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23 February 2013

Health improvements via mobile phones: achieving scale

Filed under: Accenture, Barcelona, Cambridge, healthcare, mHealth, MWC, partners — David Wood @ 10:27 pm

How can mobile reach its potential to improve both the outcomes and the economics of global health?

MWC13_logoThat’s the headline question for the panel I’m chairing on Wednesday at the Mobile World Congress (MWC) event in Barcelona.

MWC is an annual conference that celebrates progress with mobile technology. Last year, there were over 67,000 attendees, including:

  • More than 12,000 mobile app developers
  • 3,300+ press members representing 1,500 media outlets from 92 countries
  • CEOs from more than 3,500 companies.

This year, a larger venue is being used, and the attendee numbers are expected to be even larger. Keynote speakers include the CEOs or Presidents from Vodafone, Telefonica, China Mobile, AT&T, Telecom Italia, NTT DoCoMo, Korea Telecom, Deutsch Telekom, Qualcomm, Nokia, General Motors, CNN Digital, American Heart Foundation, Bharti Enterprises, Qtel, Ericsson, Viber Media, Juniper Networks, Dropbox, Foursquare, Deezer, Mozilla, Ubuntu, Tizen, Jolla, and countless more.

And in the midst of all that, there’s a panel entitled Health: Achieving Scale through Partnerships – which, in my role as Technology Planning Lead for Accenture Mobility, I’ve been asked to chair.

MWC as a whole generates a lot of excitement about mobile technology – and about relative shifts in the competitive positions of key companies in the industry. However, it strikes me that the subject under discussion in my panel is more profound. Simply put, what we’re discussing is a matter of life and death.

Done well, mobile technology has the potential to enable the delivery of timely healthcare to people who would otherwise be at risk of death. Prompt diagnosis and prompt treatment can spell the difference between a bitterly unpleasant experience and something that is much more manageable.

But more than that: mobile technology has the potential to address very significant financial problems in the delivery of healthcare. Runaway medical bills impact individuals around the planet. According to a 2010 report by the World Health Organisation (PDF):

When people use healthcare services, they often incur high, sometimes catastrophic costs in paying for their care.

In some countries, up to 11% of the population suffers this type of  severe financial hardship each year, and up to 5% is forced into poverty. Globally, about 150  million people suffer financial catastrophe annually while 100 million are pushed below the poverty line.

It’s not just individuals who are facing ruinous costs from healthcare. A 2011 study by the World Economic Forum and Harvard University anticipates that productivity losses and medical treatment for diabetes, heart disease and other non-contagious chronic diseases will cost economies $47 trillion by 2030. In the UK, the growing cost of treating diabetes alone is said to be likely to “bankrupt the NHS in 20 years”. In countries around the world, surging costs of healthcare treatment are exceeding the growth rates of the national economies.

In principle, mobile technology has the potential to reduce these trends in a number of ways:

  • By enabling more cost-effective treatments, that are less time-consuming and less personally intrusive
  • By enabling earlier detection of medical issues: prevention can be much cheaper than cure!
  • By monitoring compliance with treatment regimes
  • By improving real-time communications within busy, geographically separated teams of clinicians
  • By reducing barriers for people to access information relevant to their health and well-being.

The Creative Destruction of MedicineHere, the key phrase is “in principle”. The potential of mobile technology to beneficially transform healthcare has long been recognised. Success stories can indeed be found. This recent NBC news video featuring physician Eric Topol contains some excellent examples of the use of smartphones in medical practice; for my review of Dr Topol’s award-winning book “The Creative Destruction of Medicine” see my previous blogpost Smartphone technology, super-convergence, and the great inflection of medicine. Nevertheless, the mobile industry is full of people who remain unsure about how quickly this potential can turn into a reality.

Indeed, I regularly encounter people in the mobile industry who have been assigned responsibility in their companies for aspects of “mHealth programmes”, or similar. The recurring refrain that I hear is as follows:

  • The technology seems to work
  • Small-scale pilot trials demonstrate encouraging results
  • But it’s hard to see how these trials can be scaled up into self-sustaining activities – activities which no longer rely on any strategic subsidies
  • Specifically, people wonder how their programmes will ever deliver meaningful commercial revenues to their companies – since, after all, these companies are driven by commercial imperatives.

In this sense, the question of scaling up mobile health programmes is a matter of commercial life-or-death for many managers within the mobile industry. Without credible plans for commercially significant revenues, these programmes may be cut back, and managers risk losing their jobs.

For all these reasons, I see the panel on Wednesday as being highly relevant. Here’s how the MWC organisers describe the panel on the event website:

There are hundreds of live and pilot mHealth deployments currently underway across many and diverse territories, but many of these projects, both commercial and pilot, will remain short term or small scale and will fold once initial funding is exhausted.

To reach scale, mHealth systems must in many cases be designed to integrate with existing health systems. This is not something the mobile industry can achieve alone, despite operators’ expertise and experience in delivering end-to-end services to their customers, and will require strong working partnerships between mobile network operators, health applications and health IT providers.

Speakers in this session will draw upon their own experience to showcase examples of mHealth projects that have gone beyond the small scale and pilot stages.

They will seek to identify best practice in making mHealth sustainable, and will discuss the progress and challenges in partnering for mHealth.

The panellists bring a wealth of different experience to these questions:

Faces

  • Pamela Goldberg is CEO of the Massachusetts Technology Collaborative (MassTech), an economic development engine charged with charged with catalyzing technology innovation throughout the Massachusetts Commonwealth. She has an extensive background in entrepreneurship, innovation and finance, and is the first woman to lead the agency in its nearly 30 year history. MassTech is currently advancing technology‐based solutions that improve the health care system, expand high‐speed Internet access, and strengthen the growth and development of the state’s technology sector.
  • Kirsten Gagnaire is the Global Partnership Director for the Mobile Alliance for Maternal Action (MAMA), where she manages a cross-sector partnership between USAID, Johnson & Johnson, the UN Foundation, the mHealth Alliance and BabyCenter. MAMA is focused on engaging an innovative global community to deliver vital health information to new and expectant mothers through mobile phones. She recently co-lead the Ashoka Global Accelerator, focused on getting mid-stage social entrepreneurs in developing countries the support & resources they need to scale their work across multiple countries and continents. These organizations are focused on using innovation and technology to address global health issues. She recently spent a year living in Ghana, where she was the Country Director for the Grameen Foundation and managed a large-scale mobile health project focused on maternal and child health across Ghana.
  • Chris Mulley is a Principal Business Consultant within the Operator Solutions department of ZTE Corporation. He is responsible for the analysis of market and business drivers that feed into the development of cost-effective end-to-end solutions, targeted at major global telecom operators, based on ZTE’s portfolio of fixed-line and wireless infrastructure equipment and ICT platforms. A key part of this role involves informing ZTE Corporation’s strategic approach to the provision of solutions that meet the objectives of the European Commission Digital Agenda for Europe policy initiative for the wide scale adoption of ICT in the provision of e-Health, e-Transport and e-Government across Europe. Chris was instrumental in the establishment of an e-Health collaboration between ZTE Corporation, the Centro Internazionale Radio Medico and Beijing People’s Hospital.
  • Tong En is Deputy General Manager of the Data Service department and Director of the R&D center at China Mobile Communications Corporation (CMCC), JiangSu Company. He has long been engaged in the research of mobile communication and IoT related technologies, and has chaired or participated more than 10 CMCC research projects. He is a multiple winner of CMCC innovation awards, and has published nearly 20 academic papers.
  • Oscar Gómez is Director of eHealth Product Marketing in Telefónica Digital, where he leads the creation and implementation of a Connected Healthcare proposition to help transform Health and Social Care systems in the light of the challenges they are facing. Oscar has global responsibility over Telefonica’s portfolio of products and solutions in the eHealth and mHealth space. Oscar holds an Executive MBA from Instituto de Empresa, a M.Sc. degree in Telecommunication Engineering from Universidad Politécnica de Madrid and a Diploma in Economics from Universidad Autónoma de Madrid. He graduated in Healthcare Management from IESE in 2012.

In case you’re interested in the topic but you’re not able to attend the event in person, you can follow the live tweet stream for this panel, by tracking the hashtag #mwc13hlt1.

Postscript

Although I passionately believe in the significance of this particular topic, I realise there will be many other announcements, debates, and analyses of deep interest happening at MWC. I’ll be keeping my own notes on what I see as the greatest “hits” and “misses” of the show. These notes will guide me as I chair a “Fiesta or Siesta” debrief session in Cambridge in several weeks time. Jointly hosted by Cambridge Wireless and Accenture, on the 12th of March, this event will take place in the Møller Centre at Churchill College, Cambridge. As the event website explains,

Whether you attended Mobile World Congress (MWC), or you didn’t, you will have formed an opinion (or read someone else’s) on the key announcements and themes of this year’s show. “MWC – Fiesta or Siesta?!” will re-create the emotion of Barcelona as we discuss the hits and misses of the 2013 Mobile World Congress, Cambridge Wireless style…

Registration for this “Fiesta or Siesta” event is now open. Knowing many of the panellists personally, I am confident in predicting that sparks will fly in this discussion, and we’ll end up collectively wiser.

2 March 2011

On turkeys and eagles

Filed under: Microsoft, Nokia, partners, software management — David Wood @ 12:39 am

“Two turkeys do not make an eagle“.  That was the response given in June 2005 by outspoken Nokia EVP Anssi Vanjoki, to the news that two of Nokia’s rivals – Siemens and BenQ – were to merge their mobile phone divisions.  “The integration of the handset units of the two companies is equivalent to one big problem meeting another”, Vanjoki remarked.  It was a remark that caused some consternation in the Symbian boardroom at the time, where both Siemens and Nokia were members.

Six years later, the same pointed saying bounced around the Internet again, this time in a tweet from Vic Gundotra, VP of Engineering at Google.  On this occasion, the alleged “turkeys” were Microsoft (where Gundotra himself had worked for 15 years) and Nokia.  The tweets anticipated the February 11th announcement of Nokia identifying Microsoft’s Windows Phone as its new primary smartphone platform.  Gundotra’s implication was that Nokia’s adoption of Windows Phone would end in tears.

Behind the barb and the humour, there’s a very serious question.  When do partnerships and mergers create genuine synergies, that add up to more than the sum of their parts?  And when do these partnerships, instead, just pile one set of problems onto another – akin to tethering two out-of-form runners together as a team in a three-legged race?

That question is particularly challenging in the world of software, where Brooks’s Law tends to apply: Adding manpower to a late software project makes it later.  This statement featured in Fred Brooks’s 1975 book “The mythical man month” – a book that my first software director asked me to read, as I was just starting on my professional career.  I vividly remember another statement by Brooks in that book: “Nine women can’t make a baby in one month.”

Having extra people in a project risks increasing the number of interconnections and the varieties of communications needed.  The homely proverb “Many hands make light work” implies that more software engineers would get the job done more quickly, but the equally venerable saying, “Too many cooks spoil the broth”, comes down on the side of Brooks’s Law.

Many of my industry colleagues and acquaintances tell me that the most productive, effective software teams they ever worked in were small teams, of perhaps only 7-50 people.  Seen in that light, there is some sense in Nokia’s decision to significantly reduce the size of its software development teams.  But what are the prospects for successful synergies from the newly minted software development partnership between Nokia and Microsoft?

Some differences between the development styles of Microsoft and Nokia are well known.  For example, Nokia spreads software development across many sites in many countries, whereas Microsoft prefers concentrated development at a smaller number of sites.  Relationships between developers and testers are much closer at Microsoft than at Nokia.  Microsoft keeps tight control of source code, whereas Nokia has been centrally involved in several open source communities (such as Qt, MeeGo, and Symbian).  Viewing these differences, what steps can be taken to heighten the chances of positive and lasting cooperation?

Given this background, I offer ten suggestions, for any pair of companies embarking on a major software partnership or merger:

  1. Don’t insist on uniformity. There’s no special need for the two partners to adopt the same tools, same processes, or same internal language.  It’s the interface between the two software teams that matters, rather than whether the teams look like clones of each other.
  2. Do insist on quality. Where the software from the two teams meet, that software needs to work well.  Quality comes well ahead of quantity.  Otherwise, huge amounts of time can be wasted in debugging issues arising during the integration of the two sets of software.
  3. Be ready to revise opinions. Expect there to be misunderstandings, or for new insight to emerge as software from the two teams comes into contact.  Be sure there’s sufficient nimbleness, on both sides, to revise their software quickly in the light of learnings at the point of contact.
  4. Become experts in interface management. This is the discipline of seeking to preserve compatibility of interface, even when new features are added, or performance is improved.  Here, the “interface” includes non-functional aspects of the definition of the software (including behaviour under stress or error conditions), as well as the original set of functionality.  And when interfaces do need to change, be sure that this fact is properly understood and properly communicated.
  5. Avoid feelings of “us and them”. Find ways to build positive bonds of trust between people on the two teams.  This can include staff interchange and secondments, and shared online community tools.
  6. Practice “tough love”. Where problems arise in the interaction between the two teams, it must be possible to speak frankly about these issues, rather than keeping mum for the sake of some kind of dysfunctional “peace and quiet”.  Provided a good fulcrum of shared trust has been established, robust discussion should lead to light rather than heat – a focus on “what is best” rather than “who is best”.
  7. Keep the end-to-end experience firmly in mind. Mainstream market adoption of software needs more than just neat technology.  The larger the overall software system, the greater the need for world-class product managers and designers to keep on top of the development project.  There’s no point in optimising individual parts of this system, if there’s a fundamentally defective link in the overall chain.
  8. Paint a compelling, credible picture of the benefits that the partnership will bring. Members of both teams must be inspired by the “why” of the partnership – something that will give them sufficient reason to dig deep when times become tough.  In practice, this picture will involve a roadmap of envisioned shared success points.
  9. Design and celebrate early successes from the relationship. Identify potential “quick wins” along the path to the anticipated future larger successes.  By the way, in case these quick wins fail to materialise, don’t sweep this fact under a carpet.  This is when the tough love needs to kick in, with both sides in the relationship being ready to revise opinions.
  10. Keep investing in the relationship. Don’t take it for granted.  Recognise that old habits and old mindsets will tend to re-assert themselves, as soon as management focus moves elsewhere.  Early wins are an encouraging sign, but relationship managers need to keep the momentum running, to avoid the partnership from stagnating.

Think that’s too much advice? Believe you could give attention to one or two of these pieces of advice, and “wing it” with the others? Think again. Major software partnership is major effort. Skimp on the details, and you’ll end up with two turkeys tied together as unhelpfully as in a three-legged race. Invest profoundly in the partnership, however, and you may indeed see the birth of a new eagle.

Note: the above advice would still apply, even in the taking-things-one-step-further “acquisition scenario” discussed by Andreas Constantinou in his latest VisionMobile article “Is Microsoft buying Nokia? An analysis of the acquisition endgame“.

17 December 2008

Order from open source chaos

Filed under: chaos, Open Source, openness, partners — David Wood @ 11:57 am

Various videos and PDFs from the recent Symbian Partner Event are now available online.

One video that amply repays viewing is Jay Sullivan of Mozilla speaking on “Chaos and order: a Mozilla story”. You’ll find it on the presentations page of the SPE website.

Mozilla’s declared mission – “promote choice and innovation on the Internet” – has a lot in common with what Symbian is trying to do. One size does not fit all. Mozilla’s declared methods – involving open source, weak copyleft, and an independent foundation – also resonate with those of the Symbian Foundation. Even the sizes of the organisations are broadly comparable (Jay mentioned that Mozilla has around 175 employees).

Mozilla has been travelling along this particular road a lot longer than Symbian. This helps to explain why many Symbian people in the audience were hanging intently on every word in the presentation.

The questions that the presentation sought to answer included:

  • How can your organisation harness openness (where more and more things happen in public), rather than fight it?
  • How do you get your customers to support each other (peer-to-peer support), rather than always going to the centre for support?
  • How can a comparatively small company take advantage of wide public support to compete with huge existing players?
  • How can 75 developers inside the company leverage 100s of external daily contributors, 1000s of less frequent contributors, 10s of 1000s of overnight testers, and around one million beta testers?

In part, the answer to these questions is to use appropriate tools. For example, Mozilla relies heavily on the Bugzilla bug-tracking database.

In part, the answer comes down to attitude. Mozilla have adopted widespread openness of information sharing: they use wikis and newsgroups, which are almost all publicly accessible. (The exception is a small amount of personnel information.) Another example: Everyone in the world is able to dial into the company weekly status update meeting. (Jay commented: “We know our competition dials in”.)

What I personally found most interesting was Jay’s analysis of the potential chaos that ensues from this openness. For example, there can be a great deal of “noise” in the online comments from all sorts of people: it’s hard to filter postings that are based on reality, from those based on speculation or fantasy. There’s a constant trail of chat, with input from all over the world. Everyone can propose changes to the project. In such an environment, how can real work get done? How can you mediate among 50,000 people who all have ideas to improve a particular dialog box in the UI of an application? How to deal with strongly vocal minorities?

The answers were fascinating (and deeply practical):

  • Open doesn’t mean democracy
  • Decision-making is messy (but that doesn’t mean you should step back from openness)
  • Be prepared to tolerate some messiness
  • Treat disagreements as negotiations
  • Managers of the project need to drive towards definite outcomes – focusing on what is the right outcome rather than who has the right ideas
  • Organise a chorus (rather than a chaos), around local leaders
  • Although anyone can propose changes, you need to earn significant amounts of credibility before you are allowed to implement a change
  • Ensure quality through multiple reviews
  • Review for performance regressions as well as for functionality
  • Educate participants about the vision and the mission of the project, which in turn allows greater micro-level decisions
  • Guide participants towards using the appropriate communication channels for particular topics, and to back up their assertions with research and data
  • Create small focused teams with responsibility for specific areas of product interest
  • Create a common language, to allow discussions to be more productive
  • You still need to have clearly identified decision makers, even though you push as much of the discussion out “to the edge” as possible.

These are good thoughts to keep in mind in the midst of the inevitable turmoil as the Symbian Foundation places 40 million lines of code into open source (and makes corresponding changes in processes) over the next 18 months.

3 December 2008

Accelerating the transformation

Filed under: China, Nokia, partners — David Wood @ 9:59 am

As noted by Tom Krazit of CNET News, there was lots more news from yesterday’s Nokia World event than merely the buzz about the newly announced highly attractive N97. It was also announced that the acquisition of Symbian by Nokia has completed.

One practical impact of the completion of this deal is that preparation can now accelerate – for the forthcoming Symbian Foundation, and for the deep integration of the Symbian and S60 software engineering teams.

As Tom Krazit notes:

After entertaining the world press in Barcelona during the early part of this week, Symbian and Nokia executives will be in San Francisco later this week to discuss their plans for mobile computing and open source, and we’ll have reports from the Symbian Partner Event on Thursday.

Personally, I’m about to board my flight to San Francisco for this event. I’m particularly looking forward to open and insightful discussion at this event – including the panel discussion on “Succeeding in the US: the key factors“, where I’ll be asking for comments and questions from the audience.

Just as I expect very significant amounts of wireless innovation to come from North America in the near future, I also expect very significant amounts to come, perhaps more in the future, from China. Later this month I’ll be speaking at an event in Beijing, about “Symbian Platform Development“. I’m looking forward to learning a lot – since I plan on listening as well as speaking 🙂

In case anyone would like to try to meet up while I’m in San Francisco or in Beijing, please get in touch.

Footnote: There’s still time to register for the Partner Event.

11 November 2008

Symbian Partner Event, San Francisco, 4th Dec

Filed under: Events, partners, Symbian Foundation — David Wood @ 1:59 pm

Historically, admission to Symbian Partner Events has been restricted to signed-up members of Symbian’s Partner Network. However, for our event at the Palace Hotel in San Francisco on Thursday 4th December, we’re going to open up participation.

Some parts of the day will still be restricted to signed partners. However, most of the proceedings on the day will be open to a wider group of attendees – such as mobile developers, journalists, the open source community, and representatives of companies that may be considering partnering with Symbian.

Space will be limited so anyone thinking of attending should register their interest as soon as possible via the event website.

Full details of speakers, panellists, and other sessions at the event will be published on the event website shortly. In the meantime, here are a few highlights:

  • Keynote presentations from a leading member of the open source community, senior representatives from network operators and phone manufacturers, Symbian executives, and the management of the Symbian Foundation;
  • “Fast Forward” technology seminars
  • An open roundtable discussion on “Succeeding in the US: the key factors”
  • “Symbian Foundation Platform Architecture Overview”
  • “Symbian Foundation Q&A”.

There will also be an exhibition of partner products and solutions, as well as ample opportunity to network with movers-and-shakers of the global mobile industry.

Footnote: Here’s the LinkedIn entry for this event.

22 September 2008

Open source coexistence with marvellous non-free add-ons

Filed under: business model, Open Source, partners — David Wood @ 5:25 pm

“Has Symbian thought open source through?” That’s the question David Meyer of ZDNet asks this morning. David explains the context of his question:

Last week I visited Symbian’s labs here in London. The assembled hacks were shown some very interesting stuff, such as what could be done with a quad core mobile chipset… There was also some cool stuff with mobile-based audio EQ, which always pleases me.

We also got shown some of the fruits of Symbian’s work with Scalado on the graphics front. The engineer demonstrated very quick loading of and zooming into a 21-megapixel picture, which was very impressive but raised … unanswered questions: … what precisely is to happen with this valuable work once Symbian goes open source?

Given that [going open source] will involve stripping out all the third-party, proprietary stuff that can’t go open source, why is Symbian still bothering with such partnerships?

Here’s my answer. First, I’m sure that there are aspects of going open source which we in Symbian have yet to think through properly. Moving some 400,000 files of source code into open source is bound to pose a whole host of unexpected problems. However, this particular question is one that has received considerable thought.

The highly impressive Scalado mobile imaging software which Symbian licensed earlier this year is only one of a large number of add-on or plug-in solutions which are available, either as part of Symbian OS itself, or as a pre-integrated supplementary solution. For obvious reasons, I won’t say anything more about Scalado, but I’ll address the general question of an add-on solution A from vendor V, which may be included in a phone created by customer C of Symbian. Suppose that A is currently subject to a license fee F, which is payable:

  • Either from C direct to V,
  • Or from Symbian to V, with the costs in this case currently being covered as part of the Symbian OS licence fee paid by C to Symbian.

So what happens to this licence fee F once the Symbian platform becomes open source, and there’s no longer any licence fee for Symbian platform?

It turns out there are quite a few options available.

For example, the Symbian platform may exclude A, but may instead include a more basic version A0. This will be good enough for many purposes – and will allow customers to build many kinds of successful phones. But customers who want particularly responsive or feature-rich behaviour in the area covered by A will be able to pay fee F directly to V, and will apply A in place of A0 in their phones. So long as the code for A is independent of the Symbian platform code for A0 (in legal terms, so long as A is not a derivative work of A0), there’s no obligation on V to licence their code using the EPL applicable to the Symbian platform itself. That is, they won’t need to make their source code available.

Is this somehow at variance with the motivation of Symbian in creating an open source platform? It depends what you think the primary motivation is for this move. If you think that motivation is to drive out all cost from phones, you may be surprised by this option. However, once you realise that the main drivers are actually to lower barriers of entry and experimentation, to boost innovation, to deepen collaboration, to raise quality, and to accelerate time-to-market, you won’t be so surprised. Open source does not imply low-value! And nor does open source imply that anything which builds on top of it, needs to be zero cost.

Another option is that vendor V will make A available royalty-free as part of the open source platform, but will earn revenues:

  • From consultancy work in the area of A
  • Or, from making available a chargeable new version A1 that provides even better performance and/or new features.

In short, there will be plenty of ways for creative partner companies to continue to earn handsome income from their add-on and plug-in solutions to Symbian platform software.

I’ll close by returning to the last part of the initial question: “…why is Symbian still bothering with such partnerships?” It’s because these partnerships collectively generate a huge quantity of impressive add-on and plug-in solutions, which allow our customers to customise and optimise their phones in numerous ways. And that’s good for everyone.

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