Interview with Estenda Co-Founder RJ Kedziora

RJ Kedziora, co-founder and COO of Estenda,  shares his  journey from a tech-savvy childhood in the 70s to becoming a leader in healthcare innovation. RJ reflects on his early fascination with computers, starting with the IBM PC Junior, and his academic pursuit of artificial intelligence. His career path has traversed the evolution of software development, consulting, and the Internet boom of the late 90s. With a unique blend of empathy and technical expertise, RJ emphasizes the importance of understanding the end user's perspective, particularly in healthcare, where technology like electronic medical records was just beginning to take shape in the early 2000s. His insights highlight the transformative potential of healthcare technology and the importance of effective communication.

Listen in as we explore the integration of large language models in healthcare and the delicate balance of harnessing technology while preserving human skills. RJ shares his thoughts on the potential benefits of AI tools, such as ambient listening for note-taking, which could allow physicians to focus more on patient care. We also touch upon the significance of balancing productivity and wellness, drawing from RJ's personal experiences as a triathlete and his journey from baking vegan cakes to writing his upcoming book, "A Productive Harmony Framework." RJ offers valuable perspectives on managing energy over time, understanding one's chronotype for optimal productivity, and maintaining a vibrant life. Whether you're interested in healthcare innovation, AI technology, or personal wellness, this episode offers a wealth of insights and inspiration.

As of March 2025 HealthBiz is part of CareTalk. Healthcare. Unfiltered and can be found at the following links: 

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• Apple https://podcasts.apple.com/us/podcast/caretalk-healthcare-unfiltered/id1532402352
• YouTube https://www.youtube.com/@CareTalkPodcast
• CareTalk website  https://www.caretalkpodcast.com/ 

Host David E. Williams is president of healthcare strategy consulting firm Health Business Group. 

Episodes through March 2025 were produced by Dafna Williams.

Transcript

0:00:00 - David Williams
It's not easy translating ideas into tangible impact in healthcare, especially when doing so involves software and advanced analytics. So how can healthcare providers and other organizations without software developers get their solutions to market? Hi everyone, I'm David Williams, president of strategy consulting firm Health Business Group and host of the Health Biz Podcast, where I interview top healthcare leaders about their lives and careers. My guest today is RJ Kedziora, co-founder and COO of Estenda, which develops custom software, data analysis and AI solutions for healthcare and medtech. Do you like this show? If so, please subscribe and leave a review, RJ. Welcome to the Health Biz Podcast, David. Thanks for having me Looking forward to the conversation Outstanding. Well, I'm very interested in what you're doing at Estenda and have been doing for a while, but I want to start off by how you started off and ask about your background, your upbringing. You know what was your childhood like, Any influences that have stuck with you in your career? 

0:01:10 - RJ Kedziora 
Yeah. I'm a child of the 70s, so you know, grew up running around in the woods behind the house having fun, biking down to the swim club on the weekends, you know, on the weekends, and early on I was fortunate that my parents were able to buy a personal computer, the IBM PC Junior. And you know we had the Atari and, you know, played my fair share of games but was very fascinated at an early stage of what could I do with the computer. 

And even back then started programming and just you know, simple little things of like how do I get the cursor to move around the screen. But it was just fascinating to me what the computer was capable of even back then. 

And today it's just it's mind blowing what you can accomplish much more easily. So I went my collegiate career in the early nineties. I went in with the intention of getting a PhD in artificial intelligence and I find it amusing because AI has sort of blown up on the scene today, but it's been around for a long time and that was my intent going into college until my senior year. 

When I got that job offer I was like, ok, do I continue academic and take on more debt or go out in the world and, you know, earn a living? So I did choose to go out in the world and earn that living and very happy that I did, and I've always had my hand in AI systems over the years as they've gone through different iterations. So it's been fascinating. 

0:02:44 - David Williams
That sounds like a good approach. I may have been just a little bit ahead of you because I remember, before the uh, the ibm pc junior, what I remember about the pc junior sometimes they called it uh the chiclet and they're like chiclet keyboard or something on it. But uh, and I didn't have a atari uh game station. But I did actually have an atari computer. I think it was the atari 2600, was the game station. I I had the Atari 800 and the 400, which actually had even the membrane keyboard. That was worse than that. A 6502 processor used to crash but an overheat, that was the big thing, but it was really cool to have it. Did you have the modem with the acoustic coupler? 

0:03:19 - RJ Kedziora 
I had that. The fascinating thing about the PC Junior was it did have a wireless keyboard, nice, so you could work across the room. And so to manage that, it had a 20.5. 

0:03:31 - David Williams
So you wouldn't get much on the screen at any one point in time, but to see it across the room. 

0:03:35 - RJ Kedziora 
It had to be pretty big, so that was always interesting and fun to do it. Yeah, it's still that computer did have the five and a half floppy drive. Right, it's still that computer did have the five and a half floppy drive and cartridges in combination to to you know, work on various systems. Ms-dos is pre windows kind of thing. Yeah, yeah, yeah. 

0:03:54 - David Williams
You know, and even in high school. 

0:03:55 - RJ Kedziora 
We were fortunate. My junior year they got a computer lab and so it was introduced to other programming languages and Pascal and C, nice. So that just really drove my passion. And I did get a degree in computer science that was the basics a minor in psychology, because part of that AI was just a fascination of the brain, the mind and everything around that. 

0:04:19 - David Williams
And it still drives me today. 

0:04:20 - RJ Kedziora 
I'm very much fascinated. 

0:04:21 - David Williams
That sounds good. Well, it's good if you can have those sort of foundational things that then lead to a career. And it sounded like you started off in doing software development originally and some consulting, and what did you get out of that before going and deciding that Estenda was going to be your thing? 

0:04:38 - RJ Kedziora 
Yeah, I did. When I graduated, I worked through a variety of large Fortune 50 organizations, some smaller companies consulting big and small to discover where did I really fit in the world and what did I enjoy doing? 

It was through the 90s, the internet boom and how can I play in that? It was fascinating to me in how do I make my mark on the world. And while software and coding is essential and it's very important, what I learned early on was the idea that what's more important is that end user Empathy and understanding who you are developing for and what you're developing for the idea of communication. Who you are developing for and what you're developing for the idea of communication. Like you could be the smartest person, but if you can't communicate, if you can't understand that user's perspective that you're developing for, that solution is not going to work as well as it could be, and so realizing that early on it was like, okay, where can I make a biggest impact? 

And healthcare, back in the early 2000s, pre-smartphone, pre-social media and everything pre-EMRs weren't a major thing. They existed, but they weren't a major thing in the early 2000s. So I was like, yeah, what industry did I want to make a mark on and take on as a challenge? And it was healthcare. 

0:06:00 - David Williams
That sounds good. So healthcare has always been a pretty big part of the economy, a lot bigger now even than it was in the early 2000s, and kind of behind when it comes to technology. And that was, as you say, before there were EMRs, but it was before the High Tech Act, it was before the Affordable Care Act and so on. So what did you see as the original kind of unmet need and what was the status of what was? I forget there's been a few iterations, but what we now call digital health, we were calling it e-health, I think at the time Maybe it was something that had a different name before that. Maybe I'll be able to remember that. 

0:06:41 - RJ Kedziora 
But what? Was going on in that environment, as of you know, 20 years ago. Yeah, it was. 

0:06:44 - David Williams
I think healthcare has always embraced technology. 

0:06:47 - RJ Kedziora 
So there is a lot of you know diagnostic equipment out there, medic, you know MRIs, x-rays and stuff like that. 

So they have embraced technology. I think from my perspective, they haven't embraced data. They're the last industry to really embrace data and that was as we started to extend in those early stages. That's what it was all about. How do we gather this data that is available? How do we gather more information to create a better picture of a patient? We were fortunate in those early days that we had a congressional grant for the development of a diabetes disease management solution with military healthcare. So we got to work with Walter Reed Army Medical Center, the Boston VA, the Indian Health Services, still working with Joslin Diabetes Center. That was part of that. Today, 20 plus years later, still working with the Indian Health Services today. So been a great journey with those groups, but back then it was, it was okay. How do we get more information about what's happening with the patient? How do we share that with your healthcare practitioner so they can better understand your sympathy, your condition, your experience? It comes back to that empathy. How does that physician understand you know what's going on with? 

you the nutritionist, the educator, you know how can we paint that better picture? So that's really what drove so much of what we were doing back then of just how do we? Get this information. 

0:08:17 - David Williams
Yeah, makes sense. And what have you seen in terms of an evolution? I mean, you mentioned that when you started out it was pre-EMR, pre-smartphone. I mentioned, you know, pre-high-tech act and so on. What has been the evolution since then? 

0:08:33 - RJ Kedziora 
I tie it to that data where it was a challenge of getting the information. Now we're overwhelmed with the amount of information. How many biometric devices are on the market? I saw an infographic on LinkedIn a couple of days that outlined all of the various different wearables you could measure information about your body various different wearables you could measure information about your body Everybody's aware of, like the rings and the watches to track heart rate and you know CG at continuous glucose meters to measure your glucose. You can measure your sweats there's just all sorts of things. 

I just bought a Muse headband that can monitor your brain waves. Nice, I haven't quite figured out what I'm doing with that just yet. 

0:09:15 - David Williams
Yeah. 

0:09:16 - RJ Kedziora 
It's just more information, and so that's the challenge today is now. There's just so much data that's out there, that's available. How do we find the patterns? And this is where it's interesting is, you know, our customers are a mix of, like, big Fortune 50 companies and then startups too, and as we have these conversations, it's like oh, we have all this data, let's find the patterns and show the user whether it's the patient or the doctor that pattern. 

0:09:44 - David Williams
And I'm always like well then, what? What are they going to do with this? 

0:09:46 - RJ Kedziora 
And so it's like trying to push that of like. Okay, now we need to go beyond that and provide a recommendation. And, okay, here's an inflection point in the patient's experience Call them up, interact with them, or, if we're developing a patient-focused app, they're using it. Okay, now is when we can surface some information, some educational information, to help change their experience. 

0:10:11 - David Williams
So yeah, today it's now. 

0:10:13 - RJ Kedziora 
Just there's so much information, what do you do with it? At the same time, there are still plenty of interoperability challenges in healthcare. There are new, better methods, but it's still it's like for your money you can go to any ATM in the world and put your money out. Yes, healthcare data is more complex by many order of magnitudes, but we should be able to get there. We're not quite there yet. 

0:10:39 - David Williams
Yeah, reflecting on what you're saying about data and how healthcare is slow to embrace data Now there's too much in a way. But I think back to the days of you know, pre-emr. You'd go into an office with these files. They'd pull out your manila folder and before an encounter physician at the time would kind of flip through it. Probably this stuff wasn't very legible, so they were like all right, I'm not sure what's in here, let me ask. 

And so you had that pattern with a patient and then when a lot of new information came out and it started around that time too, people would come and have printouts, you know, from the internet. 

And so the physician was worried they're going to have like all the stuff that they need to spend the whole appointment like disabusing them of whatever they saw on the internet. 

And then you'd have maybe these first either wearables or maybe, let's say, if you had a blood pressure monitor or something and you print out all of your records. And so the first experiences dealing with data were actually not that great, that great. And at the same time, if you fast forward to today, I was seeing there's at least some preliminary evidence that's getting some attention, that the you know looking at how well chat GPT can do on diagnosis and they'll say you know, and then there was an example that that does well better than doctors. But then it also said it did maybe better than doctors using it using chat GPT because they override it or they don't know how to prompt, or both. So, anyway it's, it's an interesting evolution that you're describing, so I'd love to dig in a little bit about what you're seeing today, like what's the state of the art and what are some of these friction points. 

0:12:09 - RJ Kedziora 
Yeah, so yes, generative AI has burst on the scene. It's barely, I'm not sure, the actual anniversary of ChatGPT's release, but it's right, it's November 2022. So we're right around there as we're recording this. So it's barely two years old and it's already changing the world, changing education, changing healthcare, and I think a big aspect of it is we're all hoping it to be so much more. Yeah, and I feel like we have to accept it for what it is today. And how do we make the most beneficial use of it? So you know, I don't know, there's been a number of these studies which have compared, you know, the large language models and their ability to figure out what's going on with the patient case versus a physician, and I know there was one recently in the New York Times, and. But when you sort of dig into the actual underlying article, it was like six case studies, right. 

It wasn't a huge example set and the physicians that were as comparators and using the AIs were not trained to use the AI. So was it a great comparison? No, was it interesting? Yes, it was interesting and we have to embrace it. We have to use it, understand where it is and how to be that effective. It's not replacing doctors. It's not replacing educators anytime soon, but we should use it. 

Doctors are people too. They're fallible. They can't. There's so much information that comes available, so much research, good research that's out there. They just we as individuals can't keep up with all that. The computers, the technology can't. So some of the big use cases now in healthcare are ambient listening. So just like you're on your teams or you know go-to meeting or whatever technology you use, and it can scribe out the meeting so you don't have to take notes. That's being embedded into hospitals now. You know around the country, such that the computer can listen and take notes and transcribe it. On the other side, computers are very good at summarizing that information the DNA system. So here's what's information your reference has patient charts and trying to understand it. Well, emrs were not really designed for patient care. They were designed for just capturing this information and billing purposes, probably above everything. 

And so if you talk to 10 doctors, 10 of them are probably going to be like yeah, I don't like my EMR, and so that makes it fascinating. Okay, how do I use the power of the technology to one? Listen to that conversation. Let the doctor be a doctor, let the nurse be a nurse and do what they. Why they got into it to work with the patients. 

You know the human aspects of it instead of typing away at a keyboard. So let the computer listen to that. It can also focus on you, know what information is on that chart and is aware of the clinical research that is out there and what I'm waiting for. And just hey, if somebody wants to do this together, you know, give me a call, but bring those things together and let the AI surface questions today to the doctor, and the doctor can then say, oh yeah, what about that? And so now we're really augmenting the physician's capabilities, because they're just not aware of every little thing that's happening in the world, because they're just not aware of every little thing that's happening in the world. And maybe the AI picked up something about the conversation that the physician didn't, because there are four patients behind and it's lunchtime and they're hungry, they're human, and so there's a lot of power of what we can do with that technology. On the flip side of that, you know when you asked about challenges, there are definitely risks, you know. 

we have to be aware of those risks. That's why I phrase it as we have to embrace it where it's at, not where it's going to go. So there's a lot of that fear of the AI is going to replace the doctor. Well, it's not today, you know. So, as software developers are using AI more and more kind of thing to write code, the expectation is that they're looking at that code and understanding. Well, I have the same expectation of my physician. 

It's like yes use the AI because I'm going to get a better treatment out of it. But you know I want you to be involved. I want that human in the middle and that's a major step in mitigating the risks there of making sure you have that human in the middle. 

0:16:41 - David Williams
Yeah, I'm just thinking about where it might go. I like the point about just thinking about where it is today and focusing on that, because the human brain isn't designed to understand like an exponential change or something. So it's hard. I could say, yeah, if this were 20% faster what it would be like, but if it's a completely different paradigm, it's hard to say. I could say, yeah, if this were 20 percent faster what it would be like, but if it's a completely different paradigm, it's hard to do. 

I wonder whether some of these technologies, on the one hand, you can see how it could enable a physician, especially if they're open minded with the idea about like gee, I don't, here's what I don't really know and this could actually open it up and I can use my you know brain and training in order to do the interpretation. But I could also see it kind of you know, dumbing somebody down. So the same way, if you're always flying on autopilot or always using the GPS, then if you try to navigate yourself, it's very difficult. I even think back to, you know, going back to the era when you and I were growing up. I was yesterday. 

The other day I was at a volunteer event and they were trying to figure out, you know, if they're going to have enough items for the bag packing for the next couple of days. And the director pulled out their iPhone. She's using the calculator function. She's saying like 55 plus, 47 plus, and she wasn't getting it right. And so just tell it to me. And you know this plus this, plus this minus that, and I always have it right away. And there were a couple of high school kids there and they'd never seen anything like that, you know, and I think they never would have any idea of how to contemplate it. So I do get concerned about people. Yeah, initially, sure they're going to interpret it, maybe if they've done it before, but if you're just coming into it, you don't know anything about programming, you just know about prompting. 

0:18:10 - RJ Kedziora 
You know where are we going to be. 

So I find this conversation fascinating because people in the Middle Ages and even in the 19th century were having the same conversations about books like our books, gonna ruin our ability to understand and comprehend information and remember information, because now it's in the books. I just have to go read it. That obviously has not proven true. Yeah, you know, you know telephones. When they came around, everyone's like oh, you can't use the telephone. You know you got to go talk to the person in you know, like face to face the telephone. The telephone is horrible. Yeah, no, it's not. And so I think the challenge with technology today is it's happening faster and faster and faster so we have less time to absorb it as a society. So the internet we all thought this was going to be the greatest thing since sliced bread, but we've seen a lot of challenges, unexpected challenges in how it turned out and how it implemented it it was going to bring us all together. 

Well, it's probably separated us in many different ways, so we have to definitely be cautious and careful of what it can do and the over-reliance on it. But it's also going to change how we interact with the world, to empower us to accomplish greater things, and so I really look forward to seeing that come about as we progress. 

0:19:40 - David Williams
Let me ask you a concrete kind of a question. I know your company is ISO 13485 certified. I don't know what that means and I didn't put it into my LLM to check it out. 

0:19:50 - RJ Kedziora 
There you go, yes, ask your LLM, and then, if you still don't understand it, say, hey, can you explain that to me like a fifth grader? Yeah, and it will do just that for you, which is a fascinating use of technology. Yeah, 13-485 is how we usually read the numbers out. 

At the really base level of it. It's a quality management system. We have a well-developed, documented quality management system and we've been certified in the use of this. We get audited independently, independently audit ourselves. We have third-party auditors, our customers audit us. 

It always makes fun, makes these experiences fun, because they come in and it's like okay, are you following your process? And it's like okay, so it's that okay, are you following your process? And it's like okay, so it's that cross-check. But what it does for us as we are developing these solutions for various different customers, it makes sure we're thinking about all the individual things you need to think about. So it's very checklist driven, very process oriented. So when you go into a design process or a design review or a code review, say, we're looking at your code, here are all the things we want to think about during that process. And if you take a step back from a software development project, if you're creating a process or data analytics systems, like, what are your goals for accomplishing that? So we make sure that they're documented. That's part of that process. We make sure those questions are asked and answered and the answer may be in the early stages of a project. We're not going to worry about that today. Yeah, but you've thought about it, so early on. 

You're not too much worried about performance and scalability because you're only going to have a dozen users. As you start crowding, then, yes, you have to think about that Cybersecurity, think about that day one. It is very essential. So that's what the ISO 13485 is about is a well-documented software development process. 

0:21:57 - David Williams
Very good, yeah, depending on the ISO. I think depends on the number, how you pronounce it, cause there's like ISO 27,001 and they don't say ISO 27 one, cause I think I assume the zeros that are over there. So very interesting, all right. So I feel, rj, I feel this has been a fairly wide ranging conversation so far, but let's actually widen it some more. And I was looking at what you're doing and it looks like maybe a decade or so ago you were working for a cake company, is that? 

0:22:23 - RJ Kedziora 
right, yes, and that does generate a lot of questions over the years, even when I got involved in it. And it's fascinating because, coming up from that software development background and experience, it's very algorithm driven and so, like I enjoy cooking, but baking is very specific, like you can't just take a bunch of ingredients and throw it together and out comes a cake. There's ratios, as, as you're you know, developing that cake recipe certain amount of flour needs a certain amount of fat, needs certain amount of sugar, so it actually tastes good, tastes good. And so, yeah, we had this idea of creating a cake. It was called better cake. Yeah, it was better for you was more nutritious, lower calories, all natural ingredients. It happened to be vegan. We were we're a little ahead of the vegan. 

Yeah, boom, kind of thing it was everybody's you know job I was the baker. I got to come up with the recipes, so I did that in my kitchen late at night. My girls were much younger than they loved it because they were the taste testers. And then we moved to a commercial facility and we got to the point where we did produce 5,000 pieces of cake and we were at a bunch of shows and stuff like that. But as everybody's second job it just never really had the legs. 

So it was a fun experiment for a couple of years there and, like I said, my girls loved it because they were the taste testers. 

0:23:47 - David Williams
Well, one of my sons is a vegan, so if there's any leftover cake, maybe we'll do one. We've got a leftover bread that's getting ready to bake for this evening, all right. So I asked you the question which I ask everybody about childhood influences, and now I am thinking back to how you mentioned that you used to take your bike down to the swimming pool, and now I noticed that you're a triathlete, so did you run back? So what's it like being a triathlete? 

0:24:11 - RJ Kedziora 
It's an awesome experience being a triathlete. I love it. It's very much. There's a physical aspect to it obviously, you know, as you're out there, swim, bike run kind of thing. But so much of why I enjoy it is the mental aspects of it, you know. So when I get up at 430, quarter of five and it's pitch black out and it's cold and okay, I need to get out there and do my training, need to jump in the pool and start and start swimming you know I do some ocean swimming it's like, oh, that just does not look like fun. But get out there and do it. 

Um, you know, when it's 90 degrees and you got to go run, you know 10 miles, your 10 mile run, it's like, okay, grab some water, grab some electrolytes, let's go. So that's a huge part of it, that, the mental aspect of the challenge. And I've done the adventure runs and things like that over the years. But, um, I used to do the marathons but that that focused exercise was just too much, yeah, on my body. So triathlon gives me a lot of opportunity to use different muscle groups and all right different movement patterns. 

So I have a goal of living. It's funny I was saying I have a goal to live to 100 with a good quality of life and someone said why only 100? So I adjusted it. I have a goal of living to 100 plus with a good quality of life, nice. 

0:25:34 - David Williams
As somebody who's involved in healthcare a lot, my usual advice to people if they they can do it is live to whatever age you're going to do and then drop dead. Don't deal with the healthcare system if you can avoid it. So, anyway, good luck with that, all right. So the question. I usually have a last question for people, which is about any books that they have enjoyed reading that they would recommend. So I'll ask you about that. But then there's another one about what you're reading and what you're writing. There you go. 

0:26:03 - RJ Kedziora 
So thank you for the prompt. I am not an AI system, but what's fascinating is I've been on this journey for the last year. I am writing my first book, tentatively titled A Productive Harmony Framework how to Be Productive in the 21st century, where time management isn't really the first thing you should think about. It's really about energy management and it ties into that triathlon experience. It's like you need sleep, you need to eat better, you need to move. 

You don't necessarily need to exercise or do a triathlon. You just need to move. And how do you guard your mental energy in all of this? And so, out of that, I've been reading a ton of other books on productivity and how do you maximize that without burning out, which is a key aspect of this, particularly today. One of the books that I loved reading, which I highly recommend, was called when, by Dan Pink, and when we think about making decisions, it's very often like what am I going to do or how am I going to do it? He asked the question of when, yeah, and there's a core essential there the idea of the chronotype. Are you? 

0:27:14 - David Williams
a morning person or an evening person? 

0:27:15 - RJ Kedziora 
Yes, and how does that drive your productivity within the day? I'm very much a morning person, so I should focus on things that take a lot of creation time and a lot of energy mental energy in the morning, in the afternoon, after lunch, kind of thing, regardless of what I eat, kind of thing. I'm going to have a lull in that energy. So that's when I should be focused on email and just the administrative tasks, and then I get another burst of sort of creativity and focus around dinner time, which my wife doesn't like. 

0:27:45 - David Williams
So much, because you know she's like I'm hungry, I'm like. 

0:27:49 - RJ Kedziora 
I'm still, I'm productive, I'm you know, I'm trying to get this done kind of thing. So yeah, I would definitely one you know I'll say Dan Pink's book when is all is is is worth picking up and reading in my book. You know to be selfish when it it won't get published until like next fall, kind of thing. Okay, a work in progress, but yeah, dan Pink win. 

0:28:12 - David Williams
Great, all right, that's a good one. I think I listened to the the blankest version of that one, so I don't know if I got it. 

0:28:18 - RJ Kedziora 
Yeah, he's definitely been out there on the podcast scene talking about it. It's fascinating. 

0:28:23 - David Williams
Good Well. Rj Kedziora, co-founder and COO of Astenda triathlete baker. Reader. Writer. Thank you for joining me today on the Health Biz Podcast. You've been listening to the Health Biz Podcast with me, david Williams, president of Health Business Group. I conduct in-depth interviews with leaders in healthcare, business and policy. If you like what you hear, go ahead and subscribe on your favorite service. While you're at it, go ahead and subscribe on your second and third favorite services as well. There's more good stuff to come and you won't want to miss an episode. If your organization is seeking strategy consulting services in healthcare, check out our website, healthbusinessgroupcom.