What’s holding healthcare back, and how can technology break through? In this episode, Dr. Reza Mirza, a rheumatologist and co-founder of Strelo Health, dives into the top challenges facing healthcare technology today and shares actionable solutions. From his unique journey as an aspiring zoologist to a leader in AI integration, Dr. Mirza sheds light on tackling administrative burdens, improving patient care, and overcoming lengthy waitlists.
10:42 Challenges in Healthcare Technology Adoption - Exploring the barriers to integrating technology in healthcare and strategies for overcoming them.
16:37 Future of Medicine and Technological Innovations - Discussing groundbreaking advancements shaping the future of medicine.
22:14 The Era of Cure in Medicine - Examining how medical breakthroughs are transforming chronic disease management into curative treatments.
27:31 Navigating Medical Legal Risks - An overview of the common legal challenges faced by healthcare professionals and how to mitigate them.
33:09 The Future of Healthcare: AI and Beyond - A dive into how AI is revolutionizing patient care and what lies ahead in healthcare innovation.
39:11 Privatization vs. Public Healthcare - Debating the pros and cons of privatized versus public healthcare systems and their implications for patients.
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Transcript:
Dr Jordan Vollrath (00:01.133)
All right, today we're talking to Dr. Reza Mirza. He's a rheumatologist, internist, and assistant professor of medicine at McMaster University. He's been published in The Lancet and has authored multiple national and international guidelines. He's a co-founder of Strello Health, a startup integrating AI into the clinic to manage the administrative and backend burden of running a clinic, including phone calls, scheduling, and paperwork. Dr. Mirza, thanks so much for joining us today.
Dr Reza Mirza (00:28.383)
thank you so much for having me, Jordan. It's such a joy being here.
Dr Jordan Vollrath (00:32.397)
So you've been all over the place, like academia, like clinic, dealing with the weird and wonderful and the zebras, technology and AI. What did you want to be when you grew up? How did you actually get to this point?
Dr Reza Mirza (00:47.522)
That's a really good question. When I was a little boy, my dream job was to be a zoologist. I was like, I want to go in like study animals. And then I don't know, at some point, think my mom convinced me that I was never going to make money as a zoologist, and I should be a lawyer. And I wrote my LSATs, and I got good grades, and I was about to apply to law school. And then suddenly got cold feet. And I just realized that I never want to do like a lifetime of paperwork.
Little did I know medicine's tons of paperwork, but way less than being a lawyer. So that was sort of the path. then, yeah, just kind of, know, technology just seems to be so advanced. And rheumatology is cool because we have so many new drugs that leverage technology. So I think it's kind of a mix of all that.
Dr Jordan Vollrath (01:34.519)
And then how does the epidemiology side fit into everything then? Cause that's definitely like also another big aspect of the training and the background.
Dr Reza Mirza (01:38.509)
Wait a
Dr Reza Mirza (01:43.884)
Yeah, yeah. So I've done a lot of epi training and I still do a lot of work in epidemiology and guidelines. I think it's just a matter of fact that I went to McMaster. We've had this really big epidemiology program. My master supervisor is
Gordon Guy, who's like the king of evidence-based medicine, he coined the term, in fact. So I just happened to go to a lecture by him in med school, and then I was like, this guy's really smart. I'm gonna go talk to him after class. And I spoke to him, and he's like, why don't you do some research with me? That was 10 years ago, and I still do research with him. So was kind of just like, place, right time.
Dr Jordan Vollrath (02:20.717)
There you go, yeah, serendipity. And then how did you wind up like making the switch over into AI health tech? Cause that's obviously like another huge accomplishment. Like, spurred that?
Dr Reza Mirza (02:22.786)
Yeah. Yeah.
Dr Reza Mirza (02:33.262)
So I left a little bit of backstory out. So after I decided not to apply to law school, after university, I moved back home and I had no idea what I was gonna do with my life. Just all I knew was that I wasn't going to law school, I had no backup plan. And then I just sat at home for like three months, applying to like every job under the sun. And...
And I think like, you know, I had just watched the social network about like Mark Zuckerberg and the, I was like, you know, technology seems really cool. Like maybe, maybe I could try to find a job in Silicon Valley. And then somehow I found a job in San Francisco as a junior project manager at a tech company. And I worked there for a year. And then I came back to Toronto, worked as a project manager for another year. So I had some tech experience and all this time, you know,
It was not very satisfying because I was like as a junior project manager, kind of just like this middle manager that connects clients to designers, to the programmer. I just felt like I wasn't doing anything. I wasn't doing anything meaningful. And I had friends in medicine, like my co-founder, in fact, was one of them. And he's like, yeah, medicine's great. Like, you know, on a day-to-day basis, like you change people's lives. Like you diagnose them with something or cure them or, you know, you can help them significantly. So.
I kind of made the jump because I wasn't working on the cutting edge, is what it was. So then I went to medicine, always hoping one day that I could tie them together and it looks like I finally got there.
Dr Jordan Vollrath (03:56.545)
Very cool. Before getting into medicine, I dug holes. They're like, there hasn't been a whole lot of application of my landscaping previous career into technology or health. I kind of wish I'd spent a year or two in the Bay Area. That probably would have been quite helpful.
Dr Reza Mirza (04:12.622)
Well, I mean, you did pretty well without Saw.
Dr Jordan Vollrath (04:17.117)
How's things going with Strela? Like it's pretty cool that you guys are taking sort of a different approach to bringing AI into healthcare. We've seen just this absolute explosion of AI, especially when it's the ambient scribe, like, okay, here's a tool, get the physician just upgraded with this, and that's gonna make life so much smoother. But you guys are going a bit of a different route, like actually looking at the rest of the workflows and the other staff in the clinic.
Dr Reza Mirza (04:42.86)
Yeah, yeah, you We just had this idea that, okay, my co founder, he just exited from startup like a year ago, they were doing referral management. And he had like good pickup, like, you know, it's hard to find who to refer to. Like, you don't know, like patients might be like, I want someone that speaks this language, or I want someone in this location in that city. Anyway, so he would we were all etching to do a startup together. And then AI seemed, you know, the next hot thing like
It's gonna penetrate every industry, like it's gonna get into healthcare for sure. So like you said, Scrive's been done, Diagnosis, you since Watson, they've been trying to go at this, a lot of people working on this, but very few companies have even attempted to do any of the other stuff in the clinic. Like what about all the faxes that are coming in? What about, you know, dealing with the phone calls, all the emails, all the inbound requests?
So we wanted to do it and combined with that, it's the fact that it's hard getting good help. Like it's very hard to get good admin help. The turnover is high, the burnout is high. So we thought that was a really good use case. And a few companies are trying this, but there's no penetration. Like, you know, we, found a couple of competitors online and they had like little user reviews on their website. So I called a couple of those clinics, none of them use AI on their phone lines. I don't know what the review's all about, but you know, no one's really using this yet in the clinic. So we're like, wow, this is like.
wide open opportunity.
Dr Jordan Vollrath (06:06.477)
What's the biggest hurdle to actually getting that adoption? Because again, it seems like, duh, like why not? Other than, I don't know, maybe security or privacy implications, which I'm sure everybody's obviously looking at very closely, be it compliant with all the regulations. But like when it comes to that change management and getting buy-in, like why is it difficult to actually get those over the line?
Dr Reza Mirza (06:19.896)
Bye.
Dr Reza Mirza (06:29.038)
So you know what's crazy? We just started in June and so it's been a few months and we already have over 50 physician practices signed up. Like they've signed letters of intents and some clinics, they're jumping at it. Like as soon as they hear about this, they're like, we were thinking of shutting down the phone lines. You know, like they just, and other clinics have gone to email only. There's one clinic that has like outsources or phone calls like some other, I don't know where. So.
People are looking for solutions. And once they hear that there's this solution, they're quite excited. And I've heard of weird use cases I wouldn't even consider. Like this one refugee clinic is like, can you guys do really rare languages? I was like, well, the voice technology does about 20, but the text can do pretty much any language. So if they were texting, we probably could do any documented language. yeah, so people are eager once they hear about it.
Yeah, in terms of like you said, like, yeah, like privacy, you know, we've hired like a privacy impact assessment, and we've got a lawyer, and we're looking at all the regulations and the guidelines from like, CMA. And yeah, yeah, so that stuff is like being dealt with by professionals. But doctors want this.
Dr Jordan Vollrath (07:42.957)
I guess the doctors are a bit of a fickle population in general. Like I personally had just signed up for a patient engagement tool called the My Viva Plan. And I have met them like, I must've been a couple years ago and like this exact tool does, it's like the computer replacing me basically, like in a good way. Like it just like follows up with your patients between appointments and like works on their goals as it relates to mental health and as it relates to their weight management and like.
gives them education. It's honestly like the perfect fit for my practice and my patient demographics. But even then it took me like a year to like finally feel the courage that like, okay, I've got enough of my like to-do list done to take on another project. And even then after like signing the contract itself, it took like, I don't even want an embarrassing amount of months before I'd like read through the emails and like felt comfortable using the software to actually then like launch it.
to the patient. It is kind of just this like interesting dichotomy of like, you're just struggling. feel like it's so hard to keep my head above water, but then almost like there's like a foot on you pushing you down when you're trying to figure out like, okay, the tools and how to get out of that. Just trying to keep yourself from sinking.
Dr Reza Mirza (09:01.362)
Yeah, yeah, no, I think you're right. We are probably one of the most risk averse populations of like professionals. Just I think the path to become a doctor and then your job is all about like not missing things and red flags and yellow flags that, you know, I think adopting new technology, especially like if it has implications on your patients, you're like, I don't want my patients to get pissed. I don't want to get more calls for this because of this tool that is trying to like reduce my workload.
But the thing that's really convinced me and is sort of like what I tell people to reassure them is that they chat GBT and all these new tools like Claude and so on and so forth. They're already passing the MCAT. They're approaching subject level expertise of PhDs. Their reasonabilities are out of this world. Give it a logic puzzle and it'll just do it way better than.
any of us like, I'll do like 100 steps in like 30 seconds, you're like, well, I can't do that. So I think if it can do all that, there's no way that we can't shepherd this thing to book an appointment.
Dr Jordan Vollrath (10:10.849)
Like those monotonous, kind of like repetitive mundane things. Like that seems like the first obvious, like why have we not got this figured out already?
Dr Reza Mirza (10:20.824)
Totally. Totally. Yeah. And so I think, I think, I think we're going to pull this off. We're launching live, like as we speak in our first clinic beta testing it. And then once that goes, if that goes well and that goes well, then we're going to launch it to the people on the wait list.
Dr Jordan Vollrath (10:36.127)
Incredible. Well, best wishes for the launch coming up here. That's exciting.
Dr Reza Mirza (10:39.49)
Thank you. Thank you. Yeah, we're excited too.
Dr Jordan Vollrath (10:42.217)
So your practice, however, you're mostly hospital-based, is that correct?
Dr Reza Mirza (10:46.316)
Yeah, yeah, my clinic's in the hospital and I do some inpatient as well.
Dr Jordan Vollrath (10:49.793)
Are you seeing much in the way of like adoption of tech, not even necessarily AI, but like just new software, new health tech in that hospital setting and the hospital clinic setting, the inpatient setting?
Dr Reza Mirza (11:03.244)
Yeah, I would say, like probably the EMR drives a lot of the things. So like people will build in and around the EMR. Like how do you search for signals in the data? It'll be like, you can slice and dice with Epic. It was kind of crazy. Like, I don't know if this is a sustainable model where they're charging hospitals like a million dollars per year for subscription service. Like I have to think that if like, if all of Alberta,
is on this, on Epic. And like Hamilton Health Sciences has a separate subscription from St. Joe's down the street. we're talking about, and then UHN and then like, you each hospital system is paying its own massive fee. You're telling me the 50 to a hundred plus million dollars that Canada is spending, we couldn't just hire a crack team of Google engineers to just make it as like a national, I mean, I hate government projects because it seems like we do half the job and then we just sell it off and like everything fails, but like.
It seems crazy that we're paying this massive subscription fee. Anyway, sorry, that was a tangent to your question though of like the other thing I see a lot of just mostly like the hospital is signing up for, scribe and like AI in that domain. So we have like a hospital scribe demo that's going on that a few of the people in the hospital have access to, but not all, I would say the hospital is the slowest. It's like the most bureaucratic setting.
Dr Jordan Vollrath (12:22.913)
I could definitely see that. Well, probably the most risk averse, the most red tape to get through, I guess also kind of the highest stakes in terms of risk and just volume of patients and data. So it sort of does make sense. And then, yeah, you raise an interesting point of like, why has a lot of this technology just sort of like been centralized through the government or something like that, which brings up kind of an interesting problem of like, okay, well, if we put together sort of this monopolistic
chunk of technology. Then we're kind of missing out on all of that, like innovation and like things coming out of the woodwork that we're now seeing with EMRs and with the new technology, sort of those grassroots smaller organizations popping up all over the place. And then it's kind of like, does that just then get frozen in time? This like big monolithic EMR system. And then at the same time, It was kind of interesting, like the Canadian Medical Association, they owned an EMR.
Dr Reza Mirza (13:07.618)
That's true.
Dr Reza Mirza (13:15.374)
Thanks
Dr Jordan Vollrath (13:20.813)
This was, can't remember how many years ago, but apparently it did not go very well. was a practice solutions or one of those ones. But yeah, they had an EMR and I guess it just did not quite cut the mustard. And so they're very like, okay, we don't think this is our role anymore.
Dr Reza Mirza (13:39.34)
Yeah, I think the EMR becomes, I think everyone who gets into health tech, a thought that probably crosses everyone's mind at some point is like, what about a better EMR? Because everyone hates EMRs and they're just like, because nothing is perfect. Nothing really fits everyone's needs because everyone's needs are a little bit different. So do think a lot of people, it seems like a lot of people gravitate towards, and the more you look into it, the more you realize it's like a pit of despair.
Dr Jordan Vollrath (14:06.733)
Well, but then the heterogeneity of having 12 different EMRs, that's like part of the huge problem of why it's so challenging to have new stuff coming out and like the interoperability challenges and just like, then you miss out on that centralization, standardization and probably a lot of like the unit cost and economics of it. But then, yeah, so I don't know. I don't know if I have a good answer on this one. It's gonna be interesting to see how it unfolds over the coming years.
Dr Reza Mirza (14:35.566)
Totally. Yeah, I don't know if I hope it gets solved. I don't know. I'm not hopeful.
Dr Jordan Vollrath (14:41.163)
Have you heard of, what was the name of it, Cure before?
Dr Reza Mirza (14:45.07)
yeah, I have heard of Cure. I have, yeah.
Dr Jordan Vollrath (14:47.789)
Cause that seems like it would be right up your alley dealing with a lot of like the kind of rarer diseases and conditions, but it basically plugs into your EMR and then it just analyzes all your patient charts and like everybody's, you know, the data it has available, the blood pressures and the heart rates and the meds they're on and the symptoms they've described. And then it flags people as being like higher risk for having some sort of rare zebra diagnosis.
Dr Reza Mirza (15:14.508)
Yeah, yeah, I heard about it. I think they approached me to see if I want to like run it on my EMR. The trouble was I was like based in the hospital. So then we'd have to go through like multiple levels of bureaucracy. So like, in the end, it just was too much effort for me to like, I didn't have the wherewithal to go through all that. But I think, I think that's the future. Like at some point, like I think what LLMs have shown us is that like vast amounts of data can now be summarized.
decently or well.
almost instantaneously in an automated fashion. And like, you don't need to have this like sleuth to like go through like 10 years of like pathology reports and imaging. You can just have something do that for you, flag out the key things. And I think, I think that's going to be the big game changer. It's just summarizing all that data and be like, Hmm, these are the diseases that can cause all these things or, you know, this constellation. And it'll take out all that like groundwork that like sometimes we don't have the time to do, or we don't even have access sometimes due to
like the issues of mention of the interoperability.
Dr Jordan Vollrath (16:20.189)
exactly, exactly. Well, I guess where do you see healthcare going, you know, this next 10 years or so here? You've been doing medicine for a little bit now. If we keep on the current trajectory, like are we all going to have space pods that just heal people at the touch of a button or like, what do you actually foresee playing out here?
Dr Reza Mirza (16:37.71)
Yeah, it's so I'll give you I'll give you a really topical and timely example that I think it's kind of telling. So there was a New England case series of this girl like refractory lupus, like nothing worked. They like your chemo-etter cyclophosphamide combination biologics. She was just dying of her lupus, like high dose steroids. Nothing was stopping it. It was like relentless. And then
They tried, I don't know if you've heard of these like CAR T cells, like this new thing, they take your T cells and they genetically modify it. So has like an antibody receptor, so it has homing capacity. So you can put it to home in on whatever you want. So the current ones are for blood-based B cell cancers. So as a CD19, so targets B cells and it's really effective for like B cell cancers. Like, you know, your fifth line agent doesn't work, CAR T cells will work. And you're like, wow.
So they gave it to this lupus patient and lupus is a disease of a lot of antibodies. So their B cells are very active and she went in total remission. And now it's been, this just happened. So I think it was like about a year ago that she got treated. She's been in drug free remission for a year. That's basically cure. Like she's no medicine and she's
Dr Jordan Vollrath (17:46.573)
That was wild.
Dr Reza Mirza (17:49.63)
Well, serology like a negative her compliments are normal. Everything is normalized. No symptoms. She's cured like and maybe it'll come back. I don't know. But functionally, she's cured as of this moment. And they've done it for other things too. Now they then they tried my esteem your Gravis for Fractry and it worked. So it basically B cell diseases. So we we found potentially an almost curative technology, her B cell disease, which is a broad spectrum of things.
And I think, and that's just one technological innovation. And I think with cancer, there's like, if you look at like the checkpoint inhibitors, there's people who had metastatic melanoma that are just not dying. Like it's like five years out, seven years out. And there's this cohort like that just seemed to survive now. So I think we're getting to a point where medicine, the technologies, I mean, I don't know if we can afford it. That's going to be the big trouble, but.
We're getting to a point where the technology might be good enough that we're entering cure for things that were previously unthinkable for cure. And then we're also getting really good like backend technology, like better processors and like better, you know, like better AI and, know, all this other stuff that's gravy, but then even the meds are getting amazing.
Dr Jordan Vollrath (19:06.487)
Like from your perspective, being a lot more plugged in on the academic side and sort of the cutting edge of the research, like what can they do to actually get this kind of stuff out there at a actually reasonable price? Cause isn't it just like so cost prohibitive and long in duration to actually get through human trials and get a drug to market? I mean, that's like a absolutely wild just outcome.
that the drugs are achieving there, but like it probably costs who knows how many gazillion dollars to get to that point. And then, yeah, what is that drug going to cost for, you know, however many doses it took to basically achieve cure or remission?
Dr Reza Mirza (19:34.435)
Yeah.
Dr Reza Mirza (19:46.06)
Yeah, yeah. So with the car T cells, they're really tough because they take your T cells and genetically modify them. So you need like a lab built around that person. Like I saw a paper kit coming out from China where they're making off the shelf car T cells. So it looks like that might be an option. So if they can do that on mass, then you don't have to do the whole expensive genetic modification piece and you can just like mass produce. I know like Princess Margaret in Toronto, they hired like a car T guy to make it in a house for them.
So instead of being, yeah, so people are trying, people are trying to do this stuff, but it's just, you know, the regulation and I don't know, there's a signal that now that a few people have gotten T cell cancers from the car seat T cell therapy. So it's like, might be causing cancer.
So maybe that's a quality control thing. So this stuff is just like, we're playing with tactical nukes in a way, right? Like this really powerful thing that we are just understanding how to leverage. So it may just have to be slow and expensive, unfortunately.
Dr Jordan Vollrath (20:50.593)
From that angle, like from the actual like pharmacology and the biologics coming out, is it moving too slowly? Or do you think that like that sort of risk benefit and the time that it takes to suss that out? Like, do you think we actually are on a pretty good path currently?
Dr Reza Mirza (21:05.762)
You know, I think like from the patient perspective, like it's probably never fast enough. You're like, I want, like, I want to be cured. Like, I don't want to be taking these drugs that partially work or, you know, have all these side effects. Like I want better things of it. Like, I mean, of course, like if you're suffering, you want to not. but I think, you know, from a, like, from a rheumatologist perspective, like there's a new stuff coming out, like regularly, which is one of the reasons I chose rheumatology. Cause I was like, I like cutting edge in tech, but like rheumatology feels like, you know, we have new drugs all the time coming out.
So it's kind of actually hard to stay on top of these things because new trial for this, a new trial for that, a new biologic here, a new pathway. you know, so it feels pretty fast from my perspective, but I can see how like, you know, from the patient perspective, you know, it's like, like they were talking about this five years ago and now it's available, you know, and just, yeah, I don't know if there's a better way. Like maybe if we get really good in silico, like if the predictions on the computer model is like 99.9 % accurate.
Maybe you don't need to do this massive RCT because you're like, we know, we already know. So maybe that maybe that's the future.
Dr Jordan Vollrath (22:08.461)
Yeah, I guess once we get better at just modeling proteins digitally, that'll speed things up quite a bit. Very cool, very cool. What else is going on in the world of rheumatology that you're excited about? I never hear about all this fun stuff.
Dr Reza Mirza (22:14.851)
Yeah.
Dr Reza Mirza (22:22.956)
Yeah, so yeah, the CAR T cell thing is definitely top of mind. What else? Like I think, I think when I describe what's happening now, I say that we're, I think we're entering the era of cure. Like I think the biologics was a year of remission where it's like, okay, we can routinely, like if you send me a rheumatology patient and they have like a clear cut diagnosis, like I could probably get them in remission. But
I think now, like think my generation, like this, our generation, it's gonna be like the year of cure where like, there's gonna be people that like are gonna not have disease anymore. So I think that's the really exciting thing. We're getting better like diagnostics, better, you know, like just better antibody tests and better imaging tests, like, you know, point of care ultrasound is getting really good. Yeah, there's just, there's a lot.
Dr Jordan Vollrath (23:14.029)
Those that were just at the FMF conference, were right next to a booth with the point of care ultrasounds and like the butterfly ones coming out. Like they looked like pretty cool actually.
Dr Reza Mirza (23:25.934)
I actually think that at some point, I don't know when, there's gonna be a generation of med students that'll probably be better, like more expert with the ultrasound probe than with a stethoscope. Because it's like, why listen to the heart and try to figure out what valve it's coming from and have them do these random maneuvers. When you can just look at the valve, you'd be like, that valve is totally destroyed. That's the problem. Or like, this person's having like...
you know, gallbladder pain, like let's just put a probe on the gall, yeah, there's a stone right there. Like I think it's probably their problem. You know what I mean? Like as opposed to just pressing on the belly, like, yeah, this Murphy sign is, you know, you're like, I can look at your gallbladder. And it was like all this fluid around it and it's like thickened and inflamed and you know, like, I think it just, it's just, we're slow. We're slow to adopt new technology, you know, in part because, you know, we're just so risk averse, I think.
Dr Jordan Vollrath (24:18.571)
I mean, how standard is point of care ultrasound becoming in the hospital now? Cause like back in med school, you're looking at the likelihood ratios of all these physical exam tests. So you're like, why are we even bothering to learn these things? Like, first if you've got your Pocus device that you can just look at a thrombus or you can look at a stone. You look at an abscess under the skin, you're like, that's like, duh.
Dr Reza Mirza (24:42.168)
Totally, yep.
Dr Reza Mirza (24:46.946)
Yeah, no, it makes like, think intuitively, it makes so much sense. I think that the trouble that we run into, I think that happens is when, because it's so operator dependent, that when people who don't know what they're doing, they're like looking at something, and then they either totally miss it or miscall it. And I think emerge, it's becoming kind of standard of care to do POCUS. And then that's actually the area where there's the most...
legal issues that arise because emergency, know, there's like emergencies and then there's this provider who's not a radiologist, who's not a sonographer, but leveraging these skills on a day-to-day basis to make clinically important decisions and then it's, you know, so it's like this partial expert is making decisions. So then I think that's where we run into trouble. Like I think the key would be like, you know, if they had like, we really should just have 24 hours access to these things like
access to the expert. You know, you're the emerge dog, you probably know every single emergency in the book, but you may not know what the ultrasound looks like for every single one of them. I don't know. Yeah, it's tough. It's infinite knowledge, and we are ignorant and fallible.
Dr Jordan Vollrath (25:59.189)
Well, this interesting because like literally two podcasts ago, I was talking to somebody from the CFPC and this was one of like the interesting points that came up is just like how much stuff gets done just out of the interest of like risk aversion, like not out of like, because we think it's necessary. Like is this consult required or do we need a second pair of eyes on this? But just like, I just don't really want the medical legal risk associated with this. Like I'm like reasonably sure that
this is the diagnosis and the subsequent treatment from it. But just like how much of that sort of duplication of effort takes place for that final 5 % of the outcome.
Dr Reza Mirza (26:39.308)
Yeah. Yeah. No, like every time I see like a case of query giant cell arthritis, I'm throwing them on like high dose steroids on the off chance of like this thing, like, you know, that causes vision loss. And I'm like, I really don't think you have giant cell, but you know, until we do further testing, I can't say with certainty. then, you know, like it becomes this like default pattern of like doing potentially what feels like the wrong thing. Cause you're like, I'm just, I'm just trying to like cover an off chance.
Right? You're like, why am I always just trying to cover it off to, but yeah, it just kind of built into us. Like it's part of our training and we kind of just get raised this way. And then we raise our future generations and it just becomes a sort of like, mean, yeah. I mean, hopefully we, approach like, know, better, better decision-making or omniscience or something.
Dr Jordan Vollrath (27:31.693)
We'll wait for AI to everyone's walking around the hospital with their, the Apple vision pro chat, GPT on the one side. That'd be great. What's the, what's the biggest hurdle that you guys are facing as the specialists in the hospital right now? Like primary care out in the community, obviously like access to care funding and just like people being able to get in there, but you guys have had.
Dr Reza Mirza (27:40.556)
Yeah.
Dr Jordan Vollrath (27:57.067)
wait lists out the wazoo since forever. like what is the biggest thing that you guys are currently trying to figure out?
Dr Reza Mirza (28:04.832)
I think, I think, you know, what is it? I don't know. think.
Dr Jordan Vollrath (28:11.019)
Or is that still it? It's just been a problem longer.
Dr Reza Mirza (28:14.038)
Yeah, yeah, I think just the waitlist is the big thing. It's like people, you know, like I'll do call and I'll get these like really sick patients from the inpatients or like they got this vasculitis and they got pulmonary hemorrhage or their kidneys are failing or whatever. And then, you know, like I got this massive waitlist and I'm trying to, you know, my schedule is booked out like four or five months and I just, I'm like new out of practice. I'm already booking four months out and this guy's like, you know,
he has this emergency and it's like, how do I get him in two weeks from now? And then he calls back or I get his lab result two weeks after that. And his kidney function is getting worse. I'm like, how do I, how do I get him in again? It's like, where do I find spots for these people? That's probably the hardest thing. I'm trying to consider like getting a physician's assistant to like, trying to help me manage the easy stuff, leaving me more room for the complicated stuff. But yeah, we actually, we actually, there was a government grant for a PA that they'll pay for the half of their salary.
Dr Jordan Vollrath (29:05.497)
cool.
Dr Reza Mirza (29:06.626)
For the first year, nobody applied to like out of the PA graduating class. I don't know why, maybe they wanted like a chill out patient practice that like was not rheumatology, but we had no applications. yeah, yeah.
Dr Jordan Vollrath (29:18.803)
Really interesting. I think there also just aren't very many PAs right now. Like this is sort of, it's not literally brand new, but it's still in terms of volume and numbers of them. Like it is relatively still in the early stages here in Canada.
Dr Reza Mirza (29:34.199)
Totally. You know, the, the other thing that like I was going to say that you asked me this earlier, but I never got to it. I just would strelo. And you reminded me with your question, like what the biggest problem is with, like my practice, the biggest problem with strelo. I'll just, I just wanted to mention this in case someone that's listening might have a hookup is a like working with EMR companies, they have such a moat. they, they like their users are entrenched. All are your data. All my data is like locked into Acura.
And it'd be so hard for me to transfer all that over. And it probably would not be easy. And I'm sure it'd come out really ugly on the other end. so users are stuck. And the EMR companies, don't really want to deal with startups. If you have a small company, they're not interested in building out API access. But what's interesting is in the States, it's actually legally required to have interoperability.
Like there was actually an article I was reading from like a month ago, how some companies are making it very difficult to get API access or putting up hoops. Like you've got to apply and they might reject you for no good reason and not give you an explanation or they'll ignore you for a little bit. And the government's coming harder on these people. They're coming down on them. there's like, so I wish Canada was similar where like it mandated these companies had to open up access so that technology could flourish.
Dr Jordan Vollrath (30:56.257)
I wonder if it will get to that point, sort of like these like anti monopolistic practices of like, okay, the data is locked down. Cause I think you're right. That is in part a big contributor, a huge factor as to like why things are slow moving. Like they're sort of, they have the stickiest product in healthcare. Like just how much of a pain in the butt it is to like migrate EMRs and like map all the data over. it literally takes months on end. And so they've sort of.
they have a captive audience. Like they know that their customers, until they get really, really, really pissed off, they're not gonna go anywhere. And so it's sort of like, once they're in, they're in, and then they just don't really have as much of that drive and that impetus to like bring on those innovation and those connections and like API access. They're sort of like, well, okay, maybe we're gonna wait and...
do this in-house or acquire a company and then start building it in and then that becomes our sort of unique advantage in the landscape of, know, when a new graduated physician starts a clinic, why they might pick us, but it almost sort of like erodes away at their unique selling features, I guess. So then they're in no hurry to do these things.
Dr Reza Mirza (32:12.716)
Yeah, yeah, exactly. Yeah, I think you got it right on the head. That's exactly the issue. And it just it really just stifles innovations like the issue because if like the biggest thing that our program or like our chief technical officer has been working on is like integration like that's been his like his primary focus for since June. And it's kind of unbelievable like that.
Like if this was just like an API, that'd be like a five minute job. Like, all right, yeah, it's documented here. Like this is the login credentials. you just, I mean, I'm not a programmer, but I've looked at some documentation.
Dr Jordan Vollrath (32:46.359)
I imagine there's probably like a fair bit of like security risk there. Like if they just have this like wide open pipeline for data coming in and out, they're going to be like pretty selective with who actually gets to interface with that. But definitely like that bottleneck of just everything getting locked down within the EMR is probably like one of the single biggest hurdles that the system is facing.
Dr Reza Mirza (32:53.23)
Thank you.
Dr Reza Mirza (32:59.554)
Right.
Dr Reza Mirza (33:09.558)
Absolutely. What do you see for the future of healthcare?
Dr Jordan Vollrath (33:14.105)
That's a tough one. think more AI is probably at the risk of sounding like a, you know, just repeating myself too much here. I really think like the full spectrum of like diagnosis through to treatment and through to like follow up for patients is going to be huge in the AI space. Like I can already see it like having a mostly virtual and exclusively virtual practice for the last several years. Like I haven't actually
poked and prodded a patient in a long time. And it's like, okay, there's definitely limitations there in terms of what you can't do, but was just how much you can do purely with like audio and video and text transmission. And so I don't think it's going to take as long in terms of when the technology is able to like really augment what physicians are able to do, what a nurse practitioner is able to do, what a PA is able to do. It's going to be sort of that like,
bringing it together and those regulatory hurdles that do it. But I see like a ton of advancement in terms of just the software that healthcare is running on and like how much quicker it would be for patients to, I don't know, like there is a company in California where they have these kiosks in the mall where you go in and you just talk to like Skynet and it tells you after the end of it, it does send off for a final review. There is a doctor in like,
the Batcave reviewing all these things somewhere along the lines. But like it is getting to that point very quickly where like patients will be able to just go and talk to an interface with a computer. And it's probably going to be pretty accurate pretty quickly.
Dr Reza Mirza (34:53.742)
Yeah, I was watching this video from MIT Media Lab where they took a video of someone and then they slowed down the frame rate and they added it to like, I don't know, somehow they changed the hue so that it would pick up on subtle hue changes. And then they could essentially visualize the pulse as it like pulsed into the person's face.
And then they could see that the pulse was irregular and they could make a diagnosis of AFib just from a video of some guy's face. you know, you're thinking that was like several years ago, like pre, like, you know, I would say, you know, modern AI products. like, if we were already able to do things like that, I think the, you know, there's a lot that can be done that we're not even conceiving yet with these tools.
Dr Jordan Vollrath (35:43.023)
exactly. I think there's also going to be a bit of a renaissance in terms of health literacy. Like just right now, the amount of things that are preventable, but just people don't know or they don't really understand the importance when it comes to their physical activity or their diet or these other things that just lifestyle and habit measures that really add up. So I think there's going to be a big push there. It's kind of hard to see like how exactly that plays out because the education system
is going to need some extra budget and like the healthcare side of things is probably going to be fairly reluctant to just like hand some of that over. So it definitely be interesting to see how things play out with the government and how that goes forward. But I do think that there is a lot to be said for the critique of how Western medicine is more sick care than healthcare and kind of going upstream of those problems. so
Even then, again, I could definitely see a large role for AI to be playing in that. The amount of stuff you can learn just by having this text interface communication back and forth with a computer program, it is quite remarkable.
Dr Reza Mirza (36:51.564)
Yeah, yeah, it's true. It gives you like access to unlimited data, basically like the breadth of the human corpus, and you can ask it and query any question and it'll give you like a fairly like, in most cases, if it's been well documented, very reasonable answer for the question. And I think you're right. Like I think kids and I've even seen trainees like medical trainees are using it routinely. I think most I think most people who
are like savvy with a computer or using it. And with like younger generations who are growing up with it, they're probably just going to use it as like their new Google search. And what does a chat GPT say? And I think it's going to be just like, you're going to have a personal assistant for any question that you ever have. And it'll get to know you. It'll have memory of you. And I think it'll probably be the highly educational for people. they're probably like, I don't know.
Dr Jordan Vollrath (37:40.909)
Well, even just like the companionship side of things too. Like we got our grandpa, Amazon Alexa for his birthday or for Christmas a couple of months ago. And then he just like once in a while starts talking to it. Like we didn't see that coming. Like we thought he'd be like playing his old timey music, but he'd like kind of interacts with it socially sometimes, which was kind of an interesting unintended side effect too. So.
Dr Reza Mirza (38:02.798)
you
Dr Jordan Vollrath (38:07.871)
Again, kind of just like seeing how these things play out going forwards, I am quite excited for the tech aspect of things. I guess let alone like all the pharmaceutical advances and like all the DNA changing technology, the precision healthcare. I mean, I think it's definitely going to be a very, very transformative century for healthcare.
Dr Reza Mirza (38:27.214)
Yeah, yeah, it seems like everything is moving really rapidly. And it's hard to imagine. Like, yeah, it's like one of those Horizon events, right? You can't see beyond the horizon. And it's going to be, there's going be a lot of changes that are hard to predict, for sure.
Dr Jordan Vollrath (38:42.615)
Do you think there'll be much impact in terms of like this, it seems like healthcare is pushing towards the privatization side of things, like budgets are tight, everybody's constrained, is going to be bringing in like private pay healthcare going to be transformative to the healthcare system going forwards, or does that wind up just chasing our tail and then the healthcare outcomes start worsening and it turns into more of like the outcomes that the US is obtaining.
Dr Reza Mirza (39:11.822)
Yeah, I'm of two minds. I really do support the fact that people have free access to healthcare, because I think if you have a sick population, it just doesn't make any sense. What's the point of having a country if everyone's just going to be ill? But the one way that I could imagine privatization could work is if you set up the system by its very nature to fund the public system.
so that like the profits would go back into the public system so that you don't have this like two tier system where one is like you can get the best care and either when you get like the worst doctors with the worst MRI machines or the worst CT scanners that are like, you know, a century old and you know, you don't that that seems like unacceptable to me. So if the profits were somehow routed back to the public system to keep it updated, then I think that would be reasonable. I think like the UK system
It's the doctors are forced to work public and private. You can't just be purely private, I think, or at least that was my understanding. So I think as long as we can ensure that we maintain the quality of the public system, that would be reasonable. But I agree, like you say, I agree that there's this risk or this concern about do we end up like the states where, you know, people like will go bankrupt because, you know, I'm of that Michael Moore documentary, like people go bankrupt because they like got ill and went to the hospital and they get this like $200,000 bill and you're like.
Really? Like they came in and had a surgery and we're like in the ICU for three days and like that's $200,000. You know, it just doesn't make any sense what's happening there. But, but, you know, we do have to change healthcare. Like the current model is not working. We need to have like, I think some different minds involved that are not afraid to make changes that aren't like a servant to the political system that they serve.
I think that's sort of the key there.
Dr Jordan Vollrath (41:06.509)
I think like too, when you look at it as well, like kind of the whole financial system is almost set up like this intergenerational Ponzi scheme where as long as the population continues to grow, we could continue funding the slightly smaller layer above it for its healthcare and for all the other like public resources. But kind of like, okay, what do we do when...
you know, that doesn't become sustainable anymore. Like in Canada, now they're like really, really looking at the immigration rates again. And then suddenly we're going to have sort of that inverted pyramid and like, okay, now we're, now we're going to be looking at all the other challenges that come along with that. it's sort of like, I don't know, can we take that private aspect of healthcare that the States has without all the like insurance companies and the bureaucracy and the red tape and sort of like that wasted middleman.
funding that's just sucking up all the resources, keep it from getting parasitized, but apply some of that for that private funding to breathe new life into the Canadian healthcare system with some extra funding. Maybe, I don't know.
Dr Reza Mirza (42:14.434)
Yeah, I think you're right. A big problem in the States is definitely that, like, you know, that how much of the dollar, the healthcare dollar goes towards like the insurance middleman and how much like their job is just and the hospitals kind of collude to jack up prices. Yeah, think, yeah, definitely we need a reframe of like the situation. No doubt. No doubt.
Dr Jordan Vollrath (42:38.83)
I'm things continue to go on the upward trajectory though. But I guess before we wrap up for the afternoon here, any other final thoughts or things you wanted to shout out before we close off?
Dr Reza Mirza (42:49.262)
Yeah, I mean, think, first of all, thank you so much for having me. Like this was great. I really enjoyed it. Even before we got on the camera, it was a lot of fun too. But yeah, it's crazy how quickly things are changing. I think there is both risk and potential here and we need smart, mindful people who are...
putting thought into this. And I think that's the approach we're taking with Strello. And I think you're doing the same thing. just, you know, this conversation reflects that. And, you know, you know, from my epidemiology, like hat, like what I've seen is that
If you look at like phase one data or animal data and when you look on the internet like these there's all these like nootropic people who like I'm gonna have lion's mane mushroom and all this stuff and like I'm gonna get stronger and smarter and faster and like they you'll read these forums and like or people will come to clinic and they'll bring this like data and they're like look at this paper and it's like animal data or it's like first phase one data and and I think tying this back to the health care system we're like speaking from like extrapolating from other health care systems
The trouble is that when you get like, when the rubber hits the road, what you think you know often turns out not to be true. And I think like most things that work in animals or work like an early phase or like work theoretically do not work in people. And a lot of times what you think you know turns out not to be the case. So I think like, you know, the key is like moving forward.
It's like, let's keep having these great ideas and let's keep innovating and let's keep doing what makes sense. Then also have the mindfulness to realize, wait a minute, my outcomes are not what I expected. How do we do this better? Because the new way is not better necessarily. It has its own flaws, its own limitations. The CAR T-cell is causing T-cell cancer. So how do we do it better so we can cure without introducing cancer into our lives?
Dr Reza Mirza (44:55.246)
So I think like, yeah, that'd be like, I don't know, final thoughts.
Dr Jordan Vollrath (44:59.223)
Can't move too quickly, I guess, or yeah, get over your skis in terms of, okay, we need to like, massively adopt different things or completely do a page one rewrite. Cause yeah, definitely. Then there is the risk of like, okay, this went the wrong way. We thought we had a pretty good hypothesis, but then oops.
Dr Reza Mirza (45:15.118)
Yeah, yeah. What I'll just say, like a final thing, like for like Strello, the way we, and not just for the company, but even just for the point, like what we, don't, we don't know whether AI is going to be super effective in the role of an MOA or admin support. We think it will. Like, I mean, if it can do all this other stuff, why not? But to that end, like, because we are uncertain, we're going to hire an admin.
to review all the call logs, just because there is that uncertainty. And we don't want someone to call in and be like, I'm dying of chest pain. Like, all right, I got you booked in for three weeks from now. But we don't want that to happen, right? But actually, the model's really good with emergencies. Anyway.
Dr Jordan Vollrath (45:57.747)
I mean, the triage side of things is definitely like, again, one of the biggest bottlenecks in the healthcare system. they're looking very forward to seeing the company grow and follow along with the progress in terms of all of that behind the scenes.
Dr Reza Mirza (46:12.43)
Thank you so much. This was great.
Dr Jordan Vollrath (46:14.733)
Okay, Dr. Reza Mirza, thank you so much for joining us today. Really appreciate it.
About the Author
Cherry Health
Canada's Medical Network
About the Author
Cherry Health
Canada's Medical Network
About the Author
Cherry Health
Canada's Medical Network
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