Athenahealth was right in the middle of the biggest industry news stories to come out of HIMSS13. While the CommonWell Health Alliance announcement sucked the air out of every other announcement at the conference, athenahealth’s Healthcare Information Technology Code of Conduct proposed a set of five principles they hope can “move the industry foward,” including data portability and provider choice, a topic I wrote about yesterday that is a very real hurdle thousands of smaller clinics are facing as they strive to keep up with Meaningful Use requirements.
To discuss these issues and others, including cloud/SaaS security concerns and the importance of having the freedom to speak out on industry issues, I asked Dan Haley, athenahealth vice president of government and regulatory affairs, to answer the following five questions.
Special thanks to Dan for participating. Connect with him on Twitter @DanHaley5.
1. athenahealth was part of the biggest news to come out of HIMSS13, and that was the CommonWell Health Alliance. One year from now, what do you think this alliance will have accomplished?
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.
In 1997, athenahealth’s founders, Jonathan Bush and Todd Park, started running a birthing center in California. They quickly discovered that their doctors were spending way too much time dealing with administrative grunt work and too little time caring for patients. A big part of the reason was the lack of the kind of information availability and fluidity that even then was already prevalent in most of the economy. So they set out to change that. Our company vision, practically stamped on our foreheads the day we start with athena, is to create a national health information backbone that makes health care work as it should.
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 EHR 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.
Some commentators out there in the health care blogosphere have reacted with deep skepticism to CommonWell, assuming that any effort driven by for-profit companies, as opposed to mandated by government, is inherently suspect. I don’t agree with that point of view, obviously, but I also don’t begrudge them their skepticism. Our industry certainly has not covered itself in any measure of glory on interoperability. Exhibit 1 might be the fact that it has been more than a decade and a half since athenahealth established our corporate vision, and it remains the case that most care providers cannot easily access or share data easily. That is nuts.
As I’ve said repeatedly since HIMSS, anyone who thinks athena would be part of an effort to lock up information in a new proprietary silo, as some have suggested CommonWell is an effort to do, obviously has never met our CEO. For Jonathan Bush, and by extension for all of us at athena, “silo” is a curse word.
2. While it didn’t receive nearly as much publicity, athenahealth also announced something you call the Code of Conduct. What struck me as interesting about this announcement was the first provision, “Empowering Data Portability and Provider Choice,” which is a vow to pay for and facilitate the transfer of a provider’s clinical data if they choose another EHR vendor, which can be a huge endeavor. Why did athenahealth think it was necessary to offer this type of challenge? And how realistic do you think it is to expect your competitors to sign on and support a cause you are spearheading?
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.”
It also isn’t supposed to compete with various other efforts out there to get the industry on the same page on some basic home truths. The last part of your question—how do we expect to get competitors to sign on to an effort that we initiated—is completely legitimate. But the fact that the Code originated with one company represents a strength as well as a challenge. It is an immutable truth of large, consensus-based organizations that their output must accommodate the varying impulses, concerns, and imperatives of each of their members. That can sometimes dilute the output of such groups past the point of efficacy. 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 EHR 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 healthcare. 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/SaaS offerings are often the target of criticism. John Halamka even described it as “your mess run by someone else.” What additional 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?
With all due respect to Dr. Halamka – who is a great health IT advocate – that is malarkey (I look for any opportunity to use the word malarkey). I mean, certainly cloud-based services can be “your mess run by someone else.” If that is the case, you need to find yourself a new cloud services provider.
Done correctly, cloud-based services are “your mess, cleaned up and run by someone else.” I mentioned athenahealth’s corporate vision earlier. Underlying that 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. Whether the service in question is EHR, revenue cycle management, care coordination, patient communication, or data and business analysis, our cloud-based platform is the perfect mechanism for achieving that end. 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 what you find is story after story reflecting the same basic incident patterns: institutions printing out medical records and losing track of the paper, which no technology is going to 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.
A few years back everyone cringed at the idea of conducting financial transactions “in the cloud.” Serious people thought online shopping would never catch on, because nobody could possibly be comfortable entering credit card information on a webpage. The notion of a secure cloud isn’t theoretical—they are all around us. This is just another example of how health information technology for some reason lags years behind the rest of the information economy. But we’re catching up.
4. athenahealth representatives seem more willing than other EHR vendors to engage in public conversations and “make waves,” which I definitely find refreshing, but also something that I imagine has caused 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?
I joined athenahealth in August of last year, and immediately got pretty active on social media and in the blogosphere. But it wasn’t until more recently that I discovered “Twitter chats” and others in the industry started to comment (often admiringly) on how free I apparently feel to engage, comment, and provoke. It seems strange to me in retrospect, but until others pointed it out I hadn’t realized just how rare that flexbility can be in our industry.
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 asked about, 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.
It goes even further – if I get into a policy discussion and say something that one might objectively think is “bad for our business,” the reaction of colleagues would not be “you need to put a sock in it.” The reaction would be “if X is good policy and bad for our business, then we need to change our business.”
This goes to the most basic truth about our company and our culture. We sell services, but we don’t exist just to sell services. We are working to fix a part of the healthcare system that is horribly broken. Again, it goes back to athenahealth’s founding. Those deep deficiencies in the health information system in this country that motivated Jonathan and Todd to start a healthcare services company still exist today. They have very real, serious implications for cost, quality, and access to care. We continue to believe we can be part of solving them.
When I was first considering the move to athenahealth a good friend who knows the company well said to me, “there is something to be said for working at a place where everyone is rowing in the same direction and knows why.” We have more than 2,000 employees today (and growing), and everyone is required to commit our vision statement to memory. No employee is expected to say that we do what we do just “to sell services.”
5. I’ve read that Black Book has named 2013 the “year of the great EHR vendor switch.” Since switching EHRs 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 lags more than a decade behind.
I have to believe that at some point a critical mass of doctors is going to reject the proposition that it is okay for the technology they are forced to use in their professional lives to be so exasperatingly inferior to the technology that they (and their kids!) use in every other aspect of their lives. At that point they will start finally to demand better of their vendors. That inevitability, in my view, is the best hope for an eventual “great EHR vendor switch.”
Of course it would help if the government would stop paying doctors to buy static software-based technology that should have been allowed to go the way of the dodo around the end of the last century… but that is a whole other set of questions.
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