An X-Ray Look Into Decentralization


Hope everyone had a good weekend, I certainly had an interesting one. I thought I had pink eye on Friday, then stood out in the snow for 4 hours on Saturday, and came down with my first cold of the year. I have updated the Matt at the end of this email to highlight how I truly feel (edited by yours truly, you’ll want to look).

Safe to say I feel sick, and not in the “Oh, that’s sicks” way, but the “Oh, he needs to be hospitalized” way.

Good news? I don’t have pink eye.

More good news? The sickness doesn’t stop my fingers from typin’. I always deliver. Let’s get to it. Today is going to mark the start the first multi-week focus on a massive and blooming industry. I’ll set up the industry, and then over the next few weeks discuss some key opportunities.

I’m So Sick of This Buzzword

I’m guessing that most of you all know the word decentralization in terms of crypto, which is fair given that I’d guess most of the country thinks the same thing. Crypto is a very fundamental, beneficial, and volatile use case, but decentralization encompasses much more than that and has subtly taken over the way the world works.

Here’s the definition:

Note, bitcoin not mentioned once.

Learn more from visuals? Here ya go:

More On the Whole “Subtly Taken Over the World” Thing

Once you finally get over the connection of crypto to decentralization you can see that this concept rapidly disrupting markets. Not only disrupting them but spreading out the opportunity to the individual level.

  • Airbnb has decentralized what used to be a hotel-centric travel industry owned by a few large companies. Now anyone can monetize their real estate.
  • Uber/Lyft have decentralized the taxi and cab hailing industry. Giving anyone with access to a car the ability to make money.
  • Crypto currencies have decentralized the financial system that was navigated through centralized banks, governments, etc. (Venmo and PayPal have accelerated this as well)
  • Smile Direct Club has decentralized much of orthodontia from the physical orthodontist office to a subscription, direct to consumer model.
  • Telehealth has decentralized some (I say this lightly because healthcare is a tricky one) primary care to be handled outside of the hospital.

From these examples, you should be able to see the trend. While all of these may not be textbook definitions of decentralization, you can get the idea. Decentralization has the ability to penetrate nearly any market or system and is becoming more significant as our ability to connect/exchange information while not being in the same physical location expands.

And this makes sense, right? I think so. Nearly all those businesses listed above allow you to get what you want faster and cheaper. Faster because most of it is done through your phone. Cheaper because it introduces more competition, driving prices down.

Alright, now that we’re all on the same page on definitions, let’s talk opportunity.

What’s the Opportunity?

When I think about slow, overcomplicated, and centralized services two things come to mind: the government (like the DMV or something) and healthcare.

Let’s focus on healthcare for this week.

I’m not suggesting that the work of our healthcare hero’s is boring. In fact, I would argue the opposite; that the work of doctors, nurses, vets, etc. is exciting and much more fulfilling than the 9-5. But I would say that the systems around the hospital are outdated.

One prime example of where decentralization makes the most sense is radiology. Making some assumptions and dumbing it down a little, the job of a radiologist is to look at X-rays, ultrasounds, MRIs, etc. and make a diagnosis. Compared to other doctors in the hospital they have less patient interaction and the actual labor needed to conduct an X-ray is done entirely by technicians.

All that’s really needed is a computer and the radiologist.

And you know where else you can find a computer and a radiologist? At a radiologist’s house.

That’s right, decentralized radiology.

How Would this Work?

Take an X-ray and email it to the doctor?


The actual equipment needed to take the radiographs is something most hospitals have. Most hospitals also have radiology technicians to administer them. You just need the software. This could be a computer program, an app, a portal, or all the above.

Of course, privacy is important (more now than ever) but hospitals have already figured encryption out. If that doesn’t work you could just copy Paypal, WhatsApp, or even Microsoft Outlook’s encryption model.

Lastly, you’ll need users. Gaining traction would be critical, and also probably super hard. Reaching critical mass for doctors will take effort, but hospital contracts should be easier to negotiate. In an ideal world, this interface would have thousands of doctors to ensure one is always available for any hospital in any time zone. The benefits are obvious though, so once critical mass is reached, they should be flocking to you.

The key here is that this would make the process much more efficient. No more hospital administration fees, no more hospitals or private practices taking huge cuts of the profits, and no more competing priorities. Just the patient and the provider.

The Obvious Benefits

There are several.

  • We’ve seen that the medical specialties that have the best work life balance are becoming the most competitive. Indicating medical students’ interest in good work life balance is at an all time high. So maybe if we introduce remote work and flexible hours, it would help in attract more doctors and combating the growing shortage below.

More desirable work environment = more doctors

  • Decentralization of radiology would combat diagnostic inequalities present in healthcare. Currently, urban areas have more, and superior medical facilities than rural areas. This creates a huge health disparity for rural America.

By decentralizing radiology, as long as the rural hospital had a computer (spoiler alert, they all do), then this disparity is completely eliminated.

Broke your arm in the middle of Wyoming? Boom, have a great radiologist in Dallas look at it, no problem. Skip the trip across the state to a better funded hospital.

  • Lessen the individual hospital’s cost. If there is no doctor physically present, then the cost will drop significantly for the hospital.
  • Quicker results. As I mentioned with the other examples I listed above, decentralization speeds things up. For example, currently a hospital could have two patients competing for the same radiologist. This wouldn’t happen with the remote model.
  • This will eliminate the need for a radiologist to be on call. This one is pretty self-explanatory, but odds are one radiologist in the network somewhere is available.

Saucy Brew Works

You know what could never be decentralized? Grabbing a beer at the bar with friends. Specifically at Saucy Brew Works. Saucy Brew Works has some great craft beer that I would highly recommend, and some pizza to go with it.

Their trivia goes hard (literally, it’s really hard), and their beer goes harder. Stop by if you’re in Columbus or Cleveland and go find some in a store if you’re not. My personal favorite Love You, Bye. #ad

Looking Forward

I see this as a huge opportunity. There are a few examples of people doing this right now, but it’s still so, so, so early that any working model that gains enough retention would kill.

The average healthcare worker is 53.2. These people didn’t grow up with technology, they’re not going to make it. Anyone who is tech savvy, can create a user-friendly interface, and acquire users (both doctors and hospitals) would absolutely crush.

This idea could most likely also spill into Psychiatry, and creating some sort of telephone triage model for hospitals (think 911 but specifically for healthcare to save on any unneeded ambulance bills).

Government and healthcare are two huge elephants that are overlooked when it comes to creating “techy solutions” that could be flipped upside down (in a good way).

Next week we’ll continue our adventure through decentraland.

‘Til Friday.

from, matt

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