Eliminating Documentation Headaches With Jake Michalski Of Comprehend PT

Paperwork got you down? In this episode of the Physical Therapy Owners Club podcast, Nathan Shields interviews Jake Michalski, the creator of Comprehend PT. They explore how artificial intelligence (AI) is revolutionizing the documentation process for physical therapists, especially if you’re struggling with excessive paperwork. Don’t miss the valuable insights that Jake has to offer.

Nathan and Jake further discuss how AI will change the future of Physical Therapy, his insight on the PT industry as a whole, and how the creation of his company is similar to physical therapy entrepreneurs, with the same headaches for growth, structure, and marketing.

Ready to reclaim your time and focus more on patient care than paperwork? Dive into this episode and see how AI can transform your practice. ​

Want to talk about improving your PT business, or have a burning question? Book a call with Nathan – https://calendly.com/ptoclub/discoverycall.

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Welcome to the show. I’ve got a good friend and a business associate who I’m really excited to introduce to the PT world. If you haven’t met him already, his name is Jake Michalski, Founder and CEO of Comprehend PT , an AI company that is helping physical therapists overcome the biggest issue that physical therapists have. It’s the biggest headache. It is always ranked number 1 or number 2 on any survey as to the biggest problem related to physical therapy outside of reimbursements. That is documentation. It’s a pain in the butt. It takes so much time. Jake is leveraging AI to tackle that.

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First of all, thanks for joining me, Jake. I appreciate it.

Thanks for having me on. I am super excited to be here. I am super excited to talk about what we’re doing but also the more broad PT industry as a whole, how hopefully things are changing, and documentation, the burden that it is is going to be diminished soon.

That would be such a relief. At the forefront, Jake has asked me to be part of, what do you call me? Not a board of directors, but a board of advisors or something like that?

Advisors, yeah.

An advisor to his company.

You’re on my advisor board for the company.

He reached out to me a few months ago in late 2023 and picked my brain. He asked if I had any guidance for them. A few months ago, you didn’t even have anybody using your product. Now, you’ve got a number of people using the product, getting feedback, making quick changes, and all that new company startup stuff, right?

Yes. It’s fun to still be responsive to our users, There are a lot of big conglomerates out there. As you grow, it’s a lot harder to be responsive to users. We’re still in a phase where every time we have customer support, I’m happy about it. I’m excited to hear what people have to say. I’m excited to make a change because you’re helping me make it better. We’re still nimble enough where all the feedback matters.

That’s cool. Tell me a little bit about what your observations are since you are in the PT space. Correct me if I’m wrong. You come from the tech world. We can get into your story a little bit later. As you’ve changed from the tech world to see what’s happening in the physical therapy space, what are your initial ideas and thoughts about the physical therapy industry as a whole?

My initial observation is that the PT industry is pretty behind. I look at some of the software out there, like the WebPT and other EMRs that are mainstream. They look like they were made in the ‘90s at times. WebPT has its SOAP 2.0, which is slick, but a lot of people are still using SOAP 1.0, which looks like it’s from the ‘90s.

Even other software and other things that we’re seeing, chiropractors are like the same. They’re using outdated software that works for them. That’s really cool, but they don’t get to take part in the next wave of evolution. Some of these software are still hosted. This is broader medical as well. They’re hosted on-site. They’re not using the Cloud. They’re using old machines that are slow. They’re not all that user-friendly.

It’s fun because that’s a huge opportunity for us to make things better. For instance, surgeons are potentially using Epic. Epic is a more advanced EHR that has a streamlined UI that is on the bleeding edge whereas a lot of what we’re seeing in the PT space is a lot of the EMRs are behind. There’s a lot of room for renovation growth, which is where we come in.

Why do you think that? Why are we so behind? I’ve said for the past few years that PT is behind a decade or two. It’s like, “Why are we so behind? What is it? Is there not enough money in the industry? Do we not care as providers for that stuff?”

I have a few opinions on this that all stem from insurance reimbursement. In my head, if insurance was reimbursing more, then you’d see PT spending more to optimize their time to have better sell. If you could spend $1,000 a month on an EMR, you’d have a pretty good EMR, but because insurance reimbursement isn’t high enough, you don’t have the margin to spend $1,000 per user on an EMR.

It all trickles down from that. That’s the core problem, but there are a few different things at play. PTs are content with what they have, but it’s because they don’t know what’s out there and what they could have. There isn’t room in the EMR space to be bleeding edge and do all this fun stuff because AI engineers are super expensive and whatnot. There are a lot of things at play, but it all stems from insurance reimbursement being too low.

Physical therapists, as a whole from what I’ve seen, don’t like change a lot. They’re not the most tech-savvy, have you found?

Yeah. The people are wildly friendly and super charismatic. I love having conversations with them. They’re great people as a whole, but they want to treat people. That’s what I found. They want to help people get better. They went into PT not for the money, not for anything in particular. They went into PT to help people get better. That is a very altruistic goal.

Sometimes, you see a doctor. Did you become a doctor because you want to help people get better or did you do it to make money? What we’re overseeing is PTs getting into PT to help people get better. That’s what they want to do. They don’t want to waste time fumbling through their EMR. They don’t want to waste time learning a new tool that may or may not help them become more efficient. They’ve been burned in the past, so they’re focused on their patient and on helping people get better, and they’re amazingly good at it.

There are so many technical questions where I’m not illiterate, but I can’t speak at the same level as our doctor of physical therapy on staff. Chris, my cousin, is a doctor of physical therapy. He’s the guy that can speak the lingo and know what’s going on. That’s not my avenue. I’m here to help you become more efficient with AI. Chris comes in and he helps me understand what people mean by that. As resistant to change as people might be and as not tech-savvy as PTs might be, everyone is super friendly, but it’s because they want to help people get better. That’s what we’ve observed.

The beauty of your product is that it not only solves that headache, but in solving that headache of documentation and doing so in a compliant manner, it gives physical therapists more time to treat and focus on the patient versus focusing on their documentation. That’s the beauty of leveraging new technology. As we introduce it and use it more and more, it should get cheaper over time, but also, we get used to using it and make it more efficient. That’s what really excites me about your product. Not only does it solve a headache for most physical therapists, but it also is going to make their time more efficient.

100%. Let them do more of what they love and then less of what they don’t. I see a world one day where it’s, “Let me see my patient all day, and then I go home at the end of the day.” That’s it. All of the overhead is taken care of. Maybe it’s a little mic that you wear throughout the whole day that’s listening the whole time. If that’s what it takes so you can treat all day and you don’t have to ever lift a finger on a computer and type a word on a computer for work, that’s where we want to get to. We’re going to get you as close to it as we can with our technology.

I am at fault because I don’t think we really explained what exactly your product does. We’re 5, 10, or 15 minutes into this and I haven’t even explained what you do. Quickly, how are you leveraging AI to solve the documentation headache?

The quick version is you whip out your phone, your iPad, or your laptop, you click Record in our software, and we listen to your visit. After the visit, you hit our Comprehend button and we generate a note. A normal SOAP note is easy. We can do ICD-10. We can do differential diagnosis. We can recommend billing codes. We can do all that in our software.

Where it really gets cool is we integrate with EMRs as well. We’re able to look at your EMR and see what fields need to be filled in. You click a single button and, all of a sudden, your note’s done in your EMR. All you have to do is read it over, make sure it’s right, and make sure you agree, and hit submit. Whereas in the past, you’re spending hours in your EMR, typing all this stuff. We think it’s a huge value add.

You’re leveraging AI for it. I tried Dragon Software many years ago. It worked okay, but I had to then cut and paste or maybe I sent off my mini cassette recording of my transcriptions or dictations over to someone to to transcribe it, type it out, and get it back to me three days later. Whereas using AI to record an initial evaluation or even record a dictated note and then integrate into the EMRs to the SOAP as well as with the goals, the measurements, and that kind of stuff, all filled in for you, right?

Exactly right. Dragon is one of our competitors. It’s the idea, “I can do speech-to-text.” What we found in initial testing was that it is not very accurate. They have the power mic. They’ll do speech-to-text, but they don’t have the context of physical therapy. They have general medicine, and it’s riddled with errors. If you’re going in and fixing those errors, it’s almost as time-consuming as if I would’ve typed to myself. If you don’t read over the errors, all of a sudden, you’re already going to a note that’s full of issues.

I have some clients who get notes from doctors that are riddled with errors. It’s like, “I know that was written by a Dragon.” We solve that by giving the AI context like, “This is the conversation between a physical therapist and their patient.” In addition, we pass through a second filter, so it’s going to reword what was said during the visit in your style and your tone using words that you’ve used in the past. It’s able to identify, “This is a PT-specific word. Use that specific word and whatnot.”

That’s the cool thing about AI. Not only is it taking what they’re saying and integrating it into the EMR, but it is also learning along the way. I don’t know if you have anyone six months into it yet.

Almost there.

The people you have four months into it, that system’s running much more smoothly than the initial user because AI is learning along the way.

Over time, it’s able to learn your style and your tone. It becomes perfect for you. What we’re seeing is it’s pretty quick onboarding. It ends up being you instantly get a note that’s generated. That’s decent, but it might not sound like you right away. With a little bit of refinement, you can get it there within a week. It’s really fast learning. All of a sudden, you’re like, “All I did was click the button and it wrote the note better than I would have in my style in my tone after a week of using it.” That’s super cool. We love that.

That’s impressive. That was the goal back in the day for most owners. If I can get my providers to walk out the door with their last patient of the day, have no notes to take home, and they’re able to free their minds that way, people would be avoiding burnout significantly more if they didn’t have to do the typing, the writing, and the ensuring that I wrote it correctly with all the goals, measures, and all that kinda stuff. If I could have that AI scribe, that would be huge.

We see that as being a big thing in the industry as a whole, burnout, churn among employees, and, over time, providers not wanting to be a PT anymore and people leaving the industry. A lot of it stems from this documentation problem. It ends up being insurance reimbursement and documentation. If we can document better, we could potentially increase reimbursement or whatnot. You don’t have to play that game of insurance denials and whatnot. You get infinite hiring ability too. Imagine if you could hire and put on the application, “No notes.” You have an AI scribe doing your notes for you, right?

If we can document better, we could potentially increase your personal whatnot. You don't have to play that game of insurance denials and whatnot.
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Yeah. If you’re recruiting physical therapists, you say, “FYI. We use AI. Hopefully, you don’t mind that.” That’s awesome.

You’re like, “We added to your notes. You’re not going to be taking notes home for hours on end every day.” We’re seeing that as being a big thing for the clinic directors when we’re signing them up.

I figure you’ve had to do a lot to ensure the safety of that. Since this is an AI situation, the potential for hacks or whatnot is there. You’ve had to put a lot of robust work into the HIPAA compliance aspect of it, right?

Yeah. For the origin story of the product, it was a few years ago around Christmas dinner. My cousin, Chris, is doing notes while we’re all eating. I’m like, “One day, AI is going to help you with that.” Fast forward a little bit, I had gone to school for AI and computer science. I was working for a government contractor doing flight code for Military planes and satellites. The pilot turns to the plane moving and then satellites that are going to do some crazy stuff. I can’t talk too deeply about it. It was cool stuff, but I wasn’t all that fulfilled.

I built my cousin, Chris, a proof of concept. He’s like, “If you can make this happen, this would change the world.” I had to put my head down for six months to make it HIPAA-compliant. It’s a cool concept, but to get it to market and make it usable in the industry, there is a huge headache to ensuring security. Everything’s encrypted in rest and encrypted in transit. We’re using Cloud hosting that’s ultra-secure. There’s also a lot of documentation on breach notifications and a lot of other HIPAA stuff that needs to be in place before you can claim HIPAA security, which took six months’ worth of effort to be secure.

Maybe you’ve noticed some parallels in the growing pains of your business. Maybe you’ve worked with enough PT owners that even though you are in a completely different industry, working in PT, you’re seeing some of the same growing pains that we are as physical therapy owners.

In the beginning, it’s you being a provider and doing your thing, and then as you try to scale and stuff, things get tricky. You add people. You have inefficient systems potentially. You need to create systems to help manage the people and whatnot. That’s what we were seeing. You hire people and it’s like, “How do I make sure these people are producing? How do I make sure that I’m setting them up to win, not setting them up to fail and whatnot?” There’s a lot of that going on.

Task management is a huge thing. As the original person who founded the company and stuff, my time, I get stretched super thin. How do you manage that? You’re supposed to be a provider. In a PT’s case, you’re the one doing the care, but then also, at the end of the day, you have to go home and do all the administrative stuff. That’s a headache in itself.

You’re seeing the same thing, right?

100% the same thing.

You’re the CTO.

I’m the CTO and CEO. I am a sales guy. I’m a marketing guy. I am still the coder guy. There’s a lot going on. We’ve grown to a point where there are eight or so of us, so we have people that do all of that. It’s cool to see things taken from my hand and they’re doing a better job than I was. That’s awesome. I love seeing that. That’s a cool place to be in where you hire people who are better than you and let them do their thing. I assume it’s the same for you. I end up doing administrative stuff for eight hours a day. At the end of my day, when there’s nobody online and I don’t have to reply to support calls, help people, or make sure everybody’s going well, I can then go back and code some more. That’s the place that I’m in.

It’s very similar. I’ve been able to witness how you’ve grown over the last few months. When I talked to you, you had someone else maybe, but it was just you.

There was a time when it was just me. My cousin, Chris, was always around, but he was user zero. He was the guy that was using it and giving feedback. He was the PT brain. Whenever I needed to pick a PT’s brain and needed help from the PT side, I could always go to him. He was working full-time at a job. I was picking his brain and then finally, I got him on board.

We then got Alana on board. She’s our COO. I had never done sales, marketing, or run a business. I had a cool thing that I built. I’m a technical guy. She was a huge help. Running a business side was her unique value prop. That was her thing. I was a tech guy that was attached. She taught me so much. I was able to help her and she helped me. We fit together super well.

We then brought on a coder from Silicon Valley. That’s Arpita. She’s amazing. She’s a fantastic project manager and also a developer. She has taught me how to run a team and how we could get it so that everyone’s efficient, not just a single person coding a project. We have four coders. That’s a cool process in itself, but a huge thing to manage. She has helped run that side of things.

There are so many different places and so many moving pieces going on. I’m constantly switching throughout the day. At the end of the day, it’s like, “Where can I put eight hours of focused energy into something specific to be a computational unit but also the overarching manager?” That is probably the exact same thing for any clinic owner.

Exactly. The thing that’s great about you that physical therapy owners can take away, and this is what I’ve witnessed from my perspective, is that you’ve always reached out to other people to get advice or network. You name it. You reached out to me. Honestly, some of our conversations are more business-focused. It’s like, “What do I need to do next?” You’re asking me these questions. I love being a part of seeing your growth.

The mantra that I always relate to the physical therapy owners is to reach out, step out, and network. You have to pull your head out of treating patients 24 hours a day and network. Reach out to people to see, “What do I need? Where do I need to go next?” whether that’s a coach, a consultant, or a mentor. Find someone or get into a network of people who are experienced and can guide you a little bit. That’s where I’ve seen a lot of growth with you.

We’ve gone over an organization board and what that looks like. There’s a lot more to it now than there was initially when I showed you what an org board was and how it should be set up. Kudos to you that you have reached out and found those people. You’re looking at the next steps, systems, and how to onboard, train, and that kind of stuff. That’s no different than the physical therapy world.

I met Scott Fritz along the way. He says, “Your net worth is your network.” It’s either that or the other way around.

It’s flipped.

Your network is your net worth. It’s so true because I don’t have enough experience. I don’t know if any individual can have enough experience to really understand everything that’s going on. The more people you can talk to that have done something similar and have done something like this before, you’re going to get snippets of gold and everything that they’re saying. It’s like, “If I had to go make all the same mistakes that you’ve made in the past that you learned from, you implemented, and you’re no longer making, I’m probably going to fail. How many people can I talk to that will give me snippets of gold as often as possible to help me grow?”

It’s all about the unknown unknowns. That’s what you want to uncover in those conversations. I was like, “What are the things that I don’t know that can hurt me?” You were like, “An org board.” I’ve heard of it, but I didn’t realize the importance of how it affects growth until I sat with you and then I went through the exercise of making one. I’m like, “I need this. Otherwise, things are going to fall apart as soon as we start to scale.” We were geared up to scale pretty early on because we had that conversation early on when we built that early on.

When there were 3 or 4 of us, we were ready to onboard 5, 6, or 7 more people. We’re still in that growth stage where that original org chart has changed. It has changed a lot, but that’s the point. You figure out, “Who is the next hire? Where do we need the most attention?” If you’re hiring great people to do great work, that’s awesome, but you need to be more strategic about it.

You don’t want to hire them to do anything you ask them to do. You want to hire them to do a specific thing and take that off of your plate.

Do the thing that I’m doing poorly. Exactly. 100%.

It’s awesome to see your growth. It isn’t all that much different than the physical therapy owner who is looking to scale as well, right?

Yeah. Let’s figure out where we need more computational units. Do you need more providers to be giving care? Do you need somebody at the front desk? Do you need somebody to be doing marketing? There are so many parallels where the unique value prop or the core value proposition for what you guys do is to help people get better. What I do is help people help people get better. I’m software. You’re physical therapy. Those are the computational units. The rest surrounding the business is very much the same.

Since you’ve been in the physical therapy space, you’ve seen some of the other players in the physical therapy space. I’ve interviewed Pedro Teixeira of Prediction Health. I know you’ve talked to him as well. Where do you see AI affecting physical therapy in the future? Where do you see this going?

I’m partial in that I think documentation is the biggest burden. AI will help us be more efficient with documentation and make it so we don’t have to. Unfortunately, insurance is using it to audit your notes. We can give you a tool to fight back against insurance. There will always be some amount of ebb and flow between providers and insurance, but now, it is heavily favoring insurance.

Documentation is the biggest burden, and AI will help us be more efficient with documentation and make it, so we don't have to.
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There needs to be a shift back towards an equilibrium where providers have a tool that helps them be more efficient, write better notes, get better reimbursement rates and whatnot, and do less documentation. I’m partial. Documentation is the holy grail of AI and physical therapy, but eventually, there will be clinical decision-making support. You’re able to see, “Here are the top three things that could be given the patient’s history and given what we know about them today. Make sure you check these things. You might not be thinking of a frozen shoulder, but maybe it is. Did you rule these things out?” It’ll be something to bounce ideas off of.

AI isn’t able to think creatively like a human would. It’s more of an aid to help you bounce ideas off. I use it every day like, “I’m thinking about this. What are your thoughts?” I ask the AI that and it spits back, “Here are four things.” Sometimes, it’s useful, and sometimes, it’s not. Every once in a while, to those things, they are like, “That’s interesting. Double down on that. Tell me more. What do you mean by that? It spurs something in my own mind where it’s like, “Let me go do that.” That’s a cool place to be in.

How do we leverage that to help a PT be more efficient in their care? How do we make it so we can get better outcomes? That’s the altruistic goal. Now, it is, “How do we make your time more efficient? How do we make you do more of what you love?” That’s our goal. Whereas eventually, it will be, “How can we use AI to have better outcomes? How can we leverage AI so that people get better faster?” That sounds super cool to me. How can we make it so their care is better?

We’re helping with care being better in that you don’t have to be on a computer or writing stuff down as you talk. Instead, you can give your full attention to your therapist. Eventually, you’ll see it being more for better outcomes with enough data about, “These are the best activities to do given this data.” It could be, “Given this subset of what we know about the patient, we’re able to say with 94% confidence it’s going to be this, and then the other 6% is this.” That’s an eventuality. That’s the holy grail of all medicine as well. Now, we have documentation with AI.

The way things are going, we’re probably not that far off. Do you think maybe in a few years?

The rate at which AI is going is far faster than anyone ever thought. It’s a little backward of what people thought. People originally thought it was going to take more blue-collar automation or more of the mundane work that’s repetitive and automate that. What we’re seeing is the exact opposite. It went right for creative stuff. It went for image generation. It went for coding.

Content creation.

It went for a lot of more white-collar weird jobs like that rather than bottom-up. It’s hard to say with confidence where AI will go, but it is going after high-value or high-ticket items like clinical decision-making and whatnot as an aid to a doctor, a physical therapist, and that kind of thing. How far? I can’t say with confidence what’s going to happen within the next three years, but I will say that I could build it to something that’s pretty clever and is going to potentially help you be more productive, be more creative, and have better outcomes.

The ball is completely in your court as far as how utilized it gets. The accuracy is still something that needs to be studied over time. It’s not an instant like, “We built a tool. Here you go.” There’s so much that needs to go into vetting the tool and making sure it’s not leading you astray. It doesn’t make you dependent on it. Rather, it’s a lever that helps you be more efficient.

Pedro said the same thing. That’s cool that you both recognized that. That is how AI will help us take all the knowledge that’s out there and all the studies. Based on the patient’s history, their mode of injury, and their past medical history, they can look at those things, compare it against all the studies that are out there in the history of the world, and say, “More than likely, it is this diagnosis. These are the best three treatments for it,” right?

Yeah. It will be like, “These will have the best outcomes.”

A lot of people might get a little bit hesitant because the human’s not involved in that, but if people looked at it as an opportunity for feedback, recommendations, and like, “I don’t have to read all the articles all the time to stay on top of the most efficient things that I should provide for this particular case. AI can do that for me based on my skillset and what I know. I can take what that provides me and implement it in my care to get the most efficient outcomes,” that’d be huge. That’s awesome.

I agree. That’s the holy grail of AI in medicine or AI in the whole medical sector. It’s the clinical decision-making support. I don’t think it’s taking the human out of the loop. Especially in physical therapy, people are always going to want human interaction. They’re never going to want a robot to manipulate their arm. Maybe eventually in 100 years, we will get there, but at least for now, it’s like, “This machine could twist me in the wrong way and break my arm off. I don’t really trust it.”

They never stop.

Whereas used as a support for a human to make a human more efficient or to make a human do more of what they love, that seems more in line with what it should be.

AI can be used as a support for a human to make them more efficient and do more of what they love.
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Where do you see Comprehend PT being in 2024? Tell the audience a little bit. You’re integrated with a couple of EMRs at this point. Where do you see this going over the course of 2024 and then going forward?

Our main objectives for 2024 are to have more customers, to be integrated with more EMRs, and to have official partnerships with more EMRs. We have official partnerships with Empower EMR. They used to be MWTherapy. Sharif is a great guy. I love the team and whatnot. They’re awesome. We are happy that they’re our first official partnership.

We integrate with Prompt, WebPT, PtEverywhere, and Jane. We’re working through an official partnership with Jane, but we want to get more of those official partnerships and more supporting EMRs. We have some meetings set up with HelloNote and a few other EMRs in order to get integrated. We’re excited about those opportunities. We’re excited about the official partnerships. We want to be compatible with all EMRs.

We want to get to a point where you can use Comprehend and it’s the same interface no matter what EMR you’re using. Let’s say you’re a traveling PT. You don’t have to learn the documentation system. You have to know, “Comprehend. It’s common amongst all EMRs. I hit record and Comprehend, and all of a sudden, my documentation is done. I read it over. I didn’t have to figure out, “Their charting system, I have to do this. This is how they like it arranged.” Instead, a clinic owner shared their Comprehend template with the traveling PT and their note sounds like the clinic. They have a clinic level, “This is what notes generally look like.”

That’s beautiful.

We think that’s the trajectory of growth integrating with all EMRs, having official partnerships with the EMRs, and getting it into the hands of more users. We want to see this widely applicable. We want to see this used everywhere and be a 100% marketed option. That’s the goal. We’ll see how close we can go.

That’s awesome. That’s super exciting. If people want to learn a little bit more about Comprehend PT, where do they go?

They’re going to go to www.ComprehendPT.ai. They can google Comprehend PT as well and it will show up as your first result. I am super proud. There is a lot of good information out there on AI and stuff. We aggregate and show you how to use it in a pretty concise manner there.

That’s cool. If we’re silly physical therapists that go to ComprehendPT.com , is it going to redirect us to ComprehendPT.ai ?

Yes, it will. You don’t have to worry about it. We funnel all the domains. We got everything that was even close, like ComprehendScribe.com , ComprehendHealth.ai , ComprehendPT.ai , and ComprehendPT.com. We have a lot of different domains that all funnel to the main one.

That’s great. Thanks for joining me. If people wanted to reach out to you directly, are you on the socials?

Yeah. @ComprehendHealth is our Insta. If you google Comprehend PT, there are a lot of pages that’ll correlate to us. There’s a phone number at the bottom if you want to talk to us. You can get my personal cell phone if you want to talk, shoot me a text, or whatever you want. Our email is at the bottom of our site as well. We’re very responsive. We’re still in a phase where we listen to our customers. We love the feedback.

That’s great. Thanks for the time. I appreciate it.

I appreciate it. Thanks.

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