Athenahealth Inc. made news last week when it purchased mobile apps vendor Epocrates Inc. CEO Jonathan Bush says the move is about more than just gaining access to Epocrates' user base of several hundred thousand physicians. In an interview, he described how the Epocrates apps, which are nearly ubiquitous among physicians, could be used by doctors to order tests and update patients' electronic records in any EHR [electronic health record] system. This would mark a major turn from the traditional role of Epocrates products, which function as an information resource. Bush hopes it will also move the industry away from the enterprise EHR model.
Of course, there will be challenges. Just ask Mark Zuckerberg, CEO of Facebook, about how users react when a company makes changes to popular applications. And figuring out how to blend Epocrates' apps with athenahealth's existing offerings may take time.
Why did athenahealth make the move to buy Epocrates?
Jonathan Bush: It was the brand. It was the awareness level and the favorability level. Ninety percent of doctors are aware of the Epocrates brand and the favorability is almost as high. We have 87% favorability among those who know about us but our awareness is 30%. Our biggest obstacle as a company [and people ask, 'what keeps you awake at night'] is the sound of doctors signing contracts for legacy software having never learned that you can do it in the cloud. We now have the opportunity to cross that bridge and get over that obstacle.
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What will be the biggest obstacle to integrating Epocrates' apps?
Bush: The biggest obstacle we will face is that we are so used to shouting very loudly to get attention, and all of a sudden we have this giant microphone. If we shout into that microphone, it's going to turn off doctors.
This brand is trusted because it is very carefully curated. Doctors are protected from noisy, untrue or generally self-promoting content. And so our biggest nightmare scenario is that our marketers and culture of 'damn it, you need to know about us,' actually corrupts the user base by being too loud. The thing that could go most wrong with this deal is that we would actually overuse it too quickly and turn off doctors.
How will you integrate Epocrates' apps into athenahealth products?
Bush: Epocrates is going to remain separate, but it's going to be surfaced and visible and usable inside athenaClinicals pretty quickly. So if you happen to be on athenaClinicals, Epocrates will be inside it. Everybody who's got Epocrates can continue to get Epocrates. We're not going to do anything with that besides continue to invest in content and maybe add new research tools. Right now, the research tool is strictly looking up drugs, but we might try to add a research tool around diagnostics or procedures.
You often talk about trying to build a "health information backbone." Where does Epocrates fit into that?
Bush: Epocrates today is a read-only application. It's just content, but it's everywhere. Epocrates accounts are owned by individual doctors, not by systems or medical groups.
The thing that could go most wrong with this deal is that we would actually overuse it too quickly and turn off doctors.
Many doctors may have an appointment at the university, a private practice on the side and maybe do some consulting or speaking on their own. You have three or four identities where you find a doctor. Historically we have sold to systems and organizations, not to the doctor. Epocrates is attached to the doctor no matter what situation he's in. And that's read-only, it's his pocket research assistant.
What if he could do his ordering and his medical record stuff in that pocket regardless of what setting he's in? When he's at the university he's on Epic, when he's in his private practice he's on athenaNet, when he's teaching or doing research he's on some homegrown system, but he's always using Epocrates to upload to those systems, to write to those systems.
It sort of ends the idea of enterprise software as the point of control. Now the doctor has an agent, an avatar, that can play inside the hospital system, inside the private purchase system or just independently. So that's the ultimate form of this, where each doctor becomes the sender and receiver without actually being in any EHR system. Eventually, the universities will say 'screw this. Why don't I just get rid of Epic and have it all be in athena?'
Is this how you think the industry should operate? More broadly?
Bush: This is exactly how things should go. Anything else would be wrong. Whether it's athena or not, that model of a marketplace is what should happen. There should be a free and open and sustainable market for health information exchange that allows doctors to go where the best place is and for patients to go to the best place. The national health information backbone is only brought to life by a sustainable market for health information exchange.
What Epocrates represents is a Knights of Malta passport. You can go to any country you want. You can go to any setting you want, and your information will follow you. And, over time, that's the way it should work. If the hospital wants to keep itself on some tired old Epic system they can, but over time those things will just die away as doctors increasingly stay on the cloud. I don't know if that will ever completely happen, but my sense is that the next five years is when the spike will happen, when the preponderance of decision making moves in this direction.
This was first published in January 2013