SimplePractice vs TherapyNotes vs TheraNest: The IT and Security Side
Behavioral health practices get less attention from software vendors than primary care, and it shows. The three systems most small practices end up choosing between — SimplePractice, TherapyNotes and TheraNest — are all built for this work. Where they differ is in the parts nobody demos: how your data leaves the system, who else can reach it, and what happens when you want to go somewhere else.
Which EHR is best for a small behavioral health practice?
For most practices under ten clinicians, SimplePractice is the easiest to run and the hardest to leave; TherapyNotes is the strongest on documentation and billing; TheraNest sits between them on price. All three will sign a Business Associate Agreement, which is the minimum bar — the real differences are in data export, integrations and how each handles telehealth.
The BAA is table stakes, not a differentiator
All three sign one. That is worth confirming in writing rather than assuming, but it does not separate them. What separates them is everything the BAA does not cover: the integrations you bolt on afterwards.
A practice signs with an EHR, then connects a scheduling tool, a payment processor, a transcription service and increasingly an AI note-taker. Each of those is a separate vendor touching patient information, and each needs its own agreement. The EHR’s compliance posture tells you nothing about theirs.
Where each one actually differs
SimplePractice
The most polished of the three and the one clinicians pick themselves. Telehealth is built in rather than bolted on. The trade-off is portability: export is possible but awkward, and practices that grow past a handful of clinicians sometimes find they have outgrown it and cannot leave cheaply. Ask about bulk export formats before you sign, not when you want out.
TherapyNotes
Stronger on clinical documentation and insurance billing, which matters if you are in-network. The interface is plainer. It tends to suit practices where billing complexity is the daily pain rather than scheduling. Support is generally well regarded, which is worth more than a feature list when something breaks mid-session.
TheraNest
Usually the cheapest per clinician, with a wider feature spread that includes group practice management. The breadth comes at some cost in depth. For a two- or three-person practice watching costs it is a reasonable landing spot; for a practice with heavy billing it can feel thin.
The questions worth asking that have nothing to do with features
- How do I get my data out, and in what format? Ask for a sample export. “You can export” and “you can export something usable” are different answers.
- Who at the vendor can see client notes? Support staff usually can, for troubleshooting. That is normal and disclosed — but you should know it rather than discover it.
- What happens to telehealth recordings? If sessions are recorded at all, where do they live, how long, and who can retrieve them.
- Does the mobile app store anything on the device? This matters the moment a clinician loses a phone.
- What is the incident notification commitment? If the vendor is breached, how quickly do you find out? Your own 60-day clock may start before they tell you.
The part most practices get wrong
The EHR is rarely where data leaks. It leaks around the edges — a spreadsheet exported for a board report, a client list emailed to a biller, an AI transcription tool a clinician connected to their calendar without telling anyone.
We ran a check on our own company’s Microsoft 365 tenant and found ChatGPT holding read access to every file we owned. Nobody had done anything wrong; someone signed in with their work account and clicked Accept. There was no alert and no expiry. It had been there for months.
Whichever of these three you choose, the thing worth doing afterwards is checking what else has quietly been granted access to the account your practice runs on.
If you would like a second opinion on that before you sign anything, we are happy to look — and we will tell you if the answer is that you are fine.
General information, not legal or clinical advice. Confirm current terms with each vendor before deciding.
