SCaLE 6X: Interview with Scott Shreeve, MD

Scott Shreeve, MD was a featured speaker at the Southern California Linux Expo. Board certified in Emergency Medicine, he founded Medsphere Systems Corporation. He remains deeply involved with the Health 2.0 movement, bringing his entrepreneurial vision for transforming health care. He blogs at http://crossoverhealth.wordpress.com. Scott granted an interview after his talk, "Opening Up: The Inevitable Conversation within Healthcare," was well received as a part of the Demonstrating Open Source Health Care Solutions program on Friday.

LinuxWorld: What was your, "Eureka," moment with Free/Open Source Software?

Scott Shreeve: My personal, "Eureka," came in September 2001. After a rotation through the Veterans Administration I had exposure to the VistA Electronic Health Record (EHR). I thought it was a good system. The, "Eureka," came when my brother Steve was evaluating the architecture of VistA. Because VistA itself was available through the Freedom of Information Act and there was an Open Source database available that could run on top of an Open Source operating system we realized that we could, for the first time, have an Open Source EHR stack.

LW: You're a relatively young man, educated during the rise of the Internet.

A. How exposed to technology were you growing up and throughout your formal schooling?

SS: I was mostly exposed to technology through my brother Steve. I remember when we bought our first TRS 80 he would spend hours programming this little dog to walk around the screen. I was never very interested but I enjoyed listening to him talk and watching what he created.

As I entered medical school I was never a programmer or developer, I was a consumer. I was innovative on the side of adoption of technology.

I do distinctly recall in 1992 the first time I saw the Internet, in the Economics Lab with Steve. He showed me these pictures that could be seen on the computer.

B. How is your message being received by older generations of physicians?

SS: Older generations of physicians are resigned to the fact that medicine has changed dramatically and that it is their imperative to either adapt or retire. In my experience half of those have chosen to redouble their efforts to learn the technology which has enabled them to remain competitive and relevant. Their wisdom in medicine, when complimented by technology gives them the credibility to teach the next generation.

LW: A lot of what you discuss as critical is founded on an agreed-upon standard at the database level of a highly sophisticated multiuser application. As an advocate, what is your involvement in your daily work with the upper part of that stack?

SS: What I think will happen will be that the technical underpinnings of that stack and the technology will become less relevant with the advent of cloud computing or utility computing. I think Google is the best example of this. When I'm using Google Docs I have no idea what is going on behind the scenes. To be candid, I really don't care. It's' the user experience--so seamless, so simple--that allows it to be effective for me to complete the task at hand. I think that to the extent that health care technology and related applications can become a beautiful interface atop a black box that will help them to become ubiquitous.

LW: Many Americans have security concerns with the idea of a black box, especially with distributed networks. How do you answer these concerns?

SS:That's a fair and legitimate concern. Because health care is generally five to seven years behind behind other industries, there are now models to follow--most importantly, the banking and financial model. Many people are comfortable passing along the most sensitive personal information and are confident that the systems properly manage their information and protect them. I think this is analogous of what could and should happen in health care.

As health care entities develop the degree of confidence that banks and financial institutions have developed, that the concern over privacy will be minimized. It will never go away, because there is always the potential of using sensitive information against the individual. It will be requisite on the government and private companies to insure that there are policies and practices that preserve privacy while enabling the freedoms that help transactions to occur in a proper away.