Last november there was a conference where several parties presented their thoughts and ideas about Big DATA in care.

In healthcare it is important to do research on patterns of symptoms that will end up to be incurable illnesses. In breast cancer research, massive examining of images (X-ray, MRI, CT, ..) has led to all kinds of visual patterns that give strong evidence of future risks of cancer. In breast cancer this works (in the Netherlands) partially, but there are numerous other areas that can benefit from the research into massive amounts of Big DATA.

However, it is often difficult to get access to these massive amounts of data. Hospital records are scattered around and can’t be accessed easily, even within a single hospital. Privacy and expertise on ensuring anonymity is often an issue in distributing data.

One posibility is to learn from industries that have more experience with big data. For example,Izovator -experts in storage of content in the media industries – created a shared environment for hospitals where storage would become much cheaper and where tools to access and work with this data would be available, based on standards. This led to the realization that getting access to all these images in a central location has tremendous opportunity; to do research on patterns that can be found in these massive amounts of data. And these patterns will help future patients in better prevention and cure.

Sharing big data becomes the next BIG step towards a better care!

My grandmother had such a button but almost never wore it since she would not be caught dead with such an ugly accessory (even at 93 and still a bit vain). Research shows that more than 50%(*) of the people that have such an alarm often do not wear the button because the feel stigmatized by wearing it.

These companies spend lots of money on the development of software and hardware but almost never ask their customers what is it exactly that they want and what it should look like. I am even convinced there is a market for “designer alarm buttons”.

Question is how to involve them in a way that can show what technology does and how it can help them, in stead of leaving them with incomprehensible technologies. But that will be discussed in one of the next postings.

(*) Porter, E.J. (2005). Wearing and using personal emergency respone system buttons. Journal of Gerontological Nursing, 31(10), 26-31.

(Digital) conversations against loneliness

Games are always a great seducer to get people to interact with one another. In WordFeud the possibility also exists to chat with your opponent while playing a game. This leads to lots of conversations, often between elderly and their family but also between strangers. Conversation diminishes loneliness and less loneliness leads to less doctor visits… The best examples for the creation of social technologies in healthcare can often be found in everyday life. When families get together they also often play boardgames like Scrabble. I fondly remember the games of Scrabble we played with my grandmother. WordFeud brings this same mechanism to our digital lives. And often keeping the conversation alive through a digital channel enhances the meetings in real live.

Also published on www.tedxmaastricht.nl

There is however one aspect missing that I think will turn out to be crucial to it’s succes: uncertainty.

Friendship is by definition two sided. It does not have to be symmetrical (meaning you both feel the same towards eachother) but at least there is to be some level of reciprocity. Most group of friends consist of a small group of people that have a high level of reciprocity and close bonds in their relations to each other. Around that group there is a larger community where the level of reciprocity is not consistent for the whole core group. They are sort of in the group and out of the group at the same time, depending on who you ask.

This foggy definition of a circle of friends is something we as humans need since we deal badly with rejection. This lack of Transparancy makes it possible to create blurry edges for people to feel in while in fact they are only partly accepted. This blurry edge however does create a gradual path for people to move into the circle step by step. This is something we probably all recognise from our own experience, especially during school.

Because of this transparancy in Circles what you end up with is the relationships type in LinkedIn where everyone is a friend since it is too confronting to reject someone as a friend. And when everyone is you friend than no one is.

So unless Google is able to build in a combination of reciprocity and bit of vagueness in circles my prediction is that it will not succeed. If they (or Facebook) does succeed in modelling how friendships works in real life than that social network will win the battle. Because, aren’t we all looking for friends?

Looking at this speech is still amazing after all those years. Not just because of the eloquence of Kennedy but because of the idealistic spirit of a society that sets a goal and is willing to make great sacrifices in order to achieve that goal. I think in our age and time we have lost some of that willingness to put society first and the individual second.

There is no strife, no prejudice, no national conflict in outer space as yet. Its hazards are hostile to us all. Its conquest deserves the best of all mankind, and its opportunity for peaceful cooperation many never come again. But why, some say, the moon? Why choose this as our goal? And they may well ask why climb the highest mountain? Why, 35 years ago, fly the Atlantic? Why does Rice play Texas?

We choose to go to the moon. We choose to go to the moon in this decade and do the other things, not because they are easy, but because they are hard, because that goal will serve to organize and measure the best of our energies and skills, because that challenge is one that we are willing to accept, one we are unwilling to postpone, and one which we intend to win, and the others, too.

And of course, as he promised, this was the result on July 1969.

There was one part of the book that really got me thinking and it was about the loss of the local notables.

If we look at the long tail from Chris Anderson we are now  seeing that the long tail does exist but also creates havoc in a lot of professions due to the price pressure of the (often quite capable) amateurs. This counts for filmmakers, photographers and many other professions where there are also a lot of amateurs craving for attention. There are of course some that are succeeding and even flourishing but as a profession they are hit hard

A second effect is that in some cases there are winners that really take it all. Examples like Google, Facebook, Amazon and (some) others. These have become highly profitable companies that have become un-beatable monopolies in markets they often created themselves (but we now can not do without..).

What we are now losing is the middle ground, the vanishing local notables. On the one hand we have highly profitable de-facto monopolies and at the other end of the scale we have hordes of amateurs whose business model consist of their 15 seconds of fame and a proverbial Apple. In the area in between in the past lots of people were able to get relatively rich on a local level. The doctor, the lawyer, the local care dealer, the supermarket owner. their numbers are going down due to the transfer of part of their business to the few (global) winners and part of their business to amateurs that work for an Apple.

With their disappearance we also see a disappearance of local culture since these often were the people and companies that supported local activities. We may gain some brilliant cultural  institutions like “The concertgebouw orkest” but we will lose many local orchestra’s, museums but also social activities that will not be sponsored anymore by the local notables.

In the digital realm this is probably an enhancement of our lives. After all, we only need one concertgebouworkest since we can listen to their breathtaking digital recordings for ever after. However, we also have a physical local presence that we should cherish.

What is the answer to this dilemma I do not know, neither does Jaron. But it is certainly something we will have to think about in the years ahead.

At the start of the open source movement the statement was that Open Source was to be free like in free speech, not as in free beer. In English the word free has two connotations: free as in gratis (no money) and free as in libre (free to go). Unfortunately open source has become free beer.

For an innovative product to be sustainable it needs a business model. Picture a young programmer that, in his time off from his day job, creates an innovative product that others start to use. After some time more and more demands will be made for new functionality and the solving of bugs. More and more of his free time will be spent on this product. He can not quit his day job because his innovative product does not bring in money in license fees since it is gratis. After some time he quits the project. Sourceforge, the place where many open source projects have a home, is filled with interesting but nonetheless failed projects like these. Sourceforge is the place where projects go to die ..

The main reason why a few examples like Joomla and Linux survive is because of many companies around it make money by delivering services. Because it is not innovative it is a product category that is understood by potential customers that are willing to pay for services implementing it. What we need is a business model for the software itself. What we need to do is to severe the connection between the openness of the software (to be able to inspect code is a good thing) and the business model behind it (being able to make a living creating great products).

We run the risk that the same thing now is happening in the open data movement. Pressure is set on several organizations to open up their data so app developers can build applications on top of it. We should realize that, once these organizations do not make money on that data, that the quality and access to that data will not be of strategic importance to them. We should as much as possible enforce the openness of the data to prevent a monopoly of information access. But the original creators of that data should be able to make a llving out of it.

Data should be free like in free speech, not as in free beer …

Eckart was a remarkable person, sometimes a bit difficult but always inspiring and, well, very present. He developed the vision that people work best in small teams up to 50 people. And implemented this vision!

When he left in 1996 the company had more than 4000 employees but was divided in units not larger than 50 people, called a Cell (from the biological cell). When a group grew to big it was split up and half the management team and employees started a new cell in a different place. There Board was doing their best not to steer the cells directly but tried to convince. There was almost no middle management (and nobody listened to them anyway). In many ways it was a Pancake organization before the electronic means were there. This was possible because Eckart was one of the few CEO’s that did not like raw power for himself.

Anyway, while looking into my archive I found the letter below that was part of the yearly report of 1995 (the reports were always very special, this one was designed as a folding map were you put in several papers between tabs (some of you elderly people will remember them!). This letter describes (in Dutch) how the Internet is not so much about infrastructure and computers but about connecting people and was written by the director of the McLuhan program (BSO was a sponsor of this program). Quote:

Het beeld van een wereldomspannende netwerkomgeving is niet zozeer dat van een ‘snelweg’ als wel dat van een soort ‘wereldgeest’

The concept of a worldwide network is not as much about a ‘highway’ but more about some sort of world ‘conscience’.

Funny how many of these issues already came together in 1995..

The building of the General Motors Headquarters in the 1920's. A textbook example of the big Firm

A couple of years ago I read the book “De eeuw van mijn vader” (“My father’s century”) from Geert Mak. In this book he describes how the Dutch society has changed from 1900 to 2000. One of the passages that struck me most was his statement that the majority of people in 1900 were not an employee at a firm. Many people were self employed as sail maker, baker, carpenter and other craftsmanships. Other were employed on a temporary basis as day laborer. For many people this independence meant of course mainly insecurity and near starvation.

It did open my eyes that the big Firm as a way to organize work is something relatively recent and started around that time. Before the Firm work was done by many individual and small informal companies, afterwards much of the work is done in large companies with often an emphasis on management and control. At the same time there was the shift from mainly local transactions to global transactions.

These days we again see a move towards smaller size of companies and and more informal contacts to coordinate work. Most important example is of course the explosion of Independent Professionals. But also many examples of small companies that supply a specific service, often on a global scale, like BasecampHQ, Evernote and others. My conclusion is that the Social Media and Cloud and the themes they bring forth put pressure on the size of Firms. Big is beautiful nor efficient anymore.

In 1936 (Nobel price winner) Robert Coase wrote the artikel “The nature of the Firm”. In this (very famous and often cited) article he states that the size of a Firm is based on the difference in transaction costs between the market (buying the service) and organizing the service yourself. He describes the relation between transaction costs and size as follows. The firm grows when:

• the less the costs of organizing and the slower these costs rise with an increase in the transactions organized.
• the less likely the entrepreneur is to make mistakes and the smaller the increase in mistakes with an increase in the transactions organized.
• the greater the lowering (or the less the rise) in the supply price of factors of production to firms of larger size.

Transaction costs in this are all costs associated with a transaction: communication, contracts, delivery, etc. If we compare these with the themes Scalability, Communication, Cooperation, Anyplace and Anywhere and Transparency it is clear that these themes are lowering the external transaction costs dramatically.

Scalability: the advantage of the Firm has always been that within the Firm it is easier to share resources over several activities. Now many operational costs have become variable costs in relation to turnover this advantage of size is not valid anymore. The risks of major investments in infrastructure is therefore also largely diminished. Due to the high level of automated processes there is less advantage in high volumes of purchasing

Communication and Cooperation: Finding people has become easy, contacting them has become easy and exchanging information on specifications and expectations has become easy. This means that transaction costs go down. This holds mainly for external costs since internally searching and working with people was enabled by the Firm.

Anytime, Anywhere: The Firm creates a context where it is easier to know what to expect from others and has a management structure to enforce compliance to this context. Social technology now enables us to contact everybody from everywhere at any moment. A natural advantage of the firm was that it was easier to do business within the Firm on a global scale. Now small companies can do the same in a virtual enterprise.

Transparency: We now see reputation mechanisms to build trust without previous experience with that person of service. We see reviews of previous experience of others that are similar to us. We know we are looking at the same data stored in the cloud. I know where you really are because of location based services. This transparency drives down risk immensely.

From all of the above it follows that due to social and cloud technologies Firms will shrink in size. Small will be more efficient. This also has a lot of impact on middle management whose role it was to coordinate work in the Firm. This coordinating role of management will evaporate and thereby create flatter organizations: Pancakes!