I met Jonathan Bush right after the HIStalk/Healthia cocktail party at this year’s HIMSS conference. As a HISsie winner in every category he or his company was nominated, athenahealth CEO, President, and co-founder Jonathan Bush was gracious enough to receive his honors in person and then entertain the crowd with his commentaries on HIMSS, the industry, and boat shows. After the festivities, I went to whisper in his ear that I was "Inga" and he thought I was trying to give him a peck on the cheek. Of course in return he gave me a little air kiss – and then a big laugh when he realized I was just trying to tell him my secret (it was so very cute.)
Besides being cute, Jonathan has proved to be an innovative and successful leader, leading his company to last year’s most successful IPO. And he is big HIStalk fan (I think he and Mr. H are tight.) We appreciate and thank him for taking the time to share his wit and wisdom with other HIStalk readers!
About 50% of doctors practice medicine in small groups. The vast majority of them don’t use EMRs. Why not?
For the past 5 years, we have seen a huge uptick in the buzz around the adoption of EMRs and what it will mean for healthcare. EMR software companies issue press releases on new functionality or new versions and the prospect of a paperless delivery system. With all this innovation by software companies, and HIT conferences popping up every month to discuss "interoperability" and "standards," why on earth haven’t more doctors in small groups adopted EMRs?
Better yet, why do the small-doc practices that have EMRs resist using them to their fullest advantage?
The other day I was on the phone with a Wall Street Journal technology reporter, discussing the lack of adoption of EMRs by physicians practicing in small groups. I was glad this got the attention of a journalist who doesn’t normally cover healthcare. A little over 8% of 1-3 doctor practices have some kind of EMR…and the actual usage of "fully functional" EMR technology stands under 5% (data from MGH’s Institute for Health Policy). Earlier, more optimistic estimates were closer to 15-20%, but so far, no go.
The problem is, EMRs are usually tools, not services, I explained. If they were services that docs could use properly while increasing cash flow, they’d be flying off the shelf.
So the journalist asked a reasonable question: How much cash flow does athenahealth’s EMR service provide for physicians?
And I had a totally unreasonable answer: "Uh…"
The fact is, I don’t know! Here’s what I do know: Our EMR increases cash flow by removing paper from the process. Unlike old school EMRs, our athenaClinicals service handles all of the documents that enter our clients’ office as part of the service. So far, that’s more than 60 documents every day per FTE physician — 68% of which would have to be handled manually by the client. This means that even if they had traditional EMR tools, our clients would still be handling a large portion of their documents manually. But how much was it costing them to handle those manual documents before they got onto the athenahealth network?? Not the foggiest clue. What about if they got some consultant or custom programmer to build a bunch of interfaces and maintain them every time something changed at the lab? Not sure, but it sounds ugly and expensive to me.
What’s the solution? Actually, I’m not sure. What do you guys think? Invest in a time study? Wait for real P4P payments to kick in before the REAL docs out in the community adopt or let the academics with endowments lead the adoption wave?
So I will stop my post here, because one of the core reasons I like Mr. HISTalk, Inga and this blog so much is that it has emerged as a disruptive presence in how folks in our industry get their news and discuss topics and trends. So let’s discuss this…maybe we can get an actual dialogue started here that will begin to disrupt our industry’s stagnant approach to the small physician market.