The Real Cost of a Cheap EHR

You’re paying 200 bucks a month for your EHR, but that’s not what it’s costing you. You’re losing 40 or 50 grand every year because of extra staff, you’re missing patients, at night you’re charting after your kids go to bed, and none of that shows up on the invoice. I built Esprebecause I watched functional medicine practitioners trapped in systems designed for hospitals, not for healers like us. The true expense of a cheap EHR isn’t the subscription price. It’s what it steals from your practice, your family, and really your ability to help patients. Here’s what functional providers miss with their comparing systems and why the lowest cost EHR on paper, it’s costing you so much more than you’ve calculated. Providers shop for EHRs the way they shop for gym memberships. Here’s the monthly cost, Checklist of features, check, check, check. Pick the cheapest one that covers the basics, but you’re not paying for software. You’re paying for the time it steals. That’s the thing. When providers start shopping for an EHR, they focus on the number. They think 200, 500, 1,000 bucks. They think this is my charting system. Here’s what I’m paying. It handles notes, scheduling, messaging, telehealth, billing, that’s what they say. The feature checklist, it’s there. What they miss is the expense that doesn’t show up on the invoice. How much does the system really help with your workload? How does the staff actually work together? Does patient communication in the portal really function? Or do patients have to call every time? Because some portals are horrible. How much time are you spending after hours just to keep the system running? I mean, you know what I’m talking about. There’s no line item for that. That doesn’t come in as a deduction on your invoice, but you’re paying it. Most EHRs start as a basic subscription. It’s a few hundred bucks a month. Then you add telehealth, upcharges, e-prescribing, lab, automated reminders, all the features that were hidden at checkout, and customization, forget about it. 30,000 to 40,000 bucks at a whack. I mean, we’ve talked to so many of our docs who, when they have something that they want done that’s special, it winds up being just incredibly prohibitive to get anything added. So what becomes of the couple hundred bucks, 500, 600, 800, depends on the level of desperation and a whole lot more. And that’s only the visible cost. The hidden cost shows up as a full -time employee, right? An extra three or $4,000 a month at a minimum, rather than paying for maybe a complete EHR. Maybe that’s a better idea. It shows up as patients calling for information they should have gotten from the portal. It shows up as you hire more staff to manage the workarounds. Yes, the ever-present workarounds. We do them all the time. You’re waiting longer for charts to get completed. You’re working until midnight because the system doesn’t understand how your work flows. Inefficient staff costs way more money than a better EHR. A better EHR, that’s why I say it’s betterThe real math. Times spent charting after hours, times your hourly rate, plus staff salaries to compensate for system failure, plus lost revenue from patients you couldn’t see because you were buried in documentation. The true cost of a cheap EHR is a 60-hour workweek instead of a 30 -hour workweek. You do the math. All right, next. The feature checklist trap. Why does every EHR say it does the same thing, but doesn’t. Providers assume that if the feature checklist is the same, the systems are equivalent. Notes, scheduling, messaging, telehealth, billing, prescriptions, it’s all there. Hey, what’s the difference? Well, features aren’t workflow. A checklist is not a practice. The biggest mistake practitioners make is focusing only on features rather than how they flow together. They see the checklist and everything’s there. They assume it’s gonna work. What’s the cheapest one? They never experienced what it’s like to work with an EHR that understands their particular environment. We get this all the time. We have doctors calling us saying, they promised us this incredible experience, and it wasn’t incredible. In fact, it was unbelievably bad. What they wind up with is inefficient staff time, costing them way more money than a better EHR. They need to look at what it costs them in burnout and cognitive fatigue, just mental overload, and total time. I was thinking about this. Like at Costco, you walk down the aisle and they have wine that has a rating on it, right? You wanna get a good one, like a 90, 92 point. If you’re really in a spending mood, you can get a 95.1. They don’t have that on EHRs. There’s no number that’s stuck on that label from doctors who’ve used it. Oh, maybe I’ll tell you what, I’ll use a big brand like Epic or Oracle. Yikes. The feature checklist is designed to get you to buy, not to show you whether the system will save you time or work for you. The systems that went on checklist features are the ones that create the most workflow frag that just blows things up. They’ve tacked on module after module after module to check more boxes, to follow the rules, because that’s the regulation. You don’t even wanna think about handling inboxes because the patient portal is a smoking mess. I can recall the chaos before we embedded comms in our system, trying to remember what I was gonna say to who. Walking down the hallway, you know, like you walk in the other room, you forget, did you go to get the keys or were you gonna call your kids or, and then with a brilliant workflow hack, I must say, we made it all so simple with internal texting. Instead of wasting time and money walking down the hallway to find the right team member, which may be in a room or maybe somewhere in the bathroom, and then cleaning up sticky notes, which, you know, sticky notes at the end of the day, you could be texting texts between staff members with perfect documentation. In other words, the sticky note gets lost, you get lost trying to find the staff member, but when you have internal, everything gets documented, every word. When you’re evaluating an EHR, talk to other providers. Like people who are in a practice like yours and ask them, does that software really do what it promises? How long does it take you to complete a chart? How much do you work after hours? How much does your staff like using it? Now that is the question because, boy, if you wanna get the down low, ask the people at the front desk how much, you know, both you have to deal with every day because your EHR is horrible. Testimonials and provider feedback are the evidence. If you want that wine sticker on your EHR, ask the front desk people. A checklist, trust me, that is not the indicator of the excellence of the system. It just doesn’t work that way, which brings me to the next problem. This is why systems like the bigs, like Epic and Oracle, and also smaller systems, they just don’t work for functional medicine and they never will. Like the major EHRs, they’re designed for big hospitals and insurance systems so they could communicate securely and manage the hospital, which makes sense, but they weren’t designed for you. Your EHR thinks you’re a billing department, which you’re not, that’s crazy. That’s why you’re burned out. You never wanted to be a billing department, you wanted to be a doc, so that’s that. When a functional medicine practice uses the same tools for relationship care, they painfully feel it. They’re filling out all those extra click boxes because there’s no way to handle the important stuff. It’s not there. Timeline, nutrition, specialties, compounds, it’s just not there. The unique symptoms that tell the story, you know, the functional medicine stuff that makes us really good at what we do. Industrial hospital-based EHRs push you to diagnoses codes and templates rather than the patient story. You get useless data points. I mean, they’re all over the place. Insurance-based systems are asking, did we get the bill right? And a functional medicine system is asking, how can we understand this patient better? Are they responding to treatment? Are they having a better quality of life? I mean, the difference couldn’t be starker. And I mean stark, you have black and white, you have numbers. And on the other side, you have the beating heart of a human being. And this system understands it. A good one, Espre understands this. The other one, it can add and subtract. It does that really well. That’s not people. Architectural mismatch is not a bug you can fix by customizing your way out of it. It’s the very foundation of the system. I mean, it’s the basis. It was built for a different job. So legacy EHRs, they don’t include a lot of stuff, especially supplements and compounds that are just central to our practice, right? They don’t have longitudinal symptom tracking. They don’t allow you to customize lab trending. So I like to look at the hemoglobin A1C and triglycerides. How do they work together? And we can follow all of that in a really good system. So instead of a unified timeline, you’ve got fragmentation and chaos everywhere. I call it getting fragged. There’s just so much obnoxious junk. You have super long notes that are 20 or 30 pages long from the compliance officer. And I’m sure you’ve seen them. I’ll get them. A patient will come in. It’s a new patient. Say, hey, could you review my records? I’m sure. And then on one page, there’s a whole bunch of dates and numbers and names. And the next page, they have one lab value. And the next page, they have numbers and names and another lab value. And it keeps going and going and going. And I haven’t gotten to what’s wrong with the patient. It’s in the like 27th page, buried somewhere in a little one line diagnosis. I’m like, oh my gosh, horrible. That is bad. In our system, everything’s unified. And in a few concise, clear pages, you get the whole picture. And the lab makes sense. So if you’re using an insurance-based EHR for functional medicine, you’re working against the grain every single day. The system is built to optimize for something you don’t even need, right? The reason you feel like a failure when you can’t make it work isn’t because you’re doing something wrong. It’s because the tool was built for a different job. And here’s the next thing, the workaround tax. And for me, I want to just praise you for your ability to work around. Everyone who’s been in this system for a while knows how to work around. And we do workarounds all the time for patients. If this drug doesn’t work, we’re gonna work around and get this one, right? With software, you shouldn’t have to do that. Doctors are running six or eight systems just to be able to work. And that shouldn’t be the way with an EHR. Doctors are amazing at working them. They just know how to do it because they’ve had crappy EHRs for years. So they do it. And they think that’s the nature of EHRs. They’re good at building a parallel system outside of their EHR. So if you’re paying for six other apps, your checklist EHR is just not working. So we work with those doctors around their practice. They have male chimps, they have fax chimps, male chimps. That would be a lot of chimps, yeah. They have a contract with a compounding lab outside of their regular eScribe so that they can do this outside. Then they get all those labs or the compounds that they got to transfer them from this system, copy paste and put them in their system. And it’s insane, total nonsense. So they got to repeat their documentation. So instead of a couple of keystrokes, literally from inside a spree with customized functional medicine compounds that are immediately integrated into the chart perfectly without any errors, you have separate multi -step processes that will guarantee errors and totally waste time. They’re going to say, I know what we’ll do, let’s customize it. Phone call, 30 grand or whatever it is, crazy amount of money. And you can’t customize it enough to make the architecture work. When you don’t have the entrances and exits right, it doesn’t matter how you try to make the building different, you can’t get in and out. They don’t have the ability to bring those concepts in. And when people switch to a spree, they’re stunned by how much time they spent trying to make the wrong tool work, working around. It’s like using a screwdriver when you need a vice grip. It’s ridiculous, it just won’t work. The workaround tax is invisible on the profit and loss statement on your actual invoices. It shows up as staff time, subscription fees to different platforms. And if you can’t duct tape it, it probably can’t be fixed. And there’s a lot of duct tape. So each workaround introduces a new point of failure. I mean, it’s going to happen and information gets lost. I just think of sticky notes. That’s like my visual reference point. I think of the sticky notes that have been just everywhere in my past, not anymore. So patients call because he didn’t get something and maybe that sticky note went in the trash. I sometimes have crumbled them up and in frustration thrown them away. I think it happens. Staff members duplicate work because the systems don’t talk to each other. And then you’ve got this compounding problem. The more workarounds you add, the more fragile that whole structure becomes. And then without upgrading one tool, you get the other one and they break. Count how many separate platforms you’re paying for that should be inside your EHR. Each one represents a tax on your time and a liability risk. If you’re running more than one or two, you’re compensating. And big cars and compensation, it’s not cool. Now, this next one is what most providers get wrong. When you know it’s time to switch, and trust me, waiting is costing you more than you can imagine. At some point, you know it’s not just inconvenient or a concern about making switches. It’s starting to destroy your lifestyle. If you’re charting after your kids go to bed or something’s happening at home, it’s not you. It’s your EHR. You’re charting at night. You’re not finishing charts at all. You have a stack that’s weeks behind. You can’t continue to see as many patients because you’re backed up with trying to get your documentation done. That’s a huge loss on every level. You have external systems that need to be upgraded, but you can’t upgrade. You’re starting to impact revenue and quality of care because you can’t spend the time you need for each patient. So, and what’s more important than quality of care, right? That’s like, ultimately, you could put a whole lot of other things on the side and make a lot of sacrifices, but quality of care, you can’t. You’re too busy clearing out the backlog of clicks. It’s crazy. You’re in a fight you’re gonna lose. More time, more energy, mo’ money. That’s how it’s gonna be. By the time people do make the change, they’re buried under the cost. Emotionally, financially, cognitively. I think that’s why sometimes it’s so hard for people because their brain’s fried from having to deal with this for so long. They say, once they’ve done it, I can’t believe I waited this long. I should have done this years ago. Migration paralysis, I have not found the ICD -10 code for it, but it’s a real thing. And the fear of switching is that you’ve done it before and you don’t wanna look stupid and you’re probably not gonna get anything you really need. The real fear underneath it though, it’s emotional. I’ve already invested time in this system and I’ve tried really hard. And what if the next one proves the same thing that it’s not the systems that are the problem, I’m just not really good at this. I mean, nobody likes that, right? I think about a World War II story that I’ve heard. What the Nazis would do to torture their inmates is they would get a huge pile of gravel and they’d give them a shovel and a wheelbarrow and they’d have them shovel that stuff in a wheelbarrow and move it across the camp and pile it somewhere else. And the next day they’d make them move it from that pile that they’d done the day before back to where it was. And they would do that day after day after day to make them feel like everything they did was meaningless and it drove them insane. And I think that was an experiment that they did to see how long would it take? Well, my question to you is how long is it gonna take before you decide to do something different? What’s going on in medicine is like that. Doing work that’s not gratifying, it’s not helpful, not useful and takes you away from the most important part of your life has to stop. The emotional toll of staying with a broken system is greater than that temporary discomfort of a couple days of switching. But you don’t see that until you’re on the other side. And when you are, it’s beautiful. Everything comes together. If you’re working into the night, finishing charts a week behind, you’ve crossed the threshold. The system is destroying your ability to practice medicine at some level. Either your joy is gone or you just don’t have the time to do a great job and the best time to switch, let’s like planting a tree, two years ago, the second best time is right now. Waiting costs more than switching. So let’s talk about what actually changes when you use software built for functional medicine. When a patient books an appointment with a smart EHR like a spree, they walk into a system that expertly extracts their story in detail using validated questionnaires across all specialties and provides a doctor with a chart that instantly recognizes the underlying conditions that are driving the pathology and the whole story. The story is everything. If you really listen to the patient, they’ll tell you what’s wrong. They’ll tell you what you need to do. You’ll do what they say based on their story so that it really, really works. And this is the best part. And I love this. You’ll get credit for being brilliant. And all you had to do was listen and get their story. If you’re not in that listening environment, you’re basically getting demography, where do they live and their background and a 1965 symptom checklist. You’ve seen them. We should go to the doctor’s office. And it’s like, here’s all the major surgeries that you could possibly have, like 30 or 40 of them. And then every symptom in the book, and its pages. And it’s kind of illegible, but it’s not designed for insight into the patient. It’s designed for compliance. Then the doctor and the nursing staff, they’re gonna repeat at some level that superficial history taking process. So you do these forms and you have to do them sometimes every time you hit the doctor’s office. Then the nurse is gonna come and ask you a bunch of questions. Then the doctor’s gonna come in and ask you the same questions again. And the patient enters this environment thinking, I’m so frustrated. They’re frustrated. You’re frustrated. They’re burned out on filling these forms out again and again. And they know there’s no benefit. Those forms go in a drawer most of the time, right? Nobody ever looks at them. And doctors are driven to total distraction by the frag of the chart where, box, box, box, box, click, click, click, click. What about the patient? What about this? No, I gotta… The first time healthcare pros use a SPRE’s rapid history system, they’re stunned. Because instead of trying to cobble together a useful story, let me try to remember from that 1965 symptom list and the nursing intake maybe, and maybe they’re good interviews. They have everything they need to get to the heart of the problem with ESPREinstead of all that within seconds, literally seconds. Functional medicine software excels at workflow. Rather than trying to make everything work around billing, the focus is on the story, that individual, that beating heart of the person. The story is the beginning of the note. It doesn’t drive anything like accounting does. That’s a cold, hard world, right? The story of the patient drives everything. Deeper focused questions. Once you have that beginning history, you can go deep and you can get things done fast. All the labs you need and nutritional protocols, that all flows from the story, not from an ICD-10 code. In a generic EHR, each chart is disconnected from the next one, right? You get a patient who comes in with a complaint, which you ICD-10, and then you give them maybe a silver bullet treatment, maybe you give them more. They had chest pain, so I give them Toprol, and it doesn’t look at the underlying problems and how to transform this into a healing process, right? ICD-10 treatment, that’s it. That’s how the EHR works. You may not work that way, but that’s the way your system does. So now you’re gonna have to fill out your word processing within it to accomplish what you really need. SPRE is designed to manage the patient’s care over time. Rather than handling billing and documentation over time, it handles the patient over time. And the beautiful architecture, and it is beautiful, changes everything. And I kind of think of it this way. If you were gonna go on a date and you had a choice of going with someone who was incredibly charming and attractive and just wonderful to spend time with, or somebody who they really didn’t think the way you do and they didn’t really enjoy the things you do and they’re not particularly attractive, what would you choose? Choose ESPRE. I mean, you’re gonna spend more time with your EHR than you do your spouse or your kids. Make it count. ESPRE practices say they were working well into the night before they made the switch. Now they’re finishing on time. They do a ton less meaningless work. In fact, I think there’s almost none. And they feel better after they switch. It’s not just emotional, they have more time. In our system that we’ve been sharing with other doctors, we have zero churn. In other words, once people start and integrate it into their practice, they never leave because it’s that good. If you found this useful, check out my next video on this channel.