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All Things EMR | Meaningful Use

Part 2: Musings from the Burn Unit

Todd RothenhausYou may recall from Part 1 of the Burn Unit series, I began sharing some experiences with deploying ambulatory EHR at Steward Health Care. My first realization was that the traditional software model (on-premises hosting of application servers and systems) didn’t really fit the ambulatory model. Given the high pace of change in health care IT, Meaningful Use, ICD-10, 5010, and everything else, the need for frequent updates are as important as ever. Having to take new code meant having to pull resources off other projects, and EHR was taking a whole lot of resources to begin with.

An even bigger issue was having to own the entire application. Every time we rolled out a new practice, we repeated the same exact steps: spin up a VM, have the vendor deliver the code, configure the system, prepare content, enroll providers in electronic prescribing, test and deploy interfaces, etc. Every time we encountered a configuration issue, we owned it. If we found out a pharmacy had changed their fax number, we’d change it ourselves–in our nearly seventy separate practice databases.

We were less than 25% through our 1,500 affiliates, most of whom were 1-3 doctor practices, and new agreements were coming in weekly. It just wouldn’t scale. I realized: even an ASP model won’t help.

As CIO, I saw a lot of web-native stuff that looked pretty good to me–-no CAPEX investment, subscription model, automatic updates. The only problem was that these offerings were not really connected to our outcomes–-and many of them cost a lot. It seemed that a lot of vendors were using the web to cut costs, but were pocketing the entire difference without offering any additional value. At one point I was presented with a $700,000 subscription for order sets!

While were we painstakingly figuring out how to build individual data capture elements into our legacy EHR, athenahealth’s Clinical Intelligence team took our managed care contracts and pre-configured athenaNet to capture every P4P measure our physicians were enrolled in–-customized by patient and by contract. Then they did the same thing for Meaningful Use. At that point it dawned on me: the same company that wrote the code should provide expertise and service to configure it, and be at risk for outcomes.

As we continue to collectively force-feed IT to into the health care economy, health IT strategy must evolve from “roll out EHR” (which everyone is doing) to include new approaches to electronic patient relationship management, advanced integration, and data analysis across the continuum of care. For IPAs and POs without hospital affiliation, the commitments in cash and time to develop an “ambulatory strategy” are overwhelming. For hospitals and health systems, there are too many projects getting in the way of real innovation.

As a CIO, I welcomed the opportunity to take some of the ambulatory work off my plate.

Rothenhaus is the chief medical information officer for athenahealth.

All Things EMR | Practice Management

EHR & HIT News Round-Up

  • One of the better blogs in health IT is written by the intrepid John D. Halamka, MD. Not only is he an ER doctor and CIO at Deaconess Beth Israel Medical Center, he has also been CIO at Harvard Medical School on top of being a full professor there. But regular readers may have been surprised to learn earlier this week that he’s stepping down from the role as CIO at Harvard because he says it requires more time than he’s able to provide.
  • It is true that you never hear about the thousands of airplanes that take off and land safely every day, but it does happen all the time. No, what makes the news of course are the horrible crashes or even when wingtips mistakenly brush on the tarmac.  But it was reported a few days ago that the World Health Organization has found that stepping into hospital is “riskier” than stepping on a jet airliner and that “millions of people die each year from medical errors and infections linked to health care…” The risks of infection and the dangers medical errors are not news but it’s still a startling comparison.
  • As we know too well here at athenahealth, being a doctor today is not what it used to be. Given the obstacles to actually providing care, compounded with the threat of a malpractice suit, piles of debt from medical school and the challenges of running a successful practice, it’s no surprise that many are asking themselves if it was all worth it. This piece in The New York Times from a working physician asks the question. What do you think? Are you happy with your choice? Is the path sustainable? Check out the 206 comments.
  • At lunchtime today, July 27, athenahealth will be hosting a free webinar on quality management and your EHR. You will learn what is offered in various quality management programs, which are the right programs for your practice and how the right vendor can help deliver profits. Sign up and learn what you need to know to get paid what you deserve.
  • We may try to explain to doctors how to use an EHR as a revenue source–and we prove it with performance–but how well do doctors explain those electronic charts to their patients? Not well, according to a poll reported in this recent article.   
  • Finally, The New York Times explores some of the friction between industry and government over the usability of EHR in this article.  Mary Kate Foley, VP for user experience here, is quoted in the piece. “What scares me is design details mandated from on high…That’s going to prevent me from making my electronic health records more usable. It will hurt innovation.” Stay tuned for more on usability here in the athenahealth blog…


Introducing athenaCoordinator: Care Coordination to Benefit the Whole Community

Jonathan BushWe have some big news to announce.

Today, we signed the papers for the planned acquisition of Proxsys LLC, a provider of cloud-based patient access and care coordination services based in Birmingham, Alabama. Learn more about the pending sale in our press release.

If all goes according to plan, we will launch a fourth service, to be known as athenaCoordinator, sometime during Q3 2011. By integrating Proxsys into athenaNet, information would be able to flow more easily throughout the health care supply chain, improving care coordination for current and future clients. It would be the latest piece of the national health information backbone we have been steadily constructing.

Buying Proxsys would allow us to turn care coordination, referral, and order facilitation services into an immediate, market-ready reality. It would also put us one step closer to achieving our vision of an information infrastructure that helps health care work as it should.

Here’s a quick look at how we got to this stage. As we developed our prototype for care coordination and referral services, we realized it needed some help. During pilot testing, we learned that it couldn’t always function in the often incongruent health care supply chain. Different systems mean data can’t be easily exchanged. If that’s not clear, let’s use Facebook to explain. Millions of people seem to enjoy sharing vacation photos or finding old chums from high school on Facebook, but all the sharing they do within Facebook can’t be done outside it without a duplicate effort. If your old pal wants to remain on LinkedIn Island, you can’t easily trade wedding pictures. The same is true in health IT. Sharing patient data over different systems means, at the very least, expensive, slow, and duplicated steps.

But imagine now if docs could “friend” or be “friended” by the entire health care supply chain in their network! Imagine if they could zip a patient, with no duplication of effort, to where he or she needs to go and then the patient gets zipped back the same way! That of course is what the athenahealth vision is all about—to build an information infrastructure that helps health care work as it should.

Yet we have tons of medical tests being duplicated because results are lost in the gaps between different systems, and legions of patients are lost to follow-up because they weren’t properly connected to where they need to go next.

Of course millions of dollars (oh, and lives) are at stake, but the fact that the right lab or doc is on the wrong network is a crappy excuse for having uncoordinated care…really crappy. Again, this was a roadblock in our early care coordination trials. And since only so many providers in the world are actually on athenaNet (sadly), we weren’t going to be very good coordination-of-care enablers if we only helped people go from athena to athena.

Then we found Proxsys.

Proxsys reminds me of a deep cuts, oldies version of athenaCollector. It was founded in 2004 and its magic is getting patients from docs into ancillaries and hospitals electronically and seamlessly…REGARDLESS of which systems those hospitals are on, and REGARDLESS of insurance rules. They have been on a noble mission to wade through scut work for their clients…and it is a holy mess. Yet they remain undaunted. Even if they are waiting on hold with insurance companies to get the right pre-certification themselves…or typing patient data into some disconnected hospital system that can’t take an interface…their service coordinates the delivery of the right info from doctor’s office to hospital (or wherever) with shocking accuracy. Way better than that mammography phone number scribbled on an index card that you got last time, eh?

We immediately knew that we wanted to include Proxsys in the athena family so that we could make those deliveries of information with shocking accuracy for all our clients, and so THEY could deliver that information for their patients. Needless to say, our “last mile team” and process gurus and developers are veritably weeping with joy at the things they could do to combine our insurance connectivity with Proxsys’s incredible manual wherewithal to create efficiency. In the meantime, we would be able to send ANY patient from ANY doc to ANY hospital, REGARDLESS of what system they are all on.

Is the picture coming together now?

Now I wouldn’t be a future enterpriser if I didn’t point out that we could make those transactions a lot cheaper and a lot better if one side (or BOTH sides) in the exchange are on athenaNet…but you wouldn’t have me any other way, right?

I am grateful beyond words that Proxsys founder George Salem had the faith in us to believe that we can help carry that mission forward. So let’s get ready to welcome athenaCoordinator to the family—care coordination that benefits the WHOLE community.

All Things EMR | Healthcare Policy & Reform | Meaningful Use

EHR & HIT News Round-Up

  • There’s some bad news about the hospital business here in Massachusetts. The Boston Globe reports that economic weakness and cuts to Medicare reimbursements are hurting some hospitals in the state. The problems are compounded by a lack of funds to fix infrastructure and even the outlays required for EHR, which, depending on the system, can be a hard pill to swallow. According to the piece, “We are entering what is going to be a down period for hospitals, especially those without market clout,’’ said John McDonough, director of the Center for Public Health Leadership at the Harvard School of Public Health. “There will be far fewer independent, freestanding community hospitals. Some will close, some will be swallowed up by larger systems.’’ Also in danger of getting dragged down by pending Medicare cuts are the well-regarded teaching hospitals in the Boston area.
  • The development of Health Information Exchanges (HIE) has gained momentum reports Government Health IT. The article, based on a recent report from a non-profit advocate, does however share that HIEs are having trouble navigating the maze of government deadlines, disparate systems, mandates for Meaningful Use of EHRs and uncertainty about reform.
  • As political leaders in Washington hash out future spending cuts, in what are reported to be some prickly sessions, USA Today reports that one complication to emerge from the talks is the possibility of raising the eligible age for Medicare from 65 to 67. While it would be a move to save money, the paper reports that it could leave some in the lurch. Speaking of Medicare, chief Donald Berwick is said to be in a “race against time” to achieve his own set of objectives.  
  • In a revision of the rules for Meaningful Use of an EHR, the government is looking to delay some electronic physician quality reporting requirements.
  • Maybe it’s the same kind of information overload that seems to plague all of us these days, but many doctors don’t appear to be getting the most out of their EHR. According to this article from Information Week, physicians in small practices simply need more time to get a handle on all the aspects of a solution. The problem, beyond untapped resources, could be a gap in the care coordination that will be needed under current and future reforms. 
  • Doctors are often remembered for their bedside manner. But what if the doctor is a jerk? No doubt you’ve encountered at least one. Some medical schools are now screening candidates at the front door for their ability to deal successfully with their fellow humans. What do you think? Is this the right step? One of our twitter followers suggested that social maturity be addressed later, when the student undergoes residency interviews. Let us know your view!


My View on Point Lookout

jonathan bushAs you may have heard, athenahealth recently announced the purchase of the Point Lookout resort on Maine’s Penobscot Bay, just down the road from our operations center in Belfast. I wrote a similar blog post for our athenahealth employee website that answers the critical questions, like whether or not it’s dog-friendly and if this means employees no longer have to stay in a nearby motel when they are working or training in Belfast.

But many of them, like probably many of you, are asking more broadly why a cloud-based company is buying more brick and mortar. This was the toughest one for me personally.

My call is that if we are to be a national health information backbone, we are going to also be a national convener of key thinkers in health information. The market for management of health information barely exists at all, but it is the single most important missing piece to more transparent and affordable health care in the US. It needs a fertile place for idea exchange (think Davos).  

I will try it out myself this September. I’ve been sending out invitations to entrepreneurs who have shown to be disrupters for good in health care. Each will bring one investor and one client…and we will engage in two days of radical honesty. Can’t wait to see what happens!

But some are also asking how are we going to fill all those cabins and meeting rooms. Well, that’s a good one too.

A few points:

  1. We have gained 20% MORE employees and almost 30% MORE customers EVERY year. So, even though we can’t predict what our future growth will be, we expect the demand for special athenahealth gatherings to go up and up.
  2. In particular, a huge chunk of our new athenaClinicals clients are coming out of a BURNED software-based EHR implementation. We have a pressing need to get key physician opinion leaders together for training (and therapy!) that we never had before. Our new CMIO, Todd Rothenhaus, MD, has his work cut out for him, since he is charged with training a new cadre of American physicians that documents their care in the cloud and MAKES money doing so.
  3. The guy who owned Point Lookout before us had to dump it in a fire sale. That said, usage has been going up for the last three years since he bought it. In fact, we think the place may get pretty close to break-even next year on just non-athenahealth use…too bad he had to sell, he almost made it through the tunnel.

Maine is a unique venue that few people in work/life get to visit…and it is stunningly memorable when they do. I think it may end up being a great edge for entry into the world of convening people. If not, and it’s a total failure (perish the thought), we can always sell it again. We already have three offers!

Rocket Fuel