Time to Critical Care: How AI Can Cut Patient Wait Times | Dr. Jamie Wisser & Robert Holton
Dasha: Welcome to the Biomedical Frontiers Podcast, where we explore pivotal research projects and disruptive innovations aimed at translating scientific advancements into tangible healthcare solutions. I'm your host, Dasha Tyshlek
Well, welcome to another episode of Biomedical Frontiers. We are so excited. We're gonna have two guests today continuing with our theme of physician-led innovation. We have in the studio today. We are getting to film in a studio Rob Holton, who's the COO and President of Actual Healthcare Solutions, and Dr.
Jamie Wisser, who is the founder of Actual HealthCare Solutions and also a renowned trauma surgeon here in Jacksonville with me in the studio coming from the New York and Connecticut area. So he is really traveled for us to be able to have this interview among other things. Welcome to the show.
Rob: Thank you so much. Thanks Dasha. Welcome. 
Dasha: Well, there's so much to cover today, but I want to start Jamie, with your story and one of the things that you had mentioned to me is that you had done a 26 hour surgery. Can you talk about what that surgery was, why it was required, and what it's like to perform something so intense?
Jamie: Having been a reconstructive trauma surgeon for many, many years and taking call, emergencies happen at all hours of the day and night, and one of many, but this particular one and individual had had his. Upper limb essentially removed. If you ever saw, I don't know if I can reference commercial products, but Terminator two, you know, where there's the mechanical hand that is encountered in a glass case that was left following the original movie and became the focus of the problem in the second movie.
 That's exactly what this person's upper limb looked like. So there was exposure of bone, there was exposure of joints, there was dissociation of joints, disruption of tendons, nerves, blood vessels. The skim is completely torn off. And when I asked where the vost segment was, they had it in a basin.
And it looked like an empty, you know, like playtex glove. So in order to reconstruct that, the problem is you can't just like slip it back on and it will live and you're fine. What has to happen is that every critical part has to be reconnected and restored in terms of blood flow, in blood flow out, nerves, tendons, fractures of the bones the joints, which are essentially held together by ligaments.
The joints being reconnected in a way that the ligament structures are restored in the way they originally were anatomically present. So it's a big jigsaw puzzle. It's like taking a, you know, a tabletop full of disrupted tissues. You have to envision what it takes to put it back together in terms of what the normal anatomy looks like.
And then you have to start with one point and get to the other in a sequence where. The priority is to return blood flow to the disrupted and otherwise essentially dead segment that's been removed from the patient's body, but yet get access to those very, very tiny structures by incising, or disrupting that degloved envelope of tissue in a way that it doesn't compromise the blood flow and make the restoration of blood flow impossible.
It's, it's an incredibly arduous task, but sequentially, if it's done in the right order and it's done effectively and efficiently it can work and that individual is pain-free, has its entire hand, is a career photographer. Won a million, well, $6 million product liability lawsuit. From England, which was the manufacturer's home company, you know, larger company and is an absolutely creative individual.
He gave me a copy of Black Panther when it first came out so I could watch it and I was enamored. It, it's, our relationship has been unbelievable. 
Dasha: Wow. That's, that seems incredibly intricate. And one question for me is, when you're, when you're doing a surgery like that, how much of that reconnection is something that you can plan ahead?
And how much is something that you have to be thinking about in the moment while you're performing the surgery? 
Jamie: The planning ahead part is based upon surgical principles, right? You have to start with almost like construction. You have to start with the foundation. Right. So what's the foundation of our anatomy?
It's the bones and joints, right? So you, you have to have the skeletal foundation put back together upon which to then build the more superficial structural integrity. The, the difficulty comes in, are the items that are going to be more superficially restored? Are they going to be viable? Are they going to be alive?
Are they not going to die because the small, tiny little vessels clot off in thrombose with lack of blood flow. Okay? Okay. 'cause the blood that was in them. Is going to do what it does Normally it's going to detect that there's traumatic injury inflammation's going to set in, the coagulation cascade is going to start and the capillaries arterials es the tiny little vessels they clot off.
And it's very, very difficult once they clot off to be able to recanalize them or get them to have blood flow through them. You know, again, so one of the things from an educationally strategic standpoint is you know that you have to use, you know, thrombolytic medications, which are medications that break the blood clotting cascade down to restore flow.
You have to use those intermittently during the procedure in order to make sure that the tissues that you're going to reestablish blood flow to have a place for the blood to go. Okay. Because even though the larger vessels will have the blood go in and the blood go out, if it's not getting to the more.
You know, fine structured vasculature, the tissues will die and they will die right on the OR table. So, so in addition to the educational understanding of you have to establish the foundation, right? The skeletal structures, you have to have a temporary way by which to restore blood flow as fast as possible.
So that's where we use temporary shunts, which are available. They're commercial products in order to bring blood in and bring blood out so that we have the luxury of time to then be able to work on the finer structures and restore what their integrity needs to be. 
Dasha: What other technologies or innovations have enabled this type of reconstruction to really reattach a limb?
Jamie: You know, nothing beyond the last 30 years. You know, things like high powered microscopes. You know, find surgical instruments, but it's really about the technician. It's about the technique and knowing what steps need to be followed in what sequence and executing them. It's not necessarily about speed, obviously a 26 hour operation, but it's about efficiency.
And what efficiency means is when you assume a step needs to be done and you execute the, the step that you do it precisely, accurately, and you can move on to the next one. If you have to go back and redo things, that's where you get into a circadian sort of snowball effect of what you're doing is not really working.
And it's very easy for the. Eventuality to be, you know, one that's not wanted, which is where the tissues literally die on the table. And meanwhile, you have to forget just what we're working on. You have to focus on the health and wellbeing of the patient in general. That requires teamwork with the anesthesiologists.
It requires thinking about the patient's overall physiology, being on an operating room table for that long period of time, preventing larger blood clot formation within their vasculature, preventing cardiac and, and respiratory and pulmonary consequences of prolonged anesthesia and positive pressure ventilation.
I mean, there's so many physio, you know, renal flow for, for getting rid of waste. You know, there's so many physiological elements to the individual that give us a yes or no. It's like green light or red light. Red light is the patient's not doing well. We have to abandon the reconstruction, stop, move, you know, to whatever the next salvage step will be.
Once the patient is, the term is resuscitated, but as long as the resuscitation can be going on and on and on during the operation and the patient is physiologically doing well, then you can go ahead and continue to do the reconstructive work. 
Dasha: Yeah, that's very interesting and, and so good to know that there are experts like yourself out there who are not, not only have that, that long amount of training and practice required to make it happen, but also the stamina to be in the surgery room for 26 hours to, to perform that from start to finish really well.
So that's, it's so remarkable. Well, Actual HealthCare Solutions. Is not a surgical medical technology. It's something entirely different. And I'd like to start diving into that from the perspective of what is it that you are observing and experiencing as a surgeon, as a physician that started you down the path of wanting to develop software and AI tools in healthcare?
Jamie: I think the the simplest way to consider it is that there was inherent frustration with our inability as hospital systems and physician practices to try to navigate some of the electronic technological changes that were rapidly being integrated into the practicing of medicine and the healthcare system.
And what was happening is that, and, and this is not to be critical in any way, but the way that, physicians think the way that hospital staff think about caring for patients is very, very contradictory to managing data entry and computer navigating. They're just completely different skill sets. Now, bright people can do both very, very well, but there are many people where that transition is not smooth at all.
And I'm one of those people I'm, I'm not technologically sophisticated or savvy. I can handle it, but I, I use as an example for me to go from the operating room into the recovery room or PACU as it's called, to give orders that are required as a step and then get back to the operating room is a procedure that took maybe five minutes where I took a piece of paper, I used my handwriting, I wrote down what I needed, I instructed the nurses, and off I was to the next operation, right to the pre-op area.
Now to enter the data in the computer, you know, it takes 20 to 30 minutes for me. There are others where it's faster, but that's not the case. So the time allocation required to navigate the electronic steps was, it wasn't cost effective, it wasn't useful, it, there was nothing that was good about it. And the other issue is.
The difficulty with data entry and correcting of data to even be able to find what's incorrect, review it, and then try to amend it, and then have the people on the receiving end try to figure out that it's not what you originally entered, but the amendment that's ipor important. You know, there were so many navigating elements to this that was affecting the simple delivery of the care between I and the nursing staff in the recovery room.
That's just one example. Okay. The way I bypass that is I talk to people, right? I'll go up to the nurses taking care of my patients, I'll explain to 'em what my thought process is, and then they'll go through the computer system and they'll get me on the phone. They have to reach me, I'm operating.
They're like, Dr. Wisser, you have to correct blah, blah, blah in the, in the computer, you know, for us to get what we need brought to the floor from the pharmacy, let's say as an example. And so what it had created is it had created this circadian. In my opinion, wasteful allocation of time to manage the technological elements that there had to be a better way there, there had to be something that simplified the process, that expedited the affecting of the care delivery.
And then that simple example became analytically as I looked further and further into the problem, into a system-wide assessment of this isn't just happening with Dr. ER's patients in the hospital when I'm operating on a particular day, this was going on globally because look, over 50% of the physicians in the country are 50 years of age or older.
 We were not raised, we were not born with, you know, the education of managing technological data interactivity all day long. And so our feelings are. Twofold, either A, we take the time or have the capability to be able to master what's required, or B, we have to hire people to do it who are younger and, and that adds to cost and expense and the intuitiveness of the kind of interfaces that we were faced with.
And this is not a blame game, this is just an observation. The intuitiveness was counter counterintuitive. 
Dasha: It's like, really? Is it, and Rob, I'd love to get your thoughts. Is it very bad just design of how you work through these softwares? Or is it more than that? Like there's just a lot of steps and complexity that's almost outside of the UI design?
Rob: Yeah, I mean, I, I think there's, there's really two inherent problems, right? It one's a, an operational workflow issue, right? And the other one's a clinical workflow issue, right? And, you know, some of the stuff that, that Jamie was talking about, you know, he's in the ER getting a phone call about, you know, a prescription or an update, right?
That's operational, right? That's not necessary, that's not clinical delivery of be benefits to the patient, right? And I think, you know, these EMR systems that we have, the, they are. Fundamentally built purposely built to, to create kind of islands, right? So that when, when you get into this EMR system, you are trapped on this island, right?
And there's all these islands that are around. And if you happen to be a surgeon practicing in a hospital system, well the EMR that you have, your medical practice might be different than the one that's in, in the operating room 
Jamie: or more than one hospital system, right? Because I work out of five. So, I mean, I can't even begin to tell you the number of EMRs and the data is not transferable between 
Rob: them.
Wow. So yeah, I mean, so now you're, now you're trying to fix two separate issues, right? Is how do we just inherently make the pro the paperwork process streamlined so that we are getting rid of the errors, we're speeding up the process and we're getting, you know, top of license use. I mean, the fact that you have surgeons or, or nurse practitioners you know, who should be in the surgical suite spending 15, 20 minutes?
You know, typing away on an antiquated EMR system. I mean that they're better served in front of patients doing what they do best, which is, is healthcare, right? Not data entry. So those, that's probably one of the bigger hurdles. 
Jamie: I think the most important thing that was revolutionary in the way I thought about actual healthcare solutions was we're not here, or my goal was not to replace or try to supersede, leapfrog, or substitute for what I otherwise term are the legacy EMR systems or EHR systems, by the way, that stands for electronic medical record or electronic health record systems that have been entrenched over the last 20 years, well since 2004.
So 21 years in the, in the healthcare system. It's not to look at them as being bad actors. It's not looking at them as being antiquated and out of date. What, and that was my initial. Mindset was these things, I, I, I can't even deal with them. They don't do what I need them to do. And, and there's gotta be a better way when in fact they've served an incredibly invaluable purpose, which is, if I needed a medical record when I was training, somebody had to physically go to the medical records department.
We had to assume that it wasn't on microfilm, which is what it would be stored on previously, and it was in physical condition, you know, chart. It had to physically be brought to where I was, for me to be able to review it and hope that it had the information in there that I needed. Right. So, so the electronic medical record systems have taken that physical, real world model and brought that into the 21st century.
For which I, I congratulate them. I, I, I, I really respect everything they've done. But that was, and I've termed this, you know, digital health 1.0. Mm-hmm. That was let's digitize what, digitize what exists, and let's put it into electronic form and do the best we can to make it accessible as well as we can with the interfaces that, you know, are it developer programmed and are not necessarily using the programming.
That physicians or other types of practitioners, inherently the way we think and what would be easiest for us. So, so again, digital Health 1.0. What, what's really exciting now is what we've termed Digital Health 2.0 and what Digital Health 2.0 is focusing on is let's take those islands of isolated siloed data and let's find a way to bridge those islands.
Mm-hmm. To use Rob's description to create a translating technological capability so that the information in one particular EMR on a particular island is now translatable and inter relatable. It's called interoperability. And then also make the ability to execute those functions, be. AI assisted. So we just ask the question even verbally with our system, and it does the work for us.
So it just facilitates our ability as practitioners to get back to what we are supposed to be doing. I mean, if I go to a hospital floor and I walk on the floor, I can tell you, I can see a half dozen nurses sitting at computer terminals typing. I go around the corner to where the doctor's area is. I see the nurse practitioners and PAs, and even some of the, you know, surgeons typing medical, doctors typing.
I'm like, what the hell are you guys doing? What are you supposed to be doing? You're supposed to be in the patient's room, talking to the patient, observing the patient, making clinical judgment assessment on that interaction, which may be just a casual conversation. That gives you a clue as to what may be going on, because the person is not articulate in telling you exactly what the issue is.
You know, all of that has been supplanted by the need to have date timestamped entry, because it's all, all reviewable from a medical-legal standpoint. And that's, and the metric analytics that are driving the business model for hospital systems, these are the things that are counterintuitive to the practice of medicine, in my opinion.
Right. Yeah. So the whole idea was what can we do technologically to take all of those parameters and all of those bits of information that are critical to the functioning of the current healthcare system and make them easier for doctors and, you know, other types of, you know, health professional providers to navigate them simply, intuitively.
And let artificial or augmented intelligence do a lot of the work for us. 
Dasha: Yeah. And by the way, this is, you know, from a patient perspective, these things are also very observable because I think, you know, my experience as a patient includes having a doctor come in and type, turn towards a computer and type in the middle of our conversation, which means that, that time that I thought were gonna be spending face to face, or maybe they're gonna be like touching my shoulder, evaluating what's going on or whatever, that, that time, some of that time is now spent having to type notes.
So I see that, you know, then there's also the aspect that the silos that you're talking about, you know, on one hand you've got, I, I don't know how many logins I have into how many different patient portals. And of course even when you have the patient portals. As a patient, your experience still typically includes before you come into the office, you fill out the paperwork.
When you get into the office, somehow you still fill out more, more paperwork all digitally on iPads. But you're kind of wondering, okay, I did one, but now I have more. And then when you get into the room with the nurse and the doctor, that doesn't necessarily mean that all that stuff you filled out actually makes it into the room, which is, that's or is reviewed.
And when 
Rob: you go to the radiology center to get the MR mri, you fill out all the paperwork all over again. Again, again. Absolutely. Yes. 
Dasha: And, and you just wonder, you're like, well, it has been digitized. Why, why isn't it just, you know, traveling and all of those, and 
Rob: it all creates delays. Right. And I'm sure you've seen it yourself.
You know, I've got something wrong. I should be able to get in to see my doctor in a reasonable amount of time, or, and I need to get a referral. I should have that, I should be able to get that referral in a reasonable amount of time. Get my MRI. Right. I mean, at the end of the day, what this is about, and really where a HS focuses on is accelerating the time to critical care.
Right, because time in healthcare, time matters. That's obvious. But in specialty care, right? Delays can be deadly. Mm-hmm. And that if you, that's what we're really addressing here, and going back to what, what Jamie was saying originally, I mean, it's a multi-step process, right? Again, if you have all of these different islands that you're capped, you're speaking different languages, you know, your radiology center, the hospital system, your primary care physician to speed up.
You know, to accelerate that time to critical care, the first thing you need to do is start to build these bridges, right? So that we can share the information so that they have what they need, right? That's the first step. So that's kinda the operational workflow that we talk about, right? And then what can we use the current technology to, once we've solved those issues, how do we accelerate the clinical care and how do we use AI to augment, not replace, but to augment the human?
Because again, there's additional delays there. And I think that's really what, what's at the heart of a HS and, and really Jamie's vision, which is brilliant, right? We, we have, we have the capabilities in the humans, right, to do incredible things in the surgery. We have incredible technologies and we have vast amounts of data.
But they're all in different places, and it's just a matter of, and the system has been fighting it. How do you, how do you merge all of this together so that it works efficiently, accurately, and generates improved healthcare outcomes? 
Dasha: Okay. So I have this question. Jamie, you mentioned that you started working on the concept for a HS and the technology for it 10 years ago.
Mm-hmm. But now you're powered by ai. You've got natural language processing capabilities. You're able to take data from unstructured things, make it structured that, at least in my mind, it's something that's really just come around very recently, at least has been in our vernacular very recently. How in the early years of developing, trying to develop a solution, did you already know there was gonna be, like, did you have to become educated in data science or did somebody come in and say, this is how we're gonna do it?
How did it come about that you saw the problem and you had an inkling of how it should look, but the kind of, the technologies behind it are, are more recent? 
Jamie: I think if you take a look at our architectural design diagrams from years ago, what we had was we had boxes that weren't necessarily filled in with what needed to be in existence and how we could create what needed to be inside those boxes to execute the functions.
And so where, listen, when you start something, all that, all that time ago the fear is being leapfrog or, you know, what the need is, will be replaced by something more technologically modern or other people or larger corporations doing the same work. Listen, they've tried and, and they've backed away. I mean, I don't want to name organizations, but you know, large technological companies gathered to gathering with investors and they literally have moved away from it.
 And I think the reason is. That the architectural drawings with those boxes followed the flow of the physician mindset, which was, what do I need as a doctor to make this process simpler? And then it was a matter of backfilling. So it was a matter of finding the correct technological engineers, architectural designers, to fill in the code, fill in the structural elements within those boxes to make the functionality work.
And as technology has evolved with, you know, the advent of ai it's made that process faster, easier, but more importantly, it's allowed those original. Design diagrams to be, you know, accentuated with tentacles into the things we can now do. So the architectural design is continuing, not that it's using AI to change the designs, but the people who are doing the designs, the AI is assisting in figuring out how to get it done.
And quickly, I mean, quickly since Rob joined the organization about a year ago. The exponential improvement in what our structural capabilities are has been extraordinary 'cause of Rob's background in computer engineering as well as business from Hopkins. Yeah, 
Dasha: I, and I really wanna get into some of that, but I just wanna put a point on that.
When you, as you were describing that, it's like music to my ears in terms of my engineering brain going, oh my gosh, okay. So you, you didn't even know like what that tool was gonna be, whether it's a hammer or a screwdriver, but you knew that you kind of outlined what the requirements were gonna be and the technology might not have been there 10 years ago, but it might have started being there five years ago and you could start matching it.
And just in terms of that mindset, instead of trying to, you know, use what, getting 
Jamie: stuck with what's in this box, we can't do further. Yes. Being, 
Dasha: being stuck in what exists, thinking way outside the box and, and then driving the requirements. You know, being the early people who actually go out there and say like, is is the technology ever gonna be able to do this?
That, so that's, it's visionary. It's beautiful. Rob, I wanna turn to how did you get involved and what are you guys doing now? 'cause you're at a really important inflection point. 
Rob: Yeah. Ab absolutely. And I, and just to, just to follow up, I think, you know, I've been, I've been an operating executive for early stage healthcare technology companies for, for 20 years.
I've, I've founded my own companies. I've been brought in, like I was with a HS as an operating executive. I've seen a lot of founders, right. And I've seen a lot of failures and I've seen a lot of successes. And I think really the genius behind and, and why a HS is successful right now is that, that, as Jamie was talking about, he started with an endpoint.
And worked backwards, right? And seeing the problems, as you know, firsthand as a surgeon, right? Knows where those problems is, knew where we had to get to, and was very clear on that end result. And the boxes that he talks about, how do we get there? It doesn't really matter. There, there's, that's not the focus.
The focus is we have to get here and I, and just like in the surgery, triaging in surgery, I, I have to figure out a way to get there. And as technology has evolved, it's allowed us to adapt, bring new things in, try new things with that sole focus of accelerating that time to critical care and streamlining these operations.
And that allows us to continue to be nimble no matter what happens two weeks from now, two months from now, or two years from now. A HS and the, the core architecture that he built allows us to incorporate those tech technologies, commercialize them, ensure that we deliver the benefits to the patients, into the physicians.
Jamie: I think if. You had to summarize in a simple metaphor what actual healthcare solutions is and what we're trying to do, we're literally trying to technologically not replace, but offer a technological method to execute what we do in the real world. So if what we do in the real world takes a whole lot of time, it's very inefficient.
It's, you know, requiring, contacting people via telephone or whatever, email, whatever, you know, whatever that is. That's been very time consuming. We're technologically looking for this ability to bridge that and have it be automatedly simple and taken care of for the doctors so they don't have to waste the time.
And it's, I I use the term waste the time because there's so much time limitation. To be able to reach out and execute whatever those functions are. If I need an infectious disease doctor, 'cause somebody has an infection, I have to get on the phone, explain the story. Will you see the patient? Do you have hours today?
Can you get the patient in? You know, that's taking time outta my day when I got patients in the waiting room. Right? So, so we're trying to take the real world elements and simplify them. And facilitate them, but most importantly, that's just a simple example of, and, and Rob has a background with, you know, his organization and infectious disease data management from his previous, you know career activities.
We, we have to get that patient in to see the infectious disease doctor like fast because the infection is gonna become a riping problem and could even become life threatening. So it's not like there's time to delay. It doesn't have to be. Underdiagnosed or failed to get definitive treatment, cancer patient management, that leads to death.
It doesn't have to be that catastrophic, but on a minute by minute, day-to-day basis, there are other clinical scenarios that require action. And, and that's where the technological bridge is so, so helpful because it doesn't matter what the scenarios are in the practice of clinical medicine, we have developed the system to be very adaptable, to be able to manage all of them by being generic in what the problem may be, but the methodology of how to address the problem being sort of intuitive within the designs.
Dasha: Can, can we dive into that just a little bit more? Because when I hear like we have kind of a general solution, but it's able to adapt to me. Mm-hmm. I mean, I know that I, I've experienced some of these AI solutions and obviously, you know, almost everybody's now using Chad GPT and Perplexity and Gemini and all of that.
But can you describe like. First of all, can you describe some of these scenarios in detail? Like examples you, you mentioned, you know, typing in the notes and, and then having to make a correction and that having to be very manual. But maybe walking through a, a kind of a simple example of a patient journey and the physician's experience in the workflow during that journey without a HS then with a HS and maybe dropping in there.
Like what does that adaptability do or how does that adaptability work to adjust to the situations? How is it all kind of part of the same whole? 
Jamie: We're gonna do this in two parts. I'm going to describe the way it is or the way it traditionally has been, and then Rob will describe how the system adapts to it.
Okay. So I've got a patient who, I am a hand and upper extremity specialist. I don't do shoulder work that's for shoulder fellowship trained doctors, so has a shoulder issue but has a multilevel upper limb issue, cervical spine issue. I need to get the patient treated. I need to get the patient treated in a timely manner because I've got an intervention that I need to take care of.
But we need to take care of the multifocal elements at multiple levels that have to be addressed. Mm-hmm. I, for me to get a patient in to see the specialist that I normally work with, who I know and I trust, I have to get on the phone with either the office manager or have somebody in my office get on the phone with the office manager to get an expedited appointment.
 I just got a call from a neurologist the other day where we have a woman with a completely contracted hand with neurological issues and he's like, what are you planning to do? And I told him what my outline was and he goes, well, we need to do a, a, an electrodiagnostic study. And that study is booked out for three months, but I'm trying to get it expedited.
So he, the doctor who I've known for 35 years, got on the computer to try to squeeze in the patient's appointment, to get the test that's needed. And he will follow up with telling the someone in the office to tell the patient that they now have this appointment. I mean, the mechanics of it, it doesn't have to be life threatening.
You know, the mechanics of it are arduous, but we've been living with this and doing this forever, and it leads to incredible office expenses because for those doctors who are seeing patients every 15 minutes or, you know, shorter timeframes, they don't have the time they have to allocate. So they've hired staff to do all of this work.
And when a staff person is calling to try to get in to see a doctor, they're dealing with people at a staff level. They're not getting to the decision maker of, I'll stay late to see this person tomorrow. It, it, it's all way too cumbersome. So, so what our system has done is we've literally, I like to use the analogy of when I, my family or my close friends need care urgently.
I get on the phone with the doctor by calling the doctor's cell phone and I get the ball rolling. But that's just me. Those are people like me. What happens to the average person who has no access to this? What happens to the average individual that is just a name and a number, meaning a cell phone number or an email that literally has no prioritization in the system?
That can't be, that's the universality democratization that we focused on. So I'm gonna let Rob now talk through how the referral system works or how patients can initiate a referral and expeditiously get to the decision makers and what the decision makers get in terms of information already through the system to make a decision about whether they're the right referral doctor for that patient.
And if they're not, they can render that opinion expeditiously and let the referring doctor the primary know that it's, it's not happening. And either the specialist makes a recommendation or the doctor is able to use our system with its AI capabilities to be able to then select another specialist who has the same capabilities that may be geographical, poss geographically, you know, able and possible to see the patient.
So I'm gonna turn it over to Rob because he is intimately aware of the engineering elements that have integrated the AI much more so than I, and he can, you know, talk to literally how the system takes care of the problem. 
Rob: Sure. Thanks Jamie. So, yeah, I think again, if we go back to that. Building the bridges kind of analogy, right?
And, and with a HS, we've built those bridges. So the doctors, the special, you know, the specialists, the surgeons, the radiology centers, they're all on our platform. And so when Jamie has to make that referral, right, based upon the symptomology, based upon the patient records that are already in the system that a HS has access to, we can, our AI will then select, you know, will filter through based upon symptoms, availability, right?
Geo, geography, and specialty. What are the appropriate specialists that we need to make those referrals to, that have the availability immediately to do it right? But not only that, because we're already integrated with his system and with the specialist system. Our AI will summarize the patient records and information.
If they have radiology, we'll attach it as part of that referral. So now we're giving the, the specialist an informed referral that they can very quickly look and say, okay, here's the patient. You know, we can see that, you know, there is, you know, a partial tear in, you know, in, in one of the ligaments.
This is something that I can work on quickly. It's the right referral. I can accept it. And at doing so, all the medical records will then transfer over, right? Regardless of the island that they're on. 
Dasha: How many of these islands, by the way, are there 
Rob: thousands. 
Dasha: Thousands of different 
Rob: rs. Yeah. 11. But it's not even that Epic has, and again, I, I agree with Jamie.
What these EMR companies have done has been groundbreaking, right? And, and they have taken us to the 21st century. This is about how do we make them better, right? How do we get them out of those islands? Because with Epic, right, those four or five different instances of Epic. App version three doesn't communicate very well with version four, so you could both be on app.
But you still can't transfer records, right? And so that's what our bridge building does. So we can transfer that information so you can make an informed decision take on that. And because you know that this is a good referral, right? You can accelerate that appointment time, get them in quickly. Right. 
Dasha: And what I heard you say also, and I don't wanna drive, you know, sled over this too quickly, is that the previous method of kind of identifying even who to refer to is either like, you know, somebody because you've, you've worked in the field and there's some people, you know, or somebody, a staff member has to go and do like online web research or call, you know, either way you don't have a, a clear way of really connecting to other people to see like who's available.
It's, it's all still very manual. And I don't know how many offices will do that online research or, or how that really works. But what you're also describing is that once you're in the system, the system can look at what kind of cases you've taken and your location and maybe does it also look at online information and everything and just Yeah.
AB 
Rob: absolutely 
Dasha: put puts out like, you know, AB 
Rob: Absolutely. And I think there's 
Dasha: five other people who do this thing, by the way, and one of them has availability. 
Rob: Absolutely. And it does, and our system doesn't automate it in the sense that we can't take, we don't take personal decision out of it. Mm-hmm. Right?
If I, that's the most important. If I have a surgeon that I trust and I want to use, right, our system will still use that surgeon. Right? This is giving you democratizing access. So if either that surgeon isn't available or if I don't have that surgeon that I trust that can do this, I am now giving you educated decision making capabilities to decide where to send this person to on, on important data driven.
 Suggestions, right? So again, we don't make them health, we can't take the human outta healthcare. The, the, our system is great because of the humans. All we're doing is unloading all the superf superfluous work that happens ahead of time and allow them to focus on what they do best. So if it is that relationship, they can, they can utilize that.
If they need new relationships, we can help build those as well. 
Dasha: That's really, that's really good. And now there's also this really important radiology component. Absolutely. And I wanna get into that. What can you talk a little bit about. What that 
Rob: Absolutely. And so radiology is another, it's another island.
Right. And so, you know, I, I've got, you know, it could take a week to get in to get the MR MRI done, the CT scan. It can take another, once the data comes back, it can take another two days, three days for the, the radiologist opinion to cut a report to come back again. What the radiologists are doing is fantastic work, and we're not trying to replace radiologists, but when you're talking about accelerating that time to critical care, you know, how can I, if I've got the MRI, the CT scans, I don't have the radiologist report yet.
There's a lot of work I can do if I know directionally where I need to go. Right. So we've incorporated AI radiology where we can do initial radiologist report and complete clinical diagnosis on those MRI files, the CT scan files and get them to you in 30 seconds. Right. So now you can start 30 seconds, 30 seconds, while you're still in the room with the patient, right?
So yes, the, the, the specialist will review them, we can run it within 30 seconds and give all of the interpretations, right, so they can start to make the appropriate decisions moving forward. What's even more exciting is with our latest version, is it's not just a static read of that, of the, let's say the MRI, our AI is now available for the specialist to ask follow-up questions in real time and collaboratively.
The specialist and the AI can now deep dive into those radiologist reports. So if the, the specialist has a concern or see something in the MRI that either the original radiologist report doesn't have, or the AI didn't pick up, they can ask questions, the AI will then re-scan those radiology images and deep dive into it to be able to get incredibly insightful and information and clarity on how do we move forward.
Imagine the time it would take to be able to get ahold of the radiologist that had given you the report to ask a follow up question to reanalyze it. Right. Again, if, if, if we know that, that, that delays in, in critical care are, are negating healthcare outcomes, anything that we can do to speed that up is gonna have a positive impact, right?
It's going to allow people to focus on what they do best. And that's really what I think is really special about a HS and, and our AI radiology technology. 
Dasha: Yeah, that's, that's really fantastic. And there, there's something that we had talked about and. Tomorrow, by the way, for, for our listeners tomorrow Jamie and Rob are gonna be also presenting at a conference that I'm hosting here in Jacksonville.
And they're actually gonna be speaking with one of their first customers, which is Coastal Health here in Jacksonville. And so we made this session so that the customer can actually describe the problems it's solving for them. But I wanna bring something a little bit forward into this podcast. Which one of the things that really surprised me was that sometimes the radiology report isn't available in the surgery room for the surgeon and there's all these workarounds people have had to develop or they have to bring in CDs and use like an older piece of equipment that still accepts CDs.
Can you just describe that? 'cause to, that was blowing my mind when I heard that. I, you know, I just didn't realize that some of these things are still, we're still relying on CDs and things 
Jamie: like that. So when I'll feel this one. 'cause it's talking pen inoperative access, so. Listen, I'll tell you exactly what I do.
I take pictures with my iPhone and I bring them into the operating room from the images that were opened on my computer screen in my office. Why? Because if I'm working at a hospital that's outside the Princeton, Penn Healthcare System, and you know, I sent my patient to Princeton Radiology, you know, I could get access to the image by portal access, but I have no way to transfer it to the operating room at a completely unrelated, you know Princeton uses Prince and Pen uses Epic.
This other one uses Cerner. They're, they're, they're not compatible. So I literally take a picture on my phone. And I have it that I can refer to before I'm operating. Like, okay, this is the approach I'm using, et cetera. What our technology now has created, which is just astronomically phenomenal, and I won't go into all the details to give away all the secrets but is the ability to access radiology images regardless of the origin of where the imaging study was taken nationwide.
So it's a PAC server is where the images are stored. They're in a DICOM modality anyway. So what we do is we simplify it. We create a, a, a universal language for all the imaging studies, and as a result, it's very simple. It's not sophisticated, it's, but I'm not gonna say exactly how we do it, and that's what the AI reads.
And so you can literally, as a surgeon, go back to your access to our technology. And you can have a voiceover of what you were planning to doing when you reviewed it. And you can literally play it back for 10 or 30 seconds and, and say, okay, that remem I remember now. And then move on. 
Dasha: Yeah. That's that's, it's remarkable that the it's systems really were that siloed, but it's also amazing that you're designing something that is able to basically bust through the bureaucracy.
It's like, hey, you know, may, connecting these systems, getting everybody's systems to talk to each other, 1100 systems, that's, that's a lot of connections. Whatever that math will be is impossible. But you've, you've kind of developed a way that goes, it, it doesn't, it doesn't rely on having to make those individual connections work.
It works above it all. 
Rob: Incredible. Yeah. And, and the offshoots of that will, will blow you away. And again, it gets back to focusing on what is the end result, right. Accelerating time, you know, accelerating time to, to critical care. And, and building these bridges. And we talked about radiology, right? And, and there was an offshoot based on the, the system that we've built that you, you're learning new stuff every day.
So we were talking with one of the largest radiology centers in the country one of the top three. And we talk about the delays of getting you into, to radiology to, to actually just get your scans done. Well, one of the biggest delays is that they can't bill the, the radiology center bills, the MRI for insurance with these, these different islands, they're getting the MRI order from the specialist.
But in order to bill insurance, they actually need the clinical notes to do it. But none of these systems. It can provide you with the clinical notes 'cause they're on an island. So as part of our AI radiology, we, we kind of stumbled into this problem and they said, well, if we can get the order plus clinical notes immediately when they submit the order for the appointment.
We can accelerate, how quickly we can get them in, get them the financial pre-clearance, get that taken, get it billed, and get them back to the offices faster. Well, for us, again, if our goal is to accelerate time to critical care, that's a no-brainer for us. Right? And so you talk about all of these different offshoots and not being so focused on the, the product necessarily itself, but what that end goal is, it opens up opportunities to be able to use what we've built, bring in these additional technologies, and really commercialize and accelerate time to critical care.
And it's been absolutely fascinating and successful. 
Dasha: Yeah, and I, I can see the opportunity for partnership with you guys will be tremendous because instead of having to, for a company, let's say, that develops a way to use a particular kind of imaging. To detect something new or to, to look at a problem in a, in a different way.
Instead of them now having to go and go work with 1100 different systems and go to all the different centers partnering with you, you basically have a platform for inter interoperability. You've absolutely, instead of interoperability being a committee kind of thing, you've made it into a technological platform.
Your platform is interoperability. 
Rob: Absolutely. 
Dasha: Wow. Well I wanna get a little bit into the personal because it's obvious even from this conversation you guys have a really great relationship as founder and president, COO, the company, kind of having that relationship of a visionary operator.
And to me this is also an incredible learning opportunity because on our podcast we have a lot of physicians, we have a lot of scientists as well who are doing research and they're saying, well. You know, I'd like to make companies, but I am not gonna be the one who's gonna leave my role to go run it. I need partners.
And so I wanna talk about that teamwork and that relationship you have and how that works. 
Jamie: Well, I'll just simplify it by saying, when I was growing up, how many times was I told as a child, it's not what you know, it's who you know. I mean, how many times have we heard that as people? Well, it's really true.
You have to know a lot. But you really have to know the right people. And, and I've been through multiple, multiple management iterations with this corporation and it hasn't been until the last year when we got the right team together that the acceleration has been really, I'm trying to keep up 'cause these guys are moving fast.
So so Rob can talk about how we serendipitously found one another. 
Rob: Sure, absolutely. I had my previous company, which I had founded, base 10 Genetics. I had completed the sale of, of Base 10 and, and briefly you know we ended up building out infectious disease management platform for skilled nursing facilities, healthcare.
 It happened right in the beginning of COVID. Right. And a lot of the same problems that, that Jamie was going after we were dealing with in real time in the middle of COVID. Right. And as, as patients were getting sent to nursing homes. Right. They're incredibly frail. Again, this is, we're talking about in the first six months of COVID where.
You know, we talk about, you know, time matters in healthcare and, and delays can be deadly. You know, it was taking weeks to get medical records from new patients coming into nursing homes Right. Weeks to get their healthcare files. Even though they were fully digital, they were just at a different platform.
And those weeks were literally killing people in nursing homes. Right. And we needed, we spent two years, I had 50 programmers. We duct taped solutions together so we could get those medical records back in, in two days, right? And we went on and built, you know clinical decisions, port software and, and, and, and really turned around nursing homes and, and in, in COVID for infectious disease as well as working with the CDC.
 But. When I sold out, I was literally listening to pitch nights online, just to, you know, I, I was supposed to be semi-retired for a little while, and I heard Jamie speak. And I actually wasn't, no offense, Jamie, I wasn't even you know, at that seminar to, to hear a HS it was for another company.
And I started hearing what he had built and what their, and in my mind I was like, where was he three years ago? I could have saved another 3000 lives. But what he, instead of the duct tape solutions that we had to put together, he built it from an architectural standpoint. And I immediately knew while I, you know, I had to be involved with this.
And I started reaching out to Jamie while he was still speaking like three or four different times. I'm like, we need to talk. We need to talk. Eventually. He's like, yeah. And he reached out. And then we just started talking about shared beliefs, understandings, where we go. You know, Jamie is a visionary and, and, you know, and I think one of the best parts of the, of, of his being a visionary is understanding what he does best and what he can bring people in with different skill sets and let them really do what they do best.
Right. And I think that's the key. So for listeners that are out there, that, that are, you know, researchers physicians and have great ideas, but as you said, you know, they don't wanna run it, they don't wanna leave what they're doing, that's fine. Be, you know, be the visionary behind it, but bring in people and, and give them the ability to execute on your vision and you will be successful.
Just like I could not go into his operating room, right. It's not what I do. I, I don't have his vision. I don't have his skillsets. I have a much different set of skill sets. I know how to build companies, right? Sometimes it's counterintuitive. But you know, that is start the startup world, Jamie has, is strong enough to give me the latitude to really bring his vision to life.
 And it's been an incredible partnership. And if without that, these early stage companies don't work. 
Dasha: Now you guys are I mentioned the word inflection point. 'cause when Jamie and I talked, you, you described some of the early pivots in terms of, okay, trying to go to market this way, but it turns out the sales sales cycle is long and the operating costs are too high.
And there's all of this, you know, the technology can be really good, but who you target with, what exact offering, how you get to them, that all kind of has to also be done. Right? So talk to me a little bit about where you are in the field with the company. What are, what's the next six to 12 months look for you guys and what are some of the challenges that you're overcoming like in this past year and into now that are really creating that momentum and traction actually getting the technology into the world at a large scale?
Rob: Sure. That's a, that's a lot to unpack. So we'll kind of go piece by piece and direct me where you want me to go. But I think, look, at the end of the day, when you're dealing with an early stage company, ideas are easy. Execution is everything, right? We can have the greatest product that's gonna save a million lives, but if we can't execute and commercialize it and bring it into the market, all you've done is waste your time.
'cause you're, you're gonna bankrupt it and no one gets it, right? If you have a mediocre product with excellent execution, you'll at least get it into the marketplace, right? So what we've been dealing with over the last year is really refining this incredible platform that's been built and build and, and creating, what is that?
What's the beachhead that we're gonna target so that we can execute relentlessly and get it into the marketplace? Right? And that's a struggle, especially when you've built something that is so dynamic, so powerful. We've talked about four or five different things, right? Just on this podcast. How do we get that into the market?
And so for the first six months, I mean, it was really refining that product line. So we knew we were gonna target, you know, the specialists specifically originally in, in orthopedic care. 'cause we knew we could have a really high impact, right? We knew we could deliver an ROI to the, to the, to the end user very quickly, and we could be profitable and prove our, our prove the value of our platform, which is exactly what we've done.
So we started with Coastal. Go ahead. 
Dasha: Could, could you describe a little bit of how did you ultimately what are some of the principles around figuring out that right beachhead market? Is it customer, you know, people talking about customer discovery and interview? Like what are some of the processes and principles?
Yeah, 
Rob: absolutely. I mean, I think it's basic. You say it's basic business, right? But unfortunately a lot of companies don't follow it. Right. The first thing that you actually have to do, and it, and it goes back to almost like high school economics, right? Which is you have to define the value void, right?
That's a but yeah. But you can do a 26 hour surgery. You know, I even when I go to La Quinta, I can't even walk into an operating, you know, in an operating room. So but you have to define what that value void is, right? Is it, you know, is it important? Is there, you know, I can solve a problem, but if that problem that I'm solving doesn't provide an economic benefit to my client, they're not gonna use it.
Right? The other thing is, okay, I, I know that, here's the problem. So in this case, right, it was how do we get the right referrals? How do we get the right patient to the right doctor at the right time for the right reasons? We know that there's a value void there. Well, if, if the value, if the, if the value that I'm creating is say, you know, a hundred dollars, keep it easy, but it's costing me $150 to deliver.
Then that's the wrong beachhead, right? I can't make money. I have to survive as a company. So find the value void. What does it cost to deliver that value void? Right? And how important is that to these, to, to your end client? I mean that, as basic as that sounds, that's the cornerstone of your go-to-market strategy because if you get those things right, pe your clients will move mountains to get your product right.
And so by, by targeting, you know, orthopedic surgeons that we knew were having referral problems that we knew weren't getting the patient records that they needed to perform the surgeries, right? Even if they got the right client, right, the cancellation rate at the day or the day before of surgery were really high.
They're losing money. So we knew exactly what we could do from an economic standpoint and that's how we decided to push in and, and that's how we ended up getting coastal. 
Jamie: I think the biggest change. When you look at the history of the way healthcare is delivered nationwide, is that the margins, right?
The economic margins have been so restricted. That efficiency is the only answer in practicing or as a hospital system in order to be able to manage the economic parameters that have been imposed on the system. Look, for better or worse, it's the way it is, right? We're not judgmental. We're just saying, okay, these are the parameters.
How do we manage them? And so for every, I'll use a term, you know, day of patient hours where there might be room for three or four patient, new patient visits as a specialist. If that patient that comes through is going to consume my services. Which are what? You know, I make money when I operate, right?
It's what I do. Then that was a three or four new patient visit that was efficient and drove the productivity of my practice and generated revenue, right? But if those three to four patient, new patient visits either have one or two no-shows, or the people who come through don't really need what I'm offering or are well enough that they don't need the intervention that I naturally do for the patients who do, then those three to four patient visits were kind of wasted on that day.
And if I'm seeing patients 200 days out of a year, and that inefficiency is multiplied times 75%, let's say, of those visits, now all of a sudden my operating schedule is down 75%. Whereas those new patients, which have been pre-screened, and by the way, one of the beauties of our platform is that. Every bit of it can be handled by the doctor's staff.
The only thing a physician is required to do is render a medical opinion. Everything else is staff manageable and it has an internal communication capability. So a physician assistant, as an example, could look at 10 referrals that have come through and, you know, say referral three and 10, they need intervention right away.
You know, they need whatever it might be. And then the doctor can focus on those and, you know, inform the scheduler to reach out and get those patients in the office, get the insurance information scored away, et cetera. So. So the technological ability to increase the marginal utility of those new three or four patient visits.
When I see patients each day drives the revenue of the practice because in the end practices, whether they're hospital owned, whether they're private, whether they's a combination or you know, investor owned, it's all about are you paying for your overhead? Are you paying for the salaries? We pay all of you, and are you generating profits that make our investment into your organization, you know, profitable?
Right. So, so the key has been, and I think this is most important when it comes to new technological innovation by small, you know, entrepreneurial types, no matter who they are, is that if you can get an ROI. That's a no-brainer, like an aha moment to click in the customer, IE the physician or the hospital administrator's minds, they'll pay attention.
Mm-hmm. And they'll give you that shot if there's no immediate drive to ROI, they literally don't have the time of day to listen to anything more than politely, and they will move on to the next new, new greatest thing. 
Rob: Yeah. And, and I do wanna just, I, I do want, we talked a lot about money, right? And, and the reality is that it, that's a huge driver, right?
Driving revenue, driving profitability. But the, one of the great things is when you have perfect alignment, right, with what our vision is, right? That also equates into healthcare outcomes, right? So even though we are talking right now about driving profitability, driving revenue, we're not taking the the patient component out of it.
Because think about if you've got 30% of your visits are, are inappropriate and, and you're losing, you know, surgical time for that. How many patients didn't get to go see Jamie that really needed to, right. Or the cardiologist, right? If the, so you're literally denying services. To patients that really need that specialty care.
And so, yes, I, we absolutely are focused on driving that ROI, 'cause that's what buys our, our, our product and gets it into our client's hands. But I want, I wanna make sure everybody understands that, that that is what's driving it. But the end result is an incredible, you know, increase in patient outcomes and access 
Dasha: and it, from a patient perspective, when I hear it, it's actually really encouraging because, you know, one of the things that you feel as a patient is that you're just completely outside the system.
You're not the payer, you're not the, you're not in an administrative role. You're not, you know, you have a lot of the times as a patient, you feel like you have very little say in what happens to you. You things take away longer than make sense to you. And 
Jamie: you're the wit. 
Dasha: Yes. And, and, and you almost feel like I, you have no, influencer of the system, even the, you know, the only person really that you feel like you have any influence with is, is the physician. And that's why the physician gets all the, you know, yeah. Stuff from the, from the patient because, you know, it's not because the patient actually, I think generally speaking, the one thing physicians and patients for sure all agree on technol technology wise is whatever gets us more time together is the best thing.
Right? Absolutely. Whenever I've done patient interviews and physician interviews, nobody wants AI to replace doctors. The patients don't want that. They're just like, Hey, I've been waiting for 35 days to see the doctor. When I went to see that, it turned out it wasn't exactly the right specialist. They, they look at, you know, the, the elbow instead of the shoulder, and, and now I have to wait another, and the 
Rob: clock starts all over again.
Dasha: And by the way, sometimes these places aren't very close. You're taking time off of work, it's lost productivity. What if you have kids who's watching them? So there, there is, that cost translates into time and frustration for the patient as well. So. 
Jamie: We had, and I can use the term because I'm a member of the Department of Orthopedics at NYU Lango Medical Center, when we had focus group meetings with the doctors, the, the orthopedists in the department about what are your pressure points?
What, what kind of things can we solve for you? I mean, this is years ago. I'll never forget. I'll use his first name Brad, but, but I won't use his last name, basically said, well, you know, the problem is, is that patients are waiting 45 to 60 days to come and see me. And when they go to my front desk, if they don't have like the imaging study, I can't see them because I can't get access to it.
And they have to reschedule. And these people have been waiting 45 to 60 days. He goes, that is the most frustrating thing for him as the doctor, because I'm turning work away because I don't have what I need. How can you solve that problem? And literally, it was based on that comment that we pivoted, this is like seven years ago, to we gotta include radiology with this.
So our U-S-P-T-O patent, as we had talked about, we have two of them actually includes the radiology segment because it's that important. There's so many specialties that depend on imaging studies. It's, it's insane. We are very dependent on that technology and we have to think, you know, all the predecessors before us, but right now it's the access that's the issue and the timely access, that's the 
Dasha: problem.
Well we're gonna be wrapping up the episode, but kind of last thoughts. We have, we do have, in addition to entrepreneurial physicians and scientists, we also have a lot of students, medical school students who listen in. What are some lessons or inspirational ideas that you would like to leave for the next generation of physicians and scientists who are entering the field and want to make people's health and lives better?
Jamie: I think the message is very clear. If you have an idea and you think that it could potentially have traction, bounce it off people. Share it, get feedback. And if you have validation that comes through and it's something that you're interested in pursuing, then lay out a pathway for yourself. It doesn't matter what age you are, come up with a roadmap and see if as you start moving down that roadmap, the, the dominoes fall into place.
If they don't, but you still have faith and are encouraged by your idea, then think of an alternative pathway or, or method by which to bring it into, you know, fruition. There are many, as Robert said, there are many ideas. Execution. Execution is everything, but, but I think that the kind of human interaction that you receive along the way.
To help validate your idea or refine the idea and help guide that pathway, the knowledge that people impart, especially mentors to you along that journey. It's invaluable because there are those who have done it. There's nothing, there's very little on this planet that is de novo, you know, brilliant and unrelated to anything else.
It's all about taking what we've learned as our baseline and trying to expand upon that, right? So, so if you have a method and your method doesn't work, but you still believe in the idea, find another alternative. You know, find a different pathway and get the assistance. Get opinions, get feedback, and you'll either be told very, very bluntly, it ain't gonna happen.
My mother was an English and speech teacher, so the fact that I said that's unbelievable, it ain't gonna happen. And. Think of something else, right? Or you'll get encouragement. And if you get encouragement, you'll get people who are interested, people who are interested will give you their insights. And I think that that is, no matter how old you are, how young you are, I think that's the way to try to just envision a method of moving forward with your own ideations and seeing if there's, you know, some way to, to bring them into a reality.
Dasha: Fantastic. And Rob, how about from you entrepreneurial lessons for those who listen, want to be 
Rob: sure starting, and I wanna be very clear, this is for business. This is not medical practice advice because I, I, I don't think it's a good idea of medical practice, but from a business perspective without question, you can't fear failure, right?
 You know, failure is the biggest form of innovation that we have. If you are brutally honest with yourself and not take things personally, right? It's all about every time you fail, you can learn something from it, right? And that is how we advance products. It's how we advance, understanding, clarity, and innovation forward is through our failures, right?
So I, I like to talk about you have to build. The best measure, learn, iterate, feedback, loop around, right? Because then you can take every experience, whether it is talking to somebody about your idea, right? Piloting a program, measure everything. Learn from it, right? Iterate from that. That's how you learn from those failures.
That's how you make groundbreaking discoveries. That's how you grow your company, company, right? So it is, it is. You cannot fear failure. You need to celebrate failure. Failure and learn from it, right? So we talk about, we, we like to say, fail fast, learn faster. Iterate, execute, and overcome. That's how you will drive your ideas to successful companies.
Dasha: What if you're, what if you're working on something new idea and you're getting, you are getting feedback that it's not right. How do you, how do you tell the difference between the idea itself not being right or, or the, the way that you're thinking about it? Like what are some between the failure and the feedback, how do you, it's a great discern.
Rob: It's a great question, right? 
Dasha: What to pivot on. 
Rob: Well, so is it a data point or is it a market trend, right? Because you know, everybody has an opinion and so is what you're, the feedback that you're getting, is it just one person who doesn't like your idea? Is there an ulterior motive you don't know? Right?
And that's why one of the Ja things Jamie said is. Ask questions, get feedback. Don't listen to just one person. Right? Think about it. If you flip a coin, if I flip it two times, I can probably get heads twice. If I flip it a thousand times, I'm not gonna get a thousand heads in the row, right? So it's about making sure you're getting enough feedback, right?
To know is this an iteration? Do I tweak it? Is it a pivot where I completely walk away from it? Right? And so in my perspective, or from my opinion, that's what you need to do. It's not about a single point of validation. Get a handful. If they're all saying the same thing, then okay, maybe it is time to pivot, right?
But if you're getting varying degrees now, that's something to learn from that I could iterate and migrate towards, if that makes sense. 
Jamie: And the other thing is that I'm just gonna talk about the a HS journey, if I may, to try to prove the point is that I have a lot of physician friends, family members who are physicians, colleagues.
I spoke to them. I said, what do you think about this? If this could exist, would you use it? Would it be interesting to you? Would it be helpful? And what everyone would do is they would take what I presented and they'd add something. They'd say, yeah, well if it could do this, then that would be really helpful to me.
And what we've found is we've marketed the, the, you know, the first commercial version is that we're getting the same kind of feedback from our customers. It's, this is great, but we really are just focusing on this element of it, because that's really helpful to us. So the way we've designed our market entry is we have so many features and capabilities built into the platform.
We can focus on specific ones for the particular client and offer that to them. So the kind of information that comes back along the way really is as simple as it sounds, the ultimate reinforcer. And from our friend and family investment round, which was $1.2 million over half of 'em were from doctors. That's where I then had to go and say, alright, if that's the endpoint as rapid identified, how do we move backwards and execute?
And that's where pivots were necessary. Trials were important. Pilots were important. Focus groups among peers. But most important, importantly the biggest focus group input came from a couple of 30 something year olds who happened to have been shadowing me on a given day. And I was telling them about it.
And what they said was, oh my God, we don't. You know, know where to go. And our recommendations to one another when we have a problem is either go to urgent care or an emergency room. We literally don't know how to navigate any of this. We get lists of participating providers from our insurance companies.
We don't know who to go to. We don't have the time to go look at Google reviews. We don't have the time to know if they take care of the problem that we're having, you know? And so we're frustrated, we're literally handcuffed by lack of knowledge. 
Dasha: These were young doctors or patients. 
Jamie: Patients. Patients.
And that's one of the things that's been so beautiful about the platform, is it's very patient centric. Yeah. Which has been number one mandated by the government, by an executive order in 2019. But more importantly, it's critical because ultimately patients are making the choices. They're making the decisions about the care they wanna receive, and they want as much information that could be helpful to them in the process.
So our platform really, really takes that into consideration. 
Dasha: It's, it's really, go ahead, Rob. 
Rob: Yeah, no, I was gonna give you just a quick real life example of what we were just talking about and with Coastal, right, which is our development partner, our new cl, our client doing the AI radiology, when they first started using the platform, right, they came back to us and said, you know, the, the, the architecture that we had built was really focused about trying to deliver the results in under 30 seconds.
And we were limiting how, you know, how long that they could actually be viewing the files. Right. And they came back and it's just not long enough. Right. We needed, you know, we need double that and I knew I'd have to change the architecture to be able to get that done. And we go back to that same question.
Is that a data point, right? Or is that a market trend? And, and fortunately after 20 years, I've got a large number of trusted sources of people. So I literally got on the phone and asked six different people, Hey, is this, would this be a, a problem for you if you were using it? Should I change it to this?
Right? Within a matter of a couple of hours, I got all the responses I needed to know that that Coastal's input was not merely a data point, a valuable data point, but it was also a trend that we needed to fix. And so we talk about that, you know, measure, learn, iterate, feedback, loop, right? And how quickly, how can you condense that?
We understood now that this was something we had to change in our platform, and we had in 48 hours rewritten the underlying architecture and was able to solve that problem and deliver it back to coastal in under 48 hours, right? That is, that's how you build a company, right? You build the partnership, you build the understanding, and you build a better product because we are able to make that very data-driven and you know, assessment that this is something fundamentally we had to change and we did it quickly once we decided it was time.
Jamie: And there's been a real feedback in the last maybe three weeks over the fact that one of the largest EMR companies, you know, epic which is in over 50% of the hospital systems nationwide, and it's done an absolutely stunningly tremendous service to the country with what it has created, okay? That they're now moving into the AI iterative, you know, generative AI space, and they're announcing it as a corporate decision.
 And the feedback through LinkedIn and, and other social media has been, oh my God, this is gonna kill the young innovators. You know, what do we do? And, and, and, you know, some of those of us who have been doing this now for a long time or who far more sophisticated than I have come back with feedback of yes.
But the most important thing here is, is what your innovative thought and executed idea focused on is it to improve patient outcome and care and help drive revenues for those who are going to use it. If you can improve patient care, delivery, and efficacy and make it more efficient and economically valuable to the, you know, physician or hospital health system, it doesn't matter whether you are.
A two man management team or you are an entire multi-billion dollar corporation. It doesn't matter who creates it, it will be used and it will be of value. And it's not about who gets there first. If we've learned nothing else in the business world with innovation, it's about who does the better job.
So ultimately the innovation becomes an indispensable part of the way that they conduct their lives, whether it's on the patient side or the provider side. I hate that term provider, but I'll use it. That's the key. It has to be invaluable.
And it's like, wow, how did we even do this without X beforehand? That's the mission. And as you're iterating and thinking if you can find something that is new, but then determin is determined by the popula to be indispensable. Then you've, you've won the game. 
Dasha: Yeah. I, I will echo that. What are some things that, you know, are there any white papers or materials that people can go and take a look at for Actual Healthcare Solutions or any of your own writing that you would like to point our audience to?
Jamie: My co-author and I will be publishing a book that talks about the journey and the benefits that will be available. We're planning on it being available for a meeting at the beginning of December. In New York for New York Innovation Week at the Health Information Technology Laboratory out of Columbia University.
 The, it's called HIT Lab. That's its acronym. IT has HIT lab. It's a push for you. It has validated our platform. They have found it to be exceptional and that was three years ago. And we have changed and iterated so many different times. So we, for their fall, you know, summit, we are going to have the book be available, but until that time people can go to our company name actual healthcare solutions.com and can read about and actually test drive, you know, a little bit of the platform and take a look at what it can do.
Dasha: Very good. Rob and Jamie, it was so wonderful having you on the show. Thank you so much. You, thanks 
Jamie: for having us. This has been great. Yeah. Had a great time talking about everything.
Dasha: Absolutely. And to our listeners all of these things are gonna be linked in the show notes. Now, this episode's coming out before the book is, but once the book is out, we will shout out a little bit about it on whatever episode it comes out during, so that you guys will be notified. You can go read Jamie ER's work, and also just wanna point people who are interested in these topics to a couple other resources.
We have had a really great episode last summer with Dr. With Mark Hanson. And about heartbeat Health, and that was about AI being applied in the cardiology and telemedicine and expediting care there. So if you're interested in these kinds of issues, please take a look. And I just wanna have a couple words to conclude this season, which has been so interesting.
We really started with a focus. We wanted to create a focus in this season on physician led innovation, kind of how innovation happens at the bedside when people who are actually delivering the care, who are with the patient are observing problems, how do they translate them? And we've heard so many interesting stories.
We have stories about rural hospital systems that are actually creating an innovation, innovation engine in order to address rural health problems.
We heard from two doctors who've started nonprofits in order to address challenges that they're seeing in communities or even to bring new medications for ultra rare patients into into the world. We've heard about rare diseases and physicians who are trying to do basic research and understanding what those are.
Take a look through this season and we look forward to hearing to, and we look forward to speaking with you on our next season about innovations in oncology. Thank you.
David: Thank you for listening to Biomedical Frontiers Stories with Innovators in Healthcare. My name is David Chen and I'm the managing director of the Walls H Culture Center for Translational Research at the University of Virginia. Our mission is to help bring promising new biomedical research and technology into the hands of the provider and the patient.
If you found this episode valuable, please let us know by subscribing, following, or sharing. You can learn more about our promising translational research projects on our website. See links in the show notes.