It’s Morning in India

This week’s award for not knowing what world you’re living in surely goes to the French high school and college students who blockaded their campuses, and snarled rail traffic, in a nationwide strike against the French government’s decision to raise its pension retirement age from 60 to 62. If those students understood the hypercompetitive and economically integrated world they were living in today, they would have taken to the streets to demand smaller classes, better teaching, more opportunities for entrepreneurship and more foreign private investment in France — so they could have the sorts of good private sector jobs that would enable them to finance retirement at age 62. France already discovered that a 35-hour workweek was impossible in a world where Indian engineers were trying to work a 35-hour day — and so, too, are pension levels not sustained by a vibrant private sector.

What is most striking to me being in India this week, though, is how many Indians, young and old, expressed their concerns that America also seems at times to be running away from the world it invented and that India is adopting.

With President Obama scheduled to come here next week, at a time when more than a few U.S. politicians are loudly denouncing immigration reforms, free trade expansion and outsourcing, more than a few Indian business leaders want to ask the president: “What’s up with that?” Didn’t America export to the world all the technologies and free market dogmas that created this increasingly flat, global economic playing field — and now you’re turning against them?

“It is the Silicon Valley revolution which enabled the massive rise in tradable services and the U.S.-built telecommunication networks that allowed creation of the virtual office,” Nayan Chanda, the editor of YaleGlobal Online, wrote in the Indian magazine Businessworld this week. “But the U.S. seems sadly unprepared to take advantage of the revolution it has spawned. The country’s worn-out infrastructure, failing education system and lack of political consensus have prevented it from riding a new wave to prosperity.” Ouch.

Saurabh Srivastava, co-founder of the National Association of Software and Service Companies in India, explained that for the first 40 years of Indian independence, entrepreneurs here were looked down upon. India had lost confidence in its ability to compete, so it opted for protectionism. But when the ’90s rolled around, and India’s government was almost bankrupt, India’s technology industry was able to get the government to open up the economy, in part by citing the example of America and Silicon Valley. India has flourished ever since.

“America,” said Srivastava, “was the one who said to us: ‘You have to go for meritocracy. You don’t have to produce everything yourselves. Go for free trade and open markets.’ This has been the American national anthem, and we pushed our government to tune in to it. And just when they’re beginning to learn how to hum it, you’re changing the anthem. ... Our industry was the one pushing our government to open our markets for American imports, 100 percent foreign ownership of companies and tough copyright laws when it wasn’t fashionable.”

If America turns away from these values, he added, the socialist/protectionists among India’s bureaucrats will use it to slow down any further opening of the Indian markets to U.S. exporters.

It looks, said Srivastava, as if “what is happening in America is a loss of self-confidence. We don’t want America to lose self-confidence. Who else is there to take over America’s moral leadership? American’s leadership was never because you had more arms. It was because of ideas, imagination, and meritocracy.” If America turns away from its core values, he added, “there is nobody else to take that leadership. Do we want China as the world’s moral leader? No. We desperately want America to succeed.”

This isn’t just so American values triumph. With a rising China on one side and a crumbling Pakistan on the other, India’s newfound friendship with America has taken on strategic importance. “It is very worrying to live in a world that no longer has the balance of power we’ve had for 60 years,” said Shekhar Gupta, editor of The Indian Express newspaper. “That is why everyone is concerned about America.”

India and America are both democracies, a top Indian official explained to me, but emotionally they are now ships passing in the night. Because today the poorest Indian maid believes that if she can just save a few dollars to get her kid English lessons, that kid will have a better life than she does. So she is an optimist. “But the guy in Kansas,” he added, “who today is enjoying a better life than that maid, is worried that he can’t pass it on to his kids. So he’s a pessimist.”

Yes, when America lapses into a bad mood, everyone notices. After asking for an explanation of the Tea Party’s politics, Gupta remarked: “We have moved away from a politics of grievance to a politics of aspiration. Where is the American dream? Where is the optimism?”

Thomas Friedman again hits the nail on the head on American innovation and spirit. The US for so long has been the innovation hub of the world for major thinking (and we continue to be today). However, there is a feeling in the air that we are losing our edge. Around the world, American's are thought of so highly because off "imagination, ideas and meritocracy." But this article shows that maybe that view is changing.

Hopefully, Mr. Friedman is stating that OTHER countries are feeling we are now being pessimists, and that is not his thought. It would be heavy handed to say that most American's are worried they cant pass on a spirit of optimism to their kids. We maybe in tough times the past few years and for the next few years. But 5 years does not change the American spirit.

Our culture is still the idea generating culture it has always been and the most the world has ever seen. We must fight, push, struggle, succeed, fail and invent everyday to continue this spirit. It's who we are; its what we do, no matter what short term issues we are focused on today.

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Seth's Blog: Make a Dent in the Universe

Where, precisely, do you go in order to get permission to make a dent in the universe?

The accepted state is to be a cog. The preferred career is to follow the well-worn path, to read the instructions, to do what we're told. It's safer that way. Less responsibility. More people to blame.

When someone comes along and says, "not me, I'm going down a different path," we flinch. We're not organized to encourage and celebrate the unproven striver. It's safer to tear them down (with their best interests at heart, of course). Better, we think, to let them down easy, to encourage them to take a safer path, to be realistic, to hear it from us rather than the marketplace.

Perhaps, years ago, this was good advice. Today, it's clearly not. In fact, it's disrespectful, ill-advised and short sighted. How dare we cheer when a bold changemaker stumbles? Our obligation today isn't to spare the feelings of our peers from future disappointment. It's to establish an expectation that of course they're going to do something that matters.

If you think there's a chance you can make a dent, GO.

Now.

Hurry.

You have my permission. Not that you needed it.

At a Company-wide meeting today, I read this quote from Seth Godin's blog. This is what innovation is all about. I have found that we all have the ability to innovate - its not about taking chances and risks, its about the mind set that you are not going to be satisfied with the status quo and you are going to find a better way. But sometimes, you have to help people find their inner innovator.

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Steven Johnson - Where do Good Ideas Come From?

I often get asked by executives of other companies and other entrepreneurs where we find the ideas to keep rolling out new products.  In fact, some of them suggested I put more blog posts toward this subject, so I will!  (Give the people what they want!)  Even during the tough times of 2009, we "innovated our way through the downturn."  We have rolled out 2 blockbuster products in the past 18 months and have two more in the works that I am excited about.

It definitely starts with our people.  We passionate people who really care about making healthcare safer and more efficient.  We all believe There is a Better Way to deliver care.  But it goes beyond that - at Mobile Aspects, we create an atmosphere to collaborate.  I think thats what Steven Johnson hit upon so well here in this TED Talk that he gave.  You need people from different backgrounds to talk, share ideas and cross pollinate.  Our eingineering teams work closely with our clients.  Our clients tell us the problems they have, and we draw up different solutions.  From that comes beautiful ideas that we then execute and deliver. 

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Why we have HIPAA laws: Scrapers' Dig Deep for Data on the Web

Unscrupulous practices. These are the types of companies that ruin it for the rest of us who are truly trying to help people and hospitals. If I am a hospital, I totally see why they have to be so protective of their patients' data. You never know what some people are trying to do.

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Pretty cool, may not be useful: Glympse Is a Real-Time and Private Location Sharing Tool

I am not sure how practical this is to use, but it is pretty cool. I am pretty sure someone will figure out how to share location properly with a good case, and also solve any usage (will people use glympse more than once?) and privacy issues. Getting closer though.

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Classic: David Blaine at TEDMED. Great video, insane ideas.

"If one person can do it, anyone should be able to." I love insane ideas. They are the best ideas.

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Walt Mossberg video: iPad in Paris (tablet only on business travel)

Now I have been toting only my iPad for business trips (about 4 / month) since the iPad launched. It has been a major success for me in travels vs the laptop. For the 90% of the work of email checking, surfing, reviewing / editing presentations, documents and spreadsheets, etc, the iPad is terrific. The updated versions of Keynote app for iPad is a great way to make impressive presentations (a big part of my job in communicating to customers and employees).

Then add on that I no longer need to carry physical books in my bag or a video player, the iPad is an incredible success. I have at any time 2-3 new books ready to read and 3-4 movies ready to watch. I am reading a book a week now, if not more (previous to iPad it MAY have been a book a month).

I actually found it funny that Mr. Mossberg needed to do an article on traveling with an iPad at this point in time as I think most iPad owners (now in the millions) found this out as soon as they got their ipad. But thats alright, this is also communicating to the 10's of millions of people who are still unsure about iPad and other upcoming tablets.

A major benefit, not to be under estimated, is I now just carry a very light iPad (vs notebook) in a light over the shoulder bag. I have been able to get rid of the ugly laptop roller bag or large backpack, both of which stressed my back. Plus it looks a little more chic. :-)

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Airprint Printing in iOS 4.2 Looks Great; Print Command on Share Button

Biostatistics - sometimes cause of death is plain old age.

Some people die like that, too. The trouble is there's not a good name for it.

Is there a single problem that gets the final chain of events going? Or should "old age" under some circumstances be considered an actual cause of death - equal to lung cancer, leukemia and diabetes?

Those questions are becoming increasingly important as more and more people die at very advanced ages without an obvious cause that can be confidently entered on the death certificate.

The difficulty of naming a cause of death in the very old is becoming enough of a problem in the industrialized world that the World Health Organization is likely to address it head-on it in the next year.

"If we can't find a way of dealing with this, then I think mortality statistics will lose much of their value," said Lars Age Johansson, who chairs WHO's Mortality Reference Group and is a biostatistician with Sweden's National Board of Health and Welfare. "I see this as very, very important."

Part of the reason it's important is that mortality statistics are the backbone of public health.

Without knowing how the members of a population die, and at what ages, epidemiologists can only guess how many deaths are potentially preventable. On the other hand, good mortality data can identify overlooked problems and help public health agencies decide where to direct effort and money.

The issue is especially topical because experts from around the world next year will start updating the International Classification of Diseases, medicine's official list of more than 14,000 diagnoses.

"Each revision of the ICD is the right moment to reconsider this question," said Gerard Pavillon, a French biostatistician who will c0-lead the mortality statistics committee.

Some places began recording all deaths and their causes in the early 1800s. The original ICD, called the International List of Causes of Death, was adopted in 1893. It had 161 headings (with more specific causes falling under some of them). Paradoxically, it was probably easier for a physician to choose a cause of death then than it is now when far more is known about the complicated physiology of dying.

Today, doctors are expected to list both "immediate" and "underlying" causes of death and how long those diseases had been present. They are also asked to list "significant conditions contributing to death" but not causing it directly. But picking the "underlying cause" - which is the most important one - when a patient has several chronic illnesses, such as hypertension, dementia and coronary heart disease, is often difficult.

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Scientist at Work - Dr. Donald A. Redelmeier - Debunking Myths of the Medical World

We should all celebrate the likes of Dr. Don Redelmeier. Now I dont think that US Healthcare is necessarily broken, but we founded Mobile Aspects, believing there is a better way. Dr. Redelmeier is one of those rare people who doesnt live and think within the lines that life paints. He views everything from a different angle and questions why we do thinks in a certain way. Because of him, we have rules for hands free driving only. We have further public education on the perils of drinking and driving. Though it may be uncomfortable to look introspectively at healthcare, it is incredibly encouraging to see that it is becoming more commonplace. This is leading to change in healthcare... change that is making hospitals safer, smarter and more efficient.

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Goldilocks: The importance of "Just Right" in this volatile healthcare environment

In my newest post to our Mobile Aspects Innovation blog, I discuss the value of real time, reliable data.  Everyone knows that data is king today.  However, with not only constant, but large changes daily in the current healthcare environment, along with a lot of unknown territory, the value of this data is even more important.  Link to post:  http://www.mobileaspects.com/blog/?p=269

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Newest MA blog post: Topflight customer service from a Shoe Salesman and a Cabinet Maker

Tony Hsieh, the CEO of Zappos, wrote a terrific article in the August, 2010 Harvard Business Review.  He recognized that he and his company have one product: customer service.  They don’t make a widget, they just resell someone else’s widgets.  But his company goes the extra mile in everything they do in customer service and have set the standard.  They allow people to return shoes up to 365 days after receipt, they have no call trees, they truly believe that Customer Service is an extension of marketing and not a ‘cost they must pare’ to the Company.

At Mobile Aspects, since Day 1, we have had the same philosophy: Customer service is a differentiator and is 1.a in priority (right next to having an incredibly easy to use, reliable product).  But every member of our team, top to bottom is incredibly focused on customer service.  When you call our 800 number with a question, you dont get a call tree; you will reach one of our Client Service team in Pittsburgh.  These aren’t just call center people, but in fact, great people who have serviced and worked with the product in the field and continue to do so today.

Customer service is not just about taking a call and filing it.  It is about the relationship with the customer.   Our customers know most of our employees by name, know their cell phone numbers and know their home phone numbers (as Tony Hsieh says, ‘the telephone is one of the best branding devices.’).  They know us and our families and we know our customers by heart and their families.  I can’t tell you how many times customers call us just to talk.  We love to ‘just talk’!

Sometimes when you call, you will reach our CTO, our VP of Engineering, or many other people outside of core Customer Service.  Yours truly, and also the CFO and all management go out into into the field weekly and discuss and talk with customers to get their feedback.  No one, and I mean, NO ONE has a desk job at our company.  Truly at Mobile Aspects, we believe customer service is EVERYONE’s responsibility, and you see that from the incredible dedication of our people.  When an issue happens in the field, you will not see a team of people react faster and work harder to solve that customer’s problems.

It’s starts with the culture in the company set by our great employees.  But it also continues into our HR practices.  We look for only those people that have shown us strong evidence they will do whatever it takes for our customers, roll up their sleeves, and do anything we can to make them happy.  Everyone in our company knows how important a happy customer is.  We’re not perfect (we’re just human beings!), but we make up for any imperfections with passion.

Though we make a widget, we also understand every business is in the hospitality business.  It makes the customer feel comfortable about the company and the product.  Our customers know if they call us with an issue, we’ll jump to solve it.  And if we can’t solve it remotely, we’ll be in a car or on a plane the next day to solve it in person.  Customer service is not just for hotels, it’s also vital to the business of a Shoe Salesman and Cabinet Maker.

This entry was posted on Wednesday, July 28th, 2010 at 11:30 pm and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.

In my post on the Mobile Aspects blog, I discuss Zappos' philosophy on customer service, as well as our own. Hospitality is in everyone's business. The most important thing we can all provide is a great customer experience. Click on the link to read the whole post.

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The Volt vs The Leaf. Both a great choice, but one wins out

I am close to getting ready to be in the market for a new car. My trusty Mazda 6 Hatchback Sport is still doing very well after almost 6 years (and barely 55k miles). But with all the ads now coming up around electric cars I am getting excited. We already own a hybrid (Toyota Camry Hybrid) and love getting 30+ mpg's in the city and 40 on the highway in such a big, family friendly car.

So far, the choices are boiling down to the Chevy Volt and the Nissan Leaf (mainly because of availability). Thankfully, both have a $7,500 federal tax credit and the state of Pennsylvania will give us an additional $500.

My main factors for choosing a car would be:
1. Cool (I know thats generally in the eye of the beholder)
2. Size (needs to be big enough for wife + 2 growing girls)
3. High MPG
4. Technology
5. Want to buy American
6. Layout of dash, console
7. Want to have a nice car, but not to showy

(note: agreement by the wife trumps all of the above). Now reviewing the two cars, I think I am landing on the Volt. It is definitely bigger and that is a big reason. The other and more important is that the Volt has the backup gasoline engine.

It seems a lot of environmentalists want to 100% eliminate use of oil. I am not in this camp. I believe we need to reduce oil consumption, but eliminating is too extreme (right now) of a goal. Overuse of oil is bad not only for the environment, but also because extra money gets into bad people's hands. A reduction of oil use by 20% in the very near term (next decade) will have a real effect - only spare money goes to terrorists, and all the spare money will be gone. The US has already flattened out amount of oil use on an annual basis. Now we can reduce the overall use year over year, in combination with better catalytic converters, will reduce pollution tremendously enabling the ecosystem some 'breathing room'.

The other great thing about the Volt is that it uses standard 120v plugs in the house. The Leaf will require new plugs in the house, adding cost and frustration. On a daily basis, I can get to work or the airport and back without having to use any oil. If I combine this with moving my electric source to a clean energy provider I will dramatically reduce my personal footprint.

Lastly, the Volt is American. I would like to buy American more often, but in the past, American cars have been clunky, poorly laid out internally, uncool, immediate value loss cars with poor quality. This caused us to buy the Toyota Camry Hybrid last time and the Mazda 6 before. This is changing in both reality and perception now (perception vs reality IS important).

Now my only problem with the Volt (other than still a little hesitancy to buy a Chevy due to perception issues) is price. Now Chevy says that their cost is so high due to the battery. But the Leaf would have this same problem, yet comes in at $8,000 less. At least Chevy has made the lease rate the same as the Leaf ($350 per month).

I haven't 100% decided, and I haven't even seen in person, nevertheless test driven either car. But on what I know so far, the Chevy Volt seems to be the choice over the Nissan Leaf. The prevailing thought I have heard is 'the Volt an be your first car, whereas the Leaf really should be your 2nd or even 3rd car.' Let's hope more choices come on the market soon. In the mean time, I am hopeful the Volt can be a pretty big mass market hit, reduce our oil usage and put America in the lead again.

From The New York Times:

The Volt, G.M.’s Plug-In Car, Gets a $41,000 Price Tag

The carmaker has begun taking orders for the plug-in vehicle, which is expected to be at dealers in November.

http://nyti.ms/dAzIY7

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Oil Rig Alarm Was Not Fully Turned On, Worker Says

Once again, one of the biggest learning from the BP oil disaster is that severe disasters are never the result of one smoking gun incident, but a series of errors:

"At hearings this week, crew members have described repeated failures in the weeks before the disaster, including power losses, computer crashes and leaking emergency equipment."


This applies to energy disasters, healthcare disasters (unnecessary death or serious injury to patient), and industrial accidents.  Human beings are very good at putting measures into place and to learn from previous disasters.  The problem is they eventually fail due to human involvement.  It only takes being careless just that one time.  Alarm fatigue became a big issue on the oil rig, and so the workers turned it off so they wouldn't be woken up (listen up car manufacturers!).

Design of systems for human interaction has become the skill du jour.  We practice it heavily at Mobile Aspects.  Our RFID systems for hospitals are some of the easiest to use for any system in healthcare.  But we also realize that design of failure systems is just as important: systems work the way as intended 99% of the time.  1% sounds minuscule, but in reality, it is a large number.  We advocate for our systems and for anything else that our customers ensure the failsafes built in are meant for human use and without alarm fatigue.

From The New York Times:

Oil Rig Alarm Was Not Fully Turned On, Worker Says

The safety alarm was not fully activated to avoid waking up the crew, and so did not sound during the disaster, a worker testified.

http://nyti.ms/a3cmDW

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Congrats to Childrens Hospital Boston - ranked #1 Childrens Hospital... again!

Most kids have no more than the usual assortment of childhood medical mishaps and never go beyond the ER if they spike a fever or the outpatient clinic for tests. But there's always that "what if." Many thousands of children every year do need expert care. What do you do if your child has a heart defect, or a disorder that interferes with digestion? Out of all of the roughly 5,000 U.S. hospitals, only about 1 in 30 has deep expertise in caring for children with serious problems. For youngsters who need that quality of care, the Best Children's Hospitals rankings showcase the medical centers that see kids every day who have cancer, cystic fibrosis, defective hearts, and countless other life-threatening or rare conditions beyond the capabilities of most hospitals, even those with sizable pediatric departments.

A small number of hospitals—eight this year—ranked in all 10 specialties and make up the 2010-11 Best Children's Hospitals Honor Roll. They are in alphabetical order.

Childrens Hospital Boston continues to lead the way in Pediatrics. From its cutting edge research, great staff, to its outreach in the community (as well as being the hospital Curious George goes to) Childrens show how to do it. We have worked closely with the staff there in the operating rooms in use of our RFID systems. In fact, they pioneered our RFID tissue tracking system. We want to thank them for being such tremendous partners!

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Congrats to all our RFID clients on the top Hospitals list!

2010 US News and World Report Honor Roll

 

It's no secret that all hospitals are not equal. The special quality shared by the 152 that made it into the new 2010-11 Best Hospitals rankings (out of nearly 5,000 that were considered), and even more so by the 14 in this year's Honor Roll, is their ability to take on and meet the most difficult challenges. Their operating rooms showcase delicate, demanding procedures—excising a cancerous portion of a pancreas without destroying the rest of the fragile organ, say, or restoring function to an arthritis-ravaged hand through a creative blend of fusing joints and splicing tendons. They are referral centers for ill patients with multiple risks—advanced age plus heart failure plus diabetes, perhaps.

Patients at these centers are not exempt from picking up hospital-based infections, getting the wrong drugs, or becoming victims of other medical errors. No matter how skilled or deep their expertise, even "best hospitals" don't do everything right. But when high stakes call for unusual capabilities, they are hospitals that can save lives that might be lost or preserve quality of life that might be sacrificed. That is why U.S. News has published the Best Hospitals rankings for 21 years: to help guide patients who need high-stakes care because of the complexity or difficulty of their condition or procedure. For 2010-11 we analyzed 4,852 hospitals, virtually every one in the United States, in 16 specialties from cancer and heart disease to respiratory disorders and urology. Only 152 centers appear in even one of the 16 specialty rankings. Fourteen ultra-elite Honor Roll hospitals had very high scores in six or more specialties.

 

 

The Honor Roll requirements were so stiff that 99.7 percent of all centers in the nation were excluded. A hospital had to be ranked in at least six specialties, but ranking alone was insufficient for inclusion. It also had to have an extremely high score (in statisticians' terms, at least 3 standard deviations above the mean). That earned 1 point per specialty. Reaching the top of the Honor Roll called for even higher scores (4 or more standard deviations above the mean), earning 2 points, in far more specialties. The highest-ranked hospitals on the Honor Roll, which is ordered by points, had high scores in 15 of the 16 specialty rankings. Johns Hopkins stands at No. 1—as it has for the last 20 years.

It continues that the top hospitals in the country are also the most forward looking and innovative. From Massachusetts General Hospital, to the Cleveland Clinic to the University of Pennsylvania and many others on the list, they all use our RFID systems to make their operations more efficient and drive actionable data. We know how important innovation is to the list and we are proud, in our small part, to help these hospital achieve excellence.

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VA hospital may have infected 1,800 veterans with HIV: A process problem RFID fixes

via cnn.com

I can tell you from deep reviews of the VA and civilian hospitals that i many cases, the VA has better processes. They are just in the news a lot more because (a) they are under a microscope using Federal money; (b) they treat our most important population: our veterans; and (c) they are one f the largest healthcare systems in the US. Our Veterans deserve only the best case and usually they get it at the VA.

But, again, being under the microscope, they get in the news fairly often. In this case, a VA hospital is in hot water for not properly cleaning some of their dental equipment. They have had to send notices to 1,800 vets that they may have acquired HIV, Hep B or C. If this sounds familiar, its because it is. Last year, the VA was cited for similar issues in colonoscopies.

In fact, Mobile Aspects pioneered a solution for cleaning processes with RFID 2 years ago (iRIScope). One customer, the Hospital of the University of Pennsylvania is using the system to track the cleaning, use and storage of over 200 scopes in 6 locations. With RFID, all the data is gathered automatically, and proactive alerts are sent out in "bad" situations. Further, our RFID scope tracking system literally has lights that glows red, and locks down the cabinets, if a potentially dirty scope is placed back into storage.

The dental issue at this VA is similar. The VA deserves recognition for having a dental tool cleaning protocol (most hospitals wouldn't). However, someone broke protocol. Subsequently, they had to send a notice to 1,800 veterans because their manual records are hard to decipher. This is where RFID comes into play - without the user logging anything, we see that someone didnt do a step properly and we immediately log it and send out an alert. If there is a downstream issue, instead of sending a notice to 1,800 veterans, the hospital only needs to send out a notice to the 100 veterans that the improperly cleaned tool was used on.

Properly implemented in an extremely simple to use manner, RFID logs every step and creates alerts right at the point of potential error. Additionally, if an error does still occur, there is good, actionable data at the users fingertips. This is the power of RFID to heal hospitals.

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Want To Know What A Hospital Charges? Good Luck. Need RFID for good, actionable data.

Transparency in healthcare? We all know it only exists months after a surgery is performed and it is often inaccurate. Unless I was at one of Mobile Aspects' member hospitals, if I was paying for my own surgery (I am thankful to have good Healthcare Insurance), I would definitely hire a consultant to review my bill and argue with the hospital. I can tell you hospitals have very poor estimates of cost - they dont gather data well. As shown in end results, the data is poor and inaccurate.

Before, they would estimate supplies being used in a case - this estimate came from data hand entered into their systems (read: poor data with many typos). Then the operating room charge (often $100/minute or more) is another poor estimate of human resources and cheaper supplies used in the case. No one was looking, who cared if it was accurate?!

But steps are being taken. Our client hospitals saw the problem and wanted to get a much better view and deliver better service to their patients. With our RFID data gathering systems, they are getting a much richer, real-time, accurate view of their costs per case. They know exactly what devices were used on a case, the supplies, the length of the case, the doctor performing the case, etc. All without having to hand enter one piece of data! Our systems gather the information automatically. Now, our member hospitals are able to give clear estimates to patients, based on the physician. At some of our member hospitals, even the physician is given a receipt of all items used in the case: its sitting in his inbox before he scrubs out!

Its not going to change that there is variability from patient to patient, and you dont know until you are in the case with the patient on the table. However, you can give ranges of costs to the patient before they enter based on good, actionable data.

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How Data Travels From a Wireless Device

How Data Travels From a Wireless Device

How Data Travels From a Wireless Device

How does that picture you just sent your buddy get from your phone to his computer, exactly? Surprisingly enough, not through pixie dust and unicorn dreams! Here's how it really works.

This infographic from Time Warner Cable shows just how involved the process is, and acts as a good reminder that sending something "wirelessly" actually often involves, well, a whole bunch of wires. [TWC Untangled via Business Insider]

Send an email to Brian Barrett, the author of this post, at bbarrett@gizmodo.com.

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RFID fixes charge capture problems in hospital operating rooms: we need to see Goldilocks

The health insurance industry is fraught with problems from end to end. The industry has a lot of checks and balances against inaccurate charge claims by hospitals. This has been built up over a 50 year period so that (a) insurance providers can catch errors and (b) the insurance industry can cut costs by denying claims.

In an operating room setting, 40+ percent of a claim comes just from implants and supplies alone. The average hospital typically has a one size fits all charge for the lower cost supplies (they may also bill that as part of the OR room charge). But the real cost of supplies in in implants (hips, knees, stents, heart valves, etc). Hospitals use extremely manual processes to charge for the expensive implants : often taking stickers off of product, placing on to a charge sheet and after the case typing these into a billing system.

This leads to tremendous error: about 15-20% of supplies and implants billed in the OR are incorrect. This can be as minor as getting the size of an implant wrong to as major as not billing for a stent or billing for too many stents. The reason has nothing to do with any incompetency by people working in the OR (on the contrary, these are highly trained, skilled and smart people). The problem is the OR is a high stress environment (we call it the 'Warzone' of the hospital) and manual systems break. Imagine trying to scan a barcode or peel a sticker off a stent in the middle of the case with a patient coding and a doc yelling!

The hospitals and patients come out on the losing end of this system. If too much is billed, the health insurance industry has many checks and balances in place to catch and deny the claim - costing the hospital and patient months of paperwork to correct and refile. Insurance companies live in plush office buildings, not a stressful hospital, so this is easy for them. If the hospital misses a stent and doesn't charge for it, the health insurance provider's cost is reduced by $2,000, so they won't correct it. The hospital just lost $2,000 and the information about the implant is not on the patient record.

Mobile Aspects' RFID systems ensure accurate, reliable, real time information when it comes to these supplies and devices. In the OR environment, staff simply scan the barcode of the patient before a case starts. Anything then removed from our shelf is automatically captured and sent to the billing system. If any devices are not used, it is simply placed back on our shelves and the charge is credited in real time. This leads to Goldilocks charge capture: not too much, not too little, but just right (and just right every time). And when 40% of the case cost is implants and supplies in the OR, we better all ensure we get it just right.

From The New York Times:

DIGITAL DOMAIN: See You in 6 Months. And Your Insurer Is O.K. With the Bill.

Instant electronic processing of medical insurance claims has long been discussed, but its adoption has been slow.

http://nyti.ms/cfxRUs

Posted via email from Suneil Mandava's Posterous

The House always wins: Why Rx Insurance is likes being inefficient

Great article from the NYTimes this weekend discussing how claims processing works in the healthcare industry. The whole industry is setup to have incomplete, inaccurate information and late payments. This is to the benefit of insurance providers. They can always fall back on 'systemic problems' rather than taking blame when things go wrong. It is nearly impossible to read an insurance report and find a problem (though i bet more than 25% of claims have a problem), but the insurance providers can blame anyone else in the system.

There is $300-$500 billion of waste in insurance processing: where do you think all that money goes? There are no drivers pushing them to make this a better process - much like Blockbuster actually wanted you to return movies late (15% of their video rental business came from late fees), the insurance industry likes all this lag in the system. The House always wins under these circumstances.

From The New York Times:

DIGITAL DOMAIN: See You in 6 Months. And Your Insurer Is O.K. With the Bill.

Instant electronic processing of medical insurance claims has long been discussed, but its adoption has been slow.

http://nyti.ms/cfxRU

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US Healthcare Quality comes down to the basics: Uninsured More at Risk Even in Hospitals

A new study finds that even after they have heart attacks or strokes and are admitted to hospitals, the uninsured are more likely to die than those who carry private insurance.

A gap persisted even after the researchers adjusted for disparities in the patients’ underlying health, socioeconomic status and other factors.

Researchers analyzed more than 150,000 discharges of working-age Americans, ages 18 to 64, who were hospitalized for heart attack, stroke or pneumonia. The data was drawn from the 2005 Nationwide Inpatient Sample.

The study found that uninsured patients who had heart attacks were 52 percent more likely to die in the hospital than the privately insured, and those who had a stroke were 49 percent more likely to die in the hospital.

“We thought there would be some disparity and a little bit of a difference, but we were surprised there were such significant differences,” said Dr. Omar Hasan, a hospitalist at Brigham and Women’s Hospital in Boston who was the lead author of the study, in the Journal of Hospital Medicine.

One reason, Dr. Hasan suggested, may be that patients who have trouble getting care may have more advanced disease.

“We know for a fact that people who are uninsured delay seeking care,” he said.

The pattern continues: In the US, driving better healthcare and bringing down costs start and end with the basics. This new study points out how our system catches disease much to late in the process. For those that are uninsured, almost by definition, they dont have annual checkups and preventative checkups. Therefor, diseases are caught much too late, are very expensive to treat, and lead to a much higher level of patient mortality.
Education is going to be paramount as the new healthcare bill kicks in. People without insurance for decades, all of a sudden will have insurance. However, their behaviors wont change all of a sudden. They are used to going to the ER's as their first point of service. Further education will be required on how to access the healthcare system. To the non-user, it can be mindboggling.

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Eliminate waste in Healthcare by focusing on the basics: $3.6 trillion could be saved

Key cuts to healthcare waste saves $3.6 trillion

Maggie Fox, Health and Science Editor
WASHINGTON
Mon Jun 14, 2010 12:01am EDT

WASHINGTON (Reuters) - The U.S. healthcare industry can cut $3.6 trillion in waste over 10 years with a few common-sense steps to eliminate fraud, errors and to encourage efficiency and healthier behavior, according to an analysis by Thomson Reuters.

Politics  |  Health

Recommended changes include giving patients a medical "home" to better coordinate care, eliminating a culture of fraud, encouraging patients to ask about healthcare costs, and rewarding quality improvement initiatives.

Such changes could reduce waste by 5 percent a year, adding up to $3.6 trillion over 10 years, according to the report.

"Last year, we published a report concluding that the U.S. healthcare system wastes $700 billion a year," Bob Kelley, vice president for healthcare analytics at Thomson Reuters, said in a statement.

"This new report describes a possible path for significantly reducing that waste."

Kelley and colleagues at Thomson Reuters, parent company of Reuters news agency, asked clients what they were doing that worked. They also read published studies on ways to cut waste.

The report, available at factsforhealthcare.com, outlines some of the best measures.

They include:

* Encouraging everyone to manage their own health through personal behavior to prevent diseases, early detection and appropriate care for chronic diseases.

* Using a simple checklist approach to prevent medical errors, which cost $50 billion to $100 billion a year. For instance, Dr. Peter Provonost at Johns Hopkins University in Baltimore estimates his checklist he uses when inserting a catheter to deliver medication, called a central line, reduced infection rates from 11 percent to zero. This prevented 43 infections and eight deaths and saved the hospital $2 million.

* Reducing opportunities for fraud. A George Washington University report estimated that in 2007, fraud accounted for 5 percent to 10 percent of the $2.3 trillion in healthcare spending.

"The goal is to change the culture of fraud," the report reads, adding that while most providers submit legitimate bills, "the public and the provider community need to be better educated about how fraudulent payments directly reduce resources available to patients for legitimate and necessary healthcare services."

* Reduce fragmentation in the delivery of care, better coordinating care among specialists and cutting administrative costs.

* Create a "culture of performance improvement" that promotes the quick dissemination and adoption of best practices.

"New Jersey's five largest health plans and five physician groups have created a pilot program allowing hospitals and physicians to communicate with health plans and address administrative tasks through a single Web portal," the report reads.

Electronic records are key, the report said. "The Minnesota Department of Health estimates that when fully implemented, a law requiring the standard, electronic exchange of routine healthcare business transactions will save the state more than $60 million per year," it reads.

Democrats in Congress passed a healthcare reform bill in March that largely focuses on health insurance. Republicans say the plan is too expensive at a time of monstrous federal budget deficits, but President Barack Obama has argued it is possible to use reform to save money.

"Great effort was expended to provide a balanced and specifically apolitical viewpoint equally weighing the concerns of patients, providers, payers, and purchasers," the Thomson Reuters report reads.

(Editing by Philip Barbara)

Comments

Jun 14, 2010 6:27am EDT

No mention of the biggest waste of health care funds – the US private health insurance industry. We could save $400 billion annually with a single payer plan for this nation. It would much more efficient than the suggestions listed.

macman2 Report As Abusive

Jun 14, 2010 7:06am EDT

Obamacare will never work unless we turn the health insurers into non profit entities.

Storyburn_has Report As Abusive

Jun 14, 2010 9:24am EDT

Our healthcare and insurance industry are the same as banking and mortgage filled with greedy management plus some unethical doctors. They take advantage of the inefficiency and ineffective of our governemnt and bureaucratic system. Basically they have been milking tax payers money for years.

gwng99 Report As Abusive

Jun 14, 2010 12:01pm EDT

Even if no other reforms come to pass, it is absolutely necessary to take a hard look at the DME (durable medical equipment) racket. In our city, a block of these fraudsters was shut down after an investigation. When a $14.99 pair of support stockings turns into a $75.00 pair after the amount of latex in the stocking turns it into DME, something is fishy. It’s the same with the scooters, walkers, etc. Billions could be saved if prices were reasonable and realistic.

CalGal Report As Abusive

Jun 14, 2010 12:29pm EDT

Keep call insurance companies greedy – - what about calling government incompetent and wasteful? * * *

Why do lefties keep insisting that going to a single payer system will save money? What about the billions of dollars of fraud that is built into the Medicaid and Medicare because Congress tells it what to do? What about the poor record keeping systems they have so they can’t keep track of their payments?

jimmy37 Report As Abusive

Jun 14, 2010 3:40pm EDT

Jimmy37-
The fraud in Medicaid and Medicare is not due to congress telling it what to do, but hospitals and doctors double and triple billing as well as billing for services not rendered. The poor record keeping is only a piece of the puzzle.

indieinfla Report As Abusive

Jun 14, 2010 8:34pm EDT

“Kelley and colleagues at Thomson Reuters, parent company of Reuters news agency, asked clients what they were doing that worked. They also read published studies on ways to cut waste.”
No industry experience, just 3rd party analysis and this constitutes a story that is newsworthy? Trying to grab headlines?
Why not actually do some thorough research of people in the industry?

buckeyecal Report As Abusive

Jun 15, 2010 12:05am EDT

The billing process, as it exists now, is perhaps the single biggest contributor to fraud and abuse. Lack of effective regulation allows fraud to occur. As a response, the fiduciary intermediates unilaterally claim fraud on what are basically random claims. This results in dissatisfied providers while unfairly enriching the billing entities. The incentive is to increase collections by whatever legal means, and this involves knowing which loopholes to use, rather than relying on good medical care and acting in the interest of the patient. No other nation has the insurance industry so entrenched in health care. The insurance industry is largely responsible for our healthcare system, and this is based largely on legalized corruption and greed. When we realize that our system is not the best in the world, we will begin to make progress.

JUANDEMTY Report As Abusive



 

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Its a funny thing in US healthcare - we do the complex incredibly well, but we cant do the simple basics well at all. We can practically cure cancer, but we lose biopsies all the time. Reuters came out with a study echoing this. Atul Gawande is pioneering the idea of checklists in the hospital. Doctors and nurses may not like it, but it is needed. There are so many resources that need to come together for a successful surgery, at the right time, and the right place that is incredibly hard to run things from mental notes anymore. Much like car seats for babies - you are protecting the baby when the drive goes well. You are protecting for that one in a million chance when things go bad. When there are 300 million patients, many more million surgeries, one in a million aint that great of odds anymore.
The report focuses on other basics - early detection and prevention of diseases (a common theme of mine is that the earlier a problem is found out, the cheaper it is to fix and the better the outcome), eliminating fraud (more transparency in all billing will help here), and focusing on best practices.
I like how these are framed as common sense solutions. While I dont know if I believe we can drive $3.6 trillion of waste out solely from fixing these issues, I do believe they are a great place to start to get the ball rolling and quickly.

Posted via web from Suneil Mandava's Posterous

Case of process vs treatment: Why Patients Aren’t Getting the Shingles Vaccine

This is a microcosm of one ofthe big issues in US medicine: we do big expensive treatments well, but not basic fundamentals. In this case, it is reimbursement getting in te way of shingles vaccines that would eliminate the problem for millions of Americans. Instead of spending $100 per person to eliminate the problem, we spend $10,000 - $15,000 and clog up our healthcare system in treating it down the line. In engineering and development there is a rule of thumb: it cost 1x to solve the problem in design, 3x to solve in development and testing and 8x to solve the problem once deployed. I would have to think it's even more exaggerated in medicine when comparing solving at the PCP's office vs when the disease manifests itself and must be treated.

From The New York Times:

DOCTOR AND PATIENT: Why Patients Aren’t Getting the Shingles Vaccine

Most doctors recommend immunizations against flu and pneumonia for older patients, but they do not do the same with the shingles vaccine.

http://nyti.ms/aU6Nup

Posted via email from Suneil Mandava's Posterous

Don't boycott BP stations. Just hurting family run biz. We must continue to reduce need for oil overall

From The New York Times:

YOUR MONEY: Punishing BP Is Harder Than Boycotting Stations

Telling oil companies that you’re not going to take it anymore requires a change in lifestyle.

http://nyti.ms/cZ1fhh

Posted via email from Suneil Mandava's Posterous

No spin from the Coast Guard: Cap Said to Recover 10,000 Barrels of Oil a Day

From The New York Times:

Cap Said to Recover 10,000 Barrels of Oil a Day

The increase indicated engineers are making some progress in stanching the flow, Thad W. Allen of the Coast Guard said.

http://nyti.ms/9HTrfV

Posted via email from Suneil Mandava's Posterous

Great Firewall gets 4Square: China Blocks Foursquare After Users Check in to Tiananmen Square

Thanks, John: Former UCLA basketball coach John Wooden dies

Hospitals leaving items in patients after surgery - Is RFID the answer?

Drill bits, screws, sponges, clamps, needles, catheters, electrodes. These are some of the things accidentally left inside patients after surgery at California hospitals.

These instances are referred to as "never" events, meaning they are never supposed to happen. But even though they are reported in a small percentage of surgeries, they occur with alarming regularity.

Surgical equipment inadvertently left inside patients after procedures and operations accounts for the second-most-common preventable adverse event in acute care, behind serious pressure ulcers, or bed sores.

In the latest fiscal year, California hospitals reported 197 cases of "retained foreign objects" for a total of 350 incidents over the past two years. They accounted for 14 percent of all preventable errors reported during those two years. That's out of 2,446 adverse events reported in California from July 1, 2007, through Dec. 31, 2009, according to the state Department of Public Health.

In 29 of the cases involving a retained foreign object, the state deemed the problems serious enough to issue fines, according to public health officials. Three years ago, a new law gave state public health officials the authority to issue administrative penalties for violations that put patients at risk of death or injury.

Reducing mistakes

The state intends to use $800,000 of the almost $3 million in such hospital fines that have been collected since 2007 to research how to help hospitals reduce their chances of leaving objects behind after a surgery or procedure. The funds have been approved, but will not be available until after a state budget is signed.

"We really want to drive change. Penalties are one way of driving this change," said Kathleen Billingsley, deputy director of the state public health department's Center for Health Care Quality.

Billingsley said that many hospitals have begun making significant improvements to their quality systems in response to their mistakes.

San Francisco General is one such hospital. This year, the hospital was hit with a $25,000 fine for a 2008 case in which a surgical sponge, the most common object left behind after any procedure, was discovered in a patient three months after she had endured more than eight hours of surgery to treat two types of cancer.

The surgery required two surgical teams to remove the patient's uterus, fallopian tubes and ovaries, to resection her bowel and colon and to reduce the size of the tumor. There were complications of massive bleeding, and the surgery had to be conducted in two stages over the course of a couple of days.

The surgical teams conducted a routine counting of equipment after the operation, but missed a 4-by-8-inch piece of surgical sponge that had been used to stanch the bleeding. It was later removed, and the patient, who the hospital will not identify because of privacy laws, continues to seek care at the hospital.

"This was a very unfortunate incident and, whether or not there was a fine involved, we would have addressed this very seriously," said Dr. Todd May, chief of the medical staff for San Francisco General.

The health implications of leaving items in patients' bodies varies widely depending on the patient and other complications.

May said the case motivated the hospital to make several key changes. For one, the hospital no longer uses sponges that small for abdominal surgeries. Now patients who undergo surgeries identified as high risk for a retained object undergo a low-dose X-ray to detect anything left behind. Sponges used in those procedures now have a special strip that will show up on the scans.

Inspection before closure

Under San Francisco General's revised policies, any member of a surgical team, including all nurses and technicians, are required to examine the incision before closure and permitted to call for an instrument recount at any time. The hospital has had no further incidents of retained foreign objects.

Other techniques being explored by hospitals include radio-frequency detection systems and bar codes on the equipment, said Dr. Niraj Sehgal, UCSF associate professor in hospital medicine and the associate chairman of quality and safety in the department of medicine.

While some solutions seem simple, no one solution works for all hospitals, Sehgal said. While some technologies can decrease the likelihood of error, medicine is practiced by humans.

"There's an element there that still relies on a human to be perfect," he said, "and humans are not perfect."

The federal government also has begun to focus on "never" events. In 2008, the Centers for Medicare and Medicaid stopped reimbursing hospitals for the cost of caring for patients who experienced "never" events such as retained foreign objects after surgery. The theory is that hospitals shouldn't be paid twice for preventable errors - once for the initial procedure, and again for the follow-up treatment to correct the error.

Since 2007, California has issued 156 administrative penalties to 108 hospitals. These penalties carry fines of $50,000 for the first violation, $75,000 for the second, and $100,000 for the third or subsequent violations at the same hospital.

So far, $4.8 million in penalties has been assessed and $2.9 million has been collected.

Hospitals can appeal the fine by requesting a hearing, but they still must submit a plan to the state explaining how they intend to correct the problem.

'It's unfair and unsettling'

An attorney who represents hospitals that have appealed penalties accused the state of "terrorizing" hospitals.

"There's no statute of limitations, no criteria. You can get a letter a year later saying we're fining you $50,000 for a retained foreign object you reported a year earlier," said Mark Kadzielski, head of the West Coast health care practice for Fulbright & Jaworski. "It's unfair and unsettling to hospitals."

Officials from the California Hospital Association, a trade group that represents more than 400 hospitals statewide, acknowledged that the public reporting of the fines is difficult for hospitals, but they generally support the state's efforts to reduce the number of preventable mistakes.

"We all share the same goals," said Debby Rogers, vice president of quality and emergency services for the hospital group. "Using those funds to focus back on hospitals and areas we can approve is a great idea."

E-mail Victoria Colliver at vcolliver@sfchronicle.com.

This article appeared on page A - 1 of the San Francisco Chronicle

When we started Mobile Aspects, we looked closely at this problem. In discussing with several physicians and hospitals, a few conversations pointed us in the direction of solving the problem of surgical instruments and other items left in patients. We decided not to pursue this route for several business and technological reasons. However, I know of a few companies solving this problem with RFID (including another Pittsburgh based company called ClearCount). I tend to think RFID should be used in hospitals where it will solve patient safety and workflows issues AS WELL AS generate actionable data. However, this maybe a rare case where just having the former is good enough.

Posted via web from Suneil Mandava's Posterous

BP and Exxon share prices after oil spills: | The Economist

Happy w/ new AT&T data plans - my iPhone data usage has fallen >50% with addition of iPad 3G

iPhone and iPad data plan changesPaul Sakuma/Associated Press The iPad and iPhone will be affected by AT&T’s latest data changes.

AT&T announced Wednesday that it will start offering metered data plans for mobile device users rather than a $30 all-you-can-use monthly plan.

For people who use less than 200 megabytes of data a month, the price of the new plan is effectively cut in half.

The latest announcement could signal the beginning of a new arms race between mobile phone carriers. In the past, carriers tried to woo customers by offering mobile packages that were gauged by the number of voice minutes available each month. But as my colleague Jenna Wortham wrote last month, people are talking on mobile phones less as data usages continues to rise.

AT&T also announced a new service that will let smartphone users tether their device, including the iPhone, to a computer and use the phone to access the Internet as a modem. The tethering feature will cost an additional $20 a month. Apple iPhone users have long requested that service.

The lowest-priced data option is called DataPlus and will cost $15 a month. It gives mobile phone subscribers access to 200 megabytes of data each month enough to send and receive 1,000 e-mails without attachments and an additional 150 with attachments. The plan would also offer access to 400 Web pages, the ability to post 50 photos to social Web sites and watch up to 20 minutes of streaming video through the mobile phone.

AT&T said in a press release that 65 percent of AT&T smartphone customers use less than 200 MB of data per month on average. If DataPlus users go over the allotted 200 megabytes in a single month they will have the option to purchase an additional 200 megabytes for another $15.

DataPro, the next step up, provides 2 gigabytes of data a month to a single phone for $25 a month. AT&T says, on average, 98 percent of its current mobile customers use less than 2 gigabytes of data each month.

The DataPro option will allow mobile phone customers to send and receive 10,000 e-mails without attachments and 1,500 e-mails with attachments. In addition, users will be able to view 4,000 Web sites and post up to 500 photos online through their phone. They will also be able to watch three hours of streaming video. If a DataPro subscriber goes over the 2 gigabytes, they will be able to purchase an additional gigabyte for $10.

The tethering feature is only available to the DataPro customers.

The service changes will go into effect on June 7 with the expected release of the iPhone’s new operating system, iPhone OS4.

Although the $30-a-month unlimited data plan will be eliminated, existing AT&T customers will have the option to be grandfathered in to their existing monthly charge.

IPad users will be affected by the service changes too. AT&T said that new iPad customers will have the option to purchase a $25 monthly plan for access to 2 gigabytes of data. This will replace the $29.99 unlimited access option currently offered for the iPad.

I have been using my iPad 3G since launch day in the US 6 weeks ago - the readers of this blog know I love it. But an amazing thing happened - my iPhone data usage has fallen through the floor! I have gone from over 400MB / month to under 200 MB. Additionally, whereas previously I bought the Moxie case for my iPhone to double battery life, now I never go below 50% on the battery. This is all because my data usage has been transferred to the iPad. I am happy that Apple is allowing me to grandfather in my $29.99 / month unlimited data plan for iPad because i guzzle data on that device (but still nowhere close to some people I have read about).
The news plans from AT&T will save me $30 / month ($15 x 2 iPhones in my family, with two more daughters coming of age shortly). But I am sure it will be copied by Verizon to save everyone money.

Posted via web from Suneil Mandava's Posterous

New King of Technology - Apple Overtakes Microsoft as World's Most Valueable Company

The moment was marked Wednesday when Apple, the maker of iPods, iPhones and iPads, shot past Microsoft, the computer software giant, to become the world’s most valuable technology company.

This changing of the guard caps one of the most stunning turnarounds in business history for Apple, which had been given up for dead only a decade earlier, and its co-founder and visionary chief executive, Steven P. Jobs. The rapidly rising value attached to Apple by investors also heralds an important cultural shift: Consumer tastes have overtaken the needs of business as the leading force shaping technology.

Microsoft, with its Windows and Office software franchises, has dominated the relationship most people had with their computers for almost two decades and that was reflected in its stock market capitalization. But the click-clack of the keyboard has ceded ground to the swoosh of a finger across a smartphone’s touch screen.

And Apple is in the right place at the right time. Although it still sells computers, a greater portion of its revenue is coming from handheld devices. Overall, the technology industry sold about 172 million smartphones last year, compared with 306 million PCs, but smartphone sales grew at a five times faster pace.

Microsoft depends more on maintaining the status quo, while Apple is in a constant battle to one up itself and create something new, said Peter A. Thiel, the co-founder of PayPal and an early investor in Facebook. “Apple is a bet on technology,” he said. “And Apple beating Microsoft is a very significant thing.”

As of Wednesday, Wall Street valued Apple at $222.12 billion and Microsoft at $219.18 billion. The only American company valued higher is Exxon Mobil, with a market capitalization of $278.64 billion.

The revenue of the two companies are comparable with Microsoft at $58.4 billion and Apple at $42.9 billion. But Microsoft is sitting on far more cash, $35.7 billion to Apple’s $23 billion, which makes the value assigned by the market to Apple — essentially a bet on its future prospects — all the more remarkable.

Microsoft and Apple declined to comment.

Apple’s climb to the top of the heap cements the reputation of Mr. Jobs, who once operated in the shadow of Microsoft’s co-founder William H. Gates.

“It is the single most important turnaround that I have seen in Silicon Valley,” said Jim Breyer, a venture capitalist who has invested in some of the most successful technology companies.

While Apple is at the top of its game, it faces a new and powerful rival in Google, which is battling Apple in mobile devices with its Android operating system, and mobile advertising. Google, with a market cap of about $151.43 billion, also appeared to leap ahead of Apple in a new, potentially important area, Internet-connected televisions. And Google is steering consumers toward yet a new model of computing in which Internet applications, rather than iPhone or desktop applications, rule.

“The battle has shifted from Microsoft against Apple to Apple against Google,” said Tim Bajarin, a technology analyst who has been following Apple since 1981. “Apple has a significant lead. But Google is going to be a powerful competitor.”

Apple and Microsoft initiated the personal computing revolution in the late 1970s, but Microsoft quickly outflanked Apple and grew to become one of the most profitable businesses ever created.

A little more than a decade ago, Apple, which had pushed out Mr. Jobs in 1985, was widely believed to be on the path to extinction.

Michael S. Dell, the founder and chief executive of Dell computer, went so far as to suggest that Apple should shut itself down and return any money to shareholders. (The computer maker is now worth about a 10th of Apple.) Around the same time, Microsoft’s chief technology officer called Apple “already dead.” But with the return of Mr. Jobs to Apple in 1996 — and an investment by Microsoft of $150 million — the company began a slow path to recovery. Apple’s rebirth began in earnest with the introduction of the iPod music players and Mr. Jobs began to gain a reputation for anticipating what consumers want. The company elbowed aside Sony and came to dominate the music distribution business with the iTunes online music store. It later upstaged Nokia, the dominant brand in mobile phones, by introducing the iPhone in 2007. And earlier this year, Mr. Jobs shook things up again, with the introduction of the iPad, a table computer that has the potential to create a new category of computers and once again reshape the way people interact with their devices.

Mr. Jobs helped create “the best desktop computer, the best portable music device, the best smartphone and also now the best tablet,” said Steve Perlman, a serial entrepreneur who was an executive at both Apple and Microsoft and is now the chief executive of OnLive, an online gaming company.

As Apple grew increasingly nimble and innovative, Microsoft has struggled to build desirable updates to its main products and to create large new businesses in areas like game machines, music players, phones and Internet search. Microsoft, which is a component stock of the Dow Jones Industrial Average, has lost half its value since 2000.

Still, Microsoft is a hugely powerful and profitable company in the tech world. Its Windows software runs 9 out of every 10 computers, while more than 500 million people use its Office software to perform their daily tasks like writing letters or sending e-mail messages. These two franchises account for the bulk of Microsoft’s $58.4 billion in annual revenue.

But it is Apple that has the momentum. “Steve saw way early on and way before Microsoft that hardware and software needed to be married into something that did not require effort from the user,” said Scott G. McNealy, the co-founder and longtime chief executive of Sun Microsystems, which almost merged with Apple. “Apple’s products are shrink-wrapped and ready to go.”

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