Your EHR is the biggest software decision a private practice makes — it's where your notes, scheduling, billing, and client portal live, and switching later is painful. In 2026 the decision has a new axis: how good is the built-in AI?
Here's how the three EHRs therapists ask us about most stack up. (We track 14 practice-management platforms in the directory if none of these fit.)
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At a glance
| SimplePractice | Carepatron | Healthie | |
|---|---|---|---|
| Starting price | From $49/mo | Free plan; paid from ~$19/user/mo | Free/low-cost starter; scales by seats |
| Free plan | No | Yes — genuinely functional | Yes — low-cost starter tier |
| AI notes | AI Note Taker add-on (extra cost) | Built into paid tiers | Via marketplace partners |
| Telehealth | Built in | Built in | Built in |
| Insurance billing | Mature (eligibility, claims) | Included | CMS-1500, insurance billing |
| Client portal | Yes, polished | Yes, modern | Yes + programs/group care |
| Stand-out | Ecosystem maturity | Value for money | API-first flexibility |
| BAA / HIPAA | Yes | Yes | Yes |
SimplePractice — the safe default
SimplePractice is the EHR a huge share of US solo therapists and small groups already use, and its maturity shows everywhere: polished mobile app, deep insurance workflows (eligibility checks, claim filing), an enormous help ecosystem, and a client portal your clients have probably already used at some other practice.
Its AI Note Taker add-on captures in-person or telehealth sessions and drops a draft note directly into the chart — the note never leaves your EHR, which simplifies the privacy story considerably.
The catches: it's the most expensive starting point here (from $49/mo before the AI add-on), there's no free tier, and the AI notes are less specialized than a dedicated scribe like Mentalyc. You're paying for polish and ecosystem, not cutting-edge AI.
Best for: established practices that bill insurance and want everything to just work. Try SimplePractice
Carepatron — best value, best free plan
Carepatron is the fast riser. It bundles scheduling, documentation (with a huge community template library), telehealth, billing, payments, and intake forms — and its free plan is genuinely functional for a solo starter, not a crippled demo.
Paid tiers from ~$19/user/month add AI transcription and AI-assisted note drafting natively — making Carepatron one of the cheapest routes to an EHR with real built-in AI documentation.
The catches: it serves a broad health-and-wellness audience, so some mental-health-specific depth (think complex insurance workflows) trails SimplePractice, and the company is younger.
Best for: new practices, cash-pay practices, and anyone who wants modern software with AI included instead of sold separately. Try Carepatron
Healthie — best for virtual-first and growing organizations
Healthie powers many virtual-first mental health organizations, from solo practices to venture-backed clinics. Customizable charting, telehealth, group programs, payments, insurance billing, and — its real differentiator — a robust API and marketplace that lets you build custom client experiences on top. Many mental health startups quietly run on Healthie.
AI scribes arrive via marketplace partners rather than being built in, which means more choice but more assembly.
The catches: for a simple solo practice it's more platform than you need, and the best parts (API, programs, marketplace) only matter if you'll use them.
Best for: group practices, virtual-first clinics, and anyone who may need custom workflows as they scale. Try Healthie
How to decide
- You bill insurance heavily and want zero surprises: SimplePractice.
- You're starting out or watching costs: Carepatron — start on the free plan, upgrade when the caseload justifies it.
- You're building something bigger than a solo practice: Healthie.
- You love your current EHR but hate typing notes: don't switch — add a standalone scribe instead. Our AI scribe comparison covers the best ones.
Whichever you pick, confirm the BAA covers every feature you use — including AI add-ons. Our HIPAA guide explains what to check, and the full directory has pricing and HIPAA status for every tool we track.
FAQ
Can I switch EHRs without losing my notes? All three support data export/import, but migrations are always tedious — expect to run both systems in parallel for a month. This is why picking well up front matters.
Is an EHR's built-in AI note taker as good as a dedicated scribe? Usually not yet — dedicated scribes like Mentalyc and Upheal specialize harder in therapy formats. The EHR advantage is workflow: the note lands in the chart automatically with no copy-paste.
Do all three sign BAAs? Yes, all three offer BAAs as HIPAA-covered platforms. Confirm that AI features are covered under the same BAA before using them with real sessions.
What about TherapyNotes or Jane? Both are solid — TherapyNotes is a mental-health-specific stalwart and Jane is beloved for scheduling. We focused on these three for their AI trajectories; browse all practice-management tools for the full field.