From Hardware to Intelligence: Charting the Course for AI in Medical Device

Khullani Abdullahi (00:01.71) Welcome to the AI in Chicago podcast. I am very excited to have Dr. Heather McCombs with me today. AI in Chicago is hosted by myself, Khullani Abdullahi. I'm the founder of TechneAI, a AI governance strategy, policy, and enablement training firm based here in Chicago. in the Fulton Market area. So, strided the podcast to take our leading AI thinkers throughout the state of Illinois and Chicago more broadly, and to learn about the work that they're doing hands on. Dr. McCombs is a clinician turned enterprise leader. Her career trajectory is notably distinct. She started off in clinical practice as a doctor of Padaich- I'm gonna fix that one. Padi, can you say that for me? Podiatric medicine to a prominent leader in strategic AI initiatives within major healthcare organizations. Her foundational experience includes establishing and managing a private practice for over 15 years, growing into an eight figure revenue business before its eventual sale. She has an extensive clinical background, which gives her a deep understanding of patient needs. Heather (00:53.772) Podiatric. Khullani Abdullahi (01:17.646) and the intricacies of clinical workflows, as well as the practical implications of technological advancements at the point of care. This understanding has been invaluable in her current strategic roles, and it currently directly informs her approach to developing and deploying medical device and AI solutions that are not only technologically sound, but also clinically relevant, safe, and readily adoptable by health care professionals. So thank you so much for joining us, Dr. McCombs. You've had a unique background. You have a unique background. You've kind of gone through this transition from physician to business executive. And now you're leading AI initiatives in pharma, med device, enterprise organizations. The space is still very early. Can you walk us through that journey and how you arrived at this intersection of healthcare, advanced tech, and strategy? Heather (02:13.652) Absolutely. And thank you so much for having me today. It's a pleasure to be here. And congratulations on the podcast. Some great episodes that you've had preceding mine. And so a little bit about me. After practicing medicine for about a decade, I loved what I did clinically. I had grown the business. I was very entrepreneurial in thinking about what comes next and how to drive efficiencies, how to look at additional service lines, ways that we provided different types of referrals, wound care management, limb salvage, et cetera. And as I led our contract negotiations with healthcare providers and insurers, I started thinking about the need for an MBA because I needed to have more formal education in what I was learning as on-the-job training. So I had the opportunity to Khullani Abdullahi (03:01.207) Mm. Heather (03:12.482) do an MBA at Notre Dame. And it was a fantastic experience to experience the cohort of the executive program. And I made some wonderful friends from various backgrounds and disciplines of pharma, medical device, and many other industries, the beverage industry, for one, as we've seen expand in Chicago. And so I started thinking about Khullani Abdullahi (03:32.462) So. Heather (03:39.936) There's so much happening in the world. And I really was set on the trajectory of consulting, because how could I drive more efficient processes in healthcare in what was then really a very fragmented approach where we were not yet totally standardized on a single EMR. We have many different health systems that lack interoperability, patients fall through the cracks. Incidental findings are missed and how do you really think about as a consultant, know, McKinsey, BCG, various other Huron, how do you address that? So I started thinking about what would a career look like where I could leverage clinical experience with my newly honed MBA and really the framework of consulting and the matrix of how you think about problem solving. And so, you know, so many times we have problem solving, but it's theoretical. So actually being on the ground and having solved these problems was very interesting, especially living through a go lab of Epic in a hospital when we went from paper records to EMR that was digital. So I really thought about that. And it was interesting because I was contacted by a couple of Khullani Abdullahi (04:43.391) Right. Khullani Abdullahi (04:49.134) Thank Heather (05:04.204) companies to interview as I started looking. And one of those happened to be a large medical device company. And it was really strange because I didn't fit the mold. I wasn't an accountant where you could check 11 of 12 boxes and say, okay, everything fits. But I had this unique background and there was one leader who I flew down to Florida to meet and he said, I'd like you to join my team. And so, you know, I had a pharma offer, but it was more like a, well, we see you could potentially fit, but you don't have pharma experience. Now, discount the fact I've been writing prescriptions and engaging with pharma representatives for the last 15 years, but I really, really, this leader, this executive who I went on to work for for almost five years in various capacities, he really embodied the leadership principles. but also very forward thinking. And I learned so much and that was what was so helpful in making that transition because it was not only, I know you have the clinical background, but it was here are the problems we need to solve. And so initially I went into this large medical device company in a consulting role where we focused on our work with health systems. and we focused on taking what I knew clinically and applying it to drive efficiencies. And so that was where we started to see real world examples of cost savings when we applied efficiencies. For example, we were looking at interventional radiology and providers that preferred to do certain procedures or biopsies under a modality and maybe there were scheduling mismatches. or there were insurance prior authorization challenges. And so how did we actually build something that would level load a system so that you knew when the patient was ready to be scheduled, that the insurance was cleared and the scheduling and the procedure could take place. And then also the place of service was so important because when you're going to do an MRI for risk concern, unless this patient has many other comorbid conditions, the outpatient setting is just fine. Khullani Abdullahi (07:22.262) Right. Heather (07:23.874) You know, you don't need to take up your valuable inpatient space for this patient. But a lot of that was also awareness of the community and then how do you incentivize these patients? It's making the available, the appointments available more earlier so that the patients will be, they'll be incentivized to use the outpatient services. So we focused on that and then actually moved over. Khullani Abdullahi (07:27.948) more Heather (07:50.856) My boss was then appointed to be the chief data officer and data was an emerging field in 2018. It was really like, what do we do with this data? And we didn't have guardrails around it. We had HIPAA protections. We started to see GDPR in the EU, but what did we do? And so, especially as a medical device company, we produce a lot of data that we don't own. So how do we start to think about moving from just producing boxes and machines to the things that enable those boxes and machines to work faster and to deliver insights. And so that's where having this strategic leader and giving me the opportunity to develop my own leadership capabilities and leverage my skills really helped. to bring me to where I am at the crossroads of healthcare, medical device, thinking about pharma ecosystems to today. So that's... Khullani Abdullahi (08:56.034) Thank you. One thing that I think stood out in your comments is how important the right leader at the right time can be. If you could just share a little bit, you're a seasoned leader. What have you found to be those critical leadership qualities that are? valuable and necessary, regardless of the domain, the vertical someone may be in, whether we're dealing with AI or not, times of disruption like we are. What do you think is, what made that leader great? What kind of toolkit do you have in your own leadership bucket? Could we just talk about leadership? Because I think in our country and in the world in this moment, Great leaders are in higher demand than ever. And so being able to talk a little bit about that, would be useful, even beyond AI. Heather (09:45.312) Yes, and that's where I truly think the experience of having had several courses in leadership at Notre Dame and some of the books that I read, the lectures that I heard, the leaders I was able to encounter helped to shape that thinking. about hearing some of the stories, especially when you go back into some of the companies that were Khullani Abdullahi (10:00.366) Right. Yes. Heather (10:11.306) truly transformative in leadership, like GE with the Crotonville Institute, where you would have leaders who saw talent in their reports. And that talent might have exceeded what they themselves were capable of, but they were able to move that forward and to give those people that reported to them opportunities to grow and to develop. And I think that's what is so important to know that Khullani Abdullahi (10:16.28) Great. Khullani Abdullahi (10:28.172) Yes. Heather (10:40.064) You have skills that I might not have, but I want to help you develop and grow because I can help you reach a level that you can't get to without the doors I can open for you, but you're going to eclipse what I can do if I can help you get there. And so I think that is what's really the, maybe they term it, I don't know, servant leadership in some capacity, but it's really seeing that potential. that people that work with you have. And I had a wonderful team. I think that they were probably a little shocked. I inherited a large group of engineers in India in one medical device company. And there's a little bit the dynamics of reporting to an American woman was a little bit challenging. But I would say even to this day, years, years later, almost a decade later, Khullani Abdullahi (11:25.006) Okay. Heather (11:38.172) I am still in touch with many of them. I'm not at that company. Most of them are not either. But I see their milestones, their children, the graduations, the things that are important to them, and write the recommendations. Just see the family vacation pictures. But the way that I think we built that relationship was the cultural understanding that we you know, we had differences. And for me, it was, I could do my meetings on Sunday evening. It was fine. You know, it made life easier for them. They gave a lot. They worked hard. And so flexibility and also the recognition of small things meant a lot. had a team in the U.S. and you manage them differently than than those folks. And so I really think it's looking for the Khullani Abdullahi (12:27.138) Yes. Heather (12:35.092) individuals that you can help to thrive in their own leadership capabilities and then also giving the stretch assignments. I have one of the gentlemen who reported to me, it was just such a nice thing because he went through so many challenges with his mother dying and his son being born, his wife was a surgeon and they moved to Dubai, being able to get him a transfer from India to Dubai. Khullani Abdullahi (12:43.448) Yes. Heather (13:04.022) to still work for me. And then, you know, he was so grateful for that, that he really, you know, it just developed so much generosity of spirit that I knew I could give him these opportunities and he would certainly take them and run with them. So I think that also looking for where you can... Khullani Abdullahi (13:25.496) Yes. Heather (13:31.67) Perhaps embed someone on your team to collaborate with another team where they can get cross experience and they can start to have more visibility in the organization so that that can help them with additional opportunities. Khullani Abdullahi (13:46.124) I mean, I think the thread is like, help identify, work to identify amazing people, understand that they're humans in a context, lead with empathy, and then give the, you know, when you give the right people the right opportunity. They'll thrive and so will the organization that you're leading. I hope to see more of that across the board, right? I think leaders shape entire communities because that ripple effect goes back to their teams, their homes, their families, and their cities. Switching gears a little bit to kind of your early work in developing new data platforms. You emerged in your career at the time that we were talking about big data and predictive analytics. and no one was really thinking about AI or deep learning or generative AI. So in the world of big data, in the world where you're working with cross-functional teams in multiple settings, how do you navigate... partnering with both your internal teams and external teams as you're dealing with complex AI and digital transformation. From a consulting perspective, one of the tried and true. statistics is 80 % of digital transformation efforts fail, right? And they don't necessarily fail 100 % of the time, but they fail to a large extent. And that clearly wasn't the case in the initiatives you worked on. So tell me about kind of the cross-functional stakeholder building, consensus building, tactically, what do you do when you're given a large digital transformation initiative that doesn't exist yet? Khullani Abdullahi (15:30.466) but that now needs to be implemented. Heather (15:31.318) Well, that's a really good question because it took a lot to get the stakeholders to buy in. And just giving you a broad example, in a large medical device company, there were verticals. So every vertical was collecting their own data for the products they would build. And we saw this transformation start to move away from hardware into software and software that then Khullani Abdullahi (15:41.249) Mm. Khullani Abdullahi (15:48.675) you Mm-hmm. Heather (15:59.744) The early days we were calling, the early days of AI we were terming digital. And so in this digital software, each of these verticals was looking for their own data sources. But we found that many of these data sources could be overlapping. They could serve more than one vertical, but each vertical had their proprietary relationships. So the leader that I referenced earlier, who was so transformational in my life, he was quite a visionary. Khullani Abdullahi (16:04.365) Right. Heather (16:29.382) And he proposed, why don't we think about a consolidated effort to put into place agreements that allow the entire company to benefit. So these various verticals can all draw effectively from the same well. And so this was one of the initiatives that led to a large transformation in how we started to approach the digital product or the early AI product building. And because of that, we set forth the opportunity for these verticals to obtain their data and to spend less time, effort, and energy looking for it, contracting it, and doing all of these bespoke arrangements. Rather, it was all under a single arrangement, a single agreement. And so that helped to expedite the collection of data. and then allow them to focus on the development and then subsequently the products that would go to the FDA. Khullani Abdullahi (17:30.688) Excellent. In large enterprise organizations, the silos are significant, as you know, and there's fiefdoms and leaders of the silos. so kind of multi-stakeholder, like collaboration and building, you had the vision and your team had the vision. On the ground, did this look like one-on-one meetings with the vertical leaders and then kind of meeting with the directors? because getting buy-in to a cohesive, unified vision is a human problem. It's a human relation problem, right? Like the technical stuff I think is often easier to solve. And so tactically on the ground, what did that look like? Was it lunches, dinners? Heather (18:17.172) yes, it was a lot of individual meetings and it was a lot of trying to deliver small wins. So the small wins to get buy in and also identifying the executive sponsors who buy in from them would cascade through. So that was probably a year long endeavor. And it truly it was relationship building. Khullani Abdullahi (18:23.286) Okay, tell me more. Khullani Abdullahi (18:32.576) Yes. Excellent. Khullani Abdullahi (18:40.556) Wow, just relationship building. Heather (18:45.692) And that's where I think coming from having been in practice and having dealt with patients, their families, also the other physicians that I took care of patients for, there was a strong ability to build relationships and to try to identify what's important to that person. And how can what serves the goal of a unified data platform be Khullani Abdullahi (19:04.397) Right. Heather (19:14.934) beneficial to this person and how do we position it so that their needs are met. And then when we go to another business vertical, how do we take the wins from group A and highlight those to group B because they all know one another. So it's very important that you're consistent and that you deliver in order to ensure that you have the goodwill from one business unit to pass on to the next. Khullani Abdullahi (19:28.651) exact. Khullani Abdullahi (19:40.886) Excellent. It's almost internal consulting, right? And your client just happens to be your internal colleagues in those different verticals. I'll just recap for our audience, I think, some key takeaways here, right? So even though we're dealing with digital transformation and we're dealing with complex technology, the core of... being an effective leader in this space and in this time is really understanding who your interlocutors are, getting in front of those stakeholders, building those relationships, and then being mindful of data to show them how you're driving value in their vertical to get by it. Whether it's, and that takes a lot of meetings, I think people over rely on just sending emails and PowerPoint presentations and saying, well, clear, here's the arrow, the arrow is going up, therefore you should say yes and the project should kick off, but understanding that there's a real person on the other end of this decision and then being able to walk away from that encounter and then build something and come back and share is really critical. So you have been fortunate and I think very much in line with your own training and expertise, right time, right place, right skills, and now you're in leveraging your background and work to partner with AI vendors, to build these unified AI ecosystems, and to take medical device solutions from just hardware into this intelligence universe. Something you and I talked about off camera, off the podcast, was we were talking about the evolution of precision medicine. I've been thinking about that a lot. You said something that I'd love for you to share here again. In this AI ecosystem, how are med device companies finally having their precision medicine moment? How has that emerged? What does that look like? And do you think that that is actually the case? And if so, help make the case for med device finally having its end of one capacity to treat patients and improve clinical outcome. Heather (21:49.922) Well, you know, this is just an exciting, transformative time in healthcare. I mean, when we think about being able to look at tumor genomic sequencing and to match therapies, to find a patient that is eligible for a trial, to understand what the genomic mutations are, and potentially the next stage to be able to predict what those genes that have not yet been expressed. will express and how we can start to think about the therapies that we need as physicians in order to treat. It really speaks to a whole transformation in healthcare. And medical device plays a role in this from the standpoint, if we think about our imaging capabilities, our monitoring capabilities, you know, we are a piece of this ecosystem. Khullani Abdullahi (22:41.454) Mm-hmm. Heather (22:47.412) And we're an intelligent piece of the ecosystem with AI because we're starting to use the AI in our scans and in our monitors that will give us better insights and also identify critical findings earlier. And when I say critical findings, I'm not referring to a stroke. We can identify a brain bleed on a head CT. But I'm talking about the nuanced findings that are pixel level when you're thinking about a CT or an MR. And they don't show evidence of disease at this time. And we might not see them without the aid of AI. And it might be a couple of years before anything manifests as a patient. So this is where it's such an exciting time. And we look at medical device. Khullani Abdullahi (23:30.816) Right. Right. Yeah. Heather (23:41.91) We look at pharma, we look at the AI companies, and we think about this as a broad ecosystem where there is an interdependency and each one plays a role and there's a need for each one in the same way that we think about the patient, the treating physician, the radiologist, the pathologist, the pharmacist, and the specialist who's managing that condition, whether it's oncology, neurology, cardiology, whomever factors in. And so there are these little ecosystems around disease states. And I am just so excited that in medical device, we are able to play this role and have smart scans, smart monitors. And you know, for example, there is something now, I don't know if you've seen the stethoscope that actually has a three lead EKG in the stethoscope. And so when you see when you use it with your patient, you can open the iPad and you can show your patient what you're seeing. And then it will identify the arrhythmia that the patient may have. And so these are happening in the community setting. So you think about rural healthcare where a primary care or nurse practitioner may be the only healthcare that the patient has access to for a hundred miles. And you're able to identify these findings early so that the next action may be putting a Holter monitor on the patient so that they are monitored for any other arrhythmias, may need an echo, but you're able to catch this before there's a critical event. And that's where these devices are coming into play. that's just an example that I like from having seen it in the community. Khullani Abdullahi (25:34.744) Yes. Heather (25:35.01) And of course we have our large scanners that are hospital and outpatient imaging based, which give us really deep insights. But I think it all comes together to drive that precision care. And when you look at companies that are pulling it all together, maybe that are taking tumor specimens, and they're pulling from the chart, from the actual lab specimen, and they're really giving the guidance to physicians, our patients are in such a such a better state today with the advent of technology to have improved outcomes due to AI and digital transformation. Khullani Abdullahi (26:17.091) I love it. I am familiar with rural care in the cardiovascular space. And I remember that for a lot of rural patients, it can take 60 days before they can see someone who can even effectively diagnose or treat an arrhythmia. And so being able to move the site of care closer to rural patients and also increase the access of clinicians in those settings to have state-of-the-art AI diagnostic capabilities through those devices is very powerful because it should cut that 60 daily time down to a week, right, which also increases the likelihood that they'll have a more successful outcome. This bridge between medical devices, software, physicians, providers, health plans, we're seeing a lot of vertical integration. We're seeing, for example, UnitedHealthcare group is the largest employee we are physicians in the country, we're seeing the lines between the different industries kind of blur. As this continues and as technology improves, how are you seeing physicians respond? How are you seeing... health plans, medical device companies, how do you see these different stakeholders in healthcare in America start to think about their different roles and how their roles are evolving and changing? Heather (27:47.746) So I think physicians, especially the ones that are in training now, are using AI. And they're using AI from ambient scribe technology. actually Northwestern just published an article in the JAMA's open publication class, I believe it was two weeks ago, where they showed significant. Khullani Abdullahi (27:53.996) Yes, you do. Heather (28:17.442) So ambient scribe technology is being used all over. And it was Kaiser that published in New England Journal of Medicine's Catalyst online edition, I think it was the end of March, their use and how it impacted provider burnout. And it gave providers a sense that they were practicing medicine again by reducing the administrative burden. And surprisingly, patients were really not bothered by the ambient scribe technology because they felt they had their providers' attention. And so you looked at the hours that were saved and the providers that used it. There was really no differentiation in that study from how long they had practiced. It was more adopted in the specialties that required high documentation, so psychiatry, primary care. Khullani Abdullahi (28:52.952) for the first time. Heather (29:14.846) social work and cardiology and ER. And so it was really transformative and we're starting to see significant adoption of that. Also, we're seeing it in radiology and this is where Northwestern, which is in our own backyard, just published a study in the JAMA Open publication about the efficiency that their auto reading of chest X-ray is driving and how it's reducing burnout. So I think from a provider standpoint, especially those providers that are in training now and are adopting AI, they're really starting to see a benefit. Of course, there's skepticism. We're not yet at the point where we want AI to make our diagnosis, but we do want it to show us the red flags that we should look at. And in order to... draw our attention to things that we may not have seen with our own eyes to bring it there. Now in terms of health plans, I think we always get a little concerned when health plans use AI because as we've seen some states have banned the use of AI for prior authorization to deny claims. And we certainly don't want AI to be used nefariously to prohibit patients from receiving well-needed care. So I think the jury is still out on how they will use that. And we have seen a lot of challenges come down from UnitedHealthcare in the last six months. Khullani Abdullahi (30:43.192) Okay. Khullani Abdullahi (30:52.898) Right. So it's still kind of fast moving, evolving space. How do you, just an aside for a moment. So you mentioned two recent articles. You're not a practicing clinician, but you're still reading the journals. How are you finding time to maintain your clinical expertise, maintain your digital innovation, AI expertise, be still a full human, a wife and a mother and a daughter, right? Congratulations on your daughter's recent graduate from her Georgetown MBA. All of this while also working full-time job. What is it that you, how are you structuring time? so that you're remaining abreast of the trends, the data, the information that you need. A lot of senior leaders are struggling with that balance because they're needing to learn more than they've ever had before. But it sounds like for you it just happens throughout your day and week. So do you have time set aside? Walk us through how you're maintaining your expertise and increasing it. Heather (31:55.24) So that's a really good question because balance, we're in an era where we have information overload. And sometimes you feel like if you take a weekend off, you're going to miss something. So we all have fear of missing out, but it's also fearful of being left behind because the pace that AI is developing is happening so quickly. And so I read several journals. I subscribed to a number of publications that I receive online and so every day I'm getting the headlines of what I'd like to know more about and those are the ones I peruse. Usually I bookmark them and I save them for evening so while my husband and I are watching Netflix and reading the journal. So, because most of the time those don't actually need full attention. So. Khullani Abdullahi (32:40.332) I love it. Heather (32:48.374) But this is something that I really thrive on, and I love to see how innovation and change is happening. And also, you put yourself so many times in the shoes of the patient, and you think about, wow, this is completely transformative. Then as you think about being an administrator or in a position of leadership, how this will impact a hospital or how it will impact a medical group. Do you have reimbursement? Has reimbursement been assigned for use of an algorithm? Or have the clinical guidelines changed and will that drive additional use? Because we saw in 2021 use of CCTA with heart flow and the FFR. How is that going to change our exploratory caths in our vascular labs? What's happening? And you really kind of start to think about the implications of reimbursement. where it will cause the next cascade of clinical drivers. And I think one of those that we're going to see now is the evaluation and management of liver disease, where we've started to see CMS apply a dollar amount to a reimbursement code. And we're starting to see pharmaceuticals come through to treat MASH and MAFLD. And so this is really a transformative time in the treatment of liver disease where we've not had agents to treat this. We have one now and it's been incredibly transformative. So then you think about how does medical device play into that to help identify these patients because this has been a silent disease in many cases. And so I think the balance is you try to save some time on the weekends. I usually work on Saturday afternoons and then spend a couple hours Sunday evening working. But I really, I enjoy what I do. Khullani Abdullahi (34:46.606) Seven days a week, I just want to be clear. Khullani Abdullahi (34:53.72) feel like work too in many ways. Heather (34:55.912) No, it doesn't. And I have a wonderful husband who's always happy to listen to something that I just read. Khullani Abdullahi (35:01.132) love it. You get to process in real time. One of the things that you mentioned, I think is important to highlight. part of the shift towards these two. Heather (35:04.256) Yes, exactly. Khullani Abdullahi (35:15.788) towards the more availability of intelligent solutions embedded in devices and software and diagnostics in general is a transformation in hospital cost centers and hospital revenue centers. And some of the efficiencies that organizations like you and your leadership drive will transform revenue centers and either reduce the revenue hospitals get or increase their costs. And I think there's some policy changes that will have to happen because revenue costs and reimbursement are all really based on a model that doesn't take into intelligent care, right? It was human-based manual care and Heather (36:01.269) Yes. Khullani Abdullahi (36:02.526) How do you get reimbursement for being smart enough to negotiate a contract with the right medical device company that allows you to risk stratify 80 % of your population and keep people healthy and then therefore now none of that revenue of those in-office visits and the risk stratification that happens manually, all of that revenue is just gone. All of those sites of treatment are transformed or disappear. So there's. Yes, we're trying. Heather (36:32.672) Well, I don't think we're there yet. I think we're still, that would be the goal that we can keep people very healthy, that they don't need to have anything done, but we're a long way off. So with AI, the way that we are seeing it implemented in healthcare is two ways. One is it drives efficiency and efficiency does not come with a reimbursement. Efficiency is just the savings that you get from Khullani Abdullahi (36:43.426) Yeah. Right. Khullani Abdullahi (36:53.4) Right. Heather (37:01.728) being more efficient. And so that is, again, our scribe technology. We're seeing it with appointment scheduling, with the chatbots or the AI agents that are working through MyChart, or when you call to make an appointment, you may be connected to a chatbot or an AI agent that sounds very realistic. And they'll triage your call, give you an appointment, answer your questions, or transport you over to a nurse if you have an Khullani Abdullahi (37:02.926) Right. Heather (37:30.964) of something that is not written out in their capability to handle. And so then we also see that efficiency being driven in revenue cycle. But when we look at clinical decision support, this is where we start to see a lot of the reimbursement. And reimbursement has only been applied to a small number of primarily radiology and cardiology codes. And that is for Khullani Abdullahi (37:55.064) various. Heather (38:00.59) the identification of preserved ejection fraction in the presence of heart failure with an ECG or the biomarkers that are used in liver screening on MR. And then we see it again for the example of heart flow with their FFR plaque analysis. So we still see that number being pretty small. And I think as we start to have more patients, that are going in those directions and that are being identified, probably start to see those reimbursement dollars come down because the pie is only so large. But again, I think the reimbursement also helps to change clinical practice. And then we start to see the efficiencies. Like for example, when Khullani Abdullahi (38:49.026) Right. Heather (38:54.238) it takes no physician value or no physician work to obtain a measurement or to perform a stress analysis, then the reimbursement for that goes away because it's the simple push of a button and AI does it for you. So it's a very fluid time right now and it will be interesting to see over the next five years where the value drivers are for adopting AI because it does add a cost. Khullani Abdullahi (39:06.082) does. Heather (39:23.562) And there are costs as well to the hosting because this is very much cloud-based. And so you have the storage cost and the operating cost for a health system. Khullani Abdullahi (39:38.092) And the reimbursement and the regulatory policy framework always lags behind, right? So the adoption of the technology is going to continue to move rapidly. But earlier off camera, I was saying, I hope you run for office. And it's explicitly for reasons like this, right? Leaders like yourself who understand those intersections can help accelerate the much needed updates to reimbursements in American health care across the board simply because that lag, I think, can be catastrophic for rural hospitals and underserved communities. Like the Kaiser Permanentes of the world are gonna be just fine, right? But the vast majority of community health hospitals, those reimbursements are life or death, right? And so being able to ensure that... the advancements and adoption of AI is both feasible for them, but that it also doesn't hurt the hospital's bottom line. It'll be very interesting. so here's hoping that physician, executive leaders who do clinical and industry will be a part of that conversation. As you think about vendors and the role that they play in partnerships and ecosystem building. Do you think that the shift towards AI and the initiatives that you've been leading have increased the desire to partner, have increased the desire to build in-house, have increased the desire to acquire companies? How are you thinking about build Khullani Abdullahi (41:20.494) partner, acquire strategies for vendors and partnerships in general as you layer on additional intelligence layers to the medical devices. Heather (41:36.982) Yeah, that is definitely an evolving space because, you know, it really drives home, what are your core competencies and where do you invest your R &D dollars because what are you strategically very good at as a value differentiator? And so I think it forces us to look at partnerships because we have a vast ecosystem of early stage companies that do have regulatory clearance that are smaller, that are myopically focused on a particular workflow initiative or a disease state. And so that's what they have been focused on while in larger medical device companies, we've really had an overview of the entire landscape and we've been focused on many different areas. So it Khullani Abdullahi (42:16.61) Thank Heather (42:32.542) behooves us to think about how do we partner to take advantage of the fact that they know the space really well. And so that's where also leading to strategic alliances, joint ventures, potential acquisitions, those are all, think, on the table because we're in a space that's evolving very quickly. And, you know, we are also in a space where we're learning. Khullani Abdullahi (42:39.182) Right. Heather (42:58.978) But these are not native to us because we know what our domain is. again, when you find some, when you see some of these companies that are so singularly focused on one particular area and they do it so well, it doesn't serve you to go try to copy them. It's better to partner with them. Khullani Abdullahi (43:23.278) How do you, so in terms of the nitty gritty of evaluating companies, what do you look for as an enterprise leader when selecting partnerships? Are there specific metrics, performance key metrics, KPIs, leadership teams, data that they have, infrastructure that they use? What makes you comfortable partnering with small organizations who are are by nature less resource, not very enterprisey, probably don't have SOC 2, or maybe they do. What are those evaluation metrics so that people know what they need to build in order to partner with an enterprise org? Heather (44:09.132) So I think it's the transformative technology and it's the regulatory clearance. So we look at a lot of companies that are with breakthrough designation from the FDA indicating that they are doing something that is transformative. Also having gone through the regulatory hurdles indicates their commitment to their own future and survival and to the product that they're developing. Khullani Abdullahi (44:13.079) Okay. Okay. Khullani Abdullahi (44:25.55) Right. Heather (44:36.554) Also, what does their financial stability look like? Who are their backers? How do they partner? Because that all becomes very important. We'd like to partner with someone who we expect to be around for a long time. I featured recently internally a partner that we've had since, I believe, 14 years. And so one of the leaders in a particular care area space that has focused on helping us identify patients with early stage cancer for 14 years. And it's a very productive relationship. But that's something where we like to think about someone who's not a flash in the pan, but also from a technology standpoint, how do you interact with what we have? Because we have customers that Khullani Abdullahi (45:12.494) about. Heather (45:29.516) have on premises and we have customers that have cloud. So we're in this world right now where we have to accommodate both the on-prem versions as well as the cloud versions. And so a lot of the earlier companies have gone just to cloud, but we still have to have them be able to adapt to on-prem because our customers have not fully adopted cloud yet. So we're in this hybrid environment. And then, Khullani Abdullahi (45:45.71) Mm-hmm. Khullani Abdullahi (45:51.918) Right. Heather (45:56.05) With the workflow, think it becomes so important and we don't see this, you and I from the outside, unless you're really in it, we don't see that one extra click or going to another screen and doing it multiple times every day is really, really a burden. And so you have to actually think about how you're going to do an interface from a technical perspective that is seamless. and that already integrates with the user's environment and doesn't slow down the work that they're doing by additional GPUs or Khullani Abdullahi (46:28.066) Right. Khullani Abdullahi (46:36.17) new software, standalone software, right? I think you're speaking to the fact that even if you have the greatest technology ever and it's very innovative, if you can't get the end users, the clinicians in the hospital setting to use it willingly and enthusiastically, Heather (46:39.925) Yes. Khullani Abdullahi (46:58.54) and integrate into their existing clinical workflow, you're going to run into problems. I will say, as somebody who has worked in commercialization, very few companies who are building think about those steps until they arrive at the implementation, and they realize, my god, we have to customize this because Kaiser doesn't have the same workflow. Heather (47:18.86) you Khullani Abdullahi (47:23.242) as dignity, right? Or Catholic health charities. so like thinking through and understanding that care in America is provided across these 8,000 hospitals, 8,000 plus hospitals we have in America in very distinct ways. Do you have a heuristic or mental model for the process that you go through for evaluating vendors? You start by talking to the founders? Do you go look at their publications? Do you look at their FDA filings? Because I think there are leaders who are now responsible for the kind of work that you do and that you just start. You open up your laptop and you go through that process. But I want you to walk me through that process because that is a decision-making model. And it's a heuristic that you have that I'd love others to learn about and think about and see where they can add it to their own decision-making framework. And then also for vendors to understand how they're being evaluated. Heather (48:25.396) Exactly. So internally, when I work with our business units, it's a discussion about what's on your roadmap and what are you thinking about? And then also, how are clinical care guidelines changing? And so when you think about what you're developing, where do you need external capabilities to ensure that you have a full complement of solutions on your device? Khullani Abdullahi (48:30.498) Mm-hmm. Khullani Abdullahi (48:34.03) Mm. Heather (48:53.47) your piece of equipment, you know, in your cloud, whatever it happens to be for appropriate business unit. And so then it becomes, okay, what are the companies in this space? And so I start to look at the analysis of those companies that are operating in this space. And I really look first of all at those with the regulatory clearance, because in the areas of the world in which we operate, it's very important to have clearance already. Khullani Abdullahi (49:22.754) Right. Heather (49:23.388) And unless you're truly transformative in your breakthrough and then I look for the FDA and what is really unique, but it becomes regulatory because that's a big hurdle. And so with regulatory, we know that studies have been done and then it's studies. Then we use internally some of our own key opinion leaders to analyze the results of these studies and to review them, give us their opinion about them. from the domain expertise that they fall into. We have several meetings with them to understand where are you, how do you integrate. And again, to your point, some of these fall through the cracks when they realize they didn't think about how they would integrate. But most of the time, you'll have folks, especially in this day and age, who have come from one of the larger companies. And so they know that workflow is important. And they'll be either cloud agnostic or a Khullani Abdullahi (50:06.232) Right. Heather (50:18.05) they'll work in various forms of PACs or various AVW systems with an API connection. or Kubernetes, or they're going to Dockerize to fit wherever they need to go. And so then I think once we have evaluated, the first step would always be the clinical to ensure that we felt comfortable with the clinical match, that it fits the need and that the validation is in line with what we. we're comfortable with. Also then it's the technical, can we integrate this? What does the lift look like? Do we need to rebuild our product to do this? Then it's a no. But then it becomes the relationship of the commercial. the commercial, a lot of times I think when you're looking at a company where you have a 96 % and a 97 % AUC on their results, but the 96 % is much easier to work with. Khullani Abdullahi (51:12.354) Right. Heather (51:17.794) they'll be much more collaborative. We may have the clinical folks saying, oh, but we are 1 % stronger over here. You're both FDA cleared, you're in a margin of error, and you have to then think about what are the commercial terms that can be obtained and what is the future of this relationship look like? Because you also meet partners who have had a success and they will say, here's how I work, take it or leave it. And that may not bode so well for Khullani Abdullahi (51:24.334) Right. Yes. Yes. Khullani Abdullahi (51:44.173) Yes. Heather (51:47.806) a future long-term relationship when they show some inflexibility. So I think you also have to gauge that the team that you're working with understands your needs and may be able to also in new versions create some additional features that you may need to have from your customer feedback. Khullani Abdullahi (52:08.482) Right. One of the... I've spent, as I've shared, I've spent a lot of time on the vendor side. And I've always had the most success when I approached strategic partnerships and just vendor relations as not just a transaction, right? And I think what you're really speaking to is it's not just a transaction, right? Like we may be embedding and integrating your solutions into our devices and our products, but it's not just, I'm going to give you a check. want to be able to share Heather (52:26.785) Mm-hmm. Khullani Abdullahi (52:41.488) share feedback about future products and features that you're developing. And also, I think to your point about inflexibility, I've been at the table where that kind of conversation has happened. And to your point, it doesn't bode well because it ends up creating this dynamic that enduring renewals, because contracts have to be renewed and renegotiated, right? And so keeping that, I think, in mind and having a long-term perspective for relationship building. for the strategic partnerships, again, I it can come down to the human layer. After we've solved the regulatory hurdle, after you've cleared the clinical efficacy and key opinion leaders have signed off, there is some other, I think, qualitative metrics that are equally important that you speak to in terms of what is a long-term strategic fit and how do we create value. Has the way that you think about value changed over the years in terms of Heather (53:23.266) Mm-hmm. Heather (53:34.21) Yeah. Khullani Abdullahi (53:41.358) In the enterprise setting, whether it's on the product side, the solutions that you provide, or is value just kind of like for strategic initiatives, how are you thinking about value? Like what is the business objective criteria that you're using to kind of prioritize initiatives? Heather (54:06.375) So I think the business criteria would be budget and the ROI and can the margins that the business vertical sets be obtained with this partner. if if, you know, case is paribas, we have everything equal, can we obtain the commercial terms from company A versus company B? And so then we're, Khullani Abdullahi (54:16.556) Mm-hmm. Khullani Abdullahi (54:24.013) Okay. Heather (54:34.368) really facing how do we determine where we get the margins that we're looking for. Because ultimately we do have to generate revenue for our shareholders. And so that's one thing that we have to think about delivering care for patients, but also continuing to operate a business and that balance of being able to bring safe, effective products to market. Khullani Abdullahi (54:45.741) Right. Heather (55:01.228) but also with the partners that we work with doing it in an ethical, responsible way through the use of hardware, software, AI, agents, all of these various capabilities. But at the end of the day, we do have to deliver results. And so my view has changed when I worked at a large OEM. I had a dual reporting structure with the head of strategic alliances and learned a lot when I helped build the pharma digital business there. And this was after months of working with McKinsey on how did we find space in this area and find an opportunity? Where was the white space? What could we focus on? And where was the value proposition? And what I think I really learned from him was building on the relationship. management that we spoke about earlier, because it's so important to get the contract, to get the signature on the contract, but that is just the beginning. And the relationship starts then, and it's being able to anticipate challenges or problems. And, you know, even though I look across the ecosystems, it's still being able to be the person that someone reaches out to and try to anticipate how we can solve before something reaches a crisis point and we don't want to sacrifice a relationship for something that really could have been addressed a month before it snowballed into a problem. Khullani Abdullahi (56:41.87) There's just so much there in terms of how you're prioritizing key conversations, key initiatives. Clearly there's a lot to juggle. As you look across the landscape of healthcare, AI, digital innovation, and all of the emerging, I think the pace of the changes has accelerated. What are you most excited about? What concerns of any do you have? any predictions you have. Forecasting is really big right now and everybody is wrong, but some are more wrong than others. So we're not going to hold you to any of your forecasts or predictions, but I'd love for you to share kind of what you were thinking, well, if we had this conversation in two years, what would the world look like? Heather (57:34.786) So I think in two years, I hope we have the guardrails to continue to have ethical use of AI and we don't let it get out of control. I hope that we continue to use it as supporting mechanisms and we don't rely on it and our society uses it as an aid rather than a substitute for education. So I think that I'm really happy to see medical education incorporate the use of AI and how we think about it, how we can design clinical trials around it, how we can start to predict patients that are going to respond, how we can really drive precision medicine through AI. I just think that there's this tremendous burden for society to use it in a responsible manner. Khullani Abdullahi (58:28.864) Right, and thread that needle. Heather (58:31.806) Yes, and I think in two years we'll probably start to see a lot more targeted therapies and probably a lot more indications for use for existing drugs when we're able to identify through AI, through the use of real world data in retrospective analysis of patient cohorts where we can start to drive better outcomes for future use. Khullani Abdullahi (59:00.782) Excellent. You are based in Chicago, raised your family here, lived here. Do you see any key advantages for Chicago, Cook County, Illinois in general when it comes to health care and AI? We're, I think, very strong. Health care is a large portion of Illinois' GDP. What do you think that means for our city and state and the ecosystem? Are you optimistic about continuing to live, work, and invest in this area? Heather (59:37.154) Well, that's a loaded question, given some of the challenges we've experienced. So I think we are very fortunate to have University of Illinois, Northwestern, Rush, and the Advocate Network, also the University of Chicago, because we have such a center of development, R &D, and then we have world-class physicians. Khullani Abdullahi (59:42.294) Yes. Heather (01:00:07.074) clinical trials and just incredible breakthroughs that are happening right here in our city. And it's very exciting to see that. I feel so fortunate to be so close to Northwestern with some of the programs that are world class. The DREAM program that they have that is the only one in the world where they're doing the lung transplants. It's just, you know, it's a really fantastic city to be in. We have pharma out in the suburbs that is continuing to develop. So I think if the city can manage to get the taxes and the crime under control, it can really flourish. And we have a vibrant startup environment, especially focused on life sciences. And we see that I've been involved with Matter for a number of years. Northwestern, University of Chicago, and University of Illinois all have their startup. Khullani Abdullahi (01:00:38.679) Yes. Heather (01:01:05.794) and it's nice to see the support and also from companies that I've worked with at Matter, seeing them go on to be acquired by large corporations. I love one that was a waterproof cast, just coming from my background with having put on a lot of casts in my life. And so all of these innovations that are happening, And we have just a very, very vibrant, supportive community here. And I think Chicago gets a little bit overlooked as we think about both coasts, but it is a rich startup environment. And we've done a lot to attract companies to bring their headquarters here. And one of the companies that does get tremendous recognition now is Tempus. And so... Khullani Abdullahi (01:01:43.469) Yes. Khullani Abdullahi (01:01:58.062) Mm-hmm. Heather (01:01:59.294) I think as we start to again talk about precision care, Tempest will only continue to be more important and the fact that they're here in Chicago does again lend support to Chicago being a hub of innovation. Khullani Abdullahi (01:02:12.354) Right. Lightning Round for Chicago culture. Do you have, and maybe you won't want to reveal your hidden gem because then they won't be hidden, but do you have a particular restaurant that you and your husband and your children like to enjoy in Chicago that has just kind of been your go-to? Heather (01:02:35.206) absolutely. It's Ricardo's up on Clark Street. the Inotica is on the east side. So the Trattoria is on the east side. The Inotica is on the west side across the street from one another. So one has a pizza oven and one doesn't. Khullani Abdullahi (01:02:38.595) We'll have to kind of. Khullani Abdullahi (01:02:46.83) I split. I love it. Okay, excellent. It is Chicago summertime. What is your favorite Chicago summer pastime? Heather (01:02:59.33) So I love to walk on the lakefront and that's probably my favorite weekend past time to get up early on Saturday and Sunday morning and go for a long walk. Khullani Abdullahi (01:03:02.721) Yes. Khullani Abdullahi (01:03:09.058) I love it. And then, you a deep dish or thin crust Chicago pizza fan? You are thin crust. Is that true for your whole family, Heather, or just you? Heather (01:03:15.659) I'm a thin crust. Heather (01:03:21.92) I think it's the whole family. I don't think we can take that amount of cheese. Khullani Abdullahi (01:03:24.558) Any last thoughts that you would like to share with our audience? Heather (01:03:33.506) I appreciate the time today and I am just so excited to see that you're opening up and broadening the horizons for what's happening with AI in Chicago. And I think it's nice that you're covering all industries because this is something where it's very much a buzzword right now, AI, but when we think about the transformative impact of something like chat GPT, and you can find out the answer to Khullani Abdullahi (01:03:59.256) Bye. Heather (01:04:03.188) a lot of your questions. Now it may not be the correct answer, but this is really transforming our lives. And we've been using AI on our banking apps. When we talk to Alexa, this is something that impacts our lives in many ways. so understanding it, using it, not being afraid of it is really important. And I think you're doing a great service by shining a light on it through various industries. So. Khullani Abdullahi (01:04:31.946) Excellent. Thank you so much. I appreciate it. Heather (01:04:33.622) Continue. Khullani Abdullahi (01:04:36.312) Thank you so much, Dr. Heather McCombs. This has been very enlightening. think that our audience will really enjoy it, especially because you got down into the nitty gritty with some of the details about how to think about solving these really important problems, framing the problems properly, and then developing a strategy to kind of solve these initiatives. So thank you so much for your time. I appreciate you taking the time. Until next time, you can access the podcast on Spotify and Chicago. I'm Kalani Abdullahi with AI in Chicago, and I will talk to you soon. Thanks.