Things You’ll Learn: 

• AI has the potential to significantly improve clinical decision-making and personalize patient care, despite current challenges in its integration. 
• There’s a crucial need to reconcile AI-driven recommendations with the complexities of patient care, emphasizing the importance of the doctor-patient relationship. 
• Addressing inefficiencies and redundancies can help the healthcare system learn from other industries and create a smoother, more efficient patient experience.  
• Physicians interested in startups should be adaptable and open-minded, recognizing the parallels between healthcare and the fast-paced nature of startup environments. 
• Effective value-based care requires sustainable models that are fair and not overly burdensome, along with a focus on collecting and utilizing better data for improved healthcare delivery. 

Resources: 

• Connect with and follow Dr. Ben Schwartz on LinkedIn. 
• Subscribe to Dr. Schwartz's newsletter, The Surgeon’s Record, here! 
• Check out Dr. Schartz’s guide to startups here! 

Transcript:

Rachel Schreiber:

Hello and welcome to The Spark, a view of innovation in healthcare. I'm Rachel Schreiber, your co-host, and in this episode we're speaking with Dr. Ben Schwartz, a fellowship trained orthopedic surgeon with more than 15 years of experience and a thought leader in healthcare and innovation. He publishes a weekly newsletter called The Surgeon's Record and frequently publishes on LinkedIn. Dr. Schwartz, I first heard about you on social media and read your substack, The Dry Bones, which is now the Surgeon Record, and I'm really looking forward to speaking with you and learning more about your focus and your passion in healthcare.

Dr. Benjamin Schwartz:

Thanks for having me. I appreciate it.

Rachel Schreiber:

I'm also joined by Gerald Bortis, Chief Technology Officer at Avaneer Health.

Gerald Bortis:

Thanks, Rachel. Welcome to the Spark, Dr. Schwartz. We're excited to have you join us for today's conversation. I think you have a unique perspective. You're a practicing surgeon, you're an investor, you're an advisor, and you're also a thought leader and a voice in the healthcare technology and innovation space. To start, I'd like to hear about what's your source, your personal passion for working in healthcare? What's your spark?

Dr. Benjamin Schwartz:

Yeah, so my spark is, I come from a little bit of a medical background. My father was a hospital administrator for many years, so sort of the dark side, I guess you would call it, coming from physician's perspective. My mother was a nurse anesthetist who gave up her career to raise a family. So I came from a medical background, maybe a little bit of a different perspective. My great grandfather was a physician as well, so definitely a medical bloodline in the family and just sort of have always had a passion for biology and medicine. And then since I was really young, had a passion for technology and those two things have slowly kind of led me to where I'm now.

Gerald Bortis:

That's great. Thank you for sharing that. Since you've been practicing, you've seen technology in healthcare evolve. You're familiar with trends in healthcare, data platforms, digital transformations, the use of AI, so on. What do you think is the most significant technological shift in healthcare that could have a positive impact on physicians, hospitals, patients?

Dr. Benjamin Schwartz:

I think obviously AI is the thing that's top of mind for a lot of people. I mean, we've had EMRs, they've been around for a while, but I think AI is really the thing that has the potential to take us to the next level. I know there's a lot of, we're sort of in that maybe downward slope of innovation cycle for AI because there was a lot of hype. I think people now are starting to look at it differently. I think we're going to get there. I think AI is the real deal in healthcare. We're seeing generative AI and speech recognition, ambi ai. There's algorithms being used already in terms of clinical decision making, and I think that's only going to get better as a technology gets better. And causal ai, predictive ai, things beyond generative ai, which kind of gets all the press, but I think there are other applications of artificial intelligence and healthcare. It's going to make us better clinicians, diagnosticians, deliver better treatments, deliver more personalized treatments. And so I think we're just scratching the surface of that and that's going to continue to get better. But I think artificial intelligence, machine learning really has that ability to make us better in treating and engaging patients.

Gerald Bortis:

That's great. I'd love to dive a little bit more into that. Certainly a lot of talk about AI and how it could be used in healthcare. You've recently written a LinkedIn post about change management and why it's important to have the why around change, the why that fuels the change and the communication around it. At Avaneer, we're innovating both technologies processes. We encounter the need to communicate the why and articulate that this will help lower costs, this will help improve the patient experience. This will help set you up for better things in the future. Given the impact that AI can have, how would you communicate, how would you articulate the why around that technology?

Dr. Benjamin Schwartz:

I think it's about sort of bridging that gap between the technology and the clinical setting. Things from a technology standpoint tend to be a little bit more ones and zeros, maybe a little bit black and white. That doesn't always a hundred percent translate to the clinical setting where there's a lot of gray areas. And how do you sort of marry those two things? So the example that comes up in my practice a lot is maybe a patient comes in to the office, they have knee pain. I might tell 'em, look, you're not ready for knee replacement surgery yet. Or the evidence-based guidelines would say, an MRI is not indicated right now. And the patient might not understand why that is. And they feel like, you know what? My neighbor had an MR MRI or had an M MRI in my other knee. It showed this, and I really think I want that MRI or my knee is painful and I don't understand why not ready for knee replacement surgery yet.

And it takes a lot of time to sit down with the patient and work them through that. If you have an algorithm that's saying that, how do you reconcile that? How do you say, well, we fed all of your information into our algorithm, and our algorithm says, yeah, we understand your knee is painful, but our algorithm says you're not ready for knee replacement surgery yet. Here's maybe why, but maybe it's a black box and we don't know how the AI got to that conclusion. Or as the physician, maybe I don't agree with the recommendation of the algorithm. How do you bridge that gap? How do you account for the gray areas? Is there accounting for the gray areas? Is there accounting for the AI is just a tool or is the AI going to be the final judge in terms of treatment and say, look, the AI says you don't need that MRI insurance. The company's not going to pay for the MRI because of that. So I think those are things that we really have to kind of work through of the technology as a tool versus technology as sort of determining treatment and how do you deal with the situations where there may be disagreement between patient technology and doctor.

Rachel Schreiber:

That's really complex. It adds a huge level of complexity

Dr. Benjamin Schwartz:

I think we have to allow for that sort of art of medicine to creep in there. But at the same time, we also don't want non-evidence based treatments. And so we can't go too much to one side of the spectrum of the other where it's AI is sort of the final judge, or technology is the final judge, or it's wild west where it's whatever I want as a doctor is what goes or whatever the patient wants. If it's not evidence-based, go. So I think we have to find that middle ground somewhere.

Rachel Schreiber:

Is there something that we can learn from other industries that we could apply in healthcare? Does that kind of relate?

Dr. Benjamin Schwartz:

Yeah. I think one thing that we struggle with for a lot of different reasons in healthcare is really as some people call it the patient or the customer experience. I don't love calling patients customers, but the patient experience of how they interact with the healthcare system, there's a lot of frustration there. The inefficiencies of it, the redundancies of it. Every time I show up to a different doctor's office, I have to fill out the same paperwork. I can't get through to my doctor's office. I can't get an appointment for many, many weeks. My orthopedic surgeon doesn't know what my primary care doctor's doing, doesn't know what my endocrinologist is doing because they're in different EMR systems. So I think that patient experience and those things that throw up barriers to care, we can learn about from other industries, the customer, the patient experience to make it a smoother, better interaction with the healthcare system.

Rachel Schreiber:

I agree. Less paper, more digital and more human as well.

Dr. Benjamin Schwartz:

All those things together. I don't think we've quite figured out the right mix of those things, how technology we can use it to better facilitate, be it enabler and not a barrier in the care process. I think we're still trying to work through that.

Rachel Schreiber:

So I was really interested to see your doctor's guide for startups. I went to an ENT recently, and his bedside manner was really good. As he came in, he is like, what do you do for a living? And I said, health tech marketing. Usually that kills a conversation or people's eyes glaze over. But he was like, oh, that's interesting. And then he told me that he was on his second startup doing some innovation, and it just kind of surprised me, such a specialist. But to see that level of innovation and thinking, I thought that was really encouraging. And so I'm sure that your guide has gotten a lot of interest.

Dr. Benjamin Schwartz:

I think doctors have always been innovative within the traditional medical field. So orthopedic surgeons, we love to develop new devices and implants and stuff to use in the operating room. Same thing for ENTs and then medical physicians within medications and things like that. So I think we're innovative in spirit, but this is a little bit of a different type of innovation outside sort of the traditional medical sphere and into the startup sphere and maybe healthcare delivery, innovation, things like that. And there's a lot of interest in that, particularly from younger generations. But my generation too, and being active on social media, I have people reach out to me quite often. I've sort of written before, how do you get into these positions If you have an interest, how do you get started? And then this more recent piece was kind of companion or a follow-up piece to that of, okay, once you started to get into it, there's what to expect.

Because as a lot of people know the startup world does function a bit differently. It's fast moving. There's sometimes chaos or sometimes unknowns. Things get shuffled around to last minute. And so the piece was try to make parallels. We experienced all those things in traditional healthcare as well, and we're okay managing that. Same thing happens in the startup world, maybe from a little bit of a different perspective, but if we find those parallels, then it's an easier transition to sort of the chaos of the startup world if you have an interest in that. So occasionally I'll have a doctor reach out to me and almost to sort of translate or read between the lines of, okay, here's going on with this startup company. What does that mean? How do I interact with the founder? How do I sort of interpret what I'm being told? And it's just there's uncertainty.

Don't take it personally. If somebody has ghosted you for three weeks, it's probably not maybe, but it's probably not anything that you said or did. It's they're extremely busy. They're getting pulled in a thousand different directions. They'll probably come back to you, circle back. We all know is the term people make fun of, but they probably will circle back to you. And if not, don't be annoying. But it's okay to nudge just a quick note of, Hey, what's going on blowing up on this? Is there anything I can do to help? Yeah, I've been swamped, apologize, type of thing. So I think those types of things, if you understand them and appreciate them coming from the medical field, you'll be more successful or you'll have a better experience working with startups.

Rachel Schreiber:

That's really great. And the clinical voice is really important part of startups. I know a lot of people have great ideas, but physicians do need to be involved early and often, I suppose.

Dr. Benjamin Schwartz:

Yeah, I think so. Yeah. I mean, those are the companies that I've worked with. I have really great founders, and I think they're obviously earnestly want to fix things. A lot of 'em don't come from a medical background. And just the nature of the healthcare system, particularly the American healthcare system, is a lot of things don't make intuitive sense. And sometimes it's hard to see that, well, why don't you do it this way? Well, yeah, that makes perfect intuitive sense if you look at it from the outside, but from the inside, this is why it doesn't work. Maybe it should work that way, but it doesn't work that way. And so I think the ability to bridge that gap is important. I think at the same time as a clinician, having an open mind and being willing to see things a little bit differently or step out of the rigors of traditional healthcare without stepping over the line of doing things that you're responsible or unsafe is a good skill to have.

Rachel Schreiber:

So if you kind of step back from your daily work, when you think of healthcare, how would you describe the most optimal and effective healthcare situation or healthcare scene?

Dr. Benjamin Schwartz:

I've always believed, and I write about this often, that really the core of medicine is the doctor, patient, clinician, patient relationship. And that's, in the past has been very strong. There weren't a lot of barriers to that relationship, and now it's just over time, more and more barriers have crept into it. There's insurance company barriers, technology barriers through the EMR administrative barriers from different criteria, things that have to be met or reached. So all these things add up over time and they detract from the doctor patient relationship, which is why I think the healthcare system has struggled and some of that trust is eroded and that frustration is built. So I think if we can kind of restore that and say, you have time, you have communication, but come at it from sort of a technologically evolved standpoint, I think we'd be much better off.

And I think the technology really is at its best when it fades into the background. So maybe it's an ambient scribe, maybe it's an EMR that's more user-friendly, that I don't have to have a screen between myself and the patient. Maybe it's remote patient monitoring tools, your asynchronous communication that's not overburdensome for either party. So I think we could do a better job taking the tech tools that we have to facilitate the doctor patient relationship, but do it in the way where they sort if you don't even know they're there. Because in our lives, the best technologies, the technology that we don't really even realize we're using, that sort of becomes second nature and phase into the background.

Rachel Schreiber:

I think that creates a picture we would all like and enjoy

Dr. Benjamin Schwartz:

Both. I think we're getting there. I think it will take some work from a process perspective. And I think the other part of innovation that will feed into that is value-based care. I think there's going to be a strong link between value-based care delivery and technology.

Rachel Schreiber:

So I would like to ask you one last question about value-based care and what do you think is going to take, or what is it going to take to make that really a part of our system? I know the fee for service has its pros and cons. We're all used to it, but where do you see that gap in value-based care and what we really need to make that happen?

Dr. Benjamin Schwartz:

Yeah, I think it's going to take sustainable models. How do we hit on that? I think we need to do a better job involving clinicians in the design and implementation of those models. I think we need to make them fair. We can't make them a race to the bottom. We can't make them overburdensome from an administrative standpoint. We can't make it death by a thousand metrics. I think we have to figure out how do we make value-based care elegant and simple at the same time? It's not simple, but is there a way that we can design a program that's sort of achieve what we want to achieve, which is high value, high quality, cost effective care without designing these really convoluted programs that are hard to administer and people drop out, they just can't have financial success, or there's just too hard to exist within those models.

Rachel Schreiber:

Have you seen that there’s a need for more data?

Dr. Benjamin Schwartz:

I think more data and better data, better data. And that gets back to the EMRs and the fact that a lot of the data is hard to parse. Some of it's low quality, and that's one of the downsides of the EMRs is just sort of cut paste and then bad data just takes on a life of its own and just gets repeated over and over again when you cut and paste. Or it's hard to pick out these reams of data. They're really salient things that are important versus the things that are just like a checkbox where there's pages and pages of words that are hard to sort of parse what's important.

Rachel Schreiber:

It could be a PDF in a record.

Dr. Benjamin Schwartz:

Yeah, pdf in a record, or I think we're getting tools to pick those things out and pull those things out. But on the front end, getting the data entry in good at the beginning is going to help everything downstream instead of having the garbage in, garbage out. If you take out the garbage in part of it, then that's going to help solve the garbage out part of it. Yeah.

Rachel Schreiber:

Well, this has been a really great conversation. We need more leaders like you that are innovating, that are bringing that physician's perspective to innovation. That's really important. If our listeners want to keep up with you, they can find you on LinkedIn and your SUBSTACK blog, The Surgeon's Record.

Dr. Benjamin Schwartz:

Feel free to reach out, love anybody to subscribe to the surgeon's record, and feel free to drop a message anytime.

Rachel Schreiber:

All right. Thank you so much.

Dr. Benjamin Schwartz:

Thank you.