Stop wrestling with software that fights your business model. Here’s how to choose an EHR that actually works for DPC.
A Note on Recommendations
I have no financial relationship with any EHR vendor mentioned in this guide. Nobody is paying me for placement or reviews. I’m not a revenue partner with Hint, Elation, Cerbo, Atlas, or any other platform discussed here.
The same goes for the supporting tools I mention: QuickBooks, Gusto, Spruce, and others. I don’t get referral fees or commissions. I’m not on anyone’s affiliate or revenue share program. This is due to my policy on conflict of interest and performing fiduciary duties.
These recommendations come from one place: patterns I’ve seen in the books and operations of DPC practices over years of working directly with them. I recommend what works based on practice size, growth stage, and operational reality. That’s it.
The Real Cost of the Wrong EHR
Your EHR isn’t just a charting tool. It’s the core of your practice’s operations.
When it fits, everything runs smoother. Billing, scheduling, documentation, and communication flow in the background. You barely notice it because it supports your rhythm instead of interrupting it.
When it doesn’t fit, it quietly drains your time. I’ve watched practices spend several hours each week patching gaps between billing systems, reconciling payments by hand, or explaining to staff why one tool can’t talk to another. Those hours add up to thousands of dollars a year in wasted administrative labor.
I see this pattern across many clinics’ books. Practices using an EHR that fits their model have lower payroll costs, fewer billing errors, and faster growth. The ones fighting their system spend more time managing software than managing care.
This isn’t about flashy features or vendor marketing. It’s about operational alignment. The right EHR depends on your size, your staff, and your goals. A solo practice with 150 patients doesn’t need the same system as a multi-provider clinic with two locations and employer contracts.
What Actually Matters in a DPC EHR
Most DPC providers start their practice to escape the bureaucracy of insurance medicine, then find themselves using tools designed for insurance billing. The result is friction and confusion.
Over the years, I’ve noticed that the DPC practices with clean books and efficient workflows share the same foundation. Their EHRs meet six criteria that matter more than anything else.
1. Native Membership Billing
Your system should automate managing recurring memberships, including family accounts, employer contracts, renewals, and failed payments, avoiding manual tasks or third-party spreadsheets. When billing occurs within your EHR, records stay accurate and reconciliation is simple. Using a separate, unconnected payment processor risks errors and revenue loss.
2. Integrated Patient Communication
Direct care relies on accessible communication. Patients prefer texting, calling, or messaging without portals. Successful DPC practices use systems that automatically document messages, calls, and telehealth to patient charts. This isn’t just about convenience; it’s about risk management and clarity. Keeping communication in one system ensures no loss of patient history or instructions, especially as your panel grows.
3. Workflow That Makes Sense
If staff need a training manual for scheduling appointments, the software is overbuilt. The best EHRs are intuitive, even for new hires. Extra clicks are wasted motion, costing money. When providers can chart, bill, and communicate from one screen, efficiency improves payroll. I’ve seen this firsthand.
4. Lab and Pharmacy Integration
Even if you’re cash-based, you need to order labs and prescriptions smoothly. Successful practices have EHRs connected to lab and pharmacy systems. Older systems rely on fax, causing delays, extra work, and missing documents. Modern electronic systems eliminate these issues.
5. Scalability Without Migration
An EHR should grow with your panel size to avoid costly migrations. Ideally, you’ll have one for when you are small and medium, and once you’ve reached maturity (multiple sites, >$5 million in annual revenue). Choosing the right system early supports expansion, more staff, and new services without starting over. The only time a system change makes sense is when expanding to multiple sites, and the EHR you had doesn’t work. The EHR for a large, mature DPC isn’t ideal for a solo practitioner, and vice versa.
6. Real Cost Analysis
Low subscription costs often hide high labor costs. If a cheap system requires extra hours to reconcile payments or track memberships manually, it’s not cheap. The old cliche is true here, “cheap ain’t good, and good ain’t cheap.” The most efficient practices spend a little more on software and far less on admin time. I see it every month in payroll reports and net income statements. A better EHR directly increases profit because it reduces friction.
The Quick Decision Framework
If you want everything in one place, including membership billing, choose Hint Clinical.
If you want a stable, established clinical system that integrates well with others, choose Elation Health.
If you want to customize workflows and build complex systems as you grow, choose Cerbo.
Each one excels in a different situation. The mistake is choosing based on what another practice uses instead of what your operation needs.
Front Runners: Best in Class for DPC
1. Hint Clinical
Hint Clinical was built specifically for membership-based care. It combines an electronic medical record with built-in billing, scheduling, and communication tools.
Several of the practices I work with run Hint. It simplifies their operations because everything lives in one system. They don’t have to connect separate tools for payments, messages, and telehealth.
The interface feels current and logical. Staff can pick it up quickly, and the automation behind billing reduces reconciliation errors.
The company offers a Business Associate Agreement and publishes details about data security. While I can’t speak to audit specifics, it follows modern third-party standards similar to those used in SOC 2 reviews, which focus on data security and privacy practices.
In real terms, Hint fits best for clinics that want a single, consolidated platform from the start. It’s strong enough to handle a growing membership base and can support multiple providers without major restructuring later.
2. Elation Health
Elation has a long-standing reputation among primary care physicians. It’s not designed exclusively for DPC, but it works. The practices I’ve seen using Elation value its clinical structure and documentation quality.
The layout presents the patient summary, chart notes, and tasks in one view. For clinicians who document thoroughly, that design saves time. Elation also connects easily with Spruce for communication and with Hint Core for membership billing.
Because it’s more traditional, it may take a bit of setup to align perfectly with a pure membership model, but once configured, it’s stable and dependable.
Elation also offers telehealth and a patient portal, which some clinics pair with other secure messaging tools for better accessibility.
I recommend Elation for practices that want strong clinical tools and are willing to piece together billing and communication from integrated apps rather than one all-in-one system.
3. Cerbo
Cerbo (formerly MD-HQ) is the system for practices that like full control. It’s common among DPC clinics that also do functional or integrative care because it handles complex workflows well.
In client operations, I’ve seen Cerbo used effectively by teams that track inventory, sell supplements, or dispense medications. It allows for advanced customization and can automate parts of patient communication and billing.
That flexibility takes time to configure. It’s a fit for practices that already have staff support or an operations manager who can maintain it. For solo founders, it can feel like too much setup.
Cerbo handles membership billing internally, offers a secure patient portal, and integrates with labs and pharmacies. Like others in this tier, it provides a BAA and maintains clear data privacy policies.
Functional but Limited
Atlas.md
Atlas was one of the first EHRs designed for DPC. I still see it in many early-stage clinics because it’s affordable, reliable, and simple.
It handles membership billing, prescriptions, and patient communication well enough for a solo practice. The interface is straightforward, and it rarely breaks.
Where clinics begin to struggle is in reporting and integrations. As practices grow, the lack of deeper analytics or automation becomes more noticeable. Eventually, many migrate to newer systems that offer more flexibility.
I’ve seen it work in startup clinics with under 200 patients. Beyond that size, the friction starts to show. Choosing one of the front-runners makes more sense in almost any DPC.
Akute Health
Akute is a newer system purpose-built for direct care. It offers a clean interface and integrates membership management, telehealth, and patient communication.
Some of the clinics I support have tested Akute but eventually chose one of the front-runners. It’s still maturing as a platform, so I always advise checking its current development roadmap before committing. Early signs are promising, but it’s too new to judge long-term performance.
General-Purpose EHRs
Systems like Tebra, CharmHealth, and Praxis EMR can technically be adapted for DPC, but I’ve watched many practices lose time trying to force them to fit. They were designed for insurance workflows.
When a DPC tries to retrofit them, the clinic often ends up adding external tools for billing and communication, which increases administrative complexity.
If you’re converting from a traditional practice and already have one of these, they can serve as a bridge. For a pure DPC startup, they’re rarely the best option.
Systems to Avoid
Some systems simply don’t align with the DPC model.
Practice Fusion is a common example. It’s affordable, but it’s built for insurance billing. It lacks modern automation for memberships, and support can be inconsistent.
Large enterprise systems like Epic, Athenahealth, or eClinicalWorks are expensive and overengineered for independent clinics. I’ve seen DPCs attempt to use them and spend more time fighting configuration than seeing patients. Great for hospital systems, not for DPCs.
Consumer tools like Google Docs, SimplePractice, or a standalone Stripe setup are fine for initial planning but not for actual medical record keeping or billing at scale. They create compliance and workflow issues the moment you start growing.
Any vendor that rarely updates its platform or doesn’t communicate about data security should be treated cautiously. Migration is painful and expensive, so it’s better to start with something reliable.
Supporting Apps That Complete the System
A good EHR gets you most of the way there. A few supporting tools make it work beautifully.
Spruce Health
Spruce is the messaging platform I see most often in DPC clinics. It gives practices secure texting, calls, and telehealth all in one place. Staff can triage messages and respond from a shared inbox. Conversations stay documented and easy to review.
Gusto
Gusto is an online payroll and HR system that fits perfectly for small medical practices. It automates payroll, handles tax filings, and simplifies onboarding. The DPC owners who use it spend less time managing paychecks and more time managing patients.
Hint Core
For practices that love Elation but need recurring membership billing, Hint Core fills the gap. It automates payments, renewals, and employer invoicing, and connects cleanly to most accounting systems.
Paubox
Paubox handles encrypted email without forcing your patients to use portals. It makes secure communication look and feel like standard email while still meeting healthcare privacy requirements.
Doxy.me
For practices without built-in telehealth, Doxy.me is an easy addition. It’s web-based, simple, and doesn’t require patients to download anything.
QuickBooks Online
QuickBooks remains the accounting system of record for most DPC practices. When connected properly to your EHR or billing platform, it gives clean financial reporting and accurate revenue tracking. Xero is a viable option; its pricing and ease of use make sense if you’re going to DIY your own bookkeeping for a while.
Together, these tools create a stable, modern infrastructure. They’re not always needed all at once, but each one solves a real operational problem that I’ve seen repeatedly in DPC books.
Compliance, Privacy, and Common Sense
Every DPC handles protected health information, so HIPAA compliance is nonnegotiable. Make sure every system, for any purpose, you use signs a Business Associate Agreement and encrypts data in storage and in transit.
Some vendors also go through third-party security audits known as SOC 2 reviews. You want SOC 2 Type 2. Those audits check whether a company’s internal controls for data protection actually work in practice. Even if your EHR doesn’t publish those details, ask how they secure information and verify user access. Hint, for example, is SOC 2 Type 2, HIPAA, and ISO 27001 compliant. Elation is also SOC 2 and HIPAA compliant.
Good compliance habits also include staff training and consistent data backups. No software replaces discipline or solid information security practices.
Matching Your EHR to Your Growth Stage
Your choice should fit your current scale, not just your future plans.
A commonly seen (for a reason) setup is a Hint & Spruce combination. The choice of accounting and payroll software is a conversation you should have with your accountant.
Final Thoughts
I’ve looked inside the books of many DPC practices. The pattern is clear.
The clinics with clean financials, low admin costs, and consistent growth all have EHRs that match their operations. The ones that struggle use tools meant for someone else’s business model.
If I were starting a DPC today, I’d use Hint Clinical to keep everything connected from the start. If I were scaling with multiple providers, I’d look closely at Elation or Cerbo depending on whether I wanted structure or customization.
And if I saw a client still using Atlas after two years, I’d start planning a smooth transition before the cracks appear.
Whatever you choose, treat it as infrastructure. It shapes your time, your cash flow, and your patient experience. Choose a system that serves the model you built, not the one you left behind.
Your technology should reflect the same simplicity you promise your patients: clear, direct, and built for relationships.
Ready to Build Better Systems?
Choosing the right EHR is just the beginning. The real work is connecting it properly to your financial systems so you can actually see what’s working.
Need help connecting your EHR to QuickBooks? Or could you use some feedback on your current tech stack? That’s what we do. Clean data flows, accurate books, and financial clarity without the manual work.
Visit DPCBookkeeper.com or email daniel@dpcbookkeeper.com