How to Install OpenEMR on Debian 12 with NGINX

OpenEMR on Debian 12 with NGINX

OpenEMR (Open-source Electronic Medical Record) is a full-featured, ONC-certified electronic health records (EHR) and medical practice management software. It supports scheduling, e-prescriptions, billing, patient demographics, document storage, and clinical decision support.

Running OpenEMR on Debian 12 with NGINX provides a reliable, secure, and high-performance platform for clinics, hospitals, or healthcare startups aiming to self-host their medical records system.

Why Choose OpenEMR?

Feature	Description
EHR & EMR Functionality	Supports SOAP notes, clinical decision tools, and custom forms
Scheduling	Multi-user calendar with recurring appointments and availability tracking
Medical Billing	Includes full billing system with insurance claims and payment tracking
Patient Management	Complete demographic records, history, and document management
e-Prescribing	Integrated with drug database for electronic prescription management
User Roles & Security	Role-based access, password policies, and audit logging
Multi-language Support	Offers translations in over 30 languages
Community Support	Active open-source community and frequent updates

Why Use NGINX with OpenEMR on Debian 12?

Benefit	Explanation
Performance	NGINX is event-driven and handles high traffic loads efficiently
Secure Communication	Easily integrates with Let’s Encrypt or other SSL/TLS certificates
Scalability	Works well in distributed or containerized deployments with load balancing
PHP-FPM Integration	Separates PHP execution from web server, improving speed and isolation
Debian Stability	Debian 12 provides a rock-solid, long-supported OS for medical-grade applications

Minimum System Requirements

Component	Recommended Specification
OS	Debian 12 (Bookworm)
Web Server	NGINX + PHP-FPM
Database	MariaDB or MySQL
PHP	PHP 8.2 or newer with extensions: `pdo`, `mbstring`, `gd`, `xml`, etc.
Memory	2 GB minimum (4 GB+ recommended for production)
Disk Space	At least 2–5 GB (depends on usage and patient records)

Use Cases

Small Clinics & Private Practices: Manage appointments, charting, and billing from one interface.
Hospital Networks: Customize OpenEMR to integrate with lab systems or national databases.
NGOs & Mobile Clinics: Use on lightweight Debian servers or in the cloud for field medical work.
Medical Education: Set up private environments for training and EMR simulation labs.

Security & Compliance

OpenEMR on Debian 12 can be configured for HIPAA and GDPR compliance.
NGINX offers HTTPS via Let’s Encrypt and supports strong TLS configurations.
Built-in audit logs, user access control, and encryption support make it viable for sensitive environments.

Comparison with Other EMR Platforms

Platform	Open Source	Billing Support	Prescription Integration	Ideal For
OpenEMR	Yes	Yes	Yes	Clinics, Hospitals
OpenMRS	Yes	No (limited)	No	Research, NGOs
Oscar EMR	Yes	Yes	Yes	Canadian Practices
Practice Fusion	No	Yes	Yes	US Cloud-only Clinics

Step 1: Create a Shape.Host Instance

Visit https://shape.host and log in.

Click “Create”, then select “Instance”.

Choose your desired server location.

Select Debian 12 (64-bit) as the OS.

Choose a plan with minimum 2 CPUs, 4 GB RAM, and 20 GB SSD.

Click “Create Instance”.

After creation, locate the IP address of your instance.

Connect via SSH:

ssh root@your-server-ip

On Windows, use PuTTY.

Step 2: Install Required Packages

Update package list:

apt update

Install NGINX, MariaDB, PHP, and all required extensions:

apt install nginx mariadb-server php-fpm php-mysql php-bcmath php-xml php-zip php-curl php-mbstring php-gd php-tidy php-intl php-cli php-soap imagemagick libtiff-tools php-ldap

Step 3: Verify Services Are Active

Check MariaDB status:

systemctl is-enabled mariadb
systemctl status mariadb

Check PHP-FPM service:

systemctl is-enabled php8.2-fpm
systemctl status php8.2-fpm

Step 4: Configure PHP

Edit PHP settings:

nano /etc/php/8.2/fpm/php.ini

Update these parameters:

max_execution_time = 60
max_input_time = -1
memory_limit = 512M
post_max_size = 30M
upload_max_filesize = 30M
max_input_vars = 3000
mysqli.allow_local_infile = On

Set correct permissions and restart PHP:

chgrp -R www-data /var/lib/php/sessions
systemctl restart php8.2-fpm

Step 5: Secure MariaDB and Create Database

Run the MariaDB secure install script:

mariadb-secure-installation

Access MariaDB shell:

mariadb -u root -p

Create the OpenEMR database and user:

CREATE DATABASE openemr;
CREATE USER 'openemruser'@'localhost' IDENTIFIED BY 'Your_password2';
GRANT ALL PRIVILEGES ON openemr.* TO 'openemruser'@'localhost';
FLUSH PRIVILEGES;
QUIT;

Step 6: Download and Extract OpenEMR

Navigate to web root and download OpenEMR:

cd /var/www/
wget https://sourceforge.net/projects/openemr/files/OpenEMR%20Current/7.0.3/openemr-7.0.3.tar.gz

Extract and rename directory:

tar -pxzf openemr-7.0.3.tar.gz
mv openemr-7.0.3 openemr

Set ownership:

chown -R www-data:www-data /var/www/openemr

Step 7: Configure NGINX

Create NGINX virtual host:

nano /etc/nginx/sites-available/openemr

Paste the config below:

server {
    listen 80;
    server_name your-domain.com;

    access_log /var/log/nginx/openemr.access.log;
    error_log /var/log/nginx/openemr.error.log;

    root /var/www/openemr;
    index index.php;

    location / {
        try_files $uri $uri/ /index.php;
    }

    location ~* \.php$ {
        try_files $uri =404;
        fastcgi_index index.php;
        fastcgi_pass unix:/run/php/php8.2-fpm.sock;
        fastcgi_param SCRIPT_FILENAME $realpath_root$fastcgi_script_name;
        fastcgi_param DOCUMENT_ROOT $realpath_root;
        include fastcgi_params;
    }

    location ~* ^/sites/*/(documents|edi|era) {
        deny all;
        return 404;
    }

    location ~* ^/(contrib|tests) {
        deny all;
        return 404;
    }

    location ~* ^/(admin|setup|acl_setup|acl_upgrade|sl_convert|sql_upgrade|gacl/setup|ippf_upgrade|sql_patch)\.php {
        deny all;
        return 404;
    }

    location =https://shape-host.b-cdn.net/favicon.ico?x32662 {
        log_not_found off;
        access_log off;
    }

    location = /robots.txt {
        log_not_found off;
        access_log off;
    }

    location ~ /\.
    {
        deny all;
    }
}

Enable the site and test config:

ln -s /etc/nginx/sites-available/openemr /etc/nginx/sites-enabled/
nginx -t
systemctl restart nginx

Step 8: Enable Firewall and Configure SSL

Install UFW and allow traffic:

apt install ufw
ufw allow 'Nginx Full'
ufw allow ssh
ufw enable

Install Certbot and get SSL certificate:

apt install certbot python3-certbot-nginx
certbot --nginx -d your-domain.com

Step 9: Access Web Installer

Open your browser and visit:

https://your-domain.com

Follow the OpenEMR web installer to complete the setup.

First, the installer will check the permissions of the OpenEMR source code, so make sure you have proper permission.

Select the ‘I have created the database‘ option to set up your database integration.

Enter your database details and the new administrator admin for OpenEMR.

The database initialization will be running and your admin user will be created.

Next, make sure your PHP configuration is met with the OpenEMR requirements.

Once the installation is complete, you’ll be redirected to the OpenEMR login page. Type your admin user and password, then click Login.

If successful, you’ll see the following OpenEMR dashboard.

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