Physician’s Take on Pragmatic Innovation in Digital Health & Precision Medicine

[00:00:00] Jared: Hello everyone and welcome to another episode of the med+Design podcast, the go-to platform for the fascinating narratives of medical innovators. And today we're honored to host Dr. Ron Ribitzky a luminary in the world of digital health and precision medicine. Dr. Ribitzky is the founder and CEO of R & D Ribitzky, a firm known for its pragmatic innovation in the healthcare IT and life sciences informatics domains.

With a remarkable career that spans from being a practicing physician to a globally recognized tech entrepreneur, Dr. Ribitzky stands at the unique crossroads of medicine, technology, and business epitomizing the spirit of forward thinking and innovation. His work with R & D Ribitzky is not merely revolutionary in the fields of digital health and precision medicine, but also sets pace for the future of technological advancements in these areas.

Dr. Ribitzky's story offers enlightening perspectives on the processes of taking an innovative concept and shaping it into a practical solution, with the potential to revolutionize healthcare. His extensive knowledge and hands-on experience in the landscape of digital health innovation, make him an outstanding guest for our podcast.

We're thrilled to delve into his journey, the development of R & D Ribitzky, and his vision for the future of digital health and precision medicine. So without any further ado, let's plunge into our riveting conversation with Dr. Ron Ribitzky. Welcome to the podcast, Dr. Ribitzky, and thank you for agreeing to do it.

Looks like we had over 210 people from multiple continents signed up to tune into the conversation, so we're really excited to dig in today and I think we'll just dive right in. A couple days ago you reposted the event with a comment that was pretty funny. So what prevents digital health innovation from falling into the shiny object trap and Ty rebuttal but,

shiny objects are so much fun. What trap? So I guess we'll start there. So what trap. I think that both are right. So thank you very much for this opportunity to bring this very important topic that that, I'm so passionate about to the virtual global town square. And I'm really looking forward to this very stimulating conversation.

[00:02:01] Ron: And per perhaps about housekeeping, if I may, yeah I'm Dr. Ron Ribitzky, and maybe we do continue with Ron, Dr. Ron, whichever you're comfortable, right? Yeah let's get this outta the way. For me, shiny object is a technology marvel that lives in either the computer science lab, depending when, what's the roots computer science lab, or very deep in the R & D technology engineering team, right?

It is important. It is a spark. It sparks innovation, it sparks imagination, but in sharp contrast. Pragmatic innovation for me is a shiny object where the creators of it and usually the investors in the shiny object figuratively speaking, stood up in the lab, walked out the door, crossed the street to where the users live.

And folks who I work with, they hear that from time to time that I'm asking hey, let's pause for a moment. Let's cross to where the user is. Right? And they cross the street to the user side in order to really understand the users, their environment. What does it take to implant?

And I purposefully chose like the word choice implant as opposed to implement. Implant this new shiny object in the user environment and make it work, make it make sense, and make it work for the user end to end, not just about the shiny object and the notion of implant is because particularly in enterprise it, and even in the consumer environment, each one of us, we have our own IT setting, we have our phone, laptop, whatever.

So it has to come and work beautifully together in our new environment. And this is the make or break of traversing the traction gap. This is the make or break of achieving perpetual long-term return on adoption. Let me give you a couple examples, right? We chatted about Chat GPT. So just about five years ago,

here comes blockchain to healthcare circa 2018. Give and take with a big splash. And we started to hear around the world people, very reputable, knowledgeable people, thought leaders, oh, thank you Blockchain. Blockchain is going to solve medicine. Period. With crypto, without crypto doesn't matter.

Blockchain is gonna solve medicine. Not really. It didn't. And just five months ago, so interesting, five years and five months ago, Chat GPT hit the world and I begin to hear the same thing. I again begin to see the head of the same things, even from physicians who say, oh, thank you Chat GPT.

Now we solve all our problems. Not really. And I would say that in the blockchain era, I refer to that as a drag race. It starts with huge fanfare. There's a fire and there's noise and the truck stops over 300 feet. That's exactly what happened. If you look at valuations in capitalizations of blockchain startups that went up and die. But for me, my sense, Chat GPT nowadays we are really into a worldwide Chat GPT pandemic. So let's stop right here. We have more to cover. Okay. The worldwide Chat GPT pandemic, meaning you feel like we're cresting the hype cycle or like No, we are still climbing up still climbing that hype cycle.

The higher we climb, the faster the fall and the consequential the fall, but not, don't get me wrong.

Chat GPT has a role, right? Imagine we take a young child who can operate a car and we did not train them. We didn't tell them how it works, what to avoid and so on. Just give them the keys and go on the road. Not really, that's what I mean. That's

[00:05:58] Jared: definitely what's happening as well. Yeah. And so I guess let's talk about digital health.

And so where do you feel that we are in the digital health space at the moment? Where can we improve and at the same time also what excites you about the space?

[00:06:12] Ron: Yeah. Digital Health and innovation obviously we are in a more fascinating state, almost nearly every day. So it really takes off accelerating the innovation side.

And I would say in digital health, and I'll compare, contrast that to precision medicine. It is on the solution side. We have more and more solutions, more and more segments and sub segmented we didn't have before. And this is ignited by and influences two kind of disruptions.

I see healthcare as a market globally, right? And healthcare is not just the traditional healthcare provider organization, including all of us with the people, the patients, right? We are subject, this is spaces subject to disruption inside, out. Inside meaning people, folks like us who are a little bit ahead of the game and we try to improve, but it also disrupted from the outside in.

The horizontal players, the apples of the world the Amazons of the world, the Googles of the world, right? And it's not just the US it's the Alibabas often and China and others. And with that, come significant disruption, of course, it's interplay. Interlocking wheels of business model disruption, operating service model disruption and technology that enables both so that they're working like this.

Those horizontal players from the outside in they do it usually for two reasons. One is they realize that healthcare needs help with technology innovation. There's no doubt about it. And the other thing they realize, oh, there's a lot of money to be made. Okay. By doing it right.

The only caveat is I see this time and again horizontal players who didn't have really deep understanding of healthcare and medicine and patient care and natural disease, they think that their experience success is transferable, generalizable, say from FinTech and others to healthcare. 100 million later, 500 million

later they crash because they come from, we know it all. We are going to tell healthcare how's gonna work? You are referencing pear therapeutics which recently crashed. Say again? P E A R Therapeutics that recently crashed for a like Oh. Oh, okay. Yeah. Yeah. It was like a 500 million investment. The, oh.

They went through as a digital therapeutic was the first one of its kind. And doctors loved it, patients loved it, but they never really quite got around to figuring out how reimbursement would work for this. So they never got the insurance companies and the employers and Medicare, Medicaid involved.

Yeah. And so you can have a solution, but until you get each of the stakeholders involved from their point of view, you're not gonna get anywhere in healthcare. And you got them. You can't, I believe you from experience, you can't get them to participate if you don't really understand them.

And you don't understand, you just come there and say, you are a big shot. And say, I'm telling you, you do that because I was successful yesterday. And then but we talk primarily about digital health. For me, precision medicine is adjacent segment. I think that in precision medicine, we didn't make that

progress as we have in digital health. Precision medicine is making tremendous strides, tremendous progress, exponentially on the discovery side. Discovery, the understanding of deep biological mechanisms. But for me, precision medicine around the world is still on the basic science ground floor.

And there's a lot of room to improve from that. And what technologies are driving that discovery at a precision medicine standpoint? Is that where the generative AI or machine learning is coming into play? Yes. Plus, right? So all of the technology aspects, all the way from graph technology to digital twin to knowledge graph, to semantic services, semantic integrity services.

And then here we go back. I'm trying not to make it a Chat GPT discussion, but Chat GPT is just one way to engage a user with data in a conversational way. There's so many other ways and the notion of large language models that are required for AI and particularly machine learnings.

But the problem is I have some heartache when I hear, oh, let's democratize just for sake of democratize, everybody coming in pouring in. But healthcare has a lot of deep science in it that you need to understand, not just your general impression like the layman on the street. So it has to be domain specific large language models that are backed up by semantic integrity semantic services framework, and in between the prompt engineering.

But this comes on top of, okay where the data coming from? Can we trust the data? Where are we going to put the data? So now we talk about databases, database management system. And my take is that relational database management technology has reached, already reached its end of pragmatic life, utility life, useful life.

With regard to addressing new and emerging problem spaces and solution spaces, it just does not scale. Is relational going away anytime soon? Definitely not. There's a lot of hardworking thing that they need to continue to do there, but we need something else. Relation database management and technology.

Pretty much the simple way for me to say that they optimize and step back. They abstract the real world to spreadsheets. Our real world is not a spreadsheet, it's a far abstraction. We need something that will bring it closer to the real world. Here comes graph technology. And let's stop right here because talk about the whole can of worms there.

Yeah.

Yeah, I'd like to go back if that's okay, Jared, to what can we do to improve or what we may need to improve. Absolutely. Absolutely. Yeah. I'm sorry. I'm so passionate about it. I think that I would say what we need to improve. Ron's view of the world. And I may not be right 100% obviously, but at least you know how I come into the conversation.

This is always how I engage others. Let me tell you what's my frame of reference at the beginning of the conversation? Because I cannot own, I will not own innovation. Innovation comes from all of us, right? Interacting, cross-functional collaboration. So this improvements for me. This is my job one.

This is my number one call to action going out of this conversation. That's really my hope. I would say to begin with, we need to emphasize, we need to remind us of that, all of this healthcare, digital health, precision medicine. What's about, it's not about the payer, it's not about the healthcare provider, it's about we, the people.

The three of us, and then folks who just came in so that we the people, right? And when it is, when people recognize we the people, for me it means whole person care, right? It is not about just, oh the diabetes or it's, God forbid not only about breast cancer thing.

We've got to start practicing Whole person care, not only at the clinic. But also us, the innovators, the pragmatic innovators in digital health and precision medicine that will enable that. So we need to shift our mindset. Okay. And I would say three decades, looking back of my experience in enterprise health IT and academic medical informatics, commercial, all kinds of stuff, I would maintain that this is a huge transformative challenge for digital health practitioners. And the transformative challenge is even more acute. It's huge. It's bigger, but those who are very successful doing what they do in digital health up to now. But the missing piece is the whole person care. They didn't do whole person care, they took slice.

Okay. And I would say the next circle of practitioners in the space, that should be the, I would say take notice about the Whole Person Care is all the other players who try to emulate the successful players and come into play. I'm sorry for the bed, but me too. Yeah, look at me. I'm doing what they do, but I'm doing it better now.

We need to do something else. We need to do Whole Person Care. With that comes we need to understand that we need to design for uncertainty. How many time I came into dissonance, if you will, with the engineering team. Cause engineers usually assumes that everything that they need to do is already finite, it's already known.

We just need to write good requirements and they will do that. But practice of medicine taught me that in medicine it is everything and anything but certain, right? So we need to factor in. Uncertainty into our design, talking about AI and the Boeing crashes. The two crashes that, that we had unfortunately, and then I posted on LinkedIn about this.

This was an unfortunate but very predictable case where management and the technology engineering took over the real world. They did not fly in the cockpit, so they decided we are smarter than the pilot. So at a certain point where certain algorithms check the AI is going to take over the airplane, like blockchain will solve medicine, not really.

And couple hundred people had to die before people say, oh, we've just done something wrong. So the notion of factoring in uncertainty and recognizing that the smartest, the most educated data scientist cannot anticipate each and every situation that there is to be made, to have in the real world and just do the mass of the permutations.

No data scientists can compute all the possible permutations and write an algorithm for them. So we need to recognize uncertainty we need to build executable models of trust, particularly nowadays, fake news, fake data, deep fake, right? So the question I'm posing to my team and then rest of us ask yourself, when it comes to consequential things like healthcare, like medicine, how can you tell that you can trust the data?

How can you tell that you trust the message behind the data? How can you tell that you can trust the source of this data? So for me, as a veteran flight surgeon, air force flight surgeon, for me it translates to, oh, we don't have a healthcare problem on our hands. We have a military intelligence kind of a problem on our hand.

Of sources and methods and information in an ever-changing landscape, right? People say, oh yeah, so there's so many moving targets. I say, yeah, but in addition to, let's figure out the context of this moving target, the framework reference of this. It is changing under us all the time.

The next aspect of improvement that for me it's a call to action, is that that technology innovation that in precision medicine we need to tackle the wide space. I'll try to keep, so tackle the wide space that I've identified early on in the translation. Now medicine as you move from genomics to proteomics to disease models, environmental.

Epigenetics and those who are on the call who are interested. I wrote a book and then the link is on my LinkedIn. I wrote a book that was commissioned by National Science Foundation of that very question bridging the wide space and the other spot. By doing it, we need to tackle the burden of disease.

Culture is first kind of burden of disease around the world by packaging in then bringing it to us, the we, the people, right? And finally we need to catch up. This industry has to catch up with the experience economy. We've got to advance our design thinking to user centered design. And we need to change from return on investment to return on adoption.

Yeah, the interest, you've raised so many interesting issues. Yeah, I think one thing around like Whole Person Care and you think about how much modern medicine is designed around acute care, where somebody has a issue, a disease an ailment, and it's designed to treat the ailment versus what you're talking about with whole person is the 99.99% of the time they're outside of the hospital.

Or the decisions leading up to that moment of acute care and then the potential for precision medicine to influence those decisions without impeding an individual's sense of free will. Yeah. Which that's, like how do you balance those two things? You can perfectly have somebody, you can put them in a controlled environment and make sure they exercise daily, robotically and do the things that their smoothies in prescribed, but then What happens if I have a cheeseburger and a beer?

You mean like I, I want to be able to make that choice. So yeah, you are. And your CGM will spike in about 30 minutes uhhuh, and give you positive feedback about the negative action of your action, negative action. And I'll fine tune and I'll speak here now. Thank you for that question. You asked me in the past tense how did I balance it?

I almost told you, but I did not. But a step back, I did balance it. I did try to balance it one patient at a time in my patient populations for 10 years before was practicing, before I turned to switch to technology. And I trust that many, and it's never all, many of my colleagues around the world are doing just the same as struggling are trying to go against the limitations of the traditional EMRs and EHRs and the are imposed on them.

By technologists who view the world through technology, not from the clinical product. So I tried that for 10 years and I bring this baggage with me every day to the digital health and precision medicine space. And it is a work in progress. Can tell the story. I got permission to talk about it.

With my client, I'm entrepreneur in residence for fin software solution, privately held company. Isabella is the founder and he is an unusual guy. He and Doug Moore called me one day. They said they want the whole person care. And in my mind, almost like when we started the LinkedIn conversation.

Yeah. I wanna make sure they really understand what they're talking about. And they convinced me after calls. Not only they are convinced that they know what they're doing, but Isabella is dead set to make it happen. He's the owner, he's the founder, successful entrepreneur over 10 years in managed care and he realized himself the same thing that we are talking about right now. The whole person care. So this is our working process. We could very hard to make it happen from the digital health enabling point of view.

[00:22:05] Jared: There's another point that you brought up that was interesting as well, is the uncertainty, like baking that into the design process and how also, I think Ty talks about it as well as a lot of time in innovation we lead with this technology first thing.

We got this new thing, we gotta figure out a way to implement this in the hospital. And that's not always the best way forward, and actually I just yesterday as I was winding down, they had is that Will Smith movie about the robots? I don't know. Do you remember what it's called?

I think it was called iRobot.

[00:22:34] Ron: Oh

[00:22:34] Jared: yeah. It's from 2004, 2004. And they had this AI right, that was powering these bots and the AI went outside of the rules cuz it's, it thinks it's smarter than the rules. And basically said there's these three rules. They're just, these rules aren't that great.

I made my own rules now. And when you think about unleashing AI or this technology first without maybe a regulatory pathway in front of it those are the kind of things that, they we're talking about this 20 years ago, but it seems pretty relevant today too, correct?

[00:23:04] Ron: Yeah. And it will solve medicine. I want to remind everybody if they missed that point. So you asked me what excites me in all of this and I gave it a thought, and I think it comes down to mission to problem in people. I think that the interplay of that you guys already aware of that?

I said up on a mission to reduce a limited burden of disease with pragmatic innovation like old cups, pragmatic, not just shiny objects. And the problem uncertainty that we talked about and recognizing that practice, that there's art, there's science, and there's actual practice of medicine that is so stimulating for me.

So the notion of cross-functional collaboration is key if people continue to try that, to do the in composites, oh, the doctors are there and the market owners are there. And technology engineering there. And everybody has their own interpretation of what we talking about, right? Rightfully but we need to bust the silos.

We need to bring everybody to the table to recognize all the elements that we talked about. And so the people aspect of the problem. That I'm talking about is fascinating because I tremendously enjoy. It's also always rewarding, always positive feedback for me to work with people at the table who come from very different disciplines and we interact innovation, pragmatic innovation.

I don't see a path for pragmatic innovation to reach all these goals of return adoption and traction. If all the stakeholders as you said do not interact. And for me it's not only enriching, it's a constantly learning experience. The other part of the people is dealing with skeptics.

Smoothing the friction. I can't tell you how many times that there was I got this response, oh Ron, what you're trying to do, it's impossible. And here's the textbook or here's the technology manual, or let me prove it to you that what you wanna do is impossible. So just a notion of engaging with that, tuning into what they want to tell me.

Cause I may have a blind spot here. Listening to that and then reaching out to them and together making it work. That is a phenomenal, rewarding thing. And I'll wrap this up. I co-found one of the fund companies. I co-founded SPH Analytics six months. About six months after we had it, we only had a PowerPoint.

And we showed half of funding. And fast forward, we were incubated and fast forward I led the team to develop high fidelity pro prototype for two products that we said these products need to be there. And we launched in early 2014 and one day I was so much in the work, I didn't figure out what's going on here.

One day I almost pinched myself. I walked up and down the aisle when people used to come to an office, not vi the cubicles, was 100 people hard at work and they see me walking and say, Hey Ron, you I have a question. You said I ended up feeling like I'm taking balls like in a ping pong from one hand place with me, not against me, with me.

That's the experience of a lifetime, can't let it go. Yeah. You were so immersed in the activity of building the business and solving a meaningful problem in healthcare that being able to take a moment to step back and just have a moment of gratitude for getting to, be in the arena.

That yeah it's very fortunate that we get to be able to play with these kinds of problems.

[00:26:52] Jared: Yeah. So we've been, on the digital health and precision medicine side. And I think also, looking towards the future, how can all of us really leverage these innovations, as you're thinking about it, I guess from a pragmatic perspective?

[00:27:06] Ron: Yeah. It is to first of all understand the problems. Bring back the, we, the people. Okay. What brings us all together and stop thinking about that they keep it simple, stupid kind of thing. Medicine is anything but simple, right? And then Ty, I'll borrow your term, it is immersive.

Immerse yourself. Don't. Don't approach it as know it all. I was so successful serial entrepreneur. I will teach healthcare. How I no. There's different grand reality over there. To that point, I may, are you familiar with Dunning Krueger again? So it's a psychological phenomenon where, when you're encountering a situation for the first time, let's say that tech entrepreneur who's saying, okay I've succeeded horizontally in other domains.

I'm now going to be successful in healthcare. And so when you enter into a new domain, you start climbing the mount of peak stupid because you're overconfidence. You're overestimating your skill in a new domain, and then reality hits you and you hit into the pit despair. And then you slowly start climbing the slope of enlightenment as you gain real knowledge of the domain you're working in.

Oh, you have appreciation for how hard this is, how many different domain expertise, experts you need, where you are in order to be successful. Because healthcare is so complex, no one person can understand the whole system. Yeah. Thank you for that. Yeah. I can reflect when I was younger in the profession.

People attribute that sometimes to being an Israeli born and God forbid, doctor and Air Force. It's a kind of intense combination. And I would come into meetings and one of the leaders will say, Hey guys, check the ego out the door. I heard the words, I could understand what they mean in, in Webster, but I didn't really resonate.

I can tell you for the past two decades. Yeah, it's very deep. The notion of it's not about you. When we try to solve problem, it's not about you. It's not about me. It's about all of us, but we the people and no person can know it all. And by the way I learned trial and error through experience. I applied some marketing and sales techniques that qualifying it is lead and it's a qualifying leads qualifying the lead.

If when people come to me and they keep coming I try to figure out earlier rather than later if this person's personality is a know-it-all personality and if I begin to suspect that's a case I disengage, it's a waste of time.

[00:29:49] Jared: I love that perspective though, that we're better together. I think that from the design thinking perspective and my time with trig, when you have all these I guess specialties combining without the ego at the out the door, some really magical things happen.

And we actually, yeah, I wanted to talk about your background, but we have some really good questions in the q and a. So I think we should dig into a few of these. And so first one is from Dr. Harvey Castro. Hello, Dr. Castro, who is a good friend of our podcast. He was a past past participant.

And so he says, how do you see implementing new tools into healthcare, example, new AI models to be implemented in healthcare or hospitals?

[00:30:25] Ron: Thank you for the question, new tools in general, that's my that's my journey. All the time implementing new tools all the way. Alright.

First of all the first software ever that I developed, the AI in medicine, AI for differential diagnosing pediatrics, did not tries to implement because it was still in the computer science lab. Okay? It was in the IBM Science Center, Weissman Institute of Science, applied Mathematics. But it was new.

It was breakthrough because it was interactive, real time because at the time, AI and medicine was generally batch based system you all, a lot of data. And I said they were extra. Said you go to take up coffee and the system goes to do its work and you come back from a cup of coffee and the system gives you an answer.

That's not how I work as a clinician. So I design, develop, and demonstrated that as a clinician and that landed me at Boston Children's Hospital, harvard Medical School. At that time Boston Children's was a world pioneer in integrated hospital information system. So the situation was, there's a lab, there's a registration, there's scheduling, there's accounting, whatever.

Okay. So implementing new things. Yeah. We built an integrated software information system. Part of this, the arch architectural technology ended up on technology transfer cerner acquired the technology and that became their first online patient chart. Way back when. We've implemented actually there was one ai I owned the AI box and there was a system called an expert object.

So we designed, built in, implanted, in real live system. Think about integrated hospital information system with the predecessor for HL seven. Okay, so transactions goes on the network and each participant listens on the transaction. Figure out is the data relevant for me? So I'll grab it in. So the AI system says, oh, here's the data that interests me.

I'll grab it in and I'll go against the Oracle virtual database the clinical data warehouse. And then the use case was, oh somebody was readmitted to the hospital within 48 hours from discharge. So something is wrong. So bring the right clinician into the another thing of not fully ai, but very advanced at the time.

I can tell you, and I'm not trying to be too impress anyone, I'm telling you as it is. I conceive design and developed with my team the first ever integration of full tech search engine, a Google like, In embedded that in the clinical documentation workflow, right? So the moment the document was available online, it was fully searchable.

It was the first one for a few years. I tried to figure out there was somebody else who's done that and I didn't find anything. And the story goes on so long but a AI was on the edges since then. And it just erupted about six months ago.

[00:33:29] Jared: Yeah, absolutely. Shoot, we, okay, I, we have such great questions coming in, in the q and a.

I do wanna ask you about your background a little bit. So I think let's talk about your background just a little bit cuz I think it's really fascinating. And so I guess, can you give our listeners a brief overview of your background, particularly your journey from being physician to becoming global tech entrepreneur, thought leader in, in the digital health and precision medicine space, and also with your, military background as well in the Israeli Air Force.

There's so much to it. So wherever you wanna start.

[00:33:59] Ron: Yeah. I can tell you that when we go on marketing and sales calls my call, it's very common and I feel, I understand that, very common from my colleagues when they turn the mic to me and say, Ron I want you tell your background.

And I try to keep it very short and as short as I keep it, it's long. So I'm trying to balance, do I miss certain things or whatever. So I really try hard. Yeah. We'll see how it goes. First of all, the journey, this transition was not planned. I didn't wake up one day and decide I'm gonna be entrepreneur in technology.

I can tell you that there was a one day, I remember the moment and where I was on the street. Nearly high school graduated. I realized I want to go to medicine and here's why. So that's the only thing that was intentional. Everything else just happened. See, I think about senior resident in pediatrics.

I see folks coming in. They install computers. I ask them, what is it? They say, oh, that's not for you doctor. That's you go take care of patients. This for administration. And that I realized that I had a hole all in my education. Lucky me. It was all, it also a combination of sheer luck and great mentors.

So first CMA course in computer applications in medicine, and I got hooked on ai. Fast forward as part of residency, my six months rotation, basic science rotation, we had to leave it running and go do basic science, come back at night, do night shift. But the day job was research.

Obviously it would be ai. So I took my entire annual vacation. It was two weeks that I could take. I took everything in chunk. My wife Dar now would drive me every morning she'd drop me at the library. When she is done at work, she'll come back, pick me up every day. I spent in the library to learn more about the AI and more of it.

Okay. So I was ready for the research rotation and my chairman pediatrics connected me with applied mathematics in, I was in And my wife, kept kindly advising me very, I consistently advising at again and call Mr. Moore. He was the CEO of IBM Israel. There was reason, so I decided, okay, I need to take care of good spatial relationships.

So I gave in and I called him and he picked up call. I call him, pick up his admin. Just try for the call. And say, Hey, Mr. Moore, I'm Ron. I'm a young physician, so this is what I want. I didn't believe what he said. I couldn't believe he said, oh, sounds interesting. I'm a CEO of IBM Israel, but I don't really know much about ai.

That's what he told me, but my chief scientist does. So please call Joe and tell him I sent you. So I called Joe and it was IBM Science Center and then, and this, and I developed the system. Fast forward, a lot of, fast forward in between demonstrated the system live interactive system to the CIO, the newly appointed CIO at Boston Children's Hospital and head of Medical Informatics in Harvard physician himself.

So I present that to him and he was quite impressed, said this. He literally turned it off and asked me, Hey Ron, what do you wanna do tonight? Fast forward. He shows me an integrated information system. Architecture. One slide, there's a box. Ai he puts fingers. Say, what? Do you like to own the box? I didn't get that.

He's recruiting me. There was some control gaps still right. And I thought, he's talking academia. He is the head of American informatics, right? I say yeah. And he said, when would you like to start? I said, tomorrow morning. It was 9:30 PM we met at night, at the door. Tomorrow morning I wait for my wife and kids to wake up back in Israel and before she rushes them to school and work, I say, Hey this is what happened.

And she said, okay. I joined Boston Children's Hospital as senior program analyst. I was 10 years physician. Had my own private practice. To my knowledge, I was the only resident in Israel who ran private practice in follow a general practice. And I started a senior program analyst. In retrospect, that was a sheer luck.

I was very fortunate because I started to grow up in enterprise health from the ground up, step by step, director of application within less than a year. Two, I label that as tours of duty, two tours of duty as a CIO. That's how I relate to N C I O and NCAR most today. Then cross the cross the line, so to speak, to vendor space, beginning with Eclipses a number of startups, different situations.

R & D Ribitzky started at Harvard because consulting started to come in. And fast forward I'm getting call from a Deloitte partner, a guy, I help a few times and this is what I do when a friend calls, I help them, right? Not everything is just the money here and now. He calls me and say, you're gonna get a call from Intel.

So why? He said, that's fine. We told them to call you. They will explain it. And then I had to explain it to the rest of the world, why? Oh wow. Why they wrote me in as a senior healthcare strategist. So that does, I think the shortest version I'll tell that. Oh, okay. So one of the stories we were talking about before we started the podcast was, I think going back to your time as a flight surgeon in the Air Force, and how, do you mind just kinda sharing that story about how in order to empathize with the pilots that you were serving as a flight surgeon, do you mind just sharing that story, that journey you went through?

[00:39:52] Jared: Because I think that's

[00:39:53] Ron: Oh, okay.

Context of technology and making it fit and that just, it struck me yeah. Yeah. Thank you As a search and rescue flight surgeon, I had two roles. I had search and rescue and flight surgeon. And flight surgeons was about flight medicine and my mission I love simplicity and mission and my chartered mission was to take care to assure the wellbeing of the air crew, period.

Very simple. Not takes a long. So we used to as part of our roles as physicians in the Air Force spaces was to give them semi-annual every six months we had to talk to this young hotshot pilots, 22, 23, 25. We to talk to them about vertigo, just losing orientation spatial orientation.

And one day I felt uncomfortable because the only thing I knew about vertigo is what I could find in the textbook, right? And I was indoctrinated, Hey Ron, this is what you need to do. This is what, how you need to engage with the pilots. So I says, I never been in vertigo. I have no credibility.

They won't trust me, right? I asked for one, one with my boss with my best commander if the inspector code name spike, movie actor. He translated The Hobbit to Hebrew and wrote the Amazon book and find an Amazon Loud and Clear about his experience. And he introduced me to the philosophy of science.

One day he gave this book and say, Ron read it. And that started a whole different conversation. So I come to him and say it was formality, right? So I say I refuse to give the semiannual lecture on vertigo, sir. And he said, what do you want from me now? What do you want now? I said, I don't have credability.

Cut long story short, he allowed me, enabled that I will go on a flight. Night flight clear night, backseat. F-4 Phantom, and I had this experience of a lifetime of feeling the cognitive dissonance. I'll step back for a moment and give you the context. So here we are above the Mediterranean clear sky.

The pilot that the squadron chief tells me, Ron. Eyes closed, head to the cockpit. I'll tell you when to open it up. So I'm there like we are an international flight. Feel very good about it. Close my eyes and he says, Ron. Okay, so look outside. I look outside and I had this phenomenal experience that I see the stars on the ground, the body fooled me.

Fooled me totally. I was totally convinced the stars that I had the impression before that stars on the ground, the lights of the city lights of Haifa are in in the air in the sky. Obviously I was turned upside down without noticing because he was a pilot.

We came down and the doctrine was, if you feel weird, fly instruments, meaning your IT dashboard will save you. So just watch the instrument and fly instrument go fight against your, what the body is telling you. So we come in and we come in back home and phantom lands in unusual way, unlike your passenger says passenger one, phantom is heavy.

So it drops from the sky and then it runs, right? So it. It was a hit, like shaking my brain, shaking my entire understanding of the world. And I had aha moment. And the aha moment was that we spent, I would say wasted so much time year after year, telling the pilots, ha what will kill them? And we thought this, what will kill them?

And we give you an order to fly instruments, dissonance. So it occurred to me that if I will try to tell them what will save them, we'll give them more inherent internal motivation to do it right. So I created a whole pile of training on the visual physiology and that changed the the surgeon general doctrine.

In retrospect, this was another element of my passion. Sometime maybe obsession, but good obsession my passion to cross the street to where we, the people live, the people we serve, to understand them in their environment, not in the computer science department. Because the only thing that doctors did is they were in the clinic.

And the pilots were flying, and the pilots didn't like us so much because they knew if they will dare come to clinic. Most of the doctors most of the time will ground them out of fear that there will be an accident. So better as you sit on the ground. They won't fly. So Spike allowed me and then the squad chief.

It was a cross-functional collaboration, understanding the problem, signing after the problem. I was the first in squadron flight surgeon model after the US Navy. Another story. So cool. I'm so glad you shared that story cause you can see the thread of that lesson you learned and how you transformed really how like education happens for those pilots and how you carried that through so many of the transformation technology transformations that you led.

As you say, you wanted to cross the street from the place of the technology to the source of the truth, which is we the people that are actually having to live with this. Whatever the technology, shiny object that's being imposed, but rather to impose our wellbeing and our workplace on the technology and make that serve us rather than us serve the technology.

[00:45:47] Jared: Speaking of shiny objects as well. We're coming up on basically our last question for our time together, and we have so much more to talk about, so I think we'll just have to bring you back eventually. But I think, with this sort of like last, bit of time that we have, maybe can you tell us a little bit about, your current and emerging work at R & D Ribitzky's expert Services Group and maybe some of the client services you're involved in at the moment and projects that could shape the future of digital health and precision medicine.

[00:46:15] Ron: Yeah. I already gave you actually one example about tackling whole person care, like big time scope of the problem in a global scope with Alfine software solutions. So that is significant. And I want to emphasize again, remember that what drives me is the mission, the problem, and the people.

So one of the things that really motivates me every day with Alfine and the way easily leads that it's not just about technology. It's also about the people who will make this technology happen or did this vision happen? And I can tell you that the complimentary aspect, running a number of threads or towards a common goal, towards shared goal or more than 100 people international kind of a team is the companies company's approach to people in general and talent development in particular.

In a huge challenge, transformative challenge of moving. Here we go with a successful digital health entrepreneur and company for 10 years, recognizing that it's not okay. So this is how it worked. It'll continue to work in a totally new space. Now, the notion of transformative challenge for the entire company from leadership to the most junior person who was just hired than everybody in between. And human resources plays a significant role in that, in how do we develop talent from within, not only for the company to be successful and check the spreadsheets. It's important, but also to help develop people or they are people. And there is also a practical aspect of that because, there is a global war, if you will, on talent and recruiting talent from the outside is beginning to be very difficult.

So that, that's an amazing combination and in my humble opinion, it just on me talking. I think that fin is on a path to shape the future of digital health worldwide in Whole Person Care way. And to shape it no other. And because of that, I would say in a year or two, and I've been in Harvard in a year or two, I think that Alfine might rise to a qualified candidate for Harvard Business School case study.

Okay. It takes the totality of this to be successful not just the shiny object. The other one, the thing that shape now in retrospect but continue to do that is the experience with American culture of cardiology. And I realize we are running out of time. The short version is, okay, so I talked about Whole Person Care, precision Medicine project code name, precision.

Consumer facing, multi omics global to help what can we do about it and particularly driving treatment decisions. We with our partner, Kean Lu we are on a path to help regional and local healthcare organizations in China and rest of Asia-Pacific. Respond to and take advantage of national scale.

Hes new innovative healthcare programs working on digital twins and graph technology. And then I'll pause right here because Oh, yeah, we're running all the time.

[00:49:47] Jared: Yeah. Dr. Ribitzky I know you told me not to call you Dr. Ribitzky. Ron, just thank you for your time and just your valuable contributions to the field of digital health and being a leader in precision medicine and

before you leave how can our listeners learn more about your work and connect with you after?

[00:50:04] Ron: Thank you so much for this over here. I would say number one find me on LinkedIn. Okay, connect with me on LinkedIn. And then to learn more, more the commercial side of this, I go on rdribitzky.com.

So it'll be letter R, the letter D, and my last name, dot com, rdribitzky.com. You'll learn more about it and then sort leadership aspect of this. And if you feel like drop me a note, it's Ron at rd ribitzky com.

[00:50:32] Jared: Wonderful. Yeah. We got so many good questions that we didn't get to answer. So for everyone that still has a burning question, reach out to Ron on LinkedIn and we'll get you squared away.

But yeah, thank you everybody for joining today. Thank you. Ron Ribitzky, MD Thank you for all the work that you've done. I said Ron. Ron, exactly. And yeah, we just really appreciate your time. Thank you so much. Thank

[00:50:53] Ron: you. Thank you guys. It was such a pleasure.

[00:50:55] Jared: Thank you, Ron.

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