The Private Practice Software Checklist: How to Choose Without Overpaying

When you start looking for practice management software (EHR), it feels like walking into a cereal aisle where every box claims to "save you time," "grow your practice," and "revolutionize your workflow." They all look the same on the outside—sleek dashboards, smiling stock photos of therapists, and promises of simplicity. But the price tags—and the hidden ingredients inside those boxes—vary wildly.

Choosing software is one of the first big decisions a private practice owner makes. It’s also one of the hardest to undo. Migrating data from one system to another is a nightmare of CSV files, manual entry, and lost notes. You want to get this right the first time, not six months from now when you realize your "affordable" software is actually costing you significantly more in hidden fees than you anticipated.

Who this is for

This guide is for solo practitioners or small group owners who are either selecting their first EHR or feeling "feature fatigue" (and price fatigue) with their current big-box system. If you are tired of paying for features you don't use, or if you are suspicious that you might be overpaying, this checklist is for you.

What you’ll walk away with

You’ll get a comprehensive 4-point framework for evaluating software that cuts through the marketing hype. We’ll look at the real cost of ownership (including the "transaction fee trap"), the fundamental difference between cloud and local-first privacy models, the critical importance of data portability, and the one "usability test" you must run before you enter your credit card number.

The "All-in-One" Trap: Why More Isn't Always Better

The biggest trend in software marketing right now is the "All-in-One" promise. You will see ads everywhere promising that a single platform can handle your website, your billing, your notes, your telehealth, and your marketing. It sounds incredibly convenient to have just one login for your entire business life.

However, "All-in-One" often translates to "Master of None." You end up with a mediocre website builder attached to a mediocre video platform, all wrapped in a high monthly subscription that locks you in. If you decide you don't like their website builder later, you can't just switch websites easily because you would have to migrate your entire patient record system too.

The alternative approach is to build a "Best-in-Class" stack. This means using a dedicated, high-quality tool for telehealth like Zoom or Google Meet, a specialized tool for notes and administration like Soli, and a powerful platform for your website like Squarespace or WordPress. This approach is often cheaper and almost always results in higher quality tools for each specific task. Most importantly, it gives you the freedom to swap out one piece of your infrastructure without destroying the entire system.

Criterion 1: The Real Cost (Subscription vs. Transaction Fees)

Most clinicians look at the monthly price—$39, $69, $99—and stop there. That is a dangerous mistake because the real cost of an EHR is the combination of your subscription plus your transaction fees. Many platforms intentionally keep their base subscription price low to get you in the door, but they monetize your activity. They charge you for claims, for eligibility checks, for SMS reminders, or add a markup on credit card processing. This is the "Latte Effect" of software: small fees that seem irrelevant until you look at your end-of-year statement and realize you spent thousands on "usage fees."

Let's look at the published pricing of the major players to understand this model. SimplePractice, for example, uses a tiered pricing structure. The "Starter" plan might look cheap, but it often lacks essential features like calendar sync or customized templates. To get the features a standard practice needs, you are often pushed to the "Plus" plan, which can run significantly higher. If you are a group practice, the per-clinician cost can be substantial, and credit card processing fees are often non-negotiable revenue streams for the platform.

TherapyNotes generally prices their solo practice tier around $69 per month, but the hidden cost lies in transaction fees. They charge a small fee for every claim submitted, every eligibility check ran, and every ERA received. If you submit 20 claims a week, those cents add up to an extra $10 to $15 a month, every month. It’s not a huge amount, but it is effectively a tax on your growth.

Sessions Health starts at a lower price point for solo practitioners, but they often treat essential features as add-ons. Telehealth might be an extra monthly fee, and claims submissions might incur additional costs. Your low monthly bill can easily balloon once you turn on the features you actually need to do your job. Similarly, platforms like TheraNest often tier their pricing based on active clients, which effectively punishes you for growing your caseload.

Soli takes a different approach with a flat subscription model. We don't charge you to write a note, we don't charge you to schedule a client, and we don't penalize you for growing your caseload. If you use optional partner services like payment processing, those fees are transparent pass-throughs rather than profit centers for us.

Criterion 2: Privacy Architecture (Cloud vs. Local)

This is the most technical part of the decision, but it is also the most ethical one. You need to ask yourself where the data actually lives. In a cloud-based system, your client data lives on the vendor's server. They employ the security team, and they hold the encryption keys. This creates a "Honeypot" effect where hackers know that if they breach one central database, they get millions of records at once. You are relying entirely on their security team to be perfect, every single day. Furthermore, you don't really have control; if their server goes down, you can't access your notes.

In a local-first system like Soli, your client data lives on your device, such as your encrypted laptop or tablet. You hold the keys. You are responsible for your own device security using tools like FileVault or BitLocker, but you eliminate the risk of a mass cloud breach. A hacker cannot steal 5 million records from Soli because we don't have 5 million records. We don't have any records. They are all distributed across thousands of encrypted devices. To steal data from 1,000 therapists, a hacker would need to physically steal 1,000 laptops. The question you must answer is whether you want your client notes sitting in a massive database with millions of others, or locked in your own digital filing cabinet.

Criterion 3: Portability (Can you leave?)

This is the "pre-nup" of software. When you are in the honeymoon phase, you don't want to think about breaking up, but you need to know how you can get out before you get in. Many EHRs make it notoriously difficult to leave, a strategy known as "Vendor Lock-in." They might let you export a PDF summary of a chart, but not the raw data you need to import into a new system. Or they might charge you a "data export fee" or require you to manually download files one by one.

Before you buy, search their help center for "Export Data." If the answer is "Contact Support to request an export," be wary. This usually means they will try to talk you out of it or delay the process. If the answer is "You can print to PDF," that means you can't migrate the data easily, only read it. You want to find a button that says "Export All to PDF/CSV." You want a feature that allows you to click one button at any time, without asking permission, to receive everything you have ever written.

Criterion 4: Usability (The "Click Count")

Time is your most limited resource. A comprehensive system that requires 12 clicks to schedule a client is not a tool; it's a burden. Marketing videos are deceptive because they show you the happy path. They don't show you the loading screens, the dropdown menus, or the error messages.

You should apply the "3-Demo Rule." Don't just watch a video. Get a free trial and perform three specific tasks while counting the clicks and the seconds. First, schedule a recurring appointment. Ideally, this should take less than 5 clicks, but many systems require you to re-enter billing codes or location details every single time. Second, write and sign a simple progress note. Check if it is a maze of mandatory dropdowns or if you can use your own template. Third, generate a superbill. This should be a one-click action, but often you have to manually select dates or re-enter diagnosis codes. If the interface fights you on these basic tasks, walk away. You will be doing these tasks thousands of times a year, and the friction adds up to hours of your life.

Common Mistakes

One common mistake is buying for "Someday." Clinicians often think they might hire 10 people in three years, so they buy the expensive Enterprise system now. The reality is you should buy for the practice you have today and switch when you actually need to. Most solo practices stay solo or small group forever, so don't pay for a "Director Mode" dashboard you will never look at.

Another mistake is ignoring the add-ons. Signing up for a cheap plan and realizing later that telehealth, the portal, and claims are all extra costs can double your monthly bill. Finally, trusting the "Free" BAA is a risk. Just because a free tool like generic Zoom or Gmail can be compliant doesn't mean it is compliant out of the box. You usually need a paid version to get the Business Associate Agreement (BAA). Without that legal document, you are not HIPAA compliant, no matter how secure the software is.

Practical Next Steps

Start by listing your "Must-Haves." Be ruthless. Do you actually need insurance billing features if you are 100% private pay? Do you need a client portal if you do all scheduling at the end of sessions? If not, don't pay for them. Next, run the numbers. Look at your last 6 months of credit card processing and claims. Calculate exactly what that volume would cost on each platform's fee structure. The difference might shock you. Finally, try Soli. If you want a system that is flat-rate, local-first, and designed for simplicity, download our trial. See what it feels like to own your data and stop paying "usage fees" for your own hard work.

The bottom line

The "best" software isn't the one with the most features. It's the one that gets out of your way so you can focus on your clients. It's the one that feels like a quiet room, not a busy airport.

Sources

• SimplePractice Pricing: Official Pricing Page
• TherapyNotes Pricing: Official Pricing Page
• Sessions Health: Pricing & Fees
• TheraNest: Pricing Plans