Is Your EHR Ready for AI? ChiroHD's Co-Founder Says Most Aren't

I think that AI is more transformational than most people think. And I think a lot of the ways that it's being used by companies right now is like just scratching the surface of what's going to be coming. Every year there's some new huge thing that we're trying to solve that like I have to put on a completely different set of skills. You are Gabriel.

Hey everybody, I am super happy to be joined by Gabriel, who's leading strategy over at Kyro HD. If you've been watching, you know that him and I connected a little while back. We're going to reconnect to talk about everything new at Kyro HD, some some of the exciting things that they're bringing to the table, and ultimately, it's probably a really good idea for you to have a conversation with their team. Gabe, I appreciate you chatting with me today.

Yeah, glad to be here.

It is my pleasure. Well, let's pick it up. I know this has been a year of change in software, and with Cairo HD, you have made some pretty big moves in terms of functionality, in terms of benefits that docs can expect when coming on the platform. Maybe I'll pick it up right there. Over the last few months, What's been new with ChiroHD?

Like you said, it's been a year of transformation. You know, I think as we've looked at like where we need to go in the market, the speed that we need to go, I'm sure we'll get to it later, but AI is changing, you know, the entire face of, of all software. We made the decision to bring in another CEO, so I stepped out of that seat, but I'm now leading strategy and really focusing on the, the chiropractic connection side of things and really making sure that the products and things that we're building are actually solving issues for chiropractors. You know, the business side is fun and like, you know, was a really fun piece of it. But at the same time, it also took some, you know, I really have been heavily involved in the innovation side of things. And as business has grown, I've been less involved. So this gives me an opportunity to really refocus that energy on innovation and what we're actually building, you know, and You know, we'll get into details, but, but AI is, is kind of front and center and everything that we're looking at right now.

Yeah. Let's dig, let's dig in right now. So I'll ask you two questions. One is how you are thinking about AI. And then the follow-up to that are what are some of the exciting projects either recently released or that you can talk about soon to be released?

Yeah, I think broadly on AI, I will say, I think I join the larger development community that's been very, uh, skeptical and hands, like, I wouldn't say against, but like watching with caution and trying to figure out where it's all going to go, what it's going to be able to do. I think if you pay attention to the market the last, especially 6 months, there's been transformational changes in the models that are out there. And it's really changing pretty much everyone's expectation of what's possible and how it's going to align with the future. So I think I will just say openly, I think that AI is more transformational than most people think. And I think a lot of the ways that it's being used companies right now is like just scratching the surface of what, what's going to be coming. So I think, you know, we're, we're heavily in the process of, of not just building what I would call table stakes features that are now just super common amongst EHRs, maybe not in the Cairos space yet, but you see what people are doing out in the space. We've— I think we talked a little bit about soap note transcribed things in the past, and I've got my own take on it, but I think we're, we're looking at— we will have some sort of scribe in the next, call it, quarter. Um, but I think that's a thing that initially was very resistant to, but I think the last time we talked, I even talked about why chiropractors are probably not going to use Scribes, and I think we've solved some of that. So I think I'm really excited about the Scribe stuff we're working on. Um, we are working on a virtual assistant, which again is very common, that is becoming more and more common every day with these things. So we're, we're going to have some of those just table stakes features, but I think we're really, um, looking a little bit deeper into not just features and functionalities, but what is what is kind of the future of AI and how does it sit in here? I think that's— I would be a little more vague on that one, but I think that it's just going to be a way more integral part of everything instead of just being like, I'm going to use AI for this one little feature. I think that over the next year you're going to see AI kind of come alongside everything and be pretty much integrated in every single piece of the platform to some degree.

I think that's powerful. I love to hear it. Regarding this, this is one of my favorite questions, which is what is a feature or benefit within ChiroHD that you love that you find is dramatically underutilized by docs using ChiroHD?

Yeah, so I think one of the ones, I was actually just looking at some of those today 'cause I knew we were gonna have this conversation. So, you know, I think one of the big ones is that we, I think it's been almost 2 years now, we rolled out our advanced dashboards, like reporting dashboards. And that's something that, that we, we just recently rolled out analytics on the platform so that we could see what people use, what they're looking at and stuff. And we see that one very vastly underused. You know, we have different pieces there. We have trend charts that kind of give you a picture, uh, month over month, year over year, uh, quarter over quarter that, that a lot of people don't pay attention to. It also breaks down things like, um, you know, uh, time of appointment. So if you're looking at, you know, how quickly you're getting someone from checked in to adjusted to checked out, like we have those metrics in there. We also have things like breakdown of income by referral sources. So, you know, who's making, you know, when you're looking at who's being referred into clinics, how they're being referred in, whether that's a Facebook ad or a personal referral, you can see like actually what that translates to and spend in your office so that you can optimize your marketing campaigns. But those dashboards have just a wealth of information in them. And we see just the very light usage on them. Um, so it's one of those things that we're trying to do some things to make everyone sure that they're aware that they're there. But they're great. They've got a ton of information. I think that's a very underutilized part of the system.

Yeah, analytics are so critical and so often overlooked, I think, by docs in practice. So that's a power feature for sure. You mentioned strategy and really your role as leading strategy within the CairoHD ecosystem and sphere. And my question to that is going to be, how do you think about EHRs and EMRs? And what makes CairoHD different? I won't ask you to throw any other companies under the bus, but clearly you keep your finger on the pulse of what's going on within this industry and in the broader context of EHRs and healthcare in general. Maybe just highlight some of how you think about implementation and how Cairo HD applies it in a different way than many docs are probably used to.

Yeah, it's a great question. I think, I think this field is really tightening, which I, you know, I'm not going to say we were— I'm not going to say we were causation, but we were definitely a catalyst. Like, if you look at when Cairo HD entered the market, what was available and what's happened over the last 8 years. You know, when we entered the market, we were really the second cloud-based system that was viable for most clinics. And now almost everyone's either in the cloud or about to be in the cloud. You see most people catching up there. We were really the first to have this idea of having everything in-house, and now everyone's trying to do the same thing. So I will say, like, the differentiation is always like a little— it gets tighter and tighter as people's competitive edge, uh, changes. So I think when I'm looking at strategy, first and foremost, it's serving the chiropractic community, their patients, their workflows. And they've got some very unique workflows. You know, I talk to people in other industries and in other sectors, and like, when I start talking about some of the complexities, like, their eyes glaze over. They're like, I have no idea how we would handle that. Um, case in point, uh, patient volume. Like, it's very unique to have, you know, clinics that see 100, 200 patients a day. Like, you don't see that in any other sector of— or I don't know about any, but very, very, very few places you're going to see that level of volume, which introduces all kinds of complexity, not just from scheduling but from insurance billing and recruitments and all these different things. Like, that now you're taking what, you know, a small medical office might see 8 patients a day, very easy to manage, 8 claims a day type with one biller. But now you're doing 150 claims a day for much smaller tickets. Like, there's just all these little things that compound complexity inside of chiropractic. So making sure that we're really focused on those nuances that make chiropractic a unique market and make sure that we're serving that well is, is like a really front and center thing. Um, and, and to your point, not a negative of those other EHRs, but a lot of them haven't thought through what that type of volume is. And you see that, that there's some that have solved it better than others, and you'll see that chiropractors tend to you know, if they're a high-volume clinic, there's— they tend to gravitate to one or two solutions because there really isn't a massive solution for it. But I think in the broader kind of outside of that sense, I mean, you know, I think security is a huge thing right now. I know we've touched on AI, but like the AI security breach stuff is only getting started. Like AI is a very powerful solution that's being used in mass attacks. So like, like we're really heavily looking at our security infrastructure. We're going through some, some additional audits and some certifications to make sure that we're We're top-notch when it comes to the security side of things. We're also paying really close attention to compliance as we start working with like AI tools. There's a huge host of compliance things that as people are wanting to, you know, everyone wants to use AI for this, that, and the other. And I've seen doctors like take patient lists and drop them into ChatGPT without proper licensing or HIPAA acknowledgments, BAAs, those types of things in place. So we're really close to the pulse on what's happening in the legal aspect of this and trying to make sure that as you start using these tools in RHD. They, they're used compliantly and reg— in, in under regulatory, um, duress. Yeah. Oversight, whatever you want to call it. Yeah.

That, yeah. I think that, that, that, that is critically important. And I'll say that's kind of the boring stuff that docs don't think about until they have to. So I think it's really nice that you guys are doing the hard work, not so they don't have to, they still need to be compliant, of course, at a practice level, but knowing, uh, that the software that they're relying on from a practice management perspective all day, every day is diligent with that is, is I think really, really important for so many docs out there, especially with so many different systems available. So knowing that your system that you're using, in this case ChiroHD, is going to give you every opportunity to stay as compliant, stay as secure as possible with what you mentioned, uh, an ever-evolving landscape, is really, really important. So for sure, if we were to look forward— let's have some fun— uh, if we're to look forward next quarter, next 6 months, um, what are some product roadmaps roadmap items that, uh, you're at liberty to discuss or hint at?

Well, I, I kind of— I've mentioned two earlier that I, that I will just reiterate, is that we are looking to bring a couple AI-forward features to the market: an AI scribe tool and then also a, um, a front desk receptionist. I think those are, um, definitely in, in the near term, like, we're doing beta testing with both of those, and I think that we'll see those come up hopefully in the next quarter. I do think our scribe solution is going to be one that chiropractors haven't seen from a scribe. So I'm really excited about how that gets rolled out and how it works compared to what's in the market. You know, chiropractors have a unique thing when it comes to scribes. Most, most chiropractors are not walking through an adjustment and giving detailed oration of what they're doing. Let me— oh, I see fixation around T5 and like, like they're just not talking that way with, with, with patients, which is a challenge when you're talking about scribes versus, you know, maybe a nutritionist who's literally sitting there and talking nutrition with you for, for 30 minutes. Yeah. So, so there's some interesting things there. I'm really excited to get that out and demo and show how we've approached this. I think, I think a lot of people are going to be really excited about it. And in the Hint world, I think I've alluded to a few, but I'll give you a little more pieces here is, you know, AI is incredibly powerful in certain pieces. Um, and, and one of the biggest friction points in ChiroHD right now is, is another unique thing about chiropractors is there is a million ways that they measure things. And, um, trying to get a million ways to measure things into a, into a deterministic system is incredibly difficult. And, uh, if you look at like our com— if you look at our backlog and our, uh, complaints and feature requests and things over the last 8 years, so much of it is around like more flexible reporting. And, and we've tried over the years to just continue to add more and more and more and more reports, and it just never seems to be enough. And people want to look at it in different ways. And I'll just say that I think that that problem is going to go away sometime this year.

So, all right, all right.

And in, and in a way that, like, we don't have to necessarily continue to build millions of deterministic type reports. So I think that's another big thing we're looking at.

See, I see the breadcrumbs. I like it. All right, when you think of the future of EHR, Do you think all-encompassing, or do you, do you see it wide or narrow? There's some EHR companies that are going the route of ensuring they have every option and can do everything for a practice. There's benefits to that. There's other EHRs that are becoming very siloed and saying, we do this and then work with external partners for the other aspects of it. How are you thinking about that at ChiroHD?

Yeah, this, this one's one of the more fascinating questions here because this, this is the most crystal ball question you're asking because it really, it really is making a lot of assumptions about what's going to happen with AI. And on not on the user feature side on how developers are using it, how we're using it to build platforms and applications and features. Because, you know, even a year ago, but I'll back up even further, 5, 10 years ago, like it doing everything is just incredibly difficult. Like it's really easy to, it's way easier to focus on a particular thing not, not split your attention. Everything is complex at scale. It's really easy when you've got, you know, 50 clients, but if you've got 10,000 clients, that even that one little thing is really hard at scale. 5 years ago, it would have been like the more narrow we can keep this, the better product we can deliver. And I do think that AI is changing that drastically just because it is so much easier to deliver code and product. And so you're seeing, I think that what you're going to see on the broader landscape for outside of PowerHD for a minute, is that you're going to see a lot of companies try to go wide really fast. They're like, well, we can build everything now. Let's just go ahead and try to build everything. I do think that the— that it's no longer— it's— I shouldn't say it's no longer, but it is less of a technical problem and now it becomes more of a visionary problem. Like, can you— can you see the vision of how all of these things work together fluidly, congruently, and what— what a unified product actually looks like? And I think that's where people are going to get a little clunky because it's really hard to look across, you know, I mean, even if you look at our platform today with integrations with external systems like GoHighLevel, and you've got, you know, Zapier hooks coming in and doing things a certain way, and you've got people asking for data out in a certain way, and you're connecting with third-party apps like Sked and all of these different things, and you've got all these ingestion points, and you're also worrying about patient scheduling, new patient scheduling, doctor's notes, insurance billing, you know, reporting and analytics, retention, like all of these things have just been so wide before, before now. And I think the, the people who are going to win are the people who can zoom out and see how like all of these things work together seamlessly. And I think so we, for us, I think we're going to continue to be broad for a little while. I think we're, and I think we might actually expand that reach a little bit. But I think we do have an advantage here because we've always been broad. That's one of the things that's let us go to market the way that we have is that we didn't focus on this one little narrow piece. So we've always had a vision of this larger platform. So I think this just unlocks our ability to move a little bit wider without losing depth in the company.

That makes sense. I'm going to wrap this up with two, two personal questions.

Yeah.

What's the hardest part of being a co-founder? Lead strategist at CarroHD?

I think that's a really good question. I think that again, this is like every— if you would have asked me that every year for the last 8 years, every year I would have given you a different answer, right? Because it's— then I think maybe that is the core answer is that the job's always changing, the problem's always changing. It's not like you just have to become an expert in this one thing and then you're just good. I feel like every year there's some new huge thing that we're trying to solve that like I have to put on a completely different set of skills. I have to learn new skills. I have to You know, I mean, even this transition going from the CEO seat to the, to this new seat in leading strategy, it's, it's, it's a transformational change of how I have to think about things. So I think just the, the, the, the immense amount of change is, is challenge number one. But specifically this year, I, I think it is AI. It's like we're, everyone right now is having to put on a, a little bit of, uh, uh, tin hat and Nostradamus glasses is what I've been saying to, is like you're, you're, you're really We're in an era that no one has ever gone through. There's transformational change happening in how everyone uses technology, how technology is built, and there isn't a plan for it. There's no blueprints. Um, you know, we, we, you know, we, we're inside of a PE portfolio company. You know, every company there is taking a slightly different approach to this. When we look out at the broader market, you see, um, all these big companies, Salesforce, Slack, Facebook, Snapchat, all releasing like, here's our AI strategy. We're laying off people. We're hiring people. And You know, like, I think trying to understand where this is going and get ahead of things is just, is a very scary thing because, and I'm excited about it. It's kind of fun because it's a problem that I haven't had to sit with before. And you, it really does require conviction and feeling really good about how, how we're looking at things and hoping that we're looking at things in a slightly better lens than other people are.

That is a very, very complete and fair answer. And I'll ask a counterpoint to it, which will be the real fun one. What's the best part of being one of the co-founders and leads of strategy at Cairo HD?

The best part is, is where we've gotten to from where we started. You know, like when you start a company like this, like you have a big, you know, apple pie in the sky idea of what it's going to turn into. But then like you start getting into it and like the, like the, the actual process is 10 times harder, maybe 100 times harder than, than I thought it was going to be. And so I think, like, it is— it's a privileged spot to be in where we're at, where we're big enough now where the things, the decisions that we're making are impacting not just a ton of offices, it's impacting patient care. We're starting to see that our decisions early on are paying off and improving office efficiency. We're getting ready to make some big investments in the research space, which if you've listened to any podcast to me over the last 8 years, it's been something that I've been really passionate about and we just haven't had the scale and size and scope to be able to to do what we really wanted to do. So we're, we're in that process of really starting to connect with the Life University Center for Chiropractic Research. We're doing some things to just start playing in the research space, which is really, really exciting and probably my number one initiative when I started the company. So getting to a spot where we're actually going to be able to play in some of that is probably the most exciting thing for me right now.

I love it. I really appreciate you taking time out of your busy schedule to chat. People listening and watching, if you have not connected with Gabe's team over at ChiroHD to at least have an exploratory conversation about how ChiroHD can positively impact your workflows each and every day, and ultimately your patient experience. Uh, you're missing out on a big opportunity, so take advantage of that opportunity. Click on down below, connect with Gabe and his team, have a conversation, see if ChiroHD is right for you. They are doing some big things in chiropractic with many more to come over the coming months. Gabe, I appreciate you chatting today.

Yeah, absolutely. Thanks, Jeff. I appreciate you.

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