From Cold Calls to University Clinics: How ClinicNote's CEO Built a Company by Listening

Most EMR software companies start with a technical roadmap. ClinicNote started with a complaint about documentation.

"Her complaint or just even side comment one day about documentation led to them doing some customer discovery and seeing if there was a need indeed for documentation for speech therapists. And they found that there was."

That's Lana Fox, CEO of ClinicNote, describing the origin story of the company she now leads. In this special episode of Clinic Chats, host Kadie Jackstadt flips the script and interviews her own boss, tracing the winding path from a college painting franchise to running a health tech startup in Des Moines, Iowa. It's a conversation about startup grit, listening to your customers, and building something that actually serves the people who use it.

A Painting Business, a Side Comment, and a Minimum Viable Product

Lana's entrepreneurial roots go deeper than ClinicNote. In college, she jumped on a franchise opportunity to run an exterior painting business. She knocked on doors in the winter to sell summer paint jobs. She hired and trained crews. She got knocked down more than once.

But the experience taught her two things. First, she could sell. Second, she wanted a business built on relationships, not one-time transactions. "The nice thing about ClinicNote is that I get to build relationships with our customers," she says. "With painting, if you do a good job, people don't need your services for like seven to ten years."

ClinicNote itself was born when one of the original founders' girlfriends, a speech pathology student at the University of Iowa, pointed out how redundant and clunky clinical documentation was. The founding team did customer discovery, got accepted into the Global Insurance Accelerator, and built what they thought was a minimum viable product: SOAP notes and a reporting feature.

It wasn't enough. Clinicians wanted a full-suite EMR system, not just a couple of documentation tools. The next few years were a building process, funds ran thin, and the team needed someone who could sell. That's when Lana stepped in.

Proving the Need with a 25-Page Document

When Lana joined in 2016, the company was running out of money. She had an industrial design background and sales experience from those painting days, so she did something scrappy: she created a 25-page visual document showing what the product could look like, even though none of it was built yet.

Then she cold-called every clinic that would talk to her. She showed them the document, asked what they needed, and wrote down what they'd pay. Those numbers convinced investors to reinvest.

"From those numbers I was able to show our investors that there was that need, and they reinvested in ClinicNote."

It's a masterclass in startup validation. Don't build it and hope they come. Call them first, listen hard, and let the data do the talking.

University Clinics Changed Everything

The turning point came at the CAPCSD conference in 2017. Lana landed ClinicNote's first university customer, and it changed the trajectory of the business. University clinics pay annual subscriptions upfront, which gave ClinicNote the cash flow to keep developing the software.

The growth was steady: 1 university in 2017, 10 in 2018, 25 in 2019. Lana sees that pace as a feature, not a bug. "It's been kind of a slow-growing business, but in a sense, that's kind of a good thing because then we've been able to really listen to our customers and implement the things that are necessary and needed."

That same customer-first approach shaped the podcast itself. Clinic Chats started as a resource for private practice owners, and as ClinicNote expanded into the university space, the podcast is evolving too. The new vision: ask university clinic directors the same questions Kadie has been asking private practice owners, bridging the gap between the two worlds so students, supervisors, and aspiring practice owners all have a seat at the table.

Only 9.7% of Health Tech Funding Goes to Women-Led Startups

Lana doesn't shy away from the numbers. Only 9.7% of investor funding goes to health tech startups led by women. There's another stat she carries: most women-led businesses don't make it past a million dollars in revenue.

She's not sharing those numbers to complain. She's sharing them because she plans to beat them.

What's helped her get this far? A strong investor network in Des Moines that genuinely cares about founders as people. Mentors she actually follows up with after implementing their advice. And a team of three moms, Lana, Kadie, and Anna, who show their kids every day that working hard and caring about family aren't mutually exclusive.

"I want to show her what it's like to be a reliable boss, a reliable business owner. It's good for her to see that mommy works really hard, but she also cares a lot about her family."

The Feedback Loop That Keeps the Whole Thing Running

If there's one thread running through everything Lana describes, it's feedback. The documentation complaint that started the company. The cold calls that validated the product. The private practice clinicians who patiently tested early versions of the software and told the team what needed to change. The podcast listeners whose questions shape future episodes.

ClinicNote is now expanding research into other therapy disciplines beyond speech, but they won't build anything until they've confirmed the need. That's the pattern: listen first, build second, keep improving.

Lana's parting invitation is open-ended and genuine. If you're thinking about starting a business, if you have questions about the startup journey, or if you want to share your own clinic story on the podcast, her inbox is open: lana@clinicnote.com.

Behind every great EMR is a team that actually listens. ClinicNote was built by therapists and for therapists, handling scheduling, documentation, report writing, and billing so you can focus on your clients. Whether you run a private practice or a university clinic, it's worth a look. See how ClinicNote works.

Transcript

Kadie: You are listening to Clinic Chats. Clinic Chats is a multidisciplinary therapy podcast that was created for students, professionals, clinic directors, and supervisors. Clinic Chats is bridging the gap between graduate programs and professionals, sharing personal journeys of the smallest of private practice startups, large and expanding practices, as well as university clinic triumphs and tribulations. We hope you'll find our podcast informative and helpful in your career endeavors. Clinic Chats is sponsored by ClinicNote, an electronic medical record company for private practice and university clinics. ClinicNote was designed to make scheduling, documentation, report writing, and billing effective, efficient, and HIPAA compliant.

Kadie: Today on the podcast, I'm going to get to interview my boss, Lana Fox. She is the CEO of ClinicNote and is joining me today for a special episode because she also is the brains behind starting our podcast, Clinic Chats. So, Lana, I would like to give you a warm welcome and let you introduce yourself.

Lana: Thanks, Kadie. Happy to be here today and kind of fun to be on this side of the podcast. It's been fun to listen to all your episodes so far.

Kadie: Well, thank you. Lana was initially the one who decided, okay, let's do this. And then I kind of had the ground to just run with it. So for the first time I get to ask Lana, how did this vision for a podcast start?

Lana: Well, I joined ClinicNote in 2016. There were initially three other founders that started ClinicNote. And as it happens, companies grow and change and things just kind of morph into what the business ends up being down the road. When I joined the ClinicNote team in 2016, it was just my fiance at the time and I working on ClinicNote. And I just ended up taking over ClinicNote in 2017. He's just more of an introvert and he was happy to let me step into more of that sales CEO role in 2017, and we got some funding.

Lana: But that being said, there's always ideas running in the back of my mind of where can we take this company? How can we be of help to therapists and specifically speech therapists currently? Eventually, it would be nice to expand into some other disciplines. But yeah, it's just finding the right time to implement ideas. And so when you came along, Kadie, there was just more time for us to try things. So you were able to start the podcast, take my vision and expand upon it and run with it.

Kadie: It is so much fun. You can tell you truly do want to make a product specifically for a speech therapist and you care and listen to feedback. And that's what's been so enjoyable about the podcast is not only are we continuing your business model of taking feedback, but now we're allowing everyone else to hear that feedback so they know what's working for other owners. So it's really rewarding when I know other people are also benefiting from this.

Lana: It's been fun to hear everyone else's business stories because I think that's one of the reasons why it's easy to then connect with private practice owners because I'm also running a business and with it comes its ups and downs, its twists, its turns, and the things that go really well and the things you're like, oh, I wish I could have sidestepped that.

Kadie: Right. So whenever we originally had this thought of the podcast, we were primarily focused on private practice owners. And as our ClinicNote business has grown, our Clinic Chats podcast is also evolving. So if you'd like to share the new vision as we transform the podcast, continuing our focus on private practice, but also growing in another area.

Lana: Our vision for the new portion of the podcast is to be asking some of the same questions that Kadie's been asking private practice clinic owners to university clinic directors, just so that we can bridge that gap between private practice and university. And hopefully this will then be a podcast that university clinic directors can listen to, students can listen to, or people hoping to start a private practice in the future.

Kadie: It's going to be so beneficial for our student users to kind of get in on what it takes behind the scenes from their clinic directors and leaders. And then if they so choose to eventually go into private practice, they also have this resource available.

Lana: Yes. So from my understanding, a lot of podcasts fail like within a first few episodes, right? After six episodes, they fail. They just kind of fade off. And how many episodes are you up to now?

Kadie: It's over, oh, gosh, we're over 20. I think 22, 23.

Lana: That's awesome. So kudos to you for taking it and staying consistent. As far as your own startup journey, this is how I believe our private practice listeners are truly going to relate to you because this has been quite the startup journey of your own. So all the way back to before ClinicNote, you had some business experience. Can you fill our listeners in about all the way back to the beginning?

Kadie: Yeah. So I went to a career fair when I was in college and there was a franchise opportunity and I jumped on that opportunity to run an exterior painting business. And I know it sounds crazy, but I love hands-on learning and I've always been kind of a project-based learner.

Lana: So for me to be able to just take a business that was a franchise. And the nice thing about franchise businesses is that as long as you put in the work and follow the model that they give you, you can make money. So that, I mean, that's not to say that it was just easy. It definitely put me on my butt a few times just with hiring and training and learning how to sell. And I would actually go and knock on doors outside in the winter and cold call and ask people if I could paint their house in the summer. And so it was a huge learning experience.

Lana: But from that, what I realized is that I would really like to start a business where there's more recurring revenue. And it's not even the recurring revenue part, but it's more of the relationship building piece that's even more important. Because with painting, if you do a good job, people don't need your services for like seven to ten years usually. So the nice thing about ClinicNote is that I get to build relationships with our customers and yeah, like we're helping them with a big piece of their life. And ClinicNote is obviously, it's like my first baby basically.

Kadie: Yes. And it's such a specific, specific field that you have found. Why speech therapists? How did that even happen?

Lana: Well, it wasn't even my idea originally. My husband, who was my boyfriend at the time, wanted to start a company and he wanted to start it with two of his friends. So one of the initial founders, their girlfriend was going to school at the University of Iowa for speech pathology. And she was just like, this documentation process is kind of silly. We do a lot of repetitive entry and it should be streamlined. We shouldn't have to put in the patient's state of birth a million times while just going through the documentation process.

Lana: And since then, we found that a lot of people even do this de-identification and rewriting all the note and then putting the patient information back in and then uploading it into a storage system. So yeah, so her complaint or just even side comment one day about documentation led to them doing some customer discovery and seeing if there was a need indeed for documentation for speech therapists. And they found that there was.

Lana: So they started it, got accepted into the Global Insurance Accelerator, and then they thought they had created what was a minimum viable product. But at that point, the product was only SOAP notes and then a reporting feature. But that was it. And what they found is that people really wanted a lot more in the EMR system. They wanted a full-suite EMR system that was for speech instead of just a couple pieces of the documentation.

Lana: And so the next couple of years were kind of a building process, but with that, they were trying to take salaries and they ran out of money really, to be frank. And then I came on board to try to help with sales because I had experience with that.

Lana: And what I ended up doing to prove to our investors that there was indeed a need was I created this 25-page document that was all about what the product could look like. Because I have an industrial design background, I could make it look like it was a real product, but even though it was just a two-dimensional piece of paper that had graphics on it to show what it could look like.

Lana: From that I did that same kind of cold calling except for not knocking on doors. Instead I was phone calling any clinic that would talk with me about what was necessary in ClinicNote and then I would show them the document and they would say, oh yeah, I'd buy that. And we'd talk about what pricing would it be worth to them to purchase it. From those numbers I was able to show our investors that there was that need and they reinvested in ClinicNote. And from there, we've just been growing and improving the software and it keeps progressing.

Kadie: Can you touch on any turning point where, you know, you talk about the very beginning steps and then I'm sure there's so many hills and valleys along the way. What's a turning point in your mind where it was positive growth where you felt like, okay, this is going to make it, we are going to succeed and you feel confident in the business?

Lana: Sure. So it would have been in 2017 after we got that investment. I went to, it's called the CAPCSD conference, which is a university conference. And I got our first university customer. And what's amazing about the university vertical is that they pay for an annual subscription upfront, which has been a game changer for the ClinicNote business because then we have a little bit more money up front to be able to continue to grow the software. So that would have been mid-2017.

Lana: And then in 2018, we had 10 universities. And then 2019, we jumped up to 25 universities. So it's been kind of a slow-growing business, but in a sense, that's kind of a good thing because then we've been able to really listen to our customers and implement the things that are necessary and needed.

Lana: And I think there's still a need in private practice, but I think that our software, so part of what we've been growing is the billing portion of our software. And that just was quite a bit of an upfront expense to be able to implement. We're now using Ability Network for the billing software. And we tried a different clearinghouse first and it worked okay, but just continuing to make the right improvements so that it can be beneficial for private practices. But it's been helpful that both private practices and university clinics need pretty much the same product.

Kadie: Yes, very reassuring. I know there's been a lot of connections that have made all of this possible. Can you name some of the ways that different connections have been beneficial throughout all of this?

Lana: Something that I think has been integral to our success for ClinicNote is having a strong team of investors that not only care about us as human beings. So we live in Des Moines, Iowa is where we're located. And the startup ecosystem here is everyone just really cares about everyone. And so if you ever need anything, there's always like one of my investors will connect me to someone who has experienced that exact same thing or offer suggestions. And that's just been really helpful. So we have a tight-knit team of investors. That's one thing.

Lana: Second thing is just the startup ecosystem here is really nice. And then the third thing would just be, I have tried to work hard at being connected to people who could be helpful in any way. So making sure that I actually listen to the mentors that give advice and suggestions and reconnect with them after I've implemented that suggestion because they like to know that the things that they've helped with have made a difference and an impact. It just helps to keep those bridges strong.

Lana: So our private practice clinicians, they have all been so helpful throughout this process to be patient with the software at the very beginning. And just as we continue to make changes, they're always willing to give feedback and tell us how a certain feature is working. Let us know if something needs to be changed or improved. So that has been really important to our growth as well.

Kadie: Right. So the next steps after expanding to universities and also getting away from solely targeting speech therapists, what will the process be to expand?

Lana: So we're currently working on some research projects into some of the other disciplines because before we just start doing development, we want to make sure that we know what people actually need or if there is a need.

Kadie: Like you said, we're bridging the gaps in so many ways between universities, private practices, and now several therapy disciplines. I know before this year, you had so much focus to the business and you still do, but your focus is also now with little baby Maya. Has that impacted prioritizing the company or only motivated you even more?

Lana: Well, anyone that's a mom knows it just rocks your world when you have a baby. It's just been the best change. I have learned to lean heavily on you and Anna for just making sure that we're continuing to deliver a quality product to our customers. But it also is super motivating having a family because I want to show her what it's like to be a reliable boss, a reliable business owner. It's good for her to see that mommy works really hard, but she also cares a lot about her family.

Lana: And I think that that's something that by having the three of us be moms that work at ClinicNote, it's kind of cool because we can show our kiddos that it is good to work hard, but also how to prioritize things and make time for both, which is a balancing act, but it's kind of what makes life fun.

Kadie: Yes. And you've shared with me before a really interesting statistic about female business startups. Can you pull that off the top of your mind?

Lana: Yeah. So that statistic is that only 9.7% of investor funding goes to health tech startups led by women.

Kadie: Wow. It's kind of crazy, this amount of the statistics that there are just about women businesses in general.

Lana: There's another statistic that has to do with a women-led business and that most women-led businesses don't make it past a million dollars in revenue. So if we can pass that at some point, it would be huge.

Kadie: It'd be such an accomplishment. Such an accomplishment. And you've achieved quite the accomplishments already. As we continue to grow ClinicNote and tie it with Clinic Chats, how do you foresee our listeners in the future growing and expanding and staying connected to us?

Lana: Well, just like with ClinicNote, we always are open to feedback. So we would love to hear from our listeners to hear what they've liked about the podcast, if there's anything they'd really like to hear in the future, or if they'd want to be a part of the podcast, if they have something that they want to talk about from their clinic. Successes, failures, just learnings, because I think that there is a huge benefit to sharing our stories. And I just think it's really cool to be able to hear from each person's perspective.

Kadie: I agree. Coming from a speech therapist background and jumping into more of a business role, it's been so fun to utilize both of those experiences in this because I have therapists who will ask me certain questions like, hey, how did you get an NPI? And then I'm thinking, okay, I'm going to ask that specific question on the podcast because it reminds me things you need to know. So I just hope that we can continue to be a resource and not only with our EMR system, but also just in the information they can gain from Clinic Chats podcast.

Lana: And if people are thinking of starting a business and they have questions that they want to ask me, I'm definitely always an open resource. So my email is lana@clinicnote.com.

Kadie: Thank you so much, Lana, for taking time out of your busy schedule to join me today.

Lana: Absolutely. It's been a pleasure.

Kadie: Thank you for joining me and listening to Clinic Chats. If you have a moment, please leave a five-star review for Clinic Chats to help other SLPs find our podcast. If you'd like to share your own personal journey, please email me kadie@clinicnote.com. That's K-A-I-D-E at clinicnote.com.