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The swearing in of Donald Trump as the 45th president of the United States on Jan. 20 will kick off a shared New Year’s resolution for many industry lobbies: gain access to the new administration and influence it. The health care technology lobby, for one, will begin bending the new president’s ear on subsidies and federal mandates to prop up their businesses. But if Trump creates new bonus programs in 2017 for doctors to do much of anything — let alone buy more software — you’ll be able to knock me over with a feather.

One real fear as the Trump administration takes office is that the political discourse on health care will shift completely to repealing and replacing the Affordable Care Act, and we will lose sight of the very real fight to keep the digital age from bypassing health care entirely.


I do not want to let health care off the hook. 2017 should be the year in which the legacy information technology solutions used by so many health care providers hear their death knell, and health information networks begin their ascendance.

The health care industry, for which we pay dearly and on which our lives depend, is clinging desperately to expensive and outdated software that doesn’t earn providers or patients much in return. Despite billions of dollars of federal investment to digitize health care, the daily experience of it feels unchanged since the 1980s. Medical science and procedures have advanced, but there has been little progress eliminating the clipboards, faxes, and basement servers that continue to keep the business of health care on life support.

Health care is not really an exceptional business. It is fundamentally no different from other industries, like banking, retail, hospitality, and travel, except that they have run headlong towards the information economy. Disruptors like Uber, Waze, and Airbnb have turned their respective industries on their heads with smart, delightful applications that tap into the power of networks to leverage data for the benefit of their users. Health care can and should embrace the automation, knowledge, and resource orchestration that have defined these innovations.


What is exceptional is the opportunity we now have to conscientiously guide, build, and inform Internet-enabled, networked health care.

We have some early ideas of what this could look like from one of the stodgiest, most unlikely players in the industry: hospitals. One need only look at the beds that routinely go empty in today’s hospitals and academic medical centers to notice that consumption patterns are changing. Patient care is streaming outside hospitals’ walls into urgent care, retail clinics, telemedicine, and outpatient settings.

In response, pioneering hospitals are redefining themselves from organizations that deliver care to organizations that also orchestrate resources. They offer mobile connections; share information between providers and patients; connect to downstream labs, pharmacies, and imaging centers; and close the loop on care not just because it’s the right thing for patients but because it’s good for quality and cost. It will also help them reap big rewards in the transformation to value-based care.

The Uber of health care today is not a sexy Silicon Valley startup. In my estimation, it’s Lost Rivers Medical Center, a 14-bed community hospital in central Idaho near the Sawtooth National Forest. In the US, 35 percent of rural hospitals are currently operating at a loss. Lost Rivers was among them. But when it was on the verge of bankruptcy, it made the audacious decision to scrap its servers and clipboards and to plug into the knowledge, insight, and efficiency of athenahealth’s growing network of 85,000 providers and 83 million patient records.

Tapping into the power of the network has helped the medical center automate work for its providers and organize, scale, and automate its administration to decrease work and limit the potential for error and deviation. It also dramatically lowered the number of claims denied, and shortened the time it takes to get reimbursed, boosting cash flow. That means money gets back into the medical center’s hands quickly, and can be directed where it’s needed most — whether that’s initiating, delivering, and administering clinical care within Lost Rivers’s four walls or orchestrating resources outside them.

Here’s the beauty of the network: Unlike a politician’s promises of progress, a network progresses inexorably. It grows more knowledgeable daily and shares that knowledge, like dividends, with its users. Embracing the network model will influence the way that providers and leaders understand health care today, while they continue to build the health care systems of tomorrow.

Health care practitioners and organizations of all sizes need real-time information and connection to learn from and share information with one another. By embracing the network, the insights made each day by providers and patients and payers will, over time, become the industry’s insights.

The network effect is already taking hold in corners of the health care market. In 2017, I predict that the rest of the industry will finally begin to take note. Not all software lobbies will like it, but providers and their patients will.

Jonathan Bush is CEO and president of athenahealth, a health care technology company based in Watertown, Mass., and author of the New York Times bestseller “Where Does it Hurt? An Entrepreneur’s Guide to Fixing Health Care.”

  • @Matt,

    I appreciate the thought you put into your comment which I perceive as balanced among various perspectives. One of the interesting angles is that while there is pressure put on the physicians to achieve patient satisfaction scores there is no such pressure put on their superiors to achieve satisfaction scores from their physician employees.

    Let’s look at how this can be a problem. I work in addiction medicine and telling patients what they do not want to hear is rather common. The Motivational Interviewing model helps me to do that in a way that enables me to avoid confrontation or blaming and helps myself and my patient work as a team. However, there are occasions when the patient is, for whatever reason, determined to be nasty. They usually come around in a session or two, but they are extremely upset initially. I work in private practice so I don’t have to worry that if I make the patient angry then they will fill out a negative evaluation and I will be dinged for protecting them from themselves. Because I don’t have to worry about that I am less stressed and therefore MORE effective at reducing the tension with a difficult patient.

    When the physician does not experience the administration as having their back, then their stress level is much higher and they are LESS able to handle difficult patient situations effectively and harmoniously. I see this as a major problem in the way the service model is being implemented in medicine.

  • @Patrick,

    Here is one difference between medicine and other services industries. In other service industries the service provider is to present the customer with what the customer wants as long as the service is paid for. However, in medicine, the customer often wants what is unhealthy for them (addictive medications, unnecessary tests, etc.) and it is the obligation of the health-care provider to refuse to provide the service, even if that upsets the customer. Essentially the health-care professional is working in the service of the patient’s health, not of the patient’s desires. That is but one key difference.

    It is rather humorous imagining other service industries using this model.

    For instance, a customer is seated in a restaurant and orders dessert. The waiter looks at the customer’s expansive midriff and says “You are too heavy and dessert will not be healthy for you, so I won’t take your order.”

    • @Joseph n @Patrick

      You both make valid points. To Patrick’s emphasis, healthcare just like other service industries does have customers (we call them patients, staff, providers and administrators; they are all customers or stakeholders to their own extent). In fact, the value of the customer’s perspective is deemed so important it is one leg of the Triple Aim put forth by CMS and hospitals are graded and to some extent paid based upon customer service scores aka Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores. Customer service training such as Ritz Carlton programs are becoming popular for employeed physician groups as a result of the priority being placed on the customer service component of our industry.

      And to Joseph’s point, unfortunately or customer doesn’t always want what’s best for him/her, and we often spend countless minutes, hours of our day trying to educate or otherwise communicate the reasons why. Joseph is correct, we are not always selling a service that is desired by the customer. I could not have provided a better or more humorous example than provided by Joseph. As a physician, I often find these conversations exasperating and demoralizing, which points all the more to the importance of customer service training and learning how to get that message effectively delivered to a resistant receiver in a fashion that maintains dignity, respect and clarity as well as ultimately achieving high HCAHPS scores.

      With all that said Mr. Bush’s intent is to sell his product. That’s the real ask in this article. Not a debate as to whether or not healthcare is akin to other hospitality industries. And to that end, he’s correct in that healthcare, especially hospitals and healthcare systems, have been slow compared to other industries to adapt to the internet of things (IOT). If we could make this hurdle, then the advantage of computers and the speed of business could be harnessed for the good of all the stakeholders in this quagmire known as healthcare. And to jump that hurdle there are some regulations that need to be adhered to (HIPAA to name one elephant in the room) and others that may need to be reassessed by decision makers of our national policies as suggested by Mr. Bush.

      I feel the most salient statement of the whole piece is:

      “Tapping into the power of the network has helped the medical center automate work for its providers and organize, scale, and automate its administration to decrease work and limit the potential for error and deviation. It also dramatically lowered the number of claims denied, and shortened the time it takes to get reimbursed, boosting cash flow.”

      If we all (those of us in the healthcare arena) aspired to this outcome as a collective whole and achieved the same results, I believe we could hit the Triple Aim of improved healthcare quality, at a lower cost with enhance patient experience/satisfaction in the bullseye. Every stakeholder in the Lost River example is a winner. And that’s customer satisfaction on many levels.

  • Well I sort of agree that for the most part Health Care is not an exceptional business, with the one glaring difference being that you have to repeatedly tell your customers things that they absolutely do not want to hear, and sell them a product they often feel has no immediate value to them, and that they do not really want, We are the only business in which it is almost a sure thing that if we are making everyone happy, we are doing a terrible job. If only every individual was forward thinking enough to engage in their wellness care…….and if frogs had wings, they wouldn’t bust their asses hopping. From the patient’s perspective, the healthcare business is rather like the business of selling them overpriced rocks, which is why so many of them despise mandated insurance coverage. Often we have to drag them kicking and screaming to a healthier way of life. So yes we are different in that respect, and it is a pretty big difference.

  • From the article “Health care is not really an exceptional business. It is fundamentally no different from other industries, like banking, retail, hospitality, and travel, …”

    This statement is absurd and if the author cannot provide proof of it then I have a hard time trusting him on other points which are not so obviously false.

    • At their core, these are all service level industries, servicing both the individual and companies, and in their worlds, each with their own regulations, theybuse networkd to share information (internally amongst their remote locations).

      Can you elaborate on what you believe to be absurd about that statement?

  • Great piece. Completely agree. This insight “Health care can and should embrace the automation, knowledge, and resource orchestration that have defined these innovations.” was spot on. Are hospitals the “digital hub” for health care in the future? If that is the case, then consolidation of physician practices, consolidation of hospital systems, makes sense…

    Can startups do the same thing with automation, but enable care outside of a hospital? Or should a start-up mindset exist and flourish inside an existing incumbent?

    Time will tell.

    Davis Liu, MD
    Chief Clinical Officer
    Lemonaid Health –

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