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The evolution of eClinicalWorks


There are over 300 million people living in the United States, which creates a need for  thousands of hospitals and medical practices located within the country. EClinicalWorks (eCW) is one of the largest cloud-based health and safety software in the US. It provides secure cloud-based solutions to medical practices for all their IT needs. 


ECW’s core product, the Electronic Medical Records (EMR) manages patients’ full clinical documentation history and interoperates with other healthcare systems so patients’ medical data can be transferred seamlessly as they move between hospitals and practices.


The initial development of the EMR (Electronic Medical Records) was almost 20-years ago. Since then the software has been through many significant evolutions. Every practice that runs eCW software has a dedicated instance of the EMR—this is 11,000+ Practices with more than 850,000+ users.

Pragmatism is a widely discussed concept but rarely taken into account when you are looking for software development partners. Codurance team embodies just the right amount of practicality with the overall vision and knowledge to bring positive change to any organization.
Sapankumar Parikh eClinicalWorks

Sapankumar Parikh

Vice President of Software Development at eClinicalWorks


Creating a multi-year software modernisation project


eCW recognised the need to modernise its systems and prepare the EMR platform for the next 10 years of rapid growth. In order to take this platform to the next level, it would need to upskill its delivery teams, and this would be the first area of improvement. The full modernization project would involve creating an effective software modernisation strategy which would address eCW’s enterprise needs and lead to a full multi-year modernisation program.

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Given the size and complexity of the development team and software, it was hard to keep consistency in the code and architecture. Codurance was brought in to create a training program to upskill the developers with an in-person, hands-on approach.

Read more This training program took place in both India and the United States, it created excitement in a development approach that would allow consistency going forward.
Strategic Advice

Strategic Advice

Vice presidents within eCW from all different departments such as sales, compliance, architecture, operations and marketing were brought together. Together with Codurance, they planned out a strategic improvement approach to the EMR with the eCW leadership and senior management team’s collaboration.

Read more The internal teams were able to understand the approach they would need to take, the most important outcomes, and where the biggest improvements would be.
Software Modernisation

Software Modernisation

The EMR was initially created 20-years ago. Throughout its lifespan it had grown considerably and continuously been updated, meaning it now consisted of around 16 million lines of code. Each system within the EMR would need to be updated, creating safe areas to experiment and improve while establishing new ways of working.

Read more The system would need to continue to be live to support the thousands of eCW customers relying on its use, every day.


Software fit for the future


During any modernisation project, technical improvements need to be prioritised according to business value. Learning from an initial project, eCW envisioned a multi-team, multi-stream software modernisation project to improve not only its products’ architecture and technical processes but would also allow it to continue innovating and evolving its systems for the next 10-years of growth. 


The Codurance team created a strategic continuous improvement program (CIP) that would help eCW senior leadership strategically prioritise improvement projects according to the business value. The CIP would be efficiently managed following agile methodologies, software craftsmanship principles and DevOps mindset. It would create a knowledge transfer through tasks, allowing a learn and apply approach and creating that new working culture within the organisation.

Over 100 developers trained in modern Agile and Craftsmanship practices

QA cycle reduced from 2 weeks to under >2 hours

Reduced risk of introducing patient safety issues

The CIP would create teams of eCW personnel working closely with experienced Codurance developers so they could begin to understand the new ways of working and a cultural shift that empowers the development of new skills. 


This led to the production of 6 strategic improvement projects in core business areas (4 led by Codurance, 2 by eCW with support from Codurance). As well as creating better ways of working being replicated across the organisation with a clear understanding of the ROI and reduction of accumulated technical debt.