The Power of Hello

I just sent out the 5th episode of the Pristine Story. Here they are for reference.

The Calm Before the Storm

Building Infrastructure

Sprinting a Marathon

Peeking out of the Shadows 

Launch!

Although we have a subscribe function on the bottom of the Pristine homepage, I've probably added 95% of the 800 subscribers by hand: I took an email address, either from a business card, or from an email conversation, and added it to an excel sheet that's always open on my super-amazing Retina MacBook Pro. Before sending out each episode of the Pristine Story, I upload and clear out the sheet. Simple.

Even as the list has grown, the engagement statistics have remained quite steady. I'm hopeful that with compelling content, they'll stay steady. If they do, that means I'm doing an exceptional job.

After sending out each issue, generally about 1-1.5% unsubscribe from the blast. Given that I add people without their explicit permission, I think a 1-1.5% unsubscribe rate is excellent.

Conversely, that means 98-99% of people that I've come across haven't told me to go away. And that means that every 3 weeks, they're reminded of Pristine's existence. That's it. Just a simple reminder of our existence. The vast majority of the subscribers are / were potential stakeholders in the business. That is, they are or could be investors, advisors, employees, customers, partners, friends, family, or simply someone who could make a connection or referral.

For those that know me personally, they'll recognize a particular expression from the last paragraph: acknowledging "that I exist." I reuse it for good reason. I find it to be an honest and accurate representation of the truth: that people have lots of stuff going on in their lives, and although I'm working on cool stuff, unless they're one of the few that's actually a stakeholder in the business, they don't actually care.

Although they don't care, the Pristine Story has been a remarkably powerful concept. Every 3 weeks, they're reminded that I exist, what I'm working on, and about 3-4% write me back. Most just say "awesome" or "great status update, keep it up!" It's always great to hear positive feedback, but after sending out each episode, I always receive a handful of emails along the lines of "hey, let's catchup again" or "wait a second, I just met someone that I should introduce you to" or "now I'm interested in working for / buying from / investing in / becoming a stakeholder."

And that's why I write the Pristine Story.

The Pristine Story: The Calm Before the Storm

This post was originally featured on The Pristine Blog. 

In the last episode of the Pristine Story, I mentioned that we'd been building the core infrastructure so that we could execute on our first pilots. I'm happy to report that things are going remarkably well. Engineering is actually a few days ahead of schedule. Mark and Patrick will be on site with our first pilot site testing our software with live patients in surgery on September 30th.

I've been at home working in Austin for the past few weeks, getting things in order for a flurry of sales, marketing, and investor activity to close out the year. The next 8 weeks are going to be absolutely ridiculously exciting:

OR Manager, September 23-25, Washington DC

Health 2.0 - September 29th - October 2nd, Santa Clara

GlazedCon - September 30th, San Francisco

American College of Surgery - October 6-10, Washington DC

American Society of Anesthesiology - October 12-16, San Francisco

DEMO - October 15-17, Santa Clara

HealthTech Conference, October 30th, Mountain View

I'll be pitching / speaking / demoing at GlazedCon, DEMO, and HealthTech.

In addition to these shows and events, I'm in the Baltimore / DC area now presenting to the executive surgical team at one of the nation's premier medical institutions. I'm also flying to SF next week for a day trip to visit with three of the top VCs in the country. And in all likelihood, I'll be coming through NY a week after DEMO for VC meetings.

To help manage and prep for the wave of activity during October, we hired a Director of Marketing, Kristine Bryant. She has a strong background in hospital operations, communications and marketing, and received an MBA from the University of Texas last year. But more importantly than credentials, Kristine is just as crazy as the rest of the Pristine team. She wouldn't leave me alone until I offered her a job. She pinged me daily, refined our marketing materials, and put together a marketing plan even though I hadn't offered her a job. I'd be utterly stupid to pass up on someone who wants the job that badly. We're very excited to have her aboard.

We'll be ramping down some of our outsourced development in October, and will bring that development in house. We're looking for one full time Node.JS developer, and one full time cross-platform Android and iOS developer. If you or anyone that you know is interested in either of these roles, please reach out and let me know. We're still young enough to offer substantial equity, so if you're going to apply, the sooner the better.

And of course, I continue to blog away:

HIStalk

Monetizing Consumer Health Applications

Ephemeral Communications

Glass <3 FDA + HIPAA

The Pristine Blog

A Killer Mass Market App for Glass?

The Killer Apps for Glass

My Blog

Going for the Jugular

PHI From Glass

What's the Killer App for Glass?

Monetizing Consumer Health Applications

This post was originally featured on HIStalk.

I may be sitting on a high horse, but I have a fundamental problem with businesses that don’t have a monetization strategy from inception. The concept of "let’s build a user base and figure out how to make money off it later" is a recipe for failure. Facebook and Twitter did it successfully, but they’re the exceptions among the exceptions.

The vast majority of businesses that have employed the same model never make money, even after raising tens if not hundreds of millions of dollars. See Pinterest, Path, Instagram, Mailbox,FourSquare, Shazam, Tumblr, SnapChat, and Tinder as examples. Some of these businesses were lucky enough to be purchased at ludicrous valuations, but that’s not a bankable model. No one could have possibly foreseen those acquisitions.

The low-hanging fruit in mobile consumer applications has been picked from the proverbial money tree. As such, the Silicon Valley (SV) echo chamber has turned towards healthcare.

"It’s broken!"

"I have a $6 trillion addressable market!"

"Management is clueless and ass backwards and doesn’t know how to use technology! I’ll show them how!"

These are some of the most common and superficial jabs (and business justifications) that SV entrepreneurs throw around when talking about entering healthcare. With a fridge full of Red Bulls, an insatiable appetite, and a dose of crazy (good) naiveté, they set out to… sit at their desks and write code all day and night. Good for them. We don’t need any more email or task list apps.

Since they don’t know much about actual healthcare operations, they address patient-facing problems. That’s where most of them fail. Unfortunately, patient-facing healthcare applications are, generally speaking, an even worse idea consumer centric applications:

1. Patients aren’t willing to pay for healthcare services (Obamacare), nor do they care about their own health (obesity and smoking rates). Contrary to popular belief, Northern California isn’t representative of the rest of the country.

2. The #1 challenge facing consumer applications is behavior change. This problem is particularly true on mobile, where there’s limited screen real estate and where apps are bounded by Apple’s and Google’s miserable app stores. This stands in stark contrast to the open and accessible desktop web, where everything originates with a Google search. Many consumer-centric healthcare apps are simply never found, or if they are, they’re downloaded, only to be deleted shortly after initial use.

Combining the top two above, The only patient-facing apps that have successfully monetized are those that charged someone else access to the patient’s interaction with an app. See ZocDoc, iTriage,WebMD, PatientsLikeMe, HealthyLabs, HealthTap, Simplee, and RunKeeper as examples. Fundamentally, they employ a similar model to Google: feed referrals to organizations that want targeted, qualified referrals.

Healthcare entrepreneurs, please pursue ideas with a viable revenue model. There’s nothing more painful than calling your investors and asking for money than you originally planned for because you can’t monetize your user base. There are still plenty of opportunities that are patient facing, but please ensure that there’s someone who will pay for your referrals.

A Killer Mass Market Consumer App for Glass?

I've been pretty pessimistic about Glass's chances for success as a consumer product for any number of reasons. The greatest challenge Glass has to overcome is the existential question: why should people wear it on a daily basis?

Adoption of new technology form factors are driven by a narrow set of killer apps. I don't see a mass market killer app for Glass.

Phil Libin, CEO of Evernote, suggested that "the killer app is hyperawareness." That's another way of saying that context is king in eyeware computing.

Context is profound. And using context as a trigger is an intriguing concept. Google bet the farm onserendipitous, contextually driven search long ago when they began development of Google Now.

However, I think Phil and I are looking at the notion of context from different sides of the glass. My suggestion that context is king in eyeware computing is more of a developer guideline - that apps that developers build need to be contextual - as opposed to Phil's suggestion - that Glass is an inherently hyperaware, contextual device. At this stage, I don't find Glass to be any more hyperaware than one's smartphone, and in fact, in many ways less aware because of Glass's limited battery life.

Glass is a computer, just like a smartphone. It has certain unique traits and marginal value. It has the potential to be hyper-contextual because

1) it's hands free, and thus nonintrusive

2) there's a heads up display that can provide contextual data cues

3) it's is always there

4) the first person camera could enable fine grained contextual computing. These aspects of the device lend themselves to contextual computing if Glass knows what one is doing within a given 5 second window of time. Unfortunately, without running the camera 24/7 (which will kill the battery very quickly), Glass really has no clue what one is doing within a given 5 second window of time.

Of course, Phil described a few apps that don't require quite the level of contextual awareness I described, such as the need to purchase vegetables when one walks into the grocery store. Location is a powerful contextual trigger. However, location doesn't fundamentally make use of Glass's unique characteristics. Sure, Glass can present location-contextual data in a friction-free manner, but it doesn't justify the cost of wearing Glass.

However, if we ignore battery limitations, Glass will be the ultimate hyperaware computing device. Once Glass knows what one is doing, it can really start to provide useful information.

Going for the Jugular

Apple and Google are trying to fundamentally undercut one another.

Apple's business model is predicated on selling hardware at fat margins. In order to earn those margins, Apple must pioneer new technology platforms to drive mass market adoption and establish prices on their terms. Apple successfully commercialized desktops, laptops, mp3 players, phones, and tablets. Because Apple was first to nail the magic usability formula in each of these form factors, it set the price point and owned the mindshare of the form factor. The power of being first is profound: the average Apple laptop sells at more than 2x the ASP of the rest of the industry, and the iPhone, iPod, and iPad command the highest ASPs in their respective markets. With Glass, Google is trying to 1-up Apple at its own game. Although Glass is dramatically less useful than a phone, it still represents Google's attempt to prevent Apple from pioneering and commanding new technology markets. There're rumors circulating that Glass will cost $199 at launch. If Glass launches at that price point, Google will effectively shut Apple out of the eyeware computing market entirely. Apple cannot make money selling glasses at $199.

Apple, on the other hand, is trying to disintermediate mobile Google search. Apple has app-ified mobile, and is trying to keep users searching within apps. One of the driving visions of Siri was to be a search engine of search engines. Although Apple hasn't yet empowered developers to plug into Siri, they will in time. When Siri transforms into an intelligent search engine of search engines, expect to see Apple make a serious push to kill Google. The future of search isn't 10 blue links; the future of search is answers. Although Siri is still limited in what it can do, Apple is slowly encroaching on Google's turf, particularly as an increasing percentage of searches are performed on mobile devices.

It's fascinating to watch the two leading tech mega-giants battle it out on a global scale. Although Apple and Google are very asymmetric companies that capture value at very different points of the value chain, they are increasingly encroaching on one another's territory. Perhaps Apple will nail TV where Google failed, and perhaps smart watches will be the next computing form factor, though I have my doubts. Regardless, I believe that Google has the upper hand. Disrupting search is dramatically more difficult than disrupting Apple's hardware margins. Remember, your margin is my opportunity.