Monthly Archives: July 2011

It’s meHealth I’m Talking About – The To Do List

The following is a list of meHealth issues, and an overview of some of the steps necessary to solve them: meHealth

  • Convince stake holders of the efficacy of Personal Healthcare Pages and/or (PHP) National Electronic Health Records (EHR)
  • Enable all healthcare stakeholders (consumers, healthcare givers, healthcare managers) to use the Web as a platform to share information, deliver care and build communities
  • Enable patients to make better lifestyle choices

Collaborative Health

  • Convince stake holders that Collaborative Health Care (CHC) is a cheaper, safer, and better system
  • Enable single points of contact, self service and self help
  • Enable Doctors to make better diagnoses and prescribe better treatments through access to more useful and integrated data
  • Enable data aggregation to produce useful data of clinical significance for researchers evaluation, teaching doctors and development of health services

Non Vendor Locked Tools

  • Ensure systems are easy and economical for use by all stakeholders
  • Enable tools that help patients feel more informed, included and valued
  • Enable medical help via Web sites/browsers and smart phone apps
  • Enable easily understandable bundles of products and services that can be compared on quality and price, and used by stake holders with a wide range of capability levels
  • Enable access to and co-ordination of home based medical equipment / tools and assessments along with data-generating Web-enabled devices
  • Enable tools for doctor patient dialogue
  • Enable healthcare givers to electronically interact with patients regardless of where they are located
  • Enable disparate IT systems and processes to connect and co-ordinate with each other
  • Enable secure flexibility within mobile services, using such tools as PDAs and VOIP processes
  • Enable healthcare managers to better respond to emergencies and rapidly assess the national impact of particular treatments

Governmental Issues

  • Enable and enhance uptake by governmental agencies
  • Support government responsibility for public infrastructure and systems
  • Enable support for vast consumer and care provider populations in urban, suburban, rural and remote locations
  • Enable effective co-ordination and oversight of national E-Health activities
  • Enable tools and systems which support informed policy, investment and research decisions

Security and Privacy

  • Ensure security of all data transfers
  • Ensure privacy for patients
  • Enable confidential electronic information to be securely and seamlessly accessed and shared, by the right person at the right place and time, regardless of their location

Standards

  • Either create and enable record system standards and benchmarks, or make standards unnecessary by enabling different systems to talk/work with to one another without vendor lock, using a Web 3.0 / Semantic Solution

Data Management

  • Incentivise enhancement of IT and information management
  • Incentivise investment in infra- and info-structures
  • Ensure easy and economical training and support
  • Ensure implementation is cost effective

Infrastructure

  • Maximize existing information management and technology to improve functionality
  • Upgrade old computers and dial-up Internet access or ensure they can work within the new system
  • Ensure new systems are designed with potential user consultation
  • Support Funding to improve rural ICT infrastructure
  • Ensure broadband / ‘chatty’ high-speed connections are not necessary for most clinical consultation (Systems can be broadband based, but must not be broadband bound)

Costs

  • Reduce/Eliminate errors, inefficiencies and the wastage of time and effort
  • Lower healthcare provisioning costs
  • Ensures cost and service level transparency
  • Lowers costs on families and communities supporting the elderly
  • Cut time needed to review and implement systems and training
  • Modernise the management and transmission of data
  • Consolidate medical records/services and clinically relevant information
  • Remove duplication of healthcare efforts, expenditure and solutions
  • Reduce administration time and costs
  • Combine insurance systems reducing duplications and high overhead costs

Systems and Processes

  • Enable an integrated health care delivery system
  • Link emergency and acute hospitals with tertiary care in the community sector
  • Enable integrated healthcare delivery systems and the consolidation of medical records/services
  • Ensure B2B applications (i.e. reporting, billing and claiming processes) are integrated into general practice software systems
  • Enable the secure viewing and following of healthcare processes
Well, there is.
Bottom line: meHealth makes money, and it makes sense.
If you want to talk about the tech,  get in touch!


The e-Health Perspectives of e-Patient Dave (Part 1)

Capital I Interview Series – Number 3 (Part 1)

The e-Perspectives of e-Patient Dave 

Recently I, along with a myriad of others around the world, was introduced to the passionate, personable and thought provoking e-Patient Dave through his TED Talk ‘Dave deBronkart: Meet e-Patient Dave.

I was so inspired by his presentation, I immediately took to Twitter to send him a message of congratulations – and an invitation to become involved in my Innovation Interview Series – not least because of my long held interest in Innovation in healthcare, and in meHealth in particular.

Unsurprisingly, with  more than 180,000 views so far, and having been subtitled in nine languages, Dave’s TEDTalk has proven to be an international hit.  So much so, that TED invited him back to do a TED Conversation on “Let Patients Help”   scheduled for Wednesday 27 July at 1:00 p.m. (US) EDT.

My interview with Dave, conducted on 26 July, will be posted in a series of ‘chunks’ – some in text, and some in video format.

(NOTE: Excuse the quality of the filming/lighting/all-other-ing of this interview.  Suffice it to say, Spielberg has no worries I’m going to be sitting in his chair anytime soon!)

This first posting, to coincide with the Ted Conversation, will look at two questions in particular: the responsibility of Healthcare users and the demands they are entitled to make.

But first, lets talk about TED:

You’ve recently done a TedTalk and had a great global response to your presentation.  What has been the most surprising outcome from this success.

It’s no surprise that being  a hit on TED.com has been phenomenal at spreading the meme.  What is a pleasant surprise is that it’s clearly gone viral: the idea is currently spreading at over 1500 views a day, and volunteers have added subtitles in eight languages.  WHAT a pleasure for any advocate, to see an idea take off like that, especially across cultures. Farsi!

And what a testament to the power and reach of TED.

And who brought you into TED?

That’s my friend Lucien Engelen, His Twitter name is Zorg – which means ‘Care’ in Dutch – 20, and he is a visionary.  A visionary who has the ability to execute. About two years ago he got […] authorized to run a TEDx, the smaller regional franchise TED events, in Maastricht.  A year before it happened he announced that a patient was going to be the first speaker at this medical conference.”

Lucien Engelen is a Health 2.0 Ambassador, the Director of the Radboud REshape & Innovation Center, and on the Advisory Executive Board at Radboud University Nijmegen Medical Centre

“Clearly this is tapping into something in consumers cross culturally – people want to be involved in their healthcare around the world.”

What responsibility do you think healthcare users need to take in their own health?

The simplest eye-opener view was put forth in December 2008 by endocrinologist Stanley Feld: “Physicians are coaches. Patients are players.”  You don’t get to sit on the couch all day and then demand participatory healthcare. With rights come responsibility.  Get up off your ass; be physically engaged in your life, not just your care decisions.

For those inclined toward a more delicate view, and perhaps a more formal model, Jessie Gruman’s Center for Advancing Health has developed a terrific ten-piece framework for patient engagement:

  • Find Safe, Decent Care
  • Communicate with Health Care Professionals
  • Organize Health Care
  • Pay for Health Care
  • Make Good Treatment Decisions
  • Participate in Treatment
  • Promote Health
  • Get Preventive Health Care
  • Plan for the End of Life
  • Seek Health Knowledge

For details see this post with her speech about it and links to the full framework documents.

Should patients be allowed to read their doctors’ notes, access lab result and see images they aren’t necessarily qualified to assess?

“There’s several levels of thinking about this.. here’s entitled according to the law, and there’s what I think makes sense.”

“How do we improve healthcare?  And I assert that we have to start there, because we are approaching a genuine healthcare famine.”

Lucien Engelen, who hosted TEDx Maastricht… he’s going to be running the REshape academy in September, where I’m going to be doing my ePatient bootcamp.

He said that in the Netherlands, which is not a giant country, by 2025 they’re facing a shortage of 400,000 nurses.”

“Now anybody who plans to be alive in 2025, and there probably will be more humans in the Netherlands than there are today, is going to be facing a care shortage.  So it just seems unavoidable that that we’ve got to hand people a lifeline to try to help themselves.”

My doctor, Dr. Danny Sands, is famous for saying, “How can patients be engaged in their care if they can’t see the information?”

“For the patients to be a second set of eyes, to check the data quality, costs the healthcare system nothing more and will reduce defects.”

What responsibility do you think healthcare users need to take in demanding change in the healthcare system?

Well, that varies a lot.  All my life I’ve felt that demands aren’t necessary until one has asked courteously, offering partnership in creating the change and doing the work.

But there are times when the establishment simply will not listen.

It happened for hundreds of years with women’s suffrage.  It happened with the civil rights movement: folk singer Malvina Reynolds penned a cheerful ditty “It Isn’t Nice” about what you sometimes have to do for justice:

It isn’t nice to block the doorway
It isn’t nice to go to jail
There are nicer ways to do it,
But the nice ways always fail

Although I followed folk music in the Sixties, I didn’t hear that song until this year, in the context of yet another movement: gay rights.  It was mentioned in an episode of our great PBS series The American Experience the Stonewall Uprising.

One of the gents who was in that movement recounts what gays eventually had to do to be granted the right to live and let live.  Will we see a day when patients march in the streets?  Gays chanted “Out of the closets and into the streets!”

Will patients march, chanting “Out of the johnnies [US slang for hospital gown] and into the streets – stop the killing now”?

Personally, I’d prefer the chant “Let Patients Help.”  But if healthcare ignores that, who knows.

———————————————————————————————

End of Part One

In Part Two of my interview with e-Patient Dave, we’ll look at, among other things:  Capital I’ Innovation in healthcare, healthcare heroes, why Dave became a healthcare advocate (and the responsibilities that entails) and changing the world.

[ There’s a lot more to come from e-Patient Dave, so keep your ears tuned, and your eyes peeled – conversely, you could make things easy on yourself and either follow this blog or subscribe to the RSS feed! 🙂 ]

For more information on e-Patient Dave, check out:

(Kim and Dave Skype’d between from their homes in Sydney and Boston  on July 26, 2011. This is Part One of a multi-part series.)

Part Two of this interview can be found here

Capital I Innovation Series Introduction

It’s meHealth I’m Talking About

The move from eHealth to meHealth

eHealth can and should provide options for how stakeholders (consumers, care givers and healthcare managers) manage and interact with the healthcare system across geographic and health sector environs.  That said, if there is anywhere that Capital I Innovation is essential, I believe it is in the field of eHealth.

The term eHealth has become nigh on ubiquitous.  And yet, it is somewhat nebulous, as it can be perceived as being perceptively less than personal.  meHealth, however, is different. It demands that I, you, we, take it upon ourselves to take responsibility.

Responsibility for what?

Responsibility to expect and demand that all healthcare stakeholders at the local, regional and national – and, dare I say, international – level to work together to ensure that affordable, effective healthcare is available to one and all.

e-Health uses the internet and related communication technologies to improve healthcare delivery, collaboration, diagnostics and treatments, while reducing errors and costs.

Thus far most arguments for eHealth take-up have relied upon Web 2.0 solutions such as MedHelp, MyGP, patientslikeme and Hello Health – each excellent initiatives.  Unfortunately, these arguments for adoption, though interesting, have not been compelling enough to engender a rush towards mass adoption, at least not by healthcare service providers.  But, with the advent of Web 3.0 solutions, this situation should soon change.  It must.  However, this will only happen if all stakeholders take on the responsibility of demanding the change; this is the time for the change to meHealth.

In my recent conversation with ‘father of the internet’ Vint Cerf, we discussed eHealth. Vint remarked ,

“From my point of view, there is no doubt that having records which are sharable, at least among physicians, would be a huge help.  When people go in to be examined, they often have to repeat their medical histories.  They don’t get it right every time, they forget stuff.  Yet the doctors are not in a great position to service a patient without having good background information.  I am very much in favour of getting those kinds of records online.

If we were able to harness the electronic healthcare system to provide incentives for people to respond to chronic conditions, which are generally the worst problems we have in healthcare – whether its heart disease, diabetes, cancer, [obesity] – to take better care of themselves, then we would reduce a lot of the system costs, simply because we had a more healthy population.”

Unsurprisingly, I agree with Vint.  However, regardless of how involved individuals are in bettering their meHealth, we cannot ignore the fact that pressure on the healthcare industry is rapidly increasing, as is the cost of provision.  It is in this area where new technologies can be of great import by enabling the healthcare sector to operate as an effectively co-ordinated, interconnected system, which:

  • Lowers costs and eliminate wastage of time and effort
  • Lowers costs on families and communities supporting the elderly
  • Enables integrated healthcare delivery systems
  • Consolidates medical records/services
  • Enables the viewing and following of healthcare processes
  • Enables single points of contact, self service and self help
  • Ensures cost and service level transparency
  • Enables disparate IT systems and processes to connect and co-ordinate with each other
  • Supports vast consumer and care provider populations
  • Removes duplication of healthcare efforts, expenditure and solutions
  • Enables confidential electronic information to be securely and seamlessly accessed and shared, by the right person at the right place and time, regardless of their urban, suburban, rural or remote location
  • Enables effective co-ordination and oversight of national E-Health activities
  • Supports informed policy, investment and research decisions
  • Enables secure flexibility within mobile services, using such tools as PDAs and VOIP processes
  • Reduces errors and inefficiencies

All the above points are important, but the final one may be the most vital of all. Why?

Because in Australia, in 2010, approximately $3 billion was wasted in avoidable annual expenditure.  Australia has a population of over 22.5 million, the US has a population of nearly 311 million and China has a population of over 1.3 billion – you do the math.

Do you need more convincing?  How about this. Annually in the US approximately 225,000 people die as a result of erroneous medical treatments and hundreds of thousands are made worse by being misdiagnosed or given inappropriate treatment.  Added to that, the costs of medical problems caused over 60% of all personal bankruptcies filed in 2007.  These are just a few of the reasons why reducing, if not eliminating, errors and inefficiencies is imperative.

I think most of us are agreed that making these changes would be a good thing. So how do we do it? Its a big ask I know. And yet, it must, and can, be done. What is needed is a plan, and here is my To Do List. I welcome any and all who are interested in moving this debate forward to add to this list.

In next week’s post, we will look at eHealth and meHealth from the perspective of patient advocate ePatient Dave.

Vint Cerf: Father Knows Best! (Part 2)

Capital I Interview Series – Number 2 (Part 2)

KimmiC chats with ‘Father of the Internet’, Vinton ‘Vint’ Cerf

(Along with our particular questions, we invited some of our readers to submit their own queries to Vint, which he was happy to answer. Thanks go out to to ‘ePatient Dave’ Dave deBronkart, Brent Hall, and Roger Kermode for taking part!)

This is the final segment of the KimmiC chat with Google VP and Chief Internet Evangelist, Vinton ‘Vint’ Cerf, known around the world as one of ‘fathers of the internet’. [Part 1 available here.]

There has been a great amount of debate about Net Neutrality Vint. Do you think it is important to ongoing Innovation?


Yes, in the sense that it is intended to assure that the limited number of providers of broadband access to the Internet, do not use their control of this pipe to interfere with competing  applications that rely on this transport. It is the anti-competitive aspect that is the most critical problem. A lot of smoke and misleading argument has obscured this basic fact.

The issue here is a business issue more than anything else. It is distorted and twisted around and treated as if its a technical problem or ‘just a bunch of geeks who don’t know what they’re doing’, but this is a real, honest business problem; especially in places where there is not much competition to provide broadband service.

When you don’t have a market that’s disciplined by competition, you have the potential for real monopoly or market power abuse. If you’re the only party supplying broadband access to the internet, and if you supply vertical services like video, then you may be persuaded to interfere with someone else’s service in order to take advantage of your control over the underlying pipe.

The situation in Australia largely eliminates that problem because of the way in which you’re investing in the NBN. Here in the United States we have a serious problem because Broadband is not very competitive. We have Telcos, CableCos and maybe you could consider satellite services to be a third possible competitor, but the synchronous satellite delay makes it a lot less attractive.

Last week a popular Ted Talk by ‘ePatient DaveDave deBronkart was launched. An eHealth advocate, Dave was pleased to have the opportunity to ask you:
 Increasingly, “e-patients” are using the internet to supplement the care they receive from professionals by connecting with information, and with each other, in ways that were never possible before.

ePatient Dave

Some have found life-saving information online, but others warn that there’s garbage amid the gold. And some doctors don’t like it when patients present information they haven’t seen.

Are there lessons from other fields that have similarly faced the democratization of information? 


There are several facets to this question. First of all, there’s a lot of misinformation on the internet about healthcare. There are a lot of quacks and people who tried things and think there are correlations. Things like, “I jumped around on my left foot and sacrificed a chicken over my computer, and I got better.” So they conclude that you have to jump around on your left foot and sacrifice a chicken over your computer to get better.

Of course that’s all nonsense.  Anyone who goes out on the net looking for healthcare information should be very careful to look for bona-fides and some evidence that the information is valid.

On the other hand doctors are saying that they have more informed patients than they have ever had before because information is more readily available. I sense that people are paying more attention to their health conditions and they’ve learned a lot.

Doctors don’t have a great deal of time to tutor their patients about their problems. So one thing the healthcare system would benefit from is a deliberate provision of good quality information about either a condition, or its treatment,  its potential outcomes and possible side effects. Then the population can learn more without chewing up a lot of the doctor’s time.

As far as making a comparison with other vertical segments, none immediately come to mind, except perhaps Climate Change, which as you know is a hugely controversial thing. Perhaps one other would be in the financial services area where people go out on the net looking for advice about investments, specific stocks, or choices about home mortgages and things of that sort. All of that is subject to misinformation and deliberate fraud.

I think the honest answer is, people do get defrauded on the net. People do get involved in things that turn out to be unrealistic – ponzi schemes and whatnot. The only thing I can say is, if you don’t teach people, or at least encourage them to ask questions, or at least do some validation… if they don’t spend some time evaluating the information they’re getting, then they are going to be at risk.

The one thing that I would want to teach kids today about the net is: think critically about what you’re seeing and hearing – don’t accept everything that you see without doing some more homework.

As I’m sure you know, July 1 marked the 45th anniversary of the implementation of Medicare following President Lyndon Johnson signing the healthcare program on July 30, 1965.

How do you envisage eHealth developing with the advancement of the internet and broadband capabilities?


I have to confess that I had not been driven specifically by the eHealth vector in my work on the internet. But as it became increasingly apparent that the healthcare problem was going to get worse and worse here in the US, in terms of dollars spent per patient/capita I got more and more interested – for the same reasons that you mentioned.

As you probably know, Google has announced that its going to terminate its current efforts in the electronic health record effort. I’m disappointed at that. I think that we had hoped that it would have more traction that it did. Part of the problem is getting people to adopt and use those records – and interoperability and so on.

There is however, a small piece of light. The US CTO, Aneesh Chopra, at least succeeded in getting some agreements on a format for data that could be exchanged by email. As you know the concerns about privacy and health information have been quite intense here in the US. There’s a big, complex system here called HIPAA, (the Health Insurance Portability and Accountability Act), apparently he was able to cope with that and still get an interoperable agreement done.

US CTO Aneesh Chopra

From my point of view, there is no doubt that having records which are sharable, at least among physicians, would be a huge help. When people go in to be examined, they often have to repeat their medical histories. They don’t get it right every time, they forget stuff.  Yet the doctors are not in a great position to service a patient without having good background information. I am very much in favour of getting those kinds of records online.

The second thing I would say is that for chronic conditions, which are generally the worst problems we have in healthcare – whether its heart disease, diabetes, cancer, [obesity] – those chronic conditions cost us more per capita than anything else in the healthcare system. If we were able to harness the electronic healthcare system to provide incentives for people to respond to those problems, to take better care of themselves, then we would reduce a lot of the system costs, simply because we had a more healthy population.

On this point about a healthy population, if you are not collecting data, you can’t know what the state of health of your population is. We have to get better data.

There is a concern about Telcos on the whole, and in the US in particular, having asked for and received huge subsidies along with the removal of regulations and obligations for common carriage. In return, they have promised to provide improved services for everyone, and yet they have consistently failed to do so.


With that in mind, could you comment on Brent Hall’s question: What is the greatest threat to the future of a free and open  internet?


I worry about the: “Our business models don’t work anymore. We can’t expect the general public to pay for access to this expensive resource, so we have to find other sources of revenue to pay for the build out, which might mean government handouts,” argument. Or the, “Hey, look at those guys over there at Google and Facebook and Amazon. They’re sending streaming video over our pipes, and they’re not paying for it!

Of course we are paying for it! We pay commercial services a lot of money to put our servers up on the net. Now they’re saying, “Customers can’t pay!”
My reaction to that is: technology should be cheap enough that you can make this available to customers at a reasonable price.

Now, what are we going to do about it? Well, Google is doing something about it. We’re going to fibreize Kansas City. It’s not as big as Australia but it’s our attempt to do the work. We will expose what the problems were, what was easy, what was technically hard and what was fiscally expensive.

And by the way, I haven’t said this to [Senator] Stephen Conroy, but I would find it extraordinary if the Australian Government would be willing to share what the costs turned out to be. The reason for that is, it might encourage others, or at least give us a real datapoint so that if we want to do what you’re doing, we will all – the US and elsewhere – know what we’re getting into.

Australian Senator, and Minister for Broadband, Communications and the Digital Economy, Stephen Conroy

This could be a dangerous thing. If it turns out that its all a cock-up of some sort, if it costs more than was expected and it doesn’t get done, then nobody is going to want to talk about it. I understand that. But I am increasingly confident that you’re going to pull this off successfully. I sincerely hope you do.

The world over, citizens in their millions are calling for more openness from their respective governments. As part of the Board of advisors of Scientists and Engineers for America, what is your view of the effectiveness and potential of President Obama’s Open Government Initiative and its mandate to create an unprecedented level of openness in Government?

As you probably know, Vivek Kundra who is the CIO at OMB (the Office of Management and Budget) was vigorous in his pursuit of that objective. He got an enormous collection of government databases up and running and made them easily accessible – including budgetary information – which of course is what the OMB is all about.

US CIO Vivek Kundra

What he did was to create a tool online, which enabled you to drill-down into the budget. It allowed you to find the actual person who was responsible for spending that ‘piece’ of money in the US budget, which is unprecedented. Nobody had ever done that before.

Coupling that with tools to visualize some of this ‘dry as dust’ information was really eye opening. You began to see historical trends and things you would never see by just leafing through pages and pages of table and figures.
I’m sorry to say that in the crunch of the national debt limits and concerns over entitlements such as healthcare, social security and so on – non-discretionary expenses… in the course of  trying to negotiate reductions in spending, they reduced the budget Vivek had for some of his projects.

Whether it was causative or not, I don’t know, but recently Vivek announced that he is going to Harvard to the Berkman Centre. I don’t know who his replacement will be, but whoever it is will have less budget than Vivek originally had for the pursuit of this stuff.

President Barack Obama

I don’t think the President or any of his senior people are any less enthusiastic about openness and making information transparently available. I think they’re facing a reality of a budget problem that’s going to be hard to fix.

Looking to your past, who most influenced you in high school? I ask this, as I find it amazing that you, Jon Postel (editor of the RFC document series) and Steve Crocker (co-creator of the ARPANET) all went to the same school – was there a particular teacher, or club who inspired you there?

I actually did not meet Jon until we met at UCLA as graduate students.

Jon Postel

Steve and I were, and are, best friends -we were best men at each other’s weddings and have collaborated in many ways over the course of 5 decades.

Steve Crocker

I think the biggest influence for me in high school was the enrichment program sponsored in part by the National Science Foundation in the wake of Sputnik.
I was a direct beneficiary of the emphasis placed on science, mathematics and technology in American high schools in the 1960s. I had teachers who encouraged me in all academic subjects including history, creative writing and literature, not only math, science, physics, chemistry, etc. Steve and I were members of the math club and he was president. The club won city-wide awards in contests and that was very satisfying.

And today, why is Google a good place for an Internet Evangelist and Futurist?


Google is vibrant and alive with ideas, energy and a youthfulness that leads to innovation and Innovation. The leadership is willing to aim at big targets and is willing to allow for failure as long as the targets are ambitious enough. The company has a highly successful business model and a culture of invention and collaboration.

Vint, thank you so much for your time, which I know you extended for me. If there’s ever anything I can do for you, don’t hesitate to let me know!


If you could figure out how to fix the exchange rate between the US dollar and the Australian dollar so I can could buy more Australian wine, I’d really appreciate that!

(Kim and Vint Skype’d between from their homes in Sydney and Washington D.C. Part One of their conversation was published  on July 1, 2011)

[This interview has been translated into the Serbo-Croatian language by Jovana Milutinovich of Webhostinggeeks.com]

Capital I Innovation Series Introduction

Vint Cerf: Father Knows Best!

Capital I Interview Series – Number 2 (Part 1)

KimmiC chats with ‘Father of the Internet’, Vinton ‘Vint’ Cerf

(Along with our particular questions, we invited some of our readers to submit their own queries to Vint, which he was happy to answer. Thanks go out to to “e-Patient Dave” Dave deBronkart, Brent Hall, and Roger Kermode for taking part!)

Imagine having the opportunity to ask Johannes Gutenberg about his thoughts on how his printing press would change the industry – let alone his opinion on how his press would change the world. Well, essentially, that’s the chance that I’ve had this morning, when I was given the opportunity to speak to Google‘s VP and Chief Internet Evangelist, Vinton ‘Vint’ Cerf, known around the world as one of ‘fathers of the internet’.

When looking for a ‘poster child’ for Capital I Innovation, Vint is, to many – myself included – at the top of an impressive, international list. His list of awards and medals from around the globe is vast, as is his experience and range of interests. I do believe, in this instance, it is fair to say that when discussing Capital I Innovation – especially as it relates to the internet – ‘Father really does know best’.

As this series is based on Capital I Innovation, Lets start with how you define Innovation?
I think capital “I” innovation happens when something new is invented that has very large potential for cultural and/or economic change. However, it is important to appreciate that some innovations are stillborn if they are not, in fact, taken up widely.

In a recent book entitled Why the West Rules – For Now by Ian Morris (2010, Farrar Straus and Giroux, New York), evidence is given that strongly points to the long term evolution and adoption of agriculture ultimately replacing a hunter-gatherer way of life. The process is not instantaneous but it has dramatic effects on culture and economy.

We sometimes think of Innovation as a sudden invention but often it takes decades and even centuries to have an effect. The printing press took centuries to have its primary effect. The telegraph, railroads, highways, radio, television and even the Internet took decades but those are a blink of the eye in terms of human history, which is fairly short itself (a few tens of thousands of year for prehistory, perhaps 8,000 for “history”).

Do you see a difference between ‘little i’ and ‘Capital I’ Innovation?
Yes, I think of the lower case instance as sequential refinement and adaptation while the basic Innovation might be a dramatically different way of doing something.

The Industrial Revolution is capitalized because of that – a shift from manpower or animal power to harnessing non-biological forms of mechanical energy (water power from rivers; steam from coal and wood; hydro-electric, oil, gas, wind or solar generated electricity; internal combustion engine; fractional horsepower motors).

The Transistor (and reed switches or vacuum tubes) ushered in the harnessing the power of “mechanical” thought using computers and programs. The Telegraph ushered in new forms of communication that eventually lead to the telephone, radio, television, optical fiber, coaxial cable, microwave, etc.

Printing Telegraph

The combination of computing and communication, once the economics reached a certain level, created the conditions for the invention of packet switching and, eventually, the Internet and many other kinds of computer-based networks.

With that in mind, do you think that Cloud Computing is big enough – different enough – to be capitalised?
Yes I do, for a couple of reasons. I’ve been jokingly saying that it is like time-sharing on steroids, as, like time-sharing, it does share the same resources. However, the scale of a Cloud system is so dramatically different than any time-sharing system that’s ever existed that it does deserve to be Capital I. There is a common belief that once you scale up by a three or four orders of magnitude you are in a different space than you were before.

Of course, this raises a very interesting question about the internet, because the internet is now 6 orders of magnitude bigger than it was when we first launched it in 1983. You have to ask yourself, is it still the same architecture, the same protocols? What’s different?

Of course one thing that’s different is that there are two billion users. Another thing that’s different is that the world wide web wasn’t there, and now it is – that [came] 10 years after launch. Its also available on mobiles, which didn’t exist. So, there are a whole bunch of things about that scaling up, including data and video, which could allow you to argue that this is a whole different beast now.

The meeting I just came back from in Paris suggests this. If anyone had suggested to me in 1983 that in 2011 there would be a meeting of 50 or so countries in the OECD, for two days talking about the internet economy, concerns about intellectual property, crime on the net and so on… I would have scratched my head and said, this thing is for the military, and the research community.

You’re called by many, one of the ‘fathers of the internet’. What do you think of your baby now?

  • Astonished at its evolution and growth,
  • Hopeful that it will reach well beyond the present 2 billion users,
  • Amazed at the response to the WWW infrastructure,
  • Worried about government intervention that might seriously harm the openness that has driven innovation in and around the Internet,
  • Excited by the possibility of extending its operation across the solar system to support manned and robotic space exploration,
  • Envious of kids who get to use it at age 5 when I had to wait until I was 28… and we had to invent it first!

What is the most important piece of innovation, which has launched in your lifetime?
The obvious answer for me is, of course, the Internet, but in fact it depended on the creation of conditions that allowed this idea to be explored and, ultimately, exploited.

The ARPANET, the successful invention of packet switching, the invention of the Ethernet, the invention of the Unix operating system, the invention of the mini-computer (ie. something that could afford to be replicated and used as packet switches or routers), the invention of high speed, long distance communication technology (wired, wireless, satellite, mobile…). Those, and so many more technologies, all had to be readily available for the Internet to grow.

Business models had to be invented, not only to make and sell the equipment and software needed for the Internet to operate but for the support of the enterprises that grew up around the World Wide Web (WWW). The WWW itself would not likely have amounted to much had it not had an Internet on which to be supported. It was invented or at least became operational in a single node in December 1990, six years after the Internet became available to the academic and military communities and contemporary with the development of a commercial Internet service.

I was born in 1943. I grew up using a three-party, black dial up telephone with long-distance operators. There was no television to speak of. Jet planes were purely military. Early in my life, the atomic bomb was invented, tested and used. Microwave and radar were military systems. Sputnik happened when I was 15 and just entering high school.

We landed on the moon when I was 26. At 18 I worked in a small way on the F-1 booster rocket engines used in the Saturn V rocket that put the astronauts in orbit around the Earth.

The microwave oven became a commodity in my lifetime as did jet travel. The computer was very new during my early lifetime and I was introduced to the tube-based SAGE system (Semi-Automated Ground Environment) when I was 15.

Lasers were invented in my life time and have myriad uses today. Robotic surgical systems such as the Intuitive Surgical Da Vinci system were invented in my lifetime. So was the Pill (by Syntex and others, for birth control). The discovery of the structure of DNA occurs around 1953 when I am ten years old.

While relativity and quantum theory were already a few decades old when I was born, the existence of quarks wasn’t really demonstrated until 1968 at the Stanford Linear Accelerator (SLAC), at about the time I am working on the ARPANET at UCLA. The cochlear implant, invented by Graeme Clark beginning in 1973, was a long process, but had utterly spectacular results. My wife, who was profoundly deaf for 50 years, has two implants and is living a second life as a result!

What piece of innovation did you expect to happen/take off, that didn’t?
Two things were really disappointing. When I was working on the Saturn F-1 engines in 1962, I really did think that we would have regular, weekly space launches in 20 years, maybe out of the Antelope Valley north of Los Angeles where the famous Lockheed “Skunkworks” is located. I also thought that we would be flying personal helicopters by then, too.

I also thought 20 years was a long time (more than twice my lifetime at that point). I was wrong about all three, but I am not disappointed to have outlived thrice my lifetime at age 19!!

Where does the Interplanetary Internet project stands at the moment – and why do you think it is important?
The standards are firming up well. There are implementations of the Bundle Protocol and the Licklider Transport Protocol that realize the Interplanetary Internet architecture. Instances are on board the International Space Station and the EPOXI spacecraft. Discussions are underway in the Consultative Committee on Space Data Systems to standardize these protocols for international use.

If all space-faring nations adopt these protocols, then all espacecraft will be able to communicate with each other. Once they have completed their primary scientific missions, they can be re-purposed to become part of an interplanetary backbone network. One can imagine the aggregation of a solar internet over a period of decades, in support of both manned and robotic exploration.

Here on earth, are entrepreneurs born or made?
I think there has to be a combination of conditions to allow entrepreneurship to happen. A person has to be willing to take risks, and that often has a genetic component. But a person’s experience with risk also has to have had some positive feedback effect. If you are never successful at taking risk, you are likely to learn to be very conservative.

Conditions also have to be right to allow the risk-taking to go on long enough to produce results. This is the so called “runway” needed to go from the idea to a successful, profitable or at least self-sustaining business. It should be noted, however, that not all inventors are entrepreneurs. They may take risks in the technical sense but not necessarily in the personal (livelihood) sense.

Conditions for invention may actually require that the inventor be shielded from economic risk while exploring ideas that may have a high pay off in some sense, but such high risk that no one could afford to take the personal risk needed to explore them.

This is one reason that it is often a government that has to make the investment in research in high-risk area,s since no business or inventor would take the economic risk. It is also why inventors often die in poverty (think of Tesla) [while] others harvest wealth in addition to technical success.

What do you think are the main barriers to the success of innovation?
Sometimes they are technical (can’t process that much information in a timely way, can’t store it, can’t build a big enough data platform, uses too much power) or economic (can’t deploy the necessary infrastructure, devices out of consumer reach) or operational (too bulky, battery life too short, displays don’t work in all lighting conditions). Sometimes the major barrier is that the private sector doesn’t give innovative employees the freedom to fail.

For any particular innovation, the conditions for its sustainable growth and use may simply not yet be ready.

What do you think is imperative to allow ‘Capital I’ Innovation to occur?
Not all Innovations require government support, but often this is the only path to initial success because the risks are too high for the private sector, even venture capital or angel investors to take.

Google was essentially entirely private sector funded and that’s something of an anomaly, given its stunning success. In that case, angel investment was an important component.

Economics is another critical factor. It is possible to have a breakthrough invention that is simply too expensive for widespread adoption.

Mobiles have been stunningly successful but took many years to emerge because the costs and the physical size, battery life, and infrastructure were a long time in development. Tax breaks can be sustaining but generally don’t lead to capital I innovation, to first order.

If you could give a ‘Capital I’ Innovation Award to anyone, who would you nominate? This could be individuals, organizations and/or companies (it could also be yourself!).

Does Innovation have a nation?
I think there is no country that has a lock on innovation but some places, like Silicon Valley, have conditions that support it better than many other places. You have:

  • a continuous stream of trained, high technology graduates,
  • experienced business people,
  • venture capitalists,
  • a liquid stock market,
  • mobility from company to company, and
  • a community of players that know each other.

It is a potent brew. There are more smart people, in absolute numbers, outside of Silicon Valley than inside, but the conditions in SV are remarkable.

Is innovation an overused term?
Yes in some ways. It is too much the focus when one should be asking “under what conditions can innovation take hold and become a real driver of economic growth?”.

It could be said that a huge amount of the core innovations that we use seems to have come out of either government funding and/or telco’s (for instance MCI and AT&T). Do you agree with this? And if so, do you think it was past structural, political and economic situations that made these innovations possible.
I think we should be very careful to distinguish between innovation and participation within the infrastructure. MCI supplied point-to-point high speed pipes to build the NSFNET backbone, to build the vBNS network, and to ultimately build Internet MCI a publicly available internet service.

Where they DID pioneer was in the commercial use of optical fibre. You have to give them credit for that, and for participating in the National Science Foundation Network by contributing underlying transmission resources. The fact that they were willing to get into the game is different than them being the inventors of it.

The real innovators for NSFNET were Merit and IBM. Particularly IBM, which designed and built the original routers; though they didn’t really follow up on that. Ironically IBM built the routers for the NSFNET back bone but Cisco systems, Juniper and others turned out to inherit all the commercial value from it.

AT&T, as a very successful monopoly, had an enormous amount of resources, which they put into AT&T Bell labs. Bell Labs was absolutely one of the most innovative places anywhere in the world. Nobel prizes have come out of there, the transistor came out of there. There’s no doubt in my mind that something was lost when AT&T was broken up.

The one thing about MCI which was interesting was that, instead of doing research, they would dangle a $250m dollar cheque in front of company and say, “If you can do this, I will buy a quarter of a billion dollars worth…” Its amazing how much R&D you get out of people when you do that. So, rather than taking all the risks themselves MCI simply said, we’ll buy a lot of stuff if you make this happen.

And yes, there’s no question in my mind that government sponsorship for this kind of high risk research is important.

Many nations are in the midst of debates about Broadband. You were recently quoted as saying that you believe” internet bandwidth can increase exponentially,” adding that this would, among other applications, “enable greater access to high-def video.” Other than being able to get the latest blockbuster downloaded in no time, where else do you see it being of use?
The term “exponential” is not one I would use (a reporter put that word in my mouth). However, I do believe we are far from fully taking advantage of communication technology to achieve many gigabits per second, end-to-end on the Internet.

These speeds have a transformative potential because they dramatically reduce the cost of moving information in large quantities from one place to another. It allows replication for resilience and safety. Large files like MRI scans will be easily retrievable and processable with higher speed transport.

We can build much larger data processing systems when we can interlink the processors at terabit and higher speeds. In a recent technical session, serious mention was made of 1000Tbs (that’s a petabit per second). Holographic simulations will benefit from speeds of this kind.

By the way, Stephen Conroy was in Paris with me for the OECD Conference, and I have to say that I continue to stand in awe of the Australian Government decision to fund the fibre network.

Stephen Conroy launching the Digital Strategy 2020 (zdnet.com.au)

This is the kind of infrastructure investment that probably would not ever be made by the private sector. There would be parts of the community left out, there would be economic decisions that would reduce capacity….

This is a very big deal and I’m hoping that it all works out. If it does, it would be a bell weather example of why government investment in fundamental infrastructure is so important.

This leads neatly to Roger Kermode‘s question: What advice would you give Australian ISPs, governments and businesses to take best advantage of the NBN?
First of all, because its a Level 2 infrastructure, anybody who wants to is free to put up a level 3 routing system on top of it. That means they can all compete for any business or individual subscribers service. Then on top of that you have the enabling effect of the broadband capability. This means that people can put applications up there that they would never have put up without such a broadband infrastructure.

Next, with the fact that everybody is online, or very nearly everybody, you can begin to say, “We are going to do ‘X‘ for the entire population,” and have a reasonable expectation that you will, in fact, reach the entire population.

For example, when it comes to healthcare, and the possibility of remote diagnosis and things like that, you’d be in a position to actually exercise that idea. Whereas, most other places, including here in the U.S. would not.

I anticipate that if this infrastructure goes into place and it operates reliably that you will be exploring a space of ‘online-ness’ which no other country has ever experienced.

End of Part 1 – Follow our blog and Part 2 will be delivered to your in box next week!

Part 2 – Next week we talk about net neutrality, eHealth, Telcos, Google, the Open Government Initiative and more (including a message to Australian Senator Stephen Conroy)!

(Kim and Vint Skype’d between from their homes in Sydney and Washington D.C.)

[This interview has been translated into the Serbo-Croatian language by Jovana Milutinovich of Webhostinggeeks.com]