Choosing A Customizable EHR: A Conversation with Dr. Alex Foxman

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Dr. Alex Foxman joins host Dr. Maryal Concepcion to delve into his journey opening three practices, including the Beverly Hills Institute, his mobile home visit service, and his national virtual weight loss program. He details how DrChrono by EverHealth has revolutionized his clinical operations, enabling seamless communication and task management for each of these practices because it is an All-In-One, cloud-based, customizable EHR. The discussion also touches on the future of AI in healthcare data analytics, positioning DrChrono by EverHealth as a frontrunner in technological advancement.

Listeners gain valuable tips on evaluating EHRs, considering factors like workflow compatibility, ease of use, efficiency, and customizability that he has enjoyed with DrChrono by EverHealth.

Start your FREE TRIAL TODAY and see why DrChrono by EverHealth is the #1 All-In-One Mobile EHR!

Transcript

0:05

Primary care is an innovative, alternative path to insurance driven health care. 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 fingertips. 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.

Maryal Concepcion, MD: 0:53

As we are approaching 2025 and people are planning to open their DPCs or they're in their early days and already realizing, Oh my goodness, I might have something in terms of tech and in our case, in our conversation, we're going to focus on the EMR. That might not be working the best as I grow my practice. And so this conversation is so relevant to the end of the year, but also the beginnings of a new one. So with that, Dr. Alex Foxman, thank you so much for joining us today and sharing your experience as a physician who has multiple branches of his private practice and who is a Dr. Crono user.

Dr. Alex Foxman: 1:28

Thank you for having me. Appreciate it.

Maryal Concepcion, MD: 1:29

So let me ask because this is a physician story centered podcast. Tell us a little bit about your journey into opening your private practice were you employed before opening up your own practice?

Dr. Alex Foxman: 1:44

So I was never employed in, in, in the realm of, of medicine. I, I've had lots of jobs before in college and so forth, but not being a physician. So I graduated in 2003 in internal medicine. Don't want to date myself, but yeah, that's, that's How long I've been in practice. I'm double board certified in internal medicine and obesity medicine. Currently there's a very small percentage of positions who have double board certification in those particular fields. The reason I went into primary care, internal medicine and also private practice was really, I've always wanted to have autonomy. I always wanted to have growth and I really wanted to always be the captain of my ship. And I think that's very important. There are people who find value in, in being employed, you go to work, you do your job, you leave, you don't have to worry about the rent and the employees. And if the, toilet backs up or the supplies are out, but there's, there's a lot of, I think for me, fulfillment to be able to really write the story for my for my journey. And starting from scratch was very difficult, but ultimately I think that it, it, it shows a very good progress for most people that go into private practice, but also there's a lot of fulfillment in that as well.

Maryal Concepcion, MD: 2:58

And I am going to guess that pretty much everyone who's listening is shaking their heads, especially if they're physicians, because this is why people listen to the My DPC Story podcast. The idea of physician autonomy exists is very much alive and well on every single episode in this podcast. So I want to ask you there because, I think about not only were you focused on autonomy, but you're also a primary care physician, what was it about your personality, your outlook on business that, made you really. And you were able to honor the search for autonomy through the way you practice medicine going forward.

Dr. Alex Foxman: 3:33

Yeah, primary care gave me the ability and one. It's to be able to be part of a lot of different parts of medicine. I didn't have to just concentrate on one specific thing I could really spread out and really be flexible in a business sense with what I'm doing as well. And that's the way I've kind of looked at things. Look primary care. We're dinosaurs. Many times private practitioners are dinosaurs. It used to be that the majority of physicians were private practice physicians, but now less than 30%. I think nationwide are private practice and shrinking and that's because we're being really pushed out by corporate medicine. And everyone is just a cog in the wheel just a number sitting on a, on a seat. And I never wanted my patients to feel that way. And I felt the only way to keep control was to go private, was to provide very high quality care, unfortunately that has, financial downsides to patients as well, because that is a more costly care for the most part. But when you look at it from a large perspective actually you save money. I'll give you an example. By spending a lot of time with patients the right time you decrease the amount of referrals you do. You decrease the amount of hospitalizations. ER utilization, urgent care utilization, medication utilization, and it's clearly shown that we could definitely benefit populations by spending more time with them.

Maryal Concepcion, MD: 4:53

Absolutely. It makes me also think about when it comes to EMRs, Dr. Crono which we're focusing on today, is definitely used by specialists, gastroenterologists, podiatrists, but you are a primary care physician and I would assume that you of all people are really going to appreciate all of the different aspects of how an EMR can help you get that job done

Dr. Alex Foxman: 5:16

yeah. I consider myself an early EMRs. I started off right when I came out of residency. I went to our local hospital, which is Cedars Sinai Medical Center. I went to their, chief information officer at the time and said, what are you using for your outpatient clinics? And at the time, it was actually GE centricity. Which was a big EHR at the time. so I said, okay great. That's what I want to do. I want to be connected with the hospital My vision is that everyone's going to be connected Everyone was still on paper at that time in 2003 believe it or not And I said I want to do this and I spent a huge amount of money even before I opened my doors To put the system together now back then To have Centricity EHR it took about eight servers in my office, separate servers. It took tape backups. It took a tech person to oversee this. You had to do your own updates. If it crashed, you had support that would take, many, many hours of your day. And it wasn't very customizable. And every little thing cost A huge amount of money. Every little tweak costs a little, a huge amount of money. So it was very, very frustrating. And I unfortunately use that system for almost 12 to 15 years of my career. Struggled with it, went to the office on the weekends to do backups. It was insane. And why did I do it? Because I felt as if I was, shackled to the system. I felt as if there's no way out of it. Because we already had so much data in the system. We had so much experience. I thought this was a way for me to save time, but in reality, it actually wasted a huge amount of time and thousands and thousands, not only of dollars, but thousands of hours of my resources to get this thing going when we transitioned over to Dr. Crono, it completely changed the paradigm of how we Random practice. First of all, there are no more servers. Everything is cloud based. Which is very, very important. So all of the tech support and all of the bugs and all of the backup. Everything is done somewhere else by someone else. And that's incorporated in the cost a lot customized ability. So we're able to customize our particular practice to the way we believe we should document the way we should reach out and speak with our patients or educate them the way we should bill for the patient services the way we should interact with the rest of our, staff. All of that is something that we were able to customize. So Dr. Crono now sits as the heart of our practice. And there's many times where. It was so funny before if I had to give an order to my staff, I would have to actually run through my office and say, go draw the blood, go do this. We do this now through Dr Crono. So it's a much more efficient means of doing things. And because Dr. Crono works on so many different platforms there's a huge amount of mobility and opportunity to be independent that I've never had before. I used to have to drag a laptop around with me. Now I could either have a tablet, I could have my, iPhone I could be out in the field or elsewhere and feel as if I'm, I'm in the office being able to do things. So it gave me a lot more autonomy, a lot more freedom, a lot more opportunity to enjoy my life outside the office.

Maryal Concepcion, MD: 8:21

You mentioned how, you didn't think that there was a way out had you looked at other softwares and what was it that made you say, yes, I'm going to change and yes, I'm going to change to Dr. Crono?

Dr. Alex Foxman: 8:31

Yes. So a couple of things. One is that our servers were becoming outdated. There's more security flaws that are being shown. And I knew that it's only a matter of time until either the servers failed and I was going to have a major problem or I was going to get hacked or whatever it might be. So I knew that I had to make a change. I started doing a lot of research on different types of EHRs out there. I had a lot of interviews. I, I did a lot of demos, but the reality is, is that you're never going to know how your EHR is going to function until you're actually using it in real time, right? You can have a lot of presentations and everything looks fancy and great, but until your data is in there, your patient's data, it's in your workflow, you're not going to know. I picked Dr. Crono for, for several reasons. First of all, the the cloud based computing was very, very intriguing to me. The mobile factor of it was very, very important because I have three different types of practices. I have a mobile medical practice, a clinic based practice, and a virtual national weight loss program as well. And I had to have it function in all these different types of environments or customize it to that. And also the price point was very important as well. Cost and, as all of us, as as private practitioners, we're running businesses and we have to make sure that our businesses are run prudently and that we're not over spending on things that, that we don't have to. And I think all those things together, gravitated me to Dr. Crono also the open access. So I knew that. Others could come into partner with Dr. Crono and be able to integrate through APIs, which is quite, quite interesting and novel.

Maryal Concepcion, MD: 10:04

what you said about You got to try it out before you really commit, because you don't know your workflow. That's why I mentioned at the very top of the episode that if people are already in the place of I don't know if this is actually going to work for me. It's because they've tried out something and have found, actually, this is not going to work for me. that that's okay, that's a total normal place to be in to be transitioning, even early on in one's practice. But also, we just had Dr. Clodagh Ryan, who's been in practice for over five years, talk about her transition and how, she talked about the reasons why she knew the EHR that she was using was not working for her. Three years in and she took two years to to to transfer over. When you mention the API, I think that is something for people to really take a listen to because I, I feel in 2024 when we're recording this, that if you have an open API, you are definitely welcoming innovation and you're welcoming a progressive approach to the future, because as we know, we have wearable devices you're having, you're running a national clinic as one of the branches of your practice. You need to be able to have accessibility for your patients, no matter in what form of practice you're doing fee for service or DPC. And I think that when you have an open API that just screams, we are progressive.

11:18

Absolutely. 100%.

Maryal Concepcion, MD: 11:20

talk about the three branches, I want to go into a little bit more detail because I think it would really help for people to understand what type of practice and what spokes of your practice you have going on successfully. And then I want to ask about how you're doing it because like you said, Dr. Crono is at the heart of your practices.

Dr. Alex Foxman: 11:38

Yeah, so we could start with my private practice. It's called the Beverly Hills Institute. It's located in Beverly Hills, California. It is a primary care and preventive care practice. I always want to incorporate preventive care, which is very important. I think patients are left out of their health care way too much. So, in my practice, it's very important that patients are involved, they're educated, they're accountable, and they have a direct line of communication to our office at all times, because I think that really provides So the way we use Dr. Crono in that we do use the iPad version it's been customized by me of how I like to practice how my staff likes things as well. We use their on patient portal. Immensely to educate our patients were very transparent. So every time we finish a note, we send that note onto on patient with links on education. So they understand what's going on. And we also send those notes to all of the sub specialists as well, because it's important that we all work as a team. It's very unfortunate when everyone has siloed data, and we don't work as a team for the patient. So we work very hard to try to communicate and share that information as well. But I think one of the biggest things that, that I think impresses my patients is the ease of communication, the education and also contact with my staff. I think that's very important as well.

Maryal Concepcion, MD: 12:57

I think that in, especially in DPC, whether you're a or a person who has staff the usefulness is, definitely something to focus on for the physician, but it is very important to think about it from the patient's perspective. Because after all, when they talk to their friends, their neighbors, when DPC, grows by word of mouth, it's because of things like this, exactly. The usability by our patients is so key when people are considering what EMR they're going to use. So you talked about your primary care practice and then tell us about your home visit spoke of your practice as well as the national side of your practice that you talked about as well.

Dr. Alex Foxman: 13:36

Sure. So I also operate a mobile medical practice. It's called Mobile Physician Associates. It's located in Southern California, and we provide medical home visits to the frail, elderly and disabled population in our area. We have very complex sick patients. Average age is 86. If anyone knows about what risk scores are, the risk score on average is four. So they're considered four times. more costly and more ill than the average Medicare beneficiary. And we do it in a very unique way. we not only provide the medical home visits, but we also provide all of the ancillary services that you could get in a doctor's office directly to the person's home. That includes immunizations, With covid and flu and Pneumovax and you name it, it includes electrocardiograms and ultrasounds and sleep studies and Holter monitors and x rays. So we could do everything that that could be done in the office. Right at the person's home, and we've been doing it quite well since 2009. We've seen over 77, 000 patients, I believe that that is the future of healthcare. It's not about how much can you do to the patient to get reimbursed? It's more about how can you take care of this patient in the best way possible to not only make them healthier, but decrease overall costs for that patient population. So, that's, that's the mobile practice. I also started achieve health and weight loss. It is a national Medical weight loss and health program currently in 39 states completely virtual, where we provide weight management specialty care to patients who need it. As we know obesity and being overweight are a national epidemic. 75 percent of all people in the United States are either overweight or obese with about 40 to 45 percent being obese. And we've, we've been able to now. Significantly and successfully manage these patients when we couldn't do that before because of the novel innovations of GLP medications but these medications coupled with a very good program such as uh, Having health coaches, having body composition, remote scales that send us the information, having position oversight has dramatically changed people's lives nationally. And we're very proud of that as well. And Dr. Crono's used so differently in all these different kinds of aspects. And that's what I love about is that flexibility where we could use it either office based, we could use it mobile, or we could use it virtual.

Maryal Concepcion, MD: 16:02

Just thinking about just the differences between an exclusively home based option versus office based there versus totally virtual. The workflows are going to be so different you have Dr. Corona for all three spokes of your practice, and not, you have Dr. Corona for one, and then another for another, and then another for your third. So tell us about how you've been able to really Customize Dr. Crono in so many ways because it's not only all in one, but it has these different aspects of how it can be customized to your practices needs.

Dr. Alex Foxman: 16:37

Yeah, what's great is, is a couple of things. One is Dr. Crono has a physician sharing network where physicians could develop their own forms and, and templates and share it with other people, but also they have a, a built in very innovative and I think pretty, pretty good. Module that allows you to customize your own forms so you could customize them in many different ways. There's drop downs. There's lists. There's check boxes. There's many different things that you could do. And you don't have to be a programmer to do this. That's what's great about it. If you're able to run Excel, if you're able to do Microsoft Word or do a PowerPoint presentation, you could do this yourself. And the beauty about it is that again, yeah. You now are customizing this for your workflow for your life. It's not some other programmer telling you how you should practice. It's you doing it your own way. And it's been extremely, extremely beneficial for us in all our different practices, because every single practice. Not only my practices, but your, your, there as well Everyone is completely different. Every direct primary care practice is different from the other one. Every doctor just functions a little differently. And I believe that Having a customizable EHR is amazing because everything else that we have around us is not. We're kind of fixed into everything that's provided. This is the one thing that we can really make our own and and show. The care that we provide to our patients through documentation and efficiencies and things of that nature.

Maryal Concepcion, MD: 18:06

And I, I think that, there's definitely going to be listeners out there who are just hearing there's something other than the epic Cerner's like the, the centricities. This is amazing. And yes, these things exist because there are people out there who are thinking about, Hey, how could we make this better for our doctors and make it better for our patients? The other thing that I want to mention there is there's people also thinking about how can this be better for our staff? So for those of us who have staff, like you have your office manager at the Beverly Hills Institute, Robin, and I was watching a little clip about how she spoke about how the transition that you guys had to Dr. Crono was just, she couldn't have had it sooner is was what I got from her testimonial. So can you talk to us about how your staff adopted and was able to, work with you as you continue to customize Dr. Crono

Dr. Alex Foxman: 18:58

yeah, I mean, we could even go back to our COVID days where we're isolated, we're all doing telehealth, there, there was no real good HIPAA compliant way to communicate during that time. So we, that's where we're really. Extensively started using Dr Cronos task management system and internal messaging to really help us work remotely. Everyone was separate and we use that to this day in the same way. So orders are put in their messages are put in there. Different tasks for the, for the office questions going back and forth. It's very customizable. Also, you could have groups of people that all the messages go to or individual people so that the, the internal communication aspects of Dr. Crono, I think, are very important important in my private practice, but definitely important in my mobile practice where no one is in the office. Everyone is separate. The ultrasound tech who's on the platform as well could be, 10 miles away. The phlebotomist is elsewhere. So you have to have ways to communicate. You have to have ways to document. You have to have ways to be able to to have this all in one area. People use email here or Skype there. They use all these different platforms, and it's just impossible to, look at all these different things. So having everything in a one hub in one section where everyone sees the same thing or can see the same thing, I think is very important.

Maryal Concepcion, MD: 20:17

You have memberships so tell us how that works for both the people who you are billing insurance, but especially the people who you're billing memberships, because there are people who are running, A hybrid DPCs. And then there are people who are only running memberships.

Dr. Alex Foxman: 20:32

Yep. My private practice, Beverly Hills Institute. We have an annual fee that we charge all of our patients. We charge them per person. We charge them for family members or additional family members. So there several tiers that we have. Our fees are either monthly or they're annually and the fees, people ask all the time. Well, what are these fees for? There are things that all direct primary care and good physicians strive for same and next day appointments. Longer visits, opportunity to help set up subspecialty care, discussion of the labs when they come in or other diagnostic things, having everything in one location, which we strive for. All the things that, that patients really envision or dream about is what we try to do, right? So we have our annual fee, but we also build insurance for services as well. The Beverly Hills Institute, we use Dr. Crono for what's called revenue cycle management. For Who take all of our notes, they'll take all of the diagnoses, all of the things, and they'll run them through their billing software and build insurances for that. They will then get reimbursement from the insurances, they'll get, they'll send out statements to the patients to get reimbursement from the patients or there's a copay and so forth. And then all of that will come back to us at the very end. As as revenue and they take a small percentage of that revenue for that. But I think it's actually well worth it for the mobile practice. We don't have a membership fee. We just build Medicare and for Our achieve health and weight loss, which is the virtual weight loss practice, it is membership based only we charge a membership fee and everything else is included in that fee except for medications, which we try to help the patients reduce costs through a number of different ways, either prior authorizations or other remedies that we have for them to reduce our costs. But that's membership only for that particular practice.

Maryal Concepcion, MD: 22:26

I think that that's important for people to hear because when. You're already going from being a doctor, which is a very hard thing to achieve, to then being a doctor and a business owner. it's a lot. So I think that that's really helpful to hear Dr. Kono, is flexible, whether you're billing insurance or not.

Dr. Alex Foxman: 22:43

Yeah. I'll tell you, business is not, definitely not easy. Businesses, even though people go to school their entire lives for business, The reality is, is business is all about experience. And it is extremely gratifying though, your, your viewer should know that you don't just come out and everything is perfect. Everything always will have some sort of inherent problems and risks and, and steps backwards with some steps forward. But the reality is, is that over time, You'll be, in my opinion, much more ahead than, than behind in regards to where you would be if you were employed, just not just by satisfaction with your, with your work, satisfaction with your, family or personal life with your time for yourself. I think all those things are very important. And by being. Private, you control all of those things, which is, quite good.

Maryal Concepcion, MD: 23:30

When earlier you mentioned about how, one of the things that you had said to yourself was, I don't, I don't know about switching to an EMR, Dr. Kono in your case, because I have all of this data, housed in the servers of your prior EMR. Do you find that there's particular things that you're able to track that are meaningful versus meaningless, MIP, SMAC, or all of these things that, there's a lot of arguments about that help you understand your population of patients and what your population of patients needs?

Dr. Alex Foxman: 23:59

Yeah. First, Dr. Crono is great, but there's no perfect EHR out there. We just have to be factual. So if people are listening and thinking, Oh, everything is perfect. There's no perfect system. But what Dr Crono has is a very good team behind it. Now, it wasn't always like this before, but now it's a very, very good team that listens, that wants to make changes, positive changes that makes positive changes instead of just talking about them. So there in terms of analytics informatics, there are Reports and so forth that are provided from Dr. Crono, they're not perfect, but they're getting much, much better. And what I see right now, the most exciting part about this is the use of AI in the future with analytics and looking at data before, when I was with, with centricity practice solutions, which is centricity EMR. One thing that I thought was very important is that every single field was labeled on the backend. So in other words, if you ran a report and said, Hey, Let's look at all of the vital signs for every single patient. Everything was in so little area there and you could run a report and the back end would calculate that for you. Dr. Crono doesn't have that. Dr. Crono is more like a typewritten report for all intents and purposes. But now with AI, you don't need those fields in the background. AI will actually come in. It will scrape your data will read your data and provide you that exact same information. I really believe though. It's not there today. I believe in in the next year. We're going to have a lot of integration with Dr Corona. That's going to really just blow the socks off of most people, even today of what it's going to be capable of doing.

Maryal Concepcion, MD: 25:34

And let me ask you there, are there any other things that you are, talking to the team about in terms of this would also help my patients and myself and my practice going forward that you would You know, like you said, you have the ability to talk to someone who will listen to

Dr. Alex Foxman: 25:50

I'm part of the advisory board for Dr Cronos. So we have meetings on a quarterly basis where we submit the things that we believe would would benefit Dr Crono. I always look at it from the perspective. Not to look at things that would just benefit me on a small detail level, but look at the wide range of things that things would be benefit them. And the advisory board is made up of. I think one or two dozen physicians and and others and from all different different types of specialties. All around. So it's very interesting to see who requests what? But some of the other things that really I'm interested in is a I scribing. We all just spend too much time clicking away, and if we could have more eye to eye contact, and and just talk to the patients and have an A. I scribe actually document this for us and us do some very small alterations. That is really where we're heading. And that really is going to change the, the, the relationship with the patients and the doctors. I think every patient complains that the doctor spends way too much time looking at a screen and looking at them. And I think that's very, very wrong. But I think it's going to change very, very soon. For the, for the better.

Maryal Concepcion, MD: 26:58

It's interesting because I absolutely have had patients in my own practice, but also patients of my friend's practices who have said, I just never saw the doctor's eyes when I went into, Their practice and these are the ones that I'm speaking of formerly went to corporate practices. And that that was their reason for trying for trying DPC out like they weren't necessarily sure about what it is. And they're like, Oh, you actually get a doctor to talk with you, not a doctor typing as their mouth is moving, talking to you, but they look at you. So I think this is wonderful. And I I'm really excited for people to hear another option out there in terms of, What an EHR looks like in 2024 definitely check out the link in the show notes. Check out the link on the website at my DPC story dot com and check out. The QR code on the YouTube if you're watching, schedule a free demo to try Dr. Crono out for your practice. And on that note, I want to ask a last question in terms of when a person is trying out Dr. Crono, what high level tips do you have for them to be able to evaluate? Is this the right EMR or EHR for me?

Dr. Alex Foxman: 28:07

You have to look at your workflow, which is very important. You don't want to try to put a square peg in a round hole because it's not going to work. You want to look at ease of use. You want to look at efficiency. I, for example, I complete all my notes at the point of service. So when I'm done for the day, I don't do notes. That was not the way it was with centricity. I would have an entire Patient population to deal with at the end of the day, which is very frustrating. I think you want to look at the, the clickable nature and the mobile nature of Dr Corona, which is very important and the ability to take things on the road. If you need to and the customer customizability again. You'll never know 100 percent until you're actually deep in in Dr. Corona, but they have a lot of different demo opportunities to put in a dummy patients and things like that as well. But I think once you try it out, especially the the app version on the IOS tablet, you'll see a complete difference than than what you would see with all sorts of other very large models, like epic and Cerner.

Maryal Concepcion, MD: 29:08

Thank you so much, Dr. Boxman, for joining us today and sharing your experience as a super user, of Dr. Crono.

Dr. Alex Foxman: 29:14

Thank you very much.

Maryal Concepcion, MD: 29:18

Thank you for joining us for another episode of My DPC Story, highlighting the physician experience in the world of direct primary care. I hope you found today's conversation insightful and inspiring. If you want to dive deeper into the direct primary care movement, consider joining our My DPC Story Patreon community. Here you'll have access to exclusive content, including more interview topics and much more. Don't forget to subscribe to My DPC Story on your podcast feed and follow us on social media as well. If you're able, I'd greatly appreciate if you could leave us a review. It helps others to find the podcast. Until next time, stay informed, stay healthy, and keep advocating for DPC. Read more about DPC news on the daily at dpcnews. com. Until next week, this is Mariel Concepcion.