In this episode of NEJM AI Grand Rounds, hosts Raj Manrai and Andy Beam interview Dr. David Ouyang, a cardiologist and AI researcher at Cedars-Sinai Medical Center. The conversation explores Ouyang’s journey from medical training to AI research and entrepreneurship, his groundbreaking work in applying AI to cardiology imaging, and the challenges of bringing AI innovations from academia to clinical practice. Ouyang discusses his experience conducting randomized controlled trials (RCTs) for AI algorithms in echocardiography, the process of commercializing research through Y Combinator, and the hurdles in reimbursement for AI-based medical devices. The episode also delves into the future of AI in cardiology, the importance of clinician involvement in AI development, and the potential impact of large language models (LLMs) on medical practice. Ouyang shares insights on balancing clinical value with business considerations in health care AI and offers advice for researchers looking to conduct clinical trials for AI technologies.