The AI Tool That’s Replacing Your EMR (And Making You a Better Doctor)

Dr. J: Hi, I’m Dr. J. Welcome to the Cash Practice Solution podcast.

I am here with my great friend and my partner in this incredible Esprē adventure. We are developing this software that is developing what used to take months, maybe even a year to develop, in days. Suddenly, because of the new systems that are out, we’re able to make an incredible impact on every practice that we work with and, most importantly, in our own world.

So you understand how it works, this is kind of important. Nate is in an office with his tech team and the technology that we have right down the hall from my office. So I’m able to see a patient interaction and see a problem with it and say, “Nate, I need you to address this.”

And the great thing is, a year ago, it might have taken maybe a month to correct my little heartburn about something, and five minutes later he’ll walk into my office and say, “It’s done.”

I said, “How do you do that?”

But I’m beginning to get less surprised because, as days go by, I’m beginning to become way more comfortable with saying, “We’re going to change this. We’re going to change that. How can you do that?”

And it’s called pushing, where you get something changed and then you put it out into the environment where doctors can use it. And our doctors are benefiting by this hand over fist every day with new features that go fast.

And I think it’s probably the best software that’s out there right now because of the way that we do it. It’s very unique.

But I wanted Nate to be here so he could tell you. I think he’s really cool, so I’m not going to make him tell you how cool he is, but at least he can tell you what some of the stuff that he’s doing is and how it works.

Nathan Armstrong: Yeah, well, thank you, Dr. J, for having me. It’s a pleasure and honor.

I think it would be a disservice to what we’re going to be talking about if we don’t explain how it really started back in 2003, that you developed, when I was a young boy, when you developed really the first working algorithm to what we call our core system today. And this functional interview that is so ingrained into what we’re doing with Esprē and helping patients ultimately experience wellness.

So, talk a little bit about that, and then we’ll talk about kind of what’s happening now.

Dr. J: Yeah. So back in the early 2000s, I became a huge fan of Jeff Bland and the Institute for Functional Medicine.

So functional medicine is amazing, but they had this huge questionnaire, which was so bulky, and it was just very, very difficult to complete. It took an hour or two for each patient.

And I got a tech team together, and we worked for two years, actually, to build an algorithm that would use a lot of those questions. But we also went to the medical literature and got all the validated questionnaires that made sense. So the Beck Depression Inventory, the PHQ-9, the Menopause Rating Scale, all these things.

We put them all together, crunched it all down, and built an algorithm that would be able to interview a patient and then be able to tell us, from the functional medicine perspective, what systems need to be supported and actually improved so that the patient, instead of getting sicker over time, will get healthier, theoretically.

And I think I’ve seen it prove out in real life. It’s hard to get better and sicker at the same time. So if we’re getting patients better, they’re going to improve globally. All their disease processes are likely to get better, and they’re likely to not get sick.

So that was amazingly effective up until this past—how long has it been? Maybe this last couple of months?

Nathan Armstrong: Yeah, easy. Yeah, within the last six months, for sure.

Dr. J: Yeah. And we’ve got hundreds of thousands of patients who’ve benefited from it, and doctors all over the United States are using it.

But we’re about to go through this next phase, which is just going to completely revolutionize the next step. So we’ve been at it for 20-plus years, but this next—we couldn’t have had this conversation months ago.

Nathan Armstrong: I mean, how fast—I just want to reiterate how fast technology is moving.

I know many of you listening, watching this now, understand AI and its role in this space, but I just can’t explain enough how important it is in our working environment today and the role that I get to play in making what he said, ultimately dreams of what you want to see happen, happen at a clip that we couldn’t have done six months or a year ago.

And so utilizing these newer tools with AI is allowing us to move at a speed that we could only dream of before. And that’s ultimately my job, is to come in and harness all the tools and resources that we currently have to be able to work with and make it work for us.

And we’re seeing that happen now at such a fast pace.

Dr. J: And I think the thing, too, is, like, I think most doctors think about AI like, “We have an AI scribe,” right? Which is like, it’s a dictation thing that’s been around for a long time. It’s not a big deal. Of course we have that.

“I have an AI that helps me find a diagnosis.” Well, that’s great. It’s fine.

We’re talking about AI that actually will interpret the interaction between the patient and the doctor. And it will also create an environment where that throughput from me thinking—I don’t have to hold all of the knowledge of every condition in my head. The AI actually puts all that together and presents it to me.

It’s not determinative. It doesn’t determine the diagnosis. It’s probabilistic, they call it. So it’s probably this. It may be that. Here you go, Dr. J. Here’s your options, right?

And that used to be something that was very, very—it was very simplified. It was real, real straightforward. And we used that data. Now we’ll probably use it forever.

But now we have this whole new layer of incredible, incredible inspection of all the literature in the world.

Nathan Armstrong: Yeah.

Dr. J: And we can prejudice it, bias it towards our approach, which is natural, low toxicity, no drugs if possible, the maximum benefit to the patient with the least cost. All those things together.

Which is just mind-blowing. You can get all of that together.

Nathan Armstrong: Yeah, and that’s where this is moving. Our system of Esprē is utilizing these tools to make you a better provider, make every person using it a better clinician, and ultimately seeing better results for the patient.

Because, you know, we’re utilizing our own LLMs, which is really just a large language model in AI world speak. And we’re able to harness these to be able to understand the connection, like Dr. J was saying, between the provider and patient.

So how you practice could be completely different than how you practice. And this system will understand that connection and be able to then give you information that you really need at such a helpful and quick pace.

Dr. J: Yeah. So, you know the Golden Rule, right? So the Golden Rule is like, “Do unto others as you would have them do unto you.”

The Platinum Rule is really where we’re going with it, where it’s like, I would have my thinking offered to every doctor, but they don’t necessarily want that. They would like their thinking to be predominant.

So if I was going to do unto others as I would have, that’d be good. But if I were to do unto others as they would like, that takes an incredible amount of knowledge. I have to know everything about them.

We do that for our doctors so that our doctors can actually speak into the system. The system can learn them.

My prejudice is to use diindolylmethane with a menopausal patient with an estrogen conversion problem. Somebody else might like I3C. Okay, our system interprets that. It figures that out. Okay, Dr. Smith likes I3C.

It’s absolutely revolutionary.

Nathan Armstrong: Yeah.

Dr. J: Everything else, it’s like it queries the whole internet. It says, “Here’s all your options in the world.” And that is something that now you have to go through all that reasoning.

But if you’ve already made a decision, like I have, that DIM is the right answer, I don’t want to be offered 17 other options. I want the one that I like.

Nathan Armstrong: Right.

Dr. J: And the way that we’re doing it now, it’s the Platinum Rule, where the doctor gets what the doctor wants, and that LLM is theirs.

Nathan Armstrong: That’s right. Yeah.

So we’ve been able to harness that and basically build a system that is completely siloed. And I think security is a huge part of this, right?

Like, I think a large part, as we get into the AI world and understanding how we can utilize it specifically within the practice environment, you know, HIPAA and PHI and all these things are really important.

And so we’ve been able to accomplish that in a very effective way. And I think that’s important if you’re using the system that is utilizing some of these AI scribe features and things like he discussed. Security and data integrity are really important in protecting your information.

Dr. J: Well, and I didn’t tell you this before we started talking, but I didn’t want any foul language or cussing, and you said HIPAA and PHI. You said dirty words.

But all of that stuff, it is so intrinsic to what we’re doing. Security—that idea, my fear very early in this was that we would develop proprietary information and people would take it and pollute it, and then the purity of what we’re doing would be affected.

That’s no longer a question. Now we have these secure environments that we can work in. And thanks to the way that we’re designed and how it all works, no patient data gets released. No data mining occurs.

And because of the AI, we can build really this incredibly intense, perfect system for each practitioner. Each practitioner has their own custom-designed LLM, which to me is like, that is the Holy Grail.

And they can also draw from all the other parts of the medical literature that they like. So if they really like the latest JAMA journal article, they can use it. And if they don’t find that to be the most effective thing, they can eliminate that from their feed, and that will not influence their decision-making, which is just incredible.

Nathan Armstrong: So I think this is just so exciting to be able to talk about where we’re at right now and where we’re about to go. I mean, it’s really, if you’re a dreamer, this is exciting, you know, to be able to envision what could be possible.

Dr. J: Yeah. And I’m super glad that we’ve done this for so long because I do have a really clear path.

I know that what we’re trying to do is empower the world to be well. Really give this away, like, so that people will be able to get the kind of care they want, the Platinum Rule for themselves. Doctors will be able to provide it.

And at the end of the day, that’s a very clear path.

But man, I don’t know what tomorrow’s going to bring because 15 minutes ago everything changed.

Nathan Armstrong: Yeah.

Dr. J: I don’t know what tomorrow is going to look like, except that our goals, our principles are the same. But the actual application of it, or the execution—we’re having a meeting this afternoon with a tech guru, and who knows what that will bring in terms of the next excellent step?

But I’m really excited about what we’re doing, and I just wanted you to meet Nate. And you can see behind the scenes who the real brains of the operation are.

I’m the experienced old guy, but he’s the young whippersnapper tech dude, and we’re having a great time doing this together.

I’d really like, if you haven’t really had the experience of Esprē, it’s different than any other EMR, EHR. It’s so beyond an EMR at this point. It’s an interpretive health record.

Nathan Armstrong: Yeah.

Dr. J: And we kind of own that name. And we’re the only ones, I think, at this point, who are doing custom LLMs for each practice. And all the other AI stuff that you read about, all that stuff’s easy and already incorporated and part of it.

So, if you have a complaint, take it to him.

Nathan Armstrong: Call me.

Dr. J: So, if this resonated with you and you liked the idea of doing something that’s really cutting-edge, it’s going to make a difference for your patients and you for the rest of your career, and changing regularly for the better all the time, check us out, EsprēHealth.com.

I think you’ll love it.

Thank you.

Nathan Armstrong: Thank you.