HealthMarch 20, 2017

The pros and cons of open source EMRs

Open source software — like the famed operating system Linux — makes its source programming code openly available to download. Users also contribute to the development of the software by sharing how they have employed and modified it and redistributing it. It is estimated that over 70% of the world’s Web servers run on a combination of open source software.

In the healthcare world, open source EMR (electronic medical record) software has emerged in recent years as, potentially, a flexible and less expensive alternative to proprietary, vendor-licensed, traditional EMR systems. According to the United Kingdom's Parliamentary Office of Science and Technology, the National Health Service (NHS) has endorsed open source EMRs as an option for its provider trusts (state-funded hospitals) in England, noting that the downloadable, shareable software can help speed up development. The first NHS trust to opt for an open source EMR solution went live with its patient record system in 2015.

Even so, in England and around the world, open source EMRs are still an alternative that evokes skepticism from many healthcare professionals, who find the software less robust and reliable than traditional, proprietary EMRs and requiring more technical know-how on the part of users.

Let’s take a look at the pros and cons of open source EMRs.



Although often referred to as “free,” open source EMRs still must be purchased, albeit at a notably lower price than most proprietary EMRs developed by traditional vendors. This is because you are not paying for the company’s marketing and overhead, proprietary databases and interfaces, templates, and licensing fees.


A healthcare organization using an open source EMR will likely still need to pay for hardware and infrastructure, implementation, support and maintenance, training, and possibly any proprietary databases it chooses to include, but usually without the depth of support, data options, and secure backing of a larger, established vendor. There could also be indemnification and liability risks that are not covered by an open source solution, as they are with a traditional vendor.

Access and collaboration


Open source EMRs are very easy to acquire — you just download them from the Web. This easy access also means you can thoroughly test and “play” with the software before implementing it across your organization.

Open source software users also share their development ideas and experiences with the rest of the “community” that is using the same solution, which can help improve the software and speed up the development process.


Downloading EMR software is easy, but implementing it is another story. It is a complex process with both open source and proprietary EMRs. However, with open source software, there is not a team of specialists to assist, offer advice, and perform the implementation. Hospitals and practices with experience implementing open source EMRs suggest hiring a vendor or a consultant to do the heavy lifting and provide support.

The sharing and collaborating aspect of open source has proven successful among large communities of users, but when dealing with healthcare software, the community is still not that substantial. And since many open source EMRs are being used in smaller practices, rather than in large health systems, the users tend to be busy physicians who do not have the technical skills or the time to devote to contributing to the community’s development efforts.

Development and clinical decision support


Open source EMRs are flexible compared with proprietary EMRs that often have stricter, modular structures and do not allow modifications of the source code. This presents a great potential for customization and innovation. Traditional vendors often offer a variety of possibilities to customize their EMRs to your needs, but open source EMRs eliminate the need to ask the vendor to perform these customized modifications and the wait for them to be completed.

That flexibility extends to changing or upgrading systems. Many healthcare organizations feel that once they have gone through the time-consuming efforts of implementing a proprietary EMR and establishing it throughout the practice or health system, they are locked into staying with that vendor for an extended period of time. Open source EMRs often make it easier to add or subtract from your system or change the entire solution.

As far as functionality, open source EMRs are designed to encourage interoperability and sometimes reduce barriers to achieving interoperability that organizations encounter with other software systems.


User interface aesthetics are usually not important to open source solutions. These EMRs, once implemented, often lack icons and buttons, attractive fonts, and colorful, user-friendly layouts.

Clinical decision support data and functionality are important elements of proprietary EMRs that help support clinicians’ decision making and enhance patient safety. Not all open source EMRs offer an extensive depth of clinical decision support options. Before implementing an open source EMR, organizations should ensure that they have access to appropriate clinical decision support solutions, including:

  • Sophisticated e-prescribing functions
  • Lab ordering capabilities
  • Picklists or other tools that reduce reliance on free-text entries, which are not linked to coded clinical data and can be prone to human errors
  • Desired reporting capabilities

What’s the No. 1 concern most healthcare professionals have about open source EMRs? Privacy and security. So far, open source software has not proven to be any more or less secure than proprietary EMR software, but experts advise that all healthcare professionals continue to monitor the quality of security and the privacy of patient information regardless of what kind of EMR they use.

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