The Birth of Ambient Documentation: How an ER Doctor and College Student Built a Healthcare Tech Revolution
The Birth of Ambient Documentation: How an ER Doctor and College Student Built a Healthcare Tech Revolution
In 2014, an emergency room doctor and a college pre-med student took a leap of faith that would transform healthcare documentation. Their startup, iScribes, eventually became Dragon Ambient eXperience (DAX), now a cornerstone product for Microsoft and Nuance. Here's their remarkable journey.
An Unlikely Partnership
It began in a Virginia emergency department, where pre-med student Christopher worked as a scribe for Dr. Jared Pelo. Christopher's endless curiosity about medicine caught Jared's attention – he kept asking questions about X-ray interpretations and clinical decisions instead of just taking notes.
When Jared approached Christopher with a business proposition, Christopher was deep into medical school applications. The choice was stark: continue on the safe path to medical school or join a risky startup venture. After a surprising conversation with his father, who told him "You can go to school anytime...the experience you'll get is invaluable," Christopher joined the iScribes mission.
Building from Nothing
The early days were characterized by bootstrap ingenuity:
Working from an unheated house with Bitcoin miners providing warmth
Hand-ironed company sweatshirts
Minimum wage pay for dedicated employees
Personal loans and retirement savings keeping the company afloat
Meeting David Meisner, who brought crucial business and financial expertise
Culture as Foundation
Despite financial constraints, the founders prioritized building strong company culture:
Weekly updates and celebrations
Company sweatshirts after one year
A mission-driven community
Three core values consistently reinforced
The result? A loyal workforce of 250 employees who often felt guilty about leaving even for double the pay.
The Technology Bet
The team made a prescient decision to record and store all their documentation data, believing that someday AI could transform it into automated documentation. While their initial competitive moat was this massive dataset, the emergence of large language models changed the landscape. Nevertheless, DAX became a cornerstone product mentioned in Microsoft earnings calls.
Key Lessons
Bias toward action: "Be wrong by trying, don't be wrong by hypothesizing and not going for it."
Deep conviction matters: The level of commitment required means you need to truly believe in solving the problem.
People first: Success came from improving life for doctors, patients, and employees alike.
Build community: Strong culture creates resilience through hard times.
The iScribes story demonstrates how vision, persistence, and the right team can transform an industry. From a college student's curiosity to a product used by healthcare systems nationwide, it's a testament to the power of taking risks and believing in possibility.
Ten years later, both founders reflect on this journey with gratitude – for the lessons learned, the friendships forged, and the impact they've had on healthcare. As Christopher notes, "What a blessing to carry these lessons forward at 34." Their story continues to inspire entrepreneurs and innovators in healthcare technology.
Key Timestamps:
00:10 - Introduction and background
02:06 - Earliest days of iScribes conception
08:09 - The pivotal dinner meeting
14:22 - Early company milestones and strategy
15:34 - Key turning points: Triangle Ortho email and David Meisner
22:17 - Office space evolution and growth
27:43 - Building company culture
33:05 - Challenging moments and near-failures
36:27 - Personal sacrifices and financial risks
40:52 - Key lessons learned
43:51 - Impact on personal growth and relationships
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Understanding Brain Aging and the Fight Against Alzheimer's
In the latest episode of Medicine 3.0, Dr. Jared Pelo sits down with Dr. Christin Glorioso, physician, neuroscientist, and founder of NeuroAge, to discuss brain health, Alzheimer's prevention, and the cutting-edge science of measuring brain aging.
A Personal Mission Driven by Family History
Dr. Glorioso's journey into brain health research began with personal experience—her grandmother suffered from Alzheimer's disease, and she recently discovered she carries an APOE4 allele, which increases her own risk. This personal connection has fueled her 20-year career studying brain aging and what can be done to slow it down.
"My life has been dedicated to coming up with better solutions for people who have high risk of Alzheimer's, which if anyone lives long enough, that's really all of us," Dr. Glorioso explains.
The Science of Brain Aging
After completing her MD-PhD at the University of Pittsburgh and Carnegie Mellon, followed by postdoctoral work at MIT, Dr. Glorioso has focused on understanding the molecular changes that happen in the brain as we age. Her research reveals that approximately 2,000 RNA transcripts (about 10% of the genome) change with age in ways that can either protect against or increase the risk of neurodegenerative diseases.
One of the most encouraging findings: people whose brains are biologically five years younger than their chronological age are significantly protected from Alzheimer's disease—even if they carry genetic risk factors like the APOE4 allele.
The 40% We Can Control
While genetics plays a significant role in brain aging, Dr. Glorioso emphasizes that approximately 40% of our risk is determined by lifestyle factors we can control:
Exercise - At least 30 minutes daily, with particular benefits from getting your heart rate into zone three, which releases BDNF (brain-derived neurotrophic factor)
Diet - Mediterranean diet, coffee, tea, and foods rich in polyphenols (like berries)
Social connection - At least an hour of social time daily
Stress reduction - Cortisol is particularly harmful to brain cells
Mental activity - At least an hour daily of mentally challenging activities
Sleep - Quality sleep is essential for brain health
Measuring Brain Age
NeuroAge has developed multiple approaches to measuring brain health:
While MRI provides the most accurate assessment followed by blood biomarkers and cognitive testing, Dr. Glorioso notes that even simple cognitive tests can help determine whether memory issues are normal for your age or potentially concerning.
The Future of Alzheimer's Prevention
Beyond testing, NeuroAge is working toward developing therapies to reverse brain aging—essentially creating a "statin for Alzheimer's" that could safely prevent the disease. The data collected through their testing program contributes to this research in a privacy-protected way.
"We're creating therapies to reverse brain aging... something that's safe, you know, a pill that people can take that is going to prevent Alzheimer's in the future," Dr. Glorioso shares.
This partnership between Bionic Health and NeuroAge represents an exciting opportunity for members to assess their brain health and take proactive steps toward preventing cognitive decline. As Dr. Pelo notes, even without extensive testing, everyone can benefit from living as though they're at high risk—the lifestyle interventions that protect brain health also enhance overall quality of life.
Timestamps:
00:18: Introduction and Dr. Glorioso's background
02:11: Dr. Glorioso's path to neuroscience and MD-PhD training
07:27: Research at MIT and Pittsburgh on human brain aging
15:04: How RNA transcripts relate to brain aging and disease
18:22: The six key lifestyle factors affecting brain health
24:12: NeuroAge's three main testing approaches
27:59: The future goal: creating therapies to reverse brain aging
The Science of Body Composition: How DXA Scans Help Optimize Your Health Journey
In a recent episode of Medicine 3.0, Bionic Health physician Dr. Catherine Isaac and advisor Kelly Joniak dive deep into the world of body composition analysis, specifically focusing on DXA scans and their importance in health assessment and optimization.
Understanding Body Composition Assessment
The conversation begins with Kelly explaining different methods of body composition assessment. DXA (dual-energy X-ray absorptiometry) scans emerge as the gold standard, providing a three-compartment model that measures:
Bone mineral density
Fat mass
Fat-free mass (including lean soft tissue)
While home bioimpedance scales (BIA) only measure two compartments (fat and fat-free mass), DXA provides a more comprehensive picture with greater precision. Kelly describes BIA scales as "reliably unreliable" - consistent but not always accurate compared to DXA measurements.
Beyond Aesthetics: The Medical Value of Body Composition
Perhaps the most compelling aspect of the discussion is how body composition analysis serves as a powerful preventive healthcare tool. Dr. Isaac shares several examples of how DXA scans help identify health risks that might otherwise go undetected:
Visceral adipose tissue (VAT): This fat surrounding internal organs is invisible from the outside but strongly correlates with chronic disease risk. DXA can precisely measure VAT, helping identify people at risk for diabetes, cardiovascular disease, and even fatty liver disease.
Bone health: DXA provides T-scores and Z-scores that can signal early bone density concerns, particularly valuable for perimenopausal women and men with potential testosterone deficiency.
As Dr. Isaac notes, "We're definitely being proactive in a way that you don't normally have the tools to be."
Common Misconceptions and Mindset Shifts
The podcast challenges several fitness myths:
"I just want to lose weight": The experts emphasize that body composition matters more than the number on the scale. Someone might maintain the same weight while replacing fat with muscle, drastically improving their health.
"Muscle is more metabolically active than fat": Kelly clarifies that both tissues are metabolically active - a surprising correction to a common belief.
"Progress is linear": Both experts stress that health improvements rarely follow a straight line. Consistency matters more than perfection.
The Importance of Community and Consistency
Beyond the technical aspects, the conversation highlights the human elements that contribute to success. Kelly emphasizes that having supportive community makes consistency easier, whether it's workout partners, family involvement, or the workplace culture at Bionic Health.
Dr. Isaac shares her personal journey with weight training, including setbacks and the mental training that came with them: "Mindset is really what's going to help you achieve your goal, whatever area of your life."
Finding Your "Why"
The podcast concludes with both experts sharing their personal motivations for maintaining physical health. For Dr. Isaac, it's keeping up with her active son. For Kelly, it's seeing her 60-70 year old mother and aunt living vibrant, active lives - playing pickleball daily or hiking mountains around the world at 70.
These personal stories remind us that the numbers from a DXA scan aren't the end goal - they're tools to help us live fuller, more active lives for decades to come.
Whether you're looking to optimize athletic performance, prevent chronic disease, or simply understand your body better, this conversation provides valuable insights into how modern body composition analysis can guide your health journey with precision and purpose.
Timestamps:
00:01: Introduction to the Body Composition Module
01:48: Explanation of DXA scan technology
06:13: Drawbacks of different body composition methods
09:37: Information about skinfold testing
13:45: Discussion of visceral adipose tissue (VAT)
15:27: How visceral fat relates to chronic disease risk
18:33: Exercise recommendations for reducing visceral fat
21:05: Bone mineral density assessment
24:25: Importance of protein for muscle and bone health
27:32: Shifting focus from weight to body composition
30:08: Metabolic activity of fat and muscle tissue
Brain Health: How Music and Lifelong Learning Can Prevent Cognitive Decline
In our latest Bionic Health podcast, Dr. Jared Pelo interviews neurologist-turned-entrepreneur Dr. Josh Turknett about the science of brain health, cognitive decline prevention, and how learning complex skills like music can help maintain brain function as we age.
From Neurologist to Music Education Innovator
Dr. Josh Turknett's journey is anything but conventional. After completing medical school and a four-year neurology residency at the University of Florida, he spent years in private practice treating neurological conditions. But over time, he began to recognize a significant gap between what he could offer patients in clinical practice and what he believed they truly needed.
"I came to realize that a lot of the issues I was seeing as a neurologist were related to lifestyle and preventable types of things," Dr. Turknett explains. Through his own experience with migraines, he discovered that dietary changes had a more profound impact on his condition than conventional treatments—a revelation that would eventually lead him to reconsider his entire approach to neurological health.
While still practicing neurology, Dr. Turknett pursued his passion for music, specifically the banjo. Drawing on his background in cognitive neuroscience, he began integrating principles of neuroplasticity into his musical practice. This eventually evolved into BrainJo, an innovative platform that teaches musical instruments through neuroscience-based approaches.
The "Stimulate and Support" Framework for Brain Health
When it comes to maintaining cognitive health, Dr. Turknett advocates a simple yet powerful framework: stimulate and support.
"There are two things to think about in terms of keeping a healthy brain throughout our life," he says. "We have stimulation on one side and support on the other side."
Stimulation: Fighting Autopilot Mode
Cognitive stimulation is essential for maintaining brain health, but Dr. Turknett points out that many of us, especially in established careers, operate largely on autopilot. "The more you can spend your day on autopilot, the less cognitive stimulation you've provided," he explains.
Real cognitive stimulation comes from activities that trigger plastic reorganization in the brain—essentially, learning new knowledge and skills. This is where complex activities like learning a musical instrument come in.
BrainJo currently offers instruction in multiple instruments:
Two styles of banjo (claw hammer and fingerstyle)
Piano
Ukulele
Fiddle
With guitar coming soon
Support: Giving Your Brain What It Needs
Just as important as stimulation is providing your brain with the resources it needs to maintain existing neural connections and build new ones. Dr. Turknett identifies several key pillars of brain support:
Physical activity - Particularly activities that combine cardiovascular fitness, strength training, and cognitive demands (like tennis or pickleball)
Sleep and rest - Critical for neural recovery and consolidation
Nutrition - Including key nutrients like B12, vitamin D, magnesium, zinc, and copper
Stress management - Limiting chronic stress that can damage brain tissue
Social connection - Perhaps the most underappreciated factor in brain health
On the often-overlooked importance of social interaction, Dr. Turknett notes: "Being around other people, conversing with other people, being in social situations is an enormous cognitive stimulus... one of the reasons that we see [cognitive] deterioration is because of the loss of that stimulus when people are isolated."
Assessing Cognitive Risk and Monitoring Brain Health
Many people, especially those with family histories of dementia or genetic risk factors like APOE4, wonder how to assess their risk for cognitive decline. Dr. Turknett emphasizes that while there's no single test that can definitively predict risk, there are several approaches to monitoring brain health:
Regular cognitive assessments, whether through formal testing or self-monitoring
Basic blood work to identify conditions like metabolic syndrome or nutritional deficiencies
Lifestyle evaluation to identify areas for improvement
He recommends foodforthebrain.org for those interested in comprehensive cognitive evaluation with a nutritional focus.
Rather than viewing cognitive health as predetermined, Dr. Turknett stresses that "we are actively influencing our risk all the time." This empowering perspective frames brain health as something we can continuously improve through our daily choices.
Anyone Can Play Music: The Science of Learning at Any Age
Dr. Turknett's new book, "Anyone Can Play Music: How to Realize Your Musical Potential with the Laws of BrainJo," challenges the common belief that learning complex skills like music becomes impossible as we age.
"The reason we can learn anything at any age is because we have this ability to change the brain at any age," he explains. "Learning complex skills relies on neurological mechanisms that we all share."
The book outlines principles for leveraging these natural mechanisms, often requiring readers to unlearn ineffective approaches taught in traditional education. It's as much about how to learn anything as it is about music specifically.
A Prescription for Brain Health
For someone in their mid-40s concerned about future cognitive health, Dr. Turknett recommends:
Evaluate your current cognitive stimulation - Is your work challenging your brain, or are you on autopilot?
Incorporate complex real-world skills - Music, dance, or sports that demand coordination and strategy
Monitor nutritional status - Particularly for B12, vitamin D, and other brain-essential nutrients
Prioritize social connection - Ideally through activities that simultaneously provide cognitive stimulation
The key is finding activities you enjoy that provide both cognitive challenges and social connection—like joining a community of musicians or picking up a sport like pickleball that combines physical activity, strategy, and social interaction.
Beyond the Clinic: Making a Broader Impact
Dr. Turknett's transition from clinical practice to entrepreneurship reflects his desire to have a greater impact on brain health than the constraints of a traditional medical practice would allow.
"To actually fulfill the role that I initially signed up for... I could do a much better job doing what I'm doing now than I could in the clinic," he reflects. Through his online platform, books, and educational content, he's able to reach and help far more people than would be possible seeing patients one at a time.
This sentiment resonates with Dr. Pelo, who made a similar transition from emergency medicine to focusing on preventative health through technology. Both physicians recognize that while there will always be a need for excellent clinicians, there's also tremendous value in creating scalable approaches to health that can benefit millions.
Time Stamps:
00:01 - Introduction and welcome
00:13 - Josh's background and journey from neurologist to entrepreneur
02:59 - Josh's personal experience with migraines and lifestyle changes
03:59 - Discovering neuroplasticity and challenging fixed mindsets about adult learning
06:51 - Transitioning from clinical neurology to broader impact
10:09 - The challenge of leaving clinical practice and finding new ways to help people
11:40 - How BrainJo evolved to address cognitive health
14:33 - Musical instruments you can learn at BrainJo (banjo, piano, ukulele, fiddle)
15:26 - Assessing cognitive decline risk and preventative strategies
17:39 - The importance of monitoring cognitive function
18:37 - Key nutrients for brain health (B12, vitamin D, magnesium, zinc, copper)
20:33 - Why genetics isn't deterministic for cognitive decline
21:29 - The value of cognitive testing and brain games
23:27 - Practical advice for a 45-year-old to prevent cognitive decline
24:03 - The "stimulate and support" framework for brain health
29:19 - What types of physical activity are best for brain health
33:08 - The surprising importance of social connection for brain health
36:46 - Josh's new book "Anyone Can Play Music" and the science of learning
40:31 - Conclusion and where to find more information
Learn More
To discover more about Dr. Turknett's approaches to brain health through music, visit brainjo.academy. His new book "Anyone Can Play Music" is available wherever books are sold.
This blog post is based on a Bionic Health podcast interview. At Bionic Health, we believe in affordable, precision medicine for optimal health, delivered by doctors and AI working together.
