On Being Wrong and Learning

SXSW is going on this weekend. I've spent the past 2 nights out on the town mingling and socializing. I woke up early this Saturday morning catch up on life, then head out and do it all over again. And while I was in the shower, I recalled a great TED video I watched well over 6 months ago.

You are never wrong. You can have been wrong. But you never actively go about your day knowing and accepting "I am wrong". There's a pivotal moment between the state of being wrong and not being wrong. That sliver in time is special. For some, it's a painful moment. Many of those people never experience it. I love it. I find it to be fascinating. Because once you learn to deal with the initial discomfort of being wrong, you can learn create an enormous number of new opportunities.

The single most prominent characterization that affects your ability to remember things is vividness. There's reason why you can't remember what you ate for breakfast yesterday, but why you can remember your wedding and graduations from 20 years ago so clearly.

Synthesizing the 2 ideas above effectively explains proverb "learn from your mistakes."

I love being wrong. Because being wrong creates a distinct memory that you can learn from. The more wrong you are, the more likely you are to internalize and learn from your mistakes. The more adamant you were, the more humbled you should become after being wrong.

Serendipitous Glass

Serendipitous Glass

As I've said before, there are at least 3 fundamentally unique characteristics of Glass. 1) hands-free 2) omni-present (always there) and immediately accessible 3) heads up display.

There are absolutely enormous opportunities by combining serendipitous computing with Glass given characteristics 2 and 3 above. A few high level examples:

1) You're driving down the feeder of the highway. McDonalds is about a quarter mile ahead on the right. McDonalds offers 10% off if you pull in within the next 20 seconds. This takes the psychology of "limited time offer" to the extreme. Capitalism and competition at its finest.

2) You're at work. You're on the verge of being late to leave to the airport for a flight. A car accident happens on the fastest route to the airport. Glass notifies you so you can get up and go immediately, and routes you to avoid the accident if possible.

In healthcare, the serendipity options aren't quite as amazing. In the 2 above examples, the the reason Glass is so much better than the status quo (MultiTouch glass in your pocket) is because of Glass's accessibility and value of timing and context. In the vast majority of care settings, the cost of reaching in your pocket for a serendipitous notification isn't very high. In these use cases, Glass is better than the status quo, but only marginally.

EHRs and other point of care systems should be notifying the clinician immediately as soon as the information is put into the system, not at a later time. Having said that, Glass does present some unique opportunities for one-way messaging. Glass supports bone conduction technology. You can hear through Glass, and no one-else can. This presents enormous opportunities for one-way messaging and confidential communication in healthcare.

Why Wearable Computing?

The rumor mill has recently been abuzz about an Apple iWatch. Apple will never release an iWatch. It makes absolutely no sense. A computer-watch fails to realize the fundamental value of wearable computing.

Wearable computing is supposed to reduce the friction between you and your computer. Let's look at friction between you and the computer during each of the major computing eras. In particular, think about the marginal friction reduction between each generation and about the new application opportunities each platform presented:

Mainframes: only used by big businesses, governments, and universities. If you wanted to use one, you had to have privileged access, or sign up to schedule a turn to get access.

Desktops: you can fit one on your desk. So you had to go to your desk to access it. Desktops brought computing to the masses.

Laptops: you can fit it one your travel bag. And on your lap. But still, you can't use a laptop when you're out and about. Laptops brought computing into classrooms, onto college campuses, and into most stationery facets of life.

Capacitive multi-touch smartphones: you can fit one in your pocket. Which means you can access it everywhere you go. Every time you want to compute, you have to pull your smartphone out of your pocket. Smartphones opened up a whole new world of computing on the go.

Apple iWatch: goes on your wrist. Accessible by turning your head down and holding your arm up. The screen will be extremely small. The iWatch won't have any new hardware sensors that your smartphone doesn't already have. There could be interesting opportunities if a lightweight Kinect was integrated into the iWatch, but that won't be feasible before 2015, if not later.

Google Glass: goes on your face. The friction to compute is reduced to saying "Ok Glass". Glass will open up enormous new opportunities in serendipitous computing, and computers that can take advantage of seeing what you can see. Just imagine layering a lightweight Kinect on top of Glass…

The problem with the iWatch is that it just isn't that much better than a smartphone. Sure, you don't have to put your hand in your pocket, but is putting your hand in your pocket really that bad? No. So if you're going to invest in something in addition the smartphone in your pocket, it needs to be an order of magnitude better in ways that a smartphone can never be.

The real question is, what is Apple's strategy going to look like in the wearable computing world? Google is launching the largest platform beta ever delivered on a revolutionary new UI. Google is positioning itself as the leader, and is pushing developers to commit to Google's platform early. They're doing exactly what they should. I'm sure Apple is working on a set of glasses. I just don't think it serves Apple's best interests to wait until the product is finished before unveiling it. Apple needs to get developers on board today. They cannot afford to be 2nd in a new technology market. Their business model doesn't accommodate it.

Outsource It

This is the followup post to my first post on AthenaHealth. This post will exemplify Marc Andreesen's statement "software is eating the world", looking specifically at AthenaHealth and Square in their respective markets.

To recap, AthenaHealth offers a free practice management, EHR, analytics, and connectivity solution for outpatient clinics. Athena runs a single, multi-tenant database in the cloud that all its customers access via a web browser. Athena takes ~6% of its providers revenues in exchange for its software and services.

Athena is the biggest, best healthcare biller in the country, bar none. Their economies of scale and complete access to the raw information enable them to be the best biller possible. No one else can perform medical billing as well as Athena because no one has the scale or access that Athena has.

The key to Athena's success is that it deals with all of the shit that doctors don't want to deal with. Every year, the government implements new regulations, adds new forms, mandates new reports, etc. And of course, they continue to cut Medicare reimbursements while increasing the cost of doing business. Athena does a phenomenal job of abstracting away all of that complexity so that doctors can focus on care. As new administrative requirements spring up, Athena takes care of them. They also provide all of the tools and analytics so that doctors can run the best possible business. Athena is the ultimate outsourcer for medical clinics. They provide end-to-end  administrative services for doctors.

Square is aiming to be the go-to vendor for merchants across the country. They are the disruptor per Clayton Christensen's traditional disruption theory: disruption from below. Square doesn't provide any functionality that major retailers don't already have in their point of sales (POS) and analytics systems. But Square is delivering the first hardware and software ecosystem for merchants running on a modern, easily update-able, multi-tenant cloud hosted database and software stack (like Athena) at scale. And they're doing it at a fraction of the cost that the legacy point of sale vendors are doing it. Soon, Square will offer small merchants the kind of analytics that today are only available to large retailing organizations.

Both Square and Athena recognize that they have enormous customer bases and extremely valuable data. And that as much as they want to provide every feature and function to every merchant, they can't. That's why Athena built AthenaNet, a platform where 3rd party developers can plug into Athena's network of doctors to provide additional functions and services. Square is a much younger company, so they haven't had the opportunity to build out the development ecosystem, but they will do the same thing. They own an enormous amount of valuable data - payments - so it's only natural that they will create a development platform around themselves to 1) push innovation on the Square platform faster 2) create network effects and barriers to entry.

​Expect both companies to continue to dominate their respective industries for the foreseeable future. They provide end-to-end solutions for their customers (thus increasing customer reliance on them) and have phenomenal business models with very powerful network effects. They are the ultimate outsourcers.

The Marginal Value of Google Glass

I am ecstatic for Google Glass. I can't wait. I'm applying to the developer beta with a few healthcare ideas. The opportunities are endless.

I've been brainstorming ideas for the past few days. What can be commercialized? Will hospitals or physicians pay for it? Will the users appreciate value? Will they feel weird using it? Will the value outweigh the awkwardness of feeling kind of a like a cyborg or android?

The marginal value of Google Glass relative to modern multi-touch smartphones (iPhone, Androids) is that Glass 1) is hands-free 2) excels at providing "at-a-glance" information 3) is always available (not in your pocket). The best applications using Glass will really take advantage of those 3 traits. Apps that don't take advantage of these will be relegated to the underworld of the Glass Play Store (or whatever Google decides to call it).

On the downside, Glass doesn't have robust UI. Unlike a smartphone, tablet, or PC, there's no screen for that you can manipulate. That's severely limiting (on the bright side, Glass is designed to frequently communicate with your smartphone so that you can use it as necessary). Moreover, the small screen that is available in glass can only house a few words, maybe a dozen, as best I can tell from all the videos and journalist previews.

Those that try to take advantage of just one novel feature of Glass, without realizing and fulfilling the dream of a bigger picture of cross-device utilization will fail. ​The developers that figure out the best interplay between Glass, smartphone, and other major services (web or locally hosted enterprise services) will be the most successful.

Let the races commence.