Today, we finalized our acquisition of Proxsys, LLC, a cloud-based care coordination service based in Birmingham, Ala. This move enables us to launch our newest service offering, athenaCoordinator. To understand why athenahealth has taken this step, you need to know the story of the Proxsys founder George Salem.

In 2004, George found himself in need of medical care.  His primary care provider wrote orders for George to get some lab work and visit a specialist. Eventually he was admitted to a local hospital.

And so began George’s first-hand, labyrinthine journey through today’s fragmented health care system…

His primary care doctor, the lab, the specialist and the hospital were all on different practice management and EHR systems.  Each time he arrived at a new facility, he was an unknown quantity.  No one had advance knowledge of his identity, his medical history, his demographic information or even the reason for his visit.  He was lost in a care coordination maze.

George had to keep retelling his health story, filling out forms, having redundant blood work and vitals recorded. He was shuffled from waiting room to waiting room and facility to facility.  He had to fight the battle of getting his key documents faxed from one place to another. He had to help coordinate his own care between his providers, his insurance company and the facilities he visited.  The pre-authorization process with his insurance carrier proved to be particularly vexing. 

To top it off, George had no idea what was wrong with his body or what he could expect to pay in medical bills. As he explains today, he literally walked into the hospital with no idea how much he would be spending on his procedure.  The anxiety only added to the stress he was feeling about his health condition. 

Thankfully George ended up getting the right care despite all the frustrations, and he’s doing well today. And while athenahealth is fueled by a relentless passion to find flaws in the health care system and fix them, we recognize that there is excellent care available, provided by committed professionals. 

After George’s 2004 ordeal, he set out to fix care coordination and created Proxsys to do just that.  At athenahealth, we are in the business of finding and fixing the things that don’t work the way that they should in health care.  And when we find kindred spirits like George Salem and his team, we just get closer to the vision of creating a national health information backbone that helps make health care work as it should.

Our website provides more information about our acquisition of Proxsys and the launch of athenaCoordinator.  We believe we’re on track to significantly improve care coordination within health care communities. We think we can eliminate much of the frustration and anxiety that patients like George and so many others have known. Let us know what you think!

Today, athenahealth announces the Patient-Centered Medical Home Accelerator Program, an exciting new initiative undertaken with the National Committee for Quality Assurance (NCQA) to help medical groups around the nation. Now, practices using athenahealth’s cloud-based EHR service will automatically receive credit for some of the requirements needed to achieve recognition as a patient-centered medical home (PCMH).

You can read the official press release here but to understand first what PCMH means, it’s a key component of achieving the triple-aim of:

• improving the health of a patient population
• enhancing the patient care experience through access, reliability, and quality
• reducing health care costs

PCMH is not a new concept. The American Academy of Pediatrics came up with it in the late ’60s to describe a central location for archiving a child’s medical record—too bad there was no Cloud back then, eh? AAP expanded the concept to include (take a deep breath) “accessible, continuous, comprehensive, family-centered, coordinated, compassionate, and culturally effective” care. It was then reborn in the late 2000s with the adoption of PCMH models by a number of primary-care specialty societies, culminating with the adoption in 2007 of a joint position by the American College of Physicians, American Academy of Pediatrics, American Academy of Family Practice, and American Osteopathic Association.

Since then, thousands of practices have become medical homes nationwide. Providers in these practices typically receive additional payments, on a per-member per-month (PMPM) basis, to cover costs associated with care coordination and management. And data from PCMH pilots have been quite promising. The Patient-Centered Primary Care Collaborative (PCPCC) recently released a report summarizing a slew of PCMH pilots demonstrating increased quality of care and reductions in cost.

In order to become designated as a PCMH by insurance providers and other agencies, practices must be recognized by an approved agency. While a number of organizations have created pathways to achieve PCMH recognition, NCQA is the leader. NCQA’s program gives practices clear guidelines about organizing care around patients, working in teams, and coordinating and tracking care over time. Furthermore, NCQA clearly communicates an action plan for becoming a medical home. The PCMH standards are available from NCQA at no cost, and they provide education on how to succeed. Over 7,600 clinicians at more than 1,500 practices across the country have earned NCQA PCMH recognition.

Becoming a recognized PCMH requires thoughtful planning and a great deal of preparation, but athenahealth’s integrated solution and support services ease and accelerate the process for providers. 

Here’s how Valley Medical Group did it:

First, information technology is critical to achieving a high-functioning PCMH, as care coordination would be impossible without the ability to place reminders. Also, population management would be impossible without the ability to run reports against a practice’s entire panel. A significant number of measures required to achieve PCMH recognition are directly related to having IT infrastructure in place to support PCMH functions. Practices using the athenahealth EHR service will automatically receive credit from NCQA for these measures.

But it’s not just about IT. Practices need pre-validation for test and referral tracking and we enable this step with our document services operations. Our cloud-based services are a differentiator here as in so many other aspects of health care management.

athenahealth also eases the burden of achieving other non-IT measures. For instance, practices must meet a measure to ensure a proportion of visits are actually with the patient’s chosen clinician. For this measure, athenahealth captures the patients PCP preference and monitors the percentage of patient visits that occur with that provider.

Over time, our Quality Management Team will build further reports and functionality into athenaNet to streamline a practice’s renewal in the program.

Along with pre-validation, athenahealth is assembling a suite of additional services designed to ease the way for athenahealth clients to secure full NCQA PCMH recognition that include:

• pre-filtered reporting for NCQA PCMH applications
• additional quality management tools to track PCMH measures
• identifying payer programs that can help subsidize the cost of certification
• putting you in touch with consulting services to guide your practice to certification

Becoming a patient-centered medical home is a lot of work. athenahealth makes it a lot easier.

Rothenhaus is the chief medical information officer for athenahealth.

On a rainy afternoon in May, we visited with Dr. Steve Bien and his staff at Wilson Stream Family Practice in Farmington, Maine, to talk about overcoming the challenges facing a rural medical practice. Once his schedule cleared up for the day, he sat down in his office to share how athenahealth’s EHR and practice management services have allowed him to stay independent and provide quality care.

Hopefully you got a chance to read the blog post from Jonathan Bush about the hard lessons a company like athenahealth can learn from what’s happened to Research In Motion, or RIM, maker of BlackBerry mobile devices. He laid out the case well and it gives me a chance to talk about the importance of User Experience, or UX, in health IT. 

Let me start off by saying I want athenahealth users to have an online experience that is fluid, easy, efficient, and well-matched to the needs of various people across a medical practice. The UX (aka the user interface or UI) should deliver on the promise of our cloud-based services, such as our EHR, every time a person interacts with our application. The ease and value should be immediately apparent.

Sounds good, right? But it’s not so simple to do. Our industry has been talking about EHRs for years now, and if it were simple to make EHRs easy to use, we’d be done by now. We’re not. EHRs need to support a wide variety of health care contexts, specialties, provider types and patients. What works in one context for one type of user can be an annoying hindrance to another user in a different context.

Cracking the usability nut in one particular situation is fantastic, but not sufficient. Getting the UX consistently fluid and efficient for all users is an ongoing process, given the complexity of the cooperative work in health care.

At athenahealth, we hear a lot of requests—usually reasonable—for additional features. But at some point we have to be able to step back and realize that unless we invest in UX to unify and streamline individual features, the availability of those features won’t matter very much. It’s difficult to get the right level of investment in both the whole and the parts at the same time. That’s what we’re in the thick of now at athenahealth. We don’t want to find ourselves left behind in the market, like RIM did.

Rather than cover UX exhaustively in this blog post, I’d like to start an ongoing discussion over the next few months around these main points:

• The status of UX in the health care IT industry
• The role of UX at athenahealth
• The central importance of patient safety in UX
• The role of usage metrics

I envision this as a discussion around the usability of EHRs and I welcome comments that focus on the issues without getting into the weeds of athenaNet UX. So let’s get a discussion about usability started! And stay tuned for our next installment.

• The money flows. According to this piece in Health IT Update, about $400 million worth of incentive payments for the Meaningful Use of EHRs have gone out to physicians around the country. If you are an eligible provider, how are you doing on your path to achieving Meaningful Use? If you are late to the game, you might want to check out the latest in our popular webinar series. The sessions are always available on demand. We also have all kinds of resources available on our website. And stay tuned for more exciting news about how we are working closely with our clients to help them achieve Meaningful Use of their EHR.
• We are always happy to highlight the latest from Todd Park. He co-founded athenahealth in 1997 with Jonathan Bush and has since gone on to become the Chief Technology Officer for the U.S. Dept. of Health and Human Services. But he’s no Beltway bureaucrat. It’s his job is to share his experiences as a successful entrepreneur. Thanks to the HIStalk blog, we found this recent video clip where he talks about the current convergence of various forces and opportunities in health IT today. He takes the stage at around the 00:51 mark.
• A few weeks ago, we shared the news that Dr. John Halamka would be stepping down from his post as CIO of Harvard Medical School. Here is the exit interview. He is still blogging and holding down several other jobs.
• Cloud, cloud, cloud. Cloud computing seems to be all over the place now and you will only see more about it and cloud-based services if we have anything to say about it. We have used this blog to cover some of the legal issues around cloud-based health IT. Dan Orenstein, author of those posts and our general counsel, shows up in this piece from Becker’s Hospital Review. And here is another take, which includes some great nuggets. Take for example that, “…88 percent of health care organizations that are cloud users have reduced the cost of software applications by moving them into the cloud, with an average annual savings of 20 percent.”
• If it weren’t so hard to be a doctor, this company would not exist. Doctors have enough to worry about trying to save and heal people. They don’t need to be distracted by all the scut work we are happy to shoulder. But as hard as it is to be a doctor, what about when the doctor is the patient?  This piece somewhat mirrors what one of our clients endured when the tables were turned on him. The sources of pain are a little different but when Dr. Allen Gee tried to get medical care for one of his children he found a bizarre and frustrating obstacle course in the way.