Lessons learned starting and scaling a healthcare IT company that integrates with major electronic medical record marketplaces. Presented at the 2019 Epic App Orchard Conference.

1. An Entrepreneur’s Perspective:
Lessons Learned Building an
Electronic Medical Record
App Company

2. Lesson #1
Don’t assume the end user (patient
or clinician) is the best customer
for your product.

3. 61% of digital health startups
that start B2C end up pivoting to
B2B and selling to payers,
providers, and employers.
“
R O C K H E A L T H
“

4. The ideal biz model will:
• Allow you to capture more of
the value you create
• Speed your adoption curve
Follow the money.

5. Lesson #2
Your product must either make
money or save money in both a
“fee for service” or ”fee for value”
arrangement.

6. Too few entrepreneurs have grasped
the distinction between a product that
a physician would love to use and a
product that is so critical to the
business that a health system is willing
to pay for it.
“
H A L L E T E C C O
“

7. At least a 3x ROI is required to create a compelling opportunity.
Less staff/people cost
Less patient leakage
Less staff turnover
ER avoidance
Etc.
Save
$$$
More visits, tests, or
procedures
More complex visits
Improved HEDIS scores
Improved collections
Etc.
Make
$$$

8. Lesson #3
If you can, tie your product to a
federal mandate.

9. https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php
0%
20%
40%
60%
80%
100%
0 1 2 3 4 5 6 7 8
Year
Percent Market Penetration of a “required” EHR add-on
0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
100%
2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2017
Percent Market Penetration of EHRs

10. Lesson #4
Ensure you have a reasonable chance
of integrating your product into the
EMR. But, if possible, start with a
version of the product that doesn’t
require an integration.

11. https://dashboard.healthit.gov/quickstats/pages/physician-ehr-adoption-trends.php

12. Lesson #5
IT time is your primary bottleneck.
You must solve for minimizing
time.

13. IT Priority List
1. EMR Upgrade
2. [Maybe this will be
you]
Server changes
EMR conversion
Go-lives
New EMR features
Content uploads
App Orchard companies
Order set changes
Interface maintenance
VPN setups
Even the smallest IT ask, forces you through this
gauntlet.

14. Lesson #6
Frame your product as a solution
to the “top 3” problems facing the
organization.

15. Lesson #7
Don’t require anyone, particularly
physicians, to change behavior.

16. Two of the most important inventions of modern
medicine
One was quickly adopted. The other was not. Why?

17. Only one made life better for doctors. Anesthesia
changed surgery from a brutal, time-pressured assault
on a shrieking patient to a quiet, considered procedure.
Listerism, by contrast, required the operator to work in a
shower of carbolic acid. Even low dilutions burned the
surgeons’ hands. You can imagine why Lister’s crusade
might have been a tough sell.
“
A T U L G A W A N D E
“

18. Lesson #8
Finding the right person to “sell” in a
health system can be very challenging.
“Selling” is mostly about coaching
organizations how to buy from you.

19. Put your full-screen screenshot here
Who’s the correct buyer?

20. All enterprise sales have some flavor of the following.
📱 Champion
Meeting 📫 ROI/Biz Case
📰 Leadership
Meeting
Security /
compliance
🌙
🌈 Contract Redlines
🔊 Contract Signing
📫 IT/Tech Review
📫 Committee(s)
Presentations
📫 Budget Approval
📫 IT Approval
1-3 months 1-3 months 3-6 months 3 months 3 months w/ 80%

21. Lesson #9
Don’t rely on your own
distribution.

22. The modern physician.

23. Lesson #10
EMR marketplaces are “stamps of
approval”, not distribution
channels.

24. Lesson #11
Health system sales are very hard
to predict when they will close.
Focus on volume of meetings.
Don’t stop until you are told “no”.

25. All enterprise sales have some flavor of the following.
📱 Champion
Meeting 📫 ROI/Biz Case
📰 Leadership
Meeting
Security /
compliance
🌙
🌈 Contract Redlines
🔊 Contract Signing
📫 IT/Tech Review
📫 Committee(s)
Presentations
📫 Budget Approval
📫 IT Approval
1-3 months 1-3 months 3-6 months 3 months 3 months w/ 80%

26. It takes up to 7 touch points across multiple
modalities to reach a prospect.

27. Lesson #12
Focus on customer/EMR
environments where you can
iterate the fastest. Even better if
you have a development partner.

28. Attributes of a good development
partner
Will pay🌫
Not facing EMR
freezes
upcoming
🍉
Contact(s) able to
speak on your
behalf
🍅
”Name brand”
amongst their
peers
🍜
Story can be
proven with data🎠
Active physician
leadership💉
IT is able to
iterate on the
project
💗
Will give their
time💫

29. Lesson #13
References that can demonstrate a
return on investment are far more
valuable than saying “it works”.
Leadership will be required to make
big changes.

30. • Forward-thinking
• Want to drive change
• Will invest time &
money to make it
happen
• Not concerned being
the 1st to try something
1
• Recognize a need for
change
• Lots of competing
priorities
• Want to see others
prove it first
2
• At risk because they are
far behind
• Culture doesn’t support
new products
3
Health Systems fall into 3 categories
80%

31. Lesson #14
Make sure your engineers are
passionate about the problem
space. Give them context. But still
make integration folks apart of
your team.

32. Lesson #15
Product/market can be an illusion.

33. You may feel like you have achieved product/market fit, but
…
CMIO
CIOCOO CNO
Innovative
Systems
Not
innovative
Systems
Your contacts are on a
continuum…
And health systems are are
on a continuum…
The market is not homogenous.

34. Lesson #16
You will likely not achieve full
market penetration. Focus on
profitability.

35. Lesson #17
Healthcare is a long game. It’s a
marathon, not a sprint.

36. Lesson #18
The EMR App marketplaces have the
potential to turn the market from
being one “where the best
distribution” wins to one where the
“best product” wins.

37. Thanks!
@jonathanbaran