Choosing an EHR for a New Private Practice: athenahealth vs DrChrono vs Kareo vs Practice Fusion
Your Electronic Health Record (EHR) system is the operational backbone of your practice — it affects how fast you can see patients, how accurately claims are submitted, how quickly you get paid, and how patients experience your practice digitally. Choosing wrong means re-implementation costs of $5,000–$20,000 and months of workflow disruption. This guide compares the four most common EHRs chosen by solo and small group practices opening in 2026, with real pricing and an honest assessment of who each system is built for.
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The Quick Answer
For a new solo practice accepting insurance, athenahealth offers the strongest end-to-end billing and revenue cycle management at a percentage-of-collections pricing model (4–7%), making it low-risk for startup practices not yet at full volume. Kareo (now Tebra) is the best mid-range option at $300–$500/month with strong billing integration for small practices. DrChrono is excellent for iPad-centric practices and has robust specialty templates. Practice Fusion is the most affordable ($149/month) and suitable for straightforward primary care, but its billing module requires a separate clearinghouse. For DPC practices, skip all four and use Elation Health or Hint Health instead.
athenahealth: Best Revenue Cycle, Highest Touch
athenahealth (athenahealth.com) charges 4–7% of collections rather than a flat monthly fee — meaning you pay nothing when you're not yet collecting. This makes it uniquely low-risk for a practice in its first 3–6 months. The platform includes a built-in clearinghouse, denial management workflows, automated patient statements, and a patient portal (athenaCommunicator). ICD-10 and CPT coding suggestions are embedded in the workflow, reducing documentation time. The downside: athenahealth requires a dedicated implementation period (4–8 weeks), and its percentage model becomes expensive once you're collecting $600K+ annually — at that point, flat-fee competitors become cheaper. Customer support is responsive but you'll need to learn their workflow structure. Ideal for primary care, internal medicine, and multi-specialty group practices that want billing managed aggressively from Day 1.
Kareo (Tebra): Best All-in-One for Solo Practices
Kareo, now rebranded as Tebra (tebra.com) after merging with PatientPop, bundles EHR, billing, scheduling, and patient engagement in one platform starting at approximately $300–$500/month for a solo physician. The billing module submits to 2,000+ payers electronically and includes a claims scrubbing tool that catches common coding errors before submission, reducing denial rates. Kareo's patient portal is solid, and the integrated telehealth module (added post-COVID) adds video visit capability without a third-party tool. E-prescribing is EPCS-certified (can prescribe controlled substances electronically, which requires DEA authorization). The weakness: Kareo's reporting and analytics are less robust than athenahealth, and the merged Tebra brand is still integrating the PatientPop marketing features — some workflows feel unfinished. Best for: solo primary care, urgent care, and small specialty practices wanting one monthly bill.
DrChrono: Best for Tech-Forward and iPad-Based Practices
DrChrono (drchrono.com) is built natively for iPad and iPhone use, making it popular with physicians who want to document in the exam room on a tablet rather than a desktop. Plans run $199–$499/month with billing add-ons available. DrChrono's specialty-specific templates are a standout feature — there are pre-built templates for 40+ specialties including dermatology, pediatrics, orthopedics, and psychiatry, reducing custom setup time. The patient portal includes online scheduling, intake forms, and e-signature for consent documents. DrChrono's billing module connects to their RCM service for an additional 4–8% of collections. The main limitation is that DrChrono's desktop web interface is less polished than its mobile experience. Best for: solo specialty practices, concierge medicine, and tech-comfortable physicians who want a mobile-first workflow.
Practice Fusion: Most Affordable, ONC-Certified
Practice Fusion (practicefusion.com) is ONC-certified and HIPAA-compliant at $149/month, making it the most accessible option for a physician on a tight startup budget. It covers core EHR functions: charting, SOAP notes, ICD-10 coding, e-prescribing (including controlled substances with DEA authorization), lab order integration, and a basic patient portal. However, Practice Fusion's billing module is limited — it generates a CMS-1500 form but requires a separate clearinghouse (like Change Healthcare or Availity) for electronic claim submission, adding $50–$150/month. Customer support is thinner than athenahealth or Kareo. Practice Fusion was acquired by Veeva Systems in 2020 and development investment has been mixed. Best for: solo primary care physicians who are budget-constrained, billing-savvy, or supplementing with a separate billing service.
EHR Implementation Checklist for Day One Readiness
Regardless of which EHR you choose, budget 6–10 weeks for implementation before seeing your first patient. Key steps: (1) Complete EHR training for yourself and any staff — most vendors offer 3–10 hours of onboarding; (2) Load your fee schedule, CPT codes, and ICD-10 favorites into the system; (3) Connect the clearinghouse and test a claim submission before going live; (4) Set up your patient portal and test the intake form workflow from a patient perspective; (5) Configure e-prescribing and apply for EPCS (electronic prescribing of controlled substances) through the DEA's CSOS program — this process takes 2–4 weeks; (6) Import any existing patient records if transitioning from another practice; and (7) Run a test day with mock patients before your first real appointments. Your EHR vendor should provide an implementation checklist — if they don't, that's a red flag about their support quality.
RECOMMENDED TOOLS
athenahealth
End-to-end EHR and revenue cycle management platform pricing at a percentage of collections. Ideal for new practices that want billing managed from day one without a flat monthly fee risk.
Tebra (Kareo)
All-in-one EHR, billing, scheduling, and patient engagement platform for independent practices. Strong billing integration and telehealth at $300–$500/month.
DrChrono
iPad-native EHR with specialty-specific templates and mobile-first design. Best for solo specialists and concierge practices with tech-forward workflows.
Practice Fusion
ONC-certified EHR at $149/month — the most affordable option for budget-constrained solo physicians needing core charting, e-prescribing, and patient portal features.
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FREQUENTLY ASKED QUESTIONS
How long does EHR implementation take for a new practice?
Plan for 6–10 weeks from contract signing to first live patient. athenahealth typically requires 8 weeks. Kareo/Tebra runs 4–6 weeks. DrChrono can be configured in 3–4 weeks for straightforward setups. Budget time for staff training, fee schedule configuration, clearinghouse testing, and e-prescribing registration — cutting implementation short is one of the most common causes of billing errors and revenue delays in the first 90 days.
Can I switch EHRs after I open my practice?
Yes, but it's painful and costly. EHR migration typically costs $3,000–$15,000 for a solo practice when accounting for data export, import mapping, and retraining time. If you're in a long-term contract (athenahealth requires 1–3 year agreements), early termination fees apply. Do your due diligence before go-live — request demos for at least 3 systems, ask for a reference call with a solo physician in your specialty who has used the system for 2+ years.
Do I need a separate billing service or can the EHR handle billing?
Most modern EHRs handle claim submission, but the depth of denial management and follow-up varies dramatically. athenahealth handles the entire RCM cycle in-house. Kareo/Tebra has a built-in billing module that requires you or staff to work denials. Practice Fusion needs a separate clearinghouse. If you lack a dedicated biller, consider athenahealth's full-service RCM or a third-party billing service (typically 6–10% of collections) — physicians trying to self-bill while also seeing patients almost always have higher denial rates and slower AR.