Psychiatry EHR Comparison

5 years into running a small one-physician psychiatry private practice, my wife’s EMR/EHR, Luminello, sold to private equity and was shut down to force its users to transfer to its new owner, SimplePractice. The whole experience was so shady that she was forced to survey the market and pick a new EHR. So she did.

(This post is mostly written by her in the first person. You also might enjoy our last post about how to start a psychiatry private practice.)

Background

My practice is smallish (about 100 active patients at a time). It’s a combination of med management and some therapy. I’m completely out-of-network and do not bill insurance, and I was looking for an EMR that worked with my practice flow.

Overall, I was looking for an EMR with the following features:

• Easy billing: Patients can save their credit card easily, and I can easily charge them and send them a superbill.
• Efficient note-taking: I’m not into a million check boxes, I just want to write my note and have features that make it easy to copy forward old notes, bring in “snippets” or “smart phrases” for things that I say frequently, and have easy-to-use templates.
• E-prescribe
• Email-style messaging like MyChart with discrete messages and subject lines (NOT a long chat-style thread that looks like text messaging)
• Nice to have but not critical: Lab ordering and integration, vitals flowsheets, etc.

I think Luminello did most of these things well.

Things that I did not like about Luminello that I was hoping to remedy:

• No Google Calendar integration
• No built-in videoconferencing solution like Zoom
• No way to send automated text or voice reminders for appointments
• No way to send a mass message to my patients
• No way to see PMH, allergies, DX, past meds, etc from the note window (which necessitates the opening of another window for each thing)
• No way to send scripts from the note window

I was a part of the Luminello Facebook group, and they allowed reps from several companies into the group. Several of the companies below had reps in the groups, which I think swayed the narrative in the group quite a bit during this mass migration process. Everything sounded easy and amazing and straightforward in the pitch, but the reality wasn’t so rosy.

(And, no matter what, changing EMRs is a big hassle.)

We looked in-depth at Osmind, SimplePractice, Charm, PracticeQ, Valant, and OptiMantra.

We also briefly peeked at Kareo/Tebra, Elation, DocVilla, which were all more (and more expensive) than we needed. We’d previously ruled out DrCrono and PracticeFusion when we started our practice in 2019.

In the end, we chose Charm.

Osmind

I was super hopeful about this EMR because people spoke about it positively on the Luminello Facebook group, but it was missing some of the key features that I was looking for.

Pros:

• Zoom included in the price
• Calendar syncs with Google Calendar
• 45 different scales that you can send to the patient and then the results graph automatically
• You can add your logo to the top of the EHR to personalize it.
• Functioning app.
• When a patient logs in, it prompts them to do the intake form and add their credit card immediately.
• “Snippet” feature (and also a library of pre-existing snippets)
• Several features that seem very specific to ketamine clinics (…not my niche)

Cons:

• Higher cost, $269/month for the useful version of the product
• Chat style messaging
• Patients cannot create their own superbills AND there is no way to send patients their superbill through the EMR itself.
• No way to send any attachments at all (I believe they were working on remedying this.)
• The pre-made intake form they use includes questions about suicidality. The only way to disable this is to disable the whole section on psychiatric history. So if you send a new patient an invitation to join your practice in advance of your appointment, they may potentially be inputting into your EMR that they are suicidal (days to weeks before you even see them).
• Some of the features seem like overkill for a small practice like mine.

SimplePractice

SimePractice destroyed Luminello and handled that process incredibly poorly. (Ben: we wrote two posts about the needless cruelty and generic evilness, but even those didn’t cover everything, like how Luminello recently gave people refunds for unused months and then reversed the refund after the fact and then stopped responding to emails–craziness!)

When they first announced the Luminello transfer, SimplePractice–which is primarily a platform for therapists–had none of the features required for a physician practice. Since we moved on to another company, they have indeed launched e-prescribe, a lab form that is printable but not integrated, and snippets (though those are essentially unusable/useless, requiring you to scroll through a giant snippet list instead of triggering them via dot-phrases).

But you don’t necessarily have our baggage. So here is what we thought:

Pros:

• Can make a free account and check out the product
• Looks clean (and is, in fact, pretty “simple” to use)
• Intake process seems very streamlined
• Customizable forms that seem nice and easy to use
• Can send attachments back and forth (but not through the messaging feature itself)

Cons:

• At the time of our review, there was no place to even input vitals or allergies. (Now that they have e-prescribe, I am sure that there is a place for allergies at least?) When I asked about vitals, I was told I could “put that in my note if I wanted”
• No option to integrate labs
• No useful “snippet” or dot-phrase feature
• Chat-style messaging. While you can set an “away” message, there is no way to set an “auto-response.” (I cannot stress enough how much I dislike an endless back-and-forth chat thread for my practice style. I do not text my patients.)
• Patients are called clients, a vernacular that I don’t love.
• Notes don’t function like notes as you would expect from other EHRs. They’re basically just generic textboxes. You can’t even sign them; you can literally go back and make edits to notes from prior visits whenever you want (with a timestamp, yes, but…that’s sketchy).
• The ethics of the company really, really rubbed me the wrong way.

Charm

I liked it a lot and ultimately chose it. It is a little busy, but when you play with it, each page has a “customize” button that hides information that you do not need. Charm was actually the only EHR in this list that didn’t try to infiltrate the Luminello FB group.

Pros:

• Very affordable. Their pricing is based on volume, so it adds up to around $70-80/month for my practice.
• Zoom is built-in. Patients are sent the link automatically, and you can easily launch the session from the EHR itself.
• 2-way Google Calendar sync. Most other EMRs just have one way, but I love that this is 2 way, so much easier to never have a calendar discrepancy.
• Robust “snippet”/dot-phrase feature, and you can easily bulk add a list of snippets with a .csv file all at once.
• “Email style” messaging which allows for attachments. I do wish there was a way to add a specific message to the main chart with a click (which was a feature Luminello had). I have been copying/pasting important messages in dedicated notes so that they will be exported in the event I ever need to switch EHRs again in the future.
• Can make a free account and check it out risk-free.
• Can set up email, text, and voice reminders for appointments/requested labs/balance.
• My patients have loved getting an automatic text message with the Zoom link (a significant improvement over Luminello, where I did this manually).
• App for patients
• Can automate invoicing. And, after a recent update, it’s now easy to create and send a superbill when sending an invoice.
• Facesheet with meds, PMH, family history, social history, allergies, and diagnoses is open in a column/pane next to your note for easy access while writing your note.
• Additionally, you can send meds, order labs, and schedule appointments all without leaving the same patient note screen, which is a huge time saver. When I close my note everything is done.
• It’s easy to copy-forward a note
• Making templates is easy (but not always the prettiest with default styling)
• Very easy to schedule patients, add new patients, send forms–all in just a few clicks from your calendar.

Cons:

• The default dashboard is a bit full given all the features, but you can customize it to hide features that you don’t use.
• In general, the default options for just about everything are a little busy, but essentially everything can be customized to fit your style with a little work.
• The onboarding and setup/customization process isn’t always the most intuitive, but it didn’t take long to get things the way I wanted them.
• People on FB complain about customer service, which is based in India. So far they have been generally responsive to me.
• No dedicated app for doctors, and the website is not very mobile-friendly. This is probably the most annoying thing.

PracticeQ

A viable option for my practice after the demo I watched.

Pros:

• 79 dollars a month + 65 dollars a month for e-prescribe: So ~$145 a month.
• Intake process seems great (easily create chart, appointment, and choose which forms to send → then patient is prompted to add demographics, credit card, e-sign forms, and fill out intake forms in a very easy way)
• Lots of form templates available that seem easy to customize (for a relatively low fee they will also create your forms for you)
• Telehealth is included and the appointment link is easy to click on from the calendar
• Has a built-in dictation feature and a “snippet” feature
• Easy to make an invoice and when you do, the superbill is automatically created and added to the patient portal so that they may print this for themselves.
• Integrated lab ordering
• Can send as many calendar/text reminders as you want to patients (can set up to do this automatically)

Cons:

• Hybrid-looking messaging. It’s technically a chat feature, but at least it is located as a separate dedicated tab for patients and not pretending to be iMessage on your phone. It also allows attachments back and forth. It takes up the whole page, so it doesn’t really look like instant messaging and also has “autoreply capabilities.” Personally, I want discrete messages with subject lines and not an endless back-and-forth.
• I just…didn’t like the actual design and interaction model of this EHR. When it came to workflow, I really didn’t like how it looked or how many clicks it took to do things.

Valant

Also a viable option for my practice, but I also didn’t like how it felt (and the migration process was both pricey and limited to just patient demographics).

Pros:

• Email style messaging
• Note templates and snippets
• Seems easy to use and customize
• Unidirectional integration with Google Calendar
• Can require patients to put in their credit card before appointment link works
• Telehealth included
• Making invoices seems easy enough and  automatable
• I have heard that they have great customer service and that its backend is robust/helpful for group practices.

Cons:

• Really didn’t like the appearance of it, it felt…old?
• Could only migrate over demographics unless you pay $1000 per 1000 notes to migrate. Each of my patients have many pdfs, so that adds up quickly to a substantial cost.
• Default notes seem very heavy on checkboxes.

OptiMantra

I really liked my demo. There was some drama on the Luminello FB group about a sales rep being in the group and not disclosing their identity (but I had the same complaint about Osmind and PracticeQ because I didn’t realize that two of their reps were also posting, and I thought they were actual users). For OptiMantra, it turned out that this rep was actually the sister of someone high up in the company? The dynamics of all the people pitching their products were weird in general, but this one generated the biggest backfire in the group.

OptiMantra actually had all of the features that I needed, so I made an account to check it out. I was pretty overwhelmed by the time I got to that and things didn’t feel as smooth in real life as they did in the demo, so I ended up going with Charm.

Pros:

• Cost is about $130/month when you factor in eRx. You can get 25% off the base $99 forever by putting “benwhite25” in the “How did you find us?” field when you sign up.
• Can choose which credit card processor you want to integrate
• Email-style messaging
• Making a superbill is easy
• Have snippets
• Like Charm, can see patient meds, allergies, and diagnoses in a sidebar while making notes
• Can pre-set which factors will copy forward to your next note (less clicking per visit)
• Can even set what font and font size your notes will be in
• Two-way sync with Google Calendar
• Lots of really nice premade consent forms that look easy to edit (nicer than what Charm has)
• Really nice psych intake questionnaire template, which also seems really easy to edit
• Even have some built-in letter templates for things like work absences, which is really nice
• Like Epic, they have lots of “keywords”/smartphrases like “PATIENT_NAME” that can pull that variable info into a template, which is really nice for notes, forms, letters, etc.
• Easy to send patient records
• Once you are in the patient note, you can send scripts, add codes, add dx, and easily create/send superbill all from one place.
• Option for email-style messaging within OptiMantra

Cons:

• Their terrible name
• That weird Facebook drama
• When I logged in, it didn’t look quite as easy to use as the demo had seemed. Things got busy and confusing on screen.
• My biggest pet peeve is that the patient chart is essentially a pop-up: you have to keep clicking it anew each time you want to get to a different part of the patient chart and each new part is a new pop-up (I like to be “in” a patient’s chart and be able to do everything that needs to be done in as few clicks and windows as possible).

In the End…

I ended up going with Charm, and I am pretty pleased with my decision. Any new EMR you use will take several weeks to get fully used to, and I’m sure I could have gotten used to other products too.

It was a bit of a back-and-forth email-wise to get ready for my migration, but once it was done, it only took a day or two. So far my costs have been very low, and it looks like my costs will max at out around $80/month, which is significantly lower than any other EMR in the long run for my size practice.

My patients love the text links. I love the integrated Zoom and the two-way calendar integration even more than I thought I would. It took me a bit of work to make my templates and get it all set up, but now that I am, my follow-ups are much more efficient. I can do everything (prescribing, updating allergies, coding, etc) in my note and am able to keep Zoom open at the top of my page, copy forward the old note AND open up any documents or scales in a different column all on the same page.  (Hint: for Zoom, right-click the toolbar and turn on “keep on top,” re-size the window, and drag it to the top of the screen; now you’ll probably have better eye contact with the webcam and can keep charting in the background).

Billing is super easy and quick once patients save their credit cards. I can easily (and even automatically) send invoices and superbills.

Snippets are easy to use.

I like the email-style messaging but am a bit irritated that there is no way to add them to the official patient chart (meaning if I were to ever leave Charm and create a bulk download of the chart, the messages are not a part of that, only notes and documents). I wish they would add an “add-to-chart” feature.

While the design isn’t as modern as SimplePractice, I liked it better than PracticeQ, OptiMantra, and Valant. It’s worth taking a look at all of them to see which best meets your needs. Your preferences may not match mine.

If you are starting this process from scratch, Charm and OptiMantra are the two that I would investigate the most seriously. If you want to be more thorough, add in PracticeQ and Valant. I think you can skip Osmind unless you are doing a more interventional practice. I am biased against SimplePractice (see above), but it’s a product in development and you can decide if it meets your needs.

Lastly, affiliate stuff:

I (Ben) was able to secure an affiliate relationship with Charm that will get you a small $25 bonus if you sign up with this link, even for a free account to try.

OptiMantra will give you 25% off the base $99 monthly price forever (tell them I sent you), but the discount doesn’t extend to add-on options like eRx.

SimplePractice will give you two free months. While Osmind also has a referral program that can help support this site, there is unfortunately no reader incentive at this time.