- Because in healthcare, the standard is perfection (or, “you’re only as good as your last patient“). In other words, healthcare has little tolerance for the “minimum viable product“ ethos of Silicon Valley.
- Because Electronic Medical Records (EMR) are “good enough“ for clinicians. We are still navigating through a 30-year change cycle away from paper records (you can still see paper records in physician offices where margins are still fat and regulatory burden is low, eg: dermatology and ophthalmology practices in Florida).
- Because physicians and doctors of physical therapy are adverse to change. Even though the EMR computer keyboard is an inefficient and time-consuming method of data entry, the benefits of a computer database of patient information outweigh the cost of transitioning away from handwritten, paper notes.
However, everyone remembers the painful EMR transition and the benefits of computer vision are still not clear to a new generation of clinicians. - Because accounting profits from electronic medical records do not require abandoning the computer keyboard:
- Read Clayton Christianson’s Disruptive Innovation to understand why technological change almost never comes from industry incumbents (eg: disk drive companies did not create revolutionary new products. Their products were incremental improvements over their old product).
- Read Clayton Christianson’s Disruptive Innovation to understand why technological change almost never comes from industry incumbents (eg: disk drive companies did not create revolutionary new products. Their products were incremental improvements over their old product).
- Because clinicians are not innovators. Everyone is busy. Productivity demands on clinicians have never been higher. So, there is little time or energy for the type of ‘blue sky’ thinking that innovation demands.
It’s not that clinicians can’t innovate – it’s that the conditions in the clinical environment don’t incentivize innovation (see #4).
Also, the medical professions attract a certain type of student.- Both medical school and physical therapy school encourage rote memorization and following established protocols.
- Finally, a culture of “naming, blaming and shaming” dominates the medical-legal space and encourages defensive documentation, over-prescribing of medical tests and a cautious approach. Once clinicians graduate, professional malpractice concerns reinforce a low-risk, “do not question authority” practice pattern.
- Because healthcare is a bureaucracy where 98% of your revenues come from Medicare & commercial insurance policies. Why rock the boat? Change is more likely to impair your existing cash flow rather than add revenues. In bureaucracies, risk-taking is not viewed with the same perspective as in entrepreneurial ‘open markets’.
- Because the new technology may invoke regulatory barriers, such as HIPAA. See Answer #6 (above). In a bureaucracy, HIPAA is someone’s job. Therefore, if your new tech or device triggers a HIPAA concern, this person becomes a decision-maker and your sales process needs to clear their desk before you can make the sale.
- Because the End User is not the Customer. Again, this challenge has already been solved by EMR companies (see #2), but only after decades of struggle and billions of dollars of implementation costs. Furthermore, the “scorched earth“ dynamic created by EMR companies has left clinicians justifiably skeptical of claims by new technology vendors.
- Because Computer Vision is hard
VisualPT.ai will be the first computer vision technology in the outpatient vestibular space (to my knowledge) that also uses artificial intelligence to recognize risky gait patterns in patients who will fall but have not yet fallen down.
Going first is hard.
Pioneers often end up, not with the gold rush, but with arrows in their backs.
The good news is that there is competition and there is a market for technology-driven fall risk detection and measurement in physical therapy.