Episode 26: Love ‘em or hate ‘em, EHR and RCM are here to stay. So what’s next? Looking at the past, present, and future with A. Hadi Chaudhry, CEO of CareCloud

Justin Steinman:
Definitively Speaking is a definitive healthcare podcast series recorded and produced in Framingham, Massachusetts. To learn more about healthcare commercial intelligence, please visit us at definitivehc.com.
Hello and welcome to another episode of Definitively Speaking, the podcast where we have data-driven conversations on the current state of healthcare. I'm Justin Steinman, chief marketing officer at Definitive Healthcare and your host for this podcast. Love them or hate them, there's no doubt that EHRs are here to stay, and the reality is that most doctors and other clinical practitioners probably both love and hate their EHR at the same time alongside the revenue cycle management software that sits right next to it.
EHRs or electronic health records digitized the healthcare industry over a decade ago in large part thanks to the Obama administration's implementation of meaningful use. Yet now, even as they're widespread across the entire US healthcare system, EHR still leave a little something to be desired. There's no question that they've gotten better, but the general consensus is that they're still not as good as they should be.
Revenue cycle management, essentially, EHR'S cousin or sister or brother, depending on your perspective, is viewed in pretty much the same way absolutely better than it was a decade or even two or three decades ago, but still more painful than it should be. In other words, EHR and RCM face a challenge that all enterprise software assistance face, a complicated workflow, a demanding client, a limited R&D budget and an install base that spends hours each day using the software and has strong opinions about what it should do and what it should not.
To help me sort through all this and to take a look back and more importantly, take a look forward into the future of EHR and RCM and all other associated systems, I'm joined today by Hadi Chaudhry, the CEO and president of CareCloud. According to their website, CareCloud is a leading healthcare technology company with a comprehensive suite and proprietary cloud-based solutions for growing healthcare organizations. They serve more than 40,000 providers across more than 70 specialties with a presence in all 50 states. CareCloud offers solutions revenue cycle management, electronic health records, business intelligence, telehealth, and patient experience management. Hadi, welcome to Definitively Speaking. We're happy to have you.

Hadi Chaudhry:
Thank you, Justin, and thank you for having me on your show.

Justin Steinman:
All right. So let's get started here. You're an expert in this field. What's the state of RCM and EHR today?

Hadi Chaudhry:
The good way to start, Justin. As you mentioned in the introduction, if you think about it, what has changed or evolved over the last 20 years? The definition of EHR that exists 20 years before is completely different than what it is today. And same when it comes to the revenue cycle management. If you think about before 2,000 timeframe, other than the hospital space, especially when we talk about the office space practices, the definition of EHR was transcribe the medical documentation into a Word document and store it in a computer.
That's how the digitization of the medical records started to take place. In 2004, when President George Bush, he started, that was his initial initiative of in the next 10 years, the most of the health records in the US, in the country needs to be in the digital formats with the help of some properly designed certified EHR systems.
And then when President Obama took the office in 2009, he made this as one of his government's mandate to on one side, to setting up the organizations who will define the rules and the standards for how it's certified a good EHR system should look like. So there's a standardization of EHR systems. And then at the same time defined for the providers how to effectively and meaningfully use that system.
You can have a wonderful system implemented, but if you do not use it effectively or in the right way, there is no benefit of using that software. So today the EHR market is based on the different research. If you look at it, more than nine out of 10 office based position today has an EHR implemented compared to at the beginning of let's say 2000, merely any office, you will walk in, you will see an EHR implemented. Same way when it comes to the revenue cycle management, two decades back from merely paper-based conventional medical billing or revenue cycle management today has completely changed into a more technology-driven revenue cycle management.

Justin Steinman:
Got it. So like you said, let's unpack a few things. First off, let's just clarify. Why I started prepping for this podcast, I kept talking about, EMR, electronic medical records, and you corrected me and you said, "No, no, no, Justin. It's really EHR, electronic health records." What's the difference between EMR and EHR and why does it matter?

Hadi Chaudhry:
A great question. And the EMR, the electronic medical records, it's just merely basically a digital version of a paper patient charts. On the other hand, electronic health records come with, it's more comprehensive and come with so many other tools such as the interoperability capabilities, telehealth capabilities, electronic prescribing capabilities, lab ordering capabilities.
So when we talk about for a certified system today, we are referring to EHR in today's world. Though, it's still being used pretty much interchangeably. Sometimes we say EMRs and sometimes we say EHR. But in practicality, in reality, when it comes to the certified systems, those are the EHR systems.

Justin Steinman:
Got it. That's really helpful, thank you. And then when you were talking about meaningful use and why EHR accelerated, you said, is to make sure that people are using EHR the right way. What's the right way to use an EHR?

Hadi Chaudhry:
Let me just give you one simple example. I remember in the early 2000 timeframe, we signed up a client. A pretty much multi-location client. They were for the first time in the process of adopting to the email process, the implementation of as an example. So before that, all the communication was done through the paper-based memos. So you write a memo and attach it with a checklist and someone goes around and take the signature from everyone, from all the people.
The email process was implemented, so the practice transition from a pure memo based to an email, but the way then their memos were being done, the person still types the memo in a Word document, print it, hand sign it, scan it, attach it with an email and send it out to all the employees.
So you can say that the EMR system has been implemented in the organization, but it was not effective use of an email. So same goes with an EHR. If you use an EHR and which has a capability of properly documenting the demographic information, properly documenting the diagnosis and the charts of the treatment history and the prescriptions and the medication of a patient, and if you still do a simple paper chart, scan it, and attach it in a medical documentation system, which is part of many EHR, you're still using an EHR, but you're not using EHR effectively.
The government took a very nice carrot and stick approach for the initial couple of years. There was a very prescribed way of this is how you should use an EHR system. For the first couple of years there were incentives tied to it and then later on in the later years the incentive disappeared and then the penalties started. So I hope that one example should help you understand that what's the better definition of rightfully or meaningfully using an EHR.
If you're not using it, if you're not writing and prescription electronically, you have an EHR in your office, but you're still handwriting a prescription and handing it over to the patient. It negates the concept of using a certified EHR system.

Justin Steinman:
Got it. That that's really helpful. So one of my favorite things about working in software and I've been in software for longer than I care to remember is that things get better and the cycle time of innovation is really fast. So over the past five years, how has EHR gotten better as a software package? What's changed? What's what's been the real big innovations there?

Hadi Chaudhry:
I think first of all, if you think about from the implementation standpoint, the implementation of EHR system or adaptability of the EHR system has significantly increased. As I mentioned earlier, whether we call it more than nine out of the 10 office space providers, they have started to use an EHR system. In addition to that, telehealth has become part of the part and parcel of the EHRs or it's becoming a need of a part and parcel of EHR systems.
We have seen a transition towards more preventative health features leading towards the value-based care models. These are, we can say some of the major innovation. The rest is more already have been defined by the ONC and the like and the interoperability has gaining more and more attraction, and there are more and more capabilities that have started to become available in the EHR systems.
The business intelligence capabilities have become part of the EHR or the practice management systems. So these are some of the things that we have seen specifically over the last five years.

Justin Steinman:
So listeners of this podcast may or may not know that I used to work many years ago at GE Healthcare IT and I actually ran marketing for all the centricity product lines. One of the debates that we had and Centricity had an EMR product was how do we allocate money between innovation, government requirements, the ONCC stuff that you just did mentioned and then interoperability. As the CEO of your company, how do you allocate your investment dollars between those three really competing categories?

Hadi Chaudhry:
I think all the three are with the way we look at it are of the equal importance. We started the company, when we looked at the company or the vision of the company was one of the deficiency which we realized and saw in this health industry was. Number one was that first of all, there is no existence at that time of the proper EHR and the practice management systems. The medical billing or the RCM was being done in a very old-fashioned, conventional way and the disintegrated systems.
So you have one vendor from EHR, you have another vendor for practice management. You have another vendor for a patient engagement solution, and then they're trying to communicate or share the data using different interfaces, which comes with an own limitations. So we focused on trying to create a product of one comprehensive database which can operate in a fully integrated manner.
In addition to that, we spend a lot of dollars, the R&D towards making sure we have a direct connects with as many insurances as many payers as possible today. We have a team which is available who writes all the right standard, whether it's HL7 based interoperability standards or FHIR-based interoperability standards. So again, coming back to your question, I think in today's world, all of these things bear equal importance.

Justin Steinman:
It's a really tough question and a tough problem to solve. You've mentioned a couple times that nine out of 10 people, our doctors are using EHRs and I did some research in our database and actually found that 99% of IDNs in the United States have an EHR and 96% have a revenue cycle solution. How do you find growth in this market when you know got massive saturation?

Hadi Chaudhry:
Yeah. You're absolutely right. I think the EHR market is getting to a saturation level. Since most of the practices, because of the government initiatives and the need of the time, they have been able to adopt some kind of EHR systems. And if you look at it further, based on number of surveys, what we have seen, 80% of those EHR systems or the practices who are using the EHR system is a certified EHR system.
So it's not only that they're using an EHR system, they have implemented a certified system which can help them use it in a meaningful way to even earn some of the incentives or avoid some of the penalties and even stepping into the value-based care model, which is the future of the healthcare. So yes, there are companies who face lot of challenges who are purely dependent on the EHR as a product or practice management as a product to grow. Their growth rates have been significantly reduced.
Now, if you look at the RCM, though, yes, you are saying that it's a significant number in terms of the adaptability of an RCM, but there is one major differentiator. When we say let's say 96% or over 95% have adopted to an RCM solution. In many cases we are only referring to the product side of it. Just the basic platform that you can use for an RCM to make sure that the claim gets created in a correct way. It gets submitted to the right insurance company and the like. If you think about it even from the industry growth perspective at the macro level, based on again some of the research and I think so one of the researchers is in by the grand view research that this industry is expected to grow at over 12% between now and 2030.
So it does not include the opportunity that exists from switch from existing vendors though. The other side of the solution is more comprehensive from the RCM standpoint, which is one site is the product and the other site is the resources to help whether it's for the credentialing purpose, coding purpose, payment posting, denial management. So it's the whole workforce. It's the end-to-end solution that gets provided where the practices don't need to spend their own resources, their own budget, and it can outsource a much more cost effective level.
This industry for this outsourcing which is trying to do it in-house using a platform and trying or outsourcing it to a different vendor who can perform the same services in a much more effective way. Today, when we look at it, it's still about a 45% market that still has an opportunity of still being able to penetrate from the outsourcing perspective. So we do see our opportunity when it comes to our end-to-end product, our end-to-end RCM.

Justin Steinman:
Got it. So you really see a big services opportunity in coming in and saying, "Hey, I'll take billing off for your plate. That shouldn't be your core competency as a healthcare provider."

Hadi Chaudhry:
That is correct.

Justin Steinman:
Interesting. And you found that hospital systems are willing to let go of their building. You'd be like, "Hey man, your problem, not mine"?

Hadi Chaudhry:
Yeah. Actually they do. Especially if you think about it over last, since the COVID hit, they have been significant staff shortages. They have been significant on the one side. The reimbursement rates are going lower and lower. And on the other side, the cost of providing the medical services is significantly increasing. There's a shortage of the staff.
So they do look for opportunities and they have started look even more versus before COVID to outsource the revenue cycle management. And it's not only just the cost and the resources. It's the level set has become complicated. The compliance and regulatory requirements, the requirement by different payers, how to get their claims processed, but they need to get the claims processed in time and with the right reimbursement rates and what the requirements are. So yes, there has been more and more willingness for even whether it's the health system or the private practices to outsource their revenue cycle management.

Justin Steinman:
Yeah. I can totally see that at the small practice. These small mid-sized, these independent position groups, the IPAs, they don't want to deal with all that billing stuff. Let me just practice medicine. But it's interesting to me to hear you say that the big ones, which theoretically have, quote, unquote, "overhead" be willing to send that out. But maybe that's a way for them to get their costs under control and fixed fee and understand predictability and cost structure.

Hadi Chaudhry:
That's correct, yes.

Justin Steinman:
So it's no secret that there are two heavyweights in this market, Epic and Oracle Cerner. By sub-measures, Epic has a market share that hovers around 25%. How do you compete in a market where there are two dominant players surrounded by dozens of smaller players? What's your strategy there?

Hadi Chaudhry:
Actually even the Epic. If you look at the hospital market share of Epic, it's about actually even over 30%. If you look at Epic or Cerner, they have been able to heavily get the market share on the inpatient or the health system market. Even when you look at the ambulatory space, the practices of the market share they have, it's mostly for the hospital based practices. It's much, much more expensive system. From the licensing perspective, it's much more complicated and expensive system from the implementation activation and configuration standpoint.
So where there is no choice for a practice, they have to go for Epic. And if we just give you our own example, since we have been in this business for the last two decades now, hardly we come across the practices on the RCM side, which is an office-based position and they're using an Epic or Cerner system. It's even less than 1%. It's a tremendous opportunity in that side, yes, is if you think about the Epic and we stopped recently because of their very strict non-compete business models and one last acquisition we did, we stepped into an implementation of professional services business.
So we have stopped working with Epic because of those non-compete business models, but what we have seen to that point, their market share from all the clients we have is less than 1% or to less than 2% right now.

Justin Steinman:
Do you find people want to buy EHR and revenue cycle from the same vendor as an integrated package or do people kind of pursue a best of breed RCM on one hand and EHR on the other? What's cut the right purchasing strategy there?

Hadi Chaudhry:
That's a great question and that's where we have one of the competitive advantages because we have our whole suite of product, which is an EHR practice management, patient engagement solutions and the like and then we have the revenue cycle management or the tech-enabled revenue cycle management layer, which sits on top of it. In addition to that, we have been providing the vendor or the platform-agnostic revenue cycle management services.
So especially in the enterprise space, exactly what you're saying when I say it's an enterprise, it could be a 20 plus provider or multi-location practices. Many times it's a huge undertaking for the practices to transition from an EHR system to another vendor because the revenue cycle management company has a different EHR system. We go in, we say, "Okay, you can keep your system, your EHR system as it is your practice management system as it is. Our employees can connect to your system and we can work out of your own system."
We use on our site, our technology, our platform to import some of the claims and make sure it still goes through the same effective process to maintain the quality and the results. And then we post everything back into the existing system. And then down the road gradually when they see the quality of the work, the returns on their investment, the return or the increase on their revenue, we do come back in and keep on implementing it.
Now, it's the time to transition the EHR. Now, it's the time to transition the practice management system. So to your point, yes, it is difficult, especially in the large enterprise space for them to commit to a complete transition of their EHR best practice management if they are trying to look for a revenue cycle management solution, but starting with the revenue cycle and then gradually transitioning these other systems that does make sense and it's more doable.

Justin Steinman:
Got it. You said something that I hadn't heard before. Tech-enabled revenue cycle management. I mean software is tech-enabled. So what's the differentiation there when you're talking about tech-enabled revenue cycle management.

Hadi Chaudhry:
Again, just take you back to the history. If you think about let's say in 2002 or 2003, what is the definition of a revenue cycle? The practice will have a paper super bill with the name of the patient and some basic demographic information and all the different ICDs and the diagnosis or the diagnosis and the procedure codes. So if the patient gets treated, the doctor circles the different codes he wants to bill for the patient. If he's taking care, she's taking care of their own coding functionality, they scan the work to us or mail the work to us or any other revenue cycle company. And then most of the claims goes out by paper when someone keys that data into some basic software and gets submitted to the insurance company.
When the payments come becomes back, it's a paper-based EOB in most cases and someone again have to manually post the payment in the system and then work on the different denials that have come in. So from that type of the medical billing or the revenue cycle to today, most of the claims are systematically created with the help of the EHR and the practice management that is in use.
Most of the claims today get submitted electronically instead of paper probably maybe 20 or 30% electronic claims in 2001, 2002 timeframe to today over 80% are electronic claims or 85% are electronic claims that goes out. So the processing times or the first time pass rates of the claims. So when you submit the claim, how many claims will get rejected? So starting from, let's say, a 70 80% to today's virtually 99% first time pass rate, how that has been obtained, almost every vendor who claims to have a good practice management system, they have been able to create some kind of claim scrubbing engines.
Our rule-based scrubbing engines have a rules the result of the last 20 years of our experience and the knowledge. There are millions of rules created which scrubs the claim, cleans the claim, kicks the claims out where a manual intervention is required and we make sure when the claim gets to the insurance company is the clean claim to be processed quickly? Same case if we think about the payment posting. Most of the payments were posted manually from the EOBs and today over 90% comes back electronically and gets posted with the help of an ERAs.
So that's the shift from pure revenue cycle to a more technology enabled revenue cycle and we believe whether it's the EHR or the practice management, it's becoming a part and parcel of this overall solution.

Justin Steinman:
So let's talk a little bit about the roadmap. Looking forward five years, where are we taking EHRs? What's coming next?

Hadi Chaudhry:
One major thing where I would say the first 10 years, it was defining between 2000 and 2010 what an EHR should look like. Between 2010 and 2020, it was let's implement the EMR. Let's get the practices adopt to an EHR. Start using an EHR in a meaningful way. The next year, the next 10 years is going to come more towards how to improve the healthcare, how to improve the wellbeing of a patient, preventive care models, value-based care model models instead of P for service to more going towards the overall paper performance model.
So you don't necessarily have to be a practice. It doesn't necessarily have to be paid for each and every single visit of the practice. The practice would be paid on the overall wellbeing of the patient. In order to step towards that, we do see things or the services such as chronic care management or the remote patient monitoring, the different Devices that have started to get introduced in the industry. Those can be adopted and the data can be transmitted into the EHR to help the providers take better clinical decisions.

Justin Steinman:
Let's talk a little bit about telehealth. So COVID dramatically accelerated the adoption of telehealth. Our data shows that telehealth visits jumped from less than 20 million visits in 2019 to more than 160 million in 2020 and then dropped down to about 110 million in 2021 before actually going back under a hundred million in 2022. So look, from 2019 to 2022 was still a 5X increase. We went from 20 million to 100 million.
It feels like telehealth is starting to stabilize a little bit here. What's your prognosis for the telehealth market and then how does telehealth work with EHR and RCM and how does that all fit together?

Hadi Chaudhry:
We have as a company CareCloud is enough data to... Even if I just talk about the data that we have that should be able... And which is exactly what you were saying, we launched over telehealth product at least an year before the pandemic hit. Before the pandemic, if you look at the overall appointments of all of the entire client base that we had, one 10th of 1% of the appointments were telehealth related.

Justin Steinman:
Wow. COVID hit and that number went up to 27, 28% of the appointments that were telehealth. And now to your point, yes, when we go back and look at the data today, it started to get stabilized. Today, we see somewhere around six to 7% of the appointments are telehealth related. So from one 10th of 1% to get to about 27, 28% coming back to about six to 7% and it will keep on improving at a gradual rate going forward. But that became one of the reason for us for our survivability for many practices survivability during COVID times.
So another area that's hot right now is remote patient monitoring or RPM. I've talked about RPM with a number of guests and even had some RPM vendors on this podcast. I think it's safe to say that EHR is the central nervous system of patient care. How does RPM fit into the EHR world?

Hadi Chaudhry:
Great question. That's the next. Remote patient monitoring is absolutely the next upcoming thing and I think I'll start with the small analogy. If you go back and think about let's say in '70s or '80s if you own a car every day under the hood, you need to check 10 different things. What's the oil level? What is the water level? My car might need a service. So that you have to maintain, you have to keep track of 10 different things in order for your car to keep working effectively or keep driving effectively.
Today you don't have to worry about virtually anything. And the best or the attractive part is in many cases even the car company. They tell you, they call you. Your service is due or your car has two alerts. Why don't you bring the car to the service center? The same thing if you look at from the health standpoint. Today, most of the appointments are driven by the patient.
When you start feeling sick, "Okay. I need to see a doctor. Let me go to a doctor and get treated." Let's say in the next couple of years, within the next 10 years, we believe that most of the appointments will be driven by the healthcare providers. How will that happen? If we just merely simply take the basic example of a smartwatch. Today, a smartwatch can monitor body temperature, can monitor your heartbeat, can monitor your oxygen level and number of things.
If we just do the hypothetical example, use it here, we have the data if the patient has been vaccinated for COVID and if the patient alerts coming to the doctor, to the EHR system, with the help of that smartwatch telling, the oxygen level has dropped to a certain level, the body temperature has increased, the pulse rate has changed, this combination puts a red flag. The patient may have a COVID and especially if the patient has not received the COVID vaccination.
So the doctor or the nurse or the caregiver can pick up the phone and talk to the patient saying all the alerts that we are seeing, you may need to see us or you may need a prescription. So this is I think where the healthcare industry is going to go with the help of many of these devices and it's rapidly because the advancements that's coming, these devices are becoming more and more capable today than versus it was even five years before.

Justin Steinman:
Yeah, I love that analogy. I do think that's exactly right where instead of me calling my doctor, my doctor is going to call me and be like, "Hey Justin, come on in. Your blood pressure seems a little high these days. Are you really stressed out at work? Let's talk about that." So I think that's really interesting. So we're hitting all the big topics here, right? We've covered telehealth. We've covered our RPM. Let's hit the next one. Let's hit interoperability. Some people call interoperability the Holy Grail of healthcare IT.
People have been talking about interoperability for decades and yet as an industry, we are nowhere close to the kind of interoperability that we see in the financial world. My opinion is that we have a bunch of disincentives as an industry to deliver real interop. If I share my data with another hospital, then they're going to take my patients, which means I'm going to lose my revenue. What's your view at interop and more importantly, can we get there? Will we get there?

Hadi Chaudhry:
There's the challenge of the time as the more and more technology is being implemented, the interoperability is becoming one major question. I think if you look at the financial world today, and it can be used as one of the very strong example, at what level the interoperability or the data consolidation has to come? Think about it, talk about less about it where the credit scores or their various credit bureaus, the data gets posted to those bureaus. The data gets pulled from those bureaus.
At any point of time you can pull a consolidated credit score of any person, if financial decision has to be taken. It's pretty simple. You are going for a loan. It'll be posted. The information will be posted into a certain database. But today, if you think, look at the health sector, you have your PCP in one state in America. You get treated in one state.
The EHR has all the data. You are traveling to another state. You get sick. You end up going to an emergency. There is no way, no effective way today that exists to pull the data electronically unless someone picks up the phone and talk to the doctor on that side and yours it saying, "I have the patient. This went through and landed up into an emergency. It was being treated by you. Can I get his or her entire medical record, or the medical history?" Though there are now interoperable compliant ways to transition the transfer of the data, but still this communication has to take place in most of the cases for the data to transfer.
To answer your question, are we going to get there in interoperability? I think the answer is absolutely yes. It's just a matter of time. And again, if you go back and look at in the Obamacare, the initial requirements that were laid out of EHR or certified EHR system, it was the basic part. Interoperability was the basic part of that EHR system. As part of even the meaningful user requirements, the providers have to at least demonstrate a capability that I have transferred the patient records of two patients as an example or three patients.
There is a certain number as part of the certification or attestation. The whole idea was to make the providers aware of this concept that the data can be transferred through a certified EHR system in a compliant way. How the data or the concept was to consolidate the data? It was at that time the HIEs that started to get introduced or the regional health information exchanges. The idea was let's all of these EHRs post the data or transfer the data, or on the bidirectional way or a unidirectional way into those central databases where everyone can pull the data.
The same concept kept evolving and if you think about it, the next discussion is the qualified health information networks, the QHINs. And the idea is the same. It'll be the different network of organizations which will be able to interoperate or will be able to transfer and share the data in between. So it's going to happen. When it comes to this, are we going to the hospital or someone thinks they're going to take the patients away, I think those people then probably would be looking at it from the wrong perspective or the wrong way.
The focus should be more on the patient care. If you are treating patients well, no one is going to take the patients away from you. No one can take the patients away from you. Whenever there is a evolution, whether it's the AI, there always could be a debate of if we implement an AI, you're just going to take a lot of jobs away. No, it cannot. It will take one of the set of jobs away, but at the same time, another set of jobs will be introduced.
So I think it's the same resistance to that change, whether it's the health systems or the practices, they should really focus more towards providing the quality of care and no one can take the patient away.

Justin Steinman:
What world do you think the government has in delivering or driving healthcare interoperability? I mean the government's really involved in the financial system, right? And there's the credit protection bureaus, there's the SEC, there's all sorts of regulators. You can say they've really driven a lot of the interoperability and make all the banks work together. Does the government have a big role in healthcare IT interop?

Hadi Chaudhry:
Nowadays, the one major initiative that I can think of is the qualified health information network. This QHIN, the more support is needed towards whether it's QHIN or any other similar models, and because QHIN as a next step that is being aided by, I think it's the trusted exchange framework of common agreement, TEFCA, which provides basically the means of how to connect the different QHINs together. I'm sure there will be more initiatives that will come, but the government initiative started with this certified EHR systems towards the interoperability.
First of all, making sure the systems that are developed should have a capability of interoperability, then define the standards of the data that needs to be transferred, the transition, whether it's the FHIR standards or HL7 standards. Defining the organization who will be responsible to interop, it will be responsible to provide the way to transfer and share the data in between.

Justin Steinman:
We could have a whole other podcast talk about HL7 and FHIR and technologies and we'll dive into the weeds talking about that stuff, but we won't nerd out right now. So I got one last question before I let you go here. You can't open Apple News or your favorite news application these days without reading about AI, machine learning, ChatGPT and the like. What's going to be the impact of AI in EHR and rev cycle?

Hadi Chaudhry:
Yeah. It's an interesting development and especially talking about the ChatGPT. And if you talk about AI as an example or which is the final product, ChatGPT, it starter form... If you remember, once Elon Musk talked about the safe AI concept, the regularized AI concept, there has to be a regularized safe AI, open AI developed, which can then be leveraged by the different companies, by the different end users according to their requirements.
So the ChatGPT is the result of one of the same though it needs to get to that level, the regularization in different industries has to come and the same case goes when it comes to the healthcare. The regularization will ultimately come. There will be certain defined... defining the standards for how to effectively use the AI in the healthcare space. We can talk about many of the user cases.
It could be the AI can look at the different diagnosis and the procedures and the medication of one patient, compare it with the similar situation of many other providers who have been treating the patients and can suggest a treatment plan for the patient as an example.
But again, the responsibility would still rely on the doctor, but it recommended a suggested treatment plan can be generated. After the hospital discharge of the patient as an example. The system can give you based on using the AI that these are the different things the patient you need to be doing post-discharge. There are many things that are in place today. It does happen today, but this is a whole new different level that we are talking about today.
It's going to change drastically, dramatically over the next decade from a regularization to adoption of many of these open AIs whether it's the healthcare systems or whether it's the financial systems or many of the systems that we use today.

Justin Steinman:
But it is quite a dramatic shift. I can ask ChatGPT to generate a grocery list if I want to make Chicken Piccata. It's another thing to ask ChatGPT, "Do you know to diagnose me and give medical advice?" And this is literally life and death, not just Justin wants a good dinner.

Hadi Chaudhry:
You're absolutely right. Whether in the AI, again, it works on how effectively the system has been trained. That's the data. AI works on that data. So yes, initially probably, once some regularization will come, it can do a suggestion to the providers that this is based on my intelligence system talking to the doctor. You should pay more attention for this patient while treating, for example, a heart disease or a kidney disease based on 10 things the system can see.
Final prognosis, the final treatment, the final has to come from the doctor. It would still be the doctor's responsibility. When this whole thing, maybe in the next 10 years, there was more data into the system. It gets to the point that patients should be able to assess themself at a certain level triggering if you need to see a doctor based on all the data that's collected from the remote patient monitoring devices, the different devices and the AI that sits in the clinical, in the doctor system and then telling the patient, "Patient, you need to see a doctor."
On the one side, the doctor is connecting and saying, "Patient, you need to see me." When we look at it, it sounds scary today, but the thing will significantly improve over the next decade, hopefully.

Justin Steinman:
Yeah. So doctors though are notoriously hesitant to adopt new technology and it took too long for them to adopt EHR to come full circle here. Do you think they're ready for AI?

Hadi Chaudhry:
No. I think it's not ready for the AI, but it's the same that it'll get to a point of no choice. The change will drive itself. And the telehealth is another perfect example. The system, you can use the same as an example or the case study. Before COVID, merely a small portion of the doctors were entrusted and were even ready to do a telehealth visit because the product was not available and that mindset was not there. But today, if you talk to a provider about the telehealth, many of the doctors may already have implemented some kind of telehealth solution from the platform standpoint and at least have been conducting some percent of the telehealth visit from almost zero to at least a certain percent of the telehealth visit.
Yes, the doctors are not ready today because first of all, the platforms, the vendors, the EHRs, the practice management, those have to come up with the right tools, AI-based tools, which can help the providers treat the patient, and then that evolution will start taking place. Then that transition when adaptability will start taking place.

Justin Steinman:
Wow. So is it's exciting times here in the EHR, rev cycle AI world. I can't wait to see where you are going to take this. This has been so much fun, Hadi. Thanks for taking the time to talk with me, geek out about EHR, rev cycles, two topics that are very near and dear to my heart, so thank you.

Hadi Chaudhry:
Thank you, Justin. Likewise nice talking to you.

Justin Steinman:
Yeah. All right, and thanks for all of our listeners out there for joining us on Definitively Speaking, a Definitive Healthcare podcast. Please join me next time for a conversation with Dr. Sameer Berry, the chief medical officer at Oshi Health. Yes, I know this one has been a long time coming and I've teased it a couple of times already, but we've finally resolved all the scheduling issues, and Sameer is joining us on the next episode. As I've mentioned before, Oshi Health is a virtual multidisciplinary GI company and Dr. Berry is going to share the results of their recent research study that they conducted. I hope you will join us and promise, it'll be worth the wait.
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