The first time I ever considered getting executive coaching for myself and my team was at the Rock Health Digital Health CEO Summit, I saw one of the panelists talking about hiring an executive coach for themselves and for their team. Up until that point I had been building my start-up without executive coaching. I realize we needed a bench of amazing coaches, thinking that getting executive coaching for me and the executive team would be something that would help facilitate and keep the team on the same page and to help the company grow.
Football teams, boxers, soccer teams, and basketball teams have coaches why not your start-up? The best CEOs and founding teams get help and advice from advisors, board members, their team, and their customers, having a coach is another support system most founders don’t think of. Even the best of the best teams in the business world add executive coaching to help the founders. For example, Apple’s founder Steve Jobs, former executive chairman and CEO of Google Eric Schmidt, and Facebook CEO Sheryl Sandberg worked with Bill Campbell, you can fund more about the million-dollar coach. Being a founder can be a long and lonely path so having a coach to run ideas, strategy, and short and long-term incentives and concepts is amazingly valuable.
The band Metallica has been around for decades, in the movie “Metallica: Some Kind of Monster” the band was insightful and hired a therapist and coach Phil Towle to help keep the band together since they lost their bass player Jason Newstead and the band was falling apart, exec coach fits a need in that same way helping a person grow in their career and personal life.
I started to dig and look for executive coaching teams and realized it was hard at first to find a good team. After interviewing several coaching teams I started to understand the coaching community, after interviewing so many people I realized there is a big market out there for executive coaching. There’s a large amount of amazing talent out there to help you grow, and help your team.
One of the first experiences I had was with a Y Combinator company called Innerspace, a wisdom community for startup founders. Innerspace was founded by Joe Greenstein the founder and former CEO of Flixster & Rotten Tomatoes and Semira Rahemtulla who held free sessions for founders in San Francisco, it was an amazing experience to go to these events, and see top-tier Exec Coaches that were presenting and helping founders.
Several founders, leaders, and company executives approached me about executive coaching and how that might work. Like any relationship, it must work for the person getting coaching and for the Coach. What I did throughout the years was interviewed several coaches, I highly recommend interviewing around five executive coaches to see if there might be a fit. Getting a coach is very similar to hiring a psychologist, you must see what is out there and see what might work for you, seeing if you might fit with their personality, the way they work, and the dynamics between you both to really get an idea of how they can help you. I bucket some Executive Coaches amazing for company offsites, others are amazing at running retirees, others are amazing for 1-1 coaching, and others for doing a one-time session on a focus topic. You can always try before you commit, maybe do a month of sessions to see how things go and check-in to see if the coaching is working. Scaling yourself and getting the growth that you need is so important to see what best fits you and your team’s needs, but offsite with an executive coach to see if they can work well with you and possibly with your team. If there are several cofounders you can even create strategies to align the founders getting the same executive coach to work with all of the founders on a monthly basis, it depends on you you’re co-founders and your team’s needs on how you want to pick and use your executive coach again they’re there is a resource and a sounding board for you so really you’re in the driver seat to see if they’re giving you the advice that helps you bring your company and your startup to the next level.
Investors at times can also give Executive Coaching advice from time to time, but I found few founders that look outside to get that executive coaching expertise.
I built a bunch of possible executive coaches with that I could work by going to several of these sessions to find coaches that I could work with and my team. I highly recommend you look up this list and consider some of these possible options feel free to reach out to any of them and let them know that I mentioned them to you.
I can’t say enough good things about this executive coaching team, if you are looking for sure talk with them. You can find the founders here.
Ed is an executive coach who I did a session with, he is amazing if you can get him, sign up for his blog and newsletter, always insightful 🙂
Perhaps one of the best videos on SaaS if you are running a Software as a Service company is from David Skok of Matrix Partners: Driving SaaS Success Using Key Metrics
Enterprise Value vs Equity Value
Enterprise value (EV) and equity value/market value (MV) are business valuations. Enterprise value (EV) is used when considering the purchase of a business, whereas equity value/market value (MV), is used when considering an investment in the common stock of the business. A great resource for reviewing these valuations definitions.
The net assets of a business are funded by a combination of debt and equity. It follows that the value placed on these net assets must be the same as the value placed on the equity plus the value placed on the debt.
Net assets value = Equity value + Debt value
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The coronavirus pandemic jumpstarted the digital health tech market with solutions that bring a stronger connection between patients and doctors. More physicians are turning to new innovations that can improve the patient experience and raise the level of care necessary as we navigate these new times. Here’s my take on what’s ahead in health tech in 2021 and beyond.
Remote Patient Monitoring (RPM)
RPM is going to be a big part of our future due to COVID-19. RPM tools allow physicians and medical professionals to remotely monitor patients in real-time tracking a patient’s well-being. Medicare and Medicaid as well as other insurance companies are now receiving reimbursement for RPM. Additionally, Internet-connected blood pressure cuffs, scales, and the like can be used for RPM. IoT devices are also part of the RPM future, such as IoT glucose meters for diabetic patients, IoT thermometers, and sleep monitoring devices. By adding RPM from providers such as KeepWell,100Plus, and MD Revolution, practices can focus on patient care and have access to real-time patient data and remote staff support. With more physicians turning to virtual care, telehealth and EHRs that manage this critical patient data are proving to be the lifelines to modern healthcare going forward.
Telehealth & Telemedicine
Telehealth visits are going to supersede in-person visits as time goes on. Because of COVID-19, the world changed and Medicare and Medicaid, as well as other insurers, started paying out for telehealth visits. Telemedicine will continue to grow at a very quick rate, and verticals like mental health (psychology and psychiatry) and primary care fit perfectly into the telemedicine model, for tasks like administering prescription refills (ePrescribing) and ordering labs. Hyperlocal medical care will also move towards more of a telemedicine care team experience. Patients that are homebound families with young children or people that just recently had surgery can now get instant care when they need it. Location is less relevant because patients can see a provider from anywhere.
Machine learning will become an even bigger part of healthcare in 2021. For example, machine learning combined with telemedicine will give more insight to a physician in a remote setting reading voice intonation and facial expressions for a patient’s mood, pain, or depressional flags and the like. ML will be able to indicate and provide mood data to the physician in real-time and will allow the doctor to take any immediate action. ML-powered medical copilot scribing can help write a draft chart as the patient and doctor chat via telehealth. A lot of information is exchanged quickly, and having a real-time scribe will save time for the medical community. Companies like Diagnoss ML Medical Coding Assistant are partnering to provide ML-based scribe services. There’s also ML for early diagnosis, for example during a telemedicine appointment if a patient has a consistent cough or drop/change in tone of voice is detected, this can also be flagged to the provider to ask more questions to a patient. Practices can accelerate their business during the pandemic and integrate solutions like Holly by Nimblr.ai. This virtual assistant is vastly improving a practice’s operations and efficiencies by managing inbound and outbound scheduling calls, telehealth workflows, reducing no shows, and filling canceled slots.
Apple rolled out a series of new products and features over the past few months that will greatly impact healthcare and bring more benefits to physicians and patients. Apple is one of many players in the industry making the investment and committed to bringing the latest innovations to healthcare. Here are just a few of Apple’s exciting announcements:
Apple’s new Blood Oxygen sensor in the Apple Watch Series 6 can change the way consumers monitor their health.
The new iPad Air features more power and functionality such as an all-screen display, a smaller Touch ID sensor, new cameras, and a redesigned speaker system that will help medical staff expedite log-ins, run apps more efficiently, and review X-rays and other images.
Picture in Picture is new allowing a provider to watch medical videos while multitasking.
HomePod mini can read off reminders and texts to a medical professional from home.
iPhone 12 now has 5G with improved performance and speed. The Phone 12 Pro video camera enables providers better than ever medical video. Also, when complex medical scans need to be reviewed, this new technology can allow physicians the ability to download images faster than ever and could be lifesaving.
The Pop-Up Testing Clinic
COVID-19 has ushered in a new way of testing that has never been seen before across the country. The white tents scattered around parking lots and connected to medical facilities have proven that this new way of testing is working. Furthermore, the data that is being collected, stored, and reported at the pop-up testing clinics and then shared with various local, state, and federal public health databases is critical. Companies are creating integration tools to help share and analyze this data.
If you haven’t already, take a look at some of these new developments in digital health tech to see how they can improve your practice and ultimately enhance the patient experience. Take the time to research and determine the solutions and partners that are the best fit for your practice and patients’ needs.
DrChrono’s First Virtual Healthcare Hackathon 2021 Invites Developers to Build New Applications on the DrChrono API
Submissions are open for DrChrono Hackathon 2021; Over $15,000 awarded in cash and prizes
DrChrono Inc., the company developing the essential platform and services for modern medical practices, today announced that it will host its first Virtual Healthcare Hackathon 2021 inviting developers and designers the opportunity to leverage the DrChrono API to build new and original applications and tools for the healthcare industry. To celebrate the most innovative projects in each category, DrChrono will be giving over $15,000 in cash and prizes. COVID-19 has made a noticeable impact on the healthcare landscape and the needs of patients and doctors can benefit from new apps that can address doctor/patient data exchange, health analytics and online scheduling to name a few.
“We believe the best solutions in healthcare are built with technology prowess and an innovative spirit, not just from clinical expertise. We’re excited to see tech-forward developers put themselves in the shoes of a doctor, patient, or medical staff and build something that will bring their practice into the modern age of healthcare and also for practices that are managing the changes brought on by the pandemic,” said Daniel Kivatinos, co-founder and COO of DrChrono. “Whether a developer builds with a primary care physician, cardiologist, or urgent care clinic in mind, they can make an immediate impact and build cutting edge tools on the DrChrono API.”
DrChrono Virtual Healthcare Hackathon 2021: How it Works, Requirements and Criteria:
Requirements and what to submit: Entrants will need to sign up and obtain access to the required developer tools from DrChrono and complete a project as described in the official Hackathon rules and requirements. Entrants will be required to create an app and share a link to the application designed, a list of technologies and data sets used, a brief explanation of how the tech was used, a slide deck, and a 5 minute video that includes footage that explains the project’s features and functionality through a comprehensive demonstration.
Criteria: Overall appeal, patient usefulness, physician usefulness and visual accessibility.
Categories: Founder’s Choice, Doctor’s Choice, Patient Experience, Modern Health Solutions and Engineer’s Choice.
Dates to remember: Submissions will open on December 1, 2020 and the deadline to submit is January 12, 2021. Winners will be announced on January 29, 2021.
Judges: Michael Nusimow (CEO and Co-Founder of DrChrono), Daniel Kivatinos (COO and Co-Founder of DrChrono), Dr. Ali Sadrieh, Doctor of Podiatric Medicine (Founder of evo Advanced Foot Surgery), Lyndsay Donhoff (Vice President of People and Culture at DrChrono), Shahram Famorzadeh ( Vice President of Engineering at DrChrono) Marjon Harvey (Vice President of Sales at DrChrono), Angie Morales (Director of Marketing at DrChrono), and Steve Goldberg (Director of Engineering at DrChrono).
Prizes: More than $15,000 in cash and prizes including Apple iPads, Apple Pencils, Apple gift cards and Amazon gift cards.
DrChrono develops the essential platform and services for modern medical practices to make care more informed, more interactive, and more personalized. The open platform powers electronic health record (EHR), practice management, medical billing, and revenue cycle management solutions for thousands of physicians and millions of patients, and is fully extensible via a robust API and marketplace of applications and services. The platform is facilitating millions of patient appointments and is processing billions of dollars in medical billing. For more information visit www.drchrono.com.
It’s what you practice in private that you will be rewarded for in public.
Time is short and running a company takes an enormous amount of focus, having a family and maintaining friendships is an important part of being a whole person. Shawn Stevenson talks about relationships correlating directly to your health, if you have good relationships, your health dramatically improves. In life one of the most important things is our health, be sure to make it a priority.
I hear people saying the words “work-life balance,” are important, I once heard someone talk about “work-life integration”, which is a better way to think about work and life. Why? If you can integrate your working life and home life, you can maintain the pressures of work and the needs of family and friends for a longer period. Life isn’t a quick race, startups aren’t a quick race, startups take time, so thinking about building a startup is like planning to run across the country, what is the easiest, smartest route you can take without falling apart along the way.
Below are some insights, ideas, and thoughts on how to have more life in balance.
According to the U.S. Census Bureau, the nationwide average spent driving one-way commute to work is about 25.5 minutes, with Americans spending more than 100 hours a year commuting. Think about leveraging that time always for something productive, I always capitalize on that time. If I’m driving, I ask myself what can I do to be making an impact today? Or is there something I should be learning, or someone who I can call on this trip. The car and commute time is a great time to capitalize on a phone call or learning, listening to an audiobook.
Having a support system and social life outside of work is important, whether it be a sports team, a board game meetup, a Pokemon Go group, be sure to find a group of people you can connect with. For my family, we are part of the local YMCA, they provide members “instant social events,” where I can take my son and have a great time. My son joined the local basketball team, it helped us both get out and about without the need to plan events, they provide great resources. I highly recommend checking out the Y.
I spend about two-thirds of my time on my business and about one-third of the time networking. If I didn’t network a part of my time, DrChrono would have never have gotten in Y Combinator, we wouldn’t have found our enterprise sales leader at Stanford or found our first designer Hong. I focus on my strengths and find others who can fill my gaps.
Choose your peer group really well. The number one way to improve or play at a high level is to populate your working life with high performers.
I connect with people at least once a week that help me grow personally or professionally.
I have several people that I consider my “accountability partners’ who keep me on track and push me in areas of business and personal life that really keep me accountable.
Always have walking meetings, at DrChrono part of our company culture and to have good team communication, we tend to go on a lot of walks. Strategy walks are always productive giving, getting updates and learning from my team.
In the early days even before we incorporated back in 2008, Michael and I would go on lengthy walks to talk about action items we needed to take to build a company in healthcare. We both knew creating a lasting company in the healthcare space would be a long-term endeavor.
Communicating rapidly every step of the way would be critical. We would stroll to local coffee shops in New York City, talk along the way, grab a coffee, talk some more and walk around the city. Walking also paid off in finding some critical team members. A great example: We hired Hong our design leader simply by going on walks with him. Hong and I knew each other as friends. I would tell Hong a bit about what Michael and I were working on and he would give me input on design, we did this a bit and those walks led to him joining us early on.
Walking made us more productive. We would go for a walk, get our legs moving, blood would be flowing and get our minds in a good headspace where we would think clearly about the company. We have been doing this since the beginning of the company.
The same goes for phone calls, one of the best ways to stay in shape, be mentally healthy is to simply get up and walk around. Get a standing desk as well as your draft and send out emails. The human body wasn’t designed to sit for long periods of time, humans were designed to hunt way back when.
WORKING OUT & SLEEP
If you don’t make time for health now you will be forced into illness later, the most important thing in life is to have enough energy to tackle the problems of a day, if I don’t have enough energy I won’t perform well. I educate myself on what keeps me healthy on a weekly basis, learning from books and podcasts. For example, does water help in the mornings? Nothing tastes as good as feeling healthy.
Some tools for health that I use:
TRX Tactical is great for travel – One great way to stay in shape is TRX it’s mobile keeps you healthy and you could bring it anywhere traveling at work anywhere.
Resistance Bands are also great for travel – Another great way to stay in shape is resistance bands there actually really mobile you can throw them in your backpack.
Small Home Gym – One secret to staying healthy long term is to make a small investment in a small home gym. You don’t need anything big but a few items to really allow me to get a quick workout in on the days I simply don’t have time to go to the gym. You can buy a small weight set and kettlebells at Costo or Target for home.
Lose It! – I use it to track how I am doing with my general health.
Spark your mind daily, be careful what you let into your mind. I am trying to create sustainable greatness and focusing on my family and my business for the long term I really think about stayings invested in the long term payoff. I am playing a 10-year game, not the 6-month game so looking at things long term helps me. I believe that preparation and getting in the right state of mind allows me to put the best me out there.
Motivate – an alternative to Peptalk, just as good for the mindset
My commute is important to me, since time is everything, having a short commute makes a world of difference. I used to have a job where I worked from home and at the other extreme, I had a job where I committed several hours a day. It was really the long commuting hours job that was hard. Having a short commute makes my life way better, I can hop in the car and be at work somewhat fast.
I make sure to spend time with my son and my wife I generally drop my son off at school every day making sure I have that small bit of time in the morning making sure I am there for him. Being a good dad is important to me.
Highest value things are done when I have good “brainpower.” Throughout the day I have different times where I get a lot of work done. Here’s what I find helps me the most:
Set intentions and get priorities straight
Mornings are coveted focus time for me. I generally wake up after 6-8 hours of sleep a night, do a workout to prime myself for the day ahead. Have a glass of water and then try to figure out what will have the most impact. List out up to three things that if you accomplish them, you have made a big impact.
Your priming morning – first 60 minutes is most important. Really focus on important meetings, hard tasks and things that need to be pushed forward, i.e. important initiatives.
Then the highest value thing should be tackled first – the profit that produces results – 60 minutes no interruptions.
20 minutes – do something else like going for a walk around the block
Making time for creative thinking, for me, is sometimes at night and sometimes in the mornings, and the weekends but keeping times for this is critical.
I always create bubbles of focus, having times or days where I focus on a task. I have my “Menlo Labs” like what Thomas Edison has, a place to totally focus and an offline distraction-free, it is important to get a deep focus on one task per day.
I do like to change up my environment, I tend to work in various conference rooms at the office, I sometimes take an Uber and work in a different location, i.e. Starbucks is a great place to work for a change of environment.
You can always create more money but you can’t create more time, ”seize each day.” Remember that.
My three key areas are:
Taking time for personal development
Taking time for thinking strategy
Taking time for action and execution
Maximize every second of the day
Have training team time
Stay fully present while focusing on your time
I tend to focus on what I want (the outcome), not always tasks and everything I need to do all of the time which has allowed me to really build a company over 10 years. Here are some of my other suggestions for making the most of a productive day that has worked well for me over the years:
Be unorthodox and be unreachable at certain times to do deep focused work
Have a schedule that works for you
Get gas when no one else does, get your groceries when no one else does
Lines can kill your day suck time
Teach people how I wanted to be comminuted with, e.g. calendly & slack
Check email at specific times
Whatever you focus on multiplies
Time block on specific tasks
Spend time on profit-producing activities
Have a perspective you only have 24 hours
Don’t say “I have tomorrow”
Identify my highest four times – when do you get the best results
Figure out when you have the best focus, not when society says you need to do this task at x time.
Always remember habits define me
Some additional strategies that I use:
Think 3 or 4 steps ahead of the business
Stress is not your enemy. Focus on getting results and it reduces stress
Change your environment to change your stress
Shift my perspective
If you have a problem try to come up with two solutions
Analyze why I am stressed
Weekly master plan – work on planning out your week for an hour – a powerful purposeful intention
Always have a deadline
Celebrating weekly progress
Quick celebration and quick recover
Train your mind like a muscle, and not multitasking – do one thing to completion
Since I have my phone with me I have several critical apps I use. Here are some:
Evernote – I use this app as a general note-taking app for any meeting, it runs on any device.
AirTable – A great databasing app, great to track lists of investors, business dev
Calendly – helps me scale and allows people to find times on my calendar that work for them,
Become an expert on what apps are out there for task tracking and pick one. Education is also very important. I view learning as a lifelong endeavor. Books, audio and videos to spark my mind.
MOOGs are really taking off and there are a few that I use all of the time to sharpen my skills –
Audible – A must for everyone who wants to listen to an audiobook on the go. I use it when I am doing laundry.
CreativeLive while cooking on the weekends, I am always learning something new from the ever streaming masterclass courses that are happening. The Apple TV app is great.
Udemy is great for learning anyplace, I generally am going through a course a month to sharpen my skills in business.
Schedule a few vacations, book them now, I have been booking vacations far out, I book them and don’t wait. Having a vacation booked sets a precedent that you have slotted time off, the act of booking the time off will allow you to have some future time to look forward to. I sometimes don’t book anything too extravagant, maybe some time with family where we go drive to a hotel for a week.
Deep linking in iOS is using hyperlink URLs to launch an app with specific content. The specific content can be a particular section of an app page, or a certain tab or specific view. To test this out you can download the Twitter app, login and then close the twitter app. Next open twitter://timeline in your Safari mobile iOS browser and wallah, iOS will switch to the Twitter app and go directly to your timeline. You can even do more sophisticated app switching like this – in your, iOS Safari Browser enter this, twitter://post?message=learn%20deep%20linking and the native twitter app should open up with a draft message composed “learn deep linking”.
You can use deep linking for:
Moving data between the apps from launching an app from another app and passing information
Building a web-like URI based navigation scheme within your app
And of course integration with other apps like drchrono EHR by letting them launch your app directly
Also recording and reviewing user behavior to learn where your users launch your app from
How to use deep linking on Apple iOS iPad?
To link back into drchrono, it can now be done, you can Deep Link into the iPad iOS appointment page. This is the code to do it, it is super simple to do –
Deep link to an appointment drchrono://appointment/<appointment_id>
You can Deep Link into the iPad iOS patient chart as well –
Deep link to a patient drchrono://patient/<patient_id>
You can Deep Link A great example of a partner show has built into drchrono is our partner Physitrack –
How to Login to EHR via oAuth?
If you wanted to setup login on iOS, it can be done, the team at Eko Devices did an amazing job. They leveraged the drchrono Healthcare Doctor API which can be found here, https://www.drchrono.com/api-docs.
You can see a video here –
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We started drchrono leveraging technology; our mission: to build something physicians and patients want, tackling hard problems and to fix healthcare.
As part of our mission and as the healthcare revolution is also happening we want to enable an open API for developers from around the world to work together. We see a future where physicians and patients can use wearables, Internet of Things (IoT) devices, other medical software and hardware to leverage our cloud-based EHR and API. Healthcare should not be siloed where data is locked into a non-cloud-based EHR. In that future developers will come together to build jointly to create a better healthcare experience for everyone, providers, patients, caretakers, and family.
The Argonaut project is a way to make healthcare more interoperability, drchrono is a part of this project. The idea is to get different players in the industry on to a simple to understand easy interface. (drchrono has also committed to Sync For Science)
There is a new data standard called FHIR or Fast Healthcare Interoperability Resources.
There are some core objects or classes called “resources” that show how we represent different pieces of data in health care. Things like what is a patient look like, what does a medication look like and what does an allergy look like.
In healthcare we are always asking, how do you package data, so things like patients, they have a first name, last name, date of birth, phone number, address.
EHRs are storing patient data in different ways and it looks totally different. But if we standardize the interfaces for transferring and for receiving, the can make sure all of these different systems can communicate when sending data back and forth in an easy way. Healthcare is been transferring data for years either by hand or electronically. This is important now because we have been transferring data through on scalable standards like HL7 version 2 and X12s format. X12 and HL7 formats are delimited file formats that have embedded information with a hierarchy to that data, but it does not pass it attribute names with it. So what that means is both parties beforehand have to agree and know exactly in the format and order of the data before transfer, explicitly knowing this information before e.g. Knowing names and the delimiters in great detail. This only allows them to develop for each other using those formats.
On the other Modern formats such as JSON and XML are using a lot in web development. They are agreed on apone standards that developers can all use that tag patient information so what you call a resource you know what you are calling.
Sustaining a band like the Beatles is very similar to sustaining the momentum of a startup. You have to all be on the same page. You all have to be playing in harmony and you all have to be moving towards creating something different, unique that people actually want. I like to look to the Beatles from time to time and look at the energy that band sustained over a very long period, from 1968 to 1970.
If you look at GE or General Electric, they have been on the public markets, lasting longer than any other company on the stock market.
I see startup teams very similar to sports teams or like high energy bands.
( This blog post is a work in progress. )
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Software is living and breathing, it is something that is continually changing with “the times”, to be successful over time you must continually be iterating and updating software, working to create the best experience for your end user. Software shouldn’t be stagnant.
Many vendors in the software industry are fighting with “The Innovator’s Dilemma“, where the company has not moved to building software in fast iterative cycles. The best way to create a nimble release cycle culture in your company is to have your software created and maintained in the cloud. For vendors pre-cloud movement, it is hard for them to move to a cloud software and to Software as a Service (SaaS) models when customers are paying for older software that is working right now for them. What will justify the moved to the cloud when the customer paid large sums of money for software that is working for them. Overtime, non-cloud base software will become stagnant, it is a struggle to keep all of your users up to date.
The risk of doing large software releases in the worst case scenario; when a large software update is released, users reject it and don’t use the software at all. There is also the risk that a large software update takes to long and the software is delayed to a point where the application is “stale” altogether or never released.
The Infinite Software Release
Have you ever heard of the “infinite release cycle”? The goal is to release often allowing continuous small daily, weekly or monthly incremental changes to software. Doing large/major version releases of software every year slows down developers from moving fast and getting input. A large software release benefit’s marketing the product, the product queues up for launch and gives the marketing team something big to announce, but doing so slows down getting the product out to market for real users to take advantage of getting feedback.
For example, the drchrono iPad and Web EHR is a continual work in progress, starting January 2009 and we have been on an “infinite release cycle”, pushing code to quickly, not releasing yearly or monthly but daily or close to daily. Within a given year, we have released at least 100 to 400+ versions of drchrono, that is how we are making the drchrono platform better and better at a rapid pace.
Look at the graph below at how infinite release cycles can change the customer experience and feedback loop. The green line represents a company that is on a yearly release cycle, great for marketing and launching a product right out of the gate will tons of features, but this is sometimes bad. Customers don’t have a chance to help you refine and give input the software. The blue line represents the quarterly release cycle, it is a better then yearly releases, allowing customers a chance to give feedback and learn about software in increments. With an infinite release cycle, customers can learn the product as it comes out and as enhancements come out, the learning curve is less drastic. Fast release cycles provide quick feedback loops to be able to make changes fast for refinement. Do you think it would be easy to do this if you are building for a year in an insular environment, then realizing a customer wants a major change? It is much harder to make a major refinement if a years worth of work is complex to change, which happens often.
Version “day 1”, year 2009. drchrono iPad EHR.
In a new world of cloud-based apps and services, rolling out software in the past was episodic. Now things are moving to an almost continuous release cycle, happening fast. In today’s environment aren’t products “done” like they used to be, they can’t be. Do you recall the days of software on DVD and CD? You can’t just ship a DVD with software on it and call it a day anymore. The focus has shifted to pushing code and having the capacity for reversibility. You need to build software in real-time so you can iterate fast but also build fail-safes in place so if there is an issue, the software can be fixed it before users notice it. Reversibility is very important if you’re rolling new software out that is broken. It must be tested, one great company that does testing is Rain Forest, they have an on demand Uber-like service for quality assurance (QA) testing. As part of the deployment cycle, you need to test and talk to customers, showing them the new software, react to feedback and iterate.
Move Fast and Release Often
A critical metric to track is how long did a cycle take and what can you do tomake the next cycle faster?
Be sure to track after a developer writes code and committed to run the unit test and then how fast the code gets into production. If you can get the code out into production in 15 minutes from a change in code base out to users allows faster iteration and feedback.
After developer code is written and committed track these
Time after code was written, track how long until a unit test is run
Time after code was written, how fast the code gets into production
If you don’t track that metric, release cycles will generally get slower and slower.
Many startups start moving fast and naturally slow down on release cycles, to bi-weekly, weekly, then semi-monthly, then monthly. It can get worse from there.