What Happens Next? 2.0 Edition

Those of us who worry about the government creeping into all our lives can now stop fussing and fighting, cry it all out, and move on to implementing the Affordable Care Act (ACA).

But first, we need two core competencies: the ability to integrate health information across providers AND (soon thereafter) the ability to separate signal from noise.

Both of these competencies will require a propagation of the cloud. Let me explain why.

Our work in the health care (EHR) marketplace remains the same as if the ACA had been reversed…and it’s the same work we SHOULD have done years ago. That is, to treat the information that gets generated during the provision of care as if the consumer was actually paying for it. Because, in fact, they ARE paying for it and always have been—but the disintermediation by both third-party payers and the government has allowed us, as providers of health care services, to get pretty sloppy with the information that gets created in the name of client care.

While they are becoming more empowered, consumers haven’t throttled us during those instances when they must submit to a second test because the first result got fumbled somewhere in the care chain. Now, as each state goes for the federal dollars provided to them in the Affordable Care Act (ACA), they’ll feel greater pressure to…well…not lose information, and be able to provide it to any appropriate care giver who needs it. All while still trying to balance their budgets.

We are already seeing numerous efforts around the country to improve electronic tracking of health information, but, in most cases, the track-keeping is contained within a given health care provider’s environment. This makes it harder for people to shop around for the best provider at the best price.

Tuning the “Signal-to-Noise Ratio”

Cloud-based services automatically move patient information between providers, regardless of their “tax ID number”; yet hospitals that don’t use such services will need to invest not just in systems, but also in the ability to exchange information. This will not go well. Most health care providers don’t have this kind of technical competence…but they also don’t really have an incentive to make this happen…which is kind of why we haven’t done this yet as a sector.

When we do, providers will be held to an unprecedented level of transparency. Not only will they need to be able to share and access information from all the care a patient has received but, as long-time keepers of EHRs are learning, they’ll need the ability to sift through it. As health care integrates, we will need to fine-tune the “signal to noise ratio” in electronic charts. Pushing around all the info ever collected on a patient, in one great electronic dump, would be a disaster. Hopefully, this law will yield some improved filtering.

Different Data for Different Audiences

Again, cloud-based services that can filter and constantly re-filter patient information based on the person viewing the information, and the reason for viewing it, will be massively important in preventing information overload. Are you a doctor looking for an inconsistency in lab results? Are you a patient-centered medical home (PCMH) coordinator looking to ensure compliance? The ability to show data in different ways for different audiences is probably the single most essential non-existent competency in health information management today.

If we get these two competencies in place, and we squint a little, we can have some idea of the efficient, innovative marketplace that health care could be without the third-party system. For our part, we at athenahealth are running flat out to build these competencies for our clients…and ourselves. Anyone who doesn’t should simply be called “offline.”

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. This post first appeared at athenahealth’s blog.

3 replies »

  1. Thanks for the good writeup. It if truth be told was once a entertainment account it. Look complicated to far delivered agreeable from you! However, how could we keep up a correspondence?

  2. President Obama has out maneuvered everyone.

    Governor Scott recently said he would not support the Affordable Health Care Act because it did not do anything to cut costs. He is wrong. The act had a clause in it to remove the Medicare/Medicaid programs from the anti-trust laws, specifically price discrimination. This clause was removed by the Obama administration which means the low prices set by Congress for Medicare and Medicaid now become the standard prices for the health care industry in 2013.

    The Florida Supreme Court ruled that if a health care provider actually accepted a lower payment for a specific service then this becomes the actual price for everyone. Therefore, any healthcare provider which accepts Medicare or Medicaid must bill all patients, both private and public the same prices.

    Roy J. Meidinger

  3. Interesting. See also


    Re: “they also don’t really have an incentive to make this happen…which is kind of why we haven’t done this yet as a sector.”

    Well, yeah. JD Klienke pointed this out a long time ago (Sept 2005). Just Google “Kleinke Dot.Gov”

    “If the state of U.S. medical technology is one of our great national treasures, then the state of U.S. HIT is one of our great national disgraces. We spend $1.6 trillion a year on health care—far more than we do on personal financial services—and yet we have a twenty-first-century financial information infrastructure and a nineteenth-century health information infrastructure.2 Given what is at stake, health care should be the most IT-enabled of all our industries, not one of the least. Nonetheless, the “technologies” used to collect, manage, and distribute most of our medical information remain the pen, paper, telephone, fax, and Post-It note. Meanwhile, thousands of small organizations chew around the edges of the problem, spending hundreds of millions of dollars per year on proprietary clinical IT products that barely work and do not talk to each other. Health care organizations do not relish the problem, most vilify it, many are spending vast sums on proprietary products that do not coalesce into a systemwide solution, and the investment community has poured nearly a half-trillion dollars into failed HIT ventures that once claimed to be that solution. Nonetheless, no single health care organization or HIT venture has attained anything close to the critical mass necessary to effect such a fix. This is the textbook definition of a market failure.”

    Transparency is inversely related to margin, everything else held equal. Gonna require a new market model. To that end, I recommend Dr. Toussaint’s “Potent Medicine” recently released.