Today, in the third and final entry (see Parts I and II) of Pierre Valette’s journal from Haiti, we experience the first fully electronic patient encounter at the St. Boniface Hospital and learn more about 16-year-old Mamaille; she had been crushed by a falling building at a Port-Au-Prince school, abandoned on the Haitian border, and eventually brought to St. Boniface.

When reading Pierre’s entries, I can’t help but think of how fortunate we (U.S. citizens) are to have the level of health care that we do in the U.S. Sure, there are many things we need to improve (such as data sharing and the ability to shop for care), but those pale in comparison to the day-to-day struggles some Haitian caregivers and patients have to overcome. – Michelle, Social Media Manager

My last day. Our fifth day here.

We now have running cold water. Yesterday, the plumber made the eight-hour round-trip drive to Port-Au-Prince to buy a new pump for the water cistern on the hospital roof. This means we no longer have to carry buckets from the well in the courtyard up to the bathroom to bathe or flush the toilets. We may have lacked running water over the past few days, but the rhythm of the hospital never dissipates. Each day, hundreds of patients arrive as they always do—on foot, by motorcycle or via donkey—to receive the level of care that only the St. Boniface Hospital can provide.

Over a dozen babies have been born since we arrived. Three babies are in the NICU (Neonatal Intensive Care Unit), kept thriving by ventilators powered by ever-humming power generators. In the small pediatric ward all beds are occupied by children suffering from HIV, malaria or other ailments that plague Haiti. Their parents sit by their sides. At night, they curl up with them on their beds to sleep.

Dr. Desiree arrives late for his electronic health record (EHR) go-live today after performing an emergency C-section in the hospital’s operating room, supplied with donated equipment from a Florida hospital. Without taking a breather, he comes straight from the OR to our makeshift training area, a big smile on his face, ready to begin his first electronic encounter for the Spinal Cord Injury (SCI) Program. He will be seeing Mamaille (photographed, right), the 16-year-old girl abandoned on the Dominican border about two years earlier. Though she seems healthy by all appearances, Mamaille currently suffers from persistent infections caused by her wounds. In fact, on our third day here, when Jackie Mow, head of the athenahealth video team, filmed two of the SCI kids going to the nearby school (carried in their Walkabout wheelchairs due to the school’s lack of ramps), Mamaille had to stay behind because her wounds had become irritated.

Dr. Desiree logs onto athenaNet and is now ready to see Mamaille in his office, conveniently located across an open walkway from Mamaille’s room. There’s just one hitch. No Mamaille. Realizing that she might be photographed, Mamaille is delayed in her room, unsure of what earrings to wear. She fusses with a bag full of earrings she has made over the past year—the output of the SCI’s vocational program that has taught her basic jewelry-making skills. The normally soft-spoken Dr. Desiree calls out to her from across the hallway. Je m’habille,—I’m getting dressed—she yells back. A little white lie. Appearances are important here in Haiti—especially to Mamaille.

With the perfect set of earrings dangling from her ears, she makes her way to see Dr. Desiree’s office. To start, he encounters a small problem entering her name. Seems he hasn’t perfected the “Search Patient” function on athenaClinicals, entering far more letters than necessary. Jamie Mercurio, another member of the athenahealth implementation team, shows him that he only needs to type a few letters of her last name. He enters “L-E-J.” Mamaille LeJeune’s record immediately pops up.

Dr. Desiree takes her vitals and enters the discrete data into the system. As he talks to Mamaille, he selects the patient’s chief complaint and quickly documents the history of her present illness—all in Creole. At the end of the encounter, he enters her prescription into the system. It’s a short visit. More of a test than anything else. Dr. Desiree is slowed down a little by having to visually scan the screen for fields he’s not yet familiar with, Jamie helping him search for the prescription he needs. But with very little training and only a modest amount of assistance, Dr. Desiree successfully documents the encounter into athenaClinicals.

As Mamaille leaves the exam, Jamie and Dr. Desiree exchange a high five. Dr. Desiree did it! The St. Boniface Haiti Foundation’s SCI Program has its first electronically documented patient care experience. One small step for EHRs, one giant leap for health care in the Third World countries.

I ask Dr. Desiree what he thinks. He confides that the process took a little longer than “de documenter avec un stylo.”— to document with a pen. “Is it worth it?” I ask. “Bien sur”—of course—he responds. He’s confident that he and the care team at St. Boniface Hospital will soon develop the muscle memory needed to use the EHR efficiently.

That learning curve will be worth it as athenaClinicals begins to provide the data needed to track progress and coordinate care more effectively. Betsy Sherwood, coordinator of the SCI program couldn’t be happier. For months she’s known that this experiment in implementing electronic health records at the SCI Program could only succeed if Dr. Desiree was on board. He was indeed and has taken the first step. The staff can now follow his lead.

It’s a good day. The cloud did what it was supposed to do—bring rural Haiti an efficient and effective means of documenting, tracking and managing patient care across all care providers. Dr. Desiree is satisfied. And I can now go take my first shower since we arrived.

Look for a guest post from SCI program coordinator Betsy Sherwood later this month where she’ll speak in greater length about health care in Haiti and the day-to-day struggles physicians are faced with.

Yesterday (see Part I), athenahealth VP of Content Communications, Pierre Valette, provided a first-hand account of his team’s travels through Haiti to teach and learn from Haitian and American caregivers at the St. Boniface Hospital. In Part II of Pierre’s journal, we hear about the team’s implementation of our cloud-based electronic health record (EHR) system for the St. Boniface Haiti Foundation’s Spinal Cord Injury Program, and find out about the day-to-day hurdles caregivers and patients there have to overcome—not only to provide care, but to travel to and from the hospital. – Michelle, Social Media Manager

From Fond Des Blancs,

This morning, I started the day jogging to the nearby village of Gaspard. I ran far more slowly than I ever do—which is very slow to begin with—as I zigged and zagged to avoid large ruts and divots in the road, as well as dogs and chickens, and adjusted to the poor grading just to avoid twisting an ankle. It took me 40 minutes to cover a distance that would normally take me about 20. I imagined how hard it would be if I had to navigate these roads on a standard-issue wheelchair. (Forget about sidewalks here, they don’t exist. If you want to get anywhere under your own steam, you have to walk on a dirt road—or goat path).

The St. Boniface Haiti Foundation’s Spinal Cord Injury (SCI) Program has responded to the very poor road conditions by partnering with a group called the Rough Rider Foundation to equip every SCI patient with an off-road wheelchair called a Walkabout. The Walkabout’s heavy-duty wheels and tires, along with its solid metal frame (think mountain bike converted into a wheelchair) allow SCI patients to navigate just about any road in Fond Des Blancs, including the short road that brings three of the students to the public school each morning.
The Walkabouts are also quickly collapsible and relatively lightweight, allowing them to be strapped easily to the roof of the program’s SUV. This comes in handy when Kenny and Maxsony (pictured, right)—SCI patients on the program’s psycho-social team—travel throughout Haiti on remote patient visits.

The wheelchairs are just one manifestation of what the SCI program is doing to respond to the needs of its patients. The psycho-social program helps patients overcome the stigma associated with physical handicaps in Haiti. A rehabilitation team gives the patients a steady regimen of physical therapy designed specifically for spinal cord injury. And the medical team focuses on wound care, treating the persistent infections that contribute to the high mortality rates in Third World settings.

Over the past few years, the SCI program has generated hundreds of pounds of paper documenting the interventions of these teams, which is, in part, why Dr. Roland Desiree, director of the SCI program, was particularly excited about the potential of an EHR to provide for more seamless, quality care coordination. A member of one team can immediately see what a colleague on another team is doing without sifting through paper binders. Subsequently, if a Haitian doctor needs to consult with an expert in the U.S., she can do so while her counterpart in the U.S. looks at the exact same medical record.

The potential of implementing a cloud-based health records system in Haiti sounds great in theory, but can a go-live in a rural setting, with a non-English-speaking medical staff that’s unaccustomed to electronic documentation actually work? Well, so far, so good!

Over the past 72 hours, all signs have been positive. The Internet connection has remained strong throughout. During their initial training, the rehabilitation staff actually competed to see who could log in and enter a test patient the fastest—with the winner giving a big fist pump when he completed the task first.

Dr. Desiree, a very quiet man, let out a big “Wow!” when the system calculated BMI (Body Mass Index) immediately after he entered height and weight. Throughout all the training sessions, staff members with computer knowledge helped those who were a little slower at mastering new electronic skills. All, like Dr. Desiree, seem to understand the value of what health records can do for the program. According to Betsy Sherwood, Coordinator of the program, participants are very proud to be on the cutting-edge of health care delivery in Haiti, and are eager to learn skills that will enable them to deliver better care and develop professionally.

By midday, phase one of the EHR go-live was successful. When the team took their lunch break, more than two dozen patients had already been entered into the system. A few problems did emerge while the Monitoring & Evaluation team entered patients, but most were largely due to cultural and language differences.

For example, many of the patients don’t know their birthdates—so what should caregivers enter in that required field? How do you translate, “spinal injury from gunshot wound” into Creole? These problems are minor and, ultimately, addressable. The good news is we’ve discovered that cloud-based EHRs can indeed be implemented here in rural Haiti. And, more important, the clinical staff is completely engaged and committed to making it work—no matter what idiosyncrasies emerge and need to be resolved.

And with dozens of patients now entered into the EHR system, next on our agenda are the patient visits.

To be continued.

I recently connected with the HL7 Standards blog’s Chad Johnson (@OchoTex) for a fun “5 question” Q&A. We touched on CommonWell, the athenahealth Code of Conduct, cloud security, the unique characteristics of athenahealth culture that allow us to be so engaged in policy conversations, and the always-around-the-corner “Big EMR Switch.” I’ve included some highlights from our conversation below, but you can also check out the full interview.

If you feel compelled to ask, “Dan, how much did you pay Chad to ask these softball questions?” that would not be an unfair question. But I assure you, Chad came up with these all on his own.

1. What do you think the CommonWell Health Alliance will have accomplished a year from now?

When it comes to CommonWell, “where will you be in a year?” is exactly the correct question. The first stage of the Alliance is a one-year pilot program, to test the basic assumptions about the model and ensure that it works the way the founding companies intend. At the end of that first year, we expect the members to be sharing data between and among their systems. If we didn’t expect that, athenahealth would not be involved. A lot of work will go into making that happen.

The CommonWell Health Alliance represents a real effort to snap together some of the vertebrae to create that national information backbone. After years of annual conferences where executives of the big electronic medical record (EMR) companies stood up and solemnly pledged to solve the interoperability problem that still plagues health IT, this year at HIMSS some heavy-hitters finally took a tangible step toward that goal. We’re pleased and excited to be a part of that. We view it as a step more than a solution in and of itself, but it is an important and necessary step.

2. What struck me as interesting about the Code of Conduct was the first provision, which is a vow to pay for and facilitate the transfer of a provider’s clinical data if they choose another EMR vendor, which can be a huge endeavor. Why did athenahealth think this challenge was necessary? And do you think your competitors will sign on?

Here’s the thing about our proposed Health Information Industry Code of Conduct: it isn’t a challenge. We aren’t daring our peer companies to sign on; we’re asking them to agree to a core set of very simple principles that we believe can, if broadly adopted, help pull our industry into the 21st century. No legalese, no weasel-words, no out-clauses. Just five basic principles that we think and hope our industry can get behind. When one of our peer companies signs on we put its logo right up there on the signatory page with ours. It isn’t supposed to be “an athenahealth thing.”

Because we were able to ask ourselves a simple question–what basic propositions do we think could materially impact our industry?—and then reduce those principles to a clear, concise, one-page document, we think we managed to put forward a proposed Code that is easily understood, broadly appealing, and capable of attracting support from a wide range of forward-thinking industry stakeholders. We are also able to push on our industries in a way that consensus groups cannot do.

The provision you asked about is a perfect example. We believe absolutely that no doctor should be locked into an EMR out of fear of having to lose his or her clinical data, or having to start from scratch with a new system. That kind of ‘lock-in-by-incompetence’ model wouldn’t be accepted in any other industry in 2013. It should not be accepted in health care. A company that is confident in the quality of its services should have no problem committing to pay for data transfer for a client who decides to move on.

3. Security is a prime concern in health IT and cloud offerings are often the target of criticism. John Halamka even described it as “your mess run by someone else.” What steps are you taking to assure your clients and prospects that clinical data is just as secure in the cloud as it is in a hosted solution?

Done correctly, cloud-based services are “your mess, cleaned up and run by someone else.” Underlying the athenahealth vision is a basic approach that characterizes every service we provide to doctors, and every service we contemplate providing in the future: we look constantly for new and better ways to take administrative burdens out of care provider workflows so that they can concentrate on patient care. It allows us not only to organize our clients’ information but also to actually do the work for our clients, in real time. Moreover, while we’re doing that work, our clients have real-time, always-available access to their information. The impact of that difference in approach cannot be overstated. Cloud services aren’t an alternative to a hosted solution. Cloud services are a different proposition entirely.

As to security, clinical data is not “just as secure in the cloud as it is in a hosted solution.” Assuming one is dealing with a competent, responsible cloud provider, it can be more secure. Do a Google search for news stories on health data breaches and you find story after story reflecting the same basic incident patterns: institutions printing out medical records and losing track of the paper, which no technology can solve; and human beings misplacing portable media (laptops and thumb drives) containing PHI. Cloud services obviously eliminate the possibility of the latter because protected data is stored remotely, on highly-secure servers, not locally on any media that can be left in a cab.

4. athenahealth representatives seem more willing than other EMR vendors to engage in public conversations and “make waves.” That’s definitely refreshing, but I imagine it causes your marketing team to stock up on antacids. What is it about your company and its culture that fosters this type of open dialogue with the health IT community?

Stated simply, it starts from the top. We have a CEO, Jonathan Bush, who shoots from the hip all day long, every day. He’s the last person who would ever come down on an employee for maybe getting a little bit too enthusiastic in communicating our company point of view on the important issues impacting our industry. In fact, not only am I free to engage in the public conversations you ask about, but it is part of my job. We want athenahealth to be part of those conversations. On any number of issues, we have a point of view that is markedly distinct from—sometimes diametrically opposed to—the rest of our industry. So in a very real sense we need to be part of those conversations. We cannot rely on others to make our arguments for us.

5. I’ve read that Black Book has named 2013 the “year of the great EMR vendor switch.” Since switching EMRs is no small task — especially if the provider intends on migrating old data – do you think this prediction will come true?

I certainly hope it will. I don’t think an impartial observer would argue with the proposition that there are a lot of lousy products out there, and a lot of fed-up care providers stuck using them. In my Capitol Hill wanderings, I often say that health IT lags a decade behind the rest of the information economy. The next time you are in a doctor’s office, take a look over the check-in desk and tell me I’m wrong. In some offices, the technology being used is more than a decade behind.

I have to believe that, at some point, a critical mass of doctors will not accept that the technology they are forced to use in their professional lives is so exasperatingly inferior to the technology they (and their kids!) use in every other aspect of their lives. At that point, they will finally start to demand better of their vendors. That inevitability, in my view, is the best hope for an eventual “great EMR vendor switch.”

Of course, it would help if the government would stop paying doctors to buy static software-based technology that should have gone the way of the dodo around the end of the last century… but that is a whole other set of questions.

I welcome any and all questions regarding our work down in D.C. Comment below or find me on Twitter at @DanHaley5.

While walking the mile-long (literally) HIMSS main exhibit hall two weeks ago in New Orleans, I found it hard to avoid the conclusion that our industry is running out of words. Booth after booth, company after company, virtually everyone’s catchy slogan is a variant of someone else’s catchy slogan. Everybody is enabling something or empowering someone. Put it this way: If an attendee took a sip of beer at each appearance of the word “innovation,” he or she would be unconscious on the floor barely a quarter of the way through the hall.

If 2013 is indeed to be the year of the long-awaited HIT consolidation wave, it might be triggered by nothing more than the fact that our marketing consultants have exhausted their warehouse of available verbs.

At the athenahealth booth, I was relieved to see our long-time company slogan: “There is a better way.” In a mile-long sea of sameness, that unique simplicity was refreshing—all the more so given the strikingly convincing evidence we received this week for its veracity.

Our 2012 Meaningful Use Results
Today we formally announced that, for the 2012 Stage 1 Year 1 Medicare Meaningful Use (MU) program, an astounding 96% of athenahealth’s participating providers successfully attested. We don’t know yet how that compares specifically to the rest of our industry, but allow me to put the figure in perspective: in 2011, for Stage 1 of Medicare Meaningful Use, roughly 85% of our participating providers attested, compared to an industry average in the low 40% range.

Another telling point of reference: Last month the New England Journal of Medicine (NEJM) reported that a stunningly low 12% of eligible Medicare providers nationwide have successfully attested to Meaningful Use (find the details here). 12%!

Shortly thereafter, a counterpart of mine at one of athenahealth’s major competitors helpfully pointed out that the NEJM article only took into account attestations through May 2012. Figures through December 2012, he wrote, support an attestation rate nationally of roughly 22% of eligible Medicare providers. He typed this as if it were a good thing!

So I asked our internal big brains: Is that comparable to our athenahealth statistic? When we talk about our Medicare providers who have successfully attested, are we talking apples to apples with the national measurement? Well, I’m obliged to provide an emphatic caveat: we don’t actually track that particular metric since the true measure of our success is the attestation rate of our providers who actually participate (that’s the 96% rate above). So those big brains did some napkin calculations to come up with comparable numbers. And the figure we put up next to that 12% (or 22%) national rate is… greater than 70%.

There really is, it seems, a better way.

A Stage 3 Slowdown
In related news from HIMSS, acting Administrator of the Centers for Medicare & Medicaid Services (CMS), Marilyn Tavenner, announced that CMS will not be issuing a Meaningful Use Stage 3 final rule in 2013, as originally scheduled. Instead, they will convene a stakeholder summit in May to discuss how learning from Stage 2 should inform the eventual Stage 3 rule.

As always, we at athenahealth chafe at any deceleration in the slow national struggle for the health care system to catch up with the rest of the information economy. Contrary to many of our competitors, who insist the government is pushing too fast for standards that are too high, we believe our own results demonstrate, beyond a doubt, not only that current standards are achievable, but also that the pace of change is entirely appropriate. If, and only if, the technology providers choose to “meaningfully use” belong here in the 21st century.

As long as the government keeps subsidizing the use of technology that belongs in a museum, we will continue to see the kind of disappointing attestation rates that the NEJM featured two weeks back. Perversely, those very numbers are then used to support the proposition that the entire health care system needs to slow down and wait for HIT vendors to catch up to the modern world.

No number of flashy exhibition hall booths and catchy slogans will solve that problem. But taking a look at precisely how flexible, cloud-based services are achieving such strikingly different—and better—results is a good start.

Hello everyone, we have some exciting news to share this morning. These are my comments from a public webcast earlier today:

Since 1997, we at athenahealth have been trying to make a name for our disruptive business model and our mission to build the nation’s health information backbone. Along the way, our biggest obstacle has been gaining awareness by and access to the care givers we seek to serve. With this acquisition, we believe we have found a breakthrough.

We have always loved Epocrates. At first, we were blown away by their explosive rise in market share. Upon closer examination, our admiration found far deeper root. First, we love their app; athenahealth is strong in mobile development, with 33% of Clinicals clients using their iPhone at least once a week—but Epocrates is masterful. As the first health care app in the Apple store, Epocrates was downloaded on iPhones at a rate of 2,230 downloads per day. Recently, they added their iPad app and are already at 86,000 downloads. Second, we are proud of our own client service, but we have been humbled by how users tout Epocrates.  Aside from their beautiful app, users love the current, accurate, and beautifully constructed content within. They also love the culture behind it. Dr. Steve Kania and the Epocrates clinical content team pore over thousands of complex medical reference documents, turning the vast ocean of drug company claims into a digestable stream of understandable truth. Today, there are over 1,000,000 clinicians worldwide on Epocrates, and over half of U.S. physicians use their services every week. It’s no wonder there were 200 million drug lookups in the last year—or that 96% of physician-users reported changing a prescribing decision, thanks to Epocrates.

Like athena, Epocrates was born of an idea shared by two students in the late ‘90s. Since then, we’ve embarked on similar, almost parallel missions. We both earn client trust by making it easier for physicians to provide the health care they set out in life to deliver. Epocrates builds this trust by delivering a combination of technology and research to provide “information of value when and where users want it.” At athenahealth, our core competency is in “combining technology, knowledge, and work to provide situational awareness at the point of care.” We earn clients’ trust by helping them do well, doing the right thing. Our complementary missions form the foundation of what we believe would be a very successful partnership once the deal closes.

The complementary nature of our collective mission and cultures provides the perfect platform to fix strategic problems in our respective businesses. For Epocrates, there’s a need to build a broader and richer stream of revenue from the excellent market share and satisfaction they’ve earned. For athenahealth, whose services are deep and whose revenue model is robust, our need is awareness and share. We have so much to give doctors, and there are so few of them who really know who we are.

For years, athenahealth has been seeking a “lite” entry point that will allow physicians to learn about our services and sample our capabilities. Ideally, such an “athena-lite” exposure would include a meaningful slice of our core service set. We want doctors thinking “if I lived here, I’d be home now.” Assuming this deal closes, we will immediately set to work activating every doctor on Epocrates who wants it as an athenaCoordinator sender and receiver. As a receiver, they will get “a free sample” of athenaClinicals with each inbound referral from an athenahealth client. Because athenaClinicals is so darn beautiful, they will be able to use the app to evaluate the patient without enduring the ramp-up exhaustion associated with traditional, software based EHRs. If they like the experience, they will have the option to upgrade to athenaClinicals. Our research suggests that it will take very little work for us to deploy a simplified version of athenaClinicals that does not include pay for performance program management (i.e., meaningful use and others) or document services.  Of course, our fondest wish is that those who try will want to buy more.

We are very excited about what Epocrates could do for athenahealth, but we are just as inspired by how we could help it. Following closure of the acquisition, we would add the depth of athenahealth’s 40 million de-identified health records to the research resources Epocrates sells to drug companies today. Second, we would accelerate current Epocrates’ work on new reference tools for doctors. On top of drug reference, there would be complex consult referencing and diagnostic referencing.  Each of these new channels would be sponsored by new categories of Epocrates clients. And some of these—such as labs and institutions that perform complex procedures—are already athenahealth clients. Our work with Epocrates would further equip doctors to make the best choices possible for their patients and their own bottom line in the emerging accountable care marketplace. It would also enable athenahealth clients to showcase their excellence and generate appropriate referrals in the same environment. Accountable care is coming, and not everyone will survive. We intend to make darn sure that our clients will lead the charge and prosper.

We are still about 90 days away from closing, and so there are lots of kinks to iron.

Lastly, as some of you know, we’ve come to view culture as our most valuable asset and the thing we want to protect the most. Epocrates has it. Most companies don’t, but they do. They are a mission-oriented group of teachers and learners out to make a dent in the universe and I look forward to calling them colleagues.

Learn more about the pending deal in this press release and here.

REGULATION M-A DISCLOSURE

In connection with the acquisition of Epocrates, Inc. (“Epocrates”) by athenahealth, Inc.(“athenahealth”) pursuant to an Agreement and Plan of Merger (the “Merger”), Epocrates will file with the U.S. Securities and Exchange Commission (the “SEC”) a proxy statement and other relevant materials in connection with the proposed transaction.  Epocrates will also mail the proxy statement to Epocrates stockholders.  athenahealth and Epocrates urge investors and security holders to read the proxy statement and the other relevant material when they become available because these materials will contain important information about athenahealth, Epocrates, and the proposed transaction.  The proxy statement and other relevant materials (when they become available), and any and all documents filed with the SEC, may be obtained free of charge at the SEC’s web site at www.sec.gov.  In addition, free copies of the documents filed with the SEC by athenahealth will be available on the “Investors” portion of athenahealth’s website at www.athenahealth.com.  Free copies of the documents filed with the SEC by Epocrates will be available on the “Investor Relations” portion of Epocrates’ website at www.epocrates.com.  INVESTORS AND SECURITY HOLDERS ARE URGED TO READ THE PROXY STATEMENT AND THE OTHER RELEVANT MATERIALS WHEN THEY BECOME AVAILABLE BEFORE MAKING ANY VOTING OR INVESTMENT DECISION WITH RESPECT TO THE PROPOSED TRANSACTION.

athenahealth, Echo Merger Sub, Inc. (“MergerSub”), Epocrates, and their respective executive officers and directors may be deemed to be participants in the solicitation of proxies from the security holders of Epocrates in connection with the Merger.  Information about those executive officers and directors of athenahealth is set forth in athenahealth’s proxy statement for its 2012 annual meeting of stockholders, which was filed with the SEC on April 26, 2012, and is supplemented by other public filings made, and to be made, with the SEC.  Information about those executive officers and directors of Epocrates and their ownership of Epocrates common stock is set forth in Epocrates’ proxy statement for its 2012 annual meeting of stockholders, which was filed with the SEC on August 30, 2012, and is supplemented by other public filings made, and to be made, with the SEC.  Investors and security holders may obtain additional information regarding the direct and indirect interests of athenahealth, MergerSub, Epocrates, and their respective executive officers and directors in the Merger by reading the proxy statement and the other filings and documents referred to above.  This posting does not constitute an offer of any securities for sale.

FORWARD-LOOKING STATEMENTS

This posting contains forward-looking statements, which are made pursuant to the safe harbor provisions of the Private Securities Litigation Reform Act of 1995, including statements regarding consummation of the proposed transaction; anticipated improvements in, expansion of, and benefits of combining the companies’ service offerings and the timing thereof; the potential market for and awareness of the companies’ services; and expectations for market developments and opportunities. These statements are neither promises nor guarantees, and are subject to a variety of risks and uncertainties, many of which are beyond our control, which could cause actual results to differ materially from those contemplated in these forward-looking statements. In particular, the risks and uncertainties include, among other things: consummation of the transaction is subject to customary closing conditions, which if not met or waived would cause the transaction not to close, including the failure to obtain required approval of the contemplated transaction; failure to effectively integrate the services and operations of the companies; the risk that the anticipated market for the companies’ combined services does not materialize; the risk that service offerings will not operate in the manner expected (e.g., due to design flaws, security breaches, or otherwise); potential interruptions or delays in service offerings; reliance upon third parties, such as computer hardware, software, data-hosting, content, and internet infrastructure providers, which reliance may result in failures or disruptions in our service offerings; errors or omissions in services and the information they provide; and the evolving and complex government regulatory compliance environment in which the companies and their clients operate. Existing and prospective investors are cautioned not to place undue reliance on these forward-looking statements, which speak only as of the date hereof. athenahealth undertakes no obligation to update or revise the information contained in this posting, whether as a result of new information, future events or circumstances, or otherwise. For additional disclosure regarding these and other risks faced by athenahealth, please see the disclosure contained in our public filings with the Securities and Exchange Commission, available on the Investors section of athenahealth’s website at www.athenahealth.com and the SEC’s website at www.sec.gov.