Reinventing Healthcare to Serve People, Not Institutions

#SxSW @timoreilly

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

Tim O’Reilly

SxSW

March 16, 2015

@timoreilly

“The skill of writing is to create a context in which other people can think.”

-Edwin Schlossberg

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

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

@timoreilly

@timoreilly

The Apple Store is magical!

@timoreilly@conference @timoreilly

@timoreilly

@timoreilly

@timoreilly

Uber and Lyft and Cover are magical!

@timoreilly

@timoreilly

@timoreilly

@timoreilly

Google Now is magical!

@timoreilly

Lesson #1:

Use technology to give people super powers

@timoreilly

Our Phones Used to Be the Tool of Superheroes

Dick Tracy: 1946 Star Trek: 1964

@timoreilly

An Everyday Modern Superpower

@timoreilly

This is the key question

How do we use the capabilities of our devices

to build better human experiences?

@timoreilly

Lesson #2:

Do Less!

@timoreilly

How often have you filled out

some version of this form?

@timoreilly

20th Century Vital

Sign Monitoring

@timoreilly

Lesson #3:

Do More!

@timoreilly

@timoreilly

@timoreilly

WTF?!

@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

@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

@timoreilly

@timoreilly

Lesson #4:

Build software “above the

level of a single device”

@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

@timoreilly

Data At the Heart of the Uber System

Real-time location tracking

Dispatch

Trip tracking

Names and faces

Payment

Dynamic Pricing

Reputation

PassengerDriver

@timoreilly

Many of these data services are not run by Uber

@timoreilly

Something about state of interoperability

@timoreilly

Lesson #5:

Measure and Respond

@timoreilly

The Lean Startup

@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

@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!

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

Text

@timoreilly

“Half the money I spend on advertising is

wasted; the trouble is I don't know which

half.”

- John Wanamaker (1838-1922)

@timoreilly

Lesson #6:

These are systems made up of

computers and humans working together

@timoreilly@conference @timoreilly

@timoreilly

@timoreilly

@timoreilly

@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

@timoreilly

@timoreilly

@timoreilly

#VelocityConf @VelocityConf @timoreilly@conference @timoreilly

@timoreilly

@timoreilly

Are New Ways of Organizing People

@timoreilly

23andMe

@timoreilly

PatientsLikeMe

@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

@timoreilly

That’s the bar we need to set

for reinventing healthcare and health insurance

@timoreilly

Adding Digital To The Way the World Works Now

@timoreilly

Lesson #7:

Rethink Workflows and Experiences!

@timoreilly #Sprint15

62

@timoreilly #Sprint15

63

@timoreilly #Sprint15

64

@timoreilly

@timoreilly

Learning from Failure

@timoreilly #Sprint15

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.

@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

@timoreilly #Sprint15

70

@timoreilly #Sprint15

71

@timoreilly

@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

@timoreilly

@timoreilly

@timoreilly

@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.”

[CLEAN]

82

@timoreilly

“Unboxing” MediCal

Alan Williams

2012 Startup engineer

2013 Code for America Fellow

2014 On Food Stamps and MediCal

@timoreilly

MediCal Unboxing

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly

@timoreilly #Sprint15

99

@timoreilly

The Failure Funnel

@timoreilly

GDS

What we are going to cover today

Header 1

• Header 2• Bullet 1

Blah blah blah

• Bullet 2Blah blah blah

• Bullet 3Blah blah blah

@timoreilly

Government can work

for the people,

by the people,

in the 21st century,

if we make it so.Jennifer Pahlka

@timoreilly

for the people

@timoreilly

for people

by people

@timoreilly

Build 21st century services

of people,

by people,

for people

@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