The federal government's definition for "meaningful use" of health IT won't be finalized for several months. But that's not stopping EMR software and business services provider Athenahealth from guaranteeing clients that they'll be getting their health IT stimulus checks from the feds.For the most part, EMR vendors and their healthcare customers deploying these systems have a certain amount of tea-leaf reading to do when it comes to using health IT in "meaningful" ways that qualify doctors and hospitals to cash in on the fed's $20 billion stimulus reward program that kicks in 2011. The Dept. of Health and Human Services won't have the final meaningful use definition done till the end of the year. But because EMR systems can take months (and years) to deploy, that's not leaving healthcare providers much time to become compliant to "meaningful use" criteria when the stimulus bucks start rolling out in 2011. It's also not leaving EMR vendors much time to tweak their products for meaningful use mandates and certification.

Sure, the feds have been updating the public pretty regularly on the list of probable criteria that healthcare providers will need to meet for the "meaningful use" rules. But nothing's written in stone yet--and the federal mandates will likely continue to evolve through 2014, when the incentives end.

Nonetheless, Athenahealth is promising clients of its web-based, hosted EMR, practice management and billing systems (and back-office services, which includes claims submission and collections)that they'll meet the meaningful use criteria for health IT. And Athenahealth is putting money where its mouth is.

If clients don't receive their federal stimulus bonus checks from the feds when expected, Athenahealth will provide use of its software and services free to the client for up to six months. Typically, Athenahealth charges clients between 2% to 8% on the claims Athenahealth collects from payers monthly on behalf of the client, plus another 1% for customers using the company's cloud-based EMR applications.

"Athenahealth doesn't get paid until its customers get paid" by payers, said Richard Close, an analyst who follows Athenahealth as managing director of equity research at Jefferies & Co. "Athenahealth is closely aligned with its customers' success," he said.

"If doctors don't get their stimulus checks, that's a risk to us we're taking on," says an Athenahealth spokesman. "We're in business to get doctors paid, we see their supply chain" of interactions between third-parties like labs, pharmacies, private insurance companies and government payers--most notably HHS' Centers for Medicare and Medicaid Services.

Not only does Athenahealth host its EMR applications, its back office services include chasing down unpaid claims. Athenahealth knows when doctors receive their payments from insurers, said the spokesman. And once the feds start distributing its HITECH stimulus rewards to doctors, Athenahealth will know when those checks are sent, too, he said.

The secret to guaranteeing that Athenahealth doctors will meet HITECH's meaningful use specification is that Athenahealth is continually updating rules and requirements in its web-based software and services, making sure that users' clinical workflow and processes are mapping to and complying with all quality of care, reporting and other HITECH Act criteria, said the spokesman.

And because Athenahealth's software is hosted, the company can monitor "pretty much in real-time the effectiveness in how customers are using its software," said Close. "Athenahealth will know if a customer will qualify for the stimulus bonus," he said.

For instance, Athenahealth will alert doctors--maybe electronically, maybe by phone call--if the doc isn't writing enough patient prescriptions electronically to meet certain meaningful use criteria, which so far looks like it will include quotas about the percentage of a doctor's prescriptions that need to be electronic.

"We'll be more proactive than reactive" in making sure doctors receive their meaningful use bonuses, the spokesman said. While other vendors say their products will evolve to meet meaningful use, we're guaranteeing it and taking on the risk as a public company," he said. "We've drawn a line in the sand."