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<v Speaker 1>This is the Startup Still Say podcast.

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<v Speaker 2>Thank you for tuning in favor subscribe over LinkedIn and

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<v Speaker 2>be sure to give us your predom. I hope you

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<v Speaker 2>enjoyed this episode.

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<v Speaker 1>Hello everyone, this is Anthony Prakashi, your host for Startups

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<v Speaker 1>They'll Say. Here we are with another brand new episode,

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<v Speaker 1>and I'm super excited today to bring to you a

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<v Speaker 1>couple of my friends. We were colleagues or partners in

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<v Speaker 1>crime a couple of years earlier, but we are all

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<v Speaker 1>members of a flood of community right now and I'm

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<v Speaker 1>excited to bring to you their story, their mission and

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<v Speaker 1>vision for something super important in the healthcare world, both

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<v Speaker 1>in the US as well as the entire world that

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<v Speaker 1>they're trying to solve, and it is Their company is

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<v Speaker 1>called May June. So John, doctor John Manning here is

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<v Speaker 1>the CEO of May June and doctor Gray Fuckinberry is

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<v Speaker 1>the CEO of May June. So if about anything, I mean,

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<v Speaker 1>they always inspire me because both of them are doctors

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<v Speaker 1>by day and sometimes by night, and then the rest

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<v Speaker 1>of the twenty four hours, they are technologists and hardcore technologists.

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<v Speaker 1>I must say so a warm welcome John, and great

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<v Speaker 1>to startups Bills. Why don't we kick it off maybe

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<v Speaker 1>with John. You can go first and tell a little

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<v Speaker 1>bit more about yourself and your journey of how you

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<v Speaker 1>started off me.

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<v Speaker 2>Yeah, sure, and thanks for the introduction Anthony. We've gone

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<v Speaker 2>a long time back, so it's great to have the

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<v Speaker 2>opportunity to speak here. So I'm John Manning. I'm an

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<v Speaker 2>emergency medicine physician by training. I teach medical students and

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<v Speaker 2>residents how to care for patients in one of the

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<v Speaker 2>Level one trauma centers in Charlotte, North Carolina, and have

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<v Speaker 2>done that for almost a decade at this point, getting

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<v Speaker 2>close to that point right before coming down here, like

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<v Speaker 2>right around that time, I co founded May June with

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<v Speaker 2>an interest in building technology solutions that focused on human factors,

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<v Speaker 2>usability and just trying to make your life easier from

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<v Speaker 2>an end user perspective, the kind of short version of it.

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<v Speaker 2>And we can go in depth if interested. But I

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<v Speaker 2>used to be ascribed in a medical field in DC.

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<v Speaker 2>I hand wrote notes helping emergency positions. Was there when

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<v Speaker 2>we transitioned from paper to electronic saw the equivalent of

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<v Speaker 2>twenty different health systems across med school, residency, fellowship, etc.

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<v Speaker 2>And all with different levels of medical record integration and usability.

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<v Speaker 2>A lot of them had a lot of usability challenges,

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<v Speaker 2>and my attempt to give back was in building tech

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<v Speaker 2>solutions through made focus on that.

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<v Speaker 1>Awesome. Great, why didn't you do the same? Just introduce yourself?

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<v Speaker 3>Great and thanks again for having us. I'm excited to

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<v Speaker 3>be here. I've been looking forward to it, even though

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<v Speaker 3>I responded like so, I'm Gray Falconberry. I'm CTO trained

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<v Speaker 3>in internal medicine and pediatrics. I practice as an adult hospitalist,

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<v Speaker 3>and my other part of my day job is I'm

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<v Speaker 3>the co chair of the Global Health Informatics Program at

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<v Speaker 3>the Children's Hospital of Philadelphia, although I actually live in Atlanta.

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<v Speaker 3>That's one of the joys of technology and informatics is

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<v Speaker 3>that so much of its virtual. You know, you don't

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<v Speaker 3>have to be in the place where you practice, which

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<v Speaker 3>is really nice and allows flexibility. And I there's a

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<v Speaker 3>longer story involved, but I got into this from the

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<v Speaker 3>global health perspective actually and looking at how you can

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<v Speaker 3>sort of leverage technology abroad to improve healthcare.

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<v Speaker 1>That is awesome and it's a super worthy cause. And

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<v Speaker 1>like I've heard from both of you, I mean, it's

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<v Speaker 1>it's obviously even in a country like the US. It

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<v Speaker 1>is informatics and the amount of manual effort that goes

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<v Speaker 1>into the work aside from you guys, care for patients

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<v Speaker 1>I mean is a big part of every doctor's day, right,

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<v Speaker 1>I mean, and there's so much of others involved in

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<v Speaker 1>it as well. So let me ask you this, I mean,

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<v Speaker 1>where did you kind of get the h to say, Okay, man,

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<v Speaker 1>this is a big problem. We've got to do something

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<v Speaker 1>about it. I mean who started that? I mean, I'm

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<v Speaker 1>sure both of you have to think about that vision

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<v Speaker 1>and believe in it saying okay, we can do something

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<v Speaker 1>to do it. But John, I know you started this

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<v Speaker 1>and Gray probably joined later. So what did you tell

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<v Speaker 1>the audience about? I mean, where is it that you

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<v Speaker 1>noticed this? I mean, I know you said you were

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<v Speaker 1>ascribed maybe there, but tell us more.

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<v Speaker 2>Yeah, So it all kind of comes back full circle.

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<v Speaker 2>And when you're just trying to think through like how

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<v Speaker 2>you can improve and where those options are, you mentioned

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<v Speaker 2>usability being a big issue for physicians. Christine Sinski from

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<v Speaker 2>the American Medical Association published on that there's a thing

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<v Speaker 2>called pajama time, which is the time you spend at

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<v Speaker 2>home just charting and catching up on your documentation, and

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<v Speaker 2>every specialty has it. It's not fun, it causes burnout.

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<v Speaker 2>It leads to burnout, so it's everywhere. The specific path

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<v Speaker 2>that led to May June, interestingly was as a resident

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<v Speaker 2>in Emergency Medicine, I pitched an idea to the first

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<v Speaker 2>ever Emergency Medicine hackathon at their national conference. Got the

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<v Speaker 2>grand prize, got a bonus phase prize, and an opportunity

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<v Speaker 2>to speak at a public health summit in part of

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<v Speaker 2>the keynote in Illinois. So we built an app that

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<v Speaker 2>was based on the hackathon idea. Wrote it in Java's

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<v Speaker 2>first time that we'd ever written any sort of code.

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<v Speaker 2>It was a Java developer friend of mine who had

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<v Speaker 2>not written anything in Android before, neither had I. He

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<v Speaker 2>lived a few months away or a few blocks away,

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<v Speaker 2>and the better part of my final year of residency

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<v Speaker 2>training was building this application. All through fellowship, got a

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<v Speaker 2>lot of opportunities to work with other startups and do

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<v Speaker 2>a bit of mentoring and working with a group called Matter,

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<v Speaker 2>a health tech incubator, and time unfortunately broke a little

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<v Speaker 2>bit of the app, and when we were trying to

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<v Speaker 2>think through am I going to do this in Cotland?

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<v Speaker 2>Because Cotland is new. Am I going to switch over?

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<v Speaker 2>Am I going to just update this in Java? That

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<v Speaker 2>was almost exactly the time that Flutter was announced, so

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<v Speaker 2>December of twenty eighteen. The next month, I was in

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<v Speaker 2>Boston giving a live coding session, handshaking for five minutes,

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<v Speaker 2>showing how you can really make this because it just

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<v Speaker 2>fell in love with Flutter. A few months later, it

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<v Speaker 2>was a big informatics conference at their annual symposing or

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<v Speaker 2>their clinical Informatics conference, and in two hours introduced Flutter

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<v Speaker 2>and live coded how to create the conference's app in

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<v Speaker 2>real time while just talking and writing code. And one

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<v Speaker 2>of Gray's predecessors, his co fellow one year ahead of him,

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<v Speaker 2>tap through that conference. It was like seventy eighty people

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<v Speaker 2>in that two hour event. And when he joined Informatic

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<v Speaker 2>like that Informatic fellowship a few months later, he was

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<v Speaker 2>interested in global health and maybe Android or you know,

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<v Speaker 2>trying to build and develop for this, and she looked

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<v Speaker 2>at him, she was like, well, why don't you just

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<v Speaker 2>look into Flutter? And he started looking into this, and

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<v Speaker 2>there was a shared Slack channel with a lot of

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<v Speaker 2>Informatic fellows that were going through this new training, and

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<v Speaker 2>we started collaborating, collaborating every day or slack over years

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<v Speaker 2>and started building these solutions that would then allow other

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<v Speaker 2>people that are in and around the health tech space

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<v Speaker 2>to use the standard for interoperability FIRE within Flutter applications,

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<v Speaker 2>and much of that goes to Gray and all of

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<v Speaker 2>the time and effort that was spent in this, I

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<v Speaker 2>was I just make apps and Flutter and I live

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<v Speaker 2>code and I can talk and you know, it's the

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<v Speaker 2>emergency medicine brain. I can talk and write code at

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<v Speaker 2>the same time, you know. And that's my thing. But

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<v Speaker 2>a lot of that underpinning and architecture that's open source

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<v Speaker 2>and has been used by developers a lot across the

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<v Speaker 2>world that goes with many things to correct.

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<v Speaker 1>That is awesome. John, So you touched on a lot there, right,

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<v Speaker 1>I mean you talked about fire obviously informatics and great,

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<v Speaker 1>maybe you can wear the CTO had I've always wondered.

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<v Speaker 1>I mean, you know, you guys have very little time,

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<v Speaker 1>yet you've found the time to learn a technology like Flutter,

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<v Speaker 1>decide and pick on it saying Okay, this is the

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<v Speaker 1>best choice to move forward with what we're trying to build.

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<v Speaker 1>I mean, for I mean, obviously you don't need to

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<v Speaker 1>be an engineer to learn flutter and use flutter anymore.

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<v Speaker 1>I mean you are perfect examples for that, right. But

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<v Speaker 1>how did that love for even technology come in to

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<v Speaker 1>both of you? I mean, obviously you need a spark

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<v Speaker 1>within you, you need that push within you to say, Okay,

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<v Speaker 1>this is not something that I can outsource to a

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<v Speaker 1>company and say build it. I want to do this myself, right,

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<v Speaker 1>I mean, how did you sort of make that choice

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<v Speaker 1>great to say okay, I mean, you guys want to

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<v Speaker 1>be you know, getting your hands and feed wet with

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<v Speaker 1>building this whole thing.

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<v Speaker 3>So I my love of technology and sort of science,

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<v Speaker 3>I think at John's two, you know, is not not

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<v Speaker 3>a new phenomenon we liked growing up. In college, I

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<v Speaker 3>was a physics major and I'm minored in computer science,

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<v Speaker 3>so I had a little bit of a background, but

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<v Speaker 3>then I didn't really use it. I went to medical

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<v Speaker 3>school and was in medical school when EHRs really started

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<v Speaker 3>coming around and sort of everybody switching over from paper

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<v Speaker 3>to electronic and so I saw that transition, and at

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<v Speaker 3>the time it was exciting. I was looking forward to

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<v Speaker 3>it because again I like technology, and at the time

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<v Speaker 3>it seemed mostly good you know, the not having to

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<v Speaker 3>fight for the chart, having one chart for a patient,

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<v Speaker 3>having eight people trying to look at it. You know,

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<v Speaker 3>you didn't have to worry about that anymore, having to

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<v Speaker 3>walk across or down fifteen floors and across campus to

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<v Speaker 3>write an order and a chart. You could just put

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<v Speaker 3>it into the computer. So there were some really nice

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<v Speaker 3>things about it, and then there were a lot of

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<v Speaker 3>not nice things about it. It was obvious that, as

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<v Speaker 3>John said, the usability was not a sort of forefront

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<v Speaker 3>in anyone's mind. You know, with the design of these

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<v Speaker 3>and any sort of study or survey done on physicians

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<v Speaker 3>now you'll see that. You know that there is burnout,

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<v Speaker 3>and so you work with that long enough and it

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<v Speaker 3>becomes a source of frustration because it really felt like

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<v Speaker 3>the people who designed it hadn't ever seen a patient.

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<v Speaker 3>And that was probably true, you know they and you

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<v Speaker 3>really need to understand the workflow. You need to understand

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<v Speaker 3>how it feels and what you need and how it

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<v Speaker 3>should be organized to take care of, you know, a patient.

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<v Speaker 3>And I think what drove a lot of us into

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<v Speaker 3>informatics is the feeling that we want to be involved

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<v Speaker 3>in this, We want to help make this better. This

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<v Speaker 3>is something. This is a skill set that we feel

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<v Speaker 3>like we have and we can develop and we can

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<v Speaker 3>actually contribute and sort of change things for the better.

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<v Speaker 3>So much of medicine is already sort of set in place,

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<v Speaker 3>and there's there's so little opportunity to sort of change

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<v Speaker 3>any of it. But informatics, I think is different. It

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<v Speaker 3>is still new, it is still changing. It is a

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<v Speaker 3>lot of it is sort of set, but a lot

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<v Speaker 3>of it's not, I think enough of it's not that

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<v Speaker 3>we can sort of affect that change. And I think

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<v Speaker 3>that's what's exciting about it is the feeling that I

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<v Speaker 3>actually have the ability to hopefully, you know, help medicine

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<v Speaker 3>and healthcare be provided in a better way through technology,

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<v Speaker 3>you know. And that was sort of how informatics I think,

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<v Speaker 3>came into my life. Yeah.

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<v Speaker 2>So if you think of like as an example in

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<v Speaker 2>medicine of something that's never changed and it will never change.

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<v Speaker 2>Coagulation cascade, which sure whatever, Okay, you don't have to

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<v Speaker 2>know about it. One of there's a dozen factors. One

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<v Speaker 2>of them is literally just calcium and it was named

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<v Speaker 2>its own factor. Sure, and another one factor six. They

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<v Speaker 2>found out, oh actually it was just another version of

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<v Speaker 2>factor seven, and so there is no factor six. There

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<v Speaker 2>isn't one. So it's labeled up to a dozen or

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<v Speaker 2>a thirteen, but you're missing a whole number. And since

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<v Speaker 2>we've all learned it this way, I'm sorry you have

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<v Speaker 2>to learn it that way too, even though it makes

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<v Speaker 2>no sense. Welcome to healthcare. Here's a chance where we

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<v Speaker 2>can actually build things that match the workfload that's there.

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<v Speaker 2>To Gray's point, if you don't see it, if your

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<v Speaker 2>brain isn't literally into the weeds, and it's not there's

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<v Speaker 2>one thing to be shadowing somebody who was doing this,

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<v Speaker 2>there's another where you were putting all of your cognitive

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<v Speaker 2>effort and load into the care of a person. So

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<v Speaker 2>you don't make those mistakes, and so that you know,

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<v Speaker 2>medicine always has mistakes, but so that you minimize that

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<v Speaker 2>and yet you allow for the right processes and everything

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<v Speaker 2>to help. Well, if you have a very expert, complex

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<v Speaker 2>system that's pulling all of your attention away, you're gonna

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<v Speaker 2>get distracted and things will happen, and it's you know,

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<v Speaker 2>it can lead to it can lead to harm.

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<v Speaker 1>If you.

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<v Speaker 2>What was the the book that was talking about the

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<v Speaker 2>digital doctor from like ten years ago or ten to

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<v Speaker 2>fifteen years ago, talks about all the processes of how

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<v Speaker 2>a fifteen year old child swallowed thirty eight and a

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<v Speaker 2>half pills of a single antibiotic and seized, and all

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<v Speaker 2>of the workfload things, as well as the medical issues

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<v Speaker 2>that were a part of your electronic health record that

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<v Speaker 2>was almost like a Swiss cheese effect where everything was

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<v Speaker 2>perfectly aligned to a point of a nurse in a

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<v Speaker 2>room with a fifteen year old by himself, with mom

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<v Speaker 2>or dad not nearby, as he is individually swallowing almost

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<v Speaker 2>forty pills. There's a lot to it. So any ways

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<v Speaker 2>that we can improve that medical perspective I think is helpful.

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<v Speaker 1>Yeah, And speaking of a medical perspective, John, I mean,

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<v Speaker 1>I know both of you have touched on what you're

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<v Speaker 1>trying to make better. But if there is someone who

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<v Speaker 1>just is a layman in layman's terms, if you want

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<v Speaker 1>to explain before May June's in an after main story

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<v Speaker 1>of course, using fire which is fhir for those listening,

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<v Speaker 1>how do you explain the work that you guys are

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<v Speaker 1>doing to make this thing better?

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<v Speaker 3>So I could take this one. So part of it,

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<v Speaker 3>I think is something that we're all familiar with. And again,

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<v Speaker 3>in no way as a clinician, I think it's a

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<v Speaker 3>patient you see it. We all go to doctor's appointments

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<v Speaker 3>or healthcare appointments or therapy appointments where you would like

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<v Speaker 3>to be able to move records around. You know, you've

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<v Speaker 3>seen someone else before you would like to share those

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<v Speaker 3>records with someone else. And it's always painful. It's always

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<v Speaker 3>extremely hard. You have to fill out release sheets and

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<v Speaker 3>they have to often fax them over the fact that

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<v Speaker 3>facts comes into conversation at all anymore is ridiculous, but

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<v Speaker 3>it does in medicine all the time. You know, I

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<v Speaker 3>regularly get two hundred pages of faxes of someone's medical

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<v Speaker 3>record from another hospital, you know, trying to take care

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<v Speaker 3>of it, because medical records don't share data very well.

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<v Speaker 3>And then about not quite fifteen years ago now, there

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<v Speaker 3>was a standard that started being developed called fire Fast

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<v Speaker 3>Healthcare Interoperability Resources in order to share it. And again

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<v Speaker 3>that's a big deal because just having that information is

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<v Speaker 3>so important. So the ability to easily share healthcare data

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<v Speaker 3>you know can is not just a convenience issue, it's

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<v Speaker 3>it's a safety issue. If I don't know what medications

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<v Speaker 3>someone's taking and I give them something that interacts that

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<v Speaker 3>obviously can be incredibly dangerous. You know, I don't need

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<v Speaker 3>to do certain tests if I know that they were

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<v Speaker 3>just done somewhere else. And so having the ability to

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<v Speaker 3>more easily share that data from place to place is

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<v Speaker 3>incredibly important. And I think it helps both from sort

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<v Speaker 3>of again a frustration and a time sort of commitment,

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<v Speaker 3>as well as a pure safety issue. And that's something

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<v Speaker 3>that again we've we've sort of touched on. As John

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<v Speaker 3>pointed out, we both sort of lean slightly different directions

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<v Speaker 3>on this, but again trying to make electronic records that

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<v Speaker 3>work better for the people involved. So we want to

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<v Speaker 3>be able to share data, We want it to work well,

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<v Speaker 3>we want it to be easy to use, you know.

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<v Speaker 3>And and so I think both the sharing of the

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<v Speaker 3>data and the usability can't be overstated about sort of

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<v Speaker 3>how important those aspects are.

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<v Speaker 2>Yeah, adding to that a little bit, and when you

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<v Speaker 2>think of fire, so FIRE is now the global standard

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<v Speaker 2>for interoperable communication of healthcare data period adopted by the

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<v Speaker 2>US governments. For that large electronic medical records, they have

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<v Speaker 2>to support at least a core subset of fire data

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<v Speaker 2>that patients can get access to. And no cost, and

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<v Speaker 2>when you're trying to communicate this data, it is miles

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<v Speaker 2>beyond what was there before before the Fire standard. What

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<v Speaker 2>kind of happened through all of this sorefly Fire with

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<v Speaker 2>Flutter Library Integration FLI, where the packages that Gray had

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<v Speaker 2>developed over the course of his fellowship, which is about

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<v Speaker 2>ten million lines of code total three million lines of dart.

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<v Speaker 2>A lot of it's auto generated, but in a way

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<v Speaker 2>that allows you to use any published version of fire

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<v Speaker 2>that also goes through all its test cases and then

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<v Speaker 2>directly put this into your Flutter application. And that Android

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<v Speaker 2>equivalent of this is open heal Stack by Google for Flutter.

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<v Speaker 2>If you're building a Flutter app, you should use the

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<v Speaker 2>Firefly packages. So you know. To Gray's point, so he's

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<v Speaker 2>a medicine pedes trained hospitalist, so he cares for patients

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<v Speaker 2>when they're admitted to the hospital, adults and children. Practiced

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<v Speaker 2>in eight countries, spend a year in Uganda, wrote the

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<v Speaker 2>textbook on pediatric care in that setting, and has a

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<v Speaker 2>very high global health focus of trying to help in

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<v Speaker 2>areas that are very resource limited. My background is emergencies.

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<v Speaker 2>I care for emergencies. I did MS things and a

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<v Speaker 2>lot of the things that come around me as an

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<v Speaker 2>emergencies and disasters, and how can we improve in those cares,

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<v Speaker 2>those care settings that are unscheduled and where a lot

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<v Speaker 2>of people are afraid, And both of them have opportunities

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<v Speaker 2>to improve in rural areas as well as global. So

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<v Speaker 2>to your point that you had mentioned earlier, Anthony, of

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<v Speaker 2>what was our story, well, we both had a shared

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<v Speaker 2>interest of building things to help in healthcare from usability

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<v Speaker 2>perspect with a mobile first approach. Then collaborated on the

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<v Speaker 2>Firefly packages, reached out to the Office of the National Coordinator.

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<v Speaker 2>The actual National Coordinator at the time was Don Rucker,

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<v Speaker 2>who we got through other members of Nyjune. They had

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<v Speaker 2>connections and here we are in front of the ONC

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<v Speaker 2>talking about Firefly and how cool this is, and they said,

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<v Speaker 2>look into social help like social care areas, and so

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<v Speaker 2>that is where we built screening tools to help with

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<v Speaker 2>social need and multiple states and multiple languages, and we're

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<v Speaker 2>still on the Gravity Projects. Main page is their success story,

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<v Speaker 2>which is wonderful and cool. But you know, as clinicians,

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<v Speaker 2>we're always trying to see how best we can apply

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<v Speaker 2>this in a way that helps in rural, underserved and

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<v Speaker 2>in global areas.

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<v Speaker 1>Yeah, so you mentioned emergency medicine. One of the things

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<v Speaker 1>that always bothered me about, you know, going to a

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<v Speaker 1>hospital in the US, even if you go to an emergency,

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<v Speaker 1>is it's never an emergency in an emergency, right, I

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<v Speaker 1>mean you'd go with you know, so much pain, and

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<v Speaker 1>you'd be like, want to be seen immediately. You're invariably

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<v Speaker 1>waiting for sixty to ninety minutes before you've seen or

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<v Speaker 1>at least somebody comes and asks you something, right. I

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<v Speaker 1>mean in a lot of cases it has got to

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<v Speaker 1>do with data collection. You know, they are validating it

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<v Speaker 1>behind the scenes, so you know, just as a patient

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<v Speaker 1>myself or you know somebody who I've seen, even in

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<v Speaker 1>the children's hospitals, great, right, I mean when my daughter

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<v Speaker 1>was young, I mean, you know, she'd be running very

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<v Speaker 1>high temperature and you go there, they make your sit

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<v Speaker 1>for forty five minutes, right, I mean why because you're

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<v Speaker 1>still collecting data. So in that sort of a let's say,

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<v Speaker 1>I mean you don't want to call it life threatening,

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<v Speaker 1>but it's still an emergency. Is there something that you know?

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<v Speaker 1>Using fire in May June, I mean you can simplify

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<v Speaker 1>that process to accelerate the time to which by the

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<v Speaker 1>time you walk in through that door, a doctor is

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<v Speaker 1>able to see you at least within fifteen minutes or so.

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<v Speaker 1>I mean, you know, if sixty minutes is too much,

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<v Speaker 1>at least cut that down by yeah, you know, seventy

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<v Speaker 1>five percent.

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<v Speaker 2>So yes and no. So I think on the other

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<v Speaker 2>side of the curtain. So Atrium Health is where I

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<v Speaker 2>practice associate professor, and I care for adults and children,

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<v Speaker 2>and it's patients are not seen in the same order

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<v Speaker 2>that they arrive. They are seen often by the sickest

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<v Speaker 2>ones first. So thankfully you and your family were not

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<v Speaker 2>that sick. There's an emergency, of course, we'll address that.

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<v Speaker 2>But trust me, the very very like near death patients

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<v Speaker 2>and severe traumas and medical and traumatic resuscitations, they're seen

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<v Speaker 2>really fast. It's not sixty minutes. And there are workflow

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<v Speaker 2>tools where you can even register a patient without any

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<v Speaker 2>information quickly, be it medical or trauma, so that you

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<v Speaker 2>can give them medication and treat them and get do

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<v Speaker 2>an ultrasound or get some X rays or something at

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<v Speaker 2>the bedside to help them. All of that stuff has

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<v Speaker 2>its own workflow in American medicine that uses the electronic

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<v Speaker 2>medical record and the use of majune technology probably isn't

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<v Speaker 2>as relevant there if you look in resource limited scenarios.

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<v Speaker 2>So another example, I helped with some of the hurricane

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<v Speaker 2>relief efforts in western North Carolina where it was multiple

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<v Speaker 2>groups together and some of us were using paper and

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<v Speaker 2>some of us were using another technically medical record. That

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<v Speaker 2>will also wasn't really designed by a clinician, and it

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<v Speaker 2>was clear that there were a lot of opportunities to

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<v Speaker 2>improve with that. That's a place where we can inject

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<v Speaker 2>and help and where we have the skill set and

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<v Speaker 2>the expertise and the domain knowledge to improve in those settings.

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<v Speaker 2>And we've had conversations with groups that were interested and

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<v Speaker 2>our services from there. So from the over arching perspective

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<v Speaker 2>of you know, just emergency medicine care, usually it's going

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<v Speaker 2>to be in the low resource or disaster response or

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<v Speaker 2>international area where we can improve rather than the traditional

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<v Speaker 2>brick and mortar emergency department. But medicine always changes, you know,

403
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<v Speaker 2>if we build something and then it expands and then

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<v Speaker 2>it continues to expand. And that's right up both Gray

405
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<v Speaker 2>and my alley of ways that we can improve in

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<v Speaker 2>areas that also build on the background expertise that we have.

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<v Speaker 3>That's perfect, and I'll say a slightly different sort of

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<v Speaker 3>view of it. I again not sort of the emergent

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<v Speaker 3>view in terms of how quick we can get you in,

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<v Speaker 3>but I think that some of the stuff we do

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<v Speaker 3>can make the time we spend with you more valuable.

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<v Speaker 3>And I think that you know, most of the time,

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<v Speaker 3>the about of time that we spend with a patient,

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<v Speaker 3>most of it is collecting data and very little of

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<v Speaker 3>it is actually spent talking to a patient. And so

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<v Speaker 3>I think using technology, including some of the June you know,

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<v Speaker 3>questionnaire data gathering, structured data capture sort of stuff, a

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<v Speaker 3>lot of that could be done beforehand. And so if

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<v Speaker 3>you have a fifteen or a twenty minute appointment, or

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<v Speaker 3>you know, whatever John has available to be able to

421
00:24:21.519 --> 00:24:25.000
<v Speaker 3>see you in the emergency room before the next trauma,

422
00:24:25.279 --> 00:24:27.839
<v Speaker 3>you know, instead of spending all that time or the

423
00:24:27.839 --> 00:24:31.119
<v Speaker 3>bulk of it trying to gather all your information, make

424
00:24:31.160 --> 00:24:33.559
<v Speaker 3>sure that we have all of your medications correct, that

425
00:24:33.599 --> 00:24:35.880
<v Speaker 3>we know all of your history. If that can all

426
00:24:35.920 --> 00:24:39.400
<v Speaker 3>be shared or gathered more efficiently ahead of time, then

427
00:24:39.440 --> 00:24:41.799
<v Speaker 3>we can sort of review it quickly and then we

428
00:24:41.799 --> 00:24:44.519
<v Speaker 3>can spend more time talking to you. We can spend

429
00:24:44.519 --> 00:24:48.240
<v Speaker 3>more time ensuring that we didn't miss anything that's important.

430
00:24:48.640 --> 00:24:53.359
<v Speaker 3>We can ensure that you understand the plan, and so

431
00:24:53.599 --> 00:24:55.920
<v Speaker 3>the time that we do spend with you can be

432
00:24:56.319 --> 00:25:01.279
<v Speaker 3>actually spent with you and so sort of caring about

433
00:25:01.319 --> 00:25:03.359
<v Speaker 3>what the problem is instead of just asking you a

434
00:25:03.400 --> 00:25:06.319
<v Speaker 3>whole lot of questions. And so I think there are

435
00:25:06.319 --> 00:25:09.799
<v Speaker 3>some ways, even in sort of a traditional setting where

436
00:25:09.880 --> 00:25:12.839
<v Speaker 3>you know, we could be beneficial that. Again, I think

437
00:25:12.839 --> 00:25:14.920
<v Speaker 3>there's lots of opportunities to sort of improve that.

438
00:25:15.000 --> 00:25:15.759
<v Speaker 1>Yeah, thank you for that.

439
00:25:15.799 --> 00:25:19.000
<v Speaker 2>I mean the term doctor, go ahead, John, Oh, go ahead.

440
00:25:19.400 --> 00:25:22.720
<v Speaker 2>The term doctor comes from dose air, which means to teach.

441
00:25:23.000 --> 00:25:27.279
<v Speaker 2>It is literally your role is to map somebody's health

442
00:25:27.279 --> 00:25:31.640
<v Speaker 2>literacy and then help explain and work through that. And

443
00:25:32.119 --> 00:25:35.240
<v Speaker 2>the other point from Gray is if you've ever seen

444
00:25:35.279 --> 00:25:41.200
<v Speaker 2>there's a twenty twelve article in Jamma called the Cost

445
00:25:41.240 --> 00:25:44.400
<v Speaker 2>of Technology by Toll and it was a drawing of

446
00:25:44.440 --> 00:25:48.440
<v Speaker 2>a seven year old in their pediatricians clinic where you know,

447
00:25:48.680 --> 00:25:52.599
<v Speaker 2>they're smiling, Mom's smiling, big sisters holding baby child like

448
00:25:52.640 --> 00:25:55.640
<v Speaker 2>baby sibling. Everybody's smiling. Then the doctor is smiling but

449
00:25:55.799 --> 00:25:57.720
<v Speaker 2>has their back turn and a staring at a computer.

450
00:25:58.519 --> 00:26:01.480
<v Speaker 2>And this is over thirteen years years ago when that

451
00:26:01.680 --> 00:26:04.200
<v Speaker 2>was done, and it's still relevant today.

452
00:26:04.799 --> 00:26:08.160
<v Speaker 3>And again I think that's again to dive back into

453
00:26:08.200 --> 00:26:11.400
<v Speaker 3>the technology. I think that's where Flutter is so nice

454
00:26:11.640 --> 00:26:13.319
<v Speaker 3>and actually part of the reason we chose it as

455
00:26:13.319 --> 00:26:16.759
<v Speaker 3>the health stack. Again, I was looking at sort of

456
00:26:16.759 --> 00:26:20.400
<v Speaker 3>a global perspective and everything global it has to be mobile, right,

457
00:26:20.480 --> 00:26:23.079
<v Speaker 3>you know, it has to be at least available, and

458
00:26:23.319 --> 00:26:25.920
<v Speaker 3>most EHRs or not most of them were never designed

459
00:26:25.960 --> 00:26:29.880
<v Speaker 3>to be and so you know, we're looking at what's flexible,

460
00:26:29.960 --> 00:26:36.000
<v Speaker 3>what can be done, you know, and multiple platforms, multiple devices.

461
00:26:36.680 --> 00:26:40.480
<v Speaker 3>And that's sort of what sold me on Flutter because,

462
00:26:40.559 --> 00:26:42.440
<v Speaker 3>as John said, one of my colleagues said, well, she

463
00:26:42.480 --> 00:26:44.960
<v Speaker 3>had seen this talk about Flutter. Maybe I should look

464
00:26:44.960 --> 00:26:47.319
<v Speaker 3>into it. So I did, and I got on Slack

465
00:26:47.359 --> 00:26:49.640
<v Speaker 3>and I started working with John. And the punchline to

466
00:26:50.000 --> 00:26:52.359
<v Speaker 3>his story was that it was about two years later

467
00:26:52.559 --> 00:26:55.119
<v Speaker 3>when I realized that the speech my colleague had seen

468
00:26:55.279 --> 00:26:59.519
<v Speaker 3>was given by John that then got that, then got

469
00:26:59.559 --> 00:27:02.039
<v Speaker 3>the end of flu. So it was yeah, it's a

470
00:27:02.279 --> 00:27:03.119
<v Speaker 3>full circle.

471
00:27:03.000 --> 00:27:06.720
<v Speaker 1>Yeah, full circle indeed. And I mean, thanks for sharing

472
00:27:06.799 --> 00:27:12.279
<v Speaker 1>the procedure about how the emergency rooms work, right, I mean,

473
00:27:12.599 --> 00:27:16.759
<v Speaker 1>I know everybody comes in there and there's nothing more

474
00:27:16.799 --> 00:27:22.119
<v Speaker 1>frustrating than waiting, right, so all your anger levels go

475
00:27:22.279 --> 00:27:24.599
<v Speaker 1>up and you see a lot of people walking up

476
00:27:24.599 --> 00:27:27.240
<v Speaker 1>to the poor receptionists and saying, I've been here for

477
00:27:27.319 --> 00:27:29.640
<v Speaker 1>ninety minutes. You know why is nobody seeing me? So

478
00:27:30.480 --> 00:27:33.480
<v Speaker 1>that part is super helpful. So shifting years a little bit,

479
00:27:34.319 --> 00:27:37.720
<v Speaker 1>John and Greg, obviously you started May June with a vision, right,

480
00:27:37.880 --> 00:27:41.680
<v Speaker 1>how much of that have you achieved? And what are

481
00:27:41.720 --> 00:27:44.119
<v Speaker 1>the next couple of years looking like for you? Guys

482
00:27:44.160 --> 00:27:47.000
<v Speaker 1>with May June, either of you can take it.

483
00:27:47.039 --> 00:27:51.400
<v Speaker 2>So I'll say that our vision always shifts forward. We're

484
00:27:51.400 --> 00:27:55.640
<v Speaker 2>always working to build new things, better things. Everything we've

485
00:27:56.359 --> 00:28:00.319
<v Speaker 2>built in May June has been contracted work for hire

486
00:28:00.839 --> 00:28:07.359
<v Speaker 2>to satisfy a specific problem that needed some extra usability.

487
00:28:07.359 --> 00:28:13.000
<v Speaker 2>Flare that was cross platform by design and frequently had

488
00:28:13.160 --> 00:28:18.559
<v Speaker 2>one group or one solution that didn't match the initial expectations.

489
00:28:18.759 --> 00:28:21.559
<v Speaker 2>So a good example of the first thing we built

490
00:28:21.839 --> 00:28:24.680
<v Speaker 2>was for any MS agency that had protocols to help

491
00:28:24.680 --> 00:28:29.960
<v Speaker 2>in rural areas that the initial the content was excellent,

492
00:28:30.200 --> 00:28:32.640
<v Speaker 2>that was something they built and curated, but the delivery

493
00:28:33.400 --> 00:28:37.720
<v Speaker 2>needed help, and so we helped and you know, we

494
00:28:37.920 --> 00:28:42.920
<v Speaker 2>continue to help and support them for years. We're always building,

495
00:28:43.160 --> 00:28:45.240
<v Speaker 2>and we're always doing this in a way that can

496
00:28:45.960 --> 00:28:50.279
<v Speaker 2>scale into other solutions and can apply some of the

497
00:28:50.319 --> 00:28:54.160
<v Speaker 2>backgrounds and experiences that we have as as practicing clinicians

498
00:28:54.160 --> 00:28:58.599
<v Speaker 2>and informatis and we have other informatics clinicians that are

499
00:28:58.599 --> 00:29:01.039
<v Speaker 2>a part of MADE as well, and in addition to

500
00:29:02.480 --> 00:29:07.240
<v Speaker 2>more tech first people as well. I think for us,

501
00:29:07.559 --> 00:29:11.440
<v Speaker 2>we're always trying to find that best opportunity where we

502
00:29:11.480 --> 00:29:15.079
<v Speaker 2>can have the biggest impact on the broadest scale in

503
00:29:15.119 --> 00:29:18.079
<v Speaker 2>a way that pushes things forward in a good way.

504
00:29:18.599 --> 00:29:21.519
<v Speaker 2>And I think that's always where we've strived. And so

505
00:29:21.720 --> 00:29:24.880
<v Speaker 2>are we there yet? I'll say no, Are we always

506
00:29:24.920 --> 00:29:25.759
<v Speaker 2>going down that path?

507
00:29:25.880 --> 00:29:26.119
<v Speaker 1>Yes?

508
00:29:26.359 --> 00:29:29.319
<v Speaker 2>And you know, it's one opportunity after the next and

509
00:29:29.400 --> 00:29:32.759
<v Speaker 2>one solution after the next as we learn and make

510
00:29:32.799 --> 00:29:36.880
<v Speaker 2>our code better and as we provide that service of

511
00:29:36.920 --> 00:29:41.000
<v Speaker 2>Firefly for the global community, in addition to building upon

512
00:29:41.079 --> 00:29:44.039
<v Speaker 2>that and harnessing it with the tools that we that

513
00:29:44.079 --> 00:29:46.960
<v Speaker 2>we then deploy got it.

514
00:29:47.079 --> 00:29:49.680
<v Speaker 3>Yeah, Well, I think that a lot of what we've

515
00:29:49.680 --> 00:29:52.720
<v Speaker 3>done so far was still sort of foundation building to

516
00:29:52.759 --> 00:29:57.200
<v Speaker 3>an extent. It was sort of learning and building out

517
00:29:57.200 --> 00:29:59.480
<v Speaker 3>our skills building out. I mean, some of it was

518
00:29:59.480 --> 00:30:02.240
<v Speaker 3>certainly sort of technology building out, the tech stack and

519
00:30:02.240 --> 00:30:03.839
<v Speaker 3>that sort of thing, and some of it was also

520
00:30:04.279 --> 00:30:07.680
<v Speaker 3>sort of finding where we wanted to be. You know,

521
00:30:07.920 --> 00:30:10.279
<v Speaker 3>We've done you know a number of different projects in

522
00:30:10.279 --> 00:30:13.960
<v Speaker 3>a number of different places, sort of in and sort

523
00:30:14.000 --> 00:30:18.000
<v Speaker 3>of slightly out of healthcare, always intertwined, you know, And

524
00:30:18.079 --> 00:30:21.200
<v Speaker 3>so I think we're we've sort of found our niche

525
00:30:21.240 --> 00:30:23.720
<v Speaker 3>and sort of where we want to be. And I

526
00:30:23.759 --> 00:30:26.880
<v Speaker 3>think that's again it's sort of exciting, and a lot

527
00:30:26.880 --> 00:30:29.400
<v Speaker 3>of times it's places that other you know, groups don't

528
00:30:29.400 --> 00:30:32.440
<v Speaker 3>want to go. And again, sometimes there's a lot of

529
00:30:32.440 --> 00:30:35.799
<v Speaker 3>times there's a monetary barrier to it, you know, whether

530
00:30:35.839 --> 00:30:38.920
<v Speaker 3>it's sort of rural areas or low resource settings or

531
00:30:39.240 --> 00:30:41.839
<v Speaker 3>disaster relief one of the ones that that again John

532
00:30:41.839 --> 00:30:45.000
<v Speaker 3>brought up earlier. You know, these are all really important

533
00:30:45.039 --> 00:30:49.000
<v Speaker 3>to have good health tack tech stacks for if you're

534
00:30:49.000 --> 00:30:50.759
<v Speaker 3>going to actually collect data and be able to show

535
00:30:50.799 --> 00:30:53.319
<v Speaker 3>what you're doing, you know, who you're treating. You know,

536
00:30:53.799 --> 00:30:55.640
<v Speaker 3>it's important to be able to record all that. It's

537
00:30:55.680 --> 00:30:59.279
<v Speaker 3>really hard, though, but I think you know a lot

538
00:30:59.319 --> 00:31:02.720
<v Speaker 3>of that fit what our interests and what our passions

539
00:31:02.720 --> 00:31:06.599
<v Speaker 3>are and our knowledge and our expertise, and so I

540
00:31:06.599 --> 00:31:10.599
<v Speaker 3>think we're sort of excited and looking forward to being

541
00:31:10.599 --> 00:31:12.440
<v Speaker 3>able to use you know, who we are and what

542
00:31:12.480 --> 00:31:16.279
<v Speaker 3>we want to do it, you know, even more effectively

543
00:31:16.440 --> 00:31:17.200
<v Speaker 3>as we move forward.

544
00:31:17.680 --> 00:31:20.839
<v Speaker 1>That is great to hear, especially the part that you're

545
00:31:20.880 --> 00:31:24.440
<v Speaker 1>always kind of looking forward, right. And I try to

546
00:31:24.880 --> 00:31:28.599
<v Speaker 1>bring up AI in most of our conversations because I mean,

547
00:31:28.599 --> 00:31:32.319
<v Speaker 1>it seems to be affecting everything I mean, and especially

548
00:31:32.480 --> 00:31:34.440
<v Speaker 1>I mean, I've heard in healthcare there's a lot of

549
00:31:34.519 --> 00:31:37.680
<v Speaker 1>use cases and John, you started off with scribing. I've

550
00:31:37.680 --> 00:31:41.759
<v Speaker 1>heard a number of you hospitals using those livescribers sort

551
00:31:41.799 --> 00:31:46.160
<v Speaker 1>of thing. But with your vision for me and kind

552
00:31:46.160 --> 00:31:48.759
<v Speaker 1>of looking forward and the impact that AI can make.

553
00:31:49.480 --> 00:31:53.119
<v Speaker 1>Or the other trend I've been hearing about is you know,

554
00:31:53.359 --> 00:31:56.000
<v Speaker 1>taking the hospital to the home, right, I mean, if

555
00:31:56.000 --> 00:31:59.240
<v Speaker 1>there's critically ill patients, I mean, you're moving a lot

556
00:31:59.240 --> 00:32:02.759
<v Speaker 1>of equipment into the patient's house and still collecting data

557
00:32:03.279 --> 00:32:06.079
<v Speaker 1>and things like that. Are there's a lot of you know,

558
00:32:06.319 --> 00:32:10.400
<v Speaker 1>devices that the patients can carry home, but as a doctor,

559
00:32:10.480 --> 00:32:13.079
<v Speaker 1>you still want to collect all that information. So looking

560
00:32:13.119 --> 00:32:15.359
<v Speaker 1>at some of these new trends, I mean, what are

561
00:32:15.920 --> 00:32:19.519
<v Speaker 1>your thoughts on you know, how May June will evolve.

562
00:32:20.160 --> 00:32:23.160
<v Speaker 1>Obviously you would have given that thought. I mean I second,

563
00:32:23.160 --> 00:32:25.119
<v Speaker 1>maybe a second part of the question is, I mean,

564
00:32:25.119 --> 00:32:28.000
<v Speaker 1>how much of AI have you actually tried to bring

565
00:32:28.039 --> 00:32:31.680
<v Speaker 1>into the whole tech stack and try to do something

566
00:32:31.720 --> 00:32:31.880
<v Speaker 1>with it.

567
00:32:31.960 --> 00:32:34.640
<v Speaker 2>There's a few things from that. So the first one

568
00:32:34.799 --> 00:32:37.880
<v Speaker 2>is AI from the perspective of the clinician and the

569
00:32:37.920 --> 00:32:41.119
<v Speaker 2>second is AI from the perspective of the developer, and

570
00:32:41.160 --> 00:32:44.240
<v Speaker 2>they're totally different buckets. So let's take the first bucket. So,

571
00:32:44.359 --> 00:32:48.839
<v Speaker 2>first one, I've given local talks, given talks at Amya

572
00:32:49.240 --> 00:32:51.920
<v Speaker 2>about this, and I've tested this and I also co

573
00:32:52.079 --> 00:32:57.240
<v Speaker 2>chair our service line Innovation and Informatics group with an Atrium,

574
00:32:57.920 --> 00:33:01.279
<v Speaker 2>and we've tested this from the very beginning and with frequency,

575
00:33:02.200 --> 00:33:04.640
<v Speaker 2>there is a difference between So as a scribe, you

576
00:33:04.680 --> 00:33:07.359
<v Speaker 2>mentioned this, there's a difference between a good scribe and

577
00:33:07.400 --> 00:33:10.000
<v Speaker 2>a bad scribe, and a good scribe speeds you up.

578
00:33:10.119 --> 00:33:13.200
<v Speaker 2>A bad scribe has things interjected that gives you almost

579
00:33:13.240 --> 00:33:15.440
<v Speaker 2>twice the amount of time that you would be using otherwise.

580
00:33:16.039 --> 00:33:18.240
<v Speaker 2>Tech always changes. Even a year ago, there were a

581
00:33:18.240 --> 00:33:21.039
<v Speaker 2>lot of bad scribe ambient dictation tools out that a

582
00:33:21.039 --> 00:33:23.680
<v Speaker 2>lot of it's improved even in the last eight months.

583
00:33:24.960 --> 00:33:27.359
<v Speaker 2>And if you want something to look at, there was

584
00:33:27.400 --> 00:33:30.519
<v Speaker 2>a AI tech sprint from the VA, the Veterans Administration

585
00:33:31.079 --> 00:33:34.079
<v Speaker 2>that was hosted at the start of this year and

586
00:33:34.119 --> 00:33:37.640
<v Speaker 2>then announced early Q two, and if you just search

587
00:33:37.680 --> 00:33:41.079
<v Speaker 2>for the AI tech sprint within the VA, you can

588
00:33:41.079 --> 00:33:43.759
<v Speaker 2>see some of the companies that were well embedded in

589
00:33:43.759 --> 00:33:48.039
<v Speaker 2>that perspective. I think ambient dictation is going to have

590
00:33:48.119 --> 00:33:52.000
<v Speaker 2>a high opportunity to help clinicians caring for patients, albeit

591
00:33:52.079 --> 00:33:54.839
<v Speaker 2>in limited resource settings. That's going to be a challenge still,

592
00:33:55.640 --> 00:33:58.839
<v Speaker 2>just because all of these need a lot more cloud

593
00:33:58.839 --> 00:34:02.480
<v Speaker 2>services of a level to them, So that's going to

594
00:34:02.480 --> 00:34:05.039
<v Speaker 2>be your mileage made very depending on where you practice,

595
00:34:05.079 --> 00:34:09.440
<v Speaker 2>but there's definitely opportunity. The other aspect for decision support

596
00:34:09.599 --> 00:34:14.039
<v Speaker 2>from the clinician's perspective, I think is great. What used

597
00:34:14.039 --> 00:34:17.480
<v Speaker 2>to be called clinical decision support is now being rebranded

598
00:34:17.519 --> 00:34:21.760
<v Speaker 2>by the ONC as a decision support Instrument, which includes

599
00:34:21.800 --> 00:34:25.039
<v Speaker 2>AI and also requires you to have to get past

600
00:34:25.119 --> 00:34:28.119
<v Speaker 2>that black box of where did this algorithm come from?

601
00:34:28.199 --> 00:34:29.480
<v Speaker 2>Is this actually a hallucination?

602
00:34:29.639 --> 00:34:30.679
<v Speaker 1>Or am I like?

603
00:34:31.280 --> 00:34:34.400
<v Speaker 2>Where am I getting this recommendation? And I think that

604
00:34:34.599 --> 00:34:39.440
<v Speaker 2>guardrail is just as important as the solution itself, because

605
00:34:39.920 --> 00:34:44.039
<v Speaker 2>medical hallucinations of artificial intelligence and machine learning programs can

606
00:34:44.119 --> 00:34:46.400
<v Speaker 2>cause those same issues that I talked about where the

607
00:34:46.440 --> 00:34:49.840
<v Speaker 2>fifteen year old is swallowing almost forty pills. We don't

608
00:34:49.880 --> 00:34:53.800
<v Speaker 2>want that, and so there's that. The other perspective of

609
00:34:53.960 --> 00:35:01.559
<v Speaker 2>building within AI tools as technology specialists and developers, using

610
00:35:01.599 --> 00:35:03.880
<v Speaker 2>a model to help you as you're writing code is

611
00:35:03.960 --> 00:35:07.599
<v Speaker 2>essentially your own personalized pair programmer. I think is really

612
00:35:07.679 --> 00:35:11.000
<v Speaker 2>useful if you have at least a basic understanding of

613
00:35:11.039 --> 00:35:13.119
<v Speaker 2>the tech that you're trying to build in. It's not

614
00:35:13.199 --> 00:35:15.719
<v Speaker 2>going to supplant your knowledge and information, and you have

615
00:35:15.800 --> 00:35:18.599
<v Speaker 2>to work through some of the suggestions that are high

616
00:35:18.599 --> 00:35:22.559
<v Speaker 2>confidence and low accuracy, otherwise your code will suffer from that.

617
00:35:23.159 --> 00:35:25.960
<v Speaker 2>But there's really a lot of opportunities as you're building

618
00:35:26.880 --> 00:35:30.280
<v Speaker 2>to help speed that up, and time has shown us

619
00:35:30.320 --> 00:35:33.119
<v Speaker 2>that as well as from the perspective of the clinician

620
00:35:34.480 --> 00:35:36.039
<v Speaker 2>as you're caring for patients of the bedside.

621
00:35:36.079 --> 00:35:38.760
<v Speaker 3>And I again, and I think there's some ways to

622
00:35:38.920 --> 00:35:41.519
<v Speaker 3>use it that have not been are not sort of

623
00:35:41.519 --> 00:35:43.760
<v Speaker 3>classic when you think about it, that could end up

624
00:35:43.760 --> 00:35:47.079
<v Speaker 3>being really useful. We know, for instance, that most research

625
00:35:47.119 --> 00:35:48.880
<v Speaker 3>has to be published in English, it has to be

626
00:35:48.920 --> 00:35:51.519
<v Speaker 3>written in a certain form of English, and much of

627
00:35:51.559 --> 00:35:54.119
<v Speaker 3>the world doesn't speak English as their first language. And

628
00:35:54.199 --> 00:35:57.079
<v Speaker 3>so if you can't write a research paper in the

629
00:35:57.119 --> 00:35:59.800
<v Speaker 3>proper pros, your research is not going to be a

630
00:36:00.239 --> 00:36:02.840
<v Speaker 3>to it, just even if it's high quality and so,

631
00:36:03.159 --> 00:36:07.440
<v Speaker 3>but having AI help you write a research paper, you

632
00:36:07.480 --> 00:36:10.280
<v Speaker 3>know where your research and your methods are sound, but

633
00:36:10.519 --> 00:36:13.360
<v Speaker 3>because you may struggle with English, you can't get it published.

634
00:36:13.519 --> 00:36:16.039
<v Speaker 3>That's a barrier to entry that shouldn't be there, and

635
00:36:16.119 --> 00:36:18.800
<v Speaker 3>AI might be really helpful for, you know, to help

636
00:36:18.840 --> 00:36:21.559
<v Speaker 3>you with that. One of the ones we were actually

637
00:36:21.599 --> 00:36:24.119
<v Speaker 3>looking at was sort of what John was talking about,

638
00:36:24.159 --> 00:36:27.400
<v Speaker 3>where you teach people some basic data science and then

639
00:36:27.519 --> 00:36:32.719
<v Speaker 3>use AI to help you know, analyze your data. You know,

640
00:36:32.760 --> 00:36:34.760
<v Speaker 3>there's lots of places where they don't have people that

641
00:36:34.800 --> 00:36:37.159
<v Speaker 3>can do it themselves, and sort of AI can help

642
00:36:37.239 --> 00:36:39.440
<v Speaker 3>with that. And so I certainly think AI has a

643
00:36:39.480 --> 00:36:41.760
<v Speaker 3>good role to play. I think you have to be

644
00:36:41.800 --> 00:36:45.039
<v Speaker 3>really careful with it. I think that most AI, especially

645
00:36:45.079 --> 00:36:50.039
<v Speaker 3>in a healthcare setting, is untested. I think implementing a technology,

646
00:36:50.239 --> 00:36:52.159
<v Speaker 3>you should study it. We do with all the rest

647
00:36:52.239 --> 00:36:55.159
<v Speaker 3>of the technology, and yet AI I don't think is

648
00:36:55.239 --> 00:36:59.159
<v Speaker 3>undergoing the same sort of you know, scrutiny, which again

649
00:36:59.239 --> 00:37:01.920
<v Speaker 3>I think is going to have some difficulty and some

650
00:37:02.039 --> 00:37:04.519
<v Speaker 3>problems that it's going to introduce. It has to be

651
00:37:04.559 --> 00:37:06.880
<v Speaker 3>trained on something. Lots of the old healthcare data is

652
00:37:06.960 --> 00:37:10.840
<v Speaker 3>not great and a lot of it's biased, and I

653
00:37:11.079 --> 00:37:13.199
<v Speaker 3>think that's the other thing to really be cautious about

654
00:37:13.280 --> 00:37:15.079
<v Speaker 3>is that if you're going to train on it, we

655
00:37:15.119 --> 00:37:18.039
<v Speaker 3>know AI tends to amplify sort of biases and data,

656
00:37:19.199 --> 00:37:22.039
<v Speaker 3>and so you have to be really cautious. I think

657
00:37:23.000 --> 00:37:25.639
<v Speaker 3>using AI for especially for decision making.

658
00:37:26.199 --> 00:37:30.199
<v Speaker 2>The classic example for that was the likelihood of a

659
00:37:30.280 --> 00:37:34.079
<v Speaker 2>skin lesion being cancer was increased from the AI got

660
00:37:34.079 --> 00:37:36.480
<v Speaker 2>algorithms if you had a ruler right next to it,

661
00:37:37.000 --> 00:37:40.239
<v Speaker 2>because the images they were trained on whenever you're measuring

662
00:37:40.280 --> 00:37:43.599
<v Speaker 2>the malignant lesion, they all had rulers, and so the

663
00:37:43.679 --> 00:37:46.199
<v Speaker 2>ruler was a predictive variable.

664
00:37:47.280 --> 00:37:52.199
<v Speaker 1>That's not right. Yeah, I did AI course at Stanford

665
00:37:52.239 --> 00:37:56.559
<v Speaker 1>this summer and that's the exact same story that professor

666
00:37:56.639 --> 00:37:58.960
<v Speaker 1>told us about. So I do understand. I mean, you're

667
00:37:58.960 --> 00:38:02.679
<v Speaker 1>going to be super castle, but there are some merits, right,

668
00:38:02.719 --> 00:38:05.800
<v Speaker 1>I mean, if you test it to grace point and

669
00:38:05.440 --> 00:38:09.239
<v Speaker 1>put it through the rigor of going through all that

670
00:38:09.800 --> 00:38:12.800
<v Speaker 1>unbiased data and things like that. I mean, there is

671
00:38:12.840 --> 00:38:15.360
<v Speaker 1>some benefit to it. So switching gears a little bit.

672
00:38:16.760 --> 00:38:19.440
<v Speaker 1>How much of adoption have you seen here? And I

673
00:38:19.480 --> 00:38:21.960
<v Speaker 1>know for a fact that, I mean, you've tried to

674
00:38:21.960 --> 00:38:25.400
<v Speaker 1>take this outside of the Americas as well to some

675
00:38:25.440 --> 00:38:31.280
<v Speaker 1>of the countries. Who is using whether it's Firefly or

676
00:38:32.239 --> 00:38:35.559
<v Speaker 1>the overall stack in general, who is using it today?

677
00:38:35.920 --> 00:38:38.800
<v Speaker 3>So last week we checked again there are certain developers

678
00:38:38.800 --> 00:38:46.880
<v Speaker 3>that were implementing it in Brazil, Colombia, Mexico, Germany, Italy, India,

679
00:38:47.440 --> 00:38:50.599
<v Speaker 3>and Nigeria, Unity Candidas.

680
00:38:53.239 --> 00:38:53.840
<v Speaker 1>It's great.

681
00:38:54.159 --> 00:38:58.039
<v Speaker 2>I'll say that's good adoption from what we've developed over

682
00:38:58.079 --> 00:39:00.000
<v Speaker 2>the time. I always think that's.

683
00:39:00.639 --> 00:39:03.519
<v Speaker 1>And speaking of adoption, John and Gray, I mean, I'm

684
00:39:03.519 --> 00:39:05.400
<v Speaker 1>assuming all of this is open source as well, and

685
00:39:05.599 --> 00:39:08.159
<v Speaker 1>everything you do, you put it out there for people

686
00:39:08.199 --> 00:39:11.559
<v Speaker 1>to contribute or anything people should know about everything.

687
00:39:12.519 --> 00:39:16.000
<v Speaker 2>Everything that is the baseline package that we want to

688
00:39:16.039 --> 00:39:19.960
<v Speaker 2>help everybody is open source. So Firefly is open source.

689
00:39:20.199 --> 00:39:22.679
<v Speaker 2>The EMS project that I talked about, that's open source.

690
00:39:22.880 --> 00:39:25.840
<v Speaker 2>Some of the things that we've built were closed, some

691
00:39:25.920 --> 00:39:30.039
<v Speaker 2>have different permissive licenses that allow other people to learn from,

692
00:39:30.079 --> 00:39:34.519
<v Speaker 2>but not necessarily directly compete with, so like functional source

693
00:39:35.440 --> 00:39:39.719
<v Speaker 2>if you've heard about those. But realistically, our goal is

694
00:39:39.719 --> 00:39:41.880
<v Speaker 2>we always want to move the needle forward. We're not

695
00:39:41.880 --> 00:39:45.480
<v Speaker 2>trying to train up other people that then immediately directly

696
00:39:45.519 --> 00:39:50.280
<v Speaker 2>compete with us. But for Firefly, we want this to

697
00:39:50.400 --> 00:39:55.159
<v Speaker 2>be useful for everyone. That is a core package that

698
00:39:55.719 --> 00:39:58.800
<v Speaker 2>everybody needs to have and that will always be open source,

699
00:40:00.079 --> 00:40:02.960
<v Speaker 2>you know, through the duration that we're supporting, and it

700
00:40:03.639 --> 00:40:04.519
<v Speaker 2>needs to be like that.

701
00:40:06.000 --> 00:40:08.840
<v Speaker 3>Just definitely, and we and again we want it to

702
00:40:08.880 --> 00:40:12.239
<v Speaker 3>be We want Google's Open Health Stack we brought up before,

703
00:40:12.880 --> 00:40:17.320
<v Speaker 3>and the Android SDK is used in a number of standards.

704
00:40:17.360 --> 00:40:21.400
<v Speaker 3>Now it's actually the WHO is creating smart guidelines that

705
00:40:21.440 --> 00:40:23.159
<v Speaker 3>it's going to be used sort of around the world,

706
00:40:23.559 --> 00:40:25.800
<v Speaker 3>which is based on Open Health Stack and Android SDK,

707
00:40:26.320 --> 00:40:29.159
<v Speaker 3>And again we're not competing with them where there's no

708
00:40:29.239 --> 00:40:31.719
<v Speaker 3>reason too, there's lots of work, but we want sort

709
00:40:31.760 --> 00:40:35.199
<v Speaker 3>of a parallel option because again we see the value

710
00:40:35.199 --> 00:40:38.719
<v Speaker 3>in Flutter and being able to create something that could

711
00:40:38.760 --> 00:40:41.840
<v Speaker 3>then be used and implemented again sort of based on

712
00:40:42.039 --> 00:40:45.559
<v Speaker 3>WHO guidelines. And that's again the sort of thing where

713
00:40:45.840 --> 00:40:48.039
<v Speaker 3>we're not We don't want to keep it to ourselves.

714
00:40:48.119 --> 00:40:50.320
<v Speaker 3>We want to share it. We want anyone who's interested

715
00:40:50.440 --> 00:40:52.760
<v Speaker 3>or available or wants to try it or or you know,

716
00:40:52.800 --> 00:40:56.000
<v Speaker 3>work with it, develop, you know with it. We we

717
00:40:56.039 --> 00:40:56.880
<v Speaker 3>want to encourage that.

718
00:40:57.000 --> 00:41:00.119
<v Speaker 1>Perfect Thank you so much. Any anything else that I

719
00:41:00.119 --> 00:41:03.000
<v Speaker 1>have not asked about Me June that you want to

720
00:41:03.039 --> 00:41:05.760
<v Speaker 1>get out there in the community to not say, If.

721
00:41:05.679 --> 00:41:09.719
<v Speaker 2>Anybody is interested for us, certainly go to Majune dot com.

722
00:41:10.400 --> 00:41:13.800
<v Speaker 2>If you're interested in Firefly, there's Firefly dot dev. There's

723
00:41:13.800 --> 00:41:16.199
<v Speaker 2>a slack that people can join where you can collaborate

724
00:41:16.199 --> 00:41:19.440
<v Speaker 2>with others across the globe that are building solutions here.

725
00:41:20.000 --> 00:41:24.440
<v Speaker 2>We're pretty easily approachable. We're always happy to collaborate with

726
00:41:24.480 --> 00:41:27.519
<v Speaker 2>others that are deeply invested and interested in the space

727
00:41:27.639 --> 00:41:34.400
<v Speaker 2>and hopefully making things better for patients and families and clinicians.

728
00:41:35.400 --> 00:41:38.679
<v Speaker 2>Just as we go from you know, one month to

729
00:41:38.719 --> 00:41:40.760
<v Speaker 2>the next, one year to the next. We're always happy

730
00:41:40.760 --> 00:41:43.280
<v Speaker 2>to work work together and to collaborate.

731
00:41:43.639 --> 00:41:48.960
<v Speaker 1>I agreed, well, said John, So that Gray and John

732
00:41:49.199 --> 00:41:53.960
<v Speaker 1>always a pleasure speaking to you both. I'm always sharing

733
00:41:54.000 --> 00:41:56.840
<v Speaker 1>for you guys and talking about me June to whom

734
00:41:57.159 --> 00:42:00.000
<v Speaker 1>I think is relevant. So wish you guys the best.

735
00:42:00.079 --> 00:42:02.679
<v Speaker 1>We appreciate it, and uh you know anything you know.

736
00:42:02.840 --> 00:42:04.960
<v Speaker 1>I'll be sure to publish all the details about me

737
00:42:05.079 --> 00:42:07.880
<v Speaker 1>j you and all your repos and your slack and

738
00:42:07.920 --> 00:42:12.119
<v Speaker 1>everything on the YouTube channel, so I'm sure there'll be

739
00:42:12.320 --> 00:42:15.039
<v Speaker 1>a bunch of questions I'm sure you can answer. But

740
00:42:15.360 --> 00:42:18.960
<v Speaker 1>thanks so much for taking the time amidst your busy schedules,

741
00:42:19.599 --> 00:42:22.079
<v Speaker 1>lovely to speak to both of you, and I learned

742
00:42:22.079 --> 00:42:25.920
<v Speaker 1>a lot. Hopefully everyone listening in and tuning in learns

743
00:42:26.079 --> 00:42:27.440
<v Speaker 1>a bunch as well. Thank you so much.

744
00:42:27.880 --> 00:42:29.920
<v Speaker 3>Thank you for having us pleasure. It was fun.

745
00:42:29.960 --> 00:42:37.280
<v Speaker 1>Thank you.