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All I Want for Christmas Is My Two-Sided Market

by Jonathan Bush, President & CEO

So, if you are reading this, you probably understand that this Internet thing is going to be big. In fact, maybe you used this “Internet” to do all your Christmas shopping this year.

Like me, you may even think that NO isolated instances of software will hold any active health information within the decade. But you may not be all the way with me when I tell you that it isn’t just cloud-based software that will hold it, but a cloud-based marketplace for service.

Remember that blog post a few years back where I showed the software evolution exhibit from some future museum of ancient computing history? We need the service company in that diagram, not just the cloud computing company that precedes it, and, for that to work, we need permission to monetize the whole supply chain.

For example, the person who best knows what electronic information is needed by Cardiac, Vascular & Thoracic Surgeons (CVTS) of Greater Cincinnati (new client…woo hoo!) is someone who does not live in Washington D.C. In fact, even if someone in D.C. told them what to need, CVTS wouldn’t receive it. It would be a tiny bit off—since no one is incented to provide accurate and complete referral information—and no one would return CVTS’s call when the primary care group got it wrong. And CVTS wouldn’t hassle too much about it because they don’t want that primary care group to get pissed and start using another surgery group. Is this a hard thing to understand?

Maybe everyone buys it but they don’t see an alternative? Is there an alternative? I thought you’d never ask!

What if CVTS could design and then re-design over time what data they wanted? What if they could do it online in a little portal? Every time they piloted and adjusted a care pathway for a procedure, they would adjust the data they require in their portal. Then everyone who refers to them would start pulling the required data from their medical records. Why? Because these data would be pulled automatically by the network of cloud-based information services that sits behind all the area practices…and because CVTS would be paying for the information if and only if the data arrived electronically and complete.

The cloud-based players would be expert at pulling said data and at prompting the staff of referral-sending practices (in 6th grade English because that’s how everyone rolls except in health care)…if they weren’t, they would have lost to athenahealth, which is already expert at this.

Now pull the camera back from CVTS, and you see a social movement that would make even Arlo Guthrie cry an “Alice’s Restaurant” tear.

That is, you can get anything you want…if you make it easy and pay for it.

So why is it not happening?

Is the world really just waiting for athenahealth to get big enough to do it for everyone? I’m flattered, but I think not.

No, it isn’t happening primarily because it is illegal under the Stark and anti-kickback laws.

We need to change this.

The voters of California’s 13th congressional district already changed out Pete Stark (my first Christmas present).

Now we need to adjust his law and others so that the single most important health reform of the 21st century—the emergence of a sustainable market for the exchange of health information—can finally rise.

Happy holidays, everyone!

Jonathan Bush is the President and CEO of athenahealth.

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