David Williams at The Health Business Blog tries vainly to interpret Mr. Bush. No not that Bush, Jonathan Bush from AthenaHealth. But it’s clear that Jonathan shares similar skill with the English language as his more famous cousin. If you know what this means, please feel free to let me know.

Q: So what do you think about the Massachusetts eHealth Collaborative [MAeHC] experiment to build full electronic patient records in three communities [North Adams, Newburyport, and Brockton, in a $50 million project funded by Blue Cross and Blue Shield of Massachusetts]?

A: That’s way off on the wrong track. If you could just pay for results, rather than pay for inputs, you’ll probably do better. Markets work better. We changed AthenaHealth 100 times. We had certified nurse midwives on salary and I had no browsers. Now we’re a Web-native, dot-communist bunch of MIT guys, analysts, and recovering Fleet Bank people working together to form this integrated clinical, financial, paper, analog, digital process.

I had no browsers? Maybe he meant he had no trousers? Or maybe he wasn’t able to get on the Internets? To be fair to Bush, several of his comments in the interview about automating the peripheral information floating around in the system such as lab results rather than starting with the clinical workflow of doctors make some sense. But given that significant majorities of primary care docs in many other nations do use EMRs in the office, it seems unreasonable to suggest that American doctors can’t do it. Which leads to David’s suspicions about Bush’s motivations:

So why is Bush badmouthing MAeHC?Bush’s company, athenaHealth receives a substantial cut of physicians’ revenues in exchange for assuming the hassles of billing and collection. In the arcane world of coding and billing, where each payer maintains arbitrary, changing, and unpublished rules, and where clinical practice and billing are disconnected and paper-based, athenaHealth’s revenue cycle management approach offers a strong value proposition.I wonder if Bush is worried that MAeHC’s promotion –with payer backing– of integrated EHR and PMS systems such as eClinicalWorks will obviate the need for athena’s services and blunt the entry of athena’s new athenaClinicals.

I took part in an study (as a respondent) recently and it’s clear from the (unpublished) results that the EMR and Practice management app vendors are on a collision course in the smaller physician space. So perhaps Bush is marking his territory and is nervous about eClinicalWorks et al. if I was anywhere in that space I would be. One interviewee called eClinicalWorks the Southwest of the industry!