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I should admit that I am biased with several friends at athenahealth, including Bush... and they fund some of my Open Data work.... With that out of the way..

The killer thing about athenahealth is their overall model. They do not charge a flat fee for their services, but instead take percentage of their clients billing. That change incentives has a cascade of really cool effects, the first of which is the most obvious. They have a huge incentive to get your billing improved, and their fees are frequently offset by how much they improve your billing.

They do this by applying Cloud scaling and Big Data techniques and they have been done that way before Health IT has any idea what either of those things were. They are a clearinghouse too, which the reason that they can get the network effect coming from all of their clients billing data.

More importantly, they consistently take solid ethical stands on health IT... like breaking up with EHRA and pledging not to trap client data with a code of conduct. they, along with Allscripts, have bet heavily on a mature API play for third parties. Allscripts and athenahealth are not the only people with "an app store" for clients, but they are probably the only ones to have useful stuff in the app stores... athenahealth are leaders in Meaningful Use 2 adoption, and they publish their internal metrics on how their clients do with Meaningful Use scores. I don't know of another vendor who does that.

All of that is distinct from normal Health IT industry bullshit.

I know people at just about every vendor and I can tell you that the whole industry is fully of top-notch people... true believers... but athenahealth really takes risks as an organization that I respect. I suspect this is a top-down thing, with Jonathan Bush and his C-level suite consistently creating an environment where doing the right thing because its the right thing is corporate culture. Jonathan wrote a book that is worth reading. Jonathan is a genius and he knows it clearly an arrogant dude. (Of course me saying that is clearly... clearly.. the pot calling the kettle black). I like to think of him as the "internally consistent Bush".

Not everything is rosy with athenahealth. I am generally uncomfortable endorsing proprietary EHR companies, but efforts like OpenEMR remain scattered and inconsistent in quality (just look at the OpenEMR logo... it tells you everything you need to know). This is a catch-22, Open Source EHRs need adoption to get good and they don't get adoption because they are not as good. While athenahealth has a very strong billing offering, and their clinical components were bolted on after. While billing chops make them popular, I worry that this hampers their capacity to be a great clinical system. This is a problem for the whole industry, as CPT drags the quality of the clinical data into the toilet, but it is implicitly a bigger problem for athenahealth. They are outpatient focused, and are not a player in the hospital space. They are not always as awesome if you have to do organizational billing. Of course "not awesome" is basically industry standard in health IT. This is why the idea that they are buying IP in the hospital space is so interesting. They are clearly trying to shore-up where they are weak.

As far as you "have a locally installed EMR that is working fine, we just need training." This is an oxymoron. If you need training it isn't working fine and if its working fine you don't need training. There is a fundamental disconnect between your view of the world and your "C-levels" view. Frankly, I suspect that both of the views in question are substantially unrealistic. (Nothing personal.. its an industry-wide disease). While I can certainly endorse athenahealth as a vendor, it sounds like your organization is only half-committed to an EHR strategy in general. Even worse (continuing to presume that you are typical healthcare organization) I seriously doubt that you have an institutional understanding of what "fully committed" looks like (although you personally might). No matter what your organization decides in the end, this strategy will fail in the long term. One of the reasons that Epic is so successful is that they do not even begin to put up with bullshit like this from clients. You cannot even buy Epic without getting properly trained. No one ever, ever, ever is in a position to choose whether they are fully committed to Epic, which is why they have the track record, which is why they dominate in large hospital installs.

I accidentally wrote this when I should have been coding, and once I start ranting I just cannot stop.. but this post has some fairly good shit in it, so I will probably blog it later. Since it is one of my better rants, I don't mind "signing" it for a little extra weight.

Fred Trotter Author of Hacking Healthcare

(Edits: added more ranting for clarity and because I am still learning the reddit formatting)

The other posters are pretty spot on, so I'll skip to providing some pointers.

Healthcare is filled with tons of niches, so you may want to zero in on the types of data this company deals with. E.g. Radiology is its own world with the RIS/PACS, DICOM, Modalities, same with Pathology, etc.
Hacking Healthcare provides a pretty nice overview, so you could take a look at that (O'Reilly sells it as a PDF if you need it ASAP).

Some things you may want to look into more (at least wikipedia / google a bit):

• HL7 -- Is the way clinical data moves around. The older 2.x format is so entrenched in many areas that it worth knowing. It is a pipe-delimited format with message types (the common ones I see are ADT for admissions, discharges, & transfers, and ORM/ORU for Orders and Results, respectively). The 3.x version is XML-based. The CDA from v3 is useful. FHIR is definitely awesome, but still so early that effectively no systems I know of use it yet.
  
• Common coding systems: CPT (the procedure) & ICD9 (why was a procedure ordered) are common.
  
• Ontologies such as UMLS/SNOMED, LOINC, RadLex, ... many domains have their own terminologies.
  
  At the end of the day, healthcare is complex (whether that complexity is actually warranted is a discussion for another day), so I'm sure a healthcare analytics company would love someone who could hit the ground running. But the fact of the matter is that healthcare is in desperate need of people who can help make sense of the tons of data we are now generating. A quick learner who can learn from "domain experts" (the physician exec) would definitely be useful.

Read everything you can about IHE, DICOM and HL7. Knowledge of rules, regulations and guidelines related to imaging informatics is likewise essential.

Focus on information technology such as obtaining your MCSA (Microsoft desktop and server administration certification), CCNA (Cisco routing and switching certification), VCP (VMware certification) or OCP (Oracle database administration certification). Your local community college may be your best resource.

Knowledge of ITIL, project management (PMP), Lean, Six Sigma and software development methodologies (Agile, Kanban, Scrum and waterfall) is helpful.


https://www.abii.org/About-PACS-Administrator.aspx

https://www.abii.org/docs/Certification-Guide.pdf

http://siim.org

http://siim.org/?page=ciip_study_resources

http://siim.org/?page=pii_textbook

http://www.otechimg.com

http://ihe.net

http://ihe.net/Resources/upload/ihe_radiology_users_handbook_2005edition.pdf

http://medical.nema.org/standard.html

http://www.hl7.org/implement/standards/index.cfm?ref=nav

http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/index.html

http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/index.html

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html

http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/default.htm

http://www.acr.org/~/media/AF1480B0F95842E7B163F09F1CE00977.pdf

http://www.acr.org/~/media/3E08C87AD6E6498D9E19769E5E5E390D.pdf


http://deckard.mc.duke.edu/pdf/Samei-TG18.pdf

http://www.amazon.com/Practice-System-Network-Administration-Edition/dp/0321492668

http://www.pmi.org

I will warn you that imaging informatics as a field has sufficient breadth and depth that few, if any, will ever master the field.

Read everything you can about IHE, DICOM and HL7. Knowledge of rules, regulations and guidelines related to imaging informatics is likewise essential.

Focus on information technology such as obtaining your MCSA (Microsoft desktop and server administration certification), CCNA (Cisco routing and switching certification), VCP (VMware certification) or OCP (Oracle database administration certification). Your local community college may be your best resource.

Knowledge of ITIL, project management (PMP), Lean, Six Sigma and software development methodologies (Agile, Kanban, Scrum and waterfall) is helpful.


https://www.abii.org/About-PACS-Administrator.aspx

https://www.abii.org/docs/Certification-Guide.pdf

http://siim.org

http://siim.org/?page=ciip_study_resources

http://siim.org/?page=pii_textbook

http://www.otechimg.com

http://ihe.net

http://ihe.net/Resources/upload/ihe_radiology_users_handbook_2005edition.pdf

http://medical.nema.org/standard.html

http://www.hl7.org/implement/standards/index.cfm?ref=nav

http://www.hhs.gov/ocr/privacy/hipaa/administrative/privacyrule/index.html

http://www.hhs.gov/ocr/privacy/hipaa/administrative/securityrule/index.html

http://www.hhs.gov/ocr/privacy/hipaa/administrative/enforcementrule/hitechenforcementifr.html

http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/default.htm

http://www.acr.org/~/media/AF1480B0F95842E7B163F09F1CE00977.pdf

http://www.acr.org/~/media/3E08C87AD6E6498D9E19769E5E5E390D.pdf


http://deckard.mc.duke.edu/pdf/Samei-TG18.pdf

http://www.amazon.com/Practice-System-Network-Administration-Edition/dp/0321492668

http://www.pmi.org

>I would also recommend learning SQL

Strongly recommend the following:

https://www.amazon.com/SQL-Minutes-Sams-Teach-Yourself/dp/0135182794/ref=pd_lpo_sbs_14_img_0?_encoding=UTF8&psc=1&refRID=SZBTC01KS06VV8RC0TY2

​

"Sams Learn SQL in 10 Minutes, 5th Ed." for the non-Amazonian Link Clickers.

This exam no longer exists, but I highly recommend it. Healthcare IT is just like normal IT, but the way you handle data is different. Try this:

https://www.amazon.com/CompTIA-Healthcare-Technician-HIT-001-Guides/dp/0789749297/ref=sr_1_1?ie=UTF8&qid=1491322087&sr=8-1&keywords=comptia+healthcare

Your family member could check out this book:
https://www.amazon.com/gp/offer-listing/1558105794/ref=mw_dp_olp?ie=UTF8&condition=all

You can get it used for less than $10. It spells out the roles/expectations and scope for a nurse in a clinical informatics role. It also covers most foundational concepts/theories.

This could help influence other decisions they may be trying to make.

Either way though talking to their manager about becoming a superuser on the hospitals current EHR is a good start. If your hospital has a informatics working group then joining that can be good. General networking within the hospital so they can get some experience. Reaching out to a local chapter of himss could be good, but I'd wait until I had some experience