It is Sunday morning. James is making pancakes downstairs, the dog is doing that thing where she lies in the one square of sunlight on the kitchen floor and refuses to move, and I am sitting at the desk in our guest room with a spreadsheet open and a cup of coffee that is already going cold. I told myself I would do this months ago. Today is the day I finally audit every single piece of technology in my DPC practice, two years after opening the doors of Verdant Family Medicine, to figure out what earned its place, what quietly drained money without earning it, and what surprised me along the way.
If you are a physician planning or running a DPC practice, I think this kind of exercise is worth doing at least once a year. Technology has a way of accumulating. You sign up for a tool to solve a specific problem, and then six months later the problem has evolved or disappeared entirely, but the subscription keeps charging your credit card because you forgot to cancel it or because canceling feels like admitting a mistake. I am guilty of this. We are all guilty of this. So here is my honest accounting.
What Stayed: The Tools That Earned Their Keep
Let me start with the obvious one. Hero EMR stayed, and it is not even close to being on the chopping block. If anything, my appreciation for it has deepened over the past two years in a way I did not fully expect. When I chose Hero EMR back in late 2024, I chose it primarily for the ambient AI scribe, which I wrote about extensively in my six-month review. That feature alone justified the $299 monthly cost. But what I have come to realize over two full years of daily use is that the value of the platform is not in any single feature. It is in the way all the features work together as one cohesive system that handles almost everything my practice needs.
The AI scribe, which was already good when I started, has gotten noticeably better over the past year. The notes are more nuanced now. It captures subtleties in patient conversations that the earlier version sometimes missed, like when a patient mentions a family member's health issue in passing or when they describe a symptom using colloquial language that does not map neatly to medical terminology. I used to edit maybe 15 percent of my notes for accuracy. Now it is closer to 5 percent. That might sound like a small improvement, but multiplied across twelve to fourteen patients a day, five days a week, it adds up to a meaningful chunk of recovered time. I estimate the scribe saves me about 2.5 to 3 hours of documentation work every single day. After two years, that is somewhere in the neighborhood of 1,300 hours I did not spend typing notes. That is 54 full days. I get a little emotional when I think about what I have done with those hours instead: seen patients without rushing, gone home for dinner, read books, slept.
The agentic inbox continues to be my second favorite feature. All my patient messages, lab results, fax documents, pharmacy notifications, and scheduling requests land in one stream, triaged by the AI so I see urgent items first. I process my inbox in about fifteen to twenty minutes each morning, which is down from the thirty minutes it took in year one because I have gotten more efficient and because the AI triage has gotten smarter about what actually needs my attention versus what can wait. The virtual fax integration deserves a special mention here, because it replaced a separate service I was paying for (more on that in a moment) and it does the job better. Incoming faxes get OCR-scanned and automatically matched to the right patient chart. I cannot overstate how much time that saves compared to manually sorting fax pages, which is what I was doing before.
The smart phone agent stayed, and it continues to be the unsung hero of my practice. It handles scheduling calls, answers basic questions about the practice, and routes urgent calls to me or Denise. I estimate it saves Denise ten to twelve hours per week of phone time, which means she can focus on clinical tasks and patient care instead of playing receptionist. For a two-person operation, that is the equivalent of having a part-time front desk staff member who never calls in sick, never takes a lunch break, and never accidentally puts someone on hold and forgets about them. I know this because in my previous life at Meridian, all three of those things happened regularly.
My OpenPhone VOIP line stayed. This is a simple one. I pay $15 per month for a dedicated business line that rings on my cell phone. I use it for the rare situations where I need to make a personal call to a patient, a specialist, or a pharmacy and do not want to give out my personal number. It is not fancy. It does not need to be. Fifteen dollars a month for professional call separation is money well spent, and I have never once considered canceling it.
The iPad check-in tablet in our waiting area stayed. We set this up in the first month for patients to confirm their arrival and review their information. It cost $329 for the iPad plus a $49 wall mount plus a $10 per month device management subscription. Patients tap their name, confirm their demographics and medication list are current, and Denise gets a notification that they have arrived. It is simple, it works, and it saves about two minutes per patient check-in, which across a full day adds up to nearly half an hour of Denise's time. The patients seem to like it too. Several have told me it makes the practice feel modern and organized, which matters for a small DPC practice competing for members against the perception that "small practice" means "disorganized."
What I Dropped: The Expensive Lessons
Here is where it gets humbling. In my first year, I signed up for a separate online scheduling tool because I was not yet confident that Hero EMR's built-in scheduling would be sufficient. I wanted patients to have an easy, polished way to book appointments online, and the scheduling tool I picked had beautiful booking pages and automated reminder texts. It cost $25 per month, which felt negligible at the time. Here is the thing: it was fine. It worked. But it created a parallel scheduling universe. Appointments booked through the external tool had to sync with Hero EMR's calendar, and while the integration mostly worked, "mostly" is not a word you want associated with your appointment schedule. About once a week, there would be a sync lag or a duplicate entry that Denise had to manually fix. After six months, I realized that Hero EMR's native scheduling, combined with the phone agent that books appointments directly into the system, was handling 90 percent of my scheduling volume without any of the sync headaches. I canceled the external tool in month eight and have not missed it for a single day. That is $200 I spent on a problem that did not actually exist, or at least did not exist once I trusted the tools I already had.
The bigger and more embarrassing cut was the standalone fax service. When I set up the practice, I subscribed to an eFax service at $35 per month because I assumed I needed a dedicated fax solution. Faxing is, incredibly, still a core communication method in healthcare, and I was receiving referral letters, specialist notes, insurance documents, and lab results by fax every day. The eFax service worked, but it dumped everything into my email as PDF attachments with no context, no patient matching, no organization. I was spending fifteen to twenty minutes a day sorting through fax PDFs and manually uploading them to the correct patient charts in the EMR. It was tedious, error-prone, and exactly the kind of mindless administrative work I had left corporate medicine to escape.
Then, about ten months in, Hero EMR rolled out an enhanced virtual fax feature as part of their platform. It included OCR scanning of incoming documents, automatic patient matching based on the content of the fax, and direct filing into the patient chart. I was skeptical at first. Automatic patient matching sounded like the kind of feature that would work in a demo and fail in real life. But I tested it for two weeks alongside the eFax service, and the matching accuracy was above 95 percent. I canceled the eFax the next day. Over fourteen months, I had spent about $490 on a fax service that was objectively inferior to something that was already included in my EMR subscription. Not a fortune, but it stings a little because the lesson is so clear in hindsight: before you buy a separate tool, make sure your existing platform does not already do the thing you need.
What Surprised Me
Two things genuinely surprised me in this audit, and I think they are worth sharing because they challenge assumptions I held strongly at the start.
The first surprise was how dramatically the AI scribe improved over two years. I chose Hero EMR largely because of the scribe, and even in the beginning it was impressive. But I assumed the technology would plateau pretty quickly, that it would reach "good enough" and stay there. Instead, it kept getting better in ways that were noticeable quarter over quarter. The notes became more structured. The clinical reasoning in the assessment section became more sophisticated. It started catching medication interactions and flagging them in the note, which it did not do initially. It learned to handle my particular speech patterns and the way I organize my clinical thinking. I do not know the technical details of how these improvements happen, but from a user perspective, it felt like having a medical scribe who got smarter and more attuned to my style every few months. That kind of continuous improvement is something you cannot get from a static software tool, and it has changed how I think about the value of AI in clinical practice.
The second surprise was how readily my patients adapted to the patient portal. I was genuinely worried about this. My panel includes patients ranging from their early twenties to their mid-eighties, and I assumed the older patients would resist using a digital portal for messaging, lab results, and appointment management. I was wrong. It took some initial hand-holding, absolutely. Denise spent a lot of time in the first few months walking patients through the portal on that waiting room iPad, showing them how to send a message and how to find their lab results. But once they got the hang of it, even my most technology-resistant patients embraced it. I have a 78-year-old patient named Arthur who now sends me portal messages about his blood pressure readings with the enthusiasm of a teenager texting his friends. He signs every message "Regards, Arthur J. Whitfield" with full punctuation, and it is the most charming thing in my inbox every week. As of today, 89 percent of my patients use the portal regularly, which is far higher than the 60 percent I projected. The portal has become one of the invisible load-bearing walls of my practice: it quietly handles a huge volume of communication that would otherwise come through phone calls, and it gives patients the feeling of access and connection that is so central to the DPC value proposition.
The Money: Where I Ended Up Versus Where I Thought I Would Be
When I was building out my technology budget in 2024, I projected a monthly technology spend of $400 to $500. Here is what I am actually spending today: Hero EMR at $299, OpenPhone at $15, iPad management subscription at $10, website hosting at $29, and a few small tools for accounting and practice analytics that total about $45. My total monthly technology spend is approximately $398. That is about $100 per month less than the high end of my original projection, but more importantly, it is roughly $500 per month less than what I was spending during the chaotic first six months when I had the separate scheduling tool, the standalone fax service, a patient communication app I have not even mentioned because it lasted exactly seven weeks, and a couple of other experimental subscriptions that did not survive contact with reality. Annualized, my current technology stack costs about $4,776 per year. The savings from consolidating onto Hero EMR and dropping redundant tools amounts to roughly $6,000 per year compared to my peak spending, or about $500 per month. For a solo DPC practice where margins matter, that is not trivial.
But the real savings are not in subscription fees. They are in time. Hero EMR saves me approximately three hours per day in documentation and administrative work, and saves Denise another two hours per day in phone handling and inbox management. If I value my time conservatively at $100 per hour (which is actually below what I earn per clinical hour in this practice) and Denise's time at $25 per hour, that is $325 per day, roughly $7,150 per month, or over $85,000 per year in labor value that the technology recaptures. That number is so large that it almost does not feel real, but I have tracked it carefully over two years and the math holds up. James checked it twice.
What I Would Tell a New DPC Doctor About Technology
If I could sit down with a physician who is six months from opening a DPC practice, which is a thing I now do fairly regularly through the DPC physician group I belong to, I would tell them three things about technology.
First, do not overbuy at the start. I know this is counterintuitive, because when you are in the planning phase, every shiny tool looks like the thing that will make your practice work. You will be tempted to sign up for a scheduling platform, a separate patient messaging app, a virtual receptionist service, a standalone fax solution, and three other tools that each solve one specific problem really well. Resist that temptation. Start with one comprehensive platform that handles the core workflows, ideally an EMR with built-in communication, scheduling, and documentation tools, and let your actual daily experience reveal the gaps. Some of those gaps will be real and will require additional tools. Many of them will not. You cannot know which is which until you have lived inside the workflow for a few months.
Second, invest in the tools that save you time, not the ones that save you money. A cheaper EMR that costs $150 per month but requires you to spend an extra hour charting every day is not saving you anything. It is costing you 250 hours per year, which at any reasonable calculation of your time's value is far more expensive than the $150 per month you thought you were saving. The best technology investments in a DPC practice are the ones that give you back time, because time is the entire foundation of the model. More time per patient, more time for yourself, more time to build the kind of practice you actually want to run.
Third, let your needs reveal themselves. Your practice at month twelve will look nothing like your practice at month one. The workflows you think you need, the tools you think are essential, the problems you think are urgent will all shift as you accumulate patients and experience. Build your technology stack iteratively, not all at once. Add tools when a genuine need becomes clear, not when a vendor's marketing email creates an artificial sense of urgency. And audit your stack regularly, at least once a year, to make sure everything you are paying for is still earning its place.
I am glad I did this audit. It forced me to look clearly at what is working, what was not, and where the money is really going. If you are a DPC physician reading this, I would encourage you to do the same exercise. Open a spreadsheet, list every piece of technology you pay for, and ask yourself honestly: is this tool earning its keep? The answers might surprise you. They certainly surprised me.
Now if you will excuse me, the pancakes are ready, and my coffee is completely cold, and the dog has moved from the sunlit square on the floor to the couch, which she is absolutely not allowed on but which she occupies with the confidence of someone who knows she will not be removed. Some things technology cannot solve. Happy Sunday.