Online Extra: Crusader for Clearer E-Info

Entrepreneur Jonathan S. Bush -- yes he's related -- discusses how Web-based medical records can become a workable reality

Jonathan S. Bush serves as CEO of athenahealth, a Waltham (Mass.) company he founded in 1997. The business offers a Web-based system for managing physicians' back-office processes like insurance claims processing. The entrepreneur, a first cousin to President George W. Bush, isn't afraid to speak out about the U.S. government's goal of establishing Web-accessible electronic health records for every American. Jonathan Bush spoke recently to BusinessWeek science writer Arlene Weintraub. Following are edited excerpts from their conversation:

Q: What do you think of your cousin President Bush's plans to have all patients' medical record automated and put online, so wherever anyone goes for medical treatment, his or her entire medical history will be accessible at the click of a mouse?


I love the idea of the electronic health record. But I'm sure it won't be adopted. And if it is, it won't work.

Q: Why not?


There needs to be more investment on the process side. Physicians and hospitals can't get the easy things done. They can't get their claims paid. Some of them don't know basic things, like what their revenues are. We need to find some way to make those capabilities available to everyone.

Q: So you don't think all the software that's out there to create electronic patient charts can do the job?


Software isn't the solution. A lot of tinkering has to happen to make sure a hospital's or physician's business processes work properly so they can take advantage of the technology. Hackensack University Medical Center, for example, has people patching all the things in the electronic medical records together. They got religion, and they're going crazy and that's great. But what they really should get credit for is adapting their business practices to make the technology useful.

Q: Skeptics says doctors are technophobes who are resisting the adoption of electronic medical records. What do you think?


Not true. These guys do surgery on your heart via remote control. They look for solutions for noninvasive surgery in new devices. It's their job to [use technology]. It's not their job to futz around learning the details of every one of Aetna's 2,000 benefits packages.

Usually there's some paper pusher in the doctor's office doing that in her head. But that information needs to be online, because it changes every week. We're trying to provide virtual back-office systems to do that for medical groups.

Q: How does your technology ease the process for physicians' offices?


Say a patient calls to make an appointment. The person who takes the call might not know that the patient needs a referral. Our technology watches as that appointment is being made and corrects mistakes along the way. The technology interacts with the work flow. It automatically alerts the office that this person has the cheap version of Aetna, so they need a referral.

Q: One obstacle to e-health often cited by experts is that federal law prohibits hospitals from giving financial incentives, or "kickbacks," to doctors in return for referring patients to that hospital. That means hospitals can't buy computers and other equipment for doctors to use in their private practices outside the hospital. And the cost to put such a system in place could be tens of thousands of dollars.


How can it be O.K. for a hospital to have electronic medical records, but then not be allowed to pay for its doctors [to have access to them] when they're outside the hospital? The government needs to make some changes to make this wheel spin faster.

Q: Do you think the U.S. government is giving health-care providers enough support -- financial or otherwise -- to go digital?


I'm thrilled George put $125 million into the budget. But that's just a drop at the bottom of a bucket. He's got to do more than just focus on driving adoption of technology. He's got to focus on developing unifying standards and on including clinical information with claims processing, and so forth. I hope they make this a high priority.

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