Next Unicorns: Building the future of healthcare communication with Abridge CEO Shiv Rao | E1784

0:00That's the thing that's blowing my mind more than anything else in 2023 is that healthcare is moving at the pace that it is with this technology. Is it really moving faster finally? It is moving so fast. Why did they go from not moving fast to moving fast? Is it just because it's so broken and they're so exhausted and they're finally ready to capitulate and use the technology? Yeah, we just pushed way past the point. This Week in Startups is brought to you by Crowdbotics. Great ideas can change the world. And Crowdbotics is the fastest way to turn those ideas into code. Get a free scoping session for your next big app idea at crowdbotics.com slash twist.

0:40Vanta. Compliance and security shouldn't be a deal breaker for startups to win new business. Vanta makes it easy for companies to get a SOC 2 report fast. Twist listeners can get$1 ,000 off for a limited time at vanta.com slash twist. And LinkedIn Marketing. To redeem a free$100 LinkedIn ad credit and launch your first campaign, go to linkedin.com slash next unicorn. Hey, everybody. Welcome back to the program. Today, another amazing episode of our The Next Unicorn series. If you want to see all the startups we featured in this over the years, this week in startups.com slash next unicorns. What is the idea behind the show?

1:23We find promising companies that we think could change the world. and just last week i interviewed andy beck he's building path ai if you remember that uh it helps make pathologists superhuman right they get a 3d model they look through the microscope and it makes it easier to diagnose things like cancer maybe more accurately will drive treatment and hopefully um extend people's lives and suffer a lower suffering right great great mission today another ai founder in the healthcare space dr shiv rao is a cardiologist teacher former corporate vc don't hold it against him and the ceo co-founder of a bridge now a bridge you ask what is that amazing ai platform well takes verbal conversations between doctors and patients and it converts them into what the industry calls i believe soap notes soap notes stand for subjective objective assessment and plan basically concept is to save doctors and healthcare professionals a ton of time maybe reduce the errors and again reduce suffering increase lifespan so that the human species can enjoy more of the limited precious time we all have on the planet welcome to the show shiv thanks so much jason how has the last five years been with uh the ascension of the show's secession and everybody telling you shiv like on the show i love that character that must be incredibly annoying i love the show i just sort of nod politely and wish they were likening me to the prison knife but you know probably it's it's all the same thing i think that was the inspiration for her character was uh the name shift was uh to that i mean in the what do they call it prestige tv era Yeah.

3:10From Sopranos to Secession, I got to think it's in my top three of all time. Yeah. I mean, you're so good. I mean, it's the Sopranos and Secession, and then I got to fight for my number three spot. Totally. It's just incredible. So how long have you been working on the company? Yeah. And for people who want to check out the website, it's abridge.com. Yep. A-B-R-I-D-G. So we started Abridge in 2018. And in 2019, I'd say it was all in. Like we were going at it. And in 2018, when we started, I was juggling a couple different positions. I was sort of unwinding from that corporate VC role at a large health system.

3:52And we were also getting our research chops going inside the company because we're an AI native company. So we're dealing with lots of data. We have a lot of AI researchers, a lot of annotations that needed to happen when we first started the company in order to have a straight face, you know, coming out with a product that truly was powerful. by proprietary technology. So, 2019 is where things started to get very real. And fast forward though to 2023, I mean, it's insane. Like I'd say the last six months for us, maybe even eight months for us has just been like game changing. It's just been sort of like slow, slow, slow.

4:29And then suddenly, it doesn't feel like tailwinds. It feels like a tornado. And there's two tailwinds going on for us right now. One tailwind is just the industry. The moment in healthcare right now is such that clinician burnout, staffing shortages, labor shortages are one of the first priorities for every single health system executive out there. They need to solve that problem. It's mission critical. And the other tailwind is generative AI because everybody understands this technology now. And not only do they understand it, they use it in their daily lives. So they're open to it. They want to try it and they believe in it.

5:07And that's not where we were even last year, like in November of 2022, we held a dinner for a bunch of VIPs in healthcare and it was teaching them about generative AI. And this was two months before Jack GPT came out. And so when it busted open, everyone called us like, oh, we get it now. Like what you were talking about a couple of months ago, we're ready. Let's try this. And you're like what I've been working on for five years yes you've it is interesting how something uh can just break uh the dam and then everybody's like they go from being like i would never even ride in an electric car and then they're like you know uh how when can i get one right and uh what's the wait time and how many can i buy you know we just it's these revolutions are like slow slow slow slow slow and then boom they just arrived so one of the things i've noticed is the ability to just understand what people are saying uh and get it accurate has changed dramatically in just two or three years i was one of those guys who kept trying drag and dictate 20 years ago i remember attorneys 30 years ago having me install this stuff with headphones and training for two or three hours to get yeah and it would have them say these words over and over again and now you know i start looking at i was looking at the zoom transcript and you can watch the zoom transcript in real time during a call i didn't know you could do that and i was interviewing um uh dharmesh the ceo or the co-founder and cto of pubspot and i was watching our discussion yeah in a live transcript and i was like it's completely accurate now yeah explain to the audience how it went from being you got to train this thing for three hours to be a disaster yeah or less of a disaster siri can't call your spouse or get the you know put the beatles white album on for you to all of a sudden now it's doing transcripts perfectly and and it's not just the doing them really well now it's also doing them multilingual like two days ago crazy actually two weeks ago a federally qualified health center so a health system center that is caring for a lot of medicaid patients patients from many different backgrounds um social and cultural and they asked us they actually challenged us if we'd be willing to let them come on a demo and allow them to actually run the demo uh which i'd love to go through with you yeah absolutely we'll do it right now yeah and and speak in multiple like languages um wow They came in and spoken Brazilian Portuguese and Haitian Creole and we still, and English, and we still created one English note at the end of this and structured all the data and did all the other sort of manual tasks that clinicians have to do.

7:59And needless to say, we're still talking to them. Yeah, I mean, that's quite an eclectic collection of dialects there. no farce or iraqi or you didn't want to go back to some aztec uh you know egyptian ancient egyptian language we've never actually heard before yeah i mean it's pretty crazy we're gonna literally be able to take languages that no human has ever heard before and probably figure them out uh based on all other dialects so let's do a little demo here for those of you who are not watching what the hell are you doing go to youtube.com such this weekend and sign up and watch these incredible demos or we'll sportscast it for you we'll describe what's on the screen if you're driving please do not watch youtube when you're driving totally unless you're in cruise if you're in cruise in the backseat of a cruise or a waymo you can do that so i can share a little bit like a couple lines of like high level context before to just set the stage for for the demo um everything that we're building at the company is really based on a thesis that when you think about it, healthcare is all about people and they're having conversations.

9:05So they could be having conversations like this over video, telemedicine. They could be having conversations over the phone or call centers. And certainly most of healthcare happens in person. And we're omni-channel. We have a Swiss army knife approach. We can be a part of all those conversations wherever they are. And that's where our technology is going to structure and summarize them. And so, when we think about these conversations, they're upstream of a lot of processes in healthcare, a lot of potential. They're upstream of all the diagnostics we order as clinicians for patients, all the therapeutics we also prescribe.

9:41They're upstream of clinical trial recruitment, of coding for all things revenue cycle to keep the lights on and risk adjustment in the sort of value-based care world, which is a whole other paradigm of how you can create and capture value as a provider in the United States. And then they're also upstream of the most important things, experiences and outcomes. And so, when I think about experiences and outcomes, so you mentioned I'm a doctor. So, I'm the founder and CEO, but I'm also a practicing cardiologist. I'll see a handful of patients every month in my free time. So, I'll take the shift nobody wants on a weekend.

10:17And on Memorial Day weekend, I signed up to take cardiology calls. So I was in the hospital and in some clinics and I'd walk from room to room to room and I get to use a bridge. That's why it's a big part of why I do it. And I just hit the button, I hit record, and then I'm capturing a conversation with a patient. And we might talk about, you know, the Pittsburgh Steelers for a while because there's a lot of Carnegie Mellon DNA in our company and we're distributed, but we got a lot of people here in Pittsburgh. Yep. And that's fine. We could talk about politics, you know, the NFL draft, the weather outside, anything we want.

10:49A little bedside manner is always good to build rapport with the patient, right? It's a doctor trained to do that, actually? Yeah. Well, yeah, we are. Third year of medical school. They sort of try to teach you this is how you can build trust with a patient because at the end of the day, that's going to have the biggest impact or one of the biggest impacts on their ability to understand and follow through and be the healthiest versions of themselves. So we just have this normal organic conversation. I hit stop. I swivel my chair. The note's ready. Everything's in the record. It's all good to go.

11:18And, you know, before a bridge, what I had to do is take chicken scratch on a piece of paper, like tall guy in the Mets hat. And that means Saturday morning, I'm reading tall guy in the Mets hat. And I have to remember who was that guy? Like, who was that guy? And I'm spending hours perseverating over this. And the hospital system's losing revenues because it's too late to bill at that point in time. And it's burning me out. And let alone accuracy and the fear of inaccuracy. Oh my God, what if my chicken scratch, I remember it wrong or I, you know, the memory is just such a, a fragile and unique thing in humans that, you know, you can juxtapose, right?

11:55And you don't even know you did it. Exactly. Yeah, exactly. All right. We all know the one thing that separates great startups from the good ones is product velocity. What does it mean? Product velocity, fancy term, right? Here we got your product and your velocity speed, the speed in which your product improves. So can you ship updates? Can you release new features? Can you do bug fixes? Can you iterate on the interface? Can you solve problems for your customers? And can you do it quickly? Because you're not alone. You have competitors and your customers have choices. They may solve their problems by writing their own custom code, or they might use your solution.

12:33This is what startups are about. How fast can you get that product velocity going? And so, you know, how do you supercharge it? Everybody says, okay, yeah, we want to go faster, but you got to go faster intelligently. And Crowdbotics is going to help you do that. They're your CTO as a service. Basically, they provide you with the most optimal architecture to get your product to market as fast as possible. You'll have access to an on-demand product manager and developer talent, and they will help get your app into production 10 times faster than conventional development. Crowdbotics can work with your in-house dev team, or you can just have them work independently.

13:06And you own all the IP. You own all the source code. Let the folks at Crowdbotics supercharge your product velocity today. No more waiting. Get a free build plan at crowdbotics.com slash twist. That's a$4.99 value just for the twist listeners. You get that for free. That's C-R-O-W-D-B-O-T-I-C-S.com slash twist for a free build plan. So I'm going to share my screen. This is how I used it myself on Memorial Day weekend. I think you can see my phone. Yeah. Beautiful app. Awesome. Yeah. So this is what I use. I just opened this app up on my phone. and I'd walk from room to room to room. And so if you're my patient, I'd say, hey, Jason, do you mind if I use this note-taking solution?

13:47It's going to help me focus on you instead of - Don't mind at all, doc. Awesome. Awesome. Cool. So then I hit the button and now we can just sort of do some improv. So, hey, Jason, tell me about your shortness of breath. I heard you're having some shortness of breath. Yeah. You know, it's just the last week or so I found coming up and down the stairs in the house, I just started to feel shortness of breath, a little bit of dizziness when I got to the top of the stairs. But I sat down, I took 10 deep breaths and I was fine. But then when I woke up in the morning, I kind of tripped a little bit because I was so short of breath.

14:18And yeah, the dizziness came back. Okay, got it. And so have you noticed that the shortness of breath is worse with activity? Yes, definitely. When I'm going up the stairs, it's much worse than going down the stairs or walking on a flat surface. Have you noticed any chest pain or chest pressure? no chest pain but i i did feel a little tingling in my shoulder on the side of my heart just uh you know that's why i called okay got it um all right have you noticed any lightheaded you did mention lightheadedness right yeah i did yeah when i woke up in the morning and then when i got to the top of the stairs those were the two instances of feeling lightheaded in the last two days okay you know i'm looking at my medical record right now and you have a history of diabetes and hypertension.

15:00I'm just making this up. Yeah. And hypertension. And you know your diabetes is totally out of control. Like your last... I'm working on it, doc. Yeah. You know what? I saw you at McDonald's last week and you had like six Big Macs in front of you. Those weren't all for me, but yes, I did eat too. I have been overeating. I'm 40 pounds overweight and the diabetes isn't good. I got to cut back. I need to go. Yeah. Well, I'm not here to confront you on that. I'm only bringing it up because, you know, So diabetes, hypertension, when you tell me you have shortness of breath, I'm worried it could be related to your heart because you have these risk factors.

15:34So I think we should take this seriously. So I want you to come in this afternoon. Let's get an EKG and an echocardiogram. Okay, those are quick tests. That's going to give us a sense of how your heart's functioning. Okay, great. Are they covered or do I have to come out of pocket for those? No, they're covered. They're covered. They're easy. And I can take them both today or do I have to schedule them? No, let's get them done. Let's get them done. I don't want to waste too much time. Yeah. Yeah. Yeah. And then, you know, let's talk about your diabetes. You know, like I'm going to ask our nutritionist to call you next weekend.

16:04I want them to start you on a low salt vegan diabetic diet. Okay. I think that's going to help. Can I just do the Ozempic or Wagovia? I keep hearing about those. Yeah. I think I'm going to, that one you might need to pay a lot of money for. So I'm going to ask our nutritionist to call you next week and discuss all these weight loss medications. All right. And then, you know, also today, you know, in terms of your lightheadedness, I think that's probably because we have you on too many medications, actually, for your blood pressure. So, I think your lightheadedness is because of what we call orthostatic hypotension.

16:41When you stand up or you go up the stairs, you're feeling lightheaded. So, I want you to stop taking your metoprolol, all right? Okay. Stop taking my metoprolol. Yeah, yeah. Last thing, you know, I'm sorry to confront you on this. You're a really famous person. You're traveling the country. you're doing all sorts of stuff the world um i'm totally willing to take a selfie at school okay sweet and you're under a lot of stress too um yeah that's true it's true last time we chatted you were drinking like five bottles of wine every night good wine oh yeah it's good wine yeah i mean i was sharing them yeah okay so where are you at now i mean i have uh two to six glasses of wine a night okay all right it's a range you know depends weekends are a little heavy yeah all All right.

17:23It's a little bit better maybe than where we were before. So, in terms of your alcohol habit, I'm going to ask our behavioral health therapist to call you next week and just sort of talk through your stress and see if there are other things that we could get you going with that could help. All right? All right. Yeah. Well, you try doing six podcasts a week and we'll see how stressed out you are. I get it. I get it. All right. Last thing. I want you to start taking, you know, for your high cholesterol, I want you to start taking a torvistatin 40 milligrams a day okay okay uh torvostat yeah i got you don't worry we're gonna give you something that helps you too yeah torvostatin also called libitur oh yeah i've heard of that yeah all right good i think we have a good plan anything else you want to talk about nope just want to get that ozempic or wagovi if you can get it covered under my insurance that'd be awesome okay we'll talk about it all right so we have that conversation now what the technology does i can sort of describe in detail and then we'll look at all the output um when i was a good role play you and i are good we got a future we should be doing like the when they do a spin-off of uh of secession and they go back in time to their childhoods you and i could we can take the show on the road yeah exactly awesome um so so that means i can kind of call you into some of our demos maybe just just swoop in yeah no problem yeah so um you know when i when i was seeing patients on Memorial Day weekend, I'd walk from room to room to room.

18:50And then I'd leave and I'd realize like I have to do a lot of clerical work that serves three masters. I have to write a note that other people on the clerical team are going to read and they need to understand what's in my head. Like why did I order an EKG and an echocardiogram? But then I also need to structure data. I need to pull out diagnoses. I need to map them to these specific codes that make money for the health system. And I'm the worst at that, by the way. I do such a bad job that people chart chase me for weeks and months trying to figure out what I was thinking because I always do the most non-specific thing, which is not good.

19:22But then the third master constituent is the most important. It's the patient and the family member. And they're going to go to their portal and they're going to see my note. And in my case, they're going to see a term sometimes like transcatheter aortic valvuloplasty. And who knows what that means. And so, what ABRIDGE does is it helps with all three constituents. So here's the note. I'm going to show this in a web form factor because it's just going to give us a lot more real estate to look at. And then we can kind of geek out a little bit on how it works and how the tech pulled it off. So here is this web app.

19:59And I'm not exposing you or anybody to PHI. These are all demos. And here's our conversation. So we can kind of look at the output. So patient named Jason presents with shortness of breath and dizziness for the past week. Shreddance of breath is worse with activity, particularly when going up the stairs, not experienced chest pain, but has tingling in the shoulder on the side of the heart. A lightheadedness upon waking up in the morning and reaching the top of the stairs has a history of diabetes and hypertension, overweight by 40 pounds, admits to overeating and consuming alcohol regularly, two to six glasses of wine per night, more on the weekends, amatoprolol, and has high cholesterol.

20:30So try to summarize your story, right? And so that must be some incredible prompt to do that. it's got to go through that whole four minute conversation and then summarize all the facts that were in the whole dialogue it's it's a whole bunch of machine learning models we can get into that live below beside on top of other larger models to basically make it work um and you can see below in the assessment and plan it's organizing all the problems we talked about like shortness of breath and dizziness and diabetes and weight management and orthostatic hypotension and alcohol and high cholesterol.

21:06These are all problems it's summarized. And that's so important because that's how you make money too as a clinician. You need to, and that's how you communicate most effectively with other doctors. You need to organize your thoughts. And we're organizing those thoughts the way Medicare wants to see it. That's sort of a gold standard. How would the government want this? But it's sort of summarizing a little bit your story and the plan, EKG, ECHO, diabetes, nutritionists to start you on that diet. it and we're going to have them talking about Ozempic and Wegovi and then orthostatic hypotension, you know, discontinue the metoprolol, alcohol, behavioral health therapist is going to help you.

21:39Here's a really, really important feature. And here's the Lipitor. If I was like, wait, did I mention Lipitor? I don't remember telling Jason about Lipitor. I could highlight any part of this note. And you see what happens. Yeah, the summary. And it takes us to that portion of the transcript. Yeah, exactly. And then gives you that thumbs up and thumbs down. And was this, what does it say there? Was this evidence relevant? And so we get this, it's like RLHF. Like we're getting feedback now from our users. And this is a model that was trained with - Reinforcement learning, yep. Exactly. This is reinforcement learning.

22:11This is a model trained with millions of dollars of data that we were creating in 2018 and 2019, and also like 2020, to be able to build something that can actually build trust with these generative models. Because sometimes you don't know, did that happen or not? And if you don't trust the model, you end up looking at everything so instead you could be you know you could highlight a word um you could highlight a phrase you could highlight a whole paragraph but this is we had a debate about how much i was drinking and it needs to go you got to make sure that it wasn't your assessment of my drinking or mine or you know maybe some average of the two whatever exactly yeah and that's documented correctly yeah yeah exactly and let's just say i'm like wait did we i don't really remember that part i want to listen to it again you could even listen to it and then you know also today you know in terms of your lightheadedness i think that's that's probably because you we have you on too many so hopefully you could hear that but you can go all the way from the summary to the transcript to the ground truth which is the audio how long have doctors been using this in the field um where are you at yeah probably like about six to eight months now wow and how many like for the person who's the tip of the spear the doctor who's got the most who's not you how many have they done and what's their reaction been over the last six months yeah i the once a clinician starts using this we are like over 90 percent of clinicians stick with it they use it for every single one of their patients that's how we define it every time in clinic do they use it um it's like a percentage hit your batting rate is a hundred percent yeah exactly what was the most positive feedback and what was the most negative or let's just say scared cautious feedback yeah because this is you know any recording of a health care interaction and given the litigiousness of the united states i can see people framing this multiple ways hey this is a way to document things so that you don't get sued and if you do get sued you have the evidence i could see other people you know i've been on different boards over the decades where they say hey we should record the board calls and every law firm's like don't record the board calls because now we got a transcript and don't transcribe them and write the shortest board notes possible so it's concise so that we don't have if there is a shareholder or any kind of lawsuit they don't weaponize it against us so let's walk through the reactions and then this very acute issue yeah if you use one of your industry terms around liability go up down sideways, left, right.

24:44Yeah. Yeah, absolutely. So I can, uh, uh, I can answer those and I'll just, I'll wrap up this demo really quickly too, uh, on the other side of that. So university of Kansas health system, they have like over 2000 clinicians there across any number of different hospitals and clinics. The chief medical information officer is Dr. Greg Ader. He's an ENT doctor. Um, so this technology works across specialties, by the way, it's not purpose built for one. we've been training and annotating to be able to build for all. And Greg Ader uses it his first time in clinic. And he told us afterwards, his immediate reaction was that this is the most important thing to healthcare since the stethoscope is what he wrote for us.

25:26And we can't wait to put that on our website. But that kind of feedback is rolling in on not just a weekly basis, it's happening every single day with clinicians. So I truly believe this is the biggest, most profound opportunity for generative AI. You can't swing a stick in healthcare and not hit a billion-dollar opportunity to change something that's so important to every single one of us. And as long as you believe in the thesis that healthcare is about people and they're having conversations, that it's not about machines, that it's about people at the end of the day, and it's local too. It's happening all over the place, telemedicine, in-person, call centers.

26:04Then you can believe in all this value that not just we're demoing today, but what's downstream. Like, for example, what's downstream here is coding. Like, we can pull out all the structured data and give you the evidence to support the code. I see it says they're ICD codes. What does that stand for? Yeah. So, that's like this industry sort of nomenclature around a type of code that you can bill for, that you can get. Those are the billing codes. Yeah, we hear about that all the time. Exactly. Yeah. So these are billing codes. These HCCs are different type of billing code. But the key piece here is that we're pulling out the billing code, but we're also giving you the evidence that you can, again, go all the way back to the ground truth to use and defend.

26:44So it's like revenue insurance in a way. It's like it's creating a very trustworthy, not just transcript, but these insights that it's pulling. if you're a SaaS or services company that stores customer data in the cloud then you need to be uh SOC 2 compliant you knew that from a third party and you need that third party to close big deals and if you want to get compliant easier and faster you need to use Vanta V-A-N-T-A Vanta makes it so easy for you to get and renew your SOC 2 on average Vanta customers are SOC 2 compliant in just two to four weeks prepare that to three to five months without Vanta and Vanta can save you hundreds of hours of manual work and up to 85 % of compliance costs.

27:25This is a total no brainer. And Vanta does more than just SOC 2 compliance. They also automate up to 90 % compliance for GDPR, HIPAA and more. You can't afford to lose out on major customers. We all know that. Listen, it's a hard year. Last year was hard. You can't lose those major customers because you don't have your compliance dialed in. Just work with Vanta. Get your compliance automated and tight and tight is right. Lock down those big deals. Here's the best part. Vanta is going to give you a thousand dollars off that's 10 hundies get one thousand dollars off at vanta.com slash twist that's vanta.com slash twist for a thousand dollars off your sock too how much time does this save per interaction on average right now doctors are telling us we're saving them two to three hours a day in a clinic um yeah if you purchase if they work a 10-hour shift exactly 12-hour shift i mean we're talking about a 25 lift yeah yeah exactly exactly that's weird you know it's so interesting when i had um aaron from box on reed hoffman on and um founder of um airbnb on ryan chesky yeah i asked them like what percentage of time they were saving i asked our mesh the same thing they all said like 20 30 40 depending on the role yeah it feels like we're all we're this current wave of ai innovation out of the gate saves 30 of people's time yeah that's kind of mind-blowing if you think about on an entire economy now we're seeing it not just an artist making you know wedding invitations or you know uh seo writers or people writing blog posts or somebody doing web research yeah travel research or travel planning and we're seeing it now with doctors and as we do this it's these are people whose time is even more and more uh valuable and then you mentioned earlier there's a shortage yep you get all your doctors to use this and use it well in year one you get a free doctor for every four right every three doctors you get the fourth free yeah yeah uh just think about what this could save in health care totally and then less mistakes and the mistakes are costly so that's like and obviously there's cost in money but there's also cost in death or missing a diagnosis and suffering, right?

29:43Which are really hard to even quantify. Although I guess people do quantify them. Yeah. And the health system. There's a, there's an article that was published in the journal of general internal medicine just some months ago that estimated that doctors actually require 27 hours in a day just to do all the work that we put on their plates. Yeah. So we need this. I mean, I think one of the most profound bits of feedback that we're getting from users is that they just feel unburdened. They feel like they're operating at the top of their license. They can focus on what they want to do, which is be creative and figure out what is the differential diagnosis?

30:18What are all the possibilities here? What should we try? And I think we're also being clear that this is also an extension of every doctor and nurse's best intention to be there for their patient, even when they're not in front of them. This is the, I guess, the website you're doing mobile web or an app? this is a this is a mobile app now that's yours um this is like react or something in a wrapper or something yeah exactly so it says your conversation is ready for review explore your summary review changes to your medication so this is my view of our interaction fantastic exactly so i i get that note i make my quick edits um on average it takes like about 20 seconds if that for people to quickly make it perfect and then i say send a record but send a patient and now this is what you get.

31:01And it's the first step of our machine learning pipeline where we're not just recognizing the words, we're selectively pulling out just the medical moments, not the part about politics, not the part about the NFL draft. Your kids or whatever. Exactly. So if you went home and you could filter by the starred moments, which are like the most important moments, like the next steps, but if you went home and you were like - The starred moments are done by AI, so you're seeing like little snippets from our conversation or are these done by the doctor? By AI. Yeah. Got it. So the AI is - Can I play them or are they just transcript?

31:28like this uh all right last so do i get the entire conversation or just you can get you get the excerpts but it's kind of up to the enterprise when we do these enterprise deals so i guess the question then is we have to adjust uh because you know things that can be leaked will be leaked you could have a patient who uh a phone could get hacked and somebody's calls could be leaked and their private conversation with their doctor about something very private depression you know whatever uh fertility uh stds whatever you know something real obesity um and uh so how do you think about that yeah i we have to jump through all sorts of hoops you know in relation to hipaa which is you know the the main uh one of the main constructs in in healthcare around data privacy and security and how really like they should belong to the patient and so we have to jump through those hoops we have to jump through hoops around where is this data stored and how is it stored how long is it kept and what is the data is it just transcript is it summary does it include audio but this piece of it is i think a kumbaya across everyone which is what we also do for you for the patient is we pull out the key pieces parts of the conversation we we decode it we define everything at a level so you're explaining to people what an ekg an echocardiogram the diabetic diet ozempic so there's a glossary attached to all this so when i felt in this conversation with my doctor that they were speaking french totally now i can kind of catch up and so that whole intimidation and like not questioning your doctor etc and now i would suppose you know i might want to communicate with the doctor and double click on one of these and have a threaded discussion so and annotate this in some way yeah so i guess that's probably on the roadmap yep absolutely and and i think one of the ways we approximate for that right now is this where you turn the app off maybe in a week you get a notification like this and it says hey like jason we think your doctor talked about ozempic um and we're pulling out just the key moments and reminding you like keeping it top of line at top of mind like an endocrinologist to talk about ozempic i told you to take a torvistatin you could play that digest if we've enabled audio and the enterprise is okay we've jumped through all those hoops if you say no then you give us annotations you tell us where we went wrong and then that improves our model as well so we get that sort of that data network effect on both sides not just the clinicians but also the patients well you know i think it's uh this is a double opt-in kind of thing uh you did the courtesy of hey would it be okay for me to use this if i'm an oldster and i don't want this uh or i'm a paranoid person or as you mentioned a celebrity and i don't want there being a record of any of this uh because you're criticizing my alcohol consumption um i think you were trying to do this with chamath um but uh he's the one who's drinking far too much wine i think uh even as good as it is uh so interesting that's uh yeah and this is so many societal best practices and thinking about this young people i mean they're recording themselves doing all kinds of crazy stupid stuff so doing something intelligent like this yeah they're going to be fine and then the people who are part of the paradigm who don't want the stuff recorded well paradigms uh don't die people do so they will be part of the paradigm that doesn't want to record this but my lord can you imagine if i had this since i was going to the doctor since i I was, you know, whatever, eight years old.

35:00And I had my entire history. And then the AI could look at it and say, you know, the shortness of breath thing. He had asthma when he was a kid and he never brought this up. And he had an inhaler. And by the way, like, you know, maybe we should screen for something. Maybe he's got some lung deficiency. The AI is going to find stuff in here. That's going to be incredible. I mean, it's extraordinary. So how do you charge for this? You charge per interaction or like 25 bucks an interaction or you just charge a flat rate or. We try to make it. Yeah. Yeah, we try to make it as simple as possible per doctor per year or per clinician per year.