Electronic Health Records (EHRs) software have become essential for any organization operating in the healthcare ecosystem, from health systems to startups and small practices. Any healthcare facility's efficient operation and success depend on selecting the appropriate EHR software. Clinical workflows and patient data management are streamlined, patient quality of care is enhanced, regulatory compliance can be guaranteed, and time and money can be saved with the right EHR.

Understanding the cost structures and features of various EHR systems can be overwhelming. Moreover, involving a technical team member in the decision-making process can ensure that the chosen solution aligns with both clinical and technical requirements.

With this post, I will share a detailed breakdown of the most significant features, pricing, and benefits of the top EHR systems for startups and small practices. I aim to help you make an informed decision for your company based on my expertise gained over the past years working with both startups and established organizations in the healthcare industry.

What is an EHR Software?

Electronic Health Records (EHR) software is a digital system that collects, stores, manages, and retrieves patient health information. Key features of EHR software include patient demographics, medical history, medications, treatment plans, immunization dates, allergies, radiology images, and laboratory test results. The benefits of EHR software are numerous, including improved patient care, increased efficiency, enhanced data security, and better regulatory compliance.

The Rise of Decoupled & Headless EHRs

As technology evolves, new models of EHRs have emerged to meet the diverse needs of healthcare providers, especially startups and small practices looking for flexibility and customization. Two of these models are decoupled EHRs and headless EHRs.

Decoupled EHRs 

These are systems where the front-end (user interfaces) are connected to the back-end (data and functionalities) through APIs. This model offers organizations the flexibility to choose between using the vendor's fully functional interfaces, developing their own custom interfaces, or a combination of both. This separation allows providers to customize and extend the user experience, integrating the EHR with other applications or tailoring interfaces to fit their specific care models better. By evolving and enhancing the front-end independently, organizations can maintain robust back-end functionality while avoiding the constraints of traditional EHR interfaces.

Headless EHRs 

Take this concept a step further by providing only the back-end functionalities through robust APIs, without any built-in user interface. This API-driven approach empowers developers to build completely custom user experiences for both patients and providers. Headless EHRs offer core capabilities that are out of the box while granting flexibility in designing workflows and interfaces that precisely fit the unique requirements of each practice.

Both decoupled and headless EHRs offer increased flexibility and scalability, making them the best choice for startups and small practices aiming to innovate rapidly and differentiate their services without constraints. While they may require more technical resources and development expertise compared to traditional off-the-shelf EHR solutions, the investment is worthwhile in the long run. As a digital product agency focused on the healthcare industry, we've seen how these systems empower organizations to evolve and extend their offerings while maintaining robust back-end functionality, leading to greater adaptability and sustained success.

Top EHR Software Options for Startups and Small Practices

Healthie

Overview: Healthie is a comprehensive EHR solution that includes practice management and patient engagement tools for healthcare providers and organizations of all sizes, from startups and small practices to enterprises. It offers a cloud-based, ONC-certified system that prioritizes data security, privacy, and availability, making it suitable for different healthcare specialties.

Key Features:

• ONC Certification: ✅
• Focus on Care Coordination: ✅
• Patient Engagement Tools: ✅
• Behavioral Health Integration: ✅
• Support for Smaller Practices: ✅
• Telehealth Capabilities: ✅
• Community referrals: ✅
• Customization: ✅
• HIE Integration: ✅
• Risk Stratification Capabilities: ✅
• Dyadic Case Management Capability: ✅
• EHR model: decoupled
• Pricing: includes several tiers, FREE up to 10 active clients, and then starting at $45/month (when billed annually) for +250 active clients.

Main Benefits:

• Integrated Practice Management: Healthie offers an all-in-one solution that combines scheduling, billing, charting, and telehealth services, reducing the need for multiple software systems.
• Mobile Accessibility: Healthie's mobile app allows both providers and patients to access essential features on the go, improving flexibility and responsiveness.
• Secure Patient Communication: The platform includes HIPAA-compliant messaging, allowing for secure communication between providers and patients, which enhances engagement and care coordination. 
• Insurance Billing Support: Healthie simplifies insurance billing by allowing providers to create and submit claims directly through the platform, streamlining revenue cycles. 
• Cost-Effective for Small Practices: Offers scalable solutions that grow with the practice, making it suitable for startups and small healthcare organizations.
• Customization and Flexibility: Allows practices to tailor the platform to their specific needs and existing data, improving efficiency and provider satisfaction.
• Dedicated Support and Resources: Users have access to robust customer support, including implementation assistance, training, and ongoing technical help to ensure smooth adoption and utilization of the platform.

Medplum

Overview: Medplum is an open-source healthcare platform designed to serve as a highly customizable and interoperable solution for medical practices and organizations. It offers a robust foundation for building and scaling electronic health record (EHR) systems, care coordination tools, and patient engagement features. Medplum is particularly suited for developers, startups, and organizations seeking to create highly personalized healthcare solutions without the constraints of proprietary platforms.

Key Features:*

• ONC Certification: ✅
• Focus on Care Coordination: ✅
• Patient Engagement Tools: ✅
• Behavioral Health Integration: ✅
• Support for Smaller Practices: ✅
• Telehealth Capabilities: ✅
• Community referrals: ✅
• Customization: ✅
• HIE Integration: ✅
• Risk Stratification Capabilities: ✅
• Dyadic Case Management Capability: ✅
• EHR model: headless
• Pricing: free and open-source if self-hosted

Main benefits:

• Open-Source Flexibility: Provides unrestricted access to source code, enabling organizations to build and deploy fully customized healthcare solutions without proprietary limitations.
• Highly Customizable: Supports tailored workflows, care plans, templates, and integrations, allowing practices to adapt the platform to their specific needs.
• Scalable Architecture: Accommodates both small practices and large healthcare organizations, making it a versatile choice for varying operational sizes.
• Cost-Effective: Offers free self-hosted deployment, eliminating recurring licensing fees and reducing long-term costs for healthcare organizations.
• Community-Driven Development: Benefits from a collaborative developer community, leading to continuous updates, new features, and shared innovations.
• Future-Proof Platform: Allows continuous upgrades and customization, ensuring the system can evolve alongside changing healthcare needs.
• Support for Niche Use Cases: Ideal for startups, behavioral health practices, and organizations with unique operational requirements due to their adaptable nature.

Athenahealth

Overview: Athenahealth is a cloud-based EHR platform designed to streamline operations for healthcare practices of all sizes, with a strong focus on improving care coordination and patient engagement. It provides a fully integrated suite of solutions, including practice management, billing, and population health tools, making it a popular choice for startups and small practices. athenahealth’s intuitive interface and advanced analytics capabilities help providers optimize workflows and enhance patient outcomes.

Key Features:

• ONC Certification: ✅
• Focus on Care Coordination: ✅
• Patient Engagement Tools: ✅
• Behavioral Health Integration: ✅
• Support for Smaller Practices: ✅
• Telehealth Capabilities: ✅
• Community referrals: ✅
• Customization: ✅
• HIE Integration: ✅
• Risk Stratification Capabilities: ✅
• Dyadic Case Management Capability: ✅
• EHR model: decoupled
• Pricing: starting at $140/month per provider

Main benefits:

• Integrated Practice Management: Combines EHR, practice management, and revenue cycle management in one platform, simplifying operations for busy practices.
• Advanced Workflows: The system provides customizable features like best-practice templates, macros, and accelerators, which help reduce documentation time and improve efficiency.
• Advanced Reporting and Analytics: Provides actionable insights into practice performance, helping providers identify areas for improvement and optimize care delivery.
• Mobile app: Clinicians can document encounters on the go using the athenaOne mobile app, which integrates with existing customized macros, templates, and order sets.
• Population Health Management: Enables providers to track and improve patient outcomes with powerful data-driven insights.
• High Reliability: Athenahealth's cloud-based EHR has an industry-leading 99.98% uptime, providing a stable and reliable solution for healthcare practices.

Elation

Overview: Elation is an EHR solution that supports practices by improving rather than disrupting clinical workflows. It offers a clinical-first experience, empowering primary care physicians and practices to deliver high-quality patient care. Designed for small to medium practices—including startups and independent providers. Elation provides a cloud-based, ONC-certified system focused on efficient clinical operations and a modern patient experience.

Key Features:

• ONC Certification: ✅
• Focus on Care Coordination: ✅
• Patient Engagement Tools: ✅
• Behavioral Health Integration: ❌
• Support for Smaller Practices: ✅
• Telehealth Capabilities: ✅
• Community referrals: ✅
• Customization: limited
• HIE Integration: ✅
• Risk Stratification Capabilities: ✅
• Dyadic Case Management Capability: ✅
• EHR model: decoupled
• Pricing: starting at $349/month

Main Benefits:

• Comprehensive Clinical Tools: Offers features such as real-time charting, e-prescribing, lab integrations, and seamless referrals to support high-quality care delivery.
• Patient-Centric Care: Includes a patient portal for secure communication, appointment scheduling, and access to medical records, enhancing patient engagement. Recently introduced AI Scribing to increase focus on patient care.
• Integrated Billing and Claims: Simplifies financial management with support for direct care and insurance-based practices, including CMS 1500 forms and integrated billing tools.
• Customizable Workflows: Allows for creating templates and personalized settings to fit the unique needs of individual practices.
• Dedicated Support and Resources: Provides robust customer support, including implementation assistance, training, and ongoing technical help for smooth adoption.

Special Mention: Canvas Medical (EMR)

Overview: Canvas Medical is an electronic medical record (EMR) platform offering no-code and developer-centric solutions to accommodate various user needs. For users seeking a no-code experience, Canvas provides the "Clinic" plan, which enables healthcare providers to launch and manage their EMR without requiring programming skills. Alternatively, the "Builder" plan includes developer tools for those who wish to customize and extend the platform's capabilities through coding.

Key Features:

• ONC Certification: ✅
• Focus on Care Coordination: ✅
• Patient Engagement Tools: ✅
• Behavioral Health Integration: ✅
• Support for Smaller Practices: ✅
• Telehealth Capabilities: ✅
• Community referrals: ✅
• Customization: ✅
• HIE Integration: ✅
• Risk Stratification Capabilities: ✅
• Dyadic Case Management Capability: ✅
• EHR model: decoupled & headless options
• Pricing: based on Monthly Active Patients (MAP)

Main benefits:

• Flexible Pricing Model: Canvas employs a patient-based pricing structure, charging based on Monthly Active Patients. This approach ensures that costs align with patient engagement and revenue, making it scalable for growing practices.
• Open Core Architecture: As an open-core company, Canvas provides a foundational platform that can be extended and customized. This openness encourages innovation and allows healthcare organizations to tailor the EMR to their specific needs.
• No-Code and Low-Code Capabilities: Canvas offers tools that enable users with minimal technical expertise to configure and customize the EMR. This empowers practices to adapt the system without extensive coding, facilitating quicker implementation and adjustments.
• Extensibility and Integration: The platform supports integration with various applications and services through its robust API and SDK. This extensibility allows practices to improve functionality and streamline workflows by connecting with other tools and systems.
• Developer-Friendly Environment: For organizations with development resources, Canvas offers a developer-friendly environment with comprehensive documentation and support. This facilitates the creation of custom workflows and integrations, enhancing the system's adaptability.
• Community and Support: Canvas has a community of users and developers, providing access to shared resources, extensions, and support. This collaborative environment allows for continuous improvement and innovation within the platform.

Technical Considerations for Selecting EHR Software

• Compatibility with existing systems and devices: Ensure the EHR software integrates seamlessly with your current hardware and software systems. This includes compatibility with medical devices, practice management software, and other healthcare tools.
• Data security and compliance with regulations: Choose an EHR that adheres to industry data security and privacy standards, such as HIPAA compliance. This is crucial for protecting patient data and avoiding future legal issues.
• Scalability to grow with the practice: Select an EHR that can scale as your practice grows. This includes the ability to add new users, expand functionalities, and integrate with other systems.
• User-friendliness and training requirements: Opt for intuitive and easy-to-use software, reducing the learning curve for staff. Ensure that adequate training and support are available to help your team utilize the system effectively.
• Integration with other healthcare tools and services: The possibility of integrating your EHR with other healthcare applications and services is vital for creating a cohesive digital health ecosystem. This includes lab systems, imaging tools, and telehealth platforms and services.

Conclusion

Choosing the right EHR software is key to the success of startups and small practices. As we’ve seen through this post, they enhance clinical workflows and ensure that patient data is managed securely and efficiently. When selecting an EHR, remember to consider the technical aspects such as compatibility, security, scalability, user-friendliness, and integration capabilities. 

Each of the top EHR software listed above has unique features and cost structure. It all comes down to understanding your company’s specific needs and budget when choosing the best system for your startup.

For further guidance and support in selecting the best EHR software for your private practice or startup, feel free to contact our team; we’re eager to know your organization’s challenges and which tech is the most effective to address them.