HospitalRun is an open-source, offline-first hospital information system built with web technologies, while HospitalOS by MedSoftwares is a commercial, offline-capable hospital management system with comprehensive modules for billing, pharmacy, and mobile money payments. Both platforms are designed for environments with unreliable internet connectivity, but they differ substantially in feature completeness, maturity, and support availability.
For hospitals and clinics operating in areas where internet access is intermittent or unavailable, offline capability is not a luxury -- it is a requirement. This comparison examines both offline-first platforms to help you choose the right one for your facility.
Overview
HospitalRun
HospitalRun is an open-source hospital information system originally developed by CURE International, a network of charitable hospitals. It was designed from the start for use in developing countries where internet connectivity cannot be guaranteed. HospitalRun uses CouchDB/PouchDB for offline-first data storage and synchronization, with a modern web-based interface built on React and Node.js.
Key strengths: True offline-first architecture using CouchDB sync, modern web interface, open source under GPL license, designed for developing countries, active GitHub community.
Important note: HospitalRun has experienced periods of slow development and version transitions. As of 2026, the project has undergone a significant rewrite (from Ember.js to React), and some features from the legacy version may not yet be available in the current release. Prospective users should verify the current state of feature availability before committing to deployment.
HospitalOS
HospitalOS by MedSoftwares is a commercial hospital management system that combines offline-first capability with a comprehensive suite of hospital management modules. It covers clinical records, pharmacy, billing, laboratory, radiology, inventory, HR, and financial management in a single platform. Built for developing markets, it includes native mobile money integration, NHIS claims processing, and multi-currency support.
Key strengths: Complete hospital management suite, offline-first with online sync, mobile money payments, NHIS integration, multi-currency billing, 24/7 professional support, one-time license fee.
Feature Comparison
| Feature | HospitalRun | HospitalOS | |---|---|---| | Patient Registration | Yes | Yes | | Electronic Medical Records | Basic clinical records | Full EMR module | | Outpatient Management | Basic | Comprehensive | | Inpatient / Admissions | Basic | Full admission-to-discharge | | Pharmacy Management | Medication tracking | Comprehensive pharmacy module | | Drug Interaction Checking | Not available | Built-in | | Billing & Invoicing | Basic billing | Full billing with insurance | | Insurance Claims | Not available | NHIS claims processing | | Laboratory Management | Lab requests & results | Integrated lab module | | Radiology / Imaging | Imaging requests | Built-in radiology module | | Inventory Management | Basic supplies tracking | Full inventory management | | HR & Payroll | Not available | Integrated HR module | | Financial Reporting | Basic reports | Advanced financial dashboards | | Mobile Money Payments | Not supported | MTN, Vodafone, AirtelTigo | | Multi-Currency | Not supported | Native multi-currency | | Offline Mode | CouchDB/PouchDB sync | Full offline-first architecture | | Appointment Scheduling | Available | Built-in scheduling | | Bed Management | Not available | Full bed management | | Operating Theatre | Not available | Theatre scheduling module | | Blood Bank | Not available | Blood bank management |
The feature gap between the two platforms is significant. HospitalRun provides core clinical functionality -- patient records, basic lab, basic pharmacy, and billing -- while HospitalOS offers a complete hospital management ecosystem.
Offline Architecture Compared
Both platforms were designed for offline use, but their approaches and depth of offline capability differ.
HospitalRun Offline Architecture
HospitalRun uses CouchDB on the server and PouchDB in the browser for offline-first data management. This is an elegant technical approach:
- PouchDB stores data locally in the browser's IndexedDB
- CouchDB on the server acts as the master data store
- Automatic sync occurs when connectivity is available
- Conflict resolution is handled through CouchDB's built-in conflict management
This approach works well for clinical data entry but has limitations:
- Browser-based storage has size limits that can be an issue for large hospitals
- Complex operations (reporting, multi-department queries) may struggle offline
- The CouchDB sync model can have performance issues with very large datasets
- Limited modules mean less data needs to sync, but also less functionality offline
HospitalOS Offline Architecture
HospitalOS takes a different approach to offline capability:
- Local application with a full database installed on-premise
- All modules function completely offline -- EMR, pharmacy, billing, lab, inventory, and HR
- Automatic sync when internet connectivity is restored
- No browser storage limits since data is stored in a local database
- Full reporting available offline using local data
- Multi-workstation support with local network, no internet required
The practical difference is that HospitalOS can run an entire hospital -- from patient registration through pharmacy dispensing to billing and financial reporting -- without any internet connectivity. Staff may not even notice when internet goes down because every workflow continues uninterrupted.
Deployment and Setup
HospitalRun Deployment
Deploying HospitalRun requires:
- Technical knowledge: Familiarity with Node.js, CouchDB, and modern JavaScript tooling
- Server setup: Node.js application server with CouchDB
- Build process: React application build and deployment
- Configuration: Manual setup of hospital departments, users, and workflows
- Development status: Some features may require custom development or community modules
- Timeline: Variable -- depends on which version and features are needed
- Community support only: No commercial support team
One challenge with HospitalRun is that the project's transition between frameworks has created uncertainty about feature availability and long-term roadmap. Organizations should evaluate the current release carefully before committing.
HospitalOS Deployment
- Professional setup: MedSoftwares team handles installation and configuration
- Pre-configured modules: All hospital departments set up during deployment
- Data migration: Assisted migration from existing systems
- Staff training: Comprehensive training included
- Timeline: 2-4 weeks for full deployment
- Ongoing support: 24/7 professional support from day one
Cost Analysis
HospitalRun Costs
| Cost Item | Estimate | |---|---| | Software license | Free (GPL) | | Server hardware | $1,500 - $4,000 | | Technical setup & deployment | $5,000 - $15,000 (consultant) | | Node.js/CouchDB administrator | $6,000 - $15,000/year | | Custom development for missing features | $5,000 - $25,000 | | Training (self-directed) | $1,000 - $3,000 | | First-Year Total | $18,500 - $62,000 | | Annual Ongoing | $12,000 - $37,000 |
The biggest cost risk with HospitalRun is custom development. If your facility needs features that are not yet available in the current release -- HR management, comprehensive billing, insurance claims, mobile money -- these must be built from scratch or sourced through alternative systems.
HospitalOS Costs
| Cost Item | Estimate | |---|---| | One-time license | Competitive pricing | | Server hardware | $2,000 - $5,000 | | Installation, training, configuration | Included | | Annual support and updates | Included in license tiers | | Custom development needed | None -- all modules included | | Total | Predictable, comprehensive |
Support and Community
HospitalRun Support
- GitHub community: Issue tracking and pull requests
- Slack workspace: Community discussions
- No commercial support: Entirely community-driven
- Documentation: Available on project website and GitHub
- Contribution-based: Bug fixes and features depend on community contributions
- No SLA: No guaranteed response times for issues
HospitalOS Support
- 24/7 dedicated support: Professional support team
- Multiple channels: Phone, email, remote desktop, on-site
- Guaranteed SLAs: Response time commitments for critical issues
- Regular updates: Scheduled feature and security updates
- Training programs: Initial and ongoing staff training
- Local presence: Support teams familiar with local healthcare context
Best For
Choose HospitalRun If:
- You are a small clinic or charitable hospital with basic clinical needs
- You have Node.js/React developers who can customize and maintain the system
- Your needs are limited to patient records, basic lab, and basic pharmacy
- You want an open-source solution you can modify freely
- You are comfortable with community-only support
- Budget for software licensing is zero
- You are willing to develop missing features internally
Choose HospitalOS If:
- You need a complete hospital management system with all departments covered
- Offline capability must extend to all modules, not just clinical records
- Mobile money payment acceptance is important for your patient base
- You need NHIS or insurance claims processing
- Professional 24/7 support is a requirement
- You want to deploy quickly without custom development
- HR, payroll, and financial management are needed alongside clinical features
- You want a mature, production-tested platform with a clear roadmap
- Multi-currency billing and comprehensive financial reporting are needed
Verdict
HospitalRun deserves recognition for pioneering the offline-first approach in open-source hospital software. Its use of CouchDB/PouchDB for seamless offline-online synchronization was innovative and influenced the broader healthcare IT ecosystem. For small clinics or charitable organizations with basic clinical needs and access to JavaScript developers, it can serve as a functional starting point.
However, HospitalRun's limited feature set means it is not a complete hospital management solution. Facilities that need comprehensive pharmacy management, insurance claims processing, HR and payroll, financial reporting, mobile money payments, or multi-currency billing will find significant gaps. The project's development pace and version transitions also create uncertainty for organizations that need long-term stability.
HospitalOS provides the offline capability that makes HospitalRun appealing, combined with the comprehensive feature set that hospitals actually need to operate efficiently. Every module works offline, mobile money and NHIS integration are built in, and 24/7 professional support ensures that help is always available when it matters. For hospitals and clinics in developing countries that need a reliable, complete, and genuinely offline-capable system, HospitalOS delivers on the promise that HospitalRun aspires to. Request a demo to see the full offline experience.
FAQ
Is HospitalRun still actively developed?
HospitalRun is an active open-source project on GitHub with community contributors. However, it has undergone a major rewrite from Ember.js to React, and the pace of development has varied over the years. Some features from the legacy version may not yet be fully available in the current version. Before committing to HospitalRun, check the project's GitHub repository for the most current release status and feature availability.
Which system has better offline performance?
Both systems work offline, but HospitalOS provides more comprehensive offline capability. HospitalRun's browser-based PouchDB approach works well for clinical data entry but has browser storage limits and limited module coverage. HospitalOS runs as a local application with a full database, meaning all modules -- pharmacy, billing, lab, inventory, HR -- work seamlessly offline with no storage constraints. For a hospital that routinely operates without internet, HospitalOS offers deeper and more reliable offline functionality.
Can HospitalRun handle mobile money payments?
No. HospitalRun does not include mobile money payment integration. If your patients primarily pay through MTN Mobile Money, Vodafone Cash, AirtelTigo Money, or similar services, you would need to build a custom integration or handle mobile money payments outside the system. HospitalOS includes native mobile money integration that records payments directly in the patient's billing record.
What happens to my data if I switch from HospitalRun to HospitalOS?
MedSoftwares provides data migration assistance for facilities transitioning from HospitalRun or any other hospital system. Patient records, clinical data, and historical information stored in CouchDB can be exported and mapped to HospitalOS's data structure. The migration team validates data integrity throughout the process to ensure no patient information is lost.
Can I run HospitalRun and HospitalOS on the same hardware?
While technically possible, it is not recommended to run both systems simultaneously on the same server in a production environment. If you are evaluating both systems, you could install them on separate virtual machines or test environments. HospitalOS has modest hardware requirements and can run on standard server hardware or even a capable desktop machine for smaller facilities. Contact MedSoftwares for specific hardware recommendations based on your facility's size.
