My talk at South by Southwest on March 16, 2015. I use examples from consumer technology (the Apple Store, Uber/Lyft, and Google Now) to show where "the bar" is now for user experience, and what that should teach us about how to redesign healthcare. I also talk about the work of Code for America to debug the UX for CalFresh and MediCal.
World Government Summit on Open SourceTim O'Reilly
PDF of slides and notes from my keynote at Acquia's World Government Summit on Open Source in Washington DC October 11, 2012. I talk about how open source enabled the internet as a platform, and how it can enable government as a platform. I talk about examples from the internet and from Code for America's work with cities. I crib shamelessly from some of Jen Pahlka's talks about Code for America, and some of the lessons that can be taken from her work.
Government For The People, By The People, In the 21st CenturyTim O'Reilly
My joint keynote with Jennifer Pahlka of Code for America at the Accela Engage conference in San Diego on August 5, 2014. We talk about current advances in technology, and how they call for anyone developing services to put their users at the center. In particular, we talk about how these lessons apply to government. Making government work by the people and for the people in a 21st century way is central to restoring faith in government.
This is the original keynote file for my talk at the Smart Disclosure Summit in Washington DC on March 30, 2012. I will upload a PDF with notes separately.
My keynote at Velocity New York (#VelocityConf) on September 17, 2014. The failure of healthcare.gov was a textbook DevOps (or rather, lack of DevOps) case study. But it’s part of a wider pattern that reminds us that people should be at the heart of everything we build. In fact, getting the “people” part right is the key both to DevOps and great user experience design. It runs from the Internet of Things right through building government services that really work for citizens.
Open Data: From the Information Age to the Action Age (PDF with notes)Tim O'Reilly
This is the presentation I made at the UK Department for International Aid/Omidyar Network OpenUp! conference in London on November 13, 2012. I talk about open government not as a platform for transparency or citizen engagement, but for a developer ecosystem building useful services. A video of this talk is available at http://www.youtube.com/watch?feature=player_embedded&v=OIlxdpfu71o
WTF - Why the Future Is Up to Us - pptx versionTim O'Reilly
This is the talk I gave January 12, 2017 at the G20/OECD Conference on the Digital Future in Berlin. I talk about fitness landscapes as applied to technology and business, the role of unchecked financialization in the state of our politics and economy, and why technology really wants to create jobs, not destroy them. (There is a separate PDF version, but some readers said the notes were too fuzzy to read.)
Oakland Public Ethics Commission: Transparency, Open Data, and Gov as PlatformTim O'Reilly
I spoke at the Oakland Public Ethics commission on June 25, 2013. I was trying to set some context about how the ideas of transparency, open data, and government platform should shape their thinking. This is a PDF with notes on my talking points below each slide.
World Government Summit on Open SourceTim O'Reilly
PDF of slides and notes from my keynote at Acquia's World Government Summit on Open Source in Washington DC October 11, 2012. I talk about how open source enabled the internet as a platform, and how it can enable government as a platform. I talk about examples from the internet and from Code for America's work with cities. I crib shamelessly from some of Jen Pahlka's talks about Code for America, and some of the lessons that can be taken from her work.
Government For The People, By The People, In the 21st CenturyTim O'Reilly
My joint keynote with Jennifer Pahlka of Code for America at the Accela Engage conference in San Diego on August 5, 2014. We talk about current advances in technology, and how they call for anyone developing services to put their users at the center. In particular, we talk about how these lessons apply to government. Making government work by the people and for the people in a 21st century way is central to restoring faith in government.
This is the original keynote file for my talk at the Smart Disclosure Summit in Washington DC on March 30, 2012. I will upload a PDF with notes separately.
My keynote at Velocity New York (#VelocityConf) on September 17, 2014. The failure of healthcare.gov was a textbook DevOps (or rather, lack of DevOps) case study. But it’s part of a wider pattern that reminds us that people should be at the heart of everything we build. In fact, getting the “people” part right is the key both to DevOps and great user experience design. It runs from the Internet of Things right through building government services that really work for citizens.
Open Data: From the Information Age to the Action Age (PDF with notes)Tim O'Reilly
This is the presentation I made at the UK Department for International Aid/Omidyar Network OpenUp! conference in London on November 13, 2012. I talk about open government not as a platform for transparency or citizen engagement, but for a developer ecosystem building useful services. A video of this talk is available at http://www.youtube.com/watch?feature=player_embedded&v=OIlxdpfu71o
WTF - Why the Future Is Up to Us - pptx versionTim O'Reilly
This is the talk I gave January 12, 2017 at the G20/OECD Conference on the Digital Future in Berlin. I talk about fitness landscapes as applied to technology and business, the role of unchecked financialization in the state of our politics and economy, and why technology really wants to create jobs, not destroy them. (There is a separate PDF version, but some readers said the notes were too fuzzy to read.)
Oakland Public Ethics Commission: Transparency, Open Data, and Gov as PlatformTim O'Reilly
I spoke at the Oakland Public Ethics commission on June 25, 2013. I was trying to set some context about how the ideas of transparency, open data, and government platform should shape their thinking. This is a PDF with notes on my talking points below each slide.
Open Data: From the Information Age to the Action Age (Keynote File)Tim O'Reilly
This is the presentation I made at the UK Department for International Aid/Omidyar Network OpenUp! conference in London on November 13, 2012. I talk about open government not as a platform for transparency or citizen engagement, but for a developer ecosystem building useful services. A video of this talk is available at http://www.youtube.com/watch?feature=player_embedded&v=OIlxdpfu71o
A brochure-style presentation to introduce the big picture vision for R7 Partners, a venture capital firm that finds, funds, and builds early-stage startups with ambitious innovation.
I talk about the evolution of digital content into services, the role of sensors in the future of the web, about the idea of man-machine collaboration in internet services, and about the role of social networking in building content.
This is the pdf (with notes) of my slide deck from the Smart Disclosure Summit in Washington D.C. on March 30, 2012. Video will eventually be available.
Towards a New Distributional EconomicsTim O'Reilly
A talk I gave on December 1, 2017 for a workshop on AI and the future of the economy organized by the OECD and the Berkeley Roundtable on the International Economy. In it, I explore implications of AI and internet-scale platforms for the design of markets, with the goal of starting a conversation about what we might call "distributional economics."
My talk to the joint OECD/G20 German Presidency conference on digitalization in Berlin on January 12, 2017. Fitness landscapes as applied to technology, business, and the economy. Note that the fitness landscape slides will not be animated in this PDF, which I shared this way so that you could see my narrative in the speaker notes. While it has some slides in common with my White House Frontiers conference talk, it includes a bunch of other material.
Some Context for Thinking About
Technology and Sustainability. A version of my "Towards a Global Brain" talk with a focus on sustainability, given at the Verge conference on the convergence of buildings, transportation, energy, and information, on March 15, 2012.
Technology and Trust: The Challenge of 21st Century GovernmentTim O'Reilly
My talk at the 2013 Social Innovation Summit. Democracies get their strength from the people’s trust. When the interactions that people have with government are so divorced from how they live their lives, or are hard and unpleasant, what does that do to the trust that underlies our democracies? At Code for America, we try to restore trust in government by building interfaces to essential government services that are simple, beautiful, and easy to use.
We take four approaches: 1) we work directly with government officials (at the local level) to create the capacity inside government to build innovative solutions to hard problems; 2) we build communities of technologists and citizens who want to lend their skills to help build their governments; 3) we build tools that make citizen interactions with government easier, simpler, and more elegant, so that the experience of government is positive and breeds trust. 4) We incubate and accelerate civic startups to create new
economic models for those tools.
Don’t stop believing that government can work, and can be a force for good
The AIs Are Not Taking Our Jobs...They Are Changing ThemTim O'Reilly
My talk at the Web Summit in Dublin on November 6, 2014. Reflections on the notion that AI will take away jobs, and our need to recognize and redefine the human role in the applications we build. Covers many of the same ideas as my "Internet of Things and Humans" talk, but from a slightly different angle.
An Operating System for the Real WorldTim O'Reilly
My keynote at the Concur #PerfectTrip Devcon on October 2, 2013. I talk about the "internet operating system," and how sensors are turning it into a real world operating system, with "context aware programming." I use this metaphor to give lessons from some projects and startups putting these principles to work, including Tripit, the Google Autonomous Vehicle, Square, Uber, and Google Now.
We forget that when technology destroy, it helps us to create new ones, as long as we remember that the point isn't just cost-reduction, but doing things that were previously impossible! That means both solving hard problems, and pairing technology with people in ways that play to the strengths of each. My keynote at Strata+Hadoop World London, May 2017.
Yet another version of my book talk, this time at Harvard Business School, on March 28, 2018. This one had fewer slides with less connecting narrative so that I could spend more time interacting with the audience. I think it went pretty well. As usual, the speaker notes contain the narrative that goes with the slides, which are mostly images.
Software Above the Level of a Single DeviceTim O'Reilly
My talk at the O'Reilly Solid Conference on May 22, 2014. I mostly talk about UI implications of the Internet of Things, but also about the need for interoperability.
Do More. Do things that were previously impossible!Tim O'Reilly
My keynote at SxSW Interactive on March 9, 2018. I tackle the job of the entrepreneur to redraw the map, and not to accept the idea that technology will put people out of work rather than creating new kinds of prosperity. I try to provide a call to action to throw off the shackles of the old world and to build a new one. So many companies play defense. Cut costs, watch the competition, follow best practices. Great entrepreneurs like Jeff Bezos and Elon Musk play offense. They see the world with fresh eyes, taking off the blinders that keep companies using technology to make slight improvements to existing products and practices, rather than imagining the world as it could be, given the new capabilities that technology has given us.
Google handles over 3 billion searches a day, Amazon offers a storefront with 600 million unique items, Facebook users post 6 billion pieces of content sailing, all with the aid of complex algorithmic systems that respond to a constant influx of new data, adversarial activity by those trying to game the system, and changing preferences of users. These systems represent breakthroughs in the governance of complex, interacting systems, with algorithms that must be constantly updated to respond to rapidly changing conditions. The economy as a whole is also full of complex, interacting systems, but we still try to manage those systems with 20th century tools and processes. This talk explores what we can learn from technology platforms about new approaches that the Fed might take to improve its historical mission using the tools of agile development, big data, and artificial intelligence. My talk at the San Francisco Federal Reserve Bank FedAgile conference on November 7, 2018. Download the PPT file to read the narrative in the speaker notes. (I wish slideshare did a better job of displaying these, but they don't.)
Mobile Clinical Trial Congress: The opportunity to take a Mobile first approa...3GDR
For a video and links to content referred to within this talk click the following:
http://mhealthinsight.com/2015/04/01/mobile-first-clinical-trials/
For more details on the excellent MCT Congress event that was held on the 24-25 March 2015 at the Edinburgh Conference Centre visit:
http://www.mct-congress.co.uk/2015-edinburgh/programme/
Open Data: From the Information Age to the Action Age (Keynote File)Tim O'Reilly
This is the presentation I made at the UK Department for International Aid/Omidyar Network OpenUp! conference in London on November 13, 2012. I talk about open government not as a platform for transparency or citizen engagement, but for a developer ecosystem building useful services. A video of this talk is available at http://www.youtube.com/watch?feature=player_embedded&v=OIlxdpfu71o
A brochure-style presentation to introduce the big picture vision for R7 Partners, a venture capital firm that finds, funds, and builds early-stage startups with ambitious innovation.
I talk about the evolution of digital content into services, the role of sensors in the future of the web, about the idea of man-machine collaboration in internet services, and about the role of social networking in building content.
This is the pdf (with notes) of my slide deck from the Smart Disclosure Summit in Washington D.C. on March 30, 2012. Video will eventually be available.
Towards a New Distributional EconomicsTim O'Reilly
A talk I gave on December 1, 2017 for a workshop on AI and the future of the economy organized by the OECD and the Berkeley Roundtable on the International Economy. In it, I explore implications of AI and internet-scale platforms for the design of markets, with the goal of starting a conversation about what we might call "distributional economics."
My talk to the joint OECD/G20 German Presidency conference on digitalization in Berlin on January 12, 2017. Fitness landscapes as applied to technology, business, and the economy. Note that the fitness landscape slides will not be animated in this PDF, which I shared this way so that you could see my narrative in the speaker notes. While it has some slides in common with my White House Frontiers conference talk, it includes a bunch of other material.
Some Context for Thinking About
Technology and Sustainability. A version of my "Towards a Global Brain" talk with a focus on sustainability, given at the Verge conference on the convergence of buildings, transportation, energy, and information, on March 15, 2012.
Technology and Trust: The Challenge of 21st Century GovernmentTim O'Reilly
My talk at the 2013 Social Innovation Summit. Democracies get their strength from the people’s trust. When the interactions that people have with government are so divorced from how they live their lives, or are hard and unpleasant, what does that do to the trust that underlies our democracies? At Code for America, we try to restore trust in government by building interfaces to essential government services that are simple, beautiful, and easy to use.
We take four approaches: 1) we work directly with government officials (at the local level) to create the capacity inside government to build innovative solutions to hard problems; 2) we build communities of technologists and citizens who want to lend their skills to help build their governments; 3) we build tools that make citizen interactions with government easier, simpler, and more elegant, so that the experience of government is positive and breeds trust. 4) We incubate and accelerate civic startups to create new
economic models for those tools.
Don’t stop believing that government can work, and can be a force for good
The AIs Are Not Taking Our Jobs...They Are Changing ThemTim O'Reilly
My talk at the Web Summit in Dublin on November 6, 2014. Reflections on the notion that AI will take away jobs, and our need to recognize and redefine the human role in the applications we build. Covers many of the same ideas as my "Internet of Things and Humans" talk, but from a slightly different angle.
An Operating System for the Real WorldTim O'Reilly
My keynote at the Concur #PerfectTrip Devcon on October 2, 2013. I talk about the "internet operating system," and how sensors are turning it into a real world operating system, with "context aware programming." I use this metaphor to give lessons from some projects and startups putting these principles to work, including Tripit, the Google Autonomous Vehicle, Square, Uber, and Google Now.
We forget that when technology destroy, it helps us to create new ones, as long as we remember that the point isn't just cost-reduction, but doing things that were previously impossible! That means both solving hard problems, and pairing technology with people in ways that play to the strengths of each. My keynote at Strata+Hadoop World London, May 2017.
Yet another version of my book talk, this time at Harvard Business School, on March 28, 2018. This one had fewer slides with less connecting narrative so that I could spend more time interacting with the audience. I think it went pretty well. As usual, the speaker notes contain the narrative that goes with the slides, which are mostly images.
Software Above the Level of a Single DeviceTim O'Reilly
My talk at the O'Reilly Solid Conference on May 22, 2014. I mostly talk about UI implications of the Internet of Things, but also about the need for interoperability.
Do More. Do things that were previously impossible!Tim O'Reilly
My keynote at SxSW Interactive on March 9, 2018. I tackle the job of the entrepreneur to redraw the map, and not to accept the idea that technology will put people out of work rather than creating new kinds of prosperity. I try to provide a call to action to throw off the shackles of the old world and to build a new one. So many companies play defense. Cut costs, watch the competition, follow best practices. Great entrepreneurs like Jeff Bezos and Elon Musk play offense. They see the world with fresh eyes, taking off the blinders that keep companies using technology to make slight improvements to existing products and practices, rather than imagining the world as it could be, given the new capabilities that technology has given us.
Google handles over 3 billion searches a day, Amazon offers a storefront with 600 million unique items, Facebook users post 6 billion pieces of content sailing, all with the aid of complex algorithmic systems that respond to a constant influx of new data, adversarial activity by those trying to game the system, and changing preferences of users. These systems represent breakthroughs in the governance of complex, interacting systems, with algorithms that must be constantly updated to respond to rapidly changing conditions. The economy as a whole is also full of complex, interacting systems, but we still try to manage those systems with 20th century tools and processes. This talk explores what we can learn from technology platforms about new approaches that the Fed might take to improve its historical mission using the tools of agile development, big data, and artificial intelligence. My talk at the San Francisco Federal Reserve Bank FedAgile conference on November 7, 2018. Download the PPT file to read the narrative in the speaker notes. (I wish slideshare did a better job of displaying these, but they don't.)
Mobile Clinical Trial Congress: The opportunity to take a Mobile first approa...3GDR
For a video and links to content referred to within this talk click the following:
http://mhealthinsight.com/2015/04/01/mobile-first-clinical-trials/
For more details on the excellent MCT Congress event that was held on the 24-25 March 2015 at the Edinburgh Conference Centre visit:
http://www.mct-congress.co.uk/2015-edinburgh/programme/
Unicorn Media Index: Who Ranks Where Across News, Social and SearchTim Marklein
This report by Big Valley Marketing analyzes 75 top unicorns to benchmark their visibility and momentum across news, social and search channels. This is relevant because many founders believe unicorn status provides advantages for recruiting top talent, and demonstrates a startup’s viability for customers and prospects.
The study also showcases a new Earned Media Index™ for benchmarking earned media performance – often the most impactful but least-invested, under-measured part of the marketing and communications mix.
We conclude that unicorn status and valuation alone do not dictate media performance. We also learn a lot about category performance, company success factors, IPO impact and channel dynamics. We look forward to your feedback as we continue to study this important class of startups…
My June 4 talk to Web Manager University in Washington DC about the principles that should guide thinking about "government as platform." What are some of the success factors for technology platforms, and how is government already acting as a platform.
Government as a Platform: What We've Learned Since 2008 (pdf with notes)Tim O'Reilly
My talk at the UK Government Digital Service Sprint 15 event in London, February 2, 2015. I talk about my idea of government as a platform, and what I've learned since I first articulated the idea, with specific reference to what the GDS has taught me about the idea.
The ABCs of Practice Models: From Concierge to ACOs and Everything in BetweenKareo
Have you been wondering if you should switch to another reimbursement model like concierge or direct primary care? Or perhaps you think it is time to join a larger group like an ACO or IPA to take advantage of stronger bargaining power. How do you know if a change like this is right for your practice?
You'll learn:
- What to consider before making a change
- The pros and cons of each option
- Some of the regulatory and legal considerations
- The role of technology and practice marketing for the various choices
9 Actionable Healthcare Tweets from HIMSS 2015Buddy Scalera
9 tweets and action items for healthcare marketers and content strategists, as developed by Marilyn Cox @MarilynECox (Oracle) and Buddy Scalera @MarketingBuddy.
Be sure to visit: http://www.slideshare.net/americanregistry
Flyer Direct Primary Care Clinic MembershipRob Bartlett
Direct Care Partners is an affiliation of physicians practicing in the direct primary care clinic membership model, where insurance reimbursement is replaced by a flat, monthly membership fee. Direct Care Partners markets the #DPC "network" to employers who are including #DirectCare membership as the central BENEFIT in their group health benefits plan
Implications for risk management of digital health technologiesDavid Lee Scher, MD
Digital health technology is becoming a critical part of healthcare. As tools used in care (directly and indirectly), it has implications with regards to risk management. These are discussed from both liability and mitigation perspectives.
Mark Behl Presents: 3 Up-and-Coming Digital Health Companies That Put Patient...Mark Behl
The biggest obstacle to population health innovation is existing legacy systems. By putting patient experience first, three startups are exemplifying what is possible in digital health.
Improve Employee Health & Control Healthcare Costs with Direct Primary CareMegan Zimmerman
Direct Primary Care is providing employers of all sizes substantial cost savings while improving health outcomes. Learn how telemedicine, occupational health, wholesale medications, direct labs and imagining are working in tandem to create a cost effective and proactive healthcare model for employers.
My talk at Closing the Gap, Jeff Greene's conference on technology and income inequality, held in Palm Beach on Dec 7-8, 2015. I talk about lessons from technology for 21st century business.
Helping Government Keep Up with Moore's LawTim O'Reilly
My talk at the World Government Summit in Dubai on February 8, 2015. I talk about the pace of Moore's Law, and how AI, sensors, and on-demand are raising consumer expectations of government software. I go from there to my notion of government as a platform. PDF with Speaker notes - read the notes for the narrative that goes along with the slides.
Government as a Platform: What We've Learned Since 2008 (ppt)Tim O'Reilly
My talk at the UK Government Digital Service Sprint 15 event in London, February 2, 2015. I talk about my idea of government as a platform, and what I've learned since I first articulated the idea, with specific reference to what the GDS has taught me about the idea.
It's Not About Technology (pdf with Notes)Tim O'Reilly
My talk at Velocity 2015 Optimized Business Day. I talk about the imperative to use technology to empower workers, not replace them. This isn't just for highly paid knowledge workers. Finding ways to put everyone to work productively is one of the great challenges of the 21st century. Bonus: a great segment from Steven Vincent Benet's poem John Brown's Body.
Our fascination with machines is infinite, as is the unceasing focus to humanise them. The question is, how far are we willing to take artifical intelligence (AI)? Humans are emotional but not always emotionally intelligent, so it’s therefore possible that we end up we limiting the technology, losing ourselves in what we create. As such, to deal with the volatility, uncertainty, complexity, and ambiguity of our environment we must look beyond IT!
In this presentation, Simone explores the positives and negatives of volatility, uncertainty, complexity, and ambiguity (VUCA) with resilience vs. resistance, and teaches you how to understand talent diversity requirements in the machine age. In addition, she shows you how to elevate good habits while still retaining originality.
Technology should be a beneficial force in our lives, taking the world in exciting new directions and making us better humans. To ensure this, we need to facilitate a conversation between data technology and the human experience. Keeping social responsibility and ethical behavior in mind when designing AI systems enables us to put the right systems in place to contribute to the society we want, fostering higher levels of cognitive and emotional skills.
Jivan Virdee and Hollie Lubbock explore how to address fairness, accountability, and the long-term effects on our society when designing with data, focusing on four key areas for consideration in this space:
— Responsibility and accountability for machine learning systems
— Fair and transparent data science
— Trust and human-machine collaboration
—Automation and changes in the way we work
Along the way, they cover key issues in creating ethical AI systems and detail how we might go about tackling them and outline further questions that will need to be addressed going forward.
Big thanks to @fjord and @accenturedock for their help and support
Talk by:
https://www.linkedin.com/in/hollie-lubbock-703b77b/
https://www.linkedin.com/in/jivanvirdee/
Pew Internet Director Lee Rainie discussed the new media ecosystem with leaders of community foundations from Western states and several other locales. He described how three technology revolutions have made the media world personal, portable, participatory, and pervasive in people’s lives and how those changes have affected communities.
Mastering the demons of our own designTim O'Reilly
My talk about lessons for government from high tech algorithmic systems, given as part of the Harvard Science and Democracy lecture series on April 21, 2021. Download ppt for speaker's notes.
What's Wrong with the Silicon Valley Growth Model (Extended UCL Lecture)Tim O'Reilly
A three part lecture for the Institute for Innovation and Public Purpose at University College London. I talk about how the Silicon Valley growth model is leading from value creation to rent extraction, then about how public policy shapes our markets and what public policy students can learn from technology platforms (both what they do right and how they go wrong), and finally, I touch on some of the great mission-driven goals that could replace "increasing corporate profits" as the guiding objective of our economy.
Learning in the Age of Knowledge on DemandTim O'Reilly
The London Black Cab driver's exam, "The Knowledge of the Streets and Monuments of London," is one of the most difficult exams in the world, requiring drivers to become a human GPS. With today's tools, the smartphone and the right app turns anyone into the equivalent of a human GPS. I've been asking myself how this concept applies to the field of online learning, particularly in my own field of programming and related IT skills. How should we rethink learning in the age of knowledge on demand? My keynote at the EdCrunch conference in Moscow on October 1, 2019. As always, download the PPT to read the detailed script in the speaker notes below each slide.
What's Wrong With Silicon Valley's Growth ModelTim O'Reilly
A talk I gave on the oreilly.com live training platform on January 22, 2020, focusing on the way that many Silicon Valley startups are designed to be financial instruments rather than real companies. They are gaming the financial system, much like the CDOs that fueled the 2009 financial crash. I talk about the rise of profitless IPOs, and contrast that with the huge profits of the last wave of Silicon Valley giants. In many ways, it is an extended meditation on Benjamin Graham's famous statement, "In the short term, the market is a voting machine, but in the long term it is a weighing machine."
My talk for TechStars at Techweek Kansas City in October 2018. While this is a talk based on my book WTF?, it is fairly different from many of the others that I've posted here, in that it focuses specifically on parts of the book that contain advice for entrepreneurs, rather than on the broader questions of technology and the economy. As always, look at the speaker notes for
My plenary talk to the California Workforce Association Conference in Monterey, CA, on September 5, 2018. I talked about the role of technology to augment people rather than replace them from my book WTF? What's the Future and Why It's Up to Us, and my ideas about AI and distributional economics, in the context of today's education and workforce development systems. I also summarize some of the work Code for America has been doing on the current state of the California Workforce Development ecosystem.
My keynote at OSCON 2018 in Portland. What I love about open source software, and what that teaches us about how we can have a better future by the better design of online marketplaces and the algorithms that manage them - and our entire economy. The narrative is in the speaker notes.
My keynote at the 2018 New Profit Gathering of Leaders conference in Boston on May 17, 2018. I talk about the lessons from technology platforms, how they teach us what is wrong with our economy, and the possibilities of AI for creating better, fairer, more effective decisions about "who gets what and why" in the economy.
Slides from my talk at the Price Waterhouse Coopers Deals Exchange conference on April 26, 2018. I talk about algorithmically manage, internet-scale networks and how they are changing the very nature of the economy, the shape of companies, and the competencies that are required for 21st century success. There are many similar themes to other talks, but this is tailored to a business audience, and very specifically to one concerned with how to do M&A in an age of dominant platforms.
My keynote at the Open Exchange Summit in Nashville on April 18, 2018. I talk about the implications for many different kinds of companies of the fact that increasingly large segments of our economy are being dominated by algorithmically managed network marketplaces.
We Get What We Ask For: Towards a New Distributional EconomicsTim O'Reilly
My keynote at the Venturebeat Blueprint conference in Reno, NV on March 6, 2018. The bad maps that are holding us back from building a better world. Technology need not eliminate jobs. It could be helping us tackle the world's great problems, and helping design marketplaces that ensure a more equitable distribution of the proceeds from doing so. The narrative that goes with the deck is in the speaker notes. There is also a summary and link to the video at https://venturebeat.com/2018/03/06/tim-oreilly-to-tech-companies-use-a-i-to-do-more-than-cut-costs/
This is my March 8, 2001 pitch to Jeff Bezos on why Amazon ought to offer web services. I'm uploading it now because I'm referencing it in my forthcoming book, WTF: What's the Future and Why It's Up To Us, due from Harper Business in October 2017, and want people to be able to take a look at it. This is of historical interest only.
A somewhat longer version of my Frontiers talk about technology and the future of the economy, with additional material pitched to an audience of Internet operators at Apricot 2017, in Ho Chi Minh City, Vietnam on February 27, 2017
My talk at the White House Frontiers Conference at CMU on October 13, 2016. I was one of the warmup acts for the President, talking about why we should embrace an AI future. Full text can be seen here
How many patients does case series should have In comparison to case reports.pdfpubrica101
Pubrica’s team of researchers and writers create scientific and medical research articles, which may be important resources for authors and practitioners. Pubrica medical writers assist you in creating and revising the introduction by alerting the reader to gaps in the chosen study subject. Our professionals understand the order in which the hypothesis topic is followed by the broad subject, the issue, and the backdrop.
https://pubrica.com/academy/case-study-or-series/how-many-patients-does-case-series-should-have-in-comparison-to-case-reports/
CHAPTER 1 SEMESTER V PREVENTIVE-PEDIATRICS.pdfSachin Sharma
This content provides an overview of preventive pediatrics. It defines preventive pediatrics as preventing disease and promoting children's physical, mental, and social well-being to achieve positive health. It discusses antenatal, postnatal, and social preventive pediatrics. It also covers various child health programs like immunization, breastfeeding, ICDS, and the roles of organizations like WHO, UNICEF, and nurses in preventive pediatrics.
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
QA Paediatric dentistry department, Hospital Melaka 2020Azreen Aj
QA study - To improve the 6th monthly recall rate post-comprehensive dental treatment under general anaesthesia in paediatric dentistry department, Hospital Melaka
Struggling with intense fears that disrupt your life? At Renew Life Hypnosis, we offer specialized hypnosis to overcome fear. Phobias are exaggerated fears, often stemming from past traumas or learned behaviors. Hypnotherapy addresses these deep-seated fears by accessing the subconscious mind, helping you change your reactions to phobic triggers. Our expert therapists guide you into a state of deep relaxation, allowing you to transform your responses and reduce anxiety. Experience increased confidence and freedom from phobias with our personalized approach. Ready to live a fear-free life? Visit us at Renew Life Hypnosis..
Leading the Way in Nephrology: Dr. David Greene's Work with Stem Cells for Ki...Dr. David Greene Arizona
As we watch Dr. Greene's continued efforts and research in Arizona, it's clear that stem cell therapy holds a promising key to unlocking new doors in the treatment of kidney disease. With each study and trial, we step closer to a world where kidney disease is no longer a life sentence but a treatable condition, thanks to pioneers like Dr. David Greene.
Antibiotic Stewardship by Anushri Srivastava.pptxAnushriSrivastav
Stewardship is the act of taking good care of something.
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
WHO launched the Global Antimicrobial Resistance and Use Surveillance System (GLASS) in 2015 to fill knowledge gaps and inform strategies at all levels.
ACCORDING TO apic.org,
Antimicrobial stewardship is a coordinated program that promotes the appropriate use of antimicrobials (including antibiotics), improves patient outcomes, reduces microbial resistance, and decreases the spread of infections caused by multidrug-resistant organisms.
ACCORDING TO pewtrusts.org,
Antibiotic stewardship refers to efforts in doctors’ offices, hospitals, long term care facilities, and other health care settings to ensure that antibiotics are used only when necessary and appropriate
According to WHO,
Antimicrobial stewardship is a systematic approach to educate and support health care professionals to follow evidence-based guidelines for prescribing and administering antimicrobials
In 1996, John McGowan and Dale Gerding first applied the term antimicrobial stewardship, where they suggested a causal association between antimicrobial agent use and resistance. They also focused on the urgency of large-scale controlled trials of antimicrobial-use regulation employing sophisticated epidemiologic methods, molecular typing, and precise resistance mechanism analysis.
Antimicrobial Stewardship(AMS) refers to the optimal selection, dosing, and duration of antimicrobial treatment resulting in the best clinical outcome with minimal side effects to the patients and minimal impact on subsequent resistance.
According to the 2019 report, in the US, more than 2.8 million antibiotic-resistant infections occur each year, and more than 35000 people die. In addition to this, it also mentioned that 223,900 cases of Clostridoides difficile occurred in 2017, of which 12800 people died. The report did not include viruses or parasites
VISION
Being proactive
Supporting optimal animal and human health
Exploring ways to reduce overall use of antimicrobials
Using the drugs that prevent and treat disease by killing microscopic organisms in a responsible way
GOAL
to prevent the generation and spread of antimicrobial resistance (AMR). Doing so will preserve the effectiveness of these drugs in animals and humans for years to come.
being to preserve human and animal health and the effectiveness of antimicrobial medications.
to implement a multidisciplinary approach in assembling a stewardship team to include an infectious disease physician, a clinical pharmacist with infectious diseases training, infection preventionist, and a close collaboration with the staff in the clinical microbiology laboratory
to prevent antimicrobial overuse, misuse and abuse.
to minimize the developme
Medical Technology Tackles New Health Care Demand - Research Report - March 2...pchutichetpong
M Capital Group (“MCG”) predicts that with, against, despite, and even without the global pandemic, the medical technology (MedTech) industry shows signs of continuous healthy growth, driven by smaller, faster, and cheaper devices, growing demand for home-based applications, technological innovation, strategic acquisitions, investments, and SPAC listings. MCG predicts that this should reflects itself in annual growth of over 6%, well beyond 2028.
According to Chris Mouchabhani, Managing Partner at M Capital Group, “Despite all economic scenarios that one may consider, beyond overall economic shocks, medical technology should remain one of the most promising and robust sectors over the short to medium term and well beyond 2028.”
There is a movement towards home-based care for the elderly, next generation scanning and MRI devices, wearable technology, artificial intelligence incorporation, and online connectivity. Experts also see a focus on predictive, preventive, personalized, participatory, and precision medicine, with rising levels of integration of home care and technological innovation.
The average cost of treatment has been rising across the board, creating additional financial burdens to governments, healthcare providers and insurance companies. According to MCG, cost-per-inpatient-stay in the United States alone rose on average annually by over 13% between 2014 to 2021, leading MedTech to focus research efforts on optimized medical equipment at lower price points, whilst emphasizing portability and ease of use. Namely, 46% of the 1,008 medical technology companies in the 2021 MedTech Innovator (“MTI”) database are focusing on prevention, wellness, detection, or diagnosis, signaling a clear push for preventive care to also tackle costs.
In addition, there has also been a lasting impact on consumer and medical demand for home care, supported by the pandemic. Lockdowns, closure of care facilities, and healthcare systems subjected to capacity pressure, accelerated demand away from traditional inpatient care. Now, outpatient care solutions are driving industry production, with nearly 70% of recent diagnostics start-up companies producing products in areas such as ambulatory clinics, at-home care, and self-administered diagnostics.
Navigating the Health Insurance Market_ Understanding Trends and Options.pdfEnterprise Wired
From navigating policy options to staying informed about industry trends, this comprehensive guide explores everything you need to know about the health insurance market.
Telehealth Psychology Building Trust with Clients.pptxThe Harvest Clinic
Telehealth psychology is a digital approach that offers psychological services and mental health care to clients remotely, using technologies like video conferencing, phone calls, text messaging, and mobile apps for communication.
29. @timoreilly
Look At Everything Uber Does For Me
Lets me call a car from anywhere
Automatically tells available drivers where I am
Lets me know how long it will be till my car arrives
Lets me contact the driver by text or voice - anonymously
Lets me pay without having to pull out my wallet
Gives me a detailed receipt showing exactly where I went and
how long it took - which lets me complain if the driver didn’t go
the optimal route (and Uber gives refunds)
Lets me rate my driver, and uses that rating to manage the
quality of service
30. @timoreilly
How a Doctor’s Visit Ought to Work
•Phone detected on entry to office, hospital, or ER
•Insurance automatically checked
•Medical history automatically loaded into system
•Vitals and other quantified self info automatically loaded
•Data automatically used to sort queue and give wait times
•If ER, possible discharge to available nearby outpatient clinic or doctor’s
office
•Portable medical record updated as patient exits
•(Aside: We also need payment reform!!!)
•Lets me rate my experience, and uses that rating to manage the quality
of service
33. @timoreilly
“Why be distracted into looking backwards by the
commodity cloners of open source?...There is a new
frontier, where software "collectives" are being built with
ad hoc protocols and with clustered devices. Robotics
and automation of all sorts is exposing a demand for
sophisticated new ways of thinking....Useful software
written above the level of the single device will
command high margins for a long time to come.”
- Dave Stutz, On Leaving Microsoft, February 2003
http://www.synthesist.net/writing/onleavingms.html
34. @timoreilly
Data At the Heart of the Uber System
Real-time location tracking
Dispatch
Trip tracking
Names and faces
Payment
Dynamic Pricing
Reputation
senger
Driver
39. @timoreilly
Minimum Viable Product
“that version of a new product which
allows a team to collect the maximum
amount of validated learning about
customers with the least effort.”
- Eric Ries
40. @timoreilly
We’ve taken this for granted in web
applications. But now, with Internet of Things
applications powered by big data back ends,
Lean Startup principles apply to every real
world service!
41. Text
@timoreilly
“Only 1% of healthcare spend now goes to
diagnosis. We need to shift from the idea that you
do diagnosis at the start, followed by treatment, to
a cycle of diagnosis, treatment, diagnosis...as we
explore what works.”
-Pascale Witz, GE Medical Diagnostics
42. Text
@timoreilly
“Half the money I spend on advertising is
wasted; the trouble is I don't know which
half.”
- John Wanamaker (1838-1922)
48. @timoreilly
“We know about all these new technologies. What we
don’t know is how to organize ourselves to use them
effectively.”
- An IT executive at Fidelity, during Q&A
after a talk I gave there in 2008
57. @timoreilly
“Uber is a $3.5 billion lesson in
building for how the world *should*
work instead of optimizing for how
the world *does* work” - Aaron
Levie of Box.net
67. @timoreilly
Rescuing healthcare.gov
A team of engineers. They came in and worked tech
wizardry, right?
Maybe some of that, but a lot of the work was debugging the
communications failures that led the contractors to build
software components that didn’t work together.
68. @timoreilly
17 hour days
100 days straight
Standup meetings focused on why people weren’t
able to keep the promises they’d made to each other
Mikey Dickerson
Google Site Reliability Engineer
Mikey Dickerson
72. @timoreilly
“…one privilege the insured and well-off have is to excuse the
terrible quality of services the government routinely delivers to
the poor. Too often, the press ignores — or simply never knows —
the pain and trouble of interfacing with government
bureaucracies that the poor struggle with daily.”
—Ezra Klein
76. @timoreilly
“User needs. An empathetic service would ground itself in the concrete needs of concrete people. It’s
not about innovation, big data, government-as-a-platform, transparency, crowd-funding, open data,
or civic tech. It’s about people. Learning to prioritize people and their needs will be a long slog. It’s
the kind of change that happens slowly, one person at a time. But we should start.”
107. @timoreilly
Learn More About How You Can Help
Meetup tomorrow morning 9 am - 11 am
Halcyon, at 4th and Lavaca
c4a.me/sxsw15
codeforamerica.org/talent
whitehouse.gov/usds
Editor's Notes
The title of this talk is lifted from Lincoln’s Gettysburg Address, by way of the Code for America mission statement, but it’s a great way to think about one of the most important problems facing technologists today. I’m actually not going to talk all that much about healthcare, so much as I’m going to talk about what we learn from consumer technology about what our expectations for healthcare technology *ought* to be.
Edwin Schlossberg once said “The skill of writing is to create a context in which other people can think.”
I want to give you some context for thinking about the next big revolution in technology: the Internet of Things. The very name shows that we’re not thinking about it right. It’s actually an internet of things and humans. Framing it that way will give you much deeper insight into how to design products and services. I’ll be talking about sensors, but also about service design, and about the role of data in the applications that will power this next wave of innovation.
When you hear about the Internet of Things, you probably think about new devices, like the Apple Watch.
Or the Nest Thermostat. It’s easy to focus on the device, but ultimately, these are deeply data-connected.
What we’re really talking about are internet services and systems whose primary user interface are new kinds of sensors and actuators.
The Moto X is my favorite smartphone (so far) for this very reason. They’ve used the sensors in the phone in a variety of creative ways, from the feature shown here, that you can wake up your phone and ask it to do something without touching it, to the shake gesture to open the camera. But what I love best are features like that it notices when I’m driving. If I get a text, it says, “You just got a text? Would you like me to read it to you?” And of course, then asks me if I want to reply. What a great way to get you using speech features regularly, but also a great way to rethink the UI using the new superpowers given to my phone, and by extension to me, by clever use of the sensors.
And new devices, like the Android Wear watches, like the Samsung Gear watch I’m wearing now, or the Moto 360, pictured here, are really “Google Now” devices. They are a connection to a predictive agent, that is constantly reminding you of things, providing context, and giving you easy access to internet services.
The watch is really just a peripheral for the smartphone. And it’s super important to remember that the smartphone is the most widely distributed “Internet of Things” platform. It is packed with sensors - it can see, it can hear, it knows where it is, whether it is moving, and in what direction - and it can report these things not only to the person who is holding it but to other applications. And it has other “senses” too! It can “listen” to real time databases, and report in to them. And of course, it can interface with humans.
And so the real potential of the Internet of Things isn’t about some hot new device. It’s about how connected sensors and the data they provide call allow us to rethink the way we do things.
Consider the Apple Store. Apple used the smartphone to rethink the workflow of an industry that we’ve always taken for granted: the retail store.
Where most stores (at least in America) have used technology to eliminate salespeople, Apple has used it to augment them. Apple used the phone to give superpowers to its salespeople, eliminating the cash register in the process.
Each store is flooded with smartphone-wielding salespeople who are able to help customers with everything from technical questions to purchase and checkout. And the workflow of the store is completely rethought. You look at the items on the showroom floor, all alive and working, not in boxes. You ask questions of one of the many helpful workers, and when you’ve made your decision, the staff member asks for your email address. If you’ve ever bought anything from Apple, in the store or online, your cc is already available. Your package is summoned from the back, handed to you, and you walk out. Your receipt is emailed to you.
Former US CTO Todd Park foresees a future in which health workers will be part of a feedback loop including sensors to track patient data coupled with systems that alert them when a patient needs to be checked up on. The augmented home health worker will allow relatively unskilled workers to be empowered with the much deeper knowledge held in the cloud.
The Apple Store is a magical retail experience. That’s the real measure of a transformative technology: it makes a magical experience.
And it became magical because it used technology to enable people, not to replace them!
Or consider Uber. Most people don’t think of it as an IoT app, but that’s precisely why we need to start there. It is an application that is entirely made possible by sensors in the phone, connected to data services in the cloud. And there are some really great lessons here.
How many of you have used Uber or Lyft? If you have, you know how transformational it is to be able to know just how long it will take for a car to pick you up - to summon one whenever you need one, with the confidence that it will actually show up when and where you want it.
A couple of other apps that are playing in the “hey, let’s use sensors to change the workflow and let the user do less” include Cover, which brings an Uber-like experience to restaurants - “dine and dash” becomes the norm, with payment happening automatically. “Sensors” of course include location, but again, stored data like your face, name, and credit card are provided automatically for verification. (Disclosure: OATV is an investor in Cover.)
In the process, these applications are completely changing user expectations about how easy services ought to be to use.
Uber and Lyft and Cover are magical.
And it is worth noting once again that Uber and Lyft use technology to enable people, not to replace them! Uber and Lyft allow more people to become drivers, and more people to use on-demand transportation. They don’t just take costs out of an existing system.
One of the biggest changes in user expectation that technology will bring into our everyday lives in the next few years is going to be via “agents” like Siri and Google Now, which will bring predictive analytics to bear on routine tasks that we already depend on our computers for. Google Now routinely alerts me to leave early for work when traffic is bad,
And when I’m traveling, automatically assembles everything from my boarding pass to alerts about the weather and even events at my destination.
You can even tell Google Now to automatically remember where you parked your car. No action required beyond the additional setup. Sensors in your phone identify when you were driving, when you stopped, and when you began to walk. That you parked is an easy inference. And of course, your phone knew exactly where you were!
Google Now is magical.
And that magic changes our expectations forever.
So here’s my first lesson: Use technology to give people super powers.
This kind of superpowers. Our phones used to be the tool of superheroes.
The first role of AIs is to give super-powers to humans. We don’t think of GPS-based navigation as “AI”, but it is a kind of Artificial or Augmented Intelligence.
Think about it. Drop a smartphone enabled human in a strange city and they can still find their way around. (Of course, we could do this with a much earlier augmentation, the printed map, but the key characteristic of modern technology is that information access is much faster, and more complete. And the downside - we are much more dependent on it!)
So this is the key question. How do we use...
So what else do we learn from these applications? Do less! Less UI that requires the user to interact with the application. Use the sensors in the device to provide context to the application. Use stored data about the user rather than asking them for it again and again.
Think of that magical moment when you walk out of the Apple Store, or the Uber, without ever pulling out your wallet! That’s part of what makes them magical experiences.
Now contrast your experience in healthcare. How often have you filled out some version of this form?
https://www.flickr.com/photos/navymedicine/15084211290
And if you’ve ever been in the hospital, you probably remember how hard it was to sleep. Someone was always waking you up to check your vital signs. That’s really not necessary in the 21st century.
(There are lots of other customer-hostile features of hospitals, where everything is designed for the convenience of the staff rather than the patients.)
Not surprisingly, my second lesson could be reframed as “Do More.” Do more for the user, with less interaction. Take a look, for example, at the receipt that I get from Uber!
Uber collects information automatically from the phone’s sensors, and packages up in a useful format to confirm the details of your trip. And that’s just the beginning.
But that’s not all! Now, through integration with Expensify, you can not only have your receipt automatically turn into an expense report, if you’ve forwarded your flight details to Expensify, it can automatically have an Uber waiting for you when you arrive!!!
This example highlights another key point: namely, that the new inputs to the systems we build are often internet data services, not just data from sensors. In the end, it’s not just local sensing that matters, its sensors connected to a big data back end.
So what do I think when, weeks after my visit to the doctor, I get something like this in the mail. I may or may not have received a bill from my doctor or hospital in the meantime, but I don’t know whether to pay it until I get the insurance confirmation.
Truly broken. Truly user hostile.
So let’s compare the Uber experience with what we will soon expect from our healthcare experience.
Look at everything that Uber does for me.
Here’s how a doctor’s visit ought to work.
Of course, I’m leaving aside the most magical aspect of Uber and Lyft - that they come to you. We’ll talk about that later in this presentation.
I promised an aside on payment reform. If you’ve never taken a look at ClearHealthCosts.com, you should. It’s shocking how far our healthcare system is from a true market system. Costs vary by an order of magnitude within only a few miles. And there’s all kinds of gaming of the reimbursement system. That needs a systemic fix.
There’s another lesson here. When you think about Uber, it’s easy to see that it isn’t just a smartphone app. It’s an entire system, with different apps for passenger and driver, and a big data backend that does dispatch and billing. Healthcare is also a system. And what’s important to realize is that you can build great user experiences even when you don’t control every bit of the service.
In fact, today’s web apps are almost all composed out of services that are sometimes run by others.
I first heard this wonderful formulation of the essence of the technology future from Microsoft’s one-time open source software leader, Dave Stutz, when he retired from Microsoft in 2003. His parting advice is still worth reading.
This “software above the level of a single device” is a SYSTEM with multiple users on multiple devices.
And ultimately, it’s a system built on a big data back end! Some of that data is from sensors. Some of it is from stored memory (e.g. names and faces of driver and passenger, payment credentials). Some of it is calculated and reported in real time. And some of it (e.g. reputation) comes from explicit user input.
It’s really important to understand that the internet of today is a vast web of data services you can build on. And of course that the applications of the future are not just multiplexing data services, they are multiplexing real world services!Don’t just think about building tools for managing data. Build actual data services that people can build on.
Many of the components of the system, such as anonymized communications between you and the driver by text message or voice, or cashless billing, are made possible by third party providers (in this case Twilio and Braintree) The internet really is becoming an “operating system”, as I first claimed nearly fifteen years ago. Use its capabilities! Mapping, identity, payment are only a few of the many things that we can now take for granted when building online services. But Uber is a great example of how to assemble these into more than the sum of their parts.
Don’t build everything from scratch. There are so many useful services available by API.
By contrast, even the simplest forms of interoperability still seem to be an enormous challenge in healthcare. We’ve made great progress in sharing digital medical records, with big incentives from the US Federal government driving a lot of change. But in general, the state of composable services in healthcare is pretty miserable.
There’s a lot of opportunity here for entrepreneurs.
My next lesson from consumer technology for healthcare is to take a leaf from the way that web apps constantly measure everything from performance to the details of what people use, try to discern why, and then make changes to optimize the experience.
This kind of thinking is expressed very well in books like The Lean Startup by Eric Ries. Eric spoke earlier today here at SxSW.
One of the key ideas of the Lean Startup is of the “Minimum Viable Product”, which Eric Ries defines as “that version of a new product which allows a team to collect the maximum amount of validated learning about customers with the least effort.” And it really is at the core of most modern startups, who view their product as an ongoing series of experiments. These products are really produced through what is called “continuous deployment”, in which a series of minimum viable products are deployed in sequence.
We’ve taken this for granted in web applications. But now, with Internet of Things applications powered by big data back ends, Lean Startup principles apply to every real world service!
One obvious area is in personalized medicine, which requires new kinds of diagnostic feedback loops. Pascale Witz of GE Medical Diagnostics explained how “Only 1% of healthcare spend now goes to diagnosis. We need to shift from the idea that you do diagnosis at the start, followed by treatment, to a cycle of diagnosis, treatment, diagnosis...as we explore what works.”
I wrote a paper a few years ago about the increasing role of big data and feedback loops in healthcare. I described how healthcare is now solving what advertisers call “the Wanamaker problem” after 19th century department store magnate John Wanamaker, who said “Half the money I spend on advertising is wasted; the trouble is I don't know which half.” What Google did with pay-per-click advertising was to solve the Wanamaker problem, by building a business model that only charged advertisers when consumers clicked on their ads, and harnessing collective intelligence to predict which of those ads would be most likely be clicked on. That’s what we’re now doing with data for health - genetics and data from various kinds of sensors can be used to provide smarter care, and public health statistics and models can be used to manage better usage and cost controls.
Another really important lesson from consumer technology is that the systems we are building are not only for the benefit of people, but are in some fundamental ways still made of people...
When you use Google Maps these days, your route is influenced by real-time traffic data. In this case, you can see that traffic from Oakland to San Francisco is really backed up on the Bay Bridge itself. There’s no really good alternative.
But on another day, when traffic was particularly bad on the approach to the bridge rather than the bridge itself
Google automatically re-routed us to another route that is longer in miles but shorter in time. Google Maps is constantly learning from everyone who uses the service. We already knew about this shortcut, but usually don’t know when to take it. Now we do.
My fiance had an even more remarkable experience when driving recently in Texas. She was using navigation, in an unfamiliar environment. She was told to get on a freeway and drive 9 miles. A mile into the route, the navigation app on her phone told her to get off at the next exit. She did, and saw from the exit ramp an accident up ahead. The app had re-routed her in real time.
A huge part of “closing the loop” is learning from your users, paying attention to what they do and responding to it. I’ve often said that one of the key competencies of web applications has got to be “harnessing collective intelligence.” Sensors let Google and Uber do this in real time, but there are lots of other ways you can do this.
That experience my fiance had was made possible by Waze, acquired recently by Google. Again, internet enabled smartphones, building a real time database... I particularly love how their home page emphasizes the role of people in building the collective database. This notion of collective intelligence has been my theme song since the Web 2.0 days. And pretty early on, I started saying that in the future (that is, now), those collective intelligence applications would be driven by sensors. Or even better, humans and sensors working in concert! Waze drivers report incidents, but their phones report traffic speed and location!
Ultimately, there’s a thread that ties together the Apple Store, Uber and Lyft, and real time traffic intelligence, and that is that they are all putting together technology and humans in creative new ways to deliver great new experiences.
The challenge companies and other institutions face was well expressed by this quote from an IT executive at Fidelity investments, during a Q&A after a talk I gave there in 2008. “We know about all these new technologies. What we don’t know is how to organize ourselves to use them effectively.”
Because of course, every new technology involves massive changes in how people are organized. From factory assembly lines....
through more modern examples like open source software
as well as new services like AirBnb
Uber
And the Apple Store
are all based on new ways of using technology to organize people and the work that they do for each other.
Think about how Uber and the Apple Store have both completely rethought the workflow of their respective industries - hailing a cab, and the retail store - by using the sensors and connectivity of smartphones to augment and empower the people using them. In a way, these services are actually made OF PEOPLE and computers in a new kind of symbiosis.
And in health care - new services like 23andMe
and PatientsLikeMe are also creative new ways of collecting data from massive numbers of people, and making it possible to extract insight, and eventually fulfill the promise of personalized medicine.
What a shame that our regulatory system is working hard to hold back a service like 23AndMe!
It’s quite clear that we need some fresh thinking on healthcare data and privacy. Most people are quite willing to share their health data - what they are worried about is adverse selection by insurers and employers! Instead of regulating to prevent these abuses, we try to keep the information secret. That’s not the right approach any more!
In the end, the challenge before us is to completely reimagine the way healthcare (and other services) ought to work.
box.net founder Aaron Levie put it perfectly in a tweet. “Uber is a $3.5 billion lesson in building for how the world should work instead of optimizing for how the world does work.” I believe their latest valuation was $40 billion, but you get the idea.
That’s the bar we need to set for reinventing healthcare and health insurance. What we’re really talking about, whether with data science, or the internet of things, is how to put technology to work making great human experiences. Technology isn’t interesting for its own sake. It only matters if it makes a better world for all of us.
We’re not talking about just adding digital and connectivity to the way services work now. Putting network connected credit card readers into taxicabs didn’t radically change the taxi experience. What Uber and Lyft have put together are game changing.
What we really need to do is to completely rethink workflows and experiences.
Sensor-driven devices, and the data-backed services they enable, give us power to rethink the way things work in the real world. We don’t have to duplicate what went before.
We see a few steps in the right direction in healthcare. It’s not a mobile, on-demand app like Uber, but if you’ve ever needed a doctor in a hurry, or in a strange location, Zocdoc is a godsend. It lets you find someone nearby, in the specialty you need, who might have an open appointment.
Sherpaa, an OATV portfolio company, is trying to build a concierge-like online service for healthcare. Using a mobile or web app, you can consult with a doctor online, or get health insurance questions answered.
Todd Park, formerly White House chief technology officer, and still a special adviser to the President (and before that HHS CTO, and before that, co-founder of both AthenaHealth and Castlight Health), pointed me earlier this morning to a Florida company called ChenMed. Because of changes brought by the Affordable Care Act, which focuses on paying for outcomes rather than for procedures, ChenMed has found that they can actually provide in-person concierge-like services (like delivering medications, and other home-care visits) for low-income patients with two or more chronic conditions, who were previously “frequent flyers” at emergency rooms, for less than the cost of their original care.
That’s the closest I’ve heard yet to an “Uber for health care.” I want to learn more!
I’ve had a personal experience with this recently. A long time friend with Parkinson’s disease recently had to enter an assisted living facility, leaving her beloved apartment in New York, because she needed someone to make sure she takes her medications every three hours. In an ideal world, she’d have had someone come do that at her home.
As our population ages, there are going to be more and more people needing this kind of care. Ironically, at the same time, there are many people out of work. An uber-like concierge service could solve both problems at once, and, for many patients, at lower cost than the current institutional approach.
The last topic I want to talk about, at some length, is what we learn from failure. That’s a big topic in Silicon Valley, and it ought to be a topic in healthcare as well.
We had a big failure in 2013 that got a lot of people’s attention, when healthcare.gov was launched with much fanfare, and then proved not to work.
Mikey Dickerson (That’s him, third from the right, on the cover of Time.), one of the key players in the healthcare.gov rescue will be speaking at 5 pm upstairs here at SxSW, along with Jennifer Pahlka, founder of Code for America, and former deputy CTO of the US. I was struck by Mikey’s story, the first time I heard it, about how it was as much about debugging the human processes as it was about fixing the technology.
Mikey put 17 hour days 100 days straight. A big part of what he did was to run what in Silicon Valley we call “stand up meetings” focused on why people weren’t able to keep the promises they’d made to each other
Meanwhile, another team built healthcare.gov 2.0.
The site enrolled millions of Americans, and now works very well.
Many of the team members stayed on, and are now the core of the new United States Digital Service, a team of the best and brightest who are now working to bring modern technology to many of the nation’s most challenging problems.
Here’s info on Jen and Mikey’s session.
But there’s another dimension. I want to explicate the size of the problem.
One of the most important pieces about the healthcare.gov rescue was written by Washington Post columnist (now vox.com) Ezra Klein. He wrote about how healthcare.gov was not an exception, but the rule, when it came to government services.
Recently, I heard an eye opening segment on the radio show Marketplace. Do you know that a huge proportion of food stamp dollars are spent at stores like Walmart between midnight and 1 am on the one night that people’s SNAP cards are electronically refilled?
Who goes food shopping at midnight? People who haven’t eaten for a few days, that’s who. So it really matters when you show up at the front of the line, and suddenly your SNAP card doesn’t work because you didn’t know how to respond to a letter you received in the mail.
And that brings me to the work we do at Code for America (codeforamerica.org). We engage civic hackers around the world to help local governments find solutions to thorny problems. One of our programs sends small fellowship teams - essentially, a civic startup in a box - to work with a city for a year. Last year, one of the Fellowship teams went to work in partnership with the Human Services Agency in San Francisco on a problem with Food Stamps - now known as the Supplemental Nutrition Assistance Program, or SNAP. It turns out that one third of food stamp clients were being unnecessarily cut from benefits due to bureaucratic snafus. Essentially, they’d failed to properly fill out a necessary form or to submit it on time.
Fellows went to work on this problem in 2013,
These letters sent out by the social services department can be truly confusing. Aha, missed that QR7, did you?
The fellows replaced them with a text message saying, essentially, “There’s a problem with your benefits. Call the office.”
Jake Solomon, one of the Fellows, wrote an amazing piece about his experience, entitled People, Not Data. In it, he describes the problem: nobody who was implementing the program had ever themselves tried to comply with the rules and to respond to the instructions, until the Code for America fellows did that. As Jake said, ““User needs. An empathetic service would ground itself in the concrete needs of concrete people. It’s not about innovation, big data, government-as-a-platform, transparency, crowd-funding, open data, or civic tech. It’s about people. Learning to prioritize people and their needs will be a long slog. It’s the kind of change that happens slowly, one person at a time. But we should start.”
Jake also did an amazing presentation called The Big Thing About Small Things. https://www.youtube.com/watch?v=yViYA8IG36U I’ve used some of his slides for the rest of this talk.
He points out that 3.5 million people in California are eligible for CalFresh (Food Stamps) but not getting it.
You start to understand why when you experience the sign-on process.
Here is an animation that Jake made showing what it takes to apply online to the food stamps program.
And that’s just the beginning. It gets you an in-person interview to determine if you’re eligible.
The Fellows replaced this with a service they call Clean - six screens, and it signs you up for MediCal as well.
They uncovered other problems as well. To check the balance on your EBT card costs 0.75 at an ATM. Banks in California charged welfare recipients $20 million last year - and that’s after also charging fees to the state for issuing and managing the cards!
The Fellows built an app called Balance, that lets you check your EBT balance with a text message.
These are small things. But as Jake says,
The big thing about small things is that they add up. Here’s someone at the San Francisco social services office trying to fill out a paper form with a pencil that’s too short, on a wall that isn’t smooth.
It didn’t stop there. After finishing his own fellowship year, another Code for America fellow, Alan Williams, decided to join the team, who’d continued working on social services in San Francisco. Alan did it in an unconventional way. He decided that rather than getting a new job, he’d actually go on unemployment, food stamps, and MediCal, to really understand the system from the inside out. (After that experiment he is now working on the Health and Social Services focus area team at Code for America.)
You’ve probably all seen those “unboxing a new iPhone” articles. Well, here’s Alan’s take on “unboxing MediCal.” All of the quotes on the slides are as he reported them on Slack as he was doing the “unboxing.”
It starts with a paper brochure.
With an important letter hidden inside. You must respond within a month, or your application will be void.
There are a lot of paper forms in the book.
It’s like the SATs!
This is probably the most depressing slide in the bunch. He’s given a choice of two plans. And there is even rating information. But guess what! When it comes to things that really matter, both plans are below average. That’s right, in our enrollment materials, we tell MediCal recipients that their choice is between a bad plan and a worse one.
Remember what Ezra Klein said about the quality of social services for the poor, and healthcare.gov not being an exception, but the rule.
After making some progress on the forms, Alan takes a look at the provider directory.
It looks like a phone book. In the age of Yelp and TripAdvisor, this is pretty lame.
Alan can’t figure things out, so he decides to call for help.
Here’s a nice feature that not all services have - you can request a call back.
Notice that we’re now an hour into the process. The person Alan has reached on the phone can’t help him and says he must call another office.
And this office doesn’t have a call back feature. Wait time is 40 minutes.
Low income families - who can least afford the time (or, since they are likely on phone plans without unlimited service, the minutes), are asked to wait on hold endlessly.
Finally, at 38 minutes, Alan finally reaches someone.
But the system is down. Can you call us back - try this afternoon, or tomorrow morning?
It turns out that the healthcare.gov “system is down at the moment” message was not an exception. For many government services, this is the norm.
The code for america team has been monitoring uptime at social service sites around the country, and they are unavailable at a level that would bring public shaming to any commercial internet application. If google or Amazon were to have service levels like this, they’d be out of business.
The team has been running tests to figure out where people fall out of the social services funnel, as a guide to understanding where the process is broken. Unfortunately, it’s at almost every level.
The point is that we really need to change the system. We can’t just sprinkle a few apps on the front end and think they will lead to deep change.
Government, in many countries, is the one institution that is supposed to work for all of us. But it often does that work so badly that we lose trust in it. It’s essential that we bring government up to par with the best services of the private sector. One of the places that is doing this is the UK Government Digital Service.
Their Design Principles should be one of the bibles of user centered design for the internet of things era. Start with needs. Do less. Design with data. Iterate. Then iterate again. Build for inclusion. Understand context. Build digital services, not websites. Be consistent, not uniform. Make things open: It makes things better.
It’s about technology, yes, but far more importantly, it’s about putting technology to work for humans, not the other way around.
This is a huge cultural change for government, and that’s one reason it’s so interesting and challenging a set of problems to work on.
That’s also at the heart of the work we do at Code for America. Our Fellowship team works with cities to identify promising areas of work and to show what’s possible with technology. Our volunteer Brigades help bring local talent to work on interesting problems. And our focus area teams drill deep in areas like core digital infrastructure for cities, health and human services, criminal justice, and economic development.
We think those values are represented pretty well in the mission statement that serves as our sort of North Star, our guiding light, at Code for America. Jennifer Pahlka, the founder of Code for America, adapted it from the Gettysburg Address by Abraham Lincoln.
For the people by the people isn’t just a dusty line from the Gettysburg address. Most of the people I’ve met who work in government went into public service in the first place because of what this line represents: they wanted to serve the public. But there’s another way to say this…
For the people also really means FOR PEOPLE. And it’s also what you should be thinking about in every application you write.
I haven’t talked as much today about the notion of “by the people,” but if you’ve followed my work for the past decade, you know that I’ve talked nearly incessantly about the role of collective intelligence, expressed either explicitly through new forms of cooperation, or implicitly by the data we contribute simply by interacting with modern applications, or increasingly, implicitly, via the data shadows we leave with sensor-driven applications.
Taken together, I think that this is a pretty good mission statement for people outside government too! Technology trends tells us that we still will build services of people, and by people when we are using 21st century technology, but it’s essential that we also build services for people.