Our intrepid tech columnist Michelle Noteboom caught up with eClinicalWorks CEO Girish Navani last week to talk with him about his company’s future, his patient engagement strategy and his plans for international expansion.
Michelle Noteboom: What’s the latest news from eClinicalWorks?
Girish Kumar: There’s a lot Michelle. I like to put it into some buckets so that I can define them. The core is our EHR and practice management space and the focus continues to be on usability and always making it’s more provider-friendly; the whole space around using touch and speech. We seem to be doing some innovative work in that arena to make EHR even more usable than just point and click. In that space we’re seeing continuous growth based on good customer satisfaction and retention.
That’s part one. Obviously the government mandates dictate a lot of other things. Meaningful Use 3 comes on the horizon. Interoperability is a big deal and I think we’ve done some good work with Epic and eCW integrations now for our mutual customers, which is making interoperability even better with faster deployment for our clients.
That’s the core. There are three other things. One is revenue cycle management, which averages 2.9%. We’ve gotten good momentum in that space, with both new customers and convergent customers.
Population health: we’re competing with stand-alone companies in that space reasonably well in both ACO product lines. We did well with other quality programs, so that’s an area that we’ll continue to invest.
And then the last piece of that puzzle is the patient. For the last 15 years I’ve made the provider the center of the equation. For the last three years I’ve also made the patient the center of our equation with healow. The work we are doing in that space is pretty significant. It goes well beyond just a smart phone app. It does so many things now from wearables to appointment bookings, to allowing access to health information reminders, and so on. Patient engagement is a big deal for us.
That summarizes the four legs of the stool, as I call it, in terms of our focus that we have publicly announced. There are two other areas that we have not announced openly but we plan to over the next six to eight months. We are expanding internationally fast. We’ve got some good clients now outside the United States. We signed some pretty decent-sized deals.
International expansion is a continued growth catalyst for eClinicalWorks. For the hospital markets outside the U.S., the inpatient system has gotten some momentum. Those are areas that I will call in their early stages, while the other four are mostly current success areas where we are already vested and reaping good returns on investment.
MN: I read your recent healow announcement and wonder what you’re planning in terms of helping physicians to take all the patient data that’s being captured and making it more usable.
GK: We have a rules engine in our EHR, and going forward that rules engine will not just look at data being entered by the provider. It will look at patient-entered data and give the right alert and the right prompt.
The goal is not to flood in-boxes with data, but to watch for information and trends and highlight that to the provider. An example would be a patient with congestive heart failure who has an increase in weight over the last week. That’s of significance because there might be fluid retention, possibly indicating a heart failure. We like to prompt the provider with some alert in the in-boxes: Jackie Smith, CHF patient, last seven days, weight has gone up.
We’re not going to give them 50 reminders a day. They might end up with one, but it will be the most significant one. Plus when the patient does come into the office, we’ll have the ability to graph, trend, plot, and grid this data so that it will have some value in how they treat the patient going forward.
MN: I’ve noticed the Care Coordination Medical Record product has had some good success in the last year, especially with the physician-led ACOs. What’s unique about your product that’s helping to spur adoption?
GK: We have a simple definition of population health. We’ve said EMR was about managing one patient, one visit. Population health is about managing a panel of patients across all time horizons. That was our overall goal when we designed Population Health and CCMR.
Many population health companies only do analytics but don’t really have any rule engines underneath that do anything smart with the information. Many do not have care management built in. Coming from an EHR background, we knew very well how clinical pathways, clinical guidelines, and encounters need to be managed.
We thought that you needed care planning and case management even for populations. So that distinguishes us.
The third piece that makes us unique is overall patient engagement. Population health without integrating the reminders to patients and keeping them in the loop is really a half-baked solution. The three together make it quite a unique combination. Obviously for our EHR customers we bring the value of the integration, making it even more differentiated from many other stand-alone products.
It takes commitment. What also differentiates us is the ability to invest in R&D and implementation resources. We have many people now working in that area.
MN: Give me an idea of how many customers and employees you currently have.
GK: 4,000 employees. 14,000 unique customers that make up over 100,000 providers. That’s a pretty big number.
People like Surescripts look at the number of prescriptions processed. They say that eClinicalWorks is the second largest EHR in terms of the number of prescriptions coming through the system.
I haven’t asked them who number one is, but I’m speculating it is Epic in terms of size. And similarly, there was another data point by another company that had done a regional analysis of EHRs. They were tracking the same way. Epic was ahead in market share but if you take the hospital-employed providers out of that equation, we even have a bigger market share. There’s a lot of room to grow and a lot of hard work, but I think we’re doing well.
MN: Have you made much headway in the employed physician space or are they typically sticking with Epic?
GK: We have continued growth and success stories coming up around the employed physician groups. We have not seen an inpatient Epic/out-patient eClinicalWorks implementation, though we have quite a few inpatient Epic and community eClinicalWorks. We signed a recent one in Ohio for Nationwide Children’s that is an Epic hospital, but will use eCW for the community doctors.
Overall, we are doing well with employed groups and there is traction. The broader question is, are we going to do inpatient system in the United States? The answer I’ll give you right now is we are, and we are actively doing inpatient for international hospitals today. We have success in that space and will continue to grow that. There will be a time and a place for United States, but I don’t know the time and place yet.
MN: What countries are you in currently?
GK: We focused our attention on the international markets in India first because I felt it was important that I do something with healthcare in India, and we’ve succeeded there. We’ve since gone ahead and focused our energies around the Middle East and Africa, and we are seeing some success in those regions on the inpatient side.
On the outpatient side, we now have customers in Europe, New Zealand, and Australia.
MN: Any thoughts on the Stage 3 proposed rule?
GK: Not yet. Honestly I haven’t gone through all of it yet, but there will be a time and a place for us to do that. Like anything else, we will meet the letter of law because that’s the right thing to do for a company, but we’ll also have a say in the public comments.
There are people reviewing it in the company but I won’t start my active participation in those discussions until probably after HIMSS.
MN: We’ve seen some pushback from providers on the Meaningful Use program. Do you think that Meaningful Use is going to eventually fade away? Where do you think it’s going to be in five years?
GK: I would say broadly that there’s a role that the government plays in any industry. Just like with bowling lanes, they at least have to put the guards on it. To think that the government is not going to have any guards around the use of electronic health information would be wrong.
Now, will that be under the umbrella of a Meaningful Use program or will that will be in some other program or mandate? Because CMS is a big payer of services, it has a role to play. Plus, it’s a $1.3 trillion industry which means that it will get some level of regulation – not necessarily one that I feel is either good or bad. I would prefer none, but I know it’s a pretty significant industry and there will be rules and regulations and mandates that people need to comply with.
I think that the incentive programs will have less of a meaning and will be more around the proper use and design and capabilities of EHRs. Hopefully we have learned from some of the mistakes we made.
I thought Meaningful Use 1 was pretty sound in terms of what it did. And MU 2 had certain requirements that some people pushed back on in real life practice. You can learn from the mistakes and hopefully in Stage 3, try to implement changes, see what’s successful, and see what areas need a little bit more of tweaking and tuning to get right.
MN: Which EMR vendors do you think will still be relevant and successful in both in the acute care and outpatient care spaces by the year 2020?
GK: Well, I can make this broad statement and I think I’ll be right: the number is going to reduce greatly. Like any other industry, you end up with five or six capable companies that end up eventually playing a significant role. You cannot end up with 50 or 60 – maybe seven or eight at the max – but you can’t have 60, 100, 200. Not because the market is not big enough and not because the companies are stupid. It’s just hard to continue keeping your existing clients satisfied and moving the ball forward.
And then, the definition changes. What I used to call an EMR in 2004 or 2005 is not the same product that I call an EMR in 2015. We don’t deploy an EMR without a patient portal today. That’s just a simple basic fact. I think some day in the future an EMR without population health will be like, “Wow, how can you sell an EMR that doesn’t do big data analytics that is part of that system?”
The bar is getting higher. Companies that keep investing in population health and patient engagement and cloud services, and keep making their core products better will make it. But that’s a hard chore. Keep in mind that market size doesn’t guarantee success. That’s one lesson I’ve learned from history – that just because you are small, you’re destined to die, and just because you’re big, you’re destined to survive.
I would tell any vendor — because I remind myself the same thing every day – don’t take things for granted. Just because eClinicalWorks is successful today, unless we keep doing the right things that we did before, we will become insignificant in the future. Technology changes, times change, management changes, company founders that started the company are not around 10 years from now and somebody else is running the company.
We can’t assume that just because you have market share today that in 10 years you’re going to be there for sure. Sometimes, it’s the newer ones that can dominate.
I feel good about where we are today and about the chances of us being able to continue to innovate. We built our company with a good revenue stream from cloud services and subscriptions. We’re able to invest significant amounts of money in our R&D. But we’ll have to stay on our toes.
The way I look at it, you might not be doing great today, but you might be doing something amazing today that tomorrow will make you stand out. And you might be doing something amazing today and you might become stagnated because you made some commitments to your customers that you can’t keep. It’s hard for me to speculate if this company is absolutely going to be here 20 years from now or ten years from now. I don’t know.
MN: Where will you be personally? Will you still be running eClinicalWorks?
GK: I intend to, yes. I have been very open about this. I intend to be at eClinicalWorks for the next ten years — and you can’t plan anything beyond because you don’t know.
I’m 48 years old this year. I plan to be in 10 years doing what I do because I love what I’m doing. I have no intention of going public – that I have said very openly as well – but beyond that, I can’t be a fortune teller. I’d love to build eClinicalWorks in the next 10 years to be bigger and better and making a bigger difference in health care than it did in the last 10 years. That’s my goal, and we’ll see. I’m having a lot of fun doing it still.
MN: Fun matters. Is there anything else you want to add?
GK: We are opening up an international office.
GK: There will be an office in Europe, but I can’t tell you anything more than that today. It’s a few months out before we announce. I think that’s one of the more exciting things going on.
We’re doing work in some parts of the world today where we think we are going beyond financial motives with the understanding that health care technology can make a difference in the healthcare delivery. It was one of my broad statements when I started eCW: that technology can have a positive role to play. I am energized that I’m now able to deliver that in some parts of the world that will probably in the next 10 years benefit from the use of technology.
Let’s see where that goes, but that’s a way of me giving back, to give more meaning to the success that we’ve seen in the last decade as a business.
Michelle Ronan Noteboom covers HIT for THCB and writes the HIT Newser column.