AI Is Becoming Your New Clinical Team | Conversations in Regen Episode 28

What if AI for doctors isn't replacing physicians—but becoming the most valuable member of your clinical team?

Discover the Future of Regenerative Medicine → Visit my Website: https://pxllnk.co/AD/BOBsite

This conversation is designed primarily for physicians, healthcare professionals, and clinic owners looking to build the future of regenerative medicine. If you're a patient interested in learning how emerging technology is transforming healthcare, you're welcome here too.

In this episode of Conversations in Regenerative Medicine, Dr. Ariana DeMers, the Queen of Business Orthobiologics, sits down with Dr. Marc Gruner—double board-certified sports medicine and PM&R physician, healthcare technology entrepreneur, and digital health innovator—to explore how artificial intelligence is reshaping modern medical practice. 

From the growing role of AI for doctors to the evolving use of AI in healthcare, this conversation dives into what every physician should know about preparing for the next decade of medicine. Together, they discuss how healthcare automation is changing patient engagement, rehabilitation, documentation, and practice operations without replacing the physician's clinical expertise.

You'll also discover why digital rehabilitation, wearable technology, AI scribes, and intelligent patient workflows are becoming essential tools for doctors, and how these advancements are driving the next wave of orthopedic innovation and regenerative medicine.

Whether you're building a cash-pay regenerative medicine practice, integrating orthobiologics into your clinic, or simply looking for ways to reduce administrative burden while improving patient outcomes, this episode offers practical insights and a compelling vision of where healthcare is headed.

Building a successful cash-based orthobiologic practice is not a single decision. It is a series of the right decisions made in the right order. The Business of Orthobiologics offers three distinct programs designed to meet physicians at different stages of readiness — whether you are just beginning to explore PRP, ready to build a full practice system, or committed to going all-in on a comprehensive transformation.

Learn More here: https://thebusinessoforthobiologics.com/programs-explanation 

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Transcript

SPEAKER_00 0:00

In 2035, the key place that we'll see in where the future is going to really lie is we're going to see that there's going to be wearable data and ambient data and patient-reported outcome data that will be able to detect gate changes and we'll be able to diagnose people and be able to intervene in a preventive perspective. One in two Americans will have some type of orthopedic injury. Only like 30% of people are actually able to complete their home exercise program.

SPEAKER_01 0:31

When I tell people that I don't ever do notes after work, since I implemented AI, when I walk out the door, my notes are done, and I don't have to use uncompensated time, right? All of you out there who are still dictating late into the night or filling out your notes, please consider it will change your life. I am excited to bring everybody to conversations in regenerative medicine. This is where we go beyond the clinical science into real questions. Every physician are asking, you know, what does the future of muscoskeletal medicine actually look like? And how do I build a practice that thrives going forward? I'm Dr. Ariana Demurs, the orthopedic sports medicine surgeon and founder of the business of orthobiologics. Every two weeks, I sit down with the people who are shaping the future for regenerative medicine practices. And today's guest is exactly that kind of person. For those of you who don't know me, I'm Dr. Ariana Demers, and I am an orthopedic surgeon and sports medicine, regenerative medicine expert. And a quick word on why I host these conversations. So I lived the burnout. I lived on the insurance treadmill, the volume-based practice, as many patients as I could see, as fast as I could see them. And really, I ended up feeling that clinical excellence alone was not translating into the practice or the life that I wanted. Orthobiologics changed that for me drastically. And the business systems around that changed it even more. So that's why I built the business of orthobiologics. And that is why I get to bring guests on like today's guests. So this is the shortcut to the path that I had to figure out the hard way. And I am obsessed about teaching physicians how to add sustainable cash-pay regenerative services to their existing practices or building from the ground up. So you can earn more money, less time, improve your patient outcomes, and reclaim your lives without having to continue on the insurance volume-driven treadmill. So I want to introduce to you today this is Dr. Mark Gruner, and he is an amazing colleague and friend. Dr. Mark Gruner is double bird certified sports medicine and PMR physician with Mayo Clinic Fellowship Training and RMSK certified ultrasonographer. Additionally, he founded Limber Health, which is a digital health product scaling to 12,000 clinics and 85 million patients before a successful acquisition and has also built Ortho Bethesda's regenerative medicine program from the ground up. He's a wealth of knowledge. He also serves on the AMA digital health workgroup for CMS, PQM committee for the next generation of CPT codes. And he's also been recognized as Washington's top doctor 2024 to 2026. So my goodness, Mark, you are an impressive guy with uh a rap sheet a mile long. So welcome, welcome, welcome. I'm so glad that you're here. You know, we've been friends for years, and now we get to chat and you know, kind of dig in the things that really are interesting and I think will bring value to our listeners here on the conversations in regenerative medicine. So welcome to our conversation.

SPEAKER_00 5:02

Thank you, Ariana. It's an honor and privilege to be with the Queen of Orthobiologic. So thanks for having me.

SPEAKER_01 5:08

Yeah, yeah. We're so glad. So as we start to kind of get started, I want you to look ahead to 2035, right? What does the ideal MSK patient journey look like from diagnosis all the way through recovery? And how do you think it's gonna be different than what we're doing today?

SPEAKER_00 5:36

Yeah, thanks for thanks for having me on the show. And I spent half my career on the clinical side and half my career on the technology and entrepreneurial side. And I'm so excited with the advent of AI and and where wearables have come today that I think it's gonna be so exciting. In 2035, I really think the the key place that we'll see in where the future is gonna really lie is we're gonna see that there's gonna be wearable data and ambient data and patient-reported outcome data that will be able to detect gate changes, we'll be able to detect any loss of strength or movement compensation weeks before an injury or surgery referral is even considered. And we'll be able to diagnose people not just at the time of the visit, but before they get injured or right before they're about to get injured, and be able to intervene in a preventative perspective. And I think that's one of the things I think is coming down the pipeline in the next 10 years. I I also think that you know, right now, because of human labor and how everything's going on and and the cost of medicine, with you know it being a very fragmented system in the insurance-based healthcare world, we're gonna see a more connected, continuous loop of care. So that's connecting the patient from the time they come to see you all the way through their visit, all the way through their post-recovery journey. And you're gonna be able to have a whole team of AI agents that will be able to assist you being the captain of the ship.

SPEAKER_01 7:24

Now, you know, there's been a movement, and like when you talk about that move, there's been a movement of, you know, patients owning their own data and really like taking matters into their own hands, sometimes terrifyingly so. But do you think that this data repository is going to be patient-held, or is it still going to be inside the healthcare system?

SPEAKER_00 7:54

It is going to be patient-held. I can tell you this. My wonderful wife, she works at Microsoft and has been leading Copilot Health. And they have, they just launched a direct-to-consumer product where you connect all your wearable data, all your EMR patient records, and you can query and triage questions like what you see in Chat GPT and Clon. And that's coming down the pipeline. So it's going to be a very patient-friendly situation that we're going to see, where you all of your data will be at your access and will transfer with you across systems, which has never been really done before.

SPEAKER_01 8:59

So for me, being outside the system as an independent physician, it's this is like very frustrating. So when, you know, when patients are like super proactive and gathering their data and being, you know, the captain of their own data ship, I love it because then I have access to all their data, right? Whereas if it's left to a health system, it's so siloed and segregated and not helpful for docs and not helpful for patients. So this the fact that you're telling me this is you know really exciting for patient autonomy, but also for private practice physicians who are not bought into systems. So that's that's amazing. That that I'm I'm really looking forward to that co-pilot health. That's gonna be, I think you're right, a game changer. So another question that I have, you know, the the gap in the musculoskeletal care rehab protocols and and situation led you to build limber health. Can you kind of share for those who don't know what limber health is, please share what it is, and then maybe what lessons you've learned about patient engagement and rehabilitations that probably we all still underestimate?

SPEAKER_00 10:16

Yeah. Well, one, limber health is a suite of software products. One, we have a home exercise program on a patient-facing app that people can have. Second, we record patient report outcomes of pain and function for physical therapy. We are the largest and the only outcomes registry in physical therapy today, and have collected over 85 million patient-reported outcomes today. Third, we are, I created CPT codes called remote therapeutic monitoring that are reimbursed by Medicare and commercial payers. And what that does is it connects the care between the physician or physical therapist with the care being delivered at home. And so it covers software, which is the app that patients are on, which is a patient engagement solution, which has a host of reminders, nudges, communication that happens and tracking wearable data like step counts. Plus, it's a care navigator, which is a a coach, and they're coaching you from the time you have a procedure or the time you've left your first physical therapy appointment and connecting with you at home to make sure you're on track with your program.

SPEAKER_01 11:32

That's amazing.

SPEAKER_00 11:35

Yeah, thanks. And so the second question I didn't answer the second question, which was you know, what have you learned about patient engagement? Well, I can tell you it's been a very humbling process for me personally. You know, most people that go to medical school are type A people. You tell them what to do and they'll go out and do it. They're very proactive, and that's not how most Americans are in the US. And I I lump people in the three categories in America. Type A people, they tell you, you tell them what to do and they'll go do it. Type B people, you tell them what to do, and they need a host of reminders, engagement, nudges, easier access, a friend. I used to be a personal trainer to keep them on the track with them being successful. And then type C people, you tell them what to do and they'll never do it. So, you know, the idea behind Limber was how can we change behavior, which is really critical to having a successful physical therapy regimen?

SPEAKER_01 12:35

Yeah, so I think, you know, I love your product and I have used your product and I continue to use Limber Health. For those of you who don't know, we are in a rural underserved location, and it is not unusual for physical therapy to be booked out 12 weeks. So if I prescribe physical therapy today, most of my patients cannot get in for eight to 12 weeks. That gap is massive. And so for me, Limber Health has been filling that underserved gap amazingly well. And I can now send my patients to physical therapy, you know, same day, same week instead of 12 weeks out. So this has been really, really good. But I do agree that there are those type A, which really like it, the type B, which need lots of help and reminders. And then, yeah, that those type C ones are like, yeah, good luck, not gonna do it. So sorry. Go-kick crux. But you know, the interesting piece and and what I've found is I have a large population of what you would consider like snowbird style, where they spend, they they split time. And so what I think Limber Health has allowed my patients to do is maintain their physical therapy regimen while they travel, which has been really awesome for me and for my patients, so that they don't lose time. So that that's been great. What do you think that you know, most physicians focus on that, those procedures, right? And patients focus on pain relief. But how important do you think rehabilitation behavior change is in determining those long-term outcomes? And how how do you think, even knowing what you know now, what other technology do you think is going to enhance these long-term outcomes of regenerative medicine in the rehabilitation realm?

SPEAKER_00 14:42

Yeah, I think the the big thing that I personally think is a game changer to rehabilitation behavior change is you know being able to track your patients and understand what they're doing at home and understanding that technology can have a really more affordable and more accessible process to engage the patients to make sure they're staying on track with their program. And patients who, you know, the data is is there, you know, one in two Americans will have some type of orthopedic injury, and the people who go do therapy, only like 30% of people are actually able to complete their home exercise program. And that's because the exercises are boring, they're not fun, they will do them for a period of time, but there's not any adaptation to the exercises. And what matters most to patients is not just like doing the regenerative medicine procedure or doing the surgery, it's like them being able to get back to what they love to do. And what do people love to do? You know, if you're a runner and you love to run, you have Achilles tendinitis, you know, you you can do this magnificent regenerative medicine procedure, but if you're not rehabilitating them all the way for a period of time so they can have the load and tolerance to be able to get back to running, which is what they love to do, then it's really hard to serve them justice. And so I really believe that the behavior change and the bringing in technology to focus on the exercise to help them get back to the goal that they want to achieve is critical for any type of orthopedic procedure or regimen that we're trying to help people get back to their goals.

SPEAKER_01 16:39

What do you think is the most effective technology to date to do that right now? What do what do we have that has been shown to be the most effective?

SPEAKER_00 16:50

So I did a lot of my work in at CMS focused on value-based healthcare. So I studied, I looked at like cancer, I looked at cardiology, I looked at orthopedic surgeries. I I I essentially was able to see the same pattern, and it's the same thing with each person that keep them engaged. It's touch points, and it's having multiple touch points. And I really think that when it comes down to really understanding the human mind and behavior, it really becomes critical to understand that multiple touch points, no matter what type of intervention you're doing, is going to get people more bonded with you and gonna make them feel like they're part of a team, especially if they're they're they know that their doctor or their physical therapist are being able to check in with them when they're falling off the wagon.

SPEAKER_01 17:50

Gotcha, gotcha. So like an accountability partner, but digital and digitally like checking up on you. And so you know that the that accountability is there and you can't cheat, and they're gonna look. So maybe that's a little bit of like fear-based, like, oh no. I mean, I I know that's why I go to my personal trainer because I know otherwise, you know, that's the only way I can stay accountable. But that's definitely not the digital piece.

SPEAKER_00 18:18

One of my good friends, he's uh orthopedic surgeon, he's a tech company, and he runs the sports department for a huge place in the Midwest. And he told me he used a product called Superhuman or something similar to that for personal training. And he lost all this weight, and it was only because A, the program was expensive, but B, someone told him exactly what to do every single day because he was such a busy doc that you know just the the reminders sometimes can be helpful.

SPEAKER_01 18:50

Yeah, awesome, awesome. This is you know, this is such a uh piece of the puzzle that I think you know, we do the injections and we're like, okay, we did a great job, high five. And this kind of that this rehabilitation piece kind of falls off the map. You know, as AI becomes more capable, what aspects of medicine do you think will always require a physician? So, where should doctors continue to focus their energy to remain indispensable? And what pieces of the puzzle are kind of gonna, you know, AI is gonna take all of that over?

SPEAKER_00 19:28

Well, I think AI will be able to educate, inform, triage patients, and will will really help patients be more informed before they see you, which I think will be great because a lot of questions that people ask are sometimes basic questions that get very routine and monotonous to answer. So I think that's where it could be really effective. It also obviously is helping from a scribing perspective and billing perspective. So I don't think doctors will need it to enter things into the EMR or bill, which is exciting. I think when it comes to diagnosis, it doesn't matter if you have AI reading the images or AI coming and coming up with the diagnosis by you know someone pointing to where their body hurts. I think you really have to be able to bring it all together, and I think that's where it's hard. You know, you have to take into the person's psychology, their goals, their a lot of times in orthopedics, especially, it's not just where you're hurting and that the diagnosis is. There can be referred patterns, there can be multiple structures that are hurt, you know, for the hip, you you never know if it's coming from the back, the hip joint, or the glutes. So it's like understanding all of these things and bringing, I would say, all the elements together. I just don't think as someone who's a very heavy AI user, I don't think we'll we'll be able to get there without a human in the loop. And I think that's where which is is really going to differentiate a lot of doctors that from from still having a job in the future.

SPEAKER_01 21:08

Yeah, so I think, you know, I am also very interested in AI and AI agents. And, you know, the way that I heard it explained best, and I think this will help our our audience, you know, kind of consider because you know, there's this concern that our our jobs are up for poaching from AI. But I think the things that we as I'm trying to build AI agents and take over, you know, jobs that are currently being done by humans, what we find is that we have to have multiple agents at very different levels, you know, strategic, tactical, for the same job. So, you know, us humans are quite complex. And AI is really good about processing speed and you know, following directions and remembering things for. Most part, but they're not usually to do a human job, you need you know, three, five, seven different agents doing different pieces of the puzzle to culminate in one, you know, single job. Is that is that uh a way to kind of think about what that looks like from uh you know trying to to allay people's fears that oh my gosh, my job's gonna get taken over by AI?

SPEAKER_00 22:29

Yeah, I mean well, just think about like all the things that we do. Like I think they're gonna be able to, you know, if you ask them a uh a USMLE or board question, you know, they'll be able to answer that. But that's a very routine thing. But when you have to take in the patient's expectations, tactile feel, what are all the different scenarios of what's going on with that patient, synthesize all the data on everything you know about outcomes and and and put that whole picture together? That's where the I think it's gonna be very hard for an AI orchestration layer to communicate all those things, which is what makes humans diff different.

SPEAKER_01 23:14

Yeah, absolutely. So, you know, for physicians who want to thrive over the next decades, what do you think, what technology systems, or maybe even mindset shift should they start to adopt now to build the practice that's going to thrive in 2035?

SPEAKER_00 23:34

Yeah, I I think there's there's they need to one of the biggest factors is for, and I learned this because it was a super user when I was at Mayo, like learning processes. And what I would say is just imagine the patient's experience from before they even enter into the clinic, how they find you, to the ones they're scheduled, all the way to when they actually are brought back into your clinic, and then the post-recovery plan afterwards, and the continual patient engagement that you want them to be on in case they fall off the wagon later down the road. And sometimes it's hard because you're in the moment just seeing the patient, and you're you're on that wheel just thinking about what you need to do next to treat the next person, but think about the holistic nature of what a patient really needs, I think is gonna be critical. So that and the cost of health care has gone up significantly, so we're gonna need costs to go down in some way or provide a higher quality of care system. And you know, a lot of my work has been really focused on value-based healthcare, and value means providing higher quality at a lower cost, and so I think technology is gonna really connect the care loop together, and it's gonna hopefully bring down costs. And the way I see it is you know, there's gonna be a orchestration of agents that are gonna help with patient engagement from patient acquisition, from marketing, all the way up running it through a uh a CRM and be able to have voice and education to a patient before they even enter your clinic. They're gonna be scheduled autonomously. Once they're actually scheduled to the visit, they'll be triaged and you'll have a very informed idea of that patient and understand not just a small sample of data, but their whole holistic data pattern that's happened over the course of a year or several years before they even walk into the clinic. And I think you know that kind of orchestration of data is gonna be so unique in where technology can really help a practice thrive. From a cost perspective, I think the key piece is that right now it is so expensive to run your practice, and I think you're gonna see that you're gonna have a you can set this up now. You can go to Claude, you can have Notion linked to your Claude, and you can have a very thoughtful documentation system of a CEO, a COO, a CFO, CRO. That's not meaning that you won't have humans like at your clinic, but you'll be able to have a very robust, autonomously loop of financial data. So you can have very good metrics, even if you're like a one-doctor practice. And I think those two things are what's gonna be the future of a physician's practice in 2035.

SPEAKER_01 26:36

Awesome. Okay, where do I buy that, right? I I need that now, please. So here's the uncomfortable truth that makes these conversations really matter. You know, being a great doctor used to be enough. Like you were great, things went well, and it isn't anymore. You know, these patients expect outcomes and experience, right? The the economics that we were talking about of the insurance volume don't add up for practices or life for the most part. Like, you know, these are for the most part, if you're doing an insurance-based care, it is a volume-driven practice that ends up sucking the life out of you because it you you have to just do so much volume to make that, you know, then the numbers number. And so none of us really, for the most part, were taught business in medical school. And we sure as heck weren't taught marketing and those implementation skills. You know, you said a lot of words and letters about CRMs and CROs and CMOs and lots of, you know, I'm sure those are the C-suite words, but CRM, you know, is something that I've learned, which is a uh really, I think, important piece of the puzzle. Uh and if you if you could just enlighten everyone, if they if you don't know what a CRM is, don't worry. But Mark, can you kind of explain why a CRM might be really important in the in a year five practice?

SPEAKER_00 28:10

Yeah, well, uh going back to understanding the patient before they even come into their clinic. So the way, you know, my company was a large company that we were able to scale very quickly. The way we brought on new clients, we had a list of leads, which are the beginning of a funnel. And so you can imagine when you're trying to bring clients on, whether that's patients or new customers, there's a list of leads that you're trying to engage, and then you want to get them qualified. So to get them qualified, you then have to let them know what you do, what services you you offer, what are what is the differentiated product that you have. And some of them might be interested. And so once they're interested, you then have to have, and so there's a series of steps to go through the funnel, and that process of knowing that what are your customers and where they're going through in a funnel is called a CRM. And so it usually starts off with a lead, then it becomes a qualified lead, then it becomes some type of demo, then there's a proposal, and then there's some type of deal that's won, and that patient might be scheduled onto your schedule. And so that continuous process from a wide net, which is considered a lead, all the way down to a patient coming on your on your on your schedule, is a process, and that is usually housed in in there's various technology vendors that do it. I built one out of Claude that was equivalent to HubSpot, which is one of the largest ones in the sales world in Claude Code, and it took me about four hours, and I had something that was very unique, and that's the the amazing ability of AI today.

SPEAKER_01 29:56

That that is phenomenal. So, for those of you who don't know, that's called a customer relations manager, and it's managing these people who might want to be your customers, but maybe they're not really interested in what you have to offer. And and it's not a personal filling, it's it's a gap in the medical education system. And and this is part of why we have this conversation is to kind of close that gap and really understand what it is that we need to start to begin thinking about to consider the patient journey from the second that they understand that they might have a problem. So, you know, for our business of ortho biologics ecosystem, the same thing. There's a pathway that this is our journey for our doctors who are part of our ecosystem. And clearly, this is none of this is random. There is a pathway, and it starts with awareness, it starts with these conversations and this podcast. And from there, we do a readiness assessment to see if you're, you know, the person that is interested in getting more information about starting a adding or the biologics to your your practice. From there, you know, we have a Bob Express uh and Launchpad Live, which are live events, and then our programs, which are PRP now, which is the implementation, or our TrueMD program, which is full practice transformation. And so clearly we don't have to figure out the whole journey today, and you know, we just have to take the next step. So here's a question that I have, and I'm gonna, I'm just gonna ask directly, right? To our audience, does this sound like you? Like I can see where medicine is going. I believe in regenerative medicine, but I genuinely don't know how to implement in my practice. I I can't quite connect those dots. So if you're nodding to yourself, then that's where you need to be, is right here, because that is the single most common thing that I hear. It's not a knowledge problem. We all know that regenerative medicine is that next step. It's a roadmap problem. So stay with me because I'm gonna give you the rest of the roadmap. And you're if you're not behind, you just need a better roadmap to figure out how we do this. So, what I want to move to is really what you've said, Mark, is I think the things that are really important from this conversation is that the MSK practice in 2035 is going to be built on outcomes, data, digital rehab, AI-assisted care, not just like procedural volume. And then I think technology helps to assist that adherence to the rehabilitation protocols, which then enhances our outcomes. Um, and that I think there's a lot of people that are mildly fearful about AI. And that this is, I think, very reassuring that again, coming from someone who knows and has had a long history with AI and with you know big data, that there is gonna be a role for AI, but it's not gonna be doing the clinical judgment piece. And that is a bit too complex thus far to be able to have AI do it autonomously. And the the good news is that AI can take over the things that are driving us crazy, the the, you know, clicking the boxes, doing the billing, doing all the annoying stuff, right? The AI Scribes is one of my best friends. I love my scribe and have used an AI Scribe for years, and it's the single most important decision I made when I went to AI Scribe. It was brilliant. So I think for the physicians who are gonna thrive in that next decade, it's gonna be, you know, those physicians who build systems around their expertise and their knowledge and allow AI to take all of the pieces of the puzzle that don't require a human so that we can elevate the humanness of medicine. Do do you have anything else to add for that?

SPEAKER_00 34:31

I would just say that you said that beautifully, Ariana. And that was that was no, but I would say that you're spot on. I mean, when we went from paper to the electronic health record system, it was a nightmare because we added more work to the doctor. So the doctors who are gonna really thrive and survive in the future is if they embrace technology to realize that my patient encounter can be recorded and documented the EMR without me even being in the EMR. I don't need to be like writing after work and not being with my family. I don't need me entering billing codes like I'm just a robot. Like that can be done, and you can spend more time with humans than actually interacting with the computer. And I think once you know doctors let go of like, I need to like make sure that this note is the most perfect note in the world, I think they're gonna realize that the notes will get better over time, and they're pretty good right now, and the quality of life that you'll have over time is gonna be so much more important, and the skills that you have, meet spending time with people is just so much more important than being with some technology.

SPEAKER_01 35:58

Yeah, yeah. I will tell you, you know, when I tell people that I don't ever do notes after work, since I implemented AI, when I walk out the door, A, my notes are done, and B, I don't have to use uncompensated time, right? Like I we just that's just not what we do. So that has been a game changer. So for all of you out there who are still dictating late into the night or clicking and you filling out your notes, please, please, please consider AI scribes. It will change your life. And I think that mindset shift, you're exactly right, is don't try to be that perfect note every time because the the whole visit is captured and it is iterative. So the more that you give it, the better it's gonna get, and the better it's gonna get and the better it's gonna get. So take the reins off a little bit and go home and don't dictate for good God. So go play with your kids or go barbecue or something, right? As so, as we finish up, I just wanted to give everybody this QR code before we get pulled back into the day and before our QA session. Uh I would like to offer this is a focused three-minute assessment, and this pinpoints your biggest bottlenecks and it'll allow you to get your personalized path forward. So just scan the QR code to begin, and then you can take that the quiz on your own time so we can dive into this amazing time that Dr. Gruner has spent with us. And, you know, we have our ecosystem, and there's a number of ways. So if the assessment confirms you're ready to move forward, these are all the places that you can go. With that being said, I am gonna turn it over to everybody for any questions and then a couple of housekeeping items as well. So for all of you out there, you can either put questions in the chat or we do have a QA session. There's no open questions yet, but we can do that, or you can just raise your hand. Yeah, Kareem.

SPEAKER_02 38:22

Hey, Dr. Murray, Dr. Gruner. I'm just curious, have you guys like as you use AIs, you start to realize where the weaknesses and limitations are? So I've I have just recently started using the AI scribe assistant within ECW for my practice. I don't think it's the best one. I know there's a ton out there. Just curious as to what you guys have found to be the best AI scribe for notes.

SPEAKER_01 38:47

Yeah, go ahead. Mark, what do you thought?

SPEAKER_00 38:50

So I mean, one, there's uh a bridge has been very good with the the health systems, from what I I've heard. I personally haven't used it. We use something called Scribe Brain, which is very good. It uses a lot of large language models. A lot of them all use similar large language models now to date that are fed by like Claude or Doximity has one that's that's free. So does open evidence. They have a free one. So those are some of the the bigger ones that that I've seen that people use. I don't know, Ariana, which ones do you consider?

SPEAKER_01 39:27

I use it's called Deep Scribe, and the the one benefit that I like a lot is that it pushes directly into my EMR. So you are correct. I don't even open my EMR. I just open my little deep scrub and I communicate either on my phone or a little iPad. I just hit record, I talk to my patient, I do a bunch of things, I do the exam and I tell them what the problem is, we go over the MRI or whatever, we come up with a treatment plan, and by the time we're done, not only do I hit import, you know, I'm done recording and it imports, by the time you know that they are that the whole visit is done, there's a note. So in the EMR, if I were to open my EMR, the note would be there, but I don't open the note. I don't open my EMR. So that's super helpful for me. So that is one of those things. I think the free versions you have to like copy paste. For me, it's an automatic API electronic push, which is lovely.

SPEAKER_02 40:33

Thank you, guys.

SPEAKER_01 40:35

Yeah. What other questions? That was a great question. And I think that there's so many out there. You know, the one that I the and the reason I I got it is because I had an in-person scribe who ghosted me. And I was like, oh man, I am dead in the water. So, you know, one of my favorite things about AI scribes is they don't call in sick, they don't ghost, show up every day, they don't complain about, you know, work hours or whatever. And it's the same, it's the same. Like, you know, you don't get your B squad sometimes, or you know, no shows. So for me, that was the the big change, and that's why I pushed two AI is because I totally got ghosted by my scribe, like no call, no show. And I was like, I got nothing. So yeah, game changer for sure. All right, what other questions do we have? A bridge is really good. There's a comment in there. Yeah, yeah, I'm telling you, I I there these are these are game changers, my friends. So I think, you know, you said something that for me is really interesting is this this new model where it's it's patient-driven. And I think that this is gonna be really important, but I've come to the realization that patients are addressing their care in in terrifying ways right now. You can buy basically anything on the internet, you can get patient-ordered labs, you can get on the gray market, you can get darn near any injectable that you want. You know, you can get all sorts of peptides, you can buy testosterone on the web and ships to your house. You know, it's it's pretty mind-boggling. Where is that balance, do you think, between because I'm sure it's a backlash. We, for so long in the medical field, have held all of the pieces of the puzzle and have basically said, no, you can't have your data, no, you can't look at your stuff. And it was quite restrictive. But now we're having this backlash where they're self-directing their care and they're kind of like YouTubeing it. Where do you think that that that role of the physician, maybe as a as a guide, is gonna play in?

SPEAKER_00 43:02

Yeah, I mean, I think when I I I hate to date myself, but when I was going to medical school, I think we lived in such a paternalistic culture where it was like the doctor said you should do this, and patients would say, okay, I'll go do that. And what happens in anything, right? Like if you look at politics and what's happening in the world, you know, there's like a huge revolt, and it goes not just a little bit one way, it goes the complete opposite way. And you know, now we're in a situation where patients just want to do what they want to do. And I think it's gonna be you know, there's gonna be a swing back to the middle where people will get hurt and you know they'll do the wrong thing and they'll regret it, and they they wish they had someone that had experience and someone who knew where the data was and could extrapolate something that you know you just can't type. Out sometimes and help them make an informed choice. So this is where like shared decision making is so critical, where you hear what the patient wants to do, you make sure that it's safe, reliable, consistent, and you know, within your best judgment of what you've seen in patients like that in the past, and then you help them make a better choice than what they might have done before.

SPEAKER_01 44:24

Yeah, yeah. I mean, I just I I'm kind of on the interweb and like, oh my gosh, you can do an at-home pap smear. Like, that seems like a problem. I don't know, but maybe not. And there's been so much medical gaslighting that's happened for these patients that they're like, well, I'm just gonna chance it. And you know, at least it's good enough. It's because I'm not had no way in heck am I gonna go to the doctor because they treat me so poorly that I'll I'll just I'll do it myself, you know, to do it do it yourself kind of kit for all sorts of stuff. So I hope that we'll have that kind of pendulum swing back where we have a lot of AI assisted things to make the journey more of a guided journey of with experts at the helm, but maybe a lot of less judgment. I I don't know. I feel like my patients come in and there's that there's been so much judgment, like, oh, you know, oh let me guess, you googled it. Well, yeah, so did I, you know, I Google everything or Claude or you know, we're I I get out on a patient visit, they ask me a question I might not know.

SPEAKER_00 45:33

I go on open evidence, I just ask the question. I'm like, well, this is the answer. And so it's a different, it's a different generation where they they just want to get the right facts and they don't care how that that that comes to be.

SPEAKER_01 45:47

Right, right, right. Well, awesome. There is a question. Oh, there's a lot of questions. Is the Microsoft Health thing that you discussed like a patient dossier where they can take it with them to any doc they see?

SPEAKER_00 46:02

Yeah, they can take it to any doc. It they work with health systems and other entities, other practices, and it will it has five or six different components, but essentially the way you viewed ChatGPT and and and Claude and all these other large language models where people are asking questions, now it just hooks up to your EMR and your your wearable data, and now you're having a robust question that you ask that's more about you, and that's what people are doing today.

SPEAKER_01 46:34

And and so you know, to take that one step further, is it you know, is it integrating all of your patient visits, all your labs, all your imaging, any surgical interventions or procedures you had? It's intervening it's kind of bringing it all together.

SPEAKER_00 46:51

Yeah, you can bring it all together. It took a very long time for us to get here, and my wife talks about this all the time, how exciting it is. I mean, you can I mean, you know, first we had to get on an EMR, then we all, you know, all as you mentioned, all the health systems and payers blocked everything. So then you had to have uh everyone speak the same standard and have them share their data, and that's starting to happen for the first time, which is exciting.

SPEAKER_01 47:19

Oh my gosh, that's awesome. Because really, when you talk about the cost of running a practice, one of the things that for me is really onerous, and and I'm gonna have to talk to you offline about how to how to get this done. But in my my idea is taking the the time that my people have to spend to gather all the data, like what the heck has happened since the last time I saw them, what it what imaging has happened, what labs have happened, what doctors have they seen, what did the doctors say? Because you know, not not all things are remembered properly or appropriately. Um, and so I have a human do all that, right? I uh to to kind of collate all of that historic experience so then I can get a really good idea of who and what I am actually dealing with, so that we can, you know, put all that aside and be like, okay, I understand who you are. This is all fragmented. We did all the work and gathered it all together. So this is what I understand thus far. Here's your problems, here's how we're gonna go forward with it. So ultimately, that can be done by AI, right?

SPEAKER_00 48:27

Definitely can be done by AI.

SPEAKER_01 48:29

All right. I'll tell all my girls are out of a job.

SPEAKER_00 48:32

Taking longitudinal data, all your patient information, instead of you looking through many years of notes into a very synthesized summary that gives you a really good snapshot before you walk in the clinic, is is definitely doable with with AI.

SPEAKER_01 48:52

That well, that that's my next step. As as we continue to go into this journey further, it's it's really exciting. There's a question for you. Um, have you found or seen when patients do come in with AI handouts, that it helps at least get an idea of where their head's at, about their health, what what kind of knowledge they have, or is it the opposite? Is there a lot of misinformation out there?

SPEAKER_00 49:18

I think there's a lot of misinformation. I think for simple things, sometimes there's they're spot on. Like, you know, they're like, I I my elbow hurt, and I they're like, I play tennis, and and I I have tennis album. I'm like, yes, AI was right. But sometimes they're wrong about like they don't know all the treatment options that are available to them. And so some people anchor, so as soon as you learn something, and everyone has a selection bias, you anchor on that that is the treatment that you should need. And so that's the where I see that the problem is where you need to let them know about all the options because sometimes they they come in with some perceived notion that they need something where they might not need something.

SPEAKER_01 50:07

Yeah. So for me, I love to get an idea. And I I ask them, I'm like, I'm sure you've been Googling it. Like, tell me what you know about this so that we can, you know, make sure that you have the proper data. Um, and then sometimes they'll come in. My some of my patients are very, very spot on, and they're like, here's all the evidence for the PRP injection that I'd like to have. I'm like, great. Oh, yes, this is a good study. Oh, yes, that there's a this is the flaw of this study. Yeah, absolutely. But overall, you're you you did a good job of training your AI. Congrats. Can I borrow it? Right. Um, and there's a question about from Korea thoughts on the recent paper from Nature that showed general large language models outperforming specialized medical AI tools? What what's I I know I've read that. What's your thoughts on that?

SPEAKER_00 50:58

I've seen that paper. It's been a I I I don't think I can say anything about that. I I forget, I I'd have to refresh my memory to that paper.

SPEAKER_01 51:07

Um I think it's interesting, right? Um and and so how could that be that medically specialized AI tools don't do as good of a job as generalized, you know, Claude or or chat or any of those other perplexities. They seem to do that, and this is the study that it showed, is they seem to do a better job at predicting and describing and conversing about these health-related things. Do you think it's just a sample size problem?

SPEAKER_00 51:38

I yeah, sorry. So I just wanted to make sure that the paper that I I know of is that they compared, and I believe it was for AI scribing, but they looked at like Claude and and what's it called, and Chat GPT, and they looked at it compared to some of the the specialized tools like Dragon and and other ones that have a supervised machine learning model, but not a robust large language model. And I think what we're seeing is that now that the large language models they have so much data, which you mentioned, and that that data is so robust and it's been primed so many times, it's it's just so much more sophisticated than someone who's focused on a specialized tool with a smaller data set.

SPEAKER_01 52:31

Yeah, yeah. Well, these questions have been fantastic. I did want to offer any last closing thoughts, you know, or things that you're working on. I'd love to hear what you're working on next.

SPEAKER_00 52:47

Yeah, so one of the things that I've been really excited about was Medicare launched a new model called Access. And it's for the first time ever is allowing a digital health company to be a provider and work with practitioners to co-manage a patient. And it allows for the first time for a product, you know, for the musculoskeletal conditions, provide a home exercise program and have AI coaching, care navigation, and data tracking all done with just a technology app alone. And so I partnered with a trauma orthopedic surgeon at Duke, his name is Christian Penn. He has an amazing substack called Techie Surgeon. And me and him have partnered on so Limber's a home exercise program, and his program is called Rebel AI, and they're the AI orchestration and voice engagement layer. And MSK Access is the Part B entity, and we're able to provide care autonomously to people at a fraction of the cost.

SPEAKER_01 53:57

So that's MSKaccess.com, is that correct?

SPEAKER_00 54:01

That's correct.

SPEAKER_01 54:02

And so you can kind of go to that website and and check it out. I just popped it in the chat, and this is helping to do post-op in exercises or what is that?

SPEAKER_00 54:17

No, it's a non-surgical engagement. So and it can be marketed direct to consumer. It's covered with no copay for patients, and it's it's a really unique model where you just can get a list of someone's patients and create a system to reach out to them. And the ones that have been interested, they can try a home exercise program using AI. And the program goes live. Medicare announced this program in January. And we were one of the 70 people who were selected in the first cohort. It goes live July 5th.

SPEAKER_01 54:51

All right. So you're gonna go to mskaccess.com and it's gonna go live, and it's it's a home exercise program opportunity for your patients that are it's covered by Medicare, yeah?

SPEAKER_00 55:03

Covered by Medicare, and a lot of commercial insurers are starting to adopt it too.

SPEAKER_01 55:08

That's super cool. Well, uh, I look forward to getting my patients on home exercise programs that are covered by Medicare. And I will be a shoving this out to my patient list for sure. Everybody needs a home exercise program. So I wanted to thank everybody for joining the conversation. I appreciate your time, you being here. Uh, you know, a huge thanks to Dr. Mark Gurner with the generosity and insight and for spending your time with us today. Please, you know, make sure you you scan that readiness readiness assessment. And if it makes sense, check out the programs or book a strategy call with us to start to get orthobiologics and cash-based practice in integrated within your current practice. So I am Dr. Ariana Demers, and I will see you in two weeks for the next conversations in regenerative medicine. Thanks so much, everybody.