For providers who have hesitated implementing an EHR because of confusion, distrust or discontent, you may be patting yourself on the back. You knew there was a reason to wait. athenahealth announced a guaranteed HITECH Act bonus payment under the 2011 program year if you use its athenaClinicals EHR system.

Is this a game changer? You better believe it. For the record, I'm not endorsing any vendor. I just think Jonathan Bush has made a bold offer that could only be done because of the company's business model.

There are enough stories about long implementation schedules, cost overruns, outside consultants being brought in for traditional software systems. At family get-togethers I've listened to my pharmacist brother-in-law grumble about how their expensive new EHR doesn't accommodate particular medication documentation that he needs for his HIV/AIDS patients who are on multiple drugs. His clinic and its budget are small. It was a precious sum for that EHR - and he's anything but happy about it.

I digress. Back to athenahealth's business model. Because of the common experiences similar to those of my brother-in-law's, I think there's a bigger appetite - certainly interest - for the non-traditional EHRs. I'm talking about Web-based EHRs and EMR Lites. Because everything about healthcare reform is a moving target, it's safe to say that you need a system that's going to be flexible for whatever new rules and regulations come down the pipe in the next couple of years. It's a lot easier for Web-based EHRs to be adaptable and a lot easier on providers because they don't have to deal with potentially disruptive upgrades. It all happens on the backend. Lastly, how many systems are based on a risk-sharing model? That's why athenahealth can make such a guarantee.

By some accounts, I'm told by curious attendees, there were approximately 35-40 new EHR vendors exhibiting at the Health Information Management Systems Society (HIMSS) Annual Conference & Exhibit in Chicago last April. The market can't possibly absorb that many new vendors. So one has to wonder how many carpetbaggers were in the mix and how long they'll last.

In the end, there's no guarantee that your EHR will qualify you for a bonus payment in 2011. You want your vendor to be your partner and work with you past the implementation and have an ongoing relationship to meet those requirements. If you're a provider who worries about whether after all that investment your system will deliver meaningful use, which will lead to that bonus check, do you due diligence and ask your peers about their systems - both athenahealth's and others. And then decide if that guarantee is just too good to pass up.