A 2026 Veradigm survey of 360 independent, physician-owned ambulatory practice leaders found that 79% consider technology very or extremely important to their ability to remain independent. Eighty-eight percent believe AI and automation could deliver at least moderate improvements in practice efficiency. At the same time, 44% cited manual work and multiple process steps as a major barrier to efficient data exchange. (Veradigm Inc.)
That combination matters.
Independent practices increasingly need technology to stay viable, but many have very little infrastructure protecting them from a technology decision that does not work out.
There may be no implementation department between the software demo and the front desk trying to use the product on Monday morning. No IT team to troubleshoot the integration. No workflow analyst figuring out why information suddenly has to be entered twice. The physician choosing the product may also be the person dealing with the consequences when it does not fit.
So maybe the question is not only whether an independent practice can afford the technology.
It is whether it can afford to get the decision wrong.
A demo shows what the product can do. It rarely shows what the practice will have to do around it.
After listening to independent physicians talk through technology decisions over the years, one thing has become pretty clear to me: the problems that matter most are often difficult to see in a demo.
A demo can show that a prescription gets sent, a patient can register, or a message lands in the right inbox. What it cannot easily show is what happens when that action becomes part of a real clinical day.
How many steps came before it? Does someone have to enter the same information somewhere else afterward? What happens when the patient uses one communication channel and the practice expected another? Can the right person see what they need without someone manually moving information between systems? Does the billing workflow still work? What does the patient now have to download, remember, or log into?
One physician described the value of watching another doctor actually use an EHR during a normal half-day rather than relying on the demo. That makes a lot of sense. You can compare feature lists forever and still miss the extra step that becomes irritating when you repeat it 25 times a day.
A demo shows you what the product can do. It rarely shows you what the practice will have to do around it.
For a healthtech company, that is both a product problem and a marketing problem. A feature can perform exactly as promised and still create a bad implementation if the practice has to build too much work around it.
The subscription price may be the easiest cost to see
Independent practices are understandably sensitive to price, but the monthly fee is only one part of what a product costs.
I have heard physicians describe choosing a more expensive system because functions like the patient portal, virtual communication, prescribing, and billing worked together. The cheaper option stopped looking quite so cheap once they considered the additional products and workflows they would need to recreate the same operation.
That changes the math.
A product that costs less but creates another inbox, another manual transfer, and several extra steps in a routine workflow can be expensive in ways that never appear on the software invoice.
The cost shows up in staff time, physician attention, duplicated work, and dozens of tiny tasks that nobody bothers putting into an ROI calculation because each one only takes a minute.
Veradigm's survey gives that problem some scale. Sixty-five percent reported that clinicians spend at least an hour a day on documentation outside patient visits, while the report repeatedly points to fragmented processes and manual effort as sources of operational strain. (Veradigm)
For a small practice, the expensive product is not necessarily the one with the highest subscription fee.
Sometimes it is the one that adds five extra steps every time someone sees a patient.
Some software eventually stops feeling like software
One finding from a recent survey of 131 practicing DPC physicians made me think differently about this.
One question asked respondents which single non-EHR tool they would keep if they could keep only one. Among the 108 physicians who answered, Spruce received 21 responses and Hint received 20, followed by OpenEvidence with 13.
I don't read that as a product ranking as much as a clue about where technology becomes infrastructure.
Communication and membership management sit directly inside the mechanics of a DPC practice. They affect how patients reach the practice, how membership is administered, how information moves, and in some cases how the business gets paid.
Once a product reaches that level of importance, replacing it is not the same as canceling an app you no longer use.
You are changing part of the way the practice runs.
And that is worth thinking about from the vendor side because every physician-facing healthtech company enters an environment that already exists. The practice already has an EHR, communication habits, billing workflows, scheduling processes, patient expectations, and usually a collection of workarounds everyone has learned to live with.
The new product does not arrive alone.
It has to coexist with all of that.
Sometimes a good technology decision simply expires
This is also why I hesitate to frame technology problems as physicians needing to make better buying decisions.
Sometimes they did make a good decision.
The practice changed.
I have heard physicians describe starting with an all-in-one platform when the practice was new because it was exactly what they needed. Money was tight, the team was small, and putting communication, membership management, inventory, or other functions in one place kept the operation simple.
Then another clinician joined. Maybe another location opened. Billing became more complicated. Messages needed to be routed differently. Reporting needs changed.
The product that had reduced complexity at the beginning eventually started creating it.
So another tool was added to solve one problem, then another to solve something else. Eventually the question was no longer whether any individual product worked. It was whether the stack the practice had accumulated still made sense as a whole.
That is not necessarily a failed implementation.
Sometimes a good technology decision simply expires.
For companies selling to independent practices, that raises a question I don't see discussed nearly as much as customer acquisition or retention: what happens when a good customer legitimately outgrows you?
Healthtech companies spend enormous energy defining the ideal customer profile. They should probably be equally clear about the point at which their product stops being ideal.
What happens when the second physician joins? What about the second location? How far can the workflow stretch before workarounds start appearing? Can the data leave easily? Will the next system be able to use it? How painful will the transition be?
A product can be exactly right for a practice today and wrong for that same practice three years from now.
That is not a reason not to buy it.
It is a reason to make reversibility part of product value.
Independent-practice buyers have to think about failure differently
A large organization can ask whether a product works.
A small practice also has to ask what happens when it doesn't.
If a core system goes down, who answers the phone? How quickly? What work stops in the meantime? Is there another way to complete the workflow, or has the technology become so central that the outage essentially becomes the workflow?
Support can sound like a secondary feature until there is nobody inside the organization standing between the technology problem and patient care.
Switching creates the same problem on a larger scale.
Physicians have described EHR changes to me as an overhaul, even when they were unhappy enough with the existing product to want out. The cancellation itself may be easy. Everything around it is not.
Data has to move. Staff have to relearn workflows they already knew how to do. Integrations have to be rebuilt. Patients may need new accounts. Forms and processes change. For a while, the practice is doing the work of caring for patients and the work of rebuilding the system it uses to care for them at the same time.
Dissatisfaction does not always create churn in healthcare software because leaving has a cost too.
The more deeply a product becomes embedded in the practice, the more important it becomes to ask not only how easy it is to adopt, but how recoverable the practice is if the decision turns out to be wrong.
Patients absorb some of the adoption cost too
There is another reason the real cost of a healthtech product is larger than its subscription price.
Patients experience the stack.
They experience the extra portal, the additional app, another password, another place where a message might appear, and the form asking for information they are pretty sure they already provided somewhere else.
I have heard physicians evaluate technology decisions from this side too. One did not want patients needing “an app for this and an app for that.” Another described the ideal workflow as one where a patient could register once and have that information move automatically into the systems that needed it instead of staff or patients repeatedly filling the gaps.
That matters because a product can reduce work without actually eliminating it.
Sometimes it just moves the work.
The physician saves a step, but the front desk gains two. The front desk saves a step, but the patient now has another account to manage. The practice gets a new capability, but somebody has to reconcile what happens when it does not communicate with everything else.
That is why I am increasingly skeptical of evaluating physician-facing technology entirely at the feature level.
The real unit of adoption is bigger than the product.
It is the product plus everything required to make the product coexist with the practice.
Small practices aren't just small enterprise customers
Independent practices may look like easier healthtech customers because there are fewer decision-makers. There is no enormous procurement process and, in a physician-owned practice, the person with the problem may have the authority to solve it.
But fewer decision-makers does not mean lower adoption risk.
Often it means the consequences of the decision are more concentrated.
If the technology creates work, the same small team absorbs it. If patients struggle with it, they hear about it. If the integration fails, someone who already has another job compensates. If the product turns out to be wrong for the practice, there may be no implementation team available to undo the decision.
That should affect how companies build and market products for this audience.
“Easy to use” is not enough.
The product has to be easy to absorb.
That includes implementation, integration, support, patient experience, the work created around the product, and eventually the ability to grow beyond it or leave it.
Independent practices are already telling us how important technology has become to their ability to remain independent. (Veradigm Inc.)
That makes the opportunity for healthtech companies enormous.
It also makes the standard higher.
A good product cannot simply solve an important problem.
It has to solve that problem without becoming the practice's next one.
When a piece rests on my own data, I say so. When it rests on someone else’s, I say whose, and whether they funded it.