I have a lot of praise for Athens. I think the services they offer allow hospital libraries to finally make online resources available for their patrons to use outside of the library. Hospital libraries often cannot offer proxy access to their online resources because their hospital IT departments do not allow it. Now hospital librarians have the opportunity to provide the same type of remote access to their users as academic medical libraries have been doing for years. Hooray!
The only problem I have are the online journals. Blah.

First, I think there should be an easy standardized method for telling journal publishers that we use Athens and inform them of our ID. Why can't I just tell my subscription agent when she activates our online journal titles to include our Athens ID? Why should I go to every single journal publisher and contact them about our Athens ID!? I have 150+ online journals, that takes a lot of time for a solo librarian or 2 person hospital library.

Second, why isn't everybody allowing Athens authentication? This is my biggest frustration. There are some publishers who do not allow Athens authentication. However, they have no problem allowing academic medical libraries to provide proxy access to their journals.
For example: I contacted the American Journal of Clinical Nutrition about Athens access and I was told, "Unfortunately The AJCN does not participate directly with Athens Authentication, so I am unable to activate this service for your online subscription." But they allow proxy server access, "if only your institution has access to a proxy server." Hello...that is the whole reason I have Athens, I can't have a proxy server.
You would think the Annals of Internal Medicine or Mary Ann Liebert would allow Athens authentication. Nope. Yet JAMA, NEJM, BMJ, Elsevier, Ovid (LWW), Ingenta, and Oxford, have all been very helpful and have allowed us to use Athens for offsite authentication.

I realize Athens is rather new to the United States so I guess I will have to live with the idea of slowly activating access one by one to electronic resources until somebody comes up with a better system. However, I fail to see any good excuse as to why a publisher will not allow Athens access yet they will allow academic medical libraries to use proxy servers for off campus access.