The best EHRs for small and independent practices

Checked Oct 24, 2026As of October 2026, CharmHealth EHR scores highest for small practices (92/100), then eClinicalWorks (88) and SimplePractice (80). Scores reward a published price, a lower price per provider, documented core and AI features, and an ONC certification listing. Most EHRs here are quote-only, which costs them points. This is a formula applied to published facts, not a hands-on test, so a lower score can still be the better fit for your practice.

Scores out of 100 (each bar split by criterion)

CharmHealth EHR92
eClinicalWorks88
SimplePractice80
TherapyNotes80
Practice Fusion77
AdvancedMD60
DrChrono60
Elation Health60
Tebra60
athenaOne55
ModMed EMA55
NextGen Office55

Published pricePrice per providerCore featuresAI featuresONC certification

How we ranked them

Each tool gets up to 100 points, calculated from the published facts on its profile page.

Criterion	Points	How it's scored
Published price	25	25 if the base price per provider is on the vendor's site, 0 if it's quote-only
Price per provider	15	Full points at $100 a month or less, falling to zero at $600; quote-only scores 0
Core features	25	5 points each for e-prescribing, telehealth, patient portal, billing and claims, and a mobile app, where documented
AI features	15	15 if the vendor documents AI features such as an ambient scribe, 0 if not
ONC certification	20	20 if the product has an ONC Health IT certification listing (needed for some federal programs), 0 if not

The ranking at a glance

#	Tool	Score	Published price	Price per provider	Core features	AI features	ONC certification
1	CharmHealth EHR	92	25/25 Provider Plan: $200/mo	12/15 $200/mo	20/25 e-prescribing, telehealth, patient portal, billing	15/15 documented	20/20 listed
2	eClinicalWorks	88	25/25 EHR Only: $499/mo	3/15 $499/mo	25/25 e-prescribing, telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed
3	SimplePractice	80	25/25 Starter, solo clinician: $49/mo	15/15 $49/mo	25/25 e-prescribing, telehealth, patient portal, billing, mobile app	15/15 documented	0/20 no active listing found
4	TherapyNotes	80	25/25 Solo: $69/mo	15/15 $69/mo	25/25 e-prescribing, telehealth, patient portal, billing, mobile app	15/15 documented	0/20 no active listing found
5	Practice Fusion	77	25/25 Practice Fusion EHR: $199/mo	12/15 $199/mo	20/25 e-prescribing, telehealth, patient portal, billing	0/15 none found	20/20 listed
6	AdvancedMD	60	0/25 quote only	0/15 quote only	25/25 e-prescribing, telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed
7	DrChrono	60	0/25 quote only	0/15 quote only	25/25 e-prescribing, telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed
8	Elation Health	60	0/25 quote only	0/15 quote only	25/25 e-prescribing, telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed
9	Tebra	60	0/25 quote only	0/15 quote only	25/25 e-prescribing, telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed
10	athenaOne	55	0/25 quote only	0/15 quote only	20/25 telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed
11	ModMed EMA	55	0/25 quote only	0/15 quote only	20/25 telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed
12	NextGen Office	55	0/25 quote only	0/15 quote only	20/25 telehealth, patient portal, billing, mobile app	15/15 documented	20/20 listed

The picks

CharmHealth EHR

Highest score overallProvider Plan: $200/mo

92/100

Best for: Practices wanting free or usage-based EHR pricing with a native AI scribe available as an add-on.

What works

A free plan covers 1 provider, up to 50 encounters per month.
Encounter Plan charges $0.50 per encounter with a $25 monthly minimum, so cost follows volume.
Charm AI Scribe Plan 2 charges $2 only for encounters where the scribe is used.
REST APIs and FHIR API documentation are available by request form.

Watch for

Provider Plan is $200 per provider per month before add-ons and tax.
Unlimited AI scribe costs $125 per provider per month on top of the base plan.
eRx, EPCS, PDMP and telehealth are priced separately from the base plan.
Contract length, cancellation terms and Provider Plan bundle contents are not published.

eClinicalWorks

EHR Only: $499/mo

88/100

Best for: Independent practices wanting one vendor for EHR, practice management, billing service and an in-house AI scribe.

What works

Published monthly prices: $499 per provider for EHR Only, $599 with Practice Management.
Data migration from an existing EHR is free, and published plans say no start-up costs.
Offers its own ambient scribe, Sunoh.ai, plus several other AI tools in the same ecosystem.
Patient portal is included in all published plans.

Watch for

Contract length and cancellation terms are not published.
Sunoh.ai is sold separately at $149 per user per month, for a limited time.
No start-up costs and training covered for 1 to 9 providers; larger practices pay extra implementation fees, and airfare is billed separately.
The iOS app, eClinicalMobile, averages 3.35 stars across 3,387 ratings.

SimplePractice

Top pick for therapy practicesStarter, solo clinician: $49/mo

80/100

Best for: Solo or small therapy and behavioral health practices wanting scheduling, billing, telehealth and a client portal in one tool.

What works

Client Portal and telehealth are included in every plan.
30-day free trial and no setup fee on plans.
Cancel any time in Settings, with no minimum term stated.
Clinician app rates 4.72 from 33,999 ratings on the Apple App Store.

Watch for

AI Note Taker costs an extra $35/month per clinician on top of the plan.
No active ONC certification listing found in the CHPL search.
ePrescribe is an add-on at $49/month plus an $89 setup fee per clinician.
Cancellation is immediate and unused time is not prorated or refunded.

TherapyNotes

Solo: $69/mo

80/100

Best for: Behavioral health practices of any size that want billing, portal and optional AI notes in one system.

What works

30-day free trial with no credit card required and no long-term contract.
No signup fee, and client data import from another EMR is free.
Client portal and Basic Telehealth are included with every plan.
Solo plan starts at $69/month for one user.

Watch for

The AI add-on, TherapyFuel, costs an extra $40/month per clinician.
The mobile app has a 2.73 average rating from 40 App Store ratings.
No active ONC certification listing found in the CHPL search.
The billing-services fee and annual billing terms are not published.

Practice Fusion

Practice Fusion EHR: $199/mo

77/100

Best for: Independent or small practices new to EHR or switching, wanting a cloud EHR with e-prescribing.

What works

E-prescribing includes EPCS in 50 states plus DC, prior authorization management and e-coupons.
Complimentary 2-week trial lets a practice test the EHR before committing.
EHR pricing starts at $199 per provider per month, published on the vendor site.
Current ONC certification, version 3.7, dated 2024-08-26.

Watch for

Required annual commitment applies to the EHR plan.
No Practice Fusion AI features found. Commure, Freed and Sunoh.ai list it as an EHR they work with.
Percentage fee for Billing Services is not published.
Implementation fee for the EHR-only plan is not published.

AdvancedMD

Quote only

60/100

Best for: Independent or group practices wanting EHR, practice management, billing and AI note-taking from one cloud vendor.

What works

AI Clinical Assistant covers ambient transcription, pre-visit summaries and action items within the suite.
Patient portal, telehealth and ePrescribing with EPCS are part of the product line.
Integration Marketplace, AdvancedBiller Marketplace and an Open API support outside connections.
Version 25 holds an ONC certification dated 2025-12-15.

Watch for

No dollar prices are shown; bundle pricing requires contacting sales.
AI Clinical Assistant is desktop only for now; mobile and telehealth are coming soon.
Revenue Cycle Management is quote-only and the percentage of collections is not published.
Implementation fee, contract term and cancellation terms are not published.

DrChrono

Quote only

60/100

Best for: Independent practice owners wanting a mobile-first cloud EHR with built-in billing, telehealth and an optional AI scribe.

What works

Telehealth is built into the EHR and listed in all three plan tiers.
Patient Portal and App come with every plan.
Open REST/OAuth API and a Marketplace allow third-party integrations.
The iOS app averages 4.4 from 3,731 Apple App Store ratings.

Watch for

No prices are published for any plan; all three require contacting sales.
The EverHealth Scribe costs extra on Foundation and Growth, and is included only in Premium.
Per-claim, per-check and over-limit text, fax and call fees can add to the base price.
Contract length, cancellation terms and outsourced billing percentage are not published.

Elation Health

Quote only

60/100

Best for: Independent primary care practices wanting an EHR with built-in billing and native AI documentation tools.

What works

Note Assist AI scribe is native, with AI letters, referrals, form extraction and claim review.
EHR and billing sit on one unified platform, with AI Billing reviewing claims before submission.
Developer platform documents API, HL7 and FHIR, and a Partner Hub exists.
Telehealth is built in through Elation Telehealth, powered by Zoom.

Watch for

No list prices are published. Pricing requires contacting sales.
Contract auto-renews yearly unless written notice is given 60+ days before renewal.
Elation Go has a 1.31 average rating from only 13 Apple App Store ratings.
Implementation fee amount is not published and is set when the agreement is signed.

Tebra

Quote only

60/100

Best for: Solo to midsize independent practices wanting an EHR with built-in billing, telehealth and a native AI scribe.

What works

AI Note Assist is a native scribe inside the EHR and also suggests diagnoses and ICD-10 codes for review.
Tebra says no RCM contract is required: keep billing in-house, use a billing partner, or outsource.
Unlimited non-clinical staff at no extra cost; pricing counts prescribing providers only.
Integrated telehealth is included in the Practice Essentials bundle.

Watch for

No list price is published for any plan; pricing requires a personalized quote.
The Apple App Store average is 1.81 from 247 ratings.
The implementation fee amount is not published, and pricing depends on implementation requirements.
Which AI tools need which plan or add-on, and what they cost, is not stated.

athenaOne

Quote only

55/100

Best for: Ambulatory practices that want one cloud system covering EHR, billing operations and patient engagement, with a built-in AI scribe.

What works

Billing and collection operations come bundled with the EHR through athenaCollector.
Native athenaAmbient scribe drafts notes, diagnoses, orders and prescriptions, listed "at no additional cost".
Telehealth is built into athenaOne and its mobile app.
Current ONC certification for athenaClinicals v26, dated April 2026.

Watch for

Pricing is not published and is reported to be tied to collections, so cost is hard to compare.
Implementation fee and contract length are not published.
athenaAmbient entered user testing in February 2026 and Sage was in limited release when announced; check current availability with athenahealth.

ModMed EMA

Quote only

55/100

Best for: Specialty practices in one of the 11 supported fields that want an EHR with native AI scribe and billing options.

What works

ModMed Scribe is native, so no third-party scribe partner is needed.
Certified FHIR API with SMART on FHIR, plus a proprietary API and HL7 options.
Patient Engagement bundles portal, two-way messaging, digital intake, online scheduling and telehealth.
Dedicated implementation teams provide practice-specific training and ongoing support through ModMed Client Services.

Watch for

No list prices are published; every practice needs a custom quote.
RCM Services is sold separately, and its fee percentage is not published.
Contract length, cancellation terms and EPCS support were not confirmed.
PocketEMA averages 2.2 stars from 60 App Store ratings.

NextGen Office

Quote only

55/100

Best for: Independent practices under 10 providers wanting one cloud system for EHR, practice management and billing, with ambient AI notes.

What works

NextGen Office combines EHR, practice management, billing and an embedded patient portal in one cloud platform.
Ambient SOAP notes and order suggestions come from NextGen's own Clinical AI, not a separate scribe vendor.
Telehealth visits are integrated with the EHR, practice management, mobile and portal.
NextGen Enterprise 8 holds ONC certification, dated June 2, 2025.

Watch for

No price is published for NextGen Office. Practices must contact sales for a custom quote.
The plan or add-on needed for Clinical AI, and its price, is not published.
Implementation fee amount is not published.
Contract length, cancellation terms and EPCS detail are not published.

What is the best affordable EHR for a small practice?

Among EHRs that publish a price, the lowest base prices are on the therapy side (SimplePractice from $49 a month, TherapyNotes from $69 a month). For medical practices, the published per-provider prices are CharmHealth EHR at $200, eClinicalWorks at $499, Practice Fusion at $199. Everyone else quotes, so ask at least two vendors for a written quote that includes setup, e-prescribing, claims and any AI add-on.

Should the EHR include an AI scribe?

Several EHRs now sell or include their own AI scribe; the EHR table lists each one with its price where published. A separate scribe can also connect to many of these EHRs. Compare both in the EHR integration matrix before you pay for an add-on.

Last checked Oct 24, 2026. Every figure links to the page it came from (see Sources). Found something out of date? Tell us. How we pick and rank: methodology.