Chris Carfi (of Cerado and Social Customer Manifesto Fame, as well as being a fellow member of the VRM working group at Harvard) spent an hour this summer having a discussion at the VRM Summit to discuss Customer Driven Markets.
This is another LONG video (1 hr), but there is a really great discussion here.
25 years from now someone in my niece’s graduating class might be the VP pick for the highest office in the land (POTUS). What will that “vetting” process look like? Sure there will be the usual background check stuff, FBI calling their college roommates, PHD advisor, pastor, etc., but what happens in a world where we are declaring our intention and attention (status) all-day, every day. What happens when one of these digital natives, who have been facebooking and myspacing, and flickring and youtube-ing their daily thoughts, ideas, location, and media every day for the next 25 years runs for office?
Past Is Prologue
I had a conversation with my buddy Craig the other day and we discussed how these platforms and models were changing how users interact and part of the discussion touched specifically on:
Right now, every kid under the age of 18 in the US has grown up with potential access to the internet either at home, school, rec center, mom’s office, etc.
For the most part these kids are creating online identities in a ton of places, some are throwaway (to get access to a concert video), and others are permanent (tell my niece she has to quit MySpace and you will end up in a fight).
These kids are getting their own computers (cell phones), self-organizing digitally
They are making their own media (audio, photo, video, text) daily
They are connecting with their friends on these platforms and using them to stay in touch, bully each other, make new friends, etc.
Potentially, this generation will never lose touch with anyone they grew up with – EVER. They graduate from High School Facebook to College Facebook to Work/Life Facebook (or whatever the social platform/graph/grid/mesh evolves to). My niece will be able to keep in touch with, ignore and more importantly, have status on every single kid she is going to high school and college today. I can’t remember every single kid I went to grade school with, but I could probably find a bunch of them on Facebook if I looked hard enough.
Networking? Sure – having the world’s largest, distributed address book in history will make keeping and making connections more interesting.But what happens when you have persistent status of people you know, what they are doing, where they are /were/will be? What happens over time to this data, when it becomes the past tense (was doing, was at, was with)?
Doc Searls has said in a previous VRM meeting that he wants to see a day when the customer can have their own TOS (terms of service) that gives them the right to “nuke my info off your system if I want to quit your proprietary aspect of data”. Outside of the NUKE option (which I think we need), what about an expiration date on my status/intention/attention/media? 15 years from now, does Johnny really want his new girlfriend to see his “Growing Up Gotti” haircut from back in the day? Are those funnel photos from the Preakness really going to be appropriate when your kid decides to “see what mom was like when she was my age”?
Carrying off on this point is a really great and creepy PSA out about kids and the things they are posting to the web:
It changes the game because WE ARE ALL MAINTAINING THE STATUS over our attention/intention/action as well as that of others. There are no reporters, I dont have a secretary, no one is “going to the archives” to find out what I did last week – they just need to follow my twitter feed (which is hooked up to my friendfeed and facebook and wordpress blog) to see what I was doing. Its all in the cache/cloud/reverse chronological order. All someone needs to do is connect the dots (which is getting easier every day).
Your ideas, photos, comments, videos are out there, in the cloud/cache, forever. A persistent, ongoing record, distributed amongst different platforms and social graphs for the world to see. Add in face and voice recognition and that protest rally you went to in college, because that hippy chick you were dating at the time wanted you to go, might become a problem 20 years from now when you run for office, or a job, or meet a not-so-hippy chick. You didnt shoot the video, you didnt know you were on camera, yet it is part of your history. Lots of folks are getting gigs BECAUSE of their participation on these platforms. There are already stories in the “news” (and I do use the term loosely) about how kids are getting turned down for jobs because of things on their myspace page, beauty pageant contestants are losing their crowns because there are embarrassing photos of them on the web, kids are videotaping crimes to get on YouTube.
I hope you know this will go down on your permanent record
– The Violent Femmes Kiss Off
Things to think about:
Will our past actions prevent us from trying for a job (even Vice President) because we know what closets our skeletons are in (“I told the candidate I could not accept the VP nod because I want to spend more time with my family, and because there are some raunchy pictures of me at my roommates’s bachelor party 17 years ago”)?
Will individuals guard their expressions more closely and be more conscious of their attention/intention/status?
What happens when we run into a “blank slate” who doesnt have a facebook history or is tagged in flickr sets? Will we give them the job/trust/reputation? Will they be a social media pariah?
Will I be able to find a “cleaner” to get rid of all traces of Spring Break 2012 in Cancun before my bride-to-be finds them?
Will there be a “Identity Bankruptcy Court” that will order these graphs and platforms to nuke all traces of someone?
That discusses some of his recent troubles, his recent post for Linux Journal and how it connects with VRM.
In a previous life, I worked on a startup called medicalrecords.com. The founder created MedRec after having a medical emergency while vacationing in another country – a situation where he couldnt communicate and they didnt have his information on hand or even accessible. While we felt we had a compelling idea, we were finally crushed by a combination of under-capitalization, the dotcom downturn, HIPPA regs and something that is also facing VRM – *users didnt realize they needed it*.
The problems can be broken down into Behavior/Systems/Tools. The context for medical data ownership and portability wasnt there when we were working on MedRec and it isnt there now (although more are talking about it). Then and now, a certain apathy is present in the userbase that says “well the system/HMOs/My Doctor sucks, what can you do”. Generally-speaking, proactive management of health and wellness isn’t a priority because behaviorally we dont pay attention until we are in a crisis (or think we are about to have one).
Systems-wise, Doctors and Health organizations are under the gun to be profitable, to see as many patients as possible and to get the patient better (not necessarily well) to move them to another part of the healthcare assembly line. If this means taking blood 4 times a day (even if you only need to do it 2x) in order to bill the HMO a little more, the so-be-it. Templates are used to get the best possible outcome out of limited information and time – because doctors dont have the time to spend hours on a specific case. Also liability is a huge issue, and anything they do is looked at under the lens of risk management – they spend so much time playing defense against the user, they dont have enough time to play offense against the condition you are there for. Combine this with government (in my case the US) regulations to protect the consumer from their medical data being mishandled/misused and the system, while working, sure as hell isnt efficient. By making a one-size fits most solution, by ignoring the users who want to opt-in to their lives, they are missing the catalyst for innovation.
As far as tools go, they are out there. IT spending in the healthcare industry is evergreen – as long as that new system can shave a couple cents off of every patient, then it is worth it the investment. “A discount for locking us into your platform/proprietary model? SURE!”. Lock-in, a single “throat to choke”, someone to sue if the system fails is all a part of this. I am sure more and more hospitals and healthcare concerns are using open source for scalability, availability, security and cost – but they dont necessarily subscribe to the F/OSS ethos: users, not believers. We are talking about an industry where door-to-door salesmanship is alive and well (pharma sales reps). A couple of years ago I got to spend a few weeks in FLA while my dad was in ICU with MRSA (a particularly nasty staph infection that only responded to a drug that you can take 7 doses of before it destroys your liver). They had an incredible single-patient-record system, where everything about the patient, from notes, to timing of medicine to test results were available in realtime, as it happend, within their 4 walls. And when you walked out of the hospital *poof* – the data, the history all gone, locked into their machines – unshareable, untransmittable outside of printed or faxed results (believe me, I tried).
All of this – user apathy/lack of understanding the use-case for owning their medical data, revenue and risk management instead of health and patient services as operating principles, government policies that lock in the users without flexibility or customization and a lack of appreciation for a world outside of “lock-in”, and you have a perfect storm of suck-age.
Does VRM apply? Absolutely. User-centricity, control, having a stake in the game (I think health is possibly more important than any other transaction – other than using VRM to find a mail-order-bride of course) along with users and vendors “partying together”(thanks Dave) are all a part of VRM.
Users – need to get more active and engaged. Understand they need more control and then demand more control. Act more like a partner in their own health and less like a consumer of services (insert cathedral-bazaar reference here). Users need to understand how VRM-Health will change the quality of their care (and the care of those they love – healthare is rarely a singular effort – it effects a lot more than just the person who is sick). They need the tools to manage their personal medical record and they need to demand their healthcare providers get engaged
Government will not stay out of the discussion – they have a valuable role to play and the better informed they are, the better it is for the users (both savvy ones and the less-engaged). We will never get away from Legislation, but it can be more user-centric, more opt-in opportunities, more pushes for innovation, more requirements to make users more engaged. The government (Fed, State, Local) is the biggest payer for medical services, and VRM can help improve that situation by reducing friction in the transaction.Govt need to encourage engagement and make incentives for business to be more open
Medical Establishment needs to see value in putting users more in charge. Lots of HMOs offer wellness programs and rebates for things like going to the gym (% off gym memberships if you go x times per month). One or two innovative companies need to begin seeing the user as more of a partner and less of a victim, er, uh, consumer. Hospitals need to make data portability part of the patient bill of rights. Primary care people/orgs need to begin educating users on taking control of the management of their health. They need to start trusting the users more, build open ports into their platforms to support their communities and see HealthVRM as a building block for their business as opposed to a stumbling block