Whitepaper. The Economics of the Patient Workflow: Cracking the Code of Successful EHR Design

Transcription

1 Whitepaper The Economics of the Patient Workflow: Cracking the Code of Successful EHR Design athenahealth, Inc. Published: October 2009

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3 I. The EHR Industry Is Broken Health reform advocates have long heralded the promise of electronic health records (EHRs) to improve outcomes and lower costs. But after more than 30 years of being available to the nation s 800,000 physicians, only 4% of physicians have an extensive, fully functional electronic records system. 1 Recent research suggests that this low adoption results from the simple calculus that existing EHRs provide too little value to physicians at too high a cost. The truth: traditional EHRs fail to consistently help physicians do less work, see more patients, make more money, or deliver better care. President Obama s Health Information Technology for Economic and Clinical Health (HITECH) Act (part of the stimulus package known as the American Recovery and Reinvestment Act) is designed to overcome economic barriers to EHR adoption by providing up to $44,000 in incentive payments from Medicare for meaningful use. But concerns remain that such an incentive will do little to address the underlying problems of EHRs. While well-meaning, such an incentive could merely defray initial costs (which some studies estimate range considerably higher than the federal bonus payment 2 ) while burdening physicians with expensive EHR systems and revenue-draining maintenance and upgrade costs. At its worst, the intensified push to drive up EHR adoption could have the unintended consequence of driving some physicians out of business. Where Do We Go From Here? There is a better way. We can transcend the failures of the past with a bold, yet simple EHR solution rooted in a careful analysis of how EHRs can add economic value to physicians patient workflow. This paper presents one solution. EHRs have failed because they are designed without an understanding of the fundamental economics of patient encounter. By breaking down each stage of the patient workflow and placing it in the context of actual practice expenses, it becomes clear that the place of primary focus for most EHRs the physician s exam offers little or no financial opportunity for a practice, while most EHRs ignore areas that offer significant gains. A careful economic assessment of the five stages of the patient encounter, from check-in to checkout, reveals the enormous potential EHRs have to increase revenue through increased patient throughput, improved staff efficiency, and easy-to-manage reporting, while capturing all pay-for-performance measures. In addition, a well-designed EHR can reduce the highest costs, which include client document management, patient orders, and results follow-up. EHRs Can Be a Meaningful Solution By using an EHR that adds economic value to all aspects of the encounter, physicians are no longer forced to adopt a narrowly-focused electronic exam and an entirely new, sometimes cumbersome workflow. The solution presented in this white paper allows doctors to achieve 100% of the benefits of a paperless EHR system, while documenting the encounter as he or she desires, and gradually optimizing the workflow. Ultimately, such an optimized workflow can translate into higher EHR adoption, more revenue, better care, and more satisfied physicians, staff, and patients. And while the EHR solution presented will readily qualify for HITECH Act reimbursement, it offers physicians a robust alternative that will benefit their practices and patients far beyond the scope and reimbursement cycle envisioned in the HITECH Act. That s meaningful change that can truly benefit physicians and their patients. 3

4 II. The Basic Problem The basic problem of most EHRs on the market today is that they do not achieve a measurable positive financial impact. This is because traditional EHRs fail to account for a fundamental fact: the provider exam is the only area where a practice earns revenue. Of course, a practice can also earn money through ancillary services, but the vast majority of practice income is generated by clinical encounters. And here s the rub: most EHRs are focused primarily on changing physicians workflow. When implementing an EHR, providers (a practice s main revenue generators) must learn a new way to document their encounters. Many EHRs have limited options for doing so. Thus, the physician is forced to shoulder the full brunt of learning, adapting to, and recording information in the new electronic system. But in order for the practice to be profitable, the physician needs to be spending his or her time seeing patients and maintaining patient throughput. Burdening or slowing down the physician with time-consuming and sometimes unnecessary data collection is costly to the practice and ultimately leads to sub-optimal care. A Deeper Problem The reality is that the clinical exam is only one stage of a patient visit that can be made more efficient (and profitable) with an EHR. For example, practice staff spends many hours (and dollars) dealing with documents. From labs and test results to prescription requests, the typical practice has hundreds or thousands of phone calls, faxes, and mail to process, deliver, and record. But traditional EHRs are not designed to automate the work associated with collecting and processing paper outside of the exam room. The Basic Economics of a Typical Encounter These two problems with EHRs too much emphasis on the exam and too little attention on the rest of the workflow are the principle causes of failure and lack of adoption. To understand why, it s helpful to look at the basic costs of the patient encounter and how traditional EHRs fail to address the biggest costs of all. According to the Medical Group Management Association (MGMA) 2008 Cost Survey, in 2007 multispecialty medical practices reported costs in two general areas. Less than one-quarter of a practice s costs was for rent, supplies, insurance, and other operating expenses. The remainder, about 78% according to the survey, was for staff costs (see Figure 1). About athenahealth Data athenahealth dynamically manages and processes large amounts of information on behalf of its clients. Unlike other electronic health record, billing, and practice management solutions, athenahealth offers a combination of centrally-hosted Web- based software tools and behind-the- scenes support for clients. This means that every detail occurring during a billing transaction every claim submission, denial, number of days in accounts receivable (DAR), and more is captured electronically. athenahealth s data reflects the clinical and financial experiences of thousands of providers and hundreds of payers across the country. 4

5 Figure 1. Cost Categories for Multi-Specialty Medical Practices Cost Categories % of Total Practice Cost Physician and provider consultant cost 43.67% Total support staff cost 31.22% Total nonphysician provider cost 3.21% Medical and surgical supply cost 1.92% Ancillary services cost 3.47% Building and occupancy cost 5.97% Other general operating cost 9.17% Total Expense 100% Staff Time is 78% of Total Practice Cost Source: MGMA Cost Survey, 2008 (Based on 2007 data) Despite the fact that staff costs account for more than three-quarters of a practice s expenses, very little analysis tracks the allocation of staff costs along each stage of a patient encounter. Why is this important? If EHRs promise to improve care and increase efficiency, it is essential to understand staff costs along the entire patient encounter so the EHR doesn t add unnecessary bottlenecks and costs. athenahealth data from a multi-year research project on the patient workflow shed light on the costs associated with each stage of the patient encounter (see Figure 2). Figure 2. Staff Costs for Each Stage of the Patient Encounter Stage of Patient Encounter % of Staff Costs % of Practice Revenue 1) Scheduling, Check-in & Intake 10 20% 0% 2) Exam 20 25% 100%* 3) Orders & Results Management 30 40% 0% 4) Checkout 10 15% 0% 5) Patient Follow-Up 20 30% 0% * Not counting revenue from ancillaries Source: Based on athenahealth, Inc. client data and lean mapping research,

6 Exhibit 1. The Different Stages of a Patient Encounter and Staff Costs Associated with Each The section below walks through the five stages of a patient encounter and identifies areas to improve efficiency, lower cost and boost revenue. Economic Drivers of a Typical Clinical Encounter Work/Cost Revenue Generation scheduling check-in intake exam orders checkout follow-up 1 Staff Time - Chart Pulls and Patient Management 10-20% of Costs 2 Staff Time % of Costs Billable Provider Encounters 20-25% of Costs 100% Revenue 3 4 Staff Time - Staff Time - Document Management Costs 10-15% of Costs 30-40% of Costs $1,000 - $3,000 per Month, per MD to process documents 5 Staff Time - Follow-Up Costs 20-30% of Costs $2,500 per Month 1) Scheduling, Check-In, and Intake 10-20% of staff cost. Staff manages the first stages of the exam, including intake, where they collect data critical for the physician s revenue and to populate the patients medical records. This stage of the encounter is typically efficiently managed without too much waste. 2) Exam 20-25% of staff costs, but 100% of revenue. * Billable providers (physicians and mid-levels) generally create the only revenue for the practice. It is, therefore, critical that these employees be as productive with their time (with high utilization and a high percentage of time doing billable procedures) as possible. The more encounters the physician does, and the higher the value of the encounters, the more he or she is paid. Time management is critically important. 3) Orders and Results Management 30-40% of staff costs. A huge portion of a practice s expenses are the hidden costs associated with managing orders and thirdparty paper (i.e., paper about the patient coming from referring providers, labs, pharmacies, etc.) in support of the patient encounter. According to athenahealth data, each full-time employee handles about 1,155 pieces of documentation per month and that s on top of patient charting. athenahealth estimates that this cost per * Not counting revenue from ancillaries 6

7 provider represents $1,000-$3,000 per month. This is one area of the practice workflow where there is great potential to improve efficiency and lower costs. 4) Checkout 10-15% of staff costs. Much like check-in, most practices are efficient in this area. The essential requirement of this stage is simply to insure that all encounters are closed, orders approved, and co-pays paid before the patient departs the physician office. 5) Patient Follow-Up 20-30% of staff costs. Following up with patients is another area where staff costs add up quickly if not managed efficiently. Calling, faxing, and ing test results, returning phone calls, and tracking other patient communication typically generate hours of work for both staff and providers. This is another area where most practices lack efficiency, relying on staff to initiate and track follow-up in coordination with the provider. III. Uncovering Design Flaws in Today s EHR Industry Exhibit 2. The Five Critical Failures of Traditional EHRs In the section below, we ll explain where the traditional EHR breaks down from overburdening the physician during the exam to increasing practice costs without any efficiency gains and how each adds costs to the patient encounter. The Five Critical Failures of Traditional EHRs Work/Cost Revenue Generation 3 P4P Does not optimize potential for getting P4P during intake, exam and orders 2 eexam Time tax on MD compromises revenue generation scheduling check-in intake exam orders checkout follow-up 1 High Up-Front Cost Costly software purchase plus monthly maintenance and upgrades 2 eexam - Time Tax on MD Slows down doctors up to 1.5 hours per day 4 Clinical Document Process Management Weakness Increases cost of processing, scanning documents. 5 Staff Time - Follow Up Costs 20-30% of Costs No efficiencies gained in patient follow up 7

8 1) Typical EHR Software Is Too Expensive. EHR software is very expensive. It is generally priced on a per physician basis, so the larger the practice, the more quickly the costs spiral upwards. It is estimated that the cost of purchasing a traditional HER system is $33,000 for each physician, with an additional cost of $1,500 per doctor per month for maintenance.3 Per physician, this translates to $51,000 in costs during the first year of using an EHR and $18,000 in annual maintenance costs. Despite such high costs, traditional vendors have few incentives for delivering a promised return on investment (ROI). Because the practice invests heavily up front, the vendor has little motivation to provide excellent service after implementation. And once the EHR is installed, it is usually up to the practice to provide, or pay for, IT support for software and hardware, interface management, data set management, and scanning support. Most EHR software also requires regular upgrades due, in part, to the rapidly changing standards for software and government definitions of health care measures. For example, in 2007 PQRI had 74 measures, and by 2009 the measures had increased to 153. With each change and addition, it is the responsibility of the practice to deploy software upgrades to remain compliant. 2) EHRs Don t Save Money Because They Slow Doctors Down. Most EHR software focuses primarily on the physician exam, creating an electronic interface for the physician to document everything in the patient encounter. These EHRs encourage doctors to adopt the full electronic encounter immediately, which fundamentally changes their encounter workflow (and not always for the better). Physicians who are already accustomed to electronically recording the patient exam are able to adapt to capturing the increased level of clinical detail an EHR makes possible, especially if they believe exam data will be used in future P4P programs. But the traditional EHR model essentially forces physicians to become data entry clerks and to document patient encounters with time-consuming, structured data entry. This means lots of typing in order to record a high level of clinical detail, often with little tangible benefit to the physician. Currently, most EHR vendors are narrowly focused on updating the data entry component of the physician exam with over-structured elements that don t meet the broader needs of the practice. In the process they have failed to improve the user experience by failing to optimize all documentation methods, including dictation, free hand, jotter, or even paper. The net results are EHRs that slow physicians down, reduce patient volume, and force doctors to pay their employees overtime to remain with the physician after hours to complete patient visits. Myth: Once software is paid for, the practice is in the clear for any future payments and the ROI begins to accrue. Reality: There are lots of very real, hidden costs in the software model. Myth: EHRs make physicians more efficient. Reality: EHRs force physicians to change their workflow, adding a clerical burden for the provider who is the only revenue generating resource in the office. This can put a physician s business at risk.. 8

9 Physicians who implement health IT systems typically experience an initial loss in productivity as they learn how to use the system and adjust the ways in which they practice. In a survey of health IT adoption conducted by Gans and colleagues, many physicians practices reported that after they implemented a system, productivity in their offices dropped by between 10 percent and 15 percent for at least several months. 4 Another study of EHR adoption by solo and small group practices found that among a sample of 14 small physicians offices implementing a health IT system, the average drop in revenue from that loss of productivity was about $7,500 per physician. 5 That amount may even understate the actual loss in productivity, however, because in some practices, physicians worked longer hours to keep the practice s income the same as it was before the adoption. 6 As a result of the time burden imposed by existing EHRs, many providers cannot generate the additional income necessary to justify the significant investment in time and money that the adoption of such a system would require. 3) Software-based EHRs aren t currently designed to seamlessly manage the complex P4P cycle or comply with payment reform in a convenient way they only provide the tools. Most EHRs assume all doctors should gather complete structured data in every encounter and that every piece of data is important. Unfortunately, this approach fails to carefully consider what data is currently and will eventually be needed for P4P program reporting, and even what reports will need to be pulled. In lieu of a practical data-gathering strategy, traditional EHRs have passed on the burden of full data collection to the provider. The reality is that only a small, specific set of data needs to be structured to facilitate P4P reporting, and it doesn t need to be entered into an EHR by a physician. In fact, based on athenahealth s review of 35 national programs, 80% of all data needed for P4P or HITECH Act programs can be captured by staff at intake or when entering orders on behalf of the physician (see Figure 3). Most EHRs aren t designed EHR Exam-Room Headaches: A Doctor s Perspective Doctors in every specialty struggle daily to figure out a way to keep the computer from interfering with what should be going on in the exam room making that crucial connection between doctor and patient. I find myself apologizing often, as I stare at a series of questions and boxes to be clicked on the screen and try to adapt them to the patient sitting before me. I am forced to bring up questions in the order they appear, to ask the parents of a laughing 2-yearold if she is in pain, and to restrain my potty mouth when the computer malfunctions or the screen locks up. Excerpted from: The Computer Will See You Now By ANNE ARMSTRONG-COBEN The New York Times, March 5, 2009 Figure 3. Where Does P4P Data Come From? 1% Management Structural 2% 18% Exam 10% Intake 69% Plan Source: athenahealth, Inc. Pay-for- Performance and Quality Reporting Study, May

10 this way they put the burden squarely on the provider during the exam. What s more, software alone can t help practices keep pace with constantly evolving programs like P4P, HITECH Act guidelines, and consumer-directed health care. That s because once installed, software cannot change unless a new version comes out which then must be re-installed at every workstation. Reporting to Medicare or other payers is onerous and lacks integration with the revenue cycle unless staff performs significant manual work. 4) Traditional EHRs do not offer an efficient, closed-loop solution to the time-consuming process of collecting and monitoring paper and electronic orders and results. Despite the perception that adopting an EHR will effortlessly bring together all clinical documents into a chart, the reality is that EHR software alone does little to manage the complex and time-consuming supply chain of clinical data. Because of this complex supply chain, there are numerous pieces of data associated with a single patient encounter that don t seamlessly come together into the chart. To track labs, orders, and results, practices with traditional EHRs need to invest in the development of specialized, bi-directional interfaces. Managing the documents associated with patient visits is expensive, but it also comes with a high risk of error. What if an order gets lost or results aren t communicated back to the practice and patient? Health outcomes could be compromised. Even with EHR software, staying on top of labs, orders and results requires a significant amount of staff time. Without a closed-loop order and results management system, the cost of managing and tracking documents can be prohibitive. Myth: Doctors need to collect complete, structured data in every encounter for P4P reporting. Reality: Most P4P data collection takes place outside the exam room. Myth: Installation of an EHR eliminates the need to manage paper. Reality: The health industry is inundated with paper throughout the patient workflow (which EHR software doesn t eliminate). It s almost impossible to manage the patient workflow without having to keep track of paper.. Myth: Patient care follow-up will be driven by the available data and reporting capabilities of today s EHRs. Reality: There is no closed-loop postencounter care process because results follow-up still has to be manually initiated and tracked. 5) Patient follow-up work from orders and results involves significant cost and generally lacks process integrity. Most EHRs don t have built-in management and tracking of patient communication. This means that providers still need to initiate and manually document follow-up with patients. This creates unknown financial leakage and significant care risks for patients. 10

11 IV. There Is a Better Way While a careful economic analysis points to the failures of traditional EHR software, it also provides a roadmap for a better approach. In fact, there are several opportunities to improve the economic impact of an EHR. By enhancing revenue drivers and reducing the most significant cost burdens, a well-designed EHR eliminates the huge costs of EHR implementation and maintenance, helps the practice automatically incorporate evolving health care initiatives like P4P programs, and takes away all clinical paperwork from day one. This model truly helps the practice relieve paper congestion, improve efficiency, and boost revenue. In Exhibit 3 and in the text that follows, see how this new approach works at each stage of the patient encounter. Exhibit 3. Improving the Economics of a Clinical Encounter: A Better Way Improving the Economics of a Clinical Encounter Work/Cost Revenue Generation 1 No Up- Front Cost 3 6 All Stages of Patient Optimizes P4P Bonus Payment Workflow Process Monitored & In Control Up to 85% of data can be captured by staff during intake and orders scheduling check-in intake exam orders checkout follow-up 2 Allows Preferred Charting Mode No loss of speed 4 Efficiencies in Document Management Services & Supply Chain Savings up to $1,000 $3,000/month per provider 5 Automated Follow-Up Saves Money Savings up to $2,500 per month 1) Web-based Software at No Up-Front Cost. In this model, initial EHR investment is very low, which means that practices don t have to face burdensome financial risk. This is because Web-based EHRs do not require expensive software, hardware, or special licensing. They arrive as a specialty-specific, pre-configured system with low or no implementation fee. They provide Web-based software and upgrades at no charge. A good vendor can also build and maintain clinical result interfaces at no charge. And some vendors link EHR pricing to practice revenue, offering more than just cost reduction. That means that the vendor shares a portion of revenue earned, so they have a vested interest in the long term success of the EHR. 11

12 2) Zero Compromising of Physician Time. Some vendors delivering this type of system also provide a behind-the-scenes team of experts that regularly analyzes data coming from all the practices participating in the system. For leading vendors, this amounts to performance data from thousands of practices all over the country. As a result, they can closely monitor physician and staff time to optimize the application and provide coaching for patient throughput. What s more, this approach doesn t force physicians to become data entry clerks. First, it only captures structured data that is necessary for reporting and qualifying for incentive payments. Second, it assigns data capture to practice staff where applicable. Finally, with the flexibility built into this approach, the implementation process allows physicians to continue using paper documentation while beginning to take advantage of other EHR benefits. The vendor can work with the practice to equip physicians with the knowledge to migrate to the next phase of implementation and continue toward full utilization of the electronic chart. This means that transition onto this kind of EHR platform does not risk productivity by slowing providers down with too many changes at once. 3) Optimizes Potential of Practices to Collect P4P Bonus Revenue. A flexible, comprehensive EHR model also identifies all the programs that clients are eligible for and assists with enrollment. The system can then adjust the medical record workflow of all clients to insure the correct data is captured. For example, athenahealth data indicates that the vast majority (up to 85%) of data needed for P4P programs can be collected by the staff at intake or order entry. This suggests that for the first time staff can become a revenue generating resource, not just a cost center. And physicians no longer have to bear the burden of capturing all the P4P data. In this type of EHR, the vendor can do the necessary reporting for clients and collect payment for them. A good EHR should have 100% electronic ordering capabilities, so it not only captures about half of the required P4P data (such as labs and e-prescribing), but also sets up a closed-loop, high-integrity process for results management. Because this EHR model is Web-based, and not software-based, it turns the EHR into a revenue cycle service driven by a continuously updated rules engine. Collective clinical rules offer providers constantly updated, proactive clinical intelligence that supports increased revenues. An EHR vendor using this approach should maintain a clinical rules engine that can incorporate P4P rules so the rules automatically appear for the practice as they are needed. Also, PQRI measures can be quickly added as the Centers for Medicare and Medicaid Services (CMS) expands this initiative and increases the number of measures. The result is a constant stream of collective financial and clinical intelligence that is built into the office workflow. Denials go down, cash flow goes up, and providers have more time for patient care. 4) Full Digitization and Management of All Clinical Paperwork. Here s one of the most important differences with this kind of EHR model: from the first day the practice begins using it, the vendor should take responsibility for scanning and categorizing every incoming fax. They should match clinical documents to existing patients and patient orders, enter select data, route information to appropriate staff members, and store documents where they can be readily accessed. This helps practices automatically see the documents that need attention, from lab results to prescription renewal requests, all in one place. Critical test results are sent directly to the appropriate doctor, eliminating delays and enabling providers to get the information they need as fast as possible. This creates an automatic, closed loop system to keep all clinical information appropriately flowing. 12

13 As we have seen, results management (fax and mail) represents the single largest source of revenue leakage in a practice, averaging $1,000 $3,500 per physician per month according to athenahealth data. So vendors providing this type of EHR also send out (either electronically or via fax) reviewed and approved documents, renewals, and authorizations, freeing up staff to do more high-value work. They build and maintain electronic connections to labs, pharmacies, hospitals, and medical imaging archive systems at no additional charge. This truly eliminates paper congestion, unlike other EHRs, and improves process control. 5) Automatic Follow-Up with Patients. Vendors offering comprehensive EHR systems (those that will fully qualify for HITECH incentive payments) also provide patient communication solutions. These can generate live and automated phone calls and s to patients for appointment reminders, past due balance alerts, prescription refill alerts, disease management initiatives, and more all without the expense of valuable staff or physician time. In addition, some of these systems include a feature that automatically reaches out to select patient groups. This can be a powerful and low-cost tool for disease management with the practice s patient population. For example, when routine exams or follow-up visits are due, the practice can generate reminder calls to select patient groups. This can help with P4P compliance without added burden on the staff. It also helps improve patient care as patients receive the preventive and routine care they need. What s more, automating patient follow-up makes it easy for providers to follow best practices. Best practices are programmed into the system, and when results are in, they are communicated to the patient through a Web portal, automated phone call, live phone call, or another type of communication depending on the nature of the results. Having a system in place that can manage this efficiently and effectively helps reduce cost, remove error, and improve care. 6) Practice Workflow is Measured, Monitored, and in Control. The best EHR vendors help increase and maintain efficiency in the practice workflow. How? By helping providers apply best practices in patient throughput. This feature is largely absent from most EHR solutions. But the best EHRs are based on extensive study of the most cost-effective workflows and draw from best practices to boost efficiency and support the transition between each stage of the patient visit, from the front desk staff to clinical staff and providers. A five-stage workflow supports data capture where required for P4P reporting or meaningful use guidelines, while allowing flexible documentation of the exam where speed is a priority. What s more, because of the large amount of dynamic data some vendors regularly analyze, practices have a real-time view into the financial and clinical performance of other practices of similar size and specialty. Peer benchmarking offers opportunities for targeted improvement in workflow and practice performance. The best vendors also employ their Account Management team to monitor each practice s performance and share best practice insights. Added value through these consultative reviews means practices get regular, fresh insight about how to improve practice performance. V. The Bottom Line Traditional EHR systems focus narrowly on the physician exam, missing key opportunities to improve efficiency throughout the patient workflow. As we have seen, this approach can slow providers down and fails to automate results and order management, one of the practice s biggest staff costs. On top of that, 13

14 traditional EHRs cannot keep pace with the rapidly changing health care environment, including P4P rules and new meaningful use guidelines for EHR use, without burdening the practice with significant added costs. As a business services provider, athenahealth recognizes that what s broken are the workflows around the physician. EHRs have a unique potential to improve that efficiency, leveraging staff to maximize physician time with patients, while leaving the physician to document the exam according to his or her preferences. By expanding the power and potential of the EHR beyond the physician exam to the entire patient workflow, the burden of a successful implementation can rest more with the staff than with overburdened physicians. Thus, an EHR implementation can be a staff implementation, at least at the start, with a far more likelihood of success. athenahealth s EHR solution encompasses the entire clinical workflow from check-in to checkout. It takes away the burden of excessive data entry during the clinical exam, sets up automatic closed loop order and document management, and supports providers with a range of preferences for clinical documentation. And every step of the workflow is based on best practices for smoother practice operations. It s Time for a Better Way The HITECH Act is going to drive thousands of practices into adoption of EHRs. And with the problems outlined here, we could potentially see many practices go out of business once they start grappling with unwieldy, costly EHR systems. This kind of large-scale mandate to improve health care efficiency is commendable, but does not solve the economic problems of most EHRs on the market today. The alternative model described in this paper does address those issues. With an emphasis on the full patient encounter (not just the exam) and a focus on generating revenue for the practice, athenahealth s EHR helps providers do less work, be more profitable, and deliver better care. athenahealth: Get Paid More. Get Paid Faster. athenaclinicals SM is our unique EHR and practice management solution combining Web-based software, knowledge, and workflow management. It s a wholly integrated system that allows you to improve patient care and practice performance. With proven ROI, an emphasis on results, and unparalleled service and support, athenaclinicals keeps your practice operating at peak performance. To learn more, visit l To learn more, visit or call

15 Endnotes 1. DesRoches, C. et al. Electronic Health Records in Ambulatory Care - A National Survey of Physicians. NEJM 359(1): Rock and a Hard Place: An Analysis of the $36 Billion Impact From Health IT Stimulus Funding. PricewaterhouseCoopers Health Research Institute. April Hoffman, S. and Podgurski, A. Finding a Cure: The Case for Regulation and Oversight of Electronic Health Record Systems. Harvard Journal of Law and Technology. Volume 22, No. 1, p Fall Gans, D., Kralewski, J., Hammons, T. and Dowd, B. Medical Groups Adoption of Electronic Health Records and Information Systems. Health Affairs, 24:5, pp Miller, R. H. et al. The Value of Electronic Health Records in Solo or Small Group Practices. Health Affairs, 24:5, pp Congressional Budget Office of the Congress of the United States. Evidence on the Costs and Benefits of Health Information 15

16 2010 athenahealth, Inc. All rights reserved. athenahealth, Inc. 311 Arsenal Street Watertown, MA At athenahealth we offer integrated physician billing, practice management and electronic health record services that help practices get paid more, faster, while delivering quality patient care. To learn more about how our services can help your practice, contact us at