Project VRM and e-patients

I’ve been talking to the Project VRM group about healthcare applications of vendor relationship management, also related to the work of the Society for Participatory Medicine and the e-Patients Working Group that preceded it (of which I’ve been a founding member).

Doc Searls and I were talking about this again last week at Fiber Fete; he’s just posted a note about Dave deBronkart’s “Gimme My Damn Data” rant and its implications (expanded and well-overviewed by Dave along with Vince Kuraitis and David Kibbe) to the Project VRM site. Doc takes issue with the use of the word “consume” in the longer piece by Dave et al:

Patients today no longer only consume. They produce. What they want and need is more responsibility for their own health care. More importantly, a patient cannot be a platform if he or she is only consuming. By nature and definition, a consumer is a subordinate creature. It lives downhill from the flow of services. Platforms stand below what they support, but are not subordinate. They are the independent variable on which the variable ones standing on it depend.

Redefining journalism: the International Symposium on Online Journalism

Journalists have been curious, and often anxious, about prospects for the future of news in an era of user generated content, fragmented abundant media, and cheap or free web-based advertising platforms. Nobody doubts the importance of in-depth news reporting, but the business model’s unclear. Many publications are moving online, which may reduce some physical costs but also reduces advertising revenues. There’s still the cost of content development. Sure, you can leverage user-generated free content, which can be very good, but the time and attention required for excellent reporting can’t be free. Said another way, to the extent writing is done without compensation, it tends to be shallow and incomplete. And reporting without editorial process and fact checking is subjective, not authoritative. Reporters may try to be objective and fair, but that’s very hard to do outside a process of vetting, checks and balances.

Academics that study journalism are studying and thinking about the changing present and the future. Several gathered in Austin last week for the International Symposium on Online Journalism. I was there the second day. It was a great event; I came away with my brain churning – though I’ve had an interesting thread of complementary career paths in my life, my original goal was to be a journalist, and I’m most passionate about writing.

You can see my complete tweets (over 250, I think, in one day) here. I also jotted down some notes just after the conference; here are some thoughts based on those notes:

I felt I was hearing a consensus that news is a public good, and news reporting will increasingly be funded, coordinated, and curated through nonprofit entities. I’ve been focused quite a bit lately on Texas Tribune, which is an innovative Texas news organization operating as a nonprofit. Its CEO and editor, Evan Smith, told me at the conference that he’s feeling positive and excited about the future of journalism and the kinds of experiments we were hearing about at the conference.

Former for-profit newspapers are focusing more on infotainment to build and sustain attention and revenue – it’s harder for them to fund hard, in-depth reporting. One potential model would be for nonprofits to report in depth, and provide reporting through content syndication partnerships with for-profits. That may be one wave of the future.

Another interesting experiment presented at the conference: Spot.us, a site set up to source public funding for news stories suggested by – I think the best word to use here is particpants. We were talking a lot about participatory journalism, which could manifest in any number of ways. Anyone who can read, write, and has access to a computer can potentially report news. What works as journalism is, I think, a matter of context. Is the reporting feeding into a journalistic process of some sort, and what sort of analysis/vetting do you have within that process? I’m all for broader sourcing of facts and perspectives, but how that mix becomes journalism in today’s world of social and collaborative media is still being defined.

iPad for Breakfast

Yours truly with Bryan Person, iPad winner Charlie Nichols Browning, and Rob Quigley.
Yours truly with Bryan Person, iPad winner Charlie Nichols Browning, and Rob Quigley.

This morning (April 26, 2010), as part of the Social Media Breakfast series organized by Bryan Person and Maura Thomas, I led a discussion about the iPad. I don’t actually have an iPad myself, but I was eager to hear what the diverse SMB crowd would have to say about the impact and future of the device. Several who came had already bought iPads; we distributed them among the breakout sessions.

I framed the discussion by talking about the devices apparent strengths (light, mobile, easy to use) and limitations (hard to print, hard to interface with other systems, doesn’t have a built-in phone or camera). Then we had breakouts to discuss the iPad from various perspectives: what makes the iPad compelling; what is its impact on productivity, lifestyled, marketing, publishing, and social media; what can we expect from a world where we have connectivity like water – always on, everywhere. What had a great turnout, almost sixty people, and they were smart and vocal – so we had great conversations.

What were the conclusions? People felt that the iPad is more for lifestyle and entertainment, though there’s a potential for it to become a productivity tool. We heard that some hospitals are already incorporating it into their workflow, for instance.

One group felt that the “what the hell is that thing” confusion was part of what made the iPad compelling – people are drawn to it to try to figure it out.

They also felt that the iPad is driving a shift to new standards – platforms that start instantly, are light and mobile, incorporate touch technology, and are accessible and easy to use.

The iPad is not exactly great for productivity, though it can have an impact on efficiency. In business, it’s a great sales tool and communication tool, but it’s not a laptop or PC replacement. However it will allow sales professionals to demo anywhere, and gather information on the spot.

Where marketing is concerned, the iPad integrates both push and pull technologies and is a promising platform for ad-based content and services. There are already effective news apps. It’s also a great tool for engagement – many apps that run on the iPad and iPhone are social technologies.

The group that discussed social media was split regarding the impact of the iPad. They felt the biggest impact of the iPad would be in bringing in new social media adopters and spreading awareness of social media. Because it’s easy, it might help older people who are not digital natives adopt social media. It’s also great for multitasking. (We didn’t get into the discussion whether multitasking is evil.)

In publishing, there’s a split between specialized apps and browser-based experiences; the iPad facilitates both. The iPad might evolve as a textbook replacement. It will have an impact on organizing and editing information. The group agreed that information is more important than the platform for its delivery. There were questions about the future of print media as it becomes digital. The move from legacy to digital environments has meant lower revenues.

The iPad can be great for mobile professionals – physicians, for example, who will find the iPad even more useful as more health data is digitized and accessible in electronic health records.

The various limitations of the platform. – printing limitations, connectivity limitations, lack of USB, display interaces, cameras, and the lack of tethering were all limitations of the iPad, but none of them insurmountable. The iPad just wasn’t built to do everything. And it’s evolving.

Fiber Fete: Google’s fiber testbed

Minnie Ingersoll of Google at Fiber Fete talking about what Google is doing with it’s fiber testbed project.

What they want to do:
1) next generation applications.
2) Experiment with new and innovative ways to build out fiber networks
3) Work with “open access” networks

Not becoming a national ISP or cable tv provider. Google had suggested the FCC needed to make this kind of testbed, but realized the Commission had other focuses. Google realized this would be within their purview based on their mission statement.

Application review process for proposals from cities wanting the testbed project has begun. Over 1,100 communities applied. Evaluating based on speed and efficiency of deployment. Understanding how the community will benefit. Much will depend on the conversation they have with the communities as they learn more about their needs.

Working now on developing the offering. Openness – Is this a white label or wholesale service? What products and service partnerships are possible. Google will also develop its own high-bandwidth offerings.

May choose more than one community with very different characteristics.

Applications are full of civic pride. You learn what makes the various locations/communities unique.

Will announce services as soon as possible.

Leverage the enthusiasm – Google to create a web site to help communities connect with other resources. Don’t want to have cities feel excluded from getting higher-end broadband services.

What policies need to be in place to support broadband now?

Brough Turner asks about middle mile networks. Something Google looks at – where do they already have fiber? Sometimes communities farthest from the infrastructure, though, are the ones that would benefit most.

Bice Wilson: enthusiastic about leverage the enthusiasm concept. All the people in the room represent communities that are inventing this new cultural process. Google is helping drive the process. Are you planning to make this useful in that way (as a model)?

Google is looking for specific ways to keep the applicant communities talking to each other. Is it an email list? A forum? A wiki? Definitely looking to Open Source, create white papers and best practices from what they do so that others can benefit.

David Olsen from Portland: what type of testbed environment? Also thanks for what Google has done to raise consciousness of cities about significance of broadband.

Urban vs rural: not sure whether it will be 1, 2, 3, 4 communities. Might be in different communities, or neighborhoods or subsets of a community. Will probably be looking for more than one community, with differences. Probably a mix.

David Weinberger wonders how raw the data Google outputs about the project will be, and how immediate. Google hopes to satisfy with the amount of data, and immediacy. Google will be responsive to feedback, so people can let them know whether they’re providing enough info.

Marc Canter brings up political issues around municipalities providing pipes. Have they heard from AT&T and Comcast, etc.?

Google is definitely inviting the other providers to use their pipes. There’s plenty of room in the broadband space, and no one company has a monopoly on innovation. Discussions are ongoing about partnerships.

How open is open? What rules will there be?

Google will advocate policies around net neutrality, e.g. no content discrimination.

Garrett Conrad asks about leveraging Google’s apps vs apps the community might come up with?

The community aspect will be key, crucial. It would be wrong for Google to tell the community what they need… will be listening, but will also be prepared to offer guidance and applications.

Leslie Nulty asks what is the business structure concept that lies behind this? It’s not completely clear. Appears that Google intends to build, own, and operate these networks – become a monopoly provider. What are the checks and balances? Will Google become an unregulated monopoly?

Some will be the published, openness principles Google will be expect to be held to. Not a monopoly. Will offer reselling opportunities.

Canter: if you’re open, it’s not a monopoly.

The openness is of the service offering on top of our pipe. We’re not trying to force people into using Google apps.

Google does plan to build, own, and operate these networks in trial communities.

Nulty: price is the question for any community that might want to partner with Google.

Services will be competitively priced. Will negotiate with the municipalities on a contract that both think is fair. Google will be as transparent as they can be, and if there’s somethng they’re missing, let them know.

State regulations preventing broadband a barrier? Google wants to learn more about regulations and policies. Ask communities to explain regulatory barriers for their specific communities as part of RFI response.

Chris: Communities United for Broadband on Facebook.

Nancy Guerrera (sp?). Wants to know what it’s like working with local communities. Refers to previous project in San Francisco to set up muni wifi. Ended up building in Mountain View after discussions with SF didn’t work out. Google learned from this, though each community is different.

Will Google’s transparency extend to documenting issues/discussions with policy organizations?

Yes, if the press doesn’t document for us, we’ll do our best to document legal and regulatory barriers we encounter.

Fiber Fete: Smart Grid – The Killer App

Speaker: Ron Holcomb
CTC

“Smart Grid” implies today’s electric grid is dumb, which is pretty much the case. Energy leaves generation plant, goes into the “ether,” knowledge comes back only in the form of a meter reading. Wasteful but reliable system.

Smart Grid is really simpler than it sounds. We have command and control systems. Command and Control Systems | Communications Infrastructure | Two Way Communications Devices. Applicatioins: Automated demand response, distributed generation, distribution automation (load balancing, including better handling of catastrophic events that previously caused outages), price response (give users more control over management of their consumption), electric vehicles, outage management, voltage control.

What’s driving smart grid?

Regulatory: Energy Independence and Security Act has clear vision of SG applications and challenges. Paradigm shift has begun.

Social/environmental. Renewable portfolio standards in 33 states, some aggressive.

Economic: cabon based fuel cost volatility and looming carbon taxes.

Energy interest second to none in impact on American life, and prices and pressures are going in one direction. We have a lot of work to do here, we haven’t really attempted effective management for conservation, cost control. High speed, low latency pipe is key to business success in this context.

Significant economic benefits from wind enrgy, smart grid enabled distribution reduction of carbon emissions, reduced energy consumption, reduced cost of power-related disturbances, society benefits that exceed costs by four to one. (EPRI)

Why isn’t this happening faster, now. Question is how we pay for it?

Review of various benefits to enterprise (utility), ratepayer, and to society. Cost of service interruptions to ratepayer: $80 billion/year.

Not happening faster because so much of the ROI is indirect, hard to qualify, hard for the enterprise, the utility company, to monetize.

What is the utlility’s philosophical view re cost resposnibility? RE. social and environmental responsibility? What level of financial responsibility should utility take for outage costs born my customers? Should utility play a role in economic development and local job creation?

Strategic considerations: Stick to tried and true public power business pratices. Invest in future-proof infrastructure. Electric crews can build and maintain it. Own it, don’t lease it. Avoid risk of cores service failures by handing over command and control communications to a carrier. Avoid risk of price gouging (considering size and value of energy industry).

Fiber Fete: Telemedicine notes

Speaker: Lawrence Keyes, CEO, Microdesign

Continuing from Twitter tweets…

Talking about the DocBox, a set-top box for telemedicine. Currently seeing senior Tai Chi class taught over the DocBox, which is connected via DLS or cable of at least 384Kbs up and down. Sound is transmitted through the television set; DocBox has a built in microphone (controlled for classes centrally – microphones may be switched off for a class, can hold up your hand to speak.) Via split screen, the patients in a class can see each other.

Requires fixed IP address, “illegal” with some providers who use DHCP persistently.

It’s obvious how Fiber to the Home would help: better video and audio. Quality potentially good enough for diagnostic imaging. Electronic Health Record, video conferencing and monitoring expected. Anyone can be a provider: every patient can be a transmitter via symmetrical network, and network can be managed from anywhere.

See http://www.mxdesign.net for more info.

A thought about evolving social environments

I’ve been a member of the seminal online community, the WELL, for around two decades. I’ve been active on Facebook since it opened to non-students. Originally Facebook wasn’t conversational. Other former WELL members and I discussed how Facebook Groups didn’t seem to take off as conversational environments in quite the same way as the WELL’s conferences, many of which are still vibrant after 25 years. Facebook has changed since we had those discussions – now Wall posts and comments on Facebook are like topics and responses on the WELL. (We saw the same pattern in blogs with comments: someone posts a lead item, what we called the “zero post” on the WELL – a conversation starter. In blogs the emphasis was originally on publishing, then some blogs became more conversational, and posts followed by comments on those blogs were very much like topics within conferences on the WELL.)

One difference is that the WELL had a taxonomy: it was called a conferencing system, and was organized as conferences on subjects like Health, Media, Grateful Dead, Virtual Communities, Art, History, Design, etc. Topics were pretty free-ranging within the major subjects, but you knew where you would go to discuss a particular subject. On Facebook, there’s no organizing my subject. All kinds of conversations appear in Facebook’s news feed or activity stream – right now I see conversations about climate change and volcanoes, events, Texas politics, design, business, etc. – not organized in any particular way. A stream of comments some of which become conversations, many casual, some more active and compelling. This really seems to work, and the converations lately are not dissimilar from those I see on the WELL, despite structural differences between the WELL and Facebook.

I find myself drifting more and more into Facebook because there are real, sustained conversations there, unlike Twitter’s more drive-by posting – and because I don’t have to fiddle with a 140 character limit. Twitter feels very broadcast, compared to Facebook (or Wave, or other conversational systems). Not to diminish its importance – Twitter is a great place to share short bursts of information and links. But it’s less “social.”

This is me thinking aloud. Is there a business conclusion from all this?

I’ll close with this thought: I spoke to a group of Realtors last week, and told them not to expect miracles from social media. You’re not using social media because it’s somehow going to bring you more business than traditional media. You’re using it because it’s taking mindshare from traditional media. The audience is there – on the plus side, you can target more specifically the people who might be your customers or clients; on the minus side, they’re scattered over multiple platforms, you have to connect more directly than before, and they don’t often answer the door when salesmen come.

Keep it simple

Just learned via Twitter from someone who reads my blog that text instances of the Sociable social bookmarking links were piled up at the end of each of my posts as displayed in Google Reader. That’s nust not very poetic. Does anybody ever actually click through one of those bookmarking icons or links? I’m not convinced.

I turned all of that stuff off, as well as the Zemanta tracking pixel added to my posts via Scribefire. The web’s complicated enough; I’m making my presence as simple as possible and focusing on producing great content.

(If you’re reading this on Google Reader or some other news aggregator, and you still see something wonky, just let me know.)

A couple of insights

The sort of things you just have to write down somewhere, like on your blog…

Got these via K. Marcus Hartsfield on Facebook…

“Directly it is said that not a single thing exists, and yet we see in the entire universe nothing has ever been hidden.” (Dharma Hall Discourse #53 from the Eihei Koroku (Dogen’s Extensive Record)   

He reports finding this one written on a bathroom wall at The Omega Institute in upstate New York:

“Satori. Don’t think it will be glorious; that momentary burst of radiance illumining all. Nonsense. It is more like losing your mother in a large department store. Forever.”

Times are changing: foraging, simplicity, Shirky-smart, etc.

Two of the best ideas I heard this week were curated or catalyzed by Clay Shirky.

One is the mathematical concept of the Lévy flight, which I already wrote about in my last post.

The other is in a link e-Patient Dave sent me. I ran across it again in a discussion of models for connectivity (“freedom to connect”). In a post called “The Collapse of Complex Business Models,” Clay discusses Joseph Tainter’s Collapse of Complex Societies, applying Tainter’s thinking to the web and digital media. Tainter says that societies that become increasingly sophisticated will tend to collapse, not despite their sophistication, but because of it.

Early on, the marginal value of this complexity is positive—each additional bit of complexity more than pays for itself in improved output—but over time, the law of diminishing returns reduces the marginal value, until it disappears completely. At this point, any additional complexity is pure cost.

Tainter’s thesis is that when society’s elite members add one layer of bureaucracy or demand one tribute too many, they end up extracting all the value from their environment it is possible to extract and then some.

The ‘and them some’ is what causes the trouble. Complex societies collapse because, when some stress comes, those societies have become too inflexible to respond. In retrospect, this can seem mystifying. Why didn’t these societies just re-tool in less complex ways? The answer Tainter gives is the simplest one: When societies fail to respond to reduced circumstances through orderly downsizing, it isn’t because they don’t want to, it’s because they can’t.

He then goes on to explain the evolution of complex and entrenched procedures within sophisticated, high quality media production, and how these are now trumped by the popularity of (commitment of mindshare to) simple, “good enough” media. Clay’s closing paragraph:

When ecosystems change and inflexible institutions collapse, their members disperse, abandoning old beliefs, trying new things, making their living in different ways than they used to. It’s easy to see the ways in which collapse to simplicity wrecks the glories of old. But there is one compensating advantage for the people who escape the old system: when the ecosystem stops rewarding complexity, it is the people who figure out how to work simply in the present, rather than the people who mastered the complexities of the past, who get to say what happens in the future.

Interesting to note that there are no comments on this post, only pingbacks (links to it by others). It’s an important, already influential piece.

The first point, about foraging, is that people don’t necessarily sustain adoption of something, even if they really really like it. In the early days of blogging, I made this point in talking about links and hits from blogrolls and RSS feeds. Someone finds your blog, they really like it, so they add the link to their news aggregator. Everytime the news aggregator updates, the link to your blog produces hits, but those hits are questionable, because a common behavior is to add an RSS feed, read it for a while if at all, then move on to something else. People don’t get the web delivered every morning as a newspaper, or monthly as a magazine. It’s not push, it’s pull, and they’re surfing based on criteria other than loyalty. We have to adjust our thinking accordingly.

The second point is that complexity reaches a point of diminishing return, costs escalate beyond what we’re willing to pay, and whole systems break as a result. With media, it’s not just that it’s simpler to make something that is compelling and gets mindshare. It’s that simpler access to “good enough” media (via the web) trumps more complex (or costly) access via movies or television. Consider the traffic in torrents of lower def but “good enough” copies of movies, television shows, record albums, etc. Or think of simpler paid access to slightly more lossy music/video via iTunes, or Hulu.

There’s more to talk about, like the social thing – we’re committing mindshare to online conversations that, before, we might have commmitted to passive consumption of television programming. But you get the drift – behaviors are changing online. And low-cost/free/good-enough is as entrenched in online culture as expensive/complex/high quality is entrenched in old media culture.

Times are changing. And I’m out of time, for the moment.

Foraging and surfing

I’ve often said that we don’t know enough about how peope behave online – e.g. how they read blogs or other web sites. Do we visit the same sites over and over again? Or do we surf, following links we stumble across as we wander, and now with pervasive social media, those that are posted on Twitter, Facebook, LinkedIn, etc.? More likely both – we have some sites we visit regularly, but we also bounce around a lot.

Behaviors are probably more complex than we think. Seth Godin writes that he learned, from Clay Shirky, of something called a Lévy flight: Example: “an animal that forages will hang out in a small area, looking for nuts or berries, then will realize it has used up all the likely sources in this spot. It will then head off in a random direction, walk many paces, and start foraging again.” The online version:

Someone discovers your site. They poke and prod and join and return and return again. Then they feel as though there’s no more benefit and they move on, surfing until they find another place to forage.

Godin calls this “a much more nuanced representation of consumer behavior than solely thinking about the ideas of brand loyalty or random web surfing.” But I’m enough of a nimrod to want to substitute the word human for consumer.

Monster Scroll

At Pink Tentacle, view all the weirdly fascinating images on the Kaikidan Ekotoba monster scroll, “a mysterious handscroll that profiles 33 legendary monsters and human oddities, mostly from the Kyushu region of Japan (with several from overseas).” Example below: a Russian hitodama, or fiery apparition composed of spirits of the recently departed.

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