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

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

It begins, says Navani with the company's approach of running a business with common sense, versus dictation by Wall Street. The company was organized, he says so that it could stay agile, even at 100 million dollars. eClinicalWorks is structured into teams, with no one person more than one level away from the CEO.

Some have said that Navani makes every decision in the company, but he insists that isn't true. “People think I do everything, but I don't,” he says. “We have a team structure that lends itself to quick decision making and I get too much of the credit for putting it all together.” Navani adds that his formula for being a good leader is engaging responsibility by giving people the leverage to act on decisions. “Yet people know they don't have to fear making the wrong one,” he adds.

Those fast decisions have played a part in the version 8.0 release of ECW, which has additional components like real time clinical decision support at point of care. Bhat says it's multi-dimensional to more than, say, age, gender and diagnosis; providers can add lab results or structured data to the mix. In addition to fast deployment to almost all of its users, Bhat says ECW kept the transition to Version 8 a smooth one by maintaining some backward compatibility so the end users don't experience a big change. That, and lots of education. “We invest a lot of resources in educating our customers with online webinars and education programs at no cost,” says Bhat. “That's what we believe in. If you don't educate your customers about the new technology they may not use it.”

The game-changer, in addition to the interface for physicians is the pricing model, which was cheap, and it was transparent.

In addition to Version 8.0, ECW is seeing a big uptick in signups for its hosted solution. With 10 data centers nationwide, its emphasis on remote hosting is expected to grow. “If you consider the sheer volume of providers that are not live today, you have to see a hosted model become more prevalent,” says Wagner. “The success of the SaaS model in billing solutions is giving people confidence in the clinical model.” Wagner believes that remote software-as-a-service (SaaS) models like that of ECW can solve the problem of lengthy deployments. “Our understanding at KLAS is that ECW is about 30 percent remote-hosted - and that includes ECW being deployed through hospital groups.

Navani says that ECW's current growth is being evenly distributed between large enterprise clients, and individual private practices and federally qualified health centers. “You will see us continue to march forward on those fronts,” he says. “We will also figure out how to deploy large communities which will give us a new level of strength.”

But just how robust is that hospital interface? Though Wagner says though it's a story that still remains to be told, the fact that there is a solution in place definitely gives ECW a leg up. Indeed, the solution has been actively deployed by the New York City Department of Health to 2,000 physicians under a regional model of deployment, and Wagner says hospitals are considering ECW for their physician groups are keenly aware of that. “This New York City deployment has given ECW a huge leg up because of the kind of work they've had to do to deliver for New York” he says. “They've picked up all kinds of experience and opportunity to develop solutions for the city that then becomes part of the total solution they offer elsewhere.”

One question many ask is if ECW can continue to maintain its explosive level of group - particularly in an HIT environment where staffing shortages are a very real problem. “From an industry-wide perspective there aren't enough resources to manage the existing work,” says Wagner, who concedes though that this is not unique to ECW, because of their sustained explosive growth it will be an acute issue for them.

Navani doesn't see this as a problem. “ECW has grown rapidly, and how did we manage that?” he asks. “We figured out that growing talent was a core competency we had to build.” He says that ECW has already built the org structure and training programs. “That's one of the reasons we think we are positioned for this growth - because we've already done it.”

In addition, Navani says ECW has traditionally looked outside the HIT industry for talent - and today, that's turning out to be a plus. “Now that the economy is not that great, we can get people out of banking, finance and technology from other sectors as long as they have the right basic platform of analytical thinking, good communication, and responsibility as characteristics.” He maintains that ECW implementations start with 24 hours of signing, will full implementation within 8-12 weeks. “That's the model we are going to stick with,” he says - in addition to aggressively hiring. ECW recently crossed the 1000 employee mark.

That growth should continue because, according to Wagner, clinicians love the product, and the paradigm of the traditional PM has changed. “The clinical side of the shop is calling the shots,” he says. In the old traditional PM model they didn't care, but the old solutions are not flying anymore.”