List of Active FOSS EMR/EHR’s

Here’s about as good a summary as you can get of currently active Free and Open Source Software EHR/EMR projects courtesy of Dan Johnson, MD. Dr. Johnson is the author of the earliest known writings on Free and Open Source Software in medicine. He continues his activity in this area.

June 11, 2004,

Dear Dr. Rollow, Mr. Weir, and Mr Moy:

Thank you for speaking to me this week about DOQ-IT and open source

I promised that by today I would have prepared a summary of open source
EHR projects that I’m aware of. There is some very exciting work going
on. I will give you, below, a precis of each project and links. I will
cc the folks that offered me their information so that (a) you’ll have
contact information and (b) they can correct any misrepresentations that
I inadvertently create.

I will also post this note to the open source healthcare discussion
list, so the folks there can correct my errors. You can tune into that
discussion by sending an e-mail to with “subscribe” as the
subject. An archive of past messages is available at .

In addition, here’s a link to a comprehensive, well-documented essay on
open source software and its market: It is very long; its author has
kept it up do date for at least 4 years, and I’ve found it a useful
encyclopedia of open source references.

An extensive list of open source health care software resources is
maintained at (but is
not current beyond 2002). Other lists of open source EHR projects are
at and as well as, the open-source healthcare new site, run
by the psychiatrist Iganacio Valdes, MD, which maintains an excellent
list at

Now follows the list of open-source EHR vendors.

1: Project: tkfp
Lead: Alexander Caldwell M.D.
Developers: 10
Use in practices: 2
Tech support: informal, active
Supports billing: yes
Lab interface: yes

Special feature: designed to incorporate practice guidelines:
Has integration with “MedMapper” —
— an interactive electronic algorithm-like decision support system that
is the brainchild of David Pepper M.D. This
allows tight integration of decision support for the EMR with
documentation in the patient record. This system prompts physicians in
real time, creating dynamically editable templates for our note writing
that allow best practice and practice guidelines to be incorporated
directly into the note templates.

A *very* interesting concept; *not* formally commercial.

2: Project: OpenEMed
Lead: David Forslund
Developers: several
Use in practices: being installed as part of the SHARE project in
Mendocino County, CA.
Tech support: informal, active
Supports billing: no
Lab import: yes

Special features: OpenEMed is a set of distributed healthcare
information service components built around the OMG distributed object
specifications and the HL7 (and other) data standards and is written in
Java for platform portability.
In addition, it includes a complete JSP client implementation of a
infectious disease monitoring system (B-SAFER) for use in an Urgent Care
setting. This includes filters for a variety of data feeds including
HL7, CSV, SQL, flat files, and XML. This powerful and flexible tool is
being used to acquire a variety of data from multiple hospital systems.
Also included is a example of a simple immunization registry pilot. The
power of using these components in a variety of settings can ultimately
lead to a fully distributed medical record accessible by a patient. This
could be ideal in a regional healthcare management scenario.
David Forslund has done some simply amazing work interconnecting
regional hospitals with disparate information systems in the Southwest,
and this project is an outgrowth of his work.

3: Projects: OSCAR and EGADSS and plus

Click to access UBC-VCH-BC-CDSS%20Services%20April%202004.pdf

Leads: David Chan, MD (OSCAR),
(contact Joseph Dal Molin,
Morgan Price, MD (EGADSS)
Developers: 5, full time, employed
Use in practices: 4 or more in Canada (fully portable to the US)
Tech support: available commercially in Canada
Supports billing: partial, in Canada
Lab import: yes

Special features: OSCAR is a full-fledged office EHR developed by Dr.
David Chan of the McMasters University Family Practice program in
Hamilton, Ontario. This is the most sophisticated and complete open
source EHR. Dr. Chan has earned significant grant support for
development; the developers are eager to have US practices adopt and
extend OSCAR.
EGADSS is under initial development; it is designed to be a stand alone
reminder system that can interface with an EMR. EGADSS stands for
Evidence-based Guideline And Decision Support System.

4: Project: OpenEMR
Lead: Walt Pennington
Developers: 6
Use in practice: 175 clinics using or evaluating OpenEMR;
International use: Uganda pilot beginning
Tech support: available commercially from the Pennington Firm
Supports billing: yes
Supports lab import: in development

Special features: a functioning, commercially thriving, commercial
product based on the open source development model.
Pennington Firm
402 West Broadway
4th Floor
San Diego, CA 92101-3554
619-696-5050 or 888-480-5050

Updated 10/09/2004 by IV:
5: Project: VistA
Lead: US Veterans Administration, OpenVistA

Medsphere: Contact: Summer Bond
65 Enterprise
Aliso Viejo, CA 92656
Developers: several
Use in practice: hospital-based system
Developers: 5 in house
Sites: 7 hospitals
Tech support: full, commercial
Supports billing: yes
Supports lab: yes, and everything else

Special features: This is an example of VistA being ported to the
private sector. VistA is capable, I understand, of being a physician
office EHR, but I am not aware of commercial availability for this. I
believe that it is being used in the office setting in American Samoa.

6: Project: TORCH
Lead: Tim Cook
Developers: 100+
Sites: Not tallied (I believe that Tim has a commercial product, based
on TORCH, in several practices that he supports commercially.)
Tech support: informal
Supports billing: yes, using FreeB (
Supports lab interfaces: yes
Able to support QI guidelines: yes

Special features: TORCH is unique in that it is an actively-developed
code base that is available to developers. The TORCH2 project is an
object oriented and completely open source EHR
composed of components for; billing, practice management, accounting,
clinical coding, customizable workflow, graphing package, remote and
local scheduling using standard iCal documents, granular security model,
audit trail of every action, template and free text input is user
selectable, voice recognition (with additional software), hand writing
recognition (with additional hardware and software) and has interfaces
for PCs, PDAs and iPhones.

7: Project: CHLCare
Lead: Thomas Lewis MD
Contact: Marilyn Wetterhahn (?sp), Special Projects
Primary Care Coalition of Montgomery County
8757 Georgia Avenue, Silver Spring, MD 20910
(301) 628-3405
Details: none available see

Special features: This is an Open Source, enrollment based, encounter
based, thin, broad, web based, extensible electronic medical record for
primary care support. I have heard a presentation on this system, but
can locate no information.

8: Project: FreeMED
Lead: Jeff Buchbinder
Developers: several
Sites: at least one. FreeMED was developed., I believe, circa 1997,
for the practice of Jeff’s father, making it truly the first open source
Tech support:
Supports billing: yes, through FreeB
Supports lab: not known

Special features: I’m sorry; I’m ignorant.

There are other open source health care projects as well, I’m confident
that I’ve missed one or more that are mature and deployed. but this is
what I’m able to provide over lunch and after patient care is finished.

As a Wisconsin PRO (MetaStar) trustee, I’m excited about the potential
that DOQ-IT has for beginning to bring coherence to the healthcare
office EHR arena.


Dan Johnson md

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