OpenEMR Review: Savings or Problems? Hidden Costs and Coding Needed

Not all medical practices have sufficient budget: sometimes you have to choose the cheapest medical practice management systems. And what could be cheaper than a free open source EMR system? If you're looking for a budget-friendly and customisable software for your clinic, you've come to the right page.

In this review, we'll explore OpenEMR's features, pricing, pros and cons. Take a couple of minutes to read the article and at the end you will understand whether you should try OpenEMR for your practice or its availability and open source code is not a benefit, but a challenge.

What is OpenEMR?

OpenEMR is a free (almost) and open-source electronic medical record (EMR) and practice management system. It is widely used by healthcare organizations worldwide due to its affordability and customizable nature since 2001. OpenEMR is certified for Meaningful Use and ONC, ensuring compliance with U.S. healthcare regulations.

Also because of ONC certification free software becomes a little bit paid. We will tell you more about this nuance in the section about pricing below.

An open-source software means that its code is publicly available for anyone to use, modify, and distribute. Think of it like a medical guideline that’s freely shared among doctors—anyone can follow it, improve it, or adapt it to their needs. This type of software gives users full control.

Since OpenEMR is written in the PHP programming language, any modifications or customizations require knowledge of this language. If you’re not a developer, you’d likely need an IT specialist to help with setup, customization, and maintenance. For a non tech-savvy person which a lot of healthcare providers are the software is difficult to use.

But still, OpenEMR is a popular choice for small to medium-sized practices looking for a cost-effective solution. Is it the right fit for your practice? Let’s break it down.

Patient Management and EHR in OpenEMR

OpenEMR provides a comprehensive suite of features for medical practices. Here’s a breakdown of its core functionalities starting with patient management.

It is worth noting that the main changes of modules and functions are made thanks to maintainers, i.e. users of the platform. They make changes in the codebase and share their improvements on the official forum. The features we will talk about below are the basic set available for everyone at the end of February 2025. As you have already realised, any existing feature can be modified and adapted to the needs of your practice.

So, patient management. The platform allows you to:

• Create and maintain electronic health records (EHR).
• Work with detailed patient demographics.
• Track medical history.
• Schedule patient visits yourself and give them access to a patient portal.

The operations take place in the calendar. If you are already familiar with at least one practice management software, the interface will not surprise you: a standard calendar with the ability to create appointments and view the schedule for the day, week or month.

Right from the calendar you can create a new client card or view an existing list. The client profile is quite comprehensive and will show you the entire history of interactions and treatments:

• allergies and medical issues
• billing and insurance information
• vitals
• documents and charts
• patient-related reports
• messages and reminders
• data from the medical portal

Speaking of the portal. It has a dashboard view where patients can view documents, write a message to a provider, view their paid and unpaid bills, book an appointment, and see a health snapshot.

For those who are used to ready-made templates for keeping appointments, you're in for a disappointment here. You have to upload the documents yourself, and to add your own template you need to modify Layout-Based Forms and add all the lines and lists yourself.

Moreover, you can create forms with Xml form generator and a perl-based tool called Formscript.

Medical Billing and Coding

The main functions you can perform within the platform:

• CPT, ICD-10, and HCPCS coding.
• Electronic billing and insurance claim submissions.
• Payment tracking and revenue cycle management.

OpenEMR allows you to send paper invoices directly to patients, but only if insurance is not involved. It can also send bills directly to insurance companies, but this is rare and only works in special cases.

In most situations, medical practices use a clearinghouse to handle insurance claims. Here’s how it works:

1. OpenEMR sends the claim details to the clearinghouse.
2. The clearinghouse formats the claim correctly for the insurance company.
3. The claim is sent to the insurance company for processing.
4. Once the payment is approved, the clearinghouse sends the funds back to the medical practice, which records it in OpenEMR.

If you want OpenEMR to handle insurance billing, you’ll need someone who understands how to set up the system and submit claims properly. Different clearinghouses offer varying levels of support—some handle most of the work for you, while others require you to learn their system and do it yourself.

Technically, OpenEMR provides enough documentation to figure this out on your own. However, given the complexity and time required, it may be more practical to hire an expert who already knows the process.

E-Prescribing Feature

If you are looking for a free EMR with e-prescribing feature, OpenEMR can suit you. But still, you must pay extra fee for this feature.

The platform supports e-prescribing through third-party integrations. You need a version of OpenEMR that supports eRx and access to a certified e-prescribing service such as:

• NewCrop (Paid service for full e-prescribing functionality, including controlled substances).
• Weno Exchange (A more affordable option but with limited pharmacy networks).

To sign up for the Weno account that uses this OpenEMR Weno eRx module go to online.wenoexchange.com and select service type: EHR EZ Integration. This account is in TEST mode until you pay $300 to go live, there is no account charge for signing up.

Integrating NewCrop's e-prescribing services with OpenEMR involves several costs. This includes essential services like drug interaction checks, formulary management, and prescription routing. The fee is charged monthly per active full-time equivalent (FTE) provider. Specific rates are confidential and provided under a Non-Disclosure Agreement (NDA).

Lab integration and imaging include:

• Integration with external lab services.
• DICOM (Digital Imaging and Communications in Medicine) support.
• Ability to upload and store patient scans and images.

Telehealth Functionality

Video consultations in OpenEMR are based on the Comlink platform. This means that connecting the module will bring additional costs: the current fee is $16/month for unlimited telehealth sessions with a 14-day free trial.

The module comes bundled inside of OpenEMR, accessible directly from the modules page. To start the free trial, open the OpenEMR login, sign in and go to Modules → Manage Modules → Unregistered.

What you will get with this integration:

• Screen sharing for both patient and provider
• Multiple invitation options: via email, SMS, portal.
• Multiple device support includes iOS, Android, Linux, Windows.

The integration works well, bugs are rare. However, the price may end up being high for clinicians who use telemedicine as an additional feature rather than on a permanent basis.

Pros and Cons of OpenEMR

Before committing to OpenEMR, it’s important to weigh its advantages and disadvantages.

Pros

• Free to download and use, making it ideal for small practices with limited budgets and in-house IT specialists.
• Open-source nature allows for extensive customization to fit your practice’s needs.
• Active community of developers and users for troubleshooting and updates.
• Ensures patient data security and compliance with regulations.

Cons

• The interface can be complex, and setup requires technical and coding expertise.
• As an open-source platform, professional support is not included and may require additional fees. If there is a bug, it can take a long time until somebody answers your question in the community.
• Customization and setup can be time-consuming.
• The user interface feels dated compared to modern alternatives.
• Though it supports 30+ languages, the translations are incomplete and sometimes even wrong.

OpenEMR Pricing: Free But With Hidden Costs

One of the biggest selling points of OpenEMR is that it is free to use. However, this does not mean that there are no costs involved. Since OpenEMR is an open-source platform, medical practices may need to allocate funds for the following:

Hosting fees. If you choose cloud hosting, you’ll need to pay for a hosting provider. Costs vary depending on the provider and the size of your practice—$20 to $500/month.

Customization and support. Unlike paid EMR solutions that come with customer support, OpenEMR relies on community forums. If you need dedicated IT help:

• Hiring an IT specialist – $50 to $200/hour.
• Annual support contracts – $1,000+ per year.

Training and implementation. Setting up OpenEMR can be complex, so you might need to invest in training for your staff and many more things. Here is quick table for your convenience:

Remember we were talking about the ONC certification at the beginning? There is one third party services which is required to be used with OpenEMR to fulfill ONC certification compliance, which is the EMR Direct phiMail service. Approximate pricing is $300 setup fee and $150 yearly per provider.

While OpenEMR is free to download and use, running it efficiently requires investments in hosting, security, IT support, and billing services. For practices without in-house IT expertise, the costs can add up quickly.

If you’re looking for an alternative that includes built-in support, security, and ease of use, consider Medesk, which offers a free trial and an all-in-one cloud-based solution with predictable pricing.

Medesk: An Extensive Alternative to OpenEMR

If OpenEMR’s complexity and lack of professional support are deal-breakers for you, Medesk is an excellent alternative to consider. It is a cloud-based practice management software designed to simplify healthcare operations for small to medium-sized practices.

Why сhoose Medesk over OpenEMR?

Key Features of Medesk

• User-friendly design for seamless navigation. No more getting lost in a myriad of rows and tabs: information is where you expect to find it.
• Automated reminders and calendar management. Set up once and reduce no-shows by 20-30%.
• Streamlined billing processes and insurance claims management. You don't need an IT specialist to connect these features. Integrations are set up within the platform in a couple of clicks.

• Built-in video consultations for remote patient care. Medesk Meet is a convenient telemedicine app that is included in the subscription.
• Real-time insights into practice performance. From the first day of your trial, you have access to 40+ templates to create reports. No need to spend time on customisation, just take a ready-made report and monitor the performance of your business.
• Outstanding support. Our team is always ready to help you solve all issues. You’ll have access to onboarding, training, learning center and continuous updates and feature enhancements.

• And finally, there are no hidden costs. With Medesk you know from the beginning the amount of subscription and all minor additional fees.

Unlike OpenEMR, which requires technical expertise and maintenance costs, Medesk provides an out-of-the-box solution with a free trial to test its features.

Why not take Medesk for a spin? Sign up for a free 15-day trial today and make sure we've thought of every module: you don't have to make code changes or hire a specialist to manage a successful practice. Compare Medesk to the OpenEMR demo and feel the difference.

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