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HIStalk Interviews Girish Kumar Navani, President of eClinicalWorks

March 17, 2008 Interviews 25 Comments

girish  

I
interviewed Girish Kumar Navani of eClinicalWorks nearly two years ago and wanted to find out what’s changed since (you might want to read that interview first for perspective). You’ll notice from his industry assessment and predictions that he’s an extremely sharp businessman and modest leader. What the company is doing would be big news in any industry, but shaking up healthcare IT like eClinicalWorks has done is unheard of (well, maybe other than Epic and Meditech, which he happily acknowledges).

His major point is that smart businesspeople can run a highly profitable company while keeping customers happy and focusing on the long term instead of next quarter’s profits. When he says the company will be doing $500 million a year in ten years, I don’t even question it.

Don’t skip reading just because you aren’t involved in PM/EMR systems. I’m not either, but there’s plenty to learn no matter where in healthcare IT you work.

Thanks for talking to me again after our interview two years ago.

It’s great to read your blog. I promised you at that time that I was going to start reading your blog and I did. You’ve grown in popularity faster than anything that I know of. People are reading your blog everywhere. I had a large customer talk to me last night and he says, “So, you’re talking to HIStalk tomorrow,” and I said, “How do you know that?”

I think you should take tremendous pride. I can’t name the customer yet, but this is a group that has got hundreds of hospitals in the country and they read your blog regularly. They think it keeps them up to date on health IT and they find value in it. I do too. It’s great.

What did you think of HIMSS?

I have general opinions about conferences. I think we attend them because if you don’t, people spread rumors otherwise. I personally don’t care too much about conferences. Conferences used to be great to go and get customers that you wanted talk to. Now conferences are becoming more for networking. But with the advent of the Internet, you really don’t have to be in a location to network.

I think HIMSS was busy. I think a lot of hospital guys liked it because they felt it was worthwhile for them to be there and meet either with their existing customers or potential customers. I had dinner with Wal-Mart one evening and a few others, so I found the conference useful. It’s changing for sure and not just HIMSS. Almost every conference is changing with more and more people gathering information online versus waiting for a show.

I agree, but the attendance numbers keep going up. Did it seem bigger to you than last year?

It was a great location. Orlando always attracts people. Location has a direct correlation to how people get attracted to conferences. I think Orlando helps tremendously because you have families coming there and it’s a great time of the year. I don’t know if I noticed it was bigger, but Orlando is such a big convention center that sometimes you get lost. I like the location a lot.

eClinicalWorks has really taken off since we talked two years ago. Tell me what’s changed.

We have about 625 employees now and Westborough, Massachusetts continues to be a strong place. At our headquarters, we have over 425 people. We opened an office last year in New York City for the New York project. That’s going well and we have about 30 people there. We have an office in Atlanta and we have support and sales people that work out of their homes.

Revenues last year — we did $60 million and actually pushed a contract out into this year because I didn’t want to sign that $3 million contract in December. That’s the difference between being a private company vs. a public company. Imagine my customer saying, “I’ll sign by December 31 if you can give me something” and their surprise when I said, “I really don’t mind, actually, if we sign it on the 6th of January.” $60 million was our target and we did that, so I was content.

Our profitability continues to be good, with net profit margins around 30 to 32%. We have zero debt, zero liabilities, zero investors. All our payables our current and we pay them off in 15 days. In a way, the business has grown very big, but I still run it like a cash business. That makes it really easy to run the company. We don’t play the games of writing off R&D to depreciate just to make the books look good. We write it off and pay it off as we can.

The financial strength of the company, or at least the balance sheet and income statement, has become a bigger asset now over three years ago. Three years ago, we were about an $18 million company. Then we went to $25 or $26 million, then $40 million. Those were good years where we could show growth, but you always have to answer to customers and your $18 million is still a bit smaller than maybe you’d like for a large customer base. At $60 million, and $75 million minimum this year, we feel we’re able to handle and convince even larger customers about the strength of our company and our balance sheet.

Customer growth has been phenomenal. We have not slowed down in that regard and I don’t want to, either. [laughs] We are managing the growth, but as I have said to you before, we’re managing it by not slowing down. Very, very good numbers on training and implementation and support, which still makes up a very high part of our company. Over 68% of our expenses are from those departments and rightfully so. Rather than spending on sales, I spend in the areas that matter the most, which is to take care of our customers. That strategy has worked out well for us in both the short and the long term.

They key now is that Starbucks experience, as they say. It doesn’t matter how many stores they open, it’s the cup of coffee for every small customer that walks in. To grow very large, we’ll need to do all the little things right. To grow big, we need to grow small or stay small. That holds true not just in customer size, but in how we take care of every customer who puts their trust in us.

Did you ever think it would get this big?

[Laughs] I think it’s a journey. We don’t want to look back because if we did, most of us would be surprised that we’ve come this far. We were surprised in a positive way, but at the same time, none of us underestimates that we could have done this.

It’s both the feeling of being very confident that it could be done, but at the same time, gratitude and satisfaction and all the things that go with achieving success in the old fashioned way – organic growth, no acquisition growth, building the product that you sell, taking care of your own customers and not trying to grow them from another customer base. There’s a lot of pride you get from doing those things. From that perspective, there’s a lot of pride within the company and all the individuals that have been here and that continue to do work every day. That’s very, very obvious. I think we’ll say the same thing ten years down the road when we’re a $500 million company.

You’ve said that your supply chain background has made a difference.

I would say so. If you look at supply chain in retail, the success of that business may be because of how well it runs from a sale to replenishment and distribution. I think in the world of the Internet, the same thing applies, because pricing pressure is there and will always be there with the increased availability of price.

We know we’ve caused that. eClinicalWorks has been a great instrument for making price differentiation in ambulatory. You can actually dictate that if eClinicalWorks is at that price point, I can’t pay five times that amount, nor three times. Price will continue to be a pressure in terms of ambulatory solutions and a company that is going to do well and still have high profitability, which means you can take that and invest it in your future growth years, you need a company that is very well run, both in terms of process and also an organization in teams.

I believe that the background of looking at in that way, as an ongoing continuous improvement cycle, is one big reason why eCW continues to do as well as we do. We take a small one-doctor, two-doctor, or five-doctor group and make them go through a process. Then, we take a big project like New York or Massachusetts, where we are 185, and we break that down into a supply chain. Or if I go take a 120-doctor group, I break them down into a process and we implement them as well. So, there is definitely the learning that we’ve had in following a protocol of handoffs that are seamless, to go from sales to project management to training to support to getting feedback and replenishing your entire core process, is a big differentiation, no question.

We aren’t hierarchical at all. We are more laid out to be like an assembly line in how we work. We work in teams, we have team leaders. At any one time, I see that as a solar system. I see the team leader being the nucleus of that solar system, around which the team members revolve,  but nowhere would you ever find a team leader trying to say “I’m better than the people underneath me.” He or she coordinates a lot of what happens, but at the end of the day, we see ourselves as very different and that’s one of the reasons we’re so successful.

What’s the scope of the New York project?

For the first eight years of eCW, we always focused on speed. Make it faster. Take away clicks here, make it more intuitive, make the learning cycle shorter for your end users. We did that very well with our product.

It’s not that we don’t focus on that aspect of our company or that we don’t need to still improve, but what New York taught eCW, by working with the Department of Health, the focus was not about just speed and adoption, it was around quality improvement.

I recall an incident sitting with the assistant commissioner of New York City at a dinner table, with five eCW folks and him and his team, literally right after the contract was signed and we were going to plan out the deployment. The commissioner asked us a question: "Tell me what you would consider to be the success and failure of this project?" I said, "I think if physicians don’t adopt the EMR and use it every day, I’d classify that as a failure." We went around the table and everyone said the same thing in different words.

He said, "I disagree. If at the end of this project we cannot demonstrate that we improved the quality of care, i.e. we did not improve hypertension or control blood pressure and get diabetes under control and look a those 10 different values that the city measures themselves on, we will have a failure."

That statement was an eye-opener to me and to many in that room. The vision of that project was not just get it implemented. It was, "After the implementation, prove to me it’s going to improve quality." They worked with us for a year because it was part of our contract with the city. We’ve been doing joint development with them. Whatever we develop we will make part of our commercial release and every customer will get it.

Their leadership in understanding quality measures, decision support, and how that whole thing works and making that part of our product cycle will be part of our version 8.0, which will be launched in the next four weeks. It’s going to be revolutionary in its concept and adoption. In a year, I’ll want to see what the measures of improvement were.

We’re looking at it differently and maybe that’s the right way to look at it. New York is not just about implementing an EHR, it’s about demonstrating that you can improve quality of care. Then, it’s all about expanding that to connect into the local RHIOs. There’s another level and degree of integration that’s big in the city – connecting with their school health program, with their immunization registries. You’re now talking about a truly digital healthcare system.

The Piper Jaffray stock analyst said he’d heard about implementation backlogs and support problems.

Investment analysts have agendas that sometimes go beyond the obvious. I spoke to him at the show and disagreed with him because he’d never bothered to speak to any eCW employee or customer, so it’s very coincidental that something is written without due diligence.

The facts are the facts. We took Massachusetts and finished in 13 months when we were asked to finish it in 18 months. We started New York and are finishing that at least on schedule. In January of 2007, we took 14 to 16 weeks to implement. We ideally wanted it to be 12 weeks because that’s the template we like. Today we are at 12 weeks and we can actually do it in eight weeks if the customer really wants to do it and they have some sense of urgency to get their hardware in place.

In reality, we are in real-time mode. You sign a contract with us today, we start your implementation 24 hours from today. We follow a template and we implement it. We expanded our support system to 24 hours the middle of last year and it was so well received that everyone in our user group commented about it. We introduced real-time chat at the beginning of Q4, which was very well received.

I think there was a clarification posted by the analyst afterward, where he clarified that after speaking to me and some of the sources, that he felt that the information that he had reported was not complete. I think we’ll leave it that — there’s no validity to that statement.

Last time, you were amused that customers always wanted a server under their desk instead of an ASP. Has that changed?

It’s changing, but it’s not changing overnight. What I’m finding that centralized hosting is becoming more common. Maybe we’ll host it, maybe a data center, maybe a hospital. So the hosting is becoming more acceptable.

Software as a service, which we’ve been doing since 2003, continues to grow for eCW and is growing rather well. I still think, though, at the end of the day, physicians still believe that the data they have, as long as it’s the same system, they will be more comfortable with it. We have other solutions that we offer, like remote disaster recovery, so we’ll actually back up their data in their data centers in case they every need to use that service. Both the client-server model and the SaaS model are growing well. On the other hand, things like patient portals seem to be mostly hosted by eCW. Rarely will a customer ask to host a portal themselves.

What’s the overall status of EMR adoption after Stark relaxation?

We are still seeing growth in a big way. I’ll give you some numbers. We did $60 million last year. We did $11 million in the month of January. February was not slow either. We’re seeing real growth in terms of numbers, in terms of physicians, and implementations are good.

I think you’re seeing a slightly different curve. Youv’e got the early adopters and are moving into the mass adoption market, with more questions and more due diligence. That’s good for the market. It won’t get adopted overnight. Nobody expected it. It’s moving along at a steady clip.

Some vendors are getting more business than the others. There seems to be the delineation between the ones that can implement and have very satisfied customers and the gap continues to widen. We at eCW think that Q1 is going to be significantly higher than Q1 of 2007. The same held true for us in Q1 2007 over Q1 2006.

When Stark laws were relaxed, there was definitely the apprehension that it might help the inpatient vendors more than the outpatient vendors. As we see our traction, it’s becoming increasingly obvious that CIOs of health systems and hospitals do delineate legacy inpatient vendors and modern, web-based systems for Stark relaxation for outpatient. You have seen a continuous momentum about leading hospitals following that trend. You will see us make some significant announcements in the next quarter in the same regard.

How much of your business is replacement business?

We continue to see a very high replacement for practice management for our unified product. One product, one client, one web-based system, one application server. We’re seeing a very significant demand for private physician groups wanting to go with unified products. There seems to be a tremendous replacement of legacy PM systems in that market, so that trend is almost universal. It would be very rare for a private physician group to buy just one and not both pieces.

On the other hand, when you’re going to the hospital-employed group, interfacing to existing systems like IDX or Meditech or Siemens and Cerner like we do, replacement is not common in terms of practice management. They tend to keep the PM system or the system that they’ve used in the past for patient registration and patient accounting.

On the outpatient side, there is a significant demand for the unified product. For EMR, we saw when Amicore went away, PenChart, we got some customers out of it. We actually have a full-blown program that can migrate Amicore into eClinicalWorks. We’ve had some traction in doing conversions of Amicore customers or PenChart into eCW, but in terms of EMR to EMR, it’s not very common still. I think we’ll hear about it here and there and see some opportunities, but it’s not as rampant. There’s still momentum in the market for new implementations.

Will ad-supported free systems have an impact?

It doesn’t sit by my business model to try and do that type of solution for building an advertisement-based EMR. It doesn’t sit by my principles of how we run a business. At the end of the day, you need to be able to have predictable growth revenue so you can staff up accordingly. It can’t be seasonal. You need to be able to predict your SMS and your ASP revenues and continue to grow the company.

It’s tough to grow it the way the advertisement model might dictate. Somebody might question me since Google does it. I think it would be tough, especially considering that you have a product of the caliber of eCW available at the price point it is. You’re not making a significant investment, especially if you’re using an ASP. The pain you’re avoiding is software costs, and at eCW, an EMR for 250 bucks a month or EMR plus PM for 400 bucks a month really doesn’t make too much of a difference whether you do advertisement revenues or you don’t. I don’t believe in the model.

You mentioned Google. What did you think of the Google and Microsoft PHR announcements at HIMSS?

There is definitely a big buzz in the industry that something needs to be done regarding personal health records and employer health records. We definitely have a perspective. As it’s been written, although we haven’t written a press release, Wal-Mart has selected eClinicalWorks. We will be integrating with employer-based records there as well. In the coming months and years, PHRs will have a purpose. What mode they take or which company operates them is anybody’s guess right now.

You’ve got EMR companies that are doing patient portals and there’s a value proposition there for the EMR companies and the physician to do it and their patients can have access to their personal health records. Then, the portal can deposit that health record in any PHR system of their liking to share it with the proper entity. I think there will be intermediaries that will help – it could be Google it could be Microsoft,  it could be Dossia, it could be any of the ones that will eventually interoperate around a personal health records system.

But I also think that the big traction within that market, the patient portals, will continue to accelerate. Physicians want to have a way to communicate with their patients and that value proposition is strong. We’re seeing that with our patient portal product. I see the patient portal of eClinicalWorks plugging into not just one PHR, but multiple PHRs.

When we talked two years ago, you said the end of the line was near for the old-school EMRs. Were you right?

I think definitely so. You’re seeing that. The legacy ones have hardly any market traction. Some of them have tried to morph themselves into other companies. Many of them are essentially figureheads with no real market traction.

I predict that, over the next year, you will find desperation among public companies in ambulatory EHRs whose stock value is not doing well, in terms of pricing, giving way anything and everything. That’s going to be fascinating, because as I’ve always mentioned to you, we’re here for the long term. I see eCW and its current management being around for at least 10-15 years before we hand it over to the next generation.

I see this market being tremendously appealing. You’ll see even successful companies desperate over the next four quarters. Will it weaken their companies in the long run? I think so. We’ll keep investing what we need to in R&D this year because we have the cash, we have the profitability, and we don’t have Wall Street expectations to meet. We’ll keep plowing money back into where we need to, which is to develop newer products. 

Those we compete with will struggle in terms of being able to make that commitment because earnings per share is now at a premium. You’re trying to focus on just one single fact, which is shareholders instead of customers. We’ll see that and I think we’ll both keep watching that trend over the next 12 months.

Last time, I named some companies and asked you to give me some adjectives. Can we do that again?

[Laughs] I don’t mind doing it, but it was tough last time.

Let’s start with Allscripts.

Desperate. Company that has grown via acquisitions struggling to develop new products.

Misys.

Non-factor.

Even with iMedica?

No. Misys, non-factor.

Sage.

The only business they’ll have is where their practice management is existing. Open market traction, open market competition, usually won’t compete. Non-competitive. We don’t see Sage as much at all. Very, very small places.

GE.

Diminishing. Less of a factor in 2008 than they were in 2006.

PracticePartner.

With the acquisition by McKesson, they’ll show up in the McKesson accounts. How well they’ll do is still open. You’ll never see them in the non-McKesson accounts.

athenahealth.

Billing service. No competing EMR.

Nextgen.

Complicated, same as last time.

Epic. You admired them last time.

Respect twice. As I said to you before, if over the next 15 years we can do what they did, we’ll be thrilled.

Epic may be the only company that’s been a game-changer in an established market. eClinicalWorks would be right up there in that category. What do you think the lessons are for ambulatory or inpatient vendors?

I’ll give you two parts to the answer. It is increasingly known that to be a big player in healthcare, you have to be a long-term player. There are two companies that have proven that – Meditech and Epic. Both successful and with a large customer base. They proved that you need to be around for 20 to 30 years and be able to make decisions that are in the long-term interests of the customer vs. the short-term interests of Wall Street.

In the capitalist market on the Street, it’s ruthless for software companies. You’re running every 12 weeks trying to close the quarter. I’ve lived on that side. I used to be at Fidelity Investments and I started a subsidiary of a publicly traded software company. I learned my lessons as to what we should and what we shouldn’t do. It’s increasingly obvious that you need long-term relationships in healthcare. You also need to be able to plan a strategy of development which is years out.

I’ll give you an example about the patient portal. When people thought it was not going to be a big part of any our product roadmap, we kept investing in it, we kept developing, we kept putting money into it. While people were trying to find a partner or a third party to bolt on to sell just so they could be competitive, we kept innovating and building our own product line. Today, the tight integration that exists between the portal and the eCW EMR has become one of our big strengths. It took us two years, maybe even three plus years, to get there.

I don’t know if you would have made that decision in a publicly traded company. You would try to partner just to get some deals done. Way down the road, you might never realize that decision was made with such short-term goals and focus that you essentially sacrificed your long-term sustenance because of it.

I think the same thing holds true for some other products we will announce in this year alone. Last year for eCW, we built a foundation for our services side, where we have 24-hour support, more trainers, more project managers, more people on the interface teams so we could do everything we needed to in terms of services. 2008, for me, is the year for product innovation.

We’ll start off with Version 8 right off the bat in the next four to six weeks. We’ll come out with the next version of the portal and you’ll see eCW on smartphones and voice integration before the year is out. I don’t see too much revenue coming out of those products this year, but we still continue to invest in them because we think that’s the right strategy for us as a company because I’m looking 15 years out.

Ask the CEO of a public company if he or she is thinking 15 years out today. The answer is no. You’ve got that dilemma and I think it’s increasingly true in healthcare that the product is used for such a long period of time that product innovation is fundamental to success. So is growing a thriving company, investor-free, debt-free so you don’t have to make decisions with external entities involved.

I might go so far as to say that as a company, I have the luxury of never having to go to an external board meeting. I never get questions from people outside on why eCW made this decision vs. making that decision. The board is the five principals in the business and that’s it. We discuss and challenge each other on what we need to do. It’s a whole different paradigm to running a business when you have that much flexibility and agility.

It is increasingly difficult for publicly traded companies to meet expectations and still continue to invest in their future in terms of product innovation. It will be one of the reasons you’ll find that in our industry, Epic and Meditech and eCW will do better over the next five to 10 years than others.

And then there’s a perspective as a company CEO. I’ll use a sports analogy. I love sports. If I told you that a 21-year-old golfer showed up at Augusta National in 1997 and was asked what his odds were for winning that Master’s and he said, "I’ll do my best and we’ll see at the end of four days." And he goes on to winning it by 12 strokes and scores 18 under par. I don’t think you and I would still remember him for one bit unless the guy actually proved that he could win 13 other majors after that and 65 other tournaments. You remember Tiger Woods today for who he is. He’s been consistently able to do what he did in 1997.

That’s the spirit of a privately traded company. You focus on how you’re going to leave a legacy behind, both of a positive reputation and change, and execute for the next 10 or 15 years, year in and year out. You just make very different decisions when you think of the corporate world that way vs. what am I going to do at the end of June and the end of October and the end of December in terms of my earnings.

I see the world increasingly different for the two sides and that’s the reason you’re seeing poorly performing publicly traded companies being bought by private equity firms. That trend is not actually common in healthcare yet, but it is very common in other places. The only challenge we face in software is private equity firms like to buy companies with guaranteed revenue streams and they like to turn it around. In healthcare, companies tried to take the position of all the license fees upfront, without much focus on ongoing, recurring revenues. That hurts that model of private equity.

eCW has always focused on recurring revenues being a driver for its bottom line. The situation today is that my recurring revenue stream from existing customers balances my fixed operating expenses. You just keep moving on and innovating and coming up with newer products. I just think we’ll make it very difficult this year to compete, both in terms of functionality, product spread, pricing, and reputation with all the large customers that pot their trust, but more importantly, all the small customers that put their trust in eCW.

You’ve reached a point where you could do anything you wanted financially. Is there anything else you plan to do?

eCW is my hobby. Other than my family, that gets a lot of my time. the only other thing I do is spend my time thinking and working at the company.

My goal is in 15 years to leave a legacy behind of a very successful software company that did it in different ways than were discussed. I don’t think I’ll do anything else, at least in the short term. I’m 41 years old, so I’ve got a long way ahead. 15 years from now, I might have other hobbies and interests, but right now it’s eCW and I think it will stay that way for a long time.

Anything else?

Watch for some news to come out over the next three months. It’s going to be spectacular, both in terms of product and customer traction ongoing. You’ll definitely say,"Here’s the changing of the guard."

We’re looking forward and 2008 started us very well. We had a company event that we do once a year for all employees. The message I left them with was that we’ve talked about growth since 1999 – can you manage the growth, how much can you grow. What I told them was that the G word is out. It’s A and F, but not for Abercrombie & Fitch, but for accountability and focus. Have the responsibility for your own actions, that’s accountability, and have the focus to execute what you do every day. If you do it, the company will continue to grow. The market is very large and the product is very well received. We’ll just keep doing what we’ve done for the last nine-plus years.

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Currently there are "25 comments" on this Article:

  1. Not earthshattering but very solid stuff and some additional details/confirmation of what I have heard or been told.

  2. I have a lot of respect for Girish’s point of view. I could not agree more about the distinction between private and public. It is unfortunate how the public market has evolved to only value short term gains instead of truly building something that makes an impact. I espicially appreciate his focus on ensuring the customers satisfaction as well as driving towards improve the quality of care. To many companies use the phrase of “improving quality of care” loosely to help validate the $$ for their systems. I am eager to see how NY has impacted their development to improve the quality of care.

  3. Rumor Has it that Non-Factor (Misys ) is buying Desperate (Allscripts). Guess the lower stock price was too good to pass up.

  4. I was fortunate enough to spend some time with Girish a couple of years ago when I worked for a healthcare conference company in Boston. Unlike many corporate higher-ups, Girish is accessible and personable and also has some great ideas on the future of HIT.

    Sorry if this sounds like a fan letter, but I have a great deal of admiration for the guy, especially in light of my interaction with a lot of other “leaders” in the HIT space. The folks who work for him are lucky to have him as their CEO.

  5. Rural docs all across our State are looking for to implement new EMR’s and I have recommended an ASP model to the policy wonks at the State. I would love to hear his thoughts on the health record banking model that is about to be tested in Washington and Oregon. It is based on the premise that patients essentially own the “rights” to their medical information and make deposits in banks with it..

    With the recent release of the Iphone sdk I can’t wait to see if he can port ECW over to that platform as well.

  6. eCW has a lot of momentum. It also sound like they have some hubris. Great to be confident, but I like quiet confidence best.

  7. Re: Washington State RFP change of heart: While I don’t have inside info on this particular issue, I did work as an ITer for the State of Washington for nearly 20 yrs, including daily interactions with Health and other agencies. I won’t say how they handled this recent RFP was proper or improper, because I don’t know the case – but, State employees are often between a rock and a hard place when it comes to spending tax dollars. And it’s all tax dollars. When I was there, state agencies opting to spend money outside of Washington when there were in-state options, were routinely “caught” and dragged over hot coals in the news. It was much more than mere citizen irritation or reporters looking for a story. Citizens were genuinely angry and vocal and serious in their desire to remove people from employment or elected office when jobs were sent out of the area. Right or wrong, the view was that “our tax dollars should support our businesses.”

    Admittedly, this may have nothing whatsoever to do with the case you mention, but it could play in. (Incidently, Washington State has for years been named in independent publications as one of the top performer in most categories – so the close citizen scrutiney probably pays off.)

  8. Our experience with eclinicalworks has been terrible. The service is horrible. They do not respond to us about our problems. They hope to grow? Wow! I think that instead of making 30% profit, they should have enough employees to support their product. Unless we are the only practice that they have treated this way, I think that their growth will stall in the face of unsatisfied customers. I can see how support was a big profit item for them. Their training was poorly implemented despite large fees. We were left to struggle through many things without their help.

  9. We have a large scale implentation of ECW at a large Hospital. Over 1000 clients and 6 servers dedicated to ECW. I can only talk about the Technical aspects as I’m not a doctor or anything. I can say from my experience that ECW is NOT SUITED for large environments. Perhaps small clinics with less than 10 users. Their software is not designed for easy distribution. Their tech support is horrible. Everytime I call them all they say is reregister dll’s. We recieved a lot of complaints from end users regarding slowness. THeir architecture is flawed. It has gotten so bad that we reverted back to paper records.

  10. eClinicalworks has had great success, they can’t fool all the people all the time and still grow at the rate they apparently are growing.

  11. I sell collection services to medical practices. I run across many practices that use eCW. Story is always the same…intrigued by Girish, relatively satisfied w product (unless it’s a large practice), but awlful customer service…never a call back, no help when they do talk to somone, very dissatisfied after the sale

  12. I agree with a few others. We have a six provider practice. We started with the ASP client model but it did not work. The support people at eCW said it was because our internet was to slow (we have 2 bonded T1 lines).

    We then moved to an in house server with eCW installed locally. The migration was a nightmare, data was lost, the implementation of the software on the new server was terrible. No support, no follow up. Numerous errors that tech support blames on the network configuration. They also required that I lower the network password policy to a less then secure setting.

    Project managers answers direct questions. Take up to 4 days to reply to an e mail, if at all.

    We are only using the PM side of eCW now. We will not be pursing full EMR with them We will look elsewhere, probably Centricity.

  13. We have a 7 provider practice, 2 servers and 16 employees. I have to a agree that service is terrible, take too long to fix technical problems which almost ends up creating other problems, the billing part is a nightmare and no one has a clue why financial reports run at different dates are.. different!!

  14. I agree. Their implementation is horrible. It took them almost 2 months to solve our fax server problem…imagine having intermittent fax for 2 months. They keep blaming us, but in the end it was their poor implementation. The remote ASP has been a complete failure for us. We are now trying to host our own server. The support is horrific. Never call back. Evene when we can track them down, we don’t seem to know their stuffs and cannot solve the problem. They seem to create new problems with each attempts. If this continue…we may cut our losses and try our hands at another vendor.

  15. I can’t believe Girish actually thinks his company is “keeping customers happy”. We’ve been on eCW since 2007 and are a small solo practice. eCW has been unable to resolve a problem with their Patient Portal product we use for over a year. To top it off, they expect us to pay for the faulty product because it works “part of the time”. Really? How would that work in our business, “we gave you a medication to help with your BP, it will only work part of the time”. Happy customers? Not in our office.

  16. After reading this nice interview of eCW President Mr. Girish its surprising to see so many negative feedback of the successfull ONC/ATCB certified eCW system which is exceptionally doing good in the HIT market today by increasing their customer base aggresively . Thanks to everybody sharing their experiences with their existing systems . These are eye openers for those who are thinking of buying such products and will help in their evaluation process. Its really hard to decide which one is good and which one is bad. Lots of options lots many choices . Think about buying a car. Its about priorities “The car that’s hugely powerful, sips gas, handles like a sports car, rides like a Rolls, has a huge interior, is packed with every feature available and costs a reasonable amount. Every body wants it but the fact is that just doesn’t exist.”
    Since it’s impossible to get absolutely everything we want we do certain comprises and select the best deal by judging its value and quality.
    Regarding Technology – ” Technology presumes there’s just one right way to do things and there never is. ~Robert M. Pirsig

  17. We are a large hospital that implemented ECW years ago, I have a team of highly skilled people that absolutley hate ECW. A major flaw of the product is security. This might be a great product for a single office but it is by no means an enterprise product. IF they listened to their customer (by the way, who are ALWAY wrong) they would have a much better product. One thing they are good at…..BLAMING SOMEBODY ELSE…..I think that’s shown by Grish’s comments made about Piper Jaffray. The reason why people buy the product is that they put on a good dog and pony show, and IT’s CHEAP……where you get screwed is on the back end with hardware…..anytime there is a problem, they blame hardware…….this system tooked a quad processor quad core server to 100% and they blamed the server…..EVEN THOUGH WE TOLD THEM WHAT THE DATABASE HAD WRONG WITH IT. Lastly here at the hospital the Doctors who were responsible for getting ECW now deny ever choosing this product….so buyer beware!!!!!

    [From Mr. H] The anonymous reader’s comment made statements about eCW’s security settings that the company says were factually incorrect. I have removed those comments since I have no way to validate the reader’s identity or their claims. I would be happy to repost the comments non-anonymously if the reader is willing to identify their hospital so eCW can investigate specific details, along with a response from eCW if they wish to provide one.

  18. Can you show a screen shot of the security issue. Another thing, if this is a hospital why would you be using an abulatory system? How did that happen?

  19. I agree with the above comments. As a provider, I find eclinical great for charting and ordering. I, however, am the one also incharge of system use and implementation. The practice management side of eclinical leaves much to be desired. We are having many problems attesting for meaningful use because the reporting system in eclinical is so poor.
    And forget about any help from eclinical. If I live chat or call, I am more knowledgeable than anyone I talk with – and I have only been working with the system for 1 year. Because they can not answer simple questions, I am referred to technician who may or may not get back to me in 2 weeks!!! And when they call back I can not understand a word anyone says or simply hear that it must be a problem with my connection or computer. I agree with everyone about eclincal always blaming the customer.
    Unfortunately, they know their system is poor and they offer many programs to add to your system to help solve the problem….. for a price. Seems wrong huh.
    They rope you in with impressive talk, but once you buy in it is a whole lot of frustration!

  20. I have been using ECW in my solo practice for 5 years and am now planning to switch. Anyone have tips on how to migrate data out of ECW.

  21. This company has continually disappointed our Practice. After all our frustrations and the inability to reach customer service in a timely fashion, we terminated our service. Also not very helpful in organizing our data and returning it to us.
    We paid for a database dump on an encrypted hardrive. Information is missing and we have been emailing the company for weeks to have their IT team help. They have consistently failed to return or acknowledge us in any way. We have drafted a letter sent to our all patients informing them of withheld medical information from eclinical. Eclinical has proved to be uncooperative and they refuse to provide technical assistance. We were told by customer service that ”technically as we are no longer a customer, we do not have to provide assistance”. I find this totally unethical from a healthcare industry company and totally unprofessional. We would not choose to do business with this company again and we have informed every colleague looking for an EMR, that this company is NOT the way to go.

  22. A security issue, well where do we begin:

    -Storing passwords in clear text
    -Storing usernames and passwords in clear text in the registry
    -Not hashing passwords in the database
    -Insecure file transfer
    -VNC by nature is not secure remote software that comes standard in their product

    That is just what I have seen when looking through the files.

    My advice, stay away. Reason? Horrible support, horrible database design, and subpar programing. I would explain the style of programing as amateur that was probably started with the app being a quick fix that has been built on poor design.

  23. I can add my voice to those saying AVOID eCLINICALWORKS like EBOLA!

    Management seems too focused on too many grandiose things simultaneously. So that when for example version 10 was released:
    1) They had yet to fully DeBug version 9 from some serious flaws
    Example: IN version 9, if you had a telephone encounter on the SAME day as a well child visit, v9 would DUPLICATE all vaccines from the WCC (well child check) into the telephone enc. Thus, when you printed out the Immunization record… unless you were very observant…. it would falsely report the patients vaccine history, AND this data is required to be uploaded by law to the state
    IMM registry….. making us look like idiots for giving the same vaccine to a patient within hours of each other. While it never happened in reality

    eCW support promised a report to identify all the instances… but never followed thru

    2) version 10 is equivalent to Microsoft Windows 8: Lots of new features no one really cared about…. and so fully of defects thats it should never have been released.
    Dozens of new features that they advertise and banter about……. few (if any) actually work, work partially, or if they do function … do so at your own peril (unstable)

    v10 has crashed our office completely more times in 6 months than the previous 6 years.

    3) Lackluster or just plain incompetent support
    support is focused on CLOSING THE PROBLEM TICKET
    they don;’t care if it is fixed or not…. just get it closed
    one technique is to call… and if the person who put the ticket in the support portal is not available…. CLOSING TICKET CONTACT UNAVAILABLE.
    never mind that they have autonomous access to the servers and system… but HEAVEN FORBID you don’t hold their hand and “prove” that their code is flawed

    They have a “help hub” which in theory lets you learn new features and troubleshoot problems on your own.
    Nice in theory…. .but every time I ask for a something I found in the “help hub” its as tho I was speaking Klingon….. and I have to “prove” to them that their OWN help hub says xyz…
    Usually the ultimate response is “that is still in developments” which is eCW speak for NOT IN YOUR LIFETIME

    4) the Ultimate insult:
    After months to slow responsiveness of a MACDADDY HIGH END LOADED new server…… Support decides that all the problems are because one of the DB server is a virtual server… and not a physical server. They demand it be UN-virtualized and moved to its own physical server (even tho they approved and installed it on the virtual initially a couple years ago). So I buy a 20k server… go thru all the hoops and things they require before they will BLESS a new server and install anything on it.
    After waiting months for this to happen… TWO days before the weekend change over was to occur…. they announce I had to pay $2,000 in fees to them because this was a new install.
    WHAT a nice racquet… bad support.. demands new server since they are incompetent to fix and support THEIR OWN recommended sever…. and then blackmail the client for thousands for the pleasure of moving data from one box… to a new box (that they demanded). The server they are throwing away is less than 2 years old and eCW claimed it would provide 5j-7 years of service when they spec’d it.
    BUT since they couldn’t solved the performance… just blame the hardware and CHA CHING… earn bonus money. All the while screwing the client yet again.

    The list of eCW atrocities is endless… but the above is just a taste. When you complain cindy.favuzza@eclinicalworks.com will call, NOT have bothered to research anything about the reason for your unhappiness and just provide pretend to care while telling you they are just going to do whatever they want and they DO NOT CARE if a client of 8 years is unhappy or decides to leave. Clearly they are so big now that the people who MADE them big.. are meaningless to them.

    Save yourself a money pit that doesn’t perform, is unstable, insecure, and backed by a company that does not care.

  24. We are a solopractice and had eCW for only a yr. Thank god we switched to athena, which is fabulous and does everything as promised, unlike ecw. With ecw, we started having problems with billing right away. Customer service is the worst. Always WANTING to CLOSE the Ticket. Our project manager was useless piece of work. When we cancelled our services with them, Cindy Favuzza was the person to go to. She was never available and when she was available, she was extremely rude . Nobody knows what’s going on in their company. I am glad we are no longer with them and don’t have to deal with the nonsense.







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