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Can the company maintain high standards-and private status-despite explosive growth?

May 24, 2010
by Daphne Lawrence
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Girish navani
Girish Navani

It shouldn't be surprising that the Westborough, Mass.-based eClinicalWorks (ECW) came in as one of the top three vendors of interest voted by HCI's readers. According to a February 2009 survey from the Orem, Utah-based KLAS, 24 percent of providers considered the privately held company when making an electronic medical record (EMR) purchase. That's some achievement, considering that in 2004 that number was zero percent. The fact that ECW has zoomed to the top of providers' radar so quickly - along with satisfaction ratings that approach 100 percent-only adds to the company's mystique.

“They frankly changed the game,” says Mark Wagner, lead author of a February KLAS report that profiled the company. “One of the greatest things about ECW is that they don't believe there's anything they can't do - and so far they've delivered.”

“There's a fearlessness aspect in everything we do,” agrees Girish Kumar Navani, CEO and founder of the company. “We're just not afraid, and I think that conviction makes people want to know more about us.”

In addition to that fearlessness, adds Wagner, part of the intrigue is that the company has an unusual willingness to tackle problems from a technology standpoint. “They've proven they are willing to deliver on the things they tackle - and most deliveries are on time and issue free,” he says. “That's a great thing.”

A logical question, given the lack of originality that many agree is endemic in the HIT industry, is why aren't more companies copying the ECW model? Wagner says the answer is simple: Building a successful clinical application is not easy.

Navani agrees with that, but says there's more to it, namely the ECW culture. “To copy a company is more than copying the product,” he says. “You have to copy all our principles along with the product.”

Mark wagner
Mark Wagner

The ECW product, a unified EMR and practice management solution that is scalable to practices of all sizes, is something that physicians seem to adore. “They came out with a slick interface that physicians love and that's one of the primary reasons they're doing so well,” says Wagner. “Physicians look at it and go, ‘It's simple, it's easy, I like it.’”

In addition to a product that was almost universally hailed by physicians, the company was revolutionary in its approach to pricing. “The game-changer, in addition to the interface for physicians,” says Wagner, “is the pricing model, which was cheap, and it was transparent.” In addition, he adds, total cost of ownership is what is says it is. “That's a huge issue for providers frustrated and tired of being nickel- and dimed for everything they need done by a vendor.”

There is a third factor in the company's rocketing success - speed. As an example, less than a year after introducing ECW 8.0, 94 percent of the company’s 6,500 contracts, representing 40,000 providers, are live on the latest version.

Why such easy and fast upgrades? “A lot of us come from a strong technology background,” says Sam Bhat, vice president of sales and a co-founder of the company (Bhat himself came to eClinicalWorks from the Waltham, Mass.-based Novell) “We understand that when we build the technology, it's important to have the mechanism to distribute that technology to our customers,” he adds. At ECW, all distribution is web-based. Bhat looks at the historical challenges vendors have had in releasing upgrades to all their customers. “That's one thing that's different with us,” he says. “We are able to deploy and get improvements into the physicians' hands quickly.”

One of the greatest things about ECW is that they don't believe there's anything they can't do - and so far they've delivered.

And the speed of ECW's product enhancements mirrors that of its distribution. The company follows the principles of extreme programming (employed by such tech firms as the Mountain View, Calif.-based Google), rather than traditional waterfall development, and, says Navani, the result is that ECW comes out with significant enhancements every six months. “It makes it harder for others to copy us; and in addition, our customers know we're listening to them,” he says.

eClinicalWorks' developers also utilize a hub and spoke technology for integration that significantly cuts down on the time to build interfaces. “We do the integration with a health center once, host that hub in our data center, and the practices just connect to that hub as a spoke,” says Bhat. “We don't have to go through the effort of point to point connectors, like other vendors who have to reinvent the wheel many times.”

Finally, the company has uniquely embraced a certain sort of transparency for its customers (and indeed, its competitors as well) about what it does well and what it doesn't. For example, anyone can log into ECW's user groups online and find out what the customers are asking for - in addition to what issues they are raising. “We think that's a strength, because it allows us to move faster,” says Navani. “It creates a sense of urgency in the company that says, ‘We'd better do this, because everyone can see it!’”

That type of transparency is a big part of the culture at ECW- and at ECW, culture, it seems, is everything.