Junaid Kalia MD: Welcome to another episode of Signal and Symptoms podcast. We have an amazing special guest. We have Sherri Douville is she's so humble. First of all, when you go bring a guest in and then you go back and look at it, she is just amazing. She is an author. She's a CEO of Medigram. She has actually helped many other startups ensure that AI governance, cyber security is utmost importance. And I tell you right now as a save life AI founder, cyber security was the largest hardest thing to crack. Not to mention, of course, when we got our FD approval process, it was huge. So, I'm so glad Sherri's here.

Sherri Douville: Well, awesome. I'm honored to be here. If I'll just do a quick introduction. I I love this combination. It's really the future of medicine and and just what a what a great group of people . two awesome physician technologists and my bestie Ed Marx who's played just such a huge role in my career and did the two forwards for for my two books mobile medicine advanced health technology and been just a huge driving force in my career. Thank you for being here for me for so many important moments in my career Ed.

Sherri Douville: So, I'm Sherri Douville, CEO of Medigram and chair of the Trustworthy Technology and Innovation Consortium (TTIC). So what we do is help hospitals and medtech companies build trust infrastructure so that they can deploy AI safely and effectively. And so what that means is building real governance into AI systems that we can manage risk, improve outcomes and help ensure accountability from boardroom to bedside. And so through TTIC and as co-chair of trust for ILE EUL 2933, which is a standard for data trust infrastructure which is used for clinical AI. I work closely with hundreds of engineers around the world with medtech companies and hospitals . and also closely with CIOS, CISOs, clinicians to operationalize trust, to not just write or talk about it but also build the systems that execute ethics and prove it at runtime, and align the stakeholders that execute it and not just in theory.

Junaid Kalia MD: Thank you so much for coming. I really appreciate it. And this is very dear to me. Ed, can I go first?

Edward Marx: Yeah, of course.

Junaid Kalia MD: Okay, so here's my problem, right? I went to SaveLife AI. We had physicians, only physicians completely did all of the, you know, software in terms of clinical accuracy, all of it. Loved it. Went to the C-suite and they said, "Oh, by the way, we have no idea how to evaluate you properly". "I don't know how, I have no idea," and this is X, total, you know, the the body controls 1200 to 1400 providers depending on how they are scaling. And then I was like surprised that why not? And for me as a founder and a solutions provider, this is becoming a big issue.

Junaid Kalia MD: So how do we again, you know, we have discussed this before and I would love to your opinion on it that how to energize, you know, make sure that they actually take this seriously? Because we are so ethical, because we have the approved HIPAA cyber security framework and all of that, we did all of that, but still there seems to be a significant glacial speed. And more importantly, is there a way to improve overall process? Again, that is my problem as a founder that I want your help with. And that's what this podcast is all about. We want Signal and Symptoms. Signal means cut the noise, come to the actual problem solution. And symptoms again, putting it back to the patient itself, just to understand that how if a physician does X thing with AI, how does it improve?

Sherri Douville: When you think about the data science team, you think about them, they're in charge of building the rocket that's going to build the future. when you think about building future of like FTE reallocation, what's going to drive what the C-suite knows is is the is is a future of revenue, revenue growth, efficiency. But at the same time, the CIO is the one who's in charge of signing the launch permit . and in charge of the one and they and and they're the one that goes to prison if if if if the rocket explo flows. And so whereas the data science team, you know, they tend to be not as in tune with all the requirements around the launch permit and they tend to be less in tune with the accountability of the outcomes of those requirements. So that's the tension that we have is how do we solve the tension of the requirements of the and the accountabilities.

Junaid Kalia MD: That is beautifully done and beautifully said. And then especially the analogy, I'm going to push it back to Ed. And then we both of you have experiences and and of course Harvey's there. Do you want to just give examples for, you know, founders like us how to approach this problem better? Or in your opinion how do I involve you both somehow, so all of that, so go ahead.

Edward Marx: All right, so I have two questions that are similar but bifurcated between sort of vendors and providers. So a lot of our listeners both vendors and providers. So um as we know there's a lot of startups . everyone's doing something AI. And Sherri, you know, they they race and then all of a sudden they look back and they're like, oh my gosh, I didn't I didn't take care of X, Y, and Z which are now my big hurdles.

Edward Marx: So someone listening who's like early stages or contemplating, what are one or two things—so this is for the vendor side—what are one or two things that, you know, early stage startup should really think about that you see them often sort of ignoring just because they don't know? Because they get too excited about the actual, you know, solution they're building. Like fundamental things that they should think about as they go on this journey.

Sherri Douville (Guest): So the most fundamental thing that you should think about is the compatibility in the investor syndicate with the client community. That's the one thing I had I cannot stress that enough. I can't say too much, but I would just encourage you to consider who is the buyer and to to really evaluate what investors you would consider talking to based on who the buyer is.

Edward Marx: That's a good one. That's a very good one. That's pretty deep. So, I want to flip it then. And you're right, you know, Sherry, what you there's really multiple angles. We often think about just u like the provider side. I want to say provider, like a hospital-based or payer-based person. And then you have the inventor, the entrepreneur. But yeah, the third leg, and maybe there's more legs is the investor. So, it's this complex triangle. And like I said, there's probably more to it than that.

Edward Marx: But on the provider side, so as you know, a lot of a lot of the looks are de like a deer in headlights, right? It's like, oh my gosh, uh I get all these amazing opportunities by great companies. Uh and what do I do? What what are some of the, what is one or two things that you would advise? Because as you know, there for sure there's a a handful, right, 10% of the providers, payers, they're ready. They've got all these things in place which I'm not going to name because I want you to hit on them. They got all these things in place and they're ready and they're going and they're leading . but there's 90% that are still like, so what are one or two things you would recommend to our listeners who are in that space? Where like, hey, I'm a leader here in my health system or my payer company and dang I I know I need to do something. What do I do?

Sherri Douville: You like you mean to screen or what what what would to get set up?

Edward Marx: Like I know one big thing, one thing that you're big on is governance . like you need to cuz again, people are going, they're going 100 miles an hour when they finally do move. They go 100 miles an hour and then they're like down the road and then look behind at all the wreckage because they didn't take care of certain fundamentals . and one of them being governance. What are any other items? Like uh and you can speak about governance as well. Like what do they need to set up in order to be successful?

Sherri Douville : Absolutely. Yeah, there I mean there's many things that they need to do, you know, to set up to be successful. So I think that there has to be the product and the workflow, have to be... I think most failures come when you try to bolt on governance systems that were never designed you know for accountability. And you also have to think about what is the business trying to do. I mean I think that's that's the challenge for a lot of health systems and a lot of entrepreneurs you know trying to work with the health system.

Sherri Douville: So I I think I think the biggest mistake actually that most boards are trying to make is that they don't need themselves to be AI experts. So we are going to be coming out with another book to help them. They need to just be asking the right questions. And so that I know that this podcast you guys want to talk about equity, and so as part of part of governance. So the questions would be around the business of healthcare which is about safety, explainability, equity. So boards need to govern AI the same way they're governing finance, clinical quality. And the way they need to do that is just with a consistency, right, with dashboards, with thresholds, with evidence-based oversight. And so they don't want to do is treat it like innovation experiments. They they need to they need to be shifting more into a system of record where they're managing with real accountability. And so what what we want to do and what what we're starting to do already is work with boards to integrate AI with oversight in their existing structures.

Edward Marx: So Sherri, this is a one of those tough questions because it's so hard to predict the future, but you've got such a great grounding your career previously and we'll have to drop, I'll drop in the notes some podcasts that Sher and I have done together a couple years ago which goes in depth into her, who she is as a person, how she was raised, all her formative years and all the great expertise that she brings to the table. So we'll drop that in there. Uh but if you're looking forward, you know, and I think we can only go one to two years, and you know, where do you think we'll be? Like you're back on the on the podcast in a year or two. Have we transformed healthcare? Uh is uh primary care the same as it has been? You know, what changes do you think? You know, and I'm sure you and Art, your wonderful husband, talk about this all the time at the dinner table. So, what changes do you we're seeing the next one to two years?

Sherri Douville: So the big changes that we're anticipating is a lot of consolidation and we're seeing a lot of convergence with life sciences and large health systems. And that's where we're working doing a lot of work personally. We're bringing a lot of that to AI Med with TTIC. And so that's what we're I can't can't predict the exact timelines but within two years we're going to see a lot of manifestation of that.

Junaid Kalia MD: So here's what I wanted to say. What I'm hearing from 10,000 ft high is working backwards is my favorite phrase. So you guys are identifying the problem, the pain points and literally working backwards. What is causing the friction? What is co causing these things and you guys are thinking about it and working on it and creating solutions and writing books. And that really makes me really excited.

Harvey Castro MD MBA: The second thing I want to say is, you know, in in AI med and medicine, the greatest risk is not dreaming dreaming big enough, right? And you guys are doing it. You guys are dreaming big, but with Sherry's husband and and your brains and and knowing what those friction points are, you're able to push the envelope because you know what can be done now. So I really applaud what you're doing. And I can't wait to see your uh what you're presenting here in what couple weeks now or less. So I just wanted to say that.

Sherri Douville: Oh that's very kind. Thank you. Well, we actually, we do actually execute. I mean that's that's our passion.

Junaid Kalia MD: So going back to number one, future expand on consolidation and convergence. Number two AI adoption. What is the most biggest rate limiting factor? And in the next 1 to two years, you see those limiting factors move away?

Sherri Douville: I think it it's actually mindset is the biggest limiting factor . and I really put I push on the team on my team on their mindset. Because ironically I the biggest problem in healthcare is really misunderstanding idealism . because we are we are living in an AI economy. And there's a lot about it that probably feels unfair and is not what any one of us personally would design . but you have to accept it for what it is and and deal with it and deal with it the best way that any of us know how. And I think what's nice about having communities and a network and a consortium is that there's a lot that you can do.

Sherri Douville: And I will make one recommendation for Greg Satell who is a preeminent evidence-based change management scholar of our time is that there is a lot that you can do when you focus and his he's got a book called Cascades and we have sent seen tremendous progress with that and I highly recommend that book. So we've been focused on helping hospitals align developers, clinicians, patients through shared governance protocols. So that is not that's not just aspirations . you know, that is aligning, you know, to make sure their operations, you know, execute what what their aspirations, you know, say.

Sherri Douville: And so the the biggest, I call it misplaced idealism is is like the I think the biggest thing that potentially holds back healthcare. And and I I know that probably sounds very um probably controversial, but but I think it has to be said because we have no time to waste. Q2 next year, hospitals are going to get slammed. I was telling Ed with audits from multiple directions federally, CMS, state. And then we have the OBA related um you know OB-related stuff that comes after that and we just have no time to waste. And so that's why I'm willing to say the things that probably other people would consider very controversial because we just have no time to waste.

Edward Marx: What's been the one thing that gives you hope for the future based on what we've seen as hard as it is and all the politics and all the stuff that happens in life? But what what's one thing, you know, in all your studies and all the people you're coming across and all the things that we have the potential to do, you know, what's one thing that gives you the most hope?