Ona vs ICANotes (2026): Template-Driven Notes or an AI Scribe?

Ona and ICANotes solve the same documentation problem two different ways. ICANotes builds the note from clinical menus you click, with an ambient scribe as a paid add-on. Ona drafts the note from the visit itself, with the scribe, telehealth and billing inside the $130 practitioner seat. Both are HIPAA compliant; only ICANotes publishes ONC certification.

Quick answer:

• Choose ICANotes if the documentation you are judged on is behavioral health specific: treatment plans, group session notes, case management and PRP templates, rating scales, and a monitoring-program check inside the prescribing note.
• Choose Ona if you want the whole practice on one record and the scribe in the seat price: a full-time prescriber pays $200 a month at Ona against $282 at ICANotes once scribe and telehealth are added, and $99 activation.
• Choose either with your eyes open: ICANotes is behavioral health only by design, Ona is a general ambulatory EHR that runs behavioral health alongside eight other specialties.

This is a first-party comparison written by Ona. Every ICANotes figure below was read from icanotes.com in September 2026, and every Ona figure from ona.health/pricing on the same day. Where ICANotes wins, we say so.

The real difference: where the note comes from

ICANotes generates a narrative note from menus. You click through clinical content trees, and the system assembles prose from what you selected. Its homepage claims notes can be completed in under three minutes. That method has been in the field since 1999, and it has two properties clinicians who love it will recognize immediately: it is fast once the muscle memory is there, and it produces defensible content whether or not anyone recorded anything. Nothing depends on audio quality, a patient consenting to a recording, or a model interpreting a mumbled sentence. For a psychiatrist running thirty medication checks a day, that predictability is a real feature, not a legacy quirk.

Ona starts from the conversation. The Ambient Scribe records the visit in the room or on a telehealth call behind a per-visit consent banner the patient can pause, or accepts an MP3, M4A or WAV file up to 100MB uploaded afterwards. It separates and timestamps each speaker, then drafts a structured note against the template you chose: SOAP, DAP, BIRP, a functional-medicine timeline, your own format, or freeform. Every draft opens in a review state and nothing enters the chart until a clinician signs. Ona does not train models on your recordings.

Two honest caveats. First, Ona's drafting is not audio-only: automated charting can build the same note from intake answers or from dictation, which matters for the visits where recording is not appropriate. Second, ICANotes now has an ambient scribe of its own, listed as available now alongside an AI Readability Enhancer. So the question is not whether a scribe exists on both sides. It is what you pay for it, and what the rest of the system does while you are not writing.

Where ICANotes is genuinely stronger

Behavioral health documentation depth. ICANotes ships goal-based treatment planning, group therapy notes that auto-generate an individualized note per participant, couples and family session templates, case management and PRP notes, discharge summaries, and over 100 clinical rating scales. Ona does not build any of that. If a state Medicaid reviewer expects a treatment plan with linked goals, or your week includes group sessions, ICANotes covers a workflow Ona has no answer for.

Certification. ICANotes publishes ONC certification, the federal health IT certification program, alongside HIPAA compliance. Ona publishes HIPAA compliance and a BAA with every workspace, and no certification beyond that. If your payer contracts, your state program or your procurement checklist require a certified record, that decides it before any feature comparison starts.

Prescribing safeguards inside the note. ICANotes describes Schedule II to V prescribing through a Surescripts-connected network with DEA-compliant EPCS, drug interaction and formulary alerts, and a state prescription drug monitoring program query run inside the note rather than in a second browser tab. Ona's e-prescribing runs on embedded DoseSpot with EPCS, interaction and allergy flags at signing, licensure checked against the patient's state, and refills in one queue. It does not publish an in-note monitoring-program check. In states with mandatory checks, that is a daily difference.

Institutional settings. ICANotes describes interdisciplinary documentation, electronic orders, rounds and shift notes and eMAR for psychiatric hospitals and residential treatment centers. Ona is ambulatory software and does not do inpatient work.

Where Ona is stronger

The note is one part of a much larger record. Ona is a general ambulatory EHR that scales from solo clinicians to multi-location groups and enterprise systems. Its own homepage FAQ puts it plainly: "Ona scales from solo clinics to enterprise systems", with shared team calendars, role-based access, location-scoped channels and per-provider reporting. Behavioral health is one of nine specialties it serves, not the box it lives in. That matters if your group runs therapy next to primary care or women's health, because you buy one system instead of a behavioral health EHR plus a medical one.

The phone is part of the product. Ona's AI receptionist answers every call 24/7, books against real availability, hands urgent and sensitive calls to a person with a warm transfer on the escalation list and hours you set, and writes the transcript into the chart. Which call types go straight to a person, and during which hours, is a list the practice configures, and the scripts the agent reads out are editable without an engineering ticket. It is priced by included minutes: $100 a month for 400, $150 for 600, $200 for 800, $400 for 1,500, then $0.20 a minute. ICANotes publishes no equivalent.

Screening that scores itself. PHQ-9 and GAD-7 ship in Ona's form library with canonical 0 to 27 and 0 to 21 scoring, all five severity bands, and a preconfigured flag on item 9 of the PHQ-9. The patient fills in an ordinary form and never sees a number; Ona totals the points and raises the flag on submission, visible to clinicians only. Any single-choice form can be turned into a scored instrument the same way. To be clear about the limit: Ona shows the result on the chart and does not report scores across patients.

One published number for the practice, not the clinician. Intake, consents, scheduling, telehealth, the patient portal, tasks, reports, leads, billing and the insurance and eligibility workflow are all in the same seat as charting; the claims, ERAs and eligibility checks themselves run on an Ona Clearing House plan from $69, which cash-pay practices skip. ICANotes quotes claims, statements and text reminders through sales, so what a billing practice actually pays is not on the page.

What each one costs

Ona charges $130 per practitioner seat and $45 per staff seat per month, every feature on every plan, with 10% off the whole plan on annual billing. E-prescribing is $45 per prescribing practitioner and EPCS $25 on top. A full-time prescriber therefore lands at $200 a month with the scribe, telehealth, scheduling, portal and billing already included, or $180 on annual billing. Omnichannel messaging is $150 a month and free at two practitioners or fewer, in-platform calling with transcription is $25, and practices that bill insurance add an Ona Clearing House plan from $69 a month for 100 claims. No setup fee, no contract, 14-day trial without a card.

ICANotes prices per clinician and splits full-time from part-time. Full-time: Notes Only $55, Non-Prescribing $75, Prescribing $213 a month, each with a one-time $99 activation fee. Part-time: $35, $45 and $138, with monthly note caps of 60, 60 and 100 respectively. Telehealth is $20 per user per month and the AI Scribe $49 per user per month. The first non-clinical user is free and each additional one is $25. Claims, statements and text reminders are quoted by sales. An ICANotes+ subscription requires a three-month commitment, cancellable afterwards on 15 days' notice, and the trial runs 30 days without a card. The older Classic platform is priced separately.

Run the two comparable baskets and the crossover is clear. A full-time prescriber who wants a scribe and video pays $282 a month at ICANotes plus $99 up front, against $200 at Ona. A full-time non-prescribing therapist who wants the same two things pays $144 a month at ICANotes plus $99, against $130 at Ona, which is roughly $267 cheaper across the first year. Drop the scribe and ICANotes wins on price: $95 a month for notes, scheduling, portal and video. And nothing in Ona competes with a part-time therapist paying $45 a month for 60 notes.

How the three stack up

One axis only: how much of a behavioral health practice's week one subscription covers before you add a second line item. It is not a quality ranking, and it deliberately ignores the documentation depth where ICANotes wins. Prices are from each vendor's own pricing page, read in September 2026.

Coverage order	Platform	In the base subscription	Costs extra	Best fit	Poor fit	Published price
1	Ona	Ambient scribe, automated charting, telehealth, scheduling, intake, consents, patient portal, tasks, reports, leads, billing, the insurance and eligibility workflow	E-prescribing $45, EPCS $25, AI receptionist from $100, omnichannel $150, calls $25, clearing house from $69 for the claims, ERAs and eligibility checks	Prescribers and groups wanting phone, chart and money on one record; multi-specialty groups where behavioral health is one service line	Practices that need ICANotes-style treatment plans, group session notes or ONC certification, none of which Ona builds	$130 practitioner seat, $45 staff seat, monthly, 10% off annually
2	ICANotes	Menu-driven notes, ICANotes treatment plans, ICANotes rating scales, scheduling, portal, messaging; e-prescribing in the Prescribing tier	AI Scribe $49 per user, telehealth $20 per user, extra non-clinical users $25, claims and statements quoted by sales	Behavioral-health-only practices judged on treatment plans, group notes and certified records; prescribers who need in-note monitoring checks	Multi-specialty or integrated ambulatory groups; buyers who want the billing cost published	$55, $75 or $213 full time, $35, $45 or $138 part time, plus $99 activation
3	SimplePractice	Notes, scheduling, portal, telehealth, messaging on published solo and group tiers	Care Aide $59 plus $49 per extra clinician, Note Taker $35, included with Care Aide, ePrescribe $49 plus $89 setup, Insurance Navigator, announced at $1.79 per claim and not yet released	Solo and small group therapy practices wanting a mature, familiar product	Prescribing-heavy practices stacking three add-ons; teams wanting AI in the base price	Starter $49, Essential $79, Plus $99 solo; group Plus list $99 plus $74 per extra practitioner, currently discounted 50% for new accounts

So which one

Stay with ICANotes, or buy it, if your documentation burden is the behavioral health paperwork itself. Treatment plans with linked goals, group session notes, case management and PRP documentation, discharge summaries, over 100 rating scales and an ONC-certified record are not things Ona ships, and no amount of good note drafting substitutes for a workflow that simply is not there. The same goes for residential and hospital programs, which Ona does not serve at all.

Move to Ona when the paperwork is not the whole problem. The practices that switch are usually the ones where calls go unanswered, intake arrives on paper, claims sit in someone's inbox and the notes are only the loudest part of the noise. Ona answers the phone, takes the intake as a conversation on the patient's phone, drafts the note from the visit, raises the invoice from the signed note and tracks the claim to payment, in one record and one bill. For a prescriber it also happens to be cheaper once the scribe and video are counted honestly.

If you are comparing more widely, read Ona vs TherapyNotes for the therapy-practice question, Ona vs Valant for psychiatry, and the behavioral health documentation software guide for the wider field.

Frequently asked questions

Is Ona or ICANotes better for a psychiatry practice?

It depends on which safeguard you cannot give up. ICANotes runs a state prescription drug monitoring program check inside the note and publishes ONC certification; Ona does neither. Ona puts the ambient scribe, telehealth, scheduling, billing and the patient portal in the seat price, so a full-time prescriber pays $200 a month against $282 at ICANotes once the scribe and telehealth add-ons are on.

How much does ICANotes cost in 2026?

On the ICANotes pricing page as of September 2026: for a full-time clinician, Notes Only is $55 a month, Non-Prescribing $75, and Prescribing $213, each with a one-time $99 activation fee. Part-time rates are $35, $45 and $138 with monthly note caps. Telehealth is $20 per user per month, the AI Scribe $49 per user per month, and claims, statements and text reminders are quoted by sales.

Does ICANotes have an AI scribe?

Yes. ICANotes lists an Ambient AI Scribe as available now, plus an AI Readability Enhancer, and prices the scribe at $49 per user per month on top of the plan. The difference from Ona is not whether a scribe exists but whether you pay for it separately: in Ona the ambient scribe is part of the $130 practitioner seat.

What does ICANotes do that Ona does not?

ICANotes publishes ONC certification, runs prescription drug monitoring program checks inside the note through a Surescripts-connected network, and ships behavioral health documentation that Ona does not build: goal-based treatment planning, group session notes, case management and PRP templates, discharge summaries and over 100 clinical rating scales. If those are your workflow, ICANotes covers them and Ona does not.

What does Ona do that ICANotes does not?

Ona drafts the note from the visit itself and keeps the whole practice on one record: an AI receptionist that answers the phone 24/7 and books against the live calendar, leads, intake, consents, telehealth, billing, eligibility and claims. It is a general ambulatory EHR, so a group can run behavioral health alongside primary care or women's health on the same system rather than buying a second one.

Can Ona score PHQ-9 and GAD-7 inside the chart?

Yes. PHQ-9 and GAD-7 ship in Ona's form library with canonical 0 to 27 and 0 to 21 scoring, all five severity bands, and a preconfigured flag on item 9 of the PHQ-9. Ona totals the score and raises the flag the moment the patient submits, and the score is visible to clinicians only. There is no reporting of scores across patients.

Can I switch from ICANotes to Ona, and what does it cost?

Migration from any EHR is free. Ona's team exports and imports your data at no cost, typically within one business day, and a full cutover usually takes one to three weeks for smaller practices. The 14-day trial needs no credit card, there are no setup fees and no long-term contract, so you can run Ona beside ICANotes before committing.

Next step

Bring the two visits you dread documenting and watch both systems draft them. Book a 15-minute demo and we will run your own workflow end to end, from the call that books it to the claim that closes it, or start the 14-day free trial with full access and no credit card.