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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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No Laughing Matter: An Open Letter to Google Health Marissa Mayer

Laugh (lăf, läf) v.

  1. To express certain emotions, especially mirth or delight, by a series of spontaneous, usually unarticulated sounds often accompanied by corresponding facial and bodily movements.
  2. To feel or express derision or contempt; mock

Open Letter to Marissa Mayer

Marissa Mayer

Interim VP of Google Health
1234 Sand Hill Road
Silicon Valley, CA 98765

Dear Marissa,

Congratulations on your new assignment to head up Google Health. This will certainly be a challenging task given Google’s much anticipated entry into the Healthcare industry. I believe your own legendary success with product management and the user experience will be very useful as you launch. I wanted to be among the first to welcome you to the industry.

I will dispense with the personal background in this setting, but suffice it to say I show up on the healthcare radar here and there (partly famous, partly infamous). I am a board certified emergency medicine physician by training with a specific interest in the design, development, and distribution of life science technologies that improve the delivery and the quality of healthcare. I was the founder of the first ever enterprise open source electronic health record company and have subsequently been actively involved in the definition and promotion of the Health 2.0 movement. I have been consulting with a company to build out their “consumer experience” interface while we simultaneously define the entirely new category of “personal healthcare financial advisory services”. In addition to this work, I currently sit on the advisory board of several Health 2.0 companies and am a frequent industry speaker on open source within healthcare, electronic medical records, and Health 2.0.

Having written a few prescriptions in my day (mostly variations of morphine, which you might need in this new assignment), let me dole out a prescription to encourage Google Health back to a position of health and wealth within the industry:

  1. Get ready to rumble. The healthcare industry is littered with the carnage of decades of innovators shattering themselves against the iron anvil of the healthcare. While there have certainly been successes, there are 10x defeats. Healthcare is the most information intense industry in the world, it deals with an incredible variety of information from disparate and disconnected systems, and the applications have often been overengineered, overpriced, and oversold (even as they underperform). For these reasons, everyone was excited to see Google Health enter the space given your expertise in successfully dealing with these exact information management problems by delivery excellent information management solutions. The healthcare industry is intensely competitive, near totally dysfunctional, and the last of the great industries to be conquered by IT. You will be fought tooth and nail on standards, on regulations, on privacy issues, by people, politicians, providers, payers, patients, and probably the pope, who will one day be your ally and the next day your enemy (as the perverse or prevailing winds may blow). A new challenge will be dealing with all the naysayers, particularly the old medico-industrial complex who is quite happy with the current status quo (thank you very much!). So, Google Health must be organizationally and financially committed and willing to settle in for the long haul to have a discernible impact.
  2. Get transparent. Google has been in alot of trouble lately with the “audience” over both real and perceived missteps as it relates to personal information. The negative descriptor slogan “Don’t be evil” should be transitioned to the positive descriptor slogan “Do good” for your healthcare efforts. I think the fastest way for you to achieve this is to follow healthcare’s lead by getting transparent. This includes openly and honestly talking about how, why, where, and with whom personal healthcare information can and will be shared. While your intentions with people’s information may seem clear, unambiguous, and harmless to you, everyone has a little conspiracy theorist in themselves, particularly as it relates to their personal healthcare information. As I have stated many times, this information (your health history as contained in electronic records, digital imagery, and your DNA) is going to be a form of currency in the future. But it doesn’t stop with your privacy policy as you can and should be transparent with your Google Health intentions. I love building hype to product launch as much as anyone, but seriously, it would help your cause if people knew what your cause actually was. Get rid of the suspicion by clearly stating what you are going to be doing.
  3. Get a product out. Of course, it is better to show people what you are doing than tell them your intentions. This is what I have always loved about Google in the past is that I get to try all the different software solutions out for free. They typically were so easy to use, so functionally integrated, that I slowly, seamlessly, and almost unware that I am doing it move over to a near universal Google platform. I toyed around with GMail (and ultimately junked Outlook/Eudora), Blogger (which was launched from my Google Account), Analytics (which I absolutely love the continual improvements), Reader (which was added later and is a daily staple), and of course have toyed around with Documents but have not fully made the switch (still have some issues with advanced functionality). The point is that these products were freely available, proved “good enough” to use, the software as a service model gave me continual updates, and ultimately I began assembling my own Google Apps kit which utlimately became my daily computing platform. It all happened because there was something for me to try. GET THE PHR OUT THERE! Let people start playing with it. Better yet, open source the application from Day 1 leveraging all the various standards and let the “good enough” become the “absolutely required” because it is so simple, so seamless, and so satisfying to know that what I am using is getting better by the second due to the famous Google innovation process and worldwide collaborative outsourcing. “Release early, Release often” – remember?
  4. Throw that weight around. One of the major impediments within the healthcare information technology world is the resistance toward common standards. We have battled this fight for decades and only recently are beginning to make progress of a variety of standards, that if agreed upon and implemented, can be a huge boon to the holy grail of interoperability within healthcare. There are other major standards issues as well that deal with privacy, security, portability, access, and the associated ethics of this. Google is immediately of the size and influence that you can throw your weight around within the industry to move the momentum on these initiatives. Think of all the positive outcomes of leveraging the depth, breadth, and girth (what are you going to do about that really high corporate BMI?) of Google to help push through pervasive standards for the free movement of data.
  5. Start small, then take over the world. I actually laughed when I saw the first Google Health PHR screen shots. But about three seconds later I recognized the brillance of yet another simple user interface (thanks Marissa?) that still had everything that I needed. This simplicity provides the means to be able to start small, and as you have done so many times in other areas, immediately scale in anticipation and preparation to take over the world. It reminded me of the first time I saw Google Search homepage as well – where is everything else that supposed to be here, the flashing ads, the invasive body enhancement email, and the greasy sales feel – I laughed for about 3 seconds then as well (which is exactly how long it took me to type in in the settings of my browser). Moving from the PHR, to further advances in health search, to medical informatics and analytics, to genonmics, and ultimately to tying all of these together will be the anticipated path that I see Google pursuing.

So, again Marissa, I wish you and your new Google Health teammates the best. You are now in a unique position (you will be catapulted to a Top 10 position of the 100 most influential people within healthcare overnight) to have a singular and immediate impact within healthcare. I trust that you will use this stewardship wisely in advancing the noble cause of healthcare by leveraging one of the greatest American Corporate stories of all time. We welcome you to the industry and look forward to, and even expect, great things from Google.

But with all the great things you will surely do, just don’t laugh. LOL


Scott Shreeve, MD
CrossOver HealthCare

3 comments on “No Laughing Matter: An Open Letter to Google Health Marissa Mayer

  1. Jeff O'Connor says:

    Dr. Shreeve:

    This isn’t just an open letter to Marissa Mayer; this is a manifesto for any company that wants a chance in hell of surviving in the Health2.0 space. It hits all the high notes of the Health Train Manifesto, but is a much easier read for the average person, especially as you relate the whole concept to the “Google experience.”

    Thanks for saying what needed to be said; I hope that Google and its other major competitors in this space listen.

  2. George Van Antwerp says:

    Good entry. I like the style and the content. Healthcare is a difficult industry in which to drive change.

    Fortunately, there is always money and the trends are good for technologies and service companies.

    I think the next 5-10 years will be significant in transforming the model.

    I am going to post a summary on my blog at

  3. 80n says:

    Maybe Marissa should take a look at OpenHealthRecord. This is a proof-of-concept implementation that explores how to make a totally transparent solution that also neatly deals with the intractable problems of security and privacy.

    But perhaps OpenHeathRecord is too transparent for even Google to be able to digest.

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