Revolution (rĕv‘ə-lū’shən) n.
- The overthrow of one government and its replacement with another.
- A sudden or momentous change in a situation
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!