Iterate to innovate at the speed of AI

Accelerating healthcare innovation through iterative engineering

Daily advancements in artificial intelligence and other technologies are reshaping not only what healthcare technology companies can create for our customers, but also how we develop and deliver it. In this environment, rapid prototyping and iterative engineering are not just a technical approach: they’re a critical necessity. As the leader of athenahealth’s product engineering team, I’ve challenged my staff to break through their prior expectations of what’s possible and dive into new technologies such as generative and agentic AI that can accelerate their success.

Why healthcare must innovate at breakneck speed

At athenahealth, we often talk about practicing “the art of the possible.” But what do we mean by “possible”? Now more than at any other time in my career, new developments in technology mean we must – and can – set our sights ever higher, even from one week to the next. In such an environment, the old pace of product development cannot stand. If you take too long to develop a product based on a particular technology, it’s at risk of being obsolete by the time it actually comes to market.

For my 2,000-person product engineering team, this means we’ve had to accelerate our software development lifecycle to keep pace with industry innovation and deliver value to our customers. Rapid prototyping, made possible with help from generative AI-powered tools, allows us to move from concept to demonstration in days rather than months. We’ve used generative AI to accelerate development in virtually every area of our product portfolio, from the clinical encounter workflow to practice management, patient engagement, and healthcare interoperability. This is not a marginal improvement — it is a times-multiplier effect. Leveraging AI enables us to bring better tools to market faster.

AI is a force multiplier, not a replacement for software engineering expertise

To fully harness the potential of AI, we must equip our software engineers to understand and use it. That includes defining which parts of the job AI can take on, and which parts uniquely require human expertise and finesse. I see AI as having a powerful role in my engineers’ toolkit: not to replace them, but to free them to tackle the most strategic and rewarding aspects of the job.

Despite the popular image of the software engineer coding relentlessly into the wee hours, coding is only a fraction of what they do. AI is already quite good at automating much of that coding work. But the valuable forethought that comes before coding — architecting scalable, secure, and performant systems that empower healthcare providers and administrators to do their best work — cannot be outsourced to AI.

As I see it, it’s the teamwork of expert human and tireless AI that will truly accelerate innovation. When you have an expert guiding AI, it’s like having a power tool or an exoskeleton. That’s what I mean by a force multiplier: AI enables the engineer to funnel their expertise into unprecedented productivity and speed. This partnership between AI and engineer is central to our iterative philosophy. AI helps us prototype faster, automate routine tasks, and even serve as a sparring partner or devil’s advocate to stress-test ideas before execution; expert engineers remain critical to plan, critique, refine, and validate the work.

A cultural shift for us – and our customers

Rapid prototyping and iterative engineering require more than just new tools. They demand a cultural shift as software engineers learn how to leverage these capabilities. I've directed my engineering team to embrace continuous learning, experimentation, and resilience. At athenahealth, we are committed to upskilling our employees to work effectively alongside AI, viewing it as a powerful partner rather than a threat.

Such a mindset fosters innovation and agility, enabling us to respond to emerging challenges and opportunities. It also empowers employees to focus on strategic problem-solving and creative design rather than repetitive tasks.

This attitude I’m describing – of being open to experimenting with new tools and methods – is not solely the responsibility of us, the makers. The healthcare organizations we serve must also be ready to pivot, invest in change management, and be open to new ways to work. In particular, large healthcare organizations require thoughtful training, communication, and change management strategy to ensure smooth rollouts, especially when the speed of innovation threatens to exceed the rate at which customers can absorb change.

To manage this, athenahealth uses feature toggles that allow early adopters to try new capabilities before we roll them out to all customers. We release major athenaOne® software updates to the broader customer base three times a year, and smaller updates on an ongoing basis. This approach balances the need for rapid innovation with the realities of organizational readiness.

This dynamic is important for medical practices of all sizes to consider. Your organization’s change management and adoption processes must keep pace with the industry’s accelerating rate of innovation; otherwise, you risk being at a disadvantage relative to your competitors who have mastered their capacity for change.

Accelerating the pace of innovation – thoughtfully

The pace of innovation will only continue to accelerate. Emerging technologies will transform how we develop software, deliver care, and engage patients. Rapid prototyping and iterative engineering will remain foundational to our ability to deliver timely, impactful solutions — while keeping data security and the responsible, thoughtful use of these AI-powered tools top of mind.

One emerging area with particular promise is agentic AI — systems with agency, meaning they have full or partial autonomy to assist with or accomplish tasks set by a human. Such systems can be given a goal, constraints, and guardrails, then work proactively and purposefully to support people at scale. Unlike traditional chat-based AI, agentic systems can take initiative and reason through multi-step problems; interact with trusted tools, software, and APIs; and either achieve a goal autonomously or check in with the human and return with recommendations or actions for review. This approach helps address some of the limitations of today’s large language models by pairing their flexibility with more deterministic, reliable components.

In healthcare, agentic AI has the potential to act like a virtual team of assistants: monitoring information as it becomes available, identifying patterns that might otherwise go unnoticed, and proactively supporting better outcomes for patients, providers, and practices. Importantly, this is not about removing humans from the loop. Instead, it’s about thoughtfully delegating work — deciding how much agency the AI should have to observe, suggest, and take action — so that human expertise remains the final authority while benefiting from unprecedented scale and speed.

As we move forward, the partnership between AI and human expertise will deepen. Agentic AI is already capable of working autonomously on a broad range of tasks, from fixing simple software bugs to operating a self-driving car, with some human guidance. But even in scenarios where full AI autonomy isn’t required, it can serve as a powerful assistant to enhance human productivity and creativity.

In every scenario, careful guidance from human experts is necessary to employ AI responsibly and channel its potential into dynamic new solutions. When creativity accelerates, the need for a governance structure to protect data matters more than ever. By prioritizing a disciplined and considered approach, we have built in the seatbelts that allow us to step on the gas.

Through the athenaInstitute, we’re committed to leading this transformation. We are building technology that empowers healthcare providers and patients alike, while fostering a culture that embraces change as an opportunity for growth.

The future of healthcare depends on our ability to innovate rapidly and responsibly – harnessing AI’s creativity and speed with thoughtful, disciplined governance. At athenahealth, we are proud to be at the forefront of this journey, driving technology that transforms care and improves lives.