TL;DR
Free software for electronic medical records (like OSCAR, OpenEMR, DoliMed) offers medical, dental and therapeutic clinics a free, secure and flexible alternative.
✅ Lower cost ✅ Local hosting = data protection ✅ Compliant with Bill 25 ✅ Reduced dependence on the GAFAM ✅ Promote digital sovereignty and local expertise
👉 Ideal for SMEs in the healthcare sector that want to keep control of their data and comply with Quebec laws.
Free and open‑source software (FOSS) provides Quebec clinics, practices and patients with more transparent and controllable electronic medical record solutions. Free software means its source code is accessible, modifiable and distributed free of charge; it isn’t owned by a single vendor imposing licences and high costs. Numerous FOSS projects exist today to manage medical, dental or therapeutic records, tailored to small practices and health businesses. These solutions allow healthcare professionals and patients to keep their health data locally or in a controlled environment, thus strengthening digital sovereignty — that is, the control of Quebec and its citizens over their personal health data.
Digital sovereignty has become crucial in the current geopolitical context. In healthcare, many sensitive data are transmitted through foreign servers (notably American). Laws such as the Clarifying Lawful Overseas Use of Data Act (CLOUD Act, United States, 2018) allow U.S. authorities to demand data stored abroad. This means U.S. companies, even if they host data in Quebec, could be required to hand it over to U.S. intelligence services. Experts point out that a company under U.S. jurisdiction could be forced to respond to a data access request even for data hosted in Quebec. For citizens and healthcare professionals this creates a serious vulnerability: medical and private records could leave Canadian control. The Parti Québécois and the CAQ have recently emphasised the need to strengthen Quebec’s digital sovereignty to “break free from certain monopolies of the tech giants”. Accordingly they advocate betting on free software and developing local expertise in digital health.
Why choose free software in healthcare?
For a non‑technical audience it’s important to stress that “free” does not mean “complicated”. On the contrary, free software is often easy to install and use even without significant IT skills. For example, the DoliMed software (based on the Dolibarr ERP/CRM) is described as “an easy‑to‑use solution for managing a healthcare practice (patients, consultations, documents, etc.)” designed for doctors, dentists, physiotherapists, nurses, etc. It is available for download free of charge and can be installed on any computer or server. Similarly, OSCAR EMR is a free open‑source electronic medical record developed by physicians for their colleagues. It is a platform supported by a large community in Canada. For healthcare professionals or patients, free software offers several tangible advantages:
- Reduced cost: licences are free. An SME can therefore adopt an EMR without recurring licence fees. For example, choosing OpenEMR instead of a proprietary system like Epic or Cerner can drastically reduce IT spending.
- Data control: because the source code is open, you can ensure that no hidden function is exfiltrating data. Healthcare institutions can host the software on their own servers in Quebec, thus avoiding foreign platforms. This control is reinforced by Bill 25 (Quebec): it now requires a privacy impact assessment before any personal data is transferred outside Quebec. Organisations must explicitly inform individuals if their health data may be transferred outside the province. By using free software hosted locally, a medical practice can more easily meet these requirements, because everything is transparent and auditable.
- Adaptability and continuity: free software can be adapted or translated to suit local needs (contracts, languages, forms). There is no risk of a forced end‑of‑life for the product: the community or the institution can maintain the project in the long term. For example, OSCAR has been used in Canada for decades without ever costing licence fees, thanks to the volunteer commitment of user physicians.
- Community innovation: open‑source health projects often benefit from international contributions. OpenEMR, for example, is “the world’s most popular open‑source electronic health record software, maintained by a passionate volunteer community” and available in 30 languages. This ensures ongoing improvements (security, new features such as telehealth, e‑prescribing, etc.) at no extra cost.
- Sovereign choice: free software allows professionals to choose local or community providers for hosting and support. This reduces dependence on the American digital health giants. As one article notes, we are at the mercy of the software industry when we continue to favour proprietary solutions. By contrast, choosing a free EMR means investing in local skills and the technological independence of the province.
Quoting critics of the current policy: “open‑source systems like OSCAR and VistA, developed at lower cost, outperform most proprietary systems while offering taxpayers significant savings.” The debate is not only economic but also fundamental for data security and sovereignty: as the InterHop association reminds us, true digital sovereignty requires open‑source technologies that allow auditing and technical mastery.
Examples of FOSS solutions for healthcare
Here are some of the free EMR software programs that may suit clinics and small health businesses:
- OSCAR EMR – a popular Canadian EMR designed by physicians for family practices. OSCAR is completely open source (GPL licence) and supported by a national community. It includes patient records, appointments, prescriptions, billing, etc. (“OSCAR is an EMR system designed by physicians, for physicians”). OSCAR has been promoted as a low‑cost alternative to private giants and has demonstrated significant savings for the health system.
- OpenEMR – the most widely used free software worldwide for medical records and practice management. Available in French, OpenEMR offers a powerful appointment book, e‑prescription modules and a patient portal. Its active community ensures certification and compliance with standards (for example ONC in the United States). As their official site states, “OpenEMR is the most popular open‑source medical record software, supported by a dedicated community, always free.” This solution is well suited to small clinics seeking a flexible platform.
- OpenMRS – a global open‑source medical records platform used in many countries (especially developing nations). OpenMRS is designed to be extensible and customised to local needs. The French‑language version of their site describes OpenMRS as “an open‑source medical record system with a global community”. It is the first open‑source EMR project in the world. Although it requires a bit more technical configuration, OpenMRS can provide a robust backbone for clinics and hospitals – some African countries have set up national systems based on OpenMRS.
- GNU Health – a free health ecosystem (hospital systems, patient records, etc.), promoted by the Free Software Foundation Europe. GNU Health is developed as a social project aimed at equality of access to care. Their site presents GNU Health as “a free project for practitioners, institutions and governments: it offers electronic medical record functions, hospital management (HMIS) and health information system”. GNU Health can be installed on a local server (“GNU Health in a box”) so that all data are stored within the clinic, with no dependence on any external provider.
- DoliMed (Dolibarr ERP/CRM) – Although originally a business management package, Dolibarr can be extended via a DoliMed module to become a complete free EMR. This French software is easy for a doctor or dentist to use: patients, consultations, documents and prescriptions are managed in a clear interface. DoliMed runs on any computer and any operating system and is completely free to self‑install. It is therefore suitable for small practices seeking a ready‑to‑use solution.
- FreeMedForms – an international suite of free medical software that can serve as a desktop patient record. Although less complete than a networked EMR, FreeMedForms allows data entry and follow‑up and runs on Linux, Mac and Windows. It may suit professionals with few patients or in solo practice wanting a local desktop solution.
- Open Dental – an open‑source dental practice management software appreciated for its power and customisation. Although its site does not openly indicate the licence, the community recognises it as open source (the source code is available on GitHub). Open Dental is regularly cited as one of the few free EMRs specialised for dentistry. It offers graphical dental treatment planning, billing and connects to numerous dental devices.
- Other examples – There are also modular and extensible solutions such as ClearHealth, GNUmed or ERPNext Healthcare that can be adapted. Some small hospitals around the world also use systems like VistA (the U.S. veterans’ EMR, in its open‑source version) or variants of OpenClinic GA. The important thing is that the FOSS health community is alive: new modules are created and share their code.
These solutions show that open‑source projects exist for all medical specialities (general practice, dental, paramedical). They rely on the involvement of local users and often on Quebec service providers for implementation and support, thereby strengthening the local expertise highlighted by the authorities.
Digital sovereignty and regulation (Bill 25)
Digital sovereignty is defined as the ability of a nation or entity to control its own data and digital infrastructures. For a Quebec citizen or professional this means knowing where their health data reside and who has access to them, under which legislation. Today, despite hosting sometimes in Quebec, many platforms (Azure, AWS, etc.) are subject to U.S. law. Thus InterHop reminds us that laws like the CLOUD Act and FISA 702 give U.S. authorities extraterritorial access to global data. For example, French certification as a Health Data Host does not prevent the use of American infrastructures. Similarly in Canada, section 105 of PIPEDA does not prevent forced disclosures. That’s why Quebec is stepping up vigilance: according to the Journal de Québec, the Legault government froze a digital health record project linked to the American group Epic for fear of vulnerabilities related to the CLOUD Act. At their congress, the CAQ passed a resolution noting the disproportionate influence of U.S. giants on Quebec’s digital infrastructure. An amendment was even adopted for the government to reinforce Quebec’s digital sovereignty against technology monopolies. These political developments mean health decision‑makers are being urged to choose local, transparent solutions – notably free software – rather than entrusting our data to the vagaries of foreign regulations.
In this legal context, Quebec’s Bill 25, which has been coming into force progressively since 2022, imposes several measures strengthening the protection of personal information. For example it requires a Privacy Impact Assessment for any IT project involving sensitive data. This assessment is especially required before any data is transferred outside Quebec. In other words, if a medical practice wants to host an EMR on a server outside Quebec (or outsource outside the province), it must first prove that the security and applicable legislation are equivalent. In addition, the organisation must inform each individual concerned if their data could be communicated abroad. Finally, Bill 25 states that medical data are sensitive by nature, which triggers the strictest regime (explicit consent, reinforced access rights, etc.).
In practice, locally managed free software helps meet these requirements: it allows servers to remain physically in Quebec and makes it easy to account for data flows. The software’s default functions can be configured to maximise confidentiality (for example, access only on an internal network). And if an SME outsources, it can choose a certified Canadian host or a Quebec provider to avoid the Cloud Act. In short, using an open‑source EMR in Quebec is consistent with the obligations of Bill 25: the transparency of the code and the choice of local infrastructures make it easier to obtain clear consent and demonstrate adequate protection of data under the law.
Benefits for small healthcare businesses
Small and medium‑sized businesses (private clinics, dental or paramedical practices, physiotherapy clinics, etc.) have every interest in evaluating these FOSS options. Budgets for these SMEs are often very tight: free software costs nothing in licensing, freeing up resources for other priorities such as medications, equipment and training. Conversely, commercial software generates significant recurring fees. Medical journalist Paul Webster notes that in Canada billions of dollars are wasted buying expensive proprietary systems, while OSCAR and VistA (open source) offer significant savings to taxpayers. For a small clinic, an open‑source solution therefore brings immediate competitiveness.
The other key point is the flexibility and scalability offered by free software. An SME can start with a simple server and add features gradually (for example a billing module, teleconsultation, etc.) without changing systems. They can also choose their deployment model: on‑site or in a private Canadian cloud. Many FOSS solutions have an open‑cloud version operated by independent providers; thus the company is not forced to trust the GAFAM. This avoids the scenario criticised by InterHop: paying for a solution labelled “Made in USA/Quebec” that actually stores everything on AWS, exposing data to U.S. law.
Finally, adopting free EMRs promotes local innovation and employment in Quebec. As the authorities wish, every clinic that uses free software encourages the training of local IT and health specialists. For example, Quebec companies (like Akinox) have already developed clinical platforms during the pandemic but were little used in major public projects. Promoting free software means allowing these regional players to offer their services to clinics. A small hospital or a group of doctors can thus find a Quebec integrator expert in OpenEMR or OSCAR rather than being dependent on a foreign contractor.
Conclusion
In short, there are many free medical record management software packages that meet the needs of clinics and small health businesses. OSCAR, OpenEMR, OpenMRS, GNU Health, DoliMed, Open Dental, etc., provide complete tools (patient records, appointments, prescriptions, billing) without licence costs. For Quebec physicians, dentists or therapists these solutions offer controlled costs, customisation and independence. They fit naturally into a digital sovereignty approach: by choosing FOSS hosted in Quebec they protect their patients’ data from foreign laws, meet the requirements of Bill 25 and encourage the local ecosystem. As a Quebec expert points out, the question is not only economic but ethical — we must stop being meek in our public contracts and rethink our technological choices in healthcare. Adopting open‑source EMRs can be part of that response, enabling us to regain control of our data for everyone’s benefit.
Sources: Numerous scientific works and specialist articles show the effectiveness of FOSS systems in healthcare and the issues of digital sovereignty. For example the World Health Organization encourages free software to improve access to care. In Canada, medical editorials have documented the possible savings with OSCAR/VistA. Recent Quebec news also highlights the role of free software in Bill 25 and data security. The official websites of the projects (OpenEMR, OpenMRS, etc.) confirm their FOSS characteristics. These sources confirm that transitioning to free solutions is both possible and beneficial for Quebec’s digital sovereignty.