Agile + New Products + Milestones = Problems

Startup-photos"Build projects around motivated individuals.
Give them the environment and support they need,
and trust them to get the job done."

When you are building a new product in your startup or company, you need to have a launch date or you have milestone dates that must be met. Your epics are done but since your team is usually new, no one knows the team velocity. Quite a conundrum.

This seems to conflict with standard Agile tools, but it does not conflict with Agile principles. Just add a dash of project management.

  1. Bring the team together and estimate the time for each Epic.
  2. Group the Epics into your milestones and calculate the dates.
  3. Put the milestones into a project schedule and determine the negative float.
  4. Themes are your friend. Examine the themes, epics and user stories and rank them.
  5. Apply lean startup techniques to validate each key hypothesis.
  6. Add and subtract stories.
  7. Get to work and start calculating velocity.

Remember this is a team project, but you need to be willing to ruthlessly drop stories and epics if they don't directly contribute to your core value proposition.


The fatal flaw in machine learning AI

Machine learning is a great thing. Pexels-photo-251287The fatal flaw is our expectations of their capabilities exceed the ability of these systems as designed. Especially when they interact with people. Take the news feed on LinkedIn or Facebook for instance. Their design goal is "show people what they like to see". People will stay longer on the platform and consume more advertising. It works very well. The problem is it collapses everyone's worldview and they can no longer absorb new ideas and viewpoints. Just the opposite of being well read. The social good diminishes.

My point being is that whatever the AI designer's target goal is, that will become extremely efficient. But like all computer systems, they are extremely inflexible in looking at macro impacts, yet we deploy them without understanding the unintended consequences. I like collusion avoidance in a car because it enhances my driving skills. I don't like autonomous driving systems because it makes me a stupid, disconnected driver. 


Centurylink not connecting with Comcast 800 numbers

A couple of days ago I got my latest Comcast bill and noticed it went up. So I called the 800 number. Got a fast busy. Tried the next morning and same thing.

Tweeted Comcast Care and they said everything was fine. It wasn't.

Talked to CenturyLink (yes, I still have a landline) and turns out Comcast switched long distance carriers and didn't test to see if analog connections worked . The CenturyLink CO did not recognize them. It is now fixed.

Another fine example of how everything impacts customer experience.

My 7" 40GB $62 Traveling Tablet: Amazon Fire

On a trip to Indianapolis, I left my iPad on the plane. Tracking it did no good. I was not happy. For Christmas this year I got the cheapo Fire with Firea wimpy 8GB of storage. For $12 I added a 32GB card. Total cost = $62.

It's a great traveling companion. The screen's not the absolute best but works just fine for watching streaming movies (supports all the streaming services I use) and with 40GB downloaded movies. And yes you can read books, play games and store a lot of music. Since it has Bluetooth I use my Bluetooth stereo buds. To protect the screen I slipped it into a standard shoe shining mitt you get at the hotel.

The problem with using your phone on a trip is the battery consumption. Sometimes on a trip to NYC I've depleted the battery so much, I'm afraid I won't have enough to run the Lyft app. Now I turn my phone completely off and just use the Fire. If I happen to leave it on a plane again, I don't think I'll have as much angst.

Marketing: Less Stalking, More Talking

Many businesses have decided the best way to sell is by stalking people across the Internet and inserting ads.  Many people find this very disturbing (hence the rise of ad blockers like Ghostery and Privacy Badger.)  Other businesses build relationships with Talking people and hear their stories (using tools like InMoment). 

What the stalkers forget is the customer lifetime value (CLV).  Building relationships increase CLV while reducing Customer Acquisition Costs (CAC) because not only people talk to other people, but engaged customers also reduce churn.  This is especially true in the B2B market and enterprises is why they are investing in Customer Experience (CX).  I believe this is the future of business because markets are conversations.

Saving Money with High Deductible Insurance: Drugs and Imaging

Images.duckduckgo.comI have a high deductible healthcare plan and found out I needed an MRI earlier this year for a ski injury. Using the Regence Blue Cross / Shield tool, the $1,011 from IHC looked OK. That's where I got the MRI.

Not a good choice. Yesterday I discovered New Choice Health. They found a local imaging center for $411. That's $600 out of pocket I lost. (Ok Copay is another option for research). 

An X-ray, CT scan or MRI all yield the same result regardless of where you get them.  And they hand you a DVD that you can give to your doctor. 

Drug prescriptions are another place where you can save.  Consumer Reports found a price difference of up to 10x for the identical drug in the same region (spoiler alert: Costco was the cheapest and you don't have to be a member to use them).  GoodRX does a great job of comparing prices in your neighborhood. 

In many cases paying cash for drugs will be less than your insurance co-pay. And if you have an HSA insurance plan, you can use your HSA credit card to pay for them!

It's your money.  Take a minute to do some research and you can save hundreds of dollars a year.


Preparing for a Knee Replacement: A Checklist for the Family

You get a phone call from Mom; "Hi honey, I'm getting my knee replaced in 4 weeks, can you help Knee-replacement-rehabme?". Don't panic. We went through this and here are some tips to help you through this (disclaimer: this is not medical advice and your situation will always be different).  

Mayo Clinic has great overview of knee replacement (arthroplasty) here.

Book your airplane ticket now figuring you will need to be there at least one week after surgery. Try to find an airline that is forgiving in changing your ticket should you need to (SouthWest Airlines for example).

Since you are in charge, get a healthcare directive for the state your Mom resides. This allows you to make medical decisions if Mom cannot and gives you the right to talk to the physicians and other healthcare providers on behalf of the patient. Here’s a good place to start.  This is important because many times there are communication breakdowns between the doctor, the surgeon, physical therapists, etc. It shouldn’t be, but it happens. Be prepared. 

If you are curious about the surgeon and the hospital, you can access Medicare’s performance data here

Your mom will receive a pre-surgical packet of information. Read it and go over it with her. Put it in a “medical folder”. Make sure you both understand it. When in doubt, ask.  Don't be shy.

Get a notebook and write down the contact information for everyone on the medical side (and get their fax numbers). Make sure you have emergency contact information if something goes wrong. This notebook will also be used to create a daily log. The notebook is your best friend. Also get a calendar to record all the appointments and major tasks on it. 

Have copies of all the insurance and Medicare (if over 65) information. 

More things to do:
- Have transportation set up for your arrival if Mom does not have it: rental car, neighbor, car service, taxi, Uber, Lyft.
- Go grocery shopping and make sure you have enough to last 2-3 days after Mom comes home.
- Make sure there is a clear path for Mom to walk with walker after coming home. Remove throw rugs, runners and piles of books and magazines or anything else that might be an obstacle.
- Are there handrails for the stairs? Around the toilet? Toilet height extension? Bedpan / Urinal (if Dad)?
- Get a walker / cane  (put tennis balls on the front legs of the walker).
- Access to a fax machine (Fedex and UPS office centers have them). Many times the different parties involved cannot be reached and sending them a fax is the only way to get to them. Set up an inbound fax line like ($3.50 / month). They can send an incoming fax right to your email box.

Still with me?  Let us continue.

- If Mom has pets, make sure they are taken care of during the hospital stay. Do you need lawn care / snow removal / house cleaning? Now is the time to set it up. Also put all those contacts in your notebook.
- Buy extra dressings for the surgical site. The hospital never seems to send enough home.
- Have a second complete set of bedding. Make sure they have clean bedding when they come home.
- Set up social and entertainment suited for your family member’s situation. Do you have the names of their friends? Books? Movies? Games to play?
- Follow up on everything. Just because someone says they will do something, doesn’t mean they will (hence the complete contact list, notebook and calendar). Be tenacious. The healthcare system is very frustrating most times.

At the Hospital (normally two days):
Become friends with the nursing staff. They will tell you how your mom is doing and give great suggestions. Find out when the doctors do rounds. Be there. Listen carefully to the physical therapists because they will be teaching what Mom needs to do to get better.

Keep your Mom's spirits up and give encouragement.  Have her talk to other family members and friends.  Bring some books or an iPad to watch a movie, or whatever else your Mom likes to do.

Make sure you have a copy of medications and understand what they are for and when and how long to take them. You may also want to talk to a pharmacist and make sure there are no adverse drug reactions. When our family member was at St. Joseph’s hospital in Atlanta, they didn’t do that and two of the drugs had the potential for a fatal interaction. Fortunately we caught it in time, but the medical team did not notice it.

Understand pain management thoroughly.  You may have opiates, Tylenol (acetaminophen) or Advil (ibuprofen) recommended. Make sure you know what to use, when.  Especially the opiates.

Go over the discharge papers carefully and understand what needs to be done when Mom goes home.

When leaving the hospital take the water bottle, emesis basin, washbasin, any lotions, creams, sundries and all supplies that came into your Mom's room. They could be useful at home. You paid for them. Take them home.

Back Home and Recovery:
The first week is the most critical. Your first order of priority is prevent infections. Wash your hands. A lot. Make sure the dressings are changed on schedule (aren’t you glad you picked up extras?).  Be on the lookout for anything that doesn’t look right at the surgical site. When in doubt call. You probably will be asked to take the patient’s temperature several times a day. This too is an early warning sign if it is too high.

That knee joint needs to be used especially during the first week so it does not freeze or limit range of motion. Having them lie in bed is not good for movement and also could lead to pneumonia or blood clots. Your packets will guide you on what to do. You should see a physical therapists on the first day home and 2-3 times a week, usually for an hour. Pay close attention to what they do and their instructions. Record this in your notebook and log all the exercises done.

Have meals at the table, not in bed.

Keep Mom's sprits up.  Play games, watch TV, whatever works for the two of you.  When she is ready, invite some friends over for a visit.

And finally, be very diligent on making sure the exercises are done (record them in the log book). Remember your Mom will be using a joint that just had surgery.  Being diligent becomes habit.  And that's a good thing.

Best of luck to you and your family.  Over 700,000 knee replacements are done every year.  You're in good company.

Do you have a personal experience or advice to share?  Leave a comment!

Business Case for FHIR and Argonaut: Patient Directed Post Acute Care

FHIR's purpose is an ambitious effort that defined healthcare standards and API's to accelerate ArgonautProject_logodevelopment of useful web-like applications from Electronic Health Records (EHR).  Project Argonaut is a private sector based initiative to build useful applications to drive adoption.

Applications for whom?  The current applications are heavily internal EHR focused among multiple institutions and EHR vendors.  

Although the industry talks about "patient centric" medicine, in reality that has as much relevance as "natural" has to foods you buy at the supermarket. Outside of a beauty contest called "patient satisfaction" there is not much in the field focusing on the patient's point of view.

And therein lies the killer app that can drive widespread adoption. Build an app that patients demand.

And it's not personal health records (remember Google Health?)  Instead it needs to solve an immediate problem for a large number of people. I suggest an app  that over 1 million new patients every year have a need for 3-6 months. That happens to be the number and recovery period for total hip and knee replacements (not partial, or repairs) in the United States.  

There are evidence based protocols and procedures for optimal outcomes from surgery to full recovery over a multitude of care settings.

But who is coordinating this effort over the entire lifespan?  Is it:

  • The insurance company (or Medicare)?
  • Primary care physician?
  • Rehab center?
  • Physical therapist?

All of those answers are incorrect.

In  healthcare the presiding belief is that care manager is on the provider side of the house. In reality it is the patient or in many cases the patient's advocate. The patient advocate role could be the patient, significant other or a family member. Things get very complicated when the advocate is caring for Mom who lives three states away.

This is reality.

300px-ArgonautDeviceWe need to build a post acute care platform with a FHIR component.  But it goes beyond health records.  This is the place that the patient advocate can coordinate, collect, manage and distribute information needed for the patient's full recovery (the use cases are numerous blog posts in themselves).  Everything from medication reconciliation, getting DICOM images to the therapist, through hiring Task Rabbit to take Mom to the grocery store or find a plumber to fix the leaking faucet.

By moving the focus to the patient, several authentication and state issues can be avoided. Firstly, patients have access to their records regardless of the state involved.  As for authentication, the patient has a key ring of OAuth tokens where their identity is confirmed by each medical provider or other entity.  (it's signing into a new service using Google in reverse, where the patient is Google).

Create an application like this and FHIR will take off - Because the patient advocate will demand it.


Big Data + Analytics = A Very Large Junkyard

Have a problem, Big Data will solve it.  The problem still is in data architecture and appropriate analytics.   And most importantly, understanding the business reason for this Big Data (solve a problem, discover new insights, etc.)

Today's tools are cheap and powerful.  For instance you can download the open source edition of Pentaho to your desktop.  It will connect to numerous data sources including Hadoop.   You now have a very large haystack to find a needle.

It's like have the world's largest junkyard and you want to buy a used 2001 Ford Focus with a broken water pump.  You can design a data architecture that links to all the junkyards in three states, NAPA Junkyardfor new pumps and car dealers.  You then develop the analytics to determine where to buy the water pump.  And you find one 2 states over that can pull and ship you just what you need.   

Problem solved, right?

What you missed was the fact that the water pump was very scarce.  Why is that?  Perhaps that model year had massive water pump failures.  By investigating further you may have seen that model year had above average repairs and perhaps buying it in the first place was not a good idea.

Wrong needle, right haystack.  And that takes planning with insight.  

Protecting against data breaches in your startup company: Apple + Box

Data security can be the furthest from your mind when doing your startup company.  You have a short runway to get a product out the door and get happy customers.  Security?  Spending scarce resources on it?

I am helping a company now with these very same questions.  The path of least resistance has been to standardize on Box business plan for all data and Apple computers and devices.  Why?   From a cost basis, they are very economical and they have the necessary security bells and whistles you need today.  And most importantly, the users like them and will use them (and you don't need a part time IT person to manage them).

The first thing I do is turn on 2 factor authentication (when you login on a new device, a code is sent to your phone for verification).  Both Box and Google for business support this.  I turn on full disk encryption for Apple computers (put in a password) and passcodes for iPads and iPhones.  And enable the ability to remote wipe any stolen or lost computer or device.  Pretty simple, but you  Wellwould be surprised at the number of people who don't do this.  And it's built in (no additional cost).

On the Box side, make sure you require a passcode to access it from your iPad or iPhone.  Since you have Box business, pin devices / computers to your users and you can restrict what applications your users use with Box.  You can restrict content that can be shared or not.

With Apple and Box, you get a lot of data security built in.   Think of this as a security well.  

You start at the top with the basics and as you grow you increase security measures as you progress down the well and need more protection.   Now that wasn't that hard was it?