Open-source EHR systems compared

No. None of the open-source licenses covered here (GPL-3.0 for OpenEMR, MPL 2.0 for OpenMRS, GPL v3 or later for GNU Health) is a paid edition, so the software itself carries no per-user or per-site license fee. Your costs come from the services around the software: hosting in your own cloud account, data center or air-gapped network, database and runtime, configuration, interfaces, data migration, training, backups, upgrades, and any support contract. Some vendors and implementers sell these separately, and DeployOpen's work falls into that group when it is scoped in writing. Confirm each license against its license text and the Open Source Initiative's list before recording it in a procurement file, because this page does not assert OSI approval status for any of them. Ask every quote to itemize which services it covers and which stay with your team.

Yes. OpenEMR is a free and open-source electronic health records and practice management application, licensed under the GNU GPL v3.0. The license lets you run, copy and modify the code without a per-seat fee. Plan for the costs that the license does not cover: hosting, PHP 8.3 or later and a MySQL- or MariaDB-compatible database for recent releases, Docker or manual deployment, HTTPS setup, configuration of scheduling and billing, and upgrades. Recent security fixes in the 8.3.0 and 8.4.0 releases touched FHIR APIs, the patient portal and billing, so upgrade planning is a recurring cost. Ask any implementer to state which upgrade, patching and backup tasks their quote includes and how long they keep older versions supported.

The OpenEMR community raised $16,125 to pay for testing and certification. OpenEMR 7.0.0 was ONC certified on 7/19/22 as a 2015 Edition Base EHR after testing by SLI concluded on 6/30/22. Certification attaches to a specific version, so the project's website told users to upgrade to version 8 by March 1, 2026 to keep their system's active certification. For your organization, the certification cost is a project cost that the community funded, and it does not cover your own compliance work. You still carry the cost of upgrading, of confirming that your configuration matches the certified version, and of evidence collection for your own assessments. Ask the vendor or implementer which version they will deploy and what its current certification status is.

OpenMRS is released under the Mozilla Public License 2.0 with a Healthcare Disclaimer, and its core copyright is held by OpenMRS Inc. The license does not set a per-user or per-site fee, and no paid tier of the platform is described in the project materials supplied for this page. The paid work sits with implementers: the project describes volunteer contributors and implementer organizations that customize and deploy it. Read the Healthcare Disclaimer in full, because it shapes how the software may be relied on clinically, and have counsel review it before go-live. Ask each implementer to state their rates or fixed scope in writing, which services are included, and who owns the customizations they build.

OpenMRS Inc is a 501(c)(3) nonprofit that provides the fiscal and legal foundation and infrastructure for the OpenMRS project. That gives the project a legal home, a steward for shared infrastructure and continuity of governance, which matters if your deployment will run for many years. It does not mean the foundation sells hosting, implementation or support to you. Confirm directly with OpenMRS Inc what it offers commercially, if anything, before assuming any service exists. Implementation and ongoing support usually come from implementer organizations and the wider community. Check whether your partner has run O3 or 2.x deployments in settings like yours, and whether it will keep your modules current as the platform releases new versions.

GNU Health is licensed under the GPL v3 or later, with copyright held by Luis Falcon and GNU Solidario. The GNU Health website lists it as a GNU official package and a Digital Public Goods Alliance digital public good, and it lists deployments in countries including Spain, Argentina, Jamaica, India, Laos, Cameroon, Pakistan and Gambia. The digital public good listing describes the project's status. It does not guarantee fit for your setting or any support level. Free licensing removes the software fee, but the HIS requires a GNU/Linux or BSD server, PostgreSQL 15 or later, Python 3.10 or later, Gunicorn 23.0 and Tryton 7.0, so you still pay for hosting, administration and any local implementation partner. Ask who in your country provides installation, training and maintenance.

The supplied material for GNU Health describes no certification such as ONC certification, so do not assume one exists. Ask the project and its service providers which certifications, if any, apply in your jurisdiction and whether they cover the version you plan to deploy. The material also describes no paid edition of the HIS. Confirm with the project and its providers whether any commercial tier, support contract or managed service exists. Pay attention to the FHIR REST documentation, which warns that the server is still in development and does not fulfill the FHIR specification. If your integrations depend on FHIR, add that gap to the scope and ask the provider how they will close it.

Bahmni is an OpenMRS-based distribution, so it builds on OpenMRS, but its own license terms must be checked in its repository. Do not assume they match the MPL 2.0 terms of OpenMRS. A Bahmni deployment also combines other components, such as Odoo, OpenELIS and dcm4chee, and each component carries its own license. Ask for a written inventory listing every component, its version and its license, and confirm which of them your organization will modify or redistribute. Treat the inventory as part of the scope for any implementation, because it determines which upgrade paths and obligations apply to you. Ask implementers to show how they track those components over time.

The software license is not the main cost. OpenEMR is free and open-source under the GNU GPL v3.0, and OpenMRS is released under the MPL 2.0, so the spend goes to people and infrastructure. Cost drivers include the number of sites and users, the number of interfaces to laboratory, pharmacy, imaging or billing systems, data migration from existing records, configuration of forms and workflows, hosting in your own cloud or data center, and the testing and training your staff need. Services are quoted from a written scope, so ask each vendor or implementer to itemize these components in the quote.

The software authors and foundations generally receive no license fee from you, but they may sell services. Your organization pays for the work around the software. A typical split is an implementer for configuration, integration and migration, your cloud or hosting provider for infrastructure, your staff for clinical content and sign-off, and a support provider for ongoing fixes and upgrades. For OpenMRS, the OpenMRS Inc. nonprofit provides the fiscal and legal foundation, while implementer organizations customize and deploy it. Ask who holds responsibility for each line item in the contract.

One-time costs usually include scoping, configuration, interface build, data migration, initial testing, staff training and the first deployment. Recurring costs include hosting, backups, security patching, upgrades, monitoring, help desk coverage and support retainers. Upgrades are recurring in practice: OpenEMR's website told users to move to version 8 by March 1, 2026 to keep their certification active, which shows that version maintenance is an ongoing obligation. Ask any implementer to separate one-time build work from a recurring support scope so you can compare offers on the same basis.

The duration depends on the number of sites, the forms and workflows in scope, the interfaces required and how quickly your clinical leads can review and approve content. No duration can be stated from the supplied facts, so confirm it in writing with each implementer before work starts. Ask for the phases, the dependencies on your staff, the test cycles and the acceptance criteria. A pilot limited to one clinic with a fixed set of workflows will usually be easier to bound than a multi-site rollout.

A small clinic with strong IT skills can install and run OpenEMR, which supports Docker deployment and requires PHP 8.3 or later with a MySQL- or MariaDB-compatible database. The harder work is clinical configuration, security hardening, backups, interface work and keeping the system current. OpenEMR's Securing OpenEMR guide asks administrators to allow only HTTPS, remove setup scripts after installation and block direct web access to document folders. Organizations without these skills in-house, or those handling regulated patient data across several sites, should weigh outside help against the risk of an unpatched or misconfigured system.

Clinical staff need to define workflows, approve forms, review order sets and sign off on testing, because the software cannot decide how your clinic documents care. IT staff need to handle hosting, identity, network access, database operations, backups and monitoring. Both groups should agree on who owns configuration changes after go-live. For OpenMRS deployments, identity integration may involve the OAuth2 Login module with Keycloak or Google, and for OpenEMR it may involve LDAP or Active Directory login added in version 6.0.0. Confirm these integration needs with your identity team before scoping.

OpenEMR 7.0.0 was ONC certified on 7/19/22 as a 2015 Edition Base EHR after testing by SLI concluded on 6/30/22, and the OpenEMR website says the product is ONC certified and told users to upgrade to version 8 by March 1, 2026 to keep their system's active certification. Certification attaches to a specific software version and configuration, so an upgrade, a plug-in or a change in hosting can affect what your practice relies on. Confirm with the OpenEMR project and your certifying program which version is current and what your own attestation duties are. DeployOpen prepares systems and evidence for compliance assessments but does not issue certifications.

Choose OpenMRS when you need a platform to build or customize your own patient record application, and Bahmni when you want a packaged hospital system assembled from OpenMRS and other components. OpenMRS is a patient-based record platform designed for resource-constrained environments, licensed under the MPL 2.0, and its core runs on Tomcat or Jetty with MySQL, MariaDB or PostgreSQL. Bahmni is an OpenMRS-based distribution, so it adds packaging and modules for hospital operations, but it also adds components to run and upgrade. Compare the modules each one delivers for your settings, the team that will maintain them, and the effort each upgrade path requires.