NerdMDs StackBytes #7

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🎧 StackByte Episode Summary (Ep #7 – “Confessions of a Former CMIO: I Was Wrong About Integration”)In this episode of StackByte, host Adam Carewe, a former Chief Medical Information Officer, candidly reflects on a major shift in his thinking about health IT. Once a staunch advocate for EHR integration, Adam shares why he now believes the future belongs to tools that are intelligent, not just integrated. He explores how generative AI is enabling standalone solutions that deliver real clinical value, sparking a move from traditional ambient documentation to intelligent clinical companions. Packed with hard-won insights and real-world examples, this episode challenges healthcare leaders to rethink their tech priorities. Dive deeper into the topic in the original Substack post: Confessions of a Former CMIO: I Was Wrong About Integration. [https://open.substack.com/pub/rewskidotcom/p/confessions-of-a-former-cmio-i-was?r=1n0gtg&utm_campaign=post&utm_medium=web&showWelcomeOnShare=true] 🔹 00:00 – Intro & SetupAdam introduces the theme of the episode—why he now questions the long-held belief that “integration is king” in healthcare tech. He sets up the context for his confession, rooted in his own leadership experience at Kaiser. “For most of my career I believed it with religious conviction… But here's the confession—I think I was wrong.” 🔹 01:20 – The Old Rule: No Integration, No DealReflecting on his time at Kaiser, Adam recounts how he rejected tools that didn’t directly integrate with Epic, even if they showed promise. Back then, integration equaled usability and adoption. 🔹 03:00 – Enter Generative AI: A Game-ChangerThe rise of generative AI has changed the equation. Tools like OpenEvidence now deliver high clinical value without being embedded in the EHR. He explains how this shift reshapes what's possible in digital health. “We’ve entered an era where a tool doesn’t need to be hard-wired into the EHR to deliver value.” 🔹 05:25 – The Problem with Integrated ToolsAdam shares his experience trialing ambient note tools that were seamlessly integrated—but underwhelming. Though technically elegant, they flattened clinical reasoning and buried key insights. 🔹 07:15 – The Rise of Intelligent Clinical CompanionsHe introduces the idea of tools that go beyond documentation—tools that listen, guide, generate notes, and offer decision support. At General Medicine, his team has already shifted to using raw transcripts and building intelligence in-house. “An intelligent clinical companion doesn’t just document, it guides.” 🔹 09:45 – Rethinking the PlaybookAdam warns that many healthcare leaders are stuck in a 2018 mindset, still prioritizing integration above all else. But the grassroots adoption of non-integrated AI tools by clinicians tells a different story—one of unmet needs and innovation. 🔹 11:40 – Final Thoughts & The Real QuestionHe wraps up by encouraging leaders to ask not only does it integrate? but does it deliver outsized value even without integration? The next wave, he argues, will be defined by intelligence, not connectivity. “The tools that win physician loyalty won’t be the ones that integrate first. They’ll be the ones that act as true intelligent clinical companions.” Get full access to Rewskidotcom by Adam Carewe MD at rewskidotcom.substack.com/subscribe [https://rewskidotcom.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4]

Ep 46 | "Aging While Caregiving" | Dr. Renee Dua | Nephrologist & Serial Co-Founder

Want to support Rewskidotcom Substack and the NerdMDs | Efficiency Unlocked Podcast? ♻️ Share this post with friends in healthcare🫰 Become a paid subscriber📢 Become a sponsor (email me)🌟 Leave a 5-star review for the NerdMDs | Efficiency Unlocked Podcast 🎧 Episode Summary: In this episode of NerdMDs Efficiency Unlocked, nephrologist and serial healthtech founder Dr. Renee Dua [https://www.linkedin.com/in/reneedua/] dives into the personal and systemic challenges of "aging while caregiving." From her pioneering days building a paperless medical practice to co-founding Heal and later Renee (a digital health assistant), she shares how her professional journey intersects with her personal experiences caring for aging parents. The conversation explores the invisible burdens placed on Gen X and Millennials, the financial and emotional toll of caregiving, and the systemic gaps in policy and innovation. Dr. Dua offers candid insights into the cultural, technological, and policy shifts needed to better support caregivers—without sacrificing their own health and future security. 🔹 00:00 – Introduction & BackgroundHost welcomes Dr. Renee Dua, introducing the episode’s theme of “aging while caregiving.” Renee recounts her path from practicing nephrologist to tech founder, including launching Heal, which grew to 13 states before being acquired by Humana. Her entrepreneurial drive emerged from a desire to amplify her reach beyond “hand-to-hand” patient care. “Everybody should receive care this way—kids, moms, dads, parents—everyone in the community.” 🔹 04:33 – Founding Heal & Transition to Caregiver TechRenee shares how building Heal was both exhilarating and all-consuming—launching in multiple states while raising her children. After Heal’s acquisition, she co-founded Renee, a health assistant platform inspired by her experience managing her father’s medical needs. She reflects on the inefficiency of humans doing tasks software could automate, and the deeper realization of how caregiving impacts one’s own health and finances. 🔹 08:28 – The Caregiving Burden for Our GenerationThe discussion turns to the everyday challenges caregivers face—monitoring recurring medical issues, coordinating logistics, and balancing work, family, and self-care. Renee emphasizes how health and finances are intertwined, and how these pressures compound when caregivers lack medical knowledge or support networks. “We are not able to both save for college and make sure our parents don’t keep falling.” 🔹 14:43 – Cultural Expectations & Uncompensated LaborRenee discusses cultural norms, such as the expectation in some Asian families that eldest daughters will care for aging parents. She points out that caregiving has been unpaid labor for so long that society assumes it should remain that way, despite its economic and emotional costs. She notes that startups in the space face a tricky go-to-market challenge, as neither employers nor insurers consistently see caregiving support as their responsibility. 🔹 21:24 – Policy Blind Spots & Certification BarriersRenee critiques the lack of robust caregiver policy across political administrations and questions why informal caregivers must be certified to be recognized or compensated. She suggests caregivers could be essential partners in closing care gaps—if health plans and policymakers valued their role. 🔹 26:02 – Global Models & InspirationFrom India’s multigenerational housing to Cuba’s community doctors, Renee outlines international examples of more integrated caregiving systems. She argues the U.S. could adapt similar models, combining cultural respect for elders with cutting-edge technology, but is hindered by a healthcare system designed to maximize profit over care. 🔹 34:28 – Looking Ahead: Caregiver Assessment & AIWhile still in early development, Renee’s next venture aims to use AI to assess future caregivers early in life, helping them prepare financially, emotionally, and medically before the caregiving stage begins. She stresses the need for proactive planning, rather than crisis-driven response. 🔹 38:29 – Nerd Alert RoundIn a lighter segment, Renee shares her love for morning walks and audiobooks (listening to 50–60 a year), her desire to master the stock market, and recent book recommendations including They Called Us Exceptional and Bono’s memoir. She also reflects on ignoring bad advice to “slow down” during fellowship—a choice that has shaped her rich, unconventional career. Get full access to Rewskidotcom by Adam Carewe MD at rewskidotcom.substack.com/subscribe [https://rewskidotcom.substack.com/subscribe?utm_medium=podcast&utm_campaign=CTA_4]

15 de ago de 202548 min

NerdMDs StackBytes #7

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