A Trillion Small Problems (ft. Andrew Gostine)

What are one or two key skills that you believe have helped you to get to where you are and you look for in other people?

If people can't communicate, it doesn't matter how smart you are. It's really hard to be successful. And I realized again, like, why is nobody in healthcare using all of the amazing technology we have? Being hyperfocused on that problem solving and having other people to, to really push you forward is what sustains you when everyone is telling you it won't work.

Welcome to Digital Voices, where healthcare and life science leaders explore the real work behind transformation. This podcast is about people, leadership, and the conversations that move healthcare forward. Now your host, Ed Marx.

Welcome to another edition of Digital Voices. Thank you for tuning in. I know you have a lot of choices, so much great content out there. I listen, watch a lot myself, and you chose us. And for that, I am thankful and we'll make the next 30 minutes worthwhile because I have the amazing CEO of Artesight, Dr. Andy Gostin. Andy, welcome to Digital Voices.

Thanks for having me here.

Yeah, this is going to be so fun. We just met through the industry in the last couple of years, seeing each other around. We talk to each other and it's always interesting, you know, watching new companies emerge and do good things. But the most important thing, Andy, as we get rolling here, the most important question is what songs are in your playlist? What kind of music do you like to listen to?

So I, yeah, I was thinking about this. I actually went and checked my Spotify this morning in preparation for that, and my entire playlist has been taken over by my daughters. I have 3 of them, and the K-pop Demon Hunters album has been played on repeat. So it's a lot of pun tricks right now.

I saw the, when I was like on Netflix, like the top 10 movies right now, it's always demon hunters of some sort. So, yeah. And what about life message or mantra? Are there words that sort of guide how you live?

Starting a company is a very complicated thing. It's, people think it all comes down to one really grand idea or something like that. It really is solving a trillion small problems. And if I've ever been unable to answer the question, which is my mantra, what is the next step? I know there's an issue. And so I'm constantly asking myself and our team and our advisors and investors and our clients, what is the next step? And universally, if someone cannot answer that question, they're either lost Someone's lying to us. Uh, and so I constantly ask that question. It is my favorite question to ask.

I like that. That's good. At some point, we have a playlist for all the music, uh, on Spotify called Digital Voices. And at some point, we are going to do all of the mantras as well. And, uh, that, that's a good one. And I think that's the first time that I've heard that one out of 331 episodes.

Let—

Eddie, let's talk about you. We already know a little bit. Not only are you a founder and a doctor, but you have 3 daughters. Tell us who you are. Like, what's your story? Like, where did you grow up? Just start from the beginning.

Yeah, so I grew up in Grand Rapids, Michigan, which was a phenomenal place to grow up. I was really lucky that we had a really kind of high-performing class that I ended up in grade school and high school with. I think something like 18 of the top 20 of us ended up as physicians, and I think there's a lawyer and a chemical engineer. So it really was a phenomenal place to grow up. Um, you know, running Artisight, a little bit more difficult to do it from Grand Rapids just 'cause the airport's always a connection. So, you know, I ended up kind of throughout my journey of, of doing college in Boston and then went to medical school at Georgetown in DC, took a little bit of a detour, uh, for business school, which really kind of set the tone for the rest of my life. I was always in and out of medicine, even now. And so, you know, I went to business school. Realized in business school that there was something called artificial intelligence and you could predict things with it. And, you know, got back to medical school and I was like, why are we not using any of this here? So much of this is probably predictable. Why, why are we using humans to try to figure out what's going on? So I then started my residency at Northwestern here in Chicago, where, you know, a month after getting here, I met my future wife, which kind of created an anchor point here. And during my internship, I was very fortunate to match into a transition year where I had 22 weeks of vacation as an intern, which is unheard of because most of them get 3 weeks. And I was so bored after coming out of like a dual degree program that I realized I had to do something to fill my time. And I started a consulting company to validate either hardware or software solutions for health systems. And a lot of those companies ultimately on the strength of the research we were producing for them would craft their sales strategies and then go raise capital. And some of them turned out to be unicorns. And the venture capitalists would always ask them like, who's doing all of this validation for you? This is great. And, you know, oftentimes we were the first kind of entry point to the hospital for them. And that got me an interview with a venture capital fund and I left residency again, you I kind of left medicine with that foot out the door and I went and did venture capital at Jump Trading, which was Jump Capital, the division inside the high-frequency trading firm. And there we were tasked with shaving a microsecond off transaction times with the stock trades that the traders were doing to try to essentially do what's called high-frequency trading. Well, we ended up doing that by investing in military-grade lasers and low-orbit Satellites, really cool stuff. And then I went back to residency and they gave me my pager back and I realized again, like, why is nobody in healthcare using all of the amazing technology we have outside of here where this industry's focused on a microsecond communication? And in healthcare, like, I may never get a response from a page. It just, there was 18 generations of technologies, you know, in between where different industries were functioning. So it was about that time that, you know, I started realizing there are so many problems I want to solve. There's no way I can do this internally. And now that I understand how venture capital works, this is really a recipe for me kind of branching out. So I, you know, I finished up my fellowship at Stanford and while I was there, bumped into one of my classmates who was working at Google on computer vision, got connected to my co-founder who was a physicist working at CERN. And ended up assembling a team to solve a lot of the problems that I was frustrated by in practicing medicine and figured out if they were my problems, they were probably problems that other people had with healthcare. Uh, and turned out then when COVID hit, all those problems made people want to leave healthcare and it really was the perfect time to adopt AI. So I've just been kind of on this windy, twisted, turned path to starting a company.

That's pretty amazing. Was there a pivotal moment in your life? that fundamentally changed your trajectory? It could have been, you know, whether how you got into healthcare, how you got in tech, whatever, from life, just in general.

You know, I've kind of been on a one-way track. I think looking back on it, it would be hard to pick one. But ever since a young age, I've just been so interested in technology. I would say almost to a disservice that I ended up in healthcare. I have always been building things ever since I can remember. I woke up with anxiety one day, I think in 4th grade, because I thought the world was going to run out of electricity. And my dad took me to a marine store and we bought a solar panel and I put it on my roof, connected it to a battery, and started to get interested in alternative energy. And from there I was on a one-way track of just building things. Nobody ever told me engineering was a thing.

Yeah.

And I was sitting there with a dad as a physician and a nurse for a mother, thinking that the whole world, the only thing you could do was be a physician or a nurse. And so I ended up going to medical school because I like to say I didn't know any better. Nobody told me that engineering was a specialty or a field. And at Boston College, we didn't have an engineering department, I think until like a year ago they got one. And so I, I would have been better served as, I think, an engineer, or at least it would have been more intellectually stimulating for me. But it really has just been, I was always going to do healthcare, I was always going to build things. And then I got lucky with, you know, a path through residency and medical school that allowed me to get a different perspective.

Pretty cool. Andy, you mentioned your parents. Was there ever something that they made you do when you were a kid, you kind of like rolled your eyes, maybe not in front of them, but behind the scenes, but looking back now, like the story you just shared with the solar panel, you're glad that they kind of made you do it?

Uh, yeah, I mean, I, I probably rolled my eyes on a daily basis. It, it just kind of the entrepreneur mindset. You always think you know better. But I would say, uh, you know, I credit my mom this, like she was the one, and I had a very successful father who was a phenomenal entrepreneur, but my mother was the one that was like, you're gonna work hard. And I remember calling her in college the night before my music final, and I, I couldn't be the least I may be the least musically gifted person ever. And I remember the night before the final telling my mom, like, mom, I really don't want to study for this. I'm exhausted. It's my last final. I just want to go home for Christmas break.

Yeah.

And she said, don't you dare. You're going to study and you're going to get an A on this. And she's always pushed me to just never give up, work as hard as I can. And that, that is exactly what you need. To start a company because there are a trillion times where giving up is definitely the easy thing to do.

Yeah. Andy, yeah, it sounds like you had great parents as mentors. Was there another person in your journey that sort of helped you see who you could become as you're kind of going through this process?

I would say the investors, probably one of the bigger ones is John Kammet, who's the private equity real estate investor, founder of RealTern. Starting a company is, again, it's an impossibly difficult thing. There's not a lot of people that do it. Society, I think to some extent, kind of idolizes entrepreneurs like Elon and Bill Gates, and appropriately so. It is a very difficult thing and most people will fail. Being connected and surrounded by other successful entrepreneurs who have done it, that kind of sustain you with like, no, you're going to get this done. You're going to be able to do this. You have a better vision. You're executing better than everyone. Is really what you need because there, there's 1,000 people for every 1 person that will tell you you're gonna be successful and that you can do this, that will tell you like, you're, you're a sellout, you're doing this for the wrong reasons, you're, you're just trying to make money. When the entrepreneurs universally, the successful ones start companies because they wanna solve a problem, not because they want to be wealthy.

Yeah.

And so being hyper-focused on that problem solving and having other people to to really push you forward is what sustains you when everyone is telling you it won't work.

Pull back the curtains a little bit and give us some insight. I know there's not a typical daily for you. I'm sure it changes. Every day is a new adventure and you're always finding something new and always asking the question, hey, what's the next step? But give us some insight. What is it like to be this entrepreneurial CEO of this company? And I, by the way, I run into your stuff all the time. I'm in a hospital at least once a week. And someone's showing me their stuff, your stuff. So yeah, tell us, well, what's daily life, you know, to the best of your ability to explain that?

Well, you know, this new year, so today I worked out for the first time in about a year, so that was good. So I'm trying to turn a new leaf there. But I would say that there's probably different categories of CEOs. There's CEOs that are marketing CEOs, CEOs that have finance backgrounds. You know, I still practice medicine for a reason, which is that I want to be very close to the products and the problems and what the solutions need to look like. So I spend a lot of my days really making sure we can finance the development of the products that I want to see in existence. And I am heavily involved in the product side of our organization. Now, to run large enterprise sales, I also need to be involved in that. But I would say on a daily basis, I'm spending at least 50% of my time Looking at the products, making sure they solve my problems, talking to nurses. I'm, I'm on call tomorrow, an advocate for 24 hours on labor and delivery. I will be talking to the nurses about how smart hospitals can help them. And so it, it really is just making sure these products solve my problems and the problems of the people I work with. So it is heavily just product involvement every day. Beyond that, we're a fully distributed company. We have employees in, I think, 38 or 39 states right now. We're just kind of coming up on 200 employees at this point. And so with that, it's making sure that we can stay a remote company and that communication is flowing, making sure that we don't burden people with unnecessary meetings, making sure that people get connected with the other people in the company that they need to talk to. So I kind of consider myself the backstop on communication. across a distributed company. So it's kind of a lot of quarterbacking from that perspective as well.

Yeah, no, that's super interesting. And yeah, it'd be fun, kind of the shadow of a CEO and see what that sort of like daily life is. But yeah, all the different facets of the business, like you're describing. Tell us to the extent that you can, obviously you don't want to share competitive, you know, too much information, but what are one or two objectives for Artesight in the next couple of years?

Yeah, so there's a lot of cool stuff happening, and with the accelerations in artificial intelligence and transformers and compute, and even Jensen yesterday at CES released another generation of GPU. For us, it's really bringing all of that together. Where Artisight really exists and we have no competitors is in the applications of unsupervised or self-supervised learning in a hospital environment in a HIPAA-compliant manner. And so there's seemingly endless use cases there, and that's where I think I'm really an appropriate CEO for this company, is translating that technology to solutions for problems that I know are real clinical problems that need solutions. So big things that you're gonna see come out this year, are really kind of all in the artificial intelligence aspects. So we've been doing things like remote nursing and video streaming. That's kind of table stakes for our industry. What Artesight does, you're going to see 3 major categories. We make predictions. And so we have kind of a general purpose prediction engine that one of my co-founders published in Nature. I like to highlight that we published how to use a large language model In healthcare a month before ChatGPT came out. And so before all of a sudden the whole world became experts on LLMs. So you'll see more prediction engines, which really help us figure out like what type of monitoring does a patient need? Do they need a fall prevention algorithm? Do they need a pressure injury prevention algorithm? And so, you know, like economics, we want to allocate these types of resources to the patients that need them most. So prediction engines. You're gonna see a lot more in the form of computer vision where our self-supervised learning has now educated our computer vision monitoring to detect over 200 different events in the patient rooms and operating rooms. So this is not just fall prevention or pressure injury prevention, it's understanding like how often are we doing oral care? Did we get SCDs on the postpartum woman in room 14 to make sure she doesn't get a blood clot? So there's a ton of intelligence coming out of that. You're going to see a lot in terms of our ambient documentation, especially with big partnerships like Microsoft to support a lot of the ambient documentation the major EMR vendors are doing. A lot of that is built on top of Microsoft, and we support Microsoft with getting them the metadata about who is in the room talking, what they're saying, and sending the audio streams to Microsoft for speech-to-text analysis. And then lastly, the big category you'll see is a lot of our agents. And so you'll never make a digital nurse, you'll never make a digital doctor. And I think if people are chasing that, it's inappropriate. I think it undervalues and underrecognizes the value that humans contribute to healthcare. But there are certain tasks that God knows a nurse or a physician don't want to ever do. Like, I would love to never do medication reconciliation with a patient ever again and asking the little old woman, you know, do you still take this pill with, you know, the purple coloring on it? That just takes forever. And so having agents that can have these conversations with patients that will be literally more patient with the patients to have those conversations and get all of the information is kind of a big push for us this year. And we've already started to test those in beta and have had phenomenal results with them. So it's really just doing a lot more with the existing hardware foundation that we put into all of these hospitals. And because we're the only vendor in this space that puts a full NVIDIA GPU into our devices, we're doing all of this analysis in the patient room. We're not streaming the data to a server that is unknown location.

Yeah.

It is all about doing this in a way that protects not just the patient's privacy, But the clinician's autonomy to practice medicine.

Yeah, no, I love that. That's really good vision. Any other thoughts on smart hospital outside of what you all specifically do, but in general, like if you had a crystal ball looking forward 3 years, you know, do you think, what other areas do you think might be, you know, transforming?

Yeah, so I would say, you know, to put it into a sentence, what my vision is, is I just hope before I die, That there is at least one hospital that doesn't have a keyboard and a mouse in it. Oh yeah. I just, I never want for clinicians to be the equivalent of courtroom stenographers.

Yeah.

It's what's burning everyone out, the loss of autonomy and the incessant requirement to document everything. I wouldn't even say it's twice. It's like 3 times I'm documenting everything that I'm doing in the hospital. And so that is the overall goal. is to eliminate the keyboards and mice. And there's plenty of companies that make keyboards and mice. And I'm sorry that you're going to have to find a new product to solve.

Hopefully.

But we, we have literally worked backwards from that to build the thesis of Artisight.

You know, it's funny and I know everyone can relate to this because it still happens today is the clipboard. So I, I just today as we're recording, I'm looking at some stem cell regenerative type medicine for part of my ailing athletic body. And I did everything online and I was like, maybe finally one of these health systems has cracked the code. I'm always so hopeful because— and I can't say too much, but I had a lot of influence in this particular health system. That's all I'll say. And that was years ago, setting them up for the future. And so, I was like, okay, come on, they got it now. But sure enough, I walked in there and Andy, I'm telling you, I filled out everything online, like 10, 15 minutes of doing that and still handed me a clipboard. And worse, they asked me the same questions. I'm not talking about questions to verify who I was. I get that. But no, the basic questions like your pharmacy, your preferred pharmacy. I'm like, I entered that all in your system a week ago. It's crazy. Here's another crazy thing. I haven't shared this yet with anyone. I'm going to release it now. I was going through, I was cleaning, one of my chores during the holiday was to go through thousands of books in my library, like get rid of some and all kinds of stuff. And I saw this one. It said Building Artificial Intelligence. That's the byline. It's Rethinking Smart Objects. So it was during object programming when that phase came through, and it had artificial intelligence in the title. And I'm like, what year? It's 1999. 1999. I'm going to look this guy up because this guy, I hope he's still alive and I'm going to contact him. Daniel Rasmus. I'm going to be like, man, you were onto something. Obviously AI has been around since the '50s, but really not talked about very much. So I was like, just shocked I had a book on that whole topic. Anyways, yeah, we have a long ways to go and yeah, I'm with you. I'm sure it'll be before you die. that we'll see all this kind of things happen. So let's talk about leadership, which has really been the theme, I think, since the beginning of our conversation. What are one or two skills in addition to, so this curiosity as what is the next step? What are one or two key skills that you believe have helped you to get to where you are and you look for in other people?

You kind of hit on one there. Curiosity about the next step is very important, but I would say by far and away, more than intelligence, which Absolutely helps. You know, we love having very smart people on the team, but it all comes down to communication, communication, communication, communication. That's why I spend so much of my day just focused on, does everybody know where we're headed? Does everybody have their task list? And so making sure we have the appropriate systems in place to operationalize the vision of Vardicite. It really comes down to communication, and if people can't communicate, It doesn't matter how smart you are, it's really hard to be successful. Now, building something like a smart hospital is not something you can do with one person, you know, and I, we're all kind of waiting to see, will there be a billion-dollar company where there's just one person? I think we're still a ways from that. Certainly for what Artisight's doing, coming up on 200 people, if you can't communicate, then it's going to be very hard to get output.

Yeah.

You know, in excess of the cost of that person. And so it really comes down to communication. Like you, you need to function well as a team, especially if it's going to be a distributed company where I'm not forcing everyone to be in the same place at the same date and time.

Yeah, I think that's really good. Yeah. Communication is super key for sure. So what about something you've learned the hard way? So was there something along your journey that just made you like, uh, kind of double down on how you got through this?

I've sometimes inappropriately taken my medical school training to running a tech company. And in medical school, they will teach you, you know, it's always shared decision-making with the patients. Don't be maternalistic or paternalistic and tell them what they're gonna do. It, it really is. Again, a communication problem where you work with the patient to figure out what is the best outcome for them, and then you figure out the path there. That is not how you run a tech company. That is not how you build smart hospitals. You don't tell the hospitals who are just coming new into this industry and are otherwise, don't have all of the knowledge they need to make the decisions. You don't tell them, You know, you can pick any camera, you can pick any TV, you can kind of choose your own ending of how this rolls out and plays out and how we integrate it. It is overwhelming and it is a recipe for disaster. And so even though we've had hospitals tell us we want to be hardware agnostic, we don't want to use a specific camera because we don't want the vendor lock from it. What we found is that there really isn't great OEM hardware out there to do this.

Yeah.

And so we've had to build all of our own infrastructure. And despite wanting to be a pure AI and software company, we've had to also become a hardware company. And we need to take the decision-making process away from the hospitals and show them, similar to how Epic does it, you will do this like this by this time, or there's a delay. And the more prescriptive we get, the less, you know, we treat this like a patient-doctor relationship, the more successful we've become, the more scalable we get, the better the outcomes the hospitals have. And so it really is kind of unlearning a little bit of that medical training to function more like a tech company and less like a physician trying to participate in shared decision-making.

So Andy, obviously you're super busy being CEO and you've got this great family, 3 daughters. Where do you go to find rest? Or if you feel like your creativity's been drained, what, what do you do to sort of renew yourself?

I would say that it's probably a tie between 2 things. So hanging out with my daughters, you know, there are a lot of interesting parallels to teaching algorithms, you know, and having them become more knowledgeable and also, you know, teaching humans and my daughters and educating them about the world. And there's just a lot of fun that you get. I know as a father, you, you, you totally understand that as well. Personally, like in terms of what are my hobbies, I could have spent this entire podcast talking to you about home IoT, energy optimization, and chemistry. You know, there's a ton of parallels between pool chemistry and anesthesia. There's a ton of ideas that I get from building home automation. You know, I'm a big IoT user at home and use Home Assistant to write a ton of automations for my house and have really now almost made my house completely carbon neutral, which is really fun. So, you know, I kind of just get lost into doing more kind of automation developments, which gets me closer to the technology and gives me new ideas of like, why don't we do this in the hospital? Why are the lights on all of the time? And so I get a lot of inspiration too from just tinkering with stuff around the house.

Yeah. Eddie, you're pretty cool person, which I'm glad we had you on Digital Voices. We talked a lot about sort of the playlist with K-pop and Demon Hunter specifically, your message mantra, which came across The entire time of our conversation, what's— hey, what's the next step? We talked about growing up in Grand Rapids and just having a great mom and dad helped you along and how you came into healthcare and merged with tech. And we talked a lot about Artesight, what's it like to be CEO, some of the goals for the next couple years and where you think smart hospitals are going, technology. We talked a lot about leadership, like key qualities like curiosity and communication. We talked about like Just spending time with family and tinkering and working out, all sorts of stuff like that. Um, something that your parents taught you along the way, which also came throughout everything, is, you know, work hard, push yourself, uh, don't shortcut anything. What did we miss, or is there anything you want to double down on? I'll give you the last word.

I really think healthcare is, is a phenomenally difficult problem to solve and make it better. It's only going to get better if doctors and nurses and other hospital employees participate. And that, you know, the reason that we've seen big tech over and over again fail in healthcare is because they don't understand the workflows. And if the physicians and nurses don't participate in that process, don't start companies, and don't have a seat at the table, then we're going to get a whole bunch of solutions that don't work.

Yeah.

For our workflows. And so I guess my big ask is really that more physicians, more nurses, more PAs, NPs, everyone, respiratory therapists, that they all participate in the innovation process, or we're going to end up in a system forcing us to practice a way that really doesn't work for the workflows.

Well said, Andy. Thank you for being our guest on Digital Voices.

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