Belinda

Welcome. I'm Belinda Lange. I'm a professor in health AI at QUT, and I'm joined today with Julian Moore, who is a solutions architect and Chief AI Consultant at SMS. And we'd like to chat a little bit about AI in general and AI in physiotherapy. I’d like to start and just ask you, with all the hype around AI at the moment, how do we separate that value of AI from the hype?

Julian

Oh my word. There's much more hype than there is value, I promise. And there's a huge amount of value. But the amount of hype, if you look on LinkedIn at the moment, you would be forgiven for thinking you're five years behind the world. But the worst thing is when you look at it, it's also mainly AI generated and it's the hype,

it's always a kernel of truth that then they overhype. You know, it's ‘oh, AI can now be as good as a human’ is the example I normally use. And that was because it only made 20% errors outside of its speciality, where humans would make 23% errors.

But either way, 20% errors is bloody awful. So what we want to separate the hype is understand, I guess, the task that you want it to do, understand which tool to use to perform the task and then get some testing going of your own. There are roughly,

oh my word, there must be 100 benchmarks and every single one, I don't trust any of them. I just don't anymore. One of them came up and said that Grok was the best coding tool. And, you know, that's just so out of the world wrong. So I think some of the benchmarks get paid. I think to separate the hype, do your own testing. Most AI’s allow you a free trial. If they don't, send an email and say ‘I'm an enterprise, I'm considering using this. Give me a month.’ And they will bend over backwards and give you a month of any level platform, program you want and do your own testing.

That way at least you'll know it'll do the task you want it to do.  

Belinda

What does AI literacy look like for physiotherapists?

Julian

Think of it as AI fluency, because AI fluency in my mind means you know how to use

AI no matter whether it's video, audio, texts, analysis, diagnosis. Whatever it may be.

I think for physios we have to divide it between two things. Their business, because in business, regulation is very straightforward. It's as long as you're meeting the Data Privacy Act. You can use it in emails, you can use it in texts, you can use it in outbound calls, inbound calls, calendars. You can use it for mapping. You can use it for accounting. Whatever your business does, it's able to take on and do 80% of those business practices. It can do more, but make sure you're checking and approving along the way. And then on the flip side, when it comes to the clinical side,

really just stick to the AI scribes. Anything outside of a scribe, you're going to come into some interesting red tape. Trying to use video, trying to use audio outside of a scribe, or putting a patient's details into even a compliant GPT. You're going to come undone.  

Belinda

And you've given some really good examples of how AI can be used in physiotherapy clinics. What does an AI-enabled physiotherapy clinic actually look like?

Julian

Let's have a look from the patient's point of view because I'm not a physio. So if we say I've moved house and I've done something sporty and damaged something. So I need a physio. The first thing is I've just moved house. The physio’s AI should know

that you’ve purchased that house. That's open domain source, it's out in the way. So why not have an outreach email or text to the new home owner and to say, ‘Hey, we’re your local physio.’ So I've just received that through my letter box. So now I've read that, I've phoned up, but it's a one-person practice and they're in practice. So the AI answers and asks me about myself and what the challenge is, and it will answer in any language whatsoever. And it's fluent in all of them. And as it's having the conversation, it's built the records and it's populating all the right cells. And then it asks me to book an appointment. I confirm that and then I get a text message to go,

‘Your appointment is booked at this time’, and the day before the appointment, I'll get another text message to say this has happened. I get to the door. Now this is where we get interesting because you're on a private property now, so you could have it,

your CCTV camera inside, as I open the door, it'll identify me. And then as I go to the screen on the desk, he'll say, ‘Hi, Julian. Wonderful. Your appointment’s booked.

Brendan will be your physio today and he's just in with the client at the moment. Have a seat. I understand you've got these things going on, so I've preheated this chair that will have you ready for Brendan when he's available.’ And then it will say

in voice, in language I understand, it will then say, ‘Brendan is about to finish. So make sure your phone, you've got all your stuff’, just like Ubers do. And then as you go in, of course, Brendan will do the professional kind of look over and treat me and he can use this scribe. And then as I leave again and come back to the non-clinical side, it was able to say, ‘Hey, we've got your credit card on file.’ And so approve payment. It will now do the line entry into your account system. It will now send the invoice to your email or print one depending on whichever you want to do. It will then update all the exercises that you've been allocated. And those exercises can be videos. They can be instructions. They can go to your phone, to your email, however you want. And then as I then leave, the follow-ups would be once a week just from the AI going, ‘How are the exercises going? Do you want any guidance? Would you like to do an exercise in front of a video call so I can see you're doing them correctly? Is there anything else I can help with?’ And that could go on every week. So the touch points are not just when they're with physios but in between time you're maintaining that ongoing engagement with the client. That all sounds really exciting for, you know, a physiotherapy practice of the future.

Belinda

When do you think we'll start to see these types of integration of AI in practice?

Julian

Everything I just said I've done in some space or workspace already. So it's really how much do you want to use and how little do you want to use. And that's very important because as we progress to the future, some people will go full tilt and it'll just be, the only time you meet a human is when you meet the physio themselves.

Everything else will be automated. And that's right for some people. But I think we'll start seeing people charge more for a human experience. I think that will become the bougie kind of exclusive. ‘Oh no, we don't do AI. We have 100% human experience’,

you know. So we're going to start seeing those differentials come through. And ‘why is your physio better than my physio’ and all that type of thing. So I think we're just going to see some people go full AI and others go, no AI. And there’ll be a sliding scale all the way through and where you sit on that scale is up to the person running the practice.  

Belinda

So what do you think the changes coming, I guess, even that little bit further on. So you're thinking now, you could integrate some of those things now. We're likely to see that happening over the next two to five years. What do you see is the next step?

Julian

It's hard to say because you're only seeing the practice software start integrating. We’ve got lots of practice software integrating scribes now. And we've got so many different scribes out there. And not all scribes are created equal, for your listeners out there,

I should say. Do your benchmarks on those. However, if you then start projecting forwards, I think accounting and calendar booking and the idea that, I guess, exercise videos and tailored exercise videos, maybe even with the person's face on them doing the exercise, they'll become the norm because they will be so cheap.

Why wouldn't you? Going forwards, in clinical trials at the moment, we have video

identifying muscle spasm and we have video identifying correct adjustment and that type of thing already in different trials. We have video in America, in courtrooms

identifying how truthful the testimony is. Well, now, if you put those two things together and say, okay, ‘how on the 1 to 10, how bad is your back pain?’ Just from facial analysis we’ll be able to understand the sentiment and how truthful the pain is

they're telling us. So it gets scary quite quickly. And that's why Australia's red tape is very good because we regulate particularly well. And we, you know, having video inside a physio’s office is probably not the way to go. So going forwards I think the opportunity is almost, automate anything. And to the point where identification,

diagnosis, even manipulation to some point with a robotic assistant, will be absolutely available.  It's just, because we can, should we? That's definitely a pay grade above me. That's for someone else to decide.

Belinda

Tell me more about the robots and what you think their place might be in something like a physiotherapy practice.

Julian

When you think of robots, we should think of humanoid robots. For the listeners out there who haven't seen these and have seen the Chinese dancing robots and the kung fu robots and all those types of things. At the moment, there's a big divide in the world. We have the AI, full-bore intelligence, and that sits primarily in America.

In China, what we have is the best manufacturers in the world by a significant margin. Now, they don't do innovation very well. They do evolution extraordinarily well. And so what they're doing is they're preparing for when they get hands on to a fully autonomous humanoid robot so they can, off the shelf, they can get actuators, parts and build anything. And that's why they're a bit janky at the moment, because they're robotic, remote controlled, perform this process, then perform this process, then perform this process. Jump over this log, run 20 steps, walk up stairs. It's not autonomous. It's a remote-controlled instruction set. In America, we have three very key players. We have Optimus by Tesla, we have NEO Gamma by 1X Technologies.  

And then we have Figure 03. It'll be Figure 04 on release. And that's the Figure robot company. Those three have built their entire humanoid autonomous robots. So look, stand like us. And the concept around that is that the world is built for us. It's built for you and me. It's built for two-legged, you know, humanoids who walk around, and doors and stairs. So building a humanoid robot means we don't have to change the environment around us. So now they've got these. We're at the final stages of testing now, so all the build is done. Most of the intelligence is done.  It's now, you know, it's,

if you're in the kitchen and it's pulling the spaghetti hoops away and then you ask it to pick the cat up, it puts the spaghetti hoops away before it tries and picks the cat up. So those kind of key skills now are, bring your shopping in, put the frozen stuff in the freezer, basically put Woollies away and then from there tidy up, make the beds, vacuum, polish, clean, walk the dog, mow the lawn, all that type of thing. So we're actually there now and all those will be tested and done and they're going to be launched. Neo is launched, ready for release this year. So within 12 weeks we'll be seeing our first robots come out and they're already for sale. You can go to 1X Technologies now, place an order and have a human robot egg turn up. It climbs out of an egg. For those as old as I am, Mork and Mindy, that's what we got, these climbing out of an egg. And then, just like your vacuum, robot vacuum cleaner, it will go around, map your house and put things away, tidy up, do all the tasks. So that's where we are for the robots in home. And then it's going to be a boon. I mean, for the old-age pensioners who want to stay in their own homes, how amazing is it that they can just order the food? All that gets put away. They want a cup of tea, it gets made.

The beds get changed. All this type of thing, it'll give them their independence back.

Same with driverless cars. So that's going to be amazing. There's a huge amount of upsides. But on the flip side, there's some downsides. I think if we see them going into retail, it means those kind of student jobs typically will be gone. Warehousing.

I don't think we'll have warehouse staff at all in Australia by the end of next year. I think that's a given. Because if I've got something for $499 a month that, on the subscription, that will lift boxes and place boxes, stack vans. Well, why do I need humans? Because they have sick leave and holiday pay and Fair Work dismissals

and all that type of thing, and robots don't. And at $499, that's a lot cheaper than any human staff member. So robots are going to change the face of everything. And it sounds like we're talking about the future, but honestly, it's this year. I mean, we're in October and it's around the corner. It's weeks away, not even months away.  

Belinda

It sounds straight from the movies, but yeah, nearly here in real life.

Julian

Yeah, yeah. I mean, we are fully Jetsons and that's where we're at and where AI is very controllable, it's software that does as you instruct it. And we have lots of lovely laws that mean where we can use it and where we can't. It's really just a productivity increase. Robots. Oh my word, can you imagine? I literally have a neighbour called

Doris on the corner. And I think the first time I walk past her house with a robot behind me she's going to scream. It’s going to be truly out of this world for someone her age.  

Belinda

Yes, the future is exciting, but a little bit daunting at the same time.

Julian

It really is. But for physiotherapists, can you imagine? You finished your last patient.

All the paperwork is done by the AI, you lock up and when you leave, the robot then goes around and vacuums and cleans and tidies and sets everything back up to as you want it in the morning. And so it can absolutely be used that way. Using it clinically, I think it's got too many cameras. The privacy issues will be massive, but how lovely would it be to have an assistant just carry your kit bag? If you're going out to a sports meeting? Or how lovely would it be to help a disabled person stand or anything like this? It would be an amazing boon to have a second pair of hands.

Unfortunately we can't use them in that way or I wouldn't advise it anyway.

Belinda  

Any final thoughts around the use of AI in physiotherapy that you want to share

with the listeners?

Julian

The first thing is, understand it's a productivity uplift. Really that's what it's designed for. And the reason they call it an assistant is because that's what it was designed to do. Assist. It's not designed to replace. So treat your AI as a PA and then choose a platform, whatever platform, and then they have connectors built in. And if those connectors, so make sure you're on the business account, but if those connectors are built in, they’re secure connectors, not an API or something. So using secure connectors to connect your AI to your 365, your email, your calendar, your SharePoint, using it to connect to your practice software, using it to connect to the web. Use it to connect to your social media. Use it to connect to real estate if you're looking to buy a house, and then instead of opening any of that software, just use one screen and say, ‘What emails do I need to respond to? List them all and give me a response.’ When you do that, you can now see the responses and they're editable all within so you can edit. ‘Okay, now send that one. Okay. Now send that one. What have I got in the calendar today? Show me what's priority number one and three.

You've got this coming through. Oh that's Graham and he never does his exercises.

So I know what it's going to be up with him. I'm going to need this equipment. So can you just text me an equipment list I need to take out?’ Treat it as a PA. If you treat it as a PA, it'll increase your productivity four-fold. And then from there, and once you've got used to it and comfortable with it, you start using it on your mobile, on your watch, start using it in your daily life. So my favourite is always, you know,

just take a photo of the fridge contents and say, ‘what can I cook this evening with the ingredients I've already got? ‘And then give me an instruction on how.’ But it means when you start engaging with it this way you can then, effectively, when you're in your car driving to work, you could say, you know, whatever name you give it. ‘Hey, GPT, I'm sure I've got Graham first thing up. What else do I need to know is going on today?’ And it will start talking you through your calendar day. ‘Put this appointment in. Do this for me.’ Do that. It's the same as having a PA.

Belinda  

Thank you for sharing your expertise and sharing some really practical points about what people can do to implement AI right now, as well as some of your thoughts around, you know, the future of what's actually coming down the track. It's really very helpful for the listeners to understand what they can do now and, and what's going to be, you know, potentially available in the future. So thank you very much for your time today.

Julian

No worries. Thank you.