Why Buy Open Source (Free) EMR Software

Yes, I completely understand the irony of the title. That’s the beauty that is open source software. I’ve often talked about my fandom for open source software and it seems that open source EMR software is finally gaining some significant momentum.

As I was looking over the Open EMR website I stumbled upon a page created by the Open Source Medical Softare organization about the advantages of OpenEMR (an open source EMR package). I found the list interesting and so here’s my modified version of their list of OpenEMR advantages that should apply to any well done open source EMR:
Corporate buy-outs – I’m sure that Misys EMR users will appreciate this one. It’s never fun when your EMR software is bought out by someone else.
Bankruptcy – This is similar to a buy-out often, but sometimes can go even worse with prolonged periods with little support from your EMR vendor.
Vendor lock-in – Definitely isn’t in your EMR vendor’s best interest to make your data portable to another EMR system.
Sunsetting – If you’ve ever gone through this it’s time consuming and seems to provide little benefit (at least initially).
Duplication of engineering costs – Many people argue that EMR software should just adopt open APIs (which is a great thing), but it does meant that there’s often duplication of engineering costs.
Meta-applications built on substrate without asking permission: simulators, bio-surveillance, yet-to-be-conceived apps
No one vendor with enough engineering resources – I’m not sure open source EMR movements have beat out the engineering resources of a major EMR vendor, but it seems like it’s getting close to that point.
Corporate agenda not in harmony with customer needs – Could this really be?

I’m sure there are other reasons too. Although, it is interesting to consider some of the ways open source EMR software is able to solve some of the major pain points people feel when working with an EMR vendor.

About the author

John Lynn

John Lynn

John Lynn is the Founder of HealthcareScene.com, a network of leading Healthcare IT resources. The flagship blog, Healthcare IT Today, contains over 13,000 articles with over half of the articles written by John. These EMR and Healthcare IT related articles have been viewed over 20 million times.

John manages Healthcare IT Central, the leading career Health IT job board. He also organizes the first of its kind conference and community focused on healthcare marketing, Healthcare and IT Marketing Conference, and a healthcare IT conference, EXPO.health, focused on practical healthcare IT innovation. John is an advisor to multiple healthcare IT companies. John is highly involved in social media, and in addition to his blogs can be found on Twitter: @techguy.


  • Won’t ultimately all EMR/EHR data be an open format (e.g., ODT) giving the ability of patients to control, and be responsibility for (i.e., decide its storage location) all their medical information? I could continue to see proprietary applications (i.e. PM) that might display the practice schedule differently only with patent numbers, but in the end patient info (past, present, and future) won’t reside in their care…Also, I’m not sure the government should be a repository either.

  • packets,
    I don’t see that happening anytime soon. Give it at least 20-30 years before that will happen I think. If even then. I’m not sure most patients care that much about controlling their data. Plus, EMR vendors will be fighting tooth and nail against such a movement.

  • There is one thing that wasn’t commented on here:
    The financial backing of commercial EMR systems.

    With the ARRA stimulus and the money that is going to get paid to Medicare & Medicaid providing physicians and hospitals, EMR software needs to be certified for meaningful use. CCHIT is the only approved certifying body currently. Currently, a full Meaningful Use (Preliminary) certification costs over $30,000.

    HHS is looking at what to do about certifying open source systems, but nothing has been determined yet. Until this is figured out, there are no financial incentives for OpenEMR, other than it being free to buy.

    I am a huge open source fan, and am an avid open source developer, but I can’t justify recommending OpenEMR to a provider who is looking to get ARRA stimulus payments.

    @packets: Open data formats… NHIN is setting out the standards for information exchange of healthcare information with the NHIN. Also, CCHIT has been certifying EHRs against their interoperability protocols (based on HL7), and the NHIN standards are currently being put into their tests.

    However… Open data exchange is NOT the same as open data storage. And like it or not, the government is going to have the final say in who manages, warehouses and accesses this data.

    I doubt that EMR vendors will fight against this because there isn’t that much they can do about it. The APIs will be public, and they will be forced to interoperate.

    The quality of an EMR will ultimately be determined by its workflow and ease of use. It’s a user-facing application, so that is how should be anyway.

  • Kris,
    Thanks for joining in on the conversation.

    You’re certainly right about the difference in financial backing of an open source EMR versus a proprietary EMR software. The judgement users have to make with an open source EMR isn’t so much a financial backing question, but instead they need to evaluate the health of the community behind the open source EMR. One part of the health of an open source community is financial, but there are other factors.

    That said, I think open source EMR are slowly becoming legitimate options for healthcare providers. Something I couldn’t have said 4 years ago.

    One clarification on CCHIT. It is not an HHS approved certifying body yet either. HHS hasn’t published the EHR certification criteria yet. Nor have they specified which certifying bodies will be recognized. Don’t listen to the CCHIT spin. We all assume that CCHIT will be one of those bodies, but I’ll be very surprised if they are the only one. Especially with organizations like the Drummond Group already planning to certify EHR (see https://www.healthcareittoday.com/2009/11/03/new-ehr-certifying-body-drummond-group/ ).

    Also, as far as not being about to support OpenEMR because they can’t afford the outrageous (excuse the bias) CCHIT certification price tag, you should read the comments in this post I did about OpenEMR: https://www.healthcareittoday.com/2009/11/25/openemr-success-story/ The comments show a pretty concerted effort to become CCHIT certified to me. As much as any proprietary EHR organization I’ve seen.

  • Another open source EMR project is WorldVistA EMR. The DC Linux Users Group recently invited the President and Chief Medical Officer of WorldVistA to speak about her experiences and about the project. They have had much success as apart of the VA hospital system but she also expressed concern about the upcoming expiration of their CCHIT certification. If one is interested in OpenEMR, WorldVistA’s product may be worth checking out, as well.

  • Nick,
    They’re kind of apples and oranges really. WorldVista is meant for hospital EMR. OpenEMR is meant for ambulatory EMR. All the different flavors of Vista that have sprung from the government making it open source are very interesting to watch though.

  • good info… and very interesting.

    what happens when Open Source support stops? Read that, what guarantees are in place to assure an indefinitely sustainable future? (so far my experience with “free” and “too good to be true”… are anything but).

    thanks in advance

  • B Borden,
    This is a good question and why I wrote about evaluating the stability of an open source EMR project: https://www.healthcareittoday.com/2010/01/06/stability-of-propietary-emr-vendors-vs-open-source-emr/

    Of course, when anything stops its not a good thing. However, it’s better when an open source EMR stops than when an EMR vendor goes under. At least with the open source EMR you have all the code and permission to do anything with the code that you want. Not to mention access to all of your data in the database and the code that accesses that data which can be used to export it to a new EMR or you can take up the open source EMR and pay developers yourself.

    Sure, it’s not pretty, but you definitely have more (and easier) options with an open source EMR than you would with a proprietary EMR vendor.

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