NOTE: This live blog is no longer available here, but I duplicated it in this Linkedin post that I published soon after the event.
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(A version of this post first appeared at Grit Daily.)
Are you carrying around a lot of plastic in your pocket?
Why? You should think about going metal. Yeah, it weighs more. But, if you can slim down your wallet by pulling out a bunch of plastic credit cards you don’t use anymore, replacing them with a couple metal ones, you actually come out lighter — and thinner, too. That’s what I did.
It’s not a good idea to close those old plastic accounts, by the way, as that can have a negative effect on one’s credit score. So just throw ‘em in a drawer, never to be seen again.
But the real story is the benefits you get with certain metal cards.
I first went heavy metal a few weeks ago. Wow, did I love that American Express Business Platinum Card when it arrived! It had that certain luxury feel like, you know, a fine watch or something. Kinda how I felt when I first strapped on my stainless steel Apple Watch. I get spoiled, ya know? And the unboxing experience was almost Apple-esque. No stinking envelope for this metal card!
Why did I apply for it when I already had an Amex Delta Skymiles Platinum Card? Because of a killer perk Amex added recently to this top-of-the-line Platinum Card: a free WeWork membership for a year, which allows access to any of their global locations. Not that I plan to travel that much, but I could see myself hanging out at my cool local WeWork facilities when I get tired of working in coffee shops or in my home office (and, ahem, drinking their free coffee and beer). I would undoubtedly make some great new connections there, too.
WeWork claims the value of the membership is $2700 annually, so pretty crazy, huh? Huge hat-tip to my friend William Harris for alerting me to this awesome perk.
So, I’m dropping that other (plastic) Amex card, which I used for business expenses and paid a card fee of $195 annually. The new card is $595 per year, so $400 more to get that WeWork perk — and a bunch of other cool benefits as well. No brainer for me.
But Wait, There’s More… Metal
No sooner was I just beginning to use my new Platinum Card when another card comes along — which I also now gotta have. Maybe you heard a little bit about it? Yes, um, it’s metal. Titanium. Oh, the thrill! It has no number on it, no expiration date, no security code. Just my name and a chip, baby! And, double-um, it has — are you ready? — no annual fee, no late fees, and a lower interest rate than most cards, for those who don’t pay off their balance each month.
“Pinch me — this can’t be true!!” I screamed at my MacBook Pro as I watched the big Apple Event. And did I mention it was metal? Apple has one-upped Amex (and lots of others) on this one.
You don’t even have to call some bozo salesperson to activate the card. And how about this: you just text for support — no more calling some g-damn 800 number the back of your card. Everything about it is all in your phone, securely, in Apple Wallet.
Did I mention you get cash back with every purchase — 1, 2, or 3 percent, depending on the type?
Now, the prospect of having two metal cards in my wallet, come this summer when Uncle Timmie sends me my new one, has me doing downright crazy things. Like writing this post. About credit cards. What??
Yes, this is the strange world of the Apple fanboy. Always going heavy into the latest Apple buzz. Even writing about their chips, no less. And I’m not done yet!
(Photoshopped images of my credit cards courtesy of my awesome buddy Steve Borsch.)
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UPDATE 4/5/19:
So, you were wondering why Apple would get into such a crazy new business?
Apple Credit Card Could Be Worth $1.5 Billion in 5 Years, Analyst Says – Barron’s
(NOTE: This post first appeared at GritDaily, a brand-new media site I just learned about prior to SXSW, where I am now – magically – a contributor. Shout-out to my buddy Will.)
Did someone say they party at SXSW? ©NomadSound
People go to South By Southwest for all kinds of reasons.
Nonstop parties would be one. Call me crazy, but I went for the conference sessions in the healthcare track. (Okay, a few parties, too.) I wanted to learn about disruptions and innovations in the biggest monster market of ‘em all – at $8 trillion and counting. Knowing there was so much startup action in the healthcare and medtech sectors, I was anxious to learn more about the trends and issues driving all the excitement and change — really gnarly, difficult change — in this space.
One panel I landed in over the weekend taught me about something being touted as a “real sea change” in consumer healthcare.
Turns Out Your Doc Has Been Talking Behind Your Back
But I guess we knew that from watching this Seinfeld episode.
Seriously, physicians have to continuously write notes into your medical record as part of your normal healthcare. They have to fully document your symptoms, diagnoses, treatments, drugs prescribed, etc, etc, in great detail. They don’t just do it for your benefit – it’s a legal requirement. It’s all entered digitally now into your Electronic Health Record (EHR). But did you know that, until recently, patients didn’t get to see those notes? That was the basis for a panel at SXSW called “Transparency in Healthcare” — which was all about a movement that’s blowing up that old notion of, well, it’s-none-of-your-business.
It’s called Open Notes, and what it’s doing (quite successfully, I learned) is getting institutions. to allow you, the patient, to see those doctor notes whenever you want. That may not sound radical to you — maybe just common sense? But change tends to come s-l-o-w-l-y in the healthcare industry.
Why would this matter to you if you’re a healthy person — just, say, getting an occasional physical, or going in for a sore throat? Not much maybe. But if you have a chronic health condition, requiring you to see a physician – or physicians – frequently, it matters a lot. And one of the panelists, a former punk rock drummer, had that kind of story to tell as a malignant brain tumor survivor.
Consumer In Charge
“Healthcare has been physician-oriented for too long,” said Trevor Price, a VC on a panel I caught the previous day. “It lacks consumer focus, which is crazy,” said Lynne Chou O’Keefe of Kleiner Perkins, another on that same panel. So, I was ready now to hear what these Open Notes folks had to say about how “transparency” in healthcare is playing into that trend.
On this panel were Cait DesRoches, executive director of OpenNotes (she’s also an associate professor at Harvard Medical School), and Liz Salmi, a strategist with Open Notes and a former cancer patient. (The punk rocker referred to above, who actually once performed at SXSW when she was 19.) They were joined by Rasu Shrestha, a radiologist and big supporter of this new movement, who’s also chief strategy officer of Atrium Health. The excellent moderator was Bryan Vartabedian, a physician at Texas Medical Center, and also a writer and podcaster.
“It’s not software, we’re not a vendor — rather an international movement, funded by philanthropy,” said DesRoches of OpenNotes. “That way, we’re free from conflict of interest.”
Just how consumer focused is healthcare becoming? “We go see ‘Dr. Google’ first, before we see our own doc,” said Shrestha. Up to 7% of all Google searches are healthcare related, according to panelist Liz Salmi – more than 70,000 per minute.
“I’ve never seen anything like this (the reaction to Open Notes),” she said. “People want this!” Some 200 organizations in 20 states have already signed on to the Open Notes program.
But Are the Docs Buying In?
Okay — but how have doctors reacted? “When I first heard about this, I was freaked out,” said the moderator (a physician). “It’s a real culture change,” said radiologist Shrestha. “Initially, the thought was, we’re all gonna get sued more!” He also heard doctors saying, “We don’t have time for this.” Which caused him to think to himself, “What, you don’t have time for your patients?” But he’s since seen the “embrace from the physician community going way up” in his work at Atrium Health in North Carolina.
“Patients do now have a legal right to their records in the U.S.,” said Open Notes’ DesRoches. Still, most healthcare organizations “don’t make it easy.” With increasing adoption of Open Notes, it is getting easier, she said. “But culture change has to come with it.” Training of clinicians and nurses must play a big role.
Has there been a change in doctor behavior because of Open Notes, where it’s been adopted?
At first, DesRoches said, they tend to think they’ll get buried in calls and emails after patients are able to read their notes. “But for every one that does call, we find two that didn’t because they now better understand their instructions.”
Do doctors have to change the language they use in notes, because they know patients are now reading them? “We think of this as a backdoor to empathy that can only lead to better healthcare,” said DesRoches.
“We now have an opportunity to turn the EHR into a living, breathing, realtime document,” said panelist Shrestha. At Beth Israel Deaconess Medical Center, Open Notes’ DesRoches said they’re even starting to have patients write a short note about what’s happened since their last visit, and actually make that a part of their own medical record.
Shrestha, the radiologist and strategy officer at Atrium Health, said it’s now possible to leverage voice and AI technology “to have conversations with our patients that can go into the legal document – a co-created record.”
Then he stood up, tore open his blazer, and revealed a “Fight Burnout” t-shirt. “Doctor burnout is a huge problem today – read the studies,” he said. Because of the increased time physicians have to spend at the keyboard, entering so much data into the EHR, “docs now have their backs to the patient 44% of the time. That’s not why I went to med school!”
The clear message? If Open Notes can help alleviate that pressure, via the promise of that “co-created record,” it can only help lessen the burnout problem. Do you want a doctor who’s so stressed out, he or she can’t focus on you?
Of Open Notes, Shrestha said, “We’re seeing transformation before our eyes. We’ve cracked open (the EHR) to let the sunlight in.” Open Notes exec director DesRoches added, “Change is here – we’re not going backward.”
Yep, that’s an advancement in healthcare worth partying about.
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Update 3/18/19:
You can’t read this post and not read this (just published):
Death by a Thousand Clicks: Where Electronic Health Records Went Wrong | Fortune
Some serious investigative journalism here. Long read, but definitely worth it.
If you know how startup accelerator programs work, 18 is a seriously impressive number to achieve in 12 months. Having a program that can put that many startups, that quickly, through a rigorous process, enabling them to launch effectively out into the world, deserves some major praise. And I’m about to give it to them.
Hats off to gBETA MedTech! And especially to the program manager who runs it, Adam Choe. Adam is the man! If you’re not familiar with this program (a part of gener8tor Minnesota), it’s a free, seven-week accelerator that works with medical device, healthcare-
related software, biotech, and diagnostics startups. In 2018, it successfully ran three — count ’em, three! — cohorts of six startups each. So, yes, it prepared a total of 18 healthcare-related startups, from Minnesota and beyond, to go out and raise money, continue their product development, build out their teams, and start hitting their milestones. And it did all that very, very well.
I can say that because, as a gener8tor mentor since 2016, I was involved throughout. I have met and heard the pitches of every single one of those 18 startups — at least twice, actually. The highlight is always the final pitch of these startups at the demo night for each cohort, called “LiveBeta,” an event attended by at least a few hundred folks here in the Twin Cities (a large percentage of which are investors). That is where these founders shine! And you can really see the progress they’ve made during the seven-week program.
Hundreds gathered at the JJ Hill Center in St. Paul to hear the Fall 2018 gBeta MedTech class give their pitches.
I have never ceased to be impressed when I attend these demo nights that gener8tor and gBETA put on (and I’ve attended each and every one since gener8tor came to Minnesota in 2016). These founders get on stage and deliver amazing, very well prepared pitches that really focus great attention on the problem they’re solving and the attendant market opportunity. (And they each must have a total addressable market of hundreds of millions of dollars, or more, to participate in the program.)
The 18 startups that completed the gBETA MedTech program in calendar year 2018.
You can bet you’ll be hearing more about many of these startups going forward. Remember these 18 names! You can click through and read more about them on gBETA MedTech’s site here.
And what’s more impressive than 18? Well, try 23. That’s actually the total number of startups that gener8tor graduated here in Minnesota during 2018 when you count the five that went through its main equity program during the summer. (One of which is healthcare.) Congratulations to those startups as well: Cellular EMT, FaithBox, Onepanel, SpeechMed, and Virtue Analytics. I wrote about that cohort here.
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P.S. I should also mention here that the very first gBETA startup I mentored, which was part of the first class in Minnesota in late 2016, happened to be healthcare related — and it went on to be acquired just two short years later: CoreBiome. Congrats to them!
Click on image to enlarge.
Maybe you heard there was an Apple event? And a new phone, the iPhone Xs? And I’m guessing you saw a gazillion media stories, too, about how darn expensive it was, right? That’s actually a major pet peeve of mine — the lamestream media just cannot let go of that same tired old line. Who can afford these things? How will people ever pay that much for a phone? Blah, blah, blah. Well, you know how it always turn out. Um, Apple does okay.
Three things make that lame media line pathetic. First of all, it isn’t just a phone — it’s a supercomputer. (Do you know what those used to cost? Meaning the equivalent computer power, not that long ago.) Second, it’s the computer you use the most, if you’re like most people. (And for some people, it’s their only computer.) From that perspective, the iPhone is downright cheap. Have you ever paid multiple times the cost of an iPhone for a computer? One that won’t fit in your pocket. I sure have.
And, third, hardly anyone pays for an iPhone upfront, anyway. Small monthly payments make it like a utility. Less money than what many people spend monthly at Starbucks.
So, now that I’ve totally destroyed that meme, I’ll get to the point of this post… 🙂 And that is this: not only is the iPhone Xs a bargain, but it is by far the best smartphone out there, ever, because of what powers it: the A12 Bionic chip.
Here’s what some very smart journalists say on that subject:
Stephen Shankland, CNet (“A12 chip gives Apple big advantage over rivals“):
Click on image to enlarge.
The A12 is the industry’s first chip to be built using a 7-nanometer manufacturing process. A nanometer is a billionth of a meter, so when Apple moved from the A11 chip’s 10nm process to the A12’s 7nm, it meant the company could stuff twice the number of circuit elements called transistors into the same surface area. In the case of the A12, that’s 6.9 billion transistors.
You don’t necessarily need to understand the nuances of transistor sizes or just how small a nanometer really is. The bottom line is that the advancement will let the iPhone XS and XS Max run graphics 50 percent faster than 2017’s iPhone X, while artificial intelligence software will work 8 times faster. And perhaps most important, your battery won’t get drained.
The A12 “is so far ahead of the industry that it will still be competitive with the best Android smartphones in two years, and massively more powerful than lower-end phones,” said Stratechery analyst Ben Thompson.
The real advantage of the 7nm process is that Apple can do it all without flattening your battery. “The lower power can extend battery life or allow Apple to push the performance up by 20 percent when the user needs the extra boost,” said Linley Group analyst Linley Gwennap.
The chip industry has been in a pickle for more than a decade as the previously steady progress in ever-faster processor clock speeds sputtered. That’s forced chipmakers to figure out other ways to try to make chips better, because no longer does the same software automatically run faster with each new chip generation.
Click on image to enlarge.
Special-purpose circuitry has been one primary coping mechanism. First came graphics processing units, or GPUs, which accelerate not just gaming effects like hazy air and gleaming chrome, but also physics calculations that make explosions look real. Apple’s A11 chip had three GPU engines called cores, but the A12 has four.
More recently, chipmakers have begun adding chip technology to accelerate artificial intelligence chores. AI — also called machine learning and neural networks these days — can let devices understand speech commands, take better photos and recognize unhealthy heartbeat patterns. The A12’s built-in AI circuitry can perform 5 trillion operations per second, an eightfold increase over the A11.
Apple is in a strong position compared to some phone rivals because it controls not only the processor but the operating system and other software like speech recognition and photo apps. The company can ensure all the parts of the system work well together.
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Om Malik, Partner, True Ventures, and Founder, GigaOm (a portion of his notes on the Sept 12 Apple Event):
That new shiny new A12 Bionic chip with more cores in its neural engine, ability to do way more with its GPU and CPU… seriously— this is the most impressive work…. this is some chip nerd nirvana. Here are some facts about the A12 Bionic. It has:
Click image to enlarge.
• 6.9 billion transistors.
• Two high-performance CPU cores deliver 15% more speed and 40% greater efficiency compared to the A11.
• Four other CPU cores are 50% more efficient than those on the prior chip.
• Six-core GPU designed by Apple. It is 50% faster than the block on the A11.
• New neural engine sports eight cores, versus two in the A11, giving it a nine-fold performance bump vs. A11.
• CoreML machine-learning framework can hit 5 trillion operations/sec, versus 600 billion ops/sec on the A11 using one-tenth of the energy.
What does all this mean? This is the first serious edge-computing device with more oomph than many laptops. The neural engine can now do a lot of those things Google does in the cloud — on a device. When it comes to automatic video editing and stuff such as the identification of faces, we are going to see the power of this chip. The gaming demos and the ARKit 2 demos, should be enough of a clue as to what this new chip can enable… there is something special about the iPhone Xs. And that’s Bionic!
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James Vincent, The Verge (“A12 Bionic chip ‘the smartest and most powerful chip ever in a smartphone’):
The end result should be the same as ever: faster apps… More tangible, though, will be the new functionality enabled by this sort of processing muscle. Particularly apps that use the company’s machine learning framework, Core ML, which the new A12 Bionic runs nine times faster than last year’s chips.
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Rick Merritt, EE Times, in his report after the Apple event:
Click on image to enlarge.
The (A12’s) performance will speed a variety of operations, including unlocking the phone using Apple’s facial-recognition software. It also enables a new capability to group multiple Siri functions into shortcuts.
Third-party developers showed applications using Apple’s CoreML and ARKit 2 frameworks to enable new features supported by neural nets. They included Homecourt, an app tracking six metrics of basketball performance in real time, as well as new features in mobile games using augmented reality.
“The A12 is a game changer,” said Tim Bajarin, a veteran Apple watcher and president of Creative Strategies…
The iPhone XS and XS Max include dual 12-Mpixel-wide and telephoto cameras… (which) support a variety of features, including HDR10 and adjustable depth-of-field, relying on an image processor and the neural engine in the A12. “This is a new era of computational photography,” said Phil Schiller, Apple’s vice president of marketing.
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I didn’t need any more convincing than that, plus what I saw with my own eyes watching the live stream of the event. I ordered up an iPhone Xs Max as soon as I could, to replace my iPhone X, which I got in late 2017. I’m on the iPhone Upgrade Program, so the process is easy. I make monthly payments for my phone, automatically deducted from my business account, and I can upgrade to the latest model once per year. The net upcharge for me this time? Only five dollars more per month! … to get all the amazing new features and performance of the iPhone Xs Max. (I also had to pay off a small balance on my previous contract, as I was two months shy of a year with the iPhone X.)
It was the No-Brainer of the Century for me! And my new iPhone arrives within about two weeks.
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