October 17, 1991 - Home Infusion Nurse Meets
Computer Programmer
It sounds like the beginning of a beautiful relationship, doesn’t it? OK, don’t get the wrong idea… it isn’t that kind of a relationship. Stuart Crane was in his backyard raking leaves – a rare occurrence back in those days, as he spent most of his time in his basement working on his computer. I owned the house one street over and we were backyard neighbors. I was also outside working in the yard – something I did all the time - I didn’t have a computer. We met over the backyard fence.
“So, what do you do?”
The conversation started out the way all first neighborly meetings go… “So, what do you do?” “Home infusion therapy,” I said, “I’m an RN”. Stuart said, “I’m a computer programmer, I write database programs”. How ironic, I thought. For the previous six months or so, I had been looking, unsuccessfully, for a software program that would automate all the pen and paper based record keeping that I dealt with everyday. On that day, over the backyard fence, the seeds of CPR+ and Definitive Homecare Solutions were planted. It was literally in that very first meeting, the idea of a software program for home infusion therapy was created. Eighteen months later - April 1, 1993 - CPR+ was created, and D.H.S. was open for business.
This month, April 2008, marks the 15th anniversary of Definitive Homecare Solutions. It’s almost unbelievable to think all that was 15-16 years ago. And while the founding of the company rested on that fateful meeting back in 1991, the past 15 years could not have been possible without the great work of our incredible staff and the support of all of our fantastic customers.
Click here for a pictorial retrospective
Almost immediately after our first meeting, we began designing the software that would become CPR+. We took my boss out to lunch and made him an offer he couldn’t refuse – we’d write the software that would automate most of the paperwork in the company, dramatically improve JCAHO compliance and management reporting, all after hours on our own time, and all it would cost him was a few hundred dollars per month.
So, every night after work, I’d head over to Stuart’s basement and we’d work on the software. I’d sketch out the screens on a legal pad and Stuart would, like magic, write the code that transformed my sketches into functioning software. It was unbelievable. It truly felt like magic – like there was nothing we couldn’t make it do. Stuart’s vocabulary didn’t include the words “I can’t do it” and I wanted the system to do it all, immediately. We stayed up late, lots of nights, drinking coffee, eating pizza and writing software.
By the spring of 1992, we had built a basic and highly-customized program that began to replace all of the paper-based forms and procedures that the infusion company I worked for used. The program allowed us to enter a new patient, add demographic and medical information, medications, POT’s, progress notes, and care plans, and simply press F7 to print. Sound familiar? This is where the infamous CPR+ “Patient Menu” began. Before long, our entire staff was hooked on this simple little program. It revolutionized the way we worked. Computers were networked and we were sharing patient information between intake, pharmacy, nursing and reimbursement. No more shouting “Who’s got Mr. Smith’s chart?” …now everyone could have access to the chart. I remember sitting in a clinical case meeting and pulling up a patient on the computer. We all looked at each other and said, “How did we run this business before we got this program?”
Neither Stuart nor I had any formal business experience, but we were pretty sure that we had created something that other infusion companies would be interested in. Maybe, a lot! So, we decided to build a business around our little program. We began writing version 2.0, came up with a name for our software and our company, and bought a $10 vendor’s license from the State of Ohio. By the spring of 1993, after a bit of tricky negotiating with the large health system that owned the infusion company I worked for, we established indisputable ownership of the code, and we officially formed our company.
Then the real fun began. We were working day and night to bring CPR+ to market. With a total of $400 of start-up capital, ($200 invested by each partner and I can still remember my ex-wife complaining about that), D.H.S. began operations. I continued to work full-time as an infusion nurse and Stuart worked full-time as a programmer. Every night we worked out of Stuart’s basement to add new features to the software and market it to the home infusion industry. We got leads, we sent out information packets and free, fully functional software demo discs (3.5 inch floppies!) We used vacation days from our day jobs to visit prospective customers. We made a few early sales in the spring and summer of 1993 and our company bank account swelled to several thousand dollars! It was amazing – people were paying us real money, we were having a blast and CPR+ was on its way to becoming the most dominant software system in the industry.
By the end of 1993, with four real customers and a bunch of prospects, I quit my day job and started walking across the backyard every morning to Stuart’s basement. We had a two-line phone so I could make outgoing sales calls on line 1 and take incoming support calls on line 2. I could reach Stuart when I needed him – which was often. I’d have him on one line helping me troubleshoot an issue with a customer on the other line. It was working. By the fall of 1994, we’d sold another 25 customers, although my two-line phone was getting quite a workout.
We Doubled our Staff!
In October 1994, Stuart’s programming contract was up and although they desperately wanted him to renew for another year (for big bucks I might add); he politely said “No, I’m going to work full-time in my new business.” So we doubled our staff! With Stuart and I both working full-time, it meant that Stuart could program ALL day (not just from 6 pm to midnight) and take technical support calls. I could focus on making new sales and training new and existing customers. We closed 1994 with 33 new sales for the year and total customer base of 37.
We sat down at the end of 1994 and tried to create a budget for 1995… we thought that if we kicked butt, maybe we could sell 50 new customers in 1995. At an average price of $5K or $6K, coupled with the support fee revenue from our existing customers, we could do $300-400,000 in revenue – enough to get out of Stuart’s basement into a small office and hire an employee or two. As it turned out, in 1995 we sold 101 new systems. It was crazy. Back then, most home infusion companies were buying their first system and there were, relatively speaking, lots of them out there.
The Mid-Late ‘90s
From 1995 to 1998, we continued to grow rapidly, averaging just over eleven new sales per month for 36 consecutive months. It is awesome that so many of those early customers are still with us today. In fact, our very first “real” customer - Northside Home Infusion in Zanesville, Ohio – is still an active customer today. This is one of the companies that Stuart and I took vacation days to demo back in 1993. There are so many more – Ed and Conrad with Responsive Solutions in Myrtle Beach; Nancy Dowdle, who owned Southeast IV Homecare in Montgomery, AL (which later got purchased by Lincare Infusion . . . more on that later); Bambi Chapman with Option Care in Beaumont, TX; Arlington Clinical in Reno, NV (now owned by Omnicare); Bill and Monica with Trinity Homecare; Chris Powers with Care Solutions of Nashville, and many others. The owners of these companies invested their faith, trust (and money) in us. We were, and still are, incredibly humbled and honored by that faith. We committed ourselves to do everything we could not to let them down.
We rented our first office and quickly outgrew it in early 1996. We bought our first building in the spring of 1998 - 4,200 square feet, up from 1,250 in the rental. We had 8 or 9 employees and tons or space - this would last us forever, we thought. Four years later, we had grown to 25 employees and had programmers working in the unfinished basement of the space, with cinder block walls and the furnace 10 feet away.
CPR+ for Windows
The early 2000’s were a period of big changes for the software too. We began working on our Windows Version of CPR+ in 1998 and by June 2000, we released it to existing customers. It was a little rocky at first… but we had decided very early on that existing customers would be able to run either our DOS or Windows version simultaneously. That way, they could migrate to the Windows version at their own pace, and at their comfort level. In addition to sharing the same back-end database between our DOS and Windows versions, we also decided to keep the feel and flow of the system similar to the DOS version. These decisions paid off big time. Customers could upgrade to CPR+ for Windows with no fear of losing data, or disrupting their business. There was no data conversion required and if they ran into a problem, they could always flip back over to their DOS version. They didn’t need to spend a lot to upgrade and most of them got up and running with a couple of hours of telephone training. By taking virtually all of the risk out of the upgrade process, we were able to upgrade literally hundreds of CPR+ customers in a very short period of time (18-24 months). This gave us a lot of great customer feedback and word of mouth advertising, not to mention a nice revenue bump. Throughout the rest of the early 2000’s, we were able to focus all of our efforts on making CPR+ for Windows the most feature-rich product on the market. We added: Integrated Fax and Document Management, interfaces with UPS / FedEx, Thermal Printing support, and so much more. These new features drove new sales even higher, as did the many testimonials we could provide from hundreds of satisfied CPR+ for Windows customers.
More Space and Can You Add HME Please?
Our growth continued and with it our need for an even larger office. We sold our first building and moved into our current building in May of 2002. That was our 9th year, and thanks to several large, multi-site customers who came on board, we grew at a 63% pace over 2001. Lincare Infusion, Cleveland Clinic Homecare, SpectraCare, Corner Homecare and many others joined the CPR+ family in the early 2000’s. Some of these customers acquired other companies and promptly moved those locations to CPR+; others got acquired and we were able to convince the new ownership to stick with CPR+.
It was also during the late ‘90s - early 2000’s that many customers first started asking us for HME related enhancements. We hired Ted McGraner in 2000, based on his years of experience with a large, local HME company. Ted had 10 years of MestaMed experience. He led an HME Customer Advisory committee and we began the process of adding significant HME related enhancements to CPR+. Margins in infusion were getting squeezed and lots of companies wanted to be a “one-stop shop”. Customers also wanted to run both aspects of their business with one piece of software. Fortunately for us, they liked CPR+. They said, “if you just add this one new feature, we’ll be able to run our HME operation on CPR+.” So we did, and hundreds of new HME features later (with more on the way), a large percentage of our customers today run both their IV and HME businesses with CPR+.
MBI and SCS Acquisitions
By the mid-2000’s, the Infusion and HME markets were definitely changing. Margin pressures continued and as a result, there were significantly fewer new start-ups than in the “good old days”. The days of selling 11 new systems per month were long gone and every provider was already on their first or second information system. Fully 80% of our new sales were conversions – a customer switching from one system to CPR+. Switching systems is not high on anyone’s wish list, so this made for a much harder and much longer sales process. And, while our customer base was by now over 550 locations, a significant percentage of our total revenue came from new business. Stuart and I began talking about doing some acquisitions in 2004, figuring that 7 software companies for a small and shrinking market was about 6 too many
. I remember doing a demo with an MBI customer in July of 2002 – he was lamenting his old technology DOS based software, how it was “killing” his business and how he “couldn’t get on CPR+ fast enough”. Months went by, however, and they never bought, always having a reason to delay making the switch. In July 2005, he again called and said “his old DOS program was killing him” and he “couldn’t get on CPR+ fast enough”. More demos, more calls and more delays. We finally decided that the only way we were going to get that guy as a customer, and possibly a couple hundred more just like him, was to go out and buy the software that he used. We acquired MBI in November 2005. A few months later, in June 2006, we closed on SCS. As we did with our CPR+ to Windows conversions, we tried to minimize the perceived risk associated with switching systems. We got to know all of the MBI and SCS customers and they have gotten to know us. We worked hard to provide them with a higher level of service than they had previously received. We tried to prove our value, and so far, it has worked very well.
The Next 15 Years . . .
I have no idea what the next 15 years will bring for D.H.S. but I can tell you that the first 15 has been a great ride. Who would have thought, right? I can tell you one thing, Stuart and I are as committed today as we’ve ever been – to our customers, to the market and to our business. We will continue to evaluate opportunities to grow so that we can serve you better. We will pursue new strategic alliances, such as our relationships with B. Braun, RemitData, or SHP when we think they make sense for your business. We will continue to evaluate possible acquisitions. We will continue to aggressively compete in the HME market. This fall, we will release CPR+ v8.1 which will include hundreds of new features including the ability to do line-item based financials and split balances – something that we’ve been working on since about 1994! The bottom line is we will stay focused on how best to serve YOU. That is what has made the first 15 years a success! Why change now? Thank you for all of your support and loyalty; we will continue to work hard every day to provide you with the best software and service we can deliver.
Sincerely,
Jeff & Stuart