By John Halamka, MD
Twitter: @jhalamka
BIDMC has self-developed its core clinical information systems for many years. We certified all our applications for the 2011 and 2014 ONC criteria, attesting to Meaningful Use Stage 1 and 2 in every appropriate year. BIDMC has hundreds of person-years invested in our web-based, cloud-hosted in-patient and out-patient applications. The culture of BIDMC has always been to challenge to the status quo, to be willing to be a first mover, and to focus on value—establishing the highest quality at the lowest cost.
But the days of self-built systems cannot last forever. While we want to continue to innovate, we know that commercial vendors will be able to leverage their knowledge and capabilities to build future platforms at larger scale.
We know those platforms will need to support evolving capabilities. I have long believed that the key to the future of healthcare involves maintaining wellness across the continuum of care, not optimizing the treatment of episodic sickness in silo-ed organizations. Academic medical centers are important for research and education, but the majority of care can be delivered safely in community hospitals and practices near the home, at lower cost. The HIT software of the future needs to leverage the experience of internet centric companies, offering cloud-hosted services with a zero client footprint, easily deployable in all sites of care. There should be no special browser, desktop, or infrastructure requirements. The services should be delivered via a subscription model that can be easily turned on and off as needed. Products should include practice management, billing, a patient/clinician inpatient/outpatient shared medical record, care management, population health, and an app store of third party developed mobile products.
During my life in New England, I’ve had the opportunity to work with several professors specializing in negotiation theory. I’ve learned about the importance of aligned interests. 

athenahealth is a cloud-hosted service provider with billing, ambulatory clinical, and population health products. It has a culture of rapid cycle improvement and disruptive innovation.
For all of these reasons, BIDMC and athenahealth announced a new and unique collaboration. The collaboration between the two organizations provides athenahealth the chance to take BIDMC’s experience to a much larger audience, hopefully making a difference to providers, patients, and payers across the country. athenahealth will also accelerate its ability to develop expanded functionality more rapidly than doing it alone.
I have always served as Geneva, a neutral convener. I hope that the industry understands that I will not receive any compensation or personal benefit from the collaboration. I do not and cannot own any athenahealth stock. BIDMC will not write code for athenahealth’s new products nor receive royalties. BIDMC’s community hospitals will continue to implement the cloud hosted, web-enabled Meditech version 6.1x for inpatient support. Many BIDMC community practices use eClinicalWorks.
Over the next 5 years at BIDMC, we will select the best products and best services that meet the needs of our highly diverse network. athenahealth products will be piloted in outpatient and inpatient locations. We certainly hope that athenahealth produces excellent products but at BIDMC, we are a meritocracy and the best services at the lowest cost will win.
Just as Mayo chose Epic to reduce the number of different IT systems, BIDMC will pursue a parsimony solution – the fewest moving parts possible. That might be one vendor, but hopefully it will not be more than two.
I look forward to seeing what happens as webOMR moves from a 25 person development team to a 1500 person development team.
The future belongs to social, mobile, analytics, and cloud. The transfer of our self-developed software to athenahealth will give the industry a unique opportunity to explore the cutting edge of the possible.
John D. Halamka, MD, MS, is Chief Information Officer of Beth Israel Deaconess Medical Center, Chairman of the New England Healthcare Exchange Network (NEHEN), Co-Chair of the HIT Standards Committee, a full Professor at Harvard Medical School, and a practicing Emergency Physician. This article was originally published in his blog Life as a Healthcare CIO and is reprinted here with permission.