Pay as you go Health IT

According to this article, Health IT projects require hefty investments.   I'm going to have to disagree with Dr. Caitlin Cusack.   Maybe current Health IT projects do, but that doesn't mean they have to.   Your two cost factors are the actual hardware / software you use and the cost of training your people.

I believe that the customers should invest nothing for the software.   Just like you can get "pay as you go" mobile phones, Health IT should be delivered as "pay as you go".   How?

Build it in the cloud and scale horizontally.  It's not hard or expensive to build a system for a 3,000 patient clinic.  But instead of designing a massive silo (aks, for 10,000 customers, deploy 10,000 cloud servers.    And then just charge when the customer actually uses the thing.  Which will keep you on your toes at all times.

As for hardware, it doesn't take much.   A great netbook or desktop costs $300-$400 and you can set up secure wireless for $100 per building.   So you can automate a 5 physician office with a total investment of $5-$10K.  Because all the heavy lifting is done in the cloud (aka Amazon Web services, my favorite).  And you can run a dedicated server 24/7 with a lot of storage for less than $1,000 a year with zero installation costs.

And deployment (where the real costs are) should be done in an iterative fashion.  Prototype, pilot, repeat until satisfied.  Then expand.

This is a different way of looking at things.  When I was at Baxter Healthcare, conventional wisdom said all IT projects were heavily invested in, took many months (or over a year) to get implemented and then get everyone trained.  Working in the divisions I was rolling out new applications in 6 weeks.   And that was 25 years ago.

Prototype, pilot, repeat.

The Trick to Low Price High Volume Businesses

With Cloud Computing, cheap computer and easy merchant services it doesn't take much to start a business.   Making it a successful business is a whole different thing.

The first mistake people make is confusing price with value.  The trick here is to deliver a high value product / service, but at a low price.   If your competitor charges $6 and you charge $5.50 that doesn't mean you get the business.  At some point price becomes irrelevant.   What do you get for your six bucks?

The first and most important place to start is service. 

  • Can your customer figure out what you have?
  • Can they get answers quickly?
  • Can they buy it easily?
  • Are there no surprises?
  • When something goes wrong can they get help?

Aa You must stand behind what you have.   I have been using a hosting service for the last 10 years.  They got good reviews, I signed up. I got an email from them the other day inviting me to check out some new goodies they offered.   Turns out by clicking a button they would install a copy of SugarCRM for you.  (this is the open source equivalent of 

I pushed the button.

It installed and I logged in.  The first question was to confirm a time zone.  I did and the system crashed.  Horribly.  So I filled out a trouble ticket.  And here was my reply:

Hello Bruce,

I have tried logging in the Sugar CRM application and noticed that the issue you are facing is with scripting. We suggest you to contact the application vendor and fix the issue from your end.

If you have any further questions, please update the Support Console.


Stan Harper
Technical Specialist

Nice.  So they will have 100% installation failure and I'm supposed to fix it.

Let's just say I won't be recommending these guys to anyone soon.  

So make sure you walk through every offering you have from end to end from the customer's perspective.  And that will serve you well.

Amazon Web Services: Please Speak Up

Amazon's Web Services took a serious hit Friday due to an overloaded authentication server.   They fixed it and are taking both long and short term solutions to make sure everything is a.o.k. 

Well and good.

The number one complaint I've been hearing is not that it went away, but it was extremely difficult to find out what was going on.   You had to look at one thread to figure out what was going on.

Nothing on the blog.

No messages on the root page.

Aws My advice to my friends at AWS:  When you get your service health dashboard running, put it on the home page for the developers.  Please.

The marketing lesson here: over communicate, your fans will stick with you in both good times and bad.   

On Demand Business Apps: Where the Web is Heading

After over two years I just left a startup I co-founded.   I feel like I just sent my kid to college and although I hope for the best, you just wonder if they'll spend their time partying instead of studying. 

Reading an interesting book: "Success Built to Last: Creating a Life that Matters" .   Sounds like a self-help book, but it's not.  It talks about builders: people who are driven by core passions to make things happen.

What does this have to do with the Web?  Plenty.   Currently many people view the web as the place to buy stuff and keep in touch with friends.  We're just starting to see the effects of "builders" moving great business apps to the Web.   

Why?   There are a bunch of us who strive to bring complex systems to the business folks who traditionally could not afford them.   This process started in 1979.  But until recently it took a whole lot of money and a whole lot of time to build out complete systems.   Now with services such as  Amazon Web Services,Future you now have instant building blocks.  Sold on an "as-needed" basis.  Time to market can now be measured in weeks, not years.

And this means our marketing jobs have gotten more interesting.   So now in our conversations with the market place, the actual production and delivery of a service is becoming trivial.  So we can focus our attention on our customers getting the best use for their particular situation.  And since it's on-demand, the risk for them is virtually eliminated.   You're making blue and they want orange?  No problem, orange only take 2 weeks to make.