Does NDIS AT need ‘innovation’ yet?

On this website you can see details of an Innovation for AT plan that we crafted (with input from several others from around Australia and abroad) for the National Disability Insurance Scheme. A learned colleague in the USA, Joseph Lane, has provided a critique of sorts. Primarily he challenges the value of ‘innovation’ in AT when really the fundamentals aren’t sorted out. It is perhaps a wake up to us all:

Thank you for the opportunity to comment on your characterization for the process of technological innovation.  Your framework is very well constructed, thoughtful and thorough.  It is everything one could ask of a plan to progress from the current state of a product, service or process to a new and improved state.  All such models of the innovation process presume the necessity of innovating and then outlines the process through which innovations can be achieved.
Since the mid-18th century (see Vaclav Smil (2005), Creating the 20th Century) most technological innovation has occurred within the organizing framework of industrial corporations.  They either fund the necessary R&D internally or they conduct the necessary R&D sponsored by government agencies.  Unlike government agencies and public universities, corporations can go out of business, so they are careful to focus their R&D efforts on activities that lead directly to product/service improvements or next generation replacements.  This focus requires higher level managers to track the progress of internal R&D as well as to monitor the external state of science and state of practice (see John Gertner (2012), The Idea Factory:  History of Bell Labs).   The industrial sector pursues innovation opportunities through the free market mechanisms within fields where the available supply and demand revenues support a business case.  That is why we see unrelenting technological innovation in lucrative fields such as military weapons, sports equipment and entertainment media.
The reality is that the field of Assistive Technology devices and services does not (yet) meet the business case for sustained innovation.   Most AT manufacturers, suppliers and service providers are small businesses which are hard pressed to stay solvent.  These small companies valiantly strive to serve Persons with Disabilities who represent small, distributed and virtually anonymous markets, of largely underserved, highly varied and relatively underprivileged human beings.   We know that large numbers of People with Disabilities do not yet have access to existing AT products and services.   Identifying these consumers and delivering to them the existing AT products and services is the highest priority.  Until the AT industry builds an adequate customer base they lack adequate data (sufficient numbers, socio/geo/demographic distribution) — let alone customer feedback — to formulate good business decisions.  Once corporations have a sustainable customer base for existing products, they can turn their attention to making improvements where and if such improvement are warranted.  There are plenty of opportunities to apply science and engineering within the context of delivering, customizing and supporting AT products and services in the community.  If and when such client-based interventions form a pattern, they would serve as a template for AT product or service improvement.
Fact:  There is no shortage of ideas for technological innovations within AT corporations.  There are concepts, wireframes and even functional prototypes stacked up in most corporations, that simply lack the financial justification to refine and deploy within the marketplace.  I have seen no reports where AT corporations have said, “We are simply out of ideas for how to improve our products!”
Fact:  When corporations need expertise beyond that of internal staff, they seek out and fund that expertise in universities, government laboratories or other sources.  Healthy corporations sponsor R&D in such institutions where it is required and relevant.  I have no reports where AT product development managers have said, “Our full-time engineers are clueless, we need government to fund some random clusters of graduate students on a part-time basis to meet our needs.”
Fact:  There is no published document identifying targeted areas within the AT field for technological innovation, either articulated by corporations or documented with clinical evidence.   One might reasonably ask those calling for a focus on innovation, “Provide specific examples of product/service improvements requested by companies or demonstrated through functional outcomes data.
In summary, the concept of “technological innovation” simply has no standing within the existing NDIS framework.   It happens that it is not the primary requirement for improving the quality of life for Persons with Disabilities.  At least, not until consumers, clinicians and companies have sufficient experience with the existing platforms of AT to render informed opinions about future directions.  At present, the call for ‘innovation’ is a sideshow guaranteed to distract the well meaning but uninvolved to look beyond the reality of existing and urgent requirements.
You had previously shared with me a pyramid depicting the progression of requirements for serving the needs of People with Disabilities.  As one moves up the pyramid, there are fewer numbers of people but their AT needs are increasingly complex.   We discussed adding the two other sides to the pyramid to reflect the corresponding factors.  A second side of the pyramid could reflect the increasingly level of clinical expertise required to meet complex needs — and the role of continuing education, credentialing and consumer empowerment in ensuring the expertise is present and delivered.  The third side would show the corresponding increase in cost of AT devices and services to thoroughly meet those complex needs, because without adequate reimbursement levels the AT companies cannot make sell and support the complex AT devices, nor can the AT clinicians cover the expenses associated with assessment, training and follow-along.   Nowhere in that pyramid did I see a role for “technological innovation” because when a sustainable business case is present, the competitive forces of the free market ensure continuous innovation.
As I commented directly to the NDIA, I would purge any mention of “technological innovation” from the NDIS planning document.  It is a Pandora’s box that if left open will shift available funds — at little cost to the decision-makers and at great benefit to the program implementers — from a clear and present focus on the mundane realities of supporting the AT device and service delivery system, to the politically and professionally sexy “future potential” of AT.  As a result, PWD’s and clinicians will muddle along with a substantial portion of the funding is burned up by the well intentioned but largely clueless operating at the margins of the system.  Believe me, I’m trying my best to bridge that same gap caused by U.S. legislation in the late 1980’s and early 1990’s, but with the bulk of the available resources under their control most government staff and academic faculty are driven by unrelated incentives.
This pattern has already occurred in the United States and in the European Union.  Those who are indeed focused on delivering value will lack the time, attention and expertise to compete with those who set the rules of the competition.  Even if invited to the table, industry will become disenfranchised and turn their attention to staying solvent.  This leaves the resources to those who’s quality of life will be directly enhanced through the management of government sponsored programs, and the conduct of government sponsored “R&D”.   If Consumers and Industry are not leading — and more importantly controlling — this system, they will soon be shaken loose and left in the dust by those who dwell within the system being created.
I am unable to provide specific guidance on your “technological innovation” model, because at a fundamental level it is irrelevant to the stated goals of the NDIS.
I wish you all every success in creating a system that is focused on delivering beneficial impacts on the quality of life for Persons with Disabilities.  The rest of the world would greatly benefit from such an enlightened and selfless example.