MOST INTERESTING VENDORS: eClinicalWorks: Riding a Wave of Innovation

July 21, 2015
This week, we present profiles of our "Most Interesting Vendors," healthcare IT vendor firms making waves in the industry, and whose trajectories speak to broader trends. eClinicalWorks was chosen both because of what it has accomplished over the past decade, and because of its potential for continued growth.

Healthcare Informatics chose ambulatory EHR company eClinicalWorks (eCW) as one of this year’s most interesting vendors on the HCI 100 list both because of what it has accomplished over the past decade, and because of its potential for continued growth. Despite his company’s impressive performance in the ambulatory market, hard-charging CEO and co-founder Girish Navani isn’t satisfied. He is closely eyeing the acute-care EHR market as well.

An EHR vendor with a reputation for always being on the cutting edge of technology, the privately held eCW has grown its customer base to more than 100,000 physicians and 600,000 users. The Westborough, Mass.-based company now has 4,000 employees, and its 2014 revenue was $333 million (which placed it 39th on the 2015 Healthcare Informatics 100 list).

Yet Navani admits he initially stumbled into the idea for the company about 15 years ago. After seeing a conference presentation in Geneva, Switzerland about the potential of health IT, and then talking to his primary care doctor about his office operations, he realized how little progress had been made on automation. “I compared fields like finance and semiconductors to healthcare and felt they were two different generations of technology,” he says. “One had digitized itself completely, and the other was completely on paper. So it became a logical choice for someone looking to be an entrepreneur to make an impact.”

Girish Navani

In the first few years after founding the company, Navani and his co-founders spent a lot of time studying care delivery and pain points. “We brought a thinking that says don’t just focus on progress notes, prescriptions and labs; think about work flow, digitizing a system that is interconnected with the supply chain of healthcare.”

eCW also broke from the custom at the time and chose not to take money from outside investors. “This is 1999, the era, when every Tom, Dick and Harry was raising capital to go live with a website that was going to be measured in eyeballs, not real revenues,” Navani says. “We wanted to boot strap it, focus on generating recurring revenue and fund our growth through the success of our customers. Nobody thought we could do it. Even some people at the company said they don't think we were going to be successful doing this. But once we started gaining momentum, we were comfortable with slow-paced growth in the early phases.”

One high-profile customer that helped put eCW on the map is the Primary Care Information Project in New York City, which Farzad Mostashari, M.D., led before he became National Coordinator for Health IT. When New York City picked eCW, it was a $26 million company, and the contract was worth almost $19 million. “It was more than a turning point,” Navani says. “For that project there are more than 5,000 doctors on eCW in one geographic location,” he says, “and it is done with outcomes and population health in mind, not just EHR implementation.”

eCW also has a loyal following among federally qualified health centers, with approximately 50 percent of that market.

Erik Bermudez, a KLAS research director, says eCW has a reputation among its customers for amazing innovation. “They are seen as a software development/engineering shop that can pump out more awesome, impactful technology than almost any vendor on the market,” he says. “There is probably only one vendor on the technology side who is close to them as a competitor: athenahealth.”

eCW is already going down the path of telehealth and has advanced tools for physician-led ACOs and patient engagement. “They have done a phenomenal job of looking at all the spaces that need to be filled from a technology standpoint, for providers today and in the next generation, and every one of those spaces has a solution,” Bermudez says.

If eCW has a weakness, it is on the customer support side, he says. Customers say it is like being given a Ferrari without knowing where the gas pedal and steering wheel are. “They love the technology, but many say they don’t feel that they have a business partner to ensure that they are successful,” Bermudez added. “Of course, very few vendors actually have customers who refer to them as partners.”

Vinaya Gavini, M.D., a physician at the ADHD Clinic for Adults & Kids. In Novi, Mich., and an eCW customer, says it’s true that eCW’s software has lots of bells and whistles, “but I found it to be very user friendly and within a couple of months I got the hang of it and really like it.”

Gavini says he likes eCW’s Healow patient portal and a Messenger care management tool that automates sending messages to all his patients about upcoming appointments. “That is an example of cutting-edge technology,” he says. “No matter how much incentive I give to my staff, it was always a mundane task to call all these numbers with appointment reminders. Messenger sends them an e-mail, text message or voice mail. Our no-shows have gone down significantly.”

Although Navani is the public face of the company, several of the other co-founders also still work there, and he stresses that teamwork and a unique company culture are key to the company’s success.

He says eCW is very different from places he used to work in years past — with the typical corporate hierarchies and silos. “Those don’t exist at eCW,” he says. “I am not saying that all 4,000 people are in the same place in the bell curve of understanding the company culture. But by and large we have all adopted that our goal and mission is to make customers successful and to reward innovation.”

Although he is often urged to take the company public, Navani is reluctant. “Being a publicly traded company would take me away from focusing on the technology and customers to focusing on shareholders and return on investment. I am not ready for that kind of decision-making process, and I value my freedom far more than the dollar amount it would bring.”

Nevertheless eCW is definitely in expansion mode. Two years ago the company would not have responded to international requests for proposals, because it was keenly focused on the U.S. market, but in the last year it has picked up customers in 12 countries, and in the first quarter the company set an all-time high for physicians added in a quarter, he says.

Navani is also eyeing the acute-care market led by Epic and Cerner. “I am not satisfied and not going to stop with being an ambulatory vendor long-term,” he says.

KLAS’ Bermudez says he is not surprised to hear that eCW is considering the acute-care market. “They are as advanced as anyone, if not the leader, when it comes to technology. I don’t doubt that soon we are going to hear about them entering the inpatient space.”