Monday, September 17, 2012

An Example of What I Mean

It might be an interesting intellectual experiment to pose “a real world problem” to the very talented young minds of StartUp UCLA to see if they could collaborate to produce a viable product.

Let’s see if I can define such a challenge.  A woman in her 80s suffered a stroke which gradually has diminished her ability to speak.  Her mind is as sharp as a tack.  Her ability to vocalize her needs and thoughts has been diminishing with time.  Years ago, her family trained her on email, but at that time, the complexity of email was too much for her.  She’s a technophobe -- as are many of her peers.  But, she’s “game” to try new things if they are appropriate to her physical limitations.

Her family went looking for a “type to talk” app that could be downloaded to a stripped down iPad or another tablet.  The thought was that she could type in sentences and press a mic to have the device “speak” for her.  

The first encounter was with “Type To Talk” whose User Experience (UX) was – how shall we say – sucky.  While “free,” it actually was ad-revenue-based which meant that small ad popups appeared at the top of the screen with an X to close, but when pressed, that actually opened up the ad to a full screen display which was difficult to remove.

Further, there was no warning that selecting a voice style would generate a charge.  Again, pity the poor technophobes who got suckered into these charges randomly.  The problem, too, was that there was no default “voice” that spoke the typed words, so the user HAD to select a voice.  But, even that didn’t work.

Finally, TtT must have been designed by an audiophile who loved tweaking sound pitch, tone, etc.  The user did not want a full recording studio, she simply wanted a clean slate to type an inquiry and have the damn device verbalize that for her. Deception of this scale should not be allowed – for shame, Apple app-reviewers.  

There were a lot of so-called “product reviewers” for various alternatives – most of whom seemed to be employees paid to hype their products with zero objectivity.  Another “product reviewer” suggested Sticky Notes because he found a mic icon on the sticky note which allowed him to vocalize the contents of the note.  That functionality was removed from the iPad version. 

So, let’s go back to the wishes of the UX:  something simple like a notepad display (even half page or half screen). Given that users might be elderly, have a button to toggle between a QWERTY and an ABC alphabet keyboard to allow the user to find his/her most comfortable entry format.  And make the keys somewhat larger than usual because elderly have less precision now that they have various physical ailments. Probably, a numeric pad could be another, separate display option rather than sharing the screen space of the keyboard.

The text could be a short couple of words or a full sentence or even a paragraph.  The user would simply press a mic button to have the typed text verbalized with a default voice (chose: male or female).   Let the user stay with the default if that is adequate. Just give the user the basics, first, to let him/her get comfortable.

Settings might be allowed to go get new voices in much the same way as we retrieve ringtones: let the user hear what it would sound like before requiring a purchase.

Even more important than different voices might be different aids for different experiences.  Examples include:

            Doctor or hospital visits: maybe have “canned” scenarios of words or phrases that are commonly used in such environments.  Or allow the user to create and store “frequently used phrases” by different heading types. Add the all-to-commonly-used “What is your pain level today?” diagram so the user could easily point and select the appropriate response.

            Shopping: typical shopping lists so the user could point to a product he/she was searching for in a store.

            Family settings: allow the user to store family names (or even photos) to quickly reference.

Another prospective market is the patient with the larynx removed -- usually due to years of smoking. While many medical professionals would "prefer" that the patient learn how to speak through an artificial voice box, many are too old (and too exhausted from the surgery) to learn the new trick.  But, they all want to communicate.  The app envisioned would provide these patients with an alternative as well as an augmenting tool -- something to use as they progress with the artificial voice box.  This would give them back the desperately needed control over their surroundings, once again.

These are just a few examples of scenarios that might be of value. Even more important would be the need to conduct first hand interviews with prospective customers in the appropriate age range, with a variety of challenges, possibly with a core demo product, to elicit ideas and feedback directly from those facing these real-world challenges.  

So, THAT’s what I mean by a “real world challenge” that young StartUp entrepreneurs could address.


Just the other day, I had the pleasure of meeting nine StartUp UCLA incubator companies and their founders.  All had spent the recent summer being coached and mentored as entrepreneurs in Los Angeles’ emerging digital business space.  Two of the presenters were women: Melanie Gin of Travel Strings, an online platform for aggregating pictures and text into shareable travel stories, and Daisy Jing of Perfect Beauty, a one-stop global hub for women to build a community sharing self-image and beauty product advice.

Others who are viewable at StartUp UCLA include an investment analysis platform, a custom website generator, an app to visualize furniture in the home, another platform for casual gaming, a navigation app, interactive mobile game developers, and a mobile database app for cruise goers.

Some very impressive application development and visual technology talent was represented.  They were strong presenters as well – clear, crisp, and to the point.  Noteworthy was their sequence of slides:  they all presented the team very early in the slide deck, a lesson we will consider seriously recommending to our own WinLAVA pitch candidates.

At every table I visited, I tried to think of some “dot” with which they might connect to further their business efforts:  who did I know who might help them?  Maybe a Sony game development manager, a social investment fund, CalPERS and CalSTRS contact.

As I left the California NanoScience Institute (C(n)SI) facilities – where the event was held – I was struck by the difference between the scale of the problems these students were addressing vs. those being addressed by the C(n)SI faculty, students, and research staff.

The problems being addressed by StartUp UCLA students were small and proportionate to the world view of young students: how to occupy one’s mind while waiting to be served in a restaurant?

The folk at C(n)SI are looking at how to program nanobots to locate cancer cells in the body.

How can we elevate young minds from their intense fascination with BFFs and addictive games? How can we entice them to visually imagine alternative hypotheses and formulations of real world economic scenarios – to face a sea of troubles and thus by confronting them, solve them?

At some point, pre-frontal cortexes evolve beyond concerns about acne and “hooking up.”  What does it take for this development to occur?  How can we instill intellectual curiosity in young entrepreneurial minds?

Monday, September 10, 2012


Serena Williams won the US Open Tennis event yesterday, her 4th Flushing Meadows, NY title and a great come-back performance. She won the first set, then lost the second set 2-6 to Victoria Azarenko, the Byelo-Russian currently ranked No. 1 in the world. The third set was the challenge. Azarenka was ready to claim the match, serving at 5-4, but Williams powered back to win at 7-5.

Azarenko was clearly disappointed, and afterwards held her head in a towel. Then the interviewer asked her the usual post-competition questions, and Azarenko said, "I am just so honored to be standing here, next to this champion."

And, THAT, ladies and gentlemen, is what class looks like.

Friday, September 7, 2012

Healthcare: Entrepreneurial Opportunities

The Institute of Medicine of the National Academy of Sciences is an 18 member (5 women and 13 men) nonpartisan panel of experts from the medical, business, and public sectors who reported on September 6, 2012 that three-quarters of a trillion dollars in basic medical care and services are “wasted” annually.  That represents an inefficient, unintended outlay of $2,100 – every year -- for every man, woman, and child in the US. The report is entitled Best Care at Lower Cost: The Path to Continuously Learning Health Care in America and is available from the IOM web site.

This report represents a “hypothesis” of an entrepreneurial business opportunity of major proportions. If we could design, develop, and implement substantive operational and technical change that generated savings even approximating this scale, not only would we be putting cold hard cash back into the pockets of American consumers annually, but also we would be saving lives, improving care, avoiding fraud, and probably providing improved quality of life and a better working environment for healthcare workers and medical professionals. I didn’t even see any estimate of the savings potential related to reductions in insurance costs or medical malpractice litigation. 

Six areas of potential savings were highlighted:
            $210 billion - “unnecessary services”
            $190 billion - “excess administrative costs”
            $130 billion - “inefficient delivery of care”
            $105 billion - “inflated prices”
            $  75 billion - “fraud”   
$  55 billion - “prevention failures”

I put quotes around the descriptors because each category is subject to interpretation. Putting that another way, we could identify specific sub-hypotheses of opportunity under each major category.  One person’s “unnecessary service” might be considered another’s “essential service” – it depends on the specifics of the service provided and the patient receiving the service. Even so, developing concrete, viable, specific metrics that explained services, and distinguishing between needed vs. unneeded options under what circumstances, might go a long way toward helping the medical profession and the patient to select the appropriate services more consistently. 

What tends to happen is that we jump to conclusions like, “this is intervening in the doctor-patient relationship” or “this will result in the insurance profession choosing who lives vs. who doesn’t.” Or worse, we jump to the conclusion that additional legislation mandating uniformity across the medical spectrum is “the only answer.”

Focusing instead on incremental business solutions and technology enhancement to make better distinctions within each category avoids predicting absolute outcomes and generates options for both sides of the service relationship. We do know how medical decisions are being made today; what we need to know is what would constitute an improvement in decisions leading to better treatment outcomes and more cost-effective treatments.

To begin to address “unnecessary services” we could look at the technology field, where we speak of UX, “user experience:” a very subjective assessment of what users of different levels encounter when they come across a given technology.  The UX of an experienced pilot at the helm of a sophisticated jet is dramatically different from your grandmother trying to understand a Facebook page. One size does not fit all customers or patients. Yet, we can and do develop specific UXes for each level of technology because we understand the generic concept of UX to diagnose what specifically is experienced by the sophisticated vs. the unsophisticated user.

Perhaps we need to begin building better models of UXes in the medical profession.  What research is required to produce what tools or techniques for what levels of services? This would be the beginning of developing sub-hypotheses to tap the $210 B potential savings in “unnecessary services.” Turning the hypothesis around, focusing on tools and techniques to identity essential, effective services in any and all areas of medical delivery would be a priority.  To those who suggest “we already do that,” we would suggest the IOM report indicates otherwise. At a minimum, we need to explain the “perceived” difference between what medical insiders think is fact vs. what the outside, objective medical analysis has found to be factual.

What are the comparable sub-hypotheses we need to define the focused opportunities in the other categories?  How would we begin to identify what constitutes “excess administrative costs” in what specific medical arena?  I could probably do a better job, based on personal experience with the medical healthcare sector during the past two years alone, defining “inefficient delivery of care.” Assessing “inflated prices” means we would have a mechanism to identify true value-based pricing – how do we go about doing that?  The share of annual loss estimates attributable to “fraud” alone is strikingly small.  How well are we using appropriate technology to detect real fraud?  What are examples of “prevention failures”? 

The IOM report calls for “continuous learning” in three priority areas, identifying 10 recommendations with strategies for progress toward each goal.

Foundational Elements:
Recommendation 1: The Digital Infrastructure
Recommendation 2: The Data Utility

Care Improvement Targets:
Recommendation 3: Clinical Decision Support
Recommendation 4: Patient-Centered Care
Recommendation 5: Community Links
Recommendation 6: Care Continuity
Recommendation 7: Optimized Operations

Supportive Policy Environment:
Recommendation 8: Financial Incentives
Recommendation 9: Performance Transparency
Recommendation 10: Broad Leadership

The report is a gold mine of brain-storming ideas for entrepreneurial enterprises and services. Each recommendation offers an industry sector within which innovative products, services, and businesses could emerge. If this were the original report justifying the Internet or the flight to the moon, the mandate and potential would be crystal clear. This report constitutes a foundation for a total new vision of delivery of effective medical care for the 21st century. We can leave the report on the shelf along with a host of others or we could use the report to foster a new dialog about healthcare entrepreneurial opportunities, roll up our sleeves, and start to address these issues. Today.

Thursday, September 6, 2012

8 Revolutionary Innovators -- Women of the TR35

Annually, the MIT Technology Review Magazine publishes their list of 35 Revolutionary Innovators Under 35 - the men and women innovators who are reinventing computing, energy, and biomedicine. See the complete list at:

Noteworthy to me is the ever-increasing presence of incredible women in technology.  Eight of the 2012 TR35 list are women.  They are highlighted here for your enlightenment:

Rana el Kaliouby – inventing technology to help computers distinguish the varied faces that people make – Affectiva -

Danielle Fong – making clean energy pay off by storing it as squeezed air: LightSail Energy -

Joyce Poon – a tiny roller coaster for light could help keep data centers cool – University of Toronto -

Shannon Miller – making engines super-efficient by getting them to run at extremely high pressures – EtaGen -

Christina Fan – prenatal testing for genetic conditions from a sample of the mother’s blood – ImmuMetrix -

Leila Takayama – making robots less intimidating for the elderly and others who might need it around the home – PR2, a robot product of the Willow Garage startup -

Burcin Becerik-Gerber – using cell phones to negotiate energy-efficient settings in office buildings – University of Southern California

Nanshu Lu – designing a soft flexible electronic bond to skin and even organs for better health monitoring – University of Texas at Austin -