We have all read the articles on huge amounts of money being raised by hot, new social media software companies. Two twenty-somethings with a great idea, a Stanford pedigree and a freshly minted business plan from the Y Combinator raise $15 million dollars and move into the 18th floor of the Embarcadero Center in San Francisco. Well, that is not the way it works…  at least not in healthcare. In my experience, it involves endless meetings, lots of inane questions, and traditional Venture Capital always seem to end up at the same place:

• How long is your sales cycle? Did you really say six to twelve months?

• You mean your staff actually goes on site to train and support the client? How can that scale?

• Did you really say that you have to integrate with hospital systems and you can't just download an app or subscribe to a cloud service? That sounds way too complicated.

Now don't get me wrong, I have worked with Venture Capitalist for more than 30 years and I know some great ones, Dick Kramlich at NEA, Randy Komisar and John Doer at Kleiner Perkins, to name a few. But the Venture Capitalist landscape has changed. Funds are raising hundreds of millions of dollars, with deal size getting bigger and bigger. Valuations have grown as rapidly as planning horizons have shrunk. Deal velocity is up and patience is down.

We recently closed a Preferred Round with strategic investors, one a major vendor and the other a top-rated healthcare provider. Why would we do this? I think the number one reason is that "they get it". Not just as a financial transaction but as a shared vision for transforming healthcare. We must act and we must have strong partners that can look over the horizon.

The other day I had a chance to use Apple’s new Macbook Pro with Retina display and I was completely amazed—make that blown away! Trust me, I’m not easily impressed and I had a hard time believing it was the “best Mac Apple has ever built” according to one review from a well-respected computer hardware blog. But I stand corrected and completely agree--everything from text to photos to HD videos looked so much better and sharper. I immediately thought what would an MRI or CT scan look like on this display?

What is a retina display? Retina display is a brand name used by Apple for displays Apple claims to have a high enough pixel density that the human eye is unable to notice pixelation at a typical viewing distance. For a comparison, see the table below, comparing the resolution of a DVD, HDTV and the Retina display. Notice that the 15” Macbook retina display has 15 times more pixels then a DVD and 2.5 times more than a HDTV. Now that’s pretty impressive.

Nothing is perfect. Everything has room for improvement. The trick is to work out a way to continually improve. This is not new. There are aphorisms like “pause to sharpen the saw” and “listen to your customers.”

Easy to say, but how do you do it? At Voalté, a significant part of the company is devoted to listening to the customer and most importantly...paying attention! The Services department feeds information from our customers and users to the rest of the company in several ways through product plans for future work, and more immediate problems too.

We see a lot of information come through Engineering...specifically about new feature requests. We make a big effort to make those new features happen too. Like everyone, we have limited resources but try to make the most users happy with our changes. As a software engineer I really like to see people using the software I write to do something good and useful. It’s why I do what I do in the first place.

But that’s first degree listening. We also want to listen at a higher level, at a second degree. Apple and Steve Jobs knew no one was asking for something like the iPhone when they came out with it, but they knew through listening at a higher level that this was what people really wanted. Now, after four models and an installed base pushing 100 million phones, it’s pretty clear they were right.

New ideas are interesting, but lets face it: ideas are cheap. It’s the execution of an idea to make that idea real that’s important. Smartphones existed before Apple created the iPhone. It was how Apple made the iPhone that’s important. Hospital communications already existed before Voalté. We think, and hope you agree, that it’s our approach that is important. We listened at this higher level and combined voice, alarms, and text and we will continue to listen to improve what we have now. But we’ll also pay attention to what you’re not yet saying and practice that higher degree of listening so that we can continue to give you what you really want and need.

Voalté and Erlang

As Benjamin King pointed out in a recent blog post “Is Erlang Right for Healthcare Communication?”, Voalté uses erlang extensively and loves it! Erlang gives us the right balance of resiliency, flexibility, and maturity needed to solve the demanding problems we face on a daily basis. 

What I find truly amazing, despite erlang's age, is that the community is active and vibrant. Better tools are developed, new frameworks are created and improvements to the core are happening constantly. An increase in public activity over the past few years has lead to what I perceive as the "Erlang Renaissance". 

I love participating in this community. I especially enjoy publishing tools we create as open source in hopes that others will find them as useful as we did. 

Erlang Factory 2011

A couple of weeks ago, I presented at the Erlang Factory Conference in San Francisco on a tool I created called “emetric - Getting Useful Metrics From Your Erlang Node” (a blog post will follow soon on the topic). You can access the slide deck, but it probably won't make too much sense out of context. The Erlang Factory promised to publish the conference videos to vimeo.com in the near future. 

I have attended this conference every year since it started, but this was the first time I presented. It was a special opportunity, and I thank The Erlang Factory for offering it to me. It also allowed me to hang out with old friends, meet new people, learn fresh ideas, share thoughts and talk “shop”. 

One of the major themes for the conference was all the support tooling that’s now available to us erlang developers. Kostis and his team have created fantastic tools which appear to perform acts of magic.  As Jack Moffitt pointed out in his talk “Erlang Gives You Superpowers”. 

Here’s a quick recap of what I found to be the highlights of the event:

Distributed Social Networking
The folks at Process One have started working on fixing the social networking problem. (Putting all your personal information into a single corporation and letting them sell it is a Bad Idea[tm]). Their solution to this problem holds a lot of promise, though it won't be available until later this year when ejabberd 3.x is out.  The possibilities for Voalté are very exciting given this new open standard form of communication. 

Proper

Proper is an open source property checking test tool. You can use it to do 'random' based testing on various properties of your modules. It is extremely useful in finding edge case bugs in your code. You should be using this. 

Tidier
Tidier is a tool that does automatic refactoring. It transforms common anti-patterns or old styles into modern best practices and simpler statements. The best part is that due to erlang's functional nature, semantics are preserved. 

Example from their presentation: 

lf(X, List) ->   

 lists:filter(fun (Y) ->

  if X =:= Y -> true;

   true -> false

 end

end, List). 

to

lf(X, List) ->   [Y || Y <- List, X =:= Y]. 

There are plenty more examples of this magic in the slide deck. 

Dialyzer

Dialyzer is a static analysis tool. While erlang may be dynamic-typed (non-static typed depending on how pedantic you are), there is a facility to provide a type specification for your functions. This is more like formal documentation that the compiler checks rather than a static interface declaration or anything even remotely close to haskell's type system. 

Dialyzer uses formal documentation hints to determine if there is any incorrect code, unreachable code, etc… everything a mature static analyzer can do. 

Softlab has a public results page for open source projects. See the warnings on ejabberd…they’re quite illustrative. 

Rebar
The erlang community is rapidly standardizing on rebar as the build tool. Even in a 20+ year old language, there is still room to innovate on build tools. 

What dizzyd managed to do is take all the complexities of building erlang systems and wrap it up into a tool that uses convention over configuration. No longer is it necessary to mangle large complex makefiles if you are following OTP principles in your erlang projects. You no longer have to create large and arcane tuple littered files to configure a baroque release system. Rebar assumes you are following OTP and does most of the heavy lifting. 

All of this is provided in a single escript file, too. There are no dependencies outside of a base erlang install. 

Rebar has been a godsend to those who are managing large projects. 

CUDA  (NVIDIA’s parallel computing architecture)
Kevin Smith has written an erlang library for interfacing with CUDA called pteracuda. For me, this is a solution in search of a problem. I don't mean to imply that CUDA is not useful, far from it. There are tons of use cases: routing table lookups in O(1), biotech, stock analysis, etc. The problem is that I am not currently working in any of those fields where CUDA could be used. For now, I just get to fantasize about using a 1024 core system. 

Voalté using the cool stuff

The Erlang Factory Conference gave me the opportunity to get a closer look at lots of new tools and random geek drool items. What does this mean for Voalté and our code? Lots of exciting stuff!

We have already moved our build system to rebar. This allows us to reduce makefile size, delete code and get the same results…always a Good Thing[tm]. Rebar is also very hackable—a huge win all around. 

Proper, dialyzer and tidier will also be going our build process soon. These tools provide so much benefit that it would be foolish for us not to utilize them. I am especially looking forward to all the rewriting that tidier will do. 

What feature are you most excited hearing about? We’d love to hear your thoughts. 

In today’s mobile market frenzy, being at the forefront of mobile technology in healthcare means more than just moving quickly --it means knowing what's coming next.

On March 2, Apple introduced the iPad 2, the first iOS device to use a multi-core processor. But here at Voalté, we’re ahead of the game. We've been preparing for multi-core devices for the past six months. Our software already takes full advantage of these new processors. And when Apple announces a multi-core iPhone, we'll be ready for that too.

As the lead iOS developer, it's my job to watch mobile trends and ensure we stay ahead of the curve. I also share what I learn with other iOS developers, which is why I gave a presentation at an iOS Developers Meetup back in December 2010 concerning multi-core devices. The message of the presentation was clear:

"Multi-core iOS devices are coming. Are you ready?"

A multi-core processor is a CPU that has multiple operating cores (brains) on a single chip. In other words, it's just like having multiple CPUs, but they're all squeezed onto a single chip. The reason this is so important is because multi-core processors present a fundamental change in the way software is written.

As a metaphor, imagine you're managing a restaurant. You have one cook. As your business begins to get more customers, your cook must work faster. But as business grows, your cook eventually hits a wall and cannot keep up with the orders. Eventually, you must hire another cook. But two cooks in the kitchen are much more different than one because your original cook was used to doing everything on his own. Now the work needs to be shared and the cooks need to learn to communicate and not to step on each other’s toes. Once they work out a system, the kitchen runs smoothly again and business can continue to grow.

And so it is with computers. CPUs get faster and faster until eventually they hit a wall. At this point another core is added. But the software was used to doing everything with a single core. If the software is to take advantage of the new hardware, it must be adapted to share work between multiple resources.

Although the presentation, in its entirety, is directed at developers, I spend the introduction discussing general concepts. So if you'd like to learn a bit more about multi-core CPUs or you want to take a peak into the world of iOS engineering, here's what you'll find in the video:

There’s no question that the social media explosion being led by companies like Facebook and Twitter is having a profound impact on healthcare. While the introduction of such innovative technology into the healthcare industry is sure to be met with fiery debate, I continue to be amazed at the rate at which it’s being adopted (as of August, there were 552 hospital Twitter accounts and 341 Youtube channels) and the uses the industry keeps finding for it.

Since February 2009, when Henry Ford Hospital performed the first live-tweeted surgery, several other hospitals have followed suit, including Voalté’s first customer and key development partner, Sarasota Memorial Hospital. The hospital used this to demonstrate a new, minimally invasive approach to treating renal cell cancer from the operating room to physicians attending the Southeastern Section of the American Urological Association’s Annual meeting in Miami.

The use of hashtags have also exploded since the first healthcare hashtag, #hcsm, appeared two years ago (What is a hashtag, you ask?).  Today, several dozen other hashtags are used, driving trending topics, discussions, and even weekly conversations such as the #hcsm chat on Sundays from 9 PM – 10 PM EST. Hashtags have become so critical to the online healthcare conversation, that when Fox ePractice  unveiled its Healthcare Hashtags Social Project to better organize the conversation, over 1 million tweets were catalogued in the first week alone.

If you stop and think about it, it’s truly quite remarkable that an industry not typically known for its early adopters has really embraced this trend and pioneered some really innovative uses for it. For a Company like Voalté, it’s validation that we’re heading in the right direction, but more importantly, it represents the opportunity for caregivers to further hone their craft on a (global) scale that was previously not possible, while making enormous strides in the way patient care is delivered.

The debate over social media’s role will surely continue for some time, but it’s exciting to think of what this may all mean for the coming year and beyond. When @Jack sent the world’s first tweet back in 2006, I don’t think he expected surgeons to be live broadcasting procedures just a few years later. Are new innovative uses just around the corner for others like Foursquare or newcomer Quora? Welcome to 2011—a new decade in healthcare.

As if I didn’t have enough to do when my CEO walks in and says he wants me to attend a people management course at the Disney Institute. 

I would say that I am a pretty likeable person and I get along with ninety nine per cent of the people I meet, so why do I need people management training?  Well how about saving time, saving money, sustaining good employees and developing a strong corporate culture to name a few.  After all, a few days at Disney can’t be all bad and they do employ a lot of people and they do have a pretty successful track record.  Why not?

After the training, and filled with newfound knowledge, I decided to put my new skills to work at Barcamp Sarasota.   With my Disney training manual close at hand, I proceeded to emulate the giant mouse. Barcamp is a type of 21^st century ”unconference”, a facilitated user-driven unstructured conference usually based on a technological theme. When you arrive you can sign up to give a presentation or just meet other like-minded individuals. 

 The Disney approach to people management focuses on four main themes -recruitment, training, communication and care.  Now this is where Disney weaves it’s magic.  Their attack strategy (so to speak) is to create an overall mood by way of incorporating beautiful visuals and audio into their training and literally everything else they do. They attack your senses and arouse your emotions.  You are rendered helpless.   They create a magical formula that leaves an everlasting impression on anyone who enters their domain.  This was now going to be my new approach to organizing Barcamps, hiring employees and helping to develop an enviable corporate culture.

My first plan of action was to create a buzz, not just interest, but hype and buzz and excitement that Voalté, a prominent, young, local start up, was an organizing sponsor of Barcamp Sarasota.  The word started to spread that we were coming and also seeking to recruit a couple of summer interns for software testing. 

At Barcamp Sarasota I gave a presentation about Voalté, who we are, what we do and what our goals are.  Borrowing on Disney’s captivating audio and visual approach I included pictures, videos, and music to enhance my presentation and motivate my audience.  Before the presentation began I put up an image of the four co-founders of Voalte wearing our signature black and pink scrubs.  In the background the Pink Panther theme was playing. The mood was set.

After my presentation I was approached by many young hopefuls who all wanted to intern at Voalté .  Because of the overwhelming response, I now had to set up a round of interviews.  Once again, I had the opportunity to focus on my new people management skills.

The first item on my agenda was to prepare a plan of action prior to the interviews.

The plan included having the interns being interviewed individually by the four co-founders whose photos they had already seen at Barcamp.  Next, I prepared the conference room where the interviews were going to take place.  I wanted their first impression of Voalté to be stellar.  The conference room also included images of our advertising campaigns and trade shows.  A little attention to detail helps set the mood.

Fortunately we were able to select two interns from our pool of applicants. 

Voalté is a mobile development shop where we create iPhone and BlackBerry applications.   Now our two interns had to be trained on how to use our computer systems, how to use our development tools and how to build our software.  Training and communication was key.

Everyday became a new learning experience for our interns.  Daily they met with me for 30 minutes to review work they had completed and to receive their marching orders for the day.  They were also included in the daily developer briefings (scrum) and by the second day they were giving the other team members an update on their progress.  By the end of their first week not only did they manage to find a couple of bugs but they also completed their first test report and summary.  Everyone was very impressed.  As a reward for their hard work and efforts I took them out for lunch at the end of their first week.  Even Disney agrees that by celebrating success you create an environment of success.

When you break down and analyze the Disney “dynamic” it literally all boils down to common sense and simplicity. Disney did an amazing job of articulating and presenting their blueprint to us. It consistently works for Disney and many Fortune 500 companies. It’s really very simple if you follow the blueprint and implement the concepts.  You’ll be amazed.

As the Vice President of Innovation at Voalté, it is my responsibility to understand smartphones and work with caregivers to figure out ways to help incorporate these devices into their lives at the point of care.  In fact, our company focus is entirely on providing hospitals the best communication solution for clinical communication on the latest cutting edge mobile platform.

I have used multiple BlackBerry devices throughout my career and have also used an iPhone the last few years. I can easily claim to be a smartphone “fanatic” and it is probably the one device I would not be able to give up in my professional life (seeing the value of smartphones in my personal and business life was a deciding factor in why I started Voalté to help bring about smartphones at the point of care).

Last month I decided it was time to see what all the fuss was about regarding the Android operating system.  On April 20, 2010, at approximately 4:15PM- I pulled the SIM card out of my iPhone 3G and switched over to a Google Nexus One (both use AT&T and I wanted to make sure the carrier was not a deciding factor in the experiment).

This wasn’t just a one or two day test of the Android- this is full fledged, 100% business operations, mail, app’s, and all - switch from the Apple iPhone OS to the Google Android OS. Below are a list of my thoughts after more than a month of Android vs iPhone use:

1. Multi-tasking and widgets

The first things I noticed about the Android was the concept of widgets vs just being able to run applications. The widgets enable you to peak into an application and see small amounts of information right on your desktop. For example, my mail widget shows me the latest email that has just come in, my calendar widget shows the time and attendees of my next appointment, and my Facebook widget shows the last status update in my newsfeed.

My imagination goes into overdrive regarding the potential of Android Widgets in point of care communication- but that is the topic for another blog post.

Multi-tasking was OK (iPhone 4.0 levels the playing field)- but it really was the capability to use widgets that really impressed me.

2. Applications

The applications for Android are not up to par with Apple. It’s not even close. The look, the feel, the quality- it’s day and night. I would imagine this is due to a couple reasons. First of all- Apple has a head start in the world of App development. There are more developers working on iPhone app’s; Apple claims more than 200,000.  And while a majority are not worth downloading, there are a few gems that really raise the bar for other applications.   Second, developing software using Apple’s iPhone Software Developer Kit provides more guidance and better tools for development, compared to Android’s Java based SDK. You give developers better tools and they will build you better app’s.

There’s an App for that- and chances are- it runs much better on the iPhone.

3. Performance and Battery Life

I get pretty good battery and performance out of my iPhone (especially considering how much I use it in a single day), but the performance of the Nexus One Android running 2.1 was much better than my iPhone 3G running iPhone OS 3.X. I will admit that I was using an older generation of the iPhone, but the performance on the Android device was noticeably better. I usually get a good 12 hours out of my iPhone, but the Android was easily pushing 18-20 hours.

Performance and battery were an easy win for the Android.

4. It’s the little things

Moving from an iPhone to an Android, you quickly begin to appreciate Apple’s meticulous attention to detail and creating a compelling user experience. A simple example is the location of the home button on the Android phone- it is located directly under the touch screen and tends to be very sensitive to touch. When the virtual keyboard loads up, it is located right under the Space Bar (one of the most used buttons when constantly typing). The end result is the potential miss type that exits the application and sends you to the home screen- not a pleasant experience when deep in the thought responding to 100’s of emails (which most of us use a smartphone for). The Android is littered with these minor flaws, and while they may seem minuscule, the experience quickly becomes degraded due to these flaws.

Overall – I can’t say that either phone is a clear winner over the other. The quality of the app’s and the attention to detail make the iPhone a great platform for a mobile device, but the concept of widgets and the philosophy of the Android being more of a portal to the web make the Android a really attractive alternative. So here is the big question…

What phone will I be using next month?

Well, to be perfectly honest - a lot of that will be dependent on what we find out from our friend Steve Jobs at Apple’s World Wide Developer Conference…