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Will New Group Steal Thunder From CommonWell Health Alliance?

Posted on January 26, 2016 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.

Back in March 0f 2013, six health IT vendors came together to announce the launch of the CommonWell Health Alliance. The group, which included Cerner, McKesson, Allscripts, athenahealth, Greenway Medical Technologies and RelayHealth, said they were forming the not-for-profit organization to foster national health data interoperability. (Being a cynical type, I immediately put it in a mental file tagged “The Group Epic Refused To Join,” but maybe that wasn’t fair since it looks like the other EHR vendors might have left Epic out on purpose.)

Looked at from some perspectives, the initiative has been a success. Over the past couple of years or so, CommonWell developed service specifications for interoperability and deployed a national network for health data sharing. The group has also attracted nearly three dozen HIT companies as members, with capabilities extending well beyond EMRs.

And according to recently-appointed executive director Jitin Asnaani, CommonWell is poised to have more than 5,000 provider sites using its services across the U.S. That will include more than 1,200 of Cerner’s provider sites. Also, Greenway Health and McKesson provider sites should be able to share health data with other CommonWell participants.

While all of this sounds promising, it’s not as though we’ve seen a great leap in interoperability for most providers. This is probably why new interoperability-focused initiatives have emerged. Just last week, five major HIT players announced that they would be the first to implement the Carequality Interoperability Framework.

The five vendors include, notably, Epic, along with athenahealth, eClinicalWorks, NextGen Healthcare and Surescripts. While the Carequality team might not be couching things this way, to me it seems likely that it intends to roll on past (if not over) the CommonWell effort.

Carequality is an initiative of The Sequoia Project, a DC-area non-profit. While it shares CommonWell’s general mission in fostering nationwide health information exchange, that’s where its similarities to CommonWell appear to end:

* Unlike CommonWell, which is almost entirely vendor-focused, Sequoia’s members also include the AMA, Kaiser Permanente, Minute Clinic, Walgreens and Surescripts.

* The Carequality Interoperability Framework includes not only technical specifications for achieving interoperability, but also legal and governance documents helping implementers set up data sharing in legally-appropriate ways between themselves and patients.

* The Framework is designed to allow providers, payers and other health organizations to integrate pre-existing connectivity efforts such as previously-implemented HIEs.

I don’t know whether the Carequality effort is complimentary to CommonWell or an attempt to eclipse it. It’s hard for me to tell whether the presence of a vendor on both membership lists (athenahealth) is an attempt to learn from both sides or a preparation for jumping ship. In other words, I’m not sure whether this is a “game changer,” as one health IT trade pub put it, or just more buzz around interoperability.

But if I were a betting woman, I’d stake hard, cold dollars that Carequality is destined to pick up the torch CommonWell lit. That being said, I do hope the two cooperate or even merge, as I’m sure the very smart people associated with these efforts can learn from each other. If they fight for mindshare, it’d be a major waste of time and talent.

Healthcare IT Vendor Blogs

Posted on December 24, 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.

After 10 years and 9404 blog posts later, I’ve come to know a little something about blogs. You might also say that I’m totally bias about the power of a well written blog. The reality is that blogging is just a simple way for anyone to publish content online. Blogging has really opened up the opportunity to publish great content to everyone.

With that said, it’s not easy sustaining a blog with great content. The tyranny of time is real and however far ahead you get on your blog, time will eat that away before you can blink your eye. It takes a real commitment to keep a blog up to date with regular content.

To honor some of these efforts, I thought it would be fun to share some of my favorite healthcare IT vendor blogs. It’s great to acknowledge the effort these vendors put into creating great content. Sure, they likely want to get more exposure for their companies. That’s a given, but that doesn’t diminish that many healthcare IT vendors are creating amazing free content on a regular basis on their blogs. Here’s a quick look at a few that I enjoy.

Information Advantage Blog by Iron Mountain – This blog focuses deeply on the challenge of health information management and topics such as: health information governance, medical records scanning, health data storage, etc. Those in the AHIMA and HIM community will really enjoy the blog, but there’s a little something for anyone interested in healthcare IT.

HL7 Standards by Corepoint Health – Most of you are likely familiar with this blog since it’s the home of the #HITsm Twitter chat. They post the host and topics for each week’s #HITsm chat, but they do much more. The HL7 Standards blog has a wide variety of amazing healthcare IT content from a diverse group of guest bloggers. They rarely put up a post that’s not worth a read.

Kareo Blog by Kareo – The Kareo blog is home to Kareo product updates and the #KareoChat, but they also regularly post some great content. Kareo has long been the advocate for the independent small practice physician. Therefore, you can imagine that their content is all focused around that audience.

CloudView Blog by athenahealth – This blog is a reflection of the athenahealth CEO, Jonathan Bush. You never know what to expect. No doubt Jonathan Bush has created a culture at athenahealth that’s trying to push boundaries and we often see that reflected on the athenahealth blog. In fact, the best posts on the athenahealth blog come from Jonathan Bush himself. I also love that the CEO of the company is present on the blog. Some might argue that it’s not really Jonathan writing the post, but when you read his posts it’s all Jonathan coming through in the message.

There are many more great healthcare vendor blogs out there. If you have some favorites or ones I should check out, please share them in the comments. If we get enough recommendations we’ll do a follow up post featuring other healthcare IT vendor blogs.

Enjoy the light reading this holiday weekend!

Full Disclosure: I’ve written a few posts over the years for the Kareo and Iron Mountain blogs.

Are Patients Becoming Price and Quality Sensitive?

Posted on October 20, 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.

Yesterday I was watching the live stream of Jonathan Bush, CEO of athenahealth speaking and then on a panel at US News’ Hospital of Tomorrow event. Jonathan Bush was as good as ever and offered some really amazing insights into the changing culture of health care as we know it. He also introduced the LetDoctorsBeDoctors.com website along with the ZDoggMD Jay Z parody video called EHR State of Mind.

At one point in the panel discussion he made a point that really stuck with me. He suggested that a few years ago you could cut the price of your services in half and you’d still get the same number of patients in your office. Then he said that you could double the price of your services and you’d still get the same number of patients. He went on to say that you could provide better care to your patients and you’d still get the same number of patients.

Certainly that’s not a direct quote, but you get the gist of what he’s saying. Essentially, a few years back patients weren’t price or quality of care sensitive. Sure, maybe on a really macro scale some really doctors would be found out, but for the most part patients didn’t care what the price of healthcare was since they just paid the co-pay and they had no way of knowing the quality of care the doctor provided.

Jonathan suggested that over the past couple years this has started to change. Patients were becoming more price and quality of care sensitive. He didn’t explain why this is the case, but I’d suggest that it’s due to more availability of information and high deductible plans.

I think this shift in how patients select their healthcare is going to have wide ranging impacts on the health care system. Michael Robinson, Vice President, U.S. Health and Life Sciences, Microsoft, was on the panel with Jonathan Bush and suggested that technology was the enabler for a lot of these changes. That’s not true for all of the changes, but no doubt it plays a role in a lot of them.

Experiences Crafting a New API at Amazing Charts

Posted on August 21, 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://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 couple months ago, Amazing Charts announced an upcoming API for their new electronic health record, InLight. Like athenahealth, whose API I recently covered, Amazing Charts is Software as a Service (SaaS), offering its new EHR on the Web.

The impetus toward an API wasn’t faddish for Amazing Charts; they had a clear vision of what they wanted to achieve by doing so. They found that their interactions with various health care providers–payers, labs, radiologists, and others, along with accepting medical device data–has been hampered by reliance on common standards that involve HL7 messaging and EDI. The HL7 standards are inconsistently implemented and EDI is non-standardized, so each interface requires weeks of work.

I talked to Prayag Patil, product manager of patient engagement solutions at Amazing Charts. (They also offer patient portals to the institutions they serve.) For all their data exchanges, he said, they expect a RESTful API to provide standardization, speed, and simplicity in implementation. It should also be more suited to quick, fine-grained data transfers.

One of the common complaints of the older HL7 standards such as the CCD-A is that they are monolithic. EHR vendors and healthcare providers shove a lot into them without deciding what the recipient really needs. As Patil says, “it makes the 80% use case hard to do.” Nor is the standard used consistently by all correspondents (labs, practice management systems, devices, etc.), so extracting what’s really important at the receiving end is harder.

They’ve found that sluggish exchange has real effects on patient safety. For instance, a set of lab results, medications, and other information from a hospital discharge should be available immediately. If you wait, the patient their primary care provider won’t have it just after discharged, when its value is often critical, and the patient might lose interest and not bother to look at it later.

Amazing Charts, like athenahealth, also recognizes the value of a third-party marketplace. Patil says that innovation tends to “come from the smaller, scrappier vendors” that are enabled to produce useful apps by open APIs. The company already has a third party marketplace for apps in care coordination, revenue cycle management, patient engagement, and other tasks. But up to now the APIs weren’t published, so their developers had to work individually with any vendor who came to them, offering tools and the help needed to integrate with Amazing Charts’ service.

The company plans to introduce a patient engagement platform that will be open and accessible, with a focus on using standardized RESTful APIs to enable third party app developers to offer solutions. The company also plans to increase participation by creating thorough documentation for the APIs, and standardizing them. They are looking forward to standards such as FHIR, SMART-on-FHIR, and OpenID/OAuth, which are better specified and more consistently implemented than the currently available interfaces.

Here are the lessons I draw for others who are looking enviously at projects with APIs: going forward without all the pieces in place will be like driving on one flat tire. You just won’t get the results that you hoped for when investing in the project.

I applaud Amazing Charts for taking the difficult first steps toward API access, and doing it with good goals in mind. Their experience shows that an open API is still a hard process to get going–even as more and more companies take the leap–and one that calls for coordinated efforts throughout the organization in software design, publicity, documentation, and support.

Brilliant: Hannah Galvin Looks at ICD-10’s Five Stages of Grief

Posted on August 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.

Hannah Galvin, MD has a great article on Healthcare IT News talking about ICD-10’s five stages of grief. You can go read the article to see how she describes it, but the five stages of grief are:

  1. Denial
  2. Anger
  3. Bargaining
  4. Depression
  5. Acceptance

Pretty fascinating way to describe people’s response to ICD-10. I think we have people and organizations that are still at all 5 stages of grief associated with adopting ICD-10. Although, I think most people have bridged #3.

There are still many people that are in denial and that are angry about ICD-10. Although, that population is getting smaller and smaller. I don’t see many people still bargaining. We went through that stage for years, but I believe it’s over. The largest group of people are stuck in stage 4. I know very few people who aren’t depressed over ICD-10. The HIM profession is more excited about ICD-10 than anyone else, but otherwise it’s a general depression around the change. It’s hard to implement something where you’re not sure what value you’ll receive from it. I think that’s many people’s perspective.

Dr. Galvin’s final comment in the article linked above is also interesting: “Whether you’re ready or not, the transition is less than three months away – and in the end, I believe it will be worth all the grief.” Now we’re less than 2 months away. I’m still not sure it’s worth the switch or not, but it doesn’t really matter. It’s happening either way. I guess I’ve reached stage 5.

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://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://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.