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March 2009
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May 2009

Just in Time Patient Data: A Solution for Electronic Medical Records (EMR)

Bruce Schneier's post on "Unfair and Deceptive Data Trade Practices" pointed out how the RealAge quiz sells your answers to drug companies who then send you spam targeted email.

Aa And this got me thinking about the nightmare of EMR.  When your patient data is in color coded paper files, it's a lot harder for abuse.   And there are the conflicting interests: the insurance companies who want to spend as little money as possible, the doctors who (hopefully) want you to get better, and those who want to maximize reimbursements (e.g. revenue), the drug companies who want to sell more.   But in the end, there is one person who needs to be in control.

The patient.

And this needs to be the bottom line of any good EMR system.  The patient is in control.  But data exists in many different silos of information, held by different parties, for different purposes.   In reality this is a policy based data access problem.

The solution in "Just in Time" patient data.    If you check into an ER, the attending physician should be able to pull together all relevant information real time.  When done, it goes away.   The monolithic solutions proposed by Walmart and Google are doomed for failure from the beginning.  There is no way people want to put that much information in just one place.  Ripe for abuse. (remember the Patriot Act?)

note: or someone steals the information and holds it for ransom.

Kudos to Comcast Customer Service

Comcast has been advertising a deal for new customers who sign up for a year.  So I called to see if I could get the deal even though I am an existing and loyal customer.   When you dial the service number you get a local call center.  I explained my situation, and they found me a deal which was only $5 more than the TV deal (and a lot less than than I was paying).    Thanks Chad.

Outsourcing vs. Local Sourcing Software Development

For whatever reasons (and there are many) sometimes we need help with our software development.   One of the biggest fallacies in getting help is that it is cheaper to hire a $20 / hour engineer on the other side of the world than a $100 / hour engineer in the neighborhood.  

It's just not true in many cases.

You're looking at the wrong cost factors.  The question is "How can we get this project done, correctly, in the quickest and most cost effective manner"?

For the vast majority of us, our user requirements are a constantly shifting target.   So there is a lot of interaction between you and your development team.  Which means face to face.  And don't forget knowledge and productivity.   A good engineer can out code a mediocre engineer by a factor of 10.  Really.   Also if they are a disciplined group, you don't have to spend a lot of time up front on detailed requirements. 

In the end you get a more usable product, faster and at less cost.   And don't forget those bug fixes. 


Cockroach Companies

I borrowed that title from a very interesting Time magazine article.  While they were talking about pure play web companies, a lot of the concepts ring true.   Starting a company today can be done without committing a lot of money over a long period of time.  The trick is keeping fixed costs extremely low and pegging your variable costs to measurable results.

Aa  Freelance everything in the beginning.   (and btw pure sweat equity is soooo 90's)  That way you get the necessary level of talent early on.  Be generous to your early investors and adopters.   If it works, you can start scaling and increase your fixed costs.

By doing this you can weather erratic sales cycles without driving off the cliff.  Hence the name "Cockroach Companies".  They don't die easily.

A Winning Business Model?

You're starting a new company.  You decide to focus on maximizing profitability for each customer.   You do this by charging as much as you can while delivering as little as possible to each customer.

30-40% of your revenue is dedicated to overhead to ensure that no customer gets more service than you are contractually obligated to give.   You charge 15% more than competitive solutions for your largest customers.   For your mid-sized customers, you raise their prices 8-15% if they use your services (to maintain those profits).  

For your smallest customers you focus only on the top percentage which will barely use your service while charging as much as you can.  If they do start using your service, you immediately drop them as a customer.    Some of them go bankrupt, but that's o.k.

How well do you think this new company will do?  

Marketing Windows: Amazon and Battlestar Gallatica

What works and what doesn't changes rapidly depending upon what is going on at the time and what the next trend may be.   There are two approaches to this.Man_machine   The first is reacting quickly to events.  The TV show Battlestar Gallatica was a master of this.   The show was started in 2003 right after the US invasion of Iraq and dealt with issues of religious conflict, torture, betrayal and retribution.   The writers payed close attention to current events and wove the themes into the shows.   It was very popular and just ended  with a note of hope and warning of repeating past mistakes.

The second approach is predicting trends and building a product before it becomes poplular.  Amazon Web Services, which just marked their 3rd anniversery, was the first in Cloud Computing.  I've worked with them since the beginning and although there have been some rough patches.  But they have become a thought leader in this space and are doing quite well.

So make sure you are paying attention to what is going on around you and become relevant to the exisiting trends and conversations.  You will do much better.