Interview with Markus Hilbert, Founder EarWorks, Inc.

Topic: Effective & Integrated Office Software

Paul Dybala: Hello again, this is Dr. Paul Dybala with Audiology Online, and I want to welcome you to another one of our interviews. Today I'm speaking with the founder of Ear Works Incorporated, Markus Hilbert. He's also an audiologist and the owner of Chinook Hearing in Calgary, Alberta, Canada. He's talking to us today about the software he's created for private practice offices, called Ear Works. Markus, thank you so much for being here today.

Markus Hilbert: Thank you.

Dybala: I think it's very interesting how, while you are an audiologist, you also developed business software for your practice. So to start, could you give us a little background on that?

Hilbert: Well, basically, it all started many years ago when I took my audiology degree in Portland, Oregon. I then moved up to Canada, worked in a practice, which was a large corporation with many offices; It was what you might consider a large chain. The number of clients or patients that we saw was very much limited by the administrative work that we had to accomplish in order to see those patients.

So the powers-that-be in that company tried to create different systems and processes around our existing software to make that less of a problem, so that more of our clinician's time could actually be spent in the clinic with patients. I found that a lot of those efforts kind of went sideways, because they were missing the point. They were separating administration from clinical.

Then I started my own private practice in Calgary. I moved up to Alberta and bought out an existing practice. We had really no system in place. There were a couple of offices, and every office, every receptionist, did their own thing. It was very difficult to streamline and integrate the clinical with the administrative, and we were looking for a way to resolve that. That's really where the idea of Ear Works began. We went through various false starts where we tried different software platforms and different approaches. Ultimately then, our success came when we hired a programmer to help us develop an office-specific system; but the catch was that we took the computer away and made the programmer do all of our administrative tasks by hand.

Dybala: Really? [laughter]

Hilbert: We made it hurt, and they did that for about six to eight months, and then the programmer understood the system. So, instead of our initial approach, which was to get someone who was a genius at software to build a system, we took the genius and we took away their tools, which made it a really, really integrated process.

Dybala: Okay, just so I have this correct, you took a computer professional, a person who spends all day on a keyboard programming, and had them organizing files, filling out paperwork, and scheduling on the calendar?

Hilbert: Exactly. It was difficult to find that person, but we did. They're still with us as Senior Programmer. They really do understand the industry from the inside out, which enabled us to develop products that are very intuitive, very automated, and integrated. This makes our work as successful as it can be.

Dybala: How did you develop the software from that point?

Hilbert: We had three phases in our software development. The first phase took about three years and beta tested on a daily basis in the clinic. We ran paper files and software files at the same time. About halfway through that process, we dropped paper files and converted everything to digital. We archived all of our paper files, so that really cleaned up the office quite a bit. That in itself was probably the biggest benefit to the company and to the clinic, because we spent so much time finding files and tying up loose ends on patients. But that process took us into paper-free mode.

We actually went to market with it next, and we did that at conferences here in Canada. We basically focused on the Canadian market first. In so doing, the folks who bought it and got on board received extreme programming, which is a different approach to programming; instead of gathering all of the needs and desired features from users, implementing them into future updates and then eventually beta testing them for future release, we released two updates a week based on consistent user feedback. That was our goal.

Dybala: Tell us more about this extreme programming approach.

Hilbert: We released two new updates a week for all of our clients over the course of about a year. So anything they wanted, they could suggest it. We'd get a pile of e-mails which included requests, needs, error messages, bugs, new feature requests, whatever it might be, it was a free-for-all. These were all addressed twice every week. That really made clients very happy. But extreme programming takes a toll on everyone, both customers and staff, because there's constantly new stuff to learn; it's a really steep learning curve. One client might request something another client has no clue about, and all of a sudden they get new software that has all these new things. Navigating through new updates was a little bit of a challenge, but it was exciting. That took us through version two, and now we're on to version three, which came out October 2006. We are taking a more traditional approach with 3.0, doing beta updates on a regular basis. We are still including new features that clients want, but will probably be closing that out in the next couple of weeks.

Dybala: It sounds like from the amount of work you're doing that you've probably covered about 90% of what people need, too. So there's probably not as much of a demand for change at this point because it's become a mature platform.

Hilbert: Exactly.

Dybala: I've been browsing your web site at EarWorksInc.com, and looking through your literature, one of the big things you've stressed is how Ear Works can save you time and money. Could you share a few examples of how using your software can actually do that?





Hilbert: Absolutely. So, in the clinic environment, we have the traditional office supervisor and manager. Everything kind of goes through them. They keep a really keen eye on what's going on in the clinic for the owner, and for the branch. In my experience, they also kept an eye on me, making sure my reports were written in a timely fashion.

This back-and-forth process took a lot of time. If the process were integrated, instead of writing a report in Word or transposing it later, actually writing it during the appointment time, it would save huge amounts of time. If I didn't have to carry the file forward to the next step in the administrative process, that would be great too.

Dybala: Can you give an example?

Hilbert: One example (and there are many more) relates to billing. In Canada, of course, we have very involved government funding for medical benefits, including hearing aids, so it's a very paper-heavy, administrative process. The entire financial side of the practice is very time consuming.) Ear Works integrates the financial and administrative work right from the clinician's fingertips, and saves everybody their efforts of having to walk files manually through the entire process.

For example, if I enter an order for a hearing aid in Ear Works, it automatically creates invoices, verifies third-party eligibility, creates the forms needed to be signed by the third party, and creates tasks for any kind of requirements that the third party may have for follow-up. It creates appointments; it just does everything. So you can have a really tough day and still make sure you cross your T's and dot your I's. It just watches you like your office manager would, and alerts you to important things.

Periodically, the administrator or the owner of the company can run a quick report, and Ear Works will show all the items or tasks that are in need of attention, for example, outstanding patient invoices after X number of days, third-party payments not received, any kind of pending orders that are still in trial and haven't been finalized; all of those things are at their fingertips. So you don't even really need to be there. You can sign in from Hawaii for all anyone knows, check how your clinic is doing, and have as much control over it as your officer manager would, whom then you really don't need. It brings the small clinic, or small to midsized private practice, up to the competitive level of the larger companies that are active in our industry now.

Dybala: Well I think that should be your news sales slogan: "You can run your practice from Hawaii." That could be pretty attractive to a lot of people!

Hilbert: [laughter] Absolutely.

Dybala: You mentioned how multiple people in an office could be using Ear Works. I would also assume that it would be very effective for a single person office?

Hilbert: Absolutely. The benefit that Chinook Hearing had throughout this process was that we had three administrators doing different administrative financial jobs before Ear Works. Once we integrated the software, there was less of a need for them and they were given the opportunity to either retrain or move up in the company, and they chose different career paths. There really is no need for a heavy administrative overhead, which saves time and money as well.

When you do hire a new employee and train them on Ear Works, the learning curve is extremely quick. They don't need to know the different products and prices or what all of the third party requirements are; the system just kind of spits it out. Say, for example, you need to hire a temp on short notice to run your front desk. It would take somebody about 20 minutes to learn Ear Works, and they're ready to go and are pretty effective at it.

Dybala: What would you say is the main difference between Ear Works and some of your competitors?

Hilbert: There are a number of differences. The primary difference is that Ear Works is not only an administrative tool, but a very strong clinical tool with subjective and objective measures built in with case histories; the administrative and clinical applications are integrated. I would say that's the number one strength and difference between the competitors.

Secondly, Ear Works is not an online system. It's on a server, so you own it, and it automatically backs up. You also have security built in, so you can access remotely through the Internet, through VPN, through remote desktop or any other network options. You can also take the data you need on a laptop, go to a remote location and do some work, come back to your main location and then upload your new data to the system; this is helpful in the event that you go to a location where there is no reliable Internet access. You can definitely work with Ear Works in any situation or location.

It's very flexible and very much your program. There are no ongoing fees, there is no monthly cost; it's a one-time purchase that even the hearing aid suppliers will often times buy for a client. So basically you are getting software, that you work off with hearing aid sales you would make anyway, and it benefits your office all the way around because you've expended no cost to start it up.

Dybala: I guess the next question would be if I decided to go forward with Ear Works, how is it implemented? Let's say if I have a previous system that's digitized, or maybe if I don't have anything digitized. How does that implementation work, and what type of support should people expect once they have the product in their office?

Hilbert: Let's say there are a couple of clinicians and a couple of administrative people and they're thinking that maybe they need to implement a system or upgrade to a better system. The absolute number one thing is to ensure that the staff and clinicians on the same page. If you have administrative staff or even one clinician who's not on board with the changeover, it's not going to succeed as well as it should. The first thing we do as a company is provide a group demo. Everybody joins in, we give them a quick overview, they ask questions, and then each employee is allowed the opportunity to play with it. After the demo, the owner should be able to get their staff into the process.

From this point, we can run another training session that goes into a bit more detail, because questions will come up a few days after the first initial exposure to the program once they've said "Okay, we're going to go ahead with this." The owner or the clinic as a whole can pick a date and say, "From now on, all future administrative actions are in Ear Works and everything prior to that is in the old system," whether it be QuickBooks or paper, they can always find their data.

We create a plan up to that date, and the first thing they do is download the Ear Works application, activate it, and then they will get an activation key from us, which interlocks that system to theirs. It's part of the security feature. If their servers were stolen or the security in their computers were breached, nobody can access the program unless they had the same activation key to run Ear Works, along with the password. We can't even access individual applications because of these two features, so it's completely safe.

Once they have the system activated, they would then set up the company within the software; that includes adding logos, margins for letterhead, markups for hearing aids, etc. It's quite an extensive customization to the clinic. A customization wizard guides people through that. Some people spend about a week or less, and once that step is complete, the company's installed, activated, and basically ready to use.

Now we come in and we do training online. This is still prior to the switchover phase. People can join from any location; somebody could be on holiday, somebody could be at home, somebody could be at the office, everybody's timed into an essential online meeting, and we work on their system that's now been customized to their clinic. We start entering test patients so it's interactive; it's not just us showing them, it's them doing it on a shared screen.

We usually split up the five hours of pre-training that comes with the program into three sessions: one hour for a company setup session and then two two-hour sessions addressing different functions and features of the software. Once training is complete, the clinic staff themselves enter the schedule. They enter all their patients on the schedule from that day forward. And as patients start being seen, all of the different action items are done in the system. So at that point, Ear Works populates all of the reports and accounts payable and receivable items. The more it's used over time, the better it starts to spit out reporting information to the clinic owners.

Dybala: And then, as people have questions or as people want to learn more about it, how do you handle that support?

Hilbert: There are different support packages people can buy. Support is 60 dollars an hour (Canadian), and it is reduced in bulk, so it's like buying a phone card. You buy a support package, and as you use it up, you just pay less per support session or hour. We do offer free support as well, so the difference between free support and paid support is that if you send us an e-mail of all the questions, we'll get back to you within a couple of days to a week. If you want immediate support and you want us to log into your system and help you right then and there, that would be a paid support item.

Most of our clients are getting free support because there are very few problems that come up as this is pretty mature software, and they'll just e-mail us something and get it back in a few days and they're fine.

Dybala: Free is always good, it's hard to argue with free, but it really sounds pretty extensive. You've obviously done this with multiple clinics. It sounds like you do a good job of holding everyone's hand and getting everyone on the same page until it's all organized.

If someone wants to find out more information or if they wanted to get a demo, what kind of services do you have available, and what's the best way to reach you?

Hilbert: The best way to reach us is through the web site by e-mail and that would be: info@EarWorksInc.comAccess to the software is on demo basis, and there are two types: public and private. The public demo is offered the second Friday of every month at 1:00 p.m. Mountain Standard Time. Just go to the web site, click on the demo page, and there will be a link there to get in We basically show the software and basic features.





Public demos are good for a general overview but if you wanted to really see, "How would this work for us?" we also schedule private demos. Private demos are set at a value of $500 because you're spending your time and ours to do that; however, we do them at no charge if you choose to purchase the program. It takes $500 off the purchase price. So it's for those who want to see it and go with it, it's definitely a good thing to use the private demo.

Dybala: That sounds great. and also I want to mention that Ear Works is now a corporate partner of Audiology Online, and you can check out their web channel at www.audiologyonline.com/channels/earworksinc.com.asp which lists additional information about the company and had a link to their web site at EarWorksInc.com. Markus, thanks again!

Hilbert: My pleasure! Thank you for the interview.