Choosing an Electronic Health Record (EHR)

Many people ask me for EHR recommendations. In this post, I’ll break down the pros and cons of the platforms I’ve personally used, along with other popular EHRs commonly chosen by small to mid-sized behavioral health practices.

I have extensive experience with both SimplePractice and TherapyNotes, and SimplePractice is the EHR I use in my own practice.

SimplePractice

Best suited for: Solo practitioners, counselors, and small group practices (approximately 2–10 providers) that prioritize ease of use, efficiency, and streamlined workflows

Pros:

1. Very user friendly- visually easy to navigate, very low learning curve

2. Google Calendar integration

3. Robust documentation support: Comprehensive library of templates across therapeutic modalities and specialties. Easily customizable templates for note-taking, intake/consent forms, discharge summaries, etc.

4. Fully functioning Mobile app: Allows for dictating notes for documentation

5. All-in-one platform: scheduling, charting, billing, client portal, and telehealth in one system.

6. Client portal for messaging and telehealth access.

7. Online appointment requests

8. Free (basic) website with all paid subscriptions

Cons:

1. Expensive compared to other EHR platforms with high credit card transaction fees.

2. Pricing structure can be complex as add-ons increase total cost of your subscription

3. Non-existent phone support: you must submit a support ticket in order to have contact with a support agent.

4. Secondary insurance claim submission can be tedious and confusing.

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TherapyNotes

Best suited for: Solo practitioners and small to mid-size behavioral health practices looking for a solid, reliable, clinical-first EHR with excellent support.

Pros:

1. Excellent customer support with multiple options (phone, email, knowledge base).

2. Designed specifically for behavioral health providers.

3. All-in-one platform: scheduling, charting, billing, client portal, and telehealth in one system.

4. Patient portal allows appointment requests, form completion, and secure communication.

5. Complex billing overrides: Default service codes and modifiers for specific payers which makes coding claims easier.

6. More cost-efficient than SimplePractice: with lower credit card processing fees

7. Strong clinical documentation tools: Comprehensive library of templates across therapeutic modalities and specialties. Customizable templates for note-taking, intake/consent forms, discharge summaries, etc.

Cons:

1. No mobile app

2. Admin functions like bulk editing, multi-location scheduling, and advanced practice management features are limited, making it less ideal for larger or fast-growing practices.

3. Some advanced features (e-prescribing, AI tools, full billing services) can add significant cost on top of the base subscription

4. Confusing claims submission workflow: Claims that are unpaid, pending, rejected, or already submitted often appear together as “needing submission,” making it difficult to quickly distinguish which claims truly require action versus those awaiting payer adjudication. This can lead to extra manual review and follow-up tracking, especially for insurance-heavy practices.

5. User reports of connectivity and stability issues with telehealth

Ensora (formerly TheraNest)

Best suited for: 

Pros:

1. Built for mental/behavioral health: Purpose-built workflows for therapy documentation, scheduling, and practice management.

2. All-in-one platform: Combines EHR, scheduling, billing, secure messaging, and client portal in a single system.

3. Client engagement features: Online scheduling, automated reminders, intake forms, and a client portal help reduce administrative workload.

4. Performance issues reported: Occasional lag, slow load times, or system quirks can interrupt day-to-day workflow.

5. Value concerns for long-term users: Some practices feel pricing has increased without corresponding improvements in usability or support.

6. Flexible documentation tools: Includes a solid library of note templates and customizable forms for different modalities and practice styles.

7. Flexible pricing structure: Tiered pricing can be attractive for newer practices or part-time clinicians compared to some higher-priced competitors.

Cons:

1. Mixed customer support experiences: Some users report slow response times or less personalized support, especially after the transition to Ensora.

2. Pay more for HIPPA complaint messaging

3. Billing and insurance workflows can feel clunky and not easy to navigate: Claim submission, payment tracking, and insurance workflows are not as streamlined as more billing-focused platforms.

4. Interface can feel dated or inconsistent: Some areas of the UI feel less polished compared to newer, design-forward EHRs.

5. Client portal limitations: While functional, the portal is sometimes seen as less polished or intuitive compared to platforms like SimplePractice.

Valant

Best suited for: Practices that want a comprehensive, behavioral health-focused EHR with strong reporting, outcome measurement, and integrated workflows across scheduling, billing, and clinical care.

Pros:

1. Built specifically for behavioral health: Designed to support therapy, psychiatry, and counseling workflows with industry-relevant features rather than being a generic medical EHR.

2. Integrated all-in-one platform: Combines scheduling, clinical documentation, billing, patient portal, telehealth, and outcome measures into a single system, reducing the need for multiple tools.

3. Patient/Clinician Matching Integrated Software- patient completes intake form and system matches them with an appropriate therapist

4. Multiple automations within the EHR

5. Cloud-based accessibility: Accessible across devices (Windows, Mac, etc.) and supports remote work.

Cons:

1. No free trial- have to request a demo

2. Steep learning curve: Many users report that the system can be complex to learn initially, especially without dedicated training or support.

3. Overkill for small practices: The breadth of features may be more than what solo or very small practices need, making it feel heavy or complex.

4. Interface and usability complaints: Some users describe the interface as clunky, outdated, or overly complex for routine tasks.

5. Mobile app: not great user reviews

6. Pricing opacity & cost concerns: Valant doesn’t publish transparent pricing, and quotes can be higher than expected for smaller practices.

CharmHealth

Best suited for: small to mid-sized outpatient practices—especially solo or small group providers—seeking an affordable, cloud-based EHR with integrated scheduling, billing, and customizable templates without heavy IT demands.

Pros:

1. Affordable pricing for small practices: Offers a free plan for low-volume use and pay-per-encounter pricing that can be cost-effective for early solo practices

2. Google calendar integration

3. Integrated tools: EHR, scheduling, billing, patient portal, and RCM are integrated in one system.

4. Customization: Custom templates for notes/forms.

5. User-friendly: Easy to learn and navigate for clinicians who aren't tech savvy.

Cons:

1. Not designed specifically for behavioral health providers: While usable for many types, it’s more generalist and may require custom setup for therapy-specific documentation

2. Additional costs for add-ons: appointment reminders for patients are an additional cost per reminder sent, telehealth, and e-prescribing.

3. Mixed reviews on customer support: Limited or inconsistent support

4. Variable integration quality: Some integrations (e.g., labs like Quest) can be tricky to configure or troubleshoot.