When you're switching electronic health records or opening a new practice, you already know specialty fit matters. What you probably don't know yet is which of the obvious picks (TherapyNotes, SimplePractice, or Kareo) actually matches how your practice documents, bills, and runs day to day. Forty-plus EHRs compete for independent-practice dollars, and three dominate the small-practice conversation. Each one wins different practice shapes. Getting this decision right means filtering on specialty-native workflow, not feature-list bingo. This guide gives you the side-by-side across the three, plus a short list of what isn't in this comparison and why.
Why specialty fit matters more than feature lists
Small-practice owners consistently report the same pattern: demos feel smooth, but real workflows feel painful once the system goes live. The gap almost always traces back to specialty fit. A generic EHR with 500 features but no specialty-native templates costs 15 to 20 minutes per patient in documentation workarounds. That's two to three hours a day for a mid-volume practice, every day, forever.
The pattern emerges because most enterprise EHRs were designed for hospital systems and then shoehorned into clinic products. The scheduling module assumes multi-department booking. The charting module assumes 40 problem-list categories when your practice uses four. The billing module is built around inpatient charge capture rather than outpatient claims and superbills.
Specialty-focused EHRs make the opposite bet. TherapyNotes built for mental health first. SimplePractice built for behavioral health plus wellness-adjacent work like coaching, nutrition, and acupuncture. Kareo built for small primary care. That orientation shapes the product: note templates use the CPT code families you actually bill, intake forms match how your licensing board expects consent captured, billing ties claims to the payers your specialty contracts with most.
Practical test during evaluation: time a complete patient cycle, note to follow-up to superbill, end to end. If a generic EHR takes 18 minutes and a specialty-native EHR takes 8, the features that excited you in the demo don't pay back the daily penalty. For the broader framework, see our pillar guide to how to choose an EHR.
TherapyNotes vs SimplePractice vs Kareo: side by side
Here's the comparison at the level practitioners actually decide on. Current vendor terms shift often, so verify pricing and plan structure directly before signing anything. Kareo was acquired and rebranded as Tebra, which has reshaped parts of the product and support experience.
| Factor | TherapyNotes | SimplePractice | Kareo (Tebra) |
|---|---|---|---|
| Best-fit specialty | Mental health, behavioral | Mental health, coaching, nutrition, wellness | Primary care, small medical |
| Practice size | Solo to mid (1 to 20 providers) | Solo to small (1 to 10) | Solo to mid (1 to 15) |
| Pricing (per provider / month) | $49 to $74 | $39 to $99 | $80 to $160 |
| Billing integration | Native, strong on insurance panels | Native, variable performance by payer | Native, often requires Kareo Billing add-on |
| Data portability | CSV export standard | CSV export; some chart data stays proprietary | Varies by plan; some features locked |
| Specialty template depth | Deep mental-health library | Good coverage across mental health and wellness | Broad medical library |
| Support quality | Reported strong | Reported mixed post-expansion | Reported declined post-Tebra acquisition |
Support ratings come from practice-owner accounts, not formal scorecards. Data portability reflects whether you can export clinical records, billing history, and patient communications in formats that import cleanly elsewhere, not just PDF dumps. Pricing rows are directional: all three run promotions for new practices, so renewal rate plus per-feature add-ons after year one matter more than the intro number.
When each EHR wins
TherapyNotes wins when your practice is mental-health-first, 1 to 20 providers, and billing integration is non-negotiable. Specialty-template depth for behavioral-health documentation is the strongest of the three, and native billing is most effective when revenue depends on insurance panels.
TherapyNotes narrows fast outside behavioral health. Practices blending mental health with wellness or coaching hit the edges of what it templates for.
SimplePractice wins when your practice is solo or small (1 to 10 providers), you're blending behavioral health with wellness work (nutrition, coaching, acupuncture, PT-adjacent), and you want fast onboarding without an implementation consultant. Template coverage across wellness categories is the broadest of the three.
Support quality has reportedly become more variable as SimplePractice has scaled, with slower response times on billing escalations than two to three years ago.
Kareo (Tebra) wins when your practice is small medical, primary-care focused, and your workflow is broadly medical rather than behaviorally narrow. The template library covers more general-medicine scenarios than the other two.
Practice owners report declines in support responsiveness and implementation quality since the Tebra rebrand. If revenue depends on 48-hour denial resolution rather than two-week turnaround, weight that concern heavily on your evaluation calls.
A practical filter across all three: if a vendor can't supply references from practices your size and your specialty, move on. Biggest-logo and newest-logo references don't tell you how the product performs for a practice that looks like yours. If billing operations are their own question, our in-house vs outsource billing calculator scopes that adjacent decision.
Once you've scored these three against your specialty's needs, the EHR Fit Quiz runs the same framework against 40+ other EHRs to surface ones you might not have considered, in two minutes.
Matched to your specialty across 40+ EHRs. No email required.
What's not in this comparison
Several strong EHRs sit adjacent to the triad but don't fit the 3-way because their specialty focus runs narrower or broader.
Jane serves physical therapy, chiropractic, massage, and acupuncture practices, with specialty-native templating that rivals TherapyNotes' depth for those modalities. Excluded here because scope is narrower than the triad's mental-health and primary-care focus.
DrChrono is iPad-native and broadly specialty-flexible, which makes it powerful for practices that mix modalities. Excluded because it's more a configurable platform than a specialty-first EHR, which means more setup work upfront and more room to misconfigure.
AdvancedMD serves mid-market general practices, typically 15 to 50 providers. Excluded because practice shape runs larger than the solo-to-small zone where the triad competes.
Epic is the enterprise hospital standard. Excluded because it's designed for health systems, not ambulatory-small practices. Most independents that end up on Epic arrived via acquisition or affiliation, not shortlist. For certified-EHR status on any vendor you evaluate, the ONC Certified Health IT Product List is the authoritative source.
If your specialty or practice shape sits in one of those adjacent zones, the 3-way isn't your starting point. Start with the EHR built for your specific modality, then evaluate the triad as fallbacks. See also our small-practice EHR guide and practice management software vs EHR.
Conclusion
Specialty fit decides roughly 80% of this choice. Pricing, support quality, and data portability handle the rest. Between the three, TherapyNotes pulls ahead for mental-health-first practices, SimplePractice for behavioral-plus-wellness hybrids, and Kareo (Tebra) for small medical practices that want broad workflow coverage. If none of them fit your specialty cleanly, the adjacent options cover most remaining ground.
The EHR Fit Quiz runs your practice through the same specialty-fit framework used here and surfaces the handful of options worth a demo, without the 40-vendor spreadsheet.
Frequently Asked Questions
Can I migrate data from SimplePractice to TherapyNotes without losing records?
Migration is possible, but data fidelity varies by record type. Demographics and appointment history export cleanly in most cases. Progress notes and treatment plans can migrate as structured records or as PDF attachments depending on your originating data format. Billing history is the most complex: claims in progress typically must be completed in the originating system rather than migrated mid-lifecycle. Plan a 6 to 10 week overlap where both systems run in parallel during transition.
Is Kareo still a good choice after the Tebra acquisition?
It can be, with eyes open. The core product still serves small medical practice workflows competently. What has changed is support responsiveness and implementation quality, which multiple practice owners describe as worse than the pre-acquisition period. If your decision weights heavily on fast denial resolution or hands-on onboarding support, allocate extra due-diligence time to calling references. If your practice is self-sufficient on billing and you mostly need the documentation core to work, the concerns weigh less.
What's the difference between TherapyNotes and Kareo's therapy plan?
TherapyNotes is therapy-native from the ground up. Kareo (Tebra) offers a behavioral-health configuration of a general-medical product. The TherapyNotes templates, intake forms, treatment plans, and billing integrations were built specifically for mental-health practice from day one. Kareo's therapy plan is the same base product with behavioral-adjacent configurations layered on. For insurance-panel mental-health practice, that depth difference shows up in documentation speed and claim acceptance rates.
Can solo therapists use a medical EHR like AdvancedMD?
You can, and some do, but the cost per month and the product complexity are calibrated for larger practices. A solo therapist on AdvancedMD typically pays more and works harder to configure the product than a solo therapist on TherapyNotes or SimplePractice. The medical-first orientation also means behavioral-specific workflow patterns (group notes, longer session templates, sliding-scale billing) take more manual setup.
Which of these integrates best with Headway or Alma?
Headway and Alma (mental-health insurance network platforms) have documented integrations that are strongest with TherapyNotes and SimplePractice, since both platforms serve the same insurance-panel mental-health market. Verify current integration status directly with each vendor before signing, since these integrations are updated frequently and vary by state.