You’ll never guess who’s coming to Boston to be the keynote speaker of our 2012 User Conference.

Give up?

Try Dr. Abraham Verghese, author of my all-time favorite book, “Cutting for Stone.”

We couldn’t be more honored.

Just as last year’s keynote, Dr. Atul Gawande, best tells the story of what we have today and what we what we want to have across our health care system, Dr. Verghese speaks better than anyone of what we have and what we want inside the most intimate core of that system—the consult. Whether in the exam room, at the bedside, or over email, there is a certain sanctity to that central moment of health care. We all wish to preserve and serve that sanctity…but it seems to be deteriorating.

Here’s what Dr. Verghese told us in a recent interview:

One of my heroes is a physician who trained at Harvard and came from a small community in Laredo, Texas. He trained at Harvard and went back to Laredo and practices now, even in his 80s. And he has this ability to walk into a room and sit on the patient’s bed and create the illusion that he has all kinds of time and nowhere else he needs to be. And paradoxically by being so completely in the moment he manages to spend less time with patients than many of us who are hurrying to get on to the next thing.

Now, take the fiction version.

In “Cutting for Stone,” Dr. Verghese shares a fictional tale of doctors for whom there are no insurance companies, malpractice attorneys or auditors from the Office of the Inspector General. They have only their tools, training and each other. The presence of mind and the depth of connection to their patients that emerges from this book affected me deeply. Dr. Stone is a character who is muddled as a human, but when confronted face-to-face with a truly ill patient, he awakens to a clarity and brilliance that resonates with everything we all want medicine to be.

Years ago, when I was driving an ambulance in New Orleans, I occasionally had to treat a patient when hospitals were on “override” or too far away, but the patient was truly in medical trouble. As a result I was honored with an unfettered one-to-one bond. My tools, presence of mind, good will—and my paramedic partner—were everything that was available to the patient…and the patients took the “medicine.” The connection of that bond yielded a feeling—an adrenaline-infused feeling and true presence—that I have never, ever since felt.

At athenahealth, our strongest wish is to root out the plaque that has occluded this connection between doctor and patient. Society wants doctors to manage populations over stretches of time, not individual instances at a specific “exam room moment.” But in order to achieve the story Gawande describes without losing sight of the story Verghese tells, a new player is needed in the system.

The new player must be one the doctor can trust:

• To follow-up on everything that gets decided in that beautiful exam room moment and makes sure it happens
• To survey populations to help doctors decide which patients next require their pure, undivided attention
• To scrape and shove the Greek chorus of insurance payers and government and tort trawlers OUT of the moment and feed them what they need out in the hallway
• To leave behind an electronic chart that doctor, patient, and consulting colleagues can actually use together to be in the present and to be human in the face of illness

When I think of all those “CCHIT–compliant templates” and imagine those thousands of doctors clicking away to please their Greek choruses—and thus totally confuse any patient or colleague that they might need to share information with—I go berserk.

I’m so done with that.

This past year, we did the hardest part of the work to break free of this. We have learned all the rules and we have developed the ability to codify everything that comes at our clients, even paper. Now we need a more beautiful way of showing them what they need.

It will be something that we hope Dr. Verghese can be proud of…and even Dr. Stone as well.

Next up, stay tuned for a few extraordinary blog posts from Dr. Verghese himself….

Last week, to the disappointment of health information technology project managers and consulting firms nationwide, the Department of Health & Human Services (HHS) announced a decision to delay the implementation of ICD-10.

The story broke on February 14, with a comment by the Acting Administrator at the Centers for Medicare and Medicaid Services (CMS), Marilyn Tavenner, at the American Medical Association’s National Advocacy Conference in Washington, DC. The AMA had recently argued strenuously to delay ICD-10 owing to the significant administrative burden it would place on providers, so we can’t help but wonder if the AMA begged her to spill the beans at their party.

Two days later, in a clarifying press release, HHS Secretary Kathleen G. Sebelius announced that the department would “initiate a process to postpone the date by which certain health care entities have to comply” with ICD-10. While we still need more clarification. “Certain health care entities” sounds like government speak for HIPAA covered entities but one can’t be sure. But we are fairly sure our clients will not be exempt from the postponement.

HIMSS joined the fray Friday with a late to the party rebuttal of the HHS announcement, calling on HHS to keep to the deadline. We get their point.

Anyone who knows something about running large projects knows that momentum is the key to success. Institutional memory lasts no more than a month or two. Nearly every dollar that has already been spent on ICD-10 will need to be re-spent when the project is taken out of the box again. While the government has grown accustomed to this kind of start-and-stop on giant projects—think expensive bombers and warships—the private sector fires people for decisions like this. It seems an incredible waste to shelve ICD-10, especially since every dollar spent must ultimately come from patient service revenue.

In a way, you can’t blame the government. They’ve created a mess. While one part of HHS is mandating that codes become more granular, the other half—CMS—is joining them up again in the form of hierarchical condition categories (HCC). While providers continue to be required to choose a billing code, Meaningful Use is pushing SNOMED (Systematized Nomenclature of Medicine — Clinical Terms) for a problem list. ICD-10 running right next to Meaningful Use was a recipe for failure right from the start.

In truth, we at athenahealth are pretty disappointed in the decision.  Like most organizations, we have already invested a boatload of people and time and, like Y2K, HIPAA, ANSI 5010 and Meaningful Use, we knew we were going to make it as painless for our clients as possible. Mandates like these are bellwether opportunities for us to illustrate the failure of the traditional software model and the power of the cloud-based services in helping our clients manage change. We were ready to take on the next big thing.

The real story is that our industry just could not cope with the change. Technology remains so far behind in health care that most vendors just could not shield their clients from the enormity of the transition. If the vendor community at large had its act together, the replacement of one code set for another would not have been so daunting.

But it doesn’t. So it was.

For many people in America, this Monday means a day off from work to honor the history of this nation’s executive leadership.

For many of us at athenahealth, February 20 will also mean observing executive leadership, but from a hotel balcony deck, high above Las Vegas during the HIMSS 2012 Conference. And we’ll be observing our chief executive, Jonathan Bush, making a few remarks about the value of cloud-based services in health care, addressing others in the health IT industry, fellow disrupters, interested media and prospective and current clients. There was talk of another kimono-style splash involving a superhero suit, a wrestling mask and bungee cords. But this time will be more buttoned-down. Maybe …

If you’re a prospective client interested in attending our Cloud Party at HIMSS, shoot us an email here at the blog. We’ll make room…

If you can’t make the party, please be sure to come by our brand-new HIMSS booth at #1029. We are always excited to see you and share the latest details about our cloud-based services like athenaCoordinator, our new service that can help grow your physician network and our EHR, rated Best in KLAS for practices with 11-75 physicians, by the way…

In the meantime, take a look at our updated YouTube channel by clicking on the image below. We’ve been putting out some really cool stuff including a new User Conference video, to get clients ready for our upcoming 2012 event. On top of a jam-packed schedule, the keynote speaker will be Abraham Verghese, physician and New York Times bestselling author. If you haven’t signed up for the User Conference by now, you should. (Sign up by close of business on Feb. 17 for early-bird pricing.)

And if you’re a prospective client, check out the User Conference video anyway to see what you can expect when you join athenahealth. Where else can you play a few rounds of blackjack with the head of product strategy dealing the cards?

So far in this blog series, I have talked about “the good” in health care IT. For example, EHR interoperability—when it exists—is really good. I’ve also shared some of “the bad,” like data entry and data access in light of a 400-page paper chart. Today’s entry focuses on “the promise” of health care information technology. That is, the potential of HIT to act as a foundational service in which to share research and protocols across providers, to benefit all patients, no matter where they are or who they know.

Here goes …

I had a really good cry just after I was diagnosed with Stage 4 colon cancer. The tears were laced with fear—I was scared. I cried for me, my wife and our kids—I couldn’t think of anyone else during the first 12 hours. I felt better, temporarily, as if the tears washed away a bit of the fear. But then, by the following morning, the fear was back. I was less scared of the diagnosis, and more anxious about the unknown process of how to cure it. Or whether it was even curable.

When the poking, prodding and questioning finally stopped and my diagnosis was launched into the cosmos, my wife and I had to figure out who my doctor would actually be. More accurately, we had to figure out how to figure out who my doctor would be. Also, we obviously had to determine what my treatment plan would look like. In short, we needed a route back to health.

This, I soon came to realize, is where connections who possess both extreme compassion and access to leading edge research and physicians intersected to create my health care HOV lane—a channel in the vast highway system of health care options that the patient firmly believes gives them the best shot at arriving at a safe and healthy destination. And like an HOV lane (high occupancy vehicle for the uninitiated, a smooth-sailing highway lane), if I could find a way into it, I could get back to health faster than the rest of the traffic because I had a few friends on board with me.

Stay with me on the HOV lane. The analogy may not hold for everyone, but let me explain what I mean and how it relates to a larger problem in health care. This is a solvable issue greater than just me trying to overcome my diagnosis and get back to wellness.

First, we had a connection who exhibited an immense amount of compassion for us. A few short hours after awakening the day after my diagnosis, a distant family friend (the mother of my wife’s sister’s college roommate… I did say distant) and a veteran leader at the hospital, walked into my room. She advised us to meet with the medical and surgical oncology teams that I’ve already referenced (Dr. R and Dr. T). She is a strong woman and I took her words as gospel the second I met her. 

It was clear that, in advance of her visit, she had pulled my chart, seen that I was 39 years old, read about the state of my disease and decided she was going to help. In an unexpected turn of events, I went from crying over the fear of “figuring out how to figure out how to get a doctor” to being assigned to two of the hospital’s leading physicians—both of whom had already discussed a very progressive chemotherapy and surgical strategy to get me back to the “Kingdom of the Well.” 

And with that… I was officially in my version of health care’s HOV lane. I was comfortable with the team and the very aggressive plan of attack. We were on our way.

While unbelievably grateful for the connections and compassion exhibited by our physician friend, I thought  a lot about the other 20+ million current cancer patients who may lack proximity or any connection to a leading edge cancer institution. 

This led me to another set of questions: Do patients who receive care at more remote or less research-oriented hospitals question whether they’re getting the best care possible? Further, could these doubts somehow compromise the efficacy of their treatment? Further yet, do huge swaths of patients miss the opportunity to follow what leading research deems the most effective protocols for care?

I have to assume the answer to at least one of these questions is “yes,” at least some of the time, for some patients. But it doesn’t have to be that way.

This is where HIT companies, in collaboration with the world’s finest research institutions, have an amazing opportunity—and maybe a responsibility—to pave the way for cancer patients (and their families) on their often harrowing journey to beat this ravaging disease.  

If you watched any of the NFL playoff games, you saw several large corporations advertising that their “super computers” are being used to cure cancer. The commercials show huge 3D servers and scientists viewing holographic images of DNA—all with an eye toward unpacking the riddle that is cancer. 

Having all that information makes for impressive advertising but it needs to be deployed to huge numbers of physicians in order to see demonstrable results—such as people staying healthy.

Here’s what I mean. With any diagnosis, limitless amounts of information can be gathered and analyzed to guide treatment. Many of these data—tumor markers, for example—guide oncologists toward specific treatment protocols. However, when you couple clinical research advances and protocols with the ever-expanding vastness of personalized data for a cancer patient, I see an emerging disconnect. This disconnect relates to the ability to readily identify relevant information from these massive data structures and surface those data into the hands of the oncologist… and then, directly into the treatment protocol of the patient. 

The collaboration between HIT companies and research institutions needs to enable promulgation of cutting edge research using patient-specific markers. It needs to find its way into the hands of the physician.

In perfect alignment, the match of patient-specific markers against leading edge treatment protocols would be used to create situational awareness for a specific patient as a standard part of the care process. It’s possible; we’re just not there yet. But like my HOV lane, I can see there’s a road to get us there.   

I don’t believe this information or the situational awareness to guide care should come for free. Massive amounts of funding go into aspects such as research advancement and universal information access.

And there is most certainly a market for it.

Leading institutions are already beginning to market their care protocols, but merging these protocols seamlessly with the care process must happen to ensure a reliable entrance onto an HOV lane, not just from a research institiution, but from any physician’s office in the country. It can and should be done, in an economically rational way.

When we reach this point as an industry, and a nation, it will be possible for any cancer patient to be comforted in knowing that a region, nation or world’s worth of clinical research is behind him or her—even if location or a family connection doesn’t enable them to align with the most prestigious hospitals in the world. 

It took collaboration on my care team—my fellow passengers in that HOV lane—to get me to where I am today. Someday soon that same collaboration and the connection and compassion coupled with access to leading edge research and physicians, will be writ large across health information technology. And the HOV lane will be wide enough for everyone. It needs to be.

The first half of January was quiet for the Government Affairs team with the nation’s capital having been closed for the holidays. OK, fine, and maybe I was being a lazy blogger as some of you have pointed out.

But last week, to the delight of idling cab drivers and bored policy wonks alike, lawmakers came back from their districts and DC was back in business! And it quickly became clear that the spotlight will continue to shine hot and bright on health care—and our HIT corner of it.

Here’s how 2012 started off inside the Beltway:

Monday, Jan. 23

The Senate returned, joining the House, to begin their longest combined work period of 2012. Because of the presidential election, this year will likely be light on legislation after a more permanent solution to the payroll tax holiday-UI- Sustainable Growth Rate (SGR) extension is passed. Fortunately, we can count on the Centers for Medicare and Medicaid (CMS) and the Office of the National Coordinator (ONC) to keep us busy with… Meaningful Use!

Tuesday, Jan. 24

The House and Senate Conference Committee for H.R. 3630, the “Temporary Payroll Tax Cut Continuation Act of 2011” held its first meeting, which fondly brought back divided Super Committee memories, with high level statements coming from both parties. You can check out the meeting and read statements from Sen. Max Baucus, D-Mont. and Rep. Dave Camp, R-Mich. We in health care are paying close attention to their decision-making because without a fix to the SGR, physicians face a 27.5% cut to Medicare reimbursement starting on March 1. Ultimately, the debate will come down to the funding source  for an extension of some sort. The committee met again on February 1^st and, right now, with so many details up in the air, many expect a decision to come down to the wire.

President Obama also gave the 2012 State of the Union address. He surprised many of us by leaving health care almost entirely off the agenda. He did reference Medicare and Medicaid, but mostly focused on job creation, education reform, energy and personal responsibility. We were, of course, happy to hear him call out the need for innovation. (Cloud! Cloud! Cloud! Just sayin’…)

Wednesday, Jan. 25

CMS sent Meaningful Use (MU) Stage 2 Notice of Proposed Rulemaking (NPRM) to the Office of Management and Budget (OMB) for regulatory review. CMS had previously sent the proposed rule for new and revised standards, implementation specs and certification criteria for electronic medical records (EHRs). In case you were wondering… the rules get sent to the OMB because they have an effect on our budget.

Besides the budget implications, the Stage 2 NPRM matters because it will define the Stage 2 criteria eligible providers must meet beginning in 2014, using a certified EHR, in order to meet Meaningful Use (MU). In contrast, the certification proposed rule will inform HIT vendors of standards that they must incorporate into their development for Stage 2 certification. Some items we expect to see include more specialty-specific measures, usability requirements, certification process details and interoperability and standards specifications.

The HIT Policy Committee met again on Feb. 1, though CMS informed the committee that, due to the timing, it would not be prepared with an updated analysis of MU performance results. You can refer to their January analysis for national trends and check out our Meaningful Use dashboard for athenahealth results.  Because of the February 29^th attestation deadline, we don’t expect final Year One numbers until March.

Thursday, Jan. 26

CMS and the ONC hosted The Care Innovations Summit, with over 1,000 attendees from across the health care spectrum. It’s always a treat to hear Atul Gawande speak and see Todd Park, Farzad Mostashari and Aneesh Chopra bring enthusiasm that I’m not accustomed to finding in health IT outside the walls of athenahealth. (As a side note, we’re sad to see Aneesh Chopra leave his federal role.) I’ll focus on the summit in a subsequent post, but the biggest highlight was a clear, broad consensus on the need for VALUE-based care.

Friday, Jan. 27

On Friday, the Bipartisan Policy Center released a report, “Transforming Health Care: The Role of Health IT,” at a morning event in DC. Whether you’re looking for good data, big ideas, or a good summary view of the status of HIT and its role in health care reform, I recommend reading the report. This one is right in our wheelhouse and we’ll circle back to it soon.

En fin

If you find your brain spinning (don’t worry, mine was too), stay tuned for deeper coverage of all these topics and events in the coming months. Think of this as a cheat sheet for what’s on deck in 2012. As always, we appreciate all your comments and questions, so send them in.