There is an assumption that many countries outside the United States would turn to open-source EHR initiatives such as WorldVista and OpenEMR because they are far less expensive. In your experience is this true? Other than price, what are the requirements for a small remote clinic? The ASP model is much simpler, but how often is Internet access either not available or down? Thanks.....Bob

Tags: EHRs, Open, Source

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There are now thousands of hospitals and clinics around the world using open source EMR systems such as OpenMRS, OpenEMR, VistA, OSCAR, RPMS, FreeMed, and more. Two sources of information on the use of high quality open source health IT solutions worth visiting are Open Health News at  and the non-profit COSI Open Health site at 

Thanks. A lot has changed since my original posting 2 1/2 years ago. I am familiar with the resources you posted. I guess my current opinion is that open source is less attractive in the US right now because many of the open source EHR initiatives had a hard time making meaningful use. It would appeal to those who can't afford expensive commercial EHRs who don't plan to seek governmental reimbursement for meaningful use.....Bob

Agree. Certainly OpenMRS is being deployed in Latin America and Africa, OpenEMR in the U.S. and Pacific rim, OSCAR, in Canada, VistA in U.S. and quite a few other places - but in the U.S. in particular, commercial solutions dominate. But the picture is changing.  For many government facilities public domain or open source solutions make sense.  In West Virginia, all of our small state hospitals use VistA. Small local government supported community hospitals and rural health clinics can't afford costly commercial solutions. Oklahoma has 7 syaye veterans hospitals now running VistA. Hawaii is pilot testing VistA/RPMS in smaller government hospitals and clinics. Seeing the same in several other states. In emerging nations, open source is the only real answer. In public health, medical imaging, etc. open source is really taking hold. As an economic driver, thousands of organizations have sprung up around the world supporting open source software development, deployment, and support. It's amazing to watch.

I am a huge proponent of open source and I truly hope that the VA and DOD work together to develop a new web based open source EHR that they can share with the world. In spite of the popularity of VistA, it is very hard to install and customization requires MUMPS programming knowledge.

I have tried to assist the developers of OpenEMR, whose heart is absolutely in the right place. They have made progress and the GUI is more modern than prior evolutions. They simply need more capital and a different business plan and perhaps a different open source choice (e.g. Apache). At last word the e-prescribing module is external to the EHR---that won't fly with most docs. What are your thoughts?  Bob

Like you said, VistA is complex, aimed primarily at hospitals. RPMS, the Indian Health Service modification of VistA, is a better fit to clinics. But, OpenEMR, OpenMRS, and OSCAR are maybe the best options for small practices/clinics. What I find interesting is the many other types of open source & public domain Health IT solutions that are often ignored in the discussions. Open ISES for ambulance/emergency management, Ushahidi for emergency/disaster response, Epi Info/Map, NEDSS, ITK/VTK, Sahana, OpenClinica, Open Dental, Tolven, and on and on. Really good high quaqlity open source health IT solutions aimed at every need. Most now have foundations, a community of support companies, numerous installations, longevity, reliability, etc. I expect these communities around the best solutions will eventually start to merge into a mega-community of open health communities.

By the way, I did submit an article to Health Affairs suggesting the need for a robust standards based modern open source EHR based on many of the points you have made and their comment was that the article "didn't cover any new ground" There are clearly people who don't know good open source choices exist

Hi Bob and Peter,

This is Dr.Naresh from India.

My personal thought on open source Healthcare IT applications such as VistA is that it may be good from a monetary stand point but what is lacking is the support and customization as per each of the Hospitals requirements. We all are aware of the fact that one size will not fit all and more so is the case with Hospitals and Healthcare.

Iam aware that there have been organizations who take up this work to customize and support such applications.. but would like to know your thought process on the same.



I feel that open source is very important world wide as a means to get software that is cost effective. That being said the possible problems are that the software might not be state of the art e.g. VistA so it is difficult to customize unless you have a MUMPS programmer. Secondly, I don't like the business model for something as important as an EHR. You must have some capital to invest to continuous improve the software given the rapid changes in both medicine and technology. In other words, it should be low cost but no free. It should be hosted in the cloud and should have open APIs for developers. Just my two cents......Bob

Dr. Naresh, this is Niteen Kamerkar of OHUM Healthcare, India. It is interesting to read all the postings on this topic. We have been helping some of the large Indian Hospitals with their VistA initiative for the last 4 years. I believe there are a lot of misconceptions about Open Source in general and Open Source EMRs in particular. We have been doing a lot of awareness creation about this. It is a huge task. We are also talking to several hospitals in other countries including rural hospitals in the US. I will be more than happy to share our experiences deploying and supporting VistA.

this is a good topic, I have looked at a few emr solutions but have the greatest exposure to OpenMRS. There is a diverse collaborative network that support this software. There have been good upgrades and extensions over time. The quality of the code and the modular nature make it easy to use and the team is always ready to assist.


It is interesting for me to read this conversation.  I am just learning about the dynamic world of healthcare informatics and am interested in the time and monetary investment required to create a good EMR systems.  What can you tell me about how flexible these open source programs are, and how effective they are in meeting the needs of diverse medical communities worldwide?  Thanks,  Amy

All would have to be customized to some degree, an that means paying programmers to alter the source code. The practice management aspect would vary some from country to country as well based on who pays, etc. Open source has great potential e.g Firefox, LibreOffice but is more difficult when you are talking about electronic health records. Also, inpatient EHRs are considerably more complex than outpatients EHRs.....REH



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