How to Choose an EHR by Practice Size: Solo to Enterprise

Practice size does not change what an EHR has to do. It changes what breaks first. One clinician runs out of hours, two to five lose handoffs, six to twenty need roles and reporting, several sites need one shared record, and enterprise needs contracts and data access. Choose for the size after next.

Quick answer:

• Size does not change the feature list. It changes the first thing to fail: hours at one clinician, handoffs at two to five, roles and money at six to twenty, one record across sites, contracts at enterprise.
• Most products announce their ceiling in the price list. SimplePractice sends six or more practitioners to sales, NextGen splits into two products at ten providers, Healthie meters on active clients, Jane's cheapest plan allows twenty appointments.
• Ona is one product across the range: $130 per practitioner seat, $45 per staff seat, every feature on every plan, custom pricing at five or more practitioners, several locations or unusual volume.

What actually changes as a practice grows

Three things change, and the feature checklist is none of them.

Who touches the record. With one clinician the chart is a private notebook. With two it is a shared document, and every unwritten rule has to become a setting: who sees what, who signs, who gets told.

Where money decisions get made. A solo practice decides money once, at the invoice. A group decides it four times: what was coded, who earns it, whether the payer accepted it, and who chases the balance.

What the vendor does to your price. Some hold one shape from one clinician to fifty. Some move you to a different product. Some stop publishing numbers the moment you look like a real account. Ask that one before the demo, not after the hire.

One clinician: you run out of hours before you run out of software

The constraint at solo is not capability. It is that one person answers the phone, runs the visit, writes the note and chases the money. Anything that does not remove minutes is decoration.

On Ona that is one practitioner seat at $130 per month with the ambient scribe, charting, telehealth, billing and the patient portal already in the seat rather than sold as extras. Omnichannel messaging is included at two practitioners or fewer. The AI receptionist is the add-on that matters here, at $100 per month for 400 included minutes and $0.20 per minute beyond. Prescribers add $45, and $25 more for EPCS.

Be honest about the arithmetic: a solo clinician who wants the phone answered is at $230 per month, not $130. Cheaper headline numbers exist. SimplePractice starts at $49, $79 or $99 for one practitioner, with Care Aide at $59 and ePrescribe at $49 plus an $89 setup. Healthie's Core plan is $19 billed monthly but covers 10 active clients. Jane App's Balance plan is CAD $54 and allows 20 appointments a month.

Those caps are the point: a plan priced for one person counts something, and what it counts is usually what you are about to grow. More: running a practice single-handed.

Two to five: the handoff is the failure

The second clinician does not double the work. It creates work that did not exist: the handoff. Who called the patient back. Who has the intake form. Whether the front desk knows Thursday is telehealth only.

Buy for one shared record, one calendar, one inbox and a visible list of what is outstanding. On Ona that is a shared team calendar with per-clinician hours and overrides, a five-status task board, and a messaging layer where a thread pins to the chart, so the answer lives on the record rather than in somebody's phone.

Watch one step in Ona's price list: omnichannel messaging is included at two practitioners or fewer and $150 per month from the third. Two practitioners plus one staff member is $305 per month, or $274.50 per month on annual billing, so the third clinician adds $130 for the seat and $150 for messaging in one month.

Competitors change shape here too. SimplePractice group pricing is $99 for the first practitioner and $74 for each additional, so three clinicians is $247 before add-ons. Healthie's Group plan starts at $149 billed monthly with $50 per additional clinician. Jane App's Practice and Thrive, CAD $79 and CAD $99, each include one full-time practitioner, with per-practitioner fees on top and separate add-ons for AI scribe and insurance billing.

Six to twenty: roles, reporting, and who gets paid what

Past five, two problems arrive at once. Consistency, because twenty people document twenty ways unless the templates say otherwise. And compensation, because revenue now has to be attributable to a person before anyone is paid.

This is where reporting stops being a nice-to-have. Ona's billing produces revenue by clinician and service, which its page calls ready for compensation calculations, and the reports break visit outcomes and frequency out by provider. Rendering NPI and provider billing configuration live in settings and flow into every claim, the detail that decides whether a twelve-provider group spends Fridays fixing rejections.

Groups already running a billing service do not have to unwind it: Ona's insurance page says higher-volume groups can keep their RCM partner working inside the same claims queue. Larger practices get a dedicated account manager, and five or more practitioners gets a tailored plan rather than a different product. Two honest limits: staff notifications are email and in-app, not SMS or push, and reporting is a fixed set of live reports with CSV and Excel export, not a custom builder or a BI connector.

The field thins here in a specific way. SimplePractice moves six or more practitioners to a sales consultant. Jane App offers clinics with 10 or more practitioners a complimentary discovery call and dedicated onboarding, and says larger clinics may qualify for a Jane Payments rate review on card processing. eClinicalWorks includes initial training for one to nine providers and states that implementation fees apply above nine. NextGen draws the hardest line: NextGen Office is sold for independent practices under 10 providers, NextGen Enterprise for 10 and above. AdvancedMD publishes $429 to $1,070 per provider monthly for medical specialties and $130 to $399 for mental health. More: EHR for large group practices.

Several locations: one record, or five

Multi-location is not a bigger group. It is a different failure: the patient calls the site that did not see them, and the answer sits in a system the person on the phone cannot open. What matters is that the record, the conversation and the pipeline survive crossing a site boundary. On Ona, team channels are location-scoped, the omnichannel inbox gives one inbox per person whichever site they called, and each lead carries a location so each site filters to its own pipeline without losing the full-org view. Consent templates map per service by state, which matters across state lines. Ona's homepage FAQ puts the goal plainly: multiple providers and sites on one system instead of five.

Two limits belong in the same breath, because a demo will otherwise surface them in month two: location-aware scheduling, meaning per-site hours, rooms and equipment, is not in the product today, and the reports are a fixed set with provider-level breakdowns, no custom report builder and no BI connector today.

Price shape matters more here than anywhere: per-seat scales with headcount, which you control, while a percentage of collections scales with revenue, which is what you are trying to grow. Related: scaling a multi-location clinic.

Enterprise: contracts, volume, and the exit

At enterprise the buying committee changes: procurement asks about contracts and data, finance about volume terms, and somebody senior asks how you would leave.

Ona's answers are specific rather than grand. Every Ona Clearing House plan includes unlimited providers and payer enrollments and runs on Stedi with no separate account, contract or fee on the practice side, from Starter at $69 per month for 100 claims and 200 eligibility checks to Scale at $1,099 for 2,500 claims and 3,750 checks. Cash-pay practices need no plan. Leads can be created through an API, every report exports to CSV or Excel, and there are no setup fees and no long-term contract.

The limits are equally specific, and procurement will find them anyway. Ona publishes HIPAA compliance and a BAA with every workspace, and no third-party security certification or uptime commitment beyond that. Human support is a primarily business-hours team, responsive outside those hours but without a promised round-the-clock rotation, while the AI receptionist answers patient calls at any hour. Workspace and portal are browser-based, with no native mobile apps, and telehealth is one-to-one.

One exclusion is real at any size: Ona is ambulatory software. Inpatient and hospital workflows are not what it does, and growth does not change that. It is the only honest boundary on the range.

The size ladder, vendor by vendor

One axis only: how much of the solo-to-enterprise range each vendor covers on a single product, at a price you can read before a sales call. Not a quality ranking, and a narrow range is no flaw if it matches your practice. Every figure was read from the vendor's own live pricing page in September 2026.

Range	Platform	Starts at	Where the shape changes	Published price, September 2026
1	Ona	One clinician	Nothing changes product; custom pricing at 5+ practitioners, several locations or unusual volume	$130 practitioner seat, $45 staff seat monthly; 10% off annually; every feature on every plan
2	Tebra	Independent practices of various sizes	No published price at any size; priced per clinical provider, unlimited non-clinical staff	Not published. EPCS setup about $75 per provider; PDMP $500 per facility
3	AdvancedMD	Small mental health practices	Band shifts by specialty and size; setup free to $1,000 for smaller practices, up to $6,000	$429 to $1,070 per provider monthly, medical specialties; $130 to $399 mental health; RCM 4 to 8 percent
4	NextGen	Independent practices under 10 providers	Product change at 10 providers: Office below, Enterprise at and above	Not published
5	eClinicalWorks	One provider	Initial training included for 1 to 9 providers; implementation fees apply above nine	EHR $499 per provider monthly, with practice management $599; RCM 2.9% of collections; no start-up costs
6	Healthie	10 active clients	Meters on active clients, not clinicians; Group tier adds per-clinician fees	Core $19, Essentials $49, Plus $129, Group $149+ monthly plus $50 per extra clinician
7	SimplePractice	One practitioner	Group pricing from the second practitioner; 6+ go to a sales consultant	Starter $49, Essential $79, Plus $99; group $99 first practitioner plus $74 each additional; ePrescribe $49 plus $89 setup
8	Jane App	20 appointments a month	Per-practitioner fees from the first full-time hire; 10+ get dedicated onboarding	CAD $54 Balance, CAD $79 Practice, CAD $99 Thrive, each plus per-practitioner fees
9	Canvas Medical	Startups building a care model	Enterprise tier at 3,000 active patients; needs engineering capacity	Builder $4,000 monthly, first 1,000 monthly active patients; Enterprise on request

Elation Health publishes no price at any size, so it sits outside the table. Head-to-heads: Ona vs SimplePractice, Ona vs Jane App, Ona vs AdvancedMD.

The migration tax nobody prices

What decides this is not the plan you can afford today. It is the cost of the next size, including the cost of arriving there.

Ona migrates from any EHR at no cost, typically within one business day for the export and import, with full cutover in one to three weeks for smaller practices and most solos live in one to two weeks. No setup fee, no long-term contract, and a 14-day free trial with no credit card.

Elsewhere, as published today: AdvancedMD lists data migration at $800, $1,200 or $2,000 by tier and setup from free to $1,000 for smaller practices and up to $6,000. SimplePractice's ePrescribe carries an $89 one-time setup. Tebra lists EPCS setup at around $75 per provider.

None of those is outrageous alone. They land exactly when you are least able to absorb them: at the hire, at the second site, at the moment the practice changes size.

Frequently asked questions

What changes in an EHR as a practice grows?

The feature list barely changes. What changes is who touches the record, where money decisions get made, and what the vendor does to your price. A solo clinician needs hours back. Two to five people need handoffs that survive. Six to twenty need roles, per-provider reporting and compensation numbers. Several sites need one record instead of five. Enterprise needs contracts, volume terms and a way out.

At what size do I outgrow a solo EHR plan?

Not at a headcount. A solo plan ends at a moment rather than a number: the first time work has to pass from one person to another - a note somebody else finishes, a call somebody else returns, a claim somebody else chases - and the system cannot carry that handoff. That is why the two-to-five band above is one problem rather than four sizes, and for most practices the moment lands early in it, between the second and the fourth clinician. Published plan ceilings tend to arrive in the same window. SimplePractice prices groups at $99 for the first practitioner and $74 for each additional, and sends six or more practitioners to a sales consultant. Jane App's cheapest plan, Balance at CAD $54 a month, allows 20 appointments a month. Healthie's $19 Core plan covers 10 active clients. Check the published ceiling before you hire.

Does Ona work for multi-location groups?

Yes. Ona states that it scales from solo clinics to enterprise systems, with shared team calendars, role-based access, location-scoped team channels and per-provider reporting keeping multiple providers and sites on one system. Leads carry a location so each site filters to its own pipeline without losing the full-org view. Two honest limits: location-aware scheduling with per-site hours, rooms and equipment is not in the product today, and the reports are a fixed set with provider-level breakdowns and no custom report builder.

What does Ona cost as the practice grows?

$130 per practitioner seat and $45 per staff seat per month, every feature on every plan, with 10% off on annual billing. Two practitioners plus one staff member is $305 per month. E-prescribing is $45 per prescribing practitioner and EPCS $25 more. Omnichannel messaging is $150 per month, included at two practitioners or fewer. The AI receptionist starts at $100 per month for 400 minutes, and an insured practice adds an Ona Clearing House plan from $69 per month for the claims, ERAs and eligibility checks themselves, which cash-pay practices skip. Five or more practitioners, several locations or unusual volume gets custom pricing.

Which EHRs make you change product as you grow?

NextGen is the clearest example: NextGen Office is sold for independent practices under 10 providers and NextGen Enterprise for 10 and above, so passing that line means a different product. Others change the commercial shape instead. SimplePractice moves six or more practitioners to a custom quote, eClinicalWorks includes initial training for one to nine providers and charges implementation fees above nine, and Elation Health and Tebra publish no prices at all, so every size is a sales conversation.

When should a growing practice not switch EHR?

When the only thing that hurts is documentation and the record itself is fine, because a scribe costs less than a migration. When you are mid-credentialing or mid-payer-enrollment for a new site. And when you need something the new system openly does not have: if you run inpatient or hospital workflows, no ambulatory platform including Ona is the answer.

Next step

Pick the size you expect to be in eighteen months, not the one you are in now, and make the vendor price it in front of you. Then run one workflow end to end at that size: a call answered, a note signed, an invoice raised, a claim submitted, the revenue attributed to the right clinician. Book a 15-minute demo with your growth plan in hand, or start the 14-day free trial. Current numbers are on the pricing page.