Step 1 of 3 · 2010–14

A practicing dermatologist supplied the product’s clinical structure

Michael Sherling knew the examination workflow from practicing dermatology. Dan Cane brought software experience. When teaching Cane the clinical detail proved impractical, Cane taught Sherling enough programming to encode it himself. The pair worked on the prototype for six months. That decision put clinical content inside the product rather than requiring each practice to recreate it through templates. MM1

An anatomical interface and prebuilt clinical choices connected an examination to its note, billing information and prescriptions. The design addressed the specific work that made a generic record burdensome for a specialist. Sherling reported about 4,800 providers and eight specialties in the 2014 interview. In his later Yale account, early physician demonstrations also explain the first distribution route: doctors who understood the problem became investors and introduced the software to practices. MM1 MM3

Rivals The practical alternatives were paper records and electronic systems that required extensive typing or local customization. The entry choice concentrated on the repeated work of a specialty practice instead of attempting to cover every clinical setting immediately.

Founder Domain ExpertiseEnd-to-End Workflow

Step 3 of 3 · 2011–22

Commercial expansion brought a costly compliance settlement

In November 2022, the Justice Department announced a $45 million settlement with Modernizing Medicine. The allegations concerned three kinds of conduct: payments connected to a laboratory relationship, a program involving donated electronic records, and remuneration for customer referrals. The government also alleged that the company obtained certification despite missing required standardized vocabularies. The agreement resolved allegations; there was no determination of liability. MM4

The matters described by the government reached both customer acquisition and the product’s eligibility for federal electronic-record incentive programs. The settlement imposed a $45 million cost on the company and put its referral programs and certification practices under scrutiny. MM4

Rivals Legitimate physician recommendations and compliant electronic-record certification are different from the conduct alleged in the settlement. Competitors could sell through those same lawful channels.