EMR Stories: Bootstrapping My Direct Primary Care Practice

Posted on August 1, 2013 by W. Ryan Neuhofel, DO, MPH

Dr. Ryan Neuhofel is a Practice Fusion physician contributor

I quickly realized the traditional health care system was a mess in my first years in medical school. After briefly flirting with the idea of starting an Asian fusion taco truck, I decided to start a solo Direct Primary Care family practice to avoid a future of frustration.

Starting with a blank slate gives you room for big ideas. I envisioned an updated, high-tech version of the old school neighborhood doctor, doing house calls in-person and via webcam.

Many docs around the country were offering exceptional service with “concierge” models. However, I didn’t want all of my patients to be country club members. I’m terrible at golf and not interested in the stock market. I wanted to charge reasonable fees so that starving artists and local plumbers could afford a concierge level of service.

But if I wanted to take home a paycheck I needed to keep expenses low—rock bottom low. Starting a clinic from scratch isn’t a cheap venture. Despite forsaking many nights of sleep moonlighting during residency, my stockpile of cash reserves was dwarfed by my projected startup expenses. I could barely even afford the bootstraps to metaphorically pull myself up by.

So I had to do what any cheapskate does—I shopped!

I spent countless hours scouring deals on equipment and supplies. I found a used EKG machine on Craigslist and much of my clinic furniture from local thrift stores. My proudest find was a vintage 1957 Globe-Wernicke Streamliner steel desk for $50.

EMR Stories: Barely Bootstrapping My Direct Primary Care Practice

Despite my appreciation for the old school, I saw a great opportunity in building my practice with a digital backbone, with a health records system at the center of it. I needed an EHR that was going to be nimble, multi-device friendly and not drain my savings account.

As I started to shop for an EHR, I realized that most healthcare technology was stuck in the 1990s. Unfortunately, they didn’t know it—and they charged like they were cutting edge. Being an on-the-go doc I would have no room (or tolerance) for a cluttered server room.

By 2010 many computer applications had moved to the mythical “cloud”, but EHRs had just recently started to follow suit. I first heard about Practice Fusion while reading a health tech blog as a senior resident. The report was generally positive, but it was the “100% free” that really jumped out at me.

My initial suspicion was that it must be poorly designed, lacking features or enlisting tech support from Bangladesh. Still, I decided to register for an account after a late night inpatient call. Given the average “load time” of my residency’s EHR was around 17 minutes, I figured it would be awhile before I could play around with this free EHR.

My go-live date was 5 minutes later.

My first impression of the Practice Fusion EHR was that that it was strangely lacking clutter. No forest of dropdown menus? No randomly placed orange, brown or green boxes? As a Mac guy, I’m a sucker for clean design. Good design is pretty, but also the foundation of good function.

The system was preloaded with a few John Does so I started to fake my way through a few tasks. After creating a few notes, adding diagnoses and refilling meds I could appreciate the time-strapped doctor was a central focus of this EHR design. And I celebrated the lack of checkboxes.

My practice has now been open for over a year and we are growing steadily. We have harnessed a number of online services to accomplish my goal of a paperless practice. Practice Fusion has been my trusty – and still free – EHR. While I sometimes still dream about the taco truck, I am getting closer to realizing my vision of a modern-day Marcus Welby.

Source: http://www.practicefusion.com/blog/emr-stories-barely-bootstrapping-my-direct-primary-care-practice/


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