldn’t be more excited. I think we’re going to change the world no less than what telehealth did.

Ritu: Awesome. Thank you so much, Dr. Schoenberg. It’s been a pleasure having you on the podcast.

Roy: Terrific. Thank you so much for having me.

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Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hello listeners, a very warm welcome to the Big Unlock Podcast. My name is Ritu, and I’m the managing partner at Damo Consulting and co-host of the Big Unlock Podcast along with Rohit. We are extending a very warm welcome today to Dr. Michael Hasselberg. He’s been on the Big Unlock Podcast before — in 2022, season four, episode 138.

Welcome back. Dr. Hasselberg is the Chief Transformation and Digital Officer at Nebraska Medicine, where he is leading enterprise-wide efforts to modernize care delivery through digital innovation and operational transformation. He has a background in emergency medicine, public health, and informatics, and brings a uniquely systems-oriented perspective to scaling technology in complex health environments. Today he’s joining us on the Big Unlock Podcast and we are really excited to have this conversation. With that I’ll give it to Rohit for his introduction, and then it’s all yours, Dr. Hasselberg. Welcome once again.

Rohit: Thank you. Welcome, Michael, to the podcast — really nice to have you again. I am CEO of Damo and co-host of the Big Unlock Podcast. Short intro from our side; over to you.

Michael: It’s great to be back, and a lot has happened since we last talked in 2022, so I’m excited to dive in with both of you.

Ritu: Almost seems like a different era. Seriously. So, Dr. Hasselberg, we always love to start with an origin story because our listeners like to hear unique stories about how people got into healthcare and how they got to where they are today. If you’d like to start with that, we’d love to hear your story.

Michael: Sure. First and foremost, I’m a nurse, and very proud of being a nurse. I went on to become a psychiatric nurse practitioner very early in the psychiatric nurse practitioner movement. When I graduated, there weren’t actually any jobs for psych NPs in the city of Rochester. So, my first job as a nurse practitioner was about an hour and a half to two hours away from Rochester, where I drove every day to a very rural community in New York State where I was the only psychiatric prescriber for about six counties.

I managed the outpatient psychopharmacology clinic and the jails and the nursing homes. It was a pretty transformative experience that made me very passionate about serving vulnerable communities. The patients I served were so grateful that I was willing to drive that far every day to provide care. That experience became my underlying “why” for the rest of my career — how can we find more efficient ways to get healthcare out to communities that weren’t getting the care they deserved.

From there I finished a traditional research PhD, and after that I was tasked with developing a telehealth infrastructure for psychiatry at the University of Rochester. This was well before telehealth was widely reimbursed in the States. We built a very large telehealth infrastructure across New York State, and eventually reached a point where I couldn’t grow it further because I couldn’t graduate clinicians fast enough to take on more patients on the other end.

That’s when I really leaned into innovation. I started thinking about whether we could use technology without needing a clinician on the other end to deliver care. I got into the world of mobile apps and started working with the engineering school and computer science department to develop mobile apps for behavioral health. Then I moved from mobile apps into virtual reality when the first Oculus Quest headset came out — affordable, powerful, and untethered — and started developing mindfulness and meditation applications for VR headsets.

By that point I had different layers of digital interventions: apps, telehealth, VR headsets, and in-person care. I got really interested in data science and started thinking about whether I could use big data to risk-stratify patients to the right level of care at the right time in the right place. That drew me into machine learning and data science about seven or eight years ago.

Then COVID hit and every health system had to go digital overnight. I was put into a new position as Chief Digital Health Officer at Rochester to lead that digital transformation strategy. About two to three years ago, when the world was introduced to generative AI, our innovation team at Rochester got early access to some of those foundation models in a secured, private way. I was pretty blown away by their power. Around that time — 2022, when we last spoke — I was making comments in national forums that with the advent of generative AI, it had never been easier for health systems to develop their own AI tools in-house to solve their own problems, rather than relying entirely on vendors.

That’s when I got to meet Dr. Michael Ash, who was serving as the Chief Transformation Officer at Nebraska Medicine. Dr. Ash is a very innovative, entrepreneurial, visionary thought leader from a technology standpoint. We started exchanging ideas, and he was eventually named incoming President and CEO of Nebraska Medicine. He invited me to Omaha as a visiting professor to see the health system, and I fell in love with Nebraska, Omaha, and the organization. It was a very hard decision because I love Rochester through and through, but I took the leap to join Nebraska Medicine in Dr. Ash’s former role as Chief Transformation and Digital Officer.

Ritu: Wow, that’s a great recounting of the entire story — thank you. Really interesting for our listeners to hear as well. One thing I picked up on is that your title emphasizes transformation, not just Chief Digital Officer. What’s the difference, and where do most health systems fall short when trying to bridge that gap?

Michael: One of the things that excited me about Nebraska Medicine is that they are, I would argue, more mature and out ahead in terms of their leadership structure. They are very nimble in regards to the number of chiefs who report directly to the CEO and president. There are six chiefs — the Chief Transformation and Digital Officer being one — along with the Chief Operating Officer, Chief Financial Officer, Chief Medical Officer, Chief Nursing Officer, and then a combined Chief Legal and People Officer.

What excited me about Nebraska to do transformation at scale is that it goes well beyond just technology. In my role I’m accountable for three main verticals. First, IT — the Chief Information Officer reports up to me. Second, our innovation and venture arm, which we can dig into deeper if listeners are interested, because we’re doing some really cool things there. And third, the strategy office — we have a VP of Strategy Enablement and an entire strategy office that looks at markets, guides acquisitions, and evaluates joint ventures.

The strategy office is also where our AI efforts and engineers sit. Having strategy, innovation, and IT all underneath essentially a transformation office means we’ve got the right ingredients to do transformational work at scale. That’s what’s really exciting for me and why I took the leap to Nebraska. I think we’re very well positioned structurally to not only improve the lives of all Nebraskans, but to become the gold standard for the rest of the country on what the future of healthcare looks like.

Ritu: That’s a really good answer. Having those three things — IT, innovation, and strategy — reporting into you is directly related to the next question. A recurring issue we hear from Chief AI Officers and Chief Digital Officers is a lack of operational ownership for digital initiatives, which leads to most pilots failing or fading into obscurity. Having those three arms under you and being fully responsible must be doing a lot to ensure the success of these initiatives. We’d love to hear more about the venture arm — what’s your approach to developing new technologies and incubating ideas?

Michael: One of the really exciting things is that we already have a commitment from the health system, the university, the state, and our philanthropists to build a $2.2 billion Hospital of the Future. It’s already underway — we’ve got a hole in the ground, construction has started, and the doors will open on our main campus in about five years. We know that with healthcare and technology changing so quickly, it’s really hard to answer the question: what will the hospital room of the future look like five years from now?

To prepare ourselves to answer that question, we’ve already made significant investments in our innovation ecosystem — hundreds of millions of dollars into our Edge District. The Edge District is focused on two things: what I’d call inside-out innovation, where our researchers are developing new intellectual property that we look to potentially commercialize and spin out as startups; and outside-in, where local startups that want to get into healthcare and understand healthcare problems can get involved.

On the university side, we’ve also made significant investments in simulation and education for our future leaders. We have a program called iEXCEL, which I believe is one of the largest, if not the largest, simulation centers in the entire country. They’re using very frontier technology — we’re leaning heavily into holograms. We actually have a hologram theater where we can create holograms nearly the size of a room of hearts and organs that students can interact with as they’re learning anatomy and surgery. Of course, we also have simulation rooms and surgical simulation suites in that building.

But the really unique and exciting element is our Innovation Design Unit and Bridge Program, which sits inside Nebraska Medicine itself. We’ve built a 17-bed med-surg unit that can scale up to an ICU if needed, and it has all the bells and whistles of technology. The unit itself is modular and all glass — touch the glass and it frosts over. When we hire staff to work in the Innovation Design Unit, we look at their behavioral profiles during interviews: are they agile, knowing that how they deliver care and the technology they use is going to be constantly changing and iterating?

There’s literally a bridge off that unit to our Bridge Program — a small mockup of the unit where our engineers, data scientists, and clinicians bring in vendors or build new technology, test it in that environment, and then nurses and physicians can come over, play with it, and test it before we bring it live with patients in the Innovation Design Unit. The learnings from those technologies are informing exactly what we’re going to put into Project Health, our new Hospital of the Future. I’ve been to innovation programs around the country at some of the leading health systems, and I have never seen anything like this.

Ritu: Amazing. So, these holograms are like digital twins?

Michael: Yes, exactly. It sits on the university side, and essentially as we’re training students, we can input radiology images and the system creates a hologram of that organ from the image. Students can interact with the hologram as they’re learning anatomy and how to perform surgery.

The other exciting thing is that Nebraska is a rural state and the University of Nebraska has four campuses, one of which is in a rural part of the state where a new medical school cohort is starting up. The university has worked hard on how to transmit these holograms remotely out to that campus, so faculty specialists in Omaha can continue to support and teach those students at a distance using this forward-thinking technology. Really special and unique — and it’s what I love about being part of an academic health system, really partnering with the university side to educate our future clinicians so they’re ready to function in a hospital of the future that is digitally enabled and AI-augmented.

Rohit: With so much innovation going on, how do you prioritize and allocate resources? And if you’d like to share any success stories — and maybe some failures from a learning perspective as well?

Michael: The maturity of our structure really drives this. We have purposely placed AI — specifically our AI engineers, data analytics, and data scientists — in our strategy office, which keeps the projects we take on aligned with the most important priorities of the health system. Starting from our board metrics down to what we call our Delta projects, and then into our OKR projects.

When a new use case gets submitted, we have a very rigorous evaluation process, and where a proposal scores most points is strategic alignment to our top priorities. Within the strategy office we have a team of process engineers who, when a use case is submitted, deeply examine what problem is trying to be solved and what workflows are involved. The process engineers work closely with our enterprise architects and solution architects in IT to ask: do we already have a technology on our stack that could address this problem? If not, we work through the build-versus-buy question.

I’d argue we are more of a build shop, and that hasn’t always been the case in healthcare. We build about one new generative AI tool per month in-house. We now have 28 tools we’ve built ourselves, deployed at scale — and those AI use cases, which are aligned with our biggest health system priorities, each get what we call a Delta team. The Delta team includes operators, clinicians, informaticists, and technologists. We make sure that from build through deployment, the initiative is properly resourced to be successful and to scale. Once it’s scaled and running, the Delta team moves to the next project, and the tool is maintained as an operational program within the health system.

We’ve had a ton of success focusing on back-office work: throughput, clinical capacity. We’ve built AI tools that identify which patients in our hospital are ready for discharge and automate notifications to nurses — “this patient is ready, here are the orders needed to move them to the discharge lounge and out of the hospital.” Very similar tools around transfers: identifying which patients at rural hospitals across the state are appropriate to transfer to us, and when a patient is with us, identifying when they’re ready to transfer back. Just through automating capacity management, we’ve created over 30 net-new beds in our hospital — not by building new beds, but by automating the processes.

We’ve also automated a lot of scheduling and surgical optimization, getting the right patients in to see our surgeons at the right time. In the revenue cycle we’ve had a lot of success automating denials management, prior authorizations, and registry reporting — freeing up nurses from manually extracting data to submit to registries so the AI can do that extraction instead.

An example of something that started with significant resistance: a faculty member — a brilliant heart surgeon — went to a conference, met with an AI vendor, and came back convinced he needed their specific tool to help identify structural heart defects to get the right patients to him more efficiently. He was adamant: “The vendor says it’s plug-and-play, fully integrated into the EHR, and I needed it yesterday.” I had to spend a lot of time with him to take a step back and ask: what is the problem you’re actually trying to solve?

Once we fully understood that, I told him we have tools in-house and a data science team that I believed could not only build the same solution, but build it better because it would be personalized to his workflow. He was very hesitant and said, “I’ve heard this before — I don’t have six months to a year for you to build something.” We got past that. We were able to build a solution in less than a month, and he and his service line are very happy because it not only solves his problem, it’s tailored exactly to his workflow.

Ritu: Those are really good examples. We were bracing for the usual ambient documentation and scribe story, so it’s nice to hear about different applications.

Michael: Something people don’t know about Nebraska: when I think of the two most transformative technologies in healthcare to date, on the patient side no one would question that telemedicine has been the most transformative. And Nebraska Medicine was the birthplace of telemedicine — it started here in the Department of Psychiatry, in partnership with the Bell Telephone Company, in the 1950s. Most people don’t know that.

On the provider side, no question — ambient documentation is the most transformative technology. We were the first digital scribe pilot site in the country, in partnership with Nuance and Rush in Chicago, co-developing that technology. The two most transformative technologies in healthcare, and Nebraska was at the forefront of both. I could absolutely talk about our successes with ambient documentation, but I did want to highlight that we were one of the first, working with Nuance years ago as they were developing that technology.

Ritu: Great information — the listeners will love hearing that. We’re almost at the end; time has flown by. We’d love to hear what you see coming down the pipeline in the next one to two years that could be as transformative as ambient documentation.

Michael: I can tell you, and this may not be the sexy answer listeners are hoping for: the biggest transformative project I’ve kicked off as the new Chief Transformation Officer at Nebraska is actually a cleanup project. I’ve just launched application rationalization, and it is not an IT-driven project — it’s a health system strategic initiative.

Over the years, partly as a result of our innovative culture, we’ve had significant application sprawl. Our technology stack is very, very complex. My argument is that if we really want to continue to be leaders in AI and innovation, we have to simplify our tech stack. It will create more standardized workflows across the system, and it will free up my technologists, informaticists, and innovators — who right now are spread really thin managing so many applications.

We’re very excited, and I believe we’re going to be able to cut two-thirds of the applications on our stack over the next couple of years. That will create more efficiencies, unlock more innovation, and set us up even better from a data enablement standpoint to continue leaning into AI. Not the sexy answer, but it’s like spring cleaning — and we’ve got a lot of it to do.

Rohit: I’d add that it’s also an opportunity to infuse the remaining applications with more AI.

Michael: A hundred percent. We’re going to lean into our core applications and their functionality, and every vendor right now is introducing AI capabilities. I want to lean into my core platforms, and to do that I’ve got to remove the noise. This is a health system-level strategy, not an IT-driven initiative. We’ve already been able to identify and retire several applications, so we’re well underway.

Ritu: We’re almost at the end of the podcast. I’m sure listeners have a lot to unpack, and we’ve learned a lot of new and interesting things about Nebraska as well. Thank you so much for sharing, Dr. Hasselberg, and thank you once again for being on our podcast.

Michael: I loved it — this was a lot of fun. Hopefully you’ll invite me back in about four years, right around the time we’re opening our Hospital of the Future. Technology will have changed quite a bit by then.

Ritu: That sounds great — we’ll definitely be there for that. Thank you so much for being on our podcast.

Michael: Thank you. Alright, have a great one.

————

Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]   

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hello everyone. Welcome to the Big Unlock Podcast. My name is Ritu and I’m your co-host today along with Rohit. I’m the managing partner at Damo Consulting and host of the Big Unlock Podcast. Really happy to have our listeners here today and to welcome Dr. Klasko to the podcast.

He’s one of the most provocative voices re-imagining the future of healthcare. In 2024, Becker’s Hospital Review named him as one of the great leaders in healthcare. He’s been recognized by Fast Company as one of the most creative people in business, by Modern Healthcare as the number two most influential person in healthcare, and by Ernst & Young as Entrepreneur of the Year.

Former CEO of Jefferson Health, he led its transformation into a national model for innovation, scaling it into a 14-plus hospital system. He’s also co-author of Unhealthy: A Manifesto for Health Assurance, where he challenges the industry to move beyond sick care toward true health assurance. Today, as an advisor and investor working with organizations like General Catalyst, he’s helping build the next generation of digitally enabled, patient-centered care models. Known for questioning long-held assumptions, Dr. Klasko continues to push healthcare leaders to rethink not just how care is delivered, but why the system even exists in its current form.

Really happy to have you with us, Dr. Klasko. With that I’ll pass it to Rohit for a brief intro.

Rohit: Thank you, Ritu. Hi everyone, I’m Rohit — CEO of Damo and co-host of the Big Unlock Podcast. It is a pleasure to have you, Steve, on the podcast. We had such a wonderful presentation from you at Cornell Tech recently. Looking forward to an engaging session. Thank you.

Stephen: Well, thanks. You guys did a better introduction than I could have done. When you’re 72, you have about five different careers — we could take the whole half hour. What I told someone at a Forbes conference: a young woman came up to me and said it seemed like everybody knows me. I said, look, I’m 72, I’ve been a healthcare leader for 40 years, I’m still vertical, and my first five Google pages are still positive. There are only about ten people who can say all four of those things.

The simple answer is I started my career as a DJ. I’m a high-risk obstetrician who delivered about 1,500 babies in private practice in Pennsylvania and Florida. Through a series of events, I got my MBA at Wharton and became one of the leaders in studying what makes doctors different and how we handle change. I became the dean of a couple of medical schools, including one where we selected a class based on self-awareness, empathy, communication skills, and cultural competence — not just memorizing the Krebs cycle.

Then I became CEO of two different academic medical centers: University of South Florida — which, interestingly, is not in south Florida but in northwest Florida, which tells you everything about the logic of Florida — and then Jefferson, which we grew from roughly a $1.5 billion single-hospital entity to an 18-hospital healthcare-at-any-address system with an insurance company.

One of the things I’m most proud of: we merged our 200-year-old health science university with the number-three design university and created the first MD/Master’s in Design — the design of the human experience in healthcare. Our mission became being a 200-year-old academic medical center thinking like a startup, really embodying the model of what you’d get if a Silicon Valley entrepreneur and a health system CEO had a baby. We tried to create that at Jefferson, and in some respects that’s what we’re doing at General Catalyst now. We’ve acquired a health system, Summa, and created health assurance partners like WellSpan and others. It’s taking both sides — the tech galaxy and the traditional healthcare ecosystem galaxy — recognizing that neither has all the answers, and trying to bring them together.

Ritu: Thank you for that wonderful introduction — three questions straight away from what you’ve said. Let’s start with the first one. You’ve talked about healthcare at any address: telehealth, distributed care, digital front doors. COVID really normalized that, but we still haven’t seen that system come fully to scale. What is the problem, and why do you think digitization and the digital front door haven’t happened so far?

Stephen: I’ll start with two quotes. One is from Peter Diamandis, who said the problem with disruption is that it disrupts your current line of business. And we haven’t been willing — insurers haven’t been willing, hospitals haven’t been willing — to disrupt their current lines of business. We all talk about it. We talk about value-based care like it’s some Greek mythology myth, because we haven’t figured out how to make it work by and large.

One of my mentors was Bill Kissick, who wrote a book 45 years ago called Medicine’s Dilemmas: Infinite Needs, Finite Resources. He was the first to talk about the Iron Triangle of access, quality, and cost. If you remember ninth-grade geometry, increase one angle and you have to decrease another. So if you increase access, you’re either going to increase cost or decrease quality — unless you’re willing to disrupt the system. And disruption is painful.

He said, in a nonpolitical way: if anyone ever tells you they’re going to increase access, increase quality, and decrease cost — and it’s not going to be painful — they’re not telling the truth. The day after the ACA passed, President Obama said it would increase access, increase quality, and decrease cost with no pain to anybody. Whether that was intentional or inadvertent, it clearly wasn’t true. Trump said his plan would be fantastic, terrific, unbelievable, and really huge — and it was none of the four.

In every other disruption of every other sector — Uber and taxis, Amazon and retail — the players that weren’t willing to be fundamentally disrupted went away. Think Sears and JCPenney. Circuit City thought they could go all-e-commerce and failed. Others said, “Holy moly, this is real,” figured out how to make their old model work alongside a new model — think Target and Walmart.

That’s largely what’s happening right now in healthcare. This is the first time in our history where just about everybody’s hurting. For the last ten or fifteen years, hospitals ruled the roost and told insurers what to do. Then payers said, “If you don’t do this, I’ll send all my patients elsewhere.” Just look at UnitedHealthcare — since the ACA it became the second-best-performing stock after Apple, and it’s a middleman. But now they’re hurting and the hospitals are hurting too.

The simple answer is: until we recognize that the system is broken, fragmented, expensive, and inequitable — and probably unsustainable, though we’ve been saying that for a long time — something has to give. It’s really like Hurricane Katrina, where everybody said the levees wouldn’t hold until they didn’t. We are literally at that point in healthcare.

Ritu: I totally agree with you. Even at Cornell Tech, something I wrote down from your talk: true change can’t be incremental and slow — it has to be jolting, and it has to hurt people.

Stephen: And people have to fail. Sears and JCPenney failed. Circuit City said “we’re going all-e” and failed. I did a lot of work with Target and Walmart when I took over Jefferson, and their whole philosophy was: we’re really good at what we do, we’re not going to abandon that, but we have to be just as good as Amazon at what they do. In one case they bought a new platform, in another they built one. That was an aha moment for me.

At Jefferson, we have one of the best pancreatic cancer surgeons in the world — Dr. Charles Yeo. If you have pancreatic cancer, you don’t care about our digital health strategy, our TV screens, or our food. You want to see Dr. Yeo, and people come from around the world for that. But for the other 97% of people in Philadelphia who don’t wake up thinking of themselves as patients, all we could say was: come to my office, my ER, my urgent care, my hospital. None of them wanted to do any of that. They wanted to be a person with diabetes or congestive heart failure or COPD who could thrive without having to think about it.

One of our first big successes at General Catalyst was Livongo — sold for $18.4 billion. All Livongo did, when you really think about it, was say: we’ll be your invisible friend if you have diabetes. They partnered with Jefferson and said, “Klasko’s great — but he’s great if you need his office, urgent care, ER, or hospital. That’s not what you need 97% of the time. We’ll be there for the other 97%.” That’s what tech, payers, and health systems have to learn to do together. The ones that can disrupt on access, quality, user experience, and cost will succeed.

Ritu: That leads into the new era — you’ve also talked about how the whole idea of the annual wellness visit is going to be outdated because of the constant stream of data coming in from wearables. People need AI companions, and they’re so used to getting everything on demand. The whole model of going into the doctor’s office, seeing the doctor, and then waiting for information is going to be very outdated very soon.

Stephen: The annual visit is a farce. Think about it — imagine if your entire financial life was managed by checking in once a year and ignoring everything in between. Oh, by the way, there was a war, or inflation ticked up four years ago. We’ll just check you annually. I had my Mayo Executive Wellness exam and they gave me all this guidance on exercise and weight loss. I’m a marathon runner. Two days later I tore my hamstrings. Everything they told me was immediately irrelevant.

If they had gotten the data from my Oura ring, they would have said, “Hey Steve, you were running 25 miles a week and you stopped on Tuesday — we’d like to talk to you.” Well, I didn’t just stop. I did a face plant because I tore my hamstrings and had them surgically reattached.

My new book is going to be called — as I mentioned at the Cornell talk — Swifties, Startups, and the Singularity, where I come back from 2035 as the Chief Digital Health Officer for President Taylor Swift, because the Swifties have become a political party. We could do worse. Our healthcare motto was “make healthcare Taylor-made, make it Swift” — neither of which was true in 2026. And one of the breakup songs was: we were never, ever, ever going back together with annual physicals. Even the term “physical” is asinine — it means I’m going to check everything from the neck down once a year.

One of the companies I’m involved with, NeurFlow, did a study showing that about 30% of people who have attempted or completed suicide had seen their primary care doctor within the last four or five months. They had a “physical” and the doctor didn’t connect what may have been a warning sign. NeurFlow actually connects those warning signs. So the whole concept of continuous health narratives and much more sophisticated wearables is critical.

I had a cardiac bypass two years ago. I left the hospital on day two — actually DJing for the nurses on day two. Typical cardiac rehab would have me sitting in a waiting room about five weeks later, getting wired up and walking on a treadmill. I’m a marathon runner — I wasn’t doing that. So I talked to my cardiologist and we connected my Oura ring and Apple Watch data. He had me start walking around week two, monitoring heart rate variability, and gradually increasing. I did it all from home at a much lower cost and was back to running within about eight weeks — whereas with the traditional approach I would just have been starting treadmill walking.

This healthcare-at-any-address model not only makes care more accessible but allows you to customize it. A lot of bypass patients are sedentary people who haven’t exercised — and that’s the one-size-fits-all model in American medicine. I had an autoimmune issue, a cholesterol of 107, and weighed 140 pounds. I didn’t need to prove I could walk on a treadmill.

Ritu: Absolutely. So Dr. Klasko, you’ve been championing radical collaboration between health systems and Silicon Valley for a while now. You mentioned Summa, but in practice, what is the biggest failure you’ve seen where collaboration looked good on paper but didn’t work in the real world due to culture, incentives, or ego?

Stephen: I think you answered your own question — culture and ego. Let me expand on that. First, here’s what we hear from health system CEOs: “We are tired of putting all the Lego pieces together for all the point solutions your 28-year-old founders create.”

I’m a board advisor to five very good women’s health AI and tech companies handling different parts of women’s health — fertility, menopause, the vaginal microbiome, pregnancy. Why don’t they get together and say, “Throughout a woman’s life, we can now do more of this at home”? It’s founder ego. I sometimes have to explain to these companies: you’re not going to create an IPO based on dense breasts, or vaginal microbiome, or one part of a woman’s life like fertility alone.

The second thing is that we haven’t been that successful in the past. As one CEO told me: “You spent 40 years telling us technology would make our life easier.” Start with what he called the epidemic of EHRs — they were supposed to make our lives easier and all they did was create more administrators. There’s real skepticism that AI isn’t just our new cool EHR.

And then the third thing is incentives. One of the things I’m proud of at Jefferson: I wrote an article called “I’m Never Getting Fleeced Again.” I was at University of South Florida and a CEO came to me in 2009 — a virtual health company, even back then. He said, “Steve, I want to take you out to dinner. We couldn’t have done it without you. USF was our first client.” I asked why the dinner. He said, “We just got valued at $800 million.” I said, “That better be one hell of a dinner, because we didn’t get anything out of that.” He said, “No, no — I’m also going to send you four fleeces.” So my article was “I’m Never Getting Fleeced Again.”

If I’m really involved in helping create billion-dollar companies, that has to change. At Jefferson, we literally put a General Catalyst person on our cabinet. We co-developed. With companies like Carrum Health, we gave them total access to all our doctors and systems, but we also had an opportunity to gain equity — not pay-to-play, just true partnership. When Carrum became a significant company, I didn’t feel like I’d helped create something and gotten nothing in return.

From Jefferson’s perspective, it was also a portfolio diversifier — which is what every health system needs. If you’re struggling to make a 2% margin on your hospital business and you can’t depend on investment markets continuing to grow 10 or 15% a year, while you’re getting less and less from insurers — meanwhile $30 billion is being spent on digital health and somebody’s making a lot of money, and they can’t make it without you — you don’t need to be a genius to ask: how do I participate in that in a legal and ethical way? That’s what I talk to hospital system CEOs and boards about.

Rohit: Steve, I’m thinking about the fact that hospitals are largely set up as not-for-profit — that’s in their DNA. You’ve been CEO of a not-for-profit system. Now you have General Catalyst, clearly driven by profit, with investors expecting a return, coming in through the Summa partnership. How do you bring those two worlds together?

Stephen: I’ve been on the board or in the CEO seat of three kinds of health systems: not-for-profit, for-profit, and religious faith-based institutions. Here’s what I’d say: by and large, the faith-based institutions were the most mission-driven and the least profitable. We started every board meeting with our mission. Beyond that, the distinction between not-for-profit and for-profit is much more variable than people think.

I’ve seen not-for-profit hospitals that talk about nothing other than donor dollars, US News & World Report rankings, and beating competitors in research. And I’ve talked to people like Jonathan Perlin, who was Chief Medical Officer for HCA and now runs JCAHO, who would push back on that. He’d say, “We probably did more to normalize obstetric care through our for-profit system.” Chip Kahn, head of the Federation of American Hospitals, would say: “The difference is we pay taxes.”

That said, there are absolutely for-profit systems I wouldn’t want to be part of — and there are not-for-profit systems I wouldn’t want to be part of either. When you get to General Catalyst, it’s a genuinely different situation. I know it’s easy for me to say, but when we wrote that book — Unhealthy: A Manifesto for Health Assurance — we called it a manifesto deliberately. And my partner, who I now have the honor of working for, made a decision that to truly actualize what we wrote, we have to prove it.

We did not go and acquire a sexy, profitable LA health system. We acquired Summa Health in Akron, Ohio — literally in the middle of the country, in the middle of how health systems are doing. They weren’t going bankrupt, they were in the upper-middle tier on quality, but not what everyone was talking about. A couple-billion-dollar, few-hospital system with a small insurance company. We have this principle called responsible innovation. We didn’t invest a few hundred million dollars there to come back with a quick profit. It’s a ten-year type of commitment.

And honestly, partly why I’m not the most directly involved — I’m 72, unless they’re building assisted living facilities. But it’s exciting and I think it’s being done for the right reasons.

What frustrates me is that I’ve been doing this for 40 years, and when you go to Health Evolution, Forbes Healthcare, or similar events, you’d think we have the most equitable, fair healthcare system in the world, because everybody’s talking about what they’re doing. We’ve been talking about the same transformations for decades. The quote I used at Cornell: Jason Kidd, when he came to the Dallas Mavericks who were 24 and 52, said “I’m going to turn this team around 360 degrees.” We do a lot of turning things around 360 degrees in healthcare.

I’m hoping that people who listen to the Big Unlock Podcast and who went to the Cornell Health Tech Summit are willing to say: I’m mad as hell and I’m not going to take it anymore. We’re not turning things around 360 degrees anymore. That’s my hope.

Ritu: Thank you. Thank you so much, Dr. Klasko. It’s been a pleasure.

Stephen: Thank you. Take care, everyone.

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Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]  

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hi everyone. Welcome to our next episode of the Big Unlock Podcast, season seven. We are really excited to have Dr. Stecker with us here today. Dr. Stecker is the Chief Medical Officer and co-founder of Insight Health, where he’s focused on applying artificial intelligence to improve real-world clinical outcomes.

He’s also a practicing cardiologist and professor of medicine at Oregon Health and Science University. His work sits at the intersection of cardiology, data science, and population health, with a particular emphasis on translating predictive insights into actionable interventions. Dr. Stecker has been a leading voice in how AI can move beyond detection to truly impact prevention and care delivery.

Today he’s joining us on the Big Unlock Podcast to explore how intelligent systems are reshaping the future of cardiovascular care. With that, a very warm welcome to all our listeners. Dr. Stecker, thank you so much for joining us today.

Eric: Hi. Thank you. It’s great to be on your podcast. It’s really an honor, and you’ve had some great guests and explored some great topics in the past.

Ritu: Thank you so much, Dr. Stecker. We are really excited to have this conversation because we just came back from HIMSS and AI was everywhere. One of the more interesting things — we went to the Cornell Health Tech Summit and they really talked about wearables and this constant stream of data that’s coming in, and how that’s going to make the annual physical obsolete.

We would love to hear your thoughts on the future of continuous cardiac care with wearables and remote monitoring with AI. Do you envision a future where cardiology becomes a continuously managed condition? And if so, how?

Eric: I think there are some very exciting possibilities, and I’m glad you brought up the idea of continuous health management and continuous monitoring.

That’s an area that’s created great excitement for many people, and I do think it is in our future. It’s important, though, to distinguish that which is an evolving evidence basis. In clinical medicine, putting my academic cardiologist hat on for a moment — there are a variety of interventions and monitoring approaches we can employ, and what we emphasize depends on what is most beneficial for patients. Continuous wearables and continuous physiologic data monitoring has some evidence for benefit, and I think that will evolve significantly over time.

It’s an area where AI can intersect very well and very effectively, once autonomous AI agents are tested and FDA approved. It’s important to recognize, though, that there is a whole set of health interventions we know are very high-impact and beneficial — we just need to work on implementing them. We know what to do; we just need to do it, and AI can really improve care for those things right now.

We don’t need new technology or large clinical trials to show benefit. We have decades of very high-quality clinical evidence. Take statin medications — cholesterol medications for patients at high risk of cardiovascular events or with known heart disease. We have hundreds of thousands of patients studied in clinical trials showing significant benefit, yet identifying those patients, starting them on medication, and supporting them to ensure they take it as prescribed — these are the challenges we face right now. That gap results in hundreds of thousands or even millions of additional heart attacks and cardiovascular deaths. This is something AI can dramatically improve today, without the need for any further study.

Ritu: That’s a great answer — lots to unpack there. You talked about autonomous AI agents, and within Insight Health you’ve had particular success building a suite of these agents. We’d love to hear more about that. I also read a news update that you were recognized by OpenAI for crossing one billion tokens. What’s happening there?

Eric: Yes, thank you. I wish Sara, our CTO and co-founder, were on — he posted something about when we got the plaque for a billion tokens. We use multiple models, by the way, but for OpenAI specifically, by the time the plaque arrived in the mail, we’d already crossed ten times that threshold.

To back up a moment — the idea for our company: we have four excellent co-founders, which is a little unique. Two of us are mid-career physicians who have been practicing clinical medicine for some time and continue to do so. We’ve had to scale back significantly to build this company, but we love clinical medicine and our goal was to remove the roadblocks and allow us to have much more impact for patients in a much less painful way. There are so many speed bumps and potholes in the clinical care delivery system.

The idea came about when my co-founder Dr. Gore — our other Chief Medical Officer — and I went for weekly runs every Saturday morning, rain or shine in the Pacific Northwest. I remember it was early December 2022, dark, rainy, cold, probably 45 degrees. ChatGPT had just burst into public consciousness. Gore said, “This will transform medicine.” We were not in the tech world, not CS folks, so it took us by surprise too. We thought, this will transform medicine — we have to be involved and help guide where it goes for doctors in general and for us specifically. That was the genesis.

We were then connected — his brother is a Silicon Valley entrepreneur with a lot of contacts — and he connected us with Jay Malson and ultimately with Saron Siva. We created the company, and within six or eight months, we had, to our knowledge, the first autonomous interaction with a patient in real clinical practice. This is a specialist practice, which has been our initial focus.

There’s a lot of great technology being developed. Google, for instance, was doing some really great work at that time. But because it was being driven from the tech end rather than the clinical medicine end, they were using patient actors to do scenarios and working on the clinical intelligence layer from that angle. We understood that interacting with patients and intelligently offloading what AI can handle — allowing patients more time to discuss their condition, talk about their symptoms, and ask certain questions within guardrails — we knew that technology could do that, and we knew that was a big part of the benefit for clinicians and patients.

We were confident enough, with our clinical experience and the technological experience of our other two co-founders, that we could make this work. In the first example, we actually had a nurse sitting with the patient in the clinic. About the first week, a nurse was right next to the patient. Then we recognized, “Hey, this is working — let’s release it and let patients do it in their own homes.” That was the genesis.

Since then, we’ve built out a suite of autonomous AI agents that can interact with patients, review referrals, review prior authorizations, summarize the clinical encounter — you’re very familiar with AI scribes — and reach out to patients after the visit. All of these are orchestrated via sophisticated technology, allowing for a much more AI-intensive experience that still feels very comfortable for the patient and for clinicians.

Ritu: That’s really interesting, because we keep hearing that AI actually just augments humans. What has your experience been in reality? Are we over-romanticizing “human in the loop,” and at what point does AI need to take more autonomous decision-making? You mentioned that you eventually removed the nurse because AI was fully capable of handling it on its own. Would love to hear more about your thoughts on that.

Eric: I think you raise a couple of excellent points. I would divide autonomous action from autonomous decision-making — I think those are two separate things. They’re often conflated, and understandably so. The reason I separate them is that once you move into the world of AI making clinical decisions and issuing orders without a human in the loop, it requires a lot of technological work — both on the fundamental technology operations and on the AI safety assurance overlay layer.

It also requires a ton of clinical validation, testing, and oversight. That’s very important. We do not have enough clinicians — not enough specialists or primary care providers — so it’s very important to move in that direction. But it’s very difficult. The other challenge is trust: patient trust and healthcare worker trust among those working alongside autonomous decision-making AI within the healthcare ecosystem.

Most important, of course, are patients — they’re the center, and the reason we deliver healthcare. So autonomous decision-making is important and will come and needs to be developed, but I think we should avoid an excessive focus on it, because there is so much low-hanging fruit to pick right now to improve care through autonomous action.

There’s also appropriate debate about whether AI is really saving clinicians — or are they just having to look through more data generated by the AI scribe? Are they having to double-check for hallucinations? The answer is: absolutely, well-designed and well-implemented AI can act autonomously in a way that really improves both the clinician and patient experience. It has to be done well, but that’s something we can and are doing right now.

There’s so much benefit — and by benefit I don’t just mean healthcare efficiency and its positive financial ramifications for health systems and payers. I also mean patient outcomes: reducing death and disability from disease. We know what we need to do. We need to diagnose high blood pressure, prescribe appropriate medications, and support patients. Wouldn’t it be wonderful if every time a patient was started on a new medication, a nurse — whether an AI nurse or a real nurse — contacted them and asked: “Did you fill that prescription? How’s it going? Are you having any side effects? Do you have any questions? And when would you like me to check in again?”

If a patient says, “Check in with me in a month” — you check back in a month. Are they still taking the medication? Is it okay? Just that action can dramatically reduce mortality among middle-aged and elderly people in the United States, simply by diagnosing high blood pressure, suggesting the correct medication for the clinician to start, and then checking in with the patient. This is not a “sending rocket ships to Mars” kind of thing. We can do this right now — and in fact, we do.

Ritu: That’s a very important distinction you’ve made between autonomous action and autonomous decision-making — something really worth thinking about. Thank you for clarifying that. But that leads directly into the next question: you made a correct point about ambient AI and other tools generating more data and cognitive load for clinicians. AI can generate a flood of alerts, risk scores, and predictions — more and more information. What are your thoughts on the signal-to-noise problem? How do you ensure AI is surfacing the right interventions without overwhelming clinicians or patients? At what point do you decide how much is enough?

Eric: That’s absolutely right. Using that example — if you’re checking in with patients weekly on an oncology issue and you generate a three-quarters-of-a-page summary every time and push it into the EHR, somebody then has to look at it and decide what to do.

This is exactly why having clinicians involved in technology development and implementation is critical. Dr. Gore and I are mid-career — we’ve been attending physicians for 15 to 17 years. We have a lot of experience in clinical medicine, and we still love it. We’re not looking for an exit; we’re making our ecosystem better.

Involving clinicians in a meaningful way — not just as Chief Medical Officers with a couple of consulting meetings here and there, but actually integrating them into product development and implementation — that will be essential. Because exactly what you raised will be highlighted immediately. “Wait, you’re checking in with this patient twice a week — how do we manage that information? Only escalate medical flags. We need a protocol to distinguish routine symptom responses from things that require documentation. Maybe it’s a floating dashboard.” Involving experienced clinicians is the key. If you leave this only to people who have an MD but never practiced, or only to technology developers, the issues you highlight will be a major problem.

I don’t want to whitewash this — the technology advances so fast that sometimes we need to catch up. Having AI scribe documentation that’s two pages long may suit some clinicians, but it creates a huge cognitive load for many others. You really need abbreviated summaries that highlight key things.

You also raised alert fatigue, which is extremely well-documented and a serious problem. I’m old enough to remember paper charts in medical school. When EHRs first came out, everyone was splashing alerts everywhere, and people just clicked “Okay” to get through them. That issue is better understood now, but we may be entering a new era with AI where we need to relearn that lesson. I hope not — and the more experienced clinicians are involved, the quicker we’ll learn it.

Ritu: It’s really interesting to hear that you’re mid-career and still love medicine. That reminded me — we usually start the podcast with an origin story about how you got into healthcare, and we didn’t do that this time. We’d love to hear how you got into this, how you chose cardiology, and how you got interested in the intersection of technology and healthcare. Doctors really bring a unique perspective because you’re there every day and you know what needs to work.

Eric: My father is an engineer and my mother is a social worker, and I am an amalgamation of those two ways of thinking — which is a great fit for medicine: thoroughly analytic, but also with the interactive and social insight that social work requires.

The reason I got into cardiology is that, honestly, memorization is not a strength of mine. To get into medical school you generally need to be an excellent memorizer, and I’m about average for a smart person — which, compared to the average medical student, makes me a bad memorizer. I was somewhat dismayed in the first couple years of medical school, memorizing lists and being graded on how many items out of ten or twelve you could retain. I did fine, but it was painful.

What I loved was physiology — how systems work together. I would understand it quickly, remember it well, and integrate it into practice. In my third and fourth years, I recognized that cardiology is rich with physiology, and that you can have a major impact on patients’ health and longevity. The interesting procedures, depending on the specialty, were also a draw. For all those reasons I gravitated to cardiology and ultimately to electrophysiology.

As for technology — my father worked at an engineering company, and when Oracle first became available to consumers, we got it: floppy disks and a shelf of manuals two feet long. I learned Oracle, worked at my dad’s company, and created SQL databases. That gave me a taste for technology, a sense of it. I never pursued it further — no programming, no CS degree — but it kept me interested and involved. And ultimately, that’s how Dr. Gore and I thought of the idea and then contacted our other two co-founders to start the company.

Ritu: Very interesting. Thank you for sharing that, Dr. Stecker. Do you think the role of the cardiologist is going to get redefined in an AI world as AI takes on more diagnostic and predictive tasks? How do you think the field needs to evolve to keep up with this wave of technology that seems to be threatening to overwhelm many specialties and healthcare in general?

Eric: I sure hope it will absolutely happen. My hope is that clinicians and patients do not need to evolve too much — that the main issue is establishing comfort and warranted trust with the implementation of technology, but that the technology can fit around the current experience and improve it dramatically, unlike EHRs of 15 years ago — or frankly right now.

An example of that is our autonomous AI agents that reach out to patients before visits to gather their basic medical history, understand a patient’s pain syndrome in detail, or for a cardiology patient, understand what procedures they’ve had done and where. All of this can happen at 2:00 AM if the patient is a shift worker — in their own home, on their own time. It doesn’t have to happen in the waiting room. All the questions the doctor or nurse might ask at the beginning of the visit can be handled in the comfort of the patient’s own home. That’s an example of how technology can work more effectively and can work around the needs of the patient.

Ritu: Meeting the patient where they are rather than having the patient come to you. When you talk about these autonomous agents, are you specifically talking about voice agents or how are they operating?

Eric: There are voice agents — you call up and talk with a very natural-sounding AI agent by voice only. There are also text-based interactions. Our company has technology we call “visual voice,” where it’s like texting on your phone as you’re speaking — and as the AI communicates with you, it can also pull in videos to that stream. For instance, instructional videos. An example: as an electrophysiologist dealing with arrhythmia, I frequently send out rhythm monitors. A company can send one straight to a patient’s home and they can put it on themselves. It has instructions, but if they don’t know how, our visual voice can show them a video right there — “Put it here, do this, click that.” You don’t have to look it up on the internet or call an 800 number for help.

There are many different interactive modalities. Again, this fits with the theme of making this as accessible as possible to patients, because that’s going to promote their engagement with their health and doing what we know will promote longevity.

Ritu: With all the implementations you’ve seen so far at Insight Health, have you seen particular success in any specific category, or do you think agents are generally successful across the board?

Eric: We have seen a lot of success. It very much depends on the context — whether it’s a mid-size clinic, an insurer, a smaller or large health system. The needs will be very different for each. That’s the strength of the deep tech stack we’ve developed; we can fit any kind of need.

One example, in keeping with public health — I have a master’s in public health as well — there is a well-established set of preventive activities: colorectal cancer screening through colonoscopies or stool-based or blood-based testing, breast cancer screening, cholesterol checks, blood sugar checks. These are very well established as beneficial, but it’s very challenging for payers and insurers to transmit that down into health systems, clinics, and to patients — even when they’re highly motivated and have bonuses aligned to good care through Medicare plans.

Payers have limited ways of intervening on those gaps. Say 50% of patients aren’t getting colorectal cancer screening, and death from colon cancer is much higher in their panel than it should be. Our technology can screen, reach out to the patient, assess their interest in colorectal cancer screening, educate them about it, assess their preference — colonoscopy, stool-based home test, or blood-based test — and then actually arrange it. It can schedule the colonoscopy, arrange prep, and screen whether they need to see a gastroenterologist first or can go straight to colonoscopy.

For me, the most impactful work is what touches public health and population health. But I recognize that every clinic and every clinician has different pain points, and we can insert ourselves into any of them.

Ritu: Time’s flown by and we’re almost at the end of the podcast — it’s been a great discussion. Thank you so much, Dr. Stecker. Any last thoughts or closing advice you’d like to share with our listeners before we wrap?

Eric: I know you’ve got a sophisticated audience, and I think it’s important for them to realize that as we progress along the spectrum from autonomous action to autonomous decision-making, it will be critically important to engage the workers within healthcare organizations to ensure it’s implemented well and that trust is established. And, of course, ultimately the patients.

The further upstream we are from patient interaction, the less critical that trust-building is. If it’s point solutions working on the back end of the healthcare ecosystem, that’s relatively straightforward. If it’s patient-facing, it’s really important to work with experienced people who can do it well. And as we progress toward the world of autonomous decision-making, wearables, and constant care delivery, we’ll really need to work through what that means as a society and build acceptance before it can gain traction.

Ritu: It might be happening sooner than we realize — the COVID era of AI. Thank you so much, Dr. Stecker. It’s been a pleasure having you on our podcast.

Eric: Thank you. It’s been a great time.

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Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]
Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.

Ritu: Hi everyone. Welcome to The Big Unlock podcast, and today we are really happy to have with us Rachel Feinman, a leader at Tampa General Hospital who’s helping shape the future of digital health innovation. She works at the intersection of clinical operations, digital transformation, and emerging technologies such as AI. And she brings a thoughtful perspective on how health systems can move from technology experimentation to real operational impact. And like we were talking about at HIMSS, get out of pilot purgatory. So really looking forward to having Rachel with us here today. And welcome to all our listeners. My name is Ritu Roy. I am the co-host of The Big Unlock podcast along with Rohit. I’ll ask Rohit to quickly introduce himself, and then it’s all yours, Rachel. Thank you for joining us today.

Rohit: Thank you, Rachel, and thank you, Ritu. I’m Rohit Mahajan. I’m the co-host of The Big Unlock Podcast along with Ritu and also the CEO at BigRio. So, super excited to have this conversation. And over to you, Rachel.

Rachel: Thank you so much for having me. I’m excited to be here to talk to you guys today. It’s funny, Ritu, you started talking about pilot purgatory, and at TGH we don’t do pilots. It was a mandate from our CEO, John Couris, after a lot of frustration with the fact that a lot of pilots are akin to a slow no, or an inability to show alignment or drive results. And so some of it’s a little bit tongue in cheek, I think, in terms of naming it a pilot versus something else, because of course we don’t just initiate everything at scale right away. Yeah. But the concept is we’re not going to be in the business of endless pilots. What we’re going to do is we’re going to start with a thesis. We’re going to identify a partner, a solution, start in a place where we think we can drive results, measure those results, and then if it works and it’s driving the results that we are anticipating and wanting to see, then we’re going to scale it quickly. We’re not going to stay in that purgatory that you were talking about. So I think it’s really important from a system perspective for us to think like that. Think about trying things, scaling quickly, driving impact, and really why we’re doing what we do. And it’s about impact.

Ritu: No, that’s great. Thank you, Rachel. I think the listeners would be really interested to hear your origin story because you have a very unusual background with law, and then you pivoted to healthcare. So we would love to hear how you got where you are and what it is that you really love doing about your job, and specifically about innovation.

Rachel: Sure. Yeah. This is something I love talking about because I think there are plenty of people who find themselves professionally feeling stuck or maybe feeling like they went down a path and they weren’t necessarily using all of the skills that they have, or experiencing kind of professional joy in what they’re doing, and that was really the case for me when I was practicing law. There’s so much about it that I like. I loved the people I worked with. I loved serving clients and helping them solve problems, something that I still do today, but there were a lot of aspects of it that I didn’t enjoy. Really, as an M&A and business lawyer, I always felt like the conversation with the lawyer ended right at the good parts. It was kind of like, just as they started talking about or thinking about strategy and solving operational challenges, I was like, okay, we’re charging by the minute — or, we’re getting charged by the minute — so we’re going to hang up with you now and go draft that document we talked about. For me, it was just that feeling like I was always being excused from the party right as the good parts were starting, and then realizing and connecting the fact that as a partner within a law firm, I was actually driving the strategy and some operational decisions within our law firm. But I wanted to do that as my full-time job. And at that time I was really engaged with startups in the startup ecosystem and here in Tampa. We’re really kind of part of that rise-of-the-rest mentality that I think took shape in the last decade or two, where innovation and startups can exist and be supported in places outside of Boston, New York, and Silicon Valley. So I guess it was probably 10 or so years ago, I started advising a number of startups, doing a lot of volunteering, and that led me to my first role outside of law, which was to stand up an accelerator program focused on Israeli companies that were looking to soft-land in Florida. And one of the verticals that we ultimately focused on was healthcare. And I was just fascinated by the challenges of building a health tech startup or a med device startup and selling into health systems like the one I currently work for. And so helping those startups was great, but I really felt limited in the ability to help them from the outside. And so I had the opportunity at the time — I’m a builder, I like building new things — and this was at the same time that our CEO had the vision to create an innovation and a venture function within Tampa General. So because I had gotten to know him, I somehow convinced him — I’m so happy I did that — that I could help stand up what’s now TGH Ventures and translate his vision into practice and build a team around all of it. And it’s just been so much fun. This industry that we’re in is plagued, fortunately or unfortunately, with endless challenges. It’s also an industry that touches every one of us as a patient or a family member. And so the opportunity to really dive in and solve challenges in an industry that I know touches everyone is really impactful. So I have fun every day.

Ritu: That’s an amazing origin story, and we are so happy you kind of combined all your skills. I think the lawyer path came in very handy when you were convincing, right? You have those skills to work.

Rachel: Yeah. I like to say I’m not officially a lawyer in my job, but I get to play one on a very frequent basis because we’re negotiating deals regularly with partners that we work with, and of course when we make our investments. So it definitely still comes in handy.

Ritu: Great. So Rachel, I would like to circle a little bit back to the pilots again because we were talking to somebody else and they made a very good point that with all these new innovations, especially with AI coming out, sometimes the mentality is, okay, fail fast and innovate. But in healthcare you’re like zero risk and you really have to look at the safety aspects of it, which leads to a very bipolar situation because these two things are so much at odds. And you talked about how at Tampa you’re not doing pilots and you really look for that scaling. So how do you kind of resolve or make those two meet in the middle? We would love to know.

Rachel: Yeah, that’s a great question, and I think you hit on the reason why, as an industry, we have in the past not moved as quickly. I mean, there are good reasons for it, right? When you’re talking about patient care and safety, and oftentimes the potential for medical errors and things that can have a really significant impact, of course you need to be incredibly safe and focus in on that. Fails around safety are not okay. Right? So when we talk about failing fast, which we do often, it’s really around the fact that there’s so much opportunity to improve the system and the logistics and the administrative and operational aspects of what we do even before you get to the idea of patient care or clinical care. So that’s not to say that there are not opportunities to innovate around that, and we do, and we touch aspects of clinical care, but I think that there absolutely are opportunities to recognize challenges and move fast as it relates to — I always think about it like we’re one giant logistics company, right? When we’re coordinating care of patients, whether it’s within the walls of a hospital or it is in that connective tissue between transactional visits for patients, there’s tons of opportunity for us to look at new care delivery models and new ways of leveraging technology to make scheduling more efficient. So I think moving fast in those areas, looking at what works, seeing successes, and then scaling those is absolutely doable. And then when it comes to aspects of safety and patient care, I always like to say the old expression: go slow to go fast. So in those instances, you start at the outset with the right governance, the right people around the table, but with the end goal of going fast in mind. And then I think you can get yourself out of those cycles of admiring things and getting hung up on what-ifs and what if this happened or that happened. Get all the right people around the table, go slow in the beginning to set the right guardrails to ensure safety. And then move fast to see if something is actually going to work and make a difference.

Rohit: I was thinking about the wonderful experience I had, Rachel, at the NEXT Summit, which was a very good learning experience and very energizing. Thank you for inviting us over there. Would you like to tell us more about what’s next for next year? And also, the report was crowdsourced, so I’m sure the audience would love to hear how that was done as well.

Rachel: Yeah, sure. I’d love to share a little bit about that. So this was our very first year putting on our NEXT Summit, and really we settled on calling it NEXT because we’re focused on driving what’s next in our industry, really around innovating the business aspects of healthcare. And so we brought together around 300 attendees, made up of leaders from within our organization, investors, other health system executives, politicians, payers, folks who are involved in retail healthcare, and academia. So we had a very robust and varied audience coming together across two days to talk about and hear: what can we do? Our goal was to really be solution-oriented. A lot of times you go to some of these conferences or you hear panelists, and it’s a lot of griping about what’s wrong with our industry, what are the problems. And I think we have to recognize and name those. But our goal was, and I think we achieved it with all of our discussions, to quickly move on from, here are all of our problems, to actually focusing on solutions. That was what we did. We are going to be having the NEXT Summit again in Tampa next year, again in February. We’re really excited about that. Of the 300 people who attended, almost half of them actually came from outside of the Tampa Bay area. So that was really great, to have done this the first time without really a proven product and with a lot of people not knowing what we were going to be doing. We had so many people travel in to participate, and it was really, really great. One of the key outputs, I think, Rohit, that you were alluding to was that we worked with a frequent partner of ours, Vu Studios, that’s focused and based here in Tampa. They’re incredible at the forefront of all things AI, and their expertise really is AI and digital and film, but they do a lot. They’ve got robust partnerships with Accenture and some other groups, including us. And so what we thought was, we’ve got all these incredible minds in healthcare for two days together in one space. How can we harness this great group of people to try to drive that change that we were talking about? So we brought Vu and their intelligence hub to bear. We had one of those little phone booths — I don’t know, Rohit, if you got in it.

Rohit: I did.

Rachel: Okay. It was great. But the goal was, let’s have the first AI-generated white paper from a conference. I don’t know if we were actually the first, but I think it was the first I’d heard of it, and no one else had told me that anyone else had done it. So we centered on a topic really near and dear to many of us, which is affordability. That’s a huge challenge in healthcare. We see healthcare costs continuing to rise. And what are we, as the leaders in this industry, going to do about it? So we put everyone together and we captured thousands of insights and were able to synthesize those, leveraging AI, and generate this white paper that we sent around and published on LinkedIn and other places while people were, frankly, probably still on their flights home. So the power of AI — really excited about it.

Rohit: It was almost in real time. Yeah, it was in real time.

Ritu: Yeah. I haven’t looked at it. I would love to read it. I’ll look it up now and find it.

Rohit: Yeah. So if I may ask one more question, Rachel. You mentioned how you set up the ventures at Tampa General Hospital. So could you tell us a little bit more about the lens or the screening process, or what your vision is with this venture? And so far, have you had any successes that you would like to talk about?

Rachel: Sure. Yeah. So we do a number of things, but one of the core things is we invest in emerging startups in healthcare as a health system venture arm. Our primary focus is on driving the strategy of the health system forward. So we do significant financial diligence. We want to make sure that the companies we are investing in, we feel confident about the likelihood of a strong financial return on those investments, but we are also very focused on whether or not that company is going to help us advance our strategy as a system in one way or another. And really more specific than just improving care or driving patient experience, we’re looking very specifically and tied into our organizational action plan, which drives our organization’s strategy and those specific tactics. So a good example of that is a company that we recently invested in called Reimagine Care. Unfortunately, I’ve lived this experience this past year with my own father, who was diagnosed with esophageal cancer, and he was a patient at TGH. Unfortunately, we hadn’t yet gone live with Reimagine Care, but it really crystallized for me going through the process of managing the complex health needs and symptoms of oncology patients who are going through chemo and immunotherapy. Just trying to understand and manage what is causing these symptoms at once — I mean, it’s like a puzzle. Trying to figure out and manage the care of these patients, and the burden on our care teams is significant in terms of the number of in-basket messages going to our doctors, the nurses answering the nurse care line. It’s not 24 hours a day. They stop answering the phones at a certain amount of time, and my mom knew that. She knew, okay, if I don’t hear back the answer to these questions by this certain amount of time, I’ve got to call again because I know the nurse line is closing. And what Reimagine Care does is leverage AI coupled with 24/7 clinical support to help these patients manage their care. And one of the key drivers for us is the number of admissions of our medical oncology patients in the ED. And you have very sick patients — the last place you need them to be is in the emergency room. So what Reimagine Care has been able to do at a number of institutions where they’re already live, and where we hope they’ll be able to drive the same outcomes for us, is drive up to a 70% reduction in avoidable emergency room visits for these oncology patients, improve the satisfaction of our patients, and also help eliminate the burnout of our providers. So that’s an example of a company that we’re invested in, and I think in the next few weeks we will be live with at TGH, helping patients like my dad who are battling cancer.

Rohit: That’s wonderful to hear.

Ritu: Yeah. Great story. Thank you for sharing that, Rachel. I mean, that really hits home when you have a personal anecdote to share. So Rachel, really interesting to hear about the report as well. Would you like to share, from all the research and the published report, are there any specific areas within healthcare that you feel are very underutilized, or where the real opportunities are, say in the next one to three years? Any advice for startups or people who are building? What do you think you would really love to see, or something you haven’t seen so far, and you feel that the market is ripe for that?

Rachel: Yeah, I mean, I hate to go where everyone goes around AI, but I mean, I have to. At TGH, we are deploying AI solutions at a rapid rate. I’m very excited about that. I’m very bullish on our opportunities to leverage AI across domains to be able to support our teams and our patients. So I think that’s one of the things. I think the other thing that’s really important, and folks who are building, I would encourage them to focus on, is that we still have opportunities to improve the way that we deliver care. More and more care is going into the home. More and more care is going to settings outside of the health system. And like I mentioned, that kind of fabric between transactions — we’re very focused on that as a system, not really being transactional with you and seeing you at these particular places, but how can we make sure that we thread all of those together for a seamless experience for you and, frankly, one that’s going to enhance your care, make sure nothing falls through the cracks, make sure all different care providers are communicating with one another, and you don’t feel like you’re in different specialist silos. I think there’s still a ton of opportunity to make an impact around that.

Ritu: Great. Thank you so much. I think we are almost at the end of time, so Rohit, would you like to ask any final questions?

Rohit: Yeah, sure. So Rachel, from a Tampa General Hospital perspective, would you like to share any big plans on expansion or new things that are happening over in your system?

Rachel: TGH is constantly growing. We just had a big announcement of our partnership on the east coast of Florida with Mass General. We’re really excited to be able to serve the east coast of Florida with that partnership and a growing network of specialists. We continue to grow and expand as a system in terms of our market as well as our research and our clinicians. There’s so much growth going on. I think we’re very excited about all of that.

Rohit: That was great to hear.

Ritu: Yeah.

Rachel: Well, thank you guys so much for having me.

Ritu: Thank you so much.

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Subscribe to our podcast series at www.thebigunlock.com and write us at [email protected]  

Disclaimer: This Q&A has been derived from the podcast transcript and has been edited for readability and clarity.