Battle of the EHRs at the 2025 DPC Summit: Tech Choices for Direct Primary Care

In this episode of the My DPC Story Podcast, Dr. Ricky Haug joins Maryal as they dive into the latest trends in Direct Primary Care (DPC) technology, fresh from the 2025 DPC Summit. The focus is on the "Battle of the EHRs," where Dr. Haug, an experienced DPC physician with a multi-location, multi-provider practice, shares his firsthand insights on choosing and optimizing Electronic Health Records (EHR) systems for DPC clinics. The discussion covers key findings from the DPC Summit's EHR survey, highlighting what features doctors value most, such as ease of use, patient communication, AI integration, and workflow efficiency. The conversation also touches on common challenges, tech stack evolution, patient portal satisfaction, and the importance of adopting DPC-focused solutions to enhance both patient and staff experience. Whether you're launching a new practice or scaling up, this episode provides practical advice for navigating EHR decisions in DPC, making it a must-listen for physicians seeking to streamline operations and improve patient care. For full survey results and resources, visit mydpcstory.com/magazine.

Download the 2025 Employer Trends Report from Hint.

Register HERE for the Physician Attendees ONLY RiseUP Summit brought to you by FlexMed Staff & My DPC Story!

Transcript

Maryal Concepcion, MD: 0:55

Direct Primary care is an innovative alternative path to insurance-driven healthcare. Typically, a patient pays their doctor a low monthly membership and in return builds a lasting relationship with their doctor and has their doctor available at their fingertip. Welcome to the My DPC Story podcast, where each week you will hear the ever so relatable stories shared by physicians who have chosen to practice medicine in their individual communities through the direct primary care model. I'm your host, Marielle Conception. Family, physician, DPC, owner, and former fee for service. Doctor, I hope you enjoy today's episode and come away feeling inspired about the future of patient care direct primary care. Well, I am still in New Orleans physically, and Dr. Houg is joining me from his net of the woods in Pennsylvania. We have just come from the 2025 DPC summit and Dr. Houg and many people who were in person got our battle of the EHR results. We have our Toolkit magazine. If you have not gotten a copy or if you weren't at Summit, you can go to mighty pc story.com/magazine and you can check out a digital copy there. But. Dr. Ho has joined us today to. Give his perspective on the data that the battle of the EHR said, as well as him as a very seasoned DPC physician with multiple people working at his clinic, clinicians and support staff. He. Had, just a fun time hanging around and asking the different EHR vendors at the summit about their products. And so this conversation is all around the EHR and his opinion as a seasoned DPC doctor, as well as the data from the magazine. So thank you so much Dr. Hogg, for joining us today.

Ricky Haug, MD: 2:51

Thank you for having me. It's good to see you again so soon.

Maryal Concepcion, MD: 2:54

I know. It's awesome. tell us a little bit about your practice for people to understand in terms of how you've transitioned over time from you opening to where you are now and in terms of how your EHR has helped you serve patients as well as yourselves to manage those patients

Ricky Haug, MD: 3:13

Sure. Yeah. So I opened in 2016 and, started with 30 people or something. And and then over the years we've grown not only in terms of the number of patients, the number of docs, but also expanding in, 2022 into a second location. So, that was an adjustment, especially in the EMR where you're trying to figure out two different inventories, two different messaging. Systems you have, team members in one location, team members in another location, portals, all that sort of thing. So that was kind of an inflection point on okay, where are we? And then also from a billing standpoint, everything has gotten a lot more complicated for us. So we've been kind of managing that and, and communication platform. So I started initially just with. An an EMR. And then over time we've added communication platforms, billing platforms, and we're still, always trying to see how to maximize the efficiency of all of those things.

Maryal Concepcion, MD: 4:20

This is so important because I think that, especially coming off of DPC Summit where there's a lot of people who are coming to learn about DPC, there's a lot of people who are learning about the tools we have available to us in DPC and the people who are already planning their opening date as well as people who are looking in our battle. It was insane. Over 20% of the respondents in our survey, we had 214 people taking our survey. Said that they were looking to switch EHRs. So here, I'd love if you can tell us a little bit more about what overall goal you wanted to achieve by adding different parts of your tech stack, like you talked about, especially because you have multiple physicians, multiple locations, and multiple years and multiple patients.

Ricky Haug, MD: 5:08

Yeah, I mean, I think with each development, as, as you grow and as not only a doctor but a business owner, you're constantly thinking about okay, how can we streamline the workflow not only for our patients, not only for me, but for the entire team? How can we make this much more efficient? Then more user friendly for patients. And then from a billing standpoint, how do we make sure that we can run all the reports we need to run and manage all the finances the way we need to. So it kind of came in different iterations, but I would say the first one was with the communication platform, because when you start adding multiple docs, you have to have a way to kind of filter those messages, text messages to each person individually. And and then also, if we had prescription refills or triage questions, we wanted to be able to filter that to our nurse. And then if it was more admin or somebody who was interested in joining the practice, we wanted that to go to, we, we call it our patient care coordinator. And so it's just how do you make sure that you're able to get those messages as efficiently to the proper person who can, can answer that.

Maryal Concepcion, MD: 6:24

Totally. And I think about as you're talking about that workflow how many clicks does it take to do those, and how many clicks could it take if workflows were optimized? So. I would love here if you can tell us about your experience at DPC Summit because again, you are a person who has a practice that probably many people who went to DPC Summit will be very soon here because. So many people are looking for DPC, and I'm just wondering if you can walk us through what are the important things that you were listening for or what are the things that you were asking? Because we had an entire article rooted in Dr. Jalen Pritchards, how to Choose an EHR that grows with your practice And it had, a worksheet where you could ask questions. But my biggest thing that I was very intentional about was. A whole column of what do other TBC doctors say about the EHR that you're talking to? And so, highlighting your version of these answers, what types of things were you picking up on and interested in and hopeful for or frustrated with?

Ricky Haug, MD: 7:34

Sure. Yeah. Yeah, the, the conference, I mean, the conference was awesome this year and I, I wasn't able to go last year, but I. Did go two years ago and, and many of them before that. And it was just remarkable to see the growth. Like I, I mean, going in the first lecture, I couldn't believe how many people were in the room. And the number of vendors, I mean, back in 2016, I think there were like five vendors at the conference. And now there were, I don't know how many 50. But part of why I wanted to go, I mean, there's always new things you can learn. There's only always new ways that we can become more efficient. And, and the beauty of the movement is that it's becoming so popular that there's just a number of companies now that are looking to target direct primary care and how can they totally help direct primary care get better. So, so yeah, it was, it was great to see all the, all the different vendors and, I was looking at different EMRs that weren't even in existence in 2016. So, things have come a long way, and partly for me was kind of, adopting new technology. So what kind of AI tools are incorporated because, we, we have an interest in that and a lot of our docs in terms of helping with notes, but also, aI is so sophisticated, you can actually say, Hey, can you, pull in my last two office notes and the hospital discharge summary and write a, a brief summary, prior to my visit here, or those sorts of things. So there's so much power. AI is going to be able to incorporate into making our lives a little easier and also more efficient. With office notes and, and population management and that sort of thing. So I wanted to look at kind of where things were in the AI space, where different companies are looking to move that. I population health type things. And, and part of that is because of working with businesses is when. When you start to work with businesses that are a little bit larger, it's nice to have some sort of data. And I, I'm not, I'm not talking about all the mip, all the, that kind of stuff I'm talking about. Like how many times did they come into the office? How many times did they text you can even look at what kind of new diagnosis were, did you have just like what is the engagement data, right? And I think that's really important. I think it's also nice as now that we have so many patients who are at like 2,500 patients, it's how do you make sure that you're not letting people fall through the cracks? So if there's a way you could say. Which one of my diabetic patients has not had an A1C in the last four months. And then you can send out a message, say, Hey, you're due for your blood work. Get that in or who hasn't gotten their colonoscopy, and can we reach out and say, Hey, you know what, notice that you haven't had your colonoscopy, but we'll do, and what kind of tools can help us do that? So that was one of the things I was looking for. And then, a big thing too is like just how user friendly it is on. Mobile phone because we're out and about. And if you're the one running the practice, yeah, you're in the office seeing patients, but sometimes you're at meetings, you're working with vendors, you're doing admin time at home and you want to be able to like quickly on the fly, be able to take care of patient care on your phone.

Maryal Concepcion, MD: 11:04

It's so true. And especially because we are so. Not eight to five in the office because we have to be a type of people anymore in DPC, that, that accessibility, it's absolutely something that was echoed in the battle of EHR data that we, we have from this year's survey. And I'm wondering here too, what, as you talk about ai, I I, I would love to just hear your take on how this enhances the patient's experience because it's part of how they love our practice is how they love our tech. And I do feel that that impacts how people, either stay or churn at a practice. It's not going to be the highest thing that it impacts churn, but I do think that it does impact churn, especially with word of mouth. If a person has a bad tech experience.

Ricky Haug, MD: 11:56

Yeah, I, I agree. I think, well, I will say just the accessibility over messaging. I mean, patients absolutely love that, and it's a, it's a, it's a big separator from the large university health system based primary cares that a lot of us came from. Where you can handle so many things just by doing quick. I mean the amount of patients I took care of this morning just by texting them patients, sending pictures over about rashes and we, I could quickly write'em back, make a suggestion. Say, Hey, send me a picture next week. And they didn't have to leave their house or work to go do that that visit that that, people love that. And that's a, that's something that will want them to stay with your practice.'cause they know they can't get that type of convenience elsewhere. I think the, the ai, I mean, one. As it continues to morph, it's gonna be really helpful with triaging and quickly triage patients and help all of us make decisions easier, but also, just the engagement in in the office visit. I mean, I think one of the things that we do really well in DPC versus other places is, we take time with patients, we look'em in the eye, we sit down and do that. But if you're you, if you're sitting there typing a note, I mean it does still can take away from that. Whereas if you're have a AI scribe where you can just sit and put your computer down and just. Be really present. I mean, that can even, take that doctor patient relationship to the next level there. So I do think there's a, a real value in how that can, can continue to foster that great relationship, which then fosters all the patients telling all their friends and family and people in town how great your practice is.

Maryal Concepcion, MD: 13:49

Absolutely. And it's. It, it totally feeds into the culture of accessibility. And so it, it is really important to look at a DPC focused EHR versus a non DPC focused EHR one that's really focused on coding and optimizing codes and and billing. And so here I'm wondering, thinking about, because you've been in practice for over eight years now, you're nearing a decade of practice. Like we talked about. You have multiple doctors, multiple staff, multiple locations. I'm wondering if you could reflect on your own journey in the beginning to now. Was there anything that you had as you were building your tech stack thought this is okay, it's good enough, but looking back now, you're like, I wouldn't have gone with that. Had I known this or had I known that?

Ricky Haug, MD: 14:40

Hmm. I mean, I don't know if there's anything where I wouldn't have gone with that. I, when I started out, I, well, one is usually you don't starting with a bunch of money, so you have to think about okay, how can I have a tech stack that's going to meet my needs, but not. Break the bank and I, I opted for, an all-in-one management tool. Had portal inventory management. I could set up like my phone. It had some texting feature. And. And, and then could also manage our subscriptions. And I just like the idea of everything together in one system. And, and that worked for a while, but then you get to the point where. It's not meeting the needs of the communication platform the way we would need. And so then, I looked into adding a communication platform and then it's, and then as we continue to expand and, and we opened a second location and had multiple providers where we're trying to, calculate. What their income is and, and all of those things. We needed a billing platform that is gonna be able to really handle all of that. And so, I I, I don't really have any regrets in terms of like that. I mean, I think it was just more of there's a transition over time and you start adding stuff. Now the question I'm having is is am I doing it the most efficient way? Or now that we've kind of expanded and tacked on a added all these things on, is there a different way where I can even make this more efficient and better? So I think, like all of us, we're always looking at, okay, what can we do here? I mean, changing your EMR is a major overhaul. It's a little anxiety producing. So it's not something I would ever take lightly, but. You also have to think about, well, how's the technology changing and what might be a better fit?

Maryal Concepcion, MD: 16:45

So here, thinking in a completely utopian world, if a patient were to come into your practice all the way to follow up after their first appointment how, what is the perfect workflow for your team at Core Family Practice?

Ricky Haug, MD: 17:04

Well, so if it's a patient who's interested in joining the practice and decides, yeah, I want to sign up, then I like them to be able to sign up online, complete their registration, initial documents, everything's ready to go, automatically uploaded into the the EMR. Once that patient signs up, they're, they're automatically uploaded into the EMR, the billing platform and communication platform seamlessly. We don't have to manually change things. Then typically we will reach out, obviously and set up an initial appointment. Then when we have them come in and do their initial appointment, I mean, it'd be great to just spend an hour with that patient. Ideally all the records are in, obviously doesn't always happen, but and then you can sit there and have a nice conversation. We do have patients do an intake form prior to coming in and then have that populate the chart. Personally, it, I would like it to populate the chart a little better than it's currently doing, but that would be nice. And then that way you come in and everything's already preloaded and, and all that. And then we can sit and kind of go through an initial visit. If we had ai, which could help produce that note and, and and also. Patient summary at the end. So at at the end, that patient summary, I like to load on the portal and that way I feel like we're both on the same page in terms of what the game plan is and something where really easy for the patient where they can get on and they could access that. I mean, if it's an app or something, that would be great, but something where they can. Say, okay, this is my medical home. This is where I go, and I can get all my information real easily. And then if I have questions, I can send a quick message and that message will be sent right to my doc so they can answer it. If I, if I need a follow up, I can either call the office or send a message, or I could go online and maybe schedule an appointment and get my follow up booked.

Maryal Concepcion, MD: 20:33

Totally, and this is very similar to how our workflow works at Bigtree md and also how you guys have intentionally designed your workflow to work so far. What about the backend in terms of, you go through the patient experience like you described. They have their after visit summary. But then they need labs. They need orders executed on. What's your ideal workflow, or how are you doing it now? Or what would you like to do in the future so that your efficiency is optimized?

Ricky Haug, MD: 21:05

Well, so for medications, either we would dispense in house. And so with that, obviously you wanna make sure that your inventory's well managed and that, any kind of ancillary charges, whether they're labs or meds, would be seamlessly billed through your billing platform rather than you having to reenter that into the billing platform. I want all the systems to talk together and link so that you're not having any of your team members doing additional work that really isn't providing. Any really real value, some, admin tasks that, that should be gone. That just leads to potential mistakes. So how to maximize that to make sure that your EMR system is communicating very efficiently with. All the platforms. I mean, that, that's something that I'd really like to do. And then we, so we either dispense in house or I can scribe the med to the patient's pharmacy and lab work. Some patients decide to get their labs at our office. So on the, when they're leaving the office, we'll have'em schedule with our nurse or we do have a phlebotomist who comes in part-time to, to help. With PE people love getting their labs in the office, so just to kind of give more time for that and and then I'll put the orders in the chart so when they go see the nurse or phlebotomist are already in there, and so they know what the orders are.

Maryal Concepcion, MD: 22:35

That's awesome. And I hope that it just gives some people, especially the listeners out there who are newer to where DPC workflows, it's, it's very familiar in terms of how we did things in fee for service, but this is stuff that is definitely is and can be even more streamlined. And, and here I I wanna point out one of the, the sections that we had in the toolkit in the Battle of the EHRs was highlighting satisfaction of different features and when it comes to patient portal overall. And the people who answered the questions on how good are patient portals of the DPC space talking about their own EHR, that was our lowest score, a 2.94 out of five. And so it's i, I go back to this is a tool that we have that our patients engage with. It is part of how our patients experience the access to our care. I have a DPC doctor, and then I literally had to email her to say. I don't know how to cancel an appointment'cause there was no portal. And it's a huge thing for me'cause that is totally extra work. Mm-hmm. So I would love to then to focus on the battle of the HR because now you got a copy. And again, if you did not get a copy, go to mighty pc star.com/magazine and look at the, the results in full. But looking. In general at the results and being able to reflect on your almost decade and practice with the demographics at your clinic that you have, I'm wondering if there's anything that really stood out to you as oh, absolutely. Or, that really surprises me. Anything in particular that stood out for you from the battle results?

Ricky Haug, MD: 24:19

Well, I think. I mean, I don't know if there's anything that stood out as shocking I mean, patients do like the portal. They like to be able to have. Access to their chart and, look at hey, what, what are my recent labs? What are, my vaccines, my, because they things come up and they have like camp forms to fill out, not that. And if they can go on and say, I got all my information right there. I didn't need to call anybody. I didn't need to get anything sent to me. They like the messaging. What surprised you in the results?

Maryal Concepcion, MD: 24:50

Yeah, so I think that one of the things that stuck out immediately was Over 20% of people who are looking to switch that one like. It just gave perspective, and this is only 214 people who responded to the survey And then I do, one of the things that I really loved was, looking at the top five reasons why people choose or why people leave an EHR. That was really fascinating because I, I think about these things that you're talking about workflows, how the patient engages, what you would like it to do. It, it's very much in alignment with what everybody else is saying. Like the reasons to choose an EHR. 65% of people said they would choose an EHR, or they did because. Ease of use. And then when you look at the reasons why people left limited customization, 32% said that that was a reason to leave. That it is difficult to use. Their EHR 42% responded that it is difficult to use. So they left their EHRI mean, what I love about how we looked at the data and what it shows is literally this is our community saying. This is the stuff that we need to make sure that our practices and our patients have good access and good experience. So those are the things that initially stood out. And then I think the other thing that stood out to me was that. Even though there was a quote unquote champion in terms of the number of categories at this particular HR one I, I still think that if you actually read the entire. EHR Battle, you can see how there's no clear winner in this race that we still need more innovation everybody's brain works differently. Some people need a portal, like I am totally in that boat. Other people do not need a portal. Other people Work well in a word pad. I will die before I ever use a word pad ever again. So it's like there are I, I think it's so relatable and it's very representative. And this was just our first year doing this. So those are the things that stuck out for me.

Ricky Haug, MD: 26:57

And there's a lot of new players, right? So, yeah. Part of it is well, in the next few years, I'm sure as the innovation changes and as newer companies come in, they're gonna come up with, a lot of new things. But I think that, um. usability, like how well is it working for me and my patients and, I mean that, that's always gonna be a, a major factor and quite frankly, like probably will change as needs change over time. And, and how well did the EMR suggest to it? Okay. But it is surprising how many people look at changing. But you know, at the end of the day, no EMR is gonna be perfect. And like you said, they're very unique. People work in little different ways. For people who were kind of used to being in the system for a while, sometimes you need something that's still a little bit kind of like that because you've, that's how you've grown up using that, this and that. And then other people are gonna come out and say, I want something totally different. What I love about the EMRs for direct primary care is that they are not necessarily centered on billing. Whereas like you, it's not about like, how can we code this to get the most money outta the insurance company? They can, they have the freedom to say, how can we make this patient centric as much as possible so that it, it works better.

Maryal Concepcion, MD: 28:25

Absolutely. When you say that, I think about how when you're really focused and your entire business model is focused on patient. Accessibility, affordability, quality, all the tenets of DPC, everything else falls in suit with that, right? If that is your mission, it really helps you see where there are problems, it helps you improve. And it literally is tied to the fact that we. Get to make the decisions at these businesses, we do not have to deal with using Cerner or Epic for another gush dang day. Right. So it's so empowering to be able to not only want change, but also to make change.

Ricky Haug, MD: 29:05

Yeah. Yep. And then the beauty of owning your own DPC is you don't have to like go through 17 committees. If you wanna change your EMR, yeah, it might be a headache, but you, you can just decide Hey, I think, I think our business model's change going in a different direction. We need to to do this. And you just implement it yourself and do it.

Maryal Concepcion, MD: 29:24

I love that. So if there are listeners who are coming off of a summit and they're like, okay, I learned a ton of things, where do I get started with my tech stack after our conversation? Thinking about what we've said and thinking about your experience, what would you say to that doctor who's in the planning to year three and practice when it comes to Tech Stack rooted in an EHR?

Ricky Haug, MD: 29:47

Well, I mean, I think number one, I mean if you've already started your practice and you're a couple years in, think about like where are your limitations in your efficiency? What are things where you feel like, you know what, I feel like we're getting hung up here. And, and then. Start looking at ways because,'cause there's a lot of different ways you could, you could address that. I mean, if you're, if you're new to D PC and you're coming out with a practice, try'em all. Because again you might want an all-in-one, you might not want an all-in-one and you wanna put pieces together. You, there's, there all have different pluses and minuses. So try out all of them and see which one seems to be. Get you in your groove the most? Because I, I think, I think it is a lot of it is very person dependent on the way that you think, the way that you feel like your flow should go and that sort of thing. So I, I would encourage people to just look into all the different options and try.

Maryal Concepcion, MD: 30:49

I love that. And yeah, that is, that is exactly why we're having this conversation. That's exactly why the toolkit and the battle of the EHR exists to help people have more input as to the opinions of our community to help them. Understand and find relatability when they're choosing tech. And I will say there's an entire article entitled Battle Tested, the EHRs that really get you through Year Zero to three. And the amazing. Paula to, who is the clinic manager at Car Direct Care talks about shifting from one EHR to another. And it's, like you said, it's not a fun experience. There's a quote in here that is not too friendly for little ears that people said about the transition and so that matters. We. In this magazine we talk about three different practices. Dr. Hoke is a rural college town physician in Ohio. Dr. Sarah Schuster is in a urban practice of multiple physicians, and then Dr. Phil Boucher has a practice that's pediatrics in Lincoln, Nebraska and is very tech focused. So, there's so many. Ways to just reinforce that this decision to choose an EHR is so personal. Mm-hmm. And you're not locked in forever, but just do know that there's more information. Rewind. Listen to Dr. Hogg's, comments here. And just be intentional about your. Practice and your patients because it literally affects both you as the practice owner or a physician at the practice as well as your patients for the perpetuity of your DPC practice.

Ricky Haug, MD: 32:28

Yeah, yeah. But, but like you said, you, you, you're gonna, you're gonna modify those systems. You're gonna modify your workflows constantly. We can always improve, right? We can always get better.

Maryal Concepcion, MD: 32:40

hundred percent. Awesome. Thank you so much for coming on today and talking and reflecting about your experience at the DPC summit.

Ricky Haug, MD: 32:48

Yeah, thanks for having me. Good to see you.

Maryal Concepcion, MD: 32:53

Thank you for listening to another episode of my DBC story. If you enjoyed it, please leave a five star review on your favorite podcast platform. It helps others find the show, have a question about direct primary care. Leave me a voicemail. You might hear it answered in a future episode. Follow us on socials at the handle at my D DPC story and join DPC didactics our monthly deep dive into your questions and challenges. Links are@mydpcstory.com for exclusive content you won't hear anywhere else. Join our Patreon. Find the link in the show notes or search for my DPC story on patreon.com for DPC news on the daily. Check out DPC news.com. Until next week, this is Marielle conception.