Free strategic advice for the @dailyemerald

Last night, I realized we’ve started bitching about the Daily Emerald in the peanut gallery without offering any positive advice for change. I’d like to offer my thoughts on how to turn the struggling newspaper into a successful digital news enterprise.

Step one: hold a transparent weekend (or weeklong) jam session to develop a strategic plan. Invite as many intelligent stakeholders as you can to a retreat, and put together a website for that retreat with the agenda, list of everyone involved, and goals. It might also be useful to have a open community forum in the week preceding to hear strengths and weaknesses from the perspective of the audience, or launch a website where the community and submit and vote on ideas for the news organization. When retreat happens, however, make it open and participatory. Make sure everyone at the retreat is documenting the discussion on Twitter, and livestream as much of the discussion as you can. Have a designated “community manager” for the retreat who looks for suggestions from watchers and brings those to the meeting. Tap the intelligence of the digital crowd, especially because you’ll be able to bring even more smart brains from afar.

Step two: campaign over summer 2009 amongst the Daily Emerald alums to raise the funds necessary to implement the strategic plan. Shop the plan out to them to get their feedback and insights, and use CRM (or customer relationship management) software to track these interactions. When I left, they were using a FileMaker database system and analog mail. I would ditch this system immediately, and my first investment would be software like Salesforce.com (which a news organization could also use to sell advertising more effectively). Using the new CRM, it would be wise to fundraise amongst the alums who want to see their old newspaper experiment with this platform called the internet. Including them in the process, by sending them the strategic plan and a link to the website with an archive of all the video, will make them more invested in the process (if they like what you’re doing at least).

Step three: implement the strategic plan starting in Fall 2009. If I were the publisher of the Daily Emerald, these three are of many things I would attempt to drastically right the direction of the news organization:

  • Quit the College Publisher habit. Being on a locked, proprietary content management system is probably the worst foundation you could have for a digital news organization. Focus heavily on recruiting a few developers out of the computer science program, and build a basic website on Django that you can grow from. If you ask nicely, the Daily Gazette at Swarthmore or Daily UW might be willing to lend enough code to get you started.
  • Move to once a week in print. I know that this would be very, very difficult, especially because the bulk of revenue comes from the print product, but it needs to happen nevertheless. Necessity is the mother of invention. Do it, and publish daily online.
  • Empower your community. Break down the ivory tower, and hold workshops to teach interested community members how to report on the issues they’re passionate about. I am quite certain that club sports at the University of Oregon don’t get the coverage they deserves, and there are probably at least several people who could tweet at games and submit high quality images for a photo gallery.

Right now at the Daily Emerald, though, they’re going about it the API emergency meeting way, and this is just one of the many reasons I think startups make more sense in this climate. I mean, look at all of the effort it’s going to take to turn this ship around, let alone reinvent it.

There’s also been discussion that student news will be largely unaffected by the tornado ripping through regional newspapers right now. Even if that is the case, I would like to propose an analogy: if you’re driving towards the cliff of irrelevance, your direction is what is most important. It doesn’t matter that your car’s engine hasn’t seized up yet.

Organizing NewsInnovation PDX

BarCamp NewsInnovation is a series of “unconferences” happening around the nation with the goal of bringing together “energetic, tech-savvy, open-minded individuals who embrace the chaos in the media industry because the ability to do really cool things still exist. We also need find those people outside of our industry who love to consume news and information and are great thinkers and innovators.”

On the 21st of February, 2009, we’re bringing a regional edition to Portland. The Daily Vanguard has generously provided space at Portland State, but we’ve still got a lot of planning to do between now and then. If you’ll be in the area and are interested in helping out, please leave your name on the wiki and sign up for the Google Group. Personally, I’ll be satisfied if I get to spend a day jamming with like-minded entrepreneurs on these ideas:

  • What are the core competencies of a news organization online?
  • What is journalism in 10 years? How does journalism evolve with technology?
  • What would a local news startup look like?

Being back in the States on the 21st also means I’m ending my work in Peru prematurely, but CoPress has really taken off and I’m stoked to get back and be able to take it to the next level.

In the news: entrepreneurship in India, Paul Farmer and Haiti, and water access around the world

Three news items that caught my eye in the last couple of days:

Building a Social Entrepreneurial Garage Startup in India – PBS MediaShift
Update from a pretty cool project to bring community radio stations to rural India. If it’s not too prohibitive to launching one of these (who knows what it takes to legally license spectrum in the country), then it could interesting to try applying the concept of a social business to this. I can see community radio for a social cause having a tremendous effect on water literacy, health education, etc. Also related: layoffs at out-sourcing firms might lead to huge innovation spikes in India. I certainly think it’s possible. Here comes the real competition.

Change Haiti can believe in – The Boston Globe
Paul Farmer and Brian Concannon argue for better US policy towards developing, and not punishing Haiti. It will be interesting to see how Obama’s foreign policy changes will affect the country’s development (especially in this economic climate and after the hurricanes). The authors are also participating in a panel discussion tomorrow night, the 27th of January, that will be broadcast live over the web.

Ecologists warn the planet is running short of water – Times Online
An annual report by the Pacific Institute in California says that the world could run out of “sustainability managed water.” Part of me wonders if this article is too broad to actually deliver anything substantial, but water is certainly going to become more and more of a local issue.

via Publish2

On the ground MobilizeMRS Research

Thursday morning, Wayne, Karen, and I went down to the clinic in Arequipa to discuss OpenMRS, FrontlineSMS, and MobilizeMRS with Lilia, the director of the clinic, and Maris, the assistant director of the clinic. There were a few goals to the meeting: understand the rudimentary electronic medical records system (EMR or MRS) in place now, assess the pros and cons of that system vs. OpenMRS, and discuss the possibility of running a clinic efficiency experiment with FrontlineSMS. We got through the first two agenda items pretty well but, being on Peruvian time, didn’t make it very far into the third.

Brain and note taking dump ahead.

The clinic has an EMR at the moment which is very limited. It was developed by a local programmer they still have good relations with and, every time they want expanded functionality, they just ask he (or she) to build it. Furthermore, the clinic staff has been talking over the last year about different ways to expand the tools. At the moment, it captures data about the patient, vital signs, and has a free text area for diagnoses. Continuing development on this software will require significant money, of course, which is why OpenMRS is probably a better long term option. Writing software for a pretty common use case doesn’t make much sense when there are customizable open source options available. Thanks to a relatively fast internet connection today, I was able to upload a HD walkthrough of their current EMR:

Tour of the clinic’s custom EMR from Daniel Bachhuber on Vimeo.

One fairly significant problem we faced Thursday morning, however, was trying to convince the clinic staff of the merits of OpenMRS without a full featured online demo or video tutorials. I personally haven’t experimented with the software very much, nor do I know all of the useful components of a medical records system, so I couldn’t necessarily sell the software with my salesmanship.

Wayne, being proactive, took the conversation from step zero so that Lilia and Maris would be able to help assess the merits and demerits of their current system:

Basic needs of a Medical Records System from Daniel Bachhuber on Vimeo.

According to the doctor, the basic needs of a medical records system are three-fold:

  1. Documentation – an EMR should have the ability to take notes and capture information on labs, Rx, Dx imaging, etc. Most importantly, this information should be searchable.
  2. Networking –  an EMR should lend accessible communication, both internally (within the clinic) and externally.
  3. Decision support – an EMR should be intelligent, and assist the clinic staff in identifying high-risk patients, etc.

Once we had these criteria established, we started talking about the pros and cons of using their current system.

Pros and cons of the current system

The pros of their system are:

  • Easy implementation – the software is already installed on the computer and they know how to use it.
  • Design specific to clinic – they can choose how they want the software to operate because they direct the development of it.
  • Know[n] commodity – they know what they’re dealing with.
  • Personal sw. provider – the developer is local and can come to the clinic to provide support, etc.
  • Economically speaking + impact – Cheap for what it does.

The cons of their system are:

  • Design specific – the design of the software is tied very much to the needs of their clinic today, and not five years in the future.
  • Expandability – uncertain as to how difficult it is to extend the system.
  • $ for upgrades – have to pay to have the developer build every single upgrade. Also, only the developer knows how to build or maintain the system.
  • Don’t really know “OpenMRS” – don’t have the proper education materials to illustrate the power and flexibility of OpenMRS.

The unfortunate thing is that their current system doesn’t match up to the needs of an EMR very well. As it stands, it’s not much more than a data storage tool. They use it to house basic information about the patient, symptoms, and diagnosis, but it isn’t very useful as a tool to manipulate the information. On top of that, the networking support (connecting computers in the reception with those in the doctor’s rooms and farmacia), has yet to be built and decision support is cost ineffective.

The clinic is interested in OpenMRS, however. On Monday or Tuesday, Wayne will be showing Lilia and Maris a demonstration of the EMR he uses back in the States. This will ideally convince them of the practicality of having a robust EMR. We’d also like to get them to a clinic in Peru that has a working demo of OpenMRS soon. If this proves feasible, then we might be able to send the programmer they have to an implementer’s training with PIH.

A thought on bringing the programmer into the fold: this might actually be an economic enterprise for him or her. My thinking is that there are a number of clinics in Arequipa still using paper records, so if the clinic HBI works with becomes a local model for using OpenMRS, then that might get the other clinics interested in medical records and incentivize the developer to get to know OpenMRS better.

In the interim, though, the clinic will still put a bit more money into the system they already have.

On the note of SMS, we discussed the possibility of how mobile might be useful to increase clinic efficiency:

Day seven, Arequipa from Daniel Bachhuber on Vimeo.

The idea wasn’t very well received, though, because the assumption is that the demographic that the clinic serves most likely will not have cell phones, and the clinic staff couldn’t really understand how the technology could be useful. Anecdotally, however, a doctor said the penetration of mobiles in this market is near or over 90%, a statistic which doesn’t seem too unrealistic to me. Furthermore, I think that mobiles could play a significant role in improving the efficiency of the clinic.

We’ve got an experiment cooking too. Building upon the pediatric idea briefly outlined in my previous post, we’d like to have a control group, an experimental group which receives a reminder for their appointment, and another experiment where the group receives a unique code for a discount on their appointment. In preparation, the clinic will start collecting cellphone numbers at registration. Ideally, this experiment will be later this spring or early in the summer.

One last thought on efficiency: we’d also like to run a two week experiment (probably in February) where patients receive a time-stamp upon checking in to the clinic, and another one when the doctor takes them for their appointment. I think mobile could a tremendous impact on the clinic’s ability to efficiently deliver healthcare (the concept of being on-time for appointments is nearly zero), but baseline numbers will be really important to calculate impact.

Greg Linch on CoPress

Greg Linch was interviewed by David Cohn in the past week about CoPress which is way, way cool:

 

As the project has been a very, uh, organic process, I thought I might clarify on a few points Greg made.

First off, it is of my humble opinion that open source content management systems are philosophically better than proprietary. The key component to this argument is that you, as the developer or end user, are allowed to edit the source code with a platform such as Drupal, WordPress, or Django, whereas with a proprietary system like College Publisher you are limited to their ideas and their development cycle. News organizations not only need to be online, but they need to be able to innovate online. On top of that, in choosing an open source CMS we’re actually hoping student news organizations will take the initiative and start experimenting with how “news” or  “journalism” is delivered. We’re different at the core because of this.

This conversation is especially timely, too. I’m in the process of drafting documents to define what the specific vision of CoPress will be for the next couple of years. Really, we’re a lot more than hosting. CoPress Hosting is an attempt to get student news organizations to be on the same platform so that they can collaborate. The core of what CoPress stands for is the network of collaboration, and we’ll be experimenting with the best tools to make this possible. In the video, Greg mentions a conversation that arose organically in our Google Group. We want to create a platform, something I’m calling a social intelligence tool, that allows those types of conversations to happen more often and to create more value. The short goal is this: the tool will connect you with the person most likely to be able to answer your question (whether it’s troubleshooting a faulty plugin or install Apache). To my knowledge, this has never been done. We’re a pretty ambitious bunch, though, and I figure we’ll give it a shot.

Greg also discusses the long-haul for the team. Personally, I never expected the project to get this big (it was originally going to be a 20% project at the Daily Emerald), so we’ve largely been making this up as we go along. We’re currently in the process of establishing six month, more formal positions, and my hope is that, if we start generating some sort of revenue stream, the core team will all be part-time positions. This is a bit different than what Greg said, but my logic is that I don’t think any of us (no offense to the team) is really qualified to do what we want to do. Part of it will be a learning experience, which will be valuable on its own, and part of it will be work, which it would be nice to be reimbursed for. 

On the plus side, we’ll be using the full genius of Joey Baker to put together a business plan and identify methods for long-term financial sustainability.

Another year, another grant application

CoPress, an initiative on its way to becoming a non-profit organization, has submitted another grant application. We’re building a better technical eco-system for student news organizations, which means that we’re creating the tools and means for the techie kids at student newspapers to share ideas, collaborate on code, and generally work together to develop really legit websites. To do this, though, will require a bit of effort (which we’re already been putting forth) and a bit of money (which we as students don’t have much of).

Ashoka’s Changemakers has a pretty cool competition called “The Power of Us: Re-imagine Media” that might help us out. The winner(s) will receive $50,000 towards their project. If you vote for us, which we very much hope you do, it might just be CoPress.

First stage of MobilizeMRS research

Day one in Arequipa: asking as many questions as I possibly could about how Health Bridges International‘s partner clinic in Alta Cayma operates. This research will serve two purposes: extensive background for how MobilizeMRS might be useful, as well as assessing resources for intra-clinic collaboration. 

A little background. The catchment area for the clinic in Alta Cayma includes 30,000 to 35,000 people. From this population, the clinic saw 22,000 visits in the past year, with between 15,000 and 17,000 unique patients. Recorded number of visits to the clinic is increasing at a rate of 4,000/year. The clinic is pretty well resourced, according to Wayne of HBI, with a team of physicians (rotating 5, not all full time), dentists (2), nurses (9, not all full time), pharmacy (4), management (2), and two specialists, a psychologist and opthamologist. Essential medications are provided through a Catholic charity program and they can get most others through donations. Where the clinic lacks is primarily in specialization, health education, and patient care advocates.

  Continue reading “First stage of MobilizeMRS research”

Striations of the city

Down the street

A view of the main street running down Alta Cayma. As the city grows, it expands outwards, and the distance from the center is a decent ruler for measuring socio-economic status. The houses, businesses, and infrastructure closer to the hub are significantly nicer than those in the periphery. Conversely, a view up the street running out of town (from a few blocks higher):

Up the street

Rural poor come to the city looking for new livelihoods, and the easiest place to start is on the outskirts of town.

Also, a wee little video of the same area.

My winter term

In about a half hour, I’m headed on Continental Flight 308 to Houston, hopefully ending up in Lima at some point tonight. The plan as it stands now is to spend two months in Peru enjoying the summer and working on a few different projects.

The first destination is Arequipa, in southern Peru, to do research for Health Bridges International (HBI) on how the clinics serving the Alto Cayma catchment area can better coordinate efforts, share resources, and work together. The specialty I hope to bring is identifying ways in which communications technology (like a Google Group, WordPress blog, or SMS) can enhance collaboration. Wayne and I worked on a questionnaire a while back that will be implemented at a healthcare providers conference on Monday and Tuesday. Here are some of the questions we’ll be asking:

  • What types of resources are you commonly lacking?
  • Do you have internet access?
  • Do check email regularly? How often?
  • Are you interested in collaborating with other local clinics/ organizations?
  • Would you be interested in sharing specialty consultations?
  • Would you be interested in sharing supplies or resources?

We’ll be trying to keep it short, but I’d enjoy any and all feedback on the questions we’re asking, as well as ideas on how to connect clinics with limited resources.

Along with doing research for HBI, I’ll be doing interviews to gather information for MobilizeMRS, a project with Isaac Holeman and (hopefully) Lewis & Clark Direct Action. These interviews, which will probably be video too, will try to deduce:

  • A solid use case for FrontlineSMS in the HBI clinic in Arequipa
  • What different stakeholders think the project can do
  • The organization of the community health workers network
  • # of trips made per day by community health workers + doctors, average distance of each trip, and how they travel
  • Access to electricity

Thanks to Josh Nesbit for feedback on the scope of this research.

At the end of January, I’ll be headed to Cajamarca to work on Oregon Direct Action’s water project in San Pablo, Peru.

More soon, I promise. Final boarding time now. If you’re going to down there at the same time, hit me up. I think I’d like to do a few weekend trips to get away from work. And an FYI for those of you that follow me on Twitter: I hope to tweet as I’m traveling around. Twitter no longer delivers international SMS, however, so the conversation might seem a bit one-sided at times. My apologies in advance.

Onward!