If you’re one of the more than 850 doctors, practice managers, nurses, executives and others already registered for our 2012 User Conference, we have a jam-packed schedule waiting for you and your colleagues starting Sunday in Boston.

And if you haven’t yet signed up, but would still like to attend, you’ll be happy to know that registration remains open.

We will present over 50 different sessions on everything from what’s happening with EMRs, Meaningful Use and health information technology on Capitol Hill, to how to maximize schedule density at your medical practice.

Not only will Abraham Verghese, MD—renowned physician and author of bestselling novel “Cutting for Stone”—be here in Boston to deliver the keynote address, but the National Coordinator for Health Information Technology, Farzad Mostashari, MD, will speak as well. 

Doctors can enroll in CME courses and everyone has a chance to win big—for charity, of course—at our exciting Casino Night. We’ll have a hall set up just for sponsors and exhibitors and rooms dedicated to product demo presentations throughout each day.

athenahealth CEO Jonathan Bush will outline our strategy for 2012 … and you’ll go home knowing why care coordination represents an important opportunity in your community, whether you are a smaller practice or a large health care system.

Finally, some of you are going to win some great awards for supporting athenahealth’s mission of making health care work as it should.

You can still sign up for the User Conference. And if you can’t make it this year, we’ll report out on the blog, on Twitter with hashtag #athenahealthUC and via other social media channels.

Physician and Stanford professor Dr. Abraham Verghese has written several books, including the New York Times bestseller, “Cutting for Stone.” Now, we at athenahealth are honored to have Dr. Verghese deliver the keynote address at our 2012 User Conference in April.

He was also good enough to join us on the phone recently to share some thoughts on modern medicine. In the first excerpt “To Live in the Moment of Patient Care,” Dr. Verghese spoke about the importance of being present for patients. 

Here is the rest of the conversation…

What are some of the promises and dangers of EHRs and HIT in the exam room?

I’m glad that we’re in the electronic medical record era whether it’s cloud computing or on a computer. The great danger is that in the process of recording this data we can neglect the patient.

In the hospital there’s been a study suggesting that in a 10-hour hospital stay, four hours are spent charting and recording. I think all of us agree that that’s probably too much time and so the great challenge for us is to find ways to be more efficient in charting. I think what athenahealth has done has really elevated that to a level where one can really focus on the patient and yet document, which is still very important.

The great danger in terms of the patient is taking an individual who’s already feeling vulnerable, perhaps even disembodied changing into a paper gown and making them feel even further disembodied. To the degree that the physician can focus on them and use the computer as an ancillary tool, it succeeds in keeping that patient-physician relationship vital and sacred without it feeling like the real focus of attention is the computer.

What is your experience with care coordination—including possible limitations and a vision for how it can be executed better?

We’re all aware of wonderful examples of how care coordination doesn’t work well. You know there are so many opportunities during transitions of care for information not to be communicated. I think that too much of the conversation about hand-offs and transitions of care is focused on the health care provider when really the focus should be the patient.

If we put on the patient’s perspective and view how it feels to go from hospital to home to outpatient visit to hospital, I think some of these conversations about transfer of care become colored differently. Too often the conversation is about hand-offs and sign-offs and those are all from the doctors’ point of view.

The short answer would be that we have, in most systems, a long ways to go in coordinating care. It’s perhaps the most difficult thing we do.

Some systems (yours it sounds like) do it very well. Certain systems are completely focused on the delivery of care to patients. The clinic model can do it very well but when an institution like mine, for example, has a mission that is two or three-fold, we’re teaching, we’re doing research and we’re doing patient care. Sometimes those tripartite missions wind up actually being in conflict with each other because you are being drawn away from this to do that, from that to do this and there are three different missions.  So I think it’s a continuing problem and I think we all marvel and look to athenahealth and other organizations to see how you do it.

It’s an important issue for us all.

Learn about and register for our upcoming User Conference, which starts April 1, here in Boston.

I hope people are watching the news around the Meaningful Use attestation data released by CMS recently, because it is so instructive as to the difference between where we are in health care and where the deliverers of keynotes THINK we are. Since last September, we’ve been publishing our Meaningful Use (MU) dashboard data and as of this week for example, we know that 83% of our Medicare MU doctors have attested to the measures.

But our constraints as a marketplace are at the practical, tactical level. According to our analysis, some 48% of what doctors order does NOT turn into a documented update to the chart within 60 days of that order. And we all know the average EHR makes docs go slower—causing employment by hospitals in large numbers—at large losses to the hospital. And NOW, based on the CMS data, it looks like a large percentage of docs are on track to miss a bloody lay-up of a bonus from the federal government! Do you guys really think we are going to build integrated ACOs that drive down hospitalization?

Pass it on—we are further behind than we think we are, and we need to hold ourselves accountable for PRACTICAL, TACTICAL outcomes before we even talk about grand outcomes like “total quality.” So what do we do? So glad you asked. I hazard three guesses, and you guys can throw in more… or challenge mine:

1. Make a market for health information exchange. Today, HIE is universally used as a NOUN. It’s a thing you buy from Aetna or Lockheed Martin or IBM. In every other information supply chain I know of, people who WANT info PAY others to give that info to them. They pay only when the info is delivered in usable form. This is, of course, not allowed in health care, but it can be. We should get behind legislation that allows for the most rudimentary mechanism for exchange in the history of man.
2. We should all go at-risk for results. Today, when a doc orders something, she doesn’t lose any money (and neither do we) if that order gets lost. Starting in March, we will be at risk for delivering orders to the receivers (labs, pharmacies, specialists, hospitals, etc.), obtaining the result back, matching it against the original order and either closing it or serving it up to the doc for further review. If we do all this, we get a dollar. If we don’t, no dollar. We will be at risk for clinical quality in the tiniest, most practical, tactical way. Alternatively, we can charge a dollar to the receiver if he or she is in our network, because we can send a value-added clean order with documentation… just the way it’s done in every other information supply chain. Very cool.
3. Face it about the cloud! I know I’m conflicted on this one, but going at-risk for results is against my self-interest and I am still doing that for the good of health care, so hear me out. If so many doctors can’t pick up basically free money from the federal government because they can’t get their legacy, software-based IT systems to make even the most fundamental changes to the information they capture and report, what do you think the odds are that these systems will enable going at-risk for a total hip replacement??? Doesn’t plunking a ton of balance sheet down for a single version of software actually orient docs AWAY from changes that would otherwise be good for them? I know some of you are saying, “Yes, but docs are working for hospitals now!” But be honest with yourself. With athenahealth and Google and Amazon KILLING each other to get competent developers, how many of them are going to take jobs customizing legacy software written in MUMPS (Massachusetts General Hospital Utility Multi-Programming System) at their community hospital system??? We all need to take a deep breath and just dump those old systems. I did it myself just this last year. I had a “fully paid up” copy of a legacy financal system. We finally had the courage to bite the bullet and sign up with NetSuite. We literally had a haze cleared out of our lives that we hadn’t even noticed was there. We can change and grow in basic ways, without “investments” and “project teams.” What a relief.

Okay, those are mine… what are yours?

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!