#LetToddWork vs. #LetToddSpeak

Update: I got some very good feedback from friends like Jackson (see comments) and smart folks like Clay Johnson (via Twitter) that made me reconsider a few points. If you don't know Clay, you should catch up with his writing and his radio appearances. His recent comments regarding Congress' Self-Lobotomizing on NPR had me cheering out loud - which, is has awkward as it sounds when you have headphones in.

@geoffclapp if the company was losing a million dollars a minute & was a seasonal business, they'd postpone the board meeting a couple weeks
— Clay Johnson (@cjoh) November 10, 2013

To Clay's point is fair. It was not, however, my experience (ironically, with a national VA health IT contract). As CTO, the Board wanted to know everything I was doing when the stuff-hit-the-fan. There were more updates, not less. I found that being transparent and getting out in front of it really helped - something I was not always good at."Too busy fixing" would never have flown, at least for me.

That said, I took a personal  "N of 1" and made a generic statement from it, without being transparent on why I believed it to be true - who knows if that experience scales to other organizations. Thankfully it has not happened to me again. There are many different possible actions by a Board in this situation. So, while I'm leaving that sentence in for the purpose of discussion, it probably would make for a stronger argument to remove it. Fair point. +1 for feedback!

My frustration is that many of the people working on this and other healthcare related problems - former PIF's like Ryan and current ones like Adam - and many other staff there, are friends. I want the public not to see these people as the problem, but the solution, and to bring confidence where there was incompetence. Perception and trust is going to be a big part of the future of our healthcare system, and having Todd out front, I think, is good for the long-term prospects of this critical movement. I don't want to give the nay-sayers the ability to claim we're hiding from the problems. Maybe it's just wishful thinking that Todd can get the team in place to fix things and be the face on the movement, but I believe he can.

Original Post:

A movement of sorts has started within digital health in response to Sen.  Darrell Issa's subpoena of United States CTO Todd Park. I won't bore you with the details, and the the premise is simple - republicans want him to testify, and the White House says he's too busy fixing Healthcare.gov right now to come over for a chat. My guess is that none of this is his decision, and being played out by people much more political than Todd.

In response to the subpoena, the digital health community has now started with it's own take - which, like any good movement has a hashtag (#LetToddWork) and a website (http://lettoddwork.org/). To be clear, I signed it (as much as approving use of my twitter handle is 'signing') - but at it's core, I'm signing to make sure Todd knows he has my full support - there are few people I support more in Government - but I think the specifics of the movement are flawed.

Like everyone in Digital Health, I've met Todd many, many times, and always been impressed by him. His energy and passion are infectious, and the idea of him behind the scenes marshaling resources to get Healthcare.gov fixed gives me confidence.

At the same time, he's the CTO of the United States. "Letting Him Work" should include communication - the idea that #LetToddWork shouldn't include this is hard, logically, for me to understand - and I think the world of Todd. I think the lack of transparency combined with taking away Todd's skill of the spoken word is a major misstep, and not the path we should encourage.

If this was a Startup - an analogy that Todd himself likes to use - would we say "Sorry, our CTO isn't coming to the board meeting to explain why our latest release failed, he's too busy fixing it." That would never be acceptable. It also would suggest that the team has been built so poorly that fixing it can't be done without one specific person - which is a bigger red flag than any other. Again, I believe Todd is inheriting this mess and inheriting this messaging, but for us to support the lack of testimony and the #LetToddWork approach is, I would argue, failing Todd.

Let me put it this way. One of the things we love about Todd is ability to get people behind a movement, such as Open Data. He comes from Healthcare. He can motivate and inspire. Isn't Todd who you want talking? Isn't that what we love about him? I am sure he's a very smart and accomplished Software Architect and Programmer at some point in his career, but if that's what he's doing now, we're in the deep stuff. We need him out front. We need a clear plan, spoken not as a bureaucrat but as someone who has success in the private sector solving problems just like this one, and someone to motivate the community behind it.

So here's what I want. I want to hear from Todd. I want Todd to tell me how I can help. I want to see a plan I can get behind, and contribute too. I want the White House to let the Todd we-all-know shine through, not be buried and hidden and used as political pawn. And I want our community not to fall into that political trap.

I have no doubt that Todd is doing everything he can, everyday, to fix this mess. I also know that if he was the Face out Front, not the Fixer in the Back, we'd all be better off.

Maybe the right movement is #LetToddSpeak

Digital Health Needs More Teddy

You know who didn't get "stymied"? Teddy f'ing Roosevelt. We need more of this in #DigitalHealth. For those who are, as Teddy said "actually in the arena" and coming up short "again and again" - I cannot say if you will know Victory or Defeat, but you will be better for it.

Innovation at Boston Children's

At this week's Strictly Mobile conference, I had the pleasure of hosting a fire-side chat with Naomi Fried, the Chief Innovation Officer of Boston Children's Hospital. If you don't know Naomi's story, you should, as it's one of innovation, empowerment, and technology - all inside a hospital. Or loosely put, "every stereotype you've had about hospitals, debunked".

Photo via Twitter

Naomi's program focuses on "innovating innovation" in the hospital, especially the development of mobile applications and services. This is done through competitions and a formal program to surface great ideas that already exist inside the staff, but have little chance of seeing the light of day without Naomi's innovation program.

While there are a wealth of interesting possible things to highlight, three things really stood out to me:

1. Shifting the currency  - Incubators, VCs, Angels, even banks, are really good and giving you money. It's never been easier to get money, but it's never been harder to execute. Building a team, finding the right skills, getting into a hospital system - and more specifically, their EMR and IT Systems - will suck up all that money and more. So what Naomi's organization did was look at where the real challenges are - finding mobile developers, project managers, IT integration, and said "rather than giving out a grant, let's give people access to human capital!". As the currency shifted from hard-dollars to soft-skills, the idea that Naomi can put a team, including developers, along side the idea originator and ramp up the execution machine puts the focus on getting products into patients hands, where it should be.

2. Self-Disruption - Probably my favorite part of the story, this is an organization that starts by disrupting from within. From the head of radiology to the head of parking (true story), everyone in encouraged to submit ideas, and, if they are selected, bring the products to actual users inside the hospital.  Consider the impact on employee morale and satisfaction when you know that rather than bringing in a number of "outsiders", the team at Boston Children's is encouraged to lead the development of solutions to problems they see and face everyday. And yes, the head of parking's idea was selected and tested.

3. Patient First - Over and over you heard Naomi speak not of the IT department, or fiance committee or even, really, other doctors. The constituent you heard her mention the most was the child receiving care and their family. So not only is the program great for internal morale, but it also serves to extend the values of the hospital right into the innovation program - something rarely, if ever, experienced. Recounting situations where the mobile apps were helping to understand discharge conditions, or providing pictures of the care team to the family, there was a clear message of transparency and empowerment for the patient, above all others.

Call it "3a" or "Bonus", but I also want to highlight a great Q&A interaction with the audience. One audience member asked "this sounds very expensive, how can you afford this?" - to which Naomi explained that the only expensive option was continuing to operate in their current manner. It reminded me of that great quote on design - "If you think good Design is expensive, wait until you see what Bad design costs you." The point being, the hospital systems are starting to think about total costs of care not only in the hard dollars, but in the time, effort, efficiency, and satisfaction of it's customers. Listening to her discuss Return on Investment by looking at the entire ecosystem would make even the most jaded health-tech entrepreneur warm with opportunity.

There are easily a dozen more points that Naomi made that could be their own blog posts as well, but these were my personal highlights. I certainly encourage you to check out some of her interviews on YouTube from Converge and World Health Care Congress. If you're not following Naomi and what she's attempting to do at Boston Children's, you're missing out on some real trend-setting things happening inside the hospital.

Here's a bit more of Naomi in her own words: Tweets by @NaomiFried 

Back in the Saddle

The time after we sold Health Hero to Bosch - many years now - was spent mentoring startup founders working at the intersection of healthcare and technology, something I love doing to advance the industry and support passionate people trying to make a difference in the world. I was often jealous working with these amazing founders at Rock Health and other organizations, as they had found “their thing”, and I was still looking for it. 

Now I'm getting back in the ring again as a founder myself, and I'm excited to announce the launch of Better. At Better, we're working with two world-class partners, the Mayo Clinic and the Social + Capital Partnership, to make the very best mobile healthcare experience available to people all over the globe, 24 hours a day, seven days a week.

For a preview, you can see the video of our AllThingsD demonstration and read the accompanying article [and thank you to David Shaywitz for his nice piece in Forbes - and MobihealthNews for their article as well]

You can also sign up for early access on our website at www.getbetter.com, but you won't find a press release or a major PR push (yet). We're a company that stands for execution, and we'd rather show you than tell you what makes Better the gold standard for mobile healthcare, and were working diligently to get that into your hands.

That said, I wanted to share the beliefs and trends that inform our approach, and why I'm so excited to push all-in on Digital Health again. 

First, there’s a lot of controversy in the Digital Health space about the future of people - very specifically, the role doctors and nurses will play. It’s possible that IBM Watson is our future doctor, and, with Big Data and evidence-based medicine, there is no doubt technology will play a significant role in the process of care.

I fundamentally believe that great care needs to start with great doctors and great nurses, and we need to focus on scaling, not replacing, them. Yes, we have a shortage of care, and yes, the cost of computing power is less than the cost of people - the classic “people don’t scale” argument. Starting with the idea that we have to replace people with machines is counterproductive, because it doesn’t force us to solve any of the real problems we have in healthcare today, like operational efficiency, care delivery, and adopting successful consumer models for engagement and growth. So, our take is simple: start out by partnering with the very best healthcare organization in the world, the Mayo Clinic, and focus relentlessly on growth and scale.  

I also believe in sensors and Quantified Self, but I believe the power of QS, sensors and wearable computing lies in how it's implemented, communicated, and acted upon. Let’s be blunt, the actionable part of the sensor experience stinks today unless you have a Ph.D. in Microsoft Excel and behavior change and the motivation to apply that change to yourself. The devices are great, the data is muddled. 

Simply throwing data back at people (especially from multiple devices) isn’t sustainable, coachable, or really healthcare - it’s data processing. So, let’s flip this on its head. What if we worked with the world's best coaches and doctors to build plans for using QS-style data (integrating it into care plans, teachable moments, and clinical protocols) and could provide both you, the user, and the care professional actionable analysis, accountability, and celebration, rather than just a badge?

We’ve seen this model before - just look to the consumer technology providers in the  financial market. E*Trade, TurboTax, and so many other systems provide people - and not just people, but experts - available to you to help you process complex or confusing moments in finance. Where is the Health Advocate, who interprets, analyzes, and coordinates how my family consumes and receives care?

I also believe any time we have legislative change to fundamental structures in a market there lies opportunity, and the market is setting up for unrivaled innovation and change in Digital Health. From HSAs to HDHPs to Exchanges to the FDA to ACA to Meaningful Use (...this keeps going for a while, lets skip ahead....) legislation is here to stay. Yes, it may change here and there in the fringe, but we’re going through a massive period of change.

I believe empowering consumers to be engaged in their health starts with choice. Mobile and consumer choice has changed every market, and healthcare is not an exception to this force. We will work to drive healthcare prices down and to expand options to as much of the population as we can. This starts by providing choice, and exceeding expectations of what “quality care” really means. At Better we’ve already taken services you simply can’t get today, made many of them free, and cut the cost of most of them by 30% or more. We will also offer more premium services at a higher price point, and if you want a jet to come pick you up in a foreign country and fly you back to the best care in the world (yes, we offer this), it costs money and is not for everyone. But the very engine of a market economy is empowering customers and growing a market is giving them the choice, and we're very sure this will have a net-positive effect on the market costs, overall.

Some people have asked me why we’re starting with direct-to-consumer, rather than employers, insurance companies, or one of the more traditional entries into the healthcare space. It’s still - wait for it - about choice. Today your employer tells you what plans you can participate in. Your plans tell you what doctors you can see. Your doctor, nurse, even the hospital you can visit might change just because you changed jobs or your HR plan got “re-evaluated” this year...and God forbid you get sick outside your hometown, when it’s not even clear what choices you have.

I’m not saying that we are not pursuing and executing in traditional distribution channels, but we’re not avoiding consumer, we’re embracing it, because if we can build a great consumer experience  every other market still wins.

I don’t like when people say something can’t be done, or when they avoid the "hard" stuff, be it consumer-centric models or FDA regulation. Just look to Health Hero for examples - everyone said we needed device connectivity and should pump data back to doctors, and anything else would fail. They couldn’t believe we’d dare start with a model that not only allowed for, but prioritized, patient-generated data and behavior change content over being a simple data pipe, and built highly optimized processes for nurses backed with technology  Five years later, everyone from Philips to Intel was doing it "our way". We all know that ended pretty well, most importantly, for our patients. 

I believe we can bring choice, access, and world-class quality to healthcare, and that means extending an experience beyond just a single market, like “chronic care” or “wellness” and focusing on the needs of the patient, whatever they may be, whenever they may happen. 

I hope you’ll join in, with your clicks, feedback, ideas, or joining the team. 

Thank you, #digitalhealth (a.k.a. Bring your Daughter to Hackathon Day)

A very quick thank you to the Digital Health community. Recently, at the Prebacked MedHack Hackathon event, I served as a mentor. At the time, there was a lot of discussion on the internet about women at tech events, specifically surrounding the PyCon "Dongle-Gate." As someone with a daughter,  I wanted to do something very small, but meaningful and personal, to try to reverse this trend. So, that day, I brought Mackenzie, 7, to join me to see what I do at these crazy events I'm always going to. And she had a blast.

She made her own business cards and handed them out. She set up a play-date with one of the an eight year old son of one of the founders. She didn't just plan it, she scheduled a meeting and put it in her calendar on her iCal.

She beta-tested peoples products. Really. Here she is testing out a healthy-eating app for kids (while wearing a jawbone up).

It goes without saying that I was unbelievably proud of my daughter that day, but I was also proud of our community. Not only did people embrace her, but they were respectful, funny, kind, and made her feel welcome.

In return, my daughter doesn't look as technology or healthcare as the land of men, but a place she can make a difference, contribute, and engage (and eat a little too much pizza. Damn hackathons) as a smart, engaged person.

Best. Hackathon. Ever.

Thank you, #digitalhealth

Health Data in one Infographic

Cartoonish

I've been called a lot of things. Some of them are nice. Some of them are, well - my mom might read this, so let's stop there. Along the way, I've probably been called cartoonish - and for all you that might have said this, I have good news. Turns out you were right!

The Kauffman Foundation made a Sketchbook video from one of my interviews with them, and published it earlier this week. Here's the press release and the video is embedded below.

Before this gets all self-promotional and weird let me make one point about Kauffman.  I don't know if I deserve this, but what Matt Pozel and Dominique Pahud created is humbling and, at the risk of getting too technical, it's super cool.

If nothing else, I want to give them heaps of credit - they cut up a few hours of me ranting on and on into a pretty neat cliff notes version of my verbal diarrhea (Related: Every single one of my friends is now trying to reach out to Matt and Dominique to figure out how productize the cliff-notes-inator for future conversations with me).

When they first approached me, they had already created the whole thing - they did all the work, animations, concepts, everything just from our video interviews. If you think the content/words are crap, that's my fault (and let me know in the comments below) - but the animation, video, concepts - that stuff is really amazing, way outside my skill set, and deserves tons of praise for it's amazing delivery of my rambling. And, they got the gap between my teeth correct, too.

It's another awesome output from the Kauffman Foundation, and one I'm proud to be associated with. If you have some time, I'd highly recommend you check out all the Sketchbook videos.

Couldn't have done it if I tried...

It's September 1st, which marks my third full month with the Nike FuelBand. Over that time, I've come to believe in the form factor (to which the FuelBand owes Jawbone a tip of the hat) and the experience as one of the best in activity monitoring. What's incredible to me is that over the last three months, without trying to achieve or knowing this pattern existed, I've become remarkably consistent:

Check this out (FuelPoints):

Even more clearly:

There is a big drop off in steps in August, but I've felt that since the last update, the FuelBand was much more conservative in it's measurement of steps (I saw a drop from about 20k per day to 15k per day) - of course, here I am blaming my tools, when it could have been me sitting on my behind. 

There's a an observer issue (which is not the Heisenberg principal, I know, for you physics bigots...) at play here, and it's hard for me to claim that the FuelBand is directly responsible for the consistency, but I've certainly found that the form factor, the fact it does not break, the battery life, and the daily incentives/rewards/goals are having an effect on my desire to exceed my numbers each day. 

It seems to be working. The lack of an API is still horrible, and the fact I had to type my data into a Google Spreadsheet just to tell you about it - yes, it's got flaws still. But in terms of consistent engagement? Impressive. 

Have you found consistency in your monthly output? Any hypothesis on why it's working (or not) for you?

Followup to Advisor Post

Chris Seper, the CEO of MedCityNews, interviewed me at the Kauffman Life Sciences Venture Summit right after I came off stage - which was both exciting and a little weird.  While we talked about a number of things, one of the videos he made was about my current hot-button topic, which is "what makes a good advisor," and specifically, my hypothesis that you want "value-connectors" not "super-connectors" when it comes to introductions from your mentors.

My thoughts on this topic - which Chris summarized well in the post - are further articulated in the Do I need an Advisor post I made recently. As a startup, you want to know that when someone makes an introduction, they are taking it really seriously. Access to a "contacts list" shouldn't be based on money (at one extreme) or "sure, I'll do that for you," (at the other)  but really based on you, the startup, earning it.  You want someone who is focused, dedicated, and willing to say "no, you are not ready" when you are not ready. 

Honestly, this seems awkwardly self-promotional to me, but I really believe in this meta topic (the rise of an unqualified "Advisor class" in Silicon Valley) and it's micro topics, such as introductions.


The post is here and the you tube video is embedded below.  

Do I need an advisor for my startup?

This was originally posted on the Rock Health Blog, and I've included only an excerpt here - you can find the full post here

Advisors can play a very positive role in the development of a company when deployed effectively. Over the last few years, however, we have seen a rise of the “Advisor Class” where it appears everyone is either advising, or believes they are in need of advice. During this same period, more self-service resources have become available, from movements like the Lean Startup, to thoughtful Q&A discussion boards, such as Quora, which boasts nearly 75,000 people following questions on entrepreneurship.

So, does my startup need an advisor? An advisory board? How do you manage that relationship to get the most value from it while expending the least amount of effort? You know your effort needs to be on your company, your product, and your team. Anything else should be given rigorous consideration before adding it to your plate. So how do I take on advisors without being distracted?

If you read no further, remember that your investors value ‘team’ more than you know. Often, in fact, than your idea itself. They are placing a bet on you, your team, and your collective ability to make decisions and execute. If you can enhance your team with a small number of focused advisors to fill gaps, that’s a great win for the team. Just remember, never once has an investor said “I don’t believe in the team, but they have a great advisory board.” – team first, team always.

If you choose to read on, the following post provides hints for you to weigh when considering advisors, and most importantly, how to maximize advisor relationships. It’s a framework, but not an answer. And remember, only you can truly decide if you need advisors, because after all….YOU are the CEO!

Read the rest on the Rock Health Blog