What’s the healthcare equivalent of reach, throw, row, go?

14157551699_bbbce23643_mThe other day we were talking about my wife’s mobile vertinary practice, and I started mapping what she does to human healthcare and reach, row, throw, go popped into my head.

My wife used to be a pool lifeguard. She told me that if something happened in the water, the level of engagement was reach (can you use a pole or arm to grab the swimmer?), throw (are they close enough for you to throw a lifesaver?), row (can you take a boat or board to the swimmer?), go (if all else fails, go in after the swimmer).

I’ve been thinking quite a bit about patient engagement lately. I truly believe that the way out of the mess we have in healthcare is through deeper engagement with the healthcare system. I call it high-touch healthcare. But I don’t mean bigger hospitals and more doctors. I’ve always taken a broader, multi-channel and longitudinal view of patient engagement.

What do I mean?

The thought I’ve been developing is there is a gradient of involvement in the healthcare system from independent (for example, looking up information) to complete (for example, surgery). And there are layers to the involvement, taking in the patient, their circle of support, clinicians, clinics and hospitals, visiting caregivers, and, for me, data.

And that’s where the reach, throw, row, go comes in. Each patient is at some level of need (from none to complete dependence) and we need to decide if we need to reach (self-serve websites, mobile devices), throw (visiting caregivers, training for family members), row (clinics and urgent care), go (hospitals, hospices).

I think this thinking comes from my background in marketing and in product development where you can’t just do one thing, but need to think of the user journey, all the touch-points, and provide the right engagement for the right issue.

To me this sounds obvious, but I am never sure if healthcare systems really get it. What do you think? Do they? Do you have examples?

Image from Vasse Nicholas, Antoine

AIs, writing, and computational literature

bender-penA few months back, I stumbled upon Inkitt. Well, more like they stumbled upon me – they were looking for someone with a background in analytics and in writing to build models around the stories in their community. The goal was to build analytic models that would understand what a good story was to basically create an AI submissions editor, an AI slush-pile reader.

On the one hand, Iniktt is building a community of writers (much like Wattpad). On the other (the business model), they are selecting the top novels to offer to book publishers. Should the book publisher not take the manuscript, Inkitt, because they already think the novel is good enough for a publisher, will publish the book. If the book sells well, Inkitt will return to the publisher once more. If the book doesn’t sell well, the rights revert to the author.

Of course, the key is to find the good novels (isn’t success in publishing always about good stories?). The community will bubble some of this up, but perhaps having a model that learns from the community what is good could accelerate the discover of new novels.

Building models of literature
I found this intriguing and started looking into computational literary analysis, also known as Digital Humanities (there’s even a journal). I uncovered a long history of work to make sense of different forms of writing, being able to analyze writing as a scholar would (here’s a recent article from Berkeley).

IBM has championed the concept of “cognitive computing“, a third wave of computing after the first two waves of tabulation and programmatic computing. In cognitive computing, systems are no longer programmed by human-generated rules, but are taught through machine learning and models trained from real data (and plenty of nudging from human specialists).

We do this at work – we feed a corpus of text into our system, along with what ontologies our experts have to give some semblance of meaning to the text (that’s the hard work some people gloss over), and the system builds a model of understanding, pulling together the relevant topics (you can see it in action here). This is how organizations are getting better at understanding sentiment, tracking leading topics, going beyond keywords and rules to build a responsive system that no human alone can build (though, don’t get swayed by the hype, as this very good article warns).

So how are folks teaching systems about story?  By giving them something to read. Facebook is teaching its system by feeding it children’s books (see reading list here). Google has been feeding a system with thousands of romance novels. Alas, these two companies are not necessarily trying to build a model for what a great children’s book or romance novel is. They are trying to tech their systems how humans converse, to better provide conversational services (bots!). Though, as many parents of early readers know, what goes in is what goes out, and young conversationalists are quite impressionable (read about the Microsoft bot). But these systems will end up being a smart as a puppy. Here’s Google’s system with some exercises that look like beatnik poetry.

Folks have also been going beyond conversation and having such systems actually write novels. For example, for NaNoWriMo (National Novel Writing Month) writers spend the month of November writing a 50,000-word story (quantity over quality). NaNoGenMo (National Novel Generation Month) is a riff off of NaNoWriMo – participants build programs that create 50,000-word stories, using computers (hm, I wonder if something mechanical would count). The exercise generated some quite fun results (not to mention the call-outs to @hugovk, whom I know, and not surprised he dove into this). I am not sure how many of these were programmatic rather than cognitive-like, being more human programming cleverness rather than machine-original.

Does it matter who writes it?
I think the distinction between all-machine or all-human or a hybrid writer is irrelevant. Already financial and sports news reports are written by machines. I received spam that reminded me of Burroughs’ cut-up fiction. A machine-generated novel recently made it through the first round of a literary contest. To me, if the story is good, does it matter who wrote it? Rather than ponder _if_ an AI can write a novel, we should be thinking of how do we live in a world where AIs write or help write novels.

I have just spent the past many years feeding and encouraging a writer (human, that is). It’s a joy to share books, writing, discuss plot and style, and practice, practice, practice. AIs will be the same – we, the humans, will give them the tools to learn and grow and find their voice. What’s wrong with that?

I, for one, welcome my new novelist overlords.

Now, excuse me, as I point my AI to go play on Wattpad.

Image by Tony Delgrosso

Recipe: How I make yogurt

I’ve been meaning to post this for a long time. The way I make yogurt was inspired by Vaugh Tan (from a meet-up back in 2012!). The philosophy he shared, and to which I already, as a biologist, ascribed to, was to understand fermentation as something a community of different organisms do. For yogurt, different bacteria have peak activity at different temperatures, each eating different sugars in the milk matrix, preparing the matrix for the next bacteria as the temperature declines. That is why I choose wrapping the fermenting bugs in a towel and a natural reduction of temperature, rather than some machine that keeps the temperature at one setting.*

The recipe
I usually make yogurt 1 gallon at a time. Just simpler for me, and matches how much we eat. I also put the yogurt in Ball (or Mason) jars, but of course, you can put it into any container you are comfortable with. And, as most yogurt folks do, I get my starter from the previous batch; though, sometimes the wife buys some different yogurt and I mix that in as well.

– 1 gal whole milk
– 4 heaping tablespoons of starter culture from the previous batch (one tablespoon per quart)

1) Heat milk
Pour milk in pot. Set to mild heat, set temp alarm to 75-77°C (or 170°F).

OK, call me crazy, but I read some weird suggestion to rub a cube of ice at the inside bottom of the pot to avoid scorching. It seems to work. I don’t think it has anything to do with cooling, of course, but I think it has to do with not pouring the milk into a dry pot, the water forming a layer (adhesion?) so the milk isn’t the only thing touching the metal. I don’t know. But it seems to reduce scorching.
heat milk

One other thing that I can’t suggest strongly enough: get a digital thermometer. I got this Polder from Amazon. I like it because it can do °F and °C and it has a temperature alert. As you can see, I use °C for making yogurt (I learned about bacteria only in °C; though I learned beer brewing in °F – crazy, I know). In any case, having the digital thermometer has allowed me to have very good control of the temperature and has facilitated production and improved quality and repeatability.

I set an alert to 75-77°C so that I don’t forget about the milk and let it boil over.

2) Cool milk
When the temperature of the milk hits 77-80°C (170-175°F) I take it off the heat and let sit until the temp comes down to around 55°C (about 130°F). For a gallon of milk, this usually takes me 20 minutes. I like this slow cooling because (I think) it lets the milk proteins and oligosaccharides slowly loosen up and get intertwined, so you have a well-set yogurt. Indeed, my milk heated and cooled like this usually sets and tastes better than when I boil the milk.

While milk is cooling, I prepare the jars and warm the starter (next steps).

3) Prepare containers
I usually use quart-sized Ball jars. You can also reuse quart-sized plastic commercial yogurt containers. Just make sure the containers were washed in a dishwasher.

To prep the clean containers for yogurt, I give them a rinse with the hottest water I can handle and let them drip dry. For 1 gallon, I use four jars and have an extra smaller one ready for any overage. This works well, as we eat the yogurt from the larger jars and when we open the smaller jar, it’s time for a new batch.

Note: unlike when making preserved foods in Ball jars, I reuse the covers, so long as they are not rusted. I do this because the dominant bug is your yogurt bugs, and you’re not preserving things for months. But if that gives you the heebeejeebees, then do what works for you.

clean jars drip dry jars
4) Warm starter
As the milk comes down to 55°C (130°F), you will want to bring your starter to temperature. I use 1 heaping tablespoon of starter (saved from the previous batch) per quart (therefore, 4 for a gallon of milk). Put the starter in a bowl, pull out a cup of the heated milk (I usually rinse cup before in hot water) and let it cool enough to handle (less than 60°C/140°F), then add to starter, to warm it up. Gently mix to smoothness.
warm starter
Note: That gunk on the cup is milk skin. Some folks like to skim it off (just touch it with a spoon and pull it out). I don’t mind and just leave it.

5) Inoculate milk
You will inoculate at 55°C (130°F). When your milk is around 55C, add the bowl of warmed starter, gently mix it in.

6) Pour into container
As soon as you can, add inoculated milk to your containers and close.

full jars capped jars
7) Store containers
Wrap containers together in a towel, and store in a place they won’t get disturbed for at least 9 hours. Wrapping them together let’s them share the heat, the towel doing enough of a job to keep the heat in and to let it fall gradually (remember the bacteria having their own peak activity temperature?). I usually leave the containers overnight, in a closet or cabinet (note home brew peeking from behind towel).
into towel wrapped
8) When incubation is done, put containers in fridge
I usually tip the jars to see how well the yogurt set. And, for me, one of the most exciting parts is that in the morning, the jars are still warm from the fermentation activity.

You could enjoy them before putting in fridge, but I always put them in fridge for a few hours to firm them up before eating.


And remember to save a bit for the next batch.

– The digital probe thermometer is key. Mine’s a Polder Digital In-Oven Thermometer – $25 from Amazon. I use it for more than yogurt, such as for grilling and making home-brew.
– I started my culture with Stoneyfield which has 6 strains in it and have since added Chobani and Fage along the way. You can use any yogurt with live cultures (it’ll say on container); though, my inclination is the more strains the better.
– Anything touching non-inoculated milk and not being heated I rinse in hot water. You don’t need to be sterile, just be clean. The cultures work fast and overwhelm anything else. Indeed, like I said, the containers should be warm when you check them at the end of fermentation. Evidence of lots of bacterial activity!



*How others make yogurt: I saw this video yesterday and could not figure out why one would spend $50 on an incubator timer when a simple towel would do.

Human permanence and nature’s flow

oxbowWhen I fly, I try to sit by the window. Night or day, the world from the plane is quite interesting, providing perspectives on humanity, the planet, time and space.

Flying over the plains of the US one can see large expanses of regularly shaped farms, straight roads, and lots of flat territory. One time, I was following a river cutting through that order, a meandering river much like the one in the photo here. And, like the one I attached here (alas, I didn’t have decent ones of my own), one could see the history of the river – its current oxbows as it meanders across the flat land; the broken off oxbows, now lakes, where the river once flowed; and evidence in the color and curve of the land of where the river once ran but now covered by a land subdivided in neat little human-understandable chunks.

This got me thinking of places where we have created walls on the sides of rivers (like in practically every European town), of how humans have always tried to force rivers to do their bidding, trying to freeze for all eternity what the rivers unconsciously have been doing for millennia.

And this controlling of the rivers provides a false permanence. The different extent to which the rivers have left their mark on the land, even if we were to try and obliterate them by channels or drainage, shows a permanence of nature’s flow that we are so foolish to think we can stop.

Image from Tim Gage

Hey Bruins, it’s concentração time

dm_160310_hurricanes_bruinsEvery Bruins fan knows that this year our favorite team has been struggling at home. On the road, Bruins are 23-7-3, which, by this table, ranks them as the second best on-the-road record in the league. At home, it’s a vastly different story. With a record of 15-16-5, Boston is in the bottom quartile, sitting at 23rd out of the 30 teams in the league.

Concentration time
I grew up in Brasil, living near the stadium of one of the football powerhouses, Flamengo. I recall that before every game, the men would spend the night at the stadium, a sort of retreat, or as they called it “concentração”, “concentration”.

I did a quick search on the topic this morning, wondering if teams still do it and found out that not only does the concept have a wikipedia entry, but it’s still a going practice in Brasil. Also, it seems that some football teams in Europe also do this to some degree, for example Man City. And what was really interesting is I found out even college football teams do it.

Really, I have no idea if there is any positive effect. Back in the 50s, a famous equipment manager for Botafogo (at the time a powerhouse from Rio), quipped “Se concentração ganhasse jogo, o time do presídio não perdia uma partida” – “If concentração would win games, then the prison team would never lose.”

At times, the players rebel against it (especially when their salaries aren’t being paid), but in Brasil, it’s in the contract that they need to abide by the concentração rules. And orgs still do complain that it’s a luxurious cost to place players in hotels near the home stadium the night before a home game.

In this excellent article on the topic (in Portuguese), players and coaches discuss the pros and cons and the culture around the concentração before the game. It’s not a simple decision. Some teams call players in 2 days before; when you add home games to away games, players are never in their own bed for most of the year. Then there are the technological changes that have made concentração more individual than team-based, solo activities on electronics versus group activities around games or movies.

Perhaps it is also culture that keeps Brasilian coaches more connected to this practice, worried that his boys will be out partying [Of note, during the last cup run, Germany and Holland did no such concentração. Player discipline?]. Many coaches have tried to mess with the formula (as have big teams in Europe). But there is a strong expectation of the positive effect of squirreling away the players before a home game, that players, coaches, and fans point to a lack of concentração on losses.

Need to crack the problem, Claude
OK, so perhaps I, too, have a bias towards this idea of some sort of retreat before a home game. Especially when I see the different between the Bruins’ home and away record.

What’s it going to take for the Bruins to shake this poor at home record? No one knows what’s causing this skew in the record between home and away, but we all know it needs to be solved. Going into the playoffs, the ability to win at home is even more important, especially for player confidence.

I’m not suggesting that Bruins start acting like they are on the road for home games. Or, perhaps, I am. Perhaps, what I am suggesting is that Claude, Don, and the amazing John Whitesides give this a ponder as the Bruins try to hold on to our standing through the end of the season and all they way to that final game in June.

Image from last night’s loss at home (which oddly put us in 1st place): ESPN

Pause for station identification

gears-William-WarbyAs I am sort of feeling my brain starting to reactivate my writing muscles, I thought now would be a good time for a station identification. No need to panic. I’ve done this before. This is my 10th pause for station identification on this site since the first one in March 2005 (and #10 seemed like an interesting milestone to point out).

Hello. My name is Charlie Schick. I am Senior Director, Healthcare, at Atigeo. I started there in a biz dev and sales role, but the role morphed into a client exec role and then into a product leadership role – stepping in where I’m needed, where I can best apply my skills, to keep the gears turning. One of the coolest offerings I am working on is building a catalog of healthcare and cyber data as part of our platform to enrich analytics and build new insight using external data. I’ll be giving talks about this throughout the year, it seems. But I’m not sure I’ll be posting much about it here, though, so feel free to ping me for more info.

Prior to Atigeo, I was at IBM, Nokia, and Boston Children’s Hospital in various roles in research, product development, sales consulting, and customer-focused go-to-market activities. During this time, I’ve designed and launched web and mobile products; provided internet, social media, and content strategy consulting; written numerous articles for online and print publications; published several biomedical research papers in leading journals; and co-authored a book on advanced phone systems. 

Biologist at heart
Oh, and I am a bio-nerd, mostly validated by my PhD in molecular and cellular biology from UMass Amherst. My bio-nerdiness is expressed in my love of certain fermented foods (I am a fermentos) and in my interest in the practical use of microbes in food, health, and interesting products. For the last few years, I have posted many things on this site and on Twitter around this fascinating topic.

And I enjoy being surrounded by PhDs at work (though the others have much more impressive PhDs, and our chief scientist has two, from MIT, no less).

Thinking and speaking and helping
This background should give you an idea of my interests and why I say what I say. Therefore, it should not be surprising that I share this experience, advising healthcare start-ups on mobile, marketing, and analytics. If you’re interested in knowing more about this, feel free to invite me to lunch or beer.

I also regularly speak in front of large audiences, sharing my experience and interests through various forms of media and design, and in the office of CxOs. Send me a note if you want to know more.

And of course, my standard disclaimer (riffing off of an ancient Cringely disclaimer)
Everything I write here on this site is an expression of my own opinions, NOT of my employer, Atigeo. If these were the opinions of Atigeo, the site would be called ‘Atigeo something’ and, for sure, the writing and design would be much more professional. Likewise, I am an intensely trained professional writer :-P, so don’t expect to find any confidential secret corporate mumbo-jumbo being revealed here. Everything I write here is public info or readily found via any decent search engine or easily deduced by someone who has an understanding of the industry.

If you have ideas that you think I might be interested in please contact me, Charlie Schick, at firstname.lastname@atigeo.com, for Atigeo-related matters; via my profile on LinkedIn; or via @molecularist on Twitter.

Image from William Warby

Thoughts on “The age of indie fitness apps is over”

I officially left the mobile world back in ’09. But, of course, since then, we’ve seen the meteoric rise of the iPhone, folks getting the idea of mobile apps, and a wave of small companies realizing the value of merging GPS, mobile, and tracking – I didn’t get too far.

As a not-so-clueless observer (here’s an article I wrote in July ’06 of the exploration I was doing around this topic), I have had an interest in the apps these small companies created. In the past many years, I’ve tested many of these apps and use two on a regular basis – Nike Running and Moves.

One thing I am excited about is I feel like we’re still in a Cambrian Explosion, a crazy boom of multiple experimentations that promises to reveal the patterns that will go and evolve and dominate. The industry needs to be able to sample the total possibility-space of the intersection of mobile, sensors, and activity (such as fitness). And, as with the Cambrian Explosion, there will be many dead ends, many patterns that will die and fail, genetic exchange of ideas that die in one place but live on in another.

One interesting thread in the last few years is the gobbling up of leading fitness apps by major brands. Lauren Goode, of The Verge, wrote an interesting article on this trend. She characterizes it as the “end of the indie fitness app“. My favorite line refers to the burnishing these brands are getting when buying a well-known fitness app brand.

It’s your favorite indie rock album being used in commercials for Target.

She also points out the slow creep of assimilation these brands are experiencing, but I don’t think it’s all that evil that “your runner’s high is getting monetized”. In then end, money has to be made, and some things are best as part of a multi-layered offering, each helping the other (some day ask me about my billion dollar bookmark business example).

But it’s a fair thing to point out – user beware.

Of course, where I keep bumping into this fusion of the mobile lifestyle, sensors, and activity is in healthcare (not just fitness or activity tracking, but wellness and behavior as well). Fitness tracking is one thing, but, as Lauren points out, we’re now “carrying around pocket computers [storing] our health information [at high] levels of granularity.”

Ponder that. Do we have to take into consideration that popular app we use will someday belong to Google, or Under Armor, or CVS?

No more indie feeling, indeed.


Tired Words from Wired: “Unicorns and Other Things We Must Stop Talking About in 2016”

It’s been a long time since I posted one of my “Tired Words” posts, where I point out a word that has been over-used, mis-used, and ab-used.

But today I cannot resist adding here some else’s list of Tired Words. It’s a nice brief article (link below). Here are the tired words Wired author, Jessi Hempel, pointed out:

  • Unicorns [CS: Yes! And I’ve heard deca-corn for $10B valuations – gah.]
  • The Sharing Economy [CS: Hm, doesn’t bug me. But the Jessi’s comment will make is clear to you why this is DOA.]
  • “Smart” anything [CS: Oy vey. Indeed.]
  • Wearables [CS: I never really liked this word. Why  can’t we say shirt, watch, glasses, whatever. So what if they have wee computers in them? They are still shirt, watch, glasses, whatever – except “smart”. No, wait, that’s not what meant (see above).]
  • The Bubble [CS: Bubble schmubble. Somedays I think we have nothing to talk about and need to sensationalize things. Bubble or no, it don’t matter to moi. Biz is always a challenge.]

BONUS!: Funny thing is Marissa Mayer made it on this list; mostly to point out that Yahoo is not so much a Tired Word but a Tired Company and irrelevant at that, so no need to even bother talking about it. As the Jessi says, “Move along. There’s nothing to see here.”

Source: Unicorns and Other Things We Must Stop Talking About in 2016

“Settings are for geeks”

control panelAs far back as I can remember, I’ve fiddled with the settings. Computers, lab instruments, routers, phones – a chief selling point was how much access I had to settings and how much could be customized.

I recall that during my “Cloud” project at Nokia, the folks at IDEO used to say “Settings are for geeks,” in that only the geeks really cared about settings and modified anything. The corollary is that the settings out of the box need to be spot on for most folks.

Spot the non-geek
And you can tell who are the folks who don’t mess with settings. They are the ones who:
– have wifi routers with crazy SSIDs and passwords
– use the annoying Nokia, ATT, TMobile, Verizon, Apple ring tones
– use the goofy Galaxy, Apple, Samsung signature in their email sent from their phones
– have MyHD or UNTITLED named hard drives or generic bluetooth device names

Recently, I was talking to someone, who shall remain nameless, about his wifi router and he was wondering why my router name and password were so usable. I not only told him why, but mentioned that one time last year at his house, I helped his daughter move his wifi router to be in a better spot in the house (enough to amaze him) and decided not to change the name and password because I knew it was too much at one time. Perhaps next time I’m at his place?

Yes, I change settings
For me, changing settings is partly to make something fit how I want to use it, especially if the manufacturer tries to brand me with a ring tone or email signature – how dare they. But, also, it’s to make things work in a human way – I always set router, hard drive, and bluetooth device names. I have always made my own ring tones. I even change the settings in my car.

Though, once set up, I usually don’t fiddle with them. I’m not that fickle to keep tweaking settings. Once set, I’m usually fine for a long time.

Am I alone?
What I don’t know is how prevalent this is. I suppose if you are reading this, you’re like me. But when I look around my office and family and friends, I feel quite alone in this. It’s almost become a sort of parlor trick to tell people what I did when they do a double-take and ask “How did you do that?”

I suppose really we should make sure that the out-of-box settings are most respectful of the user and that, much like the iOS “Hello” set up, we guide the user in personalization steps. Though I doubt the manufacturers will make it easy to remove annoying branding.

Oh, well.

Are you a setting geek like me?

Image by Les Chatfield

Blindspot: OMG – how much time has humanity wasted with spinning hard drives?

I got my first computer with a solid-state drive (SSD) last year. For me, the biggest thing I noticed was the fast boot time.

Crucial MX100 CT512MX100SSD1 2.5" 512GB SATA III MLC Internal Solid State Drive (SSD)My daughter got a computer with an SSD last Christmas. The biggest thing for her was the battery life.

Fast boot and longer battery life were not enough to make me think SSDs were anything special.

Then I took my wife’s 2009 laptop and swapped out the hard drive for an SSD. Not only did she see faster boot times, but everything else was incredibly zippy compared to the slow down the old laptop was experiencing.

Which got me thinking: How much time has humanity wasted waiting for hard drives to deliver data? These hard drives with spinning platters have made us wait for machines to boot, given us the spinning balls of Waiting for Godot, and our reading and writing to them has moseyed for decades as the computers they were in far outstripped their speed.

What would happen if all the computers in the world switched to SSDs?

Oh, my.