GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

One of the most prolific management thought leaders, Peter Drucker, defined seven sources of innovation in his book, Innovation and Entrepreneurship (1985):

1. The Unexpected. This is indeed the Eureka moment where something unexpected happens that leads to a new product or service. You weren’t looking for it; the surprise found you! It is by far, the easiest and simplest source of innovation.

The problem, though, is that there are relatively few Ah-ha moments. Most innovation is incremental and evolutionary, not never been done before revolutionary. Like the frog in the boiling water metaphor, it also takes an entrepreneurial mindset to see things evolve that others might see, but not recognize as an opportunity. In addtion, unexpected failures generally offer opportunities more than unexpected successes.

1. Incongruities.  When there is a discrepancy between what is and what should be, you have an innovation opportunity. It’s that weird feeling, an incongruity, between expectations and results. It’s a disruption in the logic or rhythm of a process. It just doesn’t feel right.

Ask why not or what if? Cognitive dissonance, the state of having inconsistent thoughts, beliefs, or attitudes, especially as relating to behavioral decisions and attitude change ,is an opportunity.

1. Process Needs. Perhaps there is a bottleneck or a weak link in a critical process. A substantial (not just a tweak) improvement to the process leads to innovation. The process innovator is always searching and saying, “There has to be a better way!”

Take advantage of the value of value chain analysis and whether there is a problem begging for a solution.

1. Industry and Market Structure. Industry and markets are always in a continual state of flux. Regulations change, product lines expand, and others shrink. Those that watch these changes may recognize untapped opportunities for new types of products and services.

The sickcare industry is rapidly changing. But, like most highly regulated industries, rules create ecostems that evolve into business models that either support or stifle innovation. Digical care, retail based clinics, Amedzon products and services and alternative care delivery channels, like telemedicine, are examples of just the beginning of the change to care at home and DIY medicine.

1. Demographics. The changing demographics (age, education, disposable income, etc.) and moving populations are rich sources of ideas for creating new products and services.

The global aging population and dropping fertility rates will be the biggest demographic headline for the next 20 years.

1. Changes in Perception. Meaning and Mood. Over time, populations and people change. The way they view life changes, where they take their meaning from and how they feel about things changes over time. Savvy innovators detect these shifts and leverage them.

Examples of such changes include the death of expertise, consumerism, the 4th industrial revolution and conveniencecare

1. New Knowledge. New technologies, knowledge and discoveries can completely change an industry. These types of innovations are usually what people mean when they talk about innovation, yet these sources have the longest lead times to commercial development.

The pace of technological change is increasing. However, those that add true value and transform an industry are few. We are experiencing a heathcare innovation bubble.

The sources of innovation and opportunity are immutable. Seeing them and translating them into solutions that add value is everpresent but rarely accomplished.

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GUEST POST from Arlen Meyers

There are endless articles celebrating the joys of boredom and its potential to stimulate creativity. But what about being not just being bored, but being a boring person?

Here is the A list of boring celebrities.

The American celebrity and attention grabbing headline culture is all about being interesting, however you define that. But, being interesting comes with its problems:

1. Its hard work and often expensive looking that way and doing all those things that you can talk about at cocktail parties or Meetups. All that botox, eyelashes, makeup and hairdos add up.
2. There are very few people in history who were able to excel at and be famous for more than one thing. Some are just famous for one thing they said. Take Thoureau for example…quiet desperation. Can you imagine spending the night with him on Waldon Pond?
3. Most people try to fake it till they make it and often come off as imposters or frauds. In fact, most celebrities are pretty boring. Famous for being famous, in popular culture terminology, refers to someone who attains celebrity status for no particular identifiable reason, or who achieves fame through association with a celebrity. The term is a pejorative, suggesting that the individual has no particular talents or abilities.
4. Keeping up with the Jones’s is so post war 50’s
5. Being good at one thing, or creating one product or company requires intense focus, not suffering from the distraction of traction.
6. Being unidimensional does not mean you don’t need a hobby or distraction now and then. I mean, how interesting is the fact that you can play amateur piano?
7. Being boring helps to separate your true friends who like that you are boring from false ones who are really after something else.
8. Being boring relieves you of any obligation to answer, “So, what are you doing interesting lately?” Then you can listen to other person, which was the point of the question in the first place. You also don’t have to lie to an interviewer who asks which books are on your night stand when you have none or haven’t touched the ones that are there as a support for you EchoDot.
9. When you tell someone you just returned from a trip and they ask what you did, you can answer “As little as possible. I just went to chill” It’s another way to detox from life
10. The vast majority of the world’s population live at the bottom rung of the hierarchy of needs. They are worried about survival, food, clothing and shelter, not being interesting or self actualization. Turns out, most of their stories and lives are much more interesting than mine.

If you pay attention, everyone is a novel. The most boring person, if you sit down and really listen, is someone interesting

Instead of trying so hard, celebrate your being boring. People will find you much more interesting than all the phonies trying to be interesting.

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

The latest smart audio report from NPR and Edison Research estimates that there are now nearly 120 million smart speakers in U.S. homes, representing 78 percent year-over-year growth. However, the survey also found that nearly 70 percent of survey respondents were “not at all likely” to buy another device.

According to a recent survey published by Voicebot.ai, one in four Americans own a smart speaker and that number continues to grow; smart speaker ownership increased by 40 percent in 2018 alone.

Just over half (53 percent) of owners use their smart speakers daily or multiple times a day. Curiously, 16 percent of the sample said they “never” use them. These are likely to have been gifts. Mine was.

Like the start of any relationship, our cyberdating experience started slow until we gradually got to know each other better . She had to learn my voice commands and I had to learn what she could and could not do. It also turns out that someone gave me a smart plug before I even knew what I was supposed to do with it. I plugged it in. Then, nothing.

Once I realized it was a way to activate lights or other electrical things by asking Alexa, I thought I’d give it a try. I must admit, though, I was getting nervous about how quickly things were moving with our relationship particularly since, even though I hardly know her, I invited her into my bedroom. Much to my surprise, she did not mind. In fact, she encouraged me to ask her more questions.

After about a month of using it to periodically listen to music or turn on and off by bedside lamp, there were ominous signs that our gig was going south:

1. Every now then and it became disconnected to my WiFi and the App on my phone was cumbersome and time consuming to navigate. A simple on-off button would have been easier.
2. I started reading about how speakers listen to our every word and sell the data to someone else without my approval. I thought we were going to keep things to ourselves before we introduced each other to our parents.

3. People like me are still trying to understand the full potential of smart speakers, and their expectations, interactions and boundaries are evolving. One survey uncovered six key tensions:

4.People are buying A LOT of smart speakers, but that doesn’t mean they aren’t nervous about eavesdropping. Curiosity about what smart speakers can do for people and their homes is being weighed against privacy concerns.

5.Talking to a machine feels futuristic, but the auditory interface can stir up feelings of nostalgia. An interactive voice assistant feels beamed from the future, but a speaker can feel like radio.

6. Smart speakers can help accomplish tasks, but they can also feel like toys. A person’s relationship to the device changes depending on whether they view it as a tool that completes tasks, or a content delivery mechanism that provides fun diversions.

7. People want a voice assistant to be friendly, but not too friendly. While it’s possible to humanize voice assistants by adding accents or emotions, people don’t want the devices to have an unprompted or imposing presence.

8. The experience reminded me of a sensory neuropathy where there was a neurologic problem with the afferent system

9. The experience reinforced my thought that putting smart speakers in the medical exam room would have lots of problems.

10. Like entrepreneurship, it was just better to pull the plugs, learn from my mistakes, and move on. No alimony. No child support. Not having to ghost Alexa on social media or avoid her at the Starbucks.

11. Maybe some day, like a bunch of techie nonsickcare entrepreneurs hope, Alexa will be a personalized patient clinical decision support tool or help with chronic disease management. It won’t help much, however, if your home dialysis machine loses it’s WiFi connection or your dog eats the smart plug.

12. There is a lot to be said for digital detox and solitude.

Now I am enjoying the disconnection, just using my expensive Sonos system that has much better sound anyway, just turning on the damn light myself and just looking up on the Internet who won the latest college football playoff game, which I really didn’t care that much about anyway. She just didn’t solve my problem and add enough value compared to the competition enough to make me switch from what I was doing before she entered my life.

Are you listening digital health, digital therapeutics and the internet of medical things? Alexa isn’t any more.

and Co-editor of Digital Health Entrepreneurship

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GUEST POST from Arlen Meyers

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GUEST POST from Arlen Meyers

The most frequently asked question most inexperienced physician entrepreneurs ask is, “How do I find investors?”. The facts are that, according to the Angel Capital Association, only 2 percent of entrepreneurs are able to pry much-needed cash from the tight hands of angel investors, and less than a half of a percent raise money from venture capitalists, according to Price Waterhouse study.

Structural changes in the venture capital industry makes it harder to find seed stage money and investors who are willing and able to lead deals. The result is a seed stage gap.

Further complicating the issue is that investor ecosystems and funding requirements vary depending on the type of product or service you are building. For example, finding the amounts of money you will need to develop a drug, device or diagnostic product will vary significantly from how you find money for your digital health app or care delivery or service improvement. The time horizons and follow on round required are also different.

So, what’s a biofounder to do?

Here’s are the stages of funding.

Obviously, there is a lot of advice on how to raise seed stage money, but here are some recurrent themes concerning the strategy and tactics involved:

Strategy

1. Be sure your idea is ready for investor prime time–i.e. you have the pieces in place and have validated most of the elements of the your business model. The ultimate validation of your model will be if you have paying customers already.

2. Fight the right kind of investor who identifies with your idea during the right stage of development. Not all investors are the same. Some favor certain industries or products, some have personal connection, some want early stage, some want later stage. Do your homework. Here are the various stages of startup funding.

3. Explore alternative and new forms of funding, such as investor, charity or product/service crowdfunding, corporoate venture, state andlocal grants and university based endowments and investment funds.

.4. Network, network, network.

5. Fail early, often, and for as little cost as possible.

6. Self-fund or bootstrap for as long as possible. Build as much value into your idea as possible before shopping it to investors.

7. Consider customer-funded business models if possible.

8. Have a fundraising plan, just like a marketing plan or financial plan, and execute it

.9. Get the right people on the bus as soon as possible.

10. Find the cheapest, smartest capital (not necessarily money) to get to your next critical success factor.

Be sure you have a fundraising plan and follow these steps.

Tactics

Now that you have some strategy, here are some nuts and bolts:

1. Network, network, network.

2. Create a one-page executive summary, a 3-minute video, a website with a button “for investors” and a 10-slide Powerpoint presentation.

3. Sell to the heart, not to the head and be sure your pitch is investor ready.

4. Be sure you have the right story teller on the team.

5. Create social media buzz about your product or service as part of your plan. You know you are successful when an investor says, “Oh, I’ve heard of you.”

6. Apply for non-diluting sources of capital like SBIR/STTR, state and local eco-devo grants, international research, and development collaborations, etc.

7. Explore accelerators, generators, and incubators that have the right model for you.

8. Find out who funded your competitors and contact them.

9. Think big, but start small demonstrating customer traction with pilots.

10. Network,network, network. Even when you are networking, you might be mingling with the wrong people. There are 15 sources that you should cultivate who can make introductions or ease the way to meet investors. Here are some tips on how to find investors on Linkedin.

11. Here is your angel investor contact to do list

Here are 10 other places to look for money:

You should also look into investor crowd funding. Here are the pros and cons.

Here are some tips on how to find angel investors:

1. Use personal networking. The best angels you will find are the ones who know you personally, or know a member of your team or advisory board. If a potential investor gets to know you BEFORE you are asking for money, your credibility and investment probability will be improved by an order of magnitude.
2. Entice angels to play along. Of course, angels are really mortals. They want to make a difference. Asking an angel to work with your company in an advisory role is a great way to establish a relationship that may lead to a cash investment. If you impress the angel, it will likely make her at least an archangel (advocate) when it comes to funding.
3. Court local angel groups. Since angel investors most often focus only in their own geographic area, it’s most effective to court the local group, or even make a guest appearance with an archangel. If you can earn an archangel’s confidence, he or she will invite you to pitch the group, and you’ll have an edge in the voting.
4. Mine national databases. If you are still alone, submit your application to the leading online website national databases of angel investors, Gust (USA) and National Angel Capital Association (Canada). These sites have arrangements with hundreds of local groups and individual investors that you might otherwise have missed. You might also check angel funds that target bioscience or digital health ideas or raise money from doctors for doctors.

Gust (formerly AngelSoft). This is perhaps the most widely-used source of information on angel investor groups across the world, run by the “Father of Angel Investing in New York,” David Rose. This software platform is used by many local angel organizations for managing deal flow.

Gust claims to have facilitated over $1 billion of investments in 500,000 startups to date, via connection through their platform to over 70,000 angel investors in 190 countries. As an entrepreneur, you simply use their investor search engine to find appropriate investors for your business according to location, industry interest, and other relevant criteria.

AngelList. This is another very popular website for raising equity or debt investments for startups. It was founded back in 2010 by Naval Ravikant and Babak Nivi of Venture Hacks, which is also a great place to visit for startup advice.

AngelList has featured over 3 million businesses for potential investors in a format that is, effectively, a social network for entrepreneurs and angels. They claim to have already raised over $560 million for 1400 startups, primarily in the US and Europe. In addition, they serve as a jobs available site for 24,000 startups.

Keiretsu Forum. This one claims to be the world’s largest single angel investor network, with 2500 accredited investor members throughout 52 chapters on 3 continents. Since its founding in 2000, its members have invested over $800 million dollars in over 800 companies in technology, consumer products, healthcare/life sciences, real estate and other segments with high growth potential.

The Founding Chapter is in Silicon Valley, California, (naturally). A caveat is that this is a for-profit organization, so fees to present may be significant.

USA Angel Investment Network. This group claims to be the largest angel investment community in the world. They have already raised $300 million for startups in the US and across the world. A caveat is that this network doesn’t offer a personal touch, as it only facilitates the exchange of contact information, so the matchmaking is left up to you.

The reach is very broad, with a network has 30 branches extending to 80 different countries. They have over 785,000 registered members with 140,000 investors and 650,000 entrepreneurs.

Angel Capital Association (ACA). The ACA is the angel industry alliance, which now includes a directory to more than 240 angel groups and 13,000 individual angels across North America. ACA member angel groups represent more than 10,000 accredited investors and are funding approximately 800 new companies each year, and managing an ongoing portfolio of more than 5,000 companies throughout North America. Here are some facts about angels:

• Angels are still predominantly men, but the number of women angels has been increasing – 22 percent of angels are women and 30 percent of new angels are women;
• Angels are based everywhere, not just in the Silicon Valley, Boston and New York;
• Most angels are experienced entrepreneurs;
• Median investment size is $25,000; and
• A typical angel has a portfolio of 11 companies, with large variation depending on how long the angel has been investing.

1. Remember angels beget angels. That means that once you get the first one, he or she becomes your best advocate for finding more. Investment angels don’t like to travel alone, so they will bring in others if they can (it’s called share the risk).
2. Don’t forget passive angels. These are angel investors who are private, meaning they don’t go to meetings, but will invest if someone they trust brings them an attractive opportunity. Find the right investment advisor, or member of your advisory board, and the “match-making” will happen.

The VIC Investor Network helps develop and commercialize biomedical technologies that originate in academic research centers and government labs.

Apply for an SBIR/STTR grant for non-equity diluting funding. If you are successful, then apply for matching grants if they are offered in your state.

Apply to be part of an iCorps team.

Be sure you have a financial model is credible

Here are some ways to be sure you are ready for fundraising prime time.

Finding seed funding for your idea is as much about when and if as where and how. It takes planning, preparation and practice and having realistic expectations about how few companies actually are funded by VCs, angels and crowd funding platforms. Be sure you have done your homework, crafted, and validated your business model canvas and done some experiments before giving up control to investors. Good luck with your venture.

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GUEST POST from Arlen Meyers

The foundation of any relationship is trust, including the doctor patient relationship and any business relationship. Busted trust, ethical lapses and an increasing distrust of technology and people who create it have created both problems and opportunities for those in the trust business.

In the bygone days of 2015, the Brookings Institute did a survey on what Americans are most afraid of. The list consisted of the usual: dying, ghosts, and other spooky things.

But, the top 8 all consisted of tech-related fears, including number 1, “cyberterrorism,” 2, “corporate tracking of personal information,” and interestingly, 8, “technology I don’t understand.”

Since then, technology has only gotten more complex, integrated, and entwined in our everyday lives including when we get sick.

In addition to their concerns about low and declining levels of trust in government, many Americans are anxious about the level of confidence citizens have in each other. Fully 71% think interpersonal confidence has worsened in the past 20 years. And about half (49%) think a major weight dragging down such trust is that Americans are not as reliable as they used to be.

Best sellers like “The 10 Laws of Trust” and “The Speed of Trust” are but a few that try to guide us mistrusting souls through the morass of deception, deceit and broken promises. Unfortunately, actions speak louder than words and saying what you’ll do, doing what you’ll say and doing what’s right in the other person’s best interest is hard. Here are some reasons why it’s so hard to do the right thing.

The ancients advise us that you get what you give. If you want money, give money. If you want love, give love. If you want forgiveness, forgive others.

But, in most places, when you screw up because you asked for forgiveness and not permission, forgiveness is not your reward.

Advances in digital health, the patient experience, crowd sourcing problems, solutions and money, big data and analytics and many more recent sick care “innovations” will depend more on high trust than high touch and high tech. The laying on of hands has been replaced with the laying on of thumbs on mobile screens and most are laying it on too thick. Data is not the new oil. Trust is. Trust me, I’m your doctor.

and Co-editor of Digital Health Entrepreneurship

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GUEST POST from Arlen Meyers

In medicine, frailty is theoretically defined as a clinically recognizable state of increased vulnerability resulting from aging-associated decline in reserve and function across multiple physiologic systems such that the ability to cope with everyday or acute stressors is comprised. In the absence of a gold standard, frailty has been operationally defined as meeting three out of five phenotypic criteria indicating compromised energetics: low grip strength, low energy, slowed waking speed, low physical activity, and/or unintentional weight loss . A pre-frail stage, in which one or two criteria are present, indentifies a subset at high risk of progressing to frailty. Various adaptations of Fried’s clinical phenotype have emerged in the literature, which were often motivated by available measures in specific studies rather than meaningful conceptual differences.

Patients who are frail before surgery are more likely to have serious complications and mortality afterward and increased costs of care, suggesting that frailty should be factored into risk calculations before surgery.

Consequently, surgeons develop clinical judgement when doing patient selection for surgery. Whether to operate is as important, if not more, than how to operate.

In several ways, organizations and companies are like patients. When they are sick, some interventions , like change management, digitization, leadership development and innovation initiatives are high risk if the company is frail.

Corporate frailty, is as yet undefined, but might include:

1. Unexplaineed revenue or market share loss
2. Exhaustion manifested by employee burnout or innovation fatigue
3. Low physical activity with resulting underproductivity, waste, or complacency
4. Slowness in seeing potential threats or opportunities or inability to respond to environmental and business model threats
5. Weakness in the C suite, lack of market power or other parts of their competitive strategy They just can’t get a grip.

Like frail patients, operating on a sick business when it is frail is associated with complications and higher rates of mortality and patient selection is key to favorable outcomes. Prehabilitation is a necessary requirement before taking them to the OR.

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GUEST POST from Arlen Meyers

Remember when you first burned your finger on something hot? Here’s how it worked. Temperature, pressure and pain fibers in the skin of your hand sent a signal to your brain that something was wrong (afferent limb). Your brain mysteriously and miraculously processed the information in a split second (central processing), and then sent a signal to the nerves that innervate the muscles of your arm and hand to respond and pull away (efferent limb). There are many neurologic diseases that affect the afferent, central and efferent components of this remarkable system, and that can cause lots of problems.

It’s the same with remote sensing devices and wearables. We’re seeing an explosion of systems that do everything from check for oral cancer via a device linked to an iPhone, to checking your vital signs via a remote gadget, to the latest iteration of the Tridorder that will measure analytes in your blood , through your skin, in the bat of an eye and transmit the results. Here’s another example.

Bill Gates described this feeeback loop in his book, Business @ The Speed of Thought, in 1999. He called it the digital nervous system and most of his predictions have happened way beyond what he predicted. What he called a nervous system has become the wiring for the 4th industrial revolution.

Like a growing fetus though, the cyberworld digital nervous system continues to evolve and develop. Unfortunately, despite all the hype and hope, there are considerable barriers to widespread adoption and penetration of remote sensing devises, systems to analyze the data and ways to respond to it that fall into four general categories:

1. Afferent limb problems: These are issues that involve the data that is derived and sent to the next step, the central processing station. For example, how do we know that the scale measuring your weight at home is actually accurate? How do I know that the person standing on the scale is actually the patient? How can we protect the data that is being sent from intruders or third party intermediaries?

2. Central processing problems:These are problems with how , when and where all this data is processed, stored, analyzed and displayed to create actionable information and generate a valuable efferent signal. For example, should the data be analyzed by a machine, a non-medical professional or someone else? How? How do we prevent “alert fatigue”, i.e. not sending some many false positive signals that users ignore the real emergencies?

3. Efferent limb problems: These are problems that involve who gets the information and what they are expected to do with it. For example, should the patient get the alerts or the doctor? What are the tools we offer to patients to change their health and wellness behavior and will they work? How do we get doctors to adopt these new technologies and use the information to prescribe interventions that will measurably reduce per capita costs, improve health outcomes and improve the patient experience.

4. End organ responses problems Perhaps the biggest problem of all is getting doctors and patients to change their behavior in response to the signals they are receiving.

All of this means that we need to build behavior modification central nervous systems. Given the complexities of human behavior the multiple factors involved, it won’t be easy.

Here’s what some people think the HIT brain will look like.

Getting doctors and patients to use a Tricorder to achieve the triple aim is fraught with obstacles that even Captain Kirk and Dr. Spock would find challenging. The first step will be to create a regulatory, reimbursement and intellectual property environmnent that creates an ecosystem with an incentive to deploy existing technologies using businesses models that create a profit. Welcome to the Starship Enterprise.

 
Image credit: Johns Hopkins Hospital

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