Epic Alternatives for Small Practices: Complete Independence Guide

Small independent practices (2-20 providers) face a challenging decision when selecting healthcare technology: follow the path of large health systems with Epic, or build a practice-independent technology stack optimized for your scale and economics.

Epic is excellent for health systems with 500+ providers. For independent practices at your scale, practice-independent alternatives save $1.46M over 5 years while giving you the flexibility to change vendors without documentation workflow disruption. Find the right fit for your practice without technology vendor lock-in.

This comprehensive guide examines Epic’s value proposition, when it makes sense for small practices (rarely), and how to build a flexible, cost-effective alternative using practice-independent tools that avoid vendor lock-in and scale naturally with your practice.

What you’ll learn:

• When Epic’s enterprise features justify its investment (health systems, academic medical centers)
• Why independent practices (2-20 providers) save $1.46M over 5 years with alternatives
• Real cost comparison: Epic $300K-$500K implementation vs OrbDoc $2,388-$4,788 annually per provider
• Success patterns from 3 practice size cohorts avoiding Epic vendor lock-in
• How to find the right fit without documentation burden or technology constraints

Built for Independent Practices (2-20 Providers) That Enterprise Solutions Overlook

Blue ocean market positioning: While Epic excels at enterprise healthcare (500+ providers, integrated health systems), independent practices (2-20 providers) represent a fundamentally different market segment. Your operational reality demands right-sized technology:

• Independent ownership: Flexibility to change vendors without $300K-$600K switching costs
• Minimal IT infrastructure: Cloud-based solutions with zero dedicated IT staff required
• Predictable economics: $2,388-$4,788 annually per provider vs $29,200-$56,200 with Epic
• Practice autonomy: Technology that adapts to your workflows, not enterprise standardization

This guide examines how to build practice-independent technology stacks optimized specifically for your scale, avoiding Epic’s vendor lock-in while maintaining clinical excellence.

Understanding Epic’s Value Proposition

Epic Systems represents the gold standard for large healthcare organizations. When you have 500+ providers, integrated delivery networks spanning multiple facilities, and enterprise-scale complexity, Epic’s comprehensive platform provides genuine strategic value.

Important context: This guide approaches Epic with respect for what they do excellently (enterprise healthcare at scale) while examining whether that excellence translates to 2-20 provider independent practices. Epic is great for the right use case. The question is whether your practice size and strategic goals match Epic’s design intent.

Epic’s Core Strengths

Comprehensive Integration: Epic isn’t just an electronic health record. It’s a complete healthcare operating system covering clinical workflows, revenue cycle management, patient engagement, population health, research databases, and administrative operations. For large health systems juggling thousands of staff members and millions of patient encounters annually, this single-vendor approach reduces integration complexity dramatically.

Proven at Scale: Epic powers 305 million patient records across 2,800+ healthcare organizations worldwide. When Mass General Brigham, Cleveland Clinic, or Kaiser Permanente need technology infrastructure supporting billions in annual revenue, Epic’s track record speaks for itself. The system is battle-tested at scales most independent practices will never approach.

Deep Clinical Workflows: Epic’s specialty-specific workflows reflect decades of refinement with academic medical centers and large physician groups. Cardiology, oncology, transplant surgery, complex multi-specialty care coordination all have mature Epic modules built by teams who understand these workflows intimately. If you’re doing cutting-edge cancer care requiring precise coordination between 15 different specialists, Epic’s depth is unmatched.

Interoperability Leadership: Epic’s Care Everywhere network connects health systems nationally. A patient seen at Penn Medicine today and University of Chicago tomorrow has their complete record available instantly. This level of interoperability requires scale, investment, and governance structures that only the largest organizations can provide.

When Epic Makes Sense

Epic isn’t an irrational choice for every organization. It makes strategic sense in specific contexts:

Scenario 1: Integrated Health System (500+ Providers) You’re not a small practice. You’re a regional health system with multiple hospitals, employed physician networks, surgery centers, and urgent care facilities. You need a single platform connecting all these entities with unified governance, standardized workflows, and consolidated data. Epic’s $20-50M implementation cost spreads across your entire organization, and the per-provider economics become reasonable at scale.

Scenario 2: Academic Medical Center You’re training the next generation of physicians, conducting research, and delivering highly specialized tertiary care. Epic’s integration with research databases, teaching tools, and complex specialty workflows justifies the investment. Your IT department has 50+ staff members dedicated to Epic optimization, and physician training happens in Epic environments.

Scenario 3: Market Leader with Growth Capital You’re not trying to remain independent. Your strategic plan involves growing from 20 providers today to 200 providers in five years through acquisition or physician employment. You need enterprise-grade infrastructure now to support that growth trajectory, and you have the capital reserves to invest $2-5M upfront.

Epic’s Market Position

In the US hospital market, Epic powers 31% of all hospital beds and dominates the large health system segment. Among organizations with 500+ physicians, Epic holds roughly 40-50% market share. This isn’t because Epic is better than all alternatives, it’s because Epic is purpose-built for exactly this market segment.

For healthcare organizations at enterprise scale, Epic’s value proposition is compelling: unified platform, proven reliability, extensive interoperability, and deep clinical functionality. The economics make sense when you’re deploying across hundreds of providers and multiple facilities.

But what about 2-20 provider independent practices?

Why Epic May Not Fit Small Practices

The same features that make Epic excellent for enterprise healthcare often create significant challenges for small independent practices. It’s not that Epic is a bad product, it’s that Epic is optimized for a completely different scale and operational model.

Economic Reality: Total Cost of Ownership

Epic Implementation Costs (10-Provider Practice):

Initial Investment:

• Software licensing: $200K-$500K (perpetual licenses or initial SaaS fees)
• Implementation and integration: $150K-$400K (6-18 months of consulting, customization, data migration)
• Hardware infrastructure: $50K-$150K (on-premises servers, network upgrades, backup systems)
• Training and go-live support: $50K-$100K (physician time, support staff training, workflow optimization)

Annual Recurring Costs:

• Software maintenance and support: $80K-$150K annually (typically 18-20% of licensing costs)
• IT infrastructure management: $60K-$120K annually (dedicated IT staff or managed services)
• Customization and optimization: $50K-$200K annually (workflow changes, specialty modules, reporting)
• Ongoing training: $20K-$40K annually (new staff, workflow updates, specialty additions)

5-Year Total Cost of Ownership: $1.46M-$2.81M for a 10-provider practice.

Per provider, this works out to $29,200-$56,200 annually. For context, the average primary care physician generates $750K-$1.2M in annual practice revenue. Epic represents 2.4-4.7% of gross practice revenue for documentation and workflow technology.

Compare to practice-independent alternatives:

• Epic implementation: $300K-$500K upfront + ongoing costs
• OrbDoc (practice-independent AI scribe): $2,388-$4,788 per provider annually (includes all features, zero setup fees, works with any EHR)
• Cloud EHR alternatives: Elation ($399/month per provider) or Tebra ($350/month per provider) run $42,000-$48,000 over 5 years per provider with zero IT overhead, zero implementation costs, and zero customization fees

5-Year Savings with Practice-Independent Alternative: $1.46M for a 10-provider practice choosing cloud EHR + modular tools over Epic.

Implementation Timeline and Disruption

Epic Implementation (10-Provider Practice):

• Planning and design: 2-4 months
• Infrastructure deployment: 1-2 months
• Data migration: 2-3 months
• Training and workflow optimization: 2-4 months
• Go-live and stabilization: 1-2 months

Total timeline: 8-15 months from contract signing to full productivity.

During this period, expect:

• 20-30% productivity decline during go-live period (2-3 months)
• Significant physician time investment in training and workflow design
• Practice revenue impact of $150K-$400K during transition
• High stress on staff managing dual systems during migration

Cloud EHR alternatives typically implement in 2-6 weeks with minimal productivity disruption. Physicians train over a weekend, go-live support happens immediately, and full productivity returns within 2-3 weeks.

IT Requirements and Dependencies

Epic Requires Dedicated IT Infrastructure:

• On-premises or hosted servers with 99.9%+ uptime requirements
• Network architecture supporting 50-100 concurrent users
• Daily backups with disaster recovery capabilities
• Security infrastructure (firewalls, VPN, access controls)
• 24/7 monitoring and support (or expensive managed services contracts)

For a 10-provider practice, this typically means:

• One full-time IT administrator ($70K-$90K annual salary plus benefits)
• Managed services contract ($5K-$10K monthly for outsourced IT support)
• Annual infrastructure refresh budget ($20K-$40K for hardware lifecycle)

Cloud EHR alternatives eliminate IT overhead entirely. The vendor manages infrastructure, security, backups, and updates. Your “IT department” is a $50/month Zoom subscription for telehealth and a practice manager who resets passwords occasionally.

Customization Costs and Vendor Lock-In

Epic’s strength is also its weakness for small practices. The system is infinitely customizable to support complex workflows, but every customization requires:

Custom Workflow Development:

• Epic consultant time: $200-$400 per hour
• Minimum projects: 20-100 hours ($4K-$40K per workflow)
• Testing and validation: Additional 10-30 hours
• Training documentation and staff education: 5-10 hours per provider

Want a custom template for your specialty? That’s $5K-$15K. Need to adjust how referrals work for your local market? Another $8K-$20K. Building a custom report for quality metrics? $3K-$10K.

Over five years, small practices typically spend $50K-$200K on customization to make Epic work for their specific workflows. Cloud EHRs allow practice managers to build templates and workflows without programming skills or consulting fees.

The Lock-In Problem:

Once you’ve invested $500K-$2M into Epic implementation and customization, switching costs become prohibitive:

• Data migration to new EHR: $100K-$300K (complex data structures, custom fields, historical records)
• Re-implementation timeline: 6-12 months (rebuilding workflows, retraining staff)
• Productivity loss during transition: $150K-$400K (revenue impact, staff overtime)
• Emotional and psychological costs: Significant (change fatigue, staff turnover, physician burnout)

Total switching cost: $350K-$900K just to leave Epic.

This is vendor lock-in by economic reality, not contractual restriction. Even if you’re unhappy with Epic, the cost of leaving keeps you committed. For a 10-provider practice, this represents 6-12 months of total practice profit locked into a single vendor decision.

Practice-independent tools avoid this trap entirely. Your EHR, AI scribe, billing system, and scheduling platform operate independently. If one vendor disappoints, you switch that component without rebuilding your entire technology stack. Your AI scribe works with Athena, eCW, Elation, Tebra, and Practice Fusion. If you change EHRs, your documentation workflow continues unchanged.

Current Approaches to EHR Selection

Small practices today generally pursue one of four paths when selecting healthcare technology. Each approach has different economics, trade-offs, and strategic implications for practice independence.

Approach 1: Epic Route Despite Small Size

Some small practices commit to Epic despite their size, typically for one of these reasons:

Reason 1: Joining Integrated Delivery Network Your practice is becoming employed by or closely affiliated with a large health system already using Epic. Your technology choice is predetermined by organizational policy. You’re adopting Epic as part of a broader strategic relationship, not as an independent technology decision.

Reason 2: Specialty Complexity Demands Your practice performs highly specialized procedures requiring Epic’s deep clinical workflows. Perhaps you’re a cardiology group doing complex ablations requiring precise integration with hospital systems. Or you’re an oncology practice participating in precision medicine trials requiring Epic’s research databases.

Reason 3: Market Interoperability Requirements Your local market is dominated by Epic-using health systems. Most of your patients have records in Epic’s Care Everywhere network, and referral partners expect seamless Epic-to-Epic data exchange. The interoperability benefits justify the implementation costs.

Economics: $1.46M-$2.81M over 5 years for 10 providers, as detailed above.

Best For: Practices with external strategic reasons to adopt Epic (employment, integration, specialty complexity) beyond pure technology evaluation.

Approach 2: Mid-Tier EHR Systems

Mid-tier EHRs like athenahealth, eClinicalWorks, and NextGen represent a middle ground between Epic’s enterprise capabilities and cloud-native simplicity. These platforms offer more features than basic cloud EHRs while costing significantly less than Epic.

Athenahealth:

• Cloud-based platform with revenue cycle management integration
• Strong billing and collections focus (contingency-based RCM model)
• Extensive third-party integration marketplace
• Implementation: 3-6 months
• Cost: $140/month base + variable RCM fees (typically 4-8% of collections)

eClinicalWorks:

• Comprehensive EHR with population health tools
• Strong in primary care and multi-specialty practices
• On-premises or cloud deployment options
• Implementation: 4-8 months
• Cost: $449/month per provider with setup fees of $10K-$50K

NextGen Healthcare:

• Specialty-focused with deep clinical content
• Customizable workflows for diverse practice types
• Ambulatory surgery center capabilities
• Implementation: 4-8 months
• Cost: $500-$600/month per provider with $20K-$75K implementation fees

5-Year Total Cost (10 providers): $400K-$800K depending on platform, customization needs, and revenue cycle services.

Economics Comparison:

• Epic: $1.46M-$2.81M
• Mid-Tier EHR: $400K-$800K
• Savings: $1.06M-$2.01M over 5 years

Best For: Practices wanting more features than basic cloud EHRs but unwilling to invest Epic-level resources. Specialty practices needing deeper workflows than primary care-focused cloud solutions. Practices with some IT capability to manage moderate implementation complexity.

Approach 3: Cloud-Native EHR Systems

Cloud-native EHRs like Elation, Tebra, DrChrono, and Practice Fusion prioritize simplicity, speed of implementation, and minimal IT overhead. These platforms sacrifice Epic’s comprehensive feature set for lower costs and faster time-to-value.

Elation:

• Primary care and direct primary care focus
• Beautiful user interface with physician-centric design
• Strong patient engagement tools
• Implementation: 2-4 weeks
• Cost: $399/month per provider, no setup fees

Tebra (formerly Kareo + PatientPop):

• Practice growth platform (EHR + marketing + billing)
• Small practice and independent practice focus
• Patient acquisition and engagement tools
• Implementation: 3-6 weeks
• Cost: $350-$450/month per provider depending on features

DrChrono:

• Mobile-first EHR with iPad/iPhone optimization
• Extensive third-party integration (200+ apps)
• Telehealth and remote care focus
• Implementation: 2-3 weeks
• Cost: $199-$499/month per provider based on features

5-Year Total Cost (10 providers): $238K-$599K for comprehensive features across these platforms.

Economics Comparison:

• Epic: $1.46M-$2.81M
• Mid-Tier: $400K-$800K
• Cloud EHR: $238K-$599K
• Savings vs. Epic: $1.22M-$2.21M over 5 years

Best For: Independent practices (2-20 providers) prioritizing speed, simplicity, and predictable economics. Practices without IT departments. Practices wanting to avoid multi-year implementation projects. Primary care and straightforward specialty practices not requiring highly complex workflows.

Approach 4: Modular Best-of-Breed Approach

Rather than selecting a single comprehensive platform, the modular approach assembles independent tools that excel at specific functions:

Core Components:

• Cloud EHR (Elation, Tebra, DrChrono): Clinical documentation and workflow
• Practice-independent AI scribe (OrbDoc): Ambient documentation across any EHR
• Billing system (Waystar, Change Healthcare): Revenue cycle management
• Scheduling platform (Phreesia, Solutionreach): Patient engagement and intake
• Telehealth tool (Zoom Healthcare, Doxy.me): Remote care delivery

Key Principle: Practice Independence

Each component works with multiple other systems. Your AI scribe isn’t locked to one EHR. Your billing system works with any EHR’s data. Your scheduling platform integrates broadly. If any vendor disappoints, you replace that component without rebuilding everything.

5-Year Total Cost (10 providers):

• Cloud EHR: $239K-$479K (Elation $399/month × 10 × 60 months)
• AI Scribe: $119K (OrbDoc $199/month × 10 × 60 months)
• Billing: $120K-$240K (3-5% of $2M annual collections)
• Scheduling/Engagement: $36K-$60K ($60-$100/month per provider)
• Telehealth: $12K-$24K ($20-$40/month per provider)

Total: $526K-$922K over 5 years

Economics Comparison:

• Epic: $1.46M-$2.81M
• Modular: $526K-$922K
• Savings: $934K-$1.89M over 5 years

Strategic Advantages:

• Flexibility: Replace underperforming components without systemic disruption
• Innovation access: Adopt new technologies as they emerge without waiting for EHR vendor
• Risk mitigation: Vendor failure or acquisition doesn’t break your entire practice technology
• Negotiating leverage: Competition between vendors keeps pricing competitive

Best For: Practices prioritizing long-term flexibility and independence. Technology-savvy practice managers comfortable coordinating multiple vendors. Practices expecting significant growth or change over 5-10 years. Practices in evolving markets where technology needs shift regularly.

Key Considerations for Small Practices

Selecting healthcare technology isn’t just about features and costs. These seven factors shape whether Epic, mid-tier EHRs, cloud platforms, or modular approaches align with your practice’s reality and strategic goals.

1. Practice Size Economics

2-5 Provider Practices:

At this scale, Epic’s economics are nearly impossible to justify. A 3-provider practice generating $2.25M-$3.6M annually would spend 8-12% of total revenue on Epic over 5 years ($292K-$562K per provider). Cloud EHR alternatives run 1.2-2% of revenue for the same period.

Administrative overhead matters significantly at small scale. With 5-8 total staff members, adding a full-time IT administrator for Epic support increases labor costs by 12-15%. Cloud systems require zero dedicated IT.

Realistic alternatives:

• Cloud EHR + practice-independent AI scribe: $150K-$320K over 5 years (3 providers)
• Mid-tier EHR with integrated features: $180K-$360K over 5 years

6-10 Provider Practices:

Epic remains expensive but becomes marginally more defensible. A 10-provider practice generates $7.5M-$12M annually, so Epic’s $1.46M-$2.81M represents 4-7% of 5-year revenue. Still significant, but not practice-threatening.

At this scale, you might afford a part-time IT administrator or managed services contract to support Epic infrastructure. However, you’re still paying enterprise prices without gaining enterprise benefits like multi-facility integration or research capabilities.

Realistic alternatives:

• Cloud EHR + modular tools: $526K-$922K over 5 years (10 providers)
• Mid-tier EHR with comprehensive features: $400K-$800K over 5 years
• Savings vs. Epic: $934K-$2.01M over 5 years

11-20 Provider Practices:

This is the threshold where Epic’s per-provider economics approach reasonability. A 20-provider practice generates $15M-$24M annually, and Epic’s cost becomes 2.4-3.8% of 5-year revenue. You can support a dedicated IT administrator whose salary is absorbed across larger revenue base.

However, most 11-20 provider practices still don’t gain Epic’s primary benefits:

• Single facility location (no multi-facility integration complexity)
• Limited specialty diversity (not coordinating 15+ specialties)
• Independent ownership (not part of integrated delivery network)

Epic’s strengths shine at 50+ providers with multiple locations and complex coordination needs. At 11-20 providers, you’re paying for enterprise capabilities you won’t use for years, if ever.

Realistic alternatives:

• Mid-tier or cloud EHR + modular tools: $1.05M-$1.84M over 5 years
• Epic: $2.92M-$5.62M over 5 years (20 providers)
• Savings: $1.87M-$3.78M over 5 years

2. Growth Trajectory and Strategic Planning

Static Practice Model:

If you’re planning to maintain current size (±2 providers) over the next 5-10 years, Epic provides no growth-related benefits. You’re investing in scalability you’ll never use. Cloud EHRs and modular approaches offer better economics for stable small practices.

Moderate Growth (2x over 5 years):

Growing from 10 to 20 providers over 5 years suggests steady expansion without dramatic transformation. Cloud EHRs and mid-tier systems scale linearly (predictable per-provider pricing). Epic requires renegotiating enterprise agreements and potentially significant infrastructure upgrades.

Aggressive Growth (5x over 5 years):

Planning to grow from 10 to 50+ providers through acquisition or rapid employment? This is where Epic’s enterprise capabilities start making sense. You’re building infrastructure today for the organization you’ll become. The $1.5M-$2.8M investment spreads across future provider count, and switching costs would be even higher if you start with cloud EHR and migrate to Epic later.

Critical question: Do you have the capital reserves and organizational capacity to invest in Epic now for growth you expect in 3-5 years? Or do you need to preserve capital for actual practice expansion (recruiting physicians, opening locations, adding services) rather than enterprise EHR infrastructure?

3. Specialty-Specific Workflow Complexity

Primary Care and Straightforward Specialties:

Family medicine, internal medicine, pediatrics, and general psychiatry typically operate with relatively standardized workflows. Cloud EHRs like Elation, Tebra, and DrChrono handle these workflows excellently. Epic’s additional complexity provides minimal clinical benefit.

Procedure-Heavy Specialties:

Gastroenterology, cardiology, orthopedics, and other procedure-oriented specialties need procedure documentation, equipment integration, and billing complexity beyond basic office visits. Mid-tier EHRs like athenahealth and eClinicalWorks offer strong specialty modules. Epic provides deeper capabilities but at 2-3x the cost.

Highly Complex Multi-Specialty Coordination:

Oncology practices coordinating chemotherapy, surgery, radiation, and palliative care across multiple subspecialists benefit from Epic’s depth. Transplant programs managing pre-transplant evaluation, surgery, and lifelong follow-up rely on Epic’s comprehensive tracking. Pediatric specialty practices coordinating with children’s hospitals often align with Epic for interoperability.

If your practice routinely coordinates 5+ different specialties and participates in complex clinical programs with Epic-using hospital partners, the integration benefits might justify the investment.

4. Budget Constraints and Capital Availability

Limited Capital (Less than $100K available):

Cloud EHR is the only realistic option. Epic requires $450K-$1.05M in first-year costs (implementation + licensing + infrastructure). Mid-tier EHRs require $50K-$150K upfront. Cloud systems like Elation ($399/month × 10 providers = $3,990/month) can start with zero upfront investment and scale monthly.

Moderate Capital ($100K-$300K available):

Mid-tier EHRs become accessible at this level. eClinicalWorks or NextGen can implement within this budget with ongoing monthly costs around $5K-$6K for 10 providers. Cloud EHR + comprehensive modular tools (AI scribe, advanced billing, telehealth) also fit comfortably within this budget.

Strong Capital (More than $500K available):

Epic becomes technically affordable, but the question shifts from “can we afford this?” to “is this the best use of capital?” Would $500K-$1.5M invested in recruiting physicians, opening a second location, or adding profitable service lines generate better ROI than Epic implementation?

For most 2-20 provider practices, the answer is yes. Physician recruitment and facility expansion typically generate 20-40% annual returns. Epic generates time savings and workflow improvements but rarely transforms practice revenue or profitability at small scale.

5. IT Capability and Technical Expertise

Zero IT Infrastructure:

Most 2-20 provider practices have a practice manager who handles passwords and a relationship with a local IT consultant for occasional network issues. Epic requires dedicated IT expertise (full-time administrator or expensive managed services contract). Cloud systems require essentially zero IT capability beyond basic internet and device management.

Basic IT Support:

If you have a part-time IT person or reliable managed services relationship, mid-tier EHRs become manageable. eClinicalWorks or athenahealth hosted deployments offload infrastructure management while still requiring some technical oversight for integrations and customization.

Dedicated IT Department:

Only at this level does Epic become operationally feasible. You need someone who can manage servers, coordinate vendor support, troubleshoot integration issues, and optimize workflows through technical configuration. For practices under 20 providers, hiring a full-time IT administrator ($70K-$90K plus benefits) rarely makes financial sense unless you’re planning significant growth.

6. Vendor Lock-In vs. Practice Independence Philosophy

This is often overlooked but strategically crucial: what’s your practice’s philosophy about vendor relationships and long-term flexibility?

Willing to Accept Vendor Lock-In:

Some practices view comprehensive platforms like Epic or athenahealth as strategic partnerships. They’re comfortable committing to a single vendor for 10-15+ years in exchange for tightly integrated features. The switching costs ($350K-$900K for Epic) don’t concern them because they have no intention of switching.

This approach works well if:

• You’re confident in your vendor’s long-term product roadmap
• Your practice model won’t change significantly over 10+ years
• You prioritize tight integration over flexibility
• You have capital and expertise to make switching economically impractical

Prioritizing Practice Independence:

Other practices view healthcare technology as modular and replaceable. They want the flexibility to switch EHRs, adopt new AI tools, change billing systems, and integrate emerging technologies without asking permission or paying switching penalties.

This approach works well if:

• Your practice is evolving rapidly (new services, locations, business models)
• You want to adopt innovation as it emerges, not wait for vendor roadmaps
• You value negotiating leverage with vendors (competition keeps pricing fair)
• You’re uncertain about 10-year technology predictions

Practice-independent tools enable this philosophy:

• AI scribe works with any EHR (switch EHRs without retraining documentation workflows)
• Billing system integrates broadly (not locked to single EHR’s billing module)
• Scheduling and telehealth platforms operate independently
• Each component replaceable without systemic disruption

7. Geographic and Market Context

Urban Market with Epic-Dominated Health Systems:

If your primary referral partners, local hospitals, and competing practices all use Epic, the interoperability benefits become more compelling. Epic-to-Epic data exchange is seamless. Patients expect their records to flow automatically between providers. Care coordination happens through shared Epic access rather than faxes and phone calls.

However, even in Epic-dominated markets, small independent practices often thrive with cloud EHRs by focusing on service quality, patient experience, and clinical niches where interoperability matters less than primary care excellence.

Rural or Underserved Market:

Epic rarely makes sense in rural contexts. Implementation and ongoing support require vendor access that’s challenging in remote areas. Internet connectivity for cloud-based Epic deployments may be unreliable. The healthcare ecosystem is less Epic-dominated, reducing interoperability pressure.

Rural practices benefit enormously from offline-capable technology (document without internet connectivity) and minimal IT overhead (no local IT administrator available). Cloud EHRs with progressive web app architecture and practice-independent AI scribes that work fully offline align better with rural operational realities.

Competitive Independent Market:

In markets with many independent practices and no dominant health system, vendor diversity is high. Your colleagues use athenahealth, eClinicalWorks, Elation, and Practice Fusion. No single platform dominates. Interoperability happens through traditional channels (faxes, electronic referrals, patient portals) rather than Epic’s Care Everywhere.

In this context, practice independence and cost optimization matter more than Epic integration. Modular best-of-breed approaches let you assemble the exact capabilities your practice needs without paying for unused enterprise features.

Evaluating Alternatives to Epic

If your practice size (2-20 providers), growth trajectory (stable or moderate), specialty (not highly complex), budget (capital-constrained), IT capability (minimal), independence philosophy (avoiding lock-in), or market context (non-Epic-dominated) suggests Epic isn’t the right fit, how do you evaluate alternatives systematically?

These evaluation criteria help you compare cloud EHRs, mid-tier platforms, and modular approaches objectively.

Must-Have Criterion 1: Practice-Independent Architecture

What This Means:

Your technology stack should work with multiple EHRs, not lock you into one vendor’s ecosystem. If you decide to change EHRs in 3 years, your AI scribe, billing system, scheduling platform, and telehealth tools continue working without disruption.

Why This Matters:

The average small practice changes EHRs every 5-7 years. Reasons include:

• Vendor acquisition changes product direction or pricing
• Practice growth outgrows current platform capabilities
• New technology emerges that better fits your workflows
• Vendor service quality declines after ownership changes
• Financial pressure to reduce technology spending

If your AI scribe is built into your EHR (Athena’s Augmedix integration, Epic’s AI features), switching EHRs means retraining your entire documentation workflow. Your physicians spent 6-12 months mastering the integrated scribe, and now they’re starting over.

Practice-independent AI scribes work the same way regardless of your EHR. Switch from Elation to Tebra? Your documentation workflow continues unchanged. Your training investment persists. Your productivity remains stable during EHR transition.

How to Evaluate:

Ask vendors: “If we change EHRs in 3 years, does your product continue working with our new system?”

• ✅ Practice-independent: “Yes, we integrate with 20+ EHRs. Your workflows stay the same.”
• ❌ Vendor-locked: “Our product is built specifically for Epic/Athena/Cerner. Switching EHRs means replacing our tool.”

Must-Have Criterion 2: Predictable Economics

What This Means:

Your technology costs should be transparent, simple, and predictable. Per-provider monthly pricing with no hidden fees, surprise charges, or complex pricing tiers. You can calculate your 5-year total cost of ownership in 5 minutes using basic math.

Why This Matters:

Small practices operate on thin margins (8-15% net profit for primary care). Technology spending competes with staff salaries, facility costs, and physician compensation. Unpredictable costs create budget stress and limit your ability to plan investments.

Hidden costs kill small practice budgets:

• Implementation fees that double the first-year cost
• Customization charges ($5K-$40K per workflow)
• Support fees for basic functionality (extra for phone support vs. email)
• Upgrade fees when vendor releases new features
• Training fees for new staff or workflow changes
• Integration fees for connecting to billing, labs, imaging
• Termination fees when you decide to switch (1-2 years remaining contract value)

How to Evaluate:

Ask vendors: “What’s our total 5-year cost for 10 providers including all fees?”

• ✅ Predictable: “$199/month × 10 providers × 60 months = $119,400. Zero setup fees, zero customization fees, zero termination fees.”
• ❌ Unpredictable: “$399/month per provider base fee, plus $50K implementation, plus customization billed hourly ($200-$400/hour as needed), plus 20% annual maintenance fee on customizations, plus support tiers ($0 for email, $2,500/month for phone support).”

Calculate per-provider annual cost and compare:

• Cloud EHR: $2,388-$4,788 per provider annually (Elation $199/month = $2,388)
• Mid-tier EHR: $4,000-$7,200 per provider annually plus implementation costs
• Epic: $29,200-$56,200 per provider annually including all costs

Must-Have Criterion 3: Zero IT Burden

What This Means:

Your practice manager can administer the system without hiring IT staff or retaining expensive managed services contracts. Cloud-based architecture with automatic updates, zero server maintenance, and vendor-managed security. Support is responsive and included in base pricing, not an expensive add-on.

Why This Matters:

A full-time IT administrator costs $90K-$120K annually (salary plus benefits) for a 10-provider practice. Managed services contracts run $5K-$10K monthly ($60K-$120K annually). For practices generating $7.5M-$12M in annual revenue, IT overhead of $90K-$120K represents 1-1.5% of revenue for infrastructure management that doesn’t improve patient care.

Cloud systems eliminate this entirely. The vendor manages:

• Server infrastructure and uptime
• Security patches and vulnerability management
• Software updates and new feature deployment
• Data backups and disaster recovery
• Compliance maintenance (HIPAA, state regulations)

Your practice manager handles:

• User account creation and password resets
• Workflow customization using visual configuration tools
• Report building using built-in analytics
• Integration management through pre-built connectors

How to Evaluate:

Ask vendors: “What IT expertise do we need on staff to run this?”

• ✅ Zero IT burden: “Your practice manager can handle everything through our web interface. We manage all infrastructure. Updates happen automatically overnight. Support included at no extra cost.”
• ❌ Significant IT burden: “You’ll need an IT administrator or managed services contract to maintain servers, coordinate updates, manage backups, and troubleshoot integration issues. Support is available during business hours for $2,500/month.”

Must-Have Criterion 4: Custom Workflows Without Customization Fees

What This Means:

Your practice manager can build specialty-specific documentation templates, modify workflows to match your processes, and create custom forms without paying hourly consulting fees or vendor customization charges. Configuration tools are visual and intuitive, not programming environments requiring technical expertise.

Why This Matters:

Every practice has unique workflows reflecting their specialty, physician preferences, local market requirements, and operational evolution. A gastroenterology practice needs colonoscopy procedure templates. A psychiatry practice needs psychiatric diagnostic interview structures. A primary care practice with cash-pay memberships needs custom visit types.

Epic and mid-tier EHRs charge $5K-$40K per custom workflow because customization requires Epic-certified consultants working in complex technical environments. Over 5 years, small practices spend $50K-$200K on customizations just to make their EHR match basic workflows.

Cloud EHRs increasingly offer visual workflow builders:

• Drag-and-drop template creation
• If-then logic for dynamic forms (if patient answers “yes” to depression screening, show PHQ-9)
• Custom fields and data capture without database programming
• Workflow automation without scripting

This lets your practice manager build customizations in hours, not months, with zero consulting fees.

How to Evaluate:

Ask vendors: “Can we build a custom procedure note template ourselves, or do we need to hire consultants?”

• ✅ Self-service customization: “Our template builder lets you create any workflow in 30-60 minutes using drag-and-drop. No programming required. Unlimited custom templates included.”
• ❌ Vendor-dependent customization: “Custom templates require our professional services team. Minimum project size is $5K (20 hours at $250/hour). Timeline is 4-8 weeks from request to deployment.”

Nice-to-Have Criterion: Modular Architecture

What This Means:

You can add or remove features as your practice evolves without renegotiating contracts or rebuilding integrations. Start with basic EHR and ambient documentation, add telehealth when you launch virtual visits, integrate advanced billing when you hire a revenue cycle specialist, connect population health tools when you join an ACO.

Why This Matters:

Small practices evolve unpredictably. You might:

• Add new services (procedure suite, imaging, infusion center)
• Expand to new locations (second office, mobile clinic)
• Change payer mix (more Medicare, add Medicaid, launch cash-pay program)
• Integrate new care models (chronic care management, remote patient monitoring)

Modular architecture lets you adapt without systemic disruption. Epic and comprehensive platforms require you to buy (and pay for) features you won’t use for years. Cloud modular approaches let you add features when needed:

• Year 1: EHR + AI scribe ($500/month per provider)
• Year 2: Add telehealth ($30/month per provider)
• Year 3: Add advanced billing system ($150-$250/month per provider)
• Year 4: Add chronic care management tools ($100/month per provider)

You’re only paying for what you actively use, and each component remains replaceable.

How to Evaluate:

Ask vendors: “Can we start with basic features and add modules later without reimplementation?”

• ✅ Modular: “Absolutely. Each module activates with a simple toggle. Add telehealth, billing, patient engagement, or population health whenever you’re ready.”
• ❌ All-or-nothing: “Our platform is comprehensive from day one. You get all features whether you use them or not. Adding features later requires reconfiguration and potential additional implementation costs.”

Implementation: Building Independent Practice Tech Stack

If you’ve decided Epic doesn’t fit your practice size, economics, or operational model, how do you build a practice-independent technology stack that delivers excellent clinical workflows, predictable costs, and long-term flexibility?

This three-phase implementation approach balances immediate needs (functional EHR), quick wins (documentation efficiency), and long-term optimization (integrated workflows).

Phase 1: Select Cloud EHR (Foundation)

Timeline: Weeks 1-4

Your EHR is the foundation of practice operations. It must handle clinical documentation, e-prescribing, lab integration, patient scheduling, and regulatory compliance. But for small practices, it doesn’t need to do everything. Focus on core clinical workflows first.

Evaluation Criteria:

1. Clinical functionality: Does it handle your specialty’s common workflows?
2. Regulatory compliance: MIPS reporting, MACRA, state-specific requirements?
3. Implementation speed: Can you go live in 2-4 weeks, not 4-6 months?
4. Pricing transparency: Simple per-provider pricing with zero hidden fees?
5. Integration ecosystem: Does it connect to labs, imaging, billing systems you need?

Top Options for 2-20 Provider Independent Practices:

Elation Health ($399/month per provider):

• Built for primary care and direct primary care
• Beautiful user interface, physician-designed workflows
• Strong patient engagement tools (portal, messaging, automated outreach)
• Fast implementation (2-3 weeks typical)
• No setup fees, no contracts, cancel anytime

Best for: Primary care practices prioritizing user experience and patient engagement. Direct primary care practices needing membership management. Practices valuing design and usability.

Tebra ($350-$450/month per provider):

• Merged platform (Kareo EHR + PatientPop marketing)
• Practice growth focus (marketing, online scheduling, reputation management)
• Integrated billing and revenue cycle management
• Mid-range implementation (3-4 weeks typical)
• Some setup fees depending on configuration

Best for: Practices prioritizing patient acquisition and growth. Smaller practices (2-8 providers) wanting all-in-one simplicity. Practices without dedicated billing staff (integrated RCM).

DrChrono ($199-$499/month per provider):

• Mobile-first design (iPad/iPhone optimized)
• Extensive third-party integration marketplace (200+ apps)
• Telehealth built-in at all pricing tiers
• Fast implementation (2-3 weeks typical)
• No setup fees, flexible pricing tiers

Best for: Mobile and technology-forward practices. Specialties doing procedures or bedside documentation. Practices wanting to heavily customize through third-party integrations.

Implementation Steps:

Week 1: Vendor demos and decision

• Schedule demos with 2-3 top contenders
• Focus on core workflows: encounter notes, prescribing, orders
• Verify integration with your labs, imaging, billing systems
• Check references from practices similar to yours
• Make decision by end of week

Week 2: Data migration and configuration

• Export patient demographics from old system
• Import into new EHR (vendor typically provides migration support)
• Configure practice settings (locations, providers, schedules)
• Build 3-5 core note templates
• Set up e-prescribing and lab integrations

Week 3: Training and parallel testing

• 2-hour training session for physicians
• 1-hour training for front desk and clinical staff
• Run parallel documentation (old EHR + new EHR) for 1 week
• Identify workflow issues and adjust configuration
• Build confidence before full transition

Week 4: Go-live and optimization

• Full cutover to new EHR
• Daily check-ins with vendor support
• Address issues in real-time
• Continue building templates based on actual use
• Stabilize workflows by end of week

Cost: $0-$5,000 (most cloud EHRs have zero or minimal implementation fees)

Phase 2: Add Practice-Independent AI Scribe

Timeline: Weeks 5-6 (After EHR Stability)

Once your EHR is stable (2-3 weeks post-go-live), add ambient documentation to reclaim 1.5-2 hours daily per physician. The key is choosing a practice-independent AI scribe that works with your current EHR and any future EHR you might adopt.

Why Practice Independence Matters:

You just spent 4 weeks implementing a new EHR. The last thing you want is your AI scribe forcing you into EHR lock-in. If you’re unhappy with your EHR choice in 2 years, practice-independent AI scribes let you switch EHRs without retraining documentation workflows.

Evaluation Criteria:

1. EHR independence: Works with multiple EHRs, not built into one vendor’s system?
2. Offline capability: Documents without internet (rural practices, basements, mobile clinics)?
3. Evidence-linking: Claim-level audio timestamps for audit defense?
4. Custom workflows: Configurable templates without consulting fees?
5. Predictable pricing: Simple per-provider monthly cost?

OrbDoc Example (Practice-Independent AI Scribe):

• Works with any EHR (Elation, Tebra, DrChrono, athenahealth, eClinicalWorks, Epic, Practice Fusion)
• $199/month per provider, zero setup fees, zero training fees
• Offline-first mobile architecture (full functionality without internet)
• Evidence-linking technology (60-second package generation (total response 90-120 minutes) audit defense with claim-level audio timestamps)
• 7-year audio retention (long-term compliance storage)
• Practice-configurable templates and workflows

10-provider practice 3-year cost:

• OrbDoc: $71,640 ($199/month × 10 × 36 months)
• Time savings: 520-780 hours annually per provider
• Revenue capture opportunity: $25K-$148K annually (AWV, TCM, CCM, BHI forms auto-captured)

Implementation Steps:

Week 5: Setup and pilot

• Sign up takes 10 minutes (email, practice info, provider list)
• Download mobile app (iOS/Android) or web interface
• 30-minute onboarding video for all physicians
• 1-2 physicians pilot for 1 week (shadow existing documentation)
• Collect feedback and adjust configuration

Week 6: Full deployment

• All physicians start using AI scribe for all encounters
• Daily productivity tracking (time savings, note completeness)
• Optimize templates based on actual encounter patterns
• Integrate with EHR workflows (copy-paste, voice commands, automation)

Cost: $0 setup + $1,990/month ongoing (10 providers)

Phase 3: Integrate Billing, Scheduling, and Engagement Tools

Timeline: Months 2-4 (After Documentation Workflows Stabilize)

With EHR and documentation workflows stable, optimize billing, scheduling, and patient engagement. This is where modular architecture shines: choose best-of-breed tools rather than settling for your EHR’s built-in (often mediocre) modules.

Billing and Revenue Cycle Management:

Most cloud EHRs have basic billing, but dedicated billing systems or revenue cycle management services often deliver better results:

Option 1: Keep EHR’s Built-In Billing

• Pros: Already integrated, included in base price, simple
• Cons: Limited features, no optimization, practice handles all collections
• Best for: Very small practices (2-5 providers) with simple payer mix

Option 2: Third-Party Billing Software

• Tools: Kareo Billing, AdvancedMD, CareCloud
• Pros: More features, better reporting, competitive pricing
• Cons: Integration work, learning curve, practice still handles collections
• Cost: $150-$250/month per provider
• Best for: 6-15 provider practices with capable billing staff

Option 3: Revenue Cycle Management Service

• Services: Athenahealth RCM, R1 RCM, Change Healthcare
• Pros: Full service (claims, denials, collections), expertise, usually increases collections 5-15%
• Cons: Percentage-based fees (4-8% of collections), less control
• Cost: 4-8% of collections (for $7.5M practice = $300K-$600K annually)
• Best for: Practices without dedicated billing expertise or with complex payer mix

Patient Scheduling and Engagement:

Option 1: EHR’s Built-In Scheduling

• Pros: Integrated, included, simple
• Cons: Limited patient-facing features, no online booking or intake automation
• Best for: Practices with simple scheduling and strong front desk

Option 2: Dedicated Scheduling Platform

• Tools: Phreesia, Solutionreach, Luma Health
• Pros: Online booking, automated reminders, digital intake, patient communication
• Cons: Monthly cost, integration required
• Cost: $60-$100/month per provider
• Best for: Practices wanting to reduce no-shows and automate patient communication

Telehealth:

Option 1: EHR’s Built-In Telehealth

• Pros: Integrated with encounters, included or low cost
• Cons: Often basic features, limited reliability
• Best for: Occasional telehealth (less than 20% of visits)

Option 2: Dedicated Telehealth Platform

• Tools: Zoom Healthcare, Doxy.me (free tier available)
• Pros: High reliability, better video quality, reasonable cost
• Cons: Separate login, encounter needs copying to EHR
• Cost: $0-$40/month per provider
• Best for: Practices doing regular telehealth (20%+ of visits) or in rural markets

Total Modular Stack Cost (10 Providers, 5 Years):

• Cloud EHR (Elation): $239,400 ($399/month × 10 × 60 months)
• AI Scribe (OrbDoc): $119,400 ($199/month × 10 × 60 months)
• Billing Software: $180,000 ($200/month × 10 × 60 months, or use RCM percentage model)
• Scheduling/Engagement: $48,000 ($80/month × 10 × 60 months)
• Telehealth: $12,000 ($20/month × 10 × 60 months)

Total: $598,800 over 5 years

Savings vs. Epic: $1.86M-$2.21M (Epic costs $2.46M-$2.81M for same practice)

Measuring Success: TCO vs. Epic

Beyond initial pricing, how do you evaluate the total cost of ownership for Epic vs. practice-independent alternatives? These calculations include all costs: implementation, licensing, IT infrastructure, training, customization, and switching costs.

5-Year Total Cost of Ownership: 10-Provider Practice

Epic Implementation and Ongoing Costs:

Initial Implementation (Year 1):

• Software licensing: $400,000 (mid-range for 10-provider practice)
• Implementation consulting: $250,000 (6-12 months of Epic-certified consultants)
• Hardware infrastructure: $100,000 (servers, network, backup systems)
• Training and go-live support: $75,000 (physician time, staff training, workflow optimization)
• Year 1 Total: $825,000

Annual Recurring Costs (Years 2-5):

• Software maintenance: $100,000 annually (18-20% of licensing)
• IT infrastructure management: $90,000 annually (full-time IT administrator)
• Customization and optimization: $100,000 annually (average, varies widely)
• Ongoing training: $30,000 annually (new staff, workflow changes)
• Annual Recurring: $320,000

5-Year Total: $2,105,000 ($825K year 1 + $320K × 4 years)

Per-provider annual cost: $42,100

Cloud EHR + Modular Tools (Practice-Independent Stack):

Implementation (Month 1):

• EHR implementation: $0 (Elation has no setup fees)
• AI scribe setup: $0 (OrbDoc has no setup fees)
• Billing software setup: $2,000 (one-time integration)
• Scheduling platform setup: $1,000 (configuration and training)
• Total Implementation: $3,000

Monthly Recurring (60 months):

• Cloud EHR (Elation): $3,990/month ($399 × 10 providers)
• AI Scribe (OrbDoc): $1,990/month ($199 × 10 providers)
• Billing software: $2,000/month ($200 × 10 providers)
• Scheduling/engagement: $800/month ($80 × 10 providers)
• Telehealth: $200/month ($20 × 10 providers)
• Monthly Total: $8,980

5-Year Total: $541,800 ($3K setup + $8,980 × 60 months)

Per-provider annual cost: $10,836

Direct Comparison: Epic vs. Practice-Independent Stack

Savings with practice-independent stack: $1,563,200 over 5 years for a 10-provider practice.

Switching Cost Analysis: Vendor Lock-In Impact

Epic Switching Costs (If Unhappy After 3 Years):

You’ve invested $1.785M into Epic over 3 years ($825K + $320K × 3). You’re unhappy with the system and want to switch to a cloud EHR. What does it cost to escape?

• Data migration to new EHR: $150,000 (Epic’s complex data structures, custom fields, 3 years of records)
• New EHR implementation: $5,000 (cloud EHR has minimal setup)
• Workflow rebuilding: $75,000 (physician time relearning documentation, staff retraining)
• Productivity loss during transition: $200,000 (revenue impact, overtime, temporary productivity decline)
• Epic contract termination: $50,000 (remaining contract value pro-rated)

Total switching cost: $480,000 just to leave Epic after 3 years.

Cumulative investment lost: $1.785M (your 3-year Epic investment has zero salvage value)

Total cost of Epic failure: $2.265M ($1.785M sunk + $480K to switch)

Practice-Independent Stack Switching Costs (If Unhappy After 3 Years):

You’ve invested $326,340 into modular stack over 3 years ($3K + $8,980 × 36 months). You’re unhappy with your EHR and want to switch to a different one. What does it cost?

• Data migration to new EHR: $5,000 (cloud EHR to cloud EHR is straightforward)
• New EHR implementation: $2,000 (another cloud EHR with simple setup)
• Workflow continuity: $0 (AI scribe works with new EHR, billing continues unchanged, scheduling unaffected)
• Training: $5,000 (physicians learn new EHR interface, but documentation workflow stays the same)
• Contract termination: $0 (most cloud EHRs have no contracts or minimal penalties)

Total switching cost: $12,000 to change EHRs in modular stack.

Cumulative investment retained: $197,400 (AI scribe, billing, scheduling tools continue working. Only EHR component replaced: $128,940 over 3 years)

Effective cost of EHR dissatisfaction: $140,940 ($128,940 EHR investment + $12K switching cost)

ROI Analysis: Time Savings and Revenue Impact

Time Savings Value:

AI medical scribe saves 1.5-2 hours daily per physician. For 10 physicians working 220 days annually:

• Time savings per physician: 330-440 hours annually
• Total time savings (10 physicians): 3,300-4,400 hours annually
• Physician hourly value: $200-$300 (based on $400K-$600K annual compensation)

Annual value of time savings: $660,000-$1,320,000

Over 5 years: $3.3M-$6.6M in reclaimed physician time.

What can you do with reclaimed time?

• See 15-20% more patients (increase revenue without adding providers)
• Improve documentation quality (reduce audit risk, increase coding accuracy)
• Enhance patient experience (more time listening, less time typing)
• Reduce burnout (leave work on time, reclaim evenings and weekends)
• Add new services (procedures, chronic care management, preventive care)

Revenue Capture Opportunity:

AI scribes with revenue intelligence (AWV, TCM, CCM, RPM, BHI form auto-capture) increase Medicare billing by $25K-$148K annually for a 10-provider primary care practice. This isn’t hypothetical: it’s capturing billable services you’re providing but not documenting properly.

5-year revenue capture: $125K-$740K

Combined value over 5 years:

• Time savings value: $3.3M-$6.6M
• Revenue capture: $125K-$740K
• Total value: $3.425M-$7.34M

Against this value, what’s the ROI?

• Epic investment: $2.105M for 3-6% of time savings value (Epic improves workflows but doesn’t provide ambient documentation)
• Practice-independent stack: $541,800 for 100% of time savings + revenue capture value

Practice-independent stack ROI: 532%-1,254% over 5 years.

Hidden Costs Comparison

Epic Hidden Costs:

• Customization fees: $50K-$200K over 5 years (unpredictable)
• IT administrator salary: Already included in $90K annually
• Productivity loss during implementation: $200K-$400K (not included in TCO above)
• Training time opportunity cost: $50K-$100K (physician time away from patients)
• Contract renegotiation costs: $20K-$50K (legal, procurement time for renewals)

Additional hidden costs over 5 years: $320K-$750K

Adjusted Epic 5-year TCO: $2.425M-$2.855M

Practice-Independent Stack Hidden Costs:

• Customization fees: $0 (self-service configuration included)
• IT support: $0 (cloud vendors manage infrastructure)
• Productivity loss: Minimal ($10K-$20K during 2-4 week implementation)
• Training time: $5K-$10K (brief onboarding for cloud systems)
• Contract management: Minimal ($1K-$2K for annual reviews)

Additional hidden costs over 5 years: $16K-$32K

Adjusted practice-independent 5-year TCO: $557,800-$573,800

Final savings comparison: $1.851M-$2.297M over 5 years for 10-provider practice choosing practice-independent stack over Epic.

How Practice-Independent AI Scribe Fits

In the context of Epic alternatives for small practices, where does a practice-independent AI scribe like OrbDoc fit strategically? It’s not an EHR replacement. It’s a documentation layer that works with any EHR you choose, providing flexibility and preventing vendor lock-in.

The EHR-Independent Value Proposition

Works With Any EHR Choice:

Most AI scribes are built into specific EHRs or tightly integrated with one vendor’s ecosystem:

• Epic’s AI features only work within Epic
• Athena’s Augmedix integration is Athena-specific
• Some AI scribes require specific EHR versions or modules

Practice-independent AI scribes take a different approach: they work with whatever EHR you have today and whatever EHR you might choose tomorrow. Your documentation workflow remains consistent across EHR changes.

Current EHR compatibility (practice-independent AI scribes like OrbDoc):

• Cloud EHRs: Elation, Tebra, DrChrono, Practice Fusion
• Mid-tier EHRs: athenahealth, eClinicalWorks, NextGen
• Enterprise EHRs: Epic, Cerner (if you choose them despite being small practice)
• Specialty EHRs: ModMed (dermatology), Clinicient (physical therapy), TherapyNotes (behavioral health)

Switching EHRs Without Losing Documentation Investment

Scenario: You implement Elation + OrbDoc today

Year 1: Your 10 physicians master Elation’s interface and OrbDoc’s ambient documentation. They’re saving 1.5 hours daily and loving the workflow. Total investment:

• Elation: $47,880 annually ($399/month × 10 × 12 months)
• OrbDoc: $23,880 annually ($199/month × 10 × 12 months)
• Total: $71,760 annually

Year 3: Elation gets acquired. The new owner changes pricing dramatically and cuts support quality. You’re unhappy and want to switch to Tebra.

With EHR-locked AI scribe: Your documentation workflow is built into Elation. Switching to Tebra means:

• Losing your AI scribe investment and training
• Physicians relearn documentation workflows from scratch
• Productivity drops during transition
• Total disruption takes 4-6 months to stabilize

With practice-independent AI scribe (OrbDoc): Your documentation workflow is independent of your EHR. Switching to Tebra means:

• OrbDoc continues working exactly as before
• Physicians only learn Tebra’s interface (not documentation changes)
• Productivity remains high (ambient documentation unchanged)
• Transition stabilizes in 2-3 weeks instead of 4-6 months

Your OrbDoc investment persists through EHR change. Training, workflows, physician satisfaction all continue uninterrupted.

Economics: Adding AI Scribe to Any EHR Path

If You Choose Epic Despite Small Practice Size:

Epic: $2.105M over 5 years (10 providers) Epic doesn’t include ambient documentation in base pricing. Add Epic’s AI features or third-party integration: $50K-$150K additional over 5 years.

Adjusted Epic + AI: $2.155M-$2.255M over 5 years

Alternative approach: Epic + Practice-Independent AI Scribe

• Epic: $2.105M over 5 years
• OrbDoc: $119,400 over 5 years ($199/month × 10 × 60 months)
• Total: $2.224M over 5 years

Slight premium over Epic’s integrated AI ($0-$100K), but you gain switching flexibility if you decide to leave Epic later. Your AI scribe investment persists through EHR change.

If You Choose Cloud EHR (Recommended for Most Small Practices):

Cloud EHR (Elation): $239,400 over 5 years (10 providers) Most cloud EHRs don’t include ambient documentation. You’re typing notes or using basic templates.

Add practice-independent AI scribe:

• Elation: $239,400 over 5 years
• OrbDoc: $119,400 over 5 years
• Total: $358,800 over 5 years

Savings vs. Epic + AI: $1.796M-$1.896M over 5 years

If You Choose Mid-Tier EHR:

Mid-Tier (athenahealth): $600,000 over 5 years (10 providers, including implementation and support)

Add practice-independent AI scribe:

• Athena: $600,000 over 5 years
• OrbDoc: $119,400 over 5 years
• Total: $719,400 over 5 years

Savings vs. Epic + AI: $1.435M-$1.535M over 5 years

Technical Advantages for Small Practices

Offline-First Architecture:

Small practices often operate in challenging connectivity environments:

• Rural practices with unreliable internet
• Basement exam rooms with poor WiFi
• Mobile clinics operating in field locations
• Practices in older buildings with infrastructure limitations

Practice-independent AI scribes built with offline-first architecture (like OrbDoc’s PWA approach) provide 100% functionality without internet connectivity:

• Record patient encounters completely offline
• Generate structured documentation immediately
• Sync automatically when connectivity returns
• Zero workflow disruption during outages

Epic and most EHR-integrated AI solutions require constant connectivity. Internet outages mean documentation stops or physicians revert to manual typing.

Evidence-Linking for Audit Defense:

Small practices lack the legal departments and compliance teams that large health systems deploy during audits. When Medicare or commercial payers request medical record audits, independent practices typically spend 15-30 hours reconstructing visit details from memory and scattered documentation.

Practice-independent AI scribes with evidence-linking technology (claim-level audio timestamps) enable 60-second audit package generation (total response 90-120 minutes):

• Auditor questions a CPT code from 6 months ago
• You locate the exact 30-second audio clip where that procedure was discussed
• Play the clip proving medical necessity
• Audit response time: 60-90 seconds vs. 15-30 hours manual reconstruction

This is particularly valuable for small practices billing higher-complexity visits (99214, 99215) where audit risk is highest. Evidence-linking provides claim-level documentation defense without legal team overhead.

Seven-Year Audio Retention:

Medicare requires medical records retention for 7 years. Most EHR-integrated AI scribes retain audio for 30-90 days (just long enough to generate the note, then deleted for storage cost savings).

Practice-independent AI scribes with 7-year audio retention provide long-term audit defense and compliance documentation. If an audit request arrives 5 years after a visit, you still have the complete audio record with claim-level timestamps.

For small practices operating on thin margins, a single successful audit defense (avoiding $50K-$200K in recoupment penalties) justifies years of AI scribe investment.

Integration with Modular Technology Stack

Documentation Layer in Practice-Independent Architecture:

The modular technology stack for small practices has several layers:

1. EHR Layer: Patient records, clinical workflows, regulatory compliance (Elation, Tebra, athenahealth)
2. Documentation Layer: Ambient AI scribe for efficient note generation (OrbDoc)
3. Billing Layer: Revenue cycle management and claims (practice management system or RCM service)
4. Engagement Layer: Scheduling, patient communication, intake automation (Phreesia, Solutionreach)
5. Care Management Layer: Telehealth, chronic care management, RPM (Zoom Healthcare, specialized CCM platforms)

Each layer operates independently. Your documentation layer (AI scribe) connects to your EHR layer without depending on it. If you change EHR layer, documentation layer continues working. If you add new care management layer, documentation layer adapts without reconfiguration.

This is the essence of practice independence: flexibility to optimize each layer without systemic disruption.

Example Implementation Timeline:

Month 1: Implement EHR (Elation)

• 2-4 weeks to go live
• Focus on core workflows stability

Month 2: Add AI Scribe (OrbDoc)

• 1-2 weeks to integrate with Elation
• Immediate time savings and workflow improvement

Month 3-4: Optimize billing and engagement

• Add scheduling platform (Phreesia)
• Optimize billing workflows
• Full stack operating efficiently

Month 5+: Continuous improvement

• Add telehealth platform when needed
• Integrate chronic care management tools as practice expands
• Replace any component that underperforms without disrupting others

Success Patterns: Small Practices Choosing Independence

How do small independent practices (2-20 providers) experience the transition from Epic consideration to practice-independent technology stacks? These general patterns emerge across practices prioritizing flexibility, economics, and long-term strategic independence.

Blue ocean positioning: Independent practices (2-20 providers) represent a market segment Epic doesn’t systematically target. While Epic excels at enterprise healthcare (500+ providers), small practices thrive with right-sized alternatives built specifically for their scale, economics, and operational reality.

Pattern 1: 2-5 Provider Practices Avoiding Epic Economics

Context: Solo practitioners or small group practices (2-5 physicians) generate $1.5M-$6M in annual revenue. Epic’s $1.46M-$2.81M 5-year cost represents 6-12% of total 5-year practice revenue. This level of technology spending is unsustainable for small practices with 8-15% net margins.

Decision Pattern: These practices quickly eliminate Epic from consideration based purely on economics. They focus evaluation on cloud EHRs (Elation, Tebra, DrChrono) and practice-independent tools that provide enterprise-quality workflows at small-practice pricing.

Typical Stack:

• Cloud EHR: $399/month per provider (Elation)
• AI Scribe: $199/month per provider (practice-independent)
• Basic billing through EHR (no separate billing system initially)
• Free or low-cost telehealth (Doxy.me, Zoom)

5-year total cost (3 providers): $107,460 ($2,990/month × 36 months)

Outcomes reported by practices in this cohort:

• Time savings: Save 2+ hours daily per physician (documentation efficiency, leave work on time consistently)
• Revenue impact: $75K-$444K over 5 years (reclaimed capacity, better coding, preventive care capture)
• Flexibility preserved: Can scale practice, change EHRs, or add services without technology constraints
• Capital preserved: $1.35M-$2.70M not spent on Epic (available for practice growth, physician recruitment, facility expansion)
• Burnout reduction: Physicians report leaving office by 6pm, regaining weekends, enjoying care again

Pattern 2: 6-10 Provider Practices Prioritizing Independence

Context: Mid-sized independent practices generating $4.5M-$12M annually. Large enough to afford Epic’s investment theoretically, but strategically committed to practice independence and avoiding vendor lock-in.

Decision Pattern: These practices seriously evaluate Epic (some even get to proposal stage) but ultimately choose modular approaches prioritizing long-term flexibility. Common reasoning: “We might grow significantly or change our business model. We don’t want $2M of locked-in technology constraining our options.”

Typical Stack:

• Cloud EHR: $399/month per provider (Elation or Tebra)
• AI Scribe: $199/month per provider (practice-independent with offline capability)
• Dedicated billing system or RCM service: $200/month per provider or 5% of collections
• Scheduling and engagement platform: $80/month per provider (Phreesia)
• Telehealth: $30/month per provider (Zoom Healthcare)

5-year total cost (10 providers): $541,800 ($9,030/month × 60 months)

Outcomes reported by practices in this cohort:

• Time savings: 520-780 hours annually per physician (save 2+ hours daily, leave work on time consistently)
• Revenue optimization: $250K-$1.48M over 5 years (capacity expansion, Medicare optimization, better collections)
• Strategic flexibility: Practices successfully changed EHRs after 2-3 years without major disruption (documentation workflows continued unchanged with practice-independent AI scribe)
• Cost savings: $1.46M over 5 years vs. Epic (reinvested in physician recruitment and second location expansion)
• Work-life balance: Physicians report regaining evenings and weekends, enjoying care again, 90% less burnout

Pattern 3: Rural Practices Requiring Offline Capability

Context: Rural family medicine practices (3-10 providers) serving communities with unreliable internet connectivity. Epic’s cloud-based architecture and constant connectivity requirements create operational risk during frequent internet outages.

Decision Pattern: These practices eliminate Epic and most EHR-integrated AI solutions early due to technical requirements. They prioritize offline-first architecture for both EHR and documentation tools. Common reasoning: “We lose internet 2-3 times per week. We can’t have documentation stop every time Comcast has an outage.”

Typical Stack:

• Cloud EHR with offline mode: Varies by platform (many cloud EHRs offer limited offline capability)
• Offline-first AI scribe: Practice-independent with PWA architecture (full functionality without internet)
• Billing: Often outsourced to RCM service (5-7% of collections)
• Minimal additional technology (focus on reliability over feature breadth)

Key Technical Requirement: AI scribe with 100% offline functionality:

• Record encounters completely offline
• Generate structured notes without connectivity
• Queue for automatic sync when internet returns
• Zero workflow interruption during outages

Outcomes reported by rural practices in this cohort:

• Operational resilience: Documentation continues during internet outages (previously, outages meant 2-4 hours of manual note writing at day’s end)
• Time savings: Save 2+ hours daily per physician despite connectivity challenges
• Work-life balance: Get home on time even with unreliable internet, no evening charting stress
• Physician satisfaction: High satisfaction with technology that matches rural operational reality
• Cost savings: $1.4M-$2.5M over 5 years vs. Epic (which would have required expensive backup internet and infrastructure)

Pattern 4: Specialty Practices Balancing Complexity and Independence

Context: Specialty practices (cardiology, gastroenterology, orthopedics, 5-15 providers) need more sophisticated workflows than primary care but want to avoid Epic’s implementation complexity and vendor lock-in.

Decision Pattern: These practices often start evaluating Epic due to specialty complexity, but discover that mid-tier EHRs (athenahealth, eClinicalWorks) or specialty-focused EHRs (ModMed for dermatology, etc.) provide 80-90% of needed functionality at 30-40% of Epic’s cost.

Typical Stack:

• Mid-tier or specialty EHR: $500-$600/month per provider (eClinicalWorks, specialty-specific platforms)
• Practice-independent AI scribe: $199/month per provider (with specialty-specific templates)
• Dedicated billing system: Typically integrated with EHR or 5-7% RCM service
• Procedure documentation: AI scribe configurable for procedure notes (colonoscopy, cardiac cath, joint injection templates)

Key Consideration: Specialty workflows require customization. Practice-independent AI scribes with self-service template building (no consulting fees) provide flexibility to create procedure-specific documentation without Epic’s $5K-$40K per workflow customization costs.

Outcomes:

• Specialty workflows supported: Custom templates for procedures, specialty-specific forms, diagnostic documentation
• Cost savings: $1.2M-$1.9M over 5 years vs. Epic
• Time savings: 1-1.5 hours daily per physician (procedure documentation particularly improved)
• Flexibility: Several practices added new procedure types or service lines without technology constraints

Pattern 5: Growing Practices Planning 2-3x Scale Increase

Context: Practices planning significant growth (10 providers today, 25-30 providers in 5 years) through physician recruitment or acquisition. These practices initially consider Epic as “infrastructure for future scale” but question whether committing to enterprise technology now makes sense.

Decision Pattern: Most choose modular cloud-based stacks with explicit growth planning: “Start with cloud tools that scale linearly (per-provider pricing), re-evaluate at 25-30 providers whether Epic makes sense then. Preserve capital now for actual practice growth (recruiting physicians, opening locations) rather than enterprise EHR.”

Typical Stack:

• Cloud EHR: $399/month per provider with linear scaling (10 providers = $3,990/month, 30 providers = $11,970/month)
• Practice-independent AI scribe: $199/month per provider (linear scaling)
• Scalable billing: RCM service percentage-based model (grows with collections, not provider count)
• Enterprise-capable engagement platform: Phreesia or similar (supports multi-location growth)

Key Strategic Principle: Pay for what you use today. Scale costs linearly as you grow. Re-evaluate technology at inflection points (25-30 providers, 50+ providers) when Epic’s economics might make sense.

Outcomes:

• Capital preservation: $1.5M-$2.5M not spent on Epic infrastructure (invested in physician recruitment, facility expansion, service line development)
• Successful growth: Practices grew from 10 to 20-25 providers over 3-4 years without technology constraints
• Future optionality: At 25+ providers, several practices re-evaluated Epic but most chose to continue with scaled modular stacks (economics still favor modular through 40-50 providers)
• Flexibility during growth: Adding providers took minutes (activate new licenses), not months of Epic capacity planning

Respectful Epic Positioning: Finding the Right Fit

Throughout this guide, we’ve examined why Epic may not fit most small independent practices (2-20 providers). This isn’t an attack on Epic. It’s an acknowledgment that Epic is purpose-built for a specific market segment (large health systems, 500+ providers, integrated delivery networks), and small practices represent a fundamentally different operational and economic reality.

Epic is genuinely excellent for the right use case. The question isn’t “which vendor is better?” but rather “which technology approach fits your practice size, strategic goals, and operational reality?”

When Epic is Genuinely the Right Choice

Large Integrated Health Systems:

If you’re Mass General Brigham, Cleveland Clinic, or Kaiser Permanente with thousands of employed physicians across dozens of facilities, Epic’s $50M-$200M implementation investment makes strategic sense. You need unified governance, standardized workflows, comprehensive interoperability, and enterprise-scale analytics. Epic delivers this better than any alternative.

Academic Medical Centers:

If you’re training the next generation of physicians, conducting NIH-funded research, and delivering highly specialized tertiary and quaternary care, Epic’s research integration, teaching tools, and deep specialty modules justify the investment. Your residents are learning Epic in training environments, making physician recruitment and onboarding simpler.

Specialty Complexity at Scale:

If you’re a 200-provider multi-specialty group coordinating complex care across 15+ specialties with hospital integration requirements, Epic’s workflow depth and coordination capabilities provide genuine clinical value. The complexity of your operations matches the sophistication of Epic’s platform.

Epic’s Strengths Are Real

Interoperability Leadership:

Epic’s Care Everywhere network enables seamless data exchange between Epic-using health systems nationally. A patient treated at Penn Medicine today and Northwestern Medicine tomorrow has complete records available instantly. This level of interoperability requires Epic’s scale, investment, and governance structures.

Comprehensive Platform:

Epic isn’t just clinical documentation. It’s revenue cycle management, population health analytics, patient engagement, research databases, supply chain management, and administrative operations in a unified platform. For organizations juggling thousands of staff and millions of patient encounters, single-vendor simplicity reduces integration complexity dramatically.

Proven Reliability:

Epic powers 305 million patient records across 2,800+ organizations globally. The system is battle-tested at scales most practices will never approach. Downtime is rare, support is extensive, and the platform handles whatever volume you throw at it.

Long-Term Partnership:

Epic doesn’t do short-term transactional relationships. They partner with health systems for decades, continuously refining workflows and adding capabilities. If you’re building a 50-year healthcare institution, Epic’s long-term commitment and stability are valuable.

Why Small Practices Face Different Reality

Economics Don’t Scale Down:

Epic’s $1.46M-$2.81M 5-year cost for a 10-provider practice ($29,200-$56,200 per provider annually) reflects enterprise software pricing that doesn’t scale down proportionally. Cloud EHRs cost $2,388-$4,788 per provider annually. The 6-12x cost difference reflects fundamentally different business models, not feature differences.

For a 500-provider health system, Epic’s per-provider cost drops to $8,000-$15,000 annually (economies of scale across implementation, infrastructure, support). At this scale, Epic’s economics become reasonable. But small practices can’t achieve these economies of scale.

Complexity Overwhelms Small Operations:

Epic’s comprehensive capabilities designed for 50-facility integrated delivery networks create overwhelming complexity for a 3-location, 10-provider independent practice. You’re managing features, modules, and infrastructure designed for organizations 50-100x your size.

Small practices benefit from simplicity. Cloud EHRs with core clinical workflows, practice-independent AI scribes, and modular tools provide exactly what’s needed without excess complexity.

Strategic Goals Differ:

Large health systems prioritize:

• Multi-facility coordination and governance
• Enterprise-wide standardization
• Comprehensive data analytics across populations
• Research integration and teaching capabilities
• Market dominance through interoperability

Small independent practices prioritize:

• Clinical excellence and patient relationships
• Operational efficiency with minimal overhead
• Flexibility to adapt to market changes
• Practice autonomy and independence
• Sustainable economics and profitability

These are fundamentally different strategic goals requiring different technology approaches.

The Right Tool for the Right Context

Epic is an excellent choice for large health systems, academic medical centers, and complex integrated delivery networks. For most small independent practices (2-20 providers), practice-independent alternatives offer better economics ($1.46M savings over 5 years), operational fit (minimal IT overhead), and strategic flexibility (avoid vendor lock-in).

This isn’t a failure of Epic. It’s about finding the right fit. Epic excels at enterprise healthcare. Independent practices thrive with right-sized alternatives built specifically for their scale.

Practice-independent alternatives exist because small practices need different solutions:

• Epic’s strength: Enterprise coordination across 500+ providers, multiple facilities, integrated research
• Small practice reality: 2-20 providers, independent ownership, flexibility to change vendors without disruption
• Different tools for different contexts: Both approaches are valid for their intended market segments

Choose Epic if:

• You’re part of or joining a large integrated health system
• You’re planning growth to 50+ providers in 3-5 years with capital to invest now
• Your specialty complexity genuinely requires Epic’s depth
• Your local market’s Epic dominance creates compelling interoperability benefits

Choose practice-independent alternatives if:

• You’re an independent practice (2-20 providers) prioritizing autonomy
• You want to save $1.46M over 5 years vs. Epic while maintaining clinical excellence
• You value flexibility to change vendors without documentation workflow disruption
• You need technology that matches small practice reality (minimal IT, zero setup fees, predictable $2,388-$4,788 annual cost per provider)
• You’re in rural or underserved markets where offline capability matters
• You want to find the right fit without documentation burden or technology constraints
• You prefer leaving work on time consistently over enterprise complexity

The question isn’t “which is better?” but rather “which fits your practice’s size, strategic goals, and operational reality?” Epic excels at enterprise healthcare. Independent practices thrive with right-sized alternatives.

Next Steps: Building Your Practice-Independent Stack

If you’ve decided practice independence makes more sense than Epic for your 2-20 provider practice, here’s your implementation roadmap.

Month 1: EHR Selection and Implementation

Week 1: Vendor Evaluation

• Demo 3 cloud EHRs (Elation, Tebra, DrChrono)
• Evaluate based on: core workflows, pricing transparency, implementation speed, integration ecosystem
• Check references from practices similar to yours
• Make selection by end of week

Week 2-4: Implementation

• Data migration from existing system
• Configuration (locations, providers, schedules, templates)
• Training (2 hours physicians, 1 hour staff)
• Go live with vendor support

Expected Cost: $0-$5,000 (most cloud EHRs have minimal setup fees)

Month 2: Add Practice-Independent AI Scribe

Week 1: Setup and Pilot

• Sign up for practice-independent AI scribe (OrbDoc: $199/month per provider, zero setup fees)
• 30-minute onboarding for all physicians
• 1-2 physicians pilot for one week

Week 2-4: Full Deployment

• All physicians adopt ambient documentation
• Measure time savings daily
• Optimize templates based on actual encounter patterns

Expected Cost: $0 setup + monthly per-provider pricing

Month 3-4: Optimize Billing and Engagement

Billing Decisions:

• Keep EHR’s built-in billing (simple practices)
• Add dedicated billing software (mid-complexity)
• Engage RCM service (complex payer mix or limited billing expertise)

Patient Engagement:

• Add scheduling platform for online booking and automated reminders
• Implement digital intake to reduce front-desk workload
• Set up automated patient communication

Expected Cost: $150-$300/month per provider depending on choices

Month 5+: Continuous Optimization

Measure Success:

• Time savings: Track documentation time before/after
• Revenue impact: Monitor collections, coding accuracy, preventive care capture
• Physician satisfaction: Regular feedback on workflows and tools
• Patient experience: Monitor satisfaction scores and online reviews

Iterate Based on Data:

• Replace underperforming components
• Add new capabilities as practice evolves
• Optimize workflows based on actual use patterns

Request Practice-Independent Demo

See how practice-independent AI scribes help independent practices (2-20 providers) find the right fit without Epic’s vendor lock-in:

Calculate Your Savings vs. Epic:

• See exactly how much you save over 5 years ($1.46M for 10-provider practice)
• Compare Epic $300K-$500K implementation vs OrbDoc $2,388-$4,788 annually per provider
• Understand total cost of ownership differences
• Review implementation timeline (2-4 weeks vs 8-15 months)

See Practice-Independent Technology in Action:

• Offline documentation: Works without internet connectivity (rural practices, basements, mobile clinics)
• Evidence-linking: 60-second audit package generation (total response 90-120 minutes) vs 15-30 hours manual chart review
• Revenue intelligence: $25K-$148K Medicare opportunity annually (AWV, TCM, CCM, BHI auto-capture)
• Works with any EHR: Elation, Tebra, athenahealth, eCW, Epic (if you choose it)
• Burnout reduction: Save 2+ hours daily, leave work on time consistently, enjoy care again

Request Demo →

Practice-independent technology for 2-20 provider practices: $199/month per provider, zero setup fees, works with your current EHR or any future EHR you might choose

Continue Learning

Related Guides:

• EHR Cost Comparison: True Total Cost of Ownership
• Practice Independence vs. Vendor Lock-In: Strategic Implications
• Rural Practice Technology: Offline-First Architecture
• Small Practice Technology Strategy: 2-20 Provider Guide

Platform Deep Dives:

• Evidence-Linking: 60-second package generation (total response 90-120 minutes) Audit Defense
• Offline-First Mobile: Document Anywhere
• Practice Independence: Works With Any EHR

Compare Alternatives:

• Athena vs. Practice-Independent Stack
• eClinicalWorks vs. Modular Approach
• Epic vs. Cloud EHR Economics

Frequently Asked Questions

Can a small practice successfully use Epic?

Yes, technically. Some 10-20 provider practices do use Epic, typically because they’re part of an integrated delivery network, have specialty complexity genuinely requiring Epic’s depth, or secured special pricing through group purchasing arrangements. However, the economics rarely make sense ($1.46M-$2.81M over 5 years for 10 providers), and most small practices find the implementation complexity and IT requirements overwhelming.

How long does it take to switch from Epic to a cloud EHR?

Data migration from Epic is complex due to Epic’s proprietary data structures and custom fields. Expect 3-6 months for complete migration including data export, cleaning, importing to new EHR, validation, and staff training. Total switching cost typically runs $300K-$600K for a 10-provider practice (migration fees, productivity loss, training time).

Do practice-independent AI scribes work as well as EHR-integrated solutions?

Practice-independent AI scribes often work better than EHR-integrated solutions because they’re purpose-built for documentation excellence rather than tightly coupled to a specific EHR’s constraints. OrbDoc provides offline capability, evidence-linking, and 7-year audio retention that most EHR-integrated AI solutions don’t offer. The key advantage is flexibility: your documentation workflow continues unchanged if you switch EHRs.

What if my practice grows to 50+ providers? Will I need to switch to Epic?

Maybe, but probably not. Cloud EHRs and modular stacks scale linearly with per-provider pricing through 40-50 providers. At 50+ providers, Epic’s economics improve (per-provider costs drop with scale), but many practices at this size still prefer practice independence and modular approaches. Re-evaluate technology at growth inflection points (25, 50, 100+ providers) based on your current operational needs, not future predictions.

How do I know if my specialty is too complex for cloud EHRs?

Most specialties work excellently with cloud EHRs or mid-tier platforms. Primary care, internal medicine, pediatrics, psychiatry, and straightforward specialties (dermatology, allergy, rheumatology) are perfect fits. Procedure-heavy specialties (gastroenterology, cardiology, orthopedics) work well with mid-tier EHRs (athenahealth, eClinicalWorks) or specialty-focused platforms. Only highly complex multi-specialty coordination (oncology programs, transplant centers, complex surgical practices coordinating with hospital systems) might justify Epic at small scale.

Can I use Epic with a practice-independent AI scribe?

Yes. OrbDoc works with Epic if you choose it despite your small practice size. This gives you flexibility: if you later decide Epic’s cost isn’t justified, you can switch to a cloud EHR without retraining your documentation workflow. Your AI scribe investment persists through EHR changes.

What happens to my data if a cloud EHR vendor goes out of business?

Cloud EHRs are required by HIPAA to provide data portability. If a vendor fails, they must provide complete data export in standard formats (typically CCDA or CSV). You can import this data into any other EHR. This is one advantage of modular approaches: each component is replaceable without systemic risk. Epic is too large to fail, but it’s also too expensive to escape ($300K-$600K switching cost).

How do I calculate ROI for practice-independent technology?

Time savings value:

• AI scribe saves 1.5-2 hours daily per physician
• 220 working days annually = 330-440 hours saved per physician
• Physician hourly value: $200-$300 (based on $400K-$600K compensation)
• Annual value per physician: $66K-$132K

Revenue capture:

• Medicare optimization (AWV, TCM, CCM, BHI): $25K-$148K annually for 10-provider primary care practice
• Better coding accuracy: 1-2% increase in collections (for $7.5M practice = $75K-$150K)
• Capacity expansion: 15-20% more patients without adding providers

Compare to investment:

• Practice-independent stack: $10,836 per provider annually
• ROI: 509%-1,118% annually (value generated vs. cost)

Summary: Finding the Right Fit for Your Practice

Epic excels at enterprise healthcare. For health systems with 500+ providers, integrated delivery networks, and academic medical centers, Epic’s $50M-$200M investment delivers genuine strategic value through comprehensive integration, proven reliability, and national interoperability.

Independent practices (2-20 providers) thrive with practice-independent alternatives. Save $1.46M over 5 years, maintain flexibility to change vendors without documentation workflow disruption, and find the right fit without Epic’s implementation complexity or vendor lock-in.

Three practice size cohorts successfully choosing practice independence:

1. 2-5 provider practices: Save $1.35M-$2.70M over 5 years, preserve capital for practice growth
2. 6-10 provider practices: Save $1.46M over 5 years, maintain strategic flexibility, enjoy care again
3. Rural practices: Save $1.4M-$2.5M over 5 years, document anywhere without internet connectivity stress

The question isn’t “which is better?” but “which fits your practice’s reality?” Epic is the right choice for enterprise healthcare. Practice-independent alternatives are purpose-built for independent practices prioritizing autonomy, flexibility, and sustainable economics.

Last updated: October 2025

Epic is genuinely excellent for large health systems and integrated delivery networks. For independent practices (2-20 providers), practice-independent alternatives offer better economics ($1.46M savings), operational fit (minimal IT), and strategic flexibility (avoid vendor lock-in).

See practice-independent technology built specifically for 2-20 provider practices: Request Demo →