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Goal: a system you can live with for a decade, judged on the dimension vendors don’t demo: how cleanly it moves money. The EHR (clinical) and PM (scheduling, claims, payments) usually come bundled, and switching costs make it a ten-year decision. Demos are clinical because the audience is clinicians. Practices bleed on billing. Weight accordingly.

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Shortlist by specialty first

Specialty fit dominates everything. Rough map: dental (Dentrix, Eaglesoft, Open Dental, cloud entrants like Curve), medical primary care and multi-specialty (athenahealth, eClinicalWorks, NextGen), therapy and behavioral health (SimplePractice, TherapyNotes, CentralReach for ABA), plus specialty-specific systems for derm, ophtho, ortho, and PT. Build a shortlist of 3 from peers in your exact specialty and size, not from search results.

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The money-side evaluation

Put these in writing to every vendor, and require demonstrations:
  • Claims out. Which clearinghouse, at what cost, with what scrubbing? Show the rejection workflow end to end.
  • Remittances in. Does it auto-post 835s? What happens with files that don’t balance, and with PLB adjustments? Can it ingest an 835 generated from a scanned EOB (how lockbox paper posts)?
  • Reconciliation surface. Can it report remittances vs. actual deposits, or does it assume posted = paid? Nearly all assume, which is why deposit-side reconciliation lives outside the PM system. It needs to export cleanly to whatever does it.
  • Eligibility and patient payments. Real-time eligibility, card-on-file, payment plans, statement costs, and the processing rates. Bundled processing is convenient and frequently overpriced. Can you bring your own processor?
  • Data out. Asked while you have leverage: what do you get if you leave? Full structured export, in what format, at what cost? A bad answer here is information about year eight.

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Contract and implementation

Price the true total: subscription, clearinghouse, statements, processing spread, implementation, training, and migration in and out. Schedule go-live far enough before opening to test claims through the full cycle. Verify integrations with live references, not the marketing page.
Lemma aside: Lemma sits on the banking side of any EHR: it reads remittances and deposits, reconciles them, and can feed 835s back into the PM system. EHRs that answer the questions above well make that easy (docs).