Since being taken private in 2019, electronic health record vendor Athenahealth decided to make its R&D organization more focused on its core business. The Massachusetts-based vendor, which had struggled in an increasingly competitive healthcare IT landscape, chose to refocus on the ambulatory market, giving up competing with large rivals like Epic and Cerner for hospital market share.

To that end, management communicated with customers to understand the day-to-day operations of independent physician clinics in the ambulatory space, and made a series of targeted investments based on physician needs. Athenahealth transformed its Austin office into an R&D center focused on improving patient and physician experiences and addressing pain points in existing tools.

Those investments began to show results in 2022. Athenahealth plans to release a "series" of new products this year, including its first patient-facing application. Chief Product Officer Paul Brient disclosed this to Healthcare Dive on the sidelines of the HIMSS annual conference in Orlando on Tuesday.

Brient also shared his views on government-driven interoperability policies, how they affect frontline physicians, and how the 25-year-old company is modernizing its EHR to alleviate the growing burnout among U.S. healthcare workers.

Consumerism drives patient app

"Strangely, when I joined, there wasn't much discussion about patients. But in the healthcare system, they're quite important, at least in my experience," said Brient, who has been at Athenahealth for about three years. "If you go to any health system or provider, it feels like stepping back in time. You have to call to make an appointment, they print out a bunch of materials for you when you leave, and when you arrive, they hand you a clipboard full of writing. I thought, why are we doing this? It's 2022."

Athenahealth plans to launch a patient engagement-focused app this year, aiming to extend the care experience beyond clinical encounters. Currently, Athenahealth's patient portal is accessible on mobile phones, but the company hopes to go beyond that model to offer more targeted and comprehensive tools.

"How do we make patient engagement a 365-day-a-year thing? Having an app would obviously help us achieve that goal," Brient said.

The patient app will include secure messaging, appointment scheduling and management, and bill payment services.

As the 21st Century Cures Act and recent HHS regulations push for increased interoperability, providing complete clinical records to patients—which Brient notes is controversial among physicians because patients may see notes and results without context before clinicians do—Athenahealth hopes to create an app more comprehensive than traditional patient portals.

The app will also allow patients to view and collect information from connected devices and venture into care management territory.

During the pandemic, the digital patient engagement, coaching, and management space grew rapidly because COVID-19 restricted access to physical care teams.

The company hopes the app will serve as a platform for overall engagement—more modern and user-friendly than Athenahealth's care management app AthenaWell, which has faced adoption challenges.

"One service we're launching this year is care management. We'll have nurse care managers helping clinics manage patients," Brient said. "You can imagine combining that with an AI chatbot for interaction—patients receive a question from the chatbot in the morning: 'How are you feeling today?' ... 'Oh, I feel terrible this morning.' Then next thing, a care manager calls you."

Divisions over information blocking rules

HHS issued two comprehensive rules in early 2020 aimed at driving the industry toward free, unhindered health data sharing among different entities. Before the rules were issued, there was significant debate over patient access and healthcare data security, as well as how to push deeply entrenched IT operations toward more open architectures.

In April of this year, the main provisions of the rules took effect, requiring hospitals and certified health IT vendors to share data with patients and each other. But physicians still have concerns about how the rules are implemented—and Brient, a longtime software executive, expressed similar views to Healthcare Dive.

"There is indeed a school of thought that simply providing lab results, imaging studies, and my notes to patients without context, or frankly, without giving me the opportunity as a physician to review them first, creates unnecessary anxiety," Brient said. "The opposite view is that I can go to LabCorp right now and get any test I want. Consumerism is happening in all sorts of ways. If I want an HbA1c test, I can go myself, order it, interpret it myself, and Google to figure it out. So I think there's a tension and a shift here."

This anxiety can also manifest as additional workload for healthcare staff. As the pandemic enters its third year, healthcare workers report record levels of burnout. Brient noted that small studies suggest open notes seem to increase call volumes at clinics, as patients raise questions about issues in the data.

"It creates more work. But like everything, it will evolve, and we'll find effective ways," Brient said. "Personally, I don't think it's good. I don't think regulators thought it through."

Brient stressed that giving patients access to their records is crucial, but implementing it as per the rules requires significant changes in how physicians write and disseminate notes.

This could lead to physicians creating some kind of private, protected, non-medical-record communication among themselves, the executive hinted.

"I wouldn't be at all surprised if a new concept emerges that isn't a note but rather private content written by physicians for other physicians," Brient said. "There are things—if you're caring for someone in the hospital, you need to discuss, like 'Hey, the mother-in-law is a bit crazy.' You don't write that down, but if you're the next person on shift, that information is very important. So if something like that gets developed, I wouldn't be surprised."

Easing click fatigue

As Athenahealth reshapes its products around ambulatory customers, the company is also taking steps to alleviate burnout by personalizing records for specific physicians.

Less than a decade ago, government mandates drove rapid adoption of EHRs in healthcare. Although EHRs streamlined care continuity, billing, and administrative functions, physicians still describe EHRs as a "major pain point."

Athenahealth's EHR is popular among physicians, but "it's a bit like the one they hate the least," Brient said. The goal is to make it like an iPhone. "You love that thing. You might have some things you don't like about it. But our goal is to get the EHR to that level, and it's entirely feasible."

Historically, EHRs adopted a one-size-fits-all workflow, requiring physicians to undergo training, which is both costly and time-consuming. To address this, Athenahealth is investing in EHR configurability, specialty-specific workflows, and even individual preference workflows, Brient said.

"There are fundamental differences in how physicians use EHRs. An important point is: do you type? Some physicians type very fast and love typing. Some physicians type 10 words per minute and hate typing. So that's a very important thing for the EHR," Brient said.

Other factors include differences in physician device preferences, whether they like voice-to-text features, and whether they want to access the EHR in the exam room.

"Over time—this isn't today—but over time, when we implement for physicians, our goal is to ask them five or six similar questions. The system will automatically configure for that type of physician. Then we won't need to train them," Brient said.

Athenahealth is working to roll out this customizable EHR for certain specialties within the next three to four years, Brient said.

In the years before the pandemic, adoption of tools like voice-to-text and AI-assisted clinical documentation grew in healthcare to streamline note-taking. Athenahealth is also interested in this area, Brient said, noting that leveraging AI is key to unlocking a delightful physician experience.

Athenahealth now has a dedicated division applying AI to clinical workflows, whereas three years ago, the company only used AI in back-office, claims-processing financial functions.

On the clinical side, Athenahealth is exploring the use of AI to reduce tasks like data reconciliation, inbox management, and workflow experience.

"If we understand how you work, know what you're doing... know what you're looking at, that's great. We'll put those on one screen; the things you want to do, we'll put them there," Brient said.