The Future of AI in Healthcare: What’s Next?

[0:00]  what does it mean to be a true innovator well today I've got Dr JH Sanders joining the heart and hustle podcast and we're talking about how in 1969 he knew that tele medicine was going to be the future of patient engagement we're going to talk about how his story of being a resident in a major Metropolitan Hospital and a conversation that he had with a doctor changed the future of healthcare but one thing we should also recognize sometimes when you're an innovator you are also early now in this conversation you're going to hear DR Sanders talk about how he was challenged to be able to have technology be the bridge to engage with people from across the country some of the challenges that he saw what the future of artificial intelligence looks like in healthcare and how we can continue to innovate to make massive changes let's get into the episode one of the things

[0:46]  we both knew was that because of the lack of specialty care specialty expertise in these rural hospitals when a patient came in and required specialty expertise they were immediately transferred out of the hospital to a secondary or tertiary Care Center the problem was that reduced the bed sensus of the hospital and eventually the bed census went to a point where the hospital had to close it didn't have the revenue strip economics 101 in Rural America the major employer in town is usually the hospital so when the Hospital goes under the entire socioeconomic fabric of that

[1:35]  Community goes under within a 3 to 5year period of time so he was not only looking for tele medicine to support the health care he was looking at it to support jobs and support the underlying fabric of the community that became the model for good or for bad became the model to the rest of the country so when we first hopped on with our call together you had mentioned that there was a day back in 1969 when you had professors who

[2:22]  introduce you to Tele medicine and artificial intelligence let's tell that story oh sure well um I actually need to go back two years before that 1967 uh I was a thirdy year resident at the Massachusetts General Hospital and those days they didn't have U an emergency medical specialty so the medical resident the surgical resident each took 12-hour shifts running the emergency department and I was there um that particular shift and all of a sudden the door of the ER swung open and I of course expected em to be there bringing in another classic Boston

[3:09]  traffic accident victim when no standing in the middle of the door was my professor of Medicine Dr Kenneth bird who was sweat sweating and red face and he looked at me and he started walking rapidly towards me and of course I knew exactly what he was going to tell me that he got caught in the Boston traffic again and now why was that important well Ken had an office he was medical director at Logan Airport medical station now anybody who's been to Boston knows that Logan airport and the Mass General only about 3 miles apart what in the world could be

[3:59]  taking him so War the traffing and the Sunner tunnle which was in those days the major tunnel there was no Ted Williams Tunnel in Boston at that time so the traffic was lined up on both sides of the tunnel and he was once again caught and took him an hour to go approximately 3 miles and he said to me he started walking rapidly toward me me grabbed my arm and I said I know Dr bird I know you got caught in the traffic again he said yes but I had an idea what do you think of it he said what if I buy two TV cameras now remember in those days it was only black and white TV cameras what

[4:48]  if I buy two TV cameras that I set one up at Logan Airport medical station and one here at the MJG and instead of having to travel over over there I could examine them from here what do you think now remember I was a resident he was my professor I thought it was the stupidest idea I'd ever heard of in my life but I had enough common sense to say G not theber that's a very interesting idea he then went from talking to me to the general director of the Mass General Dr JN noes who is an equal Maverick to Dr bird and youed to have crazy ideas brilliant

[5:36]  ideas and John gave him the money to buy two black and white TV camers and by 1969 we had everything set up and Dr bird started to examine patients over TV now he also came to me and said Jay you know I don't want to call this television medicine he said let's just call it tele medicine I said that sounds good well that's how we started I also need to tell you that um something very dramatic all the clinical Chiefs of service love being on TV huh so they were examining patience

[6:27]  using the black and white be except for one and he was Dr Tom DWI who was the chair of the Department of Psychiatry think about that the chair of Psychiatry said this will never ever work in my field and what is ironic is today Mental Health Care is one of the biggest uses of tele medicine however Ken bird being the Maverick that he was got some grant money and gave it to Tom DWI and three years later the entire department of Psychiatry wrote a series

[7:14]  of articles on the incredible effectiveness of Tes psychiatrist what they found was something that if they had asked the movie director ahead of time the movie director would have said well of course we create the emotions of a scene not simply by the dialogue and not simply by the way of the facial expressions of the actors but also how we shoot the SC and what Tom D found out was that when he got to a point with his patient that he wanted to really drive the the thing that he was saying home to the patient to think

[8:02]  about he used to move into the camera and make his head the only thing the patient saw so this came like a message from above um and when he felt the patient wasn't ready to deal with the situation he miniaturized himself by moving back on the camera and it wasn't as critical for the patient in the patient's eyes so that's how I got started in tele medicine now the flip side was how I got started in AI one of the things now this was 1969 now and I was now chief resident in medicine at the m and the uh traditionally every week

[8:54]  the third-year residents would go and find a difficult case in the hospital and present it to me as an unknown and listen to my explanation good or bad um and this particular day uh they presented me this complex patient and at the end of the session I was thinking to myself you know I I think I did a pretty good job with that one and just as I was thinking that I got a tap on the back and I turned around it's another one of my professors Dr octo Barnett who if you Google him you will see that he's identified by most people as the father of

[9:43]  bioinformatics octo by then while he was a cardiologist by training he had gotten into computers and he had computerized 1969 it computerized the MGH Laboratory and Pharmacy I mean that was unheard of so he text me on the back and he said Jay you know and he has this I won't say it he had this grin on his face and he said J you know you can be replaced by a computer 1969 I said excuse me Dr morette he said yeah you could be replaced by a computer and he start started talking to me about

[10:31]  Ai and I got interested in it um with him and started to do some work with him but both of us quickly found out we didn't have the computer power 1969 and some people will remember those who are at least as old as I am had um MIT tried to be the AI Center uh in the mid 80s they also found out they didn't have enough computer power today we have all the computer power we need and was quantum Computing coming in we're there so very early on I got started um in t medicine which I could do because the

[11:25]  telecommunication industry was exploding with new technology and capabilities so we could do it there was only one problem I forgot about our federal government I forgot about people silly me um and I couldn't get anything started in tele medicine well I I did after in in 1973 when I was at chief of medicine at the University of Miami Jackson Memorial Hospital um I got a grant from the National Science Foundation to apply tele medicine into Correctional health care and we demonstrated after a

[12:16]  three-year period of time and I started the first nurse practitioner program in the State of Florida that nurse practitioners using tele medicine connecting to the academic Medical Center were as good as board certified Physicians physically on site in the correctional facility so from 1973 to 1976 I did that and then I could not get anybody anybody interested in tele medicine until Believe It or Not 1991 when I received a call from the governor of the state of

[13:03]  Georgia Governor zel Miller and he invited me up to meet with him and he said I would like to develop a Statewide tele medicine I was blown away I I think I ran up there rather than taking a plane um and when I met wasb he put his hand out out to shake my hand and he said he introduced himself as the governor of two states and I looked at him somewhat quizzically and I said excuse me and he said yes he said Jay I'm the governor of Atlanta and I'm the governor of the rest of Georgia he said the rest of Georgia is a rural State we have

[13:53]  everything we need here in Atlanta but we don't have enough Health Care the rest of the state to make a long story short I developed the 59 site hospital to hospital tele medicine system connecting three academic medical centers with nine comprehensive Community Hospitals each of those in turn connected to rural hospitals and one of the other things that zel Miller taught me other than being the governor of two states was economics 101 which they had never taught me medical school and what he told me was that he

[14:42]  said one of the things we both knew was that because of the lack of specialty care specialty expertise in these rural hospitals when a patient came in and required specialty expertise they were immediately transferred out of the hospital hospital to a secondary or tertiary Care Center the problem was that reduced the bed sensus of the hospital and eventually the bested census went to a point where the hospital had to close it didn't have the revenue STP economics 101 in Rural America the major employer in town is usually the hospital so when the hospital goes under the entire socioeconomic fabric of that

[15:32]  Community goes under within a 3 to 5e period of time so he was not only looking for tele medicine to support the health care he was looking at it to support jobs and support the underlying fabric of the community that became the model for good or for bad became the model to the rest of the country uh State of Arizona administrators s acadm missions came to see the system they set up the system in Arizona and the state of California came they did the same thing and now if you look it is the model for uh just about every state and the country I want to I want to talk a little bit about those early days when

[16:21]  you experien the aha moment of Technology being the bridge to increase access to Medical access and health care services didn't it seem like the mass implementation of that was just around the corner it did in my mind but but but yeah it proved how incredibly naive I was then and I remain today about how long it takes to get people to change it's really terrible and it's quite candidly it's cost thousands and thousands of what um really it really has and Incredibly disappointing I wish I was not here I'm going to make a confession

[17:10]  I wish I was not 87 um I wish I was starting all over again um I remain as frustrated now as I was then about how long it takes for people to recognize and for change I mean look what it took in this country it took thousands of deaths it took Co to get people to change it's so interesting to me that we have had such a similar experience I told you when for everybody who's listening and watching today that the first company I started was a tea health tele medicine company in 2014 and I had the same Eureka moment that you did when a bill was passed here

[17:58]  in the state of Nevada assembly Bill 292 that said you could have a virtual interaction with your doctor and it could be reimbursed as if they were in the office the first thing I did was this is going to change the world I ran out to healthc Care Systems and as many people as I could possibly talk to and said there's going to be a future for this virtual interaction nobody belied me so what did I have to do DR Sanders I went to the jails in rural counties of Nevada and said we can use this virtual connectivity for Psychiatry services and mental health assessments those were the first people who bought into the idea because they had challenges because of the financial elements of transferring um inmates from the actual jail to the hospital about $1,500 so I had to pull on the element

[18:46]  of the cost Savings in order for them to believe in this idea it's amazing to hear you went through the same experience yeah same experience and that is why the coral Healthcare System in Florida and the 7s wanted this because in the State Health Care System they usually have to send two guards with an inmate into the facility for those costs in the federal system they sometimes require five guards that go with an inmate huge cost to them and huge liability for that um so that um you and I had the same same same experience I wish I was as young as

[19:32]  you and it's interesting how our our stories weave together because in 2014 I also met the CEO of Zoom the connectivity platform that we first met on and the reason why I was so attracted to their technology is they were architecting a video communication platform that was supposed to run on mobile devices the infrastructure of connectivity was so much lower needed to have a good asynchronous video and audio connection and so I said this is my telecommunications boom that I can take advantage of and we can go directly to the patient and that is how we continue to leverage tele medicine from a direct to Consumer model instead of a hospital system with the other educational institutions as well we we we connect

[20:21]  again because I know Eric one um very well and um Eric was initially with Cisco and had developed wec for Cisco and then he went off on his own uh to develop um zoom and I met him after he was play I met him in his liming room with a cast on his ankle because he was had been playing soccer and H his ankle very interesting so let's let's talk about kind of um I want to talk about the innovator's mindset so in 1998 um you were the founder of the American tele medicine Association 1993

[21:12]  1993 excuse me um so what were you thinking about in forming the association at that point in time did you feel like momentum was behind you and you need to start indoctrinating different institutions and leaders across the country to behind this vision I wish I could say that no it was literally just about a half a dozen of us um who enthusiastic about it and said you know what let's start an association and um we started in 1993 we didn't have our first um national meeting until 1995 and there were 400 people in the room I thought the entire world was in

[21:59]  the room okay um I could not believe there were 400 people who were interested um in this and then it just started to take off but once again um the difficulty we had related to um Interstate lure issues and which still bugs me as to why we have it solve that because it's a very exceedingly simple way to solve it and number two no one would pay for a tele medicine consultation so you couldn't get Physicians interested in doing it except the rural-based

[22:48]  Physicians who were getting continuing medical education that's the other thing we didn't mention about El medicine into into rural communities yes it helped the economic base yes it helped the patient but also what everybody forgets is it helps the primary care physici and it helps retention of those Physicians because there's a huge Exodus of Physicians out of rural community um but what this did was to bring the specialist to the primary care doc the primary care doc started to learn how to do these things and therefore felt more confident in dealing with these patients and said Gee you know I I could stay in this King I I will admit I probably shouldn't say this but I will um one of

[23:38]  the biggest supporters today of tele medicine is the American tele medicine Association you know it used to be one of the biggest obstacles to Tele medicine the American tele medison Association wow it wasn't until pardon the expression money when the government started to reimburse for it oh the American tele medicine assoc the American um uh Medical Association was totally in favor of but prior to that we couldn't get them involved as a matter of fact a lot of people don't know this and I will probably be singer

[24:28]  point at after saying this but around 1998 we tried to break the Log Jam related to Interstate lure you know why there is a legal problem with Interstate lure because of the definition of where Medical Care occurs for some strange reason the definition of where Medical Care occurs is at the location of the patient not the location of the F ship well if we just change the definition to the location of the physician tele medicine is totally legal and my license in my state of

[25:17]  Virginia can take care of you in Nevada I don't have to get a NADA license there was an interesting caveat that we tried tried to leverage when we started our company called the originating site fee so there was a reimbursable code I want to say it was like code 3016 or 1065 or something like that that said that you can bill as an originating site fee for hosting the tele medicine interaction and we thought that that money lever that we would pull on would get people to adopt this technology but something that's really interesting is we're we're talking about this problem from two different perspectives which I think is really unique I was coming from the perspective of the patient experience in using tele medicine to create efficiencies I used an example in

[26:05]  our previous conversation in 2015 one of the first large government institutions that I went to to say we can do tele medicine on these little devices or iPads with digital um cellular connectivity was the VA now when we went to the VA they said this is great but this doesn't fit our model let me tell you why we just invested $1.6 billion into tele medicine equipment in the form of a 65- in television with a pilt or tilt pan and zoom camera and the expectation for them the VA was to use their Global or their national network of healthcare providers to come into the VA but they expected the patient to travel 2 and 1 half hours or 3 hours from the middle of the desert to come to

[26:53]  the originating site and sit in front of a television screen a huge disconnect in consumer Behavior abolutely disconnect and by the way just one uh you know subscript to that if you look at the makeup on the uh veteran population um 2third of the veterans come from rural areas so why are we not thinking about the consumer experience in healthcare today more often it took a global pandemic for us to switch our view but one of the things that I talk about DR Sanders is is the world that we live in today whether you like it or not is based on the idea of convenience we have people who will come to your door and drop off food they will take you to the airport they will deliver things

[27:40]  directly to you you never have to leave your home but the way in which we approach medicine has been completely different we still expect for the consumer to come to the location if you will of course when appropriate to the doctor cancel all their daily appointments sit in a waiting room and then have to see their doctor on average for 5 minutes when they have to do 15 minutes of documentation it seems like we have to change things things some things up oh you're 100% correct but let me expand that magnify it um a bit um give me a give me a um give me a little preface time um we're talking about tele medicine to me tele medicine provides access to care one thing it doesn't

[28:29]  provide is accuracy to care okay I can give you multiple examples in which this has been studied and I hope nobody in the audience is actually listening to what I'm about to say but the fundamental reality is that we wonderful Physicians kill thousands of patients a year from inadvertent medical errors it's not we don't do it purposely we do it because we think we're dealing with this disease when in fact we're dealing with a totally different disease but we think the best medication for this disease um is x when in fact it's really why and

[29:19]  why is that because we haven't kept up with the literature and they multi I can give you references for the studies that have actually been done to demonstrate this Fact one of which was The Institute of medicine now the National Academy of Medicine 1999 study called to eror is human and a John's Hopkins study in 2015 in the British medical journal saying no no The Institute of medicine study was wrong where it said we kill 98,000 people a year the British medical journal article said no it's close to 215,000 people a year now I think most of the people who

[30:07]  might be listening to this are never going to go to their doctor again I don't necessarily blame them but with that said it's great if you have tele medicine but if your doctor is out of date it's not so great AI is going to bring accuracy to that conversation it's going to bring Collective expertise to the bedside not just a single physician but multiple Specialists to the bedside okay medical sensors which we haven't talked about most people wear today with their Apple watch okay and they'll be wearing them in their tattoos okay they'll be wearing in their

[30:55]  belts um under arour puts them in the shirts uh for the national football combine so the coaches can watch the performance the physiological performance of the athletes as they're going through say the 100 yard dash these already exist now if we now integrate yours not mine your genetic makeup into Those sensors with AI we're going to go from statistical healthare which is what healthare is today based on statistics we're going to go to Precision Health care what your medicine needs to be for your condition versus I

[31:45]  might have the same condition that you have but I have totally different genetics and my sensors with my AI are telling me exactly that and I need to be on a different medication that's what a access a accuracy a accountability will cause the most important change in health care and that's going to be accountability right now we go to the do when we're sick the doctor is reacting to your

[32:33]  illness we need to prevent the illness with the sensors that are telling us look your heart rate is up you're overweight you shouldn't be doing XY and Z until you lose weight and this is what you should do to lose weight our system today is reactionary instead of a accountable and that's what a new technologies are going to do for us but don't ever ask me how long that's going to take because look how wrong I was we are at an interesting intersection in time where since November of 2022 open AI one of the largest AI conglomerate companies has released

[33:21]  technology that the American people are getting used to interacting with I hear a lot of Statistics where over the last Generations on the internet at least people have become very used to communicating and searching ideas on things like Google which opens up the idea for a lot of I would say subjective I would say diagnosis of information right very dangerous people always talk about the WebMD don't search what you are feeling from a symptoms perspective on WebMD because you're going to think that you have brain cancer even if you just have a runny nose what people are starting to do now DR Sanders is they're going to things like chat G PT and they're asking questions they're putting in information about their s their life their lifestyle and they're getting more accurate diagnosis from a system because it has more data to make decisions and

[34:09]  discernment about the thing that I think is going to be very interesting is a project that we've been working on once again coming from the consumer perspective of healthcare I used an example in our last conver exactly this is in uh our previous conversation I mentioned in 200 uh 18 2019 I ruptured my Patell tendon right went in for surgery was discharged from the hospital with the classic packet of information if you have a question go refer back to this I never referred back to the packet I think I lost it as soon as I got out of the surgery center what we are doing now is we are using conversational AI with simple text messages AI that is trained on all of that discharge paperwork best practices education and allowing for the patient to then text a conversational

[34:58]  expert who can guide them through Best Practices guidance Point them towards additional resources this from my perspective of the consumer is more proactive in allowing for them to go to a trusted resource to be able to obtain information about their condition rather than being reactionary and saying I have no idea what's going on I'm going to go back into the hospital AKA at readmission that dings the hospital system on surgery and education and everything else like that what do you think about that Paradigm Shift we're in first of all I think you're a th% correct but if you want to be 10,000% correct you need to integrate your genetic profile into that now people may be thinking whoa genetic

[35:50]  profile so forth and so that's very expensive that how do you do that and so forth and so on first of all the very very simple easy way to do that when you and I were born well when you were born not when I was born they stuck your heel to take some blood to look for what's called inborn errors of metabolism okay today the cost of a genetic analysis is way down so that now that same drop of blood could be used for your specific genetic analysis okay now you integrate that genetic

[36:40]  analysis into the sensors and into the AI and now you go from you're looking at what you need to do or using your phone to look up what you need to do because the answer you're want to get still today with AI is statistical it's not going to be specific with the genetic analysis programming your AI and your sensors it's specificity and you and I are different and we're going to we're going to respond differently to that aspirin that we both take at the same time that's Precision Health heare and

[37:29]  now we need to get the federal government and the insurance companies to switch the payment mechanism to for instance what you do when you get life insurance when you get life insurance they do a physical exam if you smoke if you're overweight um what happens for the same amount of life insurance that I may want say $100,000 worth of life insurance and you want $100,000 worth of life insurance if you do all the things I just said they're going to charge you more than they're going to charge me because you're overweight and you smoke and the likelihood of your dying sooner is

[38:16]  greater okay I want that same thing for any medication I might prescribe for someone I want to look at what their genetic profile is and have ai say okay for this genetic profile don't use this weight reduction medication use that one that's when we have a responsible healthc care delivery system and I wish I would live to see that but unfortunately I will I'm hoping for something different I want to look at this as an opportunity DR Sanders instead of a challenge now one of the opportunities that we have in front of us is we we could also encourage the large EHR gorillas like Cerner and epic to be able to allow people to get fluid

[39:06]  access to all of their Healthcare records so that AI could also be smarter in our previous conversation we talked about the compartmentalization of healthc care data I want you to kind of tackle that for the audience yeah absolutely I mean the biggest problem we have is compartmentalization of of Health Data um the the office of the national coordinator the ones who certifi medical records to be ehrs are the ones who are at fault because they said I think back in almost 2014 2015 in order to be certified you have to be interoperable yet they have never ever enforce that so if I have a chronic

[39:56]  illness and I have been seen by a primary care doctor who uses Cerner record and been hospitalized in one hospital that uses an epic record and another hospital that uses eclinical work those three don't talk to each other there is a system out there but I don't since this company is a uh uh is a Consulting client I'm not going to mention it but there is a system out there that pulls every 30 days legally and agnostically from every single electronic medical record you've ever been exposed

[40:43]  to normalizes the data synthesizes the data and time sequences the data so that when you're looking at their record it's your complete record now why is that important AI has to interpret all the data to me this client's capability is the Lynch pen that does it whyc doesn't require it is amazing to me um it's almost as if onc is being driven by the private companies I probably should have zippered my mouth before saying all of that well I think

[41:33]  that your perspective is a healthy one because this is how informed people in this space also feel we see the writing on the wall where there's Simple Solutions to these macro problems but it seems like we continue to go down the same path time and time again and unless we are hitting people where it hurts AKA in the pocket we're not actually going to see the changes that the American people or the global Society of healthcare really deserves so let's cast a vision DR Sanders for the future innovators the future entrepreneurs who are seeing these problems very much like you did in 1969 actually in 1967 like I came across in 2014 where it seemed like the writing was on the wall but it seems

[42:20]  like we're fighting against macro problems and Gatekeepers who are stopping us from innovating in the space what would be your advice for these people you need to run for president I I don't know I don't know what it's going to take I thought just simple logic would solve the problem it doesn't it doesn't look what we're going through politically here in this country I I better not say anything else um about that I've spent a lot of my night my life being in incredibly naive about the reality of this country I I hate to end on that sort of down note but um that's real real problem we

[43:11]  have um it's not just medical care I mean everybody forgets one very very simple medical fact except for a few unfortunate examples when we are born we were all born with 46 chromosomes none of us none of us had a choice as to who we were born to what their religion was what their economic status was what the color of their skin was total chance every single one of us why don't people look in the mirror and realize that I mean the Prejudice that exist the religious animosity that

[44:01]  exists the economic um differences that exist just amazing to me I just can't wait until the next intelligent species takes over this planet I apologize for being a bit depressive but I'm talking reality and DR Sanders maybe we're already seeing that with the invention and the m adoption of artificial intelligence maybe the logic is going to now be grounded in data and macro perspectives of our Collective genius that is hopefully or hopefully someday going to help us make the changes that we all deserve um that's the other reason I'm going to vote for you for

[44:49]  president yes in 2042 everybody you know where to look for you know Mr Hart is going to try and reunite the heart of this nation well DR Sanders I just want to say man thank you so much for joining this conversation with me it's been an absolute pleasure and it's uh you know been so cool to be able to sit around somebody who came in all due respect lifetimes ahead of me but we have been on the same path and I think that's what the beauty of this conversation has been about as well I appreciate your time man well only appreciation is for me to thank you