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Power Hour Optometry
AI FOMO to Practical Application: Your AI Guide for Eyecare with Dr. Scot Morris
01:00:59
AI is everywhere you turn these days, but let’s face it - talking about it and actually putting it to work are two very different things. We’re past the stage of “should I be thinking about AI?” and firmly in the “what can I realistically do...
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Dr. Scott Morris
Foreign.
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Eugene Shotsman
Hi, everyone.
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Welcome to the Power Hour, Optometry's largest and longest running show. I'm your host, Eugene Shotsman, and we've.
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Got a pretty special guest with us today. Let me set it up for you.
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In the last year, maybe year and a half, you've probably heard a lot about AI. There's a lot of theory, there's some fears, and certainly there's a ton of.
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People telling you that you should be.
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Thinking about AI, but very few people telling you how to actually do it in your practice or even what to realistically expect from the state of technology today. So enter our special guest, Dr. Scott Morris. Scott is an optometrist. He sees patients every week, but he's also been on the podium, he's won awards, and for as long as I've known him, he's been on the forefront of emerging technology. He has big dreams and always have, and he's always asking, how are we changing the world and making it better? And now he's actually doing it in his own practice and in the industry. So in his practice, Scott sees about 35 to 40 patients in a six.
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Hour day with just a few staff.
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Because he has technology supporting him. Scott has been working with AI, machine learning and advanced software solutions long before anyone even knew about Chad GPT. And I asked him to join me today for a truly candid conversation about AI. So honestly, we probably could have talked.
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For four hours, but I cut it.
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Off pending audience feedback, of course, for future episodes. But we still covered a ton. First of all, we had an educated conversation about what is AI and what is it not? Where is AI going to make a big difference in healthcare and where is it not?
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We talked the role of providers versus.
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The role of technology. We talked about some key applications that we can see today and early into next year. And what makes Scott truly unique is that he's already using this stuff. He's already experimenting with some of this in his office, so his opinion is less theoretical and very practical. We talked about diagnostics, workflows, patient experience, office efficiency, and just the mindset around AI innovation in general. This is a great episode to catch you up and also to give you some practical application questions that you can start thinking about when it comes to AI. So watch it on YouTube or make sure that you're subscribed on Apple, Spotify, wherever you get your podcasts. And as always, I'm really excited to hear your feedback on this and especially this topic. Because of my speaking engagements and participation in various AI panels, I am Truly grateful to have access to some really bright minds in this space. So please reach out to me, Eugene Shotsman.com let me know what you want to learn about. If you want me to connect you with any resources or if you have ideas for future episodes, you can always reach me at the Power Hour website or Eugene Shotsman.com. look forward to being a resource for you. Okay, and let's get into today's show.
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All right, Dr. Scott Morris, welcome to the Power Hour.
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Dr. Scott Morris
Thanks for having me, Eugene.
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Eugene Shotsman
I'm excited to have you here because, you know, this topic of AI has been one where there's a lot of people who talk a lot about, a lot about great ideas and, you know, I think we all hear about tools and AI and AI this, AI that, and my mission over the last few months, specifically has been about kind of demystifying AI really talking about what it is and what it isn't, and then also trying to really get off the, you know, get. Get off the. Hypothetically, the. The train of hypothetically, what could I do for us? And get on the train of let's actually talk to people who are using it and see how you can physically use tools in your practice that make your practice better, more efficient, more productive. And that's why I was excited to have you on the show, because you're actually doing that right, Scott?
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Dr. Scott Morris
Well, well, thank you, Eugene. Yeah, I. I definitely have been hard and heavy into the artificial intelligence and a term I'm more likely to use as augmented intelligence process over the last four or five years. I kind of took Covid as an opportunity to develop something new versus just an opportunity to take some time off. So it's been a really exciting ride, and I look forward to having some conversations about that. And I totally agree with you in that I think there's a lot of hype out there that doesn't have any real reality behind it. And I also think there's a lot of things happening that no one knows about that are really going to change the way we provide care and care delivery and how we operate our businesses. So I look forward to this, us chatting about this and hopefully educating your. Your viewership about some of the things that are there and some of the things that are coming and what. What's real and what's not.
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Eugene Shotsman
Yeah. And, you know, just to give everybody context, you're also seeing patients in your practice five days a week. Right. And I think we were chatting. You saw something like 40 patients over a period of six hours yesterday with a team of three. And so.
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Dr. Scott Morris
Three not including me. Three not including me. Right.
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Eugene Shotsman
And so. And apparently, you know, looking at the reviews of. On your practice, everybody seems to be having a good time. The patience. And that sounds like your team.
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Dr. Scott Morris
And my office is a party all the time, which is a great. Yeah. Like, my staff loves it, My patients love it. It's just. And so you have a good environment. And what's that? I'm sorry.
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Eugene Shotsman
So you're using technology, and you're. And you're an example of how we could potentially use technology. But before we get into how specifically you're using technology in your office, and, you know, when we talk about technology, I know there's software and tools and. And, you know, some. You already mentioned, you know, kind of augmented intelligence. Ra. Artificial intelligence. So why don't we just, you know, from your perspective, just do a quick, brief introduction on AI and why understanding AI in healthcare actually matters.
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Dr. Scott Morris
Yeah, I think that AI is a big subject. It's like you use the word technology. Well, technology is everything from your o ring to your watch to your smartphone to a calculator to Gemini. Technology is a big thing. AI is a big thing. AI is not a single piece of technology or a single platform. It is a huge conglomeration, some connected, some not connected yet on a subgroup of technology that's out there. And I think that artificial intelligence, really anything that mimics in some way or fashion the human thought process, and that there's a lot of pieces to that. I mean, we can talk about. You know, I always kind of divide AI into three big classifications. First of all, you have basically linguistics, so things that help you hear, talk, and process everything in between. And those are things like ambient AI and scribes, and it's even Siri. Tell me about this. Well, Siri is a combination of a couple different types, but what we just did is linguistics. It listens to what I said, converts it to text, text to text, to digital, digital goes through processing, goes back out into digital, and then it speaks, you know, in terms of that. So you have linguistics, and that covers a huge topic of things, you know, different language, language translation, all those different types of things. Then you have the next big group, which is kind of machine learning. Like, well, how do we take what data is out there and learn from it? And we get. I'm sure we'll spend a lot of time talking about this particular subject, but, you know, machine learning is the next big subgroup of it, and then the third big subgroup of it is kind of the gener AI stuff. And that can be, hey, Gemini, help me write my paper. That type of situation. 2. Hey, Gemini. It was funny last night. So this is being filmed the day after the presidential elections. And my son was home, and he was like, son, Gemini, tell me who won the election. And it spits out all this stuff. So it's gender or my marketing person. Yesterday he said, well, I need to develop this for our new for our spa part of our website. And she goes, and she was on Dolly. She was, dolly, I need this. And she put out a bunch of scripts and it pops out a picture that was pretty darn good on the first go round. All of those things are generative AI, whether it be text or imaging, all this stuff. And all of this is AI. I mean, AI is everything from, you know, gosh, we're watching Netflix and we say, well, what do we want to watch next? Well, it generates a list of these are the different things that, based on what you've liked before, you might like here. Well, that's AI. You could say, siri, tell me about this. That's AI. You know, you can talk. Yesterday I was on the phone with a financial company and I was trying to get some information, and I knew that I was chatting to a chatbot. I could barely tell, but there were just enough idiosyncrasies that I'm like, okay, this is not a real person I'm talking to. It's a chatbot. But still, that was AI. And candidly, I never ended up talking to a real person on that particular situation because the chatbot got me all the information I needed. And this was at 7am My time, which maybe that's going to work. If that was a Pacific coast thing, I would have got a voicemail, right? Or got the chance to do that. So AI is such a huge topic. And I really think in the grand scheme of things, health care, we are so far behind the financial world, the legal world, the entertainment world, health care, we're still way, way, way in ancient times.
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Eugene Shotsman
But, well, and it's risky, right, in health care because. And I understand, you know, the, the, the implications in almost every other industry, but the reality is that when you're dealing with lives and health and, you know, and we, we truly, I think, have an aversion to saying, well, a machine is going to make these choices for me, whatever those choices are. And it doesn't necessarily even have to be care. It could be a patient education choice. It could be a right, it could be a. It could be as simple as how, how the machine is treating the phone call or although, and our listeners have heard me argue about this in the past where I would argue that in some cases machines are going to do a better job than the overwhelmed stressed person at your front desk who's trying to do 17 different jobs at the same time rather than just focusing on the patient. But I liked your distinction of, you know, there's the linguistic, then machine learning and the generative AI component of AI. So now let's link it to healthcare a little bit and maybe even link it to what other industries have really excelled at and why you think healthcare hasn't touched it.
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Dr. Scott Morris
Well, I think you hit on a key component. There is everybody's afraid, well, what happens if it makes a bad decision and it has a negative impact on somebody's well being? Health and I think, or illness. You know, I always think there's sick care and there's well care and you know, sick care is what we're most concerned about is what happens if it makes a bad, bad decision. But I always go up from maybe devil's advocate side is that, but how are we sure that as humans we're making the right decision? You know, we were doing a study for one of the companies I work for and many of you know, I was, I was an editor for Optometric Management for seven or eight years and now I'm the editor of a new AI journal. And I always think about it from this perspective is, you know, There are about 600,000 pages written in English every year about eye care alone, just in English. And so if you read at the normal speed of 0.83 pages per whatever the time frame I think was, per hour, it would only take you about 380 days a year to catch up with all your reading. There's a math problem there, right. So how do we know that all of us in clinical practice are actually up to date with all the science really says? And so we always wonder. It's a great scapegoat for us as humans to go, well, yeah, but if it makes a mistake, well, what if we make a mistake? Who's guarding that? Who's guiding that? Who's watching that? And the answer is nobody. And that's why I'm always, as I said in the beginning, I'm always real hesitant to say AI is going to do anything. I think if we use AI as a tool where it's augmenting what the human attributes are, all of our human positive attributes and it helps negate some of our negative attributes, there's where we're going to change the way healthcare is delivered.
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Eugene Shotsman
Well, so let's talk about some of the common AI applications that have been talked about in healthcare. You know, whether, whether successful or not successful, whether on the bleeding edge or really old news. Let's talk about the stuff that's already been discussed.
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Dr. Scott Morris
Yeah, I mean, I think there's probably about seven or eight big categories that when we get into the big topic of artificial intelligence and what is it doing and how does that affect. So I think first and foremost, the one that's getting the most press and has gotten the most press, both positive and negative maybe, is kind of diagnostic imaging. And, you know, we kind of get into a little bit linguistics. I always think of AI Human intelligence is our brain plus our sensory system. Right. So we have our eyes, our ears, our mouth, our biotactile and our smell. And if we kind of think about AI as the electronic version of those senses, I think it kind of starts to make sense. So when we think about what's going to happen and what is happening, what's already started happening in healthcare, let's do the big one, which is vision. Right? So we talk about machine vision and you know, radiology was the first of the game on this is, you know, can it read an MRI or a CT scan or some other radiological image equal or better than humans? Or as what they've learned is it doesn't do it necessarily better, but it does it as well. But when you team the two things together, both artificial and human, now all of a sudden your success rate on diagnosis is spectacular. So I think diagnostic imaging is a really big piece of the pie. And in the eye care world where everything we do, I mean, we're so tech heavy compared to most other healthcare indust. I mean, I think about you got OCTs, you got visual fields, you got topographies, you got, I mean, the list is long of all the technologies and what if we could do a better job about reading it? And I was explaining to my student doctor yesterday, not yesterday, on Monday, you know, about the fact that do you really know how to read an oct? And I spent years training docs on that in different classes. And the reality is I think most people go, oh yeah, I took a course on that. But do you understand what you're actually looking at in those small idiosyncrasies in what the sub RPE is looking like and what that means? Like, yeah, I do. And so, you know, it's one of those that if we can Use as diagnostic imaging and machine vision gets better, it's going to be one more tool we have in our toolbox that says we're going to see some of these changes before their geographic atrophy or before they're end stage or before they have significant diabetic retinopathy. We're going to see signs or the system is going to help us see signs so much earlier. So I'm so encouraged. I mean, machine vision has been in healthcare for a while and it's been out in the rest of the world for even longer than that. I think it's just starting to get there in eye care and it's going to be really, really impressive and help, help us do our jobs better.
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Eugene Shotsman
Okay, so what do you say, Scott, to somebody who says, well, I believe there's going to be a kiosk in, you know, in the mall that, you know, I'm going to stand in front of and it's going to take a, it's going to look at my, it's going to use sophisticated camera technology to look at all of, to look inside my, my eye and is going to give me a better diagnosis or at least an, an equal diagnosis that, you know, a 30 minute visit in your office would.
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Dr. Scott Morris
Well, Eugenia, and I know you didn't know this about me, but I actually own the patent on that actual technology. And being that, you know, I spent many years working that, let me just tell you, not going to see it anytime soon. I mean, that is so far away. I think like many, this is kind of, that falls under that myth and misconception typ of process. Is AI or any of that ever going to replace human doctors? The answer is not in my lifetime, probably not in my children's lifetime. I mean, it's a long way away. Will it augment us? Oh, absolutely. No doubt about it. There are so many challenges with the kiosk model, you know, and there's been three or four different kiosks, models that have come out. None of them have been successful because they lack the most important piece, which is the human element. And humans want humans to care for them. And I think if we look at augmented intelligence and artificial intelligence as a tool that helps us do our job better, I think we're going to see that. I do think that the way we deliver care will be different. Do I ever think it's going to be a kiosk in the mall? Not in my lifetime.
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Eugene Shotsman
You know, it's such a fascinating point that you just made because it is true that what we're really selling when we're talking to a patient is we're selling trust. Right? And the, in the, we're in the business of trust. And the doctors who do the best are the doctors that can be trusted by the patients. Not the mechanical superhumans who can, you know, calculate as quickly as possible and get, get in and out of the patient room and provide valuable information. The patient, no, it's the people who have the best bedside manner who end up having the greatest amount of the patient's trust. And so if you think about us being in the trust economy of, in that world, we really can't be replaced by at least not in the way that humans think about medical care. Now we really want the care to be coming from a human who we trust, who may, you know, in order to win our trust, have technology augmenting their experience. So let's talk more about other types of technology that's, that's available to augment.
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Dr. Scott Morris
That one quick little aside and then we'll get into kind of next point because we have six more to go on this one, you know, is that I always, it's my old saying, I think my, you've heard the saying before, but I remember when I first got into optometry school, I went, came home for a weekend and my grandpa said these exact words, he said, people don't know, don't care how much you know, but they know how much you care. And at the end of the day that's that trust relationship. And that is not going to get replaced anytime soon. But that being said on the other side of that is people walk into an office like mine, they're like, oh my gosh, there's so much technology here. And I go, yeah, these are all tools to provide better care for you. Oh, you know, so that's that trust you can use, you can leverage technology no matter how what kind of technology it is, you can leverage technology to help build trust as long as it helps you get to a better answer. So machine vision, right? So there's number one, I think then you get into, we talked about, let's talk olfactory, right? In terms of biosensing. And this isn't really so much in eye care per se. We don't really have anything. Trying not to break all my non disclosures. We don't really have anything on the market yet that can bio sense what's going on though there's a lot of interesting research going on and I do think in the next three to five years we're Going to see where we put biometric technology inside the eye that can check blood glucose levels, can check ocular pulse amplitude. There are some really interesting technologies coming down the pipeline in the next three to five that I do think I see a day when tonometry won't exist. Why we're going to know what it is, live time. We're going to know what ocular pulse amplitude is over a 24 hour period, over 365 days, whether they, they took their meds, didn't take their meds. That's technology that will change everything that we do. And so that's the, let's call it the olfactory sense of biosensing. And now we're looking at blood markers. I mean will we have biometrics that can check our blood, our URA ring or Google ring or whatever you want to call it? I mean we continually have all these biometrics that are out there that are doing olfactory or tactile type sensing and that's definitely going to change that. And that's not really telemedicine per se, it's more of data gathering. And as of yet there hasn't been a great merge between the really cool biometric technologies that are out there and our somewhat antiquated data systems that we're currently using. And I definitely think we'll get into that in a little while, but the data systems we're using. So I think that that piece is still out there. And then we get into kind of the brain part, right, the cerebral processing part of what we do, we start talking about machine learning and all those types of things. But what those are ultimately do, how those are going to be applications within healthcare is I really believe that evidence based medicine and developing a personalized medical approach for every single patient, not, oh well, hey, you're, you know, between 30 and 60 and a guy that's not personalized medicine, that's what's lumped some of you. I think we're going to start going, okay, here, here's a, I think I'm 56, a 56 year old guy, you know, guy. And here's what my medications is, this is my family history is. And they're going to say, well you need to take this medic versus this medication. We need to follow this biometric sensor. I think personalized medicine is way closer than everybody thinks. I mean I have my fingers in a lot of different stuff and I really think that we're five to six years away from personalized medicine though being in its infancy of Being something we're going to develop truly individualized medicine based on a whole bunch of different factors. And not that we as humans don't do that already. We look at somebody and go, okay, well tell me about this and tell me about that. But we're busy. We see a lot of patients. Do we ask all the questions? Do we do, does the patient tell us all the things that they're supposed to, they should be telling us. I think personalized medicine is one of the things I look at and go, wow, that's going to be, I look at that and go, I think that will be the single biggest change that we see in our healthcare in my lifetime is the advent of truly personalized medicine and artificial intelligence. We'll build to just simply crunch data that we just don't have the bandwidth to do.
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Eugene Shotsman
So let me see if I can summarize this in the right way and then I've got a question behind it. So I think what you're saying is, hey, we can, we're going to get better at technology as data gather devices. You know, whether it's a ring or a contact lens or whatever it is. Right, right. Or your frames. Right. Like whatever it is. But, but all of these things can be gathering data about you as a living human and putting that data into some sort of database. And then AI is going to crunch that data and is going to give your doctor and you the patient and.
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Dr. Scott Morris
Cross reference it with millions of other people like you.
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Eugene Shotsman
Right? That's it is cross reference the data, but then give your doctor and patient an optimal set of ideas for how your body might react to the next level of to, to, to treat and.
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Dr. Scott Morris
Then monitor how it actually does react.
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Eugene Shotsman
Right, right. And it's fascinating in, in that context because, and I just happened to be at a conference last week where one of the chief scientists, and this is a guy who's up for like the Nobel Prize or something, but one of the chief scientists from the Buck Institute was talking and the Buck Institute is an institute on longevity and, or focused on longevity and has some very deep pockets and sponsorships by a lot of people who are interested in living longer. And this guy was, that's exactly was the topic of his talk was that our bodies, if I take an ibuprofen and you take an ibuprofen because of my gut, because of your gut, because your biome, whatever, we're going to have a very different impact on our body. And yet the pills, the bot, the bottle says, you know, take two for, you know, guys who weigh 200 pounds or whatever, right? Like that's.
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Dr. Scott Morris
And it was the data we had when those studies came out. But we're going to have more data to truly do that type of thing. And I mean, you know, really getting creative. I'm assuming you're at the health conference, Is that what you're talking about, Eugene?
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Eugene Shotsman
I was actually. It was a different, different conference.
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Dr. Scott Morris
So, you know, then you get into the human genome and will we be able to sequence DNA? And I mean this is further down the pathway for sure. But you know, then we genomics and as a human being, I just can't process that kind of data. But you get into genomics of, you know, am I taking an nmn, am I taking nad, am I taking with alpha lipoic acid? How does that impact me? You know, it takes me days, weeks of playing with it and watching biochemistry to figure which supplement works best with my body type. But then if you said, well, could tell me what your recipe is. Your recipe is totally different. Your genome is different, your, as you said, your gut floor is different. How you synthesize, it's different. I mean, truly changing whether you look at it from longevity standpoint. I'm one of those longevity guys, Eugene. If you look into longevity versus just what happens if you're taking vitamin D, right? I mean, they say, oh, if you get over 80 milligrams or 80 on your scale of vitamin D, that's too high. I'm like, says who? I mean, maybe, maybe not. We don't know. And that's where I think the cool stuff is that not just precision medicine, but as we start heading more towards data gathering, as you say, get more to data gathering and then processing it and figuring out what evidence based medicine really is, I think we're going to look back 10 years from now and go, can you believe that we give people drops for pressure or can you believe we did this versus that? Just, just like we do now. We look back when I first came out, I talked to my student doctors. You know, I came out longer than I care to admit. And I think about some of the, some of the. I mean, glaucoma was two medications, right? We had timolol and pilocarpy. Iopidine was just coming out, right? I mean, now you go, I wouldn't even think about putting people on those meds. I mean, you're going to do three different surgeries before that happens. We're going to look back at what we do now and this is part of the evolution of medicine, right? Is that we're going to gain more data, we're going to become much more precision based and we're truly going to change the way healthcare works by changing how we deliver medication and, or procedures or whatever to different people. And so it's, we're at a really cool, fascinating evolutionary tipping point of how medicine works.
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Eugene Shotsman
Well, and it's actually a really interesting point because if you think about medicine and science in general, right. It's like the, the entirety of science is the we used to think, but now we know phenomena, right? Like that is.
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Dr. Scott Morris
Right.
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Eugene Shotsman
That is what it is. That's the whole scientific method. And so if you think about AI and really, you know, machine learning or technology, as a partner in what we used to, what we now know, it's just a partner with more data point that can process way more data points way more efficiently than we could have in a traditional, you know, double blind study or something like that.
- [27:29]
Dr. Scott Morris
Yeah, I mean, we look at, and we get in later about software I'm developing, but I mean, I look at it and go, you know, one of the biggest studies ever done in eye care. You look at the nurses study, I think it was like, like 9,000 people or something like that. I can't remember the exact numbers. But I mean, think about it this way. I mean, we're soon going to have the ability to do, you know, if the average doctor sees, let's say 20 patients a day, times five days a week, times 50 weeks a year, times 20 years, they're going to see about 100,000 patients in their lifetime. I mean, I see a day not very far off in the next three, four years when we'll see 100,000 patients and catalog all 300 data points every single day. Right. So let's see, you have something that's got an incidence rate of 0.1, let's say keratoconus. Right. I saw a keratoconus patient yesterday, an instance rate of 0.1%. Okay, so that means we're going to see a thousand keratoconus patients on Tuesday. That's Cohort 1. We're gonna have a cohort. What is today? 11, 6. So 11 5, 24 T for Tuesday. Right. Is we have a cohort of a thousand patients. We're going to follow them for the next five years. Tomorrow or today.
- [28:39]
Eugene Shotsman
All of the eye care space. Or you're saying just you?
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Dr. Scott Morris
Oh, I'm saying in all of eye care space. Right.
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Eugene Shotsman
Let's say we have. Right. So we're going to see a thousand patients with keratoconus across the entire industry tomorrow.
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Dr. Scott Morris
Yeah. When you get to a thousand providers using the same software, seeing that same amount of people. A thousand providers. Now remember there's 81,000 eye care providers in some form of practice in North America and we're just talking a thousand. I mean, when you think about, gosh, what happens when you get to 10,000 now all of a sudden you're seeing 10,000 keratoconics every single day and tracking all of it over time. The amount of data that we're going to get and how we is cross linking best for people with 48 versus 49 who have irregular asymmetric versus regular inferior. I mean there's so many different variables and way and cut and slice the data that we could just never possibly think about doing in a study because it would cost millions and take decades. What, what would cost millions and take decades we will do in days and cost little to nothing.
- [29:48]
Eugene Shotsman
Right.
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Dr. Scott Morris
That's exciting.
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Eugene Shotsman
What, what kind of, I guess cooperation, I mean, is this like, you know, I've heard that, I've heard people say, well, the EHRs should come out with their own AIs to be able to do stuff like this. But I don't know that that's, I mean right now sometimes it's hard to get EHRs to properly save a patient record after you put your notes on.
- [30:11]
Dr. Scott Morris
Yeah, and I get myself in trouble on this one all the time. But this is where, you know, if we're going to be forward thinking and we're really going to look at the future, we have to go EHRs. I led the EHR conference in 2004. The AoA put on, that was my baby. Just like I just led the AI conference at Vision Expo, you know. And so I was on the forefront of how do we get people. I remember sitting in a room, there's 600 doctors and we asked how many people are currently using EHR? 2000, 2004. And three of us raised our hands in a room of 600. Right. And so I look at that and go, EHR got us from paper records to where we are today. But unfortunately they're very much still caught in the system of let's document what we did instead of let's use documentation to help us decide what to do. And I think that I kind of coined the phrase and I've heard more and more people start using this called APHIS systems. So you have EHRs, which are kind of what I just said, and you have these APHIS systems that are Developing that are basically how would we. These are adaptive personal health information systems. So a P H I S APHIS systems that are saying let's take data and let's do something with it. But you got to collect all the right data. And that's the challenge we always have with EHR is they only collect a very small piece of data comparatively to haul the data that happens in a healthcare delivery cycle. So you know, it's going to be interesting to see. I think there's a, I think there's a war coming between EHRs and APHIS systems about who's going to win. That's called evolution, you know. Yeah, the best will survive.
- [31:59]
Eugene Shotsman
And I think, you know, it's. It's one of those common myths that I hear all the time is that like, you know, it's all of patient care is going to be AI driven because these are the, you know, you're. Whoever you're buying software from right now, they already have AI solutions that they're working on. I think the reality is that it's a far and few between of the people who are truly experimenting and making things and trying to think about what could be. Because it is. It's also really freaking expensive to have AI developers. And I know firsthand, right. We're doing some of that in our organization and quite frankly it is a patent's 100 grand.
- [32:43]
Dr. Scott Morris
I mean just out of the door.
- [32:45]
Eugene Shotsman
Right. And so it's tough, it's tough to. It's not a realistic expectation that everything is going to automatically evolve into the world of AI. I think we actually as practice owners, practice managers, as people in the industry ultimately have to lead the charge and actually manage the Apple and do the application of AI in healthcare. So I actually want to challenge you a little bit. Let's talk about some of the, you know, I guess like what's working, what's actually working today or what will be working in 2025.
- [33:19]
Dr. Scott Morris
Yeah, before I go into that, that's a great question and that's a good challenge question. Let me answer one other thing. Let me finish off that key applications.
- [33:28]
Eugene Shotsman
Because I think the other thing we.
- [33:29]
Dr. Scott Morris
Didn'T cover was, is. So I also think this we're going to see very quickly is how AI is going to change our administrative burden in terms of electronic scheduling and scheduling based on what your workflow is. Because I don't work at the same speed as other doctors and other doctors. I mean we're all different, right? And so what. How fast I see a patient can be very different. From how fast maybe my associate sees a patient. And neither right or wrong, it's just it is what it is. And let's how use the best use of time. So escheduling. You have what I'm really looking forward to. And I think we're still a few years away off of this because this is more of a financial whose pocket are we filling? Discussion than it is a technology question. But I think the insurance, the entire insurance industry needs to be completely revised. And I do think AI is going to change that. Where we now know what coverage is. And I see a day, I hope in the next three to five years where coverage payment is all done instantaneously. It's not like let's bill it and then we'll send it to somebody and we'll wait to see if we get paid. And it's 30 to 60 days if we did it right. And there's this rejection and yeah, we got an authorization. I see a day, all that just disappears. Right. I mean where it's all just automated. It's a financial transaction. It's not some huge.
- [34:49]
Eugene Shotsman
Well, what's interesting about that is that, you know, I actually, I think the nature of insurance providers because they're also scientists too. Right, Right. They're actuaries. So coverage and coverage plans, I can see that becoming much more personalized as well. Right. Because right now I go to the cafeteria, I buy one of three plans. Right. And one of the. And in all reality, you know, there is if, if data is available about me as a medical patient and if data is available about you as a medical patient. You know, I get the whole point of, you know, the point of insurance is to spread the risk. But some, some way or another, I think the scientists and actuaries can work together to really reform the entire delivery of the insurance process.
- [35:38]
Dr. Scott Morris
Absolutely agree. That'll be another big, not necessarily clinical care evolution revolution, but it will definitely be a financial revolution because, you know, I, I don't know what the latest statistic is, but the amount of money that we spend per capita on health insurance in this country or health health in this country alone is just crazy. And it has to be fixed. Right. And so that you're going to get great minds to put this together and fix this.
- [36:03]
Eugene Shotsman
Yeah. Totally agreed with you. Okay. Other. Other applications.
- [36:07]
Dr. Scott Morris
Yeah. So telemedicine is another one. And I don't. Telemedicine is always right on that edge. Is it really AI or not? I kind of vote. It depends on how it's being done. I mean, this is could be telemedicine. Right. This is not really AI. This is just another group of video technology. But, but telemedicine, in terms of, hey, you know, I have my URA ring on, and I'm sending biometric data to my doctor who lives three hours away so I don't have to go in and have my blood pressure checked every three weeks because, you know, I'm out of malignant hypertension, whatever. Now that's AI that's using telemedicine. Not necessarily televisit, but still telemedicine. So there's one of those, that. That's one of those myths, right? Well, telemedicine's AI. I'm like, parts of it.
- [36:48]
Eugene Shotsman
Your Amazon driver could deliver your visual field headset and take it away three days later. And you could do your visual field without having to go into the office.
- [36:58]
Dr. Scott Morris
If not. If not, your testing.
- [37:02]
Eugene Shotsman
Right. Like everything in the headset. Yeah.
- [37:03]
Dr. Scott Morris
It might be the drone dropping it off instead of the driver.
- [37:06]
Eugene Shotsman
Who knows? Good point.
- [37:07]
Dr. Scott Morris
Yeah, but the, you know, so there are pieces of that where we're going to leverage certain AI technologies to change the way other pieces of things happen. Right. I mean, so there's where you're using OURA ring, which is AI, to send biometric data through your phone to your doctor who gets, if there's a high number, they get a notification on their ATHIS system that says, oh, look, John Smith, you know, look what his numbers are. And he goes, oh, okay. And he gets on a conference, gets on a call, just like we're doing. This isn't the AI part. This is just the, this is patient doctor relationship. Right. And whereas we might, if they live four hours away or can't get in because they don't have a driver or, you know, can't see to drive or whatever the case may be, this may be their interface. Right. And this is still that human connection that. Hey, Mr. Smith, you know, we've been noticing your blood pressure is doing this. You know, maybe we could tend to do this. Are you still doing your workout, you know, blah, blah, blah, you know, and work out? Could be. Are you walking to the mailbox every day to check if UPS sent you? Whatever. Right. And so these are the things that can change care, which AI may influence some pieces of existing technologies that are out there.
- [38:17]
Eugene Shotsman
The sensory component is so interesting because, you know, one of the reasons we. Why we need to see patients in person is because we as doctors need to sense. Exactly. You know, we need to use our senses to, to diagnose and to evaluate. And if technology. Kind of going back to one of the first things we talked about, if technology is your sensory partner in that case, and, you know, whether it's AI then processing the information, but the technology is available to get reliable sensory data, you know, that could enhance the convenience factor of. And, you know, I understand the guy who has to drive four hours, but what about the guy who's, you know, stuck in an office and only has five minutes to see the doctor?
- [39:01]
Dr. Scott Morris
You know, and that's just, that's still another access problem. Right. And whether it's access of distance or time or availability, those are also access problems that I do see this starting to help. So let's get back to your other question because I, you, you gave me. And I. I'm sorry, I didn't write it down. So you might well know.
- [39:18]
Eugene Shotsman
The question was, okay, so I. We've got, I think, these great ideas and hypotheticals, and some of them are future. But what is actually working today and what will actually be working in 2025? How can, if, if I'm, if somebody's sitting here listening to this and they're thinking, okay, I got it. You know, there's cool, cool stuff coming down the pike. This is going to be amazing or scary, but one way or another that there's a world filled with amazing technology in the future and sometimes in the present. But how can I enhance my practice today? What can I do differently?
- [39:54]
Dr. Scott Morris
I think there's a couple really great technologies that are here today. There's some that'll be out in the next six to nine months, and there's some that are probably a little farther off. So let's do the stuff that's out there today. So I think that you have Microsoft Copilot and some of the things that the reason. So we have ambient AI and AI scribes who are now sitting in the room and listening to the conversation between me and my doctor or between me and my patient, however we want to phrase that. We're sitting there recording what we're saying and taking out, oh, yeah, Johnny played soccer and looking at Mrs. Smith. This is what we're going to do. Right. And what you've done is made a better documentation of the entire process. So I think that did it save a person being in there is a scribe. Yes. Is it better at documenting than when I look at it four hours later and go, so what did Mrs. Smith and I talked about beside Johnny's soccer game? And I can't remember everything we talked about? So now we have a record, good and bad. And you know, and like I said, that's. There can be good and bad in that discussion, because what happens if the doctor gives you the wrong information to do? Well, that's also recorded, right? So I think ambient AI and. Or AI scribes, That's. That's here now. There are numerous companies that have that out right now, depending on what software platforms you're used to. I'm trying not to do promotion, so I'm not going to say this one versus that one, but I think that that's number one. I think there's a lot of E scheduling that's AI driven scheduling. That's still very early in its infancy. But what we didn't talk about in the very beginning is the way AI gets better is data. And the more data we have, the better it gets. It learns just like a human baby, right? The more data gets, the better it learns. And I think these E scheduling technologies, though still in their infancy, are very interesting. And they're starting to come out now. We're gonna see a lot of them over the next three, six, eight months. I think all of those.
- [41:40]
Eugene Shotsman
When you say escheduling, how is that different than an online scheduler? On somebody's. On somebody.
- [41:45]
Dr. Scott Morris
Yeah. They're gonna look at it and say, but you're in for this type of exam. And based on, you know, let's. Let's say you, Eugene, you came into my office, right? And you said, I want a comprehensive vision exam, and I'm a contact lens wearer who wears gas perms and can't wear them for more than six hours because my eyes feel dry. Okay, so in today's world, we'd say, oh, we're going to schedule for a comprehensive exam. Well, but what I just said means, well, it's a gas perm. So add five minutes onto what we're doing, and then it's kind of a dry evaluation. We just got to decide, do we do that before we do the gas perm evaluation. And now all of a sudden, you're comfortable exam, you've added 10 more minutes. AI systems are going to go, wait. But if we ask the right questions in the intake piece, and I'll get to that in a second, if we ask the right questions in the intake piece, we're going to know that, that eval, that comprehensive. Well, health exam is 30 minutes. I'm just making up a tight. Making up a number is 30 minutes versus the standard 20 minutes. Well, now all of a sudden, if I see that person I see. Oh, I have a 30 minutes. So I'm like, oh, they got a lot going on. I better check into this. But now I'm not behind either as a provider. Now I'm going to be on time versus the way it is now. You get one of those. You're like, oh, man. Now I'm just. Now I'm ten minutes behind the rest of the day, and I can't catch up unless you get another one and then you're 20 minutes behind the rest of the day. And then. And then who's having a good experience? Well, it isn't your patient and it isn't your staff, and it sure the heck isn't you. Right. So those are the things.
- [43:14]
Eugene Shotsman
You're rushed the entire time. And so the patients. The patients you're seeing and you're trying to shave two minutes off of here and two minutes off of.
- [43:20]
Dr. Scott Morris
And they feel that, they know that, they sense that.
- [43:24]
Eugene Shotsman
Yep.
- [43:24]
Dr. Scott Morris
That's not good care. That's not what they're coming to see you for.
- [43:27]
Eugene Shotsman
So that's clever. I think that the. The idea of E scheduling. Keep going. I didn't mean to interrupt your flow there.
- [43:32]
Dr. Scott Morris
Yeah. Oh, no. So I think that E scheduling is a big one. We've talked to ambient scribes. I mean, I think that we're going to start seeing some more of the financial processing piece of this. Of, you know, hey, we're going to do auto verification and auto eligibility, and there's a lot of those technologies been around for a while that have been somewhat manual and they're starting to get automated. I think the Achilles heel on that is insurance companies are less than transparent about the whole process works. So developing a true AI assistant on that is. Is still a challenge, but we got to start somewhere, and we're going to start there. So those are all technologies that are kind of out now. And then we kind of get into the stuff that's just starting to hit the market, and it's going to be bigger. And that is, you know, we mentioned intake, and right now we wait till a patient gets into the office to do intake and we say, eugene, what medications are you on? You're like, I don't know, it's a little pink pill. It's about this big. What are you taking it for? I think I'm taking it for my diabetes. And so that's unreal. Or, when did you have this? Well, I think I had it three weeks ago. Well, what happened after that? Yeah, I don't really remember. When I called to make the appointment, it was an issue, but I don't really remember now. Versus auto intake features which you know, are truly adaptive. And this is where we get into these aphis systems that EHRs can't do is we get these APHIS systems go, well, let's, let's look at, you know, hey, if you ask the answer this question, we go this way. And if, then, you know, these are huge, you know, hundreds of thousands of pages of algorithms that now a history is done before you get to the office. And the history takes 10 minutes at home where they can go, well, let me just. One second, let me go look up what medication I'm taking, right? And then when you plug in the data, it pops up and goes, oh, this is for hypertension. I'm just making it up. But, you know, so it's for hypertension. And the patient goes, oh, well, we just educated the patient about why they take that little pink pill. And there's a notification, you do take this in the morning with water, right? And they're like, yeah, of course I do. Right. And so, you know, those type of adaptive intake systems that are both educational and time saving, those are things we're gonna see that are starting to show up, you know, right now. They're still, they ask the same 20 questions, but it's not really adaptive. But it's a starting, you know, versus, like the system I'm using. It's totally adaptive. I mean, it does it all before the patient ever walks in the door. And if you think that most people are taking, you know, if it's your history's five to ten minutes and all of a sudden that just disappeared, how does that change your efficiency? Right?
- [46:03]
Eugene Shotsman
Well, I'm sure that you get the doctor output. I'm sure that the doctor output matters quite a bit as well. Is that what does the provider see from that, you know, they're not going through? Because right now, sometimes you're going through pages and pages of did this box get checked or did this box not get checked?
- [46:21]
Dr. Scott Morris
Patients get tired when they're going through 10 pages of paperwork. They're like, I don't care. Just write no for everything. Let's get on with the exam. I'll tell the doctor about it, right? But do this as the doctor even ask, did they know to ask? Did they know the right question to ask? Did they ask it in the right way, in the right time, in the right language? And the language patient can accept all those things? We're going to see those challenges go away in the next few Years.
- [46:46]
Eugene Shotsman
Well, I'll give you one more that we've been playing with, and it's been kind of remarkable is, you know, you think about the busiest people in your office are oftentimes also the highest paid, right? Your office managers. And it is true that in many offices, especially ones that have had staffing problems recently, which, you know, who hasn't? Those offices are hiring new people, and then those new people are constantly pestering the office manager with. With questions all day long. And so your office manager stops what they're doing, or whether it's an office manager, an optical leader or whatever, it doesn't really matter. But somebody with experience, right, Somebody with experience whose experience is valuable in keeping your practice running and seeing patients and providing value to patients is now constantly stopping to answer questions. Well, what we found is that if you take those questions and you record the answers to those questions and you upload them to a custom GPT, and then also you upload a bunch of your office manuals and procedures and whatever, then the first line of defense, it's not 100% reliable, but the first line of defense can easily be a bot that the new hire asks. And when I say new hire, I mean really anybody with less than a year of seniority in the practice who still has to keep asking questions about how do we do this, or do you have a second, can you tell me how or where does this go? And that kind of thing. And if and if you find yourself in a place where your practice is constantly bombarded with, okay, staff shortage or not enough time to do this, not enough time to do that, this is a great way to, you know, save up to 25% of your most valuable people's time by simply, you know, making the first line of defense for questions, your knowledge bot for the whole practice. And that's not hard to do. That's available now.
- [48:25]
Dr. Scott Morris
Yeah. And that's all there now. And I think that it's not going to be very long before all that's customizably baked into your individual. You know, it's not like an EHR where everybody goes, well, let's everybody use this ehr. Now, every one of these APHIS systems can be customized to your practice, which has probably got different process and protocols than my practice, neither right or wrong. They're just what individually has happened. EHRs can't really adapt to that, as a general rule, where these adaptive systems will go, yeah, sure, this is the question that Dr. Schatzman wants for. This is the answer for that question. But Scott, has the same question but a different answer. That all that's going to. All that's. It's possible now, but it's going to get more possible as these things are just baked into these customized type programs.
- [49:11]
Eugene Shotsman
Yeah, no, that's great. So anything else that's kind of on the horizon that you think is coming in 2020?
- [49:17]
Dr. Scott Morris
Yeah, I also think that education and this. We could probably do an entire hour just on this one, Eugene. I think that the education of healthcare, and I say that from how we educate patients to how we educate staff like we're just talking about, to how we educate our young docs, to how we educate older docs like me, you know, how do we keep educated? I think we're also about to see a major revolutionary change in the way all of that is done because it can all be customized. You know, in our current education system, if you look at our young docs, our student docs, you know, just like in college, or both my kids are in college, you know, and they're like, if you, you have to, as a professor, you have to cover this much data in this much time, and if not, everybody's caught up, you just have to move to the next subject whether they're there or not. You know, we have fixed data in excessive data in fixed time. I think we're about to see a major shift. And you're starting to see this in education with tools like Khanmigo and those types of things where you're going to see that, that now you have variable time to cover this fixed data because now people can learn at their own speed. And if they're like, hey, I know the answer to this subject, I don't need to listen to a speech about it for 30 minutes. I got it. Versus the stuff I don't understand or I don't know. You know, not only will these systems be able to figure out what's our gap analysis for our student doctors or our more experienced doctors, what's our gap analysis and fix those gaps. We'll be able to do it at every different level. What do they need to know? And education also is something that right now it's an on demand service. We have the beauty of going to Copilot or Gemini or ChatGPT and say, well, tell me about this, but we have to expect that the user knows the right question to ask to get the results. Whereas in the near future it's going to be not a on demand type of service. It's going to be much more. And I don't Know if there's a great word for it, it's going to be much more of a knowledge primer type of situation where you get told what you need to know before you actually need to know it, you know. And so education, like I said, that could be a whole nother hour talk. I'd love to do that sometime. My friend Dr. Purcell and I, we go round and round and about this and you know, what the future of education looks like for our student doctors, what the future of education looks like. You know, being somebody who was on the podium for 25 years, we can do it better, right. And I think that we're about to see some of those changes.
- [51:58]
Eugene Shotsman
It's fascinating you talk about that and it's true because I think that personalizing medicine is so close to the whole concept of personalizing knowledge. Right? Personalizing what interests me and what I grasp really, really quickly is very different than what interests you and what you grasp really, really quickly. And exactly. It's, it's.
- [52:18]
Dr. Scott Morris
And how you learn than how I learn.
- [52:21]
Eugene Shotsman
Exactly.
- [52:21]
And how, how what happens to me when I listen versus when you, what happens to you when you listen. But yet you and I are both attending the same one hour lecture, right. And that's the, and actually in a couple of months, we're both giving the same one hour lecture to a room of 800 people. Right. It's, it's the, the, the truth is that, you know, how we all interpret that is, is so relevant to, to how we, how we truly ingest both information and what we do with that information. So I, I agree with you. I think that's a fascinating.
- [52:55]
Dr. Scott Morris
All of that's going to be adaptive, not retroactive. It's going to be proactive adaptive. And that's, you know, I was having that talk with my son last night, my older son who's a senior in college, and we were talking about like how does that look in the future? Right. And the, you know, it's great when they're in school because they talk. Well, I learned this way, like they're just getting that point where they figure out how they learn and how I would learn better. Right. And so I think that adopts. It's gonna, we're gonna have. If we have 330 million people in the United States, we're gonna have 330 million different ways to educate people about how to live a better, healthier life.
- [53:33]
Eugene Shotsman
Yeah, that's. I, I love that. One or two more topics, I think. What's, what's on the horizon, Scott, from Your vantage point. Yeah, and then we gotta stop for today. But we' to come back to this because I already can anticipate the feedback I'm going to hear from our audience and it's probably going to be, hey you guys.
- [53:52]
Dr. Scott Morris
Oh, we just scratched the surface, Eugene. I haven't covered 2% of what's out there yet.
- [53:57]
Eugene Shotsman
Right.
- [53:57]
Dr. Scott Morris
But you know, I think the big thing that's coming down the pipeline besides education, because I really think that's a big piece of it. I also believe that I used to, I pulled up a lecture I actually wrote 20 years ago and I said someday we're going to have evidence based medicine. And I've been chasing that ghost for 20 years. Is that there has to be a way to find out is this treatment better for you or is a different treatment better for you? And that's a combination of evidence based medicine and personalized precision medicine. Let's kind of mold those into one group. For the first time in my life, I think that we're less than three to five years away from the early stages of that of having true evidence based medicine where we have N values in the hundreds of thousands, in different demographics, across different genomes, across different things that say when we could truly personalize medicine. And that's the first step, right is it to the next big thing we're going to talk about. But I think evidence based medicine is something I know it's coming because been developing it. I mean I know it's not that far away. And so I think evidence based medicine is that first big major revolutionary change that's going to come. I have no idea what it's probably going to end up looking like because we're still very much in the infantile stages of this. But once we start to get our fingers into evidence based medicine now we can start looking at value based medicine. And that's how we fix A broken healthcare systems that are all over the world. You know, there's no healthcare system. You know, we listened like this. This country has a better system. And you know, most people would still rank healthcare systems, even the best ones, as a C, you know, or maybe a B if we're lucky. I feel that we're not that far away. In my lifetime we'll see value based medicine that says the efficacy and value of treatment A and this is the efficacy and value of treatment B. Patients you get to choose, but you make up the delta of what those costs and not cost just financially, but cost in terms of longevity and cost in terms of personal suffering. And all those things. I really do believe that that's something that we're, we're a generation away from and that's not that long.
- [56:17]
Eugene Shotsman
Yeah. So that in itself is a, is an episode. Scott, the whole concept of value based medicine and philosophically, how would that work? It's probably a super interesting conversation. And I think it might actually require both of us to do this later in the day and have a beer in our within reach. So I am super grateful that you're able to. Again, we scratched the surface and I think you and I both know it's a huge topic, but I get listener requests all the time. And more coverage on AI, Practical coverage on AI. I think we did a combination of both. I think we laid out the landscape and then we started talking about some practical stuff. We got to do more of that in the future.
- [57:01]
Dr. Scott Morris
And if I can do a little pitch. Eugene, I'm not sure you're going to, if you get edited this out, but I mean, I would encourage everybody, obviously, I would love to do, I could do one of these every week with you, but I would love to do more of these with you when we could do kind of this video thing. But that's the reason why, you know, Jobson has been so great about letting me and Dr. Ray Han Ahmed develop kind of multidisciplinary e journal called AI and Eye Care. And so there's my plug and pitch.
- [57:27]
Eugene Shotsman
It's funny because I was literally just about to say, you know, you stole my thunder, literally about to say, and if people want to learn more about AI, they could potentially read this new journal that you're coming out. Tell me more about the journal, Scott.
- [57:38]
Dr. Scott Morris
It's AI in Eye Care. And I know Jobson. It just came out two days ago, I think was our first episode. And every month we'll have columns, we're going to multiple features, we're going to do video podcasts just like this. So, Eugene, we're going to turn the tables and I'm going to ask you questions next time on that, on that platform. But, you know, we want to educate. I feel really strongly about helping educate our profession, our and our industry about what all the really amazing things that are coming out and how we can leverage those to change the way we deliver care and the way the industry works. I mean, maybe that sounds really altruistic, but that's what I want is I want to, I want to change the way the industry works. And this is the first technology I've seen in a long time that I'm like we finally have a group of technologies that can really move the needle and we can change the way we provide care as healthcare providers.
- [58:33]
Eugene Shotsman
I love that. Thank you, Scott, for sharing some of your time with us today. I look forward to future conversations and we'll make sure we post a link in the show notes to the new AI journal that Scott mentioned. Again, grateful to have you on the show. And hopefully as we get feedback from the audience, we'll decide what our next two topics are that you and I can try to cover in the next hour.
- [58:56]
Dr. Scott Morris
Hour sounds good. You guys have a great day. Thank you so much for your time, Eugene.
- [59:00]
Eugene Shotsman
Thanks, Scott.
- [59:01]
Power Hour Announcer
If you're enjoying the Power Hour, you might be asking yourself, what can I do today in my practice that's going to make an impact? So over the years, the practice coaches and consultants at the Power Practice have helped thousands of practices improve. And they often start with one thing, and that's a proprietary methodology called the Practice Profitability audit. For about $2,400, they look at all of your practice numbers and they stack them up against where a practice of your size could should be. It takes about a week for them to do and because they're so experienced, they know what your potential looks like and they're often able to take that $2400, multiply it several times over and hand it right back to you and found profits in your practice in months, not years, in months. But you get to keep the much more profitable practice for years afterwards. But here's the best news I'm going to tell you how you can have the Practice Profitability Audit completely free. See, we're really trying to get people onto the show website, which is by the way, powerpractice.com and then you click the Power Hour podcast button. The reason we want you there is because I want the audience participation, I want to hear your feedback and I want to know how to make the show better for you so you can interact with us, send us your feedback, offer your suggestions, and for a limited time when you go there, you can also request a practice profitability audit for free. Right? We're going to cover 100 of the cost, but only for five people per month. And five people per month is all we really have capacity for because this is a resource intensive audit and the practice Power Practice coaches are generally busy serving their clients. But for five people a month, they've agreed to cover 100% of the cost.
- [60:36]
Eugene Shotsman
So it's totally free to you.
- [60:38]
Power Hour Announcer
So again, take action immediately in your practice. Go to powerpractice.com click on the power Hour podcast, interact with us, but also request a practice profitability audit today.