The Value of Data Visualization from Column Five on Vimeo.

Well, the content publishers are living that right now.  Books, movies, music, newspapers, magazines – they’re clinging to old models, which were highly profitable and carried great respect. But death, in the form of new media, self-publishing and streaming access, are tearing that old life apart, destroying it viciously. The longer they hold out and the more they try to fight it off, the uglier and more difficult their business is.

But if they’d only look at content distribution with fresh eyes, they’d realize there’s real money to be made in offering content that consumers want, how they want it. They have to find their core expertise and push that forward, letting the rest drop away. As Friedman describes in The World is Flat, IBM stopped making computers and became an enterprise computing service vendor. They couldn’t compete with parts aggregators (sound familiar?) and outsourced labor, so they stopped trying.  If book publishers want to keep themselves as the sole gateway to publishing, they’re dead. <cough>ebooks<cough>  But a million digital self-publishers could sure use their editing, marketing and publishing expertise, and they could even still be the curators of great literature, both digital and physical. Think Oprah’s Book Club in which they get a cut – as long as the cut is reasonable it’s a great deal for the authors, it’s money for them, and provides a recommended reading list for consumers. Everyone wins.

It could be a heavenly new world of content distribution. Sadly, today, it’s stuck in a nightmare where nobody wins (digital versions cost as much or more than paper versions, libraries can’t lend books more than 26 times, kindle books aren’t allowed to be loaned to friends, authors make a pittance while publishers and retailers duke it out for obscene profits on each book, making up for losses everywhere else, authors left to find their own path through self-publishing create works without professional editors and marketing guidance, etc).

Let the old go, Publishing Industry; embrace the light and let’s all live happily in the next world.  Whether easy way or hard way, that world is the future.

It’s way too soon to predict, but it feels like G+ has a fighting chance.  Clearly Google has learned some hard lessons from Buzz and Wave, and done things differently with G+.   It’s not thrust on us like Buzz, nor hiding in GeekTopia like Wave.  There are clear hooks for an ordinary (social) consumer, but also many tricks for the power user.  They’ve thrown a lot of functions into it – a Facebook-like ‘stream’, a group video chat (like skype but much less clunky), group text messaging, location check-ins, photo sharing…  They’ve tried hard to make all that simple and intuitive to use (with mixed success).  It’s got a ton of potential users all lined up (cough*gmail*cough).

It also has some significant obstacles to surmount.  Facebook has already won the day for social.  They may lose ground in the future, but today, they’re It.  Twitter is more vulnerable, but with significant investment in it, G+ will have to push uphill to gain any ground from their users.  Finally, I think there’s a lot of hate for Google succeeding in social.  They’ve flailed around, and consistently under-supported their past attempts, that anything big emerging from Mountain View these days incurs a healthy dose of skepticism and fear.  (“Hurt me twice, shame on me”)   It’s so easy to insert high school analogies – Apple is the cool kid with great clothes and a flashy car.  A little mean, but it’s hard not to forgive those dazzling eyes.  Google is the nerd; the one you turn to when you have a math or science question, but not who you expect to be in the Prom Court.  ”Are you kidding?” asks society, “there’s no way we’d trust our social lives to a bunch of nerds!”

We’ll see.  They’ve factored in every algorithm and pinned everything on the outcome like it’s the Science Fair Nationals, so maybe geek movie plots can happen in real life.  On many levels, I hope so.

Here’s what I think they’ve done really well with G+:

• Built a Facebook Stream without the advertising agenda.  They’re not trying to force us to make everything public.  Choosing who you share with is easy, quick and almost fun.
• It’s like a mashup of Facebook, Twitter and Tumbler – you can broadcast to the public (Twitter), or share things with your friends (FB), and the format can be micro, mini, or long (Tumbler).  All moods, one tool.
• It’s the comments, stupid.  All Hail the triumphant return of FriendFeed.  Twitter is now just frustrating to me – where are the conversations?  Someone makes a good point, and it dies there; no comments or threaded conversations.  Solo broadcasting is fine for the narcissists and marketers, but for most people the dialog is important.
• Made video chat with your friends easy and natural.  Skype is clunky.  Facetime is only Apple, and only one-to-one.  Want to hang out for a bit with far-away friends?  There’s a Circle for that…
• Great mobile integration.  Well, for Android.

Speaking of which (iOS Apps), this decision has got to be messing with Apple.  Keep G+ app off iPhones?  (Screw the main competitor Google) Or let it through?  (Screw the new competitor Facebook)  Google…Facebook.  Google…Facebook…  Argghh!!

There are certainly flaws (it’s an early beta), and things they didn’t quite hit.  To really succeed, they’ll need to have some way to push posts to Twitter and Facebook (and I’m holding my breath until they grant access for that…).  So far it’s a limited trial of like-minded people, so it feels friendly.  No spam yet.

[Update: just saw this great post on Tips for Using G+]

But I have to say, my fingers are crossed on this one.  I really hope it succeeds, if only to give the Social Monopolies some competition.

from xkcd

Or perhaps I want to keep track of 6 important account codes, or document instructions for something that I know well, but my coworkers are fuzzy on.  I need to be able to write it up, store it safely, and forget about it.  When it comes up again, I’d need to find it quickly and easily.  Not only that, but maybe I learn the basics, and a coworker gets more details later, or realizes my documentation needs editing.

“What is this magic!” you demand in amazement.  Well, step right up folks, because it’s called the wiki.

“Oh no,” you grimace, “blech.”  Well, ok, when wikipedia made them famous they were ugly as sin, required coding to use, and had a User Interface only an engineer could love.  I’m happy to report they’ve come a long way, baby.

We use one today in our office, and while they’re still a little ugly, they’re really simple to use, have an enterprise-y social network feel to them, and are very stable and cheap to run.  We use Confluence, a product of Atlassian.   For ten users or less it’s only $10/year, and all the money goes to charity.  For larger groups it costs more, but the plans are very reasonable and the software is really solid.  [Update: and now they'll host your wiki in the cloud for the same $10!]

This allows everyone in my office to document things, tag it with labels that describe the type of info on the page, save it and forget it.  Anyone who wants to can open it, access the info, edit the page, attach files to it, add external links, embed images, video or sound.  We can all find any page by a quick search for keywords, or by the tags we’ve grouped things in.

There’s a standard text editor (no coding!), social features to share pages with coworkers or work-groups, the ability to “follow” a topic as edits happen, or review changes over time and revert to previous versions, and it’s accessed through a standard browser.  Easy, almost fun, and useful.

No more saving notes to yourself in network folders, or scribbled away in files – just post it, tag it, save it and forget it.  As your organization builds up this internal “knowledge base”, it’s like having your very own Help Desk, and everyone has contributed slowly over time, so the burden of creation and updating is shared by everyone.  It helps ease transitions when staff turns over, and cuts out wasted time from re-creating wheels.  Give it a try!

I also have a fascination (obsession) with emerging tech trends – especially tools that help me do my job.  Better ways to communicate, gather, analyze and display data, collaborate long-distance and get work done from anywhere.  There’s this world where the future is happening now, and people are moving mountains with a handful of free tools.

But these two sectors…might as well be two different planets.  There are thousands of tools and resources, incredible innovation in getting things done, rapid evolution on spreading your message (marketing)…yet very few people seem to have heard of them outside the tech sector.

I find myself with a foot in both worlds, continually shuttling information and ideas from the tech planet to the ‘organization’ planet.  In countless committees and meetings I’ve raised my hand and suggested, “I think there’s an easier way to do this…”  Colleagues pull me aside at conferences, “Can you tell me more about that thing you mentioned..?” Or asked me to mentor them in learning about and adopting emerging tools.  I’ve volunteered to help some of my favorite organizations through this stuff, but as life gets busier and money becomes scarcer (did I mention I have children? , it occurs to me that I should probably start putting my passion to work…

So I’ve set up this little hut on the internet, and am stringing rope through my sign so I can hang it out front.  If you’re interested in learning more about tools, services, and best practices that can really elevate your good work, then drop me a line.  You’ll find numerous ways to contact me on the sidebar.  If you enjoy the posts here, please leave a comment or two! I look forward to the conversation.

John

You should learn about this thing.  Oh, sure, it has many detractors, but the core intent behind it is revolutionary; what would happen if we reinvented email, to incorporate the new technologies we have today?  What would email+IM+shared documents+wikis look like?

If your response is “…huh?” check out this brilliant little explanation:

httpv://www.youtube.com/watch?v=rDu2A3WzQpo

Ohhhhh, right.  Good, now you get it.  Group conversations that actually work. A collaborative working environment, in your inbox.

But as the man says, this is only 3.5%.  You can also drag “robots” into the conversation, who sit on the sidelines and edit the conversation when needed.  Like translation – you type in English, and it translates your text (live) into another language.  As you write it. And it translates the other language back.  As they type.  In real time.  Or robots that insert maps whenever an address is typed into a wave…or inserts Twitter handles automatically, or shortens any links to bit.ly micro-urls, or insert wikipedia entries… and it’s only just started.

Oh, but there’s more.  In addition to robots who act on their own, you can add gadgets - include a poll for the group that updates real-time; add in video-conferencing so you all can talk to each other while you’re working on a document together; etc.  If you have 8 minutes, the team who developed Wave made this video:

httpv://www.youtube.com/watch?v=p6pgxLaDdQw

Whew! Starting to see how you could use this in your work?  Me too.  Last week, I was lucky enough to receive an invitation to try out the service (along with 100,000 of my closest friends), and I’ve been trying to figure out how to make all of that promised magic come to life on my screen.  And it hasn’t been easy…like most “beta projects” where a group is given a preview in return for helping the developers find the bugs before they release it into the world, Google Wave is still pretty raw.

For example, it’s slow now.  S L O W … (Then again, Google is ramping up with probably a million users all of a sudden, and their servers are already providing search for the whole world.)  And they haven’t figured out the Inbox – basically, if you ever look at any wave, it’s suddenly in your inbox, and if it’s a “public wave” (open to the public) anytime anyone in the wave-osphere (ocean?) adds a comment, it turns bold as “unread” – sheesh!  When new contacts add me, or send me a wave, they disappear under the load of all these other inbox-cloggers.   You can’t favorite or mark a wave yet, which is key now with the meta-inbox, and down the road for prioritization.

It’s also a hyper mash of humanity, from all over the world, figuring it out right now, in your inbox, commenting on each other’s ideas, teaching others what they just figured out, conversing with total strangers, stumbling through etiquette blunders because people are making up the rules as we go, etc.  In a word, it’s chaos.  And to many of us, it’s an absolute blast!

If you want to be part of the beta testing group, go here to sign up for the next round of invites.  For those just getting started, here’s my list of helpful articles on how to use this thing.  I’ll edit it and add more as I discover more, so stay tuned, or just hit my Delicious bookmarks on Wave for the latest)

Getting Started

• Mashable’s Wave Overview
• Hints and Tips from the Googlewave Blog
• A cheat sheet for new users
• The “Ultimate List” of Wave gadgets and tools
• A good list of current extensions (must log in to google acc’t)

Digging Deeper

• Keyboard shortcuts within Wave (and the official list)
• How to find waves with search terms
• Even more tools for using Wave
• Bug driving you crazy?  Look it up on Known Issues to see if it’s on their list to fix
• If it’s not there, post your bug on the Wave Help Section, Problem Solving

Good Reasons to Use It

• Why Wave is more secure than email
• A great process flow chart plugin for business
• Explaining movies to your friends

Other Blogs on Wave

Want to listen to people who really know what they’re talking about?  Try these:

• The Google Wave Blogger
• On Top of the Wave – for developers (with Spanish version!)
• Mix of developer and user posts – Mastering Wave
• Blog on WordPress, blogging and Wave – the Blog of Small Things
• Jump on that bus – SpreadGoogleWave

Twitter Resources

• @googlewavereads
• @google_wave – fans of the Wave

Ok, that’s more than enough.  If you’ve tried it, let me know your thoughts in the comments below.  If you haven’t tried it, feel free to speculate.  Wanna wave?  Try me at john.eich@googlewave.com!

As an organization with significant experience in rural electronic health record (EHR) implementation, we believe that the meaningful use definition, as drafted, will make it impossible for the average small rural hospital, including critical access hospitals (CAHs), to meet the meaningful use standard.

The result will be that the vast majority of an entire sector of providers will be excluded from receiving ARRA HIT incentive funds and, consequently, will lack the tools required to engage the challenges of healthcare reform.

In the HIT Policy Committee Meaningful Use Workgroup Presentation, the three part phasing (2011, 2013, 2015) of meaningful EHR use is characterized as a balance between on the one hand: (1) currently available EHR capabilities, (2) the time needed to implement, and (3) the implementation challenges associated with small practices (and presumably small hospitals?); and on the other hand: (1) the urgent need for health reform, and (2) the desire to substantively improve health outcomes.

According to the HIT Policy Committee presentation, the proposed Meaningful Use Matrix achieves this balance by providing escalating capabilities that will meet the need of reform and yet be feasible and achievable for providers to attain.

We disagree with this assessment. Please consider the following factors:

· The 2011 meaningful use draft requirements roughly correspond to reaching stage 4 of the 7 stage HIMSS EMR Adoption model.
· CAHs and rural hospitals average 1.2 on HIMSS EMR Adoption Scale, whereas general medical surgical hospitals average 2.5
· A “reasonable” time required for any hospital to implement from stage 1 to stage 4 (considering what is required for appropriate vendor selection, workflow assessment, education, and implementation) is 3-5 years.
· Many CAHs and rural hospitals will be required to essentially start from scratch after determining that their existing vendors will not position them to become meaningful users; and this will add to the “reasonable” time required.
· Many CAHs and rural hospitals will need to address critical network infrastructure and HIT staff expertise challenges that will also add to the “reasonable” time required.

If the above factors are granted, then average CAHs and rural hospitals that begin their implementation process now will not be able to achieve the 2011 requirements until 2013 or later and as a result will receive no reimbursement.[1] They will next be faced with the daunting challenge of reaching roughly stage 5.5 on the HIMSS adoption scale in literally no time and with little to no incentive dollars to assist the process.

One question is at the core of our concerns: If the Meaningful Use Matrix is aggressive yet achievable for hospitals that average 2.5 on the HIMSS adoption scale, how can it also be achievable for a hospital that averages 1.2 or 0? Given that achievability is one of the tenants of the HIT Policy Committee, we believe that the Committee needs to adjust the definition for hospitals currently lower on the scale.

We believe it would be reasonable to move CAHs and small rural hospitals to above stage 2 in 2011; then above stage 3 in 2013; and then to roughly stage 4 in 2015. While it is outside the scope of the word allotment to go into the requirements point by point, we would like to call attention to our own meaningful use recommendations, which identify an attainable (yet still aggressive) rural-focused phase-in of meaningful use.

Relating to the Meaningful Use Matrix requirements for 2011, two areas of particular concern are the requirement for CPOE and patient portals, both of which are advanced applications that are traditionally (and for good reason) implemented as capstone applications after dozens of other applications (such as the ancillary systems that feed the data repository, physician EMR portals, and e-MARs) are implemented. To rush these in as part of the 2011 phase, even if achievable, which we dispute, would likely lead to a high risk of implementation failure, as well as an increase in the errors the legislation is designed to prevent.

The ARRA HIT incentives, if properly structured, have the potential to profoundly increase all provider HIT adoption and care quality. But by setting the bar at a place within reach of the average large facility yet out of reach of the average small facility, HHS will effectively exclude the providers that serve predominantly rural areas. This will have a severely negative impact on rural providers, as well as on the rural communities and the 15 million rural residents that rely on them for healthcare. Please reconsider this course of action.

[1] Anthony Trenkle, director of the CMS’ office of e-Health Standards and Services, said the requirements will not be “tiered” based on when the provider adopts an EHR after 2011. Instead, whatever meaningful use standards are applicable for the year the provider applies for an EHR subsidy are the standards that provider must meet, regardless of whether it is the provider’s first year of EHR implementation.

Now you can stop scratching your head and check out Twitter!

A few notes I’d add for those getting started:

- The group of people you choose to follow completely defines your experience: if you follow people who post where they’re eating lunch, you’ll find Twitter to be bland and shallow. If you follow people who love to share great articles they’ve read, interesting pictures or videos and insights into current events, then you’ll be amazed at Twitter’s depth and interest.

- If spammers follow you, don’t freak out. Unlike email, they can’t fill your inbox. As long as you don’t follow them back, you only see messages from those fascinating people you chose to follow. It’s like you’re rubber and they’re glue! [third grade reference] If they “creep you out” sitting there, as a friend of mine put it, you can always “block” them on your followers list. Buh-bye, spammy.

- To find interesting people to follow, ‘search’ is your friend: search twitter on key topics that interest you, browse those who talk about it, click their profile to see what they tweet, and if you like them, give ‘em a try. If they start talking about lunch…well, un-follow – no message to them, no dividing up your cd collection, just a quiet sigh of relief.

- Or check out whom your favorite ‘tweeples’ follow – birds of a feather, as they say…

Well, that’s enough for now. Enjoy!

…rural America—where just 9 percent of the nation’s doctors serve 17 percent of its citizens scattered across 80 percent of its geography—is not an ideal place to find medical care.

I’m not sure if anything captures the current situation better than that snapshot.  Sadly, with impending retirements of significant percentages of existing physicians, steadily decreasing enrollments in primary care residencies, and an upcoming workforce that places more value on quality of non-work life than in the past – we’re looking at this statistic getting much worse.

Perhaps we should rewrite a verse from the Bob Dylan song . . . “Where have all the doctors gone – long time passing..?”

Social Media are tools for sharing and discussing information. Social Networking is the use of communities of interest to connect to others. You can use Social Media to facilitate Social Networking. Or, your can network by leveraging Social Media.

But why, you ask, is this distinction important?

Because to use these new tools effectively, you have to know why you’re using them.  Are you an individual looking to connect with others outside your everyday circle?  Then you’re looking for social networking, and now you can start wading through the dozens of tools that offer it to find the right tool for your speed, your need, and your feed (people/info you want to follow).

Are you an organization that is seeking to get your message out?  Then you’re looking at the media tools, and again, to pick the right one(s), look at where your target audience is online, and start joining them there.  Are they younger and informal?  Create a Facebook page.  Are they over 30 and information-sharers?  Find them on Twitter.  Purely professional crowd? LinkedIn is your arena.

It gets tricky because Social Media is by nature conversational, so “getting your message out” is often about building relationships, which is Social Networking’s core territory.  Welcome to the blurry overlap.

But, if you had to choose, which of these factors is your core goal – messaging, or networking? Pick one, lean towards tools that do that best, and expect a lot of overlap.  Because in this new media world, messaging without connecting is doomed.  Picking the core goal just helps you decide where to allocate your time most effectively in a universe of options.