This year, for the first time, athenahealth clients nominated and decided the athenaVision award winner. And with over 65% of the vote, this year’s winner was: Midlands Orthopaedics from Columbia, SC! Here is a great picture of Midlands’ Lynde Bledsoe, business office manager, and Stephanie Jackson, RN, clinical manager, accepting the award at User Conference 2013, on behalf of the medical group:

Winner: Midlands Orthopaedics
Midlands is one of the few practices that provide high-level surgical procedures (full hip replacement) at a state-of-the-art Ambulatory Surgical Center (ASC). By conducting surgery in this type of setting, Midlands sees high-quality outpatient care with a reduced chance of infection, at lower cost.

Midlands is a shining example of a medical group truly dedicated to making health care work as it should. As a result of their efforts, they have been able to negotiate higher reimbursement from payers, who are excited to pay them less than a hospital. But the best part of their work is the patient care: They can have patients up and walking around, with the help of Midlands staff, less than six hours after surgery!

The following video introduces you to Midlands’ CEO, AnnMargaret McCraw, surgeon Thomas P. Gross, MD, and Kevin Bishop (photographed, above), a 50-year-old patient who went to Midlands’ ASC for full hip replacement surgery. Wait until you see the result…

Two other practices also received athenaVision Award nominations: Infants and Children, P.A. in Florida for delivering reduced-cost/free care to those who cannot afford it and Manahawkin Urgent Care in New Jersey for filling an urgent care void in their area, and responding to Hurricane Sandy. Here is more about these exceptional care facilities:

Nominee: Infants and Children, P.A.
Infants and Children has built a culture around giving back and being part of the community they serve, participating in programs that provide for those in need here in the U.S. and around the world. Not only does Infants and Children focus on their patients, but they also have programs in place to keep their staff and families healthy and happy (e.g. bringing in a yoga instructor, nutritionist, aesthetician, providing healthy salads, etc.). Learn more in this video.

Nominee: Manahawkin Urgent Care
Manahawkin Urgent Care is a full-service medical clinic and hospital focused on the needs of Southern Ocean County, New Jersey. Dr. John Kulin and his staff specialize in dealing with small medical emergencies as well as specific treatments and procedures that cannot wait for a primary physician appointment. Manahawkin fills an essential urgent care medical void that has been neglected by the regional hospital players in the immediate area, and they were the only medical facility open in Ocean County in the days following Hurricane Sandy. During that period of time, the facility’s maximum patient volume tripled from 70 to more than 200. Learn more in this video.

An athenahealth client recently reminded me of this quote attributed to Michelangelo, which nicely summarizes one of the main themes that emerged as part of the America Health Insurance Plans (AHIP) Accountable Care Organization (ACO) Summit in Washington D.C. on Wednesday. In theory, ACOs lead to more integrated care and sustainable cost growth throughout the health care system; in practice, ACOs are creating issues in the market that should be proactively addressed via regulation and the forming of new ACOs.

Some details about this first-ever Summit: The idea originated from a conversation that our CEO Jonathan Bush had late last year with AHIP’s CEO Karen Ignagni. During their conversation, the two leaders discussed health plans and independent practices’ shared concerns regarding some of the more acute, unintended consequences of the ACO, model. One particular concern is that market consolidation under large hospital systems—including the acquisition of independent and small-practice physicians for the purpose of gaining market power—seems to be increasingly prevalent. Additionally, smaller practices are often excluded from forming ACOs due to structural impediments (e.g. regulatory bias, staffing constraints, reimbursement effects).

The AHIP ACO program included presentations from a wide variety of experts, including an antitrust enforcement officer from the Department of Justice, private sector antitrust attorneys, a self-described healthcare “futurist,” and athenahealth board member Charlie Baker. 150 key influencers attended the event, from D.C. leaders and hospital executives, to caregivers and commercial payers.

athenahealth sponsored a portion of the program, which included Jonathan describing our efforts to help clients thrive in risk-based reimbursement models while remaining independent; a lively discussion between Jonathan and Congressman Bill Cassidy, MD of Louisiana; and a panel of our clients: Mark Girard, MD, from Steward Health Care Network, David Slingerland, MD, of Hudson Headwaters Health Network and Marc Feingold, MD.

I viewed the summit as a meaningful call to arms for legislators, regulators, payers, hospital executives, and providers alike. We were excited to play a part and proud of our clients for providing tangible examples of how ACO regulation is affecting and influencing the market. And we are looking forward to continue advocating for independent providers and to creating services that enable clients to thrive—no matter the reimbursement model.

Okay, now that I’ve got that off my chest, on to the topic at hand.

Based on the FDA’s Draft Guidance for Mobile Medical Applications, it is clear that the agency intends to regulate any app that qualifies as a “device” under current FDA regulations, and is an “accessory” to medical devices, or transform a mobile platform into a medical device. Some clear examples: diagnostic imaging apps, blood glucose monitoring apps and apps that monitor a patient’s vital signs.

It is also clear from the Guidance that electronic medical textbooks, apps that automate general office operations and EMR apps will not be regulated as mobile medical apps… yet. I say “yet” because the FDA has stated it may revise its position as it figures out this thing called “technology,” as it’s used in medical practice.

Despite these examples, and two years of industry discussion following release of the Guidance, mHealth companies continue to have plenty of questions regarding the FDA’s regulation of certain mobile medical apps. Recent FDA hearings have provided some clarity regarding specific categories of apps that will or will not be regulated, but there are still some gray areas regarding regulating accessories to medical devices, an app’s intended use rather than its function, and clinical decision support tools. Based on the general language set forth in the Guidance, a staggering number of apps are likely to fall within the FDA’s purview.

For example, if the FDA regulates those apps that serve as clinical-decision support tools (that essentially collect information and convert into a patient-specific result), the Epocrates mHealth application could ultimately become subject to FDA regulation. Why? Merely because the app automates a calculation that could be done by a physician with the use of pen, paper and medical reference materials. Without clarification by the FDA, we believe the Guidance could result in the regulation of mere information delivered via technology.

At a recent event hosted by the American Conference Institute entitled “mHealth and Wireless Medical Technology,” I outlined recommendations for the FDA that would eliminate both confusion and delay, as they seek to regulate medical mobile applications:

1. Regulate the Function, Not the Category
   Don’t determine which tools to regulate based on the name they’re given (such as a ‘clinical support tool’). Focus instead on regulating based on the functions that each app provides. This will avoid the regulation of apps that merely provide electronic access to a service that’s already available (and unregulated), such as the Epocrates core app.
   
2. Create a Flexible Framework Based on Risk Profiles
   Regulate those apps that pose a high risk to patients, review apps that pose a moderate risk and do not regulate apps that pose a low risk.

We believe our recommendations will create an approach that’s beneficial for mHealth developers, physicians and patients, one that will enable innovation to provide health care professionals the right information, at the right time, at the point of care.

Stay tuned for more updates from us as the FDA finalizes its guidance in the coming months…

Of course, we are hopeful that health care reform will help (and, at least not hurt), but we believe a simpler approach to cost containment would be to bring the most American of pastimes to health care: shopping. Today with the intricacies of, and variancies in, medical billing, patients simply have no insight into the actual costs of care. And the information that consumers can access about the quality of available physicians and facilities is woefully inadequate.

In every other market of the U.S. economy, consumers have the ability to compare prices—but not in health care. Need a colonoscopy? Well, it turns out the cost of that single procedure can vary by a factor of four or more right in your own neighborhood. The athenahealth point of view is that the ability to shop begins with information, and that pricing transparency is a great place to start. (Side note: The idea of transparency has recently been getting increased exposure in the national press).

Health care prices—referred to as “contracted rates” or “allowed amounts”—are largely determined by contractual agreements between insurance companies and health care providers. Let’s put a fine point on this: the charges established by health care providers may have little bearing on what the insurance companies will actually pay. In many cases, providers receive contracted rates under their fee schedule in exchange for participating in the company’s plan. So what are the “real” rates?

Actual commercial contracted rates are some of the best kept secrets in health care, and while we guard individual provider data with our lives, our massive database allows us to compare and benchmark contracted rates across 40,000 providers, in all 50 states. We can access medical billing rates for commercial payers, Medicare and Medicaid, and have done so: the result can be explored in a new app we’ve developed called CodeView.

CodeView displays the maximum, minimum and average dollar amounts that insurers pay providers. Why does this matter? Because having access to accurate price information is essential to decrease cost. Furthermore, as any free marketer knows, having visibility to the differences in prices is key (we won’t get into the issue of private vs. single-payer systems). Those differences, the gaps, are what CodeView really attempts to highlight.

CodeView Data – The Big Picture

On average for ambulatory / physician services, across all levels of procedure complexity, we generally see an expected pattern for pay: Medicaid rates are less than Medicare rates, and Medicare rates are less than Commercial Payer rates. As seen in this first chart, the median cost for a procedure increases as the procedure’s complexity increases:

Note: Complexity is measured numerically here by Medicare’s total RVU, or Relative Value Unit, which typically serves as a basis for how much a provider should be reimbursed for a procedure or service, and incorporates complexity factors.

It is generally understood that commercial payers have a much wider variation in contracted medical billing rates than Medicare for a given procedure. What surprised us a bit with this data is that some providers are actually paid less by commercial insurers than by Medicare, for the same procedures. You can see both of these phenomena in CodeView for procedures ranging from office visits to complex cardiology imaging procedures. Here’s how the 25th percentile to 75th percentile ranges compare for Medicare and commercial payer rates, for a handful of procedures:

It’s hard to imagine the price of anything outside of health care varying so broadly. If you rename a ham sandwich a Croque Monsieur, maybe you can go from $7 to $15… but the variability on display here says one thing: opportunities to decrease health care expenditures could benefit from a little price transparency. Say what you will about governments as payers, but they do drive a better bargain.

Using CodeView

To dig further into CodeView data, let’s compare rates for a cardiology imaging procedure known as a Myocardial Perfusion SPECT. (Note: If you’d like to follow along using CodeView, you will have to change the specialty you’re viewing to ‘Cardiology,’ or use this direct link. According to our data, Medicare says a doctor is typically owed between $489 and $531 for this procedure, depending on the region of the country where it was performed. Medicaid rates vary by state, but we typically see that they are 50-90% of Medicare rates; this particular procedure falls on the lower end of that range, as Medicaid payers typically allow between $206 and $294 for this procedure.

The commercial market is where we really start seeing a huge variation. While the 25th percentile seen here (at $407) is below that of Medicare, the median rate from commercial payers for this procedure was $520, toward the upper end for Medicare. And at the 75th percentile for commercial payers’ reimbursement, caregivers received $686 for this procedure, illustrating that many private contracts are paying far more than Medicare.

CodeView: Bringing More Transparency to Healthcare Prices

Here’s the simple, obvious summary: Health care spending across the country is rising. Patients’ responsibility is growing and doctors are on the hook to collect that rising share of revenue. Wouldn’t it be great if patients, doctors—anyone—knew how much a service actually cost? Surfacing this information is just another step in demonstrating the power of athenahealth’s data in bringing transparency and openness to health care. Explore CodeView and you’ll find that we’ve highlighted the most common procedures for several specialties, across all regions of the country.

You can access the CodeView app here. Take a look. What do you see that surprises you? What data do you want to discuss with us?

Mitch was one of the physicians who led our birth center’s small team of caregivers, all dedicated to making a real difference. Since we last worked together Mitch has gone on to serve as the co-founder of mothers2mothers (m2m), an exemplary non-profit group that works to eliminate the transmission of HIV from mothers to babies and keep mothers alive.

m2m trains HIV-positive mothers as “Mentor Mothers,” (photographed, left) creating a new tier of health care providers to support overburdened medical systems in sub-Saharan Africa. Although pediatric AIDS has been virtually eliminated in the developed world, there are still almost 900 babies born every day, unnecessarily facing a life shadowed by HIV/AIDS. To date, m2m has reached more than one million mothers across nine countries.

Earlier this week, athena hosted a fundraiser for m2m. We helped raise funding to keep the Tanzania program operational. And we are evaluating putting athenaClinicals, our cloud-based electronic medical record, and athenaCommunicator, our patient communication portal, in the more than 400 m2m sites to help the caregivers capture and report on critical social history and stay in touch with clients so they remain in care. If we’re successful in this endeavor athena will be operational in three other parts of the world – India, Haiti and Africa.

As a new mom, I know how blessed we are in the United States to celebrate Mother’s Day without the threat of HIV hanging over our children. We can show our gratitude by saving other lives.

If you’d like to learn more about this incredibly special organization, please visit www.m2m.org.

Gallows humor aside, Stewart’s nearly-seven-minute segment had an effect. Following subsequent coverage by Nextgov.com —“Did Jon Stewart Foil the Pentagon’s Health Records Plan?”— it appears the Military Health System has halted their plans to beef up the Armed Forces Health Longitudinal Technology Application (AHLTA), possibly opting for the Veterans Health Information Systems and Technology Architecture (VistA) to become the EHR for both the DOD and the VA.

What does this all mean? First, the idea of digital health being a means to improve health care has gone mainstream. Second, you no longer have to be in the health care industry to realize there is an inherent need for improved interoperability.

A Common Goal to Bring Data Interoperability to Health Care

It’s great to see efforts toward better health care data interoperability in the private sector, especially by the recently formed CommonWell Health Alliance, a non-profit organization represented by athenahealth, Allscripts, Cerner, Greenway, McKesson and RelayHealth. These health IT vendors are working to create industry-wide access to patient health information by the use of existing unique identifiers, such as a patient’s cell phone number, e-mail address or driver’s license. This effort by six of the nation’s more prominent health IT providers will certainly go a long way toward fostering EHR interoperability and leveraging the value of digital patient data.

A Call for Unique Patient Identifiers

The government could also play a key role in enabling interoperability in the private sector, but there’s a missing piece: Congress has actually prohibited the Department of Health and Human Services (HHS) from establishing standards for that unique patient identifier. In his petition to the Obama Administration, health IT evangelist, Brian Ahier points out that Congress passed the Health Insurance Portability and Accountability Act (HIPAA) in 1996, which included provisions requiring HHS to “adopt national standards for electronic healthcare transactions” and “a standard unique health identifier for each individual, employer, health plan, and health care provider for use in the healthcare system.”

But, in 1998, Congress passed a law that prohibited HHS from spending any funds to promulgate or adopt any final standard for an individual’s unique health identifier until legislation is enacted approving the standard.

The Healthcare Information and Management Systems Society (HIMSS) has identified cost savings and safety benefits associated with a unique patient identifier and has recommended to Congress that they should permit HHS to develop standards—especially if doing so could increase efficiencies and prevent medical errors. As further pointed out by HIMSS:

“in the absence of a nationwide patient data matching strategy, the states, HIEs, large health plans, various consortiums, and individual electronic health record vendors have had to develop individual patient identity solutions that do not necessarily work well across systems. As our nation moves forward with greater urgency toward system-wide health information exchange, this essential core functionality to ensure the accurate match of a patient with his or her information remains conspicuously absent. The multitude of different solutions and the lack of a national coordinated approach pose major challenges for our health information infrastructure and result in millions of dollars of unnecessary costs. Patient safety, privacy, and security depend on getting this core element right, and soon.”

While the creation of a national unique patient identifier may not be in the immediate future (the petition had just over 100 signatures of the 100,000 required at the time I started writing this and is no longer listed on petitions.whitehouse.gov), it could complement and amplify the efforts of the CommonWell Health Alliance.

Maybe if Jon Stewart were to feature the equally challenging situation that the private sector faces with health care data interoperability, we just might see a change in government position and actions here, too.

Paul Sonnier is the Head of Digital Health Strategy at specialty consulting firm Popper and Company, Founder of the 17,000+ member Digital Health group on LinkedIn, an XPRIZE judge for the Nokia Sensing XCHALLENGE, and a mentor at digital health startup accelerator Blueprint Health.

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.

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.

In addition to recognizing St. Boniface with the award, athenahealth is partnering with the Foundation to implement our cloud-based electronic health records system—their first EHR—in rural Haiti. In fact, we currently have a team of athenistas in Haiti helping the Foundation get started. During their time there, our VP of Content and Communications, Pierre Valette, will share his experiences for you all. – Michelle, Social Media Manager.

It’s our third full day here.

We’ve had no running water since we arrived on Saturday at the St. Boniface Hospital in the rural region of Fond Des Blancs. The jugs of potable water in the kitchen ran dry last night (a few had gone missing over the weekend). Other than “splash showers” from buckets of cold well water, we haven’t bathed since we arrived. We’re all in good spirits, though. The electric generator is working, and the cell tower up the hill is delivering a strong Internet signal, ready to connect our friends to the cloud. So, athenahealth’s bold experiment to bring cloud-based electronic health records (EHRs) to the rural clinic where we are staying is—so far—working.

Over the past few days, athenahealth’s three person training team—Chris Vignare, Jamie Mercurio, and our very own Haitian translator, Jasmine Etienne—has been a giving crash course in athenaClinicals, our cloud-based EHR, to the Haitian and American teams who run the St. Boniface Hospital’s Spinal Cord Injury Program. The program, started three years ago after the worst earthquake in Haitian’s History, is the only one of its kind in the country of Haiti.

As the hospital ambulance drove our team the four-and-a-half hours from the Port-Au-Prince airport, Jackie Mow, our cameraperson, wondered why the clinic was set up in such an inaccessible area. The question became more pointed as we covered the final 20-kilometer stretch along a rutted, dusty dirt road that let us into the mountains.

The answer is simple: no other health care organization, not even Partners in Health, volunteered to take on the care of the many post-earthquake spinal cord-injury patients who require intensive physical and psycho-social care for the rest of their lives. Sadly, though, in the case of most third-world spinal injury patients, post-trauma life expectancy is only 12-24 months, according to Dr. Inobert Pierre, the Director of the St. Boniface Hospital.

The hospital had no experience in treating spinal cord Injury patients. But they took on the challenge because it’s in the Foundations’ charter to care for the neediest of the needy in Haiti—no matter how difficult the task. Few could be considered more needy.

On Sunday, we met Mamaille (pictured, left), a 16-year-old girl typical of many patients here. On January 12, 2010, she was crushed by a falling building at a school in Port-Au-Prince, considered dead by her family who lived in a rural province, and sent to a poorly equipped hospital in the Dominican Republic. There, the untrained workers shaved her head, eventually abandoning her on the Haitian border. Mamaille was then picked up by aid workers, her ankles eaten by rats, and eventually brought to St. Boniface’s ground-breaking Spinal Cord Injury Program.

Like all but one of the 60 patients in the program, she has beaten the odds. Three years after her injury, she’s thriving in the Program, which offers her psychological counseling, physical therapy, schooling, wound care and a supportive community.

By all measures, the Program is a health care success story—with many caregivers throughout the country seeking to follow its model. One thing the program lacks, however, is an efficient way to track patients across all care providers and measure the success of the program. That’s where this athenahealth pilot comes in: The implementation team is down here in Haiti to install athenaClinicals, which requires only a laptop, electricity, and an Internet signal. We might not have running water this week, but the hospital has all the required resources to make athenaClinicals fully functional—including templates created in Creole by the athenahealth Professional Services team.

As I write this journal, I have been watching four social workers who have just learned to log onto athenaNet and register a patient for the first time. Two of these caregivers are in wheelchairs, graduates of the program and now members of the full-time staff. One of them, Maxsony, just gave me two thumbs up. “It’s easy,” he said. And we’re thrilled to hear that.

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.