Open source EMR software: Profiling, insights, and hands-on analysis

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This is a review of Kiah, Haiqi, Zaidan, and Zaidan (2014) article, Open Source EMR software: Profiling, insights, and hands-on analysis. [1]

Research Question

The authors attempt to provide a comprehensive guide to open-source EMR software from the implementers' perspective.


While there is no evidence that free or Open-source software (OSS) is superior to closed-source software, open-source software is growing in popularity. The hope is that open-source EMR software will help overcome financial barriers to HIT adoption. Comparing the available open-source options is an important step in HIT adoption process. The authors compare 13 available and active OSS EMRs on their functionality, usability, and security. They also consider whether there is sufficient software support available for both users and developers.


The authors conducted a literature search to discover existing and active open-source EMR software. They summarize the results, providing guides for the sampled systems, and identifying gaps in the published literature related to the topic. Thirty-two papers were reviewed, including the following 13 OSS EMRs: FreeMED, GNUmed, GNU Health, Hospital OS, HOSxP, OpenEMR, OpenMRS, OSCAR, THIRRA, WorldVistA, ZEPRS, ClearHealth, and MedinTux.

The next part of the study comprised installing the software and giving feedback related to hands-on experience. The software was assessed and compared based on the following factors: technical details, usability, functionality and features, security, user support, developer support, customizability, and ease of installation.


The surveyed articles did not provide enough information to fulfill the target objective. In the hands-on study, no system met all relevant industry standards. The easiest systems to install were GNUmed, OpenEMR, and ZEPRS. OpenEMR had the best overall performance, but fell short for customizability and developer support. GNUmed provided the most security. OpenMRS is capable of offering the full spectrum of functionalities and is chosen to use in foreign countries with resource-constrained environments. HOSxP and MedinTux provide competitive functionality. ZEPRS performed poorly. WorldVista is a mature system providing user flexibility.


The literature review highlighted the barriers and hurdles to implementing OSS EMRs. The OSS EMRs evaluated using hands-on experience fulfilled structural and procedural requirements ranging from minimal to full functionality. Only a few of the OSS EMRs in the study met communication, privacy, and security requirements at the functional level. The ethical, cultural, and consumer requirements remained unfulfilled. OpenMRS is the most widely used OSS deployed in multiple countries.


OSS EMRs are gaining in popularity even though there is no evidence that OSS are superior to commercial systems. However, OSSs can provide a base for more comprehensive healthcare solutions. Overall, OSS EMR application are lacking in security, interoperability, and developer support. Available OSS EMRs require future in-depth investigation to profile the full spectrum of their functionality.


This study provides a great foundation for evaluating open-source EMR systems. While OSS EMRs do not provide the highest level usability, functionality, and security, they are on their way to being strong competitors to closed-source systems. It is important to have viable low cost options that can be successfully implemented in a resource-constrained environment. Furthermore, if these low cost systems become competitive with higher-priced systems (particularly closed-sources systems), competitors could make their product more marketable by lowering their prices or by offering additional services. Financial barriers significantly contribute to low HIT adoption rates, so these can be seen as important factors.

Related Article Reviews

  1. Heuristic evaluation of eNote: an electronic notes system
  2. The impact of electronic health records on healthcare quality: a systematic review and meta-analysis
  3. The OpenMRS System: Collaborating Toward an Open Source EMR for Developing Countries
  4. Open-source health information technology: A case study of electronic medical records


  1. Kiah M. L. M., Haiqi, A.., Zaidan B. B., and Zaidan, A. A. (2014). Open source EMR software: Profiling, insights, and hands-on analysis. Computer Methods and Programs in Biomedicine, 117, 360-382. Retrieved from