By People, For People Reinventing Healthcare to Serve People, Not Institutions

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#SxSW @timoreilly By People, For People Reinventing Healthcare to Serve People, Not Institutions Tim O’Reilly SxSW March 16, 2015

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@timoreilly “The skill of writing is to create a context in which other people can think.” -Edwin Schlossberg

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@timoreilly The smartphone is the most widely distributed “Internet of Things” platform.

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@timoreilly The Apple Store is magical!

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@timoreilly “Any sufficiently advanced technology is indistinguishable from magic.” Arthur C. Clarke

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@timoreilly @conference @timoreilly

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@timoreilly Uber and Lyft and Cover are magical!

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@timoreilly Google Now is magical!

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@timoreilly Lesson #1: Use technology to give people super powers

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@timoreilly Our Phones Used to Be the Tool of Superheroes Dick Tracy: 1946 Star Trek: 1964

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@timoreilly An Everyday Modern Superpower

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@timoreilly This is the key question How do we use the capabilities of our devices to build better human experiences?

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@timoreilly Lesson #2: Do Less!

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@timoreilly How often have you filled out some version of this form?

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@timoreilly 20th Century Vital Sign Monitoring

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@timoreilly Lesson #3: Do More!

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@timoreilly WTF?!

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@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

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@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

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@timoreilly Lesson #4: Build software “above the level of a single device”

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@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

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@timoreilly Data At the Heart of the Uber System Real-time location tracking Dispatch Trip tracking Names and faces Payment Dynamic Pricing Reputation Passenger Driver

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@timoreilly Many of these data services are not run by Uber

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@timoreilly Something about state of interoperability

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@timoreilly Lesson #5: Measure and Respond

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@timoreilly The Lean Startup

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@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

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@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!

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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

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Text @timoreilly “Half the money I spend on advertising is wasted; the trouble is I don't know which half.” - John Wanamaker (1838-1922)

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@timoreilly Lesson #6: These are systems made up of computers and humans working together

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@timoreilly @conference @timoreilly

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@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

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#VelocityConf @VelocityConf @timoreilly @conference @timoreilly

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@timoreilly Are New Ways of Organizing People

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@timoreilly 23andMe

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@timoreilly PatientsLikeMe

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@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

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@timoreilly That’s the bar we need to set for reinventing healthcare and health insurance

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@timoreilly Adding Digital To The Way the World Works Now

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@timoreilly Lesson #7: Rethink Workflows and Experiences!

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@timoreilly Learning from Failure

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@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.

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@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

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@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

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@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.”

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@timoreilly “Unboxing” MediCal Alan Williams 2012 Startup engineer 2013 Code for America Fellow 2014 On Food Stamps and MediCal

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@timoreilly MediCal Unboxing

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@timoreilly The Failure Funnel

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@timoreilly GDS

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What we are going to cover today Header 1 Header 2 Bullet 1 Blah blah blah Bullet 2 Blah blah blah Bullet 3 Blah blah blah

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@timoreilly Government can work for the people, by the people, in the 21st century, if we make it so. Jennifer Pahlka

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@timoreilly for the people

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@timoreilly for people

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by people

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@timoreilly Build 21st century services of people, by people, for people

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@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