By Scott Shreeve

I am deeply honored and profoundly grateful to be recognized, along with my brother Steve Shreeve, as the 2008 winner of the Linux Medical News Freedom Award. While this is a niche award in a niche space, it is highly symbolic in recognizing individuals who are “crying in the wilderness” regarding the promise and potential of open source within health care.

The award comes with the bitter irony of course, in the history and
historicity of the events which have led to it being awarded. On the
positive side, Medsphere was
born as a revolutionary force within the Health Care information
technology world. The company was founded on the premise that open
source could have a similar impact within health care as it has had in
other major industries of lower costs, improving quality, and
delivering more value. The open source approach has a particular
kinship with health care, as the notions of price sensitivity, peer
review, open collaboration, and transparency are desirable attributes.
I have discussed this at length before in many forums, and I see that Medsphere is still using our same slides to describe this connection.

The timing of the company being created in 2002 could not have been
better in terms of bringing VistA to the forefront.  Vista had been
implemented for 3-4 years within the VA by this time and the resulting
impact was just beginning to get published in reputable journals, peer
reviewed articles, and in the popular press. The Best Care Anywhere,
and similar articles became commonplace and national calls were made to
implement VistA as the foundation and backbone of a national IT
infrastructure. I see that this still causes groups like HIMSS to have severe indigestion, calling foul on leveraging an investment that we have already made.

We were fortunate to be able to close our first few watershed deals
in 2004 with the Oklahoma Department of Veterans Affairs and then our
first commercial break in 2005 with Midland Memorial Hospital. I will
be forever grateful to the wonderful team that we were able to recruit
to the cause, who believed in what we were doing as much as we did, and
worked as hard as we did to make it reality. These were people who had
worked at the VA for decades, knew the system inside and out, and were
beyond thrilled to see their skills be able to be plied in new settings
for the benefit of the patients. I wouldn’t begin to try to name names,
but we forged some deep friendships in the backwaters of Oklahoma in
places like Talahina, Norman, Lawton, Sulphur, Ardmore, and Claremore.
We also witnessed true collaboration, tireless effort, and a incredible
flexibility by this team to go against all odds to get it done. We
ended up putting first time systems in place in less than 70 days,
complete with training, pharmacy setups, registration of entire
facility, and order sets as well. It was an amazing time.

Midland was an entirely different experience. We were going up
against Cerner, Mckesson, Meditech, and the other big boys. David
Whiles was absolutely amazing, an early convert and believer in the
possibilities to save more than $13M dollars leveraging a proven
system. Being the first commercial adopter of VistA was not lost on
him, both from a risk and reward perspective. We spent nearly a year
visiting the hospital, given demos (17 major ones in a single trip),
and then casting (prostrating?) ourselves before the selection
committee time and time again. I give credit to their team, particular
their lab manager, who sacrificed some functionality for the overall
benefit to the entire organization. Ultimately, CEO Russell Meyers made
the call and put his faith and trust in our little outfit to pull this
off.

By now, we were growing fast, having to add team members and
increased capacity to deliver multiple implementations simultaneously.
We were also bumping up against the natural constraints of growth,
striving to maintain culture, and rushing to build the systems that
could support the rapid growth and nuances of how we worked. During
this time, our annual conferences began to really become a meaningful
and symbolic gathering time for the organization. We had some pretty
cool concepts that we rolled out in these meetings – new programs, new
software, surfboard awards, great luau parties on the beach, and
general excitement of everyone who was participating in something big.

One memorable year, I spoke about the stages of revolution. We had always talked about Medsphere in revolutionary tones, and the phrase “Viva La Revolucion!”
was emboldened in not only the t-shirts we passed out but in our entire
approach to business. We believed wholeheartedly that how we were going
to impact the entire industry was manifest destiny. Revolutions pass in stages,
and I took our group through these stages in detail and merged them
with our little corporate reality. We cast the big boys (Cerner,
Mckession, Allscripts, etc) as the big, blundering ruling class who
were not providing for the needs of people. We helped prepare the team
for the 5 stages of death by this ruling class (first denial, second
anger, third bargaining, etc) and the turmoil that we would cause.

We did not realize at the time that we were also foreshadowing some
of the internal conflict we would experience as our growth catapulted
us into the crisis (stage III). While actual deployments were humming
along successfully, the revolution turned internal with secret
policing, foreign threats, suppression of pleasure, and class struggle.
Ultimately, as is common with many revolutions, the revolutionary
forces were “extinguished” to pave way for a new regime.

Unfortunately, the extinguishing did not happen in the prescribed way, but rather in an otherworldly fashion. We were publicly
accused of releasing source code that was always intended to be
released, harboring secret organizations that were written in board
approved business plans, and seeking to destroy the company we founded
by our alleged actions in a $50M in terrorem lawsuit. The irony of course is that the company subsequently released the source code in question, publicly launched the “secret organization” in grand fashion, and followed the original strategy to much community fanfare.
All I can say is that I am grateful to see our vision being made
reality by others and wish them the very best to bring open source
health care to the masses.

Revolutions are ultimately about redemption and change, so perhaps these recent positives can begin to remove the tragedies of the past.
More personally, perhaps this award and the attendant recognition for
these efforts, provides some meaningful closure to a difficult
transition. Regardless, I still believe (and live on to innovate another day).

Viva La Revolucion!