How to Install OpenEMR on Ubuntu 24.04 with NGINX

OpenEMR on Ubuntu 24.04 with NGINX

OpenEMR is a certified open-source electronic medical record (EMR) and medical practice management solution. It supports medical billing, patient scheduling, electronic prescriptions, and health records — making it one of the most comprehensive free EMR systems available.

Deploying OpenEMR on Ubuntu 24.04 with NGINX as the web server provides a high-performance, secure, and modern environment for healthcare IT infrastructures.

Key Features of OpenEMR

Feature	Description
Patient Management	Demographics, medical history, documents, and communication tracking
EHR / EMR Functionality	Full clinical charting, SOAP notes, and medical forms
Scheduling	Calendar system for appointments and resource allocation
Medical Billing	Integrated billing and insurance module with support for X12 837/835
e-Prescribing	Electronic prescriptions, drug interactions, and dosage support
Reports and Analytics	Medical, financial, and patient reports
Multi-language Support	Over 30 language packs available
Access Control and Logging	User roles, audit trails, HIPAA compliance-ready

Benefits of Using NGINX with OpenEMR on Ubuntu 24.04

Benefit	Details
Performance	NGINX’s asynchronous architecture excels under high concurrent loads
TLS/SSL Support	Simple integration with Let’s Encrypt and modern HTTPS configurations
Reverse Proxy Ready	Ideal for proxying to PHP-FPM for better performance and isolation
Load Balancing	Built-in options for scaling OpenEMR deployments across servers
Ubuntu 24.04 Compatibility	Supports PHP 8.3, MariaDB 10.11+, and modern security libraries

System Requirements (Recommended)

Component	Specification
OS	Ubuntu Server 24.04 LTS
Web Server	NGINX + PHP-FPM 8.3
Database	MariaDB or MySQL
PHP	PHP 8.1–8.3 with required extensions (`pdo`, `gd`, `mbstring`, etc.)
RAM	Minimum 2 GB (4 GB or more for production use)
Storage	At least 2 GB for core installation + user data

Common Use Cases

Independent Clinics: Use OpenEMR for patient records, billing, and reporting.
Medical Groups: Centralize operations for multiple physicians or departments.
Telemedicine Startups: Integrate with custom frontends via APIs for remote healthcare services.
NGOs and Global Health Programs: Take advantage of multi-language support and cost-free licensing.

Security and Compliance

HIPAA-ready with logging, access controls, and backup features.
Supports encrypted communications via NGINX + TLS (Let’s Encrypt or custom certs).
Audit trail logs ensure accountability and traceability of access and modifications.

Comparison with Other EMR Systems

EMR System	Open Source	Certification	Customizable	Deployment Type
OpenEMR	Yes	ONC-certified	High	Self-hosted
OpenMRS	Yes	No	High	Self-hosted
MediTracker	No	Yes	Low	SaaS
Epic/Allscripts	No	Yes	Very Limited	Enterprise SaaS

OpenEMR on Ubuntu 24.04 with NGINX is an ideal choice for organizations looking for a powerful, customizable, and cost-effective EMR solution. NGINX enhances performance and scalability, while Ubuntu 24.04 provides long-term support and up-to-date packages for secure operation. This combination supports both small clinics and large-scale healthcare operations seeking control and efficiency in medical data management.

Create and Connect to a VPS on Shape.Host

Create a Cloud VPS Instance

Go to https://shape.host and log in.

Click “Create” → choose “Instance”.

Configure:

Location: Choose any available data center

OS: Select Ubuntu 24.04 (64-bit)

Resources: Minimum 2 CPUs, 4 GB RAM, and 20 GB SSD

Click “Create Instance”

Once created, copy your instance’s public IP address

Connect via SSH:

ssh root@your-server-ip

On Windows, use PuTTY.

Connect to the Server

Option 1: SSH (Linux/macOS/WSL)

From your terminal, run:

ssh root@YOUR_INSTANCE_IP

Replace YOUR_INSTANCE_IP with the IP of your VPS.

Option 2: Use PuTTY on Windows

Download PuTTY: https://www.putty.org
Open PuTTY and enter your instance IP under “Host Name”
Leave port as 22, connection type as SSH
Click Open
When prompted, log in as:
- Username: root
- Password: Provided in instance details or set during deployment

You’re now ready to start installing OpenEMR.

Step 1: Update the System

apt update

Updates the local package list so you install the latest versions.

Step 2: Install Required Packages

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

Installs the NGINX web server, MariaDB database, and all PHP extensions required by OpenEMR.

Step 3: Check MariaDB and PHP-FPM Services

systemctl is-enabled mariadb
systemctl status mariadb

Checks that MariaDB is installed and running.

systemctl is-enabled php8.3-fpm
systemctl status php8.3-fpm

Checks PHP-FPM service is active.

Step 4: Tune PHP Settings

nano /etc/php/8.3/fpm/php.ini

Update key settings:

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

Apply group ownership:

chgrp -R www-data /var/lib/php/sessions
systemctl restart php8.3-fpm

Step 5: Secure MariaDB & Create Database

Run the secure installation:

mariadb-secure-installation

Then enter the MariaDB shell:

mariadb -u root -p

In MariaDB shell:

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

This sets up the database and credentials OpenEMR will use.

Step 6: Download and Prepare OpenEMR

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

Downloads the OpenEMR source and prepares it for NGINX.

Step 7: Configure NGINX for OpenEMR

nano /etc/nginx/sites-available/openemr

Paste and adjust (especially server_name):

server {
    listen 80;
    server_name example.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/php8.3-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 config:

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

Step 8: Configure Firewall with UFW

ufw allow 'Nginx Full'
ufw allow ssh
ufw enable

Allows traffic for NGINX and SSH.

Step 9: Add HTTPS with Let’s Encrypt

apt install certbot python3-certbot-nginx
certbot --nginx -d ubuntu-tutorials.shape.host

Obtains and configures a free SSL cert.

Step 10: Finish Web Setup

Visit:

https://your-domain.com

Follow the OpenEMR installer to complete 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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