Access to electronic medical record systems is limited in many medical informatics education programs. The objective of this study was to inventory open-source patient record systems with decision support capabilities, implement a system for educational use, and test the effect of the system on students’ learning. We sought systems that were under active development, with source code available, having an SQL-queryable database, and having decision support capabilities. We identified 20 candidate electronic health record systems, of which 6 mentioned decision support capabilities in their documentation. Of these, the OpenMRS system appeared to meet all of the requirements for use in our course; however, decision support capabilities needed to be added by use of a custom module implementing Arden2Bytecode, an Arden Syntax interpreter. Students who used this system showed an improvement in their knowledge of decision support systems and their capabilities. We conclude that there are a number of promising open-source electronic patient record systems currently under active development, but decision support capabilities are still immature. We anticipate further developments in this area in the coming years.
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