Good afternoon, I am teaching the next generation of users (20 - 30-year-olds) how to install OpenEMR on a Mac. Here are the latest instructions I could find on the web. Is there anything more up to date that makes the installation process timelier and more efficient?
Thank you,
Robert
Hi Robert-
You appear to be new to OpenEMRā welcome to the Community!
Have you seen the OpenEMR wiki? Itās a companion site to this forum, contains static documentation composed and posted to a browseable site.
Hereās a wiki query for the posts on OpenEMR with a mac:
https://www.open-emr.org/wiki/index.php?title=Special%3ASearch&search=mac&go=Go
Hereās one of the returns , re: XAMPP and MacOS
and hereās a quikie guide to how to most efficiently use the wiki:
Feel free to come on back here with any questions you may have!
Best- Harley
Harley:
Thank you. Yes, I have been trying to follow along with the instructions on the Wiki and it takes some fortitude and persistence to transpose the older instructions so they will work on the newer software. I appreciate your recommendations and will put them to use.
I have reviewed the older instructions for installing OpenEMR on a Mac and a colleague was able to use them to install version 5.0 on their machine. He said he ran into several PHP errors when he tried installing the latest version using XAMPP.
I donāt own a MAC, so I must borrow one from the library, which is locked down and does not provide the user with administrator rights. I have petitioned the IT Center for the necessary rights so I can try to install the latest version on the MAC. I am guessing that one of the problems with installing the new version on a MAC is making sure the PHP file is set up correctly.
Any thoughts are greatly appreciated. Thanks for your help.
Robert
Harley - when I try to run this query, it tells me I am blocked from the website. I have copied the link into a browser and I receive the same message.
Thank you
Hi @Robert21, welcome. The wiki search mechanism is temporarily unavailable for those who arenāt logged in. If you donāt mind running a web search for now until itās restored or you can request a wiki account.
Stephen:
Thank you. So, should I generate a request for a Wiki account?
Robert
Hi @Robert21 -
I started this earlier this AM but I see youāve replied and gotten replies in a couple places so Iāll address your latest issues.
Glad I am youāre getting useful results transposing the older docs. I have to say I have limited experience with installations. Also I run Linux exclusively so Iām no help on Windows OR Mac installs. But given time to respond these forum members usually come up with help.
Re: your email to me, āI decided to learn OpenEMR and help my students to download, install, and maintain the application on their own computers. It is a lot of heavy lifting, but it will get the students hands dirty in terms of setting up an EHR, rather than pushing keys in a playground environment.ā
Itās true that learning to use OpenEMR will be a great help to your students. But every EMR/ EHR has its idiosyncrasies, and I think compared to a proprietary system like Epic, OpenEMRās major gotcha compared to others it its Open Source nature. Not only what youāve seen in the documentation, but the whole thing about āyou can make it do what you want if you know howā makes for a peculiar user/ support experience that wonāt be found in proprietary systems.
In terms of using the wiki, OpenEMR 5 marked a significant change in interface conventions so from that version the application will resemble the documentation the most. The wiki tells which version the particular doc was written for so generally it would apply to versions newer than the one itās written for, and be transposeable for older ones.
If you or your students have any issues at all with the docs or the operations or whatever, please do feel free to post questions here!
Best- Harley
Hi,
Just opened up the search feature on the wiki. So should now work.
Harley:
Sorry for the delay. Thanks for your response, it is greatly appreciated. Regarding your comments about Epic/OpenEMR, with EPIC, the students donāt have access to the configuration portion of the system; therefore, they never get to experience setting up an alert or creating a flow sheet. I worry that all I can do with Epic is teach them to push the right buttons to diagnose a patient or order a medication.
With OpenEMR, no matter how painful it is for me or the student, teaching them to install the program and operationalize aspects of it will provide them with real world skills that will (hopefully) transfer to working with other vender based EHRās. That is my hope. And that is how I learned with working technology.
If you know of anyone, I can reach out to who has expertise in installing and configuring OpenEMR on Windows, I would be most appreciative.
Again, I look forward to working with you.
Finally, any documentation that I create to help my students install and configure OpenEMR, I am willing to share with the OpenEMR community.
Take care,
Robert
Brady -
Thank you!! I appreciate your help. In your opinion, should I wait until 8.0 is released and teach students how to install that system, or have them install 7.04 and move to the higher version?
Thank you,
Robert
Hi Robert-
Itās my experience with Epic that the users are not taught any more than they need to know to perform their tightly restricted tasks for fear that theyāll sidestep Epic and open up their own support shop. Granted, thatās for the non- clinical users but it sounds from your description that the same principle applies to providersā training?
As you say, like learning your first coding language is the hardest because youāre learning how to program. Once you know how to program you can pick up other languages easily.
Would the system you want to set up be unpaid volunteer work or is it funded? Then once you have the EMR instance running, will you need training? What sort of infrastructure are you looking at? These days the most common setup is a public site on a cloud server accessible to anybody with a password. One reason for that is that the Community OpenEMR release package also includes a Patient Portal which non- techies (the patients) can log into for their uses.
However, OpenEMR (and its patient portal) can be run standalone on a desktop serving the site to users on an internal network behind a router or other firewall. In fact thatās the easier method since you donāt have to harden the site to intrusion. I guess it really depends on how much of the EMR āexperienceā you want to give your students: are they just learning how to use the EMR or really administering one? And on that, in my opinion re: your question to Brady, if youāre teaching the students the whole sys admin role for OpenEMR, upgrading the version of an OpenEMR instance is a valuable real- life skill to have.
I am not competent to train/ advise on installations but I know some people I can ask if theyāre able to help. However, I am qualified to serve as a consultant in the user training. Iād be happy to discuss it with you and see what we can work out for a no-cost arrangement to help with training when you get your system installed.
By the way, you are aware of the OpenEMR demos?
https://www.open-emr.org/demo/
Depending on your user load these might be useful. Maybe while heās answering your other questions Brady can tell how many users the demo systems can take at once!
This could be great!
Best- Harley
Harley:
Thanks for your response; it is greatly appreciated. I will answer your questions, one at a time.
Would the system you want to set up be unpaid or is it funded?
Unfortunately, I donāt have any funds to set up the OpenEMR server. I have two laptops that I am using to practice installing and setting up the program, but they are woefully underpowered. I have toyed with the idea of purchasing my own server and looking at ways to host it for my students. I also teach FHIR (which is an HL7 standard) and I am looking at ways to host both the FHIR server and OPENEMR, because they would be able to talk to each other and this would make for a great student experience. Students could use PostMan to send requests to the FHIR server which would then connect to the OpenEMR.
I have also talked with the ITCS (IT Computing) about setting up a virtual machine but those talks are going nowhere. Manpower issue. Politics, etc. They donāt have someone to dedicate time to maintain the server, and they probably wouldnāt give me rights to administer the server.
Ideally, I would like to learn how to become proficient in installing and configuring OpenEMR on both Windows and Macs. We try to dissuade our students from using MACS because they are not predominately used in healthcare settings. However, they donāt follow our advice. I would like to then train my students to download and install OpenEMR on their own computers, so they get the experience of learning how to bring up an EHR from scratch. I think we both agree this would benefit them greatly. As I mentioned earlier, anything that I learn and create to help my students, I am willing to share with the OpenEMR community. I like helping the little guy. I view EPIC in the same light as I view Amazon.
Will I need training?
Yes, it would be helpful to get some instruction on how to install and setup an OpenEMR system. I have no doubt that I could figure it out, but it would take a long time. There was a Russian psychologist named Vygotsky who developed what he called āthe zone of proximal developmentā which describes what a person can learn with the help of another individual. You meet them (the learner) where they are at and expand their knowledge and capabilities. I strongly believe that I will need someone to help me reach that zone of proximal development.
*What sort of infrastructure are you looking at?
*
As mentioned above, I would like to have the students learn to install and setup OpenEMR on their own computer; however, it would be nice to have a setup in the cloud or whatever space is available to run both OpenEMR and possibly a FHIR server. We can concentrate on OpenEMR because FHIR is a whole other can of worms. I would like to have a stable set up to give students a resource where they could perform functions like reporting on quality measures and developing registries, possibly building alerts.
Demos
Yes, I am aware of the demos and will review them to see if I can create some basic assignments so that students can explore basic OpenEMR functionality. For example, finding data elements contained in the United States Core Data for Interoperability.
I hope this helps. Let me know if you have any questions or concerns.
Thanks again,
Robert
Hi Robert-
Iām fairly old school as far as notions of pedagogy are concerned, but in my opinion school is a great place to teach people how to manage the compromises required in holding down a real- life job. The healthcare world is full of examples, such as at my work our lead dev who runs Mac has chosen platform agnostic dev applications so he and our other devs who use MSWindows and Linux can work together. But Iām curious what your observations are of the medical IT world, and also what are the requirements of your teaching position?
I.e., are you mandated to teach on Windows? If thatās the case, one would hope you would be financed for the bare minimum of the costs of the suftware? But if youāre not, even the Windows version of OpenEMR can be set up with its own free/ no-cost web server to deliver the OpenEMR on the sub-net itās on behind the school routerās firewall.
But a large portion the medical IT scene is installed on Linux web servers, the OS for which (and OpenEMR itself of course) is available free of charge. The EMR is delivered as a web site, into which the users log with a browser running on a PC running any OS you want. And for a user load of a couple dozen at a time, you wouldnāt need more than a 10 year old reasonably beefy desktop computer-- thereās no need for a purpose built āserverā per se, unless you want to run the OpenEMR 24/7 for the whole IT Department.
Here are some forum posts that may be old but they will give some idea of the hardware requirements. Note, they talk about RAM on the order of 8 gigsā¦
and just as a random aside this might be interesting:
OpenEMR with aaPanel and LAMP stack on Linux Virtual Machine - OpenEMR Project Wiki )
You might consider giving them the opportunity to work together, say, on a term project to come up with the ābestā (define the specification to suit) procedure to install OpenEMR on a Mac. And Iām not completely clear on the scope of your class. If itās strictly āhow to use an EMRā you would get into such user or admin tasks as discussed in the OpenEMR wiki,
Ok, but I ramble.
Once we have an idea of your actual needs I could get specific about the training I am able to offer. No matter what, I would be happy to answer emailed questions, so letās start with that.
More later- Harley
I have been using Mac exclusively, and have been installing openEMR on my macs for the last 2 years.
I have used many ways:
Initial: XAMPP (worse option, outdated, the way to go 15 years ago)
Second: Direct on Mac UNIX using terminal. Downloaded MySQL from website and installed package. Installed php and apache via brew package installer. (much better option)
Third: Docker !!! Went to Docker website to install Docker Desktop Mac. Looked at OpenEMR docker video tutorials. Copied openemr command-line utilities. Used terminal for docker commands. (By far and away, the best, easiest, and most versatile option)
If using Mac, before āopenemr-cmd upā, you need to use command:
chmod -R 755 openemr/.git
Please see my thread:
I am curious what your observations are of the Medical IT world, and what are the requirements of your teaching position?
Harley ā for my own career development, I rounded at New Hanover Regional Medical Center in Wilmington, NC, and ECU Health, located in Greenville, NC. At New Hanover, I rounded with a hospitalist who used a Smart Phone (Haiku) to review his patients before he came to the facility. I would then go around with him as he saw his patients. NHRMC had a computer terminal mounted on an articulated arm in each room. The terminal used Citrix to connect to the EPIC backend systems. I never got a chance to see the backend. Since most of my students work directly with health care professionals, I felt it was important for me to understand how they used the technology to document health care outcomes.
After the hospitalist was through visiting with their patients, we would eat lunch and then he would document what happened on a patient basis on his rounds. If he had to order medication, he usually did this while in the patientās room. Sometimes he would consult a pharmacist who was stationed on the floor.
The hospitalists also used interesting technology such as Perfect Serve to allow communication to occur among care team members. Each floor at the facility had a Business Center where everyone would meet (Nurses, Clinicians, Pharmacists, Social Workers, and Hospitalists) to discuss patient issues. All the computers in the Business Center where Windows based and connected to the EHR using Citrix. The Business Center was connected to a backup system separate from EPIC.
At ECU Health, I rounded with a Nurse Informatician whose duties where to troubleshoot problems health care professionals were having with Epic. For example, a nurse was having problems ordering a medication for a patient who would come in weekly for chemotherapy. The order for the medication would not generate because the patient had visited the ER in between therapies, and this cancelled the standing order. I learned a lot during through that experience. Like New Hanover, ECU Health connected to EPIC via Citrix running on Windows.
I have an undergraduate degree from Bethany College in Politics and Public Policy. I have a masterās degree in library and information science from the University of Pittsburgh, and an Ed. D in Instructional Design and Technology from the University of Pittsburgh. While completed my doctorate, I oversaw all the technology in the library at Duquesne University. I managed the ethernet network that had over 250 nodes, along with the electronic card catalog and CD-ROM based system for searching periodical information. I have taught educational psychology and informatics for thirty years. Currently, I am the program director for the informatics program at East Carolina University. I am not one of those people who, once they get to a certain point in their career, stops learning and only teaches what they know. This is one reason why I am trying to introduce OpenEMR in my classes.
Are you mandated to teach on Windows?
In the department that I teach, we have three programs: Health Services Management, Health Information Management, and Health Informatics (Health Informatics is a masterās program). Each program has an advisory board, and the board recommends that our students know how to use Windows based machines, and Microsoft applications.
Linux Web Servers
*The students in the informatics program are trained to act as a conduit between the IT staff of a hospital and the health care professionals; therefore, they need to understand both sides of the coin. I donāt think any of my students will touch the servers on the backend. Most of them will be involved in learning how the EHR can be configured to benefit the end-user. They also need to understand and step in when IT might do something that could impact the bottom line and the quality of care given to the patient.
For example, when I rounded at ECU Health one of the IT technicians wanted to make it mandatory that all patients being discharged receives a TB test. This freaked out the nurse I was rounding with. Doing this would add three days to the patientās stay, and result in needless expenditures. The only time a patient being discharged should get a TB test if they were going to a skilled nursing facility.*
Iām not completely clear on the scope of your class.
In my electronic health records class, I teach students how experts (nurses, physician, physical therapists) represent knowledge in the head. A lot of this is done through pattern recognition. We then look at the various features of an EHR to learn how they might enhance the health care professionals ability to diagnose and treat the patient. This is one reason why I think it is important for the students learn to basic functionality of an EHR, and how to set up and create reminders, order sets, etc.
We also discuss health care standards such as HIPAA, the Cures Act, Burden Reduction, HITECH, so that the students see how much impact governmental legislation has on the practice of medicine in America.
Actual Needs
If we were going to host an OpenEMR server, I think at a bare minimum, it should be able to support 50 simultaneous users. I still think it will be important to have students be able to download and install the software on their own machines. With that said, I feel that I need to be able to install the software and configure it so that I can pass that knowledge on to my students.
David:
Thank you. If I am reading your post correctly, the sensible thing to do would be to learn how to use Docker to install OpenEMR on a Mac. Is that a correct interpretation? I have read your post *āOpenEMR Docker Works on Mac - But Need Help with .dockerignore.ā
*
Has that issue been resolved?
David, I can use a MAC and I am not afraid to try something new, but I am not as knowledgeable as you in terms of carrying out what you describe above. Is it possible for you to create more detailed instructions that I can follow. Or is this information contained in the OpenEMR docker videos. I have never used Docker and I am unsure as to how one would go about entering the commands you reference above. But as I mentioned before, I am not afraid to learn and give it try.
I need to learn how to do this and understand what I am doing because I will need to create instructions for Mac users who have trouble downloading files to their computer. It is an interesting challenge.
Thank you,
Robert
Hi @Robert21
That was some info download, it 's clear youāre quite qualified in many ways for your project.
Donāt know if Iām seeing the essence of it all, though, because it looks to me that OpenEMR would be only one of the tools youād need in your efforts to teach how to represent and manipulate healthcare knowledge. Iām saying that because Iāve worked at different levels of involvement with 3 - 4 EMRs in my time and Iāve been surprised how each one has its own mental map of the data it works with, and its own ideas of how to manipulate it. And the maps can be very different from each other.
For example, youāve mentioned setting up reminders as a good lesson to teach. Iām pretty sure OpenEMRās reminder rule syntax is unique in all the world, being half algebra and half programming language. So teaching how to set up reminders in OpenEMR might get you too far into the weeds; it might be better to teach the logic of how to USE them, which is a much more universal process.
But anyway-- I and the other forum members are always available to answer specific questions on how OpoenEMR does things. This should be v v interswsting!
Best- Harley