The Best Open Sourse EHR Systems To Consider

This article is a review of the most popular open source EHRs, based on our experience and scientific papers. It describes the products, gives an overview of their features, Meaningful Use/Promoting Interoperability eligibility, risk of being vendor-locked, as well as user reviews and advantages and disadvantages of each.

Contact EHR expert to find out whether open source EHR is the best option for your practice.

What is an open source EHR?

Open source software allows users to freely download, install, study, modify, and use it (commercial use depends on the type of license).

Medical practices turn to open source software for the following reasons:

  • Affordable cost. Open source solutions are either cheaper to use than their proprietary counterparts, or entirely free. With them you don’t have to pay for the proprietary technologies or licensing fee.
  • Pre-built сustomization options. Open source systems are more flexible by design, and so are easier and cheaper to modify.
  • Pre-built Interoperability. Open source EHRs are built with interoperability in mind and are often easier to integrate with third-party systems than proprietary solutions.
  • Easy to test. Most open source software can be freely downloaded and installed. You can try the system at leisure and see if it fits your practice before committing to its implementation.

Top Open Source EHRs

The open source medical software market includes products like Open Dental, OpenEMR, Docmein, HealthKit, ERPNext, OpenMRS, one touch emr, Odoo, FreeMED, GNU Health, Vista EHR, Bahmni, HospitalRun, CottageMed, OpenClinic, WorldVistA, GNUmed, FreeMedForms, ZEPRS, LibreHealth EHR, DoliMed EMR, nosh EMR, Care2x, EncounterPRO, Caisis, Solismed, RemoteClinic and more. 

Top open source EHR systems (or medical software with EHR features ) Top open source EHR systems (or medical software with EHR features) by monthly keyword search volume (Google USA, Semrush). Source: https://belitsoft.com/

We have chosen three universal EHR system (OpenEHR, OpenEMR, and OpenMRS), and one speciality-specific EHR (OpenDental) for the following reasons:

  1. There is the demand for these systems.
  2. These systems are built using the most popular programming languages. 
  3. These systems are mostly HIPAA/GDPR compliant.
  4. Some of these systems have ONC certification.

1. OpenEMR: Universal EHR

An extremely popular free EHR/Practice Management software, reaching up to 3000 downloads per month, OpenEMR is much more than just a barebones record store. It has all the major features expected of an EHR:

OpenEMR Core Features

HIPAA compliance

Compliance with the HIPAA requirements is a must for any EHR. Achieving it requires securing several parts, which include OpenEMR itself, servers (Apache, MySQL, PHP), and network (firewall, router, https, certificates, etc).  OpenEMR developers make it a priority to keep OpenEMR updated with the most recent security options.

Belitsoft specializes in delivering easy to manage HIPAA-compliant solutions and technology services for medical practices of all sizes. Contact us if you would like to get a HIPAA risk assessment and analysis.

Access control is the first Technical Safeguard Standard of the HIPAA Security Rules. Assigning roles to different EHR users helps to delineate their access to the information/pages/options according to their positions. That will ensure the patients’ data will only be accessible to the authorized employees. The Administrator of an OpenEMR instance can add users to a set of appropriate user access groups.

EHR Interoperability standards support (HL7 FHIR)

The 2015 Edition Health IT Certification Criteria include the API criterion that requires health IT to provide application access to the Common Clinical Data Set via an API.

API-enabled EHR API-enabled EHR. Source: cell.com/fulltext/S2405-4712(15)00004-6

FHIR API standard is among the most popular of its kind among EHR developers. OpenEMR provides Basic FHIR EHR Interoperability standard support that allows to export/import all the patient data about patients in RESTful API format. OpenEMR also provides Basic FHIR Support using SMART on FHIR implementation or HAPI FHIR implementation to integrate EHRs with other health IT systems.

Meaningful Use Stage 3 Compliance

CMS and the ONC have established requirements (also known as Meaningful Use Stage 3 requirements or MU3) that EHR systems must meet in order to qualify for use in Promoting Interoperability Programs (formerly the Medicare and Medicaid EHR Incentive Programs). According to the MU3, to apply for insurance reimbursements clinicians should attest they are using Certified EHR Technology (CEHRT), which matches the criteria listed in 2015 Edition CEHRT. CEHRT helps health care providers and patients be confident that the EHR system or EHR module is secure, can maintain data confidentiality, and can work with other systems to share information. 

OpenEMR Version 5.0 is compliant with 2014 Edition CEHRT. The current version of OpenEMR (5.0.2) partially satisfies the criteria of 2015 Edition CEHRT, and the OpenEMR development team is working to meet the new requirements without referring to specific timelines. 

Contact Belitsoft if you would like to finalize OpenEMR to complete all required MU3 certification criteria.

Remote access

The OpenEMR software suite is a web-based application that allows users to access patient data from any computer.

Mobile compatibility

Users are able to access OpenEMR via mobile devices, both on Android (up to v9) and iOS (up to v12). The usability of pages could be constrained by the screen size, so the user would have to work in a landscape mode to ensure the best performance.

Other features:

  • Medical Records with demographics, vitals, FHIR/CCDA compatibility, and even voice recognition;
  • Scheduling, with multiple facilities support, SMS/email notifications, messaging system and more;
  • E-prescribing, including pharmacy dispensary module;
  • Billing, including flexible coding system, claims management, insurance tracking etc.;
  • Clinical decision rules;
  • Reporting, including sales, prescriptions, referrals and more;
  • Patient portal and a secure API (Application Programming Interface) to integrate third-party portals.
OpenEMR's Medical Record Dashboard OpenEMR's Medical Record Dashboard. Source: open-emr.org/demo/

OpenEMR is one of the few open source EHRs that have Office of National Coordinator for Healthcare IT (ONC) certification. This means that practices using it are eligible to participate in Promoting Interoperability program (previously known as Medicare and Medicaid EHR Incentive Programs/Meaningful Use) and receive the financial benefits that go with it. It is also HIPAA-compliant, ensuring the protection of your patient data. 

OpenEMR is written in PHP, one of the most popular programming languages. This gives you a wide array of options when choosing a company to customize the system for your practice, because there are many developers who have been working with this technology for years. It is also well-documented, which makes customization easier for the programmers and cheaper for the practice.

Another thing worth mentioning is that OpenEMR is distributed under GNU GPL (General Public License). 

The reviews of OpenEMR are mostly positive, with an average of 3,75/5 stars. Judging by what the users say, its advantages are:

  • Low cost of ownership;
  • High speed;
  • Many customization options;
  • User-friendly interface;
  • Free technical support;

However, there are drawbacks too:

  • The practice needs an in-house IT team or an outside vendor to customize OpenEMR and support it;
  • Lack of learning resources for end users;
  • Support is often slow to respond;
  • Billing and insurance modules need extra work;
  • Additional customization is required for specialty practices (e.g. Orthopedics or Mental Health).

How we can help with OpenEMR

  • We can customize OpenEMR for your practice’s workflows or medical specialty (Orthopedics, Mental Health etc.) and improve UI/UX Design;
  • We can develop additional functionality if the base features are not enough;
  • We can help you deploy your OpenEMR-based software to the cloud;
  • We can set up backups for your data;
  • We can transfer data from your old EHR to OpenEMR;
  • We can provide you with dedicated technical support;
  • We can consult you during your EHR implementation.

2. OpenMRS: Universal EHR

This system is a relative newcomer to the EHR/EMR market. Since its inception in 2004 it has been in use all over the world, including the United States. 

While OpenMRS is mainly a foundation to build a full-fledged EHR upon, its reference web-application already provides many features “out-of-the-box”, for example:

  • Web-Based EHR: this web application can run on your own servers or in the cloud (e.g. AWS);
  • Medical Records (Patient repository): a medical records store with demographics, encounter data etc.;
  • Scheduling: processing and managing appointments and provider schedules;
  • Patient workflows: entering patients into clinical programs and tracking their recovery through each stage of that program;
  • Reporting, a system of customizable reports;
  • Security, including authentication and role-based access;
  • HL7 support: ability to import HL7-formatted data;
OpenMRS's Medical Record Dashboard OpenMRS's Active Visits Dashboard. Source: openmrs.org/demo/

OpenMRS is written in Java, the most popular programming languages.

OpenMRS has modular architecture and offers a number of add-ons to customize the system to your practice’s workflows and requirements.

As OpenMRS was mostly intended to be used outside of the USA, it is not ONC-certified by default. However, with a competent development company at your side, you can build your own EHR system that satisfies the ONC criteria and gets the verification needed to participate in the incentive program.

There are few reliable reviews of OpenMRS, but the users consider it easy to use, praise its price (or lack thereof) and enjoy the control over the records it gives. However, they also note that it is hard to set up without programming knowledge and lacks mobile apps

OpenMRS is a free EHR. It is distributed under Mozilla 2.0 license.

How we can help with OpenMRS

  • We can create your custom OpenMRS-based EHR;
  • We can customize OpenMRS for your practice’s workflows or medical specialty (Orthopedics, Mental Health etc.) and improve UI/UX Design;
  • We can develop additional functionality if the base features are not enough;
  • We can help you deploy your OpenMRS-based software to the cloud;
  • We can set up backups for your data;
  • We can transfer data from your old EHR to OpenMRS;
  • We can provide you with dedicated technical support;
  • We can consult you during your EHR implementation.
  • We can help you adapt OpenMRS to Meaningful Use requirements.

3. OpenEHR: Universal EHR

OpenEHR is a set of specifications and tools for making custom medical software. EtherCIS is the leading open source implementation of the openEHR standard in action. It is a clinical data repository that consolidates data from various clinical sources, such as an EMR or a lab system, to provide a full picture of the care a patient has received.

OpenEHR uses Java, PHP, and JavaScript, which are all popular languages. Which means there is less chance of becoming vendor-locked when using a custom system - there are many companies working with these languages.

The specifications and source code for OpenEHR can be downloaded for free. However, some assembly is required before you can have an EHR/EMR of your own. This could be done either by your in-house IT-team or by a custom software company. In either case, this is a cost to be included in your budget.

OpenEHR is distributed under Apache 2 license.

How we can help with OpenEHR

  • We can customize OpenEHR implementations for your practice’s workflows or medical specialty (Orthopedics, Mental Health etc.) and improve UI/UX Design;
  • We can develop additional functionality if the base features are not enough;
  • We can help you deploy your OpenEHR-based software to the cloud;
  • We can set up backups for your data;
  • We can transfer data from your old EHR to OpenEHR-based software;
  • We can provide you with dedicated technical support;
  • We can consult you during your EHR implementation.

Why not VistA EHR

VistA is being in the service of the Department of Veterans Affairs (VA) since the late 70’s. Under the Freedom of Information Act (FOIA) most of its source code was released as public domain, which prompted companies and development teams to create derivative systems, also known as distributions: OSEHRA VistA, OpenVistA, WorldVistA and others. 

As there are many versions on the market, describing the features of each would take too long. However, there are core functions shared by the most popular ones:

  • Health information (patient records), including diagnoses, vitals, allergies etc.;
  • Scheduling;
  • e-Prescribing;
  • Billing;
  • Clinical decision support;
  • Electronic communication (messaging);
  • Patient support, e.g. patient portal or educational materials;
  • Reporting and population health, for example, immunization reports.

Some distributions, like OSEHRA VistA, can be downloaded for free. Others are paid.

The default version available to the general public, FOIA-VistA, is not ONC certified. Some of its code has been redacted pre-release, so many features don’t work as planned. The popular OSEHRA VistA has most Meaningful Use criteria fulfilled, but doesn’t have official verification. However, a number of distributions, do have certification.

VistA might seem outdated, however it gets a lot of praise from its users for functionality, speed and security. The different distributions of it, though, haven’t gathered many public reviews.

VistA and its distributions are primarily written in MUMPS or M - a programming language, used mainly by companies working in the Healthcare domain, like EPIC, Medicare and Allscripts.

It is rather rare - SourceForge, a major open source community, has only 37 MUMPS projects, compared to over 54.000 Java or 34.000+ PHP counterparts. This means that there is only a limited pool of development companies to choose from for implementation and customization, leaving you in danger of becoming vendor-locked.

As mentioned previously, VistA is a public domain software. However, its distributions use different licenses. For example, WorldVista is covered by GPL, while vxVistA 15.0 is under Apache 2.0.

4. OpenDental: a Specialty-Specific EHR

Formerly known as “Free Dental,” OpenDental is a specialized practice management/EHR system for dental health clinics. It is used both in the USA and abroad: in Australia, the Netherlands, etc.

The full function version of OpenDental is only available under the commercial license because it includes royalty bearing, licensed materials from the American Dental Association (ADA), the Code on Dental Procedures and Nomenclature (CDT).

OpenDental OpenDental is a Practice Management Software

OpenDental boasts a powerful suite of features, including, but not limited to:

  • OpenDental is designed to be used as a desktop software. There is no Web Version of Open Dental that will run in a browser by default. But some customization allows you to connect to Open Dental any time, anywhere using a supported internet browser and your mobile device;
  • Medical Records (Patient records): name, contact info, insurance/billing data etc.;
  • Scheduling: appointment calendar, color-coded entries, popup alerts, mass contact option etc.;
  • E-prescribing: single/multiple drug prescription, printable patient instructions, audit trails etc.;
  • Billing and claims management: invoice generation, billing template creation, claims validation and history etc.;
  • Reporting: customizable insurance reports, accounting reports, evaluation reports, and more;
  • Patient portal: customizable patient portal;
  • Treatment plans: creation and management of single or multiple treatment plans, with changes in procedures reflecting in tooth charts;
  • Charting: perio, ortho, 3D teeth charts integrated with prescribing, treatment plans and other modules;
  • Medical image processing: integration with radiography, scanning, and digital cameras.

OpenDental is both ONC-certified and HIPAA-compliant, so its users are eligible for incentives under Promoting Interoperability program. 

Being a popular tool for dentists, OpenDental has gathered a fair number of mostly positive user reviews (with a rating of 4,7/5 on Capterra), that are available to the general public. Among its advantages are: 

  • Professional and empathetic customer support;
  • Customization options;
  • Ease of use;
  • Features that support all aspects of a dental practice;
  • Regular improvements to the system.

However, the reviewers also mentioned a few flaws with this EHR:

  • Steep learning curve;
  • Lack of cloud deployment option;
  • Scalability problems for large practices.

OpenDental is built with C# and a powerful .NET framework. This technology stack, endorsed by Microsoft, is very popular, so you won’t have to worry about the lack of professionals to support your system.

OpenDental is covered by GPL.

How we can help with OpenDental

  • We can customize OpenDental for your practice’s workflows and improve UI/UX Design;
  • We can develop additional functionality if the base features are not enough;
  • We can set up backups for your data;
  • We can transfer data from your old EHR to OpenDental;
  • We can provide you with dedicated technical support;
  • We can consult you during your EHR implementation.
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Alex is a Deputy Business Development Director at Belitsoft
I am a customer’s advocate and an expert in Healthcare IT.
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