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Scott Shreeve, MD

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I'm the CEO of Crossover Health, a patient-centered, membership-based medical group that is redesigning the practice, delivery, and experience of health care. We offer urgent, primary, and online care to our members who can access our technology platform, practice model, and provider network from anywhere and anytime to optimize their health. Email Me



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Bush League: More Beer, Please!

Bush League (bʊshlēg) adj.
  1. Of or belonging to a minor league.
  2. Of inferior or unprofessional quality; second-rate.

I have been finalizing my plans for HIMSS 2007, the biggest healthcare IT show on the planet. It is the annual show and tell, gossip and kiss, and general meetup for healthcare IT professionals around the globe. HIMSS has become well known for its sheer excesses – booth bunnies hawking IT solutions by smiling much, saying little, and wearing less; to the annual conundrum of understanding how giving away a hummer will help influence my IT purchasing decision; and to the worthless gadgetry that is generously given by the nearly 800 vendors and ravenously consumed by the nearly 25,000 attendees.

There are also typically a host of unusual events at the show. Besides the headliner event put on by HIMSS, there are the exclusive bashes of the big vendors and other private gatherings of the healthcare elite. One of the most interesting meetings of all at this years HIMSS, however, will a much smaller avenue but much more interesting. HISTalk, the most influential, if not most widely read, Healthcare IT Blog has auctioned off a “Beers with Bush” event with the “smart, energetic, and wickedly funny” CEO of red-hot AthenaHealth, Jonathon Bush (yes, there is a relation with this Bush, but no conspiracy theories please).

The winner of the event is the open source communities very own Fred Trotter, of GPL Medicine fame. Fred is best known as being the author of Free B (open source billing system), Medsphere watchdog, and open source advocate. He has since posted on LinuxMedNews regarding his efforts to solicit the readership for questions he can ask Jonathon during their session at the pub. Not only is this a great publicity stunt by Fred, it is also an interesting opportunity to see the potential for the convergence of open source within the highly successful business model of AthenaHealth.

I have known Todd and Ed Park for about 4 1/2 years. We first met back in the fall of 2002 when Medsphere was invited to present to Waterbury Hospital in CT. It was our first every presentation, and we were quite green, but Todd was interested in our open source model and the concept behind bringing VistA to the commercial market. Since that time I have followed their successes and watched their growth with interest. We met again in May 2006 as part of the due diligence team under the direction of Bryan Roberts of Venrock Ventures (original funder of AthenaHealth). It was great to catchup, compare notes on each others successes, and discuss the future direction of healthcare IT software. The Parks are both very classy, very sharp, and their success is a result of a very clear vision, near flawless execution, and compelling outcomes for physicians offices who adopt Athena.

The compelling vision stems from Athena’s compelling business model. They provide back office automation software that leverages a proprietary claims database and workflow engine that dramatically reduces the inefficiencies of medical practice finances. As a result of this technology, they are able to provide medical practices with real-time information on claims, cash flow, and financial optimization. While Athena focuses on the revenue cycle management service, they also realize that the data inputs to the finances come from all the clinical work being done in the clinic. For this reason, they recently launched AthenaClinicals, their web based EMR which complements their web-based AthenaCollector software.

Because Athena’s business model is based on revenue cycle management, and the clinical software is a means to acquire better financial data, they do not have to charge money for the software itself. They can sell it as a service. In fact, my understanding of the revenue model is that AthenaHealth makes money off the increased collections – they are so confident they can optimize your practice that they go at risk during the implementation. This represents one of the new school business models that I had previously described as part of the Software Value Chain evolution. As the features and functions of healthcare IT continue to become commoditized, it will be the new school companies with new school business models that will be able to adapt to the disruption uninterrupted.

So my question for Fred to ask Jonathon is this: “Hey JB, since you already have a software as a service business model, since you already have your hedgehog of optimizing the revenue cycle, why don’t you release your AthenaClinicals as an open source project?” All of your proprietary knowledge and intellectual property can safely be tucked away in your Athena Collector and AthenaEnterprise, but you can reap the whirlwind of innovation for your AthenaClinicals by open sourcing the code. The Athenista’s will be hero’s, an appreciative community will be an “army of messengers”, and I believe you will be surprised by the type and degree of unintended innovation around your open source software project. Based on your successful business and your successful brand, I believe that you could accelerate the creation of a public good that you have previously discussed by engaging a worldwide public of developers, users, and potential customers.

No one could claim you were Bush League, for making the Major League decision to go open source.

One comment on “Bush League: More Beer, Please!

  1. Anonymous says:

    It seems like athena’s new clinical offering is taking a page from their “utility” concept with their PMIS offering. Given the current and emerging clinical guidelines that EHRs will have to contain, having a truly “open source” EHR may not be practical on a broad scale. For a company like Medsphere, where you can get into a place like the VA and give them some religion – that is great. But athena is trying to target the ambulatory market, where 8O% of care in the US is delivered. 55% of docs are in groups of 1-3 – all small businesses. It’s athena’s unique value prop that has all of the industry buzzing – they could just be the ones to get those practices to adopt clinical systems on a broad scale. This is at least the buzz you hear on the street and read about in the mainstream media where athena is now covered consistently.

    As you touched on, and granted I am an investor not an IT wiz, athena’s EMR looks to provide all of the traditional features physicians expect from a traditional EMR software system but where athena takes it a step further than the Allscripts (MDRX) or Nextgens (QSII) is they convert the massive amounts of analog information found in a medical practice – faxes, phone calls, patient encounters, etc. – into continuously updated clinical profiles and workflows – a service offering!! This eliminates the paper and closes the loop on key clinical processes. They then provide continually updated payer-specific coding rules and E&M coding reviews, and help docs optimize reimbursement for practice-specific pay-for-performance (P4P) payer contracts. Plus, every incoming fax to a medical practice is converted into an electronic document via athenahealth.

    Maybe open source could have a role in their offering but I think they may just have the offering that gets as close to open source EMR but still allows the average doc to run their practice and not worry about code etc…just my two cents.

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