Category Archives: Startup

FDA Regulation

Some emails this morning prompted me to write this. I have many thoughts on FDA regulations which are mainly formulated by my contact with companies that comply with FDA regulations. Note that I have no experience getting something FDA certified. If you do and want to comment please do so.

First I note that FDA regulation does not produce quality software. Whatever goes on does not include rigorous testing, How do I know? The number of bugs that appear in FDA regulated software. I have seen all sorts of bugs from showing the wrong patient data to crashing on legal DICOM to processing HL7 messages incorrectly. That is to say nothing of crashes, system hangs or other phenomenon. One of my colleagues could crash a leading vendors 3D workstation on demand. It was always funny to do it in their booth and watch their people squirm.

Second some vendors have used and still use it as an excuse to sell hardware at hugely inflated prices. Some are worse than others and at the slightest modification to a system throw up their hands and talk about how they cannot guarantee that their system will work. Once a vendor told us that hooking a trackball to a PACS workstation instead of a mouse could cause the software to click on random things. After all the mouse had not been validated. Fortunately our administrator told them just where they could stick that line. For anyone familiar with software you know that mouse movement is controlled through an abstraction layer and the software has no idea what it is talking to.

So just what is this regulation getting the customer? Not a lot other than expense. Quality software is built by having good developers and employing good software development techniques. People interested in this should check out the book ‘Dreaming in Code’ by Scott Rosenberg.

Now obviously this is anecdotal and you may reader may cry foul and say that this is all not really true. I know of no company that compiles data on software quality in healthcare. Healthcare software companies would throw up all kinds of roadblocks if this was attempted since I think most of them know what would be found. So all we have today in anecdote.

In summary I view the FDA regulation of software as a waste of time. It is good that they try to make sure that companies are not cooking people with radiation and that at some level they keep the pharma companies in line although that is a completely separate and very complicated issue.

Why scalability should concern you when you are small

Scalability is a topic often ignored by small companies. We will get to it later. We don’t have enough traffic. We don’t have the time or resources. Well that’s all well and good until something happens. Maybe that something is you becoming successful. Now your service is in demand. Your database is being pounded. Adding web servers isn’t a problem but getting them data is. Your database server thrashes in agony. And then you get upset. How could this happen? We bought big beefy machines from Dell. We paid a lot of money for them.

Engineering scalability does matter. You don’t need to have all the hardware you need to stay up when TechCrunch links to you. I would even say just having your developers model what they would do is good thing. Then at least you have a plan that has been tested. You know what you will do as traffic increases. People who know me have heard me talk about playbooks. I don’t always advocate doing exactly what your playbook says but I strongly recommend having one since it gives you a place to start. Think of it like a business plan. You won’t follow your business plan exactly but it gives you a place to start.

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The commitment of startups

It takes an extra ordinary amount of commitment and courage to do a startup. Forget everything about how it is easier now than at any time previously. That may be true but the guy saying that is not you. He will not be the one who has no money, has no time, and cannot sleep at night.

Check out this post on the commitment and sacrifice that startups require.

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Build a team around a problem, not a problem around a team

If you know a cool bunch of really smart and talented people you may be tempted to say, ‘We could start an awesome company together and take over the world.’ And in some cases you can. However this post is a word of warning.

Problems are funny things. They rarely show their whole selves that the start. They are more like an iceberg and you say, ‘See it’s not that big, there is only a little bit pointing out of the ocean.’ Meanwhile concealed below it is an enormous chunk of ice that you only find out about when you try to ram it with your ship. Similarly when you jump into a problem to provide a solution there is a lot more going on than you understand. Now this is not a bad thing, it makes the solution much more fun and interesting.

So when you start with a team and decide to work your way backwards into a problem a couple of things can happen. First if the team comes from a specific industry vertical or a vertical within a vertical their focus on the problem maybe highly skewed by there experience to a small subset of the market. At one level they can build a good product that targets a small industry. It might even be profitable. However it can be severly handicapped in terms of expansion. Why? Because all the investments to date will have been to target a small market segment with no real plan for expanding beyond where the product started. In some cases this might be fine. But what if you big neighbor text door, Mr. Tech giant says look at that. How short sighted of them to only target that industry segment. I want in on the action. Then one of two things can happen, Mr. Tech Giant says to you I will buy you and you come work for me. I will send down a business development gal to help you see your short sightedness. That story has a somewhat happy ending. The owners get bought out and make some money. The second thing that can happen is Mr. Tech Giant launches the service himself. He may have a hard time attacking your industry if you do a good job but most of the rest of the market may go to him. (I chose Mr. Tech Giant since I have a technology background and I am doing a tech startup but in other industries he may take the form of another well funded startup, a conglomerate, or just another company looking to extend its reach.)

So what are you to do? So eventually you will find a problem. It may be obvious, it might not be. However there will be a definite problem and market opportunity. So then you say what will a solution look like? At the beginning you may have a very clear idea or you may not. In either case chances are that what you end up with will not look like what you originally envisioned. In order to move forward you will need some sort of a team. For a small consumer facing web site you may just need a couple of developers who can hack something together. For many things however you will need to assemble a team, at least a small one, of people with skills and experience that you do not have. This is especially true if you are young, like me. Before assembling the team you need to look at the problem and say what is it going to take to overcome this problem? Do I need someone to bring in advertisers or do I need someone with experience forging partnerships in a specific industry. You should not feel pressed to fill all the positions at once. If you have a list of who you need when you find a good person you will know that you have a role for them. In any case people should fit in to the team to bring something that will help the company be successful.

So in closing build a team around a problem, not a problem around a team.


My Blogging Absense

I have been bad. I have not blogged in a long time. I was doing pretty good there for a while. I have been working on Yottalook a lot. So much to do as a startup. I have learned a tremendous amount about developing a business, what it takes to develop a business plan, how financing works, how to keep books and lots more. So I am going to try and be a more regular poster.

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More or Less

I have been giving a lot of though recently toward an going debate in the server business. Do I, as Google does, buy more desktop class computers and use software for reliability? Or do I buy fewer, more expensive servers that have some redundancy in hardware? Are there hybrid models? Johnathan Schwartz talked about this on his blog. Sun sells server class hardware and does argue for bigger, fewer, more powerful servers. Google is well known for using PC class hardware in an amazing density and it has worked well for them. I am looking for off the shelf hardware for right now so do I use bladesystems? I like the HP C-class half height servers because I can put 16 servers with all their support equipment in 10Us. But is it cost effective? I think that the Google approach is great but how much work does it take to build the custom racks? What is the learning curve for dealing with cooling? For now I am leaning toward cheap blades.

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Evalutating a Software as a Service Vendor

ZDNet has a great article on what to look for in a software as a service (SaaS) vendor. While SaaS has not caught on in a serious way in healthcare yet that will change. It will take a few years because of peoples fear about data traveling outside the enterprise but the cost savings of doing so will be too great. I wish I could launch a SaaS in healthcare today but I have grave doubts about adoption.

Now has a post saying the opposite of that. I think though in healthcare today people will still be very concerned about privacy. I say privacy instead of security since today it is possible to build very secure services.

Do cheapskates make good customers?

OnStartups has a post on whether cheapskates or "overly frugal" customers are good for startups. I just wanted to add one thing to the list of reasons that they are not. Collections. As a startup cash flow is very, very important. These people often do not pay on time and valuable time may be spent on trying to collect what is owed you. Just a piece of knowledge from the trenches.


Guy Kawasaki and Michael Arrington has a great video of Guy Kawasaki talking with Michael Arrington about what it takes to get a company profiled on techcrunch. So if you are not familiar with techcrunch it is a hugely popular blog that talks about new and interesting things that are happening on the web. If a company get profiled on techcrunch 10s of thousands of unique visitors will be directed to a site. I highly recommend watching this and almost anything else that Guy does since he is a great speaker.

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Cool Software

have been meaning to write about the software that I use for sometime. I am only going
to write about things that are good and useful to a startup so don’t worry. I
have found that software can be used to greatly improve my effectiveness. So my number
one piece of software is…

  1. Not a piece of software at all.
    My Blackberry
    . This thing is a life saver. If you can afford it I have found that
    the ability to work in airports, in peoples reception areas while you are waiting
    for them, just about anywhere to be indispensable. Your contacts, calendar and tasks
    are always synced. Now RIM has released Blackberry Enterprise Server Express which
    is free for one user.

  2. Plaxo.
    I want everyone in the world to use Plaxo. Incase you don’t know Plaxo is a contact
    management tool that integrates with Outlook. If you and I both use Plaxo we can exchange
    contact info without any user intervention. It allows you to request that people in
    your address book update their contact information. Everything syncs to the server
    out on the web so your calendar, contacts, tasks and notes are stored in a safe place.
    This also allows it to sync to multiple computers. It also can sync to Yahoo! Mail
    so your contacts can be used from a Yahoo account also. Your information can always
    be accessed simply by logging into a website.

    I thought SF was complicated at first but I have found it to be very easy to use.
    It has some functionality that overlaps with Plaxo such as contact management but
    has many more powerful features for managing customers, partners and competitors.
    I like the ability to create organization charts that shows who reports to who. It
    also has an awesome reporting package, not that at this point in time I have so much
    information that I need it. They offer a free account for one user so give it a try.

  4. QuickBooks
    . I didn’t want to buy QuickBooks and install it at home so I was
    overjoyed to find a hosted version. It has all the functionality that I need to mange
    the books for iVirtuoso as well as create invoices and manage time for a project.
    I would caution that this tool does not replace knowing how to keep good books. The
    documentation is also sketchy on how to do anything other than the basics. All in
    all I like and will continue to use. In the future I will link and
    QuickBooks online together.

  5. Basecamp.
    Basecamp is a project management tool that focuses on communication between team members.
    It is very simple, but that should no be confused with lack of utility. It focuses
    on the things that projects, both large and small need, communication, milestones
    and tasks. I encourage you to give it a look. It is possible to integrate this with

  6. Microsoft Outlook. Almost everything
    previously mentioned integrates with Outlook. Outlook is definitely the my hub of
    communication. If you have not used outlook 2003 give it a shot. Chances are though
    you already use it.


Notice that everything
I use ties together. This is by design. The first thing I ask myself when looking
at a new piece of software, no matter how cool is how can I integrate this into my
current technology stack. That is something that you should do too.


This weblog is sponsored by iVirtuoso, Inc.