When you’re building a therapy practice that spans time zones, languages, and legal systems, finding the right tools can be complicated. One of the most common questions we hear from location independent therapists is: Which EHR should I use?
The short answer? For many of us location independent therapists, no single EHR meets all the needs of a globally mobile practice. That’s why many of our LIT Community members don’t rely on a traditional EHR at all. Instead, they piece together tools that are a better fit for how they work.
This blog post will help you figure out what you actually need from an EHR, or whether using a combination of tools makes more sense for you.
What Is an EHR, and Do You Really Need One?
An EHR (Electronic Health Record) system is often thought of as a one-stop shop for therapists. It typically includes:
- Scheduling and availability management
- Session notes and secure record-keeping
- Invoicing and payment processing
- Client communication and portals
These systems are designed to streamline your workflow, but most are designed for therapists who work in a single country.
If you’re based in one place, serving local clients, an EHR might be a perfect fit. But if you’re working internationally, you often have additional needs, such as:
- Offering sessions in different languages
- Needing to account for taxes or multiple currencies
- Wanting to control your availability based on appointment type.
In that case, you might find (after a lot of time-consuming research) that many systems fall short.
Why EHRs Often Fall Short for Location Independent Therapists
Over the years, our LIT co-founders, Sonia and Melissa, have tested a range of EHR systems. Despite thorough research and trial runs, they’ve consistently found that most platforms don’t offer the flexibility needed for a location independent practice. And they’re not alone – this is something we hear regularly from our members in the LIT Community.
The most common issues include:
- Invoicing that doesn’t accommodate international tax needs (e.g. VAT, reverse charge, multiple currencies)
- No option to generate invoices in different languages
- Limited control over scheduling settings like time zones, buffer times, and availability by session type
- Clients are unable to book packages or specific appointment types through the client portal
- Rigid workflows that don’t reflect the realities of working online across borders
Rather than trying to make an imperfect system work, Sonia and Melissa have both chosen to combine different tools that serve specific functions well. For example, they use Acuity for scheduling, Zoom for sessions, and separate tools for notes, invoicing, and client communication. It’s what many of our members end up doing, too. We share some of our favourite tools for location independent therapists here.
This “tech stack” approach provides more control and adaptability, without having to compromise on too many features.
That’s not to say you won’t find a system that works for you. But knowing what you need and what you’re willing to compromise on is essential.
What a “Tech Stack” Can Look Like
If you decide not to use a single all-in-one EHR, you can combine tools that each do one thing really well. Many of our LIT members find that this approach gives them more flexibility and control. Here are a few examples of what a tech stack might include:
- Scheduling: Acuity, Calendly, or SimplyBook to manage bookings across time zones and session types
- Video Sessions: Zoom or Google Meet for reliable online meetings
- Notes: Secure, GDPR-compliant apps such as Therapynotes alternatives, Notion (with encryption add-ons), or other password-protected systems
- Invoicing & Payments: Stripe, PayPal, or invoicing software that supports VAT and multiple currencies
- Client Communication: Encrypted email, Signal, or secure messaging platforms when needed
- File Sharing and Business Storage: Google Workspace for client files, contracts, and all your business documents in one place
Your tech stack might look different depending on your priorities and where you and your clients are based. The key is to choose tools that work well together and support the way you want to run your practice.
Disclaimer: Regulations and data privacy laws vary depending on your location and where your clients are based. Always make sure any tool you use is appropriate for your specific legal and professional context. This information is shared for general guidance and is not legal advice.
What to Look for in an EHR (Or Your Ideal Stack of Tools): A Checklist
Here’s a starting point to help you evaluate any EHR or build your own system. These categories reflect the needs of online, location independent therapists. We’ve based this checklist on our own experiences and what our LIT Community members have shared with us. But make sure to tailor this to your own specific needs, too.
You can use this checklist to test whether an EHR (or alternative tool) will meet your needs.
🗓️ Scheduling & Availability
- Can you set different availability for different services?
- Does it accommodate different time zones (automatically converting the time)?
- Is it possible to add buffer time between sessions?
- Can clients book their own sessions (and even multiple sessions, if you offer packages)?
- Can you pause or adjust availability for travel and holidays?
🧾 Invoicing & Tax
- Does it support multiple languages, currencies, or formats?
- Can invoices be generated in multiple languages or currencies?
- Does it allow for different VAT/tax rates depending on where your clients are based?
- Does the tool support reverse-charge invoices for EU clients?
- Can you export everything easily for your accountant?
📒 Note-Taking
- What kind of notes can you keep? Can you upload PDFs or images?
- Can you use your preferred note format (like structured clinical notes or free-text summaries)?
- Is it secure and GDPR-compliant?
💬 Communication & Client Portal
- Do you want clients to have a portal where they can book, message, and pay, all in one place?
- Will the system send appointment reminders or confirmations?
How to Choose What Works for You
Before you dive into trialing (and paying for) tools, start by figuring out what you really need. Ask yourself:
- What’s essential to how I want to work?
- What are the deal-breakers (e.g., GDPR compliance, VAT rules)?
- What’s nice to have, but not required?
Then, do your research. We don’t recommend rushing into an annual plan for a tool you haven’t tested thoroughly!
At first, you might want to try trial versions or ask colleagues in the LIT Community or our free Facebook group about what has worked for them. Ensure you understand how the tool integrates into your workflow, from initial contact to session notes and invoicing.
Don’t forget that you’re not tied into one tool forever, either. As your practice grows or evolves, your tool needs may also change.
Final Thoughts
Choosing an EHR (or choosing not to use one) doesn’t have to be a forever decision. What matters is finding a setup that fits how you want to work, where you are located, and who you serve.
Whether that’s an all-in-one EHR or a DIY toolkit of different platforms, the most important thing is that it supports your work and simplifies your life.
Want support figuring out what works for you?
There’s no one-size-fits-all answer to these questions, but you don’t have to figure it out alone.
Inside the LIT Community, you’ll find a space to explore these questions with like-minded colleagues from around the world. Whether you’re comparing tools, refining your workflow, or just getting started, our members share real experiences, practical tips, and honest reflections to help you make informed choices that suit your practice and your life.
Plus, you’ll get access to all our resources and replays, coaching from the LIT co-founders, business meetups, expert workshops, and our full calendar of events, all tailored to location independent therapists.
