Friends, with Benefits

What if one doctor could “friend” or “link in” with another for the purpose of patient exchange? Today when we hear people talk about clinical integration, they’re talking about financial integration…literally owning every stage of the treatment of a patient just so that the data created from that care can be integrated. That kind of thinking has fostered a proliferation of miniature Kaiser Permanente-like health organizations across the country–each with their own multi-hundred-million-dollar proprietary system to hold their data all in one place.

I think owning a lab is an expensive way to integrate the data from that lab into a common view of a patient—let alone “owning” a cardiologist! Furthermore, as the nexus of health care moves ever further away from the hospital ward and towards the home, owning every point of health care delivery will become increasingly difficult, if not impossible. So what’s the alternative? It’s the same one that gives us integrated credit ratings and the ability to walk up to any ATM in the world and still get money from our own account. It’s a market for clinical information exchange enabled by social networking-type technology.

When you think of it, Facebook and LinkedIn present integrated pictures of all the people you’ve touched in your life or work as soon as you log in. And over time you see how that integrated picture of your life or work life improves.

I know there’s something like this for clinical integration.

I know because, at athenahealth, we just had a physician client in Texas perform our very first “friending.” This doctor friended a major health care network in Texas and it went like this:

  • Our client had a patient that needed a certain procedure, and this particular health care network was the ideal provider choice.
  • To perform the procedure, the health care network needed the patient’s insurance eligibility, key medical records, and financial information.
  • We’re building a pipeline from our cloud-based medical record into the big health care network’s proprietary system.
  • We reached an agreement that every time athenahealth performs an injection of the exact, pre-formatted clinical and financial information that the network needs to care for a patient, it would pay us for that service. The service fee would be a few dollars, significantly less than the big network’s administrative costs to verify insurance and clinical information and get that patient scheduled. This presents a new opportunity to change the way EHR technology is paid for and should encourage wider implementation through lower costs for EHRs on the front-end.
  • Now, any time that anyone we serve sends a patient to this Texas network, that patient’s chart will reflect what happens at both places.

It sounds nascent because it is. In fact, it’s the first time it’s happened anywhere.

Next year we’ll be doing more friending and more patient exchanges.

It’s health information exchange, or HIE, as a verb instead of a noun.

We think that it will result in confederated patient information—that is, the ability to consolidate a patient’s information while allowing that patient to receive treatment from a broad array of places…including (over time) his or her home.

Doctors are going to be able to friend each other. And when they do, the receiving doctor can expect to get exactly what he or she wants from the sending doctor. The charts in the athenahealth EMR from the sending doctor are going to automatically shape shift to make sure that the data the receiving doctor wants is being captured and transferred.

Finally, no matter where you go in the world, a doctor you authorized will be able to find you on athenaNet…but that’s another story.

Jonathan Bush co-founded athenahealth, a leading provider of internet-based business services to physicians since 1997. Prior to joining athenahealth, he served as an EMT for the City of New Orleans, was trained as a medic in the U.S. Army, and worked as a management consultant with Booz Allen & Hamilton. He obtained a Bachelor of Arts in the College of Social Studies from Wesleyan University and an M.B.A. from Harvard Business School.

23 replies »

  1. Interesting Blog, even though this was not what i was looking for (I am in search of clinics like this one> http://www.ccsviclinic.ca/ )… I certainly plan on visiting again! By the way, if anyone knows of a good clinic that does CCSVI Screenings? BTW..thanks a lot and i will bookmark your article: Friends, with Benefits…

  2. The sound is good.What are the factors determine between Doctor-patient relationship.You know most of clinical firms are getting more benefits after healthcare reform..

  3. … and I am beginning to think that the “embrace the the present state of technology” and don’t worry your little head about how we make money, is a conspiracy of data-mining big business wannabes.
    And the HIT industry can do a proper handshake just fine. Look up surescripts and LabCorp and Quest and RelayHealth and Emdeon and NaviNet and eCW and Medicity and Axolotl and on and on and on.

  4. athenahealth sits on the same campus in Belfast Maine as one of Bank of America’s major call centers. Athena is now using some of the same infrastructure that the former MBNA had in place when they occupied the campus before becoming BoA. What is the difference between a handshake between banks involving confidential funds transfers and the movement of patient data from provider to provider to payer to patient???? I think maybe their heads are in a better place than most of the HIT crowd who has been debating HL7 since the early 1980s.
    Do you know how much waste, how much risk and how many lives have been lost because the HIT industry can’t do a proper handshake of data? I too once ran large data centers for hospitals HIT and am embarassed to say the industry has done little to advance.
    Do any of you naysayers have an ATM card? Pay any fees for using it out of network? Does it ever inconvenience you to have such flexibility?
    Wake up and embrace the present state of technology and get out from behind the “it’s spooky to think what might happen” garbage!
    I am beginning to think the patient privacy crowd is a conspiracy of ignorance.

  5. The communication you describe detracts from patient care. You are selling systems that are dangerous, impediments to care. Devote your funds to human resources, instead of trying to make a quick buck.

  6. the master said that And over time you see how that integrated picture of your life or work life improves. yeap, i really think we need the network.medical x ray .we need the integrated things at most time.
    i would like to agree with that Our client had a patient that needed a certain procedure, and this particular health care network was the ideal provider choice.

  7. Elizabeth, I agree with your desire that everyone carry their records with them on a portable device (we’re building such a system), but I disagree with you on the availability of computers in doctors’ offices and your — and Lindley’s — lack of concern over confidentiality of patient records.
    Most docs have a computer in their office at least for submitting claims for reimbursement — whether they submit claims to payers directly or indirectly through companies like athenahealth.
    I, personally, take the issue of confidentiality seriously and think vendors and providers ignore it at their peril. No system employing remote and/or cloud or other Internet-based servers can guarantee that records on them are absolutely secure — notwithstanding their disingenuous claims to the contrary! Not only can they be breached by hackers, but every day thousands of records from server-based systems are stolen or lost. To me, the stakes are too high so unless it becomes a matter of life or death, I won’t support any system or service that wants to store my records on remote servers!
    Lindley, I’m not overly familiar with the French system but I believe the Carte Vitale has very little medical information on it — I think only blood type. It primarily is a mechanism to pay care providers. The UK’s new NHS card will have some basic medical information, like meds, allergies, chronic illnesses, etc., but no actual medical records which are what your want your docs to access when they treat you.

  8. Having just said that, it occurs to me that France actually has something similar to the medical care information card already in place.
    It’s also the mechanism for managing payment to the health care provider at the time of service, eliminating the need for claim forms and operating reports and all that other paperwork to justify the services rendered. On the other hand, because the patient is responsible for an immediate co-pay at time of service, they are more inclined to question the necessity of those services.
    I’d be interested in everyone’s thoughts on that system.

  9. I agree with E.Ward that “confidentiality” as the battle cry for care providers and medical organizations avoiding sharing patient information electronically is hogwash. On the other hand, I’ve lost enough wallets in the course of my life to find the idea of carrying a card with all my medical information on a chip a bit unnerving. Perhaps if there was some kind of dual authentication process with biometrics and special access equipment/software: which is expensive and requires a reasonable level of trust and interest in sharing health care information between patients and the entire matrix of health care providers working with a particular patient.
    This is a paradigm shift we’re talking about.

  10. So there is a bi-directional good old HL7 ADT interface, coupled with a bi-directional CCR/CCD interface, with the hospital system, which is activated for the “befriending” doctor when he/she calls the vendor (could probably be automated, if it’s not already).
    I may be overreaching, but I assume that when the “befriending” occurs, patients have an option whether they choose to “befriend” the health systems who are “befriended” by their doctors.
    What I do find “nascent” is the idea that someone pays “a few dollars” per transaction amongst “friends”….

  11. Jon,
    Are you and your family influencing policy in the Executive and Legislative Branches? It seems a fraud is being perpetrated on the taxpayers by the US Government at the behest and deceptive influential practices of HIT vendors, HIMSS, and CCHIT.
    Where is the evidence that your devices cause improvements in safety and overall outcomes?
    I practice evidence based medicine and yhe evidence for CPOE and EMR is biased and at level 3-C.

  12. J,
    This babystep sounds okay as far as it goes. If I understand correctly, you are not talking about a whole patient record. I have a degree in health information management. What I think is the best solution for physicians having access to the patient’s total medical record (meaning hospitalizations, outpatient tests, everything) on to a small chip or disc that the patient carries around with him or her. The one big problem is that the medical community throws up is that all physician’s do not have computers. If the patient carries his or her own record around, you do not need a network of computers. But, all doctors and hospitals do need to be willing to computerize their medical records. Due to increasing demands of the government for medical information every health care facility is going to have to computerize their records anyway.
    The other concern about confidentiality is hogwash. The patient has the right to see their entire medical record whether the medical community likes it or not and after working in medical records for ten years with paper medical records despite best efforts there are big problems with confidentiality which are a bigger risk than a hacker getting into electronic medical records.
    E. Ward

  13. I can attest that the vapid clinically meaningless information I put in my patient’s charts is there because 1) some regulatory agency thinks it will improve patient care, or 2) some payor requires I produce volumes of said information to justify payment for my services, and/or 3) someone designed it into the EHR and made it mandatory that it be included. If the chart wasn’t a superbill, then the record would be much more meaningful.

  14. The doctor-patient relationship is central to the practice of medicine and is essential for the delivery of high-quality health care in the diagnosis and treatment of disease.By increasing communication, most patients receive a higher quality of care

  15. @Harriet in Jon’s defense “not much” is better than nothing at all and is already worth paying for at least on a trial basis. If there is boiler plate cut and paste vapid meaningfully useless information in the record, keep in mind that some clinician put it there.
    So make CBE the norm — it is a lot easier not to put boiler plate cut and paste vapid meaningfully useless information in the chart in the first place than it is to filter it out later, howsoever it is stored and transmitted. This is very much under the control of the Nursing Guild that created this monster in the first place in order to raise its professional stature.

  16. Jonathon,
    I would be interested to hear your views on the importance of personal contact between doctor and patient.
    It is my contention that the lack of personal observation of a patient’s entire life by their doctor is what is missing in today’s medical practices. It used to be that a person’s doctor truly knew them as a person, not a chart or a set of medical records (paper or electronic).
    I am not a doctor, but I have observed so many OBVIOUS factors in many patients’ poor health that do not, and can not show up on a chart, that it makes one wonder if the forest of information contained within the person has become invisible behind all the trees of data on their “chart”.

  17. Fallacy: “The charts in the athenahealth EMR from the sending doctor are going to automatically shape shift to make sure that the data the receiving doctor wants is being captured and transferred.”
    Much of what I see on the EMRs is boiler plate cut and paste vapid meaningfully useless information. It wastes time when I review records for special interests. Unless you have a garbage separator on your devices, Jon, you provide a billing apparatus, but not much for patient care.