Welcome to This Month in Digital Health, where I highlight news articles and trends that recently caught my attention and attempt to explain why they matter. The key theme for the month? Everything’s a mess.
AI use isn’t equitable. HHS data released before the shutdown found an unsurprising digital divide in predictive AI use, with small, rural, independent, and critical-access providers all lagging. Groups such as the Coalition for Health AI fear safety net providers will only fall further behind unless they’re able to recruit the IT staff required to get AI efforts up and running. This is broadly consistent with pretty much every single type of healthcare IT, and sadly I don’t see it changing any time soon.
Of the 5 million adults projected to lose Medicaid coverage due to work requirements, 41% have three or more chronic conditions – you know, the type that require frequent interactions with a physician to manage properly.
Amazon is rolling out pharmacy kiosks, which are totally going to fare better than all the other pharmacy kiosks that have failed in the last 15 years.
Apparently moving workloads to the cloud willy nilly has left lots of healthcare organizations with unpredictable and untenable costs, which means some workloads are coming home like the Prodigal Son.
Foundation models are all the rage in radiology, as they’re based on millions of images and purportedly are more accurate. That said, FDA authorization is slow and typically tied to a single use case.
September was about puttin’ the nose to the ol’ grindstone after four weeks of being off more than I was on. I also intentionally worked half days every Monday last month, mostly to ensure I’d have time for my long runs and partly to help ease my way into the work week. (Garfield was right; no one likes Mondays.) Anyway, I have no lovely bylines to share, though I promise I was, in fact, working.
Also … as you may or may not have seen, I decided to start a monthly news roundup. The first post should go live in mid-October. As a result, I’ve decided to switch from Stuff I Read (which will be covered in said newsletter) to Stuff I Did. Is it as exciting? Probably not. Does it matter? Definitely not.
Stuff I Wrote
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Stuff I Did
I’m running the BayState Marathon in a couple weeks, so I devoted a good chunk of my non-working and non-catering-to-every-need-of-a-preschooler time to getting through the most important part of the training cycle. Now it’s taper time, which is when marathon runners rest their bodies and do their best to avoid every germ their children bring home from school.
I started writing to voters in California through Vote Forward. I did a lot of letter-writing while watching playoff baseball, because these days even when the Red Sox are playing I still have brain space left to do other things.
We have already done most of the stereotypical Fall New England Things: Go apple picking, buy several pumpkins, and run the heat and the air conditioning on the same day. (This is equal parts because of the weather and the insulation limitations of a 100-year-old house.) My wife had a pumpkin spice latte. I’ll break out the flannel soon enough.
Adventures in Fatherhood
Speaking of the Red Sox, my son and I went to our first game at Fenway Park back in August. It was roughly 90 degrees, and we lasted an hour. Highlights included the bus ride (we’re lucky enough to not need to take the very crowded Green Line), seeing Wally the Green Monster, and going to Ben & Jerry’s on Brookline Avenue once we decided we were too hot for the ballpark.
The other day, afternoon snack at school was pretzels, which my son doesn’t like. But instead of rejecting it, he asked to save it for me, since he knows I like pretzels. Kids, amirite?
I’ve been able to apply an important lesson in parenting to working with clients. Whenever my son is asking me to get him some milk and also read him a book and oh by the way throw away a soggy tissue, I tell him, “Daddy can only do one thing at a time.” This has helped me make sure I set priorities at work, too.
Happy fall. Happy Halloween. Happy conference season to my health IT friends. Until next time.
I recently hit a milestone birthday. Depending on whom you ask, I’m either “has a slightly better chance of qualifying for the Boston Marathon” years old or “needs to schedule a preventive colonoscopy” years old.
Fortunately, my patient portal happily reminded me of the latter. (I won’t say which portal it is, but I will say it rhymes with “Chai Mart.”) My portal even went a step further and surfaced a Request Appointment button.
“Hooray!” I said to myself as a classic borderline Gen X / millennial who likes talking to a stranger on the phone about as much as, well, getting a colonoscopy. I eagerly clicked the button.
My portal gave me three options for scheduling the procedure: My current PCP, my previous PCP, and my podiatrist. Now, all three are good doctors and lovely people – and not the least bit qualified to give me a colonoscopy.
There’s a cost of being too convenient
For years, keynote speakers have talked about making healthcare more convenient, much like many other industries. If you can order a burrito or plane ticket from your phone, the argument goes, then why not schedule an appointment?
I’d argue, though, that being too convenient does a disservice to the healthcare organization and the consumer / patient. The portal isn’t the ideal place to give patients free rein to schedule an appointment with anyone within a provider network, especially one as large as mine. (Again, I won’t name it, but it’s the one based in the Boston area that likes to spend a lot on both rebranding and construction projects.)
Limiting that functionality to providers with whom a patient has an established relationship is annoying, but it’s also a sensible business practice. What’s the business value of not just suggesting but making it possible for patients to do something they simply can’t and shouldn’t do?
If I tried to schedule a colonoscopy with any of those providers from the portal, it would probably trigger a six-step workflow that ends in some poor administrative staffer calling me when they should be eating lunch to recite a phone number that I could find after approximately 3 seconds of sleuthing online. (Finding the page with the phone number is one thing; scheduling the appointment is another. It took a while, but I got it done.)
More isn’t better, especially when it gets messy
I went through this experience as I started in earnest on my next eBook, which attempts to unpack the long and winding road for patient engagement technology over the last 10 years. (The timeline is only somewhat arbitrary; I made the move from journalist to research analyst in June 2015.)
There’s a duality at play here. On one hand, technology such as the portal is a lot better than it was a decade ago. It’s possible to schedule (some) appointments, log in for video visits, communicate with providers, view test results, and even link records from external sources such as your pharmacy. Each of those tasks used to require a different application or website, along with some combination of phone calls, CDs, faxes, and expletives. Some of this stemmed from portals developing these features natively; in other cases, they acquired the functionality from a once-burgeoning ecosystem of patient engagement point solutions.
On the other hand, there’s still a long way to go. For starters, more isn’t necessarily better. Just because I can do all that in my portal doesn’t mean I should, or that I want to. In fact, seeing a list of 20-odd things I can do is quite intimidating, especially if I’ve logged in with a very specific task in mind.
In addition, though there are clear benefits to having far fewer point solutions for patient engagement, we’ve lost a little bit along the way. For good or ill, those products were purpose-built to solve a single problem. They become homogenized once they’re folded into a portal trying to serve the needs of a patient population that may number in the millions.
The third issue is the general messiness of patient workflows. Effective technology needs automation, and automation is extremely challenging when workflows differ for quite literally every end user. Case in point: I called Large Affiliated Boston Hospital No. 1 to schedule my colonoscopy, only to find out my PCP has placed the order at Large Affiliated Boston Hospital No. 2, which then set up my procedure at Affiliated Boston-Area Outpatient Facility No. 13-A. (I think it’s near a Wegman’s. I may go there for lunch.)
Stop ignoring small problems with easy fixes, please
Here’s the thing. We can accept (albeit begrudgingly) that the workflow above is bewildering, and unlikely to be made simpler without systemic change irrespective of what technology is in place. But why do we have to accept that smaller problems with easier solutions have been largely ignored?
Let’s go back to the “Schedule a Colonoscopy” kerfuffle within the portal. If a patient clearly cannot go through with the workflow – in my case, not being able to receive a clinical service from my current roster of providers – then why not make that “Schedule” button go away? Or, leave it there but make it point to a page that says, “Hey, to schedule this procedure, you need to call this number?” Heck, I’d wager an error page would be preferrable for most users than a prompt to do something that’s straight up not possible. At least that way, the patient and the person they inevitably have to call on the phone can have a hearty guffaw at how the $1.2 billion EHR implementation can’t do something that’s laughingly basic and also a well-accepted clinical recommendation.
Is it extra custom coding? Yes. Is it difficult custom coding? At the risk of sounding like an overconfident and mediocre middle-aged white dude, I’m guessing it probably takes less time than it would take the provider organization and EHR vendor to get on the phone and argue over who, under their contract, is responsible for completing such work.
I know the industry isn’t going to solve the patient engagement problem quickly, with existing technology, and/or for the majority of patients, especially given the current reimbursement and regulatory environment for preventive care and the general state of balance sheets for digital health companies. Plus, let’s be honest: From patients getting kicked off insurance to funding streams drying up to the basic tenets of science and medicine facing an all-out assault, the industry has bigger fish to fry than ensuring a fairly seamless colonoscopy-scheduling experience for overconfident and mediocre middle-aged white dudes.
Still, when you hear leaders at all levels at all healthcare stakeholders talk about focusing on the proverbial low-hanging fruit in improving the patient experience – small fixes that could have a big impact – it’s hard to look at examples like this one and wonder why no one’s bothered to look under the hood.
Summer vacation is officially over. The Beastwoods have returned from a week in Portland, Maine and Acadia National Park, which came just a few days after our inaugural camping trip that wasn’t in Granny and Papa’s backyard. Both trips were indeed a success. Kiddo’s back in school and Mom and Dad are back to work. The cat, meanwhile, celebrated her 17th birthday with quite possibly the best gift we could have given her: A quiet, empty house.
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Things I Read
I neglected to bring a book on vacation, assuming incorrectly I’d not have the energy to read after bedtime. As my wife likes to say, “We all make choices.” Instead, I treated myself to a few Wikipedia rabbit holes. What did I learn?
The northernmost point in Maine, Estcourt Station, is basically a sliver of a town in Quebec that was cut off when the international boundary was properly surveyed. The border crossing closes at 5 p.m. on Friday; after that, if you want to go to the “other” side of town before Monday morning, you apparently need to drive on hundreds of miles of gravel logging roads through the North Maine Woods. Plan accordingly.
Acadia is on Mount Desert Island, which is the second-largest island on the Eastern seaboard (to Long Island). It’s just a big bigger than Martha’s Vineyard, which is in Dukes County, Massachusetts. The county includes the Elizabeth Islands – most of which are owned by the Forbes family.
The largest park in the Lower 48 is actually a state park, Adirondack Park in upstate New York. It apparently has more than 100 villages inside it, as more than half the park is actually private owned. Most villages lack cellphone coverage. (The park’s actually held up as a good example of public-private partnership for the sake of conservation.)
Adventures in Fatherhood
To answer a question I posed on LinkedIn, I believe we have determined that Vermont (Ben & Jerry’s) has the best ice cream in Northern New England – or at least the most recognizable. That said, we did find a Friendly’s in South Portland. Everyone in the family enjoyed the nostalgia, though my son was a bit confused about why his sundae had a face.
Every once in a while, I talk to my son about Very Dad Things to Do. One is turning off all the lights before we leave the house. Another is telling a Dad Story, which is a lot like a Dad Joke in the sense that it’s not very interesting. On this vacation, the Very Dad Thing to Do to which I introduced my son was getting a giant wad of napkins from McDonald’s, putting them in the glove compartment of the car, and then forgetting all about them.
If you’re ever in Waterville, Maine, and it’s not Monday or Tuesday, stop by the Children’s Discovery Museum. I only learned of its existence while perusing Google Maps from the aforementioned nearby McDonald’s during our 10:15 lunch stop, and we ended up spending two and a half hours there. Highlights included the “pizza oven,” the “rooftop garden,” and the $2 globe stress ball that we may or may not have misplaced since we got home.
I always feel a bit nostalgic just before the beginning of the school year. That’s the time, way back in 1995, when I joined the high school cross country team and started running. (The picture is from junior year, I believe, but what’s a couple years in the 90s among friends?)
I didn’t join the team because I necessarily liked running. I liked sports, particularly basketball and baseball, but those were out of the question after puberty robbed me of most of my hand-eye coordination. Mostly, I did it because I was going to a new school, my parents and I agreed it might be nice to at least recognize some faces in the hallway or in class, and we figured cross country would keep me in shape and out of trouble. It didn’t hurt that cross country wouldn’t turn anyone away and didn’t cut anyone.
The first day of practice, roughly one week before Labor Day and two weeks before school started, was the first time in years I’d committed to running more than one mile at a time. I showed up in cotton shorts, a cotton T-shirt, and high-top basketball shoes. It took at least 45 minutes – not to mention a few walking breaks – to cover the 3.1 miles of my school’s cross-country course.
I showed up the next day, though. And the next day, too. After a couple of weeks, my parents were willing to invest in proper running clothes and shoes. That was just in time for the first meet, in which I placed dead last – 29:45 for the 5K. I was dead last the following week, too, albeit a minute faster.
By the end of the season, I was firmly in the middle of the JV pack. The coach encouraged me to stick around for indoor track, which, in a twist very helpful to the narrative, also didn’t cut anyone. I did – and learned quickly that “indoor” referred to where the meets were held, not the practices. (At least not for the distance runners.) Back to the sporting goods store we went.
Carving my own path
It’s worth noting that, throughout high school, I wasn’t very fast. I’m not being self-deprecating; facts are facts.
It took until senior year to make varsity in cross country (top 7). Even then, by the end of the season at least three freshmen had improved dramatically enough to routinely beat me. (The coach kept me in the No. 7 spot, though, and none of the freshmen complained. I always appreciated that.) Meanwhile, in four seasons of indoor track and four seasons of outdoor track, I scored a point (from finishing in the top 3 for a race) exactly once. It was an indoor track meet sophomore year when I think I was one of maybe 12 kids in the entire conference who wasn’t home sick with the flu. (Get your flu shots, everyone!)
Many friends had plans to run competitively in college. If I remember right, a couple teammates even got scholarships. Meanwhile, I went to art school in the middle of Boston.
But I kept running. Freshman year, I did it on my own, mostly on the paths along the Charles River. Sophomore year was the only time the college had enough interest to form a men’s cross-country team, which I was happy to join.
Before my junior year, and arguably against my better judgment, I signed up for a fall marathon: The 2001 BayState Marathon in Lowell, with a course that wound through my hometown. The mistakes I made are easily recognizable in retrospect. I don’t recall any honest-to-goodness speed or hill workouts, and my long runs topped out at 16 miles. I also waited until – I wish I were kidding – the day before the race to buy a watch. Suffice to say, I hit a wall with about 10 miles to go. My primary memory from the race is leaning against a telephone pole to get some rest.
But I finished – and I kept running. Yes, it would be five years before I did another marathon; my first one scarred me, plus my senior-year and first-job-out-of-college schedules made it hard to commit to training. That said, I squeezed in runs whenever I got the chance and found 5Ks where I could.
Something shifted in 2006, and I started to commit to running at least one marathon a year. Except for COVID (2020) and the birth of my son (2021), I’ve managed to do it – and this year, 30 years after I started running, I’m aiming to do two marathons in one year for the first time in a decade.
Coming back slowly and steadily
To be clear, running hasn’t been all sunshine and roses. I was sidelined for a few weeks in 2000 with runner’s knee, and I’m pretty sure it came back right before my marathon in 2006. In 2015, I tore my calf in the middle of a marathon and, probably against my better judgment, hobbled to the finish line. (This prompted my wife – watching me run for the first time that day – to not-so-subtly wonder if I was always in that much pain.) I needed several weeks to recover, but over time I regained my strength and confidence. Last year, I went nearly two months without running due to pain in my right foot that was eventually diagnosed as Morton’s neuroma – the treatment for which is orthotic shoes and a dose of humility. Here, patience and pragmatism aided my recovery more than anything.
Recently, I found myself briefly stepping away from running for reasons that had nothing to do with physical health. In September 2023, roughly two weeks before I planned to run BayState – and mark the first time in eight years I ran a marathon in the spring and the fall – my father passed away. I did a speed workout a couple days later, asked myself what the hell I was doing, and promptly took 10 days off. I did that same thing that Christmas, when the weight of simultaneously celebrating and mourning left me far too fatigued to run.
My most recent stretches without running – the mental health breaks in 2023 and the wow, my foot hurts break in 2024 – were tests that I’m happy to say I feel like I passed. I think I learned a lot from 2015, when I was under orders from my physical therapist not to run (but nonetheless stay active) for nearly two months, and to take it slowly once I started back. The wisdom of fatherhood, middle age, and running a business probably helped, too. I didn’t lace up the ol’ running shoes until I was good and ready – and that ensured I actually enjoyed the experience.
Keeping at it, for many reasons
Most of the time, I have little trouble understanding why I’m still running after 30 years. After all, distance running suits my body type, desire for long stretches of quiet time, appetite, pain tolerance, and stubborn perseverance. Few people who meet me for the first time are surprised to learn I’m a runner.
Occasionally, though, I can’t help but wonder. When I head out the door in the pouring rain, after my son’s bedtime, on days so cold that only my face is exposed to the elements, or during a family vacation, I sometimes ask myself, “Why, Brian? Why?”
Part of it is probably the sense of accomplishment. It’s estimated that roughly 1% of the global population has completed a marathon; fewer have done more than 20. I’m proud to be able to say that – and to say that I’m still going. Honestly, I think the fact I wasn’t all that fast in high school helped my cause here. I never faced pressure or experienced burnout. I’m only chasing my own goals and aspirations, not someone else’s. (The free post-race bananas and bagels help.)
Pride plays a part, too. On those rough days – like this morning, when I did a hill workout in what felt like 98% humidity – I think about that 15-year-old in black high-top basketball shoes, showing up on the first day of practice with little clue about what he was getting into. I think about the 21-year-old toeing the line for his first marathon, with absolutely no clue about what he was getting into. I think about the handful of times I missed qualifying for Boston by just a few minutes, and also the time in 2012 I bonked so badly I seriously contemplated curling up for a nap on a front lawn along the cource. (I didn’t. Again, in keeping with the narrative, I kept going and I finished.) I think about when I finally qualified for Boston in 2015, on my 12th try, and had the privilege of running that race the following spring. I think about the first-time father who plodded through a handful of miles while his infant napped or his in-laws kept watch and tried to maximize family time by deciding to wedge his runs into the work week. I look back on the past versions of myself and think he’d be proud I’m still doing it at 45.
Lately, too, I think about my son. I’m not sure he fully understands why I run, or why I run races so long that he and Mommy more often than not get bored and go do something else while they wait for me to finish. (I don’t blame them.) But I know he wants to give me a hug, see my medal, and share a banana when I finally finish. He may not be able to explain the concept of pride, but I get the impression he’s proud of Daddy. And that helps to keep pushing me along, too.
Recently, Healthcare IT Today (a client of mine) was gracious enough to interview me about all things telehealth. The podcast is live, and you can give it listen here. As I’m often the one asking the questions, it was a nice change of pace to be the interview subject this time around.
Naturally, a good chunk of the conversation focused on my eBook – namely, why telehealth hasn’t had the post-pandemic comeback that so many healthcare stakeholders expected. Host John Lynn and I also tried to think of where and how telehealth might be able to expand these days without much heavy lifting.
To celebrate my appearance on the Healthcare IT Today podcast, I’m offering the eBook at a discounted price of $14.99. The discount applies until Sept. 9, which is when I’ll be back in the office after a bit of time off at the end of the summer. The half-off price applies to everyone, whether you graced the podcast with a listen or not. I’ve toyed with the idea of discount codes, but I wasn’t about to do that for the first time before I go traipsing around the woods in New Hampshire and Maine with limited Internet access, on the off chance I ended up breaking something on my website (again).
Starting this one off with Stuff I Read because Matthew Holt, a longtime observer of the healthcare technology landscape, encapsulated a lot of feelings I’ve had (but hadn’t put to paper) about last week’s interoperability glad-handing in DC. Signing a pledge to make tech tools talk to each other is admirable; doing so in the direct presence of men who are quite open about their disdain for proven medicine, healthcare’s safety net, medical research, and the needs of others is not – to say nothing of their very public targeting of the communities that all too often make computer engineering and healthcare delivery possible in the United States. For days, I’ve had a line from They Might Be Giants’ “Your Racist Friend” floating through my head: You can’t shake the devil’s hand and say you’re only kidding. Thank you, Matthew, for saying the quiet part out loud.
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Adventures in Fatherhood
Our street’s in the process of being repaved, along with a stretch of the main road through town. We’re also getting new sidewalks. What this means: My camera roll is full of videos of construction vehicles hard at work to appease my son’s truck obsession.
We recently invested in a foldable wagon. It’s bulkier than a stroller but apparently like 123% more fun. I lay even odds we actually use the stroller again.
Have had a busy few weeks on a big custom project for a client. Hoping to emerge from that soon. Happy August.
I’ve had an interesting few months. I finally bit the bullet, upgrading my website and selecting a hosting provider. The former was a good idea, and long overdue, as it let me set up a store where I could get rich selling digital content. The latter turned out not to be such a good idea since 1) it somehow managed to create a second WordPress log-in for me and 2) said log-in was linked to me staging site, not my actual website.
This meant the blog posts I created on what I thought was my existing website were in fact on the new version, which is also were I happened to create the product page for my eBook (which I also happened to edit and design over the course of the spring).
For the life of me, I couldn’t figure out how to get the new blog posts – namely, the April and May roundups you’ve come to know and love, or at the very least tolerate – to appear on the page that listed all the blog posts. That seemed like kind of a big deal. There were also some quirky tweaks to my new (or maybe existing?) website that weren’t the best, and it wasn’t clear whether they were the result of the site migration or user error.
As a result, I scrapped the hosting plan and stuck with a Business version of my old WordPress site. I didn’t lose any necessary functionality, and I didn’t end up spending more. What I’d been paying for the hosting service basically now pays for a business email address, with the added bonus that it’s not Webmail, which as far as I can tell no one actually likes.
The issue – and this is where it gets interesting, folks – is that I decided to do this a few days after I launched my eBook, which meant to link to it was dead. It also meant the April and May roundups disappeared, along with my heartfelt look back at five years of full-time freelancing. I was able to repost the eBook product page (which was easy enough to rewrite) and the career retrospective (which I’d drafted in Word), and I managed to rewrite the blog post introducing the eBook to the world.
That said, I didn’t bother redoing the roundups. To be blunt, I didn’t feel like it. Plus, the list of Stuff I Read was a bit short, and my Adventures in Fatherhood were a bit repetitive, redundant, and repetitive.
So, instead, I present to you, my loving audience, a quarterly roundup. This includes links to everything published in the last three months, along with some fun tales of raising a child that I may or may not have shared with you already.
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Dang, this list looks a lot more impressive when it covers three months instead of one, doesn’t it?
Adventures in Fatherhood
Over Memorial Day weekend, I ran a marathon in Burlington, Vermont. The course was two Figure-8 loops. All told, I went through downtown Burlington four times. This meant I ran up the hill on Main Street four times. My wife told my son this was a mean thing to make the runners do. She wasn’t wrong – and for the next two weeks, my son, who has entered the phase of asking so, so many questions – humored me a few times a day by asking, “Why did the marathon do a mean thing to the runners?”
Meanwhile, over Fourth of July weekend in the White Mountains of New Hampshire, my son was introduced to the idea that Daddy attracts mosquitos almost immediately upon going outside. (Don’t ask me why. They always have.) He then proceeded to humor us by repeatedly saying, “The bugs love Daddy.”
We’ve recently discovered store-bought frozen water- and fruit-based confections. This is lovely – but, as my son prefers to eat approximately three bites of things before declaring, “All done,” it also means at any given time there are at least two unfinished treats in the freezer. That also means there are often at least two child-sized bowls or plates in the freezer, which is a challenge when, say, we arbitrarily decide the Cheerios need their own bowl.
With any luck, I’ll get back to monthly posts starting in August, just in time for everyone to stop caring about work until Labor Day.
The eBook is a couple years in the making. Back in 2023, telehealth utilization was two years into a plateau following a mid-pandemic peak. In a lengthy blog post, I speculated on what that meant for telehealth’s future, and whether there was anything the healthcare industry could do to shape that fate. The post got a lot of positive feedback, including several recommendations for what I could add to augment my thesis and turn the post into an eBook.
If you’ve known me for even a short time, you know I like challenges. You also know I tend to overextend myself juuuuust a little bit – which is why, amid building a freelance business, raising a child, running marathons, hiking up mountains, and doing my best to clean the house, the eBook has finally arrived.
From a blog post to an eBook
So, what separates Telehealth’s Next Chapter: A Tale of Volume and Value from the blog post that preceded it?
There’s some historical perspective. This demonstrates that telehealth has pretty much always been about episodic care and explains why utilization has been on a plateau for four years running.
There’s a brief unpacking of the struggles of digital health companies not named Hinge Health, Omada Health, and (at the time I was writing at least) Hims & Hers. This offers perspective about why the road ahead for telehealth is a bit bumpy.
There’s a Debbie Downer take that the best time to act has passed us by. I think it’s because the industry’s bevy of stakeholders weren’t sufficiently motivated to act to remove barriers to adoption in the summer of 2021.
There’s an offer of a path forward – telehealth utilization that supplements value-based, purposeful in-person care in a wide range of scenarios – and a set of suggestions for how the many stakeholders involved will need to collaborate.
There are some lovely graphics, which I designed myself, and some of the best stock art that a free Canva account can buy.
Incredibly, over the course of 42 pages, there’s only one reference to running, and it’s in my bio. If I’m being honest, this very well might be the eBook’s greatest achievement.
Free for a little while longer
Initially, I planned to make the eBook available as a free download over Father’s Day weekend, complete with a great dad joke about it being my gift to you, and then charge folks for it. I even came up with a price of 73 cents per page, as a nod to Regina Holliday.
The idea, as I stated in a LinkedIn post I’ve since deleted as well as a blog post that has since disappeared for reasons I’ll explain, was to see if creating and publishing my own content would be a worthwhile extension of my freelance business.
Then, a few things happened in rapid succession.
I stopped using my web hosting service, which I’d decided wasn’t really meeting my needs. In doing so, I wiped out the version of my website that included the product page for the eBook and the blog post announcing it to the world. Oops.
As I transitioned back to WordPress, my website was down for a few days. At this point, I offered to send the eBook to anyone who asked me for it, as I had no way to collect anyone’s hard-earned money.
Sometime between finishing our Monday morning viewing of Daniel Tiger and attempting to start the work week, the wires that bring the Internet into our house got clipped. Even if I wanted to update my website, I couldn’t. (Unless I wanted to roll the dice with the open Wi-Fi at the public library, which I didn’t.)
I came to realize I never really gave a lot of thought – any, really – to how I planned to promote the eBook once I’d launched it.
Given all that, I’ve decided to make the eBook free for a bit longer, either as a download on this here website or by asking my nicely on LinkedIn or via email. The $30.66 cost will go into effect on July 8, after we’ve all recovered from the long weekend.
The first of more to come
My rationale for charging for the eBook is partly to try to cover expenses (I paid my reviewers, got professional headshots, and upgraded my website) and partly to see if there’s true demand for this type of thing. It’s not the end of the world if I take a loss. For good or ill, in the back of my head this was as much of a passion project as it was a business venture, along with a fairly low-stress way to revive my rudimentary graphic design skills. Plus, it’s already had more views than my graduate thesis, which took a lot longer to write and cost a lot more to boot.
That said, it’s hard for me not to scratch the itch for longform writing. One of my Internet-less tasks this week was starting the outline for the next eBook I hope to write, which I’d previously scrawled on a few Post-It notes in my planner. The topic: Why the philosophy of patient engagement has made great strides in the last decade even if the market for patient engagement technology kinda sorta floundered. It probably won’t be 42 pages, but it also probably (hopefully?) won’t take me more than two years to write.
As long as my schedule allows for it, I intend to create more content of interest to the digital health community.
Roughly five years ago, I joined the ranks of millions of Americans who lost their jobs at the height of the pandemic. I wasn’t shocked by any means, as I worked for an in-person event company and focused on the healthcare industry. In fact, after my managers delivered the news to the entire editorial team, they called me for the first of the one-on-one chats with the recently departed because they expected, correctly, that I would take the news well.
I don’t remember the exact date, but I do know it was a Thursday morning with weather similar to this one. For the rest of the week, I spent some time relaxing and some time fiddling with the WordPress site I’d launched in 2017 and then quickly forgotten about.
I also spent some time thinking about what to do next. Getting laid off was the latest in a series of turns in my career. In both 2012 and 2014, I left one tech publishing company for another. In 2015, I took a job as a research analyst. In 2018, I moved to an agency. In 2019, I went into the event business. It’s fair to say I was having trouble figuring out what I wanted to be when I grew up.
Amid my various moves, I’d started freelancing a few hours a week in 2015. One friend recommended me for some work reviewing running watches; another thought I’d be a good fit to write about executive leadership and enterprise IT. Over time, I took on a couple more clients in higher ed and healthcare tech, and I set up the aforementioned website to highlight my work. Soon, though, the work eventually became juuuust a bit too much to handle.
I missed it. I frequently chatted with full-time freelancers who were not only making a living as writers but thriving, thanks to their business acumen and time-management skills. In the back of my head, a future version of myself had that role. I can’t remember if it was something I daydreamed about on my commute or during my runs, but I definitely thought about it.
That said, I couldn’t see myself leaving a full-time job with benefits. Fear of the unknown proved more powerful than building a professional life as a full-time freelancer with a lot more writing and far fewer meetings. Put another way, the perceived risks of going out on my own outweighed the benefits of being my own boss, as numerous as they may have been.
Then, well, it was April 2020, and pretty much nothing was stable – jobs, health, the future, one’s supply of peanut butter, etc. I sat down with my wife for a chat. The main takeaway: “Go do this thing. It’s now or never.”
So, on Monday morning, after filing for unemployment – a key safety net as I got started – I sat down in front of the personal laptop I hadn’t opened in close to two years. I reached out to my former freelance clients. I got in touch with past colleagues from my (many) previous full-time jobs. I researched publications, consultancies, and brands with content that aligned with my past work and crafted some cold emails to send along. After that, I probably went for a run on a secluded path.
As those early hours turned to days and weeks, I’m forever grateful to everyone willing to give me work in the early days of my shift to working for myself.
I’m honestly shocked sometimes to look back and see where I am now. I’ve found my footing, achieved stability, and learned where I want to focus my efforts. I have an LLC, my own domain name and, once I get around to it, a business email address. I never imagined I’d be in a place where I’d feel comfortable bringing an eBook into the world, and yet here we are. (You didn’t think I’d get this far without mentioning my eBook, did you?)
I’ve also made some mistakes along the way, and I’d be remiss in talking about my success without acknowledging these failures. For example, I discovered that content for life science isn’t my forte, short turnaround times are difficult for me to accommodate, and certain nuances of enterprise technology are beyond my expertise.
I need to recognize that I didn’t start from scratch, too. I was privileged to have a robust network, a nest egg, experience as a 1099 contractor, a business checking account, an excellent mortgage rate, employer-sponsored health insurance, and clips when I started sending those emails asking for work in April 2020. Heck, I even had that dormant website. Yes, I had skills and expertise, but even that was mostly a matter of being in the right place at the right time and managing to take advantage of my good fortune. After all, I never would have gotten into healthcare if the CIO group at TechTarget wasn’t in need of an editor for its new healthcare site and I wasn’t in need of a new role as the Vertical Software Media Group was shutting down and just so happened to have recently dabbled in writing about EMRs and practice management software.
That’s why this post is primarily a Thank You to so many folks for helping me along the way. I may have done the work, but *you* have trusted me to do that work and been willing to vouch for me when others are looking for someone who can do that work. While I’d like to think it’s improbable that I’d be wandering aimlessly in the wilderness without all of you, I do know I’d be nowhere near my current level of success.
Here’s to five years of freelancing down and many more to go. Now if you’ll excuse me, it’s time to go for a run on a secluded path. After all, no matter where things stand in my professional life, some things will never change.
