I Don't Have Enough Priority

I regularly hear "I don't have a enough time for [X]" from friends, family, colleagues, and business associates. I'm sure you do too.

That saying is total bullshit.

You always have time. You don't have enough priority.

If you watch a single episode of TV, read a blog, play a game, or even eat, but you don't do [X], then you have implicitly stated that everything else is more important than [X].

That's fine. That's totally ok. Really.

Instead of saying that you don't have time, hold yourself to saying you don't have priority. It's 10x harder socially, but infinitely more honest.

I've been doing my best to hold myself to this. It's difficult. I'm nowhere near 100% compliance. But I find that thinking through this lens lends itself to holding more realistic perspectives of what I can and can't do. It also leads to better time management.

The Marginal Value of Google Glass, Continued, Continued

This post was originally featured on the Pristine Blog. 

Glass is just a computer. Nothing less, nothing more.

I previously identified four fundamental characteristics of Glass that make it unique. The only apps that will be successful on Glass will be those that take advantages of the new form factor.

1. Hands free

2. Heads up display

3. Friction free

4. First person camera

I just identified a 5th, and potentially a 6th unique characteristic of the Glass platform:

5. Head tracking. With the accelerometer and gyro, Glass understands head movements.

Although there aren't too many practical mainstream applications for head tracking, it presents interesting opportunities in robotics and robotic surgery. On Glass today, I find the value of head tracking to be limited, but head tracking will grow to be a far more powerful concept when coupled with larger eyeware screens. With larger screens, one can easily imagine intelligent data overlays that automatically adjust to what you see as you move your head. Although this is technically feasible with Glass today, it's just not practical given that Glass's screen doesn't obstruct the wearer's vision.

6. One-way audio. The bone conduction speakers allows for near-silent one way audio communications. In a perfectly quiet environment, 3rd parties can decipher inbound audio, but generally speaking, it's extremely difficult for non-wearers to hear what wearers are hearing. With one-way audio, Glass could be an interesting communications device in medicine in light of HIPAA regulations.

In addition to these two characteristics, I find the ambient light sensor to be intriguing. I consider it a subset of the 1st person camera. The 1st person ambient light sensor isn't compelling enough to be a fundamentally unique characteristic, but it's worth noting. I'm trying to envision the value of the light sensor in patient care environments, but I'm not coming up with much.

In retrospect, I should have identified all 6 of these when I wrote the original marginal value of Glass post in March. It's actually easy to systematically identify them: just look at the hardware sensors and human computer interaction elements. They define the marginal value of the platform.

A Shifting Basis of Competition

This post was originally featured on HIStalk. 

Software is eating the world. As a result, the basis of competition in almost every industry is changing. The venture capital (VC) industry in particular is undergoing substantial changes:

1) The JOBS act is making it easier for VCs to raise funds and for the common folk to invest in and take an equity stake in early stage companies. There will be more capital than ever to invest in early stage businesses. VCs are feeling competitive pressures from all sides.

2) Returns are concentrating among the top VC firms. The best VCs are attracting the top entrepreneurs, and vice versa.

As a result of these changes, VCs are working harder than ever to source deals. Per Tomasz Tungz, a partner at RedPoint Ventures, in order to compete, VCs must:

1) Create information asymmetries

2) Convince entrepreneurs that they’re the right partner

3) Deploy technologies that can help their portfolio companies in meaningful ways

Hospitals and health systems are remarkably similar to VCs. They employ swaths of highly specialized, highly trained people who make big important decisions that dramatically affect people’s lives. They offer what many consider to be a commodity (cash / health care services) in highly illiquid, opaque markets, with dramatic variances in price.

Hospitals and health systems could learn a thing or two from VCs:

1) Create information asymmetries. This doesn’t mean providers need to hide even more from patients (providers already do plenty of that without even trying). This means providers need to figure out how to employ analytics to make more intelligent decisions. With impending reimbursement changes in an ACO world, most analytics being deployed today are focused on identifying behaviors and processes that result in less-than-ideal, expensive outcomes. But there are a tremendous number of other data sets to explore: referring patients to clinical trials, public service campaigns that encourage patients to avoid getting sick (particularly during cold/flu seasons), and understanding the tremendous amounts of quantified self data that patients are collecting. The amount of health data to be understood is spectacularly large; the best care providers will be those that can make sense of it

2) Convince patients that they’re the right provider. The most common hospital marketing campaigns are those that say something along the lines of "Top 100 Wired / Best hospitals" or "come try this fancy new procedure." These campaigns and characterizations are superficial and highlight their complete lack of creativity, short-term, and myopic thinking. People buy stuff from people that they like. People respond to direct communication and being treated like real people, not boxes in a machine. Since everyone interacts with their local healthcare system, hospitals’ best marketing is word of mouth, and thus the best marketing strategies will be tied to improving the patient experience: transparency, communication, education, and outcomes. Marketing strategies in healthcare should be internally focused, not externally focused.

3) Deploy technologies that can help patients in meaningful ways. Obviously, hospitals have been doing this for decades, but as patients get increasingly involved in their own healthcare, the definition of "meaningful" improvements should incorporate the patients themselves. By extension, these meaningful technologies should also encourage medical practitioners to help patients make better decisions, not just treat them. Give a man a fish and he eats for a day; teach a man to fish and he eats for a lifetime. In light of #2 above, these technologies should foster a better patient experience, unlike the current cog-in-a-machine experience.

As software continues to eat the world, healthcare will oxymoronically evolve to be more people centric, not technology centric. We’ll rely on technology more than ever before, but only so that we can spend less time worrying about technology and more time delivering compelling services in ourservice economy.

PS: coincidentally, Fred Wilson from Union Square Ventures and James Kwak from The Baseline Scenario recently wrote analogies using the VC industry.

Healthcare IT Donuts

This post was originally featured on HIStalk.

There’s a famous Internet meme that explains each of the major social media networks through donuts.  

In light of National Health IT week, I thought it would be fun to look at the healthcare IT space through the donut hole:

EHR Companies

Epic: I make the most expensive donuts, I choose who I sell donuts to, and I don’t let my customers share donuts with anyone else.

Cerner: I make donuts using 85 different kinds of donut machines, but tell people it’s one big masterfully planned donut factory.

Meditech: I make donuts using a 1980s donut machine.

McKesson: I just threw out my old donut factory, and since the new one isn’t doing too well, I’m looking for a new donut factory to buy.

Siemens: I designed and manufactured every piece of equipment in my donut factory, even though most of those components are available as off-the-shelf commodities.

NextGen: I make literally every flavor of donut in existence, and none are particularly good; I wonder why I struggle to sell donuts.

GE: I make donuts, burgers, seafood, Indian food, Chinese food, and Italian food and sell them all at the same store.

Athena: I give donuts away for free, but charge people for actually eating them.

Greenway: I used to sell donuts by the dozen, but now I force people to buy a 12-month subscription to buy one donut per month.

Allscripts: I make donuts, then announce donut recalls.

eClinicalWorks: I don’t publicly talk about my donut business, but I sell lots of donuts anyway.

Practice Fusion: I give out donuts for free, and show weight-loss ads throughout the donut shop.

Startups

HealthTap: I provide a social network for people to share tips about the best and worse donut shops.

Catalyze: I help people build donut shops faster.

Pristine: I take pictures and videos of donuts and share them via Google Glass.

ePatientFinder: I match patients to weight loss clinics based on how many donuts they’ve eaten.

Simplee: I make it easier to pay for donuts.

Teladoc: / Ringadoc: I help people eat donuts over Skype.

RunKeeper: I ask people to record how many donuts they’ve eaten.

JawBone / FitBit: I automatically track how many donuts people eat using highly inaccurate algorithms.

MaxWell Health: I help people make sense of donut nutritional facts.

Kai Nexus: I provide tools to manage process improvement in donut manufacturing.

AdhereTech: I remind people to eat donuts on time.

CenterX: I make it easier and cheaper for doctors to prescribe donuts to their patients.

Ovuline: I remind women when they should eat donuts.

Miscellaneous

Merge: I like sharing pictures of donuts with all of my friends.

Mirth: I give away donuts for free, then charge customers when they ask how to open the donut box.

Medicity: I used to sell lean donuts, but now promise that my donuts aren’t influenced by my transfat parent company.

Orion: I sell kiwi donuts to most of Canada.

AirStrip: I provide solutions to watch and monitor donut-producing equipment.

ZocDoc: I help donut customers find donut shops.

WebMD / iTriage: I help people learn about different kinds of donuts.

Consulting Firms: I teach people how to eat donuts.

Every HIE: my customers promised me that they’d pay for donuts, but didn’t.

HIStalk: I write about all things donut.

The Power of Hello

I just sent out the 5th episode of the Pristine Story. Here they are for reference.

The Calm Before the Storm

Building Infrastructure

Sprinting a Marathon

Peeking out of the Shadows 

Launch!

Although we have a subscribe function on the bottom of the Pristine homepage, I've probably added 95% of the 800 subscribers by hand: I took an email address, either from a business card, or from an email conversation, and added it to an excel sheet that's always open on my super-amazing Retina MacBook Pro. Before sending out each episode of the Pristine Story, I upload and clear out the sheet. Simple.

Even as the list has grown, the engagement statistics have remained quite steady. I'm hopeful that with compelling content, they'll stay steady. If they do, that means I'm doing an exceptional job.

After sending out each issue, generally about 1-1.5% unsubscribe from the blast. Given that I add people without their explicit permission, I think a 1-1.5% unsubscribe rate is excellent.

Conversely, that means 98-99% of people that I've come across haven't told me to go away. And that means that every 3 weeks, they're reminded of Pristine's existence. That's it. Just a simple reminder of our existence. The vast majority of the subscribers are / were potential stakeholders in the business. That is, they are or could be investors, advisors, employees, customers, partners, friends, family, or simply someone who could make a connection or referral.

For those that know me personally, they'll recognize a particular expression from the last paragraph: acknowledging "that I exist." I reuse it for good reason. I find it to be an honest and accurate representation of the truth: that people have lots of stuff going on in their lives, and although I'm working on cool stuff, unless they're one of the few that's actually a stakeholder in the business, they don't actually care.

Although they don't care, the Pristine Story has been a remarkably powerful concept. Every 3 weeks, they're reminded that I exist, what I'm working on, and about 3-4% write me back. Most just say "awesome" or "great status update, keep it up!" It's always great to hear positive feedback, but after sending out each episode, I always receive a handful of emails along the lines of "hey, let's catchup again" or "wait a second, I just met someone that I should introduce you to" or "now I'm interested in working for / buying from / investing in / becoming a stakeholder."

And that's why I write the Pristine Story.