The 5-95 Rule

PUBLISHED ON  January 28, 2013

WRITTEN BY  Roni Zeiger

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I’ve had a ridiculously fortunate life and career so far.  One of my “problems” is that there are too many interesting things to work on.  I’m developing an approach to this problem, which I call the 5-95 Rule.  It’s a work in progress, and I’d like to share it in case it’s helpful and selfishly to learn how it might be improved.

Assuming a long and healthy career, I expect there will be about 5 projects that will be THE things I work on.  These are the ones that have the highest potential impact and are most uniquely suited to my background in medicine, product development, and informatics.  My last such ‘project’ was my fabulous job at Google.  The current one is a startup company called Smart Patients (more on that another time).

I estimate that over the course of my career there will be another 95 projects where (a) the project could have important impact on the world and (b) I could significantly improve the project’s chance of success.  So, a career with 5 projects that I’ll work on full time, and 95 others — hence, the 5-95 rule.  I’ve developed a pretty good sense of how to choose the 5 and dedicate myself to them.  But how do I find the other 95 and what do I do about them?

I don’t think I’ll ever have a perfect answer, but I actively think about this now.  Why try to find them at all?  I’m an impact junkie and I love to learn.  I’ve also learned lessons about how critical focus is, so we’re talking about small, targeted commitments.  One might be a formal advisory role, another a lunch and a few emails.

Currently, I’m an advisor for three companies:, ShareTheVisit, and Hobnob, and I’m on the board of directors of a non-profit, Medic Mobile.  One not-very-humble principle guides me: if I’m a formal advisor for a company, I want to be their best advisor.  If I can’t be, that’s a signal that it might not be a good enough fit.

I love that I often get asked for informal advice.  If I don’t think I can help much, I’m not shy about saying so, sharing my quick thoughts, and wishing someone good luck.  Probably once a quarter, I have lunch with a  young entrepreneur.  I’m certain that much of the time, I learn much more than they do.  (Another discussion for later: I’m convinced that the only useful definition of expert, is that someone thinks you’re an expert. The rest is self-fulfilling.)

One of the many reasons for starting to blog again is to have an easy to find “contact me” page.  If you’re one of the 95, let me know!

Patient Friendly Orders

PUBLISHED ON  December 26, 2012

WRITTEN BY  Roni Zeiger

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Here’s another technically easy and culturally hard product: Patient Friendly Orders.  My version of this idea was born when I was admitted to the hospital for pneumonia about 5 years ago.  Even though I had previously worked in that hospital, the quality of communication about my care between the patient and the medical team was poor.  This got me thinking…

There should be a touchscreen by my bed that lists all the current doctors’ orders. They’re not hidden in the chart.  They’re not explained only in ephemeral conversations that occurred without me present.  Of course, if they’re in front of me, they’re going to have to get written in English.

Let’s organize the orders, too.  Imagine a loved one is hospitalized for a severe skin infection which also caused his diabetes to get way out of control.  He has difficulty sleeping in the hospital and also needs pain control.  All the orders — whether for diabetes, infection, sleep, or pain — are organized according to the problem they address.  (While doctors’ notes are generally organized by problem, their orders are not.  I bet if we implemented Patient Friendly Orders, they’d be useful for doctors if only just for this reason.)

When the doctor or nurse or physical therapist comes in, the patient and family can have a conversation about the current plan, with that plan laid out in front of them.  They make a shared decision, and the doctor can update the plan on the same touchscreen.  “Sounds like a plan,” the patient says while actually looking at it.  When you visit your loved one, he can show you the plan, too.  If a question comes up about a given order, or why something is missing from the plan, you can make a note on the touchscreen so the medical team knows to address it when they next come by.

What about all the loved ones who can’t be in the room, the patient’s broader community?  When I was in the hospital with pneumonia, for example, I wish I could have tweeted: “Switched from ceftriaxone plus doxycycline to zosyn. Does that make sense?”  This of course raises important questions.  Certainly, any such broadcast requires truly informed consent of the patient.  I don’t think such a tweet would violate my doctor’s privacy assuming I don’t mention him or her by name.  It would be fascinating to understand what a doctor might think: “Switching to zosyn — oh [bleep], what are they going to say on Twitter?”  Is that a bad thing?  I suspect the good would outweigh the bad.

But more important, it’s a conversation the patient and his or her loved ones must be allowed to have with their community.  Indeed, we’ve probably all been a part of conversations about whether someone we care about is getting the right care.  It’s just time the patient’s medical team and the patient’s community can be part of the same conversation.

Networks of Microexperts

PUBLISHED ON  December 17, 2012

WRITTEN BY  Roni Zeiger

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We’ve heard a lot about crowdsourcing, or outsourcing work that one person would normally do to a large and often distributed crowd.  There is a related and I think even more important idea of a network of microexperts and how they amplify the collective intelligence of their members.

Gilles Frydman — a pioneer of online patient communities and now my co-founder at Smart Patients — has developed this idea with me.  He has witnessed for over 15 years the power of cancer patient communities, each an organically grown network of microexperts.  Much of our recent thinking is inspired by Reinventing Discovery by Michael Nielsen.  He talks about the 1999 chess match of world chess champion Garry Kasparov versus “The World”, where anyone was allowed to be on the virtual World team and each move was decided by popular vote.  Remarkably, The World almost beat Kasparov.  No one on their team could consistently compete with Kasparov, though several happened to have a deep understanding of one of the configurations of the chess board during the match.  And critically, one woman was also good enough to recognize who had the best suggested move because she carefully considered and understood their analyses.  She couldn’t create every insightful move, but she could recognize them, and since she also earned the trust of the community, she converted individual insights into actionable collective insight.  She tapped into a network of microexperts.

In thinking about this idea in the context of health, I’m convinced that our next exponential leap in medical progress depends on us learning from networks of microexperts.  Today when I see patients, for example, I’m often not sure what the right diagnosis or treatment is.  I may look something up, ask a nearby colleague, or if I’m really unsure, I’ll refer the patient to someone more expert.  I often don’t do this because both the patient and I want a decision sooner and because the ‘expert’ is also imperfect.

Imagine if I summarized the question in a couple sentences +/- a photo, and it was immediately posed to 100 potential experts in my network, who are chosen on a per-question basis using a relatively simple algorithm that matches my question to their experience.  And I, like the woman on The World team, am a good enough generalist to know which microexpert has the most pertinent recommendation.  Building this system would require significant innovation in how groups of doctors collaborate, but from a technology perspective we could easily build this system today.  It’s clear to me that in ten years, I’ll look back on how I’m practicing medicine today, and be embarrassed at how often I settle for poorly informed decisions.

Patients, no surprise, have already begun to figure this out.  A well-functioning online patient community is a network of microexperts.  For example, a few might have a background in statistics and have learned how to interpret the results of clinical trials.  Others have the resources to travel to centers of excellence for their relatively rare cancer and bring back to the community what they learn.  Many of them read everything they can find, share potentially useful findings, ask each other questions, and discuss potential answers.  And the best communities have a few members who are skilled at recognizing key insights brought by those who happen to be the microexperts for a given question.  It’s time to learn more from networks of microexperts!