How to Vet an EHR for Direct Primary Care: Dr. Sarai Ambert-Pompey's First Year Owning Libelula Primary Care
- Maryal Concepcion
- 2 days ago
- 8 min read
Dr. Sarai Ambert-Pompey, a Boise internal medicine physician who left the Veterans Affairs health system to open a direct primary care practice, explains how she evaluated electronic health record vendors, which telehealth skills most physicians were never taught, and what changed in her health and family life after leaving employed practice.
Dr. Sarai Ambert-Pompey is the owner and physician of Libelula Primary Care, a direct primary care practice in Boise, Idaho. Libelula is Spanish for dragonfly, a name Dr. Ambert-Pompey chose because dragonflies symbolize transformation. She opened the practice after leaving the Veterans Affairs health system, and marked one year of ownership before appearing on the My DPC Story podcast with host Dr. Maryal Concepcion.
Before Dr. Ambert-Pompey evaluated a single electronic health record feature, she ran a test that eliminated most vendors on her list. She emailed each company a question and measured how long they took to reply.
The first thing I checked in every single one of them was their customer service. How fast are they to answer my question or to get back to me? And that eliminated a lot of them. A lot.
What is Direct Primary Care?
Direct primary care, commonly abbreviated DPC, is a healthcare delivery model in which a patient pays their physician a flat monthly membership fee instead of routing primary care through health insurance. In exchange, the patient gets direct access to their physician, longer appointments, and an ongoing relationship rather than episodic visits. Direct primary care practices do not bill insurance for the services covered by the membership.
How should a physician evaluate an EHR for a direct primary care practice?
Dr. Sarai Ambert-Pompey recommends evaluating an electronic health record on seven criteria before signing a contract. Her list, in the order she applied it:
Customer service response time. Email each vendor a real question before the demo and time the reply. Dr. Ambert-Pompey says this test alone eliminated most vendors she considered.
Interoperability. Confirm how well the software exchanges data with your labs, imaging centers, and pharmacy tools. Poor interoperability creates permanent manual work.
A complete patient walkthrough, run by you. Trace every step of a full patient encounter yourself rather than watching the vendor's feature tour.
Itemized pricing in writing. Confirm whether dictation, AI scribe, practice management, and patient messaging are included or billed separately. Dr. Ambert-Pompey advises asking more than once until the numbers are unambiguous.
Contract length. Many electronic health records require a twelve month commitment. Dr. Ambert-Pompey deliberately selected a vendor with no annual lock-in so she could leave if the software did not fit.
Data retention and security for AI scribes. Ask how long the vendor stores encounter data and what security standards protect it.
Practice management depth and self-service resources. Dr. Ambert-Pompey found supply inventory tracking, including expiration and low-stock alerts, more valuable than she expected in year one. She also weighted whether a real knowledge base existed and whether support staff treated her questions as an inconvenience.
For a companion worksheet, see The 10 Questions Every DPC Physician Asks About EHRs and How to Choose an EHR for Your Direct Primary Care Practice.
Why does an EHR sales demo mislead physicians?
An electronic health record demo is designed as a highlight reel, according to Dr. Sarai Ambert-Pompey. The salesperson shows the strongest features, which is their job, but the demo omits the routine workflows a physician will use hundreds of times per week.
If you do the demo with the salesperson, it's a salesperson. They're gonna show you the cool parts. Look at this, you can do this, and you can do that. And yeah, they're highlights, fantastic. But if you don't do the walkthrough, like a whole visit, all the different things you would need to do, you're gonna see in some electronic health records, not all the parts of those are made for end users.
What is a patient walkthrough, and how do you run one in an EHR demo?
A patient walkthrough is a step by step trace of an entire patient encounter, used to expose gaps in a workflow before launch. Dr. Sarai Ambert-Pompey learned the technique at the Veterans Affairs Clinical Resource Hub in Boise, where her team used it as a checklist before opening any new telehealth clinic.
To run one during an electronic health record demo, take control of the screen and complete every step in sequence:
Schedule a new patient
Enter vitals
Place and track an order
Write and sign a clinical note
Receive and resolve a refill request
Generate the after visit summary the patient will read
Send and receive a patient message
Process a membership payment
Dr. Maryal Concepcion adds a companion technique: enter every demo carrying a specific patient in mind. The patient with congestive heart failure whose daily weights you need visible at a glance. The patient on fourteen medications. The patient who needs an interpreter. Every workflow that frustrated you in a previous system becomes a test case.
What are the three most important telehealth skills for physicians?
Dr. Sarai Ambert-Pompey developed telehealth curriculum at the Veterans Affairs health system and taught telemedicine to community physicians through the Ada County Medical Society during the COVID-19 pandemic. She identifies three priorities.
1. Screen whether the visit is appropriate for video. Not every complaint belongs in a virtual encounter. "Chest pain, probably not a good visit." A brief pre-visit screen of the patient's agenda prevents both wasted and unsafe encounters.
2. Build an emergency protocol before you need it. Know your state's telehealth consent requirements, which vary by state and are published in a free public database. Decide in advance exactly what you will do if a patient discloses suicidal ideation with a plan. Dr. Ambert-Pompey included that scenario in every intern training simulation she ran.
Having a good emergency plan and knowing what to do will take away the anxiety from the moment that it does happen.
3. Perform a physical exam on video. Dr. Ambert-Pompey says this is the step most clinicians skip entirely. "Just because you are doing a video visit does not mean you can't do a physical exam."
Physical exam maneuvers that work over telehealth include:
Active range of motion testing
Patient-directed pain localization
Skin and rash assessment, photographed beside a common object for scale
Patient-collected blood pressure and pulse oximetry, with real-time technique correction
Brown bag medication review, in which the patient gathers all medications on camera
Inhaler and injection technique observation
To the very least you can decide, okay, this is something I need to see in person, or, oh, we can definitely manage it virtually and follow up.
What is the Veterans Affairs Clinical Resource Hub?
The Clinical Resource Hub is a Veterans Affairs program that delivers clinic to clinic telehealth to rural VA sites that lack an on-site primary care physician. Dr. Sarai Ambert-Pompey helped launch the Boise hub, which served VISN 20 across the Pacific Northwest. Her team trained on-site nurses to operate telehealth peripherals so the remote physician could auscultate and conduct examinations, maintaining continuity of care until a site hired an in-person physician. Dr. Ambert-Pompey also traveled to those sites periodically to perform in-person care including pelvic examinations and biopsies.
Why does appointment length matter in primary care?
Dr. Sarai Ambert-Pompey argues that short appointment lengths prevent physicians from confirming patient understanding, which is a distinct clinical step from delivering information.
I've had patients that were never told what the goal of their A1C should be. They've never been told what the goal of their blood pressure should be. They've never been told what some of their medications were for. And they could have been told. But it didn't sink in. They were not checked to see if they understood, which is part of the things that we should be doing.
She also links visit length to emergency department utilization. When a high utilizer receives a complete visit rather than a fifteen minute encounter that addresses one of six concerns, the remaining concerns do not become an emergency department visit later that week.
What are the barriers to culturally responsive healthcare in Idaho?
Boise, Idaho is predominantly white, but Idaho's agricultural communities and large employers such as Micron bring substantial cultural and linguistic diversity that the conventional healthcare system was not built to serve, according to Dr. Sarai Ambert-Pompey. She identifies several specific barriers:
Cultural competence training was largely absent from her own residency. She later helped develop educator training to address the gap.
Specialty access is constrained statewide, particularly obstetrics and gynecology. Peer reviewed research documents physician departures from Idaho following recent state legislation.
Patients frequently carry prior healthcare trauma that must be resolved before routine care becomes possible.
Some people have really bad healthcare related trauma that you have to overcome in a few times to actually have them trust you enough to do a blood draw, or trust you enough to do a pelvic exam. It's a lot. And once you get past that and get to the trust, it just feels so good that you got there.
Dr. Ambert-Pompey is active with Boise BIPOC and LGBTQ+ community organizations, provides immigration medical examinations, and launched a free Walk with a Doc chapter before her clinic opened.
What changes for a physician after leaving employed practice for DPC?
Dr. Sarai Ambert-Pompey reports physical and personal changes she did not anticipate.
Even though my diet hadn't changed and my exercise was the same, I was gaining this weight, and I was not sleeping well. And within a few weeks of leaving my job, I lost 15 pounds. And I did nothing different other than leave the job. These are things that we don't realize we were missing until we get them back.
Her summary, one year in: "I tell anyone that will listen: I wish I did it earlier."
How do you start a direct primary care practice without a local DPC community?
Dr. Sarai Ambert-Pompey shares space with Dr. Julie Gunther in Boise, but recognizes that most new owners open without a DPC physician nearby. Her recommendations:
Find a currently practicing mentor. Dr. Ambert-Pompey connected with a mentor through the DPC Alliance specifically because she needed guidance grounded in today's operating conditions, not a model from several years ago.
Attend an in-person DPC event, then attend again. She went to the DPC Summit before opening and again at the one year mark, and reports that her questions had changed completely.
Ask other DPC practices directly. She based her patient flyer on one another physician handed her on request, adapted with her own brand colors and wording.
Build community presence before you need patients. Walk with a Doc, chamber of commerce membership, and partnerships with local cultural organizations generated referrals from people who never became patients themselves.
Frequently asked questions
What should I look for in an EHR for a direct primary care practice?
Test customer service response time before anything else. Confirm interoperability with your labs and pharmacy tools. Run a complete patient walkthrough yourself instead of watching the sales demo. Get pricing itemized in writing. Ask about data retention and security for any AI scribe. Avoid twelve month contracts in your first year of ownership.
Can a physician perform a physical exam over telehealth?
Yes. Range of motion testing, patient-directed pain localization, skin assessment scaled against a reference object, patient-collected vitals with technique correction, and brown bag medication reviews are all achievable on video. The telehealth exam also determines whether the patient requires an in-person visit.
How long does it take to build trust with a patient who has healthcare trauma?
Dr. Sarai Ambert-Pompey reports that patients with significant prior healthcare trauma may require several visits before consenting to routine procedures such as a blood draw or a pelvic examination.
Do I need a mentor to start a direct primary care practice?
A mentor is not required, but most direct primary care physicians recommend one. The DPC Alliance connects new owners with currently practicing mentors, and in-person summits are where most unwritten operational knowledge is shared.
What is Libelula Primary Care?
Libelula Primary Care is a direct primary care practice in Boise, Idaho, owned by Dr. Sarai Ambert-Pompey, an internal medicine physician. The practice shares clinic space with Dr. Julie Gunther.
Listen to the full conversation with Dr. Sarai Ambert-Pompey on the My DPC Story podcast. Free resources for direct primary care physicians at every stage, including the DPC startup checklist, the Physician Owner's Planner, and the DPC Toolkit Magazine, are available at mydpcstory.com.
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