The 10 Questions Every DPC Physician Asks About EHRs (Answered + Worksheet)
Updated: 4 days ago
I am Dr. Maryal Concepcion, a family physician in rural Calaveras County, California, and the host of the My DPC Story podcast. What follows are the ten questions I hear most, answered plainly, with a space under each one for your own answer. Print this page or copy it into a document. By the time you finish, you will have the skeleton of your own EHR decision on paper.
You will notice no vendor names anywhere. That is on purpose. The names change. The framework does not.
1. What is the best EHR for Direct Primary Care?
The direct answer: There is no single best EHR for Direct Primary Care. The right EHR depends on your practice vision, panel size, growth plans, and workflow. Instead of asking which EHR is best, score every option you are considering on the same ten categories, including membership billing, charting speed, mobile use, support quality, and scalability, then weigh the scores against your vision.
The only community-wide data on what DPC physicians actually use comes from The Toolkit's Battle of the EHRs survey of over 200 DPC EHR users, free at mydpcstory.com. The second survey opens for voting in Q1, through the My DPC Story newsletter.
Your turn: In one sentence, what does your practice look like in three years? That sentence, not a feature list, is your starting point.
2. How is a DPC EHR different from a regular EHR?
The direct answer: A traditional EHR is built to generate insurance claims, so every click path and required field exists to survive a billing audit. A DPC EHR has no claims to file, so it is built around memberships, direct patient communication, and running a small practice. The core question changes from "how does this help me bill" to "how does this help me take care of people and run a business at the same time."
Your turn: List the three things you do most in your EHR every day. Those are the workflows to test hardest in any demo.
3. How do I choose an EHR that grows with my practice?
The direct answer: Choose an EHR by starting with your practice vision, not with a demo. Score every candidate 1 to 5 on ten categories: mobile use, onboarding ease, support quality, integrations, scalability, membership billing, communication tools, charting speed, lab workflow, and automation, for a total out of 50. Then weigh the score against your vision, because the highest score is not always the winner.
A system that scores 45 but is weak on the one category your practice lives on is not your system.
A system that scores 38 but nails membership billing and mobile use might be exactly right for a solo physician who charts from her phone. The full scoring worksheet, How to Interview Electronic Health Records, is a free download at mydpcstory.com.
Your turn: Of the ten categories, circle the two your practice cannot function without. Those two are your veto categories: any EHR that scores below a 4 on either one is out, no matter its total.
4. What questions should I ask in an EHR demo?
The direct answer: In an EHR demo, ask about data migration before features: what exactly transfers, how care plans, attachments, and message history are preserved, what the timeline is, and what it costs. Build a fake patient before the call and ask the rep to walk that patient through the system. Count the clicks from "patient arrives" to "note signed." And ask the question nobody asks: how do I leave you?
Sales demos are choreographed. Your fake patient, a family of four on one membership or a patient with three chronic conditions and a lab due, is not. Also ask about support hours and whether a human who knows the system answers, and ask to speak with a current customer who runs a solo or small DPC rather than a large group.
Your turn: Describe your fake patient before your first demo. Make them complicated on purpose.
5. What should I ask before switching EHRs?
The direct answer: Before switching EHRs, ask yourself five questions: What problem am I really trying to solve? What data will not transfer, and how will I handle it? What will the downtime look like for me and my patients? How does this system grow with me? And am I making this decision from clarity or from burnout?
The first question matters most. If your inbox is a mess because nobody on your team owns the inbox, a new system just gives you a new messy inbox. Make sure the switch addresses a root cause, not a surface frustration. And write your answers down physically before your first demo, so you have something holding you to your own vision once the screens start sparkling.
Your turn: Answer question one honestly. What problem are you really trying to solve?
6. How much does a DPC EHR really cost?
The direct answer: The real cost of a DPC EHR is four buckets, not the per patient per month price on the pricing page: the subscription projected at your panel size in two years, the add-ons like e-prescribing, fax, texting, and lab interfaces, the switching cost including migration fees and your own time, and the exit cost of leaving. Add all four over three years and divide by 36 for your true monthly cost.
A price that looks great at 200 patients can look very different at 600. And your time belongs in the math: if one system saves you 15 minutes a day over another, that is over 60 hours a year. When I looked up the base hourly rate for a nurse practitioner in California, it was $79. Value your own hours at least that honestly.
Your turn: Run bucket one right now. Your projected panel in 24 months, times the per patient rate, times 12.
7. What data transfers when you switch EHRs, and what gets lost?
The direct answer: When switching EHRs, structured data like demographics and medication lists often transfer, while care plans, secure message history, attachments, PDFs, and images are the most common casualties. Never accept "yes, you can export your data" as an answer. Ask both vendors, in writing, exactly what will land in the new system, in what format, and what you will rebuild by hand.
In my own switch this month, I expected to re-enter medications by hand and was relieved to find I did not have to. I still verified every list against what the patient is actually taking, because even with the best technical support, your eyes are what ultimately catch what is missing.
Your turn: List the three types of data in your current EHR you cannot afford to lose. Put those three in writing to both vendors.
8. How long does it take to switch EHRs, and what does downtime look like?
The direct answer: An EHR switch typically involves weeks of preparation, a migration window, and up to 90 days of adjustment while you and your team rebuild muscle memory. Plan for slower weeks, time to retrain, and time to verify that data landed correctly. Treat the first 90 days as a pilot: keep a running list of frustrations, revisit workflows on a schedule, and advocate for yourself with your vendor.
Implementation is not the finish line. It can take weeks or months for limitations to show up, and something that looked perfect in the demo will not fit your real Thursday. Communicate with patients during the transition, set expectations on response times, and give your most complex and most vulnerable patients extra follow up. Patient care does not pause for software.
Your turn: Look at your calendar. Which month in the next two quarters could genuinely absorb a slower stretch?
9. Why does it matter who owns my EHR company?
The direct answer: The features you see in a demo are a snapshot; the company behind them is what you actually sign up with. Before choosing an EHR, research who owns the company, whether it has changed hands, and whether it plans to. This matters more than ever as private equity and venture capital move into Direct Primary Care, because a change in ownership can change your terms, your pricing, and your product overnight.
Google the founder. Is this someone who built the system out of their own frustration with healthcare, or someone on their fourth startup looking for an exit? Ask about the roadmap for the next 12 months and whether current users influence it. Then ask about contract terms: can the terms of service change mid contract, and if they do, what are your options and on what timeline? I am switching this month because the terms under which my patients' data lives changed, and I could not accept them. Ownership is not a footnote. It is the whole ballgame.
Your turn: Write down who owns each EHR you are considering, and when it last changed hands.
10. How do I leave an EHR? What are the exit costs?
The direct answer: Before signing with any EHR, ask what leaving looks like: the export format, the export fee, the notice period, and any early termination fees. An EHR exit costs money in export and termination fees, and it costs time in the notice period where you pay for a system you no longer use. A vendor who gets uncomfortable with the question "how do I leave you" is telling you something important.
This is the question almost nobody asks at the start of a relationship, and it is the one my husband, Dr. Jeremiah Fillo, made sure we asked this time. You are not planning to fail by asking it. You are making sure the memory of your practice, every chart, every conversation, every care plan, is never held hostage.
Your turn: For each EHR you are considering, write the answer to one question: if I need to leave in five years, what will it cost me in dollars and in format?
Take the next step
Download the full scoring worksheet, How to Interview Electronic Health Records, free in the 2025 Summer Edition of our DPC Magazine The Toolkit at mydpcstory.com. Print one copy per EHR you are considering.
Hear the whole framework on the My DPC Story podcast episode where I document my own switch, one month shy of five years in.
Vote in the second Battle of the EHRs. Voting opens Q1, and the only way in is the newsletter at mydpcstory.com.
Follow the switch in real time, spreadsheets and second guesses included, in the Patreon community.
Frequently Asked Questions
What is the best EHR for Direct Primary Care?
There is no single best EHR for Direct Primary Care, according to Dr. Maryal Concepcion. The right choice depends on a practice's vision, panel size, growth plans, and workflow. Instead of asking which EHR is best, physicians should score every option on ten categories, including membership billing, charting speed, mobile use, support quality, and scalability, then weigh those scores against their own vision.
How is a DPC EHR different from a regular EHR?
A traditional EHR is built to generate insurance claims, so every click path exists to survive a billing audit, while a Direct Primary Care EHR has no claims to file and is built around memberships, direct patient communication, and running a small practice. Dr. Maryal Concepcion frames the core question as shifting from how does this help me bill to how does this help me take care of people and run a business at the same time.
What questions should I ask in an EHR demo?
In an EHR demo, physicians should ask about data migration before features, including what exactly transfers, how care plans and message history are preserved, and what it costs. Dr. Maryal Concepcion also recommends bringing a complicated fake patient for the sales rep to walk through the system, counting the clicks from patient arrival to a signed note, and asking the question vendors rarely get: how do I leave you?
How much does a DPC EHR really cost?
The real cost of a Direct Primary Care EHR comes from four buckets, not the per-patient-per-month price on the pricing page: the subscription projected at future panel size, add-ons like e-prescribing and texting, switching costs including migration fees, and the eventual exit cost of leaving. Dr. Maryal Concepcion also values physician time in the math, noting that even 15 minutes saved per day adds up to over 60 hours a year.
Why does it matter who owns my EHR company?
It matters because the features shown in a demo are only a snapshot, while the company behind them determines what happens to pricing, terms, and support after a physician signs, explains Dr. Maryal Concepcion. She advises researching whether an EHR company has changed ownership or plans to, since private equity and venture capital investment in Direct Primary Care can change contract terms overnight.
More From My DPC Story
Caring Directly: caringdirectly.com
Find a DPC practice at The DPC Directory: thedpcdirectory.com
DPC mood in a cup, Chief Complaint Coffee: chiefcomplaintcoffee.com
Free DPC startup checklist, the Physician Owner's Planner and the DPC Toolkit Magazine: mydpcstory.com
Have a question, a challenge, or a win to share? Leave me a voicemail at mydpcstory.com/contact and you might hear it featured in a future episode.
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