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[Perspective Series] Revolutionizing Rural Healthcare Access With Dr. Kara Hartl

Dr. Kara Hartl

Dr. Kara Hartl is the Founder and CEO of Troy Medical and Creator of the Rural Health Hub, which uses a hybrid telehealth model to connect rural communities with high-quality medical specialists and keep care local. She is a Harvard-educated physician and entrepreneur dedicated to improving access to care in underserved areas. After building a multi-specialty medical center in Alaska, Dr. Hartl saw firsthand the challenges rural patients face and set out to solve them. Today, she leads innovative efforts to expand specialty care, integrate technology, and improve health outcomes for millions of rural patients.


Here’s a glimpse of what you’ll learn:


  • [2:12] Dr. Kara Hartl discusses mission to bring advanced healthcare to rural communities

  • [6:39] The origin story of Troy Medical and Rural Health Hub and tele-specialist model

  • [9:55] Shortage of specialists and challenges in rural medicine

  • [13:43] Patient experience improvements through local access to specialists

  • [14:52] Dr. Hartl talks about the economic benefits for rural hospitals and healthcare systems

  • [21:06] The business model and flywheel growth strategy of the Rural Health Hub

  • [25:37] How AI enhances diagnosis and expands healthcare capabilities

In this episode…


Millions of people living in rural communities face significantly worse health outcomes simply due to a lack of access to specialized care. Long travel distances, limited providers, and delayed treatment create a system where preventable conditions become life-threatening. As medical knowledge advances rapidly, how can high-quality care be delivered to underserved populations in a timely and sustainable manner?


Dr. Kara Hartl, a physician and healthcare innovator specializing in rural care delivery, shares a model for bridging this gap by integrating telehealth with local clinical infrastructure. She explains how bringing remote specialists into existing rural clinics improves patient access while keeping care within the community. Dr. Hartl highlights the importance of aligning incentives across hospitals, providers, and payers to create a mutually beneficial ecosystem. She also emphasizes leveraging AI to support diagnosis and decision-making, enabling frontline providers to deliver higher-quality care without needing to master every specialty.


In this episode of The Customer Wins, Richard Walker interviews Dr. Kara Hartl, Founder and CEO of Troy Medical, about transforming access to rural healthcare. Dr. Hartl discusses building a scalable healthcare marketplace, aligning financial incentives across stakeholders, and leveraging AI to enhance clinical decision-making.


Resources Mentioned in this episode



Quotable Moments:


  • “People living in rural America have a 23% higher mortality rate, 23% higher mortality.”

  • “My entire company is designed to bring this extraordinary expertise, technology, innovation and know-how into the rural community.”

  • “Nobody was doing what I needed for my patients and my community, which is long-term outpatient chronic disease management.”

  • “We basically distribute extraordinary medical expertise into rural communities, solving for rural access to care and rural care delivery.”

  • “If this is the difference between a patient living and a patient dying because of technology, I want you to find me.” 


Action Steps:


  1. Bring specialist care into local communities: Embedding remote specialists within existing clinics reduces travel barriers and increases patient follow-through, leading to earlier diagnosis and better outcomes for underserved populations.

  2. Align incentives across healthcare stakeholders: Designing systems where hospitals, providers, and payers all benefit creates sustainable growth and ensures long-term adoption and scalability of care delivery models.

  3. Leverage telehealth for chronic disease management: Consistent access to the same specialist improves continuity of care and patient trust, reducing complications and preventing costly emergency interventions.

  4. Use AI to support clinical decision-making: AI tools can surface rare conditions and guide next steps based on vast medical knowledge, empowering frontline providers to deliver higher-quality care with greater confidence.

  5. Aggregate demand through centralized platforms: Bringing multiple rural communities into one network increases access to providers and technologies, making it economically viable to deliver advanced care at scale.


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Episode Transcript:


Intro: 00:02

Welcome to The Customer Wins podcast, where business leaders discuss their secrets and techniques for helping their customers succeed and, in turn, grow their business.

Richard Walker: 00:16

Hi, I'm Rich Walker, the host of The Customer Wins, where I talk to business leaders about how they help their customers win and how their focus on customer experience leads to growth. Today is a special episode in my perspective series, where I talk with people doing very unique and different things. My guest today is Dr. Kara Hartl, founder and CEO of Troy Medical and the Rural Health Hub. Some past guests in this series include Josh DeTar of Tyfone, Ty Peck of Business Draft and Ben Wiener of Jump Speed Ventures and author of Fever Pitch. And today's episode is brought to you by Quik!, the leader in enterprise forms processing. When your business relies upon processing forms, don't waste your team's valuable time manually reviewing the forms.

Instead, get Quik!. Using Quik!, you'll be able to generate completed forms and get back clean, context-rich data that reduces manual reviews to only one out of 1000 submissions. Visit quickforms.com to get started. All right. I'm so happy to have today's guest, Dr. Kara Hartl is the founder of Troy Medical and creator of the Rural Health Hub, the initiative of bringing advanced medicine and modern technology to rural communities. She's a Harvard educated physician and former Alaska Medical Center founder. She now focuses on designing systems that connect local clinics with remote specialists and providing the consulting needed to build sustainable specialty services. Her work integrates AI enabled diagnostic and therapeutic tools to elevate rural healthcare to world class standards. Kara, welcome to The Customer Wins.

Dr. Kara Hartl: 01:51

Thanks so much for having me, Rich. I'm so glad to be here.

Richard Walker: 01:54

Oh, I'm excited to talk to you and hear your perspective. So for those who haven't heard my podcast before, I love to talk to business leaders about what they're doing to help customers win. How they build and deliver a great customer experience and the challenges of growing their own company. So, Cara, let's understand your business a lot better. How does your company really help people?

Dr. Kara Hartl: 02:12

Oh, that's such good softball to me. Rich. I really appreciate that. So I can tell you that our entire company is a mission driven company designed to bring life saving expertise and technology into rural, remote, and underserved communities. You might not realize most people don't, that people living in rural America have a 23% higher mortality rate, 23% higher mortality.

Just because you live in a rural community versus an urban community, this is 100% unacceptable. How is it that all this amazing advanced technology, this incredible expertise, this vast amount of medical knowledge exists? And yet people in rural communities die at a 23% higher rate because you don't have access. That is not acceptable. So my entire company is designed to bring this extraordinary expertise, technology, innovation and know-how into rural communities to solve this access of care problem.

And I can tell you a little bit of a backstory. I'm an ophthalmologist, so I'm a specialist by training. Right out of training in the Ivory Coast of ivory towers in the world. I ended up in interior Alaska, starting a clinic straight out of residency. Grew it into a multi-specialty medical center.

One of the things that I promised myself when I went out there was that I was going to practice extraordinary medicine, not regular standard, extraordinary like Bascom Palmer level, top of the top medicine in interior Alaska. So that meant that I needed to bring all the greatest technology and as much of the greatest expertise as I humanly could. And I succeeded in ophthalmology. We had an extraordinary center of excellence in Fairbanks, but what I didn't have was access to all the other specialties. As you can imagine, when you have a red, painful, flaming blind eye, suddenly you go see a doctor.

Where is that funny little rash that comes and goes? Those aches and pains that get better over the day. It might take you weeks, months, or years to bother going to see a doctor, especially when the doctor is 400 miles away and has a 6 to 8 month wait list. So this was my reality when patients came in with a red hot flaming eye. That's called uveitis.

Uveitis is oftentimes associated with underlying rheumatologic disease. And we didn't have a rheumatologist. And so I would diagnose them with rheumatoid arthritis, lupus, bechet's, all these crazy systemic conditions, and I had nowhere to send them. So when Covid validated telehealth as this amazing new modality that everybody could gain access to all these doctors, nobody was doing what I needed for my patients and my community, which is long term outpatient chronic disease management with a specialist in my town. We were never going to get a full time rheumatologist.

We didn't have the volume for a full time rheumatologist, but all of my Rheumatologic patients had no options. They had to fly four hours each way to go see somebody in Seattle. So during Covid, I started a company. I had this brilliant idea to bring this fractional doctor in, just like a fractional CFO into my existing infrastructure, because I already knew how to do all of the stuff in my town. I knew where to go for labs, for radiology, for infusions.

I could get all of the medicine done. I just need somebody to manage the lupus. And that wasn't going to be me as an ophthalmologist. And so I designed this. I had this brilliant idea.

You'll laugh at this story. I had this brilliant idea like December of 2020. So I go in to tell my staff, I'm like, this is this great new program we're going to start, you guys. And they looked at me like I had two heads because it was December 2020, like everybody was drowning. Are you kidding?

Like people could barely keep their heads above water. It was December 2020. And so I said, okay, okay, okay. I'm sorry guys, we'll postpone this one for a little bit. Well, three weeks later, in comes one of my most beloved patients, a patient who has psoriatic arthritis, uveitic glaucoma, chronic iritis.

I'm terrible eye disease, in other words, from a systemic cause. Could barely walk across the office, barely get into the exam room, couldn't see worth anything his feet had like such neuropathy, he could barely manage it. I literally walked out of the office in tears. I looked at my clinic staff and she said, we're starting that company, aren't we? I'm like, yeah, we're starting.

Richard Walker: 06:38

Wow.

Dr. Kara Hartl: 06:39

So that patient, his name was Troy. So I started this company because I figured out a way to bring life saving medical care to Troy and to all the other Troy's. And when I actually managed to do it successfully and saw the impact of what this company could do for people that nobody had solved for anywhere. Otherwise, I would have copied their idea or hired them, but nobody was doing what I needed, which is this chronic outpatient long term care, same doctor over and over, solving for my rural patients who were not going to connect to WiFi by themselves, who were not going to be able to follow a ten step process to do their workup. Who needed somebody to sit there and help them through the entire process of medicine?

It's very complex. So the system that I designed was so impactful that I realized this was my calling. This is what I was supposed to do in this world. And so I blew my life up. I sold my business.

I moved from Alaska to Texas because Texas has the single largest rural population, also has the issues of space, but not quite as bad as Alaska. It's pretty, pretty decent space here in Texas. And so now we're after, you know, a few years of iteration, figuring out the best possible way of doing it. We're now at the rural health hub, which is basically bringing all of this extraordinary expertise into rural communities and solving for why it's not there. And so that's what my company does.

We basically distribute extraordinary medical expertise into rural communities, solving for that rural access to care and rural care delivery.

Richard Walker: 08:18

My gosh, that is amazing. So, Cara, there's so many things I'm reacting to with this. And look, I, I love analogies and the way I'm thinking about this, I don't mean to denigrate anything you're doing. So please tell me if this is not the right type of analogy, but I think about if I go out into the wilderness and I'm at least a day's hike away from any kind of health care, and I cut myself terribly, I could die just because I don't have access to the medical treatment. I just think about how fragile we are as humans and how skilled we have to be to survive in those types of survival situations.

And then I'm thinking about the rural towns, which I don't really have experience with. I've driven through Texas, of course. I have no concept of whether they have a hospital or not, and it's never crossed my mind. So what you're really getting at is there are people out there that there's a lot of techniques and medical capabilities that would solve their problems. They just can't get it.

And so they're more likely to die or suffer for it.

Dr. Kara Hartl: 09:13

Yep. And it's not just a few rich, it's 40 to 60 million people. Depending on how you define it, 43 to 60 plus million people are living in rural communities with this 23% higher mortality rate. I mean, it's an enormous percent of the population, not just a little bit.

Richard Walker: 09:34

How much of this? So look, you and I both live in Austin, so we're used to big city capabilities. I'm from Los Angeles, used to big city capabilities. I've lived in Chicago. Same thing.

How much of this is driven by money like affordability? Or is it really about density of population to have a need to bring people in of this capability.

Dr. Kara Hartl: 09:55

So there's several aspects of that, and that's a great question. So one of the biggest things is that about 20% of Americans live in rural communities. Only 9% of physicians do. So most doctors, as you and like this, this is true of any kind of advanced field. They tend to migrate towards the big cities.

Now you take. That's just all doctors, all comers. Now you actually take this into specialty level. And it is extraordinary. The difference.

There's about 260 specialists per 100,000 in urban areas and 30 specialists, 200,000 in rural areas. So the difference is shocking. Most medicine has now become really specialty driven. Primary care quarterbacked, but specialty advanced management. So the.

The medical expertise, the medical knowledge out there has gone exponential for the past several decades. I mean, truly exponential. Used to double every six months, then three months, and now it's probably around doubling every two weeks with the amount of knowledge that's out there. I mean, the levels to which humans really have a hard time understanding that true exponential. And that's what we're at in medical expertise.

So how can you possibly know all of that medicine as a primary care doc? Now imagine that you're a nurse practitioner living in far West Texas, and you're supposed to manage every single thing that comes in, right? That's not happening. This is one of the reasons I'm so bullish in AI is because we can actually have a machine learn that has read every single article in PubMed, every single thing that's come out in medical literature and that can actually enhance these providers that are taking every single thing that comes in the door and trying to be able to manage it. The at the newest, highest, bestest levels of medical care.

Like currently, they're working on 0.01% of medical expertise, doing the absolute best they can, and there's nothing else available around them. And I mean, that's our reality. So you take this now into chronic disease, bad disease, specialty level disease. And like you can imagine that you extrapolate this, the quality of care that they're actually getting compared to the most, like the academic center, you go to Stanford and you're going to get a level of care that is absolutely extraordinary, like literally some of the best in the entire world. You go into a small town in East Texas, you're not accessing that same level of care.

So how can you take that extraordinary level of care that exists? It exists in Stanford like it's there. People are doing it all day, every day and actually bring that kind of care into the Far East. We should be able to do this. I mean, we can keep thousands of airplanes in the sky going, all of these ridiculous, logistical, crazy things that people are doing, and yet we can't figure out how to get access to a tele specialist in East Texas.

Like this is, again, like I said, this is unacceptable. And so yeah, now my life, this is my life mission.

Richard Walker: 13:01

You know, and inadvertently, I've seen this and I just you're making me realize it because my wife has been a nurse for 15 years. She's been a case manager for a couple of years. And she will talk about patients that she's seen that have a three hour drive to Austin. Like we're not that far from rural here in Austin, even.

Dr. Kara Hartl: 13:16

Not that far.

Richard Walker: 13:17

And people have to go hours and hours to get an appointment to go see something, or they have to get transportation back, you know? ET cetera. So I'll bring this back to customer experience because what I think you're really driving at is patient experience, clinical experience. But also if you're bringing in these specialists, it's their experience being able to serve a broader community. So what does it feel like in this experience in the model that you're building?

Dr. Kara Hartl: 13:43

So this, I mean, as any good model is, it's, it's, it is the best model if it is a win win win. So if all players in the ecosystem actually come out ahead, like, you know, you're onto something. So we can talk about the players in our system. So obviously the rural patients like that's the easy one. So access to care, life saving doctors, more importantly starting their medical journey in their rural community.

So imagine that farmer who has that funny little shoulder pain when he's on his tractor. I went in to see the doctor. She says, geez, Joe, I really think you might need to go see a cardiologist about that. Well, that cardiologist is two hours away. You have to take a day off of work.

He and his wife have to spend 100 bucks driving to the big city, which is terrifying in general. So he doesn't go because he doesn't really want to. Four months away. I'm fine, I'm fine. Versus, hey, Joe, why don't you come back next Tuesday?

We have a cardiologist. We have these like, super fantastic, you know, Wi-Fi enabled stethoscopes. This cardiologist could just do a quick exam. Make sure you're okay.

Richard Walker: 14:48

We stopped there. What? Do you have a Wi-Fi stethoscope? I've never heard of this.

Dr. Kara Hartl: 14:52

Best of breed. That's the second thing. We'll get to this one in just a minute. We're getting our technology partners in a second. So Joe comes in and he says, well, all right, I'll do that.

So two weeks later he comes in. He sees the cardiologist on the screen. She's listening and says, Joe, I think you need an EKG and some labs come back in two weeks later, Joe, I think this is your heart. So now you really, really need to drive in two hours because you might have a heart attack next time you're on the tractor. So now Joe understands why he's spending $100 taking a day off of work, and he and his wife are driving to the big city, get a nuclear stress test.

Realizes, geez, this is cardiac. Ends up in the cath lab, has three stents placed, stays two days in the ICU and then gets discharged. What normally happens is these hospitals, when they discharge them, they just kind of go out into the void. But instead, Joe actually is now able to follow up with this cardiologist back in his hometown. He says, hey, Joe, you're breathing a little funny.

I think you might be going into a little heart failure. Let's go ahead and treat your heart failure. Give you some Lasik, get you, get you diarrhea a little bit and keep you out of the E.R. in the ICU as a bounce back. So we can talk a little bit about the economics of everything that just happened there. So first off, the rural hospital, that patient stayed local.

That meant that rural hospitals kept that patient in their ecosystem. They got labs and EKG and medications done in their facility. So their ROI on the equipment, they already have just gone up. These rural hospitals typically are operating at -1 to 2% margins. They are barely holding on.

And they're the linchpin for rural healthcare. So we have to keep our rural hospitals viable and thriving ideally. So this actually stands up. Outpatient revenue streams on the exact same infrastructure they've already had. So that is pure revenue.

This is the best quality dollar to that hospital. Now let's talk about the cardiologist. That cardiologist now is able to have rural outreach and expand their footprint into an untapped 4 to 5 million people in rural Texas to be able to gain access to fill their provider groups. So now they're building the downstream revenue of their e m codes. And then when the patient actually needs something, then they come into the big hospital setting and they have their nuclear stress test and their cath, which is where all of the revenue comes from. But the revenue actually is again, the best quality dollar.

It's been verified by the insurance. It's all pre-planned outpatient. So the insurance companies have control over all of the things because they are of course, the payers that they want this to be an outpatient authorized, not ICU, not E.R. So, the value of that process, actually keeping it as an outpatient entry point is super beneficial to the urban hospitals. So now they have in addition to that, they get the revenue from the procedures. And then when the patient gets discharged and has close follow up.

We know that close follow up just after discharge decreases the readmission rates by almost 48%. So the readmission rates actually are a huge fine to the rural to the urban hospitals. So in addition to getting the downstream revenue of the procedures and the advanced imaging, they also decreased the fines from the bouncebacks and the readmissions because of lack of follow up. So now let's talk a little bit about the technology partners. So I can tell you that the eco stethoscope, which is a best of breed Wi-Fi enabled stethoscope, will never spend money marketing to towns of 5000 people.

So they're never going to get these advanced technologies at mass at scale out to these rural communities. So one of the things that. Right. So one of the things that the rural health hub does is we have dozens and dozens and dozens of hospitals on the hub. So we actually are able to aggregate millions of people into one common source.

Hence the hub. And we actually now become distributors for best of breed advanced technologies. So one of the other things that we do in this company is we actually vet and screen really good technology. If this is something that is the difference between a patient living and a patient dying because of technology, I want you to find me because I want to get your device out into rural America. And there's so much technology out there, but the cost for them to be able to get it out there, it's extraordinary.

The marketing, the sales, the infrastructure, it's never going to happen. But this is an untapped market. This demographic is like, this is the beard like that bar you're trying to get over, you need to go take a shovel to find. So let's go get all of this extraordinary advanced technology. We will hand carry it out there.

We operationalize it for rural workflows, which is the key thing is you have to have something that works for rural communities and rural America, and we will operationalize that and get this life saving device technology, you name it, out into these communities. So that is the final, final winner of our ecosystem.

Richard Walker: 19:58

Tara, I really, really admire how well thought out this is and how you're seeing everybody get more for what they're doing. I mean, I had this premise that the provider, the, the, the physician, whoever is overbooked and wouldn't need more business. And you're saying, no, no, no, they need to fill their book of business. And this is a chance to do that. And the other thing that I'm really admiring is the premise I've had in my business for the longest time.

If you can build up a connection to small businesses across America, the buying power is immense. But how do you get in front of those small buyers? It's so expensive to sell one person, one unit. My first sale was to MassMutual Life Insurance with 5000 sales, 5000 users. And I'm like, yes, this is the way it is.

This is how I should be selling. And we've almost given up trying to sell to an individual user because it's so expensive and so hard to do it. And you have broken the code. That's what it is. So trying to put this in words, how do you attract the rural hospital system to you so that they know about you and they want to work with you?

Dr. Kara Hartl: 21:06

So several things on this one, the flywheel is truly a self-serving flywheel. So we charge the rural hospitals very, very little. So we bring providers in and we say, you have access to these providers. Would you like this? The answer is yes.

We would love that. That would be amazing. What is it going to cost us? Well almost nothing. And so the answer is sure.

Where's the catch? No catch. You have no money. So we're going to serve. I mean, like I said, that's not where you're going to be getting the revenue from.

So they pay a little bit because it's a subscription base. And so everybody has to subscribe. And so you right size a subscription versus what the downstream revenue is. The rural hospitals need more downstream revenue. They have to have increased revenue for financial sustainability and to be able to keep those hospitals open. So they're not ones that are going to be paying a ton.

However, those so you follow them, basically follow where the money comes from. So the doctors, they pay a little bit to be on because they get the e m codes and e m codes aren't super phenomenal, but it's enough. So, you know, they probably get $150 to $200 depending on where you are and what state and what codes you do per visit. Ballpark, not counting Medicaid because Medicaid pays terribly, but so, you know, so we take a little bit of a cut of what they pay. So they subscribe to be on the hub.

There's no guarantees because you have to follow Stark Law and Anti-kickback. So there's no guarantee of referral. But funny if there's no specialist there and there's a million people, you're going to be able to fill your clinics. So we know that if we aggregate enough people that we'll be able to get them. So doctors first clinics.

Well, now you have enough clinics in there that more doctors want to get on. So now you have more doctors and more clinics want to get on. And so it just keeps going. And now you have more doctors. And so the doctors now need to refer to those cardiac casts and knee replacements and the GIS and the liver biopsies somewhere.

So now the hospitals come on and the hospitals actually pay the most because they get the greatest downstream revenue and their financial incentives are the best. They're a little bit of a longer sales cycle, but now you can see that the entire thing starts like more doctors, more hospitals, more patients, more doctors, more patients, more hospitals. And so the whole thing just continues. And then of course, as we bring technology in, this again becomes a distributor revenue, larger groups, more distributors, more distributors, better margins. You know, like all, all of these things go hand in hand.

So the flywheel actually is a self-serving flywheel. We've started adding a couple other things, but there's like one of the hospitals, they do say we don't have any bandwidth. All of our providers are full. Great. I'm going to go ahead and recruit providers for you.

So we have a recruiting arm that it's amazing how doctors want the work from home, work from anywhere. Travel lifestyle to me included. I love my travel lifestyle now. But when you're going into the clinic all day, every day, you don't have that. So there are so many doctors who want to do pure tele nowadays.

So I actually have a recruiting arm that charges $0.20 on the dollar for recruiting, because what we're doing is recruiting a provider to then go on to the hub to then be part of the subscription base.

Richard Walker: 24:15

So you can take these doctors who have left the ER to start their own clinic, who aren't getting enough of their own patients, and you can feed them more patients for telehealth.

Dr. Kara Hartl: 24:24

Yes, EHR is probably not the best one, but we can do this well anyway. Like there's there's tele neurology, tele cardiology, pulmonology, rheumatology, I mean, like, you name it, there's a, there's a gazillion different and then there's some that have in-person practices, but they want to expand like we have a sleep medicine who brought on a nurse practitioner who wants to be able to expand and I. All right, great. Let's get them on the hub. And so now they can do sleep medicine.

And in some of these advanced things onto, you know, areas that wouldn't necessarily refer in, but they can practice perfectly fine telemedicine. And then if they're going to send them a Cpap, well, they can just put it in the mail. And so that ends up being a growth and expansion mechanism for the companies that are, that do have both local and patella.

Richard Walker: 25:11

Wow. Okay, so we're talking about some of the tech here. And I want to go deeper because you and I both love AI and prior conversation. We got really deep on this, but there's so much more. So let's put this in the perspective of your own business.

How is AI impacting your ability to serve these rural communities? Is AI at the front edge, at their clinics, at their hospitals, in the local communities? Or is it all back end? What are you doing?

Dr. Kara Hartl: 25:37

So I'm so AI so I'm incredibly bullish on AI. I mean, one of the reasons I'm so bullish on AI is actually two, two big reasons. One, there's so much knowledge out there. How can you possibly assimilate that much knowledge into a human brain and be able to then express that in a way that meaningfully diagnoses and treats another person? Like we have to be able to harness this vast amount of machine learning to assimilate the information, extrapolate where this needs to go, and then a person meaningfully delivers it.

So there's a lot out there. And what will be happening sometime in the not too distant future is what I think a, the first entry point for this is a diagnostic and therapeutic assist. So ambient listening, running through the LMS and start being like, hey, ask this question like, let's go down the decision tree is this, you know, you have somebody coming in with a red eye. So I'll use my ophthalmology because I know it's the best. The differential diagnosis of a red eye goes on like 27 pages, right?

Richard Walker: 26:40

Sure.

Dr. Kara Hartl: 26:40

What are the things that go down to a red eye? Or we can use headache. That's one that everybody knows. So a headache. I don't have enough water.

I have a brain tumor. Like both of those can present as a headache. So like, how do you figure out the difference between. Drink more water and go get an MRI. So somewhere in this decision tree you go through and this is what medicine does is like you start figuring out, you know, did it like if you have a glass of water, does it go away?

Is this sequential? Does it come at various times? Do you have any neurologic symptoms, like as you go down that pathway to really tease out some of these things? So being able to have a diagnostic assist where an AI helps trigger, hey, you know, there's, there's sumac syndrome. Like what's that?

Have you ever had any retinal artery occlusions? Oh yeah, I did okay. Put in susac. So like, there's like these crazy little esoteric things that nobody's ever heard of and yet they're in the differential diagnosis and an AI knows about them. And so I think that that would be the first entry point.

What's the most empiric antibiotic you give when somebody presents with blank. How do you like what's the first line for malignant hypertension? Like what are the things that we can, we can enhance our nurse practitioners living in far West or East Texas so that they're practicing at the far edge of their scope or even beyond. So that's the first thing.

Richard Walker: 28:05

You know what this feels like to me. I've been the mystery patient for doctors for a decade. Like they could not figure it out what it is. And it was a back issue and it's mostly sciatica, but that's just the best label. It doesn't even mean that's what it is.

So what this feels like is you bounce from provider to provider, expert to expert until somebody who has that knowledge of that specialty, who's seen it 2 or 3 times and can recognize it, you finally meet that right person. You are saying, we can compress all that into AI potentially and identify it sooner, faster, easier.

Dr. Kara Hartl: 28:39

An AI can read every case report that's ever been published in the history of medical literature.

Richard Walker: 28:45

Right.

Dr. Kara Hartl: 28:46

That's it. I haven't done that. Like there's nobody that's done that. So clinical expertise, you just throw the idea out and then do it. How do you diagnose?

How do you rule in or rule out, you know, possibility rule in or rule out. And so we can, we can create the algorithms. I mean, I'm not the one creating this, but like Claud code can now create it for itself. I mean, the things that you can do now are just extraordinary. It really should go through a human filter because a human said, that's really stupid.

Like when a human says what a cataract is, you're like, no, it's not a canyon. It's something in your eye. And so like, you know, you have to have a human like put, put their, their filter into it. But if you can enhance a human. Now we're talking, I mean, at some point in time in the future, you know, in 20 years, like we know that AI will be the first line agent, like, absolutely.

I mean, that's going to happen because a human like an AI is gonna be better than a human and not that long. By the way, an AI is extraordinarily less expensive than a human. And so if we're able, one of the biggest issues we have in medicine is that I think I think we're now officially at 5.3 trillion in annual spend. It's expected to go to 7 trillion in annual spend. Like that is not sustainable, which is a huge issue.

So how do you find a way to create a financial viability in a model that is broken in so many ways? AI is one of the ways that we're going to be able to dramatically reduce the cost and, and create a system that is cost contained enough.

Richard Walker: 30:19

Look, I think you're also making a different point because this is how I'm hearing this. You're bullish on AI. It's going to make it so diagnoses are easier, faster, better. You're reaching out to rural communities to improve their healthcare, which means you're opening up the marketplace to more and more providers. So AI is not going to displace any jobs.

It's going to create more jobs, more opportunity, and more people are going to get helped as a result of it. That's how I see this.

Dr. Kara Hartl: 30:46

What we're doing is making the people that are there doing it ten times stronger. So if you had something that could think that has read every journal article ever written and could advise you on how best to approach this, you're going to be stronger. Like we all, we all joke that AI is not going to take your job. The people who are using AI are going to take your job. And so like, what, what we need to do is we need to AI enhance the people on the ground, on the front lines, doing the work so that they are so much better than what they would have been without AI.

Richard Walker: 31:20

Yeah. You are making the case for why I need to make my show longer because I'm out of time.

Dr. Kara Hartl: 31:26

I told you the beginning of a talk. I'm a little bit passionate about this.

Richard Walker: 31:31

And there's so much correlation. I mean, you're in a regulated industry with HIPAA and compliance, how you're making AI work within those boundaries. Listening to conversations and such financial advisors face the same thing about what we are listening to and what we can do with it? Unfortunately, I am really running out of time, so I gotta wrap this up. So before I get to my very last question, Cara, what's the best way to find and connect with you?

Dr. Kara Hartl: 31:53

So you can look us up on rural healthhub.com. Or you can always reach out to me@cara.com. Always available there. I'm a little bit less good about LinkedIn, but I do get around to it eventually.

Richard Walker: 32:09

Yeah, no, I get that. All right. My last question is always one of my favorites in the episode. Who has had the biggest impact on your leadership style and how you approach your role today?

Dr. Kara Hartl: 32:21

You asked me at the beginning and like, that's a tough one because how do you narrow it down? So the first, the first person I always, I always mention is my mama. She has been my rock. She's the one who told me when I was a little girl, I could always do anything. I just had to work hard for it and it would happen.

So my mama is like the greatest human I've ever known in my entire life. And she's been my rock forever. So a shout out to Barbara Hartl. I love you, mom. You're the best.

And, then I talk about my EO network. So entrepreneur organization has been his next level. So some of my early foreign mates. Rajiv Agarwal is an inspiration to me. He's who I'm helping start eye hospitals in India.

And that man just is an inspiration like ten times over. And then I look at people like, I mean, as silly as this might be, like Elon Musk and Mark Cuban, like people who could have retired a thousand times over and instead decided to go take on the things that nobody can actually take on, like space pharmaceutical companies equally as crazy. I mean, people who use the power that they have to actually move a needle, that is almost impossible to move. That only you have to have extraordinary resources and be fearless to be able to tackle these giant behemoths. I just, I see people doing that and I'm, I'm inspired.

I feel like I'm a, you know, a peon compared to this. But one day I hope that I actually might have a seat at the table to say, no, no, we need to do medicine this way. And solve problems in an innovative way. And I give a shout out as much as said as there's like all sorts of chaos when I'm in rural healthcare right now, the Rural health Transformation program has funded a lot of innovation. And so I'm hoping that in the next five years, the stimulus that the government puts into rural healthcare will find out of box solutions like what we're doing that will literally change the way we deliver healthcare and level up the entire system.

Rising rising tide raises all ships.

Richard Walker: 34:33

Yeah. For sure. I love it, I love it. Kara, this has been fascinating. And maybe I have to have you on again to talk more.

I especially know things you're doing with AI that I didn't even get to bring up. So to wrap this up, I want to give a big thank you to Kara Hartl, founder of Troy Medical and creator of the Rural Health Hub, for being on this episode of The Customer Wins. Go check out Kara's website at rural health.com. And don't forget to check out Quik! at quickforms.com where we make processing forms easier. I hope you've enjoyed this discussion.

We'll click the like button, share this with someone, and subscribe to our channels for future episodes of The Customer Wins. Kara, thank you so much for joining me today.

Dr. Kara Hartl: 35:12

Thanks so much for having me, Rich.

Outro: 35:15

Thanks for listening to The Customer Wins podcast. We'll see you again next time and be sure to click subscribe to get future episodes.

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