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The 229 Podcast: The Golden Retriever Problem - AI Agents That Won't Stop Digging with Drex DeFord

Bill Russell: My name is Bill Russell. I'm a former health system, CIO, and creator of this Week Health, where our mission is to transform healthcare one connection at a time. Welcome to the 2 29 Podcast where we continue the conversations happening at our events with the leaders who are shaping healthcare.

Let's jump into today's conversation.

All right, it's the 2 29 podcast, and today I'm joined by Drexel Ford. None other than Drexel Ford.

Drexel's been a long time since it was just you and I doing a, uh, in fact, I'd have to go back to your, uh, CrowdStrike days, I think.

Bill Russell: what we're gonna do on the 2 29 podcast, we're gonna talk a little bit about ai. I'm getting a lot of. Uh, feedback questions, uh, on how things are progressing, how people are thinking about things. So I thought it would be fun to just have you and I talk about it and I, you know, we were just looking at the news for this week.

OpenAI hires Open Claw founder, they're gonna transition open claw to an independent foundation. And it's gonna stay open source. And, uh, and Sam Altman's saying essentially this is gonna become core to open ai.

Drex DeFord | This Week Health: you've dug into this a bit. Uh, this idea of, I, I think my first assumption when I read it was that, oh my God, they're gonna make open claw part of open ai, but it's really the kind of operating.

Bill Russell: it's the, it is the concepts. Yeah.

Drex DeFord | This Week Health: that they're gonna So talk, talk a little bit about that. 'cause

Bill Russell: So what's what's interesting about that is Open Claw has the, the, uh, appearance of being something that is alive.

Bill Russell: always working, working on your behalf. You've started on something and it'll keep working it until it works the problem to death. Uh, even if it finds an answer, it will circle back and find a better answer and then find a better answer than that.

Um, and it's interesting because I, I mean the, the founder, he is brilliant by the way. I, because I, what I did is I. I took the, uh, the platform, I ran it through AI and I said, what makes this thing tick? Like, why is it, why is it as interesting as it is? Because it has, and you've talked about this, it has a bajillion people using it, and it's a massive security problem

Drex DeFord | This Week Health: Oh yeah.

Bill Russell: because you, you give it access to your file system, give it access to your web browser, give it access to your, essentially you're giving it access to your passwords, your keys, you know.

Drex DeFord | This Week Health: you're just, and you're telling it, just keep hacking me. Just keep hacking me.

It's gonna be wide, widely accepted. Uh, it's just gonna take a little time for us to figure out how to put the controls around it and whatnot. But, uh, so open call, very fascinating. So the things that make it. Uh, special. First of all, you have a sole MD file. Uh, MD is, uh, is a markdown file. It's like your doc, uh, doc X or your XLSX.

It's a markdown file, so your sole file is you tell it like, when in doubt, come back to the sole and never violate what's what we've told you in the sole. And this is where you tell us like, this is who you are as a person. This is who you are as an agent. You know, never do this, do this, whatever, this, these are the fundamental, um, things that, that, uh, grounded, I guess is the way to say it.

Every 30 minutes, it does something. And the magic is in what they do every 30 minutes or an hour, that kinda stuff. It just, it, it keeps working. And it keeps, it keeps firing stuff off. And then there, the last concept on, on that is heartbeats a heartbeat. Fires off every. Uh, 15 minutes and it's like, Hey, am I working on something?

And if I'm not working on something, should I be working on something? Is there something I've been asked to do yesterday that maybe I haven't gotten to that I should be? It's, it's a really fascinating thing. It's a combination of, of, you know, constantly waking it up to say, Hey, should you be working on something?

Think of your hard drive and you're saving all these files. It has, um, it, and it can go back and say, what, what were we talking about on September 12th, 2025?

Drex DeFord | This Week Health: It's, it's interesting to think about how all this sort of fits together then, because, Even doing Theron jobs or even doing the heartbeat jobs, thinking about a conversation that we may have had that I may have had with my, um, with my agent six months ago about something that was similar. And it's, it's saying, oh, well he asked this question last time about something that's similar to this.

Maybe I should go ahead and just work that angle because eventually Bill's gonna ask me about it.

Then it'll find APIs out on the internet. Then it will, it'll create things on your computer and you're like, whoa, I didn't ask you to do that. It's like, yeah, but. You know, this this is the best way to do this. I I It's like a golden retriever It's like, Hey, I, retrieved this. yeah, but that's supposed to be in the ground.

Don't dig up flowers. Like, leave it there. It's like, uh,

Drex DeFord | This Week Health: It's interesting too because with ClawdBot you know, you have this ability, your agent can go to that social media site for other

Bill Russell: Yeah, and so agents working with agents, and so this is gonna be the thing in healthcare, right? So agents are going to become a thing we're already seeing. Uh, uh, epic has launched their agent factory. Uh, you have agents in, uh, in, uh, Workday. You have agents in, uh, uh, ServiceNow. they're gonna be in everything, right?

Pricing.

Drex DeFord | This Week Health: It's interesting that people think they only have 10 or 15 agents, and when they actually go out and look, they have a hundred agents. I was talking to somebody about this the other day, and a lot of that is because of these things that you're talking about. wasn't an agent in. Application X when I deployed it originally, but through upgrades now there are agents there that are doing things, so,

Bill Russell: there are tools now that will find all that stuff. Right.

Drex DeFord | This Week Health: yep. Yep. I mean, in, in theory, I mean, you know, I think it's early days, you know, does it sweep them all up? Does it catch all of them? Uh, you know, how, how does this stuff work? But yep, there, there's folks that are getting there.

Drex DeFord | This Week Health: Yeah,

Bill Russell: We, hi.

Drex DeFord | This Week Health: from a, from an identity perspective too, right? We have. Human identities. We have non-human identities. Usually we mean that as things like medical equipment or service accounts that do particular actions for us. Those have been there for a while. Agents are kind of also now moving into this of like, do all those agents have identities?

Are we tracking what they actually have access to and don't have access to? Are we managing that? are we. them off. Like at some point they, we don't need this employee anymore. Are we turning it off or removing its access? So

Bill Russell: Yes,

Drex DeFord | This Week Health: really a big

So we can go back and say, Drex, you, do you know how to use the system? Yeah, it's, and, and obviously in the EHR we have that, uh, you know, pretty much pervasive across the EHR and, and most modern database. Architects will use that kind of methodology, uh, across the board. Well, we need the same thing for agents.

Agents are doing things on our behalf, but I don't want it to log on my behalf. I want it to log. Agent X did y so if you think about hiring an employee. It starts doing the wrong thing. You can go back and, and look at it's training. It's um, it's uh, programming's is programming the right word anyway.

It's, it's prompts, it's

Drex DeFord | This Week Health: go back to the sole issue. You go back to the, you know, depending on the agent and how it's constructed, it has a, it has a fundamental set of instructions. Do these things, don't do this. So.

And just this past week we put, um, we put AI agents on top of it that you can ask it questions. And it, and it scours the database and comes back with answers on, hey, you know, uh, has Drex Ford been on the show? How many times has he been on the show? What did we talk about the last time he was on the show?

Um, that kind of stuff. Uh, or, you know, has Drex come to an event like, I just saw that stuff is in there, but here's what the difference is. That's still prompt response. Prompt response agents are gonna be more along the lines of, and this is where the power comes in. Um, hey, once a week or once a day, go through all this stuff and send me, send me an email as the business owner and tell me, Hey, here are some things that you might wanna know about.

I'm doing this work for you. And in a lot of cases, that's work that wasn't being done. It's not like you're replacing somebody. It's like, it's the work we've always known that we wanted to do. Uh, analyze our invites, analyze our, uh, you know, uh, our guests on the show and that kind of stuff. And it's coming back and it's making recommendations, uh, in, in order to move that forward.

When you think about healthcare, that that's, people always go to the clinical side. And I wouldn't, I would stay on the, uh, on the operation side and the business operation side. 'cause it's, we're already doing this somewhat. When somebody cancels an appointment, it goes, Hey, here are the next three people that could, now that's just basic algorithms, but it's gonna be, become much more sophisticated in

Drex DeFord | This Week Health: Mm-hmm. Mm-hmm.

And it'll, it, it can do that analysis without a person going into the keyboard and say, Hey. We had, uh, we had 125 cancellations yesterday across the entire system. We filled 105 of them. Uh, the 25 we didn't fill. Had these characteristics perhaps were not, you know, doing our scheduling right and that kinda stuff.

Bill Russell: We're gonna have, we're gonna have an explosion of agents this year. I wanna talk to you about network operations. 'cause this is one of those areas that as I was playing around with it, with the stuff that we're creating, I thought if I were a CIO today, I have a million tools. It's collecting all these things.

And it was, uh, it was a situation where I remember a couple of conversations I had as CIO people came to me and said, Hey, we can't possibly. Review all these log files and all this stuff and, um, I know that there are tools now that do those things, but there's part of me that's thinking in, in, in two directions.

I might even write an article about it on Tuesday. Um, and the, guy talks about software pricing and why he was bullish and it was a VC guy and why they're investing in these companies around software. And he said, you know, the model is going to morph over the next year or so where we're not just paying for the software.

Or even the value of the software you're gonna pay for the value it creates from the work that it's doing. And I, I thought about that for a minute. I'm like, so is, he saying essentially he wants to get paid for the labor essentially that is being replaced by the work that's being done. And I, I reviewed the video a couple times.

Drex DeFord | This Week Health: Yeah, there's, there's two things, right? So am I driving more? The capability of you getting more revenue or am I driving cost cutting in your organization? And if I could get paid as a percentage of what I contributed to that mission, either one or two, um, that's weird, but. cool to think about how to do that.

When I was an independent consultant in the beginning, I charged by the hour or I would price projects by the hour and because I just hated the

Bill Russell: Shame on you.

Bill Russell: The word you're looking for is experienced.

Bill Russell: Well, but it, it, I'm gonna come back to this, uh, network operations thing. 'cause here's my. Experience. I sit down now with Claude Code, and by the way, I can fire up three, four instances of Claude Code, have it working on different repositories, doing different things, and um, uh, and, and by I'm not even using the AG agentic.

Version of this, I'm, it's still me prompting it and it's doing things, but I find it works longer like I used to say. So like, Hey, code this thing, it would make the change, it would come back. I put it out there, I'd test it and I'd come back. Um, but now where it is, is I say, Hey, make this change. It, it makes the change.

It goes out there, then it goes, Hey, let me check the change. It goes out there and takes control of the browser, looks at it, does some things, comes back and says, I don't really like the way this looks, and it does some more things. And it, it's almost that, that open cloth thing we were talking about where it is like, Hey, I'm not done with this problem.

Drex DeFord | This Week Health: moving at light speed. It just

Bill Russell: they are.

Drex DeFord | This Week Health: slow to us because instead of just executing your prompt and giving you an answer, it's actually, 'cause I have the same experience. Like the more I use it, the more I. Prompt it to, you know, I get answers back and I'm like, no, wait. We need to make sure that we double check this and double check this.

And now it goes out and it takes a minute to gimme my answer, but when I get my answer, it's like, that's a good, that's a good reply.

Bill Russell: I, I am, I'm thinking though. Because I've started now using, uh, I don't, I don't prompt Claude anymore. I prompt Claude code even for things like, Hey, let's take a look at this document. Let's, you know, let's, uh, look at the findings and that kinda stuff. 'cause Claude Code has more agentic kind of things. And obviously they came up with, uh, uh, Claude, uh, cowork.

Drex DeFord | This Week Health: Cowork. Yeah.

But I'm, I'm, I'm looking at that going, um, on, on the, I, I'm, I'm concerned about the pricing of software. Too much of our budgets now in healthcare, it have become fixed. And every year it's, you know, 60% now, 70% now. And it feels more and more like CIOs are like, Hey, I don't have any discretionary income.

Drex DeFord | This Week Health: Hmm. Yeah.

Bill Russell: And they trace it to, a lot of 'em, trace it to, well, you know, our, our budgets are tight and that kinda stuff.

I'm like, I don't think that's the case. I think what's happening is more and more of your, your software budgets are fixed and it's like, well, you're gonna spend this much for Microsoft, this much for Epic, this much for ServiceNow, this much for, you know, whatever it happens to be. And that becomes fixed and that becomes a larger percentage every year.

And, uh, and quite frankly could be as effective and we could, , continue to iterate on top of it. And I think historically we have been unwilling to do that because we're like, man, I can't hire a coding team, can't hire a development team, can't hire this.

Drex DeFord | This Week Health: Yeah.

Bill Russell: I, I just took a product manager. And put him into our coding team.

I took a, a, uh, graphic designer and moved him into our coding team. And you wonder why, because you don't need to know how to code.

It's how I think and it's how I work. This idea of like build versus buy is really interesting 'cause the tech is there now or it's almost there for a lot of people.

Bill Russell: Yeah. And I think we're gonna see doctors coming to us saying, Hey, can I have the APIs for blah, blah, blah? And we're gonna be like, whoa. How, how did, how did, when did we start this conversation? Um. And I, and I had a, a breakfast with Alistair, uh, Erskine, who's up at, uh, at, uh, Highmark Health, and he said, you know, bill, I realized we didn't have a good, um, a, a good system for project intake for our governance process.

He goes, so I coded it up over the weekend. He goes, it's now in place. This is a 20 $20 billion entity.

Drex DeFord | This Week Health: Right.

Bill Russell: and he just, he rolled it out. 'cause he is just like, yeah, you know, I coded up, I tested it. And he goes, it's not mission critical per se. I mean the, but it,

Bill Russell: I think.

Drex DeFord | This Week Health: just, I just want the piece that I want right now.

Bill Russell: Well, the other thing I hear people say, they'll, they'll say, ServiceNow, I love ServiceNow. It's great. It's fantastic. Oh, we use that for intake, we use that for prioritization, whatever. And now I'll talk to EM'S like, yeah, we don't have enough ServiceNow people. We can't customize it to do the things we wanna do.

And I'm sitting there going, I think they're having that experience and people that build with like actually cloud code and stuff, and they go, oh, it doesn't have a feature. Hey, what would it take to do this feature? Oh, duh duh duh duh. Would you like me to code it? Yes. Did. Okay. Would you like me to deploy it?

Drex DeFord | This Week Health: be. Yeah,

Bill Russell: Drex, I appreciate you doing this and, uh, look forward to our next conversation.

Thanks, man.

Drex DeFord | This Week Health: I'll see you soon.

Bill Russell: Thanks for listening to the 2 29 podcast. The best conversations don't end when the event does. They continue here with our community of healthcare leaders. Join us by subscribing at this week health.com/subscribe.

If you have a conversation, that's too good not to share. Reach out. Also, check out our events on the 2 29 project.com website. Share this episode with a peer. It's how we grow our network, increase our collective knowledge and transform healthcare together. Thanks for listening. That's all for now.