EHRs evolution will aid, not interfere, with patient encounters

Jonathan BushEditor’s Note: Jonathan Bush, chairman, chief executive officer and president of Watertown, MA-based athenahealth, spoke with Medical Economics about the present and future of health information technology. Here is the full interview. Excerpts of this interview were published in the October 25, 2013 issue as part of the publication’s ranking of the top 100 EHR companies.

Medical Economics: How is technology transforming medicine?

Bush: A critical point to make is that technology, when applied in the right way, has the incredible power to swing the pendulum in healthcare back to where it belongs, with the caregiver and patient. Truly transformative health information technology does not interfere with the sanctity of the encounter between caregiver and patient, but is a smart, elegant tool that doctors don’t hate, delivers and enables incredible value, and can be loved, as technology is loved in so many aspects of our lives.

Medical Economics: In your view, how has technology changed the delivery of medicine for primary care practices in 2013?

Bush: The right information at the right time in healthcare is incredibly powerful. Technology enables improved visibility of highly valuable information for primary care practices so they understand their operations–what’s working, what’s not. This level of visibility will broaden more as will (hopefully) increased transparency into the quality and cost of care delivered across the ecosystem. With information and the right technology primary care practices can thrive. They can achieve operational performance, better manage populations of patients, ensure compliance with things like Meaningful Use and ICD-10 (International Classification of Diseases 10^th Revision), and profit in alignment with the quality they deliver.

Medical Economics: If you could think about the delivery of medicine in the next 5 years, how will it change? How important has technology been in guiding this evolution?

Bush: I do think about the delivery of medicine 5 years from now. Clearly, patient engagement and empowerment are key. The entire quantified-self movement is gaining traction and will drive mobile technology and tracking innovations that bring together patients and make patients’ health records richer. This information will flow from personal devices over the cloud to the provider. I truly believe, and it’s why I come to work every day, that the cloud will be our nation’s information exchange highway. Transformative technology is monumentally important in guiding the evolution of medicine 5 years out and well beyond that. Once technology starts to integrate better, suck less and be loved more, the delivery of medicine will change and finally, the sanctity to the exam room encounter between caregiver and patient will be returned.

Medical Economics: We are 3 years into Meaningful Use. Our government continues to incentivize and will ultimately penalize physicians for not adopting EHR systems. Why has it taken such a massive push to get physicians to adopt?

Bush: Because most EHRs suck and doctors tend to be very smart people. They recognize that version 1.0 of EHRs and still many EHRs that are sold and even lead the market today are not what they should be. There’s a huge promise associated with going digital in healthcare, but it’s not about templates and Meaningful Use compliance, it’s about information access and an experience that is smart, elegant, and does not distract from what matters most.

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Medical Economics: Interoperability takes on far greater importance with meaningful use 2. Is the healthcare information technology sector ready?

Bush: Interoperability is the ability to get clean information in and out of systems and unfortunately this is still a complex process. We think efforts like CommonWell are steps in the right direction, but to be perfectly candid we are not waiting for the rest of the sector to catch up. We believe interoperability should be inherent within a health system’s or practice’s chosen platform, not treated as an extra service or charge. As part of this we take it upon ourselves to sync inconsistent information across care environments and systems to ensure it flows to the right person and right place at the right time.

Medical Economics: Ultimately who will carry the financial burden of the health information exchanges (HIEs), physicians or vendors?

Bush: Physicians will end up paying because if vendors are involved, ultimately that cost will be passed on. Taxpayers may also bear the cost in the event that the government steps in and funds HIEs because no sustainable business model was found. Once that HIE is in the middle, it is just another mouth to feed.

We think that the cost of the exchange should be borne by the people who derive the most value from it, and we price that into our core services. This enables receivers of valuable information to pay for what they want and need, and thus cost is equitably aligned with those who gain value.

We think of health information exchange as a verb, not a noun. We want the kind of open market you’d find in any other supply chain like financial services or manufacturing. Health care lags far behind other sectors because it has been hobbled by outdated law. And last, to be clear, we don’t charge the holder of information to share his or her own information, but rather put the cost on the receiver of the clean, usable information.

Medical Economics: Do you think MU2 and MU3 requirements will drive consolidation or closure of EHR companies? Why?

Bush: With or without MU2 or MU3, consolidation in the HIT space is inevitable. If you’ve been to the HIMSS (Health Information Management and Systems Society) show lately, then you’ve attempted to keep track of the number of EHRs on market. There’s a lot. ‘Survival of the fittest’ is going to be a real thing in HIT, and it’s not a bad thing.

Medical Economics: What will happen when EHR incentives run out?

Bush: If the rate of EHR adoption is sustained-and once the balance shifts to EHRs as beautiful solutions and away from the ‘thing I have to use and hate’-we will have forgotten about incentives or wonder why we needed them in the first place.

Medical Economics: We live in a mobile world. How important is mobile technology to the future of medical delivery overall? And how important is it to your EHR systems?

Bush: The company I co-founded exists to let doctors be doctors, not billing experts or IT experts. Doctors want to be free to deliver quality care at the top of their licenses.

Within the confines of your question that means giving caregivers the incredible power of quick look-up as you find with our Epocrates service. It is so important now to provide caregivers exactly the information they need at the point of care and not deluge them with tabs and folders and files they must fumble through electronically while a patient stands in front of them.

Caregivers are also people with lives and families; some of the best feedback we’ve gotten on our mobile services is how they have allowed greater work/life balance. So mobile is important for medical delivery, as you mentioned, but it also allows physicians to get home in time to eat dinner with their families, play with the kids before bedtime and then, if needed, clear out their inbox or get a look at the next day from the couch, with a ballgame on the tube.

Medical Economics: In your view, what are some of the most exciting technological developments for physicians and why?

Bush: One of the truly exciting developments for physicians I alluded to before is making HIT sexy by giving caregivers simple and elegant interfaces they love with the ability to shop.

For a guy who grew up in an era of coin-operated payphones, it’s mind-boggling to think about how the smartphone has changed how we live and how quickly that happened. The simple, elegant, purposeful technology designs we expect everywhere else in our lives are on their way to healthcare.

Also, doctors need to shop. By that I mean giving providers the right information to make choices based on quality and cost. With the right application of technology and emerging reimbursement models, providers will be able to send patients to the right place (based on quality and cost) and profit from the savings. We think this is important because everyone touches healthcare, and it should be like the rest of our lives where we are empowered to make our own decisions based on cost, value, experience, quality, etc.

Medical Economics: Let’s talk about a fast growing segment-personal health products. How will patient communication change as a result of this kind of technology?

Bush: There’s a group of people at my company who use fitness trackers to improve their own health but also to compete with each other for miles run, stairs climbed, hurdles leapt or whatever. We are obsessed with performance metrics at athenahealth so this is no surprise.

But outside the company and on the same note, we already have a robust link between provider and patient through our practice portals. Just as one example, why not have the personal health and fitness information a person/patient collects, whether it’s around physical fitness or a medical condition like diabetes and feed it through a pipeline to the doctor’s office through such a portal?  

Medical Economics: What do you think HIT vendors will be talking about in 5 years as it relates to technology platforms/applications?

Bush: Open platforms, like they have in every other industry, will win the day. Closed systems that inhibit innovation and restrict information liquidity are relics of the past. People need open application program interfaces (APIs) and access to patients and providers in a seamless way, not having to go hospital to hospital to drive innovation. Winners in this space will figure out how to build a genuine distribution platform and help others make healthcare work the way it should.

Jonathan Bush founded athenahealth, Inc. in 1997 and serves as its chairman, chief executive officer (CEO), and president. In 1999, Bush raised more than $10 million in funding from notable venture capital firms to support the effort. Prior to joining the company, Bush served as an emergency medical technician for the city of New Orleans, and was trained as a medic in the U.S. Army. He served as a consultant at Booz Allen Hamilton. Bush obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an MBA from Harvard Business School.