Christopher Herot's Weblog

TEDMED 2011

The TEDMED conference took place last week in San Diego but it took me this long to digest all of the content and follow up on all the connections I made there.

Both TED and TEDMED were founded by Richard Saul Wurman, who apparently experienced seller's remorse after he sold both conferences and each expanded well beyond his original vision. [Richard contacted me to point out that he did not receive any financial compensation as a result of the recent transfer ownership of TEDMED.] While the two events are now completely independent, they follow a similar formula: the red TED logo, speakers who are either famous or should be, polished presentations interspersed with some entertainment and long breaks, and a venue that is far enough off the beaten track that the speakers hang around for the entire event rather than helicopter in just for their talk. As at TED, the audience is sufficiently varied and interesting that any random conversation in the coffee line or at lunch will always result in an interesting conversation and often lead to a long-lasting connection. In addition to the expected practicing doctors, hospital executives and entrepreneurs I met a researcher at MIT building medical devices for the developing world and a number of designers, artists, and authors.

The Masters of Ceremony were Marc Hodosh, who had shared that role with Richard in past years, and Jay Walker who purchased the conference this year. Jay was the founder of Priceline.com and a long-term TED participant who seems to have found his calling on the TEDMED stage as he interspersed introductions and lively Q&A with showing materials from his extraordinary library of rare books.

The general theme of the conference can be summed up in two sentences:

• There are amazing advances coming in medical technology.
• These may or may not make it through the FDA approval process in time to save your life.

This was one of the few conferences where it made sense to go to every session. A representative sampling:

• Eythor Bender of Ekso Bionics demonstrated an exoskeleton that allowed a paraplegic to walk.
• Daniel Kraft showing what medicine can learn from other fields such as aviation.
• Calvin Harley of Telome Health describing how we might halt the aging process by regrowing the DNA on the end of your chromosomes. (A Russian researcher on aging cautioned me that you might not want to rush out and start gobbling down the "nutritional supplement" quite yet  - remember Vitamin E?)
• Architech Michael Graves now in a wheel chair, decribing his frustration with poorly designed hospital rooms,
• Lance Armstrong describing the decisions he and his doctor needed to make in treating his cancer.
• Quyen Nguyen of UC San Diego, showing a video of a flourescent dye that binds to tumor cells to make them more visible during surgery (photo at right).
• Diana Nyad describing her attempt to swim from Cuba to Florida and her encounters with box jellyfish.
• Paul Stamets on medicines derived from mushrooms.
• Gabor Forgacs of Organovo demonstrating an inkjet printer that was modified to "print" organs from a supply of cells.
• Yoav Medan of InSightec describing one of the breakthroughs that did get FDA approval: a device that uses focused ultrasound to do surgery without making an incision in the patient.
•  Mehmood Kahn, Chief Scientifc Officer of PepsiCo arguing that we needed processed foods (albeit of higher quality) if we were to feed the earth's seven billion inhabitants. (Although e-Patient Dave tweeted that this does not explain high fructose cory syrup.)
• Dean Kamen describing his frustration in trying to get FDA clearance for a robotic arm he developed for war veterans. (Photo at right).
• Nate Ball, an engineer and beatbox artist demonstrating how he makes all those sounds. On stage. By having Dr. Nguyen thread fiber optics through his nose so we could see an image of his vocal cords as he made various sounds.
•  Charles Pell, Physcient describing a new model of retractor that uses force sensors to back-off before it damages bones or tissue.

Next year, the conference moves to Washington, DC. In a move that can only be described as audacious, Jay Walker plans to double the size of the conference and take on the DC establishment. If anyone has the enthusiasm and resources to do it, it would be Jay.

More photos here.

Health 2.0

The Health 2.0 conference returned to San Francisco for the fifth year. Attendance continued to set records at 1500 this time around. The zeitgeist continues to be that of information technologists eager to fix all the problems of health care. With 35% doctors carrying iPads and 85% with smartphones, there is plenty of opportunity for technology, but this year there was also a closer attention to payment models and to incentives for use, both financial and psychological.

In his keynote, Mark Smith, President of the California Health Care Foundation, (photo at right) said that while technologies such as the Internet had transformed banking, travel and research, that medical consultations were still being done the same way as they had for the past fifty years. However, it is not enough to provide technology. He stressed that he wanted to fund projects that incorporated financial models that would encourage use. He said too much of what he’s seen in the past resembled the Underpants Gnomes of South Park, with business models consisting of 1. Invent Widget, 2. ????, 3. Profits!

Smith said that the most important element of any new initiative was that it reduce costs, not just by shifting them around but by reducing the “perverse incentives” that encourage volume above all else. Other opportunities lie in improving convenience to patients, rapid learning for providers on how to make sense of the increasing volume of data, and enrollment for the uninsured. As an example of how this could work, he cited how Kaiser-Permanente’s introduction of Electronic Health Records reduced specialist visits by 25%.

There was plenty of innovation on display on the stage and in the exhibit hall, such as:

• A heart rate tracker from Basis that you wear like a wrist watch.
• A web site from GoodRx that does comparison shopping for prescription drugs.
• Consumer health management and social media systems from WellnessFX, Numera Social, HealthTap, OneRecovery
• GE Intel Care Innovations home monitoring and communication system

One of the most interesting talks was from Alexandra Drane of Eliza. She used her company’s automated phone call system to conduct a survey of patients, asking them to rank the problems in their life in terms of how much those things mattered to them and how much they received support on those issues from the medical establishment. The ratio, which she called the Ostrich Index, was around 1.0 for typical medical issues such as obesity, but far higher for other sources of stress such as consumer debt. Furthermore, people with multiple issues that high Ostrich Indexes were far more likely to suffer from serious illness. Her message to the audience was that it needed to take a much broader perspective on issues that affected health and that “health is life, not what's measured in the doctor's office.”

A version of this post also appears on the SBR Health blog.

Joseph Ternullo on what's holding back telemedicine

Telemedicine has been a field with a bright future for several decades now. Recently Joseph Ternullo,  Associate Director of the Partners’ Center for Connected Health, shared his thoughts on what factors were at play. Joe was speaking at Monday's meeting of the New England Healthcare Executives Group and pointed out that while analysts have estimated the telemedicine market at$5B to $30B, that pales in comparison to the estimated $1.5 trillion that is spent in the US on healthcare.

Joe named six issues that were at work:

1. Technology
2. Gaps in offerings
3. Usability and Design
4. Behavioral issues
5. Cost
6. Policy

Joe said that technology was only 15% of the problem. We have plenty of things that work today, from videoconferencing to devices that automatically gather vital signs at home. While the technology will continue to improve, the problem today is more a matter of getting products into a form that is easily integrated into the delivery of healthcare. As William Gibson observed, "The future is already here – it's just not evenly distributed."

A more mundane but pressing problem is matching current offerings with the resources and practices of the health care sector. Joe pointed out how doctors, nurses, and patients were ill equipped to deal with the logistics of procuring, installing and maintaining telemedicine equipment. He saw an opportunity for low-cost middlement that could drop-ship a home monitoring system, integrate it into the patient's health record, and retrieve equipment when it was no longer needed or when it needed repair. Another problem is that most products are oriented to the management of one particular disease, while the patient population most in need of this technology are likley to have mutliple co-morbid conditions.

Usability and design have become an issue as technology becomes widely adopted. With users' expectations being set by devices such as the iPhone and iPad, what comes from the IT department looks clunky by comparison. For any new technology to be widely adopted these days it needs to be as easy to pick up and use as the consumer products people use in their daily life.

Influencing behavior was perhaps the most interesting. As Joe put it, “I wish there were a technology that motivated me.” We have plenty of technology that can measure physiological data and even tell us when we are engaging in unhealthy behavior, but the health care world has a lot to learn from the gaming industry how to get people to actually change what they do. In the panel discussion that followed, several people mentioned the work that BJ Fogg was doing at Stanford and the talk he gave at last year's Connected Health Symposium.

Joe said he was thinking of writing a paper on these points. I hope he does so and starts a conversation going.

UPDATE (11 June 2011): Joe says he will be doing more research on this topic over the Summer, gathering data on some controversial issues, such as the extent of co-morbidities and the need of dealing with them in patient monitoring.

 

Panel on April 7: Today’s Platform Preferences

Once again I am organizing a panel at the Vilna Shul in downtown Boston.  Last time I did this it drew a record crowd of local entrepreneurs to this historic venue on Beacon Hill and given the timeliness of the topic it should be a lively discussion this time as well.

The topic is Platforms. Once that meant PC or Mac (and maybe which flavor of Unix) but now that the user experience has moved from the desktop to mobile devices and set-top boxes there is a much wider universe to choose from. A platform is not just a development environment now but can be a route to market through an application marketplace, whether that be iPhone App Store or the Salesforce AppExchange.

The panelists bring a broad range of experience developing for all these platforms:

• Ravi Mehta, VP Products, Viximo
• Brad Rosen, CEO, Drync
• Michael Troiano, President, Holland-Mark Digital

Time: Wednesday 7 April 2010 6:00 - 8:30 pm

Place: The Vilna Shul
18 Phillips Street
Boston, MA 02114

Price: free (includes sandwiches)

Register: www.facebook.com/event.php?eid=106380966053715
www.vilnashul.org/index.php/events/event/vilna_speakers_series_todays_platform_preferences

Customer Acquisition Panel at Future Forward 08

My vote for the most useful panel at Future Forward 08 was one moderated by Doug Levin, entitled New Strategies for Customer Acquisition.

The speakers were:

• Paul Gaffney, Desktone
• George Grey, SnapMyLife
• Brian Halligan, HubSpot
• Nabeel Hyatt, Conduit Labs
• Bill Lucchini, Intuit

All were remarkably candid about the challenges of acquiring customers in the cost-efficient manner dictated by the current environment.

While there was some debate about the return on investment in "marketing" there was complete agreement on the importance investing in acquiring customers.  The difference, the panel agreed, dwells in being analytical about comparing the cost of acquiring a customer to the lifetime value of same.  While acquisition costs are declining, there are pitfalls, such as overpaying for Google Adwords.  As Nabeel Hyatt put it, in an auction system it is easy to overpay, especially where there is always some new company with $10,000 to spend trying to build market share.  Even if they go bankrupt trying, they will just be replaced by another company who is equally unconcerned about losing money on each customer in the hope they will make it up in volume. Brian Halligan pointed out that there is no substitute for putting "remarkable content" on one's Web site and thus making it a magnet for customers.  Hubspot hired a former New York Times reporter and a musician to create content for their site.  Halligan did allow as to how "turning up the knob on Adwords" could be effective for a month or so, but that was was not a sustainable practice in the long run.  Of all the panelists, only Bill Lucchini was bullish on paid search, perhaps illustrating how it works better for a company such as Intuit with deep pockets.

The freemium model was popular with the panelists.  While customers may not be sensitive to the difference between $0.99 and $3.99, offering something for free can increase the number of downloads by 15x. Offering multiple levels of features at different prices can alleviate the inevitable problem of over-charging some customers while undercharging others.  Hubspot offers a free Web site analyzer which generates an email lead from a third of those responding.

There was a lot of discussion about metrics, especially the importance of determining the cost of acquiring a happy customer. Several speakers said their sales compensation plans included some sort of clawback on commissions for customers who signed up but later dropped the service, thus incenting the salespeople to make sure the customers understood what they were purchasing and were a good fit for the product.  Doug Levin mentioned that sales at Black Duck started to take off after they methodically deconstructed the sales process and found 64 discrete steps that could be improved.

In summary, customer acquisition requires a combination of talents: creative, which can be outsourced, and analytical, which needs to be closely aligned with the business.  It is an area that is only ignore at one's peril.

Future Forward 08

The high tech world has plenty of events where techies and executives gather, from small, local gatherings such as Lunch 2.0 to big, international conferences such as the recent Web 2.0 Summit and the upcoming Le Web.  Most of these seem to be in California or Europe, but New England has a series of events all its own, produced by the team at Future Forward Events LLC,.  Last week, they produced the Future Forward Retreat which drew 135 local executives and entrepreneurs to Henderson House in Weston for a day of discussions ranging from what analysts predict for the future to the issues faced by the CIOs of the local sports franchises.

Some memorable quotes:

"All over-hyped technologies eventually become successful" - Josh Bernoff of Forrester talking about interactive television and mobile applications.

"There is nothing strategic about Game Day." - Pat Curley, CIO of the New England Patriots, describing how everything has to work when the fans show up, down to the machines that print the receipts.

All of the panel sessions were informative and interesting.  The most useful was one on customer acquisition.  The most fun was the demos.  More on those later. 

Thank you Alyssa Stern, Shayne Gilbert, and Scott Kirsner for putting on this fine event.

Nantucket Conference Agenda

The annual Nantucket Conference has just announced their agenda for this year.   This event, organized by Alyssa Stern and Shayne Gilbert of Future Forward Events, LLC is the East Coast equivalent of D or Web 2.0, bringing together a Who's Who of entrepreneurs, investors, and press from throughout New England.  Again this year they've enlisted Scott Kirsner to help with the agenda.  Since returning to Boston from Silicon Valley, Scott has become one of the primary boosters of our local high-tech industry and the lineup is a good snapshot of where we've been recently and where we are going, and it includes a few "outsiders" who should bring a much-needed perspective to what can sometimes appear to be a self-contained community.

The conference is May 1-3 on, where else, Nantucket, which by then will have emerged from Winter but not yet be overrun with the Summer's crowds.  The event is invitation-only, but don't let that stop you,  You can request an invitation here.  I would recommend this conference to anyone in New England who is starting or running a high-tech company and wants to network with other people can help.