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Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys
  1. Peter S Millard1,
  2. Juan Bru2,
  3. Christopher A Berger1
  1. 1Catholic University of Mozambique, Beira, Mozambique
  2. 2Polytechnic University of Valencia, Valencia, Spain
  1. Correspondence to Dr Peter S Millard; pmillard{at}


Background Point-of-care electronic medical records (EMRs) are a key tool to manage chronic illness. Several EMRs have been developed for use in treating HIV and tuberculosis, but their applicability to primary care, technical requirements and clinical functionalities are largely unknown.

Objectives This study aimed to address the needs of clinicians from resource-limited settings without reliable internet access who are considering adopting an open-source EMR.

Study eligibility criteria Open-source point-of-care EMRs suitable for use in areas without reliable internet access.

Study appraisal and synthesis methods The authors conducted a comprehensive search of all open-source EMRs suitable for sites without reliable internet access. The authors surveyed clinician users and technical implementers from a single site and technical developers of each software product. The authors evaluated availability, cost and technical requirements.

Results The hardware and software for all six systems is easily available, but they vary considerably in proprietary components, installation requirements and customisability.

Limitations This study relied solely on self-report from informants who developed and who actively use the included products.

Conclusions and implications of key findings Clinical functionalities vary greatly among the systems, and none of the systems yet meet minimum requirements for effective implementation in a primary care resource-limited setting. The safe prescribing of medications is a particular concern with current tools. The dearth of fully functional EMR systems indicates a need for a greater emphasis by global funding agencies to move beyond disease-specific EMR systems and develop a universal open-source health informatics platform.

This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: and

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  • Contact information: The following developers were willing to share their contact information with readers: DREAM: ict{at}; PHIS: paul.fisher{at} and OSCAR: phuttenczapski{at}

  • To cite: Millard PS, Bru J, Berger CA. Open-source point-of-care electronic medical records for use in resource-limited settings: systematic review and questionnaire surveys. BMJ Open 2012;2:e000690. doi:10.1136/bmjopen-2011-000690

  • Contributors PSM is the lead author. PSM, JB and CAB made substantial contributions to conception and design, acquisition of data, analysis and interpretation of data; drafting the article and revising it critically for important intellectual content; and final approval of the version to be published.

  • Funding This study was supported by the Fogarty International Center, National Institutes of Health (grant number: 3 D43 TW01038) and by the Catholic University of Mozambique. No funding bodies played any role in the design, writing or decision to publish this manuscript.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement All data have been published. The survey instruments are available from the authors.