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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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The Glass Trojan Horse – Transparency as Good Medicine

Trojan Horse (trōjən hôrs)

  1. Greek mythology a hollow wooden statue of a horse in which the Greeks concealed themselves in order to enter Troy.
  2. A person or thing intended secretly to undermine or bring about the downfall of an enemy or opponent
  3. Computing a program designed to breach the security of a computer system while ostensibly performing some innocuous function.

I have been blogging and twittering from the World Health Innovation and Technology conference this week while waiting to present today. The keynote speaker before me was Scott McNealy, the Chairman and founder of Sun Microsystems. He has a long and storied history with Sun, and a well earned reputation as the “human quote machine“.

He delivered.

His talk started with several examples of his health care experience (long time user as a hockey player and father of four boys) and business experience had so many corrolaries. The fight for standards. The fight for common interfaces. The fight for privacy and security. The find for high quality, low cost, and transparency. He wove all of these together to hone in on 7 ways that Open Source can help be a foundational element in solving the health care crisis.  gave a fascinating overview of how open source is perfect model for health care.

1. Lowers barriers to entry
2. Increases security
3. Faster procurement
4. Lower cost of ownership
5. Better quality products
6. Open standards
7. Lowers barriers to exit

Cool – I started singing that song in 2002 and still believe it today.

He also went through a list of interesting analogies to drive home his points:

  • “We need a HealthTone” – Everyone is familiar with the dialtone and all that it implies for innovations in human communications. Well the dialtone is rapidly being replaced by the WebTone – the figurative hum of 1’s and 0’s implying ubiquitously access to the net. We need something similar within health care – we need a HealthTone – a mechanism to allow for true data liquidity through all the various applications, services, systems, and information to speak with one another. Where is the Health Care universal jack?
  • “Nobody ‘owns’ English” – He described the tired debates about which language or protocol or architecture was the most important. He discussed how ridiculous it would be to try to monetize everytime you said a word, used it in a publication, or were charged for the common communication “platform” of english. Make the communication mechanism unique and build a support business around it(He did admit to wanting to own at least one vowel).
  • “Left Sided Drivers” – Government has a clear role in this. Used the analogy of car drivers all being told to go out in a public darwinian experiment to determine which side of the road is best to drive on. The mass confusion that would result is pointless – at the end of the day whether you drive on right or left is irrelevant but what IS important that it becomes a standard to which everyone agrees and it is appropriately enforced. Government should also determine that
  • “Value is built into the DNA of open source. It has to be” – Went through the many reasons – including the “switching costs” (practically zero in open source) and therefore you need to complete on the value that you can provide right away all day everyday. The “RFP” is open ended and if you don’t deliver then the user can switch away to another support organization. Transparent, real time support contracts. Sounds scary, but it puts the vendors proverbial feet right ot the fire. Deliver a good experience, build loyalty, and then your customers sell for you – that is the open source way.
  • “What does Oracle charge for support? Whatever it takes to win the America’s Cup” – Contrast that to this ZINGER aimed squarely at Larry Ellison. I laughed out loud when this well practiced line rolled off his tongue. Nothing like highlighting the truth with a sarcasm.
  • “A Glass Trojan Horse would not have worked” –  And the winner is . . . transparency. I absolutely loved this quote. Think about it – “Security by Obscurity” is akin to the more popular “Hope is not a strategy” phrase. When things are done in the open, in a peer reviewed environment, when your reputation is on the line, and when your reputation actually affects business – behaviors start to change, quality starts to go up, processes become more efficient, and collaborative contributions accelerate transformational change.

Unfortunately, my talk immediately followed Scott’s. We only had time to exchange business cards but I would have loved to spend some time with him swapping stories about creating the first ever enterprise open source EHR company and explaining how the EHR is the operating system of the clinic, hospital, and regional health network.

Next time. Giddyup Glass Horse!

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