Chun – Part I of IV
DIFFICULTY AT THE BEGINNING works supreme success,
It furthers one to appoint helpers.
Nothing should be undertaken.
Furthering through perseverance.
Difficulty at the Beginning
One doesn’t have to look far to see the tech giants that began from humble beginnings in a garage or bedroom. Facebook, Apple, HP, and many others were born by stubbornly committed entrepreneurs with a dream of something new and better. HarmoniMD, EHRI’s main product, began in the bedroom of Nick Smith and, in the early days, Andrew Patrick was the only other programmer. Working nights and weekends, they hammered out a working prototype.
In 2010, Nick and Andrew set out to build an electronic health record platform for documenting telemedicine encounters at the request of Dr. James Gude, who was launching OffSiteCare Resources, Inc., a pioneering telemedicine company. As they delved deeper into the EHR space, they began to see that the market was dominated by antiquated technologies that were priced in the millions of dollars even for very small hospitals.
Nick believed that by using newer cloud-based technology, hospital EHR’s could be delivered for a fraction of the price of existing systems.
In 2012, Nick teamed up with Dan Smith, founder of The Master Builder, a product he sold to Intuit in 2001, and who had been helping Dr. Gude grow OffSiteCare Resources, Inc. Dan was very skeptical of being able to break into the US market for hospital information systems because it was dominated by billion dollar companies, had very long sales cycles and the functionality bar for entry was very high. His view was that it would take a minimum of $200 million to break into the US market and compete with Cerner, Epic, and Paragon, some of the leading hospital EHRs.
At the time, the US market was being driven by a torrent of dollars from the federal government in the form of rewards for implementation of Meaningful Use software systems. With a seemingly endless supply of money ($84 billion from the feds), hospitals had few qualms about paying many millions of dollars for software and had little reason to take a chance on something new.
Nick and Dan agreed that they would research what the rest of the world was doing for hospital record automation and either drop the project or launch a new company to pursue it. Initial forays were made to Haiti, Liberia, Sierra Leone and the Philippines visiting hospitals to observe how they were managing patient information. Later trips to Egypt, Jamaica, Guyana, India, Congo, Tanzania, and other countries demonstrated that the developing world was hungry for a low-cost hospital information system and that requirements to serve these markets would need a dramatic shift in the product.
As originally envisioned, HarmoniMD, was a cloud-based platform designed to run on PCs and Mac computers. In the US, hospitals had adopted expensive server-based systems that used Computers on Wheels (COWs), which were priced from $8-10,000. The implementation and training costs for these systems often outweighed the software price. This paradigm was clearly not going to fly in the rest of the world where capital was nearly non-existent and computer sophistication limited.
Nick and Dan also realized that to be successful, HarmoniMD would have to run on inexpensive mobile devices, work well over the cell network, and be very easy for nurses to learn. This retooling would take considerable effort and time and require some new people on the team.
Rethinking HarmoniMD as a mobile app required additional research to determine all of the needs of developing-world hospitals and hiring a team with experience in building mobile apps. Being able to run well over cell networks and erratic wifi systems using inexpensive mobile devices brought their own challenges. Research indicated that the best approach would be to use an installed application on a 7” tablet. It was determined that OData, a new database connection, would allow the system to operate in an unconnected state. Compression of data transport would also minimize bandwidth requirements.
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