Mar 04 , 2015

Is an open source EMR (OpenEMR) the right choice for you?


Being the lead developer of OpenEMR,  I field calls on a daily basis from people who want to implement the open source EMR.  As part of the due diligence to discover and deliver the best possible outcome for the client I give them different options that they could consider. Part of that option is blueEHR.  to which I get the following reaction, “So you took OpenEMR and put an industrial wrapper around it.”  Let me emphasize here that, no, blueEHR is written from the ground up, it is a totally different code base on an altogether higher platform.  And it is a SaaS(Software as a service)”

So the next question is, “why do you have blueEHR and OpenEMR?” I am attempting to answer that question by asking another one, “Is an open source EMR the right choice for you? If not, what are the best alternatives.”  Because each system has its own advantages and disadvantages.

When we talk about an open source EMR we are talking about OpenEMR which serves more than 300,000 entities in 182 countries and serving 36 languages.

open source complexities

Why did these 300,000 plus entities’ choose open source software?  Or more broadly, why do open source aficionados prefer that path? Here are some of the  advantages to using open source.

  • It is cost efficient: free download of code
  • Try before you buy
  • Freedom from vendor lock in
  • It is flexible and customizable.
  • Support options
  • Auditability, quality and security of code: This might actually come as a surprise but the fact is due to the source being in the public realm it is more vetted than other closed systems.
  • Ownership of data: they have access to it.  They host their data and protect it themselves.
  • They believe they own the code. Fact is, GPL license requires that you share the code if you sell it outside of your organization.  There is one loophole in this whereby you can provide your advanced code as a SaaS

Here are a list of reasons when you should consider the use of a proprietary system:

  1. It is easier for unskilled users
  2. When it is the de-facto standard
  3. When it offers better support
  4. When you want software as a service
  5. When warranties and liability indemnities matter
  6. When you need a Vendor that will stick around

Is an open source EMR the right choice for you

While it is true that open source software is free, effectively implementing complicated, interconnected EMR software is not for the amateur.  You need to have a professional resource who knows what they are doing or you must be that resource. Here is a list of items you need to consider when implementing an on-site open source software with specific reference to EMR.

  1. Security and HIPAA compliance, very likely to be difficult to navigate .
  2. Open Source code changes has to be updated on a regular basis.
  3. Customization is a cost albeit less so than others
  4. Interfaces. You will need to interface with several third party entities such as Labs, eRX, HIEs and such.  These entities work with selected vendors and these comes at additional costs and complicated contracts.
  5. MU 2 certification and compliance.  Yes, this is different than point number one.
  6. Devices integration
  7. Patient Portals and access


Open source EMR suits two kinds of people.

  1.  The hobbyists who love to do things on their own, or
  2. Organizations with resources that can meet the points listed above.

But the need of the hour is to get away from the vice like grip of monopolistic EHR systems. EPIC holds the medical  information of  40% of the US population.  The proprietary systems on the cloud offer none of the advantages of open source. Many a times they hold your data hostage.  They are inflexible and unusable to the extent that the American Medical Association petitioned to the ONC to revise their testing standards.

Wouldn’t it be great if there was a third choice that could deliver all the advantages of open source and the proprietary EHRs while negating  the drawbacks of both?  What would that option look like?

  1. It is free. You only pay if you need additional support.
  2. There is no hardware cost: It is a SaaS (Software As A Service).
  3. It is customizable on the cloud.  We can pretty much bend it anyway you want it to be.
  4. Your data is yours: You get access to your database any time you choose.
  5. It is hosted on a HIPAA compliant secure cloud that is managed for you.
  6. Contracts in place with all outside entities at no extra cost to you.
  7. Updates to the code keeps it cutting edge.
  8. You get top of the line Practice management system, Patient portal, Telemedicine platform with Video consult capabilities.
  9. And finally, if you choose to leave you should be able to do so without a lock in, and  go back to the community version of  OpenEMR

This is what we call an open source /proprietary hybrid delivering not just an EHR but an EHR: Electronic Health Solution.  Currently blueEHR is the only proprietary systems out there that gives you all these features with all this flexibility at a low/no cost to you.  We essentially took the best of open source and the best of proprietary systems and presents it to you in a friendly and easy to implement fashion.

Over eight years we have customized, troubleshot, and implemented OpenEMR for all types of customers worldwide including governments and NGOs. We learned from our years of experience being the top most contributor of code to the OpenEMR project  and designed and developed a product from the ground up.

We provide all types of end users an option that will meet their needs:

  • Complex institutions who can manage their own IT: open source or AWS image
  • Hobbyists and fierce independent techies: open source solution
  • Small to medium range practices: SaaS Solution
  • Internet challenged parts of the world: blueEHR onsite version or open source version

Open source is all about freedom of choice: where else can you find these many choices for your EMR/EHR solution?