I have heard from our sales force (and at more than one cocktail party) that most hospitals and practices around the country are focused on Electronic Medical Records (EMR) these days and not so much on medical billing or Revenue Cycle Management (RCM) now because they want to “Do EMR first.”

But what if you are doing EMR first for revenue cycle reasons?

Isn’t the bonus money offered for “Meaningful Use” of an EMR the main driver behind the rush to implement them?  And isn’t the rush intensified by the threat of reduced Medicare rates for those who don’t “meaningfully use” health information???

Okay, so how will you get the incentive money?  My guess is that you will claim to the Feds—through the attestation process—that you are a meaningful user, right?  Claim it?  Like as in file a claim?

I don’t care if it’s MU, PQRI, BTE, or LFG for Do-Re-Mi, if you are going to be glad you moved to EMR, it’s going to be because you’re able to include clinical information in your medical billing system! If you don’t have this in mind from the get-go, you will lose LOTS and LOTS of money on your choice to do “EMR First.”

We used to not let practices do EMR with us without revenue cycle management first.  Heck, the single most powerful thing among the many powerful things that make up athenaClinicals (our EMR) is the fact that we make it easy to go after all available clinical information-driven bonus money and put it in our clients’ bank account.  We go get money!  That’s billing.  EMR—or EHR—is a Medical BILLING thing as much as it is anything else.

For those of you who are folding your arms and raising your noses babbling words like “quality” right now, my response is a similarly raised nose, but my babble is “sustainability.”  Quality, yes.  But if there is no MARKET for the exchange of clinical information, then this whole mini-revolution in health IT that we are enjoying will grow grass through it and disappear into the earth again before you know it.  Like in that book about what the earth will be like when we are gone from it, in a small number of years the health IT revolution could go the exact same way as the “eHealth” revolution of 1997.  Oh, you don’t remember that revolution?  Didn’t read with interest the postings of Caren Taylor at E*Offering?  Don’t remember the billions in market cap created (then evaporated) by WebMD and all the others?

Oops!

• We held a webinar on Friday to explain accountable care organizations, or more commonly, ACOs. It was well attended, maybe because it’s a relatively new subject that really needs explaining, which is why this article from an actual doctor was a relief to find. In it, she confesses, “quite honestly, I don’t have the time to read about it right now.” That doctor may not have time to read about ACOs but NPR found someone who could crack a few jokes on the topic…
• Lots in the headlines about Medicare these days, including a funny cartoon with a William Tell theme in the Sunday New York Times which we would share if we hadn’t run into the new paywall. Anyway, former Secretary of Labor Robert Reich offers his defense of Medicare. In particular, we appreciated this passage: “America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons, because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.”
• There are plenty of facts to gather in this Commonwealth Fund survey of sentiments regarding the health care system.  It’s worth noting that “there is strong support among adults (88%) for doctors’ use of computerized medical records (EHR) and…more than nine of 10 adults (92%) believe it is important for doctors to be able to exchange information with other doctors electronically.”
• Slightly off the HIT topic but still related, the United States seems to be falling behind in the use of communication technology compared to others.  Sweden comes out on top of 138 nations with Burundi and Chad at the bottom of the list.
• The Los Angeles Times dives into an explanation of EHRs and the federal stimulus incentives with this piece. It leads off with how patients may appreciate conveniences like electronic prescription but concludes with this quote from a doctor, “You have to learn a whole new way of documenting your patient care and managing your patient interactions, and that change is difficult…You start to see a light at the end of the tunnel after about a year. Physicians have to be patient, but they will see results.” That sounds about right.
• And finally, a NYT blog dispatch from the hospital vs. small practice front: “I’m a dying breed…”

• We held a webinar on Friday to explain accountable care organizations, or more commonly, ACOs. It was well attended, maybe because it’s a relatively new subject that really needs explaining, which is why this article from an actual doctor was a relief to find. In it, she confesses, “quite honestly, I don’t have the time to read about it right now.” That doctor may not have time to read about ACOs but NPR found someone who could crack a few jokes on the topic…
• Lots  in the headlines about Medicare these days, including a funny cartoon with a William Tell theme in the Sunday New York Times which we would share if we’d hadn’t run into the new paywall. Anyway, former Secretary of Labor Robert Reich offers his defense of Medicare. In particular, we appreciated this passage: “America spends $30 billion a year fixing medical errors – the worst rate among advanced countries. Why? Among other reasons because we keep patient records on computers that can’t share the data. Patient records are continuously re-written on pieces of paper, and then re-entered into different computers. That spells error.”
• There are plenty of facts to gather in this Commonwealth Fund survey of sentiments regarding the health care system among Americans.  It’s worth noting that “There is strong support among adults (88%) for doctors’ use of computerized medical records (EHR) and…more than nine of 10 adults (92%) believe it is important for doctors to be able to exchange information with other doctors electronically.” Here’s a PDF brief.
• Slightly off the HIT topic but still related, the United States seems to be falling behind in the use of communication technology compared to other nations.  Sweden comes out on top of 138 nations with Burundi and Chad the bottom.
• The Los Angeles Times dives into an explanation of EHR and the federal stimulus incentives with this piece. It leads off with how patients may appreciate conveniences like electronic prescription but concludes with this quote from a doctor, “You have to learn a whole new way of documenting your patient care and managing your patient interactions, and that change is difficult…You start to see a light at the end of the tunnel after about a year. Physicians have to be patient, but they will see results.” That sounds about right.
• And finally a NYT blog dispatch from the hospital vs. small practice front: “I’m a dying breed…”

You’ll often hear corporate leaders tout their employees as the company’s most valued asset, but at athenahealth we believe our culture is our most strategic asset.

I’ll dig into what “culture” means to us in future blogposts, but for starters I thought I’d write a bit about a central tenet of our culture—transparency.

So what is it? Transparency defines how we treat each other (openly, candidly, and directly), how we treat information (shared, not hoarded), and how we treat our clients and partners (connecting “say” and “do” and admitting when we have a gap there). We’ve found that we can’t actually do any of our jobs without it. We can’t innovate, service clients, or grow the company without taking it seriously.

When we prepared to become a public company in September 2007, we—our board, our advisors, our senior leadership team—had “the talk.” We were advised that because we were going to have to answer to shareholders, we’d need to prepare for “locking down” information. This triggered several questions. For example, do we need to keep holding company-wide meetings where we share confidential information, business results, plans, and financials, thereby rendering every employee an “insider”? We quickly determined that…yes we do! How else are we supposed to equip athenistas to innovate at breakneck speed? We expect people to act like grown-ups and we trust them with information.

Another question that has come up was whether employees should receive 360° feedback from peers, managers, and direct reports that is NOT anonymous. YES! We’re a company that believes in unconditional positive regard, so this level of transparency works…and it’s required for each of us to succeed.

Our employees can see transparency live and in real-time on our internal blog. It’s there that our CEO Jonathan Bush regularly tackles hard issues and shares personal stories with the entire company. Sometimes he kicks over a hornet’s nest. Some of the discussions would make you cringe. Does he need to put himself out there like that? YES! This level of transparency makes him approachable and human and models the way for others to follow.

Is our obsession with transparency risky? You bet. We might make the wrong choice and hire someone who actually doesn’t want to be trusted with such transparency. But we’re not prepared to punish the whole community for choosing wrong.

Or we might find that sharing information so candidly is off-putting, that it’s too much. But maintaining full transparency is how we’ve always been and it’s the only way we know how to be. And so far, the rewards have far, far outweighed the risks.

More on that later. In the meantime, what are your thoughts?

• On April 15^th, athenahealth is teaming up with Manatt Health Solutions to host a webinar that will dive into accountable care organizations and what they mean for practices and hospitals. It’s free and will be well worth your time. You can register here.
• Of course with the recent release of proposed rules from Washington, ACO news and analysis abounds. For one thing, how would ACOs synch up with Meaningful Use initiatives? This piece from Healthcare IT News digs into the issue. And this from The Wall Street Journal, voices skepticism, comparing ACOs to unicorns!
• And on the topic of EHR and their meaningful use, MGMA pushed out some results this week that find a low percentage of practices able to meet core requirements.
• Government HealthIT has assembled an easily scanned Top 10 list of issues for health plans in 2011. Numero uno? Compliance with the transitions to HIPAA ANSI 5010, ICD-10.
• And while we’re at it with lists, Thomson Reuters has produced a collection of the top 100 hospitals. In the inquiry they found that, “If all Medicare inpatients received the same level of care as those treated in the award-winning facilities, researchers estimate that nearly 116,000 additional patients would survive each year…”
• As you may know, Todd Park is the chief technology officer for the Department of Health and Human Services. Back in 1997, he and Jonathan Bush co-founded athenahealth as a birthing clinic in San Diego, that, due to the ordeal they suffered trying to get paid, evolved into the leading health IT services company it is today. Now at HHS, Todd runs this blog about ongoing innovation in health IT and the government, in addition to his other duties.
• As we set this blog post on the launch pad, lawmakers in Washington were warning of imminent government shutdown. Seems that many of us just want to make sure our tax returns will not get snagged in all the stalled machinery. But what about the shadows being cast over Medicare and Medicaid with some of these budget proposals? The Wall Street Journal reports that the Republican “plan would essentially end Medicare, which now pays most of the health-care bills for 48 million elderly and disabled Americans, as a program that directly pays those bills…”
• This piece from The New York Times about “desktop medicine” is a good read, as are the comments. A patient from Marina, Calif., wrote. “I understand the usefulness of computers in the examination room…but I must admit that at my last appointment I was taken aback by how little the doctor actually looked at me, compared with how much he looked at the computer. I felt a little…well, superfluous.” Ooof…
• For a public perspective that’s a little less in the weeds than you find in the online HIT spaces, this Connecticut publication ran an article explaining how ordinary people may come in contact with EHR—and health information exchange—but also the many policy considerations now being ironed out.
• Finally, enough about Capitol Hill and acronyms and all that – what about the doctors? While all the turmoil will surely affect how they practice medicine, The New York Times reports that many are understandably opting for more predictability in their work/life balance. As the reporter shares, “Younger doctors are deciding that the personal price of being at their patients’ beck and call is too high…”                                           Whether or not you’re a doctor, what do you think about changing expectations in the medical workplace?