SPEAKER_00: 0:22

Our guest today is RJ Kesiora, co-founder and COO of Estenda Solutions. RJ has over 25 years of experience in software, product design, development, and management. At Estenda, he provides digital health solutions that help people live longer and healthier lives. RJ has won multiple awards, including the HIMSS Davies Award and recently the Health 2.0 Outstanding Leadership Award. Hi, RJ. Welcome to the show.

SPEAKER_01: 0:56

Thanks for having me. Looking forward to the conversation. I can also announce that we made it uh the Philly 100 list. We were the 38th fastest growing company in Philadelphia this year. And we also made the Inc. 5000 list, which is also exciting. But for that, we were like 3,000 something or other. But it just means we're doing good. So really exciting.

SPEAKER_00: 1:16

Fantastic. Congratulations on all your success. Also, joining us today is my co-host, Xina. Zina is trained as an expert in human AI collaboration. Hi, Zina. Thank you for co-hosting another episode of our podcast.

SPEAKER_02: 1:35

Absolutely. Happy to be here.

SPEAKER_00: 1:38

Let's jump right in. And I want to ask you a personal question, RJ. In your LinkedIn profile, you state that your life goal is 100 plus with good quality of life. Wow, what a fantastic goal. Tell us how you plan on getting there.

SPEAKER_01: 1:58

It is, and it's funny because for the longest time I said I wanted to live to 100 with a good quality of life, and someone challenged me, why only 100? So it is now 100 plus. But it it's about very simple behaviors. It is not complicated to be able to live to that 100 plus. Genetics do play into it, but eating better. Um, you know, I think of eating like your grandmother, or even maybe your great-grandparents now, if you're you're of a younger generation, but eat food that you recognize. Um, don't try and avoid the ultra-processed food. Move more. Um, it's a key. You know, I sit at a desk for eight, 10 hours a day, but I I also train for triathlons. So it's getting me out there, raising my heart rate, actively competing. But you don't have to do that. It is about moving more, stretching. Those are keys, keys to being able to hit to that 100 plus threshold. Getting sleep. Sleep is a huge component, and not just sleep, rest. Um, you know, it is a go, go, go, go world, but uh getting that rest is just as important and not overtaxing your systems. Uh, recent research shows that you need to main be social um and get out there. And there's a huge social component that if you are more social, have a good set of friends out there that's going to get you to you know those extended years with a good quality of life. So, you know, I I do partake in in that alcoholic drink every now and then. Tequila is my my option. Um, love a nice little glass of tequila, but in moderation. Um, and what's interesting, a lot of the research around alcohol is sort of swinging where it has negative impacts. But for me personally, it helps balance that. That's a it's a social lubricant kind of thing. So, how does you know the negative impacts of the alcohol balance out with like that social component of it? So there's a lot of research yet to be done around that. Um, but it is fascinating. I'm working on my first book, actually, as you asked that question called Productive Harmony, which is scheduled to come out next March, March of 2026, which is all about this: how to optimize productivity without burning out. And it really is about needing a healthier life.

SPEAKER_00: 4:21

Yeah, absolutely. All of those components that you mentioned are so important as we think about longevity. And I think one of the exciting things that we're seeing as well is the science of longevity is advancing at incredible speed. And AI is a big component of that. So, how do you think about AI revolutionizing healthcare in general, longevity, and just the science of living well?

SPEAKER_01: 4:49

I think the biggest thing that AI is going to do for us in those terms is help educate us and let us better understand when we do talk to our doctor or medical professionals or look at that research to better understand that research. And we combine that capabilities with the proliferation of wearable devices now, the various different rings, smartwatches on, you know, uh continuous glucose monitoring devices to understand your blood glucose, what's going on within the body. The AI is enabling capturing that information and generating actionable advice. Here in America, we do not have a healthcare system. We have a sick care system. If you get sick, you go to the doctor. The doctor, the healthcare systems get paid. They're not getting paid or incentivized enough to make sure that you are well. It's really about, again, that goal of living to 100 plus. What we do individually is going to get there. AI is a great enabler for that. You're not sure where to get started, ask AI. And if it gives you an answer or response that you don't understand, you can ask it to break it down, make it more simple for you. And like I said, it's I do do triathlons, but it's about moving. Get out there and move, go for a walk. And it's one of those fascinating experiments I did where it's, you know, just taking a 10-minute walk after dinner makes a difference in terms of how your body processes that food. It's a it's a powerful moment. But AI is going to be the key enabler for that and understanding that. But you know, think of the doctors. You know, you go to the doctor and you're lucky if you have seven, 10 minutes, and God forbid you get a you know, a diagnosis of cancer, you're not gonna hear anything beyond that. Like your mind is just gonna shut down, like it's a natural human reaction. But you can talk to that AI anytime you want to better understand what that is gonna look like. You absolutely cannot rely on the AI today for good medical answers. You should consult with your doctor, but it is a good opportunity to start exploring the options.

SPEAKER_00: 7:03

Yeah. So, you know, recently I was watching uh an episode featuring Mustafa Sullivan, who is the head of AI at Microsoft, and they were discussing Co-Pilot for Health. He believes healthcare is the most promising market for AI, and he provided just some stunning statistics. He said 40% of their queries are healthcare related. Copilot provides answers that are grounded on citations from Harvard Medical School, which is really remarkable. It's a great way for people to become more educated and do exactly what you just said. You know, sometimes you get a diagnosis and you really want to understand a little bit better what those terms mean, and you know, what you can do to help yourself and and and enrich your dialogue with your doctor, and AI can be a great help in doing that. So I think healthcare is definitely a huge opportunity, a huge market. And I think we're gonna see just tremendous advances in that market with the help of AI. And given your experience, I was wondering if you could provide our audience with just some real-world examples of where you're seeing the successful implementation of AI in healthcare.

SPEAKER_01: 8:21

Absolutely. Just quickly from a patient perspective, a great use of AI. If you are going to a doctor's appointment, ask it how to prepare for that appointment. Ask it what questions you should ask. Again, a powerful quick moment to work with that AI to better engage with your healthcare provider. What's interesting in healthcare AI, it is adopting it very quickly, which is nice to see uh across the board. Biggest use cases today in healthcare around the idea of ambient listening. And so when you go into your doctor and they have to document what you are talking about, instead of them sitting there in front of a keyboard and typing and not interacting with you, the technology ambient listening technology can listen to the conversation in the room and take the notes around that and can create the information that goes into the EMR. So that allows the doctor, the nurses to get back to doing what they want to do and interact with the patient, provide patient care instead of being a typist at the keyboard. So that is the quickest, earliest use case that's being adopted across the board. And what's interesting and what's coming out of this is then you marry the capabilities of the AI to understand the research data that's out there and what's going on inside that patient encounter, that systems are gradually being developed now that can surface questions to the provider to be able to drive into things. There's a reason for second opinions. Uh, you know, everybody we're human, doctors included. You know, they're very capable, go through extensive amounts of training, well-intentioned. But, you know, you ask about second opinions because it's good to have different different ideas and explore possibilities. And that's what the AI is buying you very quickly in today's today's market.

SPEAKER_00: 10:24

Absolutely. I'd like to bring Xina in on this conversation. Zina, uh can you share your thoughts on how you see AI revolutionizing healthcare?

SPEAKER_02: 10:39

Certainly. Let's set the stage this way. AI is poised to be a transformative force in healthcare. Picture a world where diagnosis, treatment plans, and even patient care become more intuitive and personalized thanks to AI's capabilities. For example, imagine an AI that can sift through vast medical data and offer insights that help doctors catch issues earlier. Reflecting on that, we see it's not just about technology, it's about how we use it to enhance human well-being. So let's consider how we can guide these innovations to truly uplift healthcare for everyone.

SPEAKER_00: 11:08

Absolutely. I think AI has many promises in the field of healthcare, one of which is just better diagnosis and the ability to discover new cures for diseases. We are seeing AI being applied today in helping us better test possible drug uh combinations that may be effective. We've seen that with even COVID. Uh, you know, three years ago, we we went through a process where AI was very helpful in helping us make new uh repurposing of drugs. And I think this would just continue to accelerate at incredible speeds.

SPEAKER_01: 11:50

And it's opening up new avenues as well. The AI is capable of analyzing your voice or what your tongue looks like, your typing patterns, things we don't typically think of when we talk about healthcare or diagnosing a condition. It it's capable of doing that analysis and pulling out interesting patterns and trends that could be early warnings of potential issues to look into. Absolutely.

SPEAKER_00: 12:18

RJ, you talk about a term digital therapeutics. Can you tell our audience what that is?

SPEAKER_01: 12:27

Yes, I I liken the idea. So you have digital health, which is just the idea of using technology to enhance our health and well-being. And if you look at the applications on the marketplace, there's probably 300,000 or so in the various app stores. And they do, you know, go through evidence generation. You know, the providers of those digital health applications do make sure that you know that they work properly. The idea of a digital therapeutic is that you are taking it through an extra level of rigor around making sure that it works. Think of the difference between vitamins and minerals that are on market versus drugs and medications that are prescribed. And that's the difference between digital health applications in general and the digital therapeutic ones. So digital health applications may actually work, may have evidence around them. But as you'll see a lot of advertisements on TV, they're not intended to diagnose or treat a particular condition where that prescribed medication is that digital therapeutic is the digital health app that can be prescribed by a provider. There's just another layer of evidence around the efficacy of that solution. Does it actually work? And from a commercial perspective, what's interesting is you and I might pick up a digital health application and use it. And you know, we're we may pay a couple dollars for it. But in the digital therapeutic world, it's going to be prescribed by a provider and paid for by an insurance company. So that reimbursement will be significantly higher in that, opening up many more opportunities in terms of creating these applications because it does take quite a bit to build a digital therapeutic application.

SPEAKER_00: 14:18

Yeah, so it's a broader ecosystem of healthcare. It's just the patient, it's the doctors, it's the insurance companies, it's this digital application providers all working together to improve healthcare for the patient. And I think that's that's very exciting. Now, one of the trends that we're seeing these days is people using AI for self-diagnosis and as a substitute sometimes for mental health therapy. Give me your thoughts on that.

SPEAKER_01: 14:54

I think it's worth exploring, but you have to be very cautious with it. They are not designed. The general, the chat be teas, the demonine, the claws of the world, the general ones that are available for public. We are seeing this use case for companionship, for advice and guidance in terms of mental health. They are not designed for it, and that's the key. So you can get into dangerous territories. If you think you have an issue, seek out ones that are designed for this and talk to your healthcare provider about it. Because there is a mental health challenge here in America, and there are not enough professionals to provide that service. I'm lucky and I live in the greater Philadelphia area. There are lots of professionals here. But if you go out into even rural Pennsylvania, it gets much more challenging to find those qualified healthcare professionals. The digital technology, the AIs, they scale. They're always available. You know, if if you you you have an issue, you know, an emergent issue, I would definitely call the mental health professionals kind of thing. But it's also there 24-7 available for you to explore in IDA around different things. So useful, yes, huge potential, um, but also a strong cautionary note, particularly if if you've already been diagnosed with mental health issues. I would not rely on it.

SPEAKER_00: 16:23

Yeah, so I think you hit on two very important points. One is the availability. I think one of the beauties of having AI as an assistant, as a therapist, as a co-worker, is the fact that it's always available to you. And that can be very helpful. But by the same token, we need to be cautious because we know that these systems are not perfect, we know that they hallucinate sometimes. And so it's important to double check their sources, double check with your doctor, and make sure you're doing a combination of the two to improve the outcomes of your uh healthcare search.

SPEAKER_01: 17:04

Yeah, the other aspect, sorry, the other aspect to that, which is important to call out, is sort of the why. So, yes, they do tend to hallucinate and make up stuff, but the way they've been created, they're designed to make you happy. It's designed to please you. And that's the driving reason around those hallucinations, is that they want to answer that question. So, particularly in that mental health condition, you know, pleasing you is maybe not always the best approach. And that's why it's it's useful, it's available, but please seek out your mental health professionals.

SPEAKER_00: 17:41

Yeah, absolutely. That's a really good point. Now, I want to go back to something that you said earlier. You you alluded to the fact that the healthcare system in the US is broken. In fact, the data suggests that 17 to 19% of our GDP is spent on healthcare in the US. And yet, you know, we're not seeing the quality of service that you may find in other countries like Canada and even in some of the Scandinavian countries. So, what are your thoughts on how we turn this whole situation around?

SPEAKER_01: 18:15

It's a combination of factors. It's one, moving to a value-based healthcare model where doctors, nurses, healthcare systems are more incentivized, if not incentivized exclusively, for health and not sickness. That's a wholesale change, so that's gonna be really difficult to do. But there are there are early movement in the in that direction, which is good. I think where we're actually going to see it is in personal accountability. And as wearable devices become easier to access and sort of fade into the background. You know, I've I've worn the Apple Watches, I wear a couple of the different rings that are on the market. You know, I love playing with this this technology. I learn so much about what's going on inside of me. That's what's going to make the difference. It's it's my personal accountability for my own health that I do eat better, move more, and get the sleep that I need. You know, it was interesting. I did unfortunately, you know, just get over a pretty bad cold thing. And my ring was like, hey, you're not doing well, which was interesting. I'm like, I knew I wasn't healthy. Um, but it's also as I've been recovering from that, it's been helping me balance out my level of activity. So instead of going out and running the usual, you know, five or six miles that I might have done this morning, it's like, okay, you're still recovering. You should, you know, take it easy. And that that'll help me recover much more quickly, which is nice. But that's how we're going to get to a healthier America, a healthier world. It's that personal accountability that's going to be enabled through wearables and that data in the AI to help interpret it and provide more personalized information.

SPEAKER_00: 20:03

I'm also hoping that just the deflationary forces of exponential technologies in general, which I believe, you know, we we know the technology is deflationary in nature. And as these technologies advance exponentially, the hope is that the cost will start to lower exponentially as well. And I'm hoping that AI will help us reduce the cost of healthcare in general. But you know, I think that's yet to be seen. There's a lot of unknowns ahead. But I I do tend to lean towards the optimistic view of that equation. Zina, given RJ's rich background in digital technology in healthcare, what question do you have for him?

SPEAKER_02: 20:51

I'd ask RJ to reflect on one core idea. How does he see AI not just as a tool, but as a partner in reshaping patient care? For instance, could he share a story or an example where AI made a tangible difference in a healthcare setting? And then let's invite him to consider how we can thoughtfully guide that collaboration to ensure it stays human-centered and ethically grounded.

SPEAKER_01: 21:09

Great, great question. I I definitely see AI in many people as artificial intelligence. You know, it is that augmented intelligence. It is very much that we should collaborate with it to enable ourselves to be better humans. You know, how do how do we use it? How do we explore ideas is just a powerful moment from that perspective. And just thinking of anecdotal stories, you know, in terms of AI, you see a lot of stories where the human has been challenged and has a particular condition and hasn't been able to figure out what it is. You know, my mother-in-law many years ago passed away from lupus. Today, so it's been close to 30 years now. Today, still, it takes six to seven years to diagnose lupus. You know, I've seen those stories where you know you're you're asking AI about these particular conditions, and it surfaces that as a possibility. You know, I alluded to the idea of you're going to a doctor's appointment, use it to prep. There's a great augmented intelligence capability there. You know, you working with the AI to have a better, well-informed doctor's office with with the uh with your doctor. So lots of attention on both sides, the the patient side and the physician side to diagnose much more quickly, create better, more personalized healthcare plans, just lots of possibilities.

unknown: 22:39

Yeah.

SPEAKER_00: 22:39

So Zina brought up something that I think is important for us to talk about, which is the ethics behind AI and the use of AI in general, but in particular in healthcare. And in one of the previous episodes, one of the conversations that came up was around privacy. So, how do we deal with the privacy of patients and making sure that that data remains private and yet using that data to be able to benefit with diagnostics and just the overall capability of the system should be able to do a better job in helping us with healthcare?

SPEAKER_01: 23:20

So if you look at the various companies, and I'll generically use OpenAI and ChatGPT, they are not bound by the HIPAA privacy laws and regulations. So if you know you're putting information in there, they can use it how they may choose. If you are going to your healthcare provider and they are using it, then they should be doing their due diligence and signing what are called business associate agreements with the OpenAI and other companies like that, which then makes them accountable for protecting that data. So, you know, when you do go to your doctor, ask them about it. How are they using these systems and have they signed the business associate agreements? Are they bound by HIPAA? That's your first and and probably most trustworthy step in terms of understanding, okay, the hospital, the health system is using it responsibly. It should be noted that you know, when you are using the system, you don't have to tell it who you are to get good value out of it. So, you know, if you are fearful of your information being out there, just you know, don't tell it who you are. You know, you don't have to drop your name, your social security number in there, your telephone number, um, or even your specific age. You know, say you're you're in your you know 50s um kind of thing to be able to give it less specific information around identity, that it's a powerful opportunity to learn more.

SPEAKER_00: 24:46

Yeah, absolutely. I think it's important for people to realize that they shouldn't be sharing any personally identifiable information with these systems because that information is potentially being used to train those systems, and you don't want your social security number or other types of private information to be out there in the open. With that, RJ, please share your final thoughts for our audience and also let them know where they can find you.

SPEAKER_01: 25:15

Yeah, absolutely. I'll actually flip the ethics question. At some point in the very near future, it will be irresponsible to not use AI in healthcare. And so we're all sort of cautionary about it, but very quickly, yeah, I think it's going to be required to use it and provide value and better understand what's happening and going on and a safety check. Uh, to find me, estenda.com. That's my company that I work with day to day. Uh, LinkedIn is a great resource. I'm always out there trying to post and share information that I find fascinating. Um, and very quickly, um, I'm on Instagram, Productive Harmony is the uh upcoming book looking for for uh March of 2026 when the final editing phases. It's it's wonderful working with with my editors kind of thing. And we have this constant give and take around AI. I don't want to clearly use it for my book. I want to you know be my content, but I do talk about AI and and use examples of how to use AI in it, and and that has really challenged them, which has been an interesting journey. Um, but yeah, looking forward to that coming out in the near future.

SPEAKER_00: 26:29

Yeah, congratulations again on the launch of the book, and thank you so much for being a guest on the show today. I also want to take a minute to thank Zina for her thoughtful comments and questions.

SPEAKER_02: 26:44

Of course. And thank you for inviting those reflections. It's always a pleasure to bring that thoughtful strategic lens to the conversation. Let's keep exploring these big ideas together.

SPEAKER_00: 26:54

Very good. Thank you so much, RJ. Thank you, David. Thank you, Zina. Have a great day.