When the end finally came last week to the bizarre, 15-month legal battle between brothers Scott and Steve Shreeve and Medsphere Systems Corp., Aliso Viejo, Calif., the company they founded in 2002 only to be tossed out of in 2006, members of the healthcare open-source community posed the next question:
Just how open will the self-described open-source software developer be under its new leadership now that the Shreeves are gone and any legal posturing to preserve the notion that Medsphere is providing both open-source and proprietary software is no longer necessary?
Medsphere's new President and Chief Executive Officer Michael Doyle, in a telephone interview last week, confirmed that mutual settlement agreements had been reached between the company and the Shreeve brothers, and that they would have no further role with the company.
Doyle said he was officially named to the twin executive positions at Medsphere effective Oct. 1, but his first day in the office wasn't until Oct. 9 and his appointment wasn't made public until Oct. 16, just two days before the armistice with the Shreeves was reached.
Scott Shreeve, a former emergency room physician, opted for a conciliatory tone, but in a telephone interview also conducted last week raised again the issue of the company's future approach to open-source development that was at the center of the lawsuit against him and his brother.
"We hope he (Doyle) has the freedom and wisdom to run it as a true, open-source company, dedicated to a transparent development process, a transformative business process and a clear commitment to openness so as to engender trust in the community and the marketplace."
On June 26, 2006, Medsphere filed a $50 million, 12-count lawsuit in Orange County (Calif.) Superior Court against the Shreeves and 20 other unnamed defendants, allegingamong various complaintsmisappropriation of trade secrets, breach of contract, breach of duty of loyalty, violations of the Racketeer Influenced and Corrupt Organization Act, commission of computer crimes, intentional interference with contract relations and unfair competition. The Shreeves' employment at Medsphere also was terminated, though Steve Shreeve remained on the board.
In November, the Shreeves filed a countersuit against the company, its then-CEO and board chairman, Kenneth Kizer, and other officers.
At issue was the posting in early June of Medsphere computer code to SourceForge.net, a popular Web-based platform for open-source development projects. At the time, in addition to his position on the board, Steve Shreeve was the company's chief technology officer and Scott Shreeve was its chief medical officer.
Medsphere was founded in 2002. The Shreeves aimed to leverage the Veterans Health Information Systems and Technology Architecture, or VistA, clinical software system developed by the Veterans Affairs Department and available in the public domain, and create a comprehensive healthcare IT system Medsphere would sell to healthcare facilities outside the VA.
One of Medsphere's first jobs was to serve as the contracting organization for a group of VA programmers and open-source activists with the Pacific Telehealth & Technology Hui, a joint venture of the Defense and VA departments based in Honolulu. Their task was to develop a fully open-source version of the VistA system, which, within the VA, runs on several proprietary software systems. The Hui's open-source VistA development project was later handed off to the not-for-profit organization WorldVistA, but in the meanwhile, Medsphere won a trademark tussle with WorldVistA in 2005 and came away with the right to call its software OpenVista and went about the business of developing its own version of the VistA software.
Portions of the Medsphere code were released to the open-source "community," but other portions were kept as proprietary software.
According to Steve Shreeve, who posted online a brief history of the company after the Medsphere lawsuit against him and his brother was filed, the goal at Medsphere had always been to eventually release a software system that would be open source from "top to bottom."
According to Kizer, who remains board chairman, and Medsphere, which holds itself out as "the leading provider of open-source software for the healthcare industry," in an open letter to employees: While the company is "committed to promoting open-source improvements to VistA, it also has always been the position of Medsphere's management, board and investors that Medsphere would not release 100% of its code under an open-source license."
These differences of opinion and interpretation of what open-source means in the context of Medsphere development efforts have sparked sometimes heated debate in recent years among members of the VistA and open-source communities. The legal battles between the company and the Shreeves added fuel to the fire.
Doyle, who said he left a New York City-based billing software company, Advantedge Healthcare Solutions, to take over at Medsphere, said the company is fully committed to open source.
"We will be the red hat for healthcare IT, no question about it," Doyle said. "When I was recruited for this position, I met with the board and I told them, if you wanted me to re-create what Cerner has done using that model, I'm not interested, but I am interested if you want to use the open-source model. (Then) I'll do it."
Doyle said he was assured by the board. "They are totally committed to open-source," he said. "We believe it is the differentiator, and that's where the value-add is going to come from."
Fred Trotter, a healthcare open-source software developer, open-source advocate and a persistent and often harsh online critic of Medsphere's approach to open-source development, said he's now willing to withhold judgment, based in no small part on the decision by Medsphere to drop the Shreeve lawsuit.
"I'm very pleased with what they've done," Trotter said. "I've asked them to do a couple of things, and one of them was to stop suing the Shreeves." That wasn't because of any personal affection for the brothers, according to Trotter. "It's because the Shreeves are community members, and what they did was contribute to the community and they got sued for that." For now, Trotter said, "As far as I'm concerned, Medsphere is my friend."
Ignacio Valdes is a Texas psychiatrist who hosts LinuxMednews.com, a Web site devoted to open-source healthcare IT where much of the debate about the Medsphere approach to software development has been argued.
Valdes said Medsphere needs to open up more of its software to be considered a true open-source developer, including several applications "that were intended by the Shreeves to be open source."
"One of them was JUMPS, a Java implementation of MUMPS"the Massachusetts General Hospital Utility Multi-Programming SystemValdes said. Both the VA's VistA system and the WorldVistA version run on versions of the MUMPS database and programming language.
From the rumors he has heard, Valdes said JUMPS "would be a pretty big bridge between the MUMPS world and the Java world. If that's going to be open-sourced, that would be a significant event."
According to Medsphere's complaint, however, the source code to JUMPS was part of the June 2006 release to SourceForge that triggered Medsphere to let loose its lawyers on the Shreeves.
For Scott Shreeve, who blogs about healthcare information technology and, more often these days, about what is becoming known as Health 2.0, it's on to the next new thing, although he was a bit cagey about what that might be.
"I'm basically going to be moving now from healthcare information technology to healthcare reform," Scott Shreeve said. "It's a tool to deliver healthcare change. Let it begin again. It's going to be huge."
Scott Shreeve said he is still a believer in open-source software in the healthcare industry and what he and his brother and Medsphere tried to do.
"Everyone knows what happened here," Scott Shreeve said. "It's over. It's just better that everyone moves on. When we started six years ago, two guys and laptop, everyone laughed at us."
Now, he said, "It's just ready to blow open."
Doyle, too, is looking ahead.
"Despite all the turmoil in the company last year, we've signed some very big contracts," he said. "Can you imagine when we get some alignment and remove the distractions what this company will do?"
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