Open vs Closed EHR Systems with Jonathan Bush

Yesterday I had a video interview scheduled with Jonathan Bush from athenahealth. It was going to be broadcast live on my burgeoning EHR Videos website (Subscibe for EHR Video Email Updates) using the Google Plus Hangout technology. Everything was set until Google Plus HOA (Hangouts On Air as they’re called) wouldn’t load. It was a system wide problem and so we were unable to broadcast the interview. However, Jonathan and I were able to see each other and so we just did a more traditional interview about the subject of open vs closed EHR systems.

As you can imagine Jonathan had plenty to say on the subject of open versus closed EHR systems. We started the discussion discussing the business model of closed EHR systems and how looking at many EHR companies that seemed to be a very good business model. I asked him what was so bad about being closed.

Jonathan then told me that a closed EHR system is a great business model for the software vendor if you can get it. However, he said that as the product category matures the closed systems will get disrupted by more open options. In fact, at one point in our conversation he suggested that once some of the players become truly open, the other EHR vendors will have to follow along.

I was offered one caveat by Jonathan. He was curious if Epic was the exception to this rule. He wondered if Epic had so much money that they could last well beyond most companies. This cash could provide them the runway and opportunity to reinvent themselves along with those companies trying to disrupt them. Although, the most powerful comment made in regards to Epic was when he suggested that Epic has clients that benefit from Epic’s closed nature as well.

Another powerful comment he made was, “Affordable sounds like decline.” The concept is really interesting. Basically, so many EHR vendors have been able to charge an outrageous premium with amazing margins for their EHR software. If they were to choose to lower their price, many could misinterpret that decision as the company cutting prices to increase sales that have dropped off. Certainly the argument can be made that EHR vendors don’t need to charge what they do. However, image is important and could be influenced by a price drop.

While it’s always fun to talk about Epic with Jonathan, I also pressed him on why athenahealth wasn’t more open in the things they do. Couldn’t some of the same arguments made against closed EHR systems be applied just as easily to athenahealth? For example, why isn’t the athenahealth API more open?

In one of his more contemplative responses, Jonathan acknowledged that athenahealth was heading down the path of closed EHR systems. He saw that they were headed in a similar direction with their business model and so they had to decide if that’s the direction they wanted to continue or if they wanted to move towards a more open EHR model. He mentioned their More Disruption Please program and how the number of companies they were working with in that program was a sign of their move to be more open.

Jonathan admitted that the athenahealth API wasn’t where it should be, but that the goal was to have an API for every surface area of athenahealth. I wish we had this comment on video so we could really hold him to it. I love the idea of every surface area of an EHR being available through an API.

I also pressed Jonathan a little bit about CommonWell and whether it would be open to everyone and anyone that wanted to participate. He responded, “We expect every single maker of health information technology to obtain a key for every patient they have and see where that patient has been.” That was a pretty broad statement about openness. He did suggest that CommonWell was the right approach of knowing where the data was stored as opposed to storing every single person’s data in every clinic. It had to be a distributed patient records model.

Jonathan did also tell me that they’d recently got a call from Epic to work with them to build API connections with all the information in Epic. We’ll see if this is a step towards a more open Epic. Although, it still seems to follow the same pattern Judy discussed when she called Epic the most open EHR system she knew. She’s ok opening up with strategic partners.

I ended the conversation with me asking Jonathan what could be done to make the business model of being open work in healthcare. He mentioned two topics that deserve more time and their own dedicated post: a repriced athenaclinicals based on order and anti kick back laws as an obstacle for exchange of information. Both were preventing a market for health information. Our time ran out so I couldn’t dig into these subjects more. I’m going to see if Jonathan or someone from athenahealth would be willing to do a couple future guest blog posts on the subject.

As you can see, I covered a lot of ground with Jonathan in the 10 minutes we had. Imagine if we’d had the full 30 minutes. Plus, you could have heard it straight from him. I’m certain we’ll be inviting Jonathan back for another interview in our series of EHR Videos.

About the author

John Lynn

John Lynn

John Lynn is the Founder of the, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference,, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


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