There is no joy in (Android) appville

TechCrunch posted the-first-of-many "Top 30 Android apps of 2011" article earlier this week, which is always must-read fodder for me. As an Android owner and hacker, I'm always interested in what people think are great applications. For fun, read the article and try to figure out if the author really thought these were 30 great apps, or the editor said "Find 30 apps!" Somewhere around 17 the author just started swearing under their breath.

I was going to write about how despite it's openness and Java-based development, Android is still suffering from a lack of really great applications and developers. Don't get me wrong, some of these applications (Path, Any.do) are brilliant, but there are still damning details in the article.

Of the list of 30 applications, the only developers with more than one application on the list are people who also host their own App Store, and combined they have 7 of the 30 applications. (Five are from Google, and two are from Amazon). 

On the surface, you can discount this by saying "they are the most motivated to have great applications" or "they have the best developers because they have the biggest investment", but neither one of those really, in the end, make sense for what Android is, which is a platform. After this many years of Android, it should be hard to build a great list because you'd feel like you're leaving things out. And shouldn't be dominated by Google and Amazon.

This speaks loudly to the state of developers and development on Android. It's very easy to get started. It's easy to get distribution. It's really, really, really hard to achieve greatness.  That's not all bad - that should sound eerily like Windows development of the 1990's, or Web Development of the 2000's. We've seen these cycles before, but they are not pretty, and they all were forced to change.

The day before the "30 best apps" article, TechCrunch also had an piece on the challenges of native applications and the opportunity of HTML5. You know, the one we get every few months about the impending greatness of HTML5. Despite editors feel this article must be (re)written at least once a quarter, I'll admit it's an important topic, and a long-term trend to watch. (Sidenote: despite all the departures, there are still plenty of good contributors to TechCrunch. It's no longer must-read, but it's not dead either. I prefer pieces that take an opinion, and the latest contributors are doing that.)

The article was decent, and I liked it's presentation.  But even more important was the comment by Harry Tomey, where he summed up some of the "hidden" challenges of Android Development. Fragmentation is an oft-cited downside of Android, but I think Harry put it more concretely, especially for startups. The cost of QA and support for multiple OS versions, patches, UI overlays, and hardware form factors - all major realities in Android - have tipped into the prohibitive. 

These two TechCrunch pieces intersected quite violently - of the three "best of" applications I tried to install, all three of them worked on my phone (Droid X), only one ONE of then even installed on my Android tablet (Galaxy Tab 10.1) and well, I'll have to go to another app store to see if they work on my Kindle. Yet these are all Android devices.

At that point, I was motivated to see if they had an iPad version. That would only take one step, rather than three.  (Go ahead and make the point I'm not an average user because I have all these gadgets - the problem is only worse for the person who only has a Galaxy Tab or a Kindle and can't figure out why their "Android" apps won't work).

Reading nearly any App Store, er Market (you know what I mean. For Android. Wait, I mean, the Google one, not the Amazon Appstore on Android. URGH...) review has at least one "This piece of crap app doesn't work on my Galaxy IV-R27 Turbo!" - this got so serious, reviews in the Market now includes the model and version of the reviewer. Want to be really scared as a developer? Just scroll through a few pages like this:

At this point, I switched my opinion. This is not a problem for developers anymore. It's a consumer problem; because developers, frankly, gave up.

The problem of Android fragmentation is not a problem for most developers. I'd argue that today the majority of Android developers (remembering that the majority is still the small shop/individual, not a major corporation) don't even care anymore, and are not really trying to solve the problem. It's beyond their ability do manage, profitably.

Don't believe me? Don't believe the statement about "most are still small shop/individuals")? Okay, we'll do this your way. Download Google+ or any of the "30 great" Google apps for the Galaxy Tab 10.1. Six month later, and with the exception of GMail, they are still all simply scaled up versions of their phone versions, not taking advantage of any Android-Honeycomb futures, not attempting to deal with even the most basic fragmentation. And this is Google. Most apps from other publishers won't even install.

If this is true of the top applications for 2011, it's scary to think how many people opened an Android-based Christmas gift yesterday, and are now wondering why they can't install an app, or why a certain service doesn't work for them but works on their friend's devices. How do you even start to explain that to a consumer? 

This is a consumer problem, which will, over time, harm Android distribution, and in turn, harm developer brands. Eventually, that will lead to developers leaving the platform, unless it's addressed, quickly. Putting this genie back in the bottle is going to be the biggest challenges Google has faced, if not the biggest.

The negative impact on brands will cause publishers enough pain that they will need to figure out some path to avoid bad reviews, upset customers, and frustrated development teams. This cannot be solved with volume alone, because the volume numbers do not accuratley represent the market opportunity for a developer. They simply do not account for the overhead of fragmentation. The emperor has no clothes, and it's painfully obvious.

The only upside I see? There is a huge startup opportunity here: if you can build a Selenium-like product for developers, and a process for managing fragmentation issues, you can translate those market numbers to profitable releases across multiple versions. All of a sudden those market graphs really translate to dollars. Might be the best Android app yet.

My Steve Jobs Story

(Originally posted on G+, here: https://plus.google.com/u/0/104945599561982033177/posts/Ggi4Ev1XVxL)


Working at Apple was my dream job - I wanted to work there, and specifically for Steve Jobs, since I could remember. Some kids want to be firemen. I wanted to be a programmer at Apple. I pretended to be sick so I could stay home from elementary school to write code. My ][e was my prized possession, and later an early Mac. 

By a stroke of hard work and a little luck, I got recruited out of college all the way from east coast to come work for Apple, joining the MacApp team. Even though Steve had long been gone, it was still my dream job. To be very, very specific, I wanted to go work on the Knowledge Navigator. Since that job didn't exist (yet! Siri, way to go!) I took the MacApp job, as it allowed me to work on nearly everything that was coming out, new OS features and hardware, and mold them into something great for developers. 

MacApp was a C++ framework that was used by developers to create applications, making the Macintosh Toolbox more accessable. It was a small team, and many of the brightest minds of Apple had worked on the project at some time. It was an incredible honor. I even got stage time at WWDC ('96) co-presenting an entire session on the latest MacApp version. I was far too young to realize how amazing this all was. 

As MacApp grew long in the tooth, and the team changed (including the departure of +Greg Friedman to Microsoft, who was an amazing mentor and friend). I looked for a new opportunity, and transferred to the OpenDoc team. It was particularly nice because it was filled with great engineers, and, it was just the other side of the same building. I didn't even have to change where I park, just turn around after getting off the elevator at IL3 (the Apple building looking out on 280), rather than going straight to the frameworks team. 

A few months later, the rumors started - we were going to be buying either Be or NeXT, although everyone seemed to think it was Be. I think we couldn't fathom, as a bunch of fanboys, that Steve might be coming home. Either way, an Apple icon was coming back (Jean-Louis Gasse is no Steve Jobs, but he had a "Apple Reputation", and it was particularly interesting, since Scully hand-picked Gasse so it was Jobs/Scully/Gasse Part Duex. People forget that little bit of drama.) Rumors also swirled that we were going to be bought by Sun, so it was hard to make sense of it all. 

Without droning on about my personal history, Steve Jobs did come back. And, fairly quickly, killed off OpenDoc. I believe about 5000 people were laid off as projects that didn't fit the vision were shut down, and I was one of the unlucky. During WWDC '97, shutting down so many developer-related projects got a lot of attention, and he took some shots (and gave some out) about killing OpenDoc (see the videos below). 

People who know how important being part of Apple was to me ask if I was bitter or angry. Long before Steve passed away, I've always maintained that I was neither of those things. I was sad, and worst of all, I felt like I let down my hero. I realize how cult-like and insane that sounds, but that really his how I felt, and still feel in a weird way. Again, I was far too young to really grasp what it means to get laid off; I didn't have a mortgage or family or anything to worry about, but I bled the Apple colors, and was so disappointed in myself for not delivering something so insanely great that Steve would consider Apple worthy. But, this changed me in a good way. 

I'd probably still be an Apple employee if it wasn't for that moment. That's not good or bad, it's just fact. I learned so much in that time period - mostly from "doing it wrong" - about focus, product design, eating your own dogfood, and many more lessons, that it made me who I am, and made me a much better entrepreneur. 

It turns out, I wasn't supposed to be at Apple, I was supposed to be an entrepreneur, I was supposed to change healthcare (who knew?!) and how chronic care is delivered. I was supposed to create,build, foster, and sell a great company.

If you look at what we built for health care - insanely focused on the patient experience (even stealing fonts from Apple! Sssh) and on a big vision of changing an impossibly failed system - I got to live my Apple dream, just, elsewhere. 

The last few days were sad for me, because it brought back that feeling of never getting closure with those Apple years, that weird, almost parent/child desire to do something that would make my idol proud. 

Like so many people I wish I could have said thank you. I've decided the best way to do that is to keep trying to change the world in the ways I think are best, that I'm insanely passionate about, to give back to others in the startup space and help them find that inner insanity, and carry just a little bit of that Apple-ness and Jobs-ness into everything I do. 

It won't be about wearing a turtleneck or copying a catch phrase, but about the passion, desire, and willingness to do what I believe in, even when everyone else thinks it might be wrong.

Even though he's literally talking about something that caused great change for me personally, I find the two speeches below perfectly motivating. 


(Update 10/8/2011: I just read Sam Altman's blog post on Steve's passing, and he has a sentence that summed up my feelings exactly: "I had disappointed one of the few people I cared about not disappointing" - that may be the trick to Steve's leadership style, to personally set a standard for those who simple want to be the best. Simple, obvious, effective)

The end of my FitBit love affair

Today marked the end of a relationship. My fitbit and I are breaking up. I loved my fitbit. I told everyone I knew they had to get a fitbit. As someone who has been in the healthcare space for a while, I lauded the ease of use, data integration, and behavior change it could empower. I really believed in the device and the service.

I was not rewarded for that loyalty.

From a "let's learn a lesson here we can apply to start ups" angle (which, by the way, is the most annoying of all angles. Lessons, learning? Meh. Being angry would be easier. But I digress) , they broke two really important rules.

First, they have a very low quality device that sells for $99. For $99, the device should work, all the time.

You want to know my experience? I'm on my 7th device. That's right, SEVEN. That's how much I believed in them. To be fair, one I broke wearing in a ice hockey game, and one I lost. So I've had five that did not work. That's five hundred dollars worth of pedometers. For reference, that's a 16 GB WiFi iPad2 + shipping via a gold-plated Ferrari (not exactly sure about the details of that shipping option).

Before you start to think I'm the only one, the forums and poor Amazon reviews have many, many people all with the same issues and same phrases, over and over: broken, good support, low quality, great when it works. It appears I'm neither the most loyal, or the most frustrated, of their customers. There are a lot of good Amazon reviews as well, but the overwhelming feeling is the product violates most important rule: "just work."

Now, to be fair, Fitbit replaced the last two free of charge. They are making up for quality issues with great customer support; for me, the support team has been top notch. They've told me that this happens a lot, and they are quick to set replacements without a lot of questions, and they are always nice - even when I got a little impatient the last few times. Why was I impatient you ask? When I got my most recent  free replacement in the mail, it promptly broke within 24 hours. That's right - within 24 hours, the screen was no longer displaying data, and within 48 hours, it was no longer syncing. Again. After waiting a week for a replacement to come.

Which brings me to lesson number two. Don't make me feel stupid for buying your product.

I know, that sounds simple, right? Well, somewhere around Fitbit number four, friends starting saying "you bought another one of those things? What did you expect?" Remember that relationship analogy? Well, it sticks. You know when your friends say "Really, you're still with (or going back to) him/her? What did you expect?" - and then, when the same thing that always happens, happens again, you feel like a moron. Well, today, I feel like a moron. Maybe I thought number seven would be lucky. I can't explain it.

The good news is, there are many new startups on the horizon, with products like the Basis Watch and the Jawbone Up looking like worthy competitors, or at least something else to try to offset my disappointment. Even different failure would be easier to take than the same thing, over and over. Maybe they will work, maybe they won't - but my fierce loyalty to Fitbit has eroded to the point that it's time to look elsewhere. If they actually send me a replacement that works for more than a month, I'll post an update to this entry. I really do want them to succeed.

Today, ironically, they launched an upgraded device, the FitBit ultra. It  not only brings you choices of color (blue! plum!), but improved sensing. TechCrunch wrote a not-so-glowing review today, but for me, it's simple. You know what would be Ultra? One that worked.

Update 10/4/2011: - Fitbit offered to return my money, or provide me a new Ultra device, if I send back the  broken devices to their support team. Given I've been through this process with them for a while, this seems like a proactive and very fair response, and I was a little shocked at the offer of a financial return. Like I've said, the support team has been great, but that doesn't make up for all the issues. That said, it does make it hard to leave.

I have found the problem with our Debt Crisis...

....it's education.

Take a look at this screen shot from a recent CNN article about the United States getting "booted from the Triple-A debt club".

First, I don't believe this is an actual club. A club should have membership cards, or at least a cool logo for a t-shirt.

Second, I know we've already failed the math part of this test (what's a few trillion, anyway), but it appears we've also failed the geography part of the test as well. Dear lord.

This map can only be explained by one of the following:

1. Sarah Palin really did have a plan. 
2. Canada was still pissed about the Bruins winning the Stanley Cup, and took Alaska for their own while we slept.
3. CNN's editors went through California public schools. (Hint: This is what happens when you slash education funding)

(PS, the screen shot is from CNN and is still live as of this posting. The Photoshop awesomeness is all my own)

Update: How Awesome - they updated and fixed the graphic 4 days later! I'm not saying that we (by we, I mean me and the 4 of you that read this) but let's just pretend this was our moment in the sun. 




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The Great Incubator Debate

Today at the Computer History Museum, Chris Yeh moderated a panel of entrepreneurial thinkers, including Jonathan Abrams, Dave McClure, Adeo Ressi, Kindra Tatarsky, and Cameron Teitelman. The panel was part of the Orrick Total Access series, focused on Startup Incubators.  

After listening to the panel and taking some time to consider what I heard, here are my observations and thoughts on the session. I'm unable to squeeze in all the topics here - in particular, addressing the gaps in gender and race of founders needs further discussion.

What is an Incubator
I cannot remember an event where within the first five minutes, everyone on the panel made a concerted effort to distance themselves from the term "incubator".  To be fair, Dave McClure did exclaim “we’re an incubator, we embrace the term” after one pass through the panel with everyone explaining why they were not an incubator.

With an unfortunate run of failed experiments in the 1990's, the term incubator takes on a lot of different meanings to people. If you were in Silicon Valley for the "first bubble", you probably wince a bit when you hear the term. If you're under twenty-five, you probably don't care. In either case, it was interesting that each panelist pointed out they are not an incubator, and did so using definitional design of "what is an incubator."

In the end,  the debate on definition came down to three main topics - space, funding, and mentor networks. Only one of the participants offered all three of these attributes, although there was great debate if some, or any of them, are requirements to be called an “Incubator”.

Jonathan and Dave provide some of the most amazing space in the Valley in FoundersDen and 500Startups (read the 500Startups blog entry on space). Adeo, Cameron (StartX), and Kindra (Astia) do not provide space.
 
There was not much debate on the value of co-working or co-location. Having lots of smart, passionate people with different backgrounds, skills and experiences in close proximity creates better startups. Everyone from Mark Suster to Fred Wilson has chimed in on the topic in the past, and great environments like PariSoma, Dogpatch, exist, along with so many others, even if if you are not in an incubator.  

For me, space is important. When it’s time to move out of your home office and local Peets, its important to get into  high productivity, high-community Co-Working spaces. Jonathan had a lot to share about this point, and how it shaped FoundersDen.

The discussion of space also let to debates of "services", a term I believe that was  misunderstood by the audience, and even the panel. In today’s startup world, services are not accounting, legal, and front desk support - which you can get at Plug and Play or Regus rental offices - but having SEO, Marketing, Design, Mobile, and UX experts around, able to help with tough problems; these are the startup services of today.

I think this is one of the fundamental differences between today and the 90's incubator market. Legal, accounting, and other services are important, but to be successful today, it's less about payroll and more about customer aqusistion. I think this is directly attributable to the state of funding. I don't need to worry about payroll services when I raise $25k. I need to worry about getting revenue. In the 1990s, incubated companies were raising $5-10M rounds on ideas (or without ideas!) - so they needed legal and accounting services just to manage the intake. 

Frankly, the "support" industry for startups in the late 1990s - from legal to Solaris servers - was also tilted towards funneling big money back into the coffers of established businesses. As the Lean Startup and other movements that value execution over idea have taken hold, and server infrastructure become commodity (Rackspace, Amazon), the needs of the companies are laser focused on execution, revenue, and customers. This is a very good thing.
 
In the end, I think these market trends lead to the importance of community and mentor networks as the most critical asset that a Incubator can bring a potential applicant. The beauty of FoundersDen is not only an amazing physical space, but a curated community of people interested in helping others. I/O ventures, although not on the panel today, has a similar concept linking amazing co-working spaces, mentorship and incubator models.

It does not mean you cannot be successful without a great space - the mentor network and community is the most important aspect, which you can hear when Adeo explains that he ensures that all founders and mentors in his program have an equity stake in the other program participants. Any effort to keep incentives aligned is a good effort.

So the question to the entrepreneurs in the community is, would you give 5% of your company for amazing space and people, but no funding? I would. I’m lucky to have had an nice exit so money is not the critical aspect, but having an extended team of people, mentors and friends with aligned interests in an amazing space? Priceless.

Metrics and Scale
One of the biggest considerations you can hear, both in their words and in their voices, is the struggle of how to understand and scale the incubator process. In particular, Adeo Ressi and Dave McClure, in very different ways, are quite humble in admitting that they are still trying to figure out the metrics, values, data, and systems to filter the enormous deal-flow, and a process that is providing little repeatability in the process.

Dave often talks about Billy Beane and the Moneyball movement as one of his inspirations (if you have not read his blog post on Moneyball for Startups, please stop reading this and go do it. Now. I'll wait). If that sports reference does not translate well, I'll try to summarize a the entire book in one sentence: Billy Beane is a General Manager who figured out new models and approaches to talent aquisiton in baseball, which let small-market teams compete and excel with big market teams with less revenue.

This is the foundation for 500Startups, the Oakland A's to Sequoia's New York Yankees, but it also goes a bit deeper. What Billy Beane figured out, influenced by brilliant statisticians like Bill James, was how to break down common myths and apply a statistical model to find the best value. The subtitle for the book was "the art of winning an unfair game". That should give you the best idea yet of the fit and strategy of 500Startups.

A startup example - maybe Dave cannot afford Bill Nyguen and the Color team at $41M, but he's betting with the right system he can find the next Bill...before they are "Bill". Remember, the A's found and nurtured Jason Giambi, and later the Yankees overpaid him (Three times as much as Color, to be specific) a few years later. It's not a static state - some today's 500Startups companies will raise gigantic (and in some cases, overvalued) rounds. Dave will have participated in seed, and A rounds, and will let the Yankees take up B and futures.

This is the idea, to find a model, method, or some predictability in what seems to be a very unpredictable market. Specifically, Dave mentioned female founders, the international market, and husband and wife teams that are undervalued today, so he invests in those places. As he said - “I’m not doing this to be nice. It’s good business”.

Adeo is taking a much more scientific method with a testing and review process that he believes will lead to a data-driven approach to finding the best entrepreneurs. Although their methods, process, and outcomes have been challenged, the Startup Genome project and even Y-Combinator have been attempting similar, albeit less rigorous methods, of reviewing and synthesis of data.Cameron has created a filter by requiring you to be part of the Stanford Community, and Kindra requires at least on woman co-founder. These are all filters and methods to try to narrow down overwhelming opportunity.

It shouldn't be any surprise that many of 500Startups companies are in the area of metrics, process optimization (usually email), and related fields. Although he does not embrace it as publically as Adeo, Dave is circling the same topic. What's the signal to help identify great entrepreneurs in all the noise?

The current market, and the forseeable future, past success, market space, concept/execution, networking, and social proof (a reference is a requirement of 500Startups) will still make up the lionshare of successful applicants. It's never been easier to test out your ideas, get customer feedback, blog, execute, and network. As Mark Suster said at the Founders Showcase just a few days ago, in the age of social networking if you can't make a connection, you're probably already in trouble. So while it’s a fine process, it does lead to overwhelming in-flow. There was a time when execution set a high-enough bar as to filter out a large majority of companies that should not be funded. That bar has dropped a bit.

Personally, I'm leery of the purely data-driven approach. I added a Cognitive Psychology degree to Computer Science because I believe in the ideas of social science, but still find the process to be too malleable to believe in it as a sole input. As a startup community, we need to continue to collect and analyze success and failure.

We're currently devoid of a enough data in enough markets, and still struggling with issues of  cultural/gender/race bias. Adeo is onto something, and combining his data-driven approach with social proof, execution, and hustle found in the 500Startups methods will be the best filter for another five or ten years, as we gather actionable data we can use to have a more predictable model.

 In the end this is still a hits business, be it baseball, music, or startups. There will be misses. 

The most important thing for you to do as an entrepreneur is to know the incubator you are applying to, do the research to understand their values, process, and interests, and be sure there is a match with your values and interests. You have a responsibility to contribute to the community, to give back, and to be bigger than something you can be on your own. There are a number of great incubators (or whatever they want to call themselves!) - go make it happen!

Did we miss something? Startups and Customer Acquisition

A few minutes ago, I signed up for @TotalHealthHub, after talking to one of the team members on Twitter.

They are using LaunchRock, an excellent landing page creator for pre-launch startups. Below is a picture of the LaunchRock page right after I signed up and tweeted it out. As you can see, easy to share via Facebook, Twitter, and even email. The email includes easy-to-use address book integration. For the 2 people left I know on Orkut, there's a URL I can provide, too. Spreading the digital word could not be easier, but it still got me to thinking, have we over-focused on the social media and pre-launch phases as a startup industry?

When did we loose word-of-mouth? The thing that strikes me is there is no way for me to actually share this experience and participate in the virtual currency - in this case, early access to @TotalHealthHub - by telling my network verbally. It does not scale, but it's very powerful; looking someone in the eye and saying "you have to try this". The fact that there's no way to capitalize on that delivery mechanism is fertile ground for improvement.

The same is true post-launch. It's fantastic to have so many people signed up for your pre-launch and your VC/Angel/team wants to see that pop, so you can look at conversion rates and get real feedback from the community. It's critically important, even if you do not subscribe to the Lean Startup concepts on which it's based. But it's equally, if not more interesting, to see who is referring you after they have tried it. I have not seen many sites do a good job with referrals post-launch, which reflects who liked your execution (post-launch), not just your idea (pre-launch). There is a tool/solution gap here.

Last week I gave three presentations where I said "you have to try Earndit, it's a game changer for FitBit and the Wellness Market". I didn't stop to give everyone my custom URL - never mind reading it out, no way will I remember them all - it's hard enough to get EarndIt's name right. Yes, I could followup with a URL after the meeting,  but the conversion moment was right then, when I stood in front of them and told them they had to sign up or they were missing out.

These people represent your real users, who tried the product and want to tell people about it after the buzz settles. If nothing else, I want to be able to thank them - publicly, too - it's not only brands that like to see their mentions on Twitter and Facebook. Startups need to know these post-launch champions.

Can't I solve both of these the same way? Why can't I just put in the email of the person that recommended it to me when I sign up, be it pre-launch or post-launch? Or even their actual name, if I don't know the email - and I'm saying this as a guy whose name my mother still spells wrong sometimes, and she choose the name. Email and Names are still far more popular that Twitter or Facebook. You can find people without Twitter, and you may be able to find someone who is not on Facebook, but email is still the foundation that they are built on.

I'm not saying the current implementation misses the mark. It most certainly does not.  Twitter and Facebook are high-scale, low friction ways to get the word out to many people all at once. I also don't want to pick on LaunchRock. I know there are a lot of people that say they are selling picks in the gold rush, to which I say "thank god for them".

Creating a landing page, linking it to social media, and providing analytics are critically important to launching your startup and are exactly the type of activity that takes you away from your novel idea. LaunchRock makes this amazingly easy and productive. It's a good solution, along with others like it, such as Unbounce. Anything that helps you focus on your value add - be it AWS or LaunchRock, is a good thing. I was happy to see they are part of the latest 500Startups class, and I am sure they will tackle this issue - and many more - in the near future.

What do you think? Have I blown this out of proportion, or is it a gap in our customer development?

Update 6-13-2011: Although it's specific to Mobile Apps and the cycle of find-install-delete, I found this article  to be interesting, and if you are interested in on-boarding, may be interesting to you, too.

Thoughts on the Stanford Mobile Health conference

I like to blog about events, conferences, and shows after a few days have passed, so I can see what might have what really stuck with me, what's still rattling around in my head. In particular, the Roni Zieger quote is not something I would have written about had I written this blog Thursday night, after the show ended.

There are several great blog posts already available on the Stanford Mobile Health Conference, including those from Text in the City, Kevin Clauson (@kevinclauson), Craig Lefebvre (@chiefmaven), Andrew P. Wilson's wrap-up (@AndrewPWilson)  and what I believe to be the very first blog on the conference, over on Jeremy Vanderlan's Thulcandrian tumblr (@thulcandrian). These folks all did quite a good job summarizing the show, so there's no need to repeat them. I highly suggest you go and read their entries first, in particular, if you did not attend the show.

I've also included a list of other resources about the show at the bottom of the post. If I've missed something, go ahead and drop a note in the comments and I'll add it.

Here are some of the things that stuck with me after the conference:

1. Quality of People and Creating Opportunity

As you've already read from the other blog posts, the show was extremely well run, with a huge amount of credit to BJ Fogg, Tanna Drapkin, and the entire group of  Stanford student volunteers, A/V professionals, and catering team. I don't think it can be overstated how well the conference was prepared and executed. In particular, the show was crafted to create a community feeling among the attendees, provide lots of interaction opportunities, and keep the attendees engaged.  

It felt very much like everyone in attendance was a speaker or presenter, but it turns out that not only was that not true, the percentage was actually lower than most conferences. By my estimation, there were about 450 people at the conference and 47 speakers, which includes BJ and the three folks that made up the "walk-on" session. So for the sake of discussion, let's call that 10% of the attendees were also speakers. For comparison's sake, the American Telemedicine Association (ATA) conference had "over 4,000 attendees.... and 260 presentations". Let's assume the ATA had an average of  two presenters per presentation (by a quick review of the ATA agenda, that's very conservative), they far exceeded the speaker/attendee percentage. Yet at ATA, it never feels like you get to interact with the speakers, deeply discuss their position and findings, and debate important topics. I should be clear, the ATA is a fine show, focused very much on the industry, vendors and business aspects of the Telemedicine space, but has a very different feel to it on an intellectual level. 

It's my belief this feeling of connectedness was established through the creation of opportunity to interact, amazing quality of attendees, and speaker engagement. Nearly all of the speakers were in attendance the entire show, and were introduced to the crowd, one-by-one, at the start of the conference. This technique immediatley reduced the transaction friction between attendees and speakers. Secondly, I would proposed that the majority of the people in attendance could have been speakers. The quality of the attendees was unmatched by nearly every conference - healthcare, startup, or technology focused - that I have attended in the last 24 months. I met so many people I am honestly excited to meet up with later this month, and walked away from dozens of conversations stimulated and challenged. 

Additionally, we should not overlook the use of techniques such as Topic Tables, copious breaks, great food and a contained environment kept people off their mobiles and in the conversation. 

Now, lest you think "contained environment" means that the conference team locked us all in a room, let me explain. The conference was held at the Frances C. Arrillaga Alumni Center on the Stanford campus. As you can see, the Google Maps gods are on my side, and I was able to get you a picture of what the grounds look like when set up for a conference. A large amount of outside seating, directly off the main hall, created a great environment for interaction, and limited the exit points for attendees. Quite literally, there was nowhere else to go, and we were herded into interaction, even if it was very, very subtle. 

2. "The Missing Sessions"

Over the next few weeks, I'd like to blog about each of these topics, but in lieu of that, here's a brief summary of topics I think should be addressed in the 2012 curriculum, and more importantly, debated by the community immediatley:

How do we keep mHealth from deepening the divide between the "haves" and "have-nots"?

While there was a lot of healthy and inspired talk about SMS in Africa, the role of mobile phones in lower-income areas in the US, and related topics, I'd like to see a specific panel focused on the possibility of a divide between socio-economic classes that may be driven by mobile health. I personally have a fear that the majority of the most innovative developers and startups - and the venture capital that backs them - tend to go towards native applications for Android, iPhone and iPad. This is not only for patient communities - Sharon Bogan from Kings County (Wa.) talked about how "even [our] managers have Windows98 machines." Even with their Herculean efforts to get around budget shortfalls, the lack of quality equipment means compromises not only in the latest technology, speed, and access, but basic things like advanced security. No one deserves to have their personal information compromised because their health department cannot upgrade to a modern browser. 

What's the role of mHealth in innovating the caregiver process?

I've already talked about this a bit in other posts. I think discussing mHealth only in the context of the patient is a significant limitation to our space. To his credit, Roni Zieger did discuss Google Body, and innovative uses of tablet technology by physicians in the field. For me this only highlighted the missing professional representation of mHealth. Google Body is amazing use of WebGL, but is not exactly mobile, and the tablet demonstrations were innovative home grown use. We have to start somewhere, so this was an adequate introduction in 2011, but in the 2012 curriculum, I'd like to see a session based on professional use of mobile. Including a study that shows how to manage SMS at scale - that seems like the next burden will be how to manage, prioritize, and route a large-scale inbound SMS load.

What failed? 

This is a little unfair of me to mention, given the title of the conference was "Mobile Health:What Really Works," but I'd like to see some failures and post-mortem analysis. This years mHealth show was full of amazing presentations, and I learned something from nearly each one of them. That said, as our market grows, I'm convinced I would learn just as much from someone who failed , but learned something meaningful they can share. Like any budding market, mHealth is going to have a lot of casualties, but the mark of a great community is one that embraces their failures, shares them with the group, and rewards risk-taking. I think the community of people I met at the conference can inspire and support that type of greatness.

How to manage a global regulatory process?

The role of the encryption, security, privacy, HIPAA, and even the  FDA and regulatory process did come up quite a bit during the conference. The FDA was a diamond sponsor of the event, and had a few people in attendance, all of which is a very positive trend. That said, for companies who want to bring products into this space, it's going to be critically important to understand the global nature of the regulatory and legal landscape. As it stands today, there are some major legal differences between the EU, Asia, and US that make healthcare product development costly and challenging. The idea of adding patient mobility, international networks, and different legal systems into play makes for an intellectually challenging - but daunting - task. A panel of regulatory experts from across the globe would be fascinating. Let's not forget patients in that global picture, either - the different cultural expectations of privacy, sexual taboos, and role of the physician could have a profound effect on successful mHealth.    

3. Roni Zieger's quote

During the second day of the conference, Roni Zieger said "I've tried to make a conscious effort to stop saying 'no'. It makes me a better physician and a better parent." This has little to do with mHealth, but like so many events, if you fill a room with smart people, you get a return on that investment in many different areas. Roni did not go any further on the topic, but as a parent I started to notice how often I was saying no, don't, can't - and every time, I heard Roni's comment in my head.  I've tried over the last few days to internalize this into a more proactive, empowering, even Socratic approach to communicating. I'm hopeful it will make me a better parent (She's only 6, there is only so far we can debate Skill vs. Inspiration in the context of iCarly), but I'm pretty sure it will make me a better leader and a better communicator. 

4. Some resources that may be helpful to you:

• A list of people who tweeted during the show, or shared their Twitter address as a good way to reach them.
• Transcript of Susannah Fox's Talk
• The King County Texting Project
• Speaker Slide Decks
• Aza Raskin's blog post that inspired his talk

Update #1 - Added Andrew P. Wilson's blog entry to second paragraph.

How I Stopped Worrying and Love [the name] mHealth

Matthew Holt is very outspoken about his dislike of the name "mHealth" or "Mobile Health".

Although we've traveled in the same circles, both professionally and geographically, for many years (and share a love of EPL, no less), I've never met Matthew.  I have only been able to consume his displeasure in Twitter comments, such as these:

This always left me wondering, do Matthew and I share the same concerns, or is this something else?  Over the last few weeks I've tapped into my network to try to understand the comments, as everyone from my former VCs, employees and friends seem to have a connection to Matthew.  Thankfully, this week, Matthew answered it himself in a recent post to the Healthcare 2.0 blog. This won't surprise you if you know me, but I've got an opinion on his post.

Matthew's key point is that the terms mHealth and Mobile Health limits us to a specific device, such as a mobile phone:

"Calling something mHealth traps it to a device, in particular a cell phone, and ignores the rest of the ecosystem of the technology and culture that the cell phone is but one part of"

I personally don't share that point of view. Some of you may even go further and say  "ah, but at the Mobile Health conference this week, fitbit, dailyfeats, and zamzee all presented, and they do not use a mobile phone!" The reality is, the conference was dominated by SMS and mobile-phone solutions. This is not at all a bad thing, as we saw some wonderfully innovative work. But if you were to oversimplify Matthew's comment to "phone or not phone", you would miss the bigger point, which is the ecosystem and platforms. Specifically, he called it “unplatforms.” 

This is where Matthew and I violently agree.

I'm a platform guy. I believe in systems-thinking. Haley Joel Osment sees dead people, I see platforms and ecosystems. It's what I love, and that was my last role at Bosch, spearheading a new Telehealth Platform.

To that end, I believe one thing that was missing from the Mobile Health conference was the impact on mobile to the caregiver, a key part of the ecosystem. This is something I personally really missed the boat on at Health Hero. Tying a caregiver to a computer screen is a rather ridiculous idea, given this is the industry that made the pager market. That said, when I tweeted that idea of the role of the professional in mHealth, I got a lot of backlash, a lot of "mHealth is about patient empowerment, nothing more". I hope that's not true, or we're missing a good part of how we can improve the health industry with mobile technology.

Naming and terminology, especially in Healthcare, can be analyzed and debated to endlessly - I sometimes think debating mission statements is less painful, if you can believe that. These activities usually resulting in terminology that is either very narrow and specific, or so vague that it has no meaning. As an industry, we have not done a good job of creating a nomenclature that is inclusive of the ecosystem.

For example, I am personally fascinated by the use of Television for providing healthcare and worked on many prototypes in my spare time. Despite the struggles of Motiva, I am sure there is opportunity here. But what to call it? Telehealth? Taken, but who knows what it really means. Telecare? Taken, and differently on different continents! tHealth? Dear lord. I'm already exhausted. (Speaking of which, if I step out of my "Patient Centered Medical Home", is it my "Patient Centered Medical Yard?") Someone will come up with a clever name, and we'll follow along. This only highlights the point that the Television-based solution is but a part of an overall ecosystem, and the clever naming of the solution is far less important than it's systematized impact.

Now, do no misinterpret my point - naming does matter, especially as we, as an industry, achieve scale and impact. Naming is particularly important when it removes our attention from the integrated delivery of care across the ecosystem.

For twelve years at Health Hero, I called our solution everything from "Telehealth" to "Remote Patient Monitoring" and everything in-between. If you want to see someone make a face that looks like they just stepped in something nasty, tell a German during the due-diligence process that you provide "Remote Patient Monitoring" - the idea that patients want to be monitored may seem creepy to someone in the United States, but is down-right blasphemous in more privacy-sensitive cultures like the EU.

I have a somewhat "lighter" story that illustrates the same point. I spent a lot of time in Germany at Bosch Headquarters and UK launching NHS after the Bosch acquisition. I spent so much time, that I came back to to States and once asked someone at Starbucks to "please give me my handy". My advice to you: Don't do that in San Francisco.

As we increase the role of the consumer in their care, these names and terms really do matter. They need to be culturally and globally sensitive, provide a brand and market concept with an aspirational vision, and most importantly, provide simplicity. If I cannot explain to you, the patient, what we do in thirty seconds, why would you even try it?

At the same time, as a group of people trying to effect how care is delivered, let's not lose site of the fact that whatever we call it today will, over time, be adapted and change, and it's far more important that we don't forget the importance of the system of care and the role of our processes, technologies, and people in the healthcare ecosystem.

Update #1: Fixed a few wording and typos based on feedback, mutual friend told me Matthew prefers Matthew to Matt, so fixed all the "Matt" references

Startup Lessons Learned: Mistakes in Accelerator Land

I received some unfortunate news that my new startup would not be part of the latest i/o ventures class. We made it to the very last round but did not get over the hump. Given over 350 companies applied, making it to the last round is something to be proud of.

More than anything, though, this blog entry is about my disappointment at the mistakes I made the process that might have made a difference.  I had at least one friend say "you can't blog about not getting picked, you'll have the sent of failure". Based on what I believe in, not doing this would be very hypocritical of me. And as for my sent, well, I'm a startup guy. You expect CKOne?

So here's my experience, and my mistakes. Hopefully you can learn from them.

To start, I'd like to take an opportunity to let you know the experience with i/o was a positive one. They've created something pretty special  - a good group of forward thinking people,  an incredible space and working environment, and a "vibe" that inspires confidence. If you are looking to work with a early stage investor, make sure to add them to your list.

Although there are several partners in the firm, I met with Paul Bragiel, who led the process. I honestly can't say a bad thing about the process or Paul, and enjoyed getting to know him - and not only because he's a soccer fan, which we need more of in this country. We even had to take a programming test, which was both exciting and nerve wracking. I had not done that level of algorithm work in a long time.

In one email exchange, Paul asked me specifically why I wanted to join someone like i/o,why not go at it alone, given my background and past experiences (successes and failures, for the record!). That's worth explaining, I think, as it will also shed some light on why I would write this blog entry.

I'm a huge believer in the startup community. Specifically, I mean places like i/o, 500 Startups, Y-Combinator, and other resources and groups that are more than just investment. Please understand, I have nothing against money (especially if you'd like to write me a check...), and I'm not running a non-profit. At this stage of my entreprenueral career, I'm most interested in getting involved with a group of people with various backgrounds, expierences, failures, successes, and points of view. I think it will continue my growth, and I'd like to think with my past, I have something to offer that community as well.

Specifically, what I don't want is to pretend that I've learned everything with one successful exit, and I can just go off and do this in a corner. I could, but it would not be rewarding or interesting, and I would not learn half as much as engaging in the community.

I've said it before - one successful exit is a point on a graph. When I look back over my career, I want a line. With an upward slope.

I think this comes from the challenges of my last Startup. Creating, growing, and eventually, successfully selling Health Hero to Bosch took a very long time. We were VC backed by more traditional VC funds. Although I had a great experience with our VCs overall, we were not part of a community per se, and I really don't believe the startup world was even that interested in community back then. We struggled to even meet or work with other portfolio companies. Going through the bubble-bursting in Silicon Valley made that more evident. There were days you literally felt like the only companies that were alive. 

So, I'm writing this today to try to share some of the mistakes that I made in the process with i/o. You are quite a hypocrite if you say you want to be part of the community and want to give back, but then as soon as something negative happens, keep it to yourself. Someone else can learn from this, I'm sure of it. So, here are three things I should have done better in the process.

Communication
Here, I did one smart thing and a few bad things.

The smart thing was to monitor the partners, and as soon as they opened up some time on ohours.org, I jumped on it and drove up to the city for a twenty minute meeting. This was not just so I could re-hash my pitch in person - in fact, I didn't do that - but to get to know the people (can I work with them?) the space (can I be productive here?) and get the overall vibe of the environment. At least from my side, I hit it off with Paul, and left feeling pretty good about i/o, the people, and the working environment. And the coffee. There was honestly no better ratio of 2.5 hours of traffic to 20 minute meeting. It was totally worth it.

You need to be monitoring the people you want to invest in you, just like they will be monitoring you. Get to know as much as you can about them early and often, and any chance they present, such as ohours.org, take it.

Now, here's where I screwed up. After that meeting, I got very quiet. I really did not want to be annoying or badgering, so I only responded to emails and requests for information. I didn't reach out. This is particularly bad because I was reaching out to other people who had been in the space I am tackling, and their feedback helped me refine (pivot?) the idea to make it much more solid.

Specifically, I did reach out to one of the contributors to the TechStars book "Do More Faster" who failed in this space. Their feedback was like listening to someone coming back from a horrible, painful war - "I'm never going back there". I felt guilty even bringing it up with him - however, once I framed the core idea, they liked it. We just wrapped it in the wrong description, the wrong process. The problem was, I never communicated this to i/o. I never said "hey, this is what we learned in the month and a half since we applied."

It's fair for i/o to think I might not see how hard the original idea was going to be in a fragmented market,or that others had failed in this space; I'm a guy that hit my head against the healthcare market for a long time. And, of course, that was some of the feedback I got at the end.  

I needed to be communicating along the way - not over communicating, but letting people know where we were. I'm going to continue to struggle with "not being annoying", but I could have done this a lot better. Also, what if they loved the original idea and we started to change a bit? I need to communicate more, push myself harder.

For the record, I'm not naming the person from "Do More Faster" only because I did not ask their permission, but their feedback was really helpful.

Visualization of Winning is good, but....
I grew up playing sports and played soccer at a very high level including through my college years, which meant you got more than a little sports psychology along the way. I tend to come from that school of "visualizing success" - I see myself scoring the goal or making the play. The problem is, sometimes it can be all consuming, and I became a little too fixated on being part of i/o.  I didn't reach out to other firms, and I did not apply to the YC class (The YC application for this summer was due two weeks before the final word from i/o), because once we made the final round, I was visualizing scoring that goal, and knew this is what I wanted. Stupid mistake.

It's not going to kill me or the company, but I should have assumed the worst (visualize the best, assume the worst). That's lesson number one of any startup. I honestly think this one embarrasses me the most, as this was where I excelled getting Health Hero through the bubble bursting.  I lost my edge here.

Know your (potential) Investors
I've talked about this before so I'll try to be brief (insert joke about me and brevity here). It's critically important to know your potential investors, what they are interested in, what their backgrounds are, what else they've invested in. You need to be reading CrunchBase, blogs, and profiles of the people you want to work with. At the Launch Conference, I specifically targeted Tom McInerney during the startup speed mentoring sessions because he had  a connection to i/o; this is good.

However, neither Tom or i/o has a specific interest (based on past experience or past investment) in the general area I'm targeting. It's a bit like taking a healthcare company to Kevin Rose, or a online gaming company to RockHealth. This doesn't mean Tom, i/o, or Kevin (all people I'd love to work with) won't invest outside their comfort area, but most angels and seed funds want to invest where they feel they can help.

It's up to me, as the founder, to help paint that picture, and put it in context. I didn't do a good enough job of putting the idea in context for a group of people that literally hear at least a thousand pitches a year.

So I hope that is helpful to someone, and talking about this minor setback does not taint me with the sent of failure (I prefer "the musk of experience", for the record).

I strong urge you to check out i/o, TechStars, and 500Startups and other mentor/community driven seed funds and to give back to your community, and share your mistakes. Feel free to send this to people that might be going through an application process like i/o. We'll all be better for it.

Update: There's a really nice post about the TechStars community I just ran across, and wanted to add it here. From Highway 12 Ventures, here's "Contribution, Community, Mentorship"

Update #2: Humbled that someone in Brazil linked to this entry and wrote about the importance of hearing "no". I used Google Translate to ensure it doesn't say "This guy is a moron". At least, I hope Google got it right...http://empreendersaude.com.br/2011/04/04/por-que-receber-um-nao-pode-ser-melhor-que-receber-um-sim/

Update #3: This post was referred to by the Nokia forums, a blog post by another individual who got to then end with i/o ventures but didn't get over the hump either. It's very interesting, I'm fascinated by the African market, the role/size of Nokia, and even SMS. Something tells me there is a lot of value to understanding that more, it's not all iPhones and Android like here in Silicon Valley.  The post: http://blogs.forum.nokia.com/blog/simon-botes-forum-nokia-blog/2011/04/02/startup-lessons-from-africa