Epic has fact-checked a recent interview of athenahealth co-founder and CEO Jonathan Bush in MedCity News and found some of his assertions wanting.
The interviewer asked Mr. Bush what he would ask of Epic if he were a hospital chief information officer.
“‘I would ask them to connect and that’s starting to happen,’ Mr. Bush said in the interview. adding that athenahealth can now connect to “most of the Epic-user hospitals in the country,” but that they have only been able to do so in the past couple of months.
Epic said that statement is false. “Epic customers have been exchanging patient records with others since 2008. One hundred percent of Epic’s live customers are able to connect with other groups that use either Epic or non-Epic systems,” the company said.
Epic also said that Epic and athenahealth sites started to connect back in May 2014.
Mr. Bush also said in the MedCity News interview that Epic was subpoenaed by the House Energy and Commerce Committee regarding information-blocking.
“Epic has never been subpoenaed by Congress,” Epic retorted.
Jonathan Bush, the loquacious, confident (or arrogant?) and mostly unscripted CEO of cloud EHR company athenahealth, discusses what he would do if he were a hospital chief information officer.
Jonathan Bush, athenahealth founder and CEO, writes here about how the future of the hospital is in the network.
He writes: “The vast majority of hospitals need to redefine themselves from organizations that deliver care to organizations that orchestrate care. Even though hospitals are one of the core lines of lifeblood in healthcare, the way in which the majority of them operate aren’t appealing to patients today, nor is it sustainable to hospitals’ future existence.”
“{O}ur {healthcare} system is so broken that it’s turned this instrument {the hospital} of health and humanity into a walled citadel. To better serve the patients who are seemingly already going elsewhere, hospitals need to become a leading orchestrator of the very best care on behalf of patients.”
The folks at New York-based Mount Sinai seem to get it. Last year, readers ofThe New York Timeswere treated to a Mount Sinai marketing campaign headline that read, ‘If our beds are filled, it means we’ve failed.’It’s counterintuitive, but spot on. Mount Sinai has embraced the idea that ‘instead of receiving care that’s isolated and intermittent, patients [should] receive care that’s continuous and coordinated, much of it outside of the traditional hospital setting.’ It’s only with this shift away from a ‘filling beds’ mindset, combined with a refactoring to the way in which a hospital interacts with other players in the market, that hospitals will maintain a leading role across the care continuum.”
He urges:
Embracing the “requirement to leverage an infrastructure of cross-continuum connectedness and total cost and quality transparency. Software alone won’t get hospitals there; being part of a more connected national network is critical.”
Adopting “savvier consumer marketing that helps hospitals stand out amidst emerging players in healthcare — like CVS Health and Walgreens — who understand the consumer mindset and have built their brands around convenience and ease.”
Accepting that a “new era of hospital sales must emerge, working with insurers and employers to broker deals that send the right patients through your doors only for the services you do really well.”
Realizing that “successful hospitals will create a renaissance of accessibility: If you can’t provide an appointment slot served up via a mobile app for every procedure type within three days, you’re failing.”
Understanding that “hospitals should become ecosystem partners, not brick-and-mortar investors. This means eliminating anything that can be done in a primary care practice, a retail clinic, or at home, and exporting non-invasive surgery out of the hospital to more cost-effective specialized surgical centers.”
Jonathan Bush, founder and CEO of athenahealth, explains here why the future of the hospital is as part of a network.
.”…The vast majority of hospitals need to redefine themselves from organizations that deliver care to organizations that orchestrate care. Even though hospitals are one of the core lines of lifeblood in healthcare, the way in which the majority of them operate aren’t appealing to patients today, nor is it sustainable to hospitals’ future existence.”
“….{H}ospitals are the places where we see medical breakthroughs; where we find we are stronger, braver and more powerful than we think. In short, they are the places where humanity often shines at its brightest. However, our system is so broken that it’s turned this instrument of health and humanity into a walled citadel. To better serve the patients who are seemingly already going elsewhere, hospitals need to become a leading orchestrator of the very best care on behalf of patients.”
He recommends:
“First is the requirement to leverage an infrastructure of cross-continuum connectedness and total cost and quality transparency. Software alone won’t get hospitals there; being part of a more connected national network is critical.
“Second, hospitals need to embrace savvier consumer marketing that helps them stand out amidst emerging players in healthcare — like CVS Health and Walgreens — who understand the consumer mindset and have built their brands around convenience and ease.
“Third, a new era of hospital sales must emerge, working with insurers and employers to broker deals that send the right patients through your doors only for the services you do really well.
“Fourth, the successful hospitals will create a renaissance of accessibility: If you can’t provide an appointment slot served up via a mobile app for every procedure type within three days, you’re failing.
“And fifth, hospitals should become ecosystem partners, not brick-and-mortar investors. This means eliminating anything that can be done in a primary care practice, a retail clinic, or at home, and exporting non-invasive surgery out of the hospital to more cost-effective specialized surgical centers.”
Chris Moses, the CEO of Arsenal Health, which athenahealth bought last year, talks here about how his company’s plans fit into athenahealth’s aspirations.
He focuses on practice management and especially on such challenges as accurately predicting how and which patients will arrive at their appointments.
Med City News notes that “although the insights are not exactly surprising, Moses said gaining access to athenahealth’s {resources} …has increased its ability to detect patterns and to help practices spot potential performance issues.”
The news service reports that Arsenal’s focus includes “improving practice management inefficiencies by applying predictive analytics to things like patients with outstanding bills — who is more likely to pay. Other areas include care plan and medication adherence, care coordination and hospital readmissions. Another is improving the way clinical documents are labeled to reduce the manual work required to find them.”
“My biggest fear is that we won’t successfully attract those new economy, engineers, entrepreneurs, that the weight of the regulatory burden, the government involvement, of the huge established health systems [are] making it harder for entrepreneurs to get in and get playing,” he said.
Technology entrepreneur Jonathan Bush says he was recently watching a patient move from a hospital to a nursing home. The patient’s information was in an electronic medical record, or EMR. And getting that record from the hospital to the nursing home, Bush says, wasn’t exactly drag and drop.
“These two guys then type — I kid you not — the printout from the brand new EMR into their EMR, so that their fax server can fax it to the bloody nursing home,” Bush says.
In an era when most industries easily share big, complicated digital files, healthcare still leans hard on paper printouts and fax machines. The American taxpayer has funded the installation of electronic records systems in hospitals and doctors’ offices – to the tune of $30 billion since 2009. While those systems are supposed to make healthcare better and more efficient, most of them can’t talk to each other.
Bush lays a lot of blame for that at the feet of this federal financing.
“I called it the ‘Cash for Clunkers’ bill. It gave $30 billion to buy the very pre-internet systems that all of the doctors and hospitals had already looked at and rejected. And the vendors of those systems were about to die. And then they got put on life support by this bill that pays you billions of dollars, and didn’t get you any coordination of information!”
Bush’s assessment is colored by the fact that the company he runs — Watertown, Mass.-based athenahealth — stresses easily sharing electronic health records using the cloud. It also got a lot of the federal cash.
Dr. Robert Wachter, a hospitalist at the University of California, San Francisco, says sure — in hindsight, the government could have mandated that stimulus money be spent only on software that made sharing information easy. But, he says, “I think the right call was to get the systems in. Then to toggle to, ‘OK, now you have a computer, now you’re using it, you’re working out some of the kinks. The next thing we need to do is to be sure all these systems talk to each other.’ ”
Right now, the ability of the systems to converse is at about a 2 or 3 on a scale of zero to 10, Wachter and Bush agree.
Wachter is about to publish The Digital Doctor: Hope, Hype, and Harm at the Dawn of Medicine’s Computer Age, which assesses the value of information technology in healthcare. Up until now, he says, there has been a financial dis-incentive for doctors and hospitals to share information. For example, if a doctor doesn’t have a patient’s record immediately available, the doctor may order a test that has already been done – and can bill for that test. Keeping EMRs from talking to each other also makes it easier to keep patients from taking their medical records — and their business — to a competing doctor.
It’s time for that to change, says Dr. Karen DeSalvo, the federal government’s health IT coordinator. She is setting some standards for how to share digital information.
“The time of letting a thousand flowers bloom, and having a set of standards that are quite variable, should come to an end,” she says. “We should be working off the same set of standards.”
The billions of dollars a year the government pays out to doctors, hospitals and other institutions for patients enrolled in Medicare is a pretty good motivator. Already, Medicare is starting to increase pay to doctors and hospitals that work together to streamline care and avoid duplicative tests, and to penalize those that don’t. Winning the new payments and avoiding the penalties increasingly require proving that all of a patient’s doctors, no matter where they are, are working together. That means using electronic records that can seamlessly move from one system to the next.
Wachter says that consumers are now demanding better health information technology, too – “because we’re all used to our app stores and we know how magical it can be when core IT platforms invite in a number of apps.”
“So I think,” he says, “that even the vendors and healthcare delivery organizations that have been fighting interoperability recognize it’s the future.”
He says a lot of IT companies are now eager to come up with software that meets the demands of both the healthcare industry and consumers. About a dollar of every $6 in the U.S. economy is spent on healthcare. A new IT boom in that sector means there are billions of dollars to be made.
This story is part of a partnership that includes Montana Public Radio, NPR and Kaiser Health News.
”{M} than 70% of participants reported that they felt their organization was well positioned for future success…. More than three-quarters said they are on a good path to successfully compete in their local markets. Fear of aggressive new competition is minimal, with only 3% of survey participants saying they feel very unprepared relative to their markets.”
One nice quote: The chief strategy officer of a west-coast medical center said “We need to position our enterprise for a post-reform era,” which means “moving from a tertiary/quaternary care model only to a dual strategy in which we are also a population health manager.”The overwhelming sentiment …. was that the impediments to change are mostly internal. Less than a fifth of respondents said that market competition is the primary challenge ….in the ongoing shift from volume-based to value-based payment. A similar share said that outdated or ineffective IT infrastructure is their major roadblock, and almost two-thirds identified either cultural resistance or misalignment with physicians as their biggest obstacle.”
Apple was their favorite company, — with ”its history of cannibalizing its own products before a competitor does and promoting disruption before being overtaken by it.”
