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EMR, Penguins and the Cloud

by Thomas Kim, MD, MPH - Physician Advisor

This company is named for a goddess who typically conjures notions of compassionate wisdom. That’s certainly accurate—one of her totems is an owl. But there’s also an epithet invoked in times of battle: Athena Promachos or “She who fights in front.” Given the current state of health care, a cry to arms seems apt.

I come from the field of telehealth and if asked, I’d say complacency is our enemy. I know the never-ending slog keeps us slaved to the task at hand. But if we don’t look up and don’t act, I’d argue we risk a defeat of our own making.

In my first official outing as athenahealth's Physician Advisor, I attended the Health 2.0 “In The Doctor's Office” conference in late April in Jacksonville, Fla. Organized to help providers navigate the implications of the ARRA/HITECH Act, the agenda did a great job laying out some of the battlegrounds ahead.  Permit me to share a few dispatches


More than the current fascination of my two-year-old son, it was suggested that a rookery of penguins is a helpful metaphor describing the inertia of health care, that is, no one moves unless we all move.  While perfectly reasonable, I would suggest closer examination to reveal the subtle dance of shared work as individuals rotate out to brace the collective against harsh conditions. It’s how penguins roll, and it could be an effective approach for us all to consider. 

The Cloud

One of many tech-oriented buzzwords captivating the Interweb, I was gratified to see every presenter and attendee in agreement that cloud computing will play a key role in future health care documentation and communication.  And though challenges remain in how to achieve this, I was left considering the true potential of the cloud.  Beyond resolving basic inefficiencies, the question is less about whether to use the cloud and more about how the cloud might enable some truly transformative benefit.

Meaningful Use

Perhaps the buzzword du jour, a Beltway insider characterized federal efforts very well confirming “Meaningful Use” as an ambitious plan of political will and investment toward EMR/EHR adoption.  Having focused primarily on the Regional Extension Center program and our “Meaningful Use” guarantee at athenahealth, the question remains of how high to set the bar.  Early opinion and evidence seems to highlight prolonged implementation and meager adoption rates as reason to lower the bar.  The recent award of $1.6 million to build a time-limited, web-based, Stage 1 attestation function for Centers for Medicare & Medicaid Services (CMS) is evidence of what I fear most.  Though welcome, the considerable federal investment into EHR adoption will serve to create or sustain solutions incapable of surviving past the incentive window.  Take the question posed by Matthew Holt, host of The HealthCareBlog: “What will the landscape look like in five years and what effect will that have on choices being made today?”  

Then there’s the phenomenon of “EHR second spouses.” After spending copious time and money implementing some EHR solution, practices will make the painful decision to change spouses (EHR) whether for cost, usability, or emergence of new technology. The transition will likely begin in the back half of the “Meaningful Use” window, through 2016. The feeling at Health2.0 in Jacksonville was that this could be very real and increasingly more common.

Stand by for more dispatches from the front—and maybe some inspiring hyperbole to spark discussion.

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