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Choosing Technology That Works: Maximizing Practice Efficiency with David Keith
00:49:46
Are technology purchases in your practice delivering the value they promised, or are they just “white boxes in the closet”? In our latest episode of Power Hour, Eugene Shatsman talks with David Keith, a 25-year industry veteran and technology...
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- [00:00]
David Keith
Foreign.
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Eugene Schottzman
Hi, everyone. Welcome to the Power Hour, Optometry's largest and longest running show. I'm Eugene Schottzman and we've got an incredible episode for you today. If you've ever bought a piece of technology in your office, and who hasn't, this might sound super familiar to you. You get really excited because the rep or the company, they make some impressive promises and so finally you pull the trigger and somehow, a few months later, you end up having a white box that sits in a closet and drains monthly payments out of your bank account. So this is why I invited independent technology and practice flow expert David Keith to join the Power Hour while he was in Vegas in September. The episode is recorded live on the show floor, literally while practice owners are walking around and making equipment buying decisions. So I thought about this and I asked David some questions, like, for example, what are the kinds of things that he's seen that have led people to predictably waste money on equipment? Or for example, what leads to good staff buy in? Once you buy something, how do you get your staff to get as excited about it as the owners were when they made the buying decision? What kind of mistakes has he seen practices make consistently? And David tells some really interesting stories. And of course, we talk about the technology spectrum today and what should we actually be looking at and what are the real innovations like the despite what the company's marketing, for example, says. So David is an incredible resource because he has this really uncanny ability to cut through BS and explain things in a way that just makes sense. So I truly value his contribution to the show and I'm excited for you.
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Host
To hear what he has to say. But before we do that, I just.
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Eugene Schottzman
Want to remind you that the Power Hour is designed to be a resource.
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Host
For you, our listeners.
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Eugene Schottzman
So I get tremendous amount of value from the insights and the contact that I get from our listeners. So please reach out Eugene shotsman.com or, or the Power Hour website, let me know what you think of the show, today's conversation, or the topics we cover in general, or anything specific. My goal is to help you find untapped potential in your practice. So again, reach out@eugene shotsman.com and now.
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Host
Let'S go to our conversation with David Keith. David Keith, welcome to the Power Hour. Excited to have you here live in Vegas. We are in the Rev Cycle Partners booth and, well, it's kind of coincidental that we're in this booth, maybe intentional that we're in this, because in my opinion, you are the leading and really one of the most preeminent technology advisors and experts in the technology space. And I think your experience in thinking through how a practice can operate more efficiently certainly coincides with the mission of the booth that we're sitting in. But really what I want to talk to you about is how this industry is changing what we're seeing at the show. And truthfully, how can practices really think about technology in a way that ultimately, I don't know, drives the goals of the practice, rather than just buying another box that's going to sit in a closet somewhere? So, welcome to the show. Excited to have you here.
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David Keith
Thanks, Eugene. I appreciate the opportunity.
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Host
And you know, maybe let's just start with a little bit of background. You've been in the industry for a while. Maybe just talk a little bit about how the industry has evolved since you joined it and what you've seen.
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David Keith
Well, there's been a lot of changes. I've. It's been about 25 years. So I came from the computer networking space before I got into eye care. And when I first came on board in this industry, auto refractors were a new thing.
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Host
Yeah.
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David Keith
Auto lensometers.
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Host
And by the way, everybody thought that auto refractors were going to replace optometrists, right?
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David Keith
Absolutely.
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Host
So that was a hard thing to sell.
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David Keith
Yes, yes. We had a lot of pushback from doctors about the autorefractor. And of course, now you hardly ever. So I can count on one hand the number of practices I've been in the last five years that don't have an autorefractor, don't have an auto lensometer.
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Host
Right. So keep going.
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David Keith
You know, I've seen a lot of other types of automation. Everything used to be manual, everything. You used to need a doctor's level of skill to get any kind of good diagnostic testing. So now we can take. I mean, I joke, but it's almost true. I can take somebody from the drive through at the Burger King and in a week I can have him performing every test in your practice because the technology has gotten that good. We just don't need the same level of skill. We don't need the same level of knowledge to get those basic pieces of information that the doctor needs.
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Host
Well, and you know what that does is it obviously elevates the level of care that the doctor can provide.
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David Keith
Absolutely.
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Host
On the other side, it also makes the practice more efficient because the doctor is not so busy doing things that the tech can now do. And in really, in a lot of ways, you can just use that information to provide better patient care. And I think that's, you know, one of the things I wanted to talk to you about is that, you know, what are the key, if you had to kind of define the moments of technology that have really, up to this point, have helped transform patient care and help and have helped transform practice efficiency from your vantage point?
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David Keith
Well, the first thing that comes to mind when you ask that is the oct. I mean, the OCT changed everything. The OCT was not out when I got into this game. So the OCT gives doctors and then, of course, patients the confidence to do certain things that they didn't have the confidence to do before. I've got hundreds of OCT customers, and the comment that I hear over and over the most often is that, David, now I have the confidence to keep that patient in my practice because I know they're stable. When they start going downhill, I can refer them, but previously I didn't know, so I had to refer.
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Host
You know, practices are using OCTs in different ways, and some are. That's really one of the more foundational pieces of technology practice should have. But I want to highlight the point that there's certainly. It's not always ubiquitous how a practice should be using OCT in their practice with patients. They're seeing what's working, what's not working in terms of practices that, you know, bring on a piece of technology that's as universal as an oct.
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David Keith
Well, what I've seen over the past few years is the ability to use an OCT for screening purposes really elevates the level of patient care, and it also generates a lot of additional revenue for the practice. That's the key. It makes the doctor a better doctor. They have more information, they're able to see things sooner. They're able to engage the patient. So the patient is able to see several things. They're able to see where they are now. They're able to get an idea of where they could be if they're not compliant. Right. They get an idea of what's going to happen to them if they don't listen to the doctor. And then they can get an idea of where they should be if they follow the doctor's recommendations, what's possible for them from a visual standpoint.
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Host
Right. And you know, what's interesting is that if you think about imaging fees, at some point, doctors were kind of uncomfortable with it. Right. And you still hear it in some practices that, oh, you know, that it's going to cost $39. Are you sure you want to do it? As opposed to. Some practices are excellent at it and they make it mandatory and because they believe that it is necessary in providing the highest level of care. And I think obviously you're an advocate of providing the highest level of care. What would you say to practices that are struggling with justifying that fee to a patient?
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David Keith
The story that I actually saw on your podcast not too long ago is one of the most powerful messages I've seen. You're taking a nap and the guy comes and knocks on the door and he's selling pots and pans versus, and of course that's very frustrating, versus you're taking a nap. The guy comes and knocks on the door to tell you that your backyard is on fire and it's about to spread to your house.
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Host
Yeah, that's very useful.
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David Keith
We're not selling. Yes, the second guy is very useful. We're not selling pots and pans here, doctor. We're saving people.
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Host
Right.
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David Keith
And a lot of doctors still have not embraced that. They're afraid to talk about money with the patient, when in fact, this is the best money the patient's gonna spend this year.
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Host
Yeah, I think that's such an important mindset shift. And I think that's so incredible that, you know, when. When doctors do embrace that, it has a really positive impact on their practice. It has a positive impact on their ability to care for their patients. And it also has a really positive impact on patient retention too, right?
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David Keith
Absolutely. The ability. And this is another thing that's changed, the ability to show the patient the visual images. It's unusual now for me to go into a practice and not see a high definition screen on the wall where the doctor is able to show the patient their photos, able to show the patient their octs, able to get the patient involved. The recent thing that has been super impactful with a number of the practices is the high definition slit lamp imaging system. When you can show the patient what you just saw in the slit lamp, you can get them engaged. And that patient is not going to leave you for a $39 eye exam over at the mall. That patient has now become a believer in what you're able to do for them.
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Host
And, you know, that actually is a really good point because what we're doing is we're changing the patient conversation towards patient education. But it also makes it more efficient for the doctor because the doctor no longer has to try to explain in hypothetical and arbitrary things. They literally just point to the picture and say, see this thing? This is what concerns me on this, on this picture. And I think, you know, as you think about transformative technology. One of the questions I'd have for you is, you know, in addition to that slit lamp imaging, what else is out there today that every practice should have? Because it really does facilitate that level of better care.
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David Keith
What comes to mind when you say that is the visual field headset. So the visual field headset has now really become kind of a normal thing for practices. It's not just an aberration or a curiosity. And the ability of that platform to do other types of testing, that is something that we're going to see more and more of in the coming years.
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Host
You know, it's interesting because the visual field, it's a fraction of the price. The headset is a fraction of the price with versus the large white box alternatives. You also, you don't need a dark room, so it can be used anywhere in the practice. And like you're saying, you know, this whole thing of other tests that can be conducted is a big practice efficiency standpoint. So I completely agree with you. That is a piece of transformative technology that most practices can probably just put on their credit card and barely notice because those are becoming relatively inexpensive today. Right.
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David Keith
It's almost an impulse purchase. Now they're so inexpensive that the doctor sees it, they know how it's going to impact their practice and how it's going to impact their level of patient care and they just put it on credit card.
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Host
Yeah. So this, and this gets to my next question because I'm sure you've seen this before. You show up to a practice, you are the technology consultant. You show up to a practice, they open the closet and in the closet there's a bunch of stuff they bought and spent. And you know, it's just resources and frustration and a monthly payment and it's just sitting there in the closet. And these are mistakes that people are making. So how do you help practices prevent that from happening, number one? And number two is what usually leads to that in the first place?
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David Keith
Well, I'll take it in reverse order. What leads to it is the doctor getting excited about something and spending the money before they know they have the buy in from the staff. That's the key. Because the doctor is busy in the practice taking care of the patients, they're not usually managing the team. So you need to make sure that you have buy in from your staff that we've taught. You need to be a leader, but you need to make sure that everybody's on board with what we're about to do and the changes that we're about to make. Yes, I see it over and over.
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Host
So how do you get the buy in from the staff? How do you do that leadership exercise to bring the staff into the decision to do the thing to buy the piece of technology?
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David Keith
Well, the good ones are usually asking me to speak with some of their leadership in their practice and I will talk to them about what this can do for the patients. I remember in Miami, I was with, this is going to be a story. So I was with a doctor who was preparing to get an oct, be the first one. So we were there with the staff and we were testing a few patients. One of the patients had wet amd. Now I know what that looks like on an oct. This is going to be the first OCT for the doctor. He didn't know what he was looking at. So I said, doc, I need to talk to the staff for a minute about what's going on here and what we're seeing with this particular patient. Do you mind if I just take over? And he said, sure, go ahead. And I said, I explained to them what AMD is and what wet AMD is and what's about to happen to this guy and he doesn't know there's a freight train coming for him and he doesn't know. And with the doctor being able to see this because the patient has no visual complaints yet, with the doctor being able to see this and intervene earlier, we can make a big difference for this patient. And so what I was saying to the staff is if this was your grandfather, you would want them to have taken this test. So when you're talking to them out front, think about your grandfather and what kind of a difference it would make if the doctor was able to pick this up before it got too bad and everybody turned and looked at one of the girls in the room because it was her grandfather.
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Host
Oh my God. That's a very powerful story.
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David Keith
Yeah. And they're super successful now with their oct.
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Host
I imagine that's a pretty high capture rate for imaging in that practice.
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David Keith
I mean, the doctor and I kind of got lucky on that one. Right. It wasn't lucky for the grandfather, but I mean, we had such an amazing example of what kind of difference this early detection can make for somebody. And again, we're not selling pots and pans. That 39 bucks, that's the best 39 bucks that guy spent this year.
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Host
Yeah, 100%. So that's staff buy in. Right. So that's, that's one thing that prevents the technology from sitting in the closet. If they do have a bunch of technology sitting in the closet, what should they do?
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David Keith
So if they have a bunch of technology sitting in the closet, they need to reevaluate, why did they buy it in the first place? What were they hoping to accomplish and what has happened since then? Have those goals changed or did they simply fail to do what's necessary to implement it properly? In a lot of cases, the goals haven't changed. The doctor just didn't take the time and put the energy in to working with the staff to get things the way they needed to be. I actually see that a lot.
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Host
And I'm sure that you can go back and you can bring back that same energy and you can say, okay, well, let's, yes, we may have lost 3, 6, 12, 24 months of this thing sitting in the closet, but we can reinvigorate if they, if it's still right for our practice, we can reinvigorate that energy and we can get everybody's buy in and we can bring back whoever sold it to us to explain to us how it's supposed to benefit our practice. And we can figure out how this is, how this is something that we can integrate into our patient care protocols, Right?
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David Keith
Absolutely, absolutely. If you have the right sales rep, then that sales rep is happy to come back in, work with the staff and get this thing moving again.
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Host
Yeah. So when practices now this kind of takes me to the next process, which is, you know, people are here in Vegas shopping, right? People are walking around the show floor. They're evaluating technology, they're evaluating their options. You know, there's obviously limited budget for most practices, so what should practices really be considering big picture when they're shopping for technology? And how do you, how do you advise people to really think through the decision and the mindset that it takes to bring new technology into the practice?
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David Keith
It kind of goes back to what I said a minute ago. What are you trying to accomplish? That's what you need to look at first. What like Stephen Covey said, begin with the end in mind. What's it going to look like three years from now when this is working and working well? Get an idea in your mind of what that picture is and then look at whether or not you're looking at the right pieces to get you closer and closer to that. Everybody wants to make more money. That's, you know, with, with managed care, reimbursements are not going up. Right. So everybody wants to make more money. Most doctors still care about elevating the level of patient care. So it needs to ideally do Both. There's lots of shiny stuff out here. One of the things that people really need to evaluate is the longevity of the company that they're looking at.
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Host
So.
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David Keith
So there's a lot of startup companies around here on the floor. They've got really cool stuff. Most startup companies go out of business. You know it as well as I do.
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Host
Yep.
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David Keith
First five years, you need to take a look at the longevity of the company, because I can't tell you how many times I've had customers call me saying, you know, the support phone number has been disconnected. What's the new phone number?
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Host
There isn't a new phone.
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David Keith
There is no new phone number.
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Host
Yep.
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David Keith
Right.
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Host
So. And that's a really good point, is that, you know, it is exciting to partner with somebody who's doing something completely new, and at the same time, you have to look at who's backing it and, you know it. As I was talking, we're sitting in that. In the Rev Cycle booth, and I think they have a. They have a new product that they're offering. Well, that new product is completely new. They're launching it here in Vegas. But that new product is provided by a company that's been in business for a really long time. So they know how to launch a product. They know how to talk to the marketplace. Great. And I think when it comes to technology, it's probably something very, very similar. When we think about the fact that, you know, whoever is backing the new piece of technology, do they have the infrastructure, the support? Because inevitably, when you have something completely new, something's going to go wrong with it.
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David Keith
That's one of the things about technology, is that it breaks. So it's not will it break? It's when will it break? So being aware or finding out, doing the homework first to find out, does the company have a service department, or is it the salesman that you're talking to? Is he the service department?
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Host
Well, that's actually. That's a really, really good point, because I imagine this is one of the biggest mistakes that happens all the time, is you get excited and you're not really. You know, when I buy stuff, I'm not really thinking about what's going to happen when it breaks and how good is that customer service line. I'm just hoping it never breaks, which is stupid, because whenever I buy, but, you know, I'm buying technology for my house and, you know, my new TV breaks, I'll deal with it, and it's not going to disrupt the flow of everything that I'm doing that day. So how do you evaluate support upfront, outside from just asking the one question of what's the support like? Of course it's great.
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David Keith
Well, nothing beats asking your colleagues what their experience is. And, you know, the, the groups, the ods on Facebook type groups out there, a lot of times all you hear is the bad stuff. So, I mean, they, they turn into kind of bitch sessions. The, the best way to evaluate honestly if, if you can find someone who's got an independent bias that, that is not really tied into any one company, they're not being paid to, to, to sell you this product. Okay, that person, and I'm, you know, in this case, I'm thinking myself, unfortunately, but that person's got some experience looking at companies and evaluating those companies, and they won't stand behind. They won't tell you that you need to get something from something from somebody that they don't already know is going to be able to deliver.
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Host
I think that's a really good point, is that there are people who have independently made decisions to purchase things. There's also people who have independently made decisions to partner with companies like yourself. And I know that you get a lot of offers for people to say, hey, you know, partner with me or promote my product or something like that. And I've heard you say no three, three times or, I don't know, maybe 10 times more than you say yes.
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David Keith
I say no 99% of the time.
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Host
Yeah, well, and I, and I imagine that that selection criteria is something that doctors can really learn from when they're thinking about what is it that makes a technology the right technology for their office. So however you make that selection criteria, and I know you evaluate, you know, the management, you evaluate the support, you, you go deep when you evaluate how it is whether or not you should partner with the company. But, you know, again, doctors out here on the show floor, I heard you the one piece was, you know, be careful with startups, be careful with new shiny things. Another one is talk about the support or think about the support. What else?
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David Keith
It's kind of a touchy subject, but I'm going to say it. Find out who owns them. Find out if they were sold recently. Because if it's a company that now owns the company you're talking to, and their first priority is not patient care. Generally their first priority is return on the investment they made when they bought that organization. So in a lot of cases, a lot of cases, the first thing that happens is they fire everybody that knows what they're doing because they're Making too much money. Now, they weren't making too much money when the goal of the company was to provide the best possible product and the best possible service and the best possible experience for the practices. But now that they're owned by somebody else, that company's priority is return on their own investment.
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Host
So be careful is what you're saying. You need to be very careful, evaluate. And you know, by the way, don't worry about it. We love controversy on the show. And you know, I think one of the things that, one of the things that I value about you is in fact your truly independent perspective on technology. So, you know, shifting gears a little bit. Obviously technology plays a role in the office in terms of practice efficiency. We've already kind of covered that a little bit and we talked about some of the things that it can do for patient care. I have a really firm belief that technology is, it's a retention tool for patients as well. You know, when a patient walks in the door and you've got really outdated stuff that, you know, whether it's an outdated frame line, whether it's an outdated aesthetic or whether it's outdated technology, they're less likely to come back than if you've got new shiny things and you can show them pretty pictures and widescreen monitors and really high, high res imaging and things like that. I believe that there's a component of retention that happens from just having technology in the office. Would you agree?
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David Keith
Yes, I would. And it's all about how you present that to the patient.
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Host
Okay, so talk about that.
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David Keith
Well, the patient experience is everything. It really doesn't matter what's happened objectively with the quality of your exam if the patient doesn't perceive it. So the ability to present that effectively to a patient again, they're not going to leave you if you, if you do that job right, they're not going to leave you for a $39 eye exam at the mall. So anywhere from automated phoropters, that's, that has some of the biggest bang for the buck in terms of the patient wow factor. And a lot of doctors say, well, I don't need that. I'm really good at refracting. I know you're really good at refracting, doctor. It's not about whether or not you're a good refractionist, it's about what the patient is experiencing. So the ability of the, in that case, the automated phoropter to show them the old prescription and the new prescription with a click of a button, the doctor says, well, you know, I'm fast showing them the old and the new. It doesn't matter whether you're fast, it's what does the patient experience when it happens. Most of them have never seen you press a button. These are your old glasses. Press a button. These are the glasses you're going to take home today. And I've had so many doctors tell me when they get these new refraction systems. I actually used to be the number one guy in the world for selling automated refraction systems. And I've got some horror stories with that too, if we want to go down that road. But doctors will say, you know, I used to, if there was only a quarter doctor change, I would just tell the patient not to worry about it now because there's not much of a change right now. I show them the change and ask them what they want to do. They want the new prescription, they want to see better, they want it. I just wasn't, I was making decisions for the patient before. Now I'm presenting it to the patient and they're walking out more satisfied.
- [25:42]
Host
Yep. And that's a profound point to think about the experience from the perspective of the patient. Because, you know, I believe for most independent practices you are in the experience economy, you're not going to compete on price. Maybe you'll compete a little bit on selection in your optical, but not, not, you know, everybody's got a lot of Ray Ban and that kind of stuff and you know that. And sometimes patients can't really tell it apart. So you really, the key part is you have to compete on experience and technology is such a critical part of that experience. But I think the point that you make that's truly profound is that look at how the patient is using that technology from their perspective. Which then brings me to another point, which is that there are so many practices that have a robust pre testing lane and all they're doing is they're pushing the forehead or they're pushing the back of the head. Right. Okay, go ahead, look at the light. Okay, now look at this thing. Okay, now look at that thing. I believe that you're really under serving the practice if that's the, or if that's the approach that you're taking. Right. Because from the patient's perspective, they don't know what's going on. So would you, is there any special advice that you give to practices in terms of patient education when they're using the technology?
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David Keith
One of the best things I've seen, and this is, I recommend it to every customer that gets some Type of imaging device from me is put a 40 inch monitor on the wall above your desk so you're not trying to switch back and forth from your electronic medical records to show them the images. It's so cheap you can get a 55 inch 4K screen for 275 bucks. Now over at Best Buy or Walnut. Put that on the wall above your desk and show them the photos. Show them the Oct, show them the slit lamp images, give them their money's worth. Where? I mean, we're not necessarily in healthcare to put on a show, but the patient experiences everything. You mentioned the experience economy. I read a book by that name years ago and there's an example in that book. You could be sitting at the bar at the Ritz Carlton and order a Budweiser or you could be standing behind the construction workers at the 711 buying a Budweiser. It's the same beer.
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Host
Yep.
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David Keith
Completely different experience, right?
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Host
Completely.
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David Keith
We want to be at the Ritz Carlton, not at the 7:11.
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Host
Right.
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David Keith
So many patients or so many doctors do not get that distinction. They are busy inside their heads doing what doctors do and they're not thinking about how the patient is perceiving what's happening here.
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Host
Yep. And then, and I really do believe that analyzing every step of the experience from the patient's perspective and what I was getting at earlier too is that, you know, if you're just saying, okay, now look at the light during the pre testing standpoint, okay, shouldn't there be a little script or something like that that the tech should be saying to say, okay, this test checks your eyes for this. And whether you have it or not, it's really important for us to make sure that this is an important part of the eye exam. This test checks your prescription and make sure that you, that we have multiple points of multiple data points because we're a data driven practice or something like that that helps continuously evaluate, continuously drive value to the patient experience and continuously communicate that you're there. And there's a different perspective that the doctor is going to have than the doctor who is, you know, maybe. And not that there's anything wrong with our colleagues who work at Walmart, just that you have sometimes less, less technology available to you and less, less. And really you, you don't have the opportunity to differentiate in that type of space versus a private practice where you have free range to buy whatever you want to buy.
- [29:42]
David Keith
And you said not to disparage our friends at Walmart. I actually know a number of doctors who provide a fantastic Experience at the Walmart provide a fantastic experience at the Costco. But you're right, they are more limited in what they can do. If you have a private practice, you are blessed because you have a broad palette that you can create a work of art on.
- [30:04]
Host
Yeah. And I think, you know, thinking about best ways to improve the patient experience and really practice flow at the same time, because practice flow can be efficient, and patient experience can be really guided by. One of my least favorite things is going to the urgent care. I live in Cleveland. We have the Cleveland Clinic. Almost all the urgent cares are owned by the Cleveland Clinic. And I go to the urgent care. If I ever have to go to the urgent care, which I really, really, really despise doing, I get maybe five minutes of care in totality, right? My interaction with the tech or my interaction with the provider, whatever. I get five minutes of care over maybe an hour and a half worth of time. And it's the most frustrating thing to me as a patient because I think about, like, you're really disrespectful. If you could have provided five minutes of care in five minutes of time, I would be really happy. But you're providing five minutes of care, and it's, you know, spread out over an hour and a half. I'm really mad by hour and 29 minutes in. So, you know, for me, I think about patient experience through the lens of efficiency and practice flow as well. So what are the kinds of things that you're seeing as a technology consultant that help drive that practice flow and help drive practice efficiency, too?
- [31:18]
David Keith
It's funny, because when you're talking about the experience at the. At the urgent care, whoever said time heals all wounds, they've never sat in the waiting room at the doctor's office, right? So in talking about how technology can make it more efficient. So there's a thing that I don't even know if people talk about it anymore, but when I first got into the business, we talked about the linear flow, and we talked about putting the patient into the flow and explaining to them each step of the way, we're collecting data. Because at the end of that flow, they land in the doctor's exam chair, and we need to make sure the doctor is gonna have every single piece of information that they need. Because the doctor's job is to assess, to validate the data, to decide, okay, you know, we have an outlier here. I don't need to do anything with this piece of data because it's not. It doesn't fit. And to Make a recommendation for the patient and to guide the patient. So going through and using technology to kind of standardize each step along the way. And to your point, having scripted descriptions so the patient's really understanding, not being led blindly like cattle being taken down, you know, through us, through a stall. They're. They're part of the process, they're being engaged. And then when they sit down in front of the doctor and the doctor says, okay, this is what we have, this is what's going on and this is what I want to do about it, the patient feels like they're part of that team, they're part of that process instead of just somebody who's been shuffled around.
- [32:46]
Host
It's. Part of it is expectation setting. And the other part of it, I think is really getting someone in the mindset of there's a really strong process here and there's a. And I know what's happening to me and I know why it's happening. And therefore you've preset the expectation that the doctor's going to talk to me about this thing because the technology was. The technology that tested me had to do with that thing.
- [33:12]
David Keith
There's a big difference between being efficient and being efficiently effective.
- [33:17]
Host
Yeah.
- [33:17]
David Keith
And it all goes back to that patient's experience.
- [33:21]
Host
Efficiently effective versus just being efficient. That's a profound point. So, you know, maybe tell a little bit of a story in terms of other disasters that you've seen or if you've got any stories you can share with disasters where people have bought technology and it really hasn't worked out for their practice, or maybe just talk a little bit about mistakes people make without. Without necessarily thinking through every aspect. Because you've got 20 years of watching people make mistakes when getting technology.
- [33:52]
David Keith
I've seen some big ones. The first one that comes to mind when you ask that is a very large group in Sarasota, and so I'm in Florida, very large group in Sarasota spent, I would say $250,000 on refraction equipment, refraction systems. The doctors were excited about it. They thought this is going to change everything. And they purchased it and put it in the practice. They didn't talk to the staff about it, about how we're going to change our processes. They didn't talk about really. They got no buy in from anybody. They were sweet talked by another rep, not me. They were sweet talked by another rep about getting this stuff and what it would do. Spending money on technology can make a huge difference in your practice, but spending the money and dropping the Technology in it is not a silver bullet. It doesn't do it just because it's sitting there. What it does is it allows you to change your processes in ways to become efficiently effective in ways that you couldn't do without the technology. So the technology is the tool, the technology is not the end goal. And so many people think, if I buy this, it'll solve all my problems. You might not be able to solve your problems without it, but just buying it is not going to solve your problem.
- [35:15]
Host
Yeah. So to your earlier point, start with the goal in mind.
- [35:19]
David Keith
Yes.
- [35:20]
Host
If you understand the goal, you'll understand the solution. That really makes sense.
- [35:26]
David Keith
Yes. You need to think about the process that you're going to implement with the technology. It's not about the technology. It's what it allows you to do. It's about the process.
- [35:38]
Host
Okay, so we only have a few minutes left. So I want to talk a little bit about innovations and the future of healthcare technology and specifically eye care technology. What are you. We're obviously at a show. People are displaying lots of innovations. There's lots of really neat things that are. That are here on the show floor. And at the same time, there are trends, where the industry is heading. So let's talk about the trends, and then maybe let's talk about some of the specifics that you think people should be checking out.
- [36:09]
David Keith
Well, the. The biggest trend that I've seen over the past year is artificial intelligence. Of course, that and a lot of doctors, I've heard them say, well, that's just going to replace me. Kind of like the auto refractor where.
- [36:22]
Host
We started in the conversation.
- [36:24]
David Keith
Yeah, I'm not going to have a job anymore. Well, let me tell you, if all you do is refract, maybe the autofractor will replace you someday. If that's all you're here for, is to refract, maybe, you know, maybe a.
- [36:35]
Host
Machine higher and better use of your time because technology has supported you. And I think AI is, at least from what I've seen, AI is facilitating that. What have you seen?
- [36:45]
David Keith
Well, the ability of the instruments to send the images to a central location. So the interoperability between the equipment, the communication between the equipment and the electronic chart, the ability of the devices to send the information somewhere it used to just be to the doctor. And the doctor would assess that and validate it and then make recommendations. Now AI is going to be able to take those images and it's going to be able to provide even a higher level of information to the doctor. If there's correlations, it's going to see them. If there's relationships there, it's going to see them. AI is not, at least at this point, and I don't expect it to happen anytime soon. AI is not going to be able to establish causality. It's simply going to tell you these are the things that are correlated to the data. And then the doctor is going to be able to operate at that much higher level by looking at those possibilities and deciding which one is real and talking to the patient about, here's what we're going to do. Again, we're talking to the patient about, where are you now? Where could you be if you don't follow my recommendations and where should you be? If you're going to get on board with this and do what I'm recommending as a doctor, then you can have what you should have in terms of visual health, in terms of visual quality.
- [38:02]
Host
You know, it's interesting that, and you made this point earlier, and I just want to come back to it for just one second. Is that being able to show the patient the untreated disease state versus the treated disease state, I think that's so powerful and I don't know, is there a lot of technology that's kind of heading in that direction to kind of to be able to do the patient education in a more effective way? The show me what's going to happen if I don't take action and show me what's going to happen if I do take action.
- [38:30]
David Keith
Yes. And I'm thinking about wavefront devices because wavefront devices have the ability to feed that data to show the patient what's going to happen in a progressive way. Here's, you know, here's where you are now. Here's where you're going to be in a year. Here's where you're going to be in five years. So absolutely, that that exists.
- [38:50]
Host
So your, your take is that AI is going to drive correlation information to the, to the od. OD is going to have more information to make a good decision, make a good recommendation to show stuff, stuff to the patient.
- [39:03]
David Keith
Yes. In the future, it's not going to be the doctor or the AI. It's going to be doctors who've chosen to embrace AI and doctors who have not chosen to do that. And the doctors who have not chosen to do that are going to be sorry.
- [39:17]
Host
Yeah. And I, I, and I agree. I think that we're past the point of early adopter. I think we're at a point where we have to Be thinking about that. You know, it's kind of like you're buying a house and yes, you're going to make improvements to it later, but you got to buy the right house with the right, with the right number of bedrooms and the right number of square feet. Because yes, it will, you know, over time you can remodel and you can upgrade, but it's really hard to make a five bedroom house out of a one bedroom shack. And so I think having the platform is kind of a key part of making a technology decision today.
- [39:54]
David Keith
And one of the things you asked a question earlier about walking around on the floor, there's a lot of really cool looking shiny stuff here on the floor. It's very exciting to look at. But remember that the shiny stuff is not always the good quality stuff. And when I think about something as simple as, like you mentioned, home improvements, when I go to Home Depot to buy a hammer, I buy the $2 hammer because I don't swing that hammer very much. Right. I'm just not that, that kind of guy. Somebody who swings that hammer a thousand times a day buys the $200 hammer. So think about what you need. If you're gonna swing that things a thousand times a day. You might be, it might be cheaper for you to buy the $200 hammer.
- [40:43]
Host
Than to keep buying the $2 hammer over and over again and then not.
- [40:47]
David Keith
Getting the job done.
- [40:48]
Host
Right, exactly right.
- [40:49]
David Keith
So think about that. And there are people like myself, the $2 hammer is going to be fine. Okay. I would be wasting money on the $200 hammer. But if it's something that's going to become mission critical in your practice, probably ought to strongly consider the $200 hammer.
- [41:07]
Host
Yeah. And I heard you say the idea of, you know, talking to colleagues and having conversations with people who have done, who's experienced what you're about to go through before. What are the kinds of questions people should be asking their colleagues when they're evaluating technology?
- [41:25]
David Keith
What were you thinking when you bought it? What were you hoping to achieve? Then what happened? How did it really go? What caused it to be different between the dream you had in the beginning and the reality of it a year later, three years later, five years later? Is it the technology that didn't do what it was supposed to do or did you not take the steps in your practice to implement it properly? Sometimes it's the technology you just brought the bought the wrong thing. A lot of times it's not the technology's fault. You did buy the right thing. You just didn't use it.
- [42:05]
Host
Yep. Or you didn't. To your earlier point, which I think is so important, is you didn't get the office buy in, you didn't get the team engaged. And all of a sudden you're the only person who is having to do the heavy lifting and try to get this thing integrated. Whereas it could have been much easier because you could have gotten the whole team engaged and you could have used a consultant or gotten support from somebody to help you get that team engaged.
- [42:31]
David Keith
Well, that's going back to that. And I never finished talking about the horror story in Sarasota.
- [42:35]
Host
Oh, yeah, please.
- [42:35]
David Keith
But the, you know, they spent $250,000 on that stuff. And when they put it in, the staff said, we're not going to use that. And the doctors are too busy. Not too busy, but the doctors are busy seeing patients. They're not focused on what we need to do to get the staff on board with this decision. They just come back, you know, the truck pulls up, the sales rep comes in, says, congratulations, and the doctor starts seeing the patients and the staff hates it. They didn't talk about, here's what we're doing, here's why we want to accomplish it. This is the direction we're going, and we need everybody to be on board. And if you're not on board, we need to talk about it now because there's other opportunities out there for you if you're not on board with the direction we're going.
- [43:22]
Host
Well, and I think this is where in today's environment where it's harder to hire people, it's harder to retain people, I think that might be the pushback you get, right? If you're not, if you bring on a piece of technology and the staff says, nah, we're not going to use this now. This is, you know, the doctor's not really going to fire someone because you know that then they got to train someone. They've got to go through the process of, you know, reskilling someone while that person's fired. You know, your other two people in the practice who are doing the same job are going to have to work twice as hard and then they're going to quit because. Because they're now overwhelmed and frustrated. So it seems to me like it's unlikely that anybody's gonna fire someone over a piece of technology. But the easy solution to your point is why not just get their buy in in the first place? Why not get them to say, hey, that would be super helpful. That would be a really good idea. In our practice or at least have the conversation of why it wouldn't be.
- [44:17]
David Keith
Absolutely. And one of the great things that I've seen in the trends in the technology is that because things are getting easier and easier to use, the level of automation is increasing. Doctors are able to make hiring decisions or retaining decisions based on the people skills of the staff member, not based on the technology, not based on their technical skills. So in the old days, doctors would be held hostage by people that knew how to refract. Doctors would be held hostage by. In the old days you had to have an ophthalmic photographer to get a good picture. Right. You don't need that anymore. You've probably seen the video of my 6 year old little girl pressing the button on the camera and getting great Images because my 6 year old can do it. Your staff can do it. Sometimes even the doctor can do it.
- [45:03]
Host
Yep. Sophia looked great doing that by the way. She's ready. She's ready to go.
- [45:09]
David Keith
If anybody's looking for a great tech, she's a star. She's 10 now and we're getting ready to enroll her in optometry school.
- [45:15]
Host
Yeah, exactly. Perfect. So my, I guess final thoughts. David, as people think about the vast world of technology that's available to them, as people think of a vast number of solutions that are available to them today, let's summarize some of the things we've talked about. Get your staff buy in, consider the source. Right. Too new is might not be good. If the company's gone through major transitions recently, that may be something to look at more closely. What else should we be really as take home big takeaway points. When people are thinking about spending money and, you know, hard earned money on a piece of technology.
- [45:57]
David Keith
It goes back to the same message we started with. Begin with the end in mind.
- [46:02]
Host
Yeah.
- [46:03]
David Keith
Think about if we were sitting here three years from now having the same conversation. What needed to have happened over those three years? Right. What needed to have happened over those three years for you to be satisfied with the way it went? If you have a clear picture of what that end result looks like, it's fairly easy to chart the course. But if you never decided where you want to end up, you're not going to be able to get there.
- [46:30]
Host
Yeah. Well said, David. And thank you so much again for joining us today on the Power Hour. It's such an honor to have you on the show and quite frankly, I think your insights and the value that you bring to the industry every single day is so impressive. So thank you for being here today.
- [46:44]
David Keith
You're welcome. Thank you for having me. And I have to say the same for you. I have really enjoyed watching your podcasts and the value that you bring to doctors. I don't think they're able to get it anywhere else. I think you're providing a very unique service and I've been telling my doctors that they need to pay attention to what you say because your insights and your wisdom, I just don't see it anywhere else. Thank you for what you're doing.
- [47:08]
Host
Thank you. It's my pleasure having a lot of fun and I think that part of it is taking a lot of feedback from the industry and saying, what do you want to hear? And that's my plug for you all today, is that please, please, please provide feedback. I want to hear from you because I think guests like David, other guests we've had on the show, these are people who take their time to bring real value and I want to hear your feedback. I want to make sure this is having the right impact on your practice. I'm always available to hear that. So David will post some links in the show, in the show notes with some of the resources. Thank you so again for being on the on the show today and grateful that you were able to make the time today during this super busy live show at Vision Expo West.
- [47:48]
David Keith
Thank you, sir. It's been fun.
- [47:49]
Unknown
If you're enjoying the Power Hour, you might be asking yourself, what can I do today in my practice that's going to make an impact? So over the years, the practice coaches and consultants at the Power Practice have helped thousands of practices improve. And they often start with one thing, and that's a proprietary methodology called the Practice Profitability audit. For about $2,400, they look at all of your practice numbers and they stack them up against where a practice of your size could and should be. It takes about a week for them to do and because they're so experienced, they know what your potential looks like and they're often able to take that $2,400, multiply it several times over and hand it right back to you in found profits in your practice in months, not years in months.
- [48:31]
Host
But you get to keep the much.
- [48:33]
Unknown
More profitable practice for years afterwards. But here's the best news. I'm going to tell you how you can have the practice Profitability audit completely free. See, we're really trying to get people onto the show website, which is, by the way, power practice.com and then you click the Power Hour podcast button. The reason we want you there is because I want the audience participation, I want to hear your feedback, and I want to know how to make the show better for you so you can interact with us, send us your feedback, offer your suggestions, and for a limited time, when you go there, you can also request a practice profitability audit for free. Right? We're going to cover 100% of the cost, but only for five people per month. And five people per month is all we really have capacity for, because this is a resource intensive audit and the practice power practice coaches are generally busy serving their clients, but for five people a month, they've agreed to cover 100% of the cost.
- [49:24]
Host
So it's totally free to you.
- [49:26]
Unknown
So again, take action immediately in your practice. Go to powerpractice.com click on the power Hour podcast, interact with us, but also request a practice profitability audit today.