Open source clinic software in India: what free really costs OpenMRS, Bahmni and GNU Health as their own sites describe them, and the hosting, setup and support bill behind a free licence.

Open source clinic software is free to download and costs money to run. For a small Indian OPD the realistic bill is a server or a cloud machine, a person or company to install and update it, a backup routine, and someone to call when it breaks. Hospitals and NGO programmes with an IT team absorb those costs; a single-doctor clinic usually cannot. This post describes three well-known projects as their own sites do, then lists what running any of them would take.

A note on what these projects are for. All three are built around a hospital or a health programme with an IT team, not a receptionist and a doctor. That is not a criticism; it is the design target, and it explains most of what follows.

What are OpenMRS, Bahmni and GNU Health?

OpenMRS

OpenMRS's site calls it "The world's leading open-source EMR system" and says its community "builds and maintains the world's leading open-source medical records system". It describes a community of "Hundreds of developers, technologists, informaticists, health policy officers and government officials", and states: "No license fees or vendor lock-in. Our source code is open and free." The about page names OpenMRS Inc, "a registered 501(c)(3) nonprofit", as the body that "exists to make sure this work can continue". The licence file in the openmrs-core repository is the Mozilla Public License, version 2.0, with an appended healthcare disclaimer.

What this means for a clinic: OpenMRS is a platform, the medical record and the framework around it. Registration, a queue, billing and the rest come from modules and distributions, and the install is a software project, not an app download.

Bahmni

Bahmni's site says: "Bahmni is an easy-to-use EMR & hospital system" that "combines and enhances existing open source products into a single solution". It names OpenMRS "for electronic medical records and patient management", OpenELIS "for laboratory management", and OpenERP "for inventory, billing, financial accounting", with DICOM and PACS support. It says "Bahmni is an open source project managed by Bahmni Coalition." Its licence page lists the components and their licences, with Bahmni's own components under "MPL v2 with Healthcare disclaimer" and a note that "The Bahmni project is in the process of migrating our licenses from AGPL v3 to the MPL v2". It also notes that Odoo "is a third party component" whose licence terms should be reviewed.

What this means for a clinic: Bahmni is the closest of the three to a complete hospital system out of the box, with lab and inventory built in. That is also its weight. A clinic with no lab and no stock gets modules it will not open, and the install is sized for a hospital.

GNU Health

GNU Health's site calls it "the Libre digital health ecosystem, where Social Medicine meets state-of-the-art health informatics" and says "GNU Health is a Free/Libre, community-driven project from GNU Solidario." It is marked as a "GNU Official Package" and a member of the Digital Public Goods Alliance. Its about page lists the components: "Social Medicine and Public Health", "Hospital Management (HMIS)", "Laboratory Management (Occhiolino)", "Personal Health Record (MyGNUHealth)", bioinformatics and medical genetics, "Thalamus and Federated health networks", and "GNU Health embedded on Single Board devices". The download page offers the HIS, an embedded "GNU Health in a Box", a VirtualBox image and the source code. The licence terms are in the source; read them there.

What this means for a clinic: GNU Health is aimed at health institutions and public health programmes. The embedded version runs on a small device without a network, which is interesting for a clinic with poor connectivity, but the setup still needs someone comfortable with Linux.

What does a free licence still cost?

Put those lines in the same one-year worksheet you would use for a paid product; our post on free versus paid clinic software has the sheet. The licence line is zero. The others are not, and the support line is the one that decides whether the system is still in use after six months.

Who is responsible for patient data when you self-host?

The clinic, entirely. The Digital Personal Data Protection Act, 2023 makes the person who determines the purpose and means of processing the Data Fiduciary, and section 8 puts the duties on that fiduciary: implement technical and organisational measures (8(4)), protect the data with reasonable security safeguards (8(5)), and tell the Board and each affected patient of a breach (8(6)). With a cloud vendor, some of that work is done by a Data Processor under the contract section 8(2) requires. With a self-hosted system there is no processor; the server, the patches, the logs and the breach report are the clinic's own job. Rule 6(1) of the DPDP Rules, 2025 lists the minimum safeguards, including encryption or similar, access control, logs, backups and one-year log retention. Our DPDP guide for clinics has the detail and the dates.

Who should choose open source clinic software?

• A hospital, trust or NGO programme with an IT person or a budget for an implementation partner, that wants control of the code and the data and expects to customise.
• A clinic whose owner or a family member is technical and will treat the system as a hobby they maintain, with the backup and update chores done on time.
• A programme that must run with no connection and no vendor at all, where an embedded or local install is the point.

Who should not: a 1 to 3 doctor OPD with no technical person, where the receptionist is the only computer user and the doctor's evening is the only spare time. For that clinic the licence saving is small against the cost of the support it will not have. Our guide to choosing clinic management software in India sets out the tests that apply to any product, open or not.