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athenaCommunity Empowers Physicians For Better Patient Care

by Derek Hedges, Senior VP of Business Development

In response to a blog entry in HIStalk re: athenaCommunity’s impact on patient privacy, please see below….

First premise: Knowledge is power.

Second premise: HIPAA is intended to protect patient data that is generated in the course of healthcare operations

If you agree, you should read on.

Simple question: For the average US citizen, where do you think the majority of their clinical (and up-to-date insurance) information resides? If your answer is “in the primary care physician’s office”, you are correct. Follow-up question: If a particular ailment requires a patient to see another healthcare provider (e.g., a specialist), how does that patient’s clinical information get in the hands of this provider?

Today, your answer is likely (1) it doesn’t or (2) it involves you making copies of your chart and lugging them to your next visit. Either way, it is not efficient, reliable, or safe from a privacy or care quality perspective. Take your pick.

Over the last decade, the electronic medical record industry has been very focused on capturing data that formerly resided in a chart room at a physician’s office. Sure, EMR vendors provided connectivity with other participants in the healthcare supply chain (e.g., pharmacies), but only when access to those participants was consolidated by another organization (e.g., Surescripts)—in all cases, some other firm had to make it simple.

The EMR industry has not been focused on developing a practical and economically rational way of enabling key clinical data to be exchanged between physicians and other health care participants to better coordinate patient care. The federal government’s “meaningful use” regulations attempt to change the focus, but physician offices that have to meet these data exchange requirements will end up paying software vendors to develop point-to-point interfaces (potentially with an HIE). This is an OLD SCHOOL strategy that isn’t economically sustainable, places an enhanced financial burden on the primary care physician, and does nothing to ensure that the right data gets to the right healthcare provider at the right time. Practically speaking, it won’t work.

athenahealth is launching athenaCommunity to solve this problem. This new service offering is designed to simplify clinical data exchange between physicians and other health care participants in a way that empowers primary care physicians to truly care for their patients by ensuring that appropriate clinical and administrative data is routed to downstream trading partners without undue effort on the part of their staff. As a service organization, athenahealth will take on the majority of work (e.g., compilation of key insurance and demographic data, including pre-authorizations) related to generating and processing a clean order. Also, to ensure that patients comply with referral requests made by their PCP—a problem that often exacerbates what could otherwise be a minor healthcare issue—athenahealth will place a “reminder call” to every patient that has a referral processed through our network. In return for a clean order, athenahealth will charge the receiving provider a nominal transaction fee. Simple supply chain economics—the party that receives value pays something for it.

In short, our mission as a company is to make healthcare work as it should. In the context of this conversation, this means (1) enabling primary care providers to effectively and economically care for their patients, (2) assisting patients in their efforts to comply with the “orders” requested by their PCP, which will drive the highest quality healthcare outcome, and (3) enabling a sustainable business model. In light of recent legislative and market gyrations, this seems to make a lot of sense.

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