After Athenahealth was taken private in 2019, the electronic health record vendor decided its R&D organization needed to focus more on its core business.
The vendor, which was struggling in an increasingly competitive health IT sector, elected to reorient its attention on the ambulatory space and pivot away from elbowing for market share in the hospital market with bigger rivals like Epic and Cerner.
As a result, management reached out to their clients to take stock of a day in the life of an ambulatory independent physician practice, and made a targeted series of investment bets to support what doctors said they needed. Athenahealth repurposed its Austin office into an R&D center focused on delivering a better patient and physician experience, zeroing in on any pain points in its existing tools.
That investment is starting to bear fruit this year, as Athenahealth plans to release "a bunch" of new products, including the Massachusetts-based vendor's first patient-facing app, chief product officer Paul Brient told Healthcare Dive on the sidelines of the annual HIMSS conference in Orlando on Tuesday.
Brient also shared his thoughts on the government's push toward interoperability and how it's affecting doctors on the ground, along with how 25-year-old Athenahealth plans to modernize its record to mitigate the burnout that's reaching a fever point among U.S. medical workers.
Consumerism in the driver's seat
"Oddly, when I joined, there wasn't a lot of talk about patients. They're kind of important in the healthcare system, from my experience anyway," Brient, who's been at Athenahealth for about three years, said. "If you go to just about any healthcare system, or healthcare provider, it's kind of like going back in time. You have to call them up to get an appointment, you leave, they give you a printout of stuff, you show up, they give you a clipboard with a bunch of paper on it. I'm like, why are we doing this? It's 2022."
Athenahealth plans to release an app for patients focused on patient engagement this year, aimed at extending the care experience beyond the clinical encounter. Currently, Athenahealth's patient portal works on a phone, but the vendor wants to move beyond that with a more targeted and comprehensive tool.
"How do we make patient engagement a 365-day-a-year thing? Having an app will obviously help us do that," Brient said.
The patient app will include secure messaging, appointment scheduling and management and financial bill pay services.
But with increased interoperability spurred by the 21st Century Cures Act and recent regulations from HHS pushing the whole clinical record to the patient — something Brient noted is controversial among doctors, as patients can access notes and results without context before the clinician — Athenahealth wanted to create a more expansive app, beyond just the classic patient portal.
The app will also let patients view and collect their information from connected devices, and will dabble in the care management space as well.
The areas of digital patient engagement, coaching and management have taken off during the pandemic, as COVID-19 restricted access to a physical care team.
The hope is that the app will be a platform for holistic engagement — a more modern, available version than Athenahealth's care management app AthenaWell, which has struggled with uptake.
"One of the things we'll be doing this year is launching a care management service. We'll actually have nurse care managers helping our practices manage the patients," Brient said. "You can imagine coupling that with some AI chatbot for interaction, where patients get a question from a chatbot in the morning. 'Hey, how are you feeling today? '... 'Oh, I'm feeling terrible this morning.' And then the next thing that happens is a care manager calls you."
Split on info blocking regulations
HHS in early 2020 released two sweeping regulations meant to push the industry toward free, unfettered health data sharing across different entities. The buildup to their publication was mired by controversy over patient access versus the security of medical data, along with how to best push entrenched IT operations toward a more open architecture.
In April, the brunt of the regulations came into effect, requiring hospitals and certified health IT vendors to share data with patients and with each other. But physicians still have some worries about how they were enacted — as does Brient, the longtime software executive told Healthcare Dive.
"There's certainly a camp that says just giving patients the lab results, the imaging studies, the notes that I write about them without any context or frankly me, as a doctor, having a chance to review them first, is going to create a lot of anxiety that's unnecessary," Brient said. "The counter is, I can go right now to a LabCorp and get any test I want, just about. Consumerism is happening in all kinds of different ways. If I wanted to go get an HbA1c test, I can go myself, order it and interpret it myself and Google it and figure it out. So I think there's just a tension and a change."
This anxiety could also manifest itself in additional work for medical staff, which are reporting record-high levels of burnout as the pandemic enters its third year. Brient pointed to small-scale studies that suggest open notes seem to increase calls into the practice as people follow up with questions stemming from their data.
"It's going to generate more work. Like everything, it will evolve, and we'll figure out how to make it effective," Brient said. "Personally, I think it's not good. I don't think it was particularly well thought out by the regulators."
Brient noted that giving patients access to their records is paramount, but enacting the regulations as codified necessitates a distinct shift in how physicians write and disseminate their notes.
It could result in the creation of some sort of private, protected, not-medical-record communication method between doctors, the executive suggested.
"I wouldn't be 100% surprised if we invent a new concept that's not note, that's kind of like the private physician thing that physicians write other physicians," Brient said. "There's some things that if you're providing care to somebody in the hospital that you need to talk about, like 'Hey, the mother in law's crazy.' You don't write those things down, but they're really important things to know if you're the next person on shift. So I wouldn't be surprised if something like that gets developed."
Mitigating click fatigue
As Athenahealth works to revamp its product around its ambulatory clients, the vendor is also taking steps to ameliorate burnout by personalizing records to specific physicians.
EHRs swept onto the scene in healthcare in force a little under a decade ago, when the government mandated their adoption. Despite streamlining continuity of care, billing and administrative functions, doctors continue to say EHRs are a major pain.
Athenahealth's EHR is popular among physicians, but "it's a little bit like the one they hate the least," Brient said. The goal is to make it like the iPhone. "You love that thing. You probably have a few things you don't like about it. But our goal is to make the EHR that way, and it's totally doable."
Historically, EHRs have a one-size-fits-all workflow that physicians need to be trained on, which can be expensive both in terms of dollars and time. To try and fix this, Athenahealth is investing in the configurability of the EHR, specialty-specific workflows and even personal preference workflows, Brient said.
"There's fundamental, different ways about the way doctors work with an EHR. One of the important things is, can you type? Some doctors type super fast, and they love to type. Some doctors type like 10 words a minute, and they hate to type. So that's a really important thing for the EHR to know," Brient said.
Other factors include variability in what devices physicians prefer, whether they like voice-to-text functionality and whether they want the EHR accessible in the exam room or not.
"Over time — and this is not a thing today — but over time, when we go to implement a physician, our goal is that we will ask them five or six questions like that. And the system will automatically configure itself for physicians who work like that. And we won't have to train them, Brient said.
Athenahealth is working to roll out this customizable EHR for some specialties as soon as the next three or four years, Brient said.
In the few years leading up to the pandemic, adoption of tools like voice-to-text and artificial intelligence-enabled clinical documentation was growing in healthcare to try and streamline notetaking. Athenahealth is also interested in that space, Brient said, calling the use of AI key to cracking the code of making the EHR experience delightful for physicians.
Athenahealth now has a division devoted to applying AI to the clinical workflow, when just three years ago, the company was only using AI on the back office, claims processing, and financial side of the business.
On the clinical side, Athenahealth is exploring using AI to pare down work like data reconciliation, inbox management and workflow experience.
"If we know how you work, and know what you do ... and we know what you look at, well good. We'll put that on one screen and the things you want to do, we'll put right there," Brient said.