Over the last couple of years I've spent a lot of time directly experimenting and learning about some of the macro trends of our future (platforms / protocols, open /closed source, ai, climate, food production, workforce, demographics, D2C health et al).

There's been a lot to learn, unlearn, re-learn and evaluate especially if you have an optimism and shiny new thing bias like me! At times, especially in Australia, it's felt isolated too..... not the least when met by closed minds who argue all this 'stuff' is irrelevant or so far off future that we can ignore it....

A line from today's Bankless Opinion piece neatly summarised why I think we need more people, especially in health care, getting curious and taking a long term, strategic and risk focused view of where technology might be sending us:

"Centralized, Web2 AI has massive monopolies over data and compute. They will put all their resources behind the development of their AI models, in order to produce the most generalized & powerful model possible. They will smother competition and constrain innovation. They will go for regulatory capture and try to entrench themselves as best they can..."

There's lots of hype and claims about how AI will be great, especially when paired with a human (AI + human Dr's = progress from the stethoscope, right?!) - and I agree wholeheartedly.... and I also think humans are going to need tools and alternatives to counter the potential for big tech and AI's influence and power.

A wise part of managing future strategic risks will be to place some investment into the alternatives and protections around AI.

So what are these alternatives? Well they're in the development factories & garages getting built....in part they all have features of: decentralisation, open source, encoded governance, user-control (especially of identity and consents), personalisation, gamification, immutable records...and increasingly UX and onboarding that appeals.

The next iteration of projects are emerging in finance, retail, gaming, social networks and science. Health care, as usual, will be a laggard, but there is an increasing awareness in Australia of some aspects like data ownership and communities are starting to take shape. Greatest interoperability technology?? The informed, empowered, engaged patient!!

Now lets agree that we'll see this through a classic bell curve of adoption, and note the population adoption levels of: innovators (5%) to adopters (15%) to early majority (30%).

Here's a few signs these alternatives are shaping up:

• Statistica show cryptocurrency users at somewhere between 500m (7%) and 830m 10% of the population...

• ASX research: 15% investors hold cryptocurrency, 31% of next gen (under 25yrs)

• Immutable's IMVU has over 700k daily users

• Farcaster growing 10x over 2 weeks in January, and attracting an early set of adopters

• Desci breaking out with influential thinkers, more vision activity and clear narratives

Add to this a few other factors like: today's AI innovations are essentially V1 with the industry too ahead for meaningful regulatory control; major demographic shifts influencing existing and generationally transferred wealth; an upward looking economic outlook (especially in crypto) and there's enough incentive to get curious.

In an era of rapid technological evolution, it's critical that it provides us with tools to retain control and personal agency. The advent of AI and the dominance of big tech companies don't necessarily equate to an oppressive future, but I think we need the decentralization and open source developments to rapidly offer a counterbalance.

1. Lego and healthcare

In various conversations we've been using the lego analogy to describe how startups should be viewed as lego blocks by 'health system managers'. The feedback from people is generally positive, so we're putting it to use in this month's reflections.

Huh, why lego?

The analogy isn't new and using lego in hospitals has been done a bit for both building and service planning activities. So too has using it in thinking about health data platforms....

Here's a few features of lego that underly our thinking:

• TIMELESS: there are several foundational statements that truly demonstrate the power of principles in design and decision making. One was: 'A classic among toys, without the need of renewal'. A piece built in the 1960's will still fit perfectly into a lego set built today!

• DESIGN: lego's strength lies in its interoperability. This means that each individual piece, no matter its unique design or function, can connect and interact with every other piece to build something bigger, just as diverse startups in the healthcare sector can integrate their services to create comprehensive solutions.

• FLEXIBILITY: there are endless possibilities for customisation. Sounds a bit like personalisation right? Isn't that where health care is meant to be going? Being able to select and assemble the services & solutions that best align with a specific requirement or problem seems like a good thing to have.

• COLLABORATION & INNOVATION: Lego sets often lead to collaborative and creative play. Similarly, if we can create collaboration among different stakeholders in the healthcare industry, startups are a terrific way to innovate and develop new approaches to healthcare challenges.

2. Why the sector needs more lego builders

We reckon that to find ways for the health system to evolve into something this is ‘future-fit’, it’s going to need a fair amount of renovation & rebuild. This isn’t only about policy reform, reviews or Commissions - there’s a shipping container of these sorts of reports in most health sector archives the world over.

Instead we’re suggesting that there is a need for dedicated capability and roles focused on system renovation.

Why? We have a range of experts and processes for designing the physical environment - think hospitals, care centres and related infrastructure. Similarly, there are technology oriented functions & roles that are integral to the development of digital solutions. There are also the range of functions in most provider organisations dedicated to ‘improvement’ - largely driven by regulatory or compliance influences.

Their focus is typically a project or solution, rarely looking at the complex interactions & workflows across the myriad of components of the health system. Imagine if we did…

These talented individuals, teams (and with AI / technology supports a la digital twins for health systems) could be charged with piecing together new solutions to complex health problems. These roles would understand that future advancements in healthcare demand the development and integration of interoperable components - bridging the physical and digital experiences.

Importantly, it's not just about technical skills; these lego builders must also have access to commercial acumen, project management capabilities, and a willingness to adapt and change according to the demands of the sector. Just as Lego pieces of different shapes and sizes come together to create something greater, startups with diverse skill sets can contribute significantly to the construction of an improved and efficient healthcare landscape.

3. A few more young companies you should know

CollabCare

The team at CollabCare are led by Charles and Joe - a terrific pairing that blend serious lived experience, business, technology and digital health, product and innovation. CollabCare has a range of platform technology targeted at addressing:

• behavioural and pyschological symptoms of dementia

• loneliness and family connection

• provider's need to market and engage their services in a consumer controlled funding model

• digital family histories and storytelling.

Their solutions support best practice in dementia care, improving quality of life through greater connections, overcoming social isolation & loneliness. For their customers products enhance market differentiation, high potential customer acquisition and enable an engaging digital experience for families and residents with zero operational disruption.

SmartHeal

Founded by passionate nurse and aged care industry expert Santosh, SmartHeal is building an AI driven, no-touch wound care platform supporting clinicians in assessment, management and dressing choice.

While there’s no doubting SmartHealth is an early stage startup, the team has a growing depth of industry connections and a thirst for learning. Like all good, young companies they’re moving at pace.

Wounds Australia research shows that this is a ~$6b system wide challenge and for individual’s, an out of pocket for dressings & care of up to $400 per month. SmartHeal’s is seeking to offer low-no consumable costs and to leverage AI to improve the healing timeframe.

Virtetic

Virtetic’s Founders, Ricardo, Raph, Jing, Geremy and Carine, bring a terrific diversity of skills to improving prosthetic care. Their solution combines virtual & immersive experiences allowing patients to practice using a prosthetic without needing to have a test socket or wait for their stump to fully heal.

This allows an early awareness of activities of daily life to inform rehab and also reduce risk of phantom limb pain, unlike current screen based and desktop based solutions.

While Australia’s market is small (~150 per yr), there are both attractive international markets and adjacent clinical challenges that the team’s tech can support.

4. The 4th Point

Each issue we finish with 'The 4th Point'.... this is usually a subscriber only section with some 'so what, what next' thoughts, together with links, research and take home points.

This month is a little different….. we’re at issue 6 and so we’d like to get feedback. What can we do to improve?

Instead of taking 3 mins to read more, we’d really appreciate if you could use that time for our survey or send us a note.