Digital Medical Records, A Modest Proposal

For years and years (and years) there has been talk about the digitalization of medical records to enable portability. There are three primary problems that obstruct this vision, the first being a somewhat murky legal and regulatory environment with regard to what are the implications of the many laws dealing with privacy, data, and medical records, the second is a process issue dealing with how doctors work and their reluctance to embrace technology solutions that they perceive as inefficient, and lastly, it’s not clear that once you have your medical records how you will benefit from them.

On the last topic, one thing that should be obvious on its face is that walking into a ER with a few hundred megabytes of medical records on a flash drive is a non-starter… what would they do with them? I wonder if most doctors would want to have these records either, the burden of storing them and/or manipulating the unstructured text would be prohibitive. This issue speaks directly to the digital detritus problem I wrote about a while back, we have an exploding corpus of unstructured text data and the solution seems to be building bigger storage arrays… at some point we have to start getting rid of data that ends up not being useful.

I have a modest proposal to put forward that provides great utility, few objections, and achieves the goal of portability and digitalization of a specific kind of medical record, child immunization histories.

My idea is for an healthcare provider organization like the American Academy of Pediatrics (AAP) to sponsor an open source project to deliver a simple immunization database on a USB flash drive, with a simple but secure app that enables the printing of that record in a format that schools and other interested parties can accept. For the care provider side the app pairs to an app in the doctors office and allows for updating.

Rather than a boil the ocean approach this provides parents and other interested parties access to comprehensive immunization data for a child while not risking privacy or placing burden on care providers or parents, while doing away with the silly immunization cards that every parent has to deal with.

As a society we fail on the big things… let’s take small bites and build momentum that leads to additional progress on problems that we can solve.

The iPad is Steve Jobs’ Waterloo

Jobs has put together a remarkable track record at Apple over the years, not only releasing a string of hit products (overshadowing the few duds… like Apple TV) and making the company solidly profitable with a plurality of analysts rating it a solid buy even with a P/E of 20:1.

Having said all that, Jobs is still a mere mortal and the iPad is a dud which will seriously deflate his carefully crafted image as a hitmaker with a Midas touch precisely because he himself has publicly attached so much significance to the iPad product, which by the way is simply an awful product name that has evoked well deserved criticism as something that suggests Apple is getting into the feminine hygiene product market.

The primary problem is that Apple is competitively targeting everyone with this product despite having glaring deficiencies when pared against specific competitors. Before I get to that, let’s call a spade a spade, the iPad is a supersized version of the iPod Touch, which in itself is interesting to consider because the market typically heaps praise on companies for making successful products more capable and smaller, rather than taking successful products and simply making them bigger.

Apple is clearly putting the Amazon Kindle in their sights but against the Kindle the iPad comes us short. FIrst the screen, yes it’s big and beautiful but so is the Droid and that alone doesn’t make it better than an iPhone… but a big bright screen is exactly what I don’t want in an e-reader for 2 reasons, battery life and readability. The Kindle, and if you have used one you simply know this as fact, has a display like paper, not as good as Sony’s display in this respect but pretty close and that makes the reading experience really pleasing on the eyes, you simply don’t get eye fatigue looking at the thing.

The iPad is also much bigger and weighing it at about 1.5 pounds it needs to go on a diet. It’s remarkable how much you notice a few ounces here and there when you are using something like an e-reader, or what the effect is of throwing another 2 pounds (power cord, case, etc.) in your travel bag. Apple fundamentally erred by not using advanced composite materials instead of aluminum and something other than glass for the display. This thing is too damn heavy.

People will say “yeah but imagine watching videos on the iPad!” and that’s a fair point but how are you going to feel the first time you go to Hulu and find out you can’t watch it because the iPad doesn’t support Flash?

Apple says the battery is good for 10 hours between charges but nobody can deny that Apple has a history of optimistic battery life estimates and to achieve 10 hours the networking components will have to be turned off, which gets to the next point, netbook replacement.

Apple also called out netbook makers but how good is the iPad as a netbook replacement when you have to carry around a separate keyboard that Apple has yet to release? Sorry to be a luddite but there is no way a virtual keyboard will replace a physical keyboard for a device used as a subcompact notebook computer… ain’t gonna happen.

On pricing Apple surprised everyone by offering the device for $500 but if you need 3G, which most will, the price jumps up to $629 and then there is another $360 of data (unlimited, who would risk going with anything but?) per year. All of this adds up to a bit of sticker shock for me… it’s too expensive as an e-reader replacement and given the peculiarities of the design (e.g. virtual keyboard) somewhat pricey as a netbook. On the latter Apple has successfully delivered on a well honed premium pricing strategy so I will acknowledge that on price alone it’s probably not an issue in the netbook market but in this economy I don’t think anyone should take anything for granted.

I am also somewhat dismayed that Apple continues to stick with AT&T in the U.S. market… I simply cannot understand how Apple can overlook the customer satisfaction issues and hitch their wagon to AT&T yet again.

I have predicted leading up to this announcement that Apple would suffer the same fate that every other tablet maker has experienced, nothing in yesterdays product announcement makes me feel any differently. If you want an e-reader you are better off sticking with Amazon and if you want a netbook there are plenty of very capable options available for less and that give you more, and if you just want a touch computer then you should get a Microsoft Surface because it’s simply far more capable (there’s something I never thought I would write).

Newsday’s Paywall… the Numbers are in

In October of last year I wrote that Newsday’s paywall would fail to attract new revenue and as a defensive pricing strategy it does little.

In the final analysis, this is exactly why it will fail. By creating a pricing plan that defends rather than attacks a market the company is conceding defeat in print and this strategy will have the effect of slowing audience growth online in the one segment that the paper requires, young people. I am willing to give Newsday and Cablevision some credit for being creative with a multichannel strategy that covers TV, print and online, but this pricing plan is a throwback to a subscription model that simply doesn’t work anymore.

[From Newsday.com Destined for Failure with Pay Wall | Venture Chronicles]

Well the numbers are in and after 3 months of running a paywall, Long Island based Newsday has attracted a whopping 35 subscribers to the website… not a typo, 3-5. Of course now management is running with some creative spin saying it’s 35 more than they expected to get and the pricing strategy was, as I exactly opined back in October, a strategy to defend the existing customer base who are getting access to the web site as part of their cable, prompting one Newsday reporter to observe that “we’re the freebie newsletter that comes with your HBO“.

Of course that explanation makes no sense at all because why spend $4m, according to the Dolan’s representative, to redesign and relaunch the website if it’s something extra that subscribers of the core cable service are getting as a freebie? It’ll take them 444 years to recover their investment at this rate.

Electric Vehicles Revisited

Over the weekend @Devahaz asked me for my thoughts on current status re a post I wrote over 2 years ago lamenting the optimistic projections of newly minted electric vehicle companies.

I realize that I may be guilty of “not getting with the program” on this whole electric car business, but does anyone else scoff at the idea there will be 100,000 Better Place cars on the road in 2010 or Tesla’s at every stoplight anytime soon?

[From It’s Frothy Around Here | Venture Chronicles]

Before getting into specifics, let me say now that I am an enthusiastic supporter of EV technology for many reasons. Aside from reducing our reliance on hydrocarbons as an energy source, EVs are great purpose specific vehicles that could change the way we approach transportation. Despite my enthusiasm for this type of vehicle there are real obstacles to achieving the vision and these obstacles run a broad spectrum of government regulatory powers to the limits of current technology.

There are 3 big issues impeding the development of EVs at this time: 1) the limitations of technology as it relates to range, 2) high cost, and 3) limited infrastructure to support large vehicle fleets.

The technology is proving itself but the fact remains that EVs are limited when compared to internal combustion vehicles, which for better or worse is the standard for power and range that EVs are compared against. Putting all biases aside, you really have to acknowledge that over 100 years of internal combustion engine development has resulted in a remarkably flexible and reliable propulsion technology. You can fill up your tank anywhere, anytime in 5 minutes and go for 300-500 miles on a single tank of gasoline (diesel is even better but let’s skip that debate for the purpose of this post), and modern vehicles are very reliable and repairing them is again, something that can be done anywhere. There is no way that EVs can live up to this standard, but they really should not be expected to live up to that standard either.

The primary enemy that EVs fight is weight and a very simple physics equation that means more weight requires more power which reduces range. EVs come to the party with an inherent weight disadvantage, namely the weight of current generation batteries, which means that corners have to be cut in other areas, like less sound deadening, lighter weight body panels, more expensive composite materials, and most obviously, much smaller vehicles.

Neighborhood Electric Vehicles (NEVs) are successful at getting around the weight issue by taking advantage of a regulatory definition that allows them to do away with bodywork, safety devices, and carrying capacity in exchange for restrictions on how and where they can be driven. This may be a good compromise but the costs of acquiring these vehicles is not insignificant for the average person.

This gets to a second issue, the regulatory framework. It is exciting to think about a new generation of low cost EVs that are purpose specific, e.g. around town errands and single passenger commuter vehicles, that are not required to have safety systems like air bags, light duty drivetrains, and limited bodywork. By driving down the cost of these vehicles it would be possible for families to have multiple special purpose vehicles rather than 1 or 2 general purpose vehicles that are overkill for most day to day tasks.

This scenario runs headfirst into the reality of insuring and licensing/registering vehicles today. Case in point is the F150 that I have… it’s a rubber floor mat basic work truck that I bought new for $13k (can you believe it, a 2008 truck that I bought new) but it costs me a little over $700 a year for insurance and registration. This is a vehicle that in 2 1/2 years just turned 10k miles of use. With these level of operating cost not associated with actual use, I would be hard pressed to justify any additional vehicles in our household that are not general purpose in nature and that is exactly opposite of what we should, as a society, be doing for transportation.

For EVs the cost of acquisition is really steep. I was on the waiting list for a Chevy Volt until GM became Government Motors, after which I simply would not buy a bailout mobile on general principle, but the bigger issue is that the Volt is a $40k electric version of the Malibu and that’s a tough sell to make.

I wrote a post several years ago that I cannot find today but in it I looked at the economics of a Honda Civic Hybrid versus a straight Honda Civic and found that with the average miles driven per year of between 12-15k the payback period for the cost premium that the hybrid commanded was around 12 years. It may well be less today as manufacturers are finding the hybrid sell a lot harder in this economy but the point is the same, if you are looking at cost per mile for the same vehicle in a hybrid and non-hybrid form, you are hard pressed to justify the hybrid on the basis of money saved. Perhaps this is why hybrid buyers flock to the Prius, which does not have a non-hybrid version, as a social statement and why hybrid versions of internal combustion models languish and why already expensive larger vehicles in hybrid version have stalled.

Lastly there is the infrastructure problem… and it isn’t going away anytime soon despite what Better Place and others would have us believe. BPs problem is broadening support with automakers, who themselves have been busy buttressing support for and from battery makers as a competitive differentiator. BP thesis is that a quickly replaceable battery would lead to a new generation of vehicles that overcome the range limitation of existing battery tech. They are right, no question about it, but being right and being successful are two very different outcomes.

BP did just raise $350m so they are clearly doing something compelling but if they only markets they can point to are pilot projects in Israel (a national security issue with deep government support) and Denmark, and the only vehicles you can choose from are what Renault chooses to offer, well it’s going to be a tough sledding. I simply can’t see auto makers signing on to a proprietary technology that locks them and customers into a BP network… it’s anathema to everything that car companies are about, generalization and fungible energy support. As I said in 2007, I believe the notion that BP will have 100,000 vehicles on the road in 2010 is pure fantasy and nothing has developed in the intervening years that suggests I am wrong.

EVs offer a lot of promise but they simply are not read for primetime. Toyota acknowledges this, the Volt will have very modest sales targets, the Nissan Leaf hasn’t been burning up the sales charts, and the cadre of specialty EV producers (Fisker, Tesla, etc.) are focusing on very niche markets for high priced enthusiast vehicles.

As I have often written, energy and transportation are two very complex topics that have a point of intersection with no easy solutions. We do have a number of options that simply don’t get attention because they are not technology centric or politically attractive. Lowering vehicle weight would instantly improve fleet fuel economy but in order to do that we would have to accept lower safety standards, adopting diesel and going a step further with natural gas injection for diesel would not only provide greater fuel economy but improve large truck diesel fleet economy as the same time while tapping a fuel, LNG, that we have in abundance in the U.S., and adapting diesel and hybrid technology for large passenger vehicle use (Mercedes did this with Bluetec and an S class sedan that achieved over 30mpg). We also have biofuel and ethanol options but both have tradeoffs that make them less than ideal.

While manufacturers and politicians will continue to chase the EV dream, the reality is that this technology will remain niche and, as BP demonstrates, dependent upon governmental support for large scale deployment. This technology will continue to develop and by 2015 we should start to see the fruits of those labors on a broader scale than what is achievable today.

Book Giveaway : Blogging to Drive Business

UPDATE: The books are all gone… but I am really proud to see that we collectively raised at least $150 for the Wounded Warrior project. Thanks for all the generosity, it’s a great cause that you should feel good about supporting.

I have 12 copies of a new book, in fact I don’t even think it’s available thru Amazon yet, Blogging to Drive Business. The name makes it pretty obvious what it’s about, so all I will add is that I read it and thought it was pretty good, very actionable stuff.

I used to do these as full freebies but that was when my shipping costs we an office expense, so rather than ask you to pay for shipping I have something else in mind, if you want a copy of this book email me at jnolan at gmail dot com and if I confirm back to you that you are in the first 12 then make a $5 (or whatever amount you want) donation to the Wounded Warriors Project and I’ll cover the shipping. No need to confirm your donation, we’ll do it on the honor system.

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YouTube and Prop 8

There has been quite a bit of commentary about the decision by a Federal judge to allow video of the ongoing Prop 8 constitutionality trial to be posted on YouTube, a decision that has been stayed by the SCOTUS with a final decision due today.

In the meantime, one message is clear: Banning the public from viewing a trial on gay marriage suggests how loosely we should interpret the word “transparency” as it’s applied to government and certainly the judicial system. The government can offer citizens Web 2.0 toys to play with all it wants, giving them the opportunity to have their voices heard via public comments, and the like. But banning video of a landmark court case, whose implications will undoubtedly impact the lives of most Americans, at least by association, shows quite clearly how very behind the curtain the rest of us still are.

[From Internet Evolution - Editor's Blog - YouTube Awaits Its Verdict in Prop 8 Trial]

Much of the debate has centered on the issue of transparency in the judicial system and potential adverse effects on testifying witnesses but I have a different reason for opposing the move to post court video on YouTube. The government, whether it be federal, state or local, should not be in the business of singling out a single company for benefit or financial gain, whether it be direct or indirect financial gain.

The decision to post video on YouTube does just that; rather than making the video freely available in a range of formats the judge in this instance singled out a single hosting provider that expressly prohibits the downloading and redistribution of content, In order to distribute the Prop 8 court video someone has to distribute it as a branded YouTube video in the embedded YouTube player console.

This record of this court case should not become the property of a single video hosting provider, it is the public record and if the court is intent on making the video of the court proceedings available they should do so in an non-proprietary video format hosted by any service provider that wishes to host it, and/or downloadable from the court website directly.

Government should never be in the business of picking winners and losers in business, there’s been far too much of that going on lately and the results speak for themselves.

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Market Outlook
Week Ahead Magazine: June 8, 2014
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Google and China

Larry wrote this today and I think it pretty much sums up the situation for Google in China.

Reading all of this laid out in a blog post can be summed up in one word: Wow. Now let’s look at how Google arrived at this big decision, which could result in a complete pullout. Why would the Chinese government give a hoot if Google leaves the country? If Google departed, the Chinese government’s chosen champion—Baidu—will lock up all the search share. Baidu already has 63 percent of the Chinese market, according to comScore.

[From Assessing Google's showdown with China: Does it make sense? | Between the Lines | ZDNet.com ]

I think we all need to accept that China is not a developing country, it is a developed country with technology competency and a drive to become self-sufficient in all technology markets. At every turn over the last few years native companies have been favored over foreigners, reflecting the cultural mindset of the Chinese and the policy of the technocrats.

It’s not just in consumer and industrial technologies either, there are over 20 nuclear power plants under construction in China which reflects the official policy of Beijing to build the expertise to be completely self-sufficient in nuclear reactor engineering and manufacturing, as well as the nuclear fuel cycle, which originally supported their weapons programs. Hydrocarbons are a transition strategy for China, the end game for that country is domestically produced electricity backstopped with reliable supplies of crude.

China is fully engaged in developing it’s own aviation industry, focusing initially on a China engineered and manufactured turbofan jet engine, with plans for a commercial jumbo jet in the design phases. This parallels the China space industry that has been in successful operation for a few years now.

The automobile market in China is already the largest in the world and a burgeoning number of Chinese companies have quickly developed sophisticated domestic capabilities. The technocrats have also dictated that China will be a leader in electric vehicle design and production within 3 years, which given their current state of the art seems rather unrealistic but even if it’s 5 or 7 years the result will be the same.

Underlying all of these plans is a well funded and extensively organized network supporting industrial espionage on a scale never before seen. It is plausible that the Google China announcement is more centered on the theft of intellectual property than the hacking of Gmail accounts, although I don’t wish to diminish the seriousness of the latter.

I wrote almost 3 years ago to the day that Google would regret agreeing to censor web content in China, that is was utter hypocrisy on the part of Google to do so and a betrayal of their brand values. Over the years we have seen Google walk back from their decision, at first stating that it was a mistake and now a full and complete departure appears in the works. Google got beat by China and we are all worse off as a result… you can’t sleep with dogs and not expect to get some fleas as a result.

More on this topic (What's this?)
China Transformation or Bust
China Economy Transformation or Bust, Part 2
Read more on Investing in China, Google at Wikinvest

Cable Commercials From Hell

In no particular order these are the commercials that I hear on cable news and on satellite radio that make me cringe:

- That Chet Holmes guy… you know, the guy who grew sales for “a well known billionaire”. I can’t even begin to catalogue all the ways that this guy is just odious.

- Anyone marketing gold. It’s hard to listen to these hucksters pushing gold as an investment while insinuating that “it’s gold so it’s never going to be worth zero!” as if gold hasn’t suffered steep losses as a commodity. Invariably these ads feature a voiceover of some hick saying “well my daddy told me to buy gold so that’s what I did!”.

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- Taxmasters… and JKHarris. Both of these companies, along with credit card debt workout agencies, make it sound like their solution is all gain and no pain. I suppose I’d feel differently about these companies if I had tax problems and didn’t have anywhere to turn, but I don’t and I also know well enough that paying someone to process paperwork for me isn’t a great deal either. If I did have tax problems I’d probably just take it as a sign that I should run for public office.

Your Tax Dollars at Work

The Federal government, specifically the Federal Highway Administration, is spending $1.2 billion of your money to nationalize the 511 highway traffic reporting system, replicating what Yahoo, Google, Navteq, and others are already doing. This is a great example of the overreach that is endemic to the Federal government but what is really troubling about it is that they are forcing significant expenditures upon states at a time when states across the country are running cumulative deficits of $145 billion and growing.

This is the kind of initiative that the Federal government should stay out of… $1.2 billion (plus whatever the states will have to spend) may not sound like a lot of money in an age when we throw around “a trillion” without a measure of shock to go with it, but this is real money for which ROI will be difficult to achieve in light of the fact that the private sector is already doing it.