Ann and Eric Fishman, with EHR TV, speaking with Jonathan Bush, CEO and President of Athena Health.
Dr. Eric Fishman: This is Dr. Eric Fishman with EHRTV and today Ann Fishman and I have the pleasure of speaking with the inimitable Jonathan Bush and we are going to be talking about Athena Health, talking about Anodyne but first, Ann has a couple of questions.
Ann Fishman: I just want to know what makes Jonathan Bush tick?
Jonathan Bush: I love you, Ann. Keep talking.
Ann Fishman: Explain it in a very accessible way.
Jonathan Bush: My cause is an information backbone that makes healthcare work as it should or at least that helps. That’s it. That’s the cause. There should be one. There isn’t one, there is no market for one. The logical markets for them have largely been illegal. There is a cultural resistance to one. There is even, believe it or not because they don’t know what it means, there is public resistance to one and mostly there is a lot of entrenched makers of isolated software that would have a lot to lose by it. So, pretty much everybody is against it and it’s good and I figured out with millions of errors and lots of help from my colleagues, a way to make money building such a backbone, to have the backbone actually get stronger as connectivity improves and so we’re going with it; and so far, you know, they are liking it.
Ann Fishman: What makes you unique in the health IT space? What are you bringing that nobody else can?
Jonathan Bush: Well, obviously, it’s EHRTV. So, we only have before the next commercial on real life a little bit of time and so I think I will keep it at the mission statement level. We’ve got a thing called a hedgehog, which is whatever we’re doing, 1700 of us in 3, 4, 5 offices, it’s got to fit the hedgehog, every product and ours is it’s got to be the best in the world at getting more cash for doctors everyday for doing the right thing and if it’s a really neat thing but it actually makes doctors lose money or if it’s really like a thing that makes doctors money but it’s bad for society, we skip those and narrowly focus on this piece. It makes for completely different business model and makes for a completely different culture but over a long, long haul – we have been doing it for 14 years now – it really, really pays.
Ann Fishman: Now, you said something very important – it it’s bad for society, you would move it up.
Jonathan Bush: Doctors will kill you. They might do it for a little while but if you sort of drag them into violating the Hippocratic oath in small steps, in a frog and a frying pan kind of way and then they wake up and they realize that they have been part of the problem, you know, the passive aggressive rage that doctors are capable of knows no bounds.
Dr. Eric Fishman: Anodyne Health – now says an Athena company.
Jonathan Bush: It’s an Athena company and business intelligence is part of this picture. If you aren’t able to unabashedly see in real life in real time where you are, there is nothing you can do about moving in the right direction; and a lot of folks that fear Athena because of the scope of our services still want to use Athena’s reporting, still want to have that data frame for understanding their world. So, we have decided to keep the name separate and let people buy that without buying our other stuff.
Dr. Eric Fishman: Jonathan, if you don’t mind, we could play an acronym game.
Jonathan Bush: Acronym game.
Dr. Eric Fishman: Over there you can see a bunch of acronyms. Is there any one that you want to talk about?
Jonathan Bush: I like PCMH. I don’t like the acronyms but I think the idea of medical home is a neat idea. I think risk is a good idea but the idea of wrapping it in another ridiculous three-letter acronym ACO versus all the other ones is annoying and the idea that the government is going to design it and we are all going to do it is absurd but the idea is a good one. PHI, I think about a lot.
Ann Fishman: NLU is Natural Language Understanding.
Jonathan Bush: Ah, interesting – Natural Language Understanding as a really complicated analytical thing as opposed to speaking in English small sentences without coding it.
Dr. Eric Fishman: Is it common?
Jonathan Bush: Yeah, I think it is. We are basically going to be conscientious objectors next year. We’re going to do a whole another like sit-in on the coder engines in EMRs and we are just going to be like sit-in, none of it. Doctor says the exam is going to be this. We are going to have the MA do all the briefing, all the analytics on pee in the cup and dip and blood pressure and height and weight, build little trends on it, pull it into a single briefing and the doctor is going to say “basically, this is what I see” and it’s going to be two sentences and done and then he is going to decide totally separately what level it is – level 1, 2, 3, 4 – and we are going to tell CMS that we are doing this and we are going to say that we are right and we are going to defend these guys to the core of the earth and we are going to see what happens.
Ann Fishman: You mean to bypass ICD-10?
Jonathan Bush: No, no, they can still do ICD-10 by bypassing the whole clicky click exams to defend what level it is and create reams and reams of bologna data that no doctor wants to see because then what happens is doctors don’t want to receive electronic patient summaries from other doctors who have EMRs because they are afraid of all the crap that’s going to come in to justify level 4 or 5 or 3 or what have you. So, we are going to get natural language encounters.
Ann Fishman: Is the government at the end of the day going to be good for healthcare or bad for healthcare?
Jonathan Bush: Oh my God! We had the best debate at Wharton on Saturday – me and Zeke Emanuel and some guy from the Manhattan Institute – and Zeke wrote that thing and he is not a shy man and he was ripping and I had to admit at the end even though every single provision in the bill I thought was a disaster, I thought the bill was a disaster, I thought it was going to increase the cost of care in ways that they haven’t even begun. The fact is the private sector didn’t get off its tocus. So, I think in the end we are going to look – the date was 2020 – and we are going to look and the question was “Is it going to be better because of this bill?” and I think the answer is it is going to be better because of this bill because even though everyone is going to create passive aggressive annoying layers of coding to insulate themselves from the bill, they are also going to get enough fear in their pants that they actually go out and start to innovate themselves and we are already seeing it. We are already seeing hospitals stopping worrying about heads-on beds and starting to say “How much market share do I have to steal to keep my beds full but actually utilize 50% less?” and that’s exciting. That was the first time I’ve ever heard a hospital CEO say that; it was in Nashville.
Ann Fishman: Since data capture seems to be a big impetus for a lot of the regulations and maybe some of the technology, is it possible to get too much data?
Jonathan Bush: Oh my God! It’s so possible, yeah. So, data that’s like even 5 minutes old is not worth having, data that isn’t decisionable is not worth having and data that’s so inaccurate, it’s like built for passive aggressive ulterior reasons is not worth having. So, that’s like 90% of the chart needs to go and then you start with that 10% and you keep that real time and tight. That’s the idea of the natural language Ernest Hemmingway encounter. So, we are going to do a whole new version of Athena Clinicals next year on the iPad, on Safari but here is the deal – there is only going to be 10 screens on it, ever, 10 pages, period. No matter how many times you click, you can only see one of those 10 pages and if you don’t like that, go back to the browser and click your way through to kingdom come and you are just going to have to deal within those 10 pages and we think that what’s going to happen is people are going to tighten up what they have to say and what comes out of those encounters is actually going to be useful to everybody in the clinical information supply chain. So, I am big into that. This year I really learned a lot about coordination of care and I think we, with Athena Coordinator, which came out this year since last time we spoke. We have actually found a business model where the sender and the receiver actually makes more money for doing the right thing on coordination of care. It’s basically the opposite of Epic. You buy Epic and you make everybody work for you and you make them use the thing because that way they have to send…
Dr. Eric Fishman: My last question.
Jonathan Bush: Yeah.
Dr. Eric Fishman: Did you get a picture from Athens when Ann and I were standing in front of the Acropolis and we thought of you because of Athena?
Jonathan Bush: I think I did, I think I did. If I was organized enough, I would like have a file in my thing where I save the pictures so I could keep it for scrapbooking...
Ann Fishman: What’s Anodyne doing that’s different?
Jonathan Bush: I think, just like Athena, you know all of our technology is only used in the service of a service. So, we got really cool technology here but the important part about Anodyne is we decide what the cube of data should look like and how people should look at it and we only let you look at your data that way. So, the analytical frame that you have and that your account manager has and that I have on how you are doing is the same. So, I know good and bad – good and bad is always relative, right? – in everything – love, sex, marriage, children, grades, everything.
Ann Fishman: That’s our next segment.
Jonathan Bush: So, to be able to have everybody on one frame, on one database, looking at their performance using one set of lenses makes for a level of truth that you can’t have even with some sort of cognosed application that’s got millions more features and millions more, you know, ways of being used. It doesn’t matter if you got a million ways of using if you don’t know what ‘good’ means. So, that’s what Anodyne does that no one else does, they refused to be used other than the way we describe and then we follow up with them, it’s a business intelligence service. We will tell you how you are doing on the phone if you don’t look at your report.
Ann Fishman: I have one more question.
Jonathan Bush: Yeah.
Ann Fishman: Are you more a business guy, a IT guy or a public policy guy?
Dr. Eric Fishman: Or a visionary?
Jonathan Bush: Oh, I’m a public policy guy. Business and IT are the…
Ann Fishman: …the means to change the world.
Jonathan Bush: Means, yeah. I will call myself a vision guy or a mission guy. I like missions and I don’t really like being handed the mission by someone who has more power than me; it makes me feel incredibly violated. I didn’t know anything about the internet when I started Athena, not at all. I didn’t have e-mail, nothing. So, I really think whether its carrier pigeons or the internet or National Standards or services, it’s whatever gets the mission and you pick missions that – you know, you would feel good if you made a million dollars succeeding at it, where the world would say “Hey, thanks for succeeding at that.”
Dr. Eric Fishman: I am going to give you a 4 gigabyte thumb drive and you are going to tell me what you’re going to put on it.
Jonathan Bush: Oh, pictures, pictures, just like the ones you sent me. I don’t have enough pictures, I want more pictures. I don’t like our website’s all these words, no one reads them.
Ann Fishman: Oh, really?
Jonathan Bush: Yeah.
Ann Fishman: You want us to send you some pictures.
Jonathan Bush: Yeah. Well, I got the one from Greece. Alright, well thank you guys for focusing on Athena Health.
Dr. Eric Fishman: We will be back.
Jonathan Bush: Take care, doctor. Thank you very much.
Ann Fishman: Love to be with you.