One of the greatest challenges in building that organization was finding high-quality software engineers who truly understood the healthcare industry. The cost and lead-time in training employees was significant. From basic terms like CPT and ICD9 to the concepts behind capitation, a tremendous amount of learning was required before a skilled software developer could become productive.

The alternative of using contract labor was equally problematic. Although contracting organizations claimed to have healthcare expertise on their staffs, the reality proved disappointing. Often, one individual from an organization would have healthcare experience, so the organization would market themselves as healthcare solutions providers. Making an investment to train contract employees in healthcare is a poor use of resources.