This transcription is provided by artificial intelligence. We believe in technology but understand that even the smartest robots can sometimes get speech recognition wrong.

Health IT leaders reduce clinician burnout and enhance efficiency with Ambience Healthcare. Their AI powered platform automates clinical documentation, coding, and administrative tasks, allowing clinicians to focus more on patient care.

Seamlessly integrating with EHR systems, Ambience improves workflows and patient outcomes. Ready to revolutionize your healthcare operations? Visit ThisWeekHealth. com slash Ambience today and discover the power of AI with Ambience Healthcare.

today on Newsday.

Nikhil Buduma: It's not just what you do in the room or medication you prescribe, but it's getting that person truly bought in to making a change in their health, which is honestly only possible when you can build an authentic relationship. And I think AI has this beautiful opportunity to make that possible at scale.

I'm Sarah Richardson, a former CIO and president of this Week Health's 2 2 9 community development where we are dedicated to transforming healthcare one connection at a time.

Sarah Richardson: Well, good morning and welcome to Newsday. We've got Nikhil Buduma with us today. He's a leading figure in applying AI to healthcare. As the co-founder and chief scientist of ambiance healthcare, he has been instrumental in developing AI solutions, alleviate clinician burnout and enhance patient care.

Ambiance is AI platform adopted by institutions like Cleveland Clinic and John Muir Health. Integrates seamlessly with EHR systems to streamline clinical documentation and workflows. Nikhil, thanks for joining me on Newsday today.

Nikhil Buduma: Of course, it's been an exciting week, so it's a lot to talk about.

Sarah Richardson: There's always lots to talk about in these spaces, and we've got three really fun, just topics to cover.

Nikhil Buduma: I think it's exciting, but it's also not surprising. we've seen this sort of class of technologies become very good outside of healthcare.

People oftentimes talk about these models starting to automate so much of the software development workflow. And I think even Bill last week was talking about how he's using things like cursor to, to bootstrap applications from scratch. It's kind of incredible how, how good these models are becoming at reasoning.

And so, it's not surprising that models are actually very good at taking information inside of a clinical case and starting to, to use that information, do reasoning on top of it, and come to really effective predictions as to what diagnosis a patient might have. I think that. We should expect these capabilities to get better.

Sarah Richardson: So I'm a big fan of all the things that we're hearing in terms very specifically about being able to reduce some of the burden on physicians. So you consider that the models that are trained on these vast data sets can now generate differential diagnosis and recommend treatments with high accuracy.

Maybe that cuts down on the time it takes you to get to a specialist or have your PCP being that inter, being that true intermediary for you, but also collecting the patient history. It proposes care plans, you can review and finalize, you can enhance efficiency. And then with these tools that are listening and providing explanations, it also increases satisfaction and understanding on the patient experience side.

Nikhil Buduma: It used to be you needed a point solution to fix one problem. Now you have to a degree in Achilles platform point solutions that are addressing multiple aspects of your organization, and it's always with the patient and the clinician in mind first. And technologists sometimes get in front of the technology first.

You're making a ton of really good points. It's almost like imagine having a clone of yourself that's able to do all the things that would normally require your level of expertise to do well. But detract away from practicing top of license. Like imagine if you had a world class fellow read the chart before you walked into a room and could say, Hey, this is what's going on with the patient.

You kind of do need something really smart to queue you up for success. The data in the EHR is messy, and I think, you know, the paper, the two papers are really exciting, but I think there are some limitations, obviously to what they're talking about, including it's a purely simulated environment.

You and I both know how messy the data inside of the EHR is and reasoning over real world data is gonna be a. Whole different set of challenges compared to reasoning over a very sort of simply structured case. Also diagnosis is only a small part of what a clinician does, right. You talked about how.

It's not just about making a diagnosis, but it's about designing a care plan. It's about knowing when that care plan's not working. It's about titrating that care plan when potentially you've got heart failure, but your diabetes worsening and all of a sudden your heart failure medication's not working.

Sarah Richardson: Especially when if you're a CIO/CMIO, and we just spent a weekend with 'em, is understanding the capabilities limitations of what it can actually do and how you integrate 'em effectively.

But every single physician we talk to is like, I get to spend more time looking at my patient. That alone, that human connection. So we often talk about where's the human in the loop with ai. Well, the human in the loop in this case, to me, is not just the accuracy of what's being produced by ai, and obviously the physician has to sign off on that.

It's the human in the loop in terms of the ability to spend more time with a person. And when people are sick, they want their doctor to like look at them and know how they're feeling and not be worried about if the right billing code got captured and how fast the claim gets out the door. Patient doesn't even know about that stuff most of the time, and so when the doctor doesn't have to worry about it anymore or anybody in that clinical setting.

Nikhil Buduma: I think it's very exciting. a lot of physicians are starting to realize what it feels like to not have that burden on their shoulders anymore.

You get to look people in the eye. You get to build that authentic human relationship, and that's that your relationship that also helps you. Get people invested in their health and to buy into that behavior change that can be so important to addressing things like chronic disease. Those are oftentimes the biggest predictors of long-term health outcomes.

It's not just what you do in the room or medication you prescribe, but it's getting that person truly bought in to making a change in their health, which is honestly only possible when you can build an authentic relationship. And I think AI has this beautiful opportunity to make that possible at scale.

And this becomes, I feel like, honestly for once we're getting in front of the problem first. 'cause we know that it's coming. And we don't usually do that in healthcare and technology. Usually the technology fixes something we created in the first place. Well, guess what? We're actually way ahead of that curve.

I feel like in this scenario. So I'm grateful to see where things go. And I'm also grateful for products like ambience because it makes you excited about being able to take care of patients in the best version of yourself as well.

Nikhil Buduma: Hopefully we extend the careers of folks by five, 10 years because it's less burdensome to be in healthcare.

Sarah Richardson: Well, and we need them. Here's what I love next too, that we found evolution of hospital operations over 25 years. The first disclosure, I have to admit is that, yeah, I started my hospital career 25 years ago.

They've been bought o they've been bought. But back in the day when you were replacing, green screens and putting in gigabit backbone networks, but this is amazing. It was the transition from paper to digital that hospitals moved from paper-based records to comprehensive EHR systems, which at the time was about enhancing data accessibility.

For the first time we had data sharing. The patient could get their information across multiple departments. You never longer had to send things through a pneumatic tube for results between different floors. Even in some cases, I. We had the incorporation of scribes and telehealth has changed how clinicians interact with patients and documentation, advancement and treatments.

So when you think back on, my goodness, a quarter century of hospital operations and healthcare, what's most important to you about what you are doing for the next 25 years to really continue to change this curve?

Nikhil Buduma: I was about to pose that to you, Sarah.

Sarah Richardson: I'll answer after you.

Nikhil Buduma: In some ways I, I heard this, I can't remember who it was, but it was at a previous 2, 2, 9 event where someone said, you know what? In many ways, the EHR succeeded in what it set out to do. It set out to make data more interoperable, and it set out to improve patient safety by leaps and bounds.

And I think what has unintentionally happened over the last 25 years is our most highly skilled clinical professionals have sort of woken up and realized that while these systems are incredibly important to the practice of medicine and delivering better care to patients, it also has turned them into manual data entry specialists, which is not really, wasn't part of the job description when they entered medicine in the first place.

And I think there's potentially other components too, where it's brought. In some ways, the complexity around coding and billing is a whole other area of sort of change over the last 25 months. One could argue that in some ways EHRs helped at least sort of alleviate some of the complexity around coding and billing

It's often harder to trust this, the data that's inside of the system of record. because it was often entered by somebody who didn't really want to do it, who was probably burnt out, might have been falling behind. And so, it's no surprise that oftentimes you've got missing and contradicting information instead of the EHR that people have to navigate all the time.

Sarah Richardson: Except that now to your point, with every intent of the innovation or creation of something, it causes different. Problems as well as solves different issues that are out there. The advent of the ability to really have people leaning into data governance and data management and digital tooling as careers.

The type of acuity from the application of what people were doing that became advanced as well to me was so fascinating. Some of these niche. Aspects, your web programmers that came on board, the, your security analyst that had, we said one guy in security, 25 years ago who would make sure that the vendor assessment had some very basic elements built into it, and now you have security teams because of the complexity of everything that's going on.

So. What I love about the evolution of healthcare it's created an entire industry of professionals. Really the STEM spaces that are so critical to everything that we're doing today. The advancement technology has been everywhere, not just in healthcare, and people give healthcare a bad rap because it's behind.

I do believe, though, I. We'll continue to see the acceleration of adoption of certain technologies in healthcare like we are with AI, as an example, because we have to, and we've proven through all of these years that we can successfully build out systems that have a responsible nature to them. We've just accelerated that entire curve.

Sarah Richardson: how about if I tell you what I want it to be versus what I think it'll be?

And whether it's a PCP or some level of a specialist who's able to integrate all of the information coming to them, they become the hub, they become the delivery mechanism by which I'm having a thoughtful conversation about how healthy I am, my habits, my behaviors, my medications, my conditions, whatever's happening in my life, but I have one person.

The coordination of care is handled by technology, and so I have one person with whom I need to speak because today still trying to go to multiple specialists just to get like your hip figured out. Is time consuming and you have to understand how the system works. So I'd like to believe that we remove the friction in understanding healthcare, remove the friction in how to even get what you need as a patient, and that honestly to me is also universally available to people regardless of your politics.

Nikhil Buduma: That is an exciting vision. In some ways, turning this very episodic, convoluted interaction with the healthcare system into one continuous conversation where you've got, let's say, like an AI agent that's now sort of like the steward of your care, your navigator, and your coach.

That's an incredible vision. I don't think that's that far off. I think you're right that's going to happen in the next 10 years. And I think it's gonna be a step function improvement in the quality of experience for the patient.

Sarah Richardson: What do you want as a patient? Because even today you can, breathe into your metabolic device and wear your wearable and do all these things, but you are still coordinating all of the peripheral things that are available to you as a consumer.

Nikhil Buduma: I'll build upon what you shared. And also maybe tie in some of the elements from the previous article we talked about. I would love for care to be less about. Generic protocols and more about a deep understanding of me as a person and what's the right sort of personalized precision intervention for me, given my genetics, genomics, my social history, my preferences.

And it's not to say that, the state of medicine today, makes it hard to deliver that. I think we know a lot actually about, about the human body. We know about if we had infinite time and all the right experts in the room collaborating on everyone's care all the time, I think we could make incredible decisions and really bend the cost curve.

Clicking a button and accessing the sum total expertise of the world's best specialists in that interaction. Deliver the best possible care to that person in that particular point in time. I think that's not science fiction anymore. I think AI and how it's integrated into the workflow and the ability to have the right sort of governance and regulatory infrastructure to know these technologies are safe.

I think that's gonna be solved in the next five to 10 years.

Sarah Richardson: And the better accuracy and quality and engagement leads in theory to lower costs, which means we could take care of the higher acuity That's gonna happen just because no matter how well you take care of yourself, aging is aging. You get older and it's just, you gotta take care of things differently.

Take the curtain away. And informed citizens are gonna make better decisions. So I love that. But here's the fascinating one too. We'll end with this article, and this is right outta conversations that Bill likes to have. The healthcare is misunderstanding cloud computing, and we've gotta house all this information somewhere.

We've gotta make, have all this data available and. Bill consistently is debating the persistent misconception about cloud computing and some of its benefits. So we'll just touch on many healthcare organizations. They lack fundamental understanding of cloud characteristics, which means they may not utilize it effectively.

And as we shift to platforms and these models that provide flexibility, now the service models will continue to change. Security compliance is rougher. The concerns about data security and compliance are always gonna be a challenge, even though there's so many advancements. And more importantly, the ability to really understand when, how, and where to utilize these technologies that are available, whether you're the ciso, the CIO, the CMI, the digital officer.

Anywhere truly in the healthcare C-suite, you have to continue to, I guess what we like to say, demystify the cloud, but really teach the organization about how data is used, where it's used, where it's housed, how we're paying for it to get in and out of the systems. What do we actually need to be keeping for periods of time.

Nikhil Buduma: hundred percent.

Sarah, I will never be as much of an expert on cloud for healthcare as you and Bill. So I'm actually curious to hear what do you think are the, like one or two biggest conceptual mistakes that health IT professionals make when thinking about reasoning about cloud and how it should be used in health systems?

Sarah Richardson: I'll speak most recently from where I came from now. Tivity Health, phenomenal niche in the healthcare space, really serving seat Medicare Advantage seniors, also some commercial. Partners as well. But what was most interesting was do you have to be in the cloud to be successful as an organization? Is on-prem still a viable option?

What's funny is you see every pendulum, like on-prem to cloud. Some people are going back to on-prem, in some cases, some solutions. You always had to leave on-prem because of the size of the data at the time. I believe in the first misconceptions is believing that you have to go to the cloud at all.

I'm a big fan of multi-vendor strategies because I think it creates competition innovation and allows you to have some flexibility because you have an outage, earn issue with one. Unless you've got a really great diversification path, you're gonna have potentially a bump in certain services. It's how I feel about pacs.

It's how I feel about just different aspects of where you are practicing medicine. That's a different conversation though for like critical access or community Connect partners as an example. So the care setting is key. Really know what does your organization need. How is that financially viable? Is it now a capital expense, an operating expense?

This is what I need to be thinking about. This is what I'm a against and here's where I want to be in the next two to three years. Guess what? They will come together and work with you. To me, it's a crime. When you don't have your top partners, you a room together being a. Cohesive group to help you manage your system.

So if you've got Salesforce and you've got AWS and you've got, let's just say ambience and you've got Rubrik all in the room together, they need to appreciate what is the mission of the organization and how do you as chosen partners, 'cause there's not lack of choice in most of our solutions today. How as choice and partners do you help us be successful?

Our goals. This is how we're thinking about our budget. How do we come to a good structure over the next three to five years that is financially sustainable and actually helps us to accomplish all the goals that we have as a system? And I think we're seeing more of these conversations where it's not just, I'm gonna have a conversation with my cloud vendor and I'm gonna have a conversation with my AI partner and I'm gonna have another conversation with my document management solution and instead saying.

Let's just all get in a room and talk about this is the strategy, this is what we're trying to accomplish. How do we work together to, to make that possible? That's an incredible idea. And I'm putting two and two together. I'm seeing that happen more and more often. Nowadays

Sarah Richardson: you have to because other pieces and you did it this past weekend, people are like, oh my gosh, where do I get some of this education?

And I've said to partners before I sign on the dotted line, it's your responsibility to help us stay current on X, Y, Z. What is coming next? What are the new technologies? What are the regulations? We're gonna do it too. Let's match those learnings together. 'cause we're probably gonna teach each other things we weren't aware of.

'cause you're partners, if you are a CIO, whoever your partner is. They're talking to 20, 30, 40, 50 CIOs every week or every month. That's why I love our 2, 2 9 summits. You're getting hundreds of perspectives in a room with 20 people because everyone is crowdsourcing the information they're hearing and learning all of the time.

Nikhil Buduma: I appreciate it. It's about to get more complex, which is definitely I think I. Probably anxiety inducing for a lot of leaders. Because AI is a whole new wrench in the cloud stack. There's I think it was Dr. Sanner from Loma Linda who mentioned this over the weekend, I think we were talking about how the role of the CIO is about to evolve from managing applications whether they're deployed on premise or deployed on the cloud to managing AI agents. And these agents have very, sort of different compute characteristics, very different data governance protocols from traditional software applications.

So I'm also very excited to see sort of how this conversation continues to evolve as we start to move. Further and further towards using AI agents to do more of the work inside of health systems like we've been talking about over the last couple of days.

Sarah Richardson: And you had John DOR at your recent conference, talk about the speed by which things evolve was that things every 13 to 14 years these big revolutions come through.

This will shorten that timeline for sure. And hey, here's where I say to people, if that's the world you wanna live in, you're gonna have an amazing career as a CIO. If that terrifies you or you're like, I just don't wanna keep up anymore. Then there will still be enough to me. I think legacy opportunities for a period of time.

I'll be the 80-year-old person who probably has every gadget possible and like telling every, telling all the kids about, we used to do this, but it just depends how you're wired. But a lot of people who went into, I wanna maintain a data center, or I love this aspect of my job. They will need to retool.

There's a lot of retooling, I think, mentally in terms of also how kids are learning what we're learning in colleges today, which is why you're also seeing a decrease. Did a podcast about a month ago with one of my girlfriends who teaches PhD programs at Lipscomb in Nashville, and she said, less and less people are getting these advanced degrees because they're going and get these certifications.

That allowed them to keep up with the pace of what's happening. Across the world today. And I believe that will continue to be a true statement as well. So I'm hopeful that it also becomes a bit of an equalizer in terms of expectations and career options for people because it is moving quick. And if you don't wanna be on that bullet train you gotta really rethink what could be next.

But there is so much opportunity out there, it's probably one of the most exciting times to be in healthcare right now. A

There's no substitute for, having the confidence that the thing that you're automating is the right thing to automate. And that comes from experience, it comes from battle scars, from actually tackling real problems in health systems. So I think I personally think the best the best outcomes are gonna come from.

The right collaboration between new folks who are really adept at using these new tools, partnering with leaders who deeply understand the problems of healthcare and the challenges of delivering solutions that work in the real world.

Sarah Richardson: Agree with you, mark. And guess what? We're all patients first. So we are the best inputs for the solutioning and things that need to happen.

'cause you're seeing and feeling it every single day. And so I'm hopeful that it's re-energizing the whole slew of careerists that know that it's harder than it's ever been before to be in healthcare from a regulatory perspective and yet from a technological perspective, it's also the most advanced and most exciting.

So bring those two together. They basically balance a space where we can all thrive and be successful. So thank you so much for taking time to cover the news and. Continue to producing amazing solutions for our practitioners and our patients out there. And what you do is exactly what is needed right now and for the future.

Nikhil Buduma: An exciting time.

Thanks for listening to Newsday. A lot's happening in our industry. And while Newsday covers interesting stuff, another way to stay informed is by subscribing to our Daily Insights email, which delivers expertly curated health IT news straight to your inbox.