Best EHR for Psychiatry and Prescribing Practices (2026)

If you prescribe, the EHR has to carry controlled substances, not just notes. Ona puts EPCS, an ambient scribe, telehealth and the whole chart in one subscription at $200 per prescriber per month, with no setup fee. TherapyNotes and JotPsych both come in cheaper, JotPsych by a wide margin, ICANotes and Osmind cost more, and Valant publishes no price.

Quick answer:

• What you are actually buying: EPCS for Schedule II-V with DEA-compliant two-factor, identity proofing done once, a refill queue, interaction and allergy flags at the moment of signing, a licensure check against the patient's state, and staff who can draft a script for you.
• What one prescriber costs, checked in September 2026 on each vendor's own pricing page. Seat plus prescribing: JotPsych from $69 for JotRx alone with no plan seat, $115 on Moonlighting plus JotRx with a 15-note monthly cap, or $197 on Basic plus JotRx for unlimited notes; TherapyNotes $134; SimplePractice $148 plus $89 once; Ona $200; ICANotes $213 plus a $99 activation fee; Osmind $298; Valant not published. All-in, adding each vendor's own AI documentation and video because Ona carries both in the seat: TherapyNotes $189, SimplePractice $207, ICANotes $282, Osmind $298, Ona still $200.
• Where Ona fits: prescribing practices that want the note, the video visit and the money on the same record, and that do not need scores charted across visits.

What changes the moment you prescribe

A therapy practice can run on documentation software. A prescribing practice cannot, and the reason is that the DEA has opinions about your software.

EPCS is not a checkbox. It is a certified path: your identity gets proofed against a federal standard, your signing gets a second factor that is not a password, and every controlled-substance transaction gets a tamper-evident log that survives a subpoena. Vendors that offer it either built it or embedded someone who did. Vendors that do not offer it will sell you everything else on the tour and leave that slide out.

So the buying question is narrower than "which EHR is best for behavioral health". It is: which system carries a controlled substance from your chart to the pharmacy without you opening a second application, and what does the rest of the practice cost once that is switched on.

Ona is a general ambulatory EHR that scales from solo clinics to enterprise systems. Psychiatry and prescribing practices are one of the segments it serves, not the whole of what it is, and this piece is about that segment specifically. The behavioral health page covers the wider category.

The six things to test on a prescribing demo

Ask for these six by name. Any vendor worth buying will show you all six inside twenty minutes.

1. EPCS for Schedule II-V, signed with real two-factor. Push notification or hardware token, not an emailed code. Ona routes controlled substances through DoseSpot's EPCS with DEA-compliant two-factor, push or hardware token, and keeps a tamper-evident log of prescriber, substance, timestamp and location.

2. Identity proofing handled once. Federal identity proofing is a chore. It should happen at onboarding and then never interrupt you again. In Ona it is completed once at onboarding.

3. Interaction and allergy flags before signing, not after. A flag that arrives after transmission is a liability notice, not a safety feature. Ona shows known interactions and allergy contraindications before you sign, with severity and a cited source, and leaves the clinical call to you.

4. A refill queue in the same inbox. Pharmacy refill requests should land where new prescriptions live, so you can approve, deny, modify a dose or convert to a new script in one pass. That is how Ona handles them.

5. A licensure check against the patient's state. Multi-state telepsychiatry is where good practices get into trouble. Ona checks active licensure against the patient's state at signing and warns you up front. Cross-state compliance is still yours to own, and Ona says so plainly.

6. Delegated drafting with both names on the audit trail. Front-desk staff and nurses preparing drafts for a clinician to review and sign is the difference between a twenty-minute refill block and a two-hour one. Ona supports it and records both roles.

One more to ask about rather than assume: a Prescription Drug Monitoring Program lookup. Ona's e-prescribing page does not describe a PDMP check, and SimplePractice lists a PDMP registration fee as a separate charge in its pricing footnotes. If your state mandates a check before you write, put that question on the demo agenda and get the answer in writing.

What a prescriber actually costs, platform by platform

One axis only: how much of a prescribing practice's day a single subscription covers - the chart, the note, the controlled substance, the video visit and the money - before you add a second vendor. This is a coverage ranking, not a quality ranking, and a narrow practice is often better served by a narrower product. Every price below was read off the vendor's own pricing page in September 2026.

Coverage order	Platform	What one subscription covers for a prescriber	Current limits	Published price for one prescriber: seat plus prescribing, then all-in
1	Ona	Charting, ambient scribe, telehealth, scheduling, intake, consents, patient portal, invoicing and the insurance and eligibility workflow are in the seat; e-prescribing and EPCS are the two add-ons; AI receptionist on top, and a clearing house plan for the claims, ERAs and eligibility checks themselves	Scores are not charted across visits; telehealth is 1:1; no SMS or push reminders; browser only, no native apps; human support is business hours; no third-party security certification published	$130 seat + $45 e-prescribing + $25 EPCS = $200/mo seat plus prescribing, and $200 all-in because the ambient scribe and telehealth are already in the seat; 10% off annually, no setup fee; Ona Clearing House from $69/mo if you bill insurance
2	JotPsych	Notes, e-prescribing and medication management in the note including EPCS, scheduling and telehealth; billing, RCM and credentialing are sold as separate services; states it works with any EHR or replaces it	Prescribing, auditing and video are separately priced modules below the top tier; the $53 Moonlighting tier caps you at 15 notes a month; billing is priced apart from every plan, including Everything; groups of 7 or more clinicians get 10% off any plan, and switching takes 20% off if data starts moving within 30 days of the proposal	JotRx alone $69/mo with no plan seat for a physician who only prescribes; Moonlighting $53 + JotRx $62 = $115/mo capped at 15 notes; Basic $135 + JotRx $62 = $197/mo; add JotMeet $26 for video and Basic plus JotRx is $223/mo all-in; Everything $269/mo adds JotAudit and JotMeet
3	Osmind	Interventional psychiatry EHR with automated SPRAVATO REMS submission, lab ordering and a billing network	EPCS and labs priced on top of the EHR; two of three plans are a percentage of collections that is not published	Osmind One $249 + EPCS $49 = $298/mo seat plus prescribing, and $298 all-in because telehealth is included and the AI scribe is listed as coming soon and not priced on Osmind One; labs $15/mo per provider, REMS $4 per submission
4	TherapyNotes	Notes, scheduling, basic telehealth, client portal, medication history and formulary checks, EPCS at no additional fee, 24/7 phone and email support	Electronic claims, ERAs and eligibility requests billed at 14 cents each; reminders 14 cents per text or call; psychiatry note generation listed as still to come	Solo $69 + ePrescribe $65 = $134/mo seat plus prescribing; add TherapyFuel $40 and Premium Telehealth $15 and it is $189/mo all-in, or $199 in a group where the first clinician is $79
5	ICANotes	Behavioral health documentation on pre-configured clinical templates, with a dedicated prescribing plan	$99 activation fee; three-month commitment; telehealth and AI scribe are per-user add-ons; claims, statements and text reminders quoted by sales	Prescribing $213/mo + $99 activation, seat plus prescribing; add AI Scribe $49 per user and Telehealth $20 per user and it is $282/mo all-in; non-clinical users are free for the first and $25 each after
6	SimplePractice	Broad practice management with client portal, telehealth and progress notes in the plan; ePrescribe bolts on	ePrescribe carries an $89 one-time setup fee and a separate PDMP registration fee; confirm controlled-substance coverage before you commit; insurance filing priced per claim	Plus $99 + ePrescribe $49 = $148/mo seat plus prescribing, plus $89 once; add Care Aide $59 for the account owner and it is $207/mo all-in, telehealth being in every plan; Note Taker alone $35
7	Valant	Behavioral health EHR built around psychiatric practice, including intensive outpatient and partial hospitalization programs	No published price; every figure comes after a contact form and a call with a specialist	Not published

Two figures per vendor, because one number cannot answer this honestly. The first is the seat plus whatever that vendor charges to prescribe. The second is all-in: the same seat with that vendor's own AI documentation and video added, because Ona carries the ambient scribe and telehealth inside the $200 rather than metering them, and a comparison that leaves them out is not a comparison. Our behavioral health pricing comparison prints the same two numbers for the same vendors.

Two honest readings of that table. First, Ona is not the cheapest headline number and we are not going to pretend it is. On the seat plus prescribing, TherapyNotes at $134 and SimplePractice at $148 both start lower and JotPsych undercuts Ona on all three of its published prescribing paths. All-in, TherapyNotes at $189 stays below Ona and SimplePractice at $207 moves above it. A supervising or collaborating physician who only prescribes takes JotRx alone at $69 a month with no plan seat. A prescriber who can live inside 15 notes a month pairs Moonlighting at $53 with JotRx at $62, so $115. A full-time prescriber on unlimited notes is Basic at $135 plus JotRx at $62, so $197 against Ona's $200. On the seat plus prescribing, JotPsych wins that row. Add JotMeet at $26 for video visits, which Ona includes, and Basic plus JotRx plus JotMeet is $223.

Second, and this is the reading that decides it, the two products are strongest at different things. It would be easy and wrong to say JotPsych is a bill that arrives on top of a chart you already pay for. Its own page says "Works with any EHR. Or replaces it entirely", and it is genuinely bought both ways: as a layer over a record a practice is keeping, and as the whole system. So the sums are comparable, and the question is what each one is built to do well.

Ona's $200 buys breadth on one record: chart, ambient note, 1:1 video visit, scheduling, intake, consents, patient portal, invoicing and the insurance and eligibility workflow, with e-prescribing and EPCS switched on. The AI receptionist and the claim cycle run on that same record rather than on a second vendor, priced apart as usage: an Ona Clearing House plan from $69 a month if you bill insurance, and the AI receptionist from $100 a month for 400 minutes if you want the phone answered.

JotPsych's money buys depth in one clinical world. It is behavioral health documentation and billing defence: notes written to survive the audit, payer documentation rules checked against every signed note, and coding and audit risk surfaced before you sign rather than after a denial. Nothing in Ona does that. The rest of the practice is priced apart: video visits are JotMeet at $26 a month, unlimited note auditing is JotAudit at $62, and billing sits outside every plan including the $269 Everything bundle, at $179 per clinician a month self-serve or 6 percent of insurance collections with a $299 monthly minimum.

So the comparison that matters is not $115 or $197 against $200. It is what is most likely to be wrong in your practice. If the denials and the downcodes are the problem, buy the product built to fight them. If you are paying for a record, a scribe, a scheduler, a video tool and a phone line separately, buy the one record wide enough to hold all of it.

Where Ona's $200 stops being the whole story is insurance. Claim submission runs through Ona Clearing House, which starts at $69 a month for 100 claims, 100 ERAs and 200 eligibility checks, with unlimited providers and payer enrollments on every plan and no separate account to open. Cash-pay practices skip it entirely. Price that in before you compare.

How the prescribing workflow actually runs in Ona

The reason to put prescribing inside the record rather than beside it is that the medication list stops being a document you maintain.

A visit is recorded with the patient's consent and the ambient scribe drafts a structured note against your own template - SOAP, DAP, BIRP, or one you build. Nothing leaves the chart until you sign it. The dispensary sits on the same patient record, so the script goes out from inside the note you are already writing, and the structured medication list updates the moment it transmits. Refills come back to the same queue.

Telehealth runs in the browser on LiveKit, opened from the consultation with one click. Patients join from an emailed link with no account and no app, which matters more in psychiatry than in most specialties, because the appointment that gets kept is the one with the least friction in front of it. Visits are 1:1 today.

Screening forms are honest about their scope. Ona ships PHQ-9 and GAD-7 with canonical scoring, 0 to 27 and 0 to 21, all severity bands, and a preconfigured critical flag when item 9 is answered above "Not at all". Scores are clinician-only; the patient fills in an ordinary form and never sees a number.

On the money side, insurance eligibility runs in real time against major national and regional payers with co-pay, deductible and out-of-pocket maximum landing on the chart before the session, and claims generate from the signed note into a pre-filled CMS-1500. Medicare and Medicaid are supported for eligibility and claim submission.

Where Ona is not the right answer

Say the uncomfortable part out loud, because the fastest way to waste a quarter is to migrate into the wrong system.

Ona scores PHQ-9 and GAD-7 on the form and stops there. Ona's own help page states there is no cross-patient reporting and no charting of scores across visits yet, so each result lives on its own form. If charting instrument scores across a course of care is central to how you practise or how you get paid, vendors that build around structured psychiatric rating scales will serve you better today, and you should buy for that rather than hope.

Ona also publishes no statement about 42 CFR Part 2. If you run a substance use disorder program covered by Part 2, that is a hard requirement and you should look at vendors built around it.

Everything else in the limits column is real too: telehealth is 1:1, so no group visits; there are no native mobile apps, the workspace and the patient portal are mobile-friendly web; appointment reminders are booking confirmations by email rather than timed SMS cadences; human support is an in-app chat and email team working primarily business hours, where TherapyNotes advertises 24/7 phone support; and Ona publishes HIPAA compliance and a BAA with every workspace but no third-party security certification and no uptime figure. If procurement needs a certificate, ask before you trial, not after.

Who should buy what

Buy Ona if you want one record from the first phone call to the paid claim, with the scribe and the video visit already in the seat, and you would rather add e-prescribing and EPCS as two clean line items than assemble a stack. It suits prescribing practices at any size, from a solo psychiatrist to a multi-location group.

Buy TherapyNotes if price per prescriber is the deciding number and your practice is therapy-led with prescribing attached. EPCS at no additional fee on a $69 base is the strongest published entry price in this set, and 24/7 phone support is a genuine advantage. Budget $134 for the seat plus prescribing and $189 once TherapyFuel and Premium Telehealth are on.

Buy JotPsych if what is broken is the documentation and the coding, whether you keep your current record or let JotPsych become it. Prescribing starts at $69 a month for JotRx alone if the physician only prescribes, $115 on Moonlighting plus JotRx inside a 15-note monthly cap, or $197 on Basic plus JotRx for unlimited notes. It can drop onto the system you already have with no migration, and its note auditing against payer documentation rules has no equivalent in Ona. Our Ona vs JotPsych comparison puts the two side by side.

Buy ICANotes if your documentation style is built around its templates and you value that specific note output enough to absorb an activation fee and a three-month commitment.

Buy Osmind if you run interventional psychiatry with SPRAVATO, ketamine or TMS. The REMS submission and lab plumbing exist for a reason, and no general platform replaces them.

Buy Valant if you run intensive outpatient or partial hospitalization programs and want a psychiatry-first suite, and accept that you will not see a number until you have taken the call.

Buy SimplePractice if you are therapy-first with light prescribing and want its template library and client portal. Our own SimplePractice review goes deeper.

Frequently asked questions

What does an EHR need if I prescribe controlled substances?

EPCS for Schedule II-V with DEA-compliant two-factor signing, identity proofing handled once at onboarding, a refill queue that takes pharmacy requests back into the same chart, interaction and allergy flags shown before you sign rather than after, a licensure check against the patient's state, and delegated drafting so staff can prepare a script for you to review. Everything else is preference.

How much does an EHR cost for one prescriber in 2026?

Checked on each vendor's own pricing page in September 2026. Seat plus prescribing: JotPsych from $69 for JotRx alone with no plan seat, $115 on Moonlighting plus JotRx with a 15-note monthly cap, or $197 on Basic plus JotRx for unlimited notes; TherapyNotes $134 a month; SimplePractice $148 plus an $89 one-time setup fee; Ona $200; ICANotes $213 plus a $99 activation fee; Osmind $298. Ona keeps the ambient scribe and telehealth in that seat, so the all-in figures add each vendor's own equivalents: TherapyNotes $134 plus TherapyFuel $40 and Premium Telehealth $15 is $189, SimplePractice $148 plus Care Aide $59 is $207, ICANotes $213 plus AI Scribe $49 and Telehealth $20 is $282, JotPsych Basic plus JotRx plus JotMeet at $26 is $223, Osmind stays $298 with video included, and Ona stays $200. JotPsych's Everything bundle, which adds auditing and video visits, is $269. Valant publishes no figure and quotes after a call. Read each one as a starting point: claims, reminders and AI drafting are priced differently on every vendor here, and JotPsych prices billing and credentialing apart from every plan, and prices auditing, prescribing and video separately below the Everything tier.

Does Ona support EPCS for Schedule II-V?

Yes. Ona runs an embedded DoseSpot dispensary on every patient record, with EPCS for Schedule II-V signed through DoseSpot's DEA-compliant two-factor, either push or hardware token. Identity proofing is completed once at onboarding. E-prescribing is $45 per prescribing practitioner per month and EPCS is $25 more and requires e-prescribing.

Can support staff prepare prescriptions for a prescriber to sign?

In Ona, yes. Front-desk staff and nurses can prepare draft prescriptions for a clinician to review and sign, and both roles are captured on the audit trail. The audit log records who prescribed what, when and from where. Ask any vendor to show this on the demo with a real staff login, not a slide.

Does Ona track PHQ-9 and GAD-7 scores over time?

No. Ona scores PHQ-9 on the canonical 0-27 range and GAD-7 on 0-21, with severity bands and a preconfigured flag on item 9, and the scores are visible to clinicians only. Ona's own help page states there is no cross-patient reporting or charting of scores across visits yet, so each result lives on its form. If charting scores across visits is central to how you practise, buy for that.

Which EHR is cheapest for a solo psychiatrist?

JotPsych, on its lightest paths. A supervising or collaborating physician who only prescribes takes JotRx alone at $69 a month with no plan seat. A prescriber who stays inside 15 notes a month pairs Moonlighting at $53 with JotRx at $62, so $115. For unlimited notes it is Basic at $135 plus JotRx at $62, so $197. TherapyNotes is $69 plus $65 for ePrescribe, so $134, and includes controlled substances at no additional fee; add TherapyFuel at $40 and Premium Telehealth at $15 to match what Ona keeps in the seat and it is $189. Ona is $200 with the record, the ambient scribe and telehealth in the seat rather than billed as add-ons, and 10 percent off when billed annually; an insured practice adds an Ona Clearing House plan from $69 a month for 100 claims, 100 ERAs and 200 eligibility checks, which cash-pay practices skip. The cheapest line item and the cheapest practice are not always the same thing: check what the chart, claims, reminders and AI drafting cost on top, and check the note cap.

Next step

Test it on your hardest refill day, not on a demo patient. Book a 15-minute walkthrough and ask to see a Schedule II script signed from inside a note, a refill approved from the queue, and the licensure warning fire on an out-of-state patient. Or start the 14-day free trial, full access, no credit card. Wider view: the honest look at Ona, including what it does not do yet.