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Jonathan Bush of athenahealth in media spotlight

Jonathan Bush, CEO of athenahealth Inc., is the pre-eminent personality in the EHR vendor universe.

A new Fortune profile of the mercurial businessman, cousin to a former president and nephew to another, paints his company’s recent More Disruption Please startup conference in Maine as a frathhouse-like corporate gathering complete with Bush hijinks such as wild ATV driving and drinking games.

And while the piece quotes admirers of athenahealth’s cloud-based, open architecture approach to health IT and of Bush’s entrepreneurial spirit, writer Jen Wieczner also gives plenty of attention to critics, such as hedge fund manager David Einhorn, who openly short-sold athenahealth stock and drove down its price.

Meanwhile, Bush’s memoir, Where Does it Hurt? An Entrepreneur’s Guide to Fixing Health Care, came out last spring and is an entertaining window into the sometimes wacky workings of the 45-year-old’s brain.

The book chronicles Bush’s journey from diffident college student to New Orleans ambulance driver to improbable founder of a failed chain of women’s health and birthing centers. Eventually he started an electronic medical billing company, which is how Watertown, Mass.-based athenahealth began in 1997.

Indeed, Wieczner depicts athenahealth as still largely a medical billing operation, even though the $5 billion company has positioned itself as the leading cloud EHR vendor. Bush and other athenahealth execs have pointedly and as being closed, un-interoperable systems that ultimately don’t serve patients well.

Wieczner notes that athenahealth’s billing system has only 5% to 7% of the ambulatory market and its EHR less than 3% of the ambulatory clinical market. However, she also points out the company’s remarkable growth, with an average annual revenue gain of 32% (even though that performance has tailed off lately and the company has said it expects to lose money in 2015).

For Bush, however, it is actually athenahealth’s More Disruption Please online marketplace — on which other companies sell health IT products and services and give athenahealth a hefty cut of every sale — that is a key part of the company eventually becoming a kind of national standard or “backbone” of the health IT industry.

I interviewed Bush and watched him give a dynamic speaking performance at a connected health conference in Boston in October.

He strode the stage like a rock star, drawing repeated laughs and energetic applause from the audience with often humorous and sometimes risqué calls for more iconoclasm and risk-taking in health IT.

In my brief chat with Bush, he furiously munched on fruit while criticizing both Democrats and Republicans for being too big government-oriented, but declined to directly take on ONC, which his cousin, former President George W. Bush, established by executive order.