Free EMR Newsletter Want to receive the latest news on EMR, Meaningful Use, ARRA and Healthcare IT sent straight to your email? Join thousands of healthcare pros who subscribe to EMR and EHR for FREE!

Ready For a Third-Party Market for Apps on Your EHR? athenahealth Explains How (Part 2 of 2)

Posted on July 20, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

In part 1 of this article, I explained why EHR vendors need to attract outside developers to remain competitive, and how athenahealth’s More Disruption Please (MDP) program pursued this goal by developing open APIs. This part goes on to describe how they made their athenahealth Marketplace an actuality.

Through experimentation, API developers throughout companies and governments have found a toolbox of best practices to develop and promote their APIs. athenahealth pretty much did everything in this toolbox:

  • A prominent public announcement (in this case, coming from the CEO Jonathan Bush himself)

  • A regular set of hackathons to answer developer questions and familiarize them with the APIs,

  • An early pilot partnership that created a demonstration project and produced insights for further development, described in Part 1 of this article

  • An accelerator program that offers seed funding, free office space, mentorship, technical resources, support, and contacts with the client base

  • A commitment to support both physicians and partners, including a requirement that athenahealth developers work on API documentation

Access to the APIs is easy–for security purposes, a developer has to agree to the run-of-the-mill terms and conditions, but the process is fast and there is no charge. The athenahealth Marketplace is large and thriving, with more than 2,500 members.

Having spent a lot of money for an EHR, clinicians who are growing more tech-savvy and have come to love their mobile apps will demand more and more value for the money. Vendors are coming to realize that they can’t produce all the value-added solutions and functionality their customers want.

The SMART Platform has, for several years, championed the availability of EHR data to fuel app development by EHR users and third-party companies. The recent FHIR standard has drawn enthusiasm from vendors. A number of them, including athenahealth, have formed the Argonauts project to develop shared definitions and ensure that, in an interoperable way, they can provide the most common types of data used by US clinicians.

But as explained before, supporting an API does not automatically lead to more effective, beneficial apps or services. athenahealth has gone to the next level to attract real-time, dynamic applications to its Marketplace, and in turn is reaping the benefits.

Ready For a Third-Party Market for Apps on Your EHR? athenahealth Explains How (Part 1 of 2)

Posted on July 17, 2015 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

A number of electronic health record vendors now grant access to EHR data to programmers at user sites through an application programming interface (API). Hospitals and ambulatory practices are making great use of APIs to extract data on patients and analyze it to improve care (or at least their bottom lines–it’s good for marketing to patients as well as protecting them from adverse medical events).

Far fewer EHRs allow totally new applications to be built by outsiders, suitable for sale or free distribution to health care providers. To find out more about how this can be jump-started, I talked recently to Chip Ach at athenahealth, whose outspoken CEO Jonathan Bush has committed to dealing with health care in new ways. (I reviewed Bush’s book, Where Does It Hurt?,in another article.) Chip Ach is senior architect for athenahealth’s More Disruption Please (MDP) program.

MDP is building an open, API-based ecosystem on athenahealth’s cloud-based platform for entrepreneurs to connect, collaborate, and scale more efficiently in health care. athenahealth allows both established and start-up health IT companies to sign up as partners, creating a large marketplace of innovative, third-party health care solutions. Applications solve such problems as scheduling, speeding up payments, and increasing engagement with patients.

The value of a third-party market
Let’s step back a minute to look at why both vendors and health care providers would want a marketplace for companies to write apps based on their EHR data. Start with the obscurity of the data itself: very few health care providers can find out from their EHRs which patients are frequent ER visitors or which surgeons have consistently better outcomes–data that could trigger critical interventions. Even fewer EHRs provide information to patients, and the patient portals that some providers have made available usually offer extremely limited views.

Second, most EHRs have poor interfaces, a gawkiness that becomes especially evident on the tablets and cell phones that are just as popular among clinicians as the general population. A healthy competition and atmosphere of experimentation among interface developers will greatly improve EHR usability.

Clinicians are just too diverse for one vendor to take into account all their needs. More often than now, clinicians report a drop in productivity after the introduction of EHRs, even after the users get acclimated. If an agile development process could create unique and customizable interfaces, doctors and nurses could go back to focusing on patients.

Finally, unanticipated uses for patient data can emerge from an open marketplace. The use of analytics and clinical decision support could skyrocket.

athenahealth management decided several years ago that the health care system needs a radical change toward generating and accepting new solutions to its pain points. Calling this a “Health Care Internet,” they see it as a place for health care providers to compare and “shop” for nearly any product or service they might want or need, whether it be data management, digital check-in, self-pay, mobile charge capture, or transcription. MDP and the athenahealth Marketplace are their contributions to change.

Steps toward athenahealth’s Marketplace
It takes a special program like MDP to draw developers to a platform, particularly in health care where so many developers are deterred by the field’s complexity and issues of liability. In keeping with the company vision to straighten out the operation of the health care system, athenahealth embraced an open platform, adhering to industry standards such as HL7 and investigating the publication of open APIs.

At the same time, their programmers were modularizing a rather monolithic code to reap the productivity benefits that this would offer. Modularization facilitated the design of APIs to connect one module with another. After announcing a few open APIs and seeing the program catch on, the MDP team asked itself: why not make all their modules available to outside programmers, including those that were previously considered internal?

Early in the program, they found a company eager to develop an appointment scheduling application, and worked closely with them to make it possible. Ach’s team promised to get the API working in three months, which was quite a tight deadline. None of the team had prior experience doing an open API for a market, and they needed to face a lot of new requirements that openness created–for instance, adding an authentication layer, deciding how to deliver documentation on the APIs, and offering the opportunity for developers to get a feel for using the APIs. They now have a developer’s portal open to those who sign their modest terms and conditions. There is no fee or vetting process.

To speed up delivery of an API, athenahealth developers sought out a management service and chose Mashery to do the job. In the end, after a lot of long workdays, they met their three-month deadline. The partner was so sure they’d miss the deadline that it wasn’t ready to use the API–but it caught up and successfully released the app. Along the way, the MDP team learned some of the range of data that needed to be exposed by their APIs.

Eventually, athenahealth dedicated itself to rigorously modularizing their code with well-defined interfaces between all components–like Amazon.com–and to exposing as many interfaces as they could to partners. Naturally, this was potentially frightening; both managers and programmers have to take a leap of faith. What would design decisions made years ago look like when put out in the light of day? How many changes would they have to make?

According to Ach, developers were not resistant for ego reasons (they didn’t mind showing the architecture to outsiders), but worried about their ability to seamlessly upgrade the API in the future. A lot of decisions had to be made quickly before opening the APIs to third-party developers, who would come to depend on them and assume they would remain unchanged. Ach says the teams have been happy with their choices, although early on, in the effort to keep the process moving forward, they didn’t create all their naming standards and left that to be done later.

So the process went smoothly on the inside–but how did it fare externally? That’s the subject of part 2 of this article.

A 6 Step Guide to Succeeding as an ACO

Posted on June 18, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

Farzad Mostashari’s company, Aledade, raising $30 million is a good sign that healthcare organizations are going to be spending a lot of time and money figuring out these new ACO and value based reimbursement models. If you’re a healthcare organization that hasn’t started learning about ACOs, here’s a good whitepaper to start.

The whitepaper is titled “Succeeding as an ACO: A 6-Step Guide for Health Care Organizations” and does a lot more than just talk about the 6 steps to building an ACO. It covers ACO in a pretty thorough way. However, the 6 steps are pretty valuable as well:

1. Understand Your Costs
2. Reduce Out-Migration from Your Network
3. Maximize Pay-for-Performance Reimbursement
4. Identify Early Opportunities for Utilization Reductions
5. Support Chronic Care and Disease Management
6. Predict Who Will Develop Issues

Is your healthcare organization ready for the changing reimbursement model and ACOs? If you’re not sure, read through this FREE whitepaper and you’ll have a better idea of what’s happening and how you want to position yourself and your organization in this changing reimbursement environment.

What Happens When Billing Is Optimized?

Posted on May 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

In my recent EHR workshop in Dubai I talked with them about the many changing EHR business models that I’ve seen over the last 10 years. I was really trying to highlight how these new business models have generally been good for healthcare since it’s caused EHR prices to drop to a much more reasonable price point.

Take for example the Free EHR model. Whether you love it or hate it, one thing is certain: Free EHR has caused all the other EHR vendors to lower their price. I’ve seen this over and over again with EHR vendors. It’s hard to compete with an overpriced product against free. So, they had to lower their price so that the price of their EHR didn’t look as bad against free.

One model that I mentioned to those who attended my workshop was that some EHR vendors charge a percentage of billing in order to use their EHR software. athenahealth is the most famous for this approach. Their business model has worked pretty well for them because they’re able to say that not only will the practice get the EHR software for free, but athenahealth also can make the case that by having them assist with the practices billing, then they can help to better optimize the practices billing as well. So, the practice is getting more effective billing and a free EHR. This is why athenahealth could charge such a high percentage of an organization’s billing.

Turns out that there are a lot of billing companies that make a similar business case. Pay me 4-6% of your billing and we’ll optimize your billing which will actually make you more money than you’re paying us. Most of the billing management companies work off of this approach. Of course, this approach works best when you’re talking about practices that aren’t doing a good job managing their billing. This actually seems to apply to most practices.

What I’ve started to wonder is what’s going to happen once all of these practices’ billing is basically optimized? Now the percentage of billing starts to feel really expensive. Practices won’t be good at realizing the optimization that’s occurred and I’m sure that many will choose to take on the billing again. As they take on the billing, they’ll head back to a less than optimized state and then they’ll be ripe pickings for a billing company again.

I can see this cycle happening over and over again. Plus, if you’re a billing company or a company like athenahealth that makes your money off of a percentage of billing, then there’s always new practices that are at every stage of the cycle. So, there’s new business all over the place. The key for these organizations is to find the practices that are at the right place in the cycle.

Will anything happen to stop this cycle?

The athenahealth EHR and Meaningful Use Guarantees

Posted on April 27, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I’ve written many times about the various meaningful use guarantees that many companies have made over the years. athenahealth being one of the first to do so. In fact, they’ve made it part of their company culture to make guarantees. They’ve done it with Meaningful Use, ICD-10, EOBs, PQRS and MSSP guarantees. Jonathan Bush, President and CEO of athenahealth, recently did a blog post that explained why they do these guarantees:

When Leon Leonwood Bean, founder of L.L.Bean, first created the infamous Bean Boot (officially known as the Maine Hunting Shoe), he sent mailers out to local fishermen and hunters to promote the new boot and guarantee complete satisfaction. Within a few weeks, 90 of the first 100 boots purchased were returned. The leather uppers had separated from the rubber bottoms. Though it almost put L.L.Bean out of business, L. L. stayed true to the guarantee and refunded the customers. After borrowing more money to perfect the boot, he put them back on the market. This winter, over 100 years later, L.L.Bean couldn’t even keep up with the demand for Bean Boots. They’ve even become the latest badge of hipsterdom.

Today, L.L.Bean continues to guarantee satisfaction on all its products. Customers are always trying to return 10 year old boots for brand new ones. But the company doesn’t get persnickety about it. The amount of business the guarantee drives (as evident by this year’s demand) more than makes up for the cost of some free boots, which may never have become a practical winter fashion statement without putting money on the line.

Jonathan Bush goes on to talk about how many people think that the guarantee is about marketing, but it’s not. It’s about a corporate mandate that inspires innovation around something that’s important to customers. You can see how this works. If your bottom line is affected by a guarantee, then you’re sure as heck going to work like crazy to figure out how to solve that problem. At least you better, or your going to go out of business.

Pretty smart thinking as long as you’re smart about which things are worth guaranteeing. The wrong guarantee and you could have your company spending time innovating on something that doesn’t matter. Of course, at least you also get the benefit of the guarantee marketing bump whether Jonthan wants to admit it or not.

Athenahealth Goes After Hospitals and Tavenner Steps Down

Posted on January 22, 2015 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

There were two big pieces of news this week that I thought I’d discuss. Hopefully you’ll also add your thoughts and insights in the comments.

1. Athenahealth Moves Into Hospital Market With Acquisition Of Atlanta Startup RazorInsights
I thought the announcement of this acquisition was really interesting. Literally the day before this came out, someone asked me what I thought of Athenahealth. After some discussion, they said do you think they’ll take on Epic and Cerner. I quickly responded, “Well, they don’t have an inpatient EHR, so they don’t have a dog in the fight.” Well, now they do have a dog in the fight. Of course, RazorInsights still isn’t a big competitor of Epic and Cerner. However, if I know Jonathan Bush, that’s the ambition. At least that’s what his numerous cloud rants lead you to believe that he thinks he can take down Epic and Cerner with one single word: Cloud. We’ll see what RazorInsights can do under the Athenahealth umbrella.

2. CMS Leader Marilyn Tavenner Steps Down
Neil Versel has a great article covering Tavenner’s departure. His comments are pretty interesting when it comes to her staying low-profile and away from the media during her tenure at CMS. She’s certainly taken a lot of heat from the botched rollout of Healthcare.gov and other programs.

Personally, I’ll most remember her for her promise at HIMSS 2014 that ICD-10 was going to happen and that healthcare organizations better be ready. Of course, we know how that story played out with Congress passing a few lines in the SGR bill to delay ICD-10 another year. Given Tavenner’s promise, I’m quite sure she was blind sided by Congress’ move as well.

I’m not sure her departure is a good or a bad thing for healthcare. I’m sure that the healthcare behemoth will move along like it always has. Best of luck to her wherever she lands. No doubt working in the government in a high profile position is a rather thankless job that usually pays below market wages.

Who do you think will take Tavenner’s position at CMS? Does it matter?

Communities Help Open Source Electronic Health Records Thrive (Part 3 of 3: Project Round-up)

Posted on December 16, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

This series examines the importance of community and what steps are being taken by open source projects in health IT to create communities around their projects. My previous posting covered VistA and its custodial organization, OSEHRA. The last article in this series covers some important projects in open source with very different approaches to building community.

In addition to VistA, the electronic health record with the most success in building community is OpenMRS, using a unique approach. The project has an unusual genesis. They didn’t come out of a technology center such as Silicon Valley, or a center of health research such as my own Boston. Instead, they were inspired by the Regenstrief Institute at Indiana University.

Getting only a small amount of attention in the United States, OpenMRS proved quite valuable in the developing regions of Africa, especially Rwanda. The U.S. developers realized right away that, for their software to be useful in cultures so far from Indiana, it would have to be understood and fully embraced by local experts.

Indeed, a number of accomplished software developers can be found in Rwanda and surrounding countries. The challenge to OpenMRS was to attract them to the goal of improving health care and to make work on OpenMRS easy.

OpenMRS not only trained developers in African countries to understand and adapt their software to local conditions, but mentored them into becoming trainers for other developers. The initial project to train Rwandan developers thus evolved, the local developers becoming competent to train others in neighboring countries.

In this way, the OpenMRS developers back in the U.S. opened up the project in a unique way to people on other continents. To be sure, the developers had a practical end: they knew they could not provide support to every site that wanted to install OpenMRS, or adapt it to local needs. But they ultimately created a new, intensely committed, international community around OpenMRS. Regular conferences bring together OpenMRS developers from far-flung regions.

The SMART platform is not an EHR itself, but an application programming interface (API) that its developers are asking EHR vendors to adopt. The pay-off for adoption will be that all compliant EHRs can interoperate, and a software developer can write a single app that runs on all of them. SMART was developed at Harvard Medical School with support from ONC. It now runs on top of FHIR, an HL7 project to provide a modern API giving access to all EHR data.

EHRs are not by any means the only community-building efforts in open source health IT. Another significant player is Open Health Tools, which came into being in recognition of the creative work being done by research firms, university professors, and others in various health IT areas.

OHT brings together a wide range of developers to build software for research, clinical work, and other health-related projects. It’s remarkably diverse, providing a meeting place for all projects interested in making health care technology work better. Although they have had problems finding financial support, they now solicit dues from interested projects and seem poised to grow.

For a while, OHT had grand visions of recruiting their members to contribute to a unified “framework” on which other software developers could build applications. This proved to be a bit too big a bite to chew, given the wide range of activities that go on in health IT. But OHT still encourages members to find common ground and make use of each other’s advances.

Aaron Seib, CEO of Open Health Tools, listed the main goals OHT has for its member developers: making communities discoverable, making their licensing intelligible, and addressing the intellectual property barriers that can constrain a project’s adoption. OHT also helps establish trust and connect the dots among the community members to multiply effects across member communities. Roger Maduro of Open Health News writes that OHT has played a critical role in building the open health ecosystem, including the VistA community.

Many other institutions also sense a need for community. A few years ago I spoke with John Speakman, who was working for the National Cancer Institute at the time. They had developed some software that was very popular among developers, but no one made any contributions back to the common software base, and the NCI wanted the users of the software to start taking responsibility for the tools on which they depended. He took on the task of building community, but left when he realized it was not going to take hold.

Among the problems was the well-known dependence of government agencies such as the NCI on contractors. Speakman points to an organizational and cultural gap between “the big Beltway Bandit companies (who will never use the code themselves to do biomedical science) over academic groups engaged in biomedicine.” He also thinks the NCI intervened too much in community activities, instead of letting community members work out disagreements on their own. “If the government is going to invest in the seeding of open source communities,” he says, “it has to (a) focus on releasing the data and see what folks do with it, and (b) use as light a hold as possible on how the communities run themselves.”

Athenahealth stands out among EHR vendors with its More Disruption Please program. There it is building an ecoystem of third-party tools that its customers can use as part of its cloud-based service. This goal is similar to that of the open source SMART platform, which is trying to get EHR vendors and other data stores to adopt a common API and thus make themselves more open to software developers.

Openness and community go together. Although the health IT field is slow to adopt both practices, some projects could be entering into a virtuous cycle where open source developers learn to appreciate the value of their communities, which in turn reward the most open projects with greater success.

Jonathan Bush Loves Health Data–But How Will We Get As Much As He Wants?

Posted on September 24, 2014 I Written By

Andy Oram is an editor at O'Reilly Media, a highly respected book publisher and technology information provider. An employee of the company since 1992, Andy currently specializes in open source, software engineering, and health IT, but his editorial output has ranged from a legal guide covering intellectual property to a graphic novel about teenage hackers. His articles have appeared often on EMR & EHR and other blogs in the health IT space. Andy also writes often for O'Reilly's Radar site (http://radar.oreilly.com/) and other publications on policy issues related to the Internet and on trends affecting technical innovation and its effects on society. Print publications where his work has appeared include The Economist, Communications of the ACM, Copyright World, the Journal of Information Technology & Politics, Vanguardia Dossier, and Internet Law and Business. Conferences where he has presented talks include O'Reilly's Open Source Convention, FISL (Brazil), FOSDEM, and DebConf.

The fervent hope of health care reformers is that someday we will each know as much about our bodies–our vital signs, the health of our organs, the contents of our genomes-as corporations know about our marketing habits. One of the recent expressions of this dream comes in Jonathan Bush’s engaging and readable account of the healthcare system, Where Does It Hurt?.

Bush is a tireless advocate for bottom-up, disruptive forces in healthcare, somewhat in the same camp as Vinod Khosla (whose Health Datapalooza keynote I covered) and Clayton Christensen (who wrote the forward to Bush’s book). What Bush brings to the discussion is hands-on experience at confronting the healthcare behemoth in an explicitly disruptive way (which failed) as well as fitting into the system while providing a bit more light by building athenahealth (which succeeded).

Bush’s book tours the wreckage of the conventional health care system–the waste, errors, lack of communication, and neglect of chronic conditions that readers of this blog know about–as well as some of the promising companies or non-profits that offer a way forward. His own prescription for the health care system rests on two main themes: the removal of regulations that prevent the emergence of a true market, and the use of massive data collection (on physicians and patients alike) to drive a rational approach to health care.

Both government and insurers would have a much smaller role in Bush’s ideal health care system. He recognizes that catastrophic conditions should be covered for all members of society, and that the industry will need (as all industries do) a certain minimum of regulation. (Bush even admitted that he “whined” to the ONC about the refusal of a competitor to allow data exchange.) But he wants government and insurers to leave a wide open field for the wild, new ideas of clinicians, entrepreneurs, and software developers.

Besides good old-fashioned human ingenuity, the active ingredient in this mix is data–good data (not what we have now), and lots of it. Bush’s own first healthcare business failed, as he explains, through lack of data along with the inconsistency of insurance payments. A concern for data runs through this book, and motivates his own entrance into the electronic health records market.

What’s missing from the Where Does It Hurt?, I think, is the importance of getting things in the right order: we can’t have engaged patients making free choices until an enormous infrastructure of data falls into place. I have looked at the dependencies between different aspects of health IT in my report, The Information Technology Fix for Health: Barriers and Pathways to the Use of Information Technology for Better Health Care. Let’s look at some details.

Bush wants patients to have choice–but there’s already a lot of choice in where they get surgery or other procedures performed. As he points out, some of the recent regulations (such as accountable care organizations) and trends in consolidations go in the wrong direction, removing much of this choice. (I have also written recently about limited networks.) One of Bush’s interesting suggestions is that hospitals learn to specialize and pay to fly patients long distances for procedures, a massive extension of the “medical tourism” affluent people sometimes engage in.

But even if we have full choice, we won’t be able to decide where to go unless quality measures are rigorously collected, analyzed, and published. Funny thing–quality measures are some of the major requirements for Meaningful Use, and the very things that health IT people complain about. What I hear over and over is that the ONC should have focused laser-like on interoperability and forgone supposedly minor quests like collecting quality measurements.

Well, turns out we’ll need these quality measures if we want a free market in health care. Can the industry collect these measures without being strong-armed by government? I don’t see how.

If I want a space heater, I can look in the latest Consumer Reports and see two dozen options rated for room heating, spot heating, fire safety, and many other characteristics. But comparable statistics aren’t so easy to generate in health care. Seeing what a mess the industry has made of basic reporting and data sharing in the data that matters most–patient encounters–we can’t wait for providers to give us decent quality measures.

There’s a lot more data we need besides provider data. Bush goes into some detail about the Khosla-like vision of patients collecting and sharing huge amounts of information in the search for new cures. Sites such as PatientsLikeMe suggest a disruptive movement that bypasses the conventional health care system, but most people are not going to bother collecting the data until they can use it in clinical settings.

And here we have the typical vicious cycle of inertia in health care: patients don’t collect data because their doctors won’t use it, doctors say they can’t even accept the data because their EHRs don’t have a place for it, and EHR vendors don’t make a place for it because there’s no demand. Stage 3 of Meaningful Use tries to mandate the inclusion of patient data in records, but the tremendous backward tug of industry resistance saps hope from the implementation of this stage.

So I like Bush’s vision, but have to ask: how will we get there? athenahealth seems to be doing its part to help. New developments such as Apple’s HealthKit may help as well. Perhaps Where Does It Hurt? can help forward-thinking vendors, doctors, health information exchanges, entrepreneurs, and ordinary people pull together into a movement to make a functioning system out of the pieces lying around the landscape.

If You Were an EHR, Which Would You Be?

Posted on August 6, 2014 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

I was recently watching a video of Derek Hough, Dancer on Dancing with the Stars (and much more). In the interview Derek was asked which dance best fit various periods of his life. As an #HITNerd, I thought we could do something similar with EHR vendors. So…

If You Were an EHR, Which Would You Be? Are you…

Epic – Single minded, focused and dominating in their sphere. Closed to outside discussions, but very thoughtful and caring of those in your inner circle. A bulldog if someone comes after something you consider important. Built on an aging system that’s done well, but many question how much longer they can be successful on top of such an old platform.

Cerner – The second child who’s done really well for themselves, but wonders why the older brother gets all the attention. They’re successful, well educated, built on a strong foundation, open to improvement. They’ve recently taken on a little bit of baggage. They decided to marry someone who’s been divorced and has four children. We’re not sure how this new marriage is going to work out and how it’s going to impact the family structure.

MEDITECH – This is the middle child. Ahead of their time, but no one notices them anymore. They’re quiet and mostly stay to themselves in their corner. Sure, they’d like to be noticed and get more attention, but they don’t mind too much since they’ve been so successful.

Allscripts – Flashy. Exciting and unpredictable. They’re the one that wears the flashy green jacket to the party. They’ve worked on so many things in their life that it’s hard to really place who they are and what they do. They’ve seen a lot of success, but don’t make us predict what they’ll do next. They seem to have a clear vision of where there going (albeit different than it was 2-3 years ago), but that could change so you have to stay on your toes.

athenahealth – Despite some ADD tendencies, they’ve largely stayed the course on what they want to do and what they want to become. They’re always interesting to be around, because they’re never shy to say what they think or feel about anything. While not as successful as some other people, they still have a lot of potential that could blow up for good or bad. If nothing else, they’re the life of the party and always keep things interesting.

I could keep going, but that’s a good start using a few of the larger or more well known EHR vendors. Which one is most like you? Also, I really hope that many of you will join me in the comments and revise/improve upon what I’ve written or do something similar for another EHR vendor. Let’s have some fun and learn about people’s perceptions of these companies in the process.

Note: Cerner is an advertiser on this site.

KLAS Gives athenahealth, Not Epic, its 2013 “Best in KLAS” award

Posted on February 6, 2014 I Written By

Anne Zieger is veteran healthcare consultant and analyst with 20 years of industry experience. Zieger formerly served as editor-in-chief of FierceHealthcare.com and her commentaries have appeared in dozens of international business publications, including Forbes, Business Week and Information Week. She has also contributed content to hundreds of healthcare and health IT organizations, including several Fortune 500 companies. Contact her at @ziegerhealth on Twitter or visit her site at Zieger Healthcare.

While Epic Systems may still be that the giant in the room, according KLAS, athenahealth is the best overall software vendor for 2013.

athenahealth’s taking first place pushes Epic to second for the first time in eight years. athenahealth got the most positive opinions from the thousands of providers participating in the KLAS poll, notably praise for the usability of its athenaClinicals, athenaCollector and athenaCommunicator products, according to EHR Intelligence.

athenahealth CEO Jonathan Bush was all too happy to take a victory lap. “The old guard of each IT leaders is finally being displaced by more nimble innovative models designed for healthcare’s future – not for its past,” Bush told EHR Intelligence.

Epic still remains in first place as for its overall software suite, reports EHR Intelligence. And it took home multiple prizes this year. But there’s a revolution brewing outside the Epic palace, it would appear. Not one that calls for angry peasants and pitchforks, but clearly some level of entrenched discontent is at work here.

Other well-known vendors of EMRs took their lumps as well. For example, Cerner came in at seventeenth, McKesson at 20th, and Allscripts came in 23rd.

So what to make of all of this? As my colleague John Lynn notes, awards of this kind are best taken with a grain of salt. After all, providers don’t need software that wins popularity contests, they need software which they can afford, which can handily meet Meaningful Use standards and which doctors and nurses and other clinicians can use without a hitch. Being sure their vendors win sexy awards really isn’t on their worry list.

Still, the fact that Epic has been unseated after eight years at the top of KLAS’s best vendor list may mean something. Perhaps Epic’s grip on the market is loosening a bit?