Tech & Innovation in Canadian Health (And Lack Thereof) with Dr. Sam Gharbi

About the Episode

In an enlightening conversation, Dr. Sam Gharbi, an internal medicine expert and tech innovator, explores the intersection of healthcare and technology. As co-founder of Arya Health, he discusses the innovative development of user-friendly electronic health records, addressing deep-rooted administrative obstacles and the medical industry's resistance to technological change. His insights reveal the complex landscape of healthcare innovation, highlighting the struggle for efficient, interconnected systems in a sector often reluctant to change.

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Objectives and Discussions

• Problem with Canada’s Healthcare System
• Dr. Sam Gharbi's personal experience
• The Quebec medical strike
• Is universal healthcare a right? (American vs. Canadian healthcare)
• Why is it difficult for top down authorities to implement effective systems?
• Tech company and healthcare: The Birth of Arya Health
• How to interconnect fragmentation and innovation in healthcare technology
• Steps to unlocking the future of technology
• The need for doctors supporting doctors
• Hope for the future of healthcare

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More Resources:

LinkedIn: https://cherryhealth.co/linkedin

Facebook: https://www.facebook.com/cherryhealthinc/

Instagram: @cherry.health

Twitter: @cherryhealthinc

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Have questions? We want to hear them!

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Transcript

Speaker Identification:

[Host]: Dr. Jordan Vollrath

[Speaker]: Dr. Sam Gharbi

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Jordan Vollrath (00:01.527)
Today we're joined by Dr. Sam Gharbi internal medicine specialist physician and co-founder at Arya Health. How you doing, Dr. Gharbi?

Sam (00:10.658)
Good, Jordan. How you doing?

Jordan Vollrath (00:12.695)
Doing well, doing well, thank you. So where do you wanna start? What do you wanna cover today? I know you've got a lot on your plate. You're like well ingrained in the innovation world. You as a power user of tech and adopting stuff yourself, where do you wanna go with?

Sam (00:29.302)
Yeah, I mean, listen, there's so many places that we can explore. Yeah, thanks for having me. I mean, it's always good to shoot the shit and kind of explore the space. I think, you know, for this, I'm pretty open-minded. We could sit here and for the next several hours just complain about how everything's broken beyond belief in healthcare. I think anybody who's listening to this, if they're a doctor or nurse in healthcare or not in healthcare, probably agree almost ubiquitously that things are getting worse. It's rare that all Canadians.

will agree fundamentally and ubiquitously on an issue. And I think I haven't talked to anybody in a long time who thinks healthcare is getting better. Wait times aren't getting better. Hospitals aren't running more efficiently. Emergency rooms are overflowing and getting shut down. Nobody seems to have a family doc. Walk-ins are a disaster. The technology we're using, doctors are literally revolting against. The Ascender and Epic.

you know, implementations. That being said, we can't keep using paper. Any real kind of innovation is often almost impossible to push through because of bureaucracy. The bureaucracy seems endless and nonsensical and ultimately is harming patients. So yeah, it's from every angle you can look at with healthcare, it is not getting better.

Jordan Vollrath (01:50.411)
So your perspective as an internist, what's your practice like? Are you in the hospital? Do you do like outpatient clinic mostly? What does that actually look like?

Sam (01:59.094)
Yeah, so I've been internal medicine staff for almost 10 years now. It's crazy how quickly it's gone by. Um, you know, the bulk of my practice over the past 10 years has been a mixed inpatient and outpatient. So, you know, more and more I've been doing more clinics just because I'm the co-founder of Arya Health, which is a electronic health record company and tech company. So I run, um, that company in a big way with two of my co-founders. We're also doctors. So between that, that takes up a lot of my time on top of.

just running clinic. And then over the past 10 years, I've also been working at the hospital across the lower mainland. So I've also had an administrative job as the associate chief medical information officer for Vancouver Coastal Health and BGH. So, you know, I've been doing that for a while, which I stepped aside from a couple of years ago because we implemented Cerner and, you know, not the most popular, but still a win, I think, from being still on paper.

Um, so I do a mix of, and I have done a mix of administrative publicly. So I've seen that angle and, you know, sat at those meetings and met a lot of the decision makers, worked at the hospital and the trenches, both in the big city, so at Vancouver general, but also up in Yellowknife, you know, up in Prince George, you know, Vancouver Island and the interior, you name it, you know, we've, we've all do locums at different places that are underserved and, um, you see, you see a lot of things there that, that are pretty wild. Um,

And then yeah, so pretty much the gamut. I think I get bored pretty easily, so I try to keep busy and challenged.

Jordan Vollrath (03:34.915)
Across those different health systems, was there anybody that shone through as sort of a shining beacon of light that was doing it properly? Like is there any little oases of medicine out there that have their acts together and things seem to be going well from your experience?

Sam (03:50.558)
It's funny because ever since I got into med school, I've been obsessed with that. I think the thing that I'm most passionate about is healthcare delivery. And so, you know, every time you go to a new hospital, I trained in McGill. So you keep going to different hospital and you'd always see things done a bit differently. Some places did certain things better than others, but Quebec healthcare was a bit of a sinking ship. I think it's most people know that Quebec healthcare is tenuous in terms of a lot of different factors. And so.

First chance I got, I actually ended up getting an IFMSA internship where they said you can go anywhere in the world and do an internship in healthcare. So I'd heard how good France was. So I was like, oh, let's go to France. I've heard it's really great healthcare. And so I go there for three months and I've been in the Cote d'Azur in the East and obviously because I speak French as well growing up in Montreal it helps. And so I was there for three months and I was...

bewildered how bad it was. I was like, wow, this is very bad. This is actually even worse than how we do it in Montreal and Quebec from what I'd seen at that point. And I mean, obviously the caveat is that I was in a particular city, but Nice is not a poor city. You know, Nice is quite a wealthy city in a wealthy region of the Côte d'Azur and the south of France, the French Riviera. So I was like, okay, well, this is even worse than what I'd seen in my microcosm.

Jordan Vollrath (04:48.063)
Really?

Sam (05:11.23)
And then about a year later, I remember there was a big strike in Quebec and the doc went on strike. But as part of going on strike, they said we're also not teaching the interns and the students. So they told us to just go home and sit around until the strike got resolved. And anybody who knows Quebec politics and union politics knows that these things don't get resolved.

Jordan Vollrath (05:28.319)
They can strike. Cause I thought that was like a whole part of the medical profession is you can't strike. That was just like one of those deeply ingrained facts where it was just like, that's not allowed no matter what. But they did it. Kovacs just YOLO'd it and they did it.

Sam (05:39.618)
Yeah, they did it. They were like, Hey, you know what, to hell with it. Let's just do it. And the government went down hard on them for it. I mean, you know, at some level we have to band together. And if we think we're not being compensated well, they're treated well. And we don't think care is being provided. Well, um, you gotta do what you gotta do. Right. So, um, part of the reason why I think that we.

Jordan Vollrath (05:49.215)
Good for them to some degree, I guess.

Sam (06:05.942)
We keep feeling that we get pushed around and dog just feel lies. I mean, we got these loose associations. We don't really have real unions. You know, sure. We have the CMPA. That's great. You know, we got colleges, which are, you know, people are more afraid of than actually are they helpful necessarily. But, you know, I think in their case in Quebec, they got pushed to the point where they said to heck with it, we're out.

Jordan Vollrath (06:28.607)
What were they mad about what was going on at the time?

Sam (06:31.614)
I think it was mainly around pay. Quebec was getting paid about half as much as the rest of the country, if you're a physician. And a lot of folks were leaving to the States or to the rest of the country. But also, I think infrastructure is a little bit back then anyways was lacking. I think they've caught up since then. They built super hospitals on the Beagle side and on the French side, the Chim as well. But yeah, a list of grievances. And we all know that in Quebec, people are more prone to protest and riot, be it all those hockey riots that...

Jordan Vollrath (06:33.748)
Yeah.

Sam (07:01.462)
you know, if the Habs beat the Bruins, it was definitely gonna be a riot. Didn't matter if it was the first round. If tuition was gonna go up, it'd be a riot. But, you know, it affected us pretty negatively at the time as students because we were told we couldn't, you know, be taught. We couldn't do our clerkships. So you're a third year medical student, and you're like, well, I gotta match to residency. I gotta do these rotations. Am I gonna fall behind? And, you know, there are reports of...

some of the students would actually go to the hospital and be like, I want to learn, and they'd be physically pushed out and escorted out of the hospital. So it was pretty wild. And I remember I'd written my USMLEs, my American board exams. So immediately, as soon as I heard the news, I was like, okay, great opportunity to travel, do healthcare somewhere else, and kind of get a taste of how other people are doing things. Maybe it's better than here. So I went to California, and we just packed a bag of clothes, packed a bag of books, and...

for about a year almost, I was going from site to site in San Diego and across LA and Monterey and San Francisco, Salinas, you name it, all over the map. And just kind of doing rotations. And everywhere I went, it was just kind of a chance to experience, okay, what are they doing well, what are they not doing well? And especially as a Canadian, you always hear about how bad the American healthcare system is or how good it is in different ways. And it was nice to just be like, okay, well, let me see a first hand.

Let me judge for myself. Yeah, they weren't doing things perfectly either, right? In terms of quality of care, I thought that at some of those sites there was the best quality of care, but if you had access, if you had the money. So that's the problem, right?

Jordan Vollrath (08:43.531)
Was that the primary differentiator between the people who thought highly of Canada's system or not? Was whether you were one of the in-group with insurance and access? Yeah.

Sam (08:52.274)
Exactly. So it depends on where you are philosophically. So if you believe that universal healthcare is a right, which I personally do, then you say that's the most important variable. Now somebody else may say, I think the most important variable is quality of care, not necessarily access to care, right? And a lot of Americans feel that way. They say, listen, you can go buy a fancy haircut or go to super clips or super cuts, whatever it is, whatever you can afford, right?

It's a different mindset. I was bewildered to hear that from a lot of my colleagues there where they said, why would I have to pay for the other person's healthcare? They're obese. They have diabetes. They're not taking care of themselves. I don't want my tax dollars to take care of them, which as a Canadian sounds pretty nuts to most of us where we don't have that same culture necessarily. Some, some people may be more do than others, but I think, you know, you're right and wrong depends on where you are. Philosophically. You know, some people are liberal, some are conservative.

Some people believe in this, some people believe in that, and that's okay. And I think in the States, you know, I wasn't there to be, you know, and I'm not much of an ideologue. I try to be pretty practical in my approach to things. But I thought, oh, this is interesting where the quality of care is amazing. You know, we had a patient, I remember, show up and say, Doc, I'm feeling pretty tired. And that same day they had the blood test at the same place. And that same day they were like, oh, there's a couple of lymph nodes that are swollen. That same day they did an ultrasound. That same day they did a biopsy.

And within 24 hours, they had a diagnosis of saying, hey, listen, this is lymphoma. And by the end of the week, they had their PET scan and they were started on chemo. That would never happen in Canada. That would never happen in most Western countries. Now, that's a problem because, you know, if that's you or if that's your family member, you want that standard of care. You want that quality of care. You know, here you would go to a walk-in. If maybe you have a family doc, but a quarter of Canadians don't.

and you go to a walk-in, you see somebody who sees you, maybe once they order tests, maybe they follow up with you, maybe they don't, maybe that gets lost in the ethers, you may have to chase after that. You get the report at some point, maybe then that somebody faxes an ultrasound, maybe that fax gets delivered, maybe it doesn't, maybe they call you, maybe you miss the voicemail. You know, six months goes by, you keep getting sicker, you end up in the hospital, oh guess what, it's fairly advanced, prognosis is poor.

Sam (11:14.85)
So everybody loses in that case. The patient obviously loses, the physicians involved lose, the system loses, the cost of care goes up. It's a disaster. And that happens every day in one way or another in this country. So for people like me, and I'm sure you feel the same way and a lot of people listening feel the same way, it's not okay. It's absolutely not only unethical, but it should be illegal and we have to do a better job. And I think that's what.

drives me in a big way where it's not just working within the healthcare system, but saying, how can we make it better so that these things don't happen, right? The system allows these to happen all the time.

Jordan Vollrath (11:51.927)
So what's the antidote to that happening in Canada then, right? So I mean, you have to have some sort of barrier to entry to prevent just gross overuse and misuse of the system, right? So getting stuff done that's unnecessary queues up the line to be longer in the States that barrier to entry is money in Canada, that barrier to entry is evidently time, like, is there a nice, happy middle ground where the same procedures get done just faster and publicly?

funded healthcare dime.

Sam (12:23.838)
It's a great question. And I think that's what I think a lot of people have struggled with and I've kind of struggled with in terms of thoughts. You read about different systems, you experience different systems. You look at it financially, you look at it logistically. And I think, I don't think that we need to throw more money at the problem. I think a lot of people say we need more money and money will solve the issue. I disagree with that because let me give you an example within Vancouver coastal Providence healthcare.

and PHSA, these big three health authorities within Vancouver's lower mainland. We spent over $1.5 billion to essentially go live with the Cerner electronic health record. And so that's not even all of Vancouver. So as soon as you hit Burnaby onwards, that's all Fraser Health and they're using Meditech. If you're on Vancouver Island, they're on a different system of Cerner. So just for this small portion of the province and a portion of the city of Vancouver,

We spent $1.7 billion of tax dollars, and counting by the way, the project has been going on for 15 years. You're telling me 15 years and 1.7 billion and counting, that's a problem. I don't think more money would have made things better in this case, right? But I do think we should have quickly developed and implemented a viable electronic health record system for Vancouver and possibly the whole province.

on the same system so information can be shared in a meaningful way. Well, gone in the way of that was politics and bad decision making. It wasn't money. And I think that when I look at almost every issue in healthcare, the majority of them are not fueled necessarily by money. Some are. Some, for example, the lack of family doctors is because of money. A family doctor in BC gets grotesquely underpaid in my opinion. And I'm not a family doctor, so I don't know. I'm not biased when I say this, I think. But I look at...

how important of a job it is and how difficult of a job it is. But they're billing maybe 30 bucks a visit. If it's a standard visit to see your family doctor, I'm not mistaken, you know, the fee codes are about 30 bucks. And if you look across the country, they're in that $30 range, $35 range, maybe 50 bucks if you have a physical exam. I may be wrong on this, because I haven't looked at it for a while, but when I talk to my buddies who are GPs, that's the biggest complaint. When you look at these training programs, when I was at McGill,

Sam (14:45.586)
we had many, many empty GP spots. Across the country every year, the number one residency spot that has the most empty spots is family practice. But wait a second, what is the number one type of physician we need more of? Family doctors. So something's broken with the system. And when you look at it, unfortunately or fortunately, this is just how people are motivated. They're motivated by money in a lot of ways, or at least they'll say, why should I do work? It's as difficult, as important.

but be compensated so much less for it. And so folks say, well, I'm gonna go become a specialist. And they won't even have jobs. As you know, a lot of people don't get jobs as specialists. They do fellowship after fellowship, and then maybe they move to the States, maybe they go somewhere rural. That's a problem. That's one of the money problems. And listen, if you think you clearly are seeing with people's behavior that they feel that they're not being compensated fairly for the job that they're doing. And so maybe a little bit more money there.

could save a lot more money down the line. But I think that's part of the problem where the way the system looks at the issues is very narrow-sided, very short-sided and narrow-minded and doesn't look at savings. You spend maybe a million here, but you save 10 million there, and they don't look at that, or at least I haven't seen that in a meaningful way. And yeah, so I think at the end of the day, some of it is money, but most of it is not. A lot of it is politics, bureaucracy, and logistics.

Jordan Vollrath (16:13.807)
How do you start fixing that, I guess, right? Like for example, with the provincial wide EHR system, like why did that project go so over budget and take so much longer or not hit the results it needed, right? It's like, why is it so difficult even for top down authority to implement systems like this in an effective manner?

Sam (16:36.782)
I think part of it is accountability, a big part of it is accountability. Nobody is really held accountable in any meaningful way or is capable to quarterback things in a meaningful way. And I think part of it is incompetence, to be honest, when you spend that much money over that much time and have that little to show for it. And maybe part of it is corruption, to be honest, because in 2008 when this project was greenlit, the liberal government at the time said you can only use Meditech or Cerner in the province of BC.

But usually there's a process for that. You should have an RFP process where different people bid forward and a certain level of transparency. As far as I'm aware, that did not happen, right? And so that's a big problem if you're giving that kind of contract out. And one, would you make the decision to allow two systems that don't connect with each other, especially when those two systems exist in the same city where patients go back and forth, right? Why would you take outdated technology and not...

update that. Why would you go to American companies and give them billions when you can support local? We have a lot of great people here in Canada and in BC in the tech sector. If you'd given them a fraction of that money and worked with them, we could have built our own system and owned that system and operated in a meaningful way, created jobs for Canadians, for British Columbians, right? Why would we not do that? That's insane to me. And I think that, you know, that was done at the Ministry of Health level. So I don't-

know the details, I don't think anybody outside of that room really knows, but they were bad mistakes. So if we're talking about that. Now why were those mistakes? Because those were politicians, right? Politicians and I can't blame them ultimately because if every four years you and I had to win a popularity contest to still have a salary and a job, I guarantee you we may not make the best decisions in the long term. And that's partially a problem of our system.

I don't know how to fix that and I'm not even gonna go there. But the reality is that I can completely understand why somebody who has to dance and keep everybody happy and be like, please vote for me, won't necessarily make the best decisions for the majority of people over the long term, which are difficult decisions that expend political capital. And so you could say, hey, they're corrupt. That's an easy say. You could say, hey, you know what, they're dumb. Hey, they're this and that, which we usually do as voters. But if you're in their shoes,

Sam (18:59.83)
you can definitely empathize with the predicament they're in. They have families, they have mortgages, they have to pay the bills, and so ultimately they'd make easier decisions rather than difficult decisions. They'd kick them out of office. But at the same time, those people aren't healthcare professionals. Here in BC, our Minister of Health, and across most of the country, the vast majority of our ministers of health and ministries of health are politicians. They're not doctors, they're not nurses. That's a problem.

You know, you wouldn't make your general somebody who had never served in the military or had even done basic training. If you haven't worked in a hospital, you haven't worked in a clinic, you haven't been in the trenches, maybe you shouldn't be allowed to make those decisions for all of us.

Jordan Vollrath (19:46.079)
It's interesting how it works that way. Like it's sort of a follow the incentives and then suddenly the behavior makes more sense, right? Like when you're dealing with a four year political cycle, obviously the incentive is to not lose your job, right? Whereas you look at somewhere like China where they're not so much concerned about elections, you know, they're looking at things on the 50, 100 year time horizon, right? So that weighs into it a lot. I mean, in terms of the giant EHR project, obviously you guys at ARIA

Sam (20:08.91)
ways that you would pass. I didn't know what to do in terms of the calculation.

Jordan Vollrath (20:16.273)
building your own. It was a great time to segue over to that, right? I imagine giving, given $1.5 billion, you guys could have moved mountains for the entire province. Where does the actual expense of implementing a system like that lie? Like the dev costs upfront, I'm sure.

You know, on the order of like a seven digit number, definitely not a nine or a 10 digit number. Is it the implementation? Is it just literally the bureaucracy and red tape behind the scenes? Or like, why not just have a homegrown solution? Something like that applicable and built for the region.

Sam (20:53.614)
Yeah. And I mean, it's a great question. At the end of the day, tech is not that expensive or difficult as people think. You know, you have that big arrived can, you know, controversy and the amount of money that was spent on that. It doesn't cost millions of dollars to build an app. It doesn't cost millions of dollars to build an electronic health record. The first version of ARIA that we built, we built with tens of thousands of dollars. And then we built iterations of it with hundreds of thousands of dollars, not millions, not billions.

You know, the tech is not that difficult, not that complicated. What's difficult is a lot of the other pieces logistically, you know, what exactly are you building, who's accountable? How do you go about doing that? Right. And I think that if you put a hundred people in the room and nobody's ultimately accountable, there's going to be a lot more waste than if you have a small group of people innovating and building and who are spending out of their own pocket and reliable. Because

If you look at it, you know, at the end of the day, even within the tech sector, we even within the private sector, the folks who are innovating are these small startups because they're lean and there's much more accountability and the founders are putting off in their own money or their own necks out on the line like we we've done. And I think that we actually accomplished more with much less. And then usually what happens is in the tech sector, these startups get bought out by Microsoft and Google and get run to the ground, right? I've seen even in health tech in Canada, a lot of really

good companies being bought out by bigger groups and essentially being shut down or run to the ground effectively. So if you look at it, it really comes down to a lot of that kind of accountability. And at the end of the day, I think that if you had given a local group like us or anybody else, to be honest with you, I think a lot of folks here could have done a whole hell of a lot for way less. And tens of millions of dollars could have been game changing.

It actually irks me in a big way when I see the kind of money that people spend on nonsense when it comes to healthcare, researching things that may be superfluous. And ultimately you see the disaster, which is, you know, you go to the emerge, you go to the wards, you're in the ICUs, it's a goddamn war zone. It's, you know, it's backed up. People are sick. People are frustrated. People don't have GPs. People aren't getting their tests done. And yet we're throwing money and wasting money at nonsense. And there's no accountability.

Sam (23:18.398)
And I think, you know, that's a disaster. Um, how do we fix it? I mean, I got some ideas.

Jordan Vollrath (23:26.399)
I mean, the people in charge of making the rules aren't incentivized to change the rules to no longer be in their favor. Like, what do you do at that point, right?

Sam (23:35.338)
Yeah, you know, healthcare is a microcosm of our society at large. And so, um, you know, I think that, again, you speak with most Canadians and I think that most Canadians would agree that country's not doing great. Um, and maybe veered away from some of the things that did make this place a great, great country and great values. And, and I think that we need to get back to that in terms of accountability, in terms of transparency, and in terms of doing a better job of taking care of ourselves.

Jordan Vollrath (24:01.687)
Well, now the new federal funds transfers come into the provinces have strings attached with them. So there is a new layer of some accountability actually getting added on there. It'll be interesting to see how that plays out. BC, you guys actually, I think, were the first province to fully sign the deal. I don't know if you have any insight on what those strings attached were. I have no idea myself.

Sam (24:22.294)
No, I got no idea. I got no idea how a lot of this money moves around or gets transferred or how things work. From what I've heard through the grapevine and through colleagues who've worked with doctors at BC or on different boards and this and that, again, it's a lot of politics and right. Who's your representatives? What are they doing to get money moved around and this and that. So something I wouldn't want to be part of.

Jordan Vollrath (24:49.691)
What inspired you to team up with the other two and actually start your own electronic health record? How did that initial conversation go?

Sam (24:58.734)
Uh, yeah. So, uh, rich Stramco and rich van de Green are, uh, two, two of my best buddies from residency and, um, great guys. I know rich has been, um, on the podcast and, uh, you know, I had kind of thought for all throughout med school and residency. Wouldn't be great to, to find. I didn't even want to build one. I was just trying to find a great electronic health record. I'd used every single one out there, you know, in States, Canada, Europe, anywhere I ended up going.

And they're all pretty bad, you know, old tech, poorly designed, bad UI, bad UX, death by a thousand cuts. And I always thought to myself, well, there's a lot wrong with healthcare, but technology is one thing that's made every sector more efficient and more effective with better outcomes. Why can't we do that in our field? And in fact, technology and healthcare has made us less efficient, right? Almost every doctor subjectively says, my AMR, I'd rather just do it on paper. It's quicker. Or they revolted against it. Or, you know, you even look at it objectively.

most docs, you know, papers coming out saying they're spending 25, 30, 35% of the time just typing away or dealing with their EMR. So I remember I had just graduated and I had started up a clinic with some friends and the EMR was so awful. I won't name any names, but it was so bad. It was so bad. Yeah, yeah. It was the worst part of my day. I didn't even want to work in the clinic because the EMR was so bad. I just picked up horses to the hospital.

Jordan Vollrath (26:17.015)
You tell me offline after just for my own curiosity.

Sam (26:27.338)
And I remember one day I was walking home and particularly frustrated. And I was like, no, it's going to kill me. We have to build our own. I was like, there's no other solution. I, I don't know. I haven't seen anything that works out there. And I call Rich Stramco up and I say, Hey, Rich, uh, I'm going to start building an EMR just for my own clinic. Um, I know we've talked about this in the past and, you know, we're both pretty passionate about this kind of stuff in terms of how to make healthcare better and, uh, you know, he was like, what are you crazy? What the hell do we know about starting a business and

building a tech company. And my rep, I was like, well, nobody else knows what they're doing. So it couldn't be any worse than whatever else is out there. Worst case scenario, we fail and we learn from it. And maybe we build something just for ourselves. In best case scenario, we do good and fix a problem that's fairly ubiquitous. And that's kind of how it started. And then shortly after Rich Van De Green, we approached him as well and said, hey, listen,

Would you be interested in this? And we, the three of us got together and, you know, we just kind of figured it out. None of us have business backgrounds. Um, I did a health informatics masters in Portland, Oregon and OHSU. So help me a little bit, but not really that much to be honest with you. I'd worked with a couple of different tech startups at that point and had some insight, but nothing really that would give me any meaningful insight or experience into this and we just through trial and error built Arga.

Jordan Vollrath (27:57.439)
And what's the key differentiator there on the platform? Is it really like that time spent clicking and navigating and moving through the platform? Is that like the idea that was the main problem you were trying to solve with it?

Sam (28:11.222)
It first started with really just getting rid of the paper cut. So I remember other systems that I was using, it would take me five, seven minutes just to create a prescription, print or fax a prescription, which is insane, right? Um, creating a note and a note template and clicking through that was impossible if non-existent, um, you know, doing your buildings was so clunky. So many pop-ups, so many buttons.

creating a task for your MOA was just like, Jesus, why are there nine fields for me to create a task? Why is there so much information here? And there's no transparency in terms of, you're creating information in a system that's then lost in that system, right? In the ethers. And you're hoping that people look at that information in a meaningful way and act on it. So just created too much anxiety and stress on top of the inefficiencies. With ARIA version 1.0, when we first built it was, let's make it as simple as possible. No pop-ups.

not a million buttons all over the screen, across and down the side, icons that you don't know what they mean, and you're like, oh, should I click on this? You know, something else pops up and it breaks, and then you gotta reboot the whole system. Something that's just simple, intuitive, doesn't crash on you, works the right way. And it's not that hard. It's, you know, you review old information when you see a patient, you create new information, you share that information, and then you do your billing. That's fairly universal for most healthcare practitioners. We don't need

a GP, a specialist EMR, an allied healthy EMR, like we do right now in the ecosystem. And then having these silos information that don't communicate. So we said, let's just build something that any healthcare practitioner can use. We all work fairly similarly. This shouldn't be so complicated. Obviously some people are gonna want an Android over an iPhone and that's fine. But we said to ourselves, I think a lot of us would rather something that's simple, basic and easy. And that was the core of what we built with RAA originally.

Then with the pandemic, we said, well, things are going virtual. So we built an entire virtual platform, patient self booking, patient telehealth, text message, email reminders, and a patient portal. So the entire gamut of tools integrated with the EMR so that information can flow seamlessly between doctors and their patients, right. And securely. So, cause people were emailing prescriptions and all that kind of nonsense, if you recall, you know, um, which is an ideal.

Jordan Vollrath (30:35.88)
the chief medical information officer would not approve of that.

Sam (30:40.914)
Yeah, yeah, not ideal. So we've built that and over the years what we've done is that ARIA has grown organically. We spend zero dollars on sales and marketing to be honest with you. It's just been through word of mouth. And essentially what's happened is that we're across Canada and five different provinces now which is amazing. And we've expanded every two weeks we add functionality. We just don't sit back and say, oh well, we've done everything perfect.

keeps having to be better. And I think compared to a lot of competitors where I remember saying, it hasn't changed in 20, 30 years, it's not good enough. We keep trying to innovate. So we use the platform ourselves in the clinic. We then meet and every week and say, hey, this could be better, that could be better. We engage with our user base and we've built out recently AI. So we've built out AI and integrated it in the system in an incredible way. So you can just click the AI scribe, it records your

You listen to the conversation and can essentially put together a note based on a template of your choice. So game changer, imagine not needing to type or dictate notes.

Jordan Vollrath (31:46.361)
Cool.

I think the AI Scribes is one of the coolest new applications of technology. It's just like you mentioned, you know, spend 35% of your time typing and that's gone, like just literally gone, a hundred percent gone. It's wild. Well, so

Sam (31:59.894)
Yeah. Oh yeah. And it's so good. And that's the thing where people who may have not seen this don't realize how much better it is than even you writing your own notes, right? You may say, no, write a great notes. No, no, this it's really, really impressive.

Jordan Vollrath (32:19.731)
In terms of the complexity of the existing tools are out there and just like how clunky it feels, how much of that could have been solved with more training, right? Cause you can see the argument of like, okay, we spend how many hours learning how to use our needle driver and our forceps trying to suture, right? Like it's something you practice at, you train at, you take courses on, you have people watch you do it and give you feedback. How much training does ARIA require

with it. How much time should we be spending learning to use this tool?

Sam (32:54.926)
The average user spends half an hour in training. So whenever somebody signs up and then they go to start using the tool, half an hour. The most we've seen is an hour and we've actually seen 20% of people needing no training at all, which sounds insane because with Cerner we said come in for three, four, five days. So back when we did the Cerner implementation, it was several days of training. And imagine a healthcare system where you're already short on staff.

Now to have to train people, imagine you're running a clinic and you have turnover in terms of locos and students and MOAs who come and go. You have to build a system that's so intuitive that it needs little to no training. If my elderly parents can sign up for a Gmail account and a Facebook account and figure it out and they never had any training on how to do that and how to use it, then you know what? I'm pretty sure we can build an EMR for people who have all this education and expertise.

without needing that much training.

Jordan Vollrath (33:58.443)
What is the difference I guess you sort of from what I've seen there's kind of two clumps of EHR systems You've got your like

small independent clinics often utilized by allied health. So you'll find it in like a physiotherapist office or a chiropractor's office, something like the Jane App EMR. And then you've got your other bundle of provincially certified EMRs. And the price difference for a user to be on these is like an order of magnitude separate. Like what going on behind the scenes, what is actually the difference between the two buckets?

Sam (34:33.782)
Yeah, it's a great question. I think a lot of it is waste with the bigger corporations have more mouths to feed, more people working there. The amount of times that I've worked with some of these bigger corporations, either related to HealthTech and ARIA or not, but I'm always amazed how many people work there. And I'm like, there's so much redundancy that may not necessarily need to be there. But again, it's that whole accountability. Who's running the show? Do they know everybody here? Does everybody need to be here?

We've even had that with Arya, to be honest with you. Like you, you're trying to figure out how to run a company and you're saying, well, do we need this role? Sometimes you look at it and you're like, actually we didn't end up needing that. We don't need that many people, um, to run things. And I've seen, you know, the Cerner project, there were times where we are in a meeting with 150 people. I'm like, why aren't there 150 people on this call? Why are there a hundred people on this call? Right. Oh, they're stakeholders. But, you know,

Jordan Vollrath (35:26.827)
What did that cost per hour of time?

Sam (35:30.186)
Well, they were paying the docs a hundred bucks, I think, I'm not mistaken, a hundred bucks an hour. So just imagine how expensive that meeting is, right? And so it's these kinds of things that are silly and wasteful. And I think I know that there's a lot of waste in these bigger groups. And it's kind of like, it's not just health tech, it's every big corporation. Listen, Nike spends how much money to give to Tiger Woods to wear a hat, right? It's a fundamental problem with our culture and our economics where-

you know, Nike shoe probably cost seven bucks, but they're charging you, you know, 150 bucks because Tiger Woods is getting, you know, a hundred million a year. Again, I'm throwing numbers that I don't, I don't know how accurate these are.

Jordan Vollrath (36:05.887)
Yeah, yeah, no, I get your point though, right? Like the branding and the marketing and that sort of bloating that occurs.

Sam (36:11.838)
Yeah. And if you look at, you know, TELUS, for example, which is the big, bad guy of healthcare for most doctors and groups, you see, I don't necessarily think that for the record, but I know a lot of people who work there and, you know, that we've worked with in the past and other organizations. But if you look at TELUS being the ones with the deepest pockets, and they're all over Canada, but you got to say, you know, they're spending a lot of money.

then they have a huge budget. But what kind of innovation are we seeing? Every couple of years, they just buy a new EMR, right? But with that kind of money, you should be able to build something pretty incredible, but you're not. All you can do is every couple of years, you buy a new EMR, run it to the ground, and then transition everybody to the next EMR. It's very bad for healthcare, right? Now, I don't think that everybody should be on the same EMR. That's never gonna happen, because people have different tastes, and that's the free market. I do think, however,

There should be more accountability in a lot of ways in terms of how you treat doctors, how you treat clinics and how you run technology in a meaningful way. It always bewilders me because I look at, in Alberta, we've approached Alberta Health Services in the province of Alberta and said, listen, we have a lot of users in Alberta and they want to connect to electronic delivery results in Alberta. Our users currently get it through eFAPS. So obviously you have to deliver.

results to doctors, but you can do that through directly connecting to the electronic system. Now we have something called Acceleris and BC, we have that. To BC's credit, it was fairly transparent. We said, hey, we're an EMR company, we meet all the standards for security and privacy. Can we see your API? Let's make sure that we're vetted in a way that's appropriate. And then within a couple of weeks of work, we did that and we connected to it. In Alberta, it's been five years that we've been asked just to be allowed to start the process. And they've said, well, there's a big queue.

And nobody's moving in that queue. And the only person, the only group that really is connected in a meaningful way it has been is TELUS. And so you gotta start asking yourself some questions where why isn't that queue moving? Why is the ministry not helping? Why have we written letters to everybody under the sun and they've said too bad, so sad? Well guess what, that's not good enough because you have doctors who are taking care of patients and you have to allow people to see information in a transparent, effective way. This bureaucracy is completely unnecessary.

Sam (38:37.522)
Why the paperwork? Five years? I could understand a couple months for sure. Obviously due process is important. But I say whenever something is that ludicrous, it's either complete incompetence or there's some level of sinister or work that's going on that's not kosher. And I think that's the problem. And I know obviously in Alberta, the recent news that AHS is going to be broken down into four different groups, for better or for worse. But maybe they looked at that and they said...

Jordan Vollrath (39:05.567)
Maybe that'll speed things up on the queue. Who knows?

Sam (39:09.434)
Who knows? But clearly the government looked at it and said, well, there's a level of inefficiency and bureaucracy and incompetence here that is unacceptable for Canadians and for patients and doctors. And I mean, that's one example that needs to be shared because I think people need to know about these kinds of things and it's not okay. In Saskatchewan, we've had interest from folks in Saskatchewan, we have some people who want to use the platform, but in Saskatchewan, if you use TELUS...

you get paid a buck per patient by the government. Um, that's, that's what was told to us. Again, I still can't believe it. I still, um, I'm like, that can't be true. That's insane. But apparently you get money from the government if you're using a particular platform. And so it destroys competition. And last time I checked, this is a country of free market, right? The, the lifeblood of a healthy economy is competition.

and a free and open market. Obviously you have to have vetting in terms of certain standards, but the fact that you're picking and choosing winners and not allowing innovation, because on one hand, all I hear all the time from our universities and from our health authorities and hospitals is innovation. We love innovation, we support innovation. You go to LinkedIn, everybody's hooray for innovation. Okay.

Well, clearly the ecosystem is not set up for innovation when you have these kinds of legislation and money being paid. You know, money talks, right? You can talk as cheap, but when you see these kinds of actions, we had the same problem in British Columbia, there was PETO, the Physician Information Technology Office, roughly 10 years ago, that picked four EMRs and said everybody else could go to hell. And those EMRs, you get $5,000 if you choose one of them. And then we give you 300 bucks a month to use one of them.

Now I know this because I was a beneficiary of that when I first started, right? I agree. I was aware. But if you want a free market and if you want innovation, do you think it's okay to spend taxpayer dollars to give to big companies that don't need it through doctors who can afford it themselves and who can afford to make decisions on maybe better systems? And I think that's a big, big problem.

Jordan Vollrath (41:01.379)
How did that go?

Jordan Vollrath (41:06.731)
video.

Sam (41:30.27)
And we see that in too many provinces in this country.

Jordan Vollrath (41:34.132)
How would you?

tie the two together, I guess, right? Cause the innovation, the free market, you know, just having new things come to see the light of day versus then on the other side of things, you've got more fragmentation. So I'm specifically talking about the EHR space here. So I can definitely see the benefit of like one patient, one record, having everything just interconnected and less scattered that way. But then just like you're saying, now tech gets old, it doesn't get innovated upon, it gets bloated, the price goes up, there's not new features

You know, you miss out on that sort of next generation of things coming along. So how would you marry the two concepts of having new things come about and not having things get dilute?

Sam (42:19.082)
Now that's a great question and I think it's a very simple solution. I think people are thinking too binary. People are thinking very like black and white about this. When it comes to technology is really ultimately what's important to be distributed among different practitioners is the patient information. So the patient information doesn't necessarily need to be all on one platform. You can have data be transferred between systems. For example, you can email.

from Gmail to Outlook. You can email from Outlook to Yahoo. You know, our governments didn't say everybody needs to use Gmail, all the others need to go away. You can send information between different servers because information is on a server codified as data. That data can be shared securely, privately, and effectively between systems because we do that in every other aspect of how we use technology, right?

The reason why it isn't being done so in healthcare is because these companies don't want that to happen so they can control their customer base and not allow you to move around freely. You recall back in the day with telecoms, they said, oh, your phone number belongs to us. So people would say, well, I'd love to leave Telus or I'd love to leave Rogers, but I don't want to lose my phone number. So government came in and said, and appropriately so, that's not okay. That's not part of the free market. That's harming them.

you know, users and Canadians. It's the same thing. Listen, at the end of the day, these companies can't hold patient data hostage, doctors, you know, clinic data hostage. That is the part that's ridiculous. And not only that in terms of data migration, when you go, want to go from one system to another, but there's a responsibility that data flows from one system to another, securely and effectively. We can do that. The technology is there. Again, this is not difficult stuff to do. It's the politics.

you know, and the nonsense that's stopping that from happening. Now that's very different from the interaction with that data. So that user interface and the technology that takes that data and then shurns out meaningful analytics, turns out meaningful note creation and data creation, that you should be allowed to use whatever you want because different people have different tastes, right? The same way that not everybody dresses the same, not everybody drives the same car, not everybody, you know, we're not a bunch of

Sam (44:44.882)
you know, robots, right? This isn't communism. This is, and that's the thing where you're like, it's a very simple process. Allow people to choose whatever front end that they want in terms of platform, but you must force the backend. And that's not what people are doing. If anything, what you see again and again in this country is politicians and policy forcing people towards one or two big vendors. Those two big vendors doing nothing for innovation, driving up costs because there's no competition.

and ultimately harming the whole system.

Jordan Vollrath (45:16.711)
Is this the premise underlying like the FHIR standard for interconnectivity? Like I see this mentioned all the time. I don't really understand what that actually is. Is that just like mapping of a specific variable universally and then platforms can talk to each other using that same language?

Sam (45:35.614)
Exactly. So roughly speaking, it's that if you're building your platform, you build it on the fire platform so that you can actually move data in a way for data sharing that's meaningful. So in the States, it was actually the Bush administration back in, back in 2007 that passed that legislation. I think if I'm not mistaken. And part of the reason I think why Cerner and Epic became as big as they did is because they were able to meet a lot of those criteria and everything else. Right. And so they're

The Cope and Pepsi of EMRs right now in North America anyways, we've adopted them in Canada in a big way, but when we were doing the Cerner Go Live here in Vancouver, I remember actually going to existing vendors in the community and saying, Hey, listen, you know, we'd like to utilize this platform to connect to your data. So if you're a GP or a specialist using a community EMR, that data can flow back and forth from the hospital to you, from you to the hospital. And everybody I talked to at these different

you know, back when I was in that role told me to go to hell, essentially, you know, they weren't interested. And most of them haven't built this functionality to this day. And even for us, you know, uh, we haven't built it in a meaningful way for the Cerner platform. So even in the versioning of Cerner that we bought and implemented, it was largely ignored, unfortunately, which is again, bad planning, bad policy. I remember flying down to Kansas city, which is where Cerner headquarters are and met with a bunch of people on two separate occasions and saying, Hey,

Can we get access to this? Can we set this up? And it never really went anywhere. But at the end of the day, there's only so much you can do, right? I was working full-time as a doctor, part-time in this administrative role, and there's only so much you can kill yourself to do the right thing. And it was disappointing. I think it's really disappointing because it puts us in a precarious position where you've spent all this money, and now you know what, maybe in a few decades from now, it's not longer, you're gonna have to gut the whole system or move to another system.

Jordan Vollrath (47:31.187)
And so in that mission, you know, to stick it to the man, you know, the underdog comeback story here up against the Tellises and the Epics, what's the critical step to doing that? Is it just that grind of organic growth, that bottom up ground swell, bringing on doctors and clinics one at a time? Or what is that, what unlocks that next level of actually getting the technology out there?

Sam (47:34.779)
Thank you.

Sam (47:59.082)
Yeah, I think it's a good question. Anybody who's listening, I would say, definitely stick it to the man if you can. We don't do enough of that. A lot of people just put their head down and say, oh, what can you do? You're a doctor, you're a nurse, you're a citizen of the country. And I mean, listen, if you think something's not done right, get involved or don't complain, right? A lot of people just complain. And I think, regardless of what happens with Arya, I'm really proud of the work that we've done as doctors to get together and try to fix our own problems. And I think that ultimately,

You know, we've seen a really nice growth and who knows how far we go because at the end of the day, you know, you plant a seed and it depends on how fertile that soil is for what you want to do. It's tough to do innovation in this country. It's tough to do business and it's tough to, you know, do meaningful change. And I think a lot of that depends on the culture, the politics, the bureaucracy, right? And we're a small guy and we don't listen.

We're not here saying we want to be a big guy necessarily, we're just trying to do meaningful work and meaningful change and help whoever's open to begin working with us. So I think that what I always tell people is, hey, listen, if you're frustrated about these things that we're talking about, and if you feel the same way, well, listen, do something about it, here's something out there, and here's a group of us who are doing something about it, and be surprised how a small group of people working together can really make a difference sometimes.

Jordan Vollrath (49:29.143)
Just getting like-minded individuals gathered together, right? Be that agent of change, the change you wanna see in the world, right?

Sam (49:37.77)
Yeah, exactly. That's all you can really do. And, you know, I mean, maybe I'm crazy, you know, it'd be, life would be a lot easier if we weren't working as doctors and then running a tech company as well. But to be honest with you, anytime I take a vacation, go sit on the beach, you know, you're having my time by day three, you're like, I'd like to get back to work. This is okay. But you know, when you're doing meaningful work, I think it really resonates. And yeah, that's what I put out there.

Jordan Vollrath (50:06.795)
I mean, what can doctors do just to help speed things up on that front? Like I know in perhaps this situation, there's some incumbents and there's some active downforce and pressure from the top trying to remain in that position as the top dog, but we see a lot of companies struggling even where there isn't really competition or where the status quo is just not having any technology implemented and they're battling against that, you know,

anything, you know, that investment of time and having to learn something or, or take a little bit of a risk and adopt a new procedure or a new workflow seems to be like a fairly high barrier of change. It just isn't a lot of appetite for it in healthcare in general.

Sam (50:53.238)
Yeah, it's a really great point. And I think it's always something that surprises me because you talk to people and almost universally people are frustrated and they're tired and things are inefficient and they feel spread too thin and death by a thousand cuts. And I think there's a lot of reasons for that. But then when you give them a solution, right? People will say, ah, that's too tough. But I think part of that is the culture of us as doctors and we're only to blame for a lot of our own hardships.

But also think it's just human psychology, right? Somebody comes up to you and says, hey listen, would you like a new kitchen? You'd be like, oh yeah, I'd love to renovate my kitchen. Be like, well I'll renovate it for you. And you'd be like, ah, too much cost, too much hassle. It's good enough. And you'd be like, well you just complained about how bad it was. Yeah, but the hassle of the mess and the cost. And then you say, well how about if we took the cost away? Which is often what I try to do and what we try to do with Arya and what a lot of...

people doing innovation try to do, right? A lot of these startups, a lot of these innovation groups are not prohibitively expensive compared to other folks. And so, I'll give you an example. When I first started as a doctor, I was using a system and that system said, you have to pay $30,000 to go live. And I said, why? That's crazy, it's an insane amount of money for one doc to go live with the system. And so I said, nope, this is nonsense. But I shopped around and most people wanted 10, 15, 20,000 plus.

which is nuts, it's a completely unreasonable amount of money. You know, with Arya we charge nothing. So if you want to go live, there's zero fees, because there shouldn't be fees. And so at the end of the day, I think that even if you remove that barrier and you say, hey, I'll renovate your kitchen and at no cost to you. And they'll say, ah, still the hassle, you know, so much hassle. And so you say, well, we've innovated, we've provided you with a solution, we've removed the barriers to cost. And still you see so many people say,

Jordan Vollrath (52:41.836)
Mm-hmm.

Sam (52:50.782)
You know, the mess of renovating my kitchen may not be worth it. So I think to those people, I say, well, okay, that's fine. Everybody can, you know, it's, it's your decision, but ultimately I think a little bit things sometimes have to get a little bit worse before they get better. And I think for a lot of us, it's, you know, yeah, you have to put in that work. So we've been fortunate that, you know, there's been a big enough group of people who've said, yeah, you know what, this makes a lot of sense as a game changer. And I think from.

From a change standpoint, you have to give people something that's worth that hassle. That's really that next level of, okay, this is so meaningful in terms of that innovation and technology. But I think, again, for anybody listening, support each other. Get together. We're all physicians here, and we're not supporting each other in any meaningful way. If anything, people are competing amongst each other and making life harder for ourselves. If you see physicians doing innovation, support them. It's only going to make things better for you.

and ultimately work with them in a meaningful way. I think that's how we can solve a lot of our own problems. I'm not a firm believer in thinking somebody else is gonna fix my problems. You should roll up your sleeves and do it yourself.

Jordan Vollrath (54:05.247)
Yeah, it really comes down to like, you know, what is within our power to actually change.

when it comes to the healthcare system, right? Like you've got your own day-to-day workflow, your clinic, how you actually operate. And a lot of that is your people and your technology and your tools, right? And then there's all these other things and there's a lot of finger pointing going on and a lot of blame like towards the government, you know, we're waiting for the problem to get solved. We're waiting for the billing code to get changed, the fee to increase, the like, you name it, right? But when it comes to those pieces internally, it's tough getting moving. I mean, we see this even on-

We've been at it for about four years now, and we've got about 2000 clinics using our platform. So that's about like 500 per year. And it's free, it doesn't cost anything. There's a physician shortage. We're giving away water in the desert and still getting people to adopt and use technology.

It's like, it's pulling teeth sometimes and it's same frustrations across the board for all the companies that we meet. Right. And then when you're, when you're dealing with the associations and the colleges and some of the larger bodies or even just like the smaller regional pieces, there's sort of that. Like.

distrust with private enterprise, right? So there's like the public healthcare and then everybody sees the for-profit sector as evil and lesser, right? So even though it's got nothing to do with like whether the patient has to pay for healthcare, it's just, okay, there's for-profit entities out there. And so that vibe immediately changes even that way, right? So it's tough. How do you actually foster that culture when really the only connection point between all the providers

Jordan Vollrath (55:50.005)
schools and the training they do. And then afterwards you've got the colleges and the associations. And it's just like, no one really seems to be interested in. Yeah. Really.

bringing everybody into a circle and saying like, okay, let's start trying these different things. Unless, as you mentioned, you know, you're one of the big guys, one of the larger companies, and then they've bought their access at that point. And now they're like, okay, all right, this is a certified company. They've got the promotion or the featured space, you know, on the website or as like a member benefit or all these different spots. So it's, how do you actually get the physicians or the broader medical community to start actually being more open to change

try and do things.

Sam (56:32.978)
super discouraging sometimes because I think almost all of us in the space where we're trying in the startup world, small businesses, innovation, this and that, everything's against you, right? It really is an uphill battle. And especially in Canada where every day it feels like things are getting more bureaucratic. The colleges rule with an iron fist. The associations don't really do much for us. And in fact, sometimes they harm us with some of their policies.

the different health authorities really don't let you do anything meaningful outside of you know and even when you're within it. And it just seems like everything's stuck but that's why we have our problems. That's why things are broken. You know if these people were doing the work that's needed and I know that these are good people. Again the truth is I've worked with a lot of these people and they're smart and they work really hard and they mean well but they haven't been able to get the results that we need. So you have to say okay listen guys it's not about finger pointing.

at an individual, personal or ego level, it's about saying, it's not working. What we're doing is not working. Healthcare is broken in this country. This used to be the greatest country in the world. I'll say it, it makes me, maybe some people will be like, oh, that sounds crazy. I remember growing up here. You know, my parents immigrated here. I was a little baby when we came to Canada, grew up in Montreal. I can tell you, this really was the best. Housing was affordable, jobs were plenty. Everybody seemed to have a house and a cottage. People went on vacations.

people had good jobs and it seemed like almost anything was possible, right? It kind of felt like the best of all worlds between American capitalism and some of that European socialism, we had kind of best of both worlds. It feels more and more that we have the worst of both worlds, we have the worst of capitalism and the worst of socialism in a lot of ways where it's just impossible to get anything done. And things have kind of fallen apart around us and I don't think this is just me saying this, I know that in private conversation with almost anybody from any.

economic class from friends who are doctors to friends who are blue collar and everything in between You know people are frustrated when people are feeling stuck and I think that you know We've we failed as a society. It's not finger-pointed to anybody in particular, but it's saying listen. It's not working okay, if it's not working then we have to find a better way and Those of us who trying to You know, we really need to think

Sam (58:55.042)
band together and I know, listen, Ari has always supported Cherry, you guys have us as well and I think we do the same thing with all the other small companies. So there's a lot of good people doing good work out there and so I think instead of complaining or finger pointing, which never really does anything good, I think the only way really is to say, hey listen, let's support each other. If it's a sink and ship, then it's a sink and ship where we all go down together. But

Jordan Vollrath (59:03.067)
Look out for each other, right?

Sam (59:23.106)
but that's all we can do, right? And hope that people at some point start saying, oh, okay, these guys are sincere, they are doing good work, they're not a threat to the establishment, right? Because these government bodies may feel threatened sometimes, but what's odd is we always say we're trying to work with them and they don't engage with us, right? Like the amount of times that we've written letters and we've said, hey, we wanna sit at these tables with the big boys and with you and help, we're doctors, we're healthcare practitioners.

We care, we're sincere about this. And so I think that it's very tough, but those politics aren't good for anyone, right? We have to set our egos aside, do the work that needs to be done. Otherwise things are only gonna get worse.

Jordan Vollrath (01:00:08.035)
I fully agree with you. Alright, well we've hit the hour mark. Any final comments before we wrap her up?

Sam (01:00:11.086)
I'm out.

Sam (01:00:14.506)
No, listen, maybe on a more bright note, I mean, so much, so much bleakness, but I think, listen, there's a lot of good stuff. I think there's a lot of good stuff to come. I think from an ARIA standpoint, anybody who hasn't heard of us or checked us out, please do check us out on our website. It really is pretty amazing. I know I'm biased when I say this, but it's a game changer if you're doing outpatient care in terms of how much more efficient you can be and provide better care. And it's, it's really been.

a shining light and, you know, for some of the work that we've been doing and hope that we can keep spreading that to other colleagues out there in the country.

Jordan Vollrath (01:00:53.067)
What's the website, where can they find it, and what's the price differential between Arya per capita and one of the big boys?

Sam (01:01:01.118)
Yeah, so you can find us at aryaehr.com, a-r-y-a-e-h-r.com. And price difference is depending on the vendor, we're as much as half the price for your monthly fees. And we have no set of costs, so you don't have to pay any training fees, go live fees, anything like that. So you'll save thousands of bucks per year, and you can spend that on a nice vacation, much deserved to somewhere nice, nice and warm and relaxing.

Jordan Vollrath (01:01:28.023)
Somewhere tropical. Right on, okay. Dr. Gharbi, thank you for joining us. Really appreciate your time.

Sam (01:01:33.186)
Thank you sir, thanks for having me.