Navigating the Digital Transition: The Best Internal Medicine EHRs of 2025

Navigating the Digital Transition: Top 5 Internal Medicine EHR ystems for 2025

Section 2: Identifying the Top 5 Internal Medicine EHRs for 2025

Section 3: In-Depth Reviews of the Top 5 Internal Medicine EHRs

Section 5: Key Considerations for Internal Medicine Practices 34Section 6: The Future of EHRs in Internal Medicine (Trends for 2025 and Beyond)

Section 1: Introduction

The landscape of internal medicine is increasingly shaped by technology, with Electronic Health Records (EHRs) at the forefront of this transformation. An effective Internal Medicine EHR system is no longer a luxury but a foundational tool for delivering quality patient care, ensuring operational efficiency, and maintaining financial stability in a modern internal medicine practice. These systems are pivotal in managing complex patient histories, coordinating care for chronic conditions, streamlining billing processes, and facilitating meaningful patient engagement. As technology evolves, particularly with advancements in artificial intelligence (AI) and interoperability, the capabilities of EHRs are expanding, offering new avenues to enhance medical practice.

This report aims to provide a comprehensive analysis of the top 5 EHR systems anticipated to lead the market for internal medicine practices in 2025. The selection process involved a multi-faceted methodology, prioritizing EHRs that demonstrate strong suitability for the unique demands of internal medicine. Key criteria included robust clinical functionalities tailored to internal medicine workflows, positive user reviews and satisfaction ratings from practicing physicians, comprehensive practice management and billing capabilities, advanced technological features such as AI and robust interoperability, and overall relevance and future-readiness for the 2025 healthcare environment. The analysis draws upon a wide array of sources, including industry reports, vendor documentation, and user feedback from reputable review platforms.

Section 2: Identifying the Top 5 Internal Medicine EHRs for 2025

The selection of the top EHRs for internal medicine in 2025 is grounded in a comprehensive evaluation of several critical factors. These include:

Internal Medicine Suitability: The system’s features, templates, and workflows must align with the diverse and often complex needs of internal medicine, which encompasses managing chronic diseases, preventive care, and acute adult illnesses.
User Reviews and Satisfaction: Feedback from practicing physicians and clinic staff on platforms like G2, Software Advice, and Capterra provides real-world insights into usability, support, and overall satisfaction.
Core Feature Set: Essential EHR functionalities such as charting, e-prescribing, lab integration, order management, and patient portals are baseline requirements.
Practice Management and Billing Integration: Seamless integration or robust native capabilities for scheduling, billing, revenue cycle management (RCM), and reporting are crucial for operational efficiency.
Technological Advancement & Future-Readiness: Adoption of current and emerging technologies, particularly AI, robust interoperability (FHIR, HL7, CommonWell, Carequality), telehealth capabilities, and mobile accessibility, indicates a vendor’s commitment to innovation and long-term viability.¹
Vendor Stability and Support: The vendor’s market presence, financial stability, and the quality of their customer support and implementation services are also key considerations.

Based on these criteria, the following five EHR systems have been identified as leading options for internal medicine practices in 2025:

NextGen Healthcare Enterprise EHR: A long-standing player with specific solutions and high rankings for internal medicine and ambulatory care, focusing on AI and interoperability.²
athenahealth athenaOne: A cloud-native, all-in-one solution known for its strong RCM services, network insights, and increasing AI integration, suitable for small to mid-sized practices.⁶
eClinicalWorks EHR: A widely adopted Internal Medicine EHR in ambulatory settings, offering a comprehensive suite of features including extensive AI tools and patient engagement solutions.⁶
Praxis EMR: Consistently ranked #1 in user satisfaction due to its unique AI-driven, template-free charting approach that adapts to the physician’s style. It has also been rated #1 in Internal Medicine by KLAS.¹⁵
Althea Smart EHR / EHI EHR (Enable Healthcare Inc.): An emerging, AI-focused, and mobile-first EHR solution garnering positive early reviews for usability and offering specific internal medicine protocols and tools.¹⁸ These appear to be closely related or the same entity marketed under different names or by different partners.¹⁸

The EHR market is dynamic, and while established vendors like NextGen, athenahealth, and eClinicalWorks frequently appear on “top EHR” lists, newer or more specialized systems are gaining significant traction. Praxis EMR, for instance, consistently achieves high user satisfaction due to its unique AI-driven, template-free charting methodology.¹⁵ Similarly, Althea Smart EHR / EHI EHR is noteworthy for its strong emphasis on AI and mobile-first design, catering to modern practice needs.¹⁸ This trend suggests that internal medicine practices are increasingly looking beyond just comprehensive feature sets and are prioritizing user experience, efficiency gains through AI, and specialized functionalities that truly align with their workflows.

It is also important to recognize that generic “top EHR” lists may not always reflect the best choices for a specific specialty like internal medicine. For example, systems like Epic EMR, while comprehensive, are primarily aimed at large hospitals and may be overly complex and expensive for typical independent internal medicine practices.³ SimplePractice, another EHR sometimes listed, is more focused on behavioral health services.²³ SmartClinix, mentioned as a rising star ⁶, currently has less extensive third-party review data compared to the selected top five. The EHRs chosen for this report demonstrate a stronger and more consistent alignment with the needs of ambulatory internal medicine and primary care settings, as evidenced by their feature sets and user feedback within these contexts.

Section 3: In-Depth Reviews of the Top 5 Internal Medicine EHRs

This section provides a detailed examination of each of the top 5 Internal Medicine EHR systems identified for usability, pricing, and compatibility with internal medicine in 2025. Each review covers an overview, key features, pricing, user sentiment, system architecture, practice management capabilities, mobile access, patient engagement, and implementation/support.

(The company logos and software screenshots mentioned below would be inserted as actual image files in a blog post format.)

3.1 NextGen Healthcare Enterprise EHR

A. Overview and Focus

Company Background: NextGen Healthcare, established in 1974, is a well-known and trusted partner in the ambulatory healthcare sector.⁴
Logo: The NextGen Healthcare logo consists of the text “NextGen Healthcare” with a stylized graphic to the left. The graphic features a rounded square shape divided into four smaller squares; the top left and bottom right are filled with a solid teal color, while the top right and bottom left are white.⁵ (Image: NextGen Healthcare Logo)
Core Strengths for Internal Medicine: NextGen Healthcare offers solutions specifically tailored for ambulatory practices, with internal medicine being a key specialty.⁴ The system has been recognized with a #1 ranking for EHR in Internal Medicine by KLAS Research.³ Its core strengths lie in its comprehensive approach, focus on AI and automation to enhance efficiency, robust interoperability capabilities, and tools for patient engagement.⁴
NextGen’s extensive experience in the ambulatory sector, combined with its specific targeting of internal medicine needs, makes it a formidable option. The company’s strategic direction towards AI and enhanced interoperability aligns well with the anticipated demands of healthcare in 2025 and beyond.
B. Key Features and Clinical Workflow

Internal Medicine-Specific Content: The platform provides specialty-specific content, templates, and workflows designed for various medical fields, explicitly including internal medicine.² This ensures that the system can adapt to the nuanced documentation and care planning requirements of internists.
General EHR Functionalities: NextGen Enterprise EHR includes a full suite of standard EHR tools:

Charting: Features like “Grand Central charting” aim to streamline the clinical documentation process.³¹
E-prescribing: Integrated e-prescribing capabilities are standard.¹⁰
Lab Integration: Connectivity with major labs is supported for ordering and receiving results.²⁹
Order Management: Comprehensive tools for managing various types of medical orders.
Telehealth: Native telehealth functionalities are available, allowing for virtual patient consultations.²
Patient Portal: A robust patient portal facilitates patient engagement and access to health information.²⁸
AI & Automation:

NextGen Ambient Assist: This AI-powered tool is designed to streamline clinical documentation by listening to patient-provider conversations and generating SOAP notes, aiming to reduce administrative burden and save providers significant time.⁴
AI Rules Engine: Utilized in the billing process to ensure precise and accurate claims submission.⁴

Screenshots: (Image: Screenshot of NextGen Healthcare EHR main dashboard/interface ⁴) (Image: Screenshot of NextGen Mobile App interface ⁴) (Image: Screenshot depicting NextGen Ambient Assist in action, if available, or a conceptual representation ⁴)
The combination of general EHR robustness, tailored content for internal medicine, and the introduction of advanced AI tools like Ambient Assist positions NextGen as a system capable of addressing both current and future clinical needs. The focus on reducing documentation time is a particularly strong selling point for busy internal medicine physicians.
C. Pricing and Cost Considerations

Pricing Model: NextGen Healthcare does not publicly disclose its pricing for NextGen Enterprise; it is typically provided via custom quotes based on practice size, specific specialty needs, and required functionalities.³⁴
Estimated Costs:

NextGen Enterprise EHR: Industry analysts and user reviews suggest a starting range of $300-$545 per provider per month.³⁵ Some sources indicate pricing around $299 per provider/month for nurses and $379 per provider/month for physicians.²
NextGen Office EHR (for practices with under 10 providers): Pricing is reported to start at approximately $299 per provider per month.³²

Additional Costs: Practices should anticipate potential additional costs for implementation services, comprehensive training programs, ongoing system maintenance, and any optional add-on modules that extend functionality.³ Generally, NextGen does not offer a free trial for its EHR solutions.²
The lack of transparent, publicly available pricing is common in the Internal Medicine EHR market, necessitating direct engagement with the vendor for an accurate cost assessment. The differentiation between the Enterprise and Office versions allows NextGen to cater to a broader range of practice sizes, though the cost implications must be carefully evaluated.
D. User Reviews and Market Sentiment
G2: NextGen Healthcare EHR holds an average rating of 3.7 out of 5 stars, based on 158 reviews.²⁵

Positive Feedback: Users often praise its customizability, suitability for procedure-based processes, and the utility of templates and macros for charting. Some users find it user-friendly and describe it as a robust and complete EHR system.²⁸ It has been noted as particularly good for billing in specialties like pain management.²⁸
Negative Feedback: Common criticisms include the system being “clicky” or having a complex interface, leading to inefficiencies. Slow loading times and performance issues are also reported. Some users have experienced undependable hosting support and found the interface less flexible than desired. Technical issues and a steep learning curve are also mentioned.²⁸
Software Advice & Affiliated Sites:

NextGen Office EHR (via Software Finder): This version has an average rating of 3.9 out of 5 stars from 661 reviews.³⁹ Users appreciate features like smart phrases for note writing, ease of checking eligibility and benefits, and high customizability.³⁹
Syndicated Reviews (Software Finder): Feedback highlights smooth prescribing but notes that support can be unreliable and costly. The system is considered not ideal for dermatology due to excessive clicks and scrolling. Some users found the price high and customer service disappointing. Others found it good for employee tracking and care management, and some deemed it user-friendly, though with limited specialty areas. The mobile app is generally seen as easy to use. While offering a comprehensive EHR/PM system, the initial setup can be complicated. Navigation is easy for some, but tasks like lab ordering can be click-intensive. System downtime is also a concern for some users.³⁹
SoftwareReviews.com (Info-Tech): The platform received a composite score of 7.2/10 from 30 reviews ⁴⁰ (another page shows 7.1/10 from 29 reviews ⁴¹). The likeliness to recommend is around 79-81%.⁴⁰ Positive aspects include being trustworthy, respectful, having client-friendly policies, and continuous product improvement. A specific con mentioned is that customization of dashboards could be better.⁴¹ The patient charting tool is praised for efficiency and customizable templates, though reporting features are cited as needing improvement.⁴⁰

Capterra: The platform has a rating of 4.0 out of 5 stars from over 200 reviews.³² FinancesOnline reports a 4.4/5 rating based on 17 user reviews.⁴²
Reddit: User discussions often describe NextGen as “clicky” and having an outdated appearance, though generally functional, especially with proper customization and the use of smart phrases or text expanders. Some users found it tedious and frustrating due to the number of clicks required.³⁸
User sentiment for NextGen Healthcare EHR is notably mixed. The system’s strength in customization and breadth of features is often acknowledged. However, recurring concerns about usability – particularly the “clickiness” and perceived complexity of the interface – and occasional slow performance are significant. The quality of customer support also appears to vary. The user experience can be heavily influenced by the specific product version (Enterprise vs. Office) and the thoroughness of its initial setup and customization. This variability underscores the importance of in-depth, practice-specific demonstrations before selection.
E. System Architecture and Integration

All-in-One vs. A La Carte: NextGen Enterprise is marketed as a fully integrated, award-winning platform.⁴ Similarly, NextGen Office is described as a fully integrated clinical and billing platform.²⁸ This points towards an all-in-one system design rather than an à la carte approach where modules are selected individually.
Interoperability: NextGen Healthcare demonstrates a strong commitment to interoperability, supporting key industry standards:

It utilizes the Mirth® Connect Integration Engine for HL7 messaging and offers APIs, including support for FHIR (Fast Healthcare Interoperability Resources).³⁴ An API Marketplace is also available to facilitate third-party integrations.³⁴
The platform connects to national health information networks such as Carequality and Surescripts Record Locator and Exchange, enabling broader data sharing.⁴⁴
NextGen Healthcare is also committed to supporting the Trusted Exchange Framework and Common Agreement (TEFCA), further underscoring its dedication to national connectivity.⁴⁴
The system aims to provide seamless data exchange capabilities, allowing internal medicine practices to connect with colleagues, patients, hospitals, urgent care facilities, and even non-NextGen Healthcare systems.⁴
The robust support for prevailing interoperability standards is a critical asset for internal medicine practices, which often need to exchange patient data with a variety of other specialists and healthcare facilities. The inclusion of the Mirth engine, a well-regarded tool in healthcare integration, further strengthens its interoperability claims.
F. Practice Management and Billing Capabilities

Integrated PM: Yes, NextGen offers an award-winning, fully integrated Practice Management (PM) solution integrated with their Internal Medicine EHR.⁴ It has been ranked #1 for Practice Management by Black Book Research for multiple years.⁵
PM Features: The PM system includes comprehensive tools for patient registration, appointment scheduling, enterprise-wide configurability with automated eligibility verification, and intelligent check-in workflows. It also provides robust reporting and analytics capabilities.⁴
Billing Software: The integrated billing software is designed to optimize financial performance. Key features include:

AI Rules Engine: Ensures precise and accurate claims through AI-driven automation, streamlining workflows and optimizing the revenue cycle.⁴
Clearinghouse and EDI: An award-winning clearinghouse designed to streamline claims processing, reduce denials, and accelerate reimbursements.⁴
Coding and Operations Support: Intuitive workflows powered by advanced technology to ensure billing accuracy and staff efficiency.⁴
Collections and A/R Management: Tools to boost Accounts Receivable (A/R) efficiency and collections pre-service, during service, and post-service.⁴
Rules-based charge creation and claims scrubbing are also supported.²⁸
NextGen Healthcare appears to provide exceptionally strong and highly-rated practice management and billing functionalities. These are vital for the financial sustainability and operational smoothness of an internal medicine practice. The incorporation of an AI Rules Engine for claims processing is a modern feature aimed at enhancing accuracy and reducing manual effort.
G. Mobile Access and Patient Engagement
Mobile App: NextGen Mobile is available, with a strong presence on iOS.³⁴ While Android compatibility is mentioned for NextGen Practice Management ⁴⁶ and generally for EHR access ⁴⁷, the primary mobile EHR app highlighted seems more developed for iOS. NextGen Mobile for Enterprise users offers features like speech-to-text, remote scribe services, and Ambient Assist.³¹
iOS App Features (NextGen® Mobile Solutions, 4.4 stars from 2.5K Ratings ⁴⁵): Allows users to view their clinical schedule, access key clinical content, securely communicate with team members and colleagues, capture charges and images directly into the EHR, and capture diagnosis codes on the go. Dictation of patient encounters is also a key feature.³¹
Patient Engagement: The platform offers a comprehensive suite of patient engagement tools:

NextGen Patient Portal: Enables patients to schedule appointments, request refills, participate in virtual visits, and connect with providers.³¹
Other features include self-scheduling options, automated appointment reminders (text and email), virtual visits, secure messaging, online payment options, and integration with Apple Health for patient-generated data.²⁹
NextGen provides solid mobile capabilities, especially for users on the iOS platform. The patient engagement tools are comprehensive and align with contemporary patient expectations for access and communication, which is beneficial for managing ongoing care in internal medicine.
H. Implementation and Support

Implementation: NextGen Healthcare offers a full range of services to ensure successful onboarding and ongoing use of its solutions. This includes a strategic approach with clear guidance, full support during the go-live phase, and post-implementation follow-up.⁴ The company employs experienced project managers, consultants, and trainers.⁴ Data migration options, such as CCDA files, encounter notes, and scanned documents, are available, though fees may apply.³⁶ However, some user reviews suggest that implementation can be challenging.⁴⁹
Customer Support: Support channels include phone support (877-523-2120, option 6 for urgent matters), email (info@nextgen.com), and a client support case submission via the NextGen Success Community.³⁴ The Success Community serves as a web support portal for logging cases and accessing resources.³⁶ NextGen Office boasts JD Powers and Associates recognition for excellent customer support, with average phone hold times under 2 minutes and a 48-hour turnaround for web cases.³⁶ Despite these claims, user reviews present a mixed picture of support reliability and associated costs, with some users reporting excellent account management and others experiencing issues with tech knowledge or responsiveness.³⁹
While NextGen promotes a comprehensive support and implementation framework, the variation in user experiences, particularly regarding support quality and the complexity of implementation, is a crucial factor. The NextGen Success Community is highlighted as a valuable resource for users. The discrepancy between official support claims and some user experiences suggests that the quality of support might depend on the specific product (Enterprise vs. Office) or the nature of the issue.
I. Other Distinguishing Factors

Longevity and Experience: With decades in the healthcare IT market, NextGen Healthcare has a deep understanding of ambulatory practice needs.
Focus on Ambulatory Care: The company’s solutions are specifically designed for outpatient settings, which is a direct fit for most internal medicine practices.
Proactive AI Integration: The development and promotion of AI tools like NextGen Ambient Assist indicate a commitment to leveraging advanced technology to solve common EHR pain points.
NextGen’s established presence, specific focus on ambulatory care, and forward-looking AI initiatives make it a significant EHR vendor. However, the reported usability challenges cannot be ignored. The effectiveness of new AI tools in mitigating these challenges will be key to its future success and user satisfaction.

3.2 athenahealth athenaOne

A. Overview and Focus

Company Background: Founded in 1997, athenahealth is known for its cloud-based services encompassing Internal Medicine EHR, revenue cycle management (RCM), and patient engagement solutions.⁵²
Logo: The athenahealth logo is a stylized lowercase “a” enclosed in a circle, both in a teal or dark cyan color. The horizontal bar of the “a” is angled upwards, resembling an arrow. This is typically to the left of the company name “athenahealth” in a dark grey or black sans-serif font.⁷ (Image: athenahealth Logo)
Core Strengths for Internal Medicine: athenaOne is positioned as an all-in-one, AI-powered solution particularly well-suited for small to medium-sized practices, with 83% of its customers falling into the 1-5 clinician category.⁷ Key strengths for internal medicine include its integrated platform, strong network insights derived from its vast user base, a significant focus on reducing administrative workload through RCM services and AI, and tailorable workflows.⁷ The system received four Best in KLAS Software and Services awards in 2024 for various independent practice categories.⁹
The cloud-native architecture of athenaOne, combined with its emphasis on network-driven intelligence and comprehensive RCM services, presents a compelling package for internal medicine practices aiming for integrated clinical and financial efficiency.
B. Key Features and Clinical Workflow

Internal Medicine-Specific Content/Primary Care: athenaOne offers tailorable web, mobile, and voice-driven workflows that can be adapted to various specialties, including primary care.⁷ The system is designed to simplify documentation with specialty-specific workflows that surface relevant testing and results.⁵⁹ While detailed internal medicine templates are not explicitly enumerated in all provided materials, the platform’s customizability with best-practice templates, macros, and features like Pre-Encounter Prep and Focused Encounter supports the diverse documentation needs of internists.⁶⁰ The Mobius Clinic app also makes athenahealth documentation templates available on mobile devices for HPI, ROS, and PE sections.⁶¹ Shared patient records, voice-powered services, and population health support are also key components.⁶²
General EHR Functionalities:

Patient Charts: Curated health histories with automatic integration of records, orders, and results from the athenahealth network.⁷
E-prescribing: Standard e-prescribing capabilities.
Lab Integration: Seamless integration for lab orders and results.
Telehealth: Fully integrated telehealth solution (athenaTelehealth) for virtual consultations.⁵⁹
AI-Powered Capabilities:

Administrative/RCM AI: AI is leveraged for smarter insurance selection, automatic claim creation after patient encounters, and denial management by analyzing data from the network to identify and predict claim issues.⁵⁷
Clinical AI: Network-informed diagnosis and care gap insights are surfaced at the point of care within encounter workflows.⁷ “Ambient Notes” (AI-powered clinical note generation) and voice-powered services (speech-to-text dictation powered by Nuance) aim to reduce documentation burden.⁵⁹

Screenshots: (Image: Screenshot of athenaOne main dashboard/interface ⁷) (Image: Screenshot of athenaOne mobile app interface ⁷) (Image: Screenshot showcasing an AI-driven feature like Ambient Notes or network insights dashboard, if available ⁷)
The emphasis on leveraging network-derived data for real-time clinical decision support and identifying care gaps is a significant advantage for proactive internal medicine. Furthermore, the application of AI to streamline administrative tasks and RCM processes directly addresses major operational pain points for medical practices.
C. Pricing and Cost Considerations

Pricing Model: athenahealth offers flexible pricing, primarily a percentage-based model where practices pay a certain percentage of their monthly collections (typically reported as 4-7%).⁶³ An encounter-based model is also mentioned.⁶³ Pricing is customized based on specific needs, and interested practices must request a quote.⁶³
Estimated Costs: The starting price for a basic license is often cited around $140 per provider per month.⁶³ athenahealth emphasizes a “no hidden fees” and “no long-term contracts” policy, allowing practices to leave at any time and take their data.⁷
Additional Costs: Potential additional costs include those for data migration (ranging from $500 to over $10,000 depending on volume), custom integration with multiple systems ($2,500 to $25,000), and staff training ($500 to $5,000 depending on sessions).⁶⁵ One-time implementation and data migration fees are based on record volumes.⁶⁶
The percentage-of-collections model can be appealing as it aligns the vendor’s success with that of the practice. However, this model may prove more expensive for practices that are already highly efficient in their billing or operate on high revenue with low margins.⁶⁶ The absence of long-term contracts provides a degree of flexibility and reduces vendor lock-in risk.
D. User Reviews and Market Sentiment
G2: athenaOne has an average rating of 3.4 out of 5 stars from 110 reviews ⁵² (some sources cite 3.5/5 from 101 reviews ⁹).

Positive Feedback: Users appreciate that it is a tech-savvy, bundled EHR and PM platform. Features like ambient notes for reducing documentation time, API integration, and intuitive navigation (for some) are highlighted. It’s considered good for patient information lookup, payment handling, and scheduling. Auto-filling capabilities, patient photos in records, and well-designed reports are also praised.⁹
Negative Feedback: The startup and customization process can be lengthy. Full potential often requires API integration. Some users describe the interface as clunky, requiring too many clicks, and perceive it as designed more for billing/coding than for physician documentation. Customer service receives mixed reviews, with some finding it slow, unhelpful, or difficult to reach by phone. Software glitches and UI slowdowns have also been reported.⁹
Software Advice/Capterra: The platform scores around 3.8 out of 5 stars based on over 800 reviews.⁹

Positive Feedback: Ease of use is often praised, along with the revenue-based fee structure and the availability of an online knowledge base. The ability for different practices to see and edit patient information is a plus. Strong Internal Medicine EHR functionality and scalability are noted. Good integration allows faster record access, and some practices report reductions in FTEs and overtime.⁹
Negative Feedback: Some users report issues with billing transparency.³² Customer service representatives are sometimes found to be unhelpful, and direct phone access can be difficult. Payment processing limitations (e.g., to US Bank) and the RCM solution not always being fully end-to-end are concerns for some.⁹ The system can be particular about computer hardware or Windows versions.⁷² Some smaller practices find it expensive.⁷¹
athenaOne is generally well-regarded for its comprehensive integrated platform, particularly its RCM services and network-derived insights. However, usability for clinical documentation presents a mixed picture, with some users finding it efficient while others deem it cumbersome. Customer service quality appears inconsistent based on user reports. The platform’s strengths in administrative and financial management are significant, but practices should carefully evaluate the clinical workflow aspects.
E. System Architecture and Integration

All-in-One vs. A La Carte: athenaOne is fundamentally an all-in-one solution, integrating EHR, medical billing, practice management, and patient engagement into a single, cloud-based platform.⁷
Interoperability: athenahealth demonstrates a commitment to interoperability through various mechanisms:

Standards Support: The platform supports common healthcare data standards such as HL7, FHIR (Fast Healthcare Interoperability Resources), and C-CDA (Consolidated Clinical Document Architecture).⁷⁴
National Networks: athenaOne integrates with national health information networks including CommonWell Health Alliance and Carequality, facilitating broader patient data exchange across different EHR systems.⁶²
API Access: A robust athenaOne API allows for integration across various workflows, including patient management, appointments, charting, documents, orders, insurance, and finances.⁶²
The cloud-native architecture, coupled with support for key interoperability standards and extensive API capabilities, positions athenaOne as a well-connected platform, which is crucial for internal medicine practices needing to coordinate care across diverse settings.
F. Practice Management and Billing Capabilities

Integrated PM: Yes, practice management is an integral component of the athenaOne suite.⁷
PM Features: The PM module includes tools for scheduling, comprehensive reporting and analytics, streamlined front-desk collections workflows, and AI-powered patient insurance package selection to improve accuracy and efficiency.⁷
Billing Software (often referred to as athenaCollector ⁶³): This is a core strength of athenahealth.

It leverages network data and AI-driven tools to improve claim accuracy and reduce manual work for staff.⁷
A sophisticated rules engine and expert billing teams identify and resolve claim errors before submission, contributing to an industry-leading clean claims submission rate of 98.4%.⁷
Services include medical coding relief with expert, certified coders, an authorization determination engine and specialists to acquire authorizations, automatic payment posting, and enhanced claim resolution services where athenahealth teams work complex claims and denials to completion.⁷
Billing and Revenue Cycle Management are standout capabilities for athenaOne. The platform’s heavy reliance on automation, network intelligence, and available expert services aims to maximize collections, reduce administrative burdens, and improve the financial health of practices. This is particularly beneficial for internal medicine practices managing ongoing patient care and complex billing scenarios.
G. Mobile Access and Patient Engagement
Mobile App: athenaOne offers a mobile app for both iOS and Android devices.⁵⁴

iOS App Features (4.6 stars from 2.8K Ratings ⁷⁸): Providers can access their daily schedule, manage their clinical inbox, prepare for upcoming visits, use existing documentation accelerators (templates, macros), document exams, place orders, and create new patient cases and order groups. Users can also add/edit medical problems, allergies, histories, and capture images during exams.⁷⁸
Android App Features (Functionality may vary ⁷⁷): Allows access to daily schedules, upcoming appointments, inbox categories (open encounters, labs, patient cases), patient information lookup (contact details, care team, insurance, pharmacies), and review of chart sections like allergies, problems, vaccines, medications, and labs & imaging.⁷⁷ Some user reviews suggest that the Android version may have fewer features or less functionality compared to the iOS version.⁷⁷
Patient Engagement (athenaCommunicator ⁶³): athenaOne provides a comprehensive suite of patient engagement tools:

An integrated Patient Portal and a dedicated patient mobile app (athenaPatient ⁷⁸).
Features include patient self-scheduling, automated appointment reminders (phone, text, email), secure patient-provider messaging, online bill pay, access to health history and test results, and automated wellness outreach campaigns to help maintain schedule density and ensure patients receive essential care.⁷
athenahealth provides robust mobile app offerings for providers, although there might be a feature disparity between the iOS and Android versions that practices with diverse device ecosystems should investigate. The patient engagement suite is comprehensive, aligning with modern healthcare trends that empower patients in their care management.
H. Implementation and Support

Implementation: athenahealth provides robust onboarding support with dedicated implementation teams guiding practices through the process.⁷ The typical go-live timeline for small practices is approximately 11 weeks, while larger or multi-site deployments may take 16 weeks or more, especially when coordinating multiple legacy systems.⁶⁶ The process generally includes data strategy definition, data extraction and migration, quality assurance and user acceptance testing (UAT), role-based training (self-paced eLearning and instructor-led sessions), and go-live support (virtual or onsite).⁶⁶ For API integrations, a detailed process involving exploration, contracting, technical specification, building/testing, validation, and go-live is outlined.⁷⁶
Customer Support: athenahealth offers a partnership-oriented customer support model that includes coaching and training services (live and on-demand), a dedicated Customer Success Manager for proactive performance coaching, and 24/7 technical support for software, workflow, and usage questions.⁷ Customers can log in to the athenaOne® Success Community to contact support teams or track cases.⁶⁷ Sales inquiries can be made via phone (800-981-5084) or online forms.⁶⁷ Despite these offerings, user reviews on support quality are mixed, with some praising helpfulness and others citing slow responses or unhelpful representatives.⁹
athenahealth outlines a structured implementation process and provides multiple avenues for customer support. However, the variability in user-reported support experiences suggests that practices should clarify service level expectations and perhaps seek references from similar practices. The role of the Customer Success Manager could be pivotal in ensuring a positive ongoing relationship.
I. Other Distinguishing Factors

Network Effect: A significant differentiator is the leveraging of de-identified data from its extensive network of over 160,000 providers. This data fuels real-time benchmarks, evidence-based best practices, and local/regional insights, aiding in clinical decision-making and operational improvements.⁷
Deep RCM Expertise: The company has a strong historical focus and service offering in revenue cycle management, aiming to take on burdensome administrative work for practices.⁵⁷
Cloud-Native SaaS Model: athenaOne is built as a Software-as-a-Service (SaaS) solution, ensuring continuous updates and accessibility.⁵⁴
The “network effect” is a unique value proposition, potentially offering internal medicine practices valuable comparative data and insights they might not get from standalone systems. This, combined with their RCM focus, makes athenaOne a strong contender for practices prioritizing financial health and data-driven improvements.

3.3 eClinicalWorks Internal Medicine EHR

A. Overview and Focus

Company Background: Founded in 1999, eClinicalWorks has become a market leader in the EHR space, particularly among independent ambulatory practices.⁷⁹ The company reports that over 180,000 physicians and nurse practitioners worldwide use its EHR.¹⁴
Logo: The eClinicalWorks logo features the company name in a stylized sans-serif font, with the “e” and “W” capitalized and slightly larger. Below the name, the tagline “Improving healthcare together” is often present.¹⁴ (Image: eClinicalWorks Logo)
Core Strengths for Internal Medicine: eClinicalWorks offers a comprehensive Internal Medicine EHR and Practice Management solution, increasingly enhanced with AI-powered capabilities across various modules.¹³ The platform includes strong patient engagement tools, primarily through its healow (Health and Online Wellness) platform, and robust support for Value-Based Care initiatives.⁷⁹ It supports over 40-50 medical specialties and sub-specialties, including specific solutions and templates for primary care and internal medicine.¹⁰
eClinicalWorks positions itself as a feature-rich platform suitable for internal medicine practices seeking a comprehensive system with a significant emphasis on AI-driven efficiencies and patient interaction tools. The breadth of its offerings aims to cover the entire patient journey.
B. Key Features and Clinical Workflow

Internal Medicine-Specific Content/Primary Care: The EHR provides a wide range of templates and pre-configured diagnoses to expedite data entry for primary care and internal medicine workflows.⁸⁵ Hundreds of customizable templates and Order Sets are available, allowing providers to tailor documentation to specific medical conditions.⁸⁵ A case study highlights its use by “Internal Medicine Specialists,” although the focus of that particular study was on their gastroenterology services.⁸⁶ The system includes a real-time Clinical Decision Support System (CDSS) to aid providers at the point of care.⁸⁵
General EHR Functionalities: Core capabilities include comprehensive charting, e-prescribing, robust lab integration, appointment scheduling, referral management, and population health tools.¹²
AI-Powered Features: eClinicalWorks has heavily invested in AI across its platform:

Sunoh.ai: An AI-powered medical scribe using ambient speech technology to convert natural patient-provider conversations into clinical documentation.¹¹
AI Assistant (Eva – eClinicalWorks Virtual Assistant): A conversational EHR interface allowing users to interact with the system using natural language for tasks like scheduling, documentation, and record searches.¹¹
Image AI: Manages inbound faxes by matching them to patient records and interpreting their content.¹³
Automated Playlists (RPA): Uses Robotic Process Automation to navigate multiple screens for repetitive tasks, enhancing efficiency and simplifying staff onboarding.¹³
healow No-Show AI Prediction Model: Forecasts patient no-shows with up to 90% accuracy to help practices manage schedules and reduce missed appointments.⁸²

Screenshots: (Image: Screenshot of eClinicalWorks V12 EHR interface, possibly showing the multidimensional Internal Medicine EHR layout or AI features ¹⁴) (Image: Screenshot of the healow patient app interface ⁹⁰) (Image: Screenshot or graphic illustrating an AI feature like Sunoh.ai or PRISMA search ¹⁴) The eClinicalWorks website (e.g., V12 page ⁸⁹, Products & Services page ³⁵) contains various graphics and representations of their software, including the healow app.
The depth of AI integration across diverse clinical and administrative workflows is a key differentiator for eClinicalWorks. The availability of customizable templates is crucial for meeting the varied documentation requirements inherent in internal medicine.
C. Pricing and Cost Considerations
Pricing Model: eClinicalWorks offers transparent, fixed pricing for its primary EHR and PM plans, which is a notable contrast to some competitors.³⁴

EHR Only: $449 per month per provider.¹²
EHR with Practice Management: $599 per month per provider.¹²
RCM as a Service: 2.9% of practice collections.¹²

Additional Costs: For the standard plans (EHR Only, EHR with PM), there are typically no start-up costs.³⁴ eClinicalWorks also offers free data migration from a practice’s existing EHR, which can be a significant cost saving.⁹³ Features such as e-prescribing are included in the monthly provider fee.¹² However, an implementation fee may apply for practices with more than nine providers.⁸⁸
The pricing structure of eClinicalWorks, particularly its fixed-fee options and the inclusion of free data migration for many scenarios, offers a degree of predictability and potential cost savings that can be very attractive to internal medicine practices.
D. User Reviews and Market Sentiment
G2:

eClinicalWorks (EHR): Holds an average rating of 3.6 out of 5 stars from 148 reviews.⁹⁶
eClinicalWorks RCM: Rated 4.1 out of 5 stars, though based on a smaller number of reviews.⁹⁸
Positive Feedback (EHR): Some users find it user-friendly with easy access to information. Its comprehensive functionality, customizable templates, and suitability for scheduling and billing are often cited as strengths. Good integration capabilities are also mentioned.⁹⁶
Negative Feedback (EHR): Common complaints include the system being expensive for some, having an outdated or difficult user interface, and issues with poor or slow customer support. Performance problems like slowness or freezing, complexities in data migration, and insufficient training are also reported. More concerning are some reports of data loss or errors in saving information, and workflows that require too many clicks.⁹⁶
Software Advice/Capterra/Other Platforms:

Software Finder (SelectHub analysis): eClinicalWorks received perfect scores for features reducing documentation time, patient engagement, and claims processing. It also scored highly for minimizing coding errors and for its reporting capabilities. However, a steep learning curve and limited customization options were noted as cons.⁸⁸
TrustRadius: Shows a low average rating (e.g., 3.4/10 from a set of critical reviews ⁹⁵), with users complaining about subpar support, problematic updates, clunky integrations, and a slow system. Some positive mentions relate to note layout and basic record-keeping.⁹⁵
ConsumerAffairs: Features numerous negative reviews. Users cite issues with customer service, persistent technical difficulties, billing problems, and the system being overly complex and slow.⁹⁹
EMRSystems.net: Presents mixed feedback. Positives include automation features, good scheduling tools, e-prescribing, and an effective patient portal. Negatives include system slowness, glitches, excessive clicks, an outdated interface, and difficult customer support.¹⁰⁰
Capterra (via YouTube reviews): One user mentioned it took about a month for staff to become comfortable with the system and that data transfer from a previous system (Greenway Prime Suite) worked well. This user strongly recommended having an internal “super user” for effective setup and ongoing tech support.¹⁰¹ Another review noted that eClinicalWorks is cost-effective and stable but not necessarily the best in the market, and that their consultants could be difficult to deal with.¹⁰²
SoftwareReviews.com (Info-Tech): eClinicalWorks Core EHR received a composite score of 6.7/10 from 15 reviews. Pros included reliability, security, and enabling productivity. A con mentioned was “Under Delivered” by one reviewer. It scored well for appointment management and cloud hosting.¹⁰³
User reviews for eClinicalWorks are notably polarized. While the platform’s comprehensive nature and specific features like AI enhancements are acknowledged, a significant number of users report substantial challenges with usability, system performance, and the quality and responsiveness of customer support. This high degree of variability in user experience suggests that a practice’s success with eClinicalWorks may heavily depend on factors like thorough training, the presence of dedicated internal IT support or “super users,” and perhaps the specific version or modules being used. The ongoing AI enhancements may be a strategic effort to address some of the long-standing usability concerns.
E. System Architecture and Integration

All-in-One vs. A La Carte: eClinicalWorks offers distinct plans such as “Internal Medicine EHR Only” and “EHR with Practice Management,” suggesting a model that allows for both an integrated all-in-one approach and some degree of modularity.¹² The system is described as a comprehensive solution with unified practice management.⁸⁶
Interoperability: eClinicalWorks has a significant focus on interoperability, highlighted by:

PRISMA: Its proprietary health information search engine designed to aggregate patient records from disparate EHRs nationwide, providing a longitudinal patient view.¹³
FHIR APIs: Offers FHIR (Fast Healthcare Interoperability Resources) APIs through both the eClinicalWorks FHIR Developer Portal (for provider-facing apps) and the healow FHIR Developer Portal (for patient-facing apps).¹⁰⁴
Electronic Health Information (EHI) Export: Provides functionality for authorized users to export EHI for single patients or entire patient populations.¹⁰⁴
Standard Integrations: Supports integrations for Health Information Exchange (HIE), clinical data exchange (e.g., labs, pharmacies via HL7 ¹²), patient engagement platforms, external practice management systems, medical devices, financial systems, and public health reporting agencies.¹⁰⁴
The platform’s strong emphasis on interoperability, particularly through its PRISMA network and adoption of FHIR APIs, is a critical capability for internal medicine practices that frequently need to exchange patient data with specialists, hospitals, and other healthcare entities.
F. Practice Management and Billing Capabilities

Integrated PM: Yes, Practice Management is offered as an integrated component of the eClinicalWorks suite, often bundled with the EHR.¹²
PM Features: The PM system includes tools for appointment scheduling, patient tracking, comprehensive reporting, and eligibility verification.¹²
Billing Software: eClinicalWorks provides flexible Revenue Cycle Management (RCM) options:

RCM Service Model: A full-service option where eClinicalWorks manages the practice’s billing for a percentage of collections (typically 2.9%).¹²
Self-Service Practice Management Model: Practices can handle their own billing using the integrated PM tools.⁷⁹
The system employs bots for automated eligibility checking and real-time claim scrubbing to ensure claims are clean before submission. It also supports electronic remittance advice (ERA) for electronic payments, automated appeals generation, and patient statement generation.⁸⁹ eClinicalWorks claims a 98% or higher first-pass acceptance rate for claims processed through its RCM service.¹¹
The availability of both full-service RCM and self-service PM options offers internal medicine practices the flexibility to choose a billing model that best suits their staffing and operational preferences. The automation features within the billing process are designed to improve efficiency and reduce errors.
G. Mobile Access and Patient Engagement
Mobile App:

eClinicalMobile® app: Available for physicians on both iOS and Android devices, allowing access to Internal Medicine EHR functionalities on the go.¹²
healow™ app: A dedicated patient app available on iOS and Android, facilitating patient engagement.³⁴
healow App Features: Patients can access their appointments, view lab results, check vitals, manage medications (including refill requests), communicate securely with their provider’s office, book appointments online, link health trackers and remote monitoring devices, and manage health records for multiple family members.⁹²
Patient Engagement: eClinicalWorks offers an extensive suite of patient engagement tools, largely centered around the healow platform. This includes:

healow Open Access®: For patient self-scheduling.⁸⁹
healow Sign: For electronic patient signatures.⁸⁹
healow Chatbot: Answers FAQs and allows patients to book appointments, pay bills, and access records 24/7.⁸⁹
healow CHECK-IN™ and Kiosk: Contactless check-in solutions allowing patients to verify demographics, sign consents, update forms, and pay copays from smartphones or practice kiosks.¹³
healow Remote Patient Monitoring (RPM): Gathers data from patient wearables and trackers.⁸⁹
Patient Portal: Provides 24/7 access to medical information on any device.¹²
Messenger Campaigns: For targeted patient outreach.⁷⁹
eClinicalWorks provides a very comprehensive set of tools for patient engagement through its healow platform, along with mobile applications for both clinical staff and patients. This strong focus on patient interaction and remote access is well-aligned with modern healthcare delivery models.
H. Implementation and Support

Implementation: The eClinicalWorks implementation process can be complex, often benefiting from experienced guidance. Third-party consulting firms like ReMedi Health Solutions ⁸⁰ and TrueNorth ITG ¹⁰⁷ offer specialized eClinicalWorks implementation, optimization, and support services. eClinicalWorks suggests minimum training hours for different roles (e.g., 12-16 hours for providers, 12 hours for billers, 8 hours for front office staff ¹²). The company offers data conversion for demographic data, metadata, and clinical data from previous systems.¹²
Customer Support: eClinicalWorks provides customer support through various channels, including phone (508-475-0450), email, live chat, and an online customer support portal (my.eclinicalworks.com).³⁴ However, user reviews regarding customer support are sharply divided. Many users across multiple platforms have reported significant dissatisfaction with the quality, responsiveness, and effectiveness of eClinicalWorks support, citing long wait times, difficulty getting issues resolved, and communication challenges.⁹⁵
The implementation of eClinicalWorks can be a substantial undertaking, potentially requiring dedicated internal resources (like a “super user” ¹⁰¹) or external consultants for optimal setup and workflow customization. The widespread negative feedback concerning customer support is a critical area of concern that practices must thoroughly investigate and consider when evaluating this EHR.
I. Other Distinguishing Factors

Aggressive AI Adoption: One of the platform’s most notable characteristics is its broad and deep integration of AI technologies across numerous facets of the EHR, from clinical documentation with Sunoh.ai to administrative tasks with Image AI and RPA.¹³
Comprehensive healow Platform: The healow suite of applications provides a unified ecosystem for patient engagement, telehealth, remote monitoring, and patient self-service tools.⁷⁹
Cloud-Based Infrastructure: The eClinicalWorks Cloud is powered by Microsoft® Azure®, offering anytime, anywhere access without the need for practices to manage servers, maintenance, or updates.¹³
The extensive suite of AI tools and the integrated healow platform are significant differentiators for eClinicalWorks, aiming to modernize practice operations and enhance patient interaction. However, the effectiveness of these advanced features can be undermined if core usability and support challenges persist.

3.4 Praxis EMR

A. Overview and Focus

Company Background: Praxis EMR, by Infor-Med Corporation, is a leading innovator in Electronic Medical Record software, serving thousands of physician-users across the U.S. and worldwide.¹¹¹
Logo: The Praxis EMR logo typically features the word “Praxis” in a stylized font, often accompanied by “EMR” and sometimes a graphic element like a stylized caduceus or abstract shapes, usually in blue and green tones.¹⁶ (Image: Praxis EMR Logo)
Core Strengths for Internal Medicine: Praxis EMR’s most significant distinction is its consistent #1 ranking in user satisfaction across multiple independent surveys and review platforms, including those by the AAFP, AmericanEHR, Software Advice, and Capterra.¹⁵ This high satisfaction is primarily attributed to its unique AI-driven “Concept Processing” engine, which enables template-free charting. The system learns from each physician’s unique way of practicing medicine, adapting to their individual style and vocabulary.¹⁶ Praxis EMR has also been rated #1 in Internal Medicine by KLAS.¹⁵
The core appeal of Praxis EMR for internists lies in its physician-centric design that prioritizes charting flexibility and efficiency, aiming to reduce documentation burden and physician burnout—a common pain point with traditional template-based EHRs.
B. Key Features and Clinical Workflow

Internal Medicine-Specific Content: Being template-free, Praxis EMR is inherently adaptable to any medical specialty, including the diverse needs of internal medicine.¹⁶ It allows physicians to document encounters in their own words and preferred style, rather than conforming to pre-set templates.¹⁷ Its #1 KLAS rating in Internal Medicine underscores its suitability for this field.¹⁵
General EHR Functionalities:

AI-Based Charting: The cornerstone of Praxis, its Concept Processing AI learns and gets faster with use.¹⁶
E-prescribing: Integrated with SureScripts.¹¹⁴
Lab Integration: Supports two-way lab integration for orders and results.¹¹⁴ Real-time integrated labs stream results directly into charts.¹²¹
Document Management: PraxDocs™ for document management.¹⁷
Patient Portal: AI-driven patient portal for communication and record access.¹⁷
Telemedicine: Integrated telehealth capabilities, designed to be streamlined by the template-free charting approach.¹⁷
AI-Driven Features:

Concept Processing: The AI engine that learns the physician’s charting patterns and medical decision-making.¹⁶
Knowledge Exchanger™: Allows physicians to share and import specialized knowledge and charting elements from colleagues.¹¹⁴
Intelligent Practice Advisories: Provides timely medical advice and decision support at the point of care, customizable by the practice.¹¹⁴
Smart Agents™: Automated tools for reminders and event tracking within the clinic.¹¹⁴
AI-Driven Patient Intake: Personalizes and streamlines the patient intake process.¹⁷

Screenshots: (Image: Screenshot of Praxis EMR main interface, highlighting the template-free charting area ¹⁶) (Image: Screenshot illustrating the Concept Processing or AI learning aspect ¹⁶) (Image: Screenshot of the Praxis Patient Portal or Datum+ reporting, if available ¹⁶)
The AI-driven, template-free charting mechanism is the standout feature of Praxis EMR. This approach promises a significant reduction in documentation time and a more natural, personalized charting experience, which can be particularly beneficial in internal medicine where patient encounters can be complex and varied.
C. Pricing and Cost Considerations

Pricing Model: Praxis EMR is offered on a subscription basis.
Estimated Costs:

First Provider: $219 per month under a 60-month agreement, or $259 per month under a 48-month agreement.¹¹⁴
Additional Providers: Custom pricing is provided for additional providers in a practice.¹¹⁴
Support and Upgrades: An additional fee of $70 per month typically covers support, software updates, and upgrades.¹¹⁴

Additional Costs: Initial implementation and training are generally included in the starting price.¹¹⁵ However, some features like speech recognition software or cloud access might incur additional costs.¹²² Adding practitioners after the initial implementation phase can also be costly.¹²²
Praxis EMR offers relatively transparent pricing for the initial provider. The value proposition centers on the AI-driven system delivering significant time savings and efficiency, which could offset the subscription costs. Practices should clarify all potential add-on costs during the evaluation process.
D. User Reviews and Market Sentiment
G2: Praxis EMR has a high rating of 4.5 out of 5 stars, though based on a relatively small number of reviews (3 reviews) on this platform.¹²²

Positive Feedback: Reviewers praise its ability to learn from the user, making medical practice easier. It efficiently manages billing and prescriptions, offers effective text-to-speech recognition, and facilitates efficient EHR documentation through its “Concept Processing.” Users also find it easy to find records and learn the system.¹²²
Negative Feedback: One user mentioned occasional system glitches that prevent program access. The lack of a free trial is noted. Additional costs for features like speech recognition, cloud access, and support after the first year are also cited as drawbacks, along with the potential expense of adding practitioners post-implementation and the absence of a patient self-pay portal.¹²²
Software Advice: Praxis EMR has consistently been ranked #1 in Usability and Customer Satisfaction/Recommended by Software Advice in their FrontRunners reports for multiple years (2018-2025, including specific mentions for 2020, 2021, and 2023).¹⁵ In 2021, it achieved an overall score of 4.96 out of 5.0 in the FrontRunners report.¹¹¹

User Comments (from Software Finder, likely syndicated ¹²⁵): Users describe it as a “more efficient choice” compared to systems like Epic, streamlining charting and ordering. They highlight its effective prescription and billing features, ease of charting, customization options, and superior documentation capabilities. The interface is often described as easy to use, with quick support available. The AI is likened to a personal assistant that adapts to the user’s workflow.
Reported Cons: Some users found the initial setup “a bit complex.” A sentiment expressed is that the system requires the physician to deeply understand their own practice and charting patterns for optimal use, which can be challenging but ultimately beneficial.

Capterra: Praxis EMR was named the #1 Rated EHR in the Value for the Money Report for 2022-2025.¹⁶ It was also featured in the Capterra Top 20 EMR report in 2019, earning the #1 score in Review Ratings with a perfect 5-star rating.¹²⁷
KLAS Research: Praxis EMR has been rated #1 by KLAS in Internal Medicine EHR, Family Medicine EHR, and for Ambulatory EMRs in the 1-5 physician segment.¹⁵
The market sentiment for Praxis EMR is overwhelmingly positive, particularly regarding physician satisfaction with its unique AI-driven, template-free charting methodology. Users consistently praise its efficiency, customizability, and the way it adapts to their individual practice styles. The primary potential drawback appears to be the initial learning curve associated with its different approach and some potential extra costs for ancillary services.
E. System Architecture and Integration

All-in-One vs. A La Carte: Praxis EMR appears to function as a comprehensive, integrated EHR system. It offers integrated options for billing and revenue cycle management.¹⁷
Interoperability:

Direct Integrations: Praxis EMR integrates with laboratories (offering two-way communication), e-prescribing services like SureScripts, and supports HL7 standards.¹¹⁴
Data Exchange: The system is designed to connect to various billing and practice management systems and can migrate patient demographics.¹⁷ It emphasizes seamless data exchange with other healthcare systems for comprehensive patient care.¹⁷
Datum+™: This technology is key for reporting and data extraction, embedding discrete data within the physician’s narrative text, which facilitates MACRA, MIPS, and PQRS reporting.¹⁷
While broader interoperability frameworks like FHIR, CommonWell, or Carequality are not explicitly detailed as directly supported in the provided snippets for Praxis itself ¹¹⁹, Praxis does state a commitment to interoperability.¹¹² The unique template-free structure necessitates a robust method like Datum+ for extracting structured data for exchange.
Praxis EMR provides good fundamental interoperability for essential tasks like lab integration and e-prescribing. Its unique template-free nature means its approach to structured data exchange, primarily through the Datum+ feature, is critical for meeting broader interoperability demands. Practices should inquire specifically about its capabilities with FHIR resources and participation in larger health information exchange networks if these are key requirements.
F. Practice Management and Billing Capabilities

Integrated PM: “Integrated Practice Management” is listed as a feature ¹⁷, and the system is designed to connect with external billing and PM systems if needed.¹⁷
PM Features: Includes patient self-scheduling and appointment management tools, driven by AI.¹⁷
Billing Software: Praxis offers integrated billing and revenue options, catering to various practice models including Direct Primary Care, Concierge Medicine, and full insurance-based RCM services.¹⁷

PraxCoder™: A unique feature that utilizes the Concept Processor to ensure documentation supports optimal coding, helping to maximize reimbursements and avoid under-coding or illegal up-coding, which can be a risk with template-based systems.¹²¹
Automated MIPS and ACO reporting capabilities are also highlighted.¹²¹
Praxis EMR provides integrated solutions for practice management and billing, with a particular strength in leveraging its AI to ensure that clinical documentation aligns with appropriate coding. This focus on compliant and optimal coding is a significant benefit for the financial health of internal medicine practices.
G. Mobile Access and Patient Engagement

Mobile App/Access: Praxis EMR is cloud-based and promotes “wireless and mobile ready” access from anywhere, anytime, on various devices including computers, tablets (iPad), laptops, and smartphones (iPhone, other handheld devices).¹²¹ This suggests robust web-based mobile accessibility rather than necessarily distinct native iOS or Android applications being the primary mode of mobile interaction.
Patient Engagement:

AI-Driven Patient Portal: Enhances patient communication and engagement through personalized interactions tailored to individual patient needs.¹⁷
Patient Self-Scheduling: AI is used to streamline appointment bookings via online patient self-scheduling.¹⁷
Secure Communication: Secure email communication with patients is supported.¹¹⁴
Praxis EMR offers strong patient engagement features, particularly through its AI-enhanced patient portal and self-scheduling tools. Mobile access is facilitated via its cloud-based nature, allowing use on a wide range of devices through a web browser, which provides flexibility, though the experience might differ from that of dedicated native mobile apps.
H. Implementation and Support

Implementation: The implementation process is structured in three stages: individual provider training, system set-up and installation, and staff instruction.¹³⁰ A “rapid start-up” is facilitated by the Praxis Knowledge Exchanger™, which allows new users to import knowledge from colleagues or specialty databases.¹¹⁴ One user review noted that the initial setup was “a bit complex,” indicating that while structured, it requires attention to detail.¹²⁵
Customer Support: Praxis EMR is highly rated for its training and support, having been ranked #1 in these categories by the American Academy of Family Physicians (AAFP) in multiple EHR User Satisfaction Surveys.¹⁵ Support options include:

Phone support (800-985-6016).¹⁶
LiveSupport chat (available Monday through Friday, 8 am – 8 pm EST, with weekend/overnight support by request).¹³⁰
A Praxis Customer Support Portal which includes options to submit a ticket, access news/updates, an online forum for peer interaction, troubleshooting guides, and a knowledgebase with manuals and tutorials.¹³⁰
It’s noted that support after the first year of use may not be free.¹²²
Praxis EMR has a strong reputation for excellent customer support and training, which is crucial given its unique AI learning model. The multi-stage implementation and various support channels aim to ensure users can effectively adopt and utilize the system.
I. Other Distinguishing Factors

Template-Free AI Charting (Concept Processing): This is the paramount unique selling proposition of Praxis EMR. The system learns and adapts to the physician’s individual medical practice style, rather than forcing the physician to adapt to pre-defined templates.¹⁶
Physician-Centric Design: The entire philosophy of Praxis EMR revolves around reducing physician burnout and allowing doctors to practice medicine in their own words and style, thereby improving job satisfaction and patient care quality.¹¹²
DataMiner™: A powerful, integrated research tool that allows physicians to instantly query any clinical data from their patient population, useful for clinical studies, health maintenance tracking, and quality improvement initiatives.¹⁷
Praxis EMR offers a fundamentally different paradigm for EHR interaction that strongly resonates with physicians, especially those who find template-based systems restrictive and time-consuming. The focus on learning the user’s methods, rather than imposing a rigid structure, is its most compelling attribute.

3.5 Althea Smart EHR / EHI EHR (Enable Healthcare Inc.)

A Note on Branding: The EHR solutions marketed as “Althea Smart EHR” (often associated with MD Synergy ¹⁸) and “EHI EHR” (from Enable Healthcare Inc. ²⁰) appear to be very closely related, if not the same underlying platform. Both emphasize AI-driven features, mobile accessibility, and solutions for various specialties, including internal medicine. This review will consider them collectively, highlighting specific branding where information differs.

A. Overview and Focus

Company Background: Enable Healthcare Inc. (EHI) has been a player in the EHR market for approximately 15 years, offering an AI-powered EMR software.²¹ MD Synergy positions Althea Smart EHR as a “game changing” platform leveraging Apple technology for a unique user experience.¹⁸ AltheaHealth.io presents AI agents for healthcare automation that can integrate with EHRs.¹⁹
Logo: (Image: EHI EHR / Enable Healthcare Inc. Logo ²²) (Image: Althea Smart EHR Logo, if available from MD Synergy website)
Core Strengths for Internal Medicine: Both EHI EHR and Althea Smart EHR emphasize AI-powered documentation, including voice recognition and ambient listening capabilities, to reduce charting time.¹⁸ EHI EHR specifically highlights an “Advanced CC-HPI Protocol for Internal Medicine,” pre-built SOAP notes and templates for IM, personalized lab insights, and health maintenance/risk assessment plans tailored for the specialty.²⁰ Althea Smart EHR is noted for its native iOS integration and strong mobile experience.¹⁸ An AI-powered patient risk predictor (eApredict by EHI) is another key feature.²⁰
The strong emphasis on modern technologies like AI and mobile-first design (particularly for Althea), combined with EHI’s explicit internal medicine-specific tools, makes this a compelling emerging option for practices prioritizing innovation and tailored workflows.
B. Key Features and Clinical Workflow
Internal Medicine-Specific Content:

EHI EHR: Offers an “Advanced CC-HPI Protocol for Internal Medicine,” pre-built SOAP notes, encounter plans, and templates specifically for IM. It also provides personalized lab insights, personalized intake forms, and tools for health maintenance and risk assessment plans relevant to internal medicine.²⁰
Althea Smart EHR: Features smart charting with voice recognition, use of macros and templates, ability to copy previous notes, and save notes as templates for future use.¹³⁵ It supports various specialties including Primary Care, Cardiology, and Gastroenterology, indicating adaptability for internal medicine needs.¹³²

General EHR Functionalities: Standard features include charting, e-prescribing, lab integration, integrated telemedicine, and a patient portal.¹³⁷
AI-Powered Features:

EHI EHR: Features “enableAssist,” an AI-powered charting tool that helps generate assessment and plan components of notes. It also includes “eApredict,” an AI patient risk predictor that displays color-coded risk levels for various conditions.²⁰ Intelligent coding automation is also highlighted.²⁰
Althea Smart EHR: Emphasizes AI-powered documentation through “Althea Speech” (powered by Nuance) for medical-specific speech-to-text, and ambient listening technology to automatically generate structured clinical notes in real-time.¹⁸

Screenshots: (Image: Screenshot of EHI Internal Medicine EHR interface showing AI features like enableAssist or eApredict ²⁰) (Image: Screenshot of Althea Smart EHR mobile (iOS) interface ¹⁸) (Image: Screenshot depicting voice recognition or telemedicine in Althea/EHI ²²)
The explicit internal medicine protocols and templates offered by EHI EHR are a notable advantage. Both EHI and Althea heavily promote AI for documentation efficiency, which is a key trend for 2025. The mobile-centric design of Althea, particularly its iOS focus, caters to physicians desiring flexibility.
C. Pricing and Cost Considerations
Pricing Model (Althea Smart EHR – via FindEMR ¹³⁹): Althea Smart Internal Medicine EHR is offered through tiered subscription plans:

Basic: Starting at $200 per provider per month. Includes mds:practice, cloud hosting, IMO (+), with add-ons for electronic claims (+$39.26) and eligibility (+$26.18).
Standard: Starting at $540 per provider per month. Includes everything in Basic, plus Althea Smart EHR, Document Center, Drug Database, and EPCS.
Premium: Starting at $640 per provider per month. Includes everything in Standard, plus Althea Speech.
Enterprise: Custom pricing. Includes everything in Premium, plus Althea Kiosk + Althea Health, unlimited telemedicine, unlimited SMS, and chat.
Pricing Model (EHI EHR – Enable Healthcare Inc. ¹⁴¹): EHI EHR also offers tiered plans and bundles:

EHR Essential: $250 per month.
EHR Pro: $400 per month (includes customization of specialty templates, integrated fax, population health analytics, physician & practice mobile app).
EHR Enterprise: $550 per month (includes proprietary practice branded app, custom marketing campaigns, Direct Messaging, EPCS, 10 non-medical users per provider).
Bundles: Essentials Bundle (Pro EHR + PMS app) at $500/mo; Pro Bundle (Pro EHR + RCM service) at 6% monthly + transaction fees; Elite Bundle (Enterprise EHR + PMS + RCM service) – contact for pricing.
Numerous Add-ons: Pricing is listed for additional providers ($150/mo), prescribers ($45/mo), EPCS ($250/yr per MD), voice recognition ($100/user), eligibility checks (15 cents/transaction), Direct Messaging ($250/yr), dedicated account manager ($100/mo), CCM/RPM services ($15/patient), etc..¹⁴¹

AltheaHealth.io (AI Agents ¹⁹): Offers fixed fee models based on usage or a pay-as-you-go model for qualified organizations. Claims an ROI of 0.01-0.1 of equivalent staff time.
The pricing structures for both Althea Smart Internal Medicine EHR and EHI EHR are relatively transparent with their tiered offerings, though the extensive list of add-ons for EHI EHR means practices need to carefully calculate the total potential cost based on their specific needs. The AI agent pricing from AltheaHealth.io is usage-based, which could be cost-effective if it delivers on its ROI promise.
D. User Reviews and Market Sentiment
G2:
Enable Healthcare (EHI EHR): Rated 5.0 out of 5 stars, but this is based on only one review.²¹

Pros (from single review): Interactive dashboard, AI-featured app easy to implement, good for managing practice data, scheduling, patient management, invoice/billing processing, care management, medical records, all in a single system.
Cons (from single review): Lack of customization for the dashboard.
Althea Smart EHR (MD Synergy): No direct G2 page found in snippets, but often compared to or an alternative for other EHRs.¹⁴² Althea Health (related to Althea.io AI agents) is mentioned as an alternative on app stores.⁷⁸
Software Advice/Capterra/Other:
Althea Smart EHR (MD Synergy): Recognized as a top-rated EMR software for 2025 by Software Advice and GetApp, earning accolades in flagship reports.¹⁴³ Consistently high ratings on Capterra and other major review sites are mentioned.¹⁸

User Quotes (from MD Synergy site, citing Software Advice ¹⁴³): “Overall experience has been great! A very easy and smooth transition from our previous EHR. Althea was easy to use, adaptable, and improved our practice management.” “I really enjoy how user friendly the app is! The features create a very efficient workflow when working on patient charts.”
User Quotes (from MD Synergy site, general ¹³³): “Super-efficient and intuitive, user-friendly.” “Took me hours to understand the system, rather than weeks.” “Haven’t taken a chart home since I started using this system.” “Telemedicine option… amazing video streaming is flawless.” “Dictation is incredibly efficient.” “Very customizable and works well with our needs.”

EHI EHR (Enable Healthcare Inc.): Customer testimonials on their website are positive: “Excellent EMR system. Everyone is helpful, easy to reach and very kind. EMR is powerful, fast and updated.” “Very easy to use EMR. Extremely responsive support staff.” “The best EMR to work with. The support team is awesome.”.¹³⁴
Apple App Store (Althea Smart EHR by Althea Care, LLC): Rated 4.5 out of 5 stars from 8 ratings.¹³⁵ Reviews praise it as “Efficient, Precise and User-friendly EMR software,” “Easy and Intuitive,” and the “Best EMR I have used,” highlighting its suitability for busy practices and ease of transition.¹³⁵ Another page shows 5.0 from 1 rating.¹³⁸
While formal G2 presence for Althea Smart EHR is limited in the snippets, and EHI EHR has very few G2 reviews, the accolades from Software Advice/GetApp for Althea, positive testimonials on vendor sites, and strong App Store ratings for Althea suggest a positive user experience, particularly around ease of use, efficiency, AI features (like dictation), and mobile functionality. The main cons from FindEMR for Althea were potential disruption during transition and limited integration with some third-party systems.¹³⁹
E. System Architecture and Integration
All-in-One vs. A La Carte:

Althea Smart EHR: Described as a single solution for EHR, Practice Management, Patient Portal, and RCM services.¹³⁸ Offers add-on features like telemedicine, text alerts, eFax.¹³²
EHI EHR (Enable Healthcare Inc.): Provides an integrated suite including AI-powered Internal Medicine EHR, practice management, billing, telehealth, voice recognition, and branded patient portal app.¹³⁷ Solutions are listed for Clinical, Billing & Admin, and Care Coordination, suggesting comprehensive coverage that can be bundled.²⁰
Interoperability:

Althea Smart EHR: Open APIs facilitate interoperability with a wide range of health IT systems.¹³⁹
EHI EHR (Enable Healthcare Inc.): Uses LOINC standards for lab interfaces for bi-directional data interchange.¹⁴⁴ The footer of their website mentions “CCDA API” and “FHIR Resources,” indicating support for these standards.²² Their data export guide details CCDA R2.1, HL7, EDI, and custom JSON data formats for exchange.¹⁴⁵
AltheaHealth.io (AI Agents): Designed to integrate with a wide range of EHR platforms.¹⁹
Both platforms appear to be designed as comprehensive, all-in-one systems, with EHI EHR offering more distinctly bundled solutions. They support key interoperability standards like FHIR and HL7 (EHI explicitly), and Althea mentions open APIs, which are crucial for data exchange in internal medicine.
F. Practice Management and Billing Capabilities
Integrated PM:

Althea Smart EHR: Includes Practice Management as part of its single solution.¹³⁸ Users report it improved practice management.¹⁴³
EHI EHR (Enable Healthcare Inc.): Offers Practice Management solutions, including an AI-driven Medical Billing App and Medical Billing Service with end-to-end claims management and a dedicated account manager. Pricing for RCM services is 5-8% of collections.¹³⁴ Specific billing system features include coordination of benefits alerts, add-on code evaluation, ICD error prevention, modifier application, patient collection prompts, and intelligent coding based on HPI.²⁰
PM Features:

Althea Smart EHR: Appointment scheduling, analytics and reporting.¹³⁹
EHI EHR: Scheduling, patient data management, robust clinical and administrative analytics.²²
Billing Software:

Althea Smart EHR: Integrated billing and insurance support.¹³³
EHI Internal Medicine EHR: Comprehensive medical billing system with AI and automation. Features include end-to-end claims management, prior authorization focus (98% approval claimed), mobile payment app for patients, ARIA AI for automated claim checks and payment posting.²⁰
Both platforms offer integrated practice management and billing solutions. EHI EHR details a particularly robust, AI-enhanced billing and RCM service, which is a significant asset for internal medicine practices focused on financial optimization.
G. Mobile Access and Patient Engagement
Mobile App/Access:

Althea Smart EHR: Built for the iOS platform (iPad, iPhone), offering a truly mobile experience for accessing records and charting on the go.¹⁸ Can be accessed through any mobile browser on iOS and Android devices as well.¹³⁹
EHI EHR (Enable Healthcare Inc.): Offers a complete mobile EHR to manage practice and patients anywhere.¹⁴⁰ Provides a proprietary practice branded app for patients in higher tiers.²² EHI Health Service app on Google Play for RPM data collection (Android).¹⁴⁸ MyEmrApp also listed under Enable Healthcare Inc. on Google Play.¹⁴⁸
Patient Engagement:

Althea Smart EHR: Patient portal for accessing health records, lab results, appointments, billing details, and secure messaging.¹³⁹ Text messaging for appointment reminders, health maintenance, and immunization reminders.¹³⁵
EHI EHR: Patient portal access, self-check-in kiosk, automated call/text/email campaigns, branded practice app (myEMRapp) for scheduling, self-check-ins, co-payments.²⁰ Solutions for Chronic Care Management (CCM), Remote Patient Monitoring (RPM), and Annual Wellness Visit (AWV) programs.²⁰
Both platforms emphasize mobile access and modern patient engagement. Althea has a strong iOS focus for its provider-facing app, while EHI offers branded patient apps and specific apps for programs like RPM. The comprehensive care coordination solutions (CCM, RPM) from EHI are particularly relevant for internal medicine.
H. Implementation and Support
Implementation:

Althea Smart EHR: Reviewers praise its intuitive design and rapid training process (minimal 30 minutes mentioned ¹³²). One user noted a “very easy and smooth transition”.¹⁴³ However, FindEMR notes that transitioning to a new EHR always requires training and may temporarily disrupt workflows.¹³⁹
EHI EHR (Enable Healthcare Inc.): Emphasizes user-friendly interfaces and customizable options.²¹ Data export guide suggests working with technology vendors to reduce implementation time.¹⁴⁵ Personalized 1-on-1 training and online training offered in higher tiers.¹⁴¹
Customer Support:

Althea Smart EHR: Reviewers consistently praise its responsive support team.¹⁸ Offers 24/7/365 phone and email support.¹³⁹
EHI EHR: Customer testimonials highlight helpful, easy-to-reach, kind, and responsive support staff.¹³⁴ Phone support is available (866-876-8272 for general inquiries, 973-241-3187 for product inquiries).¹³⁴ A contact message form is also available.¹⁵² Qualifacts (related entity or partner) mentions 97% customer support satisfaction.¹⁵³
Both Althea and EHI EHR are generally reported to have positive implementation experiences and responsive customer support, which is a significant advantage, especially for practices transitioning systems or needing ongoing assistance.
I. Other Distinguishing Factors

Strong AI Focus: Both heavily lean into AI for documentation, risk prediction (EHI), and workflow automation.
Mobile-First (Althea): Althea Smart EHR strongly emphasizes its native iOS experience.
Internal Medicine Specific Protocols (EHI): EHI EHR’s explicit mention of IM-specific HPI protocols and templates is a key differentiator.
Branded Practice Apps (EHI): The ability for practices to have their own branded mobile app is a unique offering from EHI.
The modern technological approach (AI, mobile) and specific tailoring for internal medicine (especially by EHI) make this combined entity a forward-looking choice. The positive user feedback on ease of use and support further bolsters its appeal.

Section 4: Comparative Analysis

This section provides a side-by-side comparison of the top 5 EHRs based on key features, pricing, user satisfaction, interoperability, and AI capabilities to help internal medicine practices identify the best fit for their specific needs.

A. Feature Comparison for Internal Medicine

Feature Category	NextGen Healthcare Enterprise	athenahealth athenaOne	eClinicalWorks EHR	Praxis EMR	Althea Smart EHR / EHI EHR
IM-Specific Templates	Yes (Customizable) ²	Yes (Tailorable Workflows) ⁷	Yes (Hundreds Customizable) ⁸⁵	No (Template-Free AI Learning) ¹⁶	Yes (EHI: Pre-built IM templates; Althea: Customizable) ²⁰
AI Charting/Scribe	NextGen Ambient Assist ⁴	Ambient Notes, Voice-Powered Services ⁵⁹	Sunoh.ai, AI Assistant (Eva) ¹¹	Concept Processing (Learns User) ¹⁶	EHI: enableAssist; Althea: Althea Speech, Ambient Listening ¹⁸
Integrated Telehealth	Yes ²	Yes (athenaTelehealth) ⁵⁹	Yes (healow TeleVisits) ⁷⁹	Yes ¹⁷	Yes (Unlimited in some plans) ¹³²
Patient Portal	Yes ²⁸	Yes (Integrated) ⁷	Yes (healow) ¹²	Yes (AI-Driven) ¹⁷	Yes ²²
Mobile App (Provider)	iOS primarily (NextGen Mobile) ³⁴	iOS & Android (athenaOne App) ⁷⁷	iOS & Android (eClinicalMobile) ³⁴	Web-based mobile access ¹²¹	Althea: Strong iOS; EHI: Mobile EHR, Branded App option ¹⁸
Chronic Care Management Tools	Population Health Features ⁴⁸	Population Health Support ⁵⁹	CCM, Population Health ⁷⁹	Datum+ for reporting ¹⁷	EHI: CCM, RPM, AWV programs ²⁰
Interoperability (FHIR)	Yes (Mirth Connect) ³⁴	Yes ⁷⁴	Yes (FHIR APIs) ¹⁰⁴	Inquire for specifics (HL7 supported) ¹¹⁴	EHI: Yes (FHIR Resources mentioned) ²²
All-in-One (EHR/PM/Billing)	Yes ⁴	Yes ⁷	Yes (Bundled options) ⁶⁸	Yes (Integrated options) ¹⁷	Yes ¹³⁴

B. Pricing Model Comparison

EHR System	Base Pricing Model	Estimated Starting Cost (per provider/month)	Key Cost Considerations
NextGen Enterprise EHR	Custom Quote ³⁴	$300 – $545+ ²	Implementation, training, maintenance, add-ons. No free trial.³
athenahealth athenaOne	% of Collections (4-7%) or Encounter-based ⁶³	~$140 + % of collections ⁶³	No long-term contracts. Data migration, integration, training can be extra.⁷
eClinicalWorks EHR	Fixed Fee or % of Collections (RCM) ¹²	EHR Only: $449; EHR+PM: $599 ⁶⁸	No start-up costs for standard plans; Free data migration often.⁹³ RCM 2.9%.⁶⁸
Praxis EMR	Subscription ¹¹⁴	$219 – $259 (first provider) ¹¹⁴	Support/updates extra ($70/mo). Some features/cloud access may be add-ons.¹¹⁴
Althea / EHI EHR	Tiered Subscription ¹³⁹	Althea: $200+; EHI: $250+ ¹³⁹	Numerous add-ons for EHI. Althea tiers include more features progressively.¹³⁹

Note: Pricing is subject to change and varies based on practice size, specific needs, and chosen modules/services. Direct vendor consultation is essential for accurate quotes.

C. Usability and User Satisfaction Synthesis

User satisfaction presents a varied landscape. Praxis EMR consistently leads in physician satisfaction surveys, with users lauding its AI-driven, template-free charting that adapts to their individual styles, significantly reducing documentation time and improving enjoyment of use.15 This high satisfaction stems from its fundamentally different approach to EHR interaction, which directly addresses common physician frustrations with rigid, click-heavy systems.

Althea Smart EHR / EHI EHR also garners positive feedback for ease of use, intuitive design (especially Althea’s iOS app), and efficient AI-powered documentation tools.¹³³ The rapid training time and responsive support contribute to this positive perception.¹⁸

NextGen Healthcare Internal Medicine EHR and athenahealth athenaOne receive more mixed reviews regarding usability. While both are praised for their comprehensive features and customizability, a segment of users finds them “clicky,” complex to navigate, or occasionally slow.²⁸ For athenaOne, some physicians feel it’s more geared towards billing and coding efficiency than physician documentation ease.⁵² NextGen users sometimes report an outdated feel or a steep learning curve depending on the version and customization.³⁸ Both vendors are actively incorporating AI (Ambient Assist for NextGen, Ambient Notes for athenaOne) to likely address these documentation burden complaints.⁴

eClinicalWorks Internal Medicine EHR shows the most polarized user sentiment. While its feature depth and AI initiatives are extensive, many users report significant challenges with an outdated UI, system slowness, excessive clicks, and critically, inconsistent customer support.⁹⁵ This suggests that while powerful, the actual user experience can be frustrating for a substantial number of its users.

The pattern emerging is that EHRs prioritizing a physician-centric user experience (Praxis) or leveraging modern, intuitive interfaces with AI (Althea/EHI) tend to receive higher satisfaction ratings for usability. More established, feature-heavy systems (NextGen, athenaOne, eClinicalWorks) may offer greater breadth but sometimes at the cost of a more complex or less streamlined physician interaction, a gap they are now trying to bridge with AI documentation tools.

D. Interoperability Capabilities

All top EHRs recognize the criticality of interoperability, but their approaches and highlighted strengths vary:

NextGen Healthcare Enterprise EHR: Strong support for FHIR, HL7 (via Mirth Connect), APIs, Carequality, Surescripts Record Locator, and TEFCA commitment.³⁴
athenahealth athenaOne: Supports HL7, FHIR, C-CDA, and connects to CommonWell and Carequality, with a robust API.⁶²
eClinicalWorks EHR: Features PRISMA (health information search engine), FHIR APIs, EHI Export, and various HIE/direct messaging integrations.¹³
Praxis EMR: Supports HL7 and integrates with labs and e-prescribing. Uses Datum+ for structured data from narrative text. Specifics on FHIR, CommonWell, or Carequality need direct inquiry.¹⁷
Althea Smart EHR / EHI EHR: EHI EHR supports LOINC, CCDA R2.1, HL7, EDI, and mentions FHIR Resources. Althea promotes open APIs.²²

Most leading EHRs are aligning with FHIR standards, essential for future data exchange. Connections to national networks like Carequality and CommonWell are becoming standard for established players. For internal medicine, which often involves co-managing patients with multiple specialists, robust and seamless interoperability is non-negotiable.

E. AI and Future-Readiness

AI is rapidly becoming a defining feature in EHRs, moving beyond hype to practical application.1

Praxis EMR has AI (Concept Processing) at its core, learning physician patterns for over two decades.¹⁶
eClinicalWorks has aggressively integrated AI across its platform: Sunoh.ai (scribe), Eva (assistant), Image AI (faxes), RPA, and no-show prediction.¹¹
Althea/EHI EHR heavily emphasizes AI for documentation (ambient listening, voice recognition, AI-assisted charting) and risk prediction.¹⁸
NextGen Healthcare is promoting NextGen Ambient Assist for AI-driven SOAP notes and an AI Rules Engine for billing.⁴
athenahealth uses AI for administrative tasks (insurance selection, claim creation, denial management) and is rolling out Ambient Notes and voice-powered clinical services.⁵⁷

The trend is clear: AI is being deployed to reduce administrative burden, streamline clinical documentation, improve RCM, and enhance decision support.¹ EHRs that effectively integrate these AI tools without adding complexity will be better positioned for 2025 and beyond.

Section 5: Key Considerations for Internal Medicine Practices

Choosing an Internal Medicine EHR is a significant decision with long-term implications for an internal medicine practice. Beyond the specific features of any system, several overarching considerations should guide the selection process.

A. Defining Practice Needs:
Before evaluating any EHR, a practice must clearly define its unique requirements. This involves assessing:

Practice Size and Structure: A solo practitioner has different needs than a multi-provider group or a practice with multiple locations. Scalability is key if growth is anticipated.³
Budget: EHR costs can vary significantly, from initial purchase and implementation to ongoing maintenance, subscriptions, and potential add-on modules.² A clear budget helps narrow the options.
Technical Expertise: The IT proficiency of staff will influence the choice between a highly customizable Internal Medicine EHR requiring more technical oversight versus a more straightforward, user-friendly option.³⁸
Specific Workflow Requirements: Internal medicine involves diverse patient encounters, chronic disease management, preventive care, and often complex medication regimens. The EHR must support these specific workflows efficiently. For example, how does the system handle long-term care planning, health maintenance reminders, or population health management for diabetic patients?.⁴
Specialty Focus: While all selected EHRs cater to internal medicine, the depth of specific templates, order sets, or decision support tools for common internal medicine conditions should be evaluated.

B. Importance of Demos and Trials:
Vendor demonstrations are crucial, but they should be tailored to the practice’s specific internal medicine workflows, not generic presentations.33 Practices should prepare specific use-case scenarios to test during a demo. If available, free trials or sandbox environments allow for hands-on experience, which is invaluable.2 Given the mixed reviews on usability for some systems, seeing the software in action with practice-specific data or scenarios is paramount.
C. Data Migration and Implementation Planning:
Transitioning from an old EHR (or paper records) is a significant undertaking.

Data Migration: The scope, cost, and timeline for migrating existing patient data (demographics, clinical notes, problem lists, medications, allergies, etc.) must be clearly understood.² Some vendors offer free basic demographic data migration, while full clinical data migration can be costly.⁶⁵ The integrity and completeness of migrated data are critical.
Implementation Timeline & Process: A clear implementation plan with defined responsibilities, timelines, and go-live support is essential.⁴ This includes workflow analysis, system configuration, staff training, and post-go-live optimization. The average implementation can take weeks to months.⁶⁶
Staff Training: Adequate training for all users (physicians, nurses, administrative staff) is vital for successful adoption and efficient use of the new system.⁷
D. Vendor Support and Long-term Partnership:
An EHR is a long-term investment, making the vendor relationship critical.

Support Availability and Quality: Practices should investigate the types of support offered (phone, email, chat, portal), response times, and hours of availability.¹⁶ User reviews often provide candid feedback on actual support experiences, which can differ from vendor claims.⁹
Updates and Upgrades: How does the vendor handle system updates and regulatory changes? Are these seamless, or do they cause disruption?.⁵⁹
Vendor Vision and Roadmap: Does the vendor have a clear vision for future development, particularly regarding AI, interoperability, and evolving care models?.¹
E. Scalability for Future Growth:
The chosen EHR should be able to accommodate practice growth, whether that means adding more providers, new locations, or expanded service lines.2 Cloud-based systems generally offer better scalability than server-based ones.13

The process of selecting an EHR requires careful consideration of these factors. It’s not merely about comparing feature lists but about finding a true technology partner that aligns with the practice’s clinical philosophy, operational needs, and future aspirations. The significant variation in user experiences, even with top-tier EHRs, underscores the necessity of thorough due diligence, including customized demos, reference checks with similar practices, and a clear understanding of all associated costs and support structures.

Section 6: The Future of Internal Medicine EHRs (Trends for 2025 and Beyond)

The EHR landscape is in a constant state of evolution, driven by technological advancements, regulatory shifts, and changing expectations from both providers and patients. For internal medicine practices looking towards 2025 and beyond, several key trends will significantly shape the functionality and utility of EHR systems.¹

A. Increased AI and Automation:
Artificial intelligence is poised to move from a buzzword to an indispensable component of EHRs. In 2025, AI-powered automation will extend beyond basic tasks. We anticipate more sophisticated AI-driven clinical decision support, predictive analytics for disease risk assessment and patient adherence, and significantly enhanced workflow automation.1 AI medical scribes that convert natural conversation into structured clinical notes (like Sunoh.ai, NextGen Ambient Assist, athenaOne Ambient Notes, Althea Speech) will become more refined and widely adopted, aiming to alleviate physician documentation burden—a major contributor to burnout.4 AI will also play a greater role in medical billing, coding accuracy, and revenue cycle management, improving efficiency and reducing errors.1

B. Enhanced Interoperability and Data Sharing:
The push for true interoperability—breaking down data silos between disparate healthcare systems—will continue to intensify.1 While significant progress has been made with standards like HL7 and FHIR, and networks like Carequality and CommonWell, 2025 will see increased demand for more seamless, real-time data exchange [13