This guest post is by Roman from how this website makes money.
Two years ago I stumbled across the concept of blogging for money. Instantly it hit me as the perfect thing: sit behind a computer, design a site, write, be my own boss, work from home, what could be better? I knew nothing about traffic, SEO, backlinks, Pagerank, or keywords. I knew nothing about how to make money with a website. So what did I do next? I registered the domain name howthiswebsitemakesmoney.
Looking back all I can do is laugh at my arrogance. Like thousands before me and thousands who will come after me, my first attempt at blogging was a site about making money online.
Two years later, I know how to start a site, I know how to write content, I know about SEO, I know about backlinks, I know how to add advertisements … but I still do not know how to make good money online. The site makes dimes a day, not dollars.
The site has been two years of disappointment. Two years of waking up in the morning and seeing the same green egg in AdSense. Two years of waiting for a four-digit affiliate check with my name on it. Two years of working without pay. Two years of scratching my head.
So I asked for advice, and every time the reply was the same: create a site about something else. Create a site about what you know and what you enjoy. Do not create a site with the intent to make money, create a site with the intent to help people by doing something you enjoy doing.
What happened when I changed my intent
Six months ago I created a new site. This time my intent was pure pleasure.
I live in Prague and I love it here. So I made a little site about how great Prague is and what people should do when they come for a visit. It was built in a month. In a gust of activity I designed the site and wrote the content.
It was so easy. I did not agonize over what to write about. The content flowed effortlessly from my head to the keyboard. I did not have to take long walks with the dog or waste water standing dazed in the shower coming up with new ideas. I just sat down at the computer and wrote about what I know. It was so easy I actually looked forward to it.
As an afterthought, I created a simple page where people can order a real postcard from Prague. Visitors select a picture of Prague and fill out a form indicating what they want written on the postcard. After they hit the Submit button I get the request by email. I grab a postcard and, like an ancient scribe long before computers, lick the tip of the pen and write. After pounding a Prague stamp on the postcard I toss it into the mailbox on my way to work. I charge $4.00 for this five minutes of work.
I created this site with no aspirations of becoming rich, no day dreams of shaking hands with Oprah, no imagined scenes of telling my employer to find some other donkey to kick around. I created the website because it was easy for me to do and I enjoyed it. I made it because I needed a break from my ‘real’ website. I expected nothing to happen.
Again, I was wrong.
My hand is ink blue from all the postcards I have written.
I wrote a postcard from a son playing a trick on his mother: “Hi, Mom! Sorry for not calling in last few days. But I am in Prague with friends. Having a great time and the beer is sooo cheap. Say hi to Dad.”
I have written postcards to countries all over the world. Some of them in languages other then English—I have no idea what I am writing. Fortunately, the order form does not allow Chinese characters!
I get emails from people thanking me for the information they found on the site, thanking me for the postcard, asking for more information.
I feel like I am making the world a better place. I made a website about something I know about and am interested in and people are thanking me. Emotionally it is a soft, warm, fuzzy ball.
And yes, I am making money.
Intend to enjoy and you might make money
I learned a lot about making money online not from my site about making money, but from licking postage stamps.
New arrivals to the make-money-online scene go through the same initiation—they start out with the intent to make money, then fail to make more then a pile of pennies. For some it means the end and they quit, but for others this brutal introduction teaches them that their intent needs to change.
Of course, making money is about traffic, clicks, affiliates, backlinks SEO, but it’s also about finding something you enjoy doing. If your intent is only to make money the odds are stacked against you: you will probably quit. But if your intent is to do something you enjoy then you will keep moving forward until one day, you will be surprised to find that you are making money.
What’s your intent?
Roman intends to figure out how this website makes money. He has been trying to do that for two long years, so when he needs a break and do something fun he goes onto his other website to send a real postcard to his mother who misses him very much.
Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.
But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?
In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.
Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:
Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."
Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.
The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.
If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.
Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".
More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.
How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.
The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.
Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu sus planes de <b> propio entretenimiento de noticias </ b> muestran, pero a nadie ver? Como Peter Kafka en informes MediaMemo, Hulu es actualmente el casting para un presentador de la serie que se publica todos los días, teniendo una 'Daily Show' al estilo de enfoque satírico de las últimas noticias de entretenimiento. Hulu (respaldado por EE.UU. gigantes de televisión NBC ...
Apple ya vende paquetes de tarjetas de regalo IPAD | iLounge <b> Noticias </ b> de noticias iLounge discutir la venta de Apple ahora IPAD paquetes de regalo Tarjeta Más noticias de Apple de los principales independientes. . iPod, iPhone, y el sitio IPAD
Congo Siasa: <b> Noticias </ b> que nos perdimos weekNews último que no blog la semana pasada: El recién ordenado cardenal de Kinshasa, Laurent Monsegwo, llegó a Kinshasa desde Roma el . miércoles a gran aclamación Monsengwo es generalmente considerado como oposición a Kabila, pero rara vez se toma pública ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
This guest post is by Roman from how this website makes money.
Two years ago I stumbled across the concept of blogging for money. Instantly it hit me as the perfect thing: sit behind a computer, design a site, write, be my own boss, work from home, what could be better? I knew nothing about traffic, SEO, backlinks, Pagerank, or keywords. I knew nothing about how to make money with a website. So what did I do next? I registered the domain name howthiswebsitemakesmoney.
Looking back all I can do is laugh at my arrogance. Like thousands before me and thousands who will come after me, my first attempt at blogging was a site about making money online.
Two years later, I know how to start a site, I know how to write content, I know about SEO, I know about backlinks, I know how to add advertisements … but I still do not know how to make good money online. The site makes dimes a day, not dollars.
The site has been two years of disappointment. Two years of waking up in the morning and seeing the same green egg in AdSense. Two years of waiting for a four-digit affiliate check with my name on it. Two years of working without pay. Two years of scratching my head.
So I asked for advice, and every time the reply was the same: create a site about something else. Create a site about what you know and what you enjoy. Do not create a site with the intent to make money, create a site with the intent to help people by doing something you enjoy doing.
What happened when I changed my intent
Six months ago I created a new site. This time my intent was pure pleasure.
I live in Prague and I love it here. So I made a little site about how great Prague is and what people should do when they come for a visit. It was built in a month. In a gust of activity I designed the site and wrote the content.
It was so easy. I did not agonize over what to write about. The content flowed effortlessly from my head to the keyboard. I did not have to take long walks with the dog or waste water standing dazed in the shower coming up with new ideas. I just sat down at the computer and wrote about what I know. It was so easy I actually looked forward to it.
As an afterthought, I created a simple page where people can order a real postcard from Prague. Visitors select a picture of Prague and fill out a form indicating what they want written on the postcard. After they hit the Submit button I get the request by email. I grab a postcard and, like an ancient scribe long before computers, lick the tip of the pen and write. After pounding a Prague stamp on the postcard I toss it into the mailbox on my way to work. I charge $4.00 for this five minutes of work.
I created this site with no aspirations of becoming rich, no day dreams of shaking hands with Oprah, no imagined scenes of telling my employer to find some other donkey to kick around. I created the website because it was easy for me to do and I enjoyed it. I made it because I needed a break from my ‘real’ website. I expected nothing to happen.
Again, I was wrong.
My hand is ink blue from all the postcards I have written.
I wrote a postcard from a son playing a trick on his mother: “Hi, Mom! Sorry for not calling in last few days. But I am in Prague with friends. Having a great time and the beer is sooo cheap. Say hi to Dad.”
I have written postcards to countries all over the world. Some of them in languages other then English—I have no idea what I am writing. Fortunately, the order form does not allow Chinese characters!
I get emails from people thanking me for the information they found on the site, thanking me for the postcard, asking for more information.
I feel like I am making the world a better place. I made a website about something I know about and am interested in and people are thanking me. Emotionally it is a soft, warm, fuzzy ball.
And yes, I am making money.
Intend to enjoy and you might make money
I learned a lot about making money online not from my site about making money, but from licking postage stamps.
New arrivals to the make-money-online scene go through the same initiation—they start out with the intent to make money, then fail to make more then a pile of pennies. For some it means the end and they quit, but for others this brutal introduction teaches them that their intent needs to change.
Of course, making money is about traffic, clicks, affiliates, backlinks SEO, but it’s also about finding something you enjoy doing. If your intent is only to make money the odds are stacked against you: you will probably quit. But if your intent is to do something you enjoy then you will keep moving forward until one day, you will be surprised to find that you are making money.
What’s your intent?
Roman intends to figure out how this website makes money. He has been trying to do that for two long years, so when he needs a break and do something fun he goes onto his other website to send a real postcard to his mother who misses him very much.
Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.
But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?
In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.
Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:
Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."
Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.
The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.
If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.
Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".
More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.
How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.
The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.
Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
Hulu plans its own entertainment <b>news</b> show, but will anyone watch?
As Peter Kafka at MediaMemo reports, Hulu is currently casting for a presenter for the show which will be published daily, taking a 'Daily Show'-style satirical approach to the latest entertainment news. Hulu (backed by US TV giants NBC ...
Apple now selling iPad Gift Card packages | iLounge <b>News</b>
iLounge news discussing the Apple now selling iPad Gift Card packages. Find more Apple news from leading independent iPod, iPhone, and iPad site.
Congo Siasa: <b>News</b> we missed last week
News I failed to blog on last week: The newly ordained cardinal of Kinshasa, Laurent Monsegwo, arrived in Kinshasa from Rome on Wednesday to huge acclaim. Monsengwo is usually considered to be opposed to Kabila, but rarely takes public ...
bench craft company rip off
This guest post is by Roman from how this website makes money.
Two years ago I stumbled across the concept of blogging for money. Instantly it hit me as the perfect thing: sit behind a computer, design a site, write, be my own boss, work from home, what could be better? I knew nothing about traffic, SEO, backlinks, Pagerank, or keywords. I knew nothing about how to make money with a website. So what did I do next? I registered the domain name howthiswebsitemakesmoney.
Looking back all I can do is laugh at my arrogance. Like thousands before me and thousands who will come after me, my first attempt at blogging was a site about making money online.
Two years later, I know how to start a site, I know how to write content, I know about SEO, I know about backlinks, I know how to add advertisements … but I still do not know how to make good money online. The site makes dimes a day, not dollars.
The site has been two years of disappointment. Two years of waking up in the morning and seeing the same green egg in AdSense. Two years of waiting for a four-digit affiliate check with my name on it. Two years of working without pay. Two years of scratching my head.
So I asked for advice, and every time the reply was the same: create a site about something else. Create a site about what you know and what you enjoy. Do not create a site with the intent to make money, create a site with the intent to help people by doing something you enjoy doing.
What happened when I changed my intent
Six months ago I created a new site. This time my intent was pure pleasure.
I live in Prague and I love it here. So I made a little site about how great Prague is and what people should do when they come for a visit. It was built in a month. In a gust of activity I designed the site and wrote the content.
It was so easy. I did not agonize over what to write about. The content flowed effortlessly from my head to the keyboard. I did not have to take long walks with the dog or waste water standing dazed in the shower coming up with new ideas. I just sat down at the computer and wrote about what I know. It was so easy I actually looked forward to it.
As an afterthought, I created a simple page where people can order a real postcard from Prague. Visitors select a picture of Prague and fill out a form indicating what they want written on the postcard. After they hit the Submit button I get the request by email. I grab a postcard and, like an ancient scribe long before computers, lick the tip of the pen and write. After pounding a Prague stamp on the postcard I toss it into the mailbox on my way to work. I charge $4.00 for this five minutes of work.
I created this site with no aspirations of becoming rich, no day dreams of shaking hands with Oprah, no imagined scenes of telling my employer to find some other donkey to kick around. I created the website because it was easy for me to do and I enjoyed it. I made it because I needed a break from my ‘real’ website. I expected nothing to happen.
Again, I was wrong.
My hand is ink blue from all the postcards I have written.
I wrote a postcard from a son playing a trick on his mother: “Hi, Mom! Sorry for not calling in last few days. But I am in Prague with friends. Having a great time and the beer is sooo cheap. Say hi to Dad.”
I have written postcards to countries all over the world. Some of them in languages other then English—I have no idea what I am writing. Fortunately, the order form does not allow Chinese characters!
I get emails from people thanking me for the information they found on the site, thanking me for the postcard, asking for more information.
I feel like I am making the world a better place. I made a website about something I know about and am interested in and people are thanking me. Emotionally it is a soft, warm, fuzzy ball.
And yes, I am making money.
Intend to enjoy and you might make money
I learned a lot about making money online not from my site about making money, but from licking postage stamps.
New arrivals to the make-money-online scene go through the same initiation—they start out with the intent to make money, then fail to make more then a pile of pennies. For some it means the end and they quit, but for others this brutal introduction teaches them that their intent needs to change.
Of course, making money is about traffic, clicks, affiliates, backlinks SEO, but it’s also about finding something you enjoy doing. If your intent is only to make money the odds are stacked against you: you will probably quit. But if your intent is to do something you enjoy then you will keep moving forward until one day, you will be surprised to find that you are making money.
What’s your intent?
Roman intends to figure out how this website makes money. He has been trying to do that for two long years, so when he needs a break and do something fun he goes onto his other website to send a real postcard to his mother who misses him very much.
Fueled by the economic stimulus passed by Congress in 2008, the federal government has embarked on a controversial $30 billion program to induce doctors throughout the country to adopt electronic health records (EHRs) by 2014. The purpose is to create an interconnected system of electronic health records to improve safety and reduce medical costs.
But the United Kingdom has spent the last 6 years working on the same idea, and it's proven to be a colossal failure -- so much so that the government is drastically cutting its program. What happened to their plan? Should we be paying attention before rushing ahead with our own?
In 2005 the United Kingdom embarked on the largest investment ($18 billion) in health information technology in the world. Yet despite expectations that the system would increase efficiency and reduce medical errors, their efforts neither improved health nor saved money -- in fact in some cases, they may have led to patient harm.
Britain's government-run medical system is obviously different from our complex public-private insurance system. However, its electronic health record project bears an uncanny resemblance to the program President Obama is starting. Here are the mistakes the British committed that we are now repeating:
Too large and ambitious: The UK project tried to accomplish too much, too fast, attempting to digitize health records for the whole population in a period of four years. This massive undertaking is years behind schedule and has delivered only a fraction of what it promised. Despite all the money poured into the system, the vast majority of hospitals in the UK still don't have integrated electronic health records. Because non-clinicians developed the system, the electronic forms they designed have little to do with how doctors treat patients -- making it unworkable for many physicians. As the Chair of the British House of Commons Public Accounts Committee recently stated, "This is the biggest IT [Information Technology] project in the world and it is turning into the biggest disaster."
Too dependent on commercial, proprietary companies: Rather than create one system and beta-test it, the UK government depended on four companies to build the system, two of which quit or were fired for missing deadlines. So the health records were never developed in the south of England. The computer software was secret and proprietary. There was no accountability to the public, and the vendors did not provide enough technical support to clinicians having trouble using the records.
The resulting software errors and crashes caused missing or incorrect clinical information and sometimes threatened patient safety, for example by causing surgical delays and the cancellation of hundreds of operations.
If a country like Britain -- which already has a national health system and is a fraction of the size of the US -- had so many problems with electronic health records, imagine the problems America would face. Here, instead of four companies competing for contracts, we have dozens of vendors -- most with proprietary software -- vying for billions in stimulus funds. It will be virtually impossible to make their products compatible, therefore not allowing all doctors in different offices to see the same patient's health information.
Even our partial adaption of electronic health records is causing problems. Over the last couple of years, doctors and hospitals have reported to the FDA dozens of medical injuries -- including six deaths and preventable heart attacks -- caused by problems related to computerized health records such as software errors and unreadable computer screens. Some errors resulted in drug doses that were 10 times higher than intended. FDA officials called this the "tip of the iceberg".
More than 50 medical organizations, including the AMA, have called on the Secretary of Health and Human Services to delay the program. In response, the administration delayed some of the required health IT functions, but kept the same 2014 deadline.
How do we avoid the UK's failure? The administration or Congress should slow down the program and delete those parts of the legislation that fine doctors for not using this technology. There's no need to have this system in place by 2014. Instead, we should conduct rigorous studies of the cost-effectiveness of electronic health records systems before mandating their use. Rather than force doctors to choose from dozens of commercial software products developed in secret, we should take a hint from the non-commercial sector, such as the Veterans Administration, which uses "open-source" coding so people can work collaboratively to continuously improve the system.
The Obama administration wants government programs to be based on evidence of effectiveness. Simply following the lead of "IT believers" and salesmen without the requisite evidence will repeat the UK's failures. Now is the time to proceed carefully, consider existing research and the British experience, and chart a more rational course into the digital age of medicine.
Stephen B. Soumerai is Professor of Population Medicine at Harvard Medical School. Anthony Avery is Professor of Primary Care at the University of Nottingham Medical School, UK.
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